About Herbs

Bottom Line: Artemisia was shown to be effective in the treatment of malaria.

Artemisia annua is an herb traditionally used in Chinese medicine to treat fever, inflammation, and malaria. A compound in Artemisia was shown to be effective in treating malaria in a clinical trial. Another case study showed that Artemisia was effective in treating chronic bladder infection. Artemisia prevented cancer cells from dividing in laboratory studies but clinical trials have not been conducted to support this.

Treatment of malaria:
In a clinical trial for the treatment of malaria, 132 patients were assigned to three test groups. Each group received either low-dose artemisia, high-dose artemisia or quinine (a conventional treatment for malaria). After 7 days of treatment, there were no symptoms of malaria in any of the three groups. Although artemisia was found to be as effective as quinine, researchers suggest that artemisia should not be used to treat malaria because symptoms reappeared at much faster rates in Artemisia groups. It is unclear whether artemisia is effective against strains of malaria that are resistant to quinine.

Another study compared low-dose and high-dose Artemisia with sulfadoxine-pyrimethamine (another conventional malaria treatment) for the treatment of malaria. All 3 groups had similar numbers of cures and failures after 7 days of treatment. As with the previous study, symptoms reappeared more quickly and in greater numbers in the Artemisia groups. Therefore, Artemisia should not be used to treat malaria.

Qing Hao, absinthium, sweet wormwood, and annual wormwood

An herb commonly known as wormwood or mugwort, different species of Artemisia have been used in Western and Chinese medicinal formulas to treat various ailments. Terpenoids and flavonoids derived from Artemisia annua have cytotoxic activities in several human tumor cell lines ^{(1) (2)}. Two of the components, artemisinin and artesunate, have been studied as anticancer treatments. The plant is traditionally used for reducing fevers, inflammation, headache, bleeding and for treating malaria and has been shown to have antibacterial properties ⁽³⁾. Systematic reviews on Artemisinin show that it is as effective as quinine in treating both uncomplicated and severe malaria ^{(4) (5)}. However, increased risk of relapse may limit its uses ^{(6) (7)}. It is unclear whether artemisia is effective against strains of malaria that are resistant to quinine. In addition, in vitro studies indicate that artemisinin may be an effective treatment for other protozoal infections such as leishmaniasis ⁽⁸⁾, Chagas' disease, and African sleeping sickness ⁽⁹⁾. Patients with gastrointestinal disorders or those taking antacids should not take artemisia because it increases the production of stomach acid ^{(10) (11)}.

Abrotamine, Beta-bourbonene, Farnesyl acetate, camphene, isoartemisia ketone, caryophyllene, Beta-humulene, cadinene, Delta-cadinene, Alpha-pinene, Beta-pinene, camphene, limonene, 1,8-cincole, artemisia ketone, alpha-thujone, copaene, gamma-cadinene, vitamin A ⁽³⁾, and artemisinin ⁽¹²⁾

Artemisia annua contains artemisinin, a compound that has known antimalarial effect by suppressing Plasmodium's ablility to use host erythrocyte protein ⁽¹³⁾. Artesunate, a semisynthetic derivative of artemisinin has an endoperoxide bridge that reacts with iron in heme to form singlet oxygen and free radicals. In addition to antimalarial effects, artemisinin also effectively induces apoptosis and cell cycle arrest of Leishmani donovani promastigotes ⁽⁸⁾. It has been shown to have an antiproliferative effect on medullary thyroid carcinoma cells ⁽²⁾. and induce apoptosis in a lung cancer cell line by modulating p38 and calcium signaling ⁽¹⁴⁾.

Absorption
Artemisinin is absorbed faster from the tea preparations than from capsules. The maximum plasma concentrations were observed after 30 minutes following intake ⁽¹⁵⁾. Artesunate is rapidly absorbed and reaches maximum plasma level within 45-90 minutes. It is metabolized in the liver by hydrolysis to dihydroartemisinin ⁽¹⁶⁾.

Post partum women with anemia should not take Artemisia ⁽³⁾.
Patients with ulcers or gastrointestinal disorders should not take Artemisia ^{(10) (11)}.

Reported (Oral): Artemisia may cause abdominal pain, bradycardia, diarrhea, nausea, vomiting, decreased appetite, flu-like symptoms, fever, and decreased reticulocyte count.
Reported (Topical): Artemisia may cause dermatitis ⁽¹¹⁾

Mueller MS, et al. Randomized controlled trial of a traditional preparation of Artemisia annua L. (Annual Wormwood) in the treatment of malaria. Trans R Soc Trop Med Hyg. 2004 May;98(5):318-21.
132 patients were randomly assigned to receive 5 grams of artemisia annua herb /L (1 liter/day for 7 days); 9 grams of artemisia annua herb /L (1 liter/day for 7 days); and quinine sulphate tablets (500 mg quinine sulphate, three times daily for 7 days). There was quick resolution of parasitaemia and clinical symptoms following 7 days of treatment. Although the cure rates were 74% with Artemisia compared with 91% for quinine, researchers conclude that artemisia cannot be recommended as a substitution for quinine because symptoms reappeared at much faster rates in Artemisia groups. It is unclear whether artemisia annua is effective against strains of malaria that are resistant to quinine. Further investigation is warranted.

Blanke CH, et al. Herba Artemisiae annuae tea preparation compared to sulfadoxine-pyrimethamine in the treatment of uncomplicated falciparum malaria in adults: a randomized double-blind clinical trial. Trop Doct. Apr 2008;38(2):113-116.
In order to compare the efficacy and safety of Artemisia annua herb compared to sulfadoxine-pyrimethamine for the treatment of malaria induced by Plasmodium falciparum, 13 participants received 5 or 9 g Artemisia annua/L/day + placebo tablet and 10 received sulfadoxine-pyrimethamine (25 mg/kg sulfadoxine and 1.25 mg/kg pyrimethamin) + placebo tea 3.5 g Radix Gentianae/L/day. Clinical symptoms and adverse events were recorded along with the parasitological cure rates. The number of adverse events was similar between the treatment groups. Although the 7-day cure rate was similar between the groups, more failures were seen in the group receiving Artemisia annua after 28 days. Because insufficient treatment and thus incomplete cure is thought to select for treatment-resistant organisms, Artemisia annua herb monotherapy for malaria is not advised.