Kacip Fatimah (Labisia Pumila)
Kacip Fatimah is traditionally used to maintain a healthy female reproductive system, to help tighten and lubricate, and to enhance sexual function. Kacip Fatimah is rich in phytoestrogen and isoflavones, that may ease menopausal symptoms. Oak Gall is rich in antioxidants and is traditionally used as postpartum care to tighten the reproductive system.
In Malaysia, Labisia pumila is popularly known locally as “Selusuh Fatimah” (literally Fatimah’s childbirth medicine) and “Kacip Fatimah” (Fatimah’s betel scissors). The Labisia pumila roots were found to contain a benzoquinone derivative and mixture of resorcinol derivatives. Based on partial characterizations of some isolated compounds, a pelagonidin derivative and long alkenyl chain were suggested to be present.
Traditional Uses:
Kacip Fatimah has been traditionally used by the Malay women for many generations in childbirth in inducing and eases delivery, as a post partum medication to help contract the birth channel, to regain body strength, regulate menstrual cycle and avoid painful or difficult menstration, and to alleviate menopausal symptoms. The plant is traditionally boiled and the water extraction is taken as a drink. Other traditional uses include treating dysentery, rheumatism, and gennoehoea. It is also used as antiflatulence by helping to drive away and prevent the formation of gas. The plant will also help to firm and tone the abdominal muscles. Scientific studies have established that the medicinal properties and biological activities of Kacip Fatimah are due to the presence of phyto-estrogen (plant estrogen) that is naturally found in the plant.
The Labisia pumila is a small herbaceous under shrub that roots from the stem. There are few leaves which point upwards. The root is tough and woody with long primary roots and few secondary roots. The tip of the leaf is pointed with a base that is tapered or rather broad –rounded. The leaf has a slight odor and taste. The whole leaf is about 5-35cm long and 2-8cm wide finely toothed with numerous veins. It is of a dark green color on adaxial and lighter green on the abaxial. Flowers on the shrub are very small, generally white or pink, in spike like panicle of small clusters. They range from 6-30 cm long with sepals, petals and stamens. The petals wrap around and enclose the stamens. The fruit are about .5cm in diameter and are either bright red or purple.
Microscopic Characteristics of the Root and Leaf:
Root:
The fairly abundant sclereid, which occur singly are elongated rectangular in outline and have thickened, pitted walls, Lumen maybe present or absent. Starch is sometimes present inside the large lumen. The abundant starch granules are simple and spherical to oval or sometimes rectangular in shape. No bilium or striation is present. The abundant sclereids are found in large fragments.
According to Stone (1998), there are three varieties of Kacip Fatimah tin Malaysia that exist. They are Labisia Pumila var., alata L. pumila var pumila and L.pumila var Ianceolata. Each variety commands a different use and thus, it is important to ensure that the right variety is used in each case. Species identification is made difficult by the lack of difference in the leaves and petioles between var. alata and var. pumila. Thus, an efficient method of authentification needs to be developed. Preliminary studies had been conducted previously on Kacip Fatimah using the agro forestry approach involving intercropping of Kacip Fatimah under rubber and rattan (pers. Comm. Khozirah Shaari). However, the planting of Kacip Fatimah as a monoculture crop has yet to be studied but nonetheless, these studies showed that Kacip Fatimah was best propagated by seeds or root cuttings. The plants thrive best in shady areas and non- waterlogged humus rich soil.
While being used by the indigenous people of Malay the Kacip Fatimah plant were usually boiled and the water soluble extract was taken as drink. Interest had recently been shown in the herbal preparation to determine its mode of action and potential pharmacological application. In the mean time commercial preparations as can drinks have been marketed without knowledge of the mode of action potential toxicity and side effects. Because it is given to women post-partum, the possibility of it being a phyoestrogen was considered highly likely. An earlier in-vitro study using human endometrial adenocarcinoma cells of the Ishikawa Var 1 line showed that extract of the rots of L. pumila var alata exhibited a weak but specific estrogenic effect on the cells, resulting in enhanced secretion of alkaline phosphatase. Recent studies in the Institute for Medical Research, the water extracts of Kacip Fatimah were able to displace estradiol binding to antibodies raised against estradiol, making it similar to other estrogens such as estrone and estriol. Binding to estrogen receptors are being investigated.
If they were phytoestrogens, the extract should also displace estradiol binding to the estrogen receptors. If they were phytoestrogens, the extract should also displace estradiol binding to the estrogen receptors. These phyestrogens will then have certain effects on the animals depending on whether they are full estrogen agonists, or antagonists, or partial agonists like clomiphene. It is also possible that Kacip Fatimah acts as estrogen receptor modulators (SERMS) like Tamosifen or Raloxifene which is active at certain tissues only (4,5). For example, Reloifene, being active only at the bones and lipids and not the breasts and uterus, commonly target tissues for estrogen action.
On the other hand, a lot more is know about estrogen receptors and how it causes effects at the cellular level. There are two isoforms, alpha(ERa) and beta (ERb) with 97% homology at the DNA binding site and 59% homology at the ligand binding site and more diverse at the or regions of the receptor molecule. Both isomers bind estradiol effectively and combine together or dimerized upon binding to estridol at the DNA binding site called the estrogen response element (ERE). The two isomers differ most at the so called Activation Function 1 and Activation Function 2 (AF1 and AF2) in the N- and C- terminus respectively. When E2 binds to the receptor binding domain, the AF2 is exposed and interacts with cofactors which help transmit the signal to the DNA (5, 6, and 7). Other mechanism of actions also exists in the tissues. Rather than dimerize, the ER may actually bind to DHA bound protein complexes such as activating protein-1 and causes transrepression.
The gene expressions are controlled by the AP-1 sites. The SERMS Raloxifene and Tamodifen for example stimulate the AP-1 with Era and ERb, while E2 stimulate the transcription only in presence of ERa. If ERb is present than the AP-1regulated transcription is repressed. (8) The E2 signaling action may also be modified by other signal transducing systems, independent of the ligand itself. Example, epidermal growth factor may cause phosporylation of the serine residues of the ligand itself. Example, epidermal growth factor may cause phosphorylation of the serine residues of the estrogen receptor at the AF-1 region and increase the transcription activity of the E2 ER binding (9). The action of estrogens may also be modified by enzymes which may convert the active E2 to inactive Estriol or Estone similar to the enzyme 11-ßhydroxysteroid dyhydrogenase in the tissues which convert active cortisol to inactive cortisone (10,11).
In theory therefore, the phytoestrogens may have effects at the site of binding at both or one or other of the Estrogen receptor isomers, or act as an AF or as an activating protein or like EGF act by modulating the receptor molecule , or as a peripheral enzyme modulator such as 11 HSD. Recent studies at the IMR gave some clues to its mode of action. Given to normal female rats, the serum levels of estradiol E2 were unchanged but the level of free testosterone was significantly higher. In castrated rats, there were no significant effects on the levels of E2 or testosterone. This preliminary data suggest that Kacip Fatimah does not increase estrogen levels but instead cause increases in free testosterone from the ovaries and it does not work without ovaries. The increase in free testosterone may cause increase in libido and sexuality in women. This could be the effect that the women taking Kacip Fatimah are looking for! It also means the herb should not work in menopausal women if the effect is via increased production of testosterone from the ovaries. On the other hand, if it were to work by peripheral enzymes converting E2 to testosterone, then it is independent of the ovaries but still needs adequate levels of estradiol. In women without pituitaries the herb should not work unless the effect is like Clomiphene and causes increase in secretion of FDH from the pituitary, or by antagonizing the hormone. Inhibin produced by the ovaries at the pituitary level.
Clearly the potential effect of Kacip Fatimah as a SERM and any possible increase risk for breast or uterine cancer has to be considered. The following pharmacological studies, in-vitro and in-vivo are being proposed to determine the possible mechanism of actions of KF, and the clinical trials (phase I, II, III) would evaluate the physiological effects of Kacip Fatimah in women and support the basic research being carried out in the IMR.
Along with the above claimed uses and science. Other claimed traditional uses of the Kacip Fatimah plant include using it to effectively treat dysentery, rheumatism and gonorrhea. It is also used as anti-flatulence by helping drive away and preventing the formation of gas. By cleansing and avoiding painful or difficult menstruation it is used as an anti-dysmenorrheal. This plant will also help to firm and tone the abdominal muscles. All these properties and biological activity is due to the presence of phytoestrogens that is naturally found in the plant.