Ephedra - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

EPHEDRA A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J AMES N. P ...

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EPHEDRA A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright ©2003 by ICON Group International, Inc. Copyright ©2003 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Ephedra: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-83595-0 1. Ephedra-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on ephedra. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON EPHEDRA................................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Ephedra ......................................................................................... 6 E-Journals: PubMed Central ......................................................................................................... 8 The National Library of Medicine: PubMed .................................................................................. 8 CHAPTER 2. NUTRITION AND EPHEDRA ......................................................................................... 11 Overview...................................................................................................................................... 11 Finding Nutrition Studies on Ephedra ........................................................................................ 11 Federal Resources on Nutrition ................................................................................................... 18 Additional Web Resources ........................................................................................................... 18 CHAPTER 3. ALTERNATIVE MEDICINE AND EPHEDRA .................................................................. 21 Overview...................................................................................................................................... 21 The Combined Health Information Database............................................................................... 21 National Center for Complementary and Alternative Medicine.................................................. 22 Additional Web Resources ........................................................................................................... 35 General References ....................................................................................................................... 42 CHAPTER 4. DISSERTATIONS ON EPHEDRA .................................................................................... 43 Overview...................................................................................................................................... 43 Dissertations on Ephedra ............................................................................................................. 43 Keeping Current .......................................................................................................................... 44 CHAPTER 5. BOOKS ON EPHEDRA ................................................................................................... 45 Overview...................................................................................................................................... 45 Book Summaries: Federal Agencies.............................................................................................. 45 Book Summaries: Online Booksellers........................................................................................... 46 The National Library of Medicine Book Index ............................................................................. 47 Chapters on Ephedra .................................................................................................................... 47 CHAPTER 6. PERIODICALS AND NEWS ON EPHEDRA ..................................................................... 49 Overview...................................................................................................................................... 49 News Services and Press Releases................................................................................................ 49 Academic Periodicals covering Ephedra....................................................................................... 53 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 57 Overview...................................................................................................................................... 57 NIH Guidelines............................................................................................................................ 57 NIH Databases............................................................................................................................. 59 Other Commercial Databases....................................................................................................... 61 APPENDIX B. PATIENT RESOURCES ................................................................................................. 63 Overview...................................................................................................................................... 63 Patient Guideline Sources............................................................................................................ 63 Finding Associations.................................................................................................................... 66 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 69 Overview...................................................................................................................................... 69 Preparation................................................................................................................................... 69 Finding a Local Medical Library.................................................................................................. 69 Medical Libraries in the U.S. and Canada ................................................................................... 69 ONLINE GLOSSARIES.................................................................................................................. 75 Online Dictionary Directories ..................................................................................................... 75 EPHEDRA DICTIONARY ............................................................................................................. 77

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INDEX .............................................................................................................................................. 105

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with ephedra is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about ephedra, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to ephedra, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on ephedra. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to ephedra, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on ephedra. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON EPHEDRA Overview In this chapter, we will show you how to locate peer-reviewed references and studies on ephedra.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and ephedra, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “ephedra” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Herbs and Supplements: Here's What You Need to Know to be a Wiser Consumer of Alternative Therapies Source: Diabetes Forecast. 55(10): 95-97. October 2002. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: Dietary supplements, such as herbs, amino acids, botanical extracts, vitamins, and minerals are increasingly popular, including among people with diabetes. This article outlines strategies with which readers can be wise consumers of these alternative therapies. The author reviews the safety issues of prescription drugs versus alternative therapies, then discusses interactions between drugs and herbs. One sidebar lists dangerous herbs and supplements that people with diabetes should never take:

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chaparral, coltsfoot, comfrey, ephedrine (ephedra or ma huang), germander, jin bu huan, lobelia, phenylalanine, sassafras, L-tryptophan, and yohimbe. The article concludes with a list of suggestions for safe supplement use. 1 figure. •

Herbal Supplements: Any Relevancy to Dental Practice? Source: New York State Dental Journal. NYSDJ. 68(10): 26-30. December 2002. Contact: Available from Dental Society of the State of New York. 7 Elk Street, Albany, NY 12207. (518) 465-0044. Summary: The increasing popularity of herbal supplements demands that dentists be more knowledgeable about the effects these supplements have on oral health and treatments. Based on the medical literature, at least some of the popular products appear to have the potential to elicit oral manifestations and adverse interactions with dental drugs. This article reviews these interactions and the relevancy of herbal supplements to dental practice. Specific herbal supplements discussed include Echinacea, ephedra (Ma huang), feverfew, garlic, ginkgo, ginseng, kava, St. John's wort, and valerian. The author notes that the effects seem to be associated primarily with antiplatelet, sedative, and hepatotoxic (toxic to the liver) properties of the herbs. An understanding of the effects of herbal supplements can allow dentists to provide improved dental care and educate patients who are using these products. 33 references.

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Natural Products and Diabetes Treatment Source: Diabetes Educator. 24(2): 201-202, 205-206, 207. March-April 1998. Contact: Available from American Association of Diabetes Educators. 100 West Monroe Street, 4th Floor, Chicago, IL 60603-1901. (312) 424-2426. Summary: This article provides information about natural products as diabetes treatment. The authors point out that some natural products are potentially damaging to people with chronic diseases, especially if they are used instead of proven scientific treatment regimens. However, Americans spend about 14 billion dollars each year on alternative medicines and treatments. The authors briefly discuss the following natural products that have been promoted in relation to diabetes: ackee fruit, alfalfa, aloe vera, argimony, artichokes, barley, bitter melon, burdock root, capsaicin (cayenne pepper), carrot oil, charcoal, chromium, coriander, dandelion root, devil's club, eucalyptus, ephedra, evening primrose, fenugreek seeds, fo-ti, garlic, ginkgo biloba, ginseng, glucomannan, grape seed, guayusa, guar gum (karaya gum), gymnena, juniper, licorice, mushrooms, neem seed oil, onions, pectin (apples), periwinkle, potatoes, yellow root (golden seal), and yohimbine. The authors note that the few products that do have a mild impact on lowering blood glucose levels are significantly less effective than standard treatments. In order to ensure that no toxic effects occur and that treatment objectives are achieved, health professionals should closely monitor any person who decides to use a natural product for diabetes. The article includes general guidelines for counseling people who use herbs. 39 references. (AA-M).

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Quick Tour Through The World of Echinacea and Other Herbal Medications: Should Dialysis And Transplant Patients Use Them? Source: For Patients Only. 14(2): 10-12. March-April 2001. Contact: Available from For Patients Only. 18 East 41st Street, New York, NY 10017. (818) 704-5555. Fax (818) 704-6500.

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Summary: This article reviews herbal medications, including Echinacea, and their use by people on dialysis or who have received a kidney transplant. Echinacea is an herb that claims to assist in the treatment of upper respiratory tract infections and flu and that is used to increase the immune system. The author notes that increasing the immune system of a transplant recipient could cause the patient to enter a rejection episode; therefore Echinacea is not recommended. The author stresses that although herbs may have unpleasant side effects for the general population, for dialysis and transplant recipients they could cause dangerous medical problems, or worse, death. The data on how the body excretes herbs is limited at best. This becomes even more of a concern in the renal patient population since it is not known how reduced kidney function, dialysis, and various prescribed medications can impact their effectiveness and safety. In addition, due to lack of regulation, the herbs that patients can purchase may not have a consistent level of potency, meaning that one tablet may contain more of the desired herb than another tablet. The author briefly reviews a group of herbs, noting their health claims and any special issues for patients with end stage renal disease (ESRD). Herbs covered include aloe, Echinacea, ephedra (Ma Hung, Ephedrin, ultimate xphoria), ginkgo biloba, garlic, ginseng, kava kava, licorice root, and St. John's wort. •

Herbal Therapies and Diabetes Complications Source: Diabetes Self-Management. 18(1): 87-88, 91-92, 95-96, 98. January-February 2001. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Website: www.diabetes-self-mgmt.com. Summary: This article, the third of a series of articles on herbal therapies, reviews herbal and alternative therapy supplements for the treatment of diabetic complications. Both the Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Trial (UKPDS) demonstrated that keeping blood glucose levels as close to normal as possible can delay or prevent the development of complications in people with either type 1 or type 2 diabetes. Some of the new, experimental treatments for complications of diabetes include nutritional and herbal supplements. Many supplements may be of potential benefit in the treatment or prevention of heart disease, including fish oil, fenugreek, garlic, red yeast, antioxidants, and several herbs that inhibit blood clotting such as ginger, garlic, gingko biloba, and ginseng. The symptoms of peripheral neuropathy may be eased with alpha lipoic acid, capsaicin, and evening primrose oil. Although bilberry and gingko biloba have both been proposed as potential treatments for diabetic retinopathy, neither is currently recommended for this use. The herb yohimbe has a reputation as a aphrodisiac and a treatment for impotence, but clinical trials do not support its use. There are several experimental drugs and some herbal supplements that may prevent damage caused by the conversion of extra glucose in the cells into sorbitol, including flavonoids, quercetin, and extracts from licorice root. Although being overweight is not considered a complication of diabetes, it can make controlling blood glucose levels more difficult. Losing a small amount of weight can lower both blood glucose and blood cholesterol levels. Numerous herbal and nutritional supplements exist for people who are trying to lose weight. Common ingredients found in herbal weight loss preparations include various diuretics and laxatives, guarana, ephedra, and garcinia. The article reviews studies on these products, identifies their adverse effects, and presents typical dosing regimens. In addition, the article provides guidelines for safe supplement use and lists suggestions for further reading. 1 table.

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Here's a Closer Look Inside the Medicine Cabinets of ESRD Patients Source: For Patients Only. 14(4): 22-23. July-August 2002.

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Contact: Available from For Patients Only. 18 East 41st Street, New York, NY 10017. (818) 704-5555. Fax (818) 704-6500. Summary: This newsletter article helps dialysis patients review the medications that they may be taking, including prescriptions, over the counter products, vitamins, and herbal products. The authors discuss the medications that are commonly recommended to patients, focusing on the possible effects and interactions of each group. The authors note that because of special vitamin and mineral needs, vitamins especially made for dialysis patients are typically recommended. Other categories discussed include phosphate binders, blood pressure medications (antihypertensives), erythropoietin, and herbal products (including Echinacea, chamomile, ephedra). The authors conclude by encouraging readers to educate themselves about their medications and to stay involved and active in the management of their own health. 1 table.

Federally Funded Research on Ephedra The U.S. Government supports a variety of research studies relating to ephedra. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to ephedra. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore ephedra. The following is typical of the type of information found when searching the CRISP database for ephedra: •

Project Title: EFFECTS OF EPHEDRA ON HUMAN ADRENOCEPTOR SUBTYPES Principal Investigator & Institution: Feller, Dennis R. Pharmacology; University of Mississippi University, MS 38677 Timing: Fiscal Year 2001; Project Start 12-SEP-2001; Project End 31-AUG-2003 Summary: (APPLICANT'S ABSTRACT): A majority of Americans are overweight and 33% of our population is classified as obese. Ephedrine and related analogs are the major active components of Ephedra or ma huang (Ephedra sinica) herbal products that are proposed to cause weight loss. The mechanism of this effect is not well understood. The beneficial and adverse effects of ephedrine, including Ephedra herbal products are linked to interactions with alpha and beta-adrenergic receptors. Many of the previous pharmacological studies with ephedrine and Ephedra occurred prior to the discovery of cloned human adrenergic receptor subtypes. This project plans to systematically examine the pharmacological properties (receptor affinities and functional effects) of the compounds in herbal products on subtypes of human alpha- (alpha2a, alpha2b, alpha2c and alphala, alphalb and alphad) and beta-(beta1, beta2 and beta3) adrenergic receptors.

2 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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The specifc aims are as follows: 1) To collect Ephedra samples, and through solvent extraction and chromatographic techniques, separate these preparations into fractions for biological testing. Active constituents in the fractions will be isolated, purified and characterized; and 2) To establish the binding potency, and functional activities of isolated compounds on human alpha- and beta-adrenergic receptors that are expressed in CHO, HEK and PAZ-6 cells. With the multiplicity of adrenergic receptor subtypes discovered, it will be important to establish the pharmacological adrenergic receptor selectivity (either as an agonist or antagonist) for each of the isolated Ephedra compounds. These studies will determine whether ephedrine alkaloids, or other components contribute to adverse and beneficial effects associated with herbal Ephedra use. Due to the abuse potential, it is clear that the evaluation of the safety and effectiveness of Ephedra herbal products needs greater scrutiny, and results of these studies will provide an understanding of the molecular and cellular basis for extrapolation to their observed in vivo actions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NEAR-INFRARED VCD OF CHIRAL PHARMACEUTICALS Principal Investigator & Institution: Nafie, Laurence A. Distinguished Professor; Chemistry; Syracuse University Syracuse, NY 13210 Timing: Fiscal Year 2001; Project Start 01-APR-2001; Project End 31-MAR-2005 Summary: APPLICANT'S The objective of the proposed research is to apply Fourier transform near-infrared vibrational circular dichroism (FT-near-IRVCD), as a new in situ probe of molecular chirality, to the analysis of pharmaceutical molecules and final formulated pharmaceutical products. Currently, there is no available technology for the determination of enantiomeric purity, absolute configuration or conformational states of chiral pharmaceutical molecules in situ as formulated products. We propose to combine the existing related technologies of FT mid-IR VCD spectroscopy, conventional FT nearIR absorption and reflection spectroscopy, and solid-phase mid-IR and UV-visible CD sampling methods to yield a new methodology for probing chiral pharmaceuticals. FTVCD instrumentation in the mid-infrared region has recently become commercially available as a sensitive probe of molecular structure and chirality. FT-near-IR spectroscopy has shown remarkable sensitivity and sampling flexibility in recent years for the determination of quality-control factors in wide varieties of products, such as food, chemicals and pharmaceuticals. The resulting new spectroscopic technique, FTnear-IR VCD, will possess the analytical capability to probe enantiomeric purity, absolute configuration, molecular conformation, and particle-size distribution in solids, in final formulated chiral pharmaceuticals, as well as any prior step in the synthesis and production process. In addition to solution-phase sampling, we will investigate the use of mulls, pellets, powders, films and spin-coated samples. The use of dual polarization modulation methods developed recently by the principal investigator to automatically correct CD baselines, will suppress birefringence effects in all solid samples, thus eliminating many problems of reproducibility in solid-phase CD sampling. Where possible, near-IR VCD will be correlated to mid-IR VCD using frequency assignments and 2D-FT-mid-IR/near-IR correlation spectroscopy. The research will proceed in stepwise fashion from existing mid-IR instrumentation and methods to the development of new near-IR instrumentation and methods. With FT-near-IR-VCD technology in hand, we will then develop sensitive analytical measures of first pure chiral pharmaceutical samples, including protein pharmaceuticals, and then excipients of various kinds. Pharmaceutical molecules of particular interest are propranolol, ephedra drugs, including ephedrine, norephedrine, pseudoephedrine, norpseudoephedrine, N-methyl

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ephedrine and N-methyl pseudoephedrine, the analgesics ibuprofen and naproxen, and cyclosporins and selected protein pharmaceuticals. The excipients to be studied include dextrose (glucose), sucrose, lactose, cyclodextrins and cellulose. After these studies, we will measure FT-near-IR-VCD of excipient-supported final pharmaceutical products. The sensitivity of FT-near-IR VCD to particle size, moisture Content and aggregation in protein pharmaceuticals will be determined. The ratio of pharmaceutical to excipient will be varied until proportions equivalent to those used for human administration are achieved. This will permit in situ quality of control of chiral and physical properties in final-stage pharmaceutical products. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “ephedra” (or synonyms) into the search box. This search gives you access to fulltext articles. The following is a sample of items found for ephedra in the PubMed Central database: •

Ephedra and Its Application to Sport Performance: Another Concern for the Athletic Trainer? by Powers ME. 2001 Dec; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=155439

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Ephedra/ephedrine: cardiovascular and CNS effects. by Wooltorton E, Sibbald B. 2002 Mar 5; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=99410

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Voluntary recall of ephedra products not enough, MD says. by [No authors listed]; 2002 Jan 22; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=99285

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 3 4

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with ephedra, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “ephedra” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for ephedra (hyperlinks lead to article summaries): •

“All but death, can be adjusted”. Ma Huang (ephedrine) adversities. Author(s): Mack RB. Source: N C Med J. 1997 January-February; 58(1): 68-70. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9019118&dopt=Abstract

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Adverse cardiovascular events temporally associated with ma huang, an herbal source of ephedrine. Author(s): Samenuk D, Link MS, Homoud MK, Contreras R, Theoharides TC, Wang PJ, Estes NA 3rd, Theohardes TC. Source: Mayo Clinic Proceedings. 2002 January; 77(1): 12-6. Erratum In: Mayo Clin Proc. 2003 August; 78(8): 1055. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11795249&dopt=Abstract

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An herbal supplement containing Ma Huang-Guarana for weight loss: a randomized, double-blind trial. Author(s): Boozer CN, Nasser JA, Heymsfield SB, Wang V, Chen G, Solomon JL. Source: International Journal of Obesity and Related Metabolic Disorders : Journal of the International Association for the Study of Obesity. 2001 March; 25(3): 316-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11319627&dopt=Abstract

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Comments on “ma huang toxicity” letter by Dr. Theoharides. Author(s): Karch SB. Source: Journal of Clinical Psychopharmacology. 1999 April; 19(2): 196-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10211931&dopt=Abstract

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Fulminant exacerbation of autoimmune hepatitis after the use of ma huang. Author(s): Borum ML. Source: The American Journal of Gastroenterology. 2001 May; 96(5): 1654-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11374728&dopt=Abstract

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Ma huang toxicity. Author(s): Hutchins GM. Source: Mayo Clinic Proceedings. 2002 July; 77(7): 733. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12108613&dopt=Abstract

10 Ephedra

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Sudden death of a healthy college student related to ephedrine toxicity from a ma huang-containing drink. Author(s): Theoharides TC. Source: Journal of Clinical Psychopharmacology. 1997 October; 17(5): 437-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9316003&dopt=Abstract

•

Sudden hearing loss associated with ephedra use. Author(s): Ann Intern Med. 2003 Mar 18;138(6):I56 Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 2003 February 15; 60(4): 375-7. /entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12639104

11

CHAPTER 2. NUTRITION AND EPHEDRA Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and ephedra.

Finding Nutrition Studies on Ephedra The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “ephedra” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7

Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

12 Ephedra

The following is a typical result when searching for recently indexed consumer information on ephedra: •

Ephedra dangers documented. Source: Anonymous Health-News. 2000 December; 6(12): 6 1081-5880

•

FDA holds expert advisory committee hearing on Ma Huang. Source: Blumenthal, M. HerbalGram. Austin, TX : American Botanical Council and the Herb Research Foundation. Spring 1996. (36) page 21-23, 73. 0899-5648

•

FDA proposes warnings and dose limits on Ephedra. Source: Blumenthal, M. HerbalGram. Austin, TX : American Botanical Council and the Herb Research Foundation. Summer 1997. (40) page 26-27. 0899-5648

•

Ma Huang update: industry group submits Ma Huang safety data to Texas Department of Health. Source: Blumenthal, M. Webb, G. King, P. HerbalGram. Austin, TX : American Botanical Council and the Herb Research Foundation. Fall 1995. (35) page 21-22. 0899-5648

•

Ma huang: ancient herb, modern medicine, regulatory dilemma. Source: Blumenthal, M. King, P. HerbalGram. Austin, TX : American Botanical Council and the Herb Research Foundation. Summer 1995. (34) page 22-26, 43, 56-57. 0899-5648

•

Nebraska law criminalizes ma huang. Source: HerbalGram. Austin, TX : American Botanical Council and the Herb Research Foundation. Fall 1996. (38) page 31. 0899-5648

•

This cold and flu season, try the world's oldest medicine: Ephedra. Source: Castleman, M. Veg-Times. Mt. Morris, Ill. : Vegetarian Times. October 1991. (170) page 79-80, 82-85. 0164-8497

•

Working to get ephedra banned. Source: Anonymous Consum-Repage 2003 February; 68(2): 6 0010-7174

The following information is typical of that found when using the “Full IBIDS Database” to search for “ephedra” (or a synonym): •

Endophytic fungi from plants living on gypsum soils as a source of secondary metabolites with antimicrobial activity. Author(s): Centro de Investigacion Basica, Merck, Sharp and Dohme de Espana SA. Josefa Valcarcel 38, E-28027 (Spain) Source: Pelaez, F. Collado, J. Arenal, F. Basilio, A. Cabello, A. Diez Matas, M.T. Garcia, J.B. Gonzalez, A. del val Gonzalez, V. Gorrochategui, J. Hernandez, P. Martin, I. Platas, G. Vicente, F. Mycological-Research (United Kingdom). (1998). volume 102(6) page 755761. plant diseases pathogens fungal diseases soil gypsum saline soils arundo atriplex diplotaxis ephedra phragmites australis rosmarinus officinalis scirpus stipa tenacissima leaves stems alternaria alternata Summary: maladie des plantes agent pathogene maladie fongique sol gypse sol salin arundo atriplex diplotaxis ephedra phragmites australis rosmarinus officinalis scirpus stipa tenacissima feuille tige alternaria alternata

•

Production of tumours and roots by Ephedra following Agrobacterium rhizogenes infection. Source: O'Dowd, N.A. Richardson, D.H.S. Canadian-journal-of-botany-=-Journalcanadien-de-botanique (Canada). (February 1994). volume 72(2) page 203-207. ephedra agrobacterium rhizogenes symptoms neoplasms roots organogenesis pathogenesis tissue culture alkaloids biosynthesis 0008-4026

Nutrition 13

Summary: ephedra agrobacterium rhizogenes symptome organogenese pathogenese culture de tissu alcaloide biosynthese •

neoplasme

racine

Transtorine, a new quinoline alkaloid from Ephedra transitoria. Source: Al Khalil, S. Alkofahi, A. El Eisawi, D. Al Shibib, A. Journal-of-natural-products (USA). (February 1998). volume 61(2) page 262-263. jordan ephedra chemical composition quinoline alkaloids spectrometry chemical structure antimicrobial properties enterobacter escherichia coli pseudomonas aeruginosa staphylococcus aureus 0163-3864 Summary: jordanie ephedra composition chimique alcaloide quinolique spectrometrie structure chimique propriete antimicrobienne enterobacter escherichia coli pseudomonas aeruginosa staphylococcus aureus

Additional physician-oriented references include: •

2-(N-nitroso-N-methylamino)propiophenone, a direct acting bacterial mutagen found in nitrosated Ephedra altissima tea. Source: Tricker, A R Wacker, C D Preussmann, R Toxicol-Lett. 1987 September; 38(1-2): 45-50 0378-4274

•

A comparative study on commercial samples of Ephedrae herba. Source: Liu, Y.M. Sheu, S.J. Chiou, S.H. Chang, H.C. Chen, Y.P. Plant-Med. Stuttgart, W. Ger. : Georg Thieme Verlag. August 1993. volume 59 (4) page 376-378. 0032-0943

•

A component of the medicinal herb ephedra blocks activation in the classical and alternative pathways of complement. Author(s): Department of Medical Biochemistry, University of Wales College of Medicine, Cardiff, UK. Source: Ling, M Piddlesden, S J Morgan, B P Clin-Exp-Immunol. 1995 December; 102(3): 582-8 0009-9104

•

Acute psychosis due to the interaction of legal compounds--ephedra alkaloids in 'vigueur fit' tablets, caffeine in 'red bull' and alcohol. Author(s): Department of Chemical Pathology, Beaumont Hospital, Dublin, Ireland. Source: Tormey, W P Bruzzi, A Med-Sci-Law. 2001 October; 41(4): 331-6 0025-8024

•

Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. Author(s): Department of Medicine, University of California, San Francisco, and the California Poison Control System, 94143-1220, USA. Source: Haller, C A Benowitz, N L N-Engl-J-Med. 2000 December 21; 343(25): 1833-8 0028-4793

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Adverse cardiovascular events temporally associated with ma huang, an herbal source of ephedrine. Author(s): Division of Cardiology, New England Medical Center, Boston, MA 02111, USA. Source: Samenuk, David Link, Mark S Homoud, Munther K Contreras, Robert Theohardes, Theoharis C Wang, Paul J Estes, N A Mark 3rd Mayo-Clin-Proc. 2002 January; 77(1): 12-6 0025-6196

•

Adverse events associated with supplements containing ephedra alkaloids. Author(s): University of Manitoba, Winnipeg, Manitoba, Canada. Source: Geiger, J D Clin-J-Sport-Med. 2002 July; 12(4): 263 1050-642X

14 Ephedra

•

Alkaloidal, lignan and phenolic constituents of Ephedra alata. Source: Nawwar, M.A.M. Barakat, H.H. Buddrus, J. Linscheid, M. Phytochemistry. Oxford, Eng. : Pergamon Press. 1985. volume 24 (4) page 878-879. 0031-9422

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An acute clinical trial evaluating the cardiovascular effects of an herbal ephedracaffeine weight loss product in healthy overweight adults. Author(s): Miami Research Associates, Miami, Florida 33143, USA. [email protected] Source: Kalman, D Incledon, T Gaunaurd, I Schwartz, H Krieger, D Int-J-Obes-RelatMetab-Disord. 2002 October; 26(10): 1363-6 0307-0565

•

Chiral gas chromatographic determination of ephedrine-type alkaloids in dietary supplements containing Ma Huang. Author(s): U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, Washington, DC 20204, USA. Source: Betz, J M Gay, M L Mossoba, M M Adams, S Portz, B S J-AOAC-Int. 1997 MarApril; 80(2): 303-15 1060-3271

•

Comparative analysis of 5.8 S rRNA from Ephedra kokanica Regl. (Gymnospermae) and other plant species. Author(s): A.N. Belozersky Laboratory of Molecular Biology and Bioorganic Chemistry, Moscow State University, U.S.S.R. Source: Melekhovets YuF Troitsky, A V Biochim-Biophys-Acta. 1990 April 6; 1048(2-3): 294-6 0006-3002

•

Content versus label claims in ephedra-containing dietary supplements. Author(s): Department of Pharmaceutical Sciences, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock 72205, USA. [email protected] Source: Gurley, B J Gardner, S F Hubbard, M A Am-J-Health-Syst-Pharm. 2000 May 15; 57(10): 963-9 1079-2082

•

Cytotoxicity assessment of Ma-huang (Ephedra) under different conditions of preparation. Author(s): Departments of Biology and Chemistry, The Hong Kong University of Science and Technology. Source: Lee, M K Cheng, B W Che, C T Hsieh, D P Toxicol-Sci. 2000 August; 56(2): 42430 1096-6080

•

Delta5-olefinic acids in the seed lipids from four Ephedra species and their distribution between the alpha and beta positions of triacylglycerols. Characteristics common to coniferophytes and cycadophytes. Author(s): ISTAB, Universite Bordeaux 1, Talence, France. [email protected] Source: Wolff, R L Christie, W W Pedrono, F Marpeau, A M Tsevegsuren, N Aitzetmuller, K Gunstone, F D Lipids. 1999 August; 34(8): 855-64 0024-4201

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Dietary supplements containing ephedra alkaloids. Source: Hutchins, G M N-Engl-J-Med. 2001 April 5; 344(14): 1095-6; discussion 1096-7 0028-4793

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Ephedra and ephedrine for weight loss and athletic performance enhancement: clinical efficacy and side effects. Source: Evid-Rep-Technol-Assess-(Summ). 2003 March; (76): 1-4 1530-440x

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Ephedra causes myocarditis. Source: Leikin, J B Klein, L J-Toxicol-Clin-Toxicol. 2000; 38(3): 353-4 0731-3810

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Ephedra dangers documented. Source: Anonymous Health-News. 2000 December; 6(12): 6 1081-5880

Nutrition 15

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Ephedra is linked to CNS, cardiovascular risks. Author(s): Spectrum Health, Grand Rapids, Mich., USA. Source: Chase, S L RN. 2001 February; 64(2): 103 0033-7021

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Ephedra supplement may have contributed to sportsman's death. Author(s): Florida. Source: Charatan, F BMJ. 2003 March 1; 326(7387): 464 1468-5833

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Ephedra update: industry coalition asks FDA to adopt national labeling guidelines on ephedra; offers cooperative research with NIH. Source: Blumenthal, M. HerbalGram. Austin, TX : American Botanical Council and the Herb Research Foundation. 2000. (50) page 64-65. 0899-5648

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Ephedra/ephedrine: cardiovascular and CNS effects. Source: Wooltorton, Eric Sibbald, Barbara CMAJ. 2002 March 5; 166(5): 633 0820-3946

•

Ephedrine pharmacokinetics after the ingestion of nutritional supplements containing Ephedra sinica (ma huang). Author(s): Department of Pharmaceutics, University of Arkansas for Medical Sciences, College of Pharmacy, Little Rock 72205, USA. Source: Gurley, B J Gardner, S F White, L M Wang, P L Ther-Drug-Monit. 1998 August; 20(4): 439-45 0163-4356

•

Ephedrine-type alkaloid content of nutritional supplements containing Ephedra sinica (Ma-huang) as determined by high performance liquid chromatography. Author(s): Department of Pharmaceutics, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock 72205, USA. Source: Gurley, B J Wang, P Gardner, S F J-Pharm-Sci. 1998 December; 87(12): 1547-53 0022-3549

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Estimation of the Age of Extant Ephedra Using Chloroplast rbcL Sequence Data. Author(s): Department of Plant Biology, University of Georgia, Athens, Georgia. Source: Huang, J Price, R A Mol-Biol-Evol. 2003 March; 20(3): 435-40 0737-4038

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Extract versus herb: effect of formulation on the absorption rate of botanical ephedrine from dietary supplements containing Ephedra (ma huang) Source: Gurley, B Ther-Drug-Monit. 2000 August; 22(4): 497 0163-4356

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FDA proposes warnings and dose limits on Ephedra. Source: Blumenthal, M. HerbalGram. Austin, TX : American Botanical Council and the Herb Research Foundation. Summer 1997. (40) page 26-27. 0899-5648

•

Flavonoids from Ephedra aphylla. Source: Hussein, S.A.M. Barakat, H.H. Nawar, M.A.M. Willuhn, G. PhytochemistryOxford. Oxford : Elsevier Science Ltd. August 1997. volume 45 (7) page 1529-1532. 00319422

•

Four cyclopropane amino acids from Ephedra. Source: Starratt, A.N. Caveney, S. Phytochemistry-Oxford. Oxford : Elsevier Science Ltd. Sept 1995. volume 40 (2) page 479-481. 0031-9422

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Herbal ephedra/caffeine for weight loss: a 6-month randomized safety and efficacy trial. Author(s): New York Obesity Research Center, St Luke's-Roosevelt Hospital and Columbia University, New York 10025, USA. Source: Boozer, C N Daly, P A Homel, P Solomon, J L Blanchard, D Nasser, J A Strauss, R Meredith, T Int-J-Obes-Relat-Metab-Disord. 2002 May; 26(5): 593-604 0307-0565

16 Ephedra

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Hypersensitivity myocarditis associated with ephedra use. Author(s): Rush Presbyterian St. Luke's Medical Center, Chicago, Illinois 60612, USA. Source: Zaacks, S M Klein, L Tan, C D Rodriguez, E R Leikin, J B J-Toxicol-Clin-Toxicol. 1999; 37(4): 485-9 0731-3810

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Hypersensitivity myocarditis with ephedra use. Source: Kurt, T L J-Toxicol-Clin-Toxicol. 2000; 38(3): 351 0731-3810

•

Leber hereditary optic neuropathy associated with use of ephedra alkaloids. Author(s): Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA. Source: Warner, R B Lee, A G Am-J-Ophthalmol. 2002 December; 134(6): 918-20 00029394

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Mannan glycopeptide elicits p-coumaroylamino acids in Ephedra distachya cultures. Source: Song, K.S. Tomoda, M. Shimizu, M. Sankawa, U. Ebizuka, Y. PhytochemistryOxford. Oxford : Elsevier Science Ltd. January 1995. volume 38 (1) page 95-102. 00319422

•

Myocardial infarction temporally related to ephedra--a possible role for the coronary microcirculation. Author(s): Department of Cardiology, Marshfield Clinic, 1000 N Oak Ave, Marshfield, WI 54449, USA. [email protected] Source: Rezkalla, S H Mesa, J Sharma, P Kloner, R A WMJ. 2002; 101(7): 64-6

•

New observations on the secondary chemistry of world Ephedra (Ephedraceae). Source: Caveney, S. Charlet, D.A. Freitag, H. Maier Stolte, M. Starratt, A.N. Am-j-bot. Columbus, Ohio : Botanical Society of America Inc. July 2001. volume 88 (7) page 11991208. 0002-9122

•

Nitrosation products from the plant Ephedra altissima and their potential endogenous formation. Source: Tricker, A R Wacker, C D Preussmann, R Cancer-Lett. 1987 May; 35(2): 199-206 0304-3835

•

Nucleotide sequences of cytosolic 5S ribosomal RNAs from two gymnosperms, Gnetum gnemon and Ephedra kokanica. Author(s): A.N. Belozersky Laboratory of Molecular Biology and Bioorganic Chemistry, Moscow State University, USSR. Source: Melekhovets YuF Troitsky, A V Valiejo Roman, K M Bobrova, V K AntoNovember, A S Nucleic-Acids-Res. 1988 May 11; 16(9): 4155 0305-1048

•

Pharmacokinetics and cardiovascular effects of ma-huang (Ephedra sinica) in normotensive adults. Author(s): Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA. Source: White, L M Gardner, S F Gurley, B J Marx, M A Wang, P L Estes, M J-ClinPharmacol. 1997 February; 37(2): 116-22 0091-2700

•

Pharmacological actions of analogues of feruloylhistamine, an imidazole alkaloid of Ephedra roots. Source: Hikino, H. Kiso, Y. Ogata, M. Konno, C. Aisaka, K. Kubota, H. Hirose, N. Ishihara, T. Plant-Med-J-Med-Plant-Res. Stuttgart, W. Ger. : Thieme-Stratton. December 1984. volume 50 (6) page 478-480. 0032-0943

Nutrition 17

•

Pharmacological properties of traditional medicines (XXVII). Interaction between Ephedra Herb and Gypsum under hyperthermal conditions in rats. Author(s): Department of Traditional Chinese Medicinal Sciences, Shenyang Pharmaceutical University, China. Source: Yuan, D Sunouchi, H Sakurai, T Saito, K Kano, Y Biol-Pharm-Bull. 2002 July; 25(7): 872-4 0918-6158

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Pharmacology of ephedra alkaloids and caffeine after single-dose dietary supplement use. Author(s): Division of Clinical Pharmacology, San Francisco General Hospital, University of California, 94143, USA. [email protected] Source: Haller, Christine A Jacob, Peyton 3rd Benowitz, Neal L Clin-Pharmacol-Ther. 2002 June; 71(6): 421-32 0009-9236

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Phylogenetic inferences from chloroplast chlB gene sequences of Nephrolepis exaltata (Filicopsida), Ephedra altissima (Gnetopsida), and diverse land plants. Author(s): Departement de Biochimie, Cite Universitaire, Universite Laval, Quebec, Canada. [email protected] Source: Boivin, R Richard, M Beauseigle, D Bousquet, J Bellemare, G Mol-PhylogenetEvol. 1996 August; 6(1): 19-29 1055-7903

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Separation and determination of ephedrine alkaloids and tetramethylpyrazine in Ephedra sinica Stapf by gas chromatography-mass spectrometry. Author(s): Tsinghua University, Beijing, China. Source: Li, H X Ding, M Y Lv, K Yu, J Y J-Chromatogr-Sci. 2001 September; 39(9): 370-4 0021-9665

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Sudden hearing loss associated with ephedra use. Author(s): Division of Otolaryngology, Penn State University, M.C. H091, P.O. Box 850, Hershey, PA 17033, USA. [email protected] Source: Schweinfurth, J Pribitkin, E Am-J-Health-Syst-Pharm. 2003 February 15; 60(4): 375-7 1079-2082

•

The pharmacology of psychoactive alkaloids from ephedra and catha. Author(s): Departement de Pharmacologie, Universite de Geneve, Switzerland. Source: Kalix, P J-Ethnopharmacol. 1991 April; 32(1-3): 201-8 0378-8741

•

This cold and flu season, try the world's oldest medicine: Ephedra. Source: Castleman, M. Veg-Times. Mt. Morris, Ill. : Vegetarian Times. October 1991. (170) page 79-80, 82-85. 0164-8497

•

Transtorine, a new quinoline alkaloid from Ephedra transitoria. [Erratum: Aug 1999, v. 62 (8), p. 1214.]. Source: Al Khalil, S. Alkofahi, A. El Eisawi, D. Al Shibib, A. J-nat-prod. Washington, D.C. : American Society of Pharmacognosy. February 1998. volume 61 (2) page 262-263. 0163-3864

•

Use of Ephedra-containing products and risk for hemorrhagic stroke. Author(s): Stroke Program, Department of Neurology, University of Texas at Houston, USA. [email protected] Source: Morgenstern, L B Viscoli, C M Kernan, W N Brass, L M Broderick, J P Feldmann, E Wilterdink, J L Brott, T Horwitz, R I Neurology. 2003 January 14; 60(1): 132-5 1526632X

•

Vibrational circular dichroism in ephedra molecules. Experimental measurement and ab initio calculation. Author(s): Department of Chemistry, Syracuse University, New York 13244-4100, USA.

18 Ephedra

Source: Freedman, T B Ragunathan, N Alexander, S Faraday-Discuss. 1994; (99): 131-49; discussion 199-215 1359-6640 •

Working to get ephedra banned. Source: Anonymous Consum-Repage 2003 February; 68(2): 6 0010-7174

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

•

The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

•

The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

•

The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

•

Google: http://directory.google.com/Top/Health/Nutrition/

•

Healthnotes: http://www.healthnotes.com/

•

Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMD®Health: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

Nutrition 19

The following is a specific Web list relating to ephedra; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Minerals Creatine Source: Integrative Medicine Communications; www.drkoop.com Phosphocreatine Alternative names: Creatine Source: Integrative Medicine Communications; www.drkoop.com

•

Food and Diet Athletic Performance Source: Healthnotes, Inc. www.healthnotes.com Weight Loss and Obesity Source: Healthnotes, Inc. www.healthnotes.com Weight Management Index Source: Healthnotes, Inc. www.healthnotes.com

21

CHAPTER 3. ALTERNATIVE MEDICINE AND EPHEDRA Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to ephedra. At the conclusion of this chapter, we will provide additional sources.

The Combined Health Information Database The Combined Health Information Database (CHID) is a bibliographic database produced by health-related agencies of the U.S. federal government (mostly from the National Institutes of Health) that can offer concise information for a targeted search. The CHID database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “ephedra” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: •

Ephedra and Ephedrine for Weight Loss and Athletic Performance Enhancement: Clinical Efficacy and Side Effects Source: Rockville, MD: Food and Drug Administration. 2003. 6 p. Contact: Available from Agency for Healthcare Research and Quality. U.S. Department of Health and Human Services, 2101 East Jefferson Street, Rockville, MD 20852. (301) 594-1364. PRICE: Free. AHRQ Publication No. 03-E022. Summary: This Evidence Report/Technology Assessment, funded by the National Institutes of Health Office of Dietary Supplements, the National Center for Complementary and Alternative Medicine, and the Agency for Healthcare Research and Quality, addresses research questions regarding the efficacy of herbal ephedra and ephedrine for weight loss and athletic performance through a comprehensive literature review and synthesis of evidence. The report assesses the safety of these products through a review of clinical trials, as well as meta-analyses where appropriate. In

22 Ephedra

addition, the ephedra- and ephedrine-related adverse events reports on file with the Food and Drug Administration, published case reports, and reports to a manufacturer of ephedra-containing products are reviewed. The report is divided into four major sections: reporting the evidence, methodology, findings, and future research.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to ephedra and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “ephedra” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to ephedra: •

2-(N-nitroso-N-methylamino)propiophenone, a direct acting bacterial mutagen found in nitrosated Ephedra altissima tea. Author(s): Tricker AR, Wacker CD, Preussmann R. Source: Toxicology Letters. 1987 September; 38(1-2): 45-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3307024&dopt=Abstract

•

A component of the medicinal herb ephedra blocks activation in the classical and alternative pathways of complement. Author(s): Ling M, Piddlesden SJ, Morgan BP. Source: Clinical and Experimental Immunology. 1995 December; 102(3): 582-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8536376&dopt=Abstract

•

A critical evaluation of Internet marketing of products that contain ephedra. Author(s): Ashar BH, Miller RG, Getz KJ, Pichard CP. Source: Mayo Clinic Proceedings. 2003 August; 78(8): 944-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12911041&dopt=Abstract

•

Acridine orange fluorescence in shoot tips of ephedra. Author(s): PAOLILLO DJ Jr. Source: Acta Histochemica. 1964 June 30; 18: 276-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14195154&dopt=Abstract

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Acute psychosis due to the interaction of legal compounds--ephedra alkaloids in 'vigueur fit' tablets, caffeine in 'red bull' and alcohol. Author(s): Tormey WP, Bruzzi A. Source: Med Sci Law. 2001 October; 41(4): 331-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11693229&dopt=Abstract

Alternative Medicine 23

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Addressing the potential risks associated with ephedra use: a review of recent efforts. Author(s): Schulman S. Source: Public Health Reports (Washington, D.C. : 1974). 2003 November-December; 118(6): 487-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14563905&dopt=Abstract

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Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. Author(s): Haller CA, Benowitz NL. Source: The New England Journal of Medicine. 2000 December 21; 343(25): 1833-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11117974&dopt=Abstract

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Adverse events associated with supplements containing ephedra alkaloids. Author(s): Geiger JD. Source: Clinical Journal of Sport Medicine : Official Journal of the Canadian Academy of Sport Medicine. 2002 July; 12(4): 263. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12150162&dopt=Abstract

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An acute clinical trial evaluating the cardiovascular effects of an herbal ephedracaffeine weight loss product in healthy overweight adults. Author(s): Kalman D, Incledon T, Gaunaurd I, Schwartz H, Krieger D. Source: International Journal of Obesity and Related Metabolic Disorders : Journal of the International Association for the Study of Obesity. 2002 October; 26(10): 1363-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12355332&dopt=Abstract

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Antiinflammatory principle of Ephedra Herbs. Author(s): Hikino H, Konno C, Takata H, Tamada M. Source: Chemical & Pharmaceutical Bulletin. 1980 October; 28(10): 2900-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7448938&dopt=Abstract

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Antiinvasive, antiangiogenic and antitumour activity of Ephedra sinica extract. Author(s): Nam NH, Lee CW, Hong DH, Kim HM, Bae KH, Ahn BZ. Source: Phytotherapy Research : Ptr. 2003 January; 17(1): 70-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12557251&dopt=Abstract

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Citrus aurantium as a thermogenic, weight-reduction replacement for ephedra: an overview. Author(s): Preuss HG, DiFerdinando D, Bagchi M, Bagchi D. Source: J Med. 2002; 33(1-4): 247-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12939122&dopt=Abstract

24 Ephedra

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Comparative analysis of 5.8 S rRNA from Ephedra kokanica Regl. (Gymnospermae) and other plant species. Author(s): Melekhovets YuF, Troitsky AV. Source: Biochimica Et Biophysica Acta. 1990 April 6; 1048(2-3): 294-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2322582&dopt=Abstract

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Content versus label claims in ephedra-containing dietary supplements. Author(s): Gurley BJ, Gardner SF, Hubbard MA. Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 2000 May 15; 57(10): 963-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10832496&dopt=Abstract

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Contribution of alkaloid fraction to pressor and hyperglycemic effect of crude Ephedra extract in dogs. Author(s): Harada M, Nishimura M. Source: J Pharmacobiodyn. 1981 September; 4(9): 691-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7334454&dopt=Abstract

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Cytotoxicity assessment of Ma-huang (Ephedra) under different conditions of preparation. Author(s): Lee MK, Cheng BW, Che CT, Hsieh DP. Source: Toxicological Sciences : an Official Journal of the Society of Toxicology. 2000 August; 56(2): 424-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10911002&dopt=Abstract

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Delta5-olefinic acids in the seed lipids from four Ephedra species and their distribution between the alpha and beta positions of triacylglycerols. Characteristics common to coniferophytes and cycadophytes. Author(s): Wolff RL, Christie WW, Pedrono F, Marpeau AM, Tsevegsuren N, Aitzetmuller K, Gunstone FD. Source: Lipids. 1999 August; 34(8): 855-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10529097&dopt=Abstract

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Determination of ephedra alkaloids by liquid chromatography/tandem mass spectrometry. Author(s): Sullivan D, Wehrmann J, Schmitz J, Crowley R, Eberhard J. Source: J Aoac Int. 2003 May-June; 86(3): 471-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12852561&dopt=Abstract

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Dietary supplements containing ephedra alkaloids. Author(s): Traub SJ, Hoyek W, Hoffman RS.

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Source: The New England Journal of Medicine. 2001 April 5; 344(14): 1096; Author Reply 1096-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11291669&dopt=Abstract •

Dietary supplements containing ephedra alkaloids. Author(s): Hutchins GM. Source: The New England Journal of Medicine. 2001 April 5; 344(14): 1095-6; Author Reply 1096-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11291668&dopt=Abstract

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Effect of a multicomponent, ephedra-containing dietary supplement (Metabolife 356) on Holter monitoring and hemostatic parameters in healthy volunteers. Author(s): Gardner SF, Franks AM, Gurley BJ, Haller CA, Singh BK, Mehta JL. Source: The American Journal of Cardiology. 2003 June 15; 91(12): 1510-3, A9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12804749&dopt=Abstract

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Efficacy and safety of ephedra and ephedrine for weight loss and athletic performance: a meta-analysis. Author(s): Shekelle PG, Hardy ML, Morton SC, Maglione M, Mojica WA, Suttorp MJ, Rhodes SL, Jungvig L, Gagne J. Source: Jama : the Journal of the American Medical Association. 2003 March 26; 289(12): 1537-45. Epub 2003 Mar 10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12672771&dopt=Abstract

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Efficient Synthesis of Ephedra Alkaloid Analogues Using an Enantiomerically Pure N-[(R)-(+)-alpha-Methylbenzyl]aziridine-2-carboxaldehyde. Author(s): Hwang GI, Chung JH, Lee WK. Source: The Journal of Organic Chemistry. 1996 September 6; 61(18): 6183-6188. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11667453&dopt=Abstract

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Ephedra and ephedrine: modest short-term weight loss, at a price. Author(s): Worley C, Lindbloom E. Source: The Journal of Family Practice. 2003 July; 52(7): 518-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12841963&dopt=Abstract

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Ephedra as soma meaning hemp fibres with soma later misidentified as the hemp plant itself. Author(s): Mahdihassan S. Source: Indian J Hist Sci. 1986 January; 21(1): 1-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11621255&dopt=Abstract

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Ephedra causes myocarditis. Author(s): Leikin JB, Klein L.

26 Ephedra

Source: Journal of Toxicology. Clinical Toxicology. 2000; 38(3): 353-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10866341&dopt=Abstract •

Ephedra in perspective--a current review. Author(s): Abourashed EA, El-Alfy AT, Khan IA, Walker L. Source: Phytotherapy Research : Ptr. 2003 August; 17(7): 703-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12916063&dopt=Abstract

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Ephedra is linked to CNS, cardiovascular risks. Author(s): Chase SL. Source: Rn. 2001 February; 64(2): 103. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11249416&dopt=Abstract

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Ephedra supplement may have contributed to sportsman's death. Author(s): Charatan F. Source: Bmj (Clinical Research Ed.). 2003 March 1; 326(7387): 464. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12609922&dopt=Abstract

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Ephedra/ephedrine: cardiovascular and CNS effects. Author(s): Wooltorton E, Sibbald B. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2002 March 5; 166(5): 633. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11898947&dopt=Abstract

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Ephedra-free is not danger-free. Author(s): Marcus DM, Grollman AP. Source: Science. 2003 September 19; 301(5640): 1669-71; Author Reply 1669-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14500960&dopt=Abstract

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Ephedrine pharmacokinetics after the ingestion of nutritional supplements containing Ephedra sinica (ma huang). Author(s): Gurley BJ, Gardner SF, White LM, Wang PL. Source: Therapeutic Drug Monitoring. 1998 August; 20(4): 439-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9712471&dopt=Abstract

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Ephedrine-type alkaloid content of nutritional supplements containing Ephedra sinica (Ma-huang) as determined by high performance liquid chromatography. Author(s): Gurley BJ, Wang P, Gardner SF. Source: Journal of Pharmaceutical Sciences. 1998 December; 87(12): 1547-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10189265&dopt=Abstract

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Estimation of the Age of Extant Ephedra Using Chloroplast rbcL Sequence Data. Author(s): Huang J, Price RA. Source: Molecular Biology and Evolution. 2003 March; 20(3): 435-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12644564&dopt=Abstract

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Exertional heatstroke in an infantry soldier taking ephedra-containing dietary supplements. Author(s): Oh RC, Henning JS. Source: Military Medicine. 2003 June; 168(6): 429-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12834129&dopt=Abstract

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Extract versus herb: effect of formulation on the absorption rate of botanical ephedrine from dietary supplements containing Ephedra (ma huang). Author(s): Gurley B. Source: Therapeutic Drug Monitoring. 2000 August; 22(4): 497. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10942193&dopt=Abstract

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False-positive RIA for methamphetamine following ingestion of an Ephedra-derived herbal product. Author(s): Levisky JA, Karch SB, Bowerman DL, Jenkins WW, Johnson DG, Davies D. Source: Journal of Analytical Toxicology. 2003 March; 27(2): 123-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12670009&dopt=Abstract

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Fatty acid composition of Ephedra campylopoda seed oil. Author(s): Kleiman R, Spencer GF, Earle FR, Wolff IA. Source: Chem Ind. 1967 August 5; 31: 1326-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6073517&dopt=Abstract

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Herbal ephedra/caffeine for weight loss: a 6-month randomized safety and efficacy trial. Author(s): Boozer CN, Daly PA, Homel P, Solomon JL, Blanchard D, Nasser JA, Strauss R, Meredith T. Source: International Journal of Obesity and Related Metabolic Disorders : Journal of the International Association for the Study of Obesity. 2002 May; 26(5): 593-604. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12032741&dopt=Abstract

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HPLC determination of (+)-pseudoephedrine and (-)-ephedrine in Japanese herbal medicines containing ephedra herb using solid-phase extraction. Author(s): Ichikawa M, Udayama M, Imamura K, Shiraishi S, Matsuura H. Source: Chemical & Pharmaceutical Bulletin. 2003 June; 51(6): 635-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12808238&dopt=Abstract

28 Ephedra

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Hypersensitivity myocarditis associated with ephedra use. Author(s): Zaacks SM, Klein L, Tan CD, Rodriguez ER, Leikin JB. Source: Journal of Toxicology. Clinical Toxicology. 1999; 37(4): 485-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10465246&dopt=Abstract

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Hypersensitivity myocarditis with ephedra use. Author(s): Kurt TL. Source: Journal of Toxicology. Clinical Toxicology. 2000; 38(3): 351. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10866340&dopt=Abstract

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Hypotensive actions of ephedradines, macrocyclic spermine alkaloids of Ephedra roots. Author(s): Hikino H, Ogata K, Konno C, Sato S. Source: Planta Medica. 1983 August; 48(4): 290-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6635014&dopt=Abstract

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Is an ephedra ban coming? Author(s): Cockey CD. Source: Awhonn Lifelines / Association of Women's Health, Obstetric and Neonatal Nurses. 2003 April-May; 7(2): 103-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12735217&dopt=Abstract

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Isolation and hypoglycemic activity of ephedrans A, B, C, D and E, glycans of Ephedra distachya herbs. Author(s): Konno C, Mizuno T, Hikino H. Source: Planta Medica. 1985 April; (2): 162-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4034736&dopt=Abstract

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JAMA patient page. Ephedra and ephedrine. Author(s): Torpy JM, Lynm C, Glass RM. Source: Jama : the Journal of the American Medical Association. 2003 March 26; 289(12): 1590. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12672776&dopt=Abstract

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Leber hereditary optic neuropathy associated with use of ephedra alkaloids. Author(s): Warner RB, Lee AG. Source: American Journal of Ophthalmology. 2002 December; 134(6): 918-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12470769&dopt=Abstract

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Maokonine, hypertensive principle of Ephedra roots. Author(s): Tamada M, Endo K, Hikino H.

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Source: Planta Medica. 1978 November; 34(3): 291-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=704697&dopt=Abstract •

Medicine. Ephedra--scientific evidence versus money/politics. Author(s): Wolfe SM. Source: Science. 2003 April 18; 300(5618): 437. Erratum In: Science. 2003 May 21; 300(5621): 905. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12702860&dopt=Abstract

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Myocardial infarction temporally related to ephedra--a possible role for the coronary microcirculation. Author(s): Rezkalla SH, Mesa J, Sharma P, Kloner RA. Source: Wmj. 2002; 101(7): 64-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12426924&dopt=Abstract

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NEJM study detailing the causative link between ephedra-containing supplements and adverse cardiovascular and neurovascular. Author(s): Wolf L, Wolf M, Snavely M, Staudenmeier JJ; ii. Source: Military Medicine. 2002 September; 167(9): Ii. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12363175&dopt=Abstract

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New observations on the secondary chemistry of world Ephedra (Ephedraceae). Author(s): Caveney S, Charlet DA, Freitag H, Maier-Stolte M, Starratt AN. Source: American Journal of Botany. 2001 July; 88(7): 1199-1208. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11454619&dopt=Abstract

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Nitrosation products from the plant Ephedra altissima and their potential endogenous formation. Author(s): Tricker AR, Wacker CD, Preussmann R. Source: Cancer Letters. 1987 May; 35(2): 199-206. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3581050&dopt=Abstract

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Nonpigmenting solitary fixed drug eruption caused by a Chinese traditional herbal medicine, ma huang (Ephedra Hebra), mainly containing pseudoephedrine and ephedrine. Author(s): Matsumoto K, Mikoshiba H, Saida T. Source: Journal of the American Academy of Dermatology. 2003 April; 48(4): 628-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12664035&dopt=Abstract

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Nucleotide sequences of cytosolic 5S ribosomal RNAs from two gymnosperms, Gnetum gnemon and Ephedra kokanica. Author(s): Melekhovets YuF, Troitsky AV, Valiejo-Roman KM, Bobrova VK, Antonov AS.

30 Ephedra

Source: Nucleic Acids Research. 1988 May 11; 16(9): 4155. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3375077&dopt=Abstract •

ON THE SELECTIVITY OF CERTAIN PYRONINS FOR RIBONUCLEIC ACID IN SHOOT TIPS OF EPHEDRA. Author(s): PAOLILLO DJ Jr. Source: Acta Histochemica. 1964 June 30; 18: 283-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14195155&dopt=Abstract

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Pakistan Ephedra. I. Author(s): Qazilbash NA. Source: Pharm Weekbl. 1971 April 23; 106(17): 345-59 Contd. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5551435&dopt=Abstract

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Pakistan ephedra. II. Comparative study of Ephedra nebrodensis and Ephedra gerardiana. Author(s): Qazilbash NA. Source: Pharm Weekbl. 1971 May; 106(19): 373-82. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5573892&dopt=Abstract

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Pharmacognostical studies of Ephedra plants Part I - The comparative histological studies on Ephedra rhizomes from Pakistan and Afghanistan and Chinese crude drugs “Ma-Hung-Gen”. Author(s): Namba T, Kubo M, Kanai Y, Namba K, Nishimura H, Qazilbash NA. Source: Planta Medica. 1976 May; 29(3): 216-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=948522&dopt=Abstract

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Pharmacokinetics and cardiovascular effects of ma-huang (Ephedra sinica) in normotensive adults. Author(s): White LM, Gardner SF, Gurley BJ, Marx MA, Wang PL, Estes M. Source: Journal of Clinical Pharmacology. 1997 February; 37(2): 116-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9055137&dopt=Abstract

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Pharmacological actions of analogues of feruloylhistamine, an imidazole alkaloid of Ephedra roots. Author(s): Hikino H, Kiso Y, Ogata M, Konno C, Aisaka K, Kubota H, Hirose N, Ishihara T. Source: Planta Medica. 1984 December; 50(6): 478-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6531409&dopt=Abstract

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Pharmacological properties of traditional medicines (XXVII). Interaction between Ephedra Herb and Gypsum under hyperthermal conditions in rats. Author(s): Yuan D, Sunouchi H, Sakurai T, Saito K, Kano Y.

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Source: Biological & Pharmaceutical Bulletin. 2002 July; 25(7): 872-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12132660&dopt=Abstract •

Pharmacology of ephedra alkaloids and caffeine after single-dose dietary supplement use. Author(s): Haller CA, Jacob P 3rd, Benowitz NL. Source: Clinical Pharmacology and Therapeutics. 2002 June; 71(6): 421-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12087345&dopt=Abstract

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Phylogenetic inferences from chloroplast chlB gene sequences of Nephrolepis exaltata (Filicopsida), Ephedra altissima (Gnetopsida), and diverse land plants. Author(s): Boivin R, Richard M, Beauseigle D, Bousquet J, Bellemare G. Source: Molecular Phylogenetics and Evolution. 1996 August; 6(1): 19-29. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8812302&dopt=Abstract

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Phytochemical investigation on cultivation of medicinal plants. X. On the alkaloid biogenesis in Ephedra. Author(s): IMASEKI I, SHIBATA S. Source: Pharm Bull. 1956 August; 4(4): 277-80. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13378951&dopt=Abstract

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Phytochemical investigation on cultivation of medicinal plants. XII. On the alkaloid biogenesis in Ephedra. (3). Author(s): SHIBATA S, IMASEKI I, YAMAZAKI M. Source: Pharm Bull. 1957 February; 5(1): 71-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13452765&dopt=Abstract

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Phytochemical investigation on cultivation of medicinal plants. VII. On the alkaloid biogenesis in Ephedra. Author(s): SHIBATA S, IMASEKI I. Source: Pharm Bull. 1953 September; 1(3): 285-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13166542&dopt=Abstract

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Phytochemical investigation on cultivation of medicinal plants. XIV. On the alkaloid biogenesis in ephedra. 4. Author(s): SHIBATA S, IMASEKI I, YAMAZAKI M. Source: Pharm Bull. 1957 December; 5(6): 594-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13527148&dopt=Abstract

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Production of nitrosamines from ephedrine, pseudoephedrine and extracts of Ephedra foliata under physiological conditions. Author(s): Alwan SM, Al-Hindawi MK, Abdul-Rahman SK, Al-Sarraj S.

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Source: Cancer Letters. 1986 May; 31(2): 221-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3697965&dopt=Abstract •

Psychosis related to ephedra-containing herbal supplement use. Author(s): Walton R, Manos GH. Source: Southern Medical Journal. 2003 July; 96(7): 718-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12940331&dopt=Abstract

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Public health officials caution against ephedra use. Health officials caution consumers against using dietary supplements containing ephedra. The stimulant can have dangerous effects on the nervous system and heart. Author(s): Meadows M. Source: Fda Consumer. 2003 May-June; 37(3): 8-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12793385&dopt=Abstract

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Safety and efficacy of ephedra and ephedrine for enhancement of athletic performance, thermogenesis and the treatment of obesity. Author(s): Shekelle P, Hardy M. Source: Phytomedicine : International Journal of Phytotherapy and Phytopharmacology. 2002 January; 9(1): 78. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11924769&dopt=Abstract

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Separation and determination of ephedrine alkaloids and tetramethylpyrazine in Ephedra sinica Stapf by gas chromatography-mass spectrometry. Author(s): Li HX, Ding MY, Lv K, Yu JY. Source: Journal of Chromatographic Science. 2001 September; 39(9): 370-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11565946&dopt=Abstract

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Separation and quantitation of the stereoisomers of ephedra alkaloids in natural health products using flow injection-electrospray ionization-high field asymmetric waveform ion mobility spectrometry-mass spectrometry. Author(s): McCooeye M, Ding L, Gardner GJ, Fraser CA, Lam J, Sturgeon RE, Mester Z. Source: Analytical Chemistry. 2003 June 1; 75(11): 2538-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12948119&dopt=Abstract

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Separation and quantitative analysis of ephedra alkaloids by gas chromatography and its application to evaluation of some ephedra species collected around Himalaya. Author(s): Yamasaki K, Fujita K, Sakamoto M, Okada K, Yoshida M. Source: Chemical & Pharmaceutical Bulletin. 1974 December; 22(12): 2898-902. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4468111&dopt=Abstract

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Studies on the constituents of Ephedra. I. Determination of alkaloids in Ephedra. Author(s): KIMURA K, HIKINO H.

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Source: Pharm Bull. 1957 August; 5(4): 300-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13494120&dopt=Abstract •

Sudden hearing loss associated with ephedra use. Author(s): Schweinfurth J, Pribitkin E. Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 2003 February 15; 60(4): 375-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12625221&dopt=Abstract

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The combination therapy of Ephedra herb and Loxoprofen caused gastric lesions in mice. Author(s): Cho S, Hong T, Jin GB, Yoshino G, Miura M, Aikawa Y, Yasuno F, Cyong JC. Source: The American Journal of Chinese Medicine. 2002; 30(4): 571-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12568284&dopt=Abstract

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The need for regulation of dietary supplements--lessons from ephedra. Author(s): Fontanarosa PB, Rennie D, DeAngelis CD. Source: Jama : the Journal of the American Medical Association. 2003 March 26; 289(12): 1568-70. Epub 2003 Mar 10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12672775&dopt=Abstract

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The pharmacology of psychoactive alkaloids from ephedra and catha. Author(s): Kalix P. Source: Journal of Ethnopharmacology. 1991 April; 32(1-3): 201-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1881158&dopt=Abstract

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The relative safety of ephedra compared with other herbal products. Author(s): Kingston RL, Borron SW. Source: Annals of Internal Medicine. 2003 September 2; 139(5 Pt 1): 385; Author Reply 386-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12965952&dopt=Abstract

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The relative safety of ephedra compared with other herbal products. Author(s): Dickinson A. Source: Annals of Internal Medicine. 2003 September 2; 139(5 Pt 1): 385; Author Reply 386-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12965951&dopt=Abstract

•

The relative safety of ephedra compared with other herbal products. Author(s): Whitaker JM.

34 Ephedra

Source: Annals of Internal Medicine. 2003 September 2; 139(5 Pt 1): 385; Author Reply 386-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12965950&dopt=Abstract •

The relative safety of ephedra compared with other herbal products. Author(s): Kimmel SE. Source: Annals of Internal Medicine. 2003 August 5; 139(3): 234. Erratum In: Ann Intern Med. 2003 Aug 5; 139(3): 235. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12899599&dopt=Abstract

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The relative safety of ephedra compared with other herbal products. Author(s): Kalman DS, Antonio J, Kreider RB. Source: Annals of Internal Medicine. 2003 June 17; 138(12): 1006; Author Reply 1006-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12809464&dopt=Abstract

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The relative safety of ephedra compared with other herbal products. Author(s): Bent S, Tiedt TN, Odden MC, Shlipak MG. Source: Annals of Internal Medicine. 2003 March 18; 138(6): 468-71. Summary for Patients In: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12639079&dopt=Abstract

•

The role of chemical fingerprinting: application to Ephedra. Author(s): Schaneberg BT, Crockett S, Bedir E, Khan IA. Source: Phytochemistry. 2003 March; 62(6): 911-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12590118&dopt=Abstract

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Time to ban ephedra--now. Author(s): Guharoy R, Noviasky JA. Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 2003 August 1; 60(15): 1580-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12951759&dopt=Abstract

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Transitorine, a new quinoline alkaloid from ephedra transitoria Author(s): Al-Khalil S, Alkofahi A, El-Eisawi D, Al-Shibib A. Source: Journal of Natural Products. 1999 August; 62(8): 1214. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10480799&dopt=Abstract

•

Transtorine, a new quinoline alkaloid from Ephedra transitoria. Author(s): al-Khalil S, Alkofahi A, el-Eisawi D, al-Shibib A.

Alternative Medicine 35

Source: Journal of Natural Products. 1998 February; 61(2): 262-3. Erratum In: J Nat Prod 1999 August; 62(8): 1214. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9514010&dopt=Abstract •

Ursolic acid in Retanilla ephedra. Author(s): Silva M. Source: Journal of Pharmaceutical Sciences. 1967 July; 56(7): 908-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6034838&dopt=Abstract

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Use of Ephedra-containing products and risk for hemorrhagic stroke. Author(s): Karch SB. Source: Neurology. 2003 September 9; 61(5): 724-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12963785&dopt=Abstract

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Use of Ephedra-containing products and risk for hemorrhagic stroke. Author(s): Morgenstern LB, Viscoli CM, Kernan WN, Brass LM, Broderick JP, Feldmann E, Wilterdink JL, Brott T, Horwitz RI. Source: Neurology. 2003 January 14; 60(1): 132-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12525737&dopt=Abstract

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Vibrational circular dichroism in ephedra molecules. Experimental measurement and ab initio calculation. Author(s): Freedman TB, Ragunathan N, Alexander S. Source: Faraday Discuss. 1994; (99): 131-49; Discussion 199-215. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7549538&dopt=Abstract

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Voluntary recall of ephedra products not enough, MD says. Author(s): Sibbald B. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2002 January 22; 166(2): 225. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11826949&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com®: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMD®Health: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to ephedra; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Allergic rhinitis Source: Integrative Medicine Communications; www.drkoop.com Allergies Source: Integrative Medicine Communications; www.drkoop.com Asthma Source: Healthnotes, Inc. www.healthnotes.com Asthma Source: Integrative Medicine Communications; www.drkoop.com Asthma Source: Prima Communications, Inc.www.personalhealthzone.com Bronchitis Source: Integrative Medicine Communications; www.drkoop.com Common cold Source: Integrative Medicine Communications; www.drkoop.com Cough Source: Healthnotes, Inc. www.healthnotes.com Cough Source: Integrative Medicine Communications; www.drkoop.com Hay Fever Source: Healthnotes, Inc. www.healthnotes.com

Alternative Medicine 37

Infection Source: Integrative Medicine Communications; www.drkoop.com Nasal congestion Source: Integrative Medicine Communications; www.drkoop.com Obesity Source: Integrative Medicine Communications; www.drkoop.com Respiratory ailments Source: Integrative Medicine Communications; www.drkoop.com Sinus Congestion Source: Healthnotes, Inc. www.healthnotes.com Sinusitis Source: Integrative Medicine Communications; www.drkoop.com •

Chinese Medicine Baokening Keli Alternative names: Baokening Granules Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Baokening%20Keli&mh=10&s b=---&view_records=View+Records Ertong Qingfei Wan Alternative names: Ertong Qingfei Pills; Ertong Qingfei Wan (Er Tong Qing Fei Wan) Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Ertong%20Qingfei%20Wan& mh=10&sb=---&view_records=View+Records Fangfeng Tongsheng Wan Alternative names: Fangfeng Tongsheng Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Fangfeng%20Tongsheng%20 Wan&mh=10&sb=---&view_records=View+Records

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Fengliaoxing Fengshi Dieda Yaojiu Alternative names: Fengliaoxing Fengshi Dieda Wine Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Fengliaoxing%20Fengshi%20D ieda%20Yaojiu&mh=10&sb=---&view_records=View+Records Geiie Dingchuan Wan Alternative names: Gejie Dingchuan Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Geiie%20Dingchuan%20Wan &mh=10&sb=---&view_records=View+Records Goupi Gao Alternative names: Goupi Plaster Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Goupi%20Gao&mh=10&sb=--&view_records=View+Records Jiufen San Alternative names: Jiufen Powder Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Jiufen%20San&mh=10&sb=--&view_records=View+Records Lusika Wan Alternative names: Lusika Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Lusika%20Wan&mh=10&sb=--&view_records=View+Records

Alternative Medicine 39

Mahuang Alternative names: Ephedra; Herba EphedraeHerba Ephedrae Source: Chinese Materia Medica Mahuanggen Alternative names: Ephedra Root; Radix Ephedrae Source: Chinese Materia Medica Qufeng Shujin Wan Alternative names: Qufeng Shujin Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Qufeng%20Shujin%20Wan&m h=10&sb=---&view_records=View+Records Shayao Alternative names: Shayao Pills; Shayao
(Sha Yao) Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Shayao&mh=10&sb=--&view_records=View+Records Shufeng Dingtong Wan Alternative names: Shufeng Dingtong Pills; Shufeng Dingtong Wan
(Shu Feng Ding Tong Wan) Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Shufeng%20Dingtong%20Wan &mh=10&sb=---&view_records=View+Records Shujin Wan Alternative names: Qufeng Shujin Pills; Qufeng Shujin Wan Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Shujin%20Wan&mh=10&sb=--&view_records=View+Records •

Herbs and Supplements Achillea Alternative names: Yarrow; Achillea millefolium L. Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Acorus Alternative names: Sweet Flag; Acorus calamus L. Source: Alternative Medicine Foundation, Inc. www.amfoundation.org

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Borago Alternative names: Borage; Borago officinalis Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Caffeine Source: Healthnotes, Inc. www.healthnotes.com Cardec DM Source: Healthnotes, Inc. www.healthnotes.com Ephedra Alternative names: Ephedra sinica, Ephedra intermedia, Ephedra equisetina Source: Healthnotes, Inc. www.healthnotes.com Ephedra Alternative names: Ephedra sinensis, Ma huang Source: Integrative Medicine Communications; www.drkoop.com Ephedra Source: Prima Communications, Inc.www.personalhealthzone.com Ephedra (Ma huang) Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,777,00.html Ephedra sinensis Alternative names: Ephedra Source: Integrative Medicine Communications; www.drkoop.com Ephedra1 Alternative names: Ephedra, Ma Huang; Ephedra sinica Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Ephedrine and Pseudoephedrine Source: Healthnotes, Inc. www.healthnotes.com Epinephrine Source: Healthnotes, Inc. www.healthnotes.com Eyebright Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Ginger Alternative names: Zingiber officinale Source: Healthnotes, Inc. www.healthnotes.com Glycyrrhiza1 Alternative names: Licorice; Glycyrrhiza glabra L. Source: Alternative Medicine Foundation, Inc. www.amfoundation.org

Alternative Medicine 41

Herbal decongestant Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,949,00.html Licorice Alternative names: Glycyrrhiza glabra, Glycyrrhiza uralensis Source: Healthnotes, Inc. www.healthnotes.com Lobelia Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Ma huang Alternative names: Ephedra Source: Integrative Medicine Communications; www.drkoop.com Ma huang Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca MAO Inhibitors Source: Prima Communications, Inc.www.personalhealthzone.com Mixed Amphetamines Source: Healthnotes, Inc. www.healthnotes.com Nadolol Source: Healthnotes, Inc. www.healthnotes.com Oral Corticosteroids Source: Healthnotes, Inc. www.healthnotes.com Phenelzine Source: Healthnotes, Inc. www.healthnotes.com Phenylpropanolamine Source: Healthnotes, Inc. www.healthnotes.com Prunella Alternative names: Self Heal; Prunella vulgaris L. Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Sassafras Alternative names: Sassafras albidum (Nuttall) Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Schisandra Alternative names: Schisandra chinensis Source: Healthnotes, Inc. www.healthnotes.com

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Selegiline Source: Healthnotes, Inc. www.healthnotes.com Sibutramine Source: Healthnotes, Inc. www.healthnotes.com St. John's wort Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,824,00.html Thyme Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Traditional Chinese Medicine Herbs Source: Healthnotes, Inc. www.healthnotes.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

43

CHAPTER 4. DISSERTATIONS ON EPHEDRA Overview In this chapter, we will give you a bibliography on recent dissertations relating to ephedra. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “ephedra” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on ephedra, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Ephedra ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to ephedra. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

Ephedra: a C to Java Migration Environment by Martin, Johannes; Phd from University of Victoria (canada), 2002, 172 pages http://wwwlib.umi.com/dissertations/fullcit/NQ68135

•

Ligands Derived from the Ephedra Alkaloids Coordination Chemistry and Asymmetric Catalysis by Harrison, Frank William; Phd from University of Toronto (canada), 1983 http://wwwlib.umi.com/dissertations/fullcit/NK59883

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The Safety and Efficacy of an Herbal Supplement Containing Ephedrine (ma Huang) and Caffeine (guarana Extract) by Belfie, Laura Michelle; Msc from University of Guelph (canada), 2002, 99 pages http://wwwlib.umi.com/dissertations/fullcit/MQ71190

44 Ephedra

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 5. BOOKS ON EPHEDRA Overview This chapter provides bibliographic book references relating to ephedra. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on ephedra include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “ephedra” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on ephedra: •

PDR for Herbal Medicines. 1st ed Source: Montvale, NJ: Medical Economics Company. 1998. 1244 p. Contact: Available from Medical Economics Publishing Inc. P.O. Box 10689, Des Moines, IA 50336. (800) 922-0937. Fax (515) 284-6714. Website: www.medecbookstore.com. PRICE: $59.99. ISBN: 1563632926. Summary: Most of today's herbal remedies exhibit varying degrees of therapeutic value. Some, such as ginkgo, valerian, and saw palmetto, seem genuinely useful, while others, such as ephedra, tansy, and nightshade, can actually be dangerous. As the use of unfamiliar botanicals spreads, the need to steer patients toward the few truly useful preparations and warn them away from ineffective, dangerous alternatives is becoming an increasingly significant priority. This volume, from the publishers of Physicians Desk Reference, brings together the findings of the German Regulatory Authority's herbal watchdog agency (commonly caused Commission E). This agency conducted an

46 Ephedra

intensive assessment of the peer-reviewed literature on some 300 common botanicals, weighing the quality of the clinical evidence and identifying the uses for which the herb can reasonably be considered effective. This reference book contains profiles of over 600 medicinal herbs. Each entry contains up to 9 standard sections: name(s), description, actions and pharmacology, indications and usage, contraindications, precautions and adverse reactions, overdosage, dosage, and literature. The entries have also been indexed by scientific and common name, indications, therapeutic category, and side effects. To assist in identification, the reference book includes a section of full-color plates of the plants included. The book concludes with a glossary of the specialized botanical nomenclature and other unfamiliar terminology, a list of poison control centers, and a list of drug information centers. Some of the herbs are listed for use for abdominal cramps or distress, acid indigestion, appetite stimulation, rectal bleeding, various bowel disorders, stomach cancer, cholelithiasis (gallstones), colic, colitis, constipation, dehydration, diarrhea, digestive disorders, dysentery, enteritis, anal fissure, flatulence (intestinal gas), gastritis, gastroenteritis, gastrointestinal disorders, gout, helminthiasis, hemorrhage, hemorrhoids, hepatitis, hypercholesterolemia, jaundice, liver and gall bladder complaints, liver disorders, malaria, nausea, abdominal pain, and vomiting.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print®). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “ephedra” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “ephedra” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “ephedra” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Ephedra and Ephedrine for Weight Loss and Athletic Performance Enhancement: Clinical Efficacy and Side Effects by Paul G. Shekelle (2003); ISBN: 1587631350; http://www.amazon.com/exec/obidos/ASIN/1587631350/icongroupinterna

•

Ephedra: The Truth Behind Today's Most Controversial Supplement by Mike Fillon (2003); ISBN: 1580543707; http://www.amazon.com/exec/obidos/ASIN/1580543707/icongroupinterna

•

Ephedra: Who Is Protecting the American Consumers?: Hearing Before the Oversight of Government Management, Restructuring, and t by United States (2003); ISBN: 016070099X; http://www.amazon.com/exec/obidos/ASIN/016070099X/icongroupinterna

•

The history and natural history of Ephedra as Soma by S. Mahdihassan; ISBN: 969804003X; http://www.amazon.com/exec/obidos/ASIN/969804003X/icongroupinterna

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The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “ephedra” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:8 •

Dietary supplements containing ephedra: health risks and FDA's oversights: testimony before the Subcommittee on Oversight and Investigations, Committee on Energy and Commerce, House of Representatives Author: Crosse, Marcia.; Year: 2003; Washington, D.C.: United States General Accounting Office, [2003]

•

Quality and safety of products containing Ephedra Herba on the Dutch market; Year: 1998; Bilthoven: RIVM, 2001

Chapters on Ephedra In order to find chapters that specifically relate to ephedra, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and ephedra using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “ephedra” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on ephedra: •

Herbal Medications, Nutraceuticals, and Diabetes Source: in Miller, L.G. and Murray, W.J., eds. Herbal Medicinals: A Clinician's Guide. New York, NY: Pharmaceutical Products Press. 1998. p. 115-133. Contact: Available from Haworth Herbal Press. 10 Alice Street, Binghamton, NY 139041580. (800) HAWORTH. Fax (800) 895-0582. E-mail: [email protected]. Website: www.haworthpressinc.com. PRICE: $39.95 plus shipping and handling. ISBN: 0789004666. Summary: This chapter discusses the use of herbal medications and nutraceuticals in the management of diabetes. Diabetes mellitus is a syndrome characterized by impaired glucose tolerance or a deficiency or an absolute lack of insulin. Typical symptoms include polyuria, polydipsia, polyphagia, and fatigue. People who have type 1 diabetes require exogenous insulin to adequately control blood glucose levels, whereas people who have type 2 diabetes may be able to control their blood glucose with diet, exercise, and oral medications. Any substance that affects blood glucose may adversely affect the

8

In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

48 Ephedra

patient's blood glucose control, and herbal products are no exception. The chapter uses a case based format to provide information on the pharmacology of various herbs and nutraceuticals, potential and known interactions, adverse herbal side effects, and effects of the disease state that may affect medication efficacy. Herbs and nutraceuticals discussed include momordica charantia, chromium picolinate, ginseng, ephedra, fenugreek, and GS4. 4 tables. 76 references.

49

CHAPTER 6. PERIODICALS AND NEWS ON EPHEDRA Overview In this chapter, we suggest a number of news sources and present various periodicals that cover ephedra.

News Services and Press Releases One of the simplest ways of tracking press releases on ephedra is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “ephedra” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to ephedra. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “ephedra” (or synonyms). The following was recently listed in this archive for ephedra: •

US lawmaker threatens tougher ephedra regulation Source: Reuters Industry Breifing Date: July 23, 2003

•

Lawmaker threatens tougher ephedra regulation Source: Reuters Medical News Date: July 23, 2003

50 Ephedra

•

CVS pharmacies to stop selling ephedra products Source: Reuters Industry Breifing Date: July 11, 2003

•

Panel subpoenas ex-Metabolife execs on Ephedra Source: Reuters Medical News Date: July 10, 2003

•

U.S. report can't link ephedra, health complaints Source: Reuters Health eLine Date: May 01, 2003

•

Group repeats call for U.S. ban on ephedra Source: Reuters Health eLine Date: April 17, 2003

•

Consumer advocacy group repeats call for U.S. ban on ephedra Source: Reuters Medical News Date: April 17, 2003

•

Coroner: Ephedra played role in pitcher's death Source: Reuters Health eLine Date: March 13, 2003

•

California prosecutors sue New Jersey company over ephedra Source: Reuters Medical News Date: March 11, 2003

•

California prosecutors sue company over ephedra Source: Reuters Health eLine Date: March 11, 2003

•

Regulate ephedra, other supplements, US docs say Source: Reuters Health eLine Date: March 10, 2003

•

California lawmaker proposes ban on ephedra Source: Reuters Medical News Date: March 06, 2003

•

Warning labels for ephedra may be on the horizon Source: Reuters Health eLine Date: February 28, 2003

•

Warning labels for ephedra may be on horizon Source: Reuters Medical News Date: February 28, 2003

•

Baseball player's death re-ignites ephedra debate Source: Reuters Health eLine Date: February 19, 2003

•

Ephedra tied to more adverse effects than other herbal products Source: Reuters Medical News Date: February 03, 2003

•

Ephedra has more side effects than other herbs Source: Reuters Health eLine Date: February 03, 2003

Periodicals and News 51

•

High ephedra doses tied to stroke risk Source: Reuters Health eLine Date: January 17, 2003

•

Supplement maker gives Feds ephedra safety records Source: Reuters Industry Breifing Date: November 20, 2002

•

California governor backs ephedra legislation Source: Reuters Industry Breifing Date: August 19, 2002

•

Senator wants US to determine ephedra risk Source: Reuters Industry Breifing Date: August 01, 2002

•

Government delays action against Ephedra Source: Reuters Health eLine Date: June 17, 2002

•

Health Canada recalls drugs with ephedra, ephedrine Source: Reuters Industry Breifing Date: January 10, 2002

•

Ephedra dietary supplement reported safe for weight loss Source: Reuters Industry Breifing Date: December 20, 2000

•

Ephedra group responds to negative study Source: Reuters Health eLine Date: November 07, 2000

•

Ephedra Education Council responds to NEJM study Source: Reuters Industry Breifing Date: November 07, 2000

•

Weight-loss herb ephedra in crossfire again Source: Reuters Health eLine Date: November 06, 2000

•

Phenylpropanolamine, ephedra linked to serious adverse side effects Source: Reuters Industry Breifing Date: November 06, 2000

•

Dietary supplement groups petition FDA for ephedra standards Source: Reuters Industry Breifing Date: October 26, 2000

•

New debate set in US over weight-loss herb ephedra Source: Reuters Health eLine Date: August 07, 2000

•

Ephedra labels often misleading Source: Reuters Health eLine Date: April 20, 2000

•

FDA to withdraw portions of ephedra proposal Source: Reuters Medical News Date: March 01, 2000

52 Ephedra

•

Ephedra Working Group Issues Safety Recommendations Source: Reuters Medical News Date: August 27, 1996 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “ephedra” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “ephedra” (or synonyms). If you know the name of a company that is relevant to ephedra, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “ephedra” (or synonyms).

Periodicals and News 53

Academic Periodicals covering Ephedra Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to ephedra. In addition to these sources, you can search for articles covering ephedra that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

55

APPENDICES

57

APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute9: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

9

These publications are typically written by one or more of the various NIH Institutes.

58 Ephedra

•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

Physician Resources 59

NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.10 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:11 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

10

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 11 See http://www.nlm.nih.gov/databases/databases.html.

60 Ephedra

•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway12 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.13 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “ephedra” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 212 11 3 0 0 226

HSTAT14 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.15 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.16 Simply search by “ephedra” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

12

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

13

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 14 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 15 16

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

Physician Resources 61

Coffee Break: Tutorials for Biologists17 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.18 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.19 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

17 Adapted 18

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 19 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

63

APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on ephedra can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to ephedra. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to ephedra. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “ephedra”:

64 Ephedra

•

Other guides Bacterial Infections http://www.nlm.nih.gov/medlineplus/bacterialinfections.html Cancer Alternative Therapy http://www.nlm.nih.gov/medlineplus/canceralternativetherapy.html Dietary Supplements http://www.nlm.nih.gov/medlineplus/dietarysupplements.html Health Fraud http://www.nlm.nih.gov/medlineplus/healthfraud.html Hepatitis C http://www.nlm.nih.gov/medlineplus/hepatitisc.html Herbal Medicine http://www.nlm.nih.gov/medlineplus/herbalmedicine.html Severe Acute Respiratory Syndrome http://www.nlm.nih.gov/medlineplus/severeacuterespiratorysyndrome.html

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on ephedra. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

NCCAM Consumer Advisory on Ephedra Source: Gaithersburg, MD: National Center for Complementary and Alternative Medicine. 2003. 3 p. Contact: Available from National Center for Complementary and Alternative Medicine Clearinghouse. P.O. Box 7923, Gaithersburg, MD 20898. (888) 644-6226; INTERNATIONAL PHONE: (301) 519-3153; TTY: (866) 464-3615; FAX: (866) 464-3616; EMAIL: [email protected]. PRICE: Free. Summary: This consumer advisory from the National Center for Complementary and Alternative Medicine (NCCAM) announces the U.S. Department of Health and Human Services' series of actions to protect the public from the risks of dietary supplements containing ephedra. It explains what ephedra is, its effects on the human body, and the risks of taking dietary supplements containing ephedra. The advisory refers consumers to a report containing a systematic review of the existing scientific literature on ephedra

Patient Resources 65

efficacy and safety in weight loss and athletic performance enhancement. It also provides advice to consumers regarding products containing ephedra. •

HHS Acts to Reduce Safety Concerns Associated with Dietary Supplements Containing Ephedra: Fact Sheet Source: Rockville, MD: Food and Drug Administration. 2003. 2 p. Contact: Available from Food and Drug Administration. 5600 Fishers Lane, Rockville, MD 20857. (888) 463-6332. PRICE: Free. Summary: This Food and Drug Administration fact sheet reports on new evidence, including a study by the RAND Corporation, suggesting that dietary supplements containing ephedra may present significant or unreasonable risks as currently marketed. The fact sheet lists a series of actions designed to protect Americans from these risks. Information is also provided on the RAND study, which reviewed the recent evidence on the risks and benefits of ephedra and ephedrine.

•

Evidence on the Safety and Effectiveness of Ephedra: Implications for Regulation Source: Rockville, MD: Food and Drug Administration. 2003. 5 p. Contact: Available from Food and Drug Administration. 5600 Fishers Lane, Rockville, MD 20857. (888) 463-6332. PRICE: Free. Summary: This Food and Drug Administration White Paper discusses the implications for the regulation of ephedra, based on the evidence of its safety and effectiveness. Background information on dietary supplements in general is given, followed by an overview of ephedra, including statistics on its use in the U.S., its chemical makeup, and its regulation under the Dietary Supplement Health and Education Act of 1994. The results of several review studies and meta-analyses of ephedra's safety and effectiveness are summarized. Information is also given on the Department of Health and Human Services' actions to address concerns about ephedra's safety. 13 references. Healthfinder™

Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

HHS Acts to Reduce Potential Risks of Dietary Supplements Containing Ephedra Summary: The Department of Health and Human Services (HHS) today announced a series of actions designed to protect Americans from potentially serious risks of dietary supplement products containing ephedra. Source: U.S. Food and Drug Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7282

66 Ephedra

•

Update on Actions To Reduce Risks of Ephedra Summary: In this document, the Department of Health and Human Services outlines a series of actions designed to protect Americans from potentially serious risks of dietary supplement products containing Source: National Center for Complementary and Alternative Medicine, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7447 The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to ephedra. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources

A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMD®Health: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to ephedra. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with ephedra.

Patient Resources 67

The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about ephedra. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “ephedra” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “ephedra”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “ephedra” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “ephedra” (or a synonym) into the search box, and click “Submit Query.”

69

APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.20

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

20

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

70 Ephedra

libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)21: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

21

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

Finding Medical Libraries 71

•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

72 Ephedra

•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries 73

•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

74 Ephedra

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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

75

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

77

EPHEDRA DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Cramps: Abdominal pain due to spasmodic contractions of the bowel. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adipose Tissue: Connective tissue composed of fat cells lodged in the meshes of areolar tissue. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Agrobacterium: A genus of gram-negative, aerobic, rod-shaped bacteria found in soil, plants, and marine mud. With the exception of Agrobacterium radiobacter, members of this genus invade the crown, roots, and stems of plants, via wounds, causing the transformation of the plant cells into proliferating tumor cells (plant tumors). [NIH] Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Alfalfa: A deep-rooted European leguminous plant (Medicago sativa) widely grown for hay and forage. [NIH]

78 Ephedra

Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Aloe: A genus of the family Liliaceae containing anthraquinone glycosides such as aloinemodin or aloe-emodin (emodin). [NIH] Alpha-1: A protein with the property of inactivating proteolytic enzymes such as leucocyte collagenase and elastase. [NIH] Alternaria: A mitosporic Loculoascomycetes fungal genus including several plant pathogens and at least one species which produces a highly phytotoxic antibiotic. Its teleomorph is Lewia. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Anaerobic: 1. Lacking molecular oxygen. 2. Growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Anal Fissure: A small tear in the anus that may cause itching, pain, or bleeding. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anaplasia: Loss of structural differentiation and useful function of neoplastic cells. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Angina: Chest pain that originates in the heart. [NIH] Angina Pectoris: The symptom of paroxysmal pain consequent to myocardial ischemia usually of distinctive character, location and radiation, and provoked by a transient stressful situation during which the oxygen requirements of the myocardium exceed the capacity of the coronary circulation to supply it. [NIH]

Dictionary 79

Angiosperms: Any member of the more than 250,000 species of flowering plants (division Magnoliophyta) having roots, stems, leaves, and well-developed conductive tissues (xylem and phloem). Angiosperms are often differentiated from gymnosperms by their production of seeds within a closed chamber (the ovary). The Magnoliophyta division is composed of two classes, the monocotyledons (Liliopsida) and dicotyledons (Magnoliopsida). [NIH] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Antiangiogenic: Having to do with reducing the growth of new blood vessels. [NIH] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antifungal: Destructive to fungi, or suppressing their reproduction or growth; effective against fungal infections. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antioxidants: Naturally occurring or synthetic substances that inhibit or retard the oxidation of a substance to which it is added. They counteract the harmful and damaging effects of oxidation in animal tissues. [NIH] Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Antitumour: Counteracting tumour formation. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aromatic: Having a spicy odour. [EU] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH]

80 Ephedra

Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteriovenous: Both arterial and venous; pertaining to or affecting an artery and a vein. [EU] Astringents: Agents, usually topical, that cause the contraction of tissues for the control of bleeding or secretions. [NIH] Autoimmune Hepatitis: A liver disease caused when the body's immune system destroys liver cells for no known reason. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile duct: A tube through which bile passes in and out of the liver. [NIH] Bile Pigments: Pigments that give a characteristic color to bile including: bilirubin, biliverdine, and bilicyanin. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Biogenesis: The origin of life. It includes studies of the potential basis for life in organic compounds but excludes studies of the development of altered forms of life through mutation and natural selection, which is evolution. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Biotransformation: The chemical alteration of an exogenous substance by or in a biological system. The alteration may inactivate the compound or it may result in the production of an active metabolite of an inactive parent compound. The alteration may be either nonsynthetic (oxidation-reduction, hydrolysis) or synthetic (glucuronide formation, sulfate conjugation, acetylation, methylation). This also includes metabolic detoxication and clearance. [NIH] Bladder: The organ that stores urine. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a

Dictionary 81

network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Body Regions: Anatomical areas of the body. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Callus: A callosity or hard, thick skin; the bone-like reparative substance that is formed round the edges and fragments of broken bone. [NIH] Capsaicin: Cytotoxic alkaloid from various species of Capsicum (pepper, paprika), of the Solanaceae. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carcinogenic: Producing carcinoma. [EU] Carcinogens: Substances that increase the risk of neoplasms in humans or animals. Both genotoxic chemicals, which affect DNA directly, and nongenotoxic chemicals, which induce neoplasms by other mechanism, are included. [NIH] Cardiac: Having to do with the heart. [NIH]

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Cardioselective: Having greater activity on heart tissue than on other tissue. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Division: The fission of a cell. [NIH] Cellobiose: A disaccharide consisting of two glucose units in beta (1-4) glycosidic linkage. Obtained from the partial hydrolysis of cellulose. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Chamomile: Common name for several daisy-like species native to Europe and Western Asia, now naturalized in the United States and Australia. The dried flower-heads of two species, Anthemis nobilis (Chamaemelum nobile) and Matricaria recutita, have specific use as herbs. They are administered as tea, extracts, tinctures, or ointments. Chamomile contains choline, coumarins, cyanogenic glycosides, flavonoids, salicylate derivatives, tannins, and volatile oils. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Cholelithiasis: Presence or formation of gallstones. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Choline: A basic constituent of lecithin that is found in many plants and animal organs. It is important as a precursor of acetylcholine, as a methyl donor in various metabolic processes, and in lipid metabolism. [NIH] Chromium: A trace element that plays a role in glucose metabolism. It has the atomic symbol Cr, atomic number 24, and atomic weight 52. According to the Fourth Annual Report on Carcinogens (NTP85-002,1985), chromium and some of its compounds have been listed as known carcinogens. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Clear cell carcinoma: A rare type of tumor of the female genital tract in which the inside of the cells looks clear when viewed under a microscope. [NIH] Clinical trial: A research study that tests how well new medical treatments or other

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interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Colic: Paroxysms of pain. This condition usually occurs in the abdominal region but may occur in other body regions as well. [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Combination Therapy: Association of 3 drugs to treat AIDS (AZT + DDC or DDI + protease inhibitor). [NIH] Comfrey: Perennial herb Symphytum officinale, in the family Boraginaceae, used topically for wound healing. It contains allantoin, carotene, essential oils (oils, volatile), glycosides, mucilage, resin, saponins, tannins, triterpenoids, vitamin B12, and zinc. Comfrey also contains pyrrolizidine alkaloids and is hepatotoxic if ingested. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU]

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Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compress: A plug used to occludate an orifice in the control of bleeding, or to mop up secretions; an absorbent pad. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Cones: One type of specialized light-sensitive cells (photoreceptors) in the retina that provide sharp central vision and color vision. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Coumarins: Synthetic or naturally occurring substances related to coumarin, the deltalactone of coumarinic acid. Coumarin itself occurs in the tonka bean. The various coumarins have a wide range of proposed actions and uses including as anticoagulants, pharmaceutical aids, indicators and reagents, photoreactive substances, and antineoplastic agents. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyclodextrins: A homologous group of cyclic glucans consisting of alpha-1,4 bound glucose units obtained by the action of cyclodextrin glucanotransferase on starch or similar substrates. The enzyme is produced by certain species of Bacillus. Cyclodextrins form inclusion complexes with a wide variety of substances. [NIH] Cyclosporins: A group of closely related cyclic undecapeptides from the fungi Trichoderma polysporum and Cylindocarpon lucidum. They have some antineoplastic and antifungal action and significant immunosuppressive effects. Cyclosporins have been proposed as adjuvants in tissue and organ transplantation to suppress graft rejection. [NIH] Dairy Products: Raw and processed or manufactured milk and milk-derived products.

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These are usually from cows (bovine) but are also from goats, sheep, reindeer, and water buffalo. [NIH] Decongestant: An agent that reduces congestion or swelling. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. [NIH] Delusions: A false belief regarding the self or persons or objects outside the self that persists despite the facts, and is not considered tenable by one's associates. [NIH] Dental Care: The total of dental diagnostic, preventive, and restorative services provided to meet the needs of a patient (from Illustrated Dictionary of Dentistry, 1982). [NIH] Dentists: Individuals licensed to practice dentistry. [NIH] DES: Diethylstilbestrol. A synthetic hormone that was prescribed from the early 1940s until 1971 to help women with complications of pregnancy. DES has been linked to an increased risk of clear cell carcinoma of the vagina in daughters of women who used DES. DES may also increase the risk of breast cancer in women who used DES. [NIH] Dextroamphetamine: The d-form of amphetamine. It is a central nervous system stimulant and a sympathomimetic. It has also been used in the treatment of narcolepsy and of attention deficit disorders and hyperactivity in children. Dextroamphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulating release of monamines, and inhibiting monoamine oxidase. It is also a drug of abuse and a psychotomimetic. [NIH] Diabetes Insipidus: A metabolic disorder due to disorders in the production or release of vasopressin. It is characterized by the chronic excretion of large amounts of low specific gravity urine and great thirst. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diabetic Retinopathy: Retinopathy associated with diabetes mellitus, which may be of the background type, progressively characterized by microaneurysms, interretinal punctuate macular edema, or of the proliferative type, characterized by neovascularization of the retina and optic disk, which may project into the vitreous, proliferation of fibrous tissue, vitreous hemorrhage, and retinal detachment. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Dilatation: The act of dilating. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration

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in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diuresis: Increased excretion of urine. [EU] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Duodenum: The first part of the small intestine. [NIH] Dysentery: Any of various disorders marked by inflammation of the intestines, especially of the colon, and attended by pain in the abdomen, tenesmus, and frequent stools containing blood and mucus. Causes include chemical irritants, bacteria, protozoa, or parasitic worms. [EU]

Dysmenorrhea: Painful menstruation. [NIH] Dyspepsia: Impaired digestion, especially after eating. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Emodin: Purgative anthraquinone found in several plants, especially Rhamnus frangula. It was formerly used as a laxative, but is now used mainly as tool in toxicity studies. [NIH] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endotoxins: Toxins closely associated with the living cytoplasm or cell wall of certain microorganisms, which do not readily diffuse into the culture medium, but are released upon lysis of the cells. [NIH] Enteritis: Inflammation of the intestine, applied chiefly to inflammation of the small intestine; see also enterocolitis. [EU] Enterobacter: Gram-negative gas-producing rods found in feces of man and other animals,

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sewage, soil, water, and dairy products. [NIH] Enterocolitis: Inflammation of the intestinal mucosa of the small and large bowel. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Ephedrine: An alpha- and beta-adrenergic agonist that may also enhance release of norepinephrine. It has been used in the treatment of several disorders including asthma, heart failure, rhinitis, and urinary incontinence, and for its central nervous system stimulatory effects in the treatment of narcolepsy and depression. It has become less extensively used with the advent of more selective agonists. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Erythropoietin: Glycoprotein hormone, secreted chiefly by the kidney in the adult and the liver in the fetus, that acts on erythroid stem cells of the bone marrow to stimulate proliferation and differentiation. [NIH] Escherichia: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms occur in the lower part of the intestine of warm-blooded animals. The species are either nonpathogenic or opportunistic pathogens. [NIH] Escherichia coli: A species of gram-negative, facultatively anaerobic, rod-shaped bacteria commonly found in the lower part of the intestine of warm-blooded animals. It is usually nonpathogenic, but some strains are known to produce diarrhea and pyogenic infections. [NIH]

Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Eucalyptus: A genus of Australian trees of the Myrtaceae family that yields gums, oils, and resins which are used as flavoring agents, astringents, and aromatics, and formerly to treat diarrhea, asthma, bronchitis, and respiratory tract infections. [NIH] Evacuation: An emptying, as of the bowels. [EU] Excipient: Any more or less inert substance added to a prescription in order to confer a suitable consistency or form to the drug; a vehicle. [EU] Exhaustion: The feeling of weariness of mind and body. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extraction: The process or act of pulling or drawing out. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH]

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Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Feverfew: Aromatic perennial Tanacetum parthenium used to treat migraines, arthritis, and as a febrifuge. It contains tannins, volatile oils (oils, essential), and sesquiterpene lactones, especially parthenolide. [NIH] Flatulence: Production or presence of gas in the gastrointestinal tract which may be expelled through the anus. [NIH] Flatus: Gas passed through the rectum. [NIH] Flavoring Agents: Substances added to foods and medicine to improve the quality of taste. [NIH]

Forearm: The part between the elbow and the wrist. [NIH] Fungi: A kingdom of eukaryotic, heterotrophic organisms that live as saprobes or parasites, including mushrooms, yeasts, smuts, molds, etc. They reproduce either sexually or asexually, and have life cycles that range from simple to complex. Filamentous fungi refer to those that grow as multicelluar colonies (mushrooms and molds). [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gallstones: The solid masses or stones made of cholesterol or bilirubin that form in the gallbladder or bile ducts. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastritis: Inflammation of the stomach. [EU] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Germ Cells: The reproductive cells in multicellular organisms. [NIH] Ginger: Deciduous plant rich in volatile oil (oils, volatile). It is used as a flavoring agent and has many other uses both internally and topically. [NIH] Ginkgo biloba: Exclusive species of the genus Ginkgo, family Ginkgoacea. It produces extracts of medicinal interest. Ginkgo may refer to the genus or species. [NIH]

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Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH] Glucans: Polysaccharides composed of repeating glucose units. They can consist of branched or unbranched chains in any linkages. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose tolerance: The power of the normal liver to absorb and store large quantities of glucose and the effectiveness of intestinal absorption of glucose. The glucose tolerance test is a metabolic test of carbohydrate tolerance that measures active insulin, a hepatic function based on the ability of the liver to absorb glucose. The test consists of ingesting 100 grams of glucose into a fasting stomach; blood sugar should return to normal in 2 to 21 hours after ingestion. [NIH] Glucose Tolerance Test: Determination of whole blood or plasma sugar in a fasting state before and at prescribed intervals (usually 1/2 hr, 1 hr, 3 hr, 4 hr) after taking a specified amount (usually 100 gm orally) of glucose. [NIH] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Gout: Hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with formation of uric acid calculi. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Graft Rejection: An immune response with both cellular and humoral components, directed against an allogeneic transplant, whose tissue antigens are not compatible with those of the recipient. [NIH] Gram-negative: Losing the stain or decolorized by alcohol in Gram's method of staining, a primary characteristic of bacteria having a cell wall composed of a thin layer of peptidoglycan covered by an outer membrane of lipoprotein and lipopolysaccharide. [EU] Gram-positive: Retaining the stain or resisting decolorization by alcohol in Gram's method of staining, a primary characteristic of bacteria whose cell wall is composed of a thick layer of peptidologlycan with attached teichoic acids. [EU] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Gymnosperms: Gymnosperms are a group of vascular plants whose seeds are not enclosed by a ripened ovary (fruit). Gymnosperms are distinguished from the other major group of seed plants, the angiosperms, whose seeds are surrounded by an ovary wall. The seeds of many gymnosperms (literally, "naked seed") are borne in cones and are not visible. Taxonomists now recognize four distinct divisions of extant gymnospermous plants (Coniferophyta, Cycadophyta, Ginkgophyta, and Gnetophyta). [NIH] Hair follicles: Shafts or openings on the surface of the skin through which hair grows. [NIH] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or

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as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Helminthiasis: Infestation with parasitic worms of the helminth class. [NIH] Hematoma: An extravasation of blood localized in an organ, space, or tissue. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhagic stroke: A disorder involving bleeding within ischemic brain tissue. Hemorrhagic stroke occurs when blood vessels that are damaged or dead from lack of blood supply (infarcted), located within an area of infarcted brain tissue, rupture and transform an "ischemic" stroke into a hemorrhagic stroke. Ischemia is inadequate tissue oxygenation caused by reduced blood flow; infarction is tissue death resulting from ischemia. Bleeding irritates the brain tissues, causing swelling (cerebral edema). Blood collects into a mass (hematoma). Both swelling and hematoma will compress and displace brain tissue. [NIH] Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [NIH] Hepatic: Refers to the liver. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Hepatotoxic: Toxic to liver cells. [EU] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Heterotrophic: Pertaining to organisms that are consumers and dependent on other organisms for their source of energy (food). [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hyperbilirubinemia: Pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice. [NIH] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperthyroidism: Excessive functional activity of the thyroid gland. [NIH] Hyperuricemia: A buildup of uric acid (a byproduct of metabolism) in the blood; a side

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effect of some anticancer drugs. [NIH] Hypoglycemic: An orally active drug that produces a fall in blood glucose concentration. [NIH]

Ibuprofen: A nonsteroidal anti-inflammatory agent with analgesic properties used in the therapy of rheumatism and arthritis. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Imidazole: C3H4N2. The ring is present in polybenzimidazoles. [NIH] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Impotence: The inability to perform sexual intercourse. [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Indigestion: Poor digestion. Symptoms include heartburn, nausea, bloating, and gas. Also called dyspepsia. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Information Centers: Facilities for collecting and organizing information. They may be specialized by subject field, type of source material, persons served, location, or type of services. [NIH] Ingestion: Taking into the body by mouth [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH]

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Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intracellular: Inside a cell. [NIH] Ionization: 1. Any process by which a neutral atom gains or loses electrons, thus acquiring a net charge, as the dissociation of a substance in solution into ions or ion production by the passage of radioactive particles. 2. Iontophoresis. [EU] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Irritants: Drugs that act locally on cutaneous or mucosal surfaces to produce inflammation; those that cause redness due to hyperemia are rubefacients; those that raise blisters are vesicants and those that penetrate sebaceous glands and cause abscesses are pustulants; tear gases and mustard gases are also irritants. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH]

Juniper: A slow growing coniferous evergreen tree or shrub, genus Juniperus. The Juniper is cultivated for its berries, which take up to three years to ripen. The resinous, sweetly flavored berries are borne only by the female juniper, and can be found in various stages of ripeness on the same plant. [NIH] Karaya Gum: Polysaccharide gum from Sterculia urens, an Indian tree; it is used as suspending or stabilizing agent in foods, cosmetics and pharmaceuticals; also as bulkforming laxative, surgical lubricant and adhesive, and in the treatment of skin ulcers. [NIH] Kava: Dried rhizome and roots of Piper methysticum, a shrub native to Oceania and known for its anti-anxiety and sedative properties. Heavy usage results in some adverse effects. It contains alkaloids, lactones, kawain, methysticin, mucilage, starch, and yangonin. Kava is also the name of the pungent beverage prepared from the plant's roots. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Kinetic: Pertaining to or producing motion. [EU] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Laxative: An agent that acts to promote evacuation of the bowel; a cathartic or purgative. [EU]

Library Services: Services offered to the library user. They include reference and circulation. [NIH]

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Life cycle: The successive stages through which an organism passes from fertilized ovum or spore to the fertilized ovum or spore of the next generation. [NIH] Ligaments: Shiny, flexible bands of fibrous tissue connecting together articular extremities of bones. They are pliant, tough, and inextensile. [NIH] Lipid: Fat. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Malaria: A protozoan disease caused in humans by four species of the genus Plasmodium (P. falciparum (malaria, falciparum), P. vivax (malaria, vivax), P. ovale, and P. malariae) and transmitted by the bite of an infected female mosquito of the genus Anopheles. Malaria is endemic in parts of Asia, Africa, Central and South America, Oceania, and certain Caribbean islands. It is characterized by extreme exhaustion associated with paroxysms of high fever, sweating, shaking chills, and anemia. Malaria in animals is caused by other species of plasmodia. [NIH] Malaria, Falciparum: Malaria caused by Plasmodium falciparum. This is the severest form of malaria and is associated with the highest levels of parasites in the blood. This disease is characterized by irregularly recurring febrile paroxysms that in extreme cases occur with acute cerebral, renal, or gastrointestinal manifestations. [NIH] Malaria, Vivax: Malaria caused by Plasmodium vivax. This form of malaria is less severe than malaria, falciparum, but there is a higher probability for relapses to occur. Febrile paroxysms often occur every other day. [NIH] Manic: Affected with mania. [EU] Manic-depressive psychosis: One of a group of psychotic reactions, fundamentally marked by severe mood swings and a tendency to remission and recurrence. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Melanin: The substance that gives the skin its color. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH]

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Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Methamphetamine: A central nervous system stimulant and sympathomimetic with actions and uses similar to dextroamphetamine. The smokable form is a drug of abuse and is referred to as crank, crystal, crystal meth, ice, and speed. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microcirculation: The vascular network lying between the arterioles and venules; includes capillaries, metarterioles and arteriovenous anastomoses. Also, the flow of blood through this network. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Conformation: The characteristic three-dimensional shape of a molecule. [NIH] Molecular Structure: The location of the atoms, groups or ions relative to one another in a molecule, as well as the number, type and location of covalent bonds. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Mustard Gas: Severe irritant and vesicant of skin, eyes, and lungs. It may cause blindness and lethal lung edema and was formerly used as a war gas. The substance has been proposed as a cytostatic and for treatment of psoriasis. It has been listed as a known carcinogen in the Fourth Annual Report on Carcinogens (NTP-85-002, 1985) (Merck, 11th ed). [NIH] Mutagen: Any agent, such as X-rays, gamma rays, mustard gas, TCDD, that can cause abnormal mutation in living cells; having the power to cause mutations. [NIH] Mutagenic: Inducing genetic mutation. [EU] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocarditis: Inflammation of the myocardium; inflammation of the muscular walls of the heart. [EU]

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Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Naproxen: An anti-inflammatory agent with analgesic and antipyretic properties. Both the acid and its sodium salt are used in the treatment of rheumatoid arthritis and other rheumatic or musculoskeletal disorders, dysmenorrhea, and acute gout. [NIH] Narcolepsy: A condition of unknown cause characterized by a periodic uncontrollable tendency to fall asleep. [NIH] Natural selection: A part of the evolutionary process resulting in the survival and reproduction of the best adapted individuals. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neurotic: 1. Pertaining to or characterized by neurosis. 2. A person affected with a neurosis. [EU]

Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nitrosamines: A class of compounds that contain a -NH2 and a -NO radical. Many members of this group have carcinogenic and mutagenic properties. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Normotensive: 1. Characterized by normal tone, tension, or pressure, as by normal blood pressure. 2. A person with normal blood pressure. [EU]

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Nosocomial: Pertaining to or originating in the hospital, said of an infection not present or incubating prior to admittance to the hospital, but generally occurring 72 hours after admittance; the term is usually used to refer to patient disease, but hospital personnel may also acquire nosocomial infection. [EU] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Optic Disk: The portion of the optic nerve seen in the fundus with the ophthalmoscope. It is formed by the meeting of all the retinal ganglion cell axons as they enter the optic nerve. [NIH]

Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease. [NIH] Oral Manifestations: Disorders of the mouth attendant upon non-oral disease or injury. [NIH]

Organ Culture: The growth in aseptic culture of plant organs such as roots or shoots, beginning with organ primordia or segments and maintaining the characteristics of the organ. [NIH] Organ Transplantation: Transference of an organ between individuals of the same species or between individuals of different species. [NIH] Organogenesis: Clonal propagation which involves culturing explants from roots, leaves, or stems to form undifferentiated callus tissue; after the cells form shoots, they are separated and rooted. Alternatively, if the callus is put in liquid culture, somatic embryos form. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Overdosage: 1. The administration of an excessive dose. 2. The condition resulting from an excessive dose. [EU] Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 oxygenation the process of supplying, treating, or mixing with oxygen. [EU] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Parasitic: Having to do with or being a parasite. A parasite is an animal or a plant that lives on or in an organism of another species and gets at least some of its nutrients from it. [NIH]

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Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perennial: Lasting through the year of for several years. [EU] Perineum: The area between the anus and the sex organs. [NIH] Peripheral Neuropathy: Nerve damage, usually affecting the feet and legs; causing pain, numbness, or a tingling feeling. Also called "somatic neuropathy" or "distal sensory polyneuropathy." [NIH] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Plant Diseases: Diseases of plants. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Poison Control Centers: Facilities which provide information concerning poisons and treatment of poisoning in emergencies. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Pollen: The male fertilizing element of flowering plants analogous to sperm in animals. It is released from the anthers as yellow dust, to be carried by insect or other vectors, including wind, to the ovary (stigma) of other flowers to produce the embryo enclosed by the seed. The pollens of many plants are allergenic. [NIH] Polydipsia: Chronic excessive thirst, as in diabetes mellitus or diabetes insipidus. [EU] Polyphagia: Great hunger; a sign of diabetes. People with this great hunger often lose weight. [NIH] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH]

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Polyuria: Urination of a large volume of urine with an increase in urinary frequency, commonly seen in diabetes. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Propranolol: A widely used non-cardioselective beta-adrenergic antagonist. Propranolol is used in the treatment or prevention of many disorders including acute myocardial infarction, arrhythmias, angina pectoris, hypertension, hypertensive emergencies, hyperthyroidism, migraine, pheochromocytoma, menopause, and anxiety. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Protozoan: 1. Any individual of the protozoa; protozoon. 2. Of or pertaining to the protozoa; protozoal. [EU] Pseudomonas: A genus of gram-negative, aerobic, rod-shaped bacteria widely distributed in nature. Some species are pathogenic for humans, animals, and plants. [NIH] Pseudomonas aeruginosa: A species of gram-negative, aerobic, rod-shaped bacteria commonly isolated from clinical specimens (wound, burn, and urinary tract infections). It is also found widely distributed in soil and water. P. aeruginosa is a major agent of nosocomial infection. [NIH] Psychoactive: Those drugs which alter sensation, mood, consciousness or other psychological or behavioral functions. [NIH] Psychosis: A mental disorder characterized by gross impairment in reality testing as evidenced by delusions, hallucinations, markedly incoherent speech, or disorganized and agitated behaviour without apparent awareness on the part of the patient of the

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incomprehensibility of his behaviour; the term is also used in a more general sense to refer to mental disorders in which mental functioning is sufficiently impaired as to interfere grossly with the patient's capacity to meet the ordinary demands of life. Historically, the term has been applied to many conditions, e.g. manic-depressive psychosis, that were first described in psychotic patients, although many patients with the disorder are not judged psychotic. [EU] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Pyogenic: Producing pus; pyopoietic (= liquid inflammation product made up of cells and a thin fluid called liquor puris). [EU] Pyrrolizidine Alkaloids: Alkaloids found in various species of Senecio and other plants. There are at least ten different chemicals, many of them hepatotoxic, teratogenic, and carcinogenic. The plants may cause damage in grazing herds, but no longer have medical use. [NIH] Quercetin: Aglucon of quercetrin, rutin, and other glycosides. It is widely distributed in the plant kingdom, especially in rinds and barks, clover blossoms, and ragweed pollen. [NIH] Radioactive: Giving off radiation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Reality Testing: The individual's objective evaluation of the external world and the ability to differentiate adequately between it and the internal world; considered to be a primary ego function. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative

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enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinoids: Derivatives of vitamin A. Used clinically in the treatment of severe cystic acne, psoriasis, and other disorders of keratinization. Their possible use in the prophylaxis and treatment of cancer is being actively explored. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Rhinitis: Inflammation of the mucous membrane of the nose. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Rod: A reception for vision, located in the retina. [NIH] Rutin: 3-((6-O-(6-Deoxy-alpha-L-mannopyranosyl)-beta-D-glucopyranosyl)oxy)-2-(3,4dihydroxyphenyl)-5,7-dihydroxy-4H-1-benzopyran-4-one. Found in many plants, including buckwheat, tobacco, forsythia, hydrangea, pansies, etc. It has been used therapeutically to decrease capillary fragility. [NIH] Salicylate: Non-steroidal anti-inflammatory drugs. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Sassafras: The dried bark, deprived of most of the cork, of the root of Sassafras variifolium. [NIH]

Screening: Checking for disease when there are no symptoms. [NIH] Sebaceous: Gland that secretes sebum. [NIH] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Shivering: Involuntary contraction or twitching of the muscles. It is a physiologic method of heat production in man and other mammals. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as

Dictionary 101

the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Sorbitol: A polyhydric alcohol with about half the sweetness of sucrose. Sorbitol occurs naturally and is also produced synthetically from glucose. It was formerly used as a diuretic and may still be used as a laxative and in irrigating solutions for some surgical procedures. It is also used in many manufacturing processes, as a pharmaceutical aid, and in several research applications. [NIH] Spasmodic: Of the nature of a spasm. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectroscopic: The recognition of elements through their emission spectra. [NIH] Spermidine: A polyamine formed from putrescine. It is found in almost all tissues in association with nucleic acids. It is found as a cation at all pH values, and is thought to help stabilize some membranes and nucleic acid structures. It is a precursor of spermine. [NIH] Spermine: A biogenic polyamine formed from spermidine. It is found in a wide variety of organisms and tissues and is an essential growth factor in some bacteria. It is found as a polycation at all pH values. Spermine is associated with nucleic acids, particularly in viruses, and is thought to stabilize the helical structure. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Staphylococcus: A genus of gram-positive, facultatively anaerobic, coccoid bacteria. Its organisms occur singly, in pairs, and in tetrads and characteristically divide in more than one plane to form irregular clusters. Natural populations of Staphylococcus are membranes of warm-blooded animals. Some species are opportunistic pathogens of humans and animals. [NIH] Staphylococcus aureus: Potentially pathogenic bacteria found in nasal membranes, skin, hair follicles, and perineum of warm-blooded animals. They may cause a wide range of

102 Ephedra

infections and intoxications. [NIH] Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become specialized and take the place of those that die or are lost. [NIH] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Systemic: Affecting the entire body. [NIH] Tenesmus: Straining, especially ineffectual and painful straining at stool or in urination. [EU] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermogenesis: The generation of heat in order to maintain body temperature. The uncoupled oxidation of fatty acids contained within brown adipose tissue and shivering are examples of thermogenesis in mammals. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tin: A trace element that is required in bone formation. It has the atomic symbol Sn, atomic number 50, and atomic weight 118.71. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH]

Dictionary 103

Tissue Culture: Maintaining or growing of tissue, organ primordia, or the whole or part of an organ in vitro so as to preserve its architecture and/or function (Dorland, 28th ed). Tissue culture includes both organ culture and cell culture. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicokinetics: Study of the absorption, distribution, metabolism, and excretion of test substances. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tumour: 1. Swelling, one of the cardinal signs of inflammations; morbid enlargement. 2. A new growth of tissue in which the multiplication of cells is uncontrolled and progressive; called also neoplasm. [EU] Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50 to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Uric: A kidney stone that may result from a diet high in animal protein. When the body breaks down this protein, uric acid levels rise and can form stones. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH]

104 Ephedra

Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [NIH]

Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Valerian: Valeriana officinale, an ancient, sedative herb of the large family Valerianaceae. The roots were formerly used to treat hysterias and other neurotic states and are presently used to treat sleep disorders. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Venous: Of or pertaining to the veins. [EU] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH] Vitamin A: A substance used in cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Vitreous: Glasslike or hyaline; often used alone to designate the vitreous body of the eye (corpus vitreum). [EU] Vitreous Hemorrhage: Hemorrhage into the vitreous body. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Vulgaris: An affection of the skin, especially of the face, the back and the chest, due to chronic inflammation of the sebaceous glands and the hair follicles. [NIH] Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Yohimbine: A plant alkaloid with alpha-2-adrenergic blocking activity. Yohimbine has been used as a mydriatic and in the treatment of impotence. It is also alleged to be an aphrodisiac. [NIH]

105

INDEX A Abdominal, 46, 77, 83, 88, 96 Abdominal Cramps, 46, 77 Abdominal Pain, 46, 77, 88 Adenosine, 77, 81 Adipose Tissue, 77, 102 Adrenergic, 6, 77, 86, 87, 98, 102, 104 Adverse Effect, 5, 6, 50, 77, 92, 101 Aerobic, 77, 98 Affinity, 77, 101 Age of Onset, 77, 103 Agonist, 7, 77, 86, 87 Agrobacterium, 12, 13, 77 Alertness, 77, 81 Alfalfa, 4, 77 Algorithms, 78, 80 Alkaloid, 13, 15, 17, 18, 24, 25, 26, 30, 31, 34, 78, 81, 104 Aloe, 4, 5, 78 Alpha-1, 78, 84 Alternaria, 12, 78 Alternative medicine, 4, 52, 78 Amino acid, 3, 16, 78, 89, 97, 98, 100, 102, 103 Anaerobic, 78, 87, 101 Anal, 46, 78 Anal Fissure, 46, 78 Analgesic, 78, 91, 95 Anaphylatoxins, 78, 83 Anaplasia, 78, 95 Anemia, 78, 93 Anesthesia, 78 Angina, 78, 98 Angina Pectoris, 78, 98 Angiosperms, 79, 89, 103 Anorexia, 79, 88 Antagonism, 79, 81 Antiangiogenic, 23, 79 Antibiotic, 78, 79 Antibody, 77, 79, 83, 90, 91 Antifungal, 79, 84 Antigen, 77, 79, 83, 90, 91 Antigen-Antibody Complex, 79, 83 Anti-inflammatory, 79, 91, 95, 100 Antimicrobial, 12, 13, 79 Antineoplastic, 79, 84 Antioxidants, 5, 79 Antipyretic, 79, 95

Antitumour, 23, 79 Anus, 78, 79, 83, 88, 97, 99 Anxiety, 79, 92, 98 Aromatic, 79, 88, 97 Arterial, 79, 80, 90, 98 Arteries, 79, 80, 81, 84, 94 Arterioles, 80, 81, 94 Arteriovenous, 80, 94 Astringents, 80, 87 Autoimmune Hepatitis, 9, 80 B Bacteria, 77, 79, 80, 86, 87, 88, 89, 94, 98, 101, 104 Base, 80, 92 Benign, 80, 89, 95 Bile, 80, 88, 92, 93 Bile duct, 80, 88 Bile Pigments, 80, 92 Bilirubin, 80, 88, 90 Biogenesis, 31, 80 Biotechnology, 8, 47, 52, 59, 80 Biotransformation, 80 Bladder, 46, 80, 91, 104 Bloating, 80, 91 Blood Glucose, 4, 5, 47, 80, 91, 92 Blood pressure, 6, 80, 90, 94, 95, 101 Blood vessel, 79, 80, 82, 90, 92, 101, 102, 104 Body Mass Index, 81, 96 Body Regions, 81, 83 Bone Marrow, 81, 87, 93 Bowel, 46, 77, 78, 81, 87, 92 Branch, 73, 81, 97, 101, 102 Breakdown, 81, 85, 88 Bronchitis, 36, 81, 87 C Caffeine, 13, 14, 16, 17, 22, 23, 27, 31, 40, 43, 81 Calcium, 81, 83 Calculi, 81, 89 Callus, 81, 96 Capsaicin, 4, 5, 81 Carbohydrate, 81, 89, 97 Carcinogenic, 81, 95, 99 Carcinogens, 81, 82, 94 Cardiac, 81, 87, 95 Cardioselective, 82, 98

106 Ephedra

Cardiovascular, 8, 9, 13, 14, 15, 16, 23, 26, 29, 30, 82, 100 Carotene, 82, 83, 100 Case report, 22, 82 Cell, 77, 78, 80, 82, 83, 86, 89, 92, 95, 96, 97, 99, 103 Cell Division, 80, 82, 97 Cellobiose, 82 Cellulose, 8, 82, 97 Central Nervous System, 13, 23, 81, 82, 85, 87, 88, 90, 94, 100 Cerebral, 82, 87, 90, 93 Chamomile, 6, 82 Chemotactic Factors, 82, 83 Cholelithiasis, 46, 82 Cholesterol, 5, 80, 82, 88, 90 Choline, 82 Chromium, 4, 48, 82 Chronic, 4, 82, 85, 91, 97, 102, 104 Chronic Disease, 4, 82 Clear cell carcinoma, 82, 85 Clinical trial, 5, 6, 14, 21, 23, 59, 82, 86, 99 Cloning, 80, 83 Cofactor, 83, 98 Colic, 46, 83 Colitis, 46, 83 Collagen, 78, 83 Colon, 83, 86, 92 Combination Therapy, 33, 83 Comfrey, 4, 83 Complement, 13, 22, 78, 83, 84 Complementary and alternative medicine, 21, 22, 42, 84 Complementary medicine, 22, 84 Compress, 84, 90 Computational Biology, 59, 84 Cones, 84, 89, 100 Congestion, 37, 84, 85 Consciousness, 78, 84, 86, 98 Constipation, 46, 84 Consumption, 84, 88, 99 Contraindications, ii, 46, 84 Coronary, 16, 29, 78, 84, 94 Coronary Thrombosis, 84, 94 Coumarins, 82, 84 Curative, 84, 95, 102 Cyclic, 81, 84 Cyclodextrins, 8, 84 Cyclosporins, 8, 84 D Dairy Products, 84, 87 Decongestant, 41, 85

Degenerative, 85, 90 Dehydration, 46, 85 Delusions, 85, 98 Dental Care, 4, 85 Dentists, 4, 85 DES, 12, 78, 85 Dextroamphetamine, 85, 94 Diabetes Insipidus, 85, 97 Diabetes Mellitus, 85, 97 Diabetic Retinopathy, 5, 85 Diagnostic procedure, 52, 85 Diarrhea, 46, 85, 87 Diarrhoea, 85, 88 Digestion, 80, 81, 85, 86, 91, 92, 93, 102 Dilatation, 85, 98 Diploid, 85, 97 Direct, iii, 13, 22, 85, 86, 99, 102 Dissociation, 77, 85, 92 Distal, 86, 97 Diuresis, 81, 86 Dopamine, 85, 86, 95, 97 Double-blind, 9, 86 Drug Interactions, 86 Duodenum, 80, 86, 102 Dysentery, 46, 86 Dysmenorrhea, 86, 95 Dyspepsia, 86, 91 E Edema, 85, 86, 90, 94 Effector, 83, 86 Efficacy, 15, 16, 21, 25, 27, 32, 43, 46, 48, 65, 86 Embolus, 86, 91 Emodin, 78, 86 Endemic, 86, 93 Endogenous, 16, 29, 86 Endotoxins, 83, 86 Enteritis, 46, 86 Enterobacter, 13, 86 Enterocolitis, 86, 87 Environmental Health, 58, 60, 87 Enzymatic, 78, 81, 82, 83, 87, 100 Enzyme, 84, 86, 87, 93, 98 Ephedrine, 4, 6, 7, 8, 9, 10, 13, 14, 15, 17, 21, 25, 26, 27, 28, 29, 31, 32, 40, 43, 46, 51, 65, 87 Epinephrine, 40, 77, 86, 87, 95 Erythropoietin, 6, 87 Escherichia, 13, 87, 88 Escherichia coli, 13, 87, 88 Esophagus, 87, 90, 102 Eucalyptus, 4, 87

Index 107

Evacuation, 84, 87, 92 Excipient, 8, 87 Exhaustion, 79, 87, 93 Exogenous, 47, 80, 86, 87, 103 Extraction, 7, 27, 87 F Family Planning, 59, 87 Fat, 77, 81, 82, 86, 87, 93, 96, 100 Fatigue, 47, 87, 90 Fatty acids, 87, 102 Feces, 84, 86, 88 Fetus, 87, 88 Feverfew, 4, 88 Flatulence, 46, 88 Flatus, 88 Flavoring Agents, 87, 88 Forearm, 80, 88 Fungi, 12, 79, 84, 88, 94, 104 G Gallbladder, 77, 88 Gallstones, 46, 82, 88 Gamma Rays, 88, 94 Ganglia, 88, 95 Gas, 14, 17, 32, 46, 86, 88, 91, 94, 95 Gastric, 33, 88, 90 Gastritis, 46, 88 Gastroenteritis, 46, 88 Gastrointestinal, 46, 87, 88, 93, 100 Gastrointestinal tract, 88, 100 Gene, 17, 31, 47, 80, 88 Germ Cells, 88, 96, 101 Ginger, 5, 40, 88 Ginkgo biloba, 4, 5, 88 Ginseng, 4, 5, 48, 89 Glucans, 84, 89 Glucose, 5, 8, 47, 80, 82, 84, 85, 89, 91, 100, 101 Glucose tolerance, 47, 89 Glucose Tolerance Test, 89 Glycine, 78, 89, 95 Gout, 46, 89, 95 Governing Board, 89, 98 Graft, 84, 89 Graft Rejection, 84, 89 Gram-negative, 77, 86, 87, 89, 98 Gram-positive, 89, 101 Growth, 79, 89, 95, 96, 97, 101, 103 Gymnosperms, 16, 29, 79, 89, 103 H Hair follicles, 89, 101, 104 Haploid, 89, 97 Headache, 81, 89

Heart failure, 87, 90 Heartburn, 90, 91 Helminthiasis, 46, 90 Hematoma, 90 Hemorrhage, 46, 90, 102, 104 Hemorrhagic stroke, 18, 35, 90 Hemorrhoids, 46, 90 Hepatic, 89, 90 Hepatitis, 46, 64, 90 Hepatocytes, 90 Hepatotoxic, 4, 83, 90, 99 Hereditary, 16, 28, 89, 90 Heredity, 88, 90 Heterotrophic, 88, 90 Homologous, 84, 90 Hormone, 85, 87, 90, 91, 100 Hydroxyproline, 78, 83, 90 Hyperbilirubinemia, 90, 92 Hypercholesterolemia, 46, 90 Hypertension, 90, 98 Hyperthyroidism, 90, 98 Hyperuricemia, 89, 90 Hypoglycemic, 28, 91 I Ibuprofen, 8, 91 Id, 19, 35, 66, 72, 74, 91 Imidazole, 17, 30, 91 Immune system, 5, 80, 91 Immunosuppressive, 84, 91 Impairment, 91, 93, 98 Impotence, 5, 91, 104 In situ, 7, 91 In vitro, 91, 103 In vivo, 7, 91 Incontinence, 87, 91 Indicative, 46, 91, 97, 104 Indigestion, 46, 91 Infarction, 90, 91 Infection, 12, 37, 82, 88, 91, 93, 95, 96, 98, 100, 102 Inflammation, 79, 81, 83, 86, 87, 88, 90, 91, 92, 94, 97, 99, 100, 104 Information Centers, 46, 91 Ingestion, 15, 26, 27, 89, 91, 97 Insulin, 47, 89, 91, 92, 103 Insulin-dependent diabetes mellitus, 91, 92 Intestinal, 46, 82, 87, 89, 92 Intestine, 81, 86, 87, 92 Intracellular, 81, 91, 92 Ionization, 32, 92 Ions, 80, 85, 90, 92, 94

108 Ephedra

Irritants, 86, 92 Ischemia, 78, 90, 92 J Jaundice, 46, 90, 92 Juniper, 4, 92 K Karaya Gum, 4, 92 Kava, 4, 5, 92 Kb, 58, 92 Kinetic, 92 L Labile, 83, 92 Large Intestine, 92, 99, 101 Laxative, 86, 92, 101 Library Services, 72, 92 Life cycle, 88, 93 Ligaments, 84, 93 Lipid, 82, 91, 93 Liver, 4, 46, 77, 80, 87, 88, 89, 90, 93 Localized, 90, 91, 93, 97 Locomotion, 93, 97 Lymphatic, 91, 93 M Malaria, 46, 93 Malaria, Falciparum, 93 Malaria, Vivax, 93 Manic, 93, 99 Manic-depressive psychosis, 93, 99 MEDLINE, 59, 93 Melanin, 93, 97 Membrane, 83, 89, 93, 99, 100 Meninges, 82, 93 Menopause, 93, 98 Mental, iv, 6, 58, 60, 85, 87, 93, 98 Mental Disorders, 93, 99 Meta-Analysis, 25, 93 Metabolic disorder, 85, 89, 93 Metastasis, 94, 95 Methamphetamine, 27, 94 MI, 75, 94 Microbe, 94, 103 Microcirculation, 16, 29, 94 Mobility, 32, 94 Modification, 78, 94 Molecular, 7, 14, 16, 27, 31, 59, 61, 78, 80, 84, 94 Molecular Conformation, 7, 94 Molecular Structure, 7, 94 Molecule, 79, 80, 83, 85, 86, 94, 96, 99 Monitor, 4, 94 Motion Sickness, 94, 95 Mucus, 86, 94

Mustard Gas, 92, 94 Mutagen, 13, 22, 94 Mutagenic, 94, 95 Mydriatic, 94, 104 Myocardial infarction, 16, 29, 84, 94, 98 Myocarditis, 15, 16, 25, 28, 94 Myocardium, 78, 94, 95 N Naproxen, 8, 95 Narcolepsy, 85, 87, 95 Natural selection, 80, 95 Nausea, 46, 88, 91, 95 Need, 3, 33, 45, 47, 67, 77, 95, 103 Neoplasms, 12, 79, 81, 95 Nerve, 77, 78, 95, 96, 97, 99 Nervous System, 32, 82, 95, 102 Neuropathy, 16, 28, 95, 97 Neurotic, 95, 104 Neurotransmitter, 77, 78, 86, 89, 95 Niacin, 95, 103 Nitrogen, 78, 95, 103 Nitrosamines, 31, 95 Norepinephrine, 77, 86, 87, 95 Normotensive, 16, 30, 95 Nosocomial, 96, 98 Nucleic acid, 95, 96, 101 O Ointments, 82, 96 Optic Disk, 85, 96 Oral Health, 4, 96 Oral Manifestations, 4, 96 Organ Culture, 96, 103 Organ Transplantation, 84, 96 Organogenesis, 13, 96 Ovary, 79, 89, 96, 97 Overdosage, 46, 96 Overweight, 5, 6, 14, 18, 23, 96 Oxidation, 79, 80, 96, 102 Oxygenation, 90, 96 P Palliative, 96, 102 Pancreas, 77, 91, 96 Parasitic, 86, 90, 96 Pathogenesis, 13, 97 Pathologic, 84, 90, 97 Patient Education, 64, 70, 72, 75, 97 Peptide, 78, 97, 98 Perennial, 83, 88, 97, 103 Perineum, 97, 101 Peripheral Neuropathy, 5, 97 Pharmaceutical Preparations, 82, 97 Pharmacokinetic, 97

Index 109

Pharmacologic, 78, 97, 103 Phenylalanine, 4, 97 Physiologic, 77, 97, 99, 100 Plant Diseases, 12, 97 Plants, 12, 17, 30, 31, 46, 77, 78, 79, 82, 86, 89, 95, 97, 98, 99, 100, 103 Pneumonia, 84, 97 Poison Control Centers, 46, 97 Poisoning, 88, 95, 97 Pollen, 97, 99 Polydipsia, 47, 97 Polyphagia, 47, 97 Polysaccharide, 79, 82, 92, 97 Polyuria, 47, 98 Posterior, 78, 96, 98 Practice Guidelines, 60, 98 Precursor, 82, 86, 87, 95, 97, 98, 101, 103 Probe, 7, 98 Propranolol, 7, 98 Protease, 83, 98 Protein S, 47, 80, 98 Proteins, 78, 79, 83, 94, 95, 97, 98, 100, 103 Proteolytic, 78, 83, 98 Protozoa, 86, 98 Protozoan, 93, 98 Pseudomonas, 13, 98 Pseudomonas aeruginosa, 13, 98 Psychoactive, 17, 33, 98 Psychosis, 13, 22, 32, 98 Public Policy, 59, 99 Pulmonary, 80, 84, 99 Pulmonary Artery, 80, 99 Pulse, 94, 99 Pyogenic, 87, 99 Pyrrolizidine Alkaloids, 83, 99 Q Quercetin, 5, 99 R Radioactive, 92, 99 Randomized, 9, 16, 27, 86, 99 Reality Testing, 98, 99 Receptor, 6, 79, 86, 99, 100 Rectal, 46, 99 Rectum, 79, 83, 88, 91, 92, 99 Refer, 1, 83, 88, 93, 96, 99 Regimen, 86, 99 Respiration, 94, 99 Retina, 84, 85, 99, 100 Retinal, 85, 96, 99 Retinoids, 100, 104 Rheumatism, 91, 100 Rheumatoid, 95, 100

Rheumatoid arthritis, 95, 100 Rhinitis, 36, 87, 100 Rigidity, 97, 100 Rod, 77, 87, 98, 100 Rutin, 99, 100 S Salicylate, 82, 100 Saponins, 83, 100 Sassafras, 4, 41, 100 Screening, 83, 100 Sebaceous, 92, 100, 104 Sedative, 4, 92, 100, 104 Serotonin, 95, 100, 103 Serum, 78, 83, 100 Shivering, 100, 102 Side effect, 5, 15, 46, 48, 50, 51, 77, 91, 100, 103 Small intestine, 86, 90, 92, 101 Smooth muscle, 78, 81, 101 Sodium, 89, 95, 101 Solvent, 7, 101 Soma, 25, 46, 101 Somatic, 96, 97, 101 Sorbitol, 5, 101 Spasmodic, 77, 101 Specialist, 67, 101 Species, 14, 24, 32, 78, 79, 81, 82, 84, 87, 88, 93, 96, 98, 99, 101, 102, 104 Spectroscopic, 7, 101 Spermidine, 101 Spermine, 28, 101 Spinal cord, 82, 93, 95, 101 Staphylococcus, 13, 88, 101 Staphylococcus aureus, 13, 88, 101 Stem Cells, 87, 102 Stimulant, 32, 81, 85, 94, 102 Stomach, 46, 77, 87, 88, 89, 90, 95, 101, 102 Stress, 88, 95, 100, 102 Stroke, 18, 51, 58, 90, 102 Subacute, 91, 102 Subclinical, 91, 102 Subspecies, 101, 102 Sympathomimetic, 85, 86, 87, 94, 95, 102 Synapse, 77, 102 Systemic, 80, 87, 91, 102 T Tenesmus, 86, 102 Therapeutics, 31, 102 Thermogenesis, 32, 102 Thrombosis, 98, 102 Thrombus, 84, 91, 102 Thyroxine, 97, 102

110 Ephedra

Tin, 97, 102 Tissue Culture, 13, 103 Tolerance, 89, 103 Tone, 95, 103 Torsion, 91, 103 Toxic, iv, 4, 90, 95, 103 Toxicity, 9, 10, 86, 103 Toxicokinetics, 103 Toxicology, 22, 24, 26, 27, 28, 60, 103 Toxins, 79, 86, 91, 103 Trace element, 82, 102, 103 Transfection, 80, 103 Translation, 78, 103 Trees, 87, 103 Tryptophan, 4, 83, 100, 103 Tumour, 79, 103 Type 2 diabetes, 5, 47, 103 U Unconscious, 91, 103 Uric, 89, 90, 103 Urinary, 81, 87, 91, 98, 103, 104 Urinary tract, 98, 104

Urinary tract infection, 98, 104 Urine, 80, 85, 86, 91, 98, 103, 104 V Vagina, 85, 104 Valerian, 4, 45, 104 Vascular, 89, 91, 94, 102, 104 Venous, 80, 90, 98, 104 Venules, 81, 94, 104 Veterinary Medicine, 59, 104 Virulence, 103, 104 Viruses, 101, 104 Vitamin A, 6, 104 Vitreous, 85, 99, 104 Vitreous Hemorrhage, 85, 104 Vivo, 104 Vulgaris, 41, 104 W Wound Healing, 83, 104 Y Yeasts, 88, 104 Yohimbine, 4, 104

Index 111

112 Ephedra

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