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cultures involved aqueous extracts, such as hot water teas (Heron and Yarnell, 2001). A tea has very little NDGA (a constituent of concern, see below) compared with an alcoholic extract or the powdered dry leaf because NDGA is poorly soluble in water (Obermeyer et al., 1995). Pima Indians used the tea orally as a diuretic, emetic, or expectorant, and topically as an antiseptic or poultice (Mabry et al., 1977). In many American Indian cultures, chaparral tea has been used to mitigate colds, bronchitis, and other breathing problems; for menstrual cramps; and for numerous intestinal problems. It has also been applied topically for painful joints, skin infections, snakebites, burns, and allergies (Mabry et al., 1977; Moerman, 1998). The leaves have been used both as a decoction in a bath or as an external poultice for rheumatism and arthritis, as well as for scratches, wounds, and bruises (Moerman, 1998). There are a few reports of the use of chaparral extracts by southwest native healers in the management of type 2 diabetes (Gowri et al., 2000). In the medical literature there is a paucity of reports involving the ingestion of chaparral capsules or tablets, except for those resulting in adverse effects (described below).

2. Adverse effects

The clinical data suggest a pattern of hepatotoxicity. This pattern is discussed in more detail below. One difficulty in evaluating the clinical data on chaparral is that in most of the cases, the chaparral preparation ingested was not described in any detail. Additionally, the product purity and quality were not reported.

Clinical trial data: Table B provides a summary of a small clinical trial that was conducted among 59 terminal cancer patients to examine the effect of NDGA and chaparral tea on tumor growth. Thirty-six patients consumed chaparral tea (16–24 oz/d) while 23 patients consumed NDGA (250–3,000 mg/day). Selected blood tests and urinalysis were repeated at 2 to 4 week intervals. An analysis of the 45 patients who were treated for at least 4 weeks suggested that there were no hematological or chemical abnormalities that could be attributed to the treatment. Patients reported minor adverse effects as described in Table B. Of the 59 treated patients, no pattern of hepatotoxicity was reported following consumption of either chaparral tea or NDGA by the terminally ill cancer patients. The reasons why 14 subjects dropped out were not reported.

Clinical case reports: Table C-1 summarizes clinical case reports of patients who took chaparral without the added complication of additional ingredients. Careful inspection of Table C-1 reveals 9 cases of well-diag-

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