Artemisia
annua anamed (A3)
1. Tropical malaria is an illness which, if incorrectly treated, or not treated at all, can lead to death. Particularly at risk are "last-minute tourists", i.e. people who take no time to learn and practise even the most basic preventive measures. Natural medicine can be of help only if one is prepared to devote the necessary time and attention to the treatment process.
2. Prophylaxis: The World Health Organisation (WHO) recommends that different preventive drugs be taken for different countries. You can obtain a list of recommended drugs from your pharmacist or, failing that, from an institute of tropical medicine. Such measures, however, can never give 100% protection from any illness. Artemisia annua anamed is not suitable as a preventive drug, as we still have too little experience of its use in this respect.
3.
Treatment. The WHO also provides lists of the drugs recommended
for each country. Again, there is no one drug that is suitable in all
circumstances. Often combinations of several drugs are required, particularly
to prevent more serious illnesses developing. In our opinion, tea made
from the leaves of Artemisia annua anamed (A3) can be used in addition
to any other treatment.
4. Development workers and other Europeans in the tropics should, during their first year, strictly follow the preventive treatment recommended for tourists. Once a European has had a number of attacks of malaria, (s)he usually begins to develop a certain degree of immunity, or resistance, to the malaria parasites.
5. Partially immune people. These include those people who live in regions where malaria is endemic, and who are therefore exposed to malaria throughout their entire lives. For such people, a life-long preventive treatment against malaria would not be appropriate; firstly because of the side-effects of the drugs, secondly because of the cost, and thirdly because the malaria parasites would develop resistance to the drugs. Anamed practises Natural Medicine, and, in doing so, examines carefully both the effects and the side effects of treatments based on plants and conventional treatments based on chemicals. In our books "Natural Medicine in the Tropics" we have described many plants which are used by people to treat malaria.
6. The Artemisia Malaria Programme (AMP). The resistance of Plasmodium falciparum to synthetic anti-malarials, together with the resistance of the vector mosquitoes to insecticides, has resulted in a search for new anti-malarial agents. For more than three centuries, we have relied on extracts of the bark of the Cinchona species to treat malaria. As has been widely reported in the press, pharmaceutical concerns the world over are conducting research into a new healing plant which originates in China, the Artemisia annua. Wild plants of this sort have three disadvantages; they do not grow in the tropics, they produce few leaves and they have too low a content of the effective ingredient, to be useful in the form of a tea.
We can now offer a hybrid, that is rich in the essential ingredient, that we call Artemisia annua anamed (A3). It is already growing successfully in many countries, to name a few; Germany, Cambodia, the Dem. Rep. Congo and Uganda, Sudan, South Africa and Tanzania.
Please see Publications and Materials for details of how to order papers, in English or German, that give more information about the anamed malaria programme. A kit which contains seeds is also available, for those who wish to share their results with us.
Clinical
Results of the Use of Artemisia annua tea
Dr Hans-Martin Hirt, Anamed Coordination, Winnenden, Germany
Clinical
Results of the Use of Artemisia annua Tea - March 2000
Without any doubt, the isolation of artemisinin from the
Chinese medicinal plant Artemisia annua (1972) and the use of semi-synthetic
medicines from artemisia have widened the range of treatment for malaria.
Numerous studies in tropical countries have already demonstrated the very
great potential of artemisia based medicines. (1-4) In contrast,
we know of no clinical studies of the effectiveness and safety of tea
preparations from the dried leaves of artemisia. This is somewhat surprising,
given the fact that there has been much written about the use of such
tea in traditional Chinese herbal medicine for over a thousand years (5),
and it is included in the current Pharmacognosy of the Peoples' Republic
of China (6). Medicines from artemisinin derivatives are also available
in the large towns of Africa. In towns such as Kampala, Uganda, and Nairobi,
Kenya, the price is between $10 and $15. It is, therefore, on grounds
of cost, inaccessible to the greatest part of the African population.
Hybrids of Artemisia annua are already cultivated for commercial export
in countries such as Madagascar (7) and Tanzania (8). Also, our own experiences
show that one particular hybrid, which we have named "Artemisia annua
anamed", or "A3", can be cultivated in Central Africa (9). For these reasons,
since 1997, anamed (10) has investigated whether leaves from this hybrid,
which are rich in the essential ingredient artemisinin, can be cultivated
locally and used to treat of malaria. Anamed centres which already use
Artemisia annua are asked to keep a strict record of their clinical experience,
and to share their results with other groups in the network. So far we
have data from three centres, which are summarised in this paper.
Manner of use
One litre of boiling water is poured onto 5 g dried leaves of Artemisia
annua anamed.
It is allowed to brew for 10 to 15 minutes, and then poured through a
sieve. This tea is then drunk in four portions in the course of the day.
The period of treatment is between 5 and 7 days.
Results
Three participating groups in the D.R Congo have sent detailed reports
with information about the individual patients, any side-effects and their
clinical progress, as well as the results of laboratory tests. These three
studies were all made with the agreement of the local government doctors,
and with the informed agreement of the patients concerned.
1. Nebobongo
We have already presented the results from Nebobongo (North-east D.R.Congo,
near the town of Isiro) (9). Of 48 patients who were admitted to hospital
with the classical symptoms of malaria, and who were found to have malaria
parasites (all P. falciparum) in their blood, after 5 days treatment 44
(92%) had blood free of parasites. 37 patients said they were totally
without symptoms, while 11 patients complained of some discomfort, 3 of
them had headache, 1 fever, 4 pains in the joints and 1 giddiness. The
patients showed no significant side-effects. 11 (25%) reported feelings
of sickness, though no patient actually vomited. In this investigation,
no measure of the density of parasites in the blood was made, though after
treatment no patient had a relapse. Nebobongo is in an area where malaria
is completely endemic, the patients were all over 18 years old and had
only ever lived in areas where malaria is endemic. They were all patients
of the leading doctor of Nebobongo Hospital, and the laboratory tests
were undertaken by qualified laboratory assistants.
2. Lwiro, Bukavu
Lwiro is about 60 km north of Bukuvu, in the north-east of the D.R.Congo.
Under the leadership of biologist Innocent Balagizi and the care of the
nurse and a laboratory assistant in the regional health centre TALKIS
in Lwiro, a total of 91 patients were treated with artemisia tea for five
days between February 1998 and August 1999. Each patient had come to the
health centre with symptoms typical of malaria, and all were shown to
have plasmodium in the thick blood smears (59 patients; P. falciparum,
15; P. malariae, 15; both P. falciparum and P. malariae and 2; both P.
falciparum and P. vivax). These patients had all almost exclusively lived
in areas in which malaria is endemic, so they had a significant immunity
to malaria. Five of the patients were under 18 years old (17 months, 19
months, and 10, 11, and 17 years). Following treatment, no parasites were
to be found in the blood of 86 of the 91 patients (95%). Whilst being
treated, 21 patients complained of giddiness, 11 of feelings of sickness,
10 of noises in the ears, 8 of eye problems, 2 of itchiness and 2 of stomachache.
31 of the 92 patients said that they had no new complaints. The thick
blood smears were negative following treatment for each of the five children.
For 24 patients, the parasite concentration in thick blood smears was
determined before treatment and on every second day up to the eighth day
following the first treatment. Before treatment between 4 and 175 parasites
were counted in the field of view. The number decreased markedly in the
first two days, and a zero count was found between the fourth and sixth
days. On the fourth day, parasites were still to be found in the blood
of 14 patients, on the sixth day of 4 and on the eighth day no patients
had parasites in their blood (one patient showed no clinical improvement
by the fifth day of treatment and was transferred to hospital). The progress
of 31 patients was regularly checked following treatment. When discharged,
tests showed that none of them had any parasites in their blood. Within
the first month, 4 patients (13%) were once again positive, in the second
month 2 patients (6%), in the third month 6 patients (19%) and in the
fourth month after treatment 7 patients (23%). In this area in which malaria
is endemic, after 4 months 50% of the patients had a measurable parasitaemia.
3. Kinshasa
21 patients were treated with artemisia tea for seven days in the Red
Cross Health Centre, 75 Av. Loya, Kinshasa 1, under the supervision of
Ethnopharmacologist Konda Ku Mbuta. Two doctors, two nurses and a qualified
laboratory assistant work in this hospital. The patients arrived at the
Out-patients Department with symptoms typical of malaria, and each produced
a positive think blood smear. We have records of the parasite concentrations
for 13 patients; for whom the number of trophozoites in the field of view
was between 2 and 10. All the patients were over 18 years old. During
treatment, two patients complained of stomachache, one of colic and one
of giddiness. One patient had a fever until the third day of treatment,
and another until the last day. One patient had already been treated intravenously
with quinine, and one patient, who showed advanced symptoms of AIDS, died
two days after treatment. With regard to the immunity of the patients,
we can say that in the inner-city area of Kinshasa malaria does not appear
to be endemic. It could be therefore that only some of the patients are
semi-immune. After 7 days treatment with artemisia tea, the blood smears
of 19 (91%) of the 21 closely monitored patients were negative. The smears
of two patients still contained a few trophozoites. According to the statement
of the Health Centre, of the 21 patients, 20 showed a good clinical recovery.
Discussion
Observations are presented of the effectiveness of artemisia tea from
three centres in the Democratic Republic of Congo. The three health centres
operate completely independently from each other. anamed in Germany provides
an exchange of information. According to the data presented here, a recovery
rate of over 90% was observed, if one takes as the criterion the absence
of asexual forms of plasmodium on the last day of treatment. Also the
clinical side-effects appeared to be satisfactory as judged by the vast
majority of the patients, even allowing for the difficulty of being totally
objective on this score. In areas where malaria is endemic, it is sometimes
hard to tell whether or not malaria is actually the cause of the presented
symptoms. Parasites are often present in the blood of semi-immune people
who show no malaria symptoms.
The actual causes, particularly with people with a low parasite count,
can therefore be difficult to ascertain. The investigations presented
here do not completely clarify this problem. We do emphasise, however,
that the data presented here originates from patients who, in the clinical
judgement of doctors and nurses, were ill with malaria and needed treatment
with antimalarial drugs. The positive results could, on the other hand,
be achieved as a result of the (secret) additional use of chloroquine
or quinine. In the Congo chloroquine can be bought without prescription,
and in the region around Bukavu quinine can be extracted from the cinchona
tree, from which a traditional preparation can be made and used.
The results presented here should not be treated, therefore, as one would
standardised data from clinical studies. An exact record of the concentration
of parasites in the blood of the patients who were treated is not available,
only the average parasite count per visual field. If one accepts the simplification
that 0.002 microlitre blood is shown in the visual field (11), then the
average concentration of parasites was 4,800 per microlitre (using the
records of 36 patients), that is a rather high concentration of parasites
for semi-immune patients (12). With all the semi-synthetic artemisinin
derivatives (Artemether, Arteether and Artesunate), there is a recrudescence
rate of up to 50% (3).That means that there is a minute count of plasmodium,
that cannot be detected with the microscope, that survive the treatment,
and multiply themselves again until they are in sufficient number to cause
a reinfection. Because of the short half-life of artemisinin, a recrudescence
within the first four weeks after treatment can be expected (13).
Results from Bukavu show new evidence of 13% of treated patients having
malaria parasites in the blood within the first month. Although in an
area in which malaria is highly endemic one can scarcely differentiate
between a recrudescence and a new infection, one must take the problem
of recrudescence with artemisia tea treatment into account. To make an
accurate assessment of the recrudescence rate in any given locality one
must make an examination of the plasmodium using DNA tests.
Altogether, the results from each of the three centres demonstrate a very
pronounced effectiveness of artemisia tea. In areas in which there is
absolutely no possibility of obtaining plentiful supplies of antimalarial
drugs, this treatment would have great potential if artemisia could be
cultivated locally.
It is important to note that artemisia tea is not a new development, it
has been used extensively to treat malaria in traditional Chinese medicine
(6). With a traditional medicine whose use has been proved over several
hundred years (5), the danger of serious side-effects is much less than
with a newly developed drug. In view of the fact that Artemisia annua
is completely new in African traditional medicine, one must attach the
greatest importance to the earlier recognition of problematical side-effects.
The undesirable effects of seeing and hearing difficulties were reported
only from Bukavu, not from the other centres. In the Bukavu region there
are extensive plantations of cinchona trees, and, since these particular
side-effects are well recognised as resulting from treatment with quinine,
it remains questionable as to whether these really are genuine side-effects
of artemisia tea.
The reports of previous investigations underline the necessity of confirming
the observed results by means of a clinical study. In my opinion an open,
random and carefully controlled study would be most appropriate.
The practicality of conducting such a project in field conditions was
recently discussed (14). There should be a control group of patients,
who are treated with chloroquine or with another standard treatment of
the particular region. It would be important to supervise the daily consumption
of the tea, and to exclude any possibility of the additional use of another
antimalarial drug during the study, for example through the qualitative
proof of chloroquine metabolism in the urine before and after treatment
(15). Further, important epidemiological data about the region must be
known, e.g. is malaria endemic, is transmission stable or unstable (i.e.
whether the incidence of malaria is constant throughout the year, or whether
it varies because of other factors, e.g. the weather or humidity), the
morbidity and mortality of the population regarding malaria, the situation
with regard to resistance. Also important are not only the standardised
documentation of the clinical symptoms and the laboratory results (with
measurements of the parasite concentration standardised on a count of
200 Leukozytes) during therapy, but also observations of the patients
and results of laboratory tests for four weeks after the end of the treatment.
Countrywide Use? Pros and cons
Disadvantages:
Very effective healing plants can, in general, also cause strong side-effects.
Given the correct dosages, the isolated ingredient artemisinin seems to
produce virtually no side-effects. Tea made from the leaves, which extracts
many components, has been used for thousands of years in Chinese traditional
medicine, though no clinical studies have been conducted. Careless usage
could lead to the development of resistances. For this reason, some scientists,
e.g. at the University of Tübingen, warn against its widespread use at
the present time.
Advantages:
The problem is very urgent. Every 12 seconds, somewhere in the world,
somebody dies from malaria. The not altogether easy cultivation of Artemisia
annua, and the bitter taste of the tea, will ensure that this plant
will not be used to excess. In 161 recorded cases, over 90% of people
were healed using artemisia tea. These were native people, and therefore
semi-immune, in three clinics in the Dem. Rep. Congo (see above).
In this situation, one can understand if particular anamed groups (such as anamed Tanzania, or anamed South-Uganda) recommend country-wide cultivation, or, like anamed Congo South Kivu, already cultivate artemisia at several clinics around the town of Bukavu. One cannot expect any one country to undertake a clinical study of the efficacy and side-effects of artemisia tea. Much less can one expect this to be undertaken by a pharmaceutical company, the meagre profits from the sales of tea would never cover the costs of the research. Further, people would be encouraged to produce their own teas, and so the profit from established drugs (Lariam, Doxycyclin, Fansidar...) would be endangered.
Empirical observation must therefore suffice, until such time as a humanitarian organisation is willing to finance clinical studies.
The extent to which the use of artemisia tea is recommended must be left to the scientists in the current national anamed groups. National research institutes (in Uganda, Makerere University, in Congo, Centre de Recherche en Sciences Naturelles, Bukavu and Centre de Recherche en Sciences de la Santé, Kinshasa....) are involved in these decision-making processes, and are in a position to advise national health officials.
The anamed coordination in Germany has committed itself to:
1. making hybrid seeds available.
2. providing information about cultivation in the tropics.
3. recording the effectiveness and side-effects, and publishing the results
in the national languages of southern countries, as an aid to decision-making.
The decision as to how widespread the cultivation of Artemisia annua should be in a particular country must remain with the national authorities. Their analysis of the balance between its usefulness on the one hand and the risks on the other is a step towards achieving some independence from multinational pharmaceutical firms, to having a legitimate voice on health issues and to more democracy in the field of health.
References
1. WHO. Assessment of therapeutic efficacy of antimalarial
drugs. WHO/MAL/96.1077. Geneva. WHO 1996.
2. Guo-Qiao Li, Xing-Bo G, Lin-Chun Fu, Hua-Xiang Jian and Xin-Hua Wang.
Clinical trials of artemisinin and its derivatives in the treatment of
malaria in China. Trans. Royal Soc. Trop. Med. Hyg. (1994), 88, Suppl.
1, 5-6.
3. Tran Tinh Hien. An overview of the clinical use of artemisinin and
its derivatives in the treatment of falciparum malaria in Vietnam. Trans.
Royal Soc. Trop. Med. Hyg. (1994), 88, Suppl. 1, 5-6.
4. Nosten F. Artemisinin: large community studies Trans. Royal Soc. Trop.
Med. Hyg. 88, Suppl. 1, 45-46.
5. Woerdenbag H J, Pras N. Artemisia annua L. - Der einjährige Beifuß.
(1991) Z Phytotherapie 12:133-139.
6. The Peoples Republic of China. Pharmacopoeia. Vol 1. Beijing: The People's
Health Publisher, 1985.
7. Delabays N. Biologie de la Reproduction chez l'Artemisia annua L. et
Génétique de la Production en Artemisinine. (1997) Thèse de doctorat.
Faculté des Sciences de l'Université de Lausanne.
8. In the Moshi region, Tanzania, Personal observations.
9. Mueller MS; Karhagomba IB; Hirt HM; Wemakor E. The potential of Artemisia
annua L. as a locally produced remedy for malaria in the tropics: agricultural,
chemical and clinical aspects. ( Non published data ).
10. Action for Natural Medicine (ANAMED), c/o Dr. Hans Martin Hirt, Schafweide
77, D-71364 Winnenden, Germany.
11. Petersen E, Marbiah NT, New L, Gottschau A. Comparison of two methods
for enumerating malaria parasites in thick blood films. Am J Trop Med
Hyg 1996; 55: 485-9.
12. Shute GT. (1988) The microscopic diagnosis of malaria. In: Wernsdorfer
WH, McGregor I (eds). Malaria. p.805, Churchill Livingstone, Edinburgh.
13. Seidlein L, Bojang K, et al. A randomized controlled trial of Artemeter/Benflumetol,
a new antimalarial and pyrimethamine/sulfadoxine in the treatment of uncomplicated
falciparum malaria in African children. Am. J. Trop. Med. Hyg. 58(5),
1998, pp 638-644.
14. Willcox M L. A clinical trial of "AM", a Ugandan herbal remedy for
malaria. J Pub Health Med (1999)21(3), 318-324.
15. Betschart B, Sublet A, Steiger S. (1991) Determination of antimalarial
drugs under field conditions using thin layer chromatography: Journal
of Planar Chromatographie. Vol. 4, p 111 -114.
ANAMED Germany,
c/o Dr. Hans Martin Hirt, Schafweide 77,
71364 Winnenden, Germany.
Fax: +49 7195 65367
Email: anamed@t-online.de
Elementos que se incluyen en el kit
Además de manuales e información impresa, en alemán, inglés o francés.
a.- Hygrometer (para medir la humedad),
b.- Semillas (unas 1.200, protegidas con cristales),
c.- Té en hojas para preparar la infusión y
d.- Guía gráfica de los pasos del cultivo.
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