Mosby's Handbook of Herbs & Natural Supplements This page intentionally left blank f o u r t h e d i t i o n Linda Skidmore-Roth, RN, MSN, NP Consultant Littleton, Colorado Formerly, Nursing Faculty New Mexico State University Las Cruces, New Mexico El Paso Community College El Paso, Texas 11830 Westline Industrial Drive St. Louis, Missouri 63146 MOSBY’S HANDBOOK OF HERBS & NATURAL SUPPLEMENTS, FOURTH EDITION ISBN: 978-0-323-05741-7 Copyright © 2010, 2006, 2004, 2001 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Permissions may be sought directly from Elsevier’s Rights Department: phone: (⫹1) 215 239 3804 (US) or (⫹44) 1865 843830 (UK); fax: (⫹44) 1865 853333; e-mail: healthpermissions@elsevier.com. You may also complete your request on-line via the Elsevier website at http://www.elsevier.com/permissions. Notice Knowledge and best practice in this field are constantly changing. As new research and experience broaden our knowledge, changes in practice, treatment, and drug therapy may become necessary or appropriate. Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on his or her own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the Author assumes any liability for any injury and/or damage to persons or property arising out of or related to any use of the material contained in this book. The Publisher Library of Congress Control Number 2009923753 Editor: Tamara Myers Senior Developmental Editor: Laura M. Selkirk Publishing Services Manager: Pat Joiner-Myers Project Manager: Joy Moore Design Project Manager: Paula Catalano Printed in the United States of America Last digit is the print number: 9 8 7 6 5 4 3 2 1 BREASTFEEDING CATEGORIES Category 1A No data available. Category 2A Compatible with breastfeeding. Category 3A Compatible with breastfeeding but use caution. Category 4A Strongly discouraged in breastfeeding. Category 5A Contraindicated in breastfeeding. HERBAL CLASSIFICATION The American Herbal Products Association (AHPA) created a rating system that classifies herbal products according to their relative safety and potential toxicity based on the following four categories: Class 1 Herbs that can be consumed safely when used appropriately. Class 2 Herbs for which the following use restrictions apply, unless otherwise directed by an expert qualified in the use of the described substance: 2a For external use only. 2b Not to be used during pregnancy. 2c Not to be used while nursing. 2d Other specific use restrictions as noted. Class 3 Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of an expert qualified in the appropriate use of this substance.” Labeling must include proper use information as follows: dosage, contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of the substance. Class 4 Herbs for which insufficient data are available for classification. From the American Herbal Products Association: Botanical Safety Handbook, Boca Raton, Fla, 1997, CRC Press. This page intentionally left blank CONSULTANTS Lorie Crawford, MScN, BScN, BA Senior Instructor, Nursing Aurora College Northwest Territories Canada Michelle Denyer, RN, MSN, GNP-BC Assistant Professor/Clinical Department of Family Nursing Care School of Nursing University of Texas Health Science Center–San Antonio San Antonio, Texas Laura Dosanjh, BS University of Maryland Baltimore, Maryland Valerie S. Eschiti, RN, MSN, CHTP, HNC Assistant Professor Wilson School of Nursing Midwestern State University Wichita Falls, Texas Becky A. Ridenhour, PharmD St. Louis College of Pharmacy St. Louis, Missouri Stephanie Maxine Ross, CNC, HT, MH Clinical Assistant Professor College of Nursing and Health Professions Drexel University Philadelphia, Pennsylvania Carolyn E. Sabo, CNE, EdD, RN Professor School of Nursing University of Nevada–Las Vegas Las Vegas, Nevada Pamela A. Shuler, DNSc, CFNP, RN Certified Family Nurse Practitioner Great Smokies Medical Center of Asheville Asheville, North Carolina Paula Kohn, MA, RN, PhD Professor Emeritus Pace University Pleasantville, New York Judith Sweet, FNP, MSN Associate Health Sciences Professor School of Nursing University of California–San Francisco San Francisco, California Molly M. Michelman, MS, RD Lecturer Department of Nutrition Sciences University of Nevada–Las Vegas Las Vegas, Nevada Catherine Ulbricht, PharmD Chief Editor Natural Standard Research Collaboration Cambridge, Massachusetts vii This page intentionally left blank PREFACE It is estimated that almost half of all health care consumers in the United States take some form of herbal or natural product supplement alone or in combination with conventional medicines. Yet the therapeutic value of many of these products is unproven. Additionally, some products may interact with prescription medications, and some products may be harmful to clients with certain conditions. Of perhaps even greater concern is the fact that the majority of clients who use alternative medicines never mention their use to their health care providers. Because of the prevalence of the use of herbal products, health care professionals need access to reliable, unbiased information about herbs and other alternative medicines. Mosby’s Handbook of Herbs & Natural Supplements, fourth edition, does not advocate for or against the use of herbal products and other natural supplements. Rather, this book acknowledges the widespread use of these types of remedies with the goal of providing health care professionals with current, reliable, unbiased information with which to advise clients on the responsible and intelligent use of herbal products as a part of their overall health treatment and maintenance plan. This book contains detailed monographs of 300 herbs and natural supplements, appendixes filled with key information, a glossary, and a comprehensive index, all designed to be easy to use and to provide the depth of information today’s health care professionals demand. Herbal Monographs Mosby’s Handbook of Herbs & Natural Supplements provides the user with an essential reference that allows easy access to extensive information on 300 herbal and natural supplements. A unique feature of this handbook is the consistent format, which allows for quick reference without sacrificing the depth of detail necessary for a thorough understanding of the material presented. The following information is provided whenever possible: Common Name. Each herb or supplement is arranged alphabetically by the most common name, in natural order. Hence, black hellebore is located within the Bs and white cohosh within the Ws. Scientific Name. The scientific, or botanical, name immediately follows the common name whenever applicable. The scientific name provides positive identification for various species or substances that might share a common name. Occasionally, more than one species is listed when various herbs are chemically similar. Gentian, for example, has two scientific names: Gentiana lutea and Gentiana acaulis. Other Common Names. Most herbs and natural supplements are known by a variety of additional names. The most common of these are listed here and in the index of the book to aid the user in locating and identifying particular herbs or natural supplements. Origin. This section briefly states the origins of each herb or supplement. Uses. This section explains the uses for which the remedy is known or has been known in the past. Included in the section wherever possible is Investigational Uses, a category that provides information on current research and possible new uses for a variety of herbs and supplements. ix x Preface Actions. In this section of the monograph, the actions of the herb or supplement are explained, together with any research or studies performed. Product Availability. The common available forms and plant parts used are listed in this section of the monograph, followed by dosages. Whenever possible, the dosages are divided by use; age group, including specific pediatric and geriatric doses; and any limiting conditions, such as renal impairment or pregnancy. Because of great variance in reported dosages, references are cited whenever possible. Contraindications. This section includes classification systems and an explanation of situations in which a particular herb or supplement should not be used. This information may also include warnings for specific groups of people based on lack of research in a particular area. The first classification system is from the Australian Therapeutic Goods Administration. While this system is recommended for drugs, it is also appropriate for herbs because it allows for individual analysis of herbs in pregnancy. The second classification system is used for breastfeeding. Both of these systems classify only a select group of herbs and focus solely on pregnancy and breastfeeding. The third classification system, which has been used in past editions, is from the American Herbal Products Association (AHPA). The AHPA assigns a safety rating to many of the herbs and supplements in use today. These ratings are broken into four main classes with several subclasses, and usually identify specific plant parts or forms of each herb. Detailed descriptions of all three of these classifications can be found in the beginning of the book. Side Effects/Adverse Reactions. Side effects and adverse reactions are broken down by body system. Any life-threatening side effects are underlined and in bold, italic type, making them easy to find. Interactions. The interactions are conveniently broken into four categories—drug, herb, food, and lab test interactions—making it quick and easy to look for particular types of interactions. Pharmacology. Pharmacokinetics for various herbs and natural supplements, including information on peak, half-life, binding, and excretion, are covered here. Immediately following the pharmacokinetic information is a table of Chemical Components and Possible Actions. This table lists the potentially active chemical constituents for each herb and any possible actions those components might have. Client Considerations. Client considerations are based loosely on the nursing process and are organized into Assess, Administer, and Teach Client/Family categories. Considerations are consistently organized under these headings to highlight information in a format convenient for client care. Icons. Throughout the monographs, certain icons are used to highlight key information. The Alert icon ! calls out key information regarding toxicity, dangerous interactions, and other significant reactions that may threaten a client’s health. The Popular Herb icon is used to show that an herb has been designated by the Herbal Research Foundation as an herb in common use in the identifies information of special interest to United States. The Pregnancy icon pregnant or lactating clients. The Pediatric icon highlights information for pediatric clients. Preface xi Appendixes Herb Resources. This appendix contains a list of herbal resources located on the Internet, including key organizations, not-for-profit research agencies, and additional educational resources. Herb/Drug Interactions. This table is a single, handy resource for reviewing all known drug interactions for the herbs and supplements listed in this book. Pediatric Herbal Use. This extensive appendix covers current pediatric herbal use and research. Abbreviations. This alphabetical list explains the meanings of abbreviations found in this book. References Each monograph has been individually referenced, with detailed references listed at the end of the book. Glossary The glossary explains the special vocabulary of herbal medicine. Terms such as tincture, infusion, extract, and decoction are defined clearly and succinctly. Index The comprehensive index allows the user to look up each herb by any of its common or scientific names, as well as by any of the conditions it may be used to treat. That is, the reader can use the index to find a comprehensive list of herbs used in the treatment of cancer, HIV, or other conditions. This page intentionally left blank CONTENTS Herbal Monographs Acidophilus, 1 Aconite, 4 Agar, 6 Agrimony, 9 Alfalfa, 12 Allspice, 15 Aloe, 18 American Hellebore, 22 Andrographis, 24 Androstenediol, 26 Angelica, European, 27 Anise, 30 Arginine, 33 Arnica, 35 Artichoke, 37 Ash, 39 Astragalus, 40 Avens, 42 Balsam of Peru, 45 Barberry, 46 Barley, 49 Basil, 50 Bay, 52 Bayberry, 54 Bearberry, 56 Bee Pollen, 59 Benzoin, 61 Beta-Carotene, 63 Betel Palm, 64 Bethroot, 67 Betony, 68 Bilberry, 70 Birch, 73 Bistort, 75 Bitter Melon, 76 Bitter Orange, 78 Black Catechu, 80 Black Cohosh, 82 Black Haw, 85 Black Hellebore, 87 Black Pepper, 89 Black Root, 91 Blessed Thistle, 93 Bloodroot, 95 Blue Cohosh, 97 Blue Flag, 99 Bogbean, 101 Boldo, 103 Boneset, 105 Borage, 107 Boron, 110 Boswellia, 111 Brewer’s Yeast, 112 Broom, 114 Buchu, 116 Buckthorn, 118 Bugleweed, 120 Burdock, 122 Butcher’s Broom, 125 Butterbur, 127 Cacao Tree, 130 Calcium, 132 Calumba, 133 Capsicum, 134 Caraway, 137 Cardamom, 138 Carline Thistle, 140 Carnitine, 141 Cascara, 143 Castor, 145 Catnip, 147 Cat’s Claw, 149 Celandine, 152 Celery, 154 Centaury, 156 Chamomile, 158 Chaparral, 160 Chaste Tree, 163 Chaulmoogra Oil, 165 Chickweed, 166 Chicory, 168 Chinese Cucumber, 170 Chinese Rhubarb, 172 Chitosan, 175 Chondroitin, 176 Chromium, 178 Cinnamon, 180 Clary, 182 Clematis, 184 Cloves, 186 Coenzyme Q10, 188 xiii xiv Contents Coffee, 190 Cola Tree, 193 Colostrum, Bovine, 196 Coltsfoot, 197 Comfrey, 199 Condurango, 202 Copper, 204 Coriander, 205 Corkwood, 207 Couchgrass, 209 Cowslip, 211 Cranberry, 213 Creatine, 215 Cucumber, 217 Daffodil, 219 Daisy, 221 Damiana, 222 Dandelion, 224 Devil’s Claw, 228 DHEA, 230 Dill, 232 Dong Quai, 234 Echinacea, 238 Elderberry, 241 Elecampane, 243 Ephedra, 245 Eucalyptus, 249 Evening Primrose Oil, 252 Eyebright, 254 False Unicorn Root, 257 Fennel, 258 Fenugreek, 260 Feverfew, 263 Figwort, 265 Fish Oils, 268 Flax, 269 Folic Acid, 272 Fo-ti, 273 Fumitory, 274 Galanthamine, 277 Gamma Linolenic Acid, 278 Garcinia, 280 Garlic, 281 Gentian, 285 Ginger, 287 Ginkgo, 290 Ginseng, 294 Glossy Privet, 297 Glucomannan, 299 Glucosamine, 301 Glutamine, 303 Glycine, 304 Goat’s Rue, 304 Golden Rod, 306 Goldenseal, 308 Gossypol, 311 Gotu Kola, 314 Grapeseed, 316 Graviola, 318 Green Tea, 319 Ground Ivy, 322 Guarana, 323 Guar Gum, 326 Guggul, 328 Gymnema, 330 Hawthorn, 332 Hops, 334 Horehound, 337 Horse Chestnut, 339 Horseradish, 341 Horsetail, 343 Huperzine A, 345 Hyssop, 346 Iceland Moss, 349 Indigo, 350 Inosine, 352 Irish Moss, 353 Jaborandi, 355 Jamaican Dogwood, 357 Jambul, 359 Jimsonweed, 360 Jojoba, 363 Juniper, 364 Kaolin, 367 Karaya Gum, 368 Kava, 369 Kelp, 373 Kelpware, 375 Khat, 377 Khella, 379 Kudzu, 381 Lady’s Mantle, 384 Lavender, 385 Lecithin, 387 Lemon Balm, 389 Lemongrass, 392 Lentinan, 393 Licorice, 395 Lily of the Valley, 400 Lobelia, 402 Contents Lovage, 404 Lungwort, 406 Lycopene, 408 Lysine, 409 Maitake, 411 Male Fern, 412 Mallow, 415 Marigold, 416 Marijuana, 418 Marjoram, 420 Marshmallow, 422 Mayapple, 424 Meadowsweet, 427 Melatonin, 429 Milk Thistle, 432 Mistletoe, European, 434 Monascus, 436 Morinda, 439 Motherwort, 441 Mugwort, 443 Mullein, 445 Mustard, 447 Myrrh, 449 Myrtle, 452 Neem, 455 Nettle, 457 New Zealand Green-Lipped Mussel, 459 Night-Blooming Cereus, 460 Nutmeg, 462 Oak, 466 Oats, 468 Octacosanol, 470 Oleander, 471 Oregano, 473 Oregon Grape, 475 Pansy, 478 Papaya, 479 Parsley, 481 Parsley Piert, 483 Passionflower, 484 Pau D’arco, 487 Peach, 489 Pectin, 491 Pennyroyal, 492 Peppermint, 494 Perilla, 497 Peyote, 499 Pill-Bearing Spurge, 501 Pineapple, 503 Pipsissewa, 504 Plantain, 506 Pokeweed, 508 Pomegranate, 510 Poplar, 513 Poppy, 514 Prickly Ash, 516 Propolis, 518 Pulsatilla, 519 Pumpkin, 521 Pycnogenol, 522 Pygeum, 524 Queen Anne’s Lace, 527 Quince, 529 Quinine, 530 Ragwort, 533 Raspberry, 534 Rauwolfia, 536 Red Bush Tea, 538 Rose Hips, 540 Rue, 541 Safflower, 545 Saffron, 547 Sage, 548 SAM-e, 550 Sassafras, 552 Savory, 554 Saw Palmetto, 555 Schisandra, 558 Senega, 559 Senna, 561 Shark Cartilage, 564 Siberian Ginseng, 565 Skullcap, 567 Slippery Elm, 569 Sorrel, 571 Soy, 572 Spirulina, 575 Squill, 577 St. John’s Wort, 579 Storax, 582 Tea Tree Oil, 584 Thymus Extract, 585 Tonka Bean, 586 Turmeric, 588 Valerian, 591 White Cohosh, 593 Wild Cherry, 594 Wild Yam, 596 Wintergreen, 598 xv xvi Contents Witch Hazel, 599 Wormseed, 601 Yarrow, 603 Yellow Dock, 605 Yellow Lady’s Slipper, 607 Yerba Maté, 608 Yerba Santa, 610 Yew, 612 Yohimbe, 614 Appendixes A. Herbal Resources, 617 B. Drug/Herb Interactions, 618 C. Pediatric Herbal Use, 646 D. Abbreviations, 662 References, 663 Glossary, 715 Index, 717 Acidophilus 1 Acidophilus A (a-suh-dah’fuh-lus) Scientific name: Lactobacillus acidophilus, alone or combined with Lactobacillus bulgaricus Other common names: Acidophilus milk, Bacid, Kala, Lactinex, Lactobacillus GG, MoreDophilus, Probiata, Probiotics, Superdophilus, yogurt Origin: Acidophilus is commercially prepared. Uses Acidophilus is used to increase the normal flora in the gastrointestinal tract in uncomplicated diarrhea, antibiotic-induced diarrhea, Clostridium difficile diarrhea, to treat or prevent vaginal candida infections with or without antibiotics, and to treat bacterial and other candida and urinary tract infections. Lactobacillus acidophilus may decrease Campylobacter pylori, and some Lactobacillus spp. may decrease lipoprotein concentrations. Yogurt is used topically to treat thrush in the infant. Acidophilus may be effective for atopic dermatitis (eczema), atopic disease, Helicobacter pylori infections, irritable bowel syndrome, and respiratory infections (Jellin et al, 2008). Acidophilus is used for the treatment of diarrhea in children. In adults it is used for hepatic encephalopathy, high cholesterol, and necrotizing enterocolitis prevention, although research has been inconclusive. Investigational Uses Preliminary research is exploring the use of Lactobacillus to stimulate nonspecific immunity (Miettinen et al, 1996) and to prevent recurrent superficial bladder cancer (Aso et al, 1995), proliferation of breast cancer (Biffi et al, 1997), colonic preneoplastic lesions (Rao et al, 1999), and inhibition of H. pylori (Lorca et al, 2001; Gotteland et al, 2006; Shimizu et al, 2002). Studies have shown a decrease in growth of Gardnerella vaginalis (Aroutcheva et al, 2001) and rotavirus positive and negative status in children with acute diarrhea (Lee et al, 2001). Actions Replenishment of Normal Bacterial Flora and Suppression of Bacterial Infection Lactobacillus is part of the normal flora living in the gastrointestinal tract. It acts by competing for nutrients with other organisms such as Candida, thus preventing the other organism from reproducing and flourishing to infection. Most people obtain sufficient quantities of Lactobacillus by including dairy products such as milk and yogurt in their diet. Lactobacillus is also responsible for assisting in the digestion and absorption of several vitamins, including the fat-soluble vitamins and proteins. Research shows that Lactobacillus GG promotes local antigen-specific immune responses in the immunoglobulin A (IgA) class, protects the body from invasive pathogens, prevents cell membrane permeability defects, and controls the absorption of antigens (Majamaa et al, 1997). This supplement also inhibits the growth of vaginal microorganisms such as Escherichia coli, Candida albicans, and G. vaginalis (Hughes et al, 1990). Treatment of Diarrhea in Children Several studies in children have shown mixed results when acidophilus is used for diarrhea. However, use of L. acidophilus is gaining popularity in use for diarrhea (Van Niel et al, 2002). Adverse effects: Underline = life-threatening 2 Acidophilus Treatment of Clostridium difficile Diarrhea Research shows that Lactobacillus GG is a reliable alternative to antibiotic therapy for relapsing C. difficile diarrhea (Bennett, 1996). Of the 32 patients included in this study, all reported improved symptoms and 84% were cured with a single treatment. Because Lactobacillus remains in the gastrointestinal tract longer than other bacteria, it is useful for treating a variety of gastrointestinal conditions. Hypocholesteremic Action It is believed that Lactobacillus decreases cholesterol by assimilating it. However, one study showed no improvement in cholesterol levels when subjects took Lactobacillus four times a day for 21 days (Lin et al, 1989). The fact that this study used a strain of Lactobacillus other than L. acidophilus could account for the differing results. Other Possible Actions A few other studies have investigated the potential role of Lactobacillus in preventing recurrent superficial bladder cancer (Aso et al, 1995), increasing the production of tumor necrosis factor-alpha (TNF-alpha), increasing interleukin-6 and interleukin-10, and inducing nonspecific immunity (Miettinen et al, 1996). The consumption of Lactobacillus has been shown to decrease enzymes in the colon that may play a role in causing cancer (Marteau et al, 1990). However, research has not yet confirmed this hypothesis. Also, use of Lactobacillus has been shown to decrease H. pylori in vitro by acid production and low pH (Lorca et al, 2001). Product Availability The following forms contain added cultures of 500 million to 10 billion organisms: capsules, dairy products (acidophilus milk, yogurt), granules, powder, tablets, vaginal suppositories, liquid, chewable tablets. Dosages Dosage information is for replenishment of normal bacterial flora and suppression of bacterial infection. No dosage information is available for other uses. • Adult PO: 1-10 billion organisms (or an amount of product containing the equivalent) divided tid-qid • Adult vaginal suppository: insert one suppository (1 billion) in vaginal fornix nightly ⫻ 7 days Clostridium difficile • Adult PO: 1.25 billion live Lactobacillus GG in two divided doses for 2 weeks • Child PO: 5-10 billion live Lactobacillus GG in rehydrating solution • Infant topical: apply yogurt in mouth to treat oral thrush Contraindications Dairy products are not recommended for use by lactose-sensitive individuals. Acidophilus-containing products may be used during pregnancy and lactation and may be given to children ⬎3 yr. Do not give in the presence of high fever. Side Effects/Adverse Reactions This product is well tolerated by most individuals. GI: Flatus SYST: Severe infections, bacteremia (immunocompromised patients) (Griffiths et al, 1992; Sussman et al, 1986) = Pregnancy = Pediatric ! = Alert = Popular Herb Acidophilus 3 Interactions A Drug Antacids: Antacids should be taken 30-60 min before acidophilus. Antibiotics: Acidophilus should not be used concurrently with antibiotics. Separate by at least 2 hours. Azulfidine: Acidophilus may reduce the effect of azulfidine. Immunosuppressants (cyclosporine, tacrolimus, azathioprine), antineoplastics: Acidophilus should not be used concurrently with immunosuppressants or antineoplastics. Warfarin: Acidophilus may decrease warfarin action; use together cautiously. Herb Garlic: Acidophilus may decrease the absorption of garlic. If taken concurrently; separate the dosages by 3 hours. Client Considerations Assess Replenishment of Normal Bacterial Flora/Suppression of Bacterial Infection • Assess for recent antibiotic use if candida infection is present vaginally or if thrush is identified. Provide a list of dairy products that contain Lactobacillus (e.g., acidophilus milk, yogurt). • Assess for lactose-intolerant clients. Discourage the use of supplemental dairy products and recommend the use of Lactobacillus in supplement form instead. Hypercholesteremia • Assess the client’s lipid profile: cholesterol, total triglycerides, LDL, and HDL. • Assess the client’s diet for foods high in cholesterol, LDL, and HDL. • Assess whether the client is taking medication to treat hypercholesteremia. • Assess for the use of garlic (see Interactions). Administer • Instruct the client to take acidophilus PO as a supplement, or in milk or yogurt. Take on an empty stomach in AM or 1 hour before each meal. • Refrigerate Lactobacillus in supplement form to prevent spoilage. Nonrefrigerated products often are not viable by the time they are purchased. Instruct the client to continue to refrigerate supplements. • Administer Lactobacillus GG to individuals with candida infections who cannot tolerate other products. Teach Client/Family Replenishment of Normal Bacterial Flora/Suppression of Bacterial Infection • Instruct the client to take all antibiotics as prescribed, even if candida infection occurs. • Teach the client about the use of Lactobacillus in the diet for infection prevention and maintenance. Unless contraindicated, provide information about dairy products that naturally contain Lactobacillus. Hypercholesteremia • Inform the client that acidophilus may be added to the diet without altering the medication therapy, diet, or exercise regimen. Adverse effects: Underline = life-threatening 4 Aconite Aconite ! (a’kuh-nite) Scientific names: Aconitum napellus L., Aconitum columbianum, Aconitum chinense, Aconitum carmichaeli Other common names: Aconitis tuber, autumn monkshood, blue monkshood root, blue rocket, bushi, chuan-wu, friar’s cap, helmet flower, monkshood, mousebane, soldier’s cap, wolfsbane Origin: Aconite can be found in Asia, Europe, and North America. Uses Aconite is used primarily in Europe and Asia. Because of its extreme toxicity, many trained herbalists in the United States do not use this product. The root is the plant part used in traditional medicine. In Asia, aconite has multiple uses and is usually mixed with other herbs. Circa 1500 BC, aconite was used to make poisonous arrows. In homeopathic and Oriental medicine, aconite extract is used as a hypotensive and analgesic and to relieve cancer pain. It is also used to decrease fever and to treat arthritis, bruises, fractures, sciatica, and rheumatism. Aconite is extremely heating and therefore is used to treat cold extremities and poor digestion. Aconite is a counterirritant. Actions Except for toxicology studies, very little research is available on the pharmacologic actions of aconite. Most qualified herbalists use this product only after proper processing. It is commonly used in traditional Chinese medicine. Cardiovascular Action Cardiovascular action results from the ability of aconite to raise membrane permeability for sodium ions, thus prolonging cardiac repolarization. When minute quantities of the herb were given to rabbits intraperitoneally, severe nerve damage and damage to the myelin sheath occurred (Kim et al, 1991). This herb is considered cardiotoxic. One study (Wright, 2001) identifies the irreversible blocking of heart sodium channels by one component (lappaconitine) of the herb piconite. Another study (Gu et al, 2008) found that in rats and mice there was no significant change in cardiac hypertrophy with the use of aconite. Stimulation of Immunity Aconitum carmichaeli increases the secretion of interleukin-1b, tumor necrosis factor-alpha (TNF-alpha), and interleukin-6 in human mononuclear cells (Chang et al, 1994). Neither the mechanism of immune stimulation nor the exact site of action has been identified. Analgesic and Antiinflammatory Actions In mouse studies, aconite alkaloids have been shown to be much more potent and effective than hydrocortisone and indomethacin for reducing inflammation. Lappaconitine, an alkaloid of aconite, has been identified as a central-acting, nonopioid analgesic that decreases the pain response during both the first and second pain phases (Ono et al, 1991). In Ayurvedic medicine, aconite root generally is considered safe. However, before use the herb is processed using an elaborate detoxification method to make it safe. The level of toxicity drops significantly during such controlled processing (Mahajani et al, 1990). Another way toxicity is reduced is by cooking the root with other herbs, foods, and salt. Toxicity still occasionally occurs, but its occurrence is rare. = Pregnancy = Pediatric ! = Alert = Popular Herb Aconite 5 Product Availability Dried root (prepared); homeopathic; liniment; tincture of dried root: 1:10, 1:20; tincture of fresh leaf: 1:2; a few Chinese forms of this herb are sold only to herbalists. Plant Parts Used: Leaves, roots, flowers Dosages Use of this herb is not generally recognized as safe, and it is not found over the counter. Maximum dosage is 25 mg tid (Aconitum napellus). • Adult homeopathic preparation: 6 c-30 c strength, dilute 1 part aconite tincture to 99 parts water or alcohol, repeat 4 additional times, resulting in a 6 c potency (Jellin et al, 2008). • Adult topical liniment: maximum 1.3%, no typical dosage Contraindications ! Class 3 herb. Aconite should never be used during pregnancy and breastfeeding. It should not be given to children. Aconite can be absorbed through the skin if handled improperly. Because of its extreme toxicity, this herb should be administered only by a trained herbalist. Side Effects/Adverse Reactions The following results from moderate to high doses. CNS: Weakness, tingling in extremities, restlessness, sweating, dizziness, reduced consciousness, coma CV: Hypotension, bradycardia, cardiac arrhythmias, tachyarrhythmias, death EENT: Blurred vision, throat constriction, oral numbness GI: Nausea, vomiting, anorexia, diarrhea META: Metabolic respiratory acidosis, hypokalemia MS: Weakness, paresthesia RESP: Paralysis to respiratory tract Interactions Drug Antiarrhythmics (beta-blockers), antihypertensives, cardiac glycosides (digoxin): Increased toxicity and death may occur when aconite is used with these and other cardiac agents; do not use concurrently. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Alkaloid Aconitine Paralysis of nerve endings and central nervous system; antiinflammatory; analgesic Highly toxic Neuromuscular blocker Analgesic; irreversibly blocks heart sodium channels Yunaconitine (Lai et al, 2006) Hypaconitine Lappaconitine Continued Adverse effects: Underline = life-threatening A 6 Agar Primary Chemical Components and Possible Actions—cont’d Chemical Class Individual Component Alkaloid (cont’d) Mesaconitine; Oxoaconitine; Picraconitine; Aconine; Napelline Malonic acid; Succinic acid; Itaconic acid; Aconitic acid Acid Possible Action Sugar Starch Fat Resin Client Considerations Assess • Assess for client use. Many other natural products have the same uses as aconite, without the extreme toxicity. ! • Assess for the use of antiarrhythmics, antihypertensives, and cardiac glycosides. Toxicity and death may occur (see Interactions). Administer • Inform the client that aconite is not available over the counter. Only herbalists trained in the use of aconite may administer this herb. Teach Client/Family • Warn the client never to use aconite in children or those who are pregnant or breastfeeding. • Because of its extreme toxicity, warn the client never to use aconite except under the direction of a qualified herbalist. ! • Warn the client not to touch the aconite plant; toxicity and death can occur. Agar (ah’gur) Scientific names: Gelidium cartilagineum, Gracilaria confervoides, and others Other common names: Agar-agar, agarweed, Chinese gelatin, colle du japon, E406, gelose, Japanese gelatin, Japanese isinglass, layor carang, seaweed gelatin, vegetable gelatin, vegetarian gelatin Origin: Agar is found in several species of red marine algae in oceans around the world. Uses Agar is used as a bulk laxative and as a treatment for neonatal hyperbilirubinemia (Vales et al, 1990). However, most naturopaths and herbalists would not use this product to treat neonatal hyperbilirubinemia. It is used in dentistry to make dental = Pregnancy = Pediatric ! = Alert = Popular Herb Agar 7 impressions (Jellin et al, 2008). Agar is commonly found in foods and is safely and A regularly used as a thickener in place of gelatin by those with gelatin sensitivity. Actions Laxative Action Agar swells in the intestine, thus stimulating peristalsis and increasing bulk content in the colon. It is not broken down and therefore passes through the gastrointestinal system almost unchanged. Hypocholesteremic Action For many centuries in Japan, seaweed was thought to decrease atherosclerosis. In 1960, Kameda’s study showed a decrease in blood pressure using Laminaria spp., and the following year, Kameda’s results with rabbits showed a decrease in both blood pressure and cholesterol (Kameda et al, 1960, 1961). However, subsequent studies using rats were unable to duplicate these results. Several more studies have used various types of seaweed, including Porphyra tenera, which has been shown to decrease cholesterol levels significantly in rabbits. The anticholesterol action of agar takes place in the gut, where it interferes with the absorption of cholesterol (Fahrenbach et al, 1966). Other Actions Research shows the immune property and antiinfective property of agar (Fu et al, 2007). Another study (Chen et al, 2004) identified the inhibitory effects on some types of cancer cells. Product Availability Flakes, powder, strips Plant Part Used: Thallus Dosages Bulk Laxative • Adult PO: 4-16 g (1-2 tsp) powder mixed with fruit or 8 oz liquid, taken daily-bid; do not use dry; take with at least 8 oz of water Contraindications Class 2d herb. Until more research is available, agar should not be used during pregnancy and breastfeeding and should not be given to children. Agar should not be used when coma or gastrointestinal obstruction is present. Avoid use in those with swallowing difficulties. Side Effects/Adverse Reactions GI: Bowel obstruction, esophageal obstruction RESP: Choking, aspiration (if client is not alert or if insufficient liquids are given) SYST: Decreased absorption of vitamins and minerals Interactions Drug All PO drugs: Agar will cause decreased absorption of all PO drugs. Electrolyte solutions: Agar causes dehydration when used with electrolyte solutions; do not use concurrently. Continued Adverse effects: Underline = life-threatening 8 Agar Interactions—cont’d Tannic acids: Agar causes dehydration when used with tannic acids; do not use concurrently. Thyroid products: Because of the high iodine content of agar, avoid concurrent use with thyroid products. Pharmacology Pharmacokinetics Very little is known about the pharmacokinetics of agar, although this herb is known to increase the excretion of cholesterol, decrease the digestion of fat, and decrease the retention of nitrogen. Gastrointestinal absorption is poor. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Calcium salt Sulfuric acid Polysaccharide Alginic acid Agarose Agaropectin Increases bulk in the colon Hypocholesteremic Client Considerations Assess • Assess the reason the client is using this product. • Assess the client’s bowel pattern and determine whether laxatives are used frequently; monitor for bowel obstruction. • If the client is using agar for its anticholesterol action, assess the client’s lipid levels: triglycerides, cholesterol, HDL, and LDL. • Assess for the use of thyroid products; the iodine in some agar products may interfere with thyroid hormones (see Interactions). • Assess for the use of electrolyte solutions and tannic acids (see Interactions). Administer • Instruct the client to take agar PO on an empty stomach to prevent improper absorption of vitamins and medications. ! • Give with at least 8 oz of water, to prevent obstruction; without sufficient liquid, agar may swell and burst in the esophagus. Teach Client/Family • Until more research is available, caution the client not to use agar during pregnancy and breastfeeding and not to give it to children. • Teach the client the signs and symptoms of bowel obstruction. • Explain that vitamins and minerals may not be absorbed properly while taking agar. • Instruct the client about lifestyle changes that prevent constipation: increased fluids, bulk in the diet, and exercise. = Pregnancy = Pediatric ! = Alert = Popular Herb Agrimony 9 A Agrimony (a’gruh-mow-nee) Scientific names: Agrimonia eupatoria, Agrimonia pilosa var., Agrimonia japonica Other common names: Ackerkraut, agronmonia, church steeples, cocklebur, funffing, funffinger kraut, langyacao, liverwort, longyacao, philanthropos, potter’s piletabs, sticklewort, stickwort Origin: Agrimony is grown in Asia, Europe, and the United States. Uses Agrimony in the form of tea or gargle is used to treat a sore throat. Agrimony may be used topically as an astringent, to help stop bleeding, and to treat cuts and abrasions. Little research exists on its use in humans. Some herbalists report that agrimony has antiasthmatic, sedative, antiinflammation, decongestant, and diuretic properties, although no scientific studies support these claims. Diuretic and uricosuric use have been reported (Giachetti et al, 1986). Most other uses are based solely on anecdotal reports. However, agrimony has been used for decades as a hemostatic to promote blood coagulation. It has been used to decrease vaginal bleeding and discharge and for urinary tract infections. Ointments made from agrimony may shrink hemorrhoids and soothe sores, insect bites, and athlete’s foot. It may be used for its antibacterial action to treat vaginal trichomoniasis. Agrimony is used in combination with licorice root, fennel seed, and eyebright as an eyewash (Mills, Bone 2005). Investigational Uses Agrimonia pilosa is currently used in China to treat cancer (Sugi, 1997). One study (Min et al, 2001) showed an inhibitory effect against HIV-1. Another study (Venskutonis, 2007; Correia, 2007) showed activity of agrimony as a radical scavenger and antioxidant. Actions Most of the research on agrimony was done in the 1950s and 1960s. Very little research has been done in recent years. Hemostatic Action Some early studies reported that agrimony promotes blood coagulation. In one study, when Agrimonia was given to rabbits intravenously, platelets and calcium increased and clotting time decreased (Yao et al, 1957). However, other early studies reported that A. pilosa does not promote coagulation but instead increases clotting time. Even at high doses (15 mg/kg), agrimony given intravenously to rabbits had this result (Qu et al, 1957). Frogs treated with agrimony experienced elevated blood pressure and respiration, as well as increased heart rate and cardiac contractility (Wu et al, 1941). Mice treated with agrimony experienced prolonged tail bleeding time and, as a result of antiplatelet action, acute pulmonary thromboembolism (Hsu et al, 1987). This conflicting research indicates that strict controls need to be in place in order to replicate these studies. Antiinflammatory Action The antiinflammatory action of agrimony has been demonstrated on rabbits. In one study, when the irritated conjunctivas of rabbits were treated with agrimony, a definite decrease in inflammation occurred. This effect may have resulted Adverse effects: Underline = life-threatening 10 Agrimony from high levels of the tannin phlobaphere, a potent astringent in the herb (Eda, 1972). Antibacterial Action A study of 40 women with vaginal trichomoniasis showed that a decoction of agrimony extract inhibited the growth of gram-positive bacteria (Wang et al, 1953). When a 200% concentrated extract was applied over the vaginal wall and a cotton ball treated with the herb was inserted into the vagina for 3 to 4 hours, 37 of the women were cured with one treatment. In another study using a decoction of Agrimonia eupatoria, agrimony inhibited the growth of Mycobacterium tuberculosis (Peter-Horvath, 1965) and even destroyed streptomycin- and paraaminosalicylic-acid–resistant strains. The only strains not affected were those resistant to isoniazid. Other Actions One study showed that A. pilosa inhibited carcinoma in laboratory animals, but not in human fibroblasts (Kampo Kenkyu,1979). Another study demonstrated the antitumor activity of agrimonii, one of the tannins in agrimony, on test mice (Miyamoto et al, 1985, 1988). A single dose of 10-30 mg/kg resulted in almost complete resolution of the tumor. Yet another study (Min et al, 2001) evaluated several Korean plants for anti-HIV-1 activity. Agrimonia pilosa showed anti-HIV-1 activity. Still another study identified antihyperglycemic insulin-releasing and insulin-like activity of agrimony (Gray, Flatt, 1998). Product Availability Gargle, tablets, tea, ointment, capsules, poultices, bath tonics Plant Parts Used: Flowers, leaves, stems Dosages Ophthalmic • Adult topical eyewash: 30 g/500 ml licorice root, fennel seed, eyebright, and agrimony (dilution 1:1) (Mills, Bone, 2000) Sore Throat • Adult PO gargle: 3 g in water/day Other • Adult PO tablet: 3 g daily or equivalent (Blumenthal, 1998) • Adult PO tea: 3 tsp in 1 cup boiling water, up to 4⫻/day • Adult topical: apply as poultice as needed using 10% water extract Contraindications Until more research is available, agrimony should not be used during pregnancy and breastfeeding, and it should not be given to children. Agrimony should not be used by persons with hypersensitivity to this plant or to roses. Side Effects/Adverse Reactions CV: Palpitations, flushing of the face, hypotension GI: Upset, constipation INTEG: Photosensitivity, photodermatitis SYST: Hypersensitivity, rash, allergic reactions, hypoglycemia = Pregnancy = Pediatric ! = Alert = Popular Herb Agrimony 11 Interactions A Drug Anticoagulants (warfarin, heparin): Agrimony may decrease clotting times when used with anticoagulants; avoid concurrent use (PO) (theoretical). Antihypertensives: Agrimony used wih antihypertensives may increase hypotension. Antidiabetics: Agrimony may increase hypoglycemic effect; monitor blood glucose (Jellin et al, 2008). Lab Test Agrimony decreases glucose test; increases PT, INR, and clotting time. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Tannin Ellagitannins Wound healing; astringent Antiinflammatory Nonhemostatic Antitumor Agrimonin Trace gallotannins A; B; C; Pimic acid Agrimonii Agrimonic acid; Pedunculagin; Casuarictin; Potentillin Photosensitivity; anticoagulant Furanocoumarin Polysaccharide Silic acid Urosolic acid Agrimonolide Flavonoid Essential oil Vitamin Luteolin; apigenin B1; K; C Seeds Also Contain Acid Oleic acid; Linoleic acid; Linolenic acid Client Considerations Assess • Assess the reason the client is using this product. • Assess the client for hypersensitivity reactions such as rash or breathing difficulty. If such reactions are present, discontinue use of agrimony and administer antihistamines. • Assess for the use of anticoagulants, antidiabetics, and antihypertensives (see Interactions). Administer • Instruct the client to take agrimony PO in tea or tablet form. • Instruct the client to dilute the herb in warm water for use as a gargle. Adverse effects: Underline = life-threatening 12 Alfalfa • Instruct the client to store eyewash frozen in sterile blocks, or use immediately. • Advise the client to boil the herb for 10 minutes using low heat and apply as a poultice several times per day. Teach Client/Family • Until more research is available, caution the client not to use agrimony during pregnancy and breastfeeding and not to give it to children. • Inform the client that agrimony may increase hypotension when taken with antihypertensives. It may decrease blood glucose levels when taken with antidiabetics, including insulin. Agrimony may increase the risk of bleeding when taken with anticoagulants. Alfalfa (al-fal’fuh) Scientific name: Medicago sativa L. Other common names: Buffalo herb, lucerne, medicago, phytoestrogen, purple medic, purple medick Origin: Alfalfa grows throughout the world. Uses Alfalfa is used as a diuretic, and to increase blood clotting and to relieve inflammation of the prostate. It is also used for acute or chronic cystitis and to treat digestive disorders, including constipation and arthritis. Alfalfa seeds are made into a poultice and applied topically to treat boils and insect bites. Alfalfa is primarily used as a nutritive tonic and alkalizing herb. It is used to boost normal vitality and strength, stimulate the appetite, and help in weight gain. Alfalfa is an excellent source of betacarotene, potassium, calcium, and iron. Investigational Uses Researchers are experimenting with the use of alfalfa to protect against carcinogens in the gastrointestinal tract, decrease cholesterol levels, prevent menopausal symptoms, and treat atherosclerosis. Actions Antiatherosclerotic Action Several research studies have focused on the ability of alfalfa to counteract the atherosclerotic effect of dietary cholesterol. In one study, monkeys that were fed high levels of cholesterol with alfalfa added showed a decrease in cholesterolemia and plasma phospholipids. The distribution of their plasma lipoproteins also normalized, as did the extent of aortic atherosclerosis. In a subsequent study of monkeys fed semipurified food and alfalfa saponins, the monkeys showed a decrease in cholesterol levels with no change in HDL levels and an increase in fecal excretion of neutral steroids and bile (Malinow et al, 1981, 1983). Another study using rabbits showed similar results, with prevention of hypercholesteremia and atherosclerosis. Alfalfa saponins and seeds also produced similar results in rabbits (Malinow et al, 1980). = Pregnancy = Pediatric ! = Alert = Popular Herb Alfalfa 13 Estrogenic Action In one study, chromatography was used to examine several types of alfalfa tablets for the presence of coumestrol, a phytoestrogen. This phytoestrogen was found in all of the alfalfa tablets studied (Elakovich et al, 1984). Alfalfa has estrogenic effects that may result from the chemical components of coumetrol, daidzein, and genisten (Jellin et al, 2008). Product Availability Capsules, flour, flowering tops, infusion, fluid extract (from leaves), poultice (from seeds), sprouts, tablets Plant Parts Used: Flowers, germinating seeds, whole herb, leaves Dosages • Adult PO fluid extract: 5 ml tid maximum; 1-2 ml tid-qid (Smith, 1999) • Adult PO tea: 5-10 g, steeped as a tea (Jellin et al, 2008) • Adult PO powder: 5-300 grains (a food status) • Adult PO capsules: 3-6 caps daily • Adult PO seeds: 40 g heated tid (for high cholesterol) Contraindications Because it may act as a uterine stimulant, alfalfa should not be used during pregnancy except under the direction of a qualified herbalist. It should not be used by persons who are hypersensitive to this herb or who have lupus erythematosus. The seeds of alfalfa should not be eaten because they contain a toxic amino acid. Side Effects/Adverse Reactions CV: Hypotension INTEG: Photosensitivity SYST: Systemic lupus erythematosus (SLE)-like syndrome (from sprouts), bleeding, blood dyscrasias Interactions Drug Anticoagulants (heparin, warfarin): Alfalfa may increase prothrombin time and prolong bleeding when taken with anticoagulants. Antidiabetics (including insulin): Alfalfa may potentiate hypoglycemic action; use cautiously. Estrogens, hormonal contraceptives: Alfalfa may interfere with hormone replacement therapy or hormonal contraceptives. Herb Black cohosh, blood root, burdock, hops, kudzu, licorice, red clover, soy, thyme, white horehound, yucca: Alfalfa increases estrogen effect. Nettle, parsley: Alfalfa increases the risk of clotting. Lab Test Alfalfa decreases total cholesterol and glucose test. Adverse effects: Underline = life-threatening A 14 Alfalfa Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Caroteinoid Saponins Lutein Aglycones Cancer prevention Antiatherosclerotic, anticholesterol Antifungal Medicagenic acid; Hederagenin Formononetin Glycosides; Genistein; Daidzein Coumestrol Lucernol; Sativol; Trifoliol Isoflavonoid Coumarin Chlorophyll Minerals Copper; Iron; Manganese; Zinc A, C, D, E, K, B-Complex Alpha; Beta Calcium; Phosphorus; Potassium; Sodium; Magnesium Vitamins Carotene Electrolytes Seeds Also Contain L-canavaine Estrogenic Antidiabetic Increased immune response Estrogenic Stachydrine Homostachydrine Betaine Estrogenic Trigonelline Fatty oil Client Considerations Assess • Assess the reason the client is using this product. • Assess for allergic reactions. If present, discontinue use of this herb and administer an antihistamine or other appropriate therapy. • Assess for SLE-like symptoms. If these symptoms occur, determine whether the client is using alfalfa sprouts and, if so, the amount and duration of use (Malinow et al, 1982; Roberts et al, 1983). Persons with SLE should not use alfalfa seeds (Bengtsson et al, 2002). • Assess for use of anticoagulants, antidiabetics, estrogens, contraceptives (hormonal), and other herbs (see Interactions). Administer • Instruct the client to take alfalfa PO as powder, tablets, capsules, fluid extract, or flowering tops, or in food as flour or sprouts. Teach Client/Family • Because alfalfa acts as a uterine stimulant, caution the client not to use this herb during pregnancy unless under the direction of a qualified herbalist. = Pregnancy = Pediatric ! = Alert = Popular Herb Allspice 15 • Inform the client that a SLE-like syndrome has occurred in persons using alfalfa A sprouts and that alfalfa seeds should not be consumed by those with SLE because the latent disease may be reactivated (Jellin et al, 2008). • Teach the client to report bleeding, hot flashes, lupuslike symptoms to health care provider. Allspice (awl’spise) Scientific names: Pimento officinalis, Eugenia pimenta Other common names: Clove pepper, Jamaica pepper, pimenta, pimento Origin: Allspice is a tree that grows in Central America, Mexico, and the West Indies. Uses Allspice is used to treat indigestion, flatulence, muscle pain, and dental pain. Contemporary use is limited, and allspice is rarely used therapeutically. However, it is often used as a flavoring or aromatic spice. Investigational Uses Researchers are experimenting with the use of allspice as an antimicrobial and as a treatment for diabetes and hypertension. Actions Most of the primary research available has focused on several possible actions of Pimenta dioica. Antibacterial and Antifungal Actions One study showed that allspice is effective against yeasts and fungi (Hitokoto et al, 1980). Eugenol, one of the chemical components of allspice, may be responsible for this action. Cardiovascular Action One study showed that allspice acts as a hypotensive, presumably because of the ability of tannic acid to exert a depressant effect on smooth muscle and cardiac tissue. However, it is also possible that allspice extract produces a negative inotropic effect (Súarez et al, 1997). P. dioica has been shown to act as a central nervous system depressant, as well as a hypotensive. When aqueous extract of allspice was given to rats intravenously at doses of 30, 70, and 100 mg/kg, the larger fraction produced the greatest hypotensive effect, with no significant changes in heart rate or ECG (Súarez et al, 1997). However, further studies are needed to determine whether the substance in P. dioica that is responsible for the hypotensive effect is tannin or some other component. Antihyperlipidemic effects may occur with the use of allspice. One study (Shyamala, 2005) showed rats fed with a high-fat diet, then given allspice, showed marked improvement in triglyceride levels. Lee et al (2007) studied the antihistone acetyltransferase activity that is present in adrogen receptor– dependent prostate cancer. There was significant inhibition of prostate cancer cell growth with allspice. Adverse effects: Underline = life-threatening Allspice 16 Other Actions Allspice may possess antioxidant properties as demonstrated by its radical scavenging activity (Yun et al, 2003). Allspice has shown insulin-like activity, improving glucose metabolism (Broadhurst et al, 2000). Product Availability Extract, pimento water, oil, powder Plant Parts Used: Berries (dried, unripened, rind), powdered fruit Dosages Dosages vary Indigestion/Flatulence • Adult PO: 2 tsp powder mixed in 8 oz water bid-tid • Adult PO: 3 drops of essential oil on sugar Pain • Adult topical: mix oil or powder in water to make a paste, apply prn Contraindications Class 1 herb. Until more research is available, allspice should not be used therapeutically during pregnancy and breastfeeding, and it should not be given therapeutically to children. Allspice use is not recommended for use by persons with colitis, irritable bowel syndrome, Crohn’s disease, diverticulitis, or cancer. Side Effects/Adverse Reactions CNS: Seizures (high doses), CNS depression EENT: Irritation of mucous membranes (topical) GI: Nausea, vomiting, gastroenteritis, anorexia INTEG: Rash, hypersensitivity reactions (topical) Interactions Drug Anticoagulants, antiplatelets: Allspice may inhibit platelets, causing bleeding (Jellin et al, 2008). Minerals: Allspice may interfere with the absorption of minerals such as iron and zinc. Do not use concurrently with mineral supplements. Pharmacology Pharmacokinetics Very little is known about the pharmacokinetics in humans. Two metabolites, homovanillic acid and homomandelic acid, have been identified. = Pregnancy = Pediatric ! = Alert = Popular Herb Allspice 17 Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Volatile oil Eugenol Cineole, levophel andrene; palmitic acid Antifungal; antioxidant; central nervous system depressant; prostaglandic activity; digestive enzymes; antiplatelet Antioxidant; central nervous system depressant; prostaglandic activity; digestive enzymes Methyleugenol; Caryophylene Vitamin Flavonoid Glycoside Sesquiterpene Mineral Tannin A; C; Thiamine; Riboflavin; Niacin Quercetin Antiinflammatory Wound healing; antiinflammatory Resin Sugar Gum Client Considerations Assess • Assess the reason the client is using this product. • Assess the client’s use of mineral supplements; allspice may interfere with their absorption (see Interactions). • If allspice is being used to treat hypertension, assess the client’s cardiac status: blood pressure, pulse, character, and edema. Also, assess for other medications the client may be taking to treat this condition. Administer • Instruct the client to take powder PO or use as a topical treatment. Teach Client/Family • Until more research is available, caution the client not to use allspice therapeutically during pregnancy and breastfeeding and not to give it therapeutically to children. • Teach the client to limit the time that allspice is used to prevent seizures. • Teach the client to never use ⬎5 ml of allspice oil; toxicity may occur. Adverse effects: Underline = life-threatening A 18 Aloe Aloe ! (a’low) Scientific names: Aloe vera L., Aloe perryi, Aloe barbadensis, Aloe ferox, Aloe spicata Other common names: Aloe, aloe barbadensis, aloe vera, Barbados, bitter aloes, burn plant, Cape aloe, Curacao aloe, elephant’s gall, hsiang-dan, lily of the desert, lu-hui, socotrine aloe, Venezuela aloe, Zanzibar aloe Origin: Aloe is a succulent found throughout the world. It is native to Africa. Uses Aloe is used topically to treat minor burns, sunburn, cuts, abrasions, bedsores, diabetic ulcers, acne, and stomatitis. It is used internally as a stimulant laxative, a tonic, and to treat duodenal ulcers, renal calculi, and active bleeding ulcers. Aloe may also be used to relieve radiation burns suffered by cancer patients and may help slow the development of wrinkles. Investigational Uses Researchers are experimenting with the use of the leaf gel (dried juice), taken internally, as a treatment for diabetes mellitus, HIV, cancer, ulcers, colitis, irritable bowel syndrome, bleeding, asthma, and the common cold. Actions Aloe products have been used for centuries for a variety of purposes. Antiinflammatory and Wound Healing Actions The topical actions of topical aloe products are well documented. Numerous studies have demonstrated their antiinflammatory, wound-healing properties. Aloe products have been used to reduce inflammation by inactivation of bradykinin, to inhibit prostaglandin A2, to oxidize arachidonic acids, and to block thromboxane A. The wound-healing action of aloe may result from its causing increased blood flow in the affected area. Other research demonstrates that aloe products have additional medicinal effects. One study (Hutter et al, 1996) indicates that Aloe barbadensis, when used topically on mice, produces effects equivalent to those of topical hydrocortisone. Tests have demonstrated the antiinflammatory activity of aloe vera gel extract when used to treat induced edema of the rat paw. The extract reduced edema and the number of neutrophils migrating into the rat’s peritoneal cavity (Vazquez et al, 1996). In addition, aloe has been shown to be an effective treatment for aphthous stomatitis (Plemons et al, 1994). Laxative Action The laxative effects of aloe result from its ability to inhibit absorption without stimulating peristalsis (Ishii et al, 1990, 1994a, 1994b). Antiviral Action Aloe increases immunity by acting on cytokine. It stimulates phagocytosis in neutrophils, activates complement systems, stimulates B-lymphocytes to make a specific antibody, and also stimulates T-lymphocyte activity (Carrington Laboratories; Sheets et al, 1991). Montaner et al (1996) found that CD4 counts and P24 antigens are = Pregnancy = Pediatric ! = Alert = Popular Herb Aloe 19 not affected by acemannan, one of the polysaccharide components of aloe, at A 1600 mg/day. Antidiabetes Action Aloe gel acts as a thromboxane inhibitor (TXA2), promotes vasodilation, and maintains homeostasis within the vascular endothelium (Heggers, 1993). Studies have shown that aloe gel reduces blood glucose levels significantly within 2 weeks, but not to normal levels (Bunyapraphatsara et al, 1996a, 1996b; Yongchaiyudha et al, 1996). Other Possible Actions At this time research is minimal on the use of aloe to treat asthma and peptic ulcer. However, studies are underway, and action for these disorders is possible. Aloe has also been shown to inhibit cell transformation and to be antimutagenic (Woo et al, 2002). In Davis et al (2006), no improvement was shown in irritable bowel syndrome in a group of 58 patients, and Shah (2007) reports it is best to wait until further studies have been conducted to use aloe vera for inflammatory bowel disease. Product Availability Available Forms Capsules: 75, 100, 200 mg extract or powder; cream; gel: 98%, 99.5%, 99.6%; jelly; juice: 99.6%, 99.7%; tincture (1:10, 50% alcohol) shampoo and conditioner Plant Parts Used: Large, blade-like leaf, secretory cells below leaf epidermis, roots (rarely) Dosages Active Bleeding Ulcer • Adult PO juice: 1 L/day (Murray, Pizzorno, 1998) HIV/AIDS • Adult PO: 800-1600 mg/day (acemannan) (Pizzorno, Murray, 2006) Laxative • Adult PO dried juice: 50-300 mg at bedtime (Federal Register, 1985) • Adult PO aloe latex extract: 100-200 mg aloe or 50 mg aloe extract at bedtime (Jellin et al, 2008) Renal Calculi • Adult PO dried juice: take a dose just below that of the laxative dose (Murray, Pizzorno, 1998) Psoriasis vulgaris • Adult topical cream: 0.5% of a 50% ethanol extract of aloe, combined with castor/ mineral oil tid ⫻5 days/wk ⫻ 1 month Genital Herpes • Adult topical cream: 0.5% of a 50% ethanol extract of aloe, combined with castor/mineral oil tid ⫻ 5 days/wk ⫻ 2 wk Skin Irritation/Wounds • Adult and child PO capsules: 100-200 mg at bedtime • Adult and child PO extract: 50-100 mg at bedtime • Adult and child topical leaf gel: apply prn; do not use on deep wounds Adverse effects: Underline = life-threatening 20 Aloe Contraindications ! Pregnancy category 4; breastfeeding category 3A Aloe should not be given to children younger than 12 years of age. It should not be used by persons with kidney disease, cardiac disease, or bowel obstruction. Deaths have been reported with IV/IM injections. Aloe gel should be used cautiously in intestinal obstruction, Crohn’s disease, ulcerative colitis, appendicitis, and other bowel disorders, since aloe gel could be contaminated with aloe latex (Newell et al, 1996). Aloe should not be used topically by persons who are hypersensitive to this plant, garlic, onions, tulips, or other plants of the Liliaceae family. It should not be used topically on deep wounds. Dried aloe juice is not for long-term use. Side Effects/Adverse Reactions GI: Spasms, intestinal mucosa damage (irreversible), hemorrhagic diarrhea (internal use of dried juice) GU: Red-colored urine, nephrotoxicity (internal use of dried juice) INTEG: Contact dermatitis, delayed healing of deep wounds (topical use) META: Hypokalemia (frequent internal use) Reproductive: Uterine contractions causing spontaneous abortion, premature labor (internal use of dried juice) Interactions Drug Antiarrhythmics, antidiabetics, cardiac glycosides, loop diuretics, potassium-wasting drugs, systemic steroids, thiazides: Aloe products taken internally may increase the effects of antiarrhythmics, cardiac glycosides, antidiabetics, loop diuretics, potassium-wasting drugs, systemic steroids, and thiazides. Herb Jimsonweed: The action of jimsonweed is increased in cases of chronic use or abuse of aloe. Licorice/horsetail: Licorice/horsetail may cause hypokalemia when used with aloe taken internally; avoid concurrent use. Lab Test Serum potassium: Aloe may lower test values with long-term aloe use. Primary Chemical Components and Possible Actions* Chemical Class Individual Component Possible Action Vitamin Enzyme A; B group; C; E Carboxypeptidase Bradykinase Magnesium lactate Sodium; Potassium; Calcium; Magnesium; Manganese; Copper; Zinc; Chromium; Iron Antioxidant; immunostimulant Antiinflammatory; analgesic Blocks histamine Mineral = Pregnancy = Pediatric ! = Alert = Popular Herb Aloe 21 Primary Chemical Components and Possible Actions—cont’d Chemical Class Individual Component Possible Action Polysaccharide (leaf, resin) Anthraquinone (leaf, resin) Glucomannans Acemannan Barbaloin; Isobarbaloin; Anthrone-C glycosides Immunomodulation Antiviral; anti-HIV Purgative effect (large amount); aids absorption from the gastrointestinal tract (small amount) Penetrative ability Antiseptic Antiinflammatory (internal use); keratolytic (topical use) Lignin Saponin Salicylic acid Amino acid *Aloe spp. contain more than 75 different constituents. Client Considerations Assess General Use • Assess the reason the client is using this product. • Assess whether the client is taking cardiac or renal medications (antidysrhythmics, cardiac glycosides, loop diuretics, antidiabetes agents, thiazide diuretics). Assess whether systemic steroids or potassium-wasting drugs are being used. Inform the client that aloe products taken internally may increase the effects of these drugs. • Assess for the use of licorice, jimsonweed, or other herbs that contain cardiac glycosides (see Interactions). ! • Assess for internal use. Caution client that dried juice aloe products taken internally can be dangerous and should be used only under the supervision of a qualified herbalist. Antidiabetes Use • Assess all prescription antidiabetes agents used by the client. • Assess fasting blood glucose, 2 hours postprandial (60-100 mg/dl normal fasting level; 70-130 mg/dl normal 2 hours level). • Assess blood and urine glucose levels during herb use to determine adequate control. • Assess for hypoglycemia and hyperglycemia. Laxative Use of Dried Juice Products • Assess for repeated laxative use of aloe or traditional products. • Assess blood and urine electrolytes if herb is used often. • Assess for cramping, gastrointestinal spasms, and hemorrhagic diarrhea. • Assess for cause of constipation: identify whether fluids, bulk, or exercise is lacking from lifestyle. Skin Disorders • Assess area to be treated with topical aloe products. Identify characteristics of burns, rashes, inflammation, and color of area. Aloe products should not be used on deep wounds; healing can be delayed. Adverse effects: Underline = life-threatening A 22 American Hellebore ! • Assess for route of use. Caution the client not to use by injection; persons have died using this route (Anon, 1998). Administer • Instruct the client to use aloe internally only under the direction of a qualified herbalist. Electrolyte imbalances may occur. • Juice of the plant can be used topically by cutting off a leaf, warming, and squeezing gel onto affected area. • Refrigerate 100% aloe vera gel after opening. Teach Client/Family • Inform the client that pregnancy category is 4 and breastfeeding category is 3A. • Caution the client not to use aloe in children younger than 12 years of age. • Caution the client not to use aloe topically if hypersensitive to this plant, garlic, onions, or tulips. • Caution the client not to use aloe topically on deep wounds. • Caution the client that dried aloe juice is not for long-term use. American Hellebore (uh-mehr’i-kuhn heh’luh-bowr) Scientific name: Veratrum viride Other common names: False hellebore, green hellebore, Indian poke, itchweed, swamp hellebore Origin: American hellebore is a perennial found in the United States. Uses American hellebore traditionally has been used as a diuretic, an antihypertensive, and to treat pneumonia, seizure disorders, and nerve pain. Investigational Uses Research is ongoing to determine the usefulness of American hellebore for the treatment of hypertensive crisis, myasthenia gravis, and pregnancy-induced hypertension. Actions Cardiovascular Action American hellebore produces many cardiovascular effects, including reduced blood pressure and increased blood flow to the vital organs. It has been used to treat hypertensive conditions such as pregnancy-induced hypertension and hypertensive crisis (Arena et al, 1986). However, scientific evidence supporting any of the anecdotal claims for American hellebore is lacking. Because the toxic and therapeutic levels are so close, it is not a commonly used herb. Other Actions American hellebore historically was used in Rome to make poisonous arrows. Product Availability Fluid extract, powder, tincture Plant Parts Used: Dried rhizome, roots = Pregnancy = Pediatric ! = Alert = Popular Herb American Hellebore 23 Dosages A Hypertensive Disorders • Adult PO fluid extract: 1-3 minims q2hr until stabilized • Adult PO powder: 2 grains • Adult PO tincture: 20-30 minims No other dosage information is available. Contraindications Class 3 herb (root). American hellebore should not be used during pregnancy except under the direct supervision of a competent herbalist. Until more research is available, this herb should not be used during breastfeeding, and it should not be given to children. American hellebore should not be used by persons with hypersensitivity to it or those with cardiovascular disorders such as hypotension, cardioversion, cardiac glycoside toxicity, or pheochromocytoma. Side Effects/Adverse Reactions CNS: Dizziness, paresthesia, seizures CV: Hypertension, hypotension, bradycardia, arrhythmias EENT: Salivating, dysgeusia GI: Nausea, vomiting, anorexia, abdominal cramps INTEG: Hypersensitivity reactions RESP: Shortness of breath, respiratory depression Toxicity: Nausea, vomiting, diarrhea, abdominal pain, change in vision, burning throat, coma, paralysis, dyspnea Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Alkaloid Veratridine Verticinone (Zhou et al, 2008) Veracintine Pseudojervine; Rubijervine; Jervine; Neogermitrine; Cevadine; Protoveratrine; Protoveratridine Topical analgesic; parasiticide Antineoplastic Steroidlike Resin Client Considerations Assess • Determine the reason the client is using American hellebore and suggest safer, more conventional alternatives. Because the therapeutic and toxic levels of this herb are very close, this herb is rarely used. Adverse effects: Underline = life-threatening Andrographis 24 • Assess for hypersensitivity reactions. If present, discontinue use of this herb and administer antihistamine or other appropriate therapy. Administer • Instruct the client to store American hellebore products in a cool, dry place, away from heat and moisture. Teach Client/Family • Advise the client not to confuse American hellebore with European hellebore and pheasant’s eye (Jellin et al, 2008) • Caution the client not to use American hellebore during pregnancy except under the direct supervision of a competent herbalist. Do not give this herb to children or use during breastfeeding. • Because the therapeutic and toxic levels are very close, advise the client to avoid using American hellebore altogether. Safer alternatives are available. Andrographis (an-dro’graf-iz) Scientific name: Andrographis paniculata Other common names: Bidara, carmantina, chiretta, Chuan Xin Lian, creat, fat ha lai jone, Indian echinacea, kalmegh, kariyat, kirta, sadilata, vizra ufar Origin: Andrographis is found growing wild in India and Sri Lanka and is cultivated in many other parts of the world. Uses Andrographis is used for the common cold, influenza, sinusitis, HIV, snake and insect bites, colic, diabetes, diarrhea, flatulence, hepatoxicity, leprosy, venereal diseases, and tonsillitis. It also is used as a tonic, antiseptic, antipyretic, and laxative. Actions Angrographis may be used in the common cold to provide symptomatic relief. Most research for angrographis focuses on use in the common cold. Several studies (Caceres et al, 1999; Hancke et al, 1995; Melchior et al, 1997) with over 250 participants have focused on the reduction of the severity and duration of the common cold. Another study (Melchior et al, 2000) found that a combination of andrographis and eleutherococcus caused similar effects. These effects may be due to the immunostimulant properties. Many diabetic patients in the Philippines have used andrographis to control blood glucose for many years. One study (Reyes et al, 2006) confirmed blood glucose control in diabetic rats. Antioxidant and antiinflammatory activities were noted in Sheeja et al (2006). Product Availability Caps, tincture Plant Parts Used: Aerial parts Dosages Common Cold • Adult PO dried extract: 400 mg tid = Pregnancy = Pediatric ! = Alert = Popular Herb Andrographis 25 Preventing the Common Cold A • Adult PO 200 mg/day ⫻ 5 days Fever, Sore Throat • Adult PO 3-6 g/day Other • Adult PO dried aerial parts: 1.5-6 g/day • Adult PO dried herb: 6-9 g/day as infusion • Adult PO: 3-6 ml/day of a 1:2 liquid extract or equivalent in tablet or cap (Mills, Bone, 2005) Contraindications Pregnancy category 4; breastfeeding category 1A Andrographis may be used in children. It should not be used in hypersensitivity. Do not use in gallbladder disease, bleeding disorders, hypotension, hyperacidity, and duodenal ulcers. Side Effects/Adverse Reactions CV: Hypotension GI: Nausea, vomiting, GI distress Reproductive: Infertility Interactions Drug Anticoagulants, antiplatelets, antihypertensives: Andrographis may increase the effect of these drugs. Immunosuppressants: Andrographis (long-term) may decrease the action of immunosuppressants (Mills, Bone, 2005). Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Diterpenes Andrographolide; Deoxyandrographolide, Neoandrographolide, Isoandrographolide, Bisandrographolide, Andrographiside (Chen et al, 2006) Hepatoprotective, Antidiabetic Flavonoids Client Considerations Assess • Assess the reason the client is using andrographis. • Assess for the use of anticoagulants, antiplatelets, immunosuppressants, and antihypertensives. Caution the client that the effects of these drugs may be increased. Administer • Keep andrographis in a dry area, away from direct sunlight. Adverse effects: Underline = life-threatening Androstenediol 26 Teach Client/Family • Inform the client that pregnancy category is 4 and breastfeeding category is 1A. • Inform the client that andrographis may be used in children under the supervision of a qualified herbalist. • Teach the client that andrographis should not be used in bleeding disorders, gallbladder disease, or hypotension. Androstenediol (an-dro-sten’di-ol) Scientific names: 4-Androstene-3beta, 17beta-diol, 5-androstene-3beta, 17beta-diol Other common names: 4-AD, 4-androstenediol, 5-AD, 5-androstenediol, androdiol Uses Androstenediol is used for weight training and recovery, and to increase testosterone production and stamina. Actions Androstenediol is a prohormone and a precursor of testosterone. It can be converted to the hormones estradiol, DHEA, and estrone. Androstenediol is able to decrease HDL and increase LDL (Broeder et al, 2000). There is improvement in cardiovascular function following trauma hemorrhage that may be mediated by gamma activity (Shimizu et al, 2006). Product Availability Tablets Dosages Weight Training • Adult PO: 100 mg bid Contraindications Androstenediol should not be used in children or those who are pregnant, breastfeeding, hypersensitive, or have breast or prostate cancer or heart disease. Side Effects/Adverse Reactions ENDO: Increased endogenous testosterone, estrone, facial hair in women Interactions Drug Estrogens, estridol, estrone, testosterone: Androstenediol increases the effect of estrogens, estridol, estrone, and testosterone. Lab Test HDL: Androstenediol can decrease HDL. = Pregnancy = Pediatric ! = Alert = Popular Herb Angelica, European 27 Client Considerations A Assess • Assess the reason the client is using androstenediol. • Identify if the client is taking testosterone or estrogens that should not be taken with this product. • Assess if the client has breast/prostate cancer or coronary disease. Administer • Keep androstenediol in a dry area, away from direct sunlight. Teach Client/Family • Teach the client not to use androstenediol in children or those who are pregnant or breastfeeding until more research is available. Angelica, European Scientific names: Angelica sinensis (see Dong Quai); Angelica acutiloba, Angelica archangelica, Angelica atropurpurea, Angelica dahurica, Angelica edulis, Angelica gigas, Angelica keiskei, Angelica koreana, Angelica polymorpha, Angelica pubescens, Angelica radix Other common names: American angelica, European angelica, garden angelica, Japanese angelica, wild angelica Origin: Angelica is a member of the parsley family grown in Iceland and several other northern areas. Uses Angelica is used to treat headaches, backaches, osteoporosis, asthma, allergies, and skin disorders; to increase gastric juices for digestion and to improve circulation; and as a diuretic, an antispasmodic, and a cholagogue. It has also been used as a folk remedy to treat stomach cancer (Duke, 2003). In addition, it has been used as a mild antiseptic; as an expectorant; to ease rheumatic pains, stomach cramps, muscle spasms; and as a treatment for bronchitis. Investigational Uses Angelica has been shown to possess sedative and antibacterial actions. It may be effective for premature ejaculation using a multiingredient cream containing angelica. Actions Several possible actions dealing primarily with the calcium channel blocking action and antibacterial action of the Angelica spp. have been researched. Calcium Channel Blocking Action All coumarins in A. archangelica exhibit significant calcium antagonist activity, and folk medicine supports this use. According to one study, these coumarins include archangelicin, bergapten, imperatorin, isoimperatorin, isopimpinellin, osthol, ostrathol, oxypeucedanin, phellopterin, and xanthotoxin (Harmala et al, 1991, 1992). This study used 20 solvents to measure the inhibition of depolarized increased calcium uptake in rat pituitary cells. Significant hypotensive action occurred (Hikino, 1985; Yoshiro, 1985), as did negative inotropic and antiarrhythmic action (Hikino, 1985). Adverse effects: Underline = life-threatening 28 Angelica, European Sedative Action To assess the sedative/tranquilizing effect of angelica and its antiadrenergic activity, a study was performed in which xanthotoxol was isolated from the dried root of A. archangelica. In all species studied (dogs, cats, rats, mice, and hamsters), a significant degree of muscle relaxation occurred while the level of consciousness remained intact. This is a critical point of difference between sedative/hypnotic agents and sedative/ tranquilizing effects (Jacobsen, 1964; Turner, 1965). Thus, there is real potential for the use of angelica as a sedative or minor tranquilizer (Sethi et al, 1992). Both Japanese and Chinese angelica (see Dong Quai, pages 234-237) have shown pain-relieving and mild tranquilizing effects in animals (Hikino, 1985; Tanka et al, 1977; Yoshiro, 1985). Premature Ejaculation Applying the multiingredient cream to the glans penis 1 hr before intercourse, and washing off just before intercourse, showed improved delay in ejaculation (Choi et al, 2000). Other Actions Angelica may play an indirect role in preventing tumors through increased TNF-alpha production by macrophages. One study (Yang et al, 2004) identified the role angelica polysaccharides play in inducing the release of peritoneal macrophages. Product Availability Drops, fluid extract, tincture, whole herb, capsules, liniment Plant Parts Used: Fruit, roots (used by most herbalists), seeds, whole herb, leaves Dosages Counterirritant • Adult topical essential oil: dilute and apply 10-15 drops to inflamed areas (Blumenthal, 1998) Other • Adult PO dried root: 1-2 g tid (Pizzorno, Murray, 2006); 4.5 g/day (Jellin et al, 2008) • Adult PO dried root infusion: 1-2 g tid (Pizzorno, Murray, 2006) • Adult PO fluid extract: 0.5-2 ml tid (1:1 dilution) (Murray, Pizzorno, 2006) • Adult PO tincture: 1-3 ml tid (1:5 dilution) (Moore, 1996) GI Problems/Stimulate the Appetite • Children PO tincture: 1.5 g of 1.5 g/ml • Children PO fluid extract: 1.5-3 g of 1:1 g/ml Contraindications Class 2b/2d herb. Angelica should not be used during pregnancy because it can induce miscarriage. Also, avoid use in breastfeeding. Persons with diabetes (angelica can increase blood glucose), peptic ulcers, or bleeding disorders should use this herb cautiously. Side Effects/Adverse Reactions CV: Hypotension GI: Anorexia, flatulence, spasms of the gastrointestinal tract, dyspepsia GU: Cream: skin irritation, erectile dysfunction INTEG: Photosensitivity, phototoxicity, photodermatitis SYST: Bleeding may occur when used with anticoagulants = Pregnancy = Pediatric ! = Alert = Popular Herb Angelica, European 29 Interactions A Drug Antacids, H2-blockers (cimetidine, famotidine, nizatidine, ranitidine); proton pump inhibitors (lansoprazole, omeprazole, esomeprazole, pantoprazole, rabeprazole): Angelica may increase stomach acid, which may decrease the antacid, H2-blocker action (Jellin et al, 2008). Anticoagulants (heparin, warfarin), antiplatelets: Many Angelica spp. increase prothrombin time and prolong bleeding when taken with anticoagulants. Avoid the concurrent use of angelica with all anticoagulants. Doxazosin: Angelica may increase the effect of doxazosin. Tolbutamide: Angelica dahurica may delay elimination of tolbutamide (Ishihara et al, 2000). Avoid the concurrent use of angelica with tolbutamide. Herb Anise, arnica, bogbean, boldo, capsicum, celery, chamomile, clove, danshen, fenugreek, feverfew, garlic, ginger, ginkgo, Panax ginseng, horse chestnut, horseradish, licorice, meadowsweet, prickly ash, onion, papain, passionflower, poplar, red clover, tumeric, willow: Avoid concurrent use; it may pose risk of bleeding (Jellin et al, 2008). Lab Test Plasma partial thromboplastin time (PTT): Angelica may increase PTT in clients taking warfarin concurrently. Prothrombin time and plasma International Normalized Ratio: Angelica may increase test values in clients taking warfarin concurrently. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Coumarin Osthol; Xanthotoxin Antiinflammatory; analgesic; photosensitivity Xanthotoxol Angelicin; Bergapten; Imperatorin; Oreoselone; Oxypeucedanin; Umbelliferone; Xanthotoxol; Angelol I, H, Methoxycoumarin, Scopoletin (Kwon et al, 2002); Decursinol; Peucedanone Angelica archangelica contains: Terpene hydrocarbon Continued Adverse effects: Underline = life-threatening 30 Anise Primary Chemical Components and Possible Actions—cont’d Chemical Class Individual Component Possible Action Alcohol Ester Lactone Alpha-angelica Increases calcium binding Alpha-phellandrene; beta-phellandrene Flavor/scent; inhibits contraction of ileal muscles; inhibition of uterine smooth muscle (Du et al, 2005) Aliphatic carbonyl Polysaccharide Flavonoid Palmitic acid Volatile oil Client Considerations Assess • Assess the reason the client is using this product. • Assess for diabetes, bleeding disorders, or use of anticoagulants, antacids, H2 blockers, proton pump inhibitors (see Interactions). Angelica should be used cautiously by clients with these conditions. Administer • Instruct the client to take angelica PO as a tincture or fluid extract, or in whole herb form. Many products require dilution. Tinctures should be taken with liquids. Essential oil requires dilution before use. Teach Client/Family • Advise the client not to use angelica during pregnancy. Angelica archangelica may be given to children. • Inform the client that sunburn may occur. Advise the client to use sunscreen and protective clothing to prevent burns (Blumenthal, 1998). • Teach the client not to store angelica in plastic because reaction with the essential oil may occur. Anise (an’us) Scientific name: Pimpinella anisum Other common names: Aniseed, sweet cumin Origin: Anise is an annual grown throughout the world. = Pregnancy = Pediatric ! = Alert = Popular Herb Anise 31 Uses Anise is used internally as an expectorant to treat bronchiectasis, bronchitis, emphysema, and whooping cough. It is also used internally as an antibacterial, an antispasmodic, an abortifacient (large quantities), a diaphoretic, a diuretic, a stimulant, and a tonic. Anise can be used by steam inhalation with tea tree, pine, and chamomile to treat acute and chronic sinusitis. It is used externally to treat catarrhs of the respiratory system (asthma, bronchitis). Other reported uses include treatment for cancer, cholera, colic, dysmenorrhea, amenorrhea, epilepsy, indigestion, insomnia, lice, migraine, nausea, neuralgia, rash, scabies, and to improve breastfeeding (Duke, 2003). Anise is used as a fragrance and flavoring in food. It may be given to children to reduce gas, colic, and respiratory symptoms (Romm, 2003). Actions Antibacterial Action One study identifies the inhibition of gram-positive and gram-negative organisms. Another study shows the inhibition of the mycotoxin of Aspergillus. Other Actions Anise is used for a variety of purposes. It has been used topically (bergapten, one of the chemical components, has been isolated) in conjunction with ultraviolet light to treat psoriasis (Newell et al, 1996). Anise oil mixed with sassafras oil is used as an insect repellent (Chandler et al, 1984), and anise oil may be applied topically to treat lice and scabies (Chevallier, 1996). In addition, one study has shown that the essential oil of Pimpinella anisum exerts an anticonvulsant effect in mice. In this study the essential oil not only suppressed induced tonic convulsions, but it also increased the threshold of clonic convulsions (Pourgholami et al, 1999). Anise also acts as a catecholamine similar to adrenalin and possesses estrogenic properties (Albert-Puleo, 1980). One study has shown the ability of this herb to block inflammation, carcinogenesis, possibly due to tumor necrosis factor–mediated signaling (Chainy et al, 2000). Another study (Boskabady et al, 2001) has identified the relaxant effects of Pimpinella anisum, including bronchodilation. A newer study (Kosalec et al, 2005) used the essential oil and extract from anise to study the antifungal activity. There were significant differences in antifungal activity between the essential oil and fluid extract. The essential oils’ antifungal activity was much stronger than the extract. Anise suspension has identified a protective quality against gastric-induced ulcers in rats (Al Mofleh et al, 2007). The volatile oil in anise, anethole, may be responsible for the estrogenic action (Newell et al, 1996). Product Availability Essential oil, toothpaste, whole herb Plant Part Used: Fruit (ripe and dried) Dosages • Adult PO essential oil: 1-5 drops diluted prn (Moore, 1996) • Adult PO whole herb: 3 g (Blumenthal, 1998) • Adult topical: 5%-10% concentration essential oil, applied prn; spirit of anise 0.25-0.50 tsp (1:10 dilution in alcohol), diluted (Moore, 1996) • Child PO tea: 1⁄2-3 cups daily (Romm, 2003) Adverse effects: Underline = life-threatening A 32 Anise Contraindications Anise is not recommended for therapeutic use during pregnancy. It should not be used by persons with hypersensitivity to anise or anethole. The essential oil should never be given to children. Anise may be used during breastfeeding. Side Effects/Adverse Reactions CNS: Seizures (essential oil) (internal) EENT: Stomatitis (toothpaste) ENDO: Hypermineralocorticism (internal) GI: Nausea, vomiting, anorexia (internal) INTEG: Hypersensitivity, contact dermatitis RESP: Pulmonary edema (essential oil) (internal) Interactions Drug Estrogens, hormonal contraceptives: Large quantities of anise may interfere with estrogen replacement therapy or hormonal contraceptives (theoretical) (Jellin et al, 2008). Iron: Anise may increase the action of iron; do not use concurrently. Warfarin: Anise may increase the action of warfarin, do not use concurrently (Heck et al, 2000). Lab Test Increased: PT, INR Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Volatile oil Anethole Antimicrobial, antifungal, estrogenic Bergapten Umbelliprenine; Umbelliferone; Scopoletin Photosensitivity, carcinogenic Quercetin Rutin; Luteolin; Isoorientin; Isovitexin; Apigenin Antiinflammatory Alpha-pinene Coumarin Lipid/fatty acid Flavonoid Sitosterol Linalool Anisaldehyde Client Considerations Assess • Assess the reason the client is using this product. • Assess the client for hypersensitivity reactions and contact dermatitis. If these are present, discontinue use of anise and institute antihistamines or another appropriate therapy. = Pregnancy = Pediatric ! = Alert = Popular Herb Arginine 33 • Assess for the use of iron supplements, warfarin (see Interactions). A • Assess the client’s fluid and electrolyte balance. Weigh the client weekly to determine water and sodium retention. Administer ! • Instruct the client to take anise PO using the whole herb or seeds. The essential oil should be used under an herbalist’s supervision only. Toxicity can occur. Teach Client/Family • Caution the client not to use anise therapeutically during pregnancy. It may be used during breastfeeding. • Caution the client that anise tea is often used to treat children’s respiratory conditions, but the essential oil should never be given to children. • Caution the client not to use anise essential oil without an herbalist’s supervision; toxicity is common. Both seizures and pulmonary edema can result. • Caution the client that Illicium anisatum L. is poisonous and that it can easily be confused with Illicium verum (Small, 1996). Arginine (ahr’juh-neen) Scientific name: 2-amino-5-guanidinopentanoic acid Other common names: Arginine hydrochloride, L-arginine Origin: Synthetic Uses Arginine is a supplement used for congestive heart failure, erectile dysfunction, peripheral vascular disease, angina, interstitial cystitis, and chronic renal failure. Other uses may include upper respiratory infections, diabetes, burns, adrenoleukodystrophy, migraine, wound healing, and an appetite supplement in AIDS. Actions Cardiovascular Action Several studies have identified the cardiovascular actions of arginine. Hambrecht et al (2000) showed a corrective action on endothelial dysfunction in chronic congestive heart failure. In another study (Rector et al, 1996) patients showed a considerable improvement in congestive heart failure when arginine was given for 4 to 6 weeks. The effect on angina patients was similar. Three studies (Bednarz et al, 2000; Blum et al, 1999; Maxwell et al, 2000) showed consistent improvement in the ECG and symptoms of angina when arginine was added at the dose of 6 g/day. Erectile Dysfunction The use in erectile dysfunction showed contradictory results. One study (Chen et al, 1999a) showed considerable improvement in erectile dysfunction after the addition of 5 g/day for 6 weeks. Another study (Moody et al, 1997) showed no improvement when 1.5 g/day was administered for 17 days. Other Actions Other actions that have been studied include peripheral vascular disease, interstitial cystitis, chronic renal failure, diabetes, and upper respiratory infections. Most of these conditions have only one study each, with very limited results. Adverse effects: Underline = life-threatening 34 Arginine Product Availability Tablets, capsules, IV Dosages • Adult PO: 2-3 g/day; may increase to 15 g/day in cardiac disease Very little information is available on dosages. Contraindications Until more research is available, avoid use in children, pregnancy, or breastfeeding. Avoid use in severe hepatic disease, herpes, acrocyanosis, asthma, hypotension, renal disease. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, cramping, increased number of stools META(IV use): Increased BUN, hyperkalemia Interactions Drug ! ACE inhibitors, potassium-sparing diuretics: ACE inhibitors and potassium-sparing diuretics taken with arginine (IV) may lead to fatal hypokalemia (theoretical). Alcohol, NSAIDs, platelet inhibitors, salicylates: Alcohol, NSAIDs, platelet inhibitors, and salicylates taken with arginine may cause gastric irritation. Antihypertensives: Arginine taken with antihypertensives may lead to increased hypotension (theoretical) (Jellin et al, 2008) Cyclosporine: Arginine may counteract the therapeutic effects of cyclosporine (Jellin et al, 2008) Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Essential amino acid L-Arginine Antianginal Client Considerations Assess • Assess the reason the client is using this product. • Assess for severe hepatic disease, renal disease, hypotension, acrocyanosis, and asthma. Avoid giving arginine in these conditions. • Identify medications taken such as ACE inhibitors, alcohol, NSAIDs, potassium-sparing diuretics, platelet inhibitors, salicylates. Avoid use of arginine with these medications. Administer ! • Arginine IV should be given only by a qualified herbalist or other integrative medicine specialist. Severe hypokalemia and increased BUN may occur. Teach Client/Family • Advise the client not to use arginine in children or those who are pregnant or breastfeeding until more research is available. = Pregnancy = Pediatric ! = Alert = Popular Herb Arnica 35 A Arnica ! (ahr’ni-kuh) Scientific name: Arnica montana L.; may also include A. chamissonis less., A. cordifolia hook, A. fulgens pursh, A. soronia greene Other common names: Leopard’s bane, common arnica, sneezewort, mountain snuff, mountain tobacco, wolf’s bane Origin: Arnica grows wild in the mountains of Europe and Russia. Some species can be found in the western United States. Uses Arnica is used topically to decrease inflammation in bruises, sprains, wounds, acne, boils, rashes. It may be used in cardiovascular problems to decrease cholesterol if supervised by a qualified herbalist. Arnica should not be used internally except under the supervision of a qualified herbalist. It is used in small quantities as a flavor in beverages and desserts (Jellin et al, 2008). Actions Antiinflammatory Action Two studies have identified antiinflammatory properties of arnica. One study (Lussignoli et al, 1999) found that inflammation was decreased in rat paw edema, possibly due to a decrease in interleukin-6. Another study (Schaffener, 1997) showed the antiinflammatory effect of helenalin, one of the chemical components of arnica. A more recent study (Brinkhaus et al, 2006) showed that clients who took homeopathic arnica had much less postoperative swelling after arthroscopy. Cytotoxic Action One study (Willuhn et al, 1994) showed low cytotoxicity when compared with other antineoplastics. Helenalin showed the greatest cytotoxic effect. Other Actions Arnica montana decreased mild postpartum bleeding in a randomized doubleblind, placebo-controlled study of 40 participants (Oberbaum et al, 2005). Product Availability Topical: spray, cream, salve, ointment; oral: tablets, tea, tincture, sublingual Plant Parts Used: Dried flower heads, rhizome Dosages • Adult topical: apply to affected area as needed Very little information is available on dosages. Contraindications ! Pregnancy category 7; breastfeeding category 5A. Because arnica is considered poisonous, injection is contraindicated. Death can occur. Internal use is contraindicated unless supervised by an expert; serious renal and hepatic damage can occur. Arnica should not be used in children. Do not use full-strength tincture on broken skin as contact dermatitis can occur. Do not use for prolonged periods. Continued Adverse effects: Underline = life-threatening 36 Arnica Side Effects/Adverse Reactions INTEG: Rash, contact dermatitis If taken internally (contraindicated) CNS: Nervousness, restlessness, coma, death CV: Cardiac arrest, cadiotoxicity, hypertension GI: Abdominal pain, diarrhea, vomiting, anorexia, hepatic failure HEMA: Bleeding INTEG: Contact dermatitis (topical), Sweet syndrome MS: Weakness RESP: Dyspnea Interactions Drug Antihypertensives: May decrease the antihypertenisve effect if arcina is taken internally. Lab Test APTT, PT, INR: Arnica increases these lab tests. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Polysaccharide Galacturonic acid Inhibits complement; increases immune response Sesquiterpenes Phenolic compound Helenalin; 11-Alpha; 13-Dihydrohelenalin Cardiotoxic; inhibits platelet aggregation; cytotoxicity; analgesic; antiinflammatory Client Considerations Assess • Assess the reason the client is using this product. • Assess the condition of the skin: broken, bruised, rashes. Arnica should not be used for prolonged periods on this type of skin. • Assess for Sweet syndrome, psoriasis. Administer • Use only topically, unless under the supervision of a qualified herbalist. • Do not use for prolonged periods; allergic reactions may occur. • Do not use full-strength on broken, hypersensitive skin. Do not use on open wounds or abrasions. Teach Client/Family ! • Teach the client not to use internally unless supervised by a competent herbalist. Arnica is considered poisonous and can be cardiotoxic. Serious hepatic and renal toxicity can occur. • Inform the client that pregnancy category is 7 and breastfeeding category is 5A. = Pregnancy = Pediatric ! = Alert = Popular Herb Artichoke 37 • Instruct the client not to use for extended periods on broken or bruised skin; A contact dermatitis can occur. • Keep out of reach of children; ingestion of flowers or roots can lead to death. ! Artichoke (ahr’tuh-chowk) Scientific name: Cynara scolymus asteraceae Other common names: Alcachofra, garden artichoke, globe artichoke Origin: Artichoke is cultivated in central Europe and the Mediterranean. Uses Artichoke is used to lower cholesterol levels, to increase appetite, to aid digestion, and for indigestion in the upper gastrointestinal tract. It also has antioxidant and hepatoprotective properties. Actions There are very few studies for any use or action. However, artichoke is being marketed for its possible antilipidemic, hepatoprotective, and digestant properties. Antilipidemic Action The studies relating to the antilipidemic action of artichoke are minimal. In one study (Petrowicz et al, 1997) artichoke leaf was administered to 44 individuals with no change in cholesterol levels. However, a later study (English et al, 2000) saw a drop in cholesterol and LDL/HDL ratios that was statistically significant. The drop in cholesterol levels may be due to cynarin and luteolin, two chemical components in artichoke. These components may interfere with cholesterol synthesis. Other Actions Two other actions are included in beginning research. These include the hepatoprotective effects of artichoke and the reduction in gastrointestinal symptoms, including dyspepsia. Artichoke leaf may protect the liver from harmful effects (Kraft, 1997). Product Availability Standardized extract (2.5%-15% caffeylquinic acid), tincture (5:1 dilution) Plant Part Used: Leaf Dosages • Adult PO standardized extract: 1-2 (320 mg) caps tid (McCaleb et al, 2000) • Adult PO tincture (5:1 dilution): 15-30 drops in a small amount of water tid (McCaleb et al, 2000) • Adult PO dried herb: 6 g in three divided doses (Blumenthal, 1998) Irritable Bowel Syndrome • Adult PO leaf extract: 640 mg daily (Jellin et al, 2008) Dyspepsia • Adult PO leaf extract: 320-640 mg daily (Jellin et al, 2008) High Cholesterol • Adult PO fluid extract: 1800-1920 mg/day in 2 or 3 divided doses (Jellin et al, 2008) Adverse effects: Underline = life-threatening Artichoke 38 Contraindications Artichoke should not be used by those with bile duct blockage, gallstones, or hypersensitivity to artichoke or Asteraceae family herbs such as arnica or chrysanthemums. Until further research is completed, medicinal artichoke should be avoided in children or those who are pregnant or breastfeeding until more research is available. Use cautiously in hepatic or renal disease. Side Effects/Adverse Reactions GI: Hunger MS: Weakness Interactions Drug Iron salts: Artichoke tea may interfere with the absorption of iron salts. Lab Test Blood glucose: Artichoke decreases blood glucose. Primary Chemical Components and Possible Actions Chemical Class Individual Component Acid Caffeic acid; Caffeylquinic acids; Chlorogenic acid Cynarin Cynaroside Luteolin Scolymoside Possible Action Antilipidemic, hepatoprotectant Antilipidemic Client Considerations Assess • Assess the reason the client is using this product. • Assess the client for the presence of gallstones, bile duct blockage, or past hypersensitivity to artichoke or plants in the Asteraceae family. • Identify if the client is using iron salts, since artichoke in a tea may interfere with iron salts absorption. Hyperlipidemia • Obtain cholesterol testing on a regular basis if client is using for hyperlipidemia. • Obtain a diet history to identify high-cholesterol foods that may need to be eliminated. Administer • Using tincture or fluid extract mixed in a small amount of water. Teach Client/Family • Advise the client to avoid use in children or those who are pregnant or breastfeeding until more research is available. = Pregnancy = Pediatric ! = Alert = Popular Herb Ash 39 A Ash ! Scientific names: Fraxinus americana, Fraxinus atrovirens, Fraxinus excelsior, Fraxinus heterophylla, Fraxinus jaspida, Fraxinus polemoniipolia, Fraxinus simplifolia, Fraxinus verticillata Other common names: Bird’s tongue, common ash, European ash, weeping ash, white ash (not the same as prickly ash) Origin: Ash is a tree found in regions of North America. Uses Ash has been used traditionally as a diuretic and tonic. Investigational Uses Ash is being investigated as an antiinflammatory for rheumatic and arthritic conditions. Some reports identify ash to be as good an antiinflammatory as nonsteroidal antiinflammatories. Actions Very little research has been done on ash. A few studies have focused on the antiinflammatory properties of ash. One study (el-Ghazaly et al, 1992) compared ash with diclofenac. The results from both were similar. Product Availability Liquid extract (no standardized extract is available) Plant Parts Used: Leaves, bark Dosages • Adult PO: 20-40 drops tid-qid, use in water or other fluids Contraindications Class 1 (bark). Ash should not be used in children or those who are pregnant or breastfeeding until more research is available. Ash is contraindicated in clients with hypersensitivity to this product or salicylates. Side Effects/Adverse Reactions GI: Slight nausea Primary Chemical Components and Possible Actions Chemical Class Individual Component Flavonoids Iridoide monoterpenes Mannitol Tannins Triterpenes Phenolic acids Phytosterols Mucilages Hydroxycoumarins Rutin Possible Action Fraxin; Isofraxidin; Aesculin Adverse effects: Underline = life-threatening Astragalus 40 Client Considerations Assess • Identify the reason the client is using this product. • Assess mobility and decrease in inflammation if using for arthritic conditions. Monitor ROM, swelling, and heat of joints. Administer • Give fluid extract in a small amount of water or other fluids. Teach Client/Family • Advise the client to keep ash away from children and pets. The FDA considers this herb unsafe and poisonous. • Advise the client not to confuse ash with northern prickly ash or southern prickly ash (Jellin et al, 2008). Astragalus (as’tri-guh-lus) Scientific names: Astragalus gummifer, Astragalus membranaceus Other common names: Huang-qi, tragacanth, Milk Vetch, Yellow Leader Origin: Astragalus is available throughout the world. The most common species are grown in China, Japan, and Korea. Uses Astragalus is used to treat bronchitis, chronic obstructive pulmonary disease, colds, flu, gastrointestinal conditions, weakness, fatigue, chronic hepatitis, ulcers, hypertension, and (by injection) viral myocarditis (Chang et al, 1987). This herb is used in contemporary Chinese medicine and other models to improve immune system health. Astragalus is thought to be an aphrodisiac and may improve sperm motility. Investigational Uses Researchers are experimenting with the use of astragalus to treat cancer and to increase immunity in HIV/AIDS. It is also commonly used to decrease the toxic effects of radiation or chemotherapy. Astragalus may lower blood glucose levels and may be used in combination with other herbs. Actions Stimulation of Immunity and Anticancer Action Studies have shown that astragalus improves immune function in a number of ways. It increases the numbers of both macrophages (Kajimura et al, 1996) and white blood cells. Another study has shown an increase in immunoglobulins A, G, and M and a concurrent decrease in upper respiratory infections. Astragalus also increases the functioning of B-cells (Kajimura et al, 1997) and T-cells (Mavligit et al, 1979). Astragalus may intensify phagocytosis, stimulate pituitary-adrenal activity, and stimulate production of interferon. These research studies provide evidence for the use of astragalus to treat cancer and other conditions with decreased immune response such as HIV/AIDS. = Pregnancy = Pediatric ! = Alert = Popular Herb Astragalus 41 Cardioprotective Action Astragalus has been widely used for viral diseases, including viral myocarditis in China. This study (Chen et al, 2006a) looked at the cardioprotective effects on mice induced with this type of infection. Astragalus showed similar improvement compared with the use of perindopril for treating viral myocarditis. Product Availability Capsules, decoction, fluid extract, solid (dry) extract, tincture Plant Part Used: Roots Dosages Dosage can vary widely • Adult PO capsules: 400-500 mg 8-9 times/day (Foster, 1999), up to 8-15 g/day • Adult PO decoction: 9-30 g dried root/day (Mills, Bone, 2000), boil for 1-2 hr, drain • Adult PO fluid extract: 4.5-8.5 ml/day in divided doses (1:2 dilution) (Mills, Bone, 2000) or 2-4 ml tid (1:1 dilution) (Murray, Pizzorno, 1998) • Adult PO solid (dry) extract: 100-150 mg tid (0.5% 4-hydroxy-3-methoxy isoflavone) (Murray, Pizzorno, 1998) Contraindications Pregnancy category 2; breastfeeding category 1A. Astragalus should not be used by persons with acute infections, or in the presence of fever or inflammation. Astragalus may be given to children. Side Effects/Adverse Reactions INTEG: Allergic reactions (rare) Interactions Drug Antihypertensives: Astragalus may decrease or increase the action of antihypertensives; avoid concurrent use. Cyclophosphamide: Astragalus may decrease the effect of cyclophosphamide. Immunosuppressants: Astragalus may interfere with immunosuppressant therapy (theoretical) (Jellin et al, 2008). Interferon: The combination of interferon and astragalus has been shown to prevent or shorten the duration of upper respiratory infections. Interleukin-2: Astragalus may increase the effect of drugs such as interleukin-2 (IL-2). In contrast, other studies have shown that the effects of IL-2 can be decreased when combined with astragalus. Research is inconclusive at this time. Lab Test Semen specimen analysis: Astragalus may increase sperm motility in vitro. PT, INR: Astragalus may increase PT, INR. Adverse effects: Underline = life-threatening A 42 Avens Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Glycosides Astragalan I, II, III; Bassorin; Tragacanthin Astramembrannin I, II Increased immunity Saponin Betaine Beta-sitosterol choline Polysaccharides Vitamin A Flavonoids Increased immunity Astroglucans A, B, C Client Considerations Assess • Assess for allergic reactions; if present, discontinue use of this herb and administer antihistamine or other appropriate therapy. • Assess for the use of other medications, including IL-2, the action of which may be increased (see Interactions). • Assess for infections, fever, inflammation. Astragalus should not be used in infection, fever, or inflammation. Administer • Instruct the client to take astragalus PO as a tincture, decoction, fluid extract, or in capsule form. • Inform the client that astragalus injections, which are used to treat viral myocarditis, are to be given by naturopaths only. Teach Client/Family • Inform the client that pregnancy category is 2 and breastfeeding category is 1A. • Inform the client that astragalus may be given to children. • Caution the client not to use astragalus if experiencing acute infections or inflammation. • Inform the client that this herb is generally considered safe. Avens (a’vunz) Scientific name: Geum urbanum Other common names: Benedict’s herb, bennet’s root, blessed herb, city avens, clove root, colewort, geum, goldy star, herb bennet, way bennet, wild rye, wood avens Origin: Avens is a member of the rose family found in Europe. Uses Avens has traditionally been used internally to treat diarrhea, sore throat, fever, headache, and gastric inflammation. It has also been used as an astringent, antiinflammatory, and antiseptic. Topically, avens has been used to treat wounds and hemorrhoids. It is rarely used today. It may be used as a flavoring in food. = Pregnancy = Pediatric ! = Alert = Popular Herb Avens 43 Actions Research studies of the effects of avens on humans are nonexistent, and animal studies are rare. Most reported uses for this herb are anecdotal. Few avens products are available in the United States. Antiinflammatory Action The antiinflammatory action of avens may result from its ability to produce prostaglandins and decrease cyclooxygenase (Tunon et al, 1995). Avens is thought to possess antiinflammatory action equal to that of NSAIDs; however, no research is available to either confirm or disprove this action. Product Availability Fluid extract, powder, tea, tincture Plant Parts Used: Dried plant, rhizome, roots Dosages Many different dosages are reported. Wound Healing • Adult topical: apply prn Other • Adult PO fluid extract of herb: 1 dram • Adult PO fluid extract of root: 1⁄2-1 dram • Adult PO powdered root/herb: 15-30 grains as a tonic • Adult PO tea: 1-4 g steeped in boiling water, strained, 3 ⫻/day (Jellin et al, 2008) Contraindications Until more research is available, avens should not be used during pregnancy and breastfeeding. It should not be given to children. Side Effects/Adverse Reactions GI: Nausea, anorexia, dyspepsia Interactions Lab Test BUN creatinine: Avens may increase BUN, creatinine. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Volatile oil Eugenol Antiinflammatory; antioxidant, astringent Wound healing; antiinflammatory Tannin Gum Resin Roots Also Contain Acid Gallic acid; Caffeic acid; Chlorogenic acid Adverse effects: Underline = life-threatening A 44 Avens Client Considerations Assess Antiinflammatory • Assess the client for pain: location, intensity, duration. Determine what alleviates and aggravates the condition. • Assess for the use of prescription and over-the-counter medications to treat pain and inflammation. Administer • Instruct the client to take avens PO as an extract, or as a powder made from the herb or its roots. Teach Client/Family • Caution the client not to use avens in children or those who are pregnant or breastfeeding until more research is available. • Instruct the client to report any changes in the symptoms or characteristics of the condition. • Advise the client to use this herb with caution or under the supervision of a qualified herbalist because research on the use, side effects, and toxicity of avens is rare. = Pregnancy = Pediatric ! = Alert = Popular Herb Balsam of Peru 45 Balsam of Peru (bawl’sum uv Peh’rew) Scientific names: Myroxylon balsamum, Myroxylon pereirae Other common names: Balsam of tolu, balsam tree, opobalsam, Peruvian balsam, resina tolutana, resin tolu, Thomas balsam Origin: Balsam of Peru is a tree found in Central and South America. Uses Balsam of Peru in suppository form is used to treat hemorrhoids. This herb is used internally to treat postextraction alveolitis, cough, bronchitis, colds, burns, fever, lowered immunity, and parasites (scabies). Balsam of Peru is also taken orally as a diuretic and to expel worms. Topically, it is used to heal wounds, promote local circulation, ease joint and arthritic complaints, and treat dry socket in dentistry (Jellin et al, 2008). Actions Balsam of Peru is used primarily for generalized wound healing. Skin graft donor sites were treated with balsam of Peru–trypsin ointment to assist in healing skin graft donor sites. This retrospective study used 36 clients, all showing considerable improvement in the donor sites (Carson et al, 2003). Because it is an oleoresin and tends to be a warming herb, balsam of Peru is used to improve circulation and relieve congestion. Product Availability Cream, feminine hygiene products, lotion, ointment, other commercial products, shampoo, suppositories Plant Part Used: Bark (oleo resin) Dosages Hemorrhoids • Adult suppositories: 1.8-3 mg prn Wound Healing • Adult topical: 5%-20% concentration ointment, used for no longer than 7 days Contraindications Class 2d herb. Use topically for no longer than 7 days. Persons with kidney irritation or febrile illnesses should avoid the use of balsam of Peru. Side Effects/Adverse Reactions GU: Albuminuria, pyelitis, necrosis of the kidney (if taken internally) INTEG: Contact dermatitis, photodermatitis Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Ester mixture Cinnamein Cinnamic acid ester Antiseptic; antibacterial Antiseptic; antibacterial Wound healing, epithelial cell growth Resin Benzoic acid Volatile oil Adverse effects: Underline = life-threatening B 46 Barberry Client Considerations Assess • Assess the reason the client is using this product. • Assess the client for contact dermatitis and photodermatitis after prolonged use. Discontinue the use of this herb if these conditions are present. Administer • Instruct the client to use as a topical or suppository. This herb may be used PO if under the direction of a qualified herbalist. Barberry (bahr’beh-ree) Scientific name: Berberis aquifolium Pursh Other common names: Berberry, jaundice berry, oregon grape, pepperridge bush, pipperidge, sour-spine, sowberry, trailing mahonia, wood sour Origin: Barberry is a shrub found in Europe and North America. Uses Barberry has been used for many centuries for kidney pain and the removal of kidney stones (Arayne et al, 2007). It is used as an antimicrobial against a wide variety of bacteria, fungi, viruses, helminths, and chlamydia. Primary uses for barberry include bacterial diarrhea, intestinal parasite infection, and ocular trachoma infections. It antagonizes the effects of cholera and Escherichia coli, decreases ventricular tachyarrhythmias, decreases inflammation, and increases platelets in thrombocytopenia. Barberry can lower heart rate and enhance the flow of bile through hepatic function. It may be used for stomach ailments, ulcers, and as a cathartic. Barberry may also be used topically to treat dry, scaly skin, and psoriasis. Actions Barberry has been used for more than 3000 years in Chinese and Ayurvedic medicine. Antimicrobial Action Many studies have demonstrated the effectiveness of barberry against a wide variety of fungi, protozoans, helminths, viruses, and bacteria, including Chlamydia spp. Sensitivity screens were performed on 54 different microorganisms using berberine, one of the alkaloids of barberry. Antimicrobial effects were found against grampositive and gram-negative organisms, as well as protozoa. Barberry was found to be effective against Bacillus cereus, Bacillus pumilus, Bacillus subtilis, Candida albicans, Candida glabrata, Candida tropicalis, Candida utilis, Corynebacterium diphtheriae, E. coli, Entamoeba histolytica, Giardia lamblia, Klebsiella pneumoniae, Leishmaniasis spp., Mycobacterium tuberculosis, Shigella boydii, Sporotrichum schenkii, Staphylococcus albus, Staphylococcus aureus, Streptococcus pyogenes, Trichophyton mentagrophytes, Trichomonas vaginalis, and Vibrio cholerae. Barberry may also be effective against HIV-1 by inhibiting HIV-1 reverse transcriptase (Gudima et al, 1994). = Pregnancy = Pediatric ! = Alert = Popular Herb Barberry 47 Cardiovascular Action In one study using cats, barberry demonstrated both positive and negative inotropic and antihypertensive effects. In a human study of 12 patients with refractory congestive heart failure, participants were studied before and after intravenous administration of berberine. Low doses produced no circulatory changes, whereas higher doses caused a significant reduction in pulmonary vascular resistance and a decrease in left ventricular end-diastolic pressure. Measurable increases occurred in stroke index, ventricular injection fraction, and left ventricular ejection fraction (Marin-Neto et al, 1988). Another study of 100 individuals with ventricular tachyarrhythmias reported that berberine suppressed premature ventricular contractions without serious side effects (Huang et al, 1990). Several methods of action have been proposed for the cardiovascular actions of berberine, including calcium channel blocking (Zhou et al, 1995), potassium channel blocking (Hua et al, 1994), and inhibition of catecholamine synthesis (Lee et al, 1996). Product Availability Fluid extract tablets, tea, tincture Plant Parts Used: Fruit (rarely used), root bark Dosages • Adult PO decoction: 1.5-3 g/day (Mills, Bone, 2000) • Adult PO fruits: 1-2 tsp whole or mashed barberries in 150 ml boiling water, steeped 10-15 min and strained (berberidis fructus) • Adult PO fluid extract: 6-9 ml/day (1:1 dilution) (Mills, Bone, 2000) • Adult PO tablets: 200 mg bid-qid • Adult PO tincture: 3-6 ml/day (1:2 dilution) (Mills, Bone, 2000) Contraindications Pregnancy category is 5; breastfeeding category is 4A. Do not use in neonatal jaundice (Mills, Bone 2005). Side Effects/Adverse Reactions CNS: Confusion, disorientation CV: Hypotension, cardiac damage GI: Diarrhea, gastrointestinal discomfort, hepatotoxicity GU: Nephritis, spontaneous abortion RESP: Dyspnea Interactions Drug Antihypertensives: Barberry may increase the antihypertensive action; use cautiously. Calcium channel blockers: Barberry may increase the effect of calcium channel blockers. Lab Test AST/ALT, total bilirubin, urine bilirubin: Barberry may increase these test values. Adverse effects: Underline = life-threatening B 48 Barberry Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Alkaloid, isoquinoline Berberine Decreased blood pressure, antiarrhythmic, antiplatelet, immunosuppressant K+ channel blocking Uterine stimulant Oxyacanthine Isochinoline Berbamine Bervulcine Jatorrhizine Magnoflorine Aporphine Palmatine Anthocyan Chlorogenic acid Phenol Syringaresinol Antiinflammatory Client Considerations Assess • Assess the reason the client is using this product. ! • Assess the client for hypersensitivity reactions and toxicity. Discontinue use of this herb if these are present. • Assess for possible or confirmed pregnancy. • Assess cardiac status (blood pressure; ECG; pulse; heart rate, rhythm, and character) in clients who are using barberry to treat ventricular tachyarrhythmias. • Assess for confusion and disorientation, diarrhea, nephritis. Discontinue use of this herb if these conditions are present. Administer • Instruct the client to take barberry PO as the whole herb, infusion (tea), commercial tablets, or tincture. It is bitter and should be taken in small doses. Large doses may cause nausea, vomiting, and a drop in blood pressure. • When using barberry as a compress for conjunctivitis, soak the cloth in barberry infusion. • Use less than 500 mg per day; berberine considered toxic (Jellin et al, 2008). Teach Client/Family • Inform the client that pregnancy category is 5 and breastfeeding category is 4A. • Inform the client that there are more effective medications than barberry for controlling ventricular tachyarrhythmias. = Pregnancy = Pediatric ! = Alert = Popular Herb Barley 49 Barley (bahr’lee) Scientific names: Hordeum distichon, Hordeum irregulare, Hordeum jubalum, Hordeum leporinum, Hordeum vulgare Other common names: Barley grass, foxtail grass, hare barley, milled barley, pearl barley, scotch barley, wild barley Origin: Barley grows wild in Asia and parts of Ethiopia. It is cultivated in many parts of the world. Uses Barley has been used traditionally for irritable bowel syndrome, diarrhea, and gastritis. It has also been used to decrease cholesterol, prevent cancer, and control diabetes. Actions Most studies using barley focus on the intestinal actions. One study (Gruenwald et al, 1998) identified barley as a demulcent and reported healing of the gastrointestinal tract. Another study (Mitsyama et al, 1998) identified the barley in food as having a healing effect and improving damage in the gastrointestinal tract in animals. The juice contains many vitamins, including B1, B2, B6, B12, panothenic acid, folic acid, and beta carotene, and many minerals, including potassium, calcium, magnesium, and phosphorous. Product Availability Contained in food; no specific forms are available. Plant Part Used: Grain Dosages No published dosages are available. Contraindications Barley should not be used medicinally (high doses) in pregnancy or in those with barley sensitivity (Jellin et al, 2008). Side Effects/Adverse Reactions SYST: Anaphylaxis, asthma Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Fatty oils Hydroxycoumarins Linoleic acid; Oleic acid Aesculetin; Gramine; Herniarin; Hordenine Scopotetin; Tyramine Umbelliferone Glucodifructose; Glucose; Fructose; Raffinose; Saccharose Demulcent Oligosaccharides Sympathomimetic Continued Adverse effects: Underline = life-threatening B 50 Basil Primary Chemical Components and Possible Actions—cont’d Chemical Class Individual Component Polysaccharides Vitamins Starch; Fructans B2; B6; E; Folic acid; Nicotinic acid; Panothenic acid Albumin; Globulin; Glutelines; Prolamines Proteins Possible Action Fiber Client Considerations Assess • Determine the reason the client is using barley medicinally. • Assess for barley sensitivity, and exposure to barley flour, because it can cause asthma. Administer • Administer after receiving diagnosis of gastrointestinal symptoms. • Instruct the client to store barley in a cool, dry place, away from moisture. Teach Client/Family • Caution the client that barley should not be used medicinally in pregnancy until more research is available. Basil (ba’zul) Scientific names: Ocimum basilicum, Ocimum sanctum Other common names: Common basil, sweet basil, holy basil, St. Josephwort Origin: Basil is a member of the mint family found throughout the world. Uses Basil is used as an antiseptic, antidiabetic, antiinflammatory, and immunostimulant. It is also used to treat ulcers, arthritis, renal disease, insect bites (Jellin et al, 2008), and joint edema. Contemporary uses include treatment for flatulence, anxiety, and coughs. Investigational Uses Researchers are studying the immunostimulant properties and the performance enhancement properties (Maity et al, 2000) of Ocimum sanctum. Actions Research has focused on the hypoglycemic, antiinflammatory, and immunostimulant properties of basil. = Pregnancy = Pediatric ! = Alert = Popular Herb Basil 51 Hypoglycemic Action One study of 62 patients with type 2 diabetes demonstrated the ability of basil to lower blood glucose levels (Reichart, 1997). All of the participants underwent a 10-hour fasting blood glucose test after discontinuing any other hypoglycemics 1 week before the test. In addition, all patients completed a 5-day washout period to clear all other agents from their systems before the study began. Results showed that fasting blood glucose levels decreased 17% with the use of basil as compared with the use of a placebo. Both cholesterol and urinary glucose levels also decreased, but not significantly. Antiinflammatory Action A 1996 study by Singh used fixed O. sanctum to treat rats with inflamed paws. Basil exerted significant activity as an antiarthritic and antiinflammatory. The study also demonstrated the antiinflammatory and analgesic effects of basil when given intraperitoneally (Singh et al, 1996). Immunostimulant Action To identify its immunoregulatory profile in sheep erythrocytes, basil was tested against Salmonella typhosa. The results showed an increased antibody titer and may indicate that basil could be used as an immunostimulant (Godhwani et al, 1988). In Ayurvedic medicine, basil has been used to increase immunity and metabolic function and to treat respiratory problems. Other Actions O. sanctum root extract was found to increase swimming performance in mice. This study suggests that this effect may be due to a central nervous system stimulant and/or antistress activity (Maity et al, 2000). Basil may possess antioxidant properties as demonstrated by its radical scavenging activity (Yun et al, 2003; Berić, et al 2008). Product Availability Leaves (chopped and powdered), tea, tincture Plant Part Used: Leaves (fresh and dried) Dosages • Adult PO dried leaves (tea): 2.5 g in 1⁄2 cup water, strained, daily or bid • Adult PO tincture: 1-2 ml 3-5 times/day (1:5 dilution) (Smith, 2007) Contraindications Class 2b/2c/2d herb. Basil is not recommended for therapeutic use during pregnancy and breastfeeding and should not be given therapeutically to infants or toddlers. Basil should be used cautiously by persons with diabetes and those who use this herb for extended periods. Side Effects/Adverse Reactions ENDO: Hypoglycemia GI: Hepatic carcinoma Interactions Drug Antidiabetics, insulin: Basil (medicinally) may increase the hypoglycemic effects of insulin, antidiabetics; do not use concurrently. Lab Test Blood glucose: Basil may increase blood glucose levels. Adverse effects: Underline = life-threatening B Bay 52 Primary Chemical Components and Possible Actions Chemical Class Sesquiterpenes Volatile oil Individual Component Possible Action Linalool Estragole Analgesic Increased immunity; mutagenic Antioxidant Eugenol; Methyleugenol Triterpene, Methyl chavicol (Zhelijazkov et al, 2008) Flavonoid Phenylpropanes Caffeic acid Monoterpenes Antiulcer Cineol; Geraniol; Camphor; Ocimene Client Considerations Assess • Assess diabetic clients for the use of antidiabetics or insulin (see Interactions). • Assess diabetic clients for symptoms of hypoglycemia and hyperglycemia. Administer • Instruct the client to take basil PO either fresh or as a powder. Only the leaves should be used. Teach Client/Family • Caution the client not to use basil therapeutically during pregnancy and breastfeeding and not to give it therapeutically to infants or toddlers. One of the chemical components of basil, estragole, can produce mutagenic effects when taken in high levels during pregnancy. • Caution the client not to use basil for extended periods of time; it is a known mutagen. • Caution the client not to use basil concurrently with oral antidiabetic agents or insulin; hypoglycemia may occur. Bay (bay) Scientific name: Laurus nobilis Other common names: Bay laurel, bay leaf, bay tree, laurel, sweet bay, Roman laurel Origin: Bay is found in Mediterranean areas. Uses Bay is used as a rubefacient and as a treatment for rheumatic disorders, gastric ulcers, amenorrhea, colic, polyps, cancer, and spasms. Bay fruits are used in the treatment of uterine fibroids, cirrhosis, and joint pain (Duke, 2003). Bay has been = Pregnancy = Pediatric ! = Alert = Popular Herb Bay 53 used as a repellent for cockroaches (Verma et al, 1981), and as a cooling herb. Therapeutic use of bay is uncommon. B Actions Antiulcerogenic Action When researchers administered bay to rats with induced gastric ulcers, results indicated antiulcerogenic activity for bay extracts at 20% and 40% and an oily fraction of the seeds. Acute toxicity studies also found bay to be safe when used in this manner. Antidiabetes Action Bay has been shown to both stimulate and decrease the actions of glucose. Hypoglycemic activity has been reported for bay leaf extracts (Ashaeva et al, 1984). Other Actions The volatile oil of bay leaves has been shown to possess bactericidal and fungicidal activity (MacGregor et al, 1975). Wound healing activity was demonstrated in a study (Nayak et al, 2006). The study using rats showed that bay can be used to treat different types of wounds. The effects were assessed by rate of wound closure, period of epithelialization, content and histopathology of tissue granulation. Product Availability Creams (essential oil), extract, fruit, leaves (typically used as a spice), lotions (essential oil), soaps (essential oil) Plant Parts Used: Berries, leaves, oil Dosages • Adult PO: Dosage varies widely • Adult topical: apply creams, lotions, and soaps as desired Contraindications Class 1 herb. Until more research is available, bay should not be used therapeutically during pregnancy and breastfeeding. It should not be given therapeutically to children. Side Effects/Adverse Reactions GI: Impaction, perforation of gastrointestinal tract, severe gastrointestinal bleeding (whole intact leaf) INTEG: Contact dermatitis RESP: Asthma, dyspnea Interactions Drug CNS depressants, opioids: Bay may increase the action of CNS depressants, opioids; avoid concurrent use (Jellin et al, 2008). Antidiabetics, insulin: Bay may increase the hypoglycemic effects of insulin, antidiabetics; do not use concurrently. Lab Test Blood glucose: Bay may increase blood glucose levels. Adverse effects: Underline = life-threatening Bayberry 54 Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Volatile oil Eugenol Antistress; antiinflammatory; antioxidant Analgesic Bactericidal Linalool Alpha-pinene; Sabinene; Limonene; Piperidine; Cineole; Camphene; Phenylhydrazine; Geraniol Alpha-Phellandrene, Beta-Pinene (Sangun et al, 2007). Nandergine Lactone Catechin Proanthocyanidin Launobine Boldine Alkaloid Isodomesticine Neolitsine Costunolide; Laurenobiolide Reticulin Client Considerations Assess • Assess the reason the client is using this product. • Assess diabetic clients’ use of insulin or antidiabetics; monitor blood glucose levels (see Interactions). • Assess for symptoms of hypoglycemia or hyperglycemia. Administer • Instruct the client to take bay PO with a diabetic diet to enhance hypoglycemia. Teach Client/Family • Until more research is available, caution the client not to use bay during pregnancy and breastfeeding. Do not give bay to children. • Advise the client not to use bay concurrently with oral antidiabetics or insulin; hypoglycemia may occur. Bayberry (bay’beh-ree) Scientific name: Myrica cerifera Other common names: Candleberry, myrica, wax myrtle, spicebush, sweet oak, tallow shrub, vegetable tallow, waxberry, wax myrtle Origin: Bayberry is a shrub found in the southern and eastern regions of the United States. = Pregnancy = Pediatric ! = Alert = Popular Herb Bayberry 55 Uses Traditionally, bayberry has been used internally to treat diarrhea, jaundice, coughs, and colds, as well as to induce emesis, as an antipyretic, and for uterine bleeding. Topically, it is used to treat skin conditions (such as varicose veins, hemorrhoids) and ulcers, and to promote wound healing. It is also used as a douche for treatment of leukorrhea. Bayberry may be used as a gargle to relieve sore throats and gums. Contemporary use is eclectic. Bayberry is mostly used as an adjunct in formulas. Actions Almost no primary research is available on bayberry. Its possible actions include antipyretic and antibacterial effects (Paul, 1974). It is a stimulating, warming astringent with action similar to that of cinnamon. Choleretic activity and mineralocorticoid effects have also been reported (Duke, 2003). After bioassay, Myrica cerifera showed increased antithrombin activity (Chistokhodova et al, 2002). Product Availability Capsules: 450, 475 mg; fluid extract; tea Plant Parts Used: Dried root bark, flowers Dosages Skin Conditions • Adult topical: apply prn as a wash made by decoction Sore Throat • Adult gargle: use diluted in water (Smith, 2007), up to 3⫻/day Other • Adult PO cold infusion: 2-4 oz tid (Moore, 1996) • Adult PO fluid extract: 1-3 ml tid (either 1:2 or 1:5 dilution) (Moore, 1996) • Adult PO capsules: 1 cap up to 3⫻/day Contraindications Class 1 herb. Until further research is available, bayberry is not recommended for internal use during pregnancy and breastfeeding. It should not be given to children. Plant parts should not be consumed; hepatotoxicity can occur. Side Effects/Adverse Reactions CV: Hypertension, weight gain, hypernatremia GI: Nausea, vomiting, anorexia, gastric irritation, hepatotoxicity SYST: Allergic rhinitis, hypersensitivity, possible malignancies (injectable form) Interactions Drug Antihypertensives: Bayberry’s tannin content may increase sodium and water retention (Jellin et al, 2008). Adverse effects: Underline = life-threatening B 56 Bearberry Primary Chemical Components and Possible Actions* Chemical Class Individual Component Tannin Flavonoid glycoside Triterpene Myricitrin Myricadiol Myricalactone Myrica acid Taraxerol; Taraxerone Palmitic acid; Lauric acid Possible Action Astringent; wound healing; antiinflammatory Bile stimulant Mineralocorticoid; antibacterial Gum Starch Volatile oil *The constituents have not been reported to any great extent in primary research. Client Considerations Assess • Assess the reason the client is using this product. • Assess for cardiovascular disease (hypertension, tachycardia); monitor blood pressure, pulse, and weight weekly; monitor electrolytes. • Assess for hepatic disease; avoid use in hepatic disease. • Assess client’s weight and for edema; mineralocorticoid effect may occur. Administer • Instruct the client to take bayberry fluid extract PO. • Instruct the client to apply topically as needed. A hot compress can be made by pouring hot bayberry tea on a towel. Teach Client/Family • Caution the client not to use bayberry in children or those who are pregnant or breastfeeding until more research is available. • Advise the client that excessive use of bayberry in large doses can cause nausea and vomiting. Bearberry (behr’beh-ree) Scientific names: Arctostaphylos uva-ursi, Arctostaphylos coactylis, Arctostaphylos adenotricha Other common names: Arctostaphylos, bear’s grape, crowberry, foxberry, hogberry, kinnikinnick, manzanita, mountain box, rockberry, uva-ursi Origin: Bearberry is an evergreen found in rocky, mountainous regions. = Pregnancy = Pediatric ! = Alert = Popular Herb Bearberry 57 Uses Bearberry exerts antimicrobial effects against Escherichia coli, Proteus vulgaris, Enterobacter aerogenes, Streptococcus faecalis, Staphylococcus aureus, Salmonella typhi, and Candida albicans. Bearberry traditionally has been used as a diuretic (it is especially effective in cases of highly acidic urine), an antiinflammatory, and an astringent. Contemporarily, it is used as a decoction to treat urinary tract infections. Bearberry may be useful in premenstrual bloating. Actions Little primary research is available detailing the mode of action of bearberry. Antiseptic/Diuretic Action The diuretic effect of bearberry results from both its triterpene chemical components and arbutin, a hydroquinone. These components stimulate diuresis. Antiinflammatory Action One of the flavonoid components of bearberry, quercitrin, is responsible for decreased inflammation. Arbutin and urosolic acid may also be responsible for its antiinflammatory effects (Jahodar et al, 1985). Antimicrobial Action Research on the antimicrobial effect of bearberry has focused on arbutin. Arbutin has been reported to be effective as a diuretic and as a urinary antiseptic in moderate doses, but only if the urine is alkaline. Use of the whole plant is most effective because of the combined effects of arbutin and gallic acid, another chemical component (Constantine et al, 1966; Leung, Foster, 1996). Urosolic acid has been found to be effective against gram-positive and gram-negative bacteria and yeast (Kowalewski et al, 1976; Zaletova et al, 1986). Arctostaphylos uva-ursi has been shown to be effective against methicillin-resistant Staphylococcus aureus (Shimizu et al, 2001). Bearberry has shown an inhibitory effect against Arcobacter butzleri, A. cryaerophilus, and A. skirrowii (Cervenka et al, 2006). Methanol extracts showed strong antimicrobial activity. Product Availability Dried leaves, drops, fluid extract, powdered extract, tablets, tea Plant Part Used: Dried leaves Dosages • Adult PO fluid extract: 3-12 ml/day of a 1:1 dilution (Mills, Bone, 2005) • Adult PO freeze dried leaves: 500-1000 mg tid • Adult PO infusion: 1.5-4 g (1-2 tsp), infuse in cold water to decrease tannin extraction, take 1 cup tid • Adult PO powdered solid extract: 250-500 mg (expressed as 10% arbutin, one of the chemical components of bearberry) tid • Adult PO tincture: 6-12 ml/day of a 1:5 dilution (Mills, Bone, 2005) Contraindications ! Pregnancy category is 5; breastfeeding category is 4A. Bearberry should not be given to children younger than 12 years of age. Hepatotoxicity may occur in pediatric patients. Bearberry should be used cautiously by persons with electrolyte imbalances, renal disease, acidic urine, constipation, iron Continued Adverse effects: Underline = life-threatening B 58 Bearberry Contraindications—cont’d deficiency, anemia, malnutrition due to high tannin level, and disorders involving gastrointestinal irritation. It is not intended for prolonged use unless used under the direction of an experienced herbalist. Side Effects/Adverse Reactions In very high doses only. GI: Nausea, vomiting, anorexia, hepatotoxicity GU: Discolored urine (dark green) INTEG: Cyanosis Toxicity: Tinnitus, vomiting, seizures, cardiovascular collapse, delirium, shortness of breath, feeling of suffocation Interactions Drug Diuretics: Concurrent use of bearberry and diuretics can lead to electrolyte loss, primarily hypokalemia. NSAIDs: Bearberry may increase the effect of NSAIDs. Urine acidifiers: Urine acidifiers may inactivate bearberry; do not use concurrently. Pharmacology Pharmacokinetics Very little is known about the pharmacokinetics in humans. In one study examining the pharmacokinetics of the chemical components of bearberry, six healthy clients drank a tea made from uva-ursi and their urine was subsequently analyzed. After 3 hours, 53% of the arbutin equivalents were recovered in the urine, and after 3 to 6 hours, another 14% of the other hydroquinones were excreted (Paper et al, 1993). Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Hydroquinone Arbutin Methylarbutin Antiseptic; astringent; antiinflammatory; antibacterial, antifungal Antibacterial Tannin Triterpene Iridoid monoterpene Piceoside Phenol carboxylic acid Flavonoid Corilagin Monoglucoside; Methylarbutin Gallo; Ellgic; Condensed Diuretic Monotropein Gallic acid Quercitrin Myricitrin; Hyperoside Antiinflammatory Volatile oil = Pregnancy = Pediatric ! = Alert = Popular Herb Bee Pollen 59 Client Considerations Assess • Determine the reason the client is using bearberry. • Assess for the use of urinary acidifiers and diuretics. If the client is using diuretics, monitor electrolytes (see Interactions). • Assess urine alkalinity. Urine may need to be alkaline in order for bearberry to be effective. ! • Assess for signs and symptoms of toxicity: tinnitus, vomiting, seizures, change in cardiovascular status, hepatotoxicity. Administer • Instruct the client to take dried leaves PO. The berries should not be used. Teach Client/Family • Inform the client that pregnancy category is 5 and breastfeeding category is 4A. • Caution the client not to use bearberry in children younger than 12 yr of age. • Advise client that bearberry may turn urine green-brown. Bee Pollen (bee pah’lun) Scientific name: Apis mellifera (source organism) Other common names: Buckwheat pollen, maize pollen, pine pollen, pollen pini, puhuang, rape pollen, royal jelly, songhuafen, typha pollen Origin: Bee pollen is available throughout the world. Uses Bee pollen is used to treat asthma, prostatitis, impotence, bleeding gastric ulcers, and high altitude sickness. It is also used to desensitize allergies and to increase appetite immunogenic effects and energy level thereby combating fatigue and depression. Topically, bee pollen is used in skin products and for skin disorders such as eczema and diaper rash (Jellin et al, 2008). Investigational Uses Studies are underway to determine the effectiveness of bee pollen in treating cancer, menopausal symptoms, hypercholesteremia, and heart disease. Actions Bee pollen has been used for many years as a food source in times of scarcity. Its high nutrient content can sustain people and animals when food is not available. Gastric Protective Action In a study of patients with bleeding gastric ulcers (Georgieva et al, 1971), 40 patients were given 250 mg of bee pollen bid. The patients exhibited a positive response, with ulcers showing signs of healing. Adverse effects: Underline = life-threatening B 60 Bee Pollen Altitude Sickness Prevention Chinese research has investigated the use of bee pollen to prevent altitude sickness by testing rats and mice exposed to low partial-pressure oxygen to simulate 12,000 meters above sea level. Some rats and mice were given no bee pollen, while others were fed various bee pollen species. Those fed bee pollen proved to have a higher survival rate than those not fed bee pollen. In another 2-year study using humans (Peng et al, 1990), some participants were given bee pollen over a period of 3 to 7 days before a change in altitude to more than 5000 meters above sea level. As compared with individuals who received no bee pollen, these individuals showed either no adverse reaction or a greatly lessened reaction to the rise in altitude. Thus bee pollen appears to increase the ability to adapt to a high-altitude environment. Antiallergy Action In folk medicine, bee pollen is sometimes given to individuals with allergies to stimulate desensitization. Other Actions Fifty-five postmenopausal women with menopausal symptoms were treated with Melbrosia for 3 months. Menopausal evaluation tool and psychological questionnaires were given and cardiovascular disease markers in blood were evaluated at the beginning and end of the study. There was a significant reduction in the Kupperman score, Zerssen’s Symptoms List, and Zung Depression Score (Georgiev et al, 2004). Product Availability Bars; capsules: 500, 1000 mg; granules: 300 mg; liquid; tablets: 500, 1000 mg; wafers; source: bee pollen is a combination of flower pollen, nectar, and the digestive juices of the worker honeybee Apis mellifera. Dosages • Adult PO: 500-1000 mg tid 1⁄2 hr before meals Contraindications Bee pollen should not be used by persons with pollen allergy or diabetes. Persons with known pollen allergy should be tested for allergic reaction before using bee pollen products. Avoid use in hepatic disease. Side Effects/Adverse Reactions GI: Nausea, diarrhea, vomiting, anorexia, hepatotoxicity, acute hepatitis (Jellin et al, 2008) INTEG: Rash, allergic reactions, hypersensitivity SYST: Anaphylaxis Interactions Drug Antidiabetics, insulin: Bee pollen decreases the effectiveness of insulin, antidiabetics, and increases hyperglycemia; do not use concurrently. Lab Test PT, ALT, AST, LDH, bilirubin, alkaline phosphatase: Bee pollen may increase these tests. = Pregnancy = Pediatric ! = Alert = Popular Herb Benzoin 61 Primary Chemical Components and Possible Actions Chemical Class Protein Carbohydrate Mineral Fatty acid Vitamin Flavonoid Phytosterin Nicotinic acid Riboflavin Ash Individual Component Possible Action Glucose; Fructose Alpha-linolenic acid; Linolenic acid B complex; C Client Considerations Assess • Assess the reason the client is using this product. • Assess for allergies to bee pollen before using; anaphylaxis may occur. Client should be tested for an allergic reaction to the particular bee pollen to be used. • Assess for hepatic disease and diabetes; avoid use in these conditions. • Assess the client for use of antidiabetes agents or insulin; bee pollen may decrease the effectiveness of these products (see Interactions). Administer • Instruct the client to take bee pollen PO before meals. • Instruct the client to store bee pollen in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that bee pollen may be used during pregnancy and breastfeeding, and may be given to children. • Caution the client that allergic reactions can be severe in individuals with sensitivity to bee pollen. • Instruct clients taking oral antidiabetes agents or insulin to monitor blood glucose often. Benzoin (behn’zuh-wun) Scientific names: Styrax benzoin, Styrax paralleloneurus, Styrax tonkinesis Other common names: Benjamin tree, benzoe, benzoin tree, gum benjamin, Siam benzoin, Sumatra benzoin Origin: Benzoin is a resin from the trees of genus Styrax. Uses Benzoin is used topically to promote wound healing and as an antiseptic, a mucosal protectant, and an adhesive. It is also used as an expectorant and as an inhalant for bronchial disorders. Adverse effects: Underline = life-threatening B Benzoin 62 Actions Benzoin has been used topically for many years as an antiseptic and a skin protectant. However, many other products are just as effective. There is little evidence for its other uses. Product Availability Cream, lotion, ointment, tincture Plant Part Used: Bark gum resin Dosages and Routes • Adult and child inhalant: 5 ml benzoin gum/1 pt water; breathe vapors or place tincture directly on handkerchief (Jellin et al, 2008) • Adult and child topical: may be applied to the affected area q2hr-q4hr; test a small area before applying to larger area; a few drops of benzoin tincture q2hr (Jellin et al, 2008) Contraindications Class 1 herb. Benzoin should not be used internally or by those with hypersensitivity to this herb. Side Effects/Adverse Reactions GI: Gastritis, gastrointestinal hemorrhage (ingestion) INTEG: Rash, allergic reactions, hypersensitivity, contact dermatitis RESP: Asthma (inhalation) SYST: Anaphylaxis Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Acid Benzoic acid Cinnamic acid Antiseptic; protectant Client Considerations Assess • Assess for hypersensitivity reactions, including anaphylaxis. Benzoin use should be discontinued if any hypersensitivity reactions occur. • Assess for gastrointestinal bleeding: dark tarry stools, frank blood, gastritis, abdominal pain; do not use internally. Administer • Instruct the client to use benzoin as a topical or an inhalant only; skin may become discolored. Teach Client/Family • Caution the client that gastritis and gastrointestinal hemorrhage can occur if benzoin is taken internally. = Pregnancy = Pediatric ! = Alert = Popular Herb Beta-Carotene 63 Beta-Carotene (bay’tuh kare’uh-teen) Scientific names: Beta-Carotene Other common names: A-Beta-Carotene, Betacarotene, Carotenes, caroentoids, provitamin A Origin: Beta-carotene is available naturally in fruits and vegetables. Synthetically, it may be manufactured from fungi or algae. Uses Beta-carotene is used for erythropoietic protoporphyria (EPP); age-related macular degeneration (AMD); breast, gastric, ovarian, prostatic, and colorectal cancer; exercise-induced asthma; osteoarthritis; sunburn; cervical dysplasia; and hypertension. Actions Anticancer Action Beta-carotene is a vitamin A precursor and antioxidant. It is thought to reduce the risks of cancer. However, two double-blind, placebo-controlled studies with approximately 50,000 subjects found an increased risk of cancer over that in the placebo controlled group (Albanes, 1995; Omenn, 1996). When the study was reviewed, many of the subjects were found to be smokers. Therefore, as noted above, smokers should not use increased beta-carotene. There are numerous other studies in support of beta-carotene for preventing cancers, including gastric and breast (Jellin et al, 2008). Action Against Age-Related Macular Degeneration There are many studies (Age-Related Eye Disease Study Research Group, 2001; West, 1994) that identify the beneficial effects of beta-carotene in age-related macular degeneration, especially when combined with other supplements such as zinc, vitamin C, and vitamin E. Product Availability Tablets, capsules Plant Parts Used: Whole fruit or vegetable Dosages AMD • Adult PO: 15 mg beta-carotene given with 500 mg vitamin C, 80 mg zinc oxide, and 400 units vitamin E daily Contraindications Beta-carotene should not be used after angioplasty, or in those who have asbestos exposure or those who smoke. Side Effects/Adverse Reactions INTEG: Yellow-orange skin color Continued Adverse effects: Underline = life-threatening B Betel Palm 64 Interactions Drug Alcohol, bile acid sequestrants, colchicine, mineral oil, neomycin (PO), olestra, orlistat, proton pump inhibitors: Beta-carotene is decreased by these agents. Lab Test HDL-2: Beta-carotene may decrease HDL-2 levels. Client Considerations Assess • Assess the reason the client is using beta-carotene. • Identify if the client has been exposed to asbestos, has had an angioplasty recently or is a smoker, since these persons should not supplement beta-carotene. • Identify if the client is using alcohol, olestra, bile acid sequestrants, mineral oil, neomycin (PO), orlistat, proton pump inhibitors, since these agents decrease betacarotene levels. Administer • Keep beta-carotene in a dry area, away from direct sunlight. Teach Client/Family • Teach the client that beta-carotene supplements should not be used in those who have recently had angioplasty, who have been exposed to asbestos, or who smoke. Betel Palm (bee’tul pahlm) Scientific name: Areca catechu Other common names: Areca nut, betal, betal nut, chavica betal, hmarg, maag, paan, pan masala, pan parag, pinang, pinlag, supai Origin: Betel palm is a palm found in China, India, the Philippines, and the tropical regions of Africa. Uses Betel palm is used to treat depression, schizophrenia, respiratory conditions, cough, and sore throat. It is also used as a psychostimulant and digestive aid. Betel palm is used recreationally as a CNS stimulant. Actions Psychiatric Action Betel has been used for centuries in Asia as a psychostimulant. However, studies of the rat brain have shown that betel inhibits monoamine oxidase (MAO). The aqueous fraction is the most potent inhibitor of MAO-A. Several older studies have also demonstrated the antidepressant action of betel palm (Dar et al, 1997; Van der Hyden et al, 1987). Betel chewing is shown to decrease symptomatology in schizophrenia (Sullivan et al, 2000). = Pregnancy = Pediatric ! = Alert = Popular Herb Betel Palm 65 Parasympathetic Nervous System Action Betel palm has been shown to increase muscarinic action, salivation, and central nervous system stimulation in mice. When chewed, betel palm also lowers heart rate and induces euphoria. Thyroid Function Action A study of mice given betel leaf extract demonstrated a dual role on thyroid function (Panda et al, 1998). At high doses, the leaf extract increased T4 (thyroxine) and decreased T3 (triiodothyronine), whereas at lower doses the opposite was true. High doses also increased lipid peroxidation. Thus, betel leaf has been shown to produce both inhibitory and stimulatory effects on thyroid function. Product Availability Leaves, nut, pressed juice Plant Parts Used: Leaves, nut Dosages Sore Throat • Adult PO gargle: use prn Other • Adult PO: 2 g fresh nut, chew for 15 min or more and spit out • Adult PO: roll leaves and place between teeth and gums/lips Contraindications Betel palm should not be used during pregnancy and breastfeeding, and should not be given to children. Clients with oral or esophageal cancers, ulcers, esophagitis, or renal disease should avoid its use. Side Effects/Adverse Reactions CNS: Stimulation, facial flushing, fever, dizziness, seizures, acute psychosis, anxiety, insomnia, restlessness CV: Palpitations, tachycardia or bradycardia EENT: Red stains on teeth, oral leukoplakia, oral submucosal fibrosis, oral carcinogenesis (chewing) (Chen et al, 1999; Norton, 1998; Molin et al, 2007), blurred vision GI: Nausea, vomiting, diarrhea or constipation, red feces, abdominal cramping/ pain; intestinal epithelial cell lining alteration (Kumar et al, 2000) RESP: Increased asthma symptoms Interactions Drug Alcohol: Betel palm increases the effects of alcohol; do not use concurrently. Antiglaucoma agents: Betel palm decreases the action of antiglaucoma agents; do not use concurrently. Beta-blockers, calcium channel blockers, cardiac glycosides (digoxin): Betel palm increases the action of beta-blockers, calcium channel blockers, cardiac glycosides; do not use concurrently. Cholinergics: Betel palm may increase the effects of cholinergics; avoid concurrent use (Jellin et al, 2008). MAOIs: Betel palm may increase chance of hypertensive crisis. Continued Adverse effects: Underline = life-threatening B 66 Betel Palm Interactions—cont’d Neuroleptics: Extrapyramidal symptoms can occur when betel palm is combined with neuroleptics; do not use concurrently (Fugh-Berman, 2000). Food Tyramine foods: Betel palm may increase the chance of hypertensive crisis. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Alkaloid Arecoline Parasympathomimetic; sympathomimetic; monoamine oxidase inhibitor Arecaidine; Arecaine; Arecolidine; Guvacine; Guvacoline; Isoguvacine Phenol Volatile oil Tannin Chavicol; Chaibetol; Cadinene; Allylpyrocatechol Catechin type Wound healing; antiinflammatory Client Considerations Assess • Check the client’s mouth for changes such as leukoplakia and fibrosis. • Assess for cardiac arrhythmias, milk-alkali syndrome, asthma, and central nervous system changes. • Assess for medications used by the client: antiglaucoma agents, beta-blockers, calcium channel blockers, cardiac glycosides, cholinergics, MAOIs, neuroleptics (see Interactions). • Assess for alcohol use. Administer • Betel palm PO is used as either the fresh nut, which is chewed or used as a gargle, or the leaves. However, there are many dangerous side effects. Teach Client/Family • Caution the client not to use betel palm in children or in those who are pregnant or breastfeeding. • Caution the client that chewing the root over long periods of time can lead to mouth fibrosis and oral carcinoma. = Pregnancy = Pediatric ! = Alert = Popular Herb Bethroot 67 Bethroot (bayth rewt) Scientific names: Trillium erectum, Trillium grandiflorum Other common names: Birthroot, cough root, ground lily, Indian balm, Indian shamrock, Jew’s harp, purple trillium, rattlesnake root, snake bite, squaw root, stinking benjamin, three-leafed trillium, trillium pendulum, wake-robin Origin: Bethroot is a member of the lily family found in Canada and parts of the United States. Uses Bethroot is used externally to treat insect bites, hemorrhoids, hematomas, varicose veins, and ulcers. It is used as a douche to treat leukorrhea. Internally, bethroot is used to relieve pain and treat dysmennorrhea and heavy menses (Jellin et al, 2008). Traditionally, bethroot has been used as an expectorant and to treat bleeding, snake bites, and skin irritation. This plant is on the endangered species list in many states and therefore should not be harvested from the wild. Actions Very little research is available for bethroot. Astringent Action The astringent activity of bethroot may account for its ability to control bleeding by constricting the blood vessels (Duke, 2003). This may be the result of the chemical component saponin. Antifungal Action The saponins in bethroot are believed to exert significant antifungal effects (Duke, 2003). Product Availability Extract, powder, powdered root Plant Parts Used: Leaves, rhizome, roots Dosages Astringent/Expectorant • Adult PO fluid extract: 30 minims Bleeding • Adult PO tincture: 1-3 ml q 15 min, up to 4 doses daily Other • Adult PO powder: 1 tsp powder/1 pt water prn Contraindications Class 2b herb. Because it can cause uterine stimulation, bethroot should not be used during pregnancy. It should not be given to children or used during breastfeeding until more research is available. Side Effects/Adverse Reactions CV: Cardiotoxicity—change in blood pressure, pulse, ECG GI: Nausea, vomiting, anorexia, gastrointestinal irritation, abdominal cramping HEMA: Constriction of blood vessels Continued Adverse effects: Underline = life-threatening B Betony 68 Interactions Drug Cardiac glycosides (digoxin): Bethroot may decrease the effects of cardiac glycosides; use together cautiously. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Saponin Trillin; Trillarin; Kryptogenin; Chlorogenin; Nologenin Convallamerin-like Astringent; expectorant, antifungal Cardiotoxicity Glycoside Tannic acid starch Client Considerations Assess • Assess the reason the client is using this product. ! • Assess for cardiotoxicity: monitor blood pressure, pulse, and changes in cardiac status. • Assess for use of cardiac glycosides (see Interactions). • Assess for change in respiratory status (expectorant use) or decrease in surface bleeding. Administer • Instruct the client to take bethroot PO as a tincture or an expectorant. • Store bethroot in a cool, dry, place, away from heat and moisture. Teach Client/Family • Caution the client not to use bethroot during pregnancy because it can induce labor. Until more research is available, caution the client not to use this herb during breastfeeding and not to give it to children. Betony (beht’nee) Scientific name: Stachys officinalis L. (Trevisan) Other common names: Bishopswort, wood betony Origin: Betony is a member of the mint family found in the southern and western regions of Europe and Siberia. Uses Betony is used to treat seizures, palpitations, diarrhea, asthma, headaches, anxiety, bronchitis, wounds, renal stones, and hypertension. = Pregnancy = Pediatric ! = Alert = Popular Herb Betony 69 Actions Very little research exists for betony. B Antihypertensive Action The antihypertensive effect of betony may result from glycosides present in the herb. Stachydrine, one of the chemical components in this herb, is a systolic depressant. Other Actions The astringent and antidiarrheal actions of betony are a result of its high tannin content. Product Availability Capsules, tea, tincture Plant Parts Used: Flowers, leaves Dosages • Adult PO tea, infusion, gargle, or smoked • Adult PO tincture: 2-4 ml bid-tid Contraindications Class 1 herb. Because uterine stimulation can occur, betony should not be used during pregnancy. Do not give this herb to children, and avoid using it during breastfeeding until more research is available. Side Effects/Adverse Reactions GI: Hepatotoxicity, gastrointestinal irritation, nausea, anorexia Interactions Drug Antihypertensives: The hypotensive effects of betony may increase the action of antihypertensives; avoid concurrent use. Primary Chemical Components and Possible Actions Chemical Class Individual Component Flavonoid Glycoside Possible Action Astringent; antidiarrheal; wound healing; antiinflammatory Tannin Stachydrine Betaine; Betonicide; Acetoside; Campneoside; Forsythoside B Systolic depressant Leucosceptoside B Adverse effects: Underline = life-threatening Bilberry 70 Client Considerations Assess • Assess the reason the client is using this product. • Assess the client’s use of antihypertensives; monitor blood pressure, pulse, and character (see Interactions). ! • Assess hepatic function test results (AST, ALT, bilirubin) to identify hepatic damage. If hepatic function levels are increased, discontinue use of this herb. Administer • Instruct the client to take betony PO as a tea, tincture, or infusion. • Instruct the client to store betony in a cool, dry place, away from heat and moisture. Teach Client/Family • Because it can stimulate the uterus, caution the client not to use betony during pregnancy (Chevallier, 1996). Advise the client to avoid the use of this herb during breastfeeding and to avoid giving it to children until more research is available. • Advise the client to use small doses, as large doses can cause significant GI irritation (Jellin et al, 2008). Bilberry (bil’beh-ree) Scientific name: Vaccinium myrtillus Other common names: Airelle, bilberry, black whortle, bleaberry, bog bilberry, European blueberry, huckleberry, trackleberry, whinberry, whortleberry Origin: Bilberry is found in the central, northern, and southeastern regions of Europe. Uses Bilberry has been used to improve night vision; to prevent cataracts, macular degeneration, and glaucoma; to treat varicose veins and hemorrhoids; to prevent hemorrhage after surgery; and to prevent and treat diabetic retinopathy and myopia. Other uses for bilberry include decreasing diarrhea, dyspepsia in adults or children, controlling insulin levels, as a diuretic and as a urinary antiseptic. Actions Research is more extensive for bilberry than for many other commonly used herbs. Areas of research include the use of bilberry for treating circulatory disorders, glaucoma, cataracts, macular degeneration, poor night vision, and diabetic/hypertensive retinopathy. Studies have also focused on its use as an antilipemic. Ophthalmologic Action Studies indicate that night vision improved significantly when individuals were given bilberry. Participants experienced improved night visual acuity, improved adjustment to darkness, and restoration of acuity after glare. Further research has confirmed the findings of the previous studies (Muth et al, 2000). These actions may be due to the affinity of bilberry for the retina. In addition, bilberry may be useful for the prevention and treatment of glaucoma, cataracts, and macular degeneration of the eye (Bravetti, 1989). Chemical components in bilberry may alter the collagen structure = Pregnancy = Pediatric ! = Alert = Popular Herb Bilberry 71 of the eye and decrease intraocular pressure. The collagen-stabilizing effects of Vaccinium may offer protection against glaucoma and the development of cataracts and macular degeneration of the eye. Antidiabetic Action The anthocyanoside components of bilberry have been shown to decrease hyperglycemia in dogs (Bever et al, 1979). Their effect is somewhat weaker than that of insulin. However, a single dose has an extended duration of up to several weeks (Bever et al, 1979). Other Actions Some of the other proposed actions of bilberry include its lipid-lowering effect and its ability to treat inflammatory joint disease, microscopic hematuria, and varicose veins. Studies in rats have shown that the anthocyanosides promote collagen synthesis and inhibit collagen loss. Bilberry also has been studied for its antioxidant effect (Milbury et al, 2007; Bao et al, 2008). Product Availability Capsules: 60, 80, 120, 450 mg; fluid extract; fresh berries, dried berries; liquid; tincture; dried roots, dried leaves Plant Parts Used: Berries, roots, leaves Dosages Cataracts • Adult PO extract: 40-80 mg standardized to 25% anthocyanosides (anthocyanadin) tid (Murray, Pizzorno, 1998) Diabetes Mellitus • Adult PO extract: 80-160 mg standardized to 25% anthocyanosides tid (Murray, Pizzorno, 1998) Glaucoma • Adult PO extract: 80 mg standardized to 25% anthocyanosides tid (Murray, Pizzorno, 1998) Other • Adult PO fresh berries: 55-115 g tid • Adult topical decoction: 1⁄8-1⁄4 ounce (5-8 g) of crushed dried fruit in 150 ml of water, boil 10 min, strain, use warm • Adult gargle/mouthwash: prepare decoction 10%, rinse or gargle Contraindications Pregnancy category is 1; breastfeeding category is 2A. Bilberry has been used traditionally to help stop breastfeeding (Blumenthal, 1998). Avoid large doses in those with clotting/bleeding disorders. Side Effects/Adverse Reactions GI: Constipation (large consumption of dried fruits) Interactions Drug Anticoagulants (heparin, warfarin), NSAIDs: Bilberry may increase the action of anticoagulants, NSAIDs; use caution if taking concurrently. Continued Adverse effects: Underline = life-threatening B 72 Bilberry Interactions—cont’d Antidiabetics: Bilberry may increase hypoglycemia; use caution if taking concurrently. Antiplatelet agents: Bilberry may cause antiaggregation of platelets; use caution if taking concurrently. Aspirin: Bilberry may increase the anticoagulation action of aspirin; use caution if taking concurrently. Insulin: Bilberry leaves may significantly decrease blood glucose levels; monitor carefully. Iron: Bilberry interferes with iron absorption; avoid concurrent use. Herb Hypoglycemic herbs (devil’s claw, fenugreek, garlic, horse chestnut, ginseng [Panax, Siberian]): Bilberry may increase hypoglycemic effect when used with hypoglycemic herbs (Jellin et al, 2008). Lab Test Blood glucose: Bilberry may decrease blood glucose. Pharmacology Pharmacokinetics Peak 15 minutes; eliminated via bile. Therapeutic properties vary by harvest area (Burdulis et al, 2007). Primary Chemical Components and Possible Actions Chemical Class Individual Component Flavonoid Acid, phenolic, organic Pectin Anthocyanosides Rutin Disaccharides Possible Action Astringent; antiinflammatory; antidiarrheal Tannin Cinnamic acid; Benzoic acid Antioxidant; increased circulation; antiaggregation of platelets; antianginal; antiulcerative; gastroprotective Lowered intraocular pressure Delphinidin, Cyanidin (Du et al, 2004) Client Considerations Assess • Assess whether the client is taking anticoagulants, antidiabetic agents, or antiplatelet agents. Bilberry is known to induce hypoglycemia, anticoagulation, and antiplatelet aggregation (see Interactions). = Pregnancy = Pediatric ! = Alert = Popular Herb Birch 73 • Monitor improvement in vision if using to treat cataracts or glaucoma. • Monitor blood glucose if using to treat diabetes mellitus. B Administer • Instruct the client to take bilberry PO in the form of tincture, capsules, fluid extract, or fresh berries. Teach Client/Family • Inform the client that pregnancy category is 1 and breastfeeding category is 2A. • Advise the client to notify the herbalist if diarrhea persists for more than 4 days. ! • Advise the client that use of higher-than-recommended doses or use of this herb for extended periods will result in toxicity, and may result in death (leaves). Birch (burch) Scientific names: Betula alba, Betula pendula, Betula verrucosa, Betula pubescens, Betula lenta Other common names: Birch tar oil, birch wood oil, black birch, cherry birch, sweet birch oil, white birch Origin: Birch is found in Russia, throughout Europe, and in the eastern region of the United States. Uses Birch is used internally as an analgesic, a diuretic, and to treat urinary stones and gout. It is also used as a topical treatment for arthritic joints, aching muscles, and muscle spasms. Birch can also be applied externally for sores and boils. Investigational Uses Studies are underway to determine the effectiveness of birch as an antioxidant used to decrease free radicals and as a prostate cancer treatment. Actions Almost no research is available on birch. Existing information on its uses comes from anecdotal evidence taken from traditional herbal medicine. However, birch is thought to possess significant antioxidant activity (Matsuda, 1998), and one study investigated its diuretic effects (Bisset, 1994). A newer study discussed in Saxena (2006) identified the use of birch bark in prostate cancer. Preliminary tests show that betulonic acid, from betulinol, discourages human prostate cancer cells from dividing and allows those cells to die. Product Availability Decoction, dried bark, essential oil, tea Plant Parts Used: Bark, leaves, twigs Dosages • Adult PO tea: boil 2-3 g (Blumenthal, 1998) bark and twigs for 1 hr; strain; use tid • Adult topical: apply only to area to be treated; to prevent contact dermatitis, do not apply essential oil to broken skin Adverse effects: Underline = life-threatening 74 Birch Contraindications Class 1 herb. Until more research is available, birch should not be used internally by persons who are pregnant or breastfeeding, and should not be given to children. Birch should not be used by persons with hypersensitivity to it or with other allergic conditions, or by persons with congestive heart failure, hypertension (Jellin et al, 2008), or severe kidney disease. Side Effects/Adverse Reactions SYST: Allergic reactions Interactions Drug Diuretics: Birch may decrease the action of diuretics. Herb Celery: Birch used with celery may cause cross-sensitization. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Flavonoid Quercetin Antioxidant; antiinflammatory Hyperoside; Avicularin Birch tar oil Turpentine oil Creosol Betulin Antitumor action; anticancer action Diuretic Tannin proanthocyanidins Client Considerations Assess • Assess the reason the client is using this product. • Assess for allergic reactions, rash, wheezing, and chest tightness. If present, administer antihistamine or other appropriate therapy. • Monitor cardiac parameters, increased blood pressure. Administer • Instruct the client to take birch PO as a tea or infusion, or to apply topically. Teach Client/Family • Caution the client not to use birch internally in children or those who are pregnant or breastfeeding until more research is available. • Because contact dermatitis may occur, advise the client to avoid direct skin contact with birch by using a carrier oil, to avoid use on broken skin, and to first test the ! oil on a small area. • Keep sweet birch essential oil away from children. It may result in a fatal reaction when applied to the skin. = Pregnancy = Pediatric ! = Alert = Popular Herb Bistort 75 Bistort (bis-tawrt’) Scientific name: Polygonum bistorta Other common names: Adderwort, common bistort, Easter ledges, Easter mangiant, knotweed, oderwort, osterick, patience dock, snakeroot, snakeweed, twice writhen Origin: Bistort is found in Europe and is cultivated in North America. Uses Bistort is used externally to treat bites, stings, burns, snakebites, and hemorrhoids. It is used internally to treat peptic ulcers, irritable bowel syndrome, ulcerative colitis, and diarrhea. Investigational Uses Research is ongoing into the potential use of bistort as an antiviral to induce interferon-like activity. Actions In traditional herbal medicine, bistort has been used both internally and externally to treat a variety of conditions. Currently, research is focused on the antiviral and interferon activity of the Polygonum species. One study focused on the antiinflammatory action of bistort (Duwiejua et al, 1999). In this study, two compounds with significant antiinflammatory properties were isolated. Another study has shown a substance that is able to induce interferon-like activity (Smolarz et al, 1999). When bistort was evaluated (Manoharan et al, 2007) for cytotoxic activity against various cancers, it showed moderate to very good cytotoxic activity. Product Availability Powder, roots (cut and dried), tea Plant Parts Used: Leaves, rhizome, roots Dosages • Adult PO: 1 tsp powdered root in 1 cup boiling water, take as often as tid • Adult topical: use powder and water to make a poultice, apply to area prn Contraindications Class 1 herb. Until more research is available, bistort should not be used during pregnancy and breastfeeding. Side Effects/Adverse Reactions GI: Gastrointestinal irritation, hepatotoxicity Interactions Drug Oral drugs: Bistort given with oral drugs may cause precipitation of some drugs; separate by the longest period of time as practical (Jellin et al, 2008) Adverse effects: Underline = life-threatening B Bitter Melon 76 Primary Chemical Components and Possible Actions Chemical Class Leaves Contain Tannin Phenol Roots Contain Flavonoids Starch Gallic acid Phlobaphene Anthranoide Individual Component Possible Action Bistortaside A (Liu et al, 2006); Friedelanol (Duwiejua, 1999) Wound healing; antiinflammatory; astringent, antidiarrheal Emodin Laxative Client Considerations Assess • Assess the reason the client is using this product. • Assess the client’s gastrointestinal symptoms (cramping, diarrhea, bleeding). ! • Assess hepatic function test results; hepatotoxicity can occur. Administer • Instruct the client to take bistort PO no more often than tid. • Instruct the client to use bistort topically as a poultice to decrease inflammation. Teach Client/Family • Until more research is available, caution the client not to use bistort during pregnancy and breastfeeding. Bitter Melon ! (bi’tur meh’lun) Scientific name: Momordica charantia L. Other common names: Balsam apple, balsam pear, bitter cucumber, bitter gourd, bitter pear, carilla cundeamor, karolla Origin: Bitter melon is an annual and is cultivated in Africa, India, South America, and parts of Asia. Uses Bitter melon is used as an antipyretic, an anthelmintic, and a laxative. It may also be used for diabetics, ulcers, colitis, and renal stones. = Pregnancy = Pediatric ! = Alert = Popular Herb Bitter Melon 77 Investigational Uses Researchers are experimenting with the use of bitter melon as an antifungal and androgenic, as well as its use as a treatment for HIV and other viral infections, malaria, Helicobacter pylori, diabetes, and infertility. Actions Antidiabetes Action Several studies have focused on the hypoglycemic effects of bitter melon (Oishi et al, 2007; Dans et al, 2007; Roffey et al, 2007; Harinantenaina et al, 2006). One study of 100 participants with moderated non–insulin-dependent diabetes showed a significant reduction in fasting and postprandial blood glucose levels with the use of bitter melon (Ahmed et al, 1999). The diabetic action of this herb is thought to result from its ability to increase the functioning of beta cells in the pancreas (Ahmed et al, 1998). Another study demonstrated that the mechanism of action of this herb could be attributed in part to the increased glucose utilization of the liver, rather than an insulin secretion effect (Sarkar et al, 1996). Antiinfective Action One study noted a marked inhibition of HIV-1 replication in participants with T-lymphocytes that were acutely but not chronically infected with HIV-1 (Zheng et al, 1999). Another study focused on the antimalarial effects of M. charantia. A total of 46 different plant species were studied in vitro for their antimalarial activity on Plasmodium falciparum chloroquine-resistant malaria. M. charantia was shown to be moderately effective, as were other species. However, another study showed no antimalarial effects for bitter melon (Ueno et al, 1996). Product Availability Aqueous extract, juice, tincture, fruit Plant Parts Used: Fruit, leaves, seed oil, seeds Dosages • Adult PO aqueous extract: 15 g/day (Murray, Pizzorno, 1998) • Adult PO juice: 2 oz/day (Murray, Pizzorno, 1998) Contraindications ! Because it may cause uterine contractions and bleeding, bitter melon should not be used during pregnancy. Bitter melon also should not be used during breastfeeding or by persons with hypersensitivity to it. When taken internally, the seeds are toxic to children. Side Effects/Adverse Reactions GI: Hepatotoxicity, nausea, vomiting, anorexia Interactions Drug Oral hypoglycemics: Bitter melon may increase the effects of oral hypoglycemics; use together cautiously. Lab Test Blood glucose: Bitter melon may decrease test values (if taken with antidiabetics) Glycosylated hemoglobin (A1c): Bitter melon may decrease A1c in diabetics after 7 wk of therapy (Jellin et al, 2008) Adverse effects: Underline = life-threatening B 78 Bitter Orange Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Triterpenoid Steroid glycoside Momordincines Momordin Charantin Antifungal Hypoglycemia Hypoglycemia Toxicity Polypeptide P3 Vicine Proteins Serine protease inhibitors Flavonoid aglycones Alpha, Beta-Momordarin BGIA, BGTI Taxifolin, Quercetin, Kaempferol Myritcetin, Luteolin, Isorhamnetin, Rhamnetin (Smolarz, 2002) Client Considerations Assess • Assess the reason the client is using this product. • Assess blood glucose (both fasting and postprandial) while the client is taking this herb. • Assess all medications taken by diabetic clients (see Interactions). • Assess for gastrointestinal symptoms: nausea, vomiting, anorexia; if these occur, discontinue bitter melon. Administer • Instruct the client not to use the red arils (outer coverings) around the seeds if taking PO. Teach Client/Family ! • Caution the client not to use bitter melon during pregnancy; uterine stimulation and bleeding can occur. This herb should be avoided during breastfeeding. • When taken internally, the seeds are toxic to children. Bitter Orange (bit’uhr owr’uhj) Scientific name: Citrus aurantium Other common names: Bigarade orange, nerol, Seville orange, sour orange Origin: Bitter orange is grown in Asia and parts of the Mediterranean. Uses Bitter orange has been used traditionally as a sedative, an appetite stimulant, an insecticide for mosquitos, and for Tinea infections and dyspepsia. It is also used for anemia, kidney/bladder disorders, heart, and circulation. Topically bitter orange is used for inflammation of eyelids, conjunctivae, muscle pain, rheumatic pain, and phlibitis. = Pregnancy = Pediatric ! = Alert = Popular Herb Bitter Orange 79 Investigational Uses Studies are underway for the use of bitter orange as a topical antifungal agent. B Actions Antifungal Action One study identifies bitter orange’s possible topical antifungal action (Ramadan et al, 1996). The research discusses topical fungal infections such as tinea corporis, tinea cruis, and tinea pedis. There was a cure rate of 80% in the group treated with bitter orange oil. Very little research other than this study is available for the action of bitter orange. Bitter orange is being used by some individuals for weight loss (Haller 2005; Haaz 2006). Five weeks after bitter orange extract was studied in mice, there was increased liver antioxidant ability and change in liver histology (Jiao et al, 2007). Product Availability Fluid extract, tincture, tea Plant Part Used: Fruit Dosage Weight Loss • Adult PO extract: 975 mg with 900 mg St. John’s wort and 528 mg caffeine per day (Jellin et al, 2008) Fungal Skin Infections • Adult topical: apply pure oil of bitter orange once a day for 1-3 wk (Jellin et al, 2008) Contraindications Bitter orange should not be used medicinally during pregnancy, breastfeeding, peptic ulcer disease, or those with angle-closure glaucoma, hypertension, or tachyarrhythmias. Children, or individuals using tanning beds or other ultraviolet light, should not use this herb. Side Effects/Adverse Reactions CNS: Anxiety, restlessness, nervousness, headache EENT: Sore throat GI: Anorexia, gastrointestinal upset, nausea INTEG: Photosensitivity, skin redness, edema MS: Gout Interactions Drug Cytochrome P450 3A4 substrates (calcium channel blockers, immunosuppressants, benzodiazepines, azole antifungals, macrolides, SSRIs): Bitter orange can inhibit cytochrome P450 3A4 and increase drug levels (Jellin et al, 2008). MAOIs: Bitter orange given with MAOIs may increase blood pressure (Jellin et al, 2008). Lab Test Blood glucose: Bitter orange may decrease blood glucose levels. Adverse effects: Underline = life-threatening Black Catechu 80 Primary Chemical Components and Possible Actions Chemical Class Hesperidin Oxypeucedanin Flavanoe Glycosides Volatile Oils Individual Component Possible Action Antifungal Phototoxicity Neohesperidin Naringin Limonene Jasmone Linalyl acetate Geranyl acetate Citronellye acetate CNS stimulation; insomnia; hypertension Client Considerations Assess • Determine the reason the client is using bitter orange. • Assess if the client is pregnant or breastfeeding or has been diagnosed with peptic ulcer disease. • Assess for blood pressure, tachycardia, glaucoma; avoid use if present. Administer • Advise client to keep bitter orange in a cool, dry place. Teach Client/Family • Advise the client that bitter orange should not be used medicinally in children or those who are pregnant or breastfeeding until more research is available. • Inform the client that gastrointestinal symptoms (nausea, anorexia, gastrointestinal upset) are common. • Advise the client to use sunscreen and protective clothing or stay out of the sun to prevent burns. Caution the client not to use tanning beds while taking this herb. Black Catechu (blak cat’uh-shoo) Scientific name: Acacia catechu Other common names: Catechu wood extract Origin: Black catechu grows wild in Asia, parts of Burma, and Eastern India. It is a naturalized tree in Jamaica. Uses Black catechu has been used traditionally for diabetes and hypertension, and topically for mouth ulcers such as stomatitis. Since it is an astringent and an antiseptic with a high tannin content, it is used for diarrhea, irritable bowel syndrome, and other gastrointestinal disorders. Black catechu is also used as a contraceptive. = Pregnancy = Pediatric ! = Alert = Popular Herb Black Catechu 81 Actions Very little research is available on the actions of black catechu. A few animal studies are available, but most information comes from anecdotal reports. Antidiabetic Action One study identified the hypoglycemic action of black catechu using animals (Singh et al, 1976). Cardiovascular Action One small study (Sham et al, 1984) identified the hypotensive action of this herb. Other Actions The other actions studied include contraception (Azad et al, 1984) and antineoplastic effect (Agrawal et al, 1990). The antineoplastic effect was tested on leukemic cells, including chronic myeloid, acute myeloblastic, acute lymphoblastic, and chronic lymphocytic. All types showed a marked reduction in leukemic cells. Black catechu is being studied for its antimicrobial action (Rani, 2004; Voravuthikunchai, 2004). Product Availability Dried extract, tea/infusion, tincture Plant Part Used: Heartwood of the tree Dosages • Adult dried extract: PO 0.3-2 g tid or a single dose of 0.5 g • Adult tea/infusion: 0.3-2 g of dried extract prepared as a tea or infusion in 8 oz of water • Adult tincture: 2.5-5 ml of a 1:5 dilution in 45% alcohol added to a small amount of liquid • Adult topical: use tincture as a mouthwash or paint on mucous membranes Contraindications Black catechu should not be used in children or those who are pregnant, breastfeeding, or have immunosuppressive conditions. Do not use for long-term treatment because of high tannin content. Side Effects/Adverse Reactions CV: Hypotension ENDO: Hypoglycemia GI: Constipation Interactions Drug Anticholinergics: Black catechu may increase constipation when used with anticholinergics. Antidiabetics: Black catechu may increase hypoglycemia (theoretical). Antihypertensives: Black catechu may increase hypotension when used with antihypertensives. Iron salts, zinc: Black catechu combined with iron salts, zinc form an insoluble complex; do not use together. Lab Test Hemoglobulin: Black catechu may decrease hemoglobulin. Adverse effects: Underline = life-threatening B Black Cohosh 82 Primary Chemical Components and Possible Actions Chemical Class Individual Component Flavonoids Catechu-red Galactopyranosyl Catechins Possible Action Decreases gastrointestinal inflammation Catechin Epicatechin (Shen, 2006) Acacatechin Quercetin Gum Client Considerations Assess • Assess the reason the client is using black catechu. • Assess gastrointestinal system if using for gastrointestinal symptoms: diarrhea, constipation, abdominal pain, flatulence. • Assess cardiac status in cardiac clients: heart rate, blood pressure; hypotension may occur. • Monitor blood glucose in diabetic clients; hypoglycemia may occur. Administer • PO: Use dried extract, tea, infusion, or tincture Teach Client/Family • Advise the client not to use black catechu in children or those who are pregnant or breastfeeding until more research is available. • Inform the client that constipation may occur. Black Cohosh (blak koe’hahsh) Scientific names: Actaea racemosa, Cimicifuga racemosa Other common names: Black snakeroot, bugbane, bugwort, cimicifuga, rattleroot, rattleweed, squaw root Origin: Black cohosh is a perennial that grows in the eastern region of the United States and in parts of Canada. Uses Black cohosh is used as a smooth-muscle relaxant, an antispasmodic, an antitussive, an astringent, a diuretic, an antidiarrheal, an antiarthritic, and a hormone balancer in perimenopausal women. It is also used to decrease uterine spasms in the first trimester of pregnancy, as an antiabortion agent, and as a treatment for dysmenorrhea. = Pregnancy = Pediatric ! = Alert = Popular Herb Black Cohosh 83 Investigational Uses Investigation is ongoing into the use of black cohosh to treat menopausal symptoms. Actions Black cohosh has been researched extensively in the past few years, primarily for its effects when used to treat menopausal symptoms. The triterpene glycosides may be responsible for black cohosh’s antiinflammatory and hormonal effects. Estrogenic Action In a very large study involving more than 100 physicians and more than 600 female patients, cimicifuga extract was given. Within 6 to 8 weeks, both physical and psychologic menopausal symptoms improved significantly. Most improved within 4 weeks (Stolze, 1982). Another double-blind study included 60 female patients who received cimicifuga extract, conjugated estrogens, or diazepam for 12 weeks. Patients using cimicifuga extract showed a significant improvement compared with patients using the two drugs (Warnecke, 1985). In a third study (also double blind), 80 female patients received cimicifuga extract, conjugated estrogens, or a placebo for 12 weeks. Those taking cimicifuga showed better results on the Kupperman Menopausal Index than the other patients (Stoll, 1987). These studies and others provide adequate evidence to support the use of black cohosh as an alternative to estrogen therapy in menopausal women. Unlike estrogens, black cohosh does not affect the secretion of prolactin, follicle-stimulating hormone, luteinizing hormone (Freudenstein et al, 2002). Another study (Zierau et al, 2002) identified contradictory results from previous studies. In this study antiestrogen results occurred when estradiol activities were antagonized. LH levels may be altered. Black cohosh was studied for safety and efficacy in breast/prostate cancer patients (Walji et al, 2007). A critical assessment of clinical and preclinical studies of black cohosh and cancer (breast, prostate) was presented. It appears that black cohosh is safe in breast cancer without risk for liver disease. Bone Resorption Action No long-term studies have provided information on the role of black cohosh in the prevention of osteoporosis. However, epidemiologic studies have shown that black cohosh prevents osteoporosis in postmenopausal women. Product Availability Caplets: 40, 400, 420 mg; capsules: 25, 525 mg; fluid extract; powdered rhizome; solid (dry) powdered extract; tincture Plant Parts Used: Rhizome (dried and fresh); roots Dosages • Adult PO caplets/capsules: 40-80 mg bid standardized to 1 mg triterpenes (27-deoxyactein) (20 mg) per caplet/capsule (total of 4-8 mg triterpene glycosides/day) • Adult PO liquid extract: 0.9-6 ml/day (1:1) (Mills, Bone, 2005) • Adult PO powdered rhizome: 1-2 g • Adult PO solid dry powdered extract: 250-500 mg (4:1) • Adult PO tincture: 6-12 ml/day (1:10) (Mills, Bone, 2005) • Adult PO decoction 1.5-9 g daily Adverse effects: Underline = life-threatening B Black Cohosh 84 Contraindications Pregnancy category is 3; breastfeeding category is 4A. Black cohosh should not be given to children except under the supervision of a qualified herbalist. Black cohosh should not be used in patients with a history of estrogen receptor–positive breast cancer, cholestasis, or celiac disease. Side Effects/Adverse Reactions CV: Hypotension, slow heart rate ENDO: Uterine stimulation, miscarriage GI: Nausea, vomiting, anorexia Interactions Drug Antihypertensives: Black cohosh increases the action of antihypertensives; avoid concurrent use. Docetaxel, doxorubicin: Black cohosh may increase the toxicity of docetaxel and doxorubicin; avoid concurrent use. Hormonal contraceptives: Black cohosh may increase the effects; avoid concurrent use. Hormone replacement therapy: Black cohosh may alter the effects of other hormone replacement therapies; use together cautiously. Sedatives/hypnotics: Black cohosh may increase the hypotension; avoid concurrent use. Tamoxifen: Black cohosh may augment the antiproliferative properties of tamoxifen (Freudenstein, 1999). Lab Test Luteinizing hormone (LH): Black cohosh may reduce LH and test results (Jellin et al, 2008). Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Acid Caffeic acid; Fukinolic acid; Cimicifugic acids (A, B, E, F) Ferulic acid Isoferulic acid Salicylic acid Actein; 27-Deoxyactein; Cimicifugoside; Cimicifugoside (B, M) Inhibits neutrophil elastase Antiinflammatory Triterpene glycoside Actacaepoxide Cycloartane glycoside = Pregnancy = Pediatric ! = Alert = Popular Herb Black Haw 85 Primary Chemical Components and Possible Actions—cont’d Chemical Class Individual Component Possible Action Flavonoid Formononetin May affect hormones (LH, FSH, prolactin, estradiol) Caffeic acid derivative Tannins Saponins Isoferulic acid Client Considerations Assess • Assess for menopausal and menstrual irregularities: length of cycle, amount of flow, spotting, pain, and hot flashes. • Assess for the presence of ovarian cysts or fibroids. • Assess for the use of other hormonal products: estrogen, progesterone, contraceptives, thyroid products, steroids, and androgens. Concurrent use requires caution (see Interactions). • Assess for breast cancer or other cancers; avoid concurrent use. Administer • Instruct the client to take black cohosh PO using standardized products. • Advise the client that effects are usually not seen until black cohosh is taken for at least 4 weeks. Teach Client/Family • Inform the client that pregnancy category is 3 and breastfeeding category is 4A. • Caution the client not to give black cohosh to children. Black Haw (blak haw) Scientific names: Viburnum prunifolium; Viburnum opulus Other common names: American sloe, cramp bark, guelder-rose, may rose, nannyberry, sheepberry, shonny, silver bells, sloe, stagbush, sweet haw, sweet viburnum Origin: Black haw is found in the eastern region of the United States. Uses Black haw is used as a diuretic; an antispasmodic; a sedative; for headaches, arthritis, fever, and other pains; a uterine relaxant; and to treat dysmenorrhea, asthma, and cardiovascular conditions such as hypertension. Actions Black haw is a bronchospasmolytic, antiasthmatic, hypotensive, and astringent (Mills, Bone, 2005). The only major action of black haw that has been studied is its ability to reduce uterine excitability in laboratory animals (Reynolds, 1996). Adverse effects: Underline = life-threatening B 86 Black Haw One of the coumarins, scopoletin, may be responsible for the antispasmatic and uterine relaxant effect. However, preliminary studies have shown cardiovascular activity of the iridoid glucosides of Viburnum prunifolium (Cometa et al, 1998). One other study showed a digitalis-like activity on frogs and guinea pigs (Vlad et al, 1977). Product Availability Capsules, extract, tablets Plant Parts Used: Bark of the roots, stem, or trunk Dosages • Adult PO decoction: may be taken tid; may also be used with other herbs (peppermint, chamomile, cramp bark, false unicorn root) • Adult dried bark, infusion decoction: 7.5-15 g/day • Adult liquid extract: 12-24 ml/day (1:1) or 1.5-4.5 ml/day (1:2) • Adult tincture 15-30 ml/day (1:5) (Mills, Bone, 2005) Contraindications Pregnancy category is 3; breastfeeding category is 2A. Persons with kidney stones should use this herb cautiously. Side Effects/Adverse Reactions GI: Gastrointestinal upset, irritation; nausea, vomiting (large doses) Interactions Drug Anticoagulants (aspirin, heparin, warfarin): Black haw may increase the action of anticoagulants; do not use concurrently. Food Calcium, iron, zinc: Black haw may decrease the absorption of calcium, iron, zinc from foods (Jellin et al, 2008). Lab Test INR, platelet count, AST, ALT, alkaline phosphatase: Black haw may increase these levels. Primary Chemical Components and Possible Actions Chemical Component Individual Component Possible Action Coumarin Scopoletin Scoplin; aesculetin Salicin; Salicylic acids Amentoflavon Antispasmodic; uterine relaxant Phenol acid Flavonoid Oxalate Volatile oil Tannin Resin = Pregnancy = Pediatric ! = Alert = Popular Herb Black Hellebore 87 Primary Chemical Components and Possible Actions—cont’d Chemical Component Individual Component Triterpenoids Virgatic acid; Vibsanin B; 3-Hydroxyvibsanin E; Oleanadien (Fukuyama, 2002) Possible Action Client Considerations Assess • Assess for allergic reactions such as rash, chest tightness, and trouble breathing. If present, administer antihistamine or other appropriate therapy. • Assess for bleeding; check for the use of aspirin, NSAIDs, and anticoagulants (see Interactions). • Assess for menstrual discomfort and relief after using this herb. Administer • Instruct the client to take black haw as an infusion or tea. Teach Client/Family • Inform the client that pregnancy category is 3 and breastfeeding category is 2A. • Teach the client that black haw may be given to children as an antispasmodic. Black Hellebore ! (blak heh-luh-bowr) Scientific name: Helleborus niger Other common names: Christe herbe, Christmas rose, Easter rose, melampode Origin: Black hellebore is a perennial ornamental plant. Uses Black hellebore traditionally has been used as an anthelmintic, antianxiety agent, and antipsychotic; as a treatment for restlessness; and for its laxative effect. It has also been used to induce abortion and to treat pregnancy-induced hypertension, amenorrhea, and central nervous system conditions such as seizure disorders, meningitis, and encephalitis. Investigational Uses Investigation is ongoing into the use of black hellebore as an immunostimulant for cancer patients. Actions ! Black hellebore is considered poisonous. Most herbal practitioners do not use it because of the potential for toxic reactions. The only identified therapeutic actions of black hellebore are its possible antifungal and antineoplastic properties. When compared with the action of cyclophosphamide, the action of black hellebore is weak (Büssing et al, 1998). Very little research has been done on this herb because it is so toxic. Adverse effects: Underline = life-threatening B 88 Black Hellebore Product Availability Fluid extract, powdered root, solid extract Plant Parts Used: Rhizome (dried), root Dosages Laxative • Adult PO fluid extract: 1-10 drops prn • Adult PO powder: 10-20 grains prn • Adult PO solid extract: 1-2 grains prn Contraindications ! Because it can cause abortion, black hellebore should not be used during pregnancy. Until more research is available, this herb should not be used during breastfeeding and should not be given to children. Persons with hypersensitivity to black hellebore should not use this herb. This plant is considered poisonous; therefore its use is discouraged. Side Effects/Adverse Reactions CNS: Dizziness, paresthesia, seizures CV: Hypertension, hypotension, bradycardia, arrhythmias GI: Nausea, vomiting, anorexia, diarrhea, abdominal cramps, burning in throat INTEG: Hypersensitivity reactions, dermatitis RESP: Shortness of breath, respiratory failure related to contamination of the herb Toxicity: Nausea, vomiting, diarrhea, abdominal pain, change in vision, burning throat, coma, paralysis Interactions Drug Cardiac glycosides (digoxin): Black hellebore contains cardiac glycosides; use with digoxin or other cardiac glycosides can lead to additive effect; avoid concurrent use. Diuretics: Black hellebore with a diuretic can lead to toxicity; avoid concurrent use. Macrolide antibiotics (azithromycin, clarithromycin, erythromycin): Black hellebore used with a macrolide can lead to cardiac toxicity; avoid concurrent use (Jellin et al, 2008). Herb Buckthorn, cascara: Hypokalemia can result from the use of buckthorn or cascara with Helleborus spp.; avoid concurrent use. Primary Chemical Components and Possible Actions Chemical Class Individual Components Possible Action Agylcone Glycosides Saponosides Resin Ranunculosides Hellebrin Helleborin; Helleborcin; Bufadienole Toxicity = Pregnancy = Pediatric ! = Alert = Popular Herb Black Pepper 89 Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue use of this herb and administer antihistamine or other appropriate therapy. • Assess for use of cardiac glycosides, diuretics, macrolides; avoid use with black hellebore. ! • Determine the reason the client is using black hellebore and suggest safer, more conventional alternatives. This herb is rarely used because its toxic and therapeutic levels are so close. Administer • Instruct the client to store black hellebore in a cool, dry place, away from heat and moisture. Teach Client/Family • Because it can cause abortion, caution the client not to use black hellebore during pregnancy. Until more research is available, caution the client not to use this herb during breastfeeding and not to give it to children. ! • Advise the client that this plant is considered poisonous and should not be used. Black hellebore is commonly contaminated with other Helleborus spp., which yields a more poisonous plant. Black Pepper (blak peh’pur) Scientific name: Piper nigrum Other common names: Biber, filfil, hu-chiao, kosho, krishnadi, lada, pepe, peper, pfeffer, phi noi, pimenta, pjerets, poivre, the king of spices, the master spice Origin: Black pepper is found in the Spice Islands. Uses Black pepper traditionally has been used internally to treat gastrointestinal symptoms such as flatus, anorexia, indigestion, heartburn, peptic ulcers, abdominal pain, cramps, colic, diarrhea, and constipation. It has also been used to treat joint and respiratory disorders and to stimulate mental processes. Black pepper is used externally to treat neuralgia and scabies. Actions Black pepper has been researched for its melanocyte proliferation and antibacterial, antiandrogenic, antioxidant, and chemoprotective/carcinogenic actions. One of the alkaloids, piperine, may be responsible for black pepper’s antiandrogenic, antiinflammatory, and hepatoprotective properties. The amide feruperine is an antioxidant. Melanocyte Proliferation A study undertaken to identify repigmenting agents (Lin et al, 1999) identified the ability of black pepper to promote melanocyte proliferation. Black pepper was found to stimulate melanocyte growth. This was also true of piperine, one of the alkaloids of black pepper. Adverse effects: Underline = life-threatening B 90 Black Pepper Antibacterial and Antioxidant Actions Two studies identified the antibacterial properties of black pepper (Dorman et al, 2000, Reddy, 2004). One study focused on several herbs possessing powerful antibacterial effects. The other study demonstrated the antibacterial effect of black pepper against Staphylococcus aureus growth. Piper nigrum was also found to act as an antioxidant when it was studied to determine its potential application in food preservation (Nakatani et al, 1986). Chemoprotective/Carcinogenic Action Several studies have focused on the carcinogenic properties of black pepper. Most of these studies used laboratory animals that were force-fed black pepper in large amounts. These laboratory animals developed various tumors, depending on the study (El-Mofty et al, 1988, 1991; Shwaireb et al, 1990). Other studies have shown a chemoprotective effect in the colon. This effect may be due to the reduction of toxins (Nalini et al, 1998). Product Availability Powder Plant Part Used: Fruit Dosages • Adult PO: 300-600 mg/day, max 1.5 g/day (Jellin et al, 2008). Contraindications Class 1 herb (fruit). Until more research is available, black pepper (medicinally) should not be used therapeutically during pregnancy and breastfeeding, and should not be given therapeutically to children. Black pepper should not be used therapeutically by persons with hypersensitivity to this herb. Side Effects/Adverse Reactions EENT: Eye irritation, swelling (topical eye contact) INTEG: Hypersensitivity reactions MISC: Weak carcinogenic action RESP: Apnea (large amounts in children) Interactions Drug Cytochrome P450: Concurrent use of black pepper with drugs metabolized by cytochrome P450 should be avoided. Phenytoin: Black pepper with dilantin speeds absorption and slows elimination of phenytoin (Jellin et al, 2008). Propranolol: Black pepper speeds absorption and increases effect of propranolol (Jellin et al, 2008). Theophylline: Black pepper increases absorption of theophylline (Jellin et al, 2008). Lab Test Phenytoin, propranolol, theophylline, serum drug assays: Black pepper can increase phenytoin, propranolol, theophylline concentrations, and serum drug assays (Jellin et al, 2008). = Pregnancy = Pediatric ! = Alert = Popular Herb Black Root 91 Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Alkaloid Piperine Melanocyte proliferation; hepatoprotective; antiinflammatory; antiandrogenic (Hirata, 2007) Essential oil Safrole Eugenol Myristicin Tannic acid Amide Piperyline; Piperlongumine; Piperidine; Piperettine; Piperanine; Chavicin Sabinene; Carvone; Myrcene; Limonene; Borneol; Carvacrol; Linalool; Alpha-pinene; Betapinene; Humelene; Bisabolone; Caryophyllene Aromatic Weak carcinogen Feruperine Weak carcinogen Antioxidant Client Considerations Assess • Assess for hypersensitivity reactions. If these are present, discontinue use of black pepper and administer antihistamine or other appropriate therapy. • Assess for the use of phenytoin, propranolol, theophylline, and drugs metabolized by cytochrome P450 (see Interactions). Administer • Instruct the client to store black pepper in a cool, dry place, away from heat and moisture. Teach Client/Family • Advise the client not to use black pepper therapeutically in children or those who are pregnant or breastfeeding until more research is available. Black Root (blak rewt) Scientific names: Veronicastrum virginicum, Leptandra virginica, Veronica virginica Other common names: Bowman root, brinton root, Culver’s physic, Culver’s root, high veronica, hini, leptandra, physic root, quitel, tall speed-well, Veronica Origin: Black root is found in the United States and Canada. Adverse effects: Underline = life-threatening B Black Root 92 Uses Black root is used as an emetic, a diuretic, a laxative, and an astringent, as well as to relieve jaundice. This herb is rarely used today. Actions Very little primary research is available for black root. In traditional herbal medicine, black root has been used for the astringent properties of its tannic acid component and the diuretic effect of D-mannitol/mannite. Product Availability Root (dried and fresh), tincture Plant Parts Used: Rhizome, roots Dosages • Adult PO tea: 1-2 tsp dried root, mixed in cold water, then boiled and steeped for 15 min • Adult PO tincture: 1-2 ml tid Contraindications Class 1 herb (dried root); class 2b/2d herb (fresh root). Black root should not be used during pregnancy (abortifacient) and breastfeeding, and should not be given to children. Side Effects/Adverse Reactions CNS: Headache, drowsiness GI: Nausea, vomiting, anorexia, abdominal cramps, stool color change, hepatotoxicity (large amounts of dried leaves) Interactions Drug Atropine: Black root forms an insoluble complex with atropine, which reduces the atropine effect; do not use concurrently. Cardiac glycosides (digoxin), scopolamine: Black root forms an insoluble complex with cardiac glycosides, scopolamine; do not use concurrently. Diuretics: Black root may increase hypokalemia in those receiving diuretics; avoid concurrent use or added potassium; supplementation may be needed (Jellin et al, 2008). Hepatotoxic agents: Avoid the concurrent use of black root with any hepatotoxic agents. Herb Potassium-depleting herbs (horsetail, licorice): Black root may cause increased potassium depletion when given with horsetail, licorice (theoretical). Lab Test AST, ALT, alkaline phosphatase: Black root may increase these tests. Potassium: Black root may decrease potassium level. = Pregnancy = Pediatric ! = Alert = Popular Herb Blessed Thistle 93 Primary Chemical Components and Possible Actions Chemical Class Individual Component Volatile oil Tannic acid Verosterol Leptandrin Acid Possible Action Astringent; wound healing; antisecretory Cinnamic acid; Paramethoxycinnamic acid Resin Gum Mannite D-Mannitol Diuretic Client Considerations Assess ! • Assess hepatic function test results (AST, ALT); monitor for hepatotoxicity, including jaundice, fever, and increases in hepatic function levels. If increased levels are present, discontinue use of this herb. Administer ! • Caution the client to avoid the consumption of dried leaves; hepatotoxicity can occur. Teach Client/Family • Caution the client not to use black root in children or those who are pregnant or breastfeeding until more research is available. Blessed Thistle (bleh’suhd thi’sul) Scientific names: Carbenia benedicta, Cnicus benedictus, Carduus benedictus Other common names: Cardo santo, chardon benit, holy thistle, kardobenediktenkraut, spotted thistle, St. Benedict thistle Origin: Blessed thistle is an annual found in Europe and Asia. Uses Blessed thistle is used for gastrointestinal discomfort; hepatic disorders such as jaundice, hepatitis, myrroghia, and dyspepsia; to improve digestion and memory; to stimulate lactation; to treat anorexia; and as a bacteriocidal. Actions Blessed thistle has primarily been used to stimulate the appetite and increase gastric secretion. The sesquiterpene lactone cnicin may be responsible for the appetite stimulant and antibacterial properties. However, some reports indicate that this herb may possess antiinfective properties. Adverse effects: Underline = life-threatening B 94 Blessed Thistle Product Availability Capsules, dried herb, tea, tincture Plant Parts Used: Dried leaves, upper stems, seeds Dosages • Adult PO: 4-6 g herb daily (Blumenthal, 1998) Contraindications Class 2b herb. Blessed thistle should not be used during pregnancy and should not be given to children. It should not be used by persons with hypersensitivity to this herb. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia INTEG: Contact dermatitis SYST: Hypersensitivity Interactions Drug H2-blockers, proton pump inhibitors: Blessed thistle may decrease the action of H2-blockers and proton pump inhibitors (theoretical) (Jellin et al, 2008). Herb Asteraceae species (arnica, boneset, burdock, bullerbur, carlile thistle, chamomile, chicory, colts’ foot daisy, dandelion, echinacea, elecampane, feverfew, goldenrod, lutein, marigold, milk thistle, mugwort, ragwort, safflower, santonica, saw palmetto, southern wood, stevia, tansy, wild lettuce, wormwood, yarrow): Blessed thistle may cause cross sensitivity. Lab Test AST, ALT, alkaline phosphatase: Blessed thistle may increase these levels. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Sesquiterpene lactone Tannins Cnicin; Salonitenolide Weak cytotoxic; appetite stimulant; antibacterial Client Considerations Assess • Assess for allergic reactions and contact dermatitis; if these are present, discontinue use of this herb. Administer • Instruct the client to store blessed thistle in a cool, dry place, away from heat and moisture. = Pregnancy = Pediatric ! = Alert = Popular Herb Bloodroot 95 Teach Client/Family • Caution the client not to use blessed thistle in children or those who are pregnant or breastfeeding until more research is available. • Inform the client that research on this herb is lacking. Bloodroot ! (bluhd’rewt) Scientific name: Sanguinaria canadensis L. Other common names: Coon root, Indian paint, paucon, pauson, red puccoon, redroot, sweet slumber, tetterwort Origin: Bloodroot is a perennial found in Canada and the southern region of the United States. Uses Bloodroot has been used for its expectorant, antimicrobial, antiinflammatory, antiplaque (dental—topically), and antifungal properties. It has also been used topically for the treatment of skin, ear, and nose cancer and for nasal polyps. Actions The use of bloodroot is considered to be obsolete because of its toxicity. However, its various actions account for its continued use. The isoquinolone alkaloids sanguinarine and chelerythrine possess antimicrobial and antimycobacterial actions. Sanguinarine is a hypotensive dental antiplaque and CNS depressant. Analgesic Action The analgesic action of bloodroot occurs via mechanisms similar to those of opioids, with paralysis of the nerve endings leading to lessened pain. Antiplaque Action The antiplaque action of bloodroot is well documented in the literature. Some toothpaste and mouthwash manufacturers include bloodroot as an ingredient to help limit oral plaque. The alkaloid sanguinarine is effective against various oral bacteria (Dzink et al, 1985; Godowski, 1989). This action appears to be due to an alkaloid present in the herb. Topical Action Bloodroot has been found to corrode and destroy topical cancers and topical fungal infections (Phelan et al, 1963). In cancers of the nose and ears, bloodroot has been shown to destroy these lesions. Other Actions Methanol extracts of the rhizomes of bloodroot were analyzed. Two isoquinoline alkaloids were identified in the active fraction. Sanguinarine and chelerythrine inhibited the growth of bacterium (Mahady, 2003). Product Availability Extract, tincture Plant Part Used: Rhizome Dosages • Adult PO extract: 0.06-0.3 ml tid (1:1 in 60% alcohol) • Adult PO tincture: 0.3-2 ml tid • Adult PO rhizome: 60-500 mg tid (Jellin et al, 2008) Adverse effects: Underline = life-threatening B 96 Bloodroot Contraindications ! Class 2b/2d herb. Bloodroot should not be used during pregnancy and breastfeeding, and it should not be given to children. Bloodroot should not be used to treat deep wounds. The FDA classifies this herb as unsafe; therefore this herb should be used only under the supervision of a qualified herbalist. Handling the fresh root without gloves can cause skin irritation. Side Effects/Adverse Reactions CNS: Headache, central nervous system depression, loss of consciousness CV: Hypotension, shock, coma (excessive doses) EENT: Glaucoma (high-doses) GI: Nausea, vomiting, anorexia INTEG: Contact dermatitis (topical) Interactions Drug Antihypertensives, ganglionic/peripheral adrenergic blockers: Bloodroot may increase the effects of these products. CNS depressants: Bloodroot may increase the sedative effect of CNS depressants. Corticosteroids: Bloodroot may increase potassium loss. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Isoquinolone alkaloid Sanguinarine Hypotensive, dental antiplaque, central nervous system depressant, antimicrobial, antimycobacterial Homochelidonine; Sanguidimerine; Chelirubine; Sanguilutine; Allocryptopine Chelerythrine Antimycobacterial (Newton et al, 2002) Protopine; Oxysanguinarine; Berberine; Coptisine Resin Client Considerations Assess ! • Assess the client’s cardiovascular status (blood pressure; pulse, including character) and level of consciousness. Hypotension, shock, and coma may occur with increased doses. • Determine the quantity of the herb ingested. = Pregnancy = Pediatric ! = Alert = Popular Herb Blue Cohosh 97 Administer • Caution the client to take only carefully calculated doses of bloodroot. Higher doses can lead to coma. • Caution the client to not take orally the juice or powdered rhizome of bloodroot; may cause toxicity. Teach Client/Family • Caution the client not to use bloodroot in children or those who are pregnant or breastfeeding until more research is available. • Caution the client to use bloodroot only under the direction of a competent herbalist. Bloodroot is considered unsafe by the FDA. Blue Cohosh (blew koe’hahsh) Scientific name: Caulophyllum thalictroides Other common names: Blue ginseng, papoose root, squaw root, yellow ginseng Origin: Blue cohosh is a perennial found in the midwestern and eastern regions of the United States. Uses Blue cohosh is used to induce labor, to treat rheumatism, to increase menstrual flow, and as an anticonvulsant, antispasmodic, and abortifacient (Rao, 2002). Actions Blue cohosh can cause perinatal stroke, profound CHF and shock, acute MI, and severe multiorgan hypoxic injury (Dugoua, 2008). The saponin caulosaponin and magnoflorine are uterine stimulants. The alkaloid methylcystine is a CNS stimulant and also acts as nicotine would. Embryotoxic Action Blue cohosh is known to contain embryotoxic alkaloids (Jones et al, 1998). Both blue and black cohosh have been used for centuries to stimulate uterine contractions. However, studies have only recently confirmed the embryotoxic nature of blue cohosh. Two studies have shown significant embryotoxicity when a mother ingested blue cohosh to stimulate uterine contractions. In one case, the infant was born with acute myocardial infarction associated with congestive heart failure and shock (Jones et al, 1998). Uterine Stimulant Action Four of the alkaloids present in blue cohosh—baptifoline, anagyrine, ubiquitous, and magnoflorine—were tested to determine their uterine stimulant actions. Research revealed that the four are effective only when present together. When tested individually, each exhibited marginal uterotonic activity but showed no uterine stimulant activity. Saponins of the root and rhizome exert a definite oxytocic action, increasing the tone and rate of contractions (Brinker, 1995). Product Availability Capsules: 500 mg; dried root; powder; tablets; tea; tincture Adverse effects: Underline = life-threatening B 98 Blue Cohosh Plant Parts Used: Aerial parts, rhizome, roots Dosages Likely unsafe for oral use (Jellin et al, 2008) • Adult PO dried root/rhizome: 0.3-1 g tid • Adult PO extract: 0.5-1 ml tid (1:1 in 70% alcohol) Contraindications Pregnancy category is 6; breastfeeding category is 5A. Blue cohosh should not be given to children because the seeds are poisonous to them. Persons with cardiac disease, celiac disease, malabsorption, and vitamin A, D, E, K deficiency should not use blue cohosh. This product should only be used by a qualified herbalist and not the general public. Side Effects/Adverse Reactions CV: Chest pain, hypertension, CHF, stroke, acute MI ENDO: Hyperglycemia GI: Gastrointestinal irritation, cramps, diarrhea, mucous membrane irritation Reproductive: Embryotoxic, inductive of labor SYST: Nicotinic toxicity (Rao et al, 2002) Interactions Drug Antianginals, antidiabetics: Blue cohosh may decrease the action of antianginals, causing chest pain, and antidiabetics; avoid concurrent use. Antihistamines, barbiturates, methylphenidate, phenothiazines: Blue cohosh’s metabolism may be decreased. Antihypertensives, peripheral adrenergic blockers: When used with antihypertensives, peripheral adrenergic blockers, blue cohosh will decrease their action; avoid concurrent use. Corticosteroids, hormonal contraceptives, tetracyclines: Blue cohosh may increase metabolism and decrease the effect of these products. Nicotine: Blue cohosh will increase the effects of nicotine and may cause toxicity; avoid concurrent use. Lab Test Blood glucose: Blue cohosh may increase blood glucose level. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Alkaloid Methylcystine Central nervous system stimulant; nicotinic toxicity (Rao et al, 2002) Embryotoxicity Taspine = Pregnancy = Pediatric ! = Alert = Popular Herb Blue Flag 99 Primary Chemical Components and Possible Actions—cont’d Chemical Class Individual Component Possible Action Uterine stimulant Saponin Magnoflorine; Anagyrine; Baptifoline; Ubiquitous Thalictroidine; Lupanine; Sparteine Caulosaponin; Cauloside Uterine stimulant (Satchithanandam, 2008) Phosphoric acid Phytosterol Client Considerations Assess • Assess cardiac status (blood pressure; pulse, including character, rate, and rhythm). Assess for the use of all medications (see Interactions). • Assess diabetic clients for hypoglycemia; check glucose levels. ! • Assess for toxicity; look for signs similar to those of nicotine poisoning (tachycardia, diaphoresis, abdominal pain, vomiting, muscle weakness, fasciculations). Administer • Ensure that commercial preparations are taken in the correct dosage. Teach Client/Family • Inform the client that pregnancy category is 6 and breastfeeding category is 5A. • Caution the client to keep blue cohosh products out of the reach of children because the seeds are poisonous to them. • Advise the client not to use nicotine products while using blue cohosh. The effects of nicotine will be increased. Blue Flag (blew flag) Scientific name: Iris versicolor Other common names: Dagger flower, dragon flower, flag lily, fleur-de-lis, flower-de-luce, liver lily, poison flag, snake lily, water flag, wild iris Origin: Blue flag is a perennial found in the wetlands of the United States. Uses Blue flag is used primarily for its antimicrobial effects. It is also used for its laxative side effect and its emetic and diuretic properties. Blue flag is used topically to treat sores, bites, and bruises. Actions Most of the information available on the actions of blue flag is based on anecdotal evidence rather than primary research. The anecdotal evidence focuses on the Adverse effects: Underline = life-threatening B 100 Blue Flag use of this herb as a laxative and an antiinflammatory. The tannins may be responsible for these actions. Irilon and irisolone may cause a laxative effect. Because of the toxicity of this herb, the unsupervised internal use of blue flag is not recommended. Product Availability Extract: 0.5-1 fluid drams (2.5-5 ml); powdered root: 20 grains (1300 mg); solid extract: 10-15 grains (650-975 mg); tincture: 1-3 fluid drams (5-15 ml) Plant Parts Used: Rhizome with roots Dosages Laxative • Adult PO powdered root: 10-20 grains one-time dose • Adult PO tincture: 1⁄2-3 fluid drams one-time dose Other • Adult topical powdered root: make poultice, apply prn Contraindications Pregnancy category is 2; breastfeeding category is 2A. Blue flag should not be given to children. It is contraindicated in all but small doses. Side Effects/Adverse Reactions CNS: Headache EENT: Mucous membrane irritation, soreness GI: Nausea, vomiting, anorexia, hepatotoxicity SYST: Death by poisoning Interactions Drug Anticoagulants, antiplatelets, salicylates: Blue flag may increase risk for bleeding. Antihypertensives, ganglionic or peripheral adrenergics: Blue flag may increase the effect of these products. Barbiturates, beta-blockers, sedative/hypnotics: Blue flag’s effect may be decreased. Cardiac glycosides (digoxin): Use with blue flag may lead to increased side effects (Jellin et al, 2008). Diuretics: Use with blue flag may lead to hypokalemia (Jellin et al, 2008). Herb Aloe, buckthorn, cascara, castor, horsetail, licorice, podophyllium, senna, yellow dock: Use with blue flag may lead to hypokalemia. Lab Test Blood glucose, INR, PT: Blue flag may increase blood glucose, INR, PT levels. Potassium: Blue flag may decrease potassium levels. = Pregnancy = Pediatric ! = Alert = Popular Herb Bogbean 101 Primary Chemical Components and Possible Actions Chemical Class Individual Component Volatile oil Triterpene Glycoside Xanthone Flavonoid Starch Tannin Furfural Irigermanal Irilon; Irisolone Irigenin; Tectoridine Possible Action Laxative Wound healing; antiinflammatory Gum Client Considerations Assess • Assess for severe nausea and vomiting. • Assess for irritation or soreness of the mucous membranes. ! • Assess for toxicity. Administer • Instruct the client to take blue flag PO to treat constipation. Dosages for other uses are not documented. Teach Client/Family • Inform the client that pregnancy category is 2 and breastfeeding category is 2A. • Caution the client not to give blue flag to children. • Advise the client not to use blue flag internally except under the direction of a competent herbalist and not to use it topically near mucous membranes. Bogbean (bahg’been) Scientific name: Menyanthes trifoliata Other common names: Buckbean, marsh trefoil, water shamrock Origin: Bogbean is found in the wetlands of the United States and Europe. Uses Bogbean is used as an antiinflammatory, and to treat anorexia and gastrointestinal distress. Actions Very limited primary research exists on bogbean. One study researched its analgesic effect, postulating that bogbean decreases prostaglandin synthesis (Huang et al, 1995). Two chemical components of bogbean, caffeic acid and ferulic acid, have been identified as bile stimulants. Antiinfective properties have also been identified Adverse effects: Underline = life-threatening B 102 Bogbean (Bishop et al, 1951). In addition, anecdotal information suggests that bogbean stimulates the appetite and gastric juices. Immunomodulating polysaccharide fractions were identified in bogbean (Kudik-Jaworska, 2004). Product Availability Dried leaf, fluid extract, tincture Plant Part Used: Leaves Dosages • Adult PO dried leaf: 1.5-3 g (Blumenthal, 1998) prepared as tea, used as often as tid • Adult PO fluid extract: 1-2 ml (1:1 dilution) tid with 8 oz water Contraindications Class 2d herb. Because uterine stimulation can occur, bogbean should not be used during pregnancy. Until more research is available, this herb should not be used during breastfeeding. Bogbean should not be given to children. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia SYST: Bleeding, hemolysis (if taken with anticoagulants, NSAIDs, antiplatelets) Interactions Drug Antacids, H2 antagonists, proton pump inhibitors: Bogbean decreases the effect of these products. Anticoagulants, antiplatelets, aspirin, NSAIDs: Use of bogbean with anticoagulants, antiplatelets, aspirin, and NSAIDs may increase the risk of bleeding; do not use concurrently. Laxatives, stimulants: Bogbean may increase the effect of these products. Herb Angelica, anise, arnica, boldo, capsicum, celery, chamomile, clove, danshen, fenugreek, feverfew, garlic, ginger, ginkgo, horse chestnut, horseradish, licorice, meadowsweet, prickly ash, onion, papain, passionflower, poplar, red clover, turmeric, wild carrot, willow: Use with bogbean may increase risk for bleeding (Jellin et al, 2008). Lab Test Hemoglobin: Bogbean may decrease hemoglobin levels. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Acid Caffeic acid; Ferulic acid Chlorogenic acid; Salicylic acid; Vanillic acid; Folic acid; Palmitic acid Bile stimulant = Pregnancy = Pediatric ! = Alert = Popular Herb Boldo 103 Primary Chemical Components and Possible Actions—cont’d Chemical Class Individual Component Possible Action Alkaloid Gentianin; Gentianidine; Choline Quercetin Rutin Hyperin; Kaempferol; Trifolioside Antiinflammatory Antioxidant; immunomodulating (Kudik-Jaworska, 2004) Flavonoid Coumarin Scopoletin Iridoid Carotene Ceryl alcohol Client Considerations Assess • Assess for bleeding. Determine whether the client is also taking aspirin, NSAIDs, anticoagulants, or antiplatelets, all of which will increase the risk of bleeding. • Assess for pain and inflammation. Determine whether the client is taking bogbean to treat these conditions. Administer • Instruct the client to store bogbean in a cool, dry place, away from heat and moisture. Teach Client/Family • Because uterine stimulation can occur, caution the client not to use bogbean during pregnancy. Until more research is available, caution the client not to use bogbean during breastfeeding. • Do not give bogbean to children. • Advise the client to avoid using bogbean with other medications that can cause bleeding: aspirin, anticoagulants, antiplatelets, NSAIDs. Boldo (bole’doe) Scientific names: Boldea boldus, Peumus boldus Other common names: Boldea, boldine, boldo-do-Chile, boldus Origin: Boldo is an evergreen found in Chile, Peru, and Morocco. Uses Boldo is used as a laxative, liver tonic, and sedative. It is also used to treat spastic conditions of the gastrointestinal tract, flatulence, gout, dysmenorrhea, colds, and weakness. Adverse effects: Underline = life-threatening B 104 Boldo Investigational Uses Research is ongoing into the use of boldo as a treatment for gallstones. Actions Although boldo has been used to treat various conditions in many parts of the world, its actions are not well researched. Boldo is thought to possess diuretic, anthelmintic, and hepatoprotective actions. The tannins are responsible for wound healing and antiinflammatory actions. However, very little primary research is available to confirm these actions. Diuretic Action Boldo has been shown to possess diuretic effects. In a study of dogs given boldo, urine excretion increased by 50% (Speisky et al, 1994). Anthelmintic Action One of the chemical components of boldo, the volatile oil, ascaridole, exhibits anthelmintic activity. Other Actions Boldo may exert antioxidant, hepatoprotective, and antiinflammatory activity. However, little research currently exists to confirm these possible actions. Boldo has shown uterine stimulant effects and teratogenic effects in rats (Almedia, 2000). Only one study (Lanhers et al, 1991) could be found to confirm these effects. This study used an in vitro technique in mice. Boldine, the main alkaloid, appears to possess a hepatoprotective action but does not possess antiinflammatory action. Product Availability Extract, tea, tincture Plant Part Used: Leaves Dosages ! Do not exceed recommended dosage. • Adult PO: 0.2-3 g dried leaves daily • Adult PO: 60-200 mg of dried leaf tid or as a tea tid (Jellin et al, 2008) • Adult tincture: 1.5-6 ml/day (1:5); 1.8-6 ml/day (1:10)(Mills, Bone, 2005) • Adult liquid extract: 0.7-2 ml/day (1:2) (Mills, Bone, 2005) Contraindications Pregnancy category is 7; breastfeeding category is 5A. Boldo should not be given to children. Persons with neurologic or respiratory disease, renal disease, obstruction of the bile duct, or severe hepatic disease should avoid the use of boldo. Persons with gallstones should use this herb cautiously. Side Effects/Adverse Reactions Very high doses CNS: Paralysis, exaggerated reflexes, convulsions, coma, death RESP: Respiratory depression Interactions Drug Anticoagulants, antiplatelets: Boldo given with anticoagulants, antiplatelets can lead to increased risk of bleeding (Jellin et al, 2008). CNS depressants: Boldo may increase the effect of these products. = Pregnancy = Pediatric ! = Alert = Popular Herb Boneset 105 Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Isoquinolone alkaloid Boldine; Isoboldine; Reticuline Antispasmodic; diuretic; antiinflammatory; antipyretic; antioxidant Ascaridole; thymol; transverbenol Anthelmintic Flavonoid Volatile oil Coumarin Resin Tannin Wound healing; antiinflammatory Client Considerations Assess ! • Assess for central nervous system reactions and respiratory depression. If either is present, discontinue use of this herb. Administer • Instruct the client to store boldo in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 7 and breastfeeding category is 5A. • Caution the client not to use boldo in children. Keep boldo products out of the reach of children because this herb is toxic in high doses. • Advise the client to avoid the use of boldo if central nervous system disorder, respiratory disorder, or severe hepatic disease is present. Boneset (bown’seht) Scientific name: Eupatorium perfoliatum Other common names: Agueweed, crosswort, eupatorium, feverwort, Indian sage, Joe-pye-weed, sweating plant, thoroughwort, vegetable antimony Origin: Boneset is a perennial found in the wetlands of the United States and Canada. Uses Boneset is used to treat fever, bronchitis, and influenza. It is also used as a sedative, a laxative, and an expectorant. Investigational Uses Beginning research has shown antiinflammatory, immunostimulant, and woundhealing properties of boneset. Also, it has the possibility of a weak antibacterial Adverse effects: Underline = life-threatening B 106 Boneset action against gram-positive organisms, action against some parasitic infections, and a cytotoxic response. Actions The flavonoids may be responsible for wound healing and antiinflammatory properties. Pyrrolizidine alkaloids are hepatotoxic when used over a long period of time or in high doses. Several other chemical components of boneset have been identified, but the action is unknown. Immunostimulant Action One study demonstrated that the chemical components of boneset increase both granulocytes and macrophages (Wagner et al, 1985). Another study showed an increase in phagocytosis when boneset was combined with Echinacea angustifolia, Baptisia tinctoria, and Arnica montana. This increase in phagocytosis was much more pronounced when boneset was used in combination with the three other species than when it was used alone (Wagner et al, 1991). Other Actions Boneset has been shown to possess emetic, antiinflammatory, and antimalarial properties (Hall, 1974; Lira-Salazar, 2006). A study focused on the possible effects of boneset on the common cold and showed no changes in the cold as a result of the use of this herb (Gassinger et al, 1981). Habtemariam et al (2000) discovered a weak antibacterial effect (gram-positive organisms [Staphylococcus aureus, Bacillus megaterium]) and a potent cytotoxic effect when compared with chlorambucil. Product Availability Extract, tea Plant Parts Used: Dried leaves, flowers, whole herb Dosages • Adult PO extract: 10-40 drops mixed in a small amount of liquid, tid • Adult PO tea: 2-6 tsp dried leaves (crushed) or flowers in ⱖ8 oz water, boiled then steeped for 15 min, tid Contraindications Class 4 herb. Because uterine stimulation can occur, boneset should not be used during pregnancy. Until more research is available, this herb should not be used during breastfeeding. Persons with hepatic disorders, an allergy to ragweed (Jellin et al, 2008), or a hypersensitivity to boneset should not use this herb. Avoid long-term use; toxicity can occur. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, diarrhea, hepatotoxicity SYST: Hypersensitivity Interactions Herb Asteracae family (daisy, chrysthanemum): Boneset can produce allergic reactions with these herbs. = Pregnancy = Pediatric ! = Alert = Popular Herb Borage 107 Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Alcohol Volatile oil Triterpenes Flavonoid Tremetol Antidiabetic Kaempferol; Quercetin; Astragalin; Rutin Eupatorin Wound healing; antiinflammatory Glycoside Resin insulin sterols Pyrrolizidine alkaloids Hepatotoxic Client Considerations Assess ! • Assess for hepatotoxicity (jaundice, increased hepatic function test levels, claycolored stools, right upper-quadrant pain). If these symptoms occur, use of this herb should be discontinued. • Assess for gastrointestinal symptoms, nausea, vomiting, diarrhea; if these symptoms occur, use of herb should be discontinued. • Assess for hypersensitivity reactions; if present, discontinue use of this herb. Administer • Instruct the client to take boneset PO as a tea or extract. • Instruct the client to store boneset in a cool, dry place, away from heat and moisture. • Inform the client that boneset may be given to children in small doses. Teach Client/Family • Because uterine stimulation can occur, caution the client not to use boneset during pregnancy. Until more research is available, advise the client not to use this herb during breastfeeding. Borage (baw’rij) Scientific name: Borage officinalis Other common names: Beebread, common borage, common bugloss, cool tankard, ox’s tongue, starflower Origin: Borage is an annual found in North America and Europe. Uses Borage is used to treat arthritis, hypertension, the common cold, and bronchitis. It has been used primarily as a galactagogue but should not be used during breastfeeding until research confirms or denies the presence of pyrrolizidine alkaloids. Borage is also used for menopause, depression, adrenal replenishment, and as a tonic. Adverse effects: Underline = life-threatening B 108 Borage Investigational Uses Borage may decrease body fat accumulation. Actions Antiinflammatory Action Several studies have demonstrated the beneficial effects of borage oil for treating rheumatoid conditions. Diets high in arachidonic acid have been shown to increase the formation of prostaglandin and leukotriene with proinflammatory action (Zurier et al, 1996). Two studies have shown that doses of 1.1 to 1.4 g gammalinolenic acid in borage seed oil reduces joint inflammation significantly (Leventhal et al, 1993; Pullman-Mooar et al, 1990). A study using a combination of evening primrose oil and borage oil showed positive results in rheumatologic conditions (Belch et al, 2000). However, not all studies have shown positive results. Antihypertensive Action One study has shown that the high levels of gamma-linolenic acid in borage oil are responsible for its ability to decrease hypertension. The decrease in blood pressure occurred in response to two factors: (1) a reduction in the affinity to angiotensin II receptors in cells that produce aldosterone and (2) a reduction in the aldosterone/ renin ratio (Engler et al, 1998). Other Actions A borage oil study has shown a decrease in body fat accumulation in rats. Rats were fed a low-fat diet containing borage oil. The result was a decrease in body fat mass (Takahashi et al, 2000). Rosmarinic acid may be responsible for the antioxidant action in borage (Bandoniene, 2002). Borage extract revealed in the lab the presence of several radial scavenging components. Product Availability Capsules: 240, 500, 1300 mg; seed oil Plant Parts Used: Leaves, seeds, stems Dosages Joint Inflammation • Adult PO seed oil: 1.1-1.4 g gamma-linolenic acid daily (Leventhal et al, 1993; Pullman-Mooar et al, 1990) Contraindications Class 2a/2b/2c herb. Until more research is available, borage should not be used during pregnancy and breastfeeding because of the possible presence of pyrrolizidine alkaloids. It should not be given to children. Side Effects/Adverse Reactions GI: Hepatotoxicity Interactions Drug Anticoagulants, antiplatelets, salicylates: Borage may increase the risk for bleeding. Anticonvulsants: Bogbean may decrease the effect of this product. = Pregnancy = Pediatric ! = Alert = Popular Herb Borage 109 Interactions—cont’d Hepatotoxic drugs: Borage when given with hepatotoxic drugs, may lead to increased hepatotoxicity (Jellin et al, 2008). Herb Eucalyptus: Use with borage may increase unsaturated pyrrolizidine alkaloid (UPA) (Jellin et al, 2008). Lab Test AST, ALT, alkaline phosphatase, PT, INR: Borage may increase these levels. Primary Chemical Components and Possible Actions Chemical Class Individual Component Alcohols Aldehydes Mucilage Acid Tannin Hexanol, Cis-z-hexenol Essential oil Nonadecane, Tetrocosane, Hepatocosane Hydrocarbons Fatty acid Oleic Alkaloid, pyrrolizidine Rosmarinic acid Possible Action Expectorant Diuretic Wound healing; antiinflammatory Malic acid Gamma-linolenic, Linoleic, Alpha-linolenic, Stearidonic, Palmitic (Mhamdi, 2007) Saturated Amabiline Thesinine Antiinflammatory; antihypertensive Hepatotoxic Antioxidant (Bandoniene, 2002) Client Considerations Assess ! • Assess for hepatotoxicity (jaundice, increased liver function test levels, claycolored stools, right upper-quadrant pain). If these occur, use of borage should be discontinued. • If the client is using borage to treat joint conditions, assess for pain and inflammation (location, duration, intensity), including aggravating and alleviating factors. • Assess blood pressure and pulse if borage is being used to treat hypertension. • Assess body weight if using to decrease body fat accumulation. Administer • Instruct the client to use borage oil that contains 20% to 26% gamma-linolenic acid. Adverse effects: Underline = life-threatening B 110 Boron Teach Client/Family • Caution the client not to use borage in children or those who are pregnant or breastfeeding until more research is available. • Caution the client that one of the chemical components of borage, an alkaloid known as amabiline, can cause hepatotoxicity. Nettle, dandelion, and marshmallow root treat the same conditions as borage and are safer herbs; therefore they may be better choices. Boron ! (bor’on) Scientific names: Boron, B Other common names: Borate, boric acid, boric tartrate Origin: Boron is a mineral found naturally. Uses Boron is used to increase bone density, for osteoarthritis. Boric acid is used topically as an astringent and as an irrigant for the eye. Actions Boron is an element found in nature. It may be responsible for the absorption of calcium, phosphorus, and magnesium from the diet. Boron has been shown to be helpful in the management of osteoarthritis, as supplementation may decrease pain during movement (Travers et al, 1990). When given with hormone replacement in women, boron showed reduced incidence of lung cancer. It may play a role in host defense against cancer due to inflammation (Mahabir, 2008). Product Availability Tablets, capsules, solution Dosages ! Do not use boric acid/borate orally because it can be fatal. • Adult PO: 3-6 mg/day (Pizzorno, Murray, 2006). Contraindications ! Do not use boric acid/borate orally—it can be fatal. Boron should not be used in children, or those who are pregnant, breastfeeding, hypersensitive, or have renal/hepatic disease. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, indigestion (large doses) INTEG: Alopecia, dermatitis SYST: Acute poisoning: tremors, seizures, irritability, weakness, lethargy, headache, depression, exfoliation, rash Interactions Drug Estrogens: Boron may increase the effect of estrogens. = Pregnancy = Pediatric ! = Alert = Popular Herb Boswellia 111 Interactions—cont’d Lab Test Magnesium, phosphorous: Boron may decrease the effect of magnesium, phosphorous. Client Considerations Assess • Assess the reason the client is using boron medicinally. Administer • Keep boron in a dry area, away from direct sunlight. Teach Client/Family • Advise the client not to use boron in children or those who are pregnant or breastfeeding until more research is available. • Advise the client of acute poisoning symptoms. ! • Instruct the client to not use boric acid/borate orally because it can be fatal. Boswellia (bahz’weh-lee-uh) Scientific name: Boswellia serrata Other common names: Indian frankincense, olibanum Origin: Boswellia is a tree or shrub and is found in India, America, North Africa, and Arab countries. Uses Boswellia has been used traditionally for arthritis and other inflammatory conditions. It has been used commonly for syphilis, asthma, and cancer. Actions Antiinflammatory Action Boswellia was studied in animals to determine the result on inflammatory disease. Boswellia decreases leukotriene synthesis that is responsible for maintaining inflammation and edema. Boswellia resin action in ulcerative colitis may be due to the inhibition of 5-lipoxygenase (Bruneton, 1995; Gupta et al, 1997; Ammon, 2003). Product Availability Caps, tabs, standardized fluid extract (60%-65% boswellic acids), cream, resin Plant Part Used: Dried resin Dosages Inflammation • Adult PO: cap/tabs 400 mg tid Ulcerative colitis • Adult PO: cap/tabs 350-400 mg tid for 6 weeks Adverse effects: Underline = life-threatening B 112 Brewer’s Yeast Other Doses • Adult PO: dried resin 2-9 g/day • Adult PO: standardized extract: 600-1200 mg/day (60% boswellic acids) (Mills, Bone, 2005) Contraindications Pregnancy category is 2; breastfeeding category is 2A. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Boswellic acids Beta-boswellic acid; Acetyl-beta boswellic acid; 11-keto-beta boswellic acid; Acetyl 11-keto beta boswellic acid Nonredox inhibitors of leukotriene synthesis (Ammon, 2002) Respiratory support Wound healing Volatile oils Terpinoids Arabinose Xylose Beta sitosterin Client Considerations Assess • Assess the reason the client is using boswellia medicinally. Administer ! • Do not administer large doses; lethal doses have been identified in rodents. Teach Client/Family • Inform the client that pregnancy category is 2 and breastfeeding category is 2A. • Teach the client that boswellia may be used in children. Brewer’s Yeast (brew’uhrz yeest) Scientific name: Saccharomyces cerevisiae Other common names: Medicinal yeast Origin: Brewer’s yeast originates from the beer brewing process. Uses Brewer’s yeast has been used traditionally for irritable bowel syndrome, diarrhea, and gastritis and has been used topically for acne and contact dermatitis. It has also been used as a source of high-content vitamin B-complex and protein (Jellin et al, 2008). = Pregnancy = Pediatric ! = Alert = Popular Herb Brewer’s Yeast 113 Investigational Uses Studies are underway to confirm the antiinfective and antidiabetic uses of brewer’s yeast. Actions Antiinfective Action One study (Izachia et al, 1998) identified that brewer’s yeast is capable of preventing Clostridium difficile–associated diarrhea. The action may be due to the reduction of C. difficile toxin–mediated secretion. Another study (Li et al, 1998) identified the antiviral effect of polysaccharides in brewer’s yeast. The viruses that were inhibited were poliovirus III, adenovirus III, ECHO6 virus, enterovirus 71, vesicular stomatitis virus, herpesviruses I and II, and coxsackie A16 and B3 viruses. Antidiabetic Action Two studies (Holdsworth et al, 1988; Li, 1994) identified the antidiabetic effects of brewer’s yeast. Glucose values were lowered in both studies. Product Availability Tablets, powder, liquid Plant Part Used: Yeast from beer brewing process Dosage Gastrointestinal symptoms • Adult PO powder: 1-2 tsp tid Contraindications Brewer’s yeast should not be used in persons with compromised immune systems or Crohn’s disease. Those who have Crohn’s disease are likely to have developed antibodies to the yeast. Side Effects/Adverse Reactions CNS: Severe headache (hypersensitive reactions) ENDO: Decreased blood glucose (diabetic clients) GI: Abdominal cramps, flatulence SYST: Allergic reactions Client Considerations Assess • Determine the reason the client is using brewer’s yeast medicinally. • Assess for severe, migraine-like headaches that may be due to a hypersensitive reaction. Brewer’s yeast should be discontinued if this occurs. • Assess diabetic client’s blood glucose levels. Brewer’s yeast may lower blood glucose. Administer • PO using powder. Teach Client/Family • Teach the client that brewer’s yeast should not be used in immunocompromised individuals. Adverse effects: Underline = life-threatening B 114 Broom Broom ! (brewm) Scientific names: Sarothamnus scoparius Other common names: Bannal, broom top, genista, ginsterkraut, hogweed, Irish broom top, sarothamni herb, Scotch broom, Scotch broom top. Do not confuse with Spanish broom or butcher’s broom. Origin: Broom is a deciduous plant found in Europe, and in the Pacific Northwest and eastern regions of the United States. Uses Broom is used as an antiarrhythmic, a diuretic, and an emetic or uterine contactant. Actions Antiarrhythmic Action Sparteine, one of the alkaloid components of broom, has shown antiarrhythmic activity similar to that of antiarrhythmic IA. Sparteine decreases heart rate and is considered to be similar to quinidine (Bowman et al, 1980). It can also inhibit sodium and potassium transport across the cell membrane in cardiac cells (Pugsley et al, 1995) and is used in Germany to treat cardiac disorders. Diuretic Action Scoparoside, one of the flavone glycosides of broom, exerts a powerful diuretic effect at high doses. Other Actions Sparteine has been shown to cause strong uterine contractions and for this reason should not be used during pregnancy. In many countries, broom is used to stimulate labor. In addition, many of the lectins (a type of plant-derived hemagglutinin) have been used as pharmacologic probes (Young et al, 1984). One study has shown that the lectins are able to bind B- and T-lymphocytes (Malin-Berdel, 1984). Product Availability Cigarette, extract, root, tea Plant Parts Used: Flowers, twigs Dosages Dosages are not clearly delineated in the literature. Contraindications ! Because it can cause spontaneous abortion, broom should not be used during pregnancy. Until more research is available, broom should not be used during breastfeeding and should not be given to children. It should not be used by persons with hypertension, arrhythmias, or other severe cardiac conditions. The FDA considers this herb unsafe. Side Effects/Adverse Reactions CNS: Headache, mind-altering effect (smoking) CV: Arrhythmias GI: Hepatotoxicity = Pregnancy = Pediatric ! = Alert = Popular Herb Broom 115 Side Effects/Adverse Reactions—cont’d Overdose: Nausea, vomiting, dizziness, confusion, tachycardia, shock Reproductive: Uterine contractions and spasms, spontaneous abortion Interactions Drug Antiarrhythmics, antihypertensives, cardiac glycosides: Broom may increase the effect of antiarrhythmics, antihypertensives, and cardiac glycosides; do not use concurrently. Antidiabetics (glyburide, insulin, miglitol): Broom decreases the hypoglycemic effect of these agents; avoid concurrent use. MAOIs: Scotch broom may cause hypertensive crisis when used with MAOIs; do not use concurrently (Jellin et al, 2008). Lab Test AST, ALT, alkaline phosphatase, creatinine: Broom may increase these levels. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Alkaloid Flavone glycoside Sparteine Scoparoside Kaempferol; Quercetin derivatives Oxysparteine; Spiraeoside; Lupanine; Genitoside; Isoquercetin Sarothamnoside Antiarrhythmic IA; oxytoxic Diuretic Antiinflammatory Isoflavone Caffeic acid derivative Essential oil Client Considerations Assess • Assess the reason the client is taking broom medicinally. ! • Assess cardiac status (blood pressure; pulse, including character; rhythm). Identify any other cardiac agents (antiarrhythmics, antihypertensives, cardiac glycosides) the client is taking. ! • Identify MAOIs the client is taking; broom should not be used with MAOIs because of high tyramine content. ! • Assess for overdose symptoms such as nausea, vomiting, dizziness, confusion, tachycardia, and shock. If any of these symptoms are present, use of this herb should be discontinued immediately. Administer • Inform the client that there is no consensus on dosage. Adverse effects: Underline = life-threatening B 116 Buchu Teach Client/Family • Because broom can cause spontaneous abortion, caution the client not to use this herb during pregnancy. • Advise the client not to use broom in children or those who are breastfeeding until more research is available. ! • Caution the client that the FDA considers this herb unsafe because of its hepatotoxic effects. • Caution the client that using this herb to induce abortion is unsafe; a follow-up therapeutic abortion may be needed. • Teach the client the symptoms of overdose (nausea, vomiting, dizziness, confusion, tachycardia, shock). Buchu (boo’choo) Scientific names: Barosma betulina (Agathosma betulina), Barosma serratifolia, Barosma crenulata Other common names: Agathosma, betuline, bocco Origin: Buchu is found in South Africa. Uses Buchu is used as a diuretic and an antiseptic, and for the treatment of the common cold, stomachaches, rheumatism (Simpson, 1998), gout, leukorrhea, yeast infections, and urinary tract infections, including cystitis. Buchu is also used in combination with uva-ursi for benign prostatic hyperplasia. Actions No substantial information exists to document any of the actions or uses of this herb. Diuretic Action Two of the flavonoid components of buchu, diosphenol and terpen-4-ol, may be responsible for its diuretic action. However, diosphenol and terpen-4-ol are not considered to be a more powerful diuretic than caffeine or any other xanthane product (Simpson, 1998). Antibacterial Action A douche made from an infusion of buchu leaves may be used as an antibacterial treatment for yeast infections and leukorrhea. Diosphenol may be responsible for the antibacterial effect (Chevallier, 1996). One study suggests there is little potential for buchu to be used as an antimicrobial (Lis-Balchin, 2001). Other Actions One of the flavonoids, quercetin, is an antiinflammatory. Pulegone is a powerful abortifacient. Product Availability Decoction, dried leaves, fluid extract, tablets, tincture Plant Part Used: Leaves = Pregnancy = Pediatric ! = Alert = Popular Herb Buchu 117 Dosages • Adult PO infusion: 3-6 g dried leaves/day (Mills, Bone, 2000) • Adult PO tea: 1 cup of tea (1 g dry leaf in 150 ml of water, boil 5-10 min, strain) given several times per day (Jellin et al, 2008) • Adult PO fluid extract: 2-4 ml/day (1:2 dilution) (Mills, Bone, 2000) • Adult PO tincture: 5-10 ml/day (1:5 dilution) (Mills, Bone, 2000) Contraindications Pregnancy category is 3; breastfeeding category is 3A. Buchu should not be given to children. It should not be used by persons with severe hepatic or renal disease. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, diarrhea, hepatotoxicity GU: Increased menstrual flow, spontaneous abortion, nephritis Interactions Drug Anticoagulants (heparin, warfarin), antiplatelets: Buchu can increase the action of anticoagulants, antiplatelets causing bleeding; avoid concurrent use. Antidiabetics(glyburide, insulin, miglitol): Buchu decreases the hypoglycemic effect; avoid concurrent use. Lab Test AST, ALT, alkaline phosphatase, PT, INR: Buchu may increase these levels. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Flavonoid Diosphenol Quercetin Diosmin; Rutin; Diosmetin; Terpene-4-ol Pulegone Antibacterial; diuretic Antiinflammatory Volatile oil Limonene Menthone Mucilage Resin Coumarin Hepatotoxicity; abortifacient Diuretic Client Considerations Assess • Assess the reason the client is taking buchu medicinally. ! • Assess hepatic function test results (ALT, AST, bilirubin); buchu can cause hepatotoxicity. Watch for jaundice, right upper-quadrant pain, and clay-colored stools. If symptoms occur, use of this herb should be discontinued. • Assess for use of anticoagulants (see Interactions). Adverse effects: Underline = life-threatening B 118 Buckthorn Diuretic Use • Assess urinary status (intake and output, bladder distention, pain, burning during urination); watch for beginning nephritis. If these symptoms occur, use of this herb should be discontinued. Administer • Instruct the client to take PO as dried leaves, infusion, fluid extract, or tincture. Buchu should not be boiled; boiling robs the herb of its healing properties. • Instruct the client to store buchu in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 3 and breastfeeding category is 3A. • Advise the client not to use buchu in children. • Advise the client to report changes in urinary status, jaundice, and stool color. Buckthorn (buhk’thawrn) Scientific name: Rhamnus cathartica Other common names: Common buckthorn, European buckthorn, hartsthorn, purging buckthorn, waythorn Origin: Buckthorn is found in Canada, Europe, and the United States. Uses Buckthorn is used as a powerful laxative. Actions Laxative Action The laxative action of the anthranoid components of buckthorn is well documented in the mainstream pharmacologic literature. This action results from direct chemical irritation of the colon, which increases the rate at which stool is propelled through the bowel. A similar laxative herb is cascara. Product Availability Crushed herb, syrup Plant Parts Used: Bark, fruit Dosages • Adult PO: 20-30 mg hydroxyanthracene derivative (glucofrangulin A) (Blumenthal, 1998) Contraindications Class 2b/2c/2d herb. Buckthorn should not be used during pregnancy and breastfeeding and should not be given to children younger than 12 years of age. This herb should not be used by elderly persons or persons with the following disorders: colitis, irritable bowel syndrome, Crohn’s disease, gastrointestinal obstruction, unknown abdominal pain, appendicitis, gastrointestinal bleeding, hepatic disease. Dehydration and electrolyte loss may occur if buckthorn is used for more than 8 to 10 days. = Pregnancy = Pediatric ! = Alert = Popular Herb Buckthorn 119 Side Effects/Adverse Reactions CNS: Nervousness, tremors GI: Nausea, vomiting, diarrhea, anorexia, abdominal cramps; possible hepatotoxicity (Lichtensteiger et al, 1997) META: Dehydration, fluid and electrolyte imbalances (with increased dose or increased duration) RESP: Decreased respirations Interactions Drug Antacids: Antacids may decrease the action of buckthorn if taken within 1 hour of the herb. Antiarrhythmics, cardiac glycosides (digoxin): Chronic buckthorn use can cause hypokalemia and enhance the effects of antiarrhythmics, cardiac glycosides; do not use concurrently. Corticosteroids, thiazide diuretics: Hypokalemia can result from use of buckthorn with corticosteroids, thiazide diuretics; do not use concurrently. Herb Jimsonweed: The action of jimsonweed is increased in cases of chronic abuse of buckthorn. Other herbs: Hypokalemia can result from the use of buckthorn with adonis, convallaria, helleborus, licorice root, and strophanthus; avoid concurrent use (Brinker, 1998). Food Milk: Milk may decrease the action of buckthorn; avoid concurrent use. Lab Test Dipstick urine tests: May alter results; urine may be pink, red, or orange (Jellin et al, 2008). Potassium: Buckthorn may decrease potassium levels. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Anthranoid Anthraquinone glycosides Emodin Frangulin A, B; Glucofrangulin A, B Laxative Laxative Client Considerations Assess • Assess the reason the client is taking buckthorn medicinally. • Assess blood and urine electrolytes if the client uses this herb often. • Assess the cause of constipation; identify whether bulk, fluids, or exercise is lacking. • Assess for cramping, rectal bleeding, nausea, and vomiting. If these symptoms occur, buckthorn use should be discontinued. • Assess for medications and herbs used (see Interactions). Adverse effects: Underline = life-threatening B 120 Bugleweed Administer • Instruct the client not to take buckthorn within 1 hour of other drugs, antacids, or milk. This herb should be taken with other herbs to buffer its effects and prevent griping. Teach Client/Family • Caution the client not to use buckthorn in children younger than 12 years of age and those who are pregnant or breastfeeding. • Advise the client to avoid long-term use of buckthorn (for ⬍8-10 days), which can result in the loss of bowel tone. • Instruct the client to notify the provider if constipation is unrelieved or if symptoms of electrolyte imbalance occur (muscle cramps, pain, weakness, dizziness). • Advise the client that urine may turn pink, red, or orange. Bugleweed (byew’guhl-weed) Scientific names: Lycopus virginicus, Lycopus europaeus Other common names: Carpenter’s herb, common bugle, Egyptian’s herb, farasyon maiy, gypsy-weed, gypsy-wort, lycopi herba, menta de lobo, middle comfrey, Paul’s betony, sicklewort, su ferasyunu, water bugle, water horehound Origin: Bugleweed is a member of the mint family found in Europe and the United States. Uses Bugleweed is used as an astringent and analgesic, and as a treatment for Graves’ disease, fever, tachycardia, and mastodynia. Mild forms of hyperthyroidism can be successfully treated with bugleweed. Actions Antithyroid Action Bugleweed has been shown to inhibit thyroid-stimulating hormone (TSH), Graves’ immunoglobulin, and iodothyronine deiodinase (Brinker, 1990; Winterhoff et al, 1994). One study demonstrated pronounced antithyroid activity, pronounced peripheral T4 conversion, and decreased thyroid secretion independent of TSH activation (Auf’mkolk et al, 1984). These actions differ from those of the traditional antithyroid agents and may be due to the phenols lithospermic and rosmarinic acids. Other Actions Bugleweed has shown antigonadotropic actions and an ability to decrease prolactin. A significant decrease occurred in both luteinizing hormone (LH) and testosterone levels when Lycopus europaeus extract was given orally. This action may be due to the phenols lithospermic and rosmarinic acids. Bugleweed has been shown to decrease the binding of human chorionic gonadotropin (hCG) to rat testes (Auf’mkolk et al, 1984). This research indicates that bugleweed may also exert contraceptive effects. Product Availability Dried herb, fluid extract, tincture = Pregnancy = Pediatric ! = Alert = Popular Herb Bugleweed 121 Plant Parts Used: Flowers, leaves (dried and fresh), roots, stems. The leaf extract contains a much higher concentration of the active components than does the root extract. Dosages • Adult PO dried herb: 1-3 g tid • Adult PO fluid extract: 1-3 ml (1:1 dilution in 25% alcohol) tid • Adult PO infusion: 1-3 g dried herb, infused, tid • Adult PO tincture: 2-6 ml (1:5 dilution in 45% alcohol) tid (British Herbal Pharmacopoeia, 1983) Contraindications Pregnancy category is 5; breastfeeding category is 5A. Bugleweed should not be given to children. Persons with thyroid tumors, hypopituitarism, pituitary adenoma, hypogonadism, congestive heart failure, or hypothyroidism should avoid the use of this herb. Side Effects/Adverse Reactions ENDO: Hypothyroidism, enlarged thyroid gland (high doses) Interactions Drug Antidiabetics: Bugleweed given with antidiabetes agents may lead to increased hypoglycemia (Jellin et al, 2008). Thyroid preparations: Bugleweed can interfere with the action of thyroid preparations; do not use concurrently. Herb Wildthyme, balmleaf: Wild thyme, balmleaf can suppress the effects of the thyroid, additive effects when used with bugleweed; avoid concurrent use. Lab Test Radioactive isotopes: Bugleweed can interfere with procedures using radioactive isotopes (Jellin et al, 2008). Prolactin, glucose: Bugleweed may decrease these levels. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Phenol Lithospermic acid; Rosmarinic acid Chlorogenic acid; Caffeic acid; Ellagic acid; Ursolic acid; Sinapinic acid; Hydrocinnamic acid Luteolin-7-glucoside Antithyroid; antigonadotropic Flavone Amino acid Mineral Sugar Continued Adverse effects: Underline = life-threatening B 122 Burdock Primary Chemical Components and Possible Actions—cont’d Chemical Class Individual Component Phenolic acids Possible Action Wound healing; antiinflammatory Tannin Caffeic acid Client Considerations Assess • Assess the reason the client is taking bugleweed medicinally. Treatment of Graves’ Disease • Assess the client’s thyroid panel (T3, T4, T7, TSH levels). Bugleweed should not be used in place of antithyroid agents. • Assess for the use of antithyroid agents. Bugleweed should not be used with other thyroid medications but may be used with other antithyroid herbs (see Interactions). • Assess for nervousness, excitability, and irritability. • Check the client’s weight, blood pressure, and pulse weekly. Check for puffiness of the periorbits, hands, and feet, which may indicate hypothyroidism. Administer • Instruct the client to take this herb at the same time each day to maintain blood levels. • Instruct the client to store bugleweed in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 5 and breastfeeding category is 5A. • Caution the client not to use bugleweed in children. • Caution the client not to use bugleweed with thyroid products or radioisotopes. • Teach the client how to keep a graph of weight, pulse, and mood. • Teach the client the symptoms of continuing hyperthyroidism: diarrhea, fever, irritability, sleeplessness, intolerance to heat, and tachycardia. • Instruct the client to inform all other health care providers of herbs taken. Burdock (buhr’dahk) Scientific names: Arctium lappa, Arctium minus Other common names: Bardane, beggar’s buttons, clotbur, cockle buttons, cuckold, edible burdock, fox’s clote, gobo, great bur, great burdock, happy major, hardock, lappa, love leaves, personata, philanthropium, thorny burr, wild gobo Origin: Burdock is a perennial found in China, Europe, and the United States. Uses Burdock seeds are used for their hypotensive, myodepressant, and renotropic properties. Burdock roots are used for their hypoglycemic, antiseptic, toxicopectic, and antitumor actions. Burdock is used for skin disorders such as psoriasis, eczema, = Pregnancy = Pediatric ! = Alert = Popular Herb Burdock 123 poison ivy, boils, and canker sores. Burdock compresses can soothe the swelling of arthritis, rheumatism, and hemorrhoids. It is also commonly used in food, especially in Chinese populations (Jellin et al, 2008). Actions Burdock’s actions include a depurative, mild laxative, and mild diuretic (Mills, Bone, 2005). Hypoglycemic Action The inulin content of burdock root makes up approximately 60% of its weight. When used to treat diabetes in rats, Arctium lappa extract caused a long-lasting reduction in blood glucose and an increased tolerance of carbohydrate (Lapinina et al, 1964). Antimicrobial Action The roots of Arctium spp. have demonstrated antibacterial activity against Staphylococcus spp., and two compounds present in the fresh root have been found to possess antifungal and antibacterial properties. Arctium was active in vitro against the gram-negative organisms Escherichia coli and Pseudomonas aeruginosa; against the gram-positive organism Staphylococcus aureus; and against the fungi Microsporum gypseum, Trichophyton spp., and Epidermophyton floccosum (Reisch et al, 1967; Pereira et al, 2005; Gentil et al, 2006). These actions were lost when the roots were dried. Antitumor Action A polymer from burdock root may assist in the prevention of cancer by decreasing mutagens, possibly by adsorption (Morita et al, 1984, 1985). An extract of A. lappa root also decreased tumor growth (Foldeak et al, 1964). Burdock showed antiproliferative and apoptotic effects by action of arctigenin, one of the compounds in this herb (Matsumoto, 2006). Other Actions One study identified a hepatoprotective effect of burdock. Mice were injected with carbon tetrachloride or acetaminophen. A. lappa was able to reverse hepatic effects (Lin et al, 2000, 2002). Product Availability Capsules: 425, 475 mg; cream; salve; fluid extract; root; tea; tincture Plant Parts Used: Dried roots (most active, used part), leaves, seeds Dosages • Adult PO decoction: 1 cup tid-qid • Adult PO fluid extract: 1-3 ml bid • Adult PO tincture of root: 3-5 ml bid-qid • Adult topical: apply as compress or as a cream prn Contraindications Pregnancy category is 2; breastfeeding category is 2A. Burdock may be used in children. It should not be used by persons who are hypersensitive to this plant. Burdock should be used cautiously by persons with diabetes or cardiac disorders. Side Effects/Adverse Reactions CV: Hypotension ENDO: Hypoglycemia Continued Adverse effects: Underline = life-threatening B 124 Burdock Interactions Drug Antidiabetics (glyburide, insulin, miglitol): An increased hypoglycemic effect can occur when burdock is taken with antidiabetics; avoid concurrent use. Antihypertensives, calcium channel blockers: Burdock may possibly increase the hypotensive effect of antihypertensives, calcium channel blockers; avoid concurrent use. Lab Test Blood glucose: Burdock may decrease blood glucose level. Primary Chemical Components and Possible Actions Chemical Class Individual Component Carbohydrate Insulin Tannin Polyphenolic acid Volatile acid Nonhydroxy acid Polyacetylene Glycoside Gamma-guanidinon-butyric acid Lactone glycoside Lignan Possible Action Hypoglycemia Wound healing; antiinflammatory Arctiopiricin Anthroquinones Antimicrobial Arctiin Antinephrotic; central nervous system stimulant; hypotensive Antiproliferative, apoptotic Arctigenin Matairesinol (a lignan) A; B; C; D; E; F; Neoarctin Daucosterol Matairesinol Lappaol Arctigenin Xyloglucan Root Calcium antagonist; hypotensive Active against gramnegative bacteria Active against grampositive and gramnegative bacteria Leaves, flowers Client Considerations Assess • Assess the reason the client is using burdock. • Monitor blood pressure and blood glucose levels while the client is taking this herb. = Pregnancy = Pediatric ! = Alert = Popular Herb Butcher’s Broom 125 • Assess for the use of antidiabetics, antihypertensives, and calcium channel blockers (see Interactions). B Administer • Instruct the client to store burdock in a tight container away from sunlight and moisture. Teach Client/Family • Inform the client that pregnancy category is 2 and breastfeeding category is 2A. • Inform the client that burdock may be used in children. Butcher’s Broom (bu’chuhrz brewm) Scientific name: Ruscus aculeatus Other common names: Box holly, knee holly, pettigree, sweet broom Origin: Butcher’s broom is an evergreen found in the Mediterranean and the southern region of the United States. Uses Butcher’s broom has been used as a laxative and diuretic, to treat varicose veins, peripheral vascular disease, arthritis, hemorrhoids, leg edema, diabetic retinopathy, carpal tunnel syndrome, and to relieve inflammation. Investigational Uses Butcher’s broom may be used for orthostatic hypotension and chronic venous insufficiency. Actions Butcher’s broom’s actions are antiinflammatory venotonic (Mills, Bone, 2005). Venous Action Several research studies have focused on the use of butcher’s broom to treat varicose veins. In fact, when Ruscus aculeatus was given with ascorbic acid and hesperidin to 40 patients with chronic phlebopathy of the lower limbs, an immediate and significant positive change (improvement of the varicose veins) occurred (Cappelli et al, 1988). Another study investigated the antielastase and antihyaluronidase effect of two chemical components present in R. aculeatus, the saponins and sapogenins. This study demonstrated a remarkable antielastase activity that could help improve venous insufficiency (Facino et al, 1995). The peripheral vascular effects of butcher’s broom appear to be mediated selectively by calcium channels and alpha-1–adrenergic receptors (Bouskela et al, 1994). More recent studies (Vanscheidt et al, 2002; Aguilar et al, 2007) confirm older studies in the use of butcher’s broom for chronic venous insufficiency. Antimicrobial Action One study tested the use of 20 Palestinian plant species used in folk medicine, including R. aculeatus. The research tested these 20 herbs against Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Proteus vulgaris, Pseudomonas aeruginosa, and Candida albicans. Of the 20 plants tested, R. aculeatus was the least effective against Candida albicans and demonstrated limited activity against the other organisms (Ali-Shtayeh et al, 1998). Adverse effects: Underline = life-threatening 126 Butcher’s Broom Other Actions One study (Redman, 2000) identified the positive effect of butcher’s broom in orthostatic hypotension. Butcher’s broom is an alpha-adrenergic agonist. The chemical components ruscogenin and neoruscogenin may be responsible for this action. Product Availability Capsules: 75, 100, 150, 400, 470, 475 mg; fluid extract; ointment; suppositories (available in Europe); tablets; tea Plant Parts Used: Dried rhizome, dried roots, leaves Dosages • Adult PO: 7-11 mg total ruscogenin (Blumenthal, 1998) • Adult PO tea: 1 heaping tsp/1 cup water • Adult topical ointment: apply to area as needed Chronic Venous Insufficiency • Adult PO root extract: 150 mg with 150 mg hesperidin with 100 mg ascorbic acid bid (Jellin et al, 2008) Other dosages are not consistently delineated in the literature. Contraindications Class 1 herb. Pregnancy category is 2; breastfeeding category is 2A. Butcher’s broom should not be given to children (no data available). Persons with benign prostatic hypertrophy (BPH) and hypertension should avoid the use of this herb. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, gastritis (rare) Interactions Drug Alpha-adrenergic blockers: Butcher’s broom may decrease the action of alpha-adrenergic blockers; avoid concurrent use. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Steroidal saponin Phytosterol; Glucopyranosyl Ruscin Ruscogenin; Neoruscogenin Vascoconstrictor Coumarin Sparteine Tyramine Increased vasopressor effect Glycolic acid Anthraquinone Euparone = Pregnancy Laxative = Pediatric ! = Alert = Popular Herb Butterbur 127 Primary Chemical Components and Possible Actions—cont’d Chemical Class Ethanol Fatty acid Benzofuranes Individual Component Possible Action Euparone, Ruscodibenzofurane Client Considerations Assess • Determine whether the client is using butcher’s broom to treat venous insufficiency. If so, assess for symptoms (pain, swelling of legs when standing or sitting). If symptoms are present, check for constrictive clothing before administering herb. • Assess for hypertension or BPH. Avoid administering this herb to clients with these conditions. Administer • Instruct the client to take as a tea, in capsule form, or as a fluid extract. • Instruct the client to store butcher’s broom in a cool, dry place, away from moisture and heat. Teach Client/Family • Inform the client that pregnancy category is 2 and breastfeeding category is 2A. • Caution client not to give butcher’s broom to children (no data available). Butterbur (buh’tuhr-buhr) Scientific names: Petasites hybridus, Petasites officinalis, Tussilago petasites Other common names: Blatterdock, bog rhubarb, bogshorns, European pestroot, flapperdock, langwort, sweet coltsfoot, umbrella leaves, western coltsfoot Origin: Butterbur is a perennial found in Europe and Asia. Uses Butterbur is used to treat respiratory conditions such as asthma, whooping cough, and coughs resulting from other respiratory illnesses. It is used as a diuretic, sedative, and treatment for irritable bowel syndrome and arthritis. Butterbur is also used topically for wound healing. Use in the United States is uncommon. Investigational Uses Researchers are experimenting with the use of butterbur to treat migraine headaches, urinary tract spasms resulting from calculosis, prevention of gastric ulcers, and seasonal allergic rhinitis (Schapowal, 2002; Thome et al, 2002). Adverse effects: Underline = life-threatening B 128 Butterbur Actions Antimigraine Action One study showed that a group of migraine sufferers who received butterbur experienced a 56% reduction in the number of migraine headaches. In addition, the headaches experienced by this group were of shorter duration than those experienced by participants who received a placebo (Eaton, 1998). Butterbur extract was more effective than a placebo and is well tolerated to prevent migraines (Lipton et al, 2004). Antispasmodic Action The active chemical components petasin and isopetasin may be responsible for the antispasmodic action of butterbur, which includes reduction of spontaneous activity and spasm in the smooth muscle system. Butterbur thus may have the potential for treating urinary tract spasms resulting from calculosis (Eaton, 1998). Carcinogenesis Action The butterbur root contains pyrrolizidine alkaloids, which in animal studies have been linked to the development of cancer and hepatotoxicity. The recommendation is that human daily intake of pyrrolizidine alkaloids not exceed 1 mcg (Reglin et al, 1998). New formulas of butterbur are available in which the pyrrolizidine alkaloid content is well below this recommended level (pyrrolizidine alkaloid–free Petasites sp.). Other Actions Studies have shown that butterbur may be used for seasonal allergic rhinitis, without sedative effects of traditional antihistamines (Schapowal, 2002; Thome, 2002). Butterbur possesses COX-2 inhibitors and may be used for inflammatory conditions (Fiebich et al, 2005). Product Availability Capsules: 25 mg; cigarette; extract; fluid extract; fresh leaves Plant Parts Used: Flowers, leaves, roots, stems Dosages • Adult PO infusion: pour boiling water over 1.2-2 g of herb, steep 10 min, strain, drink 2-4 oz as often as qid (Moore, 1996) • Adult PO fluid extract: 1-3 ml tid (1:2 dilution) (Moore, 1996) • Adult topical: apply fresh leaves as a poultice prn Contraindications ! Butterbur should not be used during pregnancy and breastfeeding. It should not be given to children. Persons with decreased gastrointestinal or genitourinary motility should avoid the use of this herb; symptoms may worsen. The pyrrolizidine alkaloids in this herb can cause irreversible hepatic damage. Side Effects/Adverse Reactions EENT: Color change of sclera GI: Nausea, vomiting, anorexia, abdominal pain, color change of stools, constipation, hepatotoxicity GU: Difficulty in urination INTEG: Color change of skin RESP: Dyspnea, shortness of breath SYST: Carcinogenesis (resulting from high levels of pyrrolizidine alkaloids) = Pregnancy = Pediatric ! = Alert = Popular Herb Butterbur 129 Interactions Drug Anticholinergics, antimigraine agents, beta-blockers: The effects of anticholinergics, antimigraine agents, and beta-blockers may be enhanced by the use of butterbur; avoid concurrent use. Herb Pyrrolizidine alkaloid (UPA)-containing herbs: Butterbur may add to toxicity (Jellin et al, 2008). Lab Test Hepatic function tests: Butterbur may increase hepatic function tests (Jellin et al, 2008). Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Alkaloid Petasin; Isopetasin Antispasmodic; antiinflammatory Hepatotoxic Pyrrolizidine Oxopetasin esters; Senecionine; Integerrimine; Senkirkine Volatile oil Sesquiterpenes Pectin mucilage tannins Pethybrene; Petasitene Client Considerations Assess • Assess the reason the client is taking butterbur medicinally. ! • Assess for hepatotoxicity: increased hepatic function test results (AST, ALT, bilirubin), clay-colored stools, and upper-quadrant pain. If symptoms are present, discontinue use of butterbur immediately. • Assess for medications used (see Interactions). Administer • Instruct the client to take PO, use topically, or smoke. • Instruct the client to store butterbur in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use butterbur in children or those who are pregnant or breastfeeding until more research is available. • Caution the client not to use excessive doses of this herb; carcinogens are present in the pyrrolizidine alkaloids. • Caution the client not to confuse the leaves of butterbur with those of other Petasites spp. Adverse effects: Underline = life-threatening B 130 Cacao Tree Cacao Tree (kuh-kau’ tree) Scientific name: Theobroma cacao Other common names: Cacao, chocolate, cocoa, cocoa butter Origin: The cacao tree is found in Mexico and is cultivated in other parts of the world. Uses Cacao is used extensively in food and drink. The flavonoids in cacao are potent diuretics, mild central nervous system stimulants, and cardiac stimulants. Cacao is not used therapeutically by herbalists or naturopaths. It has been used topically (cocoa butter) to treat wrinkles and prevent stretch marks in pregnancy. Investigational Uses New studies are confirming that cacao flavanols reduce the risk for cardiovascular disease (Balzer et al, 2008; Erdman et al, 2008). Actions Cacao has been used for centuries as a food and as a flavoring for food and drink. Antioxidant Action Cacao may exert significant antioxidant effects because of one of its chemical components, catechin, a flavonoid also found in black tea. Catechin has been shown to increase immune response and decrease mutagenesis (Waterhouse et al, 1996). Stimulant Action Since cacao contains xanthines, which are also present in coffee and tea, it acts as a mild central nervous system stimulant. It also acts as a cardiac stimulant and produces a mild diuretic effect. Theobromine, a chemical component of cacao, is one of the weakest xanthines. Cardiovascular Action Two new studies (Balzer et al, 2008; Erdman et al, 2008) showed a decrease in cardiovascular risk when cocoa flavanols were consumed on a regular basis in those with a significant cardiovascular risk or those who were diabetic. The regular consumption can reverse vascular dysfunction in diabetes. Product Availability Butter, extract, powder, syrup Plant Part Used: Seeds Dosages Dosages are not clearly delineated in the literature. Contraindications Until more research is available, consumption of cacao should be avoided by persons with hypersensitivity to this herb; persons with irritable bowel syndrome, gastroesophogeal reflux disease, or colitis; pregnant or breastfeeding women; and children. Persons with anxiety disorders should avoid large amounts. Consumption of cacao in large amounts may cause death in animals. = Pregnancy = Pediatric ! = Alert = Popular Herb Cacao Tree 131 Side Effects/Adverse Reactions Cacao is generally well tolerated when taken in reasonable amounts, although it may cause hypersensitivity or side effects in some individuals. C Interactions Drug MAOIs: The tyramine content in cacao may increase the vasopressor effect of MAOIs; do not use concurrently. Theophylline: Cacao may decrease the metabolism of xanthines such as theophylline, thereby increasing theophylline levels; do not use concurrently. Herb Ephedra, guarana, yerba maté: Cacao may increase the effects of these products. Food Coffee, tea, cola: Cacao may increase central nervous system stimulation when used with caffeinated foods and drinks. Lab Test Catecholamines, VMA levels, bleeding time: Cacao in large amounts may cause increased catecholamines, VMA levels, bleeding time. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Flavonoid Catechin Epicatechin Theobromine Antioxidant, CV protectant Alkaloid Caffeine Tyramine Trigonelline Polysaccharides (Redgwell et al, 2000) Central nervous system stimulant; diuretic Cardiac stimulant Increased vasopressor effect Client Considerations Assess • Assess the reason the client is using cacao tree medicinally. • Assess for hypersensitivity to chocolate. Individuals with this hypersensitivity should not use cacao. • Assess for cardiovascular disease, colitis, and irritable bowel syndrome. Individuals with these conditions should not use cacao in large amounts. • Assess for the use of MAOIs and theophylline (see Interactions). • Monitor blood pressure: blood pressure may be elevated. Administer • Instruct the client to store cacao in a cool, dry place, away from heat and moisture. Adverse effects: Underline = life-threatening 132 Calcium Teach Client/Family • Caution the client not to use cacao medicinally in children or in those who are pregnant or breastfeeding until more research is available. • Caution the client to keep cacao-containing products away from pets. Calcium (kal’-see-um) Scientific name: Calcium, Ca Other common names: Bone meal, calcium acetate, calcium carbonate, calcium citrate, calcium gluconate, calcium gluceptate, calcium lactate Origin: Calcium is a naturally occurring element. Uses Calcium is used as an antacid, in osteoporosis prevention, and for calcium supplementation, and to prevent and treat hypocalcemia, hypermagnesemia, hypoparathyroidism, and vitamin D deficiency. Actions Calcium is cation needed for maintenance of nervous, muscular, and skeletal function, enzyme reactions, normal cardiac contractility, coagulation of blood, secretory activity of exocrine and endocrine glands. Product Availability Tablets, capsules Dosages Antacid • Adult PO: 0.5-1.5 g 1 hr after meals and bedtime Prevention of Hypocalcemia, Depletion, Osteoporosis • Adult PO: 1-2 g daily Contraindications Calcium should not be used in fluid restriction, dehydration, or breastfeeding. Side Effects/Adverse Reactions GI: Constipation, anorexia, nausea, vomiting, flatulence, diarrhea, rebound hyperacidity, eructation Pharmacology Pharmacokinetics Onset 20 minutes, duration up to 2 hours, crosses placenta, excreted in urine and feces, bioavailability of calcium products differ widely (Hanzlik et al, 2005). Client Considerations Assess • Assess the reason client is using calcium. Administer • Keep calcium in a dry area, away from direct sunlight. = Pregnancy = Pediatric ! = Alert = Popular Herb Calumba 133 Teach Client/Family • Teach the patient that calcium may be used in pregnancy and breastfeeding and may be given to children. C Calumba (kal-um’ba) Scientific names: Jateorrhiza calumba, Jateorrhiza palmata Other common names: Cocculus palmatus, columbo root, calumba root Origin: Calumba is found only in Madagascar and Mozambique. Uses Calumba has traditionally been used to treat diarrhea and flatulence. It is an old, eclectic herb from South Africa whose use is uncommon in the United States. Actions Very little research is available documenting any uses or actions of calumba. There are no human studies for any use, and for that reason the use of this herb is not recommended. Calumba has been used in Africa as a dye for clothing and a flavoring for food. Columbin, one of the chemical components, may be responsible for sedative effects. Product Availability Capsules, tincture Plant Part Used: Roots Dosages • Adult PO infusion: 1-2 oz tid (Moore, 1996) • Adult PO tincture: 1-2 ml before meals (1:5 dilution) (Moore, 1996) Contraindications Until more research is available, calumba should not be used during pregnancy and breastfeeding. It should not be given to children. Side Effects/Adverse Reactions CNS: High doses: sedation, coma, paralysis GI: Vomiting Interactions Drug Antacids, H2-blockers, proton pump inhibitors: Calumba may decrease the action of antacids, H2-blockers, and proton pump inhibitors (theoretical) (Jellin et al, 2008). Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Columbamine Jateorhizine Continued Adverse effects: Underline = life-threatening 134 Capsicum Primary Chemical Components and Possible Actions—cont’d Chemical Class Individual Component Palmatine Alkaloid Columbin Possible Action Sedative Client Considerations Assess • Determine the reason the client is using calumba. Administer • Instruct the client to store calumba in a tightly sealed container. Teach Client/Family • Caution the client not to use calumba in children or in those who are pregnant or breastfeeding until more research is available. Capsicum (kap’si-kuhm) Scientific names: Capsicum frutescens, Capsicum annum Other common names: Capsaicin, cayenne pepper, chili pepper, hot pepper, paprika, pimento, red pepper, tabasco pepper Origin: Capsicum is found in tropical areas of the Americas. Uses Capsicum is used topically to treat diabetic neuropathy, psoriasis, postmastectomy pain, Raynaud’s disease, herpes zoster, arthritis, muscular pain, and poor peripheral circulation. It is used internally as a gastroprotective agent in peptic ulcer disease, to reduce cholesterol and blood clotting, to promote cardiovascular health, and to treat coronary artery disease, the common cold, flu, and vascular congestive conditions. Capsicum is commonly used by herbalists in the United States as an adjunct where vasodilation or warmth is needed. Actions Gastroprotective Action Capsaicin, one of the chemical components of capsicum, was found to protect against Helicobacter pylori–associated gastrointestinal disease. Test results have shown that doses similar to those that can be achieved in the diet are sufficient to provide the anti–H. pylori action (Jones et al, 1997). Also, capsicum can protect the stomach against gastric mucous damage if taken 30 minutes before aspirin dose (Jellin et al, 2008). Pain Relief Action Topical capsicum preparations are used to relieve muscular pain and the pain associated with arthritis and a variety of other conditions (Keitel et al, 2001). The chemical components responsible for pain relief are the capsaicinoids. The = Pregnancy = Pediatric ! = Alert = Popular Herb Capsicum 135 most effective of these is capsaicin (Cordell et al, 1993), which can alter P-mediated pain transmission. Research has shown that capsaicin cream is an effective and safe treatment for relief of the pain associated with diabetic neuropathy (Tandan et al, 1992). C Possible Cardiovascular Actions Research on rats has shown cardiovascular responses such as hypotension, decreased heart rate, and vasodilation that may be due to the tachykinins in capsaicin. Capsaicin acts on the vanilloid receptors found in many tissues (Cuprian et al, 1998). Enhanced Immunity Action In one study, rats were divided into five groups and fed various amounts of capsaicin in their diets. The rats that were fed a medium level of capsaicin (20 ppm) showed an increase in the T-cell mitogen-induced lymphocyte proliferative response, and an increase in B-cell, immunoglobulin G (IgG), immunoglobulin M (IgM), and tissue necrosis factor-alpha (TNF-alpha) levels, suggesting an increased immune function (Yu et al, 1998). Product Availability Capsules, tablets: 400, 500 mg; cream: 0.025%, 0.075%, 0.25% concentrations; gel: 0.025% concentration; lotion: 0.025%, 0.075% concentrations; spice; spray: 5%, 10% concentrations; tincture Plant Part Used: Dried fruit Dosages Pain Relief • Adult topical: apply cream (0.025%-0.075% concentration) for at least 2 wk for beginning pain relief; may use up to qid Other • Adult PO capsules/tablets: 400-500 mg daily tid • Adult PO tincture: 5-15 drops in water qid (1:5 dilution) (Moore, 1996). Contraindications Class 1 herb (internal use); class 2d herb (external use). Until more research is available, capsicum should not be used internally, medicinally during pregnancy and breastfeeding. It should not be used by persons with hypersensitivity, and should not be given to children. This herb should not be used on open wounds or abrasions, or near the eyes. It is extremely vesicant in undiluted form. Side Effects/Adverse Reactions GI: Gastrointestinal cramping, pain, diarrhea (internal use) INTEG: Severe burning, itching, and stinging that lessen with each application; painful irritation of mucous membranes (all topical use) MISC: Sweating, running nose, tearing of eyes (internal use) Interactions Drug Alpha-adrenergic blockers: Capsicum may decrease the action of alphaadrenergic blockers; avoid concurrent use. Continued Adverse effects: Underline = life-threatening 136 Capsicum Interactions—cont’d Clonidine, methyldopa: Capsicum may decrease the antihypertensive effects of clonidine, methyldopa; avoid concurrent use. MAOIs: Capsicum may precipitate hypertensive crisis when used with MAOIs; do not use concurrently. Topical products: There are no known drug interactions of topical capsicum preparations with other topical products. Herb Feverfew, garlic, ginkgo, ginseng: Capsicum may increase the risk for bleeding. Lab Test Coagulation time: Capsicum may cause increased coagulation time. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Volatile oil Capsaicin Capsaicinoid Lutein Capsanthin; Capsorubin; Carotene; Oleoresin; Resiniferatoxin; 3,6-Epoxide Capsicoside E, F, G Pain relief; anti– Helicobacter pylori Antioxidant Saponins Protein Fat Vitamin Provitamin A; C E P; B1; B2; B3 Antimicrobial Antioxidant Client Considerations Assess • Assess the reason the client is using capsicum medicinally. • Assess for gastrointestinal conditions such as peptic ulcer, irritable bowel syndrome, and colitis. Some recent research has identified gastroprotective effects of capsicum; however, other researchers believe capsicum should not be used if the aforementioned conditions are present (see Actions). • Assess for improvement in the symptoms of diabetic neuropathy, psoriasis, or herpes zoster if the client is using capsicum for any of these conditions. • Determine whether the client is using MAOIs or antihypertensives. Capsicum should not be used concurrently with these medications (see Interactions). Administer • Instruct the client to use topically as soon as pain is starting to return. The stinging and burning sensations that some people experience with topical capsicum products should subside after repeated applications. = Pregnancy = Pediatric ! = Alert = Popular Herb Caraway 137 Teach Client/Family • Caution the client not to use capsicum in children or those who are pregnant or breastfeeding until more research is available. C Caraway (kar’uh-way) Scientific name: Carum carvi L. Other common names: Kummel, kummelol, oleum cari, oleum carvi Origin: Caraway is a biennial herb grown in Europe, Siberia, the Himalayas, parts of Asia, and now in the United States. Uses Caraway has been used traditionally for gastrointestinal disorders such as flatulence, constipation, abdominal distention, irritable bowel syndrome, dyspepsia, colic, heartburn, indigestion, and stomach ulcers, and as a gargle for laryngitis. It is also used for the common cold, bronchitis, and to relieve menstrual cramps (Jellin et al, 2008). Investigational Uses Studies are underway for antiinfective uses against Bacillus, Pseudomonas, Candida, and Dermatomyces, as an antineoplastic and a diuretic. Actions Antispasmodic Action The effects of peppermint oil used in conjunction with caraway oil are comparable with cisapride for treating dyspepsia. Both peppermint and caraway oils were well tolerated and produced a minimum of side effects. Caraway oil has been shown to be effective in treatment of Helicobacter pylori infections, epigastric pain, and gastric ulcers (Khayyal et al, 2001; Madisch et al, 1999; Mickelfield et al, 2000). Antimicrobial Action When tested on animals, caraway demonstrated effectiveness against Bacillus, Pseudomonas, Candida, and Dermatomyces spp. and other gram-positive and gramnegative organisms (Hopf et al, 1977; Iacobellis et al, 2005). Antiulcergenic Action In one study, 32 patients with duodenal ulcers or gastroduodenitis were given several laxative herbs, including caraway. Patients with obstipation syndrome improved (Matev et al, 1981). Other Actions Strong diuretic action was identified in the lab using normal rats. The actions are furosemide-like and thiazide-like (Lahlou et al, 2007). Product Availability Tea, capsules, oil, volatile oil, seeds, water, powder, infusion Plant Part Used: Seeds Adverse effects: Underline = life-threatening 138 Cardamom Dosage • Adult PO essential oil: 1-4 drops in a tsp of water or on a sugar cube before meals • Adult PO seeds: 1.5-6 g finely crushed seeds, chewed and swallowed • Adult PO infusion: use to make infusion bid-tid between meals; press 1-2 tsp of finely ground seeds, add 150 ml of hot water, let steep 10-15 min before straining and drinking Contraindications Class 1 herb. Caraway should not be used in hypersensitivity or gastroesophageal reflux disease or during pregnancy (uterine relaxation may occur) (theoretical). Side Effects/Adverse Reactions GI: Anorexia, diarrhea, hepatic dysfunction GU: Renal dysfunction INTEG: Redness, irritation, contact dermatitis Primary Chemical Components and Possible Actions Chemical Class Individual Component Glucosides Monoterpenoides Volatile oil Janipediol; L-Fucitol Terpene; D-Limonene; Ketone Ketone, D-Carvone; Terpene; D-Limonene Possible Action Chemoprotective Client Considerations Assess • Assess the reason the client is using caraway medicinally. Administer • Protect from light and moisture; place in metal or glass containers. Teach Client/Family • Teach the client that caraway should not be used medicinally in pregnancy (uterine relaxation may occur), in breastfeeding, or for children until more research is available. Cardamom (kahr’duh-muhm) Scientific name: Elettaria cardamomum Other common names: Cardamom seeds, Malabar cardamom Origin: Cardamom is a perennial found in India. = Pregnancy = Pediatric ! = Alert = Popular Herb Cardamom 139 Uses Cardamom is an aromatic used to treat dyspepsia, colic, flatulence, irritable bowel syndrome, gallstones, viruses, the common cold, cough, bronchial congestion, and anorexia. It is most commonly used therapeutically by Ayurvedic practitioners. Actions Enhanced Skin Permeation One study showed that cardamom oil enhances skin permeation for indomethacin. Pretreating the skin with cardamom oil for 5 min greatly enhanced the permeation of indomethacin (Huang et al, 1999). Much research is underway to identify which crude herb extracts increase permeation. Gastroprotective Action Cardamom is used in the Unani system of medicine to treat gastrointestinal disorders. When cardamom was tested in the lab using rats, the gastric lesions induced by aspirin, ethanol, and pylorous ligature were significantly reduced, some by 100% (Jamal et al, 2006). The volatile oils in cardamom exert antispasmotic and antiflatulent properties. Product Availability Fluid extract, powder, seeds (dried and whole), tincture Plant Part Used: Seeds Dosages Recommended dosages vary widely. • Adult PO fluid extract: 10-30 drops before meals • Adult PO powder: 15-30 grains before meals • Adult PO tincture: 5-10 drops prn or before meals (Moore, 1996); 1-2 g/day (Jellin et al, 2008) • Adult PO whole seeds: 1.5 g (Blumenthal, 1998) chewed before meals • Adult PO ground seeds: 1.5 g per day (Jellin et al, 2008) Contraindications Class 1 herb. Until more research is available, cardamom should not be used during pregnancy and breastfeeding. It should not be given to children. Persons with gastroesophageal reflux disease should avoid the use of cardamon. Persons with gallstones should use this herb with caution. Side Effects/Adverse Reactions GI: Gallstone colic INTEG: Contact dermatitis (rare) Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Volatile oil Cineol Linalyl acetate Alpha-terponyl Antispasmodic, antiviral, antiflatulent Continued Adverse effects: Underline = life-threatening C 140 Carline Thistle Primary Chemical Components and Possible Actions—cont’d Chemical Class Individual Component Possible Action Analgesic Linalool Alpha-pinene Limonene Myrcene Client Considerations Assess • Assess the reason the client is taking cardamom medicinally. • Assess for contact dermatitis; if present, discontinue use of cardamom. Administer • Instruct the client to store cardamom away from sunlight and moisture. • Instruct the client to take right before meals. Teach Client/Family • Caution the client not to use cardamom in children or those who are pregnant or breastfeeding until more research is available. • Advise the client not to exceed the recommended dosage. Carline Thistle (kahr’luhn thi’suhl) Scientific name: Carlina acaulis Other common names: Dwarf carline, felon herb, ground thistle, southernwood root, stemless carline root, carlina Origin: Carline thistle is found in Europe. Uses When used internally, carline thistle is used as a mild diuretic, diaphoretic, spasmolytic, an antimicrobial against Staphylococcus aureus, and for the treatment of gallbladder disease. It is used topically to treat dermatosis, wounds, ulcers, and cancer of the tongue (Tamuki et al, 1994). Carline thistle is also used to treat herpes and toothaches (Jellin et al, 2008). Actions Very little research exists on carline thistle. Most of the available information is anecdotal. The volatile oil may have an antibacterial action. Product Availability Liquid, tea, tincture Plant Parts Used: Leaves, roots, seeds Dosages • Adult PO decoction: 3 g herb in 150 ml water, boil 5 min, 1 cup tid • Adult PO infusion: 2 tbsp herb in 8 oz water, boil 15 min and let stand 1⁄2 hr; 1 cup tid between meals = Pregnancy = Pediatric ! = Alert = Popular Herb Carnitine 141 • Adult PO tincture: 20 g chopped herb in 80 g ethanol (60%), let stand 10 days, 40 drops qid • Adult topical liquid: may be applied prn C Contraindications Until more research is available, carline thistle should not be used during pregnancy and breastfeeding. It should not be given to children. Side Effects/Adverse Reactions CNS: Pain, spasms, seizures (overdose) Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Antibacterial Hypoglycemia Wound healing; antiinflammatory Volatile oil Inulin Tannin Client Considerations Assess • Assess the reason the client is using carline thistle medicinally. ! • Assess for symptoms of overdose: pain, spasms, seizures. If these symptoms occur, use of carline thistle should be discontinued. Administer • Instruct the client to store carline thistle in a sealed container away from sunlight and moisture. Teach Client/Family • Caution the client not to use carline thistle in children or those who are pregnant or breastfeeding until more research is available. • Inform the client that very little scientific research is available to support claims for the therapeutic use of carline thistle. • Advise the client not to confuse carline thistle with other Carlina spp. Carnitine (kahr’nuh-teen) Scientific names: L-Carnitine Other common names: LPT, LAT, ALC Origin: Synthetic. It is found in its natural state in food. Uses Carnitine is used for angina, congestive heart failure, Alzheimer’s disease, other types of dementia, post myocardial infarction, and to improve athletic performance. Adverse effects: Underline = life-threatening 142 Carnitine Actions Carnitine is needed in the body for the transport of fatty acids into the cell. Cardiovascular Action Several studies have identified the positive results of carnitine in post myocardial infarction recovery, intermittent claudication, angina, and congestive heart failure. All studies point to the improvement in ventricular hypertrophy, decreased angina attacks, and decreased mortality (Davini et al, 1992; Illicento et al, 1995; Singh et al, 1996). Significant improvement in walking distance was reported in those diagnosed with intermittent claudication (Bolognesi et al, 1996; Brevett et al, 1999). Another study (Spasov et al, 2006) using lab rats showed normalization in myocardial function in contractibility, relaxation, blood pressure, maximal isometric loading test, after a carnitine-deficient diet was replaced with a carnitine-rich diet. Other Actions Carnitine has also shown positive results in Alzheimer’s disease and other dementias (Bonavita, 1986; Calvani et al, 1992). Beginning research has shown carnitine to be beneficial in decreasing the harmful effects from antiretroviral therapy in HIV (Semino-Mora et al, 1994), in preterm infants with recurrent apnea (Kumar et al, 2004), and in wound healing (Koybasi et al, 2005). Product Availability Tablets Dosage • Adult PO: 1500-6000 mg tid Contraindications The effects of carnitine are not known in severe hepatic/renal disease. Recommended amounts are not known for children, or those who are pregnant or breastfeeding. Side Effects/Adverse Reactions ENDO: Myasthenia gravis–like symptoms (DL-carnitine) GI: Anorexia, nausea, vomiting, diarrhea, abdominal pain Interactions Drug Thyroid hormones: Carnitine may inhibit the effects of thyroid hormone replacement therapy; avoid concurrent use. Valproic acid (Depakane, Depakote, valproate): These drugs can induce L-carnitine deficiency (Jellin et al, 2008). Lab Test HDL, lymphocytes, serum triglycerides: Carnitine may cause increased CD4, CD8 lymphocyte count in those not treated with antiretrovirals; increased HDL cholesterol in children on hemodialysis; or decreased serum triglyceride in children on hemodialysis (Jellin et al, 2008). = Pregnancy = Pediatric ! = Alert = Popular Herb Cascara 143 Client Considerations Assess • Assess the reason the client is using carnitine. • Monitor cardiac status, if client is using as a supplement in angina, post myocardial infarction, or congestive heart failure. • Monitor mental status if client is using carnitine for dementia. Administer • Keep carnitine in a cool, dry area, away from excessive light. Teach Client/Family • Teach the client that it is not known how much carnitine is needed for children, or those who are pregnant or breastfeeding. Cascara (ka-skar’uh) Scientific name: Rhamnus purshiana Other common names: Californian buckthorn, sacred bark Origin: Cascara is found along the coast in the Pacific Northwest region of the United States. Uses Cascara is used as a laxative. Actions Laxative Action The laxative action of the anthraglycosides in cascara is well documented in the mainstream pharmacologic literature. This action results from direct chemical irritation in the colon, which increases the propulsion of stool through the bowel. Product Availability Capsules, fluid extract, tea, tincture Plant Part Used: Dried aged bark Dosages Laxative • Adult PO: 20-30 mg hydroxyanthracene (cascaroside A), one-time dose (Blumenthal, 1998) • Adult PO tincture: 1-2 tsp (5-10 ml) (1:5 dilution), one-time dose (Moore, 1996) Contraindications Pregnancy category is 3; breastfeeding category is 3A. Cascara should not be given to children. Use of this herb is contraindicated when gastrointestinal bleeding, obstruction, abdominal pain, nausea, vomiting, appendicitis, or Crohn’s disease are present. Cascara should not be used by those who are hypersensitive to this product. Continued Adverse effects: Underline = life-threatening C 144 Cascara Side Effects/Adverse Reactions GI: Nausea, vomiting, diarrhea, abdominal cramps, laxative dependency GU: Urine discoloration; hematuria, albuminuria (high doses, extended use) MS: Osteomalacia SYST: Vitamin and mineral deficiencies, fluid and electrolyte imbalances (high doses, extended use) Interactions Drug Antacids: Antacids may decrease the action of cascara if taken within 1 hour of the herb. Antiarrhythmics, cardiac glycosides (digoxin): Chronic cascara use can cause hypokalemia and enhance the effects of antiarrhythmics, cardiac glycosides; do not use concurrently. Corticosteroids, thiazide diuretics: Hypokalemia can result from use of cascara with corticosteroids, thiazide diuretics; avoid concurrent use. Herb Adonis, convallaria, helleborus, horsetail, licorice root, strophanthus: Use with cascara may lead to hypokalemia; avoid concurrent use. Aloe, castor, blackroot, blue flag, buckthorn, butternut, rhubarb, senna, wild cucumber, yellow dock: Increased laxative effect when used with these herbs (Jellin et al, 2008). Digitalis, lily of the valley, squill: Use with cascara can lead to cardiac toxicity. Food Milk: Milk may decrease the action of cascara; avoid concurrent use. Lab Test Serum and 24-hour urine estrogens: Cascara may increase or decrease test values. Potassium levels: Cascara may reduce potassium levels. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Anthraglycoside Cascarosides A, B, C, D Barbaloin; Deoxybarbaloin; Chrysaloin Laxative Laxative Emodin glycoside Client Considerations Assess • Assess blood and urine electrolytes if the client uses this herb often. • Assess the cause of constipation: determine whether fiber, fluids, or exercise is missing from the client’s lifestyle. • Assess for cramping, rectal bleeding, nausea, and vomiting; if these symptoms occur, discontinue use of cascara. = Pregnancy = Pediatric ! = Alert = Popular Herb Castor 145 • Assess for all medications and herbs taken by client; evaluate if drug interactions could occur (see Interactions). Administer • Instruct the client not to take cascara within 1 hour of other drugs, antacids, or milk. This herb should be taken with a carminative to prevent griping. Teach Client/Family • Inform client that pregnancy category is 3 and breastfeeding category is 3A. • Caution the client not to use cascara in children, or those who are pregnant or breastfeeding until more research is available. • Advise the client to avoid long-term use of cascara because it can cause loss of bowel tone. • Instruct the client to notify the provider if constipation is unrelieved or if symptoms of electrolyte imbalance occur (muscle cramps, pain, weakness, dizziness). • Teach patient that urine may turn pink or orange. Castor (kas’tuhr) Scientific name: Ricinum communis Other common names: African coffee bean, bofareira, castor bean, castor oil plant, Mexico seed, Mexico weed, palma Christi, tangantangan oil plant, wonder tree, wunderbaum Origin: Castor is a perennial found in India and Africa. Uses Castor oil is used internally as a laxative, an emetic, a gastrointestinal antiinflammatory agent, and an anthelmintic. It is also used to treat leprosy and syphilis (Scarpa et al, 1982). Externally, it is used to treat boils, abscesses, carbuncles, tumors, inflammation of the middle ear, and migraine headaches. Castor may be used topically to stimulate the resolving of toughened tissue and wound healing. Castor is also used to induce labor. Investigational Uses Studies are ongoing to determine the effectiveness of castor as a contraceptive. Actions Laxative Action The laxative action of castor occurs as a result of its ability to increase fluid in the colon and stimulate peristalsis, which results in increased propulsion of stool through the colon. Castor can be used to empty the colon completely of stool, as is necessary to expel worms. Contraceptive Action Reports confirm that women in Korea, India, Algiers, and Egypt have used castor beans in some form to prevent pregnancy. Some Egyptians believe that pregnancy will be prevented for at least 9 months if a woman consumes one castor seed after her baby is born. (NOTE: This practice could be extremely toxic.) One recent study evaluated the contraceptive action of castor beans in female rabbits. The rabbits were treated with 7.5 mg/kg of castor for 10 days, then mated with proven male rabbits. The treated rabbits showed a 4.3-fold decrease in pregnancy (Salhab et al, 1997). Adverse effects: Underline = life-threatening C 146 Castor Product Availability Oil emulsion in concentrations of 36.4%, 60%, 67%, and 95%; oil liquid in 100% concentration; purge in 95% concentration Plant Part Used: Seeds Dosages • Adult PO: 15-60 ml daily • Adult topical oil pack: apply prn bid for up to 2 wk Contraindications Class 2b/2d herb. Castor should not be used during pregnancy and breastfeeding. It should not be given to children. Persons with hypersensitivity to castor or with gastrointestinal disorders such as obstruction or bleeding, irritable bowel syndrome, appendicitis, Crohn’s disease, undiagnosed abdominal pain, and biliary tract disorders/ obstructions should avoid the use of this herb. Side Effects/Adverse Reactions GI: Nausea, vomiting, abdominal cramps META: Fluid and electrolyte imbalances (chronic use) REPRODUCTIVE: Induce labor SYST: Allergic reactions Interactions Drug Antacids, other drugs: To prevent decreased absorption of castor, do not take within 1 hour of antacids and other drugs. Cardiac glycosides (digoxin): Use with castor oil may lead to increased cardiac adverse reactions (theoretical) (Jellin et al, 2008). Corticosteroids, diuretics: Use with castor oil may increase hypokalemia (theoretical) (Jellin et al, 2008). Laxatives: Use with castor oil may lead to electrolyte imbalances (Jellin et al, 2008). Herb Licorice, horsetail, stimulant laxative herbs: Used with castor oil may lead to hypokalemia (Jellin et al, 2008). Food Milk: To prevent decreased absorption of castor, do not take within 1 hour of milk. Primary Chemical Components and Possible Actions Chemical Class Fatty oil Lectin Pyridine alkaloid Triglyceride Tocopherol = Pregnancy Individual Component Possible Action Ricin D Toxic Ricinoleic acid; oleic acid = Pediatric ! = Alert = Popular Herb Catnip 147 Client Considerations Assess • Assess blood and urine electrolytes if this herb is used often. • Assess for the cause of constipation: determine whether bulk, fluids, or exercise are missing from the client’s lifestyle. • Assess for cramping, nausea, and vomiting. If these symptoms occur, discontinue use of castor. Administer • Instruct the client to take castor alone for better absorption. It should not be taken within 1 hr of other drugs, antacids, or milk. Teach Client/Family • Caution the client not to use castor in children or those who are pregnant or breastfeeding. • Advise the client to avoid the long term use of castor because it can cause loss of bowel tone, as well as severe nutrient depletion and electrolyte loss. • Instruct the client to notify the provider if constipation is unrelieved or if symptoms of electrolyte imbalance occur (muscle cramps, pain, weakness, dizziness). Catnip (kat’nip) Scientific name: Nepeta cataria Other common names: Cataria, catmint, catnep, cat’s play, catwort, field balm, nip Origin: Catnip is a perennial found in the United States. Uses Catnip is used internally to treat migraines, anxiety, colic, insomnia, the common cold, menstrual cramps, digestive disorders, asthma, and influenzae. It is used externally to treat arthritis and hemorrhoids. Catnip is commonly used only to treat mild conditions and is often given to infants and children. Investigational Uses Catnip may be used to inhibit infections of Staphylococcus aureus (Nostro et al, 2001). Actions Very little research is available on the actions of catnip. Most reports are anecdotal. Sedative Action One of the chemical components of catnip, nepetalactone (a volatile oil), may be responsible for the sedative, calming effect of catnip. These effects are similar to those of valerian. Catnip is best known for the reaction cats have to it and the euphoria that results (Hatch, 1972). Its calming effects on humans make Nepeta cataria useful for treating anxiety, digestive disorders, and colic (Chevallier, 1996). Adverse effects: Underline = life-threatening C 148 Catnip Antiinflammatory Action Anecdotal reports are available that document the topical use of catnip to improve the inflammation seen in arthritis and joint conditions (Chevallier, 1996). Currently, no primary research studies are available to substantiate these claims. Antimicrobial Action An extract of N. cataria was tested on 44 Staphylococcus aureus strains. There was significant inhibition of these organisms (Nostro et al, 2001). Product Availability Capsules: 360 mg; dried leaves; elixir; liquid; tea; tincture; available in combination with other herbs. Plant Parts Used: Dried leaves, flowers Dosages • Adult PO infusion: 10 tsp dried leaves in 1 L water, cover while steeping, allow to stand 10 min; 2-6 oz tid (Moore, 1996) • Adult PO tincture: 1-5 ml tid (Moore, 1996) Asthma Attacks • Child PO: steep one small handful of lobelia and catnip in a quart of boiling water for 30 min; serve hot 1⁄4-1⁄2 cup at a time, as needed; watch for side effects for 15 min before repeating (Romm, 2000). Antipyretic • Child PO: prepare 1 oz of catnip to 1 quart of water, steep, strain; may be used in infants (Romm, 2000). Contraindications Class 2b herb. Catnip should not be used during pregnancy because of its possible mild uterine stimulant action. Side Effects/Adverse Reactions CNS: Headache, malaise GI: Nausea, vomiting, anorexia Interactions Drug Alcohol, CNS depressants: The effects of alcohol, CNS depressants (Jellin et al, 2008) may be enhanced when used with catnip. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Volatile oil Nepetalactone Camphor; Epinepetalactone; caryophyllene; Thymol; Carvacrol Sedative; antispasmodic Wound healing; antiinflammatory Tannin = Pregnancy = Pediatric ! = Alert = Popular Herb Cat’s Claw 149 Primary Chemical Components and Possible Actions—cont’d Chemical Class Individual Component Terpenoids Sterols Alpha-amyrin, Beta-amyrin Possible Action Dancosterol, betasitosterol, campesterol (Klimek et al, 2005) Client Considerations Assess • Assess for the reason the client is using catnip medicinally. • Assess for possible pregnancy. Because of its uterine stimulant action, catnip should not be used during pregnancy. • Assess for menstrual irregularities such as increased flow and pain. • Assess for the use of alcohol and sedatives (see Interactions). Administer • Instruct the client to take catnip internally as an infusion or use topically. Teach Client/Family • Caution the client not to use catnip during pregnancy because of its possible mild uterine stimulant action. • Advise the client that catnip may be given to infants and children. Cat’s Claw (kats klaw) Scientific names: Uncaria tomentosa, Uncaria guianensis Other common names: Life-giving vine of Peru, samento, una de gato Origin: Cat’s claw is a member of the madder family and is found in South America and Southeast Asia. Uses Cat’s claw is used today as an immune system stimulant, an antiinflammatory, and a contraceptive. It is used to treat arthritis, irritable bowel syndrome, colitis, and Crohn’s disease. Actions Antiinflammatory Action Cat’s claw is used widely in traditional Peruvian medicine. It inhibits the production of the proinflammatory cytokine, TNF-alpha, which is a critical mediating of the immune response (Allen-Hall et al, 2007). However, little else is known about this herb from a purely scientific standpoint. Immunostimulant Action In Europe, cat’s claw is used in combination with antiviral drugs to treat AIDS patients. However, no scientific research confirms this use. The immunostimulant action of cat’s claw may be due to the combined actions of several of Adverse effects: Underline = life-threatening C 150 Cat’s Claw its chemical components, but no research confirms that possibility. In one limited study, cat’s claw bark was shown to inhibit the growth of leukemia cells in humans without damaging normal healthy bone marrow (Stuppner et al, 1993). Another study demonstrated the ability of cat’s claw to increase phagocytosis, thereby increasing the immune system (Wagner et al, 1985). Cat’s claw shows enhancement of DNA repair, mitogenic response, and leukocyte recovery after chemotherapy-induced DNA-damage in human volunteers (Sheng et al, 2001). This study confirms another study using laboratory animals (Sheng et al, 2000). Product Availability Capsules: 500, 600 mg; root (powdered and raw); tablets (standardized extract): 25, 150, 175, 300, 350 mg Plant Parts Used: Leaves, roots, stem bark Dosages • Adult PO bark (traditional Peruvian dose): 20-30 g finely chopped, then boiled in 1 L water 1⁄2 hr and allowed to stand until it reaches room temperature, tid • Adult PO capsules/tablets: may be taken in amounts up to 5400 mg/day in divided doses • Adult PO decoction: 1 tbsp powdered root in 1 qt water, simmered 45 min; 1 tsp in hot water qAM, before meals • Adult PO tincture: 20-40 drops up to qid; tincture may be standardized to contain 3% total oxindole alkaloids and 15% total polyphenol Contraindications Pregnancy category is 6; breastfeeding category is 3A. Until more research is available, cat’s claw should not be given to children younger than 3 years of age. Persons with multiple sclerosis, tuberculosis, AIDS, or hemophilia and those who have had organ transplants or who have other autoimmune disorders should not use this herb. Side Effects/Adverse Reactions CV: Hypotension GI: Diarrhea Interactions Drug Antihypertensives: Cat’s claw may increase the hypotensive effects of antihypertensives; avoid concurrent use. Hormones (animal), insulin, plasma (fresh), vaccines (passive): Cat’s claw may interact with hormones made from animal products, insulin, fresh plasma, passive vaccines composed of animal sera (Foster, 1995); avoid concurrent use. Immunostimulants: Do not use cat’s claw with other immunostimulants (Jones, 1995). Immunosuppressants: Cat’s claw should not be used with immunosuppressants; immunosuppressant therapy will be decreased (Jellin et al, 2008). = Pregnancy = Pediatric ! = Alert = Popular Herb Cat’s Claw 151 Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Oxindole alkaloid Isopteropodine; Pteropodine; Isomitraphylline Rhynchophylline Immune stimulant Indole alkaloid Mytraphylline Hirsutine Gambirine Isorynchophylline; Uncarine F Glucosides; Cadambine; 3-Dihydrocadambine; 3-Isodihydrocadambine Antiviral; antiinflammatory Quinovic acid glycoside Tannin Proanthocyanidin Polyphenol Catechin Beta sitosterol Indole alkaloid Decrease hypertension, heart rate, cholesterol Diuretic Bladder contractions Cardiovascular Wound healing; antiinflammatory Carboxystrictosidine Client Considerations Assess • Assess the reason the client is using cat’s claw medicinally. • Assess for decreasing blood pressure. If the decrease is significant, discontinue use of cat’s claw. Determine whether the client is using antihypertensives, which will lower blood pressure further. • Assess for recent use of vaccines, hormones, insulin, or fresh plasma, all of which may contraindicate the use of this herb. In Europe, use of these drugs is considered a contraindication to the use of cat’s claw (see Interactions). Administer • Instruct the client to use only standardized cat’s claw products if possible. Teach Client/Family • Inform the client that pregnancy category is 6 and breastfeeding category is 3A. • Advise client not to give cat’s claw to children until more research is available. • Instruct the client to have blood pressure checked regularly while taking this herb. Adverse effects: Underline = life-threatening C 152 Celandine Celandine (seh’luhn-deen) Scientific name: Chelidonium majus Other common names: Celandine poppy, common celandine, felonwort, garden celandine, greater celandine, rock poppy, swallow wort, tetter wort, wart wort Origin: Celandine is a member of the poppy family found in Asia, North America, and Europe. Uses Flowers and leaves of celandine are used to treat spastic conditions of the gastrointestinal tract. Celandine is also used as a liver and gallbladder tonic, to stimulate digestion, and to decrease inflammation. Roots of celandine are used to treat irregular menses and to decrease pain of toothache, tooth extraction. Investigational Uses Researchers are experimenting with the use of celandine to strengthen the immune system and to treat cancer and AIDS. Actions Antispasmodic Action In studies using frogs and mice, a celandine extract reduced gastralgia and pain from gastric ulcers. Chelidonium has been shown to stimulate bile flow when tested in guinea pigs (Rentz, 1948). It also has been shown to relieve histamine-induced spasms in guinea pigs (Kustrak et al, 1982). Nonspecific Immune Stimulation Celandine may act as a chemoprotective agent for stomach cancer in humans. One study using 6-week-old rats showed that celandine inhibited glandular stomach carcinogenesis (Kim et al, 1997). One celandine product that is used in Europe but is not approved in the United States is Ukrain, which is reported to be an antitumor product that acts by inhibiting RNA and DNA replication (Ukranian Anticancer Institute, 1997; Habermehl et al, 2006). Antimicrobial Action Several research articles have discussed the powerful antimicrobial effects of celandine. Its effectiveness has been demonstrated against Candida pseudotropicalis, Microsporum gypseum, Microsporum canis, Trichophyton mentagrophytes, Epidermophyton floccosum, and Streptococcus mutans (Cheng et al, 2006) using herbs gathered during the fall harvest (Vukusic et al, 1991). The strength of the herb varies depending on the season of harvest. Product Availability Extract, tea, tincture Plant Parts Used: Flowers, leaves, roots Dosages • Adult PO: 2-5 g herb (12-30 mg total alkaloids as chelidonine) daily (Blumenthal, 1998; Jellin et al, 2008) = Pregnancy = Pediatric ! = Alert = Popular Herb Celandine 153 • Adult PO tincture: 10-25 drops, up to 1 ml (1:2 dilution) tid (Moore, 1996) • Adult PO fluid extract: 1-2 ml tid (Jellin et al, 2008) • Adult topical extract: apply to warts and corns full strength C Contraindications Class 2b/2d herb. Celandine should not be used during pregnancy and breastfeeding. It should not be given to children. Celandine should not be given to those with biliary obstruction, glaucoma, or hepatic disease. If used alone, this herb is for short-term use only; if used in a formula, it can be used long term (Moore, 1996). Side Effects/Adverse Reactions CNS: Dizziness, drowsiness, fatigue, lethargy, insomnia, restlessness CV: Hypotension GI: Nausea, hepatotoxicity (mild to severe) GU: Polyuria, polydipsia INTEG: Stabbing or itching sensation at lesion Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Alkaloid Chelidonine Reverse T-helper cell deficiency, proapoptotic (Habermehl et al, 2006) Antimicrobial Chelerythrine; Sanguinarine; Lectin Client Considerations Assess • Assess the reason the client is using celandine medicinally. ! • Assess for hepatotoxicity (increased hepatic function test results, clay-colored stools, right upper-quadrant pain, jaundice). If present, discontinue use of celandine. Administer • Instruct the client to store celandine in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use celandine in children or those who are pregnant or breastfeeding until more research is available. • Teach the client to recognize the symptoms of hepatotoxicity: clay-colored stools, jaundice, and right upper-quadrant pain. Adverse effects: Underline = life-threatening 154 Celery Celery (seh’luh-ree) Scientific name: Apium graveolens Other common names: Apium, celery seed, celery seed oil, marsh parsley, smallage, wild cherry Origin: Celery is a biennial found worldwide. Uses Celery seeds are used to treat hypertension, seizure disorders, as a diuretic, and to stimulate labor. Celery juice is used to treat edema, hypertension, joint inflammation, anxiety, and headache. Celery is also used to treat diabetes and has an antiplatelet activity. Therapeutic use in the United States is uncommon. Actions Antihypertensive/Anticholesterol Action Studies using dogs have shown that celery products lower the levels of circulating dopamine, norepinephrine, and epinephrine. This action is believed to result from the ability of celery to inhibit tyrosine hydroxylase. These findings support the traditional use of celery as an antihypertensive (Le Ot et al, 1992). Drinking aqueous celery extract for 8 weeks caused a significant reduction in serum total cholesterol in rats. The action was due to increased bile acid excretion (Tsi et al, 2000). Anticonvulsant Action One of the chemical components of celery, an alkaloid, has been shown to be an effective anticonvulsant (Yu et al, 1984). In one study, celery seeds were able to protect rats and mice from seizures initiated by chemical, audio, and electric means. The seeds contain an alkaloid that exerts both anticonvulsant and central nervous system depressant actions (Kulshrestha et al, 1970). Other Actions Studies have shown that apigenin, one of the chemical components of celery, exerts a strong antiplatelet effect and also inhibits the formation of thromboxane B (Teng et al, 1988). Information has also become available regarding the antifungal effects of celery (Jain et al, 1973). In addition, the oil may possess hypoglycemic and antitumor effects. Caution needs to be exercised with the use of celery in geriatric patients, because celery allergy has been underestimated (Untersmayr et al, 2008). Product Availability Capsules: 450, 505 mg; seeds; tincture Plant Parts Used: Seeds, whole plant Dosages • Adult PO: 1⁄2-1 tsp seeds in 1 cup hot water tid (Moore, 1996) • Adult PO: 1-2 ml 2-5 times/day (Smith, 1999) = Pregnancy = Pediatric ! = Alert = Popular Herb Celery 155 Contraindications Pregnancy category is 3; breastfeeding category is 3A. Celery seeds should not be given to children except as a food source. Persons with allergies to birch or mugwort and those with kidney inflammation should never use celery products. Side Effects/Adverse Reactions CNS: Central nervous system depression GU: Uterine stimulation INTEG: Dermatitis, phototoxic bullous lesions (birch-celery syndrome) SYST: Hypersensitivity reactions, anaphylaxis, angioedema Interactions Drug Anticoagulants, antiplatelets: When given with celery, there is an increased risk of bleeding (theoretical) (Jellin et al, 2008). Antihypertensives, diuretics: Celery may increase the effect of these products. CNS depressants: When used with celery, effects may be increased (theoretical) (Jellin et al, 2008). Thyroid replacement: Celery may decrease the effect of thyroid hormone replacement (Jellin et al, 2008). Herb Anticoagulant/antiplatelet herbs (angelica, anise, arnica, bogbean, boldo, capsicum, chamomile, clove, fenugreek, feverfew, garlic, ginger, ginkgo, ginseng [Panax], horse chestnut, horseradish, licorice, meadowsweet, prickly ash, onion, passionflower, poplar, red clover, turmeric, willow): When used with celery there is an increased risk of bleeding (Jellin et al, 2008). Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Mineral Sodium Maintain electrolyte balance Chlorine D-Limonene Selinene Phthalide Flavonoid Nitrate Alkaloid Furanocoumarins Hypotensive Antiinflammatory Antiplatelet; histamine inhibitor Luteolin Apigenin Anticonvulsant Xanthotoxin; Bergapten (Lombaert et al, 2001) Adverse effects: Underline = life-threatening C 156 Centaury Client Considerations Assess • Assess the reason the client is using celery medicinally. ! • Assess for hypersensitivity reactions, including birch-celery syndrome and anaphylaxis. • Assess the client’s level of consciousness; central nervous system depression can occur. Administer • Instruct the client that celery seeds and juice are used to treat different conditions. Teach Client/Family • Inform the client that pregnancy category is 3 and breastfeeding category is 3A. • Caution the client not to use celery products in children except as a food source. • Inform clients with allergies to birch or mugwort, and those with kidney inflammation, never to use celery products. • Advise the client to stay out of the sun or to wear protective clothing when using celery products. Psoralen, one of the chemical components of celery, may cause a phototoxic rash. Centaury (sen’taw-ree) Scientific names: Centaurium erythraea, Centaurium umbellatum, Centaurium minus Other common names: Bitter clover, bitter herb, bitterbloom, centaurea, common centaury, European centaury, eyebright, feverwort, filwort, lesser centaury, minor centaury Origin: Centaury is an annual or biennial member of the Gentian family found in Europe. Uses Centaury is used to treat dyspepsia, lack of gastric secretions, and loss of appetite. In traditional herbal medicine, centaury is used as an anthelmintic, an antidiabetic, an antihypertensive, and a treatment for kidney stones. No scientific evidence supports any of these uses or actions. Centaury may be given to infants and children to treat anxiety, insomnia, tension, colic, irritable bowel syndrome, and topical inflammation. It may also be used to treat symptoms of attention deficit hyperactivity disorder (Romm, 2000). Centaury is commonly used in the United Kingdom and Australia; its use is less common in the United States. Actions No supporting evidence exists to document any actions of this herb. However, initial studies have suggested that the xanthone chemical components in centaury may show promise as antioxidants and that they may possess some antiinflammatory properties, although these are thought to be weak. The phenolic acid may be an antipyretic, and gentiopicroside, a monoterpenoid, is an antimalarial. = Pregnancy = Pediatric ! = Alert = Popular Herb Centaury 157 Product Availability Fluid extract, powder, whole herb Plant Parts Used: Flowers, leaves, stem Dosages C • Adult PO fluid extract: 1-3 ml taken before meals (1:5 dilution) (Hobbs, 1995) • Adult PO cold infusion: 1-2 oz tid (Moore, 1996) • Adult PO tea: steep 2-4 g in 150 ml boiling water (Jellin et al, 2008) • Adult PO powder: 1 g taken tid with honey on a cracker • Adult PO tincture: 0.5-1 ml taken before meals (1:2 dilution) (Moore, 1996) • Adult PO whole herb: 1-2 g taken daily Contraindications Class 1 herb. Until more research is available, centaury should not be used during pregnancy and breastfeeding. Persons with gastric or peptic ulcers should not use this herb. Side Effects/Adverse Reactions GI: Anorexia Primary Chemical Components and Possible Actions Chemical Class Individual Component Alkaloid Gentianine; Gentianidine; Gentioflavine Iridoids; Bitters; Gentiopicroside; Centapicrin; Gentioflavoside; Sweroside; Swertiamarin Alpha-amyrin; Beta-amyrin; Erythrodiol; Crataegolic acid; Oleanolic acid; Oleanolic lactone; Sitosterol; Stigmasterol; Campesterol; Brassicasterol Monoterpenoid Triterpenoid Phenolic acid Flavonoid Xanthone Fatty acid Possible Action Antimalarial Antipyretic Eustomin; Demethyleustomin Palmitic acid; Stearic acid Antioxidant Client Considerations Assess • Determine the reason the client is using centaury. Administer • Instruct the client to store centaury away from light and moisture. Adverse effects: Underline = life-threatening 158 Chamomile Teach Client/Family • Caution the client not to use centaury during pregnancy and breastfeeding until more research is available. • Caution the client not to confuse the three Centaurium spp. listed in the Scientific names section with other Centaurium spp. They are different herbs. • Inform the client that no supporting research is available to document any uses for or actions of this herb. Chamomile (ka’muh-meel) Scientific names: Matricaria chamomilla, Matricaria recutita, Chamaemelum nobile, Anthemis nobile Other common names: Common chamomile, English chamomile, German chamomile, Hungarian chamomile, Roman chamomile, sweet false chamomile, true chamomile, wild chamomile Origin: Chamomile is a perennial found in Europe. Uses Chamomile is used as an antiinflammatory and to treat insomnia, anxiety, and spasms. It is commonly used to treat digestive conditions such as irritable bowel syndrome, indigestion, colitis, and Crohn’s disease. Chamomile is used as a topical treatment to promote wound healing. Investigational Uses Studies are underway to determine the effectiveness of chamomile as an antioxidant and as a treatment for menopausal symptoms. Actions Chamomile is a widely recognized herb in Western culture. The medicinal use dates back many centuries. Chamomile is calming, carminative, and antispasmotic (Altern Med Rev, 2008). Antianxiety Action One of the flavonoid components of chamomile, apigenin, has shown an affinity for benzodiazepine receptors, which accounts for the antianxiety and sedative qualities of this herb (Viola et al, 1995; Medina et al, 1998). Two other studies have shown a mild hypnotic effect in laboratory animals as a result of the flavonoid component (Berry, 1995; Mills, Bone, 1991). Multiple studies have documented the ability of chamomile to decrease anxiety and promote relaxation and sleep. Antidiabetes Action Evidence has demonstrated that two flavonoids in chamomile, glucoside and chamaemeloside, produce hypoglycemic effects (Konig, 1998). However, the current recommended dose for humans of 0.05% to 0.1% is too low to have any significant effect on glucose levels. Phytoestrogen Action One study evaluated the efficacy of 13 isoflavonoids, flavonoids, and lignans, plus several phytoestrogens, in the treatment of estrogen-dependent tumors. Apigenin, a flavonoid present in chamomile, exerted a significant effect on DNA synthesis in = Pregnancy = Pediatric ! = Alert = Popular Herb Chamomile 159 estrogen-dependent and estrogen-independent human breast cancer cells (Wang et al, 1997). Further studies are necessary to clarify the possible cancer preventative effects of these chemical components. Antispasmodic Action in the Gastrointestinal Tract Studies have shown the antispasmodic action of chamomile on the gastrointestinal tract. In one study, infant colic was significantly reduced when chamomile tea was given to 69 infants with colic symptoms (Weizman et al, 1993). However, this was a study of short duration (7 days). Other Actions Chamomile has shown an inhibitory effect against Arcobacter butzleri, A. cryaerophilus, A. skirrowii (Cervenka, et al, 2006); methanol extracts showed strong antimicrobial activity. Product Availability Capsules: 360 mg; cream; fluid extract; lotion; shampoo and conditioner; tea; tincture; various cosmetics Plant Part Used: Dried flowers Dosages • Adult PO capsules: 300-400 mg, standardized to 1% apigenin and 0.5% essential oil, as often as 6 times/day (Foster, 1998) • Adult PO fluid extract: 1-2 ml tid (1:1, 45% ethanol) (Smith, 1999) • Adult PO tea: 2-4 oz prn (Moore, 1996) • Adult PO tincture: 3-10 ml tid (1:5, 45% ethanol) (Bradley, 1992) • Adult topical: 11⁄2 cups water mixed with 2 tsp dried flowers, cover, let stand 10-15 min, strain, apply as a compress • Child PO tea: 1⁄2-4 cups daily (Romm, 2000) • Child PO tincture: 1⁄4-1 tsp as often as qid (Romm, 2000) • Child topical: as a wash or cream, apply prn to treat inflammation (Romm, 2000) Contraindications German chamomile: Pregnancy category is 1; breastfeeding category is 2A. German chamomile (Matricaria chamomilla) may be given to children. Roman chamomile (Chamaemelum nobile) is a known abortifacient and should not be used during pregnancy and breastfeeding, but it may be given to children. Persons with asthma should not use this herb. Cross-hypersensitivity may result from allergy to sunflowers, ragweed, or members of the aster family (echinacea, feverfew, milk thistle). Side Effects/Adverse Reactions EENT: Burning of the face, eyes, mucous membranes (topical) SYST: Hypersensitivity Interactions Drug Alcohol: Chamomile may increase the effects of alcohol (theoretical). Anticoagulants: Chamomile (C. nobile) may interfere with the actions of anticoagulants; avoid concurrent use. CNS depressants: Chamomile may increase the effects of other sedatives; avoid concurrent use (Jellin et al, 2008). Adverse effects: Underline = life-threatening C 160 Chaparral Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Flavonoid Apigenin Anxiolytic/phytoestrogen; antiinflammatory Hypoglycemia Volatile oil Acid Farnesol Nerolidol Germacranolide Alcohol Glucoside; Chamaemeloside Luteolin Chamazulene Bisabolol; Bisabololosides A, B; Azulenes Angelic acid; Tiglic acid Antiinflammatory Antiallergy; antioxidant Antiinflammatory; antispasmodic Amyl alcohol; Isobutyl alcohol Coumarin Glycoside Heniarin Umbelliferone Fatty acid Client Considerations Assess • Determine whether the client is using chamomile for insomnia. • Assess the client’s sleeping patterns: ability to fall asleep and stay asleep, hours of sleep. • Assess for the use of alcohol, anticoagulants, and sedatives (see Interactions). Administer • Instruct the client to store chamomile in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use C. nobile during pregnancy; it is a known abortifacient. • Instruct the client to avoid using chamomile concurrently with other sedatives or alcohol; chamomile may increase their effects. Chaparral ! (sha-puh-rehl’) Scientific names: Larrea tridentata, Larrea divaricata Other common names: Creosote bush, greasewood, Hediondilla Origin: Chaparral is a shrub found in Mexico and the southwestern region of the United States. = Pregnancy = Pediatric ! = Alert = Popular Herb Chaparral 161 Uses Chaparral has traditionally been used to treat bronchitis, fever, joint inflammation, cancer, and diabetes. Chaparral is also used to treat chickenpox and snakebites and as a mouthwash to prevent tooth decay (Jellin et al, 2008). Investigational Uses Studies are underway to determine the efficacy of chaparral as an antitumor agent, an antimicrobial (Verastegui et al, 1996), and an anti-HIV-1 agent (Gnabre et al, 1996). Actions Hypoglycemic Action One study evaluated the glucose-lowering ability of chaparral in mice with type 2 diabetes. Blood glucose decreased significantly, a finding that suggests the need for further study of the hypoglycemic effect of this herb (Luo et al, 1998). It is a welldocumented fact that the Pima Indians have treated diabetes with chaparral for centuries. Antitumor Action Chaparral may represent a new class of HIV-responsive agents with clinical significance. Lignans isolated from chaparral have shown anti–HIV-1 activity (Gnabre, 1997). Factors used to evaluate tumors were survival time and the percentages of tumors that decreased in size, remained static, or increased in size. Results showed that the antitumor effects were better in vivo (Anesini et al, 1998). Previous studies demonstrated the antiproliferative activity of chaparral on T lymphoma cells in culture (Anesini et al, 1996). Other Actions One study (Verastegui et al, 1996) showed good antimicrobial activity against growth of yeasts, molds, and bacteria. More research needs to be completed to confirm these results. Another study (Gnabre et al, 1996) showed anti–HIV-1 activity. This activity may be due to two tricyclic ligans. The tannins in chaparral may be responsible for its antifungal action (Treviño-Cueto et al, 2007). Chaparral may be useful in the treatment of gallstone disease. In a lab experiment using hamsters with gallstones, concentrations up to 40-mg/dl were able to remove the gallstones (Arteaga et al, 2005). Product Availability Capsules, tablets, tea, tincture Plant Part Used: Leaves Dosages • Adult PO capsules: 2-4/day (Moore, 1996) • Adult PO tincture: 1-3 ml (1:5 dilution) tid (Moore, 1996) • Adult topical: apply strong decoction tid (Moore, 1996) Contraindications Pregnancy category is 5; breastfeeding category is 5A. Until more research is available, chaparral should not be given to children. Persons with hepatic or renal disease should avoid the use of this herb. The American Herbal Product Association has recommended that chaparral products not be sold until the hepatotoxicity question has been answered. Continued Adverse effects: Underline = life-threatening C 162 Chaparral Side Effects/Adverse Reactions GI: Hepatotoxicity (Sheikh et al, 1997; Stickel et al, 2000), hepatic failure INTEG: Contact dermatitis Interactions Drug Anticoagulants, antiplatelets, salicylates: Chaparral may increase the action of these products. MAOIs: Chaparral may decrease the effect of MAOIs. Lab Test ALT, AST, total bilirubin, urine bilirubin: Chaparral may increase ALT, AST, total bilirubin, and urine bilirubin. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Phenolic compound Nordihydroguaiaretic acid Lignans Dihydroguaiaretic acid; Nor-Isoguaiasin Hepatotoxicity, antiinflammatory, platelet inhibitor Anti-HIV, antioxidant (Vassão et al, 2007) Antifungal Tannins (TreviñoCueto et al, 2007) Client Considerations Assess • Assess the reason the client is using chaparral medicinally. ! • Assess for hepatotoxicity (increasing AST and ALT test results, clay-colored stools, right upper-quadrant pain). If symptoms are present, use of this herb should be discontinued immediately. • Assess for contact dermatitis. If it is present, use of this herb should be discontinued. Administer • Instruct the client to store chaparral away from moisture and sunlight. Teach Client/Family • Inform the client that pregnancy category is 5 and breastfeeding category is 5A. • Advise the client not to give chaparral to children until more research is available. ! • Advise the client to avoid chaparral because it can cause serious hepatic damage. The FDA considers chaparral an unsafe herb. = Pregnancy = Pediatric ! = Alert = Popular Herb Chaste Tree 163 Chaste Tree (chayst tree) Scientific name: Vitex agnus castus Other common names: Chasteberry, gatillier, hemp tree, keuschbaum, monk’s pepper Origin: Chaste tree is a shrub found in the Mediterranean and Europe. Uses Chaste tree is used to treat premenstrual syndrome symptoms, dysmenorrhea, menstrual irregularities, mastodynia, uterine bleeding, impotence, spermatorrhea, prostatitis, and infertility in women. Chaste tree may also be used to increase lactation. Vitex is thought to enhance the natural production of progesterone and luteinizing hormone and diminish the release of follicle-stimulating hormone. Actions Scientific studies to support any of the uses for or actions of chaste tree are lacking. Antiprolactin Secretion The few studies that have been published focus on the hypoprolactinemic effect of chaste tree. In concentrations of 3.3 mg/ml, the extract significantly inhibited thyrotropin-releasing hormone–stimulated prolactin release (Jarry et al, 1991). Another study confirms the inhibition of prolactin secretion (Sliutz et al, 1993). These studies suggest that chaste tree may produce beneficial effects in all conditions that relate to luteal phase defects. Premenstrual Syndrome Action One study using the premenstrual tension syndrome (PMTS) scale has shown that chaste tree significantly reduces premenstrual syndrome symptoms. Participants reported decreased incidence of breast tenderness, headache, constipation, edema, and tension (Lauritzen, 1997). Two other studies confirm the results of the 1997 study (Berger et al, 2000; Loch et al, 2000). Other Actions Dopaminergic action via opioid receptors was identified (Meier et al, 2000). This is the first study suggesting this action. Product Availability Aqueous-alcoholic extract, capsules, fluid extract, powder, solid extract, tea, tincture Plant Part Used: Ripe, dried fruit Dosages Impotence • Adult PO extract: 350-500 mg daily (Murray, Pizzorno, 1998) Menopause • Adult PO dry powdered extract: 250-500 mg tid (4:1 dilution) (Murray, Pizzorno, 1998) • Adult PO fluid extract: 4 ml (1 tsp) tid (1:1 dilution) (Murray, Pizzorno, 1998) • Adult PO powdered berries or tea: 1-2 g tid (Murray, Pizzorno, 1998) Premenstrual Syndrome • Adult PO fluid extract: 2 ml (Murray, Pizzorno, 1998) Adverse effects: Underline = life-threatening C 164 Chaste Tree • Adult PO dry powdered extract: 175-225 mg (0.5% agnuside content) (Murray, Pizzorno, 1998) Other • Adult PO capsules: 20 mg daily • Adult PO fluid extract: 30-40 mg daily (Blumenthal, 1998) • Adult PO tincture: 1-2 ml bid-tid (Smith, 1999) Contraindications Pregnancy category is 2; breastfeeding category is 2A. Until more research is completed, chaste tree should not be given to children. Side Effects/Adverse Reactions CNS: Headache GI: Diarrhea, abdominal cramps, anorexia INTEG: Rash, itching Interactions Drug Antipsychotics: Chaste tree may interfere with the antipsychotic action (theoretical) (Jellin et al, 2008). Beta-blockers: Chaste tree may lead to hypertensive crisis. Dopamine agonists (levodopa, parlodel, pramipexole, ropinirole): Chaste tree may increase the action of dopamine agonists (theoretical) (Jellin et al, 2008). Estrogens, hormonal contraceptives: Chaste tree may interfere with the action; avoid concurrent use. Lab Test Serum prolactin: Chaste tree may decrease serum prolactin Primary Chemical Components and Possible Actions Chemical Class Individual Component Essential oil Sesquiterpenoids; Alphapinene; Beta-pinene; Castine; Eucalyptol; Limonene; Cineole Flavonoid Iridoid glycoside Progesterone Hydroxyprogesterone Testosterone Possible Action Agnuside, Aucubin Hormonal Hormonal Hormonal Client Considerations Assess • Determine the condition for which the client is using chaste tree. • Assess for menstrual irregularities and whether the client is using chaste tree to treat conditions such as premenstrual syndrome, uterine bleeding, or increased = Pregnancy = Pediatric ! = Alert = Popular Herb Chaulmoogra Oil 165 menstrual flow. Discontinue use of herb if nausea, diarrhea, or abnormal changes in menses occurs (Smith, 1999). ! • Assess for increasing depression to suicidal proportions as a result of estrogen deficiency. C Administer • Instruct the client to store chaste tree in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 2 and breastfeeding category is 2A. • Advise the client not to give chaste tree to children until more research is available. • Inform the client that few scientific studies confirm any of the claims made for chaste tree. • Advise the client to notify the prescriber immediately if depression occurs. Chaulmoogra Oil (chawl-mew’gruh) Scientific names: Hydnocarpus wightiana, Hydnocarpus anthelmintica, Taraktogenos kurzii Other common names: Gynocardia oil, hydnocarpus oil, krabao’s tree seed Origin: Chaulmoogra oil is found in India and China. Uses In traditional herbal medicine, chaulmoogra oil (in an injectable, subcutaneous form) has been used to treat leprosy, eczema, and psoriasis. Traditional Chinese medicine practitioners use the seeds in a decoction for external use only to treat scabies, trichomoniasis, tinea, and yeast infections (Hydnocarpus da fengzi). Investigational Uses Beginning research shows positive results using Hydnocarpus oil to treat wounds in leprosy (Oommen et al, 1999). Actions Antileprotic Action Several research studies have confirmed the efficacy of chaulmoogra oil against Mycobacterium leprae (Levy, 1975; Noordeen, 1991). However, many more effective treatments are available via traditional pharmacology. Since the 1940s, practitioners in developed countries have rarely used chaulmoogra oil to treat leprosy. Another study (Oommen et al, 1999) showed more positive wound healing than with traditional chemotherapeutic agents for leprosy. The rats tested showed an increase in weight and strength of scar tissue. Product Availability Oil, injectable (subcutaneous); oil, topical Plant Part Used: Seeds Dosages • Adult subcutaneous oil: 15 ml injected twice weekly until remission. No typical doses (Jellin et al, 2008) Adverse effects: Underline = life-threatening 166 Chickweed Contraindications Until more research is available, chaulmoogra oil should not be used during pregnancy and breastfeeding. It should not be given to children. Side Effects/Adverse Reactions GI: Gastrointestinal upset, irritation (subcutaneous) INTEG: Precipitation under skin (subcutaneous), pain at injection site Primary Chemical Components and Possible Actions Chemical Class Individual Component Cyanogenic glycoside Fatty acid Acid Possible Action Palmitic acid; Oleic acid Chaulmoogric acid (Hypnocarpic acid) Gorlic acid Flavolignan Protein Phytosterols Client Considerations Assess • Assess for eczema and psoriasis before and after treatment with this product. • Determine whether the client is using chaulmoogra oil to treat possible leprosy. Inform the client that safer, better-tested treatments exist. Administer • Instruct the client to store chaulmoogra oil in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use chaulmoogra oil in children or those who are pregnant or breastfeeding until more research is available. • Inform the client that mainstream medications are more effective than chaulmoogra oil for the treatment of leprosy. • Advise the client that only an experienced health care provider should diagnose leprosy. Chickweed ! (chik’weed) Scientific name: Stellaria media Other common names: Mouse-ear, satinflower, star chickweed, starweed, stitchwort, tongue grass, white bird’s eye, winterweed Origin: Chickweed is an annual found in Europe and North America. = Pregnancy = Pediatric ! = Alert = Popular Herb Chickweed 167 Uses Chickweed is used internally as an antitussive, an expectorant, a demulcent, and as a treatment for sore throat, peptic ulcer, gastroesophageal reflux disease, and dyspepsia. Externally, chickweed is used to treat boils, abscesses, burns, rashes, psoriasis, eczema, pruritus, and insect bites and also promotes wound healing. Chickweed is also eaten as a food in salads (Jellin et al, 2008). Investigational Uses Chickweed may be useful as an antihepatoma agent (Lin et al, 2002) and an antioxidant (Pieroni et al, 2002). Actions Scientific studies of the medicinal uses of chickweed are lacking. Human cases of nitrate toxicity and paralysis have been reported. The available literature supports the use of chickweed as a weed killer. Other Actions Antioxidant activity was identified. Twenty-seven extracts of weedy vegetables were tested for antioxidant effect. Stellaria media along with two other herbs showed strong in vitro inhibition of xanthine oxidase (Pieroni et al, 2002). The antioxidant action may be due to rutin, a flavonoid. Fifteen crude drugs including Stellaria media were tested for in vitro antihepatoma activity on five human hepatic cancer cell lines. Stellaria media was not as effective as Coptis groenlandica (Lin et al, 2002). Product Availability Capsules, crude herb, fluid extract, oil, ointment, tea, tincture Plant Parts Used: Flowers, leaves, stems Dosages Skin Conditions • Adult topical ointment: apply prn • Adult topical poultice: apply prn Other • Adult PO capsules: 3 capsules tid • Adult PO fluid extract: 15-30 drops diluted, as often as tid • Adult PO tea: take qid prn • Adult PO tincture: take prn Contraindications Pregnancy category is 3; breastfeeding category is 2A. Until more research is available, chickweed should not be given to children (no data available). High doses of chickweed can be toxic (Duke, 2003). Side Effects/Adverse Reactions CNS: Headache, dizziness SYST: Nitrate toxicity, paralysis (high doses) Adverse effects: Underline = life-threatening C 168 Chicory Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Nitrate toxicity Saponin Vitamin A; B complex; C (375 mg/100 g) Coumarin Hydroxycoumarin Flavonoid Nitrate salt Mineral Rutin Antioxidant Calcium Iron Client Considerations Assess ! • Assess for toxicity. • Determine the reason the client is using chickweed. Administer ! • Inform the client that because of the potential for nitrate toxicity, only qualified herbalists should administer this herb (Duke, 2003). Teach Client/Family • Inform the client that pregnancy category is 3 and breastfeeding category is 2A. • Advise the client not to give chickweed to children (no data available). • Instruct the client not to use this herb unless under the supervision of a qualified ! herbalist. No scientific studies exist to document any of its actions or uses. Nitrate toxicity and paralysis can occur. Chicory (chik’o-ree) Scientific name: Cichorium intybus Other common names: Blue sailors, garden endive, succory, wild succory Origin: Chicory is a perennial found in Egypt, India, and the United States. Uses Chicory is used as a diuretic and laxative, a coffee substitute, a sedative, an appetite stimulant, and a treatment for cancer. It can be found in many tea product formulas. Chicory is a very mild herb used for its bitter properties, mostly as a tonic. Actions Very few studies are available for chicory. This herb is thought to possess sedative, laxative, and antiarrhythmic properties, but no studies have proven any of these claims. = Pregnancy = Pediatric ! = Alert = Popular Herb Chicory 169 Hepatoprotective Action One of the chemical components of chicory, esculetin (a phenolic coumarin), has been found to exert hepatoprotective effects (Zafar et al, 1998). In one study, rats were given paracetamol, a chemical that causes hepatic damage, followed by esculetin. Esculetin reduced mortality rates and prevented a rise in hepatic function enzymes (Gilani et al, 1998). Other Actions Mast cell–mediated allergic reactions were inhibited in vivo and in vitro by Cichorium intybus (Kim et al, 1999). The nonalkaloid acetylcholinesterase inhibitors from chicory have shown promise for use in severe dementia and Alzheimer’s disease (Rollinger et al, 2005). Product Availability Crude herb, extract, root (roasted and raw) Plant Parts Used: Leaves, roots Dosages • Adult PO crude herb: 3 g daily (Blumenthal, 1998) (NOTE: Dosages vary widely) • Adult PO decoction: 3-6 oz prn • Adult PO tea: 2-4 g of the root in 150 ml boiling water for 10 min, strain (Jellin et al, 2008) Contraindications Class 1 herb. Chicory should not be used during pregnancy and breastfeeding and should not be given to children. Persons who have cardiovascular disease or are hypersensitive to chicory or asteraceae/compositae herbs should avoid its use. Persons with gallstones should use chicory only under the supervision of an herbalist. Side Effects/Adverse Reactions INTEG: Contact dermatitis, other allergic skin rashes Interactions Drug Cardioactive products: Chicory may increase the effect of these products. Lab Test PT, INR: Chicory may alter the results of these tests. Primary Chemical Components and Possible Actions Chemical Class Guaianolides (Kisiel et al, 2001) Polysaccharide Chicoric acid Glycoside Individual Component Possible Action Inulin Lactucin; Lactucopicrin Increased probiotic, antiarrhythmic Sedative Continued Adverse effects: Underline = life-threatening C 170 Chinese Cucumber Primary Chemical Components and Possible Actions—cont’d Chemical Class Individual Component Carbohydrate Sterol Triterpenoid Lactone Tartaric acid Acetophenone Phenolic coumarin Flowers: Anthocyanins Esculetin Delphinidin (Norbaek et al, 2002) Possible Action Aromatic Hepatoprotective Client Considerations Assess • Assess the reason the client is using chicory medicinally. • Assess for allergic reactions (rash, itching, contact dermatitis); discontinue use if any of these symptoms are present and administer antihistamine or other appropriate therapy. Administer • Instruct the client to store chicory away from moisture and light. Teach Client/Family • Caution the client not to use chicory in children or those who are pregnant or breastfeeding. • Advise clients with cardiovascular disease not to use chicory. • Advise clients with gallstones to use this herb only with caution and under the supervision of a qualified herbalist. Chinese Cucumber (chy-neez’ kyew’kuhm-buhr) Scientific name: Trichosanthes kirilowii Other common names: Chinese snake gourd, gua-lou, tia-hua-fen Origin: Chinese cucumber is a member of the gourd family found in China. Uses Chinese cucumber is used to treat HIV/AIDS, cancer, inflammation, ulcers, and diabetes. It is also used to induce abortion. Not a commonly used herb, gua lou ren (the seed) is primarily used in traditional Chinese medicine as a respiratory sedative, demulcent, and expectorant. Actions Uterine Stimulation Trichokirin inhibits protein synthesis and also acts as an abortifacient. This action is believed to be mediated by the ribosome inactivation (Nie et al, 1998). = Pregnancy = Pediatric ! = Alert = Popular Herb Chinese Cucumber 171 Antitumor Action Trichokirin has exhibited anti-HIV activity (Nie et al, 1998). The antitumor action may be due to modulation of programmed cell death and arrested proliferation. Other medicinal plants with this action are soy, garlic, ginger, and green tea (Thatte et al, 2000). Another study (Akihisa et al, 2001) identified compounds from the seeds of Trichosanthes kirilowii. The compounds tested showed inhibition of Epstein-Barr virus, early antigen (EBV-EA). Product Availability Juice Plant Parts Used: Fruit, rind of fruit, seed Dosages • Adult: dosages are not clearly delineated in the literature. Chinese cucumber juice is used to induce abortion. Contraindications Class 1 herb. Because Chinese cucumber is a powerful abortifacient, it should not be used during pregnancy. Until more research is available, this herb should not be used during breastfeeding. It should not be given to children. Persons with seizure disorders or diarrhea should not use this herb. Side Effects/Adverse Reactions CNS: Fever, seizures GI: Diarrhea, gastric upset (Jellin et al, 2008) REPRODUCTION: Abortion SYST: Hypersensitivity, fluid in the lungs and brain, heart damage, death Interactions Drug Antidiabetics: Chinese cucumber may increase the effects of antidiabetics. Primary Chemical Components and Possible Actions Chemical Class Trichobitacin Trichosanthin Trichokirin Karasurin Sterol Palmitic acid Galactose Galactonic acid gamma-lactone Individual Component Alpha-trichosanthin; Beta-trichosanthin Possible Action Anti–HIV-1, increase CD4 cells Abortifacient, cytotoxic Ribosome inactivator Abortifacient Antiinflammatory Adverse effects: Underline = life-threatening C 172 Chinese Rhubarb Client Considerations Assess • Assess the reason the client is using Chinese cucumber medicinally. • Assess for the presence of seizure disorders. If present, do not use Chinese cucumber. Administer • Chinese cucumber may be used by an herbalist to induce abortion by applying Chinese cucumber juice to a sponge and inserting into vagina. Under the supervision of a competent herbalist, this herb can be injected intramuscularly or extraamniotically to induce first-trimester abortions. Teach Client/Family • Caution the client not to use Chinese cucumber during pregnancy because it is an abortifacient. • Caution the client not to use Chinese cucumber in children or those who are breastfeeding until more research is available. Chinese Rhubarb (chy-neez’ rew’bahrb) Scientific name: Rheum palmatum Other common names: Himalayan rhubarb, medicinal rhubarb, rhei radix, rhei rhizoma, rubarbo, Turkish rhubarb Origin: Chinese rhubarb is a perennial found in China and Tibet. Uses Chinese rhubarb is used as a laxative and an antidiarrheal. It is commonly found in “neutralizing cordial’’ formulas today, which were also very popular from the 1800s through the 1940s. Short-term use is recommended. Chinese rhubarb may be used as part of a detoxifying regimen. This herb is not the same as garden rhubarb. Actions Laxative and Antidiarrheal Actions The laxative action of anthranoids is well documented in the mainstream pharmacologic literature. This action is a result of direct chemical irritation of the colon, which increases the propulsion of the stool through the bowel. The anthraquinones possess purgative properties, and the tannins and bitters possess antidiarrheal properties. Small doses have a tightening, drying effect; larger doses cause a laxative or purgative effect (Weiss, 1988; Yim et al, 1999). Renal Action In one study in which Chinese rhubarb was combined with an angiotensin-converting enzyme (ACE) inhibitor and captopril, an antiarrhythmic, renal failure was slowed. The use of the herb together with the two drugs produced much better results than did either the drugs or the herb alone (Zhang, 1990). Another study (Song et al, 2000) identified decreasing urinary interleukin 6 (IL-6) and lowered immune inflammation after Rheum palmatum was given. Determination of urinary IL-6 level is useful in studying the severity of immune inflammation of chronic renal failure. = Pregnancy = Pediatric ! = Alert = Popular Herb Chinese Rhubarb 173 Product Availability Extract, powder, syrup, tablets, tincture Plant Parts Used: Bark, dried root, dried underground parts Dosages C Diarrhea • Adult PO decoction or tincture: 1 tsp daily • Adult PO neutralizing cordial: 1-4 ml, dilute in water, q1⁄2-2 hr according to urgency of symptoms (Smith, 1999) Gastrointestinal Bleeding • Adult PO powder or tablets: 3 g bid-qid Laxative • Adult PO decoction: 1-2 tsp daily; may be taken with evening meal • Adult PO tincture: 1⁄2-1 tsp daily; may be taken with evening meal Contraindications Class 2b/2c/2d herb. Until more research is available, Chinese rhubarb should not be used by persons with hypersensitivity to this herb or by pregnant and breastfeeding women. It should not be given to children. Chinese rhubarb should not be used by persons with gastrointestinal bleeding or obstruction, abdominal pain, nausea, vomiting, appendicitis, or Crohn’s disease. Use of this herb should be short term, unless under the supervision of a qualified herbalist. Side Effects/Adverse Reactions GI: Nausea, vomiting, diarrhea, abdominal cramps, laxative dependency GU: Urine discoloration, hematuria, albuminuria (high doses, long term use) SYST: Vitamin and mineral deficiencies, fluid and electrolyte imbalances (high doses, long term use) Interactions Drug Antacids: Antacids may decrease the effectiveness of Chinese rhubarb if taken within 1 hour of the herb. Antiarrhythmics, cardiac glycosides, corticosteroids: Chronic use of Chinese rhubarb can cause hypokalemia and enhance the effects of antiarrhythmics, cardiac glycosides, corticosteroids. Thiazide diuretics: Chronic use of Chinese rhubarb can cause hypokalemia and enhance the effects of thiazide diuretics; avoid concurrent use. Herb Jimsonweed: The action of jimsonweed is increased in cases of chronic use or abuse of Chinese rhubarb. Licorice root: Hypokalemia can result from the use of Chinese rhubarb with licorice root; avoid concurrent use. Food Milk: The effectiveness of Chinese rhubarb may be decreased when taken concurrently with milk. Lab Test Potassium level: Chinese rhubarb may decrease potassium levels. Adverse effects: Underline = life-threatening 174 Chinese Rhubarb Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Anthraquinones Rhein; Senosides (A, B, C), Aloe-emodin (Wang et al, 2008) Laxative Decreased mitochondrial activity, energy production Tannins Chrysophanol; Aloe emodin Gallo Wound healing; antiinflammatory Galloy-1-glucose; Galloy-1-saccharose; Lindleyine; Isolindleyine Stilbene Phenolic Polyketide synthase Glucogallin; Gallic acid; Catechin Benzalacetone synthase Client Considerations Assess • Assess the reason the client is using Chinese rhubarb medicinally. • Assess blood and urine electrolytes if the client uses this herb often. • Determine the cause of constipation, identifying whether bulk, fluids, or exercise is missing from the client’s lifestyle. • Assess for cramping, nausea, and vomiting; if these symptoms occur, discontinue use of this herb. • Assess for medications used (see Interactions). Administer • Instruct the client to take Chinese rhubarb with other herbs to prevent griping. For best absorption, this herb should not be taken within 1 hour of other drugs, antacids, or milk. Teach Client/Family • Caution the client not to use Chinese rhubarb in children or those who are pregnant or breastfeeding until more research is available. • Caution the client to avoid long-term use of this herb, which can cause loss of bowel tone. • Instruct the client to notify the provider if Chinese rhubarb does not relieve constipation or if symptoms of electrolyte imbalance occur (muscle cramps, pain, weakness, dizziness). = Pregnancy = Pediatric ! = Alert = Popular Herb Chitosan 175 Chitosan (kie’tuh-san) Scientific name: N/A Other common names: Chitosan ascorbate, deacetylated chitin, N-acetylchitosan Origin: Chitosan comes from the shell of marine crustaceans. Uses Chitosan is used orally for weight loss, to control blood pressure, and to decrease cholesterol. Topically it is used for periodontitis and tissue healing. Investigational Uses New studies are underway for chitosan’s use in chronic renal failure, as a hemostatic, for drug delivery systems, and for assistance in nerve regeneration. Actions Weight Loss Action One study using 50 obese women studied the effects of chitosan on body weight (Zahorska et al, 2002). Significantly more weight was lost in the chitosan group. Another study (Kobayashi et al, 2002) had results that were similar. Fat deposition and lipase activity decreased significantly in chickens when chitosan was added to the diet. In a review of 14 studies with over 1100 participants, it was shown that there was a placebo control group. Those taking chitosan lost about 3.7 extra pounds and improved their blood pressure and cholesterol (Hitti, 2005). However, in trials over 4 wk the weight loss was variable. Other Actions Chitosan is able to absorb protein and adhere to nerve cells, promoting nerve regeneration (Yang et al, 2001). Product Availability Powder, tablets Plant Parts Used: N/A Dosage • Adult PO: take for 2-3 days • Adult topical: apply to stop bleeding or for assistance in nerve regeneration. Renal Failure with Hemodialysis • Adult PO: 1.35 g tid (Jellin et al, 2008) Contraindications Chitosan should not be given to children or those who are pregnant, breastfeeding, have osteoporosis or Paget’s disease, or who are hypersensitive to shellfish. Side Effects/Adverse Reactions CV: Hypotension GI: Constipation, flatulence, steatorrhea, weight loss Interactions Drug Fat-soluble vitamins or minerals: Chitosan may decrease the absorption of fat-soluble vitamins or minerals; separate by 2 hours or more. Adverse effects: Underline = life-threatening C 176 Chondroitin Client Considerations Assess • Assess the reason the client is using chitosan. • Assess the gastrointestinal system for constipation, flatulence, steatorrhea; if severe, chitosan may need to be discontinued. Administer • Keep chitosan in a dry area, away from excessive heat or moisture. Teach Client/Family • Advise the client not to use chitosan in children or those who are pregnant or breastfeeding until more research is available. Chondroitin (kahn-droe’uh-tuhn) Scientific names: Chondroitin sulfate, chondroitin sulfuric acid, chonsurid Other common names: CAS, Chondroitin Sulfate, Chondroitin C Origin: Chondroitin is obtained from bovine tracheal cartilage. Uses Chondroitin is used alone or in combination with glucosamine to treat joint conditions such as arthritis. It is also used as an antithrombotic, an extravasation therapy agent, and as a treatment for ischemic heart disease and hyperlipidemia. Actions Antiarthritic Action Chondroitin attracts essential fluid into the joints, which acts as a shock absorber. It also attracts needed nutrients into cartilage (Benedikt, 1997). Research findings continue to conflict regarding the beneficial effects of chondroitin. It may protect cartilage from degradation. An NIH study on chondroitin that included 1583 people with knee pain showed no benefit in patients with mild knee osteoarthritis (Brett, 2008). Another review found the preservation of joint-space within the osteoarthritic knee had no change in symptoms (Kelly, 2005; Bruyere et al, 2008). Extravasation Action Chondroitin has been used to treat extravasation after ifosfamide therapy. One study demonstrated its ability to decrease pain and inflammation (Mateu et al, 1996). The same study also used chondroitin after vindesine therapy and showed that it relieved extravasation (Mateu et al, 1996). Similar results were obtained using chondroitin after doxorubicin therapy and vincristine therapy (Comas et al, 1996). Antithrombolytic Action Because of its ability to inhibit thrombi (Lane et al, 1992), chondroitin is used as an anticoagulant in hemodialysis. Product Availability Capsules: 200, 400 mg; source: cartilage of the bovine trachea = Pregnancy = Pediatric ! = Alert = Popular Herb Chondroitin 177 Dosages • Adult PO weight ⬍120 pounds: 1000 mg glucosamine and 800 mg chondroitin • Adult PO weight 120-200 pounds: 1500 mg glucosamine and 1200 mg chondroitin • Adult PO weight ⬎200 pounds: 2000 mg glucosamine and 1600 mg chondroitin (Theodosakis, 1997) Contraindications Until more research is available, chondroitin should not be used during pregnancy and breastfeeding. It should not be given to children. Chondroitin should not be used by persons with bleeding disorders, asthma, prostate cancer, or renal failure. Side Effects/Adverse Reactions CNS: Headache, restlessness, euphoria GI: Nausea, vomiting, anorexia SYST: Bleeding Interactions Drug Anticoagulants, NSAIDs, salicylates: Chondroitin used with anticoagulants, NSAIDs, or salicylates can cause increased bleeding; do not use chondroitin at high doses. Lab Test Anti-factor Xa: May be increased when used with chondroitin (Jellin et al, 2008). Prothrombin time: May be increased when used with high dose of chondroitin and glucosamine (Jellin et al, 2008). Pharmacology Pharmacokinetics Very little is known about the pharmacokinetics. The half-life of this herb is extended when used by persons with renal failure. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Mucopolysaccharide Glycosaminoglycan (GAC) Lyases Chondroitinase AC, B Antitumor Client Considerations Assess • Assess the reason the client is using chondroitin. • Assess for joint conditions: joints involved; aggravating and ameliorating factors; and pain location, intensity, and duration. • Assess for other medications used; chondroitin should not be used concurrently with anticoagulants, NSAIDs, or salicylates because of the risk of increased bleeding. Adverse effects: Underline = life-threatening C 178 Chromium Administer • Instruct the client to store chondroitin in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use chondroitin in children or those who are pregnant or breastfeeding until more research is available. Chromium (krow’mee-uhm) Other common names: Chromium picolinate, chromium polynicotinate, chromium chloride Origin: Chromium is available from dietary sources such as brewers yeast, molasses, brown sugar, coffee, tea, and some wines and beers. Uses Chromium is an essential trace mineral that is required for proper metabolic functioning. It may be helpful in the treatment of decreased glucose tolerance, arteriosclerosis, elevated cholesterol, glaucoma, hypoglycemia, diabetes, and obesity. Actions Nutritional trivalent chromium (Cr+3) is different from industrial hexavalent chromium (Cr+6), which is extremely toxic. Industrial hexavalent chromium is responsible for serious pulmonary disorders and cancer in exposed workers. The population as a whole is believed to be deficient in nutritional chromium because even well-balanced diets fall short of providing the needed chromium levels (Anderson, 1985). Improved Glucose Tolerance Since the 1950s, at least 15 well-controlled studies have been conducted on the use of chromium to improve glucose tolerance. Chromium has been shown to increase the number of insulin receptors in peripheral tissues; to increase the binding of the insulin to receptors; to decrease tyrosine phosphatase; to terminate the receptor response; and to decrease fasting glucose, serum lipids, and HbA1c levels. Chromium may also increase HDL cholesterol (Anderson, 1998). Most of the studies showing positive results have occurred in type 2 diabetes mellitus, maturity-onset. Althuisa et al (2002) studied glucose and insulin responses to dietary chromium supplement. No changes in glucose or insulin responses were found in nondiabetic subjects. In two journal articles (Boggs, 2007; Barclay, 2005) evidence was presented that chromium may not improve glycemic control in type 2 diabetes. Other Actions Preliminary information on the ability of chromium to decrease obesity is available. Because a lack of chromium increases the percentage of body fat, supplementation in those who lack the required levels may help them lose weight. Chromium supplementation has been shown to increase muscle mass and decrease body fat (Kaats et al, 1998). Because the chromium excretion of athletes is increased, supplementation may be necessary. However, evidence supporting the need for supplementation to = Pregnancy = Pediatric ! = Alert = Popular Herb Chromium 179 improve athletic performance is lacking (Clarkson, 1997). Another action may be the antithrombotic mechanism of chromium. Chromium was identified as preventing experimental venous thrombosis (Pacheco et al, 2000). Product Availability C Capsules Dosages • Adult PO: 50-200 mcg/day (Food and Nutritional Board, 1989) • Adult PO: 200-600 mcg/day (La Valle et al, 2001) • Child PO: 0-0.5 yr: 10-40 mcg/day • Child PO: 0.5-1 yr: 20-60 mcg/day • Child PO: 1-3 yr: 20-80 mcg/day • Child PO: 4-6 yr: 30-120 mcg/day • Child PO: 7 yr and older: 50-200 mcg/day Contraindications Until more research is available, chromium should be given to children and used during pregnancy and breastfeeding only in the recommended dosages listed. Side Effects/Adverse Reactions CNS: Headache, insomnia, mood change, restlessness, irritability HEMA: High doses: anemia, thrombocytopenia, hemolysis MISC: High doses: renal failure, hepatic dysfunction Interactions Drug Antacids (calcium carbonate), calcium supplements: Calcium products reduce the absorption of chromium; separate by ⱖ2 hr. Antidiabetics (acarbose, acetohexamide, chlorpropamide, glimeperide, glipizide, insulin, metformin, miglitol, pioglitazone, tolazamide, tolbutamide, troglitazone): Chromium may reduce the action of antidiabetics. Ascorbic acid: An increase occurs in both chromium and ascorbic acid absorption when taken together. Iron, zinc: Absorption of chromium is decreased when taken with iron, zinc. Food Complex carbohydrates: Absorption of chromium is increased when taken with complex carbohydrates. Lab Test Blood glucose: Chromium decreases test values. HDL levels: Chromium may increase levels. Triglycerides: Chromium may decrease levels (Jellin et al, 2008). Pharmacology Pharmacokinetics Absorption of chromium is minimal at 1% to 2% of supplement. Chromium is bound by transferrin and albumin and is transported through the circulatory system, where it is converted to an organic form and stored in tissues. Excess chromium is excreted via the kidneys. Adverse effects: Underline = life-threatening 180 Cinnamon Client Considerations Assess • Assess for symptoms of chromium deficiency (fasting hyperglycemia, decreased lean body mass, increased body fat, increased intraocular pressure). • Assess for possible conditions related to chromium deficiency: stress, trauma, extreme exercise, pregnancy, infection. • Assess for the use of ascorbic acid, iron, and zinc (see Interactions). Administer • Instruct the client to store chromium in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to exceed recommended dosages for children or those who are pregnant or breastfeeding until more research is available. • Instruct the client not to take chromium supplements with zinc or iron supplements; these two minerals decrease the absorption of chromium. • Inform the client of ways to increase chromium in the diet: brewers yeast, molasses, brown sugar, coffee, tea, and some wines and beers. Cinnamon (si’nuh-muhn) Scientific name: Cinnamomum spp. Other common names: Cassia, Cassia lignea, Ceylon cinnamon, Chinese cinnamon, cinnamomom, false cinnamon, Padang cassia, Panang cinnamon, Saigon cassia, Saigon cinnamon Origin: Cinnamon is found in India, South America, Sri Lanka, and the West Indies. Uses Cinnamon is used as an antifungal, analgesic, and antiseptic, and to treat diarrhea, the common cold, abdominal pain, hypertension, loss of appetite, and bronchitis. It is also used to treat passive internal bleeding, sometimes as an essential oil in combination with Erigeron essential oil. In contemporary use, cinnamon is rarely used alone. It is considered one of the major adjuvant herbs used in small amounts to assist in the assimilation of an herbal formula. Cinnamon is an aromatic and tends to be spicy, warming, and vasodilating, as well as cooling (see Actions). Actions Cinnamon is considered to be spicy, warming, and vasodilating due to the volatile oils. It is also considered to be drying and cooling due to the tannin content. This warming and cooling combination is especially effective for the treatment of diarrhea when there is griping. Cinnamon is often added to laxative formulas for this purpose. It is an aromatic stimulant, mainly to the gastrointestinal tract; a carminative; and an astringent. Cinnamon possesses marked hemostatic power and is used to flavor unpleasant-tasting medicines. = Pregnancy = Pediatric ! = Alert = Popular Herb Cinnamon 181 Antimicrobial/Antifungal Action Cinnamon bark has been shown to be effective against the following organisms that cause respiratory tract infections: Candida albicans, Candida tropicalis, Aspergillus niger, Aspergillus fuigatis, Aspergillus midulans, Aspergillus flavus, Histoplasma, and Cryptococcus neoformans (Viollon et al, 1994). Cinnamon extract has shown an inhibitory effect on Helicobacter pylori (Tabek et al, 1999). Arcobacter butzleri, A. cryaerophilus, and A. skirrowii (Cervenka et al, 2006) methanol extracts showed strong antimicrobial activity. Antidiabetic Action The insulin-potentiating effect of cinnamon bark and its role in glucose metabolism have been studied (Khan et al, 1990, Verspohl et al, 2005; Pham et al, 2007). In a study in which streptozocin was administered long term to induce diabetes mellitus in rats, cinnamon bark conferred some protection against diabetic conditions when administered along with the streptozocin (Onderoglu et al, 1999). Product Availability Dried bark, essential oil, leaves, fluid extract, powder, tincture Plant Parts Used: Bark, leaves Dosages Dosages vary widely Passive Bleeding • Adult PO essential oil: used in combination with Erigeron essential oil, diluted in a carrier oil such as vegetable oil; 10-30 drops (Smith, 1999) Other • Adult PO bark: 2-4 g daily (Blumenthal, 1998) • Adult PO essential oil: 0.05-0.2 ml diluted in a carrier oil daily • Adult PO infusion: 1 cup bid-tid at meals • Adult PO fluid extract: 0.5-1 ml tid • Adult PO tincture: 1-3 ml tid Contraindications Class 2b/2d herb. Until more research is available, except as a spice or for flavoring, cinnamon should not be used during pregnancy and breastfeeding. It should not be given to children. Persons with hypersensitivity to cinnamon or balsam of Peru should not use cinnamon. Prolonged use is not recommended in persons with intestinal or gastric ulcers. Side Effects/Adverse Reactions CNS: Flushing CV: Increased heart rate EENT: Stomatitis, glossitis, gingivitis GI: Increased motility, anorexia, irritant (full doses) INTEG: Allergic dermatitis (topical) (Jellin et al, 2008). RESP: Shortness of breath SYST: Hypersensitivity Adverse effects: Underline = life-threatening C 182 Clary Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Volatile oil Eugenol; Cinnamaldehyde Antimicrobial; analgesic; antioxidant Weiterhin; Cinnamic acid O-glucoside Diterpene Mucilage Cyclobutane lignan Coumarin Cinnamyl acetate Gastrointestinal protectant Cinbalansan Client Considerations Assess • Assess the reason the client is using cinnamon medicinally. • Assess for hypersensitivity (rash, wheezing); if present, discontinue use of cinnamon and administer an antihistamine or other appropriate therapy. Administer • Instruct the client to store cinnamon in a cool, dry place, away from heat and moisture. • Instruct the client to dilute cinnamon oil in a carrier oil. Teach Client/Family • Caution the client not to use cinnamon bark therapeutically in children or those who are pregnant or breastfeeding until more research is available. Clary (kla’ree) Scientific names: Salvia sclarea, Euphrasia officinalis (eyebright) Other common names: Clary oil, clary sage, clear eye, eyebright, muscatel sage, orvale, see bright, toute-bonne Origin: Clary is a perennial found in Europe. Uses Clary is used as an antiinflammatory to decrease muscle and nervous tension; an antispasmodic; a sedative; an astringent; and as a treatment for menopausal symptoms, premenstrual syndrome, decreased libido, and fatigue. It is also used to stimulate the adrenals and, in Europe, as a remedy for sore throat. Actions Antimicrobial Action Several chemical components of Salvia sclarea have been found to possess antimicrobial properties. The diterpenoids and sesquiterpenoids were tested for antimicrobial effects against bacteria and yeast. Dehydrosalvipisone, sclareol, manool, oxoroyleanone, spathulenol, and caryophyllene were found to be active against Staphylococcus aureus. = Pregnancy = Pediatric ! = Alert = Popular Herb Clary 183 Dehydrosalvipisone and manool were found to be active against Candida albicans, and caryophyllene was found to be active against Proteus mirabilis (Ulubelen et al, 1994). Another study (Peana et al, 1999) demonstrated that clary exerts a weak antimicrobial effect against S. aureus, C. albicans, Escherichia coli, and Staphylococcus epidermidis. However, the antimicrobial effect increased as the microbes remained in contact with the chemical component for longer periods. Antitumor Action The Tn antigen, which is a specific marker in several human carcinomas, has been isolated from Salvia sclarea. The identification of the marker came from SSL, a lectin present in clary (Medeiros, 2000). Although still in the preliminary stages, this research on the possible antitumor action of clary shows promise. Cytotoxic and proapoptotic action from the diterpenoids in clary was identified in the lab (Rózalski et al, 2006). Also, the antibacterial and cytotoxic activity was identified in the lab after using the dilution method (Hayet et al, 2007). Product Availability Essential oil Plant Parts Used: Essential oil of leaves and flowers Dosages • Adult: dosages are not clearly delineated in the literature. Contraindications Class 1 herb. Clary should not be used during pregnancy and breastfeeding. It should not be given to children. Persons who have estrogen-sensitive cancers, breast cysts, and uterine fibroids should not use this herb. Undiluted essential oil should not be applied topically or taken internally. Side Effects/Adverse Reactions CNS: Drowsiness, headache, euphoria, dizziness, nightmares, stupor (high doses) ENDO: Increased menstrual bleeding Interactions Drug Alcohol, hypnotics: Clary increases the action of alcohol, hypnotics (theoretical); do not use concurrently. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Diterpenoids Sclareol Manool; Salvipisone; Ferruginol; Microstegiol; Candidissiol Caryophyllene oxide Spathulenol; Dehydrosalvipisone; Oxoroyleanone Antimicrobial; cytotoxic, proapoptic Antimicrobial Sesquiterpene Continued Adverse effects: Underline = life-threatening C 184 Clematis Primary Chemical Components and Possible Actions—cont’d Chemical Class Alpha-amyrin Beta-sitosterol Flavonoid Essential oil Linalyl acetate Linalool Pionene Lectin Individual Component Possible Action Apigenin; Luteolin; 4-Methylapigenin Nerol Estrogen-like SSL Antitumor Client Considerations Assess • Determine the reason the client is using clary. • Assess for the use of alcohol and hypnotics (see Interactions). Administer • Instruct the client to store clary in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use clary in children or those who are pregnant or breastfeeding until more research is available. • Advise the client not to use alcohol or hypnotics while taking this herb. ! Clematis (kli-ma’tuhs) Scientific name: Clematis virginiana L. Other common names: Devil’s darning needle, old man’s beard, traveller’s joy, vine bower, woodbine Origin: Clematis is a perennial shrub found in Asia and North America. Uses Clematis is used both externally and internally to treat frontal and migraine headaches. It is also used to treat skin disorders, hypertension, and varicose veins (Jellin et al, 2008). Clematis is rarely used and is not easily found over the counter. Actions Clematis is rarely used today because of the availability of safer herbs and drugs. The fresh juice reportedly contains protoanemonin, a vesicant oil, which is a direct irritant to the skin and mucous membranes (American Herbal Products Association, 1988). Product Availability Extract, juice = Pregnancy = Pediatric ! = Alert = Popular Herb Clematis 185 Plant Part Used: Fresh leaves Dosages • Adult PO extract: 0.5-2ml tid in water (Moore, 1996) • Adult topical: apply prn C Contraindications Until more research is available, clematis should not be used during pregnancy and breastfeeding. It should not be given to children. Persons with vasculitis should not use this herb (Moore, 1996). Side Effects/Adverse Reactions EENT: Severe mucous membrane irritation GI: Irritation, colic, diarrhea GU: Irritation INTEG: Severe irritation Toxicity: Dizziness, seizures, confusion, death (rare) Interactions Drug All Western medications: Avoid concurrent use with all Western medications (Moore, 1996). Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Saponin Anemonin Central nervous system stimulant Vesicant oil Protoanemonin Client Considerations Assess • Assess the reason the client is using clematis. • Assess for the characteristics of migraine headache: aura, halo, and blurred vision; location, intensity, and duration of pain; need for opioids in the past; alleviating, aggravating, and nutritional factors. ! • Assess for toxicity. • Assess for medication use (see Interactions). Administer ! • Instruct the client to use activated charcoal to treat overdose. Asphyxiation is the cause of death. Teach Client/Family • Caution the client not to use clematis in children or those who are pregnant or breastfeeding until more research is available. • Caution the client not to allow clematis to remain in extended contact with the skin or mucous membranes; blistering is common. Adverse effects: Underline = life-threatening 186 Cloves Cloves (klowvz) Scientific names: Syzygium aromaticum, Eugenia caryophyllata, Caryophyllus aromaticus Other common names: Oil of cloves, oleum caryophylli Origin: Cloves are found in South America, Sumatra, and Tanzania. Uses Cloves are used mainly as an essential oil; a treatment for toothache; a topical anesthetic in dentistry; and an antiseptic, antibacterial, and antiinflammatory for the oral mucosa. They may also be used as a flavoring or antimicrobial in formulas. Actions Clove oil possesses antihistamine, spasmolytic, mildly antiseptic, anthelmintic, and larvicidal properties. Topical Anesthetic Action When applied topically, cloves have been found to inhibit prostaglandin synthesis, cyclooxygenase, and lipoxygenase. Eugenol, one of the chemical components of cloves, is responsible for these actions (Rasheed et al, 1984). Antimicrobial Action In underdeveloped countries where most people cannot afford the high cost of medications, cloves have been used to treat diarrheal diseases in children. In one study, the antibacterial effect of cloves was tested using a decoction of aqueous dried extract. The extract showed activity against Salmonella E., Shigella D., Shigella F., Escherichia coli, and Enterobacter (Tsakala et al, 1996). Another study investigated the efficacy of cloves against cytomegalovirus (CMV). Cloves demonstrated significant effectiveness against CMV in low concentrations in vitro (Yukawa et al, 1996). Syzygium aromaticum showed active inhibition of hepatitis C virus (HCV) when tested with 71 medicinal plant extract (Hussein et al, 2000). Another study (Dorman et al, 2000) investigated the volatile oils in several medicinal plants, including cloves. All oils exhibited significant antimicrobial effect (Dorman et al, 2000). Other Actions Cloves have shown slight antioxidant properties when used on rats with aflatoxins (Abdel-Wahhab et al, 2005). This could be due to two chemical components, eugenol and acetyl-eugenol, both phenols. Product Availability Component in cigarettes and mouthwash; essential oil; tincture Plant Part Used: Dried flower buds Dosages • Adult mouthwash: ⱕ1 oz of 1%-5% essential oil prn • Adult PO tincture: 5-30 drops (1:3 dilution) prn • Adult PO: 120-300 mg (Jellin et al, 2008) • Adult topical: 1-5 drops essential oil prn • Adult topical tincture: 15% for athletes foot (Jellin et al, 2008) = Pregnancy = Pediatric ! = Alert = Popular Herb Cloves 187 Contraindications Class 1 herb. Until more research is available, do not use cloves medicinally during pregnancy and breastfeeding. Do not give them to children. Essential oil should be used only when diluted in a carrier oil. Side Effects/Adverse Reactions CNS: Depression, seizures EENT: Tissue irritation, airway injury HEMA: Disseminated intravascular coagulation INTEG: Skin irritation RESP: Bronchospasm, pulmonary edema Interactions Drug Anticoagulants, platelet inhibitors, salicylates: Cloves may increase the effect of these products. Lab Test PT, INR, AST, ALT, alkaline phosphatase: Cloves may increase these levels. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Phenol Eugenol; Acetyl Eugenol; Beta-caryophyllene Antimicrobial; analgesic; antioxidant Local anesthetic Terpene Client Considerations Assess • Assess the reason the client is using cloves medicinally. ! • Assess for allergic reactions (bronchospasm, pulmonary edema). If allergic symptoms are present, use of the herb should be discontinued and emergency measures instituted. Administer • Instruct the client to store cloves in a cool, dry place, away from heat and moisture. • Instruct the client to dilute essential oil in a carrier oil. Teach Client/Family • Caution the client not to use cloves medicinally in children or those who are pregnant or breastfeeding until more research is available. Adverse effects: Underline = life-threatening C 188 Coenzyme Q10 Coenzyme Q10 (koe-ehn’zime kyew tehn) Scientific name: 2,3 dimethoxy-5 methyl-6-decaprenyl benzoquinone Other common names: Co-Q10, mitoquinone, ubidecarenone, ubiquinone Origin: Coenzyme Q10 is found in dietary sources. Uses Coenzyme Q10 is used to treat ischemic heart disease, congestive heart failure (CHF), angina pectoris, hypertension, arrhythmias, diabetes mellitus, deafness, Bell’s palsy, decreased immunity, mitral valve prolapse, periodontal disease, and infertility. Investigational Uses Research is underway to determine the efficacy of coenzyme Q10 in the treatment of breast cancer. Migraine prevention is also being investigated as a possible use of Q10 (Rozen et al, 2002). Research has confirmed that coenzyme Q10 does not slow the progression of Huntington’s disease (The Huntington Study Group, Neurology, 2001) or congestive heart failure (Khatta et al, 2000). Actions Coenzyme Q10 is a fat-soluble vitamin-like compound known as ubiquinone. It is synthesized in humans and is involved in adenosine triphosphate (ATP) generation. Coenzyme Q10 functions as an endogenous antioxidant, protecting against free radial damage within the mitochondria. Myocardial Enhancement Researchers have discovered lowered levels of coenzyme Q10 in patients with cardiac conditions such as ischemic heart disease (Hanaki et al, 1991) and dilated cardiomyopathy (Langsjoen et al, 1990). The greater the severity of the cardiac disease, the lower the coenzyme Q10 level (Littarru et al, 1972). In one study of 88 patients with cardiomyopathy who received 100 mg/day of coenzyme Q10 for up to 2 years, 75% of the patients improved significantly as noted by ejection fraction and cardiac output (Langsjoen et al, 1988). In another study of patients with cardiomyopathy who received coenzyme Q10 for 12 weeks, stroke volume and ejection fraction improved significantly after treatment (Langsjoen et al, 1985). Adriamycin Toxicity Prevention Coenzyme Q10 has been shown to prevent cardiac toxicity associated with adriamycin therapy. In studies using lab animals given adriamycin followed by coenzyme Q10, the restoration of appropriate coenzyme Q10 levels prevented changes in the heart (Domae et al, 1981; Ogura et al, 1979). Therefore, it appears that coenzyme Q10 may be used to prevent adriamycin cardiac toxicity in humans, but more research is needed to confirm this assumption. Other Actions Coenzyme Q10 has shown promise as a migraine preventive agent. Thirty-two patients with a history of episodic migraines were given 150 mg/day of coenzyme Q10. There was a 50% reduction in number of days with migraines (Rozen et al, 2002). Coenzyme Q10 is being studied for antiparkinson’s disease and other neurologic diseases (Littarru et al, 2005; Sharma et al, 2006). = Pregnancy = Pediatric ! = Alert = Popular Herb Coenzyme Q10 189 Product Availability Capsules, tablets Dosages Dosages vary widely. C Breast Cancer, Cardiovascular Disease, Diabetes • Adult PO: ⬎300 mg/day (La Valle et al, 2001) Other • Adult PO: 30-200 mg/day (La Valle et al, 2001) Contraindications Until more research is available, coenzyme Q10 should not be used at excessive levels during pregnancy and breastfeeding. It should not be given to children. Persons with hypersensitivity should not use this nutritional supplement. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, diarrhea, epigastric pain Interactions Drug Anticoagulants (heparin, warfarin): Coenzyme Q10 may decrease the action of anticoagulants; avoid concurrent use. Antidiabetics, beta-blockers, HMG-CoA reductase inhibitors, phenothiazines (chlorpromazine), tricyclic antidepressants: Antidiabetes agents, beta-blockers, HMG-CoA reductase inhibitors, certain phenothiazines (chlorpromazine), tricyclic antidepressants may decrease the action of coenzyme Q10 and deplete endogenous stores; avoid concurrent use. Herb L-carnitine: Giving with coenzyme Q10 can lead to additive action (Jellin et al, 2008). Pharmacology Pharmacokinetics Supplements are absorbed at the levels of 2% to 3%. Peak occurs at approximately 6 hours. Primary Chemical Components and Possible Actions Chemical Class Individual Component Ubiquinone Benzoquinone Possible Action Antioxidant Client Considerations Assess • If the client is using coenzyme Q10 for a cardiovascular condition, assess cardiovascular status (blood pressure; pulse rhythm, character). • Assess medication use (see Interactions). Adverse effects: Underline = life-threatening 190 Coffee Administer • Instruct the client to store coenzyme Q10 away from moisture and light. Teach Client/Family • Caution the client not to use coenzyme Q10 at increased levels in children or those who are pregnant or breastfeeding until more research is available. • Instruct the client to avoid concurrent use of coenzyme Q10 with anticoagulants, or to have lab parameters monitored carefully if used concurrently. • Advise the client to avoid using coenzyme Q10 with phenothiazines, tricyclics, beta-blockers, and cholesterol-lowering agents. Coffee (kaw’fee) Scientific name: Coffea spp. Other common names: Bean juice, café, espresso, java, mocha Origin: Coffee is found in Central and South America. Uses Coffee is used to increase alertness, mood, exercise tolerance, and to enhance bronchodilation. Historically, coffee was administered by mouth for asthma, headache, and colds, or by rectum as an antidote for opium poisoning. It is used in herbal medicine to stimulate the appetite and facilitate digestion. Coffee promotes peristalsis and accelerates circulation (Felter, 1922). It may prevent onset of Parkinson’s disease and gallstones (Jellin et al, 2008). Actions The xanthine group has been studied extensively in mainstream pharmacology research. Xanthines, of which caffeine is one, stimulate the central nervous system by binding to adenosine receptors in the brain. One study researched the effects of elevated homocysteine concentrations, which are present in unfiltered coffee. Elevated homocysteine levels are a risk factor for cardiovascular disease. Consumption of 1 L of unfiltered coffee per day for 14 days significantly raised fasting homocysteine concentrations by 10% (Grubben et al, 2000). Another study researched the possible correlation between coffee consumption and decreased risk of gallstone disease in men. Of the 1081 subjects who had symptomatic gallstone disease, 885 required cholecystectomy. After adjusting for other factors, results showed that the men who consumed two to three cups of coffee per day showed a decrease in gallstone disease, while those who drank four or more cups of coffee per day showed an even greater decrease in the disease (Leitzmann et al, 1999). Coffee consumption may lower blood uric acid levels. This study showed levels of uric acid significantly decreased with coffee intake, but not with tea (Choi, Curran, 2007, Choi, Willett, Curran, 2007). Coronary calcification was inversely associated with coffee consumption. A sample of 1570 men and women without coronary artery disease participated in this study (Rizzo, 2008). The results may be due to the diterpene in coffee. Product Availability Roasted seed (beans) = Pregnancy = Pediatric ! = Alert = Popular Herb Coffee 191 Plant Part Used: Seeds Dosages • Adult PO infusion: 2-8 oz (Felter, 1922) NOTE: Lethal dose is approximately 100 cups of coffee C Contraindications Class 2b/2d herb. Until more research is available, coffee should not be used medicinally during pregnancy and breastfeeding. It should not be given to children. Coffee should also be avoided by persons with cardiovascular disease because of increased homocysteine levels, anxiety, bleeding disorders, osteoporosis, glaucoma, and duodenal or gastric ulcers. Side Effects/Adverse Reactions CNS: Headache, insomnia, increased affect and mood, decreased seizure threshold, dizziness, irritability, depression CV: Palpitations, extrasystole, restlessness, increased blood pressure GI: Nausea, vomiting, gastroesophageal reflux disease, peptic ulcer GU: Increased diuresis MS: Tremors Interactions Drug Alendronate: Coffee may decrease the effect significantly. Antacids, H2-blockers, proton pump inhibitors: Coffee may decrease the action of these products (theoretical) (Jellin et al, 2008). Aspirin, disulfiram, mexiletine, quinolones, riluzole, terbinafine, theophylline, verapamil: These drugs may increase caffeine levels and possibly increase adverse reactions (theoretical) (Jellin et al, 2008). Benzodiazepines: Caffeine reduces the benzodiazepine effect. Beta-blockers: Caffeine increases blood pressure in those taking beta-blockers. Bronchodilators, xanthines (theophylline): Large amounts of coffee increases the action of some bronchodilators, and xanthines such as theophylline. Estrogens, hormonal contraceptives: These agents may decrease metabolism of caffeine with possibility of adverse reactions (theoretical) (Jellin et al, 2008). Lithium: Levels of lithium are decreased by caffeine. MAOIs: Large amounts of coffee should be avoided; hypertensive reactions may occur. Herb Caffeine-containing herbs (cocoa, cola nut, guarana, yerba maté): Use with these herbs may lead to increased levels and increased adverse reactions (Jellin et al, 2008). Ephedra: Concurrent use of ephedra and coffee may increase hypertension and central nervous system stimulation; avoid concurrent use. Minerals (calcium, magnesium): Caffeine may increase the excretion of these minerals. Food Grapefruit juice: This juice may increase caffeine levels. Continued Adverse effects: Underline = life-threatening 192 Coffee Interactions—cont’d Lab Test AST: Coffee may decrease test values in alcoholics. Secretion provocation test: Coffee may increase test values. Serum 2-hour postprandiol glucose: False increase if caffeine is ingested during test. Specimen infertility screen: Heavy coffee consumption may decrease number of motile sperm. Pharmacology Pharmacokinetics Half-life 31⁄2-41⁄2 hours. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Xanthine Caffeine Central nervous system stimulant Increased cholesterol, low-density lipoproteins, triglycerides Diterpene Chlorogenic acid Galactomanan protein Free amino acid Polyamine Tannin Wound healing; antiinflammatory Vitamin B Mineral Coffee Oil Contains Fatty acid Stearic acid Sterol Tocopherol Cafestol Cahweol Lanosterol Niacin (trace) Client Considerations Assess • Assess the reason the client is using coffee medicinally. • Determine how much coffee the client consumes and its effect on mood, affect, and sleep patterns. = Pregnancy = Pediatric ! = Alert = Popular Herb Cola Tree 193 • Assess cardiac status of clients with cardiac disease (blood pressure, pulse, increased palpitations; hypertension and tachycardia may also be present). • Assess for the use of bronchodilators, xanthines, and ephedra (see Interactions). Administer • Instruct the client to store coffee in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use coffee medicinally in children or medicinally in those who are pregnant or breastfeeding until more research is available. • Inform the client that withdrawal symptoms are common after the use of coffee for extended periods. Cola Tree (koe’luh tree) Scientific names: Cola nitida, Cola acuminata Other common names: Bissy nut, cola nut, guru nut, kola nut, kolatier Origin: The cola tree is an evergreen found in parts of Africa and Indonesia. Uses Cola tree is used as an antidepressant, a diuretic, and an antidiarrheal. It is used to treat heart disease, dyspnea, fatigue, morning sickness, and migraines. Cola tree may also be used topically to promote wound healing and reduce inflammation. Actions Cola tree products have been used by people on the Ivory Coast to stimulate the central nervous system. The tribes of Hausa-Fulani in the northern part of Nigeria use Cola nitida (Ibu et al, 1986). Because tannins, which possess carcinogenic effects, are present in the cola nut, this herb is not recommended for extended use (Morton, 1992). Hormonal Action In a study using rat pituitary cells, the cells first were treated for 24 hours with differing doses of cola extract, then stimulated with luteinizing hormone-releasing hormone (LH-RH). The findings indicated that cola species inhibit LH-RH. With more studies, results may point to the ability of cola tree products to regulate gonadotropin release (Benie et al, 1987). Antiinfective Action One study has identified the antiinfective action of the aqueous and alcoholic extracts of Cola nitida (bark) when tested against pathogenic bacteria. The results showed that the extracts inhibited beta-hemolytic streptococci, Escherichia coli, Neisseria gonorrhoeae, Pseudomonas aeruginosa, Staphylococcus aureus, Klebsiella pneumoniae, Proteus mirabilis (Ebana et al, 1991), and mycobacteria (Adeniyi et al, 2004). Another study (Kamagate et al, 2002) indicated that kola extract is not effective against bacteria at regular doses used by chewing. Other Actions Other actions of cola tree products include central nervous system stimulation, increased gastric acid flow, mild diuresis, and a mild positive chronotropic effect. One study identified the effects of Cola nitida on the locomotor activities of Adverse effects: Underline = life-threatening C 194 Cola Tree mice. Low doses had no effect, whereas high doses exerted a depressive effect (Ajarem, 1990). Product Availability Cola nut, cola wine, fluid extract, powdered herb, solid extract, tincture Plant Part Used: Seeds Dosages • Adult PO cola extract: 0.25-0.75 g/day (Blumenthal, 1998) • Adult PO cola fluid extract: 2.5-7.5 g/day (Blumenthal, 1998) • Adult PO cola nut: 2-6 g/day (Blumenthal, 1998) • Adult PO cola wine: 60-180 g/day (Blumenthal, 1998) • Adult PO decoction: 1-2 tsp powder in 1 cup water, boiled 15 min • Adult PO fluid extract: 5-40 drops bid-tid with meals, mixed in a small amount of liquid • Adult PO solid extract: 2-8 grains tid • Adult PO tincture: 10-30 g/day (Blumenthal, 1998) Contraindications Class 2b/2d herb (seeds). Until more research is available, cola tree products should not be used during pregnancy and breastfeeding. It should not be given to children. These products should not be used by persons with hypersensitivity to chocolate or with stomach or duodenal ulcers. Persons with cardiac disease such as ischemic heart disease, hypertension, arrhythmias, or heart palpitations should avoid their use. Cola tree products should be used with caution by persons with anxiety, nervousness, or mood disorders. Avoid prolonged use. Side Effects/Adverse Reactions CNS: Anxiety, insomnia, nervousness, irritability, restlessness, headache CV: Hypertension, hypotension, tachycardia, bradycardia, palpitations GI: Nausea, vomiting, anorexia, abdominal distress, cramps, gastrointestinal mucosa irritation, bright yellow oral pigmentation (Ashri, 1990) GU: Diuresis INTEG: Hypersensitivity reactions Interactions Drug Analgesics: Cola tree products may increase the effect of analgesics; avoid concurrent use. Antacids, H2-blockers, proton pump inhibitors: Coffee may decrease the action of these products (theoretical) (Jellin et al, 2008). Antiinfectives (quinolones): Quinolones may increase the effect of cola tree. Aspirin, disulfiram, mexiletine, riluzole, terbinafine, theophylline, verapamil: These drugs may increase caffeine levels and possibly increase adverse reactions (theoretical) (Jellin et al, 2008). Benzodiazepines (diazepam, clonazepam, temazepam, triazolam): Benzodiazepines may decrease the effect of cola tree products. Beta-blockers (metoprolol, propranolol): Cola tree products may increase blood pressure when used with beta-blockers. = Pregnancy = Pediatric ! = Alert = Popular Herb Cola Tree 195 Interactions—cont’d Estrogens, hormonal contraceptives: May decrease metabolism of caffeine with possibility of adverse reactions (theoretical) (Jellin et al, 2008). Furoquinolones(alatrofloxacin, ciprofloxacin, levofloxacin), salicylates (aspirin): Furoquinolones, salicylates (aspirin) may increase the effect of cola tree products. Lithium: Lithium may decrease the effect of cola tree, caffeine-containing products. MAOIs (phenelzine, tranylcypromine): Cola tree products may increase blood pressure when used with phenelzine and tranylcypromine. Psychoanaleptic agents: Cola tree products may increase the action of psychoanaleptic agents. Xanthines: Cola tree products may increase the action of xanthines (e.g., theophylline, caffeine); avoid concurrent use. Herb Ephedra: Concurrent use of ephedra and cola tree may increase hypertension and central nervous system stimulation; avoid concurrent use. Minerals (calcium, magnesium): Caffeine may increase the excretion of these minerals. Food Caffeinated coffee, cola, tea, grapefruit juice: Cola tree may increase the effects of these products. Pharmacology Pharmacokinetics Caffeine crosses the placenta and enters breast milk. Primary Chemical Components and Possible Actions Chemical Class Individual Components Possible Action Alkaloid Theobromine; Caffeine; Theophylline Central nervous system stimulant Carcinogenic Tannin Cardiac glycoside Anthraquinone Glucide Saponin Flavonoid Phenol Catechin Epicatechin Laxative Client Considerations Assess • Assess for hypersensitivity reactions. If these are present, discontinue the use of cola tree products and administer antihistamines or other appropriate therapy. Adverse effects: Underline = life-threatening C 196 Colostrum, bovine • Assess cardiac status in cardiac patients (blood pressure, pulse, palpitations, hypertension, tachycardia). • Assess the client’s mental status (affect, mood, euphoria). • Assess for the use of medications, caffeinated drinks, and ephedra (see Interactions). Administer • Instruct the client to store cola tree products in a sealed container in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use cola tree products in children or those who are pregnant or breastfeeding until more research is available. • Instruct the client not to confuse the cola tree herb with other types of cola. Colostrum, bovine (ke-la’-strem) Other common names: Bovine immunoglobulin, colostrum, hyperimmune bovine colostrum Origin: Colostrum is secreted by new mothers for a few days after giving birth. Uses Colostrum is used in graft-versus-host disease, in rotavirus diarrhea in children, to burn fat, to stimulate the immune system in HIV, and for athletic training. Actions Research is just beginning in regard to bovine colostrum. At present most information comes from anecdotal reports. Product Availability Liquid, powder Dosages Athletic Training • Adult PO: 125 ml bid (not available in the United States) AIDS-Related Cryptospordium Diarrhea • Adult powder: 10 g ⫻ 21 days Contraindications Bovine colostrum should not be used in children or those who are pregnant, breastfeeding, or hypersensitive to bovine milk. Side Effects/Adverse Reactions GI: Nausea, vomiting, increased hepatic function tests HEMA: Decreased hematocrit = Pregnancy = Pediatric ! = Alert = Popular Herb Coltsfoot 197 Primary Chemical Components and Possible Actions Chemical Class Protein Carbohydrates Fat Vitamins Minerals Immunoglobulins Individual Component Possible Action C IgA IgG IGF IGF-I Phosphatidylethanolamine Stimulate immunity Stimulate immunity Client Considerations Assess • Assess the reason the client is using bovine colostrum. Administer • Keep bovine colostrum in a dry area, away from direct sunlight. Teach Client/Family • Teach the patient that bovine colostrum should not be used in children or those who are pregnant or breastfeeding until more research is available. Coltsfoot (koeltz’ fut) Scientific name: Tussilago farfara Other common names: British tobacco, bullsfoot, coughwort, donnhove, farfara, fieldhove, filius ante patrem, flower velure, foal’s-foot, foalswort, hallfoot, horse-foot, horse-hoof, kuandong hua, pas díane Origin: Coltsfoot is a perennial found in Europe; the United States; Canada; and central, western and northern Asia. Uses Coltsfoot is used to treat respiratory conditions such as bronchitis, cough, and asthma. It is also used to treat inflammation of the oral mucosa. Investigational Uses Research is underway concerning coltsfoot as an antimicrobial. Actions Two studies have demonstrated the ability of coltsfoot to inhibit nitric oxide synthesis in macrophages. The clinical significance of this finding is unknown, however (Ryu et al, 1999). Another study found that coltsfoot inhibits the binding of both platelet Adverse effects: Underline = life-threatening 198 Coltsfoot activating factor and Ca2+ entry blocker to membrane vesicles (Hwang, 1987). Other studies have focused on the toxic effects of Tussilago farfara L. and the isolation of new chemical components (Sperl et al, 1995; Wang et al, 1989; Liu et al, 2006). The screening of 16 medicinal plants showed that 6 possessed significant antimicrobial action (Kokoska et al, 2002; Kim et al, 2006). Product Availability Dried herb, extract, syrup, tea, tincture Plant Parts Used: Dried flowers, leaves, roots Dosages • Adult PO decoction: 0.6-2.9 g dried herb • Adult PO dried herb: 4.5-6 g/day (Blumenthal, 1998) • Adult PO fluid extract: 0.6-2 ml tid (1:1 dilution in alcohol 25% concentration) • Adult PO syrup: 2-8 ml tid (1:4 dilution) • Adult PO tea: 1-3 tsp dried herb in 8 oz boiling water, let stand 10 min, strain, take tid Contraindications Class 2b/2c/2d herb (flowers). Coltsfoot should not be used during pregnancy and breastfeeding. It should not be given to children. Coltsfoot should not be used by persons with hepatic disease or those who are hypersensitive to ragweed, chamomile, or other members of the composite family. Persons with cardiac disease, or hypertension should use this herb cautiously. Coltsfoot should not be used for longer than 6 weeks. Pyrrolizidine alkaloid content should not exceed 10 mcg. Side Effects/Adverse Reactions CNS: Fever CV: Hypertension GI: Nausea, vomiting, anorexia, diarrhea, jaundice, hepatotoxicity (rare) INTEG: Hypersensitivity reactions RESP: Upper respiratory infection Interactions Drug Antiarrhythmics, antihypertensives: Coltsfoot may antagonize antiarrhythmics and antihypertensives; avoid concurrent use (theoretical). Herb Eucalyptus: Eucalyptus may increase the toxicity of coltsfoot; avoid concurrent use (theoretical) (Jellin et al, 2008). Pyrrolizidine alkaloid (UPA)-containing herbs (borage, gravel root, agrimony, petasities, comfrey, dusty miller, ragwort): Use with these herbs and coltsfoot will lead to increased toxicity; do not use concurrently (Jellin et al, 2008). Lab Test AST, ALT, alkaline phosphatase: Coltsfoot may increase these levels. = Pregnancy = Pediatric ! = Alert = Popular Herb Comfrey 199 Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Alkaloids Tussilagone Senkirkine Isotussilagone; Senecionine; Senecionin Pressor effect Hepatotoxicity Tannin Triterpenes Sesquiterpenoid Arnidiol; Faradiol; Beta-amyrin Bisabolene; Epoxide (Ryu et al, 1999) Farfaratin (Wang et al, 1989) Flavonoids Phytosterol Mucilage Inhibition of nitric oxide synthesis Demulcent Client Considerations Assess • Assess the reason the client is using coltsfoot. • Assess for hypersensitivity reactions. If these are present, discontinue the use of this herb and administer antihistamines or other appropriate therapy. ! • Assess for hepatotoxicity (increased hepatic function tests, jaundice, clay-colored stools, right upper-quadrant pain). If these occur, herb use should be discontinued. • Assess for the use of antiarrhythmics and antihypertensives (see Interactions). Administer • Instruct the client to store coltsfoot products in a cool, dry place, away from heat and moisture. • Because of the presence of hepatotoxic pyrrolizidine alkaloids, caution the client not to use coltsfoot for longer than 6 weeks. Teach Client/Family • Caution the client not to use coltsfoot in children or those who are pregnant or breastfeeding because hepatotoxicity may occur. • Advise the client to report any side effects to the provider. • Caution the client not to confuse peppermint with coltsfoot; they are similar in appearance. Comfrey (kuhm’free) Scientific name: Symphytum officinale Other common names: Black root, blackwort, boneset, bruisewort, consound, gum plant, healing herb, knitback, knitbone, salsifly, slippery root, wallwort Origin: Comfrey is a perennial found in the United States, Australia, and parts of Asia. It is cultivated in Japan. Adverse effects: Underline = life-threatening C 200 Comfrey Uses Comfrey is used topically to promote wound healing and to decrease inflammation caused by bruises and sprains. It has also been used internally for many years as a treatment for colitis and peptic ulcer disease. However, because hepatotoxicity may occur, internal use is no longer recommended. Actions In the past, comfrey was used internally to treat many conditions, including gastrointestinal complaints. However, because its pyrrolizidine alkaloids can cause hepatotoxicity, comfrey is now recommended for topical use only. Comfrey should be applied once the wound has begun to heal; the allantoin stimulates cell division and wound healing. Several studies have focused on the toxic results of the internal use of comfrey (Couet et al, 1996; Mei et al, 2005). Studies have found comfrey to be carcinogenic. Plantain (Plantago major) can be used in place of comfrey, both internally for its healing properties and topically on open wounds. Product Availability Capsules, extract, ointment, tea Plant Parts Used: Leaves, roots Dosages NOTE: Because of the potential for hepatotoxicity, internal use of comfrey is no longer recommended. Wound Healing • Adult topical products: may be applied to wounds as needed (5%-20% dried herb present in product); use no longer than 6 weeks (Blumenthal, 1998) • Adult poultice of fresh green leaves: may be applied prn to granulate wounds over broken bones Contraindications Class 2a/2b/2c herb; class 3 herb (leaf, root). Until more research is available, comfrey should not be used during pregnancy and breastfeeding. It should not be given to children. Comfrey should not be used by persons who are hypersensitive to this herb. Comfrey is for external use only, and should not be used for more than 6 weeks in 1 year. Internal use may cause fatal hepatotoxicity. Do not use this herb on broken skin. Pyrrolizidine alkaloid content should not exceed 10 mcg. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, abdominal pain, hepatomegaly, hepatotoxicity, venoocculsive disease, hepatic adenoma (all reactions from oral use) GU: Bladder tumors INTEG: Hypersensitivity reactions (oral and topical use) Interactions Herb Eucalyptus: Eucalyptus may increase the toxicity of comfrey; avoid concurrent use (theoretical) (Jellin et al, 2008). = Pregnancy = Pediatric ! = Alert = Popular Herb Comfrey 201 Interactions—cont’d Pyrrolizide alkaloid (UPA)-containing herbs (agrimony, borage, coltsfoot, dusty miller, gravel root, petasities, ragwort): Use of these herbs with comfrey (internally) will lead to increased toxicity; do not use concurrently (Jellin et al, 2008). Lab Test ALT, AST, total bilirubin: Comfrey may increase ALT, AST, total bilirubin, and urine bilirubin. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Pyrrolizidine Alkaloids Triterpenoid Asparagine Tannin Allantoin Mucilage Polysaccharides Rosmarinic Acid Lasiocarpine; Symlandine; Symphytine; Echimidine Symphytoxide A Hepatotoxic Hypotensive Astringent Wound healing Demulcent Antiinflammatory Client Considerations Assess ! • If the client is taking comfrey internally, which is no longer recommended, assess for hepatotoxicity: increased hepatic function tests (AST, ALT, bilirubin), jaundice, clay-colored stools. If these symptoms are present, use of the herb should be discontinued. • If the client is using comfrey topically to promote wound healing, assess the wound for temperature, redness, swelling, bleeding, and purulent drainage. Administer • Instruct the client to store comfrey products in a cool, dry place, away from heat and moisture. • Instruct the client not to use comfrey for more than 6 weeks in 1 year. Teach Client/Family • Caution the client not to use comfrey in children or those who are pregnant or breastfeeding until more research is available. • Because hepatotoxicity may occur, caution the client not to take comfrey internally. In some countries internal use has been banned. • Advise the client not to use comfrey on broken skin. Absorption of pyrrolizidine alkaloids may occur. Adverse effects: Underline = life-threatening C 202 Condurango Condurango (kohn-du-rahn’go) Scientific name: Marsedenia condurango Other common names: Condor-vine bark, condurango bark, condurango blanco, eagle vine, gonolobus, condurango triana, marsedenia condurango Origin: Condurango is found in South America. Uses In traditional herbal medicine, condurango is used as an astringent and as a treatment for anorexia and syphilis. Investigational Use Research is underway to determine the efficacy of condurango as a cancer treatment. Actions Antitumor Action One study evaluated the differentiation-inducing activity of condurango in the mouse myeloid leukemia cell line. Among the chemical components of the herb, the condurango glycosides were the most potent differentiation inducers of phagocytic cells after 24 hours of treatment with these compounds. This indicates the antitumor action of condurango (Umehara et al, 1994). Another study identified the antitumor activity of this herb against sarcomas (Hayashi et al, 1980). Other Actions The tannins in condurango possess astringent properties that contribute to its wound healing effects. Product Availability Bark, fluid extract, powdered bark, tincture Plant Part Used: Dried bark Dosages • Adult PO bark: 2-4 g daily (Blumenthal, 1998) • Adult PO extract: 0.2-0.5 g daily (Blumenthal, 1998) • Adult PO fluid extract: 2-4 g daily (Blumenthal, 1998) • Adult PO infusion: 2 tsp powdered bark in 8 oz boiling water, let stand 15 min, take tid • Adult PO tincture: 1-2 ml tid or 2 g daily (Blumenthal, 1998) • Adult PO water extract: 0.2-0.5 g daily (Blumenthal, 1998) Contraindications Until more research is available, condurango should not be used during pregnancy and breastfeeding. It should not be given to children. Condurango should not be used by persons with hepatic disease, any seizure disorder, or a hypersensitivity to this herb or any herb in the milkweed family. Side Effects/Adverse Reactions CNS: Seizures (overdose of bark), paralysis GI: Nausea, vomiting, anorexia, hepatotoxicity INTEG: Hypersensitivity reactions, anaphylaxis = Pregnancy = Pediatric ! = Alert = Popular Herb Condurango 203 Interactions Drug Cardiac glycosides (digoxin), iron products: Absorption of digitoxin, digoxin, and iron products may be reduced when used with condurango; avoid concurrent use (theoretical). Medications metabolized by P450 enzyme system (carbamazepine, bupropion, orphenadrine, cyclophosphamide, citalopram, azole antifungals, macrolide antibiotics, omeprazole): Use condurango cautiously with these drugs, especially in clients with hepatic disorders. Medications metabolized by cytochrome P2A6 enzyme system (carbamazepine, paroxetine, ritonavir, sertraline): Use these medications cautiously with condurango. Primary Chemical Components and Possible Actions Chemical Class Tannin Glycoside Essential oil Resin Caoutchouc Condruit Phytosterin Sitosterol Vanillin Coumarin Esculetin Flavonoid Acid Individual Component Condurango A, A0, A1, B0, C, C1, D0, E0, E2 Condurangin Caffeic acid; Cholorogenic acid Possible Action Astringent Antitumor Bile stimulant Strychnine-like alkaloid Client Considerations Assess • Assess the reason the client is using condurango. • Assess for hypersensitivity reactions. If present, discontinue the use of condurango and administer an antihistamine or other appropriate therapy. ! • Assess for hepatotoxicity: increased AST, ALT, and bilirubin levels; jaundice, claycolored stools, right upper-quadrant pain. • Assess for adverse central nervous system reactions. • Identify all medications taken by the client (see Interactions). Adverse effects: Underline = life-threatening C 204 Copper Administer • Instruct the client to store condurango in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use condurango in children or in those who are pregnant or breastfeeding until more research is available. Copper (kop’ur) Scientific names: Copper, Cu Origin: Copper is an essential trace mineral. Uses Copper is used to prevent and treat osteoporosis and osteoarthritis, to improve wound healing, and to treat copper deficiency. Actions There is little scientific evidence for the use of copper in larger doses. Copper is a trace mineral found in food. There seems to be no need for extra supplementation. Acquired copper deficiency can cause hematologic/neurologic conditions (Kumar, Butz, Burritt 2007), Menkes disease, Wilson’s disease, and cancer (Daniel et al, 2004). Product Availability Tablets, capsules Dosages • Adult PO: 900 mcg/day Contraindications Copper should not be used in high doses in children, those who are pregnant or breastfeeding, or who have renal/hepatic disease. Side Effects/Adverse Reactions GI: Liver, GI damage (high doses) Client Considerations Assess • Assess the reason the client is using copper. Administer • Keep copper in a dry area, away from direct sunlight. Teach Client/Family • Teach the patient that copper should not be used in high doses in children or those who are pregnant or breastfeeding until more research is available. = Pregnancy = Pediatric ! = Alert = Popular Herb Coriander 205 Coriander (koe’ree-an-duhr) Scientific names: Coriandrum sativum, Coriandrum sativum var. vulgare, Coriandrum sativum var. microcarpum Other common names: Chinese parsley, cilantro, coriander Origin: Coriander is found throughout the world. Uses Coriander is used as an anthelmintic and appetite stimulant, as a treatment for arthritic conditions and dyspepsia, and as an antiseptic. It is also used as a spice and flavoring in foods. Actions Antilipidemic Action Three studies using laboratory rats fed a high-fat diet have evaluated the antilipidemic action of Coriandrum sativum (Chithra et al, 1997, 1999, 2000). In all three studies, the use of coriander seeds lowered the lipid level significantly, with levels of total cholesterol and triglycerides decreased. The levels of low-density lipoprotein (LDL) and very-low-density lipoprotein (VLDL) cholesterol decreased, while highdensity lipoprotein (HDL) cholesterol levels increased. Antidiabetic Action In traditional herbal medicine, coriander has been used for many years to lower blood glucose. When streptozocin-diabetic mice were fed coriander in their diet and in their drinking water, a significant reduction in blood glucose occurred. Sequential extraction revealed insulin-releasing activity (Gray et al, 1999). In an older study evaluating the antidiabetic action of several herbs, coriander was shown to decrease glucose levels in diabetic mice (Swanston-Flatt et al, 1990). Other Actions Fresh coriander seeds were found to exert abortifacient effects on female rats. An oral dose of 250-500 mg/kg produced an antiimplantation effect but failed to produce complete infertility (Al-Said et al, 1987). A mixed fraction of dill, cilantro, coriander, and eucalyptus essential oils showed additive, synergistic, or antagonistic effects depending on organism (Delaguis et al, 2002). A new study (Eguale et al, 2007) discusses the anthelmintic activity in vitro and in vivo. Another study (Emamghoreishi, Khasaki, Aazam, 2005) evaluated the anxiolytic effect of coriander. It has long been used for anxiety and insomnia in folk medicine. A significant antibacterial activity, as determined using the agar diffusion method, was shown when used with coriander essential oil (Lo Cantore et al, 2004). Product Availability Crude extract, tincture, whole herb Plant Parts Used: Dried fruits Dosages Dosages vary widely. • Adult PO decoction: 2 tsp crushed herb in 150 ml boiling water, let stand 15 min, strain, drink 8 oz before meals • Adult PO tincture: 10-20 drops after meals • Adult PO whole herb: 3 g/day in divided doses (Blumenthal, 1998) Adverse effects: Underline = life-threatening C 206 Coriander Contraindications Class 1 herb (fruit, seed). Until more research is available, coriander (medicinally) should not be used during pregnancy and breastfeeding. It should not be given to children. Coriander should not be used by persons with hypersensitivity to this herb. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, fatty hepatic tumors INTEG: Hypersensitivity reactions, anaphylaxis Interactions Drug Antidiabetics: Coriander may increase the effects of antidiabetics; use together cautiously. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Volatile oil Coriandrol; linalool; Limonene; Alpha-pinenes; Cymene; Camphor; Camphene; Terpinene; Monoterpene; Phellandrene; Carvone; Geraniol; Borneol Spasmolytic Quercetin; Isoquercetin Rutin Glucuronide; Coriandrinol Antiinflammatory Antioxidant; astringent Sitosterol Triacontanol Flavonoid Tannin Fatty acid Coumarin Minerals/Vitamins Oleic acid; Petroselinic acid; Linolenic acid Scopoletin; Umbelliferone Vitamin C, Calcium, Potassium; Iron, Magnesium Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue use of coriander and administer an antihistamine or other appropriate therapy. • Assess for the use of antidiabetics (see Interactions). Administer • Instruct the client to store coriander in a sealed container away from light and moisture. = Pregnancy = Pediatric ! = Alert = Popular Herb Corkwood 207 Teach Client/Family • Caution the client not to use coriander in children or those who are pregnant or breastfeeding until more research is available. C Corkwood (kawrk’wud) Scientific name: Duboisia myoporoides Other common names: Pituri, corkwood tree Origin: Corkwood is found in South America and Australia. Uses Before commercial preparations of scopolamine were available, corkwood was used to prevent nausea and vomiting associated with motion sickness. It has also been used to decrease spasms of the gastrointestinal system. Actions Anticholinergic Action Two of the chemical components of corkwood, scopolamine and hyoscyamine, exert anticholinergic activity (Griffin et al, 1975). This action inhibits acetylcholine at receptor sites in the autonomic nervous system. The results are a decrease in secretions and an increase in blood pressure, blurred vision, and other visual disturbances. One study (Jãger et al, 2006) demonstrated the anticonvulsant activity of Danish folk medicines, including corkwood. Product Availability Liquid, tablets, leaves Plant Parts Used: Leaves, roots, stems Dosages Many different dosages are reported. Contraindications Until more research is available, corkwood should not be used during pregnancy and breastfeeding. It should not be given to children. Corkwood should not be used by persons with hypersensitivity to this herb or those with angle-closure glaucoma, myasthenia gravis, or gastrointestinal/genitourinary obstruction. Persons with congestive heart failure, prostatic hypertrophy, hypertension, arrhythmia, or gastric ulcer should avoid the use of corkwood. Side Effects/Adverse Reactions CNS: Confusion, anxiety, restlessness, irritability, headache, dizziness, flushing, hallucinations CV: Palpitations, tachycardia, postural hypotension EENT: Blurred vision, dry mucous membranes GI: Nausea, vomiting, anorexia, dry mouth, constipation, abdominal distress Continued Adverse effects: Underline = life-threatening 208 Corkwood Side Effects/Adverse Reactions—cont’d GU: Hesitancy, retention INTEG: Hypersensitivity reactions RESP: Tachypnea Interactions Drug Alcohol, antihistamine, opioids, phenothiazines, tricyclics: An increased anticholinergic effect occurs when corkwood is used with alcohol, antihistimines, opioids, phenothiazines, and tricyclics. Antiparkinson agents: Corkwood may interfere with the effect of antiparkinson agents. Beta-blockers, cardiac glycosides: Corkwood may alter cardiac function. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Phenolic Glycosides Primulaverin, Primeverin (Müller et al, 2006) Scopolamine; Hyoscyamine Valtropine; Valeroidine Butropine Anticonvulsant Alkaloid Leaves Alkaloid Nicotine Anticholinergic Client Considerations Assess • Assess the reason the client is using corkwood. • Assess for hypersensitivity reactions. If present, discontinue the use of corkwood and administer an antihistamine or other appropriate therapy. • Assess the client’s mental status (mood, affect, anxiety, restlessness). • Assess for urinary hesitancy or retention. • Assess for medication use (see Interactions). Administer • Instruct the client to store corkwood products away from moisture and light. • Advise the client to use hard candy, liquids, and chewing gum to alleviate dry mouth. Teach Client/Family • Caution the client not to use corkwood in children or those who are pregnant or breastfeeding until more research is available. • Advise the client to avoid driving and operating machinery if dizziness occurs. • Inform the client that if using for scopolamine effect, other sources are a better choice (Jellin et al, 2008). = Pregnancy = Pediatric ! = Alert = Popular Herb Couchgrass 209 Couchgrass (kuch’gras) Scientific names: Agropyron repens, Elymus repens, Graminis rhizomo, Triticum repens L. Other common names: Cutch, dog grass, durfa grass, quack grass, quitch grass, Scotch quelch, triticum, twitch-grass, witch grass Origin: Couchgrass is found in Europe and is now grown in the United States. Uses Couchgrass is used in the treatment of cystitis, urethritis, prostatitis, upper respiratory conditions, gout, rheumatism, and cough. It is also used as an irrigant to treat urinary tract disorders with inflammation, as a demulcent and antimicrobial, and to prevent renal gravel. The juice of the roots is used to treat cirrhosis of the liver, and some species are used to treat tumors and cancer. Couchgrass is not commonly used today. Actions No research is available on the actions of this herb. Existing studies focus on the composition of the chemical components of couchgrass. Urolithiasis Action Grasses et al (1995) reports that although the use of Agropyron repens does not improve urolithiasis of calcium oxalate stones, alterations in diet does affect the formation of calcium oxalate stones. This study compared three different diets: standard, high glucosidic, and high protein. An increase in citraturia occurred when A. repens was added to a high-protein diet, resulting in a reduction in stone formation. Antimicrobial Action Limited research is available on the antimicrobial action of couchgrass. The essential oil, agropyrene, has been shown to possess antimicrobial effects. Product Availability Capsule, cut rhizome, fluid extract, tablet, tincture Plant Part Used: Rhizome Dosages No published dosage is available for irrigation. • Adult PO decoction: place 2 tsp cut rhizome in 8 oz water, bring to a boil, simmer 10 min, use tid; a single dose consisting of approximately 3-10 g of the herb can also be used • Adult PO fluid extract: a 1:1 dilution is recommended • Adult PO tincture: use 2-4 ml tid (1:5 dilution recommended) Ulcerative Colitis • Adult PO juice: 100 mg daily ⫻ 1 mo (Jellin et al, 2008). Contraindications Pregnancy category is 3; breastfeeding category is 2A. Do not use couchgrass as an irrigant if edema caused by cardiac or renal conditions is present. Continued Adverse effects: Underline = life-threatening C 210 Couchgrass Side Effects/Adverse Reactions INTEG: Rash META: Hypokalemia, hyperglycemia Interactions Drug Antidiabetics: Couchgrass may increase hyperglycemia. Diuretics: Potassium wasting diuretics with couchgrass may lead to hypokalemia. Lab Test Blood glucose: Couchgrass may increase blood glucose levels. Potassium: Couchgrass may decrease potassium level. Pharmacology Pharmacokinetics Mannitol, present in couchgrass, is poorly absorbed by oral route. Most other pharmacokinetics and pharmacodynamics are unknown. Primary Chemical Components and Possible Actions Chemical Class Individual Component Polysaccharide Mucilage Saponin Sugar alcohol Essential oil Triticin Possible Action Cancer prevention Mannitol; Inositrol Agropyrene Polyacetylene; Carvone Vanilloside Vanillin Phenolcarboxylic acid Silicic acid Silicate Lectin Vitamin Mineral Diuretic Antifungal Antimicrobial A; B complex Iron Client Considerations Assess • Assess potassium levels if use is frequent. • Assess for skin rash if product comes in contact with the skin. • Assess the client for cardiac and renal disorders. If edema is present, do not use couchgrass as an irrigant. Administer • Instruct the client to take couchgrass PO as a decoction or extract. • Instruct the client to store the herb in a sealed container in a dry, dark environment. Teach Client/Family • Inform the client that pregnancy category is 3 and breastfeeding category is 2A. = Pregnancy = Pediatric ! = Alert = Popular Herb Cowslip 211 Cowslip (kow’slip) Scientific name: Primula veris Other common names: Artetyke, arthritica, buckles, crewel, drelip, fairy cup, herb Peter, key of heaven, key flower, may blob, mayflower, our lady’s keys, paigle, palsywort, password, peagle, petty mulleins, plumrocks Origin: Cowslip is found in the western region of the United States, Europe, and western Asia. Uses Cowslip is used to treat insomnia, anxiety, restlessness, and nervousness. The root is used for chronic cough. Actions Respiratory Action One study conducted in Europe evaluated the effect of pharmacotherapeutic options and herbal remedies for bronchitis. The herbal remedy Primula veris showed an effect equal to that of pharmacologic treatments (Ernst et al, 1997), as did several other combination herbal products with oil of eucalyptus, peppermint, anise, and ivy extract. Other Actions Older studies have identified both hypotensive and hypertensive effects of saponins, chemical components in Primula veris. The saponin may be responsible for this action. Two flavonoids, quercetin and apigenin, are responsible for the antiinflammatory and antispasmodic effects of cowslip. These effects are common in all herbs with these chemical components. Product Availability Dried herb, fluid extract Plant Part Used: Flowers Dosages • Adult PO fluid extract: 1-2 ml tid (1:1 dilution in alcohol 25%) • Adult PO infusion: 1-2 g dried herb, tid Contraindications Class 1 herb (flower, root). Until more research is available, cowslip should not be used during pregnancy and breastfeeding. It should not be given to children. Cowslip should not be used by persons with hepatic disease, gastrointestinal conditions, or hypersensitivity to this herb. Side Effects/Adverse Reactions CV: Hyper/hypotension GI: Nausea, vomiting, anorexia, diarrhea, gastritis, hepatotoxicity INTEG: Hypersensitivity reactions, contact dermatitis SYST: Hypersensitivity Continued Adverse effects: Underline = life-threatening C 212 Cowslip Interactions Drug Antihypertensives, diuretics: Cowslip may increase the effect of antihypertensives, diuretics. CNS depressants: Cowslip may increase the effect of antianxiety agents and sedatives/hypnotics; do not use concurrently. Lab Test AST, ALT, alkaline phosphatase: Cowslip may increase these levels. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Flavonoid Quercetin; Apigenin Antiinflammatory; antispasmodic Antiinflammatory Phenol Kaempferol Luteolin; G1, 2, 3, 4, 5, 6, (Huck et al, 2000) Primulaveroside; primveroside Hypotensive; hypertensive Astringent Saponin Tannin Volatile oil Carbohydrate Client Considerations Assess • Assess the reason the client is using cowslip. • Assess for hypersensitivity reactions, including contact dermatitis. If present, discontinue use of cowslip and administer antihistamine or other appropriate therapy. ! • Assess for hepatotoxicity (increased AST, ALT, bilirubin levels; jaundice; claycolored stools; right upper-quadrant pain). If present, herb use should be discontinued and appropriate action taken. • Assess for the use of antihypertensives, antianxiety agents, diuretics, and sedative/ hypnotics (see Interactions). Administer • Instruct the client to store cowslip products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use cowslip in children or those who are pregnant or breastfeeding until more research is available. • Inform the client that scientific research is lacking to support any of the uses for or actions of cowslip. = Pregnancy = Pediatric ! = Alert = Popular Herb Cranberry 213 Cranberry (kran’beh-ree) Scientific names: Vaccinium macrocarpon, Vaccinium oxycoccus, Vaccinium erythrocarpum Other common names: Bog cranberry, isokarpalo, marsh apple, mountain cranberry, pikkukarpalo Origin: Cranberry is a small shrub found in the United States, from Tennessee to Alaska. Uses Cranberry is used to prevent (but not to treat) urinary tract infections. It may be used to treat kidney stones. Actions Urinary Tract Action Studies abound on the urinary tract action of cranberry. It is well known that cranberry juice is useful for the prevention of urinary tract infections (Jackson et al, 1997; Jepson et al, 2000; Lavigne et al, 2007). The increase in urine acidity causes a decrease in organism growth. However, cranberry juice is not effective for the treatment of urinary tract infections. Cranberry does decrease ionized calcium in urine by 50% and therefore may be used to treat recurrent kidney stones (Murray, Pizzorno, 1998). Antioxidant Action One study evaluated the antioxidant properties of blueberry and cranberry juice. Consumption of cranberry juice increased the ability of plasma to increase antioxidants. Blueberry juice did not exert this effect (Pedersen et al, 2000). However, this was a small study with only nine participants. Cardiovascular Action There is a growing body of evidence that the phenolic acids (benzoic, hydroxycinnamic, ellagic) in cranberries may contribute to reducing cardiovascular risk, including decreased platelet aggregation, reducing blood pressure, and increasing resistance of LDL to oxidation (McKay et al, 2007). Oral Antiplaque Action One study using a high-molecular-weight cranberry constituent found that the substance altered subgingival microbes and therefore would be able to control periodontal disease (Weiss et al, 1998). Product Availability Capsules, fresh berries, juice Plant Part Used: Berries Dosages • Adult PO capsules: 9-15 capsules/day (400-500 mg each) (McCaleb et al, 2000) • Adult PO capsules (powdered concentrate): 2 capsules daily • Adult PO juice: 1-2 cups daily (Murray, Pizzorno, 1998) Adverse effects: Underline = life-threatening C 214 Cranberry Contraindications Pregnancy category is 1; breastfeeding category is 2A. Cranberry should not be used by persons with oliguria, anuria, or hypersensitivity to this herb. Side Effects/Adverse Reactions GI: Diarrhea (large doses) INTEG: Hypersensitivity reactions Interactions Drug Cytochrome P45 2C9 substrates: Cranberry may inhibit cytochrome P45 2C9 enzymes. Warfarin: Cranberry, when given with warfarin, may increase the international normalized ratio and increase the risk for bleeding. Lab Test Urine pH: Cranberry decreases urine pH. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Phenolic Acid Benzoic acid; Ellagic, hydroxycinnamic Malic acid; Citric acid; Quinic acid Oligosaccharides Fructose Decreased CV risk Carbohydrate Anthocyanin Proanthocyanidins Flavonoids Glycosides Antimicrobial Antimicrobial Quercetin; Myricetin Epicatechin; Catechin Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue use of cranberry and administer an antihistamine or other appropriate therapy. • Assess the client’s genitourinary status: urinary frequency, hesitancy, pain, or burning. If a urinary tract infection is present, refer the client for antibiotic therapy. Administer • Instruct the client to store cranberry products away from light and moisture. Teach Client/Family • Inform the client that pregnancy category is 1 and breastfeeding category is 2A. • Caution the client not to use cranberry in place of antibiotic therapy if urinary frequency, hesitancy, pain, or burning are present. • Advise the client that cranberry is effective for preventing urinary tract infections but not for treating them. = Pregnancy = Pediatric ! = Alert = Popular Herb Creatine 215 Creatine (kree’uh-teen) Origin: Creatine is an amino acid that occurs naturally in dairy products, seafood, and beef. It is manufactured by the body in the liver, kidney, and pancreas. Uses Creatine is used for gyrate atrophy, McArdle’s disease, muscular dystrophy, amyotrophic lateral sclerosis, and rheumatoid arthritis. It is used in congestive heart disease to improve exercise tolerance and to enhance athletic performance. Actions Exercise Performance Enhancement A group of athletes was evaluated for increased muscle strength after creatine supplementation. Measures used to determine muscle strength included knee extensor torque and ammonia and lactate levels. The study concluded that creatine supplementation increased muscle strength (Greenhaff et al, 1993). Cardiovascular Action One study focused on the effects of dietary creatine supplementation in patients with congestive heart failure. Muscle metabolism was measured using a cannula inserted into an antecubital vein. Maximum voluntary contraction was also measured. Researchers drew the participants’ blood at rest and at 2 minutes after exercise to compare measurements of lactate and ammonia buildup. Results indicated increased muscle contractions. Researchers concluded that creatine supplementation increased skeletal muscle endurance and lessened abnormal skeletal muscle metabolic response to exercise (Andrews et al, 1998). Neuroprotective Action Creatine supplementation increases partial neuroprotection against 3-NP–induced toxicity. The data suggest that creatine may play a role in the development of spinal cord neurons (Ducray et al, 2007). Another use may be in Parkinson’s disease. Creatine is a neuroprotective factor in developing nigral dopaminergic neurons (Andres, 2005). Product Availability Powder, tablets Dosages Different dosages are reported. • Adult PO normal dietary dose: 2 g/day To Enhance Athletic Performance • Adult PO: loading dose 20 g/day ⫻ 5 days, then 2 or more g/day Congestive Heart Failure • Adult PO: 20 g/day ⫻ 5-10 days (Jellin et al, 2008) Gyrate Atrophy • Adult PO: 1.5 g/day (Jellin et al, 2008) Muscular Dystrophy • Adult PO: 10 g/day Amyotrophic Lateral Sclerosis • Adult PO: 10 g per day ⫻ 12-16 mo (Jellin et al, 2008) Adverse effects: Underline = life-threatening C 216 Creatine McArdle Disease • Adult PO: 150 mg/kg daily ⫻ 5 days, then 60 mg/kg daily (Jellin et al, 2008) Muscular Dystrophy • Child PO: 5 g/day (Jellin et al, 2008) Contraindications Until more research is available, creatine supplements should not be used during pregnancy and breastfeeding. They should not be given to children. Creatine supplementation is not recommended for persons with renal or cardiac disease. Side Effects/Adverse Reactions GI: Nausea, anorexia, bloating, weight gain, diarrhea SYST: Dehydration, cramping (high doses) Interactions Drug Glucose: Increased glucose intake may increase the storage of creatine in muscle tissue. Nephrotoxics (aminoglycosides, NSAIDs, cyclosporine, and others): Use of these agents and creatine may lead to nephrotoxicity. Herb Caffeine, ephedra: Increased caffeine intake may decrease the effects of creatine. Food Carbohydrates: When creatine is combined with carbohydrates, creatine levels are increased significantly (Jellin et al, 2008). Lab Test Serum creatinine: Creatine may lead to increased creatinine levels. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Amino acid Arginine (precursors) Enhancement of exercise endurance Glycine (precursors) Client Considerations Assess • Assess for signs of abuse in athletes; creatine is used as a performance enhancer. • Assess for use of caffeine, ephedra, glucose, and nephrotoxics (see Interactions). Administer • Instruct the client to store creatine products in a sealed container in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use creatine supplements in children or those who are pregnant or breastfeeding until more research is available. • Advise the client not to use creatine to treat renal or cardiovascular disease. Research on the cardiovascular action of creatine is inconclusive. = Pregnancy = Pediatric ! = Alert = Popular Herb Cucumber 217 • Inform the client that creatine has been used to increase endurance during intense exercise sessions lasting less than 1 hour. • Caution the client that the effects of long-term creatine supplementation are unknown. C Cucumber (kyew-kuhm-bur) Scientific name: Cucumis sativus Other common names: Wild cucumber, cow cucumber Origin: Cucumber is a vegetable found in India. Uses In traditional herbal medicine, cucumber is used as a diuretic and to treat both hypertension and hypotension. It is used topically to soothe irritated skin. The cucumber seeds may possess anthelmintic properties. Wild cucumber is not the same as cucumber available in grocery stores. Actions Very little research has been done on wild cucumber. It has been used as a mild diuretic for many years (Duke, 2003). The diuretic action may be due to cucurbitin, a glycoside. However, all of the available information on its uses comes from traditional herbal medicine and is not based on scientific research. Many studies have been done from a botanical rather than a medicinal perspective. Product Availability Juice; seeds; shampoo, conditioner, and cosmetics with cucumber as a component Plant Parts Used: Fruit, seeds Dosages • Adult PO ground seeds: 1-2 oz prepared as a decoction steeped in water • Adult topical: apply prn Contraindications Until more research is available, cucumber should not be used during pregnancy and breastfeeding. It should not be given to children. Cucumber products should not be used by persons with hypersensitivity to this herb. Side Effects/Adverse Reactions GI: Heartburn, belching (fruits) META: Electrolyte/fluid imbalance Interactions Drug Diuretics: Cucumber may increase the diuretic effect of other diuretics; avoid concurrent use. Lab Test Potassium: Cucumber may decrease potassium levels. Adverse effects: Underline = life-threatening 218 Cucumber Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Fatty acid Glycoside Resin Cucurbitin Mild diuretic Client Considerations Assess • Determine how much cucumber the client is using. The seeds should not be used in amounts greater than the recommended dose. • Assess for the use of diuretics (see Interactions). Administer • Instruct the client to store cucumber products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use cucumber in children or those who are pregnant or breastfeeding until more research is available. = Pregnancy = Pediatric ! = Alert = Popular Herb Daffodil 219 Daffodil ! (da’fuh-dil) Scientific name: Narcissus pseudonarcissus Other common names: Daffydown-dilly, fleur de coucou, Lent lily, narcissus, porillon Origin: Daffodil is a flowering plant found in Europe and the United States. Uses Daffodil is taken internally as an emetic and as a treatment for respiratory conditions such as congestion. It is used topically to relieve joint inflammation and pain and to treat burns and wounds. Actions Anti-HIV Action Two studies evaluated the anti-HIV action of daffodil (Weiler et al, 1990; Balzarini et al, 1991). The Weiler study determined that the polysaccharide component, sulphoevernan, binds to the virus rather than to the host cell. Similarly, the Balzarini study showed that a lectin component, NPA, also binds to the virus rather than to the host cell. Anticancer Action One study (Wang et al, 2000) focused on the effects of the lectins on differing carbohydrate-binding when daffodil is used to treat human hepatoma, human choriocarcinoma, mouse melanoma, and rat osteosarcoma. The lectins may be toxic to these cancers. The results showed Narcissus pseudonarcissus to be only mildly cytotoxic. Product Availability Extract, powder Plant Parts Used: Bulb, flowers, leaves Dosages Different dosages are reported. Emetic • Adult PO extract: 3 grains Joint Pain, Inflammation, Wound Healing • Adult topical: Apply prn Respiratory Conditions • Adult PO powder: 20 grains-2 drams Contraindications ! Daffodil should not be used during pregnancy and breastfeeding. It should not be given to children. Persons who are hypersensitive to daffodil should not use it. Daffodil bulbs and flowers should not be consumed. Serious and even fatal reactions can occur from flower and bulb consumption. Side Effects/Adverse Reactions CNS: Paralysis, paresthesia, chills CV: Cardiovascular collapse (bulbs) EENT: Swelling of mouth, throat, tongue Continued Adverse effects: Underline = life-threatening D 220 Daffodil Side Effects/Adverse Reactions—cont’d GI: Nausea, vomiting, anorexia, salivation INTEG: Hypersensitivity reactions, contact dermatitis, daffodil itch RESP: Respiratory collapse (bulbs) Interactions Herb Mineral supplements (calcium, iron, zinc): Daffodil may decrease mineral absorption from mineral supplements (Jellin et al, 2008). Food Minerals in foods (calcium, iron, zinc): Daffodil may decrease mineral absorption from food (Jellin et al, 2008). Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Alkaloid Narcissine Lectin agglutinin (NPA) Masonin; Homolycorin; Hemanthamine; Galanthine; Galanthamine; Anticholinesterase, Analgesic; Pluviine; Lycorine Chelidonic acid Sulphoevernan Emetic Anti-HIV Acid Polysaccharide Anti-HIV Client Considerations Assess • Assess the reason the client is using daffodil. • Assess for hypersensitivity reactions, contact dermatitis, and daffodil itch. If these are present, discontinue the use of daffodil and administer an antihistamine or other appropriate therapy. ! • Assess for consumption of bulbs and flowers. Serious and even fatal reactions can occur. Administer • Instruct the client to avoid any use of daffodil products unless supervised by a qualified herbalist. Teach Client/Family • Caution the client not to use daffodil in children or those who are pregnant or breastfeeding until more research is available. • Strongly caution the client not to consume daffodil bulbs or flowers. Serious and ! even fatal reactions can occur. = Pregnancy = Pediatric ! = Alert = Popular Herb Daisy 221 Daisy (day’zee) Scientific name: Bellis perennis Other common names: Bairnwort, bruisewort, common daisy, day’s eye, pansy, wild daisy Origin: Daisy is a perennial found throughout the world. Uses Daisy is used as a pain reliever and to treat diarrhea, cough, and gastrointestinal spasms. It is also used to relieve arthritis joint pain and inflammation, and as a blood purifier and an antifungal. Actions Very little scientific research is available on daisy. Most of the research has focused on identifying its chemical components, which had not been studied previously. Antimicrobial Action One study revealed that the triterpenoid glycoside components of Bellis perennis L. are responsible for its antifungal activity. In this study these glycosides were effective against human pathogenic yeasts such as Candida and Cryptococcus spp. (Bader et al, 1990). Another study evaluated the essential oils of daisy for potential antimicrobial activity. Two of the oils exhibited activity against both gram-positive and gramnegative bacteria (Avato et al, 1997). Other Actions The volatile oil, thujone, may be responsible for increased salivation and blood flow and may be mind altering. Daisy may reduce postpartation bleeding as measured by Hgb at 72 hr after delivery (Oberbaum et al, 2005) and may decrease triglycerides (Morikawa, 2008). Product Availability None available commercially Plant Parts Used: Flowers, leaves Dosages • Adult PO infusion: 1 tsp dried flowers steeped 20 min in 1 cup boiling water, drink 2-4 cups bid-qid • Adult PO tincture: 3-4 ml taken bid-tid • Adult topical: apply a poultice of pressed leaves prn to affected area Contraindications Until more research is available, daisy should not be used during pregnancy and breastfeeding. It should not be given to children. Interactions Drug Alcohol: Daisy may increase the effect of alcohol (Jellin et al, 2008). Herb Thujone-containing herbs (cedar, oak moss, sage, tree moss, wormwood): Daisy, when used with these herbs, can lead to thujone toxicity (Jellin et al, 2008). Adverse effects: Underline = life-threatening D 222 Damiana Primary Chemical Components and Possible Actions Chemical Class Individual Component Saponin Tannin Organic acid Mucilage Essential oil Triterpenoid glycoside Flavonol Glycosides Volatile oil Polygalacteronic acid Perennisaponins A, B, C, D, E, F (Yoshikawa, 2008) Possible Action Astringent Isohamnetin; Kaemferol Thujone Antibacterial, antifungal Antifungal Salivation, blood flow, mind altering Client Considerations Assess • Determine why the client is using daisy and suggest other alternatives. Administer • Instruct the client to store daisy in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use daisy in children or those who are pregnant or breastfeeding until more research is available. Damiana (dah-mee’ah-nah) Scientific name: Turnera diffusa Other common names: Herba de la pastora, Mexican damiana, old woman’s broom, rosemary Origin: Damiana is a shrub found in the United States and in Central and South America. Uses Damiana is used as an aphrodisiac to increase sexual potency. It may irritate the urethra and increase sensitivity of the penis. Damiana may be used in combination with other herbs for sexual potency. This herb is also used as a diuretic, antidepressant, laxative, and antianxiety agent, and it is thought to produce euphoric effects when smoked. = Pregnancy = Pediatric ! = Alert = Popular Herb Damiana 223 Investigational Uses Damiana shows promise as an antidiabetic agent (Alarcon-Aguilar et al, 2002) and as a weight-loss agent. Actions Very little research is available for damiana. Two small studies have been done since 1998. One focused on the antihyperglycemic effects of damiana, testing 28 D different plant species to determine their antidiabetic effects. One herb that was found to be an effective antihyperglycemic was Turnera diffusa (Alarcon-Aguilar et al, 1998; Alarcon-Aguilar et al, 2002). Another study focused on the role of damiana in increasing the sexual behavior of male rats. This study seems to support the traditional use of Turnera diffusa as a sexual stimulant (Arletti et al, 1999). Aphrodisiac action may be due to an alkaloid present that acts like the male hormone testosterone. Product Availability Capsules, powder, tea, tincture Plant Part Used: Leaves Dosages • Adult PO decoction: 18 g powder/500 ml water tid • Adult PO tea: 1 cup tid (Murray, Pizzorno, 1998) • Adult PO liquid extract: 2-4 ml (Jellin et al, 2008) • Adult PO tincture: 2.5 ml tid • Adult PO dried leaf: 2-4 g tid (Jellin et al, 2008) Contraindications Pregnancy category is 3; breastfeeding category is 1A. Damiana should not be given to children. It should not be used by persons with hepatic disease, diabetes, or hypersensitivity to this herb. Side Effects/Adverse Reactions CNS: Hallucinations, confusion, headache, insomnia GI: Nausea, vomiting, anorexia, hepatotoxicity (high doses) GU: Urethral irritation INTEG: Hypersensitivity reactions Interactions Drug Antidiabetics: Damiana may decrease the action of antidiabetics. Lab Test ALT, AST, alkaline phosphatase: Damiana may increase these levels. Blood glucose: Damiana may decrease blood glucose levels. Adverse effects: Underline = life-threatening 224 Dandelion Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Phenolics Saccharides Terpenoids (Zhao et al, 2007) Volatile oil Cineol Choleretic; antibacterial Pinenes; Cymene Thymol Sesquiterpene Glycoside Resin Tannin Mucilage Gum Quinone Alkaloid Cyanogenic; Arbutin Wound healing Arbutin Antibacterial Testosterone-like action Client Considerations Assess • Assess the reason the client is using damiana. • Assess for hypersensitivity reactions. If present, discontinue use of damiana and administer an antihistamine or other appropriate therapy. ! • Assess for hepatotoxicity: increasing ALT, AST, and bilirubin levels; clay-colored stools; right upper-quadrant pain. If hepatotoxicity occurs, use of herb should be discontinued and appropriate action taken. Administer • Instruct the client to store damiana products in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 3 and breastfeeding category is 1A. • Caution the client not to give damiana to children. Dandelion (dan’duh-ly-uhn) Scientific names: Taraxacum officinale, Taraxacum laevigatum Other common names: Blowball, cankerwort, lion’s tooth, priest’s crown, puffball, swine snout, white endive, wild endive Origin: Dandelion is a weed found throughout the world. It is cultivated in parts of Europe. = Pregnancy = Pediatric ! = Alert = Popular Herb Dandelion 225 Uses Dandelion has been used as a laxative, an antihypertensive, a digestive aid, and a diuretic. It may also be used to remove toxins. Investigational Uses Dandelion is used experimentally as an antitumor agent and immunogenic and to treat chronic colitis. Dandelion has also been used to treat urolithiasis. However, D other pharmacologic treatments are just as effective (Grases et al, 1994). Actions Antitumor/Immunogenic Action One Chinese study evaluated immunomodulators used to restore suppressed immune functions in scald mice, including cell-mediated, humoral, and nonspecific immunity. The control group of scald mice all showed depressed immune function. Taraxacum officinale exhibited immunomodulating effects, with the effects directly related to the dose (Luo, 1993). Another study focused on nitric oxide production, which is an indicator of immune regulation and defense. T. officinale restored the ability of mouse peritoneal macrophages to inhibit nitric oxide production. The secretion of tumor necrosis factor-alpha is responsible for this effect (Kim et al, 1998). A new study (Sigstedt et al, 2008) used an extract of dandelion and showed a decreased growth of breast and prostate cancer and that dandelion may be of value as a novel anti-cancer agent. Anticolitic Action One study documents the efficacy of T. officinale when used in combination with other herbs for the treatment of chronic colitis. Twenty-four patients with chronic nonspecific colitis were given an herbal combination of T. officinale, Hypericum perforatum, Melissa officinalis, Calendula officinalis, and Foeniculum vulgare. After 15 days of treatment, defecation occurred only once daily, and diarrhea was normalized in patients with diarrhea syndrome (Chakurski et al, 1981). Other Actions One of the traditional uses of T. officinale has been to treat urolithiasis. In one study the herb improved citraturia, calciuria, phosphaturia, urine pH, and diuresis. Its urolithiatic action is believed to result from its saponin components (Grases et al, 1994). However, other products that work equally well are available to treat urolithiasis. Another study (Jeon, 2008) identified dandelion antiinflammatory (COX-2) action. Product Availability Capsule, fluid extract, fresh plant, juice, solid extract, tea, tincture Plant Parts Used: Flowers, leaves, roots Dosages • Adult PO decoction: 2-8 g dried root in 150 ml boiling water, let stand 15 min, tid • Adult PO fluid extract: 4-10 ml (1:1 in alcohol 25%) tid (Blumenthal, 1998) • Adult PO infusion: 4-10 g dried leaves in 8 oz water tid • Adult PO infusion: 2-8 g dried root in 8 oz water tid • Adult PO juice: 4-8 ml tid • Adult PO tincture: 5-10 ml (1:5 in alcohol 45%) tid • Adult PO whole herb: 4-10 g herb tid (Blumenthal, 1998) • Child PO root infusion: 1⁄4-1 cup/day several times/wk (Romm, 2000) • Child topical root tincture: 1⁄4-1 tsp bid (Romm, 2000) Adverse effects: Underline = life-threatening 226 Dandelion Contraindications Pregnancy category is 3; breastfeeding category is 2A. Dandelion should not be used by persons with hypersensitivity to this product or other Asteraceae spp. (chamomile, yarrow root) and should be used cautiously by persons with diabetes mellitus, fluid and electrolyte imbalances, hypertension, or congestive heart failure. Persons with irritable bowel syndrome, digestive diseases, bile duct obstruction, intestinal obstruction, or latex allergy should avoid the use of this herb. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, cholelithiasis, gallbladder inflammation INTEG: Hypersensitivity reactions, contact dermatitis Interactions Drug Antacids, H2-blockers, proton pump inhibitors: Dandelion may decrease the action of these drugs (Jellin et al, 2008). Anticoagulants, antiplatelets, NSAIDs, salicylates: Dandelion may increase bleeding when used with these products. Antihypertensives, insulin, antidiabetics: Dandelion may increase the effects of antihypertensives, insulin, antidiabetics; avoid concurrent use. Diuretics: Dandelion may increase diuresis when used concurrently with diuretics, leading to fluid loss and electrolyte imbalances; avoid concurrent use. Lithium: Toxicity may occur as a result of sodium excretion if dandelion is used concurrently with lithium. Herb Diuretic herbs (agrimony, artichoke, broom, buchu, burdock, celery, cornsilk, couchgrass, elder, juniper, pokeroot, shepherd’s purse, squill, uva ursi, yarrow): Dandelion may increase diuretic action of the other diuretic herbs (Jellin et al, 2008). Hypoglycemic herbs: Dandelion may increase hypoglycemia when used with hypoglycemic herbs (Jellin et al, 2008). Lab Test AST, ALT, alkaline phosphatase, APTT, INR, PT: Dandelion may increase these levels. Blood glucose: Dandelion may decrease blood glucose levels. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Acid Caffeic acid; Chlorogenic acid Linoleic acid Oleic acid Antitumor; analgesic Palmitic acid = Pregnancy = Pediatric ! = Alert Antiarteriosclerotic Antiinflammatory; antitumor Antifibrinolytic = Popular Herb Dandelion 227 Primary Chemical Components and Possible Actions—cont’d Chemical Class Coumarin Flavonoid Mineral Resin Taraxasterol Taraxerin Taraxerol Taraxalisin Terpenoid Vitamin Carotenoid Glycosides Sesquiterpene lactones Individual Component Linolenic; Chicoric; Monocaffeyltartaric; Taraxacin; Taraxacum Cichoriin; Aesculin Luteolin; Chrysoeriol Possible Action D Anticoagulant Antiinflammatory Increases digestion A; B; C; D Dihydroconiferin; Syringin; Dihydrosyringin; 11beta; 13-Dihydrolactucin; Ixerin D; Ainslioside Saponins Inulin Allergic reactions, diuretic Urolithiatic Hypoglycemic Client Considerations Assess • Assess the reason the client is using dandelion. • Assess for hypersensitivity reactions and contact dermatitis. If either of these is present, discontinue use of dandelion and administer an antihistamine or other appropriate therapy. Also, assess for hypersensitivity to other Asteraceae spp. • Identify the use of antihypertensives, diuretics, antidiabetics, insulin, and lithium. Use of dandelion should be avoided if the client is taking these medications (see Interactions). • Assess for fluid and electrolyte imbalances: check sodium chloride and potassium chloride levels. • Assess blood pressure if the client is combining dandelion with antihypertensives. • Assess blood glucose in the diabetic patient who is taking insulin or oral antidiabetes agents. Administer • Instruct the client to store dandelion products away from moisture and light. Teach Client/Family • Inform the client that pregnancy category is 3 and breastfeeding category is 2A. • Caution clients with children taking diabetic medications not to use dandelion until approved by prescriber. • Inform the client that dandelion may cause increased diuresis and that fluid and electrolyte imbalances may result. Adverse effects: Underline = life-threatening 228 Devil’s Claw Devil’s Claw (dev’uhlz claw) Scientific name: Harpagophytum procumbens Other common names: Grapple plant, wood spider Origin: Devil’s claw grows wild in southwest Africa. Uses Devil’s claw is used to increase the appetite and to treat joint pain and inflammation, arthritis, allergies, headache, heartburn, dysmenorrhea, gastrointestinal upset, malaria, gout, and nicotine poisoning. Actions Antiinflammatory Action Several studies have evaluated the antiinflammatory properties of devil’s claw in the treatment of joint conditions. The results are mixed. One Canadian study (Whitehouse et al, 1983) evaluated Harpagophytum procumbens for reduction of rat hindfoot edema. Devil’s claw was completely ineffective, even at doses greater than 100 times the recommended human dose. Another study produced similar results. No clinical significance was found when human subjects consumed devil’s claw (Moussard et al, 1992). Another study (Baghdikian et al, 1997) reported conflicting results on harpagoside, one of the chemical components of the herb, which showed analgesic and antiinflammatory properties. H. procumbens was found to produce analgesic and antiinflammatory effects (Chantre et al, 2000; Fiebich et al, 2001; Gobel et al, 2000). Another study determined that the iridoid glycosides are responsible for the analgesic, antiinflammatory, and antiphlogistic effects of devil’s claw (Wegener, 1999). Devil’s claw possesses analgesic, antiinflammatory, and hypoglycemic properties as suggested in folklore (Mahomed, 2004). Cardiovascular Action When rats and rabbits were studied to determine the cardiovascular effects of H. procumbens, a significant dose-dependent reduction occurred in arterial blood pressure, along with a reduction in heart rate at high doses. Harpagoside, one of the chemical components of the herb, exhibited less activity than did the extract of H. procumbens. The extract of H. procumbens produced a mild decrease in heart rate, with mild positive inotropic effects at low doses but a significant negative inotropic effect at higher doses. Harpagoside showed negative chronotropic and positive inotropic effects (Circosta et al, 1984). Another study demonstrated that devil’s claw exerts a protective action in hyperkinetic ventricular arrhythmias in rats (Costa De Pasquale et al, 1985). Other Actions Devil’s claw depresses the central nervous system and may be used as an anticoagulant as described in folklore (Mahomed, 2006). Product Availability Capsules, dried powdered root, dry solid extract, tea, tincture Plant Parts Used: Roots, tubers Dosages Anorexia • Adult PO infusion: 1.5 g herb tid (Blumenthal, 1998) = Pregnancy = Pediatric ! = Alert = Popular Herb Devil’s Claw 229 Gout • Adult PO dried powdered root: 1-2 g tid (Murray, Pizzorno, 1998) • Adult PO tincture: 4-5 ml (1:5 dilution) tid (Murray, Pizzorno, 1998) • Adult PO dry solid extract: 400 mg tid (Murray, Pizzorno, 1998) Osteoarthritis • Adult PO dried powdered root: 1-2 g tid (Murray, Pizzorno, 1998) • Adult PO tincture: 4-5 ml (1:5 dilution) tid (Murray, Pizzorno, 1998) • Adult PO dry solid extract: 400 mg tid (Murray, Pizzorno, 1998) D Other • Adult PO infusion: ⱕ4.5 g herb (Blumenthal, 1998) in 300 ml boiling water, let stand 8 hr, strain and drink Contraindications Pregnancy category is 3; breastfeeding category is 2A. Until more research is available, this herb should not be given to children. Persons with peptic or duodenal ulcer disease, cholecystitis, or hypersensitivity to this herb should avoid the use of devil’s claw. Side Effects/Adverse Reactions CNS: Headache CV: Hypotension EENT: Tinnitus GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions Interactions Drug Antacids, H2-blockers, proton pump inhibitors: Devil’s claw may decrease the action of these agents (Jellin et al, 2008). Antiarrhythmics, antihypertensives: Because two of the chemical components in devil’s claw exert inotropic and chronotropic effects, use this herb cautiously with antiarrhythmics and antihypertensives (theoretical). Antidiabetics: Devil’s claw may cause an additive effect with antidiabetics (Jellin et al, 2008). Warfarin: Devil’s claw taken with warfarin may cause risk of bleeding (Jellin et al, 2008). Lab Test APTT, PT: Devil’s claw may increase these levels. Primary Chemical Components and Possible Actions Chemical Class Individual Component Triterpene Resin Flavonoid Kaempferol; Luteolin Possible Action Continued Adverse effects: Underline = life-threatening 230 DHEA Primary Chemical Components and Possible Actions—cont’d Chemical Class Individual Component Possible Action Iridoid glycosides Harpagoside; Harpagide Negative chronotropic; positive inotropic, antiinflammatory Procumbide Stigmasterol Beta sitosterol Fatty acid Phenylethanols Acetoside, isoacetoside Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue use of devil’s claw and administer antihistamine or other appropriate therapy. • Assess cardiac status in any client with a cardiac condition: blood pressure, character of pulse. • Identify what prescription drugs and herbal supplements the client is taking to treat this condition (see Interactions). • Assess joint pain and inflammation in any client with an arthritic condition: pain location, duration, intensity, and alleviating and aggravating factors. Administer • Instruct the client to store devil’s claw products in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 3 and breastfeeding category is 2A. • Caution the client not to use devil’s claw in children until more research is available. DHEA Scientific name: Dehydroepiandrosterone Origin: DHEA is naturally occurring in yam (see Wild Yam, p. 596-597). Uses DHEA may be used to stimulate immunity and to treat atherosclerosis, hyperglycemia, and cancer. It is also used to prevent osteoporosis and to improve memory and cognitive functioning in Alzheimer’s disease. However, the use of DHEA for cognitive functioning has been withdrawn (Huppert et al, 2006). DHEA may be effective for adrenal insufficiency, erectile dysfunction, and schizophrenia. Investigational Uses Research is underway to determine the efficacy of DHEA used by postmenopausal women in place of traditional hormone replacement therapy. DHEA may also reduce symptoms of depression, aging, asthma, rheumatoid arthritis, and lupus erythematosus. = Pregnancy = Pediatric ! = Alert = Popular Herb DHEA 231 Actions Hormonal Action In the human body, DHEA is synthesized from a precursor steroid, pregnenolone, and then is converted into estrogens and testosterone in men and women (Baulieu et al, 1996). Reports confirm that levels of DHEA decline significantly after age 40. Some researchers suspect that this decline may be associated with insulin resistance, increased weight gain, and cardiovascular conditions (Sahelian, 1997). DHEA may D provide an alternative to hormone replacement therapy in women (Takayanagi et al, 2002). However, supplementation should not be started before the client undergoes a thorough evaluation for hormone-sensitive tumors. Cancer Stimulation/Cancer Inhibition Conflicting studies have reported increased tumor flare in patients with prostate cancer. However, initiation of antihormone therapy caused the flare to retreat (Jones et al, 1997). Cardiovascular Action One study evaluated levels of DHEA in patients with congestive heart failure. The results showed that levels of DHEA are lower in patients with congestive heart failure, in proportion to the severity of the disease (Moriyama et al, 2000). Immunoregulation Action One study (Cheng et al, 2000) evaluated the effect of DHEA and DHEA sulfate on interleukin-10 (IL-10) in laboratory mice. The results indicated that DHEA and DHEA sulfate increase IL-10, and DHEA may also affect the functioning of B-lymphocytes. Cognitive Function Action In one study, DHEA levels were found to be significantly lower in patients with Alzheimer’s disease and vascular dementia than in patients who did not have these diseases. Cortisol levels were found to be significantly higher. The usefulness of this information has not yet been determined (Bernardi et al, 2000). New information suggests that DHEA does nothing to stimulate cognitive functioning (Huppert et al, 2006). Product Availability Capsules, cream, tablets Dosages Rheumatoid Arthritis • Adult PO: 50-200 mg/day (Murray, Pizzorno, 1998) Supplementation • Adult PO men ⬎50 yr of age: 25-50 mg/day (Murray, Pizzorno, 1998) • Adult PO women ⬎50 yr of age: 15-25 mg/day (Murray, Pizzorno, 1998) • Adult PO men and women ⬎70 yr of age: 50-100 mg/day (Murray, Pizzorno, 1998) Vaginal • Adult PO topical: 10% cream applied daily (Jellin et al, 2008) Contraindications Until more research is available, DHEA should not be used during pregnancy and breastfeeding. It should not be given to children. Persons with estrogen-sensitive tumors (such as breast or uterine cancer), prostate cancer, or benign prostatic hypertrophy should not use this product. Continued Adverse effects: Underline = life-threatening 232 Dill Side Effects/Adverse Reactions CNS: Insomnia, restlessness, irritability, anxiety, increased mood, aggressiveness CV: Irregular heart rhythm (high doses) INTEG: Acne Interactions Drug Anastrozole, exemestane, fulvestrant, letrozole, tamoxifen: DHEA is a potent estrogen agonist; do not use DHEA with these agents (Jellin et al, 2008). Corticosteroids: DHEA levels are decreased by corticosteroids (Jellin et al, 2008). Cytochrome P450 3A4 substrates: DHEA may decrease the action of drugs metabolized by P450 3A4 enzyme (Jellin et al, 2008). Hormone replacement therapy: DHEA may interfere with estrogen and androgen therapy; avoid concurrent use (theoretical). Client Considerations Assess • Assess the reason the client is using DHEA. • Assess for changes in mood and inability to sleep. Watch for increasing aggressiveness, irritability, and restlessness. • Determine whether the client is currently using hormone replacement therapy; if so, use of DHEA should be avoided (see Interactions). • Assess for hormone-sensitive tumors; DHEA may stimulate the growth of these tumors. Administer • Instruct the client to store DHEA in a sealed container away from moisture and light. Teach Client/Family • Caution the client not to use DHEA in children or those who are pregnant or breastfeeding until more research is available. • Advise the client to lower the dosage of DHEA if acne develops. Dill (dil) Scientific name: Anethum graveolens Other common names: Dill seed, dillweed, garden dill, dilly Origin: Dill is found throughout the world. Uses In traditional herbal medicine, dill is used to relieve flatulence and infant colic. It is also reported to exert antispasmodic effects. = Pregnancy = Pediatric ! = Alert = Popular Herb Dill 233 Investigational Uses Research is underway to confirm the uses of dill as an antihyperlipidemic and antihypercholesterolemic (Yazdanparest et al, 2001; Kojuri et al, 2007). Actions Very little research is available for Anethum graveolens. Primary research has focused on determining the chemical components of this herb. Other information has D come from anecdotal reports and traditional uses. Antimicrobial Action One study evaluated the volatile oil of dill for antimicrobial activity. The volatile oil taken from mature plants exerted the highest antimicrobial effect. Unlike many other herbs, the geographic area in which the plant was grown did not change its antimicrobial effect. Dill inhibited the growth of both yeast and lactic acid bacteria (Shcherbanovsky et al, 1975; Stavri et al, 2005). Other Actions Rats were fed a diet high in cholesterol and fats. After feeding the rats a dill extract for 2 weeks, cholesterol was not reduced but triglycerides were reduced by 42% (Yazdanparast et al, 2001; Kojuri, 2007). Dill extracts were used on the female reproductive system, showing that dill can be used to regulate menstrual cycles in women with irregular periods (Monsefi et al, 2006). Product Availability Dried fruit, essential oil, water (concentrated and distilled) Plant Parts Used: Flowers, fruit, seeds Dosages • Adult PO dried fruit: 1-4 g tid • Adult PO essential oil: 0.05-2 ml tid, or 0.1-0.3 g daily (Blumenthal, 1998) • Adult PO seeds: 3 g daily (Blumenthal, 1998) • Adult PO water, concentrated: 0.2 ml tid • Adult PO water, distilled: 2-4 ml tid Contraindications Class 1 herb (fruit). Other than a food product, dill should not be used during pregnancy and breastfeeding. It should not be given to children except under the supervision of a qualified herbalist. Persons with a fluid or electrolyte imbalance and those with hypersensitivity to dill or other related spices should not use this herb. Side Effects/Adverse Reactions ENDO: May alter sodium balance INTEG: Hypersensitivity reactions; photodermatitis (fruit) Primary Chemical Components and Possible Actions Chemical Class Furancoumarin Flavonoid Individual Component Possible Action Quercetin; Kaempferol Glucuronide; Isohamnetin Antiinflammatory Continued Adverse effects: Underline = life-threatening 234 Dong Quai Primary Chemical Components and Possible Actions—cont’d Chemical Class Individual Component Possible Action Volatile oil Eugenol; Anethole Anethofuran; Carvone; Limonene Antioxidant Xanthone Triterpene Glucopyranosides Hydroxypipentone; hydroxygeraniol Beta-carotene Iron Potassium (Jellin et al, 2008) Client Considerations Assess • Assess the reason the client is using dill. • Assess for hypersensitivity reactions and photodermatitis. If these are present, discontinue use of dill and administer an antihistamine or other appropriate therapy. • Assess fluid and electrolytes in clients with known imbalances. Administer • Instruct the client to store dill products away from moisture and light. Teach Client/Family • Caution the client not to use dill in those who are pregnant or breastfeeding until more research is available. • Caution the client not to give dill to children unless under the supervision of a qualified herbalist. Dong Quai Scientific name: Angelica polymorpha var. sinensis Other common names: Chinese angelica, dang gui, dry-kuei, tanggwi, tang-kuei, toki, women’s ginseng Origin: Dong quai is a perennial found in Japan, China, and Korea. Uses Dong quai has been used extensively in many to treat the symptoms of menopause. It is also used to treat menstrual irregularities such as dysmenorrhea, premenstrual syndrome, and menorrhagia. Other uses include treatment for headache, neuralgia, herpes infections, and malaria. In traditional Chinese medicine, dong quai is used to treat vitiligo and anemia. Dong quai should not be confused with other Angelica spp. = Pregnancy = Pediatric ! = Alert = Popular Herb Dong Quai 235 Actions Dong quai has been used since the sixth century as a blood and liver tonic. In Chinese medicine, it has been used to treat hormonal irregularities and anemia. Hormonal Action Research on the hormonal actions of dong quai shows conflicting results. One study showed no statistical difference between dong quai and a placebo in reducing meno- D pausal symptoms (Hirata et al, 1997). During the 6-month study, participants took standardized capsules of 0.5 mg/kg of ferulic acid, one of the chemical components of dong quai, and were evaluated at 6, 12, and 24 weeks. Reported menopausal symptoms did not differ between the placebo group and the dong quai group. Researchers concluded that dong quai exerts no estrogenic effects and that it is not effective when used alone to treat menopausal symptoms. However, the herbal combination tokishakuyakusan, including peony, Angelica, alisma, and cnidium, increased progesterone secretion by means of its action in the corpora lutea (Usuki, 1991). Other Actions A study evaluating the effects of Angelica sinensis root on melanocyte proliferation showed no stimulation of melanocyte division. Instead, cell cytotoxicity resulted at higher doses (Raman et al, 1996). Other actions include decreased intraocular pressure, decreased blood pressure (Yoshihiro, 1985), decreased premature ventricular contractions (Zhuang, 1991), inhibition of platelet aggregation (Li et al, 1989), increased tumor necrosis factor (TNF) (Haranaka et al, 1985), and decreased atherosclerosis. Antiinflammatory and mild analgesic properties have also been reported. Product Availability Capsules, fluid extract, raw roots (powdered), tablets, tea, tincture; available in many combination products; not available as a standardized extract Plant Part Used: Roots Dosages Symptoms of Menopause and Premenstrual Syndrome • Adult PO fluid extract: 1 ml (1⁄4 tsp) tid (Murray, Pizzorno, 1998) • Adult PO powdered root: 1-2 g tid (Murray, Pizzorno, 1998) • Adult PO tea: 1-2 g tid (Murray, Pizzorno, 1998) • Adult PO tincture: 4 ml (1 tsp) (1:5 dilution) tid (Murray, Pizzorno, 1998) Other • Adult PO capsules/tablets: 500 mg ⱕ6 times/day (Foster, 1998) • Adult PO raw root: 1 g/day • Adult PO tea: 1 cup bid-tid (Foster, 1998) • Adult PO tincture: 5-20 drops (1:5 concentration) ⱕ tid (Foster, 1998) Contraindications Class 2b herb (root). Pregnancy category is 5; breastfeeding category is 2A. Until more research is available, dong quai should not be given to children. In Chinese medicine, dong quai has been used during pregnancy, but its use must be monitored by a qualified herbalist. This herb should not be used by persons who are hypersensitive to it, or by those with bleeding disorders, excessive menstrual flow, or acute illness. Continued Adverse effects: Underline = life-threatening 236 Dong Quai Side Effects/Adverse Reactions GI: Nausea, vomiting, diarrhea, anorexia GU: Increased menstrual flow INTEG: Hypersensitivity reactions, photosensitivity SYST: Fever, bleeding, cancer Interactions Drug Anticoagulants (anisindione, dicumarol, warfarin), antiplatelets, estrogens, hormonal contraceptives: Dong quai may increase the effects of anticoagulants, antiplatelets, estrogens, hormonal contraceptives. Herb Chamomile, dandelion, horse chestnut, red clover: Dong quai may potentiate anticoagulant activity. St. John’s wort: Dong quai may increase photosensitivity (theoretical). Lab Test APTT, prothrombin time (PT), international normalized ratio (INR): Dong quai may increase levels of APTT, PT, INR (Jellin et al, 2008). Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Volatile oil Safrole n-Butylphthalide; Ligustilide Carinene; Isosafrole; Carvacrol; Succinic acid; Nicotinic acid; Uracil B12 Osthole Psoralen; Bergapten; Imperatorin; Oxypeucedanin Angelicole; Demethylsuberosin Carcinogenic Relaxes bronchial smooth muscles Vitamin Coumarin Furocoumadin Ferulic acid Polysaccharide = Pregnancy = Pediatric ! = Alert Anticoagulant, antispasmodic, vasodilator Anticoagulant, antispasmodic, vasodilator Anticoagulant; decreased uterine movement Immunostimulation = Popular Herb Dong Quai 237 Client Considerations Assess • Assess the reason the client is using dong quai. • Assess for hypersensitivity reactions. If present, discontinue use of dong quai and administer an antihistamine or other appropriate therapy. • Determine whether the client is using anticoagulants; dong quai may increase D bleeding tendencies (see Interactions). Administer • Instruct the client to store dong quai products in a sealed container away from moisture and heat. Teach Client/Family • Inform the client that pregnancy category is 5 and breastfeeding category is 2A. • Caution the client not to use dong quai in children until more research is available. • Advise the client that photosensitivity may occur. Sunscreen or protective clothing should be worn in sunlight. Adverse effects: Underline = life-threatening 238 Echinacea Echinacea Scientific names: Echinacea angustifolia, Echinacea pallida, Echinacea purpurea Other common names: American cone flower, black sampson, black susans, cock-up-hat, comb flower, coneflower, hedgehog, Indian head, Kansas snakeroot, Missouri snakeroot, purple coneflower, red sunflower, rudbeckia, sampson root, scurvy root, snakeroot Origin: Echinacea is a perennial found in only three states: Missouri, Nebraska, and Kansas. It is cultivated in much of the world. Echinacea is a Native American remedy. Uses Echinacea is used internally, primarily as an immune stimulant and for immune support and as prophylaxis for colds, influenza, and other viral, fungal, and bacterial infections. It may be used topically to promote wound healing and to treat wounds, bruises, burns, scratches, and leg ulcers. Echinacea is more effective when taken at the onset or first signs of an illness, not after the illness is well-established. Investigational Uses Researchers are experimenting with the use of echinacea to stimulate the immune system of HIV/AIDS patients. It may also be used as a prophylaxis for colds or urinary tract infections. Actions Echinacea has been studied extensively and found to be effective in both the prevention and treatment of acute colds and upper respiratory tract infections. Native Americans have used this herb to treat various illnesses. For the past several years echinacea has been among a group of herbs accepted by practitioners of mainstream medicine. Immunostimulant Action Echinacea stimulates the nonspecific immune response via phagocytosis, which plays a major role in the immune response. It also stimulates T-lymphocytes (Wagner et al, 1981). One study has demonstrated that echinacea significantly increases the phagocytosis of red blood cells (Vomel, 1984). Another study showed that 4 weeks of treatment with echinacea pressed juice enhanced interleukin-6 (IL-6) production in response to strenuous exercise. This study suggests that prophylactic treatment with echinacea counteracts the immunosuppressive effects of strenuous exercise (Berg et al, 1998). Antiinfective Action Echinacea has been shown to inhibit streptococcal growth and tissue hyaluronidase and to stabilize hyaluronic acid (Busing, 1955). Hyaluronidase is found in pathogenic organisms. In recent years there has been a lot of controversy about echinacea’s use in the common cold. Preparations vary widely and this could account for the differences in studies (Barrett et al, 2006). There is little information regarding echinacea’s interactions or use by persons with autoimmune disease (Barnes et al, 2005). Product Availability Capsules, fluid extract, juice, solid (dry powdered) extract, sublingual tablets, tablets, tea, tincture = Pregnancy = Pediatric ! = Alert = Popular Herb Echinacea 239 NOTE: Some extracts may be standardized to 4% to 5% echinacoside; others are standardized to phenolics. Plant Parts Used: Rhizome, roots; depending on developmental stage of growth: flowers, juice from the stem, leaves, whole plant Dosages • Adult parenteral: Dose individualized to age of client and condition (NOTE: parenteral route not used in the United States; herb used parenterally in Germany) • Adult PO capsules: 500 mg-1 g tid (McCaleb et al, 2000) • Adult PO dried root: 0.5-1 g tid; can use as tea (Murray, Pizzorno, 1998) • Adult PO fluid extract: 1-2 ml tid (1:1 dilution) mixed in a little water (Bradley, 1992); 2-4 ml tid (Murray, Pizzorno, 1998) • Adult PO freeze dried plant: 325-650 mg tid (Murray, Pizzorno, 1998) • Adult PO pressed juice: 6-9 ml daily in divided doses (25:1 dilution in 22% alcohol) (McCaleb et al, 2000) • Adult PO solid (dry powdered) extract: 150-300 mg tid (6.5:1 dilution or 3.5% echinacoside) (Murray, Pizzorno, 1998) • Adult PO tea: 2 tsp (4 g) powdered herb simmered 15 min in hot water. • Adult PO tincture: 15-30 drops bid-qid or 30-60 drops bid (McCaleb et al, 2000); 2-4 ml tid (1:5 dilution) (Murray, Pizzorno, 1998); other references suggest q1-2hr when person is ill. Acute Infections • Child PO root tincture: 1⁄2-1 tsp up to q2hr (Romm, 2000) Skin Infections • Child topical tincture: 1 tbsp root/1⁄4 cup water, use as topical rinse (Romm, 2000) To Prevent Colds and Infections • Child PO root tincture: 1⁄2 tsp bid (Romm, 2000) Contraindications Pregnancy category is 1; breastfeeding category is 2A. Echinacea should not be given to children younger than 2 years of age. It should not be used by persons who have autoimmune diseases such as lupus erythematosus, multiple sclerosis, HIV/AIDS, or collagen disease or by those with tuberculosis or hypersensitivity to Bellis sp. or composite family herbs. Immunosuppression may occur after extended therapy with this herb; do not use for longer than 8 weeks without a 3-week rest period. Side Effects/Adverse Reactions GI: Hepatotoxicity (Chernecky, Berger, 2008) INTEG: Hypersensitivity reactions RESP: Acute asthma attack SYST: Anaphylaxis, angioedema Interactions Drug Cytochrome P4503A4 substrates: Echinacea may inhibit cytochrome P4503A4 enzymes (Jellin et al, 2008). Continued Adverse effects: Underline = life-threatening E 240 Echinacea Interactions—cont’d Econazole vaginal cream: The action of this cream may be decreased by echinacea; avoid concurrent use. Immunomodulators (azathioprine, basiliximab, cyclosporine, daclizumab, muromonab, mycophenolate, tacrolimus, protease inhibitors, corticosteroids): Echinacea may decrease the effects of immunosuppressants, protease inhibitors, corticosteroids and should not be used immediately before, during, or after transplant surgery. Lab Test ALT, AST, lymphocyte counts (Echinacea purpurea), serum immunoglobulin E (IgE), blood erythrocyte sedimentation rate (ESR): Echinacea may increase these tests. Sperm enzyme activity: High doses of echinacea interfere with sperm enzyme activity. Pharmacology Pharmacokinetics Immunosuppression is thought to occur after extended therapy with echinacea. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Phenylpropenoid Echinacoside glycosides Caffaric acid Chicoric acid; Aynarine Tartaric acid Antimicrobial Antioxidant Alkylamide Alkaloid Polysaccharide Essential oil Glycoproteins Flavonoid Echinacin Tussilagine; Isotussilagine; Tetraen acid; Isobutylamide Inulin Inhibits arachidonic metabolism Antiinflammatory; antiviral; immune stimulation Heteroxylin; Arabinorhamnogalactans; Fructose Palmitic; Linolenic Rutin Antioxidant Increases lymphocyte counts Client Considerations Assess • Assess for hypersensitivity reactions to this herb, members of the daisy family (genus Bellis) or composite family herbs. If hypersensitivity is present, discontinue the use of this herb and administer an antihistamine or other appropriate therapy. = Pregnancy = Pediatric ! = Alert = Popular Herb Elderberry 241 • Assess for use of econazole vaginal cream, immunomodulators, cytochrome P4503A4 substrates, protease inhibitors, and corticosteroids (see Interactions). Administer • Instruct the client to store echinacea products in sealed container away from heat and moisture. • Instruct the client not to use this herb for longer than 8 weeks without a 3-week rest period. E Teach Client/Family • Inform the client that pregnancy category is 1 and breastfeeding category is 2A. • Caution the client not to give echinacea to children younger than 2 years of age. • Caution the client to be careful not to confuse this herb with other Echinacea spp. that have different uses. Elderberry ! (el’duhr-beh-ree) Scientific names: Sambucus nigra, Sambucus canadensis Other common names: Black elder, boretree, bountry, common elder, ellhorn, European elder, sweet elder Origin: Elderberry is a shrub found in the United States and Europe. Uses Elderberry is used as a gargle for rhinitis, colds, flu in combination with sage, honey, and vinegar. It is also used as a treatment for diaphoresis, toothache, headache, sinusitis, hay fever, wounds, skin disorders, hepatic conditions, and inflammation. Investigational Uses Elderberry may be used orally for influenza. It is being studied as an antidiabetes agent. Actions Initial research on elderberry has identified antioxidant, insulin-like, and diuretic actions for this herb. However, multiple studies to confirm these actions are not yet available. Antioxidant Action One study provides information on the antioxidant properties of elderberry, which result from the anthocyanins present in elderberry flavonoids. These anthocyanins are responsible for scavenging in the bloodstream and the colon. Other chemical components, aglycons and glycosides, also provide antioxidant protection (PoolZobel et al, 1999). Insulin-Like Action Because elderberry has been used as a traditional treatment for diabetes mellitus, the insulin-like action of this herb has been studied. In one study, the insulin-releasing and insulin-like activity of Sambucus nigra produced a cumulative effect (Gray et al, 2000). Diuretic Action One study identified the diuretic activity of elderberry in rats. Rats treated with the herb experienced increased urine flow and sodium excretion (Beaux et al, 1999). Adverse effects: Underline = life-threatening 242 Elderberry Other Actions Elderberry may be useful as an antiviral. One study (Uncini et al, 2005) used elderberry to treat HIV with positive results. Product Availability Oil, ointment, syrup, tea, tincture, wine Plant Parts Used: Flowers, fruit Dosages ! • Adult PO: use only cooked berries; bark and leaves are poisonous • Adult topical: apply ointment to affected area prn • Child PO syrup: 1-2 tsp up to tid (Romm, 2000) • Child PO tea: 1⁄2-1 cup up to qid; serve hot (Romm, 2000) • Child PO tincture: 1⁄2-1 tsp up to qid (Romm, 2000) Contraindications ! Class 1 herb (ripe fruit/flowers). Until more research is available, elderberry should not be used during pregnancy and breastfeeding. Elderberry should not be used by persons with hypersensitivity to this plant or similar plants. Elderberry bark and leaves are toxic; use only the parts of the plant that are recommended. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, diarrhea INTEG: Hypersensitivity reactions SYST: Cyanide toxicity (bark, leaves, unripe berries) Interactions Drug Iron salts: Elderberry tea may prevent absorption of iron salts; do not give concomitantly; space by at least 2 hours. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Flavonoids Rutin Quercitrin Hyperoside; Isoquercitrin; Astragalin; Nicotoflorin Sambunigrine Palmitic acid, Alkanes, Triterpenes, Ursolic acid, Oleanic acid, Betulina, Betalic acid Antioxidant Antiinflammatory Glycoside Volatile oil Tannin Mucilage Anthocyanin Vitamin C Caffeic acid Cyanogenins Lignans = Pregnancy Hepatoprotectant Antioxidant Chlorogenic = Pediatric ! = Alert = Popular Herb Elecampane 243 Client Considerations Assess • Assess the reason the client is using elderberry. • Assess for hypersensitivity reactions. If present, discontinue the use of this herb and administer an antihistamine or other appropriate therapy. ! • Assess for consumption of bark and leaves, which are toxic. Administer • Instruct the client to store elderberry products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use elderberry during pregnancy or breastfeeding until more research is available. • Caution the client to be careful not to confuse elderberry with other Sambucus spp., some of which are poisonous. • Caution the client to use only the parts of elderberry recommended for use. Other parts are toxic. • Teach client that children should not play with the shafts of the plant; cyanide ! poisoning can occur. Elecampane (eh-li-cam-payn’) Scientific name: Inula helenium Other common names: Aunee, elfdock, elfwort, horseheal, horse-elder, scabwort, velvet dock, wild sunflower Origin: Elecampane is native to Asia and Europe. It has been naturalized to North America. Uses Elecampane has been used as an antimicrobial, primarily against Mycobacterium tuberculosis, and as a relaxant for smooth muscles in the trachea and ileus. In traditional herbal medicine, elecampane has been used for its expectorant, antiseptic, and diuretic effects. It is also used to treat cough, whooping cough, the common cold, bronchitis, bronchiectasis, and asthma, and may be used as an anthelmintic. Elecampane is a bitter herb that is used to stimulate digestion and the appetite. Investigational Uses Research is underway to confirm the blood glucose and blood pressure lowering uses of elecampane. Actions Very little controlled research is available for elecampane. Antimycobacterial Action The root extracts of elecampane have been studied for their antimycobacterial effects. Chromatographic fractions of the root showed significant activity against Mycobacterium tuberculosis, resulting from the volatile oils alantolactone and isoalantolactone (Cantrell et al, 1999). Adverse effects: Underline = life-threatening E 244 Elecampane Muscle Relaxant Action One study using guinea pigs demonstrated that elecampane relaxes tracheal and ileal smooth muscles. Researchers studied the effects of volatile oils isolated from 22 different plant species and compared them with the effects of catecholamines and phosphodiesterase inhibitors. One of the most potent volatile oils studied was that from elecampane root extract (Reiter et al, 1985). Anthelmintic Action When rabbits infected with worms were given boiled extracts of Inula helenium, the result was necrosis, dilatation, and atrophy of the worms (Rhee et al, 1985). These results indicate that elecampane shows promise as an anthelmintic. Other Actions The sesquiterpenes (alantolactone, isoalantolactone, epoxyalantolactone) show evidence of being chemoprotective (Lim et al, 2007; Dorn et al, 2006). Further studies are necessary, however. Product Availability Fluid extract, powder Plant Parts Used: Rhizome (dried and fresh), roots Dosages Expectorant • Adult PO infusion: pour boiling water over 1 g ground herb (1 tsp ⫽ 4 g), let stand 15 min, strain, drink 1 cup tid Other • Adult PO dried root: 3 g tid • Adult PO extract: 3 g dried root/10 ml water/20 ml alcohol tid • Adult PO fresh root: 2 tbsp tid Contraindications Pregnancy category is 3; breastfeeding category is 4A. Elecampane should not be given to children younger than 12 years of age. This herb should not be used by persons with hypersensitivity to this or similar herbs. Side Effects/Adverse Reactions CNS: Paralysis (large doses) EENT: Irritation of mucous membranes GI: Nausea, vomiting, diarrhea, gastrointestinal spasms, anorexia (large amounts) INTEG: Hypersensitivity reactions, severe contact dermatitis Interactions Drug Antidiabetics: Elecampane may decrease blood glucose; avoid concurrent use (theoretical). CNS depressants: Elecampane may increase the action of CNS depressants. Herb Sedative herbs: Elecampane may increase the action of herbs with sedative properties. = Pregnancy = Pediatric ! = Alert = Popular Herb Ephedra 245 Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Volatile oil Alantolactone; Epoxyalantolactone Isoalantolactone; Dihydroisoalantolactone; Dihydroalantolactone Antimycobacterial; expectorant, antifungal, diuretic, hypotensive, chemoprotective Polyyne Lactone Polysaccharides Alantol; Alantic acid Inulin Client Considerations Assess • Assess for hypersensitivity reactions, including contact dermatitis. If such reactions are present, discontinue use of elecampane and administer an antihistamine or other appropriate therapy. ! • Monitor for reactions indicating large dosages (nausea, vomiting, anorexia, paralysis). • Assess for client use of antidiabetics; elecampane may increase the action of antidiabetic agents. Administer • Instruct the client to store elecampane products in a glass container away from moisture and heat. This herb should not be stored in plastic. • In case of overdose, perform gastric lavage or administer activated charcoal. Overdose also may be treated with triflupromazine. Teach Client/Family • Inform the client that pregnancy category is 3 and breastfeeding category is 4A. • Caution the client not to give elecampane to children younger than 12 years of age. Ephedra ! (i-feh’drah) Scientific names: Ephedra sinica, Ephedra nevadensis, Ephedra trifurca, Ephedra equisetina, Ephedra distachya Other common names: Brigham tea, cao ma huang, desert tea, epitonin, herba ephedrae, herbal ecstasy, joint fir, ma huang, mahuuanggen, Mexican tea, Mormon tea, muzei mu huang, natural ecstacy, popotillo, sea grape, squaw tea, teamster’s tea, yellow astringent, yellow horse, zhong ma huang Origin: Ephedra is an evergreen found throughout the world. Adverse effects: Underline = life-threatening E 246 Ephedra Uses Ephedra contains ephedrine, a central nervous system stimulant with amphetaminelike properties. It has been used in Chinese medicine to treat asthma, bronchitis, headache, pulmonary congestion, and joint pain and inflammation. More recently, it has been used for its stimulant effect and to promote weight loss. Actions Much research has been done on ephedrine, which is a prescription medication and a component of ephedra. Ephedrine acts primarily on beta-receptors in the heart and on alpha-receptors, causing vasoconstriction in blood vessels. It also exerts amphetamine-like effects, causing bronchodilation, decreased gastrointestinal motility, increased mydriasis, and central nervous system stimulation. Product Availability Capsules, extract, tablets, tea, tincture; available as a component of many combination products Plant Parts Used: Leaves, seeds Dosages Dosages vary with the species of ephedra. Only E. trifurca and E. nevadensis are available as tea. Standardized products usually contain ephedrine and pseudoephedrine 6%. • Adult PO capsules/tablets (crude herb): 500-1000 mg bid-tid (Foster, 1998) • Adult PO extract: 12-25 mg total alkaloids, standardized to ephedrine, bid-tid (Foster, 1998) • Adult PO tea: use 1.5-9 g herb in 1 pt boiling water, let stand 15 min, drink in divided doses up to tid • Adult PO tincture: 15-30 drops bid-tid (Foster, 1998) Contraindications Pregnancy category is 4; breastfeeding category is 4A. Ephedra should not be given to children younger than 12 years of age. It should not be used by persons with hypersensitivity to sympathomimetics, angle-closure glaucoma, seizure disorders, hyperthyroidism, diabetes mellitus, prostatic hypertrophy, arrhythmias, heart block, hypertension, psychosis, tachycardia, or angina pectoris. Ephedra has been taken off the market, but a reversal of this decision is being considered. Side Effects/Adverse Reactions NOTE: Side effects and adverse reactions are similar to those of ephedrine. CNS: Anxiety, nervousness, insomnia, hallucinations, headache, dizziness, poor concentration, tremors, confusion, seizures, psychosis (Tormey et al, 2001) CV: Palpitations, tachycardia, hypertension, chest pain, arrhythmias, stroke, myocardial infarction, cardiac arrest GI: Nausea, vomiting, anorexia, constipation or diarrhea, hepatotoxicity GU: Dysuria, urinary retention INTEG: Hypersensitivity reactions, exfoliative dermatitis Reproductive: Uterine contractions RESP: Dyspnea = Pregnancy = Pediatric ! = Alert = Popular Herb Ephedra 247 Interactions Drug Anesthetics, halothane: Ephedra causes increased arrhythmias when used with halothane anesthetics; do not use concurrently. Antidiabetics: Ephedra may cause an increase in blood glucose level; monitor carefully. Beta-blockers: Ephedra causes increased hypertension when used with beta-blockers; avoid concurrent use. Cardiac glycosides: Ephedra may change heart rhythm; avoid using concurrently. CNS stimulants: Ephedra will cause increased CNS stimulation when used with CNS stimulants. Guanethidine: Ephedra may decrease the effect of guanethidine; monitor concurrent use carefully. MAOIs, tricyclics: Hypertensive crisis occurs when ephedra is used with MAOIs, tricyclics; do not use concurrently. Oxytocics: Ephedra causes severe hypertension when used with oxytocics; do not use concurrently. Phenothiazines: Tachycardia may result if ephedra is used with phenothiazines; do not use concurrently. Sympathomimetics, other: Ephedra increases the effect of sympathomimetics and also causes hypertension; do not use concurrently. Urinary alkalizers: Ephedra increases the effect of urinary alkalizers; monitor concurrent use carefully. Xanthines (caffeine, theophylline): Ephedra causes increased central nervous system stimulation; avoid concurrent use with xanthines. Herb Bitter orange, coffee, ginseng, green tea, guarana, Indian sida, kola nut, malvaceae, Siberian ginseng, soapwort, yerba maté: Concurrent use with ephedra may increase hypertension and central nervous system stimulation. Food Caffeinated coffee, cola, “Red Bull,’’ tea: The stimulating effect of ephedra may increase with the use of these drinks. Lab Test AST, ALT, total bilirubin, urine bilirubin: Ephedra may increase these tests. Pharmacology Pharmacokinetics Pharmacokinetics and pharmacodynamics for ephedrine are as follows: onset 15 to 60 minutes, duration 2 to 4 hours; metabolized in the liver, excreted unchanged in the urine and breast milk; crosses the blood-brain barrier and the placenta. Adverse effects: Underline = life-threatening E 248 Ephedra Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Alkaloid Ephedrine Central nervous system stimulant; bronchodilator; increased myocardial contractility Methylephedrine; Norephedrine; Ephedrine; Ephedroxane; Pseudoephedroxane Tannin Volatile oil Flavonoid Inulin Catechin Gallic acid Client Considerations Assess • Assess the reason the client is using ephedra. • Assess for hypersensitivity reactions and exfoliative dermatitis. If these are present, discontinue the use of ephedra and administer an antihistamine or other appropriate therapy. • Assess for increased cardiovascular side effects (hypertension, palpitations, arrhythmias, chest pain). If these are present, discontinue the use of ephedra immediately. • Assess for symptoms of increased central nervous system stimulation (poor concentration, insomnia, anxiety, nervousness, seizures, tremors, hallucinations). If these are present, discontinue the use of ephedra. ! • Assess all medications and supplements the client is taking; many serious interactions can occur (see Interactions). Administer • Instruct the client not to take PO dosages exceeding 24 mg/day and not to take ephedra for longer than 1 week. • Instruct the client to store ephedra products in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 4 and breastfeeding category is 4A. • Caution the client not to give ephedra to children younger than 12 years of age. • Caution any client with hypersensitivity to sympathomimetics, angle-closure glaucoma, seizure disorders, hyperthyroidism, diabetes mellitus, prostatic hypertrophy, arrhythmias, heart block, hypertension, psychosis, tachycardia, or angina pectoris not to use this herb. = Pregnancy = Pediatric ! = Alert = Popular Herb Eucalyptus 249 ! • Caution the client that ephedra has been responsible for many deaths from seizure, stroke, myocardial infarction, and cardiac arrest. ! • Advise the client to review all other medications and supplements taken for interactions; some interactions can be life threatening. Eucalyptus ! (yew-kuh-lip’tuhs) Scientific name: Eucalyptus globulus Other common names: Blue gum, fever tree, gum, red gum, stringy bark tree, Tasmanian blue gum Origin: Eucalyptus is now cultivated throughout the world. It is native to Australia. Uses Eucalyptus is used to treat nasal/pulmonary congestion and appears frequently as a component in combination products used for sinusitis and pharyngitis. It is also used as an antispasmodic to treat irritable bowel syndrome; as a treatment for gallstones, kidney stones, and cystitis; as a central nervous system stimulant; and as an aromatherapeutic agent. Eucalyptus can be used topically as an antiseptic for wounds. Investigational Uses Studies are underway to determine the efficacy of eucalyptus in the treatment of infections caused by bacteria or fungi, inflammation, and diabetes mellitus. Actions Antimicrobial Action Cineole, a chemical component of eucalyptus, has been shown to exert significant antimicrobial effects. One study has shown that this substance is highly effective against both gram-positive and gram-negative bacteria, as well as some fungi (Saeed et al, 1995). Another study with similar findings investigated 21 different species of eucalyptus (Hajji et al, 1993). Of these, Eucalyptus citriodora was the most effective species, with the widest array of antimicrobial effects. Gundidza et al (1993) determined that the essential oil of E. globulus maidenii was active against the fungi Candida albicans, Penicillium citrinum, and Aspergillus flavus, as well as the bacteria Klebsiella pneumoniae, Citrobacter freundii, Serratia marcescens, Clostridium sporogenes, and Bacillus subtilis (Moleyar et al, 1992). Another study demonstrated that cineole acts against Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus faecalis, and Bacillus subtilis (Carson et al, 1995). Decongestant Action Because of its ability to improve respiratory function significantly, one of the most common uses of eucalyptus is as an inhalant. It eases breathing by opening the nasal passages and sinuses (Cohen et al, 1982). Vicks Vaporub, a combination of eucalyptus, camphor, and menthol, significantly reduces restlessness in children with upper respiratory infections. It is postulated that the ingredients in Vicks Vaporub decrease the surface tension between water and air in the pulmonary system, increasing the surfactant of the lung. Adverse effects: Underline = life-threatening E 250 Eucalyptus Other Actions Other studies have shown that cineole increases locomotor activity in laboratory animals, acts as a spasmogenic in the duodenum of rats, and decreases drowsiness. Product Availability Aqueous-alcoholic preparation, essential oil, fluid extract, lotion, semisolid preparation; eucalyptus is a component of various cosmetics and over-the-counter products used to treat sinusitis and pharyngitis. Plant Parts Used: Branch tips, leaves Dosages NOTE: Dilute internal dosages before use. • Adult PO eucalyptol: 0.05-0.2 ml • Adult PO eucalyptus oil: 0.05-2 ml or 0.3-0.6 g daily • Adult PO fluid extract: 3 g • Adult topical aqueous-alcoholic preparation: 5%-10% prn (Blumenthal, 1998) • Adult topical essential oil: several drops rubbed into skin prn (Blumenthal, 1998) • Adult topical oil or semisolid preparations: 5%-20% prn (Blumenthal, 1998) Contraindications ! Class 2d herb (leaf). Until more research is available, eucalyptus should not be used during pregnancy and breastfeeding. It should not be given to children younger than 2 years of age. Eucalyptus should not be used near mucous membranes or on the face. Persons with hypersensitivity to eucalyptus and those with kidney, gastrointestinal, or severe hepatic disease should not use this herb. As little as 3.5 ml of eucalyptus oil taken internally can be fatal. Side Effects/Adverse Reactions CNS: Confusion, delirium, dizziness, seizures GI: Burning stomach, nausea, vomiting, anorexia INTEG: Hypersensitivity reactions RESP: Bronchospasm Interactions Drug Amphetamines, barbiturates: Eucalyptus may decrease the effectiveness of amphetamines, barbiturates; avoid concurrent use. Antidiabetics, insulin: Eucalyptus may alter the effectiveness of antidiabetics, insulin; do not use concurrently. Herb Basil, glucomannan, Queen Anne’s lace: These herbs may decrease blood glucose when used with eucalyptus (PO). Lab Test Blood glucose: Eucalyptus (PO) may decrease blood glucose levels. = Pregnancy = Pediatric ! = Alert = Popular Herb Eucalyptus 251 Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Volatile oil Eucalyptol Cineole Decongestant Decreased renal and biliary colic; antimicrobial Flavonoid Alpha-pinene; Aromadendrene; Globulol; Trans-pinocarveol; Limonene; Eucalyptus Quercetin Rutin Hyperoside Tannin Fatty acids Fatty alcohol Aromatic compounds Antiinflammatory Antioxidant Wound healing Client Considerations Assess • Assess the reason the client is using eucalyptus. • Assess for hypersensitivity reactions. If present, discontinue use of eucalyptus and administer an antihistamine or other appropriate therapy. • Assess for central nervous system reactions if the client is taking this herb internally. • Assess for the use of amphetamines, barbiturates, insulin, and antidiabetics (see Interactions). Administer • Instruct the client to store eucalyptus products in a cool, dry place, away from heat and moisture. • Instruct the client to dilute all products used internally before use. Teach Client/Family • Caution the client not to use eucalyptus in children who are younger than 2 years of age or those who are pregnant or breastfeeding until more research is available. • Inform the client that eucalyptus may be used topically on children in combination with menthol and camphor. • Alert the client that poisoning of children has occurred with only a few drops of ! eucalyptus. • Caution clients with hypersensitivity to eucalyptus and those with renal, gastrointestinal, or severe hepatic disease not to use this herb. • Use extreme caution if taking internally. Adverse effects: Underline = life-threatening E 252 Evening Primrose Oil Evening Primrose Oil (eev’ning prim’roes) Scientific names: Oenothera biennis, Primula elatior Other common names: Buckles, butter rose, cowslip, English cowslip, fairy caps, key flower, key of heaven, king’s-cure-all, mayflower, our lady’s key, palsywort, peagles, petty mulleins, plumrocks password Origin: Evening primrose is found in North America. Uses Evening primrose oil is used to treat cardiovascular disease, PMS, mastalgia, rheumatoid arthritis, multiple sclerosis, eczema, breast disorders, cough, bronchitis, irritable bowel syndrome, and other digestive disorders. Actions Evening primrose oil has been used successfully to treat cardiovascular disease, breast disorders, premenstrual syndrome, mastalgia, rheumatoid arthritis, multiple sclerosis, atopic dermatitis, and other skin disorders. GLA has shown effectiveness in reversing neurologic damage caused by multiple sclerosis. It has been shown to decrease cardiovascular disease and obesity. Because the body does not manufacture the essential fatty acids in evening primrose oil, they must be obtained from the diet. A lack of GLA prevents the nerve cell membrane from functioning properly. GLA is needed for conduction of electrical impulses. New information suggests that evening primrose oil is ineffective for menopausal symptoms (Low, Dog, 2005). Product Availability Capsules Plant Part Used: Seeds Dosages Eczema • Adult PO capsules: 6 capsules/day (240 GLA) Mastalgia • Adult PO capsules: 6 capsules/day (240 GLA) Diabetic Neuropathy • Adult PO capsules: 8-12 capsules/day (320-480 mg GLA) Premenstrual syndrome • Adult PO capsules: 6 capsules/day (240 GLA) Eczema • Child PO capsules, ages 1-12: 160 mg-4 g daily (standardized to GLA 8%) Contraindications Pregnancy category is 2; breastfeeding category is 2A. Evening primrose oil should not be used by persons with hypersensitivity to it or those with seizure disorders. Side Effects/Adverse Reactions CNS: Headache, temporal lobe seizures in schizophrenia GI: Nausea, vomiting, anorexia, diarrhea, flatulence = Pregnancy = Pediatric ! = Alert = Popular Herb Evening Primrose Oil 253 Side Effects/Adverse Reactions—cont’d INTEG: Hypersensitivity reactions, rash MISC: Inflammation, immunosuppression (with long-term use) Interactions Drug Anticoagulants, antiplatelets: Evening primrose oil can increase the action of anticoagulants and antiplatelets (theoretical) (Jellin et al, 2008). Phenothiazines: Phenothiazines (chlorpromazine) may cause seizures if used with evening primrose oil; do not use concurrently. Herb Anticoagulant/antiplatelet herbs: Evening primrose oil can increase the action of herbs with anticoagulant and antiplatelet properties (Jellin et al, 2008). Lab Test Lipid profile: Evening primrose oil may decrease triglycerides and increase high-density lipoproteins. Bleeding time: Evening primrose oil may increase bleeding time (Jellin et al, 2008). Primary Chemical Components and Possible Actions Chemical Class Individual Component Amino Acid Fatty Acid Tryptophan Linoleic acid Gamma linoleic acid (GLA) Flavonoid Triterpenoid Saponin Possible Action Decrease cholesterol Decrease hepatic injury; prostaglandin production Oleic acid; Stearic acid; Palmitic acid Rutin; Gossypetin Protoprimuloside B Client Considerations Assess • Assess the reason the client is using evening primrose oil. • Assess for hypersensitivity reactions. If present, discontinue the use of evening primrose oil and administer antihistamines or other appropriate therapy. • Assess for phenothiazine use. Evening primrose oil should not be used with this medication. • Assess for clients with seizure disorders. Do not use evening primrose oil in clients with a seizure disorder. Administer • Instruct the client to store evening primrose oil in a sealed container away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 2 and breastfeeding category is 2A. Adverse effects: Underline = life-threatening E 254 Eyebright Eyebright (eye’brite) Scientific name: Euphrasia officinalis Other common names: Meadow eyebright, red eyebright Origin: Eyebright is an annual that was originally found in Europe. Uses Eyebright is used both internally and externally to relieve eye fatigue, redness, and to treat sty and eye infections such as conjunctivitis and blepharitis. It is also used to treat nasal catarrh in sinusitis, as well as hay fever. Investigational Uses It may be used for Candida albicans (Trovato et al, 2000) and to reduce blood glucose levels (Porchezhian et al, 2000). Actions Very little research is available on eyebright. It has been used since the fourteenth century to treat eye conditions, although none of the available studies have confirmed any of its actions. One study has identified cytotoxic effects, however (Trovato et al, 1996). For that reason, eyebright is not recommended for any use. Aucubin, one of the chemical components of eyebright, has shown antibacterial, hepatoprotective, and antitumor activity. Two more studies (Trovato et al, 2000) have shown antimycotic activity in vitro on Candida albicans isolated from clinical samples from acute vaginitis. Another study (Porchezhian et al, 2000) showed decreased blood glucose levels when Euphrasia officinale was given to alloxan-diabetic rats. The diabetic rats’ blood glucose levels were decreased, but normal rats showed a lack of hypoglycemic effects. Product Availability Internal: Fresh herb, infusion, tablets, tincture; topical: infusion, fluid extract, fresh herb, lotion, poultice Plant Part Used: Flowering plant Dosages Ophthalmic • Adult topical decoction: 5-10 drops (2%) in eye to cleanse, tid-qid • Adult topical infusion: soak a towelette in infusion and apply over eye area prn Other • Adult PO dried herb: 2-4 g tid as an infusion (Mills, Bone, 2000) • Adult PO fluid extract: 2-4 ml (1:2 dilution) tid (Mills, Bone, 2000) • Adult PO tea: cover 2-3 g finely cut herb with boiling water and let stand 10-15 min, strain, drink • Adult PO tincture: 2-6 ml (1:5 dilution) tid (Mills, Bone, 2000) Contraindications Pregnancy category is 3; breastfeeding category is 2A. Eyebright should not be used by persons with hypersensitivity to this herb. = Pregnancy = Pediatric ! = Alert = Popular Herb Eyebright 255 Side Effects/Adverse Reactions CNS: Confusion, headache, weakness, fatigue EENT: Nasal congestion, blurred vision, photophobia, lid swelling, sneezing INTEG: Hypersensitivity reactions Interactions Drug Antidiabetics: May increase the effects of antidiabetics (theoretical) when Euphrasia officinalis is taken internally. Iron salts: Eyebright tea may interfere with the absorption of iron salts; separate by at least 2 hours. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Tannin Aucubin Antibacterial; hepatoprotective; antitumor Wound healing, astringent Euphroside; Veronicoside; Catapol; Ixoroside; Verproside; Mussaenoside; Ladroside Alkaloid Sterol Acids Caffeic Feralic Amino acid Flavonoid Amino acid Choline, Vitamins A/C Client Considerations Assess • Assess the reason the client is using eyebright. • Assess for hypersensitivity reactions. If present, discontinue use of eyebright and administer an antihistamine or other appropriate therapy. • Assess the eye for swelling, lacrimation, redness, and exudate. Administer • Instruct the client to apply eyebright externally as a compress or drops. • Instruct the client to store eyebright products in a cool, dry place, away from heat and moisture. Adverse effects: Underline = life-threatening E 256 Eyebright Teach Client/Family • Inform the client that pregnancy is category 3 and breastfeeding is category 2A. • If an eye infection is present, instruct the client to wash hands frequently and not to share towels with others. • Instruct the client on the correct method for washing the eye with solution. = Pregnancy = Pediatric ! = Alert = Popular Herb False Unicorn Root 257 False Unicorn Root (fawls yew’nuh-kawrn rewt) Scientific name: Chamaelirium luteum Other common names: Blazing star, devil’s bit, drooping starwort, fairy-wand, fairywart, helonias dioica, helonias root, rattlesnake, starwort Origin: False unicorn root is a lily found in the eastern region of the United States. Chamaelirium luteum is a threatened species. Uses F False unicorn root has been used as a treatment for morning sickness and menstrual irregularities such as amenorrhea and dysmenorrhea, as a uterine and liver tonic, and as a diuretic, an emetic, and a genitourinary stimulant. It is used for ovarian cysts and infertility. Actions Very little research is available on false unicorn root. A few very old articles, ranging from the early 1900s to the mid-1940s, compose most of the available information. The cited studies examined the gonadotropic effects of this herb on rats and its action on the uterus of the guinea pig and dog. These studies were unable to confirm any of the proposed actions of false unicorn root. One study (Brandt, 1996) proposes that the herb stimulates human chorionic gonadotropin. Product Availability Chopped root, dried root, tincture Plant Part Used: Roots Dosages • Adult PO decoction: 1-2 tsp herb in 1 cup water, simmer 10-15 min, strain, drink tid • Adult PO tincture: 2-4 ml (1:5) tid • Adult PO liquid extract: 1-2 ml (1:10) tid (Jellin et al, 2008) • Adult PO dried root: 1-2 g tid (Jellin et al, 2008) Contraindications Pregnancy category is 3; breastfeeding category is 2A. False unicorn should not be given to children. Persons with hypersensitivity to false unicorn root should not use it. Side Effects/Adverse Reactions GI: Nausea, vomiting (large doses) INTEG: Hypersensitivity reactions Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Steroid saponin Chamaelirin; Helonin; Diosgenin Oleic acid; Stearic acid; Linoleic acid hCG release Fatty acid Adverse effects: Underline = life-threatening 258 Fennel Client Considerations Assess • Assess the reason the client is using false unicorn root. • Assess for hypersensitivity reactions. If present, discontinue use of this herb and administer an antihistamine or other appropriate therapy. Administer • Instruct the client to store products containing false unicorn root in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 3 and breastfeeding category is 2A. • Caution the client that false unicorn root should not be given to children. • Inform the client that very little research is available to confirm any of the uses of false unicorn root. Fennel (feh’nuhl) Scientific name: Foeniculum vulgare Other common names: Aneth fenouil, bitter fennel, carosella, fenchel, fenouil, fenouille, finocchio, Florence fennel, funcho, garden fennel, hinojo, large fennel, sweet fennel, wild fennel Origin: Fennel is found in Asia and Europe and is cultivated in the United Kingdom and the United States. Uses Fennel is used to increase breast milk and the libido, to aid digestion, as a remedy for flatulence, and to treat indigestion and menstrual irregularities. Investigational Uses Investigation is underway to determine the usefulness of fennel for the treatment of infections. However, research supporting the use of this herb is limited. Actions Antimicrobial Action Other organisms fennel has shown bacteriostatic action against include the following: Aerobacter aerogenes, Bacillus subtilis, E. coli, Proteus vulgaris, Pseudomonas aeruginosa, Staphylococcus albius, and Staphylococcus aureus. Among its proposed actions are an antimicrobial effect against Listeria monocytogenes and Salmonella enteritidis. Estrogenic Action Anethole, one of the chemical components of fennel may influence milk secretion by competing with dopamine at receptor sites, thereby reducing the inhibition by dopamine of prolactin secretion. Other Actions Fennel has shown a bronchodilatory effect that may be due to potassium channel opening effect (Boskabady et al, 2004). Another study identified that fennel could be used to quiet a colicky infant (Savino et al, 2005). = Pregnancy = Pediatric ! = Alert = Popular Herb Fennel 259 Product Availability Internal: dried fruit, essential oil in water (bitter or sweet), fluid extract, tablets, tincture; topical: decoction, essential oil, extract Plant Part Used: Seeds Dosages • Adult PO dried fruit infusion: 900-1800 mg/day (Mills, Bone, 2000) • Adult PO essential oil: 5-20 drops/day (Mills, Bone, 2000) • Adult PO fennel compound tincture: 5-7.5 g daily (Blumenthal, 1998) • Adult PO fluid extract 3-6 ml/day (1:2 dilution) (Mills, Bone, 2000) • Adult PO herb: 5-7 g herb daily (Blumenthal, 1998) • Adult PO tincture: 7-14 ml/day (1:5 dilution) (Mills, Bone, 2000) F Contraindications Pregnancy category is 4; breastfeeding category is 2A. The essential oil of fennel should not be given to infants or small children. Fennel should not be used by those with hypersensitivity to it, and it should not be used for extended periods. Side Effects/Adverse Reactions CNS: Seizures, hallucinations GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions, contact dermatitis, photosensitivity SYST: Pulmonary edema, possible hormone-sensitive cancers Interactions Drug Anticonvulsants: Fennel may increase the risk of seizures; avoid concurrent use. Ciprofloxacin: Fennel affects the absorption, distribution, and elimination of ciprofloxacin. If the two are used concurrently, their dosages should be separated by at least 2 hours. Primary Chemical Components and Possible Actions Chemical Class Individual Components Possible Action Volatile oil Anethole Phytoestrogen, TNF inhibitor, secretory effect Fixed oil Tocopherol Flavonoid Dianethole; Photoanethole; Fenchone Estragole; Limonene; Camphene; Alpha-pinene Oleic acid; Linoleic acid; Petroselinic acid Kaempferol Procarcinogen Antiinflammatory Continued Adverse effects: Underline = life-threatening 260 Fenugreek Primary Chemical Components and Possible Actions—cont’d Chemical Class Individual Components Possible Action Vitamin Mineral Umbelliferone Terpinene Terpinolene Client Considerations Assess • Assess the reason the client is using fennel. • Assess for hypersensitivity reactions, contact dermatitis. If these are present, discontinue use of this herb and administer an antihistamine or other appropriate therapy. • Assess for the use of anticonvulsants, ciprofloxacin (see Interactions). Administer • Instruct the client to store fennel in a sealed container away from moisture and heat. Teach Client/Family • Inform the client that pregnancy category is 4 and breastfeeding category is 2A. • Caution the client not to give the essential oil to infants or small children. ! • Warn the client of the life-threatening side effects of fennel. Fenugreek (fen’yuh-greek) Scientific name: Trigonella foenum-graecum Other common names: Bird’s foot, Greek hayseed, trigonella Origin: Fenugreek is an annual found in Europe and Asia. Uses Fenugreek is taken internally to treat gastrointestinal complaints, including constipation, dyspepsia, and gastritis. Fenugreek is used to promote lactation, and for menstrual and menopausal discomfort. It is used topically to promote wound healing and to treat ulcers of the leg and cellulitis. Investigational Uses Studies are underway to determine the usefulness of fenugreek as an antioxidant and as a treatment for diabetes mellitus, gastric ulcers, hypercholesteremia, and infections such as tuberculosis. Actions Anticholesteremic Action Fenugreek has been studied in diabetic rats to evaluate lipid peroxidation and antioxidant effects. Results revealed disruption of free radical metabolism in the diabetic animals (Ravikumar et al, 1999). Alpha-tocopherol levels increased significantly. = Pregnancy = Pediatric ! = Alert = Popular Herb Fenugreek 261 Lower body weight and blood lipid levels were demonstrated in the laboratory when fenugreek was given for 6 weeks (Xue et al, 2007). Analgesic Action One study using laboratory rats evaluated tail-flick as a response to pain. When a large amount of fenugreek extract was given to the rats, tail-flicking behavior decreased, indicating a reduction in pain (Javen et al, 1997). Fenugreek has a central analgesic action and spinal 5-HT system is involved in this action (Parvizpur et al, 2004). Antidiabetic Action One study evaluated diabetic rats after they were fed fenugreek seed and its extracts (Ali et al, 1995). No effects were evident on fasting blood glucose levels with fenugreek alone, but when the rats received fenugreek simultaneously with glucose, a significant reduction in blood glucose occurred. Many other studies have confirmed the antidiabetes effects of fenugreek (Abdel-Barry et al, 1997, 2000; Gupta et al, 1999, 2001; Vats et al, 2002). Other Actions The effect of fenugreek seeds compared to omeprazole was evaluated on ethanol-induced gastric ulcers. The result was significant ulcer protective effects (Suja et al, 2002). Product Availability Capsules, crude herb, defatted fenugreek powder, fluid extract, powder (made from dried seeds) Plant Part Used: Seeds Dosages Diabetes Mellitus • Adult PO defatted fenugreek powder: 50 g/day (Murray, Pizzorno, 1998) Other • Adult PO: 1-6 g seeds tid • Adult PO: 6 g herb (Blumenthal, 1998) • Adult PO powdered seeds: 50 mg bid • Adult topical: 50 g powdered herb dissolved in 250 ml water, daily (Blumenthal, 1998) Contraindications Pregnancy category is 4; breastfeeding category is 2A. Until more research is available, fenugreek should not be used in children. Persons with hypersensitivity to fenugreek should not use it. Side Effects/Adverse Reactions INTEG: Hypersensitivity reactions SYST: Bruising, petechiae, bleeding Interactions Drug All medications: Because of the rapid rate at which this herb moves through the bowel and coats the gastrointestinal tract, fenugreek may reduce absorption of all medications used concurrently. Continued Adverse effects: Underline = life-threatening F 262 Fenugreek Interactions—cont’d Anticoagulants (anisindione, dicumerol, heparin, warfarin), antiplatelets, NSAIDs: There is a possible increased risk of bleeding when fenugreek is used concurrently with anticoagulants, antiplatelets, NSAIDs. Antidiabetics: Because fenugreek lowers blood glucose levels, increased hypoglycemia is possible when this herb is used concurrently with antidiabetics (theoretical). Corticosteroids, estrogens: Fenugreek may inhibit the action of these agents (theoretical) (Jellin et al, 2008). MAOIs: Fenugreek can increase the action of MAOIs (theoretical) (Jellin et al, 2008). Food Fabaceace (soybean, chickpea, peanuts, green peas): Fenugreek allergy may develop if allergic to Fabaceace species (theoretical) (Jellin et al, 2008). Lab Test Blood glucose, LDL, total cholesterol: Fenugreek may decrease total cholesterol, blood glucose (decoctions, infusions), and LDL cholesterol. Primary Chemical Components and Possible Actions Chemical Class Individual Components Possible Action Steroid saponin Fenugreekine; Smilagenin; Diosgenin; Trigogenin; Gitogenin; Yamogenin; Neotigogenin; Neogitogenin Gentianine; Carpaine; Choline; Trigonelline Lysine; Hydroxyisoleucine; Tryptophan; Histidine; Arginine Decreased blood glucose Alkaloid Amino acid Anticholesterol Antidiarrheal, laxative Anticoagulant Mucilages Coumarin Vitamin Mineral Fiber Client Considerations Assess • Assess the reason the client is using fenugreek. • Assess for hypersensitivity reactions. If present, discontinue use of this herb and administer an antihistamine or other appropriate therapy. • Assess for increased hypoglycemia in diabetic clients who are taking antidiabetics (see Interactions). • Assess for bleeding in clients who are using anticoagulants (see Interactions). = Pregnancy = Pediatric ! = Alert = Popular Herb Feverfew 263 Administer • Instruct the client to store fenugreek products in a sealed container away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 4 and breastfeeding is category 2A. • Caution the client not to use this herb in children until more research is available. • Instruct the client to report side effects and adverse reactions (bleeding, hypersensitivity, hypoglycemia) to the health care provider. • Advise the client that urine may smell like maple syrup. Feverfew (fee’vuhr-fyew) Scientific name: Chrysanthemum parthenium Other common names: Altamisa, bachelors’ button, chamomile grande, featherfew, featherfoil, febrifuge plant, midsummer daisy, mutterkraut, nosebleed, Santa Maria, wild chamomile, wild quinine Origin: Feverfew is a perennial found throughout the world. Uses Feverfew is used traditionally to treat menstrual irregularities, threatened spontaneous abortion, arthritis, and fever. Investigational Uses Research is underway to determine whether feverfew is effective in the prevention and treatment of migraine headache. Actions Antimigraine Action Primary research has focused on the use of feverfew for the prevention and treatment of migraine headache. In a study of 57 patients with severe migraine headaches, use of feverfew significantly reduced pain intensity, vomiting, and noise sensitivity (Palevitch et al, 1997). Feverfew acts as a significant migraine preventive when taken for 4 months. One theory is that feverfew decreases platelet aggregation and inhibits production of prostaglandins and thromboxanes. One of the chemical components of this herb also prevents the release of serotonin from platelets. The release of serotonin from platelets is thought to stimulate migraine headache. Antiinflammatory Action Feverfew may decrease the release of polymorphonuclear leukocytes in joints that are arthritic and inflamed (Heptinstall et al, 1998). Another study demonstrated that feverfew inhibits arachidonate metabolism in leukocytes that may increase inflammation (Williams et al, 1995). Product Availability Capsules, crude herb (fresh), extract, tablets, tincture Plant Part Used: Leaves Adverse effects: Underline = life-threatening F 264 Feverfew Dosages Migraine Prophylaxis and Treatment • Adult PO freeze dried extract: 25 mg daily • Adult PO fresh leaves: 2 large or 4 small leaves/day chewed or mixed with food (McCaleb et al, 2000) • Adult PO standardized extract: 275 mg/day (McCaleb et al, 2000) or 0.25-0.5 mg parthenolide (Murray, Pizzorno, 1998); other sources report 50-100 mg of whole leaf extract • Adult PO capsules/tablets: 300-400 mg tid-qid (Foster, 1998) • Adult PO tincture: 15-30 drops per day (Foster, 1998) standardized to 0.2-0.7 mg parthenolide Contraindications Class 2b herb. Pregnancy category is 4; breastfeeding category is 1A. Feverfew should not be given to children. It should not be used by persons with hypersensitivity to it or asteraceae/compositae family. Side Effects/Adverse Reactions CNS: Dizziness EENT: Mouth ulcers (chewed leaves) GI: Nausea, vomiting, anorexia, abdominal pain INTEG: Hypersensitivity reactions, contact dermatitis MS: Muscle stiffness, muscle and joint pain Interactions Drug Anticoagulants (anisindione, dicumarol, heparin, warfarin), antiplatelets, NSAIDs: Feverfew may increase the anticoagulant properties of anticoagulants, antiplatelets, NSAIDs (theoretical). Iron supplements: Feverfew may decrease the absorption of iron, separate by ⱖ2 hours. Herb Anticoagulant, antiplatelet herbs: Feverfew may increase anticoagulation and decrease platelet aggregation (Jellin et al, 2008). Lab Test Platelet aggregation: Feverfew may decrease platelet aggregation. Prothrombin time, plasma partial prothrombin time: It may increase prothrombin time and plasma partial prothrombin time in clients taking warfarin concurrently. Primary Chemical Components and Possible Actions Individual Class Individual Component Volatile oils Angelate, Costic acid, Pinene Sedative Monoquiterpene = Pregnancy Possible Action = Pediatric ! = Alert = Popular Herb Figwort 265 Primary Chemical Components and Possible Actions—cont’d Individual Class Individual Component Possible Action Sesquiterpene Sesquiterpene lactone Chrysanthemolide; Parthenolide Decreases serotonin Platelet inhibitor; prostaglandin synthesis; antibacterial Chrysanthemonin; Magnoliolide Melatonin Flavonoid Santamarin Tanaparthin Reynosin Monoterpenes Sleep regulation Apigenin; Luteolin; Chrysoeriol; Scutellarein; Santin Camphor Client Considerations Assess • Assess the reason the client is using feverfew. • Assess for hypersensitivity reactions. If present, discontinue use of this herb and administer an antihistamine or other appropriate therapy. • Assess for mouth ulcers and muscle and joint pain or stiffness. Administer • Instruct the client to store feverfew products in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 4 and breastfeeding category is 1A. • Caution the client not to give feverfew to children. Figwort (fig’wuhrt) Scientific names: Scrophularia nodosa, Scrophularia ningpoensis Other common names: Carpenter’s square, common figwort, kernelwort, knotty rooted figwort, rose-noble, scrofula plant, square stalk, stinking christopher, throatwort Origin: Figwort is a perennial found in China. Uses Figwort is most often used topically to treat skin disorders such as acne, eczema, contact dermatitis, urticaria, psoriasis, and pruritus. Figwort is used internally to decrease gastrointestinal symptoms, stimulate cardiac function, and reduce inflammation. Adverse effects: Underline = life-threatening F 266 Figwort Actions Very little research is available on figwort. This herb is classified as an iridoid glycoside and is related to the foxglove plant, from which digitalis is derived. Therefore some of the actions of figwort are similar to those of digitalis-like drugs. However, no primary research supports the possible cardiac actions of this herb. Miscellaneous Actions Figwort has been tested for its insulin-binding reaction (Liu et al, 1991), its antiprotozoacidal activity (Martin et al, 1998), its antiinflammatory activity (Fernandez et al, 1998), and its possible antitoxic effects in chemotherapy (Liu et al, 1993). The 1991 Liu study determined that figwort did not alter insulin binding in any way. Martin et al evaluated 60 plant species and found that figwort was active against Trichomonas vaginalis and Leishmania infantum (Martin et al, 1998). The Fernandez study found that figwort used topically exerts stronger antiinflammatory action than does figwort used orally. The action of this herb used topically is influenced by migration of neutrophils into the infected area. The 1993 Liu study found that figwort prevents toxicity in chemotherapy (Liu et al, 1993). When chemotherapeutic agents were combined with several Chinese herbs, the group treated with the herbs suffered fewer toxic reactions at a statistically significant level. Stevenson et al (2002) identified the wound healing activity of glycosides in Scrophularia nodosa. Product Availability Fluid extract, soak, tincture Plant Parts Used: Dried flowers, dried leaves Dosages • Adult PO fluid extract: 2-8 ml (1:1) daily-bid • Adult PO infusion: 2-8 g herb daily • Adult PO tincture: 2-4 ml (1:5 dilution) daily-bid • Adult topical: use as a soak or apply by compress prn Contraindications Class 2d herb (S. ningpoensis whole herb root). Until more research is available, figwort should not be used during pregnancy and breastfeeding. It should not be given to children. Figwort should not be used by persons with hypersensitivity to this herb or those who have serious cardiac disease. Side Effects/Adverse Reactions CV: Decreased heart rate, heart block, asystole GI: Nausea, vomiting, anorexia, diarrhea INTEG: Hypersensitivity reactions Interactions Drug Antiarrhythmics, beta-blockers, cardiac glycosides: The action of figwort may increase the effects of antiarrhythmics, beta-blockers, cardiac glycosides; do not use concurrently. Antidiabetics: The action of figwort may increase blood glucose levels, decrease antidiabetic action of insulin. Diuretics: Potassium-losing diuretics with figwort may cause hypokalemia (theoretical) (Jellin et al, 2008). = Pregnancy = Pediatric ! = Alert = Popular Herb Figwort 267 Interactions—cont’d Herb Cardiac glycoside herbs (black hellebore digitalis, lily of the valley, motherwort, oleander, pheasant’s eye): Cardiac glycoside effects may be increased. Lab Test Blood glucose: Figwort may increase blood glucose. Primary Chemical Components and Possible Actions Chemical Class Individual Component Amino acid Isoleucine; Leucine; Alanine; Lysine; Tyrosine; Phenylalanine; Threonine; Valine Aucubin; Catalpol Diosmetin Harpagide; Harpagoside; Isoharpagoside; Procumbid; Iridoids Ferulic acid Vanillic acid; Caffeic acid; Cinnamic acid Ningposides A, B, C, Sibirioside A, Cistanoside D, Angoroside C acteoside, Decaffeoy lactoside, Cistanoside F Harpagoside, Aucubin, Catalpol (Sesterhenn, et al, 2007) Flavonoid Phenolic acid Glycosides Possible Action Laxative Cardioactive, antiinflammatory Antiinflammatory Saponin Asparagine Tannins Client Considerations Assess • Assess the reason the client is using figwort. • Assess for hypersensitivity reactions. If present, discontinue use of figwort and administer an antihistamine or other appropriate therapy. • Assess cardiac status, including blood pressure and pulse (character). Watch for decreasing pulse. Patients with cardiac disorders should not take figwort. • Assess for other cardiovascular drugs the client may be using. Figwort should not be used concurrently with antiarrhythmics, cardiac glycosides, or beta-blockers (see Interactions). Adverse effects: Underline = life-threatening F 268 Fish Oils Administer • Instruct the client to store figwort products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use figwort in children or those who are pregnant or breastfeeding until more research is available. • Warn the client of the life-threatening side effects of figwort. ! • Advise the client that research is lacking and therefore any use or action of figwort is speculative. Fish Oils (fish oylz) Scientific names: DHA (docosahexaenoic acid), EPA (eicosapentaenic acid) Other common names: Omega 3 fatty acids, omega 3 oils Uses Fish oils are used to decrease inflammation in rheumatoid arthritis, to prevent cardiovascular disease, and to treat major depressive disorder, bipolar disorder, and dysmenorrhea. Fish oils are also used to prevent low birth weight infants in women with previous pregnancy complications. Actions Fish oils when taken orally alter major prostaglandin and leukotriene synthesis, which leads to decreased inflammation. There have been studies with no change in the condition being studied when fish oils were added. The conditions that did not improve were attention deficit–hyperactivity disorder, multiple sclerosis, male fertility, and asthma. Fish oils appear to be effective in rheumatoid arthritis, cardiovascular disease prevention (Cleland et al, 2006), bipolar disorder, depression, dysmenorrhea (Jellin et al, 2008), and lowering triglycerides (Aligeti et al, 2007). The March of Dimes funded a study showing fish oils were able to prevent low birth weight infants (Olsen et al, 2007). Product Availability Capsules, liquid Dosages • Adult PO capsules/liquid: 3-9 g/day Contraindications Fish oils should not be used in children or those who are pregnant, breastfeeding, hypersensitive, or have breast/prostate cancer or heart disease. Interactions Drug Anticoagulants: Fish oils may increase the risk of bleeding; avoid concurrent use. = Pregnancy = Pediatric ! = Alert = Popular Herb Flax 269 Client Considerations Assess • Assess the reason the client is using fish oils. • Identify if the client is taking anticoagulants that should not be taken with this product. • Assess if the client has breast/prostate cancer or coronary disease. Administer • Keep fish oils in a dry area, away from direct sunlight. Teach Client/Family • Teach the patient that fish oils should not be used in children or those who are pregnant or breastfeeding until more research is available. Flax ! (flaks) Scientific name: Linum usitatissimum Other common names: Flaxseed, linseed, lint bells, linen flax, linum Origin: Flax is a flowering annual found in the United States, Canada, and Europe. Uses Flax is generally used internally as a laxative and an anticholesteremic. Topically it is used as an inflammatory. Investigational Uses Researchers are experimenting with the use of flax to treat inflammatory conditions such as colitis, irritable bowel syndrome, diverticulitis, osteoarthritis, psoriasis, and eczema. It may also be effective in the treatment of allergies and autoimmune disorders such as multiple sclerosis, cancer, lupus erythematosus, and rheumatoid arthritis, as well as learning disorders such as attention deficit disorder with or without hyperactivity and dyslexia. Flax is also used experimentally to treat hypertension and agoraphobia. Actions Adequate levels of zinc and acidophilus are needed to metabolize flax. Anticancer Action One study showed a significantly reduced incidence of breast cancer when women consumed high levels of phytoestrogens such as the lignans found in flax products (Ingram et al, 1997). This study compared 144 women with breast cancer with 144 women without breast cancer. The women were matched demographically. Investigators determined that the largest reduction in breast cancer was associated with a high intake of equol, one of the flavone components, and enterolactone, a substance formed by the breakdown of flax. Anticholesteremic Action In a 6-week double-blind crossover study, 38 postmenopausal women with elevated cholesterol were given whole flaxseed and sunflower seed. In the experimental group, cholesterol dropped by nearly 15% (Arjmandi et al, 1999). Other studies have confirmed that the addition of flax to the diet reduces risk factors for coronary artery disease, thrombotic disorders, and cerebrovascular accident. Adverse effects: Underline = life-threatening F 270 Flax Other Actions Flax is composed of lignans and isoflavones that possess estrogenic action (Abarzua et al, 2007). There is also a prophylactic action of flax against cyclophosphamideinduced stress (Bhatia et al, 2006). Product Availability Capsules, oil, powder, softgel capsules Plant Part Used: Seeds Dosages Flax may be standardized to 58% alpha-linolenic acid. Agoraphobia • Adult PO: 2-6 tbsp/day (Rudin, 1981) Diabetes Mellitus • Adult PO: 1 tbsp/day (Murray, Pizzorno, 1998) Eczema • Adult PO: 1 tbsp/day (Murray, Pizzorno, 1998) General Use • Adult PO oil: 1-2 tbsp daily in divided doses. • Adult PO seeds: 21⁄2 tsp ground seeds bid-tid (McCaleb et al, 2000); whole flaxseed can be ground at home using a small food processor to break the hard portion of the outside of the seed; ground flax should be mixed in 6-8 oz water and eaten within 15 min Hypertension • Adult PO: 1 tbsp/day (Murray, Pizzorno, 1998) Inflammation • Adult topical: 30-40 g flax flour (Blumenthal, 1998), moistened to form a paste, prn Multiple Sclerosis • Adult PO: 1 tbsp/day (Murray, Pizzorno, 1998) Rheumatoid Arthritis • Adult PO: 1 tbsp/day (Murray, Pizzorno, 1998) Contraindications ! Class 2d herb (seed). Until more research is available, flax should not be used during pregnancy and breastfeeding. It should not be given to children. This herb should not be used by persons with bowel obstruction or dehydration, or by persons with hypersensitivity to it. Flax poultice should not be used on open wounds. Only mature seeds should be used; immature seeds are toxic. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, diarrhea, flatulence, GI obstruction INTEG: Hypersensitivity reactions Overdose: Weakness, incoordination, dyspnea, tachypnea, paralysis, seizures, death = Pregnancy = Pediatric ! = Alert = Popular Herb Flax 271 Interactions Drug All oral medications: Absorption of medications may be decreased if taken concurrently with flax. Anticoagulants, antiplatelets: Flax may increase risk of bleeding (Jellin et al, 2008). Antidiabetics, laxatives: Flax may increase the action of laxatives and antidiabetics, resulting in diarrhea, (Jellin et al, 2008). Lab Test Cholesterol, triglycerides: Flax can decrease cholesterol and increase triglycerides (Jellin et al, 2008). Glucose: Flax may decrease blood glucose (Jellin et al, 2008). Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Fatty acid Linolenic acid Linoleic acid; Oleic acid Galactose; Xylose; Arabinose; Rhamnose Decreases cholesterol Equol Secoisolariciresinol diglucoside Antitumor Anticancer, estrogenic Mucilage Protein Flavonoid Lignan Client Considerations Assess • Assess the reason the client is using flax. • Assess for hypersensitivity reactions. If present, discontinue use of this herb and administer an antihistamine or other appropriate therapy. ! • Assess for overdose reactions. • Assess for use of medications, including laxatives (see Interactions). Administer • Instruct the client to refrigerate flax products to prevent fatty acid breakdown. Teach Client/Family • Caution the client not to use flax in children or in those who are pregnant or breastfeeding until more research is available. • Inform the client that flax may decrease the absorption of all other medications. ! • Warn the client to use only mature seeds; the immature seeds are toxic. • Inform the client of the symptoms of overdose (see Side Effects). Adverse effects: Underline = life-threatening F 272 Folic Acid Folic Acid (foe’ lick a’ sid) Scientific name: Vitamin B9 Other common names: Folate, folvite Origin: Synthetic Uses Folic acid is used for hepatic disease, alcoholism, hemolysis, intestinal obstruction, pregnancy, and megaloblastic or macrocytic anemia caused by folic acid deficiency. Actions Folic acid is needed for erythropoiesis. It increases RBC, WBC, and platelet formation in megaloblastic anemias. Product Availability Tablets 0.1, 0.4, 0.8, 1, 5 mg; inj 5, 10 mg/ml Dosages Therapeutic Dose • Adult PO/IM/SUBCUT/IV: up to 1 mg daily • Child PO/IM/SUBCUT/IV: up to 1 mg daily Pregnancy/Breastfeeding • Adult PO/IM/SUBCUT/IV: 0.8 mg/day Maintenance Dose • Adult PO/IM/SUBCUT/IV: 0.4 mg/day • Child PO/IM/SUBCUT/IV ⬎4 yr: 0.4 mg/day • Child PO/IM/SUBCUT/IV ⬍4 yr: up to 0.3 mg/day • Infants PO/IM/SUBCUT/IV: up to 0.2 mg/day Contraindications Folic acid should not be used in those who are hypersensitive or who have anemias other than megaloblastic, macrocytic anemia, and uncorrected pernicious anemia Side Effects/Adverse Reactions INTEG: Flushing RESP: Bronchospasm Interactions Drug Methotrexate: Folic acid may decrease the action of methotrexate (Khanna et al, 2005). Pharmacology Pharmacokinetics Peak 1⁄2-1 hr (PO), bound to plasma proteins, excreted in breast milk, metabolized by the liver, excreted in small amounts via kidneys. = Pregnancy = Pediatric ! = Alert = Popular Herb Fo-ti 273 Client Considerations Assess • Assess the reason the client is using folic acid. • Monitor weight while taking this product. • Folate levels: 6-15 mcg/ml, Hgb, Hct, and reticulocyte count. Administer • IV: direct and undiluted 5 mg or less given at 1 min or more. It may be added to most IVs. Teach Client/Family • Teach client to obtain necessary lab work. Fo-ti (foe’tee) Scientific name: Polygonum multiflorum Other common names: Chinese cornbind, Chinese knotweed, flowery knotweed, ho shou wu Origin: Fo-ti is a climbing perennial found in China. Uses In traditional Chinese medicine, fo-ti is used as a general tonic. It is also used to slow the aging process and to treat insomnia, autoimmune disorders, hyperlipidemia, and diabetes mellitus. It may also be used to treat diverticular disease and hemorrhoids. A laxative action is present in the chemical components of fo-ti. Investigational Uses Research is underway to confirm the myocardial protective use of Polygonum multiflorum, as well as the cognitive enhancing use. Actions Information on fo-ti is lacking. Most of the available information comes from Chinese literature published in the early to mid-1990s. A few studies are available documenting the cholesterol-lowering action of this herb in animals (Chevallier, 1996; Gao et al, 2007a; Hong et al, 1994; Yang, 2005), and the root has been shown to lower triglyceride accumulations in animal livers (Liu et al, 1992). Another study (Yim et al, 2002) showed a myocardial protective action against ischemia-reperfusion injury when Polygonum multiflorum extract is used. Hsieh et al (2000) showed no cognitive enhancing properties of Polygonum multiflorum when it was studied with other Chinese herbs. An extract of fo-ti was shown to prevent skin damage from ultraviolet radiation and is thought to possess antiaging properties (Hwang et al, 2006). Product Availability Sliced root; available in combination in many herbal tonics Plant Part Used: Roots Dosages No published dosages are available. Adverse effects: Underline = life-threatening F 274 Fumitory Contraindications Until more research is available, fo-ti should not be used during pregnancy and breastfeeding. It should not be given to children. Fo-ti should not be used by persons with diarrhea or those with hypersensitivity to this herb. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, diarrhea, laxative dependence (long-term use) INTEG: Hypersensitivity reactions Interactions Drug Antidiabetics: Fo-ti may increase the action of antidiabetics (Jellin et al, 2008). Diuretics: Fo-ti may increase the risk of hypokalemia when used with potassium-losing diuretics (Jellin et al, 2008). Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Anthraquinone Emodin Rhein Laxative Chrysophanol Chrysophanic acid Client Considerations Assess • Assess the reason the client is using fo-ti. • Assess for hypersensitivity reactions. If present, discontinue use of this herb and administer an antihistamine or other appropriate therapy. Administer • Instruct the client to take fo-ti PO. • Inform the client that dark roots are the most potent. Roots with white streaks are of a lesser quality. • Instruct the client to store fo-ti in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use fo-ti in children or in those who are pregnant and breastfeeding until more research is available. • Advise the client that long-term use of this herb may lead to laxative dependence. Fumitory (fyew’muh-toe-ry) Scientific name: Fumaria officinalis Other common names: Beggary, earth smoke, hedge fumitory, wax dolls Origin: Fumitory is an annual bush or shrub found in Africa, Europe, the United States, Canada, Asia, and Australia. = Pregnancy = Pediatric ! = Alert = Popular Herb Fumitory 275 Uses Fumitory is taken internally as a laxative, a diuretic, and a treatment for biliary illness. Topically, it may be used to treat various skin disorders such as eczema, psoriasis, acne, and scabies. Fumitory may be used as an eyewash to ease conjunctivitis. Investigational Uses Researchers are experimenting with the usefulness of fumitory in the treatment of arrhythmias. Actions A review of the literature reveals very few studies supporting the use of fumitory as a diuretic, a laxative, or for treatment of skin disorders. In Germany, fumitory is approved for treatment of colicky pain in the gallbladder or biliary system. Only two studies have evaluated the possible use of fumitory in the treatment of cardiac disorders. The first study, using dogs, evaluated the efficacy of its alkaloid components in treating temporary disorders of coronary blood flow. The injected alkaloids significantly reduced ischemic shifts (Gorbunov et al, 1980). The second study evaluated a number of different plant species grown in Bulgaria. Results showed that fumitory exerted a healing effect on ischemic heart disease, atherosclerosis, and hypertension (Petkov, 1979). Another study (Rao et al, 1998) showed Fumaria indica, a different Fumaria sp. from that used for the preparations that are typically available, to be hepatoprotective. When used for irritable bowel syndrome (IBS), there was no noticeable benefit over a placebo (Brinkhaus et al, 2005). Product Availability Dried herb, extract, tincture Plant Parts Used: Flowering parts, leaves Dosages • Adult PO dried herb: 6 g/day (Blumenthal, 1998) • Adult PO fluid extract: 2-4 ml (1:1 dilution) in 25% alcohol, tid • Adult PO tea: 2-4 g tid • Adult PO tincture: 1-4 ml (1:5 dilution) in 45% alcohol, tid • Adult topical: apply dried herb prn Contraindications Until more research is available, fumitory should not be used during pregnancy and breastfeeding. It should not be given to children. Fumitory should not be used by persons with seizure disorders or increased intraocular pressure, and it should not be used by those with hypersensitivity to it. Side Effects/Adverse Reactions CNS: Seizures (overdose) CV: Decreased blood pressure, decreased pulse EENT: Increased intraocular pressure GI: Nausea, vomiting, anorexia GU: Acute renal failure INTEG: Hypersensitivity reactions Continued Adverse effects: Underline = life-threatening F 276 Fumitory Interactions Drug Antiarrhythmics, beta-blockers, cardiac glycosides: The actions of fumitory may increase the effects of antiarrhythmics, beta-blockers, cardiac glycosides; do not use concurrently. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Alkaloid Fumarine Negative chronotropic; Antihistaminic Negative chronotropic Flavonoid Cryptopine Aurotensine; Coridaline; Sinactine; Stylopine; Cryptocavine; Sanguinarine; Bulbocapnine Fumaricine; Fumritine; Fumariline Quercetin; Isoquercetin Fumaric acid Mucilage Resin Caffeic acid Antiinflammatory; bile stimulant/ antispasmodic; antioxidant Bile stimulant/ antispasmodic Choleretic Cinnamic acid Client Considerations Assess • Assess the reason the client is using fumitory. • Assess for hypersensitivity reactions. If present, discontinue use of fumitory and administer an antihistamine or other appropriate therapy. • Assess the client’s cardiac status, including blood pressure and pulse (character). Watch for decreasing pulse. • Assess for other cardiovascular drugs the client may be taking. Fumitory should not be taken concurrently with antiarrhythmics, cardiac glycosides, or betablockers (see Interactions). Administer • Instruct the client to store fumitory products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use fumitory in children or those who are pregnant or breastfeeding until more research is available. = Pregnancy = Pediatric ! = Alert = Popular Herb Galanthamine 277 Galanthamine Scientific name: Galanthus nivalis Origin: Galanthamine is a bulb plant found throughout the world. Uses Galanthamine is used widely in other countries to treat Alzheimer’s disease, myasthenia gravis, and paralysis caused by polio. Investigational Uses Research is being conducted for the use of galanthamine as an antiinfective. Actions G Acetylcholinesterase Inhibition Research has identified galanthamine as an acetylcholinesterase inhibitor that can reverse the effects of nondepolarizing muscle relaxants (Schuh, 1976). The use of galanthamine has produced both positive and negative effects in clients with Alzheimer’s disease. In several studies (Bores, 1996; Iliev, 2000; López-Pousa et al, 2007), a course of galanthamine produced an improvement in cognitive functioning in humans and animals. Other studies showed no such improvement. There is a neuroprotective action in galanthamine (Takada-Takatori et al, 2006). Antiinfective Action In a study of rats infected with salmonella, the rats were fed Galanthus nivalis agglutinin for 3 days preinfection and 6 days postinfection. G. nivalis significantly reduced salmonella numbers in the small bowel and large intestine of the infected rats (Naughton, 2000). In another study, in vitro, G. nivalis inhibited the growth of Chlamydia trachomatis by binding a glycoprotein present in the infecting organism (Amin, 1995). A strong immune response resulted when the glycoproteins of HIV-1, HIV-2, and SIV were purified with G. nivalis (Gilljam, 1993). Product Availability Ampules, tablets Plant Part Used: Bulb Dosages • Adult PO ampules or tablets: 5 mg tid; dosage may be increased gradually to 40 mg daily Contraindications Until more research is available, galanthamine should not be used during pregnancy and breastfeeding. It should not be given to children. This herb should not be used by persons with exposure to organophosphate fertilizers or those with hypersensitivity to it. Side Effects/Adverse Reactions CNS: Dizziness, anxiety, agitation, restlessness, insomnia GI: Nausea, vomiting, anorexia, abdominal cramping and pain, diarrhea INTEG: Hypersensitivity reactions Interactions Drug MAOIs: Do not use galanthamine concurrently with MAOIs; hypertensive crisis may occur. Adverse effects: Underline = life-threatening 278 Gamma Linolenic Acid Pharmacology Pharmacokinetics The components of galanthamine are known to cross the blood-brain barrier. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Acetylcholinesterase inhibitor Alkaloid Client Considerations Assess • Assess the reason the client is using galanthamine. • Assess for hypersensitivity reactions. If present, discontinue the use of this herb and administer an antihistamine or other appropriate therapy. • Assess for the use of MAOIs and organophosphate fertilizers, neither of which should be used concurrently with galanthamine (see Interactions). Administer • Instruct the client to store galanthamine products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use galanthamine in children or in those who are pregnant or breastfeeding until more research is available. • Inform the client that conventional treatments may be more effective than galanthamine. Gamma Linolenic Acid (gam’ uh linn-oh-leen’-ick as’id) Other common name: GLA Origin: See evening primrose oil, borage. Uses Gamma linolenic acid is being used for rheumatoid arthritis, cancer prevention, ADHD, depression, and psoriasis and may be used with tamoxifen in breast cancer. It may also be used for diabetic neuropathy and hyperlipidemia. Actions Omega-6 fatty acid has antiinflammatory and antiproliferative effects. It may act on T cells to normalize the immune response in rheumatoid arthritis and cancer (Jellin et al, 2008). Research has been mixed. Because GLA is completely safe, it may be used, even if there is some doubt about the therapeutic value (Dobryniewski et al, 2007). = Pregnancy = Pediatric ! = Alert = Popular Herb Gamma Linolenic Acid 279 Product Availability Capsules Plant Parts Used: Seeds of evening primrose oil, borage Dosages Rheumatoid Arthritis • Adult PO capsules: 1.1 g/day Diabetic Neuropathy • Adult PO capsules: 360-480 mg/day Hyperlipidemia • Adult PO capsules: 1.5-6 g/day G Contraindications GLA should not be used in pregnancy or breastfeeding. It should not be given to children. Side Effects/Adverse Reactions GI: Nausea, vomiting, diarrhea, flatulence HEMA: Increased bleeding time Interactions Drug Anticoagulants, antiplatelets: When anticoagulants, antiplatelets are given with GLA, they may increase the risk for bleeding. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Fatty acid Linoleic acid Gamma linoleic acid (GLA) Oleic acid; Stearic acid; Palmitic acid Rutin; Gossypetin Protoprimuloside B Decrease cholesterol Decrease hepatic injury Flavonoid Triterpenoid Saponin Mucilage Acid Tannin Malic acid Essential oil Seeds Also Contain Fatty acid Gamma-linolenic acid Oleic Alkaloid, pyrrolizidine Linoleic acid Saturated Amabiline Thesinine Expectorant Diuretic Wound healing; antiinflammatory Antiinflammatory; antihypertensive Hepatotoxic Adverse effects: Underline = life-threatening 280 Garcinia Client Considerations Assess • Assess the reason the client is using gamma linolenic acid. • Assess for use of anticoagulants or antiplatelets. These should be avoided with GLA use. Administer • Keep gamma linolenic acid in a dry area, away from direct sunlight. Teach Client/Family • Teach the client that gamma linolenic acid should not be used in children or those who are pregnant or breastfeeding until more research is available. Garcinia ! (gar-sin-ee’uh) Scientific names: Garcinia cambogia, G. indica, G. hanburyi Other common names: Camboge, gorikapuli, gutta cambodia, HCA, hydroxycitric acid, malabar tamarind, tom rong Origin: Garcinia cambogia comes from the Indian brindall berry. Uses Traditionally, garcinia is used for constipation because it possesses a strong laxative effect. Investigational Uses New studies are underway using garcinia for weight loss and hyperlipidemia. Actions There is little research for garcinia’s use in weight loss. One small study (Heymsfield et al, 1998) identified its use to reduce fatty acid synthesis and food intake and thus reduction in weight. In another study (Mahendran et al, 2002), rats with indomethacininduced gastric ulcers showed improvement when fed G. cambogia. Garcinia has been shown to lower the formation of low-density lipoprotein and triglycerides (Adaramoye et al, 2006; Jellin et al, 2008). The effect of kolaviron, a seed extract, is hypocholesterolemic, and reduction of the weight of the heart in cholesterol-fed animals (Adaramoye et al, 2005). Product Availability Tablets, capsules, powder, and as a component in snack bars and breakfast bars. Garcinia may be standardized to a fixed HCA amount. Plant Part Used: Ground drug from resin Dosage • Adult PO: 250-1000 mg tid Contraindications Garcinia should not be used in children or those who are pregnant, breastfeeding, hypersensitive, or who have renal/hepatic disease. = Pregnancy = Pediatric ! = Alert = Popular Herb Garlic 281 Side Effects/Adverse Reactions GI: Severe diarrhea, abdominal pain, nausea, vomiting SYST: Death (⬎4 g of herb) Primary Chemical Components and Possible Actions Chemical Class Individual Component Resins Xanthones Benzophenones Gambogin; Morelin dimethyl acetal; Isomoreolin B; Moreolic acid; Gambogenic acid; Gambogenin; Isogambogenin; Desoxygambogenin; Gambogenin dimethyl acetal; Isomorellin; Morellic acid; Desoxymorellin Possible Action Cytotoxic (Asano et al, 1996) Mucilages Client Considerations Assess • Assess the reason the client is using garcinia. • Monitor weight while taking this product. Administer • Keep garcinia in a dry area, away from direct sunlight. Teach Client/Family • Teach the client that garcinia should not be used in children or those who are pregnant or breastfeeding until more research is available. • Advise the patient that the herb should be used under the supervision of a qualified ! herbalist because overdose can cause death. Garlic (gahr’lik) Scientific name: Allium sativum Other common names: Ail, allium, camphor of the poor, da-suan, knoblauch, la-suan, nectar of the gods, poor-man’s treacle, rustic treacle, stinking rose Origin: Garlic is a perennial bulb found throughout the world. Uses Garlic is used as an antilipidemic, antimicrobial, antiasthmatic, and antiinflammatory. It is a possible antihypertensive agent and is used to treat some types of heavy metal poisoning. Adverse effects: Underline = life-threatening G 282 Garlic Investigational Uses Studies are underway to determine the role of garlic as an anticancer, antioxidant, antiplatelet, and antidiabetic. Actions The main actions attributed to garlic are antimicrobial, antilipidemic, antitriglyceride, antiplatelet, antioxidant, and cancer preventive. Antimicrobial Action A study using aqueous extracts of garlic in vitro showed that garlic inhibits both gram-positive and gram-negative organisms (Sovova et al, 2002). Other studies have demonstrated the antimicrobial action of garlic against Mycobacterium tuberculosis (Hughes et al, 1991), Staphylococcus aureus (Gonzalez-Fandos et al, 1994), Candida sp (Shams-Ghahfarokhi, 2006), and multidrug-resistant Streptococcus mutans (Fani et al, 2007). Between 1983 and the present, various studies identified the antifungal, antiviral, and antiparasitic actions of garlic. Cardiovascular Action Garlic has been shown to exert cholesterol-lowering, triglyceride-lowering, and antiplatelet actions. Cholesterol-Lowering and Triglyceride-Lowering Actions In one study, the cholesterol-lowering action of garlic was equal to that of bezafibrate, a prescription drug available in Germany (Holzgartner et al, 1992). However, results of other studies have been mixed. One study showed no difference in cholesterol levels between the experimental and the control group (Neil et al, 1996). However, another study showed an 11% reduction in the cholesterol levels of male subjects after 12 weeks of garlic treatment (Adler et al, 1997). The chemical component believed to be responsible for the anticholesterol action is allicin, which is believed to reduce cholesterol production by preventing gastric lipase fat digestion and fecal excretion of sterols and bile acids (Gebhardt, 1993). Antiplatelet Action The antiplatelet effect of garlic has been demonstrated, with ajoene apparently functioning as the chemical component responsible (Apitz-Castro et al, 1994). Several investigations have demonstrated the ability of garlic to reduce platelet aggregation and cyclooxygenase (Ali, 1995; Apitz-Castro et al, 1994; Bordia et al, 1996). Among the documented results are improved circulation, decreased atherosclerosis, and improved intermittent claudication. Cancer Prevention A large amount of evidence is available to support the beneficial effects of garlic in the prevention of cancer and the slowing of its progression. There may be a decrease in the development of gastric cancer when garlic is added to the diet. Another study has shown that the addition of vegetables in the Allium genus (onions, leeks, garlic) to the diet prevents gastric cancer (Dorant et al, 1996). The protective effects may be due to the antioxidant properties of these vegetables and their ability to inhibit cancer cell proliferation. Other Actions Garlic has been shown to inhibit free radicals, which may be responsible for cancer proliferation, and to decrease lipid peroxidation (Rietz et al, 1995). Other actions have been proposed, such as the hypoglycemic effects of garlic and its role as a protectant against lead, cadmium, and radiation poisoning, but to date little research supports these claims. = Pregnancy = Pediatric ! = Alert = Popular Herb Garlic 283 Product Availability Bulbs, capsules, extract, fresh garlic, oil, powder, syrup, tablets, tea Plant Part Used: Bulb (root) Dosages Garlic may be standardized to its allicin (active ingredient) content. Chronic Candidiasis • Adult PO fresh garlic: 4 g daily (Murray, Pizzorno, 1998) General Use • Adult PO extract, aged: 4 ml daily (McCaleb et al, 2000) • Adult PO fresh garlic: 4 g daily (Blumenthal, 1998; McCaleb et al, 2000) • Adult PO oil, perles: 10 mg daily (McCaleb et al, 2000) Hypercholesteremia/Hypertension • Adult PO: 40,000 mcg daily (allicin) (Murray, Pizzorno, 1998) • Adult PO capsules/powder/tablets: 600-900 mg daily in divided doses to decrease lipids (McCaleb et al, 2000) General Use • Child PO fresh garlic: 1⁄2-3 cloves daily (Romm, 2000) • Child PO syrup: 1⁄2-1 tsp/day (Romm, 2000) • Child PO tea: 1 cup daily; may give up to 4 cups daily to treat colds (Romm, 2000) Contraindications Pregnancy category is 1; breastfeeding category is 2A. Because garlic may reduce iodine uptake, it should not be used by persons with hypothyroidism. Because garlic may cause clotting time to be increased, it should not be used by persons who recently have had or are about to have surgery. Garlic should not be used by persons with stomach inflammation, gastritis, or hypersensitivity to this herb. Side Effects/Adverse Reactions CNS: Dizziness, headache, irritability, fatigue, insomnia CV: Tachycardia, orthostatic hypotension GI: Nausea, vomiting, anorexia GU: Hypothyroidism INTEG: Hypersensitivity reactions, contact dermatitis RESP: Asthma, shortness of breath SYST: Diaphoresis, garlic odor, irritation of the oral cavity, decreased red blood cells, hypothyroidism Interactions Drug Anticoagulants (anisindione, dicumerol, heparin, warfarin), antiplatelets, NSAIDs, salicylates: Garlic may increase bleeding when used with these products; do not use concurrently. Antidiabetics (acetohexamide, chlorpropamide, glipizide, metformin, tolazamide, tolbutamide, troglitazone): Because of the hypoglycemic effects of garlic, oral antidiabetic dosages may need to be adjusted. Continued Adverse effects: Underline = life-threatening G 284 Garlic Interactions—cont’d Cytochrome P4503A4 substrates: Garlic containing allicin may increase the action of cytochrome P4503A4. Hormonal contraceptives, nonnucleoside reverse transcriptase inhibitors: Garlic with allicin may decrease the action of hormonal contraceptives, nonnucleoside reverse transcriptase inhibitors. Insulin: Because of the hypoglycemic effects of garlic, insulin dosages may need to be adjusted. Herb Acidophilus: Acidophilus may decrease the absorption of garlic. If taken concurrently, separate the dosages by 3 hours. Anticoagulant/antiplatelet, fish oils herbs: Garlic used with herbs having anticoagulant/antiplatelet properties may increase risk of bleeding. Lab Test LDL, platelet aggregation, triglycerides, blood lipid profile: Garlic may decrease LDL cholesterol (aged extract taken continuously), platelet aggregation (aged extract of garlic taken over extended period of time), triglycerides (aged extract of garlic taken over extended period of time), blood lipid profile. Prothrombin time INR, APTT, serum IgE: Garlic may increase prothrombin time, INR, APTT and serum immunoglobulin E (IgE). Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Volatile oil Alliin Allicin Antiplatelet, anticoagulant Alliinase Ajoene Terpene Diallyl sulfide Vitamin Mineral Antiplatelet, anticoagulant Citral; Geraniol; Linalool A; B; C; E Selenium Germanium; Zinc; Magnesium Antioxidant Amino acid Glycoside Client Considerations Assess • Assess the reason the client is using garlic. • Because garlic is a common allergen, assess for hypersensitivity reactions and contact dermatitis. If such reactions are present, discontinue the use of garlic and administer an antihistamine or other appropriate therapy. • Assess lipid levels if the client is using garlic to decrease lipids. • Monitor CBC and coagulation studies if the client is using garlic at high doses or with anticoagulants. Identify anticoagulants the client is using, including salicylates (see Interactions). = Pregnancy = Pediatric ! = Alert = Popular Herb Gentian 285 • Determine whether the client is diabetic and is using insulin or antidiabetics; dosages may need to be adjusted (see Interactions). Administer • Instruct the client to avoid the daily use of medicinal garlic, unless under the supervision of a qualified herbalist. Blood clotting may be affected. • Instruct the client to store garlic products in a sealed container away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 1 and breastfeeding category is 2A. • Inform the client that some studies have indicated that garlic may be helpful in treating children with hypercholesterolemia (McCindle, Connor, 1998). G • Advise the client to inform all health care providers of garlic use. • Caution the client to discontinue the use of garlic before undergoing any invasive procedure in which bleeding may occur. Gentian (jehn’shuhn) Scientific names: Gentiana lutea L., Gentiana acaulis L. Other common names: Bitter root, bitterwort, feltwort, gall weed, pale gentian, stemless gentian, yellow gentian Origin: Gentian is a flowering perennial found in Europe and Asia. Uses Gentian has been used to stimulate the appetite and to treat digestive disorders such as colitis, irritable bowel syndrome, colic, gallstones, biliary pain, peptic ulcer, and heartburn. It is also used as a component in alcoholic beverages (bitters). Actions Very little primary research is available for gentian. It is typically used to stimulate the appetite and is usually mixed in alcoholic products. However, no studies support this use. Several of the chemical components, gentiopicroside, sweroside, and swertiamerine; secoiridoids are responsible for the wound-healing properties of gentian (Oztürk et al, 2006). Product Availability Fluid extract, infusion, root, tea, tincture Plant Parts Used: Rhizome, roots Dosages • Adult PO fluid extract: 2-4 g daily (Blumenthal, 1998) • Adult PO infusion: no dosage consensus • Adult PO root: 2-4 g daily (Blumenthal, 1998) • Adult PO tea: Place 1⁄2 tsp in 4 oz water, boil and strain, take tid before meals • Adult PO tincture: 1-3 g daily (Blumenthal, 1998); 2 ml tid (1:5 dilution) (Mills, Bone, 2000) Adverse effects: Underline = life-threatening 286 Gentian Contraindications Pregnancy category is 3; breastfeeding category is 2A. Gentian should not be given to children. It should not be used by persons with hypersensitivity to this herb, those with stomach irritability or inflammation, or those with stomach or duodenal ulcers. Side Effects/Adverse Reactions CNS: Headache GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions Interactions Drug Antacids, H2-blockers, proton pump inhibitors: Gentian may decrease the action of these agents (theoretical) (Jellin et al, 2008). Iron salts: Gentian may interfere with absorption of iron salts; separate by at least 2 hours. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Alkaloids Gentiopicrin Gentiamarin Gentiin Gentisin Gentianose Increased salivation, digestive juice secretions Gentisic acid Amarogentin Gentiopicroside, Swertiamarin, Sweroside Xanthones Tannins Volatile oil Isoorientin Wound healing Hypoglycemic (Sezik et al, 2005) Client Considerations Assess • Assess the reason the client is using gentian. • Assess for hypersensitivity reactions. If present, discontinue use of this herb and administer an antihistamine or other appropriate therapy. Administer • Instruct the client to store gentian products in a cool, dry place, away from heat and moisture. = Pregnancy = Pediatric ! = Alert = Popular Herb Ginger 287 Teach Client/Family • Inform the client that pregnancy category is 3 and breastfeeding category is 2A. • Caution the client not to give gentian to children. Ginger (jin’ juhr) Scientific name: Zingiber officinale Other common names: Black ginger, race ginger, zingiber Origin: Ginger is found in the tropics of Asia and is now cultivated in the tropics of South America, China, India, Africa, the Caribbean, and parts of the United States. Uses Ginger is used to prevent and relieve motion and morning sickness; to relieve sore throat, nausea, and vomiting; to treat migraine headaches; and as an antioxidant. Investigational Uses Preliminary research is available that documents the efficacy of ginger in decreasing the pain and inflammation associated with arthritis and other joint disorders. Some evidence indicates that it may also reduce platelet aggregation. Ginger may decrease hyperglycemia, ulcers, and fever. Actions Antiemetic and Antinausea Actions Several studies have documented the antiemetic and antinausea actions of ginger. When dried ginger powder was evaluated against dimenhydrinate and a placebo, ginger was found to reduce nausea and vomiting more effectively than dimenhydrinate (Mowrey et al, 1982). This effect is postulated to result from action on the digestive tract instead of the central nervous system. Ginger lacks any anticholinergic effects. Since these studies were completed, several other studies have also confirmed the antiemetic and antinausea effects of ginger. Antiinflammatory Action In one study, the ability of ginger to decrease induced paw edema in laboratory animals was equal to that of aspirin. Its ability to inhibit arachidonic acid metabolism is believed to be responsible. Ginger has been used in traditional medicine to treat rheumatic disorders. Other Actions Other actions for ginger include antiulcer, antiplatelet, antipyretic, antiinfective, antioxidant, and antidiabetic action; improved digestive function and positive inotropic action. Improved Digestive Functioning Improved digestive functioning may occur as a result of increased amylase and salivary production. Ginger has been shown to increase the absorption of other drugs and to prevent degradation during the first hepatic pass (Chang et al, 1987). Adverse effects: Underline = life-threatening G 288 Ginger Antiulcer Action The antiulcer effects of ginger may be due to two of its chemical components, gingerol and gingesulphonic acid. Improvements in ulcer patients occurred with the use of ginger decocted in water. However, relapse was common, and complete cure did not occur (Chang et al, 1987). Antiplatelet Action The antiplatelet action of ginger may be a result of the inhibition of thromboxane formation. Increases occurred in ADP, collagen, arachidonic acid, and epinephrine when ginger was used. Antipyretic Action The antipyretic effect of ginger is due to its prostaglandin inhibition. Ginger is as effective as aspirin in reducing fever (Mascolo et al, 1989). Antiinfective Action Ginger exerts antiinfective action against both gram-positive and gram-negative bacteria. Its antiinfective action was very weak when tested; however, one class of chemical components, the sesquiterpenes, did exert significant action against antirhinoviral infections (Denyer et al, 1994). Antioxidant Action The antioxidant effects of ginger may be the result of the actions of gingerol and zingerone, two of its chemical components. These components inhibit lipoxygenase and eliminate the radicals superoxide and hydroxyl (Cao et al, 1993). Another study (Ahmed et al, 2000) identified a significant lowered lipid peroxidation by maintaining activities of the antioxidant enzymes, again strengthening the supportive evidence for use of ginger as an antioxidant. Antidiabetes Action Ginger may be useful in the treatment of hyperglycemia. Rabbits treated with ginger exhibited a hypoglycemic effect (Mascolo et al, 1989). Positive Inotropic Action In one study, the cardiovascular actions of ginger included a positive inotropic effect. When subjects were asked to chew fresh ginger, their blood pressure increased. This action resulted from the pressor response, but it was short term (Chang et al, 1987). Radioprotection Action One study showed radiation protection when the extract was used. Ginger extract was given 1 hour before radiation and showed significant blocking of the effects of radiation (Haksar et al, 2006). Product Availability Capsules, dried root, extract, fresh root, powder, tablets, tea, tincture Plant Part Used: Rhizome Dosages Ginger may be standardized to its volatile oil (4%) or essential oil (8%). General Use • Adult PO dried ginger capsules: 1 g/day (McCaleb et al, 2000) • Adult PO dried root equivalent: 500 mg bid-qid (Mills, Bone, 2000) • Adult PO fluid extract: 0.7-2 ml/day (1:2 dilution) (Mills, Bone, 2000) • Adult PO fresh root equivalent: 500-1000 mg tid (Mills, Bone, 2000) • Adult PO tablets/caps: 500 mg bid-qid (Mills, Bone, 2000) • Adult PO tincture: 1.7-5 ml/day (1:5 dilution) (Mills, Bone, 2000) = Pregnancy = Pediatric ! = Alert = Popular Herb Ginger 289 Migraine • Adult PO dried ginger: 500 mg qid • Adult PO extract: 100-200 mg, standardized to 20% ginerol and shogol • Adult PO fresh ginger: 10 g/day (1⁄4-inch slice) (Murray, Pizzorno, 1998) Motion Sickness and Morning Sickness Prevention • Adult PO extract: 100-200 mg, standardized to 20% ginerol and shogol • Adult PO powder: 1-2 g 1⁄2-1 hr before traveling or upon arising • Adult PO tea, dried root: 11⁄2 tsp ground dried root in 1 cup water, boil 5-10 min, drink prn • Adult PO tea, fresh root: 1 tsp fresh root in 1 cup water, infuse 5 min, drink prn Rheumatoid Arthritis • Adult PO extract: 100-200 mg, standardized to 20% ginerol and shogol (Murray, Pizzorno, 1998) • Adult PO fresh ginger: 8-10 g/day (Murray, Pizzorno, 1998) Sore Throat • Adult PO fresh root tea: 1 tsp fresh root in 1 cup water, infuse 5 min, gargle prn (Murray, Pizzorno, 1998) General Use • Child PO ginger root tea: 1⁄4-1 cup prn (Romm, 2000) • Child PO tincture: 5-25 drops in water prn (Romm, 2000) Contraindications Pregnancy category is 1; breastfeeding category is 2A. Ginger should not be used by persons with hypersensitivity to it. Unless directed by a physician, ginger should not be used by persons with cholelithiasis. Side Effects/Adverse Reactions CV: Arrhythmias GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions Interactions Drug All oral medications: Ginger may increase absorption of all medications taken orally. Antacids, antidiabetics, antihypertensives, H2-blockers, proton pump inhibitors: Ginger may decrease the action of these agents (theoretical) (Jellin et al, 2008). Anticoagulants (ardeparin, anisindione, aspirin, dicumerol, dalteparin, heparin, warfarin), antiplatelets (abciximab): Ginger may increase the risk for bleeding when used concurrently with anticoagulants, antiplatelets (theoretical). Herb Anticoagulant/antiplatelet herbs: When used with anticoagulant/antiplatelet herbs, ginger may increase the risk for bleeding (theoretical) (Jellin et al, 2008). Lab Test Plasma partial prothrombin time, prothrombin time: Ginger may increase plasma partial prothrombin time in clients taking warfarin concurrently and may increase prothrombin time. Adverse effects: Underline = life-threatening G 290 Ginkgo Pharmacology Pharmacokinetics Information on the pharmacokinetics and pharmacodynamics of ginger is limited. Its metabolites are known to be eliminated via urinary excretion within 24 hours, and it is 90% bound to plasma proteins. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Pungent Gingerol Antioxidant; antiulcer, cardiotonic Antioxidant Zingerone Shogaol Bisabolene; Zingiberene; Zingiberol Volatile oil Proteolytic enzyme Gingesulphonic acid Sesquiterpene Antimicrobial Antiulcer Antiviral Client Considerations Assess • Assess the reason the client is taking ginger. • Assess for hypersensitivity reactions. If present, discontinue use of this herb and administer an antihistamine or other appropriate therapy. • Assess all medications used (see Interactions). Administer • Instruct the client to store ginger products in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 1 and breastfeeding category is 2A. Ginkgo (ging’koe) Scientific name: Gingko biloba Other common names: Maidenhair tree, rokan, sophium, tanakan, tebofortan, tebonin Origin: Ginkgo is a tree native to China and Japan. It is now also found in the United States and Europe. Uses Gingko is used to decrease disturbances of cerebral functioning and peripheral vascular insufficiency in persons with Alzheimer’s disease or other types of agerelated dementia. It is also used as an antioxidant, to improve peripheral artery = Pregnancy = Pediatric ! = Alert = Popular Herb Ginkgo 291 disease, and to enhance circulation throughout the body. Other reported uses include the treatment of depressive mood disorders, sexual dysfunction, asthma, glaucoma, menopausal symptoms, multiple sclerosis, headaches, tinnitus, dizziness, arthritis, altitude sickness, and intermittent claudication. Actions Much research is available documenting the uses and actions of Ginkgo biloba L. Ginkgo has been used in China since ancient times. Initial research began in Europe in the 1960s. Cognitive Enhancement Action The cognitive enhancement action of ginkgo is a result of the flavonoids present in the extract. The pharmacologic actions involve increased release of neurotransmit- G ters, including catecholamines, and inhibition of monoamine oxidase. Approximately 50 controlled studies between 1975 and 1997 have demonstrated the positive effects of gingko in the treatment of cerebral insufficiency. All studies incorporated various dosages and varying lengths of treatment, and all results were positive. However, newer studies have questioned the benefit of ginkgo for cognitive function (Carlson et al, 2007; Mazza et al, 2006). Vasoprotective and Tissue-Protective Actions The vasoprotective and tissue-protective actions of ginkgo result from several factors: its ability to relax blood vessels, to protect against capillary permeability, to inhibit platelet aggregation, and to decrease ischemia and edema. Studies have confirmed this effect in rabbits (Monboisse et al, 1993). Other Actions Gingko has been studied for its antioxidant effects, its relief of altitude sickness, its antiarthritic and analgesic effects, and its relief of ischemia in intermittent claudication. Antioxidant Action Gingko has been studied for its antioxidant effects. It has been found to eliminate free radicals and is able to inhibit polymorphonuclear neutrophils (Monboisse et al, 1993). Altitude Sickness Relief Ginkgo can relieve altitude sickness. One study involving two groups of mountain climbers focused on the effects of gingko when traveling to high altitudes. One group took 160 mg of gingko daily while climbing, and the other received a placebo. Both groups ascended to 14,700 feet and made other ascents from that point. None of the gingko group reported full-blown altitude sickness, whereas 82% of the placebo group did (Feng et al, 1989). Another study (Gertsch et al, 2002) was designed to identify the time needed to prevent acute mountain sickness. One day of pretreatment with ginkgo 60 mg tid significantly reduced the severity of acute mountain sickness. However, a newer study found no benefit in using ginkgo to prevent altitude sickness (Chow et al, 2005). Antiarthritic and Analgesic Actions Ginkgetin, a chemical component of gingko, has been studied for its antiarthritic and analgesic effects. Ginkgetin given in dosages of 10-20 mg/kg/day reduced arthritic inflammation in laboratory animals by 86% at the highest dose given (Kim et al, 1999). Adverse effects: Underline = life-threatening 292 Ginkgo Product Availability Capsules, fluid extract, tablets, tincture Plant Part Used: Leaves Dosages Ginkgo may be standardized to 24% ginkgo flavonglycosides and 6% terpene trilactones. Alzheimer’s Disease • Adult PO capsules/extract/tablets: 80 mg tid standardized to 24% flavonglycosides (Murray, Pizzorno, 1998) Asthma • Adult PO extract: 80 mg tid (Murray, Pizzorno, 1998) Cerebral Vascular Insufficiency • Adult PO extract: 80 mg tid standardized to 24% flavonglycosides (Murray, Pizzorno, 1998) General Use • Adult PO standardized extract: 40 mg tid Glaucoma • Extract: 40-80 mg tid standardized to 24% flavonglycosides (Murray, Pizzorno, 1998) Impotence from Arterial Insufficiency • Adult PO extract: 80 mg tid standardized to 24% flavonglycosides (Murray, Pizzorno, 1998) Menopause • Adult PO extract: 40 mg tid standardized to 24% flavonglycosides (Murray, Pizzorno, 1998) Multiple Sclerosis • Adult PO extract: 40-80 mg tid standardized to 24% flavonglycosides (Murray, Pizzorno, 1998) Contraindications Pregnancy category is 2; breastfeeding category is 1A. Ginkgo should not be given to children. It should not be used by persons with coagulation or platelet disorders, hemophilia, seizures, or hypersensitivity to this herb. Side Effects/Adverse Reactions CNS: Transient headache, anxiety, restlessness GI: Nausea, vomiting, anorexia, diarrhea, flatulence INTEG: Hypersensitivity reactions, rash Interactions Drug Anticoagulants (anisindione, dalteparin, dicumerol, heparin, salicylates, warfarin), platelet inhibitor (abciximab), salicylates: Because of the increased risk of bleeding, ginkgo should not be taken concurrently with these products. Anticonvulsants (carbamazepine, gabapentin, phenobarbital, phenytoin): Ginkgo components may decrease the anticonvulsant effect; avoid concurrent use. = Pregnancy = Pediatric ! = Alert = Popular Herb Ginkgo 293 Interactions—cont’d Buspirone, fluoxetine: Ginkgo given with these agents may cause hypomania (Jellin et al, 2008). Cytochrome P450IA2/P4502D6/P4503A4 substrates: Ginkgo may affect drugs metabolized by these agents; use caution if giving concurrently (Jellin et al, 2008). MAOIs: MAOI action may be increased if taken with ginkgo; do not use concurrently (theoretical). SSRIs: Ginkgo is often used to reverse the sexual side effects of SSRIs. Trazadone: Ginkgo with trazadone may cause coma (Jellin et al, 2008). Herb Anticoagulant/antiplatelet herbs: Ginkgo may increase the risk of bleeding when used with these herbs (Jellin et al, 2008). St. John’s wort: Ginkgo with St. John’s wort can lead to hypomania. Lab Test Partial thromboplastin time, ASA tolerance test: Ginkgo may cause increased bleeding (partial thromboplastin time, ASA tolerance test). Platelet activity: Ginkgo may decrease platelet activity. Prothrombin time, blood salicylate: Ginkgo may increase prothrombin time and blood salicylate. Pharmacology Pharmacokinetics Excretion ⬍30% of metabolites. Bioavailability is unaffected by food. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Flavonoid Kaempferol; Quercetin Antiinflammatory, antioxidant, cognitive enhancement Diterpene Isorhamnetin; Myricetin Ginkgolides Sesquiterpene Triterpene Ginkgetin Bilobalide Sterols; Benzoic; Ginkgolic Platelet inhibitor; neuroprotective effects Antioxidant Antiinflammatory; antiarthritic Client Considerations Assess • Assess the reason the client is using ginkgo. • Assess for hypersensitivity reactions. If present, discontinue the use of this herb and administer an antihistamine or other appropriate therapy. • Assess for the use of anticoagulants, platelet inhibitors, or MAOIs (see Interactions). Adverse effects: Underline = life-threatening G 294 Ginseng Administer • Inform the client that ginkgo takes 1 to 6 months before it becomes effective. Teach Client/Family • Inform the client that pregnancy category is 2 and breastfeeding category is 1A. • Caution the client not to give ginkgo to children. • Caution the client not to use ginkgo with anticoagulants, platelet inhibitors, trazadone, or MAOIs. Ginseng (jin’sing) Scientific names: Panax quinquefolius, Panax ginseng Other common names: American ginseng, Asiatic ginseng, Chinese ginseng, five-fingers, Japanese ginseng, jintsam, Korean ginseng, ninjin, Oriental ginseng, schinsent, seng and sang, tartar root, Western ginseng Origin: Ginseng is now found throughout the world. Panax quinquefolius is native to North America; Panax ginseng is native to the Far East. Uses Ginseng has been used for a variety of purposes for about 5000 years. It has been used to increase physical endurance and lessen fatigue, to improve the ability to cope with stress, and to improve concentration. It also may improve overall well-being. Many herbalists consider it a tonic. Investigational Uses Initial research is exploring the use of ginseng to improve cognitive functioning and to treat diabetes mellitus, hyperlipidemia, seizure disorders, cancer, male infertility, male erectile dysfunction, emphysema, and rheumatoid arthritis and to enhance immunity. Actions Most of the available research on ginseng comes from Asia, where this herb has been studied extensively. Investigators have completed research on the ability of ginseng to decrease fatigue, increase physical performance, and improve mental functioning. Studies have also been done on its anticancer and antidiabetes effects. Decreased Fatigue, Increased Physical Performance, and Improved Mental Function Decreased Fatigue One study used a questionnaire to identify participants with fatigue. The subjects were treated with either ginseng or a placebo. Results showed significant improvement in fatigue with the use of ginseng as compared with the use of a placebo (Le Gal et al, 1996). Increased Physical Performance Studies using both human subjects and laboratory animals indicate that ginseng increases physical performance. In one study, male athletes took 200 mg of standardized ginseng daily. Their performance increased significantly, as demonstrated by measurements including increased oxygen utilization and improved reaction time (Forgo et al, 1985). = Pregnancy = Pediatric ! = Alert = Popular Herb Ginseng 295 Improved Mental Function In both animal and human studies, ginseng has been shown to improve mental functioning. Anticonvulsant Action Generalized tonic-clonic convulsions were induced in rats by chemical means, then Panax ginseng was given to one group every day: 100 mg/kg 1⁄2 hour before administration of convulsive chemical (Gupta et al, 2001). There was significant protection in the group treated with Panax ginseng. Panax ginseng may show promise as an anticonvulsant. Anticancer Action A significant reduction in cancer risk occurred when a large group of human sub- G jects was divided into control and experimental groups, matched for multiple risk factors, and given ginseng. Those taking ginseng had a lower cancer risk than those in the control group (Yun et al, 1990). Also, long-term administration of ginseng inhibits tumor growth. Antidiabetic Action Ginseng has been used for centuries to treat diabetes mellitus. Its antidiabetic action results from the chemical components from adenosine, known as panaxans, and others (Ng et al, 1985). Ginseng has shown glucoregulating properties even when administered with glucose (Liu et al, 2005; Reay et al, 2006). Product Availability Capsules, dried root used for decoction, extract, powder, standardized extract, tea, tincture; may be found in creams and lotions used to treat wrinkles Plant Part Used: Roots Dosages Standardized extracts contain 5% ginsenosides (an aglycone chemical component believed to act as a stimulant). General Use • Adult PO capsules: 200-500 mg extract daily (Blumenthal, 1998) • Adult PO infusion: pour boiling water over 3 g herb, let stand 10 min, strain; may be taken tid for 3-4 wk • Adult PO powdered root: 1-4 g daily • Adult PO standardized extract: 200-500 mg daily (Blumenthal, 1998) • Adult PO tincture: 1-2 ml extract daily (1:1 dilution) (Blumenthal, 1998) Male Infertility • Adult PO crude herb (root, high quality): 1.5-2 g tid (Murray, Pizzorno, 1998) • Adult PO extract: 100-200 mg tid standardized to 5% ginsenosides (Murray, Pizzorno, 1998) Rheumatoid Arthritis • Adult PO crude herb: 4.5-6 g/day in divided doses • Adult PO extract: 500 mg daily-tid Attention Deficit Hyperactivity Disorder • Child PO: 200 mg bid in combination with ginkgo biloba ⫻ 4 wk Adverse effects: Underline = life-threatening 296 Ginseng Contraindications Pregnancy category is 1; breastfeeding category is 2A. Ginseng should not be given to children. It should not be used by persons with hypertension, cardiac disorders, or hypersensitivity to it. If breast cancer or other estrogen-dependent conditions are present, ginseng should not be used. Side Effects/Adverse Reactions CNS: Anxiety, insomnia, restlessness (high doses), headache CV: Hypertension, chest pain, palpitations, decreased diastolic blood pressure, increased QTc interval. GI: Nausea, vomiting, anorexia, diarrhea (high doses) Ginseng Abuse Syndrome: Edema, insomnia, hypertonia INTEG: Hypersensitivity reactions, rash Interactions Drug Anticoagulants (anisindione, dicumarol, heparin, warfarin), antiplatelets, salicylates: Ginseng may decrease the action of these products. Anticonvulsants: Ginseng may provide an additive anticonvulsant action (theoretical). Antidiabetics (acetohexamide, chlorpropamide, glipizide, metformin, tolazamide, tolbutamide, troglitazone): Because ginseng is known to decrease blood glucose levels, it may increase the hypoglycemic effect of antidiabetics; avoid concurrent use. Immunosuppressants (azathioprine, basiliximab, cyclosporine, daclizumab, muromonab, mycophenolate, tacrolimus): Ginseng may diminish the effect of immunosuppressants; do not use immediately before, during, or after transplant surgery. Insulin: Because ginseng is known to decrease blood glucose levels, it may increase the hypoglycemic effect of insulin; avoid concurrent use. MAOIs (isocarboxazid, phenelzine, tranylcypromine): Concurrent use of MAOIs with ginseng may result in manic-like syndrome. Stimulants: Use of stimulants (e.g., xanthines) concurrently with ginseng is not recommended; overstimulation may occur. Herb Caffeine, guarana, yerba maté, tea: Ginseng with these agents may lead to added stimulation (Jellin et al, 2008). Ephedra: Concurrent use of ephedra and ginseng may increase hypertension and central nervous system stimulation; avoid concurrent use. Food Caffeinated coffee, cola, tea: Overstimulation may occur when ginseng is used with caffeinated coffee, cola, and tea; avoid concurrent use. Lab Test Blood glucose: Ginseng may decrease blood glucose (decoctions, infusions). Plasma partial thromboplastin time, INR: Ginseng may increase plasma partial thromboplastin time and INR. Serum, urine estrogens: Ginseng may have an additive effect on serum and 24-hour urine estrogens. Serum digoxin: Ginseng may falsely increase serum digoxin. = Pregnancy = Pediatric ! = Alert = Popular Herb Glossy Privet 297 Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Triterpene saponin Ginsenosides Stimulant inhibits platelet activating factor, anticancer, CNS depressant, anticonvulsant Sesquiterpene Polyacetylenes Polysaccharide Adenosine Essential oil Peptides Falcarinol; Falcarintriol Panaxans A-U Antidiabetes Antidiabetes Client Considerations Assess • Assess the reason the client is using ginseng. • Assess for hypersensitivity reactions and rash. If these are present, discontinue the use of this herb and administer an antihistamine or other appropriate therapy. • Assess for ginseng abuse syndrome: insomnia, edema, and hypertonia. • Assess for the use of stimulants, anticoagulants, MAOIs, and antidiabetics (see Interactions). Administer • Instruct the client to store ginseng products in a cool, dry place, away from heat and moisture. • Instruct the client to avoid the continuous use of ginseng. The recommendation is to use this herb for no more than 3 continuous months, taking a break between courses (Mills, Bone, 2000). Teach Client/Family • Inform the client that pregnancy category is 1 and breastfeeding category is 2A. • Caution the client not to give ginseng to children. • Advise the client to use other stimulants and antidiabetics carefully if taking concurrently with ginseng (see Interactions). • Warn the client of the life-threatening side effects of ginseng abuse syndrome. • Instruct the client that Siberian ginseng and Panax ginseng are not the same. Glossy Privet (gloss’ ee priv’ et) Scientific name: Ligustrum lucidum Other common names: Chinese privet, dongquingzi, nu zhen, nuzhenzi, privet\ Origin: Glossy privet originates from China. Adverse effects: Underline = life-threatening G 298 Glossy Privet Uses Traditionally, glossy privet has been a part of Chinese medicine and is used for palpitations, colds, congestion, darkening hair, and reducing age spots, and the effects of chemotherapy. Actions There is very little research for use of glossy privet in any conditions; most information comes from anecdotal information. One of glossy privet’s chemical components, oleanolic acid, has shown hypoglycemic and hypolipidemic actions (Gao et al, 2007). Product Availability Powdered berries Plant Part Used: Berries Dosages • Adult PO: 5-15 g of powdered berries per day • Adult PO tea: steep 2-5 g powdered berries in 1 cup boiling water Contraindications Glossy privet should not be used in children or those who are pregnant, breastfeeding, or hypersensitive to this product. Side Effects/Adverse Reactions SYST: Allergic reactions Primary Chemical Components and Possible Actions Chemical Class Individual Component Flavonoids Apigenin, Cosmosiin, Apigenin-7, Lutinoside, Luteolin, Quercetin (Xu et al, 2007) Triterpenoids Glycosides Mannitol Oleanolic acid Possible Action Hypoglycemic, hypolipidemic Client Considerations Assess • Assess the reason the client is using glossy privet. Administer • Keep glossy privet in a dry area, away from direct sunlight. Teach Client/Family • Teach the patient that glossy privet should not be used in children or those who are pregnant or breastfeeding until more research is available. • Advise the client that if allergic reactions occur, stop using the product. = Pregnancy = Pediatric ! = Alert = Popular Herb Glucomannan 299 Glucomannan (glew-koe-man’uhn) Scientific name: Amorphophallus konjac Other common names: Konjac, konjac mannan Origin: Glucomannan is purified from konjac flour by chemical processing. Uses Glucomannan is useful as a bulk laxative. Investigational Uses Researchers are studying glucomannan for its lipid-lowering action and antidiabetic G effects. Glucomannan has also shown some efficacy in promoting weight loss. Actions Because some of the chemical components are the same (mannose and a similar polysaccharide, galactose), glucomannan has many of the same properties as guar gum. For this reason, the actions of guar gum and glucomannan may be expected to be the same. Glucomannan has been used as an antidiabetic and anticholesteremic agent, an aid to weight reduction, and a laxative. There is beginning research to suggest glucomannan possesses antibacterial proteins (Zhou et al, 2007). Antidiabetes Action Glucomannan has been shown to delay absorption of glucose from the intestine. In one study in which diabetic clients received glucomannan for 3 months, fasting blood glucose levels decreased by approximately one third, and dosages of antidiabetic agents were able to be reduced (Doi et al, 1979). Anticholesteremic Action In one study using laboratory rats, cholesterol levels were reduced when glucomannan was added to the rats’ diet (Kiriyama, 1969). When overweight individuals with high cholesterol levels were given 100 ml of a 1% glucomannan solution for 11 weeks, cholesterol levels decreased by a mean of 18%. In another study, men’s cholesterol levels decreased by approximately 10% (Arvill et al, 1995). Weight Reduction Results have been mixed when glucomannan is used for weight reduction. One study showed a decrease in weight of 2.2 kg at the end of 2 months when 1.5 g of glucomannan was added to the diet twice a day (Reffo et al, 1990). Laxative Action Because the addition of water to the polysaccharides glucose and mannose causes them to swell, these substances are used as bulk laxatives. Viscosity of the intestinal contents is increased and gastric emptying is slowed. This may be of benefit for chronic constipation in neurologically impaired children (Staiano, 2000). Product Availability Capsules, powder, tablets Plant Part Used: Tubers Dosages Diabetes Mellitus • Adult PO capsules/tablets: up to 7.2 g daily; treatment of longer than 3 mo may be required Adverse effects: Underline = life-threatening 300 Glucomannan Lipid Lowering • Adult PO capsules/tablets: no consensus on dosage Weight Loss • Adult PO capsules/tablets: 1 g tid 1 hr before meals Contraindications Until more research is available, glucomannan should not be used during pregnancy and breastfeeding. It should not be given to children. Persons with hypersensitivity to glucomannan should not use it. Side Effects/Adverse Reactions ENDO: Hypoglycemia GI: Nausea, vomiting, anorexia, diarrhea, flatulence, cramping, dyspepsia, gastrointestinal obstruction or perforation INTEG: Hypersensitivity reactions Interactions Drug All medications: Glucomannan may decrease the absorption of medications if taken concurrently; separate dosages by at least 2 hours. Antidiabetics, insulin: Glucomannan may increase the hypoglycemic effect of antidiabetics, insulin. Antilipidemics: Glucomannan may increase the action of antilipidemics. Herb Hypoglycemic herbs: Glucomannan with other hypoglycemic herbs may increase hypoglycemia (Jellin et al, 2008). Lab Test Cholesterol, glucose, low-density lipoproteins: Glucomannan may decrease levels of these lab tests (Jellin et al, 2008). Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Polysaccharide Mannose Laxative; hypoglycemic; anticholesteremic, promotes hydration Glucose Client Considerations Assess • Assess the reason the client is using glucomannan. • Assess for hypersensitivity reactions. If present, discontinue the use of glucomannan and administer an antihistamine or other appropriate therapy. • Assess for use of medications. Concurrent glucomannan use may decrease their absorption or increase their effects (see Interactions). Administer • Instruct the client to store glucomannan products in a cool, dry place, away from heat and moisture. = Pregnancy = Pediatric ! = Alert = Popular Herb Glucosamine 301 Teach Client/Family • Caution the client not to use glucomannan in children or those who are pregnant or breastfeeding until more research is available. • Caution the client that gastrointestinal obstruction and perforation have occurred in conjunction with use of this product. Glucosamine (glew-koe’suh-meen) Scientific name: 2-amino-2-deoxyglucose Other common names: Chitosamine, GS Origin: Glucosamine is found in mucopolysaccharides, chitin, and mucoproteins. Glucosamine is a naturally occurring substance; glucosamine sulfate is manufactured synthetically. Uses Glucosamine typically is used in conjunction with chondroitin to treat joint conditions such as those associated with arthritis. Investigational Uses Researchers are working to determine whether glucosamine may be effective in the treatment of diabetes mellitus. Actions Antiarthritic Action The primary action of glucosamine is to protect against and prevent osteoarthritis. Several studies have focused on the results of glucosamine use as compared with that of nonsteroidal antiinflammatories and placebos. In one study more than 200 people were given either 500 mg of glucosamine or a placebo 3 times daily for 4 weeks. The experimental group showed significant improvement in movement and pain control (Noack et al, 1994). Another study comparing the benefits of glucosamine versus ibuprofen showed the two treatments to be equally effective after the second week of treatment. Study participants were then given 500 mg of glucosamine or 400 mg of ibuprofen 3 times daily for 4 weeks. The glucosamine group reported fewer side effects (Muller-Fassbender et al, 1994). A further study compared the effects of glucosamine and piroxicam. Subjects were given glucosamine, piroxicam, both, or a placebo for 3 months. The glucosamine group reported significant improvement as measured by the Lequesne index (Rovati et al, 1994). These results were achieved with fewer dropouts and fewer side effects. Studies are being added yearly that support the use of glucosamine in arthritic conditions (Altern Med Rev, 1999; Bruyere et al, 2007; Rubin et al, 2001; Towheed et al, 2005). Product Availability Capsules, tablets Dosages General Use • Adult PO capsules/tablets: 1500 mg glucosamine and 1200 mg chondroitin for average-weight individuals; lower doses for underweight individuals; higher doses for overweight individuals Adverse effects: Underline = life-threatening G 302 Glucosamine Osteoarthritis • Adult PO capsules/tablets: 1500 mg/day (Murray, Pizzorno, 1998) Contraindications Until more research is available, glucosamine should not be used during pregnancy or breastfeeding. It should not be given to children because its effects on them are unknown. Glucosamine should not be used by persons with hypersensitivity to it. Side Effects/Adverse Reactions CNS: Drowsiness, headache GI: Nausea, vomiting, anorexia, constipation or diarrhea, heartburn, epigastric pain and cramps, indigestion INTEG: Hypersensitivity reactions, rash (rare) Interactions Drug Anticoagulants, antiplatelets: Glucosamine and chondroitin at high levels can lead to bleeding risk (Jellin et al, 2008). Antidiabetics: Glucosamine may increase the effects of antidiabetics (theoretical). Lab Test International Normalized Ratio (INR): Glucosamine and chondroitin in high doses may lead to increased INR (Jellin et al, 2008). Pharmacology Chemical Properties Glucosamine sulfate is a synthetically manufactured product or derived from chitin (marine exoskeletons). Glucosamine is required for synthesis of certain proteins needed for tendons, ligaments, and cartilage. Client Considerations Assess • Assess the reason the client is using glucosamine. • Assess for hypersensitivity reactions, rash (rare). If these are present, discontinue use of glucosamine and administer an antihistamine or other appropriate therapy. • Assess for joint pain, stiffness, and aggravating or ameliorating factors. • Monitor blood glucose in diabetic patients (see Interactions). Administer • Instruct the client to take glucosamine PO with food to reduce gastric upset. • Instruct the client to store glucosamine products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use glucosamine in children or those who are pregnant or breastfeeding until more research is available. • Inform the diabetic client that glucosamine may lower blood glucose levels. = Pregnancy = Pediatric ! = Alert = Popular Herb Glutamine 303 Glutamine (gloo’ ta-men) Scientific name: L-Glutamine Other common name: Glutamine Origin: Synthetic Uses Glutamine is used for digestive disorders, healing after illness, and infections after strenuous exercise. Actions There are few studies that support the use of glutamine in healing serious illnesses and infection after strenuous exercise. There is no supporting evidence for the use of glutamine in digestive disorders such as ulcerative colitis or Crohn’s disease (Jellin et al, 2008). The beneficial effects of glutamine may depend on the route of administration. Studies on enteral or parenteral routes need to be completed (Vermenlen et al, 2007). Product Availability Tablets Dosages • Adult PO tablets: 2-6 g daily in divided doses Contraindications Glutamine should not be supplemented in pregnancy or breastfeeding. It should not be given to children. Interactions Drug Anticonvulsants: Glutamine may decrease the anticonvulsant action of anticonvulsants; avoid concurrent use. Client Considerations Assess • Assess the reason the client is using glutamine. • Identify if the client is taking anticonvulsants that should not be taken with this product. Administer • Keep glutamine in a dry area, away from direct sunlight. Teach Client/Family • Teach the patient that glutamine should not be used in children and not supplemented in those who are pregnant or breastfeeding until more research is available. Adverse effects: Underline = life-threatening G 304 Glycine Glycine (gli’ seen) Uses Glycine is used for CVA (stroke), schizophrenia, and to increase memory. Actions Glycine may augment heart transmission and modulate immune cell responses (Schilling et al, 2004). There is evidence that glycine may improve neurotransmission. When given glycine, CVA patients improved, as did the symptoms of apathy, and social withdrawal (Jellin et al, 2008). Product Availability Tablets Dosages • Adult PO tablets: 2-60 g daily in divided doses Contraindications Glycine should not be supplemented in those who are pregnant, breastfeeding, who have breast/prostate cancer or heart disease, or who are hypersensitive to this product. It should not be given to children. Pharmacology Pharmacokinetics Glycine crossess the blood-brain barrier (Miyazato et al, 2005). Client Considerations Assess • Assess the reason the client is using glycine. Administer • Keep glycine in a dry area, away from direct sunlight. Teach Client/Family • Teach the patient that glycine should not be used in children or supplemented in those who are pregnant or breastfeeding until more research is available. Goat’s Rue (goets rew) Scientific name: Galega officinalis Other common names: French honeysuckle, French lilac, Italian fitch Origin: Goat’s rue is a perennial found in parts of Europe and Iran. Uses Goat’s rue has been reported to function as both a diuretic and an antidiabetic. It is used to increase milk production. = Pregnancy = Pediatric ! = Alert = Popular Herb Goat’s Rue 305 Actions Very little primary research is available for goat’s rue, and no scientific studies confirm any of its reported actions. However, it has been used in Europe for many years to treat hyperglycemia. Toxicity may result from two of its chemical components, galegine and paragalegine. In one study (Palit et al, 1999) Galega officinalis shows a novel weight-reducing action that is independent of reduction of food intake in mice. Another study (Atanasov et al, 2000) identified the inhibiting and disaggregating effect of Galega officinalis on platelet aggregation. Liver and lung could serve as target organs in oral toxicity (Rasekh et al, 2008). Product Availability Dried leaves G Plant Parts Used: Dried leaves, flowers, stalks Dosages • Adult PO infusion: Pour 8 oz boiling water over 1 tsp dried leaves, let stand 15 min, strain, drink bid • Adult PO tincture: 1-2 ml tid Contraindications Pregnancy category is 2; breastfeeding category is 2A. Goat’s rue should not be given to children. It should not be used by persons with hypersensitivity to it. Side Effects/Adverse Reactions CNS: Headache, restlessness, weakness GI: Nausea Interactions Drug Antidiabetics: Goat’s rue may increase the effects of antidiabetics (theoretical). Herb Hypoglycemic herbs: Goat’s rue used with other hypoglycemic herbs can lead to increased hypoglycemia (theoretical) (Jellin et al, 2008). Lab Test Blood glucose: Goat’s rue may decrease blood glucose (theoretical) (Jellin et al, 2008). Primary Chemical Components and Possible Actions Chemical Class Tannin Alkaloid Individual Components Galegine Paragalegine; Peganine, Hydroxygalegine Possible Action Wound healing Possible toxicity Diuretic, hypoglycemic Lectins Flavonoids Adverse effects: Underline = life-threatening 306 Golden Rod Client Considerations Assess • Assess the reason the client is using goat’s rue. • Assess for hypersensitivity reactions. If these are present, discontinue use of glucosamine and administer an antihistamine or other appropriate therapy. • Monitor blood glucose in the diabetic patients (see Interactions). Administer • Instruct the client to take this herb PO only after steeping for 15 minutes in boiling water and straining. Teach Client/Family • Inform the client that pregnancy category is 2 and breastfeeding category is 2A. • Caution the client not to give goat’s rue to children. Golden Rod ! (goeld-uhn-rahd) Scientific name: Solidago virgaurea Other common names: Aaron’s rod, blue mountain tea, denrod, European gosweet goldenrod, woundwort Origin: Golden rod is a flowering plant found in Europe and the United States. Uses Golden rod may be used as a diuretic, an antispasmodic, an analgesic, and an antiinflammatory. In many countries, golden rod is used to prevent urolithiasis and to help eliminate calculi that have already been formed. Golden rod also may be used to induce abortion. It has been given to children to treat otitis media and for its anticatarrh effect (Mills, Bone, 2000). Actions The primary actions of golden rod are diuretic, antispasmodic, antimicrobial, analgesic, and antiinflammatory (Melzig et al, 2004). However, little or no primary research is available to confirm most of its proposed actions and uses. One small study evaluated the ability of golden rod and several other herbs to reduce paw edema induced in laboratory rats. Golden rod has been found to reduce edema significantly. Another study identified the analgesic effects of several herbs, including golden rod. The analgesic effect is due to selective action to a single receptor (Sampson et al, 2000). Phytodor, a combination of aspen leaves/bark, common ash bark, and golden rod, is an alternative to NSAIDs or COX-2 inhibitors in painful inflammatory or degenerative rheumatic diseases (Gundermann et al, 2007). Product Availability Alcoholic extract, aqueous extract, dried herb Plant Parts Used: Flowers, leaves Dosages • Adult PO decoction: 2 tsp chopped dried herb in 8 oz water, boil 15 min, let stand 2 min, strain, take 1 tbsp tid-qid = Pregnancy = Pediatric ! = Alert = Popular Herb Golden Rod 307 • Adult PO dried herb: 6-12 g daily (Blumenthal, 1998) • Adult PO infusion of flowers and leaves: 2 tsp herb in 8 oz water, infuse 10-15 min, strain, drink all, take tid • Adult PO tincture: 0.5-1 ml bid-tid (1:5 in 45% ethanol) (Jellin et al, 2008) Contraindications Pregnancy category is 3; breastfeeding category is 2A. Golden rod should not be given to children. Without medical advice, golden rod should not be used by persons with congestive heart failure or renal disease. This herb should not be used by persons with hypersensitivity to it or other Asteraene family herbs. G Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions, rash RESP: Asthma, difficult respirations Toxicity: Gastrointestinal hemorrhage, enlarged spleen, edema of abdomen, emaciation, tachypnea, severe vomiting, death Interactions Drug CNS depressants, diuretics: Golden rod may increase CNS depression, diuretics. Lithium: Golden rod taken with lithium may result in dehydration and lithium toxicity; avoid concurrent use. Primary Chemical Components and Possible Actions Chemical Class Individual Component Phenolic glucoside Lelocarposide; Isoschaftoside Bisdesmoside Rutin Dititerpene Flavonoid Possible Action Diuretic; antioxidant, increased urine volume; increased sodium excretion Hyperoside; Isoquercitrin Caffeoylguinic acids Saponin Carotenoid Tannin Nitrate Volatile oil Polysaccharide Diuretic Wound healing; astringent Gamma-cadinene Adverse effects: Underline = life-threatening 308 Goldenseal Client Considerations Assess • Assess the reason the client is using golden rod. • Assess for hypersensitivity reactions, including asthma, rash, and difficult respirations. If such reactions are present, discontinue the use of golden rod and administer an antihistamine or other appropriate therapy. ! • Assess for symptoms of toxicity: gastrointestinal hemorrhage, enlarged spleen, severe emesis, and tachypnea. Administer • Instruct the client to take golden rod PO after preparing a decoction. • Instruct the client to store golden rod in a cool, dry place, away from heat and moisture. Teach Client/Family ! • Inform the client that pregnancy category is 3 and breastfeeding category is 2A. • Caution the client not to give golden rod to children. • Warn the client of the life-threatening side effects of golden rod. Goldenseal ! (goeld’uhn-seel) Scientific name: Hydrastis canadensis Other common names: Eye balm, eye root, goldsiegel, ground raspberry, Indian dye, Indian turmeric, jaundice root, orange root, turmeric root, yellow paint, yellow puccoon, yellow root, wild curcuma Origin: Goldenseal is a perennial originally found in the Ohio River Valley and now cultivated. Uses Goldenseal is used to treat various conditions. Its most common uses include the treatment of gastritis, gastrointestinal ulceration, peptic ulcer disease, mouth ulcer, bladder infection, sore throat, and postpartum hemorrhage. It may also be used to treat skin disorders such as pruritus, boils, hemorrhoids, anal fissures, and eczema, as well as cancer and tuberculosis. Goldenseal may also be used to promote wound healing and reduce inflammation. It is used in combination with echinacea to treat cold and flu at onset. Investigational Uses Studies are underway to determine the efficacy of goldenseal in the treatment of cholera, Giardia, shigella, Enterobacteriaceae, and salmonella. Actions Goldenseal is used for its antiinfective, immunostimulant, antipyretic, and anticancer actions. Native Americans have used it for many years. Because it has been overused, this herb is now becoming endangered in the wild. Efforts are currently under way to cultivate goldenseal. Antiinfective Action One of the chemical components of goldenseal, berberine, has been shown to be effective against a number of bacteria, fungi, and protozoa. It is effective against Staphylococcus sp., Streptococcus sp., Eschericia coli, Chlamydia sp., Salmonella typhi, = Pregnancy = Pediatric ! = Alert = Popular Herb Goldenseal 309 Corynebacterium diphtheriae, Diplococcus pneumoniae, Pseudomonas sp., Shigella dysenteriae, Entamoeba histolytica, Trichomonas vaginalis, Neisseria gonorrhoeae, Treponema pallidum, Giardia lamblia, Leishmania donovani, and Candida albicans. Many other organisms have been shown to be sensitive to goldenseal in vitro. Immunostimulant Action Berberine increases the blood supply to the spleen, with possible immune stimulant effects (Sabir et al, 1971). Berberine has also been found to increase the action of macrophages. Anticancer Action Berberine has been shown to destroy brain tumor cells in rats at rates more double G those of nitrosurea (Rong-Xun et al, 1990). An additive effect also accrues from combining berberine with nitrosurea. Product Availability Capsules, dried herb, fluid extract, powder, tablets, tea, tincture Plant Part Used: Air-dried rhizome Dosages Dosages should be standardized to berberine content. Bladder Infection • Adult PO dried root/tea: 1-2 g tid (Murray, Pizzorno, 1998) • Adult PO tincture: 4-6 ml (1-11⁄2 tsp) tid (1:5 dilution) (Murray, Pizzorno, 1998) • Adult PO fluid extract: 0.5-2 ml (1⁄4-1⁄2 tsp) tid (Murray, Pizzorno, 1998) • Adult PO freeze-dried root: 500-1000 mg tid (Murray, Pizzorno, 1998) • Adult PO powdered solid extract: 250-500 mg tid (8% alkaloids) (Murray, Pizzorno, 1998) Boils • Adult PO topical poultice: 1 tbsp root powder mixed with water or egg white to make a paste, apply to area, cover with adsorbent material, use bid (Murray, Pizzorno, 1998) General Use • Adult PO infusion/tea: 2-4 g dried rhizome, drink in divided doses tid • Adult PO fluid extract: 250 mg (1:1 dilution) tid • Adult PO powder: 250-500 mg tid • Adult PO tincture: 6-12 ml (1:5 dilution) tid • Adult PO capsules: 500-600 mg qid • Adult PO powdered root: 1⁄2-1 g divided into 3 daily doses (McCaleb et al, 2000) • Adult PO tincture: 2-4 ml (1:10 dilution) (McCaleb et al, 2000) Sore Throat • Adult PO dried root/tea: 2-4 g tid (Murray, Pizzorno, 1998) • Adult PO tincture: 6-12 ml (11⁄2-3 tsp) (1:5 dilution) tid (Murray, Pizzorno, 1998) • Adult PO fluid extract: 2-4 ml (1⁄2-1 tsp) (1:1 dilution) tid (Murray, Pizzorno, 1998) • Adult PO powdered solid extract: 250-500 mg (8%-12% alkaloids) tid (Murray, Pizzorno, 1998) Adverse effects: Underline = life-threatening 310 Goldenseal Contraindications Pregnancy category is 5; breastfeeding category is 4A. Goldenseal should not be given to children. This herb should not be used by persons who have cardiovascular conditions such as heart block, arrhythmias, or hypertension, or by those who are hypersensitive to it. Goldenseal should not be used locally by persons with purulent ear discharge or by those with a ruptured eardrum. Side Effects/Adverse Reactions CNS: Hallucinations, delirium (prolonged use); central nervous system depression, seizures; paralysis (increased doses), paresthesia CV: Bradycardia, asystole, heart block EENT: Ocular phototoxicity (tinctures)(Chignell et al, 2007). GI: Nausea, vomiting, anorexia, diarrhea, or constipation, abdominal cramping, mouth ulcers INTEG: Hypersensitivity reactions, rash, contact dermatitis; phototoxicity (topical) RESP: Dyspnea (prolonged use) Toxicity: Restlessness, nervousness, irritability, central nervous system depression, seizures, cardiovascular collapse, coma, death Interactions Drug Alcohol, antiarrhythmics, antihypertensives, beta-blockers, CNS depressants: Goldenseal may increase the effects of these products. Antacids, H2-blockers, proton pump inhibitors: Goldenseal may decrease these products (theoretical) (Jellin et al, 2008). Anticoagulants, cardiac glycosides: Goldenseal may decrease the effects of these products. Azole antifungals, benzodiazepines, calcium channel blockers: Goldenseal may slow the metabolism of these products. Cytochrome P4503A4 substrates: Goldenseal may decrease the action of these agents (theoretical) (Gurley et al, 2008; Jellin et al, 2008). Statins: Goldenseal may slow the metabolism of statins; avoid concurrent use. Vitamin B: Goldenseal may decrease the absorption of vitamin B. Lab Test Bilirubin: Goldenseal may increase bilirubin levels (theoretical) (Jellin et al, 2008). Blood osmolality, serum/urine plasma sodium: Goldenseal may increase blood osmolality and serum or urine plasma sodium. Primary Chemical Components and Possible Actions Chemical Class Individual Components Possible Action Alkaloid Berberine Immunostimulant, antibacterial, antisecretory, anticholinergic, antineoplastic = Pregnancy = Pediatric ! = Alert = Popular Herb Gossypol 311 Primary Chemical Components and Possible Actions—cont’d Chemical Class Individual Components Hydrastine Berberastine Canadine Candaline Beta-hydrastine Possible Action Antibacterial Astringent, antibacterial Resin Phytosterin Chlorogenic acid G Client Considerations Assess • Assess the reason the client is using goldenseal. • Assess for hypersensitivity reactions, including rash and contact dermatitis. If these are present, discontinue use of this herb and administer an antihistamine or other appropriate therapy. • Assess the client’s use of CNS depressants, beta-blockers, antihypertensives, antiarrhythmics, anticoagulants, cardiac glycosides, and antihypertensives. None of these drugs should be used concurrently with goldenseal (see Interactions). ! • Assess for symptoms of toxicity (see Side Effects). Administer • Instruct the client to take goldenseal PO as an extract or as a dried rhizome. • Instruct the client to store goldenseal products in a cool, dry place, away from heat and moisture. • Advise the client to avoid the sun or wear protective clothing when using goldenseal topically (Inbaraj et al, 2001). Teach Client/Family • Inform the client that pregnancy category is 5 and breastfeeding category is 4A. • Caution the client not to give goldenseal to children. • Warn the client of the many life-threatening side effects of goldenseal. ! • Advise the client not to perform hazardous activities such as driving or operating heavy machinery until physical response to the herb can be evaluated. Gossypol ! (gah’suh-pawl) Scientific name: Gossypium hirsutum Other common names: American upland cotton, common cotton, cotton, upland cotton, wild cotton Origin: Gossypol is found in cotton and is made synthetically. Adverse effects: Underline = life-threatening 312 Gossypol Uses Gossypol is used as a male contraceptive, as a vaginal spermicide female contraceptive, to induce labor and delivery, and to treat dysmenorrhea. Gossypol is used for uterine fibroids, endometriosis, and dysfunctional uterine bleeding. Actions Male Contraception The primary action of gossypol is contraceptive. Extensive testing began in China about 30 years ago. Studies have demonstrated the contraceptive effectiveness of this herb in both male and female laboratory animals. As a male contraceptive, gossypol decreases sperm production by inhibiting lactate dehydrogenase X, which is needed to produce sperm. Sperm recovered from rats and hamsters treated with gossypol were found to be immotile, with heads or tails not attached (Chang, 1980). No changes in libido or hormone levels occurred. The recommended dose for males is 20 mg per day until the sperm count is reduced to less than 4 million per ml (after about 90 days), then 75 to 100 mg given two times per month as a maintenance dose to keep the sperm count low. One study found gossypol to be more than 99% effective when used at the proposed levels (Wu, 1989). Sperm production usually returns to normal 90 days after termination of therapy. However, some men continue to experience lowered sperm production beyond 90 days. Female Contraception In female rats, gossypol has been shown to inhibit implantation and possibly to affect luteinizing hormone levels (Lin, 1985). Product Availability Extract Plant Parts Used: Roots, seeds, stems Dosages Male Contraceptive • Adult PO extract: 20 mg daily for 2-3 mo until sperm count drops to ⬍4 million sperm/ml, then 75-100 mg every 2 wk for maintenance Antineoplastic • Adult PO extract: 10 mg bid or 0.6-0.8 mg/kg/day Contraindications Because it can induce labor, gossypol should not be used during pregnancy except under the direction of a qualified herbalist. Until more research is available, this herb should not be used during breastfeeding and should not be given to children. Persons with hypersensitivity to gossypol or those with hepatic/renal damage should not use it. Males may have a lowered sperm count for ⬎90 days. Side Effects/Adverse Reactions CV: Heart failure, circulatory collapse GI: Nausea, vomiting, anorexia, diarrhea GU: Male sterility (prolonged use) INTEG: Hypersensitivity reactions MS: Muscle fatigue, weakness, paralysis = Pregnancy = Pediatric ! = Alert = Popular Herb Gossypol 313 Interactions Drug Alcohol: Gossypol when given with alcohol leads to alcohol accumulation (Jellin et al, 2008). Antifungals: Use of gossypol with antifungals may cause nephrotoxicity; do not use concurrently. Cardiac glycosides (digoxin): Gossypol may increase the risk of cardiac glycoside toxicity (theoretical) (Jellin et al, 2008). Diuretics (bumetanide, ethacrynic acid, furosemide, hydrochlorothiazide, torsemide, triamterene): Use of gossypol with diuretics may cause severe hypokalemia; do not use concurrently. NSAIDs (diclofenac, etodolac, fenoprofen, fluroprofen, indometha- G cin, ketoprofen, ketorolac, meclofenamate, nabumetone, naproxen, oxaprozin, piroxicam, sulindac, tolmetin): Gossypol used with NSAIDs may result in gastrointestinal distress and gastrointestinal tissue damage. Salicylates (aspirin): Gossypol used with salicylates may result in tissue damage. Stimulant laxatives: Gossypol with stimulant laxatives may lead to hypokalemia (theoretical) (Jellin et al, 2008). Primary Chemical Components and Possible Actions Chemical Class Individual Component Enantiomers Possible Action Contraceptive, anti-HIV Client Considerations Assess • Assess the reason the client is using gossypol. • Assess for hypersensitivity reactions. If present, discontinue use of gossypol and administer an antihistamine or other appropriate therapy. • Assess for use of antifungals or diuretics, which should not be used concurrently with gossypol (see Interactions). Monitor potassium levels, which may be decreased with gossypol use. • Assess for cardiovascular reactions, including arrhythmias. Administer • Instruct the client to take extract PO. • Instruct the client to store gossypol products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use gossypol during pregnancy unless under the direction of a qualified herbalist, because it can induce labor. • Caution the client not to use gossypol in children or those who are breastfeeding until more research is available. ! • Warn the client of the life-threatening cardiovascular side effects of gossypol. Adverse effects: Underline = life-threatening 314 Gotu Kola Gotu Kola (goe-tew’koe-lah) Scientific name: Centella asiatica Other common names: Centella, hydrocotyle, Indian pennywort, Indian water navelwort, talepetrako, teca, water pennywort Origin: Gotu kola is a creeping plant found in the swamps of Africa, Sri Lanka, and Madagascar. Uses Gotu kola is taken internally to treat hypertension, cancer, hepatic disorders, leprosy, and varicose veins; to increase fertility; and as a stimulant. It also may be taken internally to treat chronic interstitial cystitis, cellulite, and periodontal disease. Gotu kola may be used externally to promote wound healing and to treat skin disorders such as psoriasis, eczema, and keloids. Investigational Uses New studies are underway for the use of gotu kola to prevent gastric ulcers. Actions Wound Healing Action Gotu kola is used primarily as a topical preparation to promote wound healing. In one study using laboratory rats, gotu kola penetrated tissues in high concentrations and produced a faster rate of healing with topical administration than with oral. Increased collagen was found in the cell layer in the form of fibronectin (Tenni et al, 1988). One of the chemical components of gotu kola, the glycoside madecassoside, decreases inflammation while another glycoside, asiaticoside, may be responsible for wound healing. Antiinfertility Action In a preliminary study, gotu kola was shown to decrease infertility in female mice. The mechanism of action is unknown (Dutta et al, 1968). Other Actions Other possible uses of gotu kola that have not been investigated to any great degree include its antihypertensive, anticancer, periodontal disease, cellulite, and connective tissue regulation actions. One study has confirmed the gastroprotective effects of Centella asiatica. Rats were induced with gastric lesions by ethanol; the oral administration of Centella extract significantly inhibited gastric lesions (Cheng et al, 2000). Another study (Flora et al, 2007) found a beneficial effect against arsenic-induced oxidative stress but possessed no chelating properties. Positive cognition and mood was the result after administration of gotu kola in healthy elderly people (Wattanathom et al, 2008). Product Availability Capsules, cream, dried herb, extract Plant Part Used: Dried leaves Dosages No topical dosages are available. Cellulite • Adult PO extract: 30 mg triterpenes tid (Murray, Pizzorno, 1998) = Pregnancy = Pediatric ! = Alert = Popular Herb Gotu Kola 315 General Use • Adult PO capsule: 450 mg daily • Adult PO dried leaf: 0.3-0.6 g tid Periodontal Disease • Adult PO extract: 30 mg triterpenes bid (Murray, Pizzorno, 1998) Varicose Veins • Adult PO extract: 30-60 mg triterpenes daily (Murray, Pizzorno, 1998) Contraindications Pregnancy category is 2; breastfeeding category is 2A. Gotu kola should not be given to children. It should not be used by persons G with hypersensitivity to this herb or to members of the celery family. Side Effects/Adverse Reactions CNS: Sedation GI: Possible hepatotoxicity (Jorge et al, 2005). INTEG: Hypersensitivity reactions such as burning (topical use), contact dermatitis, rash, pruritus SYST: Increased blood glucose, increased cholesterol levels Interactions Drug Antidiabetics, antilipidemics: Gotu kola may decrease the effectiveness of antidiabetics, antilipidemics; do not use concurrently. CNS depressants: Gotu kola with CNS depressants results in increased sedation (theoretical) (Jellin et al, 2008). Herb Sedative herbs: Gotu kola with sedating herbs leads to increased sedation (theoretical) (Jellin et al, 2008). Lab Test Glucose, cholesterol: Gotu kola may increase these levels. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Glycoside Madecassoside; Madecasoside Asiaticoside Brahmoside; Brahminoside Centelloside Antiinflammatory Madecassol Acid Tannin Phytosterol Flavonoid Wound healing Sedative Madecassic acid; Centellic acid; Centoic acid; Asiatic acid; Asiaticentoic acid Wound healing Kaempferol; Quercetin Antiinflammatory Adverse effects: Underline = life-threatening 316 Grapeseed Client Considerations Assess • Assess the reason the client is using gotu kola. • Assess for hypersensitivity reactions: burning (topical), contact dermatitis, rash, and pruritus. If these are present, discontinue the use of this herb and administer an antihistamine or other appropriate therapy. • Assess for medications used (see Interactions). Administer • Instruct the client to store gotu kola products in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 2 and breastfeeding category is 2A. • Caution the client not to use gotu kola in children. • Explain to the client that gotu kola is not the same as other cola species. Grapeseed (grayp’seed) Scientific name: Vitis vinifera Other common name: Muskat Origin: Grapeseed is found throughout the world. Uses Grapeseed may be used as an antioxidant and an anticancer treatment. It may also be used to treat varicose veins, circulatory problems, and vision problems such as cataracts, and to improve vision by lessening eye strain. Investigational Uses Researchers are experimenting with the use of grapeseed to treat diabetes mellitus and inflammatory, degenerative, diverticular, and heart diseases. Actions Vision Improvement Grapeseed has produced beneficial effects in people with vision problems. One study focused on participants with computer-related visual stress. People who worked at a video display terminal (VDT) for at least 6 hours a day were assigned to one of three groups, receiving either grapeseed, bilberry, or a placebo. After 2 months, the grapeseed group reported much less visual stress, with improvements even greater than those seen in the bilberry group (Fusi et al, 1990). An earlier study had shown grapeseed to be significantly more effective than a placebo in improving night vision. This earlier study included 98 people who experienced prolonged nighttime visual glare or visual stress caused by VDTs (Corbe et al, 1988). Other Actions Grapeseed has shown protective effects against carbon tetrachloride hepatic poisoning in mice (Oshima et al, 1995), as well as photoprotective properties of melanins (Novikov et al, 2001). A significant antioxidant, grapeseed is stronger than the antioxidant properties of vitamin C or E for the skin (Comacchione et al, 2007). = Pregnancy = Pediatric ! = Alert = Popular Herb Grapeseed 317 Product Availability Capsules, tablets, drops, liquid concentrate, cream Plant Part Used: Seeds Dosages Dosages are standardized to 85%-95% procyanidins. Supplementation • Adult PO capsules/tablets: 50-100 daily (McCaleb et al, 2000) Therapeutic Use • Adult PO capsules/tablets: 150-300 mg daily for 21 days, then 50-80 mg daily maintenance (McCaleb et al, 2000) G Contraindications Until more research is available, grapeseed should not be used during pregnancy and breastfeeding. It should not be given to children. Side Effects/Adverse Reactions CNS: Dizziness GI: Nausea, anorexia, hepatotoxicity (theoretical) INTEG: Rash Interactions Drug Anticoagulants, antiplatelets: Grapeseed given with these agents may increase the risk of bleeding (theoretical) (Jellin et al, 2008). Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Flavonoid Kaempferol; Quercetin Tannin Tocopherol Fatty acid Proanthocyanidins Antiinflammatory, antioxidant Wound healing, antioxidant Client Considerations Assess • Assess the reason the client is using grapeseed. • If the client is using grapeseed to improve cardiovascular disorders, assess cardiovascular status: edema in legs, improvement in atherosclerosis, and improvement in varicose veins. Monitor blood pressure and pulse. • Identify other cardiovascular medications taken by the client. ! • Assess for hepatotoxicity. Adverse effects: Underline = life-threatening 318 Graviola Administer • Instruct the client to take grapeseed PO only once per day. • Instruct the client to store grapeseed products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use grapeseed in children or those who are pregnant or breastfeeding until more research is available. Graviola (grav’ ee-oh’luh) Scientific name: Annona muricata, Annon cherimola Other common names: Braxilian cherimoya, Brazilian paw paw, corossolier, corossol epineux, sour sop, toge-banreist Origin: Graviola comes from Brazil. Uses Traditionally, graviola is used for its antibiotic, sedative, emetic, and cathartic properties. Actions There is little research for graviola’s use in any condition. There is beginning evidence that graviola may be useful in cancer therapy. It is believed that acetogenins, a chemical component, may block the production of ATP (Jellin et al, 2008). Atypical parkinsonism has been linked to the consumption of fruit and infusions or decoctions prepared from the leaves (Champy et al, 2005). Product Availability No commercial products Plant Parts Used: Fruit, seeds, leaves, bark Dosages No published doses Contraindications Graviola should not be used in children or those who are pregnant, breastfeeding, hypersensitive to this herb, or who have Parkinson’s disease. Side Effects/Adverse Reactions CNS: Parkinson’s-like symptoms Primary Chemical Components and Possible Actions Chemical Class Individual Component Anticancer Neurotoxic Acetogenins Isoquinolones = Pregnancy Possible Action = Pediatric ! = Alert = Popular Herb Green Tea 319 Client Considerations Assess • Assess the reason the client is using graviola. Administer • Keep graviola in a dry area, away from direct sunlight. Teach Client/Family • Caution the client not to use graviola in children, those who are pregnant or breastfeeding, or those who have Parkinson’s disease until more research is available. • Advise the patient to report any movement disorders. G Green Tea (green tee) Scientific name: Camellia sinensis Other common name: Matsu-cha Origin: Green tea is a shrub found in Asia. Uses Green tea is used as a general antioxidant, anticancer agent, diuretic, stimulant, antibacterial, antilipidemic, and antiatherosclerotic. Investigational Uses Research is underway to confirm the use of green tea in treating HIV, increasing muscle health, reducing total cholesterol, and vascular protection. Green tea is shown to be effective in reducing the risk of bladder, ovarian, esophageal, gastric, and pancreatic cancer. Green tea may reduce the risk of breast cancer reoccurring (Jellin et al, 2008). It increases cognitive function and delays Parkinson’s disease. Actions Green tea and black tea come from the same plant, Camellia sinensis. Black tea is produced by allowing the leaves to oxidize, while green tea is cut and steamed. The major actions of green tea result from its antioxidant, anticancer, and antilipidemic properties. Antioxidant and Anticancer Actions Green tea exerts protective effects against gastrointestinal cancers of the stomach, intestine, colon, rectum, and pancreas. One study showed a significant reduction in these cancers when green tea was used (Ji et al, 1997). Green tea also has been shown to decrease the incidence of breast cancer in vitro by inhibiting the interaction with estrogen receptors (Komori et al, 1993). In one study laboratory-induced lung cancer in rats was shown to be decreased in those that received a 2% solution of green tea. The cancer rates for the green tea group were 16%, as compared with 46% in the group that drank only water (Luo et al, 1995). In many studies, black tea has been shown to increase cancer risk in the endometrium and gallbladder. The chemical component epigallocatechin gallate from green tea was able to strongly inhibit the replication of two strains of HIV when tested on blood lymphocytes (Fassina et al, 2002). Adverse effects: Underline = life-threatening 320 Green Tea Antilipidemic Action In one study, green tea produced a significant increase in HDL and a decrease in LDL lipoproteins. These reactions occurred in direct proportion to the amount of green tea consumed (Imai et al, 1995). Other Actions Green tea was able to improve muscle health by reducing or delaying necrosis in mice by an antioxidant mechanism (Buetler et al, 2002). Another action being studied is the consumption of green tea to reduce lipids and lipoproteins (Tokunaga et al, 2002). Green tea can prevent cold and flu symptoms and enhance gamma, delta T cell function (Rowe et al, 2007). Product Availability Tablets, capsules, dried/liquid extract, tea Plant Part Used: Dried leaves Dosages Green tea is standardized to 60% polyphenols. • Adult PO extract: 250-400 mg/day of standardized to 90% polyphenols (McCaleb et al, 2000) • Adult PO tea: 1 tsp tea leaves in 8 oz hot water, drink 2-5 cups/day (McCaleb et al, 2000) Contraindications Green tea should not be used by persons with hypersensitivity to this product or by those with kidney inflammation, gastrointestinal ulcers, insomnia, cardiovascular disease, or increased intraocular pressure. This herb contains caffeine. Decaffeinated tea is available, although some caffeine may remain. Side Effects/Adverse Reactions CNS: Anxiety, nervousness, insomnia (high doses) CV: Increased blood pressure, palpitations, irregular heartbeat (high doses) GI: Nausea, heartburn, increased stomach acid (high doses) INTEG: Hypersensitivity reactions Interactions Drug Antacids: Antacids may decrease the therapeutic effects of green tea (theoretical). Anticoagulants, antiplatelets: Green tea with anticoagulants, antiplatelets may increase risk of bleeding (theoretical) (Jellin et al, 2008). Beta-adrenergic blockers: Green tea used with these agents can lead to increased inotropic effects. Benzodiazepines: Green tea with these agents increases sedation (theoretical) (Jellin et al, 2008). Bronchodilators, xanthines (theophylline): Large amounts of green tea increase the action of xanthines, some bronchodilators. MAOIs (isocarboxazid, phenelzine, tranylcypromine): Green tea used in large amounts taken with MAOIs can lead to hypertensive crisis, do not use together. = Pregnancy = Pediatric ! = Alert = Popular Herb Green Tea 321 Interactions—cont’d Herb Ephedra: Concurrent use of ephedra and caffeinated green tea may increase hypertension and CNS stimulation; avoid concurrent use with caffeinated green tea products. Food Dairy products: Dairy products may decrease the therapeutic effects of green tea. Iron: Green tea may decrease iron absorption. Lab Test Glucose, VMA, urine creatine, urine catecholamine: Green tea may increase these levels. Primary Chemical Components and Possible Actions Chemical Class Individual Component Tannin Flavonoid Xanthines Lignin Organic acid Protein Vitamin Epigallocatechin gallate Catechin Epicatechin; Epicatechin gallate; Proanthocyanidins Caffeine; Theobromine; Theophylline C Possible Action Wound healing; antiinflammatory Antioxidant; anti-HIV Chemoprotective Central nervous system stimulant Lipolytic Client Considerations Assess • Assess the reason the client is using green tea. • Assess for hypersensitivity reactions. If present, discontinue the use of this herb and administer an antihistamine or other appropriate therapy. • Assess for other conditions that are contraindications to green tea use, including cardiovascular and renal disease, and increased intraocular pressure. • Assess for use of antacids, dairy products, and ephedra (see Interactions). Administer • Instruct the client to store green tea in a cool, dry place, protected from heat and moisture. Teach Client/Family • Caution the client with renal or cardiovascular disease, or increased intraocular pressure not to use green tea products that contain caffeine. • Teach the client not to use green tea with antacids or milk because its effect is decreased. Adverse effects: Underline = life-threatening G 322 Ground Ivy Ground Ivy Scientific name: Glechoma hederacea Other common names: Alehoof, cat’s foot, creeping Charlie, haymaids, hedgemaids Origin: Ground ivy is a flowering plant found in the United Kingdom. Uses Many herbalists recommend ground ivy to treat sinusitis, allergic conditions, bronchitis, and various conditions of the ears, nose, and throat. It may also be used to treat disorders of the gastrointestinal system such as diarrhea. Actions Very little information is available on ground ivy other than anecdotal evidence. Although this herb is reported to clear sinusitis, rhinitis, and upper respiratory congestion, one study identified the antiinflammatory process by controlling macrophage-mediated inflammatory-related diseases (An et al, 2006). Product Availability Fluid extract, infusion, tincture, tea Plant Parts Used: Flowers, leaves Dosages • Adult PO fluid extract: 14-28 grains tid • Adult topical: crushed leaves are applied to area • Child ⬎6 yr: to prevent toxicity use a very low dose, only under the supervision of an herbalist Contraindications Until more research is available, ground ivy should not be used during pregnancy and breastfeeding. It should not be given to children younger than 6 years of age. Ground ivy should not be used by persons with hypersensitivity to it. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions Toxicity: Diaphoresis, bronchial congestion and edema, cyanosis, pupil dilatation Interactions Drug Iron salts: Ground ivy may decrease the absorption of iron salts; avoid concurrent use. Herb Pennyroyal: Ground ivy with pennyroyal increases hepatotoxicity (Jellin et al, 2008). = Pregnancy = Pediatric ! = Alert = Popular Herb Guarana 323 Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Flavonoid Volatile oil Pulegone Abortifacient, hepatotoxic, irritant Wound healing Tannin Saponin Glycosides Resin Sesquiterpene Bitter Apigenin, Luteolin, Glucopyranoside, Cistanoside Icariol (Yamauchi et al, 2007) Glechomine Client Considerations Assess • Assess the reason the client is using ground ivy. • Assess for hypersensitivity reactions. If present, discontinue the use of this herb and administer an antihistamine or other appropriate therapy. ! • Assess for toxicity (see Side Effects). Administer • Instruct the client to store ground ivy in a cool, dry place, away from heat or moisture. Teach Client/Family • Caution the client not to use ground ivy in those who are pregnant or breastfeeding until more research is available. • Caution the client not to give ground ivy to children younger than 6 years of age. With older children, ground ivy should be used only in very small amounts under the supervision of an herbalist. • Advise the client that toxicity has occurred in animals. Guarana ! (gwah’rah-nuh) Scientific names: Paullinia cupana, Paullinia sorbilis Other common names: Brazilian cocoa, guarana gum, guarana paste, zoom Origin: Guarana is a paste made from seeds of a shrub found in the Amazon and Brazil. Adverse effects: Underline = life-threatening G 324 Guarana Uses Guarana traditionally has been used as a stimulant and is typically used in combination with other products to promote weight loss. Actions Very few studies corroborate any of the uses or actions of guarana in humans. Antioxidant Action One study examined the antioxidant effects of guarana (Mattei et al, 1998). The herb was found to possess antioxidant components. Stimulant/Weight Loss Action Guarana has been used for centuries in Brazil for its stimulant properties, which result from its high caffeine content. Weight loss occurs when ephedra is combined with caffeine products. Because guarana has a significant caffeine content, weight loss may be expected when it is combined with ephedra. However, central nervous system stimulation may be increased significantly when the two are combined. Delayed gastric emptying and promotion of fullness may be responsible for the weight reduction effect of guarana (Andersen et al, 2001). Antineoplastic Action There may be chemoprotective effects of guarana, as identified in one study (Fukumasu et al, 2006). In the laboratory, mice were used to identify the reduction in macroscopic lesions. In another study (Fukumasu et al, 2008), guarana treatment decreased proliferation and increased apoptosis of tumor cells. Other Actions The lyophilized extract of guarana seeds identified an antidepressant effect after long-term use in rats (Otobone et al, 2007). Product Availability Capsules, elixir, extract, tablets, tea; component in various supplements, drinks, flavorings, weight-loss products, and gum Plant Part Used: Seeds Dosages Dosages vary widely depending on the form used. • Adult PO: do not exceed 3 g/day Contraindications Class 2d herb (P. cupana seed). Because of its caffeine content, and until more research is available, guarana should not be used during pregnancy (caffeine crosses placenta) and breastfeeding (caffeine enters breast milk). Guarana should not be given to children. It should not be used by persons with cardiovascular diseases such as hypertension, arrhythmias, or heart block, or by persons with duodenal ulcers, diabetes, renal disease, or hypersensitivity to this product. Side Effects/Adverse Reactions CNS: Headache, anxiety, nervousness, restlessness, insomnia, tremors, seizures CV: Hypertension, palpitations, tachycardia, arrhythmias GI: Nausea, vomiting, anorexia, diarrhea INTEG: Hypersensitivity reactions = Pregnancy = Pediatric ! = Alert = Popular Herb Guarana 325 Interactions Drug Adenosine: Guarana may decrease the adenosine response. Antihypertensives: Guarana may decrease the effects of antihypertensives (theoretical). Beta-blockers: Guarana may increase the effects of beta-blockers such as metoprolol (theoretical). Bronchodilators: Guarana may increase the action of bronchodilators due to caffeine content. MAOIs (isocarboxazid, phenelzine, tranylcypromine): Guarana in large amounts taken with MAOIs can result in hypertensive crisis; do not use together. Xanthines: Xanthines such as theophylline and caffeine may increase pulse rate, blood pressure, and arrhythmias when used with guarana; avoid concurrent use. Herb Black tea, green tea, yerba maté: Guarana may increase the action of these products. Ephedra: Concurrent use of ephedra and guarana may increase hypertension and CNS stimulation; avoid concurrent use. Food Caffeinated drinks: Guarana may increase the caffeine action. Lab Test Urate, bleeding time: Guarana may increase these levels. Pheochromocytoma/neuroblastoma test: Guarana may cause a false positive result. Pharmacology Pharmacokinetics Caffeine crosses the placenta and enters breast milk. Other pharmacokinetics and pharmacodynamics are unknown. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Tannin Catechutannic acid Tannic acid; Catechol; Catechin Timbonine Caffeine Wound healing Antioxidant Saponin Xanthine Skin softener Central nervous system stimulator Theophylline Theobromine Adverse effects: Underline = life-threatening G 326 Guar Gum Client Considerations Assess • Assess the reason the client is using guarana. • Assess for hypersensitivity reactions. If present, discontinue the use of this herb and administer an antihistamine or other appropriate therapy. • Assess for use of medications and herbs (see Interactions). Administer • Instruct the client to store guarana products in a cool, dry place, away from heat and moisture. Teach Client/Family • Because of the caffeine content, caution the client not to use guarana in children or those who are pregnant or breastfeeding until more research is available. • Warn the client of the life-threatening side effects of guarana. ! • Advise client that insomnia may occur; take at least 6 hr before bedtime. Guar Gum (gwahr guhm) Scientific name: Cyamopsis tetragonolobus Other common names: Guar flour, gucran, Indian cluster bean, jaguar gum Origin: Guar gum is an annual found in India, the United States, and the tropics of Asia. Uses Guar gum has been used to treat hyperlipidemia, diabetes mellitus, and obesity. Actions The primary actions of guar gum are bulk laxative, antihyperlipidemic, and antidiabetes. Antihyperlipidemic Action Guar gum has been shown to decrease cholesterol and LDL levels with little or no effect on triglyceride HDL levels. Its cholesterol-lowering effect may be due to increased bile excretion of cholesterol. This action mirrors that of bile sequestering drugs. Guar gum used in combination with other antihyperlipidemics lowers cholesterol to a much greater extent than either used alone (Uusitupa, 1992). Antidiabetes Action The antidiabetes action of guar gum may result from the increased transit of gastrointestinal tract contents through the gastrointestinal system or from adsorbing glucose in the gut. Studies have shown guar gum to decrease blood glucose (Landin et al, 1992). Weight Reduction One study (Pittler et al, 2001) showed that guar gum is not useful for weight loss primarily because of the adverse reactions of abdominal pain, flatulence, diarrhea, and cramps. = Pregnancy = Pediatric ! = Alert = Popular Herb Guar Gum 327 Product Availability Flour Plant Part Used: Endosperm Dosages No published dosages are available. Contraindications Class 2d herb (seed). Until more research is available, guar gum should not be used during pregnancy and breastfeeding. It should not be given to children. Guar gum should not be used G by persons with hypersensitivity to this product. Persons with bowel obstruction or dehydration should not use guar gum; these conditions will worsen. Caution should be exercised in persons with swallowing difficulty. Side Effects/Adverse Reactions GI: Flatulence, nausea, vomiting, anorexia, gastrointestinal obstruction INTEG: Hypersensitivity reactions Interactions Drug All oral medications: Guar gum may decrease the absorption and action of all oral medications. Insulin: Guar gum may delay glucose absorption when used with insulin; insulin dose may need to be decreased. Food Nutrients: Guar gum can lead to decreased nutrient absorption. Lab Test Blood cholesterol, blood glucose: Guar gum may decrease blood cholesterol and blood glucose levels. Pharmacology Pharmacokinetics Pharmacokinetics and pharmacodynamics are unknown. Guar gum is not absorbed. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Polysaccharide Galactomannan Antidiabetes; antihyperlipidemic Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of guar gum and administer an antihistamine or other appropriate therapy. Adverse effects: Underline = life-threatening 328 Guggul Administer • Instruct the client to store guar gum products in a cool, dry place, away from heat and moisture. • Assess for medications used (see Interactions). Teach Client/Family • Caution the client not to use guar gum in children or those who are pregnant or breastfeeding until more research is available. • Caution the client not to use guar gum with bowel obstruction or dehydration. These conditions will worsen. • Instruct the client to take guar gum with adequate fluids to prevent bowel obstruction, dehydration. • Inform the client that caution should be taken in those with swallowing difficulties. Guggul (gew’guhl) Scientific name: Commiphora mukul Other common names: Mukul myrrh tree, myrrh Origin: Guggul is found in India. Uses Guggul is used to decrease high cholesterol, to promote weight loss, and to treat arthritic conditions. It is used in Ayurvedic medicine to treat obesity and increase fat metabolism. Guggul is believed to increase thyroid function, but no studies confirm this. Guggul may be used to treat gum infections (gingivitis, pyorrhea, mouth ulcers) and for sore throat and digestive complaints. Actions Anticholesterol Action Guggulsterones have been shown to decrease cholesterol synthesis in the hepatic system and promote the breakdown and excretion of cholesterol (Satyavati, 1991; Urizar et al, 2002; Wu et al, 2002). Three studies have investigated the use of guggul for the reduction of cholesterol and triglyceride levels, and all showed a significant reduction of both (Nityanand et al, 1989; Verma et al, 1988; Agarwal et al, 1986). Two of the studies used guggulipid, and the third used gum guggul. Antiobesity Action More studies are needed to confirm the efficacy of guggul in reducing obesity and stimulating thyroid function. To date, no studies have confirmed these potential actions. Other Actions The terpenoids and guggulsterones possess antiinflammatory actions (Francis et al, 2004). The guggulsterone Z possesses anti–prostate cancer actions (Xiao et al, 2008). Product Availability Alcoholic extract, crude gum, gugulipid, guggulsterone, petroleum ether extract = Pregnancy = Pediatric ! = Alert = Popular Herb Guggul 329 Plant Part Used: Resin Dosages • Adult PO alcoholic extract: 4.5 g daily • Adult PO crude gum guggul: 10 g daily • Adult PO gugulipid: 500 mg, standardized to 5% guggulsterones • Adult PO guggulsterone: 25 mg tid • Adult PO petroleum ether extract: 1.5 g daily Contraindications Pregnancy category is 5; breastfeeding category is 4A. Guggul should not be given to children. Persons with hypersensitivity to G guggul should not use it. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, diarrhea GU: Kidney irritation (large doses) INTEG: Hypersensitivity reactions, rash MS: Rhabdomyolysis (Bianchi et al, 2004) Interactions Drug Anticoagulants, antiplatelets: Guggul may increase risk for bleeding when used with these agents. Diltiazem, propranolol: Guggul can lead to reduced action by these agents. Thyroid hormones: Guggul may alter the action of thyroid hormones. Herb Garlic: Guggul may increase the antilipid action. Lab Test Cholesterol, LDL, triglycerides: Guggul may lower these levels. Thyroid stimulating hormone: Guggul decreases thyroid stimulating hormone. T3: Guggul increases T3. Primary Chemical Components and Possible Actions Chemical Class Individual Components Guggulsterones E; Z Aromatic acid Nonaromatic acid Steroidal compound Terpenoids Possible Action Lipid lowering; bile acid antagonist, thyroid stimulation; antiinflammatory (Francis et al, 2004); anticancer (Xiao et al, 2008) COX-2 inhibitor Adverse effects: Underline = life-threatening 330 Gymnema Client Considerations Assess • Assess the reason the client is using guggul. • Assess for hypersensitivity reactions. If present, discontinue the use of guggul and administer an antihistamine or other appropriate therapy. • Assess liver function tests, thyroid panel. Administer • Instruct the client to take guggul PO. • Instruct the client to store guggul products in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 5 and breastfeeding category is 4A. • Caution the client not to give guggul to children until more research is available. Gymnema Scientific name: Gymnema sylvestre Other common names: Gurmar, meshashringi, merasingi Origin: Gymnema is found in India and Africa. Uses Gymnema has been used traditionally in Ayurvedic medicine as a laxative, and to treat diabetes mellitus and malaria. Investigational Uses Studies are underway for the use of gymnema to lower lipids. Actions Antidiabetes Action The antidiabetes action of this herb may be due to its ability to stimulate functioning beta cells in the pancreas to release insulin. A review of the literature identified gymnema as an alternative for diabetes mellitus treatment (Leach, 2007). Lipid-Lowering Action A few studies have shown the lipid-lowering effect of Gymnema (Shigematsu et al, 2001a; Shigematsu, 2001b). Product Availability Extract Plant Part Used: Leaves Dosages Diabetes Mellitus • Adult PO extract: 200 mg bid (Murray, Pizzorno, 1998), 400 mg bid (Jellin et al, 2008) = Pregnancy = Pediatric ! = Alert = Popular Herb Gymnema 331 Contraindications Pregnancy category is 3; breastfeeding category is 1A. Gymnema may be given to children. Persons with hypersensitivity to gymnema should not use it. Side Effects/Adverse Reactions ENDO: Hypoglycemia GI: Nausea, vomiting, anorexia, inhibition of bitter/sweet taste INTEG: Hypersensitivity reactions Interactions Drug Antidiabetics (acetohexamide, chlorpropamide, glipizide, glyburide, metformin, tolazamide, tolbutamide, troglitazone), insulin: Gymnema may increase the action of antidiabetics, insulin (theoretical). Lab Test Blood glucose, LDL, total cholesterol: Gymnema may cause decreased blood glucose (decoctions, infusions), LDL cholesterol, and total cholesterol. Primary Chemical Components and Possible Actions Chemical Class Individual Component Gymnemic acid Triterpene glycosides Longispinogenin Possible Action Antidiabetes Client Considerations Assess • Assess the reason the client is using gymnema. • Assess for hypersensitivity reactions. If present, discontinue the use of gymnema and administer an antihistamine or other appropriate therapy. • Assess for use of insulin and antidiabetics (see Interactions). Administer • Instruct the client to store gymnema in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 3 and breastfeeding category is 1A. • Inform the client that gymnema may be given to children. Adverse effects: Underline = life-threatening G 332 Hawthorn Hawthorn (haw’thawrn) Scientific name: Crataegus spp. Other common names: Li 132, may, maybush, quickset, thorn-apple tree, whitethorn Origin: Hawthorn is a bush or tree found throughout the United States, Canada, Europe, and Asia. Uses Hawthorn is one of the most commonly used herbs. It is used to treat cardiovascular disorders such as hypertension, arrhythmias, arteriosclerosis, congestive heart failure, Buerger’s disease, and stable angina pectoris. Actions Cardiovascular Action Hawthorn exerts both antihypertensive and antihyperlipidemic effects. It increases blood supply to the heart, increases the force of contractions, and indirectly inhibits angiotensin-converting enzyme (ACE). The proanthocyanidins, among the chemical components of hawthorn, have been shown to inhibit ACE in a manner similar to that of the drug captopril. Hawthorn also stabilizes collagen, reduces atherosclerosis, and decreases cholesterol. The collagen-stabilizing action of hawthorn helps to keep the artery strong and free of plaque development. Hawthorn can be used with cardiac glycosides in the treatment of congestive heart failure. In one study, participants received 600 mg of standardized hawthorn extract or a placebo daily. The treatment group experienced increased cardiac working capacity and reduced blood pressure (Schmidt et al, 1994, 2000). Hawthorn has been shown to reduce hypertension in laboratory animals (Koçyildiz et al, 2006). Other Actions The hawthorn extract is a scavenger, increases intracellular GSH levels, and is not cytotoxic. Therefore, it is considered an adequate antioxidant (Ljubuncic et al, 2005). Product Availability Capsules of berries, extended release capsules, fluid extract, leaves, solid extract, tea, tincture, topical cream Plant Parts Used: Flowers, fruit, leaves Dosages Angina • Adult PO berries of flowers, dried: 3-5 g tid or as a tea (Murray, Pizzorno, 1998) • Adult PO fluid extract: 1-2 ml (1⁄4-1⁄2 tsp) tid (1:1 dilution) (Murray, Pizzorno, 1998) • Adult PO solid extract: 100-250 mg tid (10% procyanidin or 1.8% vitexin4´-rhamnoside) (Murray, Pizzorno, 1998) • Adult PO tincture: 4-6 ml (1-11⁄2 tsp) tid (1:5 dilution) (Murray, Pizzorno, 1998) = Pregnancy = Pediatric ! = Alert = Popular Herb Hawthorn 333 Coronary Artery Disease • Adult PO solid extract: 100-250 mg tid (10% procyanidin content or 1.8% vitexin4´-rhamnoside) (Murray, Pizzorno, 1998) General Use • Adult PO solid extract: 120-240 mg tid of a standardized product (18.75% procyanidines or 2.2% flavonoids) • Adult PO tea: 1-2 tsp berries, steep in 8 oz water for 15 min, strain, drink tid • Adult PO tincture: 5 ml tid (1:5 dilution) Moderate Hypertension • Adult PO solid extract: 100-250 mg tid (10% procyanidin content or 1.8% vitexin4´-rhamnoside) (Murray, Pizzorno, 1998) H General Use • Child PO tea: 1 cup several times/wk (Romm, 2000) • Child PO tincture: 1⁄4-1 tsp up to tid (Romm, 2000) • Child topical cream: apply prn (Romm, 2000) Contraindications Pregnancy category is 2; breastfeeding category is 2A. Hawthorn may be given to children. It should not be used by persons with hypersensitivity to this herb or Rosaceae spp. Side Effects/Adverse Reactions CNS: Fatigue, sedation CV: Hypotension, arrhythmias GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions Interactions Drug Antihypertensives (beta-blockers): Hawthorn may increase hypotension when used with antihypertensives; avoid concurrent use. Cardiac glycosides: Hawthorn may increase the effects of cardiac glycosides; monitor concurrent use carefully. CNS depressants: Hawthorn may increase the sedative effects of CNS depressants such as alcohol, barbiturates, and psychotropics; avoid concurrent use. Iron salts: Hawthorn tea may decrease the absorption of iron salts; separate by at least 2 hours. Herb Adonis, lily of the valley, squill: Hawthorn increases the action of Adonis vernalis, Convallaria majalis, Scillae bulbus when taken concurrently. Fenugreek, ginger: Hawthorn may increase cardiac events when used with these products. Lab Test Serum digoxin: Hawthorn may cause false increase of serum digoxin. Adverse effects: Underline = life-threatening 334 Hops Primary Chemical Components and Possible Actions Chemical Class Individual Components Possible Action Flavonoid Quercetin Rutin Hyperoside; Vitexin; Vitexin-rhamnoside Procyanidin C-1 Antiinflammatory Antioxidant Proanthocyanidin Angiotensinconverting enzyme (ACE) inhibitor; chronotropic Antiviral Catechin Epicatechin Eudesmanolide Client Considerations Assess • Assess the reason the client is using hawthorn. • Assess for hypersensitivity reactions. If present, discontinue the use of hawthorn and administer an antihistamine or other appropriate therapy. • Assess cardiovascular status if the client is taking hawthorn to treat congestive heart failure. • Assess for other cardiovascular drugs the client may be taking, including betablockers, cardiac glycosides, central nervous system depressants, and antihypertensives; assess for use of the herbs (see Interactions). Administer • Instruct the client to take hawthorn PO as an extract, tincture, or tea. • Instruct the client to store hawthorn products in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 2 and breastfeeding category is 2A. • Inform the client that hawthorn may be given to children. • Caution the client to check with the prescriber before giving hawthorn to a child who is taking cardiovascular medications (Romm, 2000). • Advise the client not to use this herb if allergic to Rosaceae spp. Hops (hahps) Scientific name: Humulus lupulus Origin: The hop plant is a perennial that is cultivated throughout the world. = Pregnancy = Pediatric ! = Alert = Popular Herb Hops 335 Uses Hops traditionally have been used as an analgesic, an anthelmintic, a sedative/ hypnotic to treat insomnia, and for attention deficit–hyperactivity disorder. It is also used to treat menopausal symptoms and to wean patients off conventional sedative prescriptions. Actions Hops have been used by the food and liquor industries as a flavoring for food and beer. Medicinal uses for hops are described here, although little reliable research exists for any uses or actions. Estrogenic Action Hops are believed to possess estrogen-like activity due to the phytoestrogen components of the hop plant and its ability to exert direct estrogenic effects (Zava et al, 1998). One older study demonstrated estrogenic activity in an acid fraction of the H plant (Zenisek et al, 1960). However, many of the other available studies contain conflicting information regarding the estrogenic action. At this point it is uncertain whether the hop plant does exert estrogen-like activity. Sedative/Hypnotic Action The sedative/hypnotic effects of hops may be due to the volatile oils present in the plant. The same volatile oils may also be responsible for the antispasticity effect. Hops possess a pentobarbital sleep-enhancing effect without influencing motor behavior and an antideppresant action, when studied in the laboratory (Zanoli et al, 2005). Antimicrobial Action One small study shows that the antimicrobial effects of hops result from the bitter acid components (volatile oils) lupulone, humulene, and linalool (Leung, 1980). Other Actions Hops did not improve bone parameters in laboratory animals (Figard et al, 2007). Product Availability Cut herb, dry extract, extract, powdered dry herb, tea Plant Part Used: Whole hops Dosages • Adult PO infusion: pour 8 oz boiling water over 0.4 g (1 tsp) ground hops cone, let stand 15 min • Adult PO extract: 2-4 mg • Adult PO cut herb: 0.5 g as a single dose (Blumenthal, 1998) • Adult PO topical: apply to affected area as needed Contraindications Pregnancy category is 3; breastfeeding category is 3A. Hops should not be used by persons who are hypersensitive to this product; persons who have breast, uterine, or cervical cancers; or those who suffer from a depressive condition. Hops are for short-term or intermittent use only. Use caution to avoid sedation in infants. Continued Adverse effects: Underline = life-threatening 336 Hops Side Effects/Adverse Reactions CNS: Sedation, dizziness, decreased reaction time GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions, including dermatitis and anaphylaxis Interactions Drug Antidepressants, antipsychotics, antihistamines, alcohol, CNS depressants: Hops may cause increased central nervous system effects when taken concurrently with antidepressants, antipsychotics, antihistamines, alcohol, CNS depressants. Cytochrome P450 (carbamazepine, bupropion, orphenadrine, cyclophosphamide, citalopram, azole antifungals, macrolide antibiotics, omeprazole, warfarin, theophylline): Hops may decrease the levels of these drugs. Estrogens: Hops may cause increased hormonal levels when taken in conjunction with estrogen (theoretical). Iron salts: Hops tea may decrease the absorption of iron salts; separate by at least 2 hours. Herb Sedative herbs: Hops may increase sedation when used with other sedating herbs (theoretical) (Jellin et al, 2008). Primary Chemical Components and Possible Actions Chemical Class Acylphloroglucinol Volatile oil Hormone Colupulone Flavonoid Individual Component Possible Action Humulene; Linalool; Lupulone Myrcene Estradiol Antineoplastic; antimicrobial Xanthohumol; Prenylnaringenin; Isoxanthohumol Avermectin Phenolic acid Tannin Estrogenic Antiinfective Cytochrome P450 inhibitor Antiinfective Ferulic acid; Caffeic acid Client Considerations Assess • Assess the reason the client is using hops. • Assess for hypersensitivity reactions and dermatitis. If present, discontinue the use of hops and administer an antihistamine or other appropriate therapy. ! • Assess for anaphylaxis. • Assess for central nervous system reactions: sedation, dizziness, and decreased reaction time. • Assess for medications used (see Interactions). = Pregnancy = Pediatric ! = Alert = Popular Herb Horehound 337 Administer • Instruct the client to store hops in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 3 and breastfeeding category is 3A. • Caution the client to avoid sedation in the infant. • Advise the client not to perform hazardous tasks such as driving or operating heavy machinery if sedation, dizziness, or decreased reaction time occurs. Horehound (hoer’hound) Scientific name: Marrubium vulgare Other common names: Common horehound, hoarhound, houndsbane, marvel, white horehound Origin: Horehound is a perennial found in Asia, Europe, the United States, and Canada. Uses In traditional herbal medicine, horehound has been used to treat upper respiratory congestion, whooping cough, anorexia, asthma, bronchitis, tuberculosis, and diarrhea, to aid digestion and increase diuresis, and as an anthelmintic and a laxative. Its topical form has been used to promote wound healing. Actions Horehound has been used primarily in Mexico, Europe, and Asia. Currently, horehound’s use as an ingredient in throat lozenges is common in the United States. Although its most common use is as an expectorant, no studies are available to support this action, and few studies support any uses or actions of this herb. One study (El Bardai et al, 2001) showed the hypotensive activity of horehound in hypertensive rats. Another study (Berrougui et al, 2006) suggests that horehound provides a natural source of antioxidants, which inhibit LDL, and increase the antiatherogenic potential of HDL. One study (Meyre-Silva et al, 2005) identified analgesic properties of horehound. Product Availability Capsules, cough lozenges, extract, powder, pressed juice, syrup, tea Plant Parts Used: Dried leaves, flowering tops, fresh leaves Dosages • Adult PO extract: 10-40 drops in a small amount of water, tid • Adult PO infusion: pour 8 oz boiling water over herb, let stand 10 min, strain; take 1-2 g up to tid • Adult PO lozenges: use prn • Adult PO powder: 1-2 g tid; 4.5 g daily (Blumenthal, 1998) • Adult PO pressed juice: 2-6 tbsp daily (Blumenthal, 1998) Adverse effects: Underline = life-threatening H 338 Horehound Contraindications Class 2b herb (whole herb). Because horehound is an abortifacient, it should not be used during pregnancy. Until more research is available, this herb should not be used during breastfeeding. It should not be given to children. Horehound should not be used by persons who are hypersensitive to it or who have arrhythmias. Side Effects/Adverse Reactions CV: Arrhythmias ENDO: Hypoglycemia GI: Nausea, vomiting, anorexia, diarrhea INTEG: Hypersensitivity reactions Interactions Drug Antiarrhythmics, emetics, ergots, sumatriptan: Antiarrhythmics, emetics (such as granisetron and ondansetron), ergots, sumatriptan may produce an increased serotonin effect when used with horehound; avoid concurrent use (theoretical). Iron salts: Horehound tea may decrease the absorption of iron salts; separate by 2 hours. Lab Test Blood glucose: Horehound may decrease blood glucose. Primary Chemical Components and Possible Actions Chemical Class Individual Component Volatile oil Camphene; Cymene; Fenchene Marrubiin Diterpene bitter Possible Action Bile secretion, expectorant, antiarrthymic Premarrubiin Tannin Flavonoid Phenylethanoid glycoside Wound healing Chrysoeriol; Luteolin; Apigenin; Vicenin II Marruboside Acteside 2; Forsythoside; Arenarioside; Ballotetroside Client Considerations Assess • Assess the reason the client is using horehound. • Assess for hypersensitivity reactions. If present, discontinue the use of horehound and administer an antihistamine or other appropriate therapy. = Pregnancy = Pediatric ! = Alert = Popular Herb Horse Chestnut 339 • Assess cardiac status: blood pressure, pulse, and ECG changes in clients with cardiac disorders. • Assess for medications used (see Interactions). Administer • Horehound products should be kept away from heat and moisture. • Use horehound for short-term use (⬍2 weeks). Teach Client/Family • Caution the client not to use horehound during pregnancy because it is an abortifacient. Until more research is available, caution the client not to use this herb during breastfeeding. • Caution the client not to give horehound to children. • Because of its many drug interactions, advise the client to consult a qualified herbalist before using horehound in any form other than lozenges. H Horse Chestnut ! (hoers chehs’nuht) Scientific names: Aesculus hippocastanum, Aesculus california, Aesculus glabra Other common names: Aescin, buckeye, California buckeye, chestnut, escine, Ohio buckeye Origin: Horse chestnut is a tree or shrub found worldwide. Uses Traditional uses of horse chestnut include treatment of fever, phlebitis, hemorrhoids, prostate enlargement, edema, inflammation, and diarrhea. It is commonly used in Germany to treat varicose veins. Investigational Uses Researchers are investigating the use of horse chestnut for treatment of venous insufficiency and varicose veins. Actions Antiinflammatory Action Several studies have focused on the antiinflammatory action of horse chestnut. The chemical component aescin, a saponin present in horse chestnut, is responsible for its antiinflammatory properties (Matsuda et al, 1997). In another study of 30 patients with Widmer stage I or II central venous insufficiency, horse chestnut decreased the activity of lysosomal enzymes associated with venous insufficiency. In the study, participants received treatment with either tablets containing the substance (aescin) or a placebo. Those who received tablets containing aescin experienced significant improvement in ankle edema and venous filling rate. Subjective symptoms showed very little improvement (Shah et al, 1997). Product Availability Standardized extract, tincture Plant Parts Used: Seeds, young bark Adverse effects: Underline = life-threatening 340 Horse Chestnut Dosages • Adult PO standardized extract: 100-150 mg daily in two divided doses • Adult PO tincture: 1-2 ml in 1⁄2 cup water, bid-qid (Smith, 1999) Contraindications Pregnancy category is 4; breastfeeding category is 3A. Horse chestnut should not be given to children. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, hepatotoxicity GU: Nephropathy, nephrotoxicity INTEG: Pruritus, hypersensitivity, rash, urticaria MS: Spasms SYST: Bruising, severe bleeding, shock; seeds are toxic Interactions Drug Anticoagulants (anisindione, dicumarol, heparin, warfarin), aspirin and other salicylates: Because of the presence of hydroxycoumarin, a chemical component of the herb that possesses anticoagulant activity, concurrent use of horse chestnut and anticoagulants, aspirin, and other salicylates increases the risk of severe bleeding. Do not use concurrently. Antidiabetics: May increase the hypoglycemic effects of diabetes medications. Iron salts: Horse chestnut tea may decrease the absorption of iron salts; separate by 2 hours. Herb Anticoagulant, antiplatelet herbs: Horse chestnut given with anticoagulant, antiplatelet herbs increases risk of bleeding (Jellin et al, 2008). Hypoglycemic herbs: Horse chestnut given with hypoglycemic herbs increases hypoglycemia (Jellin et al, 2008). Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Steroid Stigmasterol; Alpha-spinasterol; Beta-sitosterol Aescin Antiinflammatory Triterpene glycoside Flavonoid Coumarin Quercetin; Kaempferol Astragalin; Isoquercetin; Rutin Aesculetin; Fraxin; Scopolin Decreased permeability of venous capillaries Antiinflammatory Allantoin = Pregnancy = Pediatric ! = Alert = Popular Herb Horseradish 341 Primary Chemical Components and Possible Actions—cont’d Chemical Class Choline Phytosterol Amino acid Citric acid Tannin Individual Component Possible Action Wound healing; antiinflammatory Seeds Also Contain Oleic acid H Client Considerations Assess • Assess the reason the client is using horse chestnut. • Assess for symptoms of hepatotoxicity (increasing AST, ALT, and bilirubin levels; clay-colored stools; jaundice; right upper-quadrant pain). If any of these symptoms are present, discontinue the use of this herb. • Assess for bleeding, bruising, and allergic reactions such as a rash or itching. If present, discontinue the use of this herb. • Assess renal function if high dosage is suspected. Obtain blood urea nitrogen (BUN) and creatinine levels. Monitor for nephrotoxicity. • Assess for medications used (see Interactions). ! • Assess for toxicity (see Side Effects). Administer • Instruct the client to store horse chestnut in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 4 and breastfeeding category is 3A. • Caution the client not to give horse chestnut to children. ! • Warn the client of the life-threatening side effects of horse chestnut. Do not use older bark as it is poisonous. Horseradish ! (hawrs’ra-dish) Scientific name: Armoracia rusticana Other common names: Great mountain root, pepperrot, great raifort, red cole Origin: Horseradish is a perennial native to Europe but is now found throughout the world. Adverse effects: Underline = life-threatening 342 Horseradish Uses Reported Uses Horseradish is used as an anthelmintic, diuretic, and antibacterial, and to decrease joint inflammation and reduce edema. It may also be used to treat sinusitis and whooping cough. Horseradish is a pungent, warming herb. Actions Very little research is available on the actions of horseradish. Because the plant is poisonous, it should be used only as a flavoring in food unless under the supervision of a qualified herbalist. One study did show a hypotensive reaction in cats given horseradish IV (Sjaastad et al, 1984). Other studies (Agabeili et al, 2005; Weil et al, 2005) identified inhibition of growth of colon, lung, and stomach cancer cells. It also, possesses COX-1 inhibitory actions. Product Availability Fresh root, paste, powder Plant Part Used: Roots Dosages • Adult PO fresh root: 2-4 g before meals • Adult topical: 2% mustard oil maximum, applied prn Contraindications ! Class 2d herb (rhizome/root). Because it is an abortifacient, horseradish should not be used during pregnancy. Until more research is available, this herb should not be used during breastfeeding. It should not be given to children younger than 4 years of age. Persons with hypothyroidism, hyperthyroidism, renal disease, gastrointestinal ulcers, or hypersensitivity to this herb should avoid its use. Horseradish is toxic if used internally in large quantities. Side Effects/Adverse Reactions EENT: Mucous membrane irritation GI: Nausea, vomiting, anorexia, diarrhea INTEG: Hypersensitivity reactions Interactions Drug Thyroid replacement: Horseradish may interfere with thyroid replacement therapy (theoretical) (Jellin et al, 2008). Primary Chemical Components and Possible Actions Chemical Class Individual Component Coumarin Scopoletin; Aesculetin; Caffeic acid; Hydroxycinnamic acid C Vitamin Peroxidase enzyme = Pregnancy = Pediatric ! = Alert Possible Action = Popular Herb Horsetail 343 Primary Chemical Components and Possible Actions—cont’d Chemical Class Resin Flavonoid Asparagine Glucosinolate Individual Component Possible Action Quercetin; Kaempferol Antiinflammatory Mustard oil Antiinflammatory, respiratory support Client Considerations H Assess • Assess for hypersensitivity reactions. If present, discontinue the use of horseradish and administer an antihistamine or other appropriate therapy. Administer • Instruct the client to store horseradish products in a cool, dry place, away from heat and moisture. Fresh roots should be kept buried. Teach Client/Family • Caution the client not to use horseradish during pregnancy because it is an abortifacient. Until more research is available, caution the client not to use this herb during breastfeeding. • Caution the client not to give horseradish to children younger than 4 years of age. ! • Advise the client to use horseradish internally only as a food flavoring or under the direction of a qualified herbalist. The horseradish plant is toxic if used internally in large quantities. Horsetail ! (hawrs’tayl) Scientific name: Equisetum arvense Other common names: Bottle brush, corn horsetail, dutch rushes, horse willow, horsetail grass, paddock pipes, pewterwort, scouring rush, shave grass, toadpipe Origin: Horsetail is a perennial pteridophyte found throughout Europe and in parts of Asia. Uses Horsetail is used internally to increase the strength of bones, teeth, nails, and hair. It has also been used internally as an antiinfective, diuretic, and anticancer treatment, as well as to decrease gout, prevent urinary stones, treat menorrhagia, and increase strength. It is used externally to promote wound healing. Adverse effects: Underline = life-threatening 344 Horsetail Actions This herb exerts mild diuretic activity but is not recommended to treat any condition. Horsetail may increase sodium and water excretion. Anecdotal reports characterize it as an astringent used to stop bleeding, decrease inflammation, and promote wound healing. However, no evidence supports any of these claims. One study (Radulovic et al, 2006) identified antimicrobial actions against a panel of microorganisms. Another study (Dos Santos et al, 2005) found that horsetail possesses sedative and anticonvulsant effects when studied in the laboratory. Product Availability Crude herb, fluid extract; component in combination products Plant Part Used: Dried green aerial stems Dosages • Adult PO fluid extract: initially, 20-40 drops tid-qid; maintenance 20-40 drops bid-tid (1:1 dilution in 25% alcohol) • Adult PO infusion: place 1.5 g herb in 8 oz water; take 2-4 g/day • Adult PO tea: pour 8 oz boiling water over 2-3 g herb, boil 5 min, let stand 15 min, strain • Adult topical: 10 g herb/L water, used as a compress or bath prn Contraindications ! Pregnancy category is 3; breastfeeding category is 2A. Horsetail should not be given to children. This herb should not be used by persons with hypersensitivity to it or those with edema, cardiac disease, renal disease, or nicotine sensitivity. Horsetail contains nicotine and should not be used for prolonged periods. The active chemicals in this herb are absorbed through the skin and can cause death. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions Nicotine toxicity: Weakness, dizziness, fever, loss of weight, feeling of cold in extremities (very large quantities) SYST: Thiamine deficiency Interactions Drug Cardiac glycosides (digoxin): Horsetail may increase the toxicity of cardiac glycosides and increase hypokalemia. Diuretics: Horsetail may increase the effect of diuretics; avoid concurrent use (theoretical). Lithium: Horsetail taken with lithium may cause dehydration and lithium toxicity. Herb Adonis, lily of the valley, squill: Horsetail increases the action of Adonis vernalis, convalleria majalis, Scillae bulbs when taken concurrently. Tobacco: Horsetail may cause increased CNS stimulation when used with tobacco; avoid concurrent use. Food Thiamine: Horsetail may interfere with the absorption of thiamine. = Pregnancy = Pediatric ! = Alert = Popular Herb Huperzine A 345 Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Flavonoid Isoquercitrin; Equisetrin; Galuteolin Cholesterol; Campesterol; Isofucosterol; Beta-sitosterol Nicotine Diuretic Diuretic Sterol Alkaloid Central nervous system stimulant Palustrinine; Palustrine Thiaminase Minerals Thiamine deficiency Silica; Selenium; Zinc Client Considerations Assess • Assess the reason the client is using horsetail. • Assess for hypersensitivity reactions. If present, discontinue the use of horsetail and administer an antihistamine or other appropriate therapy. • Assess for the use of medications, caffeinated foods, and tobacco. Xanthines, cerebral stimulants, nicotine, coffee, tea, cola, and tobacco will cause increased central nervous system stimulation when used in conjunction with horsetail (see Interactions). ! • Assess for nicotine toxicity: weakness, dizziness, fever, weight loss, and feeling of cold in extremities. Horsetail would have to be taken in large quantities to cause a toxic reaction. Administer • Instruct the client to store horsetail products in sealed container away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 3 and breastfeeding category is 2A. • Caution the client not to give horsetail to children. • Caution the client not to confuse medicinal horsetail with other Equisetum spp. ! • Warn the client about possible nicotine toxicity and the many drug, food, and herb interactions of horsetail. ! • Warn the client to keep horsetail away from children. The active chemicals in this herb are absorbed through the skin and can cause death. Huperzine A (hoo-pehr’ zeen) Scientific name: Huperzine A Other common names: HupA, Selagine Origin: Huperzine A is a synthetic. Adverse effects: Underline = life-threatening H 346 Hyssop Uses Huperzine A is used for dementia in Alzheimer’s disease and for muscle weakness in myasthenia gravis. Actions This herb is thought to be helpful in Alzheimer’s disease, as well as in other dementias. It crosses the blood-brain barrier and is a reversible inhibitor of acetylcholinesterase. Huperzine A increases acetycholine for up to 3 or more hours. It seems to possess beneficial effects of general cognitive, behavioral disturbance and functional performance (Li et al, 2008; Peng et al, 2007). Product Availability Tablets, IM Dosages Alzheimer’s disease • Adult PO tablets: 50-200 mcg bid Senile Dementia • Adult PO tablets: 30 mcg bid Myasthenia Gravis • Adult IM: 400 mcg/day Contraindications Huperzine A should not be used in pregnancy or breastfeeding until more research is available. It is contraindicated in persons with seizures, PUD, GI ulcers, bradycardia, or other rhythm disorders. Side Effects/Adverse Reactions CNS: Sweating, blurred vision, hyperactivity GI: Nausea, anorexia, vomiting, diarrhea Client Considerations Assess • Assess the reason the client is using hyperzine A. Administer • Keep huperzine A in a cool, dry area, away from excessive light. Teach Client/Family • Teach the patient that hyperzine A should not be used in pregnancy and breastfeeding until more research is available. Hyssop (hi’suhp) Scientific name(s): Hyssopus officinalis Origin: Hyssop is a perennial found in the Mediterranean, the United States, and Canada. = Pregnancy = Pediatric ! = Alert = Popular Herb Hyssop 347 Uses Hyssop has been used as a fragrance in soaps, perfumes, and cosmetics, as well as a flavoring in food. It has been used as an antiasthmatic, antispasmotic, and expectorant, as well as to treat sore throat (used as a gargle) and for wound healing. Investigational Uses Initial evidence indicates that hyssop may be useful as an antiviral to treat HIV infections. Hyssop has also been used to treat herpes infections. Actions Hyssop is a member of the mint family. Little research is available to confirm any of its uses or actions. Antiretroviral/Antiviral Action Initial research indicates that hyssop may be useful in the treatment of HIV-1 infections (Gollapudi et al, 1995) and possibly herpes infections. One polysaccharide isolated H from hyssop was shown to inhibit HIV replication. Another study showed that the tannins and caffeic acid found in hyssop exerted antiviral activity (Kreis et al, 1990). Other Actions Anecdotal reports suggest the use of hyssop as a stimulant, expectorant, sedative, and antispasmodic. One study (Lu et al, 2002) identified the muscle-relaxing activity of Hyssopus officinalis in laboratory animals. Another study identified the antiplatelet action of the chemical components, phenylpropanoids (Tognolini et al, 2006). Product Availability Essential oil, fluid extract, tea, tincture Plant Parts Used: Essential oil from leaves and flower tips Dosages • Adult PO tea: cover 1 tsp herb with 8 oz boiling water, let stand 15 min, may take tid • Adult PO tincture: 2-4 ml tid Contraindications Class 2b herb (whole herb). Because hyssop is an abortifacient, it should not be used during pregnancy. Until more research is available, this herb should not be used during breastfeeding. It should not be given to children younger than 2 years of age. Persons with hypersensitivity to hyssop should not use it. Side Effects/Adverse Reactions CNS: Seizures GI: Nausea, vomiting, anorexia, diarrhea INTEG: Hypersensitivity reactions Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Terpenoid Marrubiin; Ursolic acid; Oleanolic acid Cardioactive; stimulates bronchial secretions Continued Adverse effects: Underline = life-threatening 348 Hyssop Primary Chemical Components and Possible Actions—cont’d Chemical Class Individual Component Volatile oil Linalool; Camphor; Pinochamphone; Thujone; Alphapinene; Beta-pinene; Limonene; Camphene; Alphaterpinene; Bornylacetate; Isopinocamphone Hesperidiin Diosmetin Flavonoid Tannin Resin Acid Polysaccharide Phenylpropanoids Possible Action Muscle relaxant Wound healing; antiviral Caffeic acid MAR-10 Antiviral Anti-HIV Antiplatelet Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of hyssop and administer an antihistamine or other appropriate therapy. • Determine the reason the client is using hyssop and suggest more effective alternatives. Administer • Children, geriatric clients, and clients who are emaciated should use only low doses of hyssop. Teach Client/Family • Caution the client not to use hyssop during pregnancy because it is an abortifacient. Until more research is available, caution the client not to use this herb during breastfeeding. • Caution the client not to give hyssop to children younger than 2 years of age. • Advise the client to use hyssop only under the direction of a qualified herbalist if using the herb for an extended period. • Warn the client not to confuse Hyssopus officinalis with other plants commonly called “hyssop.’’ These other plants are not members of the Hyssopus genus or its family, Labiatae. = Pregnancy = Pediatric ! = Alert = Popular Herb Iceland Moss 349 Iceland Moss (ise’luhnd maws) Scientific name: Cetraria islandica Other common names: Consumption moss, eryngo-leaved liverwort, Iceland lichen Origin: Iceland moss is a lichen found in Iceland and other parts of the Northern hemisphere. Uses Iceland moss has been used to treat the common cold, cough, bronchitis, inflammation, and anorexia. Investigational Uses Initial research documents the use of Iceland moss to treat bacterial and HIV-1 infections. Actions Iceland moss may be contaminated with lead. Antioxidant, Antimicrobial, Antiretroviral, Anticancer, and Antiinflammatory Actions Iceland moss has demonstrated significant antimicrobial effects against Streptococcus pyogenes, Staphylococcus aureus, Mycobacterium tuberculosis, and Helicobacter pylori (Ingolfsdottir et al, 1985, 1997). The chemical component responsible is protolichesterinic acid. Iceland moss has also been shown to exert significant activity against HIV-1 infection and certain cancers (Ingolfsdottir, 1994). Cetraria islandica showed significant antioxidant effect depending on concentration of sample. The conclusion was that C. islandia is a potential source of natural antioxidant (Gulcin et al, 2002). Another study (Freysdottir et al, 2008) identified the antiinflammatory effect of Iceland moss, possibly by changing the cytokine secretion bias. Product Availability Capsules, creams, crude herb, lozenges, tincture Plant Parts Used: All parts of the lichen Dosages Cough and Cold • Adult PO lozenges: take one lozenge prn Other • Adult PO decoction: mix 1 tsp shredded moss in 8 oz water, boil 3 min, strain, take bid • Adult PO tincture: 1-2 ml bid-tid Contraindications Class 1 herb (decoction, infusion); class 2d herb (alcoholic extract, powder, thallus). Until more research is available, Iceland moss should not be used during pregnancy and breastfeeding. It should not be given to children. This herb should not be used by persons with gastric or duodenal ulcers or by those with hypersensitivity to it. Continued Adverse effects: Underline = life-threatening I 350 Indigo Side Effects/Adverse Reactions GI: Nausea, vomiting, gastritis, anorexia, hepatotoxicity INTEG: Hypersensitivity reactions Interactions Drug Oral medications: Iceland moss can decrease absorption of oral medications (Jellin et al, 2008). Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Polysaccharide Lichenic acid Lichenin; Isolichenin Protolichesterinic acid Fumarprotocetraric acid; Lichesterinic acid Pharyneal soothing agent Antimicrobial Client Considerations Assess • Assess the reason the client is using Iceland moss. • Assess for hypersensitivity reactions. If present, discontinue the use of Iceland moss and administer an antihistamine or other appropriate therapy. ! • Assess for signs of hepatotoxicity: jaundice, clay-colored stools, and right upper-quadrant pain. Monitor hepatic function studies: AST, ALT, and bilirubin. Administer • Instruct the client to store Iceland moss in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use Iceland moss in children or those who are pregnant or breastfeeding until more research is available. • Advise the client that very little research is available that documents any actions or uses of Iceland moss. • Advise the client that prolonged use can lead to GI ulceration and liver disease. Indigo (in’di-goe) Scientific name: Indigofera spp. Other common name: Qingdai Origin: Indigo is a perennial shrub found in several regions of the world. = Pregnancy = Pediatric ! = Alert = Popular Herb Indigo 351 Uses Indigo has been used in traditional Chinese medicine to purify the liver and to treat inflammation, pain, and fever. Other uses include treatment of diabetes and mumps. Investigational Uses Indigo may be used to treat bacterial fungal infections. Actions One species of indigo (Indigofera spicata) contains substances that are hepatotoxic and teratogenic. Other indigo species do not cause these toxicities. Indigofera tinctoria has been shown to prevent hepatotoxicity in the case of carbon tetrachloride poisoning (Anand et al, 1981). Some species have shown promise in the inhibition of certain cancers. However, insufficient research supports this action at this time. One study (Chakrabarti et al, 2006) identified the insulin-sensitizing property of indigo. It is used in rural India for its antidiabetic activity. In the laboratory it reduced plasma glucose by 63%. Indigo may possess antidyslipidemic activity (Puri et al, 2007) and hepatoprotective effects (Rajkapoor et al, 2006). Product Availability Powder, tablets Plant Parts Used: Branches, leaves Dosages No dosage consensus exists. Contraindications Because birth defects have occurred in babies born to animals given Indigofera spicata, indigo should not be used during pregnancy. Until more research is available, this herb should not be used during breastfeeding. It should not be given to children. Persons who are hypersensitive to indigo should not use it. Side Effects/Adverse Reactions EENT: Redness of the eye GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions, dermatitis Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Glucoside Xanthene Indigofera spicata Also Contains Indospicine Indican Tetrahydroxanthene Dye Indigtone Teratogenic; hepatotoxic Hepatoprotective Adverse effects: Underline = life-threatening I 352 Inosine Client Considerations Assess • Assess the reason the client is using indigo. • Assess for hypersensitivity reactions and dermatitis. If present, discontinue the use of indigo and administer an antihistamine or other appropriate therapy. Administer • Instruct the client to store indigo in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use indigo during pregnancy. Birth defects have occurred in babies born to animals given Indigofera spicata. Until more research is available, caution the client not to use this herb during breastfeeding. • Caution the client not to give indigo to children. • Advise the client to avoid getting indigo in the eye. • Advise the client to learn to distinguish false, wild, and bastard indigo (Baptisia tinctoria) from Indigofera spp. used for medicinal purposes. Inosine (in’ uh-seen) Scientific name: 2,3-diphosphoglycerate Other common name: Hypoxanthine riboside Origin: Inosine is a synthetic. Uses Inosine is used to enhance athletic stamina and performance. Actions There is little research for inosine use in performance enhancement. It is thought to increase axon growth in damaged nerve cells (Jellin et al, 2008). There is a protective mechanism in platelet activation and cerebral ischemic damage (Hsiao et al, 2005). Product Availability Tablets, powder Dosages • Adult PO: 5-6 g/day Contraindications Inosine should not be used in children or those who are pregnant, breastfeeding, or hypersensitive to this product. Client Considerations Assess • Assess the reason the client is using inosine. = Pregnancy = Pediatric ! = Alert = Popular Herb Irish Moss 353 Administer • Keep inosine in a dry area, away from direct sunlight. Teach Client/Family • Caution the client not to use inosine in children or those who are pregnant or breastfeeding until more research is available. Irish Moss (ire’ish maws) Scientific name: Chondrus crispus Other common names: Carrageen, carageenan, chondrus Origin: Irish moss is a seaweed found in Europe and on the coasts of Canada. Uses Irish moss is used to treat diarrhea, gastritis, and bronchitis. Investigational Uses Research is underway to determine the effectiveness of Irish moss as an antiinflammatory and as a vehicle for delivery of gastrointestinal drugs. Actions Traditionally, Irish moss has been used to treat cough, bronchitis, and diarrhea. However, no research supports these traditional uses, and little research is available on this herb in general. One study of laboratory animals did show an antiinflammatory action when carrageenan, one of the chemical components, was injected into inflamed paws. Other proposed actions that have not been studied include potential use as an anticholesteremic, anticoagulant, and antihypertensive. The food and drug industries use Irish moss as a binder, emulsifier, and stabilizer. Product Availability Component of: cream, lotion, ointment, toothpaste, tea, granules in combination with other herbs Plant Part Used: Whole moss Dosages and Routes • Adult decoction: boil 1 oz of dried moss in 1-11/2 pints of water for 15 min, strain, drink 1 cup tid Contraindications Until more research is available, Irish moss should not be used during pregnancy and breastfeeding. It should not be given to children. This herb should not be used by persons with active gastrointestinal bleeding or a history of peptic ulcers, or by those with hypersensitivity to it. Side Effects/Adverse Reactions CV: Decreased blood pressure GI: Nausea, vomiting, anorexia, diarrhea, abdominal pain, gastrointestinal bleeding Continued Adverse effects: Underline = life-threatening I 354 Irish Moss Side Effects/Adverse Reactions—cont’d GU: Renal changes (theoretical) INTEG: Hypersensitivity reactions Interactions Drug Anticoagulants (heparin, warfarin), antihypertensives: Irish moss may increase the effects of anticoagulants, antihypertensives; avoid concurrent use. Oral medications: Irish moss may decrease absorption of oral medications. Salicylates (aspirin): Irish moss may pose an increased risk of bleeding when used with salicylates; avoid concurrent use. Primary Chemical Components and Possible Actions Chemical Class Carrageenan Iodine Bromine Mineral Vitamin Individual Component Possible Action Antiinflammatory Iron; Magnesium; Calcium; Sodium A; B Client Considerations Assess • Assess the reason the client is using Irish moss. • Assess for hypersensitivity reactions. If present, discontinue the use of Irish moss and administer an antihistamine or other appropriate therapy. ! • Assess for suspected gastrointestinal bleeding: black tarry stools, guaiac stools. • Assess for the use of antihypertensives, anticoagulants, and salicylates (see Interactions). Administer • Instruct the client to store Irish moss in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use Irish moss in children or those who are pregnant or breastfeeding until more research is available. = Pregnancy = Pediatric ! = Alert = Popular Herb Jaborandi 355 Jaborandi (zhah-boer-ahn’dee) Scientific names: Pilocarpus jaborandi, Pilocarpus microphyllus, Pilocarpus pinnatifolius Other common names: Arruda brava, arruda do mato, Indian hemp, jamguarandi, juarandi, pernambuco jaborandi Origin: Jaborandi is found in Brazil. Uses The primary use of jaborandi is to reduce the intraocular pressure caused by glaucoma and to treat xerostomia. It is also used to treat diabetes and nephritis, to stimulate milk flow in nursing mothers, and as an antiinflammatory. Jaborandi has been used topically for baldness and to treat skin disorders such as psoriasis and eczema. Actions The chemical component pilocarpine is responsible for the pharmacologic action of jaborandi. Most of the information available on this herb is derived from the mainstream pharmacologic literature on pilocarpine. Jaborandi may be administered either orally or ophthalmically. When taken orally, it acts on the cholinergic receptors, stimulating the exocrine glands and producing muscarinic effects. Gastric and bronchial secretions increase, as does motility of the urinary tract and gallbladder. Ophthalmic Action When used as an ophthalmic, jaborandi is a direct-acting miotic. This herb duplicates the muscarinic effects of acetylcholine. The result is pupillary constriction, increased aqueous humor outflow, and decreased intraocular pressure. Product Availability Essential oil, extract, powder, tincture NOTE: For information about pilocarpine (eye drops), refer to the pharmacologic literature. Plant Part Used: Leaves Dosages Ophthalmic • Adult topical drops: 1-2 gtt tid Other • Adult PO extract: 20-30 drops • Adult PO powdered leaves: 10-60 grains • Adult PO tincture: 1 dram Contraindications Class 2b herb (leaf). Until more research is available, jaborandi should not be used during pregnancy and breastfeeding. It should not be given to children. Jaborandi should not be used by persons with uncontrolled asthma, angle-closure glaucoma, or iritis or by persons with hypersensitivity to it. Persons with chronic obstructive pulmonary disease, bronchitis, cardiac disease, biliary tract disease, cholelithiasis, retinal disease, psychiatric disorders, neurologic disorders, or cognitive disorders should avoid the use of jaborandi. Continued Adverse effects: Underline = life-threatening J 356 Jaborandi Side Effects/Adverse Reactions CNS: Tremors, dizziness, headache, weakness CV: Hypertension, tachycardia, edema EENT: Rhinitis, amblyopia, epistaxis; blurred vision, stinging, eye pain (ophthalmic use) GI: Nausea, vomiting, anorexia, dysphagia GU: Urinary frequency INTEG: Hypersensitivity reactions, flushing, sweating Interactions Drug Anticholinergic: The effects of jaborandi are decreased when used internally with anticholinergics. Beta-blockers: Adverse cardiovascular reactions are increased when jaborandi is used internally with beta-blockers; do not use concurrently. Bethanechol, cholinergics (ophthalmic): Increased cholinergic effects occur when jaborandi is used internally with bethanechol, ophthalmic cholinergics. NSAIDs (topical): The action of jaborandi (ophthalmic route) is decreased when it is used with topical NSAIDs; do not use concurrently. Pharmacology Pharmacokinetics Jaborandi is absorbed well when taken internally. It is excreted via urine, metabolized as an unchanged drug. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Alkaloid Pilocarpine Direct-acting miotic; cholinergic Isopilocarpine; Pilocarpidine Jaborine Pilosine Tannic acid Jaboric acid Pilocarpic acid Volatile oil Client Considerations Assess • Assess the reason the client is using jaborandi. • Assess for hypersensitivity reactions. If present, discontinue the use of jaborandi and administer an antihistamine or other appropriate therapy. • Assess for dizziness, headache, weakness, blurred vision, hypertension, and tremors. If present, the herb dose may need to be reduced. • Assess for medication use (see Interactions). = Pregnancy = Pediatric ! = Alert = Popular Herb Jamaican Dogwood 357 Administer • Instruct the client to use the lowest PO dose possible. • Store in dry, cool environment. • Use by ophthalmic route tid. Teach Client/Family • Caution the client not to use jaborandi in children or those who are pregnant or breastfeeding until more research is available. • Advise the client that visual changes such as blurred vision may occur. The client should avoid driving or operating machinery until the particular effects are known. • Advise the client that when jaborandi is used via the ophthalmic route, the eyes initially may sting and headache, brow ache, and decreased night vision may occur. • Advise client not to confuse pilocarpine jaborandi or paraguay jaborandi with this agent (Jellin et al, 2008). J Jamaican Dogwood ! (jah-may’kuhn dawg’wood) Scientific name: Piscidia erythrina Other common names: Fish poison tree, fishfuddle, West Indian dogwood Origin: Jamaican dogwood is now found in the West Indies, the northern portion of South America, and the southern portion of the United States. Uses Jamaican dogwood has been used to treat insomnia, anxiety, asthma, migraine, dental pain, nerve pain, menstrual disorders such as dysmenorrhea, and the pain of labor. Most of its uses are intended to produce mild to moderate analgesia. Because of its toxicity, this herb is rarely used to treat any condition. Actions Very little information is available on Jamaican dogwood, and no primary research is available for any of its uses or actions. It is believed to exert an antispasmodic action, but research does not confirm this. Because of its toxicity, this herb is no longer in use to any significant extent. Its use should be discouraged and safer alternatives recommended. Product Availability Bark strips, dried bark, dried roots, fluid extract, tincture Plant Parts Used: Bark, roots Dosages • Adult PO dried bark/dried roots: 2-4 g daily divided tid • Adult PO fluid extract: 5-20 drops, increasing to a maximum of 1-2 drams daily • Adult PO tea: 1 tsp in 8 oz water, simmer 10-15 min • Adult PO tincture: 2-3 ml bid-tid (taken at bedtime if used to treat insomnia) Adverse effects: Underline = life-threatening 358 Jamaican Dogwood Contraindications ! Pregnancy category is 6; breastfeeding category is 4A. Jamaican dogwood should not be given to children. This herb should not be used by elderly persons, those with cardiovascular disease such as arrhythmias or hypotension, or those with hypersensitivity to it. Jamaican dogwood should not be used intravenously. This is a toxic herb that is not recommended for use. Side Effects/Adverse Reactions CNS: Dizziness, sedation GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions Toxicity: Sweating, tremors, salivation, numbness Interactions Drug Alcohol, antihypertensives, barbiturates, opioids: Jamaican dogwood may increase the effects of alcohol, antihypertensives, barbiturates, opioids; avoid concurrent use. Antihistamines: Antihistamines may produce an increased effect when used with Jamaican dogwood; avoid concurrent use. Herb Sedative herbs: Jamaican dogwood may increase sedation when used with sedative herbs. Primary Chemical Components and Possible Actions Chemical Class Isoflavone Rotenoid Tannin Soflavone Tataric acid Individual Component Possible Action Spasmolytic Millettone; Isomillettone; Sumatrol; Dehydromillettone; Rotenone Carcinogenic Wound healing Piscidone; Listetin; Erythbigenin; Piscerythrone; Ichthynone Piscidic fukiic; Methlfukiic Client Considerations Assess • Assess the reason the client is using Jamaican dogwood. • Assess for hypersensitivity reactions. If present, discontinue the use of Jamaican dogwood and administer an antihistamine or other appropriate therapy. • Assess for cardiovascular disease such as hypotension, bradycardia, and arrhythmias. • Assess for use of alcohol, antihistamines, antihypertensives, barbiturates, and opioids (see Interactions). ! • Assess for toxicity symptoms (sweating, tremors). = Pregnancy = Pediatric ! = Alert = Popular Herb Jambul 359 Administer • Inform the client that Jamaican dogwood may be taken PO in the form of dried products (bark, root, or bark strips), extract, tincture, or tea. • Instruct the client to store Jamaican dogwood products in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 6 and breastfeeding category is 4A. • Caution the client not to give Jamaican dogwood to children. • Advise the client that Jamaican dogwood causes drowsiness and sedation. • Caution the client not to perform hazardous activities such as driving or operating heavy machinery until physical response to the herb can be evaluated. ! • Warn the client that this herb cannot be recommended for any use or action because of its toxicity. Jambul (jam-bewl’) Scientific name: Syzygium cuminii Other common names: Black plum, jamba, jambolana, jambolo, jambool, jambu, jambula, jambulon plum, java plum Origin: Jambul is a tree found in India and Sri Lanka. Uses Jambul has been used in traditional herbal medicine as an aphrodisiac and an antispasmodic, as well as an aid in digestion. It is also used to treat diarrhea, flatulence, and diabetes mellitus. Investigational Uses Initial research indicates that jambul decreases inflammation. Actions Hypoglycemic Action Jambul has been used in Brazil for its hypoglycemic action. However, in one study using laboratory animals with streptozocin-induced diabetes, no difference was found in blood glucose levels when the animals were given jambul tea for 14 to 95 days as a water substitute (Teixera et al, 1997). Product Availability Decoction, tea Plant Parts Used: Fruit, leaves, seeds Dosages • Adult PO: powdered seed 0.3-2 g. • Adult liquid extract: 4-8 ml (Jellin et al, 2008) Contraindications Until more research is available, jambul should not be used during pregnancy and breastfeeding. It should not be given to children. This herb should not be used by persons with hypersensitivity to it. Continued Adverse effects: Underline = life-threatening J 360 Jimsonweed Side Effects/Adverse Reactions GI: Nausea, anorexia INTEG: Hypersensitivity reactions Interactions Drug Antidiabetics: Jambul may increase the effects of antidiabetics; avoid concurrent use (theoretical). Primary Chemical Components and Possible Actions Chemical Class Individual Component Fatty acid Oleic acid; Myristic acid; Linoleic acid; Palmitic acid Quercetin Corilagin; Ellagic; Galloyglucose Flavonoid Tannin Possible Action Antiinflammatory Antibacterial Essential oils Client Considerations Assess • Assess the reason the client is using jambul. • Assess for hypersensitivity reactions. If present, discontinue the use of jambul and administer an antihistamine or other appropriate therapy. • Monitor blood glucose in diabetic clients; identify antidiabetes agents used (see Interactions). Administer • Instruct the client to store jambul products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use jambul in children or those who are pregnant or breastfeeding until more research is available. • Advise client not to confuse jambolan bark with jambolan seeds (Jellin et al, 2008). Jimsonweed ! (jim’suhn-weed) Scientific name: Datura stramonium Other common names: Angel’s trumpet, angel tulip, apple-of-Peru, devil weed, devil’s apple, devil’s trumpet, Estramonio, green dragon, gypsyweed, inferno, Jamestown weed, loco seeds, locoweed, mad apple, moon weed, stramoine, stechapfel, stinkweed, thorn apple, tolguacha, trumpet lily, zombie’s cucumber Origin: Jimsonweed is a weed found in most temperate and subtropical parts of the world. = Pregnancy = Pediatric ! = Alert = Popular Herb Jimsonweed 361 Uses Although jimsonweed is highly toxic, it has been used to treat asthma, Parkinsonism, and irritable bowel syndrome, as well as to reduce gastrointestinal secretions. It also has been used as a hallucinogen. Actions Most of the information available on jimsonweed comes from mainstream pharmacologic literature regarding its component alkaloids. Its chemical components exert anticholinergic properties and block acetylcholine at parasympathetic neuroeffector sites. The blocking of vagal stimulation in the heart increases both cardiac output and heart rate and dries secretions. The chemical components responsible for these actions are atropine, hyoscine, scopolamine, and hyoscyamine. This herb is very poisonous to animals and humans, if it is not used correctly. Product Availability Cigarettes, crude herb, rectal suppositories Plant Parts Used: Flowering tops, leaves, roots Dosages J • Adult PO: 75 mg (Clause, 1961) Contraindications ! Until more research is available, jimsonweed should not be used during pregnancy and breastfeeding. It should not be given to children. Jimsonweed should not be used by persons with hypersensitivity to this plant or belladonna alkaloids. It should not be used by persons with angle-closure glaucoma, obstruction of the gastrointestinal or urinary system, thyrotoxicosis, ulcerative colitis, prostatic hypertrophy, tachycardia, tachyarrhythmia, asthma, acute hemorrhage, hepatic disease, myocardial ischemia, or central nervous system disorders such as myasthenia gravis. Persons with spastic paralysis, gastric ulcers, hyperthyroidism, chronic obstructive pulmonary disease, hypertension, congestive heart failure, and renal disease should avoid its use. The jimsonweed plant is toxic, especially the seeds. Side Effects/Adverse Reactions CNS: Headache, dizziness, confusion, anxiety, flushing, drowsiness, insomnia, weakness, involuntary movements, decreased sweating, increased/decreased body temperature, coma, seizures, death (plant ingestion) CV: Hypotension, paradoxical bradycardia, angina, premature ventricular contractions, hypertension, tachycardia, ectopic ventricular beats EENT: Blurred vision, photophobia, eye pain, pupil dilatation, nasal congestion GI: Nausea, vomiting, anorexia, dry mouth, abdominal pain, constipation, abdominal distention, altered taste GU: Retention, hesitancy, impotence, dysuria INTEG: Hypersensitivity reactions, rash, urticaria, contact dermatitis, dry skin, flushing Interactions Drug Amantadine, anticholinergics, MAOIs, tricyclic antidepressants: Increased anticholinergic effects result when jimsonweed is used with amantadine, anticholinergics, MAOIs, or tricyclic antidepressants. Continued Adverse effects: Underline = life-threatening 362 Jimsonweed Interactions—cont’d Antacids: Antacids decrease the action of jimsonweed. Phenothiazines: Jimsonweed decreases the action of phenothiazines. Herb Aloe, buckthorn, cascara, chinese rhubarb, senna: The action of jimsonweed is increased in cases of chronic use or abuse of aloe, buckthorn, cascara, chinese rhubarb, or senna. Pharmacology Pharmacokinetics The atropine component is well absorbed, metabolized by the liver, and excreted by the kidneys. It crosses the placenta and is excreted in breast milk. Primary Chemical Components and Possible Actions Chemical Class Seeds and Leaves Contain Alkaloid Seeds Also Contain Fatty acid Individual Component Possible Action Atropine; Scopolamine; Hyoscyamine; Hyoscine Anticholinergic Palmitic acid; Stearic acid; Oleic acid; Linoleic acid; Lignoceric acid All Plant Parts Contain Tannin Coumarin Wound healing Client Considerations Assess • Assess the reason the client is using jimsonweed. • Assess for hypersensitivity reactions, such as rash, urticaria, and contact dermatitis. If present, discontinue the use of jimsonweed and administer an antihistamine or other appropriate therapy. ! • Assess respiratory status, including rate, rhythm, wheezing, dyspnea, and engorged neck veins. If any of these symptoms are present, jimsonweed use should be discontinued immediately. ! • Assess for increased intraocular pressure, including blurred vision, nausea, vomiting, and increased tearing. If any of these symptoms are present, jimsonweed use should be discontinued immediately. • Assess cardiac status, including rate, rhythm, character, and blood pressure. • Assess for medications and herbs used (see Interactions). = Pregnancy = Pediatric ! = Alert = Popular Herb Jojoba 363 Administer • Instruct the client to increase bulk and water in the diet if constipation occurs. • Instruct the client to use hard candy or gum and rinse the mouth frequently if dryness of the mouth occurs. Teach Client/Family • Caution the client not to use jimsonweed in children or those who are pregnant or breastfeeding until more research is available. • Warn the client that the jimsonweed plant is toxic, especially the seeds. ! • Caution the client to report blurred vision, chest pain, and allergic reactions immediately. • Caution the client not to perform strenuous activities in high temperatures while using jimsonweed. Heat stroke may occur. ! • Advise the client to avoid consumption of jimsonweed because its alkaloid chemical components are similar to those of the deadly nightshade plant. Very little research exists on jimsonweed. ! • Caution the client to use jimsonweed only under the supervision of a qualified herbalist. This herb is considered unsafe. Jojoba ! (hoe-hoe’bah) Scientific names: Simmondsia chinesis, Simmondsia californica Other common names: Deernut, goatnut, pignut Origin: Jojoba is a shrub found in Mexico and the southwestern region of the United States. Uses Jojoba has been used primarily to treat skin disorders including scaling, eczema, psoriasis, seborrhea and chapped, dry skin. It is a component of many common skin products. Anecdotal information promotes the use of jojoba to treat hair loss and acne and to decrease the appearance of wrinkles. Actions Jojoba has been used for many years as a component in cosmetics, suntan lotions, shampoos, and hair conditioners. Primary research is lacking, and only two studies are available that relate to the medicinal uses of jojoba. One study evaluated rabbits given a 2% jojoba dietary supplement. After supplementation, cholesterol levels decreased by 40%. However, the mechanism of action was not studied (Clarke et al, 1981). Another study evaluated the antioxidant effects of jojoba, which are believed to result from its alpha-tocopherol content (Mallet et al, 1994). Most of the uses of jojoba are based on years of anecdotal information. Product Availability Beads, butter, crude wax; component of Chapstick, cream, dandruff shampoo, lipstick, lotion, soap Plant Part Used: Oil from seeds Dosages No dosage information is available. Adverse effects: Underline = life-threatening J 364 Juniper Side Effects/Adverse Reactions INTEG: Hypersensitivity reactions, contact dermatitis Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Fatty acid Alcohol Simmondsin Vitamin Mineral Wax Alpha-tocopherol Emollient B; E Chromium; Zinc; Copper Eurucic acid Myocardial fibrosis Client Considerations Assess • Assess the reason the client is using jojoba. • Assess for hypersensitivity reactions and contact dermatitis. If present, discontinue the use of jojoba and administer an antihistamine or other appropriate therapy. Administer ! • Instruct the client to use jojoba topically only. If jojoba is ingested, toxicity will occur. Teach Client/Family ! • Caution the client not to consume any part of the jojoba plant. Toxicity will occur. Juniper (jew’nuh-puhr) Scientific names: Juniperus communis, Juniperus oxycedrus L. Other common names: A’ra’r a’di, ardic, baccal juniper, common juniper, dwarf, gemener, genievre, ground juniper, hackmatack, harvest, horse savin, juniper mistletoe, yoshu-nezu, zimbro Origin: Juniper is an evergreen found in the United States, Canada, Europe, and Asia. Uses Traditionally, juniper has been used as a diuretic (for both adults and children) and an antiflatulent, as well as to treat urinary tract infections, diabetes mellitus, inflammation, gout, asthma, obesity, prostate disorders, and gastrointestinal disorders. Actions Juniper has been used for its hypoglycemic, antiinflammatory, and antimicrobial actions. However, few studies support these uses. = Pregnancy = Pediatric ! = Alert = Popular Herb Juniper 365 Hypoglycemic Action In one study, juniper was given to both diabetic and nondiabetic laboratory animals. The dried berries were shown to reduce hyperglycemia in rats with streptozocininduced diabetes (Sanchez de Medina et al, 1994; Swanston-Flatt et al, 1990). Antiinflammatory Action Juniper has been shown to inhibit prostaglandin synthesis and decrease platelet activating factor. It has been used in Sweden as an antiinflammatory (Tunon et al, 1995). Antiinfective Action One study (Cavaleiro et al, 2006) supports the antifungal activity against dermatophyte, aspergillus, and candida strains. There is a need for more research in this area. Product Availability Berry juice, capsules, essential oil, liquid, tablets Plant Part Used: Dried fruit Dosages Diabetes Mellitus • Adult PO capsules/tablets: 250-500 mg daily Gastrointestinal Disorders • Adult PO: 0.03-0.2 ml tid essential oil Inflammation • Adult PO: 0.2-0.3 mg/ml • Adult topical: commonly used in bath salts for joint disorders Urinary Tract Infection • Adult PO: 20 mg/ml Urinary Tract Infection • Child PO berry juice: dilute in water Contraindications Class 2b herb (Juniperus oxycedrus L. fruit, berry). Because it is an abortifacient, juniper should not be used during pregnancy. Until more research is available, this herb should not be used during breastfeeding. It should not be given to children younger than 2 years of age. Juniper should not be used by persons with hypersensitivity to it. Persons with diabetes mellitus and gastrointestinal disorders should use this herb with caution. Persons with urinary tract infections, kidney disease, or inflammation should use this herb only under the supervision of a qualified herbalist. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, diarrhea GU: Increased diuresis INTEG: Hypersensitivity reactions, skin irritation, burning, redness (topical) Interactions Drug Antidiabetics: Juniper may increase the action of antidiabetics (theoretical). Diuretics, minerals: Juniper may decrease the action of diuretics, mineral absorption (theoretical). Lithium: Juniper taken with lithium may result in dehydration and lithium toxicity. Continued Adverse effects: Underline = life-threatening J 366 Juniper Interactions—cont’d Lab Test Urine assays: Juniper may interfere with urine assays. Primary Chemical Components and Possible Actions Chemical Class Cresole Guaiacol Volatile oil Sesquiterpene Terpinen Juniperin Resin Acid Protein Individual Component Possible Action Piene; Sabinene; Mycrene; Limonene; Germacrene D; Gamma-Muurolene (Salido et al, 2002) Cadinene Diuretic Malic acid; Formic acid Client Considerations Assess • Assess the reason the client is using juniper. • Assess for hypersensitivity reactions, skin irritation, burning and redness. If present, discontinue the use of juniper and administer an antihistamine or other appropriate therapy. • Assess for lithium use; juniper should not be used with lithium. Administer • Instruct the client to give juniper to children 2 years of age or older PO diluted in water. It should not be given to children younger than 2 years of age. • Instruct the client not to use juniper for longer than 4 weeks. Renal damage may occur. Teach Client/Family • Caution the client not to use juniper during pregnancy because it is an abortifacient. Until more research is available, caution the client not to use this herb during breastfeeding. It should not be given to children younger than 2 years of age. = Pregnancy = Pediatric ! = Alert = Popular Herb Kaolin 367 Kaolin (kay’uh-luhn) Scientific names: Kaolin, hydrated aluminum silicate Origin: Kaolin is a naturally occurring clay that is treated for impurities. Uses Kaolin is often combined with pectin and used as an antidiarrheal. Actions Most of the information available on kaolin comes from the mainstream pharmacologic literature. Kaolin decreases both gastric motility and stool water content. It has adsorbent and demulcent properties. Product Availability Liquid Dosages Diarrhea • Adult PO: 15-100 g q3hr (varies widely) Radiation-induced Mucositis • Adult topical: 15 ml (50% kaolin/pectin and 50% diphenhydramine) solution as a rinse qid (Jellin et al, 2008) Contraindications Until more research is available, kaolin should not be used during pregnancy and breastfeeding. It should not be given to children younger than 6 years of age. Kaolin should not be used by persons with hypersensitivity to this product. Side Effects/Adverse Reactions GI: Nausea, anorexia; constipation (chronic use) Interactions Drug All medications: Kaolin decreases the absorption of all drugs; separate dosages by at least 2 hours. Herb All herbs: Kaolin decreases the absorption of all herbs; separate dosages by at least 2 hours. Client Considerations Assess • Assess the reason the client is using kaolin. • Assess the client’s bowel pattern before administration of kaolin. Monitor for rebound constipation. • Assess for dehydration in children. • Assess for medications and herbs used. Separate dosages by at least 2 hours for proper absorption (see Interactions). Administer • Instruct the client not to use kaolin for more than 48 hours for diarrhea. If diarrhea is not relieved, a health care provider should be consulted. Adverse effects: Underline = life-threatening K 368 Karaya Gum Teach Client/Family • Caution the client not to use kaolin in children younger than 6 years of age or those who are pregnant or breastfeeding until more research is available. Karaya Gum (kuh-ry’uh guhm) Scientific names: Sterculia urens, Sterculia spp. Other common names: Indian tragacanth, kadaya, kadira, katila, kullo, mucara, sterculia gum Origin: Karaya gum is a tree found in India and Pakistan. Uses Karaya gum is used primarily as a bulk laxative. It is also used as an adhesive for colostomy appliances and dentures. Lozenges made from karaya gum are used to relieve sore throat. In addition, karaya gum is used as an emulsifier in foods. Actions Karaya gum has been used primarily as a bulk laxative. It swells in the bowel and decreases the transit time of intestine contents. Karaya gum has also been used as a protectant and adhesive for dentures and other appliances such as colostomy devices. Initial evidence indicates that karaya may decrease lipids and may also decrease blood glucose levels in diabetics. However, no studies confirm these actions at this time. Product Availability Powder Plant Part Used: Dried sap Dosages No specified dosages are available. Products that include karaya gum identify the amount included. Contraindications Until more research is available, karaya gum should not be used during pregnancy and breastfeeding. It should not be given to children. Do not use karaya gum in bowel obstruction (Jellin et al, 2008). Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, abdominal pain, diarrhea, gastrointestinal obstruction Interactions Drug All medications: Karaya gum causes decreased absorption of all drugs; separate dosages by at least 2 hours. Herb All herbs: Karaya gum causes decreased absorption of all herbs; separate dosages by at least 2 hours. = Pregnancy = Pediatric ! = Alert = Popular Herb Kava 369 Pharmacology Pharmacokinetics Karaya gum is not absorbed and not digested. Primary Chemical Component and Possible Actions Chemical Class Individual Component Possible Action Polysaccharide Client Considerations Assess • Assess the reason the client is using karaya gum. • Assess the amount of bulk and water in the diet and the client’s exercise habits if karaya gum is used as a bulk laxative. • Assess for medications and herbs used. Separate dosages by at least 2 hours for proper absorption (see Interactions). K Administer • Instruct the client to store karaya gum products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use karaya gum in children or those who are pregnant or breastfeeding until more research is available. Kava (kah’vah) Scientific name: Piper methysticum Other common names: Ava, awa, kava-kava, kawa, kew, sakau, tonga, yagona Origin: Kava is a shrub found on the South Sea Islands. Uses Kava is used as an anxiolytic, antiepileptic, antidepressant, antipsychotic, and for anxiety, attention deficit–hyperactivity disorder, insomnia, restlessness, and headaches. It is also used as a muscle relaxant and to promote wound healing. Investigational Use Research is underway for use in cancer. Actions Kava acts as a sedative, an analgesic, and an anxiolytic. It has been used for ceremonial purposes in Micronesia and Polynesia for thousands of years in the place of alcoholic beverages, which have not always been available. Sedative Action The sedative action of kava is unlike any other. It appears to act directly on the limbic system. Kava lactones may actually modify receptor areas rather than bind to receptor binding sites (Holm et al, 1991). Adverse effects: Underline = life-threatening 370 Kava Anxiolytic Action There appears to be no lack of effectiveness, even at large doses over time. Several studies confirm the ability of kava to decrease anxiety. One study used 84 volunteers with anxiety conditions who received kavain, a kava lactone, in doses of 400 mg/day. In the experimental group, the result was an increase in memory and reaction time (Scholing et al, 1977). A more recent study showed a significant reduction of anxiety symptoms with the use of kava (Pittler et al, 2000). One group of volunteers was given 100 mg of kava extract three times daily, while the other received a placebo. After 4 weeks, when the subjects were evaluated using the Hamilton Anxiety Scale, the kava group reported a significant decrease in anxiety symptoms (Kinzler et al, 1991). Analgesic, Antiinflammatory Action The analgesic effect of kava appears to be unrelated to that of other pain relievers. Kava does not bind to opiate receptors and does not block pain impulses in the central nervous system. Its mechanism of action is unknown at present. One study (Folmer et al, 2006) identified kava as possessing TNF-alpha–induced activation of a nuclear factor. This information leads the researcher to believe that kava could be used for antiinflammatory conditions. Product Availability Capsules, beverage, extract, tablets, tincture Plant Parts Used: Dried rhizome, dried roots Dosages Anxiolytic • Adult PO extract, standardized: 45-70 mg kava lactones tid (Murray, Pizzorno, 1998) Depression • Adult PO extract, standardized: 45-70 mg kava lactones tid (Murray, Pizzorno, 1998) General Use • Adult PO extract, standardized: 70 mg kava lactones tid (Foster, 1998) • Adult PO capsules/tablets: 400-500 mg up to 6 times/day (Foster, 1998) • Adult PO tincture: 15-30 drops (dilution 1:2 ) taken tid in water (Foster, 1998) Sedative • Adult PO extract, standardized: 190-200 mg kava lactones 60 min at bedtime Contraindications Pregnancy category is 2; breastfeeding category is 3A. Kava should not be given to children younger than 12 years of age. This herb should not be used by persons with major depressive disorder or Parkinson’s disease, or by those with hypersensitivity to it. Side Effects/Adverse Reactions Most side effects and adverse reactions occur when high doses are taken for a long period. CNS: Increased reflexes, drowsiness EENT: Blurred vision, red eyes GI: Nausea, vomiting, anorexia, weight loss, hepatic damage = Pregnancy = Pediatric ! = Alert = Popular Herb Kava 371 Side Effects/Adverse Reactions—cont’d GU: Hematuria HEMA: Decreased platelets, lymphocytes, bilirubin, protein, and albumin; increased red blood cell volume INTEG: Hypersensitivity reactions; skin yellowing and scaling (high doses) RESP: Shortness of breath, pulmonary hypertension Interactions Drug Antiparkinsonians (carbidopa, levodopa): Antiparkinsonian drugs may increase symptoms of parkinsonism when used with kava; do not use concurrently. Antipsychotics (chlorpromazine, fluphenazine, loxapine, mesoridazine, molindone, perphenazine, prochlorperazine, promazine, thioridazine, thiothixene, trifluoperazine, triflupromazine): Antipsychotics taken with kava may result in neuroleptic movement disorders. Barbiturates (amobarbital, aprobarbital, butabarbital, phenobarbital, secobarbital): Barbiturates taken with kava may result in increased sedation. Benzodiazepines: Increased sedation and coma (theoretical) may result when kava is used with benzodiazepines, including alprazolam; do not use concurrently. CNS depressants: CNS depressants such as alcohol, benzodiazepines, and barbiturates may cause increased sedation when used with kava; avoid concurrent use. Cytochrome P450 1A2, 2C9, 2C19, 2D6, 3A4 substrates: Kava significantly decreases these substrates; use cautiously in patients taking these agents. Food Increased absorption of kava occurs when it is taken with food. Lab Test AST, ALT, LDH, bilirubin: Kava may increase hepatic function tests. Pharmacology Pharmacokinetics Most pharmacokinetics and pharmacodynamics are unknown. Kava lactones are more readily absorbed orally when taken as an extract of the root than as kava lactones alone. Kava may cross the placenta and enter breast milk. Primary Chemical Components and Possible Actions Chemical Class Individual Components Possible Action Kava lactone Kavain Sedative; anxiolytic, P450 enzyme inhibition Continued Adverse effects: Underline = life-threatening K 372 Kava Primary Chemical Components and Possible Actions—cont’d Chemical Class Individual Components Possible Action Marindinine; Methysticin; Dehydromethysticin; Yangonin; Desmethoxyyangonin; Epoxyyangonin (Matsuda et al, 2006) Chalcone Kavain Dihydrokavain Pipermethystine Bornyl esters Cinnamic acid; Pinostrobin; Flavokawain B; Dimethoxyflavanone COX-1, 2 inhibition (Wu et al, 2002) Client Considerations Assess • Assess the reason the client is using kava. • Assess for hypersensitivity reactions. If present, discontinue the use of kava and administer an antihistamine or other appropriate therapy. • Assess for use of other central nervous system depressants, including alcohol, barbiturates, benzodiazepines, antianxiety medications, and sedatives/hypnotics (see Interactions). Administer • Instruct the client to store kava products in a cool, dry place, away from heat and moisture. • Instruct the client not to use kava for longer than 3 months unless under the direction of an herbalist. This herb may be habit forming. • Inform the client that kava absorption is increased when kava is taken with food. Teach Client/Family • Inform the client that pregnancy category is 2 and breastfeeding category is 3A. • Caution the client not to give kava to children younger than 12 years of age. • Inform the client that excessive doses may result in daytime drowsiness. Advise the client not to operate heavy machinery or engage in hazardous activities if drowsiness occurs. • Caution the client not to use kava with other central nervous system depressants (see Interactions). = Pregnancy = Pediatric ! = Alert = Popular Herb Kelp 373 Kelp (kehlp) Scientific names: Laminaria digitata, Laminaria japonica, Laminaria saccharina, Marcrocystis pyrifera Other common names: Brown algae, horsetail, sea girdles, seaweed, sugar wrack, tangleweed Origin: Kelp is an algae found in the northern Atlantic and Pacific oceans. Uses Kelp has been used as an antiobesity and anticancer treatment and as an antihypertensive, antioxidant, abortifacient, and anticoagulant. It may be used for its high iodine content to treat goiter. Actions Cervical Dilatation Laminaria has been used intravenously with prostaglandin E2 to terminate secondtrimester pregnancies with fetal abnormalities. In one study, 106 pregnant women K underwent insertion of a laminaria tent, followed by administration of prostaglandin E2 (Sulprostone IV) the following morning to induce uterine contractions. This is considered a satisfactory way to terminate second-trimester pregnancies (Chung et al, 1999). Another study found the use of laminaria to be a satisfactory means of dilating the cervix for various procedures (Mayr et al, 1998). There is growing concern that contamination may occur in some alga species and that kelp therefore should not be used for cervical tents. One study (Borgatta et al, 2005) identified that laminaria, when used with misoprostol and hypertonic saline, significantly prolongs induction time and increases narcotic analgesia use, when used for second-trimester abortion. Product Availability Capsules, extract, powder, tablets Plant Part Used: Fronds Dosages • Adult PO capsules/tablets: 500-650 mg daily • Adult Laminaria tent: insert to facilitate cervical dilation, before D&C Contraindications Because of its abortifacient properties, kelp should not be used during pregnancy. Until more research is available, kelp should not be used during breastfeeding. It should not be given to children. Kelp should not be used by persons with hypersensitivity to Laminaria spp. or those with hyperthyroidism. Side Effects/Adverse Reactions CV: Decreased blood pressure GI: Nausea, vomiting, anorexia HEMA: Abnormal erythropoiesis, thrombocytopenia INTEG: Hypersensitivity reactions, acne-like eruptions Reproductive: Uterine contractions, abortion SYST: Bleeding Continued Adverse effects: Underline = life-threatening 374 Kelp Interactions Drug Anticoagulants (heparin, warfarin): Use of kelp with anticoagulants may pose an increased risk of bleeding; avoid concurrent use. Antihypertensives, ACE inhibitors: Antihypertensives may increase the hypotensive effects of kelp; avoid concurrent use. Cardiac glycosides, potassium-sparing diuretics, potassium: Kelp with these agents may lead to hypokalemia. Thyroid hormone replacement: Kelp may interfere with these agents. Lab Test Potassium, thyroid-stimulating hormone (TSH): Kelp may elevate potassium, TSH. Primary Chemical Components and Possible Actions Chemical Class Fucoidan Glucan Polysaccharide Vitamin Iodine Minerals Individual Components Possible Action Laminarin Algin Cervical dilatation Potassium Client Considerations Assess • Assess the reason the client is using kelp. • Assess for hypersensitivity reactions. If present, discontinue the use of kelp and administer an antihistamine or other appropriate therapy. • Assess for use of antihypertensives and anticoagulants (see Interactions). Monitor blood pressure. ! • Assess blood work, including complete blood count and platelets; watch for bruising, black tarry stools, or frank blood. Administer • Instruct the client to store kelp products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use kelp during pregnancy because of its abortifacient properties. Until more research is available, caution the client not to use kelp during breastfeeding and not to give it to children. • Advise the client not to use kelp tents to increase dilatation during labor. Use of kelp tents may cause contamination leading to infection and toxic shock syndrome. = Pregnancy = Pediatric ! = Alert = Popular Herb Kelpware 375 Kelpware (kelp’wehr) Scientific name: Fucus vesiculosus Other common names: Black-tang, bladder fucus, bladder-wrack, blasen-tang, quercus marina, sea wrack, sea-oak, seetang Origin: Kelpware is a seaweed found in the Atlantic and Pacific oceans. Uses In traditional herbal medicine, kelpware has been used to treat obesity and menorrhagia, to increase iodine levels in goiter, and to reduce inflammation of the renal system. Investigational Uses In preliminary research, kelpware has shown promise as an anticoagulant, antioxidant, and antimicrobial. Actions K Anticoagulant Action Kelpware has been shown to exert significant anticoagulant action. One study showed that activated partial thromboplastin time was prolonged in vitro (Durig et al, 1997). Antimicrobial, Antioxidant Action Kelpware has shown antimicrobial activity against Escherichia coli, Neisseria meningitidis, Candida guilliermondii, and Candida krusei (Craido et al, 1984). One study identified the antioxidant properties of kelpware (Ruperez et al, 2002). Product Availability Fluid extract, gel tabs, soft extract, tablets, whole plant (dried) Plant Part Used: Whole plant Dosages • Adult PO bruised plant: put 16 g herb in 500 ml water, take 2 oz tid-qid • Adult PO fluid extract: 4-8 ml before meals • Adult PO gel tabs/tablets: 3 tabs daily, then gradually increase to 24 daily • Adult PO soft extract: 200-600 mg daily Contraindications Until more research is available, kelpware should not be used during pregnancy and breastfeeding. It should not be given to children. Kelpware should not be used by persons with cardiac disorders such as recent myocardial infarction, congestive heart failure, or severe angina pectoris. It also should not be used by the elderly or persons who have cancer, thyroid disorders (except goiter), renal/hepatic disease, diabetes mellitus, or hypersensitivity to this herb. Side Effects/Adverse Reactions ENDO: Hyperglycemia GI: Nausea, vomiting, anorexia, increased hunger GU: Increased urinary output, nephrotoxicity INTEG: Hypersensitivity reactions Continued Adverse effects: Underline = life-threatening 376 Kelpware Interactions Drug Anticoagulants (heparin, warfarin): Use of kelpware with anticoagulants may pose an increased risk of bleeding; avoid concurrent use. Diuretics: Kelpware may decrease the action of diuretics. Thyroid hormones: Kelpware may decrease the effects of thyroid hormones; avoid concurrent use. Food Iron: Kelpware may reduce iron absorption. Lab Test Activated partial thromboplastin time (aPTT), thyroidstimulating hormone (TSH) T4: Kelpware may increase these tests. Radioactive iodine uptake: Kelpware may interfere with this test. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Polysaccharide Algin; Fucoidan Bulk laxative Anticoagulant Vitamin Iodine Mineral Bromine; Cadmium; Lead Client Considerations Assess • Assess the reason the client is using kelpware. • Assess for hypersensitivity reactions. If present, discontinue the use of kelpware and administer an antihistamine or other appropriate therapy. • Assess for anticoagulant and thyroid hormone therapy (see Interactions). ! • Assess blood work, including CBC and platelets. Watch for bruising, black tarry stools, and frank blood. ! • Assess for symptoms of nephrotoxicity (increased BUN and creatinine levels), which may result from heavy metal contaminants in kelpware. Administer • Instruct the client to store kelpware products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use kelpware in children or those who are pregnant or breastfeeding until more research is available. • Advise the client to not confuse bladderwort with this agent. = Pregnancy = Pediatric ! = Alert = Popular Herb Khat 377 Khat ! (kaht) Scientific name: Catha edulis Other common names: Cat, chat, gad, kaht, kat, miraa, tschut Origin: Khat is a tree found in Africa and on the Arabian Peninsula. Uses Khat has been used in traditional herbal medicine to treat fatigue, obesity, depression, and peptic ulcer. Actions Analgesic Action In a comparative study of khat, amphetamines, and ibuprofen performed to identify pain-reducing qualities, all three were found to reduce pain (Connor et al, 2000). Stimulant Action Khat has been evaluated for its amphetamine-like action, which results from one of its alkaloid chemical components, cathinone (Ahmed et al, 1993; Kalix, 1996). Khat K has been shown to be teratogenic and embryotoxic in rats (Islam et al, 1994). Another study (Banjaw et al, 2006a) identified that repeated dosing with khat led to increased aggression in male rats. Khat is similar to amphetamine and is considered to be a psychostimulant (Banjaw et al, 2006b). Antiinflammatory Action One study used the flavonoid fraction of khat to evaluate its antiinflammatory action in rats with carrageenan-induced paw edema and paw granuloma. Administration of khat produced a significant antiinflammatory action, comparable to that of oxyphenbutazone (Al-Meshal et al, 1986). Product Availability Raw leaves Plant Part Used: Raw leaves Dosages • Adult PO raw leaves: 100-200 g chewed, followed by fluids Contraindications Until more research is available, khat should not be used during pregnancy and breastfeeding. It should not be given to children. Persons with hypersensitivity to khat should not use it, and those with renal/cardiac/hepatic disease should avoid its use. Side Effects/Adverse Reactions CNS: Restlessness, insomnia, headache, psychosis, hallucinations, decreased reaction time, hyperthermia, sweating CV: Increased heart rate, arrhythmias, increased blood pressure, pulmonary edema, circulatory collapse, death GI: Nausea, vomiting, anorexia, constipation, abdominal pain, stomatitis, hepatotoxicity, abdominal spasms Continued Adverse effects: Underline = life-threatening 378 Khat Side Effects/Adverse Reactions—cont’d GU: Decreased sperm count, decreased libido INTEG: Hypersensitivity reactions SYST: Cerebral hemorrhage Interactions Drug Amphetamines, antiarrhythmics, antihistamines, antihypertensives, beta-blockers, calcium channel blockers, cardiac glycosides, decongestants, and MAOIs: Khat may increase the action of these agents. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Alkaloid Cathine Increased adrenocortical function Amphetamine-like; increased adrenocortical function Cathinone Eduline; Ephidrine; Cathinine; Cathidine Tannin Phenylpentenylamine Phenylpropyl Client Considerations Assess • Assess the reason the client is using khat. • Assess for hypersensitivity reactions. If present, discontinue the use of khat and administer an antihistamine or other appropriate therapy. • Assess for use of other medications, including antihypertensives, cardiac glycosides, beta-blockers, antiarrhythmics, calcium channel blockers, amphetamines, antihistamines, and decongestants (see Interactions). • Monitor hepatic function tests periodically (AST, ALT, and bilirubin levels); if elevated, discontinue use of khat. Administer • Instruct the client to store khat products in a cool, dry place, away from heat and moisture. Teach Client/Family ! • Caution the client not to use khat in children or those who are pregnant or breastfeeding until more research is available. • Warn the client of the life-threatening side effects of khat. = Pregnancy = Pediatric ! = Alert = Popular Herb Khella 379 Khella (keh’luh) Scientific name: Ammi visnaga Other common names: Ammi, bishop’s weed, khellin, visnagin Origin: Khella is found in Egypt and Pakistan. Uses Traditionally, khella has been used in combination with other herbs to treat angina pectoris. It has also been used to relieve abdominal cramping, dysmenorrhea, and biliary colic. Investigational Uses Researchers are working to determine whether khella is useful for the reduction of cholesterol levels, the prevention of bronchial asthma, and the treatment of atherosclerosis and severe allergic reactions. Actions Among the possible actions of khella are antidiabetes effects, calcium channel K blocking effects, and alteration of high-density lipoproteins (HDLs). No conclusions can be drawn from research. However, khella may dilate coronary vessels and bronchioles. Antidiabetic Actions An extensive survey was taken of 130 participants who had agreed to provide information about plant-based hypoglycemic treatments used in Israel. Ammi visnaga L. was among the plants listed (Yaniv et al, 1987). Another study in the laboratory, showed significant hypoglycemic effects when an aqueous extract of khella was used in rats (Jouad et al, 2002). Calcium Channel Blocking Action In a study that screened medicinal plants for their calcium-antagonistic action, one of the furanochromones present in khella, visnagin, was shown to inhibit potassium spasms. This inhibitory action results in a vasodilator response, suggesting that khella exerts a calcium-antagonistic effect (Rauwald et al, 1994). Alteration of High-Density Lipoproteins In a study focusing on the HDL-increasing effect of khella, participants with normal weight and normal lipid levels were given khellin, one of the furochromones present in Ammi visnaga. The participants received 50 mg four times daily for 4 weeks, and their lipid levels measured each week. Total cholesterol and triglyceride levels remained unchanged, although HDL levels increased and low-density lipoprotein (LDL)/HDL ratios decreased (Harvengt et al, 1983). Product Availability Capsules, dried powdered root extract, tablets, tea Plant Parts Used Fruit, roots, seeds Dosages Angina • Adult PO dried powdered root extract: 100 mg tid (12% khellin) (Murray, Pizzorno, 1998) Adverse effects: Underline = life-threatening 380 Khella Contraindications Because it is a uterine stimulant, khella should not be used during pregnancy. Until more research is available, this herb should not be used during breastfeeding and it should not be given to children. Persons with hypersensitivity to khella should not use it, and persons with hepatic disease, severe cardiac disorders, bleeding disorders, or hypotension should avoid its use. It is now considered a disapproved herb, because there are many potential risks. Side Effects/Adverse Reactions CNS: Insomnia, dizziness, headache GI: Nausea, vomiting, anorexia, constipation, elevated hepatic function tests INTEG: Hypersensitivity reactions, phototoxicity; skin cancer (topical use) Interactions Drug Anticoagulants (aspirin, heparin, warfarin): Khella increases the risk of bleeding when used with anticoagulants such as heparin, warfarin, and aspirin; avoid concurrent use. Antihypertensives, calcium channel blockers, diuretics: Increased hypotension is possible when khella is used with antihypertensives, calcium channel blockers, diuretics; avoid concurrent use. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Calcium channel blocker Anticholesterol Visnagin Khellin Furanochromone Flavonoid Quercetin; Kaempferol Isorhamnetin Camphor; Terpineol; Terpinen; Linalool Methoxypsoralen Essential oil Psoralen Protein Antiinflammatory Client Considerations Assess • Assess the reason the client is using khella. • Assess for hypersensitivity reactions. If present, discontinue the use of khella and administer an antihistamine or other appropriate therapy. • Monitor hepatic function tests, including AST, ALT, and bilirubin, at least every 6 weeks. • Assess for use of anticoagulants, salicylates, antihypertensives, calcium channel blockers, and diuretics (see Interactions). = Pregnancy = Pediatric ! = Alert = Popular Herb Kudzu 381 Administer • Instruct the client to store khella products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use khella in children or those who are pregnant or breastfeeding until more research is available. • Advise the client not to perform hazardous activities such as driving or operating heavy machinery until physical response to the herb can be evaluated. Dizziness can occur. Kudzu (kuhd’zew) Scientific name: Pueraria lobata Other common names: Japanese arrowroot, kudzu vine, ge gen Origin: Kudzu is a vine found in China and Japan. Uses Traditionally, kudzu has been used for the suppression of alcoholism and as a treatment for arrhythmias, muscular aches and pains, and measles. Actions Suppression of Alcoholism Kudzu has been used in traditional herbal medicine to suppress alcoholism. Research shows the presence of reversible inhibitors of an enzyme needed to metabolize alcohol in humans (Keung, 1993). One study showed that kudzu decreased alcoholism in hamsters. Researchers identified the hamsters’ baseline water and ethanol intake and then administered kudzu. The volume of ethanol intake decreased by approximately 50%. After the kudzu was stopped, alcohol intake returned to pretreatment levels (Keung et al, 1993). Daidzin and daidzein, two of the chemical components of kudzu, were identified as being responsible for the suppression of alcoholism (Keung et al, 1998). Cardiovascular Action Kudzu has been shown to increase cerebral blood flow and decrease myocardial oxygen consumption in patients with diagnosed arteriosclerosis. Kudzu has been used successfully to treat cardiovascular disorders such as hypertension, angina, and cardiac ischemia (Qicheng, 1980). Other Actions Some of the other proposed actions of kudzu include antipyretic and contraceptive effects. This herb may also be useful for the reduction of muscle pain. More research is needed to determine the validity of these claims. Another claim is the use of kudzu for hangovers. However, there is an increase in acetaldehyde-associated neoplasm risk (McGregor et al, 2007). Product Availability Capsules, extract, tablets, powder Plant Parts Used: Root, flowers Adverse effects: Underline = life-threatening K 382 Kudzu Dosages • Adult PO decoction: cut root into 0.4-0.7 cm slices, place in water 12-15 times the weight of the root; decoct 30 min • Adult PO root tablet: 120 mg depending on brand • Adult PO root extract: 150-300 mg tid or 300 mg daily Contraindications Class 1 herb (root). Until more research is available, kudzu should not be used during pregnancy and breastfeeding. It should not be given to children. Kudzu should not be used by persons with hypersensitivity to it and should be used cautiously by persons who have heart disease. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions Interactions Drug Antiarrhythmics, cardiac glycosides: Kudzu may enhance their effects. Anticoagulant, antiplatelets: Kudzu may increase bleeding risks when taken with these agents (Jellin et al, 2008). Estrogens, hormonal contraceptives: Kudzu may increase the action of these agents. Herb Estrogenic herbs (alfalfa, black cohosh, flaxseed, licorice, red clover, soy): These herbs may increase the action of kudzu. Primary Chemical Components and Possible Actions Chemical Class Individual Component Glycoside Kudzusaponins A1, A2, Ar, SA4, SB1 Sterol Isoflavone Daidzin; Daidzein; Puerarin; Rutin; Furylfuramide; Puerarin Possible Action Alcoholism suppression; antioxidant; antimutagenic Estrogenic, antiestrogenic Decreases HR, renin activity, platelet aggregation Client Considerations Assess • Assess the reason the client is using kudzu. • Assess for hypersensitivity reactions. If present, discontinue the use of kudzu and administer an antihistamine or other appropriate therapy. = Pregnancy = Pediatric ! = Alert = Popular Herb Kudzu 383 • Assess cardiac status, including rate, rhythm, and character. Identify cardiac conditions and cardiac medications used (see Interactions). Administer • Instruct the client to store kudzu products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use kudzu in children or those who are pregnant or breastfeeding until more research is available. K Adverse effects: Underline = life-threatening 384 Lady’s Mantle Lady’s Mantle (lay’deez man’tuhl) Scientific names: Alchemilla vulgaris, Alchemilla mollis Other common names: Alchemilla, Bear’s foot, dewcup, leontopodium, lion’s foot, nine hooks, stellaria Origin: Lady’s mantle is a flowering plant found in Europe, the United States, and Canada. Uses Traditional uses of lady’s mantle include control of bleeding (when used topically), treatment of menorrhagia, and relief of menstrual cramps, menopausal symptoms, and diarrhea. It is also used as an astringent and to heal wounds. Actions Lady’s mantle is used primarily for its astringent and antidiarrheal effects. Its astringent effects are responsible for its ability to both lessen bleeding and decrease diarrhea. The high tannin content (pedunculagin and alchemillin) is probably responsible for the wound-healing properties (Shirivasteva et al, 2007) and astringent effects of this herb. The tannins may also inhibit the enzyme elastase, and the flavonoid components of lady’s mantle have been shown to inhibit two other enzymes, trypsin and chymotrypsin. These enzyme inhibitory effects may protect elastic tissues. Product Availability Extract, tea, tablets, tincture, ointment Plant Parts Used: Flowers, leaves, root Dosages • Adult PO extract: 2-4 ml tid • Adult PO herb: 5-10 g daily (Blumenthal, 1998) • Adult PO tea: pour boiling water over 2 tsp herb, let steep 15 min, take tid • Adult PO tincture: 5 drops taken in water q 30-60 min • Adult topical ointment: apply to affected area as needed daily Contraindications Class 1 herb (whole herb). Because it may cause uterine contractions, lady’s mantle should not be used during pregnancy. Until more research is available, this herb should not be used during breastfeeding and should not be given to children. Persons with hypersensitivity to this herb should not use it. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, hepatic damage INTEG: Hypersensitivity reactions Interactions Drug Iron salts: Lady’s mantle tea may decrease the absorption of iron salts; separate by 2 hours. Lab Test AST, ALT: Lady’s mantle may increase AST, ALT. = Pregnancy = Pediatric ! = Alert = Popular Herb Lavender 385 Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Elligitannin Flavonoid Tannin Quercetin Pedunculagin; Alchemillin Antiinflammatory Wound healing; astringent Client Considerations Assess • Assess the reason the client is using lady’s mantle. • Assess for hypersensitivity reactions. If present, discontinue the use of lady’s mantle and administer an antihistamine or other appropriate therapy. ! • Assess for hepatic damage including increased hepatic function tests. Administer • Instruct the client to store lady’s mantle products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use lady’s mantle during pregnancy because it may cause uterine contractions. Until more research is available, caution the client not to use this herb during breastfeeding and not to give it to children. Lavender (la’vuhn-duhr) Scientific names: Lavandula officinalis, Lavandula latifolia, Lavandula angustifolia, Lavandula stoechas Other common names: Aspic, echter lavendel, English lavender, esplieg, French lavender, garden lavender, lavanda, lavande commun, lavandin, nardo, Spanish lavender, spigo, spike lavender, true lavender Origin: Lavender is a flowering shrub found in the Mediterranean. Uses Lavender traditionally has been used as a sedative, an anxiolytic, and to relieve insomnia. It has also been used to increase appetite and to treat cuts, abrasions, and various conditions of the nervous system. It is a common aromatherapeutic agent and is a component in many cosmetic products such as shampoos, conditioners, lotions, and soaps. Investigational Uses Initial research studies are available documenting the use of lavender to treat cancer. Lavender may be used to produce diuresis. Actions It is thought that lavender, when inhaled, acts directly on the olfactory nerve in the brain, producing a sedative effect (Lin et al, 2007; Yamada et al, 2005). Its antitumor effects may be due to perillyl alcohol and limonene, two chemical components Adverse effects: Underline = life-threatening L 386 Lavender of the herb (Mills, Bone, 2000). Several studies have documented the use of lavender for the treatment of different types of cancer (breast, pancreatic, ovarian, liver, breast, and prostate) (Bronfen et al, 1994; Gould, 1995; Haag, Gould, 1994; Stark et al, 1995). These studies show varying results, but all indicate disease stabilization or tumor regression. The anticancer action of lavender may be due to its ability to produce redifferentiation in cancer cells (Shi, Gould, 1995). The diuretic activity of lavender was studied in rats. There was an increase in diuresis that may be attributed to specific chemical components (Elhajili et al, 2001). Lavender may be effective against Giardia duodenalis, Trichomonas vaginalis, and Hexamita inflata (Moon et al, 2006). Product Availability Candles, flowers, oil, tincture, spirits; component of lotions, soaps, shampoos, and conditioners Plant Part Used: Flowers Dosages Standardized forms are not available. • Adult PO oil: place 2-4 drops on a sugar cube • Adult PO tea: place 1-2 tsp flowers in 1 cup boiling water (Blumenthal, 1998), steep 10-15 min • Adult PO tincture (1:5): take up to 2 ml tid • Adult topical: place 1-2 cups flowers in teapot, heat to boiling, strain, add to bath water (Blumenthal, 1998) Contraindications Pregnancy category is 3; breastfeeding category is 2A. Lavender may be given to children. Persons with hypersensitivity to lavender should not use it. Side Effects/Adverse Reactions CNS: Headache, drowsiness, dizziness, euphoria, central nervous system depression GI: Nausea, vomiting, increased appetite, constipation INTEG: Hypersensitivity reactions, contact dermatitis Interactions Drug CNS depressants (alcohol, antihistamines, opioids, and sedative/ hypnotics): These agents may increase sedation when used with lavender; avoid concurrent use. HMG-CoA reductase inhibitors: Lavender may decrease the action of these agents. Iron salts: Lavender tea may decrease the absorption of iron salts; separate by 2 hours. Lab Test Cholesterol: Lavender can reduce cholesterol test levels. = Pregnancy = Pediatric ! = Alert = Popular Herb Lecithin 387 Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Volatile oil Linalool; Limonene; Perillyl alcohol Linalyl acetate; Cis-ocimene; Beta-caryophyllene; Terpinene Umbelliferone Herniarin Sedative, hypotensive Antitumor Coumarin Caffeic acid (derivative) Tannin Bile stimulant Wound healing; astringent Client Considerations Assess • Assess the reason the client is using lavender. • Assess for hypersensitivity reactions such as contact dermatitis. If present, discontinue the use of lavender and administer an antihistamine or other appropriate therapy. • Assess the client’s use of alcohol, antihistamines, opioids, and sedative/hypnotics (see Interactions). Administer • Instruct the client to store lavender products in a cool, dry place, away from heat and moisture. • Lavender oil should be taken internally only under the supervision of a qualified herbalist. Teach Client/Family • Inform the client that pregnancy category is 3 and breastfeeding category is 2A. Lecithin (leh’suh-thuhn) Scientific name: 1,2,diacyl-sn-glycero-3-phosphatidycholine Other common names: Granulestin, kelecin, lecithol, vitellin Origin: Lecithin is found in foods such as eggs, beef liver, and peanuts. Commercial sources are available. Uses Lecithin is used to treat hepatic diseases, including hepatitis, cirrhosis, and liver damage; treat diseases of the central nervous system such as Alzheimer’s disease, bipolar disorder and myasthenia gravis; reduce cholesterol levels; limit tardive dyskinesia; boost the immune system; and prevent the formation of gallstones. It is also Adverse effects: Underline = life-threatening L 388 Lecithin used as an emulsifier in food, cosmetics, and other pharmaceutical products. Lecithin may be used to maintain choline concentration in marathon runners. Actions Lecithin is found in food such as meat products, fruits, and vegetables. The best sources are oranges, beef liver, eggs, and some nuts. Lecithin reduces high cholesterol levels, improves memory and liver function, and decreases tardive dyskinesia. One of its chemical components, phosphatidylcholine, is also present in S-adenosylL-methionine, commonly known as SAM-e, a supplement used to treat depression. Antihypercholesteremic Action Both the antihypercholesterolemic effect of lecithin and its ability to prevent atherosclerosis are believed to result from its ability to increase the metabolism of cholesterol in the gastrointestinal system. In one study in which 21 hyperlipidemic clients were given soybeans for 4 months, cholesterol, triglycerides, and total serum lipids were reduced by a statistically significant amount (Saba et al, 1978). In contrast, many earlier studies showed inconclusive results. Memory Improvement Lecithin has been shown to increase acetylcholine at receptor sites in the neurologic system, improving memory. One of the chemical components of lecithin, phosphatidylcholine, is a precursor to acetylcholine. One study demonstrated that memory improved significantly after 4 to 6 weeks of lecithin administration (Murray, 1996). Other Actions Phosphatidylcholine is used in Germany to treat cirrhosis of the liver, hepatitis, and toxic liver. One study using baboons showed that lecithin exerted a hepatoprotective effect against cirrhosis when the study animals were fed alcohol along with phosphatidylcholine (Murray, 1996). Lecithin has also been shown to increase immunity and dissolve gallstones. Product Availability Capsules, tablets Dosages Alzheimer’s Disease • Adult PO capsules/tablets: 100 mg tid (as phosphatidylcholine) (Murray, Pizzorno, 1998); 20-45 g daily (Jellin et al, 2008) Bipolar Disorder • Adult PO capsules/tablets: 15-30 g (as phosphatidylcholine) (Murray, Pizzorno, 1998) Gallstone Prevention • Adult PO capsules/tablets: 100 mg tid (Murray, Pizzorno, 1998) Reduction of cholesterol • Adult PO capsules/tablets: 20-30 g daily (Jellin et al, 2008) Contraindications Until more research is available, lecithin should not be used therapeutically during pregnancy and breastfeeding. It should not be given therapeutically to children. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, gastrointestinal upset, hepatitis = Pregnancy = Pediatric ! = Alert = Popular Herb Lemon Balm 389 Interactions Lab Test Cholesterol: Lecithin may decrease cholesterol results. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Phosphatide Phosphatidylcholine Antidepressant; improved cognition Fatty acid Phosphatidyl ethanolamine; Phosphatidyl serine; Phosphatidyl inositol Palmitic acid; Oleic acid; Stearic acid Carbohydrate Client Considerations L Assess • Assess the reason the client is using lecithin. ! • Assess for symptoms of hepatitis (jaundice, clay-colored stools). If present, discontinue the use of lecithin. • Monitor hepatic function tests (AST, ALT, and bilirubin) if the client is taking lecithin long term. If results are elevated, discontinue the use of lecithin. Administer • Instruct the client to store lecithin products in a sealed container away from heat and moisture. Teach Client/Family • Caution the client not to use lecithin therapeutically in children or those who are pregnant or breastfeeding until more research is available. Lemon Balm (leh’muhn bawlm) Scientific name: Melissa officinalis L. Other common names: Balm, cure-all, dropsy plant, honey plant, Melissa, sweet balm, sweet Mary Origin: Lemon balm is a perennial found in the Mediterranean, Asia, Europe, and North America. Uses Lemon balm traditionally has been used orally to treat insomnia, anxiety, gastric conditions, migraines, hypertension, bronchial conditions, Graves’ disease, attention deficit disorder, and psychiatric conditions including depression and hysteria. Lemon balm has also been used topically to treat cold sores. Adverse effects: Underline = life-threatening 390 Lemon Balm Actions Lemon balm has been studied for its antimicrobial, antiviral, and sedative actions and also as a treatment for colitis. Multiple studies are not yet available to confirm any of these proposed actions. Antimicrobial Actions One study evaluating the antimicrobial effect of lemon balm found that Melissa officinalis exhibited a relatively higher degree of activity against bacteria, fungi, and yeasts than did Lavandula officinalis (lavender) (Larrondo et al, 1995). Another study (Canadovic-Brunet et al, 2008) identified lemon balm as a radical scavenging and antibacterial herb. Antiviral Action Researchers have evaluated the virucidal and antiviral effects of M. officinalis with respect to herpes simplex virus type 1. The virucidal effect was found to occur within 3 to 6 hours of treatment (Dimitrova et al, 1993). Sedative Action The sedative action of lemon balm was identified when the hydroalcoholic extract of M. officinalis was given to mice. With high doses, the sedative effect was confirmed by a reduction in acetic acid-induced pain and induced sleep in the mice (Kennedy et al, 2002; Soulimani et al, 1991). Colitis Treatment Lemon balm was evaluated in combination with Taraxacum officinale, Hipericum perforatum, Calendula officinalis, and Foeniculum vulgare for the treatment of chronic nonspecific colitis (Chakurski et al, 1981). Results indicated that all 24 patients in the study experienced the disappearance of pain in the large intestine. Product Availability Comminuted herb, concentrated extract, cream, dry extract, fluid extract, herb powder Plant Parts Used: Dried leaves, fresh leaves, whole plant Dosages Canker Sores, Herpes Simplex Type 1, Mouth Ulcers • Adult topical concentrated extract: apply prn (dilution of 70:1) • Adult topical cream: apply bid (Murray, Pizzorno, 1998) • Adult topical poultice: apply prn Other • Adult PO infusion: pour boiling water over 1.5-4.5 g herb, let set 10 min, strain; usual dose is 8-10 g/day (Blumenthal, 1998) Alzheimer’s Disease (mild to moderate) • Adult PO standardized extract (1:1): 60 drops/day (Jellin et al, 2008) Insomnia • Adult PO extract: 80 mg with valerian extract 120 mg tid ⫻ <30 days (Jellin et al, 2008) Contraindications Pregnancy category is 3; breastfeeding category is 2A. Lemon balm may be given to children. This herb should not be used by persons with hypothyroidism or by those who are hypersensitive to it. = Pregnancy = Pediatric ! = Alert = Popular Herb Lemon Balm 391 Side Effects/Adverse Reactions GI: Nausea, anorexia INTEG: Hypersensitivity reactions Interactions Drug Barbiturates (amobarbital, aprobarbital, butabarbital, phenobarbital, secobarbital), CNS depressants (including alcohol): Lemon balm may potentiate the sedative effects of barbiturates, CNS depressants. Iron salts: Lemon balm tea may decrease the absorption of iron salts; separate by 2 hours. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Volatile oil Geranial; Neral; Citronellal; Linalool; Geraniol; Geranylactetate Citral Eugenol Cynaroside; Rhamnocitrin; Isoquercitrin; Cosmosiin; Luteolin, Apigonin Caffeic acid; Ferulic acid Rosmarinic acid Diaphoretic, sedative Glycoside Flavonoid Triterpene acid Estrogenic Antioxidant Bile stimulant Antimicrobial Tannins Client Considerations Assess • Assess the reason the client is using lemon balm. • Assess for hypersensitivity reactions. If present, discontinue the use of lemon balm and administer an antihistamine or other appropriate therapy. • Assess the client’s use of barbiturates, other central nervous system depressants and iron salts (see Interactions). Administer • Instruct the client to store lemon balm products in a sealed container, away from heat and moisture. Products may be kept for up to 1 year. Teach Client/Family • Inform the client that pregnancy category is 3 and breastfeeding category is 2A. • Inform the client that lemon balm may be given to children. Adverse effects: Underline = life-threatening L 392 Lemongrass Lemongrass (leh’muhn-gras) Scientific name: Cymbopogon citratus Other common names: Capim-cidrao, Guatemala lemongrass, Madagascar lemongrass Origin: Lemongrass is a perennial grass found in Central America, South America, the West Indies, and the tropics of Asia. Uses Lemongrass has been used in traditional herbal medicine to treat anxiety, insomnia, gastrointestinal complaints, vomiting, hypertension, and fever. It is also used as an antitussive, antiseptic, and antirheumatic. Investigational Uses The antibacterial, antifungal, analgesic, and anticholesteremic properties of lemongrass are under investigation. Actions Studies done on lemongrass have focused on its antibacterial, antifungal, analgesic, and anticholesteremic actions. Multiple studies are not yet available to confirm any of the proposed actions. Antibacterial and Antifungal Actions Lemongrass has been shown to inhibit gram-positive cocci and rods, gram-negative rods, and 12 types of fungi (Pattnaik et al, 1996). One study confirmed the bacteriocidal effect of lemongrass on Escherichia coli (Pattnaik et al, 1995b), while a similar study showed a resistance to Pseudomonas aeruginosa when combined with lemongrass (Pattnaik et al, 1995a). A more recent study found that lemongrass was effective against Plasmodium bergher (Tchoumbougnang et al, 2005). Analgesic Action One study that tested lemongrass for its analgesic effect supports its use in folk medicine as a sedative. When rats were given an infusion of lemongrass, a dosedependent analgesia occurred (Lorenzetti et al, 1991; Viana et al, 2000). Anticholesteremic and Antidiabetic Action During a study in which lemongrass was given to 22 hypercholesteremic subjects, serum cholesterol decreased in amounts that approached clinical significance. However, 90 days after completion of the study, cholesterol levels were found to have not remained at the decreased level (Elson et al, 1989). One study confirms the folkloric use of lemongrass in type 2 diabetes (Adeneye et al, 2007). Product Availability Tea Plant Part Used: Leaves Dosages • Adult PO tea: lemongrass tea may be made from fresh or dried leaves; 1-2 tsp in boiling water = Pregnancy = Pediatric ! = Alert = Popular Herb Lentinan 393 Contraindications Class 2b herb (whole herb). No absolute contraindications have been identified. Side Effects/Adverse Reactions GI: Dry mouth INTEG: Contact dermatitis Interactions Lab Test Amylase, bilirubin: Lemongrass may elevate these test results. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Essential oil Myrcene Geraniol; Limonene; Alpha-pinene; Alpha-terpineole Citral Analgesic Antimicrobial Central nervous system depressant Diterpene Aldehyde Alcohol Saponin Client Considerations Assess • Assess the reason the client is using lemongrass. Administer • Instruct the client to store lemongrass products in a cool, dry place, away from heat and moisture. Teach Client/Family • Advise the client that lemongrass has no known toxicity or side effects. Lentinan (lehnt’nehn) Scientific names: Lentinula edodes, Lentinus edodes Other common names: Forest mushroom, hua gu, pasania fungus, shiitake mushroom, snake butter Origin: Lentinan is found in the shiitake mushroom, which is found in Japan and China. Adverse effects: Underline = life-threatening L 394 Lentinan Uses Lentinan is used as an immune regulator and to treat bacterial and viral infections and cancer. Investigational Uses Lentinan has been used in treatment of digestive, breast, and prostate cancer and HIV/AIDS. Actions Antibacterial and Antiviral Actions Initial research is available that documents the antibacterial action of lentinan. Lentinan has been shown to be effective against Streptococcus sp., Actinomyces sp., Lactobacillus sp., Prevotella sp., and Porphyromonas sp., and to promote resistance to Staphylococcus sp., Escherichia sp., Bacillus sp., Candida sp., and Enterococcus sp. (Hirasawa et al, 1999). Another study showed that lentinan exerts significant antiviral action against the Western equine encephalitis virus in mice (Takehara et al, 1979). Antihypertensive Action An early study indicated that lentinan decreases hypertension in hypertensive rats. Investigators fed mice a diet of 5% mushroom powder and 0.5% NaCl (sodium chloride) solution as drinking water for 9 weeks. At the end of the study, blood pressure and plasma-free cholesterol were reduced (Kabir et al, 1987). Hemagglutinin Action A study (Tsivileva et al, 2000) has identified the hemagglutinating activity (HA) of Lentinus edodes. One morphogenetic structure of the mushroom was shown to possess significant hemagglutinating activity. Other Actions A study has shown a rebalance of cell-mediated immunity in digestive cancers with use of lentinan (Yoshino et al, 2000). However, lentinan may cause a worsening of ulcerative colitis as studied in rats (Mitamura et al, 2000). Another study (Gu et al, 2005) found that lentinan significantly reduced cell proliferation in carcinoma cells. Product Availability Whole mushroom Plant Part Used: Fruiting body Dosages • Adult injection: 1-4 mg/wk may be used (Jellin et al, 2008) Contraindications Until more research is available, consumption of lentinan (shiitake mushrooms) is not recommended during pregnancy and breastfeeding. It should not be given to children. Persons with hypersensitivity to shiitake mushrooms should not consume them. Shiitake mushrooms have been shown to promote severe respiratory, immunologic, and dermatologic reactions (Nakamura, 1992; Sastre, 1990; Van Loon et al, 1992); however, most of the available studies have focused on farmers who grow shiitake mushrooms or workers who handle them. = Pregnancy = Pediatric ! = Alert = Popular Herb Licorice 395 Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions, contact dermatitis, toxicodermia SYST: Respiratory and immunologic reactions in persons working with mushrooms Interactions Drug Didanosine (ddI, Videx): Lentinan used with didanosine may increase CD4 counts (Jellin et al, 2008). Lab Test CD4 counts: Lentinan IV with didanosine may increase CD4 counts in HIV patients (Jellin et al, 2008). Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Diuretic Mannitol Polysaccharide Client Considerations Assess • Assess the reason the client is using lentinan. ! • Assess for hypersensitivity reactions, contact dermatitis, and toxicodermia. If present, discontinue the consumption of shiitake mushrooms and administer an antihistamine or other appropriate therapy. Administer • Instruct the client to store shiitake mushrooms in a cool, dry place, away from moisture and heat. Teach Client/Family • Caution the client not to give shiitake mushrooms to children or consume mushrooms during pregnancy or breastfeeding until more research is available. Licorice (li’kuh-rish) Scientific name: Glycyrrhiza glabra Other common names: Chinese licorice, licorice root, Persian licorice, Russian licorice, Spanish licorice, sweet root Origin: Licorice is a shrub found in subtropical climates. Adverse effects: Underline = life-threatening L 396 Licorice Uses Licorice has been used as a laxative and as a treatment for asthma, malaria, hepatitis, abdominal pain, gastric disorders, dry cough, systemic lupus erythematosus (SLE), bacterial/viral infection, eczema, chronic fatigue syndrome, and sleeplessness. It has also been used as a flavoring, coloring agent, and a component in shampoos. Investigational Uses Studies are underway to investigate the estrogenic, antiinflammatory, antiviral (HIV/ AIDS), antibacterial, and pseudoaldosterone actions of licorice, most of which result from the chemical components glycyrrhizin and glycyrrhetinic acid. Actions Traditionally, licorice has been used as an expectorant, an antitussive, and a laxative. More recently, studies have begun to focus on its antiinfective, estrogenic, antiinflammatory, and pseudoaldosterone effects. Antiinfective Action One study has shown that glycyrrhizin and glycyrrhetinic acid are able to stimulate interferon, which in turn is able to block DNA replication in viruses (Abe et al, 1982). This action has definite applications for HIV/AIDS patients. Another study focused on 16 hemophilic patients with HIV infection. These patients were given 150 to 225 mg of glycyrrhizin for 3 to 7 years. While immune system results were monitored, none of the patients showed progression of the infection (Ikegami et al, 1993). Two other studies have reported similar results (Hattori et al, 1989; Mori et al, 1989). Glycyrrhiza has also been shown effective against Staphylococcus aureus, Streptococcus mutans, Mycobacterium, and Candida albicans (Mitscher et al, 1980). Estrogenic Action Glycyrrhizin has been shown to exert estrogenic activity. It is responsible for both increasing estrogen levels that are too low and decreasing those that are too high. It is thought that the isoflavone (saponin) content is responsible. Antiinflammatory Action Glycyrrhizin and glycyrrhetinic acid are able to bind to glucocorticoid receptors, thus decreasing the inflammatory response. Research has also demonstrated that many enzymes related to the inflammatory response are decreased as well (Kumagai et al, 1967). Pseudoaldosterone Action Pseudoaldosterone syndrome has been induced when large amounts of glycyrrhiza were taken, resulting in increased blood pressure, electrolyte imbalances, and decreased aldosterone levels. Glycyrrhiza may be helpful in the treatment of Addison’s disease. Other Actions Glycyrrhetinic acid has been proven useful in the treatment of peptic ulcer, duodenal ulcer, and apthous ulcer disease. Topical application of glycyrrhetinic acid has been shown to be effective against skin disorders such as psoriasis, eczema, and herpes simplex. One study (Sheela et al, 2006) showed that licorice may be a potential supplement for cancer therapy. = Pregnancy = Pediatric ! = Alert = Popular Herb Licorice 397 Product Availability Candy, capsules, chewable tablets, deglycyrrhizinated licorice (DGL), fluid extract, gum, smoking products, solid extract, tablets, tea, tincture Plant Parts Used: Rhizome, roots Dosages Asthma • Adult PO fluid extract (1:1): 2-6 ml (1:1 dilution) daily (Murray, Pizzorno, 1998) • Adult PO powdered root: 1-2 g tid (Murray, Pizzorno, 1998) • Adult PO solid extract (dry powdered): 250-500 mg (4:1 dilution) tid (Murray, Pizzorno, 1998) Chronic Fatigue Syndrome • Adult PO fluid extract: 2-4 ml (1:1 dilution) (Murray, Pizzorno, 1998) • Adult PO powdered root: 1-2 g tid (Murray, Pizzorno, 1998) • Adult PO solid extract (dry powdered): 250-500 mg (4:1 dilution) tid (Murray, Pizzorno, 1998) Gastric Disorders • Adult PO capsules: 200-600 mg/day standardized to glycyrrhizin, taken ⬍6 wk; 400-500 mg up to 6⫻/day (Foster, 1998) • Adult PO DGL: 6-8 250 mg chewable tablets/day (McCaleb et al, 2000), taken between meals or 20 min before meals • Adult PO fluid extract: 2-4 ml (1:1 dilution) tid • Adult PO powdered root: 1 g up to tid (McCaleb et al, 2000) • Adult PO solid extract (dry powder): 250-500 mg (4:1 concentration) tid • Adult PO tea: place 1 tsp crude herb in 4 oz boiling water, simmer at least 5 min, strain; tea may be taken tid after meals • Adult PO tincture: 20-30 drops up to tid (Foster, 1998) Hepatitis • Adult PO fluid extract: 2-4 ml (1:1 dilution) tid (Murray, Pizzorno, 1998) • Adult PO powdered root: 1-2 g tid (Murray, Pizzorno, 1998) • Adult PO solid extract (dry powdered): 250-500 mg tid (Murray, Pizzorno, 1998) HIV/AIDS • Adult PO fluid extract: 2-4 ml (1:1 dilution) tid (Murray, Pizzorno, 1998) • Adult PO solid extract (dry powdered): 250-500 mg tid (5% glycyrrhetinic acid) (Murray, Pizzorno, 1998) Menopause • Adult PO fluid extract: 4 ml (1 tsp) (1:1 dilution) tid (Murray, Pizzorno, 1998) • Adult PO powdered root: 1-2 g tid (Murray, Pizzorno, 1998) • Adult PO solid extract (dry powdered): 250-500 mg (4:1 dilution) (Murray, Pizzorno, 1998) Peptic Ulcer Disease, Acute • Adult PO chewable tablets: 2-4 tablets (190-380 mg) 20 min before meals (Murray, Pizzorno, 1998) Adverse effects: Underline = life-threatening L 398 Licorice Peptic Ulcer Disease, Maintenance • Adult PO chewable tablets: 1-2 tablets 20 min before meals (Murray, Pizzorno, 1998) Contraindications ! Pregnancy category is 1; breastfeeding category is 2A. Licorice may be given to children in moderate amounts. It should not be used by persons with hepatic renal disease, hypokalemia, hypertension, arrhythmias, congestive heart failure, or those with hypersensitivity to it. Side Effects/Adverse Reactions CNS: Headache, weakness CV: Hypertension, edema, arrest ENDO: Hypokalemia GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions Interactions Drug Antiarrhythmics, corticosteroids (betamethasone, dexamethasone, hydrocortisone, methylprednisolone, prednisone, triamcinolone): Licorice may increase corticosteroids and the cardiac effects of antiarrhythmics; do not use concurrently. Antihypertensives: Use of licorice with antihypertensives may cause increased hypokalemia; do not use concurrently. Azole antifungals: Licorice may increase the levels of azole antifungals; avoid concurrent use. Cardiac glycosides (digoxin): Use of licorice with cardiac glycosides may cause increased toxicity and increased hypokalemia; do not use concurrently. Cytochrome P450 3A4, 2B6 substrates: Licorice may decrease the action of these agents. Diuretics (amiloride, triamterene): Use of licorice with diuretics may cause increased hypokalemia; avoid concurrent use. Herb Aloe (taken internally), buckthorn, cascara, Chinese rhubarb: Licorice may cause hypokalemia when used with stimulant laxative herbs (aloe [taken internally], buckthorn, cascara, and Chinese rhubarb); avoid concurrent use. Food Grapefruit juice: Use of licorice with grapefruit juice may increase corticosteroid action of licorice. Lab Test Anion gap, blood, potassium, serum prolactin, serum or urine sodium: Licorice may decrease anion gap, blood; potassium (greater than 6 weeks); serum prolactin; serum or urine sodium results. Serum, urine myoglobin: Licorice may cause a possible positive test for serum, urine myoglobin. = Pregnancy = Pediatric ! = Alert = Popular Herb Licorice 399 Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Saponin Glycyrrhizin; Glycyrrhetinic acid Flavonoid Licoagrodione Liquiritigenin; Isoliquiritigenin; Isolicoflavonol Formononetin; Glabren; Glabridin; Glabrol; Hydroxyglabrol; Glycyrrhisoflavone; Isoflavonol; Kumatakenin; Licoricone; Glabrizoflavone, Pinocernbrin; Galangin Herniarin; Umbelliferone; Glycocoumarin; Licopyranocoumarin Stigmasterol; Beta-sitosterol Estrogenic; antiinflammatory; antiviral; antibacterial; pseudoaldosterone Antimicrobial Isoflavonoid Coumarin Sterol Client Considerations Assess • Assess the reason the client is using licorice. • Assess for hypersensitivity reactions. If present, discontinue the use of licorice and administer an antihistamine or other appropriate therapy. • Assess medications and herbs the client may be taking, including cardiac glycosides, antihypertensives, antiarrhythmics, and corticosteroids (see Interactions). Administer • Instruct the client to store licorice products in a cool, dry place, away from heat and moisture. • Instruct the client not to use licorice for longer than 6 weeks. Teach Client/Family • Inform the client that pregnancy category is 1 and breastfeeding category is 2A. • Teach the client that licorice may be used in children in moderate amounts. • Advise the client to increase potassium intake if using licorice for extended periods. Adverse effects: Underline = life-threatening L 400 Lily of the Valley Lily of the Valley ! (li-lee) Scientific name: Convallaria majalis Other common names: Jacob’s ladder, ladder-to-heaven, lily constancy, lily convalle, male lily, May lily, muguet, our-lady’s-tears Origin: Lily of the valley is a perennial found in the United States, Canada, and Europe. Uses Lily of the valley has been used as an anticonvulsant, a cardiotonic, and to treat heart disease. Topically, it has been used to treat burns. Actions The cardiac glycoside action of lily of the valley is due to the chemical components convallatoxol, convallarinycoside, convallotoxin, convallamarin, locundjosid, and convallosid. These chemical components are less toxic than those of foxglove, which has been used as a source for digitalis (McGuigan, 1984). Several other actions have been proposed, but to date none is supported by research. Among these proposed actions are hypoglycemic, emetic, and diuretic effects. Convallamarosides, one of the chemical components of lily of the valley, showed significant inhibition of the number of new vessels induced in mice tumor cells (Nartowska et al, 2004). Product Availability Extract, powder, capsules, drops Plant Parts Used: Flowers, leaves, roots Dosages • Adult PO standardized powder: 0.6 g (Blumenthal, 1998) Contraindications ! Class 3 herb (whole plant). Until more research is available, lily of the valley should not be used during pregnancy and breastfeeding. It should not be given to children. Persons with cardiac conditions such as heart failure and arrhythmias should not use this herb. The FDA considers lily of the valley an unsafe herb; therefore it is not recommended for use. Side Effects/Adverse Reactions CNS: Headache, dizziness, psychosis, paralysis, coma CV: Arrhythmias, heart failure, death EENT: Dilated pupils GI: Nausea, vomiting, anorexia, abdominal pain, diarrhea, increased salivation INTEG: Hypersensitivity reactions, clammy skin, dermatitis MISC: Hyperkalemia, urinary urgency Interactions Drug Antibiotics, macrolide, tetracyclines: Lily of the valley with these agents may lead to cardiac glycoside toxicity. Continued = Pregnancy = Pediatric ! = Alert = Popular Herb Lily of the Valley 401 Interactions—cont’d Beta-blockers, calcium channel blockers, cardiac glycosides: Lily of the valley used with beta-blockers or calcium channel blockers increases the risk of bradycardia; do not use concurrently. Lily of the valley may increase the effects of digoxin; do not use concurrently. Diuretics (potassium-depleting): Lily of the valley with these agents may lead to hypokalemia. Herb Buckthorn, cascara: Hypokalemia can result from the use of buckthorn or cascara with lily of the valley; avoid concurrent use. Hawthorn: Hawthorn increases the action of lily of the valley when taken concurrently. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Glycoside Convallatoxol; Convallarinycoside; Convallotoxin; Convallamarin; Locundjosid; Convallosid Convallasaponin A (Higano et al, 2007) Convallamaroside Cardiac glycoside Saponin Volatile oil Asparagin Rutin Resin L Steroidal Antioxidant Client Considerations Assess • Assess the reason the client is using lily of the valley. • Assess for hypersensitivity reactions and dermatitis. If present, discontinue the use of lily of the valley and administer an antihistamine or other appropriate therapy. • Assess for medications and herbs used (see Interactions). ! • Assess whether the client is using this herb under the supervision of a qualified herbalist. Lily of the valley is potentially deadly. ! • Assess for cardiac conditions such as heart failure and arrhythmias. Because research information is lacking, clients with these conditions should not use lily of the valley. Administer • Instruct the client to store lily of the valley in a cool, dry place, away from heat and moisture. Adverse effects: Underline = life-threatening 402 Lobelia Teach Client/Family • Caution the client not to use lily of the valley in children or those who are pregnant or breastfeeding until more research is available. • Warn the client that the FDA considers lily of the valley unsafe. Advise the client to ! use this herb only under the supervision of a qualified herbalist. Lobelia ! (loe-beel’yuh) Scientific name: Lobelia inflata Other common names: Asthma weed, bladderpod, cardinal flower, emetic herb, gagroot, great lobelia, Indian pink, Indian tobacco, pukeweed, rapuntium inflatum, vomitroot, vomitwort Origin: Lobelia is found in wooded areas of the United States and Canada. Uses Lobelia traditionally has been used to treat asthma, bronchitis, cough, and pneumonia, usually as an expectorant. Investigational Uses Researchers are studying lobelia for its cardiac effects and its antispasmodic effects in the gastrointestinal system. Its use as a smoking deterrent and treatment for psychostimulant abuse is also under investigation. Actions Lobelia is often used in combination with Capsicum frutescens (capsicum) and Symphlocarpus factida (skunk cabbage). Studies have focused on its use as a smoking deterrent and its emetic, cardiac, and expectorant properties. Smoking Deterrent Three of the chemical components of lobelia, lobeline, lobelanine, and lobelanidine, have properties similar to those of nicotine but generally are considered less potent. However, toxicity is higher with lobelia than with other traditional smoking deterrents currently on the market, such as nicotine transdermal systems (e.g., Nicoderm and Habitrol). The chemical components of lobelia inhibit smoking by first stimulating nicotine receptors and then inhibiting them. Emetic Action The emetic action of lobelia results from stimulation of the chemoreceptor trigger zone. This action is similar to that of other emetics that are available. Lobelia also activates the vagal and afferent neural pathways responsible for vomiting. Cardiovascular Action Lobelia’s cardiac action results from both positive inotropic and chronotropic effects. Blood pressure and the neurotransmitters epinephrine and norepinephrine are increased in a manner similar to that seen with nicotine usage. Expectorant Action Lobelia is considered to be a very effective expectorant and has been used to treat respiratory conditions for many years. It causes bronchodilation. = Pregnancy = Pediatric ! = Alert = Popular Herb Lobelia 403 Other Actions Lobelia inflata was found to functionally antagonize the neurochemical and behavioral effects of the psychostimulants amphetamine and methamphetamine (Dwoskin et al, 2002; Neugebauer et al, 2007). Product Availability Capsules, fluid extract, lozenges, tablets, tincture; available in combination with cayenne pepper (Capsicum frutescens) and lungwort (Pulmonaria officinalis) Plant Part Used: Dried leaves Dosages Smoking Deterrent • Adult PO tablets: the usual dosage is 2 mg taken with 4 oz water after meals for 6 wk Other • Adult PO dried herb: 0.2-0.6 g tid • Adult PO fluid extract: 8-10 drops tid (Pizzorno, Murray, 2006) • Adult PO tincture: 15-30 drops tid Expectorant • Adult PO: 100 mg leaf or 0.6-2 ml tincture (Jellin et al, 2008) Contraindications ! Class 2b herb. Until more research is available, lobelia should not be used during pregnancy and breastfeeding. It should not be given to children in large doses as an emetic. Lobelia should not be used by geriatric clients, or by persons with hepatic/renal disorders, pneumonia, nicotine sensitivity, or hypersensitivity to it. It should not be used by people who have cardiovascular disorders such as congestive heart failure, cardiac decompensation, sinus arrhythmias, valvular dysfunction, bundle branch block, or hypertension. Toxicity can result from the use of lobelia. Side Effects/Adverse Reactions CNS: Tremors, dizziness, headache, anxiety, insomnia, seizures CV: Palpitations, hypotension or hypertension GI: Nausea, vomiting, anorexia, pain in abdomen, heartburn INTEG: Hypersensitivity reactions RESP: Cough, respiratory depression or stimulation Toxicity: Seizures, nausea, vomiting, increased salivation, diarrhea, mental confusion, weakness, change in vision and hearing, respiratory depression, arrhythmias, tremors, hypothermia, coma, death Interactions Drug Nicotine: Lobelia increases the effects of nicotine-containing products; do not use concurrently. Herb Mayapple: Lobelia may decrease the laxative effect of mayapple. Adverse effects: Underline = life-threatening L 404 Lovage Pharmacology Pharmacokinetics Chemical components of lobelia may cross the placenta and enter the breast milk. Components are metabolized by the liver and lung and excreted via the kidneys. Lobelia is well absorbed by the mouth and lungs across dermal barrier. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Alkaloid Lobeline Nicotine-like, respiratory stimulant Emetic, respiratory stimulant Inhibits amphetamineinduced dopamine (Dwoskin et al, 2002) Lobelanine; Lobelanidine Lobelane Client Considerations Assess • Assess the reason the client is using lobelia. • Assess for hypersensitivity reactions. If present, discontinue the use of lobelia and administer an antihistamine or other appropriate therapy. ! • Assess for symptoms of toxicity: seizures, nausea, vomiting, increased salivation, diarrhea, mental confusion, weakness, change in vision and hearing, respiratory depression, arrhythmias, tremors, hypothermia, and coma. • Assess for the use of nicotine-containing products and mayapple (see Interactions). Administer • Instruct the client to store lobelia products in a cool, dry place, away from heat and moisture. • Instruct the client to use lobelia for no more than 6 weeks for smoking cessation. • Administer atropine 2 mg subcut for acute toxicity. Teach Client/Family • Caution the client not to give lobelia to children in large doses as an emetic, and not to use in those who are pregnant or breastfeeding until more research is available. • Warn the client to stop smoking before using lobelia as a smoking deterrent. Nicotine toxicity can occur. Lovage (luh’vij) Scientific names: Levisticum officinale, Levisticum radix Other common names: Maggi plant, sea parsley, smellage Origin: Lovage is a perennial found in Europe, the United States, and Canada. = Pregnancy = Pediatric ! = Alert = Popular Herb Lovage 405 Uses Lovage has been used as a diuretic, an antilithic, a renal antiinflammatory, a sedative, and to treat renal disorders, gastric conditions, and respiratory congestion. Actions One study (Schinkovitz et al, 2008) identified the antimycobacterial effects of lovage. Few well-controlled studies have been carried out on lovage, and at present, none of its uses or actions can be confirmed. For this reason, use of lovage cannot be recommended. Product Availability Essential oil, tea Plant Parts Used: Roots, seeds Dosages • Adult PO tea: place 1.5-3 g finely cut root in 8 oz boiling water, let stand 15 min, strain; up to 8 g herb/day may be used Contraindications Class 2b herb (root). Until more research is available, lovage should not be used during pregnancy and breastfeeding. It should not be given to children. Lovage should not be used by persons with renal disease or irritation of the kidneys, or those who are hypersensitive to it. Side Effects/Adverse Reactions GI: Nausea, anorexia INTEG: Hypersensitivity reactions, photodermatitis Interactions Drug Anticoagulants (heparin, warfarin), salicylates: Lovage may increase the effects of anticoagulants (heparin, warfarin) and salicylates; avoid concurrent use. Diuretics: Lovage may increase sodium retention. Primary Chemical Components and Possible Actions* Chemical Class Individual Component Possible Action Volatile oil Ligusticumlactone Butylphthalide; Citronellal Phthalide Antispasmodic Lactone Coumarin Furocoumarin Hydroxycoumarin Polyyne Terpenoid Volatile acid Bergaptene; Apterin Umbelliferone Falcarindiol *Investigation of the chemical components of this herb is not complete. Adverse effects: Underline = life-threatening L 406 Lungwort Client Considerations Assess • Assess the reason the client is using lovage. • Assess for hypersensitivity reactions, photodermatitis. If present, discontinue the use of lovage and administer an antihistamine or other appropriate therapy. • Assess for edema in the feet. If the client is using lovage to treat this condition, advise to use other proven treatments. • Monitor BUN, creatinine, potassium, sodium, and chloride levels during lovage therapy. If results are elevated, use of lovage should be discontinued. • Assess the client’s use of anticoagulants, which should not be used concurrently with lovage (see Interactions). Administer • Instruct the client to store lovage products in a cool, dry place, away from heat and moisture. Teach Client/Family • Advise the client not to use lovage in children or those who are pregnant or breastfeeding until more research is available. Lungwort (luhng wawrt) Scientific name: Pulmonaria officinalis Other common names: Dage of Jerusalem, Jerusalem cowslip, Jerusalem sage, lung moss, lungs of oak, spotted comfrey Origin: Lungwort is found in many parts of Europe. Uses Traditionally, lungwort has been used to treat respiratory conditions including bronchitis, congestion, and cough. It has also been used to treat diarrhea and menstrual irregularities and may be used topically as a compress to promote wound healing. Lungwort possesses antiinflammatory actions. Investigational Uses Lungwort has been investigated for use as an anticoagulant. Actions Research on any of the uses or actions of lungwort is lacking. To date, no controlled studies have been done on either laboratory animals or humans. The only studies available focus on the chemical composition of lungwort; therefore this herb should be used under the supervision of a qualified herbalist only. The tannins are probably responsible for the wound healing properties; the glycopeptides, for the anticoagulant effect (Leven et al, 1992); and allantoin, for the emollient effect. Product Availability Extract, tablets, tincture, juice, drops, syrup Plant Part Used: Leaves = Pregnancy = Pediatric ! = Alert = Popular Herb Lungwort 407 Dosages • Adult PO infusion: place 1-2 tsp dried leaves in 8 oz boiling water, let stand 10 min, take tid; alternatively, add 1 g finely cut herb to 8 oz cold water, boil rapidly 5-10 min, strain • Adult PO tincture: 1-4 ml tid Contraindications Class 1 herb. Until more research is available, lungwort should not be used during pregnancy and breastfeeding. It should not be given to children. Lungwort should not be used by persons with hypersensitivity to it. Side Effects/Adverse Reactions GI: Nausea, anorexia, irritation INTEG: Hypersensitivity reactions, contact dermatitis SYST: Increased bleeding time Interactions Drug Anticoagulants (heparin, warfarin), salicylates: Lungwort may increase the effects of anticoagulants (heparin, warfarin) and salicylates; avoid concurrent use. Lab Test PT, INR: Lungwort increases PT and INR. Primary Chemical Components and Possible Actions Chemical Class Individual Component Allantoin Flavonoid Quercetin; Kaempferol Tannin Anticoagulant Vitamin Saponin Caffeic acid (derivative) Mucilage Glycopeptide C Chlorogenic acid; Rosmarinic acid Polygalacturonane; Arabinogalactans; Rhamnogalacturonane Possible Action Emollient Antiinflammatory, astringent Wound healing Anticoagulant Antitussive Client Considerations Assess • Assess the reason the client is using lungwort. • Assess for hypersensitivity reactions and contact dermatitis. If present, discontinue the use of lungwort and administer an antihistamine or other appropriate therapy. Adverse effects: Underline = life-threatening L 408 Lycopene • Assess for bleeding. Monitor anticoagulant studies (PT, INR) (see Interactions). • Assess the client’s respiratory status, including rate, character, cough, and congestion. Administer • Instruct the client to store lungwort products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use lungwort in children or those who are pregnant or breastfeeding until more research is available. • Caution the client not to confuse Pulmonaria officinalis with Pulmonaria mollis. • Advise the client to inform all health care providers of lungwort use. Lycopene (like’uh-peen) Scientific name: psi-carotene Origin: Lycopene is a carotenoid that occurs naturally in tomatoes. Uses Lycopene is used as an antioxidant and may protect against cancer of the prostate, pancreas, and stomach. Actions Lycopene naturally occurs in tomatoes. Processing tomatoes increases the lycopene content. One study of 19 human subjects evaluated lipid peroxidation and LDL oxidation. Lycopene supplementation resulted in a reduction of lipids and LDLs and therefore may decrease the risk of coronary heart disease (Agarwal et al, 1998). Another study showed that lycopene exerts a protective effect against myocardial infarction (Kohlmeier et al, 1997) and decreased inflammation in colitis (Reifen et al, 2001). Doxorubicin cardiotoxicity was reduced when used with lycopene when studied in the lab on animals (Anjos Ferreira et al, 2007). In the lab, prostatic cancer cells were treated with various concentrations of lycopene. There was a decrease in prostate cancer cells, which may lead to successful drug treatment in prostate cancer using lycopene (Kanagaraj et al, 2007; Graydon et al, 2007). Product Availability Capsules, tablets Dosages Prostate Cancer • Adult PO: 15 mg bid (Jellin et al, 2008) Contraindications Until more research is available, lycopene supplements should not be used during pregnancy and breastfeeding. They should not be given to children. Lycopene supplements should not be used by persons with hypersensitivity to this product. = Pregnancy = Pediatric ! = Alert = Popular Herb Lysine 409 Side Effects/Adverse Reactions GI: Nausea, anorexia Interactions Lab Test Prostate specific antigen (PSA): Lycopene may decrease PSA in prostate cancer. Pharmacology Pharmacokinetics The bioavailability is significantly higher when synthetic lycopene is in oil (Tang et al, 2005). Client Considerations Assess • Assess for adequate lycopene in the diet (tomatoes, processed tomato products). Administer • Instruct the client to store lycopene products in a cool, dry place, away from heat and moisture. L Teach Client/Family • Caution the client not to use lycopene supplements in children or those who are pregnant or breastfeeding until more research is available. Lysine (lise’een) Scientific name: 2,6-diaminohexanoic acid Origin: Lysine is an amino acid manufactured by the body. It also can be found in dairy products, brewer’s yeast, meats, and wheat germ. Uses Lysine has been used to treat cold sores and other herpes infections, including genital herpes. It has also been used with some success to treat Bell’s palsy and rheumatoid arthritis and to detoxify opiates. Actions Several reports have shown that lysine improves herpes infections. One study evaluated 1543 participants by questionnaire. More than 80% of those who responded stated that lysine supplements lessened the severity of genital herpes lesions, canker sores, and cold sores (Walsh et al, 1983). Another study evaluating 45 patients taking lysine daily in various doses found a shortened duration of herpes infections and decreased recurrence. The result occurs when the lysine-to-arginine ratio increases (Griffith et al, 1978). Other studies have refuted these claims, with research showing no reduction in herpes infections (Milman et al, 1978; Simon et al, 1985). Product Availability Capsules, tablets Adverse effects: Underline = life-threatening 410 Lysine Dosages PO dosages as high as 4000 mg/day have been reported. Recurrent Herpes Simplex Labialis Infections • Adult PO: 1000 mg daily ⫻ 1 year, then 1000 mg tid ⫻ 6 months (Jellin et al, 2008) Contraindications Until more research is available, lysine supplements should not be used during pregnancy and breastfeeding. They should not be given to children. Lysine supplements should not be used by persons with hypersensitivity to this product. Side Effects/Adverse Reactions GI: Nausea, anorexia, diarrhea, abdominal pain Interactions Drug Aminoglycosides: Use of large amounts of lysine causes increased aminoglycoside toxicity; avoid concurrent use. Calcium: Lysine increases calcium absorption, decreases urine calcium loss. Pharmacology Pharmacokinetics Lysine is an amino acid that is naturally present in the body. Its pharmacokinetics and pharmacodynamics are unknown. Client Considerations Assess • Assess for aminoglycoside, calcium use. Advise the client to avoid concurrent use with lysine (see Interactions). Administer • Instruct the client to store lysine products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use lysine supplements in children or those who are pregnant or breastfeeding until more research is available. = Pregnancy = Pediatric ! = Alert = Popular Herb Maitake 411 Maitake (mah-ee-tah’keh) Scientific name: Grifola frondosa Other common names: Dancing mushroom, king of mushrooms, monkey’s bench, shelf fungi Origin: Maitake is a mushroom found in Japan. Uses Maitake has been used to treat hypertension, diabetes mellitus, cancer, high cholesterol, and obesity. Actions Maitake, along with other mushrooms, has been used for thousands of years in Asia for a variety of purposes. It is considered a “miracle herb’’ by many in the Orient. Anticancer Action Maitake is an immune modulator, helping to normalize the immune system. It exerts its anticancer action by activating interleukin-1 and increasing T-cells, both of which inhibit the proliferation of cancers (Adachi et al, 1987). Multiple studies have identified the cancer-fighting properties of maitake. Besides activating interleukin-1 and increasing T-cells, maitake also increases cytokine production and boosts the action of macrophages. Most studies have identified its anticancer properties as resulting M from the polysaccharide beta-glucan. Antiobesity Action Although its mechanism of action is unclear, maitake is responsible for weight loss when taken over an extended period of time. In one study, 30 overweight clients were given maitake powder for 2 months. The clients lost between 7 and 26 pounds when taking various dosages ranging from 20 to 500 mg daily (Yokota, 1992). Another study using laboratory animals showed weight loss after 41⁄2 months. The amount of weight lost was significant when compared with that of the control group (Ohtsuru, 1992). Other Actions One study has shown that the use of maitake reduces blood pressure and cholesterol and improves diabetes. After hypertensive laboratory animals were fed maitake powder, their blood pressure was evaluated and a small reduction was noted (Kabir et al, 1989). Other researchers found that maitake inhibits lipid metabolism. Rats given maitake showed a reduction in serum lipids, total cholesterol, and very-lowdensity lipoprotein (VLDL) (Fukushima et al, 2001; Kabir et al, 1987; Kubo et al, 1996, 1997). The antidiabetes action of maitake is believed to result from its ability to reduce insulin resistance and possibly increase sensitivity to insulin (Horio et al, 2001; Lo et al, 2008). Other studies (Kodama et al, 2008; Wang et al, 2008) identify the immunity against foreign pathogens without eliciting adverse inflammatory response. One novel study (Gu et al, 2007) identified an anti-HSV-1 protein from maitake. Therefore maitake may possess antiviral activity. Product Availability Capsules, extract Plant Parts Used: Mushroom, whole fungus Dosages • Adult PO: 250-500 mg daily Adverse effects: Underline = life-threatening 412 Male Fern Contraindications Class 1 herb (fruiting body, mycelium). Until more information is available, maitake should not be used during pregnancy and breastfeeding. It should not be given to children. Maitake should not be used by persons with hypersensitivity to it. Side Effects/Adverse Reactions ENDO: Hypoglycemia Interactions Drug Antidiabetics: Maitake may increase the action of antidiabetics. Immunosuppressants (azathioprine, basiliximab, daclizumab, muromonab, mycophenolate, tacrolimus): Maitake may decrease the effects of immunosuppressants; do not use immediately before, during, or after transplant surgery. Herb Hypoglycemic herbs: Maitake may increase the hypoglycemic effect of these herbs. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Polysaccharide Beta-glucan Antitumor Client Considerations Assess • Assess the reason the client is using maitake. • Assess for medications used; do not use with immunosuppressants; monitor closely with antidiabetics (see Interactions). Administer • Instruct the client to store maitake products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use maitake in children or those who are pregnant or breastfeeding until more research is available. Male Fern ! (mayl fuhrn) Scientific name: Dryopteris filix-mas Other common names: Bear’s paw, erkek egrelti, helecho macho, knotty brake, marginal shield-fern, shield fern, sweet brake, wurmfarn Origin: Male fern is a perennial fern found in Asia, Europe, Africa, South America, the United States, and Canada. = Pregnancy = Pediatric ! = Alert = Popular Herb Male Fern 413 Uses Male fern has been used primarily as an anthelmintic against pork, beef, and fish tapeworm. It is used topically for arthritis, neuralgia, and earache. Actions The anthelmintic activity of male fern against tapeworms is well documented. This herb is thought to produce fewer side effects than do products containing quinacrine. Male fern should be considered if traditional treatments do not result in complete expulsion of the worms. However, consideration must also be given to the toxicity of this herb, including hepatotoxicity, even though it produces fewer side effects than products with quinacrine. Clients with cardiac, renal, or hepatic disease should not use male fern. Product Availability Capsules, draught, extract Plant Parts Used: Dried rhizomes, roots Dosages Male fern is seldom used today because it is highly toxic. • Adult PO extract: 3-6 ml • Child PO extract: age 4-12 years: 0.25-0.5 ml/year of age, not to exceed 4 ml in divided doses Male fern is typically given with a saline laxative to aid in expulsion of worms. NOTE: Allow 1 week between doses. M Contraindications ! Because it is an abortifacient, male fern should not be used during pregnancy. Until more research is available, this herb should not be used during breastfeeding and should not be given to infants. Persons with cardiovascular disease, hepatic/renal disease, and gastric or duodenal ulcers should not use this herb. Male fern should not be used by persons with hypersensitivity to it. Use only PO under the supervision of a qualified herbalist. Male fern is highly toxic. Side Effects/Adverse Reactions CNS: Headache GI: Nausea, vomiting, anorexia, diarrhea, severe abdominal pain and cramping, hepatotoxicity MISC: Albuminuria, shortness of breath, hyperbilirubinemia Toxicity: Seizures, heart failure, respiratory failure, permanent blindness, coma, death Interactions Drug Antacids, H2-blockers, proton pump inhibitors: These agents may decrease the action of male fern; separate by at least 2 hours. HMG-CoA reductase inhibitors: Male fern taken concurrently with these agents may cause hepatotoxicity; do not use together. Continued Adverse effects: Underline = life-threatening 414 Male Fern Interactions—cont’d Herb Castor: Do not use male fern with castor oil; increased toxicity may occur (Jellin et al, 2008). Food Fats, oil, alcohol: Male fern with these products leads to increased absorption and adverse reactions. Lab Test Hepatic function tests: Male fern increases hepatic function tests. Primary Chemical Components and Possible Actions Chemical Class Individual Component Phloroglucinol Filicic acid Flavaspidic acid Volatile oil Tannin Possible Action Anthelmintic Anthelmintic Wound healing; astringent Albaspidin Desaspidin Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of male fern and administer an antihistamine or other appropriate therapy. • Assess for cardiovascular, renal, and hepatic disease. Clients with these conditions should not use male fern. ! • Monitor hepatic function tests (ALT, AST, bilirubin). Watch for hepatotoxicity. • Watch for signs of toxicity: seizures, heart failure, blindness, respiratory failure, ! and coma. Death can occur. Administer • Instruct the client to use male fern only PO and only under the supervision of a qualified herbalist because it is considered a high-risk herb. • Instruct the client as follows: the night before treatment, eat only a light meal or no meal, followed by a laxative. The next morning, take male fern with another laxative before breakfast. Teach Client/Family • Caution the client not to use male fern during pregnancy because it is an abortifacient. Until more research is available, caution the client not to use this herb during breastfeeding and do not give it to infants. = Pregnancy = Pediatric ! = Alert = Popular Herb Mallow 415 Mallow (ma’loe) Scientific name: Malva sylvestris Other common names: Blue mallow, cheeseflower, cheeseweed, field mallow, fleurs de mauve, high mallow, malve, zigbli Origin: Mallow is found in subtropical and temperate climates. Uses Mallow has been used to treat respiratory conditions such as cough (antitussive, demulcent), tonsillitis, sore throat, bronchitis, and irritation of the respiratory tract. It has also been used to relieve the pain of teething, scratches, and scrapes. The mallow leaves have been used to treat constipation. Actions Research is lacking on any uses or actions of mallow. To date, no controlled studies for mallow have been carried out in either laboratory animals or humans. The only studies available focus on its chemical composition; therefore mallow should be used only under the supervision of a qualified herbalist. Product Availability Dried herb, fluid extract Plant Parts Used: Dried flowers, dried leaves M Dosages • Adult PO infusion (leaf): mix 5 g dried herb (leaf) with boiling water, let stand, strain, drink daily before bedtime • Adult PO flower tea: 1.5-2 g of dried flowers in 150 ml boiling water ⫻ 10 min, strain; up to 5 g ingested per day (Jellin et al, 2008) • Adult PO dried herb: 5 g daily Contraindications Until more research is available, mallow should not be used during pregnancy and breastfeeding. It should not be given to children. Mallow should not be used by persons with hypersensitivity to it. Do not confuse mallow with marshmallow, musk mallow, or dwarf mallow. Side Effects/Adverse Reactions INTEG: Hypersensitivity reactions MS: Tremors, shaking Primary Chemical Components and Possible Actions Chemical Class Individual Component Phytoalexin Malvone A (Veshkurova, 2006) Possible Action Continued Adverse effects: Underline = life-threatening 416 Marigold Primary Chemical Components and Possible Actions—cont’d Chemical Class Individual Component Glycoside Tannin Mucilage Leukocyanin Flavonoid Galacturonorhamane; Arabinogalactane, Galacturonic acid, Rhamnose, Galactose Possible Action Wound healing; astringent Emollient, demulcat Hypolaetin; Gossypetin Client Considerations Assess • Assess for hypersensitivity reactions (rare). If present, discontinue the use of mallow and administer an antihistamine or other appropriate therapy. Administer • Instruct the client to store mallow products away from heat, insects, and moisture. Teach Client/Family • Caution the client not to use mallow in children or those who are pregnant or breastfeeding until more research is available. • Caution the client not to confuse mallow with marshmallow, musk mallow, or dwarf mallow (Althaea officinalis) because they are different herbs. • Caution the client that this herb should be used only under the supervision of a qualified herbalist. Little research is available. Marigold (mar’uh-goeld) Scientific name: Calendula officinalis Other common names: Calendula, garden marigold, pot marigold, poet’s marigold Origin: Marigold is an annual found in parts of Europe, the United States, and Canada. Uses Marigold is used topically to treat skin disorders such as venous stasis ulcers, decubitus ulcers, varicose veins, bruises, boils, and rashes. It also is used topically to help heal chapped, cracked skin and for aromatherapy. Marigold is used internally to treat gastric disorders and promote digestion. It is used both internally and topically to treat inflammation of the oral and pharyngeal mucosa. = Pregnancy = Pediatric ! = Alert = Popular Herb Marigold 417 Investigational Uses Studies are underway to determine the antitumor and antiinfective properties of marigold. Actions Antitumor Action Research is available documenting the use of lutein, a chemical component of marigold, as an antitumor agent. Mice fed a diet of lutein from marigold extract were inoculated after 2 weeks with tumor cells. Cell proliferation was measured for 70 days. Low levels of lutein were found to lower the incidence of mammary tumors, tumor growth, and lipid peroxidation, whereas higher levels were found to be less effective. Researchers concluded that low levels of dietary lutein can decrease mammary tumor development (Park et al, 1998). An earlier study showed similar results (Chew et al, 1996). Two newer studies (Jimenez-Medina et al, 2006; Barajas-Farias et al, 2006) identified the dual and opposite effect of marigold, both chemoprotectant and promoter in hepatocarcinogenesis in the laboratory. Antiinfective Action One study evaluated the use of marigold in treating the tick-borne encephalitis virus (Fokina et al, 1991). In mice inoculated with the virus, marigold was only partly effective in killing the virus. Other herbal preparations exhibited much more antiviral activity. Another study examining the effectiveness of various herbs against dermal staphylococcus, streptococcus, and protozoa found that marigold was one of the most active extracts. This information may be useful for the development of products M to treat dermal diseases (Molochko et al, 1990). Product Availability Mouthwash, ointment, tea, tincture, cream, gel, shampoo Plant Parts Used: Flowers, leaves Dosages • Adult PO tea: 1-4 ml tid • Adult PO tincture: 1-4 ml tid • Adult topical ointment: may be applied prn to the affected area Contraindications Pregnancy category is 3; breastfeeding category is 2A. Marigold should not be given to children. Persons with hypersensitivity to marigold or other plants of the Compositae family should not use it. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions Interactions Drug CNS depressants: Marigold may increase sedation when given with central nervous system depressants (Jellin et al, 2008). Herb Sedative herbs: Marigold may increase sedative action of sedative herbs (Jellin et al, 2008). Adverse effects: Underline = life-threatening 418 Marijuana Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Triterpenoid Glycoside Lutein Sterol Fatty acid Carotenoid pigment Polysaccharide Volatile oil Calendulen Sesquiterpene oligoglycosides Calendasaponins Ionone glucosides Faradiol Antiinflammatory Antitumor Officinosides C, D A, B, C, D Officinosides A, B Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of marigold and administer an antihistamine or other appropriate therapy. • Assess whether the client is allergic to other members of the Compositae family. If so, marigold should not be used. Administer • Instruct the client to store marigold products in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 3 and breastfeeding category is 2A. • Caution the client not to give marigold to children. • Inform the client that allergies to this plant can occur and that the use of marigold should be discontinued if necessary. Marijuana (mare-uh-wa’ na) Scientific name: Cannabis sativa Other common names: Anashea, banji bhang, blunt, bud, cannabis, dope, ganga, grass, hash, hashish, hemp, joint, Mary Jane, pot, sinsemilla, weed Origin: Marijuana is grown wild and is cultivated throughout the world. Uses Marijuana has been used for recreation. Dronabinol, which contains cannabis, is used to treat anorexia in appetite loss associated with AIDS and for cancer chemotherapy induced nausea. It is also helpful to reduce intraocular pressure in glaucoma. = Pregnancy = Pediatric ! = Alert = Popular Herb Marijuana 419 Actions Short-term marijuana by inhalation increases bronchodilation. However, long term it impairs lung function and leads to constrictive lung disease. It decreases intraocular pressure in glaucoma and increases the appetite (Jellin et al, 2008). In one study (Zuardi et al, 2006) cannabidiol, one of the chemical components of marijuana, showed anxiolytic and/or antipsychotic actions. Product Availability Tincture, fluid extract, inhalation Plant Part Used: Leaf flower Dosages • Adult PO tincture: 5-15 drops • Adult fluid extract: 1-3 drops • Adult dronabinol: 5-15 mg/m2 every 2-4 hr • Adult inhalation: 1-3 grains smoked Contraindications Marijuana should not be used in children or those who are pregnant or breastfeeding. Side Effects/Adverse Reactions CNS: Impaired reaction time, panic reactions, hallucinations, depression, emotional disturbances (marijuana intoxication) CV: Tachycardia, hypotension, hypertension, palpitations EENT: Red eyes, sore throat GI: Nausea, vomiting, dry mouth Interactions Drug CNS depressants: Marijuana increases the effect of central nervous system depressants. Pharmacology Pharmacokinetics Absorbed into fat cells, remains in the urine for at least 10 days. Primary Chemical Components and Possible Actions Chemical Class Individual Component Cannabinoids TCH Dronabinol Cannabidiol Possible Action Antipsychotic Client Considerations Assess • Assess the reason the client is using marijuana. • Identify if the client is taking any other central nervous system depressants that should not be taken with this product. Adverse effects: Underline = life-threatening M 420 Marjoram Administer • Keep marijuana in a dry area away from direct sunlight. Teach Client/Family • Teach the client that marijuana should not be used in children or those who are pregnant or breastfeeding until more research is available. Marjoram (mahr’juh-ruhm) Scientific name: Origanum majorana L. Other common names: Garden marjoram, knotted marjoram, oleum majoranae (oil), sweet marjoram Origin: Marjoram is found throughout the world. Uses Marjoram has been used as a diuretic and to treat bruises, headache, cough, paroxysmal cough, rhinitis, amenorrhea, dysmenorrhea, arthritis, muscle pain and stiffness, insomnia, motion sickness, and snakebite. The essential oil is used topically for pain. Marjoram is also used as a food flavoring. Investigational Uses Marjoram may be used in Alzheimer’s disease. Actions Only a few studies on marjoram have been published. Among them are investigations into the use of marjoram as an antiinfective and for the treatment of eczema. Eczema Treatment One researcher evaluated the use of marjoram in the treatment of childhood atopic eczema (Anderson et al, 2000). In this study, eight children received massage with essential oils (aromatherapy) as part of their medical regimen to control eczema. One of the essential oils preferred by the mothers doing the massage was marjoram. A significant improvement occurred in the eczema in this group. Other Actions The ursolic acid in Origanum majorana demonstrated a potent acetylcholinesterase inhibitor and therefore should be useful in Alzheimer’s disease (Chung et al, 2001). Antimicrobial activity was identified against seven fungi: Fusarium solani, Candida albicans, Aspergillus niger, A. parasiticus, Rhizopus oryzae, Rhizoctonia oryzae sativae, and Altemaria brassicicola (Leeja et al, 2007). Marjoram may also be effective in lead toxicity. There is a protective effect of the volatile oil, alcoholic and aqueous extracts of marjoram (el-Ashmawy et al, 2005). Product Availability Tea, tincture, essential oil Plant Parts Used: Dried leaves, flowering tops Dosages • Adult PO tea: add 1-2 tsp dried leaves and flowering tops to 8 oz boiling water, let stand 10 min, take bid-tid • Adult PO tincture: 1 tsp daily = Pregnancy = Pediatric ! = Alert = Popular Herb Marjoram 421 • Adult topical: may be used as a poultice or mouthwash (Jellin et al, 2008) • Adult topical essential oil: apply as needed to affected area Contraindications Class 1 herb (leaf). Until more research is available, marjoram should not be used therapeutically during pregnancy and breastfeeding. It should not be given therapeutically to children. Marjoram should not be used therapeutically by persons with hypersensitivity to this herb or other members of the Labiatae family, including mint, basil, thyme, oregano, hyssop, and sage. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, diarrhea INTEG: Serious hypersensitivity reactions Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Lactone Thymol Carvacrol Diosmetin; Luteolin; Apigenin Antiinfective Flavonoid Hydroquinone Glycoside Triaconatane Sitosterol Acid M Astringent; wound healing Cytotoxic Tannin Arbutin; Methylarbutin; Vitexin; Orientin; Thymonin Oleanolic acid Ursolic acid Potent acetylcholinesterase inhibitor Rosmarinic acid; Caffeic acid; Chlorogenic acid Client Considerations Assess ! • Assess for hypersensitivity reactions (facial edema, inability to breathe, itching, dysphagia, dysphonia). If these symptoms are present, discontinue the use of marjoram and administer an antihistamine or other appropriate therapy. Administer • Instruct the client not to use marjoram long term because of its arbutin content. • Instruct the client not to use the essential oil internally. • Instruct the client to store marjoram products in a cool, dry place, away from heat and moisture. Adverse effects: Underline = life-threatening 422 Marshmallow Teach Client/Family • Caution the client not to use marjoram therapeutically in children or those who are pregnant or breastfeeding until more research is available. It should be used as a food flavoring only. • Inform the client that marjoram is not the same herb as oregano. • Advise the client that cross-sensitivity may occur with other herbs of the Labiatae family, such as oregano, thyme, hyssop, basil, mint, sage, and lavender. • Advise the client to use marjoram for short periods of time, and to stop taking if GI symptoms occur. Marshmallow (mahrsh’meh-low) Scientific name: Althea officinalis Other common names: Althaea root, althea, mortification root, sweetweed, wymote Origin: Marshmallow is a perennial found in Europe and the United States. Uses Marshmallow is used traditionally to suppress cough and relieve sore throat and gastric disorders such as irritable bowel syndrome, gastritis, and constipation. Topically, it is used to treat minor skin disorders. Actions Very little primary research is available for marshmallow. Existing studies focus primarily on its antitussive and antiinfective properties. Antitussive Action One study evaluated the antitussive action of marshmallow and other nonnarcotic antitussives on cats (Nosal’ova et al, 1992). A nylon fiber was used to mechanically stimulate the mucous area of the respiratory system, and cough was evaluated on the basis of lateral tracheal pressure. The antitussive effect of marshmallow was found to be stronger than that of some of the nonnarcotic antitussives evaluated, which are not available in the United States. Antiinfective Action In a study focusing on the antiinfective properties of marshmallow and several other herbs against Vibrio cholerae, marshmallow was found to be less effective than some of the other plants evaluated (Guevara et al, 1994). Product Availability Capsules, dried flowers, dried leaves, dried whole root, syrup Plant Parts Used: Dried flowers, dried leaves, dried root Dosages Throat Irritation • Adult PO syrup: 10 ml as a single dose (Blumenthal, 1998) Other • Adult PO dried leaves: 5 g daily (Blumenthal, 1998) • Adult PO dried root: 6 g crude herb daily (Blumenthal, 1998) • Adult PO powdered, crushed plant: whole or part, 2 g/day = Pregnancy = Pediatric ! = Alert = Popular Herb Marshmallow 423 Contraindications Pregnancy category is 3; breastfeeding category is 2A. Marshmallow, medicinally should not be given to children. Persons who are hypersensitive to this herb should not use it. Side Effects/Adverse Reactions ENDO: Hypoglycemia GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions Interactions Drug Antidiabetics: Marshmallow may increase hypoglycemic action of antidiabetes agents (Jellin et al, 2008). Iron salts: Marshmallow may reduce the absorption of iron salts; separate by 2 hours. Oral medications: Marshmallow may reduce the absorption of oral medications; do not use concurrently. Herb Hypoglycemic herbs: Marshmallow may increase the effects of hypoglycemic herbs (Jellin et al, 2008). Lab Test Blood glucose: Marshmallow decreases blood glucose. M Primary Chemical Components and Possible Actions Chemical Class Individual Component Polysaccharide Arabinogalactans; Arabans; Glucans; Galacturonic rhamnans Quercetin; Kaempferol Scopoletin Flavonoid Pectin Starch Calcium oxalate Sterol Fat Coumarin Phenolic acid Mucilage Possible Action Antiinflammatory Caffeic acid; Syringic acid; Chlorogenic acid; Ferulic acid Antiinfective Adverse effects: Underline = life-threatening 424 Mayapple Client Considerations Assess • Assess the reason the client is using marshmallow. • Assess for hypersensitivity reactions. If present, discontinue the use of marshmallow and administer an antihistamine or other appropriate therapy. • Assess for oral medication or antidiabetic use (see Interactions). Administer • Instruct the client to store marshmallow products in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 3 and breastfeeding category is 2A. • Caution the client not to give marshmallow medicinally to children. • Advise diabetic clients to avoid using this product. Mayapple ! (may’a-puhl) Scientific name: Podophyllum peltatum Other common names: American mandrake, devil’s-apple, duck’s foot, ground lemon, hog apple, Indian apple, mandrake, raccoon berry, umbrella plant, wild lemon, wild mandrake Origin: Mayapple is a perennial found in the United States and Canada. Uses Mayapple has been used in China to treat snakebites, general weakness, poisoning, lymphadenopathy, condyloma acuminata, and cancer. In Western medicine, mayapple has been used as a laxative. Topically, the concentrated tincture and resin are useful for removing warts and condyloma. Actions Very few research studies have been done on mayapple. The few that are published deal with the toxicity of podophyllotoxin, one of its chemical components. Podophyllotoxin Intoxication One study using rats revealed severe nervous system changes when mayapple was injected. The changes included increased coarseness of nerve fibers in the cerebellum, cerebral cortex, brainstem, and spinal cord. Neuronal swelling also occurred. Although the nervous system was the only system studied, toxicity undoubtedly occurs in other systems as well (Chang et al, 1992). Other studies showed similar results (Eyberger et al, 2006; Kao et al, 1992). Product Availability Concentrated tincture (by prescription), dried rhizome, fluid extract (by prescription), resin, tincture Plant Part Used: Rhizome = Pregnancy = Pediatric ! = Alert = Popular Herb Mayapple 425 Dosages Wart Removal • Adult topical concentrated tincture: apply to wart, leave on for up to 6 hr, wash off; may be used every wk for up to 4 wk • Adult topical resin: apply to wart bid for 3 days, repeat every wk for 5 wk; do not wash off Other • Adult PO fluid extract: 1.5-3 g daily (Blumenthal, 1998) • Adult PO powdered root: 10-30 grains • Adult PO tincture: 2-10 drops daily-bid; 2.5-7.5 g daily (Blumenthal, 1998) Contraindications ! Class 2b/3 herb (root). Until more research is available, mayapple should not be used during pregnancy and breastfeeding. It should not be given to children. Mayapple should not be used by geriatric clients, debilitated persons, or those who are hypersensitive to the root. Persons with gallbladder disease, intestinal obstruction, or diabetes should avoid its use. All parts of the mayapple plant except the ripe fruit are toxic both orally and topically. Mayapple should not be used topically on large areas or on irritated warts, moles, or birthmarks. Side Effects/Adverse Reactions CNS: Confusion, dizziness, headache, psychosis, hallucinations, seizures, stupor, coma GI: Nausea, vomiting, anorexia, diarrhea, abdominal pain, hepatotoxicity HEMA: Leukopenia, thrombocytopenia, anemia INTEG: Hypersensitivity reactions MISC: Weakness, orthostatic hypotension Podophyllotoxin Intoxication: Nausea, vomiting, diarrhea, abdominal pain, thrombocytopenia, leukopenia, abnormal hepatic function tests, ataxia, numbness, altered consciousness RESP: Shortness of breath, apnea Interactions Drug Belladonna alkaloids, ipecac: Belladonna alkaloids, ipecac may decrease the laxative effects of mayapple; do not use concurrently. Cardiac glycosides: Do not use mayapple with cardiac glycosides; may increase toxicity (Jellin et al, 2008). Diuretics (potassium-losing): Mayapple when given with potassium-losing diuretics may increase hypokalemia (Jellin et al, 2008). Herb Cardiac glycoside herbs: Do not use concurrently; may increase cardiac glycoside toxicity (Jellin et al, 2008). Potassium-depleting herbs: Administration of mayapple with potassiumdepleting herbs may increase hypokalemia (Jellin et al, 2008). Laxative herbs: Hyoscyamus, lobelia, and leptandra may decrease the laxative effect of mayapple; do not use concurrently. Continued Adverse effects: Underline = life-threatening M 426 Mayapple Interactions—cont’d Food Salt: Salt may increase the laxative effect of mayapple; do not use concurrently. Lab Test AST, ALT, BUN, creatitine: Mayapple may cause increased AST, ALT, BUN, creatitine. HCT, WBC, platelets, red blood cells: Mayapple may cause decreased HCT, white blood cells, platelets, red blood cells. Pharmacology Pharmacokinetics Pharmacokinetics and pharmacodynamics are unknown. Mayapple is antimitotic. Primary Chemical Components and Possible Actions Chemical Class Podophyllotoxin Picropodophyllin Resin Flavonoid Starch Individual Component Possible Action Alpha, beta pellatin Antimitotic; toxic Antimitotic; toxic Quercetin Antiinflammatory Client Considerations Assess • Assess the reason the client is using mayapple. • Assess for hypersensitivity reactions. If present, discontinue the use of mayapple and administer an antihistamine or other appropriate therapy. ! • Assess for the symptoms of podophyllotoxin intoxication: nausea, vomiting, diarrhea, abdominal pain, thrombocytopenia, leukopenia, abnormal hepatic function tests, ataxia, numbness, and altered consciousness. • Assess for the use of medications, herbs, and salt (see Interactions). Administer • Instruct the client to treat only 25 cm2 at a time. Mayapple is extremely irritating to skin and mucous membranes. • Instruct the client to store mayapple products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use mayapple in children or those who are pregnant or breastfeeding until more research is available. • Caution the client that all parts of the mayapple plant except the ripe fruit are toxic, ! both orally or topically. • Advise the client that the health care provider may use mayapple to treat genital, vaginal, or perianal warts. = Pregnancy = Pediatric ! = Alert = Popular Herb Meadowsweet 427 Meadowsweet (meh’dow-sweet) Scientific names: Filipendula ulmaria, Spiraea ulmaria Other common names: Bridewort, dolloff, dropwort, fleur d’ulmaire, flores ulmariae, gravel root, meadow queen, meadwort, mede-sweet, queen of the meadow, spierstaude Origin: Meadowsweet is a perennial shrub found in Europe and North America. Uses Traditionally, meadowsweet has been used to treat gastrointestinal disorders such as gastritis, heartburn, indigestion, irritable bowel syndrome, and peptic ulcer disease. It has also been used to treat urinary tract infections, joint and rheumatic muscle pains, headache, fever, colds, and cancer. Actions Anticoagulant Action In one study focusing on the anticoagulant effects of meadowsweet, extracts were administrated orally and anticoagulant levels tested (Liapina et al, 1993). The flowers and seeds showed a high level of anticoagulant activity. Another study using various methods showed that all components of meadowsweet exhibit heparin-like action (Kudriashowv et al, 1991). A third study showed similar results (Kudriashowv M et al, 1990). Antiinfective Action A study evaluating the antimicrobial effects of various herbs found that those with the greatest effect against bacteria were meadowsweet, willow herb, cloudberry, and raspberry (Rauha et al, 2000, Ryzhikov et al, 2006). Antioxidant Action When researchers used spectrometry to evaluate the antioxidative activity of 92 phenolic extracts from plants, meadowsweet showed a high level of antioxidative activity calculated as gallic acid equivalents (Kahkonen et al, 1999). Anticancer Action One study found that meadowsweet caused a significant decrease in precancerous changes in mice. Mice with cervical dysplasia or carcinoma of the vagina were given meadowsweet prepared from flowers. A 67% drop in dysplasia occurred, and no recurrence was observed in 10 subjects considered completely cured in 1 year (Peresun’ko et al, 1993). Spiridonov et al (2005) studied the cytotoxicity of Russian ethnomedicinal plants including meadowsweet. The crude ethanol extract tested on cell growth exceeded the cytotoxicity of cyclophosphamide and fluoracil. Antiulcer Action One foreign study has demonstrated the antiulcer action of meadowsweet. The herb was shown to decrease formation of stomach lesions when reserpine injections were given to rats or mice (Barnaulov et al, 1980). Product Availability Dried flowers, dried herb, fluid extract, infusion, powder, tablets, tincture Plant Parts Used: Dried flowers, other above-ground parts Adverse effects: Underline = life-threatening 428 Meadowsweet Dosages • Adult PO dried flowers: 2.5-3.5 g daily (Blumenthal, 1998) • Adult PO dried herb: 1.5-5 g bid-tid • Adult PO fluid extract: 2-3 ml tid (1:1 dilution in 25% alcohol) • Adult PO infusion: 3-6 g prepared with 100 ml every 2 hr • Adult PO powder: 1⁄2 tsp dissolved in 1 oz water • Adult PO tincture: 2-4 ml bid-tid (1:5 dilution in 25% alcohol) Contraindications Pregnancy category is 4; breastfeeding category is 3A. Meadowsweet should not be given to children. It should not be used by persons with asthma or hypersensitivity to salicylates. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions RESP: Bronchospasm Interactions Drug Anticoagulants: Anticoagulants (heparin, warfarin), and salicylates may increase the risk of bleeding when used with meadowsweet; avoid concurrent use. Iron salts: Meadowsweet may decrease the absorption of iron salts; separate by 2 hours. Opioids: Meadowsweet may increase the action of opioids (Jellin et al, 2008). Herb Anticoagulant herbs: Meadowsweet given with anticoagulant herbs may increase risk of bleeding (theoretical). Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Flavonoid Quercetin; Naringenin; Flavone Kaempferol Spiraeoside; Avicularin; Hyperoside Spiraein Monotropin; Primaverosides Antimicrobial Phenolic glycoside Antioxidant Wound healing; astringent Antiinflammatory Tannin Salicin = Pregnancy Antiinflammatory = Pediatric ! = Alert = Popular Herb Melatonin 429 Primary Chemical Components and Possible Actions—cont’d Chemical Class Individual Component Possible Action Volatile oil Methylsalicylate Salicylaldehyde; Gaultherin; Isosalicin; Monotropitin; Salicylic acid; Spirein Anticoagulant Anticoagulant Coumarin Mucilage Ascorbic acid Client Considerations Assess • Assess the reason the client is using meadowsweet. • Assess for hypersensitivity reactions. If present, discontinue the use of meadowsweet and administer an antihistamine or other appropriate therapy. Clients with salicylate sensitivity or asthma should not use this herb. • Assess for the use of anticoagulants (heparin, warfarin), salicylates; these drugs M should be avoided when using this herb (see Interactions). • Monitor coagulation studies if the client is taking high doses of meadowsweet over a long period. Administer • Instruct the client to store meadowsweet products in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 4 and breastfeeding category is 3A. • Caution the client not to give meadowsweet to children. Melatonin (meh-luh-toe’nuhn) Scientific name: N-Acetyl-5-methoxytryptamine Other common name: MEL, MLT, Pineal hormone Origin: Melatonin is a naturally occurring hormone in the body. Uses Melatonin is used to treat insomnia and inhibit cataract formation. It is also used to increase longevity, treat epilepsy, hypertension, various cancers, and jet lag, and prevent weight loss in cancer patients. Because it lowers luteinizing hormone (LH), estradiol, and progesterone levels, melatonin could possibly be useful as a contraceptive (Voordouw, 1992). Adverse effects: Underline = life-threatening 430 Melatonin Actions Melatonin is a hormone produced in the body by the pineal gland. It is an antioxidant and a free-radical scavenger (Reiter et al, 1995). When tryptophan is converted to serotonin, melatonin results from enzymatic processes in the pineal gland. Melatonin production increases during sleep and decreases during waking hours (James et al, 1989). Melatonin supplementation has been found to induce and maintain sleep in adults who have low melatonin levels. The most promising use is for the geriatric client, who typically has low melatonin levels. Melatonin treatment in vivo caused a significant increase in blood glucose and a decreased level of free fatty acids (Fabis et al, 2002). Parkinson’s disease may be treated with melatonin, which lacks any serious side effects (Antolin et al, 2002). Product Availability Extended release capsules: 3 mg; injectable; liquid: 500 mcg/ml; tablets: 500 mcg, 1 mg, 1.5 mg, 3 mg Dosages Cancer (as a Single Agent) • Adult PO 20 mg daily ⫻ 2 mo IM (injectable form), then 10 mg PO daily Cancer (in Combination with Interleukin-2) • Adult PO: 40-50 mg at bedtime for 1 wk before interleukin-2 Chronic Insomnia • Adult PO tablets: 75 mg at bedtime (Murray, Pizzorno, 1998) Delayed Sleep-Phase Syndrome • Adult PO: 5 mg at bedtime Jet Lag • Adult PO: 5 mg daily 2-3 days before and 3 days after travel Chronic Insomnia • Geriatric PO tablets: extended release 1-2 mg 2 hr before meals Contraindications Until more research is available, melatonin should not be used during pregnancy and breastfeeding. It should not be given to children. Persons with hypersensitivity to melatonin and those with hepatic or cardiovascular disease, central nervous system disorders, or depression should not use it. Persons with renal disease should use melatonin with caution. Use only synthetic forms due to contamination of animal products. Side Effects/Adverse Reactions CNS: Headache, change in sleep patterns, confusion, hypothermia, sedation CV: Tachycardia GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions (rash, pruritus) Reproductive: Decreased progesterone, estradiol, LH levels Interactions Drug Anticoagulants, antiplatelets: Melatonin with anticoagulants, antiplatelets may increase the risk of bleeding (theoretical) (Jellin et al, 2008). = Pregnancy = Pediatric ! = Alert = Popular Herb Melatonin 431 Interactions—cont’d Antidiabetics: Melatonin with antidiabetics may decrease hypoglycemia (theoretical) (Jellin et al, 2008). Benzodiazepines: Melatonin may increase the anxiolytic effects of benzodiazepines; use together cautiously. Beta-blockers: Melatonin is able to reverse the negative action of beta-blockers on sleep (Jellin et al, 2008). CNS depressants: Melatonin with central nervous system depressants may increase sedation (theoretical) (Jellin et al, 2008). Cerebral stimulants: Cerebral stimulants used with melatonin may have a synergistic effect and exacerbate insomnia; avoid concurrent use. DHEA: DHEA (dehydroepiandrosterone) used with melatonin may decrease cytokine production; avoid concurrent use. Immunosuppressants: Melatonin with immunosuppressants concurrently may decrease response to immunosuppressants (Jellin et al, 2008). Magnesium: Magnesium used with melatonin increases inhibition of N-methyl-D-aspartate (NMDA) receptors; avoid concurrent use. Succinylcholine: Melatonin increases the blocking properties of succinylcholine; avoid concurrent use. Zinc: Zinc used with melatonin increases inhibition of NMDA receptors; avoid concurrent use. Herb Anticoagulant/antiplatelet herbs: Melatonin with anticoagulant/ antiplatelet herbs may increase the risk of bleeding (theoretical) (Jellin et al, 2008). Sedative herbs: Melatonin with sedative herbs may increase sedation (theoretical) (Jellin et al, 2008). Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of melatonin and administer an antihistamine or other appropriate therapy. • Assess sleep patterns: ability to fall asleep, stay asleep, hours slept, and napping, if using for insomnia. • Assess for CNS effects: confusion, headache, sedation, and changes in sleeping patterns. • Assess for medications used (see Interactions). Administer • Instruct the client to take melatonin PO to treat insomnia or jet lag. Melatonin is administered both PO and IM to cancer patients. • Instruct the client to store melatonin products in a sealed container away from heat and moisture. Teach Client/Family • Caution the client not to use melatonin in children or those who are pregnant or breastfeeding until more research is available. • Advise the client to avoid use with magnesium, zinc, and DHEA. • Advise the client to notify their health care provider of all supplements taken. Adverse effects: Underline = life-threatening M 432 Milk Thistle Milk Thistle (milk thi’suhl) Scientific name: Silybum marianum Other common names: Holy thistle, lady’s thistle, Marian thistle, Mary thistle, St. Mary thistle Origin: Milk thistle is found in Kashmir, Mexico, Canada, and the United States. Uses Milk thistle has been used to treat hepatotoxicity caused by poisonous mushrooms, cirrhosis of the liver, chronic candidiasis, hepatitis C, exposure to toxic chemicals, and liver transplantation. Actions Hepatoprotective Action Several studies have demonstrated the hepatoprotective action of silymarin, a chemical component of milk thistle (Ball et al, 2005; Gordon et al, 2006; Thamsborg et al, 1996). One of these studies noted that silymarin has been used for centuries to treat hepatic and gallbladder conditions (Flora et al, 1998). Silymarin has been found to act as an antioxidant, decreasing free radicals and increasing hepatocyte synthesis as well as exerting other hepatoprotective effects. It has been used to treat acute and chronic hepatic disease and has been found to inhibit cytochrome P450 enzymes in liver microsomes (Beckmann-Knopp et al, 2000). It is possible that drugs metabolized by CYP3A4 or CYP2C9 may interact with this herb. One study using sheep orally infected with sawfly larvae demonstrated a positive response when silymarin was used to treat the resultant hepatotoxicosis (Thamsborg et al, 1996). Milk thistle has shown promise to treat hepatitis C with few side effects. Silymarin has hepatoprotective, antiinflammatory, and regenerative properties (Giese, 2001). Nephroprotective Action A study done on African green monkeys confirmed the nephroprotective effects of silibinin and silicristin, two of milk thistle’s chemical components (Sonnenbichler et al, 1999). Kidney cells that had been damaged by cisplatin, vincristine, and paracetamol showed lessened or no nephrotoxic effects. Product Availability Tincture, capsule Plant Parts Used: Seeds, above-ground parts Dosages Alcoholism • Adult PO tincture: 70-210 mg tid (70%-80% silymarin) (Murray, Pizzorno, 1998) General Dosages • Adult PO tincture: 200-400 mg daily (dosage standardized to silymarin content) (Blumenthal, 1998) Hepatitis • Adult PO tincture: 140-210 mg tid (70%-80% silymarin) (Murray, Pizzorno, 1998) = Pregnancy = Pediatric ! = Alert = Popular Herb Milk Thistle 433 Amanita Phalloides Mushroom Poisoning • Adult IV: 20-50 mg/kg/24 hr, divided in 4 doses, give each infusion over 2 hr (not available in United States) (Jellin et al, 2008) Contraindications Class 1 herb (seed). Until more research is available, milk thistle should not be used during pregnancy and breastfeeding. It should not be given to children. Milk thistle should not be used by persons with hypersensitivity to this herb or other plants in the Asteraceae family (ragweed, daisy, marigolds, chrysanthemums). Do not use in those with hormone-sensitive cancers. Side Effects/Adverse Reactions CNS: Headache GI: Nausea, vomiting, anorexia, diarrhea GU: Menstrual changes INTEG: Hypersensitivity reactions Interactions Drug Antineoplastics (platinum): Milk thistle may prevent nephrotoxicity from platinum antineoplastics. Cytochrome P450 2C9, 3A4 substrates: Milk thistle may inhibit these substrates (Jellin et al, 2008). Estrogens: Milk thistle may inhibit the clearance of estrogen (theoretical) (Jellin et al, 2008). Lab Test AST, ALT, alkaline phosphatase, blood glucose: Milk thistle may decrease AST, ALT alkaline phosphatase, blood glucose levels. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Flavonoid Silybine Isosilybine; Silycristine; Silidianine; Taxifoline (Quaglia et al, 1999) Dehydrosilybin; Siliandrin; Silyhermin Hepatoprotective Flavonolignan Apigenin Acid Tocopherol Sterol Linoleic acid; Oleic acid; Palmitic acid Sitosterol; Cholesterol; Campesterol; Stigmasterol Mucilage Adverse effects: Underline = life-threatening M 434 Mistletoe, European Client Considerations Assess • Assess the reason the client is using milk thistle. • Assess for hypersensitivity reactions. If present, discontinue the use of milk thistle and administer an antihistamine or other appropriate therapy. • Monitor hepatic function tests (ALT, AST, bilirubin) if the client is using milk thistle to treat hepatic disease. • Assess all medications used (see Interactions). Administer • Instruct the client to store milk thistle products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use milk thistle in children or those who are pregnant or breastfeeding until more research is available. Mistletoe, European ! (mi’suhl-toe) Scientific name: Viscum album Other common names: All heal, birdlime, devil’s fuge, mystyldene Origin: Mistletoe is a parasite found in Europe, Asia, and North America depending on species. Uses Mistletoe has been used to treat hypertension, anxiety, seizure disorders, insomnia, depression, infertility, gout, hysteria, internal bleeding, and atherosclerosis. Investigational Uses Research is underway to determine the usefulness of mistletoe in the treatment of cancer. Actions Mistletoe has been used parenterally for many years in cancer patients. The majority of the research on mistletoe focuses on its antineoplastic activity. Antineoplastic Action One study demonstrated that mistletoe lengthens the survival time of cancer patients. In this study the survival time of patients treated with mistletoe was a median of 9.18 years, compared with 7.54 years for those not treated with mistletoe. However, this difference is not considered statistically significant (Stumpf et al, 2000). Another study (Stein et al, 2000) found that mistletoe induces apoptosis in lymphocytes and tumor cells. However, the research on the usefulness of mistletoe for the treatment of cancer has shown inconclusive results. A newer study (Zuzak et al, 2006) identified that pediatric medulloblastoma cells responded to Viscum album. Anti-HIV Action Another study showed that mistletoe produces immunomodulatory effects when given to HIV-infected patients and may slow the progression of the disease (Gorter et al, 1999). = Pregnancy = Pediatric ! = Alert = Popular Herb Mistletoe, European 435 Product Availability Capsules, dried leaves, stems, fluid extract, infusion, tablets, tincture; parenterally (not available in United States) Plant Parts Used: Branches, fruit, leaves Dosages • Adult PO dried leaves: 3-6 g tid • Adult PO fluid extract: 2-3 ml tid (1:1 dilution in 25% alcohol) • Adult PO tincture: 0.5 ml bid-tid (1:5 dilution in 45% alcohol) Contraindications ! Class 2d herb (Viscum album). Because it is a uterine stimulant, mistletoe should not be used during pregnancy. Until more research is available, this herb should not be used during breastfeeding and should not be given to children. Mistletoe should not be used by persons who are hypersensitive to the plant. Persons with protein oversensitivity and those with chronic progressive infections should avoid its use. Mistletoe is a toxic plant and should be kept out of the reach of children. Side Effects/Adverse Reactions CNS: Coma, seizures, delirium, hallucinations, psychosis CV: Bradycardia, hypotension or hypertension, cardiac arrest GI: Nausea, vomiting, anorexia, diarrhea, gastritis, hepatitis, hepatotoxicity GU: Nephrotoxicity INTEG: Hypersensitivity reactions MISC: Mydriasis, myosis, leukocytosis Interactions Drug Antihypertensives: Mistletoe may increase the hypotensive effect of antihypertensives; avoid concurrent use. Cardiac glycosides (digoxin): Use of mistletoe with cardiac glycosides such as digoxin, digitoxin, and calcium channel blockers may cause decreased cardiac function; avoid concurrent use. Immunosuppressants: Immunosuppressants such as azathioprine, basiliximab, cyclosporine, muromonab, sirolimus, and tacrolimus may stimulate immunity when used with mistletoe; avoid concurrent use. Iron salts: Mistletoe may decrease the absorption of iron salts; separate by 2 hours. Herb Hawthorn: European mistletoe may decrease the action of positive inotropic agents (hawthorn) (Jellin et al, 2008). Lab Test ALT, AST, total bilirubin, urine bilirubin, lymphocyte counts: Mistletoe may cause increased ALT, AST, total bilirubin, urine bilirubin, and lymphocyte counts. Red blood cells: Mistletoe may cause decreased red blood cells. Pharmacology Pharmacokinetics Pharmacokinetics and pharmacodynamics are unknown. Stimulates cuti-visceral reflexes following inflammation. Adverse effects: Underline = life-threatening M 436 Monascus Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Amine Acetylcholine Histamine Tyramine Phoratoxin Choline Betaphenylethylamine Viscotoxin Flavonoid Phenyl alyl alcohol Lectin Sugar alcohol Tyramine Uterine stimulant Quercetin; Kaempferol Syringen Antioxidant Mannitol; Quebrachitol; Pinitol; Viscumitol Terpenoid Alkaloid Tannin Wound healing; astringent Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of mistletoe and administer an antihistamine or other appropriate therapy. ! • Assess for life-threatening adverse reactions: cardiac involvement, hepatitis. • Assess for other adverse reactions: chills, fever, headache, angina, orthostatic hypotension, hypertension. • Assess all medication use (see Interactions). Administer • Instruct the client to store mistletoe products away from light, heat, and moisture. Teach Client/Family • Caution the client not to use mistletoe during pregnancy because it is a uterine stimulant. Until more research is available, caution the client not to use this herb during breastfeeding and not to give it to children. ! • Advise the client that mistletoe is a toxic plant and should be kept out of reach of children. Monascus (muhn-az’kuhs) Scientific names: Monascum purpureus, Monascum anka Other common names: Hong qu, red rice yeast, red yeast rice, zhi tai, xue zhi kang Origin: Monascus is a yeast made by fermentation. = Pregnancy = Pediatric ! = Alert = Popular Herb Monascus 437 Uses Marketed as Cholestin, monascus is used to treat hypercholesteremia. It is also used to treat gastrointestinal upset and circulatory problems. Investigational Uses Research is underway to determine the efficacy of monascus as an antimicrobial, antioxidant, and hypolipidemic, as well as for the treatment of liver toxicity. Actions Anticholesterol Action The anticholesterol action of monascus is well documented. It has been found to inhibit HMG-CoA reductase and to decrease low-density lipoprotein (LDL) and verylow-density lipoprotein (VLDL) cholesterol and plasma triglycerides (Lee et al, 2006). This herb has been studied in China for many years, with all studies reporting similar results in the decrease of cholesterol, triglycerides, and LDL cholesterol (Wang et al, 1995; Zhu et al, 1995). Antimicrobial Action One study evaluated the antimicrobial effect of “monascus making’’ in the open air. In this study, monascus was produced and dried in the open air (Kono et al, 1999). When the herb was contaminated with Micrococcus varians and Bacillus subtilis, it was able to inhibit the growth of these two microorganisms. Antioxidant and Hepatoprotective Actions Another study reviewed the antioxidant capabilities of monascus (Aniya et al, 1999) M using several types of molds. Monascus anka showed the strongest hepatoprotective action in rats. Another study has also confirmed the antioxidant and hepatoprotective actions of monascus (Aniya et al, 1998). Monoamine Oxidase Inhibition A study of the chemical components of Monascus anka has identified the presence of monankarins A-F, which inhibit monoamine oxidase (MAO). Investigators found the inhibition of MAO-B to be stronger than that of MAO-A (Hossain et al, 1996). Product Availability Whole yeast Plant Part Used: Whole yeast (mold) Dosages Hyperlipidemia • Adult PO: 300-1200 mg bid taken with lovastatin and a HMG-CoA reductase inhibitor Contraindications Until more research is available, monascus should not be used during pregnancy and breastfeeding. It should not be given to children. Monascus should not be used by persons with hypersensitivity to it or by those with hepatic diseases such as cirrhosis or fatty liver. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia; hepatotoxicity (rare) INTEG: Hypersensitivity reactions MISC: Anaphylaxis Continued Adverse effects: Underline = life-threatening 438 Monascus Interactions Drug Alcohol: Alcohol may affect hepatic function in those taking monascus. Cyclosporine, gemfibrozil: Monascus with cyclosporine may increase risk of myopathy (theoretical). Cytochrome P4503A4 inhibitors, HMG-CoA reductase inhibitors: Monascus with these agents may increase adverse reactions. Herb Cholesterol-lowering herbs: Monascus may increase the effects of cholesterol-lowering herbs. Coenzyme Q10: Monascus may decrease coenzyme Q10 levels. Thyroid activity herbs: Monascus may decrease the action of thyroid activity herbs. St. John’s wort: St. John’s wort may decrease the action of monascus. Food Grapefruit juice: Monascus with grapefruit juice may increase adverse reactions. Lab Test Creatine kinase, hepatic function tests: Monascus may increase results of these tests. Cholesterol: Monascus may decrease serum cholesterol levels. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Monoamine oxidase inhibition HMG-CoA reductase inhibitor Monankarins A-F Monacolin K Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of monascus and administer an antihistamine or other appropriate therapy. • Monitor hepatic function tests (AST, ALT, bilirubin) if the client is using high doses of monascus over a long period. Administer • Instruct the client to store monascus products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use monascus in children or those who are pregnant or breastfeeding until more research is available. = Pregnancy = Pediatric ! = Alert = Popular Herb Morinda 439 Morinda (mohr-in’duh) Scientific name: Morinda citrifolia Other common names: Carrywood, hog apple, Indian mulberry, mengkoedoe, mora de la India, noni, ruibarbo caribe, wild pine Origin: Morinda is a shrub found in Polynesia, Asia, and parts of Australia. Uses Morinda has been used in the South Pacific to treat arthritis, heart disease, diabetes, hypertension, and gastrointestinal disease. Investigational Uses Research is underway to determine the anticancer, antidiabetic, antimalarial, and anthelmintic properties of morinda. Actions Very little research is available on morinda. The few studies that have been completed have focused on its anticancer, antidiabetic, anthelmintic, and antimalarial effects. Anticancer Action One study evaluated the anticancer action of morinda on lung cancer in mice. Morinda was found to increase life span in all batches of mice. It is believed to in- M crease immunity by increasing lymphocytes and macrophages (Hirazumi et al, 1994; Wang et al, 2001). Antidiabetic Action One newer study (Kamiya et al, 2008) identified the hypoglycemic action related to the chemical components, deacetylasperulosidic acid, asperulosidic acid, lucidin, and morindone. Anthelmintic Action Another study identified the anthelmintic action of morinda (Raj, 1975). Sedative Action One older study (Younos et al, 1990) found morinda to possess sedative effects when administered to mice. Antimalarial Action When the antimalarial effects of morinda were tested, researchers noted a 60% inhibition of Plasmodium falciparum growth in vitro (Tona et al, 1999). Product Availability Capsules, dried fruit leather, juice, powder Plant Parts Used: Flowers, fruit, leaves Dosages • Adult PO tea: 5-9 g of morinda in 3 cups of boiling water, boil until volume is reduced, cool, divide in half • Adult PO tincture: 30-60 g of herb in 1 L of alcohol (not rubbing) × 3 months, use 30 ml bid • Adult topical: Use dried leaves steeped in hot water, applied as needed for fever or stomachache Adverse effects: Underline = life-threatening 440 Morinda Contraindications Until more research is available, morinda should not be used during pregnancy and breastfeeding. It should not be given to children. Morinda should not be used by persons with hyperkalemia or by those with hypersensitivity to it. Side Effects/Adverse Reactions CNS: Sedation GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions META: Hyperkalemia Interactions Drug ACE inhibitors, angiotensin II receptor antagonists, diuretics (potassium-sparing): Morinda juice with these agents may increase the risk of hyperkalemia (Jellin et al, 2008). Immunosuppressants: Morinda may decrease the effects of immunosuppressants. Lab Test Glucose: Morinda may decrease glucose levels. Potassium: Morinda may increase potassium levels. Urine tests: Morinda may interfere with urine tests due to change in color (pink to rust) (Jellin et al, 2008). Primary Chemical Components and Possible Actions Chemical Class Individual Component Alkaloid Glycosides Xeronine Glucopyranosyl; Glucopyranose Hexoic acid; Octoic acids Damnacanthal, Deacetylasperulosidic acid, Aperulosidic acid, Lucidin, Morindone Essential oil Anthraquinone Morindone Alizarin Potassium Rutin Polysaccharide Noni-ppt Possible Action Antitumor Antidiabetic Antitumor Client Considerations Assess • Assess the reason the client is using morinda. • Assess for hypersensitivity reactions. If present, discontinue the use of morinda and administer an antihistamine or other appropriate therapy. = Pregnancy = Pediatric ! = Alert = Popular Herb Motherwort 441 Administer • Instruct the client to store morinda products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use morinda in children or those who are pregnant or breastfeeding until more research is available. • Advise the client not to perform hazardous activities such as driving or operating heavy machinery until physical response to the herb can be evaluated. • Advise the client that urine may turn pink to rust color. Motherwort (muh’thur-wawrt) Scientific name: Leonurus cardiaca Other common names: I-mu-ts’ao, lion’s ear, lion’s tail, lion’s tart, oman, Roman motherwort, throwwort Origin: Motherwort is found in Europe, Canada, and the United States. Uses Motherwort has been used to treat menstrual disorders and cardiac conditions such M as palpitations. It has also been used as an anticoagulant, antiinflammatory, antispasmodic, antianxiety, and anticancer herb, as well as a cardiotonic. Actions Few research studies have been done on motherwort, although several different actions have been theorized. Traditionally, this herb has been used for its cardiovascular and uterine stimulant actions. A recent study has focused on its chemoprotective action. Cardiovascular Action One study (Xia et al, 1983) identified the ability of motherwort to inhibit platelets and improve coronary circulation in rats. This herb has also been shown to decrease heart rate and increase the force of myocardial contraction, similar to the action of digoxin. Anticoagulant Action The anticoagulant action of motherwort was identified in a study with 105 participants. The anticoagulant effect was found to result from a decrease in fibrinogen and blood viscosity (Zou et al, 1989). One of the chemical components responsible for this action may be prehispanolone. Chemoprotective Action Two studies done by the same group of researchers (Nagasawa et al, 1990, 1992) demonstrated that motherwort exerts a chemoprotective action in lesions of the breast and uterus. Both studies showed similar results. No effect was seen in pregnancydependent mammary tumors, mammary hyperplastic alveolar nodules, or uterine adenomyosis. In fact, motherwort promoted the growth of pregnancy-dependent mammary tumors and inhibited mammary hyperplastic alveolar nodules. Product Availability Dried leaves, fluid extract, tincture Adverse effects: Underline = life-threatening 442 Motherwort Plant Parts Used: Leaves, seeds Dosages • Adult PO: 4.5 g daily (Blumenthal, 1998); 2 g of dried above-ground parts or 1 cup of tea tid (Jellin et al, 2008) • Adult PO fluid extract: 4.5 ml (1:1 dilution) • Adult PO tincture: 22.5 ml (1:5 dilution) Contraindications Pregnancy category is 4; breastfeeding category is 2A. Motherwort should not be given to children. It should not be used by persons with thrombocytopenia or hypersensitivity to this herb or other members of the Labiatae family. Side Effects/Adverse Reactions CV: Decreased heart rate GI: Nausea, vomiting, anorexia, diarrhea, stomach irritation HEMA: Increased bleeding time INTEG: Hypersensitivity reactions, photosensitivity Reproductive: Uterine bleeding Interactions Drug Anticoagulants (heparin, warfarin): Use of motherwort with anticoagulants may cause increased risk for bleeding; avoid concurrent use. Beta-blockers, cardiac glycosides (digoxin): Use of motherwort with beta-blockers, cardiac glycosides may cause decreased heart rate; avoid concurrent use. CNS depressants: Motherwort can increase the action of central nervous system depressants. Iron salts: Motherwort may decrease the absorption of iron salts; separate by 2 hours. Herb Cardiac glycoside herbs: Do not use motherwort with cardiac glycoside herbs; cardiac glycoside toxicity may occur. Lab Test Clotting time: Motherwort increases clotting time. Creatine phosphokinase: Motherwort interferes with CPK. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Alkaloid Stachydrine; Leonurine Betonicine; Turicin; Leunuridin; Leonurinine Uterine stimulant = Pregnancy = Pediatric ! = Alert = Popular Herb Mugwort 443 Primary Chemical Components and Possible Actions—cont’d Chemical Class Individual Component Saponin Ursolic acid Possible Action Antiviral, antitumorigenic Flavone Cardanolide Glycoside Prehispanolone Iridoid Tannin Terpenoid Triterpene Lavandulifolioside Anticoagulant Prolongs P-Q, Q-T intervals, QRS complex; decreases blood pressure Client Considerations M Assess • Assess the reason the client is taking motherwort. • Assess for hypersensitivity reactions. If present, discontinue the use of motherwort and administer an antihistamine or other appropriate therapy. • Assess for photosensitivity if the client is taking motherwort in high doses. • Assess for risks of bleeding: increased bleeding time, bruising, bleeding gums, hematuria, and hematemesis. Administer • Instruct the client to store motherwort products in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 4 and breastfeeding category is 2A. • Caution the client not to give motherwort to children. • Because it can cause photosensitivity, advise the client to stay out of the sun or to wear protective clothing while using motherwort. Mugwort (muhg’wawrt) Scientific name: Artemisia vulgaris Other common names: Ai ye, common mugfelon herb, sailor’s tobacco, St. John’s plant, wild wormwood, wort Origin: Mugwort is a perennial found in North America. Adverse effects: Underline = life-threatening 444 Mugwort Uses Mugwort has been used as an anthelmintic and as a treatment for menstrual disorders, persistent vomiting, constipation, colic, diarrhea, depression, and anxiety. The roots have been used to treat psychiatric disorders such as psychoneurosis, neurasthenia, depression, and anxiety. Investigational Uses Studies are underway to determine the antibacterial and antifungal properties of mugwort. Actions Little research is available to document the actions of mugwort. A few initial studies have become available on its antiviral and antibacterial actions. Antiviral and Antibacterial Action One study found mugwort to be active against the herpes simplex virus. Among 78 study participants, a cure occurred in 38, and significant improvement occurred in 37. The remaining three experienced no change in herpetic keratitis caused by HSV-1 (Zheng, 1990). Another study (Chen et al, 1989) determined that mugwort exerts a strong antibacterial effect against Streptococcus mutans. Several other herbs were tested in this study, with varying results. Other Actions One study (Gilani et al, 2005) found the aqueous-methanol extract of mugwort to be hepatoprotective in induced hepatitis in mice. Product Availability Dried leaves, dried roots, fluid extract, infusion, tincture Plant Parts Used: Leaves, roots Dosages • Adult PO tincture: 2-4 ml tid; 10-25 drops (1:5) (Jellin et al, 2008) • Adult PO tea: 15 g dried herb in 500 ml boiling water, strain; 2-3 cups/day before meals (Jellin et al, 2008) Contraindications Class 2b herb (whole herb). Because it is a uterine stimulant, mugwort should not be used during pregnancy. Until more research is available, this herb should not be used during breastfeeding and should not be given to children. Persons with bleeding disorders or those with hypersensitivity to this herb or other members of the Compositae family should not use mugwort. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions, contact dermatitis SYST: Anaphylaxis Interactions Drug Anticoagulants: Use of mugwort with anticoagulants such as heparin and warfarin may cause increased risk for bleeding; do not use concurrently. Lab Test Direct bilirubin: Mugwort may cause an increase in direct bilirubin. = Pregnancy = Pediatric ! = Alert = Popular Herb Mullein 445 Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Volatile oil Thujone Camphor; Linalool; Cineole; Terpineol; Borneol; Monoterpene Uterine stimulant Sesquiterpene lactone Glycoside Coumarin Quercetin; Rutin Aesculetin; Aesculin; Scopoletin; Coumarin; Dioxycoumarin; Umbelliferone Polyacetylene Triterpene Sitosterol Stigmasterol Carotenoid M Client Considerations Assess • Assess the reason the client is using mugwort. • Assess for hypersensitivity reactions. If present, discontinue the use of mugwort and administer an antihistamine or other appropriate therapy. • Assess for the use of anticoagulants (see Interactions). Administer • Instruct the client to store mugwort products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use mugwort during pregnancy because it is a uterine stimulant. Until more research is available, caution the client not to use this herb during breastfeeding and not to give it to children. • Advise the client that mugwort and hazelnut can produce cross-sensitivity reactions. • Caution the client not to use mugwort if he or she is allergic to hazelnut (Caballero et al, 1997) or other members of the Compositae family. Mullein (muh’luhn) Scientific names: Verbascum thapsus, Verbasci flos Other common names: Aaron’s rod, Adam’s flannel, bunny’s ears, candlewick, flannel-leaf, great mullein, Jacob’s staff Origin: Mullein is a biennial herb found in Europe, Asia, and the United States. Adverse effects: Underline = life-threatening 446 Mullein Uses Mullein is used as an expectorant and antitussive to treat cough, influenza, the common cold, and upper respiratory tract conditions. It is often used in combination with other herbs to treat bronchitis and asthma. Mullein is also used to treat urinary tract infections, chronic otitis media, migraines, and eczema of the ear. Topically, mullein is used for burns, hemorrhoids, frostbite, and inflamed mucosa. Actions Very few research studies are available for mullein. Those that have been done focus primarily on its antiviral properties. Antiviral Action Two studies have focused on the antiviral action of mullein. In one study, 100 plant extracts were screened for antiviral activity against seven viruses. Mullein was found to be effective against herpesvirus type I (McCutcheon et al, 1995). The other study identified mullein’s antiviral activity against herpes suis virus (Zanon et al, 1999). Other Actions Another study (Zheng et al, 1993) showed that verbascoside, a chemical component of mullein, possesses antioxidant, anticancer, and antiinflammatory properties. Product Availability Capsules, fluid extract, oil Plant Parts Used: Dried leaves, flowers Dosages • Adult PO capsules: 580 mg taken bid with meals • Adult PO flowers: 3-4 g daily (Blumenthal, 1998) • Adult PO fluid extract: 1.5-2 ml bid (1:1 dilution) • Adult PO leaves: place 2 tsp dried leaves in 8 oz boiling water, steep 15 min; may be taken tid • Adult topical: no typical dosage (Jellin et al, 2008) • Adult oil: 5-10 drops daily • Adult powdered, crushed, cut, or whole plant: 2 g/day Contraindications Pregnancy category is 3; breastfeeding category is 2A. Mullein should not be given to children. This herb should not be used by persons with hypersensitivity to it. Side Effects/Adverse Reactions CNS: Drowsiness GI: Nausea, anorexia INTEG: Hypersensitivity reactions, contact dermatitis Interactions Drug Oral medications: Mullein may decrease the absorption of oral medications; separate by 2 hours. = Pregnancy = Pediatric ! = Alert = Popular Herb Mustard 447 Primary Chemical Components and Possible Actions Chemical Class Saponin Glycoside Complex carbohydrate Flavonoid Sterol Fructose Glucose Individual Component Possible Action Verbascoside; Forsythoside B Antiinflammatory; antioxidant; antitumor D-galactose; Arabinose; D-xylose; D-glucose Client Considerations Assess • Assess the reason the client is using mullein. • Assess for hypersensitivity reactions, contact dermatitis. If present, discontinue the use of mullein and administer an antihistamine or other appropriate therapy. Administer • Instruct the client to store mullein products in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 3 and breastfeeding category is 2A. • Caution the client not to give mullein to children. Mustard ! (muh’stuhrd) Scientific names: Brassica nigra, Brassica alba Other common names: Black mustard, brown mustard, California rape, charlock, Chinese mustard, Indian mustard, white mustard, wild mustard Origin: Mustard is found in the Mediterranean region, Europe, and India. Uses Mustard traditionally has been used as an emetic, an antiflatulent, for diuresis, to treat inflammation and joint pain, and to increase appetite. However, it is better known for its use in “mustard plaster,’’ which is used topically to treat respiratory congestion (bronchial pneumonia, pleurisy). Actions Very little research has been done on mustard. One study evaluated its anticholesterol action, with negative results. No change occurred in the cholesterol levels of rats fed amounts five times that of normal human consumption (Sambaiah et al, 1991). Another study showed that mustard oil used in laboratory animals produced an Adverse effects: Underline = life-threatening M 448 Mustard anticancer action (Choudhury et al, 1997). Anand et al (2007) identified the antihyperglycemic effect using Brassica niger in streptozotocin-induced diabetic rats. Product Availability Flour, oil, seeds, tea Plant Part Used: Seeds Dosages Decongestant • Adult topical flour poultice: mix 100 g mustard flour with warm water, pack in linen, place on chest 10 min • Adult topical mustard plaster: mix 4 oz ground black mustard seeds with warm water to make a paste, apply to chest area Footsoak • Adult topical seeds: place 1 tbsp seeds in 1000 ml hot water, soak feet 15-20 min Decongestant • Child ≥6 yr flour poultice: mix 100 g mustard flour with warm water, pack in linen, place on chest maximum 3-5 min (may cause severe burns, necrosis if left on longer than 15 min) Contraindications Class 1 herb (internal); class 2d herb (external, seed). Until more research is available, mustard should not be used therapeutically during pregnancy and breastfeeding. It should not be given therapeutically to children younger than 6 years of age. Mustard should not be used therapeutically by persons with hypersensitivity to it or by those with renal disorders, gastrointestinal ulcers, or inflammatory kidney diseases. Do not use mustard on unprotected skin. Do not confuse mustard seed with mustard oil. Side Effects/Adverse Reactions CNS: Lethargy, coma CV: Heart failure ENDO: Goiter INTEG: Hypersensitivity reactions, irritation of skin where applied, contact dermatitis SYST: Anaphylaxis, angioedema Interactions Drug Antacids, H2-blockers, proton pump inhibitors: Mustard may decrease the action of these agents (theoretical) (Jellin et al, 2008). Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Skin irritant, bacteriostatic Sinigrin Myrosin = Pregnancy = Pediatric ! = Alert = Popular Herb Myrrh 449 Primary Chemical Components and Possible Actions—cont’d Chemical Class Sinapic acid Sinapine Fixed oil Mucilage Globulin Volatile oil Protein Individual Component Possible Action Arachic acid; Erucic acid; Eicosenoic acid; Oleic acid; Palmitic acid Isothiocyanate Blistering Client Considerations Assess • Assess the reason the client is using mustard. • Assess for hypersensitivity reactions or skin irritation where mustard has been applied. Administer an antihistamine or other appropriate therapy if necessary. Olive oil may be used to soothe skin after removing mustard plaster. Administer • Instruct the client not to use mustard for more than 10 minutes (adult), 3-5 min (child) at a time or for longer than 2 weeks. • Instruct the client to wash hands well with soap and water after use to prevent irritation. • Instruct the client to store mustard products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use mustard therapeutically in children younger than 6 years of age or in those who are pregnant or breastfeeding until more research is available. • Advise the client to keep mustard out of reach of children and to avoid applying it around mucous membranes. • Inform the client that sneezing, coughing, and possible asthmatic attacks can result from breathing the allylisothiocyanate that arises with preparation and application of mustard poultices. • Teach the client not to confuse mustard seed with mustard oil. Myrrh (muhr) Scientific name: Commiphora molmol Other common names: African myrrh, Arabian myrrh, bal, bol, bola, gum myrrh, heerabol, Somali myrrh, Yemen myrrh Origin: Myrrh is a shrub found in various regions of Africa. Adverse effects: Underline = life-threatening M 450 Myrrh Uses Myrrh traditionally has been used internally to treat upper respiratory congestion, pharyngitis, gingivitis, mouth ulcers, stomatitis, leprosy, syphilis, and leg ulcers. Topically, it is used to treat wounds, decubitus ulcers, and hemorrhoids. Contemporary use is mostly limited to flavoring in foods and fragrance in cosmetic products. Investigational Uses Researchers are experimenting with the use of myrrh in combination with other products to treat colds and infections. Actions Several studies have focused on the actions of myrrh. Myrrh has been found to decrease cholesterol levels, decrease inflammation, provide analgesia, act as an antiulcer and antitumor agent, and stimulate triiodothyronine production. Antilipidemic Action When myrrh was studied along with garlic for reduction of cholesterol, triglycerides, and phospholipids, garlic was found to be far superior to myrrh (Dixit et al, 1980). However, when myrrh was studied with Allium sativum and Allium cepa, all three agents were found to prevent a rise in these three indicators (Lata et al, 1991). Antiinflammatory and Antipyretic Actions Three studies have identified the antiinflammatory action of myrrh. One study used laboratory animals that had been injected with liquid paraffin containing killed mycobacterial adjuvant. In this study, phenylbutazone, ibuprofen, and a fraction of myrrh all were shown to provide significant relief of arthritis symptoms (Sharma et al, 1977). The other studies identified a triterpene with antiinflammatory and analgesic properties (Dolara et al, 2000; Fourie et al, 1989). In this study, a significant antiinflammatory effect occurred when myrrh was administered to mice. In another study, an antipyretic action was observed (Tariq et al, 1986). Anticancer Action Myrrh’s anticancer action has been demonstrated in a study using mice. The study evaluated results at 25 to 50 days. Anticarcinogenic results were less pronounced after 50 days. The effect was comparable to that of cyclophosphamide (Al-Harbi et al, 1994). Another study showed similar results, leading researchers to conclude that the use of myrrh for the treatment of cancer is appropriate (Qureshi et al, 1993). Product Availability Capsules, fluid extract, mouthwash, resin, tincture Plant Parts Used: Gum, oil, resin Dosages • Adult PO mouthwash: mix 5-10 drops in glass of water (Blumenthal, 1998) • Adult PO tea: place 2 tsp 10% powdered resin in 8 oz boiling water, steep 15 min; may be taken tid • Adult topical tincture: 1-4 ml may be applied to the affected area bid-tid = Pregnancy = Pediatric ! = Alert = Popular Herb Myrrh 451 Contraindications Pregnancy category is 2; breastfeeding category is 3A. Myrrh should not be given to children. It should not be used by persons with hypersensitivity to it or by those with fever, severe uterine bleeding, or tachycardia. Side Effects/Adverse Reactions CNS: Anxiety, restlessness GI: Nausea, vomiting, anorexia, diarrhea INTEG: Hypersensitivity reactions, dermatitis Interactions Drug Antidiabetics: Use of myrrh with antidiabetics may cause increased hypoglycemic effects; avoid concurrent use. Lab Test Blood glucose: Myrrh may decrease blood glucose levels (theoretical) (Jellin et al, 2008). Primary Chemical Components and Possible Actions Chemical Class Individual Component Volatile oil Cadinene; Dipentene; Heerabolene; Limonene; Pinene; Eugenol; Creosol; Cinnamaldehyde; Cumic alcohol; Cuminaldehyde; Myrcene; Alpha-camphorene Resin Steroid Terpenoid Possible Action Cholesterol; Campesterol; Beta-sitosterol Amyrin; Furanosesquiterpenoid Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of myrrh and administer an antihistamine or other appropriate therapy. • Assess the client’s use of antidiabetics such as insulin. Monitor blood glucose if the client is taking concurrently with myrrh (see Interactions). Administer • Instruct the client to store myrrh products in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 2 and breastfeeding category is 3A. • Caution the client not to give myrrh to children. Adverse effects: Underline = life-threatening M 452 Myrtle Myrtle ! (muhr’tuhl) Scientific name: Myrtus communis Other common names: Bridal myrtle, common myrtle, Dutch myrtle, Jew’s myrtle, mirth, Roman myrtle Origin: Myrtle is found in the Middle East and Mediterranean regions. Uses Myrtle traditionally has been used to treat respiratory congestion, gastrointestinal conditions, urinary tract infections, whooping cough, tuberculosis, and worm infestations. It is also used topically as an astringent. Investigational Uses Initial research is underway to determine the efficacy of myrtle as an antidiabetic. Actions Very little research has been done on myrtle, with only one or two research articles at most for any of its actions. Antihyperglycemic Action An older study identified the antihyperglycemic action of myrtle on streptozocininduced diabetic mice (Elfellah et al, 1984). Blood glucose levels dropped significantly after administration of myrtle. No effect was observed on normal blood glucose levels. Hemagglutinin Action The phytohemagglutinins in myrtle have been found to be useful in the preparation of laboratory samples. Addition of phytohemagglutinins to the samples clarifies the contents and allows for increased visibility (Ortega et al, 1979). Antiinflammatory Action A study on laboratory rats evaluated the antiinflammatory action of myrtle. Rat paws were injected with carrageenan to induce inflammation. When compared with other herbs, Myrtus communis was the least effective in the reduction of inflammation (Al-Hindawi et al, 1989). Other Actions One toxicology study using laboratory rats identified the toxicity of myrtle after ingestion of the essential oil from the leaves of Myrtus communis (Uehleke et al, 1979). Interestingly, the rats were able to adapt to myrtle ingestion after repeat dosing. Infections of Pseudomonas aeruginosa are susceptible to myrtle (Al-Saimary et al, 2002). Another study done in the laboratory tested the essential oils of myrtle. The oil was found to have excellent antimicrobial action against Escherichia coli, Staphylococcus aureus, and Candida albicans (Yadegarinia et al, 2006). Product Availability Extract Plant Parts Used: Leaves, seeds Dosages • Adult PO extract: 0.2 g as a single dose = Pregnancy = Pediatric ! = Alert = Popular Herb Myrtle 453 Contraindications Until more research is available, myrtle should not be used during pregnancy and breastfeeding. It should not be given to children. Myrtle should not be used internally by persons with inflammation of the gastrointestinal tract or hepatic disease. Persons with hypersensitivity to this herb should not use it. Clients with diabetes mellitus should use myrtle cautiously. Side Effects/Adverse Reactions ENDO: Hypoglycemia GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions SYST: Facial contact: glottal/bronchial spasm, asthma-like attacks, respiratory failure in infants and children (Jellin et al, 2008) Interactions Drug Antidiabetics: Use of myrtle with antidiabetics such as insulin may cause increased hypoglycemia; do not use concurrently. Cytochrome P450: Concurrent use of myrtle with drugs metabolized by cytochrome P450 should be avoided. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Volatile oil Myrtol; Gelomytrol; Eucalyptol; Pinene; Camphor; Cineol; Myrtenylacetate; Limonene; Alpha-terpineol; Geraniol Simulates mucous membranes, antioxidant, antibacterial Tannin Acylphloroglucinols Myrtucommulone A Wound healing; astringent Antibacterial Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of myrtle and administer an antihistamine or other appropriate therapy. • Monitor blood glucose levels in diabetic clients who are taking antidiabetics concurrently with myrtle (see Interactions). • Monitor hepatic function tests (ALT, AST, bilirubin). If results are elevated, use of myrtle should be discontinued. Administer • Instruct the client to store myrtle products in a cool, dry place, away from heat and moisture. Adverse effects: Underline = life-threatening M 454 Myrtle Teach Client/Family • Caution the client not to use myrtle in children or those who are pregnant or breastfeeding until more research is available. • Advise the client to use the essential oil only under the direction of a qualified ! herbalist. Overdoses can lead to life-threatening poisoning resulting from high cineol content. = Pregnancy = Pediatric ! = Alert = Popular Herb Neem 455 Neem ! (neem) Scientific name: Azadirachta indica Other common names: Bead Tree, Holy Tree, Indian Lilac, Margosa, Nim, Nimba, Persian Lilac, Pride of China Origin: Neem is an evergreen found in India. Uses Neem traditionally has been used as an anthelmintic and to treat malaria and diabetes mellitus. It has also been used topically to treat skin conditions. Neem has been used intravaginally as a contraceptive. It is an antiinflammatory and antipyretic. Investigational Uses Researchers are experimenting with the use of neem as a contraceptive and an antiinfective. Actions Several research articles have focused on the actions of neem. Proposed actions include antimalarial, antifertility, immunomodulatory, hypotensive, antiinflammatory, antihyperglycemic, anxiolytic, hepatoprotective, and antimicrobial. Hepatoprotective, Gastroprotective Action Hepatotoxicity was induced in rats by using paracetamol. Administration of Azadirachta indica significantly reduced hepatic toxicity as measured by AST, ALT, and histopathologic study of the liver (Bhanwra et al, 2000). One study (Bandyopadhyay N et al, 2002) identified the gastroprotective effect of neem including control of hyperacidity and ulcer. Hypoglycemic Action In a study, diabetic rabbits were given neem leaf extract and seeds. Blood glucose levels were significantly reduced at the end of 4 weeks (Khosla et al, 2000). When neem was started 2 weeks before the rabbits were diabetically induced, diabetes was partially prevented. This information may be useful for the prevention of, or to delay the onset of, the disease. Another study using rats showed the inhibition of serotonin on insulin secretion that is mediated by glucose (Chattopadhyay et al, 1999). The leaf extract significantly decreased hyperglycemia. Antimicrobial and Antimalarial Actions Neem leaf extract was evaluated for its effects against coxsackievirus B. In an in vitro study of African green monkeys, coxsackie 4 virus was significantly inhibited at levels of 1000 mcg/ml at 96 hours (Badam et al, 1999). Another study identified antiplaque, anticaries, and antimicrobial effects of the neem chewing sticks called Miswak that are used in the Middle East and on the Indian subcontinent (Almas, 1999). The effects were evaluated using blood agar and other methods up to 48 hours after chewing of the sticks. Neem was found to be effective against Streptococcus mutans and Streptococcus faecalis. A study evaluating the antimalarial action of neem found that the herb is effective even against parasites that are resistant to other antimalarial agents (Dhar et al, 1998). Immunomodulatory Anticancer Action Immune response was evaluated in laboratory mice and found to be increased after the use of neem. This information corroborates the use of neem for the treatment of many infectious and noninfectious conditions (Nijiro et al, 1999). Another study Adverse effects: Underline = life-threatening 456 Neem (Ganger et al, 2006) found neem’s leaf extract to be chemoprotective against stomach tumors in mice. There was also a lack of toxicity. Antifertility Action Several studies have dealt with the antifertility properties of neem. One study using rats evaluated the effect of neem leaves on the seminal vesicles and ventral prostate. After various oral doses were administered for 24 days, investigators observed a decrease in the weights of the seminal vesicles and ventral prostate. These results suggest that neem exerts an antiandrogenic action (Aladakatti et al, 2001; Kasutri et al, 1997). Another study evaluated the occurrence of spontaneous abortion in primates given neem (Mukherjee et al, 1996). Neem seed extract was given orally for 6 days after pregnancy was confirmed. Termination of pregnancy occurred, as evidenced by a decline in progesterone and chorionic gonadotropin. Product Availability Tincture Plant Parts Used: Above-ground parts Dosages No dosage consensus exists for PO tincture or topical routes. Contraindications ! Until more research is available, neem should not be used during pregnancy and breastfeeding. It should not be given to children. Infants have died after ingesting neem oil. Persons with hypersensitivity to neem should not use it. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions SYST: Reye’s-like symptoms (infants) Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Triterpenoid Nimocinol; Meliacinol (Siddiqui et al, 2000) Odoratone; Trihydroxypregnan; Diacetoxyapotirucall Antibacterial Gedunin; Nimbolide Azadirone; Epoxyazadiradione; Nimbin; Azadiradione; Deacetylnimbin; Hydroxyazadiradione Deoxonimbolide Naheedin Insecticide Mahmoodin Limonoid = Pregnancy = Pediatric ! = Alert Antimalarial Antitumor = Popular Herb Nettle 457 Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of neem and administer an antihistamine or other appropriate therapy. Administer • Instruct the client to store neem in a cool, dry place, away from heat and moisture. Teach Client/Family ! • Caution the client not to use neem in children or those who are pregnant or breastfeeding until more research is available. • Advise the client that infants have died after ingesting neem oil. Nettle (neh’tuhl) Scientific name: Urtica dioica Other common names: Common nettle, greater nettle, ortie, stinging nettle, urtica Origin: Nettle is a perennial found in Europe, the United States, and Canada. Uses Nettle traditionally has been used as a tea to treat cough, tuberculosis, and other respiratory conditions, including allergic rhinitis. It is used as an expectorant, an astringent, a diuretic, and as a treatment for urinary tract disorders. Nettle is recognized as a bladder irrigant to reduce blood loss and inflammation in bladder conditions; benign prostatic hypertrophy (BPH) (root only). Nettle is also used for arthritis pain, often in conjunction with low doses of NSAIDs. It is used externally as a hair and scalp remedy for oily hair and dandruff. Investigational Uses Nettle may be used as a diuretic; to lower blood pressure; and for prostate cancer. Actions Benign Prostatic Hyperplasia (BPH) Action Many studies have been performed to confirm the BPH action of nettle. Several double-blind controlled studies showed a considerable improvement in urologic function after nettle was given. The change in urination occurred within 4 weeks to 6 months, depending on the study. Anticancer Action One study has shown that the use of stinging nettle root extract slows the progression of prostate cancer (Konrad et al, 2000). The rate of slowing observed was statistically significant. Analgesic and Antiinflammatory Actions In a study, nettle was shown to be an effective and inexpensive treatment for joint pain (Randall et al, 1999). In another study with similar results (Riehemann et al, 1999), nettle decreased the inflammation associated with rheumatoid arthritis. Adverse effects: Underline = life-threatening N 458 Nettle Other Actions Nettle was found to possess diuretic and hypotensive effects when a continuous perfusion of the aqueous extract was administered to rats (Tahri et al, 2000). Product Availability Capsules, dried leaves, root extract, root tincture Plant Parts Used: Leaves, roots, stems Dosages • Adult PO capsules: 150-300 mg daily • Adult PO tea: place 2 tsp dried leaves in 8 oz boiling water, steep 15 min; may be taken bid • Adult PO tincture: 1⁄2-1 tsp daily-bid Osteoarthritis • Adult PO crude stinging nettle leaf: 9 g daily (Jellin et al, 2008) Allergic rhinitis • Adult PO extract: 300 mg tid (Jellin et al, 2008) Contraindications Pregnancy category is 3; breastfeeding category is 2A. Nettle should not be given to children younger than 2 years of age. Caution should be used when giving nettle to older children and geriatric clients. Persons with hypersensitivity to nettle should not use it. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, diarrhea, gastrointestinal irritation INTEG: Hypersensitivity reactions, urticaria MISC: Oliguria, edema Interactions Drug Anticoagulants (heparin, warfarin): Nettle may decrease the effect of anticoagulants; avoid concurrent use. CNS depressants (alcohol, barbiturates, sedative/hypnotics, antipsychotics, opiates): Nettle may lead to increased central nervous system depression. Diuretics: Use of nettle may increase the effects of diuretics, resulting in dehydration and hypokalemia; avoid concurrent use. Iron salts: Nettle tea may interfere with the absorption of iron salts. Lithium: Nettle combined with lithium may result in dehydration, lithium toxicity. Herb Anticoagulant herbs: Nettle with anticoagulant herbs may decrease anticoagulation. Sedative herbs: Nettle may increase central nervous system depression in sedative herbs. = Pregnancy = Pediatric ! = Alert = Popular Herb New Zealand Green-Lipped Mussel 459 Primary Chemical Components and Possible Actions Chemical Class Scopoletin Glucoside Flavonoid Amine Volatile oil Potassium ion Pygeum Betasitosterol (root) Individual Component Possible Action Antiinflammatory Rutin Choline; Histamine; Serotonin; Formic acid Ketones Improves benign prostatic hypertrophy Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of nettle and administer an antihistamine or other appropriate therapy. Administer • Recommend that the client increase his or her intake of potassium-containing N foods to prevent hypokalemia. • Instruct the client to store nettle products in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 3 and breastfeeding category is 2A. • Caution the client not to give nettle to children younger than 2 years of age, and to use caution when giving nettle to older children and geriatric clients. • Advise the client to use nettle as a urinary tract irrigant only under the supervision of a qualified herbalist. • Inform the client that stinging and burning will result if the plant is touched. New Zealand Green-Lipped Mussel (new zee’luhnd green lipt muh’suhl) Scientific name: Perna canaliculus Other common name: NZGLM Origin: New Zealand green-lipped mussel is a mollusk. Uses New Zealand green-lipped mussel may be used to decrease inflammation and as a treatment for osteoarthritis and rheumatoid arthritis. Adverse effects: Underline = life-threatening 460 Night-Blooming Cereus Actions Antiinflammatory Action Several studies have evaluated the antiinflammatory action of New Zealand greenlipped mussel. All have shown similar results, with significant antiinflammatory effects documented (Caughey et al, 1983; Couch et al, 1982; Halpern, 2000; Miller et al, 1980, 1993). These studies used various experimental models. Other studies (Lawson et al, 2007; Mani et al, 2006) identified the increase in cytokines with significant reduction in disease incidence, onset, and severity of rheumatoid arthritis in rats. Other Actions One study (Emelyanov et al, 2002) identified the positive outcome when New Zealand green-lipped mussel is used for asthma. Since asthma is an inflammatory condition, it was considered appropriate for development of this research model. Product Availability Capsule Plant Part Used: Whole mussel Dosages • Adult PO extract: 300-350 mg tid (Jellin et al, 2008) Contraindications Until more research is available, New Zealand green-lipped mussel should not be used during pregnancy and breastfeeding. It should not be given to children. Persons with hypersensitivity to shellfish should not use New Zealand green-lipped mussel. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of New Zealand green-lipped mussel and administer an antihistamine or other appropriate therapy. Administer • Instruct the client to store New Zealand green-lipped mussel products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use New Zealand green-lipped mussel in children or in those who are pregnant or breastfeeding until more research is available. Night-Blooming Cereus (nite blew’ming si’ree-uhs) Scientific name: Selenicereus grandiflorus Other common names: Large-flowered cactus, queen of the night, sweet-scented cactus, vanilla cactus Origin: Night-blooming cereus is found in the tropics of North America. = Pregnancy = Pediatric ! = Alert = Popular Herb Night-Blooming Cereus 461 Uses Night-blooming cereus has been used to treat palpitations, dysmenorrhea, menorrhagia, shortness of breath; cardiac conditions such as angina pectoris, endocarditis; myocarditis, and urinary tract disorders such as cystitis, irritable bladder, and edema. Other disorders include hyperthyroidism and benign prostatic hypertrophy. Topically, night-blooming cereus may be used for rheumatism. Actions Very little research is available for night-blooming cereus, and results of existing studies are inconclusive (Hapke, 1995; Wadworth et al, 1992). However, two of its chemical components, cactine and hordenine, are known to be cardiac glycosides. Product Availability Fluid extract, tincture, cream Plant Parts Used: Flowers, stems, young shoots Dosages • Adult PO fluid extract (1:1): 0.6 ml 1–10 times/day • Adult PO tincture (1:10): 0.12-2 ml bid-tid • Adult topical: rub into affected area as needed Contraindications Class 1 herb (flower, stem). Until more research is available, night-blooming cereus should not be used during pregnancy or breastfeeding. Persons with hypertension, severe cardiac disorders, N or hypersensitivity to this plant should not use it. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, diarrhea, stinging or burning in the oral cavity INTEG: Hypersensitivity reactions; rash (topical) Interactions Drug Cardiac glycosides: Night-blooming cereus may increase the actions of cardiac glycosides such as digoxin and digitoxin; avoid concurrent use. MAOIs: Use of MAOIs may increase the cardiac effects of night-blooming cereus; avoid concurrent use. Since tyramine is present in night-blooming cereus, this herb should be avoided with MAOIs (theoretical). Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Glycoside Flavonoid Cactine; Hordenine Kaempferitrin; Rutin Cardiac glycoside Improved capillary function, dilatation Narcissin; Cacticine; N-methyl tyramine Continued Adverse effects: Underline = life-threatening 462 Nutmeg Primary Chemical Components and Possible Actions—cont’d Chemical Class Individual Component Possible Action Betacyan Rutinoside Improved capillary function Betacyanin Narcissin Grandiflorine Hyperoside Isorhamnetin Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of night-blooming cereus and administer an antihistamine or other appropriate therapy. • Assess the cardiac client for the use of MAOIs or cardiac drugs; recommend that the client avoid concurrent use of night-blooming cereus with these products (see Interactions). • Monitor heart rate, rhythm, and character. Administer • Instruct the client to store night-blooming cereus products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use night-blooming cereus in those who are pregnant or breastfeeding until more research is available. Nutmeg ! (nuht’mayg) Scientific name: Myristica fragrans, M. officinalis Other common names: Jaatipatree, jaiphal, jatipatra, jetikosha, mace, macis, muscadier, muskatbaum, myristica, noz moscada, nuez moscada, nux moschata Origin: Nutmeg is a tree found in the West Indies and Sri Lanka. Uses Nutmeg has been used traditionally for anxiety, depression, toothache, nausea, chronic diarrhea, joint pain, and for gastrointestinal disorders such as gastritis and indigestion. It is also used as an antiemetic, an aphrodisiac, to induce abortion, and to increase menstrual flow. Nutmeg is used as a spice in food. Investigational Uses Research is underway for nutmeg’s use as an antimicrobial, anticancer, and anxiogenic. = Pregnancy = Pediatric ! = Alert = Popular Herb Nutmeg 463 Actions Nutmeg has been studied for its antimicrobial, antiinflammatory, analgesic, antithrombotic, hypolipidemic, and chemoprotective properties. However, many of these proposed actions are documented by only one study each. Antimicrobial Actions Two chemical components of nutmeg known as malabaricones B and C, which are classified as resorcinols, showed powerful antifungal and antibacterial effects when the dried seed covers were evaluated (Orabi et al, 1991). The volatile oils of several herbs were tested for antibacterial action against 25 types of bacteria. The herbs studied were cloves, black pepper, nutmeg, geranium, oregano, and thyme, and the bacteria tested came from food spoilage, food poisoning, animal pathogens, and plant pathogens. All of the herbs that were tested showed powerful antibacterial effects (Dorman et al, 2000). Antiinflammatory, Analgesic, and Antithrombic Actions A chloroform extract of nutmeg was tested in laboratory rodents. The extract was found to decrease pain in mice and also protect against induced thrombosis (Olajide, 1999). Another study evaluated the antiinflammatory effects of nutmeg by using rats and mice with carrageenan-induced paw edema and acetic acid-induced valcular permeability. At the conclusion of the study, researchers believed myristicin to be the chemical component responsible for the antiinflammatory effect (Ozaki et al, 1989). An older study showed the analgesic effect of nutmeg on young chickens (Sherry et al, 1982). An extract of nutmeg was shown to increase both light and deep sleep in these chickens. Anxiogenic activity was identified in nutmeg. The study used mice and several maze-related activities (Sonavane et al, 2002). Hypolipidemic Action In a study of hyperlipidemic rabbits, six rabbits received fluid extract of nutmeg for 60 days at a dose of 500 mg/kg, with the remainder of the rabbits used as the control group. Significantly lower cholesterol levels were found in the hearts and livers of the experimental group, along with platelet antiaggregatory ability (Ram et al, 1996). Another study using rabbits showed that nutmeg decreased total cholesterol, reduced low-density lipoprotein (LDL) cholesterol, lowered the cholesterol/phospholipid ratio, and increased the high-density lipoprotein (HDL) ratio by significant levels (Sharma et al, 1995). Chemoprotective Action In a study of young mice with induced cancer of the uterine cervix, administration of oral Myristica fragrans resulted in a significant reduction of the cancer, with precancerous lesions unaffected (Hussain et al, 1991). In another study using mice, papilloma was induced before nutmeg was fed to the mice. A significant reduction in papilloma (50%) occurred (Jannu et al, 1991). Chirathaworn et al (2007) used the methanolic extract of nutmeg; there was a decrease in Jurkat leukemia T-cell line when tested in the laboratory. Product Availability Capsules, essential oil, powder Plant Part Used: Dried seeds Dosages Gastrointestinal Disorders • Adult PO capsules: 2 caps as a one-time dose • Adult PO essential oil: 4-5 drops on a sugar cube • Adult PO powder: 4-6 tbsp daily Adverse effects: Underline = life-threatening N 464 Nutmeg Antiflatulent • Adult PO oil: 0.3 ml Diarrhea • Adult PO powder: 4-6 tbsp daily (Jellin et al, 2008) Toothache • Adult topical essential oil: 1-2 drops applied to gums (Jellin et al, 2008) Contraindications Class 2b herb (seeds, aril). Because it can cause spontaneous abortion, nutmeg should not be used therapeutically during pregnancy. Until more research is available, nutmeg should not be used therapeutically during breastfeeding and should not be given therapeutically to children (in doses higher than that found in food). Nutmeg should not be used therapeutically by persons with hypersensitivity to it, and it should be used with caution by persons with major depression and those with anxiety disorders. Side Effects/Adverse Reactions CNS: Confusion, stupor, seizures, death GI: Nausea, vomiting, anorexia, constipation, dry mouth GU: Spontaneous abortion INTEG: Hypersensitivity reactions Interactions Drug Antidiarrheals: Antidiarrheals may be potentiated by nutmeg; monitor for constipation. Cytochrome P450 1A1, 1A2, 2B1, 2B2 substrates: Nutmeg may alter drugs metabolized by these enzyme systems (theoretical) (Jellin et al, 2008). MAOIs, psychotropic agents: MAOIs may be potentiated by nutmeg, psychotropic agents; avoid concurrent use. Herb Safrole herbs: Nutmeg with safrole herbs increases risk for toxicity (Jellin et al, 2008). Primary Chemical Components and Possible Actions Chemical Class Individual Component Fixed oil Myristic acid; Tridecanoic acid; Lauric acid; Stearic acid; Palmitic acid Eugenol; Isoeugenol; Iso-elemicin; Gerianiol; D-pinene; L-pinene; Borneol; Safrole; Limonene; Sabinene; Lysergide Malabaricone B, C A, B, C, dehydroiisoeugenol (Juhasz et al, 2000) Essential oil Resorcinol Neolignans = Pregnancy = Pediatric ! = Alert Possible Action Antimicrobial = Popular Herb Nutmeg 465 Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of nutmeg and administer an antihistamine or other appropriate therapy. • Assess for the use of antidiarrheals, MAOIs, and psychotropic agents (see Interactions). ! • Monitor for central nervous system effects (confusion, stupor, seizures); if these occur, discontinue the use of nutmeg and institute supportive measures. Monitor for changes in bowel pattern (constipation). Administer ! • Warn the client that nutmeg is toxic in large doses. • Instruct the client to store nutmeg products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use nutmeg therapeutically during pregnancy because it can cause spontaneous abortion. Until more research is available, caution the client not to use nutmeg therapeutically during breastfeeding and not to give it therapeutically to children. • Advise the client to report central nervous system effects and changes in bowel pattern. • Caution the client that nutmeg is toxic in large doses. Do not increase the dose, and ! keep nutmeg out of the reach of children. • Advise the client not to perform hazardous activities such as driving or operating N heavy machinery until physical response to the herb can be evaluated. • Caution the client not to use nutmeg with psychoactive drugs (see Interactions). Adverse effects: Underline = life-threatening 466 Oak Oak (oek) Scientific names: Quercus robur, Quercus petraea, Quercus alba Other common names: Black oak, British oak, brown oak, common oak, cortex quercus, dusmast oak, ecorce de chene, eichenlohe, eicherinde, encina, English oak, gravellier, nutgall, oak apples, oak bark, oak galls, pedunculate oak, sessile oak, stone oak, tanner’s bark, white oak, white oak bark Origin: Oak is a tree found in North America, Australia, Europe, and Asia. Uses Oak bark traditionally has been used for its antiinflammatory and astringent properties. Topically, oak is used to treat skin disorders such as psoriasis, eczema, and contact dermatitis. It has also been used as a gargle and to treat varicose veins, hemorrhoids, and burns. Oak is used internally for diarrhea, colds, bronchitis, to stimulate appetite and improve digestion. Actions Very little information is available for oak. Its proposed actions include antioxidant, antibacterial, and urolithiasis inhibitor. In one toxicology study evaluating cattle with weakness, diarrhea, and dehydration, one autopsy revealed nephritis and ulceration between the caecum and colon (Neser et al, 1982). Antioxidant Action One study focused on the antioxidant action of oak (Masaki et al, 1995). When oak and several other herbs were tested for scavenging activity, its antioxidant properties did not prove significant. Antibacterial and Urolithiasis Inhibitor Actions One study of 97 patients with urolithiasis evaluated the ability of oak to inhibit the formation of calculi (Mandana et al, 1980). Study participants were given doses of 1350 mg/day of oak extract. After 8-225 days the kidney stones were significantly decreased. Researchers also observed an inhibition of bacteria proliferation. Product Availability Capsules, decoction, extract, gall, ointment, ooze, powder, tincture Plant Parts Used: Bark, gall Dosages • Adult PO: 3 g daily (Blumenthal, 1998) • Adult PO: 1 oz bark in quart of water, boiled down to a pint and taken up to 3 times/day for 3-4 days (diarrhea) • Adult rinse/compress/gargle: 20 g/1 L water (Blumenthal, 1998) • Adult topical ointment: apply prn to affected area • Adult topical powder (bath): 5 g powder/1 L water (Blumenthal, 1998) Contraindications Class 2d herb (bark). Until more research is available, oak should not be used during pregnancy and breastfeeding. It should not be given to children. Oak should not be used by = Pregnancy = Pediatric ! = Alert = Popular Herb Oak 467 Contraindications—cont’d persons with hypersensitivity to it and should not be used topically on large areas of damaged skin. It should not be taken internally in renal/hepatic/ cardiac disease or those with eczema. Oak bark baths are contraindicated in those with hypertonia or infectious diseases. Use cautiously in those with peanut allergies. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, hepatotoxicity GU: Nephrotoxicity INTEG: Hypersensitivity reactions Interactions Drug Iron salts: Oak bark tea may decrease the absorption of iron salts. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Tannin Pedunculagin Antisecretory; astringent Flavonoid Vescalagin; Castalagin; Mongolicanin (bark) Acutissimin A, B; Eugenigrandin A; Guajavin B; Stenophyllanin C Calcium oxalate Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of oak and administer an antihistamine or other appropriate therapy. • Assess for renal/hepatic disease if oak is to be taken internally; kidney damage and necrotic liver conditions can result. Administer • Instruct the client to store oak in a cool, dry place, away from heat and moisture. • Do not administer PO in large amounts; kidney damage and necrotic liver conditions can result. • Large amounts may be carcinogenic. Teach Client/Family • Caution the client not to use oak in children or those who are pregnant or breastfeeding until more research is available. Adverse effects: Underline = life-threatening O 468 Oats Oats (oetz) Scientific name: Avena sativa Other common names: Groats, haver, haver-corn, haws, oat bran, oat grass, oat straw, oatmeal, wild oats Origin: Oats come from a grain found in North America, Russia, and Germany. Uses Traditionally, oats have been used topically to relieve the itching and irritation of various skin disorders. Taken internally, oats may have sedative properties and are used for gallstones, bowel diseases, hypertension, constipation, fatigue, flu, coughs, bladder/rheumatic disorders, preventing colon/gastric cancer, and lowering uric acid levels. Investigational Uses Oats are being researched for their antilipidemic, anticholesterol, and antidiabetic effects. Oat green tea may be effective in the treatment of drug, alcohol, and smoking addiction. Actions Anticholesterol Action Most of the research on oats has focused on the anticholesterol effect of oat bran. The bran fiber binds to cholesterol and bile components, thus removing them from the body when the fiber is excreted. Antioxidant Action Oats may possess antioxidant properties. Several components in the enrichment process are antioxidants (Emmons et al, 1999). Antiaddiction Action One study has shown that the use of oat tincture can decrease the nicotine cravings of smokers, as well as the pressor effect that occurs when nicotine is administered intravenously (Connor et al, 1975). In another study, 100 smokers with an average consumption of 20 cigarettes a day were treated with an extract of Avena sativa for the purpose of disaccustoming them to nicotine. The light smokers showed a positive result, whereas the heavy smokers did not (Schmidt et al, 1976). Product Availability Bath products, cereal, lotion, powder, tablets, tea, wafers, whole grain Plant Part Used: Grain Dosages Skin Irritation • Adult topical: apply prn • Adult topical (bath): 100 g cut herb/full bathtub of water To Lower Cholesterol Levels • Adult PO whole oats: 50-150 g daily Type 2 Diabetes • Adult PO: 25 g whole oats daily = Pregnancy = Pediatric ! = Alert = Popular Herb Oats 469 Contraindications Class 1 herb (spikelets). Oats should not be used by persons with intestinal obstruction, celiac disease, or strangulated bowel. Side Effects/Adverse Reactions GI: Bloating, flatus INTEG: Hypersensitivity reactions, contact dermatitis Interactions Drug Morphine: Oats may decrease the effect of morphine; do not use concurrently. Nicotine: Oats may decrease the hypertensive effect of nicotine. Oral medications: Oats may decrease absorption of oral medications; separate by 1 hour before or 4 hours after oats (Jellin et al, 2008). Lab Test Blood glucose, cholesterol: Oats decrease these tests; inaccurate results may occur. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Saponin Triterpenoid Furostandl Fungicidal Carotenoid Polyphenol Monosaccharide Oligosaccharide Gluten Mineral Fiber Cellulose O Iron; Manganese; Zinc Anticholesterol Client Considerations Assess • Assess for hypersensitivity reactions (rare) and for contact dermatitis from oat flour. If these are present, discontinue the use of oats and administer an antihistamine or other appropriate therapy. • Assess for morphine use (see Interactions). Administer • Instruct the client to store oats in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client with bowel obstruction, strangulated bowel, or celiac disease not to use oats. • Advise the client who is using oats to decrease cholesterol to make other prescribed lifestyle changes as well. • Inform the client that bowel function may change and flatus may occur. Adverse effects: Underline = life-threatening 470 Octacosanol Octacosanol (ahk-tuh-kah’suhn-awl) Scientific names: Sources include Eupolyphaga sinensis, Acacia modesta, Serenoa repens, and others Other common names: 1-octacosanol, 14c-octacosanol, hexacosanol, n-octacosanol, octacosyl alcohol, policosanol, tetracosanol, triacontanol Origin: Octacosanol is developed from wheat germ, sugar cane, or vegetable waxes. Uses Octacosanol is used for herpes infection, treating inflammatory skin diseases, and increasing athletic performance. It may be effective in brain reactivity and to increase cholinergic activity. Investigational Uses Researchers are experimenting with the use of octacosanol to treat Parkinson’s disease, amyotrophic lateral sclerosis (ALS), hyperlipidemia, and intermittent claudication. Actions Hyperlipidemia Action There have been several studies on the use of octacosanol for use in hyperlipidemia. One study evaluated its use in lipid metabolism. When rats who were fed a high-fat diet were given octacosanol, triglycerides were reduced significantly and serum fatty acids were increased (Kato et al, 1995). There have been several studies that confirmed the improvement in total and LDL cholesterol levels, as well as LDL/HDL ratios. All of these studies were double-blind placebo-controlled trials (Castano et al, 2000; Mas et al, 1999). In a study using octacosanol to treat ALS, no improvement was observed (Norris et al, 1986). Product Availability Capsules, tablets Plant Parts Used: Octacosanol is isolated from several different plants. Dosages PO Dosages • Adult capsules/tablets: 40-80 mg daily Parkinson’s Disease • Adult PO: 5 mg tid with meals (Jellin et al, 2008) ALS • Adult PO: 40 mg/day (Jellin et al, 2008) Contraindications Until more research is available, octacosanol should not be used during pregnancy and breastfeeding. It should not be given to children. Parkinson’s disease may worsen if client is also taking levodopa or carbidopa (Jellin et al, 2008). Side Effects/Adverse Reactions CNS: Dyskinesia, restlessness, nervousness, dizziness CV: Orthostatic hypotension GI: Nausea, vomiting, anorexia = Pregnancy = Pediatric ! = Alert = Popular Herb Oleander 471 Interactions Drug Carbidopa/levodopa: Octacosanol may cause dyskinesia when used with carbidopa/levodopa; avoid concurrent use. Lab Test Creatine phosphokinase, glucose, lipids, hepatic function tests, serum creatine: Octacosanol interferes with these tests. Client Considerations Assess • Assess clients with Parkinson’s disease for increased dyskinesia if taking carbidopa/levodopa concurrently with octacosanol (see Interactions). Administer • Instruct the client to store octacosanol in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use octacosanol in children or those who are pregnant or breastfeeding until more research is available. • Advise the client that research is lacking to support any use of octacosanol. Oleander ! (oe’lee-an-duhr) Scientific names: Nerium oleander, Nerium odoratum Other common names: Adelfa, laurier rose, rosa francesa, rosa laurel, rose bay Origin: Oleander is a shrub found in the southern United States, Indonesia, and the Mediterranean region. Uses Traditionally, oleander has been used to treat cardiac disease, diuresis, and menstrual irregularities. It has also been used as a laxative, an insecticide, an abortifacient, a parasiticide, and for ringworm. In some countries oleander is used internally as an anthelmintic, and topically to treat warts and other skin disorders. Investigational Uses New studies have shown a use for oleander in cancer. Actions Many of the chemical components of oleander are cardiac glycosides (see table). Several studies have investigated the digoxin-like toxicity of this plant. One such study focused on the toxicity of oleander in a guinea pig that experienced seizures and cardiac symptoms after eating dried oleander leaves (Kirsch, 1997). The guinea pig was released after undergoing intensive care for 24 hours. Another study reported complete atrioventricular block in a 33-year-old woman who was Adverse effects: Underline = life-threatening O 472 Oleander self-medicating with oleander (Nishioka et al, 1995). A third report focused on a 38-year-old woman with poisoning after ingesting oleander leaves. Her symptoms included those of digitalis intoxication. Use of digoxin-specific FAB proved successful (Romano et al, 1990) in the treatment of the toxicity, as well as in another reported case of oleander poisoning (Shumaik et al, 1988). One study (Pathak et al, 2000) showed human cancer cell death but not murine cancer cell death. Different concentrations of oleander were used. Canine oral cancer cells treated showed immediate response. Product Availability Extract, tincture Plant Part Used: Leaves Dosages No published dosages are available. Contraindications ! Because it can cause spontaneous abortion, oleander should not be used during pregnancy. Until more research is available, this herb should not be used during breastfeeding and should not be given to children. Persons with hypersensitivity to oleander should not use it. Because of the toxic nature of this plant, oleander is not recommended for any use. Oleander should not be used with electrolyte imbalance or heart disease. Side Effects/Adverse Reactions CNS: Depression, dizziness, stupor, headache CV: Dysrhythmias, ventricular ectopy, bradycardia, CV collapse, death GI: Nausea, vomiting, anorexia, abdominal cramps GU: Spontaneous abortion INTEG: Hypersensitivity reactions, contact dermatitis META: Hyperkalemia, peripheral neuritis RESP: Tachypnea Interactions Drug ! Calcium: Calcium may increase the action of oleander (Jellin et al, 2008). Cardiac glycosides (digoxin): Use of oleander with cardiac glycosides may cause fatal digitalis toxicity; do not use concurrently. Diuretics, macrolide antiinfectives, quinine, stimulant laxatives: Oleander with these agents may increase cardiac glycoside toxicity (theoretical) (Jellin et al, 2008). Herb Cardiac glycoside herbs: Oleander with cardiac glycoside herbs is contraindicated (Jellin et al, 2008). = Pregnancy = Pediatric ! = Alert = Popular Herb Oregano 473 Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Glycoside Nerioside; Oleandrin; Neriin; Oleandroside; Digitoxigenin; Gentiobiosyl-oleandrin; Odoroside A Glucosyl-oleandrin Cardiac glycoside Folinerin Rosagenin Rutin Cornerine Oleandromycin Client Considerations Assess • Assess for hypersensitivity reactions and contact dermatitis. If present, discontinue the use of oleander and administer an antihistamine or other appropriate therapy. ! • Assess for the use of cardiac glycosides. Fatal digitalis toxicity can result from concurrent use (see Interactions). O Administer • Instruct the client to store oleander in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use oleander during pregnancy because it can cause spontaneous abortion. Until more research is available, caution the client not to use this herb during breastfeeding and not to give it to children. ! • Advise the client that oleander is extremely toxic and should not be used except under the supervision of a qualified herbalist. All plant parts are potentially dangerous. Oregano ! (uh-reh’guh-noe) Scientific names: Origanum vulgare, Panax quinquefolis Other common names: Mountain mint, origanum Origin: Oregano is found throughout Asia, Europe, and northern Africa. It is cultivated throughout the world, including the United States. Uses Oregano is best known for its use as a food flavoring used in cooking. Therapeutically, oregano is used internally as an expectorant, as an insect repellent, for athlete’s foot, insect bites, intestine disorders such as dyspepsia and intestinal parasites, and Adverse effects: Underline = life-threatening 474 Oregano to treat respiratory disorders, cough, and bronchial catarrh. It has also been used as a systemic tonic and diaphoretic, as well as to treat menstrual irregularities. Topically, oregano is used to treat infection. It may also be added to shampoo for its antiseptic action. Investigational Uses Initial research supports the use of oregano as an antibacterial, antifungal, and antioxidant. Actions Little information is available on the actions of oregano. Proposed actions include antioxidant, antibacterial, and antifungal. Antioxidant Action Oregano is high in tocopherols, which are responsible for its antioxidant action (Lagouri et al, 1996). Another study (Nakatani, 2000) identified phenolic antioxidants from several herbs and spices. One of the herbs studied was Origanum vulgare. Antibacterial and Antifungal Actions Several herbs were evaluated to determine the antibacterial effects of their volatile oils. The volatile oils of black pepper, cloves, geranium, nutmeg, oregano, and thyme all showed significant antibacterial action against the 25 bacteria species tested (Dorman et al, 2000). Inhibition of Aspergillus was evaluated using the essential oils of oregano, mint, basil, sage, and coriander. Oregano and mint completely inhibited the growth of Aspergillus, whereas sage and coriander showed no inhibitory effects. Basil was only slightly effective (Basilico et al, 1999). Product Availability Capsules, dried herb, oil Plant Parts Used: Above-ground parts (dried) Dosages • Adult PO capsules: 2 caps daily-bid with meals • Adult PO dried herb tea: pour 250 ml boiling water over 1 tsp dried herb, let stand 10 min, strain • Adult PO oil: 5 drops added to liquid • Adult topical oil: apply to affected area prn as an antiseptic Intestinal Parasites • Adult PO emulsified oil: 200 mg tid ⫻ 6 wk (Jellin et al, 2008) Contraindications Class 1 herb (leaf). Until more research is available, oregano should not be used therapeutically during pregnancy and breastfeeding. It should not be given therapeutically to children. Oregano should not be used therapeutically by persons with hypersensitivity to this herb or other members of the Lamiaceae family, such as mint, sage, marjoram, thyme, basil, lavender, or hyssop. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia (large amounts) INTEG: Hypersensitivity reactions—facial edema, itching, dysphagia, dysphonia, inability to breathe = Pregnancy = Pediatric ! = Alert = Popular Herb Oregon Grape 475 Primary Chemical Components and Possible Actions Chemical Class Individual Component Wound healing; astringent Tannin Acid Tocopherol Volatile oil Possible Action Gallic acid Alpha; Beta; Gamma; Delta Carvacrol; Gamma-terpinene; P-cymene; Thymol Antioxidant Client Considerations Assess ! • Assess for hypersensitivity reactions (facial edema, itching, inability to breathe, dysphonia, dysphagia). If present, discontinue the use of oregano and administer an antihistamine or other appropriate therapy. If the client is allergic to other herbs in the Lamiaceae family (basil, marjoram, lavender, hyssop, mint, sage), cross-sensitivity may occur. Administer • Instruct the clients to store oregano products in a sealed container away from heat and moisture. Teach Client/Family • Caution the client not to use oregano therapeutically in children or those who are pregnant or breastfeeding until more research is available. • Caution the client not to confuse oregano with marjoram (Origanum marjorana). • Because cross-sensitivity is possible, advise the client who is allergic to other plants of the Labiatae family (thyme, hyssop, basil, marjoram, mint, sage, and lavender) not to use oregano (Benito et al, 1996). Oregon Grape ! (aw’ri-guhn grayp) Scientific name: Mahonia aquifolium Other common names: Blue barberry, creeping barberry, holly-leaved barberry, mountain grape Origin: Oregon grape is a shrub found in the western region of the United States. Uses Different forms of Oregon grape have different uses. The tincture is used to treat skin disorders such as eczema, psoriasis, dandruff, herpes, and acne, as well as hepatitis, upper-respiratory congestion, sexually transmitted diseases, arthritis, and other joint disorders. The root bark is used to treat diarrhea, fever, gallbladder conditions, renal calculi, gastrointestinal upset, ulcers, and leukorrhea. Adverse effects: Underline = life-threatening O 476 Oregon Grape Investigational Uses Initial research is available that focuses on the use of Oregon grape as an antioxidant and as a treatment for some skin disorders. Actions The possible actions of Oregon grape include antioxidant, antiproliferative, and cardiac relaxant. Antioxidant Action Most research studies have focused on the alkaloid components of Oregon grape and their antioxidant actions. Those with the most potent antioxidant actions are isothebaine and isocorydine (Sotnikova et al, 1997); berbamine and oxyacanthine (Bezakova et al, 1996); oxyberberine, corytuberine, and columbamine (Misik et al, 1995); and protoberberine (Rackova et al, 2007). Other alkaloids have been found to possess only weak antioxidant effects. Antiproliferative Action Several studies have demonstrated the antiproliferative action of Oregon grape (Augustin et al, 1999; Muller et al, 1994, 1995; Gulliver et al, 2005). All studies have confirmed that Oregon grape decreases the proliferation of psoriasis. Topical application was used to treat psoriasis in a double-blind placebo-controlled study with 82 individuals. Participants rated the effectiveness of Oregon grape as being more effective (Weisenauer et al, 1996). Another study (Augustin et al, 1999) compared treatments that differed on each side of participants’ body. Skin biopsies were used to compare each sample. There was significant improvement in the Oregon grape group. Cardiac Relaxant Action The cardiac relaxant ability of Oregon grape was demonstrated by the use of the alkaloids isothebaine and isocorydine in rats. Both alkaloids showed relaxant effects in the aorta (Sotnikova et al, 1997). Product Availability Capsules, fluid extract, powder, tincture, topical ointment, topical cream Plant Parts Used: Bark, roots, stems Dosages • Adult PO powder: 1⁄2-1 g tid • Adult PO tincture: 2-4 ml tid • Adult topical: apply tid to affected areas Contraindications Class 2b herb (root). Pregnancy category is 5; breastfeeding category is 4A. Oregon grape should not be given to children. It should not be used by persons with hypersensitivity to this herb or related herbs. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions, burning SYST: Poisoning, death (high doses) = Pregnancy = Pediatric ! = Alert = Popular Herb Oregon Grape 477 Interactions Herb Berberine herbs: Oregon grape with other berberine herbs may increase risk for berberine toxicity (Jellin et al, 2008). Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Alkaloid Berberine; Magnoflorine Oxyacanthine; Berbamine; Bisbenzy lisoquinoline alkaloid complex (BBI); Oxyberberine; Corytuberine; Columbamine; Armoline; Baluchistine; Obamegine; Aquifoline; Jatorrhizine; Protoberberine Isocorydine; Isothebaine Hydrastine; Canadine; Corypalmine; Mahonine; Isoquinolone Weak antioxidant Antioxidant Cardiac relaxant Tannin O Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of Oregon grape and administer an antihistamine or other appropriate therapy. ! • Assess for use of excessive doses. Poisoning and death can result. Administer • Instruct the client to store Oregon grape products in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 5 and breastfeeding category is 4A. • Caution the client not to give Oregon grape to children. • Advise the client that Oregon grape is not the same as barberry (Berberis vulgaris). • Inform the client that research is minimal for any uses and actions of Oregon grape. ! • Caution the client that poisoning and death may result from high doses. Adverse effects: Underline = life-threatening 478 Pansy Pansy (pan’zee) Scientific name: Viola tricolor Other common names: Field pansy, heart’s ease, Johnny-jump-up, jupiter flower, ladies’ delight, wild pansy Origin: Pansy is found throughout the world. Uses Pansy traditionally has been used to treat whooping cough, upper respiratory tract conditions such as bronchitis, skin cancer, joint pain, and inflammation. Internally it is used as a laxative and to promote metabolism. Externally it is used to treat seborrheic skin diseases, acne, impetigo, pruritus vulvae, and cradle cap in children. Investigational Uses Initial research is available documenting the use of pansy in the treatment of heart and inflammatory conditions. Actions Little research has been done on pansy. One study showed a reduction in glucose transport in the rat small intestine (Gurman et al, 1992). Another demonstrated that one of the chemical components, kalata-peptide B1, exerts antimicrobial activity (Gran et al, 2000). Another study (Toiu, et al, 2007) identified the antiinflammatory effects on bone marrow acute phase response. Total leukocyte and differential leukocyte counts were used as the measure mark. Product Availability Extract, tea, tincture Plant Part Used: Flowers Dosages • Adult PO tea: 2-4 ml tid • Adult PO tincture: 2-4 ml tid Contraindications Until more research is available, pansy should not be used during pregnancy and breastfeeding. It should not be given to children. Pansy should not be used by persons with hypersensitivity to this herb or salicylates. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, diarrhea (seeds) INTEG: Hypersensitivity reactions Interactions Drug Salicylates (aspirin): The actions of salicylates may be increased when used with pansy. = Pregnancy = Pediatric ! = Alert = Popular Herb Papaya 479 Primary Chemical Components and Possible Actions Chemical Class Individual Component Flavonoid Rutin; Luteolin; Scoparin; Saponarine; Violanthin Antiinflammatory; antipyretic Salicylate Terpene Carbohydrate Sterine Cyclic peptide Tannin Hydroxycoumarin Possible Action Kalata-peptide B1 Antimicrobial Umbelliferone Anticoagulant Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of pansy and administer an antihistamine or other appropriate therapy. Administer • Instruct the client to store pansy products away from heat, light, and moisture. Teach Client/Family • Caution the client not to use pansy in children or those who are pregnant or breastfeeding until more research is available. P Papaya (puh-pai’uh) Scientific name: Carica papaya Other common names: Melon tree, papain, pawpaw Origin: Papaya is a tree grown in Mexico, Central America, and many tropical regions. Uses Papaya is used orally for intestinal worms and gastrointestinal disorders and topically for debridement of wounds such as decubiti and other necrotic ulcers. It is used by intradisk injection in a herniated lumbar intervertebral disk. Actions The primary action of papaya is its use as a debridement enzyme. The proteolytic enzymes papain and chymopapain have been used for centuries as a debridement vehicle for necrotic skin, primarily in decubitus ulcers. One research study (Rajkapoor et al, 2002) has shown dried papaya fruits to be hepatoprotective. Another study (Mehdipour et al, 2006) identified the antioxidant potential of papaya juice in the laboratory. Adverse effects: Underline = life-threatening 480 Papaya Product Availability Tablets Plant Parts Used: Seeds, pulp, leaves, latex Dosage • Adult PO: 10 mg qid for 7 days • Adult topical: apply to affected area as needed for debridement • Adult intradisk injection Contraindications Papaya should not be given to children or those who are pregnant, breastfeeding, or hypersensitive to this product. It should not be used in contact dermatitis or in bleeding disorders. Side Effects/Adverse Reactions CNS: Paralysis CV: Hypotension, bradycardia GI: Severe gastritis, esophageal perforation INTEG: Dermatitis, caroteinemia SYST: Anaphylaxis, allergic reactions Interactions Drug Anticoagulants (anisindione, dicumarol, heparin, warfarin): When papaya is given with anticoagulants, there is a greater risk of bleeding and an increase in international normalized ratio (INR) and prothrombin time. Herb Papain: Papaya used with papain can increase adverse reactions (Jellin et al, 2008). Lab Test INR: Papaya can increase INR in those using warfarin (Jellin et al, 2008). Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Proteolytic enzymes Papain Debridement enzyme Alkaloids Glycosides Chymopapain Carpaine Myrosin; Caricin Client Considerations Assess • Assess the reason the client is using papaya. • Identify if the client is using anticoagulants. There is an increased risk of bleeding when papaya is used with anticoagulants. = Pregnancy = Pediatric ! = Alert = Popular Herb Parsley 481 Administer • Keep papaya in a closed container away from excessive heat, light, and moisture. Teach Client/Family • Teach the patient that papaya should not be used medicinally in children or those who are pregnant or breastfeeding until more research is available. Parsley (pahr’slee) Scientific name: Petroselinum crispum Other common names: Common parsley, garden parsley, rock parsley Origin: Parsley is found throughout the world. Uses Traditionally, parsley has been used to treat cough, menstrual irregularities, gastrointestinal upset, dysuria, flatulence, and joint pain and inflammation. It is also used as a diuretic, antiinfective, and antispasmodic. In the fourteenth century, parsley was used to treat gastrointestinal conditions, asthma, urinary and hepatic disease, and the plague. Investigational Uses Initial research indicates that parsley may be useful for the treatment of hypertension, urinary tract dysfunction including urinary tract infection and kidney stones, menopause as an antioxidant, and symptoms in women. Actions Researchers have identified that parsley contains phytoestrogens and that it possesses urinary antioxidant, antidiabetic agents, and antihypertensive properties. However, little research has been done on any of its proposed actions. Estrogenic Action The phytoestrogens in parsley were identified when researchers were screening for an estrogen-sensitive breast cancer cell line. Parsley was shown to exert potent estrogenic activity, equal to that of soybeans (Yoshikawa et al, 2000). Antioxidant Action Parsley’s urinary antioxidant action was demonstrated in a study involving seven men and seven women (Nielsen et al, 1999). Participants began intake of parsley to identify the excretion of flavones and on biomarkers for oxidative stress. Researchers observed an increase in the antioxidant effect. Another earlier study (Fejes et al, 1998, 2000) produced similar results. The flavonoids present in parsley were shown to exert the strongest antioxidant effect. Product Availability Capsules, essential oil, fluid extract, tea Plant Parts Used: Leaves, oil, roots, seeds Dosages • Adult PO crushed herb and root: 6 g/day • Adult PO fluid extract: 2-4 ml (1:1 dilution in 25% alcohol) tid • Adult PO tea: use 2-6 g leaves or roots Adverse effects: Underline = life-threatening P 482 Parsley Contraindications Class 2b, 2d herb (leaf, root). Until more research is available, parsley should not be used therapeutically during pregnancy and breastfeeding. It should not be given therapeutically to children. The essential oil should not be used by persons with renal inflammation. Those with cardiac/renal/hepatic conditions should avoid the therapeutic use of this herb. Side Effects/Adverse Reactions CNS: Hallucinations, giddiness, paralysis CV: Hypotension, arrhythmias GI: Nausea, vomiting, anorexia, gastrointestinal bleeding, hepatotoxicity, fatty liver GU: Renal damage INTEG: Hypersensitivity reactions, contact dermatitis, phototoxicity RESP: Pulmonary vascular congestion Interactions Drug Anticoagulants (heparin, warfarin): Large amounts of parsley may interfere with anticoagulation therapy (theoretical). Antihypertensives: Parsley may cause increased hypotension when used with antihypertensives; do not use concurrently. Aspirin: Use of aspirin may precipitate parsley allergy. Diuretics: Parsley leaf/root may interfere with diuretics’ action (theoretical). Lithium: Parsley combined with lithium may lead to dehydration, lithium toxicity. MAOIs: MAOIs used with tricyclics or selective serotonin reuptake inhibitors (SSRIs) may lead to serotonin syndrome when used with parsley; do not use concurrently. Opioids: Opioids may cause serotonin syndrome when used with parsley; do not use concurrently. Lab Test INR: Parsley may decrease INR, due to vitamin K content (theoretical). Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Mineral Vitamin Glycoside Calcium; Iron A; B; C Acetylapiin Apigenin; Luteolin Petroside Estrogenic Glucoside Protein Carbohydrate Furanocoumarin Volatile oil Flavonoid = Pregnancy Estrogenic Bergapten Psoralen; Methoxypsoralen; Oxypeucedanin Myristicin; Apiole; Betaphellandrene Apiin; Luteolin = Pediatric ! = Alert Phototoxicity = Popular Herb Parsley Piert 483 Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of parsley and administer an antihistamine or other appropriate therapy. • Assess for cardiac, hepatic, or renal disease. Clients with these conditions should avoid using parsley therapeutically. • Assess for medications used (see Interactions). Administer • Instruct the client to store parsley products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use parsley therapeutically in children or those who are pregnant or breastfeeding until more research is available. • Inform the client that research is lacking for any uses or actions of parsley. • Advise the client to use sunscreen and wear protective clothing to prevent phototoxic reactions. Parsley Piert (pahr’slee) Scientific name: Aphanes arvensis Other common names: Field lady’s mantle, parsley breakstone, parsley piercestone Origin: Parsley piert is an annual found in North America, Europe, and parts of Africa. Uses Parsley piert is used to treat urinary tract disorders such as infections and renal stones. It is also used as a diuretic and to reduce fever. Actions No research studies have been done for parsley piert, although its use continues. This herb is known to contain tannins, which are well known for their wound-healing and astringent properties. These chemicals are thought to act on the genitourinary system to soothe irritation. Product Availability Dried herb, fluid extract, tincture Plant Parts Used: Aerial parts Dosages • Adult PO fluid extract: 2-4 ml tid • Adult PO tincture: 2-4 ml tid • Adult PO tea: 1⁄2 cup herb in 1 pt boiling water; may be taken tid-qid • Adult PO dried herb: 2-4 g tid • Adult PO infusion: 2-4 g tid Adverse effects: Underline = life-threatening P 484 Passionflower Contraindications Until more research is available, parsley piert should not be used during pregnancy and breastfeeding. It should not be given to children. This herb should not be used by persons with hypersensitivity to it. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Wound healing; astringent Tannin Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of parsley piert and administer an antihistamine or other appropriate therapy. Administer • Instruct the client to store parsley piert in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use parsley piert in children or those who are pregnant or breastfeeding until more research is available. • Advise the client that research is lacking for any uses or actions of this herb. Passionflower ! (pa’shuhn flou’uhr) Scientific name: Passiflora incarnata Other common names: Apricot vine, granadilla, Jamaican honeysuckle, maypop, maypot, passion fruit, passion vine, purple passion flower, water lemon Origin: Passionflower is a perennial found in the tropics of the Americas. Uses Passionflower is used as a sedative and to treat anxiety, sleep disorders, attention deficit–hyperactivity disorder, seizures, neuralgia, nervous tachycardia, restlessness, and opiate withdrawal. Topically passionflower is used for hemorrhoids, burns, and inflammation. Investigational Uses Initial research is underway to identify the use of passionflower in the treatment of the symptoms of Parkinson’s disease and as an antitussive. = Pregnancy = Pediatric ! = Alert = Popular Herb Passionflower 485 Actions Anxiolytic Action Research on passionflower is lacking. Initial evidence indicates a possible anxiolytic action. One study using laboratory mice evaluated several herbs for their central nervous system effects: Crataegus oxyacantha, Valeriana officinalis, Hyoscyamus niger, Matricaria chamomilla, Piscidia erythrina, Atropa belladonna, and Passiflora incarnata. Passiflora incarnata showed anxiolytic action, whereas Crataegus oxyacantha and Valeriana officinalis showed sedative effects. The other herbs showed either no action or only limited central nervous system activity (Della Loggia et al, 1981). Other studies (Movafegh et al, 2008; Soulimani et al, 1997) showed similar results when the chemical components harman, harmine, harmaline, harmol, harmalol, orientin, isoorientin, vitexin, and isovitexin were tested in mice. Sedative effects were confirmed after laboratory testing. Opiate Withdrawal One study is available that confirmed the decrease in opiate cravings, restlessness, anxiety, and irritability (Akhondzadeh, 2001). Antitussive Action The significant antitussive activity of Passiflora incarnata was identified when administered to sulfur-dioxide–induced cough in mice (Dhawan et al, 2002). Product Availability Crude extract, dried herb, fluid extract, homeopathic products, tincture Plant Parts Used: Flowers, fruit Dosages General Dosages • Adult PO: 10-30 drops tid (0.7% flavonoids) • Adult PO dried herb: 0.25-1 g tid • Adult PO fluid extract: 0.5-1 ml tid • Adult PO tea: 4-6 tsp of herb in three divided doses • Adult PO tincture: 0.5-2 ml tid P Insomnia • Adult PO dried herb/tea: 4-8 g at bedtime (Murray, Pizzorno, 1998) • Adult PO dry powdered extract: 300-450 mg at bedtime (2.6% flavonoids) (Murray, Pizzorno, 1998) • Adult PO fluid extract: 2-4 ml (1⁄2-1 tsp) at bedtime (1:1 dilution) (Murray, Pizzorno, 1998) • Adult PO tincture: 6-8 ml (11⁄2-2 tsp) at bedtime (1:5 dilution) (Murray, Pizzorno, 1998) Contraindications Pregnancy category is 2; breastfeeding category is 2A. Passionflower should not be given to children. It should not be used by persons with hypersensitivity to this herb. Side Effects/Adverse Reactions CNS: CNS depression (high doses) GI: Nausea, vomiting, anorexia, hepatic toxicity Continued Adverse effects: Underline = life-threatening 486 Passionflower Side Effects/Adverse Reactions—cont’d INTEG: Hypersensitivity reactions Toxicity: Severe nausea, vomiting, drowsiness, prolonged QTc, nonsustained ventricular tachycardia (Fisher et al, 2000) Interactions Drug CNS depressants (alcohol, antianxiety agents, antipsychotics, barbiturates, opiates, benzodiazepines, sedative/hypnotics): Use of passionflower with central nervous system depressants may cause increased sedation; avoid concurrent use (theoretical). MAOIs: Use of passionflower with MAOIs may cause increased MAOI activity; avoid concurrent use (theoretical). Herb Anticoagulant/antiplatelet herbs, sedative herbs: Passionflower may increase the action of anticoagulant/antiplatelet herbs, sedative herbs (theoretical). Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Flavonoid Anxiolytic Alkaloid Vitexin; Isoorientin; Isovitexin Umbelliferone; Coumarin; Schaftoside; Isoschaftoside Harman; Harmaline Pyrone Glycoside Carbohydrate Harmine; Harmalol; Harmol Maltol Gynocardin Sucrose Uterine stimulant; MAOI action Sedative Cyanogenic Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of passionflower and administer an antihistamine or other appropriate therapy. ! • Assess for toxicity (see Side Effects) if the client is using high doses of this herb or is taking it for a prolonged period. Administer • Instruct the client to store passionflower products in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 2 and breastfeeding category is 2A. • Caution the client not to give passionflower to children. = Pregnancy = Pediatric ! = Alert = Popular Herb Pau D’arco 487 Pau D’arco (pah’ew dahr’koe) Scientific name: Tabebuia impetiginosa Other common names: Ipe, ipe roxo, ipes, la pacho, lapacho, lapacho colorado, lapacho morado, lapachol, purple lapacho, red lapacho, roxo, taheebo, tajibo, trumpet bush, trumpet tree Origin: Pau d’arco is a tree found in South America, Central America, Mexico, and Florida. Uses Pau d’arco is used in South America and the Caribbean to treat various conditions such as cold and flu, diarrhea, fever, parasitic infections, sexually transmitted diseases, candida infection (orally, topically), snakebite, wounds, joint pain, urinary incontinence, psoriasis, and infections. It is also used for ulcers, gastritis, liver ailments, asthma, bronchitis, cystitis, and boils and as a tonic, blood builder, and aphrodisiac. Investigational Uses Other possible uses for pau d’arco include the treatment of cancer, HIV/AIDS, hepatic disorders, diabetes mellitus, and lupus (systemic lupus erythematosus). It may also show efficacy as an antimicrobial. Actions Antimicrobial Action The major focus of research for pau d’arco is its antimicrobial effects. One study demonstrated its activity against Staphylococcus aureus, Escherichia coli, and Aspergillus niger. Of the extracts tested, pau d’arco was one of the most active (Anesini et al, 1993). Another study demonstrated the remarkable broad-spectrum antimicrobial activity of this herb against many gram-positive and gram-negative bacteria and fungi (Binutu et al, 1994). The stem bark was shown to be the most active; extracts of leaves were active only against Candida albicans. Park et al (2006) identified the action of pau d’arco against Helicobacter pylori. Antipsoriatic Action The antipsoriatic activity of pau d’arco was confirmed using compounds available in passionflower (Muller et al, 1999). Other Actions Lapachol, a chemical constituent, demonstrated antiulcerogenic effects in animal models. Protection was significant with 5 mg/kg. Product Availability Capsules, extract, salve, tablets, tea, tincture, liquid Plant Part Used: Bark Dosages • Adult PO capsules/tablets: 2 caps/tabs bid with water at meals; may be used as a tea • Adult PO lapachol: 1 g daily; max 1.5 g daily • Adult PO tea: place 15 g bark in 2 cups water, boil 10 min, strain, or use the contents of the capsules • Adult PO tincture: 0.5-1 ml tid • Adult PO glycerin-based liquid: 1-3 ml tid Adverse effects: Underline = life-threatening P 488 Pau D’arco Contraindications Pregnancy category is 6; breastfeeding category is 3A. Pau d’arco should not be given to children. It should not be used by persons with hypersensitivity to this herb or those with hemophilia, von Willebrand’s disease, thrombocytopenia, or other coagulative disorders. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions SYST: Bleeding; toxic reactions (theoretical) Interactions Drug Anticoagulants (heparin, salicylates, warfarin): Use of pau d’arco with anticoagulants may result in an increased risk of bleeding; avoid concurrent use (theoretical). Phytonadione (vitamin K): Use of pau d’arco with phytonadione may cause prolongation of protime. Herb Anticoagulant/antiplatelet herbs: Pau d’arco with anticoagulant/ antiplatelet herbs may increase risk of bleeding (theoretical). Lab Test Prothrombin time (PT)/international normalized ratio (INR): Pau d’arco may increase PT/INR. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Quinone Lapachone; Lapachol Tabebuin Methoxybenzoyloxy; Dimethoxybenzoyloxy Antimicrobial Dialdehyde Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of pau d’arco and administer an antihistamine or other appropriate therapy. • Determine whether the client is using other anticoagulants (e.g., warfarin, heparin, salicylates) or has a coagulation deficiency. These clients should avoid using this herb (see Interactions). Administer • Instruct the client to store pau d’arco in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 6 and breastfeeding category is 3A. • Caution the client not to give pau d’arco to children. = Pregnancy = Pediatric ! = Alert = Popular Herb Peach 489 Peach ! (peech) Scientific name: Prunus persica Other common names: Amygdalin, laetrile, vitamin B17 Origin: Peach is a tree found throughout the world. Uses Traditionally, the bark and leaves of the peach tree have been used as an anthelmintic, an expectorant, an astringent, and a diuretic, as well as to treat insomnia, cough, and constipation. In the 1970s, peach pits (Laetrile) were a popular but unproved treatment for cancer in other countries. Topically, peach is used to treat minor skin disorders such as burns, abrasions, blisters, scratches, eczema, psoriasis, and warts. Actions Initial research is available on the use of Prunus persica as an antifungal, as an agent to decrease melanin biosynthesis, and in combination to treat platelet aggregation defect and uterine myomas. Antifungal Action Peach has been shown to possess antifungal properties. When researchers screened 15 species of leaves for fungitoxic activity, the leaves of Prunus persica completely inhibited mycelial growth of Aspergillus flavus (Mishra et al, 1990). Melanin Biosynthesis Inhibitor Another study identified the inhibitory properties of peach on melanin biosynthesis (Matsuda et al, 1994). Investigators collected 38 different herbs and used the dried leaves. Results suggest that dried peach leaves may be used as a whitening agent for the skin. Platelet Aggregate Action In a study testing the platelet aggregate properties of Prunus persica, Carthamus tinctorium, and Glycyrrhiza uralensis, the experimental group experience a significant change in platelet aggregation (Shen et al, 1994). Uterine Myoma Inhibitor In a study testing the effects of peach on uterine myomas, the myomas shrank in 60% of the cases (Sakamoto et al, 1992). Anticancer Action Peach pits (under the product name Laetrile) were used extensively as a cancer treatment in the 1970s, primarily in Mexico. However, Laetrile is not currently used because of the potential for cyanide poisoning. Other Actions One study (Suh et al, 2006) identified the cholinesterase inhibitory action of peach in rats. Peach penetrates into the brain and inhibits cholinesterase. Peach may be useful in Alzheimer’s disease. Product Availability Bark, kernel oil, leaves, persic oil, seeds Plant Parts Used: Bark, kernels, leaves, seeds Adverse effects: Underline = life-threatening P 490 Peach Dosages • Adult PO tea (bark): boil 1⁄2 oz bark in 1 pt water, let stand 15 min, strain; may be taken tid • Adult PO tea (leaves): boil 1 oz leaves in 1 pt water, let stand 15 min, strain; may be taken tid Contraindications Class 2d herb (seed). Until more research is available, peach should not be used therapeutically during pregnancy and breastfeeding. It should not be given therapeutically to children. Peach should not be used by persons with hypersensitivity to it. Side Effects/Adverse Reactions Cyanide poisoning (peach pits): Severe vomiting, abdominal or epigastric pain, dizziness, coma, seizures, death EENT: Optic atrophy, tinnitus GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions Primary Chemical Components and Possible Actions Chemical Class Individual Component Bark, leaves, and seeds contain Amygdalin Bark and leaves also contain Phloretin Possible Action Cyanide poisoning Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of peach and administer an antihistamine or other appropriate therapy. Advise clients who are hypersensitive to peach skin to wear gloves when handling. ! • Assess for chronic cyanide poisoning: vision changes with optic atrophy, dizziness, nerve pain, and nerve deafness. If these are present, discontinue the use of peach immediately. Administer • Instruct the client to store peach in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use peach therapeutically in children or those who are pregnant or breastfeeding until more research is available. • Advise the client to use only the bark, leaves, or seeds—never peach pits— ! because of the potential for cyanide poisoning. = Pregnancy = Pediatric ! = Alert = Popular Herb Pectin 491 Pectin (pehk’tuhn) Origin: Pectin is found in the cell walls of all plants. Uses Traditionally, pectin has been used to treat diarrhea and to reduce blood glucose and high cholesterol levels. Topically, pectin can protect mouth ulcers. Investigational Uses Investigators are working to determine whether pectin can help prevent or reduce radiation sickness. Actions Most of the available research focuses on the use of pectin to lower blood glucose levels and cholesterol. Anticholesterol Action The addition of pectin and guar to the diet has been shown to reduce total cholesterol and triglycerides (Biesenbach et al, 1993). Another study showed that pectin decreases the transit time of feces in the colon, possibly reducing the risk of colon cancer (Harris et al, 1993). Other Actions One study (Rabbani et al, 2001) identified the use of pectin in controlling persistent diarrhea in Bangladeshi children. The diarrhea was significantly decreased by day 4 after green banana or pectin was introduced. Product Availability Pectin is not commercially available. Plant Parts Used: Cell walls of all plants, usually obtained from the rind of citrus fruits and apple. Dosages No dosage consensus is available. Contraindications No absolute contraindications are known. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions RESP: Asthma (inhalation of pectin dust) Interactions Drug Digoxin, lovastatin, tetracyclines: Pectin can interfere with the absorption of these agents. Oral medications: Pectin reduces the absorption of all drugs, vitamins, and minerals if taken concurrently. Separate doses by 3 hours to ensure adequate absorption. Continued Adverse effects: Underline = life-threatening P 492 Pennyroyal Interactions—cont’d Herb Beta-carotene: Pectin reduces beta-carotene absorption. Food Nutrients: Pectin can interfere with the absorption of all nutrients. Lab Test Cholesterol: Pectin can reduce cholesterol test results. Pharmacology Pharmacokinetics Pectin is an adsorbent, a soluble fiber; binds cholesterol and is not metabolized. Primary Chemical Components and Possible Actions Chemical Class Individual Component Polysaccharide Protopectin Possible Action Insoluble compound Client Considerations Assess • Assess for hypersensitivity reactions, such as asthma from the inhalation of pectin dust. If present, discontinue the use of pectin and administer an antihistamine or other appropriate therapy. Administer • Instruct the client to store pectin in a cool, dry place, away from heat and moisture. Teach Client/Family • Advise the client not to inhale pectin dust. • Inform the client that it is necessary to separate doses of drugs, vitamins, and minerals from doses of pectin to ensure adequate absorption (see Interactions). Pennyroyal ! (pehn-ee-rawee’uhl) Scientific names: Hedeoma pulegioides (American pennyroyal), Mentha pulegium (European pennyroyal) Other common names: American pennyroyal, European pennyroyal, mock pennyroyal, mosquito plant, pudding grass, squawbalm, squawmint, tickweed Origin: American pennyroyal is found throughout North America in wooded regions. = Pregnancy = Pediatric ! = Alert = Popular Herb Pennyroyal 493 Uses Traditionally, pennyroyal has been used as an abortifacient and to treat gout, menstrual ailments, uterine fibroids, colds, fevers, flu, chest congestion, and colic, and digestive, hepatic, and gallbladder diseases. Externally, it is used to treat skin diseases. Some herbalists recommend the use of pennyroyal for treating tumors. It may also be used as an insect repellant. Actions Little scientific research has been done on any uses or actions of pennyroyal. This herb is used as an insect repellent and has been used in the food and cosmetic industry for years. Most of the available information comes from anecdotal reports. ! Pennyroyal oil is extremely toxic and should not be ingested for any use. Product Availability Dried herb, dried leaves, flowers, oil Plant Parts Used: Flowering tops, leaves Dosages ! NOTE: Pennyroyal is extremely toxic. • Adult PO tea (dried herb): place 1 tbsp dried herb in 8 oz warm water; may be taken bid • Adutl PO tea (dried leaves): place 2 tsp dried leaves in 8 oz boiling water, let stand 15 min, strain; may be taken bid Contraindications ! Pregnancy category is 7; breastfeeding category is 5A. Pennyroyal should not be given to children. Persons with seizure disorders, renal/ hepatic disease, or those with hypersensitivity to this herb, should not use it. Pennyroyal oil is extremely toxic and should not be ingested. Dried leaf tea is safe to drink. Side Effects/Adverse Reactions CNS: Fatigue, confusion, dizziness, hallucinations, malaise, seizures, rigors, coma, death CV: Hypertension GI: Nausea, vomiting, anorexia, abdominal pain and cramping, hepatotoxicity GU: Nephrotoxicity INTEG: Hypersensitivity reactions Reproductive: Abortion RESP: Respiratory depression Interactions Drug Cytochrome P450: Concurrent use of pennyroyal with drugs metabolized by cytochrome P450 should be avoided. Lab Test ALT, AST, total bilirubin, urine bilirubin: Pennyroyal may cause increased ALT, AST, total bilirubin, and urine bilirubin. Red blood cells: Pennyroyal may cause decreased red blood cells. Adverse effects: Underline = life-threatening P 494 Peppermint Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Monoterpene Hedeomal Tannin Alpha-pinene Beta-pinene Octanone Limonene Cymene Octanol Octylacetate Methylcyclohexanone Methone Piperitenone Paraffin Volatile oil Pulegone Abortifacient Rosmarinic acid Isomenthone; D-pulegone; Menthone Diosmin; Hesperidin Flavonoid Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of pennyroyal and administer an antihistamine or other appropriate therapy. ! • Assess for symptoms of toxicity: lethargy, malaise, fatigue, oliguria, jaundice, seizures. If these are present, discontinue the use of pennyroyal immediately and administer supportive measures. Administer ! • Instruct the client to use pennyroyal only under the supervision of a qualified herbalist. This herb can be toxic. • Instruct the client to store pennyroyal products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use pennyroyal in children or those who are pregnant or breastfeeding. • Caution the client to avoid self-administration of this herb because of its toxicity. Peppermint ! (pep’er-mint) Scientific name: Mentha piperita Other common names: Brandy mint, lamb mint Origin: Peppermint is found in Europe, the United States, and Canada. = Pregnancy = Pediatric ! = Alert = Popular Herb Peppermint 495 Uses Peppermint has been used internally as an antiseptic and to treat flatulence, vomiting, diarrhea, abdominal pain, indigestion, irritable bowel syndrome, colic, and gallbladder disorders. It has also been used internally to decrease colonic spasms during endoscopy. Topically, peppermint has been used to relieve sunburn, arthritis pain, and neuralgia. It is also used in aromatherapy and as a flavoring in liquor, foods, mouthwash, and gum. Investigational Uses Peppermint is being studied for its anti–HIV-1, antiviral, and antibacterial actions. Actions Actions for mint are categorized by species (i.e., spearmint, peppermint). Spearmint and peppermint have similar actions, but research studies tend to focus on one species or the other. Anti–HIV-1 and Antiviral Actions One study evaluated the anti–HIV-1 activity of peppermint using various herbs of the Labiatae family (Yamasaki et al, 1998). Most of the plants tested showed significant anti–HIV-1 activity, including Mentha x piperita. The essential oils are believed to be responsible for this action. Peppermint has been shown to also possess antiviral activity against herpes simplex, Newcastle disease, and vaccinia (Leung, 1980). Antibacterial Action Other studies have reported on the antibacterial properties of peppermint. It has been shown to decrease Candida spp. Irritable Bowel Syndrome Persons with irritable bowel syndrome may find that peppermint oil relieves symptoms. In a placebo-controlled, double-blind study, Piper x piperita extract was evaluated for this purpose. Researchers found that peppermint oil decreased irritable bowel syndrome symptoms by inhibiting gastrointestinal smooth-muscle action (Pittler et al, 1998). Product Availability Enteric-coated capsules (peppermint), fluid extract, gum, liniment, lozenges, mouthwash, oil, ointment, tea, toothpaste Plant Parts Used: Leaves, oil extracted flowers Dosages Aromatherapy and Congestion Relief • Adult inhalant oil: use prn Irritable Bowel Syndrome • Adult PO enteric-coated peppermint oil capsules: 2 ml bid between meals (Murray, Pizzorno, 1998) Other • Adult PO capsules: 2 caps tid • Adult PO extract: 20 drops with 4 oz of water • Adult PO oil: 20 drops with 4 oz of water • Adult PO tea: place 1 tbsp leaves in 2 cups boiling water, steep 15 min; may be taken bid-tid • Adult topical ointment: apply prn to affected area up to tid Adverse effects: Underline = life-threatening P 496 Peppermint Contraindications Pregnancy category is 3; breastfeeding category is 3A. Peppermint should not be given internally to children. It should not be used internally by persons with hypersensitivity to it or by those with gallbladder inflammation, severe hepatic disease, gastroesophageal reflux disease, or obstruction of bile ducts. Peppermint should not be used topically on the face, particularly near the nose, or on infants or small children. Side Effects/Adverse Reactions GI: Nausea, anorexia, increased indigestion with hiatal hernia, exacerbation of biliary colic INTEG: Peppermint oil: hypersensitivity reactions (flushing, rash, headache, heartburn, mucous membrane irritation, urticaria, erythema); contact dermatitis (topical) SYST: Bronchospasm Interactions Drug Peppermint oil: antacids, H2-blockers, proton pump inhibitors: These agents may cause premature dissolution of enteric-coated peppermint oil (Jellin et al, 2008). Cytochrome P450 3A4 substrate: Peppermint oil may decrease drugs metabolized by cytochrome P450 3A4 substrates (Jellin et al, 2008). Pharmacology Pharmacokinetics Carminative action results from esophageal sphincter tone reduction. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Peppermint contains Volatile oil Menthol; Menthone Counterirritant; spasmolytic; antimicrobial (Iscan et al, 2002) Tannin Flavonoid Tocopherol Spearmint contains Carvone Limonene Phellandrene Pinene = Pregnancy Choleretic = Pediatric ! = Alert = Popular Herb Perilla 497 Client Considerations Assess • Assess for hypersensitivity reactions (see Side Effects). If present, discontinue the use of peppermint and administer an antihistamine or other appropriate therapy. Administer • Instruct the client to store peppermint products in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 3 and breastfeeding category is 3A. • Caution the client not to give peppermint to children. • Caution the client to keep peppermint oil products away from mucous membranes and abrasions. • Caution clients with gastroesophageal reflux disease not to use peppermint. It may worsen the condition. • Caution the client not to use peppermint oil with a heating pad or near an open flame. Perilla (puh-ri’luh) Scientific name: Perilla frutescens L. Other common names: Beefsteak plant, wild coleus Origin: Perilla is found in the Orient. Uses Perilla is used to treat allergic reactions and asthma. It is also used as a flavoring. Traditionally, perilla has been used as an antispasmodic, as well as to treat nausea, vomiting, and upper respiratory tract conditions. Investigational Uses Initial research is available that documents the use of perilla as a hyperlipidemic antiasthma and a cancer protectant. Actions Most of the research on perilla has focused on its ability to inhibit allergic reactions. Initial research has also begun to determine its hyperlipidemic and cancer protectant actions. Antiallergy Action One study tested the ability of perilla to inhibit induced systemic allergic reactions. Perilla was found to inhibit mast cell-mediated immediate-type allergic reactions (Shin et al, 2000). Other studies have also confirmed the use of perilla for the inhibition of allergic reactions (Imaoka et al, 1993; Ishihara et al, 1999). Luteolin, one of perilla’s chemical components, showed a potent inhibitor of tumor necrosis factor-alpha, inhibitor of oxazolone-induced allergic edema and an inhibitor of arachidonic acid (Ueda et al, 2002). Adverse effects: Underline = life-threatening P 498 Perilla Other Actions One study (Simoniene et al, 2005) identified the increase in phagocytosis activity in the laboratory. Another study (Korotkich et al, 2006) identified the inotropic and lusitropic effects of perilla on the rabbit myocardium. Product Availability Expressed oil of the seed, tea Plant Parts Used: Dried leaves, seeds Dosages Asthma • Adult PO seed oil: 10-20 g No other published dosages are available. Contraindications Until more research is available, perilla should not be used during pregnancy and breastfeeding. It should not be given to children. Persons with hypersensitivity to perilla should not use it. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions Interactions Drug Corticosteroids (betamethasone, dexamethasone, hydrocortisone, methylprednisolone, prednisolone, prednisone, triamcinolone): Perilla may augment the effect of corticosteroids; avoid concurrent use. Primary Chemical Components and Possible Actions Chemical Class Individual Component Benzoxepin Perilloxin; Dehydroperilloxin (Liu et al, 2000) Perillaldehyde; Perilla alcohol Perilla ketone Trans-caryophyllene; Hexadecanoic acid; Alpha-pinene; Citral; Limonene Apigenin; Shishonin Luteolin Essential oil Flavone = Pregnancy = Pediatric ! = Alert Possible Action Dermatitis Lung toxin Inhibitor of arachidonic-acid, tumor necrosis factor-alpha, oxazolone-induced allergic edema = Popular Herb Peyote 499 Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of perilla and administer an antihistamine or other appropriate therapy. Administer • Instruct the client to store perilla in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use perilla in children or those who are pregnant or breastfeeding until more research is available. Peyote ! (pay-oe’tay) Scientific name: Lophophora williamsii Other common names: Anhalonium, big chief, buttons, cactus, mesc, mescal, mescal buttons, mescaline, mexc, moon, pan peyote, peyote button Controlled Substance: Schedule I Origin: Peyote is found in Mexico and the southwestern region of the United States. Uses Traditionally, peyote has been used in Indian culture during religious activities. Other traditional uses include treatment for arthritis, rheumatism, snakebite, burns, cardiac ailments, addiction, and paralysis. Peyote is also used as a hallucinogenic, an antimicrobial, and a sedative. Topically, peyote is used for fractures and wounds. Its use is illegal in the United States and most European countries. Actions Hallucinogenic Action Research studies to date have focused on the hallucinogenic effects of peyote. One study (Keller et al, 1980) identified the ability of this herb to promote catecholamine metabolism. This research compared normal brain catecholamine formation with catecholamine metabolism that causes mind-altering effects. Results of these studies may eventually be useful in identifying a use for peyote in the treatment of mental illness. Other Actions Peyote was studied in the laboratory for tumor cell toxicity. It was concluded that peyote extracts were toxic to tumor cells and decreased immunopotentiating properties (Franco-Molina et al, 2003). Product Availability Basic pan peyote, button, mescaline hydrochloride, mescaline sulfate, soluble peyote, tincture Plant Parts Used: Dried tops, whole plant Dosages No published dosages are available. Adverse effects: Underline = life-threatening P 500 Peyote Contraindications ! Peyote should not be used during pregnancy and breastfeeding. It should not be given to children. Persons with hypersensitivity to this herb should not use it. Physical dependence and death can result from the use of peyote. Side Effects/Adverse Reactions CNS: Anxiety, paranoia, hallucinations, tremors, ataxia CV: Hypertension, tachycardia GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions SYST: Death Interactions Drug CNS stimulants: Peyote may increase central nervous system stimulation when taken with these agents. Pharmacology Pharmacokinetics Peak 4-6 hours; duration 14 hours. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Alkaloid Mescaline Formylmescaline; Acetylmescaline; Methylmescaline; Demethylmescaline; Dimethoxyphenylethylamine; Tyramine; Hordenine; Candicine; Anhalamine; Anhaladine; Anhalanine; Formylanhalamine Hallucinogenic Client Considerations Assess • Assess the client’s use of this drug or other hallucinogens (see Interactions). Administer ! • Peyote should not be administered for any reason. Use of this herb is illegal in the United States and most European countries. Physical dependence and death can occur from its use. Teach Client/Family • Caution the client not to use peyote in children or those who are pregnant or breastfeeding. • Advise the client that peyote is illegal and is not considered useful for any condition. ! • Inform the client that physical dependence and death can result from peyote use. = Pregnancy = Pediatric ! = Alert = Popular Herb Pill-Bearing Spurge 501 Pill-Bearing Spurge (pil beh’ring spuhrj) Scientific names: Euphorbia pilulifera; also known as Euphorbia hirta, Euphorbia capitata Other common names: Asthma weed, catshair, euphorbia, garden spurge, milkweed, queensland asthmaweed, snake weed Origin: Pill-bearing spurge is an annual found in India, Australia, and the southwestern region of the United States. Uses Pill-bearing spurge is used to treat respiratory conditions such as asthma, bronchitis, and allergies. It is also used for expulsion of worms and to treat colds, diarrhea, amebiasis, sexually transmitted diseases, snake bite, and ophthalmic conditions. Actions Very little primary research has been done on pill-bearing spurge. Most research or literature identifies the toxicity of the plant. One study identifies the cancer risk for humans who consume products from livestock fed species of spurge (Zayed et al, 1998). Iranians who consumed milk from goats and sheep fed spurge showed a high local incidence of esophageal cancer. Another earlier study discusses the tumorproducing action of spurge (Hergenhahn et al, 1984). One study identified the antidiarrheal action of spurge resulting from quercetin, one of its chemical components (Galvez et al, 1993). Another study has shown the sedative actions of this herb, with lower doses producing an anxiolytic action (Lanhers et al, 1991). Product Availability Capsules, fluid extract, powder, tablets, tincture Plant Part Used: Dried whole plant Dosages • Adult PO fluid extract: 0.2-0.3 ml tid (1:1 dilution in 45% alcohol) • Adult PO infusion: 120-300 mg tid • Adult PO powder: 120-300 mg tid • Adult PO tincture: 0.5-2 ml tid (1:5 dilution in 60% alcohol) Contraindications Until more research is available, pill-bearing spurge should not be used during pregnancy and breastfeeding. It should not be given to children. Persons with hemophilia, von Willebrand’s disease, or other bleeding disorders should not use this herb. Persons with hypersensitivity to pill-bearing spurge should not use it. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, gastric symptoms INTEG: Hypersensitivity reactions, contact dermatitis Interactions Drug ACE inhibitors: ACE inhibitors may increase hypotension when used with pill-bearing spurge; avoid concurrent use (theoretical). Continued Adverse effects: Underline = life-threatening P 502 Pill-Bearing Spurge Interactions—cont’d Anticholinergics (atropine, belladonna, scopolamine): Pill-bearing spurge may decrease the effects of anticholinergics; avoid concurrent use (theoretical). Anticoagulants (heparin, salicylates, warfarin), barbiturates (phenobarbital), cholinesterase inhibitors (edrophonium, donepezil, physostigmine): Pill-bearing spurge may increase the effects of anticoagulants, barbiturates, cholinesterase inhibitors; avoid concurrent use (theoretical). Disulfiram: Reaction may occur when disulfiram is used with pill-bearing spurge; do not use concurrently (theoretical). Primary Chemical Components and Possible Actions Chemical Class Choline Shikimic acid Flavonoid Triterpene Sterol Alkane Phenol Resin Tannin Individual Component Possible Action Antispasmodic Antispasmodic Quercitrin; Quercetin; Leuocyanidin Taraxerone; Taraxerol; Alpha-amyrin; Beta-amyrin Campesterol; Sitosterol Hentriacontane Sinapylglutathione Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of pillbearing spurge and administer an antihistamine or other appropriate therapy. • Assess all medications used by the client. Several theoretical drug interactions may occur (see Interactions). Administer • Instruct the client to store pill-bearing spurge in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use pill-bearing spurge in children or those who are pregnant or breastfeeding until more research is available. • Give the client a written list of medications that should not be taken with this herb. • Advise the hypersensitive client to avoid even touching this herb. = Pregnancy = Pediatric ! = Alert = Popular Herb Pineapple 503 Pineapple (pine’a-puhl) Scientific name: Ananas comosus Other common names: Ananas, golden rocket, smooth cayenne Origin: Pineapple is found in South America, Thailand, and Hawaii. Uses Pineapple is used therapeutically to treat obesity and constipation. Topically, pineapple may be used to treat wounds and inflammation. Actions Antifungal Action One study found that the chemical components of pineapple stems possess antifungal effects against Pythium sp. (Tawata et al, 1996). Other Actions Bromelain, a chemical component of pineapple, has shown promise as a platelet aggregation inhibitor. Bromelain also possesses fibrinolytic, antiinflammatory, antitumor, and skin debridement actions (Taussig et al, 1988). Another study (Rowan et al, 1990) showed rapid debridement of wounds using enzyme fractions from the pineapple stem. Debridement occurred within 4 hours. Xie et al (2005) identified antidiabetic and antidyslipidemic action of pineapple. One study (Báez et al, 2007) focused on the antitumoral activity of pineapple. Product Availability Candy, extract, flavorings, juice, syrups, whole fruit Plant Part Used: Fruit Dosages No published dosages are available. Contraindications Until more research is available, pineapple should not be used therapeutically during pregnancy and breastfeeding. It should not be given therapeutically to children. Pineapple should not be used therapeutically by persons with coagulation disorders. Persons with hypersensitivity to pineapple should not use it. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, diarrhea, stomatitis GU: Uterine contractions INTEG: Hypersensitivity reactions, rash Interactions Drug ACE inhibitors: Pineapple may antagonize the action of ACE inhibitors; avoid concurrent use. Anticoagulants (heparin, salicylates, warfarin): Pineapple may increase bleeding time when used with anticoagulants; avoid concurrent use. Adverse effects: Underline = life-threatening P 504 Pipsissewa Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Proteolytic enzyme Bromelain Wound healing; antiinflammatory; antitumor Acid Vitamin Malic acid; Citric acid A; C Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of pineapple and administer an antihistamine or other appropriate therapy. • Assess for the use of ACE inhibitors and anticoagulants (see Interactions). Administer • Instruct the client to store pineapple in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use pineapple therapeutically in children or those who are pregnant or breastfeeding until more research is available. • Advise the client not to use large amounts of pineapple; gastrointestinal upset may occur. Pipsissewa (pip-si’suh-wah) Scientific name: Chimaphila umbellata Other common names: Ground holly, prince’s pine, spotted wintergreen, wintergreen Origin: Pipsissewa is a perennial found in North America, Europe, and Asia. Uses Pipsissewa is used as an astringent and antispasmodic, as well as to treat anxiety, seizures, gastrointestinal disorders, and kidney stones. The most common use is as a urinary antiseptic. It is used topically to treat decubitus ulcers, venous statis ulcers, and superficial wounds. Investigational Uses Pipsissewa is used experimentally as a treatment for diabetes and urinary tract infections. Actions Very little information is available for pipsissewa. One study (Hausen et al, 1988) identified a naturally occurring quinone present in pipsissewa. Chimaphilin, a naphthoquinone, was found to cause contact dermatitis. Another older study (Segelman et al, 1969) found pipsissewa to possess hypoglycemic properties. Galván et al (2008) identified the antifungal and antioxidant activity of pipsissewa. = Pregnancy = Pediatric ! = Alert = Popular Herb Pipsissewa 505 Product Availability Crude extract Plant Part Used: Dried herb Dosages No published dosages are available. Contraindications Until more research is available, pipsissewa should not be used during pregnancy and breastfeeding. It should not be given to children. Persons with peptic or duodenal ulcers, ulcerative colitis, Crohn’s disease, diabetes mellitus, gastroesophageal reflux disease, or iron deficiency should not use this herb. Persons who are hypersensitive to pipsissewa should not use it. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, diarrhea, gastrointestinal irritation INTEG: Hypersensitivity reactions Interactions Drug Minerals: Minerals should be taken 2 hours before or after this herb. Primary Chemical Components and Possible Actions Chemical Class Arbutin Naphthoquinone Individual Component Chimaphilin Possible Action Urinary antiseptic Contact dermatitis; urinary antiseptic; bacteriostatic Hydroquinone Ericolin Chlorophyll Urson Isohomarbutin Reinfolin Homogentisic acid Toluquinol Hyperoside Taraxasterol Nonacosane Methyl salicylate Mineral Pectic acid Tannin Resin Gum Starch Sugar Adverse effects: Underline = life-threatening P 506 Plantain Client Considerations Assess • Assess for hypersensitivity reactions and contact dermatitis. If present, discontinue the use of this herb and administer an antihistamine or other appropriate therapy. Administer • Instruct the client to store pipsissewa in a cool, dry place, away from heat and moisture. • Instruct the client to take mineral supplements 2 hours before or after this herb. • Inform the client that pipsissewa is not for long-term use because of its hydroquinine content. Pipsissewa can cause hydroquinone toxicity (tinnitus, nausea, vomiting, convulsions, collapse). Teach Client/Family • Caution the client not to use pipsissewa in children or those who are pregnant or breastfeeding until more research is available. Plantain (plan’tuhn) Scientific names: Plantago lanceolata, Plantago major, Plantago psyllium, Plantago ovata Other common names: Blond plantago, broadleaf plantain, buckhorn, cart tract plant, common plantain, English plantain, flea seed, French psyllium, greater plantain, Indian plantago, lanten, narrowleaf plantago seed, plantain seed, psyllium, ribwort, ripple grass, snakeweed, Spanish psyllium, tract plant, way-bread, white man’s foot, wild plantain, wild saso Origin: Plantain is found worldwide. Uses Several different products are derived from plantain. Psyllium is used as a bulk laxative. Other internal uses include treatment for cough, urinary tract conditions, and diarrhea. Two plantain species are used to treat inflammation from burns and wounds. Plantain leaves are used topically for wound healing. Investigational Uses Plantain is used experimentally for the treatment of cancer and immunosuppressive disorders. Actions Two chemical components of Plantago media, verbascoside and homoplantaginin, have shown variable antiproliferative actions (Kunvari et al, 1999). Plantago lanceolata has been shown to decrease inflammation in the respiratory tract and may be recommended as a treatment for moderate chronic cough, especially for children (Wegener et al, 1999). One study showed the gastroprotective action of the chemical component polyholozide. This chemical component also has laxative action at higher doses (Hriscu et al, 1990). Another study (Rezaeipoor et al, 2000) has shown suppression of the humoral immune response in rabbits given Plantago ovato. = Pregnancy = Pediatric ! = Alert = Popular Herb Plantain 507 Product Availability Fluid extract, psyllium seeds, powder, tablets, tincture Plant Parts Used: Husks, leaves, and seeds depending on product Dosages • Adult PO fluid extract: 2-4 ml tid (1 : 1 dilution) • Adult PO seeds: 7.5 g with several glasses of water Contraindications Until more research is available, plantain should not be used during pregnancy and breastfeeding. It should not be used by persons with intestinal obstruction. Persons who are hypersensitive to plantain should not use it. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, flatus, diarrhea, bloating, obstruction INTEG: Hypersensitivity reactions, dermatitis SYST: Anaphylaxis Interactions Drug Antidiabetics, cardiac agents (beta-blockers, calcium channel blockers, cardiac glycosides): Plaintain may increase the effects of antidiabetics, cardiac agents; avoid concurrent use. Carbamazepine, lithium: Plantain may decrease the effects of carbamazepine, lithium; avoid concurrent use. Iron salts: Plantain tea may decrease the absorption of iron salts. Oral medications: Plantain may decrease absorption of all oral medications; separate by several hours. Herb Vitamins/minerals: Plantain may decrease absorption. Food Nutrients: Plantain with meals may decrease nutrient absorption. Lab Test Blood glucose: Plantain may decrease blood glucose testing (theoretical). Cholesterol: Plantain may decrease total cholesterol, LDL, HDL ratio test results. Digoxin level: Plantain may cause a false increase in serum digoxin. Primary Chemical Components and Possible Actions Chemical Class* Alkaloid Flavonoid Individual Component Possible Action Verbascoside; Homoplantaginin Possible antitumor Amino acid *Varies depending on species Continued Adverse effects: Underline = life-threatening P 508 Pokeweed Primary Chemical Components and Possible Actions—cont’d Chemical Class Tannin Mucilage Polysaccharide Lipid Glycoside Terpenoid Polyholozidic Phenylethanoid Individual Component Acteoside; Plantamajoside Cistanoside; Lavandulifolioside; Isoacetoside Possible Action Gastroprotective Inhibits arachidonic acid Client Considerations Assess ! • Assess for hypersensitivity reactions, which can be severe, including anaphylaxis. If present, plantain should be discontinued and antihistamines or other appropriate therapy administered immediately. • Assess bowel pattern if using as a bulk laxative. • Assess medication use (see Interactions). Administer • Instruct the client to store plantain in a cool, dry place, away from heat and moisture. • Instruct the client to take all other medications 2 hours before or 2 hours after this herb to ensure proper absorption. Teach Client/Family • Caution the client not to use plantain in those who are pregnant or breastfeeding until more research is available. Pokeweed ! (poek’weed) Scientific name: Phytolacca americana Other common names: Cancer jalap, cancer root, changras, coakum, crowberry, garget, pigeonberry, pocon, pokeberry, poke salad, redink plant, redwood, scoke, txiu kub nyug, Virginia poke Origin: Pokeweed is a perennial found in the eastern region of North America. Uses Pokeweed has been used as a laxative and an emetic. It is also used to treat pruritus, rheumatic disorders, and upper respiratory tract infections including cough, sore throat, and pharyngitis. = Pregnancy = Pediatric ! = Alert = Popular Herb Pokeweed 509 Investigational Uses Pokeweed is being investigated for its antifungal, antiviral, flu, HSV-1, polio, and antitumor uses. Actions Most research available for pokeweed focuses on the antifungal or antiviral actions. Product Availability Dried root, extract, powder, tincture Plant Parts Used: Fruit, leaves, roots, stems Dosages Emesis • Adult PO dried root: 60-300 mg Other • Adult PO extract: 0.2-0.5 ml Contraindications ! Pregnancy category is 6; breastfeeding category is 5A. Because it is teratogenic, pokeweed should not be used during pregnancy. Until more research is available, it should not be used during breastfeeding. Pokeweed should not be given to children; deaths have been reported. Persons who are hypersensitive to pokeweed should not use it. Side Effects/Adverse Reactions CNS: Confusion, ataxia, dizziness, headache, weakness, sweating, tremors; seizures, coma (rare) CV: Hypotension, tachycardia (rare) EENT: Blurred vision, eye itching and irritation, sneezing GI: Nausea, vomiting, anorexia, diarrhea INTEG: Hypersensitivity reactions, contact dermatitis RESP: Respiratory depression (rare) Interactions Drug CNS depressants (alcohol, benzodiazepines, opiates, sedative/ hypnotics): Pokeweed may increase the action of central nervous system depressants; avoid concurrent use. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Saponin Phytolaccigenin Phytolaccoside A-G Phytolaccatoxin; Asparagine; Oxalic acid 1, 2, 3, 4, 5, 6 Toxic Glycoprotein Triterpene glycosides Tannin Continued Adverse effects: Underline = life-threatening P 510 Pomegranate Primary Chemical Components and Possible Actions—cont’d Chemical Class Resin Betacyanin Neo-lignan Ferredoxin Lectin Lignan Flavonoids Individual Component Possible Action Betanin Isoamericanol A; Americanol A Ferredoxin I, II Kaempferol; Quercetin Antioxidant (Bylka et al, 2001) Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of this herb and administer an antihistamine or other appropriate therapy. • Assess for the use of central nervous system depressants (see Interactions). ! • Assess for toxicity. Deaths have been reported. Administer • Instruct the client to store the dried root of pokeweed in a paper or cloth sack, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 6 and breastfeeding category is 5A. ! • Warn the client not to give pokeweed to children and to store it out of the reach of children and pets. Poisoning can occur. • Instruct the client to institute emergency poison treatment in small children who ! consume even one berry. • Advise the client not to perform hazardous activities such as driving or operating heavy machinery until physical response to the herb can be evaluated. Pomegranate ! (pahm’uh-gra-nuht) Scientific name: Punica granatum Other common name: Granatum Origin: Pomegranate is found throughout the world. Uses Pomegranate is used as an anthelmintic for tapeworm and opportunistic intestinal worms, as well as to treat diarrhea. It is also used to treat hemorrhoids, as a gargle for sore throat, and as an abortifacient. Pomegranate may be effective as an antimicrobial, in the treatment of diabetes, and as an antioxidant. = Pregnancy = Pediatric ! = Alert = Popular Herb Pomegranate 511 Actions The proposed actions for pomegranate include hypoglycemic, antidiarrheal, antimicrobial, and anthelmintic. Blood glucose levels were reduced when the extract was given to hyperglycemic rats (Jafri et al, 2000). Diarrhea was reduced significantly when the extract of pomegranate seeds was given to rats induced with diarrhea by castor oil (Das et al, 1999). Antimicrobial, Amebicide, and Anthelmintic Actions Effective antiviral action was shown against genital herpes virus (HSV-2) in cell cultures when pomegranate was used (Zhang et al, 1995). Many herbs grown in Peru were tested against Vibrio cholerae, which is prevalent in that part of the world. Tea infusions and decoction of pomegranate showed the best action against this organism (Guevara et al, 1994). Another study evaluated the use of pomegranate root against Entamoeba histolytica and Entamoeba invadens. The alkaloids of the root showed no amebicide action; however, the tannic acid showed high inhibition of these organisms (Segura et al, 1990). Many herbs have been studied for their anthelmintic action against human Ascaris lumbricoides. However, only moderate inhibition has been shown when pomegranate is used in vitro (Raj, 1975). Other Actions Pomegranate peel extract has been shown to possess significant antioxidant activity in various in vitro models (Chidambara et al, 2002). One study (Kim et al, 2002) identified the chemoprotective potential of pomegranate for human breast cancer. Another study (Lansky et al, 2007) identified a wide range of clinical applications for the treatment and prevention of cancer and other diseases in which chronic inflammation plays an essential role. Tumor necrosis factor was suppressed in cells in the laboratory by pomegranate (Jung et al, 2006). Product Availability P Crude herb Plant Parts Used: Bark, fruit, pell, roots, stem Dosages No published dosages are available. Contraindications Because it is an abortifacient, pomegranate should not be used therapeutically during pregnancy. Until more research is available, pomegranate should not be used therapeutically during breastfeeding. It should not be given therapeutically to children. Pomegranate should not be used therapeutically by persons with hepatic disease or asthma. Persons who are hypersensitive to pomegranate should not use it. Side Effects/Adverse Reactions CV: Decreased blood pressure GI: Nausea, vomiting, anorexia, hepatotoxicity INTEG: Hypersensitivity reactions MISC: Carcinogenic Overdose: Hematemesis, vision disturbance, acidosis, cardiovascular shock, death Continued Adverse effects: Underline = life-threatening 512 Pomegranate Interactions Drug ACE inhibitors, antihypertensives: Pomegranate juice may increase the action of these agents (theoretical). Herb Hypotensive herbs: Pomegranate juice may increase hypotension when used with hypotensive herbs. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Alkaloid Pelletierine; Methylpelletierine; Pseudopelletierine; Isopelletierine Anthelmintic; hypoglycemic; antidiarrheal Phenol Acid Monoacylglycerol Bark and rinds also contain Tannin Gallic acid; Ellagic acid Punicalin; Punicalagin; Granatins A, B; Gallaglydilactone; Casuarinin; Tellimagrandin; Corilagin Antimicrobial Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of this herb and administer an antihistamine or other appropriate therapy. ! • Monitor hepatic function tests (ALT, AST, bilirubin) for hepatotoxicity; pomegranate should be discontinued if hepatic function tests are elevated. ! • Monitor for overdose symptoms (see Side Effects). Administer • Instruct the client to store pomegranate in a sealed container, away from heat and moisture. Teach Client/Family • Caution the client not to use pomegranate therapeutically during pregnancy because it is an abortifacient. Until more research is available, caution the client not to use pomegranate therapeutically in children or those who are breastfeeding. = Pregnancy = Pediatric ! = Alert = Popular Herb Poplar 513 Poplar (pahp’luhr) Scientific names: Populus alba, Populus tremuloides, Populus nigra Other common names: American aspen, black poplar, quaking aspen, white poplar Origin: Poplar is a tree found in the United States. Uses Poplar is used to treat arthritis and other joint conditions, diarrhea, urinary tract infections, colds, cough, flu, and gastrointestinal disorders. Actions Very little information on the therapeutic actions of poplar is available. Most studies focus on agricultural rather than medicinal use of the tree. Because of the presence of salicin, a salicylate, many of the actions and uses are the same as commercially prepared salicylates. Only one study could be found for any other actions. In this study the antiviral actions of the poplar tree leaf buds were identified (Amoros et al, 1994). Product Availability Dried bark, fluid extract Plant Part Used: Bark Dosages • Adult PO decoction: 2-5 g powdered bark, decocted, tid • Adult PO fluid extract: 2-5 ml tid (1:1 dilution in 25% alcohol) • Adult PO powdered bark: 2-5 g tid • Adult topical: 5 g dried bud per day (Jellin et al, 2008) Contraindications Until more research is available, poplar should not be used during pregnancy and breastfeeding. It should not be given to children younger than 12 years of age. Persons with hypersensitivity to salicylates, peptic ulcer disease, gastrointestinal bleeding, coagulation disorders, nasal polyps, or asthma should use this herb cautiously. Persons who are hypersensitive to poplar should not use it. Side Effects/Adverse Reactions EENT: Tinnitus GI: Nausea, vomiting, anorexia, gastrointestinal bleeding, hepatotoxicity INTEG: Hypersensitivity reactions, pruritus, rash; contact dermatitis (propolis only) Interactions Drug Anticoagulants (heparin, salicylates, warfarin): Poplar may increase bleeding time when used with anticoagulants; avoid concurrent use. Iron salts: Poplar tea may decrease the absorption of iron salts; separate by 2 hours. Adverse effects: Underline = life-threatening P 514 Poppy Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Glycoside Salicin Populin; Tremuloidin; Tremulacin Salicylate Tannin Triterpene Alpha-amyrin Beta-amyrin Sugar Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of this herb and administer an antihistamine or other appropriate therapy. Cross-sensitivity may occur with propolis, Peru balsam, salicylates (Jellin et al, 2008). • Assess for anticoagulant use (heparin, warfarin, salicylates). Concurrent poplar use should be avoided (see Interactions). Administer • Instruct the client to store poplar in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use poplar during pregnancy and breastfeeding until more research is available. • Advise the client not to give poplar to children younger than 12 years of age. Reye’s syndrome may occur with viral infections (theoretical). Poppy (pah’pee) Scientific names: Papaver somniferum, Papaver bracteatum Other common names: Great scarlet poppy, opium poppy, poppyseed, thebaine poppy, California poppy Origin: Poppy is an annual found throughout the world. Uses Poppy is used as a sedative, an antitussive, a treatment for diarrhea, and to relax gastrointestinal and smooth muscles. It is also used as an analgesic to treat colic and painful wounds. Actions Poppy is used as an illicit drug and to manufacture opiates. It is able to decrease pain impulse transmission at the spinal cord level by interacting with opiate receptors. Although most opiates are now synthetically manufactured, Papaver somniferum is still used in some parts of the world for opiate production. One study identified three = Pregnancy = Pediatric ! = Alert = Popular Herb Poppy 515 compounds present in poppy: narcotine, papaverine, and thebaine (Paul et al, 1996). In the event of testing for the use of illicit drugs, the presence of these three chemicals confirms ingestion of the poppy plant. Product Availability None available commercially Plant Parts Used: Seeds are used in bread and confections Dosages • Adult PO tea: 1 cup (2 g herb in 150 ml boiling water 10-15 min, strain) up to qid (Jellin et al, 2008) • Adult PO liquid extract: 1-2 ml per day (Jellin et al, 2008) Contraindications Until more research is available, poppy should not be used during pregnancy and breastfeeding. It should not be given to children. Persons who are hypersensitive to poppy should not use it. Side Effects/Adverse Reactions CNS: Clonic twitching, dizziness, weakness, headache, tremors, central nervous system depression GI: Nausea, vomiting, anorexia, abdominal contractions INTEG: Hypersensitivity reactions, pruritus, rash RESP: Respiratory depression Interactions Drug CNS depressants (alcohol, barbiturates, benzodiazepines, other opiates, sedative/hypnotics): Poppy increases central nervous system depression when used with CNS depressants; do not use concurrently. MAOIs: Poppy may increase the action of MAOIs. Lab Test Urine heroin, urine morphine: Poppy may cause a false positive result in urine heroin and urine morphine tests. Pharmacology Pharmacokinetics Very little is known about the pharmacokinetics in humans except when synthetic forms such as morphine are used. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Opiate Narcotine Papaverine Thebaine Isoquinoline Alkaloids Codeine; Morphine Opiate analgesic Cryptonine Uterine stimulant (Jellin et al, 2008) Adverse effects: Underline = life-threatening P 516 Prickly Ash Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of this herb and administer an antihistamine or other appropriate therapy. • Assess for the use of central nervous system depressants, MAOIs (see Interactions). Administer • Instruct the client to take poppy PO. Teach Client/Family • Caution the client not to use poppy in children or those who are pregnant or breastfeeding until more research is available. Prickly Ash (prik’lee ash) Scientific name: Zanthoxylum americanum Other common names: Angelica tree, northern prickly ash, toothache tree, yellow wood Origin: Prickly ash is a tree found in the United States. Uses Prickly ash is used to treat flatulence, fever, and circulatory disorders such as low blood pressure. Traditionally, prickly ash has been used to treat gastrointestinal disorders and to decrease inflammation resulting from arthritis and rheumatism. Actions There are very few research studies on prickly ash. One study (Gessler et al, 1994) identified the antimalarial action of Zanthoxylum chalybeum. Forty-three different herbs were tested for their antimalarial activity against Plasmodium falciparum. Of these 43 herbs, several plant parts were studied. The four most active herbs in the study were Cissampelos mucronata, Maytenus senegalensis, Salacia madagascariensis, and Zanthoxylum chalybeum. Another study identified hepatic carcinogen-metabolizing enzymes, among them cytochrome P450 (Banerjee et al, 1994). Researchers concluded that essential oils from prickly ash affect the enzymes present for activation and detoxication of certain antibiotics that use these enzymes in metabolism. Another study identified the reason for toxicity in cattle (Bowen et al, 1996). Toxicity was found to be due to an inhibitory reaction, resulting in hypotension that could be antagonized by calcium and neostigmine. Another study (Bafi-Yeboa et al, 2005) identified antifungal constituents of prickly ash. Product Availability Bark, fluid extract, tincture Plant Parts Used: Bark, berry Dosages • Adult PO bark: 1-3 g dried bark (Jellin et al, 2008) • Adult PO bark decoction: 1-3 g dry bark in water, 10-15 min, strain tid (Jellin et al, 2008) • Adult PO liquid bark extract: (1:1) 1-3 ml tid (Jellin et al, 2008) = Pregnancy = Pediatric ! = Alert = Popular Herb Prickly Ash 517 • Adult PO bark tincture: (1:5) 2-5 ml tid (Jellin et al, 2008) • Adult PO liquid berry extract: (1:1) 0.5-1.5 ml (Jellin et al, 2008) Contraindications Pregnancy category is 3; breastfeeding category is 2A. Prickly ash should not be given to children. Persons with peptic or duodenal ulcers, inflammatory conditions of the gastrointestinal tract, or hypersensitivity to this or related herbs should not use prickly ash. Side Effects/Adverse Reactions CV: Hypotension GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions, photosensitivity SYST: Bleeding Interactions Drug Antacids, H2-blockers, proton pump inhibitors: Prickly ash may decrease the action of these agents (theoretical). Anticoagulants (heparin, salicylates, warfarin): Prickly ash may increase bleeding when used with anticoagulants; avoid concurrent use. Iron salts: Prickly ash tea may decrease the absorption of iron salts; separate by 2 hours. Herb Anticoagulant/antiplatelet herbs: Prickly ash used with anticoagulant/ antiplatelet herbs may increase risk of bleeding. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Coumarin Xanthyletin; Xanthoxyletin; Allo-xanthoxyletin; Dipetaline Sesamin; Asarinin Anticoagulant Ligans Tannin Resin Alkaloid Volatile oil Isoquinoline alkaloid Furanocoumarin Cytotoxic Nitidine; Laurifoline Berberine Antifungal Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of this herb and administer an antihistamine or other appropriate therapy. • Assess for the use of anticoagulants (heparin, warfarin, salicylates). These drugs should not be used with prickly ash (see Interactions). Adverse effects: Underline = life-threatening P 518 Propolis Administer • Instruct the client to store prickly ash in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 3 and breastfeeding category is 2A. • Caution the client not to give prickly ash to children. Propolis (prah’puh-luhs) Scientific names: Propolis balsam, propolis resin, propolis wax Other common names: Bee glue, hive dross, Russian penicillin Origin: Propolis is a natural product of bees. Uses Traditionally, propolis has been used to treat inflammation and to promote wound healing. Propolis may be used for tuberculosis and bacterial, fungal, and protozoal infections. Investigational Uses Propolis may have antioxidant and antitumor uses. It may also be used as an antiinflammatory to treat a variety of conditions. Actions Most of the information on propolis focuses on contact dermatitis, which is quite common. Several articles have been published since 1976 on this hypersensitivity reaction. Most other research focuses on the antimicrobial actions of propolis. Studies have shown antiviral action against herpes simplex virus type I (Amoros et al, 1992), antiinfluenza action (Serkedjieva et al, 1992), and antibacterial actions that are significant and nonspecific (Dimov et al, 1992). Propolis has also been effective against Streptococcus mutans present in the mouth (Park et al, 1998). Another proposed action has been antiinflammation (Khayyal et al, 1993). Product Availability Tablets 600 mg; capsules 200, 500, 600 mg; topical cream, fluid extract, lozenges, gum, jelly Plant Part Used: Buds of conifers Dosages • Adult PO capsules or tablets: 600 mg daily • Adult fluid extract: 15-30 gtt mixed in 3-4 oz warm water tid • Adult topical cream: apply to affected area prn Contraindications Until more research is available, propolis should not be used during pregnancy and breastfeeding. It should not be given to children. Persons who are hypersensitive to propolis or bee products should not use it. Those with asthma should not use this product. = Pregnancy = Pediatric ! = Alert = Popular Herb Pulsatilla 519 Side Effects/Adverse Reactions GI: Nausea, anorexia, oral mucositis, stomatitis INTEG: Hypersensitivity reactions, dermatitis, eczema Primary Chemical Components and Possible Actions Chemical Class Resin Wax Essential oil Pollen Flavonoid Prenyl esters P-coumaric acid Individual Component Possible Action Pinocembrin; Pinobanksin; Galangin; Chrysin Caffeic acid, Ferulic acid Antimicrobial Antimicrobial Antimicrobial Client Considerations Assess • Assess for hypersensitivity reactions, contact dermatitis, and oral mucositis. If present, discontinue the use of this herb and administer an antihistamine or other appropriate therapy. Administer P • Instruct the client to store propolis in a cool, dry place, away from heat and moisture. Teach Client/Family • Instruct the client not to use propolis in children or those who are pregnant or breastfeeding until more research is available. Pulsatilla (puhl-suh-til’uh) Scientific name: Anemone pulsatilla Other common names: Crowfoot, Easter flower, kubjelle, meadow anemone, meadow windflower, pasque flower, prairie anemone, smell fox, stor, wind flower Origin: Pulsatilla is a perennial found in Europe. Uses Pulsatilla traditionally has been used as a sedative and diuretic, as well as to treat insomnia, cough, genitourinary disorders, menstrual irregularities, headache, otitis media, and eye conditions including cataract, glaucoma, iritis, and scleritis. Topically, pulsatilla is used for boils and skin eruptions (Jellin et al, 2008). Adverse effects: Underline = life-threatening 520 Pulsatilla Actions Pulsatilla has shown promise in the treatment of otitis media in children. Herbalists have used this plant for many years to treat this condition (Friese et al, 1997). However, little primary research is available to support this use. Protoanemonin is known to be a central nervous system depressant and to induce abortions. Product Availability Dried herb, fluid extract, homeopathic products, tincture Plant Parts Used: Dried leaves, flowers, stems Dosages • Adult PO fluid extract: 0.1-0.3 ml tid (1:1 dilution in 25% alcohol) • Adult PO infusion: 0.1-0.3 g dried herb infusion tid • Adult PO tea: 1⁄2 tsp dried herb in 1 cup boiling water, let stand 15 min, drink tid • Adult PO tincture: 0.5-3 ml tid (1:10 dilution in 25% alcohol) Contraindications Because it is an abortifacient, pulsatilla should not be used during pregnancy. Until more research is available, this herb should not be used during breastfeeding. Persons who are hypersensitive to pulsatilla should not use it. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia; burning of the tongue, throat (chewing) GU: Albuminuria, hematuria, irritation INTEG: Hypersensitivity reactions Toxicity: Seizures, dizziness, blurred vision, sneezing paralysis, irritation of nasal passages and throat, vomiting, abdominal cramping and pain, diarrhea, nephrotoxicity Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Glucoside Protoanemonin Central nervous system depression; abortifacient; sedative antipyretic (Jellin et al, 2008) Saponin Tannin Volatile oil Acid Chelidonic acid; Succinic acid Flavonoid Glucose = Pregnancy = Pediatric ! = Alert = Popular Herb Pumpkin 521 Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of this herb and administer an antihistamine or other appropriate therapy. ! • Assess for toxicity: seizures, dizziness, blurred vision, sneezing paralysis, irritation of nasal passages and throat, vomiting, abdominal cramping and pain, diarrhea, and nephrotoxicity. Administer • Instruct the client to store pulsatilla in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use pulsatilla during pregnancy because it is an abortifacient. Until more research is available, caution the client not to use this herb during breastfeeding. ! • Because of its toxicity, advise the client not to touch the pulsatilla plant. Pumpkin (puhmp’kuhn) Scientific names: Cucurbita pepo, Cucurbita maxima, Cucurbita moschata Other common names: Cucurbita, pumpkinseed, vegetable marrow Origin: Pumpkin is found in Canada and the United States. Uses Pumpkin is used as an anthelmintic, primarily for tapeworms, and to treat benign prostatic hypertrophy (BPH), childhood enuresis, and irritable bladder. Actions Pumpkin has been shown to reduce benign prostatic hypertrophy and to decrease human tapeworms, although no studies for either use are available. One study (Tarhan et al, 2007) identified antioxidant properties of the flower extract. Product Availability Seed extract, seed oil, seeds, tablets, tea Plant Part Used: Seeds Dosages Anthelmintic • Adult PO: 20-150 g tid Dysuria due to BPH • Adult PO: 5 g of ground seeds bid (Jellin et al, 2008) Other • Adult PO seeds: 10 g/day coarsely ground seeds taken with fluids Adverse effects: Underline = life-threatening P 522 Pycnogenol Contraindications Until more research is available, pumpkin should not be used therapeutically during pregnancy and breastfeeding. Persons who are hypersensitive to pumpkin should not use it. Side Effects/Adverse Reactions ENDO: Electrolyte loss (sodium, potassium chloride) GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions Interactions Drug Diuretics: Pumpkin may increase the action of diuretics; use together cautiously. Primary Chemical Components and Possible Actions Chemical Class Individual Component Amino acid Fatty acid Cucurbitin Oleic acid; Linoleic acid; Palmitic acid; Stearic acid Calcium; Selenium; Zinc; Copper; Iron; Manganese; Phosphorous; Potassium Mineral Possible Action Tocopherol Carotenoid Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of this herb and administer an antihistamine or other appropriate therapy. • Assess electrolytes levels (sodium, potassium, chloride) if the client is using pumpkin for an extended period to treat BPH. • Assess for expulsion of worms if the client is using pumpkin as an anthelmintic. Administer • Instruct the client to store pumpkin in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use pumpkin therapeutically during pregnancy and breastfeeding until more research is available. Pycnogenol Scientific names: Procyanidol oligomers from Pinus maritima; also known as Pinus nigra var. maritima Other common name: Pine bark Origin: Pycnogenol is a mixture of bioflavonoids found in pine bark. = Pregnancy = Pediatric ! = Alert = Popular Herb Pycnogenol 523 Uses Pycnogenol is used to treat hypoxia in cardiac or cerebral infarction. It is also used as an antioxidant, an antitumor, and to treat inflammation. Pycnogenol is often used in place of grape seed extract. Investigational Uses Research is underway for the uses of pycnogenol in melasma, attention deficit– hyperactivity disorder, gingival bleeding, plaque formation, chronic venous insufficiency, reduction of platelet aggregation, systemic lupus erythematous, and vascular retinopathies. Actions Pycnogenol is a mixture of bioflavonoids found in pine. Preliminary research suggests antioxidant and antitumor actions, inhibition of tumor necrosis factor (TNF)alpha, and inhibition of smoking-induced platelet aggregation. The antioxidant effect, including antiaging, has been evaluated and shown to be significant (Liu et al, 1998). Three studies show the antitumor properties of pycnogenol (Huang et al, 2005; Huynh et al, 1999, 2000). In all three studies, pycnogenol was able to induce death in cancer cells, although one study showed healthy cells intact. There was inhibition of TNF-alpha in human vascular endothelial cells (Peng et al, 2000). In another study, smoking-induced platelet aggregation was inhibited by the use of either 500 mg of aspirin or 125 mg of pycnogenol. Aspirin increased bleeding time; pycnogenol did not (Putter et al, 1999). Gingival and Antiplaque Actions One study (Kimbrough et al, 2002) identified the antiplaque action and the minimization of gingival bleeding in participants using chewing gum with pycnogenol. Those subjects using this type of gum showed no increase in plaque formation in 2 weeks. Attention Deficit–Hyperactivity Disorder One small study with 24 individuals age 24 to 53 years old were studied in a double-blind, placebo-controlled crossover study with pycnogenol, and methylphenidate, and placebo. The placebo ranked higher on a self-reporting scale (Tenenbaum et al, 2002). Product Availability Capsules, tablets Plant Parts Used: Water-soluble bioflavonoids from pine Dosages Chronic Pelvic Pain, Dysmenorrheal, Endometriosis • Adult PO: 30-60 mg daily (Jellin et al, 2008) Chronic Venous Insufficiency • Adult PO: 45-360 mg daily or 100 mg tid (Jellin et al, 2008) Coronary Artery Disease • Adult PO: 150 mg tid (Jellin et al, 2008) Diabetic Retinopathies • Adult PO: 50 mg tid (Jellin et al, 2008) Adverse effects: Underline = life-threatening P 524 Pygeum Contraindications Until more research is available, pycnogenol should not be used during pregnancy and breastfeeding. It should not be given to children. Interactions Drug Immunosuppressants: Pycnogenol may interfere with immunosuppressant action (theoretical). Lab Test Blood platelet aggregation: Pycnogenol may cause reduced blood platelet aggregation. Pharmacology Pharmacokinetics Metabolized by glucuronide and sulfate conjugation; conjugates are excreted in urine (18-24 hours), metabolites (28-34 hours). Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Bioflavonoid Proanthocyanidins Antioxidant; antitumor Client Considerations Assess • Assess the reason the client is taking this supplement. Administer • Instruct the client to store pycnogenol in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use pycnogenol in children or those who are pregnant or breastfeeding until more research is available. Pygeum (pie-jee’uhm) Scientific name: Pygeum africanum Other common name: African plum tree Origin: Pygeum is an evergreen found in Africa. Uses Pygeum had been used to treat urinary tract infections and benign prostatic hypertrophy (BPH), as well as to increase prostatic secretions. Traditionally, pygeum is used in inflammation, urinary problems, fever, and as an aphrodisiac (Jellin et al, 2008). = Pregnancy = Pediatric ! = Alert = Popular Herb Pygeum 525 Actions BPH Action Studies have focused on the use of pygeum as a treatment for BPH. Pygeum both decreases inflammation and gland size and increases prostatic secretions and urinary flow (Levin et al, 1997; Shenouda et al, 2007). Rabbits given pygeum showed a significant decrease in the partial outlet obstruction that occurs with BPH. Other literature review details how several small studies have provided very little viable information for the use of pygeum in BPH. A large-scale study is needed to investigate the usefulness of pygeum (Edgar et al, 2007). Other Actions Pygeum may be useful for male sexual dysfunction related to the BPH (Carani et al, 1991). It may also be useful in chronic prostatitis. However, more research will be necessary to confirm these results. Product Availability Powder; standardized extract (14% triterpenoids, 0.5% N-docosanol) Plant Part Used: Bark Dosages BPH • Adult PO: 75-200 mg daily may be combined with nettle for increased effectiveness Contraindications Pregnancy category is 3; breastfeeding category is 1A. Pygeum should not be given to children. Persons who are hypersensitive to pygeum should not use it. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, gastrointestinal irritation INTEG: Hypersensitivity reactions Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Triterpene Urolic acids; Oleanolic acid; Crataegolic acid Prostatic antiinflammatory Beta-sitosterol Competes with cholesterol; inhibits arachidonic acid metabolites Fatty acid Tannin Phytosterol Beta-sitosterone; Campesterol Adverse effects: Underline = life-threatening P 526 Pygeum Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of this herb and administer an antihistamine or other appropriate therapy. Administer • Instruct the client to store pygeum in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 3 and breastfeeding category is 1A. • Caution the client not to give pygeum to children. = Pregnancy = Pediatric ! = Alert = Popular Herb Queen Anne’s Lace 527 Queen Anne’s Lace (kween anz lays) Scientific name: Daucus carota Other common names: Bee’s nest, bird’s nest, carrot, devil’s plague, mother’s die, oil of carrot, philatron, wild carrot Origin: Queen Anne’s lace is found in North America. Uses Queen Anne’s lace has been used as an antibacterial, antispasmodic, antisteroidogenic, to protect the liver, and for hypertension. In children, Queen Anne’s lace is used to treat tonsillitis, intestinal parasites (as a tea), and dermatologic conditions such as photodermatosis. Actions Queen Anne’s lace has shown to be antihypotensive, antispasmodic, antisteroidogenic, hepatoprotective, and bacteriosorbent. The antispasmodic effect was evaluated in different species of animals on smooth muscles of the uterus, blood vessels, ileum, and trachea. It was found to be a smooth muscle relaxant (nonspecific) similar to papaverine, but only one tenth as potent (Gambhirr et al, 1979). The antisteroidogenic action was studied using Queen Anne’s lace seeds, which were able to arrest the development of the ovaries and reduce weight in the mouse (Majumder et al, 1997). The hepatoprotective action of Queen Anne’s lace was evaluated against carbon tetrachloride intoxication in mouse liver (Bishayee et al, 1995). Hepatic function test results were lowered, and Queen Anne’s lace provided significant protection against hepatic damage. The bacteriosorbent action has been shown by induction of agglutination (Bratthall, 1978). Product Availability Crude extract, tea Plant Parts Used: Leaves, roots, seeds Q Dosages • Adult PO tea: 2-4 g steeped in boiling water 5-10 min, strain, tid (Jellin et al, 2008) • Adult PO liquid extract (1:1): 2-4 ml tid (Jellin et al, 2008) Contraindications Until more research is available, Queen Anne’s lace should not be used during pregnancy and breastfeeding. Persons who are hypersensitive to Queen Anne’s lace should not use it. Side Effects/Adverse Reactions CNS: CNS depression, sedation, drowsiness CV: Hypotension, cardiac depression GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions, contact dermatitis, photosensitivity Interactions Drug Antihypertensives, diuretics: Queen Anne’s lace increases hypotension when used with antihypertensives, diuretics; use together cautiously. Continued Adverse effects: Underline = life-threatening 528 Queen Anne’s Lace Interactions—cont’d Cardiac glycosides (digoxin, digotoxin): Queen Anne’s lace used with cardiac glycosides may increase cardiac depression; avoid concurrent use. CNS depressants (alcohol, analgesics, anxiolytics, sedatives): Queen Anne’s lace increases the action of central nervous system depressants; use together cautiously. Estrogens: Queen Anne’s lace may interfere with the action of estrogens. Herb Sedative herbs: Queen’s Anne’s lace with sedative herbs may increase sedation (theoretical). Primary Chemical Components and Possible Actions Chemical Class Sesquiterpenes Glucosides Flavonoid Porphyrin Furanocoumarin Volatile oil Seeds also contain Fatty acid Individual Component Possible Action Chrysin; Luteolin Apigenin Antioxidant, Antiinflammatory, Radical scavenger (Kumarasamy et al, 2005) Anxiolytic DC-2,3 Pinene; Geraniol; Limonene; Terpinen; Carophyllene; Carotol; Daucol; Asarone; Dipentin; P-cymene Calcium channel blocker Oleic acid; Linolenic acid; Palmitic acid Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of this herb and administer an antihistamine or other appropriate therapy. • Assess for medication use (see Interactions). Administer • Instruct the client to store Queen Anne’s lace in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use Queen Anne’s lace during pregnancy and breastfeeding until more research is available. = Pregnancy = Pediatric ! = Alert = Popular Herb Quince 529 • Advise the client to stay out of the sun or to use protective clothing. Queen Anne’s lace causes increased photosensitivity. • Advise the client not to perform hazardous activities such as driving or operating heavy machinery until physical response to the herb can be evaluated. Quince (kwins) Scientific name: Cydonia oblonga Other common names: Common quince, golden apple Origin: Quince is found in Southwest and Central Asia and in Europe. Uses Quince traditionally has been used to treat diarrhea, gonorrhea, dysentery, Candida infections of the mouth, and sore throat. It is also a component in lotions, creams, and mouthwash. Quince is used topically to treat canker sores and gum disease. Investigational Uses Researchers are experimenting with the use of quince as an antibacterial and to treat cancer. Actions The variety of quince that is common in Peru has been shown to be effective against Vibrio cholerae when tested with several other herbs (Guevara et al, 1994). Traditional literature shows actions for cardiac and renal effects. Most of this literature is based on anecdotal reports. Primary research is lacking for this herb. New elements of the composition of quince seeds were identified as phenolics, organic acids, and Q free amino acids (Silva et al, 2005). Product Availability Decoction, fruit syrup, mucilage of seeds Plant Parts Used: Fruit, seeds Dosages Diarrhea, Thrush, Gonorrhea • Adult PO seeds: boil 2 drams in 1 pt water for 10 min; strain • Adult topical seeds: apply poultice of ground seeds to affected area prn Contraindications Until more research is available, quince should not be used during pregnancy and breastfeeding. Persons who are hypersensitive to quince should not use it. Side Effects/Adverse Reactions INTEG: Hypersensitivity reactions SYST: Toxicity (seeds) Continued Adverse effects: Underline = life-threatening 530 Quinine Interactions Drug Oral medications: Quince may decrease the absorption of all oral medications (Jellin et al, 2008). Food Nutrients: Quince may decrease the absorption of nutrients (Jellin et al, 2008). Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Seeds contain Phenolics Organic acids Free amino acids Fixed oil Protein Cyanogenic Glycosides Amygdalin Cyanide Toxicity Toxicity Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of this herb and administer an antihistamine or other appropriate therapy. ! • Assess for toxicity. Administer • Instruct the client to store quince in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use quince during pregnancy and breastfeeding until more research is available. • Advise the client to store quince out of the reach of children and pets. Quinine (kwy’nine) Scientific name: Cinchona succirubra Other common names: Cinchona, Jesuit’s bark, Peruvian bark Origin: Quinine is a tree found in mountainous tropical regions of the United States. Uses Quinine has been used to treat malaria. It has been used in mainstream medicine to treat Plasmodium falciparum and nocturnal leg cramps. = Pregnancy = Pediatric ! = Alert = Popular Herb Quinine 531 Actions Quinine inhibits parasite replication and transcription of DNA to RNA by forming complexes with the DNA of the parasite (Andrade-Neto et al, 2003). Product Availability Capsules, tablets Plant Part Used: Bark of 6- to 8-year-old trees Dosages Leg Cramps • Adult PO capsules/tablets: 250-300 mg at bedtime Other • Adult PO capsules/tablets: 650 mg q8hr ⫻ 10 days, given with pyrimethamine 25 mg q12hr ⫻ 3 days and sulfadiazine 500 mg qid ⫻ 5 days • Child PO capsules/tablets: 25 mg/kg/day divided q8hr ⫻ 3-7 days Contraindications Quinine should not be used during pregnancy and breastfeeding. It should not be used by persons with G6PD deficiency and retinal field changes. Caution should be exercised by persons with blood dyscrasias, severe gastrointestinal disease, neurologic disease, severe hepatic disease, psoriasis, cardiac arrhythmias, and tinnitus. Persons who are hypersensitive to quinine should not use it. Side Effects/Adverse Reactions CNS: Headache, stimulation, fatigue, irritability, seizures, bad dreams, dizziness, fever, confusion, anxiety CV: Angina, arrhythmias, tachycardia, hypotension, acute circulatory failure EENT: Blurred vision, corneal changes, difficulty focusing, tinnitus, deafness, photophobia, diplopia, night blindness ENDO: Hypoglycemia GI: Nausea, vomiting, anorexia, diarrhea, epigastric pain GU: Renal tubule damage, anuria HEMA: Thrombocytopenia, purpura, hypothrombinemia, hemolysis INTEG: Hypersensitivity reactions, pruritus, pigmentary changes, skin eruptions, lichen planus-like eruptions, flushing, facial edema sweating RESP: Dyspnea Interactions Drug Acetazolamide, sodium bicarbonate: Quinine used with acetazolamide, sodium bicarbonate may lead to toxicity; do not use concurrently. Aluminum salts, magnesium: Aluminum salts, magnesium may cause decreased absorption of quinine; separate doses by 3 hours. Antacids, H2-blockers, proton pump inhibitors: Quinine may decrease the action of these agents (theoretical). Anticoagulants (heparin, salicylates, warfarin), carbamazepine, cardiac glycosides (digoxin), neuromuscular blockers: Quinine may increase the action of these agents; avoid concurrent use. Continued Adverse effects: Underline = life-threatening Q 532 Quinine Interactions—cont’d Herb Anticoagulant herbs: Quinine and anticoagulant herbs may increase the risk of bleeding (theoretical). Pharmacology Pharmacokinetics PO: Peak 1 to 3 hours; metabolized in the liver, excreted in the urine; half-life is 4 to 5 hours. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Alkaloid Quinidine Quinine, Cinchonaminone Parasitic, MAOI Cardiac depressant Client Considerations Assess • Assess for hypersensitivity reactions, itching and skin eruptions. If present, quinine use should be discontinued and an antihistamine or other appropriate therapy administered. • Monitor hepatic function tests every week (ALT, AST, bilirubin). If elevated, herb use should be discontinued. • Assess for cinchonism: nausea, blurred vision, tinnitus, headache, and difficulty focusing. • Monitor blood pressure and pulse. Watch for hypotension and tachycardia. • Monitor blood studies and complete blood count. Blood dyscrasias can occur. • Assess for medications used (see Interactions). Administer • Instruct the client to store quinine in a sealed, light-resistant container, away from heat and moisture. • Instruct the client to take quinine 2 hours before or after meals at the same time of day to maintain blood level. Teach Client/Family • Caution the client not to use quinine during pregnancy and to avoid its use during breastfeeding. • Advise the client to avoid the concurrent use of quinine and over-the-counter cold preparations. = Pregnancy = Pediatric ! = Alert = Popular Herb Ragwort 533 Ragwort (rag’wawrt) Scientific name: Senecio jacoboea Other common names: Cankerwort, cocashweed, coughweed, dog standard, false valerian, golden ragwort, golden senecio, liferoot, ragweed, St. James wort, staggerwort, stammerwort, stinking nanny, squaw weed, squawroot Origin: Ragwort is found in North America. Uses Ragwort has been used internally to treat menstrual irregularities. Ragwort can be applied topically to stings, leg ulcers, and ulcers of the oral cavity. Only external use is recommended. Actions The only documented studies of ragwort focus on its toxicity. Ragwort should not be taken internally for any reason. Product Availability Dried herb, fresh herb Plant Parts Used: Flowers, leaves, seeds Dosages • Adult gargle: soak dried herb in warm water, strain, gargle prn • Adult topical: make poultice from bruised fresh herb added to a little water; apply to affected area prn • Adult topical: soak dried herb in warm water; apply to affected area prn Contraindications Until more research is available, ragwort should not be used internally during pregnancy and breastfeeding. It should not be given internally to children. Persons who are hypersensitive to ragwort or Asteraceae/Compositae family and those with hepatic disease should not use it. Internal use of ragwort is not recommended. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, hepatotoxicity, hepatic failure (internal use) INTEG: Hypersensitivity reactions Interactions Herb Eucalyptus, unsaturated pyrrolizidine alkaloid herb: Ragwort with eucalyptus may increase the risk of pyrrolizidine alkaloid toxicity (theoretical). Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Pyrrolizidine alkaloid Floridanine; Florosenine; Senecionine; Otosenine Toxic Adverse effects: Underline = life-threatening R 534 Raspberry Client Considerations Assess • Assess for hypersensitivity reactions. If present, herb use should be discontinued and an antihistamine or other appropriate therapy administered. ! • Monitor hepatic function tests (ALT, AST, bilirubin) if ragwort is taken internally. If results are elevated, herb use should be discontinued. Administer • Instruct the client to store ragwort in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use ragwort internally in children or those who are pregnant or breastfeeding until more research is available. Raspberry (raz’beh-ree) Scientific name: Rubus idaeus Other common names: Bramble, bramble of Mount Ida, hindberry, red raspberry Origin: Raspberry is found in Europe, North America, and Asia. Uses Raspberry leaves are used to promote diuresis and to treat inflammation and cough. Raspberry may be used topically to treat wounds. Raspberry, like cranberry, is considered useful for the prevention of urinary tract infections and renal calculi. There may be an antimicrobial action in raspberry roots; therefore they are used to promote wound healing and to treat sore throats and canker sores. Raspberry tea is used during pregnancy to relieve morning sickness and to speed and ease labor. Investigational Uses Research is underway to confirm the antioxidant use of raspberry and as a gastrointestinal relaxant. Actions Raspberry shows antidiabetic and antimicrobial effects. Raspberry is commonly used during pregnancy to relieve morning sickness and to aid in childbirth. Antimicrobial Action Twenty-nine Finnish plants were evaluated for their antimicrobial effects. Raspberry was shown to be effective against bacteria only (Rauha et al, 2000). The microbes used in this study were Aspergillus niger, Bacillus subtilis, Candida albicans, Escherichia coli, Micrococcus luteus, Pseudomonas aeruginosa, Saccharomyces cerevisiae, Staphylococcus aureus, and Staphylococcus epidermis. Antidiabetic Action One study evaluated raspberry for use as a treatment for diabetes. In this study, blood glucose levels were reduced significantly in laboratory animals (Briggs et al, 1997). = Pregnancy = Pediatric ! = Alert = Popular Herb Raspberry 535 Antioxidant One small study identified the antioxidant content of five types of berries by measuring their oxygen radical absorbance capacity. All berries had high antioxidant properties (Wada et al, 2002). Another study (Venskutonis et al, 2007) identified the radical scavenging activity of raspberry. Product Availability Capsules, fluid extract, powder, tablets, tea Plant Part Used: Leaves Dosages • Adult PO fluid extract: 4-8 ml tid (1 g leaves/ml 25% alcohol) • Adult PO powder/tablets: 4-8 g tid Contraindications Pregnancy category is 1; breastfeeding category is 2A. Persons who are hypersensitive to raspberry should not use it. Women with estrogen-sensitive cancers should avoid raspberry leaf (Jellin et al, 2008). Side Effects/Adverse Reactions INTEG: Hypersensitivity reactions Interactions Drug Antidiabetics (acetohexamide, chlorpropamide, glipizide, insulin, metformin, tolazamide, tolbutamide, troglitazone): Antidiabetics may increase hypoglycemia when used with this herb; monitor blood glucose levels (theoretical). Calcium, iron salts, magnesium: Raspberry tea may decrease the absorption of these agents. R Primary Chemical Components and Possible Actions Chemical Class Leaves contain Quercetin Rutin Flavonoid Tannin Fragarin Acids Vitamin Fruit contains Pectin Fructose Vitamin Individual Component Possible Action Astringent Mild oxytocic Gallic acid; Ellagic acid C C Adverse effects: Underline = life-threatening 536 Rauwolfia Client Considerations Assess • Assess for hypersensitivity reactions. If present, herb use should be discontinued and an antihistamine or other appropriate therapy administered. • Monitor blood glucose levels in diabetic clients (see Interactions). Administer • Instruct the client to store raspberry in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 1 and breastfeeding category is 2A. Rauwolfia (rau-wul’fee-uh) Scientific name: Rauvolfia serpentina Other common names: Indian snakeroot, snakeroot Origin: Rauwolfia is found in the Far East, India, and South America. Uses Rauwolfia is most often used to treat hypertension. Reserpine, one of its chemical components, is used in mainstream pharmacology, although newer synthetic drugs for hypertension are thought to be more effective. Traditional uses of rauwolfia include treatment for snake bite, insect bites, fever, and dropsy. It is also used to treat nervousness and insomnia. Actions Rauwolfia inhibits the release of norepinephrine, depleting norepinephrine stores in adrenergic nerve endings. It has been available in mainstream pharmacology as reserpine for many years. Rauwolfia is used rarely today, except in herbal practice. Product Availability Crude herb, fluid extract, injectable (reserpine), powdered extract, suppositories (reserpine), tablets, tea Plant Part Used: Root Dosages • Adult PO: 200-400 mg daily in divided doses; maintenance 50-300 mg daily or in two divided doses (available from a pharmacy with a prescription) • Adult PO tablets: 600 mg daily (equivalent to 6 mg alkaloids) Contraindications Rauwolfia should not be used during pregnancy and breastfeeding. It should not be given to children. Persons who are hypersensitive to rauwolfia or those with depression, suicidal tendencies, active peptic ulcer disease, ulcerative colitis, Parkinson’s disease, or pheochromocytopenia should not use it. Clients with seizure disorders or renal disease should use rauwolfia with caution. = Pregnancy = Pediatric ! = Alert = Popular Herb Rauwolfia 537 Side Effects/Adverse Reactions CNS: Drowsiness, fatigue, lethargy, dizziness, depression, anxiety, headache, seizures, parkinsonism CV: Chest pain, bradycardia, arrhythmias GI: Nausea, vomiting, anorexia HEMA: Purpura, increased bleeding time, thrombocytopenia INTEG: Hypersensitivity reactions, bruising, purpura, ecchymosis Interactions Drug ! Amphetamines, ephedrine, epinephrine, isoproterenol, norepinephrine: Use of rauwolfia with these agents may cause decreased pressor effects; avoid concurrent use. Cardiac drugs (beta-blockers, diuretics): Use of rauwolfia with cardiac drugs may result in increased hypotension; avoid concurrent use. Cardiac glycosides (digoxin): Use of rauwolfia with cardiac glycosides will cause severe bradycardia, do not use together. CNS depressants (alcohol, barbiturates, opioids): Use of rauwolfia with central nervous system depressants may cause increased CNS depression; avoid concurrent use. L-Dopa: Use of rauwolfia reduces the effect of L-dopa, with increased extrapyramidal motor symptoms; avoid concurrent use. MAOIs: Use of rauwolfia with MAOIs may cause excitation and/or hypertension; avoid concurrent use. Sympathomimetics: Use of rauwolfia with sympathomimetics will increase blood pressure; avoid concurrent use. Herb Ephedra: Use of rauwolfia with ephedra may result in decreased pressor effects; avoid concurrent use. Lab Test Basal nocturnal acid, gastric analysis, serum/urine sodium: Rauwolfia may cause increased gastric analysis results, basal nocturnal acid output, and serum or urine sodium. Red blood cells, serum gastrin, urine vanillylmandelic acid: Rauwolfia may cause decreased red blood cells, urine vanillylmandelic acid (VMA), and serum gastrin. Pharmacology Pharmacokinetics Reserpine peaks in 4 hours; duration 2 to 6 weeks; half-life 50 to 100 hours. It is metabolized by the liver, excreted by the kidneys, crosses the blood-brain barrier, and enters breast milk. Adverse effects: Underline = life-threatening R 538 Red Bush Tea Primary Chemical Components and Possible Actions Chemical Class Individual Component Iridoid glucoside Indole alkaloid Epiloganin Reserpine Serpentinine; Rescinnamine; Raubasine; Raupine, Methylajmaline, Methylisoajmaline, Hydroxyserpagine, Antileukemic, Yohimbinic acid, Isorauhimbinic acid Possible Action Antihypertensive Starch Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of rauwolfia and administer an antihistamine or other appropriate therapy. ! • Monitor cardiac status including blood pressure and pulse; watch for hypotension and bradycardia. • Assess for bleeding, bruising, ecchymosis, and purpura. • Assess medications and herbs used. Rauwolfia interacts with many drugs (see Interactions). Administer • Instruct the client to store rauwolfia products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use rauwolfia in children or those who are pregnant or breastfeeding. • Caution clients with depression, peptic ulcer disease, ulcerative colitis, Parkinson’s disease, or seizure disorders not to use rauwolfia. • Advise the client not to perform hazardous activities such as driving or operating heavy machinery until physical response to the herb can be evaluated. • Advise the client to rise slowly to a standing position to avoid orthostatic hypotension. Red Bush Tea (rehd bewsh tee) Scientific names: Aspalathus linearis; also known as Borbonia pinifolia and Aspalathus contaminata Other common name: Rooibos tea Origin: Red bush is a bush found in South Africa. = Pregnancy = Pediatric ! = Alert = Popular Herb Red Bush Tea 539 Uses Red bush tea is used as a beverage in place of caffeinated teas. Investigational Uses Preliminary research is exploring the antitumor properties of red bush tea and its ability to combat aging in brain tissue. Also being researched is its antihemolytic use. Actions Very little research is available for red bush tea. It is known to be high in vitamin C and to contain no caffeine. Initial research is available documenting the antioxidant and antiaging properties of this tea (Sasaki, 1993; Shimoi et al, 1996). In addition, two studies showed that suppression of cancerous cells occurred in mice given Aspalathus linearis (Komatsu et al, 1994; Marnewick et al, 2005). Another study showed that red bush tea suppresses HIV infections (Nakano et al, 1997). Simon et al (2000) identified the antihemolytic effect on red blood cells. The degree of inhibition of hemolysis was comparable with the effect of vitamin C. Product Availability No commercial products are available. Plant Part Used: Leaves Dosages No published dosages are available. Contraindications No absolute contraindications are known. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Antioxidant HIV inhibition (Jellin et al, 2008) Vitamin C Polysaccharides Flavonoids Tannins Client Considerations Assess • Identify the reason the client is using this product. Administer • Instruct the client to store red bush tea in a cool, dry place, away from heat and moisture. Teach Client/Family • Advise the client that red bush tea may be used as a beverage at any time, that it contains no caffeine, and that it is high in vitamin C. Adverse effects: Underline = life-threatening R 540 Rose Hips Rose Hips (roez hips) Scientific name: Rosa canina Other common names: Dog brier fruit, dog rose fruit, hipberries, wild brier berries, brier hip, hip, brier rose, eglantine gall, hog seed, dog berry, sweet brier, witches brier, hip tree, hip fruit, hop fruit Origin: Rose hips is found in Europe, Asia, the United States, and Canada. Uses Rose hips is usually taken for its vitamin C content. It is used internally as a diuretic, to prevent and treat colds, flu, vitamin C deficiency, renal and urinary tract disorders, arthritic conditions, rheumatism, gout, and sciatica, and to relieve constipation and increase immunity and capillary strength. Topically, the leaves may be used as a poultice to promote wound healing. Actions Very little scientific research is available for rose hips. In one study that identified its allergic properties (Kwaselow et al, 1990), workers exposed to the dust of rose hips developed asthma, rhinitis, and urticaria. Two other studies evaluated the effect of rose hips on cholesterol and triglyceride levels. Hamsters and mice fed rose hips and other fatty acids showed little or no change in the blood levels of these lipids (Gonzalez et al, 1997; Lutz et al, 1993). One study (Ninomiya et al, 2007) found rose hips to be a potent antiobesity herb because of one of the chemical components, trans-tiliroside. Product Availability Capsules, cream, extracts (usually in combination with other products), syrup, tablets, tea, tincture Plant Parts Used: Fruit, leaves Dosages • Adult PO infusion: scald 1-2 g powdered herb and steep 10-15 min, strain • Adult topical: the leaves can be used as a poultice applied to wounds daily Contraindications Until more research is available, rose hips should not be used during pregnancy and breastfeeding. Persons with hypersensitivity to rose hips should not use it. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, diarrhea INTEG: Hypersensitivity reactions Interactions Drug Iron: Rose hips increases oral iron absorption. Salicylates: Rose hips can decrease urinary excretion of salicylates. Lab Test False negative: A false negative may occur with acetaminophen occult blood. False increase: A false increase may occur with AST, bilirubin, carbamazepine, creatinine, glucose. Continued = Pregnancy = Pediatric ! = Alert = Popular Herb Rue 541 Interactions—cont’d False decrease: A false decrease may occur with LDH, theophylline. Decrease: Rose hips may decrease uric acid. Increase: Rose hips may increase calcium, sodium. Primary Chemical Components and Possible Actions Chemical Class Kaempferol Tannin Carotenoid Pectin Vitamin Acid Flavonoid Phenol Volatile oil Vanillin Sugar Trans-tiliroside Individual Component Possible Action C A, B1, B2, B3, E, K Mallic acid, Citric acid, P-coumaric acid Antioxidant Invert sugar; Saccharose Antiobesity Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of rose hips and administer an antihistamine or other appropriate therapy. Administer • Instruct the client to store rose hips in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use rose hips during pregnancy and breastfeeding until more research is available. Rue (rew) Scientific name: Ruta graveolens Other common names: Herb-of-grace, herbygrass, rutae herba, vinruta Origin: Rue is found in the Mediterranean, the Americas, Asia, Africa, and Europe. Adverse effects: Underline = life-threatening R 542 Rue Uses Rue traditionally has been used as a sedative, an anthelmintic, and to induce abortion, reduce inflammation in joint disease, relieve menstrual and gastrointestinal disorders, and to treat earaches, snake bite, and insect stings. It may also be used as an abortive agent for contraception. However, supporting evidence for many of these uses is lacking. Actions Cardiovascular Action Rue has been found to produce cardiovascular effects, including hypotension (Chiu et al, 1997). Researchers studied the effects of green beans, common rue, and kelp used concurrently. When rue was tested alone, it was found to exert positive chronotropic and inotropic effects on the right atrium but no effect on atrial tension. This study demonstrates the principle that herbs used in combination often are more potent than a single herb used alone. Antifertility Action Rue’s postcoital antifertility action was demonstrated in a study using rats and hamsters (Gandhi et al, 1991). Different preparations of Ruta graveolens were given orally. The powdered root, aerial parts, and extract of the aerial parts all showed anticonceptive action. None of these was found to be effective in hamsters. However, another study using the roots, stems, and leaf extracts found that all three preparations showed significant antifertility action in rats (Kong et al, 1989). Antiinflammatory and Analgesic Actions In one study, plants indigenous to Jordan were studied for their antiinflammatory and analgesic actions. Rue was found to decrease pain in mice (Atta et al, 1998). Product Availability Capsules, creams, crude herb, extract, oil Plant Parts Used: Above-ground parts Dosages Earache • Adult topical oil: pour oil on cotton and insert into affected ear Toothache • Adult topical leaves: may be used to fill hollow teeth Other • Adult PO capsules: 1 capsule with meals tid • Adult PO extract: 1⁄2-1 tsp with meals tid • Adult topical cream: apply prn to affected area Contraindications Class 2b/2d herb (whole herb). Because it can cause spontaneous abortion, rue should not be used during pregnancy. Until more research is available, this herb should not be used during breastfeeding and should not be given to children. Persons with hypersensitivity to rue should not use it. Persons with cardiac disease should use rue with caution. = Pregnancy = Pediatric ! = Alert = Popular Herb Rue 543 Side Effects/Adverse Reactions CV: Hypotension GI: Spontaneous abortion INTEG: Hypersensitivity reactions, photosensitivity, rash, erythema, blisters (topical) Toxicity: High doses Interactions Drug Antihypertensives: Use of rue with antihypertensives may cause increased vasodilation; avoid concurrent use. Cardiac glycosides (digoxin): Use of rue with cardiac glycosides may cause increased inotropic effects; avoid concurrent use. Primary Chemical Components and Possible Actions Chemical Class Individual Component Alkaloid Arborine, arborinine, gamma fagarine (Jellin et al, 2008) Rutamarin, bergapten, xanthotoxin (Jellin et al, 2008) Coumarin Volatile oil Psoralen Gamma-fagarine Furoquinoline Glycosides Possible Action Mutagenic, phototoxic Dictamnine Feruloylsucrose; Methylcnidioside A; Methylpicraquassioside A; Rutin; Picraquassioside (Chen, 2001) Chalepensin R Antifertility Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of rue and administer an antihistamine or other appropriate therapy. • Determine whether the client is taking other antihypertensives and/or cardiac glycosides (see Interactions). • Monitor cardiac status periodically, including blood pressure and pulse. Administer • Instruct the client to store rue in a cool, dry place, away from heat and moisture. Adverse effects: Underline = life-threatening 544 Rue Teach Client/Family • Caution the client not to use rue during pregnancy because it can cause spontaneous abortion. Until more research is available, caution the client not to use rue during breastfeeding and not to give it to children. • Caution the client to avoid using antihypertensives and cardiac glycosides concurrently with this herb (see Interactions). ! • Warn the client that rue is toxic at high doses. • Teach the client to avoid confusion with goat’s rue (Jellin et al, 2008). = Pregnancy = Pediatric ! = Alert = Popular Herb Safflower 545 Safflower (sa’flau-uhr) Scientific name: Carthamus tinctorius Other common names: American saffron, azafran, bastard saffron, benibana, dyer’s saffron, fake saffron, false saffron, zaffer Origin: Safflower is found in the Mediterranean, Europe, and the United States. Uses Safflower traditionally has been used to treat constipation and fever. Chinese herbalists use it to treat cough, dysmenorrhea, amenorrhea, and other menstrual irregularities. It has also been used as a component in products such as massage oil. Investigational Uses Safflower is being tested for its ability to decrease lipids, to treat fatty acid deficiency, and as a COX-2 and prostaglandin inhibitor. Actions The studies done on safflower focus on its antiinflammatory, antioxidant, antimycotic, and antihypertensive actions. Antiinflammatory Action The antiinflammatory actions of safflower were evaluated by identifying its triterpene content (Akihisa et al, 1996). Significant antiinflammatory properties were found in all flower species evaluated from the Compositae family. Antioxidant Action Antioxidant components were isolated from safflower (see chemical properties table) (Zhang et al, 1997). Antimycotic Action Researchers screened 56 Chinese herbs for their antimycotic action against Aspergillus fumigatus, Candida albicans, Geotrichum candidum, and Rhodotorul rubra. Safflower exerted the strongest action against Aspergillus fumigatus (Blaszczyk et al, 2000). Antihypertensive Action Safflower has been shown to lower blood pressure in hypertensive rats. It is believed to do so by acting on the renin-angiotensin system. Researchers observed a decrease in plasma renin activity and angiotensin II activity (Liu et al, 1992). Other Actions When safflower was used with ginseng for breast cancer, all concentrations studied were able to inhibit proliferation in solid tumors (Loo et al, 2004). Product Availability Capsules, dried flowers, fluid extract, fresh flowers, tea Plant Parts Used: Flowers, seeds Dosages • Adult PO dried flowers: 3 g tid • Adult PO extract: 3 g dried flowers/15 ml alcohol/15 ml water, take tid • Adult PO fresh flowers: 2 tbsp tid Adverse effects: Underline = life-threatening S 546 Safflower Contraindications Class 2b/2d herb (flower). Because it is a uterine stimulant, safflower should not be used during pregnancy. Until more research is available, this herb should not be used during breastfeeding. Persons with hypersensitivity to safflower or Asteraceae/Compositae family should not use it. Persons with bleeding disorders, HIV/AIDS, lupus, decreased immunity, burns, or sepsis should avoid its use. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions Interactions Drug Anticoagulants (heparin, salicylates, warfarin): Safflower may potentiate anticoagulant action; avoid concurrent use (theoretical). Immune serums, immunosuppressants, toxoids, vaccines: Use of safflower with immune serums, immunosuppressants, toxoids, and vaccines may cause increased immunosuppression; avoid concurrent use (theoretical). Herb Anticoagulant/antiplatelet herbs: Safflower with anticoagulant/ antiplatelet herbs may increase the risk of bleeding. Primary Chemical Components and Possible Actions Chemical Class Individual Component Glycosides Fatty acid Kaempferol; Acacetin Linoleic acid; Linolenic acid; Oleic acid; Palmitic acid; Steric acid Heliaol; Taraxasterol; Psi-taraxasterol; Alpha-amyrin; Beta-amyrin; Lupeol; Taraxerol; Cycloartenol; Enecycloartanol; Tirucalla; Dienol Dammaradienol Ferulamide; P-coumaramide; Di-p-coumaramide; Diferulamide Cartorimine Triterpene Serotonin derivative Cyclohiptenone Oxide derivative = Pregnancy = Pediatric ! = Alert Possible Action Antiinflammatory Antioxidant Anticoagulant = Popular Herb Saffron 547 Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of safflower and administer an antihistamine or other appropriate therapy. • Assess for immunosuppressant medications the client may be taking, such as vaccines, immune serums, toxoids, and immunosuppressants (see Interactions). Administer • Instruct the client to store safflower in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use safflower during pregnancy because it is a uterine stimulant. Until more research is available, caution the client not to use this herb during breastfeeding. • Caution the client to avoid taking immunosuppressants concurrently with safflower (see Interactions). Saffron (sa’-fruhn) Scientific name: Crocus sativus Other common names: Indian saffron, keser, kum kuma, true saffron, Spanish saffron, zaffron Origin: Saffron is found in Europe and Asia. Uses Saffron is primarily used as a flavoring in food. It is used, traditionally, as a sedative and an expectorant, and topically to treat skin disorders. Actions S Cytotoxic Action Very little supporting evidence is available for the claims that saffron’s chemical components crocine, picrocrocin, and safranal are cytotoxic. However, three studies have shown promise in this area (Aung et al, 2007; Escribano et al, 1996; Nair et al, 1995). Other Actions One study (Akhondzadeh et al, 2005) identified saffron as able to decrease mild to moderate depression. This study was a double-blind, randomized, placebocontrolled trial. Product Availability Powder Plant Part Used: Dried tops Dosage No published dosages are available. Lethal dose is 20 g. Adverse effects: Underline = life-threatening 548 Sage Contraindications Saffron should not be given to children or those who are pregnant or breastfeeding. Saffron is an abortifactant. It should not be used in hypersensitivity to saffron or Lolium, Olea, Salsola species plants (Jellin et al, 2008). Side Effects/Adverse Reactions CNS: Dizziness CV: Bradycardia EENT: Epistaxis GI: Anorexia, nausea, vomiting INTEG: Flushing of head and face Reproductive: Spontaneous abortion Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Carotenoids Crocine; Crocetin; Picrocrocin; Safranal Dimethyl-crocetin Cytotoxic Client Considerations Assess • Assess the reason the client is using saffron. • Assess for allergy to this herb or Lolium, Olea, Salsola species plants. Administer • Keep saffron in a cool, dry area, away from excessive light. Teach Client/Family • Teach the patient that saffron should not be used in pregnancy because spontaneous abortion may occur. It should not be used in children or breastfeeding until more research is available. Sage (sayj) Scientific name: Salvia officinalis Other common names: Dalmatian, garden sage, meadow sage, scarlet sage, tree sage, common sage, true sage, broad-leafed sage Origin: Sage is a perennial found in Europe, Canada, and the United States. Uses Sage has been used to treat menstrual disorders, diarrhea, sore throat, depression, cerebral ischemia, Alzheimer’s disease, gastrointestinal disorders, and gum disease. Topically, sage is used for herpes labialis, laryngitis, stomatitis, and inflammation of = Pregnancy = Pediatric ! = Alert = Popular Herb Sage 549 the nose or throat (Jellin et al, 2008). It is also used as a food flavoring and in cosmetics. Actions Few studies have been done on the therapeutic uses of sage. Two of its chemical components, labiatic and carnosic acid, have been identified as having antioxidant properties (Leung, 1980). Another study found that sage exerts bactericidal action against a wide range of bacteria (Koga et al, 1999). Gramnegative bacteria death occurred when sage was used. Acute inflammation was decreased when sage was administered to male rats to decrease paw inflammation (Oniga et al, 2007). Product Availability Extract Plant Parts Used: Whole plant Dosages Menstrual Irregularities • Adult PO extract: 1-4 ml (1:1 dilution in 45% alcohol) tid Sore Throat • Adult PO extract: 1-4 g as a gargle prn Contraindications Pregnancy category is 5; breastfeeding category is 5A. Sage should not be given to children. Persons with hypersensitivity to sage should not use it, and those with diabetes mellitus and seizure disorders should be monitored closely. Side Effects/Adverse Reactions CNS: Seizures GI: Nausea, vomiting, anorexia, stomatitis, cheilitis, dry mouth, oral irritation INTEG: Hypersensitivity reactions Interactions Drug Anticonvulsants: Sage may decrease the action of anticonvulsants; avoid concurrent use (theoretical). Antidiabetics, CNS depressants: Sage may increase the action of antidiabetics, CNS depressants. Iron salts: Sage tea may decrease the absorption of iron salts; separate by 2 hours. Herb Hypoglycemic/sedative herbs: Sage may increase the action of hypoglycemic and sedating herbs (theoretical). Adverse effects: Underline = life-threatening S 550 SAM-e Primary Chemical Components and Possible Actions Chemical Class Volatile oil Glycosides Individual Component Possible Action Labiatic acid; Carnosic acid; cis-P-Coumaric acid; Trans-P-Coumaric acid; Luteolin; Hydroxyluteolin; Vicenin-2; Carnosol; Rosmanol; Epirosmanol; Guldosol; Isorosmanol (Miura et al, 2002) Phenolic acid Antioxidant Antimicrobial Tannin Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of sage and administer an antihistamine or other appropriate therapy. Administer • Instruct the client to store sage in a sealed container away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 5 and breastfeeding category is 5A. • Caution the client not to give sage to children. SAM-e Scientific name: S-Adenosylmethionine Origin: SAM-e is found in all living cells and is a precursor in some amino acids. Uses SAM-e is used to treat depression, Alzheimer’s disease, migraine headache, attention deficit–hyperactivity disorder, chronic hepatic disease, and pain in fibromyalgia. It is also used as an antiinflammatory in osteoarthritis. Actions SAM-e plays an important role in normal cell function and survival and is present naturally in the human body. It is necessary for adequate functioning of the central nervous system. SAM-e is considered to be hepatoprotective, as well as an antioxidant and antidepressant. It may also play a role in decreasing Pneumocystis jiroveci, improving cognition in Alzheimer’s disease, and protecting against coronary artery disease (CAD). = Pregnancy = Pediatric ! = Alert = Popular Herb SAM-e 551 Antidepressant and Central Nervous System Actions SAM-e has been shown to be effective in the treatment of depressive disorders by acting on the methylation process in the brain (Bressa, 1994). It also has been shown to be effective in the treatment of Alzheimer’s disease, HIV-associated neuropathies, and spinal cord degeneration. Deficiencies of certain vitamins, such as folate and B12, decrease levels of SAM-e. Lowered levels of SAM-e are accompanied by a decrease in serotonin levels, which can lead to depression (Young, 1993). It is thought to increase dopamine and serotonin, as well as other neurotransmitters. One study (Shippy et al, 2004) found that SAM-e was beneficial for depression in those living with HIV/AIDS. Because levels of SAM-e in the cerebrospinal fluid are low in those with neurologic disorders, supplementation may decrease central nervous system symptoms. Initial research has shown positive results in clients with Alzheimer’s disease (Lamango et al, 2000; Morrison et al, 1996), Pneumocystis jiroveci (Merali et al, 2000), and spinal cord degeneration. Antiinflammatory Action The antiinflammatory and analgesic effects of SAM-e have been found to be equal to those of NSAIDs, with many fewer side effects than NSAIDs (Di Padova, 1987). A study using rabbits showed that the addition of SAM-e prevented osteoarthritis (Moskowitz et al, 1973). SAM-e is thought to protect cartilage and to assist in the repair of cartilage. Hepatoprotective Action Studies have found that SAM-e decreases hepatic injury associated with alcoholic cirrhosis (Mato et al, 1999). The addition of SAM-e allowed liver transplantation to be delayed in alcoholic cirrhosis. Other Actions SAM-e has been found to decrease the intensity of migraine headaches at dosages of 200 to 400 mg twice daily (Gatto et al, 1986). Product Availability Capsules, tablets Dosages S Migraine • Adult PO capsules/tablets: 200-400 mg bid Contraindications Until more research is available, SAM-e supplements should not be used during pregnancy and breastfeeding. They should not be given to children. Persons with bipolar disorder or Parkinson’s disease should not use SAM-e supplements. Side Effects/Adverse Reactions CNS: Headache, dizziness, insomnia, sweating GI: Nausea, vomiting, anorexia, diarrhea, flatulence Continued Adverse effects: Underline = life-threatening 552 Sassafras Interactions Drug Antidepressants (amitriptyline, amoxapine, citalopram, desipramine, doxepin, fluoxetine, fluvoxamine, imipramine, isocarboxazide, naratriptan, nefazodone, nortriptyline, paroxetine, phenelzine, protroptyline, sertraline, sumatriptan, tramadol, tranylcypromine, trimipramiine, venlafaxine, zolmitriptan): Combining SAM-e with antidepressants may lead to serotonin syndrome; do not use concurrently. MAOIs: SAM-e may lead to hypertensive crisis when used with MAOIs; do not use concurrently. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Converted to Cysteine Client Considerations Assess • Assess the reason the client is taking SAM-e. • Assess for depression or bipolar disorder; SAM-e should not be used in these clients as it may precipitate manic episode. Administer • Instruct the client to store SAM-e in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use SAM-e supplements in children or those who are pregnant or breastfeeding until more research is available. Sassafras ! (sa’suh-fras) Scientific name: Sassafras albidum Other Common Names: Ague tree, Bois De sassafras, cinnamon wood, Fenchelholz, Lignum floridum, Lignum sassafras, root bark, saloop, sassafrasholz, saxifras Origin: Sassafras grows wild in the eastern portion of the United States. Uses Sassafras has been used, traditionally, for integumentary conditions as an antiseptic, as a tonic, and to treat syphilis. = Pregnancy = Pediatric ! = Alert = Popular Herb Sassafras 553 Actions ! Very little research is available. The few studies that are available focus on sassafras’s toxicity. Death can occur with minor amounts of safarole or the quinones, the chemical components of this herb (Craig, 1953; Johnson et al, 2001; Updyke, 1974). Product Availability Liquid extract, oil, tea, powder, crude bark Plant Parts Used: Bark of the roots, stems Dosages • Adult PO infusion: use 2-4 g bark tid • Adult tea: use 1⁄4 tsp of powder to 1 cup boiling water; infuse for 15 min • Adult liquid extract: 2-4 ml tid (1:1 in 25% alcohol) • Adult topical: apply oil topically to area Contraindications ! Class 2d (herb). Until more research is available, sassafras should not be used in pregnancy or breastfeeding. It should not be given to children; death may occur with only a few drops in children. Use is discouraged because the plant is so toxic. Side Effects/Adverse Reactions CNS: CNS depression, ataxia, dizziness, hallucinations, paralysis, confusion, stupor, spasms, hypothermia CV: Cardiovascular collapse GI: Nausea, vomiting, anorexia, hepatic injury/carcinoma INTEG: Dermatitis, hypersensitivity to touch Reproductive: Spontaneous abortion Toxicity: This herb is extremely toxic Interactions Drug CNS depressants: Sassafras may increase the action of central nervous system depressants. Herb Sedative herbs: Sassafras may increase the action of sedative herbs. Lab Test False positive: A false positive may occur with phenytoin. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Essential oils Safarole Methyleugenol Hepatotoxic Quinones Hepatotoxic Adverse effects: Underline = life-threatening S 554 Savory Client Considerations Assess • Assess the reason the client is taking sassafras. Administer • Sassafras should be administered only by a qualified herbalist. Most herbalists do not use this herb because of its toxicity. Teach Client/Family • Instruct the client never to give sassafras to children or those who are pregnant or breastfeeding. • Caution the client not to exceed the recommended dosage; do not use long-term. ! • Warn the client that this plant is extremely toxic. Savory (say’vree) Scientific name: Satureja hortensis L. Other common names: Bean herb, summer savory, white thyme Origin: Savory is found in Europe and is cultivated in North America. Uses Savory is used to treat indigestion, diarrhea, and other gastrointestinal disorders. Traditionally, savory has also been used to stimulate the libido. Actions From research with other herbs, it can be deduced that the chemical components of savory may have the following actions: volatile oil (antibacterial), tannin (astringent), cineole (expectorant), although there is a lack of research to confirm this. One study (Sahin et al, 2003) evaluated the antimicrobial action of Saturejo hortensis. It inhibited 23 strains of 11 bacterial species. Another study (Mosaffa et al, 2006) studied the antigenotoxic effects of this herb. The herbal extract was able to reverse the oxidative damage to rat lymphocytes. Product Availability Leaves (fresh, dried) Plant Part Used: Leaves Dosages • Adult PO tincture: 1 tsp tid • Adult PO infusion: 4 tsp of herb in 8 oz of water • Child PO tincture: 1⁄2 tsp tid • Child PO infusion: 1 tsp of herb in 8 oz of water Contraindications Savory should not be used therapeutically in pregnancy or breastfeeding until more research is available. The FDA considers savory to be safe. = Pregnancy = Pediatric ! = Alert = Popular Herb Saw Palmetto 555 Side Effects/Adverse Reactions GI: Anorexia INTEG: Skin eruptions (topical) Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Antibacterial Astringent Expectorant Volatile oils Tannin Cineole Client Considerations Assess • Assess the reason the client is using savory. Administer • Keep savory in a cool, dry area, away from excessive light. Teach Client/Family • Teach the client that savory should not be used in pregnancy or breastfeeding until more research is available. Saw Palmetto (saw pal-meh’toe) Scientific names: Serenoa repens, Sabul serrulata Other common names: American dwarf palm tree, cabbage palm, fan palm, IDS 89, LSESR, sabal, scrub palm Origin: Saw palmetto is a palm found in the United States. Uses Saw palmetto is primarily used to treat mild to moderate benign prostatic hypertrophy (BPH), stages I, II. It is also used to treat chronic and subacute cystitis; to increase breast size, sperm count, sexual potency; and as a mild diuretic. Investigational Uses Research is underway to confirm the use in prostate cancer. Actions Benign Prostatic Hypertrophy Action Saw palmetto has been studied extensively for its use in the treatment of BPH. The herb has been found to decrease both the symptoms of BPH and the swelling of the prostate. A study of a saw palmetto herbal blend versus a placebo noted a decrease in the symptoms and swelling in moderately symptomatic clients with BPH in the experimental group (Marks et al, 2000). Saw palmetto extract was shown to inhibit Adverse effects: Underline = life-threatening S 556 Saw Palmetto alpha 1-adrenoceptors, which may be involved in the production of urinary tract symptoms of BPH (Goepel et al, 1999; Habib et al, 2005). Another study found that saw palmetto exerts a significant effect on urine flow rates and that it is able to control symptoms effectively (Gerber, 2000). Cytotoxicity in Prostate Cancer One study (Iguchi et al, 2001) found Serenoa repens to be cytotoxic to prostate cancer cells. The chemical component responsible for the cytotoxic action is myristoleic acid. Further research may confirm the use in prostate cancer. Product Availability Berries, capsules, fluid extract, tablets, tea Plant Part Used: Fruit Dosages Saw palmetto is standardized to 85% to 95% fatty acids and sterols. Benign Prostatic Hypertrophy • Adult PO capsules/tablets: 585 mg up to tid for 4-6 months (Foster, 1998) • Adult PO fluid extract, standardized: 160 mg bid, or 320 mg daily (Braeckman et al, 1997) • Adult PO tincture: 20-30 drops up to qid (1:2 dilution) (Foster, 1998) Other • Adult PO decoction: 0.5-1 g dried berries tid • Adult PO decoction: 1-2 g fresh berries tid Contraindications Pregnancy category is 3; breastfeeding category is 2A. Saw palmetto is an antiandrogen herb that is usually given to men. It should not be given to children. Persons with hypersensitivity to saw palmetto should not use it. Side Effects/Adverse Reactions CNS: Headache GI: Nausea, vomiting, anorexia, constipation, diarrhea, abdominal pain and cramping GU: Dysuria, urine retention, impotence INTEG: Hypersensitivity reactions MS: Back pain Interactions Drug Anticoagulants (anisindione, ardeparin, dalteparin, dicumarol, heparin, warfarin): Saw palmetto may potentiate the anticoagulant effects of salicylates; avoid concurrent use. Antiplatelets: Saw palmetto may lead to increased bleeding; avoid concurrent use. Hormones (estrogens, hormonal contraceptives, and androgens): Saw palmetto may antagonize hormone therapy; avoid concurrent use (theoretical). Immunostimulants: Saw palmetto may increase or decrease the effect of immunostimulants; avoid concurrent use (theoretical). = Pregnancy = Pediatric ! = Alert = Popular Herb Saw Palmetto 557 Interactions—cont’d NSAIDs (bromfenac, diclofenac, etodolac, fenoprofen, flurbiprofen, ibuprofen, indomethacin, ketoprofen, ketorolac, meclofenamate, mefenamic acid, nabumetone, naproxen, oxaprozin, piroxicam, sulindac, tolmetin): Saw palmetto may lead to increased bleeding time; avoid concurrent use. Lab Test Bleeding time: Saw palmetto can increase bleeding time. Semen analysis: Saw palmetto may cause metabolic changes in specimen semen analysis. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Fatty acid Lauric acid; Myristic acid; Myristolenic acid Cytotoxic Phytosterol Polysaccharide Steroid Flavonoid Tannin Volatile oil Acylglyceride Invert sugar; Galactose; Arabinose Monolaurin; Monomyristin (Shimada et al, 1997) Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of saw palmetto and administer an antihistamine or other appropriate therapy. • Assess the client’s urinary patterns, including retention, frequency, pain, urge, residual urine, and nocturia. • Assess for the use of antiinflammatories, hormones, and immunostimulants (see Interactions). Administer • Instruct the client to store saw palmetto products in a cool, dry place, away from heat and moisture. • Saw palmetto should be taken with meals to minimize gastrointestinal symptoms. Teach Client/Family • Inform the client that pregnancy category is 3 and breastfeeding category is 2A. • Caution the client not to give saw palmetto to children. • Advise the client who is taking saw palmetto for BPH to consult a qualified herbalist for supervision. • Advise the client to obtain a prostate specific antigen (PSA) test before using this herb. Adverse effects: Underline = life-threatening S 558 Schisandra Schisandra (shi-sahn’druh) Scientific name: Schisandra chinesis Other common names: Gomishi, omicha, schizandra, TJN-101, wu-wei-zu Origin: Schisandra is found in the Far East and Russia. Uses Schisandra has been used in Chinese medicine for the treatment of respiratory, hepatic, and renal disorders. It is thought to possess both antioxidant and immunostimulant properties. It may also be used to enhance athletic performance and energy. Actions Hepatoprotective and Regenerative Actions Most of the research on schisandra focuses on its hepatoprotective and regenerative functions. Two studies have focused on rats with carbon tetrachloride–induced hepatotoxicity (Zhu et al, 1999, 2000). One study evaluated results of hepatic function tests and pharmacokinetics, and both documented significant improvement in damaged livers after administration of schisandra. Another older study showed that lignan, a compound found in schisandra fruits, was able to stimulate partial liver regeneration after rats were given carbon tetrachloride (Takeda et al, 1987). Product Availability Capsules, dried fruit, extract, liquid, tincture, tablets, powder Plant Parts Used: Fruit, kernel, stems Dosages • Adult PO extract: 100 mg bid Hepatitis • Adult PO standardized extract: 20 mg lignan content daily (Jellin et al, 2008) Improving Mental/Physical Performance • Adult PO: 500 mg-2 g daily or crude herb 1.5-6 g daily (Jellin et al, 2008) Contraindications Pregnancy category is 2; breastfeeding category is 1A. Schisandra should not be given to children. Persons with hypersensitivity to schisandra should not use it. Side Effects/Adverse Reactions CNS: Central nervous system depression (rare) GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions Interactions Drug Immunosuppressants (azathioprine, basiliximab, corticosteroids, daclizumab, muromonab, mycophenolate, tacrolimus): Schisandra may decrease the effectiveness of immunosuppressants; avoid use before, during or after transplant surgery. = Pregnancy = Pediatric ! = Alert = Popular Herb Senega 559 Interactions—cont’d Lab Test ALT, AST: Schisandra may cause decreased ALT and AST. Pharmacology Pharmacokinetics Metabolized by the liver. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Triterpenoids Manwuweizic acids; Nigranoic acid; Schisandronic acid Schizandrin B Schisantherin Schizandrol Cytotoxic Ligans Sterol Vitamin Tannin Acid Hepatoprotective A; C; E Malic acid; Tartaric acid; Citric acid Resin Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of schisandra and administer an antihistamine or other appropriate therapy. Administer • Instruct the client to store schisandra products in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 2 and breastfeeding category is 1A. • Caution the client not to give schisandra to children. Senega (seh’ni-guh) Scientific name: Polygala senega Other common names: Milkwort, mountain flax, northern senega, polygala root, rattlesnake root, seneca, seneca root, seneca snakeroot, senega root, senega snakeroot, seneka Origin: Senega is a perennial found in the United States and Canada. Adverse effects: Underline = life-threatening S 560 Senega Uses Senega has widely varied uses, including treatment for snakebite, cough, bronchitis, asthma, croup, pharyngitis, and other respiratory conditions. It is also used to induce vomiting and to treat skin disorders. Actions Hypoglycemic Action The hypoglycemic action of senega results from the chemical component senegin, a saponin (Kako et al, 1996). The rhizomes appear to contain the chemical responsible for the hypoglycemic action. Increased Immune Response One study determined that the saponins in senega increase specific immune responses and act as vaccine adjuvants (Estrada et al, 2000). Sedative Action Sedative-like effects observed in laboratory animals may be due to the actions of the saponins found in senega (Carretero et al, 1986). Product Availability Dried powdered root, extract, syrup, tea, tincture Plant Part Used: Dried root Dosages Expectorant • Adult PO tea: 1 cup bid-tid Other • Adult PO dried powdered root: 0.5-1 g tid • Adult PO extract: 0.3-1 ml q4hr prn • Adult PO syrup: 2 tbsp q4hr prn • Adult PO tincture: 2.5-5 ml q4hr prn Contraindications Until more research is available, senega should not be used during pregnancy and breastfeeding. It should not be given to children. Senega should not be used by persons with hypersensitivity to this herb or salicylates. Clients with peptic or duodenal ulcers, central nervous system depression, or gastritis also should not use senega. Side Effects/Adverse Reactions CNS: Dizziness, lethargy, anxiety EENT: Blurred vision GI: Nausea, vomiting, anorexia, abdominal pain, diarrhea INTEG: Hypersensitivity reactions Interactions Drug Anticoagulants (heparin, warfarin, salicylates): Senega may increase bleeding time when used with anticoagulants; avoid concurrent use. Antidiabetics (insulin): Senega may decrease the effects of antidiabetics; avoid concurrent use. = Pregnancy = Pediatric ! = Alert = Popular Herb Senna 561 Interactions—cont’d CNS depressants (alcohol, barbiturates, benzodiazepines, opiates, sedatives/hypnotics): Use of senega with CNS depressants may cause increased central nervous system effects; avoid concurrent use. Primary Chemical Components and Possible Actions Chemical Class Individual Component Saponin Presenegin; Polygalic acid Senegin Methyl salicylate Salicylate Possible Action Hypoglycemia Anticoagulant; antiinflammatory Salicylic acid Resin Carbohydrate Polygalitol Alpha-spinasterol Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of senega and administer an antihistamine or other appropriate therapy. • Determine whether the client is taking anticoagulants, antidiabetics, or CNS depressants. Drugs in these classes should not be taken concurrently with this herb (see Interactions). Administer • Instruct the client to store senega products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use senega in children or those who are pregnant or breastfeeding until more research is available. Senna (seh’nuh) Scientific names: Cassia spp., Senna alexandrina Other common names: Alexandrian senna, black draught, Dr. Calwell dosalax, Fletcher’s Castoria, Gentlax, Khartoum senna, tinnevelly senna Origin: Senna is found throughout the world. Uses Senna is used for bowel preparation before surgery and to treat acute constipation. Adverse effects: Underline = life-threatening S 562 Senna Actions Senna stimulates peristalsis by acting on Auerbach’s plexus. It softens the feces by increasing the flow of water and electrolytes into the large intestine. Senna has been used for many years in mainstream pharmacology. Product Availability Comminuted herb, decoction, dried extract, elixir, granules (pharmaceutical), oral solution, powder, suppositories, tablets Plant Part Used: Leaves Dosages Preparation for Surgery • Adult PO black draught: dissolve 3⁄4 oz in 2.5 oz liquid; take between 2 and 4 PM the day before the procedure Other • Adult PO cold infusion, comminuted herb: pour cold water over 0.1-0.2 g herb, let stand 10 hr, strain; 1 ⫻ dose • Adult PO granules: add 1⁄2-4 tsp granules to water or juice • Adult PO infusion, comminuted herb: pour hot water over 0.1-0.2 g herb, let stand 10 min, strain; 1 ⫻ dose • Adult suppositories: insert 1-2 suppositories at bedtime • Adult PO syrup: 1-4 tsp at bedtime (7.5-15 ml) • Adult PO tablets (Senokot): 1-8 tabs/day • Child PO syrup ⬎27 kg: use 1⁄2 adult dose • Child PO syrup 1 mo-1 yr: use 1.25-2.5 ml Senokot at bedtime NOTE: Do not give black draught to children. Contraindications Pregnancy category is 1; breastfeeding category is 3A. Senna should not be given to children younger than 12 years of age unless prescribed by a physician. It should not be used by persons with intestinal obstruction, ulcerative colitis, gastrointestinal bleeding, appendicitis, nausea, vomiting, congestive heart failure, or an acute condition in the abdomen caused by surgery. Persons with hypersensitivity to senna should not use it. This herb should not be used for longer than 1-2 weeks without medical advice. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, cramping, diarrhea, flatulence, acute liver failure (senna abuse) (Vanderperren et al, 2005) GU: Pink, red, brown, or black urine; renal impairment (senna abuse) INTEG: Hypersensitivity reactions META: Hypocalcemia, enteropathy, alkalosis, hypokalemia, tetany Interactions Drug Cardiac glycosides (digoxin): Chronic use of senna may potentiate cardiac glycosides Disulfiram: Do not use senna with disulfiram (Antabuse). = Pregnancy = Pediatric ! = Alert = Popular Herb Senna 563 Interactions—cont’d Laxatives: Avoid the concurrent use of senna with other laxatives; additive effect can occur. Herb Jimsonweed: The action of jimsonweed is increased in cases of chronic use or abuse of senna. Stimulant laxative herbs: Senna may increase the laxative effect of stimulant laxative herbs. Lab Test Serum, 24-hour urine estriol: Senna may cause decreased serum and 24-hour urine estriol. Pharmacology Pharmacokinetics Onset of action 6 to 24 hours; metabolized by the liver; excreted in the feces. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Anthracene Sugar Sennoside A, A1, B, C, D Glucose; Fructose; Sucrose Laxative Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of senna and administer an antihistamine or other appropriate therapy. • Assess stools for color, consistency, character, and presence of blood and mucus. • Monitor blood and urine electrolytes if the client is using this product often. • Determine the cause of constipation (e.g., fluids, bulk, and/or exercise missing from lifestyle). • Assess for cramping, rectal bleeding, nausea, and vomiting. If these are present, discontinue the use of senna. • Assess medication and herb use (see Interactions). Administer • Instruct the client to store senna products in a sealed container away from heat and moisture. • Instruct the client to dissolve granules in water or juice before use. • Instruct the client to shake oral solution before use. Teach Client/Family • Inform the client that pregnancy category is 1 and breastfeeding category is 3A. • Caution the client not to give senna to children younger than 12 years of age. • Advise the client that the use of laxatives on a regular basis leads to loss of bowel tone. • Advise the client that urine and feces may turn yellow, brown, or red. • Advise the client not to use senna if abdominal pain, nausea, or vomiting are present. Adverse effects: Underline = life-threatening S 564 Shark Cartilage Shark Cartilage (shahrk kahr’tuhl-ij) Scientific names: Squalus acanthias (dogfish shark), Sphyrna lewini (hammerhead shark), and others Origin: Shark cartilage is obtained from the hammerhead and spiny dogfish sharks. Uses Investigational Uses Shark cartilage is primarily used to treat cancer, although research attempting to confirm this use has produced mixed results. Actions Shark cartilage has been investigated for its use in the treatment of cancer. However, the only study professing the usefulness of shark cartilage for this purpose has never been replicated. One of the chemical components in the cartilage of the dogfish shark, squalamine, has been shown to possess antibiotic properties (Moore et al, 1993). It is effective against both gram-negative and gram-positive organisms. Product Availability Capsules, concentrate, injectable, tablets Parts Used: Cartilage from the dogfish and hammerhead sharks Dosages • Adult injectable ampules: 1 daily • Adult PO capsules/tablets: 1000-4500 mg daily, usually in divided doses • Adult PO concentrate: 2 tbsp daily Contraindications Until more research is available, shark cartilage should not be used during pregnancy and breastfeeding. It should not be given to children. Shark cartilage should not be used by persons with hepatic disease or by persons who are hypersensitive to it. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, hepatitis Interactions Drug Calcium supplements: Shark cartilage combined with calcium may cause increased calcium levels. Food Fruit juice (orange, apple, grape, tomato): Fruit juice can decrease the action of shark cartilage. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Glycoprotein Squalamine Sphyrnastatin 1, 2 Antimicrobial = Pregnancy = Pediatric ! = Alert = Popular Herb Siberian Ginseng 565 Client Considerations Assess • Monitor hepatic function tests periodically (AST, ALT, bilirubin). Administer • Instruct the client to store shark cartilage in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use shark cartilage in children or those who are pregnant or breastfeeding until more research is available. Siberian Ginseng (sy-beer’ee-uhn jehn-sing) Scientific name: Acanthopanax senticosus, Eleutherococcus senticosus, Hedera senticosa Other common names: Devil’s shrub, Eleuthro, shigoka, touch-me-not Origin: Siberian ginseng is a shrub found throughout the world. It is primarily found in Russia and China. Uses Siberian ginseng has been used to increase immunity, energy, and performance and to decrease inflammation and insomnia. Actions As with ginseng, most of the available research on Siberian ginseng comes from Asia, where it has been studied extensively. In particular, Siberian ginseng has been studied for its adaptogenic, radioprotective, and anticancer actions. Adaptogenic Action Siberian ginseng has been found to normalize biologic functioning in a variety of body organs and systems, including the adrenal gland, thyroid, kidneys, white and red blood cells, and blood pressure. The herb also decreases stress reactions in the alarm phase, as seen in stress-induced biologic changes in rats (Brekham et al, 1969). Radioprotective Action Siberian ginseng has exhibited protective and therapeutic effects when laboratory animals are exposed to x-ray radiation. In one study in which rats were exposed to prolonged radiation, life spans were more than doubled. Some researchers have suggested that Siberian ginseng may be useful in oncologic treatment to protect patients from the ill effects of radiation therapy (Ben-Hur et al, 1981). Anticancer Action In animals, Eleutherococcus has decreased thyroid tumors, lung adenomas, and myeloid leukemia. The anticancer action of this herb may be due to its immunostimulant properties (Wagner et al, 1985). Other Actions Siberian ginseng possesses a neuroprotective effect by inhibiting inflammation in brain ishemia (Bu et al, 2005). Adverse effects: Underline = life-threatening S 566 Siberian Ginseng Product Availability Capsules, oil, powder, root, tablets, tea, tincture Plant Parts Used: Root, root bark Dosages Some products are standardized to total eleutheroside content or eleutherosides B, D, and E. Chronic Fatigue Syndrome • Adult PO dried root: 2-4 g tid (Murray, Pizzorno, 1998) • Adult PO tincture: 10-20 ml tid (1:5 dilution) (Murray, Pizzorno, 1998) • Adult PO fluid extract: 2-4 ml (1:1 dilution) (Murray, Pizzorno, 1998) • Adult PO solid (dry powdered) extract: 100-200 mg (20:1 dilution) standardized to contain ⬎1% eleutheroside E (Murray, Pizzorno, 1998) General Dosages • Adult PO capsules/tablets: 500 mg to 2 g daily • Adult PO extract: 2-12 ml daily (35% alcohol) (McCaleb et al, 2000) • Adult PO powdered root: 2-8 g (McCaleb et al, 2000) Contraindications Pregnancy category is 2; breastfeeding category is 2A. Siberian ginseng should not be given to children. It should not be used by persons with hypersensitivity to this or other ginseng products or persons with hypertension. Siberian ginseng should not be used for longer than 90 days without a rest period and should not be used during the acute phase of infections, although it can be used concurrently with antiinfectives for dysentery. Side Effects/Adverse Reactions CNS: Stimulation, insomnia, dizziness, anxiety, agitation (high doses) CV: Increased blood pressure (high doses) GI: Nausea, vomiting, anorexia GU: Increased vaginal bleeding, increased estrogen levels INTEG: Hypersensitivity reactions, rash Interactions Drug Antidiabetics (acetohexamide, chlorpropamide, glipizide, insulin, metformin, tolazumide, tolbutamide, troglitazone), cardiac glycosides (digoxin): Siberian ginseng may increase levels of antidiabetics, cardiac glycosides; avoid concurrent use. Cytochrome P450 1A2, 2C9, 2D6, 3A4 substrates: Siberian ginseng (standardized) may inhibit these agents. Kanamycin: Siberian ginseng may increase the action of kanamycin. Stimulants (xanthines): Concurrent use of stimulants with Siberian ginseng is not recommended; overstimulation may occur. Herb Ephedra: Concurrent use of ephedra with Siberian ginseng may increase hypertension and central nervous system stimulation; avoid concurrent use. = Pregnancy = Pediatric ! = Alert = Popular Herb Skullcap 567 Interactions—cont’d Lab Test Androstenedione: Siberian ginseng may cause increase in serum androstenedione. Blood glucose: Siberian ginseng may decrease blood glucose levels. Primary Chemical Components and Possible Actions Chemical Class Individual Component Saponin Glycan Eleutheroside Protoprimulagenin A Eleutherane A-G I, K, L, M Steroid glycoside Lignan Hydroxycoumarin Resin Vitamin E Eleutheroside A Sesamine; Eleutheroside D Isofraxidin Possible Action Binds to estrogen receptors Client Considerations Assess • Assess for hypersensitivity reactions, rash. If present, discontinue the use of Siberian ginseng and administer an antihistamine or other appropriate therapy. • Assess the use of antidiabetics, cardiac glycosides, kanamycin, stimulants, and ephedra (see Interactions). Administer • Instruct the client to store Siberian ginseng products in a cool, dry place, away from heat and moisture. • Instruct healthy clients to use Siberian ginseng for 6 weeks with a 2-week break before repeating (Mills, Bone, 2000), or use for 3 months, then repeat at a later time (German Federal Minister of Justice, 1991). Teach Client/Family • Inform the client that pregnancy category is 2 and breastfeeding category is 2A. • Caution the client not to give Siberian ginseng to children. Skullcap (skuhl’kap) Scientific names: Scutellaria laterifolia, Scutellaria baicalensis Other common names: Blue pimpernel, helmet flower, hoodwort, huang-qin, mad-dog weed, madweed, Quaker bonnet, scullcap Origin: Skullcap is found in North America. Adverse effects: Underline = life-threatening S 568 Skullcap Uses Skullcap traditionally has been used to treat seizure disorders, inflammation, anxiety, insomnia, nervous tension, spastic disorders, and high cholesterol. Investigational Uses Initial research is available for the use of skullcap as an antiviral and as a treatment for lung cancer, cerebrovascular accident (CVA), and embolism. Actions Anticancer Action Skullcap has been shown to normalize platelet-mediated hemostasis in rats with lymphosarcoma (Razina et al, 1989). This action may be responsible for the antitumor effects of skullcap. Another study documented antitumor action and antineoplastic toxicity in mice (Razina et al, 1987). Sleep Disorder Treatment Epidemiologic studies have shown the use of skullcap for the treatment of sleep disorders (Cauffield et al, 1999). Skullcap has been shown to decrease interleukin-1 and prostaglandin synthesis (Chung et al, 1995). Product Availability Capsules, dried herb tea, fluid extract, tincture Plant Parts Used: Leaves, roots Dosages • Adult PO dried herb tea: 2 g tid • Adult PO fluid extract: 2-4 ml tid (1:1 dilution in 25% alcohol) • Adult PO tincture: 1-2 ml tid (1:5 dilution in 45% alcohol) Contraindications Class 1 herb (root). Pregnancy category is 3; breastfeeding category is 2A. Skullcap should not be given to children. Persons with hypersensitivity to skullcap should not use it. Side Effects/Adverse Reactions CNS: Tremors, confusion, euphoria, seizures, stupor (overdose of tincture only) CV: Arrhythmias (overdose of tincture only) GI: Nausea, vomiting, anorexia, hepatotoxicity INTEG: Hypersensitivity reactions Interactions Drug CNS depressants (alcohol, barbiturates): Skullcap may potentiate sedation of central nervous system depressants; avoid concurrent use. Immunosuppressants (cyclosporine): Use of skullcap may decrease the effects of immunosuppressants; avoid concurrent use. Herb Sedative herbs: Skullcap with sedative herbs can increase sedation (theoretical). = Pregnancy = Pediatric ! = Alert = Popular Herb Slippery Elm 569 Interactions—cont’d Lab Test ALT, AST, total and urine bilirubin: Skullcap may cause increased ALT, AST, total bilirubin, and urine bilirubin. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Flavonoid Baicalin Anti-HIV, antineoplastic, antioxidative (Kowalezyk et al, 2006) Iridoid Sesquiterpene Luteolin; Apigenin; Hispidulin; Baicalein; Scutellarin; Scutellarein Catalpol Terpineol; Limonene; Caryophyllene; Cadinene Tannin Resin Lignin Wogonin Client Considerations Assess ! • Assess for hepatotoxicity, central nervous system overdose symptoms, and cardiovascular overdose symptoms (see Side Effects). • Assess for hypersensitivity reactions. If present, discontinue the use of skullcap and administer an antihistamine or other appropriate therapy. • Assess for the use of immunosuppressants (see Interactions). Administer • Instruct the client to store skullcap products in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 3 and breastfeeding category is 2A. • Caution the client not to give skullcap to children. Slippery Elm (sli’puh-ree ehlm) Scientific names: Ulmus rubra, Ulmus fulva Other common names: American elm, Indian elm, moose elm, red elm, sweet elm Origin: Slippery elm is found in North America. Adverse effects: Underline = life-threatening S 570 Slippery Elm Uses Slippery elm is taken internally to treat cough and gastrointestinal conditions including gastritis and gastric or duodenal ulcers. Topically, it is used for its skin smoothing effect and as a poultice to treat skin inflammation, wounds, and burns. Actions Very little information is available for slippery elm, other than anecdotal reports. Herbalists continue to use this product to treat cough and gastrointestinal conditions, and for wound healing. Product Availability Fluid extract, powdered bark Plant Part Used: Inner bark Dosages • Adult PO: place 4 g in 1⁄2 L boiling water; may be taken tid • Adult PO fluid extract: 5 ml tid • Adult PO powdered bark decoction: 4-16 ml tid • Adult topical poultice: mix boiling water with coarse powdered bark to make a poultice; apply to affected area prn Contraindications Class 1 herb (bark). Because it may cause spontaneous abortion, slippery elm should not be used during pregnancy. Until more research is available, this herb should not be used during breastfeeding and should not be given to children. Persons with hypersensitivity to slippery elm should not use it. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia GU: Spontaneous abortion (whole bark) INTEG: Hypersensitivity reactions Interactions Drug Iron salts: Slippery elm tea may decrease the absorption of iron salts; separate by 2 hours. Oral medications: Slippery elm may decrease absorption of oral medications (theoretical). Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Wound healing; astringent Tannin Hexose Pentose Methylpentose Polyuronide = Pregnancy = Pediatric ! = Alert = Popular Herb Sorrel 571 Primary Chemical Components and Possible Actions—cont’d Chemical Class Individual Component Sterol Citrostandienol; Dolichol; Phytositosterol Sesquiterpene Mineral Possible Action Calcium oxalate Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of slippery elm and administer an antihistamine or other appropriate therapy. Administer • Instruct the client to store slippery elm products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use slippery elm during pregnancy because it may cause spontaneous abortion. Until more research is available, caution the client not to use this herb during breastfeeding and not to give it to children. Sorrel ! (saw’ruhl) Scientific name: Rumex acetosa. Do not confuse with yellow dock (Rumex crispus) Other common names: Cuckoo’s meate, cuckoo sorrow, dock garden sorrel, green sorrel, sour dock Origin: Sorrel is found in Europe and Asia. Uses Sorrel is used as a diuretic, an antiseptic to treat skin infections, for sinusitis, and to stimulate secretions. It has been used traditionally to treat scurvy. Actions Research regarding sorrel’s actions is lacking. This herb is not used commonly because it is considered toxic to the liver and renal system with the presence of potassium oxalates. One study (Lee et al, 2005) identified the chemical constituents, anthraquinones, in Rumex acetosa that are cytotoxic and antimutagenic. Product Availability Liquid, tea, fresh juice Plant Parts Used: Flowers, leaves Dosage No published dosages are available. Adverse effects: Underline = life-threatening S 572 Soy Contraindications Sorrel should not be used in children or those who are pregnant, breastfeeding, or hypersensitive to this product. Side Effects/Adverse Reactions CV: CV damage EENT: Stomatitis GI: Anorexia, nausea, gastritis, abdominal cramps, hepatic dysfunction GU: Renal damage INTEG: Rash, contact dermatitis Interactions Drug Calcium, iron, zinc: Sorrel may decrease absorption of these minerals. Diuretics: Sorrel combined with diuretics will lead to an additive diuretic effect; avoid concurrent use. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Oxalates Tannin Potassium Hepatotoxic Astrigent, wound healing Anthracene Oxymethylanthraquinone Client Considerations Assess • Assess the reason the client is using sorrel. Administer • Keep sorrel in a cool, dry area, away from excessive light. Teach Client/Family • Advise the client not to use sorrel in children or those who are pregnant or breastfeeding until more research is available. • Warn the client that sorrel is fatal at levels over 5 g. Keep away from children ! and pets. Soy (sawee) Scientific name: Glycine max Other common names: Soya, soybean, soy lecithin Origin: Soy is a bean found throughout the world. = Pregnancy = Pediatric ! = Alert = Popular Herb Soy 573 Uses Soy has been used for thousands of years in China. Currently it is used to lower cholesterol and to treat hyperactivity, fever, headache, anorexia, chronic hepatitis, and other hepatic disease. Investigational Uses Research supports the use of soy for the treatment of the symptoms of menopause, as well as for the prevention of osteoporosis and various types of cancer (primarily uterine, breast, prostate, and colon cancers). Actions Soy is one of the few natural products that has been researched extensively. Although originally used as a food source, in the last few years soy has been found to possess medicinal properties. Phytoestrogen Action The isoflavones in soy are chemically similar to estradiol in the female human body. Research has shown that soy is useful for the prevention of symptoms of menopause in perimenopausal women. Studies document that soy lessens these symptoms and provides an alternative to hormone replacement therapy. One study also shows that bone loss in the spine decreases with the addition of soy-rich products to the diets of perimenopausal women (Alekel et al, 2000). Anticancer Action Several studies have evaluated the use of soy for treatment of cancer of the breast, prostate, and colon. Populations in Asia with high-soy diets have been found to have a significantly lower incidence of these cancers than other populations. Genistein, one of the chemical components of soy, has been found to decrease the growth of tumors implanted in mice (Record et al, 1997). Soy has been found to lengthen the menstrual cycle by prolonging the follicular phase, which may protect against breast cancer. A recent study postulates that the isoflavones and other chemical constituents of soy may lower the cancer risk of postmenopausal women by altering estrogen metabolism such that genotoxic metabolites are converted to inactive metabolites (Xu et al, 2000). In addition, genistein has been shown to decrease prostatic cancer and to increase the immune response in laboratory animals (Zhang et al, 1997). Antilipidemia Action Most of the research on soy deals with its anticholesterol effects. Soy has been found to lower both LDL and total cholesterol levels, with total cholesterol reduction as much as 20% (Anderson et al, 1995). Researchers have documented a slight increase in HDL levels, but not significant. In another study, 32 clients with coronary artery disease discontinued their antilipidemic medication and began a vegetarian diet containing soy-based products. LDL levels dropped significantly, with those who stayed on the diet longer experiencing more significant results (Medkova et al, 1997). Product Availability Bean curd, capsules, seitan, soy milk, tofu Plant Part Used: Bean (seed) Dosages Menopause Symptom Relief • Adult PO: 50-75 mg isoflavones daily (Murray, Pizzorno, 1998) Adverse effects: Underline = life-threatening S 574 Soy Osteoporosis Prevention • Adult PO: 55-100 mg isoflavones daily (Murray, Pizzorno, 1998) Reduction of Cholesterol • Adult PO: 25-50 g daily (Murray, Pizzorno, 1998) Contraindications No absolute contraindications are known. Side Effects/Adverse Reactions GI: Nausea, bloating, diarrhea, abdominal pain INTEG: Hypersensitivity reactions Interactions Drug Estrogens, tamoxifen, thyroid agents (dextrothyroxine, levothyroxine, liothyronine, liotrix, thyroglobulin): Soy may interfere with absorption of these agents; avoid concurrent use. Lab Test HDL: Soy may cause increased HDL cholesterol. LDL, triglycerides, total cholesterol: Soy may cause decreased LDL cholesterol, triglycerides, and total cholesterol. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Isoflavone Daidzein Genistein Phytoestrogen Antitumor; impairs thyroid function Phospholipid Phosphatidylcholine; Phosphatidylethanolamine; Phosphatidylinositol Sterol Protein Saponin Fatty acid Palmitic acid; Palmitoleic acid; Linoleic acid; Linolenic acid; Steric acid; Oleic acid Oxalates Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of soy and administer an antihistamine or other appropriate therapy. Administer • Instruct the client to store soy products in a cool, dry place, away from heat and moisture. = Pregnancy = Pediatric ! = Alert = Popular Herb Spirulina 575 Spirulina (speer-ew-leen’uh) Scientific name: Spirulina spp. (approximately 35 species) Other common names: Blue-green algae, DIHE, tecuitlatl Origin: Spirulina is an alga found in oceans in the tropics and subtropics. Uses Because of its high nutritional value, spirulina has been used both to promote weight gain in malnourished clients, to promote weight loss, and for oral leukoplakia. Investigational Uses Initial research supports the use of spirulina as an antiviral, a chemoprotective agent, for fibromyalgia, and to decrease cholesterol. Actions Spirulina has been used for centuries in South America and Africa. It has been found to possess antiviral, antitumor, anticholesterol, and immunologic properties. Very little research has been done with humans, but animal studies show little toxicity, even at very high amounts (Chamorro et al, 1996). Antiallergy Action One study evaluated the use of spirulina for the treatment of allergic reactions. Spirulina was found to decrease mast cell–mediated allergic reactions (Kim et al, 1998). Antitumor Action Spirulina has also been shown to decrease induced tumor necrosis factor (TNF)-alpha. Iron Storage During Pregnancy Another study using laboratory rats has shown that a diet of spirulina or spirulina plus wheat gluten promoted greater iron storage and a higher hemoglobin content during pregnancy (Kapoor et al, 1998). Other Actions Spirulina extract given 250 mg plus zinc 2 mg bid ⫻16 wk may be helpful for chronic arsenic poisoning (Misbahuddin et al, 2006). Another study (Khan et al, 2006) identified spirulina’s protective effect against nephrotoxicity. Product Availability Capsules, component in drinks, fresh plant, powder, tablets Plant Part Used: Whole plant Dosages • Adult PO: 3-5 g daily before meals Malnourishment • Infant PO: 3-15 g daily Contraindications Until more research is available, spirulina should be used with caution during pregnancy and breastfeeding. Caution should be used when giving spirulina products to children. Clients with thyroid conditions should not use spirulina. Heavy metal poisoning may result from high mercury content in some spirulina products. Continued Adverse effects: Underline = life-threatening S 576 Spirulina Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions Interactions Drug Thyroid hormones: The high iodine content of spirulina may decrease the action of thyroid hormones; avoid concurrent use (theoretical). Primary Chemical Components and Possible Actions Chemical Class Individual Component Amino acid Fat Carbohydrate Mineral Phenylalanine Trace element Vitamin Fatty acid Possible Action Calcium; Potassium; Magnesium; Iron Selenium; Manganese; Zinc B1; B12; E Gamma-linolenic acid (GLA) Increased uric acid levels Nucleic acid Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of spirulina and administer an antihistamine or other appropriate therapy. • Assess nutritional status if the client is using spirulina to treat malnourishment. Administer • Instruct the client to store spirulina products in a cool, dry place, away from heat and moisture. Teach Client/Family • Advise the client to use spirulina with caution in children and those who are pregnant or breastfeeding until more research is available. • Advise the client that some spirulina products may have a high mercury and radioactive ion content. • Inform the client that the protein content of spirulina is higher than the protein content of evening primrose oil. • Inform the client that the iron content of spirulina is more easily absorbed than that of many other iron products. = Pregnancy = Pediatric ! = Alert = Popular Herb Squill 577 Squill ! (skwil) Scientific names: Urginea maritima, Drimia maritima Other common names: European squill, Indian squill, Mediterranean squill, red squill, scilla, sea onion, sea squill, white squill Origin: Squill is found in Europe and Mediterranean regions. Uses Traditionally, squill has been used for its cardiac glycoside effect in the treatment of cardiac conditions such as congestive heart failure. It is also used to treat cough and to promote diuresis. Actions ! In North Africa, squill has been found to be poisonous to livestock, with ingestion of the plant leading to cardiac toxicity (El Bahri et al, 2000). Toxicity was also reported in a 55-year-old woman with Hashimoto thyroiditis who was taking squill to treat arthritis. Her symptoms were those of cardiac glycoside toxicity (Tuncok et al, 1995). Squill has exerted cardiac glycoside effects in humans but is considered to be milder than current cardiac glycoside prescription drugs (Stauch et al, 1977). Product Availability Dried bulb, extract, tincture Plant Part Used: Bulb Dosages • Adult PO decoction: pour 8 oz boiling water over 1 tsp dried bulb, let stand 15 min, allow to cool; may be taken tid • Adult PO tincture: 1⁄2-1 ml tid Contraindications Until more research is available, squill should not be used during pregnancy and breastfeeding. It should not be given to children. Squill should not be used by persons with hypokalemia, hypertropic cardiomyopathy, sick sinus syndrome, ventricular tachycardia, or second or third-degree heart block. Persons who are hypersensitive to squill should not use it. Side Effects/Adverse Reactions CNS: Anxiety, headache, tremors, central nervous system stimulation, seizures CV: Arrhythmias, heart block, asystole GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions Interactions Drug ! Cardiac agents (antiarrhythmics, beta-blockers, calcium channel blockers, cardiac glycosides): Squill may increase the effects of cardiac agents, causing life-threatening toxicity; do not use concurrently. Continued Adverse effects: Underline = life-threatening S 578 Squill Interactions—cont’d CNS stimulants (amphetamines, cerebral stimulants), glucocorticoids, laxatives: Squill may increase the effects of central nervous system stimulants, glucocorticoids, laxatives; avoid concurrent use. Iron salts: Squill may decrease the absorption of iron salts; separate by 2 hours. Lab Test Red blood cells: Squill may cause a decrease in red blood cells. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Cardiac glycoside Proscillaridin A; Scillaren A, B; Glucoscillaren; Scillaridin A; Scilliroside Inotropic; Chronotropic Flavonoid Bufadienolides Ligan Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of squill and administer an antihistamine or other appropriate therapy. • Assess cardiac status (blood pressure, pulse, possibly ECG) if the client is taking squill over an extended period of time. • Monitor electrolytes and watch for decreasing potassium levels. ! • Determine whether the client is taking other cardiac medications such as betablockers, calcium channel blockers, cardiac glycosides, and antidysrhythmics. This herb should not be used with these medications (see Interactions). • Assess for the use of central nervous system stimulants, glucocorticoids, and laxatives (see Interactions). Administer • Instruct the client to store squill products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use squill in children or those who are pregnant or breastfeeding until more research is available. • Advise the client that other, more mainstream agents are available and are preferred to squill. = Pregnancy = Pediatric ! = Alert = Popular Herb St. John’s Wort 579 St. John’s Wort (saynt jahnz wawrt) Scientific name: Hypericum perforatum L Other common names: Amber, goatweed, hardhay, John’s wort, klamath weed, mellipertuis, rosin rose, witches’ herb Origin: St. John’s wort is found in Europe, Asia, and the United States. Uses St. John’s wort is used to treat mild to moderate depression and anxiety. It may be used topically as an antiinflammatory to relieve hemorrhoids, as well as to treat vitiligo and burns. Investigational Uses St. John’s wort is used experimentally to treat warts, Kaposi’s sarcoma, cutaneous T-cell lymphoma, and other viruses such as influenzae. It is also used experimentally as an antiretroviral in the treatment of HIV, as an antiinfective against methicillinresistant strains of Staphylococcus aureus, and for phytotherapy in the treatment of psoriasis. Studies are underway to confirm St. John’s wort’s use in menopausal symptoms and seasonal affective disorder. It may be effective for nicotine withdrawl symptoms. Actions Several different possible actions have been researched in the United States and abroad, primarily in the 1980s and 1990s. Antidepressant Action The inhibition of MAO (monoamine oxidase) and COMT (catechol O-methyltransferase) by Hypericum extracts and hypericin was researched (Bladt, Wagner, 1994; Suzuki et al, 1984; Thiede et al, 1994). Hypericin was found to inhibit in vitro type A and B MAOs. In rats, MAO-A inhibition was greater than MAO-B inhibition (Suzuki et al, 1984). No relevant MAO inhibitory effect could be shown from the results of (Bladt, Wagner, 1994), and no MAOI reactions have ever been found with St. John’s wort. The inhibition of MAO was determined to be the result of flavonoids in the hypericin. Later studies could not confirm the MAOI effect (Muller et al, 1994). Other studies (Muller et al, 1998) reported an inhibition of the reuptake of norepinephrine and serotonin by Hypericum extract, which is the same mechanism of action as the tricyclics and selective serotonin reuptake inhibitors. Much of the antidepressant action may be attributed to hyperforin and adhyperforin (Chatterjee et al, 1998a, 1998b). These two constituents are found in the reproductive parts of the plant. Antiretroviral/Antimicrobial Action Investigation is underway into the possible antiretroviral action of St. John’s wort and its use in the treatment of HIV infections (Chavez, 1997). Antiretroviral action may be due to protein kinase-C–mediated phosphorylation. However, in one study, significant cutaneous phototoxicity resulted during the study, with no antiretroviral action found in the 30 participants (Gulick et al, 1999). One study (Reichling et al, 2001) found Hypericum perforatum tea effective against methicillin-resistant strains of S. aureus with an MIC value of 1.0 mcg/ml. Adverse effects: Underline = life-threatening S 580 St. John’s Wort Other Actions One study (Mannucci et al, 2007) identified the serotonin-mediated beneficial effects of St. John’s wort on reducing nicotine withdrawl symptoms. Another study identified the reduction of ceralein-induced acute pancreatitis in mice (Genovese et al, 2006). Product Availability Cream; sublingual capsules; solid forms: 100, 300, 500 (0.3% hypericin), 250 (0.14% hypericin) mg; tincture Plant Part Used: Flowers Dosages • Adult PO: 300 mg hypericum extract, standardized to 0.3% hypericin, tid • Adult topical: apply prn Contraindications Pregnancy category is 2; breastfeeding category is 3A. St. John’s wort should not be given to children. Persons who are hypersensitive to this herb should not use it. Side Effects/Adverse Reactions CNS: Dizziness, insomnia, restlessness, fatigue (PO) GI: Constipation, abdominal cramps (PO) INTEG: Photosensitivity, rash, hypersensitivity Interactions Drug ACE inhibitors, hormonal contraceptives, loop diuretics, NSAIDs, sulfonamides, sulfonylureas, tetracyclines, thiazide diuretics: St. John’s wort combined with these products may lead to severe photosensitivity; avoid concurrent use. Alcohol, MAOIs: St. John’s wort may increase MAO inhibition (suggested by early studies); do not use alcohol, MAOIs and St. John’s wort concurrently until research is available. Amphetamines, antidepressants, trazodone, tricyclics: St. John’s wort used with these products may cause serotonin syndrome. Antiretrovirals, nonnucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors: Studies indicate that St. John’s wort taken PO in combination with indinavir may decrease the antiretroviral action of this drug. Cytodrome P450 1A2, 2C9, 3A4: St. John’s wort induces these enzyme systems. Immunosuppressants: Rejection of transplanted hearts has occurred when St. John’s wort was taken PO with cyclosporine, an immunosuppressant. Other immunosuppressants may have the same drug interaction in heart transplants, as well as other transplants. Paroxetine: Increased sedation may result when paroxetine is combined with St. John’s wort (Gordon, 1998). SSRIs: Serotonin syndrome and an additive effect may occur when SSRIs are combined with St. John’s wort. Concurrent use may lead to coma. Do not use concurrently. = Pregnancy = Pediatric ! = Alert = Popular Herb St. John’s Wort 581 Interactions—cont’d Food Catecholamines, tyramine: Limit foods high in tyramine or catecholamines until further research confirms or denies the MAOI action of St. John’s wort taken PO. Lab Test Growth hormone: St. John’s wort may cause increased growth hormone (somatotropin, GH). Digoxin, serum iron, serum prolactin, theophylline: St. John’s wort may cause decreased serum prolactin, theophylline (aminophylline), serum iron, and digoxin (peak and trough concentrations). Pharmacology Pharmacokinetics Very little is known about the pharmacokinetics in humans. St. John’s wort is thought to cross the blood-brain and placental barriers and possibly enter breast milk. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Naphthodianthrone Hypericin; Pseudohypericin Antiinflammatory; antitumor; antiviral (Raffa, 1998; Yip et al, 1996) Antidepressant Antiseptic; disinfectant Phenol Flavonoid Bioflavonoid Phloroglucinol Above ground parts also contain Tannin Hyperforin Caffeic acid; Chlorogenic acid P-Coumaric acids; Hyperforin Hyperin; Hyperoside; Isoquercitrin; Kaempferol; Luteolin; Quercetin, Quercitrin, Rutin Amenotoflavone; Biapigenin Adhyperforin S Antiinflammatory; antiulcergenic Inhibits serotonin, dopamine, norepinephrine; antidepressant Wound healing Adverse effects: Underline = life-threatening 582 Storax Client Considerations Assess Antidepressant Use • Assess the client’s mental status: mood, sensorium, affect, memory (long, short), change in depression or anxiety levels. • Assess for the use of MAOIs and SSRIs, which should not be used with St. John’s wort (taken PO) until further research is available. • Assess for other drugs, foods, and herbs the client uses on a regular basis (see Interactions). Antiretroviral Use • Assess for signs of infection. • Assess CBC, blood chemistry, plasma HIV, RNA, absolute CD4/CD8⫹/cell counts/%, serum b-2 microglobulin, and serum ICD⫹ 24 antigen levels. Administer • PO: use 2 tsp herb in 150 ml boiling water. Steep 15 minutes to create infusion. • Topical: use oily hypericum preparations to treat inflammation or burns. Apply as needed. Teach Client/Family • Inform the client that pregnancy category is 2 and breastfeeding category is 3A. • Caution the client not to give St. John’s wort to children. • Advise the client to avoid high-tyramine foods such as aged cheese, sour cream, beer, wine, pickled products, liver, raisins, bananas, figs, avocados, meat tenderizers, chocolate, and yogurt and to avoid increased caffeine intake when using this herb PO. • Inform the client that the therapeutic effect may take 4 to 6 weeks for the treatment of depression. If no improvement occurs in that time, another therapy should be considered. • Advise the client to avoid the use of alcohol or over-the-counter products that contain alcohol when using this herb PO. • Advise the client to avoid the sun or use sunscreen or protective clothing to prevent photosensitivity when using this herb. Storax (stoe’raks) Scientific name: Liquidambar orientalis Other common names: Alligator tree, star-leaved gum, sweet gum tree, balsam styracis, liquid amber, opossum tree, red gum, white gum Origin: Storax is a tree found in Turkey. Uses Traditionally, storax has been used in warm-mist vaporizers and as an expectorant. It is used as a diuretic and to treat diarrhea and sore throat. In addition, it is used in the furniture, cosmetic, and food industries. Externally, storax is used to treat wounds and ulcers. = Pregnancy = Pediatric ! = Alert = Popular Herb Storax 583 Actions Very little research is available to document any uses or actions of storax. Some researchers have proposed that storax may possess antimicrobial properties similar to those of tea tree (Wyllie et al, 1989). One study (Sadic et al, 2005) identified the antibacterial activity against many bacteria at concentrations of 10% and against some bacteria at concentrations of 1%, 0.4%, and 0.2%. Product Availability Crude balsam; no medicinal commercial preparations are available Plant Parts Used: Bark, gum, leaves Dosages No dosage consensus exists. Contraindications Until more research is available, storax should not be used during pregnancy and breastfeeding. It should not be given to children. Persons with hypersensitivity to storax should not use it. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, diarrhea INTEG: Hypersensitivity reactions, contact dermatitis Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Cinnamic acid Phenylethylene Vanillin Aromatic alcohols Storesins Styrene Volatile oil Triterpenes S Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of storax and administer an antihistamine or other appropriate therapy. Administer • Instruct the client to store storax in a cool, dry place, away from heat and moisture. • Instruct the client to use storax externally on small areas only. External administration over large areas can lead to absorptive poisonings resulting in kidney damage. Teach Client/Family • Caution the client not to use storax in children or those who are pregnant or breastfeeding until more research is available. Adverse effects: Underline = life-threatening 584 Tea Tree Oil Tea Tree Oil Scientific name: Melaleuca alternifolia Other common names: Australian tea tree oil, melaleuca oil, tea tree Origin: Tea tree is found in Australia. Uses Tea tree oil traditionally has been used to clean superficial wounds and to treat insect bites and other skin conditions. All applications of this herb are topical. Investigational Uses Initial evidence is available documenting the use of tea tree oil for the treatment of bacterial, viral, and fungal infections; eczema; psoriasis; and acne vulgaris. Actions Antimicrobial Action Tea tree oil has been tested for its antimicrobial properties. The essential oil shows broad-spectrum activity against Escherichia coli, Staphylococcus aureus, and Candida albicans. The antimicrobial activity of tea tree oil may result from its ability to disrupt the cell membrane (Cox et al, 2000). Another study (Hammer et al, 1998) demonstrated activity against Candida spp. Tea tree oil may also be useful for the treatment of yeast and fungal infections of the skin and mucosa. It has been shown to be effective against C. albicans, Trichophyton rubrum, Trichophyton mentagrophytes, Trichophyton tonsurans, Aspergillus niger, Penicillium sp., and Microsporum gypsum (Concha et al, 1998). Pseudomonas aeruginosa has been shown to be less susceptible than other species to the antimicrobial action of tea tree oil (Mann et al, 2000). Other Actions There may be antiinflammatory effects of tea tree oil as investigated on human peripheral blood leukocytes (Caldefie-Chézet et al, 2006). Product Availability Cream, lotion, ointment, soap (5%-100%); component in many other commercial products Plant Parts Used: Branches, leaves Dosages • Adult topical: apply any available form prn (usually 70%-100% used for fungal infections, 5%-15% used for acne) Contraindications Until more research is available, tea tree oil should not be used during pregnancy and breastfeeding. Persons with hypersensitivity to the tea tree plant should not use tea tree oil. Side Effects/Adverse Reactions INTEG: Hypersensitivity reactions, contact dermatitis = Pregnancy = Pediatric ! = Alert = Popular Herb Thymus Extract 585 Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Coumarin Dihydrocoumarin; Melilotic acid; Methyl melilotate; Ethyl melilotate; Coumaric acid (Ehlers et al, 1995) Terpinene Pinene; Cymene Anticoagulant Hydrocarbon Antimicrobial Cineol Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of tea tree oil and administer an antihistamine or other appropriate therapy. • Assess the client’s skin condition, including redness and pustules, if the client is using tea tree oil to treat skin disorders. Administer • Instruct the client to store tea tree oil in a sealed container away from heat and moisture. • Instruct the client that tea tree oil is for external use only. It should not be taken internally. Teach Client/Family • Caution the client not to use tea tree oil during pregnancy and breastfeeding until more research is available. • Advise the client that worsening skin conditions should be treated with more conventional therapy. T Thymus Extract (thi’ mus eck’strakt) Other common names: Pure thymic extract, thymomodulin, thymosin, thymus, thymus factor, thymus polypeptides Origin: Bovine thymus gland Uses Thymus extract is used to treat infections (colds, flu, sinusitis), HIV/AIDS, rheumatoid arthritis, asthma, and cancer. Actions Thymus extract induces T-lymphocyte maturation with indirect effects on B cells and macrophages. It may improve immune function (Jellin et al, 2008). One study (Hammad et al, 2007) identified the antibacterial effect against Streptococcus Adverse effects: Underline = life-threatening 586 Tonka Bean mutans by adhesion to buccal epithelial cells. This study used an aqueous extract of thymus. Product Availability Tablets, crude fraction, or polypeptides Dosages • Adult PO: 750 mg crude fraction or 120 mg pure polypeptides Contraindications Thymus extract should not be used in children or those who are pregnant or breastfeeding until more research is available. Side Effects/Adverse Reactions None reported. However contamination is a concern. Interactions Drug Immunosuppressants: Thymus extract should not be used with immunosuppressants unless the extract is certified to be pathogen free (Jellin et al, 2008). Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Polypeptides Client Considerations Assess • Assess the reason the client is using thymus extract. • Identify if the client is using immunosuppressants. If so, make sure that the thymus product that is being used is certified pathogen free. Administer • Instruct the client to keep thymus extract in a dry area, away from direct sunlight. Teach Client/Family • Teach the client that thymus extract should not be used in children or those who are pregnant or breastfeeding until more research is available. Tonka Bean ! (tawng’kuh been) Scientific name: Dipteryx odorata Other common names: Cumaru, tonka seed, tonquin bean, torquin bean Origin: Tonka bean is a legume found in South America. = Pregnancy = Pediatric ! = Alert = Popular Herb Tonka Bean 587 Uses Tonka bean is used to decrease nausea and vomiting. Traditionally used as an aphrodisiac, it is now considered by many to be an obsolete herb. Investigational Uses Initial research has begun on the use of tonka bean for the treatment of cancer and lymphedema. Actions Very few studies on tonka bean are available other than those done to determine its chemical components. The coumarins are known to produce an anticoagulant effect. One study evaluated the use of tonka bean in combination with gingko biloba and Melilotus officinalis to treat the functional symptoms of lymphedema. It was found that the use of these three herbs together provided significant improvement after the third month of treatment (Vettorello et al, 1996). Product Availability No commercially prepared forms are available. Plant Parts Used: Fruit, seeds Dosages • Adult PO: 60 mg daily (coumarin content) Contraindications ! Class 3 herb (seed). Tonka bean should not be used during pregnancy and breastfeeding. It should not be given to children. Persons with hypersensitivity to tonka bean should not use it. The FDA classifies tonka bean as unsafe. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, hepatotoxicity INTEG: Hypersensitivity reactions Interactions Drug Anticoagulants (heparin, salicylates, warfarin), antiplatelets: Use of tonka bean with anticoagulants, antiplatelets may result in an increased risk of bleeding; avoid concurrent use. Herb Anticoagulant/antiplatelet herbs: Tonka bean with anticoagulant/ antiplatelet herbs increases the risk of bleeding. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Coumarin Coumaric acid; Dihydrocoumarin; Methyl melilotate; Ethyl melilotate; Melilotic acid Anticoagulant, hepatotoxic Continued Adverse effects: Underline = life-threatening T 588 Turmeric Primary Chemical Components and Possible Actions—cont’d Chemical Class Individual Component Hydroxymethylfurfural Fat Isoflavones Possible Action Dimethoxyisoflavone (Januário et al, 2005) Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of tonka bean and administer an antihistamine or other appropriate therapy. ! • Assess for right upper-quadrant pain and assess hepatic function tests (AST, ALT, bilirubin) for increased levels. If results are elevated, discontinue the use of tonka bean. Administer • Instruct the client to store tonka bean in a cool, dry place, away from heat and moisture. Teach Client/Family ! • Caution the client not to use tonka bean in children or those who are pregnant or breastfeeding. • Advise the client that the FDA classifies tonka bean as unsafe. Turmeric (tuhr’muh-rik) Scientific name: Curcuma longa Other common names: Curcuma, Indian saffron, Indian valerian, jiang huang, kyoo, radix, red valerian, tumeric, ukon Origin: Turmeric is found in the Far East and tropical regions. Uses Turmeric traditionally has been used in both Chinese and Ayurvedic medicine to treat menstrual disorders, colic, inflammation, bruising, dyspepsia, hematuria, and flatulence. It is also used to improve stomach and liver function. Investigational Uses Research has begun to focus on the use of turmeric for the treatment of lung, gastrointestinal, oral, and breast cancers; viruses such as HIV/AIDS; cholecystitis; and joint pain associated with arthritis and other joint disorders. Actions A study (Ramsewak et al, 2000) demonstrated the anticancer and antioxidant actions of three chemical components of turmeric, curcumins I, II, and III, on leukemia, central nervous system disorders, renal cancer, breast cancer, colon = Pregnancy = Pediatric ! = Alert = Popular Herb Turmeric 589 cancer, and melanoma. Turmeric is also known to inhibit tissue necrosis factor (TNF)-alpha. The chemical component diferuloylmethane has been shown to cause the most significant inhibition (Gupta et al, 1999). Turmeric may also exert hepatoprotective, antiinflammatory, antispasmodic, and hypolipidemic effects. One study (Uddin et al, 2005) identified the suppression of growth and induction of apoptosis in lymphoma. Another study (Ramaswami et al, 2004) used curcumin, one of the chemical components of turmeric, to identify the blocking of homocysteine-induced endothelial dysfunction. Turmeric may be useful in preventing cardiovascular disease. Product Availability Capsules, dried rhizome, fluid extract, oil, spice, tincture Plant Part Used: Rhizome Dosages • Adult PO: 400-600 mg tid (standardized to curcumin content) • Adult PO cut root: 1.5-3 g/day • Adult PO fluid extract: 1.5-3 ml (1:1 dilution) • Adult PO tincture: 10 ml (1:5 dilution) Contraindications Pregnancy category is 1; breastfeeding category is 2A. Turmeric should not be used therapeutically by persons with bile duct obstruction, peptic ulcer, hyperacidity, gallstones, bleeding disorders, or hypersensitivity to this herb. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, gastrointestinal ulceration (high doses) INTEG: Hypersensitivity reactions Interactions Drug Anticoagulants (heparin, salicylates, warfarin), antiplatelets, NSAIDs (bromfenac, diclofenac, etodolac, fenoprofen, flurbiprofen, ibuprofen, indomethacin, ketoprofen, ketorolac, meclofenamate, mefenamic acid, nabumetone, naproxen, oxaprozin, piroxicam, sulindac, tolmetin): Use of turmeric with anticoagulants, antiplatelets, NSAIDs may result in an increased risk of bleeding; avoid concurrent use. Immunosuppressants (cyclosporine): Turmeric may decrease the effectiveness of immunosuppressants; avoid concurrent use. Herb Anticoagulant/antiplatelet herbs: Turmeric with anticoagulant/ antiplatelet herbs increases the risk of bleeding. Adverse effects: Underline = life-threatening T 590 Turmeric Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Volatile oil Curcumin I, II, III Anticancer; antioxidant Sesquiterpenes Tissue necrosis factor (TNF)alpha inhibition Diferuloylmethane Polysaccharides Sugar Resin Vitamin Mineral Carotene C Potassium Client Considerations Assess • Assess for hypersensitivity reactions, including contact dermatitis. If present, discontinue the use of turmeric and administer an antihistamine or other appropriate therapy. • Assess for the use of anticoagulants, NSAIDs, and immunosuppressants (see Interactions). • Monitor coagulation studies if the client is using turmeric for long-term treatment. Administer • Instruct the client to store turmeric in a cool, dry place, away from heat and moisture. • Instruct the client to take turmeric on an empty stomach. Teach Client/Family • Inform the client that pregnancy category is 1 and breastfeeding category is 2A. • Advise the client to report bleeding gums, blood in the urine or stool, and bruising. = Pregnancy = Pediatric ! = Alert = Popular Herb Valerian 591 Valerian (vuh-lir’ee-uhn) Scientific name: Valeriana officinalis Other common names: All heal, amantilla, baldrianwurzel, capon’s tail, great wild valerian, herba benedicta, katzenwurzel, phu germanicum, phu parvum, setewale, setwell, theriacaria, valeriana Origin: Valerian is a perennial that is now cultivated throughout the world. Uses Valerian is used to treat nervous disorders such as anxiety, restlessness, and insomnia. Actions Antianxiety Action Valerian has been studied almost as extensively as St. John’s wort. Its effects are primarily neurochemical, acting on gamma-aminobutyric acid A (GABA) receptors and possibly also with other presynaptic components (Ortiz et al, 1999). Other studies support this action (Cavadas et al, 1995; Sakamoto et al, 1992; Simmen et al, 1999). Antiinsomnia Action The largest study included 121 patients with severe insomnia (Vorbach et al, 1996). They saw significant improvement within 28 days. This may indicate valerian is most effective in long-term treatment. Other Actions Valerian has shown positive results in the treatment of angina, decreasing the frequency and shortening the duration of anginal attacks (Yang et al, 1994). Product Availability Capsules, crude herb, extract, tablets, tea, tincture; combination products containing other herbs Plant Parts Used: Rhizomes, roots Dosages Insomnia • Adult PO extract: 400-900 mg 1⁄2-1 hr before bedtime (standardized) • Adult PO tea (crude herb): 1 tsp crude herb qid • Adult PO tincture: 3-5 ml qid (standardized) V Contraindications Pregnancy category is 2; breastfeeding category is 3A. Caution should be used when giving valerian to children. Persons with hepatic disease and those with hypersensitivity to valerian should not use it. Side Effects/Adverse Reactions CNS: Insomnia, headache, restlessness GI: Nausea, vomiting, anorexia, hepatotoxicity (overdose) INTEG: Hypersensitivity reactions MISC: Vision changes, palpitations Continued Adverse effects: Underline = life-threatening 592 Valerian Interactions Drug CNS depressants (alcohol, barbiturates, benzodiazepines, opiates, sedatives/hypnotics): Valerian may increase the effects of central nervous system depressants; avoid concurrent use. Cytochrome P4503A4 substrates: Valerian may inhibit these enzyme systems. Iron salts: Valerian may interfere with the absorption of iron salts; separate by 2 hours. MAOIs, phenytoin, warfarin: Valerian may negate the therapeutic effects of MAOIs, warfarin, and products containing phenytoin; do not use concurrently. Lab Test ALT, AST, total bilirubin, urine bilirubin: Valerian may cause increased ALT, AST, total bilirubin, and urine bilirubin. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Volatile oil Valepotriates Alkaloid Amino acid Flavonoid Phenol Fatty acid Aliphatic Resin Tannin Monoterpene; Sesquiterpene Increase GABA Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of valerian and administer an antihistamine or other appropriate therapy. ! • Assess liver function studies (AST, ALT, bilirubin) if the client is using valerian for long-term treatment. If results are elevated, discontinue use of the herb. • Assess medications used (see Interactions). Administer • Instruct the client that valerian products should be kept away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 2 and breastfeeding category is 3A. • Advise the client to use caution when giving valerian to children. • Advise the client not to perform hazardous activities such as driving or operating heavy machinery until physical response to the herb can be evaluated. Valerian causes sedation and dizziness. • Advise the client to discontinue the use of valerian if symptoms worsen. = Pregnancy = Pediatric ! = Alert = Popular Herb White Cohosh 593 White Cohosh ! (wite koe’hawsh) Scientific name: Actaea alba Other common names: Baneberry, snakeberry, coralberry, doll’s eye Origin: White cohosh is a perennial found on the west coast of North America and in the eastern region of the United States. Uses Traditionally, white cohosh has been used during childbirth and to treat menstrual disorders, much like black or blue cohosh. Several Native American tribes have used white cohosh to treat colds, cough, gastrointestinal disorders, and urinary tract disorders. Actions Very little information is available for white cohosh, and what information is available is mostly anecdotal. Although the entire white cohosh plant is toxic, the fruit and roots are the most toxic parts (Duke, 2002). Homeopaths have used this herb, but it not recommended for any use. Product Availability This herb is used by homeopaths. No commercial products are available. Dosages No published dosages are available. Contraindications ! White cohosh should never be used during pregnancy and breastfeeding. It should never be given to children. This is a toxic plant and should never be consumed, especially the fruit and roots. Because of its toxicity, white cohosh is not recommended for use except under the supervision of a qualified herbalist. Side Effects/Adverse Reactions CNS: Delirium CV: Tachycardia, circulatory failure GI: Nausea, vomiting, anorexia, severe abdominal cramps INTEG: Hypersensitivity reactions Primary Chemical Components and Possible Actions Chemical Class Individual Component Essential oil Protoanemonin Possible Action Severe irritant Client Considerations Assess ! • Assess for symptoms of toxicity: delirium, severe abdominal cramping, headache, tachycardia, and circulatory collapse. Adverse effects: Underline = life-threatening W 594 Wild Cherry Administer • Perform lavage or induce vomiting if the client has ingested this herb. Teach Client/Family • Warn the client never to use white cohosh in children or those who are pregnant or breastfeeding. Toxicity may result. • Warn the client not to use white cohosh for any purpose. This plant is too toxic for ! any use. Wild Cherry ! Scientific names: Prunus virginiana, Prunus serotina Other common names: Black cherry, black choke, choke cherry, rum cherry, Virginia prune Origin: Wild cherry is found in the United States. Uses Traditionally, wild cherry has been used to treat hot, dry, percussive coughs; colds; respiratory symptoms; and diarrhea. It has also been used as an astringent and bronchial sedative. Wild cherry is typically combined with other supportive lung herbs in formula. Investigational Uses Research is underway to determine possible uses for wild cherry as a cancer treatment. Actions Almost no research exists regarding the actions or uses of wild cherry. The available studies have tended to focus on its toxic effects. Because cyanide is present in the bark, seeds, and leaves, wild cherry should be used only under the direction of a qualified herbalist. If used properly, and for a few days only, this herb is considered safe. Wild cherry prepared as a cold infusion has a much lower cyanide content than when prepared as a decoction. Product Availability Fluid extract, syrup, tea, tincture Plant Part Used: Bark Dosages • Adult PO syrup: 1-2 g in 8 oz boiling water, tid (whole syrup recipe) • Adult PO tea: 3 tsp dry bark in 8 oz cold water, let stand 8 hr, strain • Adult PO tincture: 1-5 ml qid (1:5 dilution) (Moore, 1995) Contraindications Pregnancy category is 4; breastfeeding category is 2A. Wild cherry should not be given to children. Persons with respiratory or cardiovascular depression or hypotension should not use this herb (Moore, 1995). = Pregnancy = Pediatric ! = Alert = Popular Herb Wild Cherry 595 Side Effects/Adverse Reactions CNS: Headache, tremors, stupor, coma, death GI: Nausea, vomiting, anorexia, constipation, ulcer MS: Muscle weakness RESP: Respiratory failure Interactions Drug Cytochrome P4503A4 enzyme substrate agents (astemizole, azole antifungals, benzodiazepines, buspirone, calcium channel blockers, cyclosporine, estrogens, statins): Use with wild cherry may slow the metabolism; avoid concurrent use. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Cyanogenic glycoside Amygdalin Poison Acid Prunasin Phytosterol; Emulsin; Oleic acid; P-Coumaric acid; Trimethyl gallic acid Ipuranol Dextrose Tannin Wound healing; antiinflammatory Starch Calcium oxalate Client Considerations Assess • Assess for changes in respiration (decreased or labored breathing, shortness of breath). If these symptoms are present, discontinue the use of wild cherry. Administer • Instruct the client to store wild cherry in a cool, dry place, away from heat and moisture. W Teach Client/Family • Inform the client that pregnancy category is 4 and breastfeeding category is 2A. • Warn the client that overdose can be fatal as a result of cyanide poisoning. If poisoning does occur, an antidote of thiosulfate or ethylenediaminetetraacetic acid ! (EDTA) may be necessary. • Caution the client not to give wild cherry to children and to store all wild cherry products in a locked cabinet, out of the reach of children. • Inform the client that no proven uses or actions exist for this herb and that other herbs or medications are safer options. Adverse effects: Underline = life-threatening 596 Wild Yam Wild Yam Scientific name: Dioscorea villosa L. Other common names: Colic root, Mexican wild yam, rheumatism root Origin: Wild yam is a vine found in the United States and Central America. Uses Wild yam is used to treat gallbladder disease, dysmenorrhea, menopausal symptoms, rheumatic conditions, and cramps. Actions Hormone Supplementation/Menopausal Symptoms DHEA is synthesized from a precursor steroid, pregnenolone, then converted into estrogens and testosterone in both men and women (Baulieu, 1996). Levels of DHEA are reported to decline significantly after age 40; however, supplementation should not be started before a thorough evaluation of hormone-sensitive tumors is performed. Some researchers suspect that the decline in DHEA may be associated with insulin resistance, increased weight gain, and cardiovascular conditions (Sahelian, 1997). DHEA supplementation may be an alternative to hormone replacement therapy in women. Wild yam had little effect on menopausal symptoms when 23 symptomatic women used wild yam cream for 4 weeks (Komesaroff et al, 2001). Cancer Stimulant/Cancer Inhibitor Conflicting studies have reported increased tumor flare of prostate cancer in patients. However, in one study, when antihormone therapy was initiated, the flare retreated (Jones et al, 1997). Cardiovascular Action One study evaluated DHEA levels in patients with congestive heart failure. The results showed that levels of DHEA are lower in patients with congestive heart failure in proportion to the severity of disease (Moriyama et al, 2000). Immunoregulator Action One study using laboratory mice (Cheng et al, 2000) evaluated the effects of DHEA and DHEA sulfate on interleukin-10 (IL-10). The results indicated an increase in interleukin10 (IL-10) and that DHEA may be able to affect the functioning of B-lymphocytes. Cognitive Function Enhancer DHEA levels have been found to be significantly lower in persons with Alzheimer’s disease and vascular dementia than in the general population, whereas the opposite is true for cortisol levels. The applicability of this information in the treatment of clients with cognitive function impairment is unknown at this time (Bernardi et al, 2000). Product Availability Fluid extract, oil, powder, tea, tincture; also available as DHEA (see pages 230–232) Plant Part Used: Rhizome Dosages NOTE: See also dosages for DHEA on page 231. • Adult PO fluid extract: 2-4 ml (5-30 drops) tid • Adult PO tincture: 2-10 ml tid (1:5 dilution in 45% alcohol) • Adult topical oil: may be applied to affected area prn = Pregnancy = Pediatric ! = Alert = Popular Herb Wild Yam 597 Contraindications Class 1 herb (rhizome). Until more research is available, wild yam should not be used during pregnancy and breastfeeding. It should not be given to children. This herb should not be used by persons with hepatic disease or by those with a family history of breast, uterine, ovarian, or prostate cancer. Persons with hypersensitivity to wild yam should not use it. Side Effects/Adverse Reactions CNS: Headache GI: Nausea, vomiting, anorexia GU: Menstrual changes, possibility of stimulating hormone-related cancers INTEG: Hypersensitivity reactions, acne, alopecia, hirsutism, oily skin Primary Chemical Components and Possible Actions Chemical Class Individual Component Steroidal saponin Dioscin; Diosgenin; Dioscenin; Dioscin, Methyl Parvifloside, Zingiberensis, Dltonin Methyl Protodeltonin (Hayes et al, 2007) Beta-sitosterol Sterol Alkaloid Tannin DHEA Possible Action Antiinflammatory Steroid Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of wild yam and administer an antihistamine or other appropriate therapy. • Assess the client’s family history of hormone-induced cancers (breast, ovarian, uterine, prostatic). If these are present, the client should avoid the use of W wild yam. Administer • Instruct the client to store wild yam products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use wild yam in children or those who are pregnant or breastfeeding until more research is available. • Advise the client that high doses of wild yam (⬎25 mg DHEA/day) may cause irreversible voice change and hirsutism. Adverse effects: Underline = life-threatening 598 Wintergreen Wintergreen ! (win’tuhr-green) Scientific name: Gaultheria procumbens Other common names: Boxberry, Canada tea, checkerberry, deerberry, gaultheria oil, mountain tea, oil of wintergreen, partridgeberry, teaberry Origin: Wintergreen is a shrub found in North America. Uses Traditionally, wintergreen has been used topically to treat sore, inflamed muscles and joints, often after exercise. It may also be useful in the treatment of neuralgia. Wintergreen is used internally to treat bladder inflammation and urinary tract diseases, as well as diseases of the prostate and kidney. Actions As is the case with other salicylates, the chemical component methylsalicylate is responsible for the antiinflammatory and anticoagulant properties of wintergreen. It is reported to act as a counterirritant. Oral ingestion stimulates gastric function. Product Availability Cream, lotion, lozenges, oil, ointment, tea Plant Parts Used: Bark, leaves Dosages • Adult topical cream/ointment: apply to affected area tid-qid prn (10%-30% strength) Contraindications Class 1 herb (leaf). Until more research is available, wintergreen should not be used during pregnancy and breastfeeding. It should not be given to children. Wintergreen should not be used internally by persons with gastroesophageal reflux disease. Persons with hypersensitivity to wintergreen should not use it. Because of its hydroquinone glycoside content, this herb is not recommended for long-term use. Side Effects/Adverse Reactions Internal Use GI: Nausea, vomiting, anorexia, gastrointestinal irritation INTEG: Hypersensitivity reactions MISC: Hyperpnea, lethargy Internal or Topical Use SYST: Salicylate toxicity—tinnitus, nausea and vomiting, electrolyte imbalances, central nervous system toxicity, bleeding, hepatitis, endocrine changes, rhabdomyolysis, death Interactions Drug Anticoagulants (heparin, warfarin) salicylates: Use of wintergreen with anticoagulants, salicylates may cause an increased risk of bleeding; avoid concurrent use. = Pregnancy = Pediatric ! = Alert = Popular Herb Witch Hazel 599 Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Salicylate Methylsalicylate Antiinflammatory; anticoagulant Gaultherin Carbohydrate Tannin Hydroquinone derivative Isohomoarbutin; Arbutin Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of wintergreen and administer an antihistamine or other appropriate therapy. Clients who are hypersensitive to salicylates should not use this product. ! • Assess for symptoms of salicylate toxicity (tinnitus, nausea, vomiting) if the client is using high doses of wintergreen over a prolonged period. • Assess for the use of anticoagulants (see Interactions). Monitor coagulation studies if the client is taking wintergreen internally. Administer • Instruct the client to store wintergreen products in a sealed container away from heat and moisture. Teach Client/Family • Caution the client not to use wintergreen during pregnancy and breastfeeding until more research is available. • Caution the client not to give wintergreen to children. Deaths have been reported. ! If viral symptoms are present in children, Reye’s syndrome may occur if wintergreen is used. • If the client is using wintergreen topically, advise the client to leave the affected area open to air or to wrap only in material with no heating capability. • Caution the client not to use wintergreen oil internally. • Advise the client to avoid use of topical wintergreen products during hot or humid weather. W Witch Hazel (wich hayz’uhl) Scientific name: Hamamelis virginiana Other common names: Snapping hazel, spotted alder, tobacco wood, winterbloom Origin: Witch hazel is a bush found in North America. Adverse effects: Underline = life-threatening 600 Witch Hazel Uses Traditionally, witch hazel has been used to relieve hemorrhoidal, vaginal, and anal itching; decrease inflammation; and promote the healing of bruises, varicose veins, and other local inflammation. It is also used as a gargle to decrease oral irritation and inflammation and may be used as a tea for diarrhea. Actions Witch hazel has been evaluated for its antiinflammatory, antiviral, and antiaging actions. Antiinflammatory Action One study evaluated the antiinflammatory action of Polygonum bistorta, Guaiacum officinale, and Hamamelis virginiana in rats. Witch hazel did not act as an antiinflammatory in the acute stages of inflammation but did show antiinflammatory properties in the chronic phase (Duwiejua et al, 1994). Another study documented the antiinflammatory properties of witch hazel when used as an after-sun lotion (Hughes-Formella et al, 1998). Antiviral Action The antiviral action of witch hazel was shown against herpes simplex virus type 1 (HSV-1). Its antioxidative qualities were demonstrated by its radical-scavenging ability (Erdelmeier et al, 1996). Antiaging Action The active-oxygen scavenging action of witch hazel has been documented. This action may help to delay aging of the skin (Masaki et al, 1995). Product Availability Cream, dried leaves, fluid extract, pads, rectal suppositories, vaginal suppositories, witch hazel water Plant Parts Used: Bark, leaves Dosages • Adult PO dried leaf gargle: 2 g tid • Adult PO fluid extract: 2-4 ml tid (1:1 dilution in 45% alcohol) • Adult topical witch hazel water: apply to affected area tid-qid prn Contraindications Class 1 herb (bark, leaf). Until more research is available, witch hazel should not be used during pregnancy and breastfeeding. Persons who are hypersensitive to witch hazel should not use it. Witch hazel should not be ingested. Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia, constipation, hepatotoxicity INTEG: Hypersensitivity reactions, contact dermatitis Interactions Drug Iron salts: Witch hazel leaf, bark tea may decrease the absorption of iron salts; separate by 2 hours. = Pregnancy = Pediatric ! = Alert = Popular Herb Wormseed 601 Primary Chemical Components and Possible Actions Chemical Class Individual Component Flavonoid Volatile oil Saponin Tannin Quercetin; Kaempferol Eugenol; Safrole Hamamelitannin Possible Action Tumor necrosis factor inhibition (Habtemariam, 2002) Calcium oxalate Resin Gallic acid Client Considerations Assess • Assess for hypersensitivity reactions, including contact dermatitis. If present, discontinue the use of witch hazel and administer an antihistamine or other appropriate therapy. ! • Assess for right upper-quadrant pain. Assess hepatic function tests (AST, ALT, bilirubin). If results are elevated, discontinue the use of witch hazel. Administer • Advise the client to use witch hazel topically or as gargle only; it should not be taken internally. • Instruct the client to store witch hazel products in a sealed container away from heat and moisture. Teach Client/Family • Caution the client not to use witch hazel during pregnancy and breastfeeding until more research is available. Wormseed (werm’ seed) Scientific name: Artemisia absinthium, Artemisia princeps Other common names: Levant wormseed, santonica, sea wormwood, semen cinae, semen sanctum Origin: Wormseed is found throughout Asia. Uses Traditionally, wormseed is used as an anthelmintic for children and adults. Actions Most of the information on the action and uses for wormseed come from anecdotal reports. One study (Omer et al, 2007) identified the steroid-sparing effect of wormwood when used in Crohn’s disease. The mood and quality of life was also increased. Further research is lacking. Adverse effects: Underline = life-threatening W 602 Wormseed Product Availability Tablets, powder, dried herb, lozenges Plant Parts Used: Flowers, seeds Dosages • Adult PO: 2-4 grains Contraindications Wormseed should not be used in children or those who are pregnant, breastfeeding, or hypersensitive to this herb. Side Effects/Adverse Reactions CNS: Seizures, headache EENT: Blurred vision GI: Anorexia, nausea, vomiting INTEG: Rash Interactions Drug Anticonvulsants: Wormseed may lower the seizure threshold; do not use concurrently. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Glycoside Volatile oil Santonin Anthelmintic Client Considerations Assess • Assess the reason the client is using wormseed. Administer • Instruct the client to keep wormseed in a cool, dry area, away from excessive light. Teach Client/Family • Teach the client that wormseed should not be used in children or those who are pregnant or breastfeeding until more research is available. = Pregnancy = Pediatric ! = Alert = Popular Herb Yarrow 603 Yarrow (ya-row) Scientific name: Achillea millefolium Other common names: Bloodwort, gordaldo, milfoil, nosebleed, old man’s pepper, sanguinary, soldier’s woundwort, stanchgrass, thousand-leaf Origin: Yarrow is found in Asia, Europe, and North America. Uses Yarrow is used internally to treat respiratory, gastrointestinal, urinary tract, and reproductive conditions. It is used topically to promote wound healing and to treat eczema and other skin disorders. Actions Several actions have been proposed for yarrow, including contraceptive, antitumor, and antiplaque actions. Contraceptive Action One study showed that antispermatogenesis occurred in mice when an extract of yarrow was given at 200 mg/kg/day intraperitoneally for 20 days (Montanari et al, 1998). Antitumor Action One group of researchers who were observing cell division noted that an increase in tumor growth occurred during metaphase that may be due to the cytotoxic effects of yarrow (Montanari et al, 1998). Another study evaluated the antitumor properties of yarrow (Tozyo et al, 1994). The sesquiterpenoids were found to be active against leukemia in the mouse. Antiplaque Action One study proposed that the use of yarrow slows plaque formation and the development of gingivitis; however, no changes were noted in the control group (Van der Weijden et al, 1998). Other Actions Actions that are hepatoprotective, antispasmodic, and calcium antagonistic were identified (Yaeesh et al, 2006). When the extract was used in laboratory animals with induced hepatitis, the mortality rate decreased to 40% from 100% of those untreated. Product Availability Capsules, fluid extract, powder, tea, tincture Plant Parts Used: Dried leaves, flowering tops Dosages • Adult PO fluid extract: 1-2 ml tid (1:1 dilution in 25% alcohol) • Adult PO tea: 2-4 g tid • Adult PO tincture: 2-4 ml tid (1:5 dilution in 45% alcohol) • Adult topical sitz bath: 100 g herb/5 gal hot water, soak 10-20 min, rinse Y Contraindications Pregnancy category is 4; breastfeeding category is 3A. Yarrow should not be used by persons with hypersensitivity to this plant or other members of the Compositae family, such as Chamomilla recutita, Tanacetum parthenium, or Tanacetum vulgare. Adverse effects: Underline = life-threatening 604 Yarrow Side Effects/Adverse Reactions CNS: Drowsiness, sedation GI: Nausea, vomiting, anorexia GU: Uterine stimulation INTEG: Hypersensitivity reactions, contact dermatitis, photosensitivity Interactions Drug Antacids, H2-blockers, proton pump inhibitors: Yarrow may decrease the action of these agents (Jellin et al, 2008). Anticoagulants (heparin, warfarin), antiplatelets, salicylates: Use of yarrow with anticoagulants, antiplatelets, salicylates may result in an increased risk of bleeding; do not use concurrently. Antihypertensives: Use of yarrow with antihypertensives may result in increased hypotension; do not use concurrently. CNS depressants (sedatives/hypnotics, alcohol, opiates, barbiturates): Use of yarrow with central nervous system depressants may cause increased sedation; avoid concurrent use. Iron salts: Yarrow tea may decrease the absorption of iron salts; separate by 2 hours. Primary Chemical Components and Possible Actions Chemical Class Individual Component Astringent; wound healing Tannin Fatty acid Amino acid Sesquiterpene Peroxide Volatile oil Possible Action Linoleic acid; Palmitic acid; Oleic acid Alanine; Histidine; Leucine; Lysine Achimillic acids A, B, C Antitumor Linalool; Borneol; Camphor; Cineole Client Considerations Assess • Assess for hypersensitivity reactions, including contact dermatitis. If present, discontinue the use of yarrow and administer an antihistamine or other appropriate therapy. • Determine whether the client is taking anticoagulants, antihypertensives, or CNS depressants (see Interactions). = Pregnancy = Pediatric ! = Alert = Popular Herb Yellow Dock 605 Administer • Instruct the client to store yarrow products in a cool, dry place, away from heat and moisture. Teach Client/Family • Inform the client that pregnancy category is 4 and breastfeeding category is 3A. • Advise the client who is allergic to other plants of the Compositae herb family not to use yarrow. • Inform the client to monitor for bleeding and bruising and to discontinue use of yarrow if these are present. • Advise the client not to perform hazardous activities such as driving or operating heavy machinery until physical response to the herb can be evaluated. • Advise the client to use sunscreen and wear protective clothing, or to stay out of the sun, while using yarrow. Yarrow may cause photosensitivity. Yellow Dock (yeh-low dahk) Scientific name: Rumex crispus Other common names: Chin ch’iao mai, curled dock, curly dock, garden patience, hualtata, hummaidh, kivircik labada, narrow dock, niu she t’ou, oseille marron, sour dock, surale di bierdji Origin: Yellow dock is a weed found in the United States, Europe, and Asia. Uses Yellow dock is used primarily as a laxative or astringent. Topically, it may be used as an antidote to stinging nettle and to treat scabies and psoriasis. Traditionally, it has been used internally as a blood cleanser and to treat sore throat and fever. Actions Most of the available research on yellow dock focuses on its toxicology. One study investigated acute oxalate poisoning in sheep that had ingested Rumex crispus. Symptoms of toxic reactions included tremors, ataxia, and increased salivation (Panciera et al, 1990). Another study focused on the fatal poisoning of a 53-year-old man who died 72 hours after simply ingesting Rumex crispus (Reig et al, 1990). One study (Kim et al, 2004) identified the antifungal action of Rumex crispus. This extract was found to be more active than polyoxin B. Product Availability Capsules (ground root), extract, tea Plant Parts Used: Root (dried and fresh), rhizome Dosages • Adult PO: 2.5-5 mg daily Contraindications Pregnancy category is 3; breastfeeding category is 3A. Yellow dock should not be given to children. Persons with renal/hepatic disease, electrolyte imbalances, or hypersensitivity to this herb should not use yellow dock. Continued Adverse effects: Underline = life-threatening Y 606 Yellow Dock Contraindications—cont’d Persons with diabetes mellitus, poor nutritional status, or dehydration should use it with caution. Side Effects/Adverse Reactions ENDO: Severe electrolyte imbalances (hypocalcemia, metabolic acidosis) GI: Nausea, vomiting, anorexia, cramps, diarrhea INTEG: Hypersensitivity reactions Interactions Drug Calcitonin, diuretics, mithramycin, phenytoin: Yellow dock may cause increased hypocalcemia when used with calcitonin, diuretics, mithramycin, and phenytoin; do not use concurrently (theoretical). Calcium, iron, zinc: Yellow dock tea may decrease the absorption of these minerals; separate by 2 hours. Primary Chemical Components and Possible Actions Chemical Class Individual Component Chrysophanic acid Rumicin Calcium oxalate Tannin Flavonoid Anthracene Quercetin Emodin Chrysophanol; Aloe-emodin; Rhein Lapodin; Neopodin Naphthalene Possible Action Astringent Antiinflammatory Laxative Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of yellow dock and administer an antihistamine or other appropriate therapy. • Determine whether the client is taking prescription drugs or other herbal products. Yellow dock should not be used with diuretics, phenytoin, mithramycin, or calcitonin (see Interactions). Administer • Instruct the client to store yellow dock products away from moisture and light. Teach Client/Family • Inform the client that pregnancy category is 3 and breastfeeding category is 3A. • Caution the client not to give yellow dock to children. = Pregnancy = Pediatric ! = Alert = Popular Herb Yellow Lady’s Slipper 607 Yellow Lady’s Slipper (yeh’low lay’deez sli-puhr) Scientific names: Cypripedium pubescens, Cypripedium calceolus Other common names: American valerian, moccasin flower, nerveroot, Noah’s ark, whippoorwill’s shoe, yellow Indian shoe Origin: Yellow lady’s slipper is an orchid found in the forests of Europe and the United States. It is considered an endangered species. Uses Yellow lady’s slipper traditionally has been used as a sedative and a treatment for anxiety and insomnia. It has also been used as an antispasmodic, an antidepressant, and to prevent seizures. Actions No research studies support any actions of or uses for yellow lady’s slipper. Therefore this herb is not recommended for any use. Product Availability Extract, powdered root, rhizome, tea, tincture; component of various combination products Plant Parts Used: Rhizome, roots Dosages No consensus on dosage exists. Because it is on the endangered species list, yellow lady’s slipper is not recommended for use. Contraindications Until more research is available, yellow lady’s slipper should not be used during pregnancy and breastfeeding. It should not be given to children. Persons with psychosis, severe anxiety reactions, severe depression, migraines, cluster headaches, or hypersensitivity to this herb should not use it. Side Effects/Adverse Reactions CNS: Headache, insomnia, restlessness, stimulation GI: Nausea, vomiting, anorexia INTEG: Hypersensitivity reactions, contact dermatitis Primary Chemical Components and Possible Actions Chemical Class Individual Component Resinoid Glycoside Quinone Acid Cypripedin Possible Action Cypripedi Tannic acid; Gallic acid Adverse effects: Underline = life-threatening Y 608 Yerba Maté Client Considerations Assess • Assess for hypersensitivity reactions and contact dermatitis. If present, discontinue the use of yellow lady’s slipper and administer an antihistamine or other appropriate therapy. Administer • Instruct the client to store yellow lady’s slipper products in a cool, dry place, away from heat and moisture. • Inform the client that this herb is on the endangered species list and is illegal to collect. Teach Client/Family • Caution the client not to use this herb in children or those who are pregnant or breastfeeding until more research is available. Yerba Maté (yehr’buh mah-tay’) Scientific name: Ilex paraguariensis Other common names: Armino, Bartholomew’s tea, boca juniors, campeche, el agricultor, elacy, flor de lis, gaucho, jaguar, Jesuit’s tea, la hoja, la mulata, la tranquera, lonjazo, madrugada, maté, nobleza gaucha, oro verde, Paraguay tea, payadito, rosamonte, safira, union, yi-yi, zerboni Origin: Yerba maté is an evergreen found in South America. Uses Yerba maté is used as a diuretic and to treat depression, lethargy, fatigue, constipation, arthritis, diabetes, gastrointestinal disorders, urinary tract infections, cardiac insufficiency, arrhythmias, and kidney or bladder stones. In China, it is used parenterally as an antihypertensive. Actions Primary research has focused on several actions of yerba maté, including vasodilation, antioxidant, and antiobesity actions. Vasodilation Action One study evaluated the vasodilatory effects of Ilex paraguariensis leaves in rats. Researchers documented a vasorelaxing effect (Muccillo Baisch et al, 1998). Antioxidant Action Two studies reported the antioxidant effects of yerba maté. One study (Schinella et al, 2000) showed the antioxidant effect against free radicals. The second study identified the antioxidant effect as comparable to that of ascorbic acid (vitamin C). Antiobesity Action One study investigated the usefulness of yerba maté in the reduction of obesity. However, results indicated no effect (Martinet et al, 1999). = Pregnancy = Pediatric ! = Alert = Popular Herb Yerba Maté 609 Other Actions One study (Milioli et al, 2007) found yerba maté to be effective for use in Parkinson’s disease in animal models. Product Availability Fluid extract, leaves, tea Plant Part Used: Dried leaves Dosages • Adult PO fluid extract: 2-4 ml tid (1:1 dilution in 25% alcohol) • Adult PO tea: 2-4 g tid Contraindications Class 2d herb (leaf). Until more research is available, yerba maté should not be used during pregnancy and breastfeeding. It should not be given to children. Persons with anxiety disorders, hypertension, or hypersensitivity to this herb should not use it. Side Effects/Adverse Reactions CNS: Anxiety, nervousness, insomnia, restlessness, irritability, headache GI: Nausea, vomiting, anorexia, hepatotoxicity INTEG: Hypersensitivity reactions SYST: Carcinogenic (long-term use) Interactions Drug Antidiabetics: Yerba maté may decrease the action of antidiabetics. CNS depressants (alcohol, sedatives/hypnotics, opiates, barbiturates, benzodiazepines): Use of central nervous system depressants with yerba maté may produce an antagonistic effect; avoid concurrent use. CNS stimulants: Yerba maté may increase the effects of central nervous system stimulants; use together cautiously. Diuretics: Yerba maté may increase the effects of diuretics; avoid concurrent use. MAOIs: Yerba maté with MAOIs may lead to hypertensive crisis (theoretical). Food Caffeine-containing products: Caffeinated foods and drinks may increase the effects of yerba maté; avoid concurrent use. Pharmacology Pharmacokinetics Yerba maté stimulates the central nervous system; possesses diuretic, analeptic, positive inotropic, and chronotropic effects; and is lipolytic and glycogenolytic. Adverse effects: Underline = life-threatening Y 610 Yerba Santa Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Methylxanthine Caffeine; Theobromine; Theophylline Central nervous system stimulant Sterol Fat Ursolic acid Mineral Flavonoid Antitumor Iron; Calcium; Manganese; Magnesium; Sodium; Potassium; Zinc; Copper Rutin; Isoquercitrin; Kaempferol glycosides Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of yerba maté and administer an antihistamine or other appropriate therapy. • Assess for the use of CNS stimulants, CNS depressants, diuretics, and products that contain caffeine (see Interactions). ! • Assess for right upper-quadrant pain. Assess hepatic function tests (AST, ALT, bilirubin). If results are elevated, discontinue use of yerba maté. Administer • Instruct the client to store yerba maté products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use yerba maté in children or those who are pregnant or breastfeeding until more research is available. • Advise the client not to use yerba maté if he or she is allergic to other plants in the Aquifoliaceae family (e.g., holly). • Inform the client that using large amounts of yerba maté for a long period can lead to cancers of the gastrointestinal and urinary tracts. Yerba Santa (yehr’buh sahn’tuh) Scientific name: Eriodictyon californicum Other common names: Bear’s weed, consumptive’s weed, eriodictyon, gum bush, gum plant, holly herb, holy weed, mountain balm, sacred herb, tarweed Origin: Yerba santa is an evergreen found in the southwestern region of the United States. = Pregnancy = Pediatric ! = Alert = Popular Herb Yerba Santa 611 Uses Yerba santa traditionally has been used by Native Americans to decrease bruise and muscle inflammation. It has also been used to treat colds, asthma, congestion, allergies, arthritis, and rheumatism. The leaves are smoked or chewed to treat asthma. Actions Very little primary research is available for yerba santa. The only study found identified 12 new flavonoids that inhibited the metabolism of a carcinogen in hamster embryos. The chemical components cirsimaritan and chrysoeriol are thought to be chemoprotective (Liu et al, 1992). Product Availability Dried leaves, fluid extract, liniment, powder, syrup, tea Plant Parts Used: Dried leaves, roots Dosages • Adult PO expectorant: dried powdered leaves • Adult PO tea: place dried leaves in water, boil, strain, drink prn • Adult topical liniment: apply liniment of leaves to affected area prn • Adult topical poultice: mix fresh leaves with water and apply to affected area prn Contraindications Class 1 herb (whole herb). Until more research is available, yerba santa should not be used during pregnancy and breastfeeding. Persons with hypersensitivity to yerba santa should not use it. Side Effects/Adverse Reactions INTEG: Hypersensitivity reactions Primary Chemical Components and Possible Actions Chemical Class Individual Component Flavonoid Eriodictyol; Homoeriodictyol; Dimethoxyflavanone; Naringenin; Chrysoeriodictyol; Xanthoeriodictyol; Eriodict Cirsimaritin; Chrysoeriol Hispidulin; Chrysin Flavone Tannin Volatile oil Acid Resin Possible Action Chemoprotective Y Formic acid; Butyric acid; Cerotinic acid Pentacontane; Priodonal; Xanthoeriodictytol Phenol Adverse effects: Underline = life-threatening 612 Yew Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of yerba santa and administer an antihistamine or other appropriate therapy. Administer • Instruct the client to store yerba santa products in a cool, dry place, away from heat and moisture. Teach Client/Family • Caution the client not to use yerba santa during pregnancy or breastfeeding until more research is available. Yew ! (yew) Scientific names: Taxus brevifolia, Taxus baccata Other common names: American yew, California yew, chinwood, globeberry, ground hemlock, Oregon yew, western yew Origin: Yew is found in Canada and the Pacific Northwest region of the United States. Uses Yew is well known today as the plant used to manufacture the drug paclitaxel (Taxol), which is used to treat metastatic ovarian or breast cancer. Native Americans have used yew to treat arthritis and other joint disorders, as well as fever. As a folk medicine, the cooked yew leaves were used as an abortifacient; to promote menstruation; and to treat diphtheria, epilepsy, tapeworms, and tonsillitis. Actions Antineoplastic Action Yew is known for its antineoplastic properties. The main chemical component responsible for these effects is taxol, from which the drug paclitaxel (Taxol) is derived. This drug currently is used to inhibit metastatic breast cancer. It does so by inhibiting reorganization of the microtubule network needed for interphase in the cell division cycle and for mitotic cellular functions; it also causes abnormalities in bundles of microtubules during the cell cycle and multiple esters of microtubules during mitosis. Research has documented the efficacy of using Taxol in combination with radiation to treat head and neck cancers, cervical carcinomas, and breast adenocarcinomas (Pradier et al, 1999). Another study evaluated the needles of different yew species for the presence of paclitaxel and related taxoids (Van Rozendaal et al, 2000). There appears to be a wide variation in taxane content in the different species found in different countries. Product Availability Capsules, extract, salve Plant Parts Used: Bark, branch tips Dosages • Adult PO extract: 10-60 drops bid-qid • Adult PO tea: 8 oz daily • Adult topical salve: apply to affected area prn = Pregnancy = Pediatric ! = Alert = Popular Herb Yew 613 Contraindications ! Until more research is available, yew should not be used during pregnancy and breastfeeding. It should not be given to children. Yew should not be used by persons who have hepatic disease or who are immunocompromised. Persons with hypersensitivity to yew should not use it. Yew is highly toxic and should be used only under the supervision of a skilled herbalist. Side Effects/Adverse Reactions CV: Hypotension, arrhythmias, elevated triglycerides and cholesterol GI: Nausea, vomiting, anorexia, hepatotoxicity HEMA: Thrombocytopenia, leukopenia, anemia, neutropenia INTEG: Hypersensitivity reactions, alopecia MS: Joint and muscle pain Interactions Drug Antineoplastics: Use of yew with antineoplastics may cause increased myelosuppression; avoid concurrent use. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Alkaloid Taxol Taxine A, B; Taxicatin; Milossine; Ephedrine Antineoplastic Tannin Resin Lignan Flavonoid Flavone; Sequoia; Ginkgetin; Sciadopytisin Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of yew and administer an antihistamine or other appropriate therapy. • Monitor hepatic function tests (AST, ALT, bilirubin). If results are elevated, the client may need to discontinue using yew. • Assess for the use of antineoplastics (see Interactions). Administer • Instruct the client to store yew products away from heat, light, and moisture. Teach Client/Family • Caution the client not to use yew in children or those who are pregnant or breastfeeding until more research is available. • Warn the client to use yew only under the supervision of a qualified herbalist. This ! herb is highly toxic. Adverse effects: Underline = life-threatening Y 614 Yohimbe Yohimbe (yoh-heem’buh) Scientific name: Pausinystalia yohimbe Other common names: Aphrodien, corynine, johimbe, quebrachine, yohimbehe, yohimbene, yohimbime, yohimbine Origin: Yohimbe is found in West Africa. Uses Yohimbe traditionally has been used in Africa as an aphrodisiac. It is also used as a hallucinogenic. Investigational Uses Yohimbe is being studied for its use as a treatment for male erectile dysfunction, diabetes, orthostatic hypotension, and clonidine overdose. Actions Chemically, yohimbe is similar in structure to reserpine and lysergic acid. One study found that commercial yohimbe products contain primarily the chemical component yohimbine and are devoid of other alkaloids. The high content of this component may increase the potential for toxicity (Al-Majed et al, 2006; Betz et al, 1995). Erectile Dysfunction One study evaluated the well-known use of yohimbe for the treatment of erectile disorders (Riley, 1994). It showed a slight benefit in erectile disorder as compared with controls. However, yohimbe interacts with several drugs, which may lead to problems when taking this herb (see Interactions). One of the main actions of yohimbe is alpha-2 antagonism. Product Availability Tablets Plant Part Used: Bark Dosages Male Erectile Dysfunction • Adult PO tablets: 5.4 mg tid; dose may be adjusted to user’s response Orthostatic Hypotension • Adult PO tablets: 12.5 mg daily Contraindications Class 2d herb (bark). Until more research is available, yohimbe should not be used during pregnancy and breastfeeding. It should not be given to children. Persons with renal/ hepatic disease, hypertension, angina pectoris, gastric or duodenal ulcers, bipolar disorder, anxiety disorder, schizophrenia, suicidal tendencies, prostatitis, or hypersensitivity to yohimbe should not use it. Prolonged use of this herb is contraindicated. Side Effects/Adverse Reactions CNS: Headache, anxiety, restlessness, dizziness, tremors; manic reactions in psychiatric clients = Pregnancy = Pediatric ! = Alert = Popular Herb Yohimbe 615 Side Effects/Adverse Reactions—cont’d CV: Hypertension, tachycardia, flushing GI: Nausea, vomiting, anorexia, diarrhea GU: Dysuria, nephrotoxicity INTEG: Hypersensitivity reactions Interactions Drug ACE inhibitors, antihypertensives, beta-blockers, calcium channel blockers: Yohimbe may decrease or block the action of these drugs; avoid concurrent use (Musso et al, 1995). Alpha-adrenergic blockers (phentolamine, phenoxybenzamine), phenothiazines (chlorpromazine, promazine, thioxanthene), sympathomimetics (ephedrine, amphetamines, epinephrine): Use of yohimbe with alpha-adrenergic blockers, phenothiazines, sympathomimetics may result in increased toxicity; avoid concurrent use. CNS stimulants, SSRIs: Use of yohimbe with CNS stimulants, SSRIs may result in increased CNS stimulation; avoid concurrent use. MAOIs (tranylcypromine, phenelzine): Yohimbe may increase the effects of MAOIs; avoid concurrent use (theoretical). Tricyclic antidepressants (clomipramine, imipramine, amitriptyline): Use of yohimbe with tricyclic antidepressants may result in increased hypertension; dose may need to be lowered (Fugh-Berman, 2000). Food Caffeine-containing products: Use of yohimbe with products that contain caffeine may result in increased CNS stimulation; avoid concurrent use. High-tyramine foods: Use of yohimbe with foods with a high tyramine content (e.g., wine, beer, aged cheese, liver) may cause increased blood pressure; avoid concurrent use. Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Alkaloid Yohimbine Alpha-2 antagonist; increase blood pressure Alpha-yohimbine; Allo-yohimbine Y Client Considerations Assess • Assess for hypersensitivity reactions. If present, discontinue the use of yohimbe and administer an antihistamine or other appropriate therapy. • Assess for medication use. Yohimbe interacts with many types of medications (see Interactions). Adverse effects: Underline = life-threatening 616 Yohimbe • Assess for use of caffeine-containing products and high-tyramine foods (see Interactions). • Monitor blood pressure and pulse if the client is using yohimbe for an extended period. Administer • Instruct the client to store yohimbe products in a cool, dry place, away from heat and moisture. • Inform the client that dosage may be increased to treat male erectile dysfunction; however, higher doses can lead to hypertension and tachycardia. Teach Client/Family • Caution the client not to use yohimbe in children or those who are pregnant or breastfeeding until more research is available. Yohimbe is usually used by males. = Pregnancy = Pediatric ! = Alert = Popular Herb Herbal Resources The following is a sampling of online resources that provide current, reliable information about herbal products, their uses, and their health effects. Some are consumer oriented, and others are intended for health professionals. The names of the sponsoring organizations’ home pages are arranged alphabetically. URLs are provided for each individual site, or for the Internet portal through which the site may be accessed. AGRICOLA (AGRICultural OnLine Access): http://agricola.nal.usda.gov/ Alternative Medicine Home Page, from the University of Pittsburgh: http://www.pitt.edu/⬃cbw/altm.html American Botanical Council: http://abc.herbalgram.org/site/PageServer?page name⫽Homepage American Herbalists Guild: http://www.americanherbalistsguild.com/ American Herbal Pharmacopoeia: http://www.herbal-ahp.org/ American Holistic Health Association: http://www.ahha.org American Holistic Medical Association: http://www.holisticmedicine.org American Holistic Nurses Association: http://www.ahna.org American Society of Pharmacognosy: http://www.phcog.org/ Association of Natural Medicine Pharmacists: http://www.anmp.org British Herbal Medicine Association: http://www.bhma.info/ Christopher Hobbs Virtual Herbal: http://www.christopherhobbs.com/ Dr. Duke’s Phytochemical and Ethnobotanical Databases, from the Agricultural Research Service: http://www.ars-grin.gov/duke/plants.html European Herbal & Traditional Medicine Practitioners Association: http://www.ehpa.eu/ European Scientific Cooperative on Phytotherapy (ESCOP): http:// www.escop.com/ Herb Research Foundation (HRF): http://www.herbs.org Herbal Medicine, from Medline Plus: http://www.nlm.nih.gov/medlineplus/ herbalmedicine.html Herbs for Health, from About.com: http://altmedicine.about.com/ International Herb Association: http://www.iherb.org/ Rocky Mountain Herbal Institute: http://www.rmhiherbal.org/ RxList Alternatives: http://www.rxlist.com/script/main/art.asp?articlekey⫽78831 Southwest School of Botanical Medicine: http://www.swsbm.com/ HOMEPAGE/HomePage.html United Plant Savers (UpS): http://unitedplantsavers.org/ United States Pharmacopoeia (USP): http://www.usp.org/ 617 APPENDIX A APPENDIX A Drug/Drug Classes—cont’d APPENDIX B Drug/Herb Interactions The table that follows lists known drug/herb interactions for herbs included in this handbook. The pharmaceuticals and drug classes that are known to interact with herbal products are listed in the first column in alphabetical order, above the names of the herbs with which they interact. The reader should not assume that an herbal product not included here may be taken safely with a given drug or class of drugs. Research into herbal products is changing constantly, and new interactions are becoming known every day. Caution is always necessary when using herbal products, particularly when the client is taking them concurrently with pharmaceuticals. Drug/Drug Classes Herb ACE inhibitors Kelp Morinda Pineapple St. John’s wort Yohimbe Acetazolamide Quinine Adenosine Guarana Alcohol Arginine Betacarotene Betel palm Catnip Clary Corkwood Daisy Goldenseal Gossypol Hops Jamaican dogwood St. John’s wort Lavender Monascus 618 Interaction May ↑ the hypotensive effects of kelp; avoid concurrent use May ↑ risk of hyperkalemia May antagonize ACE inhibitor actions; avoid concurrent use May lead to severe photosensitivity; avoid concurrent use May ↓ or block actions of these drugs; avoid concurrent use May lead to toxicity when used with acetazolamide; avoid concurrent use May ↓ the adenosine response May cause gastric irritation ↓ by alcohol ↑ effects of alcohol; avoid concurrent use May enhance the effects of alcohol ↑ the action of alcohol May ↑ anticholinergic effect May ↑ the effect of alcohol May ↑ the effects of alcohol Leads to alcohol accumulation ↑ CNS effects ↑ effects of alcohol; avoid concurrent use May ↑ MAO inhibition; avoid concurrent use ↑ sedation when used with lavender; avoid concurrent use Alcohol may affect liver function in those taking monascus Drug/Drug Classes—cont’d Herb All medications Clematis Fenugreek Interaction Avoid concurrent use with all Western medications May cause reduced absorption of all medications used concurrently Glucomannan May ↓ the absorption of all medications if taken concurrently; space dosages by at least 2 hours Kaolin ↓ absorption of all drugs; space by at least 2 hours Karaya gum ↓ absorption of all drugs; space by at least 2 hours All oral medications Agar Causes ↓ absorption of all oral medication May cause precipitation of some drugs; separate by the longest Bistort possible time Flax Absorption may ↓ if taken concurrently Ginger May ↑ absorption of all medications taken orally Guar gum May ↓ the absorption of all oral medications Iceland moss Can ↓ absorption of all medications Irish moss Can ↓ absorption of all medications Marshmallow May ↓ absorption of oral medications; avoid concurrent use Mullein May ↓ absorption of oral medications; space by 2 hours Oats May ↓ absorption of oral medications; space by 1 before or 4 hours after oats Pectin ↓ absorption of all drugs, vitamins, and minerals if taken concurrently; space by 3 hours Plantain May ↓ absorption of all oral medications; space by several hours Quince May ↓ absorption of all oral medications Alpha-adrenergic blockers Butcher’s May ↓ action of alpha-adrenergic blockers; avoid concurrent use broom May ↓ the action of alpha-adrenergic blockers; avoid Capsicum concurrent use Yohimbe May result in ↑ toxicity; avoid concurrent use Aluminium salts Quinine May cause ↓ absorption of quinine; space by 3 hours Amantadine Jimsonweed ↑ anticholinergic effects Aminoglycosides Creatine May lead to nephrotoxicity Large amounts of lysine cause ↑ aminoglycoside toxicity; avoid Lysine concurrent use Amphetamines Eucalyptus May ↓ the effectiveness of amphetamines; avoid concurrent use Khat ↑ action of amphetamines May cause ↓ pressor effects; avoid concurrent use Rauwolfia St. John’s wort May cause serotonin syndrome Continued APPENDIX B Appendix B Drug/Herb Interactions 619 620 Appendix B Drug/Herb Interactions Drug/Drug Classes—cont’d Herb Analgesics Cola tree Anastrozole DHEA Anesthetics Ephedra Anisindione Dong quai Feverfew Antacids Acidophilus Angelica Bogbean Buckthorn Cascara Castor Chinese rhubarb Chromium Interaction May ↑ the effect of analgesics; avoid concurrent use Do not take together; DHEA is a potent estrogen agonist Causes ↑ arrhythmias when used with halothane anesthetics; avoid concurrent use May ↑ the effects of anisindione May ↑ anticoagulant effects Should be taken 30-60 min. before acidophilus. May ↑ stomach acid, which may ↓ the antacid action ↓ the effects of antacids May ↓ the action of buckthorn if taken within 1 hour of the herb May ↓ the action of cascara if taken within 1 hour of the herb To prevent ↓ absorption of castor, do not take within 1 hour of antacids May ↓ the effectiveness of Chinese rhubarb if taken within 1 hour of the herb Calcium products reduce the absorption of chromium; space by ⱖ 2 hours May ↓ the action of antacids May ↓ the action of antacids ↓ the action of jimsonweed May ↓ the action of male fern, separate by at least 2 hours May cause premature dissolution of enteric-coated peppermint oil Dandelion Devil’s claw Jimsonweed Male fern Peppermint oil Yarrow May ↓ the action of antacids Antianginals Blue cohosh May ↓ the action of antianginals, causing chest pain Antianxiety agents Cowslip May ↑ the effect of antianxiety agents; avoid concurrent use Antiarrhythmics Aconite ↑ toxicity; avoid concurrent use Internal use may ↑ the effects of antiarrhythmics Aloe Broom May ↑ the effect of antiarrhythmics; avoid concurrent use Buckthorn Chronic buckthorn use can cause hypokalemia and enhance the effects of antiarrhythmics; avoid concurrent use Cascara Chronic cascara use can cause hypokalemia and enhance the effects of antiarrhythmics; avoid concurrent use Chinese Chronic use of Chinese rhubarb can cause hypokalemia and rhubarb enhance the effects of antiarrhythmics Drug/Drug Classes—cont’d Herb Interaction Devil’s claw Figwort Fumitory Goldenseal Khat Kudzu Licorice Squill Use cautiously because of possible inotropic and chronotropic effects May ↑ the effects of antiarrhythmics; avoid concurrent use May ↑ the effects of antiarrhythmics; avoid concurrent use May ↑ the effects of antiarrhythmics ↑ action of antiarrhythmics ↑ effects of antiarrhythmics ↑ cardiac effects of antiarrhythmics; avoid concurrent use May ↑ effect of antiarrhythmics, causing life-threatening toxicity, avoid concurrent use Antibiotics Acidophilus Avoid concurrent use; space by at least 2 hours Antibiotics, macrolide Black Can lead to cardiac toxicity; avoid concurrent use hellebore Lily of the May lead to cardiac glycoside toxicity valley Anticholinergics Black Catechu May ↑ constipation when used with anticholinergics May enhance the effects of anticholinergics; avoid concurrent use Butterbur Jaborandi Internal use may ↓ effects of anticholinergics Jimsonweed ↑ effects of anticholinergics Anticoagulants Alfalfa May prolong bleeding May inhibit platelets, causing bleeding Allspice Andrographis May ↑ effect of anticoagulants Angelica May prolong bleeding; avoid concurrent use Bilberry May ↑ action of anticoagulants Black haw May ↑ the action of anticoagulants Blue flag May ↑ risk of bleeding Bogbean May ↑ risk of bleeding; avoid concurrent use Boldo Can lead to ↑ risk of bleeding Borage May ↑ risk of bleeding Buchu Can ↑ the action of anticoagulants, causing bleeding; avoid concurrent use Chamomile May interfere with the actions of anticoagulants; avoid concurrent use Chaparral May ↑ action of anticoagulants Chondroitin Can cause ↑ bleeding; avoid high doses of chondroitin Cloves May ↑ effect of anticoagulants Coenzyme May ↓ the action of anticoagulants; avoid concurrent use Q10 Dandelion May ↑ bleeding when used with anticoagulants Fenugreek Risk of ↑ bleeding when used concurrently Feverfew May ↑ anticoagulant effects Fish oil May ↑ risk of bleeding; avoid concurrent use Flax May ↑ risk of bleeding Continued APPENDIX B Appendix B Drug/Herb Interactions 621 622 Appendix B Drug/Herb Interactions Drug/Drug Classes—cont’d Herb Interaction Gamma linolenic acid Garlic Ginkgo Ginseng Glucosamine Goldenseal Guggul Horse chestnut Irish moss Kelp Kelpware Khella May ↑ risk of bleeding May ↑ bleeding; avoid concurrent use ↑ risk of bleeding; avoid concurrent use May ↓ the action of anticoagulants High levels of glucosamine can lead to bleeding risk May ↓ the effects of anticoagulants May ↑ risk of bleeding ↑ risk of severe bleeding; avoid concurrent use ↑ effects of anticoagulants; avoid concurrent use May pose ↑ risk of bleeding; avoid concurrent use May pose ↑ risk of bleeding; avoid concurrent use ↑ risk of bleeding when used with anticoagulants; avoid concurrent use Kudzu May ↑ risk of bleeding Lovage May ↑ effects of anticoagulants; avoid concurrent use Lungwort May ↑ effects of anticoagulants; avoid concurrent use Meadowsweet May ↑ risk of bleeding; avoid concurrent use Motherwort May cause ↑ risk of bleeding; avoid concurrent use Mugwort May cause ↑ risk of bleeding; avoid concurrent use Nettle May ↓ effect of anticoagulants; avoid concurrent use Papaya ↑ risk of bleeding and ↑ INR and prothrombin time Pineapple May ↑ bleeding time when used with anticoagulants; avoid concurrent use Poplar May ↑ bleeding time when used with anticoagulants; avoid concurrent use Prickly ash May ↑ bleeding time when used with anticoagulants; avoid concurrent use Quinine May ↑ action of anticoagulants; avoid concurrent use Saw palmetto May potentiate anticoagulant effect of salicylates; avoid concurrent use Senega May ↑ bleeding time; avoid concurrent use Tonka bean May result in ↑ risk of bleeding; avoid concurrent use Turmeric May result in ↑ risk of bleeding; avoid concurrent use Wintergreen May cause ↑ risk of bleeding; avoid concurrent use Yarrow May result in ↑ risk of bleeding; avoid concurrent use Anticoagulants, oral Dong quai May ↑ the effects of anticoagulants Anticonvulsants Borage May ↓ effect of anticonvulsants May ↑ risk of seizures; avoid concurrent use Fennel Ginkgo May ↓ the anticonvulsant effect; avoid concurrent use Glutamine May ↓ anticonvulsant action of anticonvulsants; avoid concurrent use Wormseed May ↓ the seizure threshold; avoid concurrent use Appendix B Drug/Herb Interactions 623 Herb Antidepressants Hops SAM-e St. John’s wort Antidiabetics Agrimony Alfalfa Aloe Basil Bay Bee pollen Bilberry Blue cohosh Broom Buchu Bugleweed Burdock Chinese cucumber Chromium Coenzyme Q10 Coriander Couchgrass Damiana Dandelion Devil’s claw Ephedra Eucalyptus Eyebright Figwort Flax Fo-ti Garlic Ginseng Glucomannan Gotu kola Horse chestnut Maitake Marshmallow Myrrh Myrtle APPENDIX B Drug/Drug Classes—cont’d Interaction ↑ CNS effects May lead to serotonin syndrome; avoid concurrent use May cause serotonin syndrome May ↑ hypoglycemic effect; monitor blood glucose May potentiate hypoglycemic action Internal use may ↑ effects of antidiabetics May ↑ hypoglycemic effects; avoid concurrent use May ↑ hypoglycemic effects; avoid concurrent use ↓ effectiveness of antidiabetics, ↑ hyperglycemia; avoid concurrent use May ↑ hypoglycemia May ↓ the action of antidiabetics; avoid concurrent use Broom ↓ the hypoglycemic effect; avoid concurrent use Buchu ↓ the hypoglycemic effect; avoid concurrent use May lead to ↑ hypoglycemia ↑ hypoglycemic effect can occur; avoid concurrent use May ↑ effects of antidiabetics May reduce the action of antidiabetics May ↓ the action of coenzyme Q10 and deplete endogenous stores; avoid concurrent use May ↑ the effects of oral antidiabetics; use together cautiously May ↑ hyperglycemia May ↓ the action of antidiabetics May ↑ the effects of antidiabetics; avoid concurrent use May cause an additive effect May ↑ blood glucose May alter the effectiveness of antidiabetics; avoid concurrent use Internal use may ↑ the effects of antidiabetics May ↑ blood glucose levels, ↓ antidiabetic action of insulin May ↑ action of antidiabetics May ↑ action of antidiabetics Because of hypoglycemic effects of garlic, oral antidiabetic dosages may need to be adjusted May ↑ the hypoglycemic effects of oral antidiabetics; avoid concurrent use May ↑ the hypoglycemic effects of oral antidiabetics May ↓ the effectiveness of antidiabetics; avoid concurrent use ↑ hypoglycemic effects May ↑ the action of antidiabetics May ↑ hypoglycemic action of antidiabetics May cause ↑ hypoglycemic effects; avoid concurrent use May cause ↑ hypoglycemia; avoid concurrent use Continued 624 Appendix B Drug/Herb Interactions Drug/Drug Classes—cont’d Herb Interaction Plantain May ↑ antidiabetic action Sage May ↑ the action of antidiabetics Senega May ↓ effects of antidiabetics; avoid concurrent use Siberian May ↑ levels of antidiabetics; avoid concurrent use ginseng Yerba Maté May ↓ the action of antidiabetics Antidiarrheals Nutmeg May potentiate antidiarrheals; monitor for constipation Antifungals Gossypol May cause nephrotoxicity; avoid concurrent use Antifungals, azole Bitter orange Can inhibit cytochrome P450 3A4 and ↑ drug levels May slow the metabolism of azole antifungals Goldenseal Licorice May ↑ levels of azole antifungals; avoid concurrent use Antiglaucoma agents Betel palm ↓ effects of antiglaucoma agents; avoid concurrent use Antihistamines Blue cohosh Metabolism of blue cohosh may be ↓ May ↑ anticholinergic effect Corkwood Hops ↑ CNS effects Jamaican May produce ↑ effect; avoid concurrent use dogwood Khat ↑ action of antihistamines Lavender ↑ sedation when used with lavender; avoid concurrent use Antihypertensives Aconite ↑ toxicity; avoid concurrent use Use with anti-hypertensives may ↑ hypotension Agrimony Andrographis May ↑ effect of antihypertensives Arnica Internal use may ↓ the effect of antihypertensives Arginine May lead to ↑ hypotension Astragalus May ↑ or ↓ action of anti-hypertensives; avoid concurrent use Barberry May ↑ antihypertensive action Bayberry Bayberry’s tannin may ↑ sodium and water retention Betony May ↑ action of antihypertensives; avoid concurrent use Black catechu May ↑ hypotension Black cohosh ↑ action of antihypertensives Bloodroot May ↑ hypotensive effects Blue cohosh ↓ the action of antihypertensives; avoid concurrent use Blue flag May ↑ effect of antihypertensives Broom May ↑ the effect of antihypertensives; avoid concurrent use Burdock May ↑ hypotensive effects; avoid concurrent use Cat’s claw May ↑ the hypotensive effects of antihypertensives; avoid concurrent use Celery May ↑ effect of antihypertensives Drug/Drug Classes—cont’d Herb Interaction Cowslip Dandelion Goldenseal Hawthorn Irish moss Jamaican dogwood Kelp Khat Khella May ↑ effect of antihypertensives May ↑ the effects of antihypertensives; avoid concurrent use May ↑ the effects of antihypertensives May ↑ hypotension; avoid concurrent use ↑ effects of antihypertensives; avoid concurrent use May ↑ effects of antihypertensives; avoid concurrent use Licorice Mistletoe, European Parsley Queen Anne’s lace Rue Yarrow Yohimbe Antilipidemics Glucomannan Gotu kola ↑ hypotensive effects; avoid concurrent use ↑ action of antihypertensives ↑ hypotension when used with antihypertensives; avoid concurrent use May cause ↑ hypokalemia; avoid concurrent use May ↑ hypotensive effect of antihypertensives; avoid concurrent use May cause ↑ hypotension; avoid concurrent use ↑ hypotension when used with antihypertensives; use together cautiously May cause ↑ vasodilation; avoid concurrent use May result in ↑ hypotension; avoid concurrent use May ↓ or block actions of these drugs; avoid concurrent use May ↑ the action of antilipidemics May ↓ the effectiveness of antilipidemics; avoid concurrent use Antimigraine agents Butterbur May enhance the effects of antimigraine agents; use cautiously Antineoplastics Acidophilus Should not be used concurrently May prevent nephrotoxicity from platinum antineoplastics Milk thistle Yew May cause ↑ myelosuppression; avoid concurrent use Antiparkinson agents Corkwood May interfere with effect of antiparkinson agents Kava ↑ symptoms of parkinsonism; avoid concurrent use Antiplatelet agents Allspice May inhibit platelets, causing bleeding May ↑ effect of antiplatelet agents Androgaphis Angelica Many species ↑ prothrombin time and prolong bleeding; avoid concurrent use Arginine May cause gastric irritation Bilberry May cause antiaggregation of platelets Blue flag May ↑ risk of bleeding Bogbean May ↑ risk of bleeding; avoid concurrent use Boldo Can lead to ↑ risk of bleeding Buchu Can ↑ the action of anticoagulants, causing bleeding; avoid concurrent use Continued APPENDIX B Appendix B Drug/Herb Interactions 625 626 Appendix B Drug/Herb Interactions Drug/Drug Classes—cont’d Herb Chaparral Cloves Dandelion Dong quai Fenugreek Feverfew Flax Gamma linolenic acid Garlic Ginkgo Ginseng Glucosamine Guggul Kudzu Saw palmetto Tonka bean Turmeric Yarrow Antipsychotics Hops Kava Antiretrovirals St. John’s wort Ascorbic acid Chromium Aspirin Bilberry Bogbean Horse chestnut Parsley Atropine Black root Barbiturates Blue cohosh Blue flag Eucalyptus Jamaican dogwood Kava Lemon balm Interaction May ↑ action of antiplatelet agents May ↑ effect of antiplatelet agents May ↑ bleeding when used with antiplatelet agents May ↑ the effects of antiplatelet agents Risk of ↑ bleeding when used concurrently May ↑ action of antiplatelets; avoid concurrent use May ↑ risk of bleeding May ↑ risk of bleeding May ↑ bleeding; avoid concurrent use ↑ risk of bleeding; avoid concurrent use May ↓ action of antiplatelets High levels of glucosamine can lead to bleeding risk May ↑ risk of bleeding May ↑ risk of bleeding May lead to ↑ bleeding; avoid concurrent use May result in ↑ risk of bleeding; avoid concurrent use May result in ↑ risk of bleeding; avoid concurrent use May result in ↑ risk of bleeding; avoid concurrent use ↑ CNS effects May result in neuroleptic movement disorders When taken PO in combination with indinavir May ↑ the antiretroviral action Both chromium and ascorbic acid absorption ↑ when taken concurrently May ↑ the anticoagulation action of aspirin May ↑ risk of bleeding; avoid concurrent use ↑ risk of severe bleeding; avoid concurrent use May precipitate parsley allergy Forms an insoluble complex with atropine; avoid concurrent use Metabolism of blue cohosh may be ↓ Effects may be ↓ May ↓ the effectiveness of barbiturates; avoid concurrent use ↑ effects of barbiturates; avoid concurrent use ↑ sedation May potentiate the sedative effects of barbiturates Drug/Drug Classes—cont’d Herb Interaction Belladonna alkaloids Mayapple May ↓ laxative effects of mayapple; avoid concurrent use Benzodiazipines Bitter orange Can inhibit cytochrome P450 3A4 and ↑ drug levels Coffee ↓ the effect of benzodiazepines May ↓ the effect of cola tree products Cola tree Goldenseal May slow the metabolism of benzodiazepines Kava ↑ sedation and coma; avoid concurrent use Melatonin May ↑ anxiolytic effects of benzodiazepines; use cautiously Beta-blockers Betel palm ↑ action of beta-blockers; avoid concurrent use Effects may be ↓ Blue flag Butterbur May enhance the effects of beta-blockers; avoid concurrent use Chaste tree May lead to hypertensive crisis Coenzyme Beta-blockers may ↓ the action of coenzyme Q10 and deplete Q10 endogenous stores; avoid concurrent use Coffee Caffeine in coffee ↑ blood pressure in those taking betablockers Cola tree May ↑ blood pressure when used with beta-blockers Corkwood May alter cardiac function Ephedra Causes ↑ hypertension when used with beta-blockers; avoid concurrent use Figwort May ↑ the effects of beta-blockers; avoid concurrent use Fumitory May ↑ the effects of beta-blockers; avoid concurrent use Goldenseal May ↑ the effects of beta-blockers Green tea May lead to ↑ inotropic effects Jaborandi Internal use may ↑ adverse cardiovascular reactions; avoid concurrent use Khat ↑ action of beta blockers Lily of the ↑ risk of bradycardia; avoid concurrent use valley Melatonin Melatonin is able to reverse the negative action of beta-blockers on sleep Motherwort May cause ↓ heart rate; avoid concurrent use Plaintain May ↑ effects of beta-blockers; avoid concurrent use Rauwolfia May result in ↑ hypotension; avoid concurrent use Squill May ↑ effect of beta-blockers, causing life-threatening toxicity; avoid concurrent use Yohimbe May ↓ or block actions of these drugs; avoid concurrent use Bethanecol Jaborandi Internal use ↑ cholinergic effects Bronchodilators Coffee Large amounts of coffee may ↑ the action of some bronchodilators Large amounts of green tea ↑ the action of some bronchodilators Green tea Guarana May ↑ the action of bronchodilators Continued APPENDIX B Appendix B Drug/Herb Interactions 627 628 Appendix B Drug/Herb Interactions Drug/Drug Classes—cont’d Herb Interaction Buspirone Ginkgo May cause hypomania Calcium Lysine ↑ calcium absorption, ↓ urine calcium loss May ↑ the action of oleander Oleander Raspberry Raspberry tea may ↓ absorption of calcium Sorrel May ↓ calcium absorption Yellow dock Tea may ↓ the absorption of calcium Calcium-channel blockers Barberry May ↑ effect of calcium-channel blockers Betel palm ↑ action of calcium-channel blockers; avoid concurrent use Can inhibit cytochrome P450 3A4 and ↑ drug levels Bitter orange Burdock May ↑ hypotensive effects; avoid concurrent use Goldenseal May slow the metabolism of calcium-channel blockers Khat ↑ action of calcium-channel blockers Khella ↑ hypotension when used with calcium-channel blockers; avoid concurrent use Lily of the ↑ risk of bradycardia; avoid concurrent use valley Plaintain May ↑ effects of calcium-channel blockers; avoid concurrent use Squill May ↑ effect of calcium-channel blockers, causing life-threatening toxicity; avoid concurrent use Yohimbe May ↓ or block actions of these drugs; avoid concurrent use Calcium supplements Chromium Calcium products reduce the absorption of chromium; space by ⱖ 2 hours Shark May lead to ↑ calcium levels cartilage Carbamazepine Plantain May ↓ effects of carbamazepine; avoid concurrent use May ↑ the action of carbamazepine; avoid concurrent use Quinine Carbidopa Octacosanol May cause dyskinesia when used with carbidopa/levodopa; avoid concurrent use Cardiac agents Plantain May ↑ effects of cardiac agents; avoid concurrent use May result in ↑ hypotension; avoid concurrent use Rauwolfia Squill May ↑ effect of cardiac agents, causing life-threatening toxicity; avoid concurrent use Cardiac glycosides Aconite ↑ toxicity; avoid concurrent use Internal use may ↑ effects of cardiac glycosides Aloe Betel palm ↑ action of cardiac glycosides; avoid concurrent use Beth root May ↓ effects of cardiac glycosides Drug/Drug Classes—cont’d Herb Interaction Black root Forms an insoluble complex with cardiac glycosides; avoid concurrent use Can lead to additive effect; avoid concurrent use Black hellebore Blue flag Broom Buckthorn Cascara Castor Chinese rhubarb Condurango Corkwood Ephedra Figwort Fumitory Goldenseal Hawthorn Horsetail Kelp Khat Kudzu Licorice Lily of the valley Mayapple Mistletoe, European Motherwort Night-blooming cereus Oleander Plantain Queen Anne’s lace Quinine Rauwolfia Rue Senna Siberian ginseng Squill May lead to ↑ side effects May ↑ the effect of cardiac glycosides; avoid concurrent use Chronic buckthorn use can cause hypokalemia and enhance the effects of cardiac glycosides; avoid concurrent use Chronic cascara use can cause hypokalemia and enhance the effects of cardiac glycosides; avoid concurrent use Use with castor oil may lead to ↑ cardiac adverse reactions Chronic use of Chinese rhubarb can cause hypokalemia and enhance the effects of cardiac glycosides Absorption of digitoxin and digoxin may ↓; avoid concurrent use May alter cardiac function May change heart rhythm; avoid concurrent use May ↑ the action of figwort; avoid concurrent use May ↑ the effects of cardiac glycosides; avoid concurrent use May ↓ the effects of cardiac glycosides May ↑ the effects of cardiac glycosides; monitor concurrent use carefully ↑ toxicity and ↑ hypokalemia May lead to hypokalemia ↑ action of cardiac glycosides ↑ effects of cardiac glycosides May cause ↑ toxicity and ↑ hypokalemia; avoid concurrent use. May ↑ effects; avoid concurrent use Do not use together; may ↑ toxicity May cause ↓ cardiac function; avoid concurrent use May cause ↓ heart rate; avoid concurrent use May ↑ actions of cardiac glycosides; avoid concurrent use May cause fatal digitalis toxicity; avoid concurrent use May ↑ effects of cardiac glycosides; avoid concurrent use May ↑ cardiac depression; avoid concurrent use May ↑ action of cardiac glycosides; avoid concurrent use Causes severe bradycardia; do not use together May cause ↑ inotropic effects; avoid concurrent use Chronic use may potentiate cardiac glycosides May ↑ levels of cardiac glycosides; avoid concurrent use May ↑ effect of cardiac glycosides, causing life-threatening toxicity; avoid concurrent use Continued APPENDIX B Appendix B Drug/Herb Interactions 629 630 Appendix B Drug/Herb Interactions Drug/Drug Classes—cont’d Herb Interaction Central nervous system (CNS) depressants Bay May ↑ the action of CNS depressants; avoid concurrent use May ↑ sedative effect of CNS depressants Bloodroot Boldo May ↑ effect of CNS depressants Catnip May enhance the effects of sedatives Chamomile May ↑ the effects of other sedatives; avoid concurrent use Cowslip May ↑ the effect of antianxiety agents and sedative/hypnotics; avoid concurrent use Elecampane May ↑ the action of CNS depressants Golden rod May ↑ CNS depression Goldenseal May ↑ the effects of CNS depressants Hawthorn May ↑ the sedative effects of CNS depressants; avoid concurrent use Hops ↑ CNS effects Kava ↑ sedation; avoid concurrent use Lavender May ↑ sedation; avoid concurrent use Lemon balm May potentiate the sedative effects of CNS depressants Marigold May ↑ sedation Marijuana ↑ effect of CNS depressants Motherwort Can ↑ the action of CNS depressants Nettle May lead to ↑ CNS depression Pokeweed May ↑ action of CNS depressants; avoid concurrent use Poppy ↑ CNS depression when use with CNS depressants; avoid concurrent use Queen Anne’s ↑ action of CNS depressants; use together cautiously lace Rauwolfia May cause ↑ CNS depression; avoid concurrent use Sage May ↑ the action of CNS depressants Sassafras May ↑ the action of CNS depressants Senega May cause ↑ CNS effects; avoid concurrent use Skullcap May potentiate sedation of CNS depressants; avoid concurrent use Valerian May ↑ effects of CNS depressants; avoid concurrent use Yarrow May cause ↑ sedation; avoid concurrent use Yerba maté May produce antagonistic effect; avoid concurrent use Central nervous system (CNS) stimulants Ephedra Causes ↑ CNS stimulation when used with CNS stimulants May ↑ CNS stimulation Peyote Squill May ↑ effects of CNS stimulants; avoid concurrent use Yerba maté May ↑ effects CNS stimulants, use together cautiously Yohimbe May result in ↑ CNS stimulation; avoid concurrent use Cerebral stimulants Melatonin May have a synergistic effect and exacerbate insomnia; avoid concurrent use Cholinergics Betel palm May ↑ the effects of cholinergics; avoid concurrent use Drug/Drug Classes—cont’d Herb Interaction Cholinergics, ophthalmic Jaborandi Internal use ↑ cholinergic effects Ciprofloxacin Fennel Affects the absorption, distribution, and elimination of ciprofloxacin; dosages should be spaced by at least 2 hours Clonidine Capsicum May ↓ the antihypertensive effects of clonidine; avoid concurrent use Contraceptives, hormonal Alfalfa May interfere with hormonal contraceptives May ↑ effects; avoid concurrent use Black cohosh Blue cohosh May ↑ metabolism, ↓ effect of hormonal contraceptives Chaste tree May interfere with the action of hormonal contraceptives; avoid concurrent use Dong quai May ↑ effects of hormonal contraceptives Garlic Garlic with allicin may ↓ the action of hormonal contraceptives Kudzu May ↑ action of hormonal contraceptives St. John’s wort May lead to severe photosensitivity; avoid concurrent use Corticosteroids Bloodroot May ↑ potassium loss May ↑ metabolism, ↓ effect of corticosteroids Blue cohosh Buckthorn Hypokalemia can result from use of buckthorn with corticosteroids; avoid concurrent use Cascara Hypokalemia may result; avoid concurrent use Castor Use with castor oil may ↑ hypokalemia Chinese Chronic use of Chinese rhubarb can cause hypokalemia and rhubarb enhance the effects of corticosteroids DHEA Corticosteroids ↓ DHEA levels Licorice May ↑ effects of corticosteroids; avoid concurrent use Perilla May augment the effects of corticosteroids; avoid concurrent use Cyclophosphamide Astragalus May ↓ the effect of cyclophosphamide Cyclosporine Arginine May counteract the therapeutic effects of cyclosporine May lead to nephrotoxicity Creatine CYP2A6, drugs metabolized by Condurango Use condurango with caution CYP450, drugs metabolized by Black pepper Avoid concurrent use Use condurango with caution, especially in clients with hepatic Condurango disorders Hops ↓ CYP450 levels Myrtle Avoid concurrent use Pennyroyal Avoid concurrent use Continued APPENDIX B Appendix B Drug/Herb Interactions 631 632 Appendix B Drug/Herb Interactions Drug/Drug Classes—cont’d Herb Interaction CYP452C9, drugs metabolized by Cranberry May inhibit cytochrome P45 2C9 enzymes CYP4503A4, drugs metabolized by Bitter orange Can inhibit CYP4503A4 and ↑ drug levels May ↓ the action of drugs metabolized by CYP4503A4 DHEA CYP4501A2, drugs metabolized by Ginkgo May affect drugs metabolized by this enzyme; use cautiously Kava significantly ↓ these substrates; use cautiously Kava Siberian Standardized Siberian ginseng may inhibit these drugs ginseng St. John’s wort Induces this enzyme system CYP4502B6, drugs metabolized by Licorice May ↓ the action of these drugs CYP4502C9, drugs metabolized by Kava Kava significantly ↓ these substrates; use cautiously May inhibit these drugs Milk thistle Siberian Standardized Siberian ginseng may inhibit these drugs ginseng St. John’s wort Induces this enzyme system CYP4502C19, drugs metabolized by Kava Kava significantly ↓ these substrates; use cautiously CYP4502D6, drugs metabolized by Ginkgo May affect drugs metabolized by this enzyme; use cautiously Kava significantly ↓ these substrates; use cautiously Kava Siberian Standardized Siberian ginseng may inhibit these drugs ginseng CYP4503A4, drugs metabolized by Echinacea May inhibit P4503A4 enzymes Garlic with allicin may ↑ the action of cytochrome P4503A4 Garlic Ginkgo May affect drugs metabolized by this enzyme; use cautiously Kava Kava significantly ↓ these substrates; use cautiously Licorice May ↓ the action of these drugs Milk thistle May inhibit these drugs Monascus May ↑ adverse reactions Peppermint May ↓ drug level oil Siberian Standardized Siberian ginseng may inhibit these drugs ginseng St. John’s wort Induces this enzyme system Valerian May inhibit the enzyme Wild cherry May slow metabolism; avoid concurrent use Decongestants Khat ↑ action of decongestants May ↓ cytokine production; avoid concurrent use Melatonin Appendix B Drug/Herb Interactions 633 Herb Dicumarol Dong quai Feverfew Didanosine Lentinan Digoxin Castor Condurango Pectin Diltiazem Guggul Disulfiram Senna Diuretics Bearberry Birch Black hellebore Black root Blue flag Castor Celery Couchgrass Castor Cowslip Cucumber Dandelion Fo-ti Golden rod Gossypol Kelpware Khella Licorice Lovage Nettle Pumpkin Queen Anne’s lace Rauwolfia Sorrel Yerba maté APPENDIX B Drug/Drug Classes—cont’d Interaction May ↑ the effects of dicumarol May ↑ anticoagulant effects May ↑ CD4 counts Use with castor oil may lead to ↑ cardiac adverse reactions Absorption of digitoxin and digoxin may ↓; avoid concurrent use Can interfere with absorption of digoxin Can lead to ↑ action of diltiazem Do not use with disulfiram May lead to electrolyte loss, primarily hypokalemia May ↓ action of diuretics Can lead to toxicity; avoid concurrent use May ↑ hypokalemia; avoid concurrent use or added potassium supplementation may be needed May lead to hypokalemia Use with castor oil may ↑ hypokalemia May ↑ effect of diuretics Potassium wasting diuretics with couchgrass may lead to hypokalemia May ↑ hypokalemia May ↑ the effect of diuretics May ↑ the diuretic effect of other diuretics; avoid concurrent use May ↑ diuresis, leading to fluid loss and electrolyte imbalances; avoid concurrent use May ↑ risk of hypokalemia with potassium-losing diuretics May ↑ diuretics May cause severe hypokalemia; avoid concurrent use May ↓ the action of diuretics ↑ hypotension when used with diuretics; avoid concurrent use May cause ↑ hypokalemia; avoid concurrent use May ↑ sodium retention May ↑ effects of diuretics, resulting in dehydration and hypokalemia; avoid concurrent use May ↑ action of diuretics; use together cautiously ↑ hypotension; use together cautiously May result in ↑ hypotension; avoid concurrent use Leads to additive diuretic effect; avoid concurrent use May ↑ effects of diuretics; avoid concurrent use Continued 634 Appendix B Drug/Herb Interactions Drug/Drug Classes—cont’d Herb Interaction Diuretics, loop Aloe Internal use may ↑ effects of loop diuretics May lead to severe photosensitivity; avoid concurrent use St. John’s wort Diuretics, potassium-depleting Lily of the May lead to hypokalemia valley Diuretics, potassium-losing Mayapple May ↑ hypokalemia Diuretics, potassium-sparing Kelp May lead to hypokalemia Morinda juice may ↑ risk of hyperkalemia Morinda Diuretics, thiazide Buckthorn Hypokalemia can result from use of buckthorn with thiazide diuretics; avoid concurrent use Hypokalemia may result; avoid concurrent use Cascara Chinese Chronic use of Chinese rhubarb can cause hypokalemia and rhubarb enhance the effects of thiazide diuretics; avoid concurrent use St. John’s wort May lead to severe photosensitivity; avoid concurrent use Docetaxel Black cohosh May ↑ toxicity of docetaxel; avoid concurrent use Doxazosin Angelica May ↑ effect of doxazosin Doxorubicin Black cohosh May ↑ toxicity of doxorubicin; avoid concurrent use Econazole vaginal cream Echinacea May ↓ the action of this cream; avoid concurrent use Electrolyte solutions Agar ↑ dehydration Ephedrine Rauwolfia May cause ↓ pressor effects; avoid concurrent use Epinephrine Rauwolfia May cause ↓ pressor effects; avoid concurrent use Estrogens Alfalfa May interfere with hormonal replacement therapy or contraceptives Androstenediol ↑ effect of estrogens May ↑ effect of estrogens Boron Chaste tree May interfere with action of estrogens; avoid concurrent use Dong quai May ↑ effect of estrogens Kudzu May ↑ action of estrogens Drug/Drug Classes—cont’d Herb Interaction Queen Anne’s May interfere with estrogen’s action lace Soy May interfere with estrogen absorption; avoid concurrent use Exemestane DHEA Do not take together; DHEA is a potent estrogen agonist Fluoxetine Ginkgo May cause hypomania Fulvestrant DHEA Do not take together; DHEA is a potent estrogen agonist Furoquinolones Cola tree May ↑ the effect of cola tree products Glucocorticoids Squill May ↑ effects of glucocorticoids; avoid concurrent use Glucose Creatine May ↑ the storage of creatine in muscle tissue Guanethidine Ephedra May ↓ the effect of guanethidine H2 blockers Angelica May ↑ stomach acid, which may ↓ the H2 blocker action Dandelion May ↓ the action of H2 blockers Devil’s claw May ↓ the action of H2 blockers Male fern May ↓ the action of male fern; separate by at least 2 hours Peppermint May cause premature dissolution of enteric-coated peppermint oil oil Yarrow May ↓ the action of H2 blockers Hepatotoxic agents Black root Avoid concurrent use May lead to ↑ hepatotoxicity Borage HMG-CoA reductase inhibitors Coenzyme HMG-CoA reductase inhibitors may ↓ the action of coenzyme Q10 Q10 and deplete endogenous stores; avoid concurrent use May ↓ the action of HMG-CoA reductase inhibitors Lavender Male fern May cause hepatotoxicity if used together; avoid concurrent use Monascus May ↑ adverse reactions Hormone replacement therapy Alfalfa May interfere with hormonal replacement therapy May alter the effects of other hormone replacement therapies Black cohosh DHEA May interfere with estrogen and androgen therapy; avoid concurrent use Hormones (animal) Cat’s claw May interact with hormones made from animal products; avoid concurrent use Continued APPENDIX B Appendix B Drug/Herb Interactions 635 636 Appendix B Drug/Herb Interactions Drug/Drug Classes—cont’d Herb Interaction Hypoglycemics, oral Bitter melon May ↑ effects of oral hypoglycemics Immunomodulators Echinacea May ↓ the effects of immunosuppressants; should not be used immediately before, during, or after transplant surgery Immunostimulants Cat’s claw Avoid concurrent use Immunosuppressants Acidophilus Avoid concurrent use May ↓ action of immunosuppressants Andrographis Astragalus May interfere with immunosuppressant therapy Bitter orange Can inhibit cytochrome P450 3A4 and ↑ drug levels Cat’s claw Will ↓ immunosuppressant therapy; avoid concurrent use Ginseng May diminish the effect of immunosuppressants; do not use before, during, or after transplant surgery Maitake May ↓ effects of immunosuppressants; do not use immediately before, during, or after transplant surgery. Melatonin May ↓ response to immunosuppressants Mistletoe, May stimulate immunity; avoid concurrent use European Morinda May ↓ effects of immunosuppressants Saw palmetto May ↑ or ↓ immunostimulant effects; avoid concurrent use Schisandra May ↓ effectiveness of immunosuppressants, avoid use before, during, or after transplant surgery Skullcap May ↓ effects of immunosuppressants; avoid concurrent use St. John’s wort Rejection of transplanted hearts has occurred when taken PO with cyclosporine; other immunosuppressants may have same interaction in this and other transplants Thymus Should not be used concurrently unless the extract is certified to Extract be pathogen free Turmeric May ↓ effectiveness of immunosuppressants; avoid concurrent use Insulin Alfalfa May potentiate hypoglycemic action; use cautiously May ↑ hypoglycemic effects; avoid concurrent use Basil Bay May ↑ hypoglycemic effects; avoid concurrent use Bee pollen ↓ effectiveness of insulin, ↑ hyperglycemia; avoid concurrent use Bilberry May significantly ↓ blood sugar levels; monitor carefully Cat’s claw May interact with insulin; avoid concurrent use Dandelion May ↑ the effects of insulin; avoid concurrent use Eucalyptus May alter the effectiveness of insulin; avoid concurrent use Garlic Because of garlic’s hypoglycemic effects, insulin dosages may need to be adjusted Ginseng May ↑ the hypoglycemic effects of insulin; avoid concurrent use Glucomannan May ↑ the hypoglycemic effects of insulin Drug/Drug Classes—cont’d Herb Interaction Guar gum May delay glucose absorption when used concurrently; insulin dose may need to be ↓ Interferon Astragalus Interleukin-2 Astragalus Ipecac Iron Anise Bilberry Chromium Rose hips Sorrel Yellow dock Iron salts Artichoke Black catechu Condurango Elderberry Eyebright Gentian Ground ivy Hawthorn Hops Horehound Horse chestnut Lady’s mantle Lavender Lemon balm Marshmallow Meadowsweet Mistletoe, European Motherwort Nettle Oak Plantain Poplar Prickly ash Raspberry Sage Slippery elm Squill May prevent or shorten upper respiratory infections May ↑ or ↓ effect of drugs such as interleukin-2 May ↓ laxative effects of mayapple; avoid concurrent use May ↑ action of iron; avoid concurrent use Interferes with iron absorption; avoid concurrent use ↓ chromium absorption when taken concurrently ↑ oral iron absorption May ↓ iron absorption May ↓ absorption of iron; space by 2 hours May interfere with the absorption of iron salts Forms an insoluble complex; avoid concurrent use Iron absorption may be ↓; avoid concurrent use Tea may prevent absorption of iron salts; space by at least 2 hours Tea may interfere with absorption of iron salts; space by at least 2 hours May interfere with absorption of iron salts; space by at least 2 hours May ↓ absorption of iron salts; avoid concurrent use May ↓ absorption of iron salts; space by at least 2 hours ↓ absorption of iron salts; space by at least 2 hours ↓ absorption of iron salts; space by 2 hours ↓ absorption of iron salts; space by 2 hours ↓ absorption of iron salts; space by 2 hours ↓ absorption of iron salts; space by 2 hours ↓ absorption of iron salts; space by 2 hours May ↓ absorption of iron salts; space by 2 hours May ↓ absorption of iron salts; space by 2 hours May ↓ absorption of iron salts; space by 2 hours May ↓ absorption of iron salts; space by 2 hours May interfere with absorption of iron salts May ↓ absorption of iron salts May ↓ absorption of iron salts May ↓ absorption of iron salts; space by 2 hours May ↓ absorption of iron salts; space by 2 hours Raspberry tea may ↓ absorption of iron salts May ↓ absorption of iron salts; space by 2 hours May ↓ absorption of iron salts; space by 2 hours May ↓ absorption of iron salts; space by 2 hours Continued APPENDIX B Appendix B Drug/Herb Interactions 637 638 Appendix B Drug/Herb Interactions Drug/Drug Classes—cont’d Herb Valerian Witch hazel Yarrow Isoproterenol Rauwolfia Kanamycin Siberian ginseng Laxatives Bogbean Castor Flax Senna Squill Letrozole DHEA Levodopa Octacosanol Rauwolfia Lithium Coffee Cola tree Dandelion Golden rod Horsetail Juniper Nettle Parsley Plantain Lovastatin Pectin Magnesium Melatonin Quinine Raspberry MAOIs Betel palm Bitter orange Broom, scotch Cacao tree Capsicum Chaparral Interaction May interfere with absorption of iron salts; space by 2 hours May ↓ absorption of iron salts; space by 2 hours May ↓ absorption of iron salts; space by 2 hours May cause ↓ pressor effects; avoid concurrent use May ↑ action of kanamycin May ↑ effect of laxatives May lead to electrolyte imbalances May ↑ the action of laxatives Additive effect can occur; avoid concurrent use May ↑ effects of laxatives; avoid concurrent use Do not take together; DHEA is a potent estrogen agonist May cause dyskinesia when used with carbidopa/levodopa; avoid concurrent use ↓ effect of levodopa, with ↑ extrapyramidal motor symptoms; avoid concurrent use ↓ levels of lithium May ↓ the effect of cola tree products Toxicity may occur if used concurrently May result in dehydration and lithium toxicity; avoid concurrent use May cause dehydration and lithium toxicity Dehydration and lithium toxicity May result in dehydration, lithium toxicity May lead to dehydration, lithium toxicity May ↓ effects of lithium; avoid concurrent use Can interfere with absorption of lovastatin ↑ inhibition of N-methyl-D-aspartate receptors; avoid concurrent use May cause ↓ absorption of quinine; space by 3 hours Raspberry tea may ↓ absorption of magnesium May ↑ chance of hypertensive crisis Concurrent use may ↑ blood pressure May cause hypertensive crisis; avoid concurrent use May ↑ the vasopressor effect of MAOIs; avoid concurrent use May precipitate hypertensive crisis; avoid concurrent use May ↓ effect of MAOIs Drug/Drug Classes—cont’d Herb Interaction Coffee Large amounts of coffee should be avoided; hypertensive reactions may occur May ↑ blood pressure when used with phenelzine and tranylcypromine Hypertensive crisis can occur when used concurrently; avoid concurrent use Hypertensive crisis may occur; avoid concurrent use Action may be ↑; avoid concurrent use May result in manic-like syndrome Large amounts of green tea taken concurrently with MAOIs can cause hypertensive crisis; avoid concurrent use Large amounts of guarana taken with MAOIs can result in hypertensive crisis; avoid concurrent use ↑ anticholinergic effects ↑ action of MAOIs May ↑ cardiac effects; avoid concurrent use Cola tree Ephedra Galanthamine Ginkgo Ginseng Green tea Guarana Jimsonweed Khat Night-blooming cereus Nutmeg Parsley Poppy Rauwolfia SAM-e St. John’s wort Valerian Methyldopa Capsicum May potentiate MAOIs; avoid concurrent use When used with tricyclics or SSRIs may lead to serotonin syndrome; avoid concurrent use May ↑ the action of MAOIs May cause excitation and/or hypertension; avoid concurrent use May lead to hypertensive crisis; avoid concurrent use May ↑ MAO inhibition; avoid concurrent use May negate therapeutic effects of MAOIs; avoid concurrent use May ↓ the antihypertensive effects of methyldopa; avoid concurrent use Minerals Allspice May interfere with absorption of minerals; avoid concurrent use May ↓ the absorption of minerals; space by 2 hours or more Chitosan Pipsissewa Should be taken 2 hours before or after pipsissewa Morphine Oats May ↓ effect of morphine; avoid concurrent use Nephrotoxics Creatine May lead to nephrotoxicity Neuroleptics Betel palm May cause extrapyramidal symptoms; avoid concurrent use Neuromuscular blockers Quinine May ↑ action of neuromuscular blockers; avoid concurrent use Nicotine Blue cohosh ↑ the effects of nicotine; may cause toxicity; avoid concurrent use Lobelia ↑ effects of nicotine-containing products; avoid concurrent use May ↓ hypertensive effects of nicotine Oats Continued APPENDIX B Appendix B Drug/Herb Interactions 639 640 Appendix B Drug/Herb Interactions Drug/Drug Classes—cont’d Herb NNRTIs Garlic St. John’s wort Norepinephrine Rauwolfia NSAIDs Arginine Bearberry Bilberry Bogbean Chondroitin Dandelion Feverfew Creatine Fenugreek Garlic Gossypol Saw palmetto St. John’s wort Turmeric NSAIDs, topical Jaborandi Opioids Bay Corkwood Jamaican dogwood Lavender Meadowsweet Parsley Oxytocics Ephedra Paroxetine St. John’s wort Phenothiazines Blue cohosh Coenzyme Q10 Corkwood Ephedra Interaction Garlic with allicin may ↓ the action of NNRTIs St. John’s wort taken PO with NNRTIs may ↓ the antiretroviral action of the drug May cause ↓ pressor effects; avoid concurrent use May cause gastric irritation May ↑ effect of NSAIDs May ↑ action of NSAIDs May ↑ risk of bleeding; avoid concurrent use Can cause ↑ bleeding, avoid high doses of chondroitin May ↑ bleeding when used with NSAIDs NSAIDs may ↓ action of feverfew May lead to nephrotoxicity ↑ risk of bleeding when used concurrently with NSAIDs May ↑ bleeding; avoid concurrent use May result in gastrointestinal distress and gastrointestinal tissue damage May lead to ↑ bleeding time; avoid concurrent use May lead to severe photosensitivity; avoid concurrent use May result in ↑ risk of bleeding; avoid concurrent use ↓ Jaborandi action; avoid concurrent use May ↑ the action of opioids; avoid concurrent use May ↑ anticholinergic effect ↑ effects of opioids; avoid concurrent use ↑ sedation when used with lavender; avoid concurrent use May ↑ the action of opioids May cause serotonin syndrome; avoid concurrent use Causes severe hypertension when used with oxytocics; avoid concurrent use ↑ sedation Metabolism of blue cohosh may be ↓ Some phenothiazines may ↓ the action of coenzyme Q10 and deplete endogenous stores; avoid concurrent use May ↑ anticholinergic effect Tachycardia may result; avoid concurrent use Appendix B Drug/Herb Interactions 641 Herb Evening primrose oil Jimsonweed Yohimbe Phenytoin Black pepper Valerian APPENDIX B Drug/Drug Classes—cont’d Interaction May cause seizures; avoid concurrent use ↓ action of phenothiazines May result in ↑ toxicity; avoid concurrent use With dilantin, black pepper speeds absorption and slows elimination of phenytoin May negate therapeutic effects of medicines containing phenytoin; avoid concurrent use Plasma, fresh Cat’s claw May interact with fresh plasma; avoid concurrent use Potassium Kelp May lead to hypokalemia Potassium-wasting drugs Aloe Internal use may ↑ effects of potassium-wasting drugs Propranolol Black pepper Speeds absorption and ↑ effect of propranolol Can lead to ↑ action of propranolol Guggul Proton pump inhibitors Angelica May ↑ stomach acid, which may ↓ drug action Beta-carotene ↓ by proton pump inhibitors Bogbean ↓ effect of proton pump inhibitors May ↓ the action of proton pump inhibitors Dandelion Devil’s claw May ↓ the action of proton pump inhibitors Male fern May ↓ the action of male fern, separate by at least 2 hours Peppermint May cause premature dissolution of enteric-coated peppermint oil oil Yarrow May ↓ the action of proton pump inhibitors Psychoanaleptic agents Cola tree May ↑ the effects of psychoanaleptic agents Psychotropic agents Nutmeg May potentiate psychotropic agents; avoid concurrent use Salicylates Arginine May cause gastric irritation May ↑ risk of bleeding Blue flag Borage May ↑ risk of bleeding Chaparral May ↑ action of salicylates Chondroitin Can cause ↑ bleeding; avoid high doses of chondroitin Cloves May ↑ effect of salicylates Cola tree May ↑ the effect of cola tree products Dandelion May ↑ bleeding when used with salicylates Garlic May ↑ bleeding; avoid concurrent use Ginkgo ↑ risk of bleeding; avoid concurrent use Continued 642 Appendix B Drug/Herb Interactions Drug/Drug Classes—cont’d Herb Ginseng Gossypol Horse chestnut Irish moss Pansy Rose hips Scopolamine Black root Interaction May ↓ action of salicylates May result in tissue damage ↑ risk of severe bleeding; avoid concurrent use ↑ risk of bleeding; avoid concurrent use May ↑ actions of salicylates Can ↓ urinary excretion of salicylates Forms an insoluble complex with scopolamine; avoid concurrent use Sedatives/hypnotics Black cohosh May ↑ hypotensive effects; avoid concurrent use Effects may be ↓ Blue flag Cowslip May ↑ the effect of sedatives/hypnotics; avoid concurrent use Lavender ↑ sedation when used with lavender; avoid concurrent use Sodium bicarbonate Quinine May lead to toxicity; avoid concurrent use SSRIs Bitter orange Can inhibit cytochrome P450 3A4 and ↑ drug levels Often used to reverse side effects of SSRIs Ginkgo St. John’s wort Serotonin syndrome and an additive effect may occur; may lead to coma; avoid concurrent use Yohimbe May cause ↑ CNS stimulation; avoid concurrent use Statins Goldenseal May slow the metabolism of statins; avoid concurrent use Stimulants Bogbean May ↑ effect of stimulants Overstimulation may occur; avoid concurrent use Ginseng Siberian Overstimulation may occur; avoid concurrent use ginseng Succinylcholine Melatonin ↑ blocking properties of succinylcholine; avoid concurrent use Sulfonamides St. John’s wort May lead to severe photosensitivity; avoid concurrent use Sulfonylureas St. John’s wort May lead to severe photosensitivity; avoid concurrent use Sumatriptan Horehound ↑ serotonin effect; avoid concurrent use Sympathomimetics Ephedra ↑ the effect of sympathomimetics and causes hypertension; avoid concurrent use Will ↑ blood pressure; avoid concurrent use Rauwolfia Yohimbe May result in ↑ toxicity; avoid concurrent use Drug/Drug Classes—cont’d Herb Interaction Systemic steroids Aloe Internal use may ↑ effects of systemic steroids Tamoxifen Black cohosh May augment the antiproliferative properties of tamoxifen Do not take together; DHEA is a potent estrogen agonist DHEA Soy May interfere with tamoxifen absorption; avoid concurrent use Tannic acids Agar ↑ dehydration; avoid concurrent use Tetracyclines Blue cohosh May ↑ metabolism, ↓ effect of tetracyclines Lily of the May lead to cardiac glycoside toxicity valley Can interfere with absorption of tetracyclines Pectin St. John’s wort May lead to severe photosensitivity; avoid concurrent use Theophylline Black pepper ↑ absorption of theophylline May ↓ metabolism of xanthines Cacao tree Thiazides Aloe Internal use may ↑ effects of thiazides Thyroid hormones Carnitine May inhibit the effects of thyroid hormone replacement; avoid concurrent use May alter the action of thyroid hormones Guggul Kelpware May ↓ effects of thyroid hormones; avoid concurrent use Soy May interfere with thyroid hormone absorption; avoid concurrent use Thyroid hormone replacement Kelp May interfere with thyroid hormone Thyroid preparations Agar Avoid concurrent use because of high iodine content in agar Can interfere with the action of thyroid preparations; avoid Bugleweed concurrent use Thyroid replacement Celery May ↓ the effect of thyroid replacement Tolbutamide Angelica May delay elimination of tolbutamide; avoid concurrent use Trazadone Ginkgo May cause coma May cause serotonin syndrome St. John’s wort Tricyclic antidepressants Coenzyme Tricyclic antidepressants may ↓ the action of coenzyme Q10 and deplete endogenous stores; avoid concurrent use Q10 Corkwood May ↑ anticholinergic effect Continued APPENDIX B Appendix B Drug/Herb Interactions 643 644 Appendix B Drug/Herb Interactions Drug/Drug Classes—cont’d Herb Interaction Ephedra Hypertensive crisis can occur; avoid concurrent use Jimsonweed ↑ anticholinergic effects when jimsonweed is used with tricyclics St. John’s wort May cause serotonin syndrome Yohimbe May result in ↑ hypertension, doses may need to be ↓ Urinary alkalizers Ephedra ↑ the effect of urinary alkalizers Urine acidifiers Bearberry May inactivate bearberry; avoid concurrent use Vaccines (passive) Cat’s claw May interact with passive vaccines composed of animal sera, avoid concurrent use Valproic acid Carnitine Valproic acid can induce L-carnitine deficiency Vitamin B Goldenseal May ↓ absorption of vitamin B Vitamins, fat-soluble Chitosan May ↓ the absorption of fat-soluble vitamins; space by 2 hours or more Vitamin K Pau D’arco Use with phytonadione may cause prolongation of pro-time Warfarin Acidophilus ↓ warfarin action May ↑ prothrombin time and prolong bleeding Alfalfa Angelica May ↑ prothrombin time and prolong bleeding; avoid concurrent use Anise May ↑ action of warfarin; avoid concurrent use Cranberry May ↑ the INR and ↑ risk of bleeding Devil’s claw May cause risk of bleeding Dong quai May ↑ the effects of warfarin Valerian May negate therapeutic effects of warfarin; avoid concurrent use Xanthines Cacao tree May ↓ the metabolism and thereby ↑ levels of xanthines such as theophylline; avoid concurrent use Large amounts of coffee ↑ the action of xanthines such as Coffee theophylline Cola tree May ↑ the action of xanthines; avoid concurrent use Ephedra Causes ↑ central nervous system stimulation; avoid concurrent use Green tea Large amounts of green tea ↑ the action of xanthines Guarana May ↑ pulse rate, blood pressure, and arrhythmias; avoid concurrent use Siberian Overstimulation may occur; avoid concurrent use ginseng Drug/Drug Classes—cont’d Herb Zinc Black catechu Chromium Melatonin Sorrel Yellow dock Interaction Form an insoluble complex; avoid concurrent use ↓ chromium absorption when taken concurrently ↑ inhibition of NMDA receptors; avoid concurrent use May ↓ zinc absorption Tea may ↓ the absorption of zinc APPENDIX B Appendix B Drug/Herb Interactions 645 APPENDIX C Pediatric Herbal Use General Precautions Because childproof packaging is not required for herbs, be sure to store them out of children’s reach. Although herbs have commonly been combined for use, the synergistic effects of multiple herbs—potentially positive as well as negative—are only beginning to be studied (Williamson, 2001; Goldman, 2008). Use of alternative and complementary therapies in children and adolescents is increasing. Be sure to inquire specifically about herb and supplement ingestion when caring for children (Gardiner, 2004; Trigazis, 2004; Martel, 2005; Shakeel, 2007; Post-White, 2009). Dosage Guidelines Start with the lowest dose in the range and work up. Frequency and consistency: 1 large dose per day is not as effective as 3-4 small doses. Tea Dosage Guidelines* Age of Child Dosage ⬍1 yrs 1-2 yrs 3-6 yrs 7-11 yrs 12 yrs-adult 1 tsp daily, working up to 1 tsp tid 1 oz-1⁄4 cup daily, working up to 1⁄4 cup tid 1 1 ⁄4- ⁄2 cup daily, working up to tid Up to 6 oz daily, working up to tid-qid 1 cup daily, working up to tid-qid *(Kemper, 1996; White, 1998; Scott, 2003) How to Make Herbal Teas (Kemper, 1996; Scott, 2003; White, 1998, Romm, 2003; McIntyre, 2005) • 1 cup boiling water • 1 tsp dried or 2-3 tsp fresh leaves, stems, or flowers Steep together 3-5 min in a covered pot; strain; serve the liquid tea when temperature is appropriate. Tincture Dosage Guidelines* Age of Child Dosage ⱕ2 yrs 3-6 yrs 7-11 yrs 12 yrs-adult Not recommended for use 2-10 drops in 1⁄4 cup water daily, working up to tid 10-20 drops in 6 oz water daily, working up to tid-qid 20-50 drops up to tid-qid *(White, 1998; Scott, 2003) 646 How to Make Herbal Decoctions (Kemper, 1996; Scott, 2003; White, 1998; McIntyre, 2005) • 2 tsp dried herb or up to 6 tsp fresh herb • 2 cups water Combine and simmer gently 5-15 min; strain; cool before serving the liquid. Decoction dose guidelines are listed with each herb. Acidophilus Uses Prevention of diarrhea and stunted growth (Saran, 2002) after antibiotics or antimicrobial herbs, treatment of oral thrush through competitive inhibition, colic (Gladstar, 2001), treatment of diarrhea (Elmer, 2001; Gaon, 2003; Fox, 2004; Salazar-Lindo, 2007) Precautions Be sure no lactose intolerance or allergy exists before prescribing yogurt. Do not give in the presence of high fever. Dosage/Administration • Acidophilus supplements: follow directions on product label (Zand, 2003) • Yogurt with live active cultures: use topically after each feeding in infants • 1⁄4 tsp 4-5 times/day for colic (Gladstar, 2001) • Diarrhea prevention (Chou, 2004; Fox, 2004): 50 ml curd containing Lactobacillus acidophilus daily (Saran 2002) • For Clostridium difficile: PO 5-10 billion live Lactobacillus GG in rehydrating solution Aloe Uses Topical treatment of minor burns, sunburn, cuts, abrasions, insect bites, acne, poison ivy, frostbite, itching of chicken pox (Vessey, 2001). Not recommended for internal use in children. Decreased bowel transit time reduces absorption of other medications (Gardiner, 2000). Research/Future Possibilities Changes in chemical composition of urine after aloe gel consumption show potential for preventing kidney-stone formation among children (Kirdpon, 2006). Precautions For external use only in children ⬍12 yrs Dosage/Administration • Topical: break off leaf, split lengthwise, apply gel to affected skin (White, 1998) Angelica Archangelica Uses Relaxing expectorant, diaphoretic, carminative, diuretic Precautions Avoid during pregnancy. Dosage/Administration • Tea: Simmer 1 tablespoon of root pieces in 2 cups of boiling water for 15 minutes. Cover while simmering. Take 1 tablespoon to 1⁄2 cup up to every 4 hours. (Romm, 2003) • Tincture: 10-40 drops up to every 4 hours. (Romm, 2003) APPENDIX C Appendix C Pediatric Herbal Use 647 648 Appendix C Pediatric Herbal Use Anise Uses Cough, expectorant, colic Research Anise oil exhibited a high level of antiviral activity against acyclovir-sensitive herpes simplex virus type 1 (Koch, 2008). Precautions Do not give the essential oil to children. Dosage/Administration • Decoct 1 tsp seed in 1 cup water; strain and serve several times/day. (White, 1998) • Tea: PO: 1⁄2-3 cups daily (Romm, 2003) • Tincture: 5 drops up to 4 times in 1 hour for colic; 1⁄4-1⁄2 tsp up to every 4 hours (Romm, 2003) Astragalus Uses Immune system support Precautions Do not use during fevers; use only Astragalus membranaceus sp.; do not use wild species of American astragalus. Dosage/Administration • Capsules/extract: follow package directions • Cooked: drop 1 stick of herb into cooking pot when making soup or cooked grains • Tea: use 1 stick of herb decocted in 1 cup water (White, 1998); see tea dosage guidelines • Tincture: 1⁄2-1 tsp 2-3 times/day (Romm, 2003) Barberry Uses Nausea, diarrhea, mucous conditions such as coughs Precautions At first, barberry increases the amount of mucus being expelled, so start with small doses; do not take for more than 10 days at a time because extended consumption may decrease B-vitamin absorption and utilization; do not give barberry if the child has high blood pressure. Dosage/Administration • Extract (strength of 1:1): use 1⁄8 tsp in 4 oz water, sipped slowly over an hour (Kemper, 1996) • Tincture (strength of 1:5): use 2-3 drops in 4 oz water, sipped slowly over an hour (Kemper, 1996) Benzoin Uses Topically as an antiseptic; as an inhalant and expectorant for bronchial disorders Precautions Allergy to benzoin can develop and cross-react with Mastisol; discontinue use if any hypersensitivity reactions occur (James, 1984). Dosage/Administration • Inhalant: 5 ml benzoin gum/1 pt water; breathe vapors • Topical: apply to affected area every 2-4 hrs; test a small area before applying to larger one Black Haw Uses Relieves muscle cramps or spasms, including irritable bladder muscles; menstrual pain Precautions Do not use if history of kidney stones or kidney disease Dosage/Administration • Capsule/decoction: for a 50-lb child (age approx 7 yrs) use 1⁄2 capsule or 1⁄2 cup decoction up to qid (White, 1998) • Cream: apply topically to relieve muscle cramps (Ody, 1993) • Tea: see tea dosage guidelines (White, 1998) Boneset Uses Colds and flu, to promote sweating, expectorant, antispasmodic Precautions High doses can cause vomiting; not for children ⬍1 yr; do not administer for longer than 7 days; can cause contact dermatitis in those hypersensitive to Asteraceae (Brinker, 1998) Dosage/Administration • Tea: 3⁄4 cup for 40-lb child, tid up to 3 days; adjust quantity by weight of child; better too little than too much (White, 1998); see tea dosage guidelines Burdock Uses Skin irritations, eczema, psoriasis Precautions Insulin dose may need to be adjusted because of hypoglycemic effect of burdock (Brinker, 1998); commercial sample may be adulterated with belladonna; do not give for longer than 2 wks; take a 1-wk break after a 2-wk regimen. Dosage/Administration • Capsule/tea: 1 capsule/day or 1 cup tea /day for a 50-lb child (White, 1998); see tea dosage guidelines • Tincture: 1⁄4-1⁄2 tsp up to 4 times/day (Romm, 2003) Catnip Uses Colic, relaxes spasms and cramps, clears flatulence, sleeplessness, minor fevers Precautions None known when using a reasonable amount (Vessey, 2001); there is a potential additive effect with drugs that sedate, such as anticonvulsants, antianxiety medications, and tricyclic antidepressants (Harkness, 2001). APPENDIX C Appendix C Pediatric Herbal Use 649 650 Appendix C Pediatric Herbal Use Dosage/Administration • Tea (internal): nursing mothers can take adult dose to ease baby’s colic; a few oz daily for infants—can give in dropper alongside nipple—or 1 fluid oz before each feeding (McIntyre, 2005); 1 cup daily for toddlers; see tea dosage guidelines for older children (White, 1998) • Tincture: 10-30 drops up to 4 times/day (Romm, 2003) Chamomile Uses Anxiety, teething, upset stomach, muscle and digestive spasms, nausea, colic Research Although the study had a very small sample size, the authors found that chamomile (specifically, Matricaria chamomilla) improved some symptoms of attention-deficit hyperactivity disorder (Niederhofer, 2008). Chamomile oil was highly active against clinically relevant acyclovir-resistant herpes simplex virus, type 1 strains (Koch, 2008). An apple pectin-chamomile extract shortened the course of diarrhea in children (Becker, 2006). Precautions Avoid if allergic to daisy family (Asteraceae), including ragweed; anaphylaxis to chamomile is well known (Subiza, 1989; Reider, 2000); to avoid contamination, use only commercial preparations. NOTE: Filling up infant on tea leaves less room for milk. Do not substitute tea for milk or formula! Dosage/Administration (Balch, 2002; Kemper, 1996; Scott, 2003; White, 1998) • Capsule: 1⁄2 capsule tid for 50-lb child • Tincture: follow package directions or 10-30 drops, up to qid (Romm, 2003) • Tea: infant: 1-3 tsp/day; toddler: 1⁄2 cup/day; 50-lb child: 1 cup tea or 1 dropperful extract/day • Tea: colic: start slowly at 1 oz/day; watch for side effects before increasing to 3-4 oz/day • Topically as a wash or salve Dandelion Uses Internal: diuretic (bladder irritations), mild laxative, increases bile secretion (liver disorders) External: warts (White, 1998), acne Precautions Do not use in children with acute gall bladder problems. Do not give to children allergic to the Asteraceae (formerly called Compositae) species (such as chamomile, yarrow root). Dosage/Administration Fresh greens as a vegetable in season, can be steamed, or steamed and marinated • Root tea: 1⁄4-1 cup daily or as a skin wash for acne (Romm, 2000) • Tincture: 10-15 drops 2-3 times daily (Romm, 2003) • Dandelion juice for warts: squeeze white juice from stems directly on wart several times/day for several weeks (White, 1998; McIntyre, 2005) Echinacea Uses Immune system support, childhood fevers, respiratory tract infections (Cohen, 2004), colds (refuted by Barrett, 2004, although echinacea decreased the risk of subsequent colds [Weber, 2005]), flu, sore throats and coughs; externally for wounds, eczema, chicken pox/herpes Research Echinacea tincture stimulated T cells within 24 hours of ingestion (Brush, 2006). Precautions Not for use during immune disorders such as lupus, tuberculosis, multiple sclerosis, or HIV infection (Brinker, 1998; Vessey, 2001); rarely, patients with asthma, eczema, or hay fever have shown allergic reactions; not for children with allergy to daisy family (Asteraceae); limit use to 10 days at a time, then take a 5-day break; for eczema (external use), take only a 2-day break. Do not give to children younger than 2 years of age. Dosage/Administration • Capsule/glycerite/tincture: 50-lb child: 1 dropperful glycerite or tincture; 1 capsule (White, 1998) • Tincture: 1⁄2 tsp bid to prevent colds and infections; for acute infections 1⁄2-1 tsp as often as every 2 hours (Romm, 2000); range from 1 drop/ 5 lbs body weight to 1 drop/ 1 lb body weight, depending on the condition’s severity (Romm, 2003) • For acute infections, 1⁄4-1⁄2 tsp. every 2 hours; for chronic infections, 3 times/day (McIntyre, 2005) • For skin infections, make a topical tincture of 1 teaspoon per 1⁄4 cup water to use as a rinse (Romm, 2003) • Tea: See tea dosage guidelines Elderberry Uses Fevers, stimulate the immune system, antiviral, flu, infections, asthma Precautions Use only blue-black elderberries; the red ones are toxic. Do NOT ingest the stem because of its cyanide content; do not use the leaves, roots, or bark internally. Only use cooked berries. Uncooked berries can cause nausea and vomiting. Large doses of elderberry juice can cause diarrhea. Dosage/Administration • Tea: 1⁄2-1 cup up to qid, taken hot. • Prepared Syrup: 1-2 tablespoons/day or 1-2 tsp up to tid. To make syrup, use 1 cup fresh or 1⁄2 cup dried elderberries, 3 cups water and 1 cup honey. Boil the berries in water, reduce heat and simmer 30-45 minutes. Smash the berries, strain them and add the honey to the strained liquid. Bottle and store in the refrigerator up to 2-3 months (Gladstar, 2001). • Tincture: 1⁄4-1 tsp up to 3 times/day (Romm, 2003) Eucalyptus Uses Decongestant for coughs and chest infections APPENDIX C Appendix C Pediatric Herbal Use 651 652 Appendix C Pediatric Herbal Use Precautions Essential oil is not for internal use (Burkhard, 1999); internal use may cause seizures (Gouin, 1996); child must be 2 yrs of age to use eucalyptus; do not apply to face of small children (Basch, 2005); not for patients with liver, gallbladder, or digestive diseases. Topical poisoning, although rare, has been reported (Darben, 1998) Dosage/Administration • Chest rub: dilute 0.5-2 ml eucalyptus oil in 25 ml almond oil (Ody, 1993); apply to chest or 1 drop per 5 ml sesame oil (McIntyre, 2005) Evening Primrose Oil Uses Eczema and atopic dermatitis (Yoon, 2002; Senapati, 2008), PMS, mastalgia, ADHD (Vessey, 2001), ADHD with borderline zinc deficiency (Arnold, 2000) Precautions May trigger temporal lobe epilepsy, especially in schizophrenics receiving phenothiazines; side effects include nausea, stomach pain, and headache. Do not give to children who have a seizure disorder. Dosage/Administration • Eczema: 1-2 g/day from capsules (Ody, 1993), but not greater than 0.5 g/kg body weight daily (Basch, 2005) • Mastalgia: 3-4 g/day (1 g tid-qid) from capsules (Integrative Medicine, 2000) • PMS: 3 g/day (1 g tid) from capsules (Integrative Medicine, 2000) Fennel Uses Upset stomach, gas, colic, cramps from diarrhea, to promote milk flow in nursing mothers Precautions Large doses may cause nausea, vomiting, and skin irritation; essential oil is not for infants or small children (Burkhard, 1999; Brinker, 1998). Long-term use may cause premature thelarche in children younger than 2 years (Türkyilmaz, 2008). Food allergy has been reported, although it is rare (Moneret-Vautrin, 2002; Mills, 2005). NOTE: Filling up infant on tea leaves less room for milk. Do not substitute tea for milk or formula! Dosage/Administration • Infant colic: 3-4 oz tea/day (Kemper, 1996) • Other conditions: See tea dosage guidelines Garlic Uses Respiratory infections, ear infections Research/Future Possibilities Garlic may increase oxygenation and improve dyspnea in children with hepatopulmonary syndrome (Najafi Sani, 2006). Garlic cloves have been used to eliminate warts, but caution is advised to avoid contact dermatitis (Silverberg, 2002). Constituents in garlic exhibit anticancer actions (Powolny, 2008). Precautions Large quantities can irritate mouth or stomach (Brinker, 1998); use sparingly for children younger than 2 years of age. May interact with drugs used to alter platelet function and coagulation (Tomassoni, 2001; Harkness, 2000). CAUTION: Topical application can result in garlic skin burns (Parish, 1987; Rafaat, 2000). Dosage/Administration • Cooked: children can eat rice or other foods flavored with garlic or can eat 1 ⁄2-3 cloves daily • Garlic oil: a 50-lb child can take 1⁄2 capsule garlic oil several times a day with food (White, 1998) • Tea: see tea dosage guidelines; up to 4 cups daily can be used during colds • Syrup: 1⁄2-1 tsp/day (Romm, 2003) • Supplements: per package dosages NOTE: Nurslings spent more time at the breast when mothers who didn’t usually consume garlic did so (Menella, 1993) Ginger Uses Nausea, motion sickness, vomiting (Langner, 1998; Quimby, 2007), digestive cramping, stomach upsets, muscle aches, menstrual cramps, headaches Research Helicobacter pylori, recognized as a primary etiologic factor in the development of gastritis and peptic ulcer disease, was susceptible in vitro to methanol extract of ginger (Mahady, 2005). Precautions Do not use during childhood fevers or in children with gallstones; in large doses over long periods, ginger can cause inflammation and weakness. Although a theoretical additive effect to warfarin has not been investigated in humans, it may be best to avoid this combination. Dosage/Administration • Fresh herb/extract/capsule: grate fresh ginger into teas or follow package directions for extract or capsule (White, 1998) • Ginger root: ⬍3 yrs: 25 mg qid; 3-6 yrs: 50-75 mg qid; 7-11 yrs: 125 mg qid; ⱕ12 yrs: 250 mg qid (Kemper, 1996) • Tea: 2 slices ginger in 1 cup water (Kemper, 1996); see tea dosage guidelines • Tincture: 5-25 drops in water up to 4 times/day (Romm, 2003) Hops Uses Restlessness, hyperactivity, insomnia, headaches, pain Research/Future Possibilities See lemon balm. Precautions Not for those with estrogen-dependent disorders; not appropriate in children with bedwetting, lethargy, or depression; not for long-term use; may cause skin irritation. There is a potential additive effect with drugs that sedate, such as anticonvulsants, antianxiety medications, and tricyclic antidepressants (Harkness, 2001). APPENDIX C Appendix C Pediatric Herbal Use 653 654 Appendix C Pediatric Herbal Use Dosage/Administration • Bath: add a few drops of oil or dried herbs in a stocking to bath water (Kemper, 1996) • Tea: See tea dosage guidelines Hyssop Uses Coughing, colds and flu, chronic phlegm Research/Future Possibilities Muscle-relaxing activity of the essential oil has been shown on guinea pig and rabbit intestine (Lu, 2002) Precautions Do not give to children ⬍2 yrs of age; use essential oil in very small quantities only for children. Dosage/Administration • Tea: can be combined with lemongrass and elderberry as tea to treat childhood fevers (White, 1998); see tea dosage guidelines Juniper Uses Diuretic, upset stomach, menstrual pain, urinary tract infection Precautions Do not give to children ⬍2 yrs of age; contraindicated for those with kidney infection and inflammation (Brinker, 1998); do not use longer than 4 wks because of potential kidney damage. Dosage/Administration • Menstrual pain: use a weak tea of 15 g berries in 500 ml water (Ody, 1993) • Urinary tract infection: PO berry juice: dilute in water • Other conditions: see tea dosage guidelines Lemon Balm Uses Nervousness, anxiety, hyperactivity, sleep disorders (Müller, 2006), irritability, tension, antiviral Research/Future Possibilities Administration of lemon balm quelled laboratory-induced stress (Kennedy, 2004). Lemon balm essential oil affected the infectivity of enveloped herpesviruses (Schnitzler, 2008); an extract of lemon balm leaves inhibited replication of herpes simlex virus type 2 (Mazzanti, 2008). Precautions There is a potential additive effect with drugs that sedate, such as anticonvulsants, antianxiety medications, and tricyclic antidepressants (Harkness, 2001). Dosage/Administration • Tea • Infants 1⁄4 cup tid • Young children up to 50 lbs: up to 5 oz tid • Older children: 1-3 cups/day • Tincture: 1⁄4-1 tsp as needed (Romm, 2003) • Cream: topically as needed • Massage oil: dilute 2-3 drops per tablespoon of carrier oil • Add a strong infusion to a warm bath (McIntyre, 2005) Lemongrass Uses Childhood fevers Precautions None identified Dosage/Administration • Tea: use in tea with hyssop and elderberry (White, 1998); see tea dosage guidelines Licorice Uses Clears mucus from chest and upper respiratory tract, soothes inflammation in digestive tract and lungs Precautions Avoid licorice if the child has high blood pressure or adrenal disease (Romm, 2003). Dosage/Administration • Tincture: 2 to 20 drops up to 4 times daily (Scott, 2003). Start with the lowest dose; if not sufficient, it may be increased. • Decoction and infusion: 1⁄3 of a teacup. To make a licorice decoction, add 1 tablespoon of chopped licorice to 2 cups of boiling water for 20-30 minutes (Romm, 2003). Lobelia Uses Expectorant, coughs, asthma Precautions Do not administer during shock or nervous prostration, low blood pressure or paralysis, or with dyspnea from heart disease (Brinker, 1998); small quantities may cause slight nausea or a tight sensation in throat; give to children ⱕ5 yrs of age only; expect expectoration! Do not use large doses. Dosage/Administration • Tea: infuse no more than 1⁄4 tsp dried herb/1 cup hot water; a 50-lb child can drink up to 1 cup tid (White, 1998); see tea dosage guidelines Nettle Uses Allergies, hay fever, colds, coughs Precautions Do not give to children ⬍2 yrs of age; do not give to those with severe allergies, especially during anaphylactic shock; excessive use may interfere with these drugs: hypoglycemics, hyperglycemics, antidiabetics, and central nervous system depressants. Contact dermatitis can occur with fresh leaf (McIntyre). APPENDIX C Appendix C Pediatric Herbal Use 655 656 Appendix C Pediatric Herbal Use Dosage/Administration • Capsule/tea: a 50-lb child can have 1⁄2 capsule/day or 1⁄2 cup tea/day to begin, increasing to tid during allergy season (White, 1998); 2 “00” size capsules 2 or 3 times daily (Romm, 2003); see tea dosage guidelines • Tincture: 1⁄4-1⁄2 tsp up to 4 times/day (Romm, 2003) • Cooked: can serve as steamed fresh greens, but be careful of the nettles; use gloves when gathering and preparing Plantain Uses Externally for bee stings, poison oak or ivy rash, chicken pox, scrapes; internally for urinary tract inflammation, respiratory inflammation, or chronic cough (Wegener, 1999) Precautions Internal use may cause nausea, vomiting, anorexia, flatus, diarrhea, bloating, or obstruction. Dosage/Administration • Tea (internal): for urinary or lung disorders, make a tea of 1⁄2 tsp dried herb; administer as often as q2h (Scott, 2003) • Topical: apply fresh poultice of leaves, or apply leaves directly Tea Tree Oil Uses Acne, athlete’s foot Research/Future Possibilities Formulations containing tea tree oil were more active than soft soap as a hygienic skin wash against Escherichia coli (Messager, 2005). Application of 100% tea tree oil may have therapeutic benefit in nickel-induced contact hypersensitivity in human skin (Pearce, 2005). Tea tree oil has been used successfully to treat warts in a pediatric patient (Millar, 2008). Precautions Oil may burn if it gets into eyes, nose, mouth, or tender areas. Do not give internally. Do not give to individuals allergic to celery or thyme because they share a potential allergen. Dosage/Administration • Dilute for use in small children: 1-2 drops per teaspoon of carrier oil, such as almond or olive (White, 1998) • 5% oil gel was used effectively on acne (Fugh-Berman, 2002) Thyme Uses Antiinflammatory, coughs, bronchitis, upper respiratory mucus, sore throats, colic Research/Future Possibilities Thyme’s essential oil has mosquito-repellent activity for hairless mice (Choi, 2002). Antifungal activity of the essential oil has been established (Pina-Vaz, 2004). Essential oils exhibit antibacterial/antimicrobial activity (Fabio, 2007). Precautions Never use essential oil internally or near eyes, nose, mouth (Mills, 2005) or sensitive mucous membranes (Romm, 2000). In large doses can cause diarrhea. One case of allergy has been reported (Benito, 1996); cross reaction occurred within the Lamiaceae family, which includes Hyssop. Dosage/Administration • Bath: for infants, add strained tea to bath water (Scott, 2003) • Chest rub: add 10 drops thyme oil diluted in 20 ml almond or sunflower oil (Ody, 1993); or 5-10 drops diluted with 2 tablespoons almond oil for topical application (Romm, 2000) • Tea: see tea dosage guidelines or use 1⁄4-1 cup up to tid • Tincture: 10 drops to 1⁄2 tsp up to tid Valerian Uses Insomnia, dyssomnia (Müller, 2006), anxiety, hyperactivity (Berdonces, 2001), attention-deficit hyperactivity disorder (Vessey, 2001), muscle or digestive cramps, flatulence, sleep difficulties in children with intellectual deficits (Francis, 2002) Precautions For some children, valerian can have a slight simulating effect—discontinue if this occurs (Gladstar, 2001). Withdrawal syndrome can occur after long-term use (Tomassoni, 2001); can be mentally habit forming; in large doses (⬎100 g daily) can cause muscle pain and heart palpitations; may be toxic to liver when used for an extended period. There is a potential additive effect with drugs that sedate, such as anticonvulsants, antianxiety medications, and tricyclic antidepressants. (Harkness, 2001) Dosage/Administration • Capsules: Follow package directions • Tea/tincture: See dosage guidelines Yarrow Uses Externally for inflammatory skin conditions such as chicken pox, poison ivy and oak rashes; internally for fever, colds, and flu (McIntyre, 2005) Research Yarrow’s antioxidant and antiinflammatory effects have been confirmed (Nemeth, 2008). The extract of yarrow exhibits a hepatoprotective effect, which may be partly attributed to its observed calcium channel blocking activity (Yaeesh, 2006). Precautions Contraindicated for children allergic to daisy family (Asteraceae) (Brinker, 1998). Dosage/Administration • Tea: See tea dosage guidelines APPENDIX C Appendix C Pediatric Herbal Use 657 658 Appendix C Pediatric Herbal Use References Arnold LE, Pinkham SM, Votolato N: Does zinc moderate essential fatty acid and amphetamine treatment of attention deficit hyperactivity disorder? J Child Adolesc Psychopharmacol 100(2):111-117, 2000. Balch PA: Prescription for Herbal Healing, Avery, New York, 2000. Barrett B: Efficacy and safety of Echinacea in treating upper respiratory tract infections in children: a randomized controlled trial. J Pediatr 145(1):135-136, 2004. Basch EM, Ulbricht CE. Natural Standard Herb & Supplement Handbook. Mosby, St. Louis, 2005. Becker B, Kuhn U, Hardewig-Budny B. Double-blind, randomized evaluation of clinical efficacy and tolerability of an apple pectin-chamomile extract in children with unspecific diarrhea. Arzneimittelforschung 56(6):387-393, 2006. Benito M, Jorro G, Morales C, Pelaez A, Fernandez A: Labiatae allergy: systemic reactions due to ingestion of oregano and thyme. Ann Allergy Asthma Immunol 76(5):416-418, 1996. Berdonces JL: Attention deficit and infantile hyperactivity, Rev Enferm 24(1):11-14, 2001. Brinker F: Herb contraindications and drug interactions, Sandy, Ore, Eclectic Medical, 1998. Brush J, Mendenhall E, Guggenheim A, et al. The effect of Echinacea purpurea, Astragalus membanaceus and Glycyrrhiza glabra on CD69 expression and immune cell activation in humans. Phytother Res 20(8):687-695, 2006. Burkhard PR, Burkhardt K, Haenggeli CA, Landis T: Plant-induced seizures: reappearance of an old problem, J Neurol 246(8):667-670, 1999. Choi WS, Park BS, Ku SK, Lee SE: Repellent activities of essential oils and monoterpenes against Culex pipiens pallens. J Am Mosq Control Assoc 18(4):348-351, 2002. Chou YK, Chen HJ, Shaio MR, Kuo YM. In vitro antibiotic susceptibility of lactobacilli isolated from commercial products containing active lactobacilli. Acta Paediatr Taiwan 45(3): 141-144, 2004. Cohen HA, Varsano I, Kahan E, Sarrell EM, Uziel Y. Effectiveness of an herbal preparation containing Echinacea, propolis, and vitamin C in preventing respiratory tract infections in children: a randomized, double-blind, placebo-controlled, multicenter study. Arch Pediatr Adolesc Med 158(3):217-221, 2004. Darben T, Cominos B, Lee CT. Topical eucalyptus oil poisoning. Australas J Dermatol 39(4):265-267, 1998. Elmer GW, McFarland LV: Biotherapeutic Agents in the Treatment of Infectious Diarrhea. Gastroenterol Clin N Am 30(3):837-854, 2001. Fabio A, Cermelli C, Fabio G, Nicoletti P, Quaglio P. Screening of the antibacterial effects of a variety of essential oils on microorganisms responsible for respiratory infections. Phytother Res 21(4):374-377, 2007. Fox CH: Probiotics in the prevention and treatment of diarrhea. J Altern Complement Med 10(4):601-603, 2004. Francis AJ, Dempster RJ: Effect of valerian, Valeriana edulis, on sleep difficulties in children with intellectual deficits: randomised trial. Phytomedicine 9(4): 273-279, 2002. Fugh-Berman A: Herbal Supplements: Indications, clinical concerns, and safety. Nutrition Today 37:122-124, 2002. Gaon D, Garcia H, Winter L, Rodriguez N, et al. Effects of Lactobacillus strains and Saccharomyces boulardii on persistent diarrhea in children. Medicine (B Aires) 63(4):293-298, 2003. Gardiner P, Dvorkin L, Kemper KJ. Supplement use growing among children and adolescents. Pediatr Ann 33(4):227-232, 2004. Gardiner P and Kemper KJ: Herbs in Pediatric and Adolescent Medicine. Pediatrics in Review. 21(2):44-57, 2000. Gladstar R: Family Herbal: A Guide to Living Life with Energy, Health and Vitality. Storey, 2001. Goldman RD, Rogovik AL, Lai D, Vohra S: Potential interactions of drug-natural health products and natural health products-natural health products among children. J Pediatr 152(4): 521-526, 2008. Gouin S, Patel H. Unusual cause of seizure. Pediatr Emerg Care 12(4):298-300, 1996. Harkness R, Bratman S: Drug-Herb-Vitamin Interactions Bible. Prima, 2000. Integrative Medicine: Quick access professional guide to conditions, herbs & supplements, Newton, Mass, Integrative Medicine Communications, 2000. James WD, White SW, Yanklowitz B: Allergic contact dermatitis to compound tincture of benzoin, J Am Acad Dermatol 11(5 Pt 1):847-850, 1984. Kemper KJ: The holistic pediatrician, New York, Harper Collins, 1996. Kennedy DO, Little W, Scholey AB. Attenuation of laboratory-induced stress in humans after acute administration of Melissa officinalis (Lemon Balm). Psychosom Med 66(4): 607-613, 2004. Kirdpon S, Kirdpon W, Airarat W, Thepsuthammarat K, Nanakorn S. Changes in urinary compositions among children after consuming prepared oral doses of aloe (Aloe vera Linn). J Med Assoc Thai 89(8):1199-1205, 2006. Koch C, Reichling J, Kehm R, et al. Efficacy of anise oil, dwarf-pine oil and chamomile oil against thymidine-kinase-positive and thymidine-kinase-negative herpesviruses. J Pharm Pharmacol 60(11):1545-1550, 2008. Langner E, Greifenberg S, Gruenwald J: Ginger: history and use, Adv Ther 15(1):25-44, 1998. Lu M, Battinelli L, Daniele C, Melchioni C, Salvatore G, Mazzanti G: Muscle relaxing activity of Hyssopus officinalis essential oil on isolated intestinal preparations. Planta Med 68(3): 213-216, 2002. Mahady GB, Pendland SL, Stoia A. In vitro susceptibility of Helicobacter pylori to botanical extracts used traditionally for the treatment of gastrointestinal disorders. Phytother Res 19(11):988-91, 2005. Martel D, Bussieres JF, Theoret Y, Lebel D, Kish S, Moghrabi A, Laurier C. Use of alternative and complementary therapies in children with cancer. Pediatr Blood Cancer, 44(7):660-668, 2005. Mazzanti G, Battinelli L, Pompeo C. Inhibitory activity of Melissa officinalis L. extract on Herpes simplex virus type 2 replication. Nat Prod Res 22(16):1433-1440, 2008. McIntyre A: Herbal Treatment of Children: Western and Ayurvedic Perspectives. Elsevier Butterworth-Heinemann, Edinburgh, 2005. Menella JA, Beauchamp GK: The effects of repeated exposure to garlic-flavored milk on the nursling’s behavior, Pediatr Res 34(6):805-808, 1993. Messager S, Hammer KA, Carson CF, Riley TV. Effectiveness of hand-cleansing formulations containing tea tree oil assessed ex vivo on human skin and in vivo with volunteers using European standard EN 1499. J Hosp Infect 59(3):220-228, 2005. Mills S, Bone K. The essential guide to herbal safety. Elsevier, St. Louis, 2005. Moneret-Vautrin DA et al: Food allergy and IgE sensitization caused by spices: CICBAA data. Allerg Immunol (Paris) 34(4):135-140, 2002. Millar BC, Moore JE. Successful topical treatment of hand warts in a paediatric patient with tea tree oil (melaleuca alternifolia). Complement Ther Clin Pract 14(4):225-227, 2008. Müller SF, Klement S. A combination of valerian and lemon balm is effective in the treatment of restlessness and dyssomnia in children. Phytomedicine 13(6):383-387, 2006. Najafi Sani M, Kianifar HR, Kianee A, Khatami G. Effect of oral garlic on arterial oxygen pressure in children with hepatopulmonary syndrome. World J Gastroenterol 12(15):2427-2431, 2006. Nemeth E, Bernath J. Biological activities of yarrow species (Achillea spp.). Curr Pharm Des 14(29):3151-3167, 2008. Niederhofer H. Observational study: Matricaria chamomilla may improve some symptoms of attention-deficit hyperactivity disorder. Phytomedicine Dec. 18, 2008 (e-pub ahead of print). APPENDIX C Appendix C Pediatric Herbal Use 659 660 Appendix C Pediatric Herbal Use Ody P: The complete medicinal herbal, DK, London, 1993. Ohnishi ST, Ohnishi T, Ogunmola GB: Sickle cell anemia: a potential nutritional approach for a molecular disease, Nutrition 16(5):330-338, 2000. Parish RA, McIntire S, Heimbach DM: Garlic burns: a naturopathic remedy gone awry, Pediatr Emerg Care 3(4):258-260, 1987. Pearce AL, Finlay-Jones JJ, Hart PH. Reduction of nickel-induced contact hypersensitivity reactions by topical tea tree oil in humans. Inflamm Res 54(1):22-30, 2005. Pina-Vaz C, Goncalves Rodrigues A, Pinto E, et al. Antifungal activity of Thymus oils and their major compounds. J Eur Acad Dermatol Venereol 18(1):73-78, 2004. Post-White J, Fitzgerald M, Hageness S, Sencer SF: Complementary and alternative medicine use in children with cancer and general and specialty pediatrics. J Pediatr Oncol Nurs 26(1): 7-15, 2009. Powolny AA, Singh SV. Multitargeted prevention and therapy of cancer by diallyl trisulfide and related Allium vegetable-derived organosulfur compounds. Cancer Lett 269(2):305-314, 2008. Quimby EL. The use of herbal therapies in pediatric oncology patients: treating symptoms of cancer and side effects of standard therapies. J Pediatr Oncol Nurs 24(1):35-40, 2007. Rafaat M, Leung AK: Garlic burns, Pediatr Dermatol 17(6):475-476, 2000. Reider N, Sepp N, Fritsch P, Weinlich G, Jensen-Jarolim E: Anaphylaxis to camomile: clinical features and allergen cross-reactivity, Clin Exp Allergy 30(10):1436-1443, 2000. Romm A: 2000 Guide to Children’s Supplements. Better Nutrition (suppl), pp 38-43, October 2000. Romm AS: Naturally Healthy Babies and Children, Celestial Arts, Berkeley, Calif., 2003. Salazar-Lindo E, Figueroa-Quintanilla D, Caciano MI, et al. Effectiveness and safety of Lactobabillus LB in the treatment of mild acute diarrhea in children. J Pediatr Gastroenterol Nutr 44(4):571-576, 2007. Saran S, Gopalan S and Krishna TP: Use of Fermented Foods to Combat Stunting and Failure to Thrive. Nutrition 18:393-396, 2002. Scott J, Barlow T, Chilingar GV: Herbs in the Treatment of Children: Leading a Child to Health, Churchill-Livingstone, St. Louis, 2003. Senapati S, Banerjee S, Gangopadhyay DN. Evening primrose oil is effective in atopic dermatitis: a randomized placebo-controlled trial. Indian J Dermatol Venereol Leprol 74(5): 447-452, 2008. Schnitzler P, Schuhmacher A, Astani A, Reichling J. Melissa officinalis oil affects infectivity of enveloped herpesviruses. Phytomedicine 15(9):734-740, 2008. Shakeel M, Little SA, Bruce J, Ah-See KW: Use of complementary and alternative medicine in pediatric otolaryngology patients attending a tertiary hospital in the UK. Int J Pediatr Otorhinolaryngol 71(11):1725-1730, 2007. Silverberg NB: Garlic cloves for verruca vulgaris. Pediatr Dermatol 19(2):183, 2002. Subiza J, et al: Anaphylactic reaction after the ingestion of chamomile tea: a study of crossreactivity with other composite pollens, J Allergy Clin Immunol 84(3):353-358, 1989. Tomassoni AJ, Simone K: Herbal medicines for children: an illusion of safety? Curr Opin Pediatr 13:162-169, 2001. Trigazis L, Tennankore D, Vohra S, Katzman DK. The use of herbal remedies by adolescents with eating disorders. Int J Eat Disord 35(2):223-228, 2004. Türkyilmaz A, Karabulut R, Sönmez K. Can Başaklar A. A striking and frequent cause of premature thelarche in children: Foeniculum vulgare. J Pediatr Surg 43(11):2109-2111, 2008. Vessey JA, Rechkemmer A: Natural Approaches to Children’s Health: Herbals and Complementary and Alternative Medicine. Pediatr Nrs 27(1):61-67, 2001. Weber W, Taylor JA, Stoep AV, et al. Echinacea purpurea for prevention of upper respiratory tract infections in children. J Altern Complement Med 11(6):1021-1026, 2005. Wegener T, Kraft K: Plantain (Plantago lanceolata L.): anti-inflammatory action in upper respiratory tract infections. Wien Med Wochenschr 149(8-10):211-216, 1999. White S, Mavor S: Kids, herbs & health, Interweave Press, Loveland, Colorado, 1998. Williamson EM: Synergy and other interactions in phytomedicines. Phytomedicine 8(5): 401-409, 2001. Yaeesh S, Jamal Z, Khan AU, Gilani AH: Studies on hepatoprotective, antispasmodic and calcium antagonist activities of the aqueous-methanol extract of Achillea millefolium. Phytother Res 20(7):546-551, 2006. Yoon S, Lee J, Lee S: The therapeutic effect of evening primrose oil in atopic dermatitis patients with dry scaly skin lesions is associated with the normalization of serum gamma-interferon levels. Skin Pharmacol Appl Skin Physiol 15(1):20-25, 2002. Zand J, Rountree B, Walton R: Smart medicine for a healthier child, ed 2, Avery, New York, 2003. APPENDIX C Appendix C Pediatric Herbal Use 661 APPENDIX D Abbreviations ac before meals AIDS acquired immunodeficiency syndrome ALT alanine aminotransferase AST aspartate aminotransferase (SGOT) bid 2 times daily BUN blood urea nitrogen CBC complete blood cell count CMV cytomegalovirus CNS central nervous system DHEA dehydroepiandrosterone ECG electrocardiogram er extended release gal gallon GERD gastroesophageal reflux disease GLA gamma linolenic acid HIV human immunodeficiency virus I&O intake and output IgA immunoglobulin A IgG immunoglobulin G IgM immunoglobulin M in inch IV intravenous MAOI monoamine oxidase inhibitor mo month NMDA N-methyl-D-aspartate NNRTI nonnucleoside reverse transcriptase inhibitor NSAID nonsteroidal antiinflammatory drug 662 OTC over the counter PA pyrrolizidine alkaloid pc after meals PMS premenstrual syndrome PO by mouth pp postprandial (following a meal) prn as required PT prothrombin time q every q2hr every 2 hours q3hr every 3 hours q4hr every 4 hours q6hr every 6 hours q12hr every 12 hours qAM every morning qd-bid 1-2 times daily qhr every hour qid 4 times daily qPM every night qs sufficient quantity SLE systemic lupus erythematosus SSRI selective serotonin reuptake inhibitors tbsp tablespoon tid 3 times daily tid-qid 3-4 times daily tsp teaspoon wk week Abarzua S et al: Effects of phytoestrogen extracts from Linum usitatissimum on the Jeg3 human trophoblast tumour cell line, Anticancer Res 27(4A):2053-2058, 2007. Abdel-Barry JA et al: Hypoglycaemic and antihyperglyceamic effects of Trigonella foenum-graecum leaf in normal and alloxan induced diabetic rats, J Ethnopharmacol 58(3):149-155, 1997. Abdel-Barry JA et al: Hypoglycaemic effect of aqueous extract of the leaves of Trigonella foenumgraecum in healthy volunteers, East Mediterr Health 6(1):83-88, 2000. Abdel-Wahhab MA, Aly SE: Antioxidant property of Nigella sativa (black cumin) and Syzygium aromaticum (clove) in rats during aflatoxicosis, J Appl Toxicol 25(3):218-223, 2005. Abe N et al: Interferon induction by glycyrrhizin and glycyrrhetinic acid in mice, Microbiol Immunol 26:535-539, 1982. Adachi K et al: Potentiation of host-mediated antitumor activity in mice by beta-glucon obtained from Grifola frondosa (maitaki), Chem Pharm Bull 35(1):262-270, 1987. Adaramoye OA et al: Possible anti-atherogenic effect of kolaviron (a Garcinia kola seed extract) in hypercholesterolaemic rats, Clin Exp Pharmacol Physiol 32(1-2):40-46, 2005. Adaramoye OA, Adeyemi EO: Hypoglycaemic and hypolipidaemic effects of fractions from kolaviron, a biflavonoid complex from Garcina Kola in streptozotocin-induced diabetes mellitus rats, J Pharm Pharmacol 58(1):121-128, 2006. Adeneye AA, Agbaje EO: Hypoglycemic and hypolipidemic effects of fresh leaf aqueous extract of Cymbopogon citrates Stapf, in rats, J Ethnopharmacol 112(3):440-444, 2007. Adeniyi BA et al: In vitro anti-mycobacterial activities of three species of Cola plant extracts (Sterculiaceae), Phytother Res 18(5):414-418, 2004. Adler AJ et al: Effect of garlic and fish-oil supplementation on serum lipid and lipoprotein concentrations in hypercholesterolemic men, Am J Clin Nutr 65(2):445-450, 1997. Agabeili RA et al: Antimutagenic activity of Armoracia rusticana, Zea mays and Ficus carica plant extracts and their mixture, Tsitol Genet 39(3):75-79, 2005. Agarwal RC et al: Clinical trial of guggulipid: a new hypolipidemic agent of plant origin in primary hyperlipidemia, Indian J Med Res 84:626-634, 1986. Agarwal S et al: Preliminary observations on leukaemic specific agglutinins from seeds, Indian J Med Res 92:38-42, 1990. Agarwal S et al: Tomato lycopene and low density lipoprotein oxidation, Lipids 33(10):981-984, 1998. Age-Related Eye Disease Study Research Group. A randomized placebo-controlled, clinical trial of high-dose supplementation with vitamins C, E, and beta carotene for age-related cataract and vision loss. AREDS report no. 9. Arch Ophthalmol:119:1439-1452, 2001. Aguilar Peralta GR et al: Clinical and capillaroscopic evaluation in the treatment of chronic venous insufficiency with Ruscus aculeatus, hesperidin methylchalcone and ascorbic acid in venous insufficiency treatment of ambulatory patients, Int Angiol 26(4):378-384, 2007. Ahmed I et al: Effects of Momordica charantia fruit juice on islet morphology in the pancreas of the streptozotocin-diabetic rat, Diabetes Res Clin Pract 40(3):145-151, 1998. Ahmed MB et al: Biochemical effects of Catha edulis, cathine and cathinone on adrenocortical functions, J Ethnopharmacol 39(3):213-216, 1993. Ahmed N et al: Effect of Momordica charantia (karolla) extracts on fasting and postprandial serum glucose levels in NIDDM patients, Bangladesh Med Res Counc Bull 25(1):11-13, 1999. Ahmed RS et al: Influence of dietary ginger on antioxidant defence system in rat: comparison with ascorbic acid, Indian J Exp Biol 38(6):604-606, 2000. Ajarem JS: Effects of fresh kola-nut extract (Cola nitida) on the locomotor activities of male mice, Acta Physiol Pharmacol Bulg 16(4):10-15, 1990. 663 REFERENCES REFERENCES 664 References Akhondzadeh S et al: Crocus sativus L. in the treatment of mild to moderate depression: a doubleblind, randomized and placebo-controlled trial, Phytother Res 19(2):148-151, 2005. Akhondzadeh S et al: Passionflower in the treatment of opiate withdrawal: a double-blind randomized controlled trial, J Clin Pharm Ther 26:369-373, 2001. Akihisa T et al: Triterpene alcohols from the flowers of compositae and their anti-inflammatory effect, Phytochemistry 43(6):1255-1260, 1996. Akihisa T et al: Antitumor promoting effects of mutiflorane type triterpenoids and cytoxic activity of karounidiol against human cancer cell lines, Cancer Lett 173(1):9-14, 2001. Al Mofleh IA et al: Aqueous suspension of anise “Pimpinella anisum” protects rats against chemically induced gastric ulcers, World J Gastroenterol 13(7):1112-1118, 2007. Aladakatti RH et al: Sperm parameters changes induced by Azadirachta indica in albino rats, J Basic Clin Physiol Pharmacol 12(1):69-76, 2001. Alarcon-Aguilar FJ et al: Study of the antihyperglycemic effect of plants used as antidiabetics, J Ethnopharmacol 61(2):101-110, 1998. Alarcon-Aguilar FJ et al: Investigation on the hypoglycaemic effects of extracts of four Mexican medicinal plants in normal and alloxan-diabetic mice, Phytother Res 16(4):383-386, 2002. Albanes D et al: Effects of beta carotene on cancer incidence, Am J Clin Nutr 62, suppl: 1427s-1430s, 1995. Albert-Puleo MJ: Fennel and anise as estrogenic agents, J Ethnopharmacol 2:337-344, 1980. Alekel DL et al: Isoflavonerich soy protein isolate attenuates bone loss in the lumbar spine of perimenopausal women, Am J Clin Nutr 72(3):844-852, 2000. Al-Harbi MM et al: Anticarcinogenic effect of Commiphora molmol on solid tumors induced by Ehrlich carcinoma cells in mice, Chemotherapy 40(5):337-347, 1994. Al-Hindawi MK et al: Anti-inflammatory activity of some Iraqi plants using intact rats, J Ethnopharmacol 26(2):163-168, 1989. Ali L et al: Characterization of the hypoglycemic effects of Trigonella foenum graecum seed, Planta Med 61(4):358-360, 1995. Ali M: Mechanism by which garlic inhibits cyclooxygenase activity: effect of raw versus boiled garlic extract on the synthesis of prostanoids, Prostaglandins Leukot Essent Fatty Acids 53(6):397-400, 1995. Aligeti VR et al: Effect of combination lipid-modifying therapy on the triglyceride lowering effect of fish oil, Am J Med Sci 333(3):168-172, 2007. Ali-Shtayeh MS et al: Antimicrobial activity of 20 plants used in folkloric medicine in the Palestinian area, J Ethnopharmacol 60(3):265-271, 1998. Allen-Hall L et al: Treatment of THP-1 cells with Uncaria tomentosa extracts differentially regulates the expression if IL-1beta and TNF-alpha, J Ethnopharmacol 109(2):312-317, 2007. Al-Majed AA et al: Reproductive, cytological and biochemical toxicity of Yohimbe in male Swiss albino mice, Asian J Androl 8(4):469-476, 2006. Almas K: The antimicrobial effects of extracts of Azadirachta indica (neem) and Salvadora persica (arak) chewing sticks, Indian J Dent Res 10(1):23-26, 1999. Almedia ER: Toxicological evaluation of the hydro-alcohol extract of the dry leaves of Peumus boldus and Boldine in rats, Phytother Res 14(2):99-102, 2000. Al-Meshal IA et al: Antiinflammatory activity of the flavonoid fraction of khat (Catha edulis Forsk), Agents Actions 17(3-4):379-380, 1986. Al-Said MS et al: Post-coital antifertility activity of the seeds of Corian-drum sativum in rats, J Ethnopharmacol 21(2):165-173, 1987. Al-Saimary IE et al: Effects of some plant extracts and antibiotics on Pseudomonas aeruginosa isolated from various burn cases, Saudi Med J 23(7):802-805, 2002. Altern Med Rev (no author listed): Glucosamine sulfate, Altern Med Rev 4(3):193-195, 1999. Altern Med Rev (no author listed): Matricaria chamomilla (German chamomile)—monograph, Altern Med Rev 13(1):58-62, 2008. Althuis MD et al: Glucose and insulin responses to dietary chromium supplements: a metaanalysis, Am J Clin Nutr 76(1):148-155, 2002. 665 American Herbal Products Association, 1988. Amin K et al: Binding of Galanthus nivalis lectin to Chlamydia trachomatis and inhibition of in vitro infection, APMIS 103(10):714-720, 1995. Ammon HP: Boswellic acids (the active agent in incense) for the treatment of chronic inflammatory diseases, Med Monatsschr Pharm, 26(9):309-315, 2003. Amoros M et al: Comparison of the antiherpes simplex virus activities of propolis and 3-methyl-but2-enyl caffeate, J Nat Prod 57(5):644-647, 1994. Amoros M et al: Synergistic effect of flavones and flavonols against herpes simplex virus type I in cell culture: comparison with antiviral activity of propolis, J Nat Prod 55(12):1732-1740, 1992. An HJ et al: Glechoma hederacea inhibits inflammatory mediator release in IFN-gamma and LPS-stimulated mouse peritoneal macrophages, J Ethnopharmacol 106(3):418-424, 2006. Anand KK et al: Histological evidence of protection of Indigofera tinctoria Linn against carbon tetrachloride induced hepatotoxicity: an experimental study, Indian J Exp Biol 19:298, 1981. Anand P et al: Preliminary studies on antihyperglycemic effect of aqueous extract of Brassica nigra (L.) Koch in streptozotocin induced diabetic rats, Indian J Exp Biol 45(8):696-701, 2007. Andersen T et al: Weight loss and delayed gastric emptying following a South American herbal preparation in overweight patients, J Hum Nutr Diet 14(3):243-250, 2001. Anderson C et al: Evaluation of massage with essential oils on childhood atopic eczema, Phytother Res 14(6):452-456, 2000. Anderson JW et al: Meta-analysis of the effects of soy protein intake on serum lipids, New Engl J Med 333:276-282, 1995. Anderson RA: Chromium intake, absorption, and excretion of subjects consuming self-selected diets, Am J Clin Nutr 41:1177-1183, 1985. Anderson RA: Chromium, glucose intolerance and diabetes, J Am Coll Nutr 17:548-555, 1998. Andrade-Neto VF et al: Antimalarial activity of Cinchona-like plants used to treat fever and malaria in Brazil, J Ethnopharmacol 87(2-3):253-256, 2003. Andres RH et al: Effects of creatine treatment on the survival of dopaminergic neurons in cultured fetal ventral mesencephalic tissue, Neuroscience 133(3):701-713, 2005. Andrews R et al: The effect of dietary creatine supplementation on skeletal muscle metabolism in congestive heart failure, Eur Heart J 19:617-622, 1998. Anesini C et al: Screening of plants used in Argentine folk medicine for antimicrobial activity, J Ethnopharmacol 39(2):119-128, 1993. Anesini C et al: “In vivo” and “in vitro” antitumoral action of Larrea divaricata Cav., Acta Physiol Pharmacol Ther Latinoam 46(1):33-40, 1996. Anesini C et al: “In vivo” antitumor activity of Larrea divaricata C.: comparison of two routes of administration, Phytomedicine 5(1):41-45, 1998. Aniya Y et al: Protective effect of the mold Monascus anka against acetaminophen-induced liver toxicity in rats, Jpn J Pharmacol 78(1):79-82, 1998. Aniya Y et al: Screening of antioxidant action of various molds and protection of Monascus anka against experimentally induced liver injuries or rats, Gen Pharmacol 32(2):225-231, 1999. Anjos Ferreira AL et al: Effect of lycopene on doxorubicin-induced cardiotoxicity: an echocardiographic, histological and morphometrical assessment, Basic Clin Pharmacol Toxicol 101(1):16-24, 2007. Anon: License revoked for aloe vera use, Nat Med Law 1:1-2, 1998. Antolin I et al: Protective effect of melatonin in a chronic experimental model of Parkinson’s disease, Brain Res 943(2):163-173, 2002. Apitz-Castro R et al: Evidence for direct coupling of primary agonist receptor interaction to the exposure of functional IIb-IIIa complexes in human blood platelet result from studies with the antiplatelet compound ajoene, Biochim Biophys Acta 1094:269-280, 1994. REFERENCES References 666 References Arayne MS et al: The berberis story: Berberis vulgaris in therapeutics, Pak J Pharm Sci 20(1):83-92, 2007. Arena JM et al: Poisoning toxicology: symptoms, treatments,5 ed, Springfield, Ill, 1986, Charles C Thomas. Arjmandi BH et al: Whole flaxseed consumption lowers serum LDL-cholesterol and lipoprotein concentrations in postmenopausal women, Nutr Res 18(7):1203-1214, 1999. Arletti R et al: Stimulating property of Turnera diffusa and Pfaffia paniculata extracts on the sexual behavior of male rats, Psychopharmacology 143(1):15-19, 1999. Aroutcheva AA et al: Antimicrobial protein produced by vaginal Lactobacillus acidophilus that inhibits Gardnerella vaginalis, Infect Dis Obstet Gynecol 9(1):33-39, 2001. Arteaga S et al: Effect of Larrea tridentata (creosote bush) on cholesterol gallstones and bile secretion in hamsters, J Pharm Pharmacol 57(9):1093-1099, 2005. Arvill A et al: Effect of short-term ingestion of konjac glucomannan on serum cholesterol in healthy men, J Clin Nutr 61(3):585-589, 1995. Asano J et al: Cytotoxic xanthones from Garcinia hanburyi, Phytochemistry 41(3):818-820, 1996. Ashaeva LA et al: The study of sugar decreasing action of Laurus nobilis leaves, Farmatsiya 33:49-51, 1984. Ashri N et al: More unusual pigmentation of the gingiva, Oral Surg Oral Med Oral Pathol 70(4):445-449, 1990. Aso Y et al: Preventive effect of a Lactobacillus casei preparation on the recurrence of superficial bladder cancer in a double-blind trial, Eur Urol 27:104-109, 1995. Atanasov AT et al: Inhibiting and disaggregating effect of gel-filtered Galega officinalis L. herbal extract on platelet aggregation, J Ethno-pharmacol, 69(3):235-240, 2000. Atta AH et al: Anti-nociceptive and anti-inflammatory effects of some Jordanian medicinal plant extracts, J Ethnopharmacol 60(2):117-124, 1998. Auf’mkolk M et al: Antihormonal effects of plant extracts: iodothyronine deiodinase of rat liver is inhibited by extracts and secondary metabolites of plants, Horm Metab Res 16(4): 188-192, 1984. Augustin M et al: Effects of Mahonia aquifolium ointment on the expression of adhesion, proliferation, and activation markers in the skin of patients with psoriasis, Forsch Komplementarmed 6(suppl 2):19-21, 1999. Aung HH et al: Crocin from Crocus sativus possesses significant anti-proliferation effects on human colorectal cancer cells, Exp Oncol 29(3):175-180, 2007. Avato P et al: Antimicrobial activity of polyacetylenes from Bellis perennis and their synthetic derivatives, Planta Med 63(6):503-507, 1997. Azad AK et al: Antifertility activity of a traditional contraceptive pill comprising Acacia catechu, A. arabica, and Tragia involuceria, Indian J Med Res 80:372-374, 1984. Badam L et al: “In vitro” antiviral activity of neem (Azadirachta indica A. Juss) leaf extract against group B coxsackieviruses, J Commun Dis 31(2):79-90, 1999. Bader G et al: The antifungal action of polygalacic acid glycosides, Pharmazie 45(8):618-620, 1990. Báez R et al: In vivo antitumoral activity of stem pineapple (Ananas comosus) bromelain, Planta Med 73(13):1377-1383, 2007. Bafi-Yeboa NF et al: Antifungal constituents of northern prickly ash, Zanthoxylum americanum mill, Phytomedicine 12(5):370-377, 2005. Baghdikian B et al: An analytical study, antiinflammatory and analgesic effects of Harpagophytum procumbens and Harpagophytum zeyheri, Planta Med 63(2):171-176, 1997. Ball KR, Kowdley KV: A review of Silybum marianum (milk thistle) as a treatment for alcoholic liver disease, J Clin Gastroenterol 39(6):520-528, 2005. Balzarini J et al: Alpha-(1-3)- and alpha-(1-6)-D-mannose-specific plant lectins are markedly inhibitory to human immunodeficiency virus and cytomegalovirus infections in vitro, Antimicrob Agents Chemother 35(3):410-416, 1991. 667 Balzer J et al: Sustained benefits in vascular function through flavanol-containing cocoa in medicated diabetic patients a double-masked, randomized, controlled trial, J Am Coll Cardiol 51(22):2141-2149, 2008. Bandoniene D, Murkovic M: The detection of radical scavenging compounds in crude extract of borage (Borago officinalis L.) by using an on-line HPLC-DPPH method, J Biochem Biophys Methods 53(1-3):45-49, 2002. Bandyopadhyay U et al: Gastroprotective effect of neem bark extract: possible involvement of H(⫹)-K(⫹)-ATPase inhibition and scavenging hydroxyl radical, Life Sci 17(24):2845, 2002. Banerjee S et al: Influence of certain essential oils on carcinogen-metabolizing enzymes and acid-soluble sulfhydryls in mouse liver, Nutr Cancer 21(3):263-269, 1994. Banjaw MY et al: Repeated Catha edulis oral administration enhances the baseline aggressive behavior in isolated rats, J Neural Transm 113(5):543-556, 2006a. Banjaw MY, Schmidt WJ: Catha edulis extract and its active principle cathinone induce ipsilateral rotation in unilaterally lesioned rats, Behav Pharmacol 17(7):615-620, 2006b. Bao L et al: Protective effects of bilberry (Vaccinium myrtillus L.) extract on KBrO3-induced kidney damage in mice, J Agric Food Chem 56(2):420-425, 2008. Barajas-Farias LM et al: A dual and opposite effect of Calendula officinalis flower extract: chemoprotector and promoter in a rat hepatocarcinogenesis model, Planta Med 72(3): 217-221, 2006. Barclay L: Chromium supplementation may not improve impaired glucose tolerance, Diabetes Care 28:712-714, 2005. Barnaulov OD et al: Anti-ulcer action of a decoction of the flowers of the dropwort, Filipendula ulmaria (L.) maxim, Farmakol Toksikol 43(6):700-705, 1980. Barnes J et al: Echinacea species (Echinacea angustifolia (DC.) Hell., Echinacea pallid (Nutt.) Nutt., Echinacea purpurea (L.) Moench): a review of their chemistry, pharmacology and clinical properties, J Pharm Pharmacol 57(8):929-954, 2005. Barrett B et al: Relations among questionnaire and laboratory measures of rhinovirus infection, Eur Respir J 28(2):358-363, 2006. Basilico MA et al: Inhibitory effects of some spice essential oils on Aspergillus ochraceus NRRL 3174 growth and ochratoxin A production, Lett Appl Microbiol 29(40):238-241, 1999. Baulieu E et al: Dehydroepiandrosterone and dehydroepiandrosterone sulfate as neuroactive neurosteroids, J Endocrinol 150:s221-s239, 1996. Beaux D et al: Effect of extracts of Orthosiphon stamineus Benth, Hieracium pilosella L., Sambucus nigra L., and Arctostaphylos uva-ursi (L.) Spreng. in rats, Phytother Res 13(3):222-225, 1999. Beckmann-Knopp S et al: Inhibitory effects of silibinin on cytochrome P-450 enzymes in human liver microsomes, Pharmacol Toxicol 86(6):250-256, 2000. Bednarz B et al: Effects of oral L-arginine supplementation on exercise-induced QT dispersion and exercise tolerance in stable angina pectoris, Int J Cardiol 75:205-210, 2000. Belch JJ et al: Evening primrose oil and borage oil in rheumatologic conditions, Am J Clin Nutr 71(1 Suppl):3525-3565, 2000. Benedikt H: Nat Pharmacol 1(8):1, 22, 1997. Bengtsson AA et al: Risk factors for developing systemic lupus erythematosus: a case-control study in southern Sweden, Rheumatology (Oxford) 41(5):563-571, 2002. Ben-Hur E et al: Effect of P. ginseng saponins and Eleutherococcus sp. on survival of cultured mammalian cells after ionizing radiation, Am J Chin Med 9:48-56, 1981. Benie T et al: Natural substances regulating fertility: effect of plant extracts in the Ivory Coast pharmacopoeia on the release of LH by hypophyseal cells in culture, C R Seances Soc Biol Fil 181(2):163-167, 1987. Benito M et al: Labiatae allergy: systemic reactions due to ingestion of oregano and thyme, Ann Allergy Asthma Immunol 76(5):416-418, 1996. REFERENCES References 668 References Bennett R: Treatment of relapsing Clostridium difficile diarrhea with Lactobacillus GG, Nutr Today 31(suppl):35s-38s, 1996. Berg A et al: Influence of Echinacin (EC31) treatment on the exercise-induced immune response in athletes, J Clin Res 1:367-380, 1998. Berger D et al: Efficacy of Vitex agnus castus L. extract Ze 440 in patients with premenstrual syndrome (PMS), Arch Gynecol Obstet 264(3):150-153, 2000. Berić T et al: Protective effect of basil (Ocimum basilicum L.) against oxidative DNA damage and mutagenesis, Food Chem Toxicol 46(2):724-732, 2008. Bernardi F et al: Allopregnanolone and dehydroepiandrosterone response to corticotropinreleasing factor in patients suffering from Alzheimer’s disease and vascular dementia, Eur J Endrocrinol 142(5):466-471, 2000. Berrougui H et al: Marrubium vulgare extract inhibits human-LDL oxidation and enhances HDL-mediated cholesterol efflux in THP-1 macrophage, Life Sci 80(2):105-112, 2006. Berry M: The chamomiles, Pharmacol J 254:191-193, 1995. Betz JM et al: Gas chromatographic determination of yohimbine in commercial yohimbe products, J AOAC Int 78(5):1189-1194, 1995. Bever B et al: Plants with oral hypoglycemic action, Q J Crude Drugs Res 17:139-196, 1979. Bezakova L et al: Lipoxygenase inhibition and antioxidant properties of bisbenzylisoqunoline alkaloids isolated from Mahonia aquifolium, Pharmazie 51(10):758-761, 1996. Bhanwra S et al: Effect of Azadirachta indica (neem) leaf aqueous extract on paracetamolinduced liver damage in rats, Indian J Physiol Pharmacol 44(1):64-68, 2000. Bhatia AL et al: Prophylactic action of linseed (Linum usitatissimum) oil against cyclophosphamide-induced oxidative stress in mouse brain, J Med Food 9(2):261-264, 2006. Bianchi A et al: Rhabdomyolysis caused by Commiphora mukul, a natural lipid-lowering agent, Ann Pharmacother 38(7-8):1222-1225, 2004. Biesenbach G et al: The lipid lowering effect of a new guarpectic fiber mixture in type II diabetic patients with hypercholesterolemia, Leber Magen Darm 23(5):204, 1993 (abstract). Biffi A et al: Antiproliferative effect of fermented milk on the growth of a human breast cancer cell line, Nutr Cancer 28:93-99, 1997. Binutu OA et al: Antimicrobial potentials of some plant species of the Bigoniaceae family, Afr J Med Sci 23(3):269-273, 1994. Bishayee A et al: Hepatoprotective activity of carrot (Daucus carota L.) against carbon tetrachloride intoxication in mouse liver, J Ethnophar-macol 47(2):69-74, 1995. Bishop CJ et al: A survey of higher plants for antibacterial substances, Botany 15:231-259, 1951. Bisset NG: Herbal drugs and phytopharmaceuticals, Boca Raton, Fla, 1994, CRC Press. Bladt S, Wagner H: Inhibition of MAO by fractions and constituents of Hypericum extract, J Geriatr Psychiatry Neurol 7(suppl 1):s57-59, 1994. Blaszczyk T et al: Screening for antimycotic properties of 56 traditional Chinese drugs, Phytother Res 14(3):210-212, 2000. Blum A et al: Clinical and inflammatory effects of dietary L-arginine in patients with intractable angina pectoris, Am J Cardiol 83:1488-1490, 1999. Blumenthal M, editor: The complete German Commission E monographs: therapeutic guide to herbal medicines, Austin, Tex, 1998, American Botanical Council; Boston, Integrative Medicine Communication. Boggs W: Chromium does not improve glycemic control in type 2 diabetes, Diabetes Care 30:1092-1096, 2007. Bolognesi M et al: Effect of 8-day therapy on propionyl-L-carnitine on muscular and subcutaneous blood flow of the limbs in patients with peripheral arterial disease, Clin Physiol 15:417-423, 1996. Bonavita E: Study of the efficacy and tolerability of L-acetylcarnitine therapy in the senile brain, Int J Clin Pharmacol Ther Toxicol 24:511-516, 1986. 669 Bordia A et al: Effect of garlic on platelet aggregation in humans: a study in healthy subjects and patients with coronary artery disease, Prostaglandins Leukot Essent Fatty Acids 55(3): 201-205, 1996. Bores GM et al: Pharmacological evaluation of novel Alzheimer’s disease therapeutics: acetylcholinesterase inhibitors related to galanthamine, J Pharmacol Exp Ther 277:728-738, 1996. Borgatta L et al: A randomized clinical trial of the addition of laminaria to misoprostol and hypertonic saline for second-trimester induction abortion, Contraception 72(5):358-361, 2005. Boskabady MH et al: Relaxant effect of Pimpinella anisum on isolated guinea pig tracheal chains and its possible mechanism, J Ethmopharmacol 74(1):83-88, 2001. Boskabady MH et al: Possible mechanism(s) for relaxant effects of Foeniculum vulgare on guinea pig tracheal chains, Pharmazie 59(7):561-564, 2004. Bouskela E et al: Possible mechanisms for the inhibitory effect of Ruscus extract on increased microvascular permeability induced by histamine in hamster check pouch, J Cardiovasc Pharmacol 24:165-170, 1994. Bowen JM et al: Neuromuscular effects of toxins isolated from southern prickly ash (Zanthoxylum clavaherculis) bark, Am J Vet Res 57(8):1239-1244, 1996. Bowman WC et al: Textbook of pharmacology, London, 1980, Bowman & Blackwell. Bradley PR, editor: British herbal compendium, vol 1, London, 1992, British Herbal Medicine Assoc. Braeckman J et al: Efficacy and safety of the extract of Serenoa repens in the treatment of benign prostatic hyperplasia: therapeutic equivalence between twice and once daily dosage forms, Phytother Res 11:558-563, 1997. Brandt D: A clinician’s view, HerbalGram 36:75, 1996. Bratthall D: Daucus carota (carrot): a selective bacteriosorbent, Adv Exp Med Biol 107: 327-333, 1978. Bravetti G: Preventative medical treatment of senile cataracts with vitamin E and anthocyanosides: clinical evaluation, Ann Ottalmol Clin Ocul 115:109, 1989. Brekham IL et al: Pharmacological investigation of glycosides from ginseng and Eleutherococcus, Lloydia 32:46-51, 1969. Bressa G: S-Adenosyl-l-methionine (SAM-e) as antidepressant: meta-analysis of clincial studies, Acta Neurol Scand 154(suppl):7-14, 1994. Brett A: Glucosamine and Chondroitin Sulfate for Knee Osteoarthritis, Journal Watch (general), available at: http://general-medicine.jwatch.org/cgi/content/full/2006/228/1. Accessed December 1, 2008. Brevett D et al: European multicenter study on propionyl-L-carnitine in intermittent claudication, J Am Coll Cardiol 34:1618-1624, 1999. Briggs CJ et al: Raspberry, Can Pharmaceutical 130:41-43, 1997. Brinker F: Inhibition of endocrine function by botanical agents, J Nat Med 1(1), 1990. Brinker F: Herb contraindications and drug interactions, Sandy, Ore, 1998, Eclectic. Brinker FJ: Eclectic dispensatory of botanical therapeutics, vol 2, Sandy, Ore, 1995, Eclectic. Brinkhaus B et al: Herbal medicine with curcuma and fumitory in the treatment of irritable bowel syndrome: a randomized, placebo-controlled, double-blind clinical trial, Scand J Gastroenterol 40(8):936-943, 2005. Brinkhaus B et al: Homeopathic arnica therapy in patients receiving knee surgery: results of three randomised double-blind trials, Complement Ther Med 14(4):237-246, 2006. British Herbal Medicine Association: British herbal pharmacopoeia, Cowling, England, 1983, Author. Broadhurst CL et al: Insulin-like biological activity of culinary and medicinal plant aqueous extracts in vitro, J Agric Food Chem 48(3):849-852, 2000. Broeder CE, et al: The andro project: physiological and hormone influence of androstenedione supplementation in men 35-65 years old participating in a high-intensity resistance training program, Arch Intern Med 160:3093-3104, 2000. REFERENCES References 670 References Bronfen JH et al: Inhibition of human pancreatic carcinoma cell proliferation by perillyl alcohol, Am Assoc Cancer Res 35:431, 1994 (proceedings). Bruneton J: Pharmacognosy, pytochemistry, medicinal plants, Paris, 1995, Lavoisier. Bruyere O, Reginster JY: Glucosamine and chondroitin sulfate as therapeutic agents for knee and hip osteoarthritis, Drugs Aging 24(7):573-580, 2007. Bu Y et al: Siberian ginseng reduces infarct volume in transient focal cerebral ischaemia in Sprague-Dawley rats, Phytother Res 19(2):167-169, Feb 2005. Buetler TM et al: Green tea extract decreases muscle necrosis in mice and protects against reactive oxygen species, Am J Clin Nutr 75(4):749-753, 2002. Bunyapraphatsara N et al: Antidiabetic activity of Aloe vera L. juice, II: clinical trial in diabetes mellitus in combination with glibenclamide, Phytomedicine 3:245-248, 1996a. Bunyapraphatsara N et al: The efficacy of aloe vera cream in the treatment of first, second and third degree burns in mice, Phytomedicine 2:247-251, 1996b. Burdulis D et al: Analysis of anthocyanin content in bilberry (Vaccinium myrtillus L.) fruit crude drugs by high-performance liquid chromatography method, Medicina (Kaunas) 43(7):568-574, 2007. Busing KH: Hyaluronidase inhibition of some naturally occurring substances used in therapy, Arzneimittelforschung 5:320-322, 1955. Bussing A et al: Effects of phytopreparation from Helleborus niger on immunocompetent cells in vitro, J Ethnopharmacol 59:139-146, 1998. Büssing A, Schweizer K: Effects of a phytopreparation from Helleborus niger on immunocompetent cells in vitro, J Ethnopharmacol 59(3):139-146, 1998. Bylka W et al: Flavonoids and free phenolic acids from Phytolacca Americana L. leaves, Acta Pol Pharm 58(1):69-72, 2001. Caballero T et al: IgE crossreactivity between mugwort pollen (Artemisia vulgaris) and hazelnut (Abellana nux) in sera from patients with sensitivity to both extracts, Clin Exp Allery 27(10):1203-1211, 1997. Caceres DD et al: Use of visual analogue scale measurements (VAS) to assess the effectiveness of standardized Andrographis paniculata extract SHA-10 in reducing symptoms of common cold, Phytomedicine 6:217-223, 1999. Caldefie-Chézet F et al: Potential anti-inflammatory effects of Melaleuca alternifolia essential oil on human peripheral blood leukocytes, Phytother Res 20(5):364-370, 2006. Calvani M et al: Action of acetyl-L-carnitine in neurodegeneration and Alzheimer’s disease, Ann NY Acad Sci 663:483-486, 1992. Canadanovic-Brunet J et al: Radical scavenging, antibacterial, and antiproliferative activities of Melissa officinalis L. extracts, J Med Food 11(1):133-143, 2008. Cantrell CL et al: Antimycobacterial eudesmanolides from Inula helenium and Rudbeckia subtomentosa, Planta Med 65(4):351-355, 1999. Cao ZF et al: Scavenging effects of ginger on superoxide anion and hydroxyl radical, Chung Kuo Chung Yao Tsa Chih 18(12):750-751, 1993. Cappelli R et al: Use of extract of Ruscus aculeatus in venous disease in the lower limbs, Drugs Exp Clin Res 14(4):277-283, 1988. Carani C et al: Urological and sexual evaluation of treatment of benign prostatic disease using Pygeum africanum at high doses, Arch Ital Urol Nefrol Androl 63:341-345, 1991. Carlson JJ et al: Safety and efficacy of a ginkgo biloba-containing dietary supplement on cognitive function, quality of life, and platelet function in healthy, cognitively intact older adults, J Am Diet Assoc 107(3):422-432, 2007. Carretero ME et al: Etudes pharmacodymiques preliminaires de Polygala microphylla L. sur le systeme nerveux central, Planta Med Phytother 20:148-154, 1986. Carrington Laboratories: Pharmacologic effects and mechanisms of action of acemann, Irving, Tex, Author. Carson CF et al: Antimicrobial activity of the major components of the essential oil of Melaleuca alternifolia, J Appl Biol 78:264-269, 1995. 671 Carson SN et al: Using a castor oil-balsam of Peru-trypsin ointment to assist in healing skin graft donor sites, Ostomy Wound Manage 49(6):60-64, 2003. Castano G et al: Effects of policosanol on post menopausal women with type II hypercholesterolemia, Gynecol Endocrinol 14:187-195, 2000. Cauffield JS et al: Dietary supplements used in the treatment of depression, anxiety, and sleep disorders, Lippincotts Prim Care Pract 3(3):290-304, 1999. Caughey DE et al: Perna canaliculus in the treatment of rheumatoid arthritis, Eur J Rheumatol Inflamm 6(2):197-200, 1983. Cavadas C et al: In vitro study on the interaction of Valeriana officinalis L extracts and their amino acids on GABAA receptor in rat brain, Arzneimittelforschung 45(7):753-755, 1995. Cavaleiro C et al: Antifungal activity of Juniperus essential oils against dermatophyte, Aspergillus and Candida strains, J Appl Microbiol 100(6):1333-1338, 2006. Cervenka L et al: Inhibitory effects of some spice and herb extracts against Arcobacter butzleri, A. cryaerophilus, and A. skirrowii, Curr Microbiol 53(5):435-439, 2006. Chainy GB et al: Anethole blocks both early and late cellular responses transduced by tumor necrosis factor: effect on NF-kappa B, AP-1, JNK, MAPKK and apoptosis, Oncogene 19(25):2943-2950, 2000. Chakrabarti R et al: Insulin sensitizing property of Indigofera mysorensis extract, J Ethnopharmacol 105(1-2):102-106, 2006. Chakurski I et al: Treatment of chronic colitis with a herbal combination of Taraxacum officinale, Hipericum perforatum, Melissa officinaliss, Calendula officinalis and Foeniculum vulgare, Vutr Boles 20(6):51-54, 1981. Chamorro G et al: Pharmacology and toxicology of Spirulina alga, Rev Invest Clin 48(5): 389-399, 1996. Champy P et al: Quantification of acetogenins in Annona muricata linked to atypical parkinsonism in Guadeloupe, Mov Disord 20(12):1629-1633, 2005. Chandler R, Hawkes D: Aniseed: spice, flavor, drug, Can Pharm J 117:28-29, 1984. Chang HM et al: Pharmacology and applications of Chinese materia medica, vol 2, Hong Kong, 1987, World Scientific. Chang J et al: The stimulating effect of radix aconiti extract of cytokines secretion by human mononuclear cells, Planta Med 60:576-578, 1994. Chang LW et al: Experimental podophyllotoxin (bajiaolian) poisoning: I, effects on the nervous system, Biomed Environ Sci 5(4):283-292, 1992. Chang MC: Effects of gossypol on the fertility of male rats, hamsters and rabbits, Contraception 21(5):461-469, 1980. Chantre P et al: Efficacy and tolerance of Harpagophytum procumbens versus diacerhein in treatment of osteoarthritis, Phytomedicine 7(3):177-183, 2000. Chatterjee SS et al: Antidepressant activity of Hypericum perforatum and hyperforin: the neglected possibility, Pharmacopsychiat 31:7-15, 1998a. Chatterjee SS et al: Hyperforin as a possible antidepressant component of Hypericum extracts, Life Sci 63:499-510, 1998b. Chattopadhyay RR et al: Possible mechanism of antihyperglycemic effect of Azadirachta indica leaf extract: part V, J Ethnopharmacol 67(3):373-376, 1999. Chavez ML: Saint John’s wort, Hosp Pharm 32:1621-1632, 1997. Chen CC et al: Water-soluble glycosides from Rutagraveolens, J Nat Prod 64(7):990-992, 2001. Chen CL et al: Safrole-like DNA adducts in oral tissue from oral cancer patients with a betel quid chewing history, Carcinogenesis 20(12):2331-2334, 1999. Chen J et al: Effect of oral administration of high-dose nitric oxide donor L-arginine in men with organic erectile dysfunction: results of a double-blind randomized placebo-controlled study, BJU Int 83:269-273, 1999a. Chen L et al: Screening of Taiwanese crude drugs for antibacterial activity against Streptococcus mutans, J Ethnopharmacol 27(3):285-295, 1989. REFERENCES References 672 References Chen LX et al: Studies on diterpenoids from Andrographis paniculata, Zhongguo Zhong Yao Za Zhi 31(19):1594-1597, 2006. Chen LX et al: Studies on flavonoids of Andrographis paniculata, Zhongguo Zhong Yao Za Zhi 31(5):391-395, 2006. Chen XJ et al: Cardiac protective effect of Astragalus on viral myocarditis mice: comparison with Perindopril, Am J Chin Med 34(3):493-502, 2006. Chen YH et al: Growth-inhibitory effects of the red alga Gelidium amansii on cultured cells, Biol Pharm Bull 27(2):180-184, 2004. Cheng CL et al: Effects of Centella asiatica on ethanol-induced gastric mucosal lesions in rats, Life Sci 67(21):2647-2653, 2000. Cheng GF et al: Regulation of murine interleukin-10 production by dehydroepiandrosterone, J Interferon Cytokine Res 20(5):471-478, 2000. Cheng RB et al: Experimental study of the inhibitory effects of Chelidonium majus L. extractive on Streptococcus mutans in vitro, Shanghai Kou Qiang Yi Xue 15(3):318-320, 2006. Chernecky CC, Berger BJ: Laboratory tests and diagnostic procedures, 5 ed, Philadelphia, Penn, 2008, Saunders. Chevallier A: Encyclopedia of medicinal plants, New York, 1996, DK. Chew BP et al: Effects of lutein from marigold extract on immunity and growth of mammary tumors in mice, Anticancer Res 16(6B):3689-3694, 1996. Chidambara KN et al: Studies in antioxidant activity of pomegranate (Punica granatum) peel extract using in vivo models, J Agric Food Chem 50(17):4791-4795, 2002. Chignell CF et al: Photochemistry and photocytotoxicity of alkaloids from Goldenseal (Hydrastis canadensis L.) 3: effect on human lens and retinal pigment epithelial cells, Photochem Photobiol 83(4):938-943, 2007. Chirathaworn C et al: Myristica fragrans Houtt, methanolic extract induces apoptosis in a human leukemia cell line through SIRT1 mRNA downregulation, J Med Assoc Thai 90(11): 2422-2428, 2007. Chistokhodova N et al: Antithrombin activity of medicinal plants from central Florida, J Ethnopharmacol 81(2):277-280, 2002. Chithra V et al: Coriandrum sativum changes the levels of lipid peroxides and activity of antioxidant enzymes in experimental animals, Indian J Biochem Biophys 36(1):59-61, 1999. Chithra V et al: Coriandrum sativum: effect on lipid metabolism in 1,2-dimethyl hydrazine induced colon cancer, J Ethnopharmacol 71(3):457-463, 2000. Chithra V et al: Hypolipidemic effect of coriander seeds (Coriandrum sativum): mechanism of action, Plant Foods Hum Nutr 51(2):167-172, 1997. Chiu KW et al: The cardiovascular effects of greens beans (Phaseolus aureaus), common rue (Ruta graveolens), and kelp (Laminaria japonica) in rats, Gen Pharmacol 29(5): 859-862, 1997. Choi HK et al: Clinical study of SS-Cream in patients with lifelong premature ejaculation, Urology 55:257-261, 2000. Choi HK, Curhan G: Coffee, tea, and caffeine consumption and serum uric acid level: the third national health and nutrition examination survey, Arthritis Rheum 57(5): 816-821, 2007. Choi HK, Willett W, Curhan G: Coffee consumption and risk of incident gout in men: a prospective study, Arthritis Rheum 56(6):2049-2055, 2007. Choudbury AR et al: Mustard oil and garlic extract as inhibitors of sodium arsenite-induced chromosomal breaks in vivo, Cancer Lett 121:45-52, 1997. Chow T et al: Ginkgo biloba and acetazolamide prophylaxis for acute mountain sickness: a randomized, placebo-controlled trial, Arch Intern Med 165(3):296-301, 2005. Chung CP et al: Pharmacological effects of methanolic extract from the root of Scutellaria baicalensis and its flavonoids on human fibroblasts, Planta Med 61:150-153, 1995. Chung YK et al: Inhibitory effect of ursolic acid purified from Origanum majorana L. on the acetylcholinesterase, Mol Cell 11(2):137-143, 2001. 673 Chung YP et al: Laminaria and sulprostone in second-trimester pregnancy termination for fetal abnormalities, Int J Gynaecol Obstet 65(1):47-52, 1999. Circosta C et al: A drug used in traditional medicine: Harpagophytum procumbens DC, II, cardiovascular activity, J Ethnopharmacol 11(3):259-274, 1984. Clarke JA et al: Effects of ingestion of jojoba oil on blood cholesterol and lipoprotein patterns in New Zealand white rabbits, Biochem Biophys Res Commun 102(4):1409, 1981. Clarkson P: Effects of exercise on chromium levels: is supplementation required? Sports Med 23:341-349, 1997. Clause EP: Pharmacognosy, 4 ed, Philadelphia, Penn, 1961, Lea & Febiger. Cleland LG et al: Reduction of cardiovascular risk factors with longterm fish oil treatment in early rheumatoid arthritis, J Rheumatol 33(10):1973-1979, 2006. Cohen BM et al: Acute aromatics inhalation modifies the airways: effects of the common cold, Respiration 43:285-293, 1982. Comacchione S et al: In vivo skin antioxidant effect of a new combination based on a specific Vitis vinifera shoot extract and a biotechnical extract, J Drugs Dermatol 6(6 Suppl):s8-13, 2007. Comas D et al: Treatment of extravasation of both doxorubicin and vincristine administration in a Y-site infusion, Ann Pharmacother 30:244-246, 1996. Cometa MF et al: Preliminary studies on cardiovascular activity of Viburnum prunifolium L. and its iridoid glucosides, Fitoterapia suppl(5):23, 1998. Concha JM et al: 1998 William J Stickel Bronze Award: antifungal activity or Melaleuca alternifolia (tea-tree) oil against various pathogenic organisms, J Am Podiatr Med Assoc 88(10):489-492, 1998. Connor J et al: The pharmacology of Avena sativa, J Pharm Pharmacol 27(2):92-98, 1975. Connor J et al: Comparison of analgesic effects of khat (Catha edulis Forsk) extract, D-amphetamine and ibuprofen in mice, J Pharm Pharmacol 52(1):107-110, 2000. Constantine GH et al: Chromatographic study of the alkaloids of Aquilegia formosa, J Pharm Sci 559:982-984, 1966. Corbe CH et al: Chromatic sense and chorioretinal circulation: a study of the effects of OPC (Endotelon), J Fr Ophtamol 1(5):453-460, 1988. Cordell GA et al: Capsaicin: identification, nomenclature, and pharmacotherapy, Ann Pharmacother 27:330-336, 1993. Correia HS et al: The activity of an extract and fraction of Agrimonia eupatoria L. against reactive species, Biofactors 29(2-3):91-104, 2007. Costa De Pasquale R et al: A drug used in traditional medicine: Harpagophytum procumbens DC, III, effects on hyperkinetic ventricular arrhythmias by reperfusion, J Ethnopharmacol 13(2):193-199, 1985. Couch RA et al: Anti-inflammatory activity in fractionated extracts of the green-lipped mussel, N Z Med J 95(720):803-806, 1982. Couet CE et al: Analysis, separation, and bioassay of pyrrolizidine alkaloids from comfrey (Symphytum officinale), Nat Toxins 4(4):163-167, 1996. Cox SD et al: The mode of antimicrobial action of the essential oil of Melaleuca alternifolia (tea tree oil), J Appl Microbiol 88(1):170-175, 2000. Craido MT et al: Toxicity of an algal mucopolysaccharide for Escherichia coli and Neisseria meningitidis strains, Rev Esp Fisiol 40:227-230, 1984. Craig IO: Poisoning by the volatile oils in sassafras in childhood, Arch Dis Child 28:475-483, 1953. Cuprian A et al: Effects of the intrathecal administration of capsaicin on the cardiac rhythm in anaesthetized rats, J Pharm Pharmacol 50(suppl):212, 1998. Daniel KG et al: Copper storage diseases: Menkes, Wilsons, and cancer, Front Biosci 9: 2652-2662, 2004. Dans AM et al: The effect of Momordica charantia capsule preparation on glycemic control in type 2 diabetes mellitus needs further studies, J Clin Epidemiol 60(6):554-559, 2007. REFERENCES References 674 References Dar A et al: Anti-depressant activities of Areca catechu fruit extract, Phytomedicine 4(1):41-45, 1997. Das AK et al: Studies on antidiarrhoeal activity of Punica granatum seed extract in rats, J Ethnopharmacol 58(1-2):205-208, 1999. Davini P et al: Controlled study on L-carnitine therapeutic efficacy in post-infarction, Drugs Exp Clin Res 18:355-365, 1992. Davis K et al: Randomised double-blind placebo-controlled trial of aloe vera for irritable bowel syndrome, Int J Clin Pract 60(9):1080-1086, 2006. Delaguis PJ et al: Antimicrobial activity of individual and mixed fractions of dill, cilantro, coriander, and eucalyptus essential oils, Int J Food Microbial 74(1-2):101-109, 2002. Della Loggia R et al: Evaluation of the activity on the mouse central nervous system of several plant extracts and a combination of them, Riv Neurol 51(5):297-310, 1981. Denyer CL et al: Isolation of antirhinoviral sesquiterpenes from ginger (Zingiber officinale), J Nat Prod 57(5):658-662, 1994. Dhar R et al: Inhibition of the growth and development of asexual and sexual stages of drugsensitive and resistant strains of the human malaria parasite Plasmodium falciparum by neem (Azadirachta indica) fractions, J Ethnopharmacol 61(1):31-39, 1998. Dhawan K et al: Antitussive activity of the methanol extract of Passiflora incarnata leaves, Fitoterapia 73(5):397-399, 2002. Di Padova C: S-Adenosylmethionine in the treatment of osteoarthritis, Am J Med 83(5A):60-65, 1987. Dimitrova Z et al: Antiherpes effect of Melissa officinalis L. extracts, Acta Microbiol Bulg 29:65-72, 1993. Dimov V et al: Immunomodulatory action of propolis, IV: prophylactic activity against gramnegative infections and adjuvant effect of the water-soluble derivative, Vaccine 10(12): 817-823, 1992. Dixit VP et al: Hypolipidemic activity of guggal resin (Commiphora mukul) and garlic (Alium sativum linn.) in dogs (Canis familiaris) and monkeys (Presbytis entellus entellus Dufresne), Biochem Exp Biol 16(4):421-424, 1980. Dobryniewski J et al: The gamma-linolenic acid (GLA) – the therapeutic value, Przegl Lek 64(2):100-102, 2007. Doi K et al: Treatment of diabetes with glucomannan (konjac mannan), Lancet 1:987-988, 1979. Dolara P et al: Local anaesthetic, antibacterial, and antifungal properties of sesquiterpenes from myrrh, Planta Med 66(4):356-358, 2000. Domae N et al: Cardiomyopathy and other chronic toxic effects induced in rabbits by doxorubicin and possible prevention by coenzyme Q10, Cancer Treat Rep 65:79-91, 1981. Dorant E et al: Consumption of onions and a reduced risk of stomach carcinoma, Gastroenterology 110(1):12-20, 1996. Dorman HJ et al: Antimicrobial agents from plants: antibacterial activity of plant volatile oils, J Appl Microbiol 88(2):306-318, 2000. Dorn DC et al: Tumor cell specific toxicity of Inhula helenium extracts, Phytother Res 20(11):970-980, 2006. Dos Santos JG et al: Sedative and anticonvulsant effects of hydroalcoholic extract of Equisetum arvense, Fitoterapia 76(6):508-513, 2005. Du JR et al: The new progress of the study about volatile oil of the angelica, Zhongguo Zhong Yao Za Zhi 30(18):1400-1406, 2005. Du Q et al: Isolation of two anthocyanin sambubiosides from bilberry (Vaccinium myrtillus) by high-speed counter-current chromatography, J Chromatogr A 1045(1-2):59-63, 2004. Ducray AD, et al: Creatine treatment promotes differentiation of GABA-ergic neuronal precursors in cultured fetal rat spinal cord, J Neurosci Res 85(9):1863-1875, 2007. Dugoua JJ et al: Safety and efficacy of blue cohosh (Caulophyllum thalictroides) during pregnancy and lactation, Can J Clin Pharmacol 15(1):e66-73, 2008. 675 Duke JA: Handbook of medicinal spices, Boca Raton, Fla, 2003, CRC Press. Durig J et al: Anticoagulant fucoidan fractions from Fucus vesiculosus induced platelet activation in vitro, Thromb Res 85(6):479-491, 1997. Dutta T et al: Crude extract of Centella asiatica and products derived from its glycosides as oral antifertility agents, Indian J Exp Biol 6(30):181-182, 1968. Duwiejua M et al: Anti-inflammatory activity of Polygonum bistorta, Guaiacum officinale and Hamamelis virginiana in rats, J Pharm Pharmacol 46(4):286-290, 1994. Duwiejua M et al: The anti-inflammatory compounds of Polygonum bistorta: isolation and characterisation, Planta Med 65(4):371-374, 1999. Dwoskin LP et al: A novel mechanism of action and potential use for lobeline as a treatment for psychostimulant abuse, Biochem Pharmacol 63(2):89-98, 2002. Dzink JL et al: Comparative in vitro activity of sanguinarine against oral microbial isolates, Antimicrob Agents Chemother 27:663, 1985. Eaton J: Butterbur: herbal help for migraine, Natr Pharmacy 10(10):23-24, 1998. Ebana RU et al: Microbiological exploitation of cardiac glycosides and alkaloids from Garcinia kola, Borreria ocymoides, Kola nitida and Citrus aurantifolia, J Appl Bacteriol 71(5):398-401, 1991. Eda A: Chinese traditional and herbal drugs communications, Fushun Fourth Hospital 1:37, 1972. Edgar AD et al: A critical review of the pharmacology of the plant extract of Pygeum africanum in the treatment of LUTS, Neurourol Urodyn 26(4):458-463, 2007. Editorial Dept: Kampo Kenkyu (2):51, 1979. Eguale T et al: In vitro and in vivo anthelmintic activity of crude extracts of Coriandrum sativum against Haemonchus contortus, J Ethnopharmacol, 110(3):428-433, 2007. Ehlers D et al: HPLC analysis of tonka bean extracts, Z Lebensm Unters Forsch 201(3):278-282, 1995. El Bahri L et al: Urginea maritima L. (squill): a poisonous plant of North Africa, Vet Hum Toxicol 42(2):108-110, 2000. El Bardai S et al: Pharmacological evidence of hypotensive activity of Marrubium vulgare and Foeniculum vulgare in spontaneously hypertensive rat, Clin Exp Hypertens 23(4): 329-343, 2001. Elakovich S et al: Analysis of coumestrol, a phytoestrogen, in alfalfa tablets sold for human consumption, J Agric Food Chem 32(1):173-175, 1984. el-Ashmawy IM et al: Protective effect of volatile oil, alcoholic and aqueous extracts of Origanum majorana on lead acetate toxicity in mice, Basic Clin Pharmacol Toxicol 97(4):238-243, 2005. Elfellah MS et al: Anti-hyperglycaemic effect of an extract of Myrtus communis in streptozotocininduced diabetes in mice, J Ethnopharmacol 11(3):275-281, 1984. El-Ghazaly M et al: Study of anti-inflammatory activity of Populus tremula, solidago virgaurea and Fraxinus execelsior, Arzneimittelforschung 42(3):333-336, 1992. Elhajili M et al: Diuretic activity of the infusion of flowers from Lavandula officinalis, Reprod Nutr Dev 41(5):393-399, 2001. El-Mofty MM et al: Carcinogenicity testing of black pepper (Piper nigrum) using the Egyptian toad (Bufo regularis) as a quick biological test animal, Oncology 43(3): 247-252, 1988. El-Mofty MM et al: Carcinogenic effect of force-feeding an extract of black pepper (Piper nigrum) in Egyptian toads (Bufo regularis), Oncology 48(4):347-350, 1991. Elson CE et al: Impact of lemongrass oil, an essential oil, on serum cholesterol, Lipids 24(8):677-679, 1989. Emamghoreishi M, Khasaki M, Aazam MF: Coriandrum sativum: evaluation of its anxiolytic effect in the elevated plus-maze, J Ethnopharmacol 96(3):365-370, 2005. Emelyanov A et al: Treatment of asthma with lipid extract of New Zealand green-lipped mussel: a randomized clinical trial, Eur Respir J 20(3):596-600, 2002. REFERENCES References 676 References Emmons CL et al: Antioxidant capacity of oat (Avena sativa L.) extracts, II: in vitro antioxidant activity and contents of phenolic and tocol antioxidants, J Agric Food Chem 47(12): 4894-4898, 1999. Engler M et al: Effects of dietary linolenic acid on blood pressure and adrenal angiotensin receptors in hypertensive rats, Proc Soc Exp Biol Med 218:234-237, 1998. English W et al: Efficacy of artichoke dry extract in clients with hyperlipoproteinemia, Arzneimittelforschung 50:260-265, 2000. Erdelmeier CA et al: Antiviral and antiphlogistic activities of Hamamelia virginiana bark, Planta Med 62(3):241-245, 1996. Erdman Jr JW et al: Effects of cocoa flavanols on risk factors for cardiovascular disease, Asia Pac J Clin Nutr 17(Suppl 1):284-287, 2008. Ernst E et al: A controlled multi-centre study of herbal versus synthetic secrolytic drugs for acute bronchitis, Phytomedicine 4(4):287-293, 1997. Escribano J et al: Crocin, safranal, and pitrocrocin from saffron inhibit the growth of cancer cell in vitro, Cancer Lett 100:23-30, 1996. Estrada A et al: Isolation and evaluation of immunological adjuvant activities of saponins from Polygala senga L., Comp Immunol Microbiol Infect Dis 21(1):27-43, 2000. Eyberger AL et al: Endophyte fungal isolates from Podophyllum peltatum produce podophyllotoxin, J Nat Prod 69(8):1121-1124, 2006. Fabis M et al: In vivo and in situ action of melatonin on insulin secretion and some metabolic implications in the rats, Pancreas 25(2):166-169, 2002. Facino RM et al: Anti-elastase and anti-hyaluronidase activities of saponins and sapogenins from Hedera helix, Aesculus hippocastanum, and Ruscus aculeatus: factors contributing to their efficacy in the treatment of venous insufficiency, Arch Pharm (Weinheim) 328(10):720-724, 1995. Fahrenbach MJ et al: Hypocholesterolemic activity of mucilaginous polysaccharides in white leghorn cockrels, Proc Soc Exp Biol Med 123:321, 1966. Fani MM et al: Inhibitory activity of garlic (Allium sativum) extract on multidrug-resistant Streptococcus mutans, J Indian Soc Pedod Prev Dent 25(4):164-168, 2007. Fassina G et al: Polyphenolic antioxidant epigallocatechin-3-gallate from green tea as a candidate anti-HIV agent, AIDs 16(6):939-941, 2002. Federal Register: 50 FR2124 et seq, Jan 15, 1985. Fejes S et al: Free radical scavenging membrane protective effects of methanol extracts from Anthriscus cerefolium L. and Petroselinum crispum, Phytother Res 14(5):362-365, 2000. Fejes S et al: Investigation of the in vitro antioxidant effect of Petroselinum crispum, Acta Pharm Hung 68(3):150-156, 1998. Felter HW: The eclectic materia medica: pharmacology and therapeutics, Sandy, Ore, 1922, reprinted by Eclectic Medical Publications. Feng SH et al: Effects of shengmaiyin and danshen-chuanxiong decoction on preventing cardiopulmonary changes in adults caused by a high-altitude environment, Zhong Xi Yi Jie He Za Zhi 9(11):643, 650-652, 1989. Fernandez MA et al: Anti-inflammatory activity in rats and mice of phenolic acids isolated from Scropularia frutescens, J Pharm Pharmacol 50:1183-1186, 1998. Fiebich BL et al: Inhibition of TNF-alpha synthesis in LPS-stimulated primary human monocytes by Harpagophytum extract steittap 69, Phytomedicine 8(1):28-30, 2001. Fiebich BL et al: Petasites hybridus extracts in vitro exhibit COX-2 and PGE2 release by direct interaction with the enzyme and by preventing p42/44 MAP kinase activation in rat primary microglial cells, Planta Med 71(1):12-19, 2005. Figard H et al: Effects of isometric strength training followed by no exercise and Humulus lupulus L-enriched diet on bone metabolism in old female rats, Metabolism 56(12): 1673-1681, 2007. Fisher AA et al: Toxicity of Passiflora incarnata L., J Toxicol Clin Toxicol 38(1):63-66, 2000. 677 Flora K et al: Milk thistle (Silybum marianum) for the therapy of liver disease, Am J Gastroenterol 93(2):139-143, 1998. Flora SJ, Gupta R: Beneficial effects of Centella asiatica aqueous extract against arsenic-induced oxidative stress and essential metal status in rats, Phytother Res 21(10):980-988, 2007. Fokina GI et al: Experimental phytotherapy of tick-borne encephalitis, Vopr Virusol 36(1): 18-21, 1991. Foldeak S et al: Aceta univ szeged, Acta Phys Chem 10:91, 1964. Folmer F et al: Inhibition of TNFalpha-induced activation of nuclear factor kappaB by kava (Piper methysticum) derivatives, Biochem Pharmacol 71(8):1206-1218, 2006. Food and Nutritional Board: Recommended dietary allowances, 10 ed, Washington, DC, 1989, National Academy Press. Forgo I et al: The duration of effect of the standardized ginseng extract G115 in healthy competitive athletes, Notobene Medici 15(9):636-640, 1985. Foster S: Cat’s claw, Health Food Bus, June 24, 1995. Foster S: 101 medicinal herbs, Loveland, Colo, 1999, Interweave Press. Fourie TG et al: A pentacyclic triterpene with anti-inflammatory and analgesic activity from the roots of Commiphora merkeri, J Nat Prod 52(5):1129-1131, 1989. Francis JA et al: Bioactive terpenoids and guggulusteroids from Commiphora mukul gum resin of potential anti-inflammatory interest, Chem Biodivers 1(11):1842-1853, 2004. Franco-Molina M et al: In vitro immunopotentiating properties and tumour cell toxicity induced by Lophophora williamsii (peyote) cactus methanolic extract, Phytother Res 17(9):1076-1081, 2003. Freudenstein J et al: Lack of promotion of estrogen-dependent mammary gland tumors in vivo by an isopropanitic Cimicifuga racemosa extract, Cancer Res 62(12):3448-3452, 2002. Freysdottir J et al: In vitro and in vivo immunomodulating effects of traditionally prepared extract and purified compounds from Cetraria islandica, Int Immunopharmacol 8(3):423-430, 2008. Friese KH et al: The homeopathic treatment of otitis media in children: comparisons with conventional therapy, Int J Clin Pharmacol Ther 35:296-301, 1997. Fu YW et al: The immunostimulatory effects of hot-water extract of Gelidium amansii via immersion, injection and dietary administrations on white shrimp Litopenaeus vannamei and its resistance against Vibrio alginolyticus, Fish Shellfish Immunol 22(6):673-685, 2007. Fugh-Berman A: Herb-drug interactions, Lancet 355(9198):134-138, 2000. Fukumasu H et al: Chemopreventive effects of Paullinia cupana Mart var. sorbilis, the guaraná, on mouse hepatocarcinogenesis, Cancer Lett 233(1):158-164, 2006. Fukumasu H et al: Paullinia cupana Mart var. sorbilis, guaraná, reduces cell proliferation and increases apoptosis of B16/F10 melanoma lung metastases in mice, Braz J Med Biol Res 41(4):305-310, 2008. Fukushima M et al: Cholesterol-lowering effects of maitake fiber, shiitake fiber, and enokitake, Exp Biol Med 226(8):758-765, 2001. Fukuyama Y et al: Triterpenoids from Viburnum suspension, Phytochemistry 60(8):765-768, 2002. Fusi L et al: Effects of procyanidolic oligomers from Vitis vinifera in subjects working at video-display units, Ann Ottalmologia Clin Oculista 116:575, 1990. Gallo M et al: Can herbal products be used safely during pregnancy? Focus on echinacea, Can Fam Physician 47:1727-1728, 2001. Galván IJ, et al: Antifungal and antioxidant activities of the phytomedicine pipsissewa, Chimaphila umbellata, Phytochemistry 69(3):738-746, 2008. Galvez J et al: Antidiarrheic activity of Euphorbia hirta extract and isolation of an active flavonoid constituent, Planta Med 59:333-336, 1993. Gambhirr SS et al: Antispasmodic activity of the tertiary base of Daucus carota Linn seeds, Indian J Physiol Pharmacol 23(3):225-228, 1979. REFERENCES References 678 References Gandhi M et al: Post-coital antifertility action of Ruta graveolens in female rats and hamsters, J Ethnopharmacol 34(1):49-59, 1991. Gangar SC et al: Modulatory effects of Azadirachta indica on benzo(a) pyrene-induced forestomach tumorigenesis in mice, World J Gastroenterol 12(17):2749-2755, 2006. Gao D et al: Antidiabetic potential of oleanolic acid from Ligustrum lucidum Ait, Can J Physiol Pharmacol 85(11):1076-1083, 2007b. Gao X et al: Blood lipid-regulation of stilbene glycoside from polygonum multiflorum, Zhongguo Zhong Yao Za Zhi 32(4):323-326, 2007a. Gassinger CA et al: A controlled clinical trial for testing the efficacy of the homeopathic drug Eupatorium perfoliatum D2 in the treatment of the common cold, Arzneimittelforschung 31(4):732-736, 1981. Gatto G et al: Analgesizing effect of a methyl donor (S-adenosylmethionine) in migraine: an open clinical trial, Int J Clin Pharmacol Res 6:15-17, 1986. Gebhardt R: Multiple inhibitory effects of garlic extracts on cholesterol biosynthesis in hepatocytes, Lipids 28(7):613-619, 1993. Genovese T et al: Hypericum perforatum attenuates the development of cerulein-induced acute pancreatitis in mice, Shock 25(2):161-167, 2006. Gentil M et al: In vitro evaluation of the antibacterial activity of Arctium lappa as a phytotherapeutic agent used in intracanal dressings, Phytother Res 20(3):184-186, 2006. Georgiev DB et al: Effects of an herbal medication containing bee products on menopausal symptoms and cardiovascular risk markers: results of pilot open-uncontrolled trial, Med Gen Med 6(4):46, 2004. Georgieva E et al: Symposium on use of bee products in human and veterinary medicine, International Beekeeping Congress 23, 1971. Gerber GS: Saw palmetto for the treatment of men with lower urinary tract symptoms, J Urol 163(5):1408-1412, 2000. German Federal Minister of Justice: German Commission E for human medicine monograph, Bundes-Anzeiger (German Federal Gazette) 17(11):1, 1991. Gertsch JH et al: Ginkgo biloba for the prevention of severe acute mountain sickness (AMS) starting one day before rapid ascent, High Alt Med Biol 3(1):29-37, 2002. Gessler MC et al: Screening Tanzanian medicinal plants for antimalarial activity, Acta Trop 56(1):65-77, 1994. Giachetti D et al: Diuretic and uricosuric activity of Agrimonia eupatoria L., Boll Soc Ital Biol Sper 62(6):705-711, 1986. Giese LA: Milk thistle and the treatment of hepatitis, Gastroenterol Nurs 24(2):95-97, 2001. Gilani AH et al: Esculetin prevents liver damage induced by paracetamol and CCL 4, Pharmacol Res 37:31-35, 1998. Gilani AH et al: Hepatoprotective activity of aqueous-methanol extract of Artemisia vulgaris, Phytother Res 19(2):170-172, 2005. Gilljam G: Envelope glycoproteins of HIV-1, HIV-2, and SIV purified with Galanthus nivalis, AIDS Res Hum Retroviruses 9(5):431-438, 1993. Gnabre JN et al: Isolation of anti-HIV-1 lignans from Larrea tridentata by counter-current chromatography, J Chromatrogr A 19(2):353-364, 1996. Gnabre JN et al: Chaparral revisited: with a dash of linseed, Mediherb Monitor 23:1-2, 1997. Gobel H et al: Effects of Harpagophytum procumbens LI 174 (devil’s claw) on sensory, motor and vascular muscle reagibility in the treatment of unspecific back pain, Schmerz 15(1):10-18, 2000. Godhwani S et al: Ocimum sanctum: a preliminary study evaluating its immunoregulatory profile of albino rats, J Ethnopharmacol 24:193-198, 1988. Godowski KC: Antimicrobial action of sanguinarine, J Clin Dent 1:96-101, 1989. Goepel M et al: Saw palmetto extracts potently and noncompetitively inhibit human alpha 1-adrenoceptors in vitriol, Prostate 38(3):208-215, 1999. 679 Gollapudi S et al: Isolation of a previously unidentified polysaccharide (Mar-10) from Hyssopus officinalis that exhibits strong activity against human immunodeficiency virus type 1, Biochem Biophys Res Commun 210(1):145, 1995. Gonzalez I et al: Plasma lipids of golden Syrian hamsters fed dietary rose hip, sunflower, olive and coconut oils, Rev Esp Fisiol 53(2):199-204, 1997. Gonzalez-Fandos E et al: Staphylococcal growth and enterotoxins (A-D) and thermonuclease synthesis in the presence of dehydrated garlic, J Appl Bacteriol 77(5):549-552, 1994. Gorbunov NP et al: Pharmacological correction of myocardial ischemia and arrhythmias in reversible coronary blood flow disorders and experimental myocardial infarct in dogs, Kardiologiia 20(5):84-87, 1980. Gordon A et al: Effects of Silybum marianum on serum hepatitis C virus RNA, alanine aminotransferase levels and well-being in patients with chronic hepatitis C, J Gastroenterol Hepatol 21(1 Pt 2):275-280, 2006. Gordon JB: SSRIs and St. John’s wort: possible toxicity? Am Fam Physician 57:950-953, 1998. Gorter RW et al: Tolerability of an extract of European mistletoe among immunocompromised and healthy individuals, Altern Ther Health Med 5(6):37-44, 47-48, 1999. Gotteland O et al: Systematic review: are probiotics useful in controlling gastric colonization by Helicobacter pylori? Aliment Pharmacol Ther 23(8):1077-1086, 2006. Gould M: Prevention and therapy of mammary cancer by monoterpenes, J Cell Biochem 22(suppl):139-144, 1995. Gran L et al: Oldenlandia affinis (R & S) DC: a plant containing uteroactive peptides used in African traditional medicine, J Ethnopharmacol 70(3):197-203, 2000. Grases F et al: Urolithiasis and phytotherapy, Int Urol Nephrol 26(5):507-511, 1994. Grasses F et al: Effect of Herniaria hirsuta and Agropyron repens on calcium oxalate urolithiasis risk in rats, J Ethnopharmacol 45:211-214, 1995. Gray AM et al: Insulin-releasing and insulin-like activity of the traditional anti-diabetic plant Coriandrum sativum, Br J Nutr 81(3):203-209, 1999. Gray AM et al: The traditional plant treatment, Sambucus nigra (elder), exhibits insulin-like and insulin-releasing actions in vitro, J Nutr 130(1):15-20, 2000. Gray AM, Flatt PR: Actions of the traditional anti-diabetic plant, Agrimony eupatoria (agrimony): effects on hyperglycaemia, cellular glucose metabolism and insulin secretion, Br J Nutr 80(1):109-114, 1998. Graydon R et al: Effect of lycopene supplementation on insulin-like growth factor-a and insulinlike growth factor binding protein-3: a double-blind, placebo-controlled trial, Eur J Clin Nutr 61(10):1196-1200, 2007. Greenhaff PL et al: Influence of oral creatine supplementation of muscle torque during repeated bouts of maximal voluntary exercise in man, Clin Sci 84:565-571, 1993. Griffin WJ et al: Analysis of Duboisia myoporoids R. Br. and Duboisia leichhardtii F. Muell, J Pharm Sci 64(11):1821-1825, 1975. Griffith R et al: A multicentered study of lysine therapy in herpes simplex infection, Dermatologica 156(5):257-267, 1978. Griffiths JK et al: Two cases of endocarditis due to Lactobacillus species: antimicrobial susceptibility, review, and discussion of therapy, Clin Infect Dis, 15(2):250-255, 1992. Grubben MA et al: Unfiltered coffee increases plasma homocysteine concentrations in healthy volunteers: a randomized trial, Am J Clin Nutr 71:480-484, 2000. Gruenwald J et al: PDR for herbal medicines, Montvale, NJ, 1998, Medical Economics. Gu CQ et al: Isolation, identification and function of a novel anti-HSV-1 protein from Grifola frondosa, Antiviral Res 75(3):250-257, 2007. Gu WL et al: Comparative study of Scrophulariae and Aconite in inhibiting myocardial hypertrophy in rats and mice, Zhong Xi Yi Jie He Xue Bao 6(4):376-380, 2008. Gu YH, Belury MA: Selective induction of apoptosis in murine skin carcinoma cells (CH72) by an ethanol extract of Lentinula edodes, Cancer Lett 220(1):21-28, 2005. REFERENCES References 680 References Gudima SO et al: Kinetic analysis of interaction of human immunodeficiency virus reverse transcriptase with alkaloids, Mol Biol 28(6):1308-1314, 1994. Guevara JM et al: The in-vitro action of plants of Vibrio cholerae, Rev Gastroenterol Peru 14(1):27-31, 1994. Gulcin I et al: Determination of antioxidant activity of lichen Cetraria islandica, J Ethnopharmacol 79(3):325-329, 2002. Gulick RM et al: Phase I studies of hypericin, the active compound in St. John’s wort, as an antiretroviral agent in HIV-infected adults, Ann Int Med 130:510-514, 1999. Gulliver WP, Donsky HJ: A report on three recent clinical trials using Mahonia aquifolium 10% topical cream and a review of the worldwide clinical experience with Mahonia aquifolium for the treatment of plaque psoriasis, Am J Ther 12(5):398-406, 2005. Gundermann KJ, Müller J: Phytodolor – effects and efficacy of a herbal medicine, Wien Med Wochenschr 157(13-14):343-347, 2007. Gundidza M et al: Antimicrobial activity of the essential oil from Eucalyptus maidenii, Planta Med 59:705-706, 1993. Gupta A et al: Modulation of some gluconeogenic enzyme activities in diabetic rat liver and kidney: effect of antidiabetic compounds, Indian J Exp Biol 37(2):196-199, 1999. Gupta A et al: Effect of Trigonella foenum-graecum (fenugreek) seeds on glycaemic control and insulin resistance in type 2 diabetes mellitus: a double blind placebo controlled study, J Assoc Physicians India 49:1057-1061, 2001. Gupta B et al: Curcuma longa inhibits TNF-alpha induced expression of adhesion molecules on human umbilical vein endothelial cells, Int J Immunopharmacol 21(11):745-757, 1999. Gupta I et al: Effects of Boswellia serrata gum resin in patients with ulcerative colitis, Eur J Med Res 2(1):37-43, 1997. Gupta YK et al: Antiepileptic activity of Panax ginseng against pentylene-tetrazole induced kindling in rats, Indian J Physiol Pharmacol 45(4):502-506, 2001. Gurley BJ et al: Supplementation with goldenseal (Hydrastis canadensis), but not kava kava (Piper methysticum), inhibits human CYP3A activity in vivo, Clin Pharmacol Ther 83(1):61-69, 2008. Gurman EG et al: The effect of food and drug herbal extracts on the hydrolysis and transport of sugars in the rat small intestine under different experimental conditions, Fiziol Zh SSSR Im IM Sechenova 78(8):109-116, 1992 (abstract) (in Russian). Haag JD, Gould MN: Mammary carcinoma regression induced by perillyl alcohol, a hydroxylated analog of limonene, Cancer Chemother Pharmacol 34:477-483, 1994. Haaz S et al: Citrus aurantium and synephrine alkaloids in the treatment of overweight and obesity: an update, Obes Rev 7(1):79-88, 2006. Habermehl D et al: Proapoptotic activity of Ukrain is based on Chelidonium majus L. alkaloids and mediated via a mitochondrial death pathway, BMC Cancer 6:14, 2006. Habib FK et al: Serenoa repens (Permixon) inhibits the 5alpha-reductase activity of human prostate cancer cell lines without interfering with PSA expression, Int J Cancer 114(2): 190-194, Mar 20, 2005 Habtemariam S et al: Cytotoxicity and antibacterial activity of ethanol extract from leaves of a herbal drug, boneset (Eupatorium perfoliatum), Phytother Res 14(7):575-577, 2000. Habtemariam S: Hamamelitannin from Hamamelis virginiana inhibits the tumour necrosis factor-alpha (TNF)-induced endothelial cell death in vitro, Toxicon 40(1):83-88, 2002. Hajji F et al: Antimicrobial activity of twenty-one eucalyptus essential oils, Fititerapia 64(1): 71-77, 1993. Haksar A et al: Zingiber officinale exhibits behavioral radioprotection against radiation-induced CTA in a gender-specific manner, Pharmacol Biochem Behav 84(2):179-188, 2006. Hall TB Jr: Eupatorium perfoliatum: a plant with a history, Mo Med 71(9):527-528, 1974. Haller CA, Benowitz NL, Jacob P: Hemodynamic effects of ephedra-free weight-loss supplements in humans, Am J Med 118(9):998-1003, 2005. 681 Halpern GM: Anti-inflammatory effects of stabilized lipid extract of Perna Canaliculus, Allerg Immunol 32(7):272-278, 2000. Hambrecht R et al: Correction of endothelial dysfunction in chronic heart failure: additional effects of exercise training and oral L-arginine supplementation, J Am Coll Cardiol 35:706-713, 2000. Hammad M et al: Inhibition of Streptococcus mutans adhesion to buccal epithelial cells by an aqueous extract of Thymus vulgaris, Int J Dent Hyg 5(4):232-235, 2007. Hammer K et al: In-vitro of essential oils, in particular Melaleuca alternifolia (tea tree) oil and tea tree oil products, against Candida spp., J Antimicrob Chemother 42(5):591-595, 1998. Hanaki Y et al: Ratio of low-density lipoprotein cholesterol to ubiquinone as a coronary risk factor, N Engl J Med 325:814-815, 1991. Hancke J et al: A double blind study with a new monodrug: kan jang—decrease of symptoms and improvements in recovery from the common cold, Phytother Res 9:559-562, 1995. Hanzlik RP et al: Relative bioavailability of calcium from calcium formate, calcium citrate, and calcium carbonate, J Pharmacol Exp Ther 313(3):1217-1222, 2005. Hapke HJ: Pharmacological effects of hordenine, Dtsch Tierarztl Wochenschr 102:228-232, 1995 (abstract). Haranaka K et al: Antitumor activities and tumornecrosis factor producibility of traditional Chinese medicines and crude drugs, Cancer Immunol Immunother 20(1):1-5, 1985. Harinantenaina L et al: Momordica charantia constituents and antidiabetic screening of the isolated major compounds, Chem Pharm Bull (Tokyo) 54(7):1017-1021, 2006. Harmala P et al: Isolation and testing of the calcium blocking activity of furanocoumarins from Angelica archangelica, Planta Med 57:A58-A59, 1991. Harmala P et al: Choice of solvent in the extraction of Angelica archangelica roots with reference to calcium blocking activity, Planta Med 58:176-183, 1992. Harris PJ et al: Dietary fibre: its composition and role in protection against colorectal cancer, Mutat Res 290(1):97-110, 1993. Harvengt C et al: HDL-cholesterol increase in normolipaemic subjects on khellin: a pilot study, Int J Clin Pharmacol Res 3(5):363-366, 1983. Hatch RC: Effects of other drugs on catnip-induced pleasure behavior in cats, Am J Vet Res 33:143-155, 1972. Hattori T et al: Preliminary evidence for inhibitory effect of glycyrrhizin on HIV replication in patients with AIDS, Antiviral Res 11:255-261, 1989. Hausen BM et al: The sensitizing capacity of chimaphilin, a naturally-occuring quinone, Contact Dermatitis 19(3):180-183, 1988. Hayashi K et al: Antitumor active glycosides from condurango cortex, Chem Pharm Bull 28:1954-1958, 1980. Hayes PY et al: Complete (1)H and (13)C assignments of the four major saponins from Dioscorea villosa (wild yam), Magn Reson Chem 45(11):1001-1005, 2007. Hayet E et al: Antibacterial and cytotoxic activity of the acetone extract of the flowers of Salvia sclarea and some natural products, Pak J Pharm Sci 20(2):146-148, 2007. Heck AM et al: Potential interactions between alternative therapies and warfarin, Am J Health Syst Pharm 57(13):1221-1227, 2000. Heggers JP: Beneficial effects of aloe in wound healing, Phytother Res 7:s48-s52, 1993. Heptinstall L et al: Feverfew: a review of its history, its biological and medicinal properties, and the status of commercial preparations of the herb. In Lawson L et al: Phytomedicines of Europe: chemistry and biological activity, Washington, DC, 1998, American Chemical Society, pp 158-175. Hergenhahn M et al: On the active principles of the spurge family (Euphorbiaceae), V: extremely skin-irritant and moderately tumor-promoting diterpene esters from Euphorbia resinifera Berg, J Cancer Res Clin Oncol 108(1):98-109, 1984. Heymsfield SB et al: Garcinia cambogia as a potential antiobesity agent: a randomized controlled trial, JAMA 280:1596-1600, 1998. REFERENCES References 682 References Higano T et al: Convallasaponin A, a new 5beta-spirostanol triglyceride from the rhizomes of Convallaria majalis, Chem Pharm Bull (Tokyo) 55(2):337-339, 2007. Hikino H: Recent research on oriental medicinal plants, Economic Med Plant Res 1:53-85, 1985. Hirasawa M et al: Three kinds of antibacterial substances from Lentinus edodes, Int J Antimicrob Agents 11(2):151-157, 1999. Hirata JD et al: Does dong quai have estrogenic effects in postmenopausal women? A double blind, placebo-controlled trial, Fertility and Sterility 68(6):981-986, 1997. Hirata N et al: Testosterone 5alpha-reductase inhibitory active constituents of Piper nigrum leaf, Biol Pharm Bull 30(12):2402-2405, 2007. Hirazumi A et al: An immunomodulatory polysaccharide-rich substance from the fruit juice of Morinda citrifolia (noni) with antitumor activity, Proc West Pharmacol Soc 37:145-146, 1994. Hitokoto H et al: Inhibitory effects of spices on growth and toxin production of toxigenic fungi, Appl Environ Microbiol 39:18-22, 1980. Hitti M: Study probes weight loss supplement chitosan, WebMDHealth, 2005, available at: http:// www.webmd.com/diet/news/20050825/study-probes-weight-loss-supplement-chitosan. Accessed June 24, 2008. Hobbs C: Handbook for healing: a concise guide to herbal products, Williams, Ore, 1995, Botanica Press. Holdsworth ES et al: Extracts of brewers yeast contain GABA which enhances activation of glycogen synthetase by insulin in isolated rat hepatocyte, Biochem Int 17(6):1107-1116, 1988. Holm E et al: Studies on the profile of the neurophysiological effects of D, L-kavain: cerebral sites of action and sleep-wakefulness-rhythm in animals, Arzneimittelforschung 41: 673-683, 1991. Holzgartner H et al: Comparison of the efficacy and tolerance of a garlic preparation versus bezafibrate, Arzneimittelforschung 42:1473-1477, 1992. Hong Y et al: Am J Chin Med 22(1):63-70, 1994. Hopf H et al: Phytochemistry 16:1715, 1977. Horio H et al: Maitake improves glucose tolerance of experimental diabetic rats, J Nutr Sci Vitaminol 47(1):57-63, 2001. Hossain CF et al: A new series of coumarin derivatives having monoamine oxidase inhibitory activity from Monascus anka, Chem Pharm Bull 44(6):1535-1539, 1996. Hriscu A et al: A pharmacodynamic investigation of the effect of polyholozidic substances extracted from Plantago sp. on the digestive tract, Rev Med Chir Soc Med Nat Iasi 94(1): 165-170, 1990. Hsiao G et al: Protective mechanisms of inosine in platelet activation and cerebral ischemic damage, Arterioscler Thromb Vasc Biol 25(9):1998-2004, 2005. Hsieh MT et al: The ameliorating effects of the cognitive-enhancing Chinese herbs on scopolamineinduced amnesia in rats, Phytother Res 14(5):375-377, 2000. Hsu M et al: Effect of hsien-ho-t’sao (Agrimonia pilosa) on experimental thrombosis in mice, Am J Chin Med 15:43-51, 1987. Hua Z et al: Inhibitory effects of berberine on potassium channels in guinea pig ventricular myocytes, Yao Hsueh Hsueh Pao 29:576-580, 1994. Huang C et al: Antiinflammatory compounds isolated from Menyanthes trifoliata L., Yao Hsueh Hsueh Pao 30:621-626, 1995. Huang W et al: Ventricular tachyarrhythmias treated with berberine, Chung Hua Hsin Hsueh Kuan Ping Tsa Chih 18:155-156, 190, 1990. Huang WW et al: Pycnogenol induces differentiation and apoptosis in human promyeloid leukemia HL-60 cells, Leuk Res 29(6):685-692, 2005. Huck CW et al: Isolation and characterization of methoxylated flavones in the flowers of Primulaveris by liquid chromatography and mass spectrometry, J Chromatography A 870 (1-2):453-462, 2000. 683 Hughes B et al: Antimicrobial effects of Allium sativum, Allium ampeloprasum and Allium cepa, garlic compounds and commercial garlic supplement products, Phytother Res 5:154-158, 1991. Hughes VL et al: Microbiologic characteristics of Lactobacillus products used for colonization of the vagina, Obstet Gynecol 75(2):244, 1990. Hughes-Formella BJ et al: Anti-inflammatory effect of hamamelis lotion in UVB erythema test, Dermatology 196(3):316-322, 1998. The Huntington Study Group: A randomized, placebo-controlled trial of coenzyme Q10 and remacemide in Huntington’s disease, Neurology 57(3):397-404, 2001. Huppert FA, Van Niekerk JK: WITHDRAWN: Dehydroepiandrosterone (DHEA) supplementation for cognitive function, Cochrane Database Syst Rev (2):CD000304, 2006. Hussain SP et al: Chemoprotective action of mace (Myristica fragrans Houtt) on methylcholanthrene-induced carcinogenesis in the uterine cervix in mice, Cancer Lett 56(3):231-234, 1991. Hussein G et al: Inhibitory effects of sudanese medicinal plant extracts on hepatitis C virus (HCV) protease, Phytother Res 14(7):510-516, 2000 Hutter JA et al: Antiinflammatory C-glucosyl chromone from Aloe barbadensis, Am Chem Society 59:541-543, 1996. Huynh HT et al: Effects of intragastrically administered pycnogenol on NNK metabolism in F344 rats, Anticancer Res 19(3A):2095-2099, 1999. Huynh HT et al: Selective induction of apoptosis in human mammary cancer cells (MCF-7) by pycnogenol, Anticancer Res 20(4):2417-2420, 2000. Hwang IK et al: An extract of Polygonum multiflorum protects against free radical damage induced by ultraviolet B irradiation of the skin, Braz J Med Biol Res 39(9):1181-1188, 2006. Hwang SB: L-652, 469—a dual receptor antagonist of platelet activating factor and dihydropyrimidines from Tussilago farfara L., Eur J Pharmacol 141(2):269-281, 1987. Iacobellis NS et al: Antibacterial activity of Cuminum cyminum L. and Carum carvi L. essential oils, J Agric Food Chem 53(1):57-61, 2005. Ibu JO et al: The effect of Cola acuminata and Cola nitida on gastric acid secretion, Scand J Gastroenterol Suppl 124:39-45, 1986. Iguchi K et al: Myristoleic acid, a cytotoxic component in the extract from Serenoa repens, induces apoptosis and necrosis in human prostatic L NCaP cells, Prostate 47(1):59-65, 2001. Ikegami N et al: Prophylactic effect of long-term oral administration of glycyrrhizin on AIDS development of asymptomatic patients, Int Conf AIDS 1993 9:234, 1993. Iliev AI et al: A post-ischaemic single administration of galanthamine, a cholinesterase inhibitor, improves learning ability in rats, J Pharm Pharmacol 52(9):1151-1156, 2000. Illicento S et al: Effects of L-carnitine administration on left ventricular remodeling after acute anterior myocardial infarction, J Am Coll Cardiol 26:380-387, 1995. Imai K et al: Cross sectional study of effects of drinking green tea on cardiovascular and liver disease, Br Med J 310:693-696, 1995. Imaoka K et al: Effects of Perilla frutescens extract on anti-DNP IgE antibody production in mice, Arerugi 42(1):74-80, 1993. Inbaraj JJ et al: Photochemistry and photocytotoxicity of alkaloids from Goldenseal l. Berberine, Chem Res Toxicol 14(1):1529-1534, 2001. Ingolfsdottir K et al: In vitro evaluation of the antimicrobial activity of lichen metabolites as potential preservatives, Antimicrob Agents Chemother 28:289-292, 1985. Ingolfsdottir K et al: Immunologically active polysaccharide from Centraria islandica, Planta Med 60:527-531, 1994. Ingolfsdottir K et al: In vitro susceptibility of Helicobacter pylori to protolichesterinic acid from the lichen Cetraria islandica, Antimicrob Agents Chemother 41(1):215-217, 1997. Ingram D et al: Case-control study of phytoestrogens and breast cancer, Lancet 350:990-994, 1997. REFERENCES References 684 References Iscan G et al: Antimicrobial screening of Mentha Piperita essential oils, J Agric Food Chem 50(14):3943-3946, 2002. Ishihara K et al: Interactions of drugs and Chinese herbs: pharmacokinetic changes of tolbutamide and diazepam caused by extract of Angelica dahuria, J Pharm Pharmacol 52(8):1023-1029, 2000. Ishihara T et al: Inhibition of antigen-specific T helper type 2 responses by Perilla frutescens extract, Arerugi 48(4):443-450, 1999. Ishii Y et al: Studies of aloe, III: mechanism of cathartic effect, Chem Pharm Bull 38:197-200, 1990. Ishii Y et al: Studies of aloe, IV: mechanism of cathartic effect, Biol Pharm Bull 17:495-497, 1994a. Ishii Y et al: Studies of aloe, V: mechanism of cathartic effect, Biol Pharm Bull 17:615-653, 1994b. Islam MW et al: Evaluation of teratogenic potential of khat (Catha edulis Forsk) in rats, Drug Chem Toxicol 17(1):51-68, 1994. Izachia F et al: Brewer’s yeast and Saccharomyces boulardii both attenuate Clostridum difficile-induced colonic secretion in the rat. Dig Dis Sci 43(9):2055-2060, 1998. Jackson B et al: Effect of cranberry juice on urinary pH in older adults, Home Health Nurse 15:198-202, 1997. Jacobsen E: Tranquilizers and sedatives. In Laurence DR, Bacharach AL, editors: Evaluation of drug activities, vol I, pharmacometrics, New York, 1964, Academic Press. Jafri MA et al: Effect of Punica granatum Linn (flowers) on blood glucose level in normal and alloxan-induced diabetic rats, J Ethnopharmacol 70(3):309-314, 2000. Jãger AK et al: Screening of plants used in Danish folk medicine to treat epilepsy and convulsions, J Ethnopharmacol 105(1-2):294-300, 2006. Jahodar L et al: Antimicrobial action of arbutin and the extract, Cesk Farm 34:174, 1985. Jain SR et al: Effect of some common essential oils on pathogenic fungi, Planta Medica 24(2):127, 1973. Jamal A et al: Gastroprotective effect of cardamom, Elettaria cardamomum Maton. fruits in rats, J Ethnopharmacol 103(2):149-153, 2006. James SP et al: Melatonin administration in insomnia, Neuropsychopharacol 3:19, 1989. Jannu LN et al: Chemoprotective action of mace (Myristica fragrans Houtt) on DMBA-induced papillomagenesis in the skin of mice, Cancer Lett 56(1):59-63, 1991. Januário AH et al: Isolation and structure determination of bioactive isoflavones from callus culture of Dipteryx odorata, Chem Pharm Bull (Tokyo) 53(7):740-742, 2005. Jarry H et al: Agnus castus as a dopaminergic active principle, Phytotherapie 12:77-82, 1991. Javen M et al: Antinociceptive effects of Trigonella foenum-graecum leaves extract, J Ethnopharmacol 58(2):125-129, 1997. Jellin JM et al: Natural medicines comprehensive database, Stockton, Calif, 2008, Therapeutic Research Faculty. Jeon HJ et al: Anti-inflammatory activity of Taraxacum officinale, J Ethnopharmacol 115(1): 82-88, 2008. Jepson RG et al: Cranberries for preventing urinary tract infections, Cochrane Database Syst Rev 2:CD001321, 2000. Ji HT et al: Green tea consumption and the risk of pancreatic and colon cancer, Int J Cancer 7:255-258, 1997. Jiao S et al: Effects of Citrus aurantium extract on liver antioxidant defense function in experimental diabetic mouse, Wei Sheng Yan Jiu 36(6):689-692, 2007. Jiménez-Medina E et al: A new extract of the plant Calendula officinalis produces a dual in vitro effect: cytotoxic anti-tumor activity and lymphocyte activation, BMC Cancer 6:119, 2006. Johnson BM et al: Screening botanical extracts for quinoid metabolities, Chem Res Toxicol 14(11):1546-1551, 2001. 685 Jones JA et al: Use of DHEA in a patient with advanced prostate cancer: a case report and review, Urology 50(5):784-788, 1997. Jones K: Cat’s claw: healing vine of Peru, Seattle, 1995, Sylvan. Jones N et al: Capsaicin as an inhibitor of the growth of the gastric pathogen Helicobacter pylori, FEMS Microbiol Lett 146:223-227, 1997. Jones TK et al: Profound neonatal congestive heart failure caused by maternal consumption of blue cohosh herbal medication, J Pediatr 132(3 pt 1):550-552, 1998. Jorge OA, Jorge AD: Hepatotoxicity associated with the ingestion of Centella asiatica, Rev Esp Enferm Dig 97(2):115-124, 2005. Jouad H et al: Hypoglycemic effect of aqueous extract of Ammi visnaga in normal and streptozotocin-induced diabetic rats, J Herb Pharmacother 2(4):19-29, 2002. Juhasz L et al: Simple synthesis of benzofuranoid neolignans from Myristica fragrans, J Nat Prog 63(6):866-870, 2000. Jung KH et al: Suppressive effect of Punica granatum on the production of tumor necrosis factor (Tnf) in BV2 microglial cells, Biol Pharm Bull 29(6):1258-1261, 2006. Kaats G et al: A randomized, double-masked, placebo-controlled study of the effects of chromium picolinate supplementation on body composition: a replication and extension of a previous study, Curr Ther Res 59(6):326-329, 1998. Kabir Y et al: Effect of shiitake (Lentinus edodes) and maitake (Grifola frondosa) mushrooms on blood pressure and plasma lipids of spontaneously hypertensive rats, J Nutr Sci Vitaminol 33(5):341-346, 1987. Kabir Y et al: Dietary mushrooms reduce blood pressure in spontaneously hypertensive rats (SHR), J Nutr Sci Vitaminol 35(1):91-94, 1989. Kahkonen MP et al: Antioxidant activity of plant extracts containing phenolic compounds, J Agric Food Chem 47(10):3954-3962, 1999. Kajimura K et al: Protective effect of astragali radix by intraperitoneal injection against Japanese encephalitis virus infection in mice, Biol Pharm Bull 19(6):855-859, 1996. Kajimura K et al: Polysaccharide os astragali radix enhances IgM antibody production in aged mice, Biol Pharm Bull 20(11):1178-1182, 1997. Kako M et al: Hypoglycemic effect of rhizomes of Polygala senega in normal and diabetic mice and its main component, the triterpenoid glycoside senegin-II, Planta Med 62(5):440-443, 1996. Kalix P: Catha edulis, a plant that has amphetamine-like effects, Pharm World Sci 18(2):69-73, 1996. Kamagate A et al: Etude in vitro de l’action de la kola “nitida” 5 hr les souches bacteriennes impliguees dans les caries dentaires et les maladies parodontales, Odontostomatol Trop 25(98):32-34, 2002. Kameda J et al: Medical studies on seaweeds, I, Fukushima Igaku Zussi 10:251, 1960. Kameda J et al: Medical studies on seaweeds, II, Fukushima Igaku Zussi 11:289-309, 1961. Kamiya K et al: Chemical constituents of Morinda citrifolia roots exhibit hypoglycemic effects in streptozotocin-induced diabetic mice, Biol Pharm Bull 31(5):935-938, 2008. Kanagaraj P et al: Effect of lycopene on insulin-like growth factor-I, IGF binding protein-3 and IGF type-I receptor in prostate cancer cells, J Cancer Res Clin Oncol 133(6):351-359, 2007. Kao WF et al: Podophyllotoxin intoxication: toxic effect of bajiaolian herbal therapeutics, Hum Exp Toxicol 11(6):480-487, 1992. Kapoor R et al: Supplementary effect of spirulina on hematological status of rats during pregnancy and lactation, Plant Foods Hum Nutr 52(4):315-324, 1998. Kasutri M et al: Effects of Azadirachta indica leaves on the seminal vesicles and ventral prostate in albino rats, Indian J Physiol Pharmacol 41(3):234-240, 1997. Kato S et al: Octacosanol affects lipid metabolism in rats fed on a high-fat diet, Br J Nutr 73(3):433-441, 1995. Keitel W et al: Capsicum pain plaster in chronic non-specific low back pain, Arzheimittel forschung 51(11):896-903, 2001. REFERENCES References 686 References Keller WJ et al: Catecholamine metabolism in a psychoactive cactus, Clin Toxicol 16(2): 233-243, 1980. Kelly J: Chondroitin sulfate preserves joint-space width in knee OA but does not affect symptoms, Medscape Medical News, available at: http://www.medscape.com/viewarticle/538152. Accessed December 1, 2008. Kennedy DO et al: Modulation of mood and cognitive performance following acute administration of Melissa officinalis, Pharmacol Biochem Behav 72(4):953-964, 2002. Keung W: Biochemical studies of a new class of alcohol dehydrogenase inhibitors from radix puerariae, Alcohol Clin Exp Res 17:1254, 1993. Keung W et al: Daidzin and daidzein suppress free-choice ethanol intake by Syrian Golden hamsters, Proc Natl Acad Sci USA 90:10008-10012, 1993. Keung W et al: Kudzu root: an ancient Chinese source of modern antidipsotropic agents, Phytochemistry 47(4):499-506, 1998. Khan A et al: Insulin potentiating factor and chromium content of selected foods and spices, Biol Trace Elem Res 24:183-188, 1990. Khan M et al: Spirulina attenuates cyclosporine-induced nephrotoxicity in rats, J Appl Toxicol 26(5):444-451, 2006. Khanna D et al: Reduction of the efficacy of methotrexate by the use of folic acid: post hoc analysis from two randomized controlled studies, Arthritis Rheum 52(10):3030-3038, 2005. Khatta M et al: The effect of coenzyme Q10 in patients with congestive heart failure, Ann Intern Med 132(8):636-640, 2000. Khayyal MT et al: Mechanisms involved in the antiinflammatory effect of propolis extract, Drugs Exp Clin Res 19(5):197-203, 1993. Khayyal MT et al: Antiulcerogenic effect of some gastrointesinally acting plant extracts and their combination, Arzneimittelforschung 51(7):545-553, 2001. Khosla P et al: A study of hypoglycemic effects of Azadirachta indica (neem) in normal and alloxan diabetic rabbits, Indian J Physiol Pharmacol 44(1):69-74, 2000. Kim DJ et al: Potential preventive effects of Chelidonium majis L. (Papaveraceae) herb extract on glandular stomach tumor development in rats treated N-methyl-N´-nitro-N-nitrosoguanidine (MNNG) and hypertonic sodium chloride, Cancer Lett 112:203-208, 1997. Kim HK et al: Inhibition of rat adjuvant-induced arthritis by ginkgetin, a biflavone from Ginkgo biloba leaves, Planta Med 65:465-467, 1999. Kim HM et al: Inhibitory effect of mast cell-mediated immediate-type allergic reactions in rats by spirulina, Biochem Pharmacol 55(7):1071-1076, 1998. Kim HM et al: Taraxacum officinale restores inhibition of nitric oxide production by cadmium in mouse peritoneal macrophages, Immunopharmacol Immunotoxicol 20(2):283-297, 1998. Kim HM et al: Inhibitory effect of mast cell-mediated immediate-type allergic reactions by Cichorium intybus, Pharmacol Res 40(1):61-65, 1999. Kim JC et al: Screening extracts of Achyranthes japonica and Rumex crispus for activity against various plant pathogenic fungi and control of powdery mildew, Pest Manag Sci 60(8): 803-808, 2004. Kim MR et al: Antioxidative effects of quercetin-glycosides isolated from the flower buds of Tussilago farfara L, Food Chem Toxicol 44(8):1299-1307, 2006. Kim ND et al: Chemopreventive and adjuvant therapeutic potential of pomegranate for human breast cancer, Breast Cancer Res Treat 71(3):203-217, 2002. Kim SH et al: Myelooptic neuropathy caused by aconitine in rabbit model, Jpn J Ophthalmol 35:417, 1991. Kimbrough C et al: Pycnogenol chewing gum minimizes gingival bleeding and plaque formation, Phytomedicine 9(5):410-413, 2002. Kinzler E et al: Clinical efficacy of a kava extract in patients with anxiety syndrome: double-blind placebo controlled study over 4 weeks, Arzneimittelforschung 41: 584-588, 1991. 687 Kiriyama S et al: Hypocholesterolemic effect of polysaccharides and polysaccharide-rich foodstuffs in cholesterol-fed rats, J Nutr 97(3):382-388, 1969. Kirsch M: Acute glycoside intoxication from the intake of oleander (Nerium oleasder) leaves in a guinea pig, Tierarztl Prax 25(4):398-400, 1997. Kisiel W et al: Guaianolides from Cichorium intybus and structure revision of Chichorium sesquiterpene lactones, Phytochemistry 57(4):523-527, 2001. Klimek B, Modnicki D: Terpenoids and sterols from Nepeta cataria L. var. citriodora (Lamiaceae), Acta Pol Pharm 62(3):231-235, 2005. Kobayasji S et al: Effects of dietary chitosan on fat deposition and lipase activity in digesta in broiler chickens, Br Poult Sci 43(2):270-273, 2002. Koçyildiz ZC et al: Crataegus tanacetifolia leaf extract prevents L-NAME-induced hypertension in rats: a morphological study, Phytother Res 20(1):66-70, 2006. Kodama N et al: Enhancement of cytotoxicity of NK cells by D-fraction, a polysaccharide from Grifola frondosa, Oncol Rep 13(3):497-502, 2005. Koga T et al: Bactericidal activities of essential oils of basil and sage against a range of bacteria and the effect of these essential oils on Vibrio parahaemolyticus, Microbiol Res 154(3):267-273, 1999. Kohlmeier L et al: Lycopene and myocardial infarction risk in EURAMIC study, Am J Epidemiol 146(8):618-626, 1997. Kojuri J et al: Effects of anethum graveolens and garlic on lipid profile in hyperlipidemic patients, Lipids Health Dis 6:5, 2007. Kokoska L et al: Screening of some Siberian medicinal plants for antimicrobial activity, J Ethnopharmacol 82(1):51, 2002. Komatsu K et al: Inhibitory effects of Rooibos tea, Aspalathus linearis, on x-ray–induced C3H10T1/2 cell transformation, Cancer Lett 77(1):33-38, 1994. Komesaroff PA et al: Effects of wild yam extract on menopausal symptoms, lipids and sex hormones in healthy menopausal women, Climacteric 4(2):144-150, 2001. Komori A et al: Anticarcinogenic activity of green tea polyphenols, Jpn J Clin Oncol 23:186-190, 1993. Kong YC et al: Antifertility principle of Ruta graveolens, Planta Med 55(2):176-178, 1989. Konig G et al: Hypoglycaemic activity on an HMG-containing flavonoid glucoside, chamaemeloside, from Chamaemelum nobile, Planta Med 64:612-614, 1998. Kono I et al: Antimicrobial activity of Monascus pilosus IFO 4520 against contaminant of Koji, Biosci Biotechnol Biochem 63(8):1494-1496, 1999. Konrad L et al: Antiproliferative effect on human prostate cancer cells by a stinging nettle root (Urtica dioica) extract, Planta Med 66(1):44-47, 2000. Korotkich I et al: Inotropic and lusitropic effects of Perilla frutescens (L.) Britton extract on the rabbit myocardium, Medicina (Kaunas) 42(5):406-412, 2006. Kosalec I et al: Antifungal activity of fluid extract and essential oil from anise fruits (Pimpinella anisum L., Apiaceae), Acta Pharm 55(4):377-385, 2005. Kowalczyk E et al: Pharmacological effects of flavonoids from Scutellaria baicalensis, Przegl Lek 63(2):95-96, 2006. Kowalewski Z et al: Antibiotic action of beta-urosolic acid, Arch Immunol Ther Exp 24:115, 1976. Koybasi S, Yilmaz T: The effect of L-Carnitine on wound healing by secondary intention in an animal model, Wounds 17(3):62-66, 2005. Kraft K: Artichoke leaf extract: recent findings reflecting effects on lipid metabolism, liver and gastrointestinal tracts, Phytomedicine 4:369-378, 1997. Kreis W et al: Inhibition of HIV replication by Hyssopus officinalis extracts, Antiviral Res 14(6):323, 1990. Kubo K, Nanba H et al: Anti-hyperliposis effect of maitake fruit body (grifola frondosa) I, Biol Pharm Bull 20(7):781-785, 1997. Kubo K, Nanba H et al: The effect of maitake mushrooms on liver and serum lipids, Altern Ther Health Med 2(5):62-66, 1996. REFERENCES References 688 References Kudik-Jaworska J et al: Immunomodulating polysaccharide fractions of Menyanthes trifoliata L, Z Naturforsch [C] 59(7-8):485-493, 2004. Kudriashowv BA et al: The content of a heparin-like anticoagulant in the flowers of the meadowsweet (Filipendula ulmaria), Farmakol Toksiko 53(4):39-41, 1990. Kudriashowv BA et al: Heparin from the meadowsweet (Filipendula ulmaria) and its properties, Izv Akad Nauk SSSR(6):939-943, 1991. Kulshrestha VK et al: A study of central pharmacological activity of alkaloid fraction of Apium graveolens Linn, Indian J Med Res 58:99, 1970. Kumagai A et al: Effects of glycyrrhizin on thymolytic and immunosuppressive action of cortisol, Endocrinol Jpn 14:39-42, 1967b. Kumar M et al: Effect of betel/areca nut (Areca catechu) extracts on intestinal epithelial cell lining, Vet Hum Toxicol 42(5):257-260, 2000. Kumar M et al: Carnitine supplementation for preterm infants with recurrent apnea, Cochrane Database Syst Rev, (4):CD004497, 2004. Kumar N, Butz JA, Burritt MF: Clinical significance of the laboratory determination of low serum copper in adults, Clin Chem Lab Med 45(10):1402-1410, 2007. Kumarasamy Y et al: The assessment of biological activities associated with the major constituents of the methanol extract of ‘wild carrot’ (Daucus carota L) seeds, J Herb Pharmacother 5(1):61-72, 2005. Kunvari M et al: Biological activity and structure of antitumor compounds from Plantago media L., Acta Pharm Hung 69(5):232-239, 1999. Kustrak D et al: Seasonal changes of alkaloid contents in celandine (Chelidonium majos L.), Acta Pharm Jugosl 32:225-230, 1982. Kwaselow A et al: Rose hips: a new occupational allergen, J Allergy Clin Immunol 83(4): 704-708, 1990. Kwon YS et al: A new coumarin from the stem of Angelica dahurica, Arch Pharm Res 25(1): 53-56, 2002. La Valle JB et al: Natural therapeutics pocket guide, Hudson, Ohio, 2001, Lexi-Comp. Lagouri V et al: Nutrient antioxidants in oregano, Int J Food Sci Nutr 47(6):493-497, 1996. Lahlou S et al: Diuretic activity of the aqueous extracts of Carum carvi and Tanacetum vulgare in normal rats, J Ethnopharmacol 110(3):458-463, 2007. Lai CK, Poon WT, Chan YW: Hidden aconite poisoning: identification of yunaconitine and related aconitum alkaloids in urine by liquid chromatography-tandem mass spectrometry, J Anal Toxicol 30(7):426-433, 2006. Lamango NS et al: Quantification of S-adenosylmethionine-induced tremors: a possible tremor model for Parkinson’s disease, Pharmacol Biochem Behav 65(3):523-529, 2000. Landin K et al: Guar gum improves insulin sensitivity, blood lipids, blood pressure, and fibrinolysis in healthy men, Am J Clin Nutr 56(6):1061-1065, 1992. Lane DA et al: Dermatan sulphate in haemodialysis, Lancet 8(339):334-335, 1992. Langsjoen PH et al: Effective and safe therapy with coenzyme Q10 for cardiomyopathy, Klin Wochenschr 66:583-590, 1988. Langsjoen PH et al: Effective treatment with coenzyme Q10 of patients with chronic myocardial disease, Drugs Exp Clin Res 11:577-579, 1985. Langsjoen PH et al: Long-term efficacy and safety of coenzyme Q10 therapy for idiopathic dilated cardiomyopathy, Am J Cardiol 65:521-523, 1990. Lanhers MC et al: Analgesic, antipyretic and antiinflammatory properties of Euphorbia hirta, Planta Med 57:225-231, 1991. Lanhers MC et al: Hepatoprotective and antiinflammatory effects of a traditional medicinal plant of Chile, Peumus boldus, Planta Med 57(2):110-115, 1991. Lansky EP, Newman RA: Punica granatum (pomegranate) and its potential for prevention and treatment of inflammation and cancer, J Ethnopharmacol 109(2):177-206, 2007. Lapinina LO et al: Investigation of some plants to determine their sugar lowering action, Farmatsevt Zh 19:52-58, 1964. 689 Larrondo JV et al: Antimicrobial activity of essences from labiates, Microbios 82(332):171-172, 1995. Lata S et al: Beneficial effects of Allium sativum, Allium cepa, and Commiphora mukul on experimental hyperlipidemia and atherosclerosis: a comparative evaluation, J Postgrad Med 37(3):132-135, 1991. Lauritzen CH et al: Treatment of premenstrual tension syndrome with Vitex agnus castus controlled, double-bind study versus pyridoxine, Phytomedicine 4(3):183-189, 1997. Lavigne JP et al: Cranberry (Vaccinium macrocarpon) and urinary tract infections: study model and review of literature, Pathol Biol (Paris) 55(8-9):460-464, 2007. Lawson BR et al: Immunomodulation of murine collagen-induced arthritis by N, N-dimethylglycine and a preparation of Perna canaliculus, BMC Complement Althern Med 7:20, 2007. Le OT, Elliott WJ. Mechanisms of the hypotensive effect of 3-N-butyl phthalide (BUPH): a component of celery oil. J Am Hypertens 1992; 40:326A. Abstract. Le Gal M et al: Pharmation capsules in the treatment of functional fatigue: a double-blind study versus placebo evaluated by a new methodology, Phytotherapy Res 10:49-53, 1996. Leach MJ: Gymnema sylvestre for diabetes mellitus: a systematic review, J Altern Complement Med 13(9):977-983, 2007. Lee CL et al: In vivo hypolipidemic effects and safety of low dosage Monascus powder in a hamster model of hyperlipidemia, Appl Microbiol Biotechnol 70(5):533-540, 2006. Lee MC et al: Oral bacterial therapy promotes recovery from acute diarrhea in children, Acta Paediatr Taiwan 42(5):301-305, 2001. Lee MK et al: Inhibitory effects of protoberberine alkaloids from the roots of Coptis japonica on catecholamine biosynthesis in PC12 cells, Planta Med 62:31-34, 1996. Lee NJ et al: Antimutagenicity and cytotoxicity of the constituents from the aerial parts of Rumex acetosa, Biol Pharm Bull 28(11):2158-2161, 2005. Lee YH et al: Anti-histone acetyltransferase activity from allspice extracts inhibits androgen receptordependent prostate cancer cell growth, Biosci Biotechnol Biochem 71(11):2712-2719, 2007. Leeja L, Thoppil JE: Antimicrobial activity of methanol extract of Origanum majorana L. (Sweet marjoram), J Environ Biol 28(1):145-146, 2007. Leitzmann MF et al: A prospective study of coffee consumption and the risk of symptomatic gallstone disease in men, JAMA 281(22):2106-2111, 1999. Leung A, Foster S: Encyclopedia of common natural ingredients used in food, drugs and cosmetics, 2 ed, New York, 1996, Wiley & Sons. Leung AY: Encyclopedia of common natural ingredients in food, drugs and cosmetics, New York, 1980, Wiley Intersciences. Leven PI et al: The anticoagulant action of a factor from the nondialyzed fraction of the ammoniacal extract of the lungwort, Pulmonaria mollissima, Eksp Klin Farmakol 55(1):38-40, 1992. Leventhal L et al: Treatment of rheumatoid arthritis with gamma-linolenic acid, Ann Intern Med 119:867-873, 1993. Levin R et al: Cellular and molecular aspects of bladder hypertrophy, Eur Urol 32(suppl):15-21, 1997. Levy L: The activity of chaulmoogra acids against Mycobacterium leprae, Am Rev Respir Dis 111:703-705, 1975. Li F et al: Antivirus effect of polysaccharides of brewer yeast in vitro, Zhongguo Zhong Yao Za Zhi 23(3):171-173, 1998. Li J et al: Huperzine A for Alzheimer’s disease, Cochrane Database Syst Rev (2):CD005592, 2008. Li RZ et al: Studies of the active constituents of the Chinese drug “duhuo” Angelica pubescents, Yao Hsueh Hsueh Pao 24(7):546-551, 1989. Li YC: Effects of brewer’s yeast on glucose tolerance and serum lipids in Chinese adults, Biol Trace Elem Res 41(3):341-347, 1994. REFERENCES References 690 References Liapina LA et al: A comparative study of the action on the hemostatic system of extracts from the flowers and seeds of the meadowsweet (Filipendula ulmaria [L.] maxim), Izv Akad Nauk Ser Biol (4):625-628, 1993. Lichtensteiger CA et al: Rhamnus cathartica (buckthorn) hepatocellular toxicity in mice, Toxicol Pathol 25(5):449-452, 1997. Lim SS et al: Induction of detoxifying enzyme by sesquiterpenes present in Inula helenium, J Med Food 10(3):503-510, 2007. Lin LT et al: In vitro anti-hepatoma activity of fifteen natural medicines from Canada, Phytother Res 16(5):440-444, 2002. Lin PW et al: Efficacy of aromatherapy (Lavandula angustifolia) as an intervention for agitated behaviours in Chinese older persons with dementia: a cross-over randomized trial, Int J Geriatr Psychiatry 22(5):405-410, 2007. Lin SC et al: Hepatoprotective effects of Arctium lappa on carbon tetrachloride- and acetaminophen-induced liver damage, Am J Chin Med 28(2):163-173, 2000. Lin SC et al: Hepatoprotective effects of Arctium lappa Linne on liver injuries induced by chronic ethanol consumption and potentiated by carbon tetrachloride, J Biomed Sci 9(5):401-409, 2002. Lin SY et al: Lactobacillus effects on cholesterol: in vitro and in vivo results, J Dairy Sci 72(11):2885, 1989. Lin YC et al: Gossypol in female fertility control: ovum implantation and early pregnancy inhibited in rats, Life Sci 37(1):39-47, 1985. Lin Z et al: Stimulation of mouse melanocyte proliferation by Piper nigrum fruit extract and its main alkaloid, piperine, Planta Med 65(7):600-603, 1999. Lipton RB et al: Petasites hybridus root (butterbur) is an effective preventive treatment for migraine, Neurology 63(12):2240-2244, 2004. Lira-Salazar G et al: Effects of homeopathic medications Eupatorium perfoliatum and Arsenicum album on parasitemia of Plasmodium berghei-infected mice, Homeopathy 95(4): 223-228, 2006. Lis-Balchin M et al: Buchu essential oils: their pharmacological action on guinea-pig ileum and antimicrobial activity on microorganisms, J Pharm Pharmacol 53(4):579-582, 2001. Littarru GP et al: Deficiency of coenzyme Q10 in human heart disease, part II, Int J Vitam Nutr Res 42:291-305, 1972. Littarru GP, Tiano L: Clinical aspects of coenzyme Q10: an update, Curr Opin Clin Nutr Metab Care 8(6):641-646, 2005. Liu C et al: Chung Kuo Chung Yao Tsa Chih 17(10):595-596, 1992. Liu F et al: Hypotensive effects of safflower yellow in spontaneously hypertensive rats and influence on plasma renin activity and angiotensin II level, Yao Hsueh Hsueh Pao 27(10): 785-787, 1992. Liu FJ et al: Pycnogenol enhances immune and haemopoietic functions in senescene-accelerated mice, Cell Mol Life Sci 54(10):1168-1172, 1998. Liu GL et al: Effect of water extract of 4 Chinese herbal drugs on the binding of insulin with human erythrocyte insulin receptor, Zhong Xi Yi Jie He Za Zhi 11(10):581-582, 606-607, 1991. Liu J et al: Two new prenylated 3-benzoxepin derivatives as cyclooxygenase inhibitors from Perilla frutescens var. acuta, J Nat Prod 63(3):403-405, 2000. Liu JQ et al: 32 cases of postoperative osteogenic sarcoma treated by chemotherapy combined with Chinese medicinal herbs, Zhongguo Zhong Xi Yi Jie He Za Zhi 13(3):132, 150-152, 1993. Liu KY et al: Phytochemical and pharmacological research progress in Tussilago farfara, Zhongguo Zhong Yao Za Zhi 31(22):1837-1841, 2006. Liu TP et al: Improvement of insulin resistance by panax ginseng in fructose-rich chow-fed rats, Horm Metab Res 37(3):146-151, 2005. Liu XQ et al: A new tannin-related compound from the rhizome of Polygonum bistorta L., J Asian Nat Prod Res 8(4):299-302, 2006. 691 Liu YL et al: Isolation of potential cancer chemopreventive agents from Eriodictyon californicum, J Nat Prod 55(3):357-363, 1992. Ljubuncic P et al: Antioxidant activity of Crataegus aronia aqueous extract used in traditional Arab medicine in Israel, J Ethnopharmacol 101(1-3):153-161, 2005. Lo HC et al: Submerged culture mycelium and broth of Grifola frondosa improve glycemic responses in diabetic rats, Am J Chin Med 36(2):265-285, 2008. Lo Cantore P et al: Antibacterial activity of Coriandrum sativum L. and Foeniculum vulgare Miller Var. vulgare (Miller) essential oils, J Agric Food Chem, 52(26):7862-7866, 2004. Loch EG et al: Treatment of premenstrual syndrome with a phytopharmaceutical formulation containing Vitex agnus castus, J Women’s Health Gend Based Med 9(3):315-320, 2000. Lombaert GA et al: Furano-coumarins in celery and parsnips: method and multiyear Canadian survey, J AOAC Int 84(4):1135-1143, 2001. Loo WT et al: The inhibitory effect of a herbal formula comprising ginseng and carthamus tinctorius on breast cancer, Life Sci 76(2):191-200, 2004. López-Pousa S et al: Galanthamine versus donepezil in the treatment of Alzheimer’s disease, Rev Neurol 44(11):677-684, 2007. Lorca GL et al: Lactobacillus acidophilus autolysins inhibit Helicobacter pylori in vitro, Curr Microbiol 42(1):39-44, 2001. Lorenzetti BB et al: Myrcene mimics the peripheral analgesic activity of lemongrass tea, J Ethnopharmacol 34(1):43-48, 1991. Low Dog T: Menopause: a review of botanical dietary supplements, Am J Med 118(Suppl 12B):98-108, 2005. Lu M et al: Muscle relaxing activity of Hyssopus officinalis essential oil on isolated intestinal preparations, Planta Med 68(3):213-216, 2002. Luo J et al: Masoprocol (nordihydroguaiaretic acid): a new antihyperglycemic agent isolated from the creosote bush (Larrea tridentata), Eur J Pharmacol 346:77-79, 1998. Luo SQ et al: Inhibitory effect of green tea extract on the carcinogenesis induced with asbestos plus benzo(a)pyrene in rat, Biomed Environ Sci 8(1):54-58, 1995. Luo ZH: The use of Chinese traditional medicines to improve impaired immune functions in scald mice, Chung Hua Cheng Hsing Shao Shang Wai Ko Tsa Chih 9(1):56-58, 80, 1993 (in English). Lussignoli S et al: Effect on Traumel S, a homoeopathic formulation, on blood induced inflammation in rats, Complement Ther Med 7(4):225-230, 1999. Lutz M et al: Comparative effects of rose hip and corn oils on biliary and plasma lipids in rats, Arch Latinoam Nutr 43(1):23-27, 1993. MacGregor JT et al: California bay oil II: biological effects of constituents, J Agric Food Chem 22:777-780, 1975. Madisch A et al: Treatment of functional dyspepsia with a fixed peppermint oil caraway oil in combination preparation as compared to cisapride, Arzneimittelforschung 49(1): 925-932, 1999. Mahabir S et al: Dietary boron and hormone replacement therapy as risk factors for lung cancer in women, Am J Epidemiol 167(9):1070-1080, 2008. Mahady GB et al: In vitro susceptibility of Helicobacter pylori to isoquinoline alkaloids from Sanguinaria canadensis and Hydrastis canadensis, Phytother Res 17(3):217-221, 2003. Mahajani SS et al: Some observations on the toxicity and anti-pyretic activity of crude and processed aconite roots, Planta Med 56:665, 1990. Mahomed IM, Ojewole JA: Analgesic, antiinflammatory and antidiabetic properties of Harpagophytum procumbens DC (Pedaliaceae) secondary root aqueous extract, Phytother Res 18(12):982-989, 2004. Mahomed IM, Ojewole JA: Anticonvulsant activity of Harpagophytum procumbens DC [Pedaliaceae] secondary root aqueous extract in mice, Brain Res Bull 69(1):57-62, 2006. REFERENCES References 692 References Maity TK et al: Effect of Ocimum sanctum roots extract on swimming performance in mice, Phytother Res 14(2):120-121, 2000. Majamaa H et al: Probiotics: a novel approach in the management of food allergy, J Allergy Clin Immunol 99(2):179-185, 1997. Majumder PK et al: Anti-steroidogenic activity of the petroleum ether extract and fraction 5 (fatty acids) of carrot (Daucus carota L.) seeds in mouse ovary, J Ethnopharmacol 57(3): 209-212, 1997. Malin-Berdel J: Flow cytometric analysis of the binding of eleven lectin to human T- and B-cells and to human T- and B-cell lines, Cytometry 5(2):204-209, 1984. Malinow MR et al: Alfalfa saponins and alfalfa seeds, Atherosclerosis 37:433-438, 1980. Malinow MR et al: Cholesterol and bile acid balance in Macaca fascicularis, J Clin Invest 67:156-162, 1981. Malinow MR et al: Experimental models of atherosclerosis regression, Atherosclerosis 48: 105-118, 1983. Malinow MR et al: Systemic lupus erythematosus-like syndrome in monkeys fed alfalfa sprouts: role of a nonprotein amino acid, Science 216(23):415-417, 1982. Mallet JE et al: Antioxidant activity of plant leaves in relation to their alpha-tocopherol content, Food Chem Toxicol 49(1):61, 1994. Mandana R et al: Therapeutic effects of Quercus extract in urolithiasis, Arch Exp Urol 33(2):205-226, 1980. Mani S, Lawson JW: In vitro modulation of inflammatory cytokine and IgG levels by extracts of Perna canaliculus, BMC Complement Althern Med 6:1, 2006. Mann CM et al: The outer membrane of Pseudomonas aeruginosa NCTC 6749 contributes to its tolerance to the essential oil of Melaleuca alternifolia (tea tree oil), Lett Appl Microbiol 30(4):294-297, 2000. Mannucci C et al: Serotonin mediates beneficial effects of Hypericum perforatum on nicotine withdrawal signs, Phytomedicine 14(10):645-651, 2007. Manoharan KP et al: Cycloartane type triterpenoids from the rhizomes of Polygonum bistorta, Phytochemistry 66(19):2304-2308, 2005. Manoharan KP et al: Evaluation of Polygonum bistorta for anticancer potential using selected cancer cell lines, Med Chem 3(2):121-126, 2007. Marin-Neto JA et al: Cardiovascular effects of berberine in patients with severe congestive heart failure, Clin Cardiol 11:253-260, 1988. Marks LS et al: Effects of saw palmetto herbal blend in men with symptomatic benign prostatic hyperplasia, J Urol 163(5):1451-1456, 2000. Marnewick J et al: Inhibition of tumour promotion in mouse skin by extracts of rooibos (Aspalathus linearis) and honeybush (Cyclopia intermedia), unique South African herbal teas, Cancer Lett 28:224(2):193-202, 2005. Marteau P et al: Effect of chronic ingestion of fermented dairy product containing Lactobacillus acidophilus and Bifidobacterium bifidum on metabolic activities of colonic flora in humans, Am J Clin Nutr 52(4):685, 1990. Martin T et al: Screening for protozoacidal activity of Spanish plants, Pharm Biol 36(1):56-62, 1998. Martinet A et al: Thermogenic effects of commercially available plant preparations aimed at treating human obesity, Phytomedicine 6(4):231-238, 1999. Mas R et al: Effects of policosanol in patients with type II hypercholesteremia and additional coronary risk factors, Clin Pharmacol Ther 65:439-447, 1999. Masaki H et al: Active-oxygen scavenging activity of plants extracts, Biol Pharm Bull 18(1):162-166, 1995. Mascolo N et al: Ethnopharmacologic investigation of ginger, J Ethnopharmacol 27:129-140, 1989. Mateu J et al: Needlestick injuries and hazardous drugs, Am J Health Syst Pharm 53(9):1068, 1071, 1996. 693 Matev M et al: Use of an herbal combination with laxative action on duodenal peptic ulcer and gastroduodenitis patients with a concomitant obstipation syndrome, Vutr Boles 20(6): 48-51, 1981. Mato JM et al: S-adenosylmethionine in alcoholic liver cirrhosis: a randomized, placebocontrolled, double-blind, multicenter clinical trial, J Hepatol 30(6):1081-1089, 1999. Matsuda H et al: Studies of cuticle drugs from natural sources, II: inhibitory effects of Prunus plants on melanin biosynthesis, Biol Pharm Bull 17(10):1417-1420, 1994. Matsuda H et al: Effects of escins Ia, Ib, IIa, and IIb horse chestnut, the seeds of Aesculus hippocastanum L., on acute inflammation in animals, Biol Pharm Bull 20(10):1092-1095, 1997. Matsuda H: Hepatoprotective, superoxide scavenging, and antioxidative activities of aromatic constituents from the bark of Betula platyphylla var. japonica, Bioorg Med Chem Lett 8(21):2939-2944, 1998. Matsuda H et al: Melanogenesis stimulation in murine B16 melanoma cells by Kava (Piper methysticum) rhizome extract and kavalactones, Biol Pharm Bull 29(4):834-837, 2006. Matsumoto T et al: Antiproliferative and apoptotic effects of butyrolactone lignans from Arctium lappa on leukemia cells, Planta Med 72(3):276-278, 2006. Mattei R et al: Guarana (Paullinia cupana): toxic behavioral effects in laboratory animals and antioxidants activity in vitro, J Ethnopharmacol 60(2):111-116, 1998. Mavligit G et al: Local xenogeneic graft-vs-host reaction: a practical assessment of T-cell function among cancer patients, J Immunol 123(5):2185-2188, 1979. Maxwell A et al: Nutritional therapy for peripheral arterial disease: a double-blind study, placebo-controlled, randomized trial of HeartBar, Vas Med 5(1):11-19, 2000. Mayr NA et al: The use of laminarias for osmotic dilation of the cervix in gynecological brachytherapy applications, Int J Radiat Oncol Biol Phys 42(5):1049-1053, 1998. Mazza M et al: Ginkgo biloba and donepezil: a comparison in the treatment of Alzheimer’s dementia in a randomized placebo-controlled double-blind study, Eur J Neurol 13(9): 981-985, 2006. McCaleb R et al: The encyclopedia of popular herbs: your complete guide to medicinal plants, Roseville, Calif, 2000, Prima Health. McCindle BW, Conner WT: Garlic extract therapy in children with hypercholesterolemia, Arch Pediatr Adolesc Med 152(11):1089-1094, 1998. McCutcheon AR et al: Antiviral screening of British Columbian medicinal plants, J Ethnopharmacol 499(2):101-110, 1995. McGregor NR: Pueraria lobata (Kudzu root) hangover remedies and acetaldehyde-associated neoplasm risk, Alcohol 41(7):469-478, 2007. McGuigan MA: Plants: cardiac glycosides, Clin Toxic Res 6:1-2, 1984. McKay DL, Blumberg JB: Cranberries (Vaccinium macrocarpon) and cardiovascular disease risk factors, Nutr Rev 65(11):490-502, 2007. Medeiros A: Biochemical and functional characterization of the Tn-specific lectin from Salvia sclarea seeds, Eur J Biochem 267(5):1434-1440, 2000. Medina JH et al: Neuroactive flavonoids: new ligands for benzodiazepine receptors, Phytomedicine 5(2):235-243, 1998. Medkova I et al: The results of exposure to an antisclerotic vegetarian diet enriched with soybased products on patients in the secondary prevention of ischemic heart disease, Ter Arkh 69(9):52-55, 1997 (Russian). Mehdipour S et al: Antioxidant potentials of Iranian Carica papaya juice in vitro and in vivo are comparable to alpha-tocopherol, Phytother Res 20(7):591-594, 2006. Mehendran P et al: The antiulcer activity of Garcinia cambogia extract against indomethacininduced gastric ulcer in rats. Phytother Res 16(1):80-83, 2002. Mei N et al: Mutagenicity of comfrey (Symphytum officinale) in rat liver, Br J Cancer 92(5):873-875, 2005. Meir B et al: Pharmacological activities of Vitex agnus castus extracts in vitro, Phytomedicine 7(5):373-381, 2000. REFERENCES References 694 References Melchior J et al: Controlled clinical study of standardized Andrographis paniculata extract in the common cold: a pilot trial. Phytomedicine 3:314-318, 1997. Melchior J et al: Double bind, placebo controlled pilot and phase III study of activity of standardized Andrographis paniculata, Herba Nees, extract fixed combination (kan jang) in the treatment of uncomplicated upper respiratory tract infection, Phytomedicine 7:341-350, 2000. Melzig MF: Goldenrod – a classical exponent in the urological phytotherapy, Wien Med Wochenschr 154(21-22):523-527, 2004. Merali S et al: S-adenosylmethionine and Pneumocystis carinii, J Biol Chem 275(2): 14958-14963, 2000. Meyre-Silva C et al: Analgesic potential of marrubiin derivatives, a bioactive diterpene present in Marrubium vulgare (Lamiaceae), Farmaco 60(4):321-326, 2005. Mhamdi B et al: Biochemical evaluation of borage (Borago officinalis) rosette leaves through their essential oil and fatty acid composition, Ital J Biochem 56(2):176-179, 2007. Mickelfield GH et al: Effects of peppermint oil and caraway oil on gastroduodenal motility, Phytother Res 14(1)20-23, 2000. Miettinen M et al: Production of human tumor necrosis factor alpha, interleukin-6, and interleukin-10 is induced by lactic acid bacteria, Infect Immun 64:5403-5405, 1996. Milbury PE et al: Bilberry (Vaccinium myrtillus) anthocyanins modulate heme oxygenase-1 and glutathione S-transferase-pi expression in ARPE-19 cells, Invest Ophthalmol Vis Sci 48(5):2343-2349, 2007. Milioli EM et al: Effect of acute administration of hydroalcohol extract of Ilex paraguariensis St Hilaire (Aquifoliaceae) in animal models of Parkinson’s disease, Phytother Res 21(8):771-776, 2007. Miller TE et al: The anti-inflammatory activity of Perna canaliculus (New Zealand green lipped mussel), N Z Med J 92(667):187-193, 1980. Miller TE et al: Antiinflammatory activity of glycogen extracted from Perna Canaliculus (NZ green-lipped mussel), Agents Actions 38(Spec): C139-142, 1993. Mills S, Bone K: The essential book of herbal medicine, 2 ed, London, 1991, Penguin. Mills S, Bone K: Principles and practice of phytotherapy, London, 2000, Churchill Livingstone. Mills S, Bone K: The essential guide to herbal safety, London, 2005, Churchill Livingstone. Milman N et al: Failure of lysine in recurrent herpes simplex labialis, Lancet 28(2):942, 1978. Min BS et al: Inhibitory effects of Korean plants on HIV-1 activities, Phytother Res 15(6): 481-486, 2001. Misbahuddin M et al: Efficacy of spirulina extract plus zinc in patients of chronic arsenic poisoning: a randomized placebo-controlled study, Clin Toxicol (Phila) 44(2):135-141, 2006. Mishra AK et al: Fungitoxic properties of Prunus persica oil, Hindustan Antibiot Bull 32 (3-4):91-93, 1990. Misik V et al: Lipoxygenase inhibition and antioxidant properties of protoberberine and aporphine alkaloids isolated from Mahonia aquifolium, Planta Med 61(4):372-373, 1995 (letter). Mitamura T et al: Effects of lentinan on colorectal carcinogenesis in mice with ulcerative colitis, Oncol Rep 7(3):599-601, 2000. Mitscher L et al: Antimicrobial agents from higher plants: antimicrobial isoflavonoids from Glycyrrhiza glabra L. var. typica, J Nat Products 43:259-269, 1980. Mitsyama K et al: Treatment of ulcerative colitis with germinating barley foodstuff feeding: a pilot study, Aliment Pharmacol Ther 12(12):1225-1230, 1998. Miura K et al: Antioxidant activity of chemical components from sage and thyme measured by the oil stability index method, J Agric Food Chem 50(7):1845-1851, 2002. Miyamoto K et al: Isolation of agrimoniin, an antitumor constituent, from the roots of Agrimonia pilosa Ledeb, Chem Pharm Bull 33:3977-3981, 1985. Miyamoto K et al: Induction of cytotoxicity of peritoneal exudate cells by agrimoniin: a novel immunomodulatory tannin of Agrimonia pilosa Ledeb, Cancer Immunol Immunother 27:59-62, 1988. 695 Miyazato M et al: Dietary glycine inhibits bladder activity in normal rats and rats with spinal cord injury, J Urol 173(1):314-317, 2005. Moleyar V et al: Antibacterial activity of essential oil components, Int J Food Microbiol 16: 337-342, 1992. Molin S, Plewig G: Betel quid chewing: traditional habit with side effects, MMW Fortschr Med 149(1-2):46-47, 2007. Molochko VA et al: The antistaphylococcal properties of plant extracts in relation to their prospective use as therapeutic and prophylactic formulations for the skin, Vestn Dermatol Venerol (8):54-56, 1990. Monboisse JC et al: Advances in Gingko biloba extract research 2:123-128, 1993. Monsefi M et al: The effects of Anethum graveolens L. on female reproductive system, Phytother Res 20(10):865-868, 2006. Montanari T et al: Antispermatogenic effect of Achillea mellefolium L. in mice, Contraception 58(5):309-313, 1998. Montaner JSG et al: Double-blind placebo-controlled pilot trial of acemannan in advanced human immunodeficiency virus disease, J Acquir Immune Defic Syndr Hum Retrovirol 12:153-157, 1996. Moody J et al: Effects of long-term administration of L-arginine on the rat erectile response, J Urol 158:942-947, 1997. Moon T et al: Antiparasitic activity of two Lavandula essential oils against Giardia duodenalis, Trichomonas vaginalis and Hexamita inflata, Parasitol Res 99(6):722-728, 2006. Moore KS et al: Squalamine: an aminosterol antibiotic from the shark, Proc Natl Acad Sci USA 90(4):1354, 1993. Moore M: Materia medica, Bisbee, Ariz, 1996, Author. Mori K et al: The present status in prophylaxis and treatment of HIV infected patients with hemophilia in Japan, Rinsho Byhori 37:1200-1208, 1989. Morikawa T, et al: Perennisosides I-VII, acylated triterpene saponins with antihyperlipidemic activities from the flowers of Bellis perennis, J Nat Prod 71(5):828-835, 2008. Morita K et al: A desmutagenic factor isolated from burdock (Arctium lappa Linne), Mutat Res 129:25, 1984. Morita K et al: Chemical nature of desmutagenic factor from burdock (Aretium lappa), Agric Biol Chem 49:925-932, 1985. Moriyama Y et al: The plasma levels of dehydroepiandrosterone sulfate are decreased in patients with chronic heart failure in proportion to severity, J Clin Endocrinol Metab 85(5): 1834-1840, 2000. Morrison LD et al: Brain S-adenosylmethionine levels are severely decreased in Alzheimer’s disease, J Neurochem 67(3):1328-1331, 1996. Morton JF: Widespread tannin intake via stimulants and masticatories, especially guarana, kola nut, betel vine and accessories, Basic Life Sci 59:739-765, 1992. Mosaffa F et al: Antigenotoxic effects of Satureja hortensis L. on rat lymphocytes exposed to oxidative stress, Arch Pharm Res, Feb:29(2):159-164, 2006. Moskowitz R et al: Experimentally induced degenerative joint lesions following partial meniscectomy in the rabbit, Arthritis Rheum 16:397-405, 1973. Moussard C et al: A drug used in traditional medicine: Harpagophytum procumbens: no evidence for NSAID-like effect on whole blood eicosanoid production in humans, Prostaglandins Leukot Essent Fatty Acids 46(4):283-286, 1992. Movafegh A et al: Preoperative oral Passiflora incarnate reduces anxiety in ambulatory surgery patients: a double-blind, placebo-controlled study, Anesth Analg 106(6):1728-1732, 2008. Mowrey DB et al: Motion sickness, ginger and psychophysics, Lancet 1(8273):655-657, 1982. Muccillo Baisch AL et al: Endothelium-dependent vasorelaxing activity of aqueous extracts of Ilex paraguariensis on mesenteric arterial bed of rats, J Ethnopharmacol 60(2):133-139, 1998. REFERENCES References 696 References Mukherjee S et al: Purified neem (Azadirachta indica) seed extracts (praneem) abrogate pregnancy in primates, Contraception 53(6):375-378, 1996. Müller A et al: Analysis of phenolic glycosides and saponins in Primula elatior and Primula veris (primula root) by liquid chromatography, evaporative light scattering detection and mass spectrometry, J Chromatogr A 1112(1-2):218-223, 2006. Muller K et al: The antipsoriatic Mahonia aquifolium and its active constituents, I: pro- and antioxidant properties and inhibition of 5-lipoxygenase, Planta Med 60(5):421-424, 1994. Muller K et al: The antipsoriatic Mahonia aquifolium and its active constituents, II, antiproliferative activity against cell growth of human keratinocytes, Planta Med 61(1):74-75, 1995 (letter). Muller K et al: Potential antipsoriatic agents: lapacho compounds as potent inhibitors of HaCaT cell growth, J Nat Prod 62(8):1134-1136, 1999. Muller WE et al: Effects of Hypericum extract on the expression of serotonin receptors, J Ger Psych Neuro 7(suppl 1):63-64, 1994. Muller WE et al: Hyperforin represents the neurotransmitter reuptake inhibiting constituent of Hypericum extract, Pharmacopsychiat 31(suppl):16-21, 1998. Muller-Fassbender H et al: Glucosamine sulfate compared to ibuprofen in osteoarthritis of the knee, Osteoarthritis Cartilage 2:61-69, 1994. Murray M: Encyclopedia of nutritional supplements, Roseville, Calif, 1996, Prima. Murray M, Pizzorno J: The encyclopedia of natural medicine, 2 ed (revised), Roseville, Calif, 1998, Prima. Musso NR et al: Yohimbine’s effects on blood pressure and plasma catecholamines in human hypertension, Am J Hypertens 8:565-571, 1995. Muth ER et al: The effect of bilberry nutritional supplementation on night visual acuity and contrast sensitivity (in process citation), Altern Med Rev 5(2):164-173, 2000. Nagasawa H et al: Effects of motherwort (Leonurus sibiricus L.) on preneoplastic and neoplastic mammary gland growth in multiparous GR/A mice, Anticancer Res 10(4):1019-1023, 1990. Nagasawa H et al: Further study of the effects of motherwort (Leonurus sibiricus L.) on preneoplastic and neoplastic mammary gland growth in multiparous GR/A mice, Anticancer Res 12(1):141-143, 1992. Nair SC et al: Saffron chemoprevention in biology and medicine: a review, Cancer Biother 10:257-264, 1995. Nakamura T: Shiitake (Lentinus edodes) dermatitis, Contact Dermatitis 27(2):65-70, 1992. Nakano M et al: Anti-human immunodeficiency virus activity of oligosaccharides from rooibus tea (Aspalathus linearis) extracts in vitro, Leukemia 11(suppl 3):128-130, 1997. Nakatani K et al: Chemical constituents of peppers (Piper sp.) and application to food preservation: naturally occurring antioxidative compounds, Environ Health Perspect 67:135-142, 1986. Nakatani N: Phenolic antioxidants from herbs and spices, Biofactors 13(1-4):141-146, 2000. Nalini N et al: Influence of spices on the bacterial activity in experimental colon cancer, J Ethnopharmacol 62:15-24, 1998. Nartowska J et al: Anti-angiogenic activity of convallamaroside, the steroidal saponin isolated from the rhizomes and roots of Convallaria majalis L., Acta Pol Pharm 61(4):279-282, 2004. Naughton PJ et al: Modulation of salmonella infection by the lectins of Canavalia ensiformis (Con A) and Galanthus nivalis (GNA) in a rat model in vivo, J Appl Microbiol 88(4): 720-727, 2000. Nayak S et al: Evaluation of wound healing activity of Allamanda cathartica. L. and Laurus nobilis. L. extracts on rats, BMC Complement Altern Med 6:12, 2006. Neil HA et al: Garlic powder in the treatment of moderate hyperlipidaemia: a controlled trial and meta-analysis, J R Coll Physicians Lond 30(4):329-334, 1996. 697 Neser JA et al: Oak (Quercus rubor) poisoning in cattle, J S Afr Vet Assoc 53(3):151-155, 1982. Neugebauer NM et al: Lobelane decreases methamphetamine self-administration in rats, Eur J Pharmacol 571(1):33-38, 2007. Newell CA et al: Herbal medicine: a guide for healthcare professionals, London, 1996, The Pharmaceutical Press. Newton SM et al: The evaluation of forty-three plant species for in vitro antimycobacterial activities; isolation of active constituents from Psoralea corylifolia and Sanguineria canadensis, J Ethnopharmacol 79(1):57-67, 2002. Ng TB et al: Hypoglycemic constituents of Panax ginseng, Gen Pharmacol 6:549-552, 1985. Nie H et al: Position 120-123: a potential active site of trichosanthin, Life Sci 62(6):491-500, 1998. Nielsen SE et al: Effect of parsley (Petroselinum crispum) intake on urinary apigenin excretion, blood antioxidant enzymes and biomarkers for oxidative stress in human subjects, Br J Nutr 81(6):447-455, 1999. Nijiro SM et al: Effect of an aqueous extract of Azadirachta indica on the immune response in mice, Onderstepoort J Vet Res 66(1):59-62, 1999. Ninomiya K et al: Potent anti-obese principle from Rosa canina: structural requirements and mode of action of trans-tiliroside, Bioorg Med Chem Lett 1:17(11):3059-3064, 2007. Nishioka SD et al: Transitory complete atrioventricular block associated to ingestion of Nerium oleander, Rev Assoc Med Bras 41(1):60-62, 1995. Nityanand S et al: Clinical trials with guggulipid: a new hypolipidemic agent, J Assoc Physicians India 37(5):323-328, 1989. Noack W et al: Glucosamine sulfate in osteoarthritis of the knee, Osteoarthritis Cartilage 2: 51-59, 1994. Noordeen SK: A look at world leprosy, Lepr Rev 62:72-86, 1991. Norbaek R et al: Anthocyanins from flowers of Cichorium intybus, Phytochemistry 60(4): 357-379, 2002. Norris FH et al: Trial of octacosanol in amyotrophic lateral sclerosis, Neurology 36(9): 1263-1264, 1986. Norton SA: Betel: consumption and consequences, J Am Acad Dermatol 38(1):81-88, 1998. Nosal’ova G et al: Antitussive action of extracts and polysaccharides of marshmallow (Althea officinalis L., var. robusta), Pharmazie 47(3):224-226, 1992. Nostro A et al: The effect of Nepeta cataria extract on adherence and enzyme production of Staphylococcus aureus, Int J Antimicrob Agents 18(6):583-585, 2001. Novikov DA et al: Photoprotective properties of melanins from grape and black tea, Radiats Biol Radioecol 41(6):664-670, 2001. Oberbaum M et al: The effect of the homeopathic remedies Arnica montana and Bellis perennis on mild postpartum bleeding – a randomized, double-blind, placebo-controlled study – preliminary results, Complement Ther Med 13(2):87-90, 2005. Ogura R et al: The role of ubiquinone (coenzyme Q10) in preventing adriamycin-induced mitochondrial disorders in rat hearts, J Appl Biochem 1:325-335, 1979. Ohtsuru M: Anti-obesity activity exhibited by orally administered powder of maitake mushroom (Grifola frondosa), Anshin, pp 188-199, July 1992. Oishi Y et al: Inhibition of increases in blood glucose and serum neutral fat by Momordica charantia saponin fraction, Biosci Biotechnol Biochem 71(3):735-740, 2007. Olajide OA et al: Biological effects of Myristica fragrans (nutmeg) extract, Phytother Res 13(4):344-345, 1999. Olsen SF et al: Duration of pregnancy in relation to fish oil supplementation and habitual fish intake: a randomized clinical trials with fish oil, Eur J Clin Nutr 61(8):976-985, 2007. Omenn GS et al: Effects of beta carotene vitamin A on lung cancer, N Engl J Med 334:1150-1155, 1996. Omer B et al: Steroid-sparing effect of wormwood (Artemisia absinthium) in Crohn’s disease: a double-blind placebo-controlled study, Phytomedicine 14(2-3):87-95, 2007. REFERENCES References 698 References Onderoglu S et al: The evaluation of long-term effects of cinnamon bark and olive leaf on toxicity induced by streptozotocin administration to rats, J Pharm Pharmacol 51:1305-1312, 1999. Oniga I et al: Effects of Salvia officinalis L. extract on experimental acute inflammation, Rev Med Chir Soc Med Nat Iasi 111(1):290-294, 2007. Ono M et al: Pharmacological studies on lappaconitine: antinociception and inhibition of the spinal action of substance P and somatostatin, Jpn J Pharmacol 55:523-530, 1991. Oommen ST et al: Effect of oil of Hydnocarpus on wound healing, Int J Lepr Other Mycobact Dis 67(2):154-158, 1999. Orabi KY et al: Isolation and characterization of two antimicrobial agents from mace (Myristica fragrans), J Nat Prod 54(3):856-859, 1991. Ortega M et al: Myrtus communis L. phytohemmagglutinins as a clarifying agent for lipemic sera, Clin Chim Acta 92(2):135-139, 1979. Ortiz JG et al: Effects of Valeriana officinalis extracts on [3H] fluni trazepam binding, synaptosomal [3H] GABA uptake, and hippocampal [3H] GABA release, Neurochem Res 34(11):1373-1378, 1999. Oshima Y et al: Powerful hepatoprotective and hepatotoxic plant oligostilbenes, isolated from the Oriental medicinal plant Vitis coignetiae (Vitaceae), Experientia 51(1):63-66, 1995. Otobone FJ et al: Effect of lyophilized extracts from guaraná seeds [Paullinia cupana var. sorbilis (Mart.) Ducke] on behavioral profiles in rats, Phytother Res 21(6):531-535, 2007. Ozaki Y et al: Antiinflammatory effect of mace, aril of Myristica fragrans Houtt and its active principles, Jpn J Pharmacol 49(2):155-163, 1989. Oztürk N et al: Effects of gentiopicroside, sweroside and swertiamarine, secoiridoids from gentian (Gentiana lutea ssp. symphyandra), on cultured chicken embryonic fibroblasts, Planta Med 72(4):289-294, 2006. Pacheco RG et al: Different antithrombotic mechanisms among gly-cosaminoglycans revealed with a new fucosylated chrondroiten sulfate from an echinoderm, Blood Coagul Fibrinolysis 11(6):563-573, 2000. Palevitch D et al: Feverfew as a prophylactic treatment for migraine: a double-blind placebocontrolled study, Phytotherapy Res 2:508-511, 1997. Palit P et al: Novel weight-reducing activity of Galega officinalis in mice, J Pharm Pharmacol 51(11):1313-1319, 1999. Panciera RJ et al: Acute oxalate poisoning attributable to ingestion of curly dock (Rumex crispus) in sheep, J Am Vet Med Assoc 196(12):1981-1984, 1990. Panda S et al: Dual role of betel leaf extract on thyroid function in male mice, Pharmacol Res 38(6):493-496, 1998. Paper DH et al: Planta Med 59(suppl):A589, 1993. Park BS et al: Antibacterial activity of Tabebuia impetiginosa Martius ex DC (Taheebo) against Helicobacter pylori, J Ethnopharmacol 105(1-2):255-262, 2006. Park JS et al: Dietary lutein from marigold extract inhibits mammary tumor development in BALB/c, J Nutr 128(10):1650-1656, 1998. Park YK et al: Antimicrobial activity of propolis on oral microorganisms, Curr Microbiol 36(1):24-28, 1998. Parvizpur A et al: Spinal serotonergic system is partially involved in antinociception induced by Trigonella foenum-graecum (TFG) leaf extract, J Ethnopharmacol 95(1):13-17, 2004. Pathak S et al: Anvirzel, an extract of Nerium Oleander, induces cell death in human but not murine cancer cells, Anticancer Drugs 11(6):455-463, 2000. Pattnaik S et al: Characterization of resistance to essential oils in a strain of Pseudomonas aeruginosa, Microbios 81(326):29-31, 1995a. Pattnaik S et al: Effect of essential oils on the viability and morphology of Escherichia coli, Microbios 84(340):195-199, 1995b. Pattnaik S et al: Antibacterial and antifungal activity of ten essential oils in vitro, Microbios 86(349):237-246, 1996. 699 Paul BD: Isolation of myricadiol, myriciatrin, taraxerol, and taxerone from Myrica cerifera root bark, J Pharm Sci 63:958-959, 1974. Paul BD et al: Gas chromatographic/mass spectrometric detection of narcotine, papaverine, and thebaine in seeds of Papaver somniferum, Planta Med 62(6):544-547, 1996. Peana AT et al: Chemical composition and antimicrobial action of the essential oils of Salvia desoleana and S. sclarea, Planta Med 65(8):752-754, 1999. Pedersen CB et al: Effects of blueberry and cranberry juice consumption on the plasma antioxidant capacity of healthy female volunteers, Eur J Clin Nutr 54(5):405-408, 2000. Peng H et al: The effect of pollen in enhancing tolerance to hypoxia and promoting adaptation to highlands, J Chin Med 70:77-81, 1990. Peng Q et al: Pycnogenol inhibits tumor necrosis factor-alpha–induced nuclear factor kappa B activation and adhesion molecule expression in human vascular endothelial cells, Cell Mol Life Sci 57(5):834-841, 2000. Peng Y et al: Huperzine A regulates amyloid precursor protein processing via protein kinase C and mitogen-activated protein kinase pathways in neuroblastoma SK-N-SH cells overexpressing wild type human amyloid precursor protein 695, Neuroscience 150(2): 386-395, 2007. Pereira JV et al: Antimicrobial activity of Arctium lappa constituents against microorganisms commonly found in endodontic infections, Braz Dent J 16(3):192-196, 2005. Peresun’ko AP et al: Clinical-experimental study of using plant preparations from the flowers of Filipendula ulmaria (L.) maxim for the treatment of precancerous changes and prevention of uterine cervical cancer, Vopr Onkol 39(7-12):291-295, 1993. Peter-Horvath M: Chem Abstracts 62:3105g, 1965. Petkov V: Plants and hypotensive, antiatheromatous and coronarodilatating action, Am J Chin Med 7(3):197-236, 1979. Petrowicz O et al: Effects of artichoke leaf on lipoprotein metabolism in vitro and in vivo, Athersclerosis 56:129-147, 1997. Pham AQ et al: Cinnamon supplementation in patients with type 2 diabetes mellitus, Pharmacotherapy 27(4):595-599, 2007. Phelan JT et al: Chemosurgical management of carcinoma of the nose, Surgery 53:310, 1963. Pieroni A et al: In vitro antioxidant activity of non-cultivated vegetables of ethnic Albanians in southern Italy, Phytother Res 16(5):467-473, 2002. Pittler MH et al: Peppermint oil for irritable bowel syndrome: a critical review and metaanalysis, Am J Gastroenterol 93(7):1131-1135, 1998. Pittler MH et al: Efficacy of kava extract for treating anxiety: systematic review and meta-analysis, J Clin Psychopharmacol 20(1):84-89, 2000. Pittler MH et al: Guar gum for body weight reduction: meta-analysis of randomized trials, Am J Med 110(9):724-730, 2001. Pizzorno J, Murray M: Textbook of natural medicine, 2-volume set, 3 ed, London, 2006, Churchill Livingstone. Plemons JM et al: Evaluation of acemannan in the treatment of recurrent aphthous stomatitis, Wounds 6:40-45, 1994. Pool-Zobel BL et al: Anthocyanins are potent antioxidants in model systems but do not reduce endogenous oxidative DNA damage in human colon cells, Eur J Nutr 38(5):227-234, 1999. Pourgholami MH et al: The fruit essential oil of Pimpinella anisum exerts anticonvulsant effects in mice, J Ethnopharmacol 66(2):211-215, 1999. Pradier O et al: Effects of paclitaxel in combination with radiation on human head and neck cancer cells (ZMK-1), cervical squamous cell carcinoma (CaSki), and breast adenocarcinoma cells (MCF-7), J Cancer Res Clin Oncol 125(1):20-27, 1999. Prochezhian E et al: Antihyperglycemic activity of Euphrasia officinale leaves, Fitoterapia 71(5):522-526, 2000. Pugsley MK et al: The cardiac electrophysiological effects of sparteine and its analogue BRB-I-28 in the rat, Eur J Pharmacol 27:319-327, 1995. REFERENCES References 700 References Pullman-Mooar S et al: Alteration of the cellular fatty acid profile and the production of eicosanoids in human monocytes by gamma-linolenic acid, Arthritis Rheum 33:1526-1533, 1990. Puri A et al: Antidyslipidemic activity of Indigofera tinctoria, J Herb Pharmacother 7(1):59-64, 2007. Putter M et al: Inhibition of smoking-induced platelet aggregation by aspirin and pycnogenol, Thromb Res 95(4):155-161, 1999. Qicheng F: Some current study and research approaches relating to the use of plants in the traditional Chinese medicine, J Ethnopharmacol 2(1):57-63, 1980. Qu DQ et al: Abstracts of the 1956 Symposium of the Chinese Pharmacy Association (Shanghai Branch), 1 ed, Shanghai Branch, 1957. Quaglia MG et al: Determination of silymarin in the extract from dried silybum marianum fruits by high performance liquid chromatography and capillary electrophoresis, J Pharm Biomed Anal 19(3-4):435-442, 1999. Qureshi S et al: Evaluation of the genotoxic, cytotoxic, and antitumor properties of Commiphora molmol using normal and Ehrlich ascites carcinoma cell-bearing Swiss albino mice, Cancer Chemother Pharmacol 33(2):130-138, 1993. Rabbini GH et al: Clinical studies in persistent diarrhea: dietary management with green banana or pectin in Bangladeshi children, Gastroenterology 121(3):554-560, 2001. Rackova L et al: Free radical scavenging activity and lipoxygenase inhibition of Mahonia aquifolium extract and isoquinoline alkaloids, J Inflamm (Lond) 4:15, 2007. Radulovi N et al: Composition and antimicrobial activity of Equisetum arvense L. essential oil, Phytother Res 20(1):85-88, 2006. Raffa, RB: Screen of receptor and uptake-site activity of hypericin component of St. John’s wort reveals sigma receptor binding, Life Sci 62:265-270, 1998. Raj RK: Screening of indigenous plants for anthelmintic action against human Ascaris lumbricoides, part II, Indian J Physiol Pharmacol 19(1):47-49, 1975. Rajkapoor B et al: Effect of dried fruits of Carica papaya on hepatotoxicity, Biol Pharm Bull 25(12):1645-1646, 2002. Rajkapoor B et al: Protective effect of Indigofera aspalathoides against CC14-induced hepatic damage in rats, J Herb Pharmacother 6(1):49-54, 2006. Ram A et al: Hyolipidaemic effect of Myristica fragrans fruit extract in rabbits, J Ethnopharmacol 55(1):49-53, 1996. Ramadan W et al: Oil of bitter orange: new topical antifungal agent, Int J Dermatol 35(6): 448-449, 1996. Raman A et al: Investigation of the effect of Angelica sinensis root extract on the proliferation of melanocytes in culture, J Ethnopharmacol 54(2-3):165-170, 1996. Ramaswami G et al: Curcumin blocks homocysteine-induced endothelial dysfunction in porcine coronary arteries, J Vasc Surg 40(6):1216-1222, 2004. Ramsewak RS et al: Cytotoxicity, antioxidant and anti-inflammatory activities of curcumins I-III from Curcuma longa, Phytomedicine 7(4):303-308, 2000. Randall C et al: Nettle sting of Urtica diocia for joint pain: an exploratory study of this complementary therapy, Complement Ther Med 7(3):126-131, 1999. Rani P, Khullar N: Antimicrobial evaluation of some medicinal plants for their anti-enteric potential against multi-drug resistant Salmonella typhi, Phytother Res 18(8):670-673, 2004. Rao CV et al: Prevention of colonic preneoplastic lesions by the probiotic Lactobacillus acidophilus NCFMTM in F344 rats, Int J Oncol 14:939-944, 1999. Rao KS et al: Antihepatotoxic activity of monomethyl fumarate isolated from Fumaria indica, J Ethnopharmacol 60:207-213, 1998. Rao RB et al: Nicotinic toxicity from tincture of blue cohosh (Caulophyllum thalictroides) used as an abortifacient, Vet Hum Toxicol 44(4):221-222, 2002. Rasekh Hr et al: Acute and subchronic oral toxicity of Galega officinalis in rats, J Ethnopharmacol 116(1):21-26, 2008. 701 Rasheed A et al: Eugenol and prostaglandin biosynthesis, N Engl J Med 310(1):50-51, 1984 (letter). Rauha JP et al: Antimicrobial effects of Finnish plant extracts containing flavonoids and other phenolic compounds, Int J Food Microbiol 56(1):3-12, 2000. Rauwald HW et al: The involvement of a Ca2⫹ channel blocking mode of action in the pharmacology of Ammi visnaga fruits, Planta Med 60(2):101-105, 1994. Ravikumar P et al: Effect of fenugreek seeds on blood lipid peroxidation and antioxidants in diabetic rats, Phytother Res 13(3):197-201, 1999. Razina TG et al: Enhancement of the selectivity of the action of the cytostatics cyclophosphamide and 5-fluorouracil by using an extract of the Baikal skullcap in an experiment, Vopr Onkol 33:80-84, 1987. Razina TG et al: The role of thrombocyte aggregation function in the mechanism of the antimetastic action of an extract of Baikal skullcap, Vopr Onkol 35(3):331-335, 1989. Reay JL et al: Effects of Panax ginseng, consumed with and without glucose, on blood glucose levels and cognitive performance during sustained ‘mentally demanding’ tasks, J Psychopharmacol 20(6):771-781, 2006. Record I et al: Genistein inhibits growth of B16 melanoma cells in vivo and in vitro and promotes differentiation in vitro, Int J Cancer 72(5):860-864, 1997. Rector T et al: Randomized, double-blind, placebo-controlled study of supplement oral L-arginine in patients with heart failure, Circulation 93:2135-2141, 1996. Reddy SV et al: Antibacterial constituents from the berries of Piper nigrum, Phytomedicine 11(7-8):697-700, 2004. Redgwell RJ et al: Isolation and characteristics of cell wall polysaccharides from cocoa (Theobroma cacao L.) beans, Planta 210(5):823-830, 2000. Redman DA: Ruscus aculeatus (butcher’s broom) as a potential treatment for orthostatic hypotension, with a case report, J Altern Complement Med 6(6):539-549, 2000. Reffo GC et al: Curr Ther Res 47:753, 1990. Reglin F et al: Butterbur root, a pain reliever with wide-range application possibilities, PraxisTelegram 1:13-14, 1998. Reichart R: Holy basil leaves and type II diabetes, Q Rev Nat Med pp 267-268, Winter 1997. Reichling J et al: A current review of the antimicrobial activity of Hypericum perforatum L. Pharmaco/psychiatry 34(suppl 1):S116-S118, 2001. Reifen R et al: Lycopene supplementation attenuates the inflammatory status of colitis in a rat model, Int J Vitam Nutr Res 71(6):347-351, 2001. Reig R et al: Fatal poisoning by Rumex crispus (curled dock): pathological findings and application of scanning electron microscopy, Vet Hum Toxicol 32(5):468-470, 1990. Reisch J et al: On the problem of the microbiological activity of simple acetylene compounds, Arzneimittelforschung 17:816, 1967. Reiter M et al: Relaxant effects of tracheal and ileal smooth muscles of the guinea pig, Arzneimittelforschung 35(1A):408-414, 1985. Reiter RJ et al: Oxygen radical detoxification processes during aging: the functional importance of melatonin, Aging Clin Exp Res 7:340-351, 1995. Rentz E: Arch Exptl Path Pharmakol 205:332, 1948. Reyes BA et al: Anti-diabetic potentials of Momordica charantia and Andrographis paniculata and their effects on estrous cyclicity of alloxan-induced diabetic rats, J Ethnopharmacol 105(1-2):196-200, 2006. Reynolds JEF, editor: Martindale: the extra pharmacopoeia, 31 ed, London, 1996, Royal Pharmaceutical Society. Rezaeipoor R et al: The effect of Plantago ovata on humoral immune responses in experimental animals, J Ethnopharmacol 72(1-2):283-286, 2000. Rhee JK et al: Structural investigation on the effects of the herbs on Clonorchis sinensis in rabbits, Am J Chin Med 13(1-4):119-125, 1985. Riehemann K et al: Plant extracts from stinging nettle (Urtica dioica), an antirheumatic remedy, inhibit the proinflammatory transcription factor NF-kappaB, FEBS Lett 442(1):89-94, 1999. REFERENCES References 702 References Rietz B et al: The radical scavenging ability of garlic examined in various models, Boll Chim Farm 134(2):69-76, 1995. Riley AJ: Yohimbine in the treatment of erectile disorder, Br J Clin Pract 48(3):133-136, 1994. Rizzo M: Coffee Inversely Associated with Coronary Clarification in Women, Reuters Health Information, 2008. Roberts JL et al: Exacerbation of SLE associated with alfalfa ingestion, N Engl J Med 308(22):1361, 1983. Roffey BW et al: Water extracts from Momordica charantia increase glucose uptake and adiponectin secretion in 3T3-L1 adipose cells, J Ethnopharmacol 112(1):77-84, 2007. Rollinger JM et al: Application of the in combo screening approach for the discovery of nonalkaloid acetylcholinesterase inhibitors from Cichorium intybus, Curr Drug Discov Technol 2(3):185-193, 2005. Romano GA et al: Poisoning with oleander leaves, Schweiz Med Wochenschr 120(16):596-597, 1990. Romm A: Better Nutrition’s 2000 guide to children’s supplements, Better Nutr 62(10):38-43, 2000. Romm A: Naturally healthy babies and children, Berkley, 2003, Ten Speed Press. Rong-Xun Z et al: Laboratory studies of berberine used alone and in combination with 1,3-bis (2-chloroethyl)-1-nitrosurea to treat malignant brain tumors, Chin Med J 103:658-665, 1990. Rovati LC et al: A large, randomized placebo controlled, double-blind study of glucosamine sulfate vs. piroxicam and vs. their association, on the kineses of the symptomatic effect in knee osteoarthritis, Osteoarthritis Cartilage 2:56, 1994. Rowan AD et al: Debridement of experimental full-thickness skin burns of rats with enzyme fractions derived from pineapple stems, Burns 16(4):243-246, 1990. Rowe CA et al: Specific formulation of Camellia sinensis prevents cold and flu symptoms and enhances gamma, delta T cell function: a randomized, double-blind, placebo-controlled study, J Am Coll Nutr 26(5):445-452, 2007. Rózalski M et al: Cytotoxic and proapoptotic activity of diterpenoids from in vitro cultivated Salvia sclarea roots. Studies on the leukemia cell lines, Z Naturforsch [C] 61(7-8): 483-488, 2006. Rozen TD et al: Open label trial of coenzyme Q10 as a migraine preventive, Cephalalgia 22(2):137-141, 2002. Rubin BR et al: Oral polymeric N-acetyl-D-glucosamine and osteoarthritis, J Am Osteopath Assoc 101(6):339-344, 2001. Rudin DO: The major psychoses and neuroses as omega-3 essential fatty acid deficiency syndrome: substrate pellagra, Biol Psychiatry 16(9):837-850, 1981. Ruperez P et al: Potential antioxidant capacity of sulfated polysaccharides from the edible marine brown seaweed Fucas vesiculosus, J Agric Food Chem 50(4):840-845, 2002. Ryu JH et al: A new bisabolene epoxide from Tussilago farfara, and inhibition of nitric oxide synthesis in LPS-activated macrophages, J Nat Prod 62(10):1437-1438, 1999. Ryzhikov MA, Ryzhikova VO: Application of chemiluminescent methods for analysis of the antioxidant activity of herbal extracts, Vopr Pitan 75(2):22-26, 2006. Saba P et al: Curr Ther Res Clin Exp 24:299-306, 1978. Sabir M et al: Study of some pharmacologic actions of berberine, Indian J Physiol Pharmacol 15:111-132, 1971. Sadic O et al: A study on inhibitory effects of Sigla tree (Liquidambar orientalis Mill. var. orientalis) storax against several bacteria, Phytother Res 19(6):549-551, 2005. Saeed MA et al: Antimicrobial studies of the constituents of Pakistani eucalyptus oils, J Fac Pharm Gazi Univ 12(2):129-140, 1995. Sahelian R: New supplements and unknown, long-term consequences, Am J Nat Med 4(8):8-9, 1997. 703 Sahin F et al: Evaluation of antimicrobial activities of Satureja hortensis L., J Ethnopharmacol Jul 87(1):61-65, 2003. Sakamoto S et al: Pharmacotherapeutic effects of kuei-chih-fu-ling-wan (Keishi-bukuryogan) on human uterine myomas, Am J Chin Med 20(3-4):314-317, 1992. Sakamoto T et al: Psychotropic effects of Japanese valerian root extract, Chem Pharm Bull 40:758-761, 1992. Salhab AS et al: On the contraceptive effect of castor beans, Int J Pharmacognosy 35(1):63-65, 1997. Salido S et al: Chemical studies of essential oils of Juniperus oxycedrus ssp. badia, J Ethnopharmacol 81(1):129-134, 2002. Sambaiah K et al: Effect of cumin, cinnamon, ginger, mustard and tamarind in induced hypercholesterolemic rats, Nahrung 35(1):47-51, 1991. Sampson JH et al: Ethnomedicinally selected plants as sources of potential analgesic compounds: indication of in vitro biological activity in receptor binding assays, Phytother Res 14(1):24-29, 2000. Sanchez de Medina F et al: Hypoglycemic activity of juniper berries, Planta Med 60(3):197-200, 1994. Sangun MK et al: Comparison of chemical composition of the essential oil of Laurus nobilis L. leaves and fruits from different regions of Hatay, Turkey, J Environ Biol 28(4):731-733, 2007. Sarkar S et al: Demonstration of the hypoglycemic action of Momordica charantia in a validated animal model of diabetes, Pharmacol Res 33(1):1-4, 1996. Sasaki Y et al: The clastogen-suppressing effects of green tea, Po-lei tea and Rooibos tea in CHO cells and mice, Mutat Res 286(2):221-232, 1993. Sastre J et al: Respiratory and immunological reactions among shiitake (Lentinus edodes) mushroom workers, Clin Exp Allergy 20(1):13-19, 1990. Satchithanandam S et al: Alkaloids and saponins in dietary supplements of blue cohosh (Caulophyllum thalictroides), J AOAC Int 91(1):21-32, 2008. Satyavati G: Guggulipid: a promising hypolipidaemic agent from gum guggul (Commiphora wightii). In Wagner H et al, editors: Economic and medicinal plant research, vol 5, San Diego, Calif, 1991, Academic Press. Savino F et al: A randomized double-blind pacebo-controlled trial of a standardized extract Matricariae recutita, Foeniculum vulgare and Melissa officinalis (ColiMil) in the treatment of breastfed colicky infants, Phytother Res 19(4):335-340, 2005. Saxena BB et al: Boc-lysinated-betulonic acid: a potent, anti-prostate cancer agent, Bioorg Med Chem, 14(18):6349-6358, 2006. Scarpa A et al: Various uses of the castor oil plant: a review, J Ethnopharmacol 5(2):117, 1982. Schaffener W: Granny’s remedy explained at the molecular level: helenalin inhibits NF-kappa B, Biol Chem 378:935, 1997. Schapowal A: Randomised controlled trial of butterbur and cetrizine for treating seasonal allergic rhinitis, BMJ 324(7330):144-146, 2002. Schilling T, Eder C: A novel physiological mechanism of glycine-induced immunomodulation: Na⫹-coupled amino acid transporter currents in cultured brain macrophages, J Physiol 559(pt 1):35-40, 2004. Schinella GR et al: Antioxidant effects of an aqueous extract of Ilex paraguariensis, Biochem Biophys Res Commun 269(2):357-360, 2000. Schinkovitz A et al: Antimycobacterial polyacetylenes from Levisticum officinale, Phytother Res 22(5):681-684, 2008. Schmidt K et al: Pharmacotherapy with Avena sativa: a double blind study, Int J Clin Pharmacol Biopharm 14(3):214-216, 1976. Schmidt U et al: Efficacy of the hawthorn (Crataegus) preparation LI 132 in 78 patients with chronic congestive heart failure defined as NYHA functional class II, Phytomedicine 1: 17-24, 1994. REFERENCES References 704 References Schmidt U et al: Effects of an herbal crataegus-camphor combination on the symptoms of cardiovascular diseases, Arzneimittelforschung 50(7):613-619, 2000. Scholing WE et al: On the effect of D, L-kavain: experience with neuronika, Med Klin 72: 1301-1306, 1977. Schuh FT: On the molecular mechanism of action of galanthamine, an antagonist of nondepolarizing muscle relaxants: Anaesthesist 25(9):444-448, 1976. Segelman AB et al: Biological and phytochemical evaluation of plants, IV: a new rapid procedure for the simultaneous determination of saponins and tannins, Lyoydia 32(1):59-65, 1969. Segura JJ et al: Growth inhibition of Entamoeba histolytica and E. invadena produced by pomegranate root (Punica granatum L.), Arch Invest Med (Mex) 21(3):235-239, 1990. Semino-Mora MC et al: Effect of L-carnitine on zidovudine-induced destruction of human myotublesm. I, Lab Invest 71:102-112, 1994. Serkedjieva J et al: Anti-influenza virus effect of some propolis constituents and their analogues (esters of substituted cinnamic acids), J Nat Prod 55(3):294-302, 1992. Sesterhenn K et al: Occurrence of iridoid glycosides in in vitro cultures and intact plants of Scrophularia nodosa L., Plant Cell Rep 26(3):365-371, 2007. Sethi OP et al: Evaluation of xanthotoxol for central nervous system activity, J Ethnopharmacol 36:239-247, 1992. Sezik E et al: Hypoglycaemic activity of Gentiana olivieri and isolation of the active constituent through bioassay-directed fractionation techniques, Life Sci 76(11):1223-1238, 2005. Shah D et al: Aescula force in chronic venous insufficiency, Schweiz Zschr Ganzheitsmedizin 9(2):86-91, 1997. Shah S: Dietary factors in the modulation of inflammatory bowel disease activity, MedGenMed 9(1):60, 2007. Sham JS et al: Hypertensive action of Acacia catechu, Planta Med 50:177-180, 1984. Shams-Ghahfarokhi M et al: In vitro antifungal activities of Allium cepa, Allium sativum and ketoconazole against some pathogenic yeasts and dermatophytes, Fitoterapia 77(4): 321-323, 2006. Sharma A et al: Prevention of hypercholesterolemia and atherosclerosis in rabbits after supplementation of Myristica fragrans seed extract, Indian J Physiol Pharmacol 39(4):407-410, 1995. Sharma JN et al: Comparison of the anti-inflammatory activity of Commiphora mukul (an indigenous drug) with those of phenylbutazone and ibuprofen in experimental arthritis induced by mycobacterial adjuvant, Arzneimittelforschung 27(7):1455-1457, 1977. Sharma SK et al: Complex-1 activity and 18F-DOPA uptake in genetically engineered mouse model of Parkinson’s disease and the neuroprotective role of coenzyme Q10, Brain Res Bull 70(1):22-32, 2006. Shcherbanovsky LR et al: Volatile oil of Anethum graveolens L. as an inhibitor of yeast and lactic acid bacteria, Prikl Biokhim Mikrobiol 11(3):476-477, 1975. Sheeja K et al: Antioxidant and anti-inflammatory activities of the plant Andrographis paniculata Nees, Immunopharmacol Immunotoxicol 28(1):129-140, 2006. Sheela ML et al: Angiogenic and proliferative effects of the cytokine VEGF in Ehrlich ascites tumor cells is inhibited by Glycyrrhiza glabra, Int Immunopharmacol 6(3):494-498, 2006. Sheets MA et al: Studies of the effect of acemannan on retrovirus infections, Mol Biother 3: 41-45, 1991. Sheikh NM et al: Chaparral-associated hepatotoxicity, Arch Intern Med 157:913-919, 1997. Shen D et al: Effect of xiaoyu pian on new platelet aggregation defect, Chung Kuo Chung Hsi I Chieh Ho Tsa Chih 14(10):589-591, 1994. Shen D et al: Determination of the predominant catechins in Acacia catechu by liquid chromatography/electrospray ionization-mass spectrometry, J Agric Food Chem 54(9):3219-3224, 2006. Sheng Y et al: DNA repair enhancement of aqueous extracts of Uncaria tomentosa in a human volunteer study, Phytomedicine 8(4):275-282, 2001. 705 Sheng Y et al: Treatment of chemotherapy-induced leukopenia in a rat model with aqueous extract from Uncaria tomentosa, Phytomedicine 7(2):137-143, 2000. Shenouda NS et al: Phytosterol Pygeum africanum regulates prostate cancer in vitro and in vivo, Endocrine 31(1):72-81, 2007. Sherry CJ et al: The pharmacological effects of the ligroin extract of nutmeg, J Ethnopharmacol 6(1):61-66, 1982. Shi W, Gould MN: Induction of differentiation in neuro-2A cells by the monoterpene perillyl alcohol, Cancer Lett 95:1-6, 1995. Shigematsu N et al: Effect of administration with the extract of Gymnema sylvestre R. Br. leaves on lipid metabolism in rats, Biol Pharm Bull 24(6):713-717, 2001a. Shigematsu N et al: Effect of long-term administration with Gymnema sylvestre R. Br. on plasma and liver lipid in rats, Biol Pharm Bull 24(6):643-649, 2001b. Shimada H et al: Biologically active acylglycerides from the berries of saw-palmetto (Serenoa repens), J Nat Prod 60(4):417-418, 1997. Shimizu M et al: Marked potentiation of activity of beta-lactams against methicillin-resistant Staphylococcus aureus by Corilagin, Antimicrob Agents Chemother 45(11):3198-3201, 2001. Shimizu T et al: Effects of Lactobacillus gasseri OLL 2716 (LG21) on Helicobacter pylori infection in children, J Antimicrob Chemother 50(4):617-618, 2002. Shimizu T et al: A role of PPAR-gamma in androstenediol-mediated salutary effects on cardiac function following trauma-hemorrhage, Ann Surg 244(1):131-138, 2006. Shimoi K et al Radioprotective effects of antioxidative plant flavonoids in mice, Mutat Res 350(1):153-161, 1996. Shin TY et al: Inhibitory effect of mast cell-mediated immediate-type allergic reactions in rats by Perilla frutescens, Immunopharmacol Immunotoxicol 22(3):489-500, 2000. Shippy RA et al: S-adenosylmethionine (SAM-e) for the treatment of depression in people living with HIV/AIDS, BMC Psychiatry:4:38, 2004. Shrivastava R et al: Effects of Alchemilla vulgaris and glycerine on epithelial and myofibroblast cell growth and cutaneous lesion healing in rats, Phytother Res 21(4):369-373, 2007. Shumaik GM et al: Oleander poisoning: treatment with digoxin-specific FAB antibody fragments, Ann Emerg Med 17(7):732-735, 1988. Shwaireb MH et al: Carcinogenesis induced by black pepper (Piper nigrum) and modulated by vitamin A, Exp Pathol 40(4):233-238, 1990. Shyamala MP et al: Probing the anti-hyperlipidemic efficacy of the allspice (Pimenta officinalis Lindl.) in rats fed with high fat diet, Indian J Physiol Pharmacol 49(3):363-368, 2005. Siddiqui BS et al: Two insecticidal tetranortriterpenoids from Azadirachta indica, Phytochemistry 53(3):371-376, 2000. Sigstedt SC et al: Evaluation of aqueous extracts of Taraxacum officinale on growth and invasion of breast and prostate cancer cells, Int J Oncol 32(5):1085-1090, 2008. Silva BM et al: Composition of quince (Cydonia oblonga Miller) seeds: phenolics, organic acids and free amino acids, Nat Prod Res 19(3):275-281, 2005. Simmen U et al: Extracts and constituents of Hypericum perforatum inhibit the binding of various ligands to recombinant receptors expressed with the Semliki Forest virus system, J Recept Signal Transduct Res 19(1-4):59-74, 1999. Simon C et al: Failure of lysine in frequently recurrent herpes simplex infection, Arch Dermatol 121:167-168, 1985. Simon M et al: Antihemolytic effect of Rooibos tea on red blood cells of Japanese quails, Gen Physiol Biophys 19(4):365-371, 2000. Simoniene G et al: The influence of common perilla (Perilla frutescens (L.) Britton) on nonspecific cell-mediated immunity–phagocytosis activity, Medicina (Kaunas) 41(12): 1042-1047, 2005. Simpson D: Buchu: South Africa’s amazing herbal remedy, Scott Med J 43(6):189-191, 1998. Singh KN et al: Hypotensive action of Acacia catechu, Planta Med 50:177-180, 1976. REFERENCES References 706 References Singh RB et al: A randomized, double-blind, placebo-controlled trial of L-carnitine in suspected acute myocardial infarction, Postgrad Med J 72:45-50, 1996. Singh S et al: Effect of fixed oil of Ocimum sanctum against experimentally induced arthritis and joint edema in laboratory animals, Int J Pharma-cognosy 34(3):218-222, 1996. Sjaastad OV et al: Hypotensive effects in cats caused by horseradish peroxidase mediated metabolities of arachidonic acid, J Histochem Cytochem 32:1328-1330, 1984. Sliutz G et al: Agnus castus extracts inhibit prolactin secretion of rat pituitary cell, Horm Metab Res 25:253-255, 1993. Small E: Confusion of common names for toxic and edible ”star anise” (Illicium) species, Econom Botany 50(3):337-339, 1996. Smith E: Therapeutic herb manual, Williams, Ore, 1999, Author. Smolarz HD et al: The investigations into the interferon-like activity of Polygonum L. genus, Acta Pol Pharm 56(6):459-462, 1999. Smolarz HD: Comparative study on the free flavonoid aglycones in herbs of different species of Polygonum L, Acta Pol Pharm 59(2):145-148, 2002. Sonavane GS et al: Anxiogenic activity of Myristica fragrans seeds, Pharmacol Biochem Behav 71(1-2):239-244, 2002. Song H et al: Investigation of urinary interleukin-6 level in chronic renal failure patients and the influence of Rheum palmatum in treating it, Zhongguo Zhong Xi Yi Jie He Za Zhi 20(2):107-109, 2000. Sonnenbichler J et al: Stimulatory effects of silibinin and silicristin from the milk thistle (Silybum marianum) on kidney cells, J Pharmacol Exp Ther 290(3):1375-1383, 1999. Sotnikova R et al: Relaxant properties of some aporphine alkaloids from Mahonia aquifolium, Methods Find Exp Clin Pharmacol 19(9):589-597, 1997. Soulimani R et al: Neurotropic action of the hydroalcoholic extract of Melissa officinalis in the mouse, Planta Med 57(2):105-109, 1991. Soulimani R et al: Behavioural effects Passiflora incarnata L. and its indole alkaloid and flavonoid derivatives and maltol in the mouse, J Ethnopharmacol 57(1):11-20, 1997. Sovovo M et al: Pharmaceutical importance of Allium sativus L. II. antibacterial effects, Ceska Slov Farm 51(1):11-61, 2002. Spasov AA et al: Comparative evaluation of the effects of carnitine stereoisomers and racemate on the cardio- and hemodynamics of rats on a carnitine-deficient diet, Vestn Ross Akad Med Nauk (7):20-27, 2006. Speisky H et al: Boldo and boldine: an emerging case of natural drug development, Pharmacol Res 29:1-12, 1994. Sperl W et al: Eur J Pediatr 154(2):112-116, 1995. Spirodonov NA et al: Cytotoxicity of some Russian ethnomedicinal plants and plant compounds, Phytother Res 19(5):428-432, 2005. Staiano A et al: Effect of the dietary fiber glucomannan on chronic constipation in neurologically impaired children, J Pediatr 136(1):41-45, 2000. Stark M et al: Chemotherapy of pancreatic cancer with the monoterpene perillyl alcohol, Cancer Lett 96(1):15-21, 1995. Stauch M et al: Effect of proscillaridin-4i-methylether on pressure rise velocity in the left ventricle of patients with coronary heart disease, Klin Wochenschr 55:705-706, 1977. Stavri M, Gibbons, S: The antimycobacterial constituents of dill (Anethum graveolens), Phytother Res 19(11):938-941, 2005. Stein GM et al: Toxic proteins from European mistletoe (Viscum album L.): increase of intracellular IL-4 but decrease of IFN-gamma in apoptotic cells, Anticancer Res 20(3A):1673-1678, 2000. Stevenson PC et al: Wound healing activity of acylated iridoid glycosides from Scrophularia nodosa, Phytother Res 16(1):33-35, 2002. Stickel F et al: Hepatotoxicity of botanicals, Public Health Nutr 3(2):113-124, 2000. Stoll W: Phytopharmacon influences atrophic vaginal epithelium: double-blind study—cimicifuga vs. estrogenic substances, Therapeuticum 1:23-31, 1987. 707 Stolze H: An alternative to treatment menopausal complaints, Gynecol 3:14-16, 1982. Stumpf C et al: Mistletoe extracts in the therapy of malignant, hematological and lymphatic disesses—a monocentric, retrospective analysis over 16 years, Forsch Komplementarmed Klass Naturheilkd 7(3):139-146, 2000. Stuppner H et al: A differential sensitivity of oxindole alkaloids to normal and leukemic cell lines, Planta Medica 59(suppl):A583, 1993. Súarez A et al: Cardiovascular effects of ethanolic and aqueous extracts of Pimenta dioica in Sprague-Dawley rats, J Ethnopharmacol 55:107-111, 1997. Sugi M: Cancer therapy by Chinese crude drugs. In Kondo K: Cancer therapy in China today, Tokyo, 1997, Shizensha. Suh SJ et al: Pharmacological characterization of orally active cholinesterase inhibitory activity of Prunus persica L. Batsch in rats, J Mol Neurosci 29(2):101-107, 2006. Suja P et al: Gastro protective effect of fenugreek seeds on experimental gastric ulcer in rats, 81(3):393-397, 2002. Sullivan RJ et al: Effects of chewing betel nut (Areca catechu) on the symptoms of people with schizophrenia in Palau, Micronesia, Br J Psychiatry 177:174-178, 2000. Sussman JI et al: Clinical manifestations and therapy of Lactobacillus endocarditis: report of a case and review of the literature, Rev Infect Dis 8(5):771-776, 1986. Suzuki O et al: Inhibition of monoamine oxidase by hypericin, Planta Med 50:272-274, 1984. Swanston-Flatt S et al: Traditional plant treatments for diabetes: studies in normal and streptozotocin diabetic mice, Diabetologia 33(8):462-464, 1990. Tabek M et al: Cinnamon extracts’ inhibitory effect on Helicobacter pylori, J Ethnopharmacol 67(3):269-277, 1999. Tahri A et al: Acute diuretic, natriuretic and hypotensive effects of a continuous perfusion of aqueous extract of Urtica diocia in the rat, J Ethnopharmacol 73(1-2):95-100, 2000. Takada-Takatori Y et al: Neuroprotective effects of galanthamine and tacrine against glutamate neurotoxicity, Eur J Pharmacol 549(1-3):19-26, 2006. Takahashi Y et al: Dietary gamma-linolenic acid in the form of borage oil causes less body fat accumulation accompanying an increase in uncoupling protein 1 mRNA level in brown adipose tissue, Comp Biochem Physiol B Biochem Mol Biol 127(2):213-222, 2000. Takayanagi R et al: DHEA as a possible source for estrogen formation in bone cells: correlation between bone mineral density and serum DHEA-sulfate concentration in postmenopausal women, Mech Ageing Dev 123(8):1107-1114, 2002. Takeda S et al: Effects of TJN-101, a lignan compound isolated from Schisandra fruits, on liver fibrosis and on liver regeneration after partial hepatectomy in rats with chronic liver injury induced by CC14, Nippon Yakurigaku Zasshi 90(1):51-65, 1987. Takehara M et al: Antiviral activity of virus-like particles from Lentinus edodes (shiitake): brief report, Arch Virol 59(3):269-274, 1979. Tamuki A et al: Clinical trial of SY skin care series containing mugwort extract, Skin Res 36: 369-378, 1994. Tandan R et al: Topical capsaicin in painful diabetic neuropathy: a controlled study with long-term follow-up, Diabetes Care 15:8-14, 1992. Tang G et al: Bioavailability of synthetic and biosynthetic deuterated lycopene in humans, J Nutr Biochem 16(4):229-235, 2005. Tanka S et al: Effects of “toki” (Angelica acutiloba Kitawaga) extracts on writhing and capillary permeability in mice (analgesic and antiinflammatory effects), Yakugaku Zassh 91: 1098-1104, 1977. Tarhan L et al: In vitro antioxidant properties of Cucurbita pepo L. male and female flowers extracts, Plant Foods Hum Nutr 62(2):49-51, 2007. Tariq M et al: Anti-inflammatory activity of Commiphora molmol, Agents Actions 17(3-4): 381-382, 1986. Taussig SJ et al: Bromelain, the enzyme complex of pineapple (Ananas comosus) and its clinical application: an update, J Ethnopharmacol 22(2):191-203, 1988. REFERENCES References 708 References Tawata S et al: Synthesis and antifungal activity of cinnamic acid ester, Biosci Biotechnol Biochem 60(5):909-910, 1996. Tchoumbougnang F et al: In vivo antimalarial activity of essential oils from Cymbopogon citrates and Ocimum gratissimum on mice infected with Plasmodium berghei, Planta Med 71(1):20-23, 2005. Teixera CC et al: The effect of Syzygium cumini L. skeels on post-prandial blood glucose levels in non-diabetic rats and rats with streptozotocin-induced diabetes mellitus, J Ethnopharmacol 56(3):209-213, 1997. Tenenbaum S et al: An experimental comparison of pycnogenol and methylphenidate in adults with attention deficit/hyperactivity disorder (ADHD), J Atten Disord 6(2):49-60, 2002. Teng CM et al: Asia Pac J Pharmacol 3:85, 1988. Tenni R et al: Effect of the triterpenoid fraction of Centella asiatica on macromolecules of the connective matrix in human skin fibroblast cultures, Ital J Biochem 37(2):69-77, 1988. Thamsborg SM et al: Putative effect of silymarin on sawfly (Arge pullata)-induced hepatotoxicosis in sheep, Vet Hum Toxicol 38(2):89-91, 1996. Thatte U et al: Modulation of programmed cell death by medicinal plants, Cell Mol Biol (Noisy-legrand) 46(1):199-214, 2000. Theodosakis J: The arthritis cure, New York, 1997, St Martin’s Press. Thiede HM et al: Inhibition of MAO and COMT by Hypericum extracts and hypericin, J Geriatr Psychiatry Neurol 7(suppl 1):s54-56, 1994. Thome OA et al: Antiinflammatory activity of an extract of Petasites hybridus in allergic rhinitis, Int Immunopharmacol 2(7):997-1006, 2002. Tognolini M et al: Comparative screening of plant essential oils: phenylpropanoid moiety as basic core for antiplatelet activity, Life Sci 78(13):1419-1432, 2006. Toiu A et al: Evaluation of anti-inflammatory activity of alcoholic extract from Viola tricolor, Rev Med Chir Soc Med Nat Iasi 111(2):525-529, 2007. Tokunaga S et al: Green tea consumption and serum lipids and lipoproteins in a population of healthy workers in Japan. Ann Epidemiol 12(3):157-165, 2002. Tona L et al: Antimalarial activity of 20 crude extracts from nine African medicinal plants used in Kinshasa, Congo, J Ethnopharmacol 68(1-3):193-203, 1999. Tormey WP et al: Acute psychosis due to the interaction of legal compounds: ephedra alkaloids in “vigueur fit” tablets, caffeine in “red bull” and alcohol, Med Sci Law 41(4):331-336, 2001. Towheed TE et al: Glucosamine therapy for treating osteoarthritis, Cochrane Database Syst Rev (2):CD002946, 2005. Tozyo T et al: Novel antitumor sesquiterpenoids in Achillea millefolium, Chem Pharm Bull 42(5):1096-1100, 1994. Travers RL et al: Boron and arthritis: the results of a double-bind pilot study, J Nutr Med 1: 127-132, 1990. Treviño-Cueto B et al: Gallic acid and tannase accumulation during fungal solid state culture of a tannin-rich desert plant (Larrea tridentata Cov.), Bioresour Technol 98(3):721-724, 2007. Trovato A et al: In vitro cytotoxic effect of some medicinal plants containing flavonoids, Bull Chim Farm 135:263-266, 1996. Trovato A et al: In vitro antimycotic activity of some medicinal plants containing flavonoids, Bull Chim Farm 139(5):225-227, 2000. Tsakala TM et al: Screening of in vitro antibacterial activity from Syzygium guineense (wild) hydrosoluble dry extract, Lab de Pharmacie Galenique, Faculte de Pharmacie 54(6): 276-279, 1996 (abstract). Tsi D et al: The mechanism underlying the hypocholesterolaemic activity of aqueous celery extracts, its butanol and aqueous fractions in genetically hypercholesterolaemic RICO rats, Life Sci 66(8):755-767, 2000. Tsivileva OM et al: Hemagglutinating activity of Lentinus edodes (Berk) Sing [Lentinula edodes (Berk) Pegler], Mikrobiologiia 69(1):38-44, 2000. 709 Tuncok Y et al: Urginea maritima (squill) toxicity, J Toxicol Clin Toxicol 33(1):83-86, 1995. Tunon NH et al: Evaluation of anti-inflammatory activity of some Swedish medicinal plants: inhibition of prostaglandin biosynthesis and PAF-induced exocytosis, J Ethnopharmacol 48(2): 61-76, 1995. Turner RA: Screening methods in pharmacology, vol 1, New York, 1965, Academic Press. Uddin S et al: Curcumin suppresses growth and induces apoptosis in primary effusion lymphoma, Oncogene 24(47):7022-7030, 2005. Ueda H et al: Luteolin as an anti-inflammatory and anti-allergic constituent of Perilla frutescens, Biol Pharm Bull 25(9):1197-1202, 2002. Uehleke H et al: Oral toxicity of an essential oil from myrtle and adaptive liver stimulation, Toxicology 12(3):335-342, 1979. Ueno HM et al: Effect of Momordica charantia L. in mice infected with Plasmodium berghei, Rev Soc Bras Med Trop 29(5):455-460, 1996. Ukrainian Anticancer Institute: Ukrain information for physicians, Vienna, Sept 1997, Nowicky Pharma. Ulubelen A et al: Terpenoids from Salvia sclarea, Phytochemistry 36(4):971-974, 1994. Umehara K et al: Studies on differentiation inducers IV: pregnane derivatives from condurango cortex. Chem Pharm Bull (Tokyo) 42(3):611-616, 1994. Uncini Manganelli RE et al: Antiviral activity in vitro of Urtica dioica L., Parietaria diffusa M. et K. and Sambucus nigra L., J Ethnopharmacol 98(3):323-327, 2005. Untersmayr E et al: Characterization of intrinsic and extrinsic risk factors for celery allergy in immunosenescence, Mech Ageing Dev 129(3):120-128, 2008. Updyke DI: Safrole, Food Cosmet Toxicol 12:983-986, 1974. Urizar NL et al: A natural product that lowers cholesterol as an antagonist ligand for FXR, Science 296(5573):1703-1706, 2002. Usuki S: Effects of herbal components of tokishakuyakusan on progester-one secretion by corpus luteum in vitro, Am J Chin Med 19(1):57-60, 1991. Uusitupa MI et al: Lathosterol and other noncholesterol sterols during treatment of hypocholesterolemia with lovastatin alone and with cholestyramine or guar gum, Arterioscler Thromb Vasc Biol 12:(7)807-813, 1992. Vales TN et al: Pharmacologic approaches to the prevention and treatment of neonatal hyperbilirubinemia, Clin Perinatol 17:245-273, 1990. Van der Hyden JAM et al: Strain differences in response to drugs in the tail suspension test for anti-depressant activity, Psychopharmacology 92:127-130, 1987. Van der Weijden E et al: The effect of herbal extracts in an experimental mouthrinse on established plaque and gingivitis, J Clin Periodontol 25(5):399-403, 1998. Van Loon PC et al: Mushroom worker’s lung: detection of antibodies against Shiitake (Lentinus edodes) spore antigens in shiitake workers, J Occup Med 34(11):10971101, 1992. Van Niel CW et al: Lactobacillus therapy for acute infectious diarrhea in children: a metaanalysis, Pediatrics 109(4):678-684, 2002. Van Rozendaal EL et al: Screening of the needles of different yew species and cultivars for paclitaxel and related taxoids, Phytochemistry 53(3):383-389, 2000. Vanderperren B et al: Acute liver failure with renal impairment related to the abuse of senna anthraquinone glycosides, Ann Pharmacother 39(7-8):1353-1357, 2005. Vanscheidt W et al: Efficacy and safety of a butcher’s broom preparation (Ruscus aculeatus L. extract) compared to placebo in patients suffering from chronic venous insufficiency, Arzneimittelforschung 52(4):243-250, 2002. Vassão DG et al: A pinoresinol-lariciresinol reductase homologue from the creosote bush (Larrea tridentata) catalyzes the efficient in vitro conversion of p-coumaryl/coniferyl alcohol esters into the allylphenols chavicol/eugenol, but not the propenylphenols p-anol/ isoeugenol, Arch Biochem Biophys 465(1):209-218, 2007. REFERENCES References 710 References Vats V et al: Evaluation of anti-hyperglycemic and hypoglycemic effect of Trigonella foenumgraecum Linn, Ocimum sanctum Linn, and Ptero-carpus marsupium Linn in normal and alloxanized diabetic rats, J Ethnopharmacol 79(1):95-100, 2002. Vazquez B et al: Antiinflammatory activity extracts from aloe vera gel, J Ethnopharmacol 55: 69-75, 1996. Venskutonis PR et al: Radical scavenging capacity of Agrimonia eupatoria and Agrimonia procera, Fitoterapia 78(2):166-168, 2007. Verastegui MA et al: Antimicrobial activity of extracts of three major plants from the chihuahuan desert, J Ethnopharmacol 52(3):175-177, 1996. Verma M et al: A natural cockroach repellent in bay leaves, Am Laboratories 13:66-69, 1981. Verma SK et al: Effect of Commiphora mukul (gum guggulu) in patients of hyperlipidemia with special reference to HDL-cholesterol, Indian J Med Res 87:356-360, 1988. Vermeulen MA et al: Specific amino acids in the critically ill patient–exogenous glutamine/ arginine: a common denominator? Crit Care Med 35(9 Suppl):S568-576, 2007. Verspohl EJ et al: Antidiabetic effect of Cinnamomum cassia and Cinnamomum zeylanicum in vivo and in vitro, Phytother Res 19(3):203-206, 2005. Veshkurova O et al: Malvone A, a phytoalexin found in Malva sylvestris (family Malvaceae), Phytochemistry 67(21):2376-2379, 2006. Vettorello G et al: Contribution of a combination of alpha and beta benzopyrones, flavonoids and natural terpenes in the treatment of lymphedema of the lower limbs at the 2d stage of the surgical classification, Minerva Cardioangiol 44(9):447-455, 1996. Viana GS et al: Antinociceptive effect of the essential oil from Cymbopogon citratus in mice, J Ethnopharmacol 70(3):323-327, 2000. Viola H et al: Apigenin, a component of Matricaria recutita flowers, is a central benzodiazepine receptors-ligand with anxiolytic effects, Planta Med 81:213-216, 1995. Viollon C et al: Antifungal properties of essential oils and their main components upon Cryptococcus neoformans, Mycopathologia 128:151-153, 1994. Vlad L et al: Digitalis-type cardiotonic action of Viburnum species extracts, Planta Med (31):228, 1977. Vomel VT: Einflub eines unsezifischon immunstimulans auf die phagozytose vanerthrozyten, Arzneim-Forsch/Drug Res 34:691-695, 1984. Voordouw BCG et al: Melatonin and melatonin-progestin combinations alter pituitary-ovarian function in women and can inhibit ovulation, J Clin Endocrinol Metab 74:108, 1992. Voravuthikunchai S et al: Effective medicinal plants against enterohaemorrhagic Escherichia coli O157:H7, J Ethnopharmacol 94(1):49-54, 2004. Vorbach EU et al: Therapy for insomniacs: effectiveness and tolerance valerian preparations, Psychopharmakotherapie 3:109-115, 1996. Vukusic I et al: Planta Med 57(suppl 2):A46, 1991. Wada L et al: Antioxidant activity and phenolic content of Oregon caneberries, J Agric Food Chem 50(12):3495-3500, 2002. Wadworth NA et al: Hydroxyethylrutosides: a review of pharmacology and therapeutic efficacy in venous insufficiency and related disorders, Drugs 44:1013-1032, 1992. Wagner H et al: An immunostimulating active principal from Echinacea purpurea, A. agnew, Phytother 2(5):166-168, 171, 1981. Wagner H et al: Alkaloids of Uncaria tomentosa and their phagocytosis enhancement activity, Planta Medica 51:419-423, 1985. Wagner H et al: Immunostimulating action of polysaccharides (heteroglycans) from higher plants, Arzneimittelforschung 35:1069-1075, 1985. Wagner H et al: Immunologic studies of plant combination preparations: in-vitro and in-vivo studies on the stimulation of phagocytosis, Arznei mittelforschung 41(10):1072-1076, 1991. Walji R et al: Black cohosh (Cimicifuga racemosa [L.] Nutt.): safety and efficacy for cancer patients, Support Care Cancer 15(8):913-921, 2007. 711 Walsh D et al: Subjective response to lysine in the therapy of herpes simplex, J Antimicrob Chemother 12:489-496, 1983. Wang C et al: Phytoestrogen concentration determines effects on DNA synthesis in human breast cancer cells, Nutr Cancer 28(3):236-247, 1997. Wang CD et al: Chemical studies of flower buds of Tussilago farfara L., Yao Hsueh Hsueh Pao 24(12):913-916, 1989. Wang H et al: Effects of lectins with different carbohydrate-binding specificities on hepatoma, choriocarcinoma, melanoma and osteosarcoma cell lines, Int J Biochem Cell Biol 32(3):365-372, 2000. Wang L et al: Bioactive triterpene saponins from the roots of Phytolacca americana, J Nat Prod 71(1):35-40, 2008. Wang L et al: Oral administration of submerged cultivated Grifola frondosa enhances phagocytic activity in normal mice, J Pharm Pharmacol 60(2):237-243, 2008. Wang L et al: Ultrasonic extraction and separation of anthraquinones from Rheum palmatum L, Ultrason Sonochem 15(5):738-746, 2008. Wang M et al: Cancer preventive effect of Morinda citrifolia, Ann NY Acad Sci 952:161-168, 2001. Wang Y et al: Acta Botanica Yunnanica 2:312, 1953. Wang Y et al: Chin J Exp Ther Prepar Chin Med 1(1):1-5, 1995. Warnecke G: Influencing menopausal symptoms with a phytotherapeutic agent, Med Walt 36:871-874, 1985. Waterhouse AL et al: Antioxidants in chocolate, Lancet 348:834, 1996. Wattanathom J et al: Positive modulation of cognition and mood in the healthy elderly volunteer following the administration of Centella asiatica, J Ethnopharmacol 116(2):325-332, 2008. Wegener T et al: Plantain (Plantago lanceolata L.): antiinflammatory action in upper respiratory tract infections, Wien Med Wochenschr 149(8-10):211-216, 1999. Wegener T: Therapy of degenerative diseases of the musculoskeletal system with South African devil’s claw (Harpagophytum procumbens DC), Wien Med Wochenschr 149(8-10): 254-257, 1999 (abstract). Weil MJ et al: Tumor cell proliferation and cyclooxygenase inhibitory constituents in horseradish (Armoracia rusticana) and Wasabi (Wasabia japonica), J Agric Food Chem 53(5): 1440-1444, 2005. Weiler BE et al: Sulphoevernan, a polyanionic polysaccharide, and the narcissus lectin potently inhibit human immunodeficiency virus infection by binding to viral protein, J Gen Virol 71(pt 1):1957-1963, 1990. Weiss EI et al: Inhibiting interspecies coaggregation of plaque bacteria with a cranberry juice constituent, J Am Dent Assoc 129(12):1719-1723, 1998. Weiss RF: Herbal medicine, England, 1988, Beaconsfield. Weizman Z et al: Efficacy of herbal tea preparation in infant colic, J Pediatr 122:650-652, 1993. West S et al: Are antioxidants or supplements protective for age-related macular degeneration? Arch Ophthalmol 112:222-227, 1994. Whitehouse LW et al: Devil’s claw (Harpagophytum procumbens): no evidence for antiinflammatory activity in the treatment of arthritic disease, Can Med Assoc J 129(3): 249-251, 1983. Wiesenauer M et al: Mahonia aquifolium in patients with psoriasis vulgaris: an intraindividual study, Phytomedicine 3:231-235, 1996. Williams CA et al: A biologically active lipophilic flavonol from Tanacetum parthenium, Phytochemistry 38:267-270, 1995. Willuhn G et al: Cytotoxicity of flavonoids and sequiterpene lactones from Arnica species against GLC4 and COLO 320 cell lines, Planta Med 60:434-437, 1994. Winterhoff H et al: Endocrine effects of Lycopus europaeus L. following oral application, Arzneimittelforschung 44(1):41-45, 1994. REFERENCES References 712 References Woo SW et al: Aloe emodin suppresses myofibroblastic differentiation of rat hepatic stellate cells in primary culture, Pharmacol Toxicol 90(4):193-198, 2002. Wright SN: Irreversible block of human heart (hH1) sodium channels by the plant alkaloid lappaconitine, Mol Pharmacol 59(2):183-192, 2001. Wu D: An overview of the clinical pharmacology and therapeutic potential of gossypol as a male contraceptive agent and in gynaecological disease, Drugs 38:333, 1989. Wu D et al: Novel compounds from Piper methysticum roots and their effect on cyclooxygenase enzyme, J Agric Food Chem 50(4):701-705, 2002. Wu J et al: The hypolipidemic natural product guggulsterone acts as an antagonist of the bile acid receptor, Mol Endocrinol 16(7):1590-1597, 2002. Wu YR et al: Zhendan Med J 6:28, 1941. Wyllie SG et al: The leaf oil of Liquidambar styraciflua, Planta Med 55:316, 1989. Xia YX et al: The inhibitory effect of motherwort extract on pulsating myocardial cells in vitro, J Trad Chin Med 3:185-188, 1983. Xiao D, Singh SV: z-Guggulsterone, a constituent of Ayurvedic medicinal plant Commiphora mukul, inhibits angiogenesis in vitro and in vivo, Mol Cancer Ther 7(1):171-180, 2008. Xie W et al: The effects of Ananas comosus L. leaves on diabetic-dyslipidemic rats induced by alloxan and a high-fat/high-cholesterol diet, Am J Chin Med 33(1):95-105, 2005. Xu X et al: Soy consumption alters endogenous estrogen metabolism in postmenopausal women, Cancer Epidemiol Biomarkers Prev 9(8):781-786, 2000. Xu XH et al: Study on flavonoids in Ligustrum lucidum, Zhong Yao Cai 30(5):538-540, 2007. Xue WL et al: Effect of Trigonella foenum-graecum (fenugreek) extract on blood glucose, blood lipid and hemorheological properties in streptozotocin-induced diabetic rats, Asia Pac J Clin Nutr 16(Suppl 1):422-426, 2007. Yadegarinia D et al: Biochemical activities of Iranian Mentha piperita L. and Myrtus communis L. essential oils, Phytochemistry 67(12):1249-1255, 2006. Yaeesh S et al: Studies on hepatoprotective, antispasmodic and calcium antagonist activities of the aqueous-methanol extract of Achillea millefolium, Phytother Res 20(7):546-551, 2006. Yamada K et al: Effects of inhaling the vapor of Lavandula burnatii super-derived essential oil and linalool on plasma adrenocorticotropic hormone (ACTH), catecholamine and gonadotropin levels in experimental menopausal female rats, Biol Pharm Bull 28(2):378-379, 2005. Yamasaki K et al: Anti-HIV-1 activity of herbs in Labiatae, Biol Pharm Bull 21(8):829-833, 1998. Yamauchi H et al: Two new glycosides from the whole plants of Glechoma hederacea L., Chem Pharm Bull (Tokyo) 55(2):346-347, 2007. Yang GY et al: Clinical studies on the treatment of coronary heart disease with Valeriana officinalis var. latifolia, Chung Kuo Chung Hsi I Chieh Ho Tsa Chih 14(9):540-542, 1994 (abstract in English). Yang PY et al: Reduction of atherosclerosis in cholesterol-fed rabbits and decrease of expressions of intracellular adhesion molecule-1 and vascular endothelial growth factor in foam cells by a water-soluble fraction of Polygonum multiflorum, J Pharmacol Sci 99(3):294-300, 2005. Yang XB et al: The role of Angelica polysaccharides in inducing effector molecule release by peritoneal macrophages, Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi 20(6):747-749, 2004. Yang Y et al: The outlook using chitosan related materials in nerve regeneration, Sheng Wu Yi Xue Gong Cheng Xue Za Zhi 18(3):444-447, 2001. Yaniv Z et al: Plants used for the treatment of diabetes in Israel, J Ethnopharmacol 19(2): 145-151, 1987. Yao JC et al: J Acad Military Med Chin PLA (1):144, 1957. Yazdanparast R et al: Antihyperlipidaemic and antihypercholesterolemic effects of Anethum graveolens leaves after the removal of furocoumarins, Cytobios 105(410):185-191, 2001. Yim H et al: Emodin, an anthraguinone derivative isolated from the rhizomes of Rheum palmatum selectively inhibits the activity of Casein kinase II as a competitive inhibitor, Planta Med 65(1):9-13, 1999. 713 Yim TK et al: Myocardial protection against ischaemia-reperfusion injury by a Polygonum multiflorum extract supplemented “Dang-Gui decoction for enriching blood,” a compound formulation, ex vivo, Phytother 14(3):195-199, 2002. Yip L et al: Antiviral activity of a derivative of the photosensitive compound of hyperican, Phytomed 3:185-190, 1996. Yokota M: Anshin pp 202-204, July 1992. Yongchaiyudha S et al: Antidiabetic activity of Aloe vera L. juice, I: clinical trial in new cases of diabetes mellitus, Phytomedicine 3:241-243, 1996. Yoshihiro K: The physiological actions of tang kuei and cnidium, Bull Oriental Healing Arts Institute of the USA 10(7):269-278, 1985. Yoshikawa M et al: Medicinal foodstuffs, XVIII: phytoestrogens from the aerial part of Petroselinum crispum MIII (parsley) and structure of 6′′-acetylapiin and a new monoterpene glycoside, petroside, Chem Pharm Bull 48(7):1039-1044, 2000. Yoshikawa M et al: Medicinal flowers. XXI. Structures of perennisaponins A, B, C, D, E, and F, acylated oleanane-type triterpene oligoglycosides, from the flowers of Bellis perennis, Chem Pharm Bull (Tokyo) 56(4):559-568, 2008. Yoshino S et al: Immunoregulatory effects of the antitumor polysaccharide lentinan on Th1/Th2 balance in patients with digestive cancers, Anticancer Res 20(6C):4707-4711, 2000. Yoshiro K: The physiological actions of tang-kuei and cnidium, Bull Oriental Healing Arts Inst USA 10:269-278, 1985. Young NM et al: Structural differences between two lectins from Cytisus scoparius, both specific for D-galactose and N acetyl-D-galactosamine, Biochem J 222:241, 1984. Young S: The use of diet and dietary components in the study of factors controlling affect in humans: a review, J Psychiatry Neurosci 18(5):235-244, 1993. Younos C et al: Analgesic and behavioural effects of Morinda citrifolia, Planta Med 56(5): 430-434, 1990. Yu R et al: Modulation of select immune responses by dietary capsaicin, Int J Vitam Nutr Res 68:114-119, 1998. Yu S et al: The anticonvulsant action of 3-n-butylphthalide (Ag-1) and 3-n-butyl-4, 5-dihydrophthalide (Ag-2), Yao Hsueh Hsueh Pao 19:566, 1984. Yukawa TA et al: Prophylactic treatment of cytomegalovirus infection with traditional herbs, Antiviral Res 32:63-70, 1996. Yun TK et al: A case-control study of ginseng intake and cancer, Int J Epidemiol 19(4):871-876, 1990. Yun YS et al: Determination of antioxidant activity of herbs by ESR, Shokuhin Eiseigaku Zasshi 44(1):59-62, 2003. Zafar R et al: Anti-hepatotoxic effects of root and root callus extracts of Cichorium intybus L., J Ethnopharmacol 63:227-231, 1998. Zahorska B et al: Effect of chitosan in complex management of obesity, Pol Merkuriusz Lek 13(74):129-132, 2002. Zaletova NI et al: Khim-Farm Zh 20:568, 1986. Zanoli P et al: New insight in the neuropharmacological activity of Humulus lupulus L., J Ethnopharmacol 102(1):102-106, 2005. Zanon SM et al: Search for antiviral activity of certain medicinal plants from Cordoba, Argentina, Rev Latinoam Microbiol 41(2):59-62, 1999. Zava DT et al: Estrogen and progestin bioactivity of foods, herbs and spices, Proc Soc Exp Biol Med 217:369-378, 1998. Zayed SM et al: Dietary cancer risk from conditional cancerogens in produce of livestock fed on species of spurge (Euphorbiaceae), III: milk of lactating goats fed on the skin irritant herb Euphorbia peplus is polluted by tumor promoters of the ingenane diterpene ester type, J Cancer Res Clin Oncol 124(6):301-306, 1998. Zenisek et al: Contribution to the identification of the estrogen activity of hops, Am Perfumer Arom 75:61, 1960. REFERENCES References 714 References Zhang HL et al: Antioxidative compounds isolated from safflower (Carthamus tinctorius L.) oil cake, Chem Pharm Bull 45(12):1910-1914, 1997. Zhang J et al: Antiviral activity of tannin from the pericarp of Punica granatum L. against genital Herpes virus in vitro, Chung Kuo Chung Yao Tsa Chih 20(9):556-558, 576, inside back cover, 1995. Zhang JH: Clinical effects of Rheum and captopril on preventing progression of chronic renal failure, Chin Med J 103:788-793, 1990. Zhang R et al: Enhancement of immune function in mice fed high doses of soy daidzein, Nutr Cancer 29(1):24-28, 1997. Zhao J et al: Phytochemical investigation of Turnera diffusa, J Nat Prod 70(2):289-292, 2007. Zheljazkov VD et al: Yield and oil composition of 38 basil (Ocimum basilicum L.) accessions grown in Mississippi, J Agric Food Chem 56(1):241-245, 2008. Zheng M: Experimental study of 472 herbs with antiviral action against the herpes simplex virus, Zhong Xi Yi Jie He Za Zhi 10(1):39-41, 46, 1990. Zheng RL et al: Inhibition of autooxidation of linoleic acid by phenylpro-panoid glycosides from Pedicularis in micelles, Chem Phys Lipids 65:151-154, 1993. Zheng YT et al: Alpha-momorcharin inhibits HIV-1 replication in acutely but not chronically infected T-lymphocytes, Chung Kuo Yao Li Hsueh Pao 20(3):239-243, 1999. Zhou JL et al: Development and validation of a liquid chromatography/electrospray ionization time-of-flight mass spectrometry method for relative and absolute quantification of steroidal alkaloids in Fritillaria species, J Chromatogr A 1177(1):126-137, 2008. Zhou Y et al: Isolation of endophytic antagonistic bacterium from Amorphophallus konjac and research on its antibacterial metabolite, Wei Sheng Wu Xue Bao 47(6):1076-1079, 2007. Zhou Z et al: Effects of berberine on single Ca2 channel current in cultured embryoic chick ventricular monocytes, Hua Hsi I Ko Ta Hsueh Hsueh Pao 26:287-290, 1995. Zhu M et al: Evaluation of the protective effects of Schisandra chinensis on phase I drug metabolism using a CC14 intoxication model, J Ethnopharmacol 67(1):61-68, 1999. Zhu M et al: Improvement of phase I drug metabolism with Schisandra chinensis against CC14 hepatotoxicity in a rat model, Planta Med 66(6):521-525, 2000. Zhu Y et al: Chin J Pharmacol 30(11):4-8, 1995. Zhuang XX: Protective effect of Angelica injection on arrhythmia during myocardial ischemia reperfusion in rat, Chung Hsi I Chieh Ho Tsa Chih 11(6):326, 360-361, 1991. Zierau O et al: Antiestrogenic activities of Cimicifuga racemosa extracts, J Steroid Biochem Mol Biol 80(1):125-130, 2002. Zou QZ et al: Effect of motherwort on blood hyperviscosity, Am J Chin Med 17(1-2):65-70, 1989. Zuardi AW et al: Cannabidiol, a Cannabis sativa constituent, as an antipsychotic drug, Braz J Med Biol Res 39(4):421-429, 2006. Zurier RB et al: Gamma-linolenic acid treatment of rheumatoid arthritis: a randomized, placebo-controlled trial, Arthritis Rheum 39:1808-1817, 1996. Zuzak TJ et al: Paediatric medulloblastoma cells are susceptible to Viscum album (Mistletoe) preparations, Anticancer Res 26(5A):3485-3492, 2006. GLOSSARY Aril: A botanical term used to denote an accessory seed coating that may form a fleshy, cuplike structure around the immature seed (ovule), as in yew and nutmeg. The aril is often brightly colored and edible. Binomial: The unique, two-part scientific name used to identify a plant. The first name is the genus; the second, the species. A designation of the variety may also follow to further differentiate the plant. Because common names differ from region to region and a single common name may often denote several herbs that differ widely from each other, use of the binomial is the only reliable way to accurately specify a particular herb. Concentration: A means of expressing the amount of herb and solvent used in formulating an herbal preparation. For example, a tincture with a 1:5 concentration contains 1 part of the herb in grams to 5 parts of the solvent in milliliters. Concentration is not the same thing as potency (see Potency). Crude herb: The raw plant, before it is dried and processed. Decoction: A liquid preparation made by boiling plant parts (such as bark, roots, or rhizome) in water. Extract: A concentrated form of the herb that is derived when the crude herb is mixed with water, alcohol, or another solvent and distilled or evaporated. Extracts may be either fluid or solid. Gall: A lump or ball that forms most often on the stems, leaves, or roots of plants at the sites of injuries caused by insects, fungi, bacteria, or other organisms. An example is the oak gall, which contains tannin. Herb: A plant that is used for its medicinal purposes. (This differs from the biological definition of an herb as a plant with no woody above-ground parts.) Infusion: A liquid preparation made by pouring water over plant parts (such as dried or fresh leaves, flowers, or fruits) and allowing the mixture to steep. Hot water (below the boiling point) is usually used, but cold water may also be used. Making a cup of herbal tea is an example. Minim: A fluid measure constituting 1⁄60 of a fluidrachm, which itself is about a teaspoonful (1⁄8 of a fluid ounce). A minim is about the equivalent of one drop of water. Nutraceutical: A food that is used for its medicinal properties. Oil, essential: The aromatic volatile oils extracted from various parts of the fresh herb. Essential oils are usually diluted before being used therapeutically. 715 716 Glossary Oil, infused: A mixture composed of the volatile oils of an herb and another oil. The so-called “carrier oil” is used to extract the volatile oils by soaking plant parts in it for a specified period. Pharmacognosy: The study of chemicals taken from natural sources to be used as drugs or in the preparation of drugs. Sources may include plants, animals, or other life forms such as fungi, molds, and yeasts. Phytochemical: The active chemical components, or constituents, present in a plant that account for its medicinal properties. Phytomedicine: The use of plants, plant parts, and preparations made from them to prevent, treat, or cure various health conditions. Potency: A measure of the strength of the active chemical components contained in an herb or herbal preparation. Standardized products ensure that the consumer receives a dosage containing a consistent potency. Poultice: Plant material (such as crushed fresh herbs) that has been wrapped in gauze or similar soft cloth, moistened, and applied topically. Powder: The dried product of an extraction process during which the herb is distilled, using a solvent such as alcohol or water, after which the solvent is completely removed. The dry solid that remains either is already in powder form or may be ground into it. Rhizome: An underground plant stem, growing more or less horizontally, that usually has roots on its underside and bears buds. Tincture: A plant extract made by soaking herbs in a liquid (such as water, alcohol, vinegar, or glycerine) for a specified period, then straining and discarding the plant material. The remaining liquid is used therapeutically. Tinctures typically are made at a concentration of 1:5 to 1:10. INDEX INDEX A Aaron’s rod, 306-308, 445-447 A-Beta-Carotene, 63-64 Acacia catechu, 80-82 Acacia modesta, 470-471 Acanthopanax senticosus, 565-567 N-acetylchitosan, 175-176 N-acetyl-5-methoxytryptamine, 429-431 Achillea millefolium, 603-605 acidophilus, 1-3 acidophilus milk, 1-3 ackerkraut, 9-12 ACNE aloe for, 18-22 figwort for, 265-268 Oregon grape for, 475-477 aconite, 4-6 aconitis tuber, 4-6 Aconitum carmichaeli, 4-6 Aconitum chinense, 4-6 Aconitum columbianum, 4-6 Aconitum napellus L., 4-6 Actaea alba, 593-594 Actaea racemosa, 82-85 4-AD, 26-27 5-AD, 26-27 Adam’s flannel, 445-447 adderwort, 75-76 ADDICTION oats for, 468-469 adelfa, 471-473 S-adenosylmethionine, 550-552 ADHD; SEE ATTENTION DEFICIT HYPERACTIVITY DISORDER aescin, 339-341 Aesculus california, 339-341 Aesculus glabra, 339-341 Aesculus hippocastanum, 339-341 African coffee bean, 145-147 African myrrh, 449-451 African plum tree, 524-526 agar, 6-8 agar-agar, 6-8 agarweed, 6-8 agathosma, 116-118 Agathosma betulina, 116-118 Agrimonia eupatoria, 9-12 Agrimonia japonica, 9-12 Agrimonia pilosa var., 9-12 agrimony, 9-12 agronmonia, 9-12 Agropyron repens, 209-210 ague tree, 552-554 agueweed, 105-107 ail, 281-285 airelle, 70-73 ai ye, 443-445 ALC, 141-143 alcachofra, 37-38 alchemilla, 384-385 Alchemilla mollis, 384-385 Alchemilla vulgaris, 384-385 ALCOHOLISM kudzu for, 381-383 alehoof, 322-323 Alexandrian senna, 561-563 alfalfa, 12-15 ALLERGIES angelica for, 27-30 butterbur for, 127-129 bee pollen for, 59-61 devil’s claw for, 228-230 perilla for, 497-499 pill-bearing spurge for, 501-502 spirulina for, 575-576 yerba santa for, 610-612 all heal, 434-436, 591-592 alligator tree, 582-583 allium, 281-285 Allium sativum, 281-285 allspice, 15-17 aloe, 18-22 aloe barbadensis, 18-22 Aloe barbadensis, 18-22 Aloe ferox, 18-22 Aloe perryi, 18-22 Aloe spicata, 18-22 aloe vera, 18-22 Aloe vera L., 18-22 altamisa, 263-265 Althaea officinalis, 422-424 althaea root, 422-424 althea, 422-424 ALTITUDE SICKNESS bee pollen for, 59-61 ginkgo for, 290-294 ALZHEIMER’S DISEASE carnitine for, 141-143 DHEA for, 230-232 galanthamine for, 277-278 huperzine A for, 345-346 lecithin for, 387-389 marjoram for, 420-422 SAM-e for, 550-552 amantilla, 591-592 amber, 579-582 AMENORRHEA bay for, 52-54 false unicorn root for, 257-258 fennel for, 258-260 feverfew for, 263-265 marjoram for, 420-422 safflower for, 545-547 American angelica, 27-30 American aspen, 513-514 American cone flower, 238-241 American dwarf palm tree, 555-557 American elm, 569-571 American ginseng, 294-297 American hellebore, 22-24 American mandrake, 424-426 American penny royal, 492-494 American saffron, 545-547 American sloe, 85-87 American upland cotton, 311-313 American valerian, 607-608 American yew, 612-613 2-amino-2-deoxyglucose, 301-302 2-amino-5-guanidinopentanoic acid, 33-34 ammi, 379-381 Ammi visnaga, 379-381 Amorphophallus konjac, 299301 amygdalin, 489-490 ananas, 503-504 Ananas comosus, 503-504 anashea, 418-420 androdiol, 26-27 andrographis, 24-26 Andrographis paniculata, 24-26 androstenediol, 26-27 717 718 Index 4-androstene-3beta, 26-27 5-androstene-3beta, 26-27 4-androstenediol, 26-27 5-androstenediol, 26-27 ANEMIA folic acid for, 272-273 spirulina for, 575-576 Anemone pulsatilla, 519-521 aneth fenouil, 258-260 Anethum graveolens, 232-234 angelica, 27-30 Angelica acutiloba, 27-30 Angelica archangelica, 27-30 Angelica atropurpurea, 27-30 Angelica dahurica, 27-30 Angelica edulis, 27-30 Angelica gigas, 27-30 Angelica keiskei, 27-30 Angelica koreana, 27-30 Angelica polymorpha, 27-30 Angelica polymorpha var. sinensis, 234-237 Angelica pubescens, 27-30 Angelica radix, 27-30 Angelica sinensis, 27-30 angelica tree, 516-518 angel’s trumpet, 360-363 angel tulip, 360-363 ANGINA PECTORIS carnitine for, 141-143 coenzyme Q10 for, 188-190 hawthorn for, 332-334 khella for, 379-381 kudzu for, 381-383 night-blooming cereus for, 460-462 valerian for, 591-592 anhalonium, 499-500 anise, 30-33 aniseed, 30-33 Annona cherimola, 318-319 Annona muricata, 318-319 ANOREXIA black pepper for, 89-91 blessed thistle for, 93-95 bogbean for, 101-103 caraway for, 137-138 cardamom for, 138-140 centaury for, 156-158 chicory for, 168-170 cinnamon for, 180-182 coffee for, 190-193 condurango for, 202-204 coriander for, 205-207 devil’s claw for, 228-230 ANOREXIA (Continued) elecampane for, 243-245 gentian for, 285-287 horehound for, 337-339 Iceland moss for, 349-350 lavender for, 385-387 marijuana for, 418-420 soy for, 572-574 Anthemis nobile, 158-160 ANXIETY angelica for, 27-30 basil for, 50-52 black haw for, 85-87 boldo for, 103-105 boneset for, 105-107, 199-201 butterbur for, 127-129 catnip for, 147-149 celery for, 154-156 centaury for, 156-158 chamomile for, 158-160 chicory for, 168-170 clary for, 182-184 cowslip for, 211-212, 252-253 hops for, 334-337 kava for, 369-372 lavender for, 385-387 lemon balm for, 389-391 lemongrass for, 392-393 lovage for, 404-406 mistletoe for, 434-436 mugwort for, 443-445 nutmeg for, 462-465 passionflower for, 484-486 peyote for, 499-500 pipsissewa for, 504-506 poppy for, 514-516 pulsatilla for, 519-521 rue for, 541-544 St. John’s wort for, 579-582 senega for, 559-561 valerian for, 591-592 Aphanes arvensis, 483-484 aphrodien, 614-616 Apis mellifera, 59-61 apium, 154-156 Apium graveolens, 154-156 apple-of-Peru, 360-363 apricot vine, 484-486 Arabian myrrh, 449-451 A’ra’r a’di, 364-366 Arctium lappa, 122-125 Arctium minus, 122-125 arctostaphylos, 56-59 Arctostaphylos adenotricha, 56-59 Arctostaphylos coactylis, 56-59 Arctostaphylos uva-ursi, 56-59 ardic, 364-366 Areca catechu, 64-66 areca nut, 64-66 arginine, 33-34 L-arginine, 33-34 arginine hydrochloride, 33-34 armino, 608-610 Armoracia rustiacana, 341-343 arnica, 35-37 Arnica chamissonis less., 35-37 Arnica cordifolia hook, 35-37 Arnica fulgens pursh, 35-37 Arnica montana L., 35-37 Arnica soronia greene, 35-37 arruda brava, 355-357 arruda do mato, 355-357 Artemisia cina, 601-602 Artemisia vulgaris, 443-445 artetyke, 211-212 arthritica, 211-212 ARTHRITIS black cohosh for, 82-85 borage for, 107-110 butcher’s broom for, 125-127 butterbur for, 127-129 catnip for, 147-149 cat’s claw for, 149-151 chondroitin for, 176-178 coriander for, 205-207 feverfew for, 263-265 ginkgo for, 290-294 glucosamine for, 301-302 guggul for, 328-330 marjoram for, 420-422 myrrh for, 328-330, 449-451 nettle for, 457-459 New Zealand green-lipped mussel for, 459-460 Oregon grape for, 46-48, 475-477 peyote for, 499-500 poplar for, 513-514 prickly ash for, 516-518 yerba maté for, 608-610 yerba santa for, 610-612 yew for, 612-613 ARTHRITIS PAIN alfalfa for, 12-15 balsam of Peru for, 45-46 basil for, 50-52 birch for, 73-74 capsicum peppers for, 134-137 ginkgo for, 290-294 artichoke, 37-38 ash, 39-40 Asiatic ginseng, 294-297 Aspalathus contaminata, 538-539 Aspalathus linearis, 538-539 ASPERGILLUS INFECTIONS oregano for, 473-475 aspic, 385-387 ASTHMA angelica for, 27-30 anise for, 30-33 bee pollen for, 59-61 beta-carotene for, 63-64 betony for, 68-70 black cohosh for, 82-85 butterbur for, 127-129 coltsfoot for, 197-199 elecampane for, 243-245 ephedra for, 245-249 garlic for, 281-285 horehound for, 337-339 hyssop for, 346-348 jimsonweed for, 360-363 licorice for, 395-399 lobelia for, 402-404 mullein for, 445-447 New Zealand green-lipped mussel for, 459-460 pill-bearing spurge for, 501-502 senega for, 559-561 thymus extract for, 585-586 yerba santa for, 610-612 asthma weed, 402-404, 501-502 astragalus, 40-42 Astragalus gummerifer, 40-42 Astragalus membranaceus, 40-42 ATHEROSCLEROSIS; SEE CORONARY ARTERY DISEASE ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD) centaury for, 156-158 gamma linolenic acid for, 278-280 ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD) (Continued) pycnogenol for, 522-524 soy for, 572-574 aunee, 243-245 Australian tea tree oil, 584-585 autumn monkshood, 4-6 ava, 369-372 Avena sativa, 468-469 avens, 42-44 awa, 369-372 Azadirachta indica, 455-457 azafran, 545-547 B B, 110-111 baccal juniper, 364-366 bachelors’ button, 263-265 Bacid, 1-3 BACTERIAL INFECTIONS angelica for, 27-30 anise for, 30-33 bearberry for, 56-59 black pepper for, 89-91 buchu for, 116-118 burdock for, 122-125 butcher’s broom for, 125-127 caraway for, 137-138 celandine for, 152-153 cinnamon for, 180-182 clary for, 182-184 cloves for, 186-187 couchgrass for, 209-210 dill for, 232-234 eucalyptus for, 249-251 fennel for, 258-260 hops for, 334-337 kelpware for, 375-376 lemon balm for, 389-391 lemongrass for, 392-393 lentinan for, 393-395 mugwort for, 443-445 oregano for, 473-475 pau c’arco for, 487-488 propolis for, 518-519 raspberry for, 534-536 sage for, 548-550 tea tree oil for, 584-585 bairnwort, 221-222 bal, 449-451 baldrianwurzel, 591-592 balm, 389-391 balsam apple, 76-78 balsam of Peru, 45-46 balsam of tolu, 45-46 719 balsam pear, 76-78 balsam styracis, 582-583 balsam tree, 45-46 baneberry, 593-594 banji bhang, 418-420 bannal, 114-116 Barbados, 18-22 barberry, 46-48 bardane, 122-125 barley, 49-50 barley grass, 49-50 Barosma betulina, 116-118 Barosma crenulata, 116-118 Barosma serratifolia, 116-118 Bartholomew’s tea, 608-610 basil, 50-52 bastard saffron, 545-547 bay, 52-54 bayberry, 54-56 bay laurel, 52-54 bay leaf, 52-54 bay tree, 52-54 bead tree, 455-457 bean herb, 554-555 bean juice, 190-193 bearberry, 56-59 bear’s foot, 384-385 bear’s grape, 56-59 bear’s paw, 412-414 bear’s weed, 610-612 beebread, 107-110 beefsteak plant, 497-499 bee glue, 518-519 bee pollen, 59-61 bee’s nest, 527-529 beggar’s buttons, 122-125 Bellis perennis, 221-222 BELL’S PALSY coenzyme Q10 for, 188-190 lysine for, 409-410 Benedict’s herb, 42-44 benibana, 545-547 BENIGN PROSTATIC HYPERTROPHY (BPH) nettle for, 457-459 night-blooming cereus for, 460-462 pumpkin for, 521-522 pygeum for, 524-526 saw palmetto for, 555-557 benjamin tree, 61-62 bennet’s root, 42-44 benzoe, 61-62 benzoin, 61-62 benzoin tree, 61-62 INDEX Index 720 Index Berberis aquifolium Pursh, 46-48 berberry, 46-48 beta-carotene, 63-64 Betacarotene, 63-64 Beta-Carotene, 63-64 17beta-diol, 26-27 betal, 64-66 betal nut, 64-66 betel palm, 64-66 beth root, 67-68 betony, 68-70 Betula alba, 73-74 Betula lenta, 73-74 Betula pendula, 73-74 Betula pubescens, 73-74 Betula verrucosa, 73-74 betuline, 116-118 biber, 89-91 bidara, 24-26 bigarade orange, 78-80 big chief, 499-500 bilberry, 70-73 BIPOLAR DISORDER fish oils for, 268-269 lecithin for, 387-389 birch, 73-74 birch tar oil, 73-74 birch wood oil, 73-74 birdlime, 434-436 bird’s foot, 260-263 bird’s nest, 527-529 bird’s tongue, 39-40 birthroot, 67-68 bishop’s weed, 379-381 bishopswort, 68-70 bissy nut, 193-196 bistort, 75-76 bitter aloes, 18-22 bitterbloom, 156-158 bitter clover, 156-158 bitter cucumber, 76-78 bitter fennel, 258-260 bitter gourd, 76-78 bitter herb, 156-158 bitter melon, 76-78 bitter orange, 78-80 bitter pear, 76-78 bitter root, 285-287 bitterwort, 285-287 black birch, 73-74 black catechu, 80-82 black cherry, 594-595 black choke, 594-595 black cohosh, 82-85 black draught, 561-563 black elder, 241-243 black ginger, 287-290 black haw, 85-87 black hellebore, 87-89 black mustard, 447-449 black pepper, 89-91 black plum, 359-360 black poplar, 513-514 black root, 91-93, 199-201 black sampson, 238-241 black snakeroot, 82-85 black susans, 238-241 black-tang, 375-376 black whortle, 70-73 blackwort, 199-201 bladder fucus, 375-376 bladderpod, 402-404 bladderwrack, 375-376 blasen-tang, 375-376 blatterdock, 127-129 blazing star, 257-258 bleaberry, 70-73 BLEEDING beth root for, 67-68 blessed herb, 42-44 blessed thistle, 93-95blond plantago, 506-508 bloodroot, 95-97 bloodwort, 603-605 blowball, 224-227 blue barberry, 475-477 blue cohosh, 97-99 blue flag, 99-101 blue ginseng, 97-99 blue-green algae, 575-576 blue gum, 249-251 blue mallow, 415-416 blue monkshood root, 4-6 blue mountain tea, 306-308 blue pimpernel, 567-569 blue rocket, 4-6 blue sailors, 168-170 blung, 418-420 boca juniors, 608-610 bofareira, 145-147 bogbean, 101-103 bog bilberry, 70-73 bog cranberry, 213-214 bog rhubarb, 127-129 bogshorns, 127-129 boi, 449-451 boia, 449-451 bois de sassafras, 552-554 boldea, 103-105 Boldea boldus, 103-105 boldine, 103-105 boldo, 103-105 boldo-do-Chile, 103-105 boldus, 103-105 bone meal, 132-134 boneset, 105-107, 199-201 borage, 107-110 Borage officinalis, 107-110 borate, 110-111 Borbonia pinifolia, 538-539 boretree, 241-243 boric acid, 110-111 boric tartrate, 110-111 boron, 110-111 Boron, 110-111 boswellia, 111-112 Boswellia serrata, 111-112 bottle brush, 343-345 bountry, 241-243 bovine immunoglobulin, 196-197 bowman root, 91-93 boxberry, 598-599 box holly, 125-127 BPH; SEE BENIGN PROSTATIC HYPERTROPHY bramble, 534-536 bramble of Mount Ida, 534-536 brandy mint, 494-497 Brassica alba, 447-449 Brassica nigra, 447-449 Braxilian cherimoya, 318-319 Brazilian cocoa, 325-328 Brazilian paw paw, 318-319 BREAST CANCER beta-carotene for, 63-64 chamomile for, 158-160 flax for, 269-271 gamma linolenic acid for, 278-280 marigold for, 416-418 soy for, 572-574 turmeric for, 588-590 yew for, 612-613 brewers yeast, 112-113 bridal myrtle, 452-454 bridewort, 427-429 brier hip, 540-541 brier rose, 540-541 Brigham tea, 245-249 brinton root, 91-93 British oak, 466-467 British tobacco, 197-199 broad-leafed sage, 548-550 broadleaf plantain, 506-508 BRONCHIAL SPASMS Chinese cucumber for, 170-172 wild cherry for, 154-156, 594-595 BRONCHITIS angelica for, 27-30 anise for, 30-33 astragalus for, 40-42 balsam of Peru for, 45-46 benzoin for, 61-62 betony for, 68-70 boneset for, 105-107, 199-201 borage for, 107-110 chaparral for, 160-162 cinnamon for, 180-182 coltsfoot for, 197-199 cowslip for, 211-212, 252-253 elecampane for, 243-245 ephedra for, 245-249 horehound for, 337-339 Iceland moss for, 349-350 Irish moss for, 353-354 lemon balm for, 389-391 lobelia for, 402-404 lungwort for, 406-408 mallow for, 415-416 mullein for, 445-447 pansy for, 478-479 pill-bearing spurge for, 501-502 senega for, 559-561 broom, 114-116 broom top, 114-116 brown algae, 373-374 brown mustard, 447-449 brown oak, 466-467 BRUISES blue flag for, 99-101 turmeric for, 588-590 witch hazel for, 599-601 yerba santa for, 610-612 bruisewort, 199-201, 221-222 buchu, 116-118 buckbean, 101-103 buckeye, 339-341 buckhorn, 506-508 buckles, 211-212, 252-253 buckthorn, 118-120 buckwheat pollen, 59-61 bud, 418-420 buffalo herb, 12-15 bugbane, 82-85 bugleweed, 120-122 bugwort, 82-85 bullsfoot, 197-199 bunny’s ears, 445-447 burdock, 122-125 burn plant, 18-22 BURNS, MINOR aloe for, 18-22 balsam of Peru for, 45-46 bistort for, 75-76 chickweed for, 166-168 daffodil for, 219-220 echinacea for, 238-241 lily of the valley for, 400-402 oak for, 466-467 peach for, 489-490 peyote for, 499-500 plantain for, 506-508 bushi, 4-6 butcher’s broom, 125-127 butterbur, 127-129 butter rose, 252-253 buttons, 499-500 C Ca, 132-134 cabbage palm, 555-557 cacao, 130-132 cacao tree, 130-132 cactus, 499-500 CAD; SEE CORONARY ARTERY DISEASE café, 190-193 calcium, 132-134 calcium acetate, 132-134 calcium carbonate, 132-134 calcium citrate, 132-134 calcium gluceptate, 132-134 calcium gluconate, 132-134 calcium lactate, 132-134 calendula, 416-418 Calendula officinalis, 416-418 California buckeye, 339-341 Californian buckthorn, 143-145 California poppy, 514-516 California rape, 447-449 California yew, 612-613 calumba, 133-134 calumba root, 133-134 camboge, 280-281 Camellia sinensis, 319-321 campeche, 608-610 camphor of the poor, 281-285 Canada tree, 598-599 721 CANCER anise for, 30-33 arnica for, 35-37 astragalus for, 40-42 beta-carotene for, 63-64 black catechu for, 80-82 black pepper for, 89-91 bloodroot for, 95-97 burdock for, 122-125 butterbur for, 127-129 celandine for, 152-153 chamomile for, 158-160 chaparral for, 160-162 chickweed for, 166-168 chicory for, 168-170 Chinese cucumber for, 170-172 couchgrass for, 209-210 daffodil for, 219-220 DHEA for, 230-232 European mistletoe for, 434-436 gamma linolenic acid for, 278-280 garlic for, 281-285 ginseng for, 294-297 goldenseal for, 308-311 gotu kola for, 314-316 green tea for, 319-321 horsetail for, 343-345, 373-374 Iceland moss for, 349-350 kelp for, 373-374 lavender for, 385-387 lentinan for, 393-395 maitake for, 411-412 meadowsweet for, 427-429 morinda for, 439-441 motherwort for, 441-443 mustard for, 447-449 myrrh for, 449-451 nettle for, 457-459 nutmeg for, 462-465 oregano for, 473-475 Oregon grape for, 46-48, 475-477 peach for, 489-490 pycnogenol for, 522-524 red bush tea for, 538-539 shark cartilage for, 564-565 Siberian ginseng for, 565-567 skullcap for, 567-569 soy for, 572-574 thymus extract for, 585-586 turmeric for, 588-590 INDEX Index 722 Index cancer jalap, 508-510 cancer root, 508-510 CANDIDA INFECTIONS acidophilus for, 1-3 barberry for, 46-48 bearberry for, 56-59 caraway for, 137-138 celandine for, 152-153 cinnamon for, 180-182 clary for, 182-184 daisy for, 221-222 eucalyptus for, 249-251 goldenseal for, 308-311 kelpware for, 375-376 lentinan for, 393-395 licorice for, 395-399 pau c’arco for, 487-488 peppermint for, 494-497 quince for, 529-530 tea tree oil for, 584-585 candleberry, 54-56 candlewick, 445-447 CANKER SORES quince for, 529-530 ragwort for, 533-534 raspberry for, 534-536 cankerwort, 224-227, 533-534 cannabis, 418-420 Cannabis sativa, 418-420 cao ma huang, 245-249 Cape aloe, 18-22 capim-cidrao, 392-393 capon’s tail, 591-592 capsaicin, 134-137 capiscum, 134-137 Capsicum annum, 134-137 Capsicum frutescens, 134-137 capsicum peppers, 134-137 carageenan, 353-354 caraway, 137-138 Carbenia benedicta, 93-95 cardamom, 138-140 cardamom seeds, 138-140 CARDIAC ARRHYTHMIAS barberry for, 46-48 broom for, 114-116 coenzyme Q10 for, 188-190 kudzu for, 381-383 cardinal flower, 402-404 CARDIOVASCULAR DISEASE barberry for, 46-48 black catechu for, 80-82 black haw for, 85-87 capsicum peppers for, 134-137 carnitine for, 141-143 CARDIOVASCULAR DISEASE (Continued) coenzyme Q10 for, 188-190 cola tree for, 193-196 devil’s claw for, 228-230 DHEA for, 230-232 evening primrose oil for, 252-253 fish oils for, 268-269 fumitory for, 274-276 garlic for, 281-285 ginger for, 287-290 grapeseed for, 316-318 hawthorn for, 332-334 kudzu for, 381-383 lily of the valley for, 400-402 lobelia for, 402-404 lycopene for, 408-409 motherwort for, 441-443 oleander for, 471-473 Oregon grape for, 46-48, 475-477 peyote for, 499-500 rue for, 541-544 yerba maté for, 608-610 cardo santo, 93-95 Carduus benedictus, 93-95 Carica papaya, 479-481 carilla cundeamor, 76-78 carlina, 140-141 Carlina acaulis, 140-141 carline thistle, 140-141 carmantina, 24-26 L-Carnitine, 141-143 carnitine, 141-143 carosella, 258-260 ␫-carotene, 408-409 Carotenes, 63-64 carotenoids, 63-64 carpenter’s herb, 120-122 carpenter’s square, 265-268 Carrageen, 353-354 carrot, 527-529 carrywood, 439-441 Carthamus tinctorius, 545-547 cart tract plant, 506-508 Carum carvi L., 137-138 Caryophyllus aromaticus, 186-187 CAS, 176-178 cascara, 143-145 Cassia, 180-182 Cassia lignea, 180-182 Cassia spp., 561-563 castor, 145-147 castor bean, 145-147 castor oil plant, 145-147 cat, 377-378 CATARACTS bilberry for, 70-73 melatonin for, 429-431 pulsatilla for, 519-521 cataria, 147-149 catechu wood extract, 80-82 Catha edulis, 377-378 catmint, 147-149 catnep, 147-149 catnip, 147-149 cat’s claw, 149-151 cat’s foot, 322-323 catshair, 501-502 cat’s play, 147-149 catwort, 147-149 Caulophyllum thalictroides, 97-99 cayenne pepper, 134-137 celandine, 152-153 celandine poppy, 152-153 celery, 154-156 celery seed, 154-156 celery seed oil, 154-156 centaurea, 156-158 Centaurium erythraea, 156-158 Centaurium minus, 156-158 Centaurium umbellatum, 156-158 centaury, 156-158 centella, 314-316 Centella asiatica, 314-316 Cetraria islandica, 349-350 Ceylon cinnamon, 180-182 Chamaelirium luteum, 257-258 Chamaemelum nobile, 158-160 chamomile, 158-160 chamomile grande, 263-265 changras, 508-510 chaparral, 160-162 chardon benit, 93-95 charlock, 447-449 chasteberry, 163-165 chaste tree, 163-165 chat, 377-378 chaulmoogra oil, 165-166 chavica betal, 64-66 checkerberry, 598-599 cheeseflower, 415-416 cheeseweed, 415-416 Chelidonium majus, 152-153 CHEMOTHERAPY TOXICITY coenzyme Q10 for, 188-190 figwort for, 265-268 cherry birch, 73-74 chestnut, 339-341 CHF; SEE CONGESTIVE HEART FAILURE chickweed, 166-168 chicory, 168-170 chili pepper, 134-137 Chimaphila umbellata, 504-506 chin ch’iao mai, 605-606 Chinese angelica, 234-237 Chinese cinnamon, 180-182 Chinese cornbind, 273-274 Chinese cucumber, 170-172 Chinese gelatin, 6-8 Chinese ginseng, 294-297 Chinese knotweed, 273-274 Chinese licorice, 395-399 Chinese mustard, 447-449 Chinese parsley, 205-207 Chinese pivet, 297-298 Chinese rhubarb, 172-174 Chinese snake gourd, 170-172 chinwood, 612-613 chiretta, 24-26 chitosamine, 301-302 chitosan, 175-176 chitosan ascorbate, 175-176 chocolate, 130-132 choke cherry, 594-595 CHOLERA anise for, 30-33 barberry for, 46-48 pomegranate for, 510-512 quince for, 529-530 chondroitin, 176-178 Chondroitin C, 176-178 chondroitin sulfate, 176-178 Chondroitin Sulfate, 176-178 chondroitin sulfuric acid, 176-178 chondrus, 353-354 Chondrus crispus, 353-354 chonsurid, 176-178 Christe herbe, 87-89 Christmas rose, 87-89 chromium, 178-180 chromium chloride, 178-180 chromium picolinate, 178-180 chromium polynicotinate, 178-180 Chrysanthemum parthenium, 263-265 chuan-wu, 4-6 chuan xin lian, 24-26 church steeples, 9-12 Cichorium intybus, 168-170 cilantro, 205-207 cimicifuga, 82-85 Cimicifuga racemosa, 82-85 cinchona, 530-532 Cinchona succirubra, 530-532 cinnamomom, 180-182 Cinnamomum spp., 180-182 cinnamon, 180-182 cinnamon wood, 552-554 CIRRHOSIS bay for, 52-54 couchgrass for, 209-210 lecithin for, 387-389 milk thistle for, 432-434 SAM-e for, 550-552 Citrus aurantium, 78-80 city avens, 42-44 clary, 182-184 clary oil, 182-184 clary sage, 182-184 clear eye, 182-184 clematis, 184-185 Clematis virginiana L., 184-185 clotbur, 122-125 CLOTTING DISORDERS agrimony for, 9-12 alfalfa for, 12-15 clove pepper, 15-17 clove root, 42-44 cloves, 186-187 Cnicus benedictus, 93-95 coakum, 508-510 cocashweed, 533-534 Cocculus palmatus, 133-134 cocklebur, 9-12 cockle buttons, 122-125 cock-up-hat, 238-241 cocoa, 130-132 cocoa butter, 130-132 coenzyme Q10, 188-190 Coffea spp., 190-193 coffee, 190-193 COGNITIVE DEFICITS black pepper for, 89-91 DHEA for, 230-232 ginkgo for, 290-294 lecithin for, 387-389 wild yam for, 596-597 Cola acuminata, 193-196 Cola nitida, 193-196 cola nut, 193-196 723 cola tree, 193-196 COLDS andrographis for, 24-26 anise for, 30-33 borage for, 107-110 buchu for, 116-118 capsicum peppers for, 134-137 caraway for, 137-138 cardamom for, 138-140 catnip for, 147-149 cinnamon for, 180-182 echinacea for, 238-241 elderberry for, 241-243 elecampane for, 243-245 glossy privet for, 297-298 Iceland moss for, 349-350 mullein for, 445-447 meadowsweet for, 427-429 pau d’arco for, 487-488 pill-bearing spurge for, 501-502 poplar for, 513-514 thymus extract for, 585-586 yerba santa for, 610-612 COLD SORES lemon balm for, 389-391 lysine for, 409-410 colewort, 42-44 COLIC andrographis for, 24-26 anise for, 30-33 bay for, 52-54 black pepper for, 89-91 caraway for, 137-138 cardamom for, 138-140 catnip for, 147-149 centaury for, 156-158 chamomile for, 158-160 dill for, 232-234 gentian for, 285-287 khella for, 379-381 turmeric for, 588-590 colic root, 596-597 COLITIS dandelion for, 224-227 lemon balm for, 389-391 COLLAGEN LOSS bilberry for, 70-73 colle du japon, 6-8 COLON CANCER beta-carotene for, 63-64 soy for, 572-574 turmeric for, 588-590 colostrum, 196-197 colostrum, bovine, 196-197 INDEX Index 724 Index coltsfoot, 197-199 columbo root, 133-134 comb flower, 238-241 comfrey, 199-201 Commiphora molmol, 449-451 Commiphora mukul, 328-330 common arnica, 35-37 common ash, 39-40 common basil, 50-52 common bistort, 75-76 common borage, 107-110 common buckthorn, 118-120 common bugle, 120-122 common bugloss, 107-110 common celandine, 152-153 common centaury, 156-158 common chamomile, 158-160 common cotton, 311-313 common daisy, 221-222 common elder, 241-243 common figwort, 265-268 common horehound, 337-339 common juniper, 364-366 common mugfelon herb, 443-445 common myrtle, 452-454 common nettle, 457-459 common oak, 466-467 common parsley, 481-483 common plantain, 506-508 common quince, 529-530 common sage, 548-550 condor-vine bark, 202-204 condurango, 202-204 condurango bark, 202-204 condurango blanco, 202-204 condurango triana, 202-204 coneflower, 238-241 CONGESTION; SEE ALSO UPPER RESPIRATORY CONGESTION eucalyptus for, 249-251 CONGESTIVE HEART FAILURE (CHF) arginine for, 33-34 barberry for, 46-48 carnitine for, 141-143 coenzyme Q10 for, 188-190 creatine for, 215-217 hawthorn for, 332-334 squill for, 577-578 wild yam for, 596-597 consound, 199-201 CONSTIPATION agar for, 6-8 aloe for, 18-22 CONSTIPATION (Continued) bitter melon for, 76-78 black pepper for, 89-91 blue flag for, 99-101 boldo for, 103-105 buckthorn for, 118-120 butcher’s broom for, 125-127 cascara for, 143-145 castor for, 145-147 chicory for, 168-170 Chinese rhubarb for, 172-174 dandelion for, 224-227 fenugreek for, 260-263 flax for, 269-271 fo-ti for, 273-274 glucomannan for, 299-301 horehound for, 337-339 karaya gum for, 368-369 licorice for, 395-399 mallow for, 415-416 marshmallow for, 422-424 mayapple for, 424-426 mugwort for, 443-445 oleander for, 471-473 peach for, 489-490 pineapple for, 503-504 plantain for, 506-508 pokeweed for, 508-510 rose hips for, 540-541 safflower for, 545-547 senna for, 561-563 yellow dock for, 605-606 yerba maté for, 608-610 consumption moss, 349-350 consumptive’s weed, 610-612 CONTACT DERMATITIS figwort for, 265-268 oak for, 466-467 propolis for, 518-519 Convallaria majalis, 400-402 cool tankard, 107-110 coon root, 95-97 copper, 204 Copper, 204 Co-Q10, 188-190 coralberry, 593-594 coriander, 205-207 Coriandrum sativum, 205-207 Coriandrum sativum var. microcarpum, 205-207 Coriandrum sativum var. vulgare, 205-207 corkwood, 207-208 corkwood tree, 207-208 corn horsetail, 343-345 CORONARY ARTERY DISEASE (CAD) alfalfa for, 12-15 chromium for, 178-180 DHEA for, 230-232 dong quai for, 234-237 fumitory for, 274-276 green tea for, 319-321 hawthorn for, 332-334 kudzu for, 381-383 lycopene for, 408-409 mistletoe for, 434-436 SAM-e for, 550-552 soy for, 572-574 corossol epineux, 318-319 corossolier, 318-319 cortex quercus, 466-467 corynine, 614-616 cotton, 311-313 couchgrass, 209-210 COUGH balsam of Peru for, 45-46 basil for, 50-52 bayberry for, 54-56 betel palm for, 64-66 black cohosh for, 82-85 butterbur for, 127-129 caraway for, 137-138 cardamom for, 138-140 chickweed for, 166-168 coltsfoot for, 197-199 couchgrass for, 209-210 daisy for, 221-222 elecampane for, 243-245 gum for, 249-251 Iceland moss for, 349-350 lemongrass for, 392-393 lobelia for, 402-404 lungwort for, 406-408 mallow for, 415-416 marjoram for, 420-422 marshmallow for, 422-424 mullein for, 445-447 nettle for, 457-459 parsley for, 481-483 passionflower for, 484-486 peach for, 489-490 plantain for, 506-508 pokeweed for, 508-510 poppy for, 514-516 pulsatilla for, 519-521 raspberry for, 534-536 senega for, 559-561 slippery elm for, 569-571 COUGH (Continued) squill for, 577-578 wild cherry for, 154-156, 594-595 cough root, 67-68 coughweed, 533-534 coughwort, 197-199 cow cucumber, 217-218 cowslip, 211-212, 252-253 cramp bark, 85-87 cranberry, 213-214 Crataegus spp., 332-334 creat, 24-26 creatine, 215-217 creeping barberry, 475-477 creeping Charlie, 322-323 creosote bush, 160-162 crewel, 211-212 Crocus sativus, 547-548 CROHN’S DISEASE cat’s claw for, 149-151 chamomile for, 158-160 crosswort, 105-107 crowberry, 56-59, 508-510 crowfoot, 519-521 Cu, 204 cuckold, 122-125 cuckoo’s meate, 571-572 cuckoo sorrow, 571-572 cucumber, 217-218 Cucumis sativus, 217-218 cucurbita, 521-522 Cucurbita maxima, 521-522 Cucurbita moschata, 521-522 Cucurbita pepo, 521-522 Culver’s physic, 91-93 Culver’s root, 91-93 cumaru, 586-588 Curacao aloe, 18-22 curcuma, 588-590 Curcuma longa, 588-590 cure-all, 389-391 curled dock, 605-606 curly dock, 605-606 cutch, 209-210 Cyamopsis tetragonolobus, 323-325 Cydonia oblonga, 529-530 Cymbopogon citratus, 392-393 Cynara scolymus asteraceae, 37-38 Cypripedium calceolus, 607-608 Cypripedium pubescens, 607-608 CYSTITIS couchgrass for, 209-210 gotu kola for, 314-316 night-blooming cereus for, 460-462 CYTOMEGALOVIRUS cloves for, 186-187 D daffodil, 219-220 daffydown-dilly, 219-220 dage of Jerusalem, 406-408 dagger flower, 99-101 daisy, 221-222 dalmatian, 548-550 damiana, 222-224 dancing mushroom, 411-412 dandelion, 224-227 dang gui, 234-237 da-suan, 281-285 Datura stramonium, 360-363 Daucus carota, 527-529 day’s eye, 221-222 deacetylated chitin, 175-176 DECUBITUS ULCERS marigold for, 416-418 myrrh for, 328-330,449-451 papaya for, 479-481 pipsissewa for, 504-506 deerberry, 598-599 deernut, 363-364 dehydroepiandrosterone, 230-232 DEMENTIA carnitine for, 141-143 DHEA for, 230-232 huperzine A for, 345-346 denrod, 306-308 DEPRESSION betel palm for, 64-66 cola tree for, 193-196 damiana for, 222-224 fish oils for, 268-269 gamma linolenic acid for, 278-280 ginkgo for, 290-294 hops for, 334-337 kava for, 369-372 khat for, 377-378 lemon balm for, 389-391 mistletoe for, 434-436 mugwort for, 443-445 nutmeg for, 462-465 St. John’s wort for, 579-582 SAM-e for, 550-552 yerba maté for, 608-610 725 desert tea, 245-249 devil’s apple, 360-363 devil’s-apple, 424-426 devil’s bit, 257-258 devil’s claw, 228-230 devil’s darning needle, 184-185 devil’s fuge, 434-436 devil’s plague, 527-529 devil’s shrub, 565-567 devil’s trumpet, 360-363 devil weed, 360-363 dewcup, 384-385 DHA (docosahexaenoic acid), 268-269 DHEA, 230-232 DIABETES aloe for, 18-22 andrographis for, 24-26 basil for, 50-52 bay for, 52-54 bilberry for, 70-73 bitter melon for, 76-78 black catechu for, 80-82 burdock for, 122-125 centaury for, 156-158 chamomile for, 158-160 chaparral for, 160-162 Chinese cucumber for, 170-172 chromium for, 178-180 cinnamon for, 302-304 coenzyme Q10 for, 188-190 coriander for, 205-207 damiana for, 222-224 DHEA for, 230-232 elderberry for, 241-243 fenugreek for, 260-263 fo-ti for, 273-274 ginger for, 287-290 ginseng for, 294-297 glucomannan for, 299-301 goat’s rue for, 304-306 grapeseed for, 316-318 guar gum for, 323-325 gymnema for, 330-331 indigo for, 350-352 jaborandi for, 355-357 jambul for, 359-360 juniper for, 364-366 khella for, 379-381 maitake for, 411-412 meadowsweet for, 427-429 myrtle for, 452-454 neem for, 455-457 parsley for, 481-483 raspberry for, 534-536 INDEX Index 726 Index DIABETES (Continued) senega for, 559-561 yerba maté for, 608-610 DIABETIC RETINOPATHY bilberry for, 70-73 butcher’s broom for, 125-127 1,2,diacyl-sn-glycero-3phosphatidycholine, 387-389 2,6-diaminohexanoic acid, 409-410 DIARRHEA acidophilus for, 1-3 andrographis for, 24-26 avens for, 42-44 bayberry for, 54-56 betony for, 68-70 bistort for, 75-76 black cohosh for, 82-85 black pepper for, 89-91 brewers yeast for, 112-113 Chinese rhubarb for, 172-174 cinnamon for, 180-182 cloves for, 186-187 cola tree for, 193-196 colostrum for, 196-197 daisy for, 221-222 dandelion for, 224-227 gum for, 249-251 horehound for, 337-339 horse chestnut for, 339-341 Irish moss for, 353-354 jambul for, 359-360 juniper for, 364-366 kaolin for, 367-368 lady’s mantle for, 384-385 lungwort for, 406-408 nutmeg for, 462-465 Oregon grape for, 46-48, 475-477 pau d’arco for, 487-488 pectin for, 491-492 pill-bearing spurge for, 501-502 plantain for, 506-508 pomegranate for, 510-512 poplar for, 513-514 poppy for, 514-516 sage for, 548-550 storax for, 582-583 wild cherry for, 154-156, 594-595 DIHE, 575-576 dill, 232-234 dill seed, 232-234 dillweed, 232-234 dilly, 232-234 2,3 dimethoxy-5 methyl5-decaprenyl benzoquinone, 188-190 Dioscorea villosa L., 596-597 2,3-diphosphoglycerate, 352-353 Dipteryx odorata, 586-588 DIVERTICULITIS fo-ti for, 273-274 grapeseed for, 316-318 dock garden sorrel, 571-572 docosahexaenoic acid, 268-269 dog berry, 540-541 dog brier fruit, 540-541 dogfish shark, 564-565 dog grass, 209-210 dog rose fruit, 540-541 dog standard, 533-534 dolloff, 427-429 doll’s eye, 593-594 dong quai, 234-237 dongquingzi, 297-298 donnhove, 197-199 dope, 418-420 dragon flower, 99-101 Dr. Calwell dosalax, 561-563 drelip, 211-212 Drimia maritima, 577-578 drooping starwort, 257-258 dropsy plant, 389-391 dropwort, 427-429 dry-kuei, 234-237 Dryopteris filix-mas, 412-414 Duboisia myoporoides, 207-208 duck’s foot, 424-426 durfa grass, 209-210 Dutch myrtle, 452-454 dutch rushes, 343-345 dwarf, 364-366 dwarf carline, 140-141 dyer’s saffron, 545-547 DYSMENORRHEA anise for, 30-33 black cohosh for, 82-85 black haw for, 85-87 boldo for, 103-105 devil’s claw for, 228-230 dong quai for, 234-237 false unicorn root for, 257-258 fennel for, 258-260 fish oils for, 268-269 DYSMENORRHEA (Continued) gossypol for, 311-313 khella for, 379-381 lady’s mantle for, 384-385 mugwort for, 443-445 oleander for, 471-473 oregano for, 473-475 parsley for, 481-483 pulsatilla for, 519-521 ragwort for, 533-534 rue for, 541-544 safflower for, 545-547 sage for, 548-550 turmeric for, 588-590 DYSPEPSIA black pepper for, 89-91 blessed thistle for, 93-95 bogbean for, 101-103 caraway for, 137-138 cardamom for, 138-140 catnip for, 147-149 centaury for, 156-158 chamomile for, 158-160 chickweed for, 166-168 coriander for, 205-207 fenugreek for, 260-263 meadowsweet for, 427-429 nutmeg for, 462-465 E eagle vine, 202-204 earth smoke, 274-276 Easter flower, 519-521 Easter ledges, 75-76 Easter mangiant, 75-76 Easter rose, 87-89 echinacea, 238-241 Echinacea angustifolia, 238-241 Echinacea pallida, 238-241 Echinacea purpurea, 238-241 echter lavendel, 385-387 ecorce de chene, 466-467 ECZEMA chaulmoogra oil for, 165-166 evening primrose oil for, 252-253 figwort for, 265-268 fumitory for, 274-276 goldenseal for, 308-311 gotu kola for, 314-316 jaborandi for, 355-357 jojoba for, 363-364 licorice for, 395-399 marjoram for, 420-422 ECZEMA (Continued) oak for, 466-467 Oregon grape for, 46-48, 475-477 peach for, 489-490 yarrow for, 603-605 EDEMA agrimony for, 9-12 alfalfa for, 12-15 angelica for, 27-30 anise for, 30-33 bearberry for, 56-59 black cohosh for, 82-85 black haw for, 85-87 black root for, 91-93, 199-201 bloodroot for, 95-97 blue flag for, 99-101 boldo for, 103-105 broom for, 114-116 buchu for, 116-118 butcher’s broom for, 125-127 butterbur for, 127-129 carline thistle for, 140-141 celery for, 154-156 chicory for, 168-170 cola tree for, 193-196 damiana for, 222-224 dandelion for, 224-227 elderberry for, 241-243 elecampane for, 243-245 false unicorn root for, 257-258 fumitory for, 274-276 ginkgo for, 290-294 goat’s rue for, 304-306 golden rod for, 306-308 green tea for, 319-321 horehound for, 337-339 horse chestnut for, 339-341 horseradish for, 341-343 horsetail for, 343-345, 373-374 juniper for, 364-366 lovage for, 404-406 mustard for, 447-449 nettle for, 457-459 night-blooming cereus for, 460-462 oleander for, 471-473 parsley for, 481-483 peach for, 489-490 pulsatilla for, 519-521 raspberry for, 534-536 saw palmetto for, 555-557 EDEMA (Continued) squill for, 577-578 storax for, 582-583 wild cucumber for, 217-218 edible burdock, 122-125 E406, 6-8 eglantine gall, 540-541 Egyptian’s herb, 120-122 eichenlohe, 466-467 eicherinde, 466-467 eicosapentaenic acid, 268-269 elacy, 608-610 el agricultor, 608-610 elderberry, 241-243 elecampane, 243-245 elephant’s gall, 18-22 Elettaria cardamomum, 138-140 Eleutherococcus senticosus, 565-567 elfdock, 243-245 elfwort, 243-245 ellhorn, 241-243 Elymus repens, 209-210 emetic herb, 402-404 encina, 466-467 English chamomile, 158-160 English cowslip, 252-253 English lavender, 385-387 English oak, 466-467 English plantain, 506-508 EPA (eicosapentaenic acid), 268-269 ephedra, 245-249 Ephedra distachya, 245-249 Ephedra equisentina, 245-249 Ephedra nevadensis, 245-249 Ephedra sinica, 245-249 Ephedra trifurca, 245-249 EPILEPSY anise for, 30-33 epitonin, 245-249 EPSTEIN-BARR VIRUS Chinese cucumber for, 170-172 Equisetum arvense, 343-345 ERECTILE DYSFUNCTION arginine for, 33-34 yohimbe for, 614-616 eriodictyon, 610-612 Eriodictyon californicum, 610-612 erkek egreiti, 412-414 eryngo-leaved liverwort, 349-350 727 ESCHERICHIA COLI INFECTIONS barberry for, 46-48 burdock for, 122-125 clary for, 182-184 cloves for, 186-187 cola tree for, 193-196 lemongrass for, 392-393 lentinan for, 393-395 pau d’arco for, 487-488 tea tree oil for, 584-585 escine, 339-341 esplieg, 385-387 espresso, 190-193 Estramonio, 360-363 eucalyptus, 249-251 Eucalyptus globulus, 249-251 Eugenia caryophyllata, 186-187 Eugenia pimenta, 15-17 eupatorium, 105-107 Eupatorium perfoliatum, 105-107 euphorbia, 501-502 Euphorbia capitata, 501-502 Euphorbia hirta, 501-502 Euphorbia pilulifera, 501-502 Euphrasia officinalis, 182-184, 254-256 Eupolyphaga sinensis, 470-471 European angelica, 27-30 European ash, 39-40 European blueberry, 70-73 European buckthorn hartsthorn, 118-120 European centaury, 156-158 European elder, 241-243 European gosweet golden rod, 306-308 European mistletoe, 434-436 European pennyroyal, 492-494 European pestroot, 127-129 European squill, 577-578 evening primrose oil, 252-253 eye balm, 308-311 eyebright, 156-158, 182-184, 254-256 eye root, 308-311 F fairy caps, 252-253 fairy cup, 211-212 fairy-wand, 257-258 fairywart, 257-258 fake saffron, 545-547 INDEX Index 728 Index false cinnamon, 180-182 false hellebore, 22-24 false saffron, 545-547 false unicorn root, 257-258 false valerian, 533-534 fan palm, 555-557 farasyon maiy, 120-122 farfara, 197-199 fat ha lai jone, 24-26 FATIGUE astragalus for, 40-42 clary for, 182-184 cola tree for, 193-196 ginseng for, 294-297 khat for, 377-378 yerba maté for, 608-610 featherfew, 263-265 featherfoil, 263-265 febrifuge plant, 263-265 felon herb, 140-141 felonwort, 152-153 feltwort, 285-287 fenchel, 258-260 Fenchelholz, 552-554 fennel, 258-260 fenouil, 258-260 fenouille, 258-260 fenugreek, 260-263 FEVER balsam of Peru for, 45-46 bitter melon for, 76-78 boneset for, 105-107, 199-201 bugleweed for, 120-122 chaparral for, 160-162 feverfew for, 263-265 ginger for, 287-290 horse chestnut for, 339-341 indigo for, 350-352 lemongrass for, 392-393 meadowsweet for, 427-429 myrrh for, 328-330, 449-451 Oregon grape for, 46-48, 475-477 pau d’arco for, 487-488 prickly ash for, 516-518 red bush tea for, 538-539 safflower for, 545-547 soy for, 572-574 yellow dock for, 605-606 yew for, 612-613 feverfew, 263-265 fever tree, 249-251 feverwort, 105-107, 156-158 field balm, 147-149 fieldhove, 197-199 field lady’s mantle, 483-484 field mallow, 415-416 field pansy, 478-479 figwort, 265-268 filfil, 89-91 Filipendula ulmaria, 427-429 filius ante patrem, 197-199 filwort, 156-158 finocchio, 258-260 fishfuddle, 357-359 fish oils, 268-269 fish poison tree, 357-359 five-fingers, 294-297 flag lily, 99-101 flannel-leaf, 445-447 flapperdock, 127-129 FLATULENCE allspice for, 15-17 andrographis for, 24-26 anise for, 30-33 basil for, 50-52 black pepper for, 89-91 boldo for, 103-105 caraway for, 137-138 cardamom for, 138-140 dill for, 232-234 juniper for, 364-366 milk thistle for, 432-434 mustard for, 447-449 prickly ash for, 516-518 turmeric for, 588-590 flax, 269-271 flaxseed, 269-271 flea seed, 506-508 Fletcher’s Castoria, 561-563 fleur de coucou, 219-220 fleur-de-lis, 99-101 fleur d’ulmaire, 427-429 fleurs de mauve, 415-416 flor de lis, 608-610 Florence fennel, 258-260 flores ulmariae, 427-429 flower-de-luce, 99-101 flower velure, 197-199 flowery knotweed, 273-274 foal’s-foot, 197-199 foalswort, 197-199 Foeniculum vulgare, 258-260 folate, 272-273 folic acid, 272-273 folvite, 272-273 forest mushroom, 393-395 fo-ti, 273-274 foxberry, 56-59 fox’s clote, 122-125 foxtail grass, 49-50 Fraxinus americana, 39-40 Fraxinus atrovirens, 39-40 Fraxinus excelsior, 39-40 Fraxinus heterophylla, 39-40 Fraxinus jaspida, 39-40 Fraxinus polemoniipolia, 39-40 Fraxinus simplifolia, 39-40 Fraxinus verticillata, 39-40 French honeysuckle, 304-306 French lavender, 385-387 French lilac, 304-306 French psyllium, 506-508 friar’s cap, 4-6 Fucus vesiculosus, 375-376 Fumaria officinalis, 274-276 fumitory, 274-276 funcho, 258-260 funffing, 9-12 funfinger kraut, 9-12 FUNGAL INFECTIONS allspice for, 15-17 barberry for, 46-48 bay for, 52-54 bearberry for, 56-59 beth root for, 67-68 bitter orange for, 78-80 blessed thistle for, 93-95 bloodroot for, 95-97 burdock for, 122-125 celery for, 154-156 cinnamon for, 180-182 daisy for, 221-222 lemon balm for, 389-391 lemongrass for, 392-393 nutmeg for, 462-465 oregano for, 473-475 pau d’arco for, 487-488 peach for, 489-490 pineapple for, 503-504 pokeweed for, 508-510 safflower for, 545-547 tea tree oil for, 584-585 G gad, 377-378 gagroot, 402-404 galanthamine, 277-278 Galanthus nivalis, 277-278 Galega officinalis, 304-306 GALLBLADDER DISEASE carline thistle for, 140-141 GALLBLADDER DISEASE Oregon grape for, 46-48, 475-477 GALLSTONE DISEASE cardamom for, 138-140 coffee for, 190-193 eucalyptus for, 249-251 gentian for, 285-287 lecithin for, 387-389 gall weed, 285-287 gamma linolenic acid, 278-280 ganga, 418-420 garcinia, 280-281 Garcinia cambogia, 280-281 Garcinia hanburyi, 280-281 Garcinia indica, 280-281 garden angelica, 27-30 garden artichoke, 37-38 garden celandine, 152-153 garden dill, 232-234 garden endive, 168-170 garden fennel, 258-260 garden lavender, 385-387 garden marigold, 416-418 garden marjoram, 420-422 garden parsley, 481-483 garden patience, 605-606 garden sage, 548-550 garden spurge, 501-502 garget, 508-510 garlic, 281-285 GASTRIC ULCERS astragalus for, 40-42 basil for, 50-52 bay for, 52-54 bee pollen for, 59-61 beth root for, 67-68 black pepper for, 89-91 capsicum peppers for, 134-137 caraway for, 137-138 carline thistle for, 140-141 celandine for, 152-153 chickweed for, 166-168 Chinese cucumber for, 170-172 fenugreek for, 260-263 gentian for, 285-287 ginger for, 287-290 goldenseal for, 308-311 khat for, 377-378 licorice for, 395-399 meadowsweet for, 427-429 myrrh for, 328-330, 449-451 GASTRITIS fenugreek for, 260-263 goldenseal for, 308-311 Irish moss for, 353-354 marshmallow for, 422-424 meadowsweet for, 427-429 nutmeg for, 462-465 GASTROINTESTINAL DISORDERS, GENERAL barley for, 49-50 bay for, 52-54 castor oil plant for, 145-147 juniper for, 364-366 lemongrass for, 392-393 licorice for, 395-399 lovage for, 404-406 marigold for, 416-418 myrtle for, 452-454 nutmeg for, 462-465 Oregon grape for, 46-48, 475-477 parsley for, 481-483 pipsissewa for, 504-506 poplar for, 513-514 poppy for, 514-516 prickly ash for, 516-518 rue for, 541-544 sage for, 548-550 slippery elm for, 569-571 yarrow for, 603-605 yerba maté for, 608-610 GASTROINTESTINAL SPASMS boldo for, 103-105 caraway for, 137-138 celandine for, 152-153 chamomile for, 158-160 corkwood for, 207-208 daisy for, 221-222 dill for, 232-234 gatillier, 163-165 gaucho, 608-610 gau-lou, 170-172 gaultheria oil, 598-599 Gaultheria procumbens, 598-599 ge gen, 381-383 Gelidium cartilagineum, 6-8 gelose, 6-8 gemener, 364-366 genievre, 364-366 genista, 114-116 GENITAL HERPES lysine for, 409-410 pomegranate for, 510-512 gentian, 285-287 Gentiana acaulis L., 285-287 Gentiana lutea L., 285-287 Gentlax, 561-563 German chamomile, 158-160 geum, 42-44 729 Geum urbanum, 42-44 GIARDIASIS barberry for, 46-48 goldenseal for, 308-311 ginger, 287-290 GINGIVITIS bloodroot for, 95-97 cranberry for, 213-214 pycnogenol for, 522-524 yarrow for, 603-605 Gingko biloba, 290-294 ginkgo, 290-294 ginseng, 294-297 ginsterkraut, 114-116 GLA, 278-280 GLAUCOMA bilberry for, 70-73 chromium for, 178-180 jaborandi for, 355-357 marijuana for, 418-420 pulsatilla for, 519-521 Glechoma hederacea, 322-323 globe artichoke, 37-38 globeberry, 612-613 glossy privet, 297-298 glucomannan, 299-301 glucosamine, 301-302 L-glutamine, 303 glutamine, 303 glycine, 304 Glycine max, 572-574 Glycyrrhiza glabra, 395-399 goatnut, 363-364 goat’s rue, 304-306 goatweed, 579-582 gobo, 122-125 golden apple, 529-530 golden ragwort, 533-534 golden rocket, 503-504 golden rod, 306-308 goldenseal, 308-311 golden senecio, 533-534 goldsiegel, 308-311 goldy star, 42-44 gomishi, 558-559 gonolobus, 202-204 gordaldo, 603-605 gorikapuli, 280-281 Gossypium hirsutum, 311-313 gossypol, 311-313 gotu kola, 314-316 GOUT birch for, 73-74 boldo for, 103-105 buchu for, 116-118 INDEX Index 730 Index GOUT (Continued) couchgrass for, 209-210 devil’s claw for, 228-230 horsetail for, 343-345, 373-374 Gracilaria confervoides, 6-8 Graminis rhizmom, 209-210 granadilla, 484-486 granatum, 510-512 granulestin, 387-389 grapeseed, 316-318 grapple plant, 228-230 grass, 418-420 gravelier, 466-467 gravel root, 427-429 GRAVES’ DISEASE bugleweed for, 120-122 lemon balm for, 389-391 graviola, 318-319 greasewood, 160-162 great bur, 122-125 great burdock, 122-125 greater celandine, 152-153 greater nettle, 457-459 greater plantain, 506-508 great lobelia, 402-404 great mountain root, 341-343 great mullein, 445-447 great raifort, 341-343 great scarlet poppy, 514-516 great wild valerian, 591-592 Greek hayseed, 260-263 green dragon, 360-363 green hellebore, 22-24 green sorrel, 571-572 green tea, 319-321 Grifola frondosa, 411-412 groats, 468-469 ground hemlock, 612-613 ground holly, 504-506 ground ivy, 322-323 ground juniper, 364-366 ground lemon, 424-426 ground lily, 67-68 ground raspberry, 308-311 ground thistle, 140-141 GS, 301-302 guar flour, 323-325 guar gum, 323-325 guarana, 325-328 guarana gum, 325-328 guarana paste, 325-328 Guatemala lemongrass, 392-393 gucran, 323-325 guelder-rose, 85-87 guggul, 328-330 gum, 249-251 gum benjamin, 61-62 gum bush, 610-612 gum myrrh, 449-451 gum plant, 199-201, 610-612 gurmar, 330-331 Gurnera diffusa, 222-224 guru nut, 193-196 gutta cambodia, 280-281 gymnema, 330-331 Gymnema sylvestre, 330-331 GYNECOLOGIC CANCER meadowsweet for, 427-429 nutmeg for, 462-465 yew for, 612-613 gynocardia oil, 165-166 gypsyweed, 360-363 gypsy-weed, 120-122 gypsy-wort, 120-122 H hackmatack, 364-366 hallfoot, 197-199 Hamamelis virginiana, 599-601 hammerhead shark, 564-565 happy major, 122-125 hardhay, 579-582 hardock, 122-125 hare barley, 49-50 Harpagophytum procumbens, 228-230 hartsthorn, 118-120 harvest, 364-366 hash, 418-420 hashish, 418-420 haver, 468-469 haver-corn, 468-469 haws, 468-469 hawthorn, 332-334 haymaids, 322-323 HCA, 280-281 HEADACHE angelica for, 27-30 astragalus for, 40-42 celery for, 154-156 clematis for, 184-185 devil’s claw for, 228-230 dong quai for, 234-237 elderberry for, 241-243 ginkgo for, 290-294 marjoram for, 420-422 meadowsweet for, 427-429 soy for, 572-574 healing herb, 199-201 HEARTBURN devil’s claw for, 228-230 gentian for, 285-287 heart’s ease, 478-479 Hedeoma pulegioides, 492-494 Hedera senticosa, 565-567 hedge fumitory, 274-276 hedgehog, 238-241 hedgemaids, 322-323 Hediondilla, 160-162 heeraboi, 449-451 helecho macho, 412-414 HELICOBACTER PYLORI capsicum peppers for, 134-137 caraway for, 137-138 Iceland moss for, 349-350 Helleborus niger, 87-89 helmet flower, 4-6, 567-569 HELMINTHIASIS barberry for, 46-48 bitter melon for, 76-78 boldo for, 103-105 castor oil plant for, 145-147 centaury for, 156-158 coriander for, 205-207 elecampane for, 243-245 hops for, 334-337 horehound for, 337-339 horseradish for, 341-343 male fern for, 412-414 morinda for, 439-441 mugwort for, 443-445 neem for, 455-457 oleander for, 471-473 peach for, 489-490 pomegranate for, 510-512 pumpkin for, 521-522 rue for, 541-544 wild cucumber for, 217-218 helonias dioica, 257-258 helonias root, 257-258 HEMORRHOIDS avens for, 42-44 balsam of Peru for, 45-46 beth root for, 67-68 bilberry for, 70-73 bistort for, 75-76 butcher’s broom for, 125-127 catnip for, 147-149 fo-ti for, 273-274 horse chestnut for, 339-341 HEMORRHOIDS (Continued) myrrh for, 328-330, 449-451 oak for, 466-467 witch hazel for, 599-601 hemp, 418-420 hemp tree, 163-165 HEPATITIS astragalus for, 40-42 lecithin for, 387-389 licorice for, 395-399 Oregon grape for, 46-48, 475-477 SAM-e for, 550-552 soy for, 572-574 HEPATOXICITY andrographis for, 24-26 neem for, 455-457 schisandra for, 558-559 herba benedicta, 591-592 herba de la pastora, 222-224 herba ephedrae, 245-249 herbal ecstasy, 245-249 herb bennet, 42-44 herb-of-grace, 541-544 herb Peter, 211-212 herbygrass, 541-544 HERPES SIMPLEX VIRUS dong quai for, 234-237 lysine for, 409-410 mugwort for, 443-445 mullein for, 445-447 Oregon grape for, 46-48, 475-477 propolis for, 518-519 witch hazel for, 599-601 high mallow, 415-416 high veronica, 91-93 Himalayan rhubarb, 172-174 hindberry, 534-536 hini, 91-93 hinojo, 258-260 hip, 540-541 hipberries, 540-541 hip fruit, 540-541 hip tree, 540-541 HIV/AIDS andrographis for, 24-26 barberry for, 46-48 bitter melon for, 76-78 chaparral for, 160-162 Chinese cucumber for, 170-172 colostrum for, 196-197 daffodil for, 219-220 European mistletoe for, 434-436 HIV/AIDS (Continued) hyssop for, 346-348 Iceland moss for, 349-350 licorice for, 395-399 marijuana for, 418-420 peppermint for, 494-497 rauwolfia for, 536-538 red bush tea for, 538-539 thymus extract for, 585-586 hive dross, 518-519 hmarg, 64-66 hoarhound, 337-339 hog apple, 424-426, 439-441 hogberry, 56-59 hog seed, 540-541 hogweed, 114-116 holly herb, 610-612 holly-leaved barberry, 475-477 holy basil, 50-52 holy thistle, 93-95, 432-434 holy tree, 455-457 holy weed, 610-612 honey plant, 389-391 hong qu, 436-438 hoodwort, 567-569 hop fruit, 540-541 hops, 334-337 Hordeum distichon, 49-50 Hordeum irregulare, 49-50 Hordeum jubalum, 49-50 Hordeum leporinum, 49-50 Hordeum vulgare, 49-50 horehound, 337-339 horse chestnut, 339-341 horse-elder, 243-245 horse-foot, 197-199 horseheal, 243-245 horse-hoof, 197-199 horseradish, 341-343 horse savin, 364-366 horsetail, 343-345, 373-374 horsetail grass, 343-345 horse willow, 343-345 ho shou wu, 273-274 hot pepper, 134-137 houndsbane, 337-339 hsiang-dan, 18-22 hua gu, 393-395 hualtata, 605-606 huang-qi, 40-42 huang-qin, 567-569 hu-chiao, 89-91 huckleberry, 70-73 hummaidh, 605-606 Humulus lupulus, 334-337 731 Hungarian chamomile, 158-160 HupA, 345-346 huperzine A, 345-346 Huperzine A, 345-346 Hydnocarpus anthelmintica, 165-166 hydnocarpus oil, 165-166 Hydnocarpus wightiana, 165-166 Hydrastis canadensis, 308-311 hydrated aluminum silicate, 367-368 hydrocotyle, 314-316 hydroxycitric acid, 280-281 HYPERCHOLESTEROLEMIA acidophilus for, 1-3 agar for, 6-8 alfalfa for, 12-15 celery for, 154-156 chondroitin for, 176-178 chromium for, 178-180 coriander for, 205-207 fenugreek for, 260-263 flax for, 269-271 fo-ti for, 273-274 garlic for, 281-285 glucomannan for, 299-301 green tea for, 319-321 guar gum for, 323-325 guggul for, 328-330 gum for, 249-251 hawthorn for, 332-334 jojoba for, 363-364 khella for, 379-381 lecithin for, 387-389 lemongrass for, 392-393 maitake for, 411-412 monascus for, 436-438 nutmeg for, 462-465 oats for, 468-469 octacosanol for, 470-471 pectin for, 491-492 skullcap for, 567-569 soy for, 572-574 spirulina for, 575-576 Hypericum perforatum L., 579-582 hyperimmune bovine colostrum, 196-197 HYPERLIPIDEMIA artichoke for, 37-38 coriander for, 205-207 green tea for, 319-321 guar gum for, 323-325 gymnema for, 330-331 INDEX Index 732 Index HYPERLIPIDEMIA (Continued) myrrh for, 449-451 nutmeg for, 462-465 octacosanol for, 470-471 soy for, 572-574 HYPERTENSION allspice for, 15-17 American hellebore for, 22-24 angelica for, 27-30 astragalus for, 40-42 barberry for, 46-48 beta-carotene for, 63-64 betony for, 68-70 black catechu for, 80-82 borage for, 107-110 burdock for, 122-125 capsicum peppers for, 134-137 celery for, 154-156 centaury for, 156-158 cinnamon for, 180-182 clematis for, 184-185 coenzyme Q10 for, 188-190 dandelion for, 224-227 dong quai for, 234-237 fumitory for, 274-276 galanthamine for, 277-278 gotu kola for, 314-316 hawthorn for, 332-334 kelp for, 373-374 kudzu for, 381-383 lemon balm for, 389-391 lemongrass for, 392-393 lentinan for, 393-395 maitake for, 411-412 mistletoe for, 434-436 parsley for, 481-483 rauwolfia for, 536-538 rue for, 541-544 safflower for, 545-547 wild cucumber for, 217-218 yerba maté for, 608-610 HYPERTHYROIDISM bugleweed for, 120-122 night-blooming cereus for, 460-462 HYPERTRIGLYCERIDEMIA garlic for, 281-285 HYPOCALCEMIA calcium for, 132-134 HYPOGLYCEMIA chromium for, 178-180 pomegranate for, 510-512 hypoxanthine riboside, 352-353 hyssop, 346-348 Hyssopus officinalis, 346-348 I Iceland lichen, 349-350 Iceland moss, 349-350 IDS 89, 555-557 Ilex paraguariensis, 608-610 IMMUNE FUNCTION, DEPRESSED aconite for, 4-6 astragalus for, 40-42 balsam of Peru for, 45-46 basil for, 50-52 bee pollen for, 59-61 boneset for, 105-107, 199-201 capsicum peppers for, 134-137 cat’s claw for, 149-151 celandine for, 152-153 coenzyme Q10 for, 188-190 dandelion for, 224-227 DHEA for, 230-232 echinacea for, 238-241 gamma linolenic acid for, 278-280 goldenseal for, 308-311 lecithin for, 387-389 lentinan for, 393-395 maitake for, 411-412 neem for, 455-457 rose hips for, 540-541 schisandra for, 558-559 senega for, 559-561 Siberian ginseng for, 565-567 spirulina for, 575-576 thymus extract for, 585-586 wild yam for, 596-597 IMPOTENCE bee pollen for, 59-61 chaste tree for, 163-165 damiana for, 222-224 saw palmetto for, 555-557 yohimbe for, 614-616 i-mu-ts’ao, 441-443 Indian apple, 424-426 Indian balm, 67-68 Indian cluster bean, 323-325 Indian dye, 308-311 Indian echinacea, 24-26 Indian elm, 569-571 Indian frankincense, 111-112 Indian head, 238-241 Indian hemp, 355-357 Indian lilac, 455-457 Indian mulberry, 439-441 Indian mustard, 447-449 Indian paint, 95-97 Indian pennywort, 314-316 Indian pink, 402-404 Indian plantago, 506-508 Indian poke, 22-24 Indian saffron, 547-548, 588-590 Indian sage, 105-107 Indian shamrock, 67-68 Indian snakeroot, 536-538 Indian squill, 577-578 Indian tobacco, 402-404 Indian tragacanth, 368-369 Indian turmeric, 308-311 Indian valerian, 588-590 Indian water navelwort, 314-316 INDIGESTION allspice for, 15-17 anise for, 30-33 indigo, 350-352 Indigofera spp., 350-352 INFECTIONS, GENERAL acidophilus for, 1-3 agrimony for, 9-12 angelica for, 27-30 anise for, 30-33 barberry for, 46-48 bay for, 52-54 bearberry for, 56-59 blessed thistle for, 93-95 bloodroot for, 95-97 blue flag for, 99-101 brewers yeast for, 112-113 burdock for, 122-125 caraway for, 137-138 celandine for, 152-153 chaparral for, 160-162 clary for, 182-184 cola tree for, 193-196 daisy for, 221-222 dill for, 232-234 echinacea for, 238-241 elecampane for, 243-245 galanthamine for, 277-278 garlic for, 281-285 ginger for, 287-290 glutamine for, 303 goldenseal for, 308-311 green tea for, 319-321 hops for, 334-337 horseradish for, 341-343 Iceland moss for, 349-350 INFECTIONS, GENERAL (Continued) kelpware for, 375-376 lavender for, 385-387 lemongrass for, 392-393 lentinan for, 393-395 licorice for, 395-399 marigold for, 416-418 marjoram for, 420-422 marshmallow for, 422-424 meadowsweet for, 427-429 monascus for, 436-438 neem for, 455-457 nutmeg for, 462-465 oregano for, 473-475 parsley for, 481-483 pau d’arco for, 487-488 peyote for, 499-500 pomegranate for, 510-512 propolis for, 518-519 Queen Anne’s lace for, 527-529 raspberry for, 534-536 sage for, 548-550 shark cartilage for, 564-565 tea tree oil for, 584-585 thymus extract for, 585-586 inferno, 360-363 INFLAMMATION aconite for, 4-6 agrimony for, 9-12 aloe for, 18-22 arnica for, 35-37 avens for, 42-44 barberry for, 46-48 basil for, 50-52 bearberry for, 56-59 bistort for, 75-76 blessed thistle for, 93-95 bloodroot for, 95-97 bogbean for, 101-103 boneset for, 105-107, 199-201 borage for, 107-110 boswellia for, 111-112 catnip for, 147-149 cat’s claw for, 149-151 celandine for, 152-153 centaury for, 156-158 chamomile for, 158-160 Chinese cucumber for, 170-172 chondroitin for, 176-178 clary for, 182-184 cola tree for, 193-196 comfrey for, 199-201 INFLAMMATION (Continued) cowslip for, 211-212, 252-253 devil’s claw for, 228-230 dong quai for, 234-237 feverfew for, 263-265 figwort for, 265-268 fish oils for, 268-269 flax for, 269-271 gamma linolenic acid for, 278-280 garlic for, 281-285 ginger for, 287-290 ginkgo for, 290-294 golden rod for, 306-308 goldenseal for, 308-311 gum for, 249-251 horse chestnut for, 339-341 Iceland moss for, 349-350 indigo for, 350-352 juniper for, 364-366 khat for, 377-378 licorice for, 395-399 motherwort for, 441-443 mullein for, 445-447 myrrh for, 328-330, 449-451 myrtle for, 452-454 nettle for, 457-459 New Zealand green-lipped mussel for, 459-460 nutmeg for, 462-465 oak for, 466-467 pansy for, 478-479 pineapple for, 503-504 plantain for, 506-508 propolis for, 518-519 pycnogenol for, 522-524 raspberry for, 534-536 rue for, 541-544 safflower for, 545-547 SAM-e for, 550-552 Siberian ginseng for, 294-297 skullcap for, 567-569 turmeric for, 588-590 wintergreen for, 598-599 witch hazel for, 599-601 INFLUENZA andrographis for, 24-26 astragalus for, 40-42 boneset for, 105-107, 199-201 capsicum peppers for, 134-137 catnip for, 147-149 echinacea for, 238-241 733 INFLUENZA (Continued) pau d’arco for, 487-488 poplar for, 513-514 thymus extract for, 585-586 inosine, 352-353 INSOMNIA anise for, 30-33 centaury for, 156-158 chamomile for, 158-160 cowslip for, 211-212, 252-253 fo-ti for, 273-274 hops for, 334-337 lavender for, 385-387 lemon balm for, 389-391 lemongrass for, 392-393 licorice for, 395-399 marjoram for, 420-422 melatonin for, 429-431 mistletoe for, 434-436 peach for, 489-490 pulsatilla for, 519-521 Siberian ginseng for, 294-297 valerian for, 591-592 INTERMITTENT CLAUDICATION carnitine for, 141-143 Inula helenium, 243-245 ipe, 487-488 ipe roxo, 487-488 ipes, 487-488 Irish broom top, 114-116 Irish moss, 353-354 Iris versicolor, 99-101 IRRITABLE BOWEL SYNDROME bistort for, 75-76 butterbur for, 127-129 cardamom for, 138-140 cat’s claw for, 149-151 centaury for, 156-158 chamomile for, 158-160 eucalyptus for, 249-251 gentian for, 285-287 jimsonweed for, 360-363 marshmallow for, 422-424 meadowsweet for, 427-429 peppermint for, 494-497 ISCHEMIC HEART DISEASE chondroitin for, 176-178 coenzyme Q10 for, 188-190 fumitory for, 274-276 isokarpalo, 213-214 Italian fitch, 304-306 ITCHING oats for, 468-469 witch hazel for, 599-601 itchweed, 22-24 INDEX Index 734 Index J jaborandi, 355-357 Jacob’s ladder, 400-402 Jacob’s staff, 445-447 jaguar, 608-610 jaguar gum, 323-325 Jamaican dogwood, 357-359 Jamaican honeysuckle, 484-486 Jamaica pepper, 15-17 jamba, 359-360 jambolana, 359-360 jambolo, 359-360 jambool, 359-360 jambu, 359-360 jambul, 359-360 jambula, 359-360 jambulon plum, 359-360 Jamestown weed, 360-363 jamguarandi, 355-357 Japanese angelica, 27-30 Japanese arrowroot, 381-383 Japanese gelatin, 6-8 Japanese ginseng, 294-297 Japanese isinglass, 6-8 Jateorrhiza calumba, 133-134 Jateorrhiza palmata, 133-134 JAUNDICE bayberry for, 54-56 black root for, 91-93, 199-201 jaundice berry, 46-48 jaundice root, 308-311 java, 190-193 java plum, 359-360 Jersualem sage, 406-408 Jerusalem cowslip, 406-408 Jesuit’s bark, 530-532 Jesuit’s tea, 608-610 Jew’s harp, 67-68 Jew’s myrtle, 452-454 jiang huang, 588-590 jimsonweed, 360-363 jintsam, 294-297 Joe-pye-weed, 105-107 johimbe, 614-616 Johnny jump-up, 478-479 John’s wort, 579-582 joint, 418-420 joint fir, 245-249 JOINT INFLAMMATION celery for, 154-156 chaparral for, 160-162 daffodil for, 219-220 JOINT INFLAMMATION (Continued) daisy for, 221-222 devil’s claw for, 228-230 ephedra for, 245-249 horseradish for, 341-343 mustard for, 447-449 nettle for, 457-459 parsley for, 481-483 rue for, 541-544 wintergreen for, 504-506, 598-599 yew for, 612-613 JOINT PAIN bay for, 52-54 daffodil for, 219-220 devil’s claw for, 228-230 ephedra for, 245-249 mustard for, 447-449 nettle for, 457-459 nutmeg for, 462-465 pansy for, 478-479 parsley for, 481-483 pau d’arco for, 487-488 jojoba, 363-364 juarandi, 355-357 juniper, 364-366 juniper mistletoe, 364-366 Juniperus communis, 364-366 Juniperus oxycedrus L., 364-366 jupiter flower, 478-479 K kadaya, 368-369 kadira, 368-369 kaht, 377-378 kalmegh, 24-26 Kansas snakeroot, 238-241 kaolin, 367-368 karaya gum, 368-369 kardobenediktenkraut, 93-95 kariyat, 24-26 karolla, 76-78 kat, 377-378 katila, 368-369 katzenwurzel, 591-592 kava, 369-372 kava-kava, 369-372 kawa, 369-372 kelecin, 387-389 kelp, 373-374 kelpware, 375-376 kernelwort, 265-268 keser, 547-548 keuschbaum, 163-165 kew, 369-372 key flower, 211-212, 252-253 key of heaven, 211-212, 252-253 Khartoum senna, 561-563 khat, 377-378 khella, 379-381 khellin, 379-381 king of mushrooms, 411-412 the king of spices, 89-91 king’s-cure-all, 252-253 kinnikinnick, 56-59 kirta, 24-26 kivircik labada, 605-606 klamath weed, 579-582 knee holly, 125-127 knitback, 199-201 knitbone, 199-201 knoblauch, 281-285 knotted marjoram, 420-422 knotty brake, 412-414 knotty rooted figwort, 265-268 knotweed, 75-76 kola nut, 193-196 kolatier, 193-196 konjac, 299-301 konjac mannan, 299-301 Korean ginseng, 294-297 kosho, 89-91 krabao’s tree seed, 165-166 krishnadi, 89-91 kuandong hua, 197-199 kubjeile, 519-521 kudzu, 381-383 kudzu vine, 381-383 kullo, 368-369 kum kuma, 547-548 kummel, 137-138 kummelol, 137-138 kyoo, 588-590 L Lactinex, 1-3 Lactobacillus acidophilus, 1-3 Lactobacillus bulgaricus, 1-3 Lactobacillus GG, 1-3 lada, 89-91 ladder-to-heaven, 400-402 ladies’ delight, 478-479 lady’s mantle, 384-385 lady’s thistle, 432-434 laetrile, 489-490 la hoja, 608-610 lamb mint, 494-497 Laminaria digitata, 373-374 Laminaria japonica, 373-374 Laminaria saccharina, 373-374 la mulata, 608-610 langwort, 127-129 langyacao, 9-12 lanten, 506-508 la pacho, 487-488 lapacho, 487-488 lapacho colorado, 487-488 lapachoi, 487-488 lapacho morado, 487-488 lappa, 122-125 large fennel, 258-260 large-flowered cactus, 460-462 Larrea divaricata, 160-162 Larrea tridentata, 160-162 la-suan, 281-285 LAT, 141-143 la tranquera, 608-610 laurel, 52-54 laurier rose, 471-473 Laurus nobilis, 52-54 lavanda, 385-387 lavande commun, 385-387 lavandin, 385-387 Lavandula angustifolia, 385-387 Lavandula latifolia, 385-387 Lavandula officinalis, 385-387 Lavandula stoechas, 385-387 lavender, 385-387 layor carang, 6-8 lecithin, 387-389 lecithol, 387-389 lemon balm, 389-391 lemongrass, 392-393 lentinan, 393-395 Lentinula edodes, 393-395 Lentinus edodes, 393-395 Lent lily, 219-220 leontopodium, 384-385 Leonurus cardiaca, 441-443 leopard’s bane, 35-37 LEPROSY andrographis for, 24-26 castor for, 145-147 chaulmoogra oil for, 165-166 leptandra, 91-93 Leptandra virginica, 91-93 lesser centaury, 156-158 LEUKEMIA turmeric for, 588-590 yarrow for, 603-605 LEUKORRHEA bayberry for, 54-56 beth root for, 67-68 buchu for, 116-118 Oregon grape for, 46-48, 475-477 levant wormseed, 601-602 Levisticum officinale, 404-406 Levisticum radix, 404-406 LIBIDO, DEPRESSED nutmeg for, 462-465 pau d’arco for, 487-488 licorice, 395-399 licorice root, 395-399 life-giving vine of Peru, 149-151 liferoot, 533-534 Lignum floridum, 552-554 Lignum sassafras, 552-554 Ligustrum lucidum, 297-298 Li l32, 332-334 lily constancy, 400-402 lily convalle, 400-402 lily of the desert, 18-22 lily of the valley, 400-402 linen flax, 269-271 linseed, 269-271 lint bells, 269-271 linum, 269-271 Linum usitatissimum, 269-271 lion’s ear, 441-443 lion’s foot, 384-385 lion’s tail, 441-443 lion’s tart, 441-443 lion’s tooth, 224-227 Liquidambar orientalis, 582-583 liquid amber, 582-583 liver lily, 99-101 liverwort, 9-12 lobelia, 402-404 Lobelia inflata, 402-404 loco seeds, 360-363 locoweed, 360-363 longyacao, 9-12 lonjazo, 608-610 Lophophora williamsii, 499-500 lovage, 404-406 love leaves, 122-125 LPT, 141-143 LSESR, 555-557 lucerne, 12-15 lu-hui, 18-22 lung moss, 406-408 lungs of oak, 406-408 735 lungwort, 406-408 lycopene, 408-409 lycopi herba, 120-122 Lycopus europaeus,120-122 Lycopus virginicus, 120-122 lysine, 409-410 M maag, 64-66 mace, 462-465 macis, 462-465 MACULAR DEGENERATION beta-carotene for, 63-64 bilberry for, 70-73 Madagascar lemongrass, 392-393 mad apple, 360-363 mad-dog weed, 567-569 madrugada, 608-610 madweed, 567-569 maggi plant, 404-406 Mahonia aquifolium, 475-477 ma huang, 245-249 mahuuanggen, 245-249 maidenhair tree, 290-294 maitake, 411-412 maive, 415-416 maize pollen, 59-61 Malabar cardamom, 138-140 malabar tamarind, 280-281 MALARIA bitter melon for, 76-78 boneset for, 105-107, 199-201 devil’s claw for, 228-230 dong quai for, 234-237 licorice for, 395-399 morinda for, 439-441 neem for, 455-457 prickly ash for, 516-518 quinine for, 530-532 male fern, 412-414 male lily, 400-402 mallow, 415-416 Malva sylvestris, 415-416 mandrake, 424-426 manzanita, 56-59 Marcrocystis pyrifera, 373-374 marginal shield-fern, 412-414 margosa, 455-457 Marian thistle, 432-434 marigold, 416-418 marijuana, 418-420 marjoram, 420-422 Marrubium vulgare, 337-339 INDEX Index 736 Index marsedenia condurango, 202-204 Marsedenia condurango, 202-204 marsh apple, 213-214 marshmallow, 422-424 marsh parsley, 154-156 marsh trefoil, 101-103 marvel, 337-339 Mary Jane, 418-420 Mary thistle, 432-434 the master spice, 89-91 MASTODYNIA bugleweed for, 120-122 chaste tree for, 163-165 maté, 608-610 Matricaria chamomilla, 158-160 Matricaria recutita, 158-160 matsu-cha, 319-321 may, 332-334 mayapple, 424-426 may blob, 211-212 maybush, 332-334 mayflower, 211-212, 252-253 May lily, 400-402 maypop, 484-486 maypot, 484-486 may rose, 85-87 meadow anemone, 519-521 meadow eyebright, 254-256 meadow queen, 427-429 meadow sage, 548-550 meadowsweet, 427-429 meadow windflower, 519-521 meadwort, 427-429 mede-sweet, 427-429 medicago, 12-15 Medicago sativa L., 12-15 medicinal rhubarb, 172-174 medicinal yeast, 112-113 Mediterranean squill, 577-578 MEL, 429-431 Melaleuca alternifolia, 584-585 melaleuca oil, 584-585 melampode, 87-89 melatonin, 429-431 Melissa, 389-391 Melissa officinalis L., 389-391 mellipertuis, 579-582 melon tree, 479-481 mengkoedoe, 439-441 MENOPAUSE SYMPTOMS black cohosh for, 82-85 clary for, 182-184 MENOPAUSE SYMPTOMS (Continued) dong quai for, 234-237 hops for, 334-337 soy for, 572-574 wild yam for, 596-597 MENORRHAGIA dong quai for, 234-237 horsetail for, 343-345, 373-374 kelpware for, 375-376 lady’s mantle for, 384-385 menta de lobo, 120-122 Mentha piperita, 494-497 Mentha pulegium, 492-494 Menyanthes trifoliata, 101-103 merasingi, 330-331 mesc, 499-500 mescal, 499-500 mescal buttons, 499-500 mescaline, 499-500 meshashringi, 330-331 mexc, 499-500 Mexican damiana, 222-224 Mexican tea, 245-249 Mexican wild yam, 596-597 Mexico seed, 145-147 Mexico weed, 145-147 middle comfrey, 120-122 midsummer daisy, 263-265 MIGRAINE HEADACHE anise for, 30-33 butterbur for, 127-129 castor for, 145-147 catnip for, 147-149 clematis for, 184-185 coenzyme Q10 for, 188-190 cola tree for, 193-196 feverfew for, 263-265 ginger for, 287-290 lemon balm for, 389-391 SAM-e for, 550-552 milfoil, 603-605 milk thistle, 432-434 Milk Vetch, 40-42 milkweed, 501-502 milkwort, 559-561 milled barley, 49-50 minor centaury, 156-158 miraa, 377-378 mirth, 452-454 Missouri snakeroot, 238-241 mistletoe, European, 434-436 mitoquinone, 188-190 MLT, 429-431 moccasin flower, 607-608 mocha, 190-193 mock pennyroyal, 492-494 Momordica charantia L., 76-78 Monascum anka, 436-438 Monascum purpureus, 436-438 monascus, 436-438 monkey’s bench, 411-412 monkshood, 4-6 monk’s pepper, 163-165 moon, 499-500 moon weed, 360-363 moose elm, 569-571 mora de la India, 439-441 MoreDophilus, 1-3 morinda, 439-441 Morinda citrifolia, 439-441 Mormon tea, 245-249 MORNING SICKNESS raspberry for, 534-536 mortification root, 422-424 mosquito plant, 492-494 mother’s die, 527-529 motherwort, 441-443 MOTION SICKNESS corkwood for, 207-208 ginger for, 287-290 mountain balm, 610-612 mountain box, 56-59 mountain cranberry, 213-214 mountain flax, 559-561 mountain grape, 475-477 mountain mint, 473-475 mountain snuff, 35-37 mountain tea, 598-599 mountain tobacco, 35-37 mousebane, 4-6 mouse-ear, 166-168 MOUTH ULCERS goldenseal for, 308-311 guggul for, 328-330 mucara, 368-369 muguet, 400-402 mugwort, 443-445 mukul myrrh tree, 328-330 mullein, 445-447 muscadier, 462-465 muscatel sage, 182-184 MUSCLE INFLAMMATION wintergreen for, 504-506, 598-599 yerba santa for, 610-612 MUSCLE PAIN allspice for, 15-17 birch for, 73-74 capsicum peppers for, 134-137 kudzu for, 381-383 marjoram for, 420-422 muskat, 316-318 muskatbaum, 462-465 mustard, 447-449 mutterkraut, 263-265 muzei mu huang, 245-249 MYASTHENIA GRAVIS galanthamine for, 277-278 huperzine A for, 345-346 lecithin for, 387-389 MYOCARDIAL INFARCTION lycopene for, 408-409 pycnogenol for, 522-524 MYOCARDITIS astragalus for, 40-42 night-blooming cereus for, 460-462 myrica, 54-56 Myrica cerifera, 54-56 myristica, 462-465 Myristica fragrans, 462-465 Myroxylon balsamum, 45-46 Myroxylon pereirae, 45-46 myrrh, 328-330, 449-451 myrtle, 452-454 Myrtus communis, 452-454 mystyldene, 434-436 N nannyberry, 85-87 narcissus, 219-220 Narcissus pseudonarcissus, 219-220 nardo, 385-387 narrow dock, 605-606 narrowleaf plantago seed, 506-508 natural ecstacy, 245-249 NAUSEA anise for, 30-33 ginger for, 287-290 nutmeg for, 462-465 perilla for, 497-499 tonka bean for, 586-588 nectar of the gods, 281-285 neem, 455-457 Nepeta cataria, 147-149 Nerium odoratum, 471-473 Nerium oleander, 471-473 nerol, 78-80 nerveroot, 607-608 nettle, 457-459 NEUROPATHY anise for, 30-33 chitosan for, 175-176 dong quai for, 234-237 SAM-e for, 550-552 wintergreen for, 504-506, 598-599 New Zealand green-lipped mussel, 459-460 NICOTINE ADDICTION lobelia for, 402-404 oats for, 468-469 NIGHT BLINDNESS bilberry for, 70-73 grapeseed for, 316-318 night-blooming cereus, 460-462 nim, 455-457 nimba, 455-457 nine hooks, 384-385 ninjin, 294-297 nip, 147-149 niu she t’ou, 605-606 Noah’s ark, 607-608 nobleza gaucha, 608-610 noni, 439-441 northern prickly ash, 516-518 northern senega, 559-561 nosebleed, 263-265, 603-605 noz moscada, 462-465 nuez moscada, 462-465 nutgall, 466-467 nutmeg, 462-465 nux moschata, 462-465 nu zhen, 297-298 nuzhenzi, 297-298 NZGLM, 459-460 O oak, 466-467 oak apples, 466-467 oak bark, 466-467 oak galls, 466-467 oatmeal, 468-469 oats, 468-469 OBESITY chitosan for, 175-176 chromium for, 178-180 ephedra for, 245-249 glucomannan for, 299-301 guarana for, 325-328 guar gum for, 323-325 guggul for, 328-330 kelp for, 373-374 737 OBESITY (Continued) kelpware for, 375-376 khat for, 377-378 maitake for, 411-412 pineapple for, 503-504 spirulina for, 575-576 yerba maté for, 608-610 Ocimum basilicum, 50-52 Ocimum sanctum, 50-52 octacosanol, 470-471 14c-octacosanol, 470-471 I-octacosanol, 470-471 n-octacosanol, 470-471 octacosyl alcohol, 470-471 oderwort, 75-76 Oenotheraa biennis, 252-253 Ohio buckeye, 339-341 oii, 420-422 oil of carrot, 527-529 oil of cloves, 186-187 oil of wintergreen, 598-599 old man’s beard, 184-185 old man’s pepper, 603-605 old woman’s broom, 222-224 oleander, 471-473 oleum cari, 137-138 oleum carvi, 137-138 oleum caryophylli, 186-187 oleum majoranae (oii), 420-422 olibanum, 111-112 oman, 441-443 omega 3 fatty acids, 268-269 omega 3 oils, 268-269 omicha, 558-559 OPIATE WITHDRAWAL passionflower for, 484-486 opium poppy, 514-516 opobalsam, 45-46 opossum tree, 582-583 ORAL INFLAMMATION cloves for, 186-187 coltsfoot for, 197-199 ORAL PLAQUE bloodroot for, 95-97 cranberry for, 213-214 gum for, 249-251 neem for, 455-457 orange root, 308-311 oregano, 473-475 Oregon grape, 46-48, 475-477 Oregon yew, 612-613 Oriental ginseng, 294-297 origanum, 473-475 Origanum majorana L., 420-422 INDEX Index 738 Index Origanum vulgare, 473-475 oro verde, 608-610 ortie, 457-459 orvale, 182-184 oseille marron, 605-606 OSTEOARTHRITIS beta-carotene for, 63-64 boron for, 110-111 copper for, 204 glucosamine for, 301-302 New Zealand green-lipped mussel for, 459-460 SAM-e for, 550-552 OSTEOPOROSIS angelica for, 27-30 black cohosh for, 82-85 calcium for, 132-134 copper for, 204 DHEA for, 230-232 soy for, 572-574 osterick, 75-76 OTITIS MEDIA golden rod for, 306-308 pulsatilla for, 519-521 our lady’s key, 252-253 our lady’s keys, 211-212 our-lady’s-tears, 400-402 OXIDATIVE STRESS black pepper for, 89-91 cacao tree for, 130-132 chickweed for, 166-168 coenzyme Q10 for, 188-190 cranberry for, 213-214 elderberry for, 241-243 garlic for, 281-285 ginger for, 287-290 ginkgo for, 290-294 green tea for, 319-321 guarana for, 325-328 Iceland moss for, 349-350 kelpware for, 375-376 meadowsweet for, 427-429 melatonin for, 429-431 monascus for, 436-438 oak for, 466-467 oats for, 468-469 Oregon grape for, 46-48, 475-477 parsley for, 481-483 raspberry for, 534-536 red bush tea for, 538-539 safflower for, 545-547 sage for, 548-550 yerba maté for, 608-610 ox’s tongue, 107-110 P paan, 64-66 Padang cassia, 180-182 Padang cinnamon, 180-182 paddock pipes, 343-345 paigle, 211-212 PAIN, CANCER aconite for, 4-6 PAIN, GENERAL beth root for, 67-68 birch for, 73-74 bloodroot for, 95-97 bogbean for, 101-103 bugleweed for, 120-122 capsicum peppers for, 134-137 cloves for, 186-187 cinnamon for, 180-182 daisy for, 221-222 dong quai for, 234-237 fenugreek for, 260-263 ginkgo for, 290-294 golden rod for, 306-308 hops for, 334-337 indigo for, 350-352 kava for, 369-372 khat for, 377-378 lemongrass for, 392-393 myrrh for, 328-330, 449-451 nettle for, 457-459 nutmeg for, 462-465 poppy for, 514-516 rue for, 541-544 SAM-e for, 550-552 pale gentian, 285-287 palma Christi, 145-147 PALPITATIONS betony for, 68-70 glossy privet for, 297-298 motherwort for, 441-443 night-blooming cereus for, 460-462 palsywort, 211-212, 252-253 Panax ginseng, 294-297 Panax quinquefolis, 473-475 Panax quinquefolius, 294-297 pan masala, 64-66 pan parag, 64-66 pan peyote, 499-500 pansy, 478-479 papain, 479-481 Papaver bracteatum, 514-516 Papaver somniferum, 514-516 papaya, 479-481 papoose root, 97-99 paprika, 134-137 Paraguay tea, 608-610 PARASITE INFECTIONS pomegranate for, 510-512 quinine for, 530-532 parsley, 481-483 parsley breakstone, 483-484 parsley piercestone, 483-484 parsley piert, 483-484 partridgeberry, 598-599 pasania fungus, 393-395 pas dı´ane, 197-199 pasque flower, 519-521 Passiflora incarnata, 484-486 passionflower, 484-486 passion fruit, 484-486 passion vine, 484-486 password, 211-212 patience dock, 75-76 paucon, 95-97 pau d’arco, 487-488 Paullinia cupana, 325-328 Paullinia sorbilis, 325-328 Paul’s betony, 120-122 Pausinystalia yohimbe, 614-616 pauson, 95-97 pawpaw, 479-481 payadito, 608-610 peach, 489-490 peagle, 211-212 peagles, 252-253 pearl barley, 49-50 pectin, 491-492 pennyroyal, 492-494 pepe, 89-91 peper, 89-91 peppermint, 494-497 pepperridge bush, 46-48 pepperrot, 341-343 perilla, 497-499 Perilla frutescens L., 497-499 PERIODONTAL DISEASE coenzyme Q10 for, 188-190 cranberry for, 213-214 gotu kola for, 314-316 guggul for, 328-330 gum for, 249-251 quince for, 529-530 sage for, 548-550 Perna canaliculus, 459-460 pernambuco jaborandi, 355-357 Persian licorice, 395-399 Persian lilac, 455-457 personata, 122-125 Peruvian balsam, 45-46 Peruvian bark, 530-532 Petasites hybridus, 127-129 Petasites officinalis, 127-129 Petroselinum crispum, 481-483 pettigree, 125-127 petty mulleins, 211-212, 252-253 Peumus boldus, 103-105 pewterwort, 343-345 peyote, 499-500 peyote button, 499-500 pfeffer, 89-91 PHARYNGITIS eucalyptus for, 249-251 myrrh for, 328-330, 449-451 pokeweed for, 508-510 senega for, 559-561 philanthropium, 122-125 philanthropos, 9-12 philatron, 527-529 phi noi, 89-91 phu germanicum, 591-592 phu parvum, 591-592 physic root, 91-93 phytoestrogen, 12-15 Phytolacca americana, 508-510 pigeonberry, 508-510 pignut, 363-364 pikkukarpalo, 213-214 pill-bearing spurge, 501-502 Pilocarpus jaborandi, 355-357 Pilocarpus microphyllus, 355-357 Pilocarpus pinnatifolius, 355-357 pimenta, 15-17, 89-91 pimento, 15-17 Pimento officinalis, 15-17 pimiento, 134-137 Pimpinella anisum, 30-33 pinang, 64-66 pineal hormone, 429-431 pineapple, 503-504 pine bark, 522-524 pine pollen, 59-61 pinlag, 64-66 Pinus maritima, 522-524 Pinus nigra var. maritima, 522-524 Piper methysticum, 369-372 Piper nigrum, 89-91 pipperidge, 46-48 pipsissewa, 504-506 Piscidia erythrina, 357-359 pituri, 207-208 pjerets, 89-91 Plantago lanceolata, 506-508 Plantago major, 506-508 Plantago ovata, 506-508 Plantago psyllium, 506-508 plantain, 506-508 plantain seed, 506-508 plumrocks, 211-212 plumrocks password, 252-253 PMS; SEE PREMENSTRUAL SYNDROME PNEUMONIA American hellebore for, 22-24 barberry for, 46-48 lobelia for, 402-404 pocon, 508-510 Podophyllum peltatum, 424-426 poet’s marigold, 416-418 poison flag, 99-101 poivre, 89-91 pokeberry, 508-510 poke salad, 508-510 pokeweed, 508-510 policosanol, 470-471 pollen pini, 59-61 polygala root, 559-561 Polygala senega, 559-561 Polygonum bistorta, 75-76 Polygonum multiflorum, 273-274 pomegranate, 510-512 poor-man’s treacle, 281-285 poplar, 513-514 popotillo, 245-249 poppy, 514-516 poppyseed, 514-516 Populus alba, 513-514 Populus nigra, 513-514 Populus tremuloides, 513-514 porillon, 219-220 pot, 418-420 pot marigold, 416-418 739 potter’s piletabs, 9-12 prairie anemone, 519-521 PREMATURE EJACULATION angelica for, 27-30 PREMENSTRUAL SYNDROME (PMS) chaste tree for, 163-165 clary for, 182-184 dong quai for, 234-237 evening primrose oil for, 252-253 prickly ash, 516-518 pride of China, 455-457 priest’s crown, 224-227 Primula elatior, 252-253 Primula veris, 211-212 prince’s pine, 504-506 privet, 297-298 Probiata, 1-3 Probiotics, 1-3 procyanidol oligomers, 522-524 propolis, 518-519 propolis balsam, 518-519 propolis resin, 518-519 propolis wax, 518-519 PROSTATE CANCER beta-carotene for, 63-64 lycopene for, 408-409 nettle for, 457-459 saw palmetto for, 555-557 soy for, 572-574 PROSTATITIS bee pollen for, 59-61 chaste tree for, 163-165 couchgrass for, 209-210 horse chestnut for, 339-341 provitamin A, 63-64 Prunus persica, 489-490 Prunus serotina, 594-595 Prunus virginiana, 594-595 PRURITUS chickweed for, 166-168 figwort for, 265-268 goldenseal for, 308-311 pokeweed for, 508-510 PSEUDOALDOSTERONE SYNDROME licorice for, 395-399 PSORIASIS anise for, 30-33 capsicum peppers for, 134-137 chaulmoogra oil for, 165-166 INDEX Index 740 Index PSORIASIS (Continued) chickweed for, 166-168 figwort for, 265-268 fumitory for, 274-276 gamma linolenic acid for, 278-280 gotu kola for, 314-316 jaborandi for, 355-357 jojoba for, 363-364 licorice for, 395-399 oak for, 466-467 Oregon grape for, 46-48, 475-477 pau d’arco for, 487-488 peach for, 489-490 yellow dock for, 605-606 psyllium, 506-508 pudding grass, 492-494 Pueraria lobata, 381-383 puffball, 224-227 puhuang, 59-61 pukeweed, 402-404 Pulmonaria officinalis, 406-408 pulsatilla, 519-521 pumpkin, 521-522 pumpkinseed, 521-522 Punica granatum, 510-512 pure thymic extract, 585-586 purging buckthorn, 118-120 purple coneflower, 238-241 purple lapacho, 487-488 purple medic, 12-15 purple medick, 12-15 purple passion flower, 484-486 purple trillium, 67-68 pycnogenol, 522-524 pygeum, 524-526 Pygeum africanum, 524-526 Q qingdai, 350-352 quack grass, 209-210 Quaker bonnet, 567-569 quaking aspen, 513-514 quebrachine, 614-616 Queen Anne’s lace, 527-529 queen of the meadow, 427-429 queen of the night, 460-462 queensland asthmaweed, 501-502 Quercus alba, 466-467 quercus marina, 375-376 Quercus petraea, 466-467 Quercus robur, 466-467 quickset, 332-334 quince, 529-530 quinine, 530-532 quitch grass, 209-210 quitel, 91-93 R raccoon berry, 424-426 race ginger, 287-290 RADIATION EXPOSURE Siberian ginseng for, 565-567 radix, 588-590 ragweed, 533-534 ragwort, 533-534 rape pollen, 59-61 rapuntium inflatum, 402-404 RASH anise for, 30-33 chickweed for, 166-168 raspberry, 534-536 rattleroot, 82-85 rattlesnake, 257-258 rattlesnake root, 67-68, 559-561 rattleweed, 82-85 Rauvolfia serpentina, 536-538 rauwolfia, 536-538 red bush tea, 538-539 red cole, 341-343 red elm, 569-571 red eyebright, 254-256 red gum, 249-251, 582-583 redink plant, 508-510 red lapacho, 487-488 red pepper, 134-137 red puccoon, 95-97 red raspberry, 534-536 red rice yeast, 436-438 redroot, 95-97 red squill, 577-578 red sunflower, 238-241 red valerian, 588-590 redwood, 508-510 red yeast rice, 436-438 RENAL CALCULI betony for, 68-70 birch for, 73-74 centaury for, 156-158 couchgrass for, 209-210 cranberry for, 213-214 eucalyptus for, 249-251 golden rod for, 306-308 horsetail for, 343-345, 373-374 RENAL CALCULI (Continued) lovage for, 404-406 oak for, 466-467 Oregon grape for, 46-48, 475-477 parsley piert for, 483-484 raspberry for, 534-536 RENAL FAILURE Chinese rhubarb for, 172-174 gum for, 249-251 resina tolutana, 45-46 resin tolu, 45-46 Rhamnus cathartica, 118-120 Rhamnus purshiana, 143-145 rhei radix, 172-174 rhei rhizoma, 172-174 RHEUMATISM bay for, 52-54 blue cohosh for, 97-99 borage for, 107-110 buchu for, 116-118 couchgrass for, 209-210 ginger for, 287-290 lemongrass for, 392-393 peyote for, 499-500 prickly ash for, 516-518 yerba santa for, 610-612 rheumatism root, 596-597 RHEUMATOID ARTHRITIS evening primrose oil for, 252-253 fish oils for, 268-269 gamma linolenic acid for, 278-280 lysine for, 409-410 thymus extract for, 585-586 Rheum palmatum, 172-174 ribwort, 506-508 Ricinum communis, 145-147 ripple grass, 506-508 rockberry, 56-59 rock parsley, 481-483 rock poppy, 152-153 rokan, 290-294 Roman chamomile, 158-160 Roman laurel, 52-54 Roman motherwort, 441-443 Roman myrtle, 452-454 rooibois tea, 538-539 root bark, 552-554 Rosa canina, 540-541 rosa francesa, 471-473 rosa laurel, 471-473 rosamonte, 608-610 rose bay, 471-473 rose hips, 540-541 rosemary, 222-224 rose-noble, 265-268 rosin rose, 579-582 roxo, 487-488 royal jelly, 59-61 rubarbo, 172-174 Rubus idaeus, 534-536 rudbeckia, 238-241 rue, 541-544 ruibarbo caribe, 439-441 rum cherry, 594-595 Rumex acetosa, 571-572 Rumex crispus, 605-606 Ruscus aculeatus, 125-127 Russian licorice, 395-399 Russian penicillin, 518-519 rustic treacle, 281-285 rutae herba, 541-544 Ruta graveolens, 541-544 S sabal, 555-557 Sabul serrulata, 555-557 Saccharomyces cerevisiae, 112-113 sacred bark, 143-145 sacred herb, 610-612 sadilata, 24-26 safflower, 545-547 saffron, 547-548 safira, 608-610 sage, 548-550 Saigon cassia, 180-182 Saigon cinnamon, 180-182 sailor’s tobacco, 443-445 St. Benedict thistle, 93-95 St. James wort, 533-534 St. John’s plant, 443-445 St. John’s wort, 579-582 St. Josephwort, 50-52 St. Mary thistle, 432-434 sakau, 369-372 SALMONELLA INFECTIONS bearberry for, 56-59 cloves for, 186-187 goldenseal for, 308-311 saloop, 552-554 salsifly, 199-201 Salvia officinalis, 548-550 Salvia sclarea, 182-184 Sambucus canadensis, 241-243 Sambucus nigra, 241-243 SAM-e, 550-552 samento, 149-151 sampson root, 238-241 Sanguinaria canadensis L., 95-97 sanguinary, 603-605 Santa Maria, 263-265 Santonica, 601-602 sarothamni herb, 114-116 Sarothamnus scoparius, 114-116 sassafras, 552-554 Sassafras albidum, 552-554 sassafrasholz, 552-554 satinflower, 166-168 Satureja hortensis L., 554-555 savory, 554-555 saw palmetto, 555-557 saxifras, 552-554 SCABIES anise for, 30-33 balsam of Peru for, 45-46 chaulmoogra oil for, 165-166 fumitory for, 274-276 yellow dock for, 605-606 scabwort, 243-245 scarlet sage, 548-550 schinsent, 294-297 schisandra, 558-559 Schisandra chinesis, 558-559 schizandra, 558-559 SCHIZOPHRENIA betel palm for, 64-66 scilla, 577-578 scoke, 508-510 scotch barley, 49-50 Scotch broom, 114-116 Scotch broom top, 114-116 Scotch quelch, 209-210 scouring rush, 343-345 scrofula plant, 265-268 Scrophularia ningpoensis, 265-268 Scrophularia nodosa, 265-268 scrub palm, 555-557 scullcap, 567-569 scurvy root, 238-241 Scutellaria baicalensis, 567-569 Scutellaria laterifolia, 567-569 sea girdles, 373-374 sea grape, 245-249 sea-oak, 375-376 741 sea onion, 577-578 sea parsley, 404-406 sea squill, 577-578 seaweed, 373-374 seaweed gelatin, 6-8 sea wormwood, 601-602 sea wrack, 375-376 see bright, 182-184 seetang, 375-376 SEIZURE DISORDERS American hellebore for, 22-24 betony for, 68-70 blue cohosh for, 97-99 celery for, 154-156 ginseng for, 294-297 mistletoe for, 434-436 mugwort for, 443-445 pipsissewa for, 504-506 skullcap for, 567-569 Selagine, 345-346 Selenicereus grandiflorus, 460-462 semen cinae, 601-602 semen sanctum, 601-602 seneca, 559-561 seneca root, 559-561 seneca snakeroot, 559-561 Senecio jacoboea, 533-534 senega, 559-561 senega root, 559-561 senega snakeroot, 559-561 seneka, 559-561 senna, 561-563 Senna alexandrina, 561-563 sent and sang, 294-297 Serenoa repens, 470-471, 555-557 setewale, 591-592 setwell, 591-592 Seville orange, 78-80 SEXUALLY TRANSMITTED DISEASES Oregon grape for, 46-48, 475-477 pau d’arco for, 487-488 pill-bearing spurge for, 501-502 shark cartilage, 564-565 shave grass, 343-345 sheepberry, 85-87 shelf fungi, 411-412 shield fern, 412-414 shigoka, 565-567 shiiitake mushroom, 393-395 INDEX Index 742 Index shonny, 85-87 Siam benzoin, 61-62 Siberian ginseng, 565-567 sicklewort, 120-122 silver bells, 85-87 Silybum marianum, 432-434 Simmondsia californica, 363-364 Simmondsia chinesis, 363-364 sinsemilla, 418-420 SINUSITIS andrographis for, 24-26 elderberry for, 241-243 eucalyptus for, 249-251 horseradish for, 341-343 thymus extract for, 585-586 SKIN CANCER bloodroot for, 95-97 SKIN DISORDERS angelica for, 27-30 barberry for, 46-48 beth root for, 67-68 clematis for, 184-185 elderberry for, 241-243 marigold for, 416-418 marshmallow for, 422-424 oats for, 468-469 oleander for, 471-473 senega for, 559-561 slippery elm for, 569-571 yarrow for, 603-605 SKIN ULCERS bayberry for, 54-56 echinacea for, 238-241 fenugreek for, 260-263 ragwort for, 533-534 skullcap, 567-569 SLEEP DISORDERS skullcap for, 567-569 slippery elm, 569-571 slippery root, 199-201 sloe, 85-87 smallage, 154-156 smellage, 404-406 smell fox, 519-521 smooth cayenne, 503-504 snakeberry, 593-594 SNAKEBITE andrographis for, 24-26 beth root for, 67-68 bistort for, 75-76 marjoram for, 420-422 mayapple for, 424-426 SNAKEBITE (Continued) pau d’arco for, 487-488 peyote for, 499-500 pill-bearing spurge for, 501-502 rauwolfia for, 536-538 rue for, 541-544 senega for, 559-561 snake bite, 67-68 snake butter, 393-395 snake lily, 99-101 snakeroot, 75-76, 238-241, 536-538 snakeweed, 75-76, 506-508 snake weed, 501-502 snapping hazel, 599-601 sneezewort, 35-37 socotrine aloe, 18-22 soldier’s cap, 4-6 soldier’s woundwort, 603-605 Solidago virgaurea, 306-308 Somali myrrin, 449-451 songhaufen, 59-61 sophium, 290-294 SORE THROAT agrimony for, 9-12 avens for, 42-44 betel palm for, 64-66 chickweed for, 166-168 clary for, 182-184 goldenseal for, 308-311 gum for, 249-251 hyssop for, 346-348 karaya gum for, 368-369 mallow for, 415-416 marshmallow for, 422-424 pokeweed for, 508-510 quince for, 529-530 raspberry for, 534-536 sage for, 548-550 storax for, 582-583 yellow dock for, 605-606 sorrel, 571-572 sour dock, 571-572, 605-606 sour orange, 78-80 sour sop, 318-319 sour-spine, 46-48 southernwood root, 140-141 sowberry, 46-48 soy, 572-574 soya, 572-574 soybean, 572-574 soy lecithin, 572-574 Spanish lavender, 385-387 Spanish licorice, 395-399 Spanish psyllium, 506-508 Spanish saffron, 547-548 SPASTICITY butterbur for, 127-129 Sphyrna lewini, 564-565 spicebush, 54-56 spierstaude, 427-429 spigo, 385-387 spike lavender, 385-387 Spiraea ulmaria, 427-429 spirulina, 575-576 Spirulina spp., 575-576 spotted alder, 599-601 spotted comfrey, 406-408 spotted thistle, 93-95 spotted wintergreen, 504-506 Squalus acanthias, 564-565 square stalk, 265-268 squawbalm, 492-494 squawmint, 492-494 squawroot, 533-534 squaw root, 67-68, 82-85, 97-99 squaw tea, 245-249 squaw weed, 533-534 squill, 577-578 Stachys officinalis L., 68-70 stagbush, 85-87 staggerwort, 533-534 stammerwort, 533-534 stanchgrass, 603-605 STAPHYLOCOCCUS INFECTIONS barberry for, 46-48 bearberry for, 56-59 black pepper for, 89-91 burdock for, 122-125 carline thistle for, 140-141 clary for, 182-184 cola tree for, 193-196 goldenseal for, 308-311 Iceland moss for, 349-350 lentinan for, 393-395 licorice for, 395-399 marigold for, 416-418 pau d’arco for, 487-488 tea tree oil for, 584-585 star chickweed, 166-168 starflower, 107-110 star-leaved gum, 582-583 starweed, 166-168 starwort, 257-258 stechapfel, 360-363 stellaria, 384-385 Stellaria media, 166-168 stemless carline root, 140-141 stemless gentian, 285-287 sterculia gum, 368-369 Sterculia spp., 368-369 Sterculia urens, 368-369 sticklewort, 9-12 stickwort, 9-12 stinging nettle, 457-459 stinking benjamin, 67-68 stinking christopher, 265-268 stinking nanny, 533-534 stinking rose, 281-285 stinkweed, 360-363 stitchwort, 166-168 STOMACH CANCER celandine for, 152-153 lycopene for, 408-409 stone oak, 466-467 stor, 519-521 storax, 582-583 stramoine, 360-363 STREPTOCOCCUS INFECTIONS barberry for, 46-48 bearberry for, 56-59 echinacea for, 238-241 goldenseal for, 308-311 Iceland moss for, 349-350 lentinan for, 393-395 licorice for, 395-399 mugwort for, 443-445 neem for, 455-457 propolis for, 518-519 stringy bark tree, 249-251 Styrax benzoin, 61-62 Styrax paralleloneurus, 61-62 Styrax tonkinesis, 61-62 succory, 168-170 su ferasyunu, 120-122 sugar wrack, 373-374 Sumatra benzoin, 61-62 summer savory white thyme, 554-555 supai, 64-66 Superdophilus, 1-3 surale di bierdji, 605-606 swallow wort, 152-153 swamp hellebore, 22-24 sweating plant, 105-107 sweet balm, 389-391 sweet basil, 50-52 sweet bay, 52-54 sweet birch oil, 73-74 sweet brake, 412-414 sweet brieg, 540-541 sweet broom, 125-127 sweet coltsfoot, 127-129 sweet cumin, 30-33 sweet elder, 241-243 sweet elm, 569-571 sweet false chamomile, 158-160 sweet fennel, 258-260 sweet gum tree, 582-583 sweet haw, 85-87 sweet marjoram, 420-422 sweet Mary, 389-391 sweet oak, 54-56 sweet root, 395-399 sweet-scented cactus, 460-462 sweet slumber, 95-97 sweet viburnum, 85-87 sweetweed, 422-424 swine snout, 224-227 Symphytum officinale, 199-201 SYPHILIS castor for, 145-147 condurango for, 202-204 Syzygium aromaticum, 186-187 Syzygium cuminii, 359-360 T tabasco pepper, 134-137 Tabebuia impetiginosa, 487-488 taheebo, 487-488 tajibo, 487-488 talepetrako, 314-316 tallow shrub, 54-56 tall speed-well, 91-93 tanakan, 290-294 tangantangan oil plant, 145-147 tanggwi, 234-237 tang-kuei, 234-237 tangleweed, 373-374 tanner’s bark, 466-467 TAPEWORMS male fern for, 412-414 pumpkin for, 521-522 Taraktogenos kurzii, 165-166 Taraxacum laevigatum, 224-227 Taraxacum officinale, 224-227 tartar root, 294-297 tarweed, 610-612 Tasmanian blue gum, 249-251 Taxus baccata, 612-613 Taxus brevifolia, 612-613 teaberry, 598-599 teamster’s tea, 245-249 tea tree, 584-585 743 tea tree oil, 584-585 tebofortan, 290-294 tebonin, 290-294 teca, 314-316 tecuitlatl, 575-576 tetterwort, 95-97 tetter wort, 152-153 thebaine poppy, 514-516 Theobroma cacao, 130-132 theriacaria, 591-592 Thomas balsam, 45-46 thorn apple, 360-363 thorn-apple tree, 332-334 thorny burr, 122-125 thoroughwort, 105-107 thousand-leaf, 603-605 three-leafed trillium, 67-68 throatwort, 265-268 THROMBOSIS nutmeg for, 462-465 throwwort, 441-443 thymomodulin, 585-586 thymosin, 585-586 thymus, 585-586 thymus extract, 585-586 thymus factor, 585-586 thymus polypeptides, 585-586 tia-hua-fen, 170-172 tickweed, 492-494 tinnevelly senna, 561-563 TJN-101, 558-559 toadpipe, 343-345 tobacco wood, 599-601 toge-banreist, 318-319 toki, 234-237 tolguacha, 360-363 tom rong, 280-281 tonga, 369-372 tongue grass, 166-168 tonka bean, 586-588 tonka seed, 586-588 tonquin bean, 586-588 TOOTHACHE cloves for, 186-187 elderberry for, 241-243 nutmeg for, 462-465 toothache tree, 516-518 torquin bean, 586-588 touch-me-not, 565-567 toute-bonne, 182-184 trackleberry, 70-73 tract plant, 506-508 tragacanth, 40-42 trailing mahonia, 46-48 traveller’s joy, 184-185 tree sage, 548-550 INDEX Index 744 Index TRICHOMONAS INFECTIONS agrimony for, 9-12 barberry for, 46-48 chaulmoogra oil for, 165-166 Trichosanthes kirilowii, 170-172 trigonella, 260-263 Trigonella foenumgraecum, 260-263 Trillium erectum, 67-68 Trillium grandiflorum, 67-68 trillium pendulum, 67-68 triticum, 209-210 Triticum repens L., 209-210 true chamomile, 158-160 true lavender, 385-387 true saffron, 547-548 true sage, 548-550 trumpet bush, 487-488 trumpet lily, 360-363 trumpet tree, 487-488 tschut, 377-378 TUBERCULOSIS barberry for, 46-48 elecampane for, 243-245 goldenseal for, 308-311 horehound for, 337-339 Iceland moss for, 349-350 nettle for, 457-459 TUMORS agrimony for, 9-12 burdock for, 122-125 chaparral for, 160-162 Chinese cucumber for, 170-172 clary for, 182-184 condurango for, 202-204 couchgrass for, 209-210 dandelion for, 224-227 ginseng for, 294-297 lavender for, 385-387 marigold for, 416-418 mayapple for, 424-426 motherwort for, 441-443 myrrh for, 328-330, 449-451 pycnogenol for, 522-524 Siberian ginseng for, 565-567 skullcap for, 567-569 soy for, 572-574 spirulina for, 575-576 yarrow for, 603-605 Turkish rhubarb, 172-174 turmeric, 588-590 turmeric root, 308-311 Tussilago farfara, 197-199 Tussilago petasites, 127-129 twice writhen, 75-76 twitch-grass, 209-210 txiu kub nyug, 508-510 typha pollen, 59-61 U ubidecarenone, 188-190 ubiquinone, 188-190 ukon, 588-590 ULCERATIVE COLITIS bistort for, 75-76 boswellia for, 111-112 cat’s claw for, 149-151 chamomile for, 158-160 dandelion for, 224-227 gentian for, 285-287 lemon balm for, 389-391 ULCERS ginger for, 287-290 meadowsweet for, 427-429 Ulmus fulva, 569-571 Ulmus rubra, 569-571 umbrella leaves, 127-129 umbrella plant, 424-426 una de gato, 149-151 Uncaria guianensis, 149-151 Uncaria tomentosa, 149-151 union, 608-610 upland cotton, 311-313 UPPER RESPIRATORY CONGESTION angelica for, 27-30 anise for, 30-33 benzoin for, 61-62 beth root for, 67-68 bloodroot for, 95-97 boneset for, 105-107, 199-201 cardamom for, 138-140 chickweed for, 166-168 Chinese cucumber for, 170-172 cinnamon for, 180-182 coffee for, 190-193 daffodil for, 219-220 elecampane for, 243-245 ephedra for, 245-249 horehound for, 337-339 hyssop for, 346-348 lobelia for, 402-404 lovage for, 404-406 lungwort for, 406-408 mullein for, 445-447 UPPER RESPIRATORY CONGESTION (Continued) mustard for, 447-449 myrrh for, 328-330, 449-451 myrtle for, 452-454 nettle for, 457-459 Oregon grape for, 46-48, 475-477 pansy for, 478-479 storax for, 582-583 yerba santa for, 610-612 UPPER RESPIRATORY INFECTIONS betel palm for, 64-66 cinnamon for, 180-182 coltsfoot for, 197-199 couchgrass for, 209-210 mullein for, 445-447 nettle for, 457-459 perilla for, 497-499 pokeweed for, 508-510 schisandra for, 558-559 senega for, 559-561 wild cherry for, 154-156, 594-595 yarrow for, 603-605 Urginea maritima, 577-578 URINARY TRACT INFECTIONS acidophilus for, 1-3 bearberry for, 56-59 buchu for, 116-118 couchgrass for, 209-210 cranberry for, 213-214 eucalyptus for, 249-251 juniper for, 364-366 meadowsweet for, 427-429 mullein for, 445-447 myrtle for, 452-454 nettle for, 457-459 parsley piert for, 483-484 plantain for, 506-508 poplar for, 513-514 pygeum for, 524-526 raspberry for, 534-536 yarrow for, 603-605 UROLITHIASIS couchgrass for, 209-210 dandelion for, 224-227 oak for, 466-467 urtica, 457-459 Urtica dioica, 457-459 UTERINE BLEEDING bayberry for, 54-56 chaste tree for, 163-165 UTERINE SPASMS black cohosh for, 82-85 black haw for, 85-87 blue cohosh for, 97-99 broom for, 114-116 Chinese cucumber for, 170-172 kelp for, 373-374 UTERINE MYOMA peach for, 489-490 uva-ursi, 56-59 V Vaccinium erythrocarpum, 213-214 Vaccinium macrocarpon, 213-214 Vaccinium myrtillus, 70-73 Vaccinium oxycoccus, 213-214 valerian, 591-592 valeriana, 591-592 Valeriana officinalis, 591-592 vanilla cactus, 460-462 VARICOSE VEINS beth root for, 67-68 bilberry for, 70-73 butcher’s broom for, 125-127 gotu kola for, 314-316 horse chestnut for, 339-341 marigold for, 416-418 oak for, 466-467 witch hazel for, 599-601 vegetable antimony, 105-107 vegetable gelatin, 6-8 vegetable marrow, 521-522 vegetable tallow, 54-56 vegetarian gelatin, 6-8 velvet dock, 243-245 Venezuela aloe, 18-22 VENOUS INSUFFICIENCY butcher’s broom for, 125-127 VENOUS STASIS ULCERS marigold for, 416-418 myrrh for, 328-330, 449-451 pipsissewa for, 504-506 VENOUS THROMBOSIS chondroitin for, 176-178 motherwort for, 441-443 nutmeg for, 462-465 Veratrum viride, 22-24 Verbasci flos, 445-447 Verbascum thapsus, 445-447 Veronica, 91-93 Veronicastrum virginicum, 91-93 Veronica virginica, 91-93 Viburnum opulus, 85-87 Viburnum prunifolium, 85-87 vine bower, 184-185 vinruta, 541-544 Viola tricolor, 478-479 VIRAL INFECTIONS brewers yeast for, 112-113 barberry for, 46-48 cardamom for, 138-140 echinacea for, 238-241 lemon balm for, 389-391 lentinan for, 393-395 mugwort for, 443-445 mullein for, 445-447 peppermint for, 494-497 pokeweed for, 508-510 pomegranate for, 510-512 poplar for, 513-514 propolis for, 518-519 St. John’s wort for, 579-582 spirulina for, 575-576 witch hazel for, 599-601 Virginia poke, 508-510 Virginia prune, 594-595 Viscum album, 434-436 visnagin, 379-381 VISUAL DEFICITS bilberry for, 70-73 grapeseed for, 316-318 vitamin B9, 272-273 vitamin B17, 489-490 vitellin, 387-389 Vitex agnus castus, 163-165 Vitis vinifera, 316-318 vizra ufar, 24-26 VOMITING black root for, 91-93, 199-201 ginger for, 287-290 lemongrass for, 392-393 lobelia for, 402-404 nutmeg for, 462-465 perilla for, 497-499 tonka bean for, 586-588 vomitroot, 402-404 vomitwort, 402-404 W wake-robin, 67-68 wallwort, 199-201 745 WARTS mayapple for, 424-426 oleander for, 471-473 peach for, 489-490 wart wort, 152-153 water bugle, 120-122 water flag, 99-101 water horehound, 120-122 water lemon, 484-486 water pennywort, 314-316 water shamrock, 101-103 waxberry, 54-56 wax dolls, 274-276 wax myrtle, 54-56 way bennet, 42-44 way-bread, 506-508 waythorn, 118-120 weed, 418-420 weeping ash, 39-40 western coltsfoot, 127-129 Western ginseng, 294-297 western yew, 612-613 West Indian dogwood, 357-359 whinberry, 70-73 whippoorwill’s shoe, 607-608 white ash, 39-40 white birch, 73-74 white bird’s eye, 166-168 white cohosh, 593-594 white endive, 224-227 white gum, 582-583 white horehound, 337-339 white man’s root, 506-508 white mustard, 447-449 white poplar, 513-514 white squill, 577-578 whitethorn, 332-334 WHOOPING COUGH butterbur for, 127-129 elecampane for, 243-245 horehound for, 337-339 horseradish for, 341-343 pansy for, 478-479 whortleberry, 70-73 wild angelica, 27-30 wild barley, 49-50 wild brier berries, 540-541 wild carrot, 527-529 wild chamomile, 158-160, 263-265 wild cherry, 154-156, 594-595 wild coleus, 497-499 wild cotton, 311-313 wild cucumber, 217-218 wild curcuma, 308-311 wild daisy, 221-222 INDEX Index 746 Index wild endive, 224-227 wild fennel, 258-260 wild gobo, 122-125 wild iris, 99-101 wild lemon, 424-426 wild mandrake, 424-426 wild mustard, 447-449 wild oats, 468-469 wild pansy, 478-479 wild pine, 439-441 wild plantain, 506-508 wild quinine, 263-265 wild rye, 42-44 wild saso, 506-508 wild succory, 168-170 wild sunflower, 243-245 wild wormwood, 443-445 wild yam, 596-597 wind flower, 519-521 winterbloom, 599-601 wintergreen, 504-506, 598-599 winterweed, 166-168 witches brier, 540-541 witches’ herb, 579-582 witch grass, 209-210 witch hazel, 599-601 wolfsbane, 4-6 wolf’s bane, 35-37 women’s ginseng, 234-237 wonder tree, 145-147 wood avens, 42-44 wood betony, 68-70 woodbine, 184-185 wood sour, 46-48 wood spider, 228-230 wormseed, 601-602 wort, 443-445 WOUNDS, SUPERFICIAL aloe for, 18-22 balsam of Peru for, 45-46 bayberry for, 54-56 benzoin for, 61-62 betony for, 68-70 carline thistle for, 140-141 chamomile for, 158-160 chickweed for, 166-168 WOUNDS, SUPERFICIAL (Continued) cola tree for, 193-196 comfrey for, 199-201 condurango for, 202-204 copper for, 204 daffodil for, 219-220 echinacea for, 238-241 elderberry for, 241-243 fenugreek for, 260-263 figwort for, 265-268 goldenseal for, 308-311 gotu kola for, 314-316 horsetail for, 343-345, 373-374 kava for, 369-372 lady’s mantle for, 384-385 lavender for, 385-387 lungwort for, 406-408 myrrh for, 328-330, 449-451 parsley piert for, 483-484 pau d’arco for, 487-488 pineapple for, 503-504 pipsissewa for, 504-506 plantain for, 506-508 propolis for, 518-519 raspberry for, 534-536 rose hips for, 540-541 slippery elm for, 569-571 tea tree oil for, 584-585 yarrow for, 603-605 woundwort, 306-308 wunderbaum, 145-147 wurmfarn, 412-414 wu-wei-zu, 558-559 wymote, 422-424 X xue zhi kang, 436-438 Y yagona, 369-372 yarrow, 603-605 YEAST INFECTIONS allspice for, 15-17 buchu for, 116-118 YEAST INFECTIONS (Continued) chaulmoogra oil for, 165-166 dill for, 232-234 lemon balm for, 389-391 tea tree oil for, 584-585 yellow astringent, 245-249 yellow dock, 605-606 yellow gentian, 285-287 yellow ginseng, 97-99 yellow horse, 245-249 yellow Indian shoe, 607-608 yellow lady’s slipper, 607-608 Yellow Leader, 40-42 yellow paint, 308-311 yellow puccoon, 308-311 yellow root, 308-311 yellow wood, 516-518 Yemen myrrh, 449-451 yerba maté, 608-610 yerba santa, 610-612 yew, 612-613 yi-yi, 608-610 yogurt, 1-3 yohimbe, 614-616 yohimbehe, 614-616 yohimbene, 614-616 yohimbime, 614-616 yohimbine, 614-616 yoshu-nezu, 364-366 Z zaffer, 545-547 zaffron, 547-548 Zanthoxylum americanum, 516-518 Zanzibar aloe, 18-22 zerboni, 608-610 zhi tai, 436-438 zhong ma huang, 245-249 zigbii, 415-416 zimbro, 364-366 zingiber, 287-290 Zingiber officinale, 287-290 zombie’s cucumber, 360-363 zoom, 325-328 Pregnancy Categories Category 1 No proven increase in the frequency of malformation or other harmful effects on the fetus despite consumption by a large number of women. Category 2 No increase in frequency of malformation or other harmful effects on the fetus from limited use in women. No evidence of increased fetal damage in animal studies. Category 3 No increase in frequency of malformation or other harmful effects on the fetus from limited use in women. Animal studies are lacking. Category 4 No increase in frequency of malformation or other harmful effects on the fetus from limited use in women. Evidence of increased fetal damage in animal studies exists, although the relevance to humans in unknown. Category 5 Has caused or is associated with a substantial risk of causing harmful effects on the fetus or neonate without causing malformations. These effects may be reversible. Category 6 Has caused or is associated with a substantial risk of causing fetal malformation or irreversible damage. Category 7 High risk of damage to the fetus. Source: Therapeutic Goods Administration, Australian Drug Evaluation: Prescribing medicines in pregnancy: an Australian categorisation of risk of drug use in pregnancy, ed 4, 1999, Commonwealth of Australia. Copyright Commonwealth of Australia. Reproduced by permission. In Mills S, Bone, K: The Essential Guide to Herbal Safety, London, 2005, Churchill Livingstone.