Chinese Medical Journal

30 THE CHINESE MEDICAL JOURNAL

DISCUSSION

As may be seen in the literature, although many drugs have been used for the treatment of tapeworm infections, very few have given reliable therapeutic results. Before the Second World War, the drugs used in most countries and considered most effective were preparations of Filix mas. However, owing to their high toxicity, they required thorough - and complicated preparation of the patient to be treated. Also they were not always satisfactory. Atebrin which came into use later for the treatment of tapeworm infections cannot be considered as satisfactory(14) since it is also toxic. In the Soviet Union Nazeroff and others(13) found that akrihin, a preparation similar to atebrin, gives also unsatisfactory results.

In China, areca nut has been in use for centuries for tapeworm infections. Since its introduction in modern medicine, it has been found more effective than either Filix mas or atebrin as shown by the works of Chung and others(4). Because it is simple to use, practically nontoxic and easy to get, it is now widely used throughout this country and many patients prepare decoctions from areca nut purchased from drugstores and treat themselves. However, as has been pointed out by Feng(3) and proved by others (4, 6-9) while the areca nut treatment is very effective in infections with T. solium, Hymenolepis nana and Diphyllobothrium latum, in T. saginata infection it is far from satisfactory. Hsti and Yang(15) treated 8 cases of T. saginata infection with the combined use of atebrin and areca nut and obtained satisfactory results; but the number of cases is too small to give any definite indication as to the value of this method of treatment.

The result of the combined use of pumpkin seeds and areca nut in the treatment of T. saginata infection is entirely satisfactory. As shown in Table 1 (series c, d and e), of the 96 cases treated with pumpkin seeds (whole kernels by mastication, whole kernal powder and oil-free powder) taken at intervals with areca nut decoction, 92.1-100 per cent of the patients, or an average 95.19 per cent, were cured. This rate of cure has never been obtained by any method of treatment used before.

This combined method of treatment has a sound pharmacological basis. Our experiments with T. saginata show that while pumpkin seeds paralyze the middle and posterior parts of the worm, areca nut has a strong paralytie effect on the scolex and the immature segments. When used together the two drugs complement each other in their action and exert their combined anthelmintic effect on the worm. This has been proved in in vitro tests as well as clinicaily. The joint action of pumpkin seeds and areca nut in the treatment of T. saginata infection is a typical example of synergism in therapeutics.

Our result of treatment of T. soliwm infection is also very satisfactory.

Although only 8 successful cases were treated with the combined method, ~

its efficacy was clearly demonstrated in the in vitro tests.