Ephedra Summary:

Ephedra is commonly known by its Chinese name "Ma Huang" due to its popularity in Chinese medicine. 

It has been used medicinally for at least 5000 years in China, and has been used in surrounding Asian countries like India for a very long time as well.

The main components of Ephedra are a class of chemicals known as alkaloids. These alkaloids are similar in structure and function to the hormone known as epinephrine (Adrenalin). They act as sympathomimetics, which increases heart rate, blood pressure, and promote the bronchioles (airway) to dilate. This allows more air in to the lungs. This last action is the reason behind ephedras common use on asthma, and bronchitis related conditions. 

This herb is incredibly useful to a trained herbalist, but is easily abused. This has lead to its banning in Australia for safety reasons. Overdose of ephedra can lead to dangerously high blood pressure which can lead to convulsions, coma, and death if not treated promptly. The problem is not in the herb itself, but the carelessness of dose.

Following a strict maximum dosage and paying close attention to how it affects your body individually will eliminate any risk of this happening.


Herbal Actions:

[1]

  • Anti-Allergenic
  • Anti-Anaphylactic [24]
  • Bronchiodilator
  • Vasodilator
  • Hypertensive
  • Circulatory stimulant
  • Antiallergenic
  • CNS Stimulant
  • Antispasmodic

Botanical Name:

Ephedra sinica (China)

Ephedra equisetina (China)

Ephedra gerardiana (India)

Ephedra vulgaris

 

Family:

Ephedraceae [1]

 

Part used:

Stems


Dosage:

Tincture (1:4) (45%):

1-4 ml three times/day [1]

Decoction:

5-10g dried herb in 250 ml water, simmered 10-15 mins. Drink this 3 times/day. [1]. 

Indications:

[1, 5]

  • Respiratory disorders
    • Asthma
    • Hay fever
    • Nasal congestion
    • Sinus pressure
    • Common cold symptoms
    • Bronchitis
  • Rheumatism
  • Low blood pressure in influenza or pnemonia
  • Circulatory insufficiency
  • To supress appetite

Common Names:

  • Ephedra
  • Ma Huang (Chinese)
  • Ephedrine
  • Epitonin

Traditional Uses:

The use of Ephedra dates back thousands of years, especially in China where it has been used for at least 5000 years as medicine. Mention of this herb have been found in some of the Hindu Vedas as well [1, 2, 8]. 

In total, its traditional usage across Asia includes the treatment of asthma, nasal congestion, hypotension, urinary incontinence, [5]. 

One of the more recent uses of ephedra is as a weight loss supplement for its ability to stimulate the CNS and increase metabolism [9]. 

 

    Botanical Description:

    The flowers of ephedra are either male or female (dioecious) [3]. 

     

    Habitat Ecology, and Distribution:

    Ephedra can be found growing on sandy shores in temperate climates in both the east and west hemispheres [3]. It is reportedly a very adaptable plant, which adds to an already simple morphological characteristics leading to some difficulty in identification of this herb [5, 7]. 

     

    Harvesting Collection, and Preparation:

    The best ephedra is reported to come from northern China, with the highest quality grown in Shanxi, Gansu, Shaanxi, and Qinghai provinces. Good quality ephedra can be identified as light green, dried, thick stemmed with a solid cent. [7]. 


    Constituents:

    [1, 5, 6, 10, 11]

    • Alkaloids (up to 2% in dried herb)
      • L-Ephedrine (Alkaloid salt)
      • D-Ephedrine
      • Pseudoephedrine
      • Norephedrine
      • N-methylephedrine
      • Benzylmethylamine
    • Flavonoid glycosides
    • Glycans
    • Proanthocyanidins
    • Crystals of calcium oxylate
    • Saponins
    • Volatile oils:
      • Terpenoids

    The chemical composition of ephedra species varies considerably depending on the climate, species, amount of rainfall, soil characteristics, harvesting techniques, and storage conditions of the plant after harvesting [5]. 


    Pharmacology and Medical Research:

    Anti-Allergenic

    An anyphalactic reaction results from a systemic release of inflammatory mediators from the mast cells and basophils [20]. In modern emergency medicine, the immediate treatment for this is an intramuscular injection of epinephrine [20]. Epinephrine is a mixed alpha- and beta- adrenergic receptor agonist, and works by alleviating allergen-induced inflammatory, and other physiological effects [21].

    Ephedra contains alkaloids very similar in structure and function to epiniphrine, with the most significant one likely being ephedrine. Similar to epinephrine, ephedrine possesses both alpha- and beta- adrenergic receptor agonist actions [24], and thus may possess similar actions towards the anti-anaphylactic actions of the emergency medicine epinephrine. 

    The alpha adrenergic receptor agonist effects cause vasoconstriction of the blood vessels which then reduce systemic vasodilation and alleviate hypotension and possible hypotensive shock, as well as reducing erythema, urticaria, and angioedema [22]. 

    The beta adrenergic receptor agonist activity dilates  brnchial airways, increases the force of myocardial contraction (positive inotropy), and increases heart rate. This results in a significant increase in cardiac output, and can reduce the severity of Ig-E mediated reactions via mast cells. [23, 24].  

    Although the actions of ephedrine and epinephrine on the alpha and beta adrenergic receptors, application is generally very different. It is imossible to inject ephedra intramuscularly without laboratory intervention, its use in the absence of epinephrine, or for more mild anaphylactic reactions, may warrent ephedras use in an emergency setting. In minor incidents, ephedra appears to offer a valuable treatment, especially in the way of bronchial asthma as further indicated through its long traditional usage. 

     

    Central nervous System Stimulant

    The alkaloid component of ephedra has well known stimulating actions on the CNS through a binding to adrenergic receptors. [4]. 

     

    Weight Loss Supportive

    Ephedra is often used as a weight loss supplement for its ability to stimulate the CNS to stimulate metabolism. It has hypolipidemic and hypocholesterolemic, as well as hypoglycemic actions which go a long way in the prevention and treatment of obesity and its associated ramifications. [23-25]. There are some side effects with ephedra alkaloids however, some of which can lead to serious events such as myocardial infarctions, cardiac arrhythmias, high blood pressure, and stroke [15, 16]. These reports have been debated, and the non-alkaloid content has also been found to be hypolipidemic through the prevention of free radical species generation, and recuperation of liver function during liver damage [17]. This action will have a much less pronounced effect on reduction of weight specifically, but addresses some of the common associated conditions with obesity such as hyperlipidemia and hypercholesterolemia. Currently, the major treatment for these conditions involves statin medications, which themselves have a wide range of negative associations and side effects [18, 19]. 

    The general consensus at the time of this writing is that the long term usage, as is the case with weight loss programs, should be avoided with ephedra. Other herbs are available instead that will achieve this purpose in a much safer mannor. 

     

    Toxicity and Contraindications:

    Contraindicated with cardiovascular conditions, thyroid disease, diabetes, or prostate enlargement [1]. 

     

    Cautions:

    • May interact with cardiac glycosides or halothane to produce arrhythmias [1]. 
    • Guanethidine has been reported to enhance the sympathomimetic effects of ephedra [1]. 
    • Combination with monoamine oxidase inhibitors (MAOI's) can significantly increase the sympathomimetic actions of ephedrine, which can lead to fatal hypertension [1]. 
    • Be cautious of ephedra products adultered with synthetic alkaloids [5]. 

     

    Traditional Chinese Medicine:

    Taste: Acrid, pungent, slightly bitter [7, 21]

    Energy: Warm [7, 21]

    Channels: Lung and bladder [21]

    Actions: Promotes sweating to disperse cold, diffuses the lungs to relieve wheezing, promotes the flow of lung Qi, reduces swelling through increasing urination. [7, 21].

    Indications: Colds with wind-cold pattern (especially with lack of sweating), chest oppression, cough, wheezing due to excess, wind edema. [7]. 

    Caution: People who sweat easily (it's a strong diaphoretic), deficiency type asthma, weak constitution, hypertension, or heart disease [7]. Avoid large doses [21]. 

     

    Synergy:

    Still compiling research. 

     

    Recent Blog Posts:

    References:

    1. Hoffmann, D. (2003). Medical herbalism: The science and practice of herbal medicine. Rochester, VT: Healing Arts Press. (Pg. 546-547)
    2. Dewick MP. (2002). Medicinal Natural Products: A Biosynthetic Approach. 2nd ed. West Sussex, England: John Wiley and Sons; p. 383.
    3. A Modern Herbal. (1931). Ephedra. Retrieved from http://www.botanical.com/botanical/mgmh/e/ephedr11.html
    4. EFSA ANS Panel (EFSA Panel on Food Additives and Nutrient Sources), 2013. Scientific opinion on safety evaluation of Ephedra species in food. EFSA J 2013; 11(11): 3467, 79 pp.
    5. Ibragic, S., & Sofic, E. (2015). Chemical composition of various Ephedra species. Bosnian Journal of Basic Medical Sciences, 15(3). doi:10.17305/bjbms.2015.539
    6. Miyazawa M, Minamino Y, Kameoka H. (1997). Volatile components of Ephedra sinica stapf. Flavour Fragr J. 12(1):15-17. 
    7. Yang, J., Huang, H., Zhu, Li-Jiang, & Chen, Y. (2013). Introduction to chinese materia medica (3rd ed.). (Pg 36-40).
    8. Kitani Y, Zhu S, Omote T, Tanaka K, Batkhuu J, Sanchir C, et al. (2009). Molecular analysis and chemical evaluation of Ephedra plants in Mongolia. Biol Pharm Bull. 32(7):1235-1243.
    9. Abourashed EA, El-Alfy AT, Khan IA and Walker L. (2003). Ephedra in perspective - a current review. Phytother Res 17: 703-712
    10. Shekelle PG, Hardy ML, Morton SC, et al. (2003). Efficacy and safety of ephedra and ephedrine for weight loss and athletic performance: a meta-analysis. JAMA 289: 1537-1545.
    11. Purev O, Pospísil F and Motl O. (1988). FPaOM: Flavonoids from Ephedra sinica Stapf. Collect Czech Chem Commun 53: 3193-3196.
    12. Starratt AN and Caveney S. (1996). Quinoline-2-carboxylic acids Ephedra species. Phytochemistry 42: 1477-1478.
    13. Konno C, Mizuno T and Hikino H. (1985). Isolation and hypoglycemic activity of ephedrans A, B, C, D and E, glycans of Ephedra distachya herbs. Planta Med: 162-163.
    14. Chumbalov TK, Chekmeneva LN and Polyakov VV. (1977). Phenolic acids of Ephedra equisetina. Chemistry of Natural Compounds 13: 238-239.
    15. Zhang L, Zou G and Yang T. (2000). Studies on extraction of water-soluble polysaccharides and the function of cleaning oxygen free-radical function of ephedra. Amino 24-26.
    16. Kalman D, Incledon T, Gaunaurd I, Schwartz H and Krieger D. (2002). An acute clinical trial evaluating the cardiovascular effects of an herbal ephedra-caffeine weight loss product in healthy overweight adults. Int J Obes Relat Metab Disord 26: 1363-1366.
    17. Haller CA and Benowitz NL. (2000). Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. N Engl J Med 343: 1833-1838.
    18. Fan, Y., Li, J., Yin, Q., Zhang, Y., Xu, H., Shi, X., Zhou, C. (2014). Effect of extractions from Ephedra sinica Stapf on hyperlipidemia in mice. Experimental and Therapeutic Medicine. doi:10.3892/etm.2014.2117
    19. Chiu JH, Abdelhadi RH, Chung MK, et al. (2005). Effect of statin therapy on risk of ventricular arrhythmia among patients with coronary artery disease and an implantable cardioverter-defibrillator. Am J Cardiol 95: 490-491
    20. Moosmann, B., & Behl, C. (2004). Selenoprotein synthesis and side-effects of statins. The Lancet, 363(9412), 892-894. doi:10.1016/s0140-6736(04)15739-5
    21. Wu, J. N. (2005). An illustrated Chinese materia medica. New York: Oxford University Press. (Pg. 280-281). 
    22. Kemp SF, Lockey RF, Simons FE. (2008). Epinephrine: the drug of choice for anaphylaxis. A statement of the World Allergy Organization. Allergy. 63:1061–1070.
    23. McLean-Tooke AP, Bethune CA, Fay AC, Spickett GP. (2003). Adrenaline in the treatment of anaphylaxis: what is the evidence? BMJ. 327:1332–1335. 
    24. Chong LK, Morice AH, Yeo WW, Schleimer RP, Peachell PT. (1995). Functional desensitization of beta agonist responses in human lung mast cells. Am J Respir Cell Mol Biol. 13:540–546.
    25. Kay LJ, Peachell PT. (2005). Mast cell beta2-adrenoceptors. Chem Immunol Allergy. 87:145–153.