Journal of Thai Traditional and Alternative Medicine

Editorial Board

Vichai Chokevivat — Thu, 31 Aug 2023 00:00:00 +0700

N/A

Thunbergia laurifolia Lindl.

Thongchai Sooksawate, Rutchanee Chantraket, Pakakrong Kwankhao — Thu, 31 Aug 2023 00:00:00 +0700

N/A

Efficacy and Safety of Ya Sahatsathara on Diabetic Peripheral Neuropathy of Lower legs in Type 2 Diabetic Patients

Thu, 31 Aug 2023 00:00:00 +0700

Introduction and objectives: Complication of peripheral neuropathy in patients with type 2 diabetes mellitus (T2DM) continues its natural course with increasing pain and numbness, loss of sensation, ulcers, infections, amputations and even death. Ya Sahatsathara (SHT) is one of the herbal medicinal formulas on the National List of Essential Medicines. There is an indication of the use for relieving gastrointestinal gas (lom kong yap), muscle and joint pain, hand spasms and foot numbness. This study aimed to investigate the efficacy and safety of SHT on peripheral neuropathy of lower legs in T2DM patients, and to assess the correlation between SHT therapy and the quality of life of the patients.

Methods: This double-blinded, randomized controlled trial was undertaken in 62 T2DM patients with peripheral neuropathy, aged 45–75 years, who received treatment in the Diabetes Clinic of Khlong Luang Hospital and Khlong Nueng THPH. The patients were divided into two groups: group 1 receiving SHT and group 2 receiving placebo. Each patient took 500 mg (2 capsules) each time, 3 times a day before meals for 28 consecutive days. Both groups received a vitamin B1 supplement after meals. Screening for peripheral nervous system degeneration was performed using the Michigan Neuropathy Screening Instrument (MNSI). The drug efficacy was evaluated with the Short-Form McGill Pain Questionnaire and the Neuropathy Total Symptom Score-6 (NTSS-6); and the quality of life (QOL) was assessed with the Diabetes-39 Questionnaire.

Results The group received SHT found a change in the pain score of McGill, which decreased by -1.66 (95%CI: -2.23, -1.09). The total score of the six sensory symptoms decreased by -1.24 (95%CI: -1.83, -0.64). Aching pain decreased by -0.69 (95%CI: -0.85, -0.53), and numbness decreased by -0.62 (95%CI: -0.76, -0.48). The evaluation of the quality of life of diabetic patients with Diabetes-39 indicated a better quality of life in terms of energy and vitality, with the effect scores decreasing by -5.27 (95%CI: -6.81, -3.72).

Discussion The scores for pain and sensory symptoms, such as aching pain and numbness, as well as the quality of life in terms of energy and vitality. The group received SHT found change in scores decreased significant differences (p-value < 0.05) compare with placebo control group. In addition, liver and kidney function values were within normal limits. The adverse reactions listed in consist of abdominal pain, dry mouth, dry throat, dizziness and constipation were mild to moderate severity.

Conclusion: Ya Sahatsathara medication in T2DM patients with peripheral neuropathy, for 28 days consecutively, can reduce sensory symptoms, pain and numbness, but increase quality of life regarding energy and vitality. No severe adverse drug reactions were observed.

A Comparative Study on the Efficacy and Side Effects of Ya That Banchop and Simethicone in Treatment of Patients with Functional Dyspepsia at HM The King’s 6th Cycle Birthday Chaloem Phra Kiat Health Center, Pathum Thani Province

Worakan Mukpradab, Thavatchai Kamoltham — Thu, 31 Aug 2023 00:00:00 +0700

Introduction and objectives: At present, dyspepsia is the most common condition of gastrointestinal diseases; and in the primary care system it is diagnosed as Functional Dyspepsia (FD). This study, therefore, aimed to explore the efficacy, side effects, and quality of life of the patients who took either Thai herbal drug Ya That Banchop (YTB) or simethicone usually prescribed to treat flatulence. It is hoped that the results of the study will provide important information to support the use of YTB in the treatment of flatulence in the future.

Methods: This clinical trial involved 80 patients with FD or idiopathic chronic flatulence. All participants were divided into two groups, 40 each: the experimental group receiving YTB and the control group receiving simethicone. Each participant took 1 capsule before meals for 7 days and used the Severity of Dyspepsia Assessment (SODA) questionnaire, Naranjo's ADR algorithm, and the abbreviated World Health Organization Quality of Life Assessment Questionnaire. Data were analyzed using descriptive statistics; and basic statistics were calculated for paired samples t-test and independent samples t-test.

Results: A comparison of the efficacy of YTB and simethicone in the treatment of FD patients before and after meals showed no significant difference (p-value < 0.001) with SODA average scores of -5.32 ± 3.63 and -7.82 ± 2.89, respectively. Both groups had medication side effects including frequent hunger, 22.5% and 10%, respectively, and insomnia, 0% and 10%, respectively. The overall quality of life scores in both groups before and after taking medications were not significantly different, with average scores of 9.82 ± 3.38 and 8.57 ± 3.30, respectively.

Discussion: A comparison of the efficacy of YTB and simethicone in treating idiopathic flatulence before and after meals showed no significant difference (p < 0.001). Side effects including frequent hunger and constipation were reported after taking YTB, while pain and insomnia were reported after simethicone medication. The overall quality of life scores in both groups before and after taking the drugs were not statistically different (p < 0.001).

Conclusion: Ya That Banchop can be the first choice for relieving functional dyspepsia, while simethicone can be substituted. And its side effects require long-term clinical studies.

Efficacy and Safety of Thai Traditional Medicine Formula “Benja Amarit” Extract in Patients with Hepatocellular Carcinoma: A Clinical Trial Phase II

Thu, 31 Aug 2023 00:00:00 +0700

Introduction and objective: Hepatocellular carcinoma (HCC) is a major life-threatening disease affecting human health worldwide including Thailand. “Benja Amarit” (BJA) is a Thai herbal medicine formula for HCC patients available in state health-care facilities. Nevertheless, clinical evidence to support the efficacy of BJA extract for HCC treatment is still lacking. This study aimed to explore the efficacy of BJA extract on the survival rate of patients with HCC.

Methods: A double-blind randomized controlled trial was conducted in HCC patients with Child-Pugh class A or B, who could not receive standard treatment. We used the case (BJA group) to control (placebo group) ratio of 2:1. Both groups received doses of treatment depending on body weight throughout the study. One-year survival, hazards ratios, alpha fetoprotein (AFP) levels, and the quality of life (QoL) of the patients were evaluated. Clinical outcomes were evaluated every 28 days for five times. An intention-to-treat analysis was used. Kaplan-Meier, log-rank test, Cox proportional hazard model, Chi square or Fisher’s exact test, Mann Whitney U test, and Generalized Estimating Equations (GEE) or Multilevel model (mixed model) were performed using STATA version 14.

Results: Of all 81 HCC patients, 45 participated initially in the study (32 in BJA group and 13 in control group). By the end of the 12-month study period, there had been 40 deaths (88.9% of all participants): 13 (100%) in the control group and 27 (84.4%) in the BJA group. Based on a comparison between the two groups, their survival rates were not different [crude hazard ratio (HR) = 0.67, 95% CI = 0.34–1.31].

Discussion: A significant HCC death prevention in the BJA group was observed with multivariate adjustments for sex, age, tumor sizes, major symptoms and AFP levels (HR = 0.25, 95% CI = 0.06–0.97, p-value = 0.046). Moreover, flatulence (HR = 3.54, 95% CI = 1.017– 11.71, p-value = 0.046) was also found to be another factor increasing the risk of HCC deaths. However, no significant difference of QoL between the two groups was detected, nor were serious adverse events (AEs) reported in the BJA group.

Conclusion and recommendation: This study on BJA treatment indicates that BJA extract is a factor for decreasing mortality in HCC patients.

A Retrospective Study on Efficacy of Thai Herbal Formulas for Treating Chronic Insomnia in Phunphin Hospital, Surat Thani Province

ศรัณยา คงยิ่ง, Thanyaluck Siriyong — Thu, 31 Aug 2023 00:00:00 +0700

Introduction and objective: This retrospective study aimed to demonstrate the efficacies of Thai herbal formulas used for chronic insomnia treatment in Phunphin Hospital, Surat Thani province, from 2020 to 2022.

Methods: The study involved a sample of 50 purposively selected patients with insomnia. Three groups of them regularly received each of Thai herbal formulas: Ya Sukkhasaiyat, cannabis oil (Deja formula), and Yahom Thephachit. Then, five parts of data of insomnia patients including personal factors, history on herbal formula use for insomnia, sleep quality (Pittsburgh Sleep Quality Index: PSQI), stress level records (ST-5 scores), and depressive disorder screening data (2Q scores) were evaluated at baseline and one month after treatment.

Results: Part 1, of all participants, most of them (78%) were female, 64% were > 60 years old, 38% had a normal BMI, 32% had diabetes and hypertension, and 64% exercised by brisk walking. Part 2, regarding the use of herbal drugs for insomnia, the efficacies of Ya Sukkhasaiyat, cannabis oil (Deja formula), and Yahom Thephachit were not significantly different in treating insomnia (P > 0.05). Part 3, after herbal therapies, the sleep quality was significantly better with the average PSQI score dropping from 10.06 to 5.20 (P < 0.001). Part 4, after taking herbal medications, the average stress level (ST-5 score) decreased significantly (P < 0.001). Part 5, after taking herbal medications, the average depression level (2Q score) slightly decreased, indicating no significant efficacies of the herbal drugs in reducing depression (P > 0.05).

Discussion: Thai herbal formulas including Ya Sukkhasaiyat, cannabis oil (Deja formula), and Yahom Thephachit were effective for the treatment of chronic insomnia which conformed to other previous studies.

Conclusion and recommendation: Thai herbal formulas are efficacious for the treatment of chronic insomnia. However, a prospective randomized controlled trial should be conducted to confirm the efficacy of herbal treatments; so they might be used as alternative remedies for chronic insomnia.

Safety Evaluation of Rhinacanthus nasutus Root Extract Gel Prepared from a Pilot Plant

Thu, 31 Aug 2023 00:00:00 +0700

Introduction and objective: Rhinacanthus nasutus (commonly known as thong phan chang in Thai) root extract gel preparation, containing 0.1% rhinacanthin C, is an herbal product that was developed as an effective topical agent for fungal skin infection using knowledge from both scientific research and Thai traditional medicine. However, the safety of a novel herbal preparation should be assessed before it is approved for use in humans. This study aimed to evaluate the safety of R. nasutus root extract gel preparation prepared in a pilot plant.

Methods: Safety study of R. nasutus root extract gel was conducted following the Organisation for Economic Co-operation and Development (OECD) Guidelines, including the bacterial reverse mutation test (Test Guideline 471) and the acute dermal irritation/corrosion test (Test Guideline 404). Skin irritation testing in healthy Thai volunteers was performed using a single patch test.

Results: Topical preparation of R. nasutus root extract was not found to cause any mutations in bacteria, nor did it irritate or corrode the animal skin. Moreover, it did not cause any skin reactions in healthy volunteers during the single patch test.

Discussion: R. nasutus root extract gel preparation, containing 0.1% rhinacanthin C, is categorized as an herbal product derived from research and development beyond traditional knowledge. Thus, the product needs safety and efficacy data from animal models and humans for product registration. In order to study the safety profile of the product according to international standards, the results suggest the R. nasutus root extract gel had non-genotoxic and non-skin corrosive effects, nor did it cause dermal irritation in both animal models and humans.

Conclusion and recommendation: R. nasutus root extract gel preparation is deemed to be safe for humans and we can further proceed to clinical trials for efficacy and safety evaluations in patients with fungal skin infections.

Anti-SARS-CoV-2 Activity and Inhibition of ACE2 and TMPRSS2 Expression of Ya Prasa Pro Yai, Ya Ha Rak and Ya Chanthalila Traditional Drug Formulas

Thu, 31 Aug 2023 00:00:00 +0700

Introduction and objective: Coronavirus disease 2019 (COVID-19) is caused by the SARS-CoV-2. Some Thai traditional drug formulas have been prescribed in Thailand to alleviate symptoms caused by the virus. The objective of this study was to investigate the anti-SARS-CoV-2 properties of Ya Prasa Pro Yai (PSP), Ya Ha Rak (Y5R) and Ya Chanthalila (CTL) drug formulas used as antipyretic in Thai traditional medicine.

Methods: The drugs were extracted and screened for anti-SARS-CoV-2 activity using plaque reduction assay. The extracts were further investigated for ACE2 and TMPRSS2 enzymatic inhibition and gene expression assays of several host-target molecules in Calu-3 cells.

Results: PSP, Y5R, and CTL traditional drug formulas were found to have shown inhibitory activities against SARS-CoV-2 at 45.6%, 45.6% and 50.1%, respectively, at the concentration of 5,000 µg/mL. CTL also significantly inhibited (71.2%) the main human receptor ACE2 at the concentration of 2,000 µg/mL, which was higher than both PSP and Y5R extracts and demonstrated TMPRSS2 enzymatic inhibition in a dose-dependent manner. CTL also significantly down-regulated the expression of ACE2, but not TMPRSS2, PIKfyve and cathepsin L in Calu-3 cells.

Discussion: The Thai traditional drug formulas reported here provided anti-SARS-CoV-2 activities. Testing of the Anti-viral properties of the three preparations at 5 mg/mL did not reveal significant differences. However, CTL showed more anti-viral activity than others consistent with the previous study that the effect may be from E. longifolia Jack, one of the components of the formulation. CTL showed inhibition of ACE2 and TMPRSS2 enzymes in dose-dependent manner compared to the controls. Moreover, the CTL preparation also demonstrated a significant down-regulation of ACE2 gene expression on calu-3, human lung cell lines which are the mechanisms inhibiting the entry into the cells in the early phase of infection.

Conclusion: Ya Prasa Pro Yai (PSP), Ya Ha Rak (Y5R) and Ya Chanthalila (CTL) herbal drug formulas were effective against SARS-CoV-2. Ya Chanthalila should be especially reconsidered as the first-line drug in clinical trials, which can not only reduce fever, but also limit SARS-CoV-2 spreading in the patient.

Effect of Extraction Time of Kaeng Liang Paste on Cell Viability and Anti-inflammatory Activity by NF-kB Induction

Thu, 31 Aug 2023 00:00:00 +0700

Introduction and objective: The occurrence of emerging diseases has encouraged scientists to search for new drugs or methods as well as food supplements for health promotion, disease prevention, treatment and rehabilitation. Nowadays, herbs are one of the targets for drug discovery. This study aimed to explore the effect of extraction time of Kaeng Liang paste on its immunological activities, as determined by cell viability assay and the anti-inflammatory activity by NF-kB induction

Methods: Kaeng Liang paste extracts were obtained by decoction at 10, 20, and 30 minutes; and the determination of cell viability and anti-inflammatory activity by NF-kB induction of the extracts was performed.

Results: The three extracts of Kaeng Liang paste were capable of reducing cell viability and proliferation of macrophages. A consequence study about NF-kB induction indicated that there was a trend to reduce the release of inflammatory substance from macrophage in NF-kB pathway. This effect could be seen when they were up-regulated by PamCys3. Especially, the extract from 30-min decoction could decrease the function of NF-kB more than those from 10-min and 20-min decoctions and the untreated cells.

Discussion: Kaeng Liang is a Thai spicy-veggie soup, whose bioactivity studies have been conducted. It has previously been reported that it has anti-cancer activity. This study is part of a study on the immunomodulatory and anti-inflammatory activities of Thai curries. Previously, the amount of constituents in phenolics and flavonoids, and antioxidant activities of Thai food extracts such as Kaeng Liang, Papaya Salad, and Pad Kaphrao were studied. The results of this study confirmed the anti-inflammatory activities of pepper and shallots, which were the main ingredients of Kaeng Liang paste. It is suggested that further studies of the mechanism of anti-inflammatory activities should be undertaken.

Conclusion and recommendation: The study has confirmed the anti-inflammatory activity of shallot and pepper, the main ingredients of Kaeng Liang paste. Nevertheless, this study was conducted in vitro, further investigations on its anti-inflammatory activity in animals, pharmacological aspects and the mechanism of anti-inflammatory activities should be undertaken.

A Comparison of Antibacterial Activity Against Acne-Inducing Bacteria, Anti-inflammatory Activity, and Total Phenolic Content of Fresh and Dried Leaves of Thunbergia laurifolia Lindl Extracts

Thu, 31 Aug 2023 00:00:00 +0700

Introduction and objective: Acne is a skin disease with swelling, redness, inflammation, or bacterial infection caused by Cutibacterium acnes and Staphylococcus aureus. In Thai traditional medicine, herbs have been employed to treat such diseases. Thunbergia laurifolia Lindl. (rang chued in Thai), with a main ingredient of phenolic compounds, is used for treating/relieving skin diseases, fever, pain, and swelling. The dried leaf extract of T. laurifolia has been reported on inhibition of C. acnes. However, a comparison of antibacterial activities of fresh and dried leaves of T. laurifolia has not yet been reported. Therefore, this study aimed to investigate T. laurifolia extract’s antibacterial activity against bacteria-inducing acne, anti-inflammatory activity, and total phenolic content, and to compare the effects of fresh and dried T. laurifolia extracts obtained with various solvents.

Methods: Antibacterial activity determination was performed using broth microdilution assay to detect minimal inhibitory concentration. Total phenolic content was evaluated using Folin-Ciocalteu technique and anti-inflammatory activity was detected in nitric oxide released from RAW264.7 cells.

Results: The comparative examination was made of fresh and dried leaves and the solvent effect on biological activity of T. laurifolia. Fresh leaf extract was found to have a higher phenolic content than dried leaf extract. Ethanolic fresh leaf extract showed the highest inhibitory effect on C. acnes growth and nitric oxide production. In addition, only fresh leaf extract could inhibit S. aureus growth.

Discussion: The biological activity of fresh leaves of T. laurifolia was better than dried leaves; and the biological activity of ethanolic extract was better than the aqueous extract. High temperatures might cause the degradation of active ingredients in T. laurifolia. Thus, the biological activity of dried leaf extracts and the aqueous extracts was lower than in the ethanolic extract of fresh leaves of T. laurifolia.

Conclusion: Of T. laurifolia, fresh leaves have better antibacterial and anti-inflammatory activities than dried leaves. The suitable extraction is maceration in 95% ethanol. Thus, ethanolic T. laurifolia fresh leaf extract is more suitable for developing anti-acne products in the future.

Macroscopic and Microscopic Characteristics of Eupatorium fortunei Turcz.

sopidawan wichienkul, Pairin Thongkhum — Thu, 31 Aug 2023 00:00:00 +0700

Introduction and objective: San Phra Hom (SPH), or Eupatorium fortunei Turcz. in the family Compositae, has properties according to ancient medicinal texts using leaves. It is an antipyretic, a cold remedy, a detoxifier, and a tonic; and it is an ingredient of Ya Khiao Hom, which is included in the National List of Essential Medicines’ antipyretic group. The objective of this study was to establish the macroscopic and microscopic characteristics of SPH leaves and stems.

Methods: The macroscopic and microscopic characteristics were evaluated, including shape, color, smell, and taste. The tissue structure was investigated under a microscope.

Results: The macroscopic characteristics of dry SPH leaves and stems were greenish-brown, thin and fragile with a light smell and slightly bitter taste, while the microscopic characteristics observed included the upper and lower epidermis in surface view, lamina, midrib and petiole in cross-sectional view, and powder drugs made from leaves/petioles and stems, which are presented as color photographs and drawings under a microscope using a photography set and a drawing tube attached to the microscope.

Discussion: As SPH leaves are used as a medicinal ingredient, the collected herbal material may contain other parts of the plant such as petioles and stems. So such parts need to be studied also in order to obtain more microscopic information. The results have been recorded by drawing and photographing under more modern microscope, under which the tissues can be more realistically drawn and photographed.

Conclusion and recommendation: The macroscopic and microscopic characteristics of San Phra Hom leaves and stems have been collected. The information can be used for pharmacognostic specifications preparation, identity proofing, herb quality control, the preparation of Thai Herbal Pharmacopoeia, and analytical service provision.

Physico-Chemical Properties of Etlingera elatior (Jack) R.M. Smith. Flowers

SAYAN RUENGKHET, Thanawat Thongchin, Aussavashai Shuayprom, Sakwichai Ontong — Thu, 31 Aug 2023 00:00:00 +0700

Introduction and objective: Dala in Thai, scientifically known as Etlingera elatior (Jack) R.M. Smith, belongs to the Family Zingiberaceae. It has been reported that dala is an antioxidant and has medicinal properties to cure hives and other skin diseases. However, the standard methods for quality control of this plant have not been established in Thai Herbal Pharmacopoeia. This study aimed to investigate the physico-chemical properties of E. elatior flowers.

Methods: Twelve samples of E. elatior flowers were obtained from natural sources in Thailand and compared to the authentic sample received from the Herbarium Laboratory. Samples of E. elatior flowers were preliminarily examined for chemical properties using color reaction. Chemical identification was performed using the thin layer chromatography (TLC) method and their physico-chemical properties were also determined.

Results: Of all 12 flower samples, based on the color reactions of the preliminary chemical examination, 11 were positive when tested for flavonoids and phenolic as well as amino acids; and based on the TLC method, they were positive to flavonoids and chlorogenic acid. As for their physico-chemical property tests including gravimetric method, their mean amounts + SD for moisture, total ash, acid-insoluble ash, water-soluble extractive and 95% ethanol-soluble extractive were 9.05 ± 2.79%, 9.34 ± 0.53%, 0.20 ± 0.06%, 19.87 ± 3.45% and 13.24 ± 1.90% w/w, respectively.

Discussion: One sample of E. elatior flowers collected from Betong district in Yala province had a chromatogram different from the other 11 samples. It had one chemical compound, but chlorogenic acid was not detected, possibly due to differences in species, herb age, harvest time, soil conditions, mineral contents, terrain or climate.

Conclusion and recommendation: The results have led to the establishment of a monograph that contains standard specifications of dala flowers in the Thai Herbal Pharmacopoeia, which will be used as a reference in the country.

Development and Method Validation of Friedelin Contents in Cannabis sativa L. Roots Using Thin Layer Chromatography Densitometry

Thu, 31 Aug 2023 00:00:00 +0700

Introduction and objective: Friedelin is an active ingredient present in Cannabis sativa L. roots and possesses antioxidant, anti-inflammatory and pain relief properties. Although cannabis is widely used in traditional medicine and as health products, there is no quality control method for it. The objective of this study was to develop an analytical method for determining the friedelin content in C. sativa roots using thin layer chromatography (TLC) densitometry.

Methods: A sample solution of C. sativa roots was injected into the TLC system. The solvent was a mixture of toluene and chloroform (9:1 ratio). After that, the plate was sprayed with vanillin-H₂SO₄ solution and detected with ultraviolet light (366 nm).

Results: This method was validated by establishing the linearity for friedelin concentrations ranging from 25.99 to 831.60 µg/mL with a determination correlation coefficient (r) of 0.9990. The % recovery was in the range of 100.57–102.45%. The limits of detection and quantitation were equal to 0.006% and 0.021% w/w (dry weight C. sativa roots, µg/µg), respectively. The average content of friedelin in C. sativa roots was 0.025% w/w (dry weight C. sativa roots, µg/µg).

Discussion: In extracting C. sativa roots, hexane was chosen as a solvent because it has high nonpolar properties; and it is able to dissolve more friedelin, a substance with nonpolar properties as well, from the C. sativa roots, compared to ethanol extraction. In the newly developed analytical method, the stationary cycle used was HPTLC plates, which were cheaper, compared to the columns of the GC-MS/FID method. Thus, a TLC dosimeter was used to develop the method for determining the amount of friedelin in C. sativa roots.

Conclusion and recommendation: This newly developed method is suitable and can be used to analyze the content of friedelin in C. sativa roots; and the appropriate specification of friedelin content in C. sativa roots can be established.

Development and Method Validation of Mitragynine Contents in Mitragyna Speciosa (Korth.) Havil. Leaves by Ultra High Performance Liquid Chromatography

Thu, 31 Aug 2023 00:00:00 +0700

Background and objective: Kratom (Mitragyna speciosa) plant has been removed from the list of controlled substances in Category 5, making it legally permissible for possession and consumption. Additionally, kratom is now recognized for its economic value. The primary active ingredient in kratom leaves is mitragynine, which induces pleasurable effects and provides pain relief. The objectives of this study were to develop a method for analyzing the quantity of mitragynine in kratom leaves using ultra-high performance liquid chromatography (UHPLC) and to test the validity of the developed analysis method.

Methods: The study was divided into three steps: developing the UHPLC method for analyzing mitragynine in kratom leaves, testing the validity of the analysis method, and analyzing the quantity of mitragynine in 17 kratom leaf samples.

Results: The appropriate conditions for the analysis were using an ARC-18 stationary phase measuring 4.6 x 150 millimeters with a particle size of 2.7 micrometers and a mobile phase consisting of 0.1% ortho-phosphoric acid in water and 0.1% ortho-phosphoric acid in acetonitrile at a flow rate of 1.0 milliliter per minute. The detection wavelength was set at 222 nanometers, with an average retention time of 7.19 minutes. The applicability test of the analysis method showed that the calibration curve was linear in the concentration range of 0.30–30.00 micrograms/milliliter, with a correlation coefficient (r) of 0.9998. The mean recovery percentage ranged from 99.72% to 100.88%, and the HORRAT values were in the range of 0.21–0.51. The precision test showed a relative standard deviation of 0.53 for samples analyzed on the same day and 0.78 for samples analyzed over three consecutive days. The limit of detection (LOD) was found to be 0.19 micrograms/milliliter, and the limit of quantification (LOQ) was 0.64 micrograms/milliliter. Using this developed UHPLC method for analysis, the study determined the quantity of mitragynine in the 17 kratom leaf samples, with concentrations ranging from 0.99% to 1.89% w/w.

Discussion: The method developed for analyzing mitragynine in raw kratom leaves using UHPLC involves the extraction of dried kratom leaves with ethanol as the solvent through the reflux method. The results of the validity test of the analysis method were all 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: The developed UHPLC method for analyzing mitragynine in kratom leaves was found to be accurate, precise, and suitable for determining the quantity of mitragynine in raw kratom leaves and kratom leaf extracts. It can be used for routine analysis.

Service Management of Medical Cannabis Clinics and Cannabis Product Prescription at Government Hospitals in Nan Province

Valika Rattanachun, Kanyarach Wongphuka, Nualchanok Wongsampant — Thu, 31 Aug 2023 00:00:00 +0700

Introduction and objective: The medical use of cannabis extract is increasingly accepted. In Thailand, the Ministry of Public Health recognizes the benefits of medical cannabis products and supports efficient public access by establishing more medical cannabis clinics in government hospitals. However, the current situations of such clinics at state hospitals fall short of the intended coverage, possibly due to various related factors. Therefore, this study aimed to investigate the clinic management and prescription of medical cannabis products in government hospitals in Nan province and identify factors associated with clinic establishment.

Methods: This cross-sectional descriptive research used a purposive sampling method to select a sample of 80 medical personnel in 15 government hospitals in the province. Data were collected using a questionnaire from October 15, 2021, to March 30, 2022, and analyzed using Pearson correlation and Fisher's exact test.

Results: Of all 80 participants, 73.8% were ready to establish medical cannabis clinics and 77.5% had positive attitudes towards providing such services. Of all the 15 hospitals, 78.5% (1 general and 11 community hospitals) had established such clinics, but 23.8% were not actively providing cannabis products due to limited resources, especially personnel. Significant correlations were found between age and work duration with attitudes (p < 0.05) and overall attitudes towards overall clinic management (p < 0.05); and between attitudes on health/medical cannabis system development and clinic establishment (p < 0.01). However, the level of knowledge of participants was only moderate and was not significantly related to the prescription of cannabis products.

Discussion: Based on the findings mentioned above, general hospitals serving as medical hubs were better equipped and more prepared to establish and provide medical cannabis clinics or services compared to community hospitals, mainly due to resource limitations, especially in terms of personnel. Although a majority of participants (95.0%) were aware of the policy objectives for setting up medical cannabis clinics and the societal awareness of cannabis treatment, there were still limitations in the knowledge and prescription practices among physicians. These limitations were influenced by their limited experience, the early stage of clinic establishment, and the insufficient capacity of the service system, resulting in a small number of patients seeking medical cannabis treatment and inadequate empirical evidence. These factors affected physicians' decisions to prescribe cannabis products.

Conclusion: To support the establishment and effective operations of medical cannabis clinics, there is a need to develop positive attitudes and perspectives towards cannabis treatment. Additionally, there should be efforts to develop medical cannabis clinics by implementing a comprehensive health service plan. The implementation will help create a clear direction and objectives for the effective functioning of such clinics. Furthermore, it is essential to conduct clinical research on the effectiveness of medical cannabis products as evidence-based practices, which will contribute to building confidence in the products for treating patients.

Traditional Food Culture for Elderly Health Promotion in Wiang Tha Kan and Yuwa Communities, San Pa Tong District, Chiang Mai Province

Samart Jaitae — Thu, 31 Aug 2023 00:00:00 +0700

Introduction and objective: Traditional food culture promotes the health of the elderly through a combination of local wisdom and lifestyle. The purposes of this research were to (1) explore traditional food culture and (2) synthesize traditional food guidelines for elderly health promotion.

Methods: This mixed methods research involved 295 elderly persons and 18 stakeholders in Wiang Tha Kan and Yuwa communities in Chiang Mai’s San Pa Tong district. Data were collected using a questionnaire, informal interviews and focus group discussions, and were then analyzed with descriptive statistics and content analysis.

Results: The traditional food culture for older persons included food preparation, raw material source seeking, cooking process, food-set arrangement, and food serving. The total mean score for traditional food culture was at a moderate level (3.46 ± 0.80). In addition, the stakeholders have suggested that, to incorporate traditional food culture into health promotion for elders, the community and relevant agencies should create and develop fresh food production areas, and promote food product development and local consumption for elderly persons.

Discussion: Traditional food culture is important for health promotion of the elderly, especially kaeng (soup) and nam phrik (chilli sauce) recipes. This option exists and operates based on community food resources diversity, beliefs and faith.

Conclusion and recommendations: The total average score of food culture for the elderly was at a moderate level. In this regard, technical and funding support should be provided for improving academic and learning resources, and creating participation process and guidelines for enhancing the utilization of food resources in the community.

Policy and Ethics

Vichai Chokevivat — Thu, 31 Aug 2023 00:00:00 +0700

N/A

Vichai Chokevivat — Thu, 31 Aug 2023 00:00:00 +0700

N/A

Editor's Note

Vichai Chokevivat — Thu, 31 Aug 2023 00:00:00 +0700

N/A

Monograph of Select Thai Material Medica: RANG CHUET

Subcommittee on the Preparation of Monographs of Selected Thai Materia Medica — Thu, 31 Aug 2023 00:00:00 +0700

N/A

Dictionary of Traditional Chinese Medicine Volume 2 (Chinese-Thai-English) (15)

Tawat Buranatawonsom — Thu, 31 Aug 2023 00:00:00 +0700

N/A

Record of Local Health Wisdom of the Honorable Thai Traditional Medicine Doctors of the year 2023: Healer Bunma Mung Pue and Healer Prawit Khaewthong

Vichai Chokevivat, Santisukh Sobhansiri, Paranat Suksut — Thu, 31 Aug 2023 00:00:00 +0700

N/A

Andrographolide, Bioactive Compounds of Andrographis paniculata as Alternative Therapeutic for Cancer

Thu, 31 Aug 2023 00:00:00 +0700

Introduction and Objective: Herbs have served as medicine throughout human history. Andrographis paniculata with bioactive constituents, diterpene lactone andrographolide (AG), has been shown to have several important biological activities, including antioxidant, anti-inflammatory, immunomodulatory, antiseptic, antimicrobial, and cytotoxic effects. However, there was no previous review focusing on their promising agent in cancer treatment including underpinning mechanism. The present review highlights the scientifically pharmacological potential of AG as anti-cancer activity.

Methods: A number of databases (PubMed, Science-Direct, Springer, ACS, NIH, GOOGLE,

MEDLINE, SCOPUS, ATLANTICS and WEB OF SCIENCE) were used to search for the cytotoxic and anticancer effects of AG in pre-clinical and clinical studies. Among systematic screening of 1,455 literature articles, 52 were proposed underlying mechanism of anticancer effect, which were included in this review.

Results: Cultured cell lines are attributable to the most part of database followed by in vivo models using rodents. We describe possible underlying mechanism of AG as a natural anticancer agent on almost all types of cell lines involving oxidative stress-induced cell death, cell cycle arrest, anti-inflammatory and immune system mediated effects, apoptosis, necrosis, autophagy, inhibition of cell adhesion, proliferation, migration, metastasis and invasion, and anti-angiogenic effects.

Discussion: Our current work sheds some light on the most importance of bioactive constituents, AG, from Andrographis paniculata on anticancer and antitumor activity. By using the main bioactive component, the concentrations or dose of AG was precisely controlled. Regarding the studied limitation, most of the findings cited in this review are mainly based on in vitro and animal studies. More experiments are required to systematically elucidate the physiological significance of AG in human under neuroendocrine regulation.

Conclusion and recommendation: Based on our review, AG represents a potential option and could be used as promising candidate for the complementary and alternative medicines for the treatment of cancer in the future.