Re-discovery of Huang Hua Hao: "Qing Hao," Artemisinin, and Malaria
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By Anna Yu, Yasaman Moradian, Arman Soltanzadeh, Maya Barajas-Tavera, and Medha Vallurupalli
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2022-02-15T18:28:25-08:00
The Bencao Gangmu 本草綱目 or Compendium of Materia Medica is a compilation of Chinese medical matter and natural history up to the 16th century. Written by Li Shizhen (1518-1593), a Chinese acupuncturist, herbalist, naturalist, pharmacologist, physician, and writer of the Ming dynasty (1368–1644), it is a 52 volume encyclopedia, first published in 1596, containing 1,892 entries (including plants, animals, and minerals), of which 374 were added by Li himself, and 11,096 prescriptions, among which more than 8,000 were collected by Li, as well as 1,109 illustrations. Li Shizhen categorized his collection into 16 categories based on “natural properties, such as water, fire, earth, metal and mineral, grass, cereal, vegetable, fruit, wood, insect, scale, crab shell, bird, animal and human beings.” These major categories are then divided and arranged into inorganic to organic and lower to higher.When writing the Bencao Gangmu, Li Shizhen traveled across China and studied a variety of sources, making this not just a medicinal guide but also a summary of accumulated Chinese medical history.
By studying the texts of ancient Chinese physicians, modern-day scientists were able to discern Huang Hua Hao 黄花蒿, or Artemisia annua (Sweet Wormwood), as a possible treatment for Malaria. Records from the third century CE claim that Artemisia annua. primarily grew in “wastelands,” though today they can be found on mountain slopes, riverbeds, roadsides, and open fields throughout southern and northern China. In the Bencao Gangmu, Artemisia annua is classified as “aromatic plants” and later placed in the order Campanulales for modern taxonomy. Whereas Qing Hao 青蒿, or Artemisia carvifolia, is another species of Artemisia that is often confused with Huang Hua Hao due to different taxonomic methods in traditional Chinese texts. Due to the confusion in the naming of Qing Hao and Huang Hua Hao, Qing Hao is often used to describe Huang Hua Hao in Chinese medical practice when looking at antimalarial treatment.
Artemisinin (Qing Hao Su 青蒿素), derived from Artemisia annua, was later isolated as the active component for the antimalarial properties of the plant and used to develop modern treatments for Malaria. Artemisinin first gathered attention as a treatment for malaria in 1967 when it was isolated by Chinese pharmaceutical chemist and malariologist, Tu Youyou, and her research team, in the Project 523. This secret military project, ordered by the People’s Republic of China, was designed to discover antimalarial treatments to prevent excess death during the Vietnam War. Tu and her colleagues investigated historical texts for traditional Chinese herbs and treatments, including a 4th century work, Zhouhou beijifang 肘後備急方 (The Handbook of Prescriptions for Emergencies) by Ge Hong and Li's Compendium of Materia Medica, where the researchers found about the treatment of intermittent fevers, a characteristic of a malarial infection, using "Qing Hao" (the traditional medical-nosological terms of the ingredient). In the original text, whole, fresh Huang Hua Hao was soaked and made into juice for ingestion. Since the text did not provide details on the exact species or parts of the plant that needed to be extracted, Tu and her team attempted various ways of preparing different types of Qing Hao in order to find the most effective solution. In the result of their project, Artemisinin was developed as the current most effective treatment for malaria. Tu’s work with Artemisinin later won the Nobel Prize in Physiology and Medicine in 2015, fueling interest in both Huang Hua Hao and Chinese Materia Medica.
This project investigates Artemisia annua and how traditional Chinese medicinal substances are documented and categorized. Additionally, it explores how that information has been used when discovering new drugs and developing treatments. Through this, it elaborates on the effects of traditional Chinese Materia Medica used in conjunction with scientific techniques to advance our understanding of medicine.
Due to its antiviral properties, chemists from Max Planck Institute of Colloids collaborated with virologists from Freie Universität Berlin to research the potential effects of Artemisia annua on SARS-CoV-2. In May of 2020, the University of Kentucky initiated a clinical trial to test the efficacy of Artemisia annua. extract and its derivative, Artesunate, which is a known antiviral treatment for malaria. The Artemisia annua extract is attractive to researchers due to its excellent safety profiles, availability and low costs. In the future, the team would like to conduct a placebo-control clinical trial to test the efficacy of the extract.
Additionally, the University of Kentucky and UK Markey Cancer Center have collaborated with ArtemiLife to study the extent of the plant’s anti-cancer properties. In the case of ovarian cancer, patients in remission have the greatest risk of recurrence, often highest within the first two years. Gynecologic oncologist Dr. Frederick Ueland at the UK Markey Cancer Center predicts that Artemisia annua. extract could be an “innovative therapy for advanced-stage cancer.” A study published by UK Markey Cancer Center showed evidence that Artesunate is effective against multiple cancer types resistant to standard treatments. Researchers would like to replicate this study and elaborate further.WORKS CITED
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