Special Issue "Safety of Complementary Medicines"

A special issue of Medicines (ISSN 2305-6320).

Deadline for manuscript submissions: closed (30 November 2018)

Special Issue Editor

Guest Editor
Assoc. Prof. Dr. Chun Guang Li

National Institute of Complementary Medicine (NICM), Western Sydney University, Penrith, NSW 2751, Australia
Website | E-Mail

Special Issue Information

Dear Colleagues,

Complementary medicines (CM) include a diverse range of therapies and products, such as acupuncture, naturopathy, vitamin and mineral supplements, mind–body practices, etc. These therapies have long been used in many countries, and, in recent times, are increasingly used in communities for preventing or managing various diseases and conditions. Some CM therapies are based on traditional practice systems, such as traditional Chinese medicine and Ayurvedic medicine, others are related to the conventional medical practice as supportive therapies. The health benefit of CM is mainly supported by traditional evidence with limited scientific evidence available. On the other hand, there are frequent concerns on their quality and safety which are often associated with product quality, improper practice, contaminants and toxicities of certain ingredients in CM products, such as pesticide residues, heavy metal and microbial contaminants in herbal medicines. It is important to understand the safety aspects of CM in order to minimise the potential risks involved and improve the quality practice/use of CM therapies and products.

This Special Issue invites original contributions, including review articles and practice guidelines, on all aspects of complementary medicines, including basic and clinical research on CM practice and related products, such as surveys, herbal toxicity, drug–herb interactions, contaminants and detections, as well as relevant quality control standards.

Assoc. Prof. Dr. Chun Guang Li
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicines is an international peer-reviewed open access quarterly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 350 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Complementary medicines
  • Traditional Chinese medicine
  • Ayurvedic medicine
  • vitamin and mineral supplements
  • acupuncture
  • herbal toxicity
  • herbal-drug interaction
  • contaminant & adulation
  • adverse reactions

Published Papers (7 papers)

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Research

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Open AccessArticle
PharmActa: Empowering Patients to Avoid Clinical Significant Drug–Herb Interactions
Received: 11 January 2019 / Revised: 15 February 2019 / Accepted: 15 February 2019 / Published: 16 February 2019
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Abstract
Herbal medicinal products (HMPs) are the subject of increasing interest regarding their benefits for health. However, a serious concern is the potential appearance of clinically significant drug–herb interactions in patients. This work provides an overview of drug–herb interactions and an evaluation of their [...] Read more.
Herbal medicinal products (HMPs) are the subject of increasing interest regarding their benefits for health. However, a serious concern is the potential appearance of clinically significant drug–herb interactions in patients. This work provides an overview of drug–herb interactions and an evaluation of their clinical significance. We discuss how personalized health services and mobile health applications can utilize tools that provide essential information to patients to avoid drug–HMP interactions. There is a specific mention to PharmActa, a dedicated mobile app for personalized pharmaceutical care with information regarding drug–HMPs interactions. Several studies over the years have shown that for some HMPs, the potential to present clinically significant interactions is evident, especially for many of the top selling HMPs. Towards that, PharmActa presents how we can improve the way that information regarding potential drug–herb interactions can be disseminated to the public. The utilization of technologies focusing on medical information and context awareness introduce a new era in healthcare. The exploitation of eHealth tools and pervasive mobile monitoring technologies in the case of HMPs will allow the citizens to be informed and avoid potential drug–HMPs interactions enhancing the effectiveness and ensuring safety for HMPs. Full article
(This article belongs to the Special Issue Safety of Complementary Medicines)
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Open AccessArticle
Guggulsterone Activates Adipocyte Beiging through Direct Effects on 3T3-L1 Adipocytes and Indirect Effects Mediated through RAW264.7 Macrophages
Received: 19 December 2018 / Revised: 18 January 2019 / Accepted: 27 January 2019 / Published: 31 January 2019
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Abstract
Background: Plant-derived phytochemicals have been of emerging interest as anti-obesity compounds due to their apparent effects on promoting reduced lipid accumulation in adipocytes. Despite such promising evidence, little is known about the potential mechanisms behind their anti-obesity effects. The aim of this study [...] Read more.
Background: Plant-derived phytochemicals have been of emerging interest as anti-obesity compounds due to their apparent effects on promoting reduced lipid accumulation in adipocytes. Despite such promising evidence, little is known about the potential mechanisms behind their anti-obesity effects. The aim of this study is to establish potential anti-obesity effects of the phytochemical guggulsterone (GS). Methods: Mature 3T3-L1 adipocytes were treated with GS, derived from the guggul plant native in northern India, to investigate its effects on mitochondrial biogenesis and adipocyte “beiging.” Further, to explore the relationship between macrophages and adipocytes, 3T3-L1s were treated with conditioned media from GS-treated RAW264.7 macrophages. Markers of mitochondrial biogenesis and beiging were measured by western blot. Results: GS treatment in adipocytes resulted in increased mitochondrial density, biogenesis (PGC1α and PPARγ), and increased markers of a beige adipocyte phenotype (UCP1, TBX1, and β-3AR). This upregulation in mitochondrial expression was accompanied by increases oxygen consumption. In GS-treated macrophages, markers of M2 polarization were elevated (e.g., arginase and IL-10), along with increased catecholamine release into the media. Lastly, 3T3-L1 adipocytes treated with conditioned media from macrophages induced a 167.8% increase in UCP1 expression, suggestive of a role of macrophages in eliciting an anti-adipogenic response to GS. Conclusions: Results from this study provide the first mechanistic understanding of the anti-obesity effects of GS and suggests a role for both direct GS-signaling and indirect stimulation of M2 macrophage polarization in this model. Full article
(This article belongs to the Special Issue Safety of Complementary Medicines)
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Open AccessArticle
Pilot Studies on Two Complementary Bath Products for Atopic Dermatitis Children: Pine-Tar and Tea
Received: 26 September 2018 / Revised: 24 December 2018 / Accepted: 28 December 2018 / Published: 8 January 2019
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Abstract
Background: Few standardized bath product clinical trials were performed for atopic dermatitis patients. Pine-tar and green tea extracts are plant-derived products that have been described as having anti-allergic effects which may reduce AD disease severity. Methods: The efficacy of two complementary bath products [...] Read more.
Background: Few standardized bath product clinical trials were performed for atopic dermatitis patients. Pine-tar and green tea extracts are plant-derived products that have been described as having anti-allergic effects which may reduce AD disease severity. Methods: The efficacy of two complementary bath products was studied and compared. Efficacy and acceptability of the bath products were measured by patient general acceptability of treatment (GAT: very good, good, fair or poor), disease severity (SCORAD: SCoring Atopic Dermatitis), quality of life (CDLQI: Children Dermatology Life Quality Index), and pertinent clinical parameters were measured before and after four weeks of treatment. Sample size calculations for further clinical trials were performed. In one group, nine AD patients were subjected to bathing with a pine-tar bath oil for 10–15 min daily for four weeks. In another group, 20 AD subjects bathed with a teabag containing green tea extracts for four weeks. Results: Significant improvements in clinical- and patient-orientated parameters were found in the pine-tar bathing group, but not the tea-bag bathing group. Both groups reported very good/good GAT on the studied products. Teabag bathing was considered not efficacious for further clinical trials. Conclusions: The pilot studies provided preliminary data on the efficacy of pine tar bath oil. We do not document a significant efficacy for bathing with tea extracts. Bathing with pine-tar is potentially a complementary topical treatment with good patient acceptance and adherence, but further evidence-based research for its recommendations is needed. Full article
(This article belongs to the Special Issue Safety of Complementary Medicines)
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Open AccessArticle
Clinical Safety of Combined Targeted and Viscum album L. Therapy in Oncological Patients
Medicines 2018, 5(3), 100; https://doi.org/10.3390/medicines5030100
Received: 20 August 2018 / Revised: 3 September 2018 / Accepted: 4 September 2018 / Published: 6 September 2018
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Abstract
Background: Despite improvement of tumor response rates, targeted therapy may induce toxicities in cancer patients. Recent studies indicate amelioration of adverse events (AEs) by add-on mistletoe (Viscum album L., VA) in standard oncological treatment. The primary objective of this multicenter observational [...] Read more.
Background: Despite improvement of tumor response rates, targeted therapy may induce toxicities in cancer patients. Recent studies indicate amelioration of adverse events (AEs) by add-on mistletoe (Viscum album L., VA) in standard oncological treatment. The primary objective of this multicenter observational study was to determine the safety profile of targeted and add-on VA therapy compared to targeted therapy alone. Methods: Demographic and medical data were retrieved from the Network Oncology registry. Allocation to either control (targeted therapy) or combinational group (targeted/add-on VA) was performed. Safety-associated variables were evaluated by adjusted multivariable analyses. Results: The median age of the study population (n = 310) at first diagnosis was 59 years; 67.4% were female. In total, 126 patients (40.6%) were in the control and 184 patients (59.4%) in the combination group. Significant differences were observed between both groups with respect to overall AE frequency (χ2 = 4.1, p = 0.04) and to discontinuation of standard oncological treatment (χ2 = 4.8, p = 0.03) with lower rates in the combinational group (20.1%, 35% respectively) compared to control (30.2%, 60.5%, respectively). Addition of VA to targeted therapy significantly reduced the probability of oncological treatment discontinuation by 70% (Odds ratio (OR) 0.30, p = 0.02). Conclusions: Our results indicate a highly significant reduction of AE-induced treatment discontinuation in all-stage cancer patients when treated with VA in addition to targeted therapy. Full article
(This article belongs to the Special Issue Safety of Complementary Medicines)
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Review

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Open AccessReview
Current Status and Major Challenges to the Safety and Efficacy Presented by Chinese Herbal Medicine
Received: 19 December 2018 / Revised: 12 January 2019 / Accepted: 15 January 2019 / Published: 18 January 2019
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Abstract
Traditional Chinese medicine (TCM) is not only used prevalently in Asian countries but has also gained a stable market globally. As a principal form of TCM, Chinese herbal medicine (CHM) is comprised of treatments using multiple Chinese herbs which have complex chemical profiles. [...] Read more.
Traditional Chinese medicine (TCM) is not only used prevalently in Asian countries but has also gained a stable market globally. As a principal form of TCM, Chinese herbal medicine (CHM) is comprised of treatments using multiple Chinese herbs which have complex chemical profiles. Due to a lack of understanding of its modality and a lack of standardization, there are significant challenges associated with regulating CHM’s safety for practice and understanding its mechanisms of efficacy. Currently, there are many issues that need to be overcome in regard to the safety and efficacy of CHM for the further development of evidence-based practices. There is a need to better understand the mechanisms behind the efficacy of CHM, and develop proper quality standards and regulations to ensure a similar safety standard as Western drugs. This paper outlines the status of CHM in terms of its safety and efficacy and attempts to provide approaches to address these issues. Full article
(This article belongs to the Special Issue Safety of Complementary Medicines)
Open AccessReview
Medicinal Cannabis—Potential Drug Interactions
Received: 30 November 2018 / Revised: 19 December 2018 / Accepted: 21 December 2018 / Published: 23 December 2018
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Abstract
The endocannabinoids system (ECS) has garnered considerable interest as a potential therapeutic target in various carcinomas and cancer-related conditions alongside neurodegenerative diseases. Cannabinoids are implemented in several physiological processes such as appetite stimulation, energy balance, pain modulation and the control of chemotherapy-induced nausea [...] Read more.
The endocannabinoids system (ECS) has garnered considerable interest as a potential therapeutic target in various carcinomas and cancer-related conditions alongside neurodegenerative diseases. Cannabinoids are implemented in several physiological processes such as appetite stimulation, energy balance, pain modulation and the control of chemotherapy-induced nausea and vomiting (CINV). However, pharmacokinetics and pharmacodynamics interactions could be perceived in drug combinations, so in this short review we tried to shed light on the potential drug interactions of medicinal cannabis. Hitherto, few data have been provided to the healthcare practitioners about the drug–drug interactions of cannabinoids with other prescription medications. In general, cannabinoids are usually well tolerated, but bidirectional effects may be expected with concomitant administered agents via affected membrane transporters (Glycoprotein p, breast cancer resistance proteins, and multidrug resistance proteins) and metabolizing enzymes (Cytochrome P450 and UDP-glucuronosyltransferases). Caution should be undertaken to closely monitor the responses of cannabis users with certain drugs to guard their safety, especially for the elderly and people with chronic diseases or kidney and liver conditions. Full article
(This article belongs to the Special Issue Safety of Complementary Medicines)
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Other

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Open AccessCase Report
Use of Acupuncture in an Infant with Restlessness and Agitation
Received: 5 May 2018 / Revised: 7 June 2018 / Accepted: 11 June 2018 / Published: 13 June 2018
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Abstract
Abstract: Background: We are reporting here about a 3-month-old boy with a history of failure to thrive, hypertrophic obstructive cardiomyopathy and neurological misbehaviour including hypotension in body muscles, who was found to have screaming attacks, agitation and restlessness. Methods/Results: Body and ear acupuncture [...] Read more.
Abstract: Background: We are reporting here about a 3-month-old boy with a history of failure to thrive, hypertrophic obstructive cardiomyopathy and neurological misbehaviour including hypotension in body muscles, who was found to have screaming attacks, agitation and restlessness. Methods/Results: Body and ear acupuncture was used both as supporting and integrative therapy to reduce the phases of restlessness and screaming and, simultaneously, the use of hypnotic drugs, as well as to improve the baby’s thriving. Conclusions: Our case has proved that standardised ear and body acupuncture applied by trained acupuncturist paediatricians is a helpful non-pharmacological treatment tool. While acupuncture is typically used in the outpatient setting, it can equally be used in the inpatient setting, as exemplified by the positive outcome of the presented case. Full article
(This article belongs to the Special Issue Safety of Complementary Medicines)
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