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Kacip fatimah

Scientific Name(s): Labisia pumila Benth. & Hook. f. Family: Primulaceae. There are 3 varieties: L. pumila var. alata (Scheff.) Mez., L. pumila var. pumila and L. pumila var. lanceolata (Scheff.) Mez. 1

Common Name(s): Kacip fatimah 1 or selusuh fatimah 2

Uses

Kacip fatimah is primarily marketed as a health tonic for pre- and postmenopausal women.

Dosing

The herb, or formulation with other herbs, is available in many commercial products as a capsule, tea, or coffee, and as a canned beverage for human consumption. A pilot study documents dosages of up to 560 mg/day in postmenopausal women. Most commercial formulations are 154 mg capsules taken twice daily.

Contraindications

Avoid use if there is a known allergy or hypersensitivity to any of the components of kacip fatimah.

Pregnancy/Lactation

Avoid use during pregnancy and lactation due to lack of clinical data.

Interactions

None well documented.

Adverse Reactions

No clinical data were found.

Toxicology

None well documented.

Botany

L. pumila , or kacip fatimah, is part of a genus of approximately 7 species and is found in Southeast Asia in the lowlands and hill forests of Malaysia at an altitude of 300 to 700 m. It is a small subherbaceous perennial with creeping stems growing from 30 to 40 cm in height. The leaves are elliptical-lanceolate in shape. The upper side of the leaf is dark green and the underside is light green to reddish-purple. The whole leaf can be more than 30 cm long and 13 cm wide. The clustered white to pink flowers are 6 to 30 cm long with sepals, petals, and stamens. The flowers produce a round, bright red to purple fruit 0.5 cm in diameter when ripe. 3 , 4

History

Kacip fatimah has been used for centuries and is still commonly consumed by Malay women in Malaysia. 3 The whole plant has been administered before and after childbirth to expedite delivery. Other reported uses include treatment of dysentery, dysmenorrhea, flatulence, gonorrhea, and hemorrhoids, 1 as well as for a condition described as “sickness in the bones.” 5 Men from several ethnic groups in the Malaysian state of Sarawak have reported increased stamina after consuming the herb. 2 The herb may also relieve throat ache when combined with the roots of Piper caninum . 6

A decoction of the herb is administered 1 to 2 months before childbirth to help strengthen and tone abdominal muscles and the vaginal wall and tissue. The herb also promotes emotional well-being, reduces fatigue, and increases libido and energy. A decoction of the leaves and roots is consumed to promote strength after childbirth, as well as to delay further conception. 3

The Malaysian government is providing support for research on the safety and efficacy of kacip fatimah because of the appearance of numerous commercial products over the last 10 years in the Malaysian market claiming increased vitality and libido. Ongoing clinical trials continue, and various patents have been filed for kacip fatimah. 3

Chemistry

There are limited chemical studies on kacip fatimah. The major components of the plant are benzoquinoid compounds contained in the root and leaves, alkenyl resorcinols, and triterpenoid compounds. 3 , 7 Antioxidant components include ascorbic acid or vitamin C, beta carotene, anthocyanins (also responsible for color of flowers, fruits, and berries), and flavonoids. 8 The root also has high iron content (107.3 to 111.6 ppm). 3

Uses and Pharmacology

Review of the medical literature primarily documents animal research on the potential clinical use of kacip fatimah in women's health. 4 , 9 , 10 , 11 Numerous toxicity studies have also been published. 5 , 7 , 12 , 13 , 14 , 15

Women's health
In vitro and animal data

Kacip fatimah maintained the integrity and morphology of the aortic wall of ovariectomized rats. The cardioprotective effects were similar to estrogen. 9 The same study found estrogen activity similar to estrone and estradiol by a water extract of kacip fatimah in an immunoassay for estradiol binding to antibodies raised against estradiol. The effect was dose dependent on estradiol and free testosterone levels in female rats. Estrogen receptor modulation may be a potential mechanism of the herb. 10

In rats, kacip fatimah may modulate postmenopausal adiposity similar to estrogen by initiating lipolysis in adipose tissue. 11 The herb's mechanism of action is associated with a uterotrophic effect and regulating body weight gain by changing the expression and secretion of adipokines, leptin, and resistin in adipose tissue. In a rat model of polycystic ovary syndrome, oral treatment with kacip fatimah increased insulin sensitivity, reduced triglyceride and total cholesterol levels, increased circulating resistin levels, and decreased leptin mRNA expression. Body weight development was not affected, but uterine weight was increased, indicating potential estrogenic effects. 4

Other pharmacologic activity
Antioxidant

The antioxidant activities of the leaf extracts are well documented. 8

Skin protection

A kacip fatimah extract protected against the effects of ultraviolet radiation by: (1) protecting dermal fibroblasts from cell death; (2) reducing expression of inflammatory mediators tumor necrosis factor-alpha and cyclo-oxygenase-2; (3) increasing expression of type 1 procollagen; and (4) reducing expression of inflammatory cytokines. 16

Stress

Pretreatment with an aqueous extract of kacip fatimah in experimental animals reversed behavioral, biochemical, and immunological changes produced by stressful stimuli and restored homeostasis. 17

Dosage

Kacip fatimah is primarily marketed as a health tonic for women by the herbal and pharmaceutical industries. The herb, or formulations with other herbs, is available in many commercial products as a capsule, tea, or coffee, and as a canned beverage for human consumption. 3 , 12 Dosages of up to 560 mg/day in postmenopausal women appeared safe. 3 Most commercial formulations are 154 mg capsules taken twice daily.

Pregnancy/Lactation

Avoid use during pregnancy and lactation due to lack of sufficient clinical data. In an animal model, a 1,000 mg/kg/day aqueous extract of kacip fatimah did not cause any teratogenic effects. Although considered statistically insignificant, an increase in body weight of pregnant animals was observed. 13

Interactions

The plant contains iron and may provide additive adverse effects in patients being treated with iron supplements. The herb may have estrogen-like effects; avoid use in patients with estrogen-sensitive cancers or patients being treated with hormonal supplements. The herb also may have additive adverse effects if patients are being treated with cholesterol medications.

Contraindications

Avoid use if known allergy or hypersensitivity to any of the components of kacip fatimah exists.

Adverse Reactions

No clinical data were found.

Toxicology

In an animal reproductive toxicity study, no observable adverse effects on pregnancy, delivery, and early pup growth in female rats were documented with 800 mg/kg/day of aqueous kacip fatimah extract. 7 Another animal study using 1,000 mg/kg/day of aqueous kacip fatimah extract observed changes in maternal body weight, but no teratogenic effects were seen in rats. 13 A similar study noted no toxicity risks in the reproductive organs of female rats. 14

No toxicity was documented with a low dose of 50 mg/kg of an aqueous kacip fatimah extract in rats. However, the 200 to 1,000 mg/kg dose in rats was associated with elevated liver enzymes and abnormal histological profiles of the liver, kidney, and lungs. 12 The same study found a petroleum ether extract of this plant to cause sinusoidal degeneration of the liver with renal tubule inflammation at days 1 to 7 postpartum in female Wistar rats. 12 Histological changes were noted in the thickness of the endometrial wall in nonpregnant rats treated with a kacip fatimah extract. 15

No observed mutagenic or genotoxic effects were documented from micronucleus assays using different dosages of kacip fatimah aqueous extracts on mammalian bone marrow cells. 5

Bibliography

1. Jamal JA. Malay traditional medicine. Tech Monitor . 2006(Nov-Dec);37-49.
2. Asiah O, Nurhanan MY, Mohd Ilham A. Determination of bioactive peptide (4.3 kda) as an aphrodisiac marker in six Malaysian plants. J Trop Forest Sci . 2007;19(1):61-63.
3. Foster S. Balancing nature and wellness: Malaysian traditions of “Ramuan” the history, culture, biodiversity and scientific assimilation of medicinal plants in Malaysia. HerbalGram . 2009;84:30-43.
4. Mannerås L, Fazliana M, Wan Nazaimoon WM, et al. Beneficial metabolic effects of the Malaysian herb Labisia pumila var. alata in a rat model of polycystic ovary syndrome. J Ethnopharmacol . 2010;127(2):346-351.
5. Zaizuhana S, Puteri J Noor MB, Noral'ashikin Y, Muhammad H, Rohana AB, Zakiah I. The in vivo rodent micronucleus assay of Kacip Fatimah ( Labisia pumila ) extract. Trop Biomed . 2006;23(2):214-219.
6. Hanum IF, Hamzah N. The use of medicinal plant species by the Temuan tribe of Ayer Hitam Forest, Selangor, Peninsular Malaysia. Pertanika J Trop Agric Sci . 1999;22(2):85-94.
7. Ezumi M, Amrah S, Suhaimi A, Mohsin S. Evaluation of the female reproductive toxicity of aqueous extract of Labisia pumila var. alata in rats. Indian J Pharmacol . 2007;39(1):30-32.
8. Norhaiza M, Maziah M, Hakiman M. Antioxidative properties of leaf extracts of a popular Malaysian herb, Labisia pumila . J Med Plants Res . 2009;3(4):217-223.
9. Al-Wahaibi A, Wan Nazaimoon WM, Norsyam WN, Farihah HS, Azian AL. Effect of water extract of Labisia pumila var alata on aorta of ovariectomized Sprague Dawley rats. Pakistan J Nutr . 2008;7(2):208-213.
10. Al-Wahaibi A, Wan Nazaimoon WM, Farihah HS, Azian AL. Effect of ovariectomy, Labisia pumila var alata treatment and estrogen replacement therapy on the morphology of adipose tissue in ovariectomized Sprague Dawley rats. J Med . 2007;1(1).
11. Fazliana M, Wan Nazaimoon WM, Gu HF, Ostenson CG. Labisia pumila extract regulates body weight and adipokines in ovariectomized rats. Maturitas . 2009;62(1):91-97.
12. Singh GD, Ganjoo M, Youssouf MS, et al. Sub-acute toxicity evaluation of an aqueous extract of Labisia pumila , a Malaysian herb. Food Chem Toxicol . 2009;47(10):2661-2665.
13. Fuad W, Sulaiman S, Islam M, Wahab M, Jamalullail S. Evaluation of the teratogenicity of aqueous extract of Labisia pumila var. alata in rats. Malays J Med Sci . 2005;12(2):13-21.
14. Wan M, Amrah S, Hasnan J, Syed S. The effects of aqueous extract of Labisia pumila var. alata ( Biolabisia ) on reproductive organs in female rats. Malays J Med Sci . 2008;15(1):111.
15. Effendy A, Siti-Nurtahirah J, Hussin Z, Lola M, Zamri-Saad M. The effects of Kacip fatimah ( Labisia pumila ) extract on kidney, liver and uterus of white rat ( Rattus norvegicus ). Presented at: The 11th International Conference of the Association of Institutions for Tropical Veterinary Medicine and 16th Veterinary Association Malaysia Congress; August 23-27 2004; Petaling Jaya, Malaysia.
16. Choi HK, Kim DH, Kim JW, Ngadiran S, Sarmidi MR, Park CS. Labisia pumila extract protects skin cells from photoaging caused by UVB irradiation. J Biosci Bioeng . 2010;109(3):291-296.
17. Kour K, Sharma N, Chandan BK, Koul S, Sangwan PL, Bani S. Protective effect of Labisia pumila on stress-induced behavioral, biochemical, and immunological alterations. Planta Med . 2010;76(14):1497-1505.

Copyright © 2009 Wolters Kluwer Health

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