MODERNIZING CHINESE MEDICINE

THE CASE OF ARMILLARIA AS GASTRODIA SUBSTITUTE

by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

Gastrodia (tianma) refers to the tuber of an orchid, Gastrodia elata. In recent years, virtually all orchids have been placed on the international endangered species list. This is because their natural growth is often limited to relatively rare habitats, and they are considered highly desirable as decorative flowering plants. One can continue to obtain these endangered species, but not from wild stocks; they must be cultivated. In order to purchase orchids and their products (such as tubers used for herbal medicine), it is necessary for buyers to obtain an acceptable certificate that meets the international trade criteria.

Gastrodia grew in East Asia among the mountainous regions from Yunnan in the southwest to northeast China and Korea (mostly growing above 300 meters). It was often used as a food, eaten raw or steamed. Gastrodia is desirable as a food because of its large starchy root with mild flavor; in fact, potatoes, also enjoyed for their starchy tubers (but introduced to China relatively recently), are sometimes produced as fakes for gastrodia (1, 2). Gastrodia tuber is distinguished from potatoes by having a mild spicy taste and ridges on the surface that are not seen in potatoes (see Figures 1-2). With China's rapid population growth, this common plant had insufficient wild resources to meet the demand during the 20th century.

Gastrodia was listed in the ancient Shennong Bencao Jing (ca. 100 A.D.) and was later classified by Tao Hongjing as a superior herb, meaning that it could be taken for a long time to protect the health and prolong life (as well as treating illnesses). Gastrodia was originally called chijian, meaning red arrow, because of its red stem shaped like an arrow (Figure 3). Later it was named tianma, or heavenly hemp (ma, usually translated as hemp, refers to many plants that have fibrous stems). The herb material is sometimes referred to as tianmagen, meaning the root (or, in this case, tuber) of tianma.

Bencao Gangmu (Compendium of Materia Medica, 1596) recorded the herb as treatment for "all wind-damp blockages, stiffness of the limbs, paralysis, wind-deficiency dizziness, and headache" (see Appendix 1 for modern listing of properties). Despite the fact that gastrodia was described frequently in materia medica guides over the centuries, and attributed near magical properties (expelling all kinds of poisons, giving strength and virility, improving circulation, and improving memory), there are few traditional formulas with this herb that come to us today (see Appendix 2 for listing). Most of the ancient formulas with gastrodia are designed to treat convulsions, such as occurs with tetanus or epilepsy, stroke, and headaches. Modern research has confirmed these uses (see Appendix 3).

Today, the best-known traditional prescription with gastrodia is from the Qing Dynasty, Tianma Gouteng Yin, a formula of obscure origins and varying details of formulation that always includes the two herbs included in the formula name: gastrodia and uncaria (gouteng). This formula is used primarily for treatment of headaches and dizziness, mainly in cases of high blood pressure. Another formula, Banxia Baizhu Tianma Tang (Pinellia, Atractylodes, and Gastrodia Combination) is mainly used in Kampo medicine, popular in Japan and Taiwan. The formula is prescribed for headaches and dizziness in persons with weak digestion and obesity, with or without hypertension.

Gastrodia drew interest during the 20^th century because of the increasingly widespread problem of hypertension. Of the Chinese herbs, uncaria and gastrodia appeared to have the greatest promise, though many other herbs have been investigated and put to use for hypertension (e.g., prunella, scute, and eucommia). Because of dwindling supplies of gastrodia during the time when this research began, its cost increased dramatically and a solution to the strained supplies was sought in cultivating the herb. Unfortunately, it was quite difficult to cultivate, a problem that was soon solved by finding the close relationship between gastrodia and the mycelium of the gastrodia mushroom, Armellaria mellea (Figure 4).

ARMILLARIA AS AN ALTERNATIVE TO GASTRODIA

Gastrodia has an unusual requirement for growth and survival: it requires a fungus, Mycena osmundicola, to sprout the seeds, and it must have Armillaria mellea mushroom mycelia incorporated into the tuber in order to maintain its maturation and growth. The seeds lack a nutrient coat, thus, they require the assistance of Mycena to draw in nutrients from soil in order to germinate. The underground tubers lack the rootlets that normally gather up nutrients; they rely, instead, on the mycelia of Armillaria to do this. Once these two requirements were understood, cultivation of gastrodia became relatively easy. By the late 1980s, an adequate cultivated supply of gastrodia was developed. Still, the plant grows slowly and the demand has remained high, so it remains one of the more expensive herbs, nearly the cost of cultivated ginseng.

More importantly, the medicinal components of gastrodia were found to be mainly the metabolites of the Armellaria mushroom (3-9). In other words, if one could grow the mushroom or just culture its mycelium, the slow growing gastrodia tuber could be dispensed with and one could use just the mushroom material or the metabolites released into culture medium to get the desired therapeutic effects. Batch fermentation of Armellaria mycelia was easily accomplished: the mycelia grow well in a simple sugar solution with just a few basic nutrients. The mycelial material was tested in the 1970s, and, as a result of more than 25 years of continual work by many research groups, the mycelia or its culture medium is frequently used instead of cultivated gastrodia. Dozens of investigations have been undertaken to show that the chemical constituents, pharmacology, and clinical effects of Armellaria and its culture medium after growing the mycelia, are indistinguishable from that of the gastrodia tuber.

According to the research results, the main active ingredient of gastrodia is gastrodin, a simple glycoside, comprised of glucose attached to 4-hydroxybenzyl alcohol (HBA); HBA is also a component of gastrodia. Other active ingredients are the aldehyde form of HBA (4-hydroxybenzylaldehyde), vanillyl alcohol, and vanillin. The content of these ingredients varies from about 0.3-1.2% of the dried tuber, with an average of about 0.8%. All of these compounds are chemically similar, produced in the mycelia from the same starting materials; pharmacology studies indicate that they all have similar effects, such as relieving spasms. Thus, for example, vanillin, as well as gastrodia tuber and gastrodin, have been used clinically in the treatment of epilepsy.

Vanillin (3-methoxy-4-hydroxybenzaldehyde, thus, 3-methoxy HBA) is the molecule that gives the flavor and fragrance to vanilla extract. Although it is found in many plants, it is best known in relation to the beans of the plant Vanilla planifolia, a member of the orchid family. Vanillin is also found in potatoes and the styrax tree. Vanillin is often synthesized; one method is using mold and fungus fermentation of wood pulp.

Vanillin is a starting material for the preparation of drugs for the treatment of hypertension and Parkinson's disease (both classified by Chinese medicine as internal wind syndromes). Vanillin is converted to l-dopa (levodopa; see Figure 5) and related compounds that influence nerve transmission. The largest single use for vanillin as a starting material for chemical synthesis is for the production of the antihypertensive drug Aldomet (see Figure 6). It is likely that the active ingredients of gastrodia either behaves in a similar manner to these drugs or are metabolized in the body to produce compounds similar to these drugs.

Gastrodin, the only unique compound among gastrodia's five main active ingredients (the other compounds are found in several plants) has been synthesized and developed into a drug in China (10-13). Its activity is indistinguishable from that of gastrodia. Gastrodin makes up, on average, about 0.4% of the gastrodia tuber, and the other similar compounds together make up a similar amount.

Synthetic gastrodin has been produced in the form of tablets, intramuscular injection, and intravenous drip. The tablets are made with 25 mg each of gastrodin, which corresponds to the amount of total active ingredients from about 3 grams of gastrodia, so that a typical dose of 3-9 grams of gastrodia tuber in decoction corresponds, roughly to ingestion of 1-3 tablets. However, the dosage of the tablets used clinically is usually considerably higher, with a total daily dose of about 250 mg.

For comparison, Normopress Capsules (for hypertension), containing methyldopa, are prescribed at a dose of 0.5-2.0 grams daily of the pure compound (250 mg/capsule). For l-dopa, the dose is varied considerably, but is usually provided in units of 100 mg, with typical daily dosing in the 500-600 mg range. In clinical trials conducted in China using the intravenous drip of gastrodin, 600 mg/day was said to give better results than the tablets or other forms of gastrodin. It is not only a higher dose than the tablet form, but by using IV drip all of it enters the blood stream (by the oral route, a small portion is likely left in the intestinal tract). This dosage of gastrodin given by IV is consistent with the amounts of dopa-related compounds used in modern medicine. By contrast, the amount of gastrodia tuber commonly used in decoctions provides notably lower levels of the active components. So, these new preparations may provide better therapeutic action. Normally, gastrodia tuber is not used alone, but is combined with other herbs, and these other herbs may make up for a lower activity of whole gastrodia.

The gastrodia mushroom, Armellaria (also listed as Armillariella), is known in China as tianma mihuanjun (gastrodia honey mushroom; mihuan means honey). Armellaria is considered an edible mushroom, but is not a highly desired one, so it is not much used and is difficult to find anywhere in the world as a culinary item. Cultivation of it is avoided because the mycelia is a well-known cause of root rot for many plants; it is feared that cultivating it will simply spread around the spores to cause damage in the surrounding area. Therefore, the batch culture is preferred as a means of getting this material.

The New Drug Group of the Chinese Academy of Medical Science in Beijing was the first to review and confirm the value of Armellaria fermentation liquid in comparison to gastrodia. They performed pharmacology experiments showing the same anticonvulsant activity of the two materials. They confirmed reports from other centers that Armellaria fermentation liquid could achieve effects similar to gastrodia: for example, it could alleviate dizziness symptoms caused by various pathological factors (hypertension, insufficient blood supply via the vertebral basal artery, Meniere's syndrome, vegetative nervous functional disturbance). Since then, numerous other studies have confirmed its value. It is also effective in improving numbed limbs, insomnia, tinnitus, epilepsy, vascular headache, and post-stroke syndrome. Armellaria is more potent gram for gram than gastrodia tuber, and can be used in approximately one-half the dose of the tuber. Armellaria tablet, for example, is given orally in doses of about 3-4 grams/day.

LESSONS LEARNED

The story of gastrodia and Armellaria brings several insights into the changing situation with herbal medicine in the 21^st century. Among the key points to grasp are these:

1. Wild supplies of herbs are being converted to cultivated supplies very rapidly. Just 25 years ago, most Chinese herbs were collected from the wild; figures given at the time were that more than 80% of the Chinese materia medica was from wild supplies. Today, the figure is rapidly heading to having only about 20% of the Chinese materia medica from the wild. This transition reflects the growing population of China, with concurrent reduction of wild resources as humans take over more of the land, the increased use of Chinese medicines both within China and around the world, and the imposition of international treaties (such as CITES; Convention on International Trade in Endangered Species) that strictly regulate transport of materials across borders. In the case of gastrodia, collection from the wild is no longer permitted; in addition, while it is still permitted for international trade, the hurdles of certification have led to minimal export of this herb.
2. The conversion to cultivation stimulates considerable research into the proper growing conditions to yield the desired content of active ingredients and an adequate harvest. This entails defining clearly the chemical constituents and their quantities in both wild and cultivated supplies and determining the soil content, climate, and pest control needed to assure a successful crop. In the case of gastrodia, cultivation of the herb required investigation to find its specific symbiotic relationship with other organisms, mainly the Armellaria mushroom mycelia. The five main active constituents of gastrodia had to be defined in order to assure that the cultivated material was suitable for use, and this led to the finding that Armellaria was the main source of the active constituents.
3. Once the active constituents are defined, it is often possible to synthesize them or make them in batch culture. Many drugs are made by these two processes. In the case of gastrodia, gastrodin has been synthesized and made into tablets and injections. Another active component, vanillin, was already available in pure form and was used in clinical trials for treatment of epilepsy. Clinical work is carried out to compare the use of the various raw materials and the synthetics, to determine their range of applications. For gastrodia, it has been shown that gastrodia tuber, Armellaria mycelium, culture medium in which Armellaria has been grown, and synthetic gastrodin all possess similar pharmacologic activities, mainly reducing spasms and mild sedative effect. Clinically, all of these are used for treatment of headache, hypertension, tinnitus, dizziness, and other disorders defined by the traditional TCM category as stirring of internal wind and agitation of liver yang.
4. Plant drugs and modern drugs are often similar. One of the most widely investigated cases is that of red rice yeast (hongqu), a traditional Chinese food and medicine that contains active ingredients that are similar to, and even identical to statin drugs (used for lowering cholesterol). In the case of gastrodia, gastrodin, and vanillin, and the other active ingredients are similar to the dopa drugs, such as l-dopa used for Parkinson's disease and methyldopa (used for hypertension). These drugs have applications similar to those of gastrodia, suggesting a similar mechanism of action. Efforts are underway in China to develop modifications of gastrodin to improve its effect and, thereby, develop a new drug.

REFERENCES

1. Zhang Enquin (ed. in chief), English-Chinese Rare Chinese Materia Medica, 1990 Publishing House of Shanghai College of Traditional Chinese Medicine, Shanghai
2. Ling Yeouruenn, A New Compendium of Materia Medica, 1995 Science Press, Beijing.
3. Cao Y, et al., Determination of the active ingredients in Gastrodia rhizome by capillary electrophoresis with electrochemical detection, Analyst 2001; 126(9): 1524-1528.
4. The New Drug Group of Department of Pharmacology, Institute of Materia Medica of Chinese Academy of Medical Science, Pharmacological actions of gastrodia watery preparation and fermentation liquid of Armellaria mellea on nervous system, Chinese Journal of Medicine, 1977; (8): 470-472.
5. The TCM Department of Capital Hospital and Fuwai Hospital, Beijing, To use Armellaria fungus tablet to replace gastrodia tuber in treating 45 cases with syndrome of deficiency of yin and flourishing yang, Chinese Journal of Medicine, 1977; (8): 473-474.
6. Zhou Linshen (Department of TCM, Beijing Friendship Hospital), Observation on curative effects of Armellaria mellea fungus tablet in treating 100 cases of neurasthenia and hypertension, etc. , Journal of New Medicine, 1978; (10): 13.
7. Jiangsu Provincial Cooperation Research Group on Gastrodia Tuber, Curative effects of gastrodia tuber Armellaria fungus tablet in treating some diseases of the nervous system, Jiangsu Journal of TCM, 1980; (1): 35-37.
8. Huang Zhengliang, The current situation of pharmacological studies and clinical applications of gastrodia tuber in China, Chinese Journal of Integrated Traditional Chinese Medicine and Western Medicine, 1985; 5(4): 251-254.
9. Lu Guangwei, Studies on Gastrodia elata tuber and its active components, Chinese Traditional and Herbal Drugs, 1985; 16 (9): 40-41.
10. Lu Guoping, et al., Pharmacological and clinical researches of gastrodin injection, Chinese Traditional and Herbal Drugs, 2002; 33(5): appendix pages 3-5.
11. Jiang Shoujun, et al., Clinical study on Tian Xuan Qing (gastrodin) injection in treating blood-supply insufficiency vertigo of the vertebra-basilar artery, Chinese Traditional and Herbal Drugs, 2002; 33(5): 449-450.
12. Duan Yunxia, Observation on the clinical effect of Tian Xuan Qing (gastrodin) in treating vertigo and headache, Chinese Traditional and Herbal Drugs, 2000; 31 (4): 288, 303.
13. Tan Yao, et al., Clinical observation on Tian Xuan Qing in treating neurasthenia by IV drip, Chinese Traditional and Herbal Drugs, 2000; 31(7): 540-542.
14. Ou Ming (chief editor), Chinese-English Manual of Common-Used Herbs in Traditional Chinese Medicine, 1989 Joint Publishing Co., Hong Kong.
15. State Administration of Traditional Chinese Medicine, Advanced Textbook on Traditional Chinese Medicine and Pharmacology (vol. 1) , 1995 New World Press, Beijing.
16. Huang Bingshan and Wang Yuxia, Thousand Formulas and Thousand Herbs of Traditional Chinese Medicine, vol. 2, 1993 Heilongjiang Education Press, Harbin.

APPENDIX 1. Current Listing of Gastrodia Indications for Use

The traditional use of gastrodia as described in the modern TCM system is to calm internal wind and dispel invading wind, and invigorate circulation in the meridians, thereby treating headache, dizziness, vertigo, convulsions, paralysis, and arthralgia. In the book Chinese English Manual of Common-Used Herbs in Traditional Chinese Medicine (14), the indications are these:

1. Calm the liver wind: For syndrome of liver wind stirring inside, such as infantile convulsion, tetanus, epilepsy, as well as dizziness and headache due to excess of liver yang or the attack of wind phlegm; recently it is also used for treatment of neurasthenia, nervous headache, and hypertension;
2. Expel wind evil and alleviate pain: For migraine, arthralgia due to wind dampness, numbness of extremities, and general fatigue.

The Advanced Textbook on Traditional Chinese Medicine and Pharmacology (15) mentions that:

This herb is mild, and can subdue hyperactive liver yang, eliminate wind, and remove obstruction in the collaterals, and is indicated for all kinds of wind syndromes, either cold or heat type or due to internal or external wind. For such cases, it is combined with other herbs according to the specific conditions. It is an important herb to treat dizziness.

Examples of combining gastrodia with other herbs include these, from the Textbook:

• For dizziness and headache due to hyperactive liver yang, combine with uncaria and haliotis.
• For upward disturbance of wind-phlegm, combine with pinellia and atractylodes.
• For migraine, combine with cnidium.
• For convulsion due to irritation by liver wind, combine with antelope horn and uncaria.
• For tetanus [tonic convulsion, a wind-phlegm disorder due to external wind], combine with arisaema and siler.
• To relieve wind and remove obstruction in the collaterals [luo vessels], producing rheumatic pain and numbness of the limbs, combine with chin-chiu, chiang-huo, and achyranthes.

A small number of other herbs are thought to have similar actions, namely uncaria (for internal wind), chrysanthemum (for both internal and external wind), and morus leaf (for external wind).

APPENDIX 2. Traditional Formulas with Gastrodia

The first three formulas listed below all derive from the same basic treatment pattern of using gastrodia with typhonium (baifuzi) and arisaema (tiannanxing) to treat "wind-phlegm" disease, causing tonic paralysis (meaning inability to have free movement because the muscles are in spasm, as opposed to cases where there is no muscular activity), headache, and stroke. These formulas also include herbs for dispelling "external wind," such as angelica, cnidum, chiang-huo, and siler. In ancient times, there was little distinction between internal and external wind. The formulas are made of powdered herbs. Another simple formulation, with just two herbs used to treat headache, is presented next. Finally, four decoction formulas are presented; two for treatment of wind phlegm using the combination of gastrodia and the main ingredients of Erchen Wan (Citrus and Pinellia Formula, for resolving phlegm), and two with the combination of gastrodia and uncaria for calming agitated yang and extinguishing internal wind (16).

Yu Zhen San (True Jade Powder; Powder for Tetanus)
from Waike Zhengzong (True Lineage of External Medicine; 1617)

Gastrodia
Typhonium
Arisaema
Siler
Angelica
Chiang-huo

The herbs are ground to powder (equal parts of all the herbs), and taken 3-6 grams each time, with warmed wine. The formula is mainly used for tetanus and spasms of various origins.

Shen Bai San (Miraculous White Powder)
from Shenqiao Wanquan Fang (Wonderfully Skillful and Comprehensive Formulas; Qing Dynasty)

Gastrodia
Typhonium
Arisaema
Angelica
Gypsum
Chrysanthemum
Cnidium

The herbs are ground to powder (equal portions), and taken with water or wine. It is used for treatment of headache due to the combination of internal and external wind.

Shenxian Jieyu Dan (Immortal's Speech Recovering Pellet)
from Xiaozhu Furen Liangfang (Academic Investigations of Women's Useful Formulas; Qing Dynasty)

Gastrodia
Typhonium
Arisaema
Chiang-huo
Acorus
Polygala
Scorpion
Saussurea

The herbs are ground to powder (all equal parts, except saussurea, half as much as the others). The powder can be formed into water pills with flour, which are to be consumed with mentha tea. The formula is used for post stroke syndrome, where speech is affected (as part of the disorder; there may also be numbness and paralysis of the limbs).

Da Xiong Wan (Major Cnidium Pill)
from Shengji Zonglu (Comprehensive Treatise on Sage's Advice; Song Dynasty)

Gastrodia
Cnidium

The herbs are ground to powder in equal parts, and formed into pills with honey; one pill each time (about 6 grams of herbs). This formula is used for dizziness, blurring of vision, and headaches. Cnidium refers to chuanxiong (Ligustcium walichii).

Tainma Banxia Tang (Gastrodia and Pinellia Decoction)
from Weisheng Baojian (Precious Mirror of Health, Yuan Dynasty)

This formula is ground to powder and then briefly decocted. It is applied to distention of the chest with copious sputum, blurring of vision, dizziness, and nausea.

Banxia Baizhu Tianma Tang (Pinellia, Atractylodes, and Gastrodia Combination)
from Yixue Xinwu (Medical Revelations; 1732)

To be decocted with a slice of ginger and 2 pieces of jujube. This formula is used for wind phlegm disorder with symptoms such as vertigo, headache, and stuffiness in the chest.

Gou Teng Yin (Gastrodia Decoction)
from Yizong Jinjian (Golden Mirror of the Medical Tradition; 1742)

The herbs are decocted. This formula is used mainly for convulsions in infants attributed to heat in the heart and lung, with high fever, head and neck extended, and lock-jaw. This is likely related to meningitis.

Tianma Gouteng Yin (Gastrodia and Uncaria Decoction)
from Zabing Zhengzhi Xinyi (New Significance of Patterns and Treatments in Miscellaneous Diseases; Qing Dynasty)

The herbs are decocted. This formula is used to treat headache, vertigo, insomnia, and other symptoms of liver wind agitation and hyperactivity of liver yang.

APPENDIX 3. Review of Clinical Applications for Gastrodia Tuber,
Armellaria Fermentation Liquid, and Armellaria Fungus Mycelium.

Huang Zhengliang of the Department of Pharmacology, at Gansu College of Traditional Chinese Medicine, presented an extensive review (8) of the pharmacology and clinical application of gastrodia, Armellaria, and derivative preparations that had been carried out initially (1977-1983). Below is his summary of the clinical applications. More recent studies (10-13) have focused on the use of gastrodin, especially by injection. Since the use of the herb materials outside of China are mostly limited to gastrodia tuber, and, increasingly, Armellaria products, this review is of current interest. Huang subdivided the studies (for which he presented 9 published sources as references) into five categories: treatment of neurasthenia (mostly the weakness following recovery from serious illness, but also chronic fatigue); epilepsy; neuralgia (various pain syndromes, including headache); vertigo (dizziness); and hyperlipidemia and hypertension.

1. Neurasthenia. There were 13 hospitals in the Kunming area (Kunming is captial city of Yunnan Province) making observations of 349 patients. They demonstrated that the synthetic gastrodin used to treat 161 cases of neurasthenia (fatigue, poor memory, insomnia, poor appetite, headache and body ache) yielded a total effective rate of 90%. In treating 99 cases of neurasthenia syndrome secondary to cerebral trauma, tuberculosis, and hepatitis, the total effective rate was 86%. As to the improvement of specific symptoms, the effects on insomnia and headache were the best, generally responding after administration of gastrodin for one week, though a course of treatment was one month. For the cases of neurasthenia accompanied by heart palpitation, when treated with gastrodin, the rate of recovering normal heart function was 93%. Armellaria fermentation liquid prepared as a tablet was used for the treatment of dizziness, tinnitus, numbness of the limbs and insomnia in 45 patients showing yin-deficiency and yang-excess syndrome; the symptomatic curative effect ranged from 60-82% for the various symptoms. Twenty of those cases were used as comparison with others treated by a gastrodia tuber preparation. The results indicated that the Armellaria fungus tablet and gastrodia tuber produced a similar therapeutic effect. The clinical effect on neurasthenia is thought to be related to the sedative action of gastrodia tuber and Armellaria fungus.
2. Epilepsy: Gastrodia tuber preparation is commonly used to treat minor paroxysm (petit mal seizure) of epilepsy, and shows benefit for other types of epilepsy as well (e.g., grand mal seizure). In Jiangsu province, there were seven hospitals that utilized vanillin in treating 291 cases of various types of epilepsy by employing a switch-over study method (patients severed as their own controls). Among them, 184 cases were treated with the gastrodia preparation alone and 107 cases had already tried various anti-epilepsy drugs without adequate response, then added the gastrodia preparation to their drug regimen. The results indicated that 142 cases had marked improvement by using gastrodia, and the total effective rate of the treatment including gastrodia was 74%. Among 184 cases treated with the gastrodia preparation only, the effective rate of minor paroxysm of epilepsy was 86%, of which the markedly effective was 57%; the effective rate of grand mal seizure and other types of epilepsy was 75%, among which the markedly effective rate was 50% .
3. Neuralgia. Based on a report of the Jilin Medical College, a 20% gastrodia tuber extract, administered by injection, was used in treating various neuralgia involving 110 cases of trigeminal neuralgia, sciatic neuralgia, and supra-orbital neuralgia. The effective rate of stopping pain was as high as 90%. Generally, during the time when there was an attack of severe pain, 2-4 ml of the solution would be given by muscular injection; this would be administered altogether 1-3 times a day, and, in most cases, the alleviation of pain from the syndrome was accomplished by giving from one to four total injections. Another report indicated that using synthetic gastrodin in treating 89 cases of vascular nervous headache yielded a total effective rate of 67%; the severity of the headache and duration of the headache both improved to a certain extent. The Jiangsu Provincial Cooperative Research Group of Gastrodia reported that using gastrodia tuber extract by intramuscular injection (2 ml/ampule involving crude herb 120 mg) or giving Armellaria fungus tablet (250 mg/tablet) by oral means gave similar results for vascular nervous headache; they treated 52 cases and their total effective rates were 83% and 81% respectively. Another report indicated that by employing cultivated gastrodia tuber extract by injection to treat multiple neuralgia also achieved a similar pain stopping effect.
4. Vertigo. Gastrodia tuber is used for the treatment of vertigo caused by liver deficiency and liver wind. Manifestations of this syndrome, such as hypertension, arteriosclerosis, Meniere's syndrome, and common vertigo due to anemia or other weakness, all respond well to gastrodia tuber. A study reported on the use of gastrodia tuber injection and Armellaria fungus tablet in treating 169 cases of vertigo syndrome; the total effective rates were 92% and 79% respectively. The effect of gastrodia tuber and Armellaria fungus on vertigo was thought to be due to their pharmacological actions of lowering blood pressure, tranquilizing, and dilating the cerebral vessels to improve cerebral blood flow.
5. Hyperlipemia and Hypertension. A report of the Central Hospital of Shanghai Jingan District indicated that one could successfully use Armellaria fungus tablet for treating hyperlipemia in patients with hypercholesterolemia. There were 43 cases treated, showing a serum cholesterol decline of 48 mg% on average after treatment; the effective rate was 83%. In patients with elevated triglyceride, the triglyceride value declined by 42 mg% on average after treatment; the effective rate for lowering triglycerides was 75%. In addition, the systolic pressure and/or diastolic pressure of 86% of the patients showed various degrees of decline, while dizziness, oppression in the chest, nervousness, and other symptoms of hypertensive syndrome also improved.

December 2002

Figure 1. Gastrodia tuber, appearing much like a potato, at harvest.

Figure 2. Dried gastrodia tubers; vertical ridges are seen on close examination,
but displayed more clearly in the artists representation in Figure 3.

Figure 3. Artist's rendition of Gastrodia elata tuber and
red arrow-like stalk (left), photo of wild plant (right).

Figure 4. Armellaria mellea, the gastrodia mushroom.

Figure 5. Closely related compounds: vanillin (left) and the drug manufactured from it,
l-dopa (right), mainly used for treatment of Parkinson's disease.

Figure 6. Closely related compounds: l-dopa (left) and methyldopa (right), used in Aldomet and
other brands of drugs for hypertension. The ring structure for the two molecules is the same,
though presented differently in these two illustrations. l-dopa illustrated here and Figure 1 are the same,
but just laid out with different orientation and level of detail for the amino acid end.