Ephedra sinica Stapf

Last updated: 7 April 2016

Scientific Name

Ephedra sinica Stapf

Synonyms

Ephedra flava F.P.Sm. [Invalid], Ephedra ma-huang Tang S.Liu [Invalid]. [1]

Vernacular Name

English Chinese ephedra, Chinese joint fir, joint fir [2]
China Cao ma huang, mahuan, ma huang [2].

Geographical Distributions

Epehedra sinica is native to China and Siberia [2].

Botanical Description

E. sinica is a member of Ephedraceaea. The stem is thin. The flowers are yellow in colour .The fruits are red berry- like and it has a few tiny leaves. [3]

Cultivation

No documentation

Chemical Constituent

E. sinica has been reported to contain alkaloids (including (1R,2S)-norephedrine, l-ephedrine and d-pseudoephedrine); tannins; flavonoid glycosides. [4][5]

Plant Part Used

Herb and root [6]

Traditional Use

E. sinica has been used traditionally for thousands of years in China. Its uses include acute nephritis, asthma and other lung problems, colds and flu, fever, chills, lack of perspiration, headache, nasal congestion, wheezing, and cough among others. [7][8]

Preclinical Data

Pharmacology

Sympathomimetic activity

E. sinica has been reported to have sympathomimetic activity. The effects of ephedra are attributed to the alkaloids, including ephedrine and pseudoephedrine. Ephedra alkaloids are potent sympathomimetic agents, stimulating β-1 and β-2 adrenergic receptors and the release of norepinephrine. The biological effects of ephedra at various dosages may include CNS stimulation, peripheral vasoconstriction, elevation of blood pressure, bronchodilation, cardiac stimulation [9] and increased pulse rate, decrease in intestinal tone and motility, mydriasis, and tachycardia. [10]

Products containing ephedra and the alkaloids ephedrine and pseudoephedrine are reported to increase weight loss, due to appetite suppression and an increase in thermogenic activity. In combination with methylxanthines such as caffeine, ephedra and its alkaloids may improve fat loss by dual actions: a central suppression of appetite and peripheral stimulation of energy expenditure covered by fat oxidation. [11][12][13] In a comparative trial, the weight loss produced by ephedrine and caffeine was similar to that of dexfenfluramine. [14] A laboratory animal study reported that the administration of ephedrine and caffeine promoted weight loss through an increase in energy expenditure, or in the more obese animals, a combination of an increase in energy expenditure and a decrease in food intake. [15] Also, the addition of aspirin to ephedra weight loss formulas may markedly potentiate the thermogenic properties of ephedra alkaloids, effects that led to a normalization of body composition. [16] More research on sympathomimetics and methylxanthines need to be carried out to identify combinations and dosage forms with improved efficiency and safety.

Antihypercholestromia activity

E. sinica has been reported in studied, ephedrine plus caffeine produced a decline in total cholesterol levels and maintained HDL levels. [17] These clinical studies are conducted with the isolated constituent ephedrine, but the herb ephedra contains this alkaloid in levels of 30-90%, and a standardized dose should provide approximately 8 mg of alkaloids. [18] It is also reported that a low-calorie diet combined with 180 mg ephedrine and 600 mg caffeine per day produced a significant weight loss of 4.0 kg compared with a placebo group. [19]

Bronchodilators activity

E. sinica has been reported to have alkaloids ephedrine and pseudoephedrine which commonly used in managing the symptoms of asthma and have been used for this condition for thousands of years. [20][21][22] As stated, E. sinica alkaloids have Beta-2 adrenergic receptor activity, causing bronchodilation. [23] Studies using a combination of the isolated alkaloid ephedrine with pharmaceutical bronchodilators such as theophylline have reported positive results in the management of asthma. [24][25]

The alkaloids of E. sinica have been successfully used as decongestants in nonprescription medicines for quite some time. [26][27] Ephedra and its alkaloids cause vasoconstriction in the nasal passages, decreasing nasal congestion and enhancing ease of air flow. [3] Studies using a combination of the isolated alkaloid pseudoephedrine with antihistaminic agents such as terfenadine and loratadine have reported positive results in the management of symptoms of allergic rhinitis. [28][29]

Anti-inflammatory, immune support

Although E. sinica has been reported to cause hepatitis in a case report, it is reported to play a role in severe hepatic failure because of its ability to inhibit TNF-α production and protease enzymes involved in apoptosis. [30]

E. sinica is used in China for nephritis, supported by reports that ephedra blocks activation in both the classical and alternative pathway of complement. [31] The role played by E. sinica in regards to innate immune system was reported in a study involving rats with spinal cord injury whereby they showed significant motor function improvement through inhibition of the system when treated with E. sinica. [32]

Toxicity

No documentation

Clinical Data

Clinical findings

Precautions

In recommended dosages, E. sinica has a long history of being safe. Exceeding the recommended dose will not improve results and may cause serious adverse health effects. [33] Recent reports suggest that E. sinica is only safe for short term use. [19]

Use with extreme caution in individuals with renal impairment, glaucoma, hypertension, cardiovascular disease, thyroid disease, diabetes, psychiatric disorders, seizure disorders, difficulty urinating or enlarged prostate. [34][35][36][37][38][39]

Side effects

If abused, taken in high dosages, or taken in pre-existing cardiovascular diseases, E. sinica may contribute to adverse events. There are several deaths reported from overdose of E. sinica. [40][41]

Symptoms of overdose include heart palpitations, extreme nervousness, sweating, enlarged pupils, severe headache, dizziness, dyspnea, elevated body temperature, and ultimately death. [42]

Recent reports has suggested that E. sinica taken at well controlled doses showed cardiovascular side effects such as increases in blood pressure, heart rate and mild palpitations. [43]

There has been a report of hepatitis associated with the use of E. sinica. [23]

Dosage

Dosage Range

Dosages recommended by manufacturers and those typically used in clinical studies range from 8-25 mg ephedra alkaloids per dose, no more than 4 times a day.

Tea: Made with 1 to 4 g, 3 times daily. [42]

Tincture (1:1): medium single dose 5 g. [42]

Extract:1 to 3 mL, 3 times daily. [42]

Tincture (1:4): 6 to 8 mL, 3 times daily. [42]

Poisonous Management

No documentation

Line drawing

No documentation

References

  1. The Plant List. Ver1.1. Epehedra Sinica. [homepage on the Internet]. c2013 [updated 2012 Mar 23; cited 2016 June 8]. Available from: http://www.theplantlist.org/tpl1.1/record/kew-333041
  2. Quattrocchi U. CRC world dictionary of medicinal and poisonous plants: Common names, scientific names, eponyms, synonyms, and etymology. Volume III E-L. Boca Raton, Florida: CRC Press, 2012; p. 73.
  3. James DA Jr, Eric JL. Traditional Chinese medicine: Scientific basis for its use. UK: Royal Society of Chemistry, 2013; p. 82-85.
  4. Gurley BJ, Wang P, Gardner SF. Ephedrine-type alkaloid content of nutritional supplements containing Ephedra sinica (Ma-huang) as determined by high performance liquid chromatography. J Pharm Sci. 1998;87(12):1547-1553.
  5. Krizevski R1, Bar E, Shalit O, Sitrit Y, Ben-Shabat S, Lewinsohn E. Composition and stereochemistry of ephedrine alkaloids accumulation in Ephedra sinica Stapf. Photochemistry, 2010;71(8-9):895-903.
  6. Schafer P. The Chinese medicinal herb farm: A cultivator's guide to small-scale organic herb production. Vermont: Chelsea Green Publishing; 2011; p. 166.
  7. Kalix P. The pharmacology of psychoactive alkaloids from ephedra and catha. J Ethnopharmacol; 1991;32(1-3):201-208.
  8. Chan EL, Ahmed TM, Wang M, Chan JC. History of medicine and nephrology in Asia. Am J Nephrol. 1994;14(4-6):295-301.
  9. Haller CA, Jacob P 3rd, Benowitz NL. Pharmacology of ephedra alkaloids and caffeine after single-dose dietary supplement use. Clin Pharmacol Ther. 2002;71(6):421-432.
  10. White LM, Gardner SF, Gurley BJ, Marx MA, Wang PL, Estes M. Pharmacokinetics and cardiovascular effects of ma-huang (Ephedra sinica) in normotensive adults. J Clin Pharmacol. 1997;37(2):116-122.
  11. Atkinson RL, Blank RC, Loper JF, Schumacher D, Lutes RA. Combined drug treatment of obesity. Obes Res. 1995;3(Suppl 4):497S-500S.
  12. Astrup A, et al. Pharmacological and clinical studies of ephedrine and other thermogenic agonists. Obes Res. 1995;3(Suppl 4):537S-540S.
  13. Boozer CN, Daly PA, Homel P, et al. Herbal ephedra/caffeine for weight loss: A 6-month randomized safety and efficacy trial. Int J Obes Relat Metab Disord. 2002;26(5):593-604.
  14. Breum L, Pedersen JK, Ahlstrøm F, Frimodt-Møller J. Comparison of an ephedrine/caffeine combination and dexfenfluramine in the treatment of obesity. A double-blind multi-centre trial in general practice. Int J Obes Relat Metab Disord. 1994;18(2):99-103.
  15. Ramsey JJ, Colman RJ, Swick AG, Kemnitz JW. Energy expenditure, body composition, and glucose metabolism in lean and obese rhesus monkeys treated with ephedrine and caffeine. Am J Clin Nutr. 1998;68(1):42-51.
  16. Dulloo AG, Miller DS. Aspirin as a promoter of ephedrine-induced thermogenesis: Potential use in the treatment of obesity. Am J Clin Nutr. 1987; 45(3):564-569.
  17. Buemann B, Marckmann P, Christensen NJ, Astrup A. The effect of ephedrine plus caffeine on plasma lipids and lipoproteins during a 4.2 MJ/day diet. Int J Obes Relat Metab Disord. 1994;18(5):329-332.
  18. Leung A, et al. Encylopedia of common natural ingredients used in foods, drugs, and cosmetics. New York: Wiley-Interscience Publication, 1996; p. 227-229.
  19. Kim HJ, Park JM, Kim JA, Ko BP. Effect of herbal Ephedra sinica and Evodia rutaecarpa on body composition and resting metabolic rate: A randomized, double-blind clinical trial in korean premenopausal women. J Acupunct Meridian Stud. 2008;1(2):128-138.
  20. Faurshou M, Svendsen UG. The bronchodilating effect of ephedrine tablets in bronchial asthma. Ugeskr Laeger. 1993;155(46):3784-3785. Danish.
  21. Laitinen LA, Empey DW, Bye C, Britton MG, McDonnell K, Hughes DT. A comparison of the bronchodilator action of pseudoephedrine and ephedrine in patients with reversible airway obstruction. Eur J Clin Pharmacol. 1982;23(2):107-109.
  22. Redman CM, Druce HM. Nonprescription bronchodilator use in asthma. Chest. 1998;114(2):657-658.
  23. Vansal SS, Feller DR. Direct effects of ephedrine isomers on human beta-adrenergic receptor subtypes. Biochem Pharmacol. 1999;58(5):807-810.
  24. Direkwattanachai C, Phanichyakarn P, Srianujatra S. Sustained release theophylline and ephedrine therapy in chronic asthma. J Med Assoc Thai. 1986;69(Suppl 2):31-37.
  25. Owen S, Stone P, Campbell L, Webster S, Woodstock AA. A controlled trial of an oral bronchodilator preparation ('Franol') in asthma. Pharmatherapeutica. 1988;5(4):240-245.
  26. Mullarkey MF. A clinical approach to rhinitis. Med Clin North Am. 1981;65(5):977-986.
  27. Hamilton LH, Chobanian SL, Cato A, Perkins JG. A study of sustained action pseudoephedrine in allergic rhinitis. Ann Allergy. 1982; 48(2):87-92.
  28. Panda NK, Mann SB. Comparative efficacy and safety of terfenadine with pseudoephedrine and terfenadine alone in allergic rhinitis. Otolaryngol Head Neck Surg. 1998;118(2):253-255.
  29. Corren J, Harris AG, Aaronson D. Efficacy and safety of loratadine plus pseudoephedrine in patients with seasonal allergic rhinitis and mild asthma. J Allergy Clin Immunol. 1997;100(6 Pt 1):781-788.
  30. Ikuhiro Y, Takashi G, Satoko T, et al. Mao (Ephedra sinica Stapf) protects against d-galactosamine and lipopolysaccharide-induced hepatic failure. Cytokine. 2008;41(3):293-301.
  31. Ling M, Piddlesden SJ, Morgan BP. A component of the medicinal herb ephedra blocks activation in the classical and alternative pathways of complement. Clin Exp Immunol. 1995;102(3):582-588.
  32. Li L, Li J, Zhu Y, Fan G. Ephedra sinica inhibits complement activation and improves the motor functions after spinal cord injury in rats. Brain Res Bull. 2009;78(4-5):261-266.
  33. Haller CA, Benowitz NL. Adverse cardiovascular and central nervous system events associated with dietary supplements containing Ephedra alkaloids. N Engl J Med. 2000;343(25):1833-1838.
  34. LaValle JB, et al. Natural therapeutics pocket guide. Hudson, Ohio: LexiComp Inc, 2000; p. 429-430.
  35. Powell T, Hsu FF, Turk J, Hruska K. Ma-huang strikes again: Ephedrine nephrolithiasis. Am J Kidney Dis. 1998;32(1):153-159.
  36. Zaacks SM, Klein L, Tan CD, Rodriguez ER, Leikin JB. Hypersensitivity myocarditis associated with ephedra use. J Toxicol Clin Toxicol. 1999;37(4):485-489.
  37. Jacobs KM, Hirsch KA. Psychiatric complications of Ma-huang. Psychosomatics. 2000;41(1):58-62.
  38. Capwell RR. Ephedrine-induced mania from an herbal diet supplement. Am J Psychiatry. 1995;152(4):647.
  39. Harada M, Nishimura M. Contribution of alkaloid fraction to pressor and hyperglycemic effect of crude Ephedra extract in dogs. J Pharmacobiodyn. 1981;4(9):691-699.
  40. Thoeharides TC. Sudden death of a healthy college student related to ephedrine toxicity from a ma huang-containing drink. J Clin Psychopharmacol. 1997;17(5):437-439.
  41. Gurley BJ, Gardner SF, White LM, Wang PL. Ephedrine pharmacokinetics after the ingestion of nutritional supplements containing Ephedra sinica (ma huang). Ther Drug Monit. 1998;20(4):439-445.
  42. PDR for herbal medicines. 2nd ed. Montvale, New Jersey: Medical Economics Company, 2000; p. 489.
  43. Andraws R, Chawla P, Brown DL.  Cardiovascular effects of ephedra alkaloids: A comprehensive review. Prog Cardiovasc Dis. 2005;47(4):217-225.