Condition:

Reproductive disorders: cessation of menstruation, dysmennorhea, endometriosis, and difficult childbirth:

In some women, on account of sadness, their menstrual bleeding is so severely reduced that the vessels carrying blood for the rivulets’ effusion contract as a result of the woman’s sighs and dry out. As a tree blooms and blossoms in summer from the sun, so too women’s menses are often opened from happiness; and as cold wind, frost, and winter dry up the trees leaves and branches, so too the streams of blood that should flow out of a woman often dry up from sadness. On the other hand, when due to an unhealthy superfluity, the humors abound in some women and flow out, causing a different and adverse suffering. The blood vessels carrying the rivulets of blood then constrict so that menstruation stops, because the tempests of the humors cause untimely coldness, and undue warmth…then the blood vessels that should flow out at a certain time become impeded, due to their aridity, and do not flow out. There are other women who have infirm and thick tissues that grow from weakness and foulness rather than from appropriate greenness. These tissues grow over their blood vessels and suppress them so much that they become severely constricted. As a result, their rivulets of blood are weighed down and cannot flow out at the right time.

Treatment:

If a pregnant woman suffers much in labor, carefully and very gently cook mild herbs in water, that is to say, fennel and asarum. Squeeze out the water, place the warm herbs around the woman’s thighs and back, tie a cloth around them and gently hold everything in place, so as to ease her pain and to open the closure of the uterus more gently and more easily. Due to the harmful and cold humors that exist in a woman’s thighs and back, a woman suffers from constriction here more than any other site, and these ingredients will induce the opening of those body parts.

Rationale:

Several reproductive abnormalities could be responsible for these conditions. Endometriosis, a condition in which the uterine lining continues to grow and eventually protrudes out of the uterus, could be the most immediate cause. Adenomyosis, a condition in which the uterine lining begins to grow inward into the uterine muscle or fibroids, small benign growths, or pelvic inflammatory disease could all be possible causes for the primary symptoms of this condition. The leading theory is that retrograde menstruation is the backward flow of menstrual discharge through the fallopian tubes into the pelvis. According to this theory, the endometrial cells may implant on the ovaries or elsewhere in the pelvic cavity leading to ectopic growth of endometrial lining outside of the uterus. Based on the information that Hildegard provides, the assumption is that the painful menstruation, cessation of menstruation, and difficulty in child bearing are all symptoms of endometriosis.

In treating difficult childbirth, the main ingredient the she prescribes is foeniculum vulgare mill or fennel. Fennel has been shown to be a significant promoter of menstruation, alleviator of female climacteric, and increases libido. A number of studies have revealed the effects of fennel on smooth muscle contraction, and it has been shown to have anti-spasmodic effects during uterine contraction. A recent set of experiments conducted by Ostad, Soodi, and Marzban, a group of researchers at the University of Tehram Medical Sciences in Iran, provide significant evidence in confirming the effects of fennel oil in maintaining uterine contractions during pregnancy, as well as in the treatment of dysmennorhea. During pregnancy oxytocin, a nine amino acid peptide that is synthesized in hypothalamic neurons and transported down axons of the posterior pituitary for secretion into blood, is released during labor when the fetus stimulates the cervix and vagina. The hormone enhances contraction of uterine smooth muscle to facilitate parturition or birth. The team at the University of Tehran demonstrated that the compounds in fennel oil can inhibit uterine contraction induced by oxytocin by binding to the oxytocin receptors on the smooth muscle, acting as an antagonist. The active compounds thought to be responsible for the binding are anol or dimethylated anethole and estragole, which are thought to have minor oestrogenic activity (agonistic activity of estrogen). Furthermore, fennel oil aids in alleviating the pain associated with dysmennorhea in a similar manner by relaxing the uterine muscle and preventing painful and rapid uterine contraction.

An interesting set of experiments conducted by Maria Lis Balchin and Stephen Hart, researchers at the School of Applied Science at South Bank University in London may provide insight regarding the mechanism of action by fennel oil on smooth and skeletal muscle. They have found that when administered in vitro, many of the active constituents, anethole and estragole, are absorbed directly into the blood stream, and that fennel may have two opposing effects on muscle tissue depending on whether or not the action is direct or indirect. They have found that the active components of fennel oil are involved in the contraction and inhibition of the twitch response to nerve stimulation in the phrenic-nerve diaphragm muscle. The researchers concluded that direct stimulation of smooth muscle by fennel components or by way of nerve stimulation will result in two different responses. The direct stimulation of fennel oil on the adrenergic receptor, a G-coupled protein receptor, on smooth muscle cell somehow makes calcium more available to the cell by causing the release from the sarcoplasmic reticulum inside of the cell, therefore, causing an increase in the amount of contractibility of the entire unit. This theory contradicts that of Osad, Soodi, and Marzban: direct stimulation resulted in less contractibility.

However, Lis Balchin and Hart propose, also, that fennel oil indirectly leads to decreased contractibility involving the indirect mechanism of action by way of post-junctional blockage of neuromuscular transmission.

Future studies could include investigating the actual mechanism of action involving the adrenergic receptor on the surface of the smooth muscle and downstream effects underlying the increased or decreased contractibility associated with the calcium ion concentration. A number of assays could be used to measure levels of secondary messengers such as cyclic AMP and calcium. Such data could clarify the exact mechanism of action regarding the active constituents of fennel oil.

Analysis of Hildegard of Bingen’s treatments and examination of the validity provides new insight into the effectiveness of folk medicine. Contemporary scientific studies suggest that the use of alternative medicine, herbal remedies, and natural supplements, has many advantages, and current analysis of the main active constituents of these substances lends additional support to this claim. For instance, the active compounds in the essential oils of sage, thyme, and rosemary-- including thujone, eucalyptol, camphor, borneol, thymol, and alpha-pinene-- have all been shown to decrease the modulation of bone metabolism as well as aid in the development of new cancer therapies.

Between 1983 and 1994, over forty- percent of the drugs approved by the FDA and sixty-percent of the anti-cancer drugs on the market were derived from natural compounds (Silverman 1.2). Among the many Chinese herbal extracts examined, the aqueous extracts of Epimedium sagittatum, Trichosanthes kirilowii and Dalbergia odorifera have been used for centuries in curing ischemic heart disease (Wang 4). Despite, the influx of information elucidating the potential uses of alternative medicines, the practice remains a controversial issue among healthcare providers in the United States and Canada.

A recent study conducted in Ontario, Canada reveals the degree of opposition surrounding the professionalization of complementary alternative medical provisions. Likewise, many physicians in the United States disclaim the efficacy of natural compounds in treating particular disorders and even advise their patients against the use of herbal remedies despite the growing amount of advocacy and scientific evidence that suggests significant correlation between natural compounds and the quality of health.

During the past decades, the contribution of herbal medicines has increased greatly in the pharmaceutical industries of Japan, Korea and China. Most herbal medicines still need to be studied scientifically, but the experience obtained from their traditional use over the years should not be ignored (Memory, 2001). In less developed continents such as Asia and Africa, serum lipid levels are low and CHD incidence is much lower as compared with Western countires (Khoo, 2002). Steroid-hormone dependent cancers including those of the breast, prostate and colon are leading causes of morbidity and mortality in western countries. In rural Asian areas, these diseases are relatively uncommon. Dietary factors, including low consumption of fruits, vegetables, and soy in the west, have been shown in various epidemiological studies as reasons for these differences (Zhand and Jenkins).

Every year the NIH (National Institute of Health), and the NSF (National Science Foundation) allocate funds to research projects all over the world, and in order to receive sufficient funding an individual project must meet certain criteria, which is mostly the ability of a project to fill in certain pieces of a larger framework. For instance, projects that receive funding concern domains of medical science such as aging, cancer, mental health, and uncovering the cellular mechanisms leading to certain disorders. The National Center for Complementary and Alternative Medicine, the only institution that focuses completely on studying components of alternative medicine, has had only a 16.8 percent success rate in receiving funds from the NIH between the years of 1998 and 2002 (Office of Extramural Research- NIH). Without adequate funding, many projects are relinquished, and the search for new treatments remains a task for the pharmaceutical sector.

However, the discovery of viable natural compounds, proving cost effective, could lessen the need for synthetic, pharmacological agents; and consequently, cause the drug companies to lose billions of dollars. Along with the rising cost of healthcare, in studying the active ingredients in natural compounds, scientists and health-care providers would be able to develop an alternative infrastructure that could possibly enhance the well-being of less-developed countries as well as those individuals in the United States that cannot afford the cost of prescription drugs. Natural remedies have also shown to be very safe with almost no drug-drug interactions and produce very few, if any, side effects.

Drug companies are showing a digression in the random screening approach and are searching for new possible lead compounds via a more rational method. The drug discovery process is very expensive and time consuming. On average, for every 10,000 compounds screened one compound will actually make it to the market. The random screening process requires no intellectualization. All compounds are rested via bioassay with absolutely no regard to structure or possible biological activity. The method is helpful in that it can screen thousands of compounds simultaneously, one or two of which may actually serve as a lead. However, when the approach was adopted by the National Cancer Institute in the early 1970’s few anti-tumorigenic compounds were identified, and one or two leads that were eventually found to be effective anti-cancer agents did not show up in the screen. Pharmaceutical companies are slowly moving toward a more rational drug design approach involving computational chemistry and molecular modeling. Many programs currently available for pharmaceutical research allow one to characterize a specific lead molecule based on lipophilic and electrostatic properties as well as characterize potential biological interaction with specific active sites and binding sites of target proteins.

In conjunction with a rational drug design approach, and increased research on the composition and biological activity of certain natural compounds, many new potential effective pharmaceutical agents could be discovered, and then mass-produced and distributed in a cost-effective way. However, much of the information regarding natural remedies has been lost as indigenous populations disperse and begin to follow the ways of modern medicine, and resources are continually being lost or destroyed. The future of medicine could be altered if increased efforts would focus on the preservation of knowledge and the resources available to study natural compounds. Futher examination of historical medical texts, such as Hildegard’s Cause et Cure, could also provide information on a number of effective lead compounds. After the careful analysis and deconstruction of the medical practices described in the twelfth-century manuscript, I feel that scientists should loosen their grip on the notion that ancient or alternative ideas are obsolete, and modern scientists should take a more objective approach in embracing these ideas. Maybe they should consider the wealth of knowledge made previously available by ancient and indigenous civilizations rather than racing ahead to develop new, more “progressive” approaches in the process of drug discovery.

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