Eastern Herbs

Herbs, as well as other alternative therapies, have historically played a much greater role in Eastern medicine, which often uses mixtures of herbs rather than single agents. As a result, it is difficult to know which of the components may actually be responsible for antiepileptic effects. In addition, published studies on these herbs do not include comparison with a placebo or "blinding" of the experimenters, thus the results may not be scientifically sound.

Qingyangsen is a mixture of Chinese roots that was given to 32 patients with an average of four generalized tonic-clonic seizures per month who were not controlled on AEDs. After 2 to 9 months of treatment, nine patients were reportedly seizure-free without side effects (11). An animal study of this mixture combined with phenytoin showed that it may reduce the production of those proteins in brain cells that may contribute to the occurrence of seizures (12). Another unblinded study treatment using a mixture of 13 Chinese herbs was compared to phenobarbital (1). One hundred patients received the herbal mixture and 40 received phenobarbital. Seizure improvement was similar in the two groups after 8 months of treatment, but fewer side effects were experienced by those using the herbal mixture.

In another study, the herbal preparation Zhenxianling, which contains peach flower buds, human placenta, and other ingredients, was given to 239 patients (13). A

>75% reduction in seizures was reported in 66%, and a >50% reduction in another 30% of persons studied.

Two Asian herbal mixtures of the same nine herbs have been reported to have similar antiepileptic efficacy: Japanese sho-saiko-to (or saiko-keishi-to) and Chinese chai-hu-keui-chi-tang (bupleurum-cinnamon combination) (14). These are composed of Bupleurum falcatum (thorowax) root, Paeonia lactiflora (peony) root, Pinellia ternata (ban xia) rhizome, Cinnamomum cassia (cassia) bark, Zingiber officinale (ginger) rhizome, Zizyphus jujuba (jujube) fruit, Panax ginseng (Asian ginseng) root, Scutellaria baicalensis (scullcap) root, and Glycyrrhiza uralensis (licorice, gan cao) rhizome in differing ratios (14). Animal studies show that this herbal mixture may prevent seizures by inhibiting the effects of calcium or by affecting cyclic nucleotides in nerve cells (15). A similar mechanism may explain the antiepileptic affect of Coleus forskohlii, an important herb in the Ayurvedic treatment of epilepsy (14). Some human studies on these Oriental herbal mixtures have been reported, but some are unpublished or are in Japanese, and others are not scientifically sound by Western standards. In one study, saiko-keishi-to was given to 24 epileptic patients and reportedly resulted in seizure control in 25% for at least 10 months (16). Approximately 50% showed improvement overall, usually within 1 month. In one unpublished study of the bupleurum-cinnamon mixture, approximately 50% of 35 epilepsy patients were reported cured (17). Sho-saiko-to has rarely been associated with the development of allergic lung inflammation and death, as well as liver injury (14).

TJ-960, another mixture of nine herbs, is the most common and important of the herbal medicines used to treat epilepsy in Japan. Its components include Paeoniae radix, Cinnamomi cortex, Bupleuri radix, Zingiberis rhizoma, Glycyrrhizae radix, Ginseng radix, Scutellariae radix, Pinelliae tuber, and Zizyphi fructus (1). TJ-960 was given to 26 patients with epilepsy and compared with 17 untreated patients (18). After 2 months, 33% of the treated patients showed a 25% reduction in seizures and improvements in cognitive functioning.

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