• Natural Product Sciences
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• v.28 no.4
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• pp.168-180
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• 2022

Ephedra is a genus of the Ephedraceae family and is found in temperate regions, such as Central Asia and Europe. Among the various ephedra species, Ma Huang (Ephedra herb) is derived from the aerial parts of Ephedra sinica S tapf, Ephedra equisetina Bunge, and Ephedra intermedia Schrenk & C.A. Mey. Ma Huang contains various ephedra alkaloids, including (-)-ephedrine, (+)-pseudoephedrine, (-)-norephedrine, (+)-norpseudoephedrine, (-)-methylephedrine, and (+)-methylpseudoephedrine, which are found naturally as single enantiomers, although they can be prepared as racemates. Although the use of Ma Huang in foods is prohibited in Korea, products containing Ma Huang can be imported, and so it is necessary to develop a suitable analytical technique for the detection of Ma Huang in foods. Herein, we report the development of analytical methods for the detection of ephedra alkaloids in products containing Ma Huang. Following sample purification by solid phase extraction, quantitative analysis was performed using ultra-performance liquid chromatography-triple quadrupole mass spectrometry (UPLC-MS/MS). Additionally, the enantiomers were successfully separated using HPLC-DAD. We successfully analyzed various food samples, where the ephedra alkaloids were qualitatively and quantitatively determined, and the enantiomers were separated. It is expected that these methods may contribute toward preventing the distribution of illegal products containing Ma Huang.

• The Journal of Internal Korean Medicine
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• v.25 no.4
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• pp.207-211
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• 2004

Recently a case of liver injury from ingestion of Taeyeumjowi-tang containing Ma-huang(Ephedra sinica stapf) arose. The patient, a 30 year-old woman, was diagnosed with asthenia and anorexia after 6 weeks of ingesting Taeyeumjowi-tang containing Ma-huang(Ephedra sinica stapf) as a treatment for her obesity. Tests showed elevated levels of serum transaminase(ALT 903 IU/L, AST 716 IU/L), alkaline phosphatase (229 IU/L), total bilirubin (1.4 mg/dl). Other possible causes of liver injury were excluded by laboratory test and medical history, so the liver injury was taken to be drug-induced. Saenggangeonbi-tang was administered. After 2 weeks of treatment with this medication, the clinical symptoms and liver function improved. This case is reported with a call for further accumulation of objective data on drug-induced liver injury, and to bring more attention to the relative levels of safety and toxicity of herbal medicines.

• Korean Journal of Food Science and Technology
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• v.51 no.1
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• pp.24-28
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• 2019

In this study, the in vitro hepatotoxic mechanism of Ephedra sinica (ma-huang) was investigated by measuring the degree of cell death, secretion of cytokine, and fat accumulation by treating HepG2 cells with 70% ethanolic extracts of ma-huang. Cell death was observed at concentrations of around $5-100{\mu}g/mL$ by treatment with ma-huang extracts (p<0.05). The secretion of interleukin 8 (IL-8) and macrophage colony-stimulating factor (M-CSF), which are inflammatory cytokines, were significantly promoted at concentrations of around 0.05-100 and $0.5-100{\mu}g/mL$, respectively (p<0.05). In this experiment, it was shown that the extracts of ma-huang stimulate the secretion of inflammatory cytokines, such as IL-8 and M-CSF, and lead to fat accumulation in the hepatocytes, thereby causing inflammation of the hepatocytes. Hepatotoxicity was observed at around 10-500 times lower concentration than the concentration required to cause serious toxicity, such as cell death, suggesting that hepatic toxicity (hepatitis) may be induced at a low dose.

• Journal of Korean Medicine for Obesity Research
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• v.6 no.2
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• pp.17-27
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• 2006

Objectives : Ma-huang (Ephedra sinica) is frequently prescribed for obesity management in oriental medicine. The main component is ephedrine alkaloids which can have serious adverse side effects such as heart attack, stroke, sudden death. There are no scientific guidelines for Ma-huang usage in the safe treatment of obesity in oriental medicine. We reviewed published studies on its safety to make evidence based guidelines. Methods : We searched electronic databases up to May 2006. We limited evidence to controlled trials for efficacy or safety, case reports for safety, and studies for Ma-huang contents analysis. Results and Conclusions : In clinical trials for weight loss, Ma-huang and ephedrine promote modest short-term weight loss but have no serious adverse effects, have only a few adverse effects associated with increased risk of psychiatric, autonomic, gastrointestinal symptoms and heart palpitations. In case reports, there have been serious adverse effects including stroke, heart attack, and death using typical doses of ephedrine or no associated illness. There are factors related to serious adverse effects, such as overuse, lack of standardization, individual sensitivity, and interactions with other drugs. Studies relating to these factors should be analyzed for safe use of Ma-huang and ephedrine. After analyzing related studies, we suggest guidelines for Ma-huang usage. We propose that the dosage should be within 4.5-7.5g per day for up to 6 months for generally healthy individual. It's use is contraindicated in individuals with heart disease, thyroid disease, diabetes mellitus, hypertension, psychiatric disorders, glaucoma, urination disorders, enlarged prostate, persons using MAOIs, methyldopa and sympathomimetic agents.

• The Journal of Korean Medicine
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• v.22 no.3
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• pp.74-80
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• 2001

Objectives : Ma-huang is a traditional Chinese medicinal herb, derived from Ephedra sinica Stapf and other Ephedra species, used to treat asthma, nose and lung congestion, and fever with anhidrosis. It contains 0.5-2.5% by weight of total alkaloids, of which ephedrine accounts for 30 to 90%. Recently, Ma-huang has been used as a source of ephedrine in many dietary supplements formulated for the treatment of obesity, since ephedrine has been found to be effective in inducing weight loss in the obese. In this study the effects of the methanol extract of Ma-huang on the adipocyte of epididymal and brown fat pads in rats fed a high fat diet for six weeks were studied. Methods : Male Sprague Dawley rats weighing an average 94g (4 weeks old) were fed either a regular diet (RE) or a high fat diet (HF), and the HF group was subdivided into a Ma-huang methanol extract (30mg/100g body weight) group (HF+MH). The weight of epididymal fat pad and brown adipose tissue were measured. The cell size and cell number per unit area of epididymal fat pad were investigated. Results : The yield weight of methanol extract of Ma-huang was 3.63mg per l00g of Ma-huang. The body weight gain of the HF group was similar with that of the HF+ MH but higher than that of the RE. The weights of the epididymal fat pads and brown adipose tissue of the RE group were lower than those of HF and HF+MH groups. The cell sizes and numbers per unit area of epididymal fat pads of the RE and HF+MH groups were larger than those of HF group. The cell numbers per unit area size of epididymal fat pads were the smallest in the RE group. Conclusions : It could be concluded that the Ma-huang extract has no effect on the epididymal fat pads in rats fed a high fat diet and the clinical application of Ma-huang for the treatment of obesity should be re-considered.

• The Journal of Internal Korean Medicine
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• v.27 no.1
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• pp.188-196
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• 2006

Background: Ma-huang (Ephedra sinica) has been widely used to treat respiratory disease in oriental medicine for over a hundred years. Ma-huang preparations contain approximately 1.25% ephedrine alkaloids. Recently, the ephedra alkaloids have received much press lately due to adverse effects in those using whole extracts as 'dietary supplements' for weight loss or athletic performance enhancement, and these reports are troubling given the increasing use of Ma-huang by the general public. The purpose of this report is to determine the proper dosage to minimize adverse effects and maximize the potential curative value. Objectives : The object of this study was to find an effective yet low risk dosage of Ma-huang. Methods : The study was designed as a double-blind randomized placebo-controlled trial. The subjects of this study were 26 adults between 20 to 40 of age who agreed to participate in this study. They were allocated through randomization into three groups. Each group took three opaque capsules three times a day. A group (N=9) took one Ma-huang capsule and two placebo capsules, B group (N=8) took two Ma-huang capsules and one placebo capsule, C group (N=9) took three Ma-huang capsules. The total trial periods was two days. To compare the adverse effects of Ma-huang according to dosage, blood pressure and pulse were checked, and other adverse effects were assessed using a morning questionnaire, patient's global assessment scale and Wong-Baker faces pain rating. Results : The following result were obtained: 1. After taking 18 g of Ma-huang per day, pulse rate had a significant increase. 2. After taking more than 6 g of Ma-huang per day, palpitation would be increased significantly. 3. After taking more than 18 g of Ma-huang per day, tiredness would be increased significantly. Conclusion: According to the results, 12 g of Ma-huang per day will minimize adverse effects and maximize the potential curative value.

• Journal of Korean Medicine for Obesity Research
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• v.7 no.1
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• pp.1-7
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• 2007

Background : Use of Ma Huang is controversial. Multiple reports of adverse effects led the U.S. Federal Drug Administration (FDA) to announce about prohibiting dietary supplements containing ephedrine alkaloids/Ma Huang. Objective : The objective of the study was to review the evidence from literature and rigorous clinical trials on the dosage, effectiveness, and adverse effects. Methods : Literature searches were conducted in U.S. FDA database after 2003 and digital Uibujeonok(醫部全錄). Hand searches of medical journal and bibliographies of identified articles were conducted. Results : Ma Huang has been used in Korean Oriental Medicine to treatment asthma and other ailments. Recently, Ephedrine/Ma Huang are used for weight loss or to enhance athletic performance in Europe and America, Korea. Ephedrine/Ma Huang are associated with increased risk of psychiatric, autonomic, or gastrointestinal symptoms, and heart palpitations. In addition to that, a risk of serious adverse events, including heart attack, stroke, epilepsy and psychiatric problem are also have been reported. Therefore, max dose of total alkaloids of ephedrine is studied in need of a specialist's part. Conclusion : In most reports, Ma Huang effectively promoted short-term weight loss and enhancement of athletic performance, But, safety with long-term use requires further investigation.

• Journal of Korean Medicine for Obesity Research
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• v.7 no.2
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• pp.27-37
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• 2007

Background Clinical practice guidelines (CPG) are systematically developed statements to assist practitioners and patients on healthcare decisions. They provide recommendations for the average patient, which should take into account individual clinical judgment and the patient's values and expectations. Ephedra has sympathomimetic effect and has been used for weight loss worldwide. However, its safety is controversial especially in autonomic and cardiovascular systems. Therefore, the need of appropriate CPG for ephedra prescription in obesity was advocated in Korean Traditional Medicine. Methods The committee comprised of specialists of obesity, oriental herbology, oriental cardiology, constitutional medicine. The committee collected all relevant references about adverse effect and safety of ephedra in the forms of meta-analysis, systematic review, randomized controlled trial, case-control study and observational study from international and domestic databases and paper journals. 11 English- and 5 Korean-language references were gathered and categorized by PICO (Patient, Intervention, Comparison, Outcome) method. We could not complete strength of recommendation which should be clarified according to the evidence grade estimation. Result The first version of CPG for ephedra prescription in obesity was issued by Korean Oriental Association for Study of Obesity. It includes topics of introduction, pharmacokinetics, side effects and adverse events, constitutional aspect and recommendations for dose, indication and contraindication. Conclusion There should be periodic upgrade of this CPG from now on. Although there are some drawbacks in this version of CPG, it has significance as the first CPG in Korean Traditional Medicine.