Clinical Abstracts
With Comments by Adriane Fugh-Berman, MD
Chinese Herbs Decrease EPO Requirement
July 2000; Volume 2; 56
Source: Bradley RR, et al. Hematopoietic effect of Radix Angelicae sinensis in a hemodialysis patient. Am J Kidney Dis 1999;34:349-354.
Summary: A 56-year-old white man with end-stage renal disease, iron-deficiency anemia, and mild secondary hyperparathyroidism had no residual renal function and was receiving dialysis four hours three times weekly. Concurrent medications included nifedipine, allopurinol, iron, vitamin C, calcitriol, a multivitamin, and rHuEPO. The patient had been chronically anemic and had been receiving approximately 620 units/kg/wk rHuEPO for five months, with only moderate effects. The patient began consuming the herbs Radix angelicae sinensis (five to six slices—about 12 g) and Radix paeoniae alba (20 slices—approximately 52 g) once weekly as tea (the herbs were boiled with three cups of water until the mixture was reduced to one cup, after which it was strained and drunk). One month after starting the herbal tea, his hematocrit rose from 29.7% to 34.4% (no change in iron or rHuEPO were made during this time, nor were any blood transfusions given). During the previous five months his hematocrit had been stable in the mid- to low-20s. During the five months of herbal therapy the mean hematocrit increased from 26.5% to 32.6% and the dose of HuEPO was reduced by > 90% (from 620 to 54 units/kg/wk). The patient also reported an increase in appetite and food intake within two weeks of starting the herbs. Approximately one month after that, the patient experienced two episodes of hypotension during dialysis, after which nifedipine was discontinued. During the five months of the herbal therapy the serum albumin rose from 3.6 to 4.4 g/dl.
Funding: None identified
Comments: Radix angelicae sinensis is dong quai (Angelica sinensis), which is commonly used by both Western and Asian herbalists to treat gynecological conditions. Radix paeoniae alba (Paeonia lactiflora or white peony) is also commonly used as part of an herbal mixture by Asian herbalists for gynecological conditions. This is a very well-documented case report that clearly shows a therapeutic beneficial effect of this herb mixture on a hemodialysis patient. The authors note that possible mechanisms for herb action include anti-inflammatory effects, the production of hematopoietic growth factors or antioxidant effects reducing the level of lipid peroxidation. The authors point out that hemodialysis patients are in a constant proinflammatory state because of interactions between blood and dialyzer membrane, and that dong quai suppresses the release of prostaglandin E2 in inflamed tissues. Additionally, angelica polysaccharides appear to protect bone marrow from radiation in a mouse model and benefits anemic mice; it is possible that angelica stimulates the regeneration of hematopoietic stem cells in bone marrow and/or hematopoietic growth factors in splenic cells.
Dong quai contains furocoumarins that can cause photosensitivity (mentioned by the authors) and can interact with warfarin to cause increased anticoagulation (not mentioned). My only major complaint is that the authors have no cause to assume that the effect reported in this case was primarily or solely due to dong quai. Apparently the authors could not find any information on white peony, and although they state, reasonably enough, that "its contribution to the patient’s clinical course is unknown," they go on to talk about only dong quai; white peony is not even mentioned in either the title or the abstract. The actual effect may be due to white peony or, most likely, a combination of the two. This Chinese herbal treatment is a whole lot cheaper than erythropoietin (which didn’t work well in this patient anyway); a clinical trial is certainly warranted.
July 2000; Volume 2; 56
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