Sarcandra glabra

Health Care Professional Information

Scientific Name
Sarcandra glabra (Thunb.) Nakai, Chloranthus glaber (Thunb.) Makino
Common Name

Herba Sarcandrae, Zhong Jie Feng, Glabrous Sarcandra Herb, Cao Shan Hu

Brand Name

Zooncan

Clinical Summary

Sarcandra glabra, an herb native to Southeast Asia, has been used in traditional Chinese medicine for the treatment of bruises, bone fractures, arthritis, nausea, internal pain, and cough (1). Some constituents are reported to have hepatoprotective (2) and cytotoxic (3) properties. Preliminary findings suggest S. glabra may be useful in the treatment of idiopathic thrombocytopenic purpura (4). In animal studies, S. glabra increases platelet production and may play a role in reducing chemotherapy-induced thrombocytopenia (5). It also exhibits protective effects against viral pneumonia (6). Caffeic acid 3,4-dihydroxyphenethyl ester (CADPE), a polyphenol component, has indicated some antitumor activity in animal models (7). S. glabra was also found to inhibit tumor growth in human leukemic cell lines (8). S. glabra extract is marketed to cancer patients to relieve fatigue and as an alternative cancer treatment, but it has not been evaluated for these uses in clinical trials. However, it may relieve some cancer treatment-induced symptoms. One human study found it reduced radiation therapy-induced mucositis and xerostomia in patients with advanced nasopharyngeal carcinoma (9). More studies are needed to confirm whether S. glabra can indeed control some cancer treatment-related symptoms and to further validate any antitumor potential.

Purported Uses
  • Bruises
  • Bone fractures
  • Arthritis
  • Nausea
  • Internal pain
  • Cough
  • Bleeding disorders
  • Cancer treatment 
Constituents
  • Fumaric acid, flavonoids, succinic acid, volatile oils and coumarin
  • Isofraxidin
  • Astilbin
  • Sesquiterpene glycosides: eudesmanolide, elemanolide, lindenane, germacranolide, chloranoside
  • Sesquiterpene lactones
  • Triptolide
  • Phenolics (stems): chlorogenic acid, caffeic acid, 4-O-glucopyranosyl rosmarinic acid, and rosmarinic acid
  • Phenolics (leaves): kaempferol-3-O-β-d-glucuronic acid, chlorogenic acid, rosmarinic acid
    (2) (3) (10) (11) (12) (13)

    Significant differences in the contents of isofraxidin and fumaric acid are found when examining S. glabra from different provenances. In addition, active components are more abundant in the stem than leaf (14).
Mechanism of Action

In influenza virus animal models, S. glabra improves susceptibility marker levels and inhibits inflammatory cytokines levels through down-regulation of NF-κB protein expression to diminish lung injury. This is in part due to the antiviral and anti-inflammatory effects of major constituents including rosmarinic acid, caffeoylquinic acid, and caffeic acid (6). An ethyl acetate extract of S. glabra inhibits proliferation and viability of human promyelocytic leukemic HL-60 cells by arresting the cell cycle S phase via up-regulation of Bax, a pro-apoptotic factor (8). The antitumor effects of CADPE occur through inhibition of tumor angiogenesis, induction of cancer cell senescence, and modulation of multiple cellular targets and signal pathways (7).

Pharmacokinetics

Studies in rats determined the plasma content of isofraxidin and astilbin after oral administration of a water extract of S. glabra 1.5 mL/100 g. Isofraxidin was absorbed quickly (time to peak concentration [Tmax], 30 min) and completely eliminated within 4 h. At all time points, only the peak of isofraxidin was detected. Astilbin was not detected and appears to have poor bioavailability (10).

Evaluations of CADPE indicate better bioavailability in human vs mouse plasma. Concentrations in human plasma at 1 min (7.51 µg/ mL) and 5 min (7.40 µg/ mL) were almost the same as the nominal concentration (7.50 µg/ mL), and levels were relatively stable at 120 min (5.52 µg/mL) and 180 min (5.50 µg/mL) (7).

Literature Summary and Critique

Huang et al. [Clinical observation of sarcandra giabra combined chemoradiotherapy for treating patients with local advanced nasopharyngeal carcinoma]. Zhongguo Zhong Xi Yi Jie He Za Zhi . 2013 Apr;33(4):456-8.
One hundred patients with advanced nasopharyngeal carcinoma undergoing chemotherapy and radiation therapy were randomized to the observation or the control group (n= 50 each). Patients in the observation group were given additional S. glabra (SG) 20 g raw herb daily, started 3 days before and continued through the course treatment. A total of 98 patients completed the study. The rate of radiotherapy-induced oral mucositis and xerostomia was significantly lower in the SG group. However, no statistical difference in complete or partial remission rates, 1- and 2-year survival rates, or disease-free progression rates between the two groups was observed. SG effects on symptoms would need to be confirmed by large-scale, well-designed clinical trials.

Dosage (Inside MSKCC Only)
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References
  1. Hocking GM. A Dictionary of Natural Products. Medford, NJ: Plexus Publishing, Inc; 1997.
  2. Li Y, Zhang DM, Li JB, et al. Hepatoprotective sesquiterpene glycosides from Sarcandra glabra. J Nat Prod. Apr 2006;69(4):616-620.
  3. He XF, Yin S, Ji YC, et al. Sesquiterpenes and dimeric sesquiterpenoids from Sarcandra glabra. J Nat Prod. Jan 2010;73(1):45-50.
  4. Zhang JZ. Clinical observation of 26 cases of idiopathic thrombocytopenic purpura treated with Sarcandra glaber. J Tradit Chin Med. Sep 1981;1(1):61-62.
  5. Zhong L, Liu T, Chen Y, et al. [The study on effect of Sarcandra glabra on prevention and treatment of thrombocytopenia by chemotherapy]. Zhong Yao Cai. Jan 2005;28(1):35-38.
  6. Cao HJ, Tan RR, He RR, et al. Sarcandra glabra extract reduces the susceptibility and severity of influenza in restraint-stressed mice. Evid Based Complement Alternat Med. 2012;2012:236539.
  7. Guo X, Shen L, Tong Y, et al. Antitumor activity of caffeic acid 3,4-dihydroxyphenethyl ester and its pharmacokinetic and metabolic properties. Phytomedicine. Jul 15 2013;20(10):904-912.
  8. Li WY, Chiu LC, Lam WS, et al. Ethyl acetate extract of Chinese medicinal herb Sarcandra glabra induces growth inhibition on human leukemic HL-60 cells, associated with cell cycle arrest and up-regulation of pro-apoptotic Bax/Bcl-2 ratio. Oncol Rep. Feb 2007;17(2):425-431.
  9. Huang DN, Huang HX, Lu Y. [Clinical observation of sarcandra giabra combined chemoradiotherapy for treating patients with local advanced nasopharyngeal carcinoma]. Zhongguo Zhong Xi Yi Jie He Za Zhi. Apr 2013;33(4):456-458.
  10. Zhao RZ, Zhao Y, Zhang LQ, et al. Determination of isofraxidin and astilbin by HPLC in rat plasma and its application after orally administration the extract of Sarcandra glabra. Pak J Pharm Sci. Jan 2013;26(1):1-6.
  11. Zhou H, Liang J, Lv D, et al. Characterization of phenolics of Sarcandra glabra by non-targeted high-performance liquid chromatography fingerprinting and following targeted electrospray ionisation tandem mass spectrometry/time-of-flight mass spectrometry analyses. Food Chem. Jun 15 2013;138(4):2390-2398.
  12. Feng S, Xu L, Wu M, et al. A new coumarin from Sarcandra glabra. Fitoterapia. Sep 2010;81(6):472-474.
  13. Zhu LP, Li Y, Yang JZ, et al. Two new sesquiterpene lactones from Sarcandra glabra. J Asian Nat Prod Res. May-Jun 2008;10(5-6):541-545.
  14. Min F, Si JP, Huang WH, et al. [Studies on furmaric acid and isofraxidin content in Sarcandra glabra of different provenances]. Zhongguo Zhong Yao Za Zhi. Aug 2008;33(15):1849-1853.

Consumer Information

How It Works

Bottom Line: Sarcandra glabra has not been shown to treat cancer in humans, but may reduce side effects caused by radiation treatment. Further studies are needed to confirm these effects.

S. glabra is an herb used in traditional Chinese medicine for bone and joint pain as well as bleeding disorders. It may help to reduce the side effects of radiation therapy, such as mouth sores and dry mouth. An extract of this herb has been examined in the lab and is claimed to stop cancer cells from multiplying. However, this effect has not been studied in humans. Long-term adverse effects are unclear.

Purported Uses
  • Cancer
    Laboratory studies have shown that an extract of S. glabra can stop cancer cell division, but human data are lacking.
  • Side effects of radiation treatment
    A small observational study reported that a special preparation of  S. glabra can help reduce mouth sores and dry mouth due to radiation therapy.
  • Bleeding disorders
    Studies done in laboratory and in animals suggest S. glabra can improve platelet count after chemotherapy, but this has not been studied in humans.
  • Bone fractures and arthritis
    As used in traditional Chinese medicine. Clinical studies have not been conducted in humans.
Research Evidence

S. glabra has been studied only minimally in humans. It may have some effect on cancer symptoms, but larger, well-designed studies are needed to see if it is safe and effective.

E-mail your questions and comments to aboutherbs@mskcc.org.