不謝！有收穫就好。 :)
關於你引的內容：
第二篇有點前後矛盾：前面說補腎活血是治法，後面又說不能補。不足為信。
第四篇是部分現代藥理的作用，實際上未必與臨床相符。
關於第一、三篇我來告訴你來龍去脈。這是我可以告訴你的一個比較客觀的答案。
這個問題的來源是：
澳洲雪梨皇家婦女醫院自然療法部門總監艾頓醫生指出，當地不少更年期的婦女，以服食人參及當歸代替西藥的「雌激素」，減低更年期徵狀，但研究發現，人參及當歸對婦女的療效較想像中小，更有刺激乳癌細胞生長的危機。
研究人員將引發乳癌的MCF-7細胞，放在實驗室內培植，再分別加入人參及當歸，結果顯示，加入當歸會將癌細胞的分裂加快十六倍，加入人參更增加二十七倍。艾頓又說，更年期女性服食雌激素，雖然會有副作用，如心臟病患者的病發率會輕微增加，但其療效卻非人參及當歸可以代替。研究又發現，當歸並不能增加女性賀爾蒙，更會引發子宮痙攣<FONT color=red:9353b0f0f0>(Kevin 注：但也有研究發現當歸既可以增強子宮的收縮力，也可以舒緩子宮的痙攣，作用是雙相的，看你怎麼用)[/color:9353b0f0f0]，患上乳癌的婦女絕不適宜服食，就算是健康正常的女性，服食亦會有副作用。艾頓質疑人參及當歸的功能，認為並無治療功效，卻有嚴重副作用，因此促請當地衛生部門加強監管這兩種草藥的買賣。
這篇文章的原文摘要：
Women are increasingly turning to herbal therapies in an effort to manage their menopausal symptoms. In this study, we investigate the estrogenic activity of four selected herbs commonly used in menopause, namely dong quai, ginseng, black cohosh, and licorice root. DESIGN: We investigated the effect of these selected herbs on cell proliferation of MCF-7 cells, a human breast cancer cell line. We also assessed their estrogenic activity in a transient gene expression assay system using HeLa cells co-transfected with an estrogen-dependent reporter plasmid in the presence of human estrogen receptor ER alpha or ER beta cDNA. Finally, we investigated the estrogenic activity of these herbs using a bioassay in mice. RESULTS: Dong quai and ginseng both significantly induced the growth of MCF-7 cells by 16- and 27-fold, respectively, over that of untreated control cells, while black cohosh and licorice root did not. The herbs tested failed to show transactivation of either hER alpha or hER beta and had no effect on uterine weight in vivo when administered orally to mice for a period of 4 days. CONCLUSIONS: Our studies show that dong quai and ginseng stimulate the growth of MCF-7 cells independent of estrogenic activity. Because of the lack of efficacy and the potential for adverse effects, use of these herbs in humans warrants caution pending further study.
不過，澳洲監管另類療法的部門，卻認為有關研究結果只屬初步結論，未能證實人參及當歸可引發癌症，該部門的發言人又表示，當地過去五年並無相關研究結果支持艾頓的研究，故暫不會將該兩種中草藥列為危害健康的產品。
其實補充雌激素的治療方法已經是證明有很多的副作用，很多人(有點醫學知識的人都不願意)用而轉向別的治療方法，而中醫就是其中之一。但是這樣報道十分牽強，理據很弱智，但也足以使一般人惊怕。但是監管部門是依據做事的，所以並不能亂來。<FONT color=red:9353b0f0f0>(Kevin注：這實在比連細辛也禁用的做法強多了)[/color:9353b0f0f0]
相關的其它醫學的文獻的摘要：
1. MAIN ABSTRACT: One of the most important issues in women's health concerns the risks and benefits of estrogen replacement therapy. Continual uncertainty and lack of consensus regarding estrogen replacement therapy has driven many women to seek alternative sources of estrogen, including herbal remedies. We adapted a recombinant cell bioassay to measure estrogen bioactivity in herbs. We studied, in vitro, estrogen bioactivity in red clover, dong quai, black cohosh, soy, licorice, chaste tree berry, fo-ti, and hops. Soy, clover, licorice, and hops have a large amount of measurable estrogen bioactivity, as suspected, based on previous reports using other methods. We discovered surprisingly high estrogen activity in extracts of fo-ti not previously reported. Chaste tree berry, black cohosh, and dong quai did not have measurable activity with this method. We also discovered that removal of a glycone group from soy increases its estrogen bioactivity significantly. We conclude that this recombinant cell bioassay for estradiol can be used to measure bioactivity in herbal products. The preparations of fo-ti studied had estrogen activity of 409 +/- 55 pmol/liter estradiol equivalents per microgram of herb, which is 1/300 the activity of 17 beta-estradiol. Clinical studies are underway to determine the estrogen bioactivity in women using dietary supplements containing these herbs.
2. Eight botanical preparations that are commonly used for the treatment of menopausal symptoms were tested for estrogenic activity. Methanol extracts of red clover (Trifolium pratense L.), chasteberry (Vitex agnus-castus L.), and hops (Humulus lupulus L.) showed significant competitive binding to estrogen receptors alpha (ER alpha) and beta (ER beta). With cultured Ishikawa (endometrial) cells, red clover and hops exhibited estrogenic activity as indicated by induction of alkaline phosphatase (AP) activity and up-regulation of progesterone receptor (PR) mRNA. Chasteberry also stimulated PR expression, but no induction of AP activity was observed. In S30 breast cancer cells, pS2 (presenelin-2), another estrogen-inducible gene, was up-regulated in the presence of red clover, hops, and chasteberry. Interestingly, extracts of Asian ginseng (Panax ginseng C.A. Meyer) and North American ginseng (Panax quinquefolius L.) induced pS2 mRNA expression in S30 cells, but no significant ER binding affinity, AP induction, or PR expression was noted in Ishikawa cells. Dong quai [Angelica sinensis (Oliv.) Diels] and licorice (Glycyrrhiza glabra L.) showed only weak ER binding and PR and pS2 mRNA induction. Black cohosh [Cimicifuga racemosa (L.) Nutt.] showed no activity in any of the above in vitro assays. Bioassay-guided isolation utilizing ER competitive binding as a monitor and screening using ultrafiltration LC-MS revealed that genistein was the most active component of red clover. Consistent with this observation, genistein was found to be the most effective of four red clover isoflavones tested in the above in vitro assays. Therefore, estrogenic components of plant extracts can be identified using assays for estrogenic activity along with screening and identification of the active components using ultrafiltration LC-MS. These data suggest a potential use for some dietary supplements, ingested by human beings, in the treatment of menopausal symptoms.
3. There is an increasing trend in the use of complementary and alternative therapies to treat or prevent hormonally dependent pathologies. Methods determined whether several of these natural products and nutraceuticals, commonly taken for hormone-related effects, possess steroid hormone activity. The agonist and antagonist estrogenic, androgenic, and progestational activities of 20 natural products and nutraceuticals were assessed using an in vitro tissue culture indicator system. Two steroid-regulated proteins (pS2 and prostate-specific antigen [PSA]) were quantified, using ELISA-type immunoassays, as markers of agonist and antagonist activity. RESULTS: Four of the products tested, two isoflavone preparations, Promensil and Estro-Logic, chamomile, and grapeseed extracts, were found to have weak estrogenic agonist activity, with the latter two also demonstrating weak progestational activity. Several of the products tested exhibited antagonistic (blocking) activity, including antiestrogenic activity by Prostate-Ease, wild yam root, and dong quai, and antiandrogenic activity by dong quai, Promensil, and rosehips. CONCLUSIONS: Several of these natural products demonstrate weak steroid hormone activity.
4. To evaluate possible estrogenic effects of dong quai on vaginal cells and on endometrial thickness in postmenopausal women. DESIGN: Double-blind, randomized, placebo-controlled clinical trial. SETTING: Department of Obstetrics and Gynecology in a large health maintenance organization (HMO). PATIENT(S): Seventy-one postmenopausal women (mean age [+/- SD], 52.4 +/- 6 years) who had follicle-stimulating hormone levels (third-generation assay) of > 30 mIU/mL with hot flashes. INTERVENTION(S): Subjects were randomized to treatment with either dong quai or placebo for 24 weeks. MAIN OUTCOME MEASURE(S): Endometrial thickness was measured by transvaginal ultrasonography; vaginal cells were evaluated for cellular maturation; menopausal symptoms were evaluated by reviewing the Kupperman index and the diary of vasomotor flushes. RESULT(S): We observed no statistically significant differences between groups in endometrial thickness, in vaginal maturation index, in number of vasomotor flushes, or in the Kupperman index. CONCLUSION(S): Used alone, dong quai does not produce estrogen-like responses in endometrial thickness or in vaginal maturation and was no more helpful than placebo in relieving menopausal symptoms.
這三篇是reviews
1. STUDY SELECTION: 29 randomized, controlled clinical trials of CAM therapies for hot flashes and other menopausal symptoms were identified; of these, 12 dealt with soy or soy extracts, 10 with herbs, and 7 with other CAM therapies. DATA EXTRACTION: Each author extracted information from half of the studies on the number of patients, study design, outcome measures, and results; the other author then checked these results. DATA SYNTHESIS: Soy seems to have modest benefit for hot flashes, but studies are not conclusive. Isoflavone preparations seem to be less effective than soy foods. Black cohosh may be effective for menopausal symptoms, especially hot flashes, but the lack of adequate long-term safety data (mainly on estrogenic stimulation of the breast or endometrium) precludes recommending long-term use. Single clinical trials have found that dong quai, evening primrose oil, a Chinese herb mixture, vitamin E, and acupuncture do not affect hot flashes; two trials have shown that red clover has no benefit for treating hot flashes. CONCLUSIONS: Black cohosh and foods that contain phytoestrogens show promise for the treatment of menopausal symptoms. Clinical trials do not support the use of other herbs or CAM therapies. Long-term safety data on individual isoflavones or isoflavone concentrates are not available.
2. RESULTS: Soy isoflavones slightly decrease total cholesterol and LDL levels. The clinical significance of this small change is yet to be determined. The synthetic isoflavone derivative ipriflavone increases bone mineral density in healthy peri- and postmenopausal women with moderate bone mineral densities. Although earlier reports have claimed that soy is beneficial for the improvement of vasomotor symptoms, recent data do not support this claim. There are insufficient data on the other alternative therapies for treating menopausal symptoms at this time. CONCLUSION: Alternative and complementary medicine may play a role in the management of menopause, however, well-designed large studies are still needed.
3. Herbal medicines have long been used in traditional healing systems to treat conditions of particular interest to women, such as premenstrual syndrome (PMS) and menopausal symptoms. For a select number of phytomedicines, including evening primrose oil, black cohosh root extract, dong quai, and chaste tree berry, scientific investigation is elucidating the pharmacologically active constituents, mechanism of action, and clinical value. CONCLUSION: Based on the available evidence, evening primrose oil and chaste tree berry may be reasonable treatment alternatives for some patients with PMS. Dong quai may have some efficacy for PMS when used in traditional Chinese multiple-herb formulas. For relief of menopausal symptoms, black cohosh root extract and dong quai have good safety profiles, but only black cohosh has demonstrated efficacy for this indication. Safety data, especially during pregnancy and lactation, are still largely lacking for many herbal medications, and recommendations for usage and dosage vary. Pharmacists who wish to recommend herbal products for women's health conditions need to evaluate the scientific literature in order to form their own opinions about appropriate use and safety.
(三篇而言，最後這篇是比較有價值的，因為提到了中藥的複方)
另外，這是一個Case report，也可以留意一下。
We present a case of a man who developed gynaecomastia after ingestion of "Dong Quai" pills. "Dong Quai" is the Chinese name for the herb Angelica polymorpha var. sinensis which is widely used as a panacea for gynaecological problems, and it is also proclaimed as an invigorating tonic for both women and men.The pharmacological effects of "Dong Quai" are likely related to the phytoestrogen that it contains.This report highlights the potential adverse effects associated with its consumption in the male, especially for the processed "Dong Quai" pills which may contain significantly higher levels of phytoestrogen than its original herbal product.
這裡還有一個不太客觀卻理性而邏輯的答案：
有關當歸的問題也有不少人問，我的回答是：中藥的作用並非這麼強。就算真的這麼強，也請放心，因為一定有另外的一個中藥也有這麼強的治療作用。而且中藥更多的時候是複方，作用並不完全等同一個中藥。 |
發表於 2004-5-22 18:04:40
發表於 2004-5-22 20:52:55
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