Department of Gastroenterology and Hepatology, Princess Alexandra Hospital Brisbane, Brisbane, Queensland, Australia; Faculty of Health Sciences, University of Queensland, Brisbane, Queensland, Australia.
Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.
Clin Gastroenterol Hepatol. 2015 Mar;13(3):422-32. doi: 10.1016/j.cgh.2014.03.014. Epub 2014 Mar 25.
In many parts of the world, there continues to be a long-standing tradition of prescribing herbal products for a range of gastrointestinal conditions. Scientific evidence supporting the use of all herbal preparations is imperfect, however, and available studies are plagued by methodological limitations. For functional gastrointestinal disorders, there is limited evidence supporting the use of some well-characterized preparations. A number of herbals have immunomodulatory activity, and in inflammatory bowel disease there are limited positive placebo-controlled trials; other studies used active controls with suboptimal doses of the comparators. Like all drugs, herbals can lead to serious adverse events (eg, hepatic failure). Quality control is a serious issue to consider when prescribing herbal medicines. Many herbal preparations are marketed without evidence for stringent adherence to good manufacturing practice guidelines. Unpredictable environmental conditions may affect the composition and the concentration of the active ingredients of plant extracts. Further, commercial herbal products usually combine a variable plethora of chemical families with possible medicinal utility. While some of these ingredients might be of benefit, the concentration and dose of these constituents needs to be closely monitored. Physicians and regulators need to remain very cautious about the use of herbal remedies. Appropriate scientific evidence for the claimed clinical benefits should become mandatory worldwide, and the standards for production and safety monitoring should comply with established standards for chemically defined products. If these principles were adopted, the full value of herbal remedies may come to light, particularly as the individually bioactive compounds present in these preparations become recognized.
在世界上许多地方，一直存在着用草药产品治疗一系列胃肠道疾病的悠久传统。然而，支持所有草药制剂使用的科学证据并不完善，并且现有的研究受到方法学限制的困扰。对于功能性胃肠道疾病，仅有有限的证据支持使用一些特征明确的制剂。许多草药具有免疫调节活性，在炎症性肠病中，有一些阳性安慰剂对照试验；其他研究使用了活性对照药物，但对照药物的剂量不理想。与所有药物一样，草药也会导致严重的不良事件（例如肝衰竭）。在开草药时，质量控制是一个需要认真考虑的问题。许多草药制剂在没有严格遵守良好生产规范指南的情况下上市销售。不可预测的环境条件可能会影响植物提取物的成分和有效成分的浓度。此外，商业草药产品通常结合了多种可能具有药用价值的化学家族。虽然其中一些成分可能有益，但这些成分的浓度和剂量需要密切监测。医生和监管机构需要对草药疗法的使用保持非常谨慎。应该在全球范围内强制要求对声称的临床益处有适当的科学证据，并且生产和安全监测的标准应符合化学定义产品的既定标准。如果这些原则得到采纳，草药疗法的全部价值可能会显现出来，特别是因为这些制剂中存在的单独生物活性化合物得到了认可。
