If you find yourself getting interested in herbal medicine, you are not alone. Herbal medicines are becoming more and more popular in the USA. Recent surveys showed that about half of the American adults have used herbal supplements within a year. Many of them can testify for the beneficial effects of herbal medicines. The often cited reasons for using the herbal remedies include the ineffectiveness of the current medical treatment on their health concerns, the high cost of the health care and prescription drugs, and the side effects of the prescription drugs etc. Backing the public demand, in 1998 the US congress approved the creation of the National Center for Complementary and Alternative Medicine (NCCAM) to explore the value of herbal medicines.

In contrast to the enthusiasm of the general public, the medical community is more skeptical towards herbal medicines in general. Surely enough, herbal medicines are not considered as drugs in USA and are hardly approvable by FDA as drugs as well. Herbal medicines are not rigorously tested by scientific studies as conventional drugs for their health benefits. Herbal medicines are not produced to the same quality standards as the conventional drugs for lot to lot consistency. The side effect profiles of herbal medicines are often not quite clear so the safety may become an issue. Ironically, while clinical studies that demonstrated the efficacy of a given herbal remedy often meet doubts from the medical community on their real benefits, any report on potential side effects of herbal remedies are taken for granted and easily accepted.

For those who simply deny any benefits from herbal remedies, the question is if a herbal medicine can do something harmful physiologically then why a herbal medicine can not do something good physiologically as well. After all, no matter what the effect is, it all works by the natural molecules contained in the herbal medicine on the physiology of the body.

To the surprise of some people, natural molecules comprise a major part of our current drugs. As late as the last two decades (1981-2002), of the 877 New Chemical Entities drugs approved by FDA, 49% were still natural products or derived from natural products¹. Not to mention the earlier decades when the drugs were predominantly developed from natural products.

Herbal medicines have been an important source of natural product drugs and the root of modern pharmacology and drug development. Take digoxin as an example². Digoxin is a modern drug used for congestive heart failure. It is a natural molecule occurring in the herb foxglove. Foxglove was originally used in folk herbal remedies consisting of a dozen of herbs. Over 200 years ago it was found to be the active ingredient of the herbal remedies. By 1906, different preparations of foxglove were included in US pharmacopeia. No standard was there. Then standard assays were developed to monitor the bioactivity of foxglove preparations. Eventually, digoxin was identified and became a standard chemical drug.

While modern drugs were largely developed from the herbal medicines in the western world, traditional oriental medicines, mainly Chinese medicine, remain most unexplored by modern drug discovery. Traditional Chinese Medicine (TCM) consists of thousands of Chinese herbs and even a larger number of herbal formulas combining several Chinese herbs. TCM also includes a unique system of theories that directs the proper use of Chinese herbs. Chinese people have solely relied on TCM for thousands of years for their health, much the same as the Western herbal medicine did for the Europeans before the modern medicine was born from it.

So far only one modern drug has been successfully developed from Chinese herbs and won the world acclaimation³. The drug is Artemisinin (Qinghaosu in Chinese name) from the Chinese herb Qing Hao. Qing Hao has been used in Traditional Chinese Medicine for many centuries to treat malaria. Artimisinin was purified from Qing Hao and further demonstrated to be superior to the standard antimalarial Quinine treatment by Chinese scientists^{4, 5}. Artemisinin also represents a novel class of chemical structure and forms the basis for synthesizing new drugs. Artemisinin and its derivatives are playing a major role in fighting malaria in the third world. This is a big contribution of Traditional Chinese Medicine on the world health.

One may ask why we only got Artemisinin when thousands of Chinese herbal medicines are around. For one reason, the drug discovery abilities in Chinese academics and pharmaceuticals are still at the infant stage. While a large number of effective Chinese remedies are being used, it remains a huge challenge to develop modern drugs from them. It is my belief that many drugs will be eventually developed from Chinese herbs just like Artemisinin. It will take dozens of years' work by scientists around the world. Before this happens, for those whose health needs are not met with the current health care system, a wise solution might be herbal medicines, especially the Chinese medicine.

References
1. Koehn FE, Carter GT. The evolving role of natural products in drug discovery. Nat Rev Drug Discov. 2005 Mar;4(3):206-20.
2. Goldman P. Herbal medicines today and the roots of modern pharmacology. Ann Intern Med. 2001 Oct 16;135(8 Pt 1):594-600.
3. Engel LW, Straus SE. Development of therapeutics: opportunities within complementary and alternative medicine. Nat Rev Drug Discov. 2002 Mar;1(3):229-37.
4. Klayman DL. Qinghaosu (artemisinin): an antimalarial drug from China. Science. 1985 May 31;228(4703):1049-55.
5. Jiang JB, Li GQ, Guo XB, Kong YC, Arnold K. Antimalarial activity of mefloquine and qinghaosu. Lancet. 1982 Aug 7;2(8293):285-8.

X. Li, Ph. D. (credentials)

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