University of Macau / Institute of Chinese Medical Sciences

There has been an upsurge in the use of Complementary and Alternate Medicines (CAMs) in both developed and developing countries. Although herbal medicines have been in use for many centuries, their quality, safety and efficacy are still of major concern. Many countries are in the process of integrating CAMs into conventional health care systems based on the knowledge and use of traditional medicines. The quality control (QC) of herbal products usually presents a formidable analytical challenge in view of the complexity of the constituents in plant material and the commercial non-availability of appropriate qualified reference standards. Sceletium, a genus belonging to the family Aizoaceae, has been reported to contain psychoactive alkaloids, specifically mesembrine, mesembrenone, mesembrenol and some other related alkaloids. Sceletium is marketed as dried plant powder and as phyto-pharmaceutical dosage forms. Sceletium products and plant material marketed through health shops and on the internet are associated with unjustified claims of specific therapeutic efficacy and may be of dubious quality. Validated analytical methods to estimate Sceletium alkaloids have not previously been reported in the scientific literature and the available methods have focused only on qualitative estimation. Furthermore, since appropriate markers were not commercially available for use as reference standards, a primary objective of this study was to isolate relevant compounds, qualify them as reference standards which could be applied to develop appropriate validated qualitative and quantitative analytical methods for fingerprinting and assay of Sceletium plant material and dosage forms. The alkaloidal markers mesembrine, mesembrenone and ∆⁷ mesembrenone were isolated by solvent extraction and chromatography from dried plant material. Mesembranol and epimesembranol were synthesised by hydrogenation of the isolated mesembrine using the catalyst platinum (IV) oxide and then further purified by semi-preparative column chromatography. All compounds were subjected to analysis by ¹H, ¹³C, 2-D nuclear magnetic resonance and liquid chromatography-tandem mass spectroscopy. Mesembrine was converted to hydrochloride crystals and mesembranol was isolated as crystals from the hydrogenation reaction mass. These compounds were analysed and characterised by X-ray crystallography. A relatively simple HPLC method for the separation and quantitative analysis of five relevant alkaloidal components in Sceletium was developed and validated. The method was applied to determine the alkaloids in plant material and dosage forms containing Sceletium. An LCMS method developed during the study provided accurate identification of the five relevant Sceletium alkaloids. The method was applied for the quantitative analysis and QC of Sceletium plant material and its dosage forms. This LCMS method was found to efficiently ionize the relevant alkaloidal markers in order to facilitate their detection, identification and quantification in Sceletium plant material as well as for the assay and QC of dosage forms containing Sceletium. The chemotaxonomy of some Sceletium species and commercially available Sceletium dosage forms were successfully studied by the LCMS method. The HPLC and LCMS methods were also used to monitor the bio-conversion of some of the alkaloids while processing the plant material as per traditional method of fermentation. Additionally a high resolution CZE method was developed for the separation of several Sceletium alkaloids in relatively short analysis times. This analytical method was used successfully to fingerprint the alkaloids and quantify mesembrine in Sceletium and its products. Sceletium species grown under varying conditions at different locations, when analyzed, showed major differences in their composition of alkaloids and an enormous difference was found to exist between the various species with respect to the presence and content of alkaloids. Sceletium and its products marketed through health shops and the internet may thus have problems with respect to the quality and related therapeutic efficacy. The QC of Sceletium presents a formidable challenge as Sceletium plants and products contain a complex mixture of compounds. The work presented herein contributes to a growing body of scientific knowledge to improve the QC standards of herbal medicines and also to provide vital information regarding the selection of plant species and information on the specific alkaloidal constituents to the cultivators of Sceletium and the manufacturers of its products.

published_or_final_version / abstract / Dentistry / Master / Master of Dental Surgery

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

The prevalence of herbal supplement use by the elderly and factors that influence regular versus occasional use were investigated in a group of independent residents of a continuing care retirement community in Salem, Oregon. A nine-page questionnaire was delivered to 402 residents of Capital Manor; 318 questionnaires were usable (84% response rate). The majority of respondents were female (68%) and Caucasian (88%) with an age range of 65 to 100 (average 82.2 years). Twenty percent of all respondents (n=65) were herbal supplement users. Sixty-two percent of them were regular users and 39% were occasional users. The majority of users were female (68%), Caucasian (85%), and non-smokers (78%). Their age range was 65 to 91 years (mean of 79.6 years). Sixty-nine percent reported living with a spouse. They had more than a high school education (78%) and had annual household incomes above $50,000 (49%). "Books, newspapers, and magazines" (84%) were the information sources most frequently relied on for herbal supplement information, followed by "medical doctor/nurse" (72%). Forty-four percent of user households spent more than $10 per month on herbal supplements. Supermarkets (41%) and health food stores (41%) were the most popular places to purchase herbal supplements. The majority of herbal supplement users strongly agreed/agreed that taking herbal supplements would "make you feel less stress" (88%), "protect you from getting a cold" (81%), and "improve your memory" (81%). Fifty-two percent of users strongly agreed/agreed that "herbal supplements may cause side effects" and 24% strongly agreed/agreed that "herbal supplement shouldn't be taken with other medications". Gingko biloba was the most frequently used of eight herbal supplements (71% of respondents) followed by echinacea (39%) and ginseng (29%). Males were significantly more likely to use saw palmetto (claimed to prevent enlargement of the prostate gland). Eighty-three percent of herbal supplement users reported having some knowledge about possible benefits of ginkgo biloba (claimed to reduce memory loss). A belief that herbal supplements "improve your memory" was significantly associated with usage. Regular herbal supplement users were significantly more likely to agree that taking herbal supplements reduces severity of memory loss. Four factors were significantly related to herbal supplement use: age group (with age group of 75 to 84 years old more likely to be users than age groups of 65 to 74 years and age group of 85 years and over); living status (with those living with spouses being more likely to be users than those living alone), health status changes in the past year (with users being more likely to report their health status as "improved" than non-users); and physical exercise participation (with users being more likely to exercise than nonusers). The fundamental hypothesis of this study was that the frequency of use of herbal supplements among older adults would be mediated by several factors including: perceived susceptibility to and severity of chronic diseases (i.e., heart disease and cancer); perceived benefits of and barriers to herbal supplement usage; information sources; vitamin/mineral supplement usage; and perceived preventive lifestyle factors. Of these, only vitamin/mineral supplement usage was significantly associated with herbal supplement usage. Ninety-seven percent of herbal supplement users also used vitamin/mineral supplements. In addition, perception of control over health (a measure of self-efficacy) was significantly associated with herbal supplement use. The more control perceived, the more likely respondents were to be herbal supplement users. In general, the Health Belief Model did not predict frequency of herbal supplement usage (i.e., regular vs. occasional). Hence, further research is needed to focus on factors predicting herbal supplement use versus non-use. In addition, lack of awareness about risks and benefits of herbal supplement use suggests a need for education targeted at older adults. / Graduation date: 2001

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Homoeopathy at Technikon Natal, 1999. / The purpose of this placebo-controlled study was to determine the morbid symptomcomplex, in healthy people, produced by the administration of Sceletium tortuosum (a South African herb) in the 6 CH potency, so that it may be prescribed according to the Law of Similars, as required by homoeopathic principles. / M

M.Tech. / Allergic rhinitis is on the increase around the world affecting between 15-20% of the global population and is the most common chronic condition of children in South Africa. Luffeel® is a propriety complex homeopathic product manufactured by Biologische Heilmittel Heel. It is available in nasal spray and tablet form. These two forms are designed to work in combination with each other in the treatment of allergic rhinitis. The aim of this study is to determine the effect of a combination of Luffeel® nasal spray and Luffeel® tablets on allergic rhinitis using Phadiatop® tests, RAST Inhalant screens and subjective evaluation on symptoms such as nasal itching, sneezing, congestion, discharge, ocular redness and itching as indicators. This study was a double-blind, placebo-controlled study conducted at the University of Johannesburg, Doornfontein campus over a period of eight weeks. Thirty participants were recruited by poster advertisement. It can be concluded that Luffeel® nasal spray and Luffeel® tablets decrease the symptoms of allergic rhinitis, when compared to the placebo, thus giving persons suffering from allergic rhinitis an alternative treatment with no rebound or lethargic effects. It can also be concluded that this study that Luffeel® nasal spray and Luffeel® tablets has no significant effect on Phadiatop® and RAST inhalant screens over an eight week period. The results are inconclusive due to the small sample size and short time frame of the study.

M.Tech. (Homoeopathy) / Insulin resistance is defined as the impaired ability of plasma insulin to facilitate peripheral glucose disposal, suppress hepatic gluconeogenesis and inhibit very low density lipoprotein (VLDL) output (Caceres et al., 2008). Insulin resistance is not a disease, but rather a feature and attribute of the Metabolic Syndrome, which is associated with a high risk of developing type two diabetes mellitus and cardiovascular disease (Brewer, 2005). Insulin resistance (IR) is globally regarded as the common and fundamental aetiological factor of the various components of the Metabolic Syndrome namely abdominal obesity, dyslipidaemia, insulin resistance and hypertension (Zimmet, 1991; Haffner et al., 1992 Stern, 1997; Beck Nielson & Groop, 1994; Tsai et al., 2012). Diabetes mellitus type 2 is a rapidly growing worldwide epidemic, but only diagnosed once the underlying metabolic abnormalities have caused damage. The fact that many recently diagnosed diabetic patients already suffer from so called “late complications of diabetes” indicates that the pre-diabetic condition is harmful to health and needs to be addressed promptly to slow down or avoid the progression to diabetes mellitus type 2 (Beck Nielson & Groop, 1994; Brewer, 2005; Tsai et al., 2012). Treatment of insulin resistance proves very difficult as dietary and lifestyle choices play an integral role in the development, treatment and management of insulin resistance; and insulin resistant patients also seem resistant to changing their behaviour (Brewer, 2005). Current conventional treatment options are limited in efficacy and may be associated with significant side-effects (Brewer, 2005; Snyman, 2009; Neal, 2003), while coherent studies on combination complementary forms of treatment are lacking (Chen et al., 2003; Guan et al., 2000; Hull, 2008; Verma et al., 1998; Winston & Kuhn, 2007; Ye et al., 2001). This study aimed to determine the efficacy of the herbal and nutritional formulation Glucostate™ in FoodState® form, on the HOMA index of insulin resistant patients. This was a collaborative randomized double-blind and double-dummy placebo controlled quantitative research study that included 40 participants. Due to the inherent nature of associated race, age and gender bias, participants were matched according to these criteria and randomly allocated to either an experimental or control group (Appendix C). The placebo group was shared between two collaborative studies. Participants volunteered to participate in the study, were between the ages of 20-45 years and consented to the procedures of the study. Participants in the treatment group received Glucostate™ tablets and placebo drops and the participants in the placebo group received placebo tablets and placebo drops. The research study was conducted over a period of 16 weeks per participant at the University of Johannesburg Health Training Centre, Doornfontein Campus. Participants were asked to maintain their original lifestyle and diet and continue as is normal for them, as alterations in weight have an effect on insulin levels. Participants were screened using blood pressure, abdominal girth, height, weight and Body Mass Index (BMI); these measurements were repeated at weeks 4, 8, 12 and 16. Fasting blood tests consisting of a lipogram, fasting glucose and fasting insulin level were done prior to and at the conclusion of the study. The Homeostasis Model Assessment (HOMA) index was calculated from the fasting insulin and glucose values. Results acquired from the research study were statistically analyzed by Statkon at the University of Johannesburg by means of descriptive statistics, parametric and non-parametric tests. The only parameters which showed statistically significant improvement for the Glucostate™ group and not the placebo group were systolic blood pressure (SBP) (p=0.004) and diastolic blood pressure (DBP) (p=0.050). There was no statistically significant change in any of the other parameters when compared to placebo. This research study determined that Glucostate™ was not effective in reducing insulin resistance and the parameters directly associated with its measurement especially when compared to the effects of placebo.

M.Tech. / Obesity is a serious health problem throughout the world, with the number of cases having increased three-fold over the last two decades, reaching epidemic levels in the United States (Kumar and Clark, 2009). According to the South African Demographic and Health Survey (SADHS) of 2002, 29.2% of South African men were overweight, whereas 56.6% of women were overweight. Obesity leads to a decreased quality of life and can have a detrimental effect on general well being (SADHS, 2002). Overweight and obesity have major psychological effects on the individual. Obese individuals often suffer from body image issues, unhappiness, a decreased morale, low self esteem and eating disorders (Rogge et al., 2004). The stigma associated with adolescent obesity causes bullying in school as well as childhood psychiatric morbidity (Gortmaker et al., 1993). The aim of this study was to determine the effect of an herbal formulation consisting of Coleus Forskohlii, Camellia sinensis, Coffea canephora, Caffeine, Evodiamine, Ilex paraguariensis and Phaseolus vulgaris on general well being in overweight and obese individuals. This study was a quantitative double-blind, placebo-controlled study, using matched pairs according to gender and body mass index (BMI). The study was conducted over twelve weeks during the period of October 2011 to January 2012 at the University of Johannesburg’s Homeopathy Clinic. The conducted study formed part of a larger study where the research sample was shared by two additional researchers (Durrheim et al., 2012) (Withers et al., 2012). This allowed for a larger sample group to be tested with numerous variables being researched. The study included sixty overweight and obese males and females between the ages of eighteen and forty five, with a BMI above 25 kg/m² and under 35kg/m². Participants were required to sign a Participant Information and Consent form (Appendix B) giving the necessary information regarding this study. The groups were randomly matched assigned by the dispenser (according to the participant’s BMI) to the experimental group or placebo group, each consisting of thirty participants. The medication was randomised by the homeopathic dispenser at the University of Johannesburg’s Homeopathy Clinic. The experimental group received a bottle of capsules containing the herbal formulation, and the placebo received identical looking placebo capsules containing a pharmaceutical maize starch.