Perceptions, knowledge and misuse of an oriental herbal drug: a survey of 608 Korean female nursing college students

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Summary

This study was designed to survey college students about their knowledge and use of Uwhangchungsimwon (UC), a Traditional Oriental herbal remedy for emergency and acute treatment of stroke, numbness, hypertension, epilepsy and arteriosclerosis. Students at three female nursing colleges in Korea completed a questionnaire containing 29 questions about the students’ demographics, knowledge and use of UC, and the placebo effect. Of 608 respondents, 217 (36%) had taken UC. Eighty-three per cent reported that UC alleviated examination tension and 28% knew that it is used as an emergency drug for stroke. Forty-two per cent believed that UC has a “placebo effect” and 20% considered its effects were more than that of a placebo. Fifty-eight per cent of those using UC felt that it was effective in inducing psychological relaxation, 4% considered that it increased their energy levels, and 6% felt it was effective in “clearing the head”; 33% reported no effects. Users also reported adverse effects: 30% reported drowsiness, 17% reported a “heavy head” and 15% experienced indigestion. Most respondents (73%) obtained information about UC from family members and friends and 33% from newspapers or the media. These results confirm health practitioner should recognize that UC is used widely for purposes other than its intended purpose (i.e., to treat stroke and hypertension) and that such use can cause adverse effects. More systematic research is needed to increase the safety of consumers when using herbs and herbal supplements.

Introduction

Uwhangchungsimwon (UC), a herbal drug available as a pill, is used for the emergency and acute treatment of stroke, numbness, hypertension, epilepsy and arteriosclerosis in Oriental Medicine. UC is composed of 29 herbs and the main components are Calculus Bovis, Moschus, Borneolum Syntheticum, Radix Ginseng, and Rhizoma Discoreae.1, 2 UC is an effective modifier of biological responses and augments body circulation. The effectiveness of UC in the treatment of cerebral ischemia, hypertension, arteriosclerosis, coma, stroke, and apoplexy has been widely demonstrated after its clinical administration, although the pharmacological actions and mechanisms underlying these actions are not fully understood.

We speculate that bilirubin and muscone are the active substances contained in UC, because the main components of UC are Calculus Bovis and Moschus. According to traditional Oriental medical theories, UC contains other herbal compounds to complement the pharmacological action of Beozoar Bovis, to maximize its beneficial effects, and to minimize its side effects. The Korean Food and Drug Administration and the Standard and Evaluation Guideline for Food and Drugs, Korea Pharmacopeia, require that UC contain at least 10% by weight of bilirubin and 2% of l-muscone.3 In Korea, UC is available as an over-the-counter drug and is regulated by the Korean Food and Drug Administration and Ministry of Health and Welfare. The usual dose is one pill (7.5 g) for adults, 23 pill for 8–15-year-olds, 12 pill for 6–7-year-olds, 13 pill for 2–4-year-olds, and 14 pill for children younger than one year, taken once or twice a day by chewing or dissolving in hot water. Consultation with a health care specialist is recommended for use by children and for long-term use (i.e., more than 7–14 days).

The pharmacological actions of bilirubin include relaxation, reduced blood pressure, anti-inflammatory action, and dissolution of cholesterol; bilirubin is thought to act by strengthening the heart, inducing relaxation, and as an anti-toxin.4, 5, 6 The pharmacological actions of muscone include enhanced heart function, anti-inflammatory action, and anti-platelet aggregation; muscone is thought to act by inducing psychological relaxation, reducing symptoms of stroke, treating abscesses, and as an anti-toxin.6, 7, 8, 9, 10

Many recent studies have demonstrated the effects of UC. In patients with cerebral vascular accident, UC prevents ischemia-induced brain damage.11 UC also aids recovery from experimentally induced ischemia in the perfused rat heart12 and, because of its dilation of cerebral resistance vessels, decreases the pulsatility index and the breath-holding index in the human cerebral artery.13

However, UC seems to be used somewhat differently from its original purposes in modern Korea. Because it can be purchased easily and cheaply from a pharmacy without a prescription and many people are not aware of its side effects, it is seen as a universal remedy for various diseases and conditions, especially to reduce mild symptoms of stress, anxiety and depression. The Korea Consumer Protection Board reported that most Koreans (76% of 300 respondents) have used UC and consider it to be a household or first-aid medicine.14 This widespread use may be based on misperceptions and lack of knowledge about the effects of UC. However, there are no systematic clinical trials reporting the long-term effects of UC. Recognizing the increasing misuse of UC among Koreans, we surveyed the prevalence of use of UC among college students and their perceptions and expectations of its effectiveness (Box 1, Box 2).

Section snippets

Materials and methods

We surveyed female students at three nursing colleges in the Chunrado province of Korea between February and March 2003. The self-report questionnaire was distributed to 663 nursing students after we had explained to them the survey's purpose and methods. Questionnaires were returned by 632 students, of which 24 were excluded from the study because of incomplete responses. Questionnaire available upon request.

Results

Demographic characteristics of the survey respondents are summarized in Table 1. Two hundred and seventeen (36%) subjects reported having used UC at least once and 391 subjects (64%) had not used UC. There were no significant differences in age, height, weight, religion and perceived health condition between users and nonusers. One hundred and seventy three (28%) subjects reported previous experience with CAM and 435 (72%) had no prior experience with CAM. Three hundred and thirty-two subjects

Discussion

We found that a relatively high proportion (36%) of female Korean college students use UC. Most respondents (83%) considered UC to be effective in alleviating examination tension or anxiety and 58% of the users felt that it was effective for psychological relaxation. Thirty per cent of users reported drowsiness as an adverse effect.

Despite the long history of UC use in Korea and scientific studies on its effects, the students appeared to be misinformed about the safe and proper use of UC,

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