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Snakeroot

Scientific Name(s): Aristolochia serpentaria L., Aristolochia reticulata Nuttall. Family: Aristolochiaceae (birthwort family)

Common Name(s): Snakeroot , Virginia snakeroot , snakeweed , sangree root , sangrel , birthwort , pelican flower , Texas snakeroot , Red River snakeroot

Uses

Snakeroot stimulates gastric secretions and smooth muscle contractions. In small doses, snakeroot can promote appetite and tone digestive organs, and larger doses promote arterial action, diaphoresis, and diuresis.

Dosing

While Aristolochia formerly was used as a bitter tonic at 1 g dosage, in view of the nephrotoxicity of aristolochic acid derivatives, it cannot be recommended at any dose.

Contraindications

Snakeroot should not be used in humans, especially in those with diseases of the GI tract.

Pregnancy/Lactation

Snakeroot is particularly dangerous to women who are pregnant or lactating.

Interactions

None well documented.

Adverse Reactions

Aristolochic acid, a component of snakeroot, can affect the kidneys and irritate the GI tract.

Toxicology

No one should use snakeroot because of its toxic effects. It is mutagenic and nephrotoxic.

Botany

Aristolochia is a genus comprising approximately 300 species of herbs and vines. A. serpentaria is a low-growing perennial (up to 0.6 m tall) found primarily in the rich woods of central and southern US, including Connecticut to Florida, Michigan, Missouri, Louisiana, Arkansas, and Texas. Snakeroot possesses a foul, fruit-like odor that attracts insects. Its exotic, brownish-purple flowers are tube-like and lined with hairs. Insects caught in this area become covered with pollen while struggling to escape and carry it to pollinate other flowers. The leaves of the plant are heart-shaped. The medicinal parts of the plant are the dried rhizome and the roots. 1 , 2 , 3 , 4 A. reticulata differs from A. serpentaria in having a larger rhizome with fewer, thicker rootlets and thicker leaves with more prominent reticulations and petioles. 1

History

Snakeroot was used as a cure for snakebite, hence the common name. Native Americans chewed the root and also applied it to wounds. Colonial and European doctors were said to have used snakeroot for infectious fevers, malaria, and rabies. The heart-shaped leaves of the plant promoted its use as a heart tonic. Modern herbalists employ snakeroot as an aphrodisiac, to treat convulsions, and to promote menstruation. None of these claims, however, have been scientifically validated. 3 , 5 One source mentions that A. serpentaria was grown in England as far back as 1632. 4

Chemistry

A. serpentaria contains borneol, essential oil, and serpentarin (aristolochin), a bitter principle that is yellow in color. Aristolactone, aristolochine (an alkaloid), gums, resins, tannins, and starch are also present. Most interest lies in the toxin aristolochic acid, a non-alkaloidal, but naturally occurring, nitro-compound. 1 , 4 , 6 Aristolochic acids occur only among the Aristolochiaceae and also are found in butterflies that feed on the plants. 7 In Taiwanese butterflies, aristolochic acid acts to protect them against birds. 8 Aristolactams, also present in the family, also are found in Annonaceae, Menispermaceae, and Monimiaceae. An extensive review discussing aristolochic acids and aristolactams, regarding specific structures from certain species and botanical occurrence is available. 7

Other Aristolochia species containing aristolochic acid include A. clematitis ; 9 A. auricularia (found to contain the highest reported amount of any species); 10 species from Sudan and China, A. bracteata , A. contorta , A. debilis , A. heterophylla , and A. mollissima ; 11 and those used as traditional Chinese medicine “Fanchi,” including A. fangchi , A. kwangsiensis , A. heterophylla , and A. moupinensis . 12 A review of Taiwanese research in natural product medicine (from 1991 to 1996) includes Aristolochiaceae. 13 Quantitative analysis of aristolochic acids has been performed. 14

Uses and Pharmacology

Snakeroot has been used as an aromatic bitter. 1 Its known effects include stimulation of gastric secretions and smooth muscle contractions of the GI tract and heart. 15 In small doses, snakeroot can promote appetite and tone digestive organs. Larger doses promote arterial action, diaphoresis, and diuresis. It is also said to be helpful in amenorrhea. 5 Unproven effects of the plant include increased circulation, heart stimulation, fever reduction, and in the treatment of dyspepsia and skin sores. 15 Folk uses of snakeroot include treatment of fever, prevention of convulsions, promotion of menstruation, and as an aphrodisiac. Snakeroot's effectiveness as an antidote for snakebite and rabies remains unproven. 3

A. clematitis , a related species, is used to stimulate the immune system and to treat wounds. 9 Taliscanine, a component of A. taliscana , has been reported to treat Parkinson's and related diseases. 16 Tumor inhibiting properties are clearly due to aristolochic acids. 6

Dosage

While Aristolochia formerly was used as a bitter tonic at 1 g dosage, in view of the nephrotoxicity of aristolochic acid derivatives, it cannot be recommended at any dose. 17

Pregnancy/Lactation

Snakeroot is particularly dangerous to women who are pregnant or lactating.

Interactions

None well documented.

Adverse Reactions

Aristolochic acid, a component of snakeroot, can affect the kidneys and irritate the GI tract.

Toxicology

Snakeroot should not be used in humans. Aristolochic acid is a known kidney toxin in rodents. 18 Several articles confirm aristolochic acid's nephrotoxic and carcinogenic effects in humans as well. Aristolochic acids from A. fangchi , A. clematitis , and others have been found to cause kidney damage or “Chinese herb nephropathy.” Cases of interstitial renal fibrosis, urothelial lesions, malignancy, Fanconi's syndrome, and end-stage renal failure all have been extensively reported. 9 , 17 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 A review with 108 references discusses this further. 37

The structural basis for mutagenicity of aristolochic acid has been reported. 38 In large doses, constituent aristolochine also can affect the kidneys and irritate the GI tract, leading to coma and death from respiratory paralysis. 5 , 6

No one should take snakeroot, especially those with any disease of the GI tract, including ulcer, reflux, or colitis, as well as those who are pregnant or breastfeeding. 15 Aristolochic acid also may cause genetic mutations; some countries ban the plant's sale. 3 A case report explains acute hepatitis from a tea mixture (including A. debilis ) containing toxic aristolochic acids. 39

Bibliography

1. Youngken H. Textbook of Pharmacognosy , 6th ed. Philadelphia, PA: Blakiston Co., 1950:287-90.
2. Hocking G. A Dictionary of Natural Products . Medford, NJ: Plexus Publishing, 1997:69-70.
3. Dwyer J, Rattray D, eds. Magic and Medicine of Plants . Pleasantville, NY: The Reader's Digest Association, 1986:324.
4. http://www.botanical.com/botanical/mgmh/s/snaker56.html
5. Duke J. CRC Handbook of Medicinal Herbs . Boca Raton, FL: CRC Press, Inc., 1985:63.
6. Evans W. Trease and Evans' Pharmacognosy , 14th ed. London: WB Saunders Company Ltd., 1996:373-74.
7. Mix D, et al. The aristolochic acids and aristolactams. J Nat Prod 1982;45(6):657-58.
8. Wu T, et al. Aristolochic acids as a defensive substance for the aristolochiaceous plant-feeding swallowtail butterfly, Pachilopta aristolochiae interpositus. J Chin Chem Soc (Taipei) 2000;47(1):221-26.
9. Fleming T, ed. PDR for Herbal Medicines . Montvale, NJ: Medical Economics Company, Inc., 1998:660-61.
10. Houghton P, et al. Aristolochic acids and aristolactams from Aristolochia auricularia . Phytochemistry 1991;30(1):253-54.
11. Mohamed O, et al. Determination of aristolochic acid A in the roots and rhizomes of Aristolochia from Sudan and China by HPLC. Zhongguo Yaoke Daxue Xuebao 1999;30(4):288-90.
12. Zhang H, et al. Pharmacognostic study on Fanchi crude drugs. Tianran Chanwu Yanjiu Yu Kaifa 1996;8(2):17-21.
13. Kuo Y, et al. Natural product research in Taiwan. IV. Taiwan Kexue 1999;52(1):1-145.
14. Hashimoto K, et al. Quantitative analysis of aristolochic acids, toxic compounds, contained in some medicinal plants. J Ethnopharmacol 1999;64(2):185-89.
15. http://www.drugs.com/
16. De la Parra J. Taliscanin and other aristolactams for treating neurological disorders, Parkinson's disease, Alzheimer's disease, and impotence. US Patent 1988. Application: US 87–8743219870820.
17. Vanhaelen M, Vanhaelen-Fastre R, But P, Vanherweghem JL. Identification of aristolochic acid in Chinese herbs. Lancet . 1994;343:174.
18. Mengs U. Acute toxicity of aristolochic acid in rodents. Arch Toxicol 1987;59(5):328-31.
19. Cosyns J, et al. Chinese herbs nephropathy: A clue to Balkan endemic nephropathy? Kidney Int 1994;45(6):1680-88.
20. Vanherweghem J, et al. Effects of steroids on the progression of renal failure in chronic interstitial renal fibrosis: a pilot study in Chinese herbs nephropathy. Am J Kidney Dis 1996;27(2):209-15.
21. Zhu M, et al. Hong Kong samples on the traditional Chinese medicine “Fang Ji” contain aristolochic acid toxins. Int J Pharmacogn 1996;34(4):283-89.
22. Tanaka A, et al. Chinese herbs nephropathy in the Kansai area: A warning report. Nippon Jinzo Gakkai Shi 1997;39(4):438-40.
23. Tanaka A, et al. Traditional remedy-induced Chinese herbs nephropathy showing rapid deterioration of renal function. Nippon Jinzo Gakkai Shi 1997;39(8):794-97.
24. Sekita S, et al. Aristolochic acids in herbal medicines. Kokuritsu Iyakuhin Shokuhin Eisei Kenkyusho Hokoku 1998;116:195-96.
25. Stengel B, et al. End-stage renal insufficiency associated with Chinese herbal consumption in France. Nephrologie 1998;19(1):15-20.
26. Cosyns J, et al. Chinese herbs nephropathy-associated slimming regimen induces tumours in the forestomach but no interstitial nephropathy in rats. Arch Toxicol 1998;72(11):738-43.
27. Motoo T. On Chinese herbs neuropathy. Nippon Naika Gakkai Zasshi 1999;88(2):368-69.
28. Cosyns J, et al. Urothelial lesions in Chinese-herb nephropathy. Am J Kidney Dis 1999;33(6):1011-7.
29. De Broe M. On a nephrotoxic and carcinogenic slimming regimen. Am J Kidney Dis 1999;33(6):1171-73.
30. Stiborova M, et al. Aristolactam I a metabolite of aristolochic acid I upon activation forms an adduct found in DNA of patients with Chinese herbs nephropathy. Exp Toxicol Pathol 1999;51(4-5):421-27.
31. Lord G, et al. Nephropathy caused by Chinese herbs in the UK. Lancet 1999;354(9177):481-82.
32. But P, et al. Chinese-herb nephropathy. Lancet 1999;354(9191):1731-32.
33. Okada M. Chinese-herb nephropathy. Lancet 1999;354(9191):1732.
34. Yang C, et al. Rapidly progressive fibrosing interstitial nephritis associated with Chinese herbal drugs. Am J Kidney Dis 2000;35(2):313-18.
35. Tanaka A, et al. Chinese herb nephropathy in Japan presents adult-onset Fanconi syndrome: Could different components of aristolochic acid cause a different type of Chinese herb nephropathy? Clin Nephrol 2000;53(4):301-06.
36. Kessler D. Cancer and herbs. N Engl J Med 2000;342(23).
37. Violon C. Belgian (Chinese herb) nephropathy: Why? J Pharm Belg 1997;52(1):7-27.
38. Pfau W, et al. The structural basis for the mutagenicity of aristolochic acid. Cancer Lett 1990;55(1):7-11.
39. Levi M, et al. Acute hepatitis in a patient using a Chinese herbal tea — a case report. Pharm World Sci 1998;20(1):43-44.

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