Journal of Thai Traditional and Alternative Medicine

Marum: Moringa Leaf and Moringa Bark

Thongchai Sooksawate — 2024-12-29

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Editorial Board

Vichai Chokevivat — 2024-12-29

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Index

Department of Thai Traditional and Alternative Medicine — 2024-12-29

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A Comparative Study of Immediate Effects of Pressure Point Massage and Acupuncture for Patients with Upper Trapezius Myofascial Trigger Points

Siraprapa Veerapattananon — 2024-12-29

Introduction and objective: Myofascial pain syndrome is a musculoskeletal condition that most commonly occurs in the neck and shoulder girdle area, negatively affecting the patient’s quality of life. The objective of this study was to compare the immediate effects of pressure point massage and acupuncture for patients with upper trapezius myofascial trigger points.

Methods: Thirty-four patients were randomized to receive a session of either pressure point massage (ischemic compression combined with deep transverse friction massage) or acupuncture. Pain intensity, muscle tension, cervical flexion range of motion and anxiety were assessed before and immediately after the treatments.

Results: Both pressure point massage and acupuncture were found to result in a significant improvement in pain intensity and muscle tension compared to baseline values (p < 0.05). However, only pressure point massage can decrease anxiety. When comparing between the two groups, no significant difference was found between pressure point massage and acupuncture in all parameters.

Discussion: Pressure point massage and the acupuncture technique were equally effective in improving pain intensity and muscle tension; and pressure point massage provided better reductions in anxiety than acupuncture in patients with upper trapezius myofascial trigger points. However, this trial only investigated the acute effectiveness of pressure point massage and acupuncture, which might not be associated with a longer-term effectiveness. In the future study, investigation of a longer-term effect would be an interesting direction.

Conclusion and recommendation: Pressure point massage reduced pain intensity, muscle tension and anxiety; and acupuncture was associated with significant decreases in pain intensity and muscle tension in patients with upper trapezius myofascial trigger points. Therefore, pressure point massage and acupuncture may be considered effective interventions for this patient population.

Comparative Study of the Efficacy of Acupuncture at Houxi, Zhongzhu and Laozhen Acupoints versus Houxi and Xuanzhong Elecctro-acupoints: A Randomized Controlled Trial

Bhasakit Wannawibool — 2024-12-29

Introduction and objectives: Current health problems in the working age population result from sitting and working in front of the computer or working in the same position for a long time. Such problems include cumulative stress tense muscles and most commonly neck and shoulder pain. Modern medicine uses treatment with pain killer drugs, muscle relaxants, or physical therapy. Traditional Chinese medicine uses herbal medications, Tuina massage, cupping, acupuncture on the neck, and acupuncture on the hands and feet. The latter method uses a small number of needles; it is convenient, safe, and reportedly effective for treating neck and shoulder pain. In this study, three acupoints at the hands were used (Houxi, Zhongzhu, and Laozhen) as they are anatomically clear for the experimental group, while another two acupoints (Houxi and Xuanzhong) at the hands and feet were used for the control group for treatment efficacy comparison.

Methods: Forty patients with neck and shoulder pain took part in this randomized controlled trial, 20 each in the experimental group and the control group; and each group received 3 treatment sessions. The patients’ pain was assessed with the short-form McGill Pain Questionnaire and a Neuropathic Pain Scale; and data analysis was undertaken with ANOVA statistics.

Results: According to data analyses for both groups, after treatment their pain levels dropped significantly. The difference in the mean pain scores before the first treatment and after the third treatment was 5.53 for the experimental group and 5.0 for the control group.

Discussion: After three treatments with acupuncture in both groups, the therapies were significantly effective in relieving pain; and there was no significant difference in pain reduction between both groups.

Conclusions and recommendations: Treatments of neck and shoulder pain with acupuncture at Houxi, Zhongzhu, and Laozhen acupoints and at Houxi and Xuanzhong acupoints had similar effectiveness. There was no significant difference between the two methods. Thus, both treatments are options for treating neck and shoulder pain, and are simple, convenient, effective, fast, and safe for use in clinical practice.

Development of Akakluwa Oil to Reduce Shoulder Muscle Pain in Patients with Lom Plai Pattakhat Sanyan 4 by Self-Massage Method

Weahalimah Hajicheteh — 2024-12-29

Introduction and objective: Shoulder muscle pain in patients with Lom Plai Pattakhat Sanyan 4 is a common health problem in working-age women, which affects work efficiency and medical treatment costs. Some may need to take time off work. This study aimed to evaluate the effectiveness of Akakluwa oil in reducing shoulder muscle pain using self-massage in the Thai Traditional Medicine Clinic, Khok Pho Hospital, Pattani province.
Methods: The study and development were conducted in three steps: (1) Study the situation, problems, and needs of 30 patients with Lom Plai Pattakhat Sanyan 4; (2) Prepare Akakluwa oil to reduce pain; and (3) Study the effectiveness of Akakluwa oil by self-massage in 28 patients. A quasi-experimental research design was used, with a single group pre- and post-test. The assessment was conducted by comparing the level of shoulder muscle pain and the degree of neck muscle movement before and after the test. The satisfaction and adverse symptoms after using the oil were assessed. The consistency value was 1.00 and the Cronbach's alpha coefficient was 0.89. Data were collected and analyzed by content analysis, percentage, mean, and standard deviation; and the dependent t-test and Wilcoxon signal rank test were used.
Results: (1) Among the participants with Lom Plai Pattakhat Sanyan 4 problems and needs, most of them had pain in the muscles of the neck, shoulders and back due to working in front of the computer for more than 6 hours a day, including numbness in the fingertips. The patients need herbal massage oil that helps relieve pain; it has properties that make them feel relaxed, has a good smell, and is easy to carry and use. (2) The preparation of Akakluwa oil is obtained by frying the core of the horse twat and mixing menthol and camphor solutions in the specified amount. The oil obtained has important properties: a light-yellow color and fragrant herbs. The viscosity ranged from 20 to 100 mPa·s and was absorbed into the skin within 5 to 15 minutes. (3) The mean level of shoulder pain after using Akakluwa oil was (M = 1.50, SD = 1.69), which was better than the mean level of pain before using Akakluwa oil, which was (M = 6.04, SD = 1.89). The range of neck muscle movement in six positions, was significantly increased (p<0.01). (4) The level of satisfaction with using Akakluwa oil was very good (M = 4.50, SD = 0.38), and no adverse effects from using the oil were found at 100 percent.
Discussion: The relief of muscle pain by self-massage combined with aromatic herbal oil resulted in relaxation for the patients. The Akakluwa oil developed from the roots of Ficus sarmentosa Buch has anti-inflammatory and pain-relieving properties. The results showed that the average pain score before use was 6.04, which decreased to 1.50 after use (p<0.001). In addition, the oil significantly increased the range of motion of the neck. The satisfaction of the users with the product was high (M = 4.50), especially in terms of the duration of action (M = 4.93), and the relief of stress (M = 4.87).
Conclusion and recommendations: Akakluwa oil can be effective in relieving shoulder muscle pain from the disease “Lom Plai Patkat Sanyan 4” and may be an alternative product for relieving muscle pain. However, further studies should be conducted on its chemical properties using various techniques and other monitoring variables such as muscle tension and quality of life to make the study more comprehensive.

The Effectiveness of Heat Herb Treatment on Pain Levels and Cervical Range of Motion in Myofascial Pain Syndrome Patients

Bodin Chatawatee — 2024-12-29

Introduction and objective: Myofascial pain syndrome can affect individuals of all ages. It stems from improper behavior or posture during activities such as prolonged sitting with hunched shoulders or extended use of computers and phones. Consequently, muscles in the upper back, shoulder blades, neck, and shoulders experience pain and stiffness, which significantly impacts daily life and overall quality of life. The aim of this study was to investigate the effectiveness of heat herb treatment on pain levels and cervical range of motion in myofascial pain syndrome’s patients..

Methods: This quasi-experiment clinical study that involved a procedure of heat herb treatment for pain relief in 30 patients with upper back pain on the scapular region. The treatment was conducted for 30 minutes per session, 3 times every other day at Traditional Thai Medicine Hospital, Prince of Songkhla University. Treatment efficacy was assessed using visual analogue scale, Cervical Range of Motion, and satisfaction with the treatment. Analysis was conducted by comparing pre- and post-treatment results using paired t-test statistics at a significance level of 0.05.

Results: Among the participants, most of them were female with an average age of 22.07±3.78 years; and 53.33% commonly experienced pain during activity or movement. After the heat herb treatment, their pain levels significantly decreased and the degree of neck movement significantly increased (p<0.001). Overall, they reported very good satisfaction with the treatment, with a mean satisfaction score of 2.97 ± 0.67.

Discussion: The heat herb treatment involves a topical heat therapy known for its pain-relieving properties and ability to increase neck movement degrees. This is achieved through the heat's impact on blood vessels within the muscles, causing them to expand and enhancing blood circulation. As a result, skin and muscle flexibility increases, muscle spasms reduce, and physiological changes occur, leading to clinical improvements. This procedure can effectively enhance the flexibility of neck and shoulder muscles, consequently increasing the range of neck movement. Therefore, the findings of this study provide valuable data supporting the use of heat herb treatment in the relief of upper back pain among patients.

Conclusion and recommendation: The heat herb treatment procedure used in this study was effective in reducing upper back pain and increasing the cervical range of motion in patients with upper back pain.

A Study of the Quality of Life of Palliative Care Patients Using Golden Turmeric Cannabis Oil in the Medical Cannabis Clinic, Udon Thani Province

Rossamalin Intayuang — 2024-12-29

Introduction and objective: The Golden Turmeric Cannabis Oil Recipe represents the wisdom of traditional Thai medicine, developed by a Thai traditional medicine doctor at Huai Koeng Hospital, Udon Thani Province. This research aimed to examine its medical benefits, namely symptom relief, the quality of life of patients, patient performance of self-help, and safety.

Methods: Quality of life measurement tools consisted of the following: (1) Edmonton Symptom Assessment System (ESAS) for measuring health state severity, (2) European Quality of Life 5-Dimension 5-Level (EQ-5D-5L), (3) visual analogue scale (VAS) for direct health valuation, and (4) daily self-care palliative performance scale (PPS). A one-group pre- and post-treatment design was conducted on patients diagnosed and indicated for palliative care, and patients’ outcomes were collected on days 0, 7, and 14 from six hospitals and 16 subdistrict health-promoting hospitals in Udon Thani province between November 2022 and November 2023. A descriptive study and Friedman test were used for data analysis.

Results: Among the 122 patients receiving palliative care, 61% were men with an average age of 68±12 years. Of these patients, 32% had cancer, 14% had cerebrovascular disease, and 68% primarily had stable symptoms (PPS>70). The primary indication for the use of Golden Turmeric Cannabis Oil was insomnia (55%), followed by pain (21%), and anorexia (16%). Significant reductions (p<0.05) were observed in pain, tiredness, nausea, loss of appetite, physical and mental discomfort, and insomnia based on ESAS measurement; based on the EQ-5D-5L score, improvements (p<0.05) were noted for movement, anxiety, and depression within the five dimensions of health; direct health assessment or VAS scores also increased (p=0.01); but here was no significant difference (p>0.05) in the PPS scores for health utility and self-care before and after using the medicine; and no changes were observed in vital signs such as blood pressure or pulse rate; however, one case reported dry mouth after using medication.

Discussion: The study results aligns with previous research indicating that cannabis helps alleviate symptoms in this kind of patients, elevate their quality of life and ensure safety. However, patients in this study group still exhibited relatively stable symptoms (PPS score >70), which may differ from patients in previous studies.

Conclusion and recommendation: Golden Turmeric Cannabis Oil has demonstrated positive effects in improving the quality of life, enhancing sleep quality, providing pain relief, and promoting appetite in patients. Further comprehensive clinical studies in palliative care patients in the long term are warranted to deepen our understanding of its efficacy and safety profile.

Effectiveness of Hemorrhoids and Skin Disease Formula in Ayurveda Textbook of Khun Nittessukkit: A Case Study in Psoriasis Patients

Nitirat Meekai — 2024-12-29

Introduction and objective: Psoriasis is a condition that affects people of all genders and ages. Currently, there is no definitive cure for the illness, and treatments are only available to alleviate symptoms. The hemorrhoids and skin disease formula (HSDF) in Ayurveda Textbook of Khun Nittessukkit, a Thai traditional medicine text, had properties for the treatment of skin conditions. Given its usage in Thai traditional medicine, the researchers were interested in studying the effectiveness of the HSDF for treating psoriasis patients.

Methods: The screening process involved selecting participants diagnosed with mild to moderate psoriasis by modern medical practitioners. A total of 40 participants were chosen and divided into two groups: the experimental group of 20 participants received HSDF and the control group of 20 participants received a 0.1% TA steroid cream. The participants were randomly assigned to each group. Treatment follow-up was done every 2 weeks for a total duration of 6 weeks. The effectiveness was evaluated using the Psoriasis Area and Severity Index (PASI) and the Dermatological Quality of Life Index (DLQI) questionnaires. Statistical methods employed included frequency, mean, percentage, standard deviation, and the comparison of skin conditions before and after the intervention using the paired t-test.

Results: The PASI severity levels (in mean scores) from the follow-up of the experimental and control groups before and after the trial were found to significantly decrease (p < 0.001). The DLQI assessment of skin disease patients in the experimental group showed a slight improvement in quality of life; the low level before treatment (mean = 2.44, SD = ± 0.46) and the low level after the trial (mean = 1.83, SD = ± 0.45). The control group had a moderate DLQI before treatment (mean = 2.59, SD = ± 0.19) and a low DLQI after the trial (mean = 2.09, SD = ± 0.22). No adverse effects were observed in either group regarding safety.

Discussion: The HSDF in Ayurveda Textbook of Khun Nittessukkit demonstrated efficacy in the treatment of psoriasis patients, compared to the treatment with 0.1% TA steroid cream. The treatment regimen involved bi-weekly follow-ups over a period of six weeks. The assessment of psoriasis severity before and after the trial showed improvement, and the patients’ quality of life also improved. This included reductions in stress related to the illness and enhancements in psychological and social well-being. In terms of safety, no adverse effects were observed in either group.

Conclusion and recommendations: This study provides evidence that supports the use of the HSDF, potentially offering a treatment alternative for physicians, traditional Thai medicine practitioners, and patients. Thus, it is recommended that further studies should be undertaken for developing the formulation to be more user-friendly and addressing the issue of turmeric stains on clothing to enhance its practicality for everyday use.

Antitumor Activity of Cannabis sativa L. Extract on Liver Cancer in Nude Mice Xenograft Model

Ruchuros Inkomlue — 2024-12-29

Introduction and objective: The most common cancer among Thai people is liver cancer. The use of cannabis botanicals for liver cancer therapies has generated widespread interest. Concerns about efficacy and side effects need to be further investigated.

Methods: Liver cancer (HepG2 cell line) was induced in BALB/c nude mice by subcutaneously injecting 10x10⁶cells in 100µl into the flank and Tanaosri Kan Daeng cannabis leaf extract (CSRD1) was fed to mice at doses of 1, 5, and 10 mg/kg/day for 24 days. Tumor growth was monitored by measuring with a vernier caliper and in vivo imaging technique.

Results: The study's findings demonstrated a significant reduction in the liver tumor size measured by vernier caliper in the nude mice xenograft model when 10 mg/kg/day of CSRD1 extract was given orally. However, no significant differences were found between the test groups compared to the control group by imaging and analyzing fluorescent signals in experimental animals (in vivo imaging).

Discussion: CSRD1 extract demonstrated a significant reduction in xenograft liver tumor size may be due to the effect of CB1 receptor on intracellular signaling pathways, which inhibits cancer cell migration, cell adhesion, cell proliferation and activates apoptosis. No significant differences were found in fluorescent signals analyzed using in vivo imaging technique due to the limitation of this method caused by tumor hypoxia.

Conclusion and recommendation: CSRD1 extract has shown potential in reducing the size of liver tumors in nude mice xenograft models. Further study is required to investigate its inhibitory effects on metastatic cancer cells. This study could be beneficial in exploring the potential medical applications of cannabis extracts.

Inhibition Effect on Antibiotic Resistant Bacteria and Protosappanin B Content in A-Po-That Formula Extract and Stability Testing

Thanakan Kitnithiprapha — 2024-12-29

Introduction and Objectives: The 21^st A-Po-That traditional drug formula exhibits antibacterial activity against many bacteria that cause diarrhea and its main chemical constituents are brazilin and gallic acid. But there have been no studies on its effects on antibiotic-resistant bacteria and its stability in inhibiting antibiotic-resistant bacteria, as well as its other chemical compounds. The objectives of the study were to examine the antibacterial effects of 21^st A-Po-That extract against extended-spectrum beta-lactamase-producing Escherichia coli or ESBL E. coli, analyze its chemical composition and assess the stability of the extract under accelerated conditions.

Methods: Extraction of the A-Po-That remedy was performed using a water decoction method. Subsequently, the antibacterial activity of the extract was assessed by the broth microdilution assay, while the chemical composition was quantified using the HPLC approach. The A-Po-That remedy extract was examined for stability under accelerated conditions for 6 months and tested/analyzed for antibacterial activity and chemical compounds.

Results: The 21^st A-Po-That remedy extract was found to exhibit antibacterial activity against ESBL E. coli with minimum inhibitory concentration (MIC) values ranging from 0.625 to 2.5 mg/mL. Protosappanin B was the primary chemical constituent of the A-Po-That extract with a chemical concentration of 2.89±0.21%w/w. The stability testing revealed that the A-Po-That extract exhibited stability in terms of its antibacterial activity and a change in its protosappanin B content after 120 days of testing. However, there was no significant difference in the content of protosappanin B between day 180 and day 0.

Discussion: The 21^st A-Po-That remedy extract effectively suppressed the growth of ESBL E. coli. However, the primary chemical compound identified was protosappanin B, which differs in contrast to what was previously reported. Seasonal and climatic changes may have an impact on the chemical composition of the remedy’s medicinal plant ingredients. Furthermore, the A-Po-That extract exhibited consistent antibacterial activity, but displayed different results in terms of chemical composition. The changes in moisture and temperature might be contributing to the changing chemical composition of the remedy.

Conclusions and recommendation: The findings indicate that the A-Po-That formula extract has the ability to inhibit ESBL E. coli growth with protosappanin B being identified as its main chemical compound. After undergoing stability testing for 180 days, the concentration of protosappanin B remained unchanged compared to day 0. However, the concentration of protosappanin B exhibited increased after 120 days. Thus, it is necessary to store A-Po-That extract in conditions of low temperature and low humidity to prevent any alteration of its chemical elements. Before performing any efficacy study of the A-Po-That formula in patients, it is necessary to perform a toxicity study first.

Antioxidant and Antipathogenic Bacterial Activities in the Gastrointestinal Tract of Raw Musa Sapientum L. Crude Extracts

Chanphen Thammaporn — 2024-12-29

Introduction and objectives: Kluai namwa (Musa sapientum L.), is an annual plant in the MUSACEAE family. It has been found that raw fruits have an astringent taste and have properties in curing gastritis, stomach ulcer and relieves mild diarrhea. Ripe fruit has a sweet taste and has properties as a mild laxative, relieves bloating, and prevents anemia. In addition, it was found that extracts from the fruit and the peel of the ripe fruit are effective in treating diarrhea, and can inhibit the growth of some bacteria such as Escherichia coli, Staphylococcus aureus, and Serratia marcescens; and stem extracts can inhibit the growth of gram-positive and gram-negative bacteria and other bacteria that grow well in acidic conditions. Therefore, to support the treatment results, a laboratory study was conducted to test the antioxidant activity and the activity against certain bacteria that cause diarrhea.

Method: In this experimental research, raw bananas were extracted by maceration with 95% ethanol; and the extract was tested for antioxidant activity using DPPH assay, ABTS assay, FRAP assay, total phenolic compound and total flavonoid content. In addition, antibacterial activity was tested against three bacterial species such as S. typhimurium, E. coli and S. aureus using disc diffusion.

Results: It was found that raw banana extract has good antioxidant activity. When tested using the DPPH assay, ABTS, and FRAP methods, the IC₅₀ values were found to be 0.612±0.008 mg/mL, and 0.023±0.000 mg/mL, and 39.892±11.659 mM Fe₂SO₂/mg, respectively. In addition, raw banana extract (95% ethanol) was found to have a higher amount of total phenolic compounds at 65.312±10.232 mg of gallic acid/mg of extract and total flavonoid content at 16.194±2.029 mg of catechin/mg of extract and has antibacterial activity against three strains of bacteria, including S.typhimurium, E. coli and S. aureus. The 95% ethanol extract of raw banana can inhibit E. coli and S. aureus the best, which has a minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) values of 6.25±0.00 and 12.5±0.00 mg/mL, respectively.

Discussion: Kluai namwa extract (95% ethanol) has antioxidant and effectively inhibit the growth pathogenic bacteria in the digestive system. So the results can be used as a guideline for developing and increasing the value of natural products to replace high-priced modern medicines and to develop them into medicines in the future.

Conclusion: The results suggest that the extract from kluai namwa has antioxidant properties and can inhibit the growth of S. typhimurium, E. coli, and S. aureus. This indicates its potential for developing natural products that could serve as alternatives to conventional medicines and may lead to the development of disease treatments in the future.

Production of Delta-9-Tetrahydrocannabinol Reference Standard from Cannabis sativa L.

Maytinee Limsiriwong — 2024-12-29

Introduction and objectives: Thailand's cannabis policy, which permits the medical use of cannabis, has led to increased production and research of cannabis-derived products. Ensuring the quality control of cannabis extracts and products to meet safety standards and legal requirements necessitates the use of a standard substance, delta-9-tetrahydrocannabinol (delta-9-THC), for comparative analysis in quantifying active compounds. The Bureau of Drug and Narcotic, Department of Medical Sciences, has undertaken the production of delta-9-THC reference standard to support national policy and reduce the ongoing reliance on imported reference standards.

Methods: Delta-9-THC was extracted and isolated from the inflorescence of cannabis using supercritical fluid extraction (SFE) with a suitable ratio of carbon dioxide to ethanol. The resulting extract was further purified using supercritical fluid chromatography (SFC) to obtaining delta-9-THC. The identity of the compound was confirmed through IR spectroscopy, mass spectrometry, and ¹H-NMR spectroscopy, and purity was analyzed using high-performance liquid chromatography (HPLC) prior to its establishing as a Department of Medical Sciences reference standard.

Results: The application of SFE with a carbon dioxide to ethanol ratio of 95:5 suitably produced a cannabinoids-rich extract. Subsequent purification of cannabinoids-rich extract via SFC achieved delta-9-THC with 99.4% purity, calculated on the as is basis, obtaining a yield of 0.6%. The produced delta-9-THC reference substance, formulated in methanol solution, adhered to ISO 17034:2016 standards for reference material production. Stability assessments indicated that the substance maintained its integrity when stored at 2–8°C over a three-year period. The homogeneity studies demonstrating uniformity throughout production batch. The certified concentration with associated uncertainty of the standard was determined to be 0.9303 ± 0.0792 mg/mL.

Discussion: The use of SFE and SFC under developed conditions enabled the selective isolation of delta-9-THC from other cannabinoids, achieving >99% purity. This method presents minimal environmental and health impacts compared to traditional organic solvents.

Conclusion and recommendations: The produced standard substance can be utilized for analyzing delta-9-THC amounts in cannabis plants, extracts, and products, ensuring the quality of domestically produced medical cannabis products. Furthermore, it serves as a resource for research, efficacy testing, toxicity assessment, and the determination of active ingredient dosages in future medical applications.

Development of Analytical Methods and Validation of Cannabinoid Quantification Methods in Cannabis sativa L. Flowers by Ultra High Performance Liquid Chromatography

Thanawat Thongchin — 2024-12-29

Introduction and objective: Cannabis (Cannabis sativa L.) has been used to treat several diseases since ancient time. Tetrahydrocannabinol (THC) is the major psychoactive compound and the other non-psychoactive ingredients are cannabidiol (CBD) and cannabinol (CBN). Cannabis has been used as an active ingredient of several drugs and products in the markets. However, the appropriate analytical methods for quality control of those compounds are still limited. This study aimed to develop analytical methods for quantification assessment of CBD, CBN and THC in cannabis flower samples using the Ultra-High Performance Liquid Chromatography (UHPLC) technique.

Methods: The study was divided into three steps: developing the UHPLC method for analyzing cannabidiol, cannabinol and tetrahydrocannabinol in cannabis flowers, testing the validity of the analysis method, and analyzing the quantity of cannabidiol, cannabinol and tetrahydrocannabinol in 12 cannabis flower samples.

Results: This method was validated by establishing the linearity for cannabidiol, cannabinol and tetrahydrocannabinol at the concentration range of 1.05–104.90, 1.00–99.60 and 1.00–99.90 μg/mL, respectively, with a determination correlation coefficient (r) of 0.999. The % recovery was in the range of 98.99–100.39%. The limit of detection of cannabidiol, cannabinol and tetrahydrocannabinol was 0.612, 0.872 and 0.320% w/w (calculated on the dry weight as C. s sativa flowers, µg/µg), respectively, while the limits of quantification were 2.041, 2.908, and 1.066% w/w (calculated on the dry weight as C. sativa flowers, µg/µg), respectively.

Discussion: The method developed for analyzing cannabidiol, cannabinol and tetrahydrocannabinol in raw cannabis flowers using UHPLC involves the extraction of dried cannabis flowers with ethanol as the solvent through the reflux method. The validity test results for the analysis method all fell within acceptable limits. This developed analysis method requires less time for analysis and involves a simple, convenient, and rapid preparation of the mobile phase.

Conclusion and recommendation: This recently developed method proves suitable for analyzing the levels of cannabidiol, cannabinol and tetrahydrocannabinol in cannabis flowers. It enables the establishment of accurate specifications for these compounds in cannabis flowers.

Quantitative Analysis of Astragalin Contents in Ethanolic Extract of Moringa oleifera Lam. (leave) by High-Performance Thin-Layer Chromatography (HPTLC)

Siriwan Chaisomboonpan — 2024-12-29

Introduction and objective: Astragalin, a flavonoid found in drumstick tree leaves (Moringa oleifera Lam., Moringaceae family), exhibits various biological activities, including anti-inflammatory and antioxidative effects and the ability to lower blood sugar levels. This herb has traditionally been used for medicinal purposes and in developing health products. However, there is currently no specification for the active marker content in this plant. This study aimed to develop an analytical method to quantify astragalin content in ethanolic extracts of drumstick tree leaves using high-performance thin-layer chromatography (HPTLC).

Methods: The development and validation were performed by weighing 100 mg of drumstick leave-ethanolic extract and dissolved in 25.0 mL of methanol. Subsequently, 1 µL of the solution was applied to the HPTLC plate coated with Silica gel GF₂₅₄ utilizing an autosampler. The mobile phase consisted of ethyl acetate, glacial acetic acid, formic acid, and water in a ratio of 20:1:1:2 (v/v/v/v). The developed plate was examined under UV366 nm after being sprayed with NP/PEG solutions, and astragalin content was quantitatively analyzed using a densitometer.

Results: This method was validated by establishing linearity for astragalin concentrations ranging from 1.96 to 11.76 µg/mL, yielding a determination correlation coefficient (r) of 0.9996. The accuracy of astragalin ranged from 97.75% to 99.49%, while the precision (%RSD) ranged from 0.22% to 0.45%. The limits of detection and quantification were determined to be 0.313 and 1.045 µg/mL, respectively. Quantitative analysis of astragalin in 12 leave-ethanolic extracts revealed an astragalin content of 0.06 ± % (w/w).

Discussion: The recently developed analytical method offers several advantages, including rapidity achieved through the simultaneous observation of multiple samples. It is also cost-effective, as the HPTLC plate employed as the stationary phase is more affordable than traditional high-performance liquid chromatography (HPLC) columns. Furthermore, this method is environmentally sustainable and safe, utilizing a reduced volume of mobile phase. Notably, the newly established method incorporates a lower acid concentration in the mobile phase than previously reported techniques. Consequently, HPTLC has been utilized to establish a method for quantification of astragalin in the ethanolic extract of drumstick tree leaves.

Conclusion and recommendation: This newly developed method is suitable and cost-effective for analyzing astragalin content in drumstick leave ethanolic extracts. The validation of the astragalin determination method in drumstick leaves using HPTLC has been successfully established and could be used to analyze astragalin content in drumstick tree leave extracts. Appropriate specifications for astragalin content in drumstick tree leave extract could be established.

Wisdom of Migraine Treatment: A Case Study of Folk Healers in Krabi Province

Jidakarn Phuengla — 2024-12-29

Introduction and objective: Migraine is a type of chronic headache. In Thai traditional medicine, it is comparable to Lom Pa Kang. People in Krabi province still receive medical treatment from folk healers. This research aimed to study wisdom about migraine treatment and explore medicinal plants used by folk healers in Krabi to treat migraine.

Methods: This qualitative research involved the selection of folk healers using purposive sampling and snowball and the collection of data on (1) general information about folk healers, (2) knowledge and wisdom of folk healers, (3) preparation of medicine formulas, and (4) information on herbal medicine formulas used in the treatment of migraine. The research was conducted over a period of 12 months.

Results: As described by folk healers, migraine is mainly caused by the wind element disorders resulting in headaches, dizziness, and blurred vision, affecting the fire element in patients with subsequent recurrences. When the two elements are out of balance, the water element (blood) is slack or insufficient blood flow to the brain, which causes headaches. Migraine is also caused by overwork, lack of sleep, eating spicy food, not eating at the right time, and stress. The treatment process includes taking a patient history, examining the body by taking the pulse on the wrist, prescribing herbal medicine, and giving advice. The principle of setting up a medicine recipe is that most folk healers will prescribe a medicine formula according to the cause of the illness and the patient's pulse rate. The medicinal formula has the main flavors being sukhum, and cool respectively. The herbs most often used by folk healers are ginger (Zingiber officinale Roscoe.) and jewel vine (Derris scandens (Roxb.) Benth.).

Discussion: In Thai traditional medicine, migraine is caused by an aggravation of wind element in the body. Physical examination by feeling the pulse reveals that the Vata and Pitta beat rapidly and strongly. Taking mainly bitter and sukhum herbs helps reduce the aggravated fire element, disperses the wind, and helps balance the wind element. Herbs used in folk medicine recipes have been reported to have pharmacological effects with analgesic and anti-inflammatory properties.

Conclusion: According to folk medicine knowledge, migraine is caused by the exacerbation of Vata and Pitta, which are related to the characteristics of the pulse. Folk healers usually prepare a migraine drug formula chiefly containing calm and cool flavor herbs to reduce the strength of the wind and fire elements.

Study of the Trade of CITES-Listed Medicinal and Aromatic Plants and Products in Thailand

Sumalee Tongdonae — 2024-12-29

Introduction and objectives: Many species of medicinal and aromatic plants (MAPs) are threatened by international trade, leading to extinction. The Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) includes several MAP species in CITES Appendices. As a CITES party, Thailand has to cooperate in controlling the trade of listed plants. This study aims to investigate the trade of CITES-listed MAPs and their products in Thailand, focusing on: 1) the current situation of MAP imports and exports, 2) challenges in enforcing domestic laws as per CITES provisions, and 3) recommendations to improve the efficiency of trade control for MAPs and their products.

Methodology: This is a mixed method study, including quantitative research to analyse trade statistics of MAPs from the CITES website and relevant data from the Department of Agriculture, and qualitative research involves literature review and surveys of herbal trade on online platforms and field study at herbal shops. Data were collected using record forms and semi-structured in-depth interviews with official staffs and entrepreneurs.

Results: The trade survey of CITES-listed MAPs found 31 species sold as herbal medicines, extracts, finished herbal products, and cosmetics. Online trade showed more varieties of species and products compared with those sold in domestic stores. The species frequently found are Panax ginseng, P. quinquefolius, Saussurea costus, Aquilaria spp., and Dendrobium spp. It was also found that scientific names of some traded herbal materials were misidentified. According to trade statistics from the CITES website between 2020 and 2022, Thailand exported the highest volume of listed MAPs (49% of the global export volume), with Dendrobium hybrids as the most exported species. During this period, reports indicated 158 export instances covering 35 species of MAPs from CITES parties to Thailand, while Thailand reported only 43 import instances of 21 species. Interviews with stakeholders revealed a lack of understanding regarding the species and regulations governing the trade of CITES-listed MAPs.

Discussion: This study reveals that the control of trade in CITES-listed MAPs and their products in Thailand is inefficient. This is not due to flaws in domestic laws, but partly due to the lack of knowledge and understanding among stakeholders regarding the trade in CITES-listed MAPs and their products.

Conclusion and recommendations: It is essential to enhance the effectiveness of trade control for MAPs and their products by establishing a comprehensive database of MAPs listed in CITES and integrating information among relevant agencies. Furthermore, training and provision of information via appropriate channels should be offered to educate officials, traders, and manufacturers involved in lawful practices regarding the trade of CITES-listed MAPs.

Policy and Ethics

Vichai Chokevivat — 2024-12-29

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A Survey of Knowledge and Opinions on Cannabis Use among People in Mueang Chiang Mai District

Natjakorn Jaimun — 2024-12-29

Introduction and objective: The policy of decriminalizing cannabis from being classified as a Category 5 narcotic may widely spread its use for both medical and recreational purposes. However, the readiness of Thai citizens, especially knowledge of the clinical benefits, risks, and laws and regulations of cannabis, has not been widely studied. This study’s objective is to investigate the knowledge and opinions of Thai citizens who live in Mueang Chiang Mai regarding cannabis use, benefits, risks, and related laws and regulations.

Methods: A cross-sectional survey study was conducted among Thai citizens aged 20 years or above who lived in Mueang Chiang Mai. A survey questionnaire was developed and validated, and then distributed to subjects using both paper-based questionnaire and online through a Google form. The questionnaire consisted of three parts, including 1) general information, 2) knowledge related to cannabis, and 3) opinions towards cannabis. Descriptive statistics were used to analyze data.

Results: A total of 329 respondents participated in the survey, with 225 females (68.39%); and most of them were 20–29 years old (47.35%). Overall, the knowledge score (on a scale 0–20) related to cannabis was moderate (14.80 ± 2.39). Average scores for general information about cannabis, benefits of cannabis, risk of cannabis, and laws and regulations related to cannabis were 3.89 ± 0.73, 3.24 ± 1.38, 3.98 ± 1.12, and 3.68 ± 0.85, respectively. Participants’ opinions indicated that cannabis should be only used for medical purposes under supervision of health professionals (4.20 ± 0.77). In addition, participants revealed that current cannabis commercials and advertisements might misinform the public (4.07 ± 0.85). Moreover, participants’ opinions showed that household cannabis planting should be restricted (4.03 ± 0.85). The least agreed-upon issues from participants were that individuals aged <18 years should be allowed to use cannabis (2.88 ± 1.15), patients with chronic conditions should be allowed to use cannabis (3.06 ± 0.81), and cannabis could be used for recreation (3.18 ± 0.97).

Discussion: The knowledge and opinions on cannabis use among people in the area remain at a moderate level, which does not align with the increasing number of cannabis shops. In addition implementing regulatory measures to control cannabis use by relevant agencies, such as the Ministry of Public Health, should be made to prevent and strengthen social immunity among the public.

Conclusion: This study demonstrates that knowledge related to cannabis among the people in Mueang district, Chiang Mai province, is at a moderate level in terms of general information, benefits, harms, and laws related to cannabis. Additionally, the people of Chiang Mai province believe that the use of cannabis for medical treatment should be under the supervision of healthcare professionals. Advertising media creates misunderstandings about cannabis, and there should be a limit on the number of cannabis plants cultivated per household.

Instructions to Authors (Revised 2023)

Department of Thai Traditional and Alternative Medicine — 2024-12-29

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Vichai Chokevivat — 2024-12-29

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Editor's Note

Vichai Chokevivat — 2024-12-29

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Monograph of Select Thai Material Medica: MARUM

Subcommittee on the Preparation of Monographs of Selected Thai Materia Medica — 2024-12-29

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Dictionary of Traditional Chinese Medicine Volume 2 (Chinese-Thai-English) (19)

Tawat Buranatawonsom — 2024-12-29

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