Ramuan, comprising a diverse mixture of ingredients, is a force for healing and beauty. Photo ©2009 Biotropics Malaysia Berhad.
Photographed by S.C. Shekar

Malaysia's rainforests provide precious medicinal plants and natural resources.
Photo ©2009 Biotropics Malaysia Berhad. Photographed by S.C. Shekar

Geography

Malaysia is part of the geographic region of Malesia in Southeast Asia that includes the modern political entities of Malaysia, Indonesia, Papua New Guinea, and the Philippines. It is an area with a relatively uniform climate of high temperatures and predictable rainfall, intersected by the equator. Here, over 30,000 plant species are known to occur—perhaps 10% of the world’s total number of plant species—with as many as half of these being endemic to the region. This ancient tropical flora, millions of years old, has evolved largely undisturbed by climatic and geological events, producing rainforests of remarkable age and diversity. Sea levels and climate variations have come and gone. Major, but often isolated, volcanic activity has contributed to the landscape. Notable geographically is the fact that in all of Malesia, only Peninsula Malaysia is connected to the adjacent continental landmass. As such, it serves as a bridge between Malesian floristic elements and those of the tropical Asian continent; the Peninsula itself has a flora of flowering plants, ferns, and gymnosperms numbering upwards of 10,000 species.³

Malaysia’s tropical climate enjoys abundant rainfall from alternating northeast and southeast monsoons. The northeast monsoon occurs from mid-November until March, and the southwest monsoon occurs from May through September. Heavy rainfall, high temperatures, and consistently high humidity (about 80%) provide perfect conditions for tropical rainforests that cover about 80% of Malaysia. An immense and varied range of habitats and vegetation comprise Malaysia’s rainforest formations. Low-lying coastal regions contain large-scale plantations, mostly on the west coast of the Peninsula. The flat coastal plains have extensive wetlands with mangrove and brackish-water swamp forest, creating a complex flora and fauna. Peat swamp forests fed by rainwater are found inland, and freshwater swamps fed by lakes and streams develop in river valleys.³

Biodiversity

Malaysia’s rainforests are among the oldest in the world, estimated at 150 million years of age. They have produced astounding genetic evolution over the ages. One hundred years ago, rainforests covered nearly 100% of modern Malaysia. Human activity over the past 50 years has reduced the size of rainforest ecosystems, as the country set on a path of rapid economic development. Rubber and oil palm plantations, along with other crops, were established in former lowland forests suitable for agriculture. Environmental degradation was recognized and addressed at the national level as early as 1974, with the establishment at the National level of the Environmental Quality Act. A new federal Ministry of Natural Resources and environment was formed in 2004. Malaysia is a party to the Convention on Biological Diversity (CBD), the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES), and the World Heritage Conventions, among other environmental and natural resource conventions and multilateral agreements.⁴

In 2001, the Global Diversity Outlook recognized Malaysia as one of the 12 mega-diversity centers of the world. The first edition of I. H. Burkill’s 1935 tome Dictionary of the Economic Products of the Malay Peninsula noted 1,200-1,300 medicinal plants of Malaysia, an estimate still often quoted in the literature.⁵ Out of more than 20,000 species of vascular plants, about 10%, or approximately 2,000 species, have documented medicinal qualities.⁶ Given modern ethnobotanical, chemical, and pharmacological literature, the number of Malaysian medicinal plants is likely greater.

Foundations of Malaysian Medicinal Plant Knowledge

The 3 major races of Malaysia—Malays, Chinese, and Indians—use medicinal plants for their daily healthcare needs. In addition, the Orang Asli, the indigenous peoples of Malaysia, use medicinal plants as the basis for healthcare.⁷

Europeans came to the region 500 years ago in search of valuable plant products, particularly the fabled and elusive spices of the East. Beyond such spices as nutmeg (Myristica fragrans, Myristicaceae) and clove (Syzygium aromaticum, Myrtaceae) were hints of the possibility of more botanical contributions for human benefit. Peter James Begbie, on observing indigenous medicine, wrote in 1834 of “the probability of this race yet revealing to us many medicinal shrubs which will prove highly valuable in compounds.”⁸

Humans have occupied Malaysia for at least 40,000 years.⁹ Most literature on medicinal plant use in Malaysia has emerged only in the last century. Books on Malay medicine featuring herbal ingredients were written in the 1880s in traditional Jawi script, thus were available only to educated Malays of the time. John Dermont Gimlette, an English physician, and I.H. Burkill, then director of the Singapore Botanic Gardens, translated an 1886 script by Munshi Ismail as The Medical Book of Malayan Medicine.¹⁰ Burkill later wrote A Dictionary of Economic Products of the Malay Peninsula (2 vols. 1935, reprinted with additions, 1966),⁵ a 2,444-page reference that still serves as the most comprehensive work on the Malay medicinal, herbal, and economic plants.

Expanding Knowledge Through Research

Until the 1980s, little further research or documentation of Malaysian medicinal plants occurred. In the 1980s, numerous ethnobotanical studies were carried out among indigenous groups and ethnic populations in Malaysia, including the Jah Het, Semai, Semaq Beri, Senoi, Hulu, and Temuan groups, as well as studies addressing traditional medicine practices among the Malay, Malaysian Indian, and Malaysian Chinese populations. However, less than a third of these studies were published in journals; the vast majority was technical reports, theses, dissertations and proceeding papers. Most are not readily available outside the originating institution.¹¹

Most universities in Malaysia now have active research programs on medicinal plants, including ethnobotany, chemistry, pharmacology, pharmacognosy, and indigenous traditional systems of healthcare.¹¹ In the 1960s, phytochemical screening on Malaysian medicinal plants was a focus of Malaysian medicinal plant research, followed by isolation and structural elucidation of pure compounds. Since 1985, substantial support has been provided for research by the Malaysian government through its Intensified Research in Priority Areas (IRPA) program. Current research focuses on ailment-based medicinal plant assessment using bioassay-guided fractionation; research on biological, pharmacological, and toxicological activities; clinical trials; and herbal product development for both domestic and export markets. Malaysian institutions have also developed key strategic international alliances with major medicinal plant research groups in other countries.¹²

Malaysia has developed a national policy that embraces biodiversity and conservation while maintaining economic development.⁴ During the Rio Earth Summit in 1992, Malaysian representatives strongly advocated an economic return for genetic or biological resources, as well as traditional knowledge. The potential for development of new genetic resources from its flora and traditional medical systems has sparked the development of a growing, government-supported biotechnology research and commercial development industry in the country.⁴

Towards A Regulatory Framework

Since 1992, all herbal products sold for human consumption, domestic and imported, must be registered with the Malaysian Ministry of Health to ensure their quality, safety, and efficacy. The Drug Control Authority of the Malaysian Ministry of Health must also license manufacturers, importers, wholesalers, and other suppliers. World Health Organization (WHO) guidelines are the basis for Malaysia’s Code of Good Manufacturing Practices. Other regulatory controls to which herbal medicines are subject include the Medicines Act (covering advertising and sales, 1956; revised 1983), the Poisons Act 1952 (revised 1989), the Drug Sales Act 1952 (revised 1989), and the 1972 Wild Species Act.¹² The Drug Control Act prohibits traditional medicine products from making therapeutic claims relative to the treatment and prevention of certain diseases. However, traditional claims relative to function, such as increase in strength and vitality, are permitted. Therapeutic claims can be made for herbal products with proven safety and efficacy, supported by clinical studies.¹²

The Scientific Committee of Malaysian Herbal Monographs is developing a standard protocol for quality control and identity standards. The first set of 20 monographs was published in 1999.¹² In 2001, the Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, also established the Herbal Medicine Research Centre (HMRC). HMRC is charged with scientifically proving the safety and efficacy of herbal medicines, standardizing herbal products, coordinating research on herbal medicines in Malaysia and the activity of researchers in the field, and producing a Malaysian herbal pharmacopeia. HMRC includes an Information Unit, Bioassay Unit, Toxicology and Pharmacology Unit, and Phytochemistry Unit.¹³

Expanding Markets

As in much of the rest of the world, the market for medicinal plants among Malaysians is increasing. In 2000, it was estimated that the market for herbal medicine in Malaysia was about US $527 million. The figure is expected to increase to more than US $1.37 billion by 2010. Raw materials for herbal medicine are often imported from China, India, Indonesia, Hong Kong, Taiwan, and the United States. Even with market increases, Malaysia is thought to produce between only 5-10% of herbal medicines used by Malaysians, with the rest imported from the previously mentioned countries.^7,14

According to a market assessment by Josef Brinckmann, vice-president of research and development at Traditional Medicinals, an herb tea manufacturer in Sebastopol, California, and editor of the Medicinal Plants and Extracts newsletter for the International Trade Centre’s Market News Service, Malaysia is a net importer of 80% of the 38 natural product categories represented in international trade by the Harmonized System Code, in dollar value. Despite this figure, Malaysia is a leading exporter of a handful of natural ingredients, offsetting the overall categories of imports. The country is a leading exporter of cocoa butter, coconut oil, black pepper (Piper nigrum, Piperaceae), capsicum fruits (Capsicum spp., Solanaceae), essential oils, tea extracts, cinchona alkaloids (from Cinchona spp., Rubiaceae), and other plant and plant-derived ingredients. Following historical patterns, most of Malaysia’s natural product exports are to Asian countries, particularly Thailand, Indonesia, Singapore, China, India, Japan, and South Korea. Malaysia is believed to be in a strong position to further develop export markets with the potential strong confidence in the Malaysian “brand,” with its proven ability for scientific rigor and quality products.¹⁵

Unique medicinal plant products, especially for North American and European markets, provide excellent opportunities for Malaysia. Biotropics Malaysia, a government-linked company, was set up in 2007 to bring well-researched Malaysian natural products to the American, European and other international markets.

Malaysia’s Unique Tradition—Ramuan

If globalization is a historical phenomenon, then the Malay Peninsula is an early point of origin. The intermingling of foreign cultures, civilizations, and religions, along with the ancient Malay social structures, evolved to create a traditional wellness system that is uniquely Malaysian, known today as ramuan, in which food, medicine, and beauty—inner health and outer beauty—blend in a multicultural approach to wellness that reflects the many cultures that are the people of Malaysia.¹⁶

Malay traditional medicine has an underlying theoretical framework akin to other Asian health systems. It is also heavily influenced by Arabic Unani medicine and its Galenic (Greco-Arabic) philosophy, but also incorporates adopted practices of the orang asli (indigenous peoples) and approaches of Indonesian, Chinese, and Indian traditional medicine systems. Similar to both Asian and Galenic philosophy, physical characteristics are believed to be constituted of the 4 elements—fire (suprawi), earth (suddawi), wind (dammawi), and water (balpawi). The nature of disease and medicines, meanwhile, is characterized as damp, cold, dry or hot, also drawing on the Indian-influenced concept of Pancha Indra—5 elements or senses. Influences from orang asli traditions include diagnoses based not only on physical characteristics but underlying spiritual or “spirit” influences, incorporating chants (jampi), prayers (doa), massage, abstinence¹² or strict prohibition (pantang), as well as color. The primary male healer is known as a bomoh. Single remedies or polyherbal prescriptions are dispensed in powders, capsules, pills, medicated oils, decoctions, infusions, simple distillates, pastes, and poultices.¹⁰

Traditional Malay practices were widely observed and recorded by European authors, but mostly in the context of folklore, superstition, or pagan rites. In 1900, Walter William Skeat detailed many folk traditions. The rites of the bomoh, he observed, were divided into 2 well-defined parts: (1) Diagnosis techniques including messages taken from the smoke of burning incense, reading coins thrown into water-jars, and reading parched rice floating on the surface of water; (2) Therapeutic rituals roughly classified into 4 types: (a) propitiatory ceremonies; (b) neutralization, or ceremonies seeking to destroy an evil principle; (c) expulsory for removing evil influence; and (d) revivification-restoring to health. The bomoh’s overriding fundamental principle was to preserve or restore the balance of the 4 elements, chiefly achieved by constant attention to and moderation in diet.¹⁷

The other primary practitioner in a Malay village is the bidan or mak bidan, often the most revered woman in a village. She performs vital tasks such as child delivery, advising mothers before and after birth, and advising young women on healthcare and health problems. The mak bidan is trained in the art of massage, which incorporates the use of aromatic and fixed oils, use of compresses and poultices, and hot stone massage to help rejuvenate a woman after childbirth, hasten blood flow to muscles, and help to regain youthfulness. This is not a single appointment with a massage therapist, but rather an elaborate healing and beauty-reviving ritual that lasts for 42 days and involves a wide range of herbal preparations and aromatic flowers, used internally and externally.¹⁸

Malaysian Herbs: Case Studies of Success

Tongkat Ali — Eurycoma longifolia

Tongkat Ali (Eurycoma longifolia, Simaroubaceae), has emerged as one of the most intriguing medicinal plants of Malaysia and adjacent countries. The name tongkat ali means “Ali’s staff,” a name which Burkill notes is common of plants in the genus Smilax and other tonics.⁵ Other Malay names for tongkat ali translate into “bitter antidote,” “bitter gall,” “bitter jujube,” “red jujube,” “white jujube,” “fold of the earth,” and “vomit of the earth” (referring to use in cleansing rituals). It is also sometimes referred to by the common English name Long Jack. This small tree has attracted the attention of Chinese, Europeans, Indians, Indonesians, and others throughout the world.

Burkill records “Bedara laut,” another name for tongkat ali, as being used in an infusion as a gargle for bleeding gums and a draught for dropsy (broadly, fluid retention) and ascites (excess fluid in the peritoneal cavity, a complication of liver cirrhosis, or possible spontaneous life-threatening bacterial infection). The Medical Book of Malayan Medicine suggests a deep respect for the herb as an ingredient in polyherbal prescriptions as a “neutralizer of poison” and “bitter antidote.” The infusion is used for coughs, fever, and as an application for “caterpillar itch”—wounds caused by the bristles of the poisonous sea creature known as hairy sea-caterpillar or fireworm (Chloeia flava, Amphinomidae).⁵

Burkill writes, “The roots, and particularly the bark of the roots, are used as a febrifuge. The bark is intensely bitter.” Though plentiful on the Peninsula, Burkill further observes that most of the supply was imported via Singapore from Borneo (island home of 2 modern Malaysian states). In decoction, it is often mentioned in the literature for “intermittent fever” (malaria). Malays have been noted to drink the decoction in instances calling for a tonic, such as after childbirth. The pounded root bark was poulticed for headache, wounds, ulcers, and other sores.⁵

The source plant, E. longifolia, common in Indonesia and Malaysia, was named by William Jack (1795-1872), surgeon with the East India Company. Jack was one of the first to attempt a catalog of Peninsular Malayan plants.¹⁹ A medium-sized tree to about 18 ft in height, it usually bears a single stem with pinnately compound leaves approximately 39 in. long and 30-40 leaflets in opposite pairs. Relatively inconspicuous flowers are borne in branched panicles, producing ovoid fruits, which are generally the size and shape of those of jujube (Ziziphus jujube, Rhamnaceae) and turn dark red when ripe. It is found as an understory tree in the lowland forests of Peninsula Malaysia, Indonesia, and other parts of Southeast Asia.²⁰

The primary modern use for tongkat ali in the treatment of erectile dysfunction (ED) stems from its traditional reputation as an aphrodisiac. A recent study looking at Malaysian cultural differences in knowledge, attitudes, and practices related to ED used focus groups to evaluate data in 66 men of varying ethnic background. The researchers found that use of traditional remedies for preventing or treating ED were commonly recognized among all groups, particularly the use of preparations of tongkat ali root. It was also reported as a means to increase sex drive and desire.²¹

As the flagship of Malaysian traditional medicines, it has been the subject of relatively extensive scientific research. One important research track has focused on claims of traditional use as an antimalarial. In vitro studies published in 1986 and 1991 showed a potential antimalarial effect of specific chemical fractions from the root.^22,23 In a 1995 study, a quassinoid mix in a semi-purified extract of the root showed that a dose-dependent complete inhibition of 6 Malaysian chloroquine-resistant Plasmodium falciparum cultures was achieved with 1.25-5.0 micrograms ml-l extract, 3 days post treatment.²⁴ The same researchers found that 3 of 9 isolated quassinoids showed antimalarial activity.²⁵ In a 2002 study, 2 compounds, 11-dehydroklaineanone and 15beta-O-acetyl-14-hydroxyklaineanone, showed potent plasmodicidal activity.²⁶ The quassinoids eurycomanone and 13,21-dihydroeurycomanone showed higher selective cytotoxicity to strains of P. falciparum in systematic bioassay-guided fractionation than 4 other quassinoids.¹⁴ A recent in vivo study looked at the activity of whole standardized root extracts, alone and in combination with artemisinin, to assess antimalarial potential. Both oral and subcutaneous doses were given, and the combination of the 2 drugs, especially by the subcutaneous route, showed excellent results.²⁷ A 2008 study looking at P. falciparum growth stages found a methanol soluble isolate of the root had the greatest inhibitory effect at trophozoites stages of P. falciparum.²⁸ These and other studies relative to antimicrobial and cytotoxic activity have catapulted tongkat ali as a leading candidate for further antimalarial research.

Of equal interest to potential international markets are studies related to traditional use as an aphrodisiac. A 1997 study evaluated the effect of tongkat ali on the libido of sexually vigorous male rats and found a dose dependant stimulation of sexual arousal absent of genital stimulation, as measured by increased mounting frequencies.²⁹ Given a tongkat ali root extract for 10 days before a study, sexually experienced male rats exhibited greater orientation toward receptive females (as measured by sexual interest behaviors, environment response, self interest, and mobility) compared with controls.³⁰ In other studies, the same battery of tests proved to increase sexual interest in middle-aged rats that were retired breeders³¹ and decrease mounting hesitation response compared to controls.³² Yet another study, this one with sexually sluggish old male rats treated with tongkat ali extract, increased yawning and stretching, both regarded as ancestral vestiges of evolution associated with promoting sexual arousal.³³ The same research group studied the aphrodisiac effects in sexually inexperienced male rats, and in a series of tests over a 9 to 12 week observation period, the inexperienced male rats treated with tongkat ali root extract gained significantly more experience than the controls.³⁴ A pro-androgenic effect on the laevator ani muscle was shown in another study.³⁵ Clearly these small studies don’t provide adequate scientific evidence to suggest throwing away Viagra®, but they do point to a scientific basis for the traditional use of tongkat ali as an aphrodisiac.

A joint study carried out by Massachusetts Institute of Technology and Malaysian research institutes indicated that the aphrodisiac activity of plants can be determined by the presence of 4.3 kDa peptide. This peptide, found in tongkat ali root, may be responsible for its aphrodisiac attributes, as it is a potent phytoandrogen shown to increase testosterone levels in rat leydig cells.^36,37 Patents have been granted on the identity of the peptide, its extraction, and its use in increasing testosterone synthesis, and an extract based on an exclusive license of this patent is produced in Malaysia and marketed as LJ100 in the United States.³⁸ At the cellular level, tongkat ali has been found to increase the level of cGMP (cyclic guanosine monophosphate), which produces smooth muscle relaxation in the corpus cavernosum, allowing blood flow that leads to an erection. It also increased levels of cAMP (cyclic adenosine monophosphate), enhancing metabolism of sugar utilization, which helps to explain its energy-boosting effects.³⁹ Antianxyolytic activity has also been experimentally confirmed.⁴⁰ Ergogenic effects were demonstrated in a study on men, including modulation of testosterone level, reduction of body fats, and increased muscle strength and size.⁴¹ It is also purportedly used as a natural energizer and sexual stimulant and potential health supplement in the maintenance and regulation of healthy ageing in men.⁴²

Kacip Fatimah Labisia pumila
Photo ©2009 Biotropics Malaysia Berhad. Photographed by Mustaffa Mahmood

Kacip Fatimah — Labisia pumila

Labisia pumila (syn L. pothoina, Ardisia pumila; Myrsinaceae, also placed in the Primulaceae family) is known in Malaysia as kacip fatimah. Labisia is a small genus of about 7 species of subherbaceous perennials found in Southeast Asia.⁴³ Labisia means “a spoon,” as the small depression of the corolla resembles the bowl of a spoon. Many Malay names for the plant are dedicated to the prophet Mohammed’s only daughter, Fatimah. Kacip fatimah is sometimes called kunci fatimah, which roughly translates into “Fatimah’s key;” selosoh fatimah means “Fatimah’s childbirth medicine;” and rumput siti fatimah is “grass of our lady Fatimah.” Other common names include tadah mata hari (intercepting the sun) and bunga belangkas hutan (woodland king-crab’s flower), among others. King-crab’s flower honors the Malay’s fondness for imagery as king crabs are commonly seen in pairs, which is regarded as a happy matrimonial pair.⁵

As a protective medicine, a decoction of the whole plant is administered after childbirth, but also before birth to expedite delivery. The decoction is also used for the treatment of dysentery, intestinal gas, and dysmenorrhea, as well as for a condition described as “sickness in the bones.”⁵

In Malaysia, kacip fatimah has not only been used for centuries, but it is taken on a regular basis by Malay women today. The fresh or dried plant is boiled in an earthen cooking pot, either alone or in decoction with other herbs. The herb, or formulations with other herbs, is readily available in powders or extracts in pills, capsules, mixtures with tea or coffee, and as a canned beverage. The decoction is given 1-2 months before childbirth. Modern perceptions of its health benefits include being a useful herb to contract the uterus after childbirth; firm and tone abdominal muscles; tighten the vaginal wall and tissue; allay painful or difficult menstruation, cramping, and irregular periods; and to generally alleviate fatigue and promote emotional well-being. Used regularly it is believed to increase vitality, libido, and energy.¹⁶ The decoction of the leaves and roots is valued to help delay conception and regain strength after childbirth.²⁰

Three varieties are found in Malaysia: the 2 major varieties used in commercial products, L. pumila var. alata and L. pumila var. pumila, as well as

L. pumila var. lanceolata. Quality control studies have identified morphological, microscopic, and chromatographic methods to differentiate between the 3 Malaysian varieties of L. pumila.¹² An herb or subshrub, with creeping rhizomes, growing from 12-18 in. in height, kacip fatimah is found on the floor of damp forests at elevations from about 200 to 2,300 ft. The distinctive elliptical-lanceolate, glabrous leaves are dark green above, usually with lighter-green margins, and tinged reddish-purple beneath. The leaves may be over a foot long and up to 5 in. wide. The small white-pink flowers occur in spike-like panicles in the leaf axils. They produce a small round, red berry when ripe.²⁰ The plant contains benzoquinoid derivatives, alkenyl resorcinols, and triperpenoid compounds.

In an investigation of 6 commercial herb products available in Malaysia, 5 products intended for use before childbirth were found to contain L. pumila var. alata root, and one product intended for use after childbirth contained L. pumila var. pumila leaf. Since Labisia pumila is often associated with habitats where tin mining occurs, with soils rich in tin, the authors of the study also investigated the tin, aluminum and iron content of Labisia plant samples. A relatively high iron content in L. pumila var. alata root (107.3-111.6 ppm) suggests the plant may help prevent anemia in pregnant women. Possible estrogenic activity had been proposed as an explanation for traditional use by pregnant women, and two small studies have shown a tendency toward possible estrogenic activity.⁴⁴

Kacip fatimah is generally considered safe for human consumption when used in the form of a traditional decoction. A pilot study on post-menopausal women indicated dosages of up to 560 mg/day as safe for consumption.⁴⁵

Given its wide use by Malay women during pregnancy, Zaizuhana et al. investigated the effect of kacip fatimah aqueous extracts at different dosage levels and time intervals on mammalian bone marrow cells using micronuclei formation to assess the potential genotoxicity and mutagenic effect of the herb. Using what was admittedly a limited experimental design, they did not observe any mutagenic potency or genotoxic effects, but urge further research.⁴⁶

A study by Effendy et al. looked at the possible liver and kidney toxicity of a petroleum ether extract of the roots of L. pumila var. alata administered subcutaneously for 7 days in laboratory animals at 3 different concentrations. The treatment groups showed mild-to-moderate hemorrhage lesions in the kidneys and liver degeneration, with the greatest abnormalities occurring in the group that received the highest dose of the extract. The authors concluded that a toxin might be present in the plant and that further studies should be carried out to determine safety. This study, however, used high doses over a short period of time in a petroleum ether extraction system as a subcutaneous injection, which is a very different preparation and will yield a complete set of different compounds than those found in traditional and conventional products using water as the extraction solvent. These purely experimental results therefore have no relevance to real-world usage by humans, where solely water decoctions are used.⁴⁷

An evaluation of the potential teratogenicity of an aqueous extract of L. pumila var. alata root at up to 1000 g/kg/day in an animal model did not show any teratogenic effect, though what was deemed as a statistically insignificant increase in body weight of pregnant animals was observed. This study furthers scientific data on the relative safety confirmed in toxicological studies conducted to date.⁴⁸

Another study looked at female reproductive toxicity and potential effects of a L. pumila var. alata aqueous extract on pregnancy and labor in rats. The authors observed no signs of reproductive toxicity or complications in pregnancy, delivery, and early pup growth in rats. There was no observable adverse effect at levels equivalent to 800 mg/kg/day.⁴⁹

Researchers from Oman and Malaysia recently looked at the effects of an aqueous extract of kacip fatimah on maintaining integrity of the aortic wall in laboratory animals. Aortic stiffness is a potentially useful measure of cardiovascular health and predictive sign of cardiovascular disease. A patentpending water extract of kacip fatimah was given at a dose of 17.5 mg/kg/day orally in drinking water. After 3 months of treatment, with another group receiving estrogen therapy, the authors concluded that the L. pumila var. alata water extract helped to maintain the integrity and morphology of the aortic wall in a manner similar to that of estrogen. They note, too, that the results were consistent with previous studies with kacip fatimah that showed an estrogenic effect. It was theorized that the herb may have possible cardio-protective effects and may be suitable for treating menopauseinduced aortic stiffness.⁵⁰

Kacip fatimah has been one of the most widely used herbs by women in Malaysia for hundreds of years. Based on the growing number of products in the Malaysian market, with claims of enhanced vitality and libido over the last 10 years, the Government of Malaysia has been providing support to universities, research institutes, and government agencies to evaluate the identity, safety, pharmacology, and human experience with L. pumila. Government interest in the herb provides funding for establishing a basic scientific understanding of the traditional use, pharmacognosy, chemistry, pharmacology, and toxicology of kacip fatimah. A patent has been filed for an aqueous extract and on-going clinical trials, if positive, will not only confirm the traditional knowledge of many generations of Malaysians but also increase international interest in the herb.