Eyeworld

61 EW INTERNATIONAL July 2015 Thus, using KRG in combination with conventional artificial tears, an additional effect is also expected be- cause KRG affects the body systemi- cally through an anti-inflammatory mechanism." Although considered safe in most people for short-term use, there are some concerns about how KRG can affect the body over the long term, Dr. Kim said. "Side effects do not occur in everyone who take ginseng, but the most common side effect is trouble sleeping," he said. The less common side effects include menstrual issues, increased heart rate, elevated blood pressure, headache, diarrhea, dizziness, and rashes. "KRG is generally well-tolerated, but caution should be taken when consuming other herbal medicine," Dr. Kim said. Identifying all possible contra- indications with KRG intake, Dr. Kim said: "There is a moderate risk that KRG could interfere with blood pressure medicine, blood thinners, monoamine oxidase inhibitors (MAOI), antidepressants, immune system suppressants, and insulin for diabetics. It should also be avoided combining ginseng with smoking and coffee, as the supplement can enhance the effects of nicotine and caffeine." The use of KRG should be avoided if there are known hormon- al problems or hormonally sensitive conditions such as endometriosis, breast or uterine cancer. "In addi- tion, do not consume KRG during pregnancy or while breastfeeding, since there is a possibility of adverse effects on the fetus and newborns," Dr. Kim said. EW Editors' note: Drs. Lim, Tong, and Kim have no financial interests related to their comments. Contact information Lim: drpatlim@singnet.com.sg Tong: louis.tong.h.t@snec.com.sg Kim: kcyeye@yuhs.ac based on tear film stability and total Ocular Surface Disease Index score, as compared to placebo after 8 weeks of KRG supplementation. Dr. Kim and colleagues reported these results in a paper published in the Journal of Ginseng Research in January 2015, providing evidence that KRG supplementation may be an addi- tional treatment option for dry eye and in patients with glaucoma using anti-glaucoma eye drops. Numerous studies have reported the anti-inflammatory, anti-stress and antioxidant properties of KRG. Also, various studies have reported the favorable effects of KRG supple- mentation in numerous diseases, including cardiovascular disease, cerebrovascular disease, hyperlip- idemic disease, sexual dysfunction, and Alzheimer's disease. The exact explanation for KRG's effect in cer- tain cases—for example, on Alzhei- mer's disease—is not yet clear, noted Dr. Kim. Recently, inflammatory reac- tions have been thought to play an increasingly important role in the pathogenesis of dry eye syndrome, according to Dr. Kim. "KRG contains various gin- senosides that are believed to be responsible for the systemic anti- inflammatory activities," he said. "Many studies have reported the anti-inflammatory effects of ginseng extracts and ginsenosides on cellular responses triggered by various induc- ers, including endotoxin, tumor necrosis factor-a, and interferon-g." As early as 1999, a study pub- lished in Biochemical Pharmacology reported that ginseng extracts and ginsenosides (including Rb1, Rb2, Rc, Rd, Re, Rf, Rg1, and Rg2) have anti-inflammatory properties in dif- ferent forms of inflammation. Two studies published in 2013, in the European Journal of Pharmacol- ogy and International Immunophar- macology, reported that ginsenosides decreased production of cytokines and inflammation mediators. Commenting on the advantages of KRG supplementation compared to other treatment for dry eye syn- drome, Dr. Kim said: "KRG has been already used widely for enhance- ment of several mental and physical capacities with considerable safety. bruises around the eye area after acupuncture]." The benefits of Korean red ginseng supplements in dry eye patients In the last 200 years, ginseng (the root of Panax ginseng C.A. Meyer) has been known to be a valuable folk medicine in East Asian coun- tries. Red ginseng is produced from steaming raw ginseng and is consid- ered to be medicinally beneficial. "Red ginseng is reported to be pharmacologically more active than raw ginseng in terms of chemical constituents (Rh4 and Rf2), which are produced in the steaming pro- cess," explained Chan Yun Kim, MD, PhD, professor, Department of Ophthalmology, Severance Hospital, Yonsei University, College of Medi- cine, Seoul, Korea. Korean red ginseng (KRG), according to Dr. Kim, has been widely used as a prophylactic and restorative agent for enhancement of mental and physical capacities. It has also been used in cases of weak- ness, exhaustion, tiredness, loss of concentration, and during convales- cence. Generally safe and having few side effects, KRG could be taken in various dosage forms (capsules and tablets of powdered drugs, extracts, tonic drinks, wine, and lozenges) based on personal preference. In an earlier study conducted by Dr. Kim and his colleagues, partici- pants reported relief from discomfort caused by anti-glaucoma eye drops after KRG intake. Furthermore, as reported by Dr. Kim and colleagues in the Journal of Ginseng Research in 2010, the signs and symptoms of dry eyes were improved in some of these patients. Results of this study have prompted Dr. Kim's research group to further examine the effect of KRG supplementation on dry eye syn- drome in patients with glaucoma. In a new randomized, double- blind, placebo-controlled study, KRG was used as a complimentary option to artificial tear eye drops rather than an alternative one. The results showed that all patients who dis- played dry eye symptoms and signs at baseline significantly improved "The whole eye has been di- vided into 5 wheels [departments], which represent the wood, fire, soil, metal, and water elements on earth," she said. "The conjunctiva/ sclera belongs to metal, which is rep- resented by the lung meridian; the cornea/iris belongs to wood, which is represented by the liver meridi- an; the palpebral conjunctiva and bulbar conjunctiva belong to water, which is represented by the kidney meridian." Dr. Lim emphasized that in the adult population (age 40 and above), dry eye patients have been catego- rized as either having fluid deficien- cy, liver-kidney yin deficiency, or lung-kidney yin deficiency. "Due to the humidity in Sin- gapore, we seem to have mainly 'lung-kidney yin deficiency' pa- tients, so we focused on this pattern differentiation to start the study," she said. According to Dr. Tong, TCM practitioners will administer the criteria based on TCM protocols as explained previously by Dr. Lim to determine the type of patients suit- able for the TCM therapy. Selected participants are then randomly assigned to the 3 treatment groups. "The study is [still] ongoing, results will be analyzed only when the last patient has completed follow up," Dr. Tong said. Meanwhile, Drs. Tong and Lim are confident about the benefits of TCM in the treatment of dry eye without adverse side effects. "From 2012 to 2014, we con- ducted a clinical trial on 90 dry eye patients using the same TCM herbal medicine and acupuncture methods, and none reported any adverse ef- fects during the study," Dr. Lim said. The eye drop used in the study is a common topical eye drop that does not contain any anti-inflammatory or steroidal prop- erties. "Thus, we do not foresee any adverse effects in this treatment modality," Dr. Tong said. Dr. Lim added: "However, we do foresee that some dry eye study patients may encounter sensitive reactions toward consumption of the herbal medicine [i.e., diarrhea, constipation, abdominal pain or

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