Beruflich Dokumente
Kultur Dokumente
401–409
© Urban & Fischer Verlag 2001
http://www.urbanfischer.de/journals/phytomed
Phytomedicine
REVIEW
Summary
Synergistic interactions are of vital importance in phytomedicines, to explain difficulties in always
isolating a single active ingredient, and explain the efficacy of apparently low doses of active con-
stituents in a herbal product. This concept, that a whole or partially purified extract of a plant of-
fers advantages over a single isolated ingredient, also underpins the philosophy of herbal
medicine. Evidence to support the occurrence of synergy in within phytomedicines is now accumu-
lating and is reviewed here. Synergistic interactions are documented for constituents within a total
extract of a single herb, as well as between different herbs in a formulation. Positive and negative
aspects of interactions are discussed together with the methods used to identify and measure syn-
ergy. The evidence is divided into experimental, in vitro instances, as well as clinical examples
where available. Herbs discussed include Ginkgo biloba, Piper methysticum (Kava-Kava), Gly-
cyrrhiza glabra, Hypericum perforatum, Valeriana officinalis, Cannabis sativa, Salix alba and oth-
ers.
j Introduction
Many of the most effective phytomedicines are on the this is not a unique property of natural products and is
drug market as whole extracts of plants, and practition- found in conventional medicines such as the synthetic
ers have always believed that synergistic interactions antidepressants where several weeks of treatment may
between the components of individual or mixtures of be necessary before a clinical improvement is seen.
herbs are a vital part of their therapeutic efficacy. Until The use of drug combinations is also not confined to
fairly recently there has been little clinical evidence to herbal products, and for example cancer chemotherapy,
demonstrate conclusively that this is the case, and it the treatment of HIV and hypertension, routinely em-
very often it is argued that the dose of supposed active ploy drug combinations consisting of two or more indi-
constituents is too low to exert any therapeutically rele- vidual substances. In fact the mechanism of action of
vant effect at all. In the absence of clinical proof this many phytomedicines is still unknown and there are
has led sceptics to dismiss these medicines as placebos, several instances of a total herb extract showing a
and it is compounded by the fact that there may be re- better effect than an equivalent dose of an isolated
sult in a measurable efficacy only after continuous ad- compound, for which we have no real rationale. Some
ministration, which might be due to a cumulative ef- of these will be outlined in this review. Speculation
fect. For this reason long-term therapy is routine, but as to the reason for this, whether it involves synergy,
0944-7113/01/08/05-401 $ 15.00/0
402 E. M. Williamson
enhanced bioavailability, cumulative effects or simply munosuppressants after transplantation, warfarin as an
the additive properties of the constituents requires fur- anticoagulant and the protease inhibitors used to treat
ther research. It will probably involve a thoroughly HIV infection. In addition, herbal products with reput-
new approach, for instance by investigating mecha- ed synergistic activity should not be used if they are
nisms using new molecular biology techniques for the potent herbs used in conditions where the dose is cru-
isolated ingredients individually and in combination, cial. Foxglove, Digitalis, is not a suitable herbal reme-
as has been described by Wagner (1999). In this re- dy for congestive heart failure and heart insufficiency
spect, we are only at the beginning of an interesting grade I and II according to the NYHY, as the therapeu-
new research field, which should shed light on how tic index is so low, but hawthorn certainly is because
these remedies work, and ultimately result in reduced of its more gentle, cumulative, and probably synergis-
side effects and a better therapeutic success. tic, effect.
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j Address
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