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BACOPA

*Botanical Names:*	Bacopa monnieri, Bacopa monniera^#, Herpestis monnieri^#
*Family:*	Scrophulariaceae
*Plant Part Used:*	Aerial parts

# Alternative name.

PRESCRIBING INFORMATION

Actions	Cognition enhancing, nervine tonic, mild sedative, mild anticonvulsant, anxiolytic, possibly adaptogenic
Potential Indications	Based on appropriate evaluation of the patient, practitioners should consider prescribing Bacopa in formulations in the context of: • Improving concentration in healthy individuals (4) • Improving mental performance and memory (3) • Nervous disorders, nervous debility (5) • Insomnia (4,6) • Epilepsy, anxiety (4,5)

Contraindications None known. Warnings and Precautions None required. Interactions None known. Use in Pregnancy and Lactation No adverse effects expected. Side Effects As with all saponin-containing herbs, oral use may cause irritation of the gastric mucous membranes and reflux. Dosage Dose per day^* Dose per week^* 5–13 ml of 1:2 liquid extract 35–90 ml of 1:2 liquid extract

* This dose range is extrapolated from traditional Ayurvedic medicine ⁴ and the author’s education and experience.

SUPPORTING INFORMATION

Traditional Prescribing	Traditional Ayurvedic uses include: • As a nervine tonic for the treatment of nervous disorders, especially nervous breakdown, epilepsy, insanity; debility, aphonia (loss of voice), hoarseness; for a supposed direct cardiac tonic activity,²^–⁴ for urinary incontinence, particularly accompanied by constipation¹ • As a tonic for diseases of the skin, nervous system, and blood ²
Traditional Prescribing	Brahmi oil, which consists mainly of brahmi juice, coconut oil, and other medicinal plants, is considered a most effective brain tonic. Brahmi oil is said to strengthen memory and revive hair growth and is used as a cooling remedy instead of ice in epidemic fevers. Brahmi oil is also employed in headache, insomnia, and epilepsy.^3,⁴
Pharmacologic Research	• An early study demonstrated Bacopa to have cardiotonic, vasoconstricting, and sedative activities.⁵ • A laboratory study using a formulation containing Bacopa (known as Brahmi Rasayan) found high doses have sedative (without affecting motor coordination), analgesic, and anticonvulsant activities.⁶ • Standardized extract of Bacopa (25% bacoside A) produced an anxiolytic effect in vivo that was qualitatively comparable with that of lorazepam (a benzodiazepine drug). Statistically significant results were elicited with higher doses of Bacopa, which, unlike lorazepam, did not produce any significant motor deficit.⁷ • An early study compared the effects of an alcohol extract of Bacopa and the tranquilizer chlorpromazine on the learning process in rats. Both substances reduced errors and improved performance in the learning phase, but the effect of Bacopa was more marked. Chlorpromazine depressed motor efficiency, but no such deleterious effect was observed with Bacopa treatment. In fact, Bacopa improved motor efficiency compared with controls.⁸ In later studies, learning and memory retention were improved in rats in a number of experimental models after oral and intraperitoneal administration of Bacopa.^9,¹⁰ • Oral doses of Brahmi Rasayan were found to suppress experimentally induced inflammation in an animal model. The activity was comparable to that of the NSAID indomethacin. The herbal formula did not produce gastric irritation.¹¹
Clinical Studies	• In an uncontrolled trial, 35 patients with anxiety neurosis were treated with the equivalent of 12 g per day of dried Bacopa for 1 month. A significant reduction occurred in anxiety, as well as improvements in mental performance and memory. This result was accompanied by a reduction in mental fatigue, a general feeling of enhanced well being, improved sleep and appetite, and an increase in body weight.^12,¹³ • Bacopa had a positive effect on concentration, but not on short-term memory, in a small number of volunteers tested in the mid-1960s.¹⁴ Bacopa (1 g/day for 3 months) improved intellectual functions such as visual motor function, short-term memory, and mental reaction times in children. Unlike individuals who were treated with Bacopa, the placebo group did not improve from baseline values.¹⁵ • An uncontrolled clinical study on 13 patients with epilepsy using a defatted ethanolic extract of Bacopa (2 to 4 mg/kg body weight/day) demonstrated reductions in the frequency of fitting over 2 to 5 months. The onset of epileptic fits was completely checked in five cases.¹⁶ • An Australian clinical trial examined the long-term effects of a Bacopa extract on cognitive function in 46 healthy human volunteers.¹⁷ The study was of double-blind, placebo-controlled design in which subjects were randomly allocated to receive Bacopa or placebo. Neuropsychologic testing was conducted before treatment and at 5 and 12 weeks after treatment. After 12 weeks, the largest cognitive change from Bacopa treatment (which was also statistically significant compared with placebo, p < 0.05) was a time reduction for the inspection time (IT) test (64.5 16.7 min vs.75.9 25.3 min). IT is regarded as a measure of the integrity of the early stages of information processing and may act as a rate-limiting factor for cognition. This finding indicates that Bacopa significantly improved the speed of visual information processing. Verbal learning rate and memory consolidation as assessed by the Rey Auditory Verbal Learning Test were also some-what improved against placebo at 12 weeks (p < 0.05). However, the most striking finding was the highly significant (p = 0.001) reduction in anxiety in volunteers receiving Bacopa. The percentage of adverse effects was similar for both groups, except that a higher incidence of nausea, dry mouth, and fatigue occurred in the Bacopa group.

REFERENCES

1 Kapoor LD. CRC handbook of Ayurvedic medicinal plants. Boca Raton, Fla: CRC Press, 1990.

2 Chopra RN, et al. Chopra’s indigenous drugs of India, ed 2. Calcutta: Academic Publishers, 1958. reprinted 1982

3 Sandu DV. Indian therapeutics, ed 2. Delhi: Sri Satguru Publications, 1987.

4 A Panel of Vaidyas. Clinical application of Ayurvedic remedies, ed 4. Delhi: Sri Satguru Publications, 1998.

5 Malhotra CL, Das PK. Indian J Med Res. 1959;47:294-305.

6 Shukia B, Khanna NK, Godhwani JL. J Ethnopharmacol. 1987;21(1):65-74.

7 Bhattacharya SK, Ghosal S. Phytomed. 1998;5(2):77-82.

8 Prakash JC, Sirsi M. J Sci Ind Res. 1962;21C:93-96.

9 Singh HK, Dhawan BN. J Ethnopharmacol. 1982;5:205-214.

10 Singh HK, Dhawan BN. Indian J Pharmacol. 1978;10:72.

11 Jain P, et al. Indian J Exp Biol. 1994;32(9):633-636.

12 Udupa KN, Singh RH. Clinical and experimental studies on rasayana drugs and Pancakarma therapy, ed 2. New Delhi: Central Council for Research in Ayurveda and Siddha, 1995.

13 Singh RH, Singh L. J Res Ayurveda Siddha. 1980;1:133-148.

14 Ghosh S, Kar SK. J Exp Med Sci. 1966;10(1):12-13.

15 Sharma R, Chaturvedi C, Tewari PV. J Res Educ Indian Med. 1987;6:1-10.

16 Mukherjee GD, Dey CD. J Exp Med Sci. 1968;11(4):82-85.

17 Stough C, et al. Psychopharmacol. 2001;156(4):481-484.

BAICAL SKULLCAP

*Botanical Name:*	Scutellaria baicalensis
*Family:*	Labiatae
*Plant Part Used:*	Root

PRESCRIBING INFORMATION

Actions	Antiinflammatory, antiallergic, antibacterial
Potential Indications	Based on appropriate evaluation of the patient, practitioners should consider prescribing Baical skullcap in formulations in the context of: • Chronic inflammatory conditions, allergy, asthma, arthritis (7) • Hypertension (4,5) • Infections, including bronchitis, the common cold, bacillary dysentery, scarlet fever (4) • High fevers, cough with thick sputum, pneumonia (5) • Nausea, vomiting, hemoptysis, jaundice, diarrhea, or dysentery-like diseases (5) • Hepatitis (6) • Adjuvant therapy for cancer (4)

Contraindications Contraindicated in cold conditions (Chinese traditional understanding).¹ Warnings and Precautions None required. Interactions None known. Use in Pregnancy and Lactation No adverse effects expected. Side Effects None expected if taken within the recommended dose range. Dosage Dose per day^* Dose per week^* 4.5–8.5 ml of 1:2 liquid extract 30–60 ml of 1:2 liquid extract

* This dose range is adapted from dried plant dose administered by decoction in TCM.³ The author’s experience and the fact that ethanol-water is a more effective solvent than is water for many phytochemicals are taken into account.

SUPPORTING INFORMATION

Traditional Prescribing	Uses and properties from TCM include: • Clearing heat and draining damp heat¹ • High fevers, cough with thick sputum, pneumonia; nausea, vomiting, hemoptysis, jaundice,¹^–³ viral hepatitis⁴ • Diarrhea or dysentery-like diseases, painful urinary dysfunction, hypertension, restless fetus, carbuncles ¹^–³
Pharmacologic Research	Baical skullcap root contains a number of flavone derivatives, including baicalin, wogonin, and baicalein.⁵ • Flavones and flavonols inhibited the release of histamine by mast cells in vitro.⁶ Baicalin and baicalein demonstrated antiallergic and antiasthmatic activity in vivo.² • Oral doses of an extract of Baical skullcap and baicalin, baicalein, and wogonin demonstrated mild antiinflammatory activity and decreased long-term bone destruction in adjuvant-induced arthritis.⁷ • Baicalin and baicalein have demonstrated significant antiplatelet activity after oral doses in an experimental model, but not anticoagulant activity.⁸ • Baicalein demonstrated antioxidant activity in vitro.⁹ Baicalein demonstrated antiepileptic and neuronal protective effects in vivo (by injection), probably because of free radical quenching and antioxidant activity.¹⁰ Baicalein reduced oxidative stress during hypoxia, ischemia, and reperfusion in vitro.¹¹ • A combination of baicalin and licorice extract dramatically reduced sorbitol levels in red blood cells in experimental models without affecting blood glucose levels.¹² This finding has implications for preventing diabetic complications. • Baical skullcap reduced the toxicity of anticancer drugs and decreased cancer cell viability in experimental tumors.¹³
Clinical Studies	• Baical skullcap extract promoted an increase in the immunoregulation index (increased immunoglobulin A [IgA] at stable IgG levels) of patients with lung cancer who were receiving antineoplastic chemotherapy.¹⁴ • Positive results have been demonstrated in uncontrolled trials for acute bronchitis, the common cold, bacillary dysentery, scarlet fever, hepatitis (baicalin;route unknown), and cholecystitis (baicalin;by injection). The daily dose for respiratory disorders ranged from 6 ml to 8 to 10 ml of a 50% decoction depending on the age of the child.² A 70% success rate was shown in chronic hepatitis with improvements in symptoms and liver function tests (route and preparation undefined).¹⁵ • In an uncontrolled trial involving 255 patients in China with allergic rhinitis, Baical skullcap and Paeonia suffructicosa were added to the TCM herbal prescription for patients with nasal inflammation.¹⁶ • An antihypertensive effect was demonstrated in an uncontrolled study involving 51 cases.²

REFERENCES

1 Bensky D, Gamble A. Chinese herbal medicine materia medica. Seattle: Eastland Press, 1986.

2 Chang HM, But PP. Pharmacology and applications of Chinese materia medica. Singapore: World Scientific, 1987.

3 Pharmacopoeia Commission of the People’s Republic of China. Pharmacopoeia of the People’s Republic of China, English ed. Beijing: Chemical Industry Press, 1997.

4 Lu LX. Shaanxi J Chin Trad Med. 1987;8(5):228-229.

5 Tang W, Eisenbrand G. Chinese drugs of plant origin. Berlin: Springer-Verlag, 1992.

6 Amella M, et al. Planta Med. 1985;51(1):16-20.

7 Kubo M, et al. Chem Pharm Bull (Tokyo). 1984;32(7):2724-2729.

8 Kubo M, et al. Chem Pharm Bull (Tokyo). 1985;33(6):2411-2415.

9 Hara H, et al. Eur J Pharmacol. 1992;221(2-3):193-198.

10 Hamada H, et al. Arch Biochem Biophys. 1993;306(1):261-266.

11 Shao ZH, et al. Acad Emerg Med. 2001;8(5):562-563.

12 Zhou YP, Zhang JQ. Chin Med J (Eng). 1989;102:203-206.

13 Razina TG, et al. Vopr Onkol. 1987;33(2):80-84.

14 Smol’ianinov ES, et al. Eksp Klin Farmacol. 1997;60(6):49-51.

15 Chang HM, et al, editors. Advances in Chinese medicinal materials research. Singapore: World Scientific, 1985.

16 Lin WS. Shanghai J Trad Chin Med. 1987;1:22-24.

BAPTISIA

*Other Common Name:*	Wild indigo
*Botanical Name:*	Baptisia tinctoria
*Family:*	Leguminosae
*Plant Part Used:*	Root

PRESCRIBING INFORMATION

Actions	Depurative, antipyretic, immune enhancing
Potential Indications	Based on appropriate evaluation of the patient, practitioners should consider prescribing Baptisia in formulations in the context of: • Treating and preventing nonspecific upper respiratory tract infections, in combination with a number of herbs, including Echinacea spp. root and Thuja (2) • Sinusitis, in combination with a number of herbs, including Echinacea spp. root and Thuja (3) • Tonsillitis, pharyngitis, pneumonia, fevers, the common cold, influenza (5) • Septic conditions, boils, mouth ulcers, inflammation of the mouth or teeth (5)

Contraindications None known. Warnings and Precautions None required. Interactions None known. Use in Pregnancy and Lactation No adverse effects expected. Side Effects None expected if taken within the recommended dose range. Dosage Dose per day^* Dose per week^* 2–6 ml of 1:2 liquid extract 15–40 ml of 1:2 liquid extract

* This dose range is extrapolated from the British Pharmaceutical Codex 1934, the British Herbal Pharmacopoeia 1983, and the author’s education and experience.

SUPPORTING INFORMATION

Traditional Prescribing	Traditional Western herbal medicine uses include: • Infections of the upper respiratory tract, particularly tonsillitis, pharyngitis; diphtheria, acute catarrhal infection, lymphadenitis, fevers, pneumonia ^1,² • Sepsis, furunculosis, typhoid conditions, enfeebled circulation, mouth ulcers, gingivitis, stomatitis ^1,²
	Native Americans administered Baptisia to children who seemed drowsy and lifeless and at the point of becoming sick. Externally,
	Baptisia was used to bathe wounds and cuts. Baptisia was official in the United States Pharmacopeia (USP) from 1831 to 1842, the National Formulary (NF) from 1916 to 1936, and was used as an emetic, cathartic, stimulant, astringent, and antiseptic.³
Pharmacologic Research	• Glycoprotein derivatives from Baptisia root have demonstrated immunomodulating activity in vitro by provoking the stimulation of B lymphocytes with a concomitant increase of interferon release.⁴ • Fractions of Baptisia extract have demonstrated immune-enhancing activity in vitro and in vivo (by injection).⁵
Clinical Studies	No clinical studies have been conducted using Baptisia alone. • Three herbal formulations containing Baptisia have been used successfully for treating and preventing nonspecific upper respiratory tract infections in randomized, double-blind, placebo-controlled trials.^6,⁷ These formulations consisted of:(a) Baptisia, Echinacea spp. root, and Thuja;(b) these same herbs combined with homeopathic remedies; and (c) E. angustifolia aerial parts and root with boneset, Baptisia, and homeopathic Arnica. In most of these trials, the daily dose of herbs was below the normal therapeutic limit (and was similar to a homeopathic protocol). Only in trials conducted with the last formulation did patients receive herbs approaching the normal therapeutic range. The daily dose in these trials ranged from 1.2 to 3.0 g of the total formulation (dry weight equivalent), including homeopathic Arnica, for periods ranging from several days in treatment trials to 8 weeks in a prevention trial.^6,⁸ • A controlled trial found combined use of the first formulation previously listed with the antibiotic doxycycline had better success than did doxycycline alone in the treatment of acute sinusitis.⁹

BARBERRY AND INDIAN BARBERRY

*Common Name:*	Barberry
*Other Common Names:*	Common barberry, European barberry
*Botanical Name:*	Berberis vulgaris
*Family:*	Berberidaceae
*Plant Parts Used:*	Root, stem bark, or both
*Common Name:*	Indian barberry
*Botanical Name:*	Berberis aristata
*Family:*	Berberidaceae
*Plant Parts Used:*	Root, stem bark, or both

Practitioners should also consider prescribing barberry for:

• Improving digestive function (bile production and release) (5)

• Gallbladder inflammation, gallstones, intestinal dyspepsia (5)

• Topical treatment for lip sores, chronic ophthalmia (5)

Practitioners should also consider prescribing Indian barberry for:

• Improving digestive function (bile production and release) (5)

• Enlargement of the liver and spleen, colitis (5)

• Topical treatment for skin ulcers and abrasions, hemorrhoids, boils, acne (5)

Contraindications Berberine-containing plants are not recommended for use during pregnancy or for jaundiced neonates. Warnings and Precautions None required. Interactions Berberine may reinforce the effects of other drugs that displace the protein binding of bilirubin. Rather than possible uterine-contracting effects, this activity might explain the traditional contraindication for berberine-containing herbs in pregnancy. Use in Pregnancy and Lactation Contraindicated in pregnancy. Side Effects At daily doses higher than 0.5 g, berberine may cause dizziness, nose-bleeds, dyspnea, skin and eye irritation, gastrointestinal irritation, nausea, diarrhea, nephritis, and urinary tract disorders. Such doses of berberine will not be reached using the liquid doses recommended here. Dosage

It is preferable to use liquid extracts quantified for their berberine content.

Barberry:

Dose per day^* Dose per week^* 3–6 ml of 1:2 liquid extract 20–40 ml of 1:2 liquid extract Indian barberry: Dose per day^† Dose per week^† 2.0–4.5 ml of 1:1 liquid extract 15–30 ml of 1:1 liquid extract For topical use of berberine-containing herbs (such as for treatment of ophthalmia), a solution of about 5 to 6 drops of a 1:2 extract is prepared in an eye bath of recently boiled water or saline. The liquid should be allowed to cool before applying to the eye. (Allowing the alcohol to evaporate through this process is important before applying to the eye.)

* This dose range is extrapolated from the British Herbal Pharmacopoeia 1983 and the author’s education and experience.

† This dose range is extrapolated from traditional Ayurvedic medicine ^4,⁵ and the author’s education and experience.

SUPPORTING INFORMATION

Traditional Prescribing	Traditional Western herbal medicine uses of barberry root, stem bark, or both include: • Gallbladder inflammation, gallstones,¹ jaundice,^1,² chronic diarrhea, dysentery, cholera infantum, intestinal dyspepsia² • Renal calculi, soreness and burning of the urinary tract ² • Leishmaniasis, malaria,¹ fever² • As a tea for blood purification, as a tonic ² • Topically as a decoction for mouth ulcers and lip sores, chronic ophthalmia ²
	Barberry was used by Native Americans to treat sore throat, ulcerated gums, and ulcerated stomach. Barberry was official in the USP from 1863 to 1882.³
	Traditional Ayurvedic uses of Indian barberry root bark include: • Debility, remittent and intermittent fever,⁴ especially malarial fever^4,⁶ • Skin diseases, inflammation ⁷ • Neuralgia, dysentery, colitis ⁴ • Enlargement of the liver and spleen, jaundice ⁴ • Diseases of the eye, ear, and face ⁴ • Topically for oriental sores, mouth sores, skin ulcers and abrasions, pimples, boils, affections of the eyelids, chronic ophthalmia, piles,⁴ muscular or rheumatic pain⁸
Pharmacologic Research	Key constituents of barberry bark include alkaloids, comprising those of the isoquinoline group:protoberberines (berberine, jateorrhizine, and palmatine) and bisbenzylisoquinolines (including oxyacanthine). The principal alkaloid is berberine. Indian barberry root bark also contains berberine.⁹ The root bark is the preferred plant part for therapeutic use for both barberry and Indian barberry. The root bark has been preferred traditionally and is higher in alkaloids than the stem bark. However, given that the entire plant is killed in the harvesting process, the stem bark is a more environmentally sustainable option. The stem bark also contains the active alkaloids, albeit at lower concentrations, and is a valid therapeutic option. Several other plant parts of Indian barberry have been used in Ayurvedic medicine, including the fruit. The following information pertains to the root bark (except when the plant part has not been defined in the study, as noted). Pharmacologic information on berberine, the signature component of barberry and Indian barberry, has also been provided when relevant. • In vitro and in vivo studies have demonstrated that berberine has antimicrobial activity against a wide variety of microorganisms, including bacteria, fungi, and parasites. Barberry tincture was better than was berberine chloride (0.2%) at inhibiting the growth of various microorganisms in vitro. Indian barberry extract (part undefined) displayed inhibitory activity against Salmonella typhi in vitro.¹⁰ • Pustular skin lesions from Staphylococcus aureus and S. pyogenes infection were healed within 2 weeks when a combination of Indian barberry (part undefined) and Cedrus deodora was taken internally and also applied as a gel in an experimental model. The combined treatment was more beneficial than was the topical application alone.¹¹ • Berberine combined with Geranium leaf extract (oral doses) significantly inhibited diarrhea. Oral berberine significantly reduced intestinal fluid accumulation triggered by Escherichia coli enterotoxin in vivo. • Berberine increased thrombocytes, decreased factor XIII activity, inhibited platelet aggregation and adhesiveness, and inhibited clot retraction in vivo (route unknown). Indian barberry root extract inhibited platelet activating factor (PAF) aggregation of platelets in a dose-dependent manner and binding of radiolabeled PAF to platelets in vitro. • Berberine has demonstrated cytotoxic activity in several in vitro models. Indian barberry extract (part undefined) demonstrated anticancer activity against human epidermal carcinoma of the nasopharynx in vitro.¹² • Intraperitoneal administration of barberry extract demonstrated higher antiinflammatory activity than did isolated berberine and three different alkaloidal fractions in experimental models of acute and chronic inflammation. • Barberry tincture increased contractions in isolated intestinal tissue and demonstrated cholagogue and cholekinetic activity in experimental models. Oral administration of berberine hydrochloride significantly increased bilirubin excretion in experimental hyperbilirubinemia without affecting the functional capacity of the liver. • Oral pretreatment or posttreatment with berberine (4 mg/kg) prevented chemical-induced liver damage, indicating hepatoprotective activity.¹³ • Berberine prolonged pentobarbital-induced sleeping time and increased strychnine-induced toxicity after oral administration, suggesting an inhibitory effect on liver drug metabolizing enzymes (cytochrome P-450).¹³ • Lipogenesis was suppressed in isolated sebaceous glands by berberine. • Berberine significantly decreased scopolamine-induced amnesia in an experimental model. • Indian barberry root extract demonstrated hypoglycemic activity in an experimental model (route unknown).¹²
Pharmacologic Research	For more information on the pharmacologic parameters of berberine, see the monograph on golden seal (Hydrastis canadensis).
Clinical Studies	No clinical studies using barberry or Indian barberry have been found. Clinical trials using berberine are outlined here. The berberine doses used in many of these trials were higher than what could be achieved using herbal liquid extracts. • Berberine (100 mg/day) demonstrated an antidiarrheal action and compared well against standard antidiarrheal drugs in an uncontrolled study involving children with gastroenteritis. In randomized, controlled trials, berberine has exhibited benefit in treating diarrhea caused by Escherichia coli infection but was of little value against Vibrio cholerae infectious diarrhea (cholera). The trials with positive outcomes for E. coli diarrhea were conducted using either untreated controls (active therapy: 400 mg of berberine sulfate as a single dose) or compared rehydration therapy against only rehydration therapy with berberine (200 mg). In another trial, neither berberine (400 mg/day) nor tetracycline exhibited any benefit over placebo in patients with noncholera diarrhea. • Berberine (900 mg/day) was more efficacious than was ranitidine in clearing Helicobacter pylori and improving gastritis in H. pylori-associated duodenal ulcer in a randomized, comparative clinical trial. Ranitidine was the superior treatment for ulcer healing. • In two controlled trials, berberine (5 to 10 mg/kg/day for 6 to 10 days) was superior to placebo and compared favorably with established drugs in treating giardiasis in children. • In an uncontrolled trial, berberine (600 to 800 mg/day) corrected hypertyraminemia and prevented the elevation of serum tyramine after tyramine stimulation in patients with liver cirrhosis. (Hypertyraminemia [i.e., elevated blood levels of tyramine] is common in hepatic cirrhosis.) • In an uncontrolled trial berberine (0.9 to 1.5 g/day for 1 to 3 months) in combination with a therapeutic diet improved the major symptoms of patients with non-insulin–dependent diabetes. Berberine treatment improved patients’ strength, normalized blood pressure, decreased blood lipids, and in 60% of patients, normalized fasting glycemic levels. • Berberine bisulfate (15 mg/day for 15 days) increased platelet counts in patients with primary and secondary thrombocytopenia in an uncontrolled clinical trial. • In a randomized, controlled trial, berberine chloride (1.5 g/day) was more efficacious than were both tetracycline and a sulfamethoxazole-trimethoprim combination in clearing asexual parasitemia in patients with chloroquine-resistant malaria (all agents were used in conjunction with pyrimethamine). • Weekly intralesional injection of berberine salt solution (1%) healed cutaneous leishmaniasis after 4 to 8 weeks in a small, uncontrolled trial. (Cutaneous leishmaniasis is a protozoal skin infection caused by species of Leishmania.)