As Published in TGForum

TG Medical : Confuscian Herbals or Herbals Confusion?
Cerise Richards, M.D.

Today in the U.S., there is a great desire to use herbal medicines as all cultures have used them throughout the ages to obtain beneficial results. The reasons for the tremendous amount of money spent in this country on herbal supplements are enumerated in an article, which I wrote for TGForum two years ago called "Hormonal Homeopathy". I would suggest that you read or reread this article to understand just what phyto-estrogens are and how they may be useful. Since that time I have gained a greater understanding of herbal medicines by reading the naturopathic and medical literature and visiting hospitals in China which practice Traditional Chinese Medicine (TCM). There I learned many things about how herbs are processed and used in treating chronic medical conditions. The differences abound between TCM and Western medicine and may not be reconcilable or even fully understood.  But the Chinese have decided that as they adopt Western practices for acute disease problems, their TCM practices may be complementary for chronic disease states.

Western Medicine follows a strictly defined rational process, utilizing chemical analysis and synthesis, biological assays and animal tests before the single drug entity ever reaches the population. Then it is subjected to lengthy human testing for dosage, efficacy and side effects.  TCM is based on a philosophy of holistic homeostasis, which relies on over two thousand years of trial and error in an empiric clinical experience of a large population. There is no single drug for a specific condition, but a formulation of 4 to 24 herbs designed for each individual's symptoms. They believe that this formulation must be taken over many months to achieve results and obtain balance. Of major importance is that each herb contains many active ingredients, which suppress or enhance each other and must be paired exactly. Almost all of the active ingredients are ingested after boiling, a decoction, and drunk as a medicinal tea. Therefore they are only extracting the water soluble ingredients. When these herbs are formulated by Western manufacturers they are powdered, subjected to acid/alkali and alcohol extraction and in few ways resemble the Chinese processing or final Chinese product. In the most recent case of herbal PC-SPES for prostate cancer, they were contaminated at the source by the addition of the synthetic estrogen, DES and did produce breast enlargement.

What we expect from taking these herbal preparations is that they will be efficacious in changing our secondary sex characteristics as breast enlargement, decreasing facial hair and improving our feminine appearance as advertised. So I decided to look at the major individual herbal ingredients found in preparations directed at our community and present them to my Chinese colleagues. Was I disappointed as they had not heard of them except for Ginseng and Dong Quai.  So if we disabuse ourselves of the notion that what we are receiving has anything to do with TCM, we can rationally begin to understand what is out there.

The following herbs are recommended for the treatment of premenopausal symptoms (PMS) and post menopausal symptoms such as hot flashes, sweating, nausea and bloating. They are Black Cohosh, Chaste berry, Dong Quai, and Saw Palmetto. These are then extrapolated by their manufacturers to sound estrogenic. There are many other herbs added to the preparations for enhancement of potential phytoestrogenic activity. These herbs have been extensively studied over the past ten years and the literature is replete with extraction of their chemical compounds, testing in vitro and their potential human use for the above symptoms. Many open label studies, as opposed to double-blind placebo controlled studies, are published by the manufacturers. Here is where the disconnect between the Phyto-estrogens found in soy and flax and these compounds begins.

First they are not true phyto-estrogens as they chemically do not look like or act like estrogens. They may bind to estrogen receptors but do not cause the growth of female vaginal or breast tissue. They appear to act by binding to the estrogen receptor, blocking true estrogen attachment and causing a negative feedback in the pituitary causing a reduction in luteinizing hormone (LH). This is thought to be the way the above symptoms are reduced.  A new term has been devised for these compounds called selective estrogen receptor modulators (SERMs). Tamoxifen for breast cancer treatment was the first SERM used clinically. It acts as an antagonist to estrogen in breast tissue and therefore helpful in treating Breast Cancer, but as an agonist in bone preventing osteoporosis. The bottom line is that I can't see how they could change our physical secondary sex characteristics except in our minds.

Black Cohosh, an indigenous N. American plant, has a long historical use in this country for menstrual cramps and menopausal complaints. Remifemin, a German product, contains an alcoholic extraction of the proposed active ingredients and has undergone extensive study. The lead company pharmacist has published a paper demonstrating no systemic estrogen effect. This pill has been recommended by the German Commission E for menopausal complaints for only six months, but a recent double-blind placebo study has shown no reduction of hot flashes above placebo effect in breast cancer patients. In Vitro breast cancer cell testing has shown no affinity for alpha or beta Estrogen receptors. Estradiol, FSH and prolactin levels are not altered by the administration of Black Cohosh. So there is only one conclusion to draw regarding its ability to enhance breast tissue. IT CAN'T !

Chaste berry is the dried ripe fruit of the Chast tree indigenous to southern Europe and used in ancient Greece. It�s mechanism of action is again related to its affect on the anterior pituitary with dopamine-like activity which releases a hormone causing a decrease in prolactin and an increase in existing progesterone. This may reduce menstrual symptoms, but not post menopausal vasomotor symptoms. The German Commission E nevertheless recommends it for both. Published studies report varying effects of Chaste berry, but the commonly recommended dose of an alcohol extraction equals 20-40 mg of fresh berries per day. There are no long term studies of drug effects.  Anyone taking dopamine receptor drugs for depression or Parkinsonism, should not use this herb.

Now Dong Quai was well known to my Chinese colleagues. Its use for curing menstrual cramps dates to the First Century A.D. and is described in the Chinese Classic of Herbal Medicine Pharmacopoeia. It is described as a panacea for all female health problems and blood purification. It is prescribed in a herbal formulation and not as a single herb. Again it does not produce estrogenic responses although a single case of male gynecomastia was reported from a formulated "Dong Quai Pill". The bottle was not analyzed. But in the long Chinese history there are no symptoms of breast enlargement or fullness. It does contain blood thinning ingredients and may cause bleeding in people on anticoagulants. It may contain a carcinogenic essential oil. A recent study by Hirata found that it does not produce Estrogen like responses and was no more helpful than placebo in relieving menopausal symptoms.

Saw Palmetto, which is derived from the American Dwarf Palm fruit, has found acceptance for the treatment of prostate symptoms and is the main ingredient of a breast enhancing herbal preparation marketed to women. In Europe it is marketed as the drug Permixon, where most of the research has been done. Again it has no phytoestrogen qualities, but is thought to inhibit the conversion of testosterone to dihydrotestosterone, which may benefit hair and prostate structures. Since we have observed the increase of gynecomastia with strong androgen receptor blockers, it is possible to think that this may increase breast tissue in men, but I have not seen any reports to that effect from the large male population taking this drug.

In conclusion I was hoping that I could tell you something positive in the herbal field, but to date I can only reiterate, "Save your money for Estrogen-Progesterone therapy by your physician, which will show definitive results."

Best of Luck in Your New Future,

Cerise Richard, M.D.