Effective Treatment for Erectile Dysfunction

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Medical Treatments for Erectile Dysfunction

Initially, there were few oral treatments for ED, being used by urologists, such as yohimbine based products, trazodone, and bupropion. They had only modest proerectile capability (11). Pharmaceutical companies were inspired to pursue oral treatments with the promise of less intrusiveness and even greater profits. The first visible evidence of fulfilling that promise was the sildenafil launch. Subsequent to Pfizer's success, multiple companies simultaneously pursued clinical trials of easy-to-use treatments for male SD. Among others, these included additional PDE-5 type compounds and other oral treatments, such as ixense (TAP Holdings, Deerfield, IL, USA), and topically applied compounds (MacroChem, Lexington, MA, USA). Additionally, PT-141 (Palatin Technology, Cranbury, NJ, USA) is a nasally administered peptide that is under development, which is presumed to work through a central nervous system mechanism. Currently, there are three highly efficacious PDE-5, FDA-approved treatments...

Cryopreservation of Ginseng Explants

With regard to the production of specific compounds, however, cell cultures often show a remarkable instability. The cryopreservation of plant cells is still a routine laboratory method but it is necessary to optimize the individual steps of the cryopreservation procedure. Butenko et al. (1984) who cryopreserved ginseng cells for the first time, used a pretreatment which combines low temperatures (+4 C) with a high sucrose concentration (20 per cent). The use of sucrose as a preculture additive and a cryoprotectant seems to be advantageous as it is not toxic for the cells even at very high concentration. Seitz and Reinhard (1987) developed a cryopreservation procedure for P. ginseng cell cultures which makes long term storage of selected strains possible. Sorbitol was used as a short term preculture additive with or without supplementary DMSO as a cryoprotectant. Cell strains of similar appearance but different ginsenoside productivity do not differ in their response to the...

Genetic Transformation of Ginseng

The first report of the induction of hairy roots in P. ginseng and the establishment of the culture followed by the infection with A. rhizogenes was demonstrated by Yoshikawa and Furuya (1987). The ginseng hairy root cultures grew more rapidly and produced saponins more effectively than the ordinary cultured roots obtained by hormonal control. Production of ginseng saponins, such as ginsenosides Rb and Rg in the hairy roots and ordinary cultured roots, as determined by TLC, was comparable. The total saponin contents per dry mass were 0.35-0.95 per cent for the transformed hairy roots and 0.38-0.91 per cent for the ordinary cultured roots. The highest contents were obtained when both hairy and ordinary roots were grown on a medium supplemented with growth regulators such as IBA and kinetin. Inomata et al. (1995) achieved the highest growth rate of ginseng hairy roots in batch culture under the effect of BA which also increased the ginsenoside production. Ginsenoside production by hairy...

Panax ginseng CAMeyer

Seeking saponins in Panax ginseng plants, the Russian research group headed by Professor Elyakov isolated from methanolic extracts of ginseng roots a series of sugar-linked compounds which they named panaxosides panaxosides A and B were reported by Elyakov et al. in 1962 and C, D, E and F by Elyakov et al. in 1964. The Russian chemists noted that on hydrolysis the saponin glycosides panaxosides A, B, and C were based on the aglycone panaxatriol and that the panaxosides D, E and F formed a separate group based on the aglycone panaxadiol. In addition Elyakov's group were able to demonstrate that the sidechains of monosaccharide molecules were different. Thus panaxoside A possessed 3 glucose units, panaxoside B 2 glucose and 1 rhamnose units, panaxoside C 3 glucose and 1 rhamnose units, panaxoside D 4 glucose units, panaxoside E 4 glucose and 1 arabinose units, and panaxoside F 6 glucose units. At the same time, in Japan, a research group headed by Professor Shibata had isolated and...

Activation And Regulation Of Sexual Response Processing of Sexual Information

Basis of a series of priming experiments Janssen et al. (76) presented an information processing model of sexual response. Two information processing pathways are distinguished (cf. 77). The first pathway is about appraisal of sexual stimuli and response generation. This pathway is thought to depend largely on automatic or unconscious processes. The second pathway concerns attention and regulation. In this model, sexual arousal is assumed to begin with the activation of sexual meanings that are stored in explicit memory. Sexual stimuli may elicit different memory traces depending upon the subject's prior experience. This in turn activates physiological responses. It directs attention to the stimulus and ensures that attention remains focused on the sexual meaning of the stimulus. This harmonic cooperation between the automatic pathway and attentional processes eventually results in genital responses and sexual feelings. Disagreement between sexual response components would occur,...

Pharmacotherapy for Men with ED

Few licensed drugs are currently available for the treatment of men with ED. Those that are available elicit their effect by one of two mechanisms. The agent boosts either the neuronal control mechanism or the local control mechanism (13). As we shall see, oral therapies can have their effect on either system, whereas the intracavernosal and intraurethral systems act locally to produce an erection. Oral agents used to treat ED should be reliable, have minimal side effects, and be simple to use (22). The oral therapies currently licensed for ED are the phosphodiesterase 5 inhibitors (PDE5 inhibitors), which have a peripheral mechanism of action, and apomorphine, which acts centrally. These agents require sexual stimulation to initiate the neuronal activation required to start the hemodynamic erectile response. This is in contrast to the PGE mediated response initiated by intracavernosal and intraurethral alprostadil administration that forces an erection (see later). Yohimbine is...

Psychological Therapies for Men with ED

In the majority of cases of ED, psychological factors are involved in either the development of the disorder or the maintenance of the problem. While recognising that many men would not seek a psychological approach to resolving the condition, an outline of performance anxiety about continued erectile failure and the effect this has on their partner and their relationship, is often appreciated by the man. Difficulties with communication and the development of suspicion and mistrust between partners may need discussion, recognition, and specific intervention. In each of these three situations, an integrative approach by the assessing clinician to ensure adequate assessment of both psychological and physical contributing factors may lead to more efficacious outcomes while recognising that the interventions themselves may be multiple, rather than relying on one treatment and progressing in a linear fashion to alternatives because of failure of first line therapy. Helping the man to start...

Erectile dysfunction

Erectile dysfunction (ED) may be defined as the consistent inability to achieve or maintain an erection sufficient to permit satisfactory sexual intercourse. The word consistent is included in the definition because most men experience transient episodes of ED that are temporary and usually associated with fatigue, anger, depression or other stressful emotions. The use of the formerly used term impotence has been virtually abandoned because of its inherent stigma of weakness and lack of power. Erectile dysfunction can occur as part of several r First, it may be useful to understand the mechanisms of normal penile erection. Penile erection occurs essentially when the penis becomes engorged with blood. The anatomical compartments (two corpora cavernosa and one corpus spongiosum) are capable of being distended with seven times their normal amount of blood. When this occurs in association with relaxation of the penile muscles, erection results. The sequence of events resulting in penile...

Ginseng And The Quality Of Life

Ginseng has been used as an agent to counter the subtle changes in health (fatigue, lack of energy, anxiety, restlessness, depression, etc.) and improve the quality of life of humans and several authors, using controlled clinical trials, have demonstrated the efficacy of standardised extracts of ginseng in combination with minerals (Tesch et al., 1987 Dorling and Kirchdorfer, 1989 Pieralisi et al., 1991). Such combination therapy has produced improved alertness, better physical activity and a feeling of well-being in both middle-aged persons and The Swedish group of Wiklund et al. (1994) devised two self-administered questionnaires, the Psychological General Well-Being Index and the Sleep Dysfunction Scale, to assess the quality of life in 205 participants taking Gericomplex capsules ( Geriatric Pharmaton, Pharmaton S.A.), capsules containing 40 mg standardised Ginseng Extract G115 and added vitamins, minerals and trace elements, and 185 persons taking identical-looking placebo...

Absorption Distribution Excretion And Metabolism Of Ginseng Saponins

Administering radioactively labelled ginseng saponins to rats orally, Joo et al. (1982) observed that total recovery of the radioactivity was only about 30 per cent and they concluded that the saponins had bound with macromolecular and membrane structures in forms which were not readily extractable. The saponins were widely distributed in the body tissues and especially in liver, kidney, blood serum, stomach and gastrointestinal tract. Early study of the pharmacokinetics of ginseng saponins revealed that little of the important protopanaxadiol-derived compound ginsenoside Rb1 is absorbed from the upper digestive tract after oral administration (100 mg kg) in rats. Intravenous injection (5 mg kg) in rats resulted in the serum level declining slowly and biexponentially with a half-life in the -phase of about 14j hours. Ginsenoside Rb1 persists for a long time in the serum and tissues, persistence being due to the Hasegawa et al., 1996) administered P. ginseng extract orally to human...

Ginseng And Antiulcer Activity

It has long been known that gastric ulcers are frequently a reaction to stress. As early as 1827 the American Indian doctor John Williams in the book The American Indian Doctor Dr. John Williams' Last Legacy, A Useful Family Herbal praised ginseng roots as an excellent medicine to alleviate inward hurts and ulcers when used in combination with other herbal drugs such as comfrey, spikenard, elecampane, camomile, angelica and fir boughs in a dilute alcoholic vehicle (Harriman, 1973). Tang and Craze in their book Chinese Herbal Medicine (1995) also refer to the use of ginseng to treat peptic ulcer due to stagnating stomach qi (or ch'i), weakness of spleen or excess heat and advise avoidance of alcohol, coffee and tea. Cheng et al. (1985) noted that ginseng pectin polysaccharide and dextrin could reduce the amount of gastric acid and the activity of the enzyme pepsin. Ginseng pectin inhibited histamine-induced secretion of gastric acid and was effective versus indomethacin-induced and...

Ginseng Memory And Intellectual Skills

Improved mental activity and therefore ginseng pretreatment was suggested for tasks requiring speed, accuracy and stamina. Ginseng administered orally was successfully used to counter the decline in learning ability that is normally produced under physiological stress (Bao et al., 1984a,c). In a 12-week doubleblind, placebo-controlled trial involving 16 fit male volunteers (aged 20-24 years) and an oral dosage of 100mg of Ginseng G115 twice a day, D'Angelo et al. (1986) noted statistically significant improvements in attention, information-processing, reaction times and well-being and, in particular, in mental arithmetic. More recent studies by Petkov and Mosharrof (1987) have offered a more detailed explanation of this improvement of learning, memory and physical capability induced by administration of standardised Ginseng G115 extract. Learning and relearning can be considered in terms of memory. Ginseng was considered particularly useful if the breakdown of mental activity was due...

Ginseng And The Central Nervous System

There are many contradictory accounts of the effects of ginseng, its extracts and its individual isolated ginsenosides on the central nervous system (CNS). Early work recorded that the stimulant effect of ginseng diminished the depressant action of hypnotic drugs such as chloral hydrate and barbiturates. Unlike amphetamine and related anorexies, ginseng can in small doses produce the CNS stimulant effect with no interference with normal sleep. Larger doses decreased motor activity yielding a general sedative effect. Such puzzling results stimulated Professor Takaji's Japanese group to carefully study the actions of the individual glycosides as well as ginseng extracts and saponin fractions. One fraction, containing the diol glycosides ginsenosides Rb1 and Rc, yielded sedative, tranquillising, analgesic and muscle-relaxing properties a second fraction, containing the triol glycosides ginsenosides Rg1, Rg2 and Rg3, shewed both stimulant and depressant activities in addition to...

Surgical Interventions for Men with ED

There are three forms of penile prostheses available semi-rigid, malleable, and inflatable. Typical candidates for a penile implant are patients with chronic disease states such as long-term diabetes and end-organ failure or severe arterio-genic impotence combined with severe veno-occlusive dysfunction and men with treatment unresponsive Peyronie's disease in combination with ED. Typical

Ginseng And Morphine And Related Opioids

The relationship between morphine and associated opioids and ginseng has proved both remarkable and unexpected. Opioids are widely used as legitimate, effective analgesics, especially in terminal afflictions such as cancers although continued use of morphine-type drugs is rapidly accompanied by the development of tolerance, the craving for ever-increasing doses, and by psychic and physical dependence. Seeking effective antagonists of the narcotic and addictive effects of opium and morphine, H.S.Kim and his colleagues in a long series of studies from 1985 onwards have demonstrated the effectiveness of ginseng versus morphine tolerance. The protopanaxadiol-type ginsenosides Rb1 and Rb2 and the protopanaxatriol-type ginsenosides Re and Rg1 inhibited the development of morphine-induced tolerance in mice and ginsenosides Rb1 and Rg1 also had an inhibitory effect on naloxone-induced withdrawal jumping response. In addition the ginsenosides inhibited body weight loss in physically dependent...

Ginseng And Atherosclerosis

Ginseng was suggested as a medicament for the control of cholesterol levels and for the treatment of anaemia. Experimental evidence does shew that ginseng is capable of increasing the red blood cell count, of promoting serum protein synthesis and of stimulating RNA formation in the liver and DNA synthesis in bone marrow. Cholesterol, a steroid alcohol, occurs naturally in the body and is found particularly in the bile and gall bladder and in the lipoproteins of the blood plasma. Although endogenous cholesterol can be formed in all cells of the body, blood cholesterol is usually produced in the liver, the body organ that controls the normal cholesterol level in the blood. High levels of cholesterol can occur in insulin and thyroid hormone deficient subjects or in persons consuming a high fat, high cholesterol containing diet. Dietary cholesterol, also called exogenous cholesterol, derives from foods such as milk, cream, butter, cheese, eggs, beef dripping, offal and other meats....

Model Of Sexual Response Showing Various Incentives And Motivations To Be Sexual And Arousal Triggering And

The assumption is that the occurrence of sexual motivation, including fantasies, must be the result of sexual information processing of some kind even though in some, or even most cases, the initiating sexual stimulus may not be known. For most people, their sexual response system reacts

Other Unlicensed Treatment Therapies for Men with ED

Several new formulations are being developed, such as topical alprostadil and intranasal apomorphine. New agents are being developed, including selective PDE3 4 5 inhibitors MS-223131 (Bristol-Myers Squibb), T-1032 (Tanabe Seiyaku), TA-1790 (Vivus), sildenafil nitrate (NCX-911) (NicOx) nonselective inhibitors of postsynaptic alpha-adrenoceptors within the corpus cavernosum phentolamine (Vasomax Schering Plough), melanocortin receptor agonists such as melatonan II (Palatin) (s.c. and intranasal) increases erections and sexual drive appetite (phase 2A) and the 5HT1 agonist VML670 (Lily Vernalis).

Ginseng As A Biological Response Modifier

Understanding the actions of ginseng has, until now, always been complicated by the mixed nature of the chemical compositions of the ginseng products used. Therefore it has not yet been possible to clearly define the biological response modifier. Ginseng preparations have been shewn to improve liver function as well as immune function and it is therefore probable that the protective action is related to an immunomodulatory effect. Pretreatment with ginseng extracts was found to prolong the survival times of test animals suffering experimental trypanosomiasis, to prevent the development of fevers induced by typhoid and paratyphoid vaccines in rabbits, and to retard the development of diseased (leukopenic) white blood cells in bacillary dysentery. Ginseng treatment stimulated the production of specific antibodies in guinea pigs immunised with influenza vaccine and in rats immunised with diphtheria toxoid and was more effective at lower doses. In mice, ginseng extracts offered protection...

The Sexual Response Cycle

There are four phases in the sexual response cycle I. excitation, II. plateau, III. orgasm, and IV. resolution (Masters, Johnson, & Kolodny, 1994). In men, phase I (excitation) is characterized by erection of the penis. Phase I takes place more slowly in women and is characterized by the production of lubricating fluid in the vagina, an increase in the diameter of the clitoris, and increased congestion of the labia with blood. For both sexes, phase II (plateau) is marked by a rise in the blood congestion of the pelvis and a strong feeling of sexual tension. A sex flush colors the forehead, neck, and chest, sometimes extending to the abdominal area. Phase III (orgasm) occurs in two stages in men a preejaculatory contraction of the muscles involved in ejaculation, and actual ejaculation. The same muscles are involved in the orgasms of women as those of men. During phase IV (resolution), which is usually completed more quickly in men than in women, the congestion of the blood vessels...

Ginseng And The Cardiovascular System

Ginseng has, as an adaptogen, been credited with the ability to normalise both high and low blood pressure conditions. Therefore it would appear to be potentially useful in the treatment of hypertension, a condition of high blood Lee et al. (1981) examined the effects of ethereal, ethanolic and aqueous P. ginseng extracts on cardiovascular function in dogs after intravenous injection (40 mg kg). The ether extract caused significant decrease of heart rate and central venous pressure, the ethanol extract significant decrease of heart rate and mean arterial pressure and the aqueous extract significant decrease of cardiac output, stroke volume and central venous pressure but the total peripheral resistance was markedly increased. Using intravenous injections of total ginsenosides in dogs, Chen et al. (1982) confirmed that the peak value of left ventricular pressure and the arterial systolic pressure were rapidly decreased. Heart rate and renal arterial blood flow decreased although renal...

Ginseng And Aphrodisiac Activity

The effect of ginseng on sexual activity has intrigued the general public and many research workers. Bao et al. (1984b) observed that there was no disturbance of the ovarian cycle in stressed female mice if ginseng was administered. Bao et al. (1984c) also reported that ginseng extracts given to male mice prevented stress-induced decrease of sexual activity. Similarly Lian and Zhang (1998) also noted that repeated daily hanging stress reduced sexual activity in male mice as assessed by licking, mounting and mating activity. The plasma testosterone level was reduced but treatment with ginsenoside Rb1 (2.5, 5 or 10 mg kg, i p) before each stress event countered the repeated stress-induced sexual deficiency and raised the plasma testosterone level. It was concluded that ginsenoside Rb1 was capable of maintaining the normal plasma testosterone level. The reported occurrence of oestrone, oestradiol and oestriol in liposoluble fractions of ginseng extracts, based on TLC results, was not...

Ginseng And Tumour Growth

The cancerous condition develops frequently in patients manifesting reduced resistance as in old age and such cancers can be combatted by strengthening the general body resistance whilst simultaneously treating the cancer with suitable drug therapy or appropriate radiation treatment. Therefore adaptogens such as ginseng or eleutherococcus should function well by stress resistance and antitoxic effect. Ginseng enhances the formation of antibodies and immune functions in cancer patients and in microbe-infected experimental laboratory animals, possibly by elevation of the cAMP (cyclic adenosine monophosphate) levels. Both antitumoral activity and stimulation of the immune function of cancer patients when ginseng was administered have been observed in experimental animals and in human subjects. The reduced susceptibility of the host to bacterial, viral or tumour attack or infection has been referred to as non-specific immunostimulation, para-immunity or biological response modification...

Ginseng And The Ageing Process

As people's lives become longer, particularly in the more civilised societies which have adequate medical and preventative services, ageing presents many problems. As we age we become less physically fit, we show obvious changes such as whitening or loss of hair, wrinkled skin which recovers more slowly from the pinch test, weakened hearing and vision, general slowing down of physical activities and we become more liable to suffer from various illnesses. Less obvious is the deterioration of the body organs prompting glandular disorders, reduction of hormone output leading to sexual impotency, gradual mental deterioration and breakdown of the immune system. Any life style, drug or medicine that can delay or slow this inevitable decline and improve the quality of life is therefore important. The ancient Chinese were convinced that ginseng was the tonic that fulfilled this role. After all, it is an adaptogen coping with stress, it is a metabolism regulator for proteins, carbohydrates and...

Ginseng In Cosmetic Preparations

Ginseng saponins are structurally near chemical relatives of the antiinflammatory compounds such as steroids and glycyrrhetinic acid from liquorice (Glycyrrhiza glabra L.). It is thus not surprising that antiinflammatory properties have been reported for ginseng extracts and ginseng has been suggested as an ingredient of cosmetic creams with non-allergenic, cutaneous bioactivity for the treatment of wrinkles and eczema. The many recent patent applications involving cosmetic creams, anti-wrinkle creams, acne applications and hair growth preparations with supporting claims of efficacy suggest probable effectiveness (cf Chapter 9). Curri et al. (1986) had reported that ginseng extract applied topically as a phospholipid liposomal formulation produced a favourable effect on skin ageing, moisturisation of the stratum corneum and improved skin elasticity. Saponins of ginseng, the ginsenosides Rb1, Rb2, Rc, Re and Rg 1, as well as 70 per cent methanolic extract of P. ginseng, increased the...

Ginseng Korean

Historical note Gin refers to man and seng to essence in Chinese, whereas Panax is derived from the Greek word pan (all) and akos (cure), referring to its use as a cure-all. Ginseng is a perennial herb native to Korea and China and has been used as a herbal remedy in eastern Asia for thousands of years. It is considered to be the most potent Qi or energy tonic in TCM. Modern indications include low vitality, poor immunity, cancer, cardiovascular disease and enhancement of physical performance and sexual function. However, a recent systematic review of RCT found that the efficacy of ginseng root extract could not be established beyond doubt for any of these indications (Coon & Ernst 2002).

B Ginseng

Ginseng is an herbal preparation derived from the aromatic root of a plant of the genus Panax, which is native to East Asia. Ginseng belongs to the Araliaceae family of plants. Siberian ginseng belongs to a different genus, Eleutherococcus senticosus. The English name of the plant is a modification of its Chinese name, ren shen, which means man and herb. The Chinese name comes from the ginseng root's resemblance to the shape of the human body, whence the plant's traditional use as a tonic for male sexual vigor and potency. The Latin name for the species, Panax, is derived from the Greek word panacea, which means cure-all, or, all-healer. There are three species of ginseng in common use in the United States American ginseng, Korean ginseng, and Siberian ginseng. All are regarded as adaptogens that normalize immune functions and are preparations that help the body adapt to change, thus lowering the risk of stress-related illness. American ginseng, whose botanical name is Panax...

Sexual Functioning

Of all the psychosocial domains affected by testicu-lar cancer and its treatment, sexual function, for understandable reasons, has been among the most frequently studied. Although findings generally indicate that sexual functioning is altered among survivors, careful consideration of this outcome is warranted. The reasons for altered sexual functioning among survivors are varied. Factors such as the physical sequelae of testicular cancer itself, treatment-related side effects, or psychological distress following treatment can affect sexual functioning.38 For example, retroperitoneal lymph node dissection (RPLND), a surgical procedure commonly used in the treatment of testicular cancer, involves the resection of retroperitoneal sympathetic nerves involved in semen emission.38 A common side effect of RPLND is dry ejaculation, which can negatively impact sexual functioning and satisfaction. Nondis-ease-related variables, such as age, physical or psychological comorbidity, and marital...


Penile erection is a vascular event, and it is important to recognize that local vasodilatation in the penis is under dual control by autonomic nerves and the endothelium (262). In the periphery major causes of impotence are vascular disease and diabetic autonomic neuropathy. Both neurogenic and endothelium-dependent relaxation of erectile smooth muscle can be impaired in diabetic men with impotence and in experimental diabetes (263,264). Within the corpus cavernosum, reduced levels of NA and decreased innervation by VIP-containing and AChE-positive nerve fibers have been reported in diabetic patients with impotence (265). NO has been proposed as an important neurotransmitter in erection. The production of NO by the corpus cavernosum following nerve stimulation is reduced in patients with vasculogenic impotence (266). In patients with neurogenic impotence a significant reduction in NOS-containing nerve fibers in the corpus cavernosum has been observed (267). Sildenafil, the latest...

Ginseng And Sleep

Many ginseng users claim improved sleep patterns as an advantage gained by regular ingestion of the roots. That Panax ginseng extract given orally in drinking water modulated sleep in unrestrained rats was demonstrated by Rhee et al. (1990) who observed that the amount of wakefulness was significantly decreased during a 12 hr period of light whilst the amount of slow wave sleep was increased. Sleep was apparently unaffected during the dark period. The same group (Lee et al., 1990a) observed that the amount of slow wave sleep and wakefulness fluctuated significantly during 48 hours food deprivation and also during the following recovery periods. However, employing age-matched male rats chronically treated with ginseng extract via drinking water, the fluctuation was markedly reduced. Therefore it was suggested that the beneficial effect of ginseng might be related, in part, to improvement of sleep caused by a stabilising effect on sleep-waking disturbances. Investigating a ginseng...

Ginseng And Alcohol

Alcohol is foreign to the human system and is normally destroyed in the liver by oxidation yielding acetaldehyde which is in turn destroyed by aldehyde dehydrogenase. Ginseng saponins significantly increased the rate of oxidation of ethanol in alcohol-fed rats (Joo et al., 1982). The liver decontaminates the body, converting chemical waste products to both useful and harmlessly useless products. In response to stress hormones the liver accelerates the conversion of waste and the generation of new protein enzymes and ginseng is known to facilitate such functioning of the liver (Fulder, 1980). Studying the effects of red ginseng extract and vitamins on alcohol-intoxicated mice, Saito et al. (1984b) stated that tocopherol inhibited alcoholic excitation and red ginseng extract and pantethine prevented memory failure in intoxicated mice. Using healthy human volunteers, Lee et al. (1987) demonstrated that in 10 out of 14 cases ginseng extract (3g 65 g body weight) accelerated blood-alcohol...

Ginseng And Diabetes

The value of ginseng preparations in the treatment of diabetes mellitus is debatable. Diabetes, diabetes mellitus or sugar diabetes, is a common condition occurring worldwide and amongst all classes of people but more frequently amongst the poor and the aged in modern industrialised communities. In such societies it is rated as the third most common cause of death after cancers and cardiovascular conditions. The disease is characterised by impaired carbohydrate metabolism caused by inadequate production in the pancreatic islets of Langerhans of the hormone insulin, a small protein molecule (molecular weight 5808) comprising two amino acid chains connected to each other by disulphide linkages. In the absence of insulin in the blood stream the blood sugar level rises abnormally (hyperglycaemia) and sugar passes readily into the urine with The causes of diabetes are multifactorial depending on hereditary traits, age, pregnancy, obesity, stress, drug-related factors (corticosteroids and...

Ginseng Siberian

Historical note Siberian ginseng has been used for over 2000 years, according to Chinese medical records, where it is referred to as Ci Wu Jia. It was used to prevent colds and flu and to increase vitality and energy. In modern times, it has been used by Russian cosmonauts for improving alertness and energy, and to aid in adaptation to the stresses of life in space. It has also been used as an ergogenic aid by Soviet athletes before international competitions and was used after the Chernobyl accident to counteract the effects of radiation.

Former Reader in Pharmacognosy University of Bradford UK

Among such plants is ginseng, the collective name for a group of plants esteemed by the Chinese for more than 5000 years, but never really accepted in western medicine and therefore soon forgotten by the western world until its reinvestigation as an alleviating agent or cure for the ills of modern stressful lifestyles. True ginseng, Panax ginseng C.A.Meyer, is a small, inconspicuous, shade-loving, perennial shrub attaining a height of about 60 cm and belonging to the ivy family Araliaceae (Fig. 1.). The generic name Panax was derived from the Greek way and a o uai meaning all-heal or all-cure and reflected the popular, traditional use of the plant as a panacea. The specific name ginseng or schinseng is a transliteration of the Chinese names Jin-chen, Jen-schen, Ren-shen, Schin-sen or Schan-shen (wild mountain ginseng) and relates to the anthropomorphic appearance of the subterranean parts of the plant, the vague resemblance of the mature roots to the human form. Cultivated or garden...

Somatic embryogenesis and plant regeneration

The suggestion of somatic embryogenesis in ginseng tissue cultures was first made by Butenko and her colleagues (1968) but at that time all attempts to achieve the regeneration of whole ginseng plants from isolated embryo-like structures failed. Pursuing their work on the culture of ginseng root tissues Chang and Hsing (1978) obtained embryoids from root derived callus in defined conditions. Regeneration systems via somatic embryogenesis were established in root callus (Chang and Hsing, 1980), in zygotic embryo callus (Lee et al., 1990) and in protoplast derived callus (Arya et al., 1991). High-yield and short period embryogenesis via callus induced by the culture of young flower buds on the MS medium supplemented with 2,4 D in the dark was developed in 1988 by Shoyama et al. Later, Arya et al. (1993) reported a rapid somatic embryo formation, obtained due to secondary and tertiary embryogenesis. Embryogenic callus was initiated from immature zygotic embryos of ginseng and the somatic...

Production of Secondary Metabolites by in vitro Culture

The first report on the production of ginsenosides in ginseng callus was published in 1970 by Japanese authors (Furuya et al., 1970). They detected by TLC and column silica gel chromatography analysis a large amount of ginsenoside Rg and a small amount of ginsenoside Rb in ginseng callus derived from petiole of cultivated ginseng grown on MS medium without glycine and supplemented with 1 mg l 2,4-D. Later Furuya et al. (1973) found that the kind and amount of saponins in the callus of the same origin are about the same as in the ginseng root. By means of TLC and column chromatography analysis they isolated the ginsenosides Rb1 and Rg1, panaxadiol, panaxatriol and oleanolic acid. Simultaneously they obtained a mixture of phytosterols consisting of a large amount of -sitosterol and a small amount of campesterol and stigmasterol. The presence of ginsenosides Rb1 and Rg1 was confirmed by NMR. The effect of auxins on saponin production in ginseng callus was studied by Furuya et al. (1983a)...

Heptadeca1 en46diyn39diol R H 513 Panaxytriol R OH

Studying extraction techniques for polyacetylene compounds in white ginseng root and using various solvents, Nho and his colleagues (1990) concluded that refluxing with methanol was the most efficient of the seven solvent systems investigated although Soxhlet extraction was almost equally effective. The solvents in order of decreasing efficiency were methanol, methylene dichloride, acetone, diethyl ether, ethyl acetate, methyl cyanide and petroleum ether. Panaxynol and panaxydol were the principal polyacetylenes present, the yield being 4.2 mg g and 6.4 mg g respectively. Continued interest in these compounds led to the isolation from the hexane extract of P. ginseng roots of a series of new polyacetylenes which were designated ginsenoynes A-E and acetylated ginsenoynes F-K (Hirakura et al., 1991, 1992)(see Appendix to Chapter 5). Later Hirakura et al. (1994) described the isolation and characterisation of the linoleoylated polyacetylenes panaxynol linoleate, panaxydol linoleate and...

Early Use As A General Tonic

The earliest Chinese texts praised the virtues of ginseng stating that if it was taken constantly it was a tonic to the five viscera (liver, lungs, heart, spleen and kidneys), quieting the spirits, establishing the soul, allaying fear, expelling evil effluvia, opening up the heart and brightening the eyes, benefiting the understanding and invigorating the body and prolonging life (Hou, 1978). Several more recent workers have shewn that ginseng extracts from stems or leaves given orally or intraperitoneally to young rodents produce body weight increase, increase in protein and ribonucleic acid (RNA) in muscle and liver cells, and no increase of weight in the prostate glands or seminal vesicles (Wang et al., 1982). Increased synthesis of protein, deoxyribonucleic acid (DNA) and RNA in the bone marrow and protein and RNA in the kidneys was also found and ginseng stem and leaf given orally accelerated the growth of young pigs. It was noted that the saponins of the aerial parts of P....

Stress And Adaptogenic Activity

Probably the most important use of ginseng and its saponins is as anti-stress agents. Stress, a normal feature of life, can readily be reproduced experimentally and is apparent in all impaired and injured animals. Stress manifests in many forms e.g. reaction to external conditions such as the fight or flight phenomenon, heat, cold, noise, starvation, physical restraint, etc., reaction to psychiatric states e.g. fear, anxiety, emotional strains, psychosomatic diseases, etc., and reaction to disease, bacterial and viral infection, physical injury, wounds, surgical operations, chemical agents, pollutants, etc. In particular, the pace of modern society places individuals in abnormal situations where stress is often The eminent Russian pharmacologists I.I.Brekhman and I.V.Dardymov, working in the Biologically Active Substances Division of the Siberian Branch of the USSR Academy of Sciences in Vladivostok in the 1950's and 1960's, carefully studied the ability of ginseng (Panax ginseng),...

Temperature Stress Reaction

Ginseng and its extracts can prevent body temperature variations in animals subjected to the stress of cold and heat exposure, although not apparently affecting normal subjects at room temperature. This was realised in 1958 when the Chinese physiologists Sung and Chi published experimental results indicating that powdered P. ginseng root contained active principles with a protective property against temperature stresses. Using male white rats fed either on a normal diet or a normal diet with 5 per cent added ginseng powder, they were able to demonstrate that after 3 weeks the ginseng-fed group were more able to withstand heat stresses of 5-6 minutes at 78-90 C or 60 minutes at -2 C. In an alternative experiment one group of rats received 2.4 ml of 50 per cent ginseng extract one hour before the temperature stress whilst the other (control) group received water only. Ginseng treated rats, on being returned to normal conditions after hot chamber treatment, recovered almost immediately...

Physical Stress Reaction

In earlier times and particularly in indigenous Chinese medicine ginseng root was employed as a remedy for premature weakness or exhaustion induced by physical or mental stress. In our own time improved physical and mental activity has frequently been reported and confirmed as the most important effect of ginseng (Sonnenborn, 1987). The period of active work is extended and the onset of fatigue correspondingly delayed. Fatigue and weariness occurs after prolonged activity, manifesting itself as irritability, failing concentration, reduced ability to rationalise and consequently inefficient working. Certainly repeated laboratory experiments had confirmed improved running ability, increased climbing performance and prolonged swimming endurance of test animals (Hou, 1978 Fulder, 1993). Positive gravity effects induced by radial acceleration generate considerable stress reaction. Kim and Koh (1964a), using 840 mice, found that a 2 mg kg body weight day injection of an ethanol extract of...

The Mechanism Of Stress Reaction

As one of the main uses of ginseng is as an antistress agent, it is necessary to consider the mechanism of stress reaction. In the living body such reaction is controlled by The hypothalamus receives signals from higher centres of the brain indicating a stress situation such stimulation causes release of chemical messengers called peptide neurohormones into the blood stream prompting the activation of the pituitary gland with the release of signals to the adrenal glands via the adrenocorticotrophin hormone (ACTH). Responding to ACTH stimulation the adrenal cortex, the outer area of the adrenal gland, secretes corticosteroids (glucocorticoids e.g. hydrocortisone or cortisol) which rapidly mobilise the body's carbohydrate, protein and fat reserves. In man hydrocortisone forms 95 per cent of the total glucosteroids formed in the adrenal cortex. Production and distribution of glucosteroid stress hormones is increased under stress although limited in the body at rest even when ginseng is...

William Ecourt

During the past 50 years a vast amount of literature of widely varying quality has accumulated concerning the pharmacology of ginseng and its preparations and by 1990, despite the scepticism of many orthodox Western physicians and pharmacologists, ginseng had already attracted considerable interest and an ever increasing degree of respectability as a herbal medicine worthy of further study and of discussion at medical and scientific meetings worldwide.


Ginseng and the Quality of Life 3. Absorption, Distribution, Excretion and Metabolism of Ginseng Saponins 9. Ginseng and Anti-ulcer Activity 10. Ginseng, Memory and Intellectual Skills 11. Ginseng and Sleep 12. Ginseng and the Ageing Process 13. Ginseng and Alcohol 14. Ginseng and Morphine and Related Opioids 15. Ginseng and the Central Nervous System 16. Ginseng as a Biological Response Modifier 17. Ginseng and Tumour Growth 18. Ginseng and the Cardiovascular System 19. Ginseng and Atherosclerosis 20. Ginseng and Diabetes 21. Ginseng and Aphrodisiac Activity 22. Ginseng and Cosmetics


Was, and still is, the treatment of the patient as a whole, not as an isolated disease condition, coupled with prophylaxis, that is, obeying the axiom that prevention is far better than cure. Therefore the medical texts of those times e.g. Shen-nung Pen-ts'ao Ching (ca. 200 A.D.) that listed some 365 plant drugs, Ming-I Pieh-lu (ca. 500), Chia-yu Pen-ts'ao (1057) and Pen-ts'ao Kang-mu (1596) that included nearly 1900 drugs of animal, vegetable and mineral origin, recommended ginseng as an excellent tonic medicine which could maintain the body in good health, induce rejuvenation and retard the inevitable process of ageing. This was due to the restoration of Yang establishing the healthy Yin Yang balance in the five visceral areas. Ginseng was therefore employed in the treatment of conditions such as defective memory, gastrointestinal disturbance and debility states. As the treatment of illness comprised the rebalancing of Yin Yang forces, the herbal plants were evaluated for their Yin...


The above survey of the pharmacology and therapeutic potential of ginsengs indicates that ginseng can strengthen the debilitated body, stimulating recuperation and improving the quality of life. Ginseng has been shewn as an agent capable of improving memory and intellectual skills at all ages and it is also certain that ginseng is of value in the countering of stresses due to temperature variation, physical strain, disease states and toxic substances. Less clear is the anti-ulcer effect as ginsengs are usually used in combination with other plants containing substances such as mucilages, pectin polysaccharides and dextrins. There is evidence of the protective effects of ginseng in old age. Protection from neural degeneration, preservation of antioxidant levels and inhibition of malondialdehyde formation collectively retard the inexorable advance of age related deterioration. Therefore ginseng has potential in geriatric tonics and medicines for the treatment of conditions such as...

Evolution Of Current Treatment Approaches

Urologists have made important contributions to the treatment of erectile dysfunction. Both the Small-Carrion and inflatable penile prostheses were introduced in the 1970s. Although patents for vacuum erection devices were obtained as early as 1917, the introduction of the vacuum erection pump by Osborn in 1974 resulted in this being a common solution for many men before the introduction of other treatment options. Alprostadil intracorporal injections were introduced in the 1980s. However, the popularity of treatment approaches decreased dramatically with the introduction of sildenafil in 1998 and the subsequent introduction of tadalafil and vardenafil. Now a man could take an effective oral agent that allowed sexual behavior to occur in a more natural way. Understandably, as the primary etiology of erectile dysfunction for majority of aging men is vascular (13,14), the main focus of therapeutic oriented research of erectile dysfunction has been the vascular dysfunction insufficiency...

Combination Therapy The Road To Success

Combining sexual pharmaceuticals and sex therapy is the oral therapy of choice to optimize treatment for all SDs. This is true for men with ED, PE, or retarded ejaculation (RE) and will also be true for FSD. Less medication is required when you modify immediate causes while appreciating other psychological obstacles (20). However, CT is by no means a new idea, and sexual medicine is not the first specialty utilizing a broad-spectrum approach to increase efficacy and satisfaction.

Combination Therapy A Brief Relevant History

In urology and many medical specialties, CT usually referred to a, two or more drug regimen, such as the 2003, AUA guidelines for BPH (27). There already is a history of using CT in sexual medicine. In the 1990s, sex therapists worked with urologists combining either ICI or vacuum tumescence therapy. Turner et al. (28a) found that psychological counseling was necessary to augment a pharmaceutically induced erection, for a man with a psychogenic ED. Kaplan managed resistance to ICI, helping five couples find satisfaction with pharmaceutical restoration of potency (28b). Hartmann and Langer (29) integrated injection therapy and sexual counseling concluding that a combined approach was beneficial. Colson described the results of a study integrating cognitive-behavior therapy and ICI technique. Of their patients, 51 were still able to experience satisfactory sexual intercourse after discontinuing injection therapy (30). Lottman et al. (31), integrated short-term therapy with...

Frequency Of Autonomic Dysfunction In Parkinsons Disease

Although the focus of routine follow-up visits between PD patients and neurologists is typically on motor symptoms of the disease, autonomic problems are frequently present and can be identified if patients are specifically asked. In one study of 48 men with PD, 89 had at least one autonomic symptom compared with 43 of elderly control subjects (2). Autonomic symptoms seen in these men with PD included erectile dysfunction (60 ), urinary urgency (46 ), constipation (44 ), dysphagia (23 ), and orthostatism (22 ), and each of these symptoms was more common in PD patients than controls. Siddiqui et al. (3) performed a comprehensive symptom survey of autonomic symptoms in 44 patients with PD, comparing the frequency and severity of these symptoms with 24 aged-matched controls. Using a five point scale to rate symptom severity, the authors tabulated the severity of symptoms in each of five areas GI, urinary, sexual dysfunction, cardiovascular, and thermoregulatory. They found that PD...

Combination Therapy Guidelines Who How and When

Counseling in this situation, is utilizing sex therapy strategies and techniques to overcome psychosocial resistance to sexual function and satisfaction (20). In a second model, the above clinicians will collaborate with nonphysician MHPs (sex therapists), resolving SD(s) through a coordinated multidisciplinary team approach to treatment. The clinical combinations will vary according to the presenting symptoms, as well as the varying expertise of these health care providers. The utilization of these two different models will require three steps. (i) The clinician first consulted by the patient will consider their interest, training, and competence. (ii) The bio-psychosocial severity and complexity of the SD as a manifestation of both psychosocial and organic factors will be evaluated. (iii) The clinician in consideration of the two previous criteria, together with patient preference, will determine who initiates treatment, as well as, how and when to refer. The guidelines for managing...

Patient Preference Sexual Scripts and Pharmaceutical Choice

Healer patient relations, minimize PSOs, and improve compliance. Preliminary comparator data, abstracted from the 2003 European Society of Sexual Medicine, suggested, patient preferences reflected, key marketing messages of the respective pharmaceutical companies (49). Prescribing physicians might take advantage of that hypothesis to increase efficacy. If safety and long-term side effects are the primary concern, sildenafil has the oldest longest database (12). If, pressed by questions regarding hardness of erection in vitro selectivity may or may not translate to clinical reality, yet some patients believe vardenafil provides the best quality erection with the least side-effect (13). What is the physician's experience with their own patients By taking a sex history and evaluating the premorbid sexual script (what used to work sexually), a skillful clinician may make an educated guess, as to which pharmaceutical to first prescribe. This transcends, try it, you'll like it. Knowledge of...

Followup and Therapeutic Probe

Discussions of follow-up most vividly illustrate the importance of integrating sex therapy and pharmacotherapy. Urologists, Barada and Hatzichristou improved sildenafil nonresponders by emphasizing patient education (e.g., food alcohol effect), repeat dosing, partner involvement, and follow-up (52,53). Patient education about the proper use of sildenafil was crucial to treatment effectiveness. Physicians can increase their success by scheduling follow-up, the first day they prescribe. As with any therapy, follow-up is essential to ensure an optimal treatment outcome. Initial failures examined at follow-up reveal critical information. The pharmaceutical acts as a therapeutic probe, illuminating the causes of failure or nonresponse (2,15,20). Retaking a quick current sexual

Summary And Conclusion

Sexuality is a complex interaction of biology, culture, developmental, and current intra and interpersonal psychology. A bio-psychosocial model of SD provides a compelling argument for CT integrating sex therapy and sexual pharmaceuticals. Restoration of lasting and satisfying sexual function requires a multidimensional understanding of all of the forces that created the problem, whether a solo physician or multidisciplinary team approach is used. Each clinician needs to carefully evaluate their own competence and interests when considering the treatment of a person's SD, so that regardless of the modality used, the patient receives optimized care. For the most part, neither sex therapy nor medical surgical interventions alone are sufficient to facilitate lasting improvement and satisfaction for a patient or partner suffering from SD. There will be new medical and surgical treatments in the future. Sex therapists and sex therapy will complement all of these approaches. This author is...

Traditional Markers Of Sexual Desire

Fantasies, which are a marker of sexual desire in DSM-IV-TR may, in fact, serve as a deliberate means of creating arousal and reinforcing desire. Data confirm the clinical experience that women fantasize to deliberately focus on their sexual feelings and avoid the distractions that are interfering with their sexual response (47).

Vascular Supply Of The Spinal Cord

Spinal Cord White Ramus

Ligation of the great radicular artery during resection of an abdominal aortic aneurysm may result in anterior spinal artery syndrome. Clinical findings include paraplegia, impotence, loss of voluntary control of the bladder and bowel (incontinence), and loss of pain and temperature sensation (although vibration and proprioception sensation are retained).

Closer Look At The Biological Basis Of Womens Sexual Desire And Arousability Including The Role Of Androgens

The neuroendocrine basis of sexual desire interest is poorly understood. The effects on sexuality of medications with known or partially known mechanisms of action suggest that more than 30 neurotransmitters, peptides, and hormones are involved in the sexual response. Currently, the most clinically important include noradrenaline, dopamine, oxytocin, and serotonin via 5HT1A and 5HT2C receptors all considered to be prosexual. Serotonin acting via most 5HT receptor sites, prolactin, and GABA, are considered sexually negative. The role of dopamine has been investigated particularly in rodents. Dopamin-ergic input from the ventral tegmental area, particularly to the nucleus accumbens and forebrain is important for cognitive and reward processes. Dopamine administration into the nuclear accumbens has been found to stimulate the anticipatory phase (or appetitive phase) of a sexual activity (54). The paraventricular nucleus and the medial preoptic area of the hypothalamus regulate the...

Biopsychosocial Approach to Therapy

There is a general expectation that modulation of the neurotransmitters involved in sexual arousability and desire from hormonal and nonhormonal therapy, will become available. As there are psychological and interpersonal sequelae of medical disruption of the sexual response, benefit beyond placebo may only be

Classification General Sexual Issues

First, as discussed earlier, some see it as much more useful when considering the sexual sequence experienced by men compared with women (5). Second, the phases are described in such a way as to seem discrete but, in actual fact, they flow into each other. For example, desire is not simply at the beginning of a sexual event, but under ordinary circumstances, continues the whole way through (11). Similarly (although ostensibly less common in men vs. women), desire may follow arousal as, for example, when a man awakens in the morning with an erection and only then becomes sexually interested.

Neoadjuvant Therapy In Rectal Cancer

Much has been made of neoadjuvant therapy and its application for mid- to lower-lying rectal tumors. The effects of downstaging possibly enhance the rate of curative surgery and may increase sphincter preservation. The Swedish rectal trial reported its five-year follow-up data on a randomized, prospective trial looking at the role of preoperative radiation in resectable rectal cancer (21,22). The study randomly assigned 1168 patients younger than 80 years of age who had resectable rectal cancer to undergo preoperative irradiation 25 Gray (Gy) delivered in five fractions in one week followed by surgery within one week or to have surgery alone. No chemotherapy was given either pre- or postoperatively. Irradiation did not increase postoperative mortality. After five years of follow-up, the rate of local recurrence was 11 (63 of 553 patients) in the group that received radiotherapy before surgery and 27 (150 of 557) in the group treated with surgery alone (P <...

Laboratory Examination

Erectile dysfunction (ED) often occurs together with sexual disinterest and it may not be easy to establish which preceded the other. Under such circumstances, it is wise to investigate common causes of ED by ensuring that the patient does not have diabetes (obtaining a fasting blood sugar), or elevated lipids assessing his total cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL), and triglycerides , or abnormal thyroid function investigating his thyroid stimulating hormone (TSH) .

Theoretical Perspectives Biological Psychological and Social

One might look first at differing points of view about sexuality in general. Some view sexual difficulties from primarily a biomedical perspective and regard sex as natural. Kolodny et al. wrote to define sex as natural means just as an individual cannot be taught to sweat or how to digest food, a man cannot be taught to have an erection, nor can a woman be taught to lubricate vaginally. Because the reflex pathways of sexual functioning are inborn does not mean that they are immune from disruption due to impaired health, cultural conditioning, or interpersonal stress (30 p. 479) Some have reworded 'naturally' to mean 'automatically, without purpose or without effort' (31).

Treatment General Considerations

Treatment follows diagnostic subtyping (Fig. 1). (A) If HSDD is acquired and generalized, the clinician must make substantial efforts towards finding the explanation(s) for the change. HSDD is sometimes (the frequency appears to be unknown) accompanied by another sexual dysfunction, especially ED, and when both occur together, it may be revealing and useful to find out which came first and to act accordingly. One might envision how a lack of sexual desire can cause erectile problems. However, the opposite is not so clear. The extent to which the presence of ED can result in a generalized lack of sexual desire appears to be entirely unknown. (B) If HSDD is lifelong but situational, a biogenic explanation is unlikely and individual psychotherapy undertaken by a mental health professional seems preferred. (C) If HSDD is acquired but situa-tional, a biogenic explanation is, again, unlikely (with the possibly exception of hyperprolactinemia). In this circumstance, psychotherapy seems...

Products Available

There are also available fresh, freeze-dried, and liquid alcoholic extracts, which come in a variety of forms including tablets, capsules, lozenges, liquids, teas, and salves. A good number of these products are combined with other herbs such as ginseng, goldenseal, and various other supplements to enhance the efficacy of Echinacea.

Individual and Population Examples

Weight, and the huge potential profits for pharmaceutical companies from weight loss medications. Contrast this with the relatively weak and distant driving forces for population-based prevention research and action. These are funded largely from government sources, and the lack of political will due to a short-term political focus and limited public pressure for change remain major obstacles. As discussed later, the driving forces for the obesity epidemic are linked to much broader sectors such as transport, the food industry, education, urban planning, building design, and local government, and this adds to the sense of impotence among health authorities about obesity prevention.

Cardiovascular Effects

According to in vitro and animal studies ginseng may benefit the cardiovascular system 'through diverse mechanisms, including antioxidant, modifying vasomotor > 2007 Elsevier Australia Antihypertensive Red ginseng has been used as an antihypertensive agent in Korea, but its clinical effect is unclear despite several in vivo and in vitro experimental studies. Recent preliminary data suggests that the antihypertensive effects may be partly attributed to an angiotensin-converting enzyme (ACE) inhibitory effect demonstrated by P. ginseng extract in vitro (Persson et al 2006). These effects were additive to the traditional ACE inhibitor enalapril. A study of isolated muscle preparations of animal heart and aorta with an alcohol-based extract of ginseng suggest that the hypotensive effect of ginseng is associated with a direct inhibition of myocardial contractility due to a reduction of calcium ion influx into cardiac cells, as well as the inhibition of catecholamine-induced contractility...

Steroid Receptor Activity

Ginseng has been shown to increase the mounting behaviour of male rats and increase sperm counts in rabbit testes. The effect is not by a direct sex-hormone-like function, but probably via a gonadotropin-like action. Ginsenoside Rb1 has been shown to increase LH secretion by acting directly on the anterior pituitary gland in male rats (Tsai et al 2003). Ginsenoside Rh1 failed to activate the glucocorticoid and androgen receptors, but did demonstrate an interaction with oestrogen receptors in vitro. The effect was much weaker than 17-beta-oestradiol. Ginseng is therefore considered to contain phyto-oestrogens (Lee et al 2003). However, there are conflicting reports about oestrogen binding activity which may in part be explained by the presence or absence of zearalenone, an oestrogenic mycotoxin contaminant (Gray eta I 2004).

Prevention Of Damage From Toxins

Ginseng extract has been shown to be beneficial in the prevention and treatment of testicular damage induced by environmental pollutants. Dioxin is one of the most potent toxic environmental pollutants. Exposure to dioxin either in adulthood or during late fetal and early postnatal development causes a variety of adverse effects on the male reproductive system. The chemical decreases spermatogenesis and the ability to conceive and carry a pregnancy to full term. Pretreatment with 100 or 200 mg kg ginseng aqueous extract intraperitoneally for 28 days prevented toxic effects of dioxin in guinea pigs. There was no loss in body weight, testicular weight or damage to spermatogenesis (Kim et al 1999). In guinea pigs P. ginseng also improves the survival and quality of sperm exposed dioxin (Hwang et al 2004).

Cardiovascular Disease

Although there are reports of ginseng causing hypertension, red ginseng is actually used as an antihypertensive agent in Korea. Acute administration of an aqueous preparation of Korean ginseng (100 mg kg body weight) to 12 healthy, non-smoking male volunteers resulted in an increase in NO levels and a concomitant reduction in mean blood pressure and heart rate (Han et al 2005). Ginseng is often used in practice as an adjuvant to both conventional and CAM treatments. An open clinical study of 44 hypertensive patients found red ginseng, 1.5 g three times daily (4.5 g day), to be useful as an adjuvant to antihypertensive medication (Han et al 1995). A combination of red ginseng and digoxin was found to be more beneficial than either drug alone in an open study of advanced congestive heart failure. There were no adverse reactions (Ding et al 1995). A combination of ginseng and ginkgo extracts has been found to improve circulation and lower blood pressure in a controlled single-dose study...

Causes and symptoms

Stimulates the amygdala and causes panic attacks. Another hypothesis is that patients with panic disorder have a hypersensitive internal suffocation alarm. This means that the patient's brain sends the body false signals that not enough oxygen is being received, causing the affected person to increase his or her breathing rate. Panic disorder patients have attacks when their overly sensitive alarm goes off unpredictably. Yohimbine, a drug used to treat male sexual dysfunction, stimulates a part of the brain called the locus ceruleus and induces panic symptoms thus pointing to this area of the brain's involvement in panic disorder. Brain neurotransmitters serotonin and GABA are suspected to be involved in causing the disorder, as well.

Adverse Reactions

Ginseng abuse syndrome (hypertension, nervousness, insomnia, morning diarrhoea, inability to concentrate and skin reactions) has been reported and there has been a report of a 28-year-old woman who had a severe headache after ingesting a large quantity of ethanol-extracted ginseng. Cerebral angiograms showed 'beading' appearance in the anterior and posterior cerebral and superior cerebellar arteries, consistent with cerebral arteritis (Ryu & Chien 1995). High doses (1 5 g day) have been associated with confusion, depression and depersonalisation in four patients (Coon & Ernst 2002). However, the majority of the scientific data suggest that ginseng is rarely associated with adverse events or drug interactions. A systematic review found that the most commonly experienced adverse events are headache, sleep and gastrointestinal disorders. Data from clinical trials suggest that the incidence of adverse events with ginseng mono-preparations is similar to that of placebo. Any...

Drugs Metabolised Chiefly By Cyp1a And Cyp2d6

Mixed reports exist as to whether ginseng may act as an inhibitor of cytochrome CYP1A (Gurley et al 2005, Lee et al 2002b, Yu etal 2005) or CYP2D6 (Gurley et al 2005) and if so whether the effect is likely to be clinically significant. Observe for increased drug bioavailability and clinical effects. Ginseng Korean 565 Vi Ginseng increased the mean plasma concentration of the calcium channel blocker nifedipine by 53 at 30 minutes in an open trial of 22 healthy subjects. Effects at other time points were not reported (Smith et al 2001). Caution.

Reduced Representation Sequencing

The sequencing of BAC ends within the context of genome survey has been described for at least ginseng (Hong et al. 2004), soybean (Marek et al. 2001) and maize (Gardiner et al. 2004). The deep sequencing of BAC ends only really becomes appropriate once a whole genome sequencing strategy has been adopted, but nevertheless there remain significant Genome Survey Sequence (GSS) resources in the public domain.

Immunomodula Tion

Siberian ginseng appears to exert an immunomodulatory rather than just an immunosuppressive or stimulating action however, evidence for the immune enhancing effects of Siberian ginseng is contradictory. Clinical studies in vitro and in vivo have revealed stimulation of general non-specific resistance and an influence on T-lymphocytes, NK cells and cytokines (Bohn et al 1987, Schmolz et al 2001), although other studies suggest that Siberian ginseng does not significantly stimulate the innate macrophage immune functions that influence cellular immune responses (Wang et al 2003). Alternatively, another in vitro study has demonstrated that activation of macrophages and NK cells does occur and may be responsible for inhibiting tumor metastasis both prophylactically and therapeutically (Yoon et al 2004).

Prevention Of Infection

Due to the herb's ability to directly and indirectly modulate immune responses, it is also used to increase resistance to infection. One double-blind study of 1000 Siberian factory workers supports this, reporting a 50 reduction in general illness and a 40 reduction in absenteeism over a 12-month period, following 30 days' administration of Siberian ginseng (Farnsworth et al 1985). More recently, a 6-month controlled trial in males and females with recurrent herpes infection found that Siberian ginseng (2 g day) successfully reduced the frequency of infection by 50 (Williams 1995). In practice, Siberian ginseng is generally used as a preventative medicine, as administration during acute infections is widely thought to increase the severity of the illness, although this has not been borne out in controlled studies using Siberian ginseng in combination with other herbs. A small RCT demonstrated a significant reduction in the severity of familial Mediterranean fever in children using a...

Significant Interactions

As controlled studies are not available, Interactions are currently speculative and based on evidence of pharmacological activity and case reports. Studies have reported that normal doses of Siberian ginseng are unlikely to affect drugs metabolised by CYP2D6 or CYP3A4 (Donovan et al 2003). ANTICOAGULANTS An In vivo study demonstrated that an Isolated constituent In Siberian ginseng has anticoagulant activity (Yun-Chol et al 1987) and a clinical trial found a reduction In blood coagulation Induced by Intensive training In athletes (Azlzov 1997). Whether these effects also occur In non-athletes Is unknown. Observe.

Contraindications And Precautions

Some authors suggest that high-dose Siberian ginseng should be avoided by those with cardiovascular disease or hypertension (BP > 80 90 mmHg) (Mahady et al 2000). Others merely suggest a caution, as reports are largely unsubstantiated (Holford & 2007 Elsevier Australia Siberian ginseng appears to alter the levels of different neurotransmitters and hormones involved in the stress response, chiefly at the HPA axis. Siberian ginseng may increase resistance to infection and has been shown to reduce frequency of genital herpes outbreaks with long-term use. Siberian ginseng affects many chemicals involved in switching on and off the body's stress responses. As such, it is used to improve wellbeing during times of chronic stress however, scientific research has yet to fully investigate its use in this regard. It may also boost immune function and reduce the frequency of genital herpes outbreaks. Evidence for improved performance in athletes in unconvincing. When will it start to work

Diagnostic Procedures

An ideal protocol for the assessment of FSAD should be constructed following theoretical and factual knowledge of the physiological, psychophysiological, and psychological mechanisms involved. The protocol then describes the most parsimonious route from presentation of complaints to effective therapy. Unfortunately, we are at present far from a consensus on the most probable causes of FSAD. Despite this disagreement, at least two diagnostic procedures should be considered. Firstly, assessment of sexual dysfunction in a biopsychosocial context should start with a verification of the chief complaints in a clinical interview. The aim of the clinical interview is to gather information concerning current sexual functioning, onset of the sexual complaint, the context in which the difficulties occur, and psychological issues that may serve as etiological or maintaining factors for the sexal problems, such as depression, anxiety, personality factors, negative self- and body image, and...

What is a Sexual Dysfunction

The experimental evidence and theoretical notions presented earlier strongly suggest that for women, sexual dysfunction is not about genital response. The women in our study who were diagnosed with FSAD according to strict DSM-IV criteria (42) turned out not to be sexually dysfunctional according to these same criteria because their genital response was not impaired. This study demonstrated that it is difficult to be sure that sexual arousal problems are not caused by a lack of adequate sexual stimulation, and that impaired genital response cannot be assessed on the basis of an anamnestic interview. This implies that the current DSM-IV criteria for sexual arousal disorder, which states that genital (lubrication swelling) response is strongly impaired or absent, is unworkable. For most women, even those without sexual problems, it is difficult to accurately assess genital cues of sexual arousal, but this is exactly what the DSM-IV definition of sexual arousal disorder requires. The...

Treatment Psychological Treatments

The emphasis on impaired genital unresponsiveness in the DSM-IV and the success of pharmacological treatments for men's erectile dysfunction have undoubtedly contributed as well. (101), sexual problems were seen as consequences of (nonsexual) psychological conflicts, immaturity, and relational conflicts. Masters and Johnson proposed to directly attempt to reverse the sexual dysfunction by a kind of graded practice and focus on sexual feelings (sensate focus). If sexual arousal depends directly on sexual stimulation, that very stimulation should be the topic of discussion (masturbation training). A sexual dysfunction was no longer something pertaining to the individual, rather, it was regarded as a dysfunction of the couple. It was assumed that the couple did not communicate in a way that allowed sexual arousal to occur when they intended to produce it. Treatment goals were associated with the couple concept the treatment goal was for orgasm through coital stimulation. This...

Does He have a Psychogenic Basis to His ED

In the anxious individual, there can be overactivity of the sympathetic system leading to increased smooth muscle tone. Alternatively, signals from the brain of an individual with a psychogenic issue can override the erectogenic parasym-pathetic output from the sacral spinal cord. Psychosexual therapy can help the individual to deal with issues such as performance anxiety, reduced attraction to his partner (which may or may not be linked to a relationship problem), past sexual trauma, misconceptions about normal sexual function, suppressed feelings about sexuality, fear of sexually transmitted diseases or pregnancy. By enquiring about early morning and spontaneous erections, which all healthy men get, one can eliminate a physical cause for ED. Asking about the sort of situations in which the ED manifests itself can also help. For instance, if he is able to masturbate with an erection while alone, but is unable to perform with a partner suggests a situational response. There may be...

Does He have an Endocrinological Cause to His ED

Dysfunctions, Addison's disease, adrenalectomy, Kleinfelter's syndrome, cytotoxic therapies, mumps orchitis, and age related testicular degeneration as well as antiandrogen medications (e.g., cyproterone acetate, spironolactone, etc.). Androgens have also been shown to influence the activity of NOS in the corporal smooth muscle, which suggests a more direct effect of low levels of testosterone on erectile function. Approximately 52 of circulating testosterone is bound to albumin, 46 is bound to sex hormone binding globulin (SHBG), and 2 is unbound. Determination of free testosterone is preferred as it represents the most accurate parameter to reflect a real testosterone deficiency in the respective target cells. However, because the methods used most widely for determination of these parameters (e.g., equilibrium dialysis method) have shown poor reliability and high cost, the standard for evaluating testosterone deficiency remains determination of total testosterone, the free androgen...

Does He have Drug Related Issues

Drugs, whether prescribed or taken recreationally, may be a source of the problem. Commonly prescribed medications are known to affect erectile function (see Table 7.2). In addition, street drugs such as cannabis, cocaine, amphetamines, and heroin have all been linked to decreased erectile function. Alcohol in excess is a well-recognized cause of ED.

Use of Questionnaires

The use of questionnaires, such as the International Inventory of Erectile Function (IIEF), are sometimes of relevance, and are a useful way of measuring improvement over time (18). The IIEF is a self-report tool that has been used in the clinical trials to assess the response of a subject to oral treatments for ED. It comprises 15 questions which cover five key areas of sexual function in men erectile function intercourse satisfaction orgasmic function sexual desire and overall satisfaction. The two key questions in relation to the studies on ED are question 3 which asks about the ability to achieve an erection sufficient for penetration When you attempted intercourse, how often were you able to penetrate (enter) your partner and question 4 which asks about the ability to maintain the erection long enough for satisfactory intercourse During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner Other questionnaires have...

Materials and Methods

This study was an open-label, historically controlled, single center phase IIa study in which men diagnosed with HG PIN were treated with 60 mg day oftoremifene for 120 days. The study primary objectives were to determine whether toremifene was able to reduce HG PIN in men with HG PIN, to evaluate its effect on other intermediate endpoints including serum total PSA and free PSA, as well as its safety and impact on male hormonal status. The effects of toremifene on quality of life issues, i.e., changes in libido, erectile function, and hot flashes were also assessed. Once informed consent was obtained, subjects were referred to the study if any prostate biopsy within the last 6 mo had HG PIN (at least 6 prostate cores were needed to be included in the study). The prostate pathology was re-evaluated to confirm HG PIN. Subjects who had HG PIN and fulfilled all of the eligibility requirements were enrolled in the study. At study day 120, subjects underwent transrectal...

Adverse Effects and Toxicity

Clinical studies have reported very few adverse effects that are of a mild nature (usually gastric distress or headache) following saw palmetto administration at normal doses. One randomized, double-blind study of finasteride, tamsulosin, and saw palmetto for 3 months observed no differences among the three treatments in terms of the effectiveness measures and no change in sexual function in those individuals receiving saw palmetto, though ejaculation disorders were noted as the most common side effect in those individuals receiving either tamsulosin or finasteride (26).

Definition Of Female Orgasmic Disorder

Most studies examining orgasmic dysfunction in women refer to orgasm problems as either primary orgasmic dysfunction or secondary orgasmic dysfunction. In general, the term primary orgasmic dysfunction is used to describe women who report never having experienced orgasm under any circumstances, including masturbation. According to the DSM-IV-TR, this would refer to those women who meet criteria for lifelong and generalized anorgasmia. Secondary orgasmic dysfunction relates to women who meet criteria for situational and or acquired lack of orgasm. By definition, this encompasses a heterogeneous group of women with orgasm difficulties. It could, for example, include women who were once orgasmic but are now so only infrequently, women who are able to obtain orgasm only in certain contexts, with certain types of sexual activity, or with certain partners. Regarding women who can obtain orgasm during intercourse with manual stimulation but not intercourse alone, the clinical consensus is...

Pharmacological Approaches

Modell et al. (89) reported no significant effect beyond placebo of either 150 or 300 mg day bupropion-SR on orgasm in 20 women with delayed or inhibited orgasm. Ito et al. (90) conducted a double-blind, placebo-controlled study of ArginMax, a nutritional supplement comprising ginseng, Ginkgo biloba, Damiana leaf, and various vitamins, on sexual function in 77 women with unspecified sexual function. Approximately 47 of women treated with ArginMax reported an increase in the frequency of orgasm compared with 30 of women treated with placebo a marginally significant group difference. It cannot be determined from the report how many women would meet a clinical diagnosis for anorgasmia. To date, there have been no published placebo-controlled studies on sildenafil for female anorgasmia and findings from uncontrolled studies are equivocal. In an open-label trial, Kaplan et al. (44) reported a very modest 7.4 improvement in orgasm at 12 weeks with 50 mg sildenafil. Participants were 30...

Open Simple Prostatectomy

This operation is reserved for BPH where the prostate weighs over 50-75 g. It is also appropriate where there is concomitant benign bladder disease requiring treatment such as a symptomatic diverticulum or a large stone. Potential risks are urinary incontinence, erectile dysfunction, retrograde ejaculation and urinary tract infection. The advantages over TURP are complete removal of the gland (therefore no recurrence) and no risk of dilutional hyponatraemia. However, there is an increased risk of intraoperative haemorrhage and a longer hospital stay. Previous prostatectomy, prior pelvic surgery and prostate cancer are contraindications to the operation.

Radical Prostatectomy

The three aims of this operation are cancer control, preservation of urinary continence and of sexual function. Two approaches are available the perineal approach was pioneered first and has the advantages of usually less blood loss and greater exposure of and access to the apex of the prostate, thus optimising removal of tumour from this critical margin and allowing precise transection of the urethra. However, its main disadvantage is that it does not allow access to perform a pelvic lymphadenectomy. Furthermore, a greater understanding of periprostatic anatomy and developments in surgical technique over the years have reduced blood loss and improved tumour clearance using the retropubic approach, to the extent that currently the perineal procedure is seldom performed. It may be indicated for small, low-grade tumours when pelvic lymphadenectomy can be safely omitted. Surgery should be deferred for at least six weeks following needle biopsy and twelve weeks following TURP to allow any...

Sources and Chemical Composition

Korean ginseng, Asian ginseng, Oriental ginseng, Chinese ginseng (7), Japanese ginseng, American ginseng (8). Note that the term ginseng can refer to the species of the genus Panax, as well as to Eleutherococcus senticosus (Siberian or Russian ginseng) (8). Unless otherwise noted, the information in this monograph refers specifically to species of the genus Panax. Depending on the particular botanical reference, there are three to six different species of Panax ginseng, and three with purported medicinal benefits P. ginseng (Chinese or Korean ginseng), Panaxpseudoginseng (Japanese ginseng), and Panax quinquefolium (American ginseng) (8). In this chapter, the term Panax ginseng will be used to refer to these species, and Siberian ginseng will be used to refer to E. senticosus. The chemical composition of Siberian ginseng differs from that of P. ginseng (8) thus, the distinction between the two is important in a discussion of therapeutic and adverse effects.

Drug Interactions

A probable interaction between warfarin and apanax ginseng product has been reported (13). A 47-year-old man with a St. Jude-type mechanical aortic valve had been controlled on warfarin with an international normalized ratio (INR) of 3.1 (goal 2.5-3.5). He experienced a subtherapeutic INR of 1.5 following 2 weeks of ginseng administration (Ginsana three times daily). Other medications included 30 mg of diltiazem three times daily, nitroglycerin as needed, and 500 mg of salsalate three times daily as needed. He had been on all of these medications for at least 3 years before the abrupt change in his INR. Discontinuation of ginseng resulted in an increase in INR to 3.3 within 2 weeks. In this regard, a randomized, double-blind, placebo-controlled trial was undertaken to study the effects of ginseng on warfarin and INR (70). Coadministration of ginseng statistically significantly reduced the INR by -0.19 (95 confidence interval, -0.36 to -0.07) as well as reduced the INR area under the...

Longterm Effects Of Cancer Diagnosis And Treatment On Survivors Family Members

The literature on the effect of cancer diagnosis and treatment on family members is sparse.74 Of studies in this area, most have focused on the impact of cancer soon after diagnosis, during recurrence, or at the terminal phase of the disease.75-77 One study shows that partners of men with prostate cancer, generally from small convenience samples, report more distress than their sick partners, but also believe that their partners are more distressed. The only reviewed study of long-term prostate cancer survivors found that couples' health-related QOL was associated with marital satisfaction.61 Distress was inversely related to levels of family support. The men's focus of concern, on their sexual functioning (i.e., impotence), was not shared to an equal degree by their non-sick partners.78,79 The most relevant study included

Acquired Delayed Ejaculation

Of ejaculation is usually irreversible and the patient should be counseled to optimize his and his partner's enjoyment from the residual sexual functioning. Androgen deficiency requires appropriate testosterone replacement therapy. In the case of inadequate stimulation, pelvic floor exercises may be helpful. Most patients require general advice on reducing precipitating factors, reduction in alcohol use, finding more time for sexual activity when not fatigued.

Inadequate Personality

Closely allied to both the dependent and passive-aggressive personalities is the inadequate personality disorder. Although no longer recognized as a specific entity in DSM-IV nomenclature, it is nevertheless included here because its frequent occurrence gives it more than historical interest. The major feature of this diagnosis involves a profound underresponse in virtually every aspect of the person's functioning. This includes underresponsiveness in relationships, school, jobs, and sexual functioning. Associated with underresponse are traits such as strong feelings of inadequacy and inferiority, a weepy sentimentalism which often emerges in the context of melodramatic events, and an inappropriate sobriety with respect to authority relationships. Although such persons may demonstrate high intelligence, excellent reading skills, and well-developed levels of conceptualization, performance skills and self-assurance are extremely limited.

Drug Delivery System Complications

To increase gastrointestinal motility, stimulant laxatives, such as bisacodyl, are beneficial. Increased retention time allows for greater fluid extraction and stool softeners, such as docusate, or bulk-forming laxatives, such as psyllium, counteract these effects. Sexual dysfunction is another adverse effect that should be monitored in both men and women. Levels of thyroid functioning, cortisol, and testosterone or estrogen should be obtained and followed if loss of libido, difficulty achieving or maintaining an erection, or amenorrhea develops. Some patients may require hormone replacement and the use of steroids.

Reproductive Biology

Lecithotrophic (nourished by stored yolk), but are later plank-totrophic, spending 1-4 weeks in the water column. Settling is triggered by the presence of a filamentous substrate (bry-ozoans, hydroids, algae). Growth rate in culture may be as much as 3 in (80 mm) per year. Life span may be as long as 24 years. Hybridizes with the Mediterranean Mytilus galloprovin-cialis in northern Europe.

Integrating Diagnostic Levels

In addition, even if the character or personality structure is not fully intact, the specific nature of the characterological context that is impaired by a psychotic or organic process can be specified. If an organic impairment is found, it is useful to clarify whether it is mild or profound, acute or chronic. The characterological context in which the organic impairment occurs is essential to report, as is the presence of any neurotic symptoms that have appeared. This kind of specificity can have a significant bearing on prognosis and intervention. For example, if a phobia or sexual impotence is linked to a symptom level of functioning in an organically impaired patient, quite different implications would be drawn than if these phenomena appeared to derive from the organicity itself.

Bladder Bowel and Sexual Disturbances

Sexual symptoms are also common among MS patients. Men most often experience erectile dysfunction, but may also suffer from problems with ejaculation (135,144). These symptoms typically accompany abnormal micturition. Women most typically experience difficulty in achieving orgasm, but may also complain of problems with lubrication (145). Both men and women may also complain of diminished libido. In contrast, a recent case of episodic hyperlibidinism has been reported (146).

Postmenopausal Dyspareunia

Postmenopausal dyspareunia is considered a major indicator for hormonal treatment (103). If nonhormonal vaginal lubricants, such as Replens, are not adequate, then estrogen-based creams or estradiol inserts in ring or tablet format are often recommended. In principle, systemic estrogen-based hormone replacement therapy may also be prescribed. Significant reduction of urogenital atrophy can be obtained through estrogen supplementation, which may, in turn, provide the context for improvements in sexual functioning (104). Presently, evidence from randomized controlled trials is tenuous regarding the benefit of hormone replacement for dyspareunic pain (105). Beyond alleviating symptoms of urogenital atrophy that may subsequently lead to sexual impairment, hormonal supplementation has not been found to substantially contribute to postmeno-pausal sexual functioning (104-106).

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