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ARALIACEAE — 1(Ginseng or Aralia or Ivy family)
This family of some 700 species in 55 genera consists mostly of trees and shrubs, but includes some twiners. Most species occur in tropical regions, particularly in Indomalaysia and tropical America. Other species are native to temperate regions, and some species have become widely distributed by horticulture and as houseplants. A characteristic of the family is the presence of resin passages which produce an aromatic smell when crushed (Corner 1952). Perhaps the best known temperate species is Hedera helix L., the ivy. The ritual use of ivy as the archetypal evergreen, and its popularity as a decorative covering for walls and fences and as a houseplant, brings it into unusually close contact with man. The root of Panax ginseng C.A.Mey. is the Korean or Oriental ginseng of commerce. It is also known as Ren Shen or as Radix Panacis Gingeng. Preparations of the root are widely used as a herbal remedy for their reputed tonic and adaptogenic properties (Dixon 1976). Several other types of ginseng are derived from members of the Araliaceae, and also from totally unrelated families (Nadkarni 1976, Lui & Staba 1980):
Allergic dermatitis following contact with species of Hedera L., Polyscias J.R.Forst. & G.Forst., Schefflera J.R.Forst. & G.Forst., and other genera has been reported, as has cross-sensitivity between genera. In addition, many species bear spines.
The green bark irritates the hands of those collecting it (Cheney 1887). As indicated by the specific epithet, the plant is armed with stout prickles.
The plant is thorny (Brekhman 1968).
This species, in common with most others in the genus, is armed with prickles. Sesamin, an allergenic principle found in sesame seed oil (Sesamum indicum L., fam. Pedaliaceae), has been isolated from the root bark of this plant (Elyakova et al. 1966, Yook et al. 1977).
This ivy is tender in Britain, needing protection in winter, and is grown mainly as a house plant. In many parts of America and in southern Europe it grows freely in the open. Varieties and cultivars of this species are also known. A substance causing dermatitis is present in the sap (Dorsey 1957) and is probably an allergic sensitiser. It is released only when the leaves or stems are bruised, and is present in an aqueous extract of the plant. Dermatitis is usually acquired in the process of cutting back the exuberant growth in the spring. It is commonly confined to exposed skin, and may be diffusely eczematous or in linear, often vesicular patterns (Dorsey 1959). If this plant is the cause of a skin eruption, reaction to a patch test with juice from crushed leaves will occur within 48 hours (Dorsey 1959, Dorsey 1962). A male aged 27 years developed bullous dermatitis of the fingers, hands, forearm, neck, and face after clearing the variegated form of this ivy from his garden. Patch tests to the leaf produced a 3+ reaction (Calnan 1981). Contact dermatitis from this ivy is rare in Britain (Calnan 1981, Hambly & Wilkinson 1978), quite common in Australia (Burry, J.N., personal communication to Calnan 1981), and reported from California (Dorsey 1957, Dorsey 1959), Southern Transvaal (Whiting 1971), Denmark (Roed-Petersen 1975), and Canada (Mitchell 1981). Roed-Petersen (1975) found three positive reactions among 138 control patients. In the case described by Hambly & Wilkinson (1978), patch test reactions were positive to Chrysanthemum L. as well as to Hedera canariensis. Clipping or just handling the plant may result in a skin rash and even blistering and inflammation (Watt & Breyer-Brandwijk 1962). This common European ivy has long been recognised as a cause of dermatitis (Zinsser 1909, Gutteling 1922, Rynes 1949, Roed-Petersen 1975). Patients allergic to Hedera canariensis also react to H. helix. The clinical features of the dermatitis as described in case reports (Cleland 1925, Muenscher 1939) suggest that allergic sensitisation may occur. Indeed, the lesions may be linear and vesicular as in poison ivy (Toxicodendron Mill. spp., fam. Anacardiaceae) dermatitis (Goldman et al. 1956, Aplin 1966). Other similar cases have been reported by Thibierge (1909) and by Burry (1969). An extract of the leaves, when used as a corn cure for the feet, caused dermatitis in a patient who later developed a recurrence after handling wet leaves (Munro 1900). Rothe (1968) described a gardener in a cemetery who developed eczema of the hands and forearms. A patch tests to the leaf of this ivy produced a positive reaction. In addition to the case reports already mentioned, Maiden (1909b), Maiden (1911) and Allen (1943) state that this ivy causes dermatitis only in some people. One of the authors (A.J.R.) has encountered four cases of dermatitis apparently attributable to this ivy, the clinical appearances of which were those of an irritant dermatitis. Patch tests with fragments of bruised leaf were positive only in one patient, but also positive in 3 of 10 control subjects. Highman (1924) obtained a negative patch test reaction with a leaf, but a positive reaction to an alcoholic extract of the leaves which produced no reaction in two controls. Whiting (1971) notes that H. helix has low sensitising potential. One of four patients who were contact sensitive to this ivy was also contact sensitive to extracts of some Compositae species and to alantolactone derived from Inula helenium L. (Roed-Petersen 1975). Several varieties of this ivy growing in Egypt have been found to contain the alkaloid emetine (Mahran et al. 1975). Emetine may produce intense skin reactions in sensitised persons (see Cephaelis ipecacuanha A.Rich., fam. Rubiaceae). The leaves and berries also contain saponins based on hederagenin. On ingestion, vomiting, diarrhoea, and nervous depression may be caused though the symptoms are considered serious only in small children (Lewis & Elvin-Lewis 1977, North 1967). A scarlatiniform eruption in a 3.5-year old boy, seemingly produced by ingested ivy leaves, has been described by Turton (1925).
An acute vesiculo-bullous eruption on the back of the hands, arms, and neck from Schefflera kwangsiensis in a 48-year old male after contact with the plant when gardening was reported by Calnan (1981). A patch test with the leaf was positive at 96 hours but not at 48 hours. This is a genus of about 200 species of creeping perennial herbs of cosmopolitan distribution (Mabberley 2008). Hydrocotyle species have close similarities with Centella L. species (fam. Umbelliferae) and have previously been classified by some authorities in a distinct family, namely the Hydrocotylaceae (Willis 1973).
Perry & Metzger (1980) noted that the sap, if brought into contact with the eyelids causes conjunctivitis. According Sheh et al. (2005) in the Flora of China, 14 species of Hydrocotyle L. are to be found in China. Hydrocotyle javanica is not included amongst these 14 species. However, Hydrocotyle nepalensis is included, this being described as "part of the highly variable complex of Hydrocotyle javanica Thunberg, which extends from Nepal east to Japan and south through Indonesia into Australia." These authors add that "[the] classification [of this species] is in need of revision across its whole geographic range."
In China, Taiwan and Japan, the macerated plant may be applied as a poultice to bruises or as a styptic to cuts or wounds, especially leech-wounds. A decoction may also be used as a wash for itch. On the Malay Peninsula, the plant is used to treat some skin diseases (Perry & Metzger 1980). In a survey of Columbian medicinal plants, Lopez et al. (2001) noted that this plant (which is known locally as chupana) mixed with animal fat will "suck the infections out of the skin".
Stuart (1911), referring to Acanthopanax ricinifolium, notes that the bark and leaves of this thorny tree are recommended for insecticidal purposes and for the treatment of skin disease and all sorts of ulcers and infected sores. Lopatin & Kolesnikova (1974) reported dermatitis caused by extracts of this species. Ingestion of an infusion of the plant caused toxicoderma (one case) and urticaria (two cases).
The stems, petioles, and leaf veins are covered with numerous thin, sharp spines which can inflict painful wounds to those who touch them (Turner 1979). The spines were thought by the Southern Kwakiutl Indians of British Columbia to be poisonous (Turner & Bell 1973). The root of this species is the Korean ginseng of commerce. In addition to saponins which are thought to be the main pharmacologically active principles, the root contains small amounts of oestrogenic substances which has been reported to cause painful and swollen breasts. Other substances have also been packaged and sold as ginseng, including mandrake root (Mandragora officinarum L., fam. Solanaceae) containing scopolamine, and snakeroot (Rauvolfia L. species, fam. Apocynaceae) containing reserpine (Anon 1979). Ginseng farmers developed dermatitis from the fungicide dithane which is sprayed on ginseng crops against blight (Schorr 1979).
The root of this species provides the traditional Chinese medicine san qi (三七), known also as tian qi (田七), Radix Notoginseng, or Radix Pseudoginseng. Radix Notoginseng (san qi) is the principal ingredient of a popular proprietary Chinese traditional medicine known variously as Yunnan Paiyao, Yunnan Baiyao, or Yin Nan Bai Yao. Although originally developed as a remedy for treating knife, sword and gun-shot injuries sustained in battle, it is now promoted also as a haemostat and anti-inflammatory agent for minor wounds. The product is available both for oral administration and for topical application. Lee & Lam (1987) reported a case of allergic contact dermatitis caused by topically applied Yunnan Paiyao (云南白药). These authors could not ascertain the composition of the product from the manufacturer so were unable to perform patch tests aimed at determining the identity of the sensitiser in the product. Baidu, a Chinese language online encyclopedia, includes a page on Yunnan Baiyao on which it is asserted that Yunnan Baiyao is a first-level protected product under the Law of the People's Republic of China, so its method of manufacture and formulation is top-secret. The original product formulation was conceived in 1902 and is manufactured by the Yunnan Baiyao Group Co Ltd. However, it is evident from online searches that products named Yunnan Baiyao are available from other manufacturers and distributors, some of which do declare the full composition of their product, others reveal only that san qi is the main ingredient, whilst others claim that their formula is a trade secret. Clearly, products named Yunnan Baiyao have to be regarded as being of uncertain composition. The following list of declared constituents is constructed from information provided on the internet by various manufacturers and distributors. It is evident from the YunnanBaiyao.co website that products from each individual manufacturer will contain only a selection of the ingredients included in the list below, and perhaps also one or more undeclared ingredients:
Internet sources suggest that the original formulation includes aconite [Aconiti Kusnezoffii Radix (or other species; see Liu et al. 2015) — cao wu; 草烏] and bear-bile [Fel Ursis — xiong dan; 熊胆], ingredients that would raise serious safety and quality control concerns at the Food and Drug Administration in the US, the European Medicines Agency in the EU, and in other jurisdictions. The controversy that surrounds the use of animal-derived products in unregulated medicines, and especially the use of bear-bile may be a reason why some manufacturers choose not to declare the full list of ingredients in their particular formulation of Yunnan Baiyao. In southern Florida, where this and related species are loosely referred to as aralias, the plants are commonly cultivated as hedges and are a frequent cause of dermatitis, which may be provoked merely by brushing against the leaves. A more acute form may result from handling cuttings (Morton 1958, Morton 1971).
Polyscias J.R.Forst. & G.Forst. species (known by their former name Nothopanax Miq.) are popular as hedge plants in Hawai‘i. In 30 years of practice there, Arnold (1972) had seen only 3 or 4 cases of dermatitis caused by them. In southern Florida, where this and related species are loosely referred to as aralias, the plants are commonly cultivated as hedges and are a frequent cause of dermatitis, which may be provoked merely by brushing against the leaves. A more acute form may result from handling cuttings (Morton 1958, Morton 1971).
Aplin (1976) noted that in Western Australia this species was suspected of having caused an irritating rash in a person who had handled the plant. In another case, a white female homemaker aged 33 years became sensitised by cutting back Hedera during the summer. The following winter she developed several attacks of acute vesicular dermatitis affecting the hands, wrists, forearms, and face subsequent to contact with Brassaia actinophylla grown as a houseplant. A patch test with lightly crushed leaf produced a strongly positive reaction, negative in three controls. Positive patch test reactions were also observed to some other species, namely Fatsia japonica Decne. & Planch., Hedera helix L., Polyscias fruticosa Harms, (syn. Panax fruticosum L.), and × Fatshedera Guillaumin, negative to Dizygotheca elegantissima R.Vig. & Guillaumin (syn. Aralia elegantissima Veitch) (Mitchell 1981). Hammershøy (1981) describes a case of a 35 year old female nursery worker who developed dermatitis of the hands and forearms two weeks after starting work with Schefflera J.R.Forst. & G.Forst. species. Patch tests to Schefflera actinophylla and Schefflera arboricola Hayata (syn. Heptapleurum arboricola Hayata) leaf, stem, and ether extracts (1% in petrolatum) were positive; ten controls were negative. Hammershøy (1981) describes a case of allergic sensitivity to this species and also to Brassaia actinophylla Endl.
The single species in this genus is a native of South China and Formosa (Mabberley 2008), but is cultivated as an ornamental in the warmer parts of Europe and America. It was originally named Tetrapanax papyriferum. Dorsey (1962) noted that the heavy yellow pollen produced by the Chinese rice paper plant in the fall and winter months may cause severe dermatitis. [Further information available but not yet included in database] References
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