herb304_January2011v4.pdf

Herb 304 Herbal Materia Medica III Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 2 Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 3 P L EAS E N O T E The information in this course is not intended to take the place of diagnosis and treatment by a qualified licensed healthcare provider. Any recommendations are for educational purposes only and are believed to be effective. However, since use of any material by others is beyond the control of the American College of Healthcare Sciences, no expressed or implied guarantee as to the effectiveness of this information can be given nor liability taken. LAS T R E V IS I O N This ACHS Textbook was last edited and revised January 2011. COP Y R I GH T N O T IC E Copyright © 2002-2011 This material must not be reproduced in any way without the written permission of the President of American College of Healthcare Sciences, 5940 SW Hood Avenue, Portland, OR 97239 United States. Telephone (800) 48- STUDY or (503) 244-0726; fax (503) 244- 0727; email achs@achs.edu; on the Web at www.achs.edu Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 4 Table of Contents PLEASE NOTE.......................................3 LAST REVISION....................................3 COPYRIGHT NOTICE..........................3 Table of Contents .................................4 Welcome.................................................8 Learning Goals ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Recom mended Re ading .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 O ptional Study Kit .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 C o urse Structure .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 O nline Interaction .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1 Interaction with Other ACHS Stud ents and Graduates with MyACHS Connect .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 C o ntacting ACHS... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 Study Time .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Practical Exper ience .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 C o m pletion .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Accreditation .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 About the Author .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 6 C o ntributing Fa culty ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 7 Program Stru cture .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 O ne Final Note .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1 Module One..........................................22 Actaea racemosa (formerly Cimicifuga racemosa) 23 Alchemilla spp. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 8 A n gelica archan gelica .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 A n gelica sinensis .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 A pium graveo lens .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Arnica montana .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 5 A stragalus memb ranaceus ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1 A s sessment Stru cture .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 8 Module Assessment .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 2 Module Two......................................... 73 B u pleurum ch inense .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Capsella bursa-p astoris ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 7 Centella asiatica (sy n o n y m Hydrocotyle asiatica) . 8 2 C hamaelirium luteum .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 7 C hio nanthus vi rginicus .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 C hrysanthemum pa rthenium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Module Assessment .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 6 Module Three...................................... 97 Cinnamo m u m spp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 8 C nicus bene dictus .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Eleutherococcus senticosu s (s y n o n y m Acanthopanax senticosu s and Hedera senticosa) ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1 1 Elym u s repens (also kn o w n as Agro pyron repens and Elytrigia repens) 12 1 E q uisetum arv ense L. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 5 E schscholzia ca lifornica .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Module Assessment .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 Module Four ...................................... 135 E u patorium per foliatum ? ? ? ? ? ? ? ? ? . . . . 136 Eupatorium pur pureum .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 F oeniculum vu lgare.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 F ucus vesicu losis .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 5 1 Ganoderma lu cidum .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 5 6 G o s s y pium hi rsutum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 6 5 Module Assessment .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 70 Module Five ....................................... 171 Grindelia spp. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 7 2 G y m nema syl vestre .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 7 7 Harpagop h ytum pr ocumbens .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 8 2 Hydrangea arbo rescens .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 90 Iris versicolor .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 9 5 Laminaria di gitata .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200 Lentinus ed odes ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208 Module Assessment .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 13 Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 6 Module Six ......................................... 214 Ligu sticum po rteri .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1 5 L ycopu s virg inicus .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 20 Mahonia aquifolia (formerly Berberis aquifolia) .. 2 2 5 Nasturtium o fficinale.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231 Ocimum basilicum .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236 Panax ginseng (s y n o n y m Panax schi nseng) . . . . . . . . . . . 242 Panax quinq uefo lius . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 5 5 Module Assessment .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 6 2 Module Seven .................................... 263 Piper methys ticum .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 64 P o p ulus balsam ifera .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 74 Prunu s sero tina .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 80 P ueraria montana var. loba ta .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 8 6 R h odiola rosea.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 94 R o s marinus o fficinalis ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302 Module Assessment .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310 Module Eight ..................................... 311 R u mex acetosa .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 312 Sambucus cana densis .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318 Sambucus ni gra .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323 Serenoa re pens .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331 Trigonella foenum graecu m ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339 Trillium erectum .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 348 Module Assessment .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 352 Module Nine ...................................... 353 T urnera diffu sa (sy n o n y m s Damiana aphr odisiaca, Turnera aphrodisiaca, and Turnera micro phylla) ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 354 T u s silago farfara .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359 U ncaria tomentosa .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365 Vaccinium macro carpon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378 Vaccinium m yrtillus .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385 Module Assessment .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 392 Module Ten........................................ 393 Verbena offi cinalis ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 394 Viburnum o pulus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 401 Viburnum pruni folium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405 Vitex agnu s -c astus .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 409 Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 7 Withania som nifera .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417 Zea mays .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 432 Module Assessment .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 436 Exam Information ............................ 437 Resources........................................... 438 C o n version s and Equivalent s ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 438 Glossary ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 438 O nline Resources ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 438 Index ................................................... 439 Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 8 Introduction Welcome On behalf of the staff and faculty of American College of Healthcare Sciences, please accept our warmest welcome. We are delighted that you have chosen to study this specially written distance-learning course, demonstrating your commitment to the fascinating and fast-growing natural health industry. This distance-learning course is intended to be a dynamic program that is updated frequently as the industry and research on natural health change. This course is distance learning at a practical, how-to level. Be sure to download and read your ACHS Program Catalog for study guidance and tips. We wish you every success with this course. Do not hesitate to call to discuss any aspect of your course with your instructors or your Student Services team. Learning Goals This course is a component of the Master Herbalist Diploma Program. It is designed to help you achieve the following goals. At the completion of this course, you will be able to: ? Identify the major active constituents and their therapeutic actions of the herbs studied; ? Describe appropriate cautions and contraindications for the herbs studied, including potential herb/drug interactions; ? Describe historical uses of the herbs studied; ? Find and discuss current research on therapeutic uses of the herbs studied; ? Ascertain the appropriate dosage for each preparation of the herbs studied; and ? Describe and prepare appropriate preparations for each of the herbs studied. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 9 Introduction Recommended Reading The recommended reading is optional recommended texts for students who want to further their studies. You do not need them to complete this course, but they are highly recommended for the serious student. The set of optional recommended reading is available from the Apothecary Shoppe College Store at a discount. To order, go to www.apothecary-shoppe.com and select ACHS Course Recommended Reading from the left-hand toolbar under ?Product Types?; then click on your course number. Optional Study K it There is an optional discounted study kit of practical materials for this course available from the Apothecary Shoppe College Store. Go to www.apothecary-shoppe.com and click on ACHS Course Study Kits from the left-hand toolbar under ?Product Types?; then click on your course number. You should also have received an email detailing what is in your kit and how best to make use of it. Many students find they retain new information more effectively by using the products they are learning about, and the study kit is a great way to get started. Course Structure This ACHS Textbook guides you through the class content and references your online resources, and correlates where needed. Our hybrid online lecture and ACHS Textbook format has a number of benefits for students: ? Online resources and practicals are updated throughout the class, which enables you to experience real-time updates about research in herbal medicines. Instructional designers and instructors can also add bonus material to the course as it is in progress. This is much the same as an in-person class, where instructors introduce new information during lectures. Online resources can use more graphics and interactive tools than is feasible in a printed document, enhancing the student experience. ? You can access your online ACHS Textbook anywhere they have access to the Internet: No need to carry around textbooks?for Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 1 0 Introduction example, you can complete readings on your lunch breaks at work or at the library while the kids listen to story time. Although many students are comfortable with a fully online format, we realize that some students learn better by reading offline. For this reason, we have laid out your ACHS Textbook in a fully searchable, printer-friendly PDF format. This enables those students who prefer printed materials or who need to print out a few modules (to take to an offline vacation, for example) to do so?simply click on the ACHS Textbook PDF link to download and use your PDF?s print feature. Please log in to your online classroom and read and review each lecture in your ACHS Textbook. You will be tested on this ACHS Textbook. If you would like to print your ACHS Textbook PDF, simply click on the PDF to download, then use the PDF?s print feature. If you need assistance to print your ACHS Textbook, please call Student Services at (800) 487-8839 or email stuserv@achs.edu. Virtual Library In your online classroom, you will find the Virtual Library. The Virtual Library is a collection of online resources put together by instructors for your reference. We also provide a paid subscription to several online databases. You will find the library collected by subject in virtual ?rooms?. Many sites include information about multiple areas. We encourage you to use the library as a beginning for your own research. Always remember to review online information with a critical eye. Since ACHS has no control over the content of these websites, we cannot accept responsibility for their content. We check each site at the beginning of each class, but site hijacking does occur and links may quickly become invalid. Please let us know if any links do not work, or if you find other sites that you would like to recommend. A s s e s s m e n t You have assessments to complete for each module in this course. Click on Assignments under the Course Home for full details. You will complete your assessments online in the virtual classroom. At the conclusion of each module, you have a module test to complete. This covers all of the material in that module. You also have Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 1 1 Introduction a project, essay, or lab option for a discussion posting and response to complete. You can find the topics for your discussion postings online under each module. You may have additional assessment, including case studies and practicals. Please follow the online instructions in each module. Completing this Course To complete this course, you must: ? Read through the ACHS Textbook. ? Read the online resources as directed. ? Read the module landing pages and follow directions for the module assessment. ? Complete all module tests in sequence online and submit them for grading. ? Prepare and post a discussion posting and response on an assigned topic for each module as directed in the online instructions. ? Complete the final examination. Online Interaction This distance-learning course uses a virtual classroom, which allows you to interact with other students in this course and your instructor. You will complete all your assessments and final exam online. When you log in, you have access to the Gradebook, and you will find links to online sources of additional information. Please ensure you complete the online orientation, so you can benefit from all the online tools available in your classroom. We have designed this course to enhance both instructor/student interaction and peer-to-peer interaction. Within the requirements of the course, the format allows you to choose the level of interaction that you have with your instructors and other students. Most students find that a greater level of interaction helps them to complete their studies and enhances their experience, but some people are naturally ?chattier? than others. Your eCompanion offers you the opportunity to email; post asynchronous messages, and chat live with your fellow classmates and instructors. Of course, you will also submit your assessments online, Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 12 Introduction take your final exam online, and have access to a range of advanced, yet easy-to-use online tools to enhance your distance-learning course. Please post questions for your instructors at the Instructor?s Virtual Office, located on the left-hand toolbar of your Course Home online. You are also welcome to email your instructor with any questions you have as you work through the course. Interaction w ith O ther ACHS Students and Graduates w ith MyACHS Connect In November 2008, ACHS launched MyACHS Connect, an online community similar to Facebook, just for ACHS students and graduates. You will be sent an invitation to join this community by email. If you do not receive this, please click on ACHS Student News, located on the left-hand toolbar of your Course Home online, and follow the links to be connected. Contacting ACHS Student Services Remember that you are always welcome to call Student Services at (800) 487-8839 or email stuserv@achs.edu. Student Services is available during regular business hours, Monday to Friday, 8:30 a.m. to 5:30 p.m., PST. Technical Assistance For technical assistance with your online course, please call the Help Desk at (877) 740-2213 or email helpdesk@myachsclass.com. The Help Desk is available 24 hours a day, seven days a week. I n s t r u c t o r If you need any assistance from your instructor with the course material or assessment, please post a question at the Instructor?s Virtual Office, located on the left-hand toolbar of the Course Home online; at the module discussion board for the appropriate module; or email your instructor using the integrated email tool in your online course. If you have queries about a specific test question, please email your instructor directly so that your question does not affect the Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 1 3 Introduction testing of other students in your class. Your instructor logs into class each day, Monday through Friday, and at least once during the weekend unless he or she notifies you of different days and times. Updates If you spot an error in the ACHS Textbook or online classes, please let us know. Send any corrections or comments to updates@achs.edu. Study T ime You should expect to spend at least nine hours per week on this three-semester-credit course. Review the course dates in the Course Checklist in the online classroom for guidance on progression through the course. Most students gain the most from their course if they spend the recommended time on their studies. We encourage you to choose a range of activities for your discussion topics. Remember that you can always complete more practical activities than is required. Practical E xperience We encourage you to experience as much practical work as possible. Your course may contain optional practical exercises and simple lab work for you to complete if you want. We share apprenticeship and work experience opportunities with students through ACHS Student News. We encourage you to take up opportunities in your area and seek out opportunities with local businesses and natural health professionals. Our courses foster a professional approach, which, along with the discipline required to complete your studies, will develop your confidence and success. As your experience in your chosen career develops, you will further enhance your confidence and success. Many students have successfully obtained volunteer or apprentice positions in their area while studying with ACHS. Many practitioners and businesses are happy to take on an enthusiastic and dedicated volunteer. Our Student Services department can provide transcripts Hint: Scroll down to the bottom of the Course Home page to view the course due dates. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 1 4 Introduction and letters of recommendation for you upon completion of your program. Completion When you have successfully completed this course, your name will be added to the list of successful graduates, and you will become entitled to special discounts and networking opportunities. If you need a copy of your transcript, you may print an unofficial copy from your online student account, or contact Student Services to order an official copy. Please complete the end of course evaluation after your final exam in the online classroom. This survey triggers the graduation process, as well as providing your feedback for our continual cycle of evaluation and improvement. If this course completion results in your successful completion of a Certificate, Diploma, or Degree program, and you are not currently enrolled in a program package you may apply for graduation. See your ACHS Program Catalog for details, located in the Virtual Library under Student Downloads. For information about how to continue your holistic health education or to schedule your next courses, please contact Admissions at admissions@achs.edu or call (800) 487-8839. Accreditation American College of Healthcare Sciences is accredited by the Accrediting Commission of the Distance Education and Training Council (DETC), 1601 18 th St. NW, Washington DC 20009-2529. Telephone (202) 234-5100, www.detc.org The Accrediting Commission of the Distance Education and Training Council is listed by the U.S. Department of Education as a nationally recognized accrediting agency. The Accrediting Commission of the Distance Education and Training Council is a recognized member of the Council for Higher Education Accreditation (CHEA). Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 1 5 Introduction What Accreditation Means for ACHS Students Accreditation means ACHS students are enrolled in a nationally recognized post- secondary school. ACHS students enjoy increased credibility and acceptance of coursework among transfer schools and employers. ACHS students can feel confident when they say with pride that they received their certification from a DETC nationally accredited school. As defined by the DETC: Accreditation ?assures students that the institution operates on a sound financial basis, has an approved program of study, qualified instructors, adequate facilities and equipment, approved recruitment and admissions policies, and advertises its courses truthfully.? Earning your certificate or diploma from an accredited school helps ensure employers, professional associations, and other colleges and universities will more readily accept course credits, certificates, and degrees. Transfer Credit Acceptance of degrees or credits from accredited institutions is largely determined by the policy of the ?receiving organization?, such as an employer or a college registrar. Accreditation is not a guarantee that credit will transfer to any college or university and ACHS does not guarantee any credits you earn will be transferable. You should always check with the college or university that you want to transfer your credits to before you enroll in a course. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 1 6 Introduction About the Author BA, Dip.NT, Dip.Acu, RH (AHG), President, Principal, and CEO The American College of Healthcare Sciences, founded in 1978 by Dorene Petersen, originated in New Zealand, later opening additional branches in Australia and Hong Kong. Today, though, ACHS is housed entirely on the U.S. campus located in Portland, Oregon. In May 2009 the College officially changed its name from the Australasian College of Health Sciences to the American College of Healthcare Sciences. The name change celebrates the College?s 20th anniversary of operations in the United States and better represents the College?s long-term goals as an Institute of Higher Learning in the U.S. President and founder Dorene Petersen holds a BA in Archaeology and Anthropology from Otago University, New Zealand, a Diploma in Natural Therapeutics from the South Pacific College of Natural Therapies in Auckland, New Zealand, and is a certified acupuncturist with specialized training in Chinese herbal medicine and moxibustion. In addition to her work as President of the College, Dorene also teaches courses for ACHS and leads the annual ACHS Summer School study-abroad programs to Greece, which explore holistic health, Mediterranean nutrition, and aromatherapy distillation, among other topics. She is an eCollege certified online instructor and is a faculty member meeting the qualifications prescribed by the Oregon Office of Degree authorization. She stays abreast of current methodologies through various trainings with the Distance Education Training Council and by regularly attending conferences about online learning, including the CITE conferences in Denver in 2005, 2006, and 2007. Dorene regularly lectures about medical herbalism, aromatherapy, and iridology, including appearances at: The South Pacific College of Natural Therapies (NZ), the National College of Naturopathic Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 1 7 Introduction Medicine (NCNM) and the Aesthetics Institute, both in Portland, Oregon, and at the Birthingway School of Midwifery in Oregon. In addition, Dorene has appeared on various TV and radio shows, including Good Morning Oregon and the National Radio Show Voice of America, and has presented papers at: The Herb Growers and Marketers Conference in Hyannis, Massachusetts; at the International Scientific Aromatherapy Symposium in Grasse, France; and at the International Herb Association Conference in Portland, Oregon. Her articles about aromatherapy have appeared in publications worldwide, including: Alternative Therapies in Clinical Practice, The News Quarterly, Making Scents, The Herbarist , and on Blogcritics.org. Dorene currently serves as Chair of the Aromatherapy Registration Council (ARC), an independent, nonprofit organization that administers the national examination in aromatherapy to ensure minimum standards of training and safety knowledge of registered aromatherapists. Petersen is also a professional member of the American Herbalists Guild. In 2009, Dorene was awarded the Professional Service Award from the International Herb Association for her outstanding contributions to the herb industry. Dorene is active with the Distance Education Training Council (DETC), and chaired the DETC annual meeting and conference in Seattle in 2006. She is also a member of the Research and Educational Standards Subcommittee of the DETC. Contributing Faculty E r i k a Y i g z a w , L L . B . ( H o n s ) , B C o m m e r c e , S e n i o r V i c e P r e s i d e n t Erika Yigzaw is the Senior Vice President at ACHS. She focuses on the coordination and delivery of the highest quality online classes and overseeing implementation of ACHS?s outcomes assessment program (which she developed) and cycle of improvement on the academic side. She holds a Bachelors Degree (B.Com) in Commerce (Economics major); an LL.B. (first professional law degree) from the University of Otago Law School; and has completed the Master Gardener program through Oregon State University. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 1 8 Introduction Before joining ACHS USA in 1997, she spent three years practicing corporate commercial law with one of New Zealand?s largest commercial law firm, Bell Gully Buddle Weir, in the Wellington then Auckland offices. She advised several multinational dietary supplement companies as well as being involved with mergers and acquisitions and intellectual property issues. She is a past member of the New Zealand Law Society. She has been a speaker at IHA and HGMN conferences in the natural health industry and at the 2006 fall workshop of the Distance Education Training Council (DETC). She is a Licensed Oregon Private Career School Teacher. In addition to her professional training and experience, Erika has been involved with ACHS since it was founded in New Zealand. She worked part time for ACHS through school and part of College, and managed the New Zealand office of the College during summer break from Law school. She has been with ACHS in the USA since 1997. She has been an advisor to the Aromatherapy Registration Council since its inception in 1997 and continues to fulfill the role of volunteer webmaster for that non-profit group. She is a member of the Herb Growers and Marketers Network (HGMN) and has presented at both the national conference for the HGMN and the International Herb Association. She works with Subject Specialists to develop new curriculum and coordinates teams of faculty, staff, and specialists for course updates. Erika has a variety of experiences in distance education methodology and administration. Erika has taken programs by distance learning in Spanish through New Zealand Correspondence Schools and eCommerce through Portland Community College. She stays abreast of current methodologies through various conferences and courses with the DETC and by regularly attending conferences on online learning, including the CITE conferences in Denver. She is a DETC accreditation evaluation team member and serves on site visits for initial and re-accreditation for DETC. Erika also presented at the DETC Fall conference 2006 on student outcomes assessment programs and in 2008 was nominated to join the Business Standards Committee of the DETC. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 1 9 Introduction Dr. Arianna Staruch, ND An ACHS faculty member since 2003, Dr. Arianna Staruch was recently appointed the ACHS Academic Dean in July 2009. As Academic Dean, Dr. Staruch is responsible for the management and oversight of ACHS faculty, and she works closely with the ACHS President and Senior Vice President on curriculum development and outcomes assessment. Dr. Staruch previously worked in medical research, first at Sloan Kettering Cancer Center and then at Cornell University Medical College, both in New York City. While at Cornell University Medical College, Dr. Staruch was promoted to department manager, supervised a staff of 11, and oversaw a half-million dollar renovation project. Dr. Staruch?s department was subject to both state and federal regulations requiring annual reports, as well as site visits. In addition, the department sought and obtained accreditation by an outside accrediting body, which improved the researchers? ability to apply for grants. Dr. Staruch later graduated from the National College of Natural Medicine and maintained a private practice in Oregon focused on women?s health as a naturopathic physician, prior to becoming Academic Dean. She still sees her long-time patients on occasion. Dr. Janet Bennion, PhD Janet has taught ethnomedicine and medical anthropology for six years at Utah Valley State College and University of Maine. She supervised student field research in Mexico, France, and East Africa, searching for ways in which natives treat and cure illnesses with their natural resources. Janet has a Ph.D. in Sociocultural Anthropology from the University of Utah and a Masters in Anthropology from Portland State University. She is an associate professor with a total of 10 years teaching experience. Marco Puccio, MS EdM Marco holds a BA (Hons) in Biology, an MS in Botany, and a Masters in Education from Stanford. He is a professional educator, botanist, and mycologist with an academic background and profound interest in general biology, the genetics of plants and fungi, and evolutionary biology. He has nurtured a deep interest in field botany, Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 20 Introduction aromatherapy, essential oils, natural perfumery, and herbal medicine since his undergraduate days in the late ?80s. Program Structure The structure of this course is different than the other Herbal Materia Medica courses. Previous courses combined a specific therapeutic group of herbs that related to each physiological system of the human body. In this course we will study many more herbs and will do so in alphabetical order by the Latin name. It is still important for you to learn to associate the particular therapeutic group of an herb with each system of the body. For example, when you think of the urinary system, the therapeutic group of herbs that will automatically spring to mind will be diuretics. This course relates to the other required courses in the Master Herbalist Diploma in this way. For example, when you study the urinary system in the Nat 211 course, you will be able to refer back to diuretics and the herbs you studied that have this action in the body, such as dandelion Taraxacum officinale . Herbs have more than one action in the body, but each group of herbs is chosen for its major action. Some herbs may fall into more than one category. One example is garlic Allium sativum, because it is both an alterative and an anthelmintic. Do not panic if these terms are unfamiliar to you. There are terminology guides, available in the online Virtual Library in text and audio format; click on Library, located on the left-hand toolbar of your Course Home online. Refer to them any time you come across a term you do not recognize. If the term is not in the glossary visit MyACHS Connect, the ACHS social networking community, and add it to the Help Build a Comprehensive Holistic Health Glossary forum. Also remember that your instructors are here to assist you with any area that is difficult or unfamiliar. With each herb studied, we learn the common name, Latin name, and the family of the herb. For example: ? Plantain is the common name; ? Plantago major is the Latin name; and ? Plantaginaceae is the family name. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 21 Introduction It is not essential to memorize the Latin and family names at once, but they are essential for correct identification of both the fresh and dried plant materials. Get into the habit of using the Latin binomial and the common name for each herb. You will find yourself able to recall them much more easily than if you try to memorize each in isolation. One F inal Note One final note before you get started. You may notice when reading this course that there is some repetition of certain material. This is a classic distance-learning technique, and it is consciously used to reinforce key points. Also, remember that the information in this course is educational and not intended to take the place of diagnosis and treatment by a qualified medical practitioner or naturopathic physician. In holistic health, our focus is always to bring the body back into balance for optimal wellness. At all times, refer clients to licensed medical professionals for diagnosis and treatment of disease. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 22 Module One Module One Module Objectives Upon completion of this module, you will be able to: ? Recall and describe the Latin binomial or scientific name, common name, and family. ? Be able to identify a photograph by the Latin name and common name of the botanicals studied. ? Identify the therapeutic potential of each botanical studied. ? Explain the pharmacological action of each botanical studied. ? List the key recommended uses for each botanical studied. ? Recall the recommended dosage and duration for each botanical studied. ? Recall and describe any contraindications and precautions associated with each botanical studied. ? Recall the regulatory status of each of botanical studied. Module Checklist ? Read and review the module. ? Read any online resources as applicable. ? Ensure you can meet the Module Objectives. ? Complete the module assessment online and respond to another student?s posting as instructed. ? Complete the Module Test. 1 Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 23 Module One A c t a e a r a c e m o s a ( formerly C i m i c i f u g a r a c e m o s a ) Image 1: by Vieux jardin botanique de Gottingen (2006) via Wikipedia.org Taxonomic Notes Botanical common name: Black Cohosh Family: Ranunculaceae C o m m o n N a m e s Baneberry, black snakeroot, bugbane, bugwort, cimicifuga, macrotys, rattle root, rattle top, rattlesnake root, rattleweed, rhizoma cimicifugae, sheng ma, snakeroot, and squaw root Do not confuse with white or blue cohosh, which are different botanicals. P r i m a r y U s e s When taken orally, black cohosh has been used for menopause support, PMS, dysmenorrhea, nerves, dyspepsia, rheumatism, fever, sore throat, cough, and as a mild sedative. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 24 Module One Topically, black cohosh can be supportive for skin health in the presence of skin conditions such as acne, mole and wart removal, and for overall rejuvenation of the skin. O v e r v i e w Wild black cohosh originates almost exclusively in the U.S. and Canada 1 . In the U.S., it has become a popular support option for menopausal concerns, including hot flashes, mood changes, diaphoresis, palpitations, and vaginal dryness 2 . P a r t s U s e d Rhizome and root Dosage and Administration Dried black cohosh rhizome: 40-200 mg daily divided into doses. Tincture: 0.4-2 mL of a (1:10) 60% ethanol tincture daily; though, doses can be as high as 1 g, three times daily. Powdered black cohosh root or tea 1-2 g, three times daily. Duration of Administration Likely safe for use up to six months. Active Constituents The active constituents of black cohosh include phytosterin, fukinolic acid, which inhibits neutrophil elastase, important in anti-inflammatory 1 Witchtl, M. ed. Herbal Drugs and Phytopharmaceuticals . Medpharm Scientific Publishers Stuttgart and CRC Press. Boca Raton: FL , 2002. 2 Don nelly GF . Herbal efficacy: the case of black coho s h . Holist Nurs Pract . 2007 May-Ju n ; 2 1 (3):103. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 25 Module One action 3 , isoferulic, caffeic, and salicylic acids, sugars, tannins, long-chain fatty acids, triterpene glycosides, including acetein, cimicifugoside, and 27-deoxyactein 45 . Black cohosh also exhibits estrogen-like effects, though the mechanism is currently unknown. Therapeutic Action Abortifacient, anti-inflammatory, antioxidant, antispasmodic, aphrodisiac, appetite stimulant, and emmenagogue Medicinal Uses Anxiety, arthritis 6 , back pain, breast pain/inflammation (mastitis), breast cysts, dyspareunia, dysmenorrhea, menopausal symptoms, polycystic ovarian syndrome, premenstrual symptoms, sedation 7 , and vaginal atrophy Studies have shown that black cohosh has no effect on LH, FSH, prolactin, or estradiol 8 . A black cohosh extract was shown to have 3 Loser B, Kruse SO , Melzig MF, Nahrstedt A. Inhibition of neutrophil elastase activity by cinnamic acid derivatives from Cimicifuga racemosa . Planta Med 2000;66 :7 5 1 -3. 4 Kruse SO , Lo h ning A, Pauli GF, et al. Fu kiic and piscidic acid esters from the rhizo me of Cimicifuga racemosa and the in vitro estrogenic activity of fu kinolic acid. Planta Med 199 9 ; 6 5 : 7 63-4. 5 Loser B, Kruse SO , Melzig MF, Nahrstedt A. Inhibition of neutrophil elastase activity by cinnamic acid derivatives from Cimicifuga racemosa . Planta Med 2000;66 :7 5 1 -3. 6 Liske E. Therapeutic efficacy and safety of Cimicifuga racemosa f or gynecologic disorders. Adv Ther. Jan-Feb 199 8 ; 1 5 ( 1 ) :45- 53. http:/ / naturalstandard.com / m o n o gra phs / m o n o frameset.asp? m o n o graph= / m o n o graphs / herbssu p plements/patient-black coho s h .asp %3Fprintversion %3Dtrue 7 http:// w w w . m s kcc.org/m s kcc/html/6 9 140.cfm 8 Liske E. Therapeutic efficacy and safety of Cimicifuga racemosa f or gynecologic disorders. Adv Ther. Jan-Feb 199 8 ; 1 5 ( 1 ) :45-53. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 26 Module One antiproliferative and antiestrogenic effects in ER-negative cells. This suggests that black cohosh mediates its effects via an estrogen- independent pathway 9 , possibly through Her2 signaling 1 0 . A rthritis Preliminary studies suggest that black cohosh may help reduce inflammation associated osteoarthritis and rheumatoid arthritis. In a review of scientific studies, researchers concluded that a combination of black cohosh, willow bark Salix spp. , sarsaparilla Smilax spp ., guaiacum Guaiacum officinale resin, and poplar bark Populus tremuloides may help ?relieve symptoms of osteoarthritis?. However, there is not enough human research to make a clear recommendation about the use of black cohosh alone for arthritis 1 1 . Contraindications There are no known contraindications listed in the Commission E Monographs. However, when taken orally, may be unsafe during pregnancy as black cohosh might have hormonal effects, and menstrual and uterine stimulant action 1 2 . Avoid if allergic to black cohosh, its constituents, or members of the Ranunculaceae family. 9 Garita-Hernandez M, Calzado MA, Caballero FJ, et al. The growth inhibitory activity of the Cimicifuga racemosa extract Ze450 is mediated throug h estrogen and progesterone receptors-independent pathways. Planta Med 2006:7 2 (4):317- 23. 1 0 Einbond LS, Wen-Cai Y, He K, et al. Growth inhibitory activity of extracts and comp o u nds from Cimicifuga species on human breast cancer cells. Phytomedicine . Ju n 2008;1 5 ( 6 - 7 ) : 504-51 1 . 1 1 http:// w w w . u m m .edu/altmed/articles/black-coho s h -000226 .htm 1 2 Dug o ua JJ, Seely D, Perri D, et al. Safety and efficacy of black coho s h (cimicifuga racemosa) during pregnancy and lactation. Can J Clin Pharmacol 2006;13:e257 - 6 1 . Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 27 Module One Drug and Supplement Interactions Tamoxifen : Black cohosh may have an additive antiproliferative effect. Chemotherapy drugs : Black cohosh may increase the toxicity of doxorubicin and docetaxel 1 3 . Cytochrome P450 3A4 : Black cohosh may interact with drugs that are metabolized by CYP3A4 enzyme 1 4 . Black cohosh may lower blood pressure and therefore should be used cautiously with other hypotensive agents such as beta-blockers like metoprolol (Lopressor®, Toprol®) or propranolol (Inderal®) and calcium-channel blockers like diltiazem (Cardizem®, Tiazac®) or verapamil (Isoptin®, Calan®). Black cohosh may contain small amounts of salicylic acid and may increase the anti-platelet effects of other agents such as aspirin 1 5 . Regulatory Status Black cohosh is listed in the Botanical Safety Handbook in Class 2b. 13 Rockwell S, Liu Y, Higgins SA . Altera tion of the effects of cancer therapy agents on breast cancer cells by the herbal medicine black coho s h . Breast Cancer Res Treat 2005;90(3):233-9. 14 Tsu kamoto S, Aburatani M, Ohta T. Is olation of CY P3A4 Inhibitors from the Black Co h o s h ( Cimicifuga racemosa ) . Evid Based Complement Alternat Med . Ju n 2005;2 ( 2 ) : 2 23-22 6 . 1 5 http:/ / naturalstandard.com / m o n o gra phs / m o n o frameset.asp? m o n o graph= / m o n o graphs / herbssu p plements/patient-black coho s h .asp %3Fprintversion %3Dtrue Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 28 Module One A l c h e m i l l a spp. Image 2: by Jina Lee (2007) via Wikipedia.org Taxonomic Notes Botanical common name: Lady?s Mantle Family: Rosaceae C o m m o n N a m e s Feuilles d?Alchemille, frauenmantelkraut, leontopodium, lion?s foot, marienmantel, nine hooks, silerkraut, and stellaria Primary Uses Lady?s mantle is used orally for mild diarrhea, heavy menstrual flow, diabetes, and as a mouthwash for mouth and throat inflammation. Traditionally, lady?s mantle is also known for its use for menopausal complaints, gastrointestinal disorders, muscle spasms, anti- inflammatory action, and as a diuretic. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 29 Module One Topically, lady?s mantle is used as an astringent for bleeding, to aid wound healing, and in folk medicine has been used with ulcers, eczema, skin rashes, and as a bath additive for the lower abdomen. Overview Lady?s mantle originates in Europe, North America, and Asia; although, today the herb is commonly imported from Poland, the Czech Republic, Bulgaria, and Hungary. Although the German Standard License once warned about possible liver damage, the warning was deemed an exaggeration and has since been removed 1 61 7 . Identifying Characteristics Part Characteristics Leaves Kidney-shaped leaves have 7-9 lobes and grow up to 8 cm in diameter; they are silverish-white Flowers Taste Flower clusters are yellowish-green late spring or early summer Faintly bitter and astringent Nearly odorless P a r t s U s e d The fresh or dried above ground parts, which are gathered at flowering time 1 8 1 6 Wichtl MW. Herbal Drugs and Phytopharmaceuticals . Ed. N.M. Bisset. Stuttgart: Medpharm GmbH Scientific Publishers, 19 94. 1 7 Witchtl MW, ed. Herbal Drugs and Phytopharmaceuticals . Trans Jo sef Brinckmann and Michael Lindenmaier. Bo ca Raton, FL : medpharm Scientific Publishers Stuttgart and CRC Press, 2002. 1 8 Blumenthal M., ed. The Com plete German Co m mis sion E Mono graphs : Therapeutic Guide to Herbal Medicines. Trans. S. Klein. Bo ston , MA: American Botanical Cou ncil, 19 9 8 . Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 3 0 Module One Collection and Cultivation Lady?s mantle can be grown is either full sun or partial shade 1 9 , and prefers well-drained 2 0 soil, especially heavy clay soils. Lady?s mantle should be seeded in spring, and will typically germinate in 3-4 weeks. When the plant is large enough to handle, plant in individual pots and grown them on a cold frame for the first winter; plant out in late spring or early summer 2 1 . Preparation Lady?s mantle can be made into an infusion or decoction. D o s a g e a n d A d m i n i s t r a t i o n Unless specifically prescribed, the average daily dose is 5-10 g of the herb 2 2 . For use with diarrhea, a typical dose would be 1 cup of tea. To prepare the tea, steep 1-4 g of lady?s mantle in boiling water for about 10 minutes, and then strain 2 3 . Drink three times per day between meals. 1 9 Th o mas. G. S. Perennial Garden Plant . Lo ndon: J. M. Dent & So n s , 19 90. Also see the Plants For A Future: Database Search Results accessed 5/5 /09: http:/ / w w w .ibiblio.org/p faf/cgi-bin/arr_html?Alchemilla+xanthochlora 2 0 Clapham, To otin and Warburg. Flora of the British Isles . Cambridge University Press, 19 6 2 . Also see the Plants For A Future: Database Search Results accessed 5/5 /09: http:/ / w w w .ibiblio.org/p faf/cgi- bin/arr_html?Alchemilla+xanthochlora 2 1 Rice. G., ed. Growing from Seed . Volume 1. Th o m p s o n and Morgan, 19 8 7 . Also see the Plants For A Future: Data base Search Results accessed 5/5 /09: http:/ / w w w .ibiblio.org/p faf/cgi-bin/arr_html?Alchemilla+xanthochlora 2 2 Blumenthal M., ed. The Com plete German Co m mis sion E Mono graphs : Therapeutic Guide to Herbal Medicines. Trans. S. Klein. Bo ston , MA: American Botanical Cou ncil, 19 9 8 . 2 3 Wichtl MW. Herbal Drugs and Phytopharmaceuticals . Ed. N.M. Bisset. Stuttgart: Medpharm GmbH Scientific Publishers, 19 94. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 3 1 Module One If diarrhea persists for more than 3-4 days, discontinue use and consult with a primary care physician. For topical use, no known typical dosage. Duration of Administration If the experience of diarrhea persists for more than 3-4 days, discontinue use and consult with a primary care physician 2 4 . Active Constituents Alchemilla contains 6-8% tannins 2 5 , which might account for its perceived astringent activity 2 6 . An aqueous extract of Alchemilla xanthochlora demonstrates lipid peroxidation and superoxide anion scavenging activity. Flavonoid extracts inhibit proteolytic enzymes, including elastase, trypsin, and alpha-chymotrypsin. This property suggests Alchemilla xanthochlora might have a role in protecting conjunctive and elastic tissues 2 7 . Pharmacological Action In a French study conducted in 1990, 42 species of Rosaceae were compared for tannin content. Of the 42 species, ?only the Rosoideae species exhibit high tannin content and elastase inhibiting activity such as Filipendula ulmaria , Geum montanum , G. rivale , Alchemilla xanthochlora , and Sanguisorba minor . Other studied species from Spiraeoideae , 2 4 Blumenthal M., ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines . Trans. S. Klein. Bo ston , MA: American Botanical Cou ncil, 19 9 8 . 2 5 Wichtl MW. Herbal Drugs and Phytopharmaceuticals . Ed. N.M. Bisset. Stuttgart: Medpharm GmbH Scientific Publishers, 19 94. 2 6 The Review of Natural Products by Facts and Comparisons . St. Lo uis, MO: W olters Kluwer Co., 19 9 9 . 2 7 The Review of Natural Products by Facts and Comparisons . St. Lo uis, MO: W olters Kluwer Co., 19 9 9 . Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 32 Module One Maloideae , and Prunoideae subfamilies are less rich in tannin and also less active 2 8 .? M e d i c i n a l U s e s Lady?s mantle is possibly safe for use when taken orally and appropriately. Alchemilla has been used for many years without reports of significant toxicity 2 93 0 . Contraindications Due to a lack of sufficient information, avoiding use while pregnant or breast-feeding is advised. A d v e r s e E f f e c t s Although The Complete German Commission E Monographs list no known side effects, some experts warn about the possibility of liver damage 3 1 . Herbs with a high tannin content may cause gastrointestinal upset. Drug and Supplement Interactions None known. Regulatory Status None known. 2 8 Lamaison JL , Carnat A, Petitjean-Freytet C. Tannin content and inhibiting activity of elastase in Ro saceae. Ann Pharm Fr . 19 90;48(6 ) :335-40. 2 9 Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines . Trans. S. Klein. Bo ston , MA: American Botanical Cou ncil, 19 9 8 . 3 0 McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association?s Botanical Safety Handbook . Boca Raton, FL : CR C Press, LL C 19 9 7 . 3 1 Wichtl MW. Herbal Drugs and Phytopharmaceuticals . Ed. N.M. Bisset. Stuttgart: Medpharm GmbH Scientific Publishers, 19 94. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 3 3 Module One A n g e l i c a a r c h a n g e l i c a Image 3: from Koehler?s Medicinal-Plants (1887) via Wikipedia.org Taxonomic Notes Botanical common name: Angelica Family: Apiaceae/Umbelliferae Common Names European angelica, garden angelica, root of the Holy Ghost, and wild angelica Not to be confused with the edible Pastinaca sativa or wild parsnip. P r i m a r y U s e s Angelica is traditionally used for respiratory inflammation with discharge, loss of appetite, peptic discomforts such as mild spasms of Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 3 4 Module One the GI tract, stomach cramps, feeling of fullness or bloating, and flatulence. Angelica is used topically in compresses for pleurisy and bronchitis. Overview Angelica archangelica is related to the species A. sinensis or dong quai; however, dong quai has a separate listing and review of uses. Identifying Characteristics Part Characteristics Leaves Large and bright green with toothed edges Flowers Flower heads have small stems of equal length that form rounded clusters called umbels; they are greenish-yellow or greenish-white and bloom in late spring or early summer Root Gray, reddish, or dark-brown on the outside with longitudinal furrows Fruit Pale, yellow, and oblong Taste Spicy and bitter Odor Unpleasant P a r t s U s e d Roots and leaves for medicinal purposes C u l t i v a t i o n a n d C o l l e c t i o n Angelica is a biennial (short-lived perennial) and can grow up to six feet (ft.) high in flower and three ft. in width. It is usually propagated by seed, although older plants can be divided. The seed loses viability quickly, within six months. Viability can be lengthened by freezing or refrigerating the seed. The seed germinates best when fresh, but it will germinate after cold storage. It can either be sown outdoors in summer or early fall, or stored in the fridge and sown in the spring. Sow in a row with one-ft. spacings and 2-3 ft. between rows. It germinates in 2-4 weeks. If harvesting will be within the first year, plant early. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 3 5 Module One Otherwise, plant it later in the season and harvest in the following year. It is a very cold hardy plant (hardy to Zone 3) and can be planted outdoors early in the season. It will continue to live as long as the flower stalks are cut off well before they go to seed. The deep roots prefer deeply tilled soil, a pH of 4.5-7, and are tolerant of a lot of water. Angelica prefers cooler areas. Harvest the root in the fall/winter of the first year, early spring of the second year, or fall/winter of the second year, depending on when planting occurred. Preparation Wash the taproot. If the root is large, cut into smaller pieces to facilitate drying. As the root is 80% water, it should be dried at relatively high heat and may take 5-10 days. Dosage and Administration Dried root: Daily dose 4.5 g or 1-2 g by infusion, times daily Tincture: (1:5 in 50% alcohol) 0.5-2.0 mL, three times daily Active Constituents Coumarins: More than 20 furanocoumarins, including angelicin, archangelicin osthol, bergapten, isoimperatorin, imperatorin, oreoselone, oxypeucedanin, umbelliferone, xanthotoxin, and xanthotoxol. Volatile oils: Major components include alpha- and beta-phellandrene, alpha- and beta-pinene, sabinene, alpha-thujene, limonene, beta- caryophyllene, linalool, borneol, acetaldehyde, and four macrocyclic lactones. Other constituents include: Archangelone (a flavonoid), palmitic acid, caffeic and cholorogenic acids, and sugars (fructose, glucose, sucrose, and umbelliferose). Pharmacological Action A tincture of angelica A. archangelica root is an effective antispasmodic when used with circular smooth muscle contractions and inhibits Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 3 6 Module One acetylcholine- and barium chloride-induced contractions of longitudinal smooth muscle 3 2 . Extracts of A. archangelica root exhibit calcium channel-blocking activity. When isolated, the coumarin archangelicin showed high activity as a calcium channel antagonist when assessed by inhibition of depolarization in rat pituitary cells 3 33 4 . Effect in humans is not known. Pharmaceutical calcium channel blockers are antihypertensives. Sixteen coumarins isolated from A. archangelica were tested for anti- inflammatory activity in cyclooxygenase 1 (COX-1) and 5- lipoxygenase (5-LO) inhibition assays in vitro . None of the coumarins demonstrated activity against COX-1, but osthol and oxypeucedanin isovalerate were active in the 5-LO assay 3 5 . M e d i c i n a l U s e s Angelica is said to possess antispasmodic, diaphoretic, expectorant, bitter aromatic, carminative, diuretic, and local anti-inflammatory properties. It has been used for respiratory catarrh, psychogenic asthma, flatulent dyspepsia, anorexia nervosa, rheumatic diseases, peripheral vascular disease, and specifically for pleurisy and bronchitis. 3 2 Barnes J, Anderson LA , Philipso n JD . Herbal Medicines, 3rd edition. Lo ndon (U K ) : Pharmaceutical Press; 2007: 54. Al so see: Izzo AA et al. Spasmolytic activity of medicinal plants used for th e treatment of disorders involving sm o oth m u scles. Phytother Res 199 6 ; 10: S107-S 108. 3 3 Barnes J, Anderson LA , Philipso n JD . Herbal Medicines, 3rd edition. Lo ndon (U K ) : Pharmaceutical Press; 2007: 54. Al so see: Harmala P et al. Ch oice of solvent in the extraction of Angelica archangelica roots with reference to calcium blocking activity. Planta Med 1 9 9 2 ; 58 : 17 6 - 1 83. 3 4 Barnes J, Anderson LA , Philipso n JD . Herbal Medicines, 3rd edition. Lo ndon (U K ) : Pharmaceutical Press; 2007: 54. Also see: Harmala P et al. Isolation and testing of calcium blocking acti vity of furanocoumarins from Angelica archangelica . Planta Med 199 1 ; 57 : A5 8 - A 5 9 . 3 5 Barnes J, Anderson LA , Philipso n JD . Herbal Medicines , 3rd edition. Lo ndon (U K ) : Pharmaceutical Press; 2007: 54. Al so see: Roo s G et al. Isolation, identification and screening for CO X - 1 and 5-L O inhibition of coumarins from Angelica archangelica . Pharmaceut Pharmacol Lett 199 7 ; 7: 15 7 - 1 60. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 3 7 Module One It has also been applied as a compress for bronchitis associated with vascular deficiency. It has been used to promote menstrual flow, antiseptic, abortifacient, and expectorant. Topically, angelica root is used to create warmth in neuralgia and rheumatism, and for skin disorders. It is also used as part of a multi- ingredient preparation for addressing premature ejaculation 3 6 . Contraindications Do not use angelica during pregnancy as used orally it is reputed to be an abortifacient, acting as a menstrual and uterine stimulant. A d v e r s e E f f e c t s The furanocoumarins present in angelica root, herb, and seed sensitize the skin to light. Subsequent exposure to UV radiation can lead to inflammation of the skin. During use of the drug or its preparations, prolonged exposure to the sun or exposure to intense UV radiation should be avoided. The use of bergapten in cosmetic and suntan lotions is ill advised by some regulatory authorities due to concerns regarding risk of skin cancer. The International Fragrance Association recommends that angelica root oil be limited to a maximum of 0.78% in products applied to sun-exposed skin. Drug and Supplement Interactions Concomitant use of herbs that have coumarin constituents or affect platelet aggregation could theoretically increase the risk of bleeding in some people. These herbs include: Anise, arnica, asafoetida, bogbean, boldo, capsicum, celery, chamomile, clove, danshen, fenugreek, feverfew, garlic, ginger, ginkgo, Panax ginseng, horse chestnut, 3 6 Natural Medicines Co m prehensive Database. Accessed 4/30/09: http:/ / w w w . naturaldatabase.com/( S ( u 5 m 1ejm y gtxk q 145b3fw40nc))/nd/Search.as px ?cs= & s = N D & pt=100&id=28 1 & ds=& name=An gelica) Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 3 8 Module One horseradish, licorice, meadowsweet, prickly ash, onion, papain, passionflower, poplar, quassia, red clover, turmeric, wild carrot, wild lettuce, and willow. Theoretically, hepatic metabolism of hexobarbitone might be inhibited by furanocoumarin constituents in angelica herb and seed. Excessive doses of angelica herb and seed can potentiate effects and adverse effects of anticoagulants. Theoretically, due to claims that angelica increases stomach acid, it might interfere with antacids, sucralfate (Carafate), H-2 antagonists, or proton pump inhibitors. Regulatory Status UK: General Sales List ? Schedule 1, Table A Clinical Review There are no documented human studies for A. archangelica . The furanocoumarin constituent bergapten has been used in the PUVA (psoralen and high-intensity long-wavelength ultraviolet irradiation) of psoriasis. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 3 9 Module One A n g e l i c a s i n e n s i s Image 4: by National Institute of Health (2008) via Wikipedia.org Taxonomic Notes Botanical common name: Dong Quai Family: Apiaceae/Umbelliferae C o m m o n N a m e s Chinese angelica, dang gui, danggui, dong qua, dong-quai, tan kue bai zhi, tang kuei, and women?s ginseng P r i m a r y U s e s When taken orally, dong quai is traditionally used for amenorrhea, for dysmenorrhea, to treat blood deficiency or ?purify? the blood, to manage hypertension, to relieve constipation, to treat and prevent cardiovascular disorders, arthritis, kidney disease, nerve pain, coronary hypertension, allergy attacks, and to protect the liver. Used topically, dong quai is an ingredient in an herbal preparation to treat premature ejaculation. In a 2000 clinical double-blind trial, results showed the placebo group experienced prolonged ejaculatory Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 4 0 Module One latency for more than two minutes at a rate of about 15% while the control group using the cream experienced a rate of about 80% 37 . Angelica sinensis has been used in Chinese, Korean, and Japanese medicine for thousands of years. Because it is used primarily for health conditions experienced by women, dong quai is commonly called female ginseng. In Chinese medicine specifically, however, dong quai is used in combination with other herbs and is believed to work best in clients with a ?yin profile?. Overview The root of dong quai has been used as a tonic and spice in China for thousands of years. Its reputation in the West is second only to ginseng. It is popular for use with gynecological problems. The name dong quai translates as ?return to order? based on its alleged restorative properties. 3 7 Choi HK, Ju n g G W , Moon KH, et al. Clinical study of SS - Cream in patients with lifelong premature ejaculation. Urology 2000;55:2 5 7 - 6 1 . Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 4 1 Module One Identifying Characteristics Part Characteristics Leaves Inferior leaves are tripinnate; superior leaves are pinnate, on long, sheathed petioles (slender stems that support the blade of a foliage leaf 3 8 ) Flowers Umbels number 10-14, with irregular rays, and each umbel contains 12-36 white flowers Root The exterior is grey-brown and wrinkled; the root consists of a head, body, and tail, and different properties are ascribed to these parts?the head is most tonic and the tail moves the blood most strongly Taste Sweet, acrid, bitter, and warm Odor Fragrant P a r t s U s e d Root C u l t i v a t i o n a n d C o l l e c t i o n Dong quai is a fragrant, perennial herb native to China, Korea, and Japan, which grows to a height of 1-1- ½ feet (ft.). Dong quai grows under the same conditions as angelica. For many years there were no viable seeds for sale in the U.S. Now, however, several herb seed companies have secured a source of good seed. The seed takes up to four months to germinate and likes to be kept very damp. 3 8 Merriam Webster Online, accessed 5/5 /09: http:/ / w w w . merriam- webster.com /dictionary/petioles Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 42 Module One Dosage and Administration When taken orally for menopausal symptoms, 4.5 g of powered dong quai root is typically used daily 3 9 . Decoction: 3-15 g made from dried root taken daily Liquid extract: Make in 1:2 ratio and take 4-8 mL daily Duration of Administration Unless instructed otherwise, may be taken long-term. Active Constituents The primary active constituents in Angelica sinensis include: Essential oil (0.4-0.7%), mainly consisting of ligustilide and n-butylidene phthalide, phytosterols, ferulic acid, and coumarins (angelol and angelicone). (n-Butylidene phthalide is a component of the essential oil with a characteristic fragrance.) Pharmacological Action Dong quai root has several coumarin constituents including osthol, psoralen, and bergapten, and contains 0.4-0.7% volatile oil. Some coumarins can act as vasodilators and antispasmodics. Osthol appears to inhibit platelet aggregation and smooth muscle contraction, and cause hypotension 4 0 . 3 9 Hirata JD, Swiersz LM, Zell B, et al. Does dong quai have estrogenic effects in po stmenopausal women? A doubl e-blind, placebo-controlled trial. Fertil Steril 199 7 ; 6 8 : 9 8 1 - 6 . 4 0 Hoult JR, Paya M. Pharmacological and biochemical actions of sim ple coumarins: natural products with therapeutic potential. Gen Pharmacol 199 6 ; 2 7 : 7 13-22 . Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 4 3 Module One Psoralen and bergapten are photosensitizing and can cause severe photodermatitis 4 14 2 . Bergapten and other dong quai constituents, such as safrole and isosafrole, are carcinogenic. Dong quai also contains a low molecular weight polysaccharide that shows anti-tumor activity in animals 4 3 . Limited research suggests that dong quai does not have estrogenic effects and, therefore, is not a phytoestrogen 4 4 . However, other research suggests that suggests estrogenic effects 4 5 . Dong quai might stimulate the growth of breast cancer cells 4 64 7 . 4 1 Hoult JR, Paya M. Pharmacological and biochemical actions of sim ple coumarins: natural products with therapeutic potential. Gen Pharmacol 199 6 ; 2 7 : 7 13-22 . 4 2 Ivie GW , Holt DL, Ivey MC. Natural toxicants in hu man fo ods: ps oralens in raw and cooked parsnip root. Science 198 1 ; 2 13:909-10. 4 3 Cho y YM, Leung KN , Ch o CS , et al. Imm u n o p harmacological studies of low molecular weight polysaccharide from An gelica sinensis. Am J Chin Med 1994;22 : 137-45. 4 4 Hirata JD, Swiersz LM, Zell B, et al. Does dong quai have estrogenic effects in po stmenopausal women? A doubl e-blind, placebo-controlled trial. Fertil Steril 199 7 ; 6 8 ( 6 ) : 9 8 1 - 6 . 4 5 Eagon PK , Elm MS, Hunter DS, et al. Medicinal herbs: modulation of estrogen action. Era of Hope Mtg, Dept Defense; Breast Cancer Res Prog, Atlanta, GA 2000;Jun 8- 1 1 4 6 Liu J, Burdette JE, Xu H, et al. Evaluation of estrogenic activity of plant extracts for the potential treatment of menopausal sym ptom s . J Agric Foo d Chem 2001;49:2472- 9 . 4 7 Amato P, Christop he S, Mellon PL . Estrogenic activity of herbs comm o nly used as remedies for menopausal sym ptom s. Menopause 2002;9 :145-50. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 4 4 Module One A dong quai extract competitively inhibits estradiol binding to estrogen receptors and induces transcription activity in estrogen- responsive cells 4 8 . Preliminary research suggests dong quai might protect against ischemia- reperfusion injury 4 9 . C l i n i c a l R e v i e w Hirata et al studied the effects of dong quai (4.5 g dried root daily) or placebo on menopausal symptoms. This was a randomized, double- blind, placebo-controlled clinical trial lasting 24 weeks and enrolling 71 volunteers. Dong quai did not produce any estrogen-like responses in endometrial thickness or in vaginal maturation. The incidence of symptoms dropped in both groups, but there was no significant difference between dong quai and placebo 5 0 . Liu et al studied the effects of a dong quai preparation (in combination with Corydalis ) on dysmenorrhea in an uncontrolled trial. A decoction was given daily, starting five days before and until cessation of menstruation. The improvement rate was reported to be 93%. After about four cycles, 72% were ?cured? 5 1 . For more reviews of clinical studies regarding dong quai, see: Mills S. & Bone K. Principles and Practice of Phytotherapy . London: Churchill Livingstone, 2000. 4 8 Eagon PK , Elm MS, Hunter DS, et al. Medicinal herbs: modulation of estrogen action. Era of Hope Mtg, Dept Defense; Breast Cancer Res Prog, Atlanta, GA 2000;Jun 8- 1 1 . 4 9 Yim TK , W u W K , Pak W F , et al. Myocardial protection against ischaemia- reperfusion injury by a Polyg o n u m multiflorum extract sup plemented 'Dang- G ui decoction for enriching blood', a comp o u nd formulation, ex vivo . Phytother Res 2000;May;14:19 5 - 9 . 5 0 Hirata JD, Swiersz LM, Zell B, et al. Does dong quai have estrogenic effects in po stmenopausal women? A doubl e-blind, placebo-controlled trial. Fertil Steril 199 7 ; 6 8 ( 6 ) : 9 8 1 - 6 . 5 1 Liu MA, Qi CH, Yang JC . Beijing J Trad Chin Med 198 8 ; 5 :30-31. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 4 5 Module One M e d i c i n a l U s e s Orally, dong quai is used for gynecological complaints including menstrual cramps, irregularity, retarded flow, weakness during the menstrual period, infertility, and symptoms of menopause. It is also used orally as a ?blood purifier?, to manage hypertension, atherosclerosis, rheumatism, ulcers, anemia, and constipation, and with allergic attacks. Dong quai may also be effective in chronic hepatitis and cirrhosis. Contraindications Dong quai is not safe for use during pregnancy because of its possible hormonal, anticoagulant, anti-platelet, and stimulant and relaxant effects. Dong quai should also be avoided while breast-feeding. Because dong quai has estrogenic effects, women with hormone sensitive conditions including breast cancer, uterine cancer, ovarian cancer, endometriosis, and uterine fibroids should avoid using dong quai. Dong quai contains several constituents that are carcinogenic. Whether these constituents are present in concentrations large enough to cause cancer with long-term or high-dose use is unknown. It may be unsafe when used orally in large amounts. Contraindications according to traditional Chinese medicine are as follows: Diarrhea caused by weak digestion, hemorrhagic disease, bleeding tendency or very heavy periods, and acute viral infections such as colds and influenza 5 2 . A d v e r s e E f f e c t s Dong quai also contains psoralens that may cause photosensitivity and photodermatitis. 5 2 Zhu DP . Am J Chin Med 198 7 ; 15 (3-4): 11 7 - 1 2 5 . Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 4 6 Module One Drug and Supplement Interactions Simultaneous use of herbs that have coumarin constituents or affect platelet aggregation could theoretically increase the risk of bleeding in some people. These herbs include: Angelica, anise, arnica, asafoetida, bogbean, boldo, capsicum, celery, chamomile, clove, danshen, fenugreek, feverfew, garlic, ginger, ginkgo, ginseng panax, horse chestnut, horseradish, licorice, meadowsweet, prickly ash, onion, papain, passionflower, poplar, quassia, red clover, turmeric, wild carrot, wild lettuce, and willow. Theoretically, dong quai might potentiate the therapeutic and adverse effects of anticoagulant and antiplatelet drugs. Dong quai has been reported to inhibit platelet aggregation. Concomitant use increases the anticoagulant effects of warfarin and the risk of bleeding. Regulatory Status Australia: Dong quai is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. UK: Dong quai is not on the UK General Sales List. U.S.: Dong quai does not have GRAS status. However, it is freely available as a ?dietary supplement? in the USA under DSHEA legislation (1994), and is accepted as a safe food additive. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 4 7 Module One A p i u m g r a v e o l e n s Image 5: by Zoofari (2008) via Wikipedia.org Taxonomic Notes Botanical common name: Celery Family: Apiaceae/Umbelliferae C o m m o n N a m e s Ache des Marais, apii fructus, celery fruit, celery seed, fruit de celeri, smallage, selleriefruchte, and selleriesamen P r i m a r y U s e s When taken orally, celery is traditionally used for rheumatism, gout, hysteria, nervousness, headache, weight loss due to malnutrition, loss of appetite, and exhaustion. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 4 8 Module One Celery is also used as a sedative, mild diuretic, urinary antiseptic, digestive aid, menstrual stimulant, antiflatulent, aphrodisiac, to reduce lactation, for regulating bowel movements, for stimulating glands, for blood purification, and as a potential insect repellant. A 2008 study conducted by the Department of Parasitology at the Chiang Mai University in Thailand investigated the chemical composition, skin irritation, and mosquito repellent properties of celery-based products in comparison to commercial repellents. The goal of the study was to determine if a natural alternative to synthetic repellents would protect from mosquitoes. The results were promising. Of the 27 volunteers, none experienced irritation from the 25% ethanolic AHE solution. Researchers believe this AHE product, once developed, could be an effective and affordable alternative to synthetic mosquito repellents 5 3 . Though adequate studies are lacking, additional historical use of celery include: Antioxidant support, arthritis, cancer 5 4 , rheumatoid arthritis and osteoarthritis 5 5 , and as a tonic. Overview The ancient Greeks and Egyptians are known to have cultivated celery, which, most likely, was used as a medicine. Excavations of Egyptian tombs have uncovered remnants of celery leaves and flowers. Today, wild celery can be found throughout Europe, the Mediterranean, and in parts of Asia. Though the leaves, stalks, root, 5 3 Tuetun B, Ch o ochote W, Po n g paibul Y, Ju n k u m A, Kanjanapothi D, Chaithon g U, Jitpakdi A, Riyo n g D, Pitasawat B. Celery-based topical repellents as a potential natural alternative for personal protection against mo s q uitoes. Parasitol Res . 2008 Dec;104(1) : 107-1 5 . Ep ub 2008 Sep 3. 5 4 Chu YF , Su n J, W u X, Liu RH. Antioxidant and antiproliferative activities of comm o n vegetables. J Agric Foo d Chem . 2002 No v 6; 50(23):6 9 10-6. 5 5 Woods JA , Jewell C, O 'Brien NM. Sedanolide, a natural phthalide from celery seed oil: effect on hydrogen peroxide and tert-butyl hydroperoxide- induced toxicity in HepG2 and CaCo- 2 hu man cell lines. In Vitr Mol Toxicol . 2001 Fall;14(3):233-40. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 4 9 Module One and seeds are all edible, the stalk and seeds are used most often. Specifically, Western cuisine is most familiar with cultivated celery, whose stalk is frequently eaten raw or cooked into foods. Allergy to celery is fairly common, because celery contains an allergen similar to the birch pollen allergen. Both in its raw and cooked form, there have been cases reported of contact dermatitis to anaphylactic shock 5 6 . P a r t s U s e d Fruit and seed Dosage and Administration For oral use, typical dosage is .5-2 g of dried fruit, three times daily, or one cup of tea. To prepare a tea, simmer 1 g of fresh, crushed dried fruit in 5 oz of boiling water for 5-10 minutes. Drink tea three times daily 5 75 8 . For use as a liquid extract, .01-.04 oz in a 1:1 ratio with 60% alcohol, three times daily 5 9 . Active Constituents Celery contains phenols and furocoumarins, phototoxic compounds 6 0 . Celery seed oil is a significant source of natural sedanolide, which is 5 6 Ruë f f F, Eberlein-K ö nig B, Przybilla B. Oral hyp o sensitization with celery juice. Allergy . 2001 Jan;5 6 ( 1 ) : 8 2 -3. 5 7 Newall CA , A nderson LA , Philpso n JD . Herbal Medicine: A Guide for Healthcare Professionals . Lo ndon, UK : The Pharmaceutical Press, 19 9 6 . 5 8 Wichtl MW. Herbal Drugs and Phytopharmaceuticals . Ed. N.M. Bisset. Stuttgart: Medpharm GmbH Scientific Publishers, 19 94. 5 9 Newall CA , A nderson LA , Philpso n JD . Herbal Medicine: A Guide for Healthcare Professionals . Lo ndon, UK : The Pharmaceutical Press, 19 9 6 . 6 0 Egan CL , Sterling G . Ph ytop h otodermatitis: a visit to Margaritaville. Cutis . 19 93 Jan;5 1 ( 1 ) :41-2 . Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 5 0 Module One found in edible umbelliferous plants and used as an herbal remedy for inflammation 6 1 . Celery tuber also contains methoxsalen (8- methoxypsoralen) and 5-methoxypsoralen. Pharmacological Action The sedative, diuretic, and antispasmodic effects of celery seeds may be caused by phthalide constituents (d-limonene, selinene, and related phthalides) 6 26 3 . Celery seed oil has bacteriostatic effects. The activity of celery seed is considered dependent on processing the material at low temperatures. Celery plant extracts have hypotensive and hypoglycemic effects, and preliminary research has shown celery-based preparations to have antiarthritis properties 6 4 . Celery is a rich source of calcium, magnesium, and iron 6 5 . Celery also contains the constituent, apiogenin, which has antiplatelet activity, the furocoumarins bergapten and celereodise, a dihydrofurocoumarin glycoside (isoquercitrin), and the coumarin glycoside apiumoside 6 6 . 6 1 Woods JA , Jewell C, O 'Brien NM. Sedanolide, a natural phthalide from celery seed oil: effect on hydrogen peroxide and tert-butyl hydroperoxide- induced toxicity in HepG2 and CaCo- 2 hu man cell lines . In Vitr Mol Toxicol . 2001 Fall;14(3):233-40. 6 2 Newall CA , A nderson LA , Philpso n JD . Herbal Medicine: A Guide for Healthcare Professionals . Lo ndon, UK : The Pharmaceutical Press, 19 9 6 . 6 3 The Review of Natural Products by Facts and Comparisons . St. Lo uis, MO: W olters Kluwer Co., 19 9 9 . 6 4 Wichtl MW. Herbal Drugs and Phytopharmaceuticals . Ed. N.M. Bisset. Stuttgart: Medpharm GmbH Scientific Publishers, 19 94. 6 5 Brinker F. Herb Contraindications and Drug Interactions . 2nd ed. Sandy, O R : Eclectic Medical Publications , 19 9 8 . 6 6 The Review of Natural Products by Facts and Comparisons . St. Lo uis, MO: W olters Kluwer Co., 19 9 9 . Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 5 1 Module One Contraindications Celery is contraindicated for use with kidney disorders and might increase inflammation. Use during pregnancy and while breast-feeding is likely safe if consumed within amounts commonly found in foods; however, the oil or seeds should not be consumed orally in large amounts. Celery might have uterine stimulant or abortifacient effects 6 7 . A d v e r s e E f f e c t s Celery can cause contact dermatitis, and allergic and anaphylactice reactions have been documented. Cross-allergenicity is possible between celery and carrots, dandelion, or wild carrot 6 86 9 . Avoid consuming large amounts of celery seed oil, which can induce Consuming large amounts of celery seed oil may induce Central Nervous System (CNS) depression. Drug and Supplement Interactions Simultaneous use of herbs with coumarin constituents, or herbs that act on platelet aggregation, might increase the risk of bleeding in some people. These herbs include: Angelica, anise, arnica, asafoetida, bogbean, boldo, capsicum, chamomile, clove, danshen, fenugreek, feverfew, garlic, ginger, ginkgo, Panax ginseng, horse chestnut, horseradish, licorice, meadowsweet, prickly ash, onion, papain, passionflower, poplar, quassia, red clover, turmeric, wild carrot, wild lettuce, and willow. Simultaneous use of herbs with sedative properties could increase therapeutic and adverse effects. These herbs include: Calamus, 6 7 Brinker F. Herb Contraindications and Drug Interactions . 2nd ed. Sandy, O R : Eclectic Medical Publications , 19 9 8 . 6 8 Newall CA , A nderson LA , Philpso n JD . Herbal Medicine: A Guide for Healthcare Professionals . Lo ndon, UK : The Pharmaceutical Press, 19 9 6 . 6 9 The Review of Natural Products by Facts and Comparisons . St. Lo uis, MO: W olters Kluwer Co., 19 9 9 . Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 52 Module One calendula, California poppy, catnip, capsicum, couch grass, elecampane, Siberian ginseng, German chamomile, goldenseal, gotu kola, hops, Jamaican dogwood, kava, lemon balm, sage, St. John?s wort, sassafras, scullcap, shepherd?s purse, stinging nettle, valerian, wild carrot, wild lettuce, ashwagandha root, and yerba mansa. Theoretically, the psoralen content in celery might increase the phototoxic response to PUVA therapy 7 0 . Drugs used in PUVA therapy include, methoxsalen (8-methoxypsoralen, 8-MOP, Oxsoralen) and Trioxsalen (Trisoralen). Regulatory Status Celery is listed in the Botanical Safety Handbook as a Class 2b. 7 0 Gral N, Beani JC , Bo n n ot D, et al. [Plasma levels of ps oralens after celery ingestion ] . [Article in French]. Ann Dermatol Venereol 1993;120:59 9 - 603. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 5 3 Module One A r n i c a m o n t a n a Image 6: from Bernd Haynold (2008) via Wikipedia.org Taxonomic Notes Common botanical name: Arnica Family: Asteraceae (formerly Comopositae ) Common Names Leopard?s bane, mountain tobacco, and wolf?s bane P r i m a r y U s e s Arnica is used topically for bruising, sprains, swellings, muscle pain, symptoms of varicose veins, and hemorrhoids. Stimulates peripheral blood supply and has anti-inflammatory and edema-reducing activity 7 1 . 7 1 Schroder H, et al. ?Helenalin and 11 alpha, 13-dihydrohelenalin, two constituents from Arnica montana L., inhi bit human platelet function via thiol- dependent pathways.? Thromb Res 1 9 90;57 ( 6 ) : 839-45. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 5 4 Module One Arnica has also been used orally for mouth and throat inflammation, insect bites, superficial phlebitis, and as an abortifacient. However, according to the Natural Standard database, arnica is toxic when taken internally except when diluted in homeopathic preparations. Overview Arnica is a perennial herb that grows 30-60 cm high and has bright yellow flowers. It is native to the mountain pastures of central Europe and a protected species in Germany. Growing scarcity may be due to soil quality. Often another closely related species is used in place of Arnica montana , A. chamissonis ssp. foliosa . Products adulterated with Mexican arnica ( Heterotheca inuloides ), a common substitute, should be avoided. Traditionally, arnica has been a popular remedy for external sprains, bruises, edema, and wounds. Topical application on uncovered, unbroken skin is always in diluted form. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 5 5 Module One Identifying Characteristics Part Characteristics Leaves Large, bright-green elliptical leaves with toothed edges Flowers Flower heads have small stems of equal length that form rounded clusters called umbels; greenish- yellow to yellow-orange; blooms June-August Root Long, thick, fleshy, and weigh up to 3 lbs.; when cut, they will yield a pungent yellowish liquid Fruit Pale, yellow, and oblong Taste Spicy and bitter Odor Faintly aromatic P a r t s U s e d Flower heads C u l t i v a t i o n a n d C o l l e c t i o n Arnica is a perennial hardy to Zone 4 or 5 that will grow 1-2 feet (ft.) high. It is generally propagated from seed, although mature plants can be divided. Seeds are difficult to germinate and must be stratified for 8-12 weeks. Germination is slow, 30 days or more, and the percentage of viable sprouts is low. When 3-4 months old, arnica is large enough to transplant. Divisions are easily made in the spring and mature plants will yield several healthy divisions. In late spring, transplants from an early seeding can be planted in the field. Spacing is one ft. apart in the row and two ft. between rows. Water immediately. Arnica grows best under full sun in rich, well-drained soil. It likes regular moisture but can easily be killed by too much water, especially during the dormant winter season. Weed control is important because arnica grows slowly the first year, but once established, it is hardy. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 5 6 Module One Harvest the flower as it starts to mature. Once picked, the flower breaks down easily, so keep the flowers cool and ship immediately if they need to be fresh upon delivery. If the flowers are to be dried, keep them in the shade until they are put in the dryer. Drying time is 5-7 days. Dosage and Administration Lotion: Dilute a 1:5 tincture by five times with water and apply 2-3 times daily. Ointment should contain about 10-25% tincture or about 15% arnica oil. Apply 2-3 times daily. Arnica preparations should not be applied to open wounds or near eyes or mouth. Poultice: 2-3 g of arnica is covered with 150 mL of hot water and strained after 10 minutes. Bandages or gauze are soaked in the infusion and then placed on the affected area. Oil: Arnica oil is obtained by macerating one part arnica flowers in five parts vegetable oil. The tincture (1:5, 45%) is also used topically as a lotion or ointment. Duration of Administration Prolonged use, which can be defined as continuous use for more than three weeks, should be avoided. Active Constituents The active components in arnica are the sesquiterpene lactones such as arnifolin, arnicolides, and helenalin, along with polysaccharides called heteroglycans. It also contains flavonoids such as eupafolin, patuletin, and spinacetin. A volatile oil that contains the antiseptic constituent thymol also is present. Phenolic acids, coumarins, carotenoids, bitters (arnicin), resins, and tannins also have been isolated. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 5 7 Module One Pharmacological Action Arnica has been shown to be an immunostimulant, as both the sesquiterpene lactone helenalin and the polysaccharide fraction stimulate phagosytosis, where a cell engulfs and digests foreign matter. Many sesquiterpene lactones have demonstrated anti-inflammatory and analgesic effects in animal models 7 2 . Mode of action for these arnica constituents has been isolated for multiple sites: ? Uncoupling of oxidative phosphorylation in neutrophils, white blood cells. ? Elevation of cAMP in rat neutrophils and liver cells. ? Inhibition of lysosomal enzymatic activity in mice/rat neutrophils and liver cells 7 3 . Helenalin and another arnica sesquiterpene lactone (11 alpha-13- dihydrohelenalin) inhibited platelet aggregation and thromboxane formation, both processes related to the inflammatory process 7 4 . M e d i c i n a l U s e s Clinical trials support the use of arnica topically for chronic venous insufficiency and muscle ache. Traditional uses are also topical for bruises, sprains, swellings, unbroken chilblains, hematomas, inflammations, dislocations, edema associated with fractures, hemorrhoids, rheumatic, muscle and joint complaints, inflamed insect bites, surface phlebitis, and symptoms of varicose veins. 7 2 Lys s G, et al. Helenalin, an antiinflammatory sesquiterpene lactone from Arnica, selectively inhibits transcription factor NF- kappa B. Biol Chem 199 7 ;378( 9 ) : 9 5 1 - 6 1 . 7 3 Hall, I. H., Starnes, C. O ., Jr., Lee, K. H., and Waddell, T. G . Mode of action of sesquiterpene lactones as anti-inflammatory agents. J Pharm Sci. 1980;69 ( 5 ) : 537-543. 7 4 Schroder H, et al. Helenalin and 11 alpha, 13-dihydrohelenalin, two constituents from Arnica montana L., inhi bit human platelet function via thiol- dependent pathways. Thromb Res 1 9 90;57 ( 6 ) : 839-45. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 5 8 Module One Pharmacologic studies suggested a use for topical antimicrobial activity. Other possible applications may be topical use for Alopecia neurotica and in hair preparations to prevent dandruff and stimulate scalp circulation. Contraindications Arnica is poisonous if taken internally. It is an irritant to mucous membranes and ingestion may result in gastroenteritis, muscle paralysis, increase or decrease in pulse rate, heart palpitations, shortness of breath and may even lead to death 7 5 . Helenalin is considered the toxic component responsible for these effects. The internal use of arnica is contraindicated for use during pregnancy due to its abortifacient property and toxicity 7 6 . Arnica preparations should not be applied to open wounds or near the eyes or mouth. A d v e r s e E f f e c t s Externally, arnica is poorly tolerated by some people, leading to allergic reactions in those with sensitive skin. It should only be applied to unbroken skin and withdrawn at the first sight of reaction. Be aware of toxic allergic skin reactions. Avoid using on those with arnica or other Compositae family allergies (including chamomile, yarrow, and calendula). Drug and Supplement Interactions When used with other drugs and/or supplements, herbs that have coumarin constituents or affect platelet aggregation could theoretically increase the risk of bleeding in some people. Some of these herbs include: Angelica, anise, asafoetida, bogbean, boldo, capsicum, celery, chamomile, clove, danshen, fenugreek, feverfew, garlic, ginger, ginkgo, Panax ginseng, horse chestnut, horseradish, licorice, meadowsweet, prickly ash, onion, papain, passionflower, 7 5 No authors listed. Final report on the safety assessment of Arnica montana extract and Arnica montana. Int.J.Toxicol . 2001;20 Sup pl 2:1 - 1 1 . 7 6 No authors listed. Final report on the safety assessment of Arnica montana extract and Arnica montana. Int.J.Toxicol . 2001;20 Sup pl 2:1 - 1 1 . Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 5 9 Module One poplar, quassia, red clover, turmeric, wild carrot, wild lettuce, and willow. According to the Natural Medicines database, there is some concern that arnica might activate the effects of anticoagulant and antiplatelet drugs and could possibly increase the risk of bleeding. Until more is known, use cautiously with patients who are taking anticoagulant or antiplatelet drugs. Some of these drugs include: Aspirin, clopidogrel (Plavix), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, ticlopidine (Ticlid), warfarin (Coumadin), and others. C l i n i c a l R e v i e w Quarz et al (1995) studied the effects of an arnica gel (20% tincture) versus placebo on 89 patients with chronic venous insufficiency. This was a randomized, double blind, placebo-controlled study. After three weeks, the symptoms of heaviness in the legs together with objective measurements of edema and venous tone were assessed. It was reported that the use of arnica produced improved venous tone, edema and feeling of heaviness in the legs as compared to placebo. The efficacy of arnica in the support of symptoms associated with varicose veins is believed to be due to a protective effect against edema 7 7 . Regulatory Status Arnica for external use is covered by a positive Commission E Monograph. Australia: Arnica for internal use is included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. External use of arnica is unrestricted. UK: It is not on the UK General Sale List. U.S.: For use in foods, arnica has Generally Recognized as Safe Status in the U.S. Otherwise, it is freely available as a dietary supplement in the U.S. under DSHEA legislation (1994 Dietary Supplement Health 7 7 Quarz P, Landfrebe W, W o hling D, et al. Paper presented at the 6th Ph ytotherapy Co n gress, Berlin, Oct 5-7 , 19 9 5 . Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 6 0 Module One and Education Act). Arnica for internal use is included in the Therapeutic Goods Act Regulations of Australia. External use is unrestricted. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 6 1 Module One A s t r a g a l u s m e m b r a n a c e u s Image 7: by Doronenko (2007) via Wikipedia.org Taxonomic Notes Common botanical name: Astragalus Family: Leguminosae (formerly Fabaceae ) C o m m o n N a m e s Astragali, beg kei, bei qi, buck qi, huang qi, hwanggi, membranous milk vetch, milk vetch root, Mongolian milk, and ogi. The Chinese name ?huang qi? means ?yellow root?, in reference to the color. P r i m a r y U s e s Astragalus has been used in traditional Chinese medicine for centuries. In combination with other herbs, astragalus is known as an adaptogen, with the ability to increase resistance to stress and disease, and to rebalance the body. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 62 Module One Traditionally, the sap from the astragalus species cultivated in Iran has been used commercially as a thickening agent for foods, lotions, and pharmaceuticals. Overview Astragalus is a perennial, medium height plant native to the drier areas of northern China and Mongolia. It now is cultivated throughout the world. Some species, including the locoweeds, are known to cause intoxication in livestock, which can be passed to humans through milk and meat. Astragalus membranaceus is not one of these selenium- accumulating species. Identifying Characteristics Part Characteristics Leaves Compound leaf with 12-18 pairs of leaflets Flowers Yellow, pea-like flowers that grow up to one inch and bloom in early summer Root Flexible, long, and covered with a tough, wrinkled, yellowish-brown exterior; the woody interior is yellowish-white in color (a yellowish color is traditionally associated with high quality, as the flavonoids and isoflavonoids impart this color 7 8 ) Fruit Seedpods are up to six inches long Taste Mild, sweetish taste Odor Roots are said to have a peculiar odor P a r t s U s e d Dried root 7 8 B o ne K. Clinical Applications of A y urvedic and Chinese Herbs. Mono graphs for the Western Herbal Practitioner. Phytotherapy Press 19 9 6 , 13. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 6 3 Module One C u l t i v a t i o n a n d C o l l e c t i o n Astragalus is a deciduous perennial hardy to Zone 4. It grows 3-6 feet (ft.) high and spreads on top to about three ft. Astragalus is easily propagated from seed and will germinate in about four weeks, with up to 12 weeks to transplant size. It must be in extremely well-drained potting mix, as it is susceptible to rot. Do not grow in heavy soil with lots of rain, or try raised beds. Transplant in late spring or early summer; plant one ft. apart and space rows 2-3 ft. apart. The soil should be deep and alkaline, and the plant prefers full sun. The long root is harvested in the late fall after three or more years of growth. To process, clean and cut the roots into small pieces and dry for approximately 7-10 days. Dosage and Administration When taken orally, a typical dose of the dried root is 10-30 g taken daily by decoction. As a 1:2 ratio liquid extract, an average dose is about 1-1 ½ teaspoons. In some cases, people have used astragalus powder 30-60 g (1-2 oz) per day. However, this should be avoided, because some research suggests that doses greater than 28 g (0.98 oz) per day offers no additional benefit and might even cause immune suppression. According to Upton 7 9 , astragalus is most commonly used in combination with other herbs. D u r a t i o n o f A d m i n i s t r a t i o n Astragalus may be administered long term for most applications, but note contraindications during acute infections. Active Constituents Astragalus root contains many triterpenoid saponins such as astragaloside I and astragaloside VIII. The root also contains flavonoid 7 9 Upton R, ed. Astragalus Root: Analytical, quality control, and therapeutic monograph . Santa Cruz, CA : American Herbal Pharmacopoeia. 19 9 9 : 1 - 2 5 Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 6 4 Module One glycosides and aglycones, polysaccharides, multiple trace minerals, amino acids such as gamma-aminobutyric acid, and canavanine, coumarins, and essential oil. The flavonoids give it its yellow color. Pharmacological Action Astragalus is an antioxidant. It has been shown to inhibit free radical production, increase the enzyme superoxide dismutase 8 0 , and decrease lipid peroxidation 8 18 2 . Astragalus is often promoted for its effects on the immune system, liver, and cardiovascular system. Astragalus seems to improve the immune response by potentiating the effects of interferon, and increasing antibody levels of IgA and IgG in nasal secretions 8 3 . It also seems to improve the response of mononuclear cells and stimulate lymphocyte production 8 4 . Additionally, there is preliminary evidence that astragalus extracts can restore or improve immune function in cases of immune deficiency 8 58 6 . For example, astragalus seems to restore suppressed T-cell function 8 0 S u peroxide dismutase catalyzes the dismutation reaction of the toxic superoxide radical to molecular oxy gen and hydrogen peroxide. It forms a crucial part of the cellular antioxidant defense mechanism . 8 1 Lipid peroxidation ? ox y gen-dependent deterioration of lipids kn o w n as rancidity. 8 2 U pton R, ed. Astragalus Root: Analytical, quality control, and therapeutic monograph . Santa Cruz, CA : American Herbal Pharmacopoeia. 19 9 9 : 1 - 2 5 . 8 3 U pton R. Ibid. 8 4 S u n Y, Hersh EM, Lee SL, et al. Prelimin ary observations on the effects of the Chinese medicinal herbs Astragalus membranaceus and Ligustrum lucidum on lym p h ocyte blastogenic respo n ses. J Biol Response Mod 1983;2:2 2 7 -37. 8 5 S u n Y, Hersh EM, Talpaz M, et al. Imm u ne restoration and/or augmentation of local graft versus ho st reaction by traditional Chinese medicinal herbs. Cancer 1 9 83;52 ( 1 ) : 70-3. 8 6 C h u D T , W o n g W L , Mavligit GM. Imm u n otherapy with Chinese medicinal herbs. II. Reversal of cycloph o s p hami de-induced imm u ne sup pression by administration of fractionated Astragalus membranaceus in vivo . J Clin Lab Immunol 198 8 ; 2 5 : 1 2 5 - 9 . Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 6 5 Module One in cancer patients 8 7 . In animal models, an astragalus extract can reverse cyclophosphamide-induced 8 8 immune deficiency 8 9 . Lower doses of astragalus appear to stimulate the immune system, but doses in excess of 28 g (0.98 oz) might suppress immunity 9 0 . When administered intravenously, some evidence suggests astragalus extract might increase proliferation and differentiation of bone marrow stem cells and progenitor cells 9 19 2 . Astragalus also shows evidence of broad-spectrum antibiotic activity 9 3 . In individuals with chronic hepatitis, astragalus seems to improve liver function, as demonstrated by improvement in serum glutamate pyruvate transaminase (SGPT) levels 9 4 . Astragalus also is thought to possess cardiotonic and hypotensive actions. It has been shown to cause vasodilation and increase cardiac output, which might be beneficial in angina, congestive heart failure, and post-myocardial infarction 9 5 . Medicinal Uses When taken orally, astragalus is used for supporting the immune system during the common cold and upper respiratory infections, and 8 7 S u n Y, Hersh EM, Talpaz M, et al. Imm u ne restoration and/or augmentation of local graft versus ho st reaction by traditional Chinese medicinal herbs. Cancer 1 9 83;52 ( 1 ) : 70-3. 8 8 C ycloph o s p hamide is in a class of drugs kn o w n as alkylating agents. It is used to treat cancers. 8 9 C h u D T . Ibid. 9 0 U pton R. Ibid 9 1 Progenitor cells are fou nd in all tissues and are respo n sible for the growth and regeneration of those tissues throug h o ut the life of the organism . 9 2 Upton R. Ibid. 9 3 U pton R. Ibid. 9 4 U pton R, ed. Astragalus Root: Analytical, quality control, and therapeutic monograph . Santa Cruz, CA : American Herbal Pharmacopoeia. 19 9 9 : 1 - 2 5 . 9 5 U pton R. Ibid. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 6 6 Module One to strengthen and regulate the immune system. It is also used in particular to increase the production of blood cells in individuals with chronic degenerative disease or in individuals with cancer who are undergoing chemotherapy or radiation therapy. In addition, astragalus is consumed orally for use with nephritis, diabetes, as an antibacterial and antiviral, a tonic, liver protectant, anti- inflammatory, antioxidant, and as a diuretic, vasodilator, or hypotensive agent. Clinical trials support the use of astragalus for impaired immunity, especially if associated with leucopenia, as an adjunct in the support of cancer care, for viral infections including the common cold, and cervical erosion associated with herpes simplex virus infection. Traditional uses of astragalus include postpartum fever and recovery from severe blood loss, fatigue, decreased appetite, organ prolapse, uterine bleeding, decreased vitality, palpitations with shortness of breath, spontaneous sweating, prostration, and chronic diarrhea. Pharmacologic studies suggest astragalus is useful for the general prevention of infection, conditions resulting in immune suppression including support for clients receiving chemotherapy, viral infections, general debility, hypertension, and protection against oxidative damage. Contraindications Astragalus is likely safe when taken in the recommended doses, but should not be used by clients with a known allergy to Astragalus membranceus , its constituents, or other members of the Fabaceae family. Not advisable during acute infections. A d v e r s e E f f e c t s The toxicity of astragalus root is reportedly very low. Although side effects have not been reported, doses greater than 28 g (0.98 oz) might cause immunosuppression. Astragalus might increase immune system activity and may not be appropriate for individuals with autoimmune disorders. It has been suggested that astragalus might interfere with immunosuppressive therapy and it is recommended to avoid concurrent use. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 6 7 Module One Drug and Supplement Interactions There are no known adverse interactions with any herbs or supplements. Some evidence suggests astragalus might reduce immunosuppression caused by cyclophosphamide (Cytoxan, Nekoosa). As previously mentioned, concurrent use might interfere with immunosuppressive therapy. Until there is further research, avoid concurrent use with immunosuppressant drugs such as azathioprine (Imuran), basiliximab (Simulect), cyclosporine (Neoral, Sandimmune), daclizumab (Zenapax), muromonab-CD3 (OKT3, Orthoclone OKT3), mycophenolate (CellCept), tacrolimus (FK506, Prograf), sirolimus (Rapamune), prednisone (Deltasone and Orasone), and other corticosteroids (glucocorticoids). Clinical Review According to the Natural Standard database, animal and in vitro data suggest several potential therapeutic applications for astragalus when used in combination with other herbs; it is not clear if astragalus alone will have the same effects. Well-designed clinical trials evaluating astragalus as a monotherapy are needed before a strong recommendation can be made. Studies have been conducted, however, to determine the viability of astragalus for use with leucopenia. Weng studied the effects of either a high dose of astragalus (~ 30 g or ~ 1 oz per day) or a low dose (~ 10g or ~ 0.33 oz per day) preparation over a period of eight weeks on 115 patients with leukopenia 9 6 . This was an open randomized clinical trial. Results showed a significant rise in white blood cell (WBC) counts in both groups after the 8-week period, although counts in the high dose group were highest 9 7 . In another study, Li examined the effects of a ginseng-astragalus injection on 176 patients with malignant tumors of the digestive tract. 9 6 Leuko penia is a reduction of in the circulating white blood cell count. 9 7 Weng XS . Ch u n g Ku o Ch u n g His I Chieh Ho Tsa Chih 19 9 5 ; 15 (8 ) : 462- 464. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 6 8 Module One This was a comparative clinical study. Results showed that when used with chemotherapy this astragalus preparation reduced toxic chemotherapy effects, increased body weight and increased cellular immune function when compared to chemotherapy alone 9 8 . Li et al studied the effects of astragalus on 92 patients suffering from ischemic heart disease in a comparative trial. Patients were given astragalus Salvia miltiorrhiza or the antianginal drug nifedipene. Results were superior for those taking astragalus as evidenced by marked relief from angina pectoris and improvements in other clinical parameters 9 9 . Regulatory Status Australia: Astragalus is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. United Kingdom: Astragalus is not covered by a Commission E Monograph and is not on the UK General Sales List. United States: Astragalus does not have GRAS status. However, it is freely available as a dietary supplement in the United States under DSHEA legislation (1994). American Herbal Products Association (AHPA) Safety Rating: Class 1?Herbs that can be safely consumed when used appropriately Assessment Structure See each module?s home page for full details of the assessment required for that module. Also, refer to the Assignments instruction page under the Course Home section. You should also view Gradebook to review the allocation of points for your final grade in this course. 9 8 Li NQ . Ch u n g Ku o Ch u n g His I Chieh Ho Tsa Chih 19 9 2 ; 12 (10):5 7 9 , 58 8- 5 9 2 . 9 9 Li SQ , Yuan RX , Gao H. Chu n g Ku o Ch u n g His I Chieh Ho Tsa Chih 19 9 5 ; 1 5 ( 2 ) : 7 7 - 80. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 6 9 Module One Each module assessment generally consists of two or more sections. These may consist of a module test and one or more required discussion board postings on an assigned topic, such as essay questions, case studies, labs, or practical exercises. Module Test Your module test is an important learning tool, as well as a way for us to assess how well you have understood and retained the information in the module. What is in your test? Module test questions are written by instructors and curriculum designers, and some come from test banks provided by the publisher. The material in your test is covered in your ACHS Textbook, publisher textbook(s), or online course materials. Questions are designed to range in difficulty from easier to more difficult, in order to provide a meaningful testing process. Test questions may require you to recall memorized facts, or may require analysis based on the information you have studied in the module. Some questions may require you to draw from information you have studied in past modules, although these are less common. Each module test uses a ?pool? of questions, and the computer draws a unique and random selection of questions for each student. For that reason, please refer to the question wording in full if you have any questions for your instructor, rather than the question number. Please review your graded tests Reviewing the instructor feedback is an important part of your learning, particularly for any questions you did not answer correctly. To view the instructor?s comments, click on your score in Gradebook, located in the Course Home, and a new window should pop up containing your graded test. Scroll down to view each question and associated comments. Ask your instructor if you do not understand a question. You can post a message at the Instructor?s Virtual Office, located on the left-hand toolbar of your Course Home online, or email your instructor. If you have queries about a specific test question, please email your instructor directly so that your question does not affect the testing of other students in your class. If Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 7 0 Module One you have general questions that are related to your test, feel free to post them in the discussion board so that other students can learn from your question (just as they would in a live class). Hint: Be sure to have pop up blocking software turned off so you can view your graded test. Discussion Postings In each module, you are required to complete a discussion posting, designed to assist student comprehension and retention of the course material. We will provide you with set topics for the discussion, which may include practical work, labs, research, essays, or many other options: You only need to choose and complete ONE topic for each module. Posting your discussion on each module discussion board is one of the course requirements. You are also required to post one meaningful response to another student?s posting. You should aim to complete your posting and response on the same day if possible. We encourage you to draft your posting and responses in a word processing document, such as Microsoft Word, and copy and paste your work into the discussion board. This gives you a lasting record of your work if you lose your Internet connection or are logged out. (If you are inactive for 15 minutes, the system logs you out automatically to preserve the integrity of the user activity logs.) The discussion/case study postings are open book, meaning you can use any materials you wish to prepare your answer, and post it to the discussion board. Be sure to cite any external sources correctly. Information on citing is in your ACHS Program Catalog. Post your response by clicking on the link Discussion under each module heading, and then on Respond. Include the word ?Module Discussion? and the name of your selection in the heading to assist your instructor to allocate your grade. Keep in mind that this sharing of answers is an important part of the learning process. Just as some students would be nervous to speak up in a classroom, you may find yourself nervous to post your response. This is perfectly normal, but do not let this slow your progress. Take a deep breath and post your answer. Everyone is here to learn with Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 7 1 Module One you. By sharing answers, each student learns from each other and your questions may help other students. This peer-to-peer interaction and synergy is one of the important benefits that our online interaction system adds to your distance-learning program. You will find that the sense of engagement you enjoy with your fellow students assists you to stay connected with your course and to build lifelong friendships. Getting Help As you get started with this first module assessment, remember that there are multiple resources available to you (see below). I n s t r u c t o r If you need any assistance from your instructor with the course material or assessment, please post a question at the Instructor?s Virtual Office, located on the left-hand toolbar of your Course Home online; at the module discussion board for the appropriate module; or email your instructor using the integrated email tool in your online course. If you have queries about a specific question, please email your instructor directly so that your question does not affect the testing of other students in your class. Your instructor logs into class each day, Monday through Friday, and at least once during the weekend. Help Desk In the unlikely event that you experience any technical difficulties, please call the technical support Help Desk at (877) 740-2213 or email helpdesk@myachsclass.com. The Help Desk is available 24 hours a day, seven days a week, 365 days a year. The Help Desk staff can help you with all technical computer-related questions (error messages, for example). If you need information about your student status (your log in information, for example), please call Student Services. Copyright © 2011 American College of Healthcare Sciences All duplication prohibited. Printed on recycled paper. 72 Module One Student Services You may email Student Services at stuserv@achs.edu or call (800) 487-8839 for assistance. The College Student Services team is available Monday through Friday, 8:30 a.m. to 5:30 p.m., Pacific Standard Time. Module Assessment You are now ready to log in and complete the module assessment online. 7 3 Module Two Module Two Module Objectives Upon completion of this module, you will be able to: ? Recall and describe the Latin binomial or scientific name, common name, and family. ? Be able to identify a photograph by the Latin name and common name of the botanicals studied. ? Identify the therapeutic potential of each botanical studied. ? Explain the pharmacological action of each botanical studied. ? List the key recommended uses for each botanical studied. ? Recall the recommended dosage and duration for each botanical studied. ? Recall and describe any contraindications and precautions associated with each botanical studied. ? Recall the regulatory status of each of botanical studied. Module Checklist ? Read and review the module. ? Read any online resources as applicable. ? Ensure you can meet the Module Objectives. ? Complete the module assessment online and respond to another student?s posting as instructed. ? Complete the Module Test. 2 7 4 Module Two B u p l e u r u m c h i n e n s e Image 8: by Girolamo Giardina (2006) via Wikipedia.org Taxonomic Notes Common botanical name: Bupleurum Family: Apiaceae Common Names Bei chai hu, chi hu, Chinese thoroughwax, hare?s ear root, sho-saiko- to, shrubby hare's-ear, sickle-leaf hare's-ear, and thoroughwax P r i m a r y U s e s Bupleurum is known to supports the body?s anti-inflammatory responses, modulate immunity, protect the liver, stomach, and kidneys from toxins, and decrease gastric ulcer development. Overview Though bupleurum resembles dill and fennel, it does not have lacey leaves but lanceate. Well known to the Chinese Pharmacopeia, 7 5 Module Two bupleurum has been used for more than 2,000 years as a liver tonic with toning properties, used with fevers, flu symptoms, cough, gynecological disorders, and general inflammation. Clinical studies suggest the blend Minor Bupleurum Decoction, a combination of nine herbs including bupleurum, may be effective for use with hepatitis B 1 0 01 0 1 and for the prevention of hepatocellular carcinoma. The blend may also be effective in vitro and in animal studies as a hepatoprotective 1 0 2 and an adjuvant for HIV infection 1 0 3 . P a r t s U s e d Root Dosage and Administration There is no known standard dosage for bupleurum alone. Active Constituents Bupleurum root has triterpene saponins 1 0 4 , polysaccharides, and polyacetylenes 1 0 5 . Bupleurum fruticosum contains phenylpropanoids 1 0 6 and the scorzonerifolium contains the lignan isochaihulacton 1 0 7 . 1 0 0 Chiang LC , Ng LT , Liu LT , Shieh DE , Lin CC . Cytotoxicity and anti-hepatitis B virus activities of saikosaponins from Bupleurum species. Planta Med . 2003 Aug ; 6 9 ( 8 ) : 705-9 . 1 0 1 Hirayama C, O k u m ura M, Tanikawa K, Yano M, Mizuta M, Ogawa N. A m ulticenter randomized controlled clinical trial of Sh o saiko-to in chronic active hepatitis. Gastroenterol Jpn . 19 8 9 Dec;24(6) : 7 1 5 - 9 . 1 0 2 Chin HW, Lin CC , Tang KS . The hepatoprotective effects of Taiwan folk medicine ham-h o n g -chh o in rats. Am J Chin Med . 19 9 6 ; 24(3-4):231-40. 1 0 3 Inada Y, Watanabe K, Kamiyama M, Kanemitsu T, Clark W S , Lange M. In vitro immu n o m odulatory effects of traditional Kampo medicine (sh o - saiko -to: SS T ) on peripheral mon o n uclear cells in patients with AIDS . Bio med Pharmacother . 19 90;44(1) : 1 7 - 9 . 1 0 4 Guinea MC, Parellada J, Lacaille-D ubois MA, Wagner H. Biologically active triterpene saponins from Bupleurum fruticosum . Planta Med . 19 94 Apr;60(2) : 1 63- 7. 7 6 Module Two Contraindications In general, bupleurum seems well tolerated. However, without sufficient clinical analysis, it is difficult to ascribe adverse effects to bupleurum alone (typically prescribed in combination with other herbs). However, in rat studies, saikosaponins, constituents of bupleurum, have been shown to increase plasma glucose concentrations 1 0 81 0 9 . 1 0 5 Wu W S , Tsai RK, Chang CH, Wang S, W u JR , Chang YX . Reactive oxy gen species mediated sustained activation of protein kinase C alpha and extracellular signal-regulated kinase for migration of hu man hepatoma cell Hepg2 . Mol Cancer Res . 2006 Oct;4(10):747-5 8 . 1 0 6 Bremner P, Tang S, Birkmayer H, Fiebich BL, Muñoz E, Marquez N, Rivera D, Heinrich M. Phenylpropanoid NF - kappaB inhibitors from Bupleurum fruticosum. Planta Med . 2004 Oct;70(10):9 14-8. 1 0 7 Chen YL , Lin SZ , Chang JY , Cheng YL , Tsai NM, Chen SP , Chang W L , Harn HJ. In vitro and in vivo studies of a novel potential anticancer agent of isochaihulactone on hu man lun g cancer A549 cells. Biochem Pharmacol . 2006 Jul 28 ; 7 2 (3):308-1 9 . Ep ub 2006 May 5. 1 0 8 Hiai S, Yo k o yama H, Nagasawa T, O u ra H. Stimulation of the pituitary- adrenocortical axis by saikos apo nin of Bu pleuri radix. Chem Pharm Bull (T o k y o ) . 19 8 1 Feb;29 ( 2 ) :495- 9 . 1 0 9 Yok o yama H, Hiai S, O ura H. Chemical structures and corticosterone secretion-inducing activi ties of saikosaponins . Chem Pharm Bull (To k y o ) . 19 8 1 Feb;29 ( 2 ) : 500-4. 7 7 Module Two C a p s e l l a b u r s a - p a s t o r i s Image 9: by Eike Wulfmeyer (2004) via Wikipedia.org Taxonomic Notes Common botanical name: Shepherd?s Purse Family: Brassicaceae Common Names Blind weed, bursae pastoris herba, capsella, caseweed, cocowort, lady?s purse, mother?s-heart, pepper-and-salt, pick-pocket, poor man?s parmacettie, rattle pouches, sanguinary, shepherd?s heart, shepherd?s scrip, shepherd?s sprout, shovelweed, St. James? weed, toywort, and witches? pouches 7 8 Module Two P r i m a r y U s e s When taken orally, shepherd?s purse can be used for headache, hypotension, PMS, regulating menstruation, vomiting blood or blood in urine, diarrhea, acute catarrhal cystitis, and mild cardiac insufficiency. Topically, shepherd?s purse is used for blood-related injuries like nosebleed and skin abrasions, as well as superficial burns. Overview Shepherd?s purse is one of the most commonly distributed flowering plants worldwide 1 1 0 , because, in part, of its self-survival and prolific growth tendencies. P a r t s U s e d Seeds, leaves, flowering shoots, seed oil, and seed pods Dosage and Administration Dried root: 1-4 g, three times daily Tea: One cup of tea, three times daily; to make tea, steep 1-4 g of dried shepherd?s purse in 150 mL of boiling water for 10-15 minutes, and then strain. Liquid extract: Use a 1:1 ratio in 25% alcohol taken three times daily in doses of 1-4 mL Avoid excessive amounts 1 1 1 . 1 1 0 Ceplitis A, Su Y, Lascoux M. Bayesian inference of evolutionary history from chloroplast microsatellites in the cosm o p olitan weed Capsella bursa- pastoris (Brassicaceae). Mol Ecol . 2005 Dec;14(14):4221 -33. 1 1 1 McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association Botanical Safety Handbook . Boca Raton, FL : CR C Press, LL C 19 9 7 . 7 9 Module Two Active Constituents The active constituents of shepherd?s purse include an organic acid, bursinic acid, and an alkaloid, bursine. Bursine resembles a sulphocyanide of sinapine , a sulfur compound found in the plants of the mustard family that is responsible for the bitter taste. Tannins are present. Other constituents include: Fumaric acid, choline, acetylcholine, aminophenol, tyramine, volatile oil, saponins, flavonoids, calcium, potassium, sulfur, sodium, and vitamin K. Shepherd?s purse has a definite styptic action but the constituent responsible for this has not been isolated. However, other styptic herbs are commonly high in tannins. Tyramine is responsible for the hypertensive action and is a sympathetic nervous system stimulant. Research has shown that shepherd?s purse contains two novel peptides, shepherin I and shepherin II, which exhibit antimicrobial activity 1 1 2 . The above ground parts of shepherd?s purse have constituents that are known to cause both positive and negative inotropic and chronotropic effects. Shepherd?s purse also might cause hypertensive and antihypertensive effects, stimulate smooth muscle, increase uterine contraction with abortifacient effects, and antihemorrhagic and urinary antiseptic effects 1 1 31 1 4 . In addition, shepherd?s purse may be effect for use with abnormal thyroid function and goiter. Its constituent sinigrin, which can break 1 1 2 http:/ / naturalstandard.com / natural standard/mo n o graphs / m o n o frameset.as p? m o n o graph= / m o n o graphs / herbssu p pl ements/s hepherdspurse.asp Accessed 4/16 / 2010 11 3 Newall CA , A nderson LA , Philpso n JD . Herbal Medicine: A Guide for Healthcare Professionals . Lo ndon, UK : The Pharmaceutical Press, 19 9 6 . 1 1 4 Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines . 1st ed. Montvale, NJ: Medical Econo mics Co m pany , Inc., 19 9 8 . 8 0 Module Two down to allyl isothiocyanate, is associated with both abnormal thyroid function and goiter 1 1 5 . Medicinal Uses Antimicrobial Alkaloids and flavonoids of shepherd?s purse were found to exert highly potent antimicrobial activity against a broad spectrum of microbes, including Gram-negative bacteria and fungi 1 1 6 . Antitumor Fumaric acid isolated from shepherd?s purse has been shown to inhibit the growth of Ehrlich tumors in mice 1 1 7 . Diuretic As a diuretic it is supportive for fluid retention, swelling and high uric acid and where uric acid or insoluble phosphates or carbonates produce irritation of the urinary tract 1 1 8 . However, it is possibly unsafe when used in patients with kidney stones, according to secondary sources 1 1 9 . 1 1 5 Newall CA , A nderson LA , Philpso n JD . Herbal Medicine: A Guide for Healthcare Professionals . Lo ndon, UK : The Pharmaceutical Press, 19 9 6 . 1 1 6 Park, C. J., Park, C. B., Hong, S. S., Lee, H. S., Lee, S. Y., and Kim , S. C . Characterization and cDN A cloning of two glycine- and histidine-rich antimicrobial peptides from the roots of shepherd?s purse, Capsella bursa- pastoris. Plant Mol.Biol 2000;44(2) :1 8 7 - 1 9 7 . 1 1 7 Kuroda, K., A kao, M., Kanisawa, M., and Miyaki, K. Inhibitory effect of Capsella bursa-pastoris extract on growth of Ehrlich solid tumor in mice. Cancer Res. 197 6 ;36(6 ) : 1 900-1903. 1 1 8 http:/ /botanical.com/bot anical/mg m h / s / s hephe47.html 1 1 9 http:/ / naturalstandard.com / naturalst andard/mo n o graphs / m o n o frameset.asp? m o n o graph= / m o n o graphs / herb ssu p plements/s hepherdspurse.asp 8 1 Module Two Skin De-Pigmenting Effects In experimental studies, an extract of shepherd?s purse had marked inhibitory effects on melanin synthesis in mouse melanoma cells. Based on these findings, the investigators concluded that shepherd?s purse may have potential as a whitening agent for UV-sensitive skin 1 2 0 . Styptic Shepherd?s purse is an extremely useful herb as it promotes blood clotting. Its hemostyptic properties are similar to ergot or hydrastis and it was used as a substitute during shortages in World War I. When dried and infused, it yields a tea, which is still considered by many herbalists to be one of the best styptics for stopping hemorrhages of all kinds: Hemorrhages of the stomach, the lungs, or the uterus, and more especially bleeding from the kidneys. It was traditionally used in catarrhal conditions of the bladder and ureters, also in ulcerated conditions and abscess of the bladder, and when there is white mucous in the urine. It is used as a fresh decoction in hematuria, or blood in the urine. As a styptic it is also supportive for diarrhea and heavy menses. Contraindications Avoid if there is a known allergy to shepherd?s purse, its constituents, or the Brassicaceae family. Avoid use during pregnancy due to its abortifacient properties. Regulatory Status Listed in the Botanical Safety Handbook in Class 2b. 1 2 0 http:/ / naturalstandard.com / naturalst andard/mo n o graphs / m o n o frameset.asp? m o n o graph= / m o n o graphs / herb ssu p plements/s hepherdspurse.asp 82 Module Two C e n t e l l a a s i a t i c a ( synonym H y d r o c o t y l e a s i a t i c a ) Image 10: by Forest and Kim Starr (2002) via Wikipedia.org Taxonomic Notes Common botanical name: Gotu Kola Family: Apiaceae C o m m o n N a m e s Brahma-buti, brahma-manduki, brahmi, centella, centellase, gota kola, gotu cola, gotu-kola, hydrocotyle, hydrocotyle asiatique, indischer wassernabel, idrocotyle, Indian pennywort, Indian water navelwort, luei gong gen, madecassol, marsh penny, talepetrako, thick-leaved pennywort, tsubo-kusa, tungchian, and white rot Do not confuse with brahmi or cola nut, which are different botanicals. P r i m a r y U s e s In the U.S., the most common use of gotu kola is for varicose veins. 8 3 Module Two In addition, when taken orally, gotu kola can be used for fatigue, the common cold and flu, hepatitis, diarrhea, indigestion, gastritis, sunstroke, tonsillitis, pleurisy, urinary tract infection (UTI), jaundice, abdominal pain, peptic ulcer disease, dysentery, trauma, shingles, leprosy, cholera, syphilis, psychiatric disorders, epilepsy, asthma, anemia, and hypertension. Gotu kola is also used for amenorrhea, elephantiasis, systemic lupus erythematosus (SLE), tuberculosis, memory loss, and as an aphrodisiac. Topically, gotu kola can be used for wound healing. Overview Gotu kola is native to India, Madagascar, Sri Lanka, Africa, Australia China, and Indonesia, and is from the perennial creeping plant, Centella asiatica , a member of the parsley family. Use of gotu kola is evidenced in both traditional Chinese and Ayurvedic medicine, and is mentioned in the Shennong Herbal , which was complied in China about 2,000 years ago. Gotu kola is not related to the kola nut; it does not contain caffeine or act as a stimulant. Identifying Characteristics P a r t s U s e d Above ground parts Part Characteristics Leaves Shriveled leaf fragments are brown-green to gray-green Fruit Rarely present Taste Spicy and sharp Odor Mildly aromatic 8 4 Module Two Dosage and Administration For oral consumption, a typical dose is 600 mg of dried leaves, three times per day. Or, one cup of tea, three times per day; to make tea, steep 600 mg of dried leaves in 150 mL of boiling water for 5-10 minutes, and then strain. For venous insufficiency, 60-120 mg of gotu kola extract can be used 1 2 1 . Topically, creams can be used for wound healing, including scars. Active Constituents The above ground parts include the primary constituents thought to be responsible for the pharmacological effects of gotu kola: The saponin-containing triterpene acids, 1-8%, and their sugar esters, including asiatic acid, madecassic acid, asiaticoside A (madecassoside), and asiaticoside B 12 2 . Gotu kola also contains essential oils, flavonoids, the flavone derivatives quercetin and kaempferol, sesquiterpenes, stigmasterol, sitosterol, and isothankuniside 1 2 31 2 4 . 1 2 1 Incandela L, Belcaro G, De Sanctis MT, et al. Total triterpenic fraction of Centella asiatica in the treatment of venou s hy pertension : a clinical, prospective, randomized trial using a combined microcirculatory model. Angiology 2001;5 2 Su p pl 2:S 6 1 - 7 . 1 2 2 Bradwejn J, Zh o u Y, Ko s z ycki D, Shlik J. A double-blind, placebo-controlled study on the effects of Gotu Kola ( Centella asiatica ) on acoustic startle respon se in healthy subjects. J Clin Psychopharmacol 2000;20:680-4. 123 Brink haus B, Lindner M, Schup pan D, Hahn EG . Chemical, pharmacological and clinical profile of the East Asian medical plant Centella asiatica. Phytomedicine 2000;7:427-48. 124 Dutta T, Basu UP . Crude extract of Centella asiatica and products derived from its glycosides as oral antifertility agents. Indian J Exp Biol 196 8 ; 6 : 1 8 1 - 2 . 8 5 Module Two Therapeutic Action Adaptogen, antidepressant, anti-infective, anti-inflammatory, antioxidant, aphrodisiac, blood purifier, cardiac, depurative, diuretic, febrifuge, hepatic, hypotensive, immunomodulator, nervine, neuroprotection, peripheral vasodilator 1 2 5 , analgesic, sedative 1 2 6 , skin, tonic, and vulnerary M e d i c i n a l U s e s Orally, gotu kola might be effective for chronic venous insufficiency 1 2 7 and lower leg circulation in venous insufficiency 1 2 8 . When applied topically, gotu kola is used to aid wound healing 1 2 9 , prevention of keloid and hypertrophic scarring, and for psoriasis 130 . Contraindications Gotu kola is generally well tolerated when taken orally for 6-12 months. However, irritation and nausea have been reported when 1 2 5 http:/ / naturalstandard.com / m o n o gra phs / m o n o frameset.asp? m o n o graph= / m o n o graphs / herbssu p plements/patient-got uk ola.asp%3Fprintversion %3Dtrue 1 2 6 http:// w w w . m s kcc.org/m s kcc/html/6 9 242.cfm 127 Brink haus B, Lindner M, Schup pan D, Hahn EG . Chemical, pharmacological and clinical profile of the East Asian medical plant Centella asiatica. Phytomedicine 2000;7:427-48. 128 Belcaro GV , Rulo A, Grimaldi R. Capillary filtration and ankle edema in patients with venou s hy pertension treated with TT F C A . Angiology 1990;41:1 2 - 8 . 129 Brinkhaus B, Lindner M, Schup pan D, Hahn EG . Chemical, pharmacological and clinical profile of the East Asian medical plant Centella asiatica. Phytomedicine 2000;7:427-48. 130 Fam A. Use of titrated extract of Centella asiatica (T E C A ) in bilharzial bladder lesions . Int Surg 1973;58 :451- 2 . 8 6 Module Two given orally in controlled trials 1 3 1 , and there are several reports of allergic contact dermatitis after topical application 132 . Contraindicated for use with diabetes; gotu kola can elevate blood glucose levels. Avoid use during pregnancy due to potential abortifacient properties. Topical use can cause photosensitivity. Use sunscreen and wear appropriate clothing to prevent sunburn. Drug and Supplement Interactions Simultaneous use of herbs with sedative properties might increase therapeutic and adverse effects. These herbs include: Calamus, calendula, California poppy, catnip, capsicum, celery, couch grass, elecampane, Siberian ginseng, German chamomile, goldenseal, hops, Jamaican dogwood, kava, lemon balm, sage, St. John?s wort, sassafras, scullcap, shepherd?s purse, stinging nettle, valerian, wild carrot, wild lettuce, ashwagandha, and yerba mansa. Regulatory Status Canada: Approved for natural health products U.K.: General Sale List, Table B U.S.: Dietary supplement, cosmetic, or homeopathic preparation 1 3 1 P ointel JP, Boccalon H, Cloarec M, Ledevehat C, Jo ubert M. Titrated extract of Centella asiatica (TE C A ) in the treatment of venou s ins u f ficiency of the lower limbs. Angiolog y . 19 8 7 Jan;38(1 Pt 1):46-50. 1 3 2 Bilbao I, Ag uirre A, Zabala R, G o n z ál ez R, Ratón J, Diaz Pérez JL. Allergic contact dermatitis from butox yethyl nicotinic acid and Centella asiatica extract. Contact Dermatitis. 199 5 Dec;33(6) :435-6 . 8 7 Module Two C h a m a e l i r i u m l u t e u m Image 11: by USDA Forest Service (2008) via Wikipedia.org Taxonomic Notes Conmmon botanical name: False Unicorn Family: Liliaceae C o m m o n N a m e s Blazing Star, fairywand, helonias, and starwort P r i m a r y U s e s When taken orally, false unicorn is primarily used with female-related problems, including: Ovarian cysts, menstrual problems, menopause, miscarriage (threatened), pregnancy (vomiting), and infertility, digestion, and contraception (to stabilize hormones after discontinued use). 8 8 Module Two In addition, false unicorn can be taken orally as a diuretic and to cleanse worms from the intestine. P a r t s U s e d Rhizome and root Dosage and Administration A standard oral dose is 1-2 g of dried root or one cup of tea, three times daily. To make tea, steep 1-2 g of dried root in 150 mL of boiling water for 5-10 minutes, and then strain. As liquid extract (1:1 in 45% alcohol), use 1-2 mL, three times daily. As a tincture (1:5 in 45% alcohol), use 2-5 mL, three times daily. Active Constituents Limited information available about false unicorn. It is thought to contain a steroidal saponin glycoside, chamaelirin, and another glycoside helonin 1 3 3 . Medicinal Uses False unicorn reportedly has anthelmintic, diuretic 1 3 4 , uterine stimulant, and menstruation stimulant activity 1 3 5 . Contraindications Likely unsafe for use while pregnant, because of potential uterine stimulant properties 1 3 61 3 7 . Also avoid use while breast-feeding. 1 3 3 Barnes J., A nderson L., and Phillipso n J.D . Herbal Medicines , T hird Edition. Pharmaceutical Press. Lo ndon, 2007. 1 3 4 Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines . 1st ed. Montvale, NJ: Medical Econo mics Co m pany , Inc., 19 9 8 . 1 3 5 McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association Botanical Safety Handbook. Boca Raton, FL : CR C Press, LL C 19 9 7 . 8 9 Module Two Contraindicated for use with infectious or inflammatory gastrointestinal conditions; false unicorn can irritate the gastrointestinal tract 1 3 8 . A d v e r s e E f f e c t s Orally, excessive doses might cause nausea and vomiting 1 3 9 . Drug and Supplement Interactions None known. Regulatory Status Canadian regulations do not allow false unicorn root as a nonmedical ingredient in oral use products 1 4 0 . 1 3 6 McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association Botanical Safety Handbook . Boca Raton, FL : CR C Press, LL C 19 9 7 . 1 3 7 Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines . 1st ed. Montvale, NJ: Medical Econo mics Co m pany , Inc., 19 9 8 . 1 3 8 Brinker F. Herb Contraindications and Drug Interactions . 2nd ed. Sandy, O R : Eclectic Medical Publications , 19 9 8 . 1 3 9 Newall CA , A nderson LA , Philpso n JD . Herbal Medicine: A Guide for Healthcare Professionals . Lo ndon, UK : The Pharmaceutical Press, 19 9 6 . 1 4 0 McGuffin M., ed. et all. American Herbal Products Asso ciation Botanical Safety Handbook . CR C Press. Boca Raton: FL , 19 9 7 . 9 0 Module Two C h i o n a n t h u s v i r g i n i c u s Image 12: by Derek Ramsey (2007) via Wikipedia.org Taxonomic Notes Common botanical name: Fringe Tree Family: Oleaceae C o m m o n N a m e s Chionanthus, fringe tree, gray beard tree, old man?s beard, poison ash, snowdrop tree, snowflower, and white fringe P r i m a r y U s e s When taken orally, fringe tree is can be used with liver disorders, gallbladder disorders, and gallstones. 9 1 Module Two In addition, fringe tree is used orally as a diuretic, tonic, and to stimulate bile flow. Overview Do not confuse with traveler?s joy, usnea, or woodbine. Identifying Characteristics Part Characteristics Taste Bitter Odor Odorless P a r t s U s e d Root bark Dosage and Administration Fringetree has been used as a liquid extract 1 4 1 . Active Constituents Five lignans, phillyrin, pinoresinol-beta-D-glucoside, pinoresinol di- beta-D-glucoside, phillyrin-2-O-beta-D-glucoside, phillyrin-6-O-beta- D-glucoside, and three secoiridoids, oleuropein, ligustroside and angustifolioside B, have been isolated from the root bark of Chionanthus virginicus L. ( Oleaceae ), a raw material used in the commercial preparation of homeopathy tinctures 1 4 2 . Contraindications Insufficient reliable information available; avoid use while pregnant and breast-feeding. 1 4 1 Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines . 1st ed. Montvale, NJ: Medical Econo mics Co m pany , Inc., 19 9 8 . 1 4 2 B o yer L, Elias R, Taoubi K, Debrauwer L, Faure R, Baghdikian B, Balansard G. Phytochem Anal. 2005 Sep-Oct;16 ( 5 ) :375- 9 . 92 Module Two A d v e r s e E f f e c t s None reported. Drug and Supplement Interactions None known. 9 3 Module Two C h r y s a n t h e m u m p a r t h e n i u m Image 13: by Vsion (2005) via Wikipedia.org Taxonomic Notes Common botanical name: Feverfew Family: Asteraceae C o m m o n N a m e s Altamisa, bachelor?s buttons, featerfoiul, featherfew, featherfoil, flirtwort midsummer daisy, Santa Maria, and tanaceti parthenii P r i m a r y U s e s When taken orally, feverfew can be used for fever, headache, migraine 1 4 31 4 4 (prevention), and regulating menstruation. In addition, 1 4 3 McCrory DC , Matchar DB, Gray RN , et al. Evidence-based guidelines for migraine headache: overview of progra m description and methodolog y . US 9 4 Module Two feverfew is used orally for arthritis, psoriasis, allergies, asthma, tinnitus, vertigo, and nausea and vomiting. Feverfew is also used for infertility, anemia, cancer, the common cold, earache, liver disease, miscarriage (prevention), muscle tension, orthopedic disorders, swollen feet, diarrhea, and dyspepsia including indigestion and flatulence. Used topically, feverfew is an insecticide, antiseptic, useful with toothache, and a general stimulant. P a r t s U s e d Leaf Dosage and Administration Taken orally for migraine, use 50-100 mg of feverfew extract daily. There is no recommended dosage for topical use. Duration Avoid long-term use. Incidents of ?Post-feverfew syndrome?, including anxiety, headaches, insomnia, and muscle and joint stiffness, have been reported 1 4 5 . Active Constituents At least 39 active constituents in feverfew have been identified 1 4 6 . Headache Con s ortium , April 2000. Available at: ww w .aan.com/cgi- bin/w hatsnewlink . pl?loc=/p ublic/practiceguidelines. 1 4 4 Joh n s o n ES , Kadam NP , Hylands DM, Hylands PJ. Ef ficacy of feverfew as proph ylactic treatment of migraine. Br Med J (Clin Res Ed) 19 8 5 ; 2 9 1 : 5 6 9 - 73. 1 4 5 Joh n s o n ES , Kadam NP , Hylands DM, Hylands PJ . Ef ficacy of feverfew as proph ylactic treatment of migraine. Br Med J (Clin Res Ed) 19 8 5 ; 2 9 1 : 5 6 9 - 73. 1 4 6 Foster S. Feverfew, Tanacetum parthenium, botanical series #310. Austin, TX : A m Botanical Cou ncil, 199 6 . 9 5 Module Two However, there are varying points of view about which constituents are responsible for the pharmacological actions in feverfew. The sesquiterpene lactone, parthenolide, was widely believed to be the active constituent 147 . In addition, feverfew contains chrysanthenyl acetate, an essential oil that is thought to be an active component 1 4 8 , and melatonin, which might contribute to its pharmacological effect 1 4 9 . Other pharmacological effects of feverfew include a cytostatic effect on tumor cell growth 1 5 0 , inhibition of inflammation and pain transmission 1 5 1 , and anti-inflammatory effects 1 5 2 . Contraindications Simultaneous use of feverfew and herbs that affect platelet aggregation could increase risk of bleeding. Some of these herbs include: Angelica, clove, danshen, garlic, ginger, ginkgo, Panax ginseng, horse chestnut, red clover, and turmeric. Feverfew may inhibit platelet aggregation, but there are no human studies to support this 1 5 31 5 41 5 5 . 1 4 7 Awang DV C . Prescribing therapeutic feverfew ( Tancetum pathrnium (L. ) Schultz Bip., sy n . Chrysanthemumparthenium (L. ) Bernh). Int Med 199 8 ; 1 : 1 1 -3. 1 4 8 de Weerdt GJ, Bo otsman HPR, Hendriks H. Herbal medicines in migraine prevention. Randomized double-blind, placebo-controlled, cross o ver trial of a feverfew preparation. Phytomedicine 1 9 9 6 ;3:22 5 -30. 1 4 9 Murch SJ, Simm o n s CB , Saxena PK. Melatonin in feverfew and other medicinal plants. Lancet 199 7 ;350:15 9 8 - 9 . 1 5 0 Ros s JJ , Arnason JT , Birnboim HC. Lo w concentrations of the feverfew comp o nent parthenolide inhibit in vitro growth of tum or lines in a cytostatic fashion . Planta Med 199 9 ; 6 5 : 1 2 6 - 9 . 1 5 1 Jain NK , Kulkarni SK. Antinocicept ive and anti-inflammatory effects of Tanacetum parthenium L. extract in mice and rats. J Ethnopharmacol 199 9 ; 6 8 : 2 5 1 - 9 . 1 5 2 Williams CA , Hoult JR , Harborne JB, et al. A biologically active lipo p hilic flavon ol from Tanacetum parthenium . Phytochemistry 199 5 ;38:2 6 7 - 70. 9 6 Module Two Oral administration of feverfew is well tolerated. However, it can cause gastrointestinal side effects like heartburn, nausea, diarrhea, constipation, abdominal pain and bloating, and flatulence. Traditional administration, chewing fresh feverfew leaves, can cause irritation like mouth ulceration, inflamed oral mucosa and tongue, swelling of the lips and, occasionally, loss of taste 1 5 6 . Mouth ulceration may be the result of direct contact with the feverfew leaves and the constituent sesquiterpene lactone 1 5 7 . Used topically, feverfew can cause allergic contact dermatitis 1 5 8 . Regulatory Status Listed in the Botanical Safety Handbook in Class 2b. Module Assessment You are now ready to log in and complete the module assessment online. Refer back to the instructions in Module One if you need to. 1 5 3 A wang DV C . Prescribing therapeutic feverfew ( Tancetum pathrnium (L. ) Schultz Bip., sy n . Chrysanthemumparthenium (L.) Bernh) . Int Med 199 8 ; 1 : 1 1 -3. 1 5 4 Heptinstall S, Groenewegen W A , Spangenberg P, Loesche W. Extracts of feverfew may inhibit pl atelet behaviour via neutraliz ation of sulph ydryl group s . J Pharm Pharmacol 198 7 ;39:459- 6 5 . 1 5 5 Heptinstall S, W hite A, Williamso n L, Mitchell JR . Extracts of feverfew inhibit granule secretion in blood platelets and polym orph o n uclear leucocytes. Lancet 1 9 8 5 ; 1 : 1071-4. 1 5 6 Awang DV C . Prescribing therapeutic feverfew (Tancetum pathrnium (L . ) Schultz Bip., sy n . Chrysanthemumparthenium ( L . ) Bernh). Int Med 199 8 ; 1 : 1 1 -3. 1 5 7 J o h n s o n ES , Kadam NP , Hylands DM, Hylands PJ. Ef ficacy of feverfew as proph ylactic treatment of migraine. Br Med J (Clin Res Ed) 19 8 5 ; 2 9 1 : 5 6 9 - 73. 1 5 8 Lamminpaa A, Estlander T, Jolanki R, Kanerva L. Occupational allergic contact dermatitis caused by decorative plants. Contact Dermatitis 199 6 ;34:330- 5. 9 7 Module Three Module Three Module Objectives Upon completion of this module, you will be able to: ? Recall and describe the Latin binomial or scientific name, common name, and family. ? Be able to identify a photograph by the Latin name and common name of the botanicals studied. ? Identify the therapeutic potential of each botanical studied. ? Explain the pharmacological action of each botanical studied. ? List the key recommended uses for each botanical studied. ? Recall the recommended dosage and duration for each botanical studied. ? Recall and describe any contraindications and precautions associated with each botanical studied. ? Recall the regulatory status of each of botanical studied. Module Checklist ? Read and review the module. ? Read any online resources as applicable. ? Ensure you can meet the Module Objectives. ? Complete the module assessment online and respond to another student?s posting as instructed. ? Complete the Module Test. 3 9 8 Module Three C i n n a m o m u m spp. Image 14: by Badagnani ( 2008) via Wikipedia.org Taxonomic Notes Common botanical name: Cinnamon Family: Lauraceae C o m m o n N a m e s Batavia cassia, batavia cinnamon, cassia twig, Ceylon cinnamon, cinnamon flos, cinnamon twig, cinnamonum, padang-cassia, Panang cinnamon, Saigon cassia, and Saigon cinnamon P r i m a r y U s e s Cinnamon is commonly used as a winter spice to flavor foods, and often accompanies nutmeg, cloves, and anise. The essential oil of 9 9 Module Three cinnamon is used in aromatherapy, because its scent is attributed with mood lifting effects 1 5 9 . Selective olfactory deficits occur in 70% to 90% of patients with Parkinson disease. In a 2003 study conducted by the Prince of Wales Medical Research Institute, cinnamon was used to help diagnose hyposmia in Parkinson?s disease 1 6 0 . When used orally, cinnamon research is showing promising applications for use with diabetes (type 2) 1 6 11 6 21 6 3 , according to the Natural Standard database. The results from two randomized in vitro and animal studies showed significant hypoglycemic effects, and cinnamon was shown effective for improving glucose and insulin metabolism. A few small human trials have shown a hypoglycemic effect that need further study as a possible support for diabetes 1 6 4 . In addition, cinnamon is taken orally for flatulence, muscle and gastrointestinal spasms, nausea and vomiting (preventing), diarrhea, 1 5 9 Idle JR. Christmas gingerbread (Lebku chen) and Christmas cheer--review of the potential role of mo od elevat ing amphetamine-like com p o u nds formed in vivo and in furno . Prague Med Rep . 2005;106(1 ) : 2 7 -38. 1 6 0 Double KL, Ro we DB, Hayes M, Chan DK , Blackie J, Corbett A, Jo f fe R, Fu n g V S , Morris J, Halliday GM. Identifying the pattern of olfactory deficits in Parkinso n ? s disease using the brief smell identification test. Arch Neurol . 2003 Apr;60(4):545-9 . 1 6 1 Khan A, Safdar M, Ali Khan MM, Khattak KN , Anderson RA . Cinnamo n im proves glucose and lipids of people with type 2 diabetes. Diabetes Care . 2003 Dec;26 ( 1 2 ) :3215 - 8 . 162 Vanschoo nbeek K, Th o massen BJ , Senden JM, W odzig W K , van Lo o n LJ . Cinnamo n su p plementation does not improve glycemic control in po stmenopausal type 2 diabetes patients. J Nutr . 2006 Apr;136(4):9 7 7 - 80. 1 6 3 Baker WL, G utierrez-Williams G , W hite CM, et al. Effect of cinnamo n on glucose control and lipid parameters. Diabetes Care 2008;31:41-3. 1 6 4 Kirkham S, Akilen R, Sharma S, Tsiami A. Diabetes Obes Metab . 2009 Dec;11 ( 1 2 ) : 1 100-13. 1 0 0 Module Three infections, the common cold, loss of appetite, impotence, enuresis, rheumatic conditions, testicle hernia, menopausal symptoms, amenorrhea, and as an abortifacient. Topically, cassia cinnamon is frequently used in suntan lotions, nasal sprays, mouthwashes, toothpaste, and as a counterirritant in liniments. Overview Avoid confusion with Chinese cinnamon (cassia). Identifying Characteristics Part Characteristics Taste Spicy, burning, and somewhat sweet and mucilaginous Odor Aromatic and characteristic P a r t s U s e d Bark and flower C o l l e c t i o n a n d C u l t i v a t i o n Cinnamon is cultivated in tropical and subtropical regions including Sri Lanka, India, Java, Sumatra, the West Indies, Brazil, Vietnam, and Madagascar, and is a major export of the Seychelles 1 6 5 . Dosage and Administration For oral dosage, one cup of tea, three times daily. To prepare the tea, steep .5-1 g of cinnamon bark in 150 mL of boiling water for 5-10 minutes, and then strain. For liquid extract (1:1 in 70% alcohol), .5-1.0 mL, three times daily. For topical use, there is no recommended dosage. 1 6 5 U nited States. Department of State. Bu reau of Public Affairs. Seychelles. Backgr Notes Ser. 198 9 N o v : 1 - 7 . 1 0 1 Module Three Duration of Administration Maximum suggested dose is 2-4 g of cinnamon bark or .05-.2 g of essential oil per day. Short-term use is likely safe and should not exceed six weeks. Active Constituents Cinnamon contains allylbenzenes and their isomers, the propenylbenzenes 1 6 6 . Cinnamon also contains monomeric and oligomeric proanthocyanidins 1 6 71 6 8 (e.g., procyanidin B-2 and procyanidin B-3) 1 6 9 . The major flavanoids 1 7 0 are quercetin, kaempferol, luteolin, and pelargonidin, and the inorganic constituents of Cinnamomi cortex include potassium, calcium, iron, manganese, and strontium. At least 94 volatile components have been identified in cinnamon bark 1 7 1 and 54 constituents have been identified in the essential oil 1 6 6 Idle JR. Christmas gingerbread (Lebkuchen) and Christmas cheer--review of the potential role of mo od elevat ing amphetamine-like com p o u nds formed in vivo and in furno . Prague Med Rep . 2005;106(1 ) : 2 7 -38. 1 6 7 Gu L, Kelm MA, Hammerstone JF, Zhang Z, Beecher G, Holden J, Haytowitz D, Prior RL. Liquid chromato graphic/electrospray ionization mass spectrometric studies of proanthocyanidins in fo ods. J Mass Spectrom . 2003 Dec;38(1 2 ) : 1 2 7 2 - 80. 1 6 8 Lazarus SA , Adamso n GE , Hammerstone JF, Schmitz HH. High- performance liquid Chromatography /Mass spectrometry analysis of proanthocyanidins in fo ods and beverages. J Agric Foo d Chem . 19 9 9 Sep;47(9 ) :3693-701. 1 6 9 Tanaka N, Sekiya N, Hattori M, Goto H, Shibahara N, Shimada Y, Terasawa K. Measurement of plasma procyanidin B - 2 and procyanidin B-3 levels after oral administration in rat. Phytomedicine . 2003 Mar;10(2-3):1 2 2 - 6 . 1 7 0 Nair S, Nagar R, G u pta R. Antiox idant phenolics and flavon oids in com m o n Indian fo ods. J As s oc Physicians India . 19 9 8 Au g ;46(8 ) : 708-10. 1 7 1 G o n g F, Liang YZ , Fu n g YS . Analysis of volatile comp o nents from Cortex cinnamomi with hy p henated chromatography and chemometric resolution . J Pharm Biomed Anal . 2004 Mar 10;34(5) : 1029-47. 1 02 Module Three made from cinnamon bark and twigs 1 7 2 . Each cinnamon plant part has a different primary constituent, in specific bark oil has cinnamaldehyde, leaf oil has eugenol, and root-bark oil has camphor 173 . Pharmacological Action As an antibacterial, extracts of cinnamon and the components cinnamaldehyde and eugenol have demonstrated in vitro activity against Campylobacter jejuni , Escherichia coli , Listeria monocytogenes , and Salmonella enterica 1 7 4 . In addition, cinnamon bark oil and its major components demonstrated in vitro antibacterial effects on Haemophilus influenzae , Streptococcus pneumoniae , Streptococcus pyogenes , Staphylococcus aureus , and Porphyromonas gingivalis , respiratory and gastrointestinal tract pathogens 1 7 51 7 6 . Cinnamon also exhibits antitumor and anticancer properties. In specific, the antitumor activity of Cinnamomum cortex is considered a result of stimulation of the reticuloendothelial system (RES), and has been shown to be closely related to TNF production 1 7 7 . 1 7 2 S hen Q , Chen F, Lu o J. [C o m parison studies on chemical constituents of essential oil from Ramulus Cin namo mi and Cortex Cinnamo mi by GC -MS] Zhong Yao Cai. 2002 Apr;25 (4):2 5 7 - 8 . 1 7 3 Wijesekera RO . Historical overview of the cinnamon industry. CRC Crit Rev Foo d Sci Nutr . 19 7 8 ; 10(1) : 1 -30. 1 7 4 Friedman M, Henika PR , Mandrell RE. Bact ericidal activities of plant essential oils and some of their is olated constituents against Campylobacter jejuni, Escherichia coli, Listeria monocytogenes , and Salmonella enterica. J Fo o d Prot. 2002 Oct;65 ( 10):1 545-60. 1 7 5 Inou ye S, Takizawa T, Yamaguchi H. Anti bacterial activity of essential oils and their major constituents against re spiratory tract pathogens by gaseous contact. J Antimicrob Chemother . 2001 May;47(5 ) : 5 6 5 - 73. 1 7 6 Inou ye S, Yamaguchi H, Takizawa T. Screening of the antibacterial effects of a variety of essential oils on respiratory tract pathogens, using a modified dilution assay method. J Infect Chemother . 2001 Dec;7(4):2 5 1 -4. 1 7 7 Haranaka K, Satomi N, Sakurai A, Haranaka R, O kada N, Kobayashi M. Antitum or activities and tum or necrosis factor producibility of traditional 1 0 3 Module Three Medicinal Uses The use of cinnamon and eugenol on human spermatozoa mobility in vitro has been studied, showing that the essential oils studied had significant spermicidal action 1 7 8 . When used topically and as part of a multi-ingredient preparation, cinnamon is also useful for premature ejaculation. Contraindications Cinnamon is likely safe when consumed in amounts commonly found in foods, and when used orally and appropriately in amounts slightly larger than those commonly found in foods. Some of the constituents active in cinnamon bark might slow heart rate and lower blood pressure. Patients with cardiovascular conditions, such as high or low blood pressure or congestive heart failure, should use cinnamon bark preparations with caution 1 7 91 8 0 . People with a known allergy to cinnamon, its constituents, or members of the Lauraceae family or balsam of Peru, should avoid use. There are known incidents of contact dermatitis 1 8 1 . Due to lack of sufficient data, not recommended for use while pregnant or breast-feeding. Chinese medicines and crude drugs . Cancer Immunol Immunother. 198 5 ; 20(1) : 1 - 5 . 1 7 8 Buch JG , Diks hit RK, Mansuri SM. Effect of certain volatile oils on ejaculated human spermatozoa. Indian J Med Res . 19 8 8 Apr;8 7 :361-3. 1 7 9 Yu SM, W u TS , Teng CM. Pharma cological characterization of cinnamo p hilin, a novel dual inhibitor of thromboxane synthase and thromboxane A2 receptor. Br J Pharmacol . 19 94 Mar;11 1 (3):906-1 2 . 1 8 0 Sui Y, Qiu D, Xie C, Chen K. [Observation of antiarrhythmic effects of Cin namo m u m migao H. W . Li on experimental arrhythmia]. Zhongguo Zhong Yao Za Zhi . 19 9 8 Au g ; 23(8) :495- 7 . 1 8 1 Calnan CD . Cinnamo n dermatitis from an ointment. Contact Dermatitis . 19 7 6 Ju n ; 2 (3):1 6 7 - 70. 1 0 4 Module Three Drug and Supplement Interactions As an antiviral, clinical studies show that Cinnamomum cassia bark extract might be effective against HIV-1 and HIV-2 replication in terms of inhibition of virus induced cytopathogenicity in MT-4 cells infected with HIV 1 8 2 . In addition, based on animal studies, cinnamon bark may cause a significant decrease in platelet counts after long-term use 1 8 3 and cinnamon may alter cardiovascular function because of its effect on the blood and cardiovascular system 1 8 4 . Regulatory Status Cinnamon has been granted GRAS (Generally Recognized as Safe) status as a food additive by the U.S. Food and Drug Administration (FDA). 1 8 2 Premanathan M, Rajendran S, Ramanathan T, Kathiresan K, Nakashima H, Yamamoto N. A survey of so me Indi an medicinal plants for anti-hu man imm u n odeficiency virus (HIV) activity. Indian J Med Res . 2000 Sep;1 1 2 : 73-7. 1 8 3 Jantan I, Rafi IA, Jalil J. Platelet-activating factor (PA F ) receptor-binding antagonist activity of Malaysian medicinal plants. Phytomedicine . 2005 Jan;1 2 ( 1 - 2 ) : 8 8 - 9 2 . 1 8 4 Yu SM, W u TS , Teng CM. Pharma cological characterization of cinnamo p hilin, a novel dual inhibitor of thromboxane synthase and thromboxane A2 receptor. Br J Pharmacol . 19 94 Mar;11 1 (3):906-1 2 . 1 0 5 Module Three C n i c u s b e n e d i c t u s Image 15: by Alberto Salguero Quiles (2005) via Wikipedia.org Taxonomic Notes Common botanical name: Blessed Thistle Family: Asteraceae/Compositae C o m m o n N a m e s Bitter thistle, carbenia benedicta, cardin, cardo santo, carduus, carduus benedictus, Cnici benedicti Herba , cnicus, holy thistle, St. Benedictine thistle, and spotted thistle P r i m a r y U s e s Traditionally, blessed thistle has been used in bitter tonic drinks to enhance appetite and to aid digestion, and also to works as a menstruation stimulant and abortifacient. Blessed thistle has been studied in vitro for use as an antimicrobial, anticancer, and anti-inflammatory agent with positive results; yet, there are no human clinical trials documenting beneficial results. When taken orally, blessed thistle can be used for loss of appetite and indigestion, as an antidiarrheal, expectorant, antibiotic, and as a diuretic. 1 0 6 Module Three When used topically, blessed thistle can be used as a poultice with boils, wounds, and ulcers. Overview Blessed thistle grows about 11-20 inches high and is native to the Mediterranean, though it has been naturalized in the U.S. and Europe. The leaves, flowering tops, and seeds can all be used medicinally. The leaves are thorny and the flowers are pale-yellow and daisy-like. The upper leaves form a cup around a flower. Used historically as a general tonic or cure-all, today blessed thistle is used as a bitter tonic for dyspepsia, flatulence, and indigestion. It is also used with wound healing, lactation (stimulation), dysmenorrhea, and diarrhea or hemorrhage. Do not confuse with milk thistle or other members of the thistle family. Identifying Characteristics Part Characteristics Leaves Thorny Flowers Pale-yellow and daisy-like Taste Bitter Odor Odorless P a r t s U s e d Leaves, flowering topics, and seeds Dosage Typical oral dose of the dried flowering tops is one cup of tea three times daily. To make the tea, steep the 1.5-3 g of the dried flowering tops in boiling water, and then strain. As a liquid extract (1:1 in 25% alcohol), 1.5-3.0mL, three times daily. Topically, there is no typical dosage. 1 0 7 Module Three Active Constituents The active constituents of blessed thistle include: Sesquiterpene lactone glycosides (such as cnicin (0.2-0.7%), polyacetylen 1 8 5 , and absinthin 1 8 6 ), triterpenoids (such as a-amyrenone, a-amyrin acetate, a- amyrine, and multiflorenol acetate 1 8 71 8 8 ), lignans (such as trachelogenin, arctigenin, and nortracheloside 1 8 9 ), flavonoids, polyenes, tannins (8%), and essential/volatile oils (0.3%) (such as p-cymene, fenchon, citral, and cinnamaldehyde 1 9 0 ). The bitterness of blessed thistle may directly result from cnicin, and the presence of lignans such as trachelogenin may also be a contributing factor 1 9 1 . Salonitenolide has also been found present 1 9 2 . 1 8 5 Vanhaelen-Fastre R. [P olyacetylen comp o u nds from Cnicus benedictus ] . Planta Medica 1974;25 :47-5 9 . 1 8 6 Kataria H. Phytochemical investigation of medicinal plant Cnicus wallichii and Cnicus benedictus L. Asian J Chem 199 5 ; 7 : 2 2 7 - 2 2 8 . 1 8 7 Kataria H. Phytochemical investigation of medicinal plant Cnicus wallichii and Cnicus benedictus L. Asian J Chem 199 5 ; 7 : 2 2 7 - 2 2 8 . 1 8 8 Ulbelen A and Berkan T. Triterpenic and steroidal comp o u nds of Cnicus benedictus . Planta Medica 197 7 ;31:375-377. 1 8 9 Vanhaelen M and Vanhaelen-Fastre R. Lactonic lignans from Cnicus benedictus . Phytochemistry 197 5 ; 14:2709. 1 9 0 Vanhaelen-Fastre, R. [C o n stitution and antibiotical properties of the essential oil of Cnicus benedictus (author's transl)] . Planta Med 1973;24(2) : 1 6 5 - 1 7 5 . 1 9 1 Schneider, G. and Lachner, I. [A nalysis and action of cnicin]. Planta Med 198 7 ; 53(3):247-2 5 1 . 1 9 2 Vanhaelen-Fastre R. [P olyacetylen comp o u nds from Cnicus benedictus ] . Planta Medica 1974;25 :47-5 9 . 1 0 8 Module Three Pharmacological Action In studies, blessed thistle has shown antimicrobial properties, which is attributed to the cnicin and polyacetylene constituents 1 9 31 9 4 . Antibacterial activity of cnicin and the essential oil of blessed thistle herb have been observed in vitro against Bacillus subtilis , Brucella species, Escherichia coli , Proteus species, Pseudomonas aeruginosa , Staphylococcus aureus , and Streptococcus faecalis 1 9 51 9 61 9 7 . Other studies have demonstrated no activity against Klebsiella , Pseudomonas , S. aureus , S. tyhpi , or yeast 1 9 8 . Several lignans have also been under investigation as antiviral (particularly anti-HIV) and anticancer agents 1 9 92 0 0 . 1 9 3 V Kataria H. Phytochemical investigation of medicinal plant Cnicus wallichii and Cnicus benedictus L. Asian J Chem 199 5 ; 7 : 2 2 7 - 2 2 8 . anhaelen-Fastrè R. [A ntibiotic and cytotoxic activi ty of cnicin isolated from Cnicus benedictus L] J Pharm Belg . 19 7 2 N o v - Dec;27 ( 6 ) : 6 83-8. 1 9 4 Vanhaelen-Fastré R. [C o n stitution and antibiotical properties of the essential oil of Cnicus benedictus (author's transl)] Planta Med . 19 73 Oct;24(2) : 1 6 5 - 7 5 . 1 9 5 Vanhaelen-Fastrè R. [A ntibiotic and cytotoxic activity of cnicin isolated from Cnicus benedictus L ] J Pharm Belg . 19 7 2 N o v - Dec;27 ( 6 ) : 6 83-8. 1 9 6 Vanhaelen-Fastré R. [C o n stitution and antibiotical properties of the essential oil of Cnicus benedictus (author's transl)] Planta Med. 1973 Oct;24(2) : 1 6 5 - 7 5 . 1 9 7 Vanhaelen-Fastré R, Vanhaelen M. [Antibiotic and cytotoxic activity of cnicin and of its hydrolysis products. Chemical structure - biological activity relations hip (author's transl)] Planta Med . 19 7 6 Mar;29 ( 2 ) : 1 7 9 - 8 9 . 1 9 8 Pérez C, Anesini C. In vitro antibacterial activity of Argentine folk medicinal plants against Salmonella typhi. J Ethnopharmacol. 1994 Aug ;44(1) :41-6 . 1 9 9 Eich E, Pertz H, Kaloga M, Schulz J, Fesen MR, Mazumder A, Po m mier Y. (- ) - Arctigenin as a lead structure for inhi bitors of hu man imm u n odeficiency virus type-1 integrase. J Med Chem . 19 9 6 Jan 5;39(1 ) : 8 6 - 9 5 . 2 0 0 Hirano T, Gotoh M, Oka K. Natural flavon oids and lignans are potent cytostatic agents against human leukemic HL-60 cells. Life Sci . 19 94;55 ( 13):1061- 9 . 1 0 9 Module Three Anti-inflammatory effects: In the standard rat paw model of inflammation, cnicin had mild anti-inflammatory effects. Lignans such as arctigenin and trachelogenin appear to exert inhibitory effects on cyclic AMP, phosphodiesterase, and histamine release in rat mast cells 2 0 1 . Antagonist activities against calcium ions and platelet activation factor have also been observed. Medicinal Uses The volatile oil content of blessed thistle may have bacteriostatic, or bacteria inhibiting, properties. In addition, cnicin, the sesquiterpene lactone constituent, may have antibacterial and antitumor activity 2 0 2 . Metabolism of the constituents, arctiin and tracheoloside, following oral ingestion results in compounds that inhibit cyclic-AMP phosphodiesterase and histamine release from mast cells 2 0 3 . Blessed thistle contains 8% tannins 2 0 4 . Contraindications Due to abortifacient properties, avoid while pregnant. Also, patients with peptic ulcer should use with caution; blessed thistle is traditionally used to stimulate digestion, gastric acid secretion 2 0 5 . 2 0 1 Nose M, Fujim oto T, Nishibe S, O gihara Y. Structural transformation of lignan com p o u nds in rat gastrointestinal tr act; II. Serum concentration of lignans and their metabolites. Planta Med. 1993 Apr;59 ( 2 ) : 131-4. 2 0 2 Leung AY , Fo ster S. Encyclopedia of Com m on Natural Ingredients Used in Foo d , Drugs and Cosmetics . 2nd ed. New York, N Y : Jo h n Wiley & So n s , 19 9 6 . 2 0 3 Leung AY , Fo ster S. Encyclopedia of Com m on Natural Ingredients Used in Foo d , Drugs and Cosmetics . 2nd ed. New York, N Y : Jo h n Wiley & So n s , 19 9 6 . 2 0 4 Newall CA , A nderson LA , Philpso n JD . Herbal Medicine: A Guide for Healthcare Professionals . Lo ndon, UK : The Pharmaceutical Press, 19 9 6 . 2 0 5 Brinker F. Herb Contraindications and Drug Interactions . 2nd ed. Sandy, O R : Eclectic Medical Publications , 19 9 8 . 1 1 0 Module Three Avoid use while breast-feeding. Though, traditionally, blessed thistle has been used to stimulate lactation, there is not enough clinical data to support this. People with a known allergy to blessed thistle, its constituents, or the Asteraceae/Compositae family should avoid use. This includes the herbs ragweed, chrysanthemums, marigolds, and daisies. Drug and Supplement Interactions Blessed thistle is thought to increase stomach acid and, therefore, might interfere with antacids, sucralfate (Carafate), H-2 antagonists, or proton pump inhibitors 206 . Regulatory Status Canada: Approved active ingredient in one traditional herbal medicine and in some homeopathics; requires pre-marketing authorization U.K.: General Sale List, Table A of Schedule 1 (requires full product license) U.S.: Dietary supplement and approved natural flavoring (used in alcoholic beverages only) 2 0 6 Brinker F. Herb Contraindications and Drug Interactions . 2nd ed. Sandy, O R : Eclectic Medical Publications , 19 9 8 . 1 1 1 Module Three E l e u t h e r o c o c c u s s e n t i c o s u s ( synonym A c a n t h o p a n a x s e n t i c o s u s and H e d e r a s e n t i c o s a ) Image 16: by Stanislav Doronenko (2006) via Wikipedia.org Taxonomic Notes Common botanical name: Eleuthero Family: Araliaceae C o m m o n N a m e s Ci wu jia, ciwujia, devil?s bush, devil?s shrub, eleuthera, eleuthero ginseng, eleutherococ, eleutherococc, Eleutherococci radix , Eleutherococcus, ginseng, phytoestrogen, prickly eleutherococc, Russian root, shigoka, Siberian ginseng, thorny bearer of free berries, touch-me-not, untouchable, Ussuri, Ussurian thorny pepperbrush, wild pepper, wu jia pi, and wu-jia 1 12 Module Three Do not confuse with Panax ginseng, which has similar botanical properties, or American ginseng, ashwagandha, blue cohosh, canaigre, codonopsis, or Panax pseudoginseng . P r i m a r y U s e s When taken orally, eleuthero is used as a stimulant, diuretic, appetite stimulant, immune system stimulant, and as an adaptogen, which increases resistance to environmental stress and improves overall vitality 2 0 7 . Eleuthero is also used orally for: Normalizing high or low blood pressure, atherosclerosis, pyelonephritis, craniocerebral trauma, rheumatic heart disease, neuroses, insomnia, Alzheimer?s disease, attention deficit-hyperactivity disorder (ADHD), chronic fatigue syndrome, diabetes, fibromyalgia, rheumatoid arthritis, influenza, chronic bronchitis, tuberculosis, reducing toxicity of chemotherapy, symptomatic care of herpes simplex type II infections, improving athletic performance, and increasing work capacity. Eleutherococcus senticosus is not used in food items 2 0 8 , but is added to skin care products. Overview The chemical content and potency of eleuthero products can vary 2 0 9 , as eleuthero is often misidentified or adulterated. Do not confuse eleuthero with American or Panax ginseng, which are different botanicals and often considerably more expensive. Some attribute the popularity of eleuthero to the Soviet Union, who, it is said, used the herb to boost their athletes? performance at a lower cost. However, eleuthero might be ineffective when taken 2 0 7 Barnes J., A nderson L., and Phillipso n J. D . Herbal Medicines , T hird Edition. Lo ndon. Pharmaceutical Press, 2007. 2 0 8 Barnes J., A nderson L., and Phillipso n J. D . Herbal Medicines , T hird Edition. Lo ndon. Pharmaceutical Press, 2007. 2 0 9 Harkey MR, Henderson G L , Gershwin ME, et al. Variability in com mercial ginseng products: an analysis of 25 preparations . Am J Clin Nutr 2001;73:1101-6 . 1 1 3 Module Three orally for increasing speed, and quality and capacity for physical work. In a clinical trial, a specific eleuthero root liquid extract standardized to eleutherosides B and E content 3.4 mL daily didn?t seem to have any effect on the endurance, performance, psychological, cardiac, or respiratory parameters in trained distance runners 2 1 02 1 1 . In another clinical trial, eleuthero was tested for its ability to increase fat utilization in humans. Using a randomized, double-blind cross-over design, nine trained endurance cyclists were given 1,200 mg of eleuthero per day (Endurox), which did not appear to have an effect on glycogen, fat utilization, or cycling performance time 2 1 2 . In addition, studies indicate that eleuthero might not improve respiration, reduce lactate production, or hasten heart rate recovery during stair-stepping exercise 213 , treadmill, or cyclic ergometry 21421 5 . There is insufficient reliable information available to rate the effectiveness of eleuthero for its other uses. However, preliminary evidence suggests eleuthero might be useful with hyperlipidemia, 2 1 0 Dowling EA , Redondo DR , Branch JD , et al. Effect of Eleutherococcus senticosus on submaximal and maximal exercise performance. Med Sci Sports Exerc 199 6 ; 2 8 :482- 9 . 2 1 1 Asano K, Takahashi T, Miyashita M, et al. Effect of Eleutherococcus senticosus extract on hu man ph y sical working capacity. Planta Med 198 6 ; 1 7 5 - 7 . 2 1 2 Eschbach LF, Webster MJ, Bo yd JC, et al. The effect of siberian ginseng (Eleutherococcus senticosu s ) on substrate utilization and performance. Int J Sport Nutr Exerc Metab 2000;10:444-51 . 2 1 3 Dus man K, Plow man SA , McCarthy K, et al. The effects of Endurox on the phy siological respo n ses to stair-stepping exercise. Med Sci Sports Exerc 199 8 ;30 Sup pl:S323. 2 1 4 Cheuvroni SN , Moffatt RF, Biggerstaff KD , et al. Ef fects of Endurox on various metabolic respo n ses to exercise. Med Sci Sports Exerc 199 8 ;30 Sup pl:S32. 2 1 5 Smerzer KD, Gretebeck PJ. Ef fect of radix Acanthopanax senticosus on submaximal running peformance. Med Sci Sports Excerc 199 8 ;30 Sup pl:S 2 7 8 . 1 1 4 Module Three ischemic stroke, and arrhythmias 2 1 62 1 72 1 8 . There is also preliminary evidence that suggests eleuthero might improve memory and feelings of well-being in middle-aged people 2 1 9 . However, more evidence is needed to accurately evaluate eleuthero for these uses. Identifying Characteristics Part Characteristics Leaves Palmate leaves with five leaflets and finely thorned petioles Flowers Small, yellow or bluish-violet, and in single umbels Root Grayish-brown to blackish-brown and smooth Fruit Black colored berries that usually contain five seeds Taste Bitter and astringent Odor Slightly acrid P a r t s U s e d Root and leaf 2 1 6 Shang SY , Ma YS, Wang SS . [E f fect of eleutherosides on ventricular late potential with coronary heart disease and myocarditis]. [Article in Chinese] Zhong Xi Yi Jie He Za Zhi 199 1 ; 1 1 : 2 80-1, 26 1 . 2 1 7 Shi Z, Liu C, Li R. [E f fect of a mixture of Acanthopanax senticosus and Elsholtzia splendens o n serum -lipids in patients with hy perlipemia]. [Article in Chinese]. Zhong Xi Yi Jie He Za Zhi 1 9 90r;10:15 5 - 6 , 132. 2 1 8 Han L, Cai D. [Clinical and experimental study on treatment of acute cerebral infarction with Acanthopanax Injection] . [Article in Chinese]. Zhongguo Zhong Xi Yi Jie He Za Zhi 199 8 ; 1 8 :472-4. 2 1 9 Winther K, Ranlov C, Rein E, et al. Ru s sian root (Siberian ginseng) im proves cognitive functions in middle-aged people, whereas Ginkgo biloba seems effective only in the elderly. J Neurological Sci 199 7 ; 1 50:S90. 1 1 5 Module Three Dosage and Administration A typical daily dose is 2-3 g of dried root in tea infusions or an equivalent preparation for use as an extract. For specific use with herpes simplex type II infections, 400 mg per day of eleuthero extract standardized to contain eleutheroside E 0.3% has been used 2 2 0 . Duration of Administration Generally safe when used short-term, up to three months 2 2 1 Active Constituents The active constituents of eleuthero include carbohydrates (polysaccharides, galactose, eleutheroside C, glucose, maltose, and sucrose), coumarins (isofraxidin-7-glucoside and 7-ethyl- umbelliferone), lignans, phenylpropanoids, triterpenoids, and essential oil at .8% 2 2 2 . Additional constituents include sesamin and isofraxidin found in the stem, and flavonoids found in the leaves 2 2 3 . Pharmacological Action The root, which is most commonly used, contains active compounds called eleutherosides A through M 2 2 4 . Eleutheroside B (syringin) and 2 2 0 Vogler BK, Pittler MH, Ernst E. The efficacy of ginseng. A sy stemic review of randomized clinical trials. Eur J Clin Pharmacol 199 9 ; 5 5 : 5 6 7 - 7 5 . 2 2 1 Wichtl, M. Ed. Herbal Drugs and Phytopharmaceuticals: A Handbook for Practice on a Scientific Basis , T hird Edition. Medpharm Scientific Publishers and CRC . Boca Raton: FL , 2004. 2 2 2 Barnes J., A nderson L., and Phillipso n J. D . Herbal Medicines, Third Edition. Lo ndon. Pharmaceutical Press, 2007. 2 2 3 Barnes J., A nderson L., and Phillipso n J. D . Herbal Medicines , T hird Edition. Lo ndon. Pharmaceutical Press, 2007. 1 1 6 Module Three eleutheroside E (syringaresinol), the most abundant, are used as marker compounds for eleuthero products 2 2 5 . Eleutherosides include a variety of diverse compounds including saponins (daucosterol, beta-sitosterol, and hederasaponin B), coumarins (isofraxidin), lignans (sesamin and syringaresinol), phenylpropanoids (syringin, caffeic acid, sinapyl alcohol, coniferyl aldehyde, and protocatechuic acid), betulinic acid, vitamin E, and provitamins like beta-carotene 2 2 6 . In addition, several constituents are thought to have both antioxidant and anticancer effects (including syringin, syringoresinol, sesamin, beta sitosterol, caffeic acid, and coniferyl aldehyde 2 2 7 ), and there is some evidence that coniferyl aldehyde protects DNA from breakage caused by ultraviolet light 2 2 8 . Preliminary evidence also suggests that, in an antioxidant capacity, eleuthero might prevent damage in ischemic stroke 2 2 9 . 2 2 4 Davydov M, Krikorian AD . Eleutherococcus senticosus (Ru pr. & Maxim.) Maxim. (Araliaceae) as an adaptogen: a closer look . J Ethnopharmacol 2000;72 :345-93. 2 2 5 Harkey MR, Henderson G L , Gershwin ME, et al. Variability in com mercial ginseng products: an analysis of 25 preparations . Am J Clin Nutr 2001;73:1101-6 . 2 2 6 Davydov M, Krikorian AD . Eleutherococcus senticosus (Ru pr. & Maxim.) Maxim. (Araliaceae) as an adaptogen: a closer look . J Ethnopharmacol 2000;72 :345-93. 2 2 7 Davydov M, Krikorian AD . Eleutherococcus senticosus (Ru pr. & Maxim.) Maxim. (Araliaceae) as an adaptogen: a closer look . J Ethnopharmacol 2000;72 :345-93. 2 2 8 Davydov M, Krikorian AD . Eleutherococcus senticosus (Ru pr. & Maxim.) Maxim. (Araliaceae) as an adaptogen: a closer look . J Ethnopharmacol 2000;72 :345-93. 2 2 9 Han L, Cai D. [Clinical and experimental study on treatment of acute cerebral infarction with Acantho panax Injection] . [Article in Chinese]. Zhongguo Zhong Xi Yi Jie He Za Zhi 1 9 9 8 ; 1 8 :472-4. 1 1 7 Module Three Anticancer effects include an antiproliferative effect on leukemia cells, as shown in a 1984 study 2 3 0 , as well as the ability to potentiate the effect of antimetabolites such as cytarabine. Eleuthero?s effectiveness as an adaptogen, was tested in a 2009 animal study. The results concluded that adaptogens induce the increase of serum Hsp72, which is regarded as a defense response to stress, and also increase tolerance to stress 2 3 1 . For more information about pharmacological actions, refer to the Natural Medicines database. Medicinal Uses Eleuthero is thought to decrease blood glucose levels, and the eleutheroside constituents appear to have hypoglycemic activity 2 3 2 . Additionally, studies show that a specific eleuthero extract standardized to contain eleutheroside 0.3% may reduce the frequency, severity, and duration of herpes simplex type II infections 2 3 32 3 4 . 2 3 0 Hacker B, Medon PJ . Cytotoxic effects of Eleutherococcus senticosus aqueous extracts in combination with N6 - (delta 2-iso pentenyl)-adenosine and 1-beta-D- arabinof uranos ylcytosine against L12 10 leukemia cells. J Pharm Sci 1984;73:270- 2. 2 3 1 Panos sian A, Wikman G, Kaur P, Asea A. Adaptogens exert a stress- protective effect by modulation of expression of molecular chaperones. Phytomedicine. 2009 Jan 31. 2 3 2 Hikino H, Takahashi M, Otake K, Ko n n o C. Isolation and hyp o glycemic activity of eleutherans A, B, C , D , E, F, and G: glycans of Eleutherococcus senticosus roots. J Nat Prod 198 6 ;49:2 93-7. 2 3 3 Williams M. Imm u n o - protection against herpes sim plex type II infection by eleutherococcus root extract. Int J Altern Complem Med 199 5 ; 13:9- 1 2 . 2 3 4 Vogler BK, Pittler MH, Ernst E. The efficacy of ginseng. A sy stemic review of randomized clinical trials. Eur J Clin Pharmacol 199 9 ; 5 5 : 5 6 7 - 7 5 . 1 1 8 Module Three Contraindications The Commission E Monographs contraindicate eleuthero for use with high blood pressure. Eleuthero can cause palpitations, tachycardia, and hypertension. It should be used with caution with patients who have known cardiovascular disorders (e.g., atherosclerotic or rheumatic heart disease) 2 3 5 . It can also cause headache and pericardial pain in patients with rheumatic heart disease 2 3 6 . Women with hormone-sensitive conditions should also avoid use. Eleuthero might have estrogenic effects 2 3 7 . Some of these conditions include: Breast cancer, uterine cancer, ovarian cancer, endometriosis, and uterine fibroids. In addition, eleuthero might worsen hypertension 2 3 8 , myocardial infarction 2 3 9 , and psychiatric conditions like hysteria, mania, and schizophrenia 2 4 0 . There is insufficient information about use during pregnancy and while breast-feeding; avoid use. 2 3 5 Mills S, Bo ne K. Principles and Practice of Phytotherapy . Lo ndon: C h urchill Living stone, 2000. 2 3 6 Mills S, Bo ne K. Principles and Practice of Phytotherapy . Lo ndon: C h urchill Living stone, 2000. 2 3 7 Eagon PK , Elm MS, Hunter DS, et al. Medicinal herbs: modulation of estrogen action. Era of Hope Mtg, Dept Defense; Breast Cancer Res Prog, Atlanta, GA 2000;Jun 8- 1 1 . 2 3 8 McGuf fin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association Botanical Safety Handbook . Boca Raton, FL : CR C Press, LL C 19 9 7 . 2 3 9 Newall CA , A nderson LA , Philpso n JD . Herbal Medicine: A Guide for Healthcare Professionals . Lo ndon, UK : The Pharmaceutical Press, 19 9 6 . 2 4 0 Newall CA , A nderson LA , Philpso n JD . Herbal Medicine: A Guide for Healthcare Professionals . Lo ndon, UK : The Pharmaceutical Press, 19 9 6 . 1 1 9 Module Three A d v e r s e E f f e c t s When taken orally, eleuthero can cause slight drowsiness, anxiety, irritability, melancholy, and mastalgia; however, these adverse effects are more likely with higher than normal doses. Long-term use of eleuthero is associated with inflamed nerves, often the sciatic nerve, which can then cause muscle spasms. There is one case report of neonatal androgenization following maternal use of eleuthero 24 12 4 2 . However, on further inquiry, the androgenization was attributed to silk vine bark contamination 2 4 3 . Drug and Supplement Interactions When used simultaneously with herbs and supplements that affect platelet aggression, eleuthero might increase risk of bleeding, because of a possible effect on platelet aggression 2 4 4 . Some of these herbs include: Angelica, anise, arnica, asafoetida, bogbean, boldo, capsicum, celery, chamomile, clove, danshen, fenugreek, feverfew, fish oil, garlic, ginger, horse chestnut, horseradish, licorice, meadowsweet, onion, Panax ginseng, papain, passionflower, poplar, prickly ash, quassia, red clover, turmeric, vitamin E, wild carrot, wild lettuce, and willow. Preliminary evidence indicates eleuthero might also have hypoglycemic effects 2 4 5 . Simultaneous use with other herbs and supplements that lower blood glucose levels could increase risk of hypoglycemia. Some 2 4 1 Koren G, Randor S, Martin S, Danneman D. Maternal ginseng use associated with neonatal androgenization. JAMA 1990;264:28 6 6 . 2 4 2 Mills S, Bo ne K. Principles and Practice of Phytotherapy . Lo ndon: C h urchill Living stone, 2000. 2 4 3 Waller DP, Martin AM, Farnsw orth NR , A wang D V . Lack of androgenicity of Siberian ginseng. JAMA 1 9 9 2 ; 2 6 7 : 2329. 2 4 4 Yun - C h oi HS, Kim JH, Lee JR. Potentia l inhibitors of pl atelet aggregation from plant so urces, III. J Nat Prod 198 7 ; 50:1059- 64. 2 4 5 Hikino H, Takahashi M, Otake K, Ko n n o C. Isolation and hyp o glycemic activity of eleutherans A, B, C, D, E, F, and G: glycans of Eleutherococcus senticosus roots. J Nat Prod 198 6 ;49:2 93-7. 120 Module Three of these include: Bitter melon, ginger, goat?s rue, fenugreek, kudzu, willow bark, and gymnema. In addition, simultaneous use with herbs with known sedative effects could enhance therapeutic and adverse effects. Preliminary evidence suggests Siberian ginseng may cause dose-dependent sedation 2 4 6 . Herbs with sedative effects include: Calamus, calendula, California poppy, catnip, capsicum, celery, couch grass, elecampane, German chamomile, goldenseal, gotu kola, hops, Jamaican dogwood, kava, lemon balm, sage, St. John?s wort, sassafras, scullcap, shepherd?s purse, stinging nettle, valerian, wild carrot, wild lettuce, ashwagandha root, and yerba mansa. Interactions with Drugs For more information about interactions with drugs, refer to the Natural Medicines database. Regulatory Status Canada: Eleuthero is an approved ingredient in Schedule OTC Traditional Herbal Medicine products and requires pre-marketing approval. U.K.: Not on the General Sale List and product licenses have not been granted. U.S.: Used as a dietary supplement. 2 4 6 Medon PJ , Fergus o n PW , Watson CF . Ef fects of Eleutherococcus senticosus extracts on hexobarbital metabolism in vivo and in vitro . J Ethnopharmacol 1984;10:235-41. 121 Module Three E l y m u s r e p e n s ( also kno wn as A g r o p y r o n r e p e n s and E l y t r i g i a r e p e n s ) Image 17: by Rasbak (2005) via Wikipedia.org Taxonomic Notes Common botanical name: Couch Grass Family: Poaceae/Gramineae C o m m o n N a m e s Agropyron, wheatgrass, couchgrass, cutch, dog grass, dog-grass, doggrass, durfa grass, graminis rhizoma, quack grass, quackgrass, quitch grass, Scotch quelch, triticum, twitchgrass, wheat grass, and witch grass P r i m a r y U s e s Traditionally, couch grass has been used to address urinary tract infections and kidney-related problems (including kidney stones). 122 Module Three Couch grass is also said to act as a diuretic in the presence of carbohydrates. The essential oil of couch grass is used for its antimicrobial properties, and extracts have been used as a dietary ingredient with diabetes patients. Overview Couch grass is one of the most common field weeds and is widely distributed throughout Europe, Northern Asia, the United States, and Australia. According to the Natural Standard database, couch grass grows up to about five feet tall and has spikes, with spikelets, about six inches. Couch grass also has rhizomes that are shiny and pale-yellow colored. Identifying Characteristics P a r t s U s e d Rhizome, roots, and short stem Dosage and Administration General dosage for the dried rhizome is 4-8 g (or in a decoction), three times daily. As a liquid extract (1:1 in 25% alcohol), 4-8 mL, three times daily As a tincture (1:5 in 40% alcohol), 5-15 mL, three times daily Part Characteristics Leaves The rhizome and stem are hollow and shiny- yellowish, light brown, or yellowish-brown Taste Bland and slightly-sweetish 123 Module Three Duration of Administration Excessive or prolonged use of couch grass should be avoided since this may result in hypokalemia 2 4 7 . Active Constituents The major active constituent in couch grass is triticin, which is a polysaccharide related to inulin. Additional active constituents include carbohydrates (fructose, glucose, inositol, mannitol, pectin, triticin, and mucilaginous substances), flavonoids (tricin), and volatile oil (mainly agropyrene). Pharmacological Action Couch grass has both anti-inflammatory and antimicrobial effects. In an animal study, an ethanolic extract exhibited only 14% inhibition of carrageenan-induced inflammation in the paws of rats 2 4 8 . As an antimicrobial, couch grass has been used as a remedy for urinary tract infections; agropyren?s essential oil and oxidation product have both been shown to be antibiotic. In addition, according to the Natural Standard database, the polysaccharide mucilage might help soothe inflammation and irritation, making it useful for digestive muscle spasms, and spasms in the bladder and urinary system. Contraindications Use of couch grass should be avoided if there is a known allergy to couch grass, its constituents, or the family Poaceae/Gramineae . Additionally, inulin could trigger an allergic reaction in some people, including throat swelling, nasal itching, coughing, and/or difficulty breathing. 2 4 7 Newall, C. A., A nderson , L. A ., and Philpso n , J. D . Herbal Medicine: A Guide for Healthcare Professionals . 19 9 6 . 2 4 8 Mascolo, N . Biological screening of Italian medicinal plants for anti- inflammatory activity. Phytother Res 198 7 ; 1 : 2 8 - 2 9 . 124 Module Three A 2000 animal study revealed that couch grass (in addition to other grass, weed, and tree pollens) caused atopic dermatitis in 150 of 1,000 dogs tested 2 4 9 . Due to lack of sufficient data, use avoid use of couch grass while pregnant or breast-feeding. Drug and Supplement Interactions None known. Regulatory Status Couch grass has Generally Recognized as Safe Status and is listed by the Council of Europe as a natural source of food flavoring. 2 4 9 Mueller RS, Bettenay SV , Tideman L. Aero-allergens in canine atopic dermatitis in so utheastern Australia based on 1000 intradermal skin tests. Aust Vet J . 2000 Jun ; 7 8 ( 6 ) :392- 9 . 125 Module Three E q u i s e t u m a r v e n s e L . Image 18: by Eric Guinther (2004) via Wikipedia.org Taxonomic Notes Common botanical name: Horsetail Family: Equisetaceae C o m m o n N a m e s Bottle brush, corn horsetail, Dutch rushes, equisetum, field horsetail, horse tail, horse willow, horsetail grass, horsetail rush, paddock-pipes, pewterwort, prele, scouring rush, souring rush, shave grass, shavegrass, and toadpipe 126 Module Three P r i m a r y U s e s Traditionally, the Native Americans of New Mexico used horsetail for food, and the Maskwaki used horsetail as animal feed, both to fatten their geese and to shine their ponies? hair 2 5 0 . Medicinally, horsetail has been used traditionally with several types of cancer, including: polyps, abdominal and oral cancers, bone cancer (in Guatemala), breast, intestine, kidney, lip, liver, stomach, and tongue cancer 2 5 1 . When taken orally, horsetail also has specific use for diuresis, edema, kidney and bladder stones, urinary tract infections, general kidney and bladder problems, alopecia, tuberculosis, brittle fingernails, rheumatic diseases, gout, frostbite, profuse menstruation, and hemorrhage (nasal, pulmonary, and gastric). When used topically, horsetail supports healing in wounds and burns. Do not confuse with Equisetum palustre (marsh horsetail), which has poisonous components. Equisetum arvense may be adulterated with Equisetum palustre , which has been shown toxic in cattle. Until toxicity for humans has been established, avoid use of Equisetum palustre 2 5 2 . Overview The medicinal use of horsetail can be traced to ancient Greece and Rome. The name Equisetum is derived from equus , which means ?horse?, and seta, which means ?bristle?. Traditionally, horsetail has been used in Europe for bleeding, ulcers, wounds, inflammation, and kidney stones. Similarly, Ayurvedic 2 5 0 Duke, J Ph D . Handbook of Medicinal Herbs. CR C Press. Boca Raton, FL : 2001. 2 5 1 Duke, J Ph D . Handbook of Medicinal Herbs . CR C Press. Boca Raton, FL : 2001. 2 5 2 Gibelli C. The hemostatic action of Eq uisetum . Arch.Intern.Pharmacodynam 1931;41:419-429. 127 Module Three medicine also uses horsetail with inflammation, as well as benign prostatic hypertrophy, urinary incontinence, and enuresis in children, and in traditional Chinese Medicine, Equisetum are used with bloody stools and urine, malaria, sore throat, and skin sores (topical). Native Americans have a long history with horsetail, including preparations for use with dysuria, bladder incontinence, kidney diseases, and as an animal feed. In the 19th century, American physicians thought horsetail might be effective with gonorrhea, prostatitis, and enuresis. Today horsetail is being studied for its potential use with osteoporosis. Horsetail might increase bone density and, therefore, work as an additive when taken in conjunction with osteoporosis agents 2 5 3 . P a r t s U s e d Above ground parts Dosage and Administration Typical dosage when taken orally is 6 g of dried herb per day. To make horsetail tea, steep 1.5 g of the dried stem in 150 mL of boiling water for 10-15 minutes, and then strain. As a tincture (1:1 in 25% alcohol), 1-4 mL, three times a day. For specific use with osteoporosis, a horsetail dry extract taken for one year 2 5 4 . (For more information, see the Natural Standard monograph.) Topically, horsetail can be used as a compress for wound healing. Use 10 g of the dried stem per liter of water. 2 5 3 Corletto F. [Female climacteric osteop orosis therapy with titrated horsetail ( E quisetum arvense ) extract plus calcium (o steosil calcium ) : randomized double blind study]. Miner Ortoped Traumatol 1 9 9 9 ; 50:201-206. 2 5 4 Corletto F. [Female climacteric osteop orosis therapy with titrated horsetail ( E quisetum arvense ) extract plus calcium (o steosil calcium ) : randomized double blind study]. Miner Ortoped Traumatol 1 9 9 9 ; 50:201-206. 128 Module Three Duration of Administration The powdered stem of horsetail may be unsafe for long-term use 2 5 5 . Active Constituents The active constituents in horsetail include flavonoids (such as apigenin, luteolin, and kaempferol, and quercetin compounds), petrosins (such as onitin), caffeic acid derivatives, sterols, tannins, saponins 2 5 62 5 72 5 8 , and significant amounts of silica 2 5 92 6 0 . Pharmacological Action Animal and in vitro studies suggest that the silicon in horsetail may make it effective for use with osteoporosis. Silicon is used in bone development and may both increase the rate of bone mineralization and enhance calcium in the bone 2 6 1 . 2 5 5 Corletto F. [Female climacteric osteop orosis therapy with titrated horsetail ( E quisetum arvense ) extract plus calcium (o steosil calcium) : randomized double blind study]. Miner Ortoped Traumatol 1 9 9 9 ; 50:201-206. 2 5 6 Oh H, Kim DH, Ch o JH, Kim YC . Hepatoprotective and free radical scavenging activities of phenolic petrosins and flavon oids isolated from E quisetum arvense. J Ethnopharmacol 2004;95 :421-4. 2 5 7 Sakurai N, Iizuka T, Nakayama S, et al. [Vasorelaxant activity of caffeic acid derivatives from Cichorium intybus and E quisetum arvense ] . [Article in Japanese]. Yakugaku Zasshi 2003;123:593-8. 2 5 8 Langhammer L, Blaszkiewitz K, Kotzorek I. Evidence of toxic adulteration of equisetum. Dtsch Apoth Ztg 197 2 ; 1 1 2 : 1 7 5 1 - 94. 2 5 9 Bassindale AR, Brandstadt KF, Lane TH, Taylor PG. En z y me-catalysed siloxane bond formation. J Inorg Biochem . 2003 Aug 1; 9 6 ( 2 -3):401-6 . 2 6 0 Piekos R, Paslawska S. Studies on the optimu m conditions of extraction of silicon species from plants with water. I. E quisetum arvense L. Herb. Planta Med 197 5 ; 2 7 : 145-50. 2 6 1 Corletto F. [Female climacteric osteop orosis therapy with titrated horsetail (Eq uisetum arvense) extract plus calciu m (o steosil calcium) : randomized double blind study]. Miner Ortoped Traumatol 1 9 9 9 ; 50:201-206. 129 Module Three In addition, horsetail has, traditionally, been used as a diuretic. Though there is limited human data, in vitro studies suggest the constituents equisetonin and flavone glycosides have diuretic properties 2 6 2 . Contraindications Due to a lack of information, horsetail should be used with caution during pregnancy and while breast-feeding. Horsetail contains thiaminsae, which breaks down thiamine, and might effect thiamine depletion 2 6 3 . Additionally, horsetail contains minimal amounts of nicotine 2 6 4 , which might interactive with nicotine allergy or nicotine toxicity, if taken in excessive quantities. In certain cases, topical contact with the nicotine in horsetail has caused seborrheic dermatitis 2 6 5 . Horsetail has also been identified as having cross-allergenicity with carrots 2 6 6 . Drug and Supplement Interactions Due to its potassium-depleting effects, horsetail may theoretically cause toxicity among patients with underlying cardiac arrhythmias or 2 6 2 Tiktins ki O L , Bablumian IuA. [T herapeutic action of Java tea and field horsetail in uric acid diathesis] Urol Nefrol (Mosk) . 19 83 Jan-Feb;(1 ) :47-50. 2 4 4 Vimo kesant S, Ku n jara S, Ru n gruangsak K, et al. Beriberi caused by antithiamin factors in fo od and its prevention. Ann N Y Acad Sci 198 2 ;378:1 23-36 2 6 4 Sudan BJ. Seborrhoeic dermatitis in duced by nicotine of horsetails ( E quisetum arvense L.) . Contact Dermatitis 198 5 ; 13:201-2 . 2 6 5 Sudan BJ. Seborrhoeic dermatitis in duced by nicotine of horsetails ( E quisetum arvense L.) . Contact Dermatitis 198 5 ; 13:201-2 . 2 6 6 Agu stin- Ubide MP, Martinez-C ocera C, Alon s o - Llamazares A, et al. Diagno stic approach to anaphylaxis by carrot, related vegetables and horsetail ( E quisetum arvense ) in a homemaker. Allergy 2004;59:7 8 6 - 7 . 1 3 0 Module Three those taking digoxin. Studies have demonstrated that horsetail likely does not affect blood pressure when taken orally 2 6 7 . Horsetail contains the constituents equisetonin and flavone glycosides, which effect horsetail?s weak diuretic action. Horsetail has preliminarily demonstrated is use as a diuretic in humans 2 6 8 . In addition, horsetail might reduce potassium levels and use of horsetail with other diuretics might lead to hypokalemia or dehydration, though there is insufficient literature to support this. 2 6 7 Gibelli C. The hemostatic action of Eq uisetum . Arch.Intern.Pharmacodynam 1931;41:419-429. 2 6 8 Tiktinski O L , Bablumian IuA. [T herapeutic action of Java tea and field horsetail in uric acid diathesis] Urol Nefrol (Mosk) . 19 83 Jan-Feb;(1 ) :47-50. 1 3 1 Module Three E s c h s c h o l z i a c a l i f o r n i c a Image 19: by Artslave (2005) via Wikipedia.org Taxonomic Notes Common botanical name: California Poppy Family: Papaveraceae C o m m o n N a m e s California poppies, poppy California, and yellow poppy P r i m a r y U s e s California poppy is said to have analgesic, anodyne, diaphoretic, diuretic, soporific, and spasmolytic properties, and the alkaloids in the roots are attributed with weak narcotic and respiratory effects 2 6 9 . In specific, when taken orally, California poppy has been used for insomnia, sedation, aches, nervous agitation, enuresis in children, and 2 6 9 Duke, J. Ph D . Handbook of Medicinal Herbs . CR C Press. Boca Raton: FL , 2001. 1 32 Module Three diseases of the bladder and liver. When used in combination with other herbs, California poppy is used for depression, neurasthenia, neuropathy, various psychiatric conditions, Foehn illness (sleep and mood disturbance associated with strong, warm wind in the Alps), vasomotor dysfunction, sensitivity to weather changes, and sedation. Additionally, when mixed with black pepper, California poppy has been used with ague, jaundice, and skin problems 2 7 0 . Overview Do not confuse with corn poppy Papaver rhoeas or opium poppy Papaver somniferum , which are different botanicals. P a r t s U s e d Dried, above ground parts Dosage and Administration When taken orally, a typical dosage is one cup of tea, four times a day. To make the tea, steep 2 g of the dried herb in 150 mL of boiling water for 10-15 minutes, and then strain 2 7 1 . As a liquid extract, a typical dosage is 1-2 mL per day. Active Constituents The active constituents in California poppy include the alkaloids californine and protopine, which seems to have benzodiazepine-like activity. Preliminary research in California poppy suggests the ability to prolong sleep, as well as spasmolytic, sedative, and anxiolytic effects 2 7 22 7 32 7 4 . 2 7 0 Duke, J. Ph D . Handbook of Medicinal Herbs . CR C Press. Boca Raton: FL , 2001. 2 7 1 McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association Botanical Safety Handbook . Boca Raton, FL : CR C Press, LL C 19 9 7 . 2 7 2 Paul LD , Springer D, Staack RF, et al. Cytochrome P450 isoenzy mes inv olved in rat liver microso mal metabolism of californine and protopine. Eur J Pharmacol 2004;485:6 9 - 7 9 . 1 3 3 Module Three Pharmacological Action Preliminary clinical research suggests California poppy, in combination with magnesium and hawthorn, might be useful with mild to moderate anxiety disorders 2 7 5 . At present, there is insufficient research to evaluate California poppy for this purpose. Medicinal Uses California poppy is traditionally used in herbal medicine as a mild sedative 2 7 6 , or sleep aid, and as an analgesic 2 7 7 . California poppy is a Native American remedy that is commonly used in Europe as a relaxant and antispasmodic. Because of its mild sedative and analgesic properties, it may be given safely to children. California poppy is used for anxiety, sleeplessness, stomach cramps, and toothache. Studies in Germany and France have supported the traditional use of California poppy for muscle relaxing, anxiety, and pain relief. It is cooling and can be given to people with nervousness who have excess heat or heat caused by adrenal weakness. It is one of the most reliable and safe relaxing herbs for children and adults and is excellent in formulas with wild oats and St. John?s wort 2 7 8 . 2 7 3 Paul LD , Maurer HH. Studies on the metabolism and toxicological detection of the Eschscholtzia californica alkaloids californine and protopine in urine using gas chromatography - mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2003;789 :43-57 . 2 7 4 Rolland A, Fleurentin J, Lanhers MC, et al. Behavioural effects of the American traditional plant Eschscholzia californica : sedative and anxiolytic properties. Planta Med 199 1 ; 5 7 : 2 1 2 - 6 . 2 7 5 Hanus M, Lafon J, Mathieu M. Double-blind, randomised, placebo-controlled study to evaluate the efficacy and safety of a fixed combination containing two plant extracts ( Crataegus oxyacantha and Eschscholtzia californica ) and magnesium in mild-to-m oderate anxiety disorders. Curr Med Res Opin 2004;20:63-71 . 27 6 Mills and Bone 2005; Hoffmann 2003; Felter and Lloyd 1983. 27 7 Mills and Bone 2005; Hoffmann 2003; Felter and Lloyd 1983. 2 7 8 http:// w w w .altmd.com/Articles/California-Po p p y -Herbal-Remedies 1 3 4 Module Three Contraindications According to the Natural Standard monograph, California poppy may ?bind with the same receptors as monoamine oxidase (MAO) inhibitors and selective serotonin reuptake inhibitors (SSRIs). Caution should be used in patients taking these agents 2 7 9 .? Simultaneous use of California poppy with herbs that have sedative effects may increase therapeutic effects and adverse effects. These herbs include: Calamus, catnip, hops, Jamaican dogwood, kava, St. John?s wort, skullcap, valerian, and yerba mansa 2 8 02 8 1 . In addition, due to lack of sufficient data, California poppy should be avoided while pregnant and breast-feeding. Regulatory Status Listed in the Botanical Safety Handbook in Class 2b. Module Assessment You are now ready to log in and complete the module assessment online. 2 7 9 Gafner S, Dietz BM, McPhail KL, Scott IM, Glinski JA , Ru s sell FE, McCollom MM, Budzinski JW , Fo ster BC , Bergeron C, Rh y u MR, Bolton JL. Alkaloids from Eschscholzia californica and their capaci ty to inhibit binding of [3H]8-Hydroxy - 2 - (di-N - propylamino )tetra lin to 5-HT1A receptors in vitro . J Nat Prod . 2006 Mar;69(3):432-5 . 2 8 0 Paul LD , Springer D, Staack RF, et al. Cytochrome P450 isoenzy mes inv olved in rat liver microso mal metabolism of californine and protopine. Eur J Pharmacol 2004;485:6 9 - 7 9 . 2 8 1 Paul LD , Maurer HH. Studies on the metabolism and toxicological detection of the Eschscholtzia californica alkaloids californine and protopine in urine using gas chromatography - mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2003;78 9 :43-57 . 1 3 5 Module Four Module Four Module Objectives Upon completion of this module, you will be able to: ? Recall and describe the Latin binomial or scientific name, common name, and family. ? Be able to identify a photograph by the Latin name and common name of the botanicals studied. ? Identify the therapeutic potential of each botanical studied. ? Explain the pharmacological action of each botanical studied. ? List the key recommended uses for each botanical studied. ? Recall the recommended dosage and duration for each botanical studied. ? Recall and describe any contraindications and precautions associated with each botanical studied. ? Recall the regulatory status of each of botanical studied. Module Checklist ? Read and review the module. ? Read any online resources as applicable. ? Ensure you can meet the Module Objectives. ? Complete the module assessment online and respond to another student?s posting as instructed. ? Complete the Module Test. 4 1 3 6 Module Four E u p a t o r i u m p e r f o l i a t u m Image 20: by SB Johnny (2007) via Wikipedia.org Taxonomic Notes Common botanical name: Boneset Family: Asteraceae/Compositae C o m m o n N a m e s Agueweed, astragalin, common boneset, crosswort, feverwort, gravelroot, Indian sage, snakeroot, sweat plant, sweating plant, tearal, teasel, thoroughwax, thoroughwort, thorough-stem, vegetable antimony, wild Isaac, wild sage, and wood boneset P r i m a r y U s e s Boneset is said to have diaphoretic and aperient (or laxative) properties. Traditionally, boneset has been used for influenza, acute 1 3 7 Module Four bronchitis, and nasopharyngeal catarrh 2 8 2 , as well as constipation and fever. In specific, when taken orally, boneset is used as an antipyretic, diuretic, laxative, emesis, and cathartic. A homeopathic preparation is used with anal herpes, back pain, bilious fever, bladder problems, bone ache, cough, fracture, fever, flu, gastritis, jaundice, indigestion, rheumatism, thirst, and wounds, among others 2 8 3 . Do not confuse with gravel root Eupatorium purpureum , which is also known as boneset, or snakeroot, a common name used for poisonous Eupatorium . O v e r v i e w The name ?boneset? speaks to one of its earliest uses: To relieve the deep bone pain associated with dengue fever. First used by Native Americans, European settlers later adopted boneset for use with fevers. Native Americans, though, have also used boneset for influenza, colds, typhoid, fevers, arthritis, rheumatism, and catarrh. By the mid-19th century, boneset has become a type of panacea among settlers. Additionally, boneset was included in the United States Pharmacopoeia from 1820 to 1916 and the National Formulary from 1926?1950, and in 1918 some physicians even used boneset with the influenza epidemic. (Boneset is indigenous to eastern North America.) Today, boneset is thought to have immunostimulating properties beneficial with cancer and HIV/AIDS patients, as well as promoting secretion and excretion of bile to soothe night sweats and achy bones. P a r t s U s e d Dried leaf and flowering parts 2 8 2 Barnes, J., A nderon L., and Phillipso n J.D . Herbal Medicines, Third Edition. Pharmaceutical Press. Lo ndon: 2007. 2 8 3 Duke, J. Ph D . Handbook of Medicinal Herbs . CR C Press. Boca Raton: FL , 2001. 1 3 8 Module Four Dosage When taken orally, a regular dose is one cup of tea, three times daily. To make the tea, steep 1-2 g of herb in 150 mL of boiling water for 5- 10 minutes 2 8 4 . As a liquid extract (1:1 in 25% alcohol) 1-2 mL, three times daily As a tincture (1:5 in 45% alcohol) 1-4 mL, three times daily Duration of Administration It is recommended that boneset be taken for no longer than two weeks at a time. Active Constituents The active constituents in boneset include sesquiterpene lactones 2 8 5 (including eupafolin, euperfolitin, eufoliatin, eufoliatorin, euperfolide, eucannabinolide, and helenalin), immunostimulatory polysaccharides (primarily 4-0-methylglucuroxylans), flavonoids (such as quercitin, kaempferol, hyperoside, astragalin, rutin, and eupatorin 2 8 6 ), diterpenes (including dendroidinic acid and hebenolide), sterols, and volatile oil 2 8 7 . Pharmacological Action Preliminary research suggests that boneset may have cytotoxic and mild antibacterial activity. In a 2000 study, boneset extract showed 2 8 4 Herz W , Kalyanaraman PS , Ramakrishnan G. Sesquiterpene lactones of Eupatorium perfoliatum . J Org Chem . 19 7 7 Ju n 24;42(13):2 2 64-71 . 2 8 5 Sesquiterpene lactones are kno w n for antimicrobial, antitum or, imm u n o stimulating, and cytotoxic activities. 2 8 6 The flavon oid eupatorin may have cytotoxic activity. 2 8 7 Herz W , Kalyanaraman PS , Ramakrishnan G. Sesquiterpene lactones of Eupatorium perfoliatum. J Org Chem . 19 7 7 Ju n 24;42(13):2 2 64-71 . 1 3 9 Module Four weak antibacterial activity against Staphylococcus aureus and Bacillus megaterium 2 8 8 . Stimulant, febrifuge and laxative: It acts slowly and persistently, and its greatest power is manifested upon the stomach, liver, bowels, and uterus. Boneset is regarded as a mild tonic in moderate doses, and is also diaphoretic, especially when taken as a warm infusion, in which form it is used in attacks of muscular rheumatism and general cold. In large doses it is emetic and purgative 2 8 9 . Traditionally, boneset has been used to address fevers and infectious diseases, such as colds and influenza. Preliminary study indicates that boneset may treat cold symptoms. Additional study is needed to confirm these results 2 9 0 . Boneset is used to spur activity in the immune system and fight infection in both viral and bacterial form. Has also been helpful in treating worms and various skin conditions. Febrifuge Popular remedy for fevers and helps patient break out into a sweat. Inflammation Aids in clearing mucous from the upper respiratory tract 2 9 1 . 2 8 8 Habtemariam S, Macpherson AM. Cytotoxicity and antibacterial activity of ethanol extract from leaves of a herbal drug, boneset ( Eupatorium perfoliatum ) . Phytother Res 2000;14:57 5 - 7 . 2 8 9 http:// w w w .botanical.com/botanical/m g m h /b/bonese65.html 2 9 0 http:/ / naturalstandard.com / m o n o graph s / m o n o frameset.asp? m o n o graph= / m o n o g raphs / herbssu p plements/patient-bones et.asp%3Fprintversion %3Dtrue 2 9 1 http:// w w w . herbco.com / p - 8 2 2 -boneset-herb-cs-wild-crafted.aspx 1 4 0 Module Four Laxative Boneset works slowly but emphatically on the bowels as a remedy for constipation. Tonic Used in moderate doses, it aids relief of muscular rheumatism and the common cold. Also, used when dyspepsia and debility occurs and helpful to relieve indigestion in older people. Contraindications Contraindicated for use with known allergies to boneset, its constituents, or members of the Asteraceae/Compositae family, such as dandelion, goldenrod, ragweed, sunflower, and daisies. Hypersensitivity to the sesquiterpene lactone constituents of boneset can result in contact dermatitis. Simultaneous use of boneset with herbs containing hepatotoxic pyrrolizidine alkaloid (PA) are contraindicated due to the potential for additive toxicity. These herbs include: Borage, butterbur, coltsfoot, comfrey, gravel root, hemp agrimony, hound?s tongue, and the Senecio species plants dusty miller, alpine ragwort, groundsel, golden ragwort, and tansy ragwort 2 9 2 . Additionally, fresh boneset herb contains the toxic chemical tremerol, which is known to cause nausea, vomiting, weakness, muscle tremors, and increased respiration. High consumption can cause coma and death. However, dried boneset does not seem to contain tremerol. Drug and Supplement Interactions None known. 292 Ch o j kier M. Hepatic sinu s oidal-obstruction sy ndrome: toxicity of pyrrolizidine alkaloids. J Hepatol 2003;39:437-46. 1 4 1 Module Four Regulatory Status Products with boneset as an ingredient have been categorized as ?Herbs of Undefined Safety? by the U.S. Food and Drug Administration. 1 42 Module Four E u p a t o r i u m p u r p u r e u m Image 21: by Sten (2004) via Wikipedia.org Taxonomic Notes Common botanical name: Gravel Root Family: Asteraceae/Compositae C o m m o n N a m e s Joe pye, joe-pye weed, kidney root, kidney root, purple boneset, queen of the meadow, roter wasserhanf, and trumpet weed Do not confuse with boneset, which is a different botanical. P r i m a r y U s e s When taken orally, gravel root is useful with urinary calculus, renal or vesicular calculi, cystitis, painful urination, urethritis, prostatitis, rheumatism, and gout. It is also used orally for malaria-induced fever, dengue virus, fever, typhus, and as an antacid, aperitif, diuretic, emetic, stimulant, tonic, and for inducing sweating. P a r t s U s e d Above ground parts, rhizome, and roots 1 4 3 Module Four Dosage and Administration No typical dosage. Duration of Administration Long-term use is not recommended 2 9 3 . Pharmacological Action Gravel root is thought to have antilithic, diuretic, and antirheumatic properties; however, these properties have not been studied. Gravel root contains various pyrrolizidine alkaloids (PA), which can be toxic, and are most concentrated in the plant roots. Pyrrolizidine alkaloids can cause hepatotoxicity, particularly unsaturated pyrrolizidine alkaloids. Contraindications Avoid use if there is a known allergy to gravel root, its constituents, or the Asteraceae/Compositae 2 9 4 family. Plants in this family include: Ragweed, chrysanthemums, marigolds, daisies, and many additional herbs. Gravel root is contraindicated for potential liver damage. Gravel root preparations contain pyrrolizidine alkaloid (PA); these constituents are hepatotoxic, pneumotoxic, carcinogenic, and mutagenic 2 9 52 9 6 . Long- term exposure to other plants with pyrrolizidine alkaloid constituents 2 9 3 McGuffin, M., Hobbs, C. , Upton , R., and Goldberg, A. eds. B otanical Safety Handbook . CR C Press. Boca Raton: FL , 19 9 7 . 2 9 4 Habtemariam S. Cistifolin, an integrin-dependent cell adhesion blocker from the anti- rheumatic herbal drug, gravel root (rhizo me of Eupatorium purpureum ) . Planta Med 199 8 ; 64:683-5. 2 9 5 Cho j kier M. Hepatic sinu s oidal-obstruction sy ndrome: toxicity of pyrrolizidine alkaloids . J Hepatol 2003;39:437-46. 2 9 6 Roeder E. Medicinal plants in Europe containing pyrrolizidine alkaloids. Pharmazie 199 5 ; 50:83-98 . 1 4 4 Module Four has been has been linked to veno-occlusive disease 2 9 7 , a disease in which some of the small veins to the liver are blocked. Subacute veno-occlusive disease can cause vague symptoms and persistent liver enlargement 2 9 8 , while acute veno-occlusive disease has the symptoms: Colicky pains in epigastrium, vomiting and diarrhea, ascites formation (within several days), and enlargement and induration of the liver (within a few weeks 2 9 9 ). U.S. dietary supplements are not required to list the amount of pyrrolizidine alkaloid contained. Therefore, all preparations with gravel root to be consumed orally are potentially unsafe 3 0 0 . There is insufficient information about the use of gravel root products that do not contain pyrrolizidine alkaloid while pregnant or breast- feeding. Drug and Supplement Interactions Simultaneous use with hepatotoxic pyrrolizidine alkaloid herbs should be avoided due to the risk of additive toxicity. Herbs containing pyrrolizidine alkaloid include: Alkanna, boneset, borage, butterbur, coltsfoot, comfrey, forget-me-not, groundsel, hemp agrimony, hound?s tongue, dusty miller, groundsel, golden ragwort, and tansy ragwort 3 0 1 . Regulatory Status Listed in the Botanical Safety Handbook as Class 2a, 2b, 2c, and 2d. 2 9 7 WHO working grou p . Pyrrolizidine alkaloids. En vironmental Health Criteria, 80. WHO: Geneva, 19 8 8 . 2 9 8 WHO working grou p . Pyrrolizidine alkaloids. En vironmental Health Criteria, 80. WHO: Geneva, 19 8 8 . 2 9 9 Roeder E. Medicinal plants in Europe containing pyrrolizidine alkaloids. Pharmazie 199 5 ; 50:83-98 . 3 0 0 Klepser TB, Klepser ME. Un safe and potentially safe herbal therapies. Am J Health Syst Pharm 1 9 9 9 ; 5 6 : 1 2 5 -38. 3 0 1 Cho j kier M. Hepatic sinu s oidal-obstruction sy ndrome: toxicity of pyrrolizidine alkaloids . J Hepatol 2003;39:437-46. 1 4 5 Module Four F o e n i c u l u m v u l g a r e Image 22: by Carsten Niehaus (2004) via Wikipedia.org Taxonomic Notes Common botanical name: Fennel Family: Apiaceae (formerly Umbelliferae ) Common Names Bari-sanuf, bitter fennel, carosella, common fennel, finnichio, Florence fennel, Foeniculi antheroleum , garden fennel, large fennel, sweet fennel, wild fennel, and xiao hui xiang P r i m a r y U s e s When taken orally, fennel is used for increasing lactation, promoting menstruation, facilitating birth, and increasing libido. It is also used for upper respiratory tract infections, coughs, bronchitis, cholera, backache, bedwetting, dyspepsia, flatulence, bloating, loss of appetite, visual problems, and for colic in infants. Topically, fennel powder is used as a poultice for snakebites. 1 4 6 Module Four Fennel seeds are used in foods and beverages to flavor liqueurs, vinegars, breads, candy, and pickles. Additionally, fennel oil is reported to protect stored fruits and vegetables from fungi 3 0 2 . Overview Fennel is native to the Mediterranean, but can be found throughout North America and particularly in coastal areas. It is also found throughout New Zealand, particularly in the North Island, and Australia, including Tasmania. References to the use of fennel date back to Greek and Roman writings, and fennel has been used for centuries in traditional herbal medicine in Europe and China. Its traditional uses include abdominal cramps, digestion (stimulate), dyspepsia, and to stimulate the production of milk in lactating mothers. Do not confuse with common garden fennel Foeniculum officinale , which is a different botanical, or wild carrot Daucus carota , which is another weed in the same family. Identifying Characteristics Part Characteristics Stem Leaves 4-5-ft high, stout, erect, cylindrical. It is bright green and smooth. Divided three or four times. Ending in thread-like structures of a tender blue green. Stems of the leaves emerge from fleshy leaf sheaths. Flowers Fruit Taste Flowers are small, bright golden yellow and carried in large branching umbrella-shaped heads (umbels), with 13-20 rays. Seeds are round and elongated, a blue-green in color, turning greenish-brown as they ripen. Sweet, warm, and agreeable Fragrant, similar to aniseed 3 0 2 Duke, J. Ph D . Handbook of Medicinal Herbs . CR C Press. Boca Raton: FL , 2001. 1 4 7 Module Four P a r t s U s e d The seeds, oil, leaves, leaf, and stalk C u l t i v a t i o n a n d C o l l e c t i o n Fennel is usually grown from seed and cultivated for its edible leaf bases, as a culinary condiment, and for its medicinal properties. When cultivating fennel, do not allow the plant to go to seed. The plants die back to the crown over winter, and produce new leaf growth in spring, sending up new flowering stems in summer. Gather the ripe split fruit in fall. Cut off the brown umbel and comb the fruit, then dry lightly in the shade. Dig the root in spring. The stem of the cultivated fennel is edible and should be collected when young and tender. Preparation Fluid extract, infusion (leaves and seeds), syrup (juice), and tincture Dosage and Administration General dosage when taken orally is one cup of tea, three times daily. To make the tea, boil 1-2 g of the crushed or ground fennel fruit or seed in 150 mL of boiling water for 5-10 minutes, and then strain. Topically, 2% and 5% naturally active botanical (NAB) fennel has been used in an emulsion 3 0 3 . Duration of Administration None known. Active Constituents The major active constituents in fennel include anethole, an intestinal stimulant, phenolic ether, which has antiseptic properties, and fenchone, and internal anesthetic. 3 0 3 Dres, C, Jo h n s o n , C, and Loda, L. En z y mes and erythema reduction. SPC 199 9 ; 7 1 (313):33. 1 4 8 Module Four The anethole and fenchone reduce upper respiratory tract secretions and may increase mucociliary activity (movement of mucus). Anethole may be allergenic, insecticidal, and toxic. Anethole polymers have also shown some estrogenic activity 3 0 4 . In addition, the essential oil in the seeds contains 50-60% trans- anethole, 20% fenchone, estragole, and phenolic ether, as well as fatty oil, albumin, and sugar. Additional constituents include: alpha pinene, beta myrcene, beta pinene, bitter fenchone, camphene, limonene, p-cymen, and safrole. Fennel is a rich source of beta-carotene, vitamin C 3 0 5 , calcium, magnesium, and iron. Pharmacological Action Fennel has anti-carcinogenic and anti-inflammatory effects due to the presence of anethole, which may interfere with TNF signaling and lead to the activation of NF-kappaB, AP-1, JNK, MEK, and apoptosis. Anethole may suppress NF-kappaB-dependent gene expression induced by tumor necrosis factor; NF-kappaB controls the expression of some genes involved in carcinogenesis and inflammation 3 0 6 . Anethole, with the constituent fenchone, reduces upper respiratory tract secretions, and there is some evidence that aqueous fennel extract might also increase mucociliary activity. In addition, anethole appears to have allergenic, insecticidal, toxic, and estrogenic activity 3 0 7 . 3 0 4 Leung AY , Fo ster S. Encyclopedia of Com m on Natural Ingredients Used in Foo d , Drugs and Cosmetics . 2nd ed. New York, N Y : Jo h n Wiley & So n s , 19 9 6 . So urce: ww w . naturaldatabase.com 3 0 5 Brinker, F. Herb Contraindications and Drug Interactions . 19 9 8 ; 2 nd 3 0 6 Chainy G B , Manna SK, Chaturvedi MM, Aggarwal BB. Anethole blocks both early and late cellular respon ses transduc ed by tumor necrosis factor: effect on N F - kappaB, AP - 1 , JN K , MAPKK and apoptosis. Oncogene . 2000 Jun 8; 1 9 ( 2 5 ) : 2 943-50. 3 0 7 Leung AY , Fo ster S. Encyclopedia of Com m on Natural Ingredients Used in Foo d , Drugs and Cosmetics . 2nd ed. New York, N Y : Jo h n Wiley & So n s , 19 9 6 . 1 4 9 Module Four Medicinal Uses Clinical trials for the use of fennel with dysmenorrhea have shown promising results. In a 2003 study, 30 women ages 15-24 were tested in three cycles. In the first cycle no medication was given, in the second cycle participants were given 250 mg of mefenamic acid, and in the third cycle they were given 25 drops of fennel at 2% concentration. The results showed fennel is effective for use with dysmenorrhea, though it may have lower potency than mefenamic acid 3 0 8 . Fennel also has been shown effective for use with infantile colic. In a clinical trial, breast-fed infants with colic were given a multi-ingredient product with 164 mg of fennel, 97 mg of lemon balm, and 178 mg of German chamomile twice a week. Results showed reduced crying time compared to placebo 3 0 9 . Additionally, fennel is indicated for appetite stimulation, bloating, bronchitis, colic in young children and babies, constipation, coughs, cramps, eye complaints, dyspepsia, fevers, flatulence, increasing milk supply in lactating mothers, increasing libido, indigestion, rheumatism, stomach cramps, stomach pains, upper respiratory tract infections. Contraindications Fennel can cause photo dermatitis, and excessive exposure to sunlight or ultraviolent light should be avoided 3 1 0 . The German Commission E Monographs note that fennel can cause allergies and should not be used for prolonged periods in medicinal 3 0 8 Namavar Jahromi B, Tartifizadeh A, Khabnadideh S. Co m parison of fennel and mefenamic acid for the trea tment of primary dysmenorrhea. Int J Gynaecol Obstet . 2003 Feb;80(2) : 1 53-7. 3 0 9 Savino F, Cresi F, Castagno E, et al. A randomized double-blind placebo- controlled trial of a standardized extract of Matricariae recutita, Foeniculum vulgare and Melissa officinalis (ColiMil) in the treatment of breastfed colicky infants. Phytother Res 2005;1 9 :335-40. 3 1 0 Brinker F. Herb Contraindications and Drug Interactions . 2nd ed. Sandy, O R : Eclectic Medical Publications , 19 9 8 . 1 5 0 Module Four amounts without a professional consultation 3 1 13 1 2 . Allergic cross- sensitivity is possible in people with allergies to carrot, celery, mugwort, or other Apiaceae family plants 313 . Drug and Supplement Interactions Fennel might increase the effects of anticoagulant herbs and supplements. Giant fennel Ferula communis contains a potent anticoagulant and induces severe hemorrhagic diathesis in grazing ewes, or similar changes in utero in lamb 3 1 4 . Regulatory Status Fennel is classed as Safe for Consumption when used appropriately. 3 1 1 American Herbal Products Associ ation?s Botanical Safety Handbook , 19 9 7 : 53 3 1 2 Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines . Trans. S. Klein. Bo ston , MA: American Botanical Cou ncil, 19 9 8 . 3 1 3 Stäger J, W üthrich B, Jo hanss o n SG . Spice allergy in celery-sensitive patients. Allergy . 19 9 1 Au g ;46(6 ) :475- 8 . 3 1 4 Shlosberg A, Eg yed MN. Examples of poiso n o u s plants in Israel of importance to animals and man. Arch Toxicol Suppl . 19 83;6:1 94-6. 1 5 1 Module Four F u c u s v e s i c u l o s i s Image 23: by Stemonitis (2006) via Wikipedia.org Taxonomic Notes Common botanical name: Bladderwrack Family: Fucaceae C o m m o n N a m e s Kelp is a common term that refers to brown algae (brown seaweed) from the class Phaeophyceae , and includes Laminaria spp. and Fucus spp., as well as Sargassum spp. and Saccharina . Since the terms kelp, seaweed and algae are often used interchangeably, it is important to use the Latin name when referring to medicinal uses of the seaweeds, to avoid confusion. Fucus vesiculosus is a brown seaweed that grows on the northern coasts of the Atlantic and Pacific oceans and the North and Baltic seas. Common names for fucus include: Bladderwrak, common seawrack, edible seaweed, kelp, kelpware, knotted wrack, sea kelp, sea oak, seetang, seaware, seaweed, and sea wrack. 1 52 Module Four P r i m a r y U s e s Orally, bladderwrack is used for thyroid disorders, iodine deficiency, lymphadenoid goiter, myxedema, obesity, arthritis, and rheumatism. In folk medicine, bladderwrack is used for arteriosclerosis, digestive disorders, ?blood cleansing?, constipation, bronchitis, emphysema, genitourinary disorders, decreased resistance to disease, anxiety, skin diseases, burns, and insect bites. Overview Fucus was once used with iodine therapy for hypofunction of the thyroid gland. However, fucus has variable iodine content and absorption conditions for bound and unbound iodine, and is no longer used in this capacity 3 1 5 . Today, fucus is often attributed with ?fat-removing? 3 1 6 or anti-obesity, antihypothyroid, and antirheumatic properties 3 1 7 . The gelling properties of alginic acid, the major polysaccharide in brown seaweeds (including fucus), are used in the dairy and baking industries to improve the texture of products 3 1 8 . Do not confuse with bladderwort, which is a different botanical. 3 1 5 Wichtl, M. PhD . Herbal Drugs and Phytopharmaceuticals: A Handbook for Practice on a Scientific Basis , T hird Edition. Medpharm and CRC Press. Boca Raton: FL , 2004. 3 1 6 Wichtl, M. PhD . Herbal Drugs and Phytopharmaceuticals: A Handbook for Practice on a Scientific Basis , T hird Edition. Medpharm and CRC Press. Boca Raton: FL , 2004. 3 1 7 Barnes, J., A nderson , L., and Phillipso n J.D . Herbal Medicines , T hird Edition. Pharmaceutical Press. Lo ndon, 2007. 3 1 8 Barnes, J., A nderson , L., and Phillipso n J.D . Herbal Medicines , T hird Edition. Pharmaceutical Press. Lo ndon, 2007. 1 5 3 Module Four Identifying Characteristics Part Characteristics Leaves Dried blades of the thallus are entire- margined, branched in two parts, and with prominent central ribs Taste Odor Mucilaginous and salty Marine-like and fishy P a r t s U s e d Thallus (whole plant) Dosage Typical dosage when taken orally is 5-10 g of the plant as a tea, three times daily. To make the tea, steep the herb in 150 mL of boiling water for 5-10 minutes, and then strain. As a liquid extract (1:1), 4-8 mL, three times a day. Duration of Administration None given. Active Constituents The active constituents of bladderwrack include about .1% volatile oil 3 1 9 , cellulose, mucilage, mannite, coloring and bitter principles, soda and iodine, and bromine compounds of sodium and potassium. Pharmacological Action Bladderwrack products are often high in iodine content and, traditionally, have been used with thyroid diseases. Transient 3 1 9 Botanical.com . Grieve, M. A Modern Herbal . Accessed 5/14/09: http:/ / w w w .botanical.com/botanical/m g m h /b/bladde54.html 1 5 4 Module Four hyperthyroidism 3 2 0 might occur as a result of bladderwrack intake, especially when iodine exceeds the normal intake of 100-200 mcg per day. At this time, there is no widely accepted standardization of iodine content in bladderwrack products. M e d i c i n a l U s e s Bladderwrack is thought to reduce obesity by stimulating the thyroid gland 3 2 1 . It also has alterative properties, to help restore health. Contraindications Simultaneous use of bladderwrack with herbs that may affect platelet aggregation could increase risk of bleeding in some people 3 2 2 . These herbs include: Angelica, clove, danshen, fenugreek, feverfew, garlic, ginger, ginkgo, Panax ginseng, poplar, red clover, and turmeric. Might be unsafe for use with hyperthyroidism, hypothyroidism, or autoimmune thyroid disease. Bladderwrack contains varying amounts of iodine (up to 600 mcg per g), and consistent use might bring out hyperthyroidism, hypothyroidism, goiter, or myxedema, even though an individual may retain normal thyroid gland function. Normal daily iodine intake for humans is 100-200 mcg 3 2 3 . Bladderwrack also contains alginate, a viscous gum that binds strontium, an alkaline metal, and reduces the absorption of strontium from the gastrointestinal tract. According to the U.S. Department of Health and Human Services ?Toxicology profile for strontium?, 3 2 0 Eliason BC . Transient hyperthyroidism in a patient taking dietary sup plements containing kelp . J Am Board Fam Pract . 19 9 8 N o v - Dec;11 ( 6 ) :478- 80. 3 2 1 Botanical.com . Grieve, M. A Modern Herbal . Accessed 5/14/09: http:/ / w w w .botanical.com/botanical/m g m h /b/bladde54.html 3 2 2 Durig J, Bruhn T, Zurborn KH, et al. Anticoagulant fucoidan fractions from Fucus vesiculosus induce platelet activation in vitro. Thromb Res 199 7 ; 8 5 :479- 9 1 . 3 2 3 Clark, CD , Bassett B., and Burge MR. Ef fects of kelp su p plementation on thyroid function in euthyroid subjects. Endocr Pract. 2003 Sep-Oct;9( 5 ) :363-9. 1 5 5 Module Four strontium absorption was reduced four-fold when a 10% sodium alginate solution was taken at the same time as bladderwrack 3 2 4 . Due to the potentially high concentrations of heavy metal contamination, bladderwrack is not recommended for use during pregnancy or while breast-feeding 3 2 5 . Avoid use if there is a known allergy or hypersensitivity to Fucus vesiculosus , its constituents, or members of the Fucaceae family. Regulatory Status Canada: Approved active ingredient in more than 50 Schedule OTC drugs, requiring premarketing authorization U.K.: General Sale List, Table A of Schedule 1 (requires product license) U.S. Dietary supplement 3 2 4 US Department of Health and Human Services, Public Health Service. Agency for Toxic Substances and Disease Registry. To xicological profile for strontium . April 2004. Available at: ww w .atsdr.cdc.go v /tox profiles/tp1 5 9 . pdf. (Accessed 8 Au g u st 2006). 3 2 5 Norman JA , Pickford CJ, Sanders TW , and et al. Human intake of arsenic and iodine from seaweed-based food s up plements and health fo ods available in the UK. F o o d Addit Contam 198 7 ; 5 ( 1 ) : 103-109. 1 5 6 Module Four G a n o d e r m a l u c i d u m Image 24: Reishi Ganoderma lucidum. Photogr aph © Steven Foster. Reproduced under license Taxonomic Notes Common botanical name: Reishi Family: Ganodermataceae C o m m o n N a m e s Basidiomycetes mushroom, ling chih, ling zhi, mannentake, mushroom, mushroom of immortality, mushroom of spiritual potency, red reishi, reishi, reishi antler mushroom, rei-shi, and spirit plant P r i m a r y U s e s Use of reishi, or ganoderma mushroom, can be traced to ancient Chinese and Japanese shamans, who believed reishi could prolong health and help keep calm while meditating. Today, Chinese medicine includes reishi in therapies for fatigue, asthma, insomnia, and cough. Some experts still believe reishi promotes longevity and vitality. Although its primary benefits seem to be improvement of liver function and respiratory system function, reishi is also thought to 1 5 7 Module Four reduce high blood pressure and cholesterol, have anti-platelet aggregation and antioxidant effects, and is current being investigated as a chemopreventive agent for invasive hepatoma cells. Overview Ganoderma lucidum , reishi mushroom, grows wild on decaying logs and tree stumps. The mushroom grows in six different colors, of which red is the most commonly used. The red variety is also commercially cultivated in East Asia and North America. According to the Natural Standard monograph, Ganoderma lucidum has been used in Chinese medicine for more than 4,000 years, and was used with liver disorders, hypertension, and arthritis. Today, human trials and animal studies show Ganoderma lucidum may benefit cancer patients and patients with liver disease. Additional possible uses, though lacking in conclusive evidence, include: Diabetes, heart disease, pain, Russula subnigricans (or basidiomycete mushroom) poisoning, hypertension, proteinuria, postherpetic neuralgia, and arthritis. 1 5 8 Module Four Identifying Characteristics Part Characteristics Stems Cap Fruit Taste About 1-6 inches long, up to 1-inch thick, twisted, and colored like the cap About .8-8 inches, fan-shaped when mature, and varnished surface Fruits annually Bitter P a r t s U s e d Fruiting body and mycelium C u l t i v a t i o n a n d C o l l e c t i o n Wood log cultivation is currently thought to be the best method 3 2 6 . Dosage and Administration When taken orally, a typical dose is 2-6 g of raw reishi mushroom per day. As a powder, 1-1-.5 g per day. As a tincture, 1 mL per day 3 2 7 . For specific use with postherpetic neuralgia, 32-72 g hot water extract per day 328 . 3 2 6 Reishi Rescue. Accessed 5/1 6 /09: http:/ / w w w .reishirescue.com/index.cfm ? f u seaction= ArticleDisplay& ArticleID=36 3 3 2 7 Reishi. Mothernature encyclopedia. ww w . m othernature.com/ency/herb/reishi.asp . (Accessed 7 No vember 199 9 ) . 3 2 8 Hijikata Y, Yamada S. Effect of Ganoderma lucidum on po stherpetic neuralgia. Am J Chin Med 199 8 ; 2 6 :375- 8 1 . 1 5 9 Module Four For use with cancer, 600-1,800 mg of reishi mushroom as Ganopoly® capsules, three times daily for up to 12 weeks 3 2 93 3 0 . *To see specific dose suggestions for use with chronic hepatitis B, coronary heart disease, diabetes, hypertension, mushroom poisoning, and proteinuria, refer to the Natural Standard monograph. Duration of Administration There are no listed restrictions on duration; however, with extended oral use (three to six months), adverse effects have appeared in rare cares including dryness of the mouth, throat, and nasal area, itchiness, stomach upset, nosebleed, and bloody stools 3 3 1 . Active Constituents The primary active constituents of Ganoderma lucidum include polysaccharides and triterpenoids, which contain ganoderic acids. The body of reishi contains ergosterol, fungal lysozyme, and acid protease 3 3 2 . Pharmacological activity is attributed to lanostanoids 3 3 3 , 329 Gao, Y., Z h o u , S. , Jiang, W ., Huang, M., and Dai, X. Effects of gano p oly (a Ganoderma lucidum polysaccharide extract) on the immu ne functions in advanced-stage cancer patients. I m munol.Invest 2003;32(3):201-2 1 5 . 330 Gao, Y., Dai, X., Chen, G., Ye, J., and Zho u , S. A Randomized, Placebo- Co ntrolled, Multicenter Study of Ganoderma lucidum (W . C urt: Fr.) Lloyd (A p h yllop h orom ycetideae) Polysaccharides (Gano p oly® ) in Patients with Advanced Lun g Cancer. International Journal of Medicinal Mushrooms 2003;5 3 3 1 McGuffin M, et al, ed. American Herbal Products Asso ciation's Botanical Safety Handbook . Boca Raton, Florida: CRC Press, 19 9 7 . 3 3 2 Jon g SC , Birming ham JM. Medi cinal benefits of the mus hroo m Ganoderma . Adv Appl Microbiol. 199 2 ;37:101-34. 3 3 3 Ma J, Ye Q, Hua Y, Zhang D, Co o per R, Chang MN, Chang JY , Su n HH. New lanostanoids from the mus hroo m Ganoderma lucidum. J Nat Prod. 2002 Jan;6 5 ( 1 ) : 7 2 - 5 . 1 6 0 Module Four lectins 3 3 4 , steryl esters and steroids 3 3 5 , polysaccharides, and triterpenes 336 . Additional constituents include sterols, coumarin, and mannitol. Pharmacological Action Reishi has potential applications for use with invasive hepatoma cells. A 2009 study by the Department of Food Science and Biotechnology, National Chung Hsing University, tested reishi to evaluate the anti- invasion effect of lucidenic acid-rich Ganoderma lucidum extract on human hepatoma HepG2 cells and the antiproliferative and antimetastatic effects of the Ganoderma lucidum extract on human hepatoma cells implanted into mice. Results showed the number of metastatic tumor-bearing mice and the number of affected organs were significantly suppressed by oral administration of the Ganoderma lucidum extract. Therefore, lucidenic acid-rich Ganoderma lucidum extract may be an effective chemopreventive agent for the tumorigenisis and metastasis of highly invasive hepatoma cells 3 3 7 . In an additional 2009 study by the Institute of Chinese Medical Sciences, University of Macau, ethanol extracts of Ganoderma lucidum and Ganoderma sinense were investigated for antiproliferative activities on human breast cancer, hepatoma, and myeloid leukemia cells. Their effect on breast cancer cells were further studied using apoptotic detection and cell cycle analyses. Results showed both extracts could 3 3 4 Kawagishi H, Mitsunaga S, Yamawaki M, Ido M, Shimada A, Kino s hita T, Murata T, Us ui T, Kim ura A, Chiba S. A lectin from m ycelia of the fun g u s Ganoderma lucidum. Phytochemistry. 199 7 Jan;44(1) : 7 - 10. 3 3 5 Lin CN , To me WP, W o n SJ. N o vel cytotoxic principles of Formo san Ganoderma lucidum. J Nat Prod . 19 9 1 Jul-A u g ; 54(4):9 9 8 - 1002. 3 3 6 Min BS, Nakamura N, Miyashiro H, Bae KW , Hattori M. Triterpenes from the spores of Ganoderma lucidum and their inhibitory activity against HIV-1 protease. Chem Pharm Bull (To k y o ) . 19 9 8 Oct;46(10):1 607-1 2 . 3 3 7 Weng CJ , Chau CF , Yen GC , Liao JW , Chen DH, Chen KD . Inhibitory Effects of Ganoderma lucidum on Tu m origenesis and Metastasis of Human Hepatoma Cells in Cells and Animal Models. J Agric Foo d Chem . 2009 May 7. 1 6 1 Module Four arrest cell cycle at different phases and have antitumoral proliferation effect 3 3 8 . M e d i c i n a l U s e s When taken orally, reishi mushroom is used for enhancing the immune system, lowering blood pressure and cholesterol, supporting and preventing viral infections and tumors, inflammatory disease, Alzheimer?s, cardiovascular disease, asthma and bronchial diseases 3 3 9 . It is also used orally for reducing stress, as a kidney tonic, and has shown potential for hepatitis and liver disease, HIV disease, altitude sickness, and inflammation of uterine fibroids and as a supportive therapy during chemotherapy 3 4 0 . Other oral uses include preventing fatigue, reducing insomnia, gastric ulcers, chronic hepatitis, neurasthenia, poisoning, yeast infections, post-herpetic neuralgia, and herpes zoster pain 3 4 1 . Reishi is also used topically and orally to reverse signs of aging such as removing wrinkles 3 3 8 Liu YW , Gao JL , Guan J, Qian ZM, Feng K, Li SP . Evaluation of antiproliferative activities and action me chanism s of extracts from two species of Ganoderma on tum or cell lines. J Agric Foo d Chem. 2009 Apr 22; 5 7 ( 8 ) :3087 - 93. 3 3 9 Wasser SP, Weis AL . ?T herapeutic effects of substances occurring in higher Basidiom ycetes mu s hroo m s : a modern perspective.? Crit Rev Immunol 199 9 ; 1 9 ( 1 ) : 6 5 - 9 6 . Yo o n SY , Eo SK , Kim YS , et al. ?A ntimicrobial activity of Ganoderma lucidum extract alone and in combination with so me antibiotics.? Arch Pharm Res 1994;17 ( 6 ) :438-42. 3 4 0 Wasser SP, Weis AL . ?T herapeutic effects of substances occurring in higher Basidiom ycetes mu s hroo m s : a modern perspective.? Crit Rev Immunol 199 9 ; 1 9 ( 1 ) : 6 5 - 9 6 . Kim DH, Shim SB , Ki m N J, et al. ?Beta-glucuronidase- inhibitory activity and hepatoprotective effect of Ganoderma lucidum . ? Biol Pharm Bull 199 9 ; 2 2 ( 2 ) : 1 6 2 -4. Wang SY , Hsu ML, Hsu HC, et al. ?The anti-tum or effect of Ganoderma lucidum is mediated by cytokines released from activated macrophages and T lym p h ocytes.? Int J Cancer 1 9 9 7 ; 70(6) : 6 9 9 - 705. 3 4 1 Wasser SP, Weis AL . ?T herapeutic effects of substances occurring in higher Basidiom ycetes mu s hroo m s : a modern perspective.? Crit Rev Immunol 199 9 ; 1 9 ( 1 ) : 6 5 - 9 6 . Hijikata Y, Yamada S. ?E f fect of Ganoderma lucidum on po stherpetic neuralgia.? Am J Chin Med 199 8 ; 2 6 (3-4):375- 8 1 . 1 62 Module Four and age spots and has been shown to protect against ionizing radiation when given before and after procedure 3 4 2 . In combination with other herbs, reishi mushroom is used as adjunct support during the care of prostate cancer. Recent research also shows potential for preventing and treating breast cancer by inhibiting the growth of breast cancer cells 3 4 3 . A 2004 study also shows potential for preventing and treating colon cancer 3 4 4 . Contraindications There is insufficient reliable information available on the use of reishi while pregnant or lactating. Because of this, it is advisable not to suggest administration to pregnant or breast-feeding clients. May be unsafe for use with patients who have allergy or hypersensitivity to reishi mushroom. Reishi mushroom might have hypotensive activity 3 4 5 . Reishi mushroom use might worsen hypotension or interfere with drug therapy to increase blood pressure. Adverse Effects It has been suggested that reishi use might increase the risk of bleeding in people with thrombocytopenia 3 4 6 . It may also worsen 3 4 2 Hobbs, C. Medicinal Mushrooms: An Exploration of Tradition, Healing, and Culture . Lo veland, CO : Interweave Press, 19 9 6 . 3 4 3 Jiang J, Slivo va V, Harvey K, Valachovicova T, Sliva D. ? Ganoderma lucidum sup presses growth of breast cancer cells throug h the inhibition of Akt/N F - kappaB signaling. ? Nutr Cancer 2004;49(2 ) : 209-1 6 . 3 4 4 Hong KJ , Du n n DM, Shen CL , Pence BC. ?E f fects of Ganoderma lucidum on apoptotic and anti-inflammatory functi on in HT-2 9 hu man colonic carcinoma cells.? Phytother Res 2004 Sep;1 8 ( 9 ) : 7 6 8 - 70. 3 4 5 Lee SY, Rhee HM. Cardiovascular effects of mycelium extract of Ganoderma lucidum : inhibition of sy m pathetic outflo w as a mechanism of its hyp otensive action. Chem Pharm Bull (To k y o ) 19 90;38:1359- 64. 1 6 3 Module Four hypotension or interfere with drug therapy to increase blood pressure. As noted under duration of administration, in rare cases, reishi can cause dryness of the mouth, throat, and nasal area, itchiness, stomach upset, nosebleed, and bloody stools, which have occurred with extended oral use (three to six months) 3 4 7 . Drug and Supplement Interactions Simultaneous use of reishi with herbs that have anticoagulant or antiplatelet activity could theoretically increase the risk of bruising and bleeding in some people. These herbs include: Angelica, anise, arnica, asafetida, 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, quassia, red clover, turmeric, wild carrot, wild lettuce, and willow. Similarly, taking reishi with other anticoagulant or antiplatelet drugs might increase the risk of bruising and bleeding. Some of these drugs include aspirin, clopidogrel (Plavix), nonsteroidal anti-inflammatory drugs (NSAIDs) such as diclofenac (e.g., Voltaren, Cataflam), ibuprofen (e.g., Advil, Motrin), naproxen (e.g., Anaprox, Naprosyn), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, warfarin (Coumadin), and others. Simultaneous use of reishi with herbs and drugs that lower blood pressure might increase risk of hypotension. Hypotensive herbs include: Black cohosh, celery seed, and Panax ginseng, among others. Drugs that lower blood pressure include captopril (Capoten), enalapril (Vasotec), losartan (Cozaar), valsartan (Diovan), diltiazem (Cardizem), Amlodipine (Norvasc), hydrochlorothiazide (HydroDiuril), furosemide (Lasix), and many others. 3 4 6 T hrombocyopenia is an abnormally low nu mber of thrombocytes (platelets); the condition may result in abnormal bl eeding and bruising . The normal platelet range is 150,000-300,000 per millimeter of blood. 3 4 7 McGuffin M, et al, ed. American Herbal Products Asso ciation's Botanical Safety Handbook . Boca Raton, Florida: CRC Press, 19 9 7 . 1 6 4 Module Four Additionally, reishi may reduce blood sugar levels and increase insulin levels 3 4 8 . Regulatory Status United States: Reishi does not have GRAS status. However, it is freely available as a dietary supplement in the United States under DSHEA legislation (1994 Dietary Supplement Health and Education Act). American Herbal Products Association (AHPA) Safety Rating: Class 1?Herbs that can be safely consumed when used appropriately. AHPA editor?s note: Rare side effects (dryness of the mouth, throat and nasal area, itchiness, stomach upset, nosebleed, and bloody stools) have been recorded after 3-6 months of continuous use. One instance of skin rash was observed following the consumption of reishi wine 3 4 9 . Canada: Reishi is listed as fungi, which are regulated as natural health products. It is permitted as a component of OTC traditional herbal medicine and as a homeopathic drug monopreparation in various dilutions, in both cases requiring pre-marketing authorization and application for a drug identification number (DIN) (Health Canada, 2000). United Kingdom: No available information Australia: No available information 3 4 8 Hikino H, Ishiyama M, Suz u ki Y, Ko n n o C. Mechanism s of hy p o glycemic activity of ganoderan B: a glycan of Ganoderma lucidum fruit bodies. Planta Med . 19 8 9 Oct;55 ( 5 ) :423-8. 3 4 9 McGuffin M, et al, ed. American Herbal Products Asso ciation's Botanical Safety Handbook. B oca Raton, Florida: CRC Press, 55 , 19 9 7 . 1 6 5 Module Four G o s s y p i u m h i r s u t u m Image 26: by USDA (1996) via Wikipedia.org Taxonomic Notes Common botanical name: Cotton Root Family: Malvaceae C o m m o n N a m e s Coton, cotton plant, cotton, cotton seed, cotton seed oil, cottonseed oil, karpasa, and upland cotton, Mexican cotton, wild cotton P r i m a r y U s e s Orally, cotton root is used for amenorrhea, dysmenorrhea, irregular, painful, or profuse menstrual bleeding, climacteric complaints, poor lactation, nausea, fever, headache, diarrhea, dysentery, urethritis, nerve inflammation, hemorrhage, as an oxytocic, and to expel afterbirth. One of the constituents in cotton, gossypol, has been studied for use as an anti-fertility drug in males, as well as in topical, vaginal contraceptive preparations. 1 6 6 Module Four Overview Today, cotton is the world?s most widely used natural fiber. Upland cotton is native to 15 states in the U.S., as well as Puerto Rico and the U.S. Virgin Islands. Archeological evidence from the Tehuacan Valley in Mexico shows the cultivation of this species as long as 5,000 years ago. In addition to cotton?s commercial uses, the plant has been considered a ?female medicine? by Indian and other folk healers. Cultivated primarily for its vegetable seed fiber, the raw material for many textile products, upland cotton is considered the most important of the cotton-yielding plants. The linters 3 5 0 are of intermediate texture and shorter than those of G. barbadense . Seeds yield a semi-drying and edible oil used in shortening, margarine, salads, and cooking oils, and for protective coverings 3 5 1 . In addition, cotton residue, cottonseed cake, or meal is an important protein for livestock. According to a 1980 study 3 5 2 , bread made with cottonseed protein is a better source of protein than enriched white bread. Cotton is an annual shrub that grows 2-5-ft. tall. When grown outside, cotton blossoms in summer; when grown in a greenhouse, it can blossom any time of year. Cotton plants have been grown for centuries as a source of cotton fibers, and are still widely used by the textile industry. Commercially, cotton is grown in the southeastern United States and westward to California 3 5 3 . 3 5 0 Linters are the fuz z of sh ort fibers that adheres to cottonseed after ginning : http:/ / m w 1 . m - w .com /dictionary/linters 3 5 1 Accessed 6/9 /09: http:/ / w w w . h ort.purdue.edu/newcrop/duke_energy/g o s s y piu m _ hirsutum . html 3 5 2 Pigg , D. 19 80. Cottonseed bread?a new use for cotton. Texas Ag . Progress. Winter 1980, p 20. 3 5 3 Accessed 5/1 6 /09: http:/ / w w w . plantoftheweek.org/week342.s html 1 6 7 Module Four According to the Southern Weed Society, cotton can be weedy or invasive 3 5 4 . Wild cotton is mainly a plant of the coastal strand and lower coastal plains. The species has a particular affinity for small islands. It also grows in disturbed places, particularly along roads and on river overflow areas, well inland. Wild cotton can grow in almost all types of well-drained soils 3 5 5 . Most cotton grown is genetically modified and heavily sprayed with herbicide. Therefore it is very important to obtain organically grown cotton for medicinal use. Identifying Characteristics Part Characteristics Leaves Grey green heart-shaped alternate leaves that are 3-5 lobed and grow to six inches across Flowers Cup shaped white to yellowish flowers grow up to 3.5 inches across, with a purple to red spot near the base Fruit 3-5 celled with 5-11 seeds per cell that produce lint and fuzz; grow up to 1.5 inches long P a r t s U s e d Root bark and seed oil Dosage and Administration When taken orally, 1-2 cups per day. To prepare, boil 1 teaspoon of cotton root bark with 3 cups of water in a covered container for 30 3 5 4 USD A Natural Resources Con servation Service. Accessed 5/1 6 /09: http:/ / plants.u sda.go v / java/profile?symbol=G OHI 3 5 5 http:// w w w . herbs2000.com/herbs/herbs_cotton.htm 1 6 8 Module Four minutes. Leave the liquid in the closed container and allow to slowly cool. Take cold 3 5 6 . Duration of Administration None known. Active Constituents Cotton root bark contains gossypol (a sesquiterpene) and flavonoids, and cottonseed contains a fixed oil comprised of about 2% gossypol and flavonoids. Gossypol is thought to cause infertility in men. Root bark contains ca 3% of a reddish acidic resin, a volatile oil, a phenolic acid (probably 2,3-dihydrobenzoic acid), salicylic acid, a colorless phenol, betaine, a fatty alcohol, a phytosterol (C 27 H46 O), a hydrocarbon (probably triacontane), ceryl alcohol, and oleic and palmitic acid 3 5 7 . Hager?s Handbook 3 5 8 also includes the constituents: Isoquercitrin, quercimeritrin, quercetin-3'-glucoside, hirsutrin, isoastragalin, palmitic acid, oleic acid, linoleic acid, a-pinene, b-caryophyllene, bisabolol, caryophyllenepoxide, bisabolenoxide, abscissin II, serotonin, chrysanthemin, gossypicyanin, and histamine. Medicinal Uses At one time, cotton root bark was used as a substitute for ergot Claviceps pulpurea , known to induce labor. Cotton root bark stimulates uterine contractions and aids with difficult labor, in addition to promoting abortion and menstruation, and reducing menstrual flow 3 5 9 . The root bark aids blood clot and secretion of breast milk, 3 5 6 Weiner MA, Weiner JA. Herbs that heal: prescription for herbal healing . Mill Valley, CA : Q uantum Bo o k s , 19 9 9 . 3 5 7 Accessed 6/9 /09: http:/ /trop ilab.com/ g o s s y piu mtincture.html 3 5 8 List, P.H. and Horhammer, L. 19 6 9 ? 1 9 7 9 . Hager's handbuch der pharmazeutischen praxis. vols 2? 6 . Springer-Verlag, Berlin. 3 5 9 Accessed 6/9 /09: http:/ / w w w . herbs2000.com/herbs/herbs_cotton.htm 1 6 9 Module Four while the seed oil also has been used with heavy menstrual bleeding and endometriosis. Traditionally, cottonseed and roots have been used with nasal polyps, uterine fibroids, and other types of cancer 3 6 0 : ?The polyphenol gossypol has shown anticancer activity in the new LL, WA and PS-150 tumor systems 3 6 1 .? Seed oil: There is controversy whether cotton seed oil is a good food. Cotton seed oil is the original vegetable oil, and is popular for cooking and frying because it has a bland to nutty flavor and can withstand high temperatures. It has function properties that make it easy to use in the food industry, such as extended natural stability 3 6 2 . However, since cotton is not considered a food crop, there are no regulations for pesticide and herbicide residues, and must be highly purified and refined to use in food. Also it tends to be too high in saturated fat and too low in monounsaturated fat 3 6 3 . Contraindications Contraindicated for use while pregnant because of possible abortifacient and uterine stimulant properties 3 6 4 . Additionally, due to a lack of information, avoid use while lactating. Gossypol is present in vegetative parts of wild cotton and the cultivated varieties. Though gossypol naturally acts as an insect repellent, it is toxic to man and nonruminant animals 3 6 5 . 3 6 0 Hartwell, J.L . 19 6 7 ? 1 9 7 1 . Plants used against cancer: A survey . Lloydia 30?34. 3 6 1 http:/ / w w w . h ort.purdue.edu/newcrop/duke_energy/g o s s y piu m _ hirsutum . html 3 6 2 http:// w w w . oilseedssf.com / products/prod_cott.html 3 6 3 http:/ / w w w .drwe il.com /drw/u / Q A A400361/Is- C o ttonseed-Oil-O kay.html 3 6 4 McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook . Boca Raton, FL : CR C Press, LL C 19 9 7 . 3 6 5 http:/ / w w w . h ort.purdue.edu/newcrop/duke_energy/G o s s y piu m _ hirsutum . html# U ses 1 7 0 Module Four Drug and Supplement Interactions None known. Module Assessment You are now ready to log in and complete the module assessment online. Refer back to the instructions in Module One if you need to. 1 7 1 Module Fi ve Module Five Module Objectives Upon completion of this module, you will be able to: ? Recall and describe the Latin binomial or scientific name, common name, and family. ? Be able to identify a photograph by the Latin name and common name of the botanicals studied. ? Identify the therapeutic potential of each botanical studied. ? Explain the pharmacological action of each botanical studied. ? List the key recommended uses for each botanical studied. ? Recall the recommended dosage and duration for each botanical studied. ? Recall and describe any contraindications and precautions associated with each botanical studied. ? Recall the regulatory status of each of botanical studied. Module Checklist ? Read and review the module. ? Read any online resources as applicable. ? Ensure you can meet the Module Objectives. ? Complete the module assessment online and respond to another student?s posting as instructed. ? Complete the Module Test. 5 1 72 Module Fi ve G r i n d e l i a spp . Image 27: by Wsiegmund (2008) via Wikipedia.org Taxonomic Notes Common botanical name: Gumweed Family: Asteraceae/Compositae C o m m o n N a m e s August flower, California gumplant, Grindelie, gum plant, gumplant, gum weed, hardy grindelia, rosin weed, scaly grindelia, tar weed, and tarweed P r i m a r y U s e s When taken orally, gumweed is used for cough, bronchitis, and inflammation of the upper respiratory tract mucous membrane. As a folk remedy, gumweed has been used for cancer of the spleen and stomach, as is reportedly an effective antidotal, antitussive, expectorant, sedative, spasmolytic, and stimulant. As a homeopathic, 1 7 3 Module Fi ve gumweed is used for asthma, bronchitis, emphysema, and splenomegaly (an enlargement of the spleen) 3 6 6 . Overview Gumweed has a long history of use for pulmonary conditions and asthma, and is considered a traditional medicine of the California Native Americans, including the Chumash 3 6 73 6 8 . Until 1960, gumweed was used for asthma, bronchitis, and poison ivy rash, but was discontinued when law began to require medicines to have proven efficacy in clinical trials 3 6 9 . The 1905 National Standard Dispensatory lists the uses of gumweed as ?stomachic, cardiac tonic, expectorant, vagal stimulant, to slow the heart, to increase blood pressure, for asthma, whooping cough, chronic bronchitis, vesical catarrh, burns, blisters, herpes zoster, poison ivy dermatitis, and in large doses to depress the nervous system? (vesical catarrh refers to bladder infections and other bladder conditions) 3 7 0 . Currently, more trials are needed to support the use of gumweed for asthma, bronchitis, and dermatitis specifically. P a r t s U s e d Dried top and leaf 3 6 6 Duke, J. Ph D . Handbook of Medicinal Herbs . CR C Press. Boca Raton: FL , 2001. 3 6 7 Strike, S. S. Ethnobotany of the California Indians volume 2. ?Aboriginal uses of California's indigenou s plants.? 19 94. 3 6 8 Trease, G. E. and Evans, W . C. Pharmacognosy , 11th edition. 19 7 8 . 3 6 9 Ano n y m o u s . The therapeutic effects of Gindelia robusta. Lancet 1890;135:5 6 5 . 3 7 0 Hare, H. A. The National Standard Dispensatory. 1905. 1 7 4 Module Fi ve Dosage and Administration When taken orally, the typical dose of gumweed is 4-6 g of the dried top or leaf per day 3 7 1 . As a fluid extract, the typical dose is 3-6 g per day. As a 1:10 tincture (60-80% ethanol), the typical dose is 1.5-3 mL per day. Duration of Administration None known. Active Constituents The grindelia species contain many diterpenoids 3 7 23 7 3 , terpenes with 20 carbon atoms and four-branched methyl groups 3 7 4 . Grindelia species also contain flavonoids, sterols, and sapogenins 3 7 53 7 63 7 7 . Little is known 3 7 1 Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines . Trans. S. Klein. Bo ston , MA: American Botanical Cou ncil, 19 9 8 . 3 7 2 Bohlman, F., Ah med, M., Borthakur, N., Wallmeyer, M., Jakup o vic, J., King , R. M., and Robinso n , H. Diterpenes related to grindelic acid and further constituents from Grindelia species. Phytochem 198 2 ; 2 1 : 1 6 7 - 1 7 2 . 3 7 3 Tim mermann, B. N ., McLaughlin, S. P., and Hoffmann , J. J. Q uantitative variation of grindelane diterpene acids in 20 species of N orth American Grindelia. Biochem Systemat Ecol 198 7 ; 1 5 :401-410. 3 7 4 Accessed 5/1 8 /09: http:/ / medical- dictionary.thefreedictionary.com/ Diterpenoid 3 7 5 Zho u , L., Fuentes, E. R., Hoff mann , J. J., and Timmermann, B. N . Diterpenoids from Grindelia tarapacana. Phytochem 199 5 ;40:1201-1 207. 3 7 6 Tim mermann, B. N ., Hoffmann , J. J., Jolad, S. D ., Bates, R. B., and Siahann, T. J. Diterpenoids and flavon oids from Grindelia discoidea. Phytochem 198 6 ; 2 5 : 7 23- 72 7 . 3 7 7 Kreutzer, S., Schimmer, O., and Waibel, R. [Triterpenoid sapogenins in the genus Grindelia]. Planta Med 1990;56 (4):392-394. 1 7 5 Module Fi ve about the mechanisms of action or potential drug interactions of these compounds. Therapeutic Action Antispasmodic, blood purifier, cardiac tonic, diuretic, hypotensive, laxative, relaxing expectorant, and stomachic Medicinal Uses Gumweed may be effective for relieving mild-to-moderate poison ivy dermatitis 3 7 8 . Contraindications Due to lack of sufficient information, gumweed is contraindicated for use while pregnant or breast-feeding. Avoid use if there is a known allergy to gumweed, its constituents, or other members of the Asteraceae/Compositae family, including: Ragweed, chrysanthemums, marigolds, daisies, and many other herbs. A d v e r s e E f f e c t s Gumweed can cause stomach irritation 3 7 9 , diarrhea 3 8 0 , and kidney irritation 3 8 1 . In addition, some species of grindelia can cause selenium poisoning. In specific, 3 7 8 Canavan D, Yarnell E. Successf ul treatment of poiso n oak dermatitis treated with Grindelia spp . (G u m weed). J Altern Complement Med. 2005 Aug ; 1 1 (4):709- 10. 3 7 9 Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines . Trans. S. Klein. Bo ston , MA: American Botanical Cou ncil, 19 9 8 . 3 8 0 Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines . 1st ed. Montvale, NJ: Medical Econo mics Co m pany , Inc., 19 9 8 . 3 8 1 McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook . Boca Raton, FL : CR C Press, LL C 19 9 7 . 1 7 6 Module Fi ve Grindelia squarrosa can concentrate selenium to 100-1000?g of selenium per gram of plant material3 8 2 . This leads to selenium toxicity in animals ingesting the plant 3 8 33 8 4 . However, there are no known reports of Grindelia camporum causing selenium poisoning in humans or animals. Selenium toxicity causes: Anxiety, sedation, convulsions, vision impairment, muscle weakness, respiratory failure, discolored teeth, skin eruptions, gastrointestinal distress, loss of hair and loss of nails3 8 5 . Drug and Supplement Interactions Gumweed may decrease the effects of some antihypertensive herbs, like Rauwolfia serpentina , because it may increase blood pressure 3 8 6 . Additionally, anecdotal evidence suggests that gumweed might increase the effects of diuretic herbs such as juniper 3 8 7 . Regulatory Status Gumweed is given a rating of Class 1, herbs that can safely be consumed when used appropriately, by the American Herbal Products Association?s Botanical Safety Handbook . 3 8 2 Parker, D. R. and Page, A. L. Plant uptake of selenium. 2005 3 8 3 Spallholz, J. E. and Hoffman, D. J. Selenium toxicity: cause and effects in aquatic birds. Aquat.Toxicol 2002;57(1-2):27-37. 3 8 4 Knight, A. P. and Walter, R. G. Plants affecting the musculoskeletal system. 2004. 3 8 5 Moxan, A. L. and Rhian, M. Selenium poisoning. Physiol Rev 1943;203:305- 337. 3 8 6 Hare, H. A. The National Standard Dispensatory. 1905. 3 8 7 Hare, H. A. The National Standard Dispensatory. 1905. 1 7 7 Module Fi ve G y m n e m a s y l v e s t r e Image 28: by Franz Eugen Köhler (1887) via Wikipedia.org Taxonomic Notes Common botanical name: Gymnema Family: Apocynaceae C o m m o n N a m e s Gur-Mar, gurmar, gurmari, gurmarbooti, Gemnema melicida , madhunashini, merasingi, meshasring, meshashringi, miracle plant, periploca of the woods, shardunika, and vishani Do not confuse with other ?miracle? botanicals, such as aloe (miracle plant), jiaogulan (miracle grass), or miracle fruit. 1 7 8 Module Fi ve P r i m a r y U s e s When taken orally, gymnema is used for diabetes , metabolic syndrome, weight loss, and cough. It is also used as an antimalarial, digestive stimulant, laxative, appetite suppressant, and diuretic. In combination with other products, gymnema is used for normalization of the metabolic rate. Overview Gymnema is native to India and widely used in Indian folk medicine. Widely distributed, gymnema use has also been identified in Australian, Japanese, and Vietnamese folk medicine. A woody, climbing plant, gymnema leaves are primarily used medicinally, though the stem is also thought to possess some pharmacological action. Gymnema leaves, for example, have been used to treat madhu meha (?honey urine?) in India for more than 2,000 years. Gymnema preparations affect taste by suppressing sweet sensations, and are used with diabetes mellitus and in food additives for obesity. As such, gymnema has been studied for its ability to manage blood sugar levels in people with diabetes and might reduce serum lipids 3 8 8 . P a r t s U s e d The leaf Dosage and Administration When used to normalize blood sugar, the typical dose is 400 mg of extract taken daily, or 200 mg of extract GS4, twice daily or 2 mL of an aqueous decoction, three times daily. To make the decoction, use 10g of shade-dried powdered leaves per 100 ml 3 8 9 . 3 8 8 Porchezhian E, Dobriyal RM. An overview on the advances of Gymnema sylvestre: chemistry, pharmacolog y and patents. Pharmazie . 2003 Jan;5 8 ( 1 ) : 5 - 1 2 . 3 8 9 Shanm u gasundaram ERB , Rajeswari G, Baskaran K, and et al. Use of Gymnema sylvestre leaf extract in the control of blood glucose in insulin- dependent diabetes mellitus . J Ethnopharm 1990;30(3):2 8 1 - 2 94. 1 7 9 Module Fi ve For supporting weight loss, 400 mg has been studied in combination with a water-soluble, calcium-potassium salt of (-)-hydroxycitric acid (HCA-SX) 4,667mg and niacin-bound chromium (NBC) 4 mg 3 9 0 . However, this combination may lead to complications in some individuals. Duration of Administration None known. Active Constituents There is limited information available about the active constituents in gymnema. The active constituents are thought to include: Gurmarin, conduritol A, and triterpene glycosides 391392393 . In addition, gymnemoside b394 gymnema acid V, and VII appear to be the key saponin constituents 395 . 3 9 0 Preuss, H. G., Garis, R. I., Bramble, J. D ., Bagchi, D ., Bagchi, M., Rao, C . V., and Satyanarayana, S. Ef ficacy of a novel calcium /p otassium salt of (-) - h ydroxycitric acid in weight control. Int J Clin Pharmacol Res 2005;2 5 (3):133-144. 3 9 1 Persaud, S. J., Al Majed, H., Raman, A., and Jones, P. M. Gymnema sylvestre stimulates insulin release in vitro by increased membrane permeability. J Endocrinol 1 9 9 9 ; 1 63(2) : 207-2 1 2 . 3 9 2 Sins heimer JE, Rao GS , and McIlhenny HM. Con stituents from G y m nema sylvestre leaves V. Isolation and preliminary characterization of the gym nemic acids. J Pharm Sci 197 0 ; 5 9 ( 5 ) : 6 2 2 - 6 2 8 . 3 9 3 Yoshikawa, M., Murakami, T., Kadoya, M., Li, Y., Murakami, N ., Yamahara, J., and Matsuda, H. Medicinal foodstuff s . IX. The inhibitors of glucose absorption from the leaves of Gymnema sylvestre R. BR . (A sclepiadaceae): structures of gy m nemosides a and b. Chem.Pharm Bull . ( T o k y o ) 19 9 7 ;45(10):1 6 7 1 - 1 6 7 6 . 3 9 4 Yoshikawa, M., Murakami, T., Kadoya, M., Li, Y., Murakami, N ., Yamahara, J., and Matsuda, H. Medicinal foodstuff s . IX. The inhibitors of glucose absorption from the leaves of Gymnema sylvestre R. BR . (A sclepiadaceae): structures of gy m nemosides a and b. Chem.Pharm Bull.( T o k y o ) 19 9 7 ;45(10):1 6 7 1 - 1 6 7 6 . 3 9 5 Murakami, N , Murakami, T, Kadoya, M, and et all. New hy p o glycemic constituents in ?g y m nemic acid? from Gymnema sylvestre. Chem Pharm Bull 199 6 ;44(2) :469-471. 1 8 0 Module Fi ve Pharmacological Action In a 2003 study, ethanolic extract of Gymnema sylvestre leaves showed effective antimicrobial activity against Bacillus pumilis , B. subtilis , Pseudomonas aeruginosa , and Staphylococcus aureus. Gymnema sylvestre was ineffective against Proteus vulgaris and Escherichia coli 3 9 6 . M e d i c i n a l U s e s Gymnema is primarily used as a hypoglycemic agent. In a 2008 animal study by Guangxi University of Traditional Chinese Medical, the conduritol A of the stem of Gymnema sylvestre was investigated for its potential hypoglycemic effect. After 14 days, results showed that high- and mid-dosage conduritol A could remarkably reduce fasted blood sugar in diabetic rats induced by alloxan. Further results concluded that conduritol A might promote the synthesis of hepatic (blood in the liver) to decrease fasted blood sugar 397 . Gymnema, when taken orally by patients with type 1 or 2 diabetes who are using insulin or oral hypoglycemics, might further reduce blood glucose and glycosylated hemoglobin 3 9 8 , and should be monitored by the prescribing physician. Contraindications Due to a lack of sufficient evidence, gymnema is contraindicated for use while pregnant and during lactation. 3 9 6 Satdive RK , Abhilash P, Fulzele DP. A ntimicrobial activity of Gymnema sylvestre leaf extract. Fitoterapia . 2003 Dec;74(7- 8 ) : 6 9 9 - 701. 3 9 7 Wei JH, Zhen HS, Qiu Q , Chen J, Zh o u F. [E x perimental [corrected] study of hy p o glycemic activity of conduritol A of stems of Gymnema sylvestre ] . Zhongguo Zhong Yao Za Zhi. 2008 Dec;33(24):2 9 6 1 - 5 . 3 9 8 Natural Medicines accessed 5/1 9 /09: http:/ / w w w . naturaldatabase.com/( S ( o u qlx0vtryexro3n1igy o y 5 5 ) ) / nd/Search.aspx ?cs= & s = N D & pt=100&id=841&ds=& nam e=Gy m nema+Sylvestre+(G YMNEMA)& searchid=14992 7 80 1 8 1 Module Fi ve A d v e r s e E f f e c t s Gymnema effects taste. Studies show gymnema reduces sweet perception in the mouth, and increases the perception of bitterness by neural inhibition 3 9 94 0 04 0 1 . Gymnema also can affect blood sugar control; therefore, blood glucose levels should be monitored closely. Drug and Supplement Interactions Gymnema can enhance the blood glucose lowering effects of insulin and hypoglycemic drugs 4 0 2 and could results in a serious hypoglycemic episode. 3 9 9 Lawless HT. Evidence for neural inhibition in bittersweet taste mixtures. J Comp Physiol Psychol. 1 9 7 9 Ju n ; 93(3):538-47. 4 0 0 Meiselman HL, Halpern BP . Ef fects of Gymnema sylvestre on complex tastes elicited by amino acids and sucrose. Physiol Behav. 1970 Dec;5( 1 2 ) : 1379- 84. 4 0 1 Meiselman HL, Halperin BP . Human judgments of Gymnema sylvestre and sucrose mixtures. Physiol Behav. 1970 Aug ; 5 ( 8 ) : 945-8 . 4 0 2 Natural Medicines accessed 5/1 9 /09: http:/ / w w w . naturaldatabase.com/( S ( o u qlx0vtryexro3n1igy o y 5 5 ) ) / nd/Search.aspx ?cs= & s = N D & pt=100&id=841&ds=& name=Gy m nema+Sylvestre+(G YMNEMA)& searchid=14992 7 80 4 0 2 Lawless HT. Evidence for neural inhibition in bittersweet taste mixtures. J Comp Physiol Psychol. 1 9 7 9 Ju n ; 93(3):538-47. 1 82 Module Fi ve H a r p a g o p h y t u m p r o c u m b e n s Image 29: Devil?s Claw Harpagophytum procumbe ns. Photograph © Steven Foster. Reproduced under license. Taxonomic Notes Common botanical name: Devil?s Claw Family: Pedaliaceae C o m m o n N a m e s Devil?s claw, devil?s claw root, grapple plant, griffe du diable, harpagophyti radix, harpagophytum, and wood spider P r i m a r y U s e s Devil?s claw as an anti-inflammatory is used to support reduction of inflammation and pain, as a bitter tonic for dyspeptic complaints, and as an orexigenic to stimulate appetite. 1 8 3 Module Fi ve Overview Devil?s claw is a native to the savannah of the Kalahari of South Africa, Namibia, and Botswana. German soldiers serving in Africa during the Hottentot rebellion in 1904 introduced its medicinal value to Europeans. It has been wild-crafted and imported into Europe since 1953. It is noted for its effectiveness with arthritis and associated inflammation and pain. Identifying Characteristics Part Characteristics Leaves Opposite to alternate, petiolate and lobed leaves Flowers Root Red-violet, yellow-violet, or violet flowers Up to 6 cm or 2.4-in. thick and 20 cm or 7.8-in. long; light-colored to reddish-brown Fruit Taste Woody fruits covered with hook-shaped projections Very bitter P a r t s U s e d Tubers of the lateral roots (secondary roots) C u l t i v a t i o n a n d C o l l e c t i o n Devil?s claw is an herbaceous plant commonly found in the southern regions of Africa. After the first rainfalls, young shoots emerge from the large, bulbous roots. They creep flat along the ground, reaching lengths of 1-1.5 m or 3.5-5 feet (ft.). The secondary storage roots or tubers are used for therapeutic purposes. Several of them may cluster together to form lateral roots that often extend to depths up to 1 m or 3.5 ft. They usually are harvested in deep ditches for this reason. The tubers must be dried immediately because they quickly rot or mold. 1 8 4 Module Fi ve Dosage and Administration In tablet form, devil?s claw has been used in doses up to 6 g or 0.2 oz daily without side effects 4 0 3 . For antirheumatic and analgesic application, the equivalent of 3-6 g or 0.1-0.2 oz daily of the dried herb should be prescribed 4 0 4 . This equates to 6-12 ml or 1.2-2.4 teaspoon daily of a 1:2 extract or 15-30 ml or 3-6 teaspoon daily of a 1:5 tincture. Tablets containing a 5:1 powdered extract should be taken at the rate of 600-1200 mg or 0.02-0.04 oz of extract daily. For gastrointestinal complaints, much lower doses can be used. Recent studies have indicated that stomach acids decrease the analgesic and anti-inflammatory effects of devil?s claw. Enteric-coated extracts of devil?s claw may be more beneficial clinically. At the very least, any preparations such as tea or a liquid extract should be administered between meals when gastric activity is lowest. D u r a t i o n o f A d m i n i s t r a t i o n No recommended limit to duration of use Active Constituents Devil?s claw contains iridoid glycosides (0.5-3.0%), primarily harpagoside (which gives it the bitter taste), isoharpagoside, harpagide (which has a slightly sweet taste), and procumbide. It also contains sugars (over 50%), triterpenes, phytosterols, phenolic acids and glycosides, and flavonoids. The sugars lead to an unusually high water-soluble fraction of 50-70%. The European Pharmacopoeia recommends that devil?s claw contain not less than 1.2% of harpagoside, calculated with reference to the 4 0 3 C hrubasik S, Sp orer F, Dillmann-Mars chner R, et al. ?Ph y sicochemical properties of harpagoside and its in vitro release from Harpagophytum procumbens extract tablets.? Phytomedicine 2000;6:469- 73. 4 0 4 S o ulimani R, Yo u n o s C , Mortier F, Derrieu C. ?T he role of stomachal digestion on the pharmacological activity of plant extracts, using as an example extracts of Harpagophytum procumbens . ? Can J Physiol Pharmacol 1 9 94;72 : 1 532-6 1 8 5 Module Fi ve dried herb. H. zeyheri is physically similar to H. procumbens and has become an inferior substitution species, despite its low level of active constituents. Pharmacological Action Devil?s claw contains iridoid glycoside constituents, harpagosgide, procumbide, and primarily harpagoside, but it appears that other compounds in addition to harpagoside contribute to its effect. It also contains phenylethanol derivatives acteoside (verbascoside) and isoaceteoside, and the oligosaccharide stachyose. The anti- inflammatory effects of the iridoid glycoside constituents are the reason devil?s claw has become popular for osteoarthritis and other inflammatory conditions. Some researchers think that harpagoside can inhibit both the cyclooxygenase and lipoxygenase inflammatory pathways 405406 . Others suggest that the anti-inflammatory effect is due to increased synthesis and release of tumor necrosis factor (TNF) - alpha by compounds other than harpagoside 407408 . There is also some evidence that devil?s claw products might be cardioactive due to a harpagide constituent. Low doses seem to slow the heart rate and increase the strength of contraction. High doses seem to weaken 4 0 5 C ycloo x y genase (CO X ) , also kn o w n as prostaglandin-endoperoxide synthase (PT G S ) , is a key regulatory enzy me in the synthetic pathway of eicosanoid production. Eicosanoids are respo n sible for multiple inflammatory, mitogenic, and angiogenic activities in various ti ssue and organ sy stems. Therefore, CO X is implicated in the production of fever, inflammation, and pain. Lipo x y genase is an enzy me that catalyzes the oxidation of polyu n saturated fatty acids to form a peroxide of the acid, which leads to increased inflammation . 4 0 6 C hrubasik S, Sp orer F, Dillmann-Mars chner R, et al. ?Ph y sicochemical properties of harpagoside and its in vitro release from Harpagophytum procumbens extract tablets.? Phytomedicine 2000;6:469- 73. 4 0 7 T u m or Necrosis Factor A proinflammato ry cytokine that is produced by white blood cells (m o n ocytes and macrophages); has an antineoplastic effect but causes inflammation (as in rheumatoid arthritis). W ordNet 1.7 . 4 0 8 Fiebich BL, Heinrich M, Hiller KO , Kammerer N. ?Inhibition of TN F -alpha synthesis in LP S - stimulated primary human mo n ocytes by Harpagop h ytum extract SteiHap 69. ? Phytomedicine 2001;8 :2 8 -30. 1 8 6 Module Fi ve heart contraction and coronary blood flow 409 . Devil?s claw extract and harpagoside appear to have antiarrhythmic effects 410411 . Devil?s claw extracts also seem to have hypoglycemic effects, stimulate production of stomach acid, increase bile production, and have weak antifungal activity. Preliminary evidence suggests that devil?s claw extract might be inactivated by stomach acid and might be more effective with parenteral or sublingual administration 412413 . However, this is somewhat controversial. Other researchers describe little effect of gastric pH on devil?s claw 414 . There also seems to be variability in harpagoside content among various commercial extracts, possibly because products are prepared from a mixture of H. procumbens and H. zeyheri . These species are similar pharmacologically, but may have differing concentrations of harpagoside and related compounds 4 1 5 . Clinical Review Lecomte et al studied the effectiveness of devil?s claw (two capsules, each containing 400 mg or 0.01 oz of a devil?s claw extract, three times daily) as an antirheumatic agent. This was a three-week double 4 0 9 Circosta C, Occhiuto F, Ragusa S, et al. ?A drug used in traditional medicine: Harpagophytum procumbens DC . II. Cardiovascular activity.? J Ethnopharmacol 1 9 84;11 : 2 5 9 - 74. 4 1 0 Circosta C, ibid 4 1 1 C o sta De Pasquale R, Bu sa G, et al. ?A drug used in traditional medicine: Harpagophytum procumbens DC . III. Effects on hy perkinetic ventricular arrhythmias by reperfusion . ? J Ethnopharmacol 198 5 ; 13:193-9. 4 1 2 Baghdikian B, Lanhers MC, Fleurentin J, et al. ?An analytical study, anti- inflammatory and analgesic effects of Harpagophytum procumbens and Harpagophytum zeyheri . ? Planta Med 199 7 ; 63:17 1 - 6 . 4 1 3 S o ulimani R, Yo u n o s C , Mortier F, Derrieu C. ?T he role of stomachal digestion on the pharmacological activity of plant extracts, using as an example extracts of Harpagophytum procumbens . ? Can J Physiol Pharmacol 1994;72 : 1 532-6 . 4 1 4 C hrubasik S, Sp orer F, Dillmann-Marschner R, et al. ?P h y sicochemical properties of harpagoside and its in vitro release from Harpagophytum procumbens extract tablets.? Phytomedicine 2000;6:469- 73. 4 1 5 Baghdikian B. Ibid. 1 8 7 Module Fi ve blind, placebo-controlled study with 50 volunteers suffering from arthrosis. The extract produced a significant decrease in pain severity when compared to placebo. Improvements were more frequent in moderate cases than in more severe cases 4 1 6 . Chrubasik et al also studied the effectiveness of devil?s claw (800 mg or 0.02 oz, three times daily) as an antirheumatic agent. This was a four-week randomized, placebo-controlled study with 118 volunteers with chronic back pain. The devil?s claw group experienced a greater reduction in pain index than the placebo group, but this had only borderline significance. Nine of 51 patients who received the herb were pain-free at the end of the study, compared to only one of 54 who received placebo 4 1 7 . Göbel et al studied the effects of a devil?s claw extract (Rivoltan, 480 mg or 0.01 oz twice daily) on non-specific back pain. This was a four- week randomized, double blind, placebo-controlled study involving 65 volunteers. There was a significant improvement in visual analogue scale scores for muscle pain in the devil?s claw group compared to the placebo group. Other significant differences were observed in muscle stiffness and muscular ischemic 4 1 8 pain 4 1 9 . Chantre et al compared the effects of a devil?s claw preparation (Harpadol, 2.61 g or 0.09 oz daily) with that of diacerein (a slow- acting drug for osteoarthritis; not available in the U.S.) in 122 patients with osteoarthritis. This was a randomized, double blind trial. Devil?s claw appeared to be comparable to diacerhein for improving pain in osteoarthritis of the hip and knee after 16 weeks. Patients taking 4 1 6 Lecomte A, Co sta JP. Cited in: Scientific Com mittee of ES C O P . ?E S C O P mo n o graphs : Harpagophyti radix . ? European Scientific Coo perative on Ph ytotherapy, Exeter, 199 6 . 4 1 7 C hrubasik S, Zimp fer CH, Schutt U, et al. Phytomed 199 6 ;3(1) : 1- 10. 4 1 8 Ischemic- relating to ischemia which is local anemia in a given body part sometimes resulting from vasoconstric tion or thrombosis or embolism . W ordNet 1.7 . 1 4 1 9 G öbel H et al. ? Harpagophytum extract LI 174 (Devil?s claw) for treating no n - s pecific back pain. Ef fects on sensory, m otor and vascular muscle respo n se.? Schmerz 2001; 15 : 10-18 . 1 8 8 Module Fi ve devil?s claw also seem to be able to decrease use of non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief 4 2 0 . Medicinal Uses Orally, devil?s claw is used for arteriosclerosis, osteoarthritis, rheumatoid arthritis, gout, myalgia, fibrositis, lumbago, tendonitis, pleuritic chest pain, gastrointestinal upset or dyspepsia, fever, and migraine headache. It also is used for difficulties in childbirth, menstrual problems, allergic reactions, loss of appetite, kidney and bladder disease, liver and gallbladder disease, and degenerative disorders of the locomotor system. Topically, devil?s claw is used for skin injuries, ulcers, and sores. Contraindications The German Commission E contraindicates devil?s claw for individuals with gastric and duodenal ulcers or gallstones. It has been stated that devil?s claw has oxytocic 4 2 1 properties, although this has never been substantiated. However, given the lack of data on the herb taken during pregnancy and lactation, its use during these periods should be avoided. A d v e r s e E f f e c t s The most common adverse effect is diarrhea. Other gastrointestinal complaints include nausea, vomiting, and abdominal pain. Devil?s claw can cause allergic skin reactions. It might also cause dysmenorrhea and instability of blood flow. Since devil?s claw can affect heart rate, contractility of the heart, and blood pressure, it might adversely affect people with cardiovascular conditions. It should be used with caution and not with hawthorn. 4 2 0 C hantre P, Cappelaere A, Leblan D, et al. ?E f ficacy and tolerance or Harpagophytum procumbens versus diacerhein in treatment of osteoarthritis.? Phytomedicine 2000;7:1 7 7 - 84. 4 2 1 O x ytocic A drug that induces labor by stimulating contractions of the muscles of the uterus. W ordNet 1.7 . 1 1 8 9 Module Fi ve Devil?s claw might decrease blood glucose levels and have additive effects with medications used for diabetes. Monitor blood glucose levels closely. Dose adjustments may be necessary. Drug and Supplement Interactions Theoretically, due to claims that devil?s claw increases stomach acid, it might interfere with antacids, H2 antagonists [cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), ranitidine (Zantac)], or proton pump inhibitors [lansoprazole (Prevacid), omeprazole (Prilosec), Pantoprazole (Pantoloc, Protonix), and Rabeprazole (Aciphex)]. Since devil?s claw can affect blood pressure, it might adversely affect drug therapy for blood pressure. As it can affect heart rate and contractility of the heart, it might interfere with drug therapy for heart conditions such as congestive heart failure or cardiac arrhythmia; use cautiously. Devil?s claw might have additive effects with medications used for diabetes and decrease blood glucose levels. Blood glucose levels should be closely monitored and dose adjustments may be necessary. Devil?s claw should be avoided or used cautiously in clients taking warfarin. Warfarin dose adjustments may be necessary. Regulatory Status Devil?s claw is official in the European Pharmacopoeia (1997) and the British Pharmacopoeia (1998). Australia: Devil?s claw is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. United Kingdom: Devil?s claw is on the UK General Sales List. United States: Devil?s claw does not have GRAS status. However, it is freely available as a dietary supplement in the United States under DSHEA legislation (1994). American Herbal Products Association (AHPA) Safety Rating: Class 2d Contraindicated in gastric and duodenal ulcers. 1 9 0 Module Fi ve H y d r a n g e a a r b o r e s c e n s Image 30: by Topjabot (2004) via Wikipedia.org Taxonomic Notes Common botanical name: Hydrangea Family: Hydrangeaceae/Saxifragaceae C o m m o n N a m e s Mountain hydrangea, seven barks, smooth hydrangea, and wild hydrangea P r i m a r y U s e s Hydrangea is said to posses both diuretic and antilithic properties, and has traditionally been used for cystitis, urethritis, urinary calculi, prostatitis, and enlarged prostate gland 4 2 2 . Hydrangea is also used orally for allergic rhinitis. 4 2 2 Barnes, J., A nderson , L., and Phillipso n , J.D . Herbal Medicines , T hird Edition. Pharmaceutical Press. Lo ndon, 2007. 1 9 1 Module Fi ve Overview Hydrangea is native to North and South America, and Eastern and Southern Asia, including the Himalayas, Indonesia, Japan, and China. An ornamental shrub, hydrangea stalks have been used for pipe stems. Medicinally, hydrangea has been used in traditional Chinese medicine and by the Cherokee of North America for urinary tract disorders, including kidney stones 4 2 3 . Human clinical trials are limited. However, in vitro and animal studies have been used to investigate hydrangea as a potential antifungal 4 2 4 , antihyperglycemic 4 2 5 , and antimalarial 4 2 6 . Additionally, results of an in vivo animal study suggest hydrangea may effectively prevent male pattern baldness 4 2 7 . Studies supporting the use of hydrangea for urinary tract disorders are lacking. 4 2 3 Tyler, V.E . The Honest Herbal?A Sensible Guide to the Use of Herbs and Related Remedies . George F. Stickley. Philadelphia, 19 8 2 . 4 2 4 Yang Q , Go n g ZZ . Purification and characterization of an ethylene-induced antifun gal protein from leaves of guilder rose ( Hydrangea macrophylla ) . Protein Expr Purif . 2002 Feb;24(1) : 7 6 - 8 2 . 4 2 5 Zhang H, Matsuda H, Kumahara A, Ito Y, Nakamura S, Yo s hikawa M. New type of anti-diabetic comp o u nds from the processed leaves of Hydrangea macrophylla var. thunbergii ( Hydrangeae Dulcis Folium ) . Bio org Med Chem Lett. 2007 Sep 1; 1 7 ( 1 7 ) :4972 - 6 . Ep ub 2007 Jun 10. 4 2 6 Ishih A, Miyase T, Terada M. Com par ison of antimalarial activity of the alkaloidal fraction of Hydrangea macrophylla var. Otaksa leaves with the hot- water extract in ICR mice infected with Plasmodium yoelii 17 XL . Phytother Res . 2003 Jun ; 1 7 ( 6 ) : 633-9 4 2 7 Tsu ji Y, Denda S, So ma T, Raftery L, Momoi T, Hibino T. A potential sup pressor of TG F -beta delays catagen progression in hair follicles. J Investig Dermatol Symp Proc. 2003 Jun ; 8 ( 1 ) : 6 5 - 8 . 1 92 Module Fi ve Identifying Characteristics Part Characteristics Leaves Large opposite and serrated leaves Flowers Large flowers with sterile and fertile flowers; dull-white to pinkish in color; clusters are 4-6- in. wide Fruit Dry capsule that persists through winter P a r t s U s e d Rhizome and root C o l l e c t i o n a n d C u l t i v a t i o n Propagation by cuttings and seed Dosage and Administration When taken orally, a typical dose is 2-4 g of dried rhizome and root or one cup of tea, three times daily. To make the tea, steep 2-4 g of dried rhizome and root in 150 mL of boiling water for 5-10 minutes, and then strain. As a liquid extract (1:1 in 25% alcohol), 2-4 mL, three times daily 428 As a tincture (1:5 in 45% alcohol), 2-10 mL, three times daily 4 2 9 Duration of Administration Excessive amounts may be unsafe for long-term use (more than 2 g of dried rhizome or root per dose) 4 3 04 3 1 . 4 2 8 McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. B oca Raton, FL : CR C Press, LL C 19 9 7 . 4 2 9 Newall CA , A nderson LA , Philpso n JD . Herbal Medicine: A Guide for Healthcare Professionals . Lo ndon, UK : The Pharmaceutical Press, 19 9 6 . 4 3 0 Newall CA , A nderson LA , Philpso n JD . Herbal Medicine: A Guide for Healthcare Professionals. L o ndon, UK : The Pharmaceutical Press, 19 9 6 . 1 9 3 Module Fi ve Active Constituents The active constituents in hydrangea include: Anthocyanins, carbohydrates (gum, starch, and sugars), cyanogenic glycosides, cyogenic glucosides, fixed oil, flavonoids (kaempferol, quercetin, and rutin), hydrangeaic acid, hydrangeol, hydrangin, hydrangenol, 3- phenyldihydroisocoumarins (hydrangenol and phyllodulcin), 3- phenylisocoumarin (thunberginol A), resin, saponins, stilbene (hydrangeaic acid), stilbenoid, volatile oil, febrifugine, isofebrifugine, and HM-30 4 3 24 3 34 3 4 . Pharmacological Action The glycoside rutin found in hydrangea is thought to inhibit tumor formation and inhibit x-ray irradiation 4 3 5 . Medicinal Uses As a homeopathic, the young root is used for bladderstone, catarrh, diabetes, gravel, incontinence, and prostatic ailments 4 3 6 . 4 3 1 McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook . Boca Raton, FL : CR C Press, LL C 19 9 7 . 4 3 2 Yang Q , Go n g ZZ . Purification and characterization of an ethylene-induced antifun gal protein from leaves of guilder rose ( Hydrangea macrophylla ) . Protein Expr Purif . 2002 Feb;24(1) : 7 6 - 8 2 . 4 3 3 Zhang H, Matsuda H, Kumahara A, Ito Y, Nakamura S, Yo s hikawa M. New type of anti-diabetic comp o u nds from the processed leaves of Hydrangea macrophylla var. thunbergii ( Hydrangeae Dulcis Folium ) . Bio org Med Chem Lett . 2007 Sep 1; 1 7 ( 1 7 ) :4972 - 6 . Ep ub 2007 Jun 10. 4 3 4 Ishih A, Miyase T, Terada M. Com par ison of antimalarial activity of the alkaloidal fraction of Hydrangea macrophylla var. Otaksa leaves with the hot- water extract in ICR mice infected with Plasmodium yoelii 17 XL . Phytother Res . 2003 Jun ; 1 7 ( 6 ) : 633-9. 4 3 5 Leung , A.Y . Encyclopedia of Com m on Natural Ingredients Used in Foo ds, Drugs, and Cosmetics . Jo h n Wiley & So n s . New York, 19 80. 4 3 6 Hutchens, A.R . Indian Herbology of North America . Merco. O ntario: Canada, 19 73. 1 9 4 Module Fi ve Contraindications Contraindicated for use if there is a known allergy to hydrangea, its constituents, or members of the family Hydrangeaceae . The safety of hydrangea for use while pregnant or breast-feeding has not been established. Avoid use. A d v e r s e E f f e c t s Hydrangea can cause contact dermatitis, and the constituent hydrangin may cause gastroenteritis 4 3 74 3 8 . Hydrangea flowers and leaves may cause toxic symptoms in humans, due to the presence of cyanogenic glycoside hygrangin 4 3 9 . Drug and Supplement Interactions None know. Regulatory Status Classified by the FDA as an Herb of Unidentified Safety 4 4 0 4 3 7 Barnes, J., A nderson , L., and Phillipso n , J.D . Herbal Medicines, Third Edition. Pharmaceutical Press. L o ndon, 2007. 4 3 8 Newall CA , A nderson LA , Philpso n JD . Herbal Medicine: A Guide for Healthcare Professionals . Lo ndon, UK : The Pharmaceutical Press, 19 9 6 . 4 3 9 Lampe. K.F . and McCann, M.A. AMA Handbook of Poisonous and Injurious Plants . AMA. Chicago, 19 8 5 . 4 4 0 Duke, J. Ph D . Handbook of Medicinal Plants . CR C Press. Boca Raton: FL , 2001. 1 9 5 Module Fi ve I r i s v e r s i c o l o r Image 31: by Boreal (2007) via Wikipedia.org Taxonomic Notes Common botanical name: Blue Flag Family: Iridaceae C o m m o n N a m e s Iris, blue flag iris, clajeux, dagger flower, dragon flavonoids, flower, flag lilly, flag lily, fleur-de-lis, flower-de-luce, harlequin blueflag, liver lily, poison flag, purple flag, snake lily, water flag, water iris, and wild iris P r i m a r y U s e s Blue flag contains the volatile oil furfural, which is a potential internal irritant. When used internally, blue flag can cause nausea, vomiting, purging, and gastrointestinal cramping. The dried root, however, is less acrid and has traditionally been used as an emetic, diuretic, and cathartic. In addition, the dried root has been used for syphilis, some scrofula (tuberculosis infection of the neck lymph glands), skin disorders, and dropsy (edema). 1 9 6 Module Fi ve Today, blue flag is used topically for skin conditions (including impetigo, eczema, and psoriasis), and detoxification (including increased urination, stimulating bile production, and laxative). Overview Blue flag, a species of iris, grows in moist meadows, marshes, and along stream banks in Northern North America. Blue flag contains iridin (also called irisin), which has both diuretic and laxative properties. Historically, blue flag roots have been used in teas, poultices, and ointments for cancer and tumor of the breast and kidney 4 4 1 . Additionally, the root is said to be an alterative, cathartic, depurative, diuretic, emetic, laxative, purgative, resolvent, sialogogue, and stimulant 4 4 2 . Little is known about blue flag?s phytochemical, pharmacological, or toxicological properties, or those of its constituents. Some related species can be toxic. Though orris root is sometimes used as a common name for blue flag, it is also used to describe the Iris species. Identifying Characteristics Part Characteristics Leaves Narrow, sword-shaped leaves Flowers Produces large blue flowers from May-July Rhizome 2-inch long annual joints that are about ¾ -inch wide Taste Pungent and unpleasant Odor Slight, but peculiar P a r t s U s e d Rhizome 4 4 1 Hartwell, J.L . Plants used against cancer: A survey . Lloydia, 19 6 7 - 1 9 7 1 . 4 4 2 Duke, J. Ph D . Handbook of Medicinal Herbs . CR C Press. Boca Raton: FL , 2001. 1 9 7 Module Fi ve Dosage and Administration Note : Dosing regimen is based on traditional health practice patterns and expert opinion; there are no available reliable human trials demonstrating safety or efficacy from a particular dose. Possibly safe : When used in homeopathic doses for a short period of time and when applied in small amounts externally. Possibly unsafe : When ingested, as blue flag may cause vomiting, catharsis, and gastroenteritis, which has resulted in death. Fresh rhizome should only be applied topically and never taken internally, as it may irritate the mouth and cause nausea and diarrhea. As a decoction, boil 1 teaspoon of dried herb in 1 cup of water, simmer for 10-15 minutes, and drink three times daily. For specific use with poisonous stings and bites, boil 1 oz of the powdered root and 1 teaspoon of vinegar in 1 pint of water; drink ½ cup every hour until the symptoms are gone. As a fluid extract, 1-2 mL, three times daily As a tincture, 1-5 mL, three times daily Duration of Administration None known. Active Constituents The active constituents in blue flag include: Isophthalic acid, salicylic acid, beta-sitosterol fatty acids, flavonoids, furfural, gum, irigenin, irilone-4'-glucoside, irisolone-4'-bioside, isoflavonoids, oleoresin (iridin), phytosterols, resin, starch, sugars, tannins, triterpenoids (notably iriversical), and volatile oil. Medicinal Uses Traditionally, an infusion of blue flag leaves and the syrup of the flowers have been used for constipation and intestinal worms . Orally, blue flag is used as a laxative and diuretic and for dermatological, anti- inflammatory, and antiemetic uses. It is also used as a bile stimulant, for liver dysfunction, and specifically for skin eruptions. 1 9 8 Module Fi ve Contraindications Contraindicated for use if there is a known allergy to blue flag, its constituents, or the Iridaceae family. Avoid large oral doses in patients with neurological/CNS disorders, as large doses of blue flag may cause neuralgic pain. Avoid in patients who are pregnant or breast-feeding, and in children. A d v e r s e E f f e c t s Blue flag root contains iridin 4 4 3 , an oleoresin used as a purgative and liver stimulant, which can be poisonous to livestock and cause nausea and severe discomfort in humans. Several poisonings after the consumption of blue flag have been reported; however the severity or details of the poisonings is not clear. Blue flag is known to cause nausea, abdominal pain, and vomiting. In addition, furfural, a volatile oil, is a known irritant to the mucous membrane, which can cause lachrymation, inflammation of the eyes, throat irritation, and headache 4 4 4 . Due to the irritant potential of the volatile oil, blue flag might not be appropriate for internal use. May be unsafe for use while pregnant and breast-feeding. Drug and Supplement Interactions Simultaneous use of blue flag with horsetail plant, licorice rhizome, or other stimulant laxative herbs can increase the risk of potassium depletion, including: Aloe dried leaf sap, wild cucumber fruit Ecballium elaterium , alder buckthorn, European buckthorn, butternut bark, cascara bark, castor oil, colocynth fruit pulp, gamboge bark exudate, 4 4 3 Duke J. Ph D . Handbook of Medicinal Herbs. CRC Press. Boca Raton: FL , 2001. 4 4 4 Barnes, J., A nderson , L., and Phillipso n , J.D . Herbal Medicines , T hird Edition. Pharmaceutical Press. Lo ndon, 2007. 1 9 9 Module Fi ve jalap root, black root, manna bark exudate, podophyllum root, rhubarb root, senna leaves and pods, and yellow dock root. Regulatory Status Listed in the Botanical Safety Handbook in Class 2b and an official drug of the United States Pharmacopoeia. 200 Module Fi ve L a m i n a r i a d i g i t a t a Image 32: by Universite de Bo urgogne (1852) via Wikipedia.org Taxonomic Notes Common botanical name: Kelp Family: Laminariaceae C o m m o n N a m e s Kelp is a common term that refers to brown algae (brown seaweed) from the class Phaeophyceae , and includes Laminaria spp. and Fucus spp., as well as Sargassum spp. and Saccharina . Since the terms kelp, seaweed and algae are often used interchangeably, it is important to use the Latin name when referring to medicinal uses of the seaweeds, to avoid confusion. 201 Module Fi ve The genus Laminaria is found in various ocean tidal regions. The species digitata is found in mainly North Atlantic Ocean tidal zones in Europe, as well as from Iceland, southern Greenland, and the eastern coasts of North America. Laminaria digitata is also known by the common names oarweed, Atlantic kelp, seaweed, seastaff, and tangleweed. P r i m a r y U s e s Taken orally, Laminaria digitata has been used for weight loss, cancer prevention, hypertension, as a laxative for constipation, and for radioactive intoxication. Topically, Laminaria digitata is used like a ?tent? in the cervix to induce cervical dilation prior to dilation and curettage (D & C) following miscarriage. In addition, Laminaria digitata tents are used during pregnancy for near-term or term cervical ripening (particularly for a first pregnancy), to facilitate labor, alone or as adjunct to prostaglandins, and for inducing first-trimester abortions. Laminaria digitata forms a viscous gel in water; as the tents absorb ambient moisture, they gradually swell to a diameter of ½ -inch over 4-6 hours. This swelling causes cervical dilation that can induce labor 4 4 5 . Overview Laminaria digitata is a seaweed native to Japan 4 4 6 considered a rich source of both iron and potassium 4 4 7 . Laminaria digitata also contains 4 4 5 The Review of Natural Products by Facts and Comparisons . St. Lo uis, MO: W olters Kluwer Co., 19 9 9 . 4 4 6 Kazzi GM, Bottom s SF , Ro sen MG. Efficacy and safety of Laminaria digitata for preinduction ripening of the cervix. Obstet Gynecol 198 2 ; 60:440-3. 4 4 7 Brinker F. Herb Contraindications and Drug Interactions . 2nd ed. Sandy, O R : Eclectic Medical Publications , 19 9 8 . 202 Module Fi ve iodine 4 4 8 , the essential substrate for the thyroid hormone, which is present in concentrations of .03-1% 4 4 9 . P a r t s U s e d Blades Dosage and Administration When taken orally, the typical dosage is capsules or tablets with 500- 650 mg of ground kelp, once daily 4 5 0 . As a topical, there is no typical dosage. Duration of Administration None known. Active Constituents The active constituents of Laminaria digitata include alginate, lamine, histamine, and laminarin 4 5 1 . Therapeutic Action Anti-aging 4 5 2 , anti-cancer 4 5 3 , antioxidant 4 5 4 , antiviral, immunomodulatory 4 5 5 , laxative, and urinary tract tonic 4 5 6 4 4 8 Eliason BC . Transient hyperthyroidism in a patient taking dietary sup plements containing kelp . J Am Board Fam Pract 199 8 ; 1 1 :478- 80. 4 4 9 Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Econo mics Co m pany , Inc., 19 9 8 . 4 5 0 Fetrow CW , Avila JR. Professional's Handbook of Complementary & Alternative Medicines . 1st ed. Spring h o u se, PA : Spring h o u se Corp.,1 9 9 9 . 4 5 1 The Review of Natural Products by Facts and Comparisons. St. Lo uis, MO: W olters Kluwer Co., 19 9 9 . 4 5 2 Fujim ura T el al Biol Pharm Bull . 2000 Oct;23(10):1 1 80-4] 203 Module Fi ve Antibacterial and Antifungal Laboratory study suggests antifungal and antibacterial activity of bladderwrack. However, there are no reliable human studies to support use as an antibacterial or antifungal agent. Anticoagulant (Blood-Thinner) Laboratory study has found anticoagulant properties in fucans or fucoidans, which are components of brown algae such as bladderwrack. However, there are no high-quality human studies available to support this use. Antioxidant Laboratory study suggests antioxidant activity in fucoidans, which are components in some brown algae. However, there is a lack of high quality human studies available to support use as an antioxidant. Cancer Several brown algae, including bladderwrack, appear to suppress the growth of various cancer cells in animal and laboratory studies. However, currently there is a lack of reliable human studies available to support a recommendation for use in cancer. 4 5 3 Skibola CFBMC Complement Altern Med. 2004 Aug 04;4(1) : 10.Skibola Brown kelp modulates endocrine hormones in female sprague-dawley rats and in hu man luteinized granulosa cells. J Nutr . 2005 Feb;135(2 ) : 2 9 6 -300] 4 5 4 [ J Agric Foo d Chem . 2002 Feb 13;50 (4):840-5]. 4 5 5 Criado MT, Ferreiros CM. Imm u n o m odulatory effect produced in mice by a com plex-carbohydrate specific lectin-like mucopolysaccharide from Fucus vesiculosus . IRCS J Med Sci. 1983;11 : 28 6 Â ? 2 8 7 . Newall C, Anderson , LA , Phillipso n JD . Herbal Medicines: A Guide for Health-Care Professionals . Lo ndon, En gland: Pharmaceutical Press; 19 9 6 4 5 6 http:// w w w . nlm .nih .g o v / medlineplus /druginfo / natural/patient- bladderwrack.html 204 Module Fi ve Diabetes Based on animal research, extracts of bladderwrack may lower blood sugar levels. However, there is a lack of reliable human studies available to support a recommendation for use in diabetes. Weight Loss Bladderwrack and other seaweed products are often marketed for weight-loss. However, safety and effectiveness have not been studied in humans 4 5 7 . Clinical Study The edible brown kelp, Fucus vesiculosus (bladderwrack), as well as other brown kelp species, lower plasma cholesterol levels. Since cholesterol is a precursor to sex hormone biosynthesis, kelp consumption may alter circulating sex hormone levels and menstrual cycling patterns. In particular, dietary kelp may be beneficial to women with or at high risk for estrogen-dependent diseases. To test this, bladderwrack was administered to three pre-menopausal women with abnormal menstrual cycling patterns and/or menstrual- related disease histories. These pilot data suggest that dietary bladderwrack may prolong the length of the menstrual cycle and exert anti-estrogenic effects in pre- menopausal women. Further, these studies also suggest that seaweed may be another important dietary component apart from soy that is responsible for the reduced risk of estrogen-related cancers observed in Japanese populations. However, these studies will need to be performed in well-controlled clinical trials to confirm these preliminary findings 4 5 8 . 4 5 7 http:// w w w . nlm .nih .g o v / medlineplus /druginfo / natural/patient- bladderwrack.html 4 5 8 http:/ / w w w . ncbi.nlm .nih .g o v / p mc/articles/PMC514561 / The effect of Fucus vesiculosus , an edible brown seaweed, upo n menstrual cycle length and 205 Module Fi ve Medicinal Uses The polysaccharide constituent of Laminaria digitata , laminarin, has antilipemic activity when partially sulfated. It also has anticoagulant activity (similar to heparin) when more extensively sulfated. The constituents histamine and lamine may be responsible for hypotensive effects 4 5 9 , and the constituent algin (sodium alginate) has laxative and demulcent effects 4 6 0 . In addition, preliminary evidence suggests alginate-containing kelp extracts may have antiviral effects, might have antiviral effects 4 6 1 ; however, the potential adverse effects of the iodine in Laminaria digitata may outweigh its use as a regular preventative measure 4 6 2 . Contraindications The average Laminaria digitata -based supplement might contain as much as 1,000 mcg iodine. Ingesting more than 150 mcg of iodine per day can cause hypothyroidism, hyperthyroidism, or exacerbate existing hyperthyroidism 4 6 3 . In addition, some Laminaria digitata supplements may contain arsenic 4 6 44 6 5 . hormonal status in three pre-m enopausal women: a case report. BMC Complement Altern Med . 2004; 4: 10. 4 5 9 The Review of Natural Products by Facts and Comparisons . St. Lo uis, MO: W olters Kluwer Co., 19 9 9 . 4 6 0 Covington TR , et al. Handbook of Nonprescription Drugs . 11th ed. Washington , DC : American Pharmaceutical Ass ociation, 19 9 6 . 4 6 1 Kathan RH. Kelp extracts as antiviral subatances. Ann N Y Acad Sci 196 5 ; 130:390-7. 4 6 2 Foster S, Tyler VE. Tyler's Honest Herbal , 4th ed., Bing hamton , N Y : Haworth Herbal Press, 19 9 9 . 4 6 3 Eliason BC . Transient hyperthyroidism in a patient taking dietary sup plements containing kelp. J Am Board Fam Pract 199 8 ; 1 1 :478- 80. 4 6 4 Pye KG, Kelsey SM, House IM, et al. Severe dyserythropoeisis and autoim m u ne thrombocytopenia associat ed with ingestion of kelp su p plement. Lancet 1 9 9 2 ;339:1 540. 206 Module Fi ve A d v e r s e E f f e c t s Oral use may also cause hypothyroidism or hyperthyroidism, or exacerbate existing hyperthyroidism 4 6 6 . In addition, arsenic poisoning is a potential risk, because Laminaria digitata concentrates arsenic from the ocean, and concentrations vary depending on the location of the harvest. Arsenic concentrations are reported to be greater in Laminaria digitata preparations from Australia and Great Britain 4 6 74 6 8 . Topically, Laminaria digitata is used for cervical ripening linked to neonatal and maternal infection, which can cause pelvic cramps and cervical bleeding 4 6 9 . Drug and Supplement Interactions Simultaneous use with potassium supplements may increase the risk of hyperkalemia 4 7 0 . 4 6 5 Norman JA , Pickford CJ, Sanders TW , Waller M. Human intake of arsenic and iodine from seaweed-based food s up plements and health fo ods available in the UK. F o o d Addit Contam 198 8 ; 5 : 103-9. 4 6 6 Eliason BC . Transient hyperthyroidism in a patient taking dietary sup plements containing kelp. J Am Board Fam Pract 199 8 ; 1 1 :478- 80. 4 6 7 Pye KG, Kelsey SM, House IM, et al. Severe dyserythropoeisis and autoim m u ne thrombocytopenia associat ed with ingestion of kelp su p plement. Lancet 199 2 ;339:1 540 4 6 8 Norman JA , Pickford CJ, Sanders TW , Waller M. Human intake of arsenic and iodine from seaweed-based food s up plements and health fo ods available in the UK. F o o d Addit Contam 198 8 ; 5 : 103-9. 4 6 9 Kazzi GM, Bottom s SF , Ro sen MG. Efficacy and safety of Laminaria digitata for preinduction ripening of the cervix. Obstet Gynecol 198 2 ; 60:440-3. 4 7 0 Brinker F. Herb Contraindications and Drug Interactions . 2nd ed. Sandy, O R : Eclectic Medical Publications , 19 9 8 . 207 Module Fi ve In addition, Laminaria digitata contains significant amounts of iodine, which might interfere with drugs for hyperthyroidism or hypothyroidism 4 7 1 . 4 7 1 Eliason BC . Transient hyperthyroidism in a patient taking dietary sup plements containing kelp. J Am Board Fam Pract 199 8 ; 1 1 :478- 80. 208 Module Fi ve L e n t i n u s e d o d e s Image 33: Shiitake Lentinus edodes. Photogr aph © Steven Foster. Reproduced under license. Taxonomic Notes Common botanical name: Shiitake Family: Polyporaceae C o m m o n N a m e s Forest mushroom, hua gu, lentinula, pasania fungus, shiitake, shitake, snake butter: This delicately flavored mushroom is also known as the king oyster. P r i m a r y U s e s When administered orally, shiitake mushroom is used for boosting the immune system, reducing serum cholesterol levels, and as an anti- aging agent. Overview Shiitake mushroom is the second most common commercially produced mushroom in the world due to its medicinal and food values. Worldwide, it is highly regarded as an excellent cancer-fighter. In fact, lentinan, a primary constituent in shiitake, is approved in Japan for use with cancer. 209 Module Fi ve Identifying Characteristics Part Characteristics Fruit Taste Umbrella-like hood that is large and dark brown In China it is known as Hsiang Ku, meaning ?fragrant mushroom?, possibly because of its caramel-like smell. P a r t s U s e d The applicable part of shiitake is the above ground fruiting body. C u l t i v a t i o n a n d C o l l e c t i o n Shiitake is a wood decay fungus. A fungus is a member of the biological kingdom of Fungi. A fungus consists mainly of complex, multicellular eukaryotes that have a cell wall composed primarily of chitin. Fungi are heterotrophs, or organisms that break down and use organic matter. They absorb nutrients from their surroundings by decomposing organic materials. Shiitake is grown in sawdust or on logs. The host is inoculated with the mycelium spawn. It may take up to 18 months before the spawn fruit. They are harvested carefully 5-7 days after the mushroom appears and can be dried. An extensive description of the cultivation and collection process is available at: http://www.ces.ncsu.edu/nreos/forest/woodland/won- 20.html Dosage and Administration The traditional intake of the whole, dried shiitake mushroom is 6?16 g or 0.2-5 oz per day. The mushroom is typically eaten in soups or taken as a decoction. It can be boiled for 10?20 minutes, cooled, strained, and consumed within 24 hours. Purified lentinan is considered a drug in Japan and is not currently available as an herbal supplement in North America. Recommended intake of lentinan extract is 1?3 g or 0.03-0.1 oz, 2-3 times per day. It is usually administered parenterally 4 7 2 and appears to have little 4 7 2 Not orally (e.g. , by subcutaneous , intramuscular, or intravenou s injection) 210 Module Fi ve antitumor activity when administered orally. Parenterally administered lentinan has been demonstrated to have immunomodulatory activity. Duration of Administration There is no recommended limit to duration of use. Active Constituents Shiitake contains proteins, fats, carbohydrates, soluble fiber, vitamins, and minerals. In addition, shiitake?s key ingredient, which is found in the fruiting body, is a polysaccharide called lentinan. Commercial preparations employ the powdered mycelium of the mushroom before the cap and stem grow. This preparation is called Lentinus edodes mycelium extract (LEM). LEM is rich in polysaccharides and lignans. Pharmacological Action Shiitake contains low concentrations of lentinan, which has been shown to have antitumor effects. Lentinan is an indigestible polysaccharide, a large complex molecule of many small sugar molecules, called beta-D-glucan or just beta-glucan particular to grains, yeast, bacteria, algae and fungi. It is thought by resembling bacteria molecules, beta-glucan may ?fool? the body into setting off an immune response, increasing macrophage, neutrophil, natural killer and lymphokine-activated killer cell activity. Stimulation of these cells by lentinan may release a number of different cytokines, including tumor necrosis factor and interleukin 2 alpha and 6 alpha, which amplify immune reactivity. Lentinan may also stimulate the production of nitric oxide in macrophages. These effects may result in antimicrobial and antitumor activities. Shiitake may reduce plasma levels of free cholesterol, triglycerides, and phospholipids due to the promotion of fibrinolysis 4 7 3 and thrombolysis 4 7 44 7 5 . 4 7 3 A normal ong oing process that dissolves fibrin and results in the removal of small blood clots. 4 7 4 The process of breaking up and dissolving blood clots 211 Module Fi ve Clinical Review Gordon et al (1998) studied the effects of lentinan on HIV-positive patients. This was a placebo-controlled dual-phase study that enrolled 98 volunteers. In one study, 10 patients each were administered 2, 5, or 10 mg of lentinan or placebo (intravenously) once a week for eight weeks. In the second study, two groups of 20 patients each were administered 1 or 5 mg of lentinan twice a week for 12 weeks, and 10 patients were administered placebo (intravenously) twice a week. A trend occurred toward increases in CD4 cells and in some patient?s neutrophil activity. Because of the small numbers, these values do not have statistical significance. In as much as no side effects such as anemia, leucopenia, pancreatitis, or neuropathy were seen, and in view of the positive effects of lentinan on certain surrogate markers (recognizing that these were small studies), the authors recommended a long-term clinical trial of lentinan in HIV-positive patients 4 7 6 . Medicinal Uses Jong and Birmingham listed eight different areas in which medicinal benefit of the shiitake mushroom had been determined 4 7 7 . These included anti-hypertensive, anti-cholesteremic, anti-viral, anti-bacterial, anti-tumor, and anti-carcinogenic properties. In humans, lentinan is approved for clinical use in Japan. Injected lentinan has reportedly increased survival time in patients with gastric and colorectal cancers. Lentinan combined with some other anticancer agents prolonged survival times in some patients with advanced cancers of different types, including gastric cancer. In a recently concluded multi-center 4 7 5 Otsu ka M, et al. ?Influences of a shiitake (Lentinus edodes)- fructo- oligo saccharide mixture (SK - 204) on experimental pulmo nary thrombosis in rats.? Yakugaku Zasshi 199 6 ; 1 1 6 ( 2 ) : 1 6 9 - 73. 4 7 6 G ordon M, et al. ?A placebo-controlled trial of the immu ne modulator, lentinan, in HIV-p o sitive patients: a phase I/II trial.? J Med 1 9 9 8 ; 2 9 :305-30. 4 7 7 J o n g S. C ., Birmingham J. M. ?Medicin al and therapeutic value of the Shiitake mus hroo m . ? Adv Appl Microbiol 1993; 39:1 53-184. 212 Module Fi ve prospective study of lentinan?s use in advanced gastric cancer patients, the combination of lentinan, tegafur, and cisplatin resulted in median survival of 297 days versus 199 days for those controls receiving the two cancer drugs without lentinan. Some substances, other than the beta-glucans identified above, have been isolated from these mushrooms, which also show anticancer activity in vitro and animal experiments. Research continues. Contraindications It is advisable not to suggest shiitake to anyone who is hypersensitive to mushrooms or a mushroom derivative. Use of shiitake may be contraindicated in individuals with eosinophilia 4 7 8 , as it may exacerbate the condition. In a small study of healthy subjects, Levy et al found that daily ingestion of 4 g of Shiitake mushroom powder for 10 weeks caused eosinophilia, increased eosinophil granule proteins in serum and stool, and increased gastrointestinal symptoms in half (five of 10) of the individuals 4 7 9 . There is insufficient reliable information available for shiitake use during pregnancy and lactation. Pregnant or nursing women should avoid consuming greater than food amounts. A d v e r s e E f f e c t s Orally, shiitake mushrooms can cause abdominal discomfort, eosinophilia, ?shiitake? dermatitis, and possibly photosensitivity 4 8 04 8 1 . In 4 7 8 An increase in eosino p hils in the circulating blood, part of the immu ne respon se to parasite infections 4 7 9 Levy AM, et al. ?Eo sino p hilia and gastro intestinal sym ptom s after ingestion of shiitake mus hroom s . ? J Allergy Clin Immunol 199 8 ; 101(5 ) : 6 13-20. 4 8 0 Levy AM. Ibid. 4 8 1 Hanada K, Hashim oto I. ?Flagellate mushroo m (S hiitake) dermatitis and photosensitivity.? Dermatol 1 9 9 8 ; 1 9 7 (3):2 5 5 - 7 . 213 Module Fi ve mushroom workers, hypersensitivity pneumonitis due to shiitake spore inhalation has occurred 4 8 2 . Drug and Supplement Interactions Antibiotics and chemotherapeutic agents: In vitro studies, animal studies and parenteral use of the mushroom beta-glucans suggest that they may enhance the efficacy of various chemotherapeutic agents, as well as antibiotics. However, it is unclear if oral use of these substances, either in concentrated forms or in the form of mushrooms, would produce similar interactions. Regulatory Status No information was available for the regulatory status in Canada, Australia or the United Kingdom. In Canada it is listed as a natural health product and as such would require a DIN if marketed. American Herbal Products Association (AHPA) Safety Rating: Class 1 Herbs that can be safely consumed when used appropriately. Module Assessment You are now ready to log in and complete the module assessment online. Refer back to the instructions in Module One if you need to. 4 8 2 Murakami M, et al. ?Decreased pulmo nary perfusion in hy persensitivity pneumo nitis caused by Shiitake mus hroo m sp ores.? J Intern Med 1 9 9 7 ; 241(1 ) : 8 5 - 8 . 214 Module Si x Module Six Module Objectives Upon completion of this module, you will be able to: ? Recall and describe the Latin binomial or scientific name, common name, and family. ? Be able to identify a photograph by the Latin name and common name of the botanicals studied. ? Identify the therapeutic potential of each botanical studied. ? Explain the pharmacological action of each botanical studied. ? List the key recommended uses for each botanical studied. ? Recall the recommended dosage and duration for each botanical studied. ? Recall and describe any contraindications and precautions associated with each botanical studied. ? Recall the regulatory status of each of botanical studied. Module Checklist ? Read and review the module. ? Read any online resources as applicable. ? Ensure you can meet the Module Objectives. ? Complete the module assessment online and respond to another student?s posting as instructed. ? Complete the Module Test. 6 215 Module Si x L i g u s t i c u m p o r t e r i Image 34: by Jerry Friedman (2008) via Wikipedia.org Taxonomic Notes Common botanical name: Osha Family: Apiaceae (formerly Umbelliferae ) C o m m o n N a m e s Bear root, chuchupate, Colorado cough root, Indian parsley, mountain lovage, porter?s licorice root, and wild celery root Do not confuse with lovage, licorice, or with poison hemlock, whose leaves look very similar. P r i m a r y U s e s Osha is primarily used for sore throat, bronchitis, cough, the common cold, influenza, pneumonia, and indigestion. Additional oral uses include viral infections like herpes and AIDS/HIV. 216 Module Si x Topically, osha can be used to prevent infection in skin wounds. Traditionally, osha has been used by Native Americans and Hispanic cultures for pneumonia, colds, bronchitis, influenza, tuberculosis, hay fever, and coughs. Today, clinical use of osha includes decongestant, and a tonic for respiratory and upper digestive systems 483 . Overview Osha, a member of the parsley family, traditionally has been used as a purifying tonic and as part of some Native American ceremonies. Osha is native to dry meadows in the Western United States, and like other members of the Apiaceae family, can be difficult to cultivate. Wild osha does not reproduce freely and when the plant is harvested part of the root is taken also; therefore, without careful harvesting, wild osha will be significantly diminished 484 . Conservationists have designated osha an endangered plant 4 8 5 . 4 8 3 Green Medicine. Accessed 5/20/09: http:/ / w w w . n p s . g o v / plants/medicinal/plants/ligu sticum_ p orteri.htm 4 8 4 Green Medicine. Accessed 5/20/09: http:/ / w w w . n p s . g o v / plants/medicinal/plants/ligu sticum_ p orteri.htm 4 8 5 United Plant Savers. United Plant Savers at risk forum website. ww w . plantsavers.org/endanger2.html (Accessed 5 Au g u st 2000). 217 Module Si x Identifying Characteristics Part Characteristics Leaves Irregularly divided Flowers Umbels of small white flowers; hermaphroditic and pollinated by insects Root Malodorous, with a strong celery-like odor Fruit Cylindrical fruits Odor Strong, celery-like odor P a r t s U s e d Root 4 8 6 Dosage and Administration As a tincture (1:2 fresh root or 1:5 dried root), 20-60 drops, five times daily 4 8 7 Osha is often combined with other herbs and supplements and sold as a multi-ingredient product. Duration of Administration None known. Active Constituents Osha contains the compound ligustilide, which might be effective as an antimicrobial and antiviral 4 8 84 8 9 . Preliminary evidence indicates that 4 8 6 McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook . Boca Raton, FL : CR C Press, LL C 19 9 7 . 4 8 7 Herb.com. Herbal Materia Medica 4.0 website. Available at: http:/ / herb.com/ materia.htm (Accessed 22 Au g u st 2000). 218 Module Si x osha might have viral protease inhibitory effects, and influenza virus 4 9 0 inhibitory effects; however, there are no published animal or human studies to support these uses. Therapeutic Action Antirheumatic, antispasmodic, diaphoretic, diuretic, expectorant, febrifuge, kidney, stomachic, and uterine tonic 4 9 1 M e d i c i n a l U s e s The roots, and the essential oil obtained from the roots, stimulate the circulation, kidneys, and uterus 4 9 2 . They also are antirheumatic, antispasmodic, diaphoretic, digestive, expectorant, febrifuge, and stomachic 4 9 34 9 44 9 5 . 4 8 8 Coulombe RA. Improve food safety throug h discovery and control of natural and induced toxicants and antitoxicants. Fedrip database, Natl Technical Info Svc (Ntis). Fedrip/1 9 9 9 /07801368. 4 8 9 Beck JJ, Stermitz FR. Addition of me thyl thioglycolate and benzylamine to (Z ) -ligu stilide, a bioactive unsaturated lactone constituent of several herbal medicines. An im proved synthesis of (Z ) -ligu stilide. J Nat Prod 199 5 ; 5 8 : 1047-5 5 . 4 9 0 Colorado State Univ. Colorado AES project CO L00271 . 19 9 9 - 2000 website. ww w .colostate.edu/depts/aes/projs / 2 7 1 . htm (Accessed 22 Au g u st 2000). 4 9 1 http://www.pfaf.org/database/plants.php?Ligusticum+porteri 4 9 2 Bow n , D . Encyclopaedia of Herbs an d their Uses. D orling Kindersley. Lo ndon, 19 9 5 . 4 9 3 Plants For A Future: Database Search Results. Accessed 5/20/09: http:/ / w w w .ibiblio.org/p faf/cgi-bi n/arr_html?Ligu sticum+ p orteri 4 9 4 Arnberger. L. P. Flowers of the Southwest Mountains. So uthwestern Monuments As s , 19 6 8 . 4 9 5 Bo w n . D . Encyclopaedia of Herbs and their Uses . Dorling Kindersley. Lo ndon, 19 9 5 . 219 Module Si x According to the Plants for a Future database: The roots, seed and essential oil (obtained from the roots and the seed) of this plant are a bitter, camphoraceous warming herb that stimulates the circulation, kidneys and uterus. They are also antirheumatic, antispasmodic, diaphoretic, digestive, expectorant, febrifuge and stomachic. They are used internally in the treatment of eruptive fevers, bronchial infections, digestive complaints, toothache, painful menstruation and retained placenta. They have also been used to treat TB and headaches. An infusion of the roots is used externally to treat body aches. The root is harvested in the autumn and can be used fresh or dried 4 9 6 . Contraindications Osha is contraindicated for use while pregnant, because of its ability to stimulate menstruation and abortifacient activity 4 9 74 9 8 . There is insufficient information about use while lactating; avoid use. Drug and Supplement Interactions None known. Regulatory Status Listed in the Botanical Safety Handbook as a Class 2b (not to be used during pregnancy). 4 9 6 http:/ / w w w . p faf.org/database/plants.p h p ? Lig u sticum+ p orteri 4 9 7 McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook . Boca Raton, FL : CR C Press, LL C 19 9 7 . 4 9 8 Brinker F. H erb Contraindications and Drug Interactions . 2nd ed. Sandy, O R : Eclectic Medical Publications , 19 9 8 . 220 Module Si x L y c o p u s v i r g i n i c u s Image 35: by Dan Mullen (2008) via Flickr.com Taxonomic Notes Common botanical name: Bugleweed Family: Lamiaceae/Labiate C o m m o n N a m e s Archangle, ashangee, bugle weed, green wolf?s foot, gypsy weed, gypsywort, hoarhound, lycopi herba, Paul?s betony, sweet bugle, Virginia water horehound, water bugle, water hoarhound, water horehound, and wolfstrapp 221 Module Si x P r i m a r y U s e s Orally, bugleweed is used for mild hyperthyroidism, premenstrual syndrome, breast pain, nervousness, insomnia; and bleeding, especially nosebleeds and heavy bleeding during menses. Overview Historically, bugleweed has been used for over-active thyroid, including the symptoms tight breathing, palpation, and shaking. Clinically, there is a lack of high quality information about the use and safety of bugleweed. Identifying Characteristics Part Characteristics Leaves Pairs of opposite leaves; upper leaves are toothed and lance-shaped, and lower leaves are wedge- shaped and gland-dotted beneath 4 9 9 Flowers Flowers are in clusters in the axils of the leaves 5 0 0 Odor Aromatic and mint-like P a r t s U s e d Above ground parts Dosage and Administration Typical dosage is .2-2 g per day 5 0 1 . Dosage should be individualized to account for weight and age. 4 9 9 Botanical.com . Grieve, M. A Modern Herbal . Accessed 5/20/09: http:/ / w w w .botanical.com/botanical/m g m h /b/buglew84.html 5 0 0 Botanical.com . Grieve, M. A Modern Herbal. Accessed 5/20/09: http:/ / w w w .botanical.com/botanical/m g m h /b/buglew84.html 5 0 1 Schulz V, Hansel R, Tyler VE. Rational Phytotherapy: A Physician's Guide to Herbal Medicine . Terry C. Telger, transl. 3rd ed. Berlin, GE R : Springer, 19 9 8 . 222 Module Si x Topically , poultices with bugleweed leaves and other herbs have been used to help heal bruising. In addition, historically, for snakebites, bugleweed root has been chewed, then a portion swallowed and the remainder applied topically. Duration of Administration None known. Active Constituents The active constituents in bugleweed are thought to include: Catechol oxidase 5 0 2 , isopimarane diterpenoids 5 0 3 , flavonoids 5 0 4 , lithospermic acid 5 0 5 , and other organic acids. Medicinal Uses Bugleweed demonstrates hormone and anti-hormone activity, including anti-gonadotropic (inhibiting the physiological activity of gonadotropic hormones) and anti-thyrotropic activity. It also seems to lower serum prolactin levels and inhibits peripheral deiodination of T4 5 0 6 . Bugleweed can also have hypoglycemic activity 5 0 7 . 5 0 2 Rom pel A, Fischer H, Meiwes D, Büldt-Karentzop o ulo s K, Magrini A, Eicken C, Gerdemann C, Krebs B. Substrat e specificity of catechol oxidase from Lycopus europaeus and characterization of the bioproducts of enzy mic caffeic acid oxidation. F E BS Lett . 19 9 9 Feb 19;445(1 ) : 103-10. 5 0 3 Hussein AA , Rodríguez B. Iso pimarane diterpenoids from Lycopus europaeus . J Nat Prod . 2000 Mar;63(3):419- 2 1 . 5 0 4 Kartnig T, Bucar F, Neuhold S. Flavon oids from the Aboveground Parts of Lycopus virginicus. Planta Med . 19 93 Dec;59 ( 6 ) : 5 63-4. 5 0 5 Wagner H, Hörhammer L, Frank U. [Litho s permic acid, the antihormo nally active principle of Lycopus europaeus L. and Symphytum officinale . 3. Ingredients of medicinal plants with hormo n al and antihormonal-like effect] Arzneimittelforschung . 19 70 May;20(5) : 705-13. 5 0 6 Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines . Trans. S. Klein. Bo ston , MA: American Botanical Cou ncil, 19 9 8 . 223 Module Si x Contraindications Bugleweed is contraindicated for use with thyroid enlargement, hypothyroid, and with simultaneous use of other thyroid-related products 5 0 8 . Additionally, bugleweed might interfere with blood glucose control and increase risk of hypoglycemia 5 0 9 . Diabetic patients should be monitored closely. Due to anti-gonadotropic and anti-thyrotropic activity, avoid use while pregnant 5 1 05 1 1 . Similarly, due to anti-prolactin activity, avoid use while lactating 5 1 2 . A d v e r s e E f f e c t s In rare cases, long-term use and excessive doses of bugleweed preparations have caused thyroid enlargement 5 1 35 1 4 . Sudden 5 0 7 Brinker F. Herb Contraindications and Drug Interactions . 2nd ed. Sandy, O R : Eclectic Medical Publications , 19 9 8 . 5 0 8 McGuffin, M., eds. et all. American Herbal Product Associ ation?s Botanical Safety Handbook . CR C Press. Boca Raton: FL , 19 9 7 . 5 0 9 Brinker F. Herb Contraindications and Drug Interactions . 2nd ed. Sandy, O R : Eclectic Medical Publications , 19 9 8 . 5 1 0 Brinker F. Herb Contraindications and Drug Interactions . 2nd ed. Sandy, O R : Eclectic Medical Publications , 19 9 8 . 5 1 1 Schulz V, Hansel R, Tyler VE. Rational Phytotherapy: A Physician's Guide to Herbal Medicine. Terry C. Telger, transl. 3rd ed. Berlin, GE R : Springer, 19 9 8 . 5 1 2 Schulz V, Hansel R, Tyler VE. Rational Phytotherapy: A Physician's Guide to Herbal Medicine . Terry C. Telger, transl. 3rd ed. Berlin, GE R : Springer, 19 9 8 . 5 1 3 Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines . Trans. S. Klein. Bo ston , MA: American Botanical Cou ncil, 19 9 8 . 5 1 4 Schulz V, Hansel R, Tyler VE. Rational Phytotherapy: A Physician's Guide to Herbal Medicine . Terry C. Telger, transl. 3rd ed. Berlin, GE R : Springer, 19 9 8 . 224 Module Si x discontinuation can lead to a sudden increase in thyroid function 5 1 5 and prolactin secretion 5 1 6 . Drug and Supplement Interactions Simultaneous use of bugleweed with thyroid-suppressing herbs can have additional therapeutic and adverse effects 5 1 7 , including: Balm leaf and wild thyme. Regulatory Status Classified in the Botanical Safety Handbook as a Class 2b, 2c, and 2d. The U.S. Food and Drug Administration (FDA) does not list bugleweed on its Generally Recognized as Safe (GRAS) list. 5 1 5 Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines . Trans. S. Klein. Bo ston , MA: American Botanical Cou ncil, 19 9 8 . 5 1 6 Schulz V, Hansel R, Tyler VE. Rational Phytotherapy: A Physician's Guide to Herbal Medicine. Terry C. Telger, transl. 3rd ed. Berlin, GE R : Springer, 19 9 8 . 5 1 7 Brinker F. Herb Contraindications and Drug Interactions . 2nd ed. Sandy, O R : Eclectic Medical Publications , 19 9 8 . 225 Module Si x M a h o n i a a q u i f o l i a ( formerly B e r b e r i s a q u i f o l i a ) Image 36: by Dr. Arianna Staruch © 2009 Taxonomic Notes Common botanical name: Oregon Grape Family: Berberidaceae C o m m o n N a m e s Barberry, berberis, blue barberry, creeping barberry, holly barberry, holly mahonia, holly-leaved berberis, mountain-grape, Oregon barberry, Oregon grape-holly, scraperoot, trailing mahonia, and water-holly P r i m a r y U s e s Oregon grape contains berberine 5 1 8 , a plant alkaloid, which has several uses, including: Carminative, febrifuge, and antimalarial. Additionally, 5 1 8 See the Natural Standard mon o graph for berberine. 226 Module Si x the salts in berberine stimulate bile secretion in humans, and in animal studies, have been to shown to act as a sedative and hypotensive 5 1 9 . When taken orally, Oregon grape is also used for peptic ulcers, gastroesophageal reflux disease (GERD), stomach upset, as a bitter tonic, as a cathartic, and to treat infections. Topically, Oregon grape is used for psoriasis and as a disinfectant. Oregon grape may be used as a substitute for goldenseal Hydrastis canadensis , which is on the United Plant Savers At-Risk List. However, Oregon grape is on the ?to-watch? list. The fruits of Oregon grape are frequently used for brandies and wines. Overview Topically, topical application of Oregon grape is used to reduce inflammation and keratinocyte hyperproliferation makers associated with psoriasis. Studies show that applying a 10% Oregon grape extract cream (Relieva, Apollo Pharmaceutical) may decrease the severity of psoriasis and improve quality of life in psoriasis patients 5 2 05 2 15 2 25 2 3 . 5 1 9 Duke, J. Ph D . Handbook of Medicinal Herbs . CR C Press. Boca Raton: FL , 2001. 5 2 0 Wiesenauer M, Lydtke R. Mahonia aquifolium in patients with Psoriasis vulgaris ; an intraindividual study. Phytomedicine 1 9 9 6 ;3:231-5 . 5 2 1 Gieler U, vo n der Weth A, Heger M. Mahonia aquifolium - a new type of topical treatment for psoriasis. J Dermatol Treatment 199 5 ; 6 :31-4. 5 2 2 Gulliver WP, D o n s k y 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 2005;1 2 :398-406. 5 2 3 Berstein S, D o n s k y H, Gullver W, et al. Treatment of mild to moderate psoriasis with Relieva, a Mahonia aquifolium extract - a double blind, placebo- controlled study. Am J Ther 2006;13:12 1 - 6 . 227 Module Si x P a r t s U s e d Rhizome, root, bark, and fruit Dosage and Administration When taken orally, a typical dosage is one cup of tea. To make the tea, steep 1-2 teaspoons of berries in 150 mL of boiling water for 10- 15 minutes, and then strain. Or, steep 2 g of root bark in 250 mL of boiling water for 5-10 minutes, and then strain. As a tincture (1:10), use 20-30 drops per day. For psoriasis , a specific 10% Oregon grape bark extract cream (Relieva, Apolla Pharmaceutical) applied to affected areas 2-3 times daily might be effective 5 2 45 2 5 . Duration of Administration None known. Active Constituents The active constituents in Oregon grape include the alkaloids berberine, jatrorrhizine, and magnoflorine 5 2 6 . Both berberine and jatrorrhizine are thought to have antibacterial and antifungal properties 5 2 7 ; jatrorrhizine appears to have good activity against a 5 2 4 Wiesenauer M, Lydtke R. Mahonia aquifolium in patients with Psoriasis vulgaris ; an intraindividual study. Phytomedicine 1 9 9 6 ;3:231-5 . 5 2 5 Gieler U, vo n der Weth A, Heger M. Mahonia aquifolium - a new type of topical treatment for psoriasis. J Dermatol Treatment 199 5 ; 6 :31-4. 5 2 6 Rackova L, Majekova M, Kost'alova D, Stefek M. Antiradical and antioxidant activities of alkaloids isolated from Mahonia aquifolium . Structural aspects. Bio org Med Chem 2004;12:4709-1 5 . 5 2 7 Slobodniko va L, Ko st'alova D, Labudov a D, et al. Antimicrobial activity of Mahonia aquifolium crude extract and its major isolated alkaloids. I2004;18:6 74- 6. 228 Module Si x variety of dermatophytes and Candida species 5 2 8 ; and both jatrorrhizine and magnoflorine appear to have antioxidant activity 5 2 9 . Pharmacological Action In studies, berberine appears to be an effective antimicrobial, including antibacterial, antifungal, antimycobacterial, and antiprotozoal 530 activity. Berberine has activity against: Staphylococcus aureus, Streptococcus pyogenes, Escherichia coli, Shigella boydii, Vibrio cholerae, Mycobacterium tuberculosis, Candida albicans, Candida tropicalis, Trichophyton mentagrophytes, Microsporum gypseum, Cryptococcus neoformans, Sporotrichum schenckii, Entamoeba histolytica, and Giardia lamblia 5 3 15 3 25 3 35 3 4 . In addition, berberine has antihypertensive, inotropic, and antiarrhythmic properties, and appears to have alpha-adrenergic blocking activity. Preliminary research suggests that berberine might lower blood glucose and low-density lipoprotein (LDL) cholesterol; 5 2 8 Vollekova A, Ko st'alova D, Kettmann V, Toth J. Antif un gal activity of Mahonia aquifolium extract and its major protoberberine alkaloids. Phytother Res 2003;17 :834-7. 5 2 9 Rackova L, Majekova M, Kost'alova D, Stefek M. Antiradical and antioxidant activities of alkaloids isolated from Mahonia aquifolium . Structural aspects. Bio org Med Chem 2004;12:4709-1 5 . 5 3 0 Amin AH, Subbaiah TV , Abbasi KM. Berberine sulfate: antimicrobial activity, bioassay, and mode of action. Can J Microbiol 196 9 ; 1 5 : 1067- 7 6 . 5 3 1 Rehman J, Dillow JM, Carter SM, et al. Increased production of antigen- specific imm u n o globulins G and M following in vivo treatment with the medicinal plants Echinacea angustifolia and Hydrastis canadensis. Immunol Lett 199 9 ; 6 8 :391- 5 . 5 3 2 Kaneda Y, Torii M, Tanaka T, Aikawa M. In vitro effects of berberine sulphate on the growth and structure of Entamoeba histolytica , Giardia lamblia and Trichomonas vaginalis. Ann Trop Med Parasitol 199 1 ; 8 5 :417- 2 5 . 5 3 3 Gupte S. Use of berberine in treatment of giardiasis. Am J Dis Child 197 5 ; 12 9 : 8 6 6 . 5 3 4 For additional studies, refer to the Natural Medicines mon o graph. 229 Module Si x inhibit aldose reductase 5 3 5 ; and have antitumor effects and protect the liver from hepatotoxins 5 3 65 3 7 . M e d i c i n a l U s e s As a decoction, the California Native Americans used Oregon grape as an appetite stimulant. Historically, the root has been used problems related to the gall and urinary passages, as well as with cholecystosis, diarrhea, dyspepsia, dysuria, fever, gravel, leucorrhea, and uterosis. As a homeopathic, the bark is used with psoriasis and other skin problems, as for the diathesis of uric acid 5 3 8 . Contraindications None known. A d v e r s e E f f e c t s Herbs with berberine might cause kernicterus; avoid use while pregnant and breast-feeding 5 3 9 . Topical, Oregon grape extract cream can cause itching, burning, skin irritation, and allergic reactions 5 4 0 . 5 3 5 Zeng XH, Zeng XJ , Li YY . Ef ficacy an d safety of berberine for congestive heart failure secondary to ischemic or idiopathic dilated cardiom y o pathy. Am J Cardiol 2003;92:1 73-6 5 3 6 Janbaz KH, Gilani AH. Studies on preventive and curative effects of berberine on chemical-induced hepatotoxicity in rodents. Fitoterapia 2000;71 :2 5 -33. 5 3 7 Anis KV , Rajeshk u mar NV , Kuttan R. I nhibition of chemical carcinogenesis by berberine in rats and mice. J Pharm Pharmacol 2001;53:763-8. 5 3 8 Duke, J. Ph D . Handbook of Medicinal Herbs . CR C Press. Boca Raton: FL , 2001. 5 3 9 Chan E. Displacement of bilirubin from albumin by berberine. Biol Neonate 1993;63:201-8 . 230 Module Si x Drug and Supplement Interactions Berberine might inhibit cytochrome P450 3A4 (CYP3A4) pathways in the liver, which metabolizes many drugs, including cyclosporine 5 4 1 . Use with caution in those taking pharmaceuticals that require a narrow therapeutic window, such as seizure, hypertension, blood clotting, and blood sugar medications. Regulatory Status Canadian regulations require bilingual labeling warning against use while pregnant 5 4 2 . 5 4 0 Wiesenauer M, Lydtke R. Mahonia aquifolium in patients with Psoriasis vulgaris ; an intraindividual study. Phytomedicine 1 9 9 6 ;3:231-5 . 5 4 1 Wu X , Li Q, Xin H, Yu A, Z h o n g M. Effects of berberine on the blood concentration of cyclosp orin A in renal transplanted recipients: clinical and pharmacokinetic study. Eur J Clin Pharmacol 2005;6 1 : 5 6 7 - 7 2 . 5 4 2 McGuffin, M. eds et al. American Herbal Product Associ ation?s Botanical Safety Handbook . CR C Press. Boca Raton: FL , 19 9 7 . 231 Module Si x N a s t u r t i u m o f f i c i n a l e Image 37: by Tigerente (2006) via Wikipedia.org Taxonomic Notes Common botanical name: Watercress Family: Brassicaceae (formerly Cruciferae ) Common Names Poor man?s bread, Indian cress, and tall nasturtium Do not confuse with nasturtium flower or scurvy grass. 232 Module Si x P r i m a r y U s e When taken orally, watercress is used with respiratory tract mucous membrane inflammation, coughs, bronchitis, and as a spring tonic. Additionally, watercress has been used as an appetite stimulant, abortifacient, aphrodisiac, bactericide, laxative, restorative, stimulant, and anthelmintic; for improved digestion; and with alopecia, cancer, flu, swine flu, goiter, polyps, scurvy, tuberculosis, and gland tumors. Topically, watercress is used with arthritis, rheumatoid arthritis, earache, eczema, scabies, and warts. Watercress is also widely used in leaf salads and as a culinary spice. Overview A common creeping herb found growing in streams and ponds or damp areas. Originally native to Eurasia, but now widespread through North America, New Zealand, and Australia, including Tasmania. 233 Module Si x Identifying Characteristics P a r t s U s e d Above ground parts (fresh or dried) Collection Watercress is best used fresh. Collect in the spring, both before and during flowering. D o s a g e a n d A d m i n i s t r a t i o n According to The Complete German Commission E Monographs , a typical dosage of dried herb would be 4-6 g, fresh herb would be 20-30 g, as a fresh-pressed juice, 60-150 g. Active Constituents Watercress contains the essential sulfurous oil, mustard oil, vitamins A (as beta carotene), C, E, B (niacin, thiamine, and riboflavin), and K, along with the minerals iodine, iron, sulfur, sodium, potassium, and magnesium 5 4 3 . 5 4 3 Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines . 1st ed. Montvale, NJ: Medical Econo mics Co m pany , Inc., 19 9 8 . Brinker F. Herb Part Characteristics Stem At first creeping, later erect, angular, tubular, and rich green Leaves Flowers Stalked leaves, smooth, shining, brownish, pinnatifid, ovate, heart-shaped leaflets, with the terminal one larger than the rest Small and white at the end of the branches Fruit Sickle-shaped pods Taste Odor Peppery and hot Aromatic 234 Module Si x One-hundred grams of watercress contains 151 mg of calcium, 54 mg of phosphorus, 1.7 mg of iron, 282 mg of potassium, 4,900 IU vitamin A, and 79 mg of vitamin C. The above ground parts of watercress contain mustard oil, which is thought to be responsible for diuretic effects and gastrointestinal irritation after consumption of large amounts of watercress 5 4 4 . One constituent, phenethyl isothiocyanate, which is released by chewing watercress, may inhibit metabolic activation of a lung carcinogen 5 4 5 . Medicinal Uses Watercress has an affinity with the digestive and respiratory systems. Watercress is used for alopecia, anemia, appetite stimulant, arthritis, bronchitis, constipation, coughs, digestion (to improve), eczema, goiter, infections, influenza, poor appetite, respiratory tract inflammation, rheumatic complaints, scabies, skin problems, a spring tonic, sluggish liver and gallbladder, and stiffness. Watercress had a reputation for cancer relief and is still used in Turkey for this purpose. Contraindications Watercress is contraindicated for use while pregnant, lactating, and with gastric or duodenal ulcers, inflammatory kidney disorders, or for children younger than 4 5 4 6 . Contraindications and Drug Interactions . 2nd ed. Sandy, O R : Eclectic Medical Publications , 19 9 8 . 5 4 4 Gruenwald J, Brendl er T, Jaenicke C. PDR for Herbal Medicines . 1st ed. Montvale, NJ: Medical Econo mics Co m pany , Inc., 19 9 8 . 5 4 5 Hecht SS, Ch u n g FL , Richie JP Jr., et al. Effects of watercress cons u m ption on metabolism of a tobacco-s pecific lung carcinogen in sm o kers. Cancer Epidemiol Biomarkers Prev 1 9 9 5 ;4:87 7 - 84. 5 4 6 American Herbal Products Associat ion?s, Botanical Safety Handbook , 19 9 7 : 78 235 Module Si x A d v e r s e E f f e c t s Watercress taken in large amounts can cause gastrointestinal irritation 5 4 7 , and excessive or prolonged use might cause kidney damage 5 4 8 . Drug and Supplement Interactions 5 4 9 CHLORZOXAZONE (Parafon Forte, Paraflex): Concomitant use with watercress may potentiate the effects of chlorzoxazone due to reduced metabolism and elimination. WARFARIN (Coumadin): Theoretically, consuming large amounts of watercress with high vitamin K content might antagonize the anticoagulant effects of warfarin. Regulatory Status Canada: No licensed product contains watercress. No known restrictions. U.K.: Herbal medicine in the General Sale List, Table A (internal or external use) of Schedule I (requiring full Product License) U.S.: Dietary supplement. Listed in the Botanical Safety Handbook as a Class 2b and 2d?contraindicated for use with gastric and duodenal ulcers, inflammatory kidney disorders, and for children younger than 4 years. 5 4 7 Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines . 1st ed. Montvale, NJ: Medical Econo mics Co m pany , Inc., 19 9 8 . 5 4 8 Brinker F. Herb Contraindications and Drug Interactions . 2nd ed. Sandy, O R : Eclectic Medical Publications , 19 9 8 . 5 4 9 http:/ / w w w . naturaldatabase.com 236 Module Si x O c i m u m b a s i l i c u m Image 38: Ocimum basilicum. Shown in fl ower. Photograph by Dorene Petersen. Taxonomic Notes Common botanical name: Sweet Basil Family: Lamiaceae (formerly Labiatae ) C o m m o n N a m e s Apigenin, basil, citral, common basil, garden basil, St. Josephwort, and Thai basil Do not confuse with Holy basil, which is a different botanical. P r i m a r y U s e s When taken orally, sweet basil is used with stomach spasms, kidney conditions, to promote blood circulation before and after childbirth, and to treat snakebites and insect bites. Additionally, sweet basil is used as an appetite stimulant, antiflatulent, diuretic, lactation stimulant, gargle and mouth astringent, in maggot- infested nasal disease, and to treat head colds, worms and warts. 237 Module Si x Overview Sweet basil is a tender, annual herb that is easy to cultivate. Historically, sweet basil was used with the practice of white magic, and Jewish people were known to hold sprays of basil in their hands to give them strength during religious fasts. Today, potted basil in doorways and on windowsills is a common sight in Spain and Italy, where locals believe it keeps negative spirits from entering the house. Its ability to repel insects makes it a valuable herb for the door and windowsill. In addition, sweet basil is a favorite herb in the kitchen. Use it sparingly, as cooking develops the flavor. It is delicious freshly chopped with tomatoes and is ideal for flavor in sauces. The flowers and leaves added to salads just before serving make them more digestible. Blend with pine nuts and sun-dried tomatoes for a wonderful rich tapenade, or with garlic and pine nuts for a wonderful pesto. In commercial foods, basil is used as an oil or oleoresin at levels usually below 0.005%. Identifying Characteristics P a r t s U s e d Leaves, oil, and flowers Cultivation Basil is an annual plant that likes a warm, sheltered spot. Keep the top shoots nipped back to prevent flowering and encourage bushy leaf growth. It is usually grown from seed. It does not like to grow near Part Characteristics Stem Obtusely quadrangular and 3-ft. high Leaves Flowers Grayish-green beneath and dotted with dark oil cells; opposite, 1-in. long and ½ -in. wide, and silky White or pink whorls in the angles of the leaves Taste Odor Peppery, strong, and agreeable Clove-like and pungent 238 Module Si x rue Ruta graveolens , basil being one of the sweetest and rue the most bitter. Dosage and Administration When taken orally as an infusion, a typical dose is 1 cup of tea, three times daily for up to eight days. As an oil, 1-2 drops, three times daily for up to eight days. As a tincture, 1-2 mL, three times daily, for up to eight days. Break for at least two weeks before resuming if needed. Active Constituents Sweet basil contains an essential oil, which in turn contains estragol (also called methyl chavicol), methyl cinnamate, ocimene, cineole, linalool, linalol, thymol, lineol, and camphor. The flowers contain tannin. Basil also contains calcium, iron, magnesium, potassium, vitamin B2, and is high in vitamins A and C 5 5 0 . Pharmacological Action In one laboratory study, Ocimum basilicum var. citratum showed antibacterial activity against Salmonella spp., Escherichai coli O157, Campylobacter jejunii , and Clostridium perferingens 5 5 1 . The essential oil of basil, obtained from the aerial parts of Ocimum basilicum L . , also showed activity against multidrug resistant clinical isolates from the genera Staphylococcus, Enterococcus, and Pseudomonas 5 5 2 . 5 5 0 Brinker F. Herb Contraindications and Drug Interactions . 2nd ed. Sandy, O R : Eclectic Medical Publications , 19 9 8 . 5 5 1 Wanniss orn B, Jarikasem S, Siriwangchai T, Th ubthimthed S. Antibacterial properties of essential oils from Thai medicinal plants. Fitoterapia . 2005 Mar;76( 2 ) : 233-6. 5 5 2 Opalchenova, G. and Obreshko va, D. Co m parative studies on the activity of basil--an essential oil from Ocimum basilicum L.- -against multidrug resistant 239 Module Si x In addition, sweet basil is used for its antimicrobial activity 5 5 35 5 4 , antioxidant activity 5 5 5 , and antiviral activity 5 5 6 . Medicinal Uses Basil has an affinity with the digestive system. Basil is used for appetite stimulation, circulation (promotion of, particularly after childbirth), constipation, coughs, diarrhea, flatulence, indigestion, insect bites, kidney tonic, nausea, severe vomiting, spasms (particularly stomach spasms), stings, and worms. The essential oil strengthens the cortex of the suprarenal glands and the nervous system. It is useful for anxiety, gout, insomnia, mental strain, migraine, scanty periods, and vertigo. The constituents methyl cinnamate, methyl chavicol, ocimene, cineole, and linalool have insecticidal activities 5 5 7 . Contraindications Sweet basil is contraindicated for use while pregnant, breast-feeding, and with infants or toddlers. Do not use for extended periods in clinical isolates of the genera Staphylococcus, Enterococcus and Pseudom onas by using different test methods. J .Microbiol.Methods 2003;54(1) : 105-1 10. 5 5 3 Yano, Y., Satomi, M., and Oikawa, H. Antimicrobial effect of spices and herbs on Vibrio parahaemolyticus . Int J Foo d Microbiol 8-1 5 - 2006;1 1 1 ( 1 ) : 6 - 1 1 . 5 5 4 Patel, V. K. and Venkatakrishna-Bhatt, H. Folklore therapeutic indigenou s plants in periodontal disorders in India (review, experimental and clinical approach). Int J Clin Pharmacol.Ther.Toxicol. 198 8 ; 2 6 (4):1 7 6 - 1 84. 5 5 5 Siurin SA . [E f fects of essential oil on lipid peroxidation and lipid metabolism in patients with chronic bronchitis]. Klin Med (Mosk) . 19 9 7 ; 7 5 ( 10):43-5. 5 5 6 Yamasaki, K., Nakano, M., Kawahata, T., Mori, H., Otake, T., Ueba, N., Oishi, I., Inami, R., Yamane, M., Nakamura, M., Murata, H., and Nakanishi, T. A nti-HIV-1 activity of herbs in Labiatae . Biol.Pharm Bull 199 8 ; 2 1 ( 8 ) : 8 2 9 - 833. 5 5 7 Leung AY , Fo ster S . Encyclopedia of Comm on Natura l Ingredients Used in Foo d , Drugs and Cosmetics . 2nd ed. New York, N Y : Jo h n Wiley & So n s , 19 9 6 . 240 Module Si x doses higher than that used as a spice 5 5 8 . Do not use the essential oil during pregnancy or nursing. It contains up to 85% estragole (methyl chavicol), which can produce liver tumors in mice 5 5 9 . The constituent, xanthomicrol, can have cytotoxic and antineoplastic activities 5 6 0 . Orally, basil is known to cause hypoglycemia 5 6 1 . A d v e r s e E f f e c t s People with a known allergy to sweet basil, its constituents, or members of the Lamiaceae/Labiatae family should avoid use. Members of the Lamiaceae/Labiatae family include: Hyssop Hyssopus officinalis , marjoram Origanum majorana , mint Mentha piperita , sage Salvia officinalis , lavender Lavandula officinalis , oregano Origanum vulgare , and thyme Thymus vulgaris . There are few reports of adverse effects from sweet basil, other than few reports of allergy to related species. Drug and Supplement Interactions Based on a study of patients with chronic bronchitis, exposure to basil essential oil lowered plasma levels of dienic conjugates and ketons, and activation of catalase in red cells characteristic of antioxidant effects 5 6 2 . 5 5 8 American Herbal Products Associat ion?s, Botanical Safety Handbook , 19 9 7 : 79 5 5 9 Brinker F. Herb Contraindications and Drug Interactions . 2nd ed. Sandy, O R : Eclectic Medical Publications , 19 9 8 . 5 6 0 Brinker F. Herb Contraindications and Drug Interactions . 2nd ed. Sandy, O R : Eclectic Medical Publications , 19 9 8 . 5 6 1 Fetrow CW , A vila JR . Professional's Handbook of Co mplementary & Alternative Medicines. 1 st ed. Spring h o u se, PA : Spring h o u se Corp., 19 9 9 5 6 2 Siurin, S. A . [E f fects of essential oil on lipid peroxidation and lipid metabolism in patients with chronic bronchitis]. Klin.Med (Mosk) 19 9 7 ; 7 5 ( 10):43-45. 241 Module Si x Additionally, in studies, sweet basil shows antibacterial activity against Salmonella spp., Enterococcus spp., Pseudomonas spp., Escherichai coli O157, Campylobacter jejunii , and Clostridium perferingens 5 6 35 6 4 . Regulatory Status Sweet basil is listed in the American Herbal Products Association?s Botanical Safety Handbook as a Class 2b, 2c, and 2d?contraindicated for use with infants and toddlers, and for extended periods of time. 5 6 3 Wanniss orn, B., Jarikasem, S., Siriwangchai, T., and Thubthimthed, S. Antibacterial properties of essential oils from Thai medicinal plants. Fitoterapia 2005;7 6 ( 2 ) : 233-236. 5 6 4 Opalchenova, G. and Obreshk o va, D. Co m parative studies on the activity of basil--an essential oil from Ocimum basilicum L.- -against multidrug resistant clinical isolates of the genera Staphylococcus, Enterococcus and Pseudom onas by using different test methods. J .Microbiol.Methods 2003;54(1) : 105-1 10. 242 Module Si x P a n a x g i n s e n g ( synonym P a n a x s c h i n s e n g ) Image 39: by Shizhao (2005) via Wikipedia.org Taxonomic Notes Common botanical name: Asian ginseng Family: Araliaceae C o m m o n N a m e s Asiatic ginseng, Chinese ginseng, ginseng, ginseng Asiatique, ginseng radix, ginseng root, guigai, Hong Shen, Japanese ginseng, Jen-Shen, Jinsao, Jintsam, Insam, Korean ginseng, Korean Panax ginseng, Korean Red Ginseng, Ninjin, Oriental ginseng, Radix Ginseng Rubra, red ginseng, Ren Shen, Renshen, Renxian, Sang, Seng, Sheng Shai Shen, and white ginseng 243 Module Si x P r i m a r y U s e s When used orally, Asian ginseng promotes resistance to external stress and stimulates immune function. It is also used for improving physical and athletic stamina, cognitive function, concentration, and memory, and is often used as a tonic for improving general wellness. Overview Asian ginseng is one of the most economically important medicinal herbs in world trade. It has been used for medicinal purposes for more than 2,000 years. Asian ginseng is native to northern mountainous regions of China and Korea and the far eastern regions of the Russian Federation. The contents of commercial preparations labeled as containing Asian ginseng can vary greatly; many contain little or no Asian ginseng 5 6 5 . Sometimes ginseng is specifically referred to as red or white ginseng. This distinguishes how some ginseng roots are prepared. For example, red ginseng is produced by steam-curing Asian ginseng for 2-3 hours before drying, while white ginseng is dried by normal processes. The concentrations of the major ginsenosides (Rb1, Rb2, Rc, Rd, Re, Rf, and Rgl) are slightly higher in white ginseng than red ginseng. 5 6 5 The Review of Natural Products by Facts and Com parison s . St. Lo uis, MO: W olters Kluwer Co., 19 9 9 . 244 Module Si x Identifying Characteristics Part Characteristics Leaves Palmate and verticillate leaves Flowers Small and grouped 15-20 umbels Root Cylindrical, repeatedly divided in the middle and tapering towards the bottom, light yellow to light brown outside, white to yellowish, cartilaginous and brittle inside Fruit Small berry that is red when ripe Taste At first bitter, then sweet and mucilaginous Odor Faint and pleasant P a r t s U s e d Root C u l t i v a t i o n a n d C o l l e c t i o n This information is the same as for American ginseng. Dosage and Administration When taken orally, a typical dosage is 2.3 g of dried, powdered root, taken daily for up to three months. As a decoction, 3-9 g dried root simmered in 720-960 mL of water for approximately 45 minutes. As an infusion, 150-250 mL of boiling water poured over 1-2 g of fine- cut powdered root, steeped covered for 10 minutes, and then strained. As a fluid extract (1:2 g/mL), 1-6 mL taken daily, and as a dry extract, standardized to 4% ginsenosides, 2 x 100 mg capsules daily taken with liquid at breakfast or 1 capsule with breakfast and 1 capsule at lunch. 245 Module Si x Recent investigation suggests that higher doses 3-9 g of dried root (equal to 80-240 mg ginsenosides per day) are possibly warranted 5 6 6 . Duration of Administration Asian ginseng appears to be safe when used for less than three months. Sometimes it is taken continuously. A ginseng-free period of two weeks is recommended between consecutive courses. There is some concern about the long-term safety due to potential hormone- like effects, which might cause adverse effects with prolonged use. Active Constituents The primary active constituents in ginseng are saponins. Dammarane- type saponins are divided into two major groups based on their aglycones: 20 (S)-protopanaxadial: ginsenosides Rb1, Rb2, Rc, and Rd; and 20 (S)-protopanaxatriol: Ginsenosides Re, Rf, Rg1, and Rg2. Additional constituents include: 40+ dammarane- and oleanane-type saponins (triterpene glycosides or triterpenoids saponins) referred to as ginsenosides or panaxosides (ginsenosides is the term developed by Asian researchers, and the term panaxosides was developed by early Russian researchers; Ginsenoside Rbo is an oleanne-type saponin). Other constituents include alkaloids, phenols, amino acids, polypeptides, proteins, and 0.05% essential oil (limonen, terpineol, citral, and polyacetylenes). Pharmacological Action The ginsenosides have a wide range of pharmacological activity. In some cases, these isolated constituents seem to counteract each other?s activity. For example, ginsenoside Rg1 raises blood pressure and acts as a central nervous system (CNS) stimulant. Ginsenoside Rb1 lowers blood pressure and acts as a CNS depressant. Ginseng is widely used as a general tonic or ?adaptogen? for fighting stress. There is some evidence that it might work against stress by affecting 5 6 6 Dharmananda S. The nature of ginseng: Traditional use, modern research, and the question of dosage. HerbalGram 2002;54:34-51 . 246 Module Si x the hypothalamic-pituitary-adrenal (HPA) axis. Panax ginseng saponins seem to increase serum cortisol concentrations and stimulate adrenal function. Panax ginseng might also increase dehydroepiandrosterone sulfate (DHEA-S) levels in women. There is some evidence that Panax ginseng can affect immune function and might have anticancer effects. Panax ginseng appears to stimulate natural-killer cell activity and possibly other immune-system activity. It might also have some antitumor activity 5 6 7 . Extracts of Panax ginseng decrease the production of tumor necrosis factor, diminish DNA strand breakage, and inhibit the formation of induced skin tumors. There is conflicting research about the antioxidant and free radical scavenging activity of ginseng. Ginsenosides have been shown to inhibit tumor cell invasion and suppress sister chromatid exchanges in human lymphocytes. Panax ginseng also contains water insoluble polyacetylenic constituents such as panaxynol, panaxydol, and panaxytriol. Panaxydol seems to have antiproliferative effects on various types of cancer cells by inhibiting cancer cell growth at the cell cycle G1 to S transition phase 5 6 8 . In peptic ulceration, Panax ginseng has shown inhibitory activity on Helicobacter pylori-induced hemagglutination. Ginsenosides have a variety of other pharmacological effects. They seem to interfere with platelet aggregation and coagulation. They also have papaverine-like effects on smooth muscle, and analgesic and anti- inflammatory effects. There is evidence that ginsenosides can relax human bronchial smooth muscle by stimulating the release of nitrous oxide from airway epithelium, which may account for the potential anti-asthmatic effect of Panax ginseng. Ginsenosides also potentiate nerve growth factor and might confer neuroprotection through 5 6 7 Shin HR, Kim JY , Y u n T K , et al. The cancer-preventive potential of Panax ginseng: a review of hu man and experimental evidence. Cancer Causes Control 2000;11 :5 6 5 - 7 6 . 5 6 8 Moon J, Yu SJ , Kim HS, Soh n J. In duction of G (1 ) cell cycle arrest and p27 ( KIP1 ) increase by panaxydol isolated from P anax ginseng. Biochem Pharmacol 2000;59 :1 109-1 6 . 247 Module Si x nicotinic activity 5 6 9 . Panax ginseng also seems to promote growth of normal intestinal flora while inhibiting Clostridial species. Panax ginseng may also lower serum cholesterol and triglycerides. Preliminary evidence suggests that Panax ginseng might prevent insulin resistance and changes in gene expression in type 2 diabetes. The estrogenic effects of ginseng are controversial. Some clinical evidence suggests it doesn't have estrogen-mediated effects such as increasing follicle-stimulating hormone (FSH) and estradiol levels, or endometrial thickness. However, case reports of ginseng side effects such as postmenopausal vaginal bleeding suggest estrogen activity. Panax ginseng extract has been shown to increase serum ceruloplasmin oxidase activity (a measure of estrogenic activity in the liver) in animal models when ovaries are removed. In vitro research also shows estrogen activity. Studies on human breast cancer cells indicate that ginseng, specifically its constituent ginsenonside-Rb1, acts as a phytoestrogen 5 7 0 . Panaxagin, a protein isolated from unprocessed ginseng root, seems to have antiviral and antifungal activity, according to preliminary research. It appears to inhibit HIV reverse transcriptase and ribosomal activity of some fungi 5 7 1 . A multi-ingredient cream preparation containing Panax ginseng is thought to work in premature ejaculation by increasing the penile vibratory threshold and reducing the amplitude of penile somatosensory evoked potentials. Some people try ginseng for cystic fibrosis because there is preliminary evidence that it has activity against Pseudomonas aeruginosa lung infections, but this effect has not yet been demonstrated in humans. There is some evidence that a 5 6 9 Lewis R, Wake G, Co urt G, et al. No n- ginsenoside nicotinic activity in ginseng species. Phytother Res 199 9 ; 13;59 - 64. 5 7 0 Lee YJ, Jin YR , Lim W C , et al. Ginsenoside-Rb1 acts as a weak phytoestrogen in MCF-7 hu man breast cancer cells. Arch Pharm Res 2003;26:5 8 - 63. 5 7 1 Ng TB , Wang H. Panaxagin, a new protein from Chinese ginseng po s sesses anti-fu n gal, anti-viral, translation-inhibiting and ribonuclease activities. Life Sci 2001;6 8 : 739-49. 248 Module Si x Panax ginseng root extract can mildly inhibit cytochrome P450 (CYP) 2D6 (CYP2D6) activity by approximately 6% in humans. However, it appears to have no effect on CYP3A4 activity 5 7 25 7 3 . Clinical Review Yun and Choi (1998) studied cancer prevention in a prospective, case- controlled study enlisting 4,587 individuals with a mean age of 56 years. Dosage varied amongst individuals? intake of a ginseng root soup, fresh ginseng root extract and other forms. Duration of administration was five years. Intake of ginseng was correlated with an overall 60% reduction in risk of dying of any type of cancer compared to non-users. Fresh root extract showed the strongest protective effect, with 69% risk reduction compared to non-users. The risk of gastric and lung cancers was also reduced significantly (67% and 70%, respectively). Scaglione et al (1996) enlisted 227 volunteers in a double-blinded, placebo-controlled, randomized, multi-center study looking at ginseng?s effect on the body?s immune response to flu vaccine. Participants were given 100 mg twice daily of ginseng extract or placebo for three months. At week four an influenza vaccine was administered. The ginseng extract group experienced a significant rise in antibody levels and number of natural killer (NK) cells. Compared to placebo, the ginseng group had significantly fewer cases of the common cold or influenza. Antibody titres and NK cell activity were significantly higher in the ginseng group. Sotaniemi et al (1995) looked at the effects of Asian ginseng on type 2 diabetes in a double-blinded, placebo-controlled, randomized, multi- center study. Thirty-six participants, all with type 2 diabetes, were enrolled in three parallel groups: A dosage group of 100 ginseng daily, a second dosage group of 200 mg ginseng daily, and a control group. Duration of administration was two months. Compared with baseline 5 7 2 Gurley BJ, Gardner SF, Hubbard MA . Clinical assessment of potential cytochrome P450-mediated herb-drug interactions . AA P S An n Mtg & Ex p o Indianapolis, IN: 2000; Oct 29 - No v 2:presentation #3460. 5 7 3 Gurley BJ, Gardner SF, Hubbard MA, et al. Cytochrome P450 phenotypic ratios for predicting herb-drug interactions in hu mans. Clin Pharmacol Ther 2002;7 2 : 2 7 6 - 8 7 . 249 Module Si x measurement, both groups experienced significant improvements in physical performance, mood, reduced fasting blood glucose levels, serum aminoterminal propeptide (PIIINP) of type 2 procollagen concentration and lowered glycated hemoglobin 5 7 4 . M e d i c i n a l U s e s Orally, Panax ginseng is used as a so-called ?adaptogen? for increasing resistance to environmental stress and as a general tonic for improving well-being. It is also used for stimulating immune function, improving physical and athletic stamina, improving cognitive function, concentration, memory, and work efficiency. It is also used orally for depression, anxiety, Pseudomonas infection in cystic fibrosis, chronic bronchitis, irritated or inflamed tissues, and as a diuretic. Panax ginseng is also used orally for anemia, diabetes, gastritis, neurasthenia, erectile dysfunction, impotence and male fertility, fever, hangover, and asthma. It is also used orally for bleeding disorders, loss of appetite, vomiting, colitis, dysentery, cancer, insomnia, neuralgia, rheumatism, dizziness, headache, convulsions, disorders of pregnancy and childbirth, hot flashes due to menopause, and to slow the aging process. Topically, Panax ginseng is used as part of a multi-ingredient preparation for treating premature ejaculation 5 7 5 . Contraindications Theoretically, Asian ginseng may prolong activated partial thromboplastin time (aPT) or thrombin time (TT) and increase test results 5 7 6 . It may reduce fasting blood glucose concentrations and test results. It may improve glucose control and reduce glycoslyated hemoglobin (HbA1c) values in patients with type 2 diabetes. However 5 7 4 For more reviews of clinical studies regarding ginseng, see Blumenthal M. The ABC Clinical Guide to Herbs . Au stin: American Botanical Cou ncil; 2003. 5 7 5 Choi HK, Ju n g G W , Moon KH, et al. Clinical study of SS - Cream in patients with lifelong premat ure ejaculation. Urology 2000;55:2 5 7 - 6 1 . 5 7 6 Park HJ, Lee JH, Son g YB , Park KH. Effects of dietary sup plementation of lipo p hilic fraction from Panax ginseng on cGMP and cAMP in rat platelets and on blood coagulation. Biol Pharm Bull 199 6 ; 1 9 : 1434-9. 250 Module Si x those on antidiabetic medications or insulin should be monitored closed by the prescribing physician. Asian ginseng can reduce international normalized ratio or prothrombin time (PT/INR) and test results in patients treated with warfarin (Coumadin). Asian ginseng is reported to decrease blood coagulation 5 7 7 ; contraindicated in cases of hemorrhage or thrombosis. It is reported to have negative inotropic and chronotropic activity and hypotensive effects. Ginseng might adversely affect patients with cardiac disorders; use with caution. It is reported to have hypoglycemic activity. Use in diabetics might increase the risk of hypoglycemic episodes; use with caution. As Asian ginseng may have estrogenic effects, women with hormone sensitive conditions should avoid ginseng. Some of these conditions include breast cancer, uterine cancer, ovarian cancer, endometriosis, and uterine fibroids. High doses of ginseng have been associated with insomnia. Theoretically, use in patients with insomnia might worsen the condition; use with caution. High doses of ginseng have been associated with insomnia 5 7 8 and agitation in schizophrenic 5 7 9 patients; use with caution. Use of Panax ginseng in newborns is associated with intoxication that can lead to neonatal death 5 8 0 . 5 7 7 Shin HR, Kim JY , Y u n T K , et al. The cancer-preventive potential of Panax ginseng: a review of hu man an d experimental evidence. Can cer Causes Control 2000;11 :5 6 5 - 7 6 . 5 7 8 Scaglione F, Cattaneo G, Alessandria M, Cog o R. Ef ficacy and safety of the standardized Ginseng extract G11 5 for potentiating vaccination against the influenza syndrome and protection against the com m o n cold. Drugs Exp Clin Res 1 9 9 6 ; 2 2 : 6 5 - 7 2 . 5 7 9 Brown R. Potential interactions of herbal medicines with antipsychotics, antidepressants and hyp n otics. Eur J Herbal Med 199 7 ;3:25 - 8 . 5 8 0 McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook . Boca Raton, FL : CR C Press, LL C 19 9 7 . 251 Module Si x A d v e r s e E f f e c t s Orally, Panax ginseng is usually well tolerated, but some patients can experience side effects. The most common side effect is insomnia. Less commonly patients can experience mastalgia 5 8 1 , vaginal bleeding 5 8 25 8 3 , amenorrhea, tachycardia and palpitations, hypertension, hypotension, edema, decreased appetite, diarrhea, hyperpyrexia, pruritus, rose spots, headache, vertigo, euphoria, and mania. Uncommon side effects can include cerebral arteritis, Stevens-Johnson syndrome cholestatic hepatitis (associated with a Panax ginseng- containing, multi-ingredient product, Prostata), and neonatal death. Some patients can have allergic skin reactions, especially with use of large amounts or prolonged use. When the multi-ingredient cream preparation (SS Cream) has been applied topically to the glans penis, sporadic erectile dysfunction, excessively delayed ejaculation, mild pain, and local irritation and burning has occurred. Drug and Supplement Interactions Simultaneous use with coffee, guarana, or tea may potentiate the effects due to caffeine content. There is some evidence that Asian ginseng might lower blood glucose 5 8 4 . Simultaneous use with other herbs and supplements that decrease blood glucose levels might increase the risk of hypoglycemia. Some of these products include: Bitter melon, ginger, goat?s rue, fenugreek, kudzu, and willow bark. Theoretically, simultaneous use of ginseng with herbs that affect platelet aggregation may increase the risk of bleeding. Ginsenosides in ginseng are reported to inhibit platelet aggregation in vitro . This effect 5 8 1 Palmer BV, Montgo mery AC , Monteiro JC , et al. Gin Seng and mastalgia [letter]. BMJ 197 8 ; 1 : 1 2 84. 5 8 2 Hopkins MP, Androff L, Benning h o f f AS . Ginseng face cream and unexplained vaginal bleeding. Am J Obstet Gynecol 198 8 ; 1 5 9 : 1 1 2 1 - 2 . 5 8 3 Greenspan EM. Ginseng and vaginal bleeding [letter]. JAMA 1983;249:2018. 5 8 4 Sotaniemi EA, Haapakos ki E, Rautio A. Ginseng therapy in no n -ins ulin dependent diabetic patients. Diabetes Care 199 5 ; 1 8 : 1373-5. 252 Module Si x has not been demonstrated in humans 5 8 5 . In two case reports, ginseng has actually been reported to decrease the effectiveness of the prescription drug warfarin. Herbs with anticoagulant or antiplatelet properties include: Angelica, anise, arnica, asafoetida, bogbean, boldo, capsicum, celery, chamomile, clove, danshen, fenugreek, feverfew, garlic, ginger, ginkgo, horse chestnut, horseradish, licorice, meadowsweet, prickly ash, onion, papain, passionflower, poplar, quassia, red clover, turmeric, wild carrot, wild lettuce, and willow. There is some evidence from one case that Panax ginseng can decrease the effectiveness of warfarin (Coumadin). However, there is in vitro evidence that ginsenoside constituents in Panax ginseng might actually decrease platelet aggregation. Theoretically, concomitant use of ginseng and antiplatelet agents might increase the risk of bleeding. However, this effect has not been reported in humans. Use with caution in patients concurrently taking anticoagulant or antiplatelet agents. Some antiplatelet and anticoagulant drugs include: Aspirin, cilostazol (Pletal), clopidogrel (Plavix), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, and ticlopidine (Ticlid). Theoretically, concomitant use might enhance blood glucose lowering effects. Monitor blood glucose levels closely. Some antidiabetes drugs include glimepiride (Amaryl), glyburide (Diabeta, Glynase PresTabs, and Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), and others. Theoretically, Panax ginseng might interfere with antipsychotic drugs by interfering with neurotransmitters. There is some concern that long-term use of 3 g of Panax ginseng daily in combination with caffeine might lead to hypertension in some patients. There is some concern that Panax ginseng might contribute to diuretic resistance. There is one case of resistance to furosemide diuresis in a patient taking a germanium-containing ginseng product. 5 8 5 Jiang X , Williams KM, Liauw W S , et al. Effect of St Jo h n ' s w ort and ginseng on the pharmacokinetics and pharmacodynamics of warfarin in healthy subjects. Br J Clin Pharmacol 2004;57:5 9 2 - 9 . 253 Module Si x Theoretically, concurrent use might interfere with immunosuppressive therapy. Panax ginseng might have immune system stimulating properties. Immunosuppressant drugs include azathioprine (Imuran), basiliximab (Simulect), cyclosporine (Neoral, Sandimmune), daclizumab (Zenapax), muromonab-CD3 (OKT3, Orthoclone OKT3), mycophenolate (CellCept), tacrolimus (FK506, Prograf), sirolimus (Rapamune), prednisone (Deltasone, Orasone), and other corticosteroids (glucocorticoids). There is some concern that Panax ginseng might have additive hypoglycemic effects when used with insulin. Insulin dose adjustments might be necessary in patients taking Panax ginseng; use with caution. Theoretically, Panax ginseng can interfere with monoamine oxidase inhibitors (MAOI) therapy. Concomitant use with phenelzine (Nardil) is associated with insomnia, headache, tremors 5 8 6 , and hypomania 5 8 7 . Panax ginseng can potentiate stimulant drug effects 5 8 8 . There is some evidence from one case that Panax ginseng can decrease the effectiveness of warfarin 5 8 9 ; however, it?s not clear how ginseng causes this interaction. Monitor patients using this combination closely. Dose adjustments may be necessary. 5 8 6 Shader RI, Greenblatt DJ. Phenylzi ne and the dream machine-ramblings and reflections . J Clin Psychopharmacol 198 5 ; 5 : 6 5 . 5 8 7 Jones BD , Ru nikis AM. Interaction of ginseng with phenelzine. J Clin Psychopharmacol 198 7 ; 7 : 201-2 . 5 8 8 Scaglione F, Cattaneo G, Alessandria M, Cog o R. Ef ficacy and safety of the standardized Ginseng extract G11 5 for potentiating vaccination against the influenza syndrome and protection against the com m o n cold. Drugs Exp Clin Res 1 9 9 6 ; 2 2 : 6 5 - 7 2 . 5 8 9 Janetzky K, Morreale AP. Probable interaction between warfarin and ginseng. Am J Health Syst Pharm 199 7 ; 54:69 2 -3. 254 Module Si x There is some evidence that Panax ginseng can inhibit the cytochrome P450 (CYP) 2D6 (CYP2D6) enzyme by approximately 6% 5 9 0 . Although this effect is unlikely to produce clinically significant interactions, it might cause slightly elevated levels of drugs metabolized by the CYP2D6 enzyme. Some of these drugs include: Amitriptyline (Elavil), clozapine (Clozaril), codeine, desipramine (Norpramin), donepezil (Aricept), fentanyl (Duragesic), flecainide (Tambocor), fluoxetine (Prozac), meperidine (Demerol), methadone (Dolophine), metoprolol (Lopressor, Toprol XL), olanzapine (Zyprexa), ondansetron (Zofran), tramadol (Ultram), and trazodone (Desyrel). Regulatory Status Canada: Food, if no therapeutic claims are made, and New Drug if drug claims are made 5 9 1 except as per the Traditional Herbal Medicine (THM) Policy. Permitted as an over-the-counter (OTC) THM, if the claim is supported by traditional references, requiring premarket authorization and assignment of a Drug Identification Number (DIN) 5 9 2 . Also, permitted as an OTC homeopathic drug with premarket authorization and assignment of a DIN 5 9 3 . U.K.: Entered in General Sale List, Table A (internal or external use) of Schedule 1 (subject to a full Product License) 5 9 4 . U.S.: Dietary supplement 5 9 5 . Asian ginseng root and powdered Asian ginseng root, powdered Asian Ginseng extract, and ginseng tablets are official in the U.S. National Formulary 5 9 6 . 5 9 0 Gurley BJ, Gardner SF, Hubbard MA . Clinical assessment of potential cytochrome P450-mediated herb-drug interactions . AA P S An n Mtg & Ex p o Indianapolis, IN: 2000; Oct 29 - No v 2:presentation #3460. 5 9 1 HPB, 19 93 5 9 2 Health Canada, 199 9 5 9 3 Health Canada, 2001 5 9 4 GSL , 19 94 5 9 5 USC , 19 94 5 9 6 USP , 2002 255 Module Si x P a n a x q u i n q u e f o l i u s Image 40: by US FWS (2006) via Wikipedia.org Taxonomic Notes Common botanical name: American ginseng Family: Araliaceae C o m m o n N a m e s American ginseng, Anchi ginseng, Canadian ginseng, ginseng, North American Ginseng, Occidental ginseng, Ontario ginseng, red berry, Ren Shen, Sang, Shang, Wisconsin Ginseng, and Xi Yang Shen P r i m a r y U s e s Orally, promotes blood sugar metabolism in healthy people and persons with type II (non-insulin dependent) diabetes. Overview American ginseng is a perennial. 256 Module Si x Avoid confusion with Eleutherococcus senticosus , also referred to as Siberian ginseng, and Panax ginseng , also referred to as Asian ginseng. Wild American ginseng has been declared an endangered species in the U.S. Identifying Characteristics Part Characteristics Leaves Green leaves divided into 3-7 toothed leaflets up to 6 inches long Flowers Small, green-white, and bloom in early summer Root Aromatic, white, and slow-growing Fruit Bright-red berries P a r t s U s e d Root C u l t i v a t i o n a n d C o l l e c t i o n American ginseng grows 1-2-ft. high with a spread of 1 foot. Propagation is by seed, fall planted outdoors or sown in flats, and then transplanted in early spring (18 months later). Seed is slow but fall- planted seed will usually germinate by the following spring/summer. Seed is very expensive and often carries disease; treat purchased seed with a 10-1 water/bleach mix. Plant seeds six inches apart and with a row spacing of 24 inches. American ginseng is hardy to Zone 3. It requires approximately 75% shade, which can best be accomplished by growing under a forest canopy or using artificial shade cloth. Choose humus-rich, loamy soil with good drainage. Ginseng loves mulch, and it will help control weeds. In dry areas, it must be irrigated once or twice a week to help raise the humidity. Ginseng is extremely susceptible to disease, and many commercial growers use toxic fungicides for control. Ginseng is harvested in the fall of the fourth year or later. Seeds are harvested in the fall when the berry is ripe. There are usually two seeds per berry. 257 Module Si x Ginseng root is traditionally dried outdoors over a long period of time. If a drying room is used, low heat and dehumidifiers are important. It is key to dry the roots slowly to prevent darkening. Dosage and Administration When taken orally as a decoction, a typical dose is 3-6 g of dried root simmered in 720-960 mL of water for approximately 45 minutes. As an infusion, 150-240 mL of boiling water poured over 1-2 g dried root and steeped for 20 minutes. As a dry extract (to help improve physical endurance), 330 mg, three times daily. Duration of Administration For therapeutic effectiveness, American ginseng is optimally used continuously over an extended period of time. Active Constituents The active constituents in American ginseng include the dammarane- type triterpene glycosides (saponins) ginsenoside Rb1, Rb2, Rc, Rd, Re, Rg1 Ro, oleanic acid derived ginsenosides, as well as malyonyl (m) ginsenosides m-Rb1, m-Rb2, m-Rc, m-Rd. Additional constituents include dammarane-type triterpene oligo glycosides (quinquenosides I, II, III, IV, and V), acetylenic alcohols (panaxynol, falcarindiol, panaxydol, and panaxytriol), and volatile oil. Pharmacological Action The principle constituents of American ginseng are known as ginsenosides, panaxosides, or saponins. American ginseng contains primarily ginsenoside Rb-1, which reportedly lowers blood pressure; has antihemolytic, antipyretic, antipsychotic, CNS depressant, and ulcer protective activity; increases GI motility; and decreases islet insulin concentrations. An American ginseng extract decreases LH (luteinizing hormone) levels and increases serum ceruloplasmin oxidase activity (a measure 258 Module Si x of estrogenic activity in the liver) in an animal model 5 9 7 . Preliminary research suggests that American ginseng extract might reduce breast cancer cell growth; however, this effect may be outweighed by its estrogenic action, which might increase the growth of breast cancer cells. American ginseng might have immunomodulating activity 5 9 8 . It seems to activate monocytes and induce tumor necrosis factor (TNF)-alpha. Ginsenosides might improve memory by influencing the effect of acetylcholine in the central nervous system 5 9 9 by an unknown mechanism. Ginsenosides do not appear to change metabolism, release, or reuptake of acetylcholine. There?s also some evidence that ginsenosides might cause an increase in sexual drive 6 0 0 . Preliminary evidence suggests that saponins found in the stems and leaves of American ginseng can reduce oxidation of low density lipoprotein (LDL) 6 0 1 cholesterol. These saponins might reverse the decrease in venous relaxation in response to acetylcholine that occurs in the presence of oxidized LDL. A hot water extract of American ginseng root seems to decrease endothelial constriction by promoting the release of nitric oxide 6 0 2 . 5 9 7 Eagon PK , Elm MS, Hunter DS, et al. Medicinal herbs: modulation of estrogen action. Era of Hope Mtg, Dept Defense; Breast Cancer Res Prog, Atlanta, GA 2000;Jun 8- 1 1 . 5 9 8 McElhaney JE , Gravenstein S, Cole SK, et al. A Placebo-Co ntrolled Trial of a Proprietary Extract of N orth American Ginseng (C V T - E002) to Prevent Acute Respiratory Illness in Institutionalized Older Adults. J Am Geriatr Soc 2004;52: 13- 9. 5 9 9 Benishin C G , Lee R, Wang LC , Liu HJ. Ef fects of ginsenoside Rb1 on central cholinergic metabolism . Pharmacology 1 9 9 1 ;42:2 23-9. 6 0 0 Murphy LL , Lee TJ. Ginseng, sex behavior, and nitric oxide. Ann N Y Acad Sci 2002;9 6 2 :372- 7 . 6 0 1 Li J, Huang M, Teoh H, Man RY . Panax quinquefolium saponins protects low density lipo proteins from oxidation. Life Sci 199 9 ; 64:53-62 . 6 0 2 Yuan CS , Attele AS, W u JA , et al. Panax quinquefolium L. inhibits thrombin- induced endothelin release in vitro. Am J Chin Med 199 9 ; 2 7 :331-8 . 259 Module Si x Clinical Review Vuksan et al (2001) studied postprandial glycemia in 12 healthy individuals taking part in a single day, randomized, placebo-controlled, crossover study. Participants were given 16 doses: 1 g, 2 g, 3 g, or placebo at 40, 20, 10 or 0 minutes before a 25 g oral glucose challenge. Ginseng reduced postprandial glycemia compared to placebo. Vuksan et al (2000) also studied postprandial glycemia in 10 individuals with type 2 diabetes in a randomized, placebo-controlled, crossover study. Participants were given 3, 6, 9 g ginseng or placebo 120, 80, 40, or 0 minutes before receiving a glucose challenge. Use of ginseng significantly lowered incremental glycemia independent of the dose used 6 0 3 . Medicinal Uses When taken orally, American ginseng is used as an adaptogen, which increases resistance to environmental stress, and as a general tonic, stimulant, diuretic, and digestive aid. Additionally, American ginseng is used with anemia, diabetes, insomnia, neurasthenia, gastritis, impotence, fever, hangover symptoms, stimulating immune function, attention deficit-hyperactivity disorder (ADHD), and for eradicating Pseudomonas infection in cystic fibrosis. American ginseng is also used for improving stress resistance, preventing the effects of aging, improving stamina, blood and bleeding disorders, atherosclerosis, loss of appetite, vomiting, colitis, dysentery, cancer, insomnia, neuralgia, rheumatism, memory loss, dizziness, headaches, convulsions, and disorders of pregnancy and childbirth. 6 0 3 For more reviews of clinical studies regarding ginseng, see Blumenthal M. The ABC Clinical Guide to Herbs . Au stin: American Botanical Cou ncil; 2003. 260 Module Si x Contraindications American ginseng has been reported to decrease blood coagulation; contraindicated in cases of hemorrhage or thrombosis. It is reported to have negative inotropic and chronotropic activity and hypotensive effects. Ginseng might adversely affect patients with cardiac disorders; use with caution. American ginseng has hypoglycemic activity. Use in diabetics might increase the risk of hypoglycemic episodes; use with caution. Because American ginseng might have estrogenic effects, women with hormone sensitive conditions should avoid American ginseng. Some of these conditions include breast cancer, uterine cancer, ovarian cancer, endometriosis, and uterine fibroids 6 0 46 0 5 . High doses of American ginseng have been associated with insomnia. Theoretically, use in patients with insomnia might worsen the condition; use with caution. High doses of American ginseng have been associated with insomnia and agitation in schizophrenic 6 0 6 patients; use with caution. A d v e r s e E f f e c t s Orally, no adverse reactions have been reported specifically with use of American ginseng. Drug and Supplement Interactions Theoretically, simultaneous use of ginseng can potentiate the stimulant effects of caffeine, coffee, tea, Guarana, or mate. 6 0 4 Eagon PK , Elm MS, Hunter DS, et al. Medicinal herbs: modulation of estrogen action. Era of Hope Mtg, Dept Defense; Breast Cancer Res Prog, Atlanta, GA 2000;Jun 8- 1 1 . 6 0 5 Amato P, Christop he S, Mellon PL . Estrogenic activity of herbs comm o nly used as remedies for menopausal sym ptom s . Menopause 2002;9 : 145-50. 6 0 6 Brown R. Potential interactions of herbal medicines with antipsychotics, antidepressants and hyp n otics . Eur J Herbal Med 199 7 ;3:25 - 8 . 261 Module Si x American ginseng may lower blood glucose. Theoretically, concomitant use with antidiabetes drugs might enhance blood glucose lowering effects and possibly cause hypoglycemia. Monitor blood glucose levels closely. Some antidiabetes drugs include glimepiride (Amaryl), glyburide (Diabeta, Glynase PresTab, and Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), and others. Theoretically, American ginseng can interfere with antipsychotic drugs, hormone therapy, and MAOI therapy. There is one case report of insomnia, headache, and tremors with concomitant phenylzine (Nardil) and unspecified ginseng use 6 0 7 . There is also one case report of hypomania with concomitant phenelzine (Nardil) 6 0 8 and unspecified ginseng use. Theoretically, simultaneous use of American ginseng can interfere with warfarin therapy 6 0 9 . Regulatory Status Canada: Food, if no therapeutic claims are made, and New Drug if drug claims are made 6 1 0 except as per the Traditional Herbal Medicine (THM) Policy. Permitted as a THM, if the claim(s) are supported by traditional references, requiring premarket authorization and assignment of a Drug Identification Number (DIN) 6 1 1 . Also, permitted as a homeopathic over-the-counter (OTC) drug with premarket authorization and assignment of a DIN 6 1 2 . 6 0 7 Shader RI, Greenblatt DJ. Phenylzine and the dream machine-ramblings and reflections . J Clin Psychopharmacol 198 5 ; 5 : 6 5 . 6 0 8 Jones BD , Ru nikis AM. Interaction of ginseng with phenelzine. J Clin Psychopharmacol 198 7 ; 7 : 201-2 . 6 0 9 Janetzky K, Morreale AP. Probable interaction between warfarin and ginseng. Am J Health Syst Pharm 199 7 ; 54:69 2 -3. 6 1 0 HPB, 19 93 6 1 1 Health Canada, 199 9 6 1 2 Health Canada, 2001 262 Module Si x U.K.: Entered in General Sales List , Table A (internal or external use) of Schedule 1 (subject to a full product license) 6 1 3 . U.S.: Dietary supplement 6 1 4 . The homeopathic tincture (IX) of the fresh or dried root is an OTC Class C drug of the Homeopathic Pharmacopoeia of the United States 6 1 5 . Module Assessment You are now ready to log in and complete the module assessment online. Refer back to the instructions in Module One if you need to. 6 1 3 GSL , 19 94 6 1 4 USC , 19 94 6 1 5 HPUS , 19 9 2 263 Module Seven Module Seven Module Objectives Upon completion of this module, you will be able to: ? Recall and describe the Latin binomial or scientific name, common name, and family. ? Be able to identify a photograph by the Latin name and common name of the botanicals studied. ? Identify the therapeutic potential of each botanical studied. ? Explain the pharmacological action of each botanical studied. ? List the key recommended uses for each botanical studied. ? Recall the recommended dosage and duration for each botanical studied. ? Recall and describe any contraindications and precautions associated with each botanical studied. ? Recall the regulatory status of each of botanical studied. Module Checklist ? Read and review the module. ? Read any online resources as applicable. ? Ensure you can meet the Module Objectives. ? Complete the module assessment online and respond to another student?s posting as instructed. ? Complete the Module Test. 7 264 Module Seven P i p e r m e t h y s t i c u m Image 41: by Forest and Kim St arr (2002) via Wikipedia.org Taxonomic Notes Common botanical name: Kava Family: Piperaceae C o m m o n N a m e s Ava, ava pepper, ava root, awa, gea, gi, intoxicating long pepper, kao, kava kava, kava-kava, kava-kava root, kava pepper, kava root, kavain, kavapipar, kawa, kawa kawa, kawa-kawa, kawa pepper, kawapfeffer, kew, long pepper, Maori kava, malohu, maluk, meruk, milik, rauschpfeffer, rhizome di kava-kava, sakau, tonga, wurzelstock, yagona, yangona, yaqona, and yongona P r i m a r y U s e s When taken orally, kava is used with anxiety disorders, stress, attention deficit-hyperactivity disorder (ADHD), insomnia, and restlessness. 265 Module Seven Overview In Europe, kava has been used with anxiety for decades. In 1990, the German Commission E approved kava as a nonprescription drug for use with symptoms of anxiety, stress, and nervous restlessness. More recently, however, kava has been implicated in some cases of hepatotoxicity in Europe and the U.S. As a result, kava supplements have been banned in Switzerland, Germany, Canada, Australia, and France. Several other countries are considering removing kava from the market. One recent meta-analysis of controlled clinical trials found kava to be safe and effective compared to placebo when used with anxiety, and a small clinical study about its adverse effects profile concluded the relative safety of the supplement as well. Furthermore, a toxicological review of kava-associated hepatic adverse event reports from Europe and the U.S. concluded that there was no clear evidence supporting a connection between kava consumption and liver damage. Please reference the detailed review of events related to kava and hepatotoxicity on the American Botanical Council website before referring to patients: www.herbalgram.org . Identifying Characteristics P a r t s U s e d Rhizome, root, and stem Dosage and Administration When taken orally, the typical daily dosage for cut dried rhizome and other oral preparations is equivalent to 60-120 mg kavalactones (kavapyrones). This amount is equivalent to 1.7-3.4 g of dried rhizome Part Characteristics Leaves Large, heart-shaped leaves Flowers Bears numerous flowers arranged in clusters shaped like ears of corn Root Grayish white on the inside and with a radiate, fan-like cross section Taste Slightly bitter, soapy, acrid Odor Faintly aromatic 266 Module Seven based on the DAC quantitative requirement of minimum 3.5% (35 mg/g) kavalactones. Kava is traditionally prepared by water extraction from the fresh root. Kava is prepared commercially with ethanol, yielding 70% kavalactones. Most clinical studies on the effectiveness of kava for anxiety disorders have used the standardized extract WS 1490 (W. Schwabe 6 1 6 ). This extract is more than twice as concentrated as most products that are commercially available. As a dried rhizome, 1.5-3 g daily, divided throughout the day, and chewed well. As a fluid extract (1:2), 3-6 mL daily, divided throughout the day. As a capsule or tablet, powdered dry extract (not less than 30% kavalactones) or semisolid (paste) extract (not less than 50% kavalactones) in daily dosage equivalent to 70-280 mg kavalactones. Most controlled clinical trials are based on three 100 mg 6 1 76 1 86 1 9 doses of a dried extract (acetone solvent), standardized to 70 mg (70%) kavalactones or 210 mg kavalactones per day. As a tea, simmer 2-4 g of the root in 150 mL boiling water for 5-10 minutes, and then strain. Drink up to three times per day. 6 1 6 Natural Medicines Co m prehensive Database accessed 6/4/09: http:/ / w w w . naturaldatabase.com/( S (t5bdq4n3uj0bofz4rvgma0em))/ nd/Search.asp x ?cs= & s = N D & pt=100&id=87 2 &ds= 6 1 7 Woelk H, Kapoula O, Lehrl S, et al. [C o m parison of kava special extract WS 1490 and benzodiazepines in patients with anxiety]. [Article in German]. Z Allg Med 1993;69 : 2 7 1 ? 7 . 6 1 8 Pittler MH, Ernst E. Ef ficacy of kava extract for treating anxiety: sy stematic review and meta-analysis. J Clin Psychopharmacol 2000;20:84-9. 6 1 9 Volz HP, Kieser M. Kava-kava extract WS 1490 versus placebo in anxiety disorders--a randomized placebo- controlled 25- week ou tpatient trial. Pharmacopsychiatry 1 9 9 7 ;30:1- 5 . 267 Module Seven Duration of Administration As a precautionary measure, the American Botanical Council suggested in December 2001 that use exceeding one month be monitored by a qualified health professional 6 2 0 . Active Constituents The primary active constituents of kava are the kavalactones (also known as kavapyrones), kavain, dihydrokavain, methysticin, dihydromethysticin, yangonin, and desmethoxyyangonin. The dried herb typically contains at least 3.5% kavalactones. Kava is traditionally prepared by water extraction from the fresh root. Commercially, kava is prepared with ethanol, yielding 30% kavalactones or acetone, yielding 70% kavalactones 6 2 16 2 2 . Kava also contains chalcones (flavokavins A, B, C), 3.2% minerals (potassium, calcium, magnesium, sodium, aluminum, and iron), and 3.5% amino acids. Pharmacological Action Kava has a variety of pharmacological effects, including: Anxiolytic, sedative, anticonvulsant, local anesthetic, spasmolytic, anti- inflammatory, and analgesic activities. However, the exact mechanism for these effects is not known 6 2 3 . In a 2001 study 6 2 4 , the effects of kava on anxiety, tension, and restlessness were investigated in a randomized, double-blind, placebo- controlled study with 40 participants. Over a five-week period, 6 2 0 ABC , 2001; Blumenthal, 2002a, b 6 2 1 Garner LF, Klinger JD . So me visual effects caused by the beverage kava. J Ethnopharmacol 1 9 8 5 ; 13:307-311. 6 2 2 Denham A, McIntyre M, Whitehou se J. Kava--the unf olding st ory: report on a work-in- progress. J Altern Complement Med 2002;8 : 237-2 63. 6 2 3 Reference the Natural Medicines mo n o graph for kava. 6 2 4 Malsch U, Kieser M. 268 Module Seven individuals were administered 300 mg kava supplement daily with the exception of week one when dosage began at 50 mg. Pretreatment of patients with benzodiazepines was tapered off over two weeks. Kava was superior to placebo on HAMA and subjective well-being scales. This study confirmed the anxiolytic effects and good tolerance of kava and showed that further symptom reduction is possible after changeover from benzodiazepine use. Additionally, in a 1997 study 6 2 5 , anxiety and agitation caused by unspecified mental disorder were examined in a randomized, double- blind, placebo-controlled, multi-center study of 101 volunteers. For the duration of 25 weeks, participants were administered 100 mg of a kava supplement three times daily (3 x 70 mg kavalactones daily). Study results showed significantly reduced somatic and mental anxiety from the eighth week on. Long-term use showed greater efficacy than short-term use. Kava was well tolerated, adverse effects were rare, and there were no withdrawal symptoms. Medicinal Uses When taken orally, kava is used with anxiety disorders, stress, attention deficit-hyperactivity disorder (ADHD), insomnia, restlessness, epilepsy, psychosis, depression, headaches (including migraines), common cold and other respiratory tract infections, tuberculosis, cancer prevention, musculoskeletal pain, bladder cancer, urinary tract infection (UTI), uterine inflammation, venereal disease, menstrual discomfort, vaginal prolapse, and as an aphrodisiac. Topically, kava is used with skin diseases like leprosy, because it promotes wound healing and works as an analgesic. Also, kava is used topically as a poultice for otitis and abscesses, and as a mouthwash for canker sores and toothaches. In addition, when used orally, kava may also be effective for reducing symptoms of anxiety related to climacteric in menopausal women, and there is evidence that kava is effective when used to prevent benzodiazepine withdrawal. 6 2 5 Volz HP, Kieser M. Kava-kava extract WS 1490 versus placebo in anxiety disorders--a randomized placebo- controlled 25- week ou tpatient trial. Pharmacopsychiatry . 19 9 7 Jan;30(1) : 1 - 5 . 269 Module Seven There is insufficient reliable information available to evaluate the effectiveness of kava for its other uses. However, epidemiological evidence suggests that increasing kava consumption might lower incidence of cancer 6 2 6 . More evidence is needed to evaluate kava for this use. Contraindications The Complete German Commission E Monographs contraindicated the use of kava in cases of endogenous depression, during pregnancy, and while nursing. In addition, kava might have CNS depressant effects and could potentially exacerbate depression in some patients 6 2 7 . Avoid simultaneous use with other CNS depressant agents like alcohol or benzodiazepine because of potential sedative effects. It is also recommended that patients discontinue use 2-3 weeks before surgery. Shown to have hepatotoxic activity 6 2 8 . Avoid use with patients who have known liver disease and patients taking hepatotoxic agents. A d v e r s e E f f e c t s Kava may cause liver damage and increase liver function tests in some patients. Liver toxicity is primarily attributed to long-term use of high doses 6 2 9 . In some patients, though, short-term use of about 3-8 weeks with typical doses might result in liver damage and increase liver 6 2 6 Steiner GG. The correlation between cancer incidence and kava cons u m ption . Hawaii Med J 2000;59:420-2. 6 2 7 Refer to the Natural Medicines mo n o graph. 6 2 8 Rus s mann S, Lauterburg BH, Helbling A. Kava hepatotoxicity. Ann Intern Med. 2001 Jul 3;135(1 ) : 6 8 - 9 . 6 2 9 Pizz orno JE , Murray MT, eds. Textbook of Natural Medicine. 2nd ed. Edinburgh: C h urchill Living stone, 199 9 . 270 Module Seven function tests 6 3 06 3 1 . Monitoring liver function tests of patients taking kava for longer than one month, as well as patients with symptoms of liver problems like fatigue, yellowing of the skin (jaundice), and dark urine, is recommended. In addition, the chronic and heavy use of kava has been linked to an increase in red blood cell volume, reduced platelet volume, reduced lymphocyte counts, and reduced serum albumin 6 3 2 . Hematuria, blood in the urine, has also been reported, though specific cause is unclear 6 3 3 . Drug and Supplement Interactions Simultaneous use of kava with other potentially hepatotoxic products or drugs might increase the risk of developing liver damage. Some of these products include: Androstenedione, chaparral, coenzyme Q10 (only in high doses), comfrey, DHEA, germander, niacin, pennyroyal oil, red yeast, scullcap, valerian, acarbose (Precose), amiodarone (Cordarone), atorvastatin (Lipitor), azathioprine (Imuran), carbamazepine (Tegretol), cerivastatin (Baycol), diclofenac (Voltaren), felbamate (Felbatol), fenofibrate (Tricor), fluvastatin (Lescol), gemfibrozil (Lopid), isoniazid, itraconazole, (Sporanox), ketoconazole (Nizoral), leflunomide (Arava), lovastatin (Mevacor), methotrexate (Rheumatrex), nevirapine (Viramune), niacin, nitrofurantoin 6 3 0 Strahl S, Ehret V, Dahm HH, Maier KP. [Necrotizing hepatitis after taking herbal medication] . [Article in German]. Dtsch Med Wochenschr 199 8 ; 1 23:1410- 4. 6 3 1 Escher M, Desmeules J, Giostra E, Mentha G. Drug Points: hepatitis associated with kava, a herbal remedy for anxiety. BMJ 2001;322:139. 6 3 2 Mathews JD , Riley MD, Fejo L, Muno z E, Milns N R , Gardner ID, Po wers JR , Ganyg ulpa E, Gu n u n u wawu y BJ . Ef fects of the heavy usage of kava on ph y sical health: su m mary of a pilot survey in an aboriginal com m u nity. Med J Aust. 198 8 Ju n 6; 148(1 1 ) : 548-5 5 . 6 3 3 Mathews JD , Riley MD, Fejo L, Muno z E, Milns N R , Gardner ID, Po wers JR , Ganyg ulpa E, Gu n u n u wawu y BJ . Ef fects of the heavy usage of kava on ph y sical health: su m mary of a pilot survey in an aboriginal com m u nity. Med J Aust. 198 8 Ju n 6; 148(1 1 ) : 548-5 5 . 271 Module Seven (Macrodantin), pioglitazone (Actos), pravastatin (Pravachol), pyrazinamide, rifampin (Rifadin), ritonavir (Norvir), rosiglitazone (Avandia), simvastatin (Zocor), tacrine (Cognex), tamoxifen, terbinafine (Lamisil), valproic acid, and zileuton (Zyflo). Simultaneous use of herbs and supplements with sedative properties might increase the risk of excessive drowsiness. Some of these include: 5-HTP, calamus, calendula, California poppy, catnip, capsicum, celery, couch grass, elecampane, German chamomile, goldenseal, gotu kola, hops, Jamaican dogwood, lemon balm, melatonin, sage, St. John?s wort, sassafras, scullcap, shepherd?s purse, Siberian ginseng, stinging nettle, valerian, wild carrot, wild lettuce, ashwagandha root, and yerba mansa. There is concern kava might potentiate the central nervous system effects of benzodiazepines such as lorazepam (Ativan), alprazolam (Xanax), and diazepam (Valium). Preliminary evidence indicates kava can inhibit the activity of cytochrome P450 (CYP) enzymes, including the CYP3A4 isoenzyme. Simultaneous use of kava and alcohol, barbiturates, and other CNS depressants can increase the risk of drowsiness and motor reflex depression. Theoretically, kava might increase the risk of extrapyramidal or dystonic reactions with drugs that antagonize dopamine. Some of these drugs include antipsychotics, metoclopramide (Reglan), and prochlorperazine (Compazine). In a 1998 study, kava extract and individual kavapyrones were investigated for their effect on neurotransmitter levels in the nucleus accumbens of rats. A small dose of kava extract (20 mg/kg body weight i.p.) caused changes in rat behavior and concentrations of dopamine in the nucleus accumbens, while higher doses (120 mg/kg i.p.) increased dopamine levels 6 3 4 . Additionally, kava might increase the effects of many drugs that are metabolized by cytochrome P450 enzymes. There is preliminary 6 3 4 Baum SS , Hill R, Ro m melspacher H. Effect of kava extract and individual kavapyrones on neurotransmitter levels in the nucleus accumbens of rats. Prog Neuropsychopharmacol Biol Psychiatry . 19 9 8 Oct;22 ( 7 ) : 1 105-20. 272 Module Seven evidence kava can inhibit the activity of cytochrome P450 (CYP) enzymes, including the CYP1A2, CYP2C9, CYP2C19, CYP2D6, and CYP3A4 isoenzymes 6 3 5 . Drugs that are metabolized by cytochrome P450 enzymes include acetaminophen (Tylenol), amitriptyline (Elavil), caffeine, haloperidol (Haldol), ibuprofen (Advil, Motrin), omeprazole (Prilosec), phenytoin (Dilantin), and phenobarbital (Barbita, Luminal). Regulatory Status Australia: Schedule 4 to the Customs (Prohibited Imports) Regulations and is listed on Appendix B-?Substances Subject to Import Controls? with annual license and permit required. Importation of kava into the Northern Territory not permitted, and clearance from the State Health authorities required for importation into Western Australia (TGA, 2000a, 2000b). The Australian Therapeutic Goods Administration (TGA) reviewed kava?s legal status and invited submissions for consideration. In 2002, the TGA ordered a voluntary recall on the sale of kava based on the prevailing international concerns over potential association with hepatotoxicity. Canada: Kava is not acceptable as a non-medicinal ingredient in oral- use products (HPB, 1993; Health Canada 1995a). When identified as a Traditional Herbal Medicine (THM) or a homeopathic drug, kava was formerly regulated as a schedule OTC drug requiring premarket authorization and assignment of a Drug Identification Number (DIN) 6 3 6 . Health Canada reviewed the safety of kava in light of the recent hepatotoxicity reports and banned the sale of kava and issued a product recall in August 2002 6 3 7 . U.K.: Kava was formerly an herbal medicine on the General Sale List, Schedule I (requiring full Product License), Table A (internal or external use) with maximum single-dose of 625 mg 6 3 8 . In December 2001 the British Medicines Control Agency (MCA) and the dietary 6 3 5 Mathews JM, Etheridge AS, Black SR. Inhibition of hu man cytochrome P450 activities by kava extract and kavalactones. Drug Metab Dispos 2002;30:11 53-7. 6 3 6 Health Canada, 199 5b, 2001; WHO, 19 9 8 6 3 7 Health Canada, 2002 6 3 8 GSL , 19 94 273 Module Seven supplement trade organizations agreed to voluntarily suspend the sales of kava until such time as the issue of potential hepatotoxicity was adequately resolved. In December 2002, MCA announced a ban on kava effective January 2003 6 3 9 . U.S.: Dietary supplement (USC, 1994). Kava rhizome, powdered kava, powdered kava extract, semisolid kava extract and kava tablets are subjects of botanical monographs in development for United States Pharmacopeia-National Formulary. Previews of the standards development were published in the Pharmacopeial Forum 6 4 0 . In March 2001, the FDA issued a public warning on kava in response to concerns about potential hepatotoxicity 6 4 1 . 6 3 9 MCA, 2002 6 4 0 USP C , 2000; 2002 6 4 1 FDA , 2002 274 Module Seven P o p u l u s b a l s a m i f e r a Image 42: by USDA (1995) via Wikipedia.org Taxonomic Notes Common botanical name: Balsam Poplar Family: Salicaceae C o m m o n N a m e s Balm of Gilead, balsam poplar buds, pappelknospen, populi gemma, and tacamahac Avoid confusion with spruce Picea excelsa and Canada balsam Abies balsamea , also known as balm of Gilead. 275 Module Seven P r i m a r y U s e s Poplar bud, consisting of the dried, unopened leaf bud of the Populus species, is used topically for superficial skin injuries, external hemorrhoids, frostbite, and sunburn 6 4 2 . Traditionally, balsam poplar was used by the Native Americans to treat skin and lung problems. Today, it is used as an expectorant and antiseptic tonic. The leaf buds are covered with a resinous sap and attributed with antiscorbutic, antiseptic, diuretic, expectorant, stimulant, and tonic properties 6 4 3 . To separate the resin from the bud, the leaf buds are boiled and the resin is dissolved in alcohol 6 4 4 . The resin is a traditional remedy used as a salve and wash for sores, rheumatism, and wounds 6 4 5 . It has also been made into a tea, which, externally, has been used as a wash for sprains, inflammation, and muscle pains, and internally can be used for lung problems and cough 6 4 6 . In addition, the buds can be steamed in hot water and inhaled to relive congestion 6 4 7 . Balsam poplar bark, however, is cathartic and tonic 6 4 8 . Although it is not specific known if Populus balsamifera bark contains salicin, most members of the genus do. Salicin is a glycoside thought to decompose 6 4 2 Blumenthal, M., ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines . Trans. S. Klein. Bo ston , MA: American Botanical Cou ncil, 19 9 8 . 6 4 3 Grieve, A Modern Herbal. Penguin, 19 84. 6 4 4 Foster, S. & Du ke. J. A. A Field Guide to Medicinal Plants . Eastern and Central N. America. Houghton Mifflin Co . , 19 90. 6 4 5 Moerman. D. Native American Ethnobotany . Timber Press. Oregon , 19 9 8 . 6 4 6 Foster, S. & Du ke. J. A. A Field Guide to Medicinal Plants. Eastern and Central N. America . Houg hton Mifflin Co , 19 90. 6 4 7 Weiner, M. A. Earth Medicine, Earth Foo d . Ballantine Boo k s , 19 80. 6 4 8 Grieve, A Modern Herbal. Penguin, 19 84. 276 Module Seven into salicylic acid, or aspirin, in the body 6 4 9 , making the bark anodyne, anti-inflammatory, and febrifuge 6 5 0 . Overview Balsam poplar Populus balsamifera is the northernmost American hardwood. It grows about 75-100-ft. 6 5 1 tall and prefers flood plains. Balsam poplar is a hardy, fast-growing tree, though generally short lived. Some trees live to 200 years. The light, soft wood is commonly used for pulp and construction 6 5 2 . Identifying Characteristics 6 4 9 Bo w n , D . Encyclopaedia of Herbs and their Uses. Dorling Kindersley, Lo ndon, 19 9 5 . 6 5 0 Plants for a Future accessed 6/1 2 /09: http:/ / w w w . p faf.org/database/plants.p h p ? P o p ulu s +balsamifera 6 5 1 Accessed 6/1 2 /09: http:/ / w w w .borealforest.org/trees/tree11.htm 6 5 2 Accessed 6/1 2 /09: http:/ / w w w . na.fs . fed.us / p ubs/silvics_manual/v olu me_2/ p o p ulu s /balsamifera.htm Part Characteristics Leaves Alternate, simple, ovate, finely serrated, 3-6-in. long, shiny dark-green, paler and often blotchy orange below, petiole long with glands at the leaf base Flowers Dioecious, male and female as hanging, several inches long, pale yellow-green catkins, and appears in early spring Bark Greenish-gray with lighter lenticels when young; later becoming darker and furrowed with long, scaly ridges Fruit Small, 2-valved, dry capsule with several small seeds Taste Leaf buds are bitter Odor Leaf buds have turpentine odor 277 Module Seven P a r t s U s e d Dried, unopened leaf buds, and bark C u l t i v a t i o n a n d C o l l e c t i o n Balsam poplar prefers a rich, well-drained, circumneutral soil. It does not like shade, is intolerant of root or branch competition, is fast growing and typically short-lived; though, trees aged 150-200 years have been documented 6 5 3 . Preparation The herbal preparation is derived from fresh, crushed buds. Dosage and Administration The common application is 5 g of the dried buds per day or semi-solid preparations equivalent to 20-30% dried buds per day 6 5 46 5 5 . For hemorrhoids, ointments or suppositories are helpful. Duration of Administration None known. Active Constituents Flavonoids, phenol glycosides (salicin), tannin, and essential oil 6 5 3 Plants for a Future accessed 6/1 2 /09: http:/ / w w w . p faf.org/database/plants.p h p ? P o p ulu s +balsamifera 6 5 4 Blumenthal M., ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines . Trans. S. Klein. Bo ston , MA: American Botanical Cou ncil, 19 9 8 . 6 5 5 Gruenwald J., Brendler T., Jaenicke C. PDR for Herbal Medicines . 1st Edition. Montvale, NJ: Medical Econo mics Co m pany , Inc., 19 9 8 . 278 Module Seven Pharmacological Action Salicin is metabolized to saligenin in the gastrointestinal tact and to salicylic acid following absorption. Salicylic acid has recognized antipyretic and anti-inflammatory properties. Tannins in poplar contribute decongestant, antipruritic, and calming effects. Medicinal Uses Orally, poplar is used as an ingredient in herbal cough preparations. It is also used orally as a stimulant and expectorant. Topically, poplar is used for sores, bruises, cuts, pimples, external hemorrhoids, frostbite, and sunburn. Contraindications Balsam poplar is contraindicated for use with patients who are allergic to poplar buds, propolis, Peru balsam, and/or salicylates 6 5 66 5 7 . The safe use of poplar while pregnant has not been established; avoid use. A d v e r s e E f f e c t s When used topically, occasional allergic skin reactions can occur. Although there have been no reports of aspirin-type allergic reactions with the use of salicin-rich plants, caution is still wise 6 5 8 . 6 5 6 Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines . Trans. S. Klein. Bo ston , MA: American Botanical Cou ncil, 19 9 8 . 6 5 7 Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines . 1st ed. Montvale, NJ: Medical Econo mics Co m pany , Inc., 19 9 8 . 6 5 8 McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook . Boca Raton, FL : CR C Press, LL C 19 9 7 . 279 Module Seven Drug and Supplement Interactions None known. Regulatory Status Populus balsamifera is listed as a Class 1 (herbs that can be safely consumed when used appropriately) in the American Herbal Products Association?s Botanical Safety Handbook . Regulated in the U.S. as an allowable flavoring agent in alcoholic beverages only 6 5 9 . 6 5 9 McGuffin, M., Eds. et all. American Herbal Products Association?s Botanical Safety Handbook . CR C Press. Boca Raton, FL , 19 9 7 . 280 Module Seven P r u n u s s e r o t i n a Image 43: by Sten Porse (2004) via Wikipedia.org Taxonomic Notes Botanical Name: Wild Cherry Family: Rosaceae C o m m o n N a m e s Black cherry, choke cherry, rum cherry bark, Virginian prune, and wild black cherry P r i m a r y U s e s Wild cherry is primarily used for colds, whooping cough, bronchitis and other lung problems, diarrhea, gout, digestive disorders, pain, and cancer. It is also used in cough syrups because of its sedative, expectorant, astringent, and antitussive effects. 281 Module Seven Overview Wild cherry is a common, early-successional tree. When crushed, the leaves release the cherry-like aroma of cyanide, and healthy leaves contain prunasin, which is converted to hydrogen cyanide when crushed. Hydrogen cyanide is toxic and defends the tree against herbivores 6 6 0 . Identifying Characteristics P a r t s U s e d Stem bark Dosage and Administration When taken orally, 5-12 drops of the liquid extract with wild cherry bark (12-14% by volume) in water, 2-3 times daily. Duration of Administration Not for long-term use. (See Regulatory Status) Active Constituents The primary active constituents in cherry are thought to be anthocyanins, including cyanidin-3-O-glucoside, cyanidins 3- glucosylrutinoside, cyanidin 3-rutinoside, and cyanidin 6 6 16 6 2 . Cherries 6 6 0 Accessed 6/1 9 /09: http:/ / w w w .duke.edu/~cwcook /trees/prse.html 6 6 1 Seeram NP , Bo urquin LD , Nair MG. Degradation products of cyanidin glycosides from tart cherries and their bioactivities. J Agric Foo d Chem . 2001 Oct;49(10):4924-9. Part Characteristics Flowers White flowers in spring Bark Smooth when young and with horizontally elongated lenticels Fruit Small cherries in early summer; small, black when ripe, and somewhat tasteless 282 Module Seven also contain a substantial amount of phenolic and antioxidant compounds 6 6 3 , nitrates and nitrites 6 6 4 , and cyanide 6 6 5 . Pharmacological Action Wild cherry bark has astringent, antitussive, and sedative effects 6 6 6 . It contains prunasin, a cyanogenic glycoside hydrolyzed to toxic hydrocyanic acid (HCN) and benzaldehyde 6 6 7 . Bark collected in the fall has a higher HCN yield (approximately 0.15%) than bark collected in the spring (approximately 0.05%); however, leaves collected in the spring have the highest HCN yield (approximately 0.25%) 6 6 8 . The constituents in cherry seem to possess anti-cancer properties. A 2005 in vitro study demonstrated that cyanidin-3-O-glucoside inhibits lipid peroxidation, inhibits cycloxygenase enzymes (COX-I and COX- 2), and inhibits the growth of breast, colon, stomach, central nervous 6 6 2 Reddy MK, Alexander-Lindo RL , Nair MG. Relative inhibition of lipid peroxidation, cycloox y genase enzy mes, an d human tum or cell proliferation by natural food colors. J Agric Foo d Chem . 2005 No v 16 ;53(23):9 2 6 8 - 73. 6 6 3 Karakaya S, El SN , Ta AA. Antioxidant activity of so me foods containing phenolic comp o u nds. Int J Foo d Sci Nutr . 2001 No v ; 5 2 ( 6 ) : 501-8 . 6 6 4 Gajewska R, Nabrzys ki M, Szajek L. [Occurrence of nitrates and nitrites in certain frozen fruits, jams, stewed fruit and fruit-vegetable juices for children and in certain types of bee honey] R ocz Panstw Zakl Hig . 19 8 9 ;40(4-6) : 2 6 6 - 73. 6 6 5 Pentore R, Venneri A, Nichelli P. Acci dental choke-cherry poiso ning : early sy m ptom s and neurological sequelae of an un u s ual case of cyanide intoxication. Ital J Neurol Sci . 19 9 6 Ju n ; 1 7 (3):233-5. 6 6 6 Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Econo mics Co m pany , Inc., 19 9 8 . 6 6 7 Leung AY , Fo ster S . Encyclopedia of Comm on Natural Ingredients Used in Foo d , Drugs and Cosmetics . 2nd ed. New York, N Y : Jo h n Wiley & So n s , 19 9 6 . 6 6 8 Leung AY , Fo ster S. Encyclopedia of Com m on Natural Ingredients Used in Foo d , Drugs and Cosmetics. 2nd ed. New York, N Y : Jo h n Wiley & So n s , 19 9 6 . 283 Module Seven system, and lung tumor cells 6 6 9 . In addition, results from a 2003 study show anthocyanins and cyanidin to reduce cell growth of human colon cancer cell lines HT 29 and HCT 116 6 7 0 ; mice consuming a cherry diet (anthocyanins or cyaniding) had significantly fewer and smaller cecal adenomas relative to mice consuming control diets. Medicinal Uses Cherries are native to Asia, but have a long history in France, Spain, Switzerland, and Japan. Some of the earliest known descriptions of cherries were reported by the Greek botanist Theophrastus around 300 BC. General Lucullus, a Roman general, often took trips searching for exotic foods and spices, and is credited with bringing cherry from Asia Minor to Italy. Historically, cherries have been used in fermentation and production of cherry spirits. Cherries are thought to possess anti-inflammatory, antioxidant, and anti- tumorigenic properties, and might help slow cardiovascular disease and the aging process. In specific, wild cherry has traditionally been used for relief of inflammatory symptoms associated with colds, fevers, and sore throats 6 7 1 . Wild cherry bark has been used with benign prostate hypertrophy in Africa 6 7 2 . 6 6 9 Reddy MK, Alexander-Lindo RL , Nair MG. Relative inhibition of lipid peroxidation, cycloox y genase enzy mes, an d human tum or cell proliferation by natural food colors. J Agric Foo d Chem . 2005 No v 16 ; 53(23):9 2 6 8 - 73. 6 7 0 Kang SY , Seeram NP , Nair MG, Bo ur quin LD . Tart cherry anthocyanins inhibit tumor development in Apc(Min) mi ce and reduce proliferation of hu man colon cancer cells. Cancer Lett. 2003 May 8;1 94(1) : 13-9. 6 7 1 Yamaguchi K, Liggett JL, Kim N C , Baek SJ. A nti-proliferative effect of horehou nd leaf and wild cherry bark ext racts on hu man colorectal cancer cells. Oncol Rep . 2006 Jan;1 5 ( 1 ) : 2 7 5 - 8 1 . 6 7 2 Stewart KM. The African cherry ( Prunus africana ) : can lesso n s be learned from an over-exploited medicinal tree? J Ethnopharmacol. 2003 Nov ; 8 9 ( 1 ) :3-13. 284 Module Seven Contraindications Wild cherry is contraindicated for long-term use and excessive amounts 6 7 36 7 4 . Also contraindicated for use while pregnant, because the constituent prunasin might be teratogenic 6 7 5 . There if insufficient information about safe use while lactating; avoid use. A d v e r s e E f f e c t s When ingested in large amounts, wild cherry can lead to fatal poisoning 6 7 6 . Drug and Supplement Interactions Preliminary evidence suggests wild cherry might inhibit the cytochrome P450 (CYP450) 3A4 enzyme 6 7 7 . Wild cherry might increase levels of drugs metabolized by CYP450 3A4; however, so far this interaction has not been reported in humans. Some drugs metabolized by CYP450 3A4 include: Lovastatin (Mevacor), ketoconazole (Nizoral), itraconazole (Sporanox), fexofenadine (Allegra), and triazolam (Halcion). Use with caution, or avoid use altogether, with patients taking these drugs. 6 7 3 McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. B oca Raton, FL : CR C Press, LL C 19 9 7 . 6 7 4 Brinker F. Herb Contraindications and Drug Interactions . 2nd ed. Sandy, O R : Eclectic Medical Publications , 19 9 8 . 6 7 5 Brinker F. Herb Contraindications and Drug Interactions . 2nd ed. Sandy, OR : Eclectic Medical Publications , 19 9 8 . 6 7 6 Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Econo mics Co m pany , Inc., 19 9 8 . 6 7 7 Budzins ki JW , Fo ster BC, Vandenhoek S, et al. An in vitro evaluation of hu man cytochrome P450 3A4 inhibition by selected commercial herbal extracts and tinctures. Phytomedicine 2000;7:2 73-82 . 285 Module Seven Regulatory Status Listed as a Class 2d (Not for long-term use; do not exceed recommended dose) in the American Herbal Product Association?s Botanical Safety Handbook . 286 Module Seven P u e r a r i a m o n t a n a var. l o b a t a Image 44: by Forest and Kim St arr (2002) via Wikipedia.org Taxonomic Notes Common botanical name: Kudzu Family: Leguminosae or Fabaceae C o m m o n N a m e s Daidzein, fen ke, kenge, gange, Ge Gen, gegen, Japanese arrowroot, kudsu, kudzu vine, kwaao khruea, mealy kudzu, pueraria, pueraria root, Radix Peurariae, and yege P r i m a r y U s e s Traditionally, kudzu has been used in China to treat alcoholism, diabetes, gastroenteritis, and deafness. Studies show that kudzu, which contains a variety of isoflavones, seems to decrease alcohol cravings 287 Module Seven and might be useful with chronic alcoholism 6 7 8 . Kudzu is also helpful with alcohol-induced hangover, including: Headache, upset stomach, dizziness, vomiting, and drunkenness. Additionally, kudzu is taken orally for menopause, myalgia, measles, dysentery, gastritis, fever, diarrhea, thirst, allergic rhinitis, cold, flu (influenza), swine flu, neck stiffness, polio myelitis, encephalitis, hypertension, angina pectoris, arrhythmia, migraine, deafness, diabetes, traumatic injuries, sinusitis, urticaria, pruritus, psoriasis, and as a diaphoretic. Intravenously, the kudzu constituent puerarin is used for ischemic stroke, which occurs when an artery to the brain becomes blocked 6 7 9 . Overview Kudzu, Pueraria montana var. lobata , originated in China and was introduced into the United States at the Philadelphia Centennial Exposition in 1876. By the early 1900s, kudzu was widely sold as an inexpensive livestock forage. An aggressive, fast-growing vine, kudzu The Soil Erosion Service (later renamed the Soil Conservation Service) starting distributing kudzu about 1933 to help control agricultural erosion. However, in 1953, the USDA removed kudzu as a cover plant, and in 1970 it was listed as a common weed of the South. Today, kudzu is estimated to cover about 7 million acres in the southeast 6 8 0 . 6 7 8 Lukas SE , Penetar D, Berko J, Vicens L, Palmer C, Mallya G, Macklin EA , Lee DY. An extract of the Chinese herbal r oot kudzu reduces alcohol drinking by heavy drinkers in a naturalistic setting. Alcohol Clin Exp Res. 2005 May;29 ( 5 ) : 7 5 6 - 6 2 . 6 7 9 Accessed 6/10/09: http:/ / w w w . strokecenter.org/patients/ais.htm 6 8 0 Accessed 6/10/09: http:/ / w w w . se-eppc.org/manual/k udzu.html 288 Module Seven Identifying Characteristics Part Characteristics Leaves Alternate and compound (trifoliate) with leaflets up 4 in. across; each leaflet is 2-3 lobed with hairy margins; foliage drops after the first fall frost Flowers Purple, fragrant, about ½ -in. long, produced in long racemes, and shaped like pea flowers; blooms July- October; does not typically flower until their third year Root Tuberous, about 7-in. wide, and grow 3-9-ft. deep; capable of storing large amounts of carbohydrates Fruit Three hard seeds are contained in flat, 2-in. long, hairy pods; matures September-October P a r t s U s e d Root, flower, and leaf C o l l e c t i o n a n d C u l t i v a t i o n Kudzu grows best in areas with mild winters, warm summers, and abundant rainfall. It can grow in a diverse variety of soils (including acid soils, lime soils, lowlands with high water tables, and over heavy subsoil), and prefers winter soil temperatures to remain above -25ºF. Large roots allow the plant to survive in dry climates and drought conditions. However, ideal conditions are moist to well drained and with acid to neutral soil type. Kudzu is an aggressive vine that can grow 60 ft. per year, ultimately forming a blanket of foliage and choking out native vegetation. New growth can exceed more than 1-ft. per day. The vines grow towards the light, including up trees, and navigate through any available opening. Abandoned fields and roadsides, as well as forest edges are preferred habitats 6 8 1 . 6 8 1 Accessed 6/10/09: http:/ / w w w . se-eppc.org/manual/k udzu.html 289 Module Seven Dosage and Administration When taken orally for use with alcoholism, a standard dose would be 1.2 g kudzu root extract, twice daily, for one month 6 8 2 . For use with cardiovascular disease, 400 mg of puerarin, the most concentrated isoflavone in kudzu, for 10 days has been shown to improve the heart function in patients with chronic cardiac failure 6 8 3 . For use with menopausal symptoms, 50 mg of Pueraria montana and 100 mg of Pueraria mirifica daily, taken for six months, has been shown to alleviate symptoms 6 8 4 . Kudzu powder, containing 100 mg of isoflavones, can also be used with menopause. Dissolve in water once daily for three months 6 8 5 . Duration of Administration None known. 6 8 2 Shebek J, Rindone JP. A pilot study exploring the effect of kudzu root on the drinking habits of patients with chronic alcoholism . J Altern Complement Med. 2000 Feb;6( 1 ) :45-8 . 6 8 3 Duan S, Li YF , Lu o XL . [E f fect of puerarin on heart function and serum oxidized-LD L in the patients with chronic cardiac failure] Hunan Yi Ke Da Xue Xue Bao. 2000 Apr 28; 2 5 ( 2 ) : 1 7 6 - 8 . 6 8 4 Lamlertkittikul S, Chandeying V. Ef ficacy and safety of Pueraria mirifica (Kwao Kruea Khao) for the treatm ent of vaso m otor sym ptom s in perimenopausal women: Phase II Study. J Med Assoc Thai . 2004 Jan;8 7 ( 1 ) :33-40. 6 8 5 Woo J, Lau E, Ho SC, Cheng F, Chan C, Chan AS , Haines CJ , Chan TY , Li M, Sham A. C o m parison of Pueraria lobata with hormo ne replacement therapy in treating the adverse health consequences of menopause. Menopause . 2003 Jul-A u g ; 10(4):352- 6 1 . 290 Module Seven Active Constituents The primary active constituents of kudzu include: Daidzin, daidzein, puerarin, genistin, genistein, tectorigenin, glycitin, tectoridin, 6"-O- xylosyltectoridin, 6"-O-xyloglycitin, biochanin A, and spinasterol 6 8 66 8 76 8 8 . Pharmacological Action Animal models of stroke suggest that an ethanolic extract of kudzu root increases the levels of norepinephrine and dopamine in the brain, potentially improving post-stroke depression 6 8 9 . Isoflavone constituents in kudzu have both estrogenic and antiestrogenic activity, which are similar to selective estrogen receptor modulators. In a 2005 study, the estrogenic components of kudzu were analyzed. Results showed the high content of isoflavones, puerarin in particular, and high estrogenic activity might make kudzu root extract effective for hormone imbalance and menopausal concerns 6 9 0 . 6 8 6 Zhang S, Ji G, Liu J. Reversal of chemic al-induced liver fibrosis in Wistar rats by puerarin. J Nutr Biochem . 2006 Jul;1 7 ( 7 ) :485- 9 1 . Ep ub 2005 Oct 10. 6 8 7 Benlhabib E, Baker JI, Keyler DE, Sing h AK . Kudzu root extract sup presses voluntary alcohol intake and alcohol with drawal sym ptom s in P rats receiving free access to water and alcohol. J Med Foo d . 2004 Sum mer;7( 2 ) : 1 6 8 - 7 9 . 6 8 8 Jeon G C , Park MS, Yo o n D Y , Shin CH, Sin HS, Um SJ. A ntitum or activity of spinasterol isolated from Pueraria roots. E xp Mol Med . 2005 Apr 30;37(2 ) : 1 1 1 - 20. 6 8 9 Yan B, Wang DY , Xing DM, et al. The antidepressant effect of ethanol extract of radix puerariae in mice expo sed to cerebral ischemia reperfusion . Pharmacol Biochem Behav 2004;78:319- 2 5 . 6 9 0 Zhang Y, Chen J, Zhang C, W u W , Liang X. Analysis of the estrogenic comp o nents in kudzu root by bioassay and high performance liquid chromatography . J Steroid Biochem Mol Biol. 2005 Mar;94(4):375- 8 1 . Ep ub 2005 Jan 26 . 291 Module Seven Medicinal Uses In animal studies, kudzu extracts and isoflavones like daidzin have been shown to suppress alcohol cravings 6 9 16 9 2 . In preclinical research, kudzu encouraged later and lower peak blood alcohol levels, as well as a flattened dose response curve 6 9 3 . Blood alcohol levels may be decreased because of delayed gastric emptying, which provides alcohol with more time for first-pass metabolism in the stomach 6 9 46 9 5 . In additional research, however, kudzu is thought to have antioxidant effects and to accelerate the metabolism of toxic alcohol metabolites 6 9 6 . Contraindications Kudzu isoflavones seem to have antiplatelet activity. Simultaneous use of kudzu with other agents that affect platelet aggregation could increase the risk of bleeding 6 9 76 9 8 . 6 9 1 Lin RC , Li TK . Ef fects of iso flavo nes on alcohol pharmacokinetics and alcohol-drinking behavior in rats. Am J Clin Nutr 199 8 ; 6 8 : 1 5 1 2 S - 5 S . 6 9 2 Xie CI, Lin RC , A nton y V, et al. Daidzin, an antioxidant iso flavon oid, decreases blood alcohol levels and shortens sleep time induced by ethanol intoxication. Alcohol Clin Exp Res 1994;18 : 1443-7. 6 9 3 Carai MA, Agabio R, Bo mbardelli E, et al. Potential use of medicinal plants in the treatment of alcoholism . Fitoterapia 2000;71:S38-42 6 9 4 Lin RC , Li TK . E f fects of iso flavones on alcohol pharmacokinetics and alcohol-drinking behavior in rats . Am J Clin Nutr 199 8 ; 6 8 : 1 5 1 2 S - 5 S . 6 9 5 Xie CI, Lin RC , A nton y V, et al. Daidzin, an antioxidant iso flavon oid, decreases blood alcohol levels and shortens sleep time induced by ethanol intoxication. Alcohol Clin Exp Res 1994;18 : 1443-7. 6 9 6 Lee JS. Su p plementation of Pueraria radix water extract on changes of antioxidant enzy mes and lipid pr ofile in ethanol-treated rats. Clin Chim Acta 2004;347:1 2 1 - 8 . 6 9 7 Shi W G , Q u L, Wang JW . [Study on interventing effect of puerarin on ins ulin resistance in patients with coronary heart disease] Zhongguo Zhong Xi Yi Jie He Za Zhi . 2002 Jan;2 2 ( 1 ) : 2 1 -4. 292 Module Seven Additionally, use cautiously with patients taking antidiabetic drugs, because kudzu might lower blood glucose levels and may have additive effects when used with antidiabetic agents 6 9 9 . A d v e r s e E f f e c t s There are no clinical studies reporting side effects from oral use. However, there has been a report of allergic reaction resulting from use of an herbal product containing kudzu 7 0 0 . Drug and Supplement Interactions Simultaneous use of kudzu with herbs that affect platelet aggregation could potentially increase the risk of bleeding in some people 7 0 1 . These herbs include: Angelica, clove, danshen, fenugreek, feverfew, garlic, ginger, ginkgo, Panax ginseng, poplar, red clover, and turmeric. Kudzu might also have additive or antagonistic effects with other estrogenic herbs, including 7 0 2 : Alfalfa, black cohosh, chasteberry, flaxseed, hops, ipriflavone, licorice, red clover, and soy. In addition, kudzu may lower blood glucose levels 7 0 37 0 4 and have additive effects when simultaneously used with other herbs and 6 9 8 Chen J, Xu J, Li J. [E f fect of puerarin on fibrinolytic activity and lipid peroxide in patients with coronary heart disease] Zhongguo Zhong Xi Yi Jie He Za Zhi. 1 9 9 9 N o v ; 1 9 ( 1 1 ) : 649-50. 6 9 9 Shen ZF , Xie MZ. [Hypo glycemic effect of the combined use of puerarin and aspirin in mice] Yao Xue Xue Bao. 198 5 N o v ; 20(11 ) : 8 63-5. 7 0 0 Akita H, Sowa J, Makiura M, Akamatsu H, Matsunaga K. Maculopapular drug eruption due to the Japanese herbal me dicine Kakko nto (k udzu or arrowroot decoction) . Co ntact Dermat itis. 2003 Jun ;48(6 ) :348-9 . 7 0 1 Luo ZR , Zheng B. [E f fect of Puerarin on platelet activating factors CD 63 and CD6 2 P , plasmino gen activator inhibitor and C-reactive protein in patients with un stable angia pectoris]. [Article in Chinese]. Zhongguo Zhong Xi Yi Jie He Za Zhi 2001;2 1 :31-3. 7 0 2 Woo J, Lau E, Ho SC, et al. Co m parison of Pueraria lobata with hormo ne replacement therapy in treating the adverse health consequences of menopause. Menopause 2003;10:352- 6 1 . 293 Module Seven supplements known to lower glucose levels. Simultaneous use might increase risk of hypoglycemia in some patients. Herbs and supplements with hypoglycemic effects include: Alpha-lipoic acid, bitter melon, cassia cinnamon, chromium, devil?s claw, fenugreek, garlic, guar gum, horse chestnut, Panax ginseng, psyllium, and Siberian ginseng. Regulatory Status Kudzu has been rated Class 1 (safely consumed when used appropriately) by the American Herbal Product Association?s Botanical Safety Handbook . 7 0 3 Lee KT, So h n IC, Kim DH, et al. Hypo glycemic and hyp olipidemic effects of tectorigenin and kaikasaponin III in the st reptozotocin-lnduced diabetic rat and their antioxidant activity in vitro. Arch Pharm Res 2000;23:461- 6 . 7 0 4 Hsu FL , Liu IM, Kuo DH, et al. Antihy perglycemic effect of puerarin in streptozotocin-induced diabetic rats. J Nat Prod 2003;66 :7 8 8 - 9 2 . 294 Module Seven R h o d i o l a r o s e a Image 45: by Christian Humme rt (2008) via Wikipedia.org Taxonomic Notes Common botanical name: Golden Root Family: Crassulaceae C o m m o n N a m e s Arctic root, golden root, hong jing tian, rhodiola, and rose root P r i m a r y U s e s Rhodiola rosea is an adaptogen, which helps the body adapt and respond to environmental, physical, and chemical stressors 7 0 5 . It is also used to help increase energy and strength, and to improve stamina and mental capacity. 7 0 5 Accessed 6/10/09: http:/ / health.le arninginf o . org/rhodiola-rosea.htm 295 Module Seven In addition, golden root can be used to improve athletic performance, sexual function, depression, anxiety, cardiac disorders (like arrhythmias), and hyperlipidemia, and has been used with cancer, tuberculosis, diabetes, cold and flu prevention, swine flu, aging, liver damage, poor hearing, weakened nervous system, weakened immunity, and improved recovery time after prolonged workout. Overview Rhodiola rosea grows at high altitudes in the arctic regions of Europe and Asia, and has been used as a traditional medicine in Russia and Scandinavia for centuries. Today, golden root is used in Russia as a tonic remedy for fatigue, short attention span, and poor memory. In Sweden and other Scandinavian countries, golden root is thought to increase capacity for mental work, and is also used as a general adaptogen 7 0 6 . The leaves and shoots can be eaten raw in salads or cooked like spinach 7 0 7 , though somewhat bitter, and the root can also be eaten raw or cooked 7 0 8 . 7 0 6 Accessed 6/10/09: http:/ / w w w .drweil.com/drw/u / Q A A400399/R h odiola-for- W hat-Ails-Y o u . html 7 0 7 Larkcom. J. Salads all the Year Rou nd. Hamlyn , 19 80. 7 0 8 Facciola. S. Cornucopia - A Source Book of Edible Plants . Kampo n g Publications . 296 Module Seven Identifying Characteristics Part Characteristics Leaves Oblong, elliptic-oblanceolate, or obovate Flowers Yellow Stem Grows 3-14 in. Taste Odor Slightly bitter Fragrant; the dried root has a rose scent P a r t s U s e d Rhizome and root (the leaves and shoots are edible) C o l l e c t i o n a n d C u l t i v a t i o n Golden root prefers a fertile, well-drained, open loam in direct sun 7 0 9 . Golden root will often self-sow and established plants are drought resistant 7 1 0 . It is hardy to zone 1, in flower May to August, and ripe (seeds) from July to August. The flowers are dioecious, either male or female; therefore, most male and female plants must be grown to seed 7 1 1 . If propagating from seed, surface sow in a sunny spot located in a greenhouse and during spring. Seeds typically will germinate in 2-4 weeks. Plant seedlings into individual pots and leave in the greenhouse for the first winter. Plant out in the early summer. Division should take place in August through October 7 1 2 . 7 0 9 Huxley. A. The New RHS Dictionary of Gardening . MacMillan Pres, 19 9 2 . 7 1 0 Chatto. B. The Dry Garden . Dent, 19 8 2 . 7 1 1 Plants for a Future accessed 6/1 1 /09: http:/ / w w w . p faf.org/database/plants.p h p ? R h odiola+rosea 7 1 2 Huxley. A. The New RHS Dictionary of Gardening . MacMillan Press, 19 9 2 . 297 Module Seven Dosage and Administration When taken orally to improve athletic performance, 200 mg of golden root extract (Finzelberg, GmbH, Germany) taken once daily, or 100 mg taken twice daily 7 1 3 . When used to improve fatigue, 50 mg of golden root extract (SHR-5) taken twice daily, or 370-555 mg once daily 7 1 47 1 57 1 6 . When used for general anxiety, 170 mg of golden root extract taken twice daily 7 1 7 . Duration of Administration None known. Active Constituents The active constituents in golden root include: Flavonoids (catechins and proanthocyanidins), organic acids (gallic acid, caffeic acid, and 7 1 3 De Bock K, Eijnde BO , Ramaekers M, Hespel P. Acute Rhodiola rosea intake can improve endurance exercise performance. Int J Sport Nutr Exerc Metab 2004;14:29 8 -307. 7 1 4 Spasov AA , Wikman GK , Mandrikov VB , et al. A double-blind, placebo- controlled pilot study of the stimulating and adaptogenic effect of Rhodiola rosea SHR-5 extract on the fatigue of students ca used by stress during an examination period with a repeated low-dose regimen. Phytomedicine 2000;7:8 5 - 8 9 . 7 1 5 Darbinyan V, Kteyan A, Pano s sian A, et al. Rh odiola rosea in stress induced fatigue - a double blind cross - o ver study of a standardized extract SHR-5 with a repeated low-dose regimen on the ment al performance of healthy ph y sicians during night duty. Phytomedicine 2000;7:365- 7 1 . 7 1 6 Shevtsov VA , Zh olus BI, Shervarly VI, et al. A randomized trial of two different doses of a SHR-5 Rh odiola ro sea extract versus placebo and control of capacity for mental work. Phytomedicine 2003;10:95 - 105. 7 1 7 Bystritsky A, Kerwin L, Feusner JD. A pilot study of Rhodiola rosea (Rh odax) for generalized anxiety disorder (GA D ) . J Altern Complement Med 2008;14:17 5 - 80. 298 Module Seven chlorogenic acid), phenolic glycosides (rhodioloside, rosin, rosavin, rosarin, rhodiolin, and rosiviridin), tannis, and p-Tyrosol 7 1 8 . The root is known to contain more than 30 compounds, including: Phenlyethanoids, phenylpropanoids, flavonoids, cyanoglycosides, monoterpenes, and triterpenes 7 1 9 . The phenylpropanoid glycoside salidroside is attributed with many of the adaptogenic, or stimulant, effects of golden root 7 2 07 2 1 . Additional constituents thought to contribute to golden root?s adaptogenic effects include: Rhodioniside, rhodioloside A-E, rhodiolin, rosin, rosavin, rosarin, rosiridin, rosiridol, rhodalgin, acetylrhodalgin, and lotaustralin 7 2 27 2 37 2 4 . The constituent rosavin is particular to Rhodiola rosea , which distinguishes it from other species in the Rhodiola family 7 2 5 . The dried rhizomes of Rhodiola rosea contain 0.05% essential oil, including: Monoterpene hydrocarbons (25.40%), monoterpene 7 1 8 Memorial Sloan-Kettering Cancer Center accessed 6/1 1 /09: http:/ / w w w . m s kcc.org/m s kcc/html/6 9356.cfm 7 1 9 Ma G, Li W , Do u D, et al. Rh odiolosides A-E , mo n oterpene glycosides from Rh odiola rosea. Chem Pharm Bull 2006;54:12 2 9 -33. 7 2 0 Darbinyan V, Kteyan A, Panos sian A, et al. Rhodiola rosea in stress induced fatigue - a double blind cross - o ver study of a standardized extract SHR-5 with a repeated low-dose regimen on the ment al performance of healthy ph y sicians during night duty. Phytomedicine 2000;7:365- 7 1 . 7 2 1 Kelly GS . Rh odiola rosea: a pos sible plant adaptogen. Altern Med Rev 2001;6 : 2 93-302. 7 2 2 Kelly GS . Rh odiola rosea: a pos sible plant adaptogen. Altern Med Rev 2001;6 : 2 93-302. 7 2 3 Akg ul Y, Ferreira D, Abourashed EA, K han IA. Lotaustralin from Rhodiola rosea roots. Fitoterapia 200 4 ; 7 5 : 6 1 2 -4. 7 2 4 Bystritsky A, Kerwin L, Feusner JD. A pilot study of Rhodiola rosea (Rh odax) for generalized anxiety disorder (GA D ) . J Altern Complement Med 2008;14:17 5 - 80. 7 2 5 Kelly GS . Rhodiola rosea: a pos sible plant adaptogen. Altern Med Rev 2001;6 : 2 93-302. 299 Module Seven alcohols (23.61%), and straight chain aliphatic alcohols (37.54%), such as n-decanol (30.38%), geraniol (12.49%), and 1,4-p-menthadien-7-ol (5.10%) 7 2 6 . Pharmacological Action The effects of golden root as an adaptogen were examined in a 2009 study on mice. Results concluded that Rhodiola rosea , in addition to other adaptogens tested, induces an increase of serum Hsp72, which is considered a defense response to stress. Increased tolerance of stress resulting from the adaptogen was attributed to its stimulation of expression of Hsp70 and particularly with Hsp72 production, a known mediator of stress response involved in reparation of proteins during physical exertion. Medicinal Uses Golden root is also thought to have antioxidant properties. In a 2009 study, the effect of Rhodiola rosea supplementation on the balance of oxidants and antioxidants in the serum and erythrocytes of competitive rowers was examined. The double-blind study included 22 members of the Polish Rowing Team. Eleven participants received 100 mg of R. rosea extract twice daily for four weeks, and 11 participants received placebo. All participants performed a 2,000 m maximum test on a rowing ergometer at the beginning and end of the study, and blood samples were taken from the antecubital vein before each exercise test, one minute after the test, and again after a 24-hour rest period. Results showed that R. rosea supplementation increased the antioxidant levels in the plasma of the professional rowers, but there was no effect on oxidative damage induced by exhaustive exercise. Contraindications Contraindicated for use if there is a known allergy or hypersensitivity to Rhodiola rosea , its constituents, or other members of the Crassulaceae family. 7 2 6 Rohlo f f J. Volatiles from rhizo mes of Rhodiola rosea L. Phytochemistry . 2002 Mar;59( 6 ) : 6 5 5 - 6 1 . 3 0 0 Module Seven Reports of side effects resulting from use of Rhodiola rosea are lacking in human studies 7 2 7 . Repeated prophylactic administration of Rhodiola rosea and other adaptogens in a 2000 animal study produced antiarrhythmic effect. Use cautiously with individuals using anti-arrhythmic agents 7 2 8 . Due to lack of sufficient research, avoid use with pregnancy and breast-feeding. A d v e r s e E f f e c t s Unsubstantiated reports suggest Rhodiola rosea might increase restlessness, irritability, and insomnia. Use cautiously with individuals who have neurological and/or psychiatric disorders. Drug and Supplement Interactions Based on human study, Rhodiola rosea may have additive effects with antibiotics 7 2 9 and with chemotherapeutic agents 7 3 0 . In addition, Rhodiola rosea may have additive effects with adaptogenic herbs and supplements 7 3 17 3 2 . Other agents considered ?adaptogenic? 7 2 7 Darbinyan V, Kteyan A, Panos sian A, Gabrielian E, Wikman G, Wagner H. Rhodiola rosea in stress induced fatigu e--a double blind cross - o ver study of a standardized extract SHR-5 with a repea ted low-dose regimen on the mental performance of healthy ph y sicians during night duty. Phytomedicine . 2000 Oct;7( 5 ) :365- 7 1 . 7 2 8 Mameskulova LA, Maslov LN . [A nti-a rrhythmic effect of ph ytoadaptogens] Eksp Klin Farmakol . 2000 Jul-A u g ; 63(4):2 9 -31. 7 2 9 Narimanian M, Badalyan M, Pano s yan V, Gabrielyan E, Panos sian A, Wikman G, Wagner H. Impact of Chisan (A D A P T - 232) on the quality-o f -life and its efficacy as an adjuvant in the trea tment of acute non - s pecific pneumo nia. Phytomedicine. 2005 No v ; 1 2 ( 10):7 23-9. Urol Nefrol (Mosk) . 19 9 5 Mar-Apr;(2 ) :46- 7 . 7 3 0 Bocharova OA , Matveev BP, Barysh niko v AIu, Figurin KM, Serebriakova RV, Bodrova NB . [T he effect of a Rhodiola rosea extract on the incidence of recurrences of a superficial bladder ca ncer (experimental clinical research)] Phytother Res. 2007 Jan;2 1 ( 1 ) :37-43. 3 0 1 Module Seven include: Panax ginseng, Panax quinquefolius, Eleutherococcus senticosus, Rhaponticum carthamoides, Leuzea carthamoides , schisandra, astragalus, ashwagandha Withania somnifera , reishi mushroom, gotu kola, holy basil, dong quai Angelica sinensis , echinacea, and royal jelly. Regulatory Status Rhodiola is not on the General Sale List, and there are no licensed products containing rhodiola available in the UK 7 3 3 . 7 3 1 Perfumi M, Mattioli L. Adaptogenic an d central nervou s sy stem effects of single doses of 3% rosa vin and 1% salidroside Rhodiola rosea L. extract in mice. 7 3 2 Kormos h N , Laktiono v K, Antos hechkina M. Effect of a combination of extract from several plants on cell-med iated and hum oral immu nity of patients with advanced ovarian cancer. Phytother Res . 2006 May;20(5) :424-5. 7 3 3 Barnes, J., A nderson , L., and Phillipso n , J.D . Herbal Medicines , T hird Edition. Pharmaceutical Press. Lo ndon, 2007. 3 02 Module Seven R o s m a r i n u s o f f i c i n a l i s Image 46: by geishaboy500 (2006) via Flickr.com Taxonomic Notes Common botanical name: Rosemary Family: Lamiaceae C o m m o n N a m e s Compass plants, compass weed, old man, polar plant, rusmari, and rusmary Do not confuse with rosinweed. 3 0 3 Module Seven P r i m a r y U s e s Rosemary is frequently used as a tonic or ?pick-me-up? for depression, mental exhaustion, and nerves 7 3 4 . When taken orally, it is also used for dyspepsia, flatulence, inducing abortion, increasing menstrual flow, gout, cough, headache, liver and gallbladder problems, loss of appetite, and for cardiovascular problems, including high blood pressure. Topically, rosemary is used for preventing baldness, alopecia areata, circulatory disturbances, toothache, eczema, joint or musculoskeletal pain such as myalgia, sciatica and intercostal neuralgia, balneotherapy, wound healing, and as an insect repellent. In foods, dried and fresh rosemary are used as a spice; the oil is used in beverages. Rosemary has antiseptic, antispasmodic, astringent, cardiac, carminative, cholagogue, diaphoretic, emmenagogue, nervine, ophthalmic, stimulant, stomachic, and tonic properties 7 3 5 . It is rich in volatile oils, flavanoids, and phenolic acids, shown to have antiseptic and anti-inflammatory actions 7 3 6 . In addition, rosmarinic acid might be effective with toxic shock syndrome, and rosmarol, an extract from rosemary leaves, is said to have significant antioxidant activity 7 3 7 . 7 3 4 Bo w n , D . Encyclopaedia of Herbs and their Uses . D orling Kindersley, Lo ndon, 19 9 5 . 7 3 5 Plants for a Future accessed 6/1 2 /09: http:/ / w w w . p faf.org/database/plants.p h p ? R o s marinus + o f ficinalis 7 3 6 Bo w n , D . Encyclopaedia of Herbs and their Uses . D orling Kindersley, Lo ndon, 19 9 5 . 7 3 7 Duke, J. A. and Ayensu , E. S. Medicinal Plants of China Reference Publications , Inc., 19 8 5 . 3 0 4 Module Seven Overview Rosemary is an evergreen, which, traditionally, has been used for flatulent dyspepsia and headache. Topically is has been used for myalgia, sciatica, and intercostal neuralgia 7 3 8 . Young shoots, leaves, and flowers can be eaten fresh or dried 7 3 9 . The leaves have a strong, somewhat bitter flavor, but the flowers are milder and can be used as flavoring in soups and stews. Rosemary leaves can be tough and can be finely chopped before use. Springs can also be used whole while cooking and then removed. Tea also can be made from the fresh or dried leaves 740 . Identifying Characteristics Part Characteristics Leaves About 1-in. long, linear, revolute, dark-green above and paler and glandular beneath Flowers Pale-bluish to light bluish-violet Stems Very wooden Taste Spicy, harsh, bitter, and somewhat pungent Odor Harsh, aromatic, and somewhat camphor-like P a r t s U s e d Leaf and twig C o l l e c t i o n a n d C u l t i v a t i o n Rosemary prefers light, dry soil, and a sheltered location. It can be propagated by seeds, cuttings and layers, and root division. Cuttings 7 3 8 Barnes, J., A nderson , L., and Phillipso n , J.D . Herbal Medicines , T hird Edition. Pharmaceutical Press. Lo ndon, 2007. 7 3 9 Lust. J. The Herb Book . Bantam book s , 19 83. 7 4 0 Facciola. S. Cornucopia - A Source Book of Edible Plants . Kampo n g Publications , 19 90. 3 0 5 Module Seven should be taken in August at about 6-in. long and planted into a shady border about two-thirds deep. Transplant the following autumn 7 4 1 . Dosage and Administration When taken orally, 2-4 g infusion of dried leaf/twig, three times daily. As a liquid extract, 2-4 mL (1:1 in 45% alcohol), three times daily 7 4 2 . As a tea, 1 cup, three times daily. To make the tea, steep 1-2 g of rosemary leaf in 150 mL of boiling water for 5-10 minutes, and then strain 7 4 37 4 4 . When used topically, add 50 g of rosemary leaf to 1 L hot water 7 4 5 . For specific use with alopecia areata, rosemary essential oil is used. Combine 3 drops rosemary, 2 drops cedarwood, 2 drops thyme, and 3 drops lavender into 3 mL jojoba oil and 20 mL grapeseed oil; every night, massage the mixture into the scalp for two minutes, and wrap a warm towel around the head to increase absorption 7 4 6 . Duration of Administration None known. 7 4 1 Grieve, M. A Modern Herbal . Botanical.com accessed 6/1 2 /09: http:/ / w w w .botanical.com /botanical/m g m h /r/rosema17 .html 7 4 2 Newall CA , A nderson LA , Philpso n JD . Herbal Medicine: A Guide for Healthcare Professionals . Lo ndon, UK : The Pharmaceutical Press, 19 9 6 . 7 4 3 Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines . Trans. S. Klein. Bo ston , MA: American Botanical Cou ncil, 19 9 8 . 7 4 4 Newall CA , A nderson LA , Philpso n JD . Herbal Medicine: A Guide for Healthcare Professionals . Lo ndon, UK : The Pharmaceutical Press, 19 9 6 . 7 4 5 Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1 st ed. Montvale, NJ: Medical Econo mics Co m pany , Inc., 19 9 8 . 7 4 6 Hay IC, Jamieson M, Ormerod AD . Randomized trial of aromatherapy. Successful treatment for alopecia areata. Arch Dermatol 199 8 ; 134:1349-5 2 . 3 0 6 Module Seven Active Constituents The active constituents in rosemary include caffeic and rosmarinic acid, both attributed with antioxidant activity 7 4 7 , and essential oil, which contains alpha-pinene, borneol, (-) camphene, camphor, verbenone, and bornyl-acetate 7 4 8 . In addition, rosemary contains phenolic diterpenes (carnosic acid, carnosol, and 12-O-methylcarnosic acid), caffeoyl derivatives (rosmarinic acid), and flavones (isoscutellarein 7-O-glucoside and genkwanin) 7 4 9 . Pharmacological Action In an in vitro study, the antimicrobial activity of essential-oil rich fractions of Rosmarinus officinalis was investigated. The main components of these fractions were alpha-pinene, 1,8-cineole, camphor, verbenone, and borneol (constituting ca. 80% of the total oil). Six microbial species, including Gram-positive bacteria ( Staphylococcus aureus and Bacillus subtilis ), Gram-negative bacteria ( Escherichia coli and Pseudomonas aeruginosa ), a yeast ( Candida albicans ), and a fungus ( Aspergillus niger) were included in testing. Results showed that S. aureus was most sensitive to the rosemary extracts and A. niger was least sensitive 7 5 0 . 7 4 7 al-Sereiti MR, Abu-A mer KM, Sen P. Pharmacology of rosemary ( R osmarinus officinalis Linn . ) and its therapeutic potentials. Indian J Exp Biol. 199 9 Feb;37(2 ) : 1 24-30. 7 4 8 Angio ni A, Barra A, Cereti E, Barile D, Co ï s s o n JD , Arlorio M, Dessi S, Coroneo V, Cabras P. chemical comp o sition , plant genetic differences, antimicrobial and antifun gal activity investigation of the essential oil of R osmarinus officinalis L. J Agric Foo d Chem . 2004 Jun 2; 5 2 ( 1 1 ) :3530-5. 7 4 9 del Baño MJ, Lorente J, Castillo J, Benavente-García O, del Río JA , Ortuño A, Q uirin KW , Gerard D. Phenolic diterpenes, flavones, and rosmarinic acid distribution during the development of leaves, flowers, stems, and roots of R osmarinus officinalis. Antioxidant activity. J Agric Foo d Chem . 2003 Jul 16 ; 5 1 ( 1 5 ) :4247-53. 7 5 0 Santoyo S, Cavero S, Jaime L, Ibañez E, Señoráns FJ , Reglero G. Chemical com p o sition and antimicrobial activity of R osmarinus officinalis L. essential oil obtained via supercritical fluid extraction. J Fo o d Prot. 2005 Apr;68 (4):7 90-5. 3 0 7 Module Seven In addition, studies show that rosemary and rosemary extracts have antioxidant properties. Specific constituents are known to have high antioxidant properties, including carnosol 7 5 1 , carnosic acid 7 5 2 , rosmanol 7 5 3 , epirosmanol 7 5 4 , and hesperidin 7 5 5 . Further studies seem to support the use of rosemary for antidiabetic effects. In a 2006 in vitro study, three different clonal lines of rosemary showed significant alpha-glucosidase inhibitory activity 7 5 6 , and in a 1994 study, the volatile oil of R. officinalis showed hyperglycemic and insulin release inhibitory effects in the rabbits 7 5 7 . Medicinal Uses In a 2009 study with mice, Rosmarinus officinalis L. was investigated for its use with depression. Hydroalcoholic extract of the stems and leaves was tested with two behavioral models, the forced swimming test and tail suspension test in mice. The extract of R. officinalis 7 5 1 Zeng HH, Tu PF , Z h o u K , Wang H, Wang BH, Lu JF . A ntioxidant properties of phenolic diterpenes from R osmarinus officinalis. Acta Pharmacol Sin. 2001 Dec;22 ( 1 2 ) : 1094-8. 7 5 2 Aruoma OI. Antioxidant actions of plant foods: use of oxidative DNA damage as a tool for studying antioxidant efficacy. Free Radic Res . 19 9 9 Ju n ;30(6) :419- 2 7 . 7 5 3 Zeng HH, Tu PF , Z h o u K , Wang H, Wang BH, Lu JF . A ntioxidant properties of phenolic diterpenes from R osmarinus officinalis. Acta Pharmacol Sin . 2001 Dec;22 ( 1 2 ) : 1094-8. 7 5 4 Haraguchi H, Saito T, O kamura N, Yagi A. Inhibition of lipid peroxidation and superoxide generation by diterpenoids from Rosmarinus officinalis. Planta Med . 19 9 5 Au g ; 6 1 (4):333-6. 7 5 5 Okamura N, Haraguchi H, Hashim oto K, Yagi A. Flavon oids in Ro s marinus officinalis leaves. Phytochemistry. 1994 Nov ;37(5 ) : 1463-6. 7 5 6 Kwo n YI, Vattem DA, Shetty K. Evaluation of clonal herbs of Lamiaceae species for management of diabetes and hypertension . Asia Pac J Clin Nutr. 2006;1 5 ( 1 ) : 107-1 8 . 7 5 7 al-Hader AA, Hasan ZA, Aqel MB. Hyperglycemic and insulin release inhibitory effects of R osmarinus officinalis. J Ethnopharmacol. 1994 Jul 22 ;43(3):2 1 7 - 2 1 . 3 0 8 Module Seven produced an antidepressant-like effect. The acute care of mice with the extract by p.o. route significantly reduced the immobility time in the forced swimming test (100 mg/kg) and tail suspension test (10-100 mg/kg), as compared to a control group, without changes in ambulation in the open-field test. Results suggest R. officinalis should be further researched for use with depression 7 5 8 . In another 2009 study, rosemary extract was investigated for its ability to increase antioxidant defenses and improve antioxidant status in aged Wistar rats (20 months old). For 12 weeks, rats were fed standard kibble (80%) supplemented with turkey breast (20%) that contained none, one, or two different containing none or one of two different supercritical fluid rosemary concentrations (0.2% and 0.02%). The supercritical fluid rosemary-treated rats presented lower nitric oxide synthase levels in the heart and lower reactive oxygen species levels in the hippocampus than the control rats. These results suggest the rosemary supplement improved the oxidative stress status in old rats 7 5 9 . Contraindications Individuals with hypersensitivity should use caution with topical preparations containing rosemary oil 7 6 0 . Rosemary is thought to be an abortifacient and emmenagogue. Avoid use with pregnancy and while lactating in amounts exceeding those typically found in food 7 6 1 . 7 5 8 Machado DG , Bettio LE , Cu n ha MP, Ca pra JC, Dalmarco JB, Pizz olatti MG, Rodrigues AL. Antidepressant-li ke effect of the extract of R osmarinus officinalis in mice: inv olvement of the mon oaminergic system. Prog Neuropsychopharmacol Biol Psychiatry. 2009 Jun 15 ;33(4):642-50. Ep ub 2009 Mar 13. 7 5 9 Posadas SJ, Caz V, Largo C, De la Gándara B, Matallanas B, Reglero G, De Miguel E. Protective effect of su percritical fluid rosemary extract, Rosmarinus officinalis , o n antioxidants of major organs of aged rats. E xp Gerontol . 2009 Jun - J ul;44(6- 7 ) :383-9. Ep ub 2009 Mar 14. 7 6 0 Barnes, J., A nderson , L., and Phillipso n , J.D . Herbal Medicines , T hird Edition. Pharmaceutical Press. Lo ndon, 2007. 7 6 1 Barnes, J., A nderson , L., and Phillipso n , J.D . Herbal Medicines , T hird Edition. Pharmaceutical Press. Lo ndon, 2007. 3 0 9 Module Seven A d v e r s e E f f e c t s Rosemary oils contains 20-50% camphor which, when taken orally, can cause epileptiform convulsions if used in sufficient quantity 7 6 2 . Ingestion of large amounts of leaves containing rosemary oil could cause deep coma, spasm, vomiting, gastroenteritis, uterine bleeding, kidney irritation, pulmonary edema, and death 7 6 3 . Additionally, ingestion of undiluted oil could cause stomach and intestinal irritation, kidney damage, and seizures 7 6 47 6 5 . When used topically, rosemary can cause photosensitivity, erythema, dermatitis in hypersensitive people 7 6 67 6 7 . Drug and Supplement Interactions Based on in vitro studies, rosemary and rosemary extracts are thought to have antibacterial activity 7 6 8 . Rosemary might also have weak antifungal activity 7 6 9 and anti-inflammatory activity 7 7 0 . 7 6 2 Barnes, J., A nderson , L., and Phillipso n , J.D . Herbal Medicines , T hird Edition. Pharmaceutical Press. Lo ndon, 2007. 7 6 3 Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines . 1st ed. Montvale, NJ: Medical Econo mics Co m pany , Inc., 19 9 8 . 7 6 4 Foster S, Tyler VE. Tyler's Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies . 3rd ed., Bing hamton , N Y : Haworth Herbal Press, 19 93. 7 6 5 The Review of Natural Products by Facts and Comparisons . St. Lo uis, MO: W olters Kluwer Co., 19 9 9 . 7 6 6 Newall CA , A nderson LA , Philpso n JD . Herbal Medicine: A Guide for Healthcare Professionals. L o ndon, UK : The Pharmaceutical Press, 19 9 6 . 7 6 7 The Review of Natural Products by Facts and Comparisons. St. Lo uis, MO: W olters Kluwer Co., 19 9 9 . 7 6 8 Ahn J, Grün IU, Mustapha A. Antimicrobial and antioxidant activities of natural extracts in vitro and in ground beef. J Foo d Prot . 2004 Jan;6 7 ( 1 ) : 148-5 5 . 7 6 9 Ozcan M. Effect of spice hydrosols on the growth of Aspergillus parasiticus NRR L 29 9 9 strain. J Med Foo d . 2005 Su m mer;8( 2 ) : 2 7 5 - 8 . 3 1 0 Module Seven In a 2000 study, rosemary was investigated for its cancer chemopreventive agents. Alcohol extracts of rosemary showed strong antitumorigenic activity 7 7 1 . Regulatory Status Rosmarinus officinalis is listed as a Class 2b (not to be used during pregnancy) in the American Herbal Product Association?s Botanical Safety Handbook . Module Assessment You are now ready to log in and complete the module assessment online. Refer back to the instructions in Module One if you need to. 7 7 0 Chan MM, Ho CT, Huang HI. Effects of three dietary phytochemicals from tea, rosemary and turmeric on inflammation-induced nitrite production. Cancer Lett. 1 9 9 5 Sep 4;96 ( 1 ) : 23-9. 7 7 1 Ho CT , Wang M, Wei GJ, Huang TC , Huang MT. Chemistry and antioxidative factors in rosemary and sage. Bio factors . 2000;13(1-4):1 6 1 - 6 . 3 1 1 Module Ei ght Module Eight Module Objectives Upon completion of this module, you will be able to: ? Recall and describe the Latin binomial or scientific name, common name, and family. ? Be able to identify a photograph by the Latin name and common name of the botanicals studied. ? Identify the therapeutic potential of each botanical studied. ? Explain the pharmacological action of each botanical studied. ? List the key recommended uses for each botanical studied. ? Recall the recommended dosage and duration for each botanical studied. ? Recall and describe any contraindications and precautions associated with each botanical studied. ? Recall the regulatory status of each of botanical studied. Module Checklist ? Read and review the module. ? Read any online resources as applicable. ? Ensure you can meet the Module Objectives. ? Complete the module assessment online and respond to another student?s posting as instructed. ? Complete the Module Test. 8 3 12 Module Ei ght R u m e x a c e t o s a Image 47: by Veldzuring (2005) via Wikipedia.org Taxonomic Notes Common botanical name: Sorrel Family: Polygonaceae C o m m o n N a m e s Acedera común, azeda-brava, common sorrel, field sorrel, garden sorrel, red sorrel, sheep?s sorrel, sorrel dock, sour dock, and wiesensauerampfer Do not confuse with wood sorrel or yellow dock. P r i m a r y U s e s Sorrel is primarily used for acute and chronic inflammation of the nasal passages and respiratory tract, and in combination with 3 1 3 Module Ei ght antibacterial therapy. It is also used as a diuretic, to stimulate secretions, and with cancer. Though sorrel might have potential for use with bacterial and viral infections, bronchitis, cancer, sinusitis, and to help improve the quality of life for cancer patients, there is little high-quality research to date. Traditionally, sorrel has been used eaten raw as a salad green, used as a spring tonic and diarrhea remedy, and used with weak diuretic. Additionally, it has been used to soothe irritated nasal passages. Currently, sorrel is an ingredient in herbal remedies like Essiac®, which is used with cancer, and Sinupret®, a European herbal sinus remedy. Overview Sorrel is commonly grown in Europe and naturalized in North America. The plant can grow to about 3-ft. high and has fleshy, green leaves. The herb was named for its lemon-like taste, which has been attributed to its oxalic acid and vitamin C content 7 7 2 . Sorrel is in leaf all year, in flower from May to June, and its seeds ripen June to August. It requires moist soil and prefers soils that are light (sandy), medium (loamy), and heavy (clay). Sorrel can grow in slight shade or direct sunlight 7 7 3 . Sorrel leaves (fresh or dried) are astringent, diuretic, laxative, and refrigerant 7 7 47 7 5 . The leaves can be eaten raw or cooked 7 7 6 , and can bee added into salads or soups for their lemon-like flavor. The leaves can 7 7 2 Locock RA . Herbal medicine: Essiac. Can Pharm J 199 7 ; 130 (Feb):1 8 - 1 9 , 51 . 7 7 3 Plants for a Future accessed 6/1 5 /09: http:/ / w w w . p faf.org/database/plants.p h p ? R u mex+acetosa 7 7 4 Grieve. A Modern Herbal . Penguin, 19 84. 7 7 5 Chiej. R. Encyclopaedia of Medicinal Plants . MacDonald, 19 84. 7 7 6 Vilmorin. A. The Vegetable Garden . Ten Speed Press, 19 8 1 . 3 1 4 Module Ei ght also be dried for future use. Note that sorrel contains high levels of oxalic acid, which is safe in small quantities, but in large quantities may ?lock up? other nutrients, such as calcium, potentially leading to mineral deficiencies. The oxalic acid content is reduced when cooked 7 7 7 . In addition, Rumex acetosa flowers can be cooked as a vegetable or used as garnish 7 7 8 , and an infusion made from the roots is astringent, diuretic, and haemostatic 7 7 9 . Identifying Characteristics Part Characteristics Leaves Lower leaves are petiolate, somewhat ovate, and narrow-shaped with two lateral teeth; the upper leaves are sessile, more oblong, and narrower Flowers Dioecious; males are green with a reddish tinge and females are redder Roots Long, tapering, and somewhat woody Taste Slightly astringent and lemon-like P a r t s U s e d Leaves, flowers, roots, and seeds C o l l e c t i o n a n d C u l t i v a t i o n Historically, sorrel has been used as a food and medicinal plant, cultivated for its edible leaves. Sorrel stops producing leaves when it flowers in summer, and starts to re-grow leaves after the seed has set. 7 7 7 Bo w n . D . Encyclopaedia of Herbs and their Uses . D orling Kindersley. Lo ndon, 19 9 5 . 7 7 8 Facciola. S. Cornucopia - A Source Book of Edible Plants . Kampo n g Publications 19 90 7 7 9 Lust. J. The Herb Book . Bantam Bo o k s , 19 83. 3 1 5 Module Ei ght Sorrel naturally dies down in the winter; however, cutting back the flowering stem will encourage new leaves 7 8 0 . To cultivate seed, however, sow in situ in spring. The leaves can then be harvested within eight weeks from sowing. Division should take place in spring also 7 8 1 . Dosage and Administration For specific use with cancer, 30 mL of Essiac® tea, 1-3 times daily has been used. Take on an empty stomach. As a tincture for sinusitis, 50 drops of an alcohol-based (19%) Sinupret® tincture, three times daily, has been used 7 8 2 . For specific use with acute or chronic sinusitis, a specific herbal combination has been used: 36 mg sorrel, 12 mg gentian root, and 36 mg each of European elder flower, verbena, and cowslip flower used three times daily 7 8 37 8 4 . 7 8 0 Grieve. A Modern Herbal . Penguin, 19 84. 7 8 1 Plants for a Future accessed 6/1 5 /09: http:/ / w w w . p faf.org/database/plants.p h p ? R u mex+acetosa 7 8 2 Ernst E, März RW , Sieder C. [Acute bronchitis: effectiveness of Sinu pret. Co m parative study with comm o n expectorants in 3,18 7 patients] F ortschr Med. 199 7 Apr 20;11 5 ( 1 1 ) : 5 2 -3. 7 8 3 Neubauer N, Marz RW . Placebo-controlled, randomized, double-blind, clincal trial with Sinu pret sugar coated tablets on the basis of a therapy with antibiotics and decongestant nasal drops in acute sinu sitis. P hytomedicine 1 9 94;1:1 7 7 - 8 1 . 7 8 4 Marz RW , Ismail C, Po p p MA. Action profile and efficacy of a herbal combination preparation for the treatment of sinu sitis. Wien Med Wochenschr 199 9 ; 1 4 9 : 2 0 2 - 8 . 3 1 6 Module Ei ght Duration of Administration Long-term use and large quantities may increase risk of oxalate kidney stones. Use with caution with individuals who have a known history of kidney stones 7 8 5 . Active Constituents The active constituents in Rumex acetosa include ascorbic acid, oxalates (including calcium oxalate), tannins, anthracene derivatives (anthranoids, aglycones, physcion, aloe-emodin, aloe-emodin acetate, emodin, and rhein), quinoids, flavonoids, and phenylpropanoid 7 8 6 . Pharmacological Action Preliminary research suggests a polysaccharide constituent of sorrel might have antitumor activity. In a 1986 study, antitumor agents from several natural sources were investigated to determine the correlation between antitumor activity and effects on some biological properties. The antitumor agents were tested on female ICR mice implanted with Sarcoma 180 solid tumor. All of the antitumor agents depressed aniline hydroxylase and aminopyrine demethylase activities, prolonged the duration of pentobarbital-induced narcosis, and significantly enhanced phagocytic and C3 activity 7 8 7 . In addition, sorrel might exhibit antimicrobial activity against viruses and bacteria that are significant human pathogens. In a 1982 study, 693 kinds of indigenous plants were randomly selected to be tested for their antimicrobial activity against 23 test organisms (Gram-positive, 7 8 5 Terris MK, Issa MM, Tacker JR. Dietary sup plementation with cranberry concentrate tablets may increase the risk of nephrolithiasis. Urology 2001;5 7 : 2 6 - 9 . 7 8 6 Choe S., Hwang B, Kim M, and et al. Chemical comp o nents of Ru mex acetellosa L. K orean J Pharmacog 199 8 ; 2 9 : 209-2 1 6 . 7 8 7 Ito H. Effects of the antitumor agents from various natural sources on drug- metabolizing sy stem, phagocytic activity and com plement system in sarcoma 180-bearing mice. Jpn J Pharmacol. 198 6 Mar;40(3):435-43. 3 1 7 Module Ei ght Gram-negative bacteria, yeast and fungi). Results showed that 250 kinds of plants exhibited some level of antimicrobial action in vitro 7 8 8 . A d v e r s e E f f e c t s Sorrel leaves contain 7-15% tannins. In general, plants that contain more than 10% tannins might cause stomach upsets, renal damage, hepatic necrosis, and increased risk of esophageal and nasal cancers. Sorrel also contains .3% oxalate (oxalic acid). Oxalic acid combines with calcium to form calcium oxalate crystals, which may develop in the kidneys, blood vessels, heart, lung, and liver, leading to hypocalcemia and renal lesions. Oxalate crystals damage mucosal tissue and cause severe irritation 7 8 9 . Drug and Supplement Interactions Rumex acetosa contains oxalate, which in large quantities can bind to other nutrients, like calcium, causing mineral deficiencies. Regulatory Status Sorrel is listed as a Class 2d (Individuals with a history of kidney stones should use this herb cautiously; Other specific use restrictions as noted) in the American Herbal Product Association?s Botanical Safety Handbook . 7 8 8 Dornberger K, Lich H. [Screening for antimicrobial and presumed cancerostatic plant metabolites (author's transl)] Pharmazie . 19 8 2 Mar;37(3):2 1 5 - 2 1 . 7 8 9 Sanz P, Reig R. Clinical and pathological findings in fatal plant oxalosis. A review. Am J Forensic Med Pathol . 19 9 2 Dec;13(4):342-5 . 3 1 8 Module Ei ght S a m b u c u s c a n a d e n s i s Image 48: by SB_Johnny (2007) via Wikipedia.org Taxonomic Notes Common botanical name: American Elder Family: Adoxaceae/Sambucaceae or Caprifoliaceae C o m m o n N a m e s American elderberry, common elderberry, elder flower, elderberry, sambucus, and sweet elder. Do not confuse with dwarf elder or European elder. P r i m a r y U s e s Elder fruit is commonly used in pies, berries, and cobblers, and can be used in recipes calling for blackberries. Elder fruit is a good source of vitamin C and improves in flavor with drying. Elderberry is attributed with many properties: Alterative, aperient, carminative, cathartic, 3 1 9 Module Ei ght cyanogentic, depurative, diuretic, emetic, excitant, hydragogue, intoxicant, laxative, poison, refrigerant, stimulant, and sudorific 7 9 0 . In folk remedies, elderberry has been used with: Abrasions, asthma, bronchitis, bruises, burns, cancer, chafing, cold, dropsy, epilepsy, fever, gout, headache, neuralgia, psoriasis, rheumatism, skin ailments, sores, sore throat, swelling, syphilis, and toothache 7 9 1 . Elderberry flowers are used for tea, and flower extracts are used in perfumery. The flowers, as an infusion, are said to have alterative and laxative properties 7 9 2 . O v e r v i e w Sambucus canadensis is an indigenous shrub that grows in all parts of the United States. American elder prefers low, damp grounds, and flowers in June and July. The berries mature in September and October 7 9 3 . Identifying Characteristics Part Characteristics Leaves Nearly bipinnate and antiposed; leaflets in 3 or 4 pairs with an odd one, oblong, oval, acuminate, smooth, serrate, with the lower ones often 2 or 3-parted Flowers Small, white, and five-petaled Fruit Small, juicy, and dark purple Taste Odor Sweetish Somewhat aromatic 7 9 0 Duke, J. Handbook of Medicinal Herbs . CR C Press. Boca Raton, FL : 2001. 7 9 1 Duke, J. Handbook of Medicinal Herbs . CR C Press. Boca Raton, FL : 2001. 7 9 2 Duke, J. Handbook of Medicinal Herbs . CR C Press. Boca Raton, FL : 2001. 7 9 3 Henriette?s Herbal Homepage accessed 6/1 5 /09: http:/ / w w w . henriettesherbal.com/eclectic/king s / sambucus.html 320 Module Ei ght P a r t s U s e d Leaf, flower, and fruit C o l l e c t i o n a n d C u l t i v a t i o n American elder is a fast-growing, deciduous shrub. It grows to about 13 ft. by 13 ft. and flowers in July. The flowers are hermaphroditic. American elder prefers light (sandy), medium (loamy), and heavy (clay) soils, and can grow in semi-shade or direct sunlight. Moist soil is preferred 7 9 4 . Dosage and Administration When the dried flower is used, a typical dose is 2-4 g by infusion, three times daily 7 9 5 . As a liquid extract (1:1 in 25% alcohol), 2-4 mL, three times daily 7 9 6 . Duration of Administration None known. Active Constituents Elder flowers are attributed with diuretic and laxative effects, and are a rich source of vitamin C. The Sambucus species are known to contain lectins with hemagglutinin characteristics, which have potential use with blood testing, including blood typing 7 9 7 . 7 9 4 Plants for a Future accessed 6/1 5 /09: http:/ / w w w . p faf.org/database/plants.p h p ? Sambucus+canadensis 7 9 5 Barnes, J., A nderson , L., and Phillipso n , J.D . Herbal Medicines , T hird Edition. Pharmaceutical Press. Lo ndon, 2007. 7 9 6 Barnes, J., A nderson , L., and Phillipso n , J.D . Herbal Medicines , T hird Edition. Pharmaceutical Press. Lo ndon, 2007. 321 Module Ei ght Pharmacological Action In a 2002 study, 13 Brazilian medicinal plants were investigated for their potential antimicrobial activity against bacteria and yeasts. Of the 13 plants, 10 plant extracts showed some level of antibacterial activity. Sambucus Canadensis exhibited some degree of antibacterial activity 7 9 8 . Contraindications The safe use of American elder during pregnancy has not been established. Avoid use while pregnant and while breast-feeding 7 9 9 . There is insufficient reliable information available about the safety of the flower or cooked fruit; avoid using amounts greater than those found in foods. A d v e r s e E f f e c t s Elder leaves and unripe berries contain cyanogenic glycosides. Ingesting either the leaves or unripe berries can cause cyanide poisoning 8 0 0 . In addition, ingesting several glasses of American elderberry juice might cause nausea, vomiting, weakness, dizziness, numbness, and/or stupor 8 0 1 . 7 9 7 Leung AY , Fo ster S. Encyclopedia of Com m on Natural Ingredients Used in Foo d , Drugs and Cosmetics . 2nd ed. New York, N Y : Jo h n Wiley & So n s , 19 9 6 . 7 9 8 Holetz FB , Pessini GL , Sanches NR , C ortez DA , Nakamura CV, Filho BP . Screening of so me plants used in the Brazilian folk medicine for the treatment of infectious diseases. Mem Inst Oswaldo Cruz. 2002 Oct;97 ( 7 ) : 1027-31. 7 9 9 Barnes, J., A nderson , L., and Phillipso n , J.D . Herbal Medicines , T hird Edition. Pharmaceutical Press. Lo ndon, 2007. 8 0 0 The Review of Natural Products by Facts and Comparisons . St. Lo uis, MO: W olters Kluwer Co., 19 9 9 . 8 0 1 The Review of Natural Products by Facts and Comparisons . St. Lo uis, MO: W olters Kluwer Co., 19 9 9 . 322 Module Ei ght Drug and Supplement Interactions Preliminary evidence suggests American elder may inhibit the cytochrome P450 3A4 (CYP3A4) enzymes 8 0 2 . American elder might increase levels of drugs metabolized by CYP3A4, which is a member of the cytochrome P450 mixed-function oxidase system (one of the most important enzymes involved in the metabolism of xenobiotics in the body); however, this interaction has not been reported in humans yet. Some drugs metabolized by CYP3A4 include: Lovastatin (Mevacor), ketoconazole (Nizoral), itraconazole (Sporanox), fexofenadine (Allegra), triazolam (Halcion), and numerous others. Use American elder cautiously or avoid in patients taking these drugs. Regulatory Status American elder flowers have Generally Recognized as Safe Status (GRAS) in the U.S 8 0 3 , and is listed as a Class 1 (herbs that can be safely consumed when used appropriately) in the American Herbal Product Association?s Botanical Safety Handbook . Elderberry leaves have been improved for use in alcoholic beverages provided hydrogen cyanide (HCN) does not exceed 25 ppm in the flavor 8 0 4 . 8 0 2 Budzins ki JW , Fo ster BC, Vandenhoek S, Arnason JT . An in vitro evaluation of hu man cytochrome P450 3A4 inhibition by selected commercial herbal extracts and tinctures. Phytomedicine . 2000 Jul;7 (4):2 73-82 . 8 0 3 FDA . Center for Food Safety and A pplied Nutrition, O f fice of Premarket Approval, EA F U S : A fo od additive database. Available at: vm .cfsan.fda.go v / ~dms/eafus. html. 8 0 4 Duke, J. Handbook of Medicinal Herbs . CR C Press. Boca Raton, FL : 2001. 323 Module Ei ght S a m b u c u s n i g r a Image 49: by Carl Axel Magnus Lindman (1917) via Wikipedia.org Taxonomic Notes Common botanical name: European Elder Family: Sambucaceae or Caprifoliaceae C o m m o n N a m e s Baccae, baises de sureau, black-berried alder, black elder, black elderberry, boor tree, bountry, elder, elder berry, ellanwood, elhorn, European alder, European elder fruit, European elderberry, holunderbeeren, and sambuci sambucus Do not confuse with dwarf elder or American elder. 324 Module Ei ght Primary Uses Sambucus nigra has diaphoretic and anticatarrhal properties. It has, traditionally, been used for influenza, colds, and chronic nasal catarrh with deafness and sinusitis 8 0 5 . Additionally, European elder is thought to possess diuretic, laxative, anti-inflammatory 8 0 6 , antioxidant, and purgative properties. Overview Sambucus nigra is a tall shrub that grows up to 30-ft. tall. It is native to Europe, but has been naturalized in the Americas. Identifying Characteristics Part Characteristics Flowers Small, yellowish-whitish, and five-petaled Fruit Black and dark-violet juice Taste Odor Mucilaginous and sweet Faint and characteristic P a r t s U s e d Leaf, flower, fruit, and bark C o l l e c t i o n a n d C u l t i v a t i o n Sambucus nigra tolerates most soils, but prefers a moist, loamy soil 8 0 7 . It can grow in some shade, but fruits better in sun 8 0 8 . The leaves open 8 0 5 Barnes, J., A nderson , L., and Phillipso n , J.D . Herbal Medicines , T hird Edition. Pharmaceutical Press. Lo ndon, 2007. 8 0 6 Barnes, J., A nderson , L., and Phillipso n , J.D . Herbal Medicines , T hird Edition. Pharmaceutical Press. Lo ndon, 2007. 8 0 7 Huxley. A. The New RHS Dictionary of Gardening . MacMillan Press, 19 9 2 . 8 0 8 Tho m p s o n . B. The Gardener's Assistant . Blackie and Son , 18 7 8 . 325 Module Ei ght as early as January, are fully open by April 8 0 9 , and fall around October or November. It is best to sow as soon as ripe in autumn, and use a cold frame. Seed should germinate in early spring. Plant seedlings in their own planters when they are large enough to handle, and if there is adequate growth, seedlings can be planted in their permanent positions during early summer. If growth is slower, put seedlings into a sheltered nursery bed or keep in planters in a sheltered position and plant out the following spring 8 1 0 . Dosage and Administration For specific use with adult influenza 15 mL (1 tablespoon) of elderberry juice-containing syrup (such as Sambucol by Nature?s Way), four times daily for 3-5 days 8 1 18 1 2 . For specific use with child influenza, 15 mL (1 tablespoon) of elderberry juice-containing syrup (such as Sambucol by Nature?s Way), twice daily for three days 8 1 3 . Duration of Administration None known. 8 0 9 Beckett. G. and K. Planting Native Trees and Shrubs . Jarrold, 197 9 . 8 1 0 Plants for a Future accessed 6/1 7 /09: http:/ / w w w . p faf.org/database/plants.p h p ? Sambucus+ nigra 8 1 1 Zakay-R o nes Z, Varsano N , Zlotnik M, et al. Inhibition of several strains of influenza virus in vitro and reduction of sy m ptom s by an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama. J Altern Complement Med 1 9 9 5 ; 1 :361- 9 . 8 1 2 Zakay-R o nes Z, Th o m E, W ollan T, Wadstein J. Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections . J Int Med Res 2004;32:132-40. 8 1 3 Zakay-R o nes Z, Varsano N , Zlotnik M, et al. Inhibition of several strains of influenza virus in vitro and reduction of sy m ptom s by an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama. J Altern Complement Med 1 9 9 5 ; 1 :361- 9 . 326 Module Ei ght Active Constituents The active constituents of Sambucus nigra have been studied in depth. The bark contains -amyrenone, -amyrin, betulin, oleanolic acid, and beta-sitosterol 8 1 4 , as well as nigrin b, a lectin similar to ricin, and other type 2 ribosome inactivating proteins (RIPs) that are less toxic to cells and animals 8 1 5 . The active constituents in the flowers and leaves contain flavonoids (including quercetin (up to 3%), rutin, hyperoside 8 1 6 , and anthocyanins 8 1 7 ), as well as essential oils (responsible for the muscat aroma characteristic of elder flowers) 8 1 8 , mucilage, tannins (3%), organic acids, glycoside (0.042% by weight), plastocyanin 8 1 9 , and sambunigrin (0.042% by weight). High amounts of N-phenylpropenoyl- L-amino acid amides have also been found in the flowers of Sambucus nigra8 2 0 . 8 1 4 Lawrie W, McLean J, and Paton AC . Triterpenoids in the bark of elder (Sambucus nigra). Phytochemistry 1964;3:26 7 - 2 6 8 . 8 1 5 Battelli MG, Citores L, Bu o namici L, Ferreras JM, de Benito FM, Stirpe F, Girbés T. To xicity and cytotoxicity of nigrin b, a two-chain riboso me- inactivating protein from Sambucus nigra : com pariso n with ricin. Arch Toxicol . 19 9 7 ; 7 1 ( 6 ) :360-4. 8 1 6 Davidek J. Isolation of chromatographically pure rutin from flowers of elder. Nature 196 1 ; 1 8 9 (4763):487-488. 8 1 7 Mulleder, U., Murkovic, M., and Pfannhauser, W . Urinary excretion of cyanidin glycosides. J . Biochem.Bi ophys.Methods 2002;53(1-3):6 1 - 6 6 . 8 1 8 Toulemonde B and Richard HM. Volatile constituents of dry elder ( Sambucus nigra L.) flowers. J .Agric Foo d Chem 1983;31(2 ) :365-370. 8 1 9 Scawen, M. D., Ramshaw, J. A., Brow n , R. H., and Boulter, D. The amino - acid sequence of plastocyanin from Sambucus nigra L. (Elder). Eur.J Biochem 5-2 - 1 9 74;44(1) : 2 9 9 -303. 8 2 0 Hensel, A., Deters, A. M., Muller, G., Stark, T., Wittschier, N., and Hofmann, T. Occurrence of N -p henylp ropenoyl-L -amino acid amides in different herbal drugs and their influenc e on hu man keratinocytes, on hu man liver cells and on adhesion of Helicob acter pylori to the human stomach. Planta Med 2007;73(2) : 142-1 50. 327 Module Ei ght Pharmacological Action The anthocyanins found in Sambucus nigra are thought to have immunomodulating and possibly anti-inflammatory effects. In a randomized, double-blind, and placebo-controlled study elderberry syrup was investigated for its use with influenza A and B. Sixty participants in Norway, aged 18-54 years, received 15 mL of elderberry (or placebo) syrup four times a day for five days. On average, symptoms were relieved four days earlier. Elderberry might be an efficient, safe, and cost-effective for use with influenza 8 2 1 . Sambucus nigra may also possess antiviral effects and inhibit influenza type A and B, as well as herpes simplex virus 1 8 2 2 by reducing hemagglutination of red blood cells and inhibiting replication of several strains of influenza A and B 8 2 3 . In a placebo-controlled, double-blind study on people living in an agricultural community during an outbreak of influenza B in 1993, significant improvement was seen as a result of a standardized elderberry extract 8 2 4 . 8 2 1 Zakay-R o nes Z, Th o m E, W ollan T, Wadstein J. Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections . J Int Med Res. 2004 Mar-Apr;32(2 ) : 132-40. 8 2 2 Serkedjieva J, Manolova N, Zg orniak-N o w o sielska I, and et al. Antiviral activity of the infu sion (SHS-1 74) from flowers of Sambucus nigra L., aerial parts of Hypericum perforatum L., and roots of Saponaria officinalis L. against influenza and herpes sim plex viruses. Phytotherapy Research 1990;4(3):9 7 - 100. 8 2 3 Zakay-R o nes, Z., Varsano, N ., Zlotnik, M., Manor, O., Regev, L., Schlesinger, M., and Mumcuoglu, M. Inhibition of several strains of influenza virus in vitro and reduction of sy m ptom s by an elderberry extract ( Sambucus nigra L.) during an outbreak of influenza B Panama. J Altern Complement Med 1 9 9 5 ; 1 (4):361-369. 8 2 4 Zakay-R o nes Z, Varsano N , Zlotnik M, Manor O, Regev L, Schlesinger M, Mumcuoglu M. Inhibition of several strains of influenza virus in vitro and reduction of sy m ptom s by an elderberry extract ( Sambucus nigra L.) during an outbreak of influenza B Panama. J Altern Complement Med. 199 5 Winter ; 1 (4):361- 9 . 328 Module Ei ght In addition, the flavonoids contained in European elder are thought to have antioxidant activity and to protect against oxidative stressors 8 2 58 2 6 . Medicinal Uses With a long history of use as a household medicinal 82 7 , Sambucus nigra has been called ?the medicine chest of country people 828.? The bark is a diuretic, purgative and, in large doses, an emetic 8 2 9 . It can be used for constipation and arthritic conditions, and an emollient ointment can be made from the green inner bark 8 3 0 . The leaves can be used either fresh or dried, and have purgative, diaphoretic, diuretic, expectorant, and haemostatic effects 8 3 1 . The dried flowers are diaphoretic, diuretic, expectorant, galactogogue, and pectoral 8 3 2 . An infusion has been used for chest problems and to bathe inflamed eyes 8 3 3 , and can also be used as a 8 2 5 Murkovic, M., Adam, U., and Pfannhauser, W . Analysis of anthocyane glycosides in hu man serum . Fresenius.J Anal.Chem 2000;366(4):379-381 8 2 6 Youdim, K. A., Martin, A., and Joseph, J. A. Incorporation of the elderberry anthocyanins by endothelial cells increa ses protection against oxidative stress. Free Radic.Biol Med 7-1 - 2000;29( 1 ) : 5 1 - 60. 8 2 7 Plants for a Future accessed 6/1 7 /09: http:/ / w w w . p faf.org/database/plants.p h p ? Sambucus+ nigra 8 2 8 Grieve. A Modern Herbal . Penguin, 19 84. 8 2 9 Chiej. R. Encyclopaedia of Medicinal Plants . MacDonald 1984 8 3 0 Bo w n . D . Encyclopaedia of Herbs and their Uses . Dorling Kindersley, Lo ndon, 19 9 5 . 8 3 1 Chiej. R. Encyclopaedia of Medicinal Plants . MacDonald, 19 84. 8 3 2 Chiej. R. Encyclopaedia of Medicinal Plants . MacDonald, 19 84. 8 3 3 Grieve. A Modern Herbal . Penguin, 19 84. 329 Module Ei ght spring tonic and blood cleanser 8 3 4 . Externally, the flowers can be used in poultices to ease pain and inflammation 8 3 5 . The dried berries can be made into a tea, which is reported to be good for cholic and diarrhea 8 3 6 . The fruit is also widely used in food preparations, particularly wines and preserves 8 3 7 . (See Regulatory Status) Contraindications The safe use of European elder during pregnancy has not been established. Avoid use while pregnant and while breast-feeding. A d v e r s e E f f e c t s The raw and unripe fruit, the seeds, the bark, and the leaves of Sambucus nigra contain cyanogenic glycoside sambunigrin. Ingestion of cyanogenic glycoside sambunigrin can cause vomiting or severe diarrhea 8 3 8 . Sambucus nigra may lower blood sugar levels; therefore, blood glucose levels may need monitoring 8 3 9 . European elder may possess diuretic properties. Use cautiously with other drugs that increase urination 8 4 0 . 8 3 4 Grieve. A Modern Herbal . Penguin, 19 84. 8 3 5 Grieve. A Modern Herbal . Penguin, 19 84. 8 3 6 Grieve. A Modern Herbal . Penguin, 19 84. 8 3 7 Grieve. A Modern Herbal . Penguin, 19 84. 8 3 8 McGuffin, M. eds et all. American Herbal Product Associ ation?s Botanical Safety Handbook . CR C Press. Boca Raton, FL : 19 9 7 . 8 3 9 Gray AM, Abdel-Wahab YH, Flatt PR . The traditional plant treatment, Sambucus nigra (elder), exhibits insulin-like and insulin-releasing actions in vitro. J Nutr. 2000 Jan;130(1) : 1 5 - 20. 3 3 0 Module Ei ght In addition, Elder may possess laxative effects. Use cautiously with other laxatives. Drug and Supplement Interactions None known. Regulatory Status Canada: Approved active ingredient in about 20 Schedule OTC Traditional Herbal Medicines and homeopathic medicines, requiring premarketing authorization. U.K.: Herbal medicine in the General Sale List, Table A (internal or external use) of Schedule 1 (requires full Product License). Europe: Listed by the Council of Europe as a source of natural food flavoring (N1 and N2 status). Category N1 refers to the fruit; there are no restrictions on quantities. Category N2 refers to restrictions on the concentrations of hydrocyanic acid permitted; 1 mg/kg is permitted in foods and beverages, 1 mg/kg for every percent proof of alcoholic beverages, 5mg/kg in stone fruit juices, 25 mg/kg in confectionary, and 50 mg/kg in marzipan. U.S.: Dietary Supplement. Essential oil or natural extractives have Generally Recognized as Safe (GRAS) status. Additionally, European elder is listed as a Class 1 (herbs that can be safely used when consumed appropriately) in the American Herbal Products Association?s Botanical Safety Handbook . 8 4 0 Beaux D, Fleurentin J, Mortier F. Ef fect of extracts of Orthosiphon stamineus Benth , Hieracium pilosella L., Sambucus nigra L. and Arctostaphylos uva-ursi (L. ) Spreng. in rats. Phytother Res . 19 9 9 May;13(3):2 2 2 - 5 . 3 3 1 Module Ei ght S e r e n o a r e p e n s Image 50: by user Catherinemorrison29 (2008) via Flickr.com Taxonomic Notes Common botanical name: Saw Palmetto Family: Arecaceae/Palmaceae C o m m o n N a m e s American dwarf palm tree, cabbage palm, ju-zhong, palmier nain, sabal, sabal fructus, and saw palmetto berry P r i m a r y U s e s Saw palmetto is said to possess diuretic, sedative, anti-inflammatory, antiseptic, endocrinological, and anabolic properties. Traditionally, saw palmetto has been used with chronic or subacute cystitis, catarrh of the genitourinary tract, testicular atrophy, sex hormone disorders, 3 32 Module Ei ght and prostatic enlargement. Today, the primary interest in saw palmetto relates to its potential use with symptoms of benign prostatic hyperplasia 8 4 1 . Combined with other herbs, saw palmetto is used with prostate cancer; vaginally, the powdered fruit is used as a uterine and vaginal tonic. Overview Historically, the Mayans used saw palmetto as a tonic, and the Seminoles used the berries as an expectorant and antiseptic. Saw palmetto was listed in the United States Pharmacopeia from 1906-1917, as well in the National Formulary from 1926-1950. It is currently a licensed product in several European countries. (See Regulatory Status for details about use in Canada, the UK, and the U.S.) Identifying Characteristics Part Characteristics Flowers Bright green, palm-like, and composed of many slender, lance-shaped divisions that fan out from a single point; stems supporting leaves have spiny teeth Fruit Olive-like, blackish-brown, small berries that are .4-.8-in. long Taste Odor Aromatic; first sweet, then burning Aromatic P a r t s U s e d Fruit C u l t i v a t i o n a n d C o l l e c t i o n Saw palmetto is a small, low-growing, dwarf-palm tree. It is native to southeastern North American, and Florida particularly. 8 4 1 Barnes, J., A nderson , L., and Phillipso n , J.D . Herbal Medicines, Third Edition. Pharmaceutical Press . Lo ndon, 2007. 3 3 3 Module Ei ght Dosage and Administration For specific use with benign prostatic hyperplasia (BHP), 160 mg of lipophilic extract containing 80% to 90% fatty acids, twice daily, has been used in clinical trials (320 mg, once daily, can also be used 8 4 28 4 38 4 4 ). Rectal administration of saw palmetto extract (640 mg, once daily), was evaluated in a 30-day controlled trial of 40 men; the 640 mg rectal administration was shown to be the oral equivalent of 160 mg, four times daily 8 4 5 . For specific use with, androgenic alopecia (alopecia areata), 200 mg combined with 50 mg of beta-sitosterol, twice daily has been used 8 4 6 . D u r a t i o n o f A d m i n i s t r a t i o n There appear to be few safety concerns associated with short-term use of saw palmetto; however, large-scale and long-term safety studies are lacking 8 4 7 . 8 4 2 Wilt TJ, Ishani A, Stark G, et al. Saw palmetto extracts for treatment of benign prostatic hyperplasia: a systematic review. JAMA 199 8 ; 2 80:1604-9. 8 4 3 Gerber GS. Saw palmetto for the treatment of men with lower urinary tract sym ptom s . J Urol 2000;163:1408-1 2 . 8 4 4 Champault G, Patel JC, Bo n nard AM. A double-blind trial of an extract of the plant Serenoa repens in benign prostatic hyperplasia. Br J Clin Pharmacol 1984;18 :461- 2 . 8 4 5 Roveda S and Colombo P. Clinical controlled trial on therapeutical bioequivalence and tolerability of Serenoa repens oral capsules 160mg or rectal capsules 640mg. Arch Med Interna 1994;46(2 ) : 6 1 - 7 5 8 4 6 Prager N, Bickett K, French N, Marcovici G. A randomized, double-blind, placebo-controlled trial to determine t he effectiveness of botanically derived inhibitors of 5-alpha-reductase in t he treatment of androgenetic alopecia. J Altern Complement Med 2002;8 :143-52 . 8 4 7 Avins AL , Bent S. Saw palmetto and lower urinary tract sym ptom s : w hat is the latest evidence? Curr Urol Rep . 2006 Jul;7 (4):2 60-5. 3 3 4 Module Ei ght Active Constituents The active constituents in saw palmetto include fatty oil, triglycerides and free fatty acids occurring as sterols, volatile oil, flavonoids, and carotenoids 8 4 8 . Pharmacological Action Saw palmetto might increase the metabolism and excretion of dihydrotestosterone (DHT) by inhibiting cellular and nuclear receptor binding. In animal and human tissue culture studies, saw palmetto extract has inhibited androgen through competition with DHT at the androgen receptor 8 4 98 5 0 . Saw palmetto (Permixon®) might selectively disrupt intra-cellular nuclear membranes of prostate cells, yielding increased apoptosis. In a 2000 in vitro study, primary cultures of fibroblast and epithelial cells from the prostate, epididymis, testes, kidney, skin, and breast were examined to determine the selectivity and specificity of the action of Permixon on the prostate. Permixon was shown to be selective; morphological changes in the prostate were accompanied by an increase in the apoptotic index and inhibited activity of the nuclear membrane bound 5alphaR isoenzymes. However, similar changes were not observed in the any of the other cells 8 5 1 . 8 4 8 Wichtel, M. ed. Herbal Drugs and Phytopharmaceuticals: A Handbook for Practice on a Scientific Basis , Third Edition. Medpharm. Boca Raton, FL : 2004. 8 4 9 Briley M, Carilla E, and Fauran F. Permixo n , a new treatment for benign prostatic hyperplasia, acts directly at the cytosolic androgen receptor in the rat prostate. Br J Pharmacol 1983;79 :327P . 8 5 0 Ravenna L, Di Silverio F, Ru s s o MA, Salvatori L, Morgante E, Morrone S, Cardillo MR, Ru s s o A , Frati L, G ulino A , Petrangeli E. Effects of the lipidosterolic extract of Serenoa repens (Permixo n ) on hu man prostatic cell lines. Prostate . 19 9 6 Oct;29 (4):2 1 9 -30. 8 5 1 Bayne CW , Ro s s M, Do n nelly F, Habib FK. The selectivity and specificity of the actions of the lipido-sterolic extract of Serenoa repens (Permixo n ) on the prostate. J Urol . 2000 Sep;1 64(3 Pt 1):8 7 6 - 8 1 . 3 3 5 Module Ei ght Medicinal Uses Saw palmetto is thought to have antiandrogenic, antiproliferative, and anti-inflammatory properties, that seem to improve the symptoms of benign prostatic hyperplasia (BPH). Saw palmetto appears to noncompetitively inhibit 5 alpha-reductase types 1 and 2 and to prevent the conversion of testosterone to dihydrotestosterone (DHT) in vitro , potentially reducing prostate growth 8 5 28 5 38 5 4 . However, 5 alpha-reductase levels in prostatic tissue and serum testosterone, DHT, and PSA do not seem to be significantly reduced by saw palmetto in vivo 8 5 5 . In addition, saw palmetto does not seem to affect overall prostate size, but shrinks the inner prostatic epithelium 8 5 68 5 7 . Saw palmetto might slow prostate cell proliferation by inhibiting fibroblast growth and epidermal growth factor, and by stimulating apoptosis 8 5 8 . 8 5 2 Di Silverio F, Monti S, Sciarra A, et al. Effects of lon g -term treatment with Serenoa repens (Permixo n ) on the concentrations and regional distribution of androgens and epidermal growth factor in benign prostatic hyperplasia. Prostate 199 8 ;37:7 7 - 83. 8 5 3 Levin RM, Das AK . A scientific basis for the therapeutic effects of Pygeum africanum and Serenoa repens. Urol Res 2000;28:201-9 . 8 5 4 Bayne CW , Ro s s M, Do n nelly F, Habib FK. The selectivity and specificity of the actions of the lipido-sterolic extract of Serenoa repens (permixo n ® ) on the prostate . J Urol 2000;164:87 6 - 8 1 . 8 5 5 Marks LS , Tyler VE. Saw palmetto extract: newest (and oldest) treatment alternative for men with sym ptomati c benign prostatic hyperplasia. I199 9 ; 53:457- 6 1 . 8 5 6 USR F Research. Clinical effects of saw palmetto extract in men with sy m ptomatic BPH webpage: ww w . u srf.org/s pepapers.html (Accessed 23 June 2004). 8 5 7 Marks L, Partin AW , Ep stein JI, et al. Effects of a saw palmetto herbal blend in men with sy m ptomatic benign prostatic hyperplasia. J Urol 2000;163:1451- 6 . 8 5 8 Di Silverio F, Monti S, Sciarra A, et al. Effects of lon g -term treatment with Serenoa repens (Permixo n ) on the concentrations and regional distribution of 3 3 6 Module Ei ght Contraindications Although systemic endocrine effects have not been noted, use during pregnancy and while breast-feeding are not advised because of potential hormonal effects on the developing fetus or infant. A d v e r s e E f f e c t s When taken orally, the adverse effects of saw palmetto are generally mild. The most frequently reported adverse effects include dizziness, headache, nausea, vomiting, constipation, and diarrhea 8 5 98 6 0 . There is some concern that saw palmetto might cause erectile dysfunction, ejaculatory disturbance, or altered libido because of its potential effects on 5-alpha-reductase. However, in clinical studies, the occurrence of impotence in men taking saw palmetto was similar to placebo and less than finasteride (Proscar ® ) 8 6 18 6 2 . Saw palmetto is said to possess anti-androgenic properties and might have an effect on estrogen receptors 8 6 38 6 4 . androgens and epidermal growth factor in benign prostatic hyperplasia. Prostate 1 9 9 8 ;37:7 7 - 83. 8 5 9 Braeckman J. The extract of serenoa repens in the treatment of benign prostatic hyperplasia: a multicenter open study. Curr Ther Res 1994;55 : 7 7 6 - 8 5 . 8 6 0 Reece-Smith H, Memon A, Smart CJ, De wbury K. The value of permixo n in benign prostatic hypertroph y . Br J Urol 198 6 ; 5 8 :36-40. 8 6 1 Wilt TJ, Ishani A, Stark G, et al. Saw palmetto extracts for treatment of benign prostatic hyperplasia: a systematic review. JAMA 199 8 ; 2 80:1604-9. 8 6 2 Carraro JC , Raynaud JP, K och G, et al. Co m pariso n of ph ytotherapy (Permixo n ) with finasteride in the trea tment of benign prostate hyperplasia: a randomized international study of 1,098 patients. Prostate 199 6 ; 2 9 : 231-40. 8 6 3 Di Silverio F, D'Eramo G, Lubrano C, Flammia GP, Sciarra A, Palma E, Caponera M, Sciarra F. Evidence that Serenoa repens extract displays an antiestrogenic activity in prostatic tissue of benign prostatic hypertroph y patients. Eur Urol. 199 2 ; 2 1 (4):309-14. 8 6 4 Elghamry MI, Hänsel R. Activity and isolated phytoestrogen of shrub palmetto fruits ( Serenoa repens Small), a new estrogenic plant. E xperientia. 196 9 Au g 15 ; 2 5 ( 8 ) : 8 2 8 - 9 . 3 3 7 Module Ei ght In addition, in an open, multicenter trial there were few reports of fatigue and muscle pain associated with the use of saw palmetto. Of 551 people treated with saw palmetto (Permixon®) for benign prostatic hypertrophy, 1.6% reported back pain 8 6 5 , and in a phase II study of the herbal mixture PC-SPES®, which includes saw palmetto and seven other herbs, of the prostate cancer patients tested, 69% reported new or worsening leg cramps 8 6 6 . There is also some concern that saw palmetto may have antiplatelet effects, increasing the risk of bleeding in some patients 8 6 7 . Yet, to date, there are no reported cases of spontaneous bleeding in patients taking saw palmetto. Drug and Supplement Interactions Simultaneous use of herbs and supplements that affect platelet aggregation might increase risk of bleeding in some people. These herbs include: Angelica, clove, danshen, garlic, ginger, ginkgo, and Panax ginseng. In addition, saw palmetto might increase risk of bleeding when simultaneously used with the following anticoagulant and antiplatelet drugs: Aspirin, clopidogrel (Plavix), nonsteroidal anti-inflammatory drugs (NSAIDs) such as diclofenac (Voltaren and Cataflam), ibuprofen 8 6 5 Carraro JC , Raynaud JP, K och G, C hish olm G D , Di Silverio F, Teillac P, Da Silva FC , Cauq uil J, C h o pin D K , Hamdy FC , Hanus M, Hauri D, Kalinteris A, Marencak J, Perier A, Perrin P. Co m parison of ph ytotherapy (Permixo n ) with finasteride in the treatment of benign prostate hyperplasia: a randomized international study of 1,098 patients. Prostate. 199 6 Oct;29 (4):231- 40; discussion 241-2 . 8 6 6 Small EJ, Frohlich MW, Bo k R, Shino hara K, Gross feld G, Ro zenblat Z, Kelly W K , Corry M, Reese DM. Prospective trial of the herbal sup plement PC- S P E S in patients with progressive prostate cancer. J Clin Oncol . 2000 Nov 1; 1 8 ( 2 1 ) :3595 - 603. 8 6 7 Cheema P, El-Mefty O, Jazieh AR. Intraoperative haemorrhage associated with the use of extract of Saw Palmetto herb: a case report and review of literature. J Intern Med 2001;2 50:16 7 - 9 . 3 3 8 Module Ei ght (Advil and Motrin), naproxen (Anaprox and Naprosyn), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, and warfarin (Coumadin) 8 6 8 . Regulatory Status Canada: Approved active ingredient in a few Schedule OTC Traditional Herbal Medicines and more than 40 homeopathic medicines, require pre-marketing authorization. U.K.: Herbal medicine in the General Sale List, Table A (internal or external use) of Schedule 1 (requires full Product License). U.S.: Dietary supplement. 8 6 8 Cheema P, El-Mefty O, Jazieh AR. Intraoperative haemorrhage associated with the use of extract of Saw Palmetto herb: a case report and review of literature . J Intern Med 2001;2 50:16 7 - 9 . 3 3 9 Module Ei ght T r i g o n e l l a f o e n u m g r a e c u m Image 51: by user aslinth (2007) via Flickr.com Taxonomic Notes Common botanical name: Fenugreek Family: Fabaceae/Leguminosae C o m m o n N a m e s Alholva, bird?s foot, bockshornklee, bockshornsame, foenugreek, Greek clover, Greek hay, Greek hay seed, hu lu ba, methi, and trigonella P r i m a r y U s e s Fenugreek is used to promote healthy blood sugar levels in those with diabetes. It is also used with loss of appetite, dyspepsia, gastritis, constipation, atherosclerosis, high serum cholesterol and triglycerides, and for promoting lactation. In addition, fenugreek has been used with kidney ailments, beriberi, hernia, impotence (and other male problems), fever, mouth ulcers, boils, bronchitis, cellulitis, tuberculosis, chronic coughs, chapped lips, baldness, and cancer. 3 4 0 Module Ei ght Topically, fenugreek can be used as a poultice for inflammation, myalgia, lymphadenitis, gout, wounds, leg ulcers, and eczema. Overview Trigonella foenum graecum is native to the Mediterranean, Ukraine, India, and China, and is widely cultivated in these regions. Fenugreek is cultivated its seeds, which contain coumarin, and are commonly used as flavoring in curries and soups. The celery-scented oil is also used in butterscotch, cheese, licorice, pickle, rum, syrup, and vanilla flavors. When mixed with cottonseed, fenugreek seed is said to increase the flow of milk in cows. Fenugreek also is a source of diosgenin, which is used in the synthesis of hormones. As with many industrial crops, a large amount of fenugreek must be ?thrown into the pot? to extract a small percentage. While the ?pot is boiling,? proteins, fixed oils, oleoresins, and gums can be extracted. Organic residue can be used for biomass fuels or manures; inorganic residues for chemical fertilizers; seed husk might be removed for its mucilage; and seed mucilage could be used after the fixed oil is extracted. Seed mucilage is viscous and a good emulsifying agent for use in the pharmaceutical and food industries 8 6 9 . Identifying Characteristics Part Characteristics Leaves Flowers Leaves petiolate and are in three In the axils of the leaves, pale-yellow, and pale violet toward the base Seeds Taste Light-brown or reddish to yellowish-grey, rhombic, and .11-.19-in. long and .07-.11-in. wide and thick Somewhat bitter and mucilaginous Odor Characteristic and spicy 8 6 9 Duke, J. Ph D . Handbook of Medicinal Herbs . CR C Press. Boca Raton: FL , 2001. 3 4 1 Module Ei ght P a r t s U s e d Seed Dosage and Administration To promote healthy blood sugar levels in those with diabetes, 10-15 g per day with meals has been used 8 7 08 7 1 . For use with hyperlipidemia, .6-2.5 g, two times daily with meals has been used 8 7 2 . For use with type 1 diabetes, 100 g of debitterized, powdered seed divided into two equal doses has been used 8 7 3 . For use with type 2 diabetes, 2.5 g of powdered seed put into capsule form, twice daily for thee months 8 7 4 , or 25 g of powdered seed divided into two equal doses 8 7 5 . 8 7 0 Madar Z, Abel R, Samish S, Arad J. Glucose-lowering effect of fenugreek in no n -ins ulin dependent diabetics. Eur J Clin Nutr 198 8 ;42:5 1 -4. 8 7 1 Bhardwaj PK , Dasgu pta DJ, Prashar BS, Kaushal SS. Co ntrol of hy perglycaemia and hyperlipidaemia by plant product. J Assoc Physicians India 1994;42:33-5. 8 7 2 Bordia A, Verma SK, Srivastava KC. Ef fect of ginger ( Zingiber officinale Rosc.) and fenugreek ( Trigonella foenumgraecum L.) on blood lipids, blood sugar and platelet aggregation in patients wi th coronary artery disease. Prostaglandins Leukot Essent Fatty Acids 199 7 ; 5 6 :379- 84. 8 7 3 Sharma RD , Raghuram TC , and Rao NS . Ef fect of fenugreek seeds on blood glucose and serum lipids in type I diabetes. Eur J Clin Nutrit 1990;44(4):301-306. 8 7 4 Bordia, A., Verma, S. K., and Srivastava, K. C . Effect of ginger (Zingiber officinale Rosc.) and fenugreek ( Trigonella foenumgraecum L.) on blood lipids, blood sugar and platelet aggregation in pa tients with coronary artery disease. Prostaglandins Leukot Essent Fatty Acids 199 7 ; 5 6 ( 5 ) :379-384. 8 7 5 Sharma RD , Sarkar A, Hazra DK , and et al. To xicological evaluation of fenugreek seeds: a long term feeding experiment in diabetic patients. Phytother Res 1 9 9 6 ; 10(6) : 5 1 9 - 5 20. 3 42 Module Ei ght Duration of Administration None known. Active Constituents The active constituents in fenugreek include alkaloids, proteins (high quantities of lysine and tryptophan), free amino acids (4- hydroxyisoleucine, histidine, lysine, and arginine), flavonoids, saponins, coumarin, lipids, mucilaginous fiber, vitamins (including nicotine acid), and minerals 8 7 6 . Pharmacological Action Fenugreek seeds contain about 50% dietary fiber and pectin and, therefore, may slow glucose absorption. About 80% of the total content of free amino acids in the seeds is present as 4- hydroxyisoleucine, which seems to directly stimulate insulin 8 7 7 . This effect, however, is glucose dependant; it only occurs in the presence of moderate to high glucose concentrations. Animal studies have observed the hypoglycemic effects of fenugreek, and associate the effect with a fraction, called the A subfraction, which contains the testa and endosperm of the defatted seeds. These same effects may not occur with lipid extracts 8 7 8 . The hypoglycemic action of fenugreek has been attributed to several mechanisms. In a 1998 study, the amino acid 4-hyroxyisoleucine in fenugreek seeds was shown to increase glucose-induced insulin 8 7 6 Barnes, J., A nderson , L., and Phillipso n , J.D . Herbal Medicines , T hird Edition. Pharmaceutical Press. Lo ndon, 2007. 8 7 7 Broca C, Manteghetti M, Gross R, et al. 4-Hydroxyisoleucine: effects of sy nthetic and natural analogues on ins ulin secretion. Eur J Pharmacol 2000;390:339-45. 8 7 8 Ribes G, Sauvaire Y, Baccou JC , Valette G, Chenon D, Trimble ER, Lo ubatières-Mariani MM. Effects of fenugreek seeds on endocrine pancreatic secretions in dogs. Ann Nutr Metab . 19 84;28 ( 1 ) :37-43. 3 4 3 Module Ei ght release in vitro in human and rat pancreatic islet cells 8 7 9 . This amino acid, however, only appeared to act on pancreatic beta cells. In another in vitro study, fenugreek seed extract was shown to phosphorylate several proteins, such as the insulin receptor, insulin receptor substrate 1 and p85 subunit of PI3-K, in both 3T3-L1 adipocytes and human hepatoma cells, HepG2 8 80 . Fenugreek?s effects, therefore, could be due to activation of the insulin-signaling pathway in adipocytes and liver cells. In human studies, fenugreek reduced the area under the plasma glucose curve (AUC) and increased the number of insulin receptors, though the mechanism of action is unclear 8 8 1 . Additionally, fenugreek seeds are thought to instigate hypoglycemic effects by stimulating glucose-dependent insulin release by beta cells 8 8 2 or by inhibition of -amylase and sucrase activity 8 8 3 . Fenugreek may also have analgesic and anticarcinogenesis effects. In rat studies, Trigonella foenum-graecum extract exhibited analgesic 8 7 9 Sauvaire, Y., Petit, P., Broca, C., Manteghetti, M., Baissac, Y., Fernandez- Alvarez, J., Gross , R . , R o ye, M., Leconte, A., G o mis, R., and Ribes, G. 4- Hydroxyisoleucine: a novel amino acid potentiator of insulin secretion. Diabetes 1 9 9 8 ;47(2 ) : 206-2 10 8 8 0 Vijayakumar, M. V., Sing h , S., C h hipa, R. R., and Bhat, M. K. The hyp o glycaemic activity of fenugreek s eed extract is mediated throug h the stimulation of an insulin signalling pathway . Br J Pharmacol 2005;146(1 ) :41-48. 8 8 1 Raghuram TC , Sharma RD, Sivakumar B, and et al. Effect of fenugreek seeds on intravenou s glucose dispo sition in no n -ins ulin dependent diabetic patients. Phytotherapy Research 1994;8( 2 ) : 83-86 . 8 8 2 Ajabnoor MA and Tilmisany AK . Ef fect of Trigonella foenum graecum on blood glucose levels in normal and alloxan-diabetic mice . J Ethnopharm 198 8 ; 2 2 :45-49. 8 8 3 Amin R, Abdul-G hani AS , and Suleiman MS. Ef fect of Trigonella feonum graecum o n intestinal absorption. Proc. of the 47th An n ual Meeting of the American Diabetes Ass ociation (India napolis U.S . A . ) . Diabetes 198 7 ;36(S u p p 1) : 2 1 1a. 3 4 4 Module Ei ght activity by blocking spinal purinoceptors 8 8 4 , and inhibited colon carcinogenesis 8 8 5 and diosgenin from fenugreek suppressed total colonic aberrant crypt foci formation 8 8 6 . Medicinal Uses Fenugreek leaves and seeds are used to make extracts and powders for medicinal use. In ancient Egypt, the use of fenugreek in incense and for embalming mummies was well documented. In Egypt today, fenugreek is used as a supplement to wheat and maize flour for making bread 8 8 7 , which increases the protein, fat, lysine, minerals, and dietary fiber contents of the bread in proportion to the amount of fenugreek used 8 8 8 . Additional documented uses of fenugreek include: In ancient Rome, fenugreek was used as an aid during labor and delivery. 8 8 4 Parvizp ur A, Ah madiani A, Kamalinejad M. Probable role of spinal purinoceptors in the analgesic effect of Trigonella foenum (TF G ) leaves extract. J Ethnopharmacol . 2006 Mar 8;104(1- 2 ) : 108-1 2 . Ep ub 2005 No v 17 . 8 8 5 Devasena, T. and Menon, V. P. Fenugreek affects the activity of beta- glucuronidase and mucinase in the colon . Phytother Res 2003;17 ( 9 ) : 1088- 1091. 8 8 6 Raju, J., Patlolla, J. M., Swamy, M. V., and Rao, C. V. Dios genin, a steroid saponin of Trigonella foenum graecum (Fenugreek), inhibits azox y methane- induced aberrant crypt foci formation in F344 rats and induces apoptosis in HT- 2 9 hu man colon cancer cells. Cancer Epidemiol.Biomarkers Prev. 2004;13(8) : 1392- 1398. 88 7 Zia T, Hasnain SN , Hasan SK. Evaluation of the oral hyp o glycaemic effect of Trigonella foenum-graecum L. (methi) in normal mice . J Ethnopharmacol. 2001 May;75 ( 2 -3):1 9 1 - 5 . 8 8 8 Hooda S, Jo od S. N utritional evaluation of wheat-fenugreek blends for product making . Plant Foo ds Hum Nutr . 2004 Fall;59 (4):149-54. 3 4 5 Module Ei ght In traditional Chinese medicine, fenugreek seeds have been used as a tonic and for weakness and edema of the legs 8 8 9 . In India, fenugreek is commonly used as a condiment and, medicinally, as a stimulant for lactation 8 9 0 . In current preliminary research, fenugreek has been shown to have stimulating effects on the uterus, intestine, and heart 8 9 1 . Contraindications Avoid use if there is a known allergy to fenugreek, its constituents, or members of the Fabaceae family. Chickpea is a member of the Fabaceae family and has exhibited cross-reactivity with patients allergic to fenugreek. Other Fabaceae plants include soybeans, peanuts, and green peas. Simultaneous use of fenugreek with herbs decrease blood glucose levels might have additive effects 8 9 2 . Closely monitor blood glucose levels in people with diabetes. Due to a lack of reliable information, contraindicated for use while pregnant and breast-feeding. A d v e r s e E f f e c t s Fenugreek can cause diarrhea and flatulence 8 9 3 . With large doses, hypoglycemia is possible 8 9 4 . Potential allergic reactions include nasal 8 8 9 Yo s hikawa M, Murakami T, Ko matsu H, Murakami N, Yamahara J, Matsuda H. Medicinal foodstuff s . IV. Fenugreek seed. (1) : structures of trigoneosides Ia, Ib, IIa, IIb, IIIa, and IIIb, ne w furostanol saponins from the seeds of Indian Trigonella foenum-graecum L. 8 9 0 Patil SP, Niphadkar PV, Bapat MM. Allergy to fenugreek ( Trigonella foenum graecum). Ann Allergy Asthma Immunol . 19 9 7 Mar;78 (3):2 9 7 -300. 8 9 1 Abdo MS, al-Kafawi AA. Ex perimental studies on the effect of Trigonella foenum-graecum (abstract). Planta Med 196 9 ; 1 7 : 14-8. 8 9 2 Madar Z, Abel R, Samish S, Arad J. Glucose-lowering effect of fenugreek in no n -ins ulin dependent diabetics. Eur J Clin Nutr 198 8 ;42:5 1 -4. 3 4 6 Module Ei ght congestion, hoarseness, persistent coughing, wheezing, facial angioedema, and shock 8 9 5 . Children drinking fenugreek tea can experience an unusual body order, and there have been reports of loss of consciousness 8 9 6 . Drug and Supplement Interactions Simultaneous use of herbs that contain coumarin constituents, or herbs that affect platelet aggregation, might increase the risk of bleeding in some people 8 9 78 9 8 . These herbs include: Angelica, anise, arnica, asafoetida, bogbean, boldo, capsicum, celery, chamomile, clove, danshen, feverfew, garlic, ginger, ginkgo, Panax ginseng, horse chestnut, horseradish, licorice, meadowsweet, prickly ash, onion, papain, passionflower, poplar, quassia, red clover, turmeric, wild carrot, wild lettuce, and willow. Simultaneous use of herbs that decrease blood glucose levels might have additive effects 8 9 99 0 0 . Herbs with hypoglycemic potential include: 8 9 3 Sharma RD, Ragh uram TC , Rao NS . E f fect of fenugreek seeds on blood glucose and serum lipids in type I diabetes. Eur J Clin Nutr 1990;44:301-6. 8 9 4 Madar Z, Th orne R. Dietary fiber. Prog Foo d Nutr Sci 198 7 ; 1 1 : 1 53-74. 8 9 5 Patil SP, Niphadkar PV, Bapat MM. A llergy to fenugreek (Trigonella foenum graecum). Ann Allergy Asthma Immunol 199 7 ; 7 8 : 2 9 7 -300. 8 9 6 Sewell AC, Mosandl A, Bo hles H. False diagno sis of maple syrup urine disease owing to ingestion of herbal tea. N Engl J Med 199 9 ;341:7 6 9 . 8 9 7 Lambert J, Cormier J. Potential in teraction between warfarin and boldo- fenugreek. Pharmacotherapy 2001;2 1 : 509-1 2 . 8 9 8 Dr. Du ke's Ph ytochemical and Ethnobotanical Databases. . Available at: http:/ / w w w .ars-grin.g o v /duke/. 8 9 9 Madar Z, Abel R, Samish S, Arad J. Glucose-lowering effect of fenugreek in no n -ins ulin dependent diabetics. Eur J Clin Nutr 198 8 ;42:5 1 -4. 9 0 0 Bhardwaj PK, Dasgu pta DJ, Pras har BS, Kaushal SS. Co ntrol of hy perglycaemia and hyperlipidaemia by plant product. J Assoc Physicians India 1994;42:33-5. 3 4 7 Module Ei ght Devil?s claw, fenugreek, garlic, guar gum, horse chestnut seed, Panax ginseng, psyllium, and Siberian ginseng. Simultaneous use with anticoagulant or antiplatelet drugs might have additive effects, increasing risk of bruising and bleeding. Some constituents of fenugreek have antiplatelet effects; however, they might not be present in clinically significant concentrations 9 0 19 0 2 . Drugs with anticoagulant or antiplatelet effects include: Aspirin, clopidogrel (Plavix), nonsteroidal anti-inflammatory drugs (NSAIDs) such as diclofenac (Voltaren and Cataflam), ibuprofen (Advil, Motrin, and others), naproxen (Anaprox, Naprosyn, and others), dalteparin (Fragmin), enoxaparin (Lovenox), and heparin. Based on its constituents, fenugreek might inhibit activity of corticosteroid drugs; however, there is no reliable human data to confirm this. Additionally, the high mucilage content of fenugreek might decrease or delay the absorption of drugs consumed orally. Regulatory Status Listed as a Class 2b (Not to be used during pregnancy) in the American Herbal Products Association?s Botanical Safety Handbook . 9 0 1 Lambert J, Cormier J. Potential in teraction between warfarin and boldo- fenugreek. Pharmacotherapy 2001;2 1 : 509-1 2 . 9 0 2 Dr. Du ke's Ph ytochemical and Ethnobotanical Databases. . Available at: http:/ / w w w .ars-grin.g o v /duke/. 3 4 8 Module Ei ght T r i l l i u m e r e c t u m Image 52: by Meneerke Bloe m (2007) via Wikipedia.org Taxonomic Notes Common botanical name: Beth Root Family: Liliaceae C o m m o n N a m e s Birthroot, coughroot, ground lily, Jew?s harp plant, Indian balm, Indian shamrock, lamb?s quarters, milk ipecac, Pariswort, rattlesnake root, snakebite, stinking Benjamin, three-leafed nightshade, and wake-Robin P r i m a r y U s e s Beth root has astringent, tonic, and antiseptic properties 9 0 3 . When taken orally, it has been used for long, heavy menstruation and pain relief, and as an expectorant. In specific, beth root has been used with hemoptysis, hematuria, menorrhagia, uterine hemorrhage, 9 0 3 Henriette?s Herbal Homepage accessed 6/1 9 /09: http:/ / w w w . henr iettesherbal.com /eclectic/king s /trillium .html 3 4 9 Module Ei ght metrorrhagia, leucorrhoea, cough, asthma, difficult breathing, and was reportedly used by Indian women to aid with childbirth. Topically, beth root is used for varicose veins and ulcers, hematomas, and hemorrhoid bleeding. In food, the leaves can be eaten cooked as a potherb or raw in salads, which imparts a somewhat sunflower seed-like taste 9 0 4 . Overview Trillium erectum is a low-growing perennial, which typically reaches about 1.5-ft. high and 1-ft. wide. Identifying Characteristics Part Characteristics Leaves Flowers Stout stem with three leaves arranged in a circle near the top; 3-7-in. long Hermaphroditic; flowers April to June; three petals are dark purple-pink-greenish or white and about 1 ¼ -in. long and ½ -in. wide Root Taste Oblong, tuberous root about 10-15-in. high Somewhat bitter and mucilaginous Aromatic and sweetish; when the roots are chewed, acrid and astringent Odor Faint, turpentine-like odor P a r t s U s e d Rhizome, dried root, and leaf C u l t i v a t i o n a n d C o l l e c t i o n Beth root thrives in open, deciduous woodland 9 0 5 . It prefers a neutral to slightly acid soil 906 , and can live in sunny or shady spots as long as 9 0 4 Plants for a Future accessed 6/1 9 /09: http:/ / w w w . p faf.org/database/plants.p h p ? Trillium +erectum 3 5 0 Module Ei ght the soil remains moist. A hardy plant, beth root can tolerate temperatures as low as -31ºF 9 0 7 . Seed in a cold frame as soon as ripe 9 0 8 . (Stored seed should be sown in late winter or early spring.) Seed typically germinates within 1-3 months at a temperature of 59ºF. Young plants should be wintered in a cold frame, and then planted out in late spring. Division when the plants die down after flowering 9 0 9 . Larger divisions can be planted into their permanent positions. Dosage and Administration When taken orally, there is no typical dosage. Topically, the ground parts are typically used as a poultice 9 1 0 . Duration of Administration None known. Active Constituents There is insufficient reliable information about the possible mechanism of action or active ingredients. 9 0 5 Phillips. R . and Rix. M. Bulbs Pan Boo k s , 19 8 9 . 9 0 6 Huxley. A. The New RHS Dictionary of Gardening . MacMillan Press, 19 9 2 . 9 0 7 Bo w n . D . Encyclopaedia of Herbs and their Uses . D orling Kindersley, Lo ndon, 19 9 5 . 9 0 8 Rice. G. (Editor) Growing from Seed . V olume 2. Th o m p s o n and Morgan, 19 8 8 . 9 0 9 Huxley. A. The New RHS Dictionary of Gardening . MacMillan Press, 19 9 2 . 9 1 0 Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines . 1st ed. Montvale, NJ: Medical Econo mics Co m pany , Inc., 19 9 8 . 3 5 1 Module Ei ght Medicinal Uses Beth root is an emmenagogue and uterine stimulant, which, in general, promote menstruation, and tone and strengthen muscle tone, glandular tissue, and blood supply of the uterus. Contemporary herbal medicine uses uterine stimulants to tone and strengthen the female reproductive organs, which can lead to improved reproductive health, improved fertility, more stable pregnancy, and improved recovery from pelvic infections and invasive gynecologic procedures 9 1 1 . Contraindications Beth root is contraindicated for use with patients who have a known cardiac condition; beth root has potential cardiotoxicity from the convallamarin-like glycoside. In addition, beth root might have menstrual or uterine stimulant activity, and should be avoided while pregnant and lactating 9 1 29 13 . A d v e r s e E f f e c t s Ingesting large amounts of beth root plant material or volatile oil might create gastrointestinal irritation and vomiting 9 1 49 1 5 . These strong purgative effects can cause reflex uterine contractions in pregnant women. 9 1 1 McGuff fin, M. eds at all. American Herbal Products Association?s Botanical Safety Handbook . CR C Press. Boca Raton, FL : 19 9 7 . 9 1 2 McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook . Boca Raton, FL : CR C Press, LL C 19 9 7 . 9 1 3 Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines . 1st ed. Montvale, NJ: Medical Econo mics Co m pany , Inc., 19 9 8 . 9 1 4 McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook . Boca Raton, FL : CR C Press, LL C 19 9 7 . 9 1 5 Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines . 1st ed. Montvale, NJ: Medical Econo mics Co m pany , Inc., 19 9 8 . 3 52 Module Ei ght When used topically, beth root can cause extreme irritation 9 1 6 . Drug and Supplement Interactions None known. Regulatory Status Listed as a Class 2b (Not to be used during pregnancy) in the American Herbal Products Association?s Botanical Safety Handbook . Module Assessment You are now ready to log in and complete the module assessment online. Refer back to the instructions in Module One if you need to. 9 1 6 Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines . 1st ed. Montvale, NJ: Medical Econo mics Co m pany , Inc., 19 9 8 . 3 5 3 Module Nine Module Nine Module Objectives Upon completion of this module, you will be able to: ? Recall and describe the Latin binomial or scientific name, common name, and family. ? Be able to identify a photograph by the Latin name and common name of the botanicals studied. ? Identify the therapeutic potential of each botanical studied. ? Explain the pharmacological action of each botanical studied. ? List the key recommended uses for each botanical studied. ? Recall the recommended dosage and duration for each botanical studied. ? Recall and describe any contraindications and precautions associated with each botanical studied. ? Recall the regulatory status of each of botanical studied. Module Checklist ? Read and review the module. ? Read any online resources as applicable. ? Ensure you can meet the Module Objectives. ? Complete the module assessment online and respond to another student?s posting as instructed. ? Complete the Module Test. 9 3 5 4 Module Nine T u r n e r a d i f f u s a ( synonyms D a m i a n a a p h r o d i s i a c a , T u r n e r a a p h r o d i s i a c a , and T u r n e r a m i c r o p h y l l a ) Image 53: by user Dominiku (2006) via Wikipedia.org Taxonomic Notes Common botanical name: Damiana Family: Bignoniaceae/Turneraceae C o m m o n N a m e s Damiana herb, damiana leaf, herba de la pastora, Mexican damiana, mizibcoc, old woman?s broom, rosemary, Turnerae diffusae folium , and Turnerae diffusae herba P r i m a r y U s e s Damiana is said to possess antidepressant, thymoleptic, mild purgative, stomachic, and aphrodisiac properties. It has been used with atonic constipation, bedwetting, boosting mental and physical capacity, 3 5 5 Module Nine depression, nervous dyspepsia, sexual disturbances, and for anxiety neurosis with a ?predominant sexual factor 9 1 7 .? Overview Damiana is a wild shrub that can be found in Mexico, Central America, and the West Indies. Traditionally, damiana has been used as an aphrodisiac 9 1 8 , and as an anti-cough and diuretic agent. Identifying Characteristics Part Characteristics Leaves Flowers Smooth and pale-green on the upper side; the underside is glabrous, with short petiolate and two small glands at the base Yellow and the capsule is one-celled, splitting into three pieces Taste Odor Bitter Aromatic 9 1 9 P a r t s U s e d Leaf and stem Dosage and Administration When taken orally, a typical dose is 2-4 g of dried leaf, three times a day, or one cup of tea, three times a day. To make the tea, steep 2-4 g of dried leaf in 150 mL of boiling water for 5-10 minutes, and then strain. As a liquid extract, a typical dose is 2-4 mL. 9 1 7 Barnes, J., A nderson , L., and Phillipso n , J. D . Herbal Medicines , T hird Edition. Lo ndon: Pharmaceutical Press, 2007. 9 1 8 Alcaraz-Melendez L, Delgado-R odriguez J, Real-Co sio S. Analysis of essential oils from wild and micr opropagated plants of damiana ( Turnera diffusa ) . Fitoterapia 2004;75 :6 9 6 - 701. 9 1 9 http:// w w w . herbsguide.net/damiana.html 3 5 6 Module Nine Active Constituents More than 35 compounds have been identified in damiana, including flavonoids, terpenoids, saccharides, and cyanogenic glycosides, specifically: Triacontane, beta-sitosterol, hexacosanol, 5-hydroxy- 7,3,4-trimethoxyflavone, arbutin, tannins, resins, hydroquinone glycosides, and luteolin 8-C-E-propenoic acid 9 2 09 2 1 . Damiana extracts are said to have CNS depressant activity shown in animal studies and antibacterial activity in vitro resulting from the constituent quinone arbutin 9 2 2 . Pharmacological Action Traditionally, Turnera diffusa has been used as an aphrodisiac. In a 2008 study, Turnera diffusa was investigated for the anti-aromatase and estrogenic activity of its constituents. The methanolic and 24 compounds isolated from Turnera diffusa were studied. The methanolic extract showed dose-dependent inhibitory activity of the aromatase enzyme with the IC(50) value of 63.1 microg/ml. Of the 24 compounds tested, pinocembrin and acacetin showed the most potent inhibition (respective IC(50) values of 10.8 and 18.7 microM). The extract of Turnera diffusa and the compounds pinocembrin and acacetin could, therefore, effectively suppress aromatase activity 9 23 . M e d i c i n a l U s e s In a 1999 animal study, Turnera diffusa extract was evaluated for use with sexual complaints. Sexually potent and sexually sluggish/impotent 9 2 0 Arletti R, Benelli A, Cavazzuti E, et al. Stimulating property of Turnera diffusa and Pfaffia paniculata extracts on the sexual-behavior of male rats. Psychopharmacology (Berl) 199 9 ; 143:15 - 9 . 9 2 1 Zhao J, Pawar RS, Ali Z, Khan IA. Ph ytochemical investigation of Turnera diffusa. J Nat Prod 2007;70:28 9 - 9 2 . 9 2 2 Newall CA , A nderson LA , Philpso n JD . Herbal Medicine: A Guide for Healthcare Professionals . Lo ndon, UK : The Pharmaceutical Press, 19 9 6 . 9 2 3 Zhao J, Dasmahapatra AK, Khan SI, Kh an IA. Anti-aromatase activity of the constituents from damiana ( Turnera diffusa ) . J Ethnopharmacol . 2008 Dec 8;1 20(3):387- 93. Ep ub 2008 Sep 26 . 3 5 7 Module Nine male rats were orally given different amounts of Turnera diffusa and Pfaffia paniculata fluid extracts (0.25, 0.50, 1.0 ml/kg). Both plant extracts (singly or in combination) improved copulation of the sluggish/impotent rats. In specific, the highest dose of both extracts increased the percentage of rats that achieved ejaculation, and significantly reduced mount, intromission, and ejaculation latencies, post-ejaculatory interval, and intercopulatory interval. These results support the traditional use of damiana as a sexual stimulant 9 2 4 . Contraindications Avoid excessive use because damiana contains cyanogenetic glycosides and arbutin 9 2 5 . Due to a lack of toxicity data, damiana should be avoided while pregnant and breast-feeding. Use caution with patients who have a known allergy or hypersensitivity to Turnera diffusa , its constituents, and plants in the Turneraceae family. In addition, use cautiously with patients with a history of breast cancer 9 2 6 , because damiana may interact with progesterone receptors on cells, and with patients taking medications for diabetes or to control blood sugar 9 2 7 as damiana may affect blood sugar levels. Avoid use with patients who have Alzheimer?s and Parkinson?s disease, because ethanol extract of the leaves and stem have CNS depressant action. 9 2 4 Arletti R, Benelli A, Cavazzuti E, Scarpetta G, Bertolini A. Stimulating property of Turnera diffusa and Pfaffia paniculata extracts on the sexual-behavior of male rats. Psychopharmacology ( Berl). 19 9 9 Mar;143(1) : 1 5 - 9 . 9 2 5 Barnes, J., A nderson , L., and Phillipso n , J.D . Herbal Medicines , T hird Edition. Lo ndon: Pharmaceutical Press, 2007. 9 2 6 Zava DT, Dollbaum CM, Blen M. Estrogen and progestin bioactivity of fo ods, herbs, and spices. Proc Soc Exp Biol Med. 199 8 Mar;21 7 (3):369- 7 8 . 9 2 7 Alarcon-A g uilara FJ, Ro man-Ramo s R, Perez-G utierrez S, Ag uilar-C o ntreras A, Co ntreras-Weber CC, Flores-Saenz JL . Study of the anti-hy perglycemic effect of plants used as antidiabetics. J Ethnopharmacol. 199 8 Ju n ; 6 1 ( 2 ) : 101-10. 3 5 8 Module Nine A d v e r s e E f f e c t s Do not use in excessive amounts. When taken orally, 200 g of damiana extract has been shown to cause tetanus-like convulsions and paroxysms with symptoms reminiscent of rabies and strychnine poisoning 9 2 8 . Drug and Supplement Interactions Damiana may act as an antidiabetic or hypoglycemic agent affecting blood sugar levels 9 2 99 3 0 . In addition, damiana may stimulate intracellular receptors for progesterone cells 9 3 1 . Regulatory Status Damiana is listed as a Class 1, and herb that can be safely consumed when used appropriately, in the American Herbal Products Association?s Botanical Safety Handbook . Damiana also appears on the U.S. Food and Drug Administration?s (FDA) Generally Recognized as Safe list and is widely used as a food flavoring. 9 2 8 Newall CA , A nderson LA , Philpso n JD . Herbal Medicine: A Guide for Healthcare Professionals . Lo ndon, UK : The Pharmaceutical Press, 19 9 6 . 9 2 9 Alarcon-A g uilara FJ, Ro man-Ramo s R, Perez-G utierrez S, Ag uilar-C o ntreras A, Co ntreras-Weber CC, Flores-Saenz JL . Study of the anti-hy perglycemic effect of plants used as antidiabetics. J Ethnopharmacol. 199 8 Ju n ; 6 1 ( 2 ) : 101-10. 9 3 0 Alarcon-A g uilar FJ, Ro man-Ramo s R, Flores-Saenz JL , A g uirre-Garcia F. Investigation on the hyp o glycaemic effects of extracts of fo ur Mexican medicinal plants in normal and alloxan-diabetic mice . Phytother Res . 2002 Jun ; 1 6 (4):383-6. 9 3 1 Zava DT , Dollbaum CM, Blen M. Estr ogen and progestin bioactivity of fo ods, herbs, and spices. Proc Soc Exp Biol Med . 19 9 8 Mar;21 7 (3):369- 7 8 . 3 5 9 Module Nine T u s s i l a g o f a r f a r a Image 54: by user Ekko (2007) via Wikipedia.org Taxonomic Notes Common botanical name: Coltsfoot Family: Asteraceae/Compositae C o m m o n N a m e s Ass?s foot, brandlattich, British tobacco, bullsfoot, colts foot, Coughwort, farfarae folium leaf, fieldhove, filuis ante patrem, flower velure, foal?s foot, foalswort, guflatich, hallfoot, horsefoot, horsehoof, kuandong hua, pas d?ane, pas Diane, pferdefut, and tussilage P r i m a r y U s e s Taken orally, coltsfoot is primarily used with acute respiratory tract mucous membrane inflammation (with cough and hoarseness), acute or mild inflammation of the oral and pharyngeal mucosa, asthma , bronchitis, laryngitis, pertussis, and sore throat. 3 6 0 Module Nine As an inhalant, coltsfoot is used with cough and for wheezing. Overview The name ?farfara? is derived from farfarus , an ancient name for white poplar. The leaves of coltsfoot and white poplar resemble each other. Historically, coltsfoot was called Filius ante patrem , or ?the son before the father,? because the flowers bloom and wither before the leaves appear. According to A Modern Herbal 9 3 2 , the botanical name Tussilago indicates the herb is a ?cough dispeller,? further supported by authorities like Dioscorides, Galen, Pliny, and Boyle who have recommended smoking coltsfoot leaves to relieve cough. In addition, coltsfoot works as a demulcent, expectorant, and tonic, and can be combined with herbs like horehound and marshmallow. 9 3 2 Grieve, M. A Modern Herbal . Botanical.com accessed 7/23/09: http:/ / w w w .botanical.com/botanical/m g m h /c/coltsf8 8 . html 3 6 1 Module Nine Identifying Characteristics Part Characteristics Leaves Flowers Fruit Taste Odor Thin, palmate, lobed, about 7-8-in. wide, and with a distinct petiole; the lower leaf is white and felted and the upper lead is yellowish-green Perennial herb that flowers from February-April; yellow capitula with narrow ligulate florets White pappus Somewhat mucilaginous and sweet Slight P a r t s U s e d Flower and leaf C o l l e c t i o n a n d C u l t i v a t i o n The leaves are typically collected in June and early July, and the flowers are collected around February. Dosage and Administration No typical dosage. Duration of Administration According to the German Commission E Monographs, do not use for more than 4-6 weeks per year. Active Constituents 9 3 3 Tussilago farfara contains flavonoids (including the flavonols kaempferol and quercetin, and their glycosides), alkaloids (pyrrolizidine-type 9 3 4 ), 9 3 3 Barnes, J., A nderson , L., and Phillipso n , J.D . Herbal Medicines , T hird Edition. Pharmaceutical Press. Lo ndon, 2007. 3 62 Module Nine acids (caffeic acid, caffeoyltartaric acid, ferulic acid, gallic acid, p - hydroxybenzoic acid, and tannic acid), carbohydrates (including mucilage and inulin), and tannins. Additional constituents include: Bitter (glycoside), choline, paraffin, phytosterols, triterpene, tussilagone, and volatile oil. Pharmacological Action In a 1989 study, 35 asthmatics in the convalescent stage were given a Chinese herbal medicine decoction including Viscum coloratum (15g), Psoralea corylifolia (15g), Eucommia ulmoides (15g), Lycium chinense (9g), Tussilago farfara (15g), Artemisia capillaris (9g), and Pogostemon cablin (9g) daily for 10 weeks. Results showed different MEFV parameters were improved after use of the herbal decoction, suggesting airway obstruction in convalescent asthmatics might be reversible 9 3 5 . In addition, an extract of Tussilago farfara , tussilagone, has been found to be an effective cardiovascular and respiratory stimulant. When administered intravenously, tussilagone has been shown to produce an instant and dose-dependent pressor effect in anesthetized dogs (0.02- 0.3 mg/kg), cats (0.02-0.5 mg/kg), and rats (0.4-4 mg/kg) similar to the effect of dopamine 9 3 6 . 9 3 4 Due to its pyrrolizidine alkaloid content, coltsfo ot may be toxic to the liver in large doses. Roder, E., Wiedenfeld, H., and Jost, E. J. [T u s silagine - a New Pyrrolizidine Alkaloid from Tussilago farfara . ] . Planta Med 198 1 ;43(9) : 9 9 - 102. 9 3 5 Fu JX . [Measurement of MEFV in 66 cases of asthma in the convalescent stage and after treatment with Chinese herbs]. Zhong Xi Yi Jie He Za Zhi . 19 8 9 N o v ; 9 ( 1 1 ) : 6 5 8 - 9 , 644. 9 3 6 Li YP, Wang YM. Evaluation of tussilagone: a cardiovascular-respiratory stimulant isolated from Chinese herbal medicine. Gen Pharmacol . 19 8 8 ; 1 9 ( 2 ) : 2 6 1 -3. 3 6 3 Module Nine M e d i c i n a l U s e s In a 2008 study 937 , 22 aqueous extracts from 17 Turkish plants were investigated for antibacterial activity and toxicity. Extracts of Tussilago farfara leaves, Helichyrsum plicatum flowers, aerial parts of Solanum dulcamara , and Urtica dioica leaves showed the most inhibitory activity against the bacteria S. pyogenes , S. aureus , and S. epidermidis . Tussilago farfara flower buds, traditionally used in Oriental Medicine for asthma and bronchitis, showed anti-inflammatory activity by inhibiting arachidonic acid metabolism and nitric oxide (NO) production in lipopolysaccharide-activated macrophages in a 2005 animal study. The neutroprotective and antioxidant effects of Tussilago farfara might be useful with neurodegenerative disorders associated with inflammation, A(beta), excitotoxicity, and/or oxidative stress 9 3 8 . A d v e r s e E f f e c t s Both coltsfoot leaves and flowers contain unsaturated pyrrolizidine alkaloids in varying amounts; unsaturated pyrrolizidine alkaloids (UPAs) are hepatotoxic and hepatocarcinogenic, and repeat exposure to low concentrations of unsaturated pyrrolizidine alkaloids has been linked to veno-occlusive disease, a condition in which some of the small veins in the liver become blocked. (Teas made from coltsfoot leaves extract UPAs.) In addition, hepatotoxic PAs may be carcinogenic and mutagenic 939940 . 9 3 7 Turker AU, Usta C. Biological screening of so me Turkish medicinal plant extracts for antimicrobial and toxicity activities. Nat Prod Res . 2008 Jan 20;22 ( 2 ) : 136-46. 9 3 8 Cho J, Kim HM, Ryu JH, Jeong YS , Lee YS, Jin C. Neuroprotective and antioxidant effects of the ethyl acetate fraction prepared from Tussilago farfara L . Biol Pharm Bull . 2005 Mar;28 (3):455- 60. 9 3 9 Cho j kier M. Hepatic sinu s oidal-obstruction sy ndrome: toxicity of pyrrolizidine alkaloids. J Hepatol 2003;39:437-46. 9 4 0 Roeder E. Medicinal plants in Europe containing pyrrolizidine alkaloids. Pharmazie 199 5 ; 50:83-98 . 3 6 4 Module Nine Drug and Supplement Interactions Simultaneous use of coltsfoot and herbs and supplements that affect platelet aggregation might increase the risk of bleeding in some people. Herbs that affect platelet aggregation include: Angelica, clove, danshen, garlic, ginger, ginkgo, and Panax ginseng. Avoid simultaneous use of coltsfoot and hepatotoxic pyrrolizidine alkaloid-containing herbs due to the potential for additive toxicity. Hepatotoxic pyrrolizidine alkaloid-containing herbs include: Alkanna, boneset, borage, butterbur, coltsfoot, comfrey, forget-me-not, gravel root, groundsel, hemp agrimony, and hound?s tongue, as well as the Senecio species plants dusty miller, groundsel, golden ragwort, and tansy ragwort 941 . Due to the potential risk of hypotension, use caution when combining with additional herbs and supplements that have hypotensive effects, including: Andrographis, casein peptides, cats claw, coenzyme Q-10, fish oil, L-arginine, lycium, stinging nettle, and theanine. Regulatory Status Coltsfoot is listed in the American Herbal Products Association?s Botanical Safety Handbook as a Class 2b (not to be used during pregnancy), Class 2c (not to be used while nursing), and Class 2d (not to be used long-term) 9 4 2 . Canada: Not to be taken as a single active constituent. Approved active component in a few Traditional Medicines, some homeopathic medicines, and required pre-marketing authorization. U.K.: Not included on the General Sale List. U.S.: Products containing PA herbal ingredients are to be labeled: ?For external use only. Do not apply to broken or abraded skin. Do not use when nursing.? 9 4 1 Cho j kier M. Hepatic sinu s oidal-obstruction sy ndrome: toxicity of pyrrolizidine alkaloids. J Hepatol 2003;39:437-46. 9 4 2 McGuffin, M., eds et all. American Herbal Products Asso ciation?s Botanical Safety Handbook . CR C Press. Boca Raton, FL : 19 9 7 . 3 6 5 Module Nine U n c a r i a t o m e n t o s a Image 55: by Johannes Keplinger (2006) via Wikipedia.org Taxonomic Notes Common botanical name: Cats Claw Family: Rubiaceae C o m m o n N a m e s Cat?s claw, griffe du chat, life-giving vine of Peru, samento, and uña de gato P r i m a r y U s e s Taken orally, cats claw is used with colitis, diverticulitis, gastritis, hemorrhoids, leaky bowel syndrome, osteoarthritis, parasites, peptic ulcers, rheumatoid arthritis, and viral infections like herpes zoster, herpes simplex, and human immunodeficiency virus (HIV). Cats claw can also be taken orally for allergic rhinitis, arthritis, asthma, birth control, bone pains, cancer (especially urinary tract cancer), ?cleansing? the kidneys, dysentery, gonorrhea, and wound healing. 3 6 6 Module Nine Overview Uncaria tomentosa is native to the Amazon rainforest, as well as tropical areas in Central and South America, and can grow up to 100- ft. high. It is a woody vine with hook-like thorns from which the name ?cats claw? derives. Historically, South Americans dating back to the Incans have used cats claw with health challenges like arthritis, dysentery, fevers, inflammation, and stomach ulcers, and as a form of birth control 9 4 3 . There are several plant species marketed as cats claw, but the most common are Uncaria tomentosa and Uncaria guianensis . Both species are used for the same indications, though, traditionally, Uncaria tomentosa is thought to be a more effective immunostimulant. There are two chemotypes of Uncaria tomentosa with different alkaloid patterns: The pentacyclic alkaloid is considered more medicinal and the tetracyclic alkaloid is considered less potent. Currently, cats claw is being researched for its potential use with Alzheimer?s disease, Crohn?s disease, HIV, multiple sclerosis, osteoarthritis and rheumatoid arthritis, and systemic lupus erythematosus (SLE or lupus). P a r t s U s e d Roots, root bark, stem bark, and leaves Dosage and Administration When taken orally, a typical dose of cats claw is 350-500 mg, 1-2 times daily. When taken as a decoction, 1 g of root bark boiled for about 15 minutes in 250 mL of water, then taken 1-3 times daily. As a tincture, 1-2 mL, taken 2-3 times daily. 9 4 3 Accessed 7/23/09: http:/ / w w w .altmd.com/Articles/Cats-claw-U na-de-gato- U ncaria-tomentosa 3 6 7 Module Nine For use with cancer, boil 6.5 g of dried bark in water for three hours, and ingest for 15 days 9 4 4 . Duration of Administration None known. Active Constituents Uncaria tomentosa has two chemotypes: The pentacyclic alkaloid type and tetracyclic alkaloid type. The pentacyclic alkaloid type (POAs), which some consider to be the primary constituent in cats claw, has few to no tetracyclic alkaloids (TOAs). However, the tetracyclic alkaloid chemotype contains mainly TOAs, with few to none POAs. Note that TOAs are antagonistic toward the beneficial effects of POAs and, therefore, it is important to distinguish the two. Pentacyclic alkaloids contain: Isopteropodine (uncarine E), pteropodine (uncarine C), speciophylline (uncarine D), uncarine F, mitraphylline, and isomitraphylline. Tetracyclic alkaloids contain: Rhynchophylline, isorhynchophylline, corynoxeine, isocorynoxeine, pentacyclic indol alkaloids, tetracyclic indol alkaloids, and precursor alkaloids. Uncaria tomentosa also contains carboxy alkyl esters, flavonols, polyhydroxylated triterpenes, procyanidins, sterols, tannins, and triterpenes. Pharmacological Action Cats claw includes the major alkaloid rhynchophylline. Research supports rhynchophylline might have cardiovascular effects such as dilating peripheral blood vessels, lowering heart rate, and it might 9 4 4 Rizzi R, Re F, Bianchi A, De Feo V, de Simo ne F, Bianchi L, Stivala LA. Mutagenic and antimut agenic activities of Uncaria tomentosa and its extracts. J Ethnopharmacol . 19 93 Jan;38(1 ) : 63-77 . 3 6 8 Module Nine lower blood cholesterol. Rhynchophylline is also thought to inhibit sympathetic nervous system activity 9 4 5 . Due to its anti-inflammatory action, cats claw is used with osteoarthritis. Its effect appears to inhibit production of prostaglandin E2 and tumor necrosis factor-alpha (TNF-alpha). In a 2001 study, cats claw was investigated for its use with osteoarthritis of the knee. Results showed cats claw to have antioxidant and anti-inflammatory properties, perhaps resulting from its ability to inhibit TNFalpha and PGE2 production, and pain associated with activity was reduced 9 4 6 . In addition, there is potential for the use of cats claw with cancer and viral infections. Some of cats claw?s constituents appear to have antioxidant, immunostimulant, and antiviral effects 9 4 79 4 8 . In a randomized, placebo-controlled study, 23 healthy males were tested for their immune response to the pneumonia vaccine. They were administered 350 mg of cats claw twice daily for two months. Those who received the cats claw had an elevated lymphocyte/neutrophil ratio at two months (p<0.05) and at five months showed no loss of immunity (based on decay of 12 serotype pneumococcal antibody titers). The placebo group showed significant loss of immunity at five months 9 4 9 . 9 4 5 The Review of Natural Products by Facts and Comparisons . St. Lo uis, MO: W olters Kluwer Co., 19 9 9 . 9 4 6 Piscoya J, Rodriguez Z, Bu stamante SA , O k u hama NN , Miller MJ, Sandoval M. Efficacy and safety of freeze-dried cat' s claw in osteoarthritis of the knee: mechanism s o f action of the species Uncaria guianensis. Inflamm Res . 2001 Sep;50(9) :442-8 . 9 4 7 Sandoval M, Charbonnet RM, Oku hama NN , et al. Cat's claw inhibits TN Falpha production and scavenges free radicals: role in cytoprotection. Free Radic Biol Med 2000;29 :7 1 - 7 8 . 9 4 8 Piscoya J, Rodriguez Z, Bu stamante SA, et al. Efficacy and safety of freeze- dried cat?s claw in osteoarthritis of the knee: mechanism s of action of the species Uncaria guianensis. Inflamm Res 2001;50:442-448. 9 4 9 Lamm S, Sheng Y, Pero RW . Persistent respo n se to pneumococcal vaccine in individuals su p plemented with a no vel water-soluble extract of Uncaria tomentosa, C-Med-100. Phytomedicine. 2001 Jul;8 (4):2 6 7 - 74. 3 6 9 Module Nine In a randomized, placebo-controlled study of 12 healthy volunteers DNA repair and immune system enhancement were analyzed. One group was administered 250 mg/day of C-Med-100 supplement and another was administered 350 mg/day. A third group received a placebo. In both non-placebo groups, there was 12-15% enhanced DNA repair (as measured by alkaline elution, after eight weeks of use). No toxic effects were observed 9 5 0 . Medicinal Uses Cats claw is used as an anti-inflammatory to relieve pain and inflammation associated with osteoarthritis, painful and swollen joints, and rheumatoid arthritis. Cats claw also has a long history of use with chronic inflammatory disorders, including colitis, diverticulitis, gastritis, hemorrhoids, leaky bowel syndrome, parasites, and peptic ulcers. Research indicates cats claw may also be useful with viral infections including herpes zoster, herpes simplex, and human immunodeficiency virus (HIV). Current research is investigating the antioxidant properties of cats claw, as well as its ability to affect gene expression and modulate the immune system. Contraindications Cats claw has immune stimulating effects and is, therefore, contraindicated for use with patients who have autoimmune disorders. In specific, avoid use with multiple sclerosis and systemic lupus erythematosus (SLE). In addition, cats claw might reduce blood pressure and aggravate hypotension. A d v e r s e E f f e c t s Taken orally, cats claw can cause headache, dizziness, and vomiting. 9 5 0 Sheng Y, Li L, Holmgren K, Pero RW . DN A repair enhancement of aqueous extracts of Uncaria tomentosa in a human volunteer study. Phytomedicine. 2001 Jul;8 (4):2 7 5 - 8 2 . 3 7 0 Module Nine Avoid use while pregnant as cats claw can be used for birth control and while breast-feeding due to lack of reliable safety information. Drug and Supplement Interactions Cats claw may lower blood pressure. Use caution with patients also taking hypertensive medication. In addition, cats claw is immunostimulating. It stimulates phagocytosis and increases respiratory cellular activity and the mobility of leukocytes. Therefore, cats claw might interfere with immunosuppressant therapy and drugs, including: Azathioprine (Imuran), basiliximab (Simulect), cyclosporine (Neoral and Sandimmune), daclizumab (Zenapax), muromonab-CD3 (OKT3 and Orthoclone OKT3), mycophenolate (CellCept), tacrolimus (FK506 and Prograf), sirolimus (Rapamune), prednisone (Deltasone and Orasone), and other corticosteroids (glucocorticoids). Preliminary evidence suggests that cats claw can inhibit cytochrome P450 (CYP450) 3A4 enzyme, an enzyme involved in the metabolism of xenobiotics, which is primarily found in the liver. Cats claw might increase amounts of drugs that are metabolized by CYP450 3A4, though the interaction has yet to be reported in human studies. Drugs that are metabolized by CYP450 3A4 include: Lovastatin (Mevacor), ketoconazole (Nizoral), itraconazole (Sporanox), fexofenadine (Allegra), and triazolam (Halcion). Use caution with patients who are taking these drugs. Regulatory Status Canada: Status undetermined. No products containing cats claw are listed in the Health Canada Drugs Product Database 9 5 1 . UK: Not listed in the General Sale List 9 5 2 . No monograph in the British Pharmacopoeia . US: Dietary supplement 9 5 3 . No monograph in the USP-NF. 9 5 1 Health Canada, 2001 9 5 2 GSL , 19 94 3 7 1 Module Nine V a c c i n i u m a n g u s t i f o l i u m Image 56: by user Topjabo t (2004) via Wikipedia.org Taxonomic Notes Common botanical name: Blueberry Family: Ericaceae C o m m o n N a m e s Blueberries, highbush blueberry, hillside blueberry, lowbush blueberry, and rabbiteye blueberry P r i m a r y U s e s Vaccinium angustifolium berries are one of the best sources of antioxidants among fruits and vegetables. The phenolic compounds found in berry extracts have been shown to inhibit human low-density lipoprotein and liposome oxidation. In a 2006 animal study, the effects of a blueberry-rich diet on the content and structure of glycosaminoglycans (GAGs) were investigated. For 13 weeks, rats 9 5 3 USC , 19 94 3 72 Module Nine were fed either a blueberry or control diet. Results showed that there was 13% more GAGs in the aortas of the blueberry-fed rats, demonstrating the potential for a blueberry-rich diet to affect structural alterations in rat aortic tissue GAGs. In addition, Vaccinium angustifolium has been used to prevent cataracts and glaucoma, fever, hemorrhoids, multiple sclerosis, ulcers, urinary tract infections, and varicose veins. It is also used to improve circulation, as a laxative and as a tonic after miscarriage, for colic and labor pain, and is currently being investigated for use with diabetes. O v e r v i e w Blueberry fruit can be eaten raw, cooked into preserves, or eaten dried, and a tea can be made from the leaves dried fruit. Of the commercially grown blueberry varieties, Vaccinium angustifolium ripens first 9 5 4 . The dried fruit and leaves are used for diarrhea, and blueberry tea can be used with sore throat and other inflammations of the mouth and throat. Blueberry juice is used as a contrast agent in magnetic resonance imaging (MRI). Do not confuse blueberry with bilberry. In the U.S., ?blueberry? refers to the species of Vaccinium listed in this monograph. However, elsewhere in the world, blueberry may refer to the European plant Vaccinium myrtillus , which is called bilberry in the U.S. 954 Plants For a Future accessed 7/23/09: http:/ / w w w . p faf.org/database/plants.p h p ? Vaccinium +ang u stifolium 3 7 3 Module Nine Identifying Characteristics Part Characteristics Leaves Flowers Fruit Taste Glossy, blue-green White, about ¼ -in. wide, and blooms in May Blue-black, about ½ -in. wide, and mature in mid- to late-summer Somewhat sweet P a r t s U s e d Fruit and leaves C o l l e c t i o n a n d C u l t i v a t i o n Vaccinium angustifolium is a deciduous and twiggy shrub native to the Northeastern United States. It can grow to about 2-ft. tall and 2-ft. wide, and has an open crown of leaves. Vaccinium angustifolium prefers moist, well-drained soil with a highly acidic pH, and full sun to partial shade. In general, the more sun, the more flowers and fruits. Dosage and Administration No typical dosage. Active Constituents Vaccinium angustifolium is rich in fiber and vitamin C and contains ellagitannins, flavonols (such as quercetin and kaempferol), catechins, phenolic acids, and the polyphenolic compound resveratrol, which is a phytoalexin. In animal studies, resveratrol has been shown to have anti-cancer, anti-inflammatory, blood-sugar-lowering, and other beneficial cardiovascular effects. 3 7 4 Module Nine Vaccinium angustifolium also contains the active constituents beta- carotene, chlorogenic acid, glutathione, alpha-tocopherol 9 5 5 , more than 25 individual anthocyanidins, and proanthocyanidins. (Both anthocyanidins and proanthocyanidins have antioxidant activity 9 5 69 5 7 .) According to a 2002 study conducted by the U.S. Department of Agriculture, anthocyanidins in whole blueberry preparations do not appear to absorb well in humans 9 5 8 . In addition, the resveratrol content in cooked blueberries appears to be less than the concentrations found in raw blueberries 9 5 9 . Pharmacological Action According to preliminary research, the antioxidant effects of blueberry extracts may have anticancer activity and could reduce the oxidative cellular damage that naturally occurs with aging. In a 1996 study, Vaccinium angustifolium showed potential in vitro anticancer activity 9 60 , and in a later study, rats given antioxidant-rich dietary supplements (including blueberry at 14.8, 9.1, or 18.6 gm of dried aqueous extract per kilogram of diet) for eight months showed reversed age-related deficits in several neuronal and behavioral 9 5 5 Wang SY , Jiao H. Scavenging capacity of berry crops on su peroxide radicals, hydrogen peroxide, hydroxyl radicals, and singlet oxy gen. J Agric Foo d Chem 2000;48:5 6 7 7 - 84. 9 5 6 Youdim KA , Sh u kitt-Hale B, MacKinn o n S, et al. Polyp henolics enhance red blood cell resistance to oxidative st ress: in vitro and in vivo (1 ) . Biochim Biophys Acta 2000;15 1 9 : 1 1 7 - 2 2 9 5 7 Cao G, Sh u kitt-Hale B, Bi ckford PC, et al. Hyperoxia-induced changes in antioxidant capacity and the effect of dietary antioxidants. J Appl Physiol 199 9 ; 8 6 : 1 8 1 7 - 2 2 . 9 5 8 Wu X, Cao G, Prior RL. Absorption and metabolism of anthocyanins in elderly wo men after cons u m ption of elderberry or blueberry . J Nutr 2002;132:1 8 6 5 - 7 1 9 5 9 Lyo n s MM, Yu C, To ma RB, et al. Resveratrol in raw and baked blueberries and bilberries. J Agric Foo d Chem 2003;51:5 8 6 7 - 70. 9 6 0 Bom ser J, Madhavi DL , Singletary K, Smith MA. In vitro anticancer activity of fruit extracts from Vaccinium species. Planta Med. 199 6 Ju n ; 6 2 (3):2 1 2 - 6 . 3 7 5 Module Nine parameters 96 1 . These results indicate that in addition to the beneficial effects on cancer and heart disease, the phytochemicals in blueberry might be useful for reversing neuronal and behavioral aging. In addition, blueberry, a relative of cranberry, may prevent bacterial adhesion to the bladder and bacterial colonization 9 6 29 6 3 . Medicinal Uses Blueberry is currently being researched for use with hyperglycemia. In a 2009 study, blueberry, which is rich in anthocyanin components, was found to alleviate symptoms of hyperglycemia in diabetic mice. The anti-diabetic activity of different anthocyanin-related extracts was evaluated. Gavage administration (500 mg/kg body wt) with a phenolic-rich extract and an anthocyanin-enriched fraction lowered elevated blood glucose levels by 33 and 51% respectively 9 64 . Additionally, a 2006 study investigated the anti-diabetic properties of Vaccinium angustifolium . Ethanol extracts of root, stem, leaf, and fruit were tested for anti-diabetic activity in peripheral tissues and pancreatic beta cells. Results showed that root, stem, and leaf extracts enhanced glucose transport in C2C12 cells by 15-25% in presence and absence of insulin after 20 h of incubation; no enhancement, however, resulted from 1 h of exposure. In 3T3 cells, though, only the root and stem extracts enhanced glucose uptake; this effect was more 9 6 1 Joseph JA , Sh u kitt-Hale B, Deniso va NA , Bielinski D, Martin A, McEwen JJ, Bickford PC. Reversals of age-related declines in neuronal signal transduction, cognitive, and motor behavioral deficits with blueberry, spinach, or strawberry dietary sup plementation. J Neurosci. 199 9 Sep 15 ; 1 9 ( 1 8 ) : 8 1 14-21 . 9 6 2 Howell AB, Vorsa N, Der Marderosian A, Fo o LY .Inhibition of the adherence of P- fimbriated Escherichia coli to uroepithelial-cell surfaces by proanthocyanidin extracts from cranberries. N Engl J Med . 19 9 8 Oct 8;339(1 5 ) : 1085- 6 . 9 6 3 Ofek I, Goldhar J, Zafriri D, et al. Anti-E scherichia coli adhesin activity of cranberry and blueberry juices. N Engl J Med 199 1 ;324:15 9 9 . 9 6 4 Grace MH, Ribnicky DM, Kuh n P, Po ulev A, Lo gendra S, Yo u sef GG , Raskin I, Lila MA. Hypoglycemic activity of a novel anthocyanin-rich formulation from lowbush blueberry, Vaccinium angustifolium Aiton . Phytomedicine. 2009 May;16 ( 5 ) :406-1 5 . Ep ub 2009 Mar 20. 3 7 6 Module Nine significant after 1 h than after 20 h. In the absence of insulin, glucose uptake was increased by up to 75%. Stem, leaf, and fruit extracts also reduced apoptosis by 20-33% in PC12 cells exposed to elevated glucose for 96 h. These results suggest Vaccinium angustifolium contains constituents with insulin-like properties and protects against glucose toxicity 9 6 5 . Contraindications Blueberry leaf might decrease blood glucose and is contraindicated for use with patients who have diabetes. Similarly, might decrease serum triglycerides and test results, though this effect has yet to be reported in humans 9 6 6 . Avoid use while pregnant or breast-feeding due to a lack of safety information. A d v e r s e E f f e c t s None reported. Drug and Supplement Interactions Use caution with patients who have diabetes or are taking blueberry supplements. Blueberry leaf might decrease blood glucose 9 6 7 . 9 6 5 Martineau LC , Co uture A, Sp o or D, Benhaddou- A ndalou s si A, Harris C, Meddah B, Leduc C, Burt A, Vu o n g T, Mai Le P, Prentki M, Bennett SA, Arnason JT , Haddad PS. Anti-diabetic properties of the Canadian lowbush blueberry Vaccinium angustifolium Ait. P hytomedicine . 2006 No v ; 13(9- 10):6 1 2 - 23. Ep ub 2006 Sep 18 . 9 6 6 Cignarella A, Nastasi M, Cavalli E, Pu glisi L. N o vel lipid-lowering properties of Vaccinium myrtillus L. leaves, a traditional antidiabetic treatment, in several models of rat dyslipidaemia: a com pariso n with ciprofibrate. Thromb Res 199 6 ; 84:311- 2 2 . 9 6 7 Cignarella A, Nastasi M, Cavalli E, Pu glisi L. N o vel lipid-lowering properties of Vaccinium myrtillus L. leaves, a traditional antidiabetic treatment, in several models of rat dyslipidaemia: a com pariso n with ciprofibrate. Thromb Res 199 6 ; 84:311- 2 2 . 3 7 7 Module Nine Regulatory Status Blueberry is listed as a Class 1, safely consumed when used appropriately, by the American Herbal Products Association?s Botanical Safety Handbook . 3 7 8 Module Nine V a c c i n i u m m a c r o c a r p o n Image 57: by user Vvulto (2005) via Wikipedia.org Taxonomic Notes Common botanical name: Cranberry Family: Ericaceae C o m m o n N a m e s American cranberry, arandano Americano, arandano trepador, cranberries, European cranberry, grosse moosbeere, kranbeere, large cranberry, moosebeere, mossberry, ronce d?Amerique, small cranberry, trailing swamp cranberry, and tsuru-kokemomo P r i m a r y U s e s Cranberry juice and fresh cranberries have traditionally been used for urinary tract infections, as well as blood disorders, liver problems, loss of appetite, scurvy, stomach problems, and in the preparation of wound dressings 9 6 8 . 9 6 8 Barnes, J., A nderson , L., and Phillipso n , J.D . Herbal Medicines, Third Edition. Pharmaceutical Press. Lo ndon, 2007. 3 7 9 Module Nine In foods, cranberries are commonly used in juices and as a flavoring. Overview Vaccinium macrocarpon is native to North America, which produces about 98% of the world?s cranberry supply. The shrub is low trailing and evergreen, and grows in bogs. Do not confuse with high-brush cranberry Viburnum opulus , also known as cramp bark. Identifying Characteristics Part Characteristics Leaves Small, glabrous, and elliptic Flowers White with four turned-back petals Fruit Small, reddish berries Taste Tart P a r t s U s e d Fruit Dosage and Administration For urinary tract infection, a typical dose taken orally via a sweetened juice preparation is 16-32 oz daily. For the prevention of urinary tract infection, a typical dose taken orally via a sweetened juice preparation is 4-32 oz daily. For use with renal sores, a typical dose taken orally via a sweetened juice preparation is 16-32 oz. Duration of Administration Cranberry is a common food and there is no known duration for general use. To lower pH for urinary tract infections, minimum duration of use is 2-5 days. The optional effect will occur after 12-15 days of use. 3 8 0 Module Nine Active Constituents Vaccinium macrocarpon fruit contains the active constituents ellagitannins, flavonols (such as quercetin and kaempferol), catechins, phenolic acids, anthocyanidins, and proanthocyanidins (also known as condensed tannins, a class of flavanols). Additional constituents include ascorbic acid, beta-carotene, chlorogenic acid, glutathione, and alpha-tocopherol 9 6 9 . In addition, cranberries have a high-molecular weight compound (yet to be identified) that might deter bacteria from adhering to the urinary tract epithelial cells 9 7 09 7 1 . Cranberry juice has been shown to inhibit the adherence of 77 isolates of Escherichia coli from patients with urinary tract infections. Additional investigations show that drinking cranberry juice might help manage urinary tract infections in certain patients 9 7 2 . Though, cranberry does not seem to release bacteria once adhered to the urinary tract epithelial cells 9 7 3 . 9 6 9 Wang SY , Jiao H. Scavenging capacity of berry crops on su peroxide radicals, hydrogen peroxide, hydroxyl radicals, and singlet oxy gen. J Agric Foo d Chem 2000;48:5 6 7 7 - 84. 9 7 0 Sobota AE. Inhibition of bacterial adherence by cranberry juice: potential use for the treatment of urinary tract infections. J Urol 1984;131:1013-6. 9 7 1 Ahu ja S, Kaack B, Roberts J. Lo s s of fimbrial adhesion with the addition of Vaccinum macrocarpon to the growth medium of P- fimbriated Escherichia coli. J Urol 199 8 ; 1 5 9 : 5 5 9 - 6 2 . 9 7 2 Schmidt DR, Sobota AE. An examination of the anti-adherence activity of cranberry juice on urinary and non urinary bacterial isolates. Microbios 1 9 8 8 ; 5 5 : 1 73-81 . 9 7 3 Lowe FC , Fagelman E. Cranberry juice and urinary tract infections : what is the evidence? Urology 2001;5 7 :407-13. 3 8 1 Module Nine Pharmacological Action Research suggests that the fructose on cranberries may contribute to their anti-infective action 9 7 4 . In tests, cranberry juice has been shown to have effective antibacterial activity against E. coli, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa , and Proteus mirabilis 9 7 59 7 6 . Cranberry juice has been shown to reduce the recurrence of urinary tract infection. In a 2001 study, Vaccinium macrocarpon was investigated for use with urinary tract prevention in women. Participants (150 women) were assigned either 50 mL of cranberry- lingonberry juice daily for six months, 100 mL of lactobacillus drink five days per week for one year, or no intervention. Cranberry juice significantly reduced the recurrence of urinary tract infections compared to lactobacillus or no intervention, with a 20% reduction in absolute risk compared with the control group 9 7 7 . In addition, cranberry has possible chemopreventive activity including initiation of apoptosis in tumor cells, cell cycle arrest, reduced ornithine decarboxylase activity, decreased expression of matrix metalloproteinases associated with prostate tumor metastasis, and anti-inflammatory activities including inhibition of cyclooxygenases 9 7 89 7 9 . 9 7 4 Howell AB , Vorsa N, Fo o LY , et a l. Inhibition of the Adherence of P- Fimbriated Escherichia coli to Uroepithelial-Cell Surfaces by Proanthocyanidin Extracts from Cranberries (letter). N Engl J Med 199 8 ;339:1085- 6 . 9 7 5 Harkins K. W hat's the use of cranberry juice? Age Ageing 2000;29:9 - 1 2 . 9 7 6 Schmidt DR, Sobota AE. An examination of the anti-adherence activity of cranberry juice on urinary and non urinary bacterial isolates. Microbios 1 9 8 8 ; 5 5 : 1 73-81 . 9 7 7 Kontiokari T, Su ndqvist K, N u utinen M, Pok ka T, Ko s kela M, Uhari M. Randomised trial of cranberry-lingo nberry juice and Lactobacillus G G drink for the prevention of urinary tract infections in wo men. BMJ. 2001 Jun 30;322( 7302):1 5 7 1 . 9 7 8 Neto CC . Cranberry and its ph ytochemicals: a review of in vitro anticancer studies . J Nutr. 2007 Jan;137(1 Su p pl):1 8 6 S - 1 93S. 3 82 Module Nine In several in vitro animal studies, cranberry extracts were shown to stop tumor cell proliferation and to initiate apoptosis. Studies have included: CAL-27 oral cancer, DU145 androgen-independent prostate carcinoma, HCT116 colon carcinoma, HepG2 human liver cancer, HT-29 colon carcinoma, KB oral cancer, LNCaP prostate tumor, MCF-7 human breast cancer, and U87 glioblastoma multiforme cell lines 9 8 09 8 1 . In a 2006 animal study, for example, two cranberry extracts slowed the growth of explant tumors, and one of the extracts induced complete regression 9 8 2 . Medicinal Uses Cranberry juice is used for urinary tract infections, as a urinary deodorizer for people with incontinence (to reduce ammonical urinary odors), prevention of urinary catheter blockage, to heal skin around urostomy stomas, and for management of kidney stones (stones are more soluble in an acid environment). Cranberry is also used for scurvy, pleurisy, as a diuretic, antiseptic, antipyretic, and for cancer. 9 7 9 Boivin D, Blanchette M, Barrette S, Moghrabi A, Béliveau R. Inhibition of cancer cell proliferation and sup pressi on of TN F -induced activation of N F kappaB by edible berry juice. Anticancer Res. 2007 Mar-Apr;27 ( 2 ) : 937-48. 9 8 0 Seeram NP , Adams LS , Zhang Y, Lee R, Sand D, Scheuller HS, Heber D. Blackberry, black raspberry, blueberry, cranberry, red raspberry, and strawberry extracts inhibit growth and stimulate apoptosis of hu man cancer cells in vitro . J Agric Foo d Chem . 2006 Dec 13;54(25 ) : 9329-39. 9 8 1 Parry J, Su L, Moore J, Cheng Z, Luther M, Rao JN , Wang JY , Yu LL . C hemical com p o sition s , antioxidant capacities, and antiproliferative activities of selected fruit seed flours. J Agric Foo d Chem . 2006 May 31;54(11 ) :3773-8. 9 8 2 Fergus o n PJ , Kurow s ka EM, Freeman DJ , Chambers AF, Koropatnick J. In vivo inhibition of growth of hu man tu mor lines by flavon oid fractions from cranberry extract. Nutr Cancer. 2006;5 6 ( 1 ) : 8 6 - 94. 3 8 3 Module Nine Contraindications Use caution with patients who have diabetes due to high caloric content of cranberry juice. Sugar-free preparations are advisable 9 8 3 . Due to its acidity, cranberry juice might increase absorption of B12 in people taking proton pump inhibitors, people with atrophic gastritis, and people with hypochlorhydria. In addition, cranberry juice and cranberry extracts might increase the risk of kidney stones. (For example, drinking 30 mL of cranberry juice creates about 1.9 mg of oxalate. Concentrated extracts might contain larger amounts of oxalate.) Use caution with patients who have a history of kidney stones. A d v e r s e E f f e c t s When used in moderation, cranberry is well tolerated. Excessive use (such as 3-4 L per day) can cause gastrointestinal upset and diarrhea, and drinking more than 1 L of cranberry juice per day over an extended period of time can also increase the risk of uric acid kidney stone formation. Drug and Supplement Interactions There have been reports of an interaction between cranberry juice and Warfarin 9 8 4 . Though the mechanism of interaction is not known, avoid use with patients taking Warfarin unless the health benefits outweigh the risks 9 8 5 . In addition, the acidity in cranberry juice might increase absorption of vitamin B-12 in people taking proton pump inhibitors, including: Lansoprazole (Prevacid), omperazole (Prilosec), and rabeprazole (Aciphex). 9 8 3 Barnes, J., A nderson , L., and Phillipso n , J.D . Herbal Medicines , T hird Edition. Pharmaceutical Press. Lo ndon, 2007. 9 8 4 Barnes, J., A nderson , L., and Phillipso n , J.D . Herbal Medicines , T hird Edition. Pharmaceutical Press. Lo ndon, 2007. 9 8 5 Cou ncil Directive 2004/24/EC . Official Journal of the European Communities 2004, 136: 85 - 90. 3 8 4 Module Nine Regulatory Status Canada: Food (CFIA, 2000) or Natural Health Product (NHP) depending on label claim statement. In Canada, Natural Health Products, also referred to as complementary medicines or traditional remedies, are subject to the Food and Drug Act and Regulations 9 8 6 . UK: Food. Not listed in the General Sale List (GSL). No monograph in the British Pharmacopoeia . U.S.: Food 9 8 7 or dietary supplement depending on label claim statement 9 8 8 . Cranberry Liquid Preparation, for manufacturing purposes only, is official in the 20th edition of the National Formulary 9 8 9 (NF). 9 8 6 Health Canada, 2000 9 8 7 USD A , 19 9 7 9 8 8 USC , 19 94 9 8 9 USP , 2002 3 8 5 Module Nine V a c c i n i u m m y r t i l l u s Image 58: by user Copepodo (2008) via flickr.com Taxonomic Notes Common botanical name: Bilberry Family: Ericaceae C o m m o n N a m e s Airelle, bilberry fruit, bilberry leaf, black whortles, bleaberry, blueberry, burren myrtle, dwarf bilberry, dyeberry, huckleberry, hurtleberry, Myrtilli fructus , trackleberry, whortleberry, and wineberry P r i m a r y U s e s Bilberry is administered orally to support degenerative retinal conditions, varicose veins, atherosclerosis, venous insufficiency, and hemorrhoids. It is also used to improve night vision 9 9 0 , but a study in 9 9 0 Levy Y, Glovins k y Y. ?T he effect of anthocyanosides on night vision . ? Eye 199 8 ; 1 2 : 9 6 7 - 9 . 3 8 6 Module Nine 2000 showed it may not be as effective as was once thought 9 9 1 . It is also used orally for angina, arthritis, dermatitis, diabetes, gout, and prevention and support of gastrointestinal, kidney, and urinary tract imbalances. Applied topically, it has shown effectiveness for mild inflammation of the mouth and throat mucous membranes. Overview Bilberry is a deciduous shrub native to northern and central Europe. It grows in height to 20-50 cm or about 16 inches. The standardized, concentrated extract of bilberry fruit is used mainly for disorders of the eyes and circulatory system. Bilberry leaf extract was used as support for diabetes before insulin. It was found effective as a method of reducing glycosuria 9 9 2 and postprandial hyperglycemia 9 9 3 . For this reason, the leaf extract is contraindicated for diabetes and anyone taking insulin 9 9 4 . Identifying Characteristics Part Characteristics Leaves Small, ovate, short-petioled leaves with crenated and serrated edges Flowers Pale-red to greenish Fruit Globular, coarsely wrinkled, and black or blue Taste Faintly bitter and astringent P a r t s U s e d Fruit (berries) and leaves 991 Muth ER, Laurent JM, Jasper P. ?T he effect of bilberry nutritional sup plementation on night visual acuity and contrast sensitivity. ? Altern Med Rev 2000;5:1 64-73. 9 9 2 Glycosuria is the presence of glucose in the urine. 9 93 Postprandial hyp o glycemia is excess glucose in the blood following a meal. 9 94 Blumenthal M. The ABC Clinical Guide to Herbs , 2003, 6. 3 8 7 Module Nine C o l l e c t i o n a n d C u l t i v a t i o n Bilberry prefers to grow on heath land in a moist environment. The berries and leaves are collected in summer. Dosage and Administration Clinical studies of bilberry?s effectiveness have used formulations containing 25% of the bioflavonoid complex anthocyanoside. The typical oral dose of the dried, ripe berries is 20-60 g or 0.7-2 oz daily. A decoction of the berries is prepared by adding 5-10 g, or 1-2 teaspoons, of mashed berries to 1 cup or 236 mL of cold water. The water is simmered for 10 minutes, and then strained. The decoction is also applied topically. When used as a tea, steep 1 g, or 1-2 teaspoons, of finely chopped dried leaf in 150 mL or 5 oz boiling water for 5-10 minutes, and then strain. It is recommended to avoid prolonged use, which can be defined as continuous use for more than three weeks. As a fluid extract (1:1), 2-4 mL or 0.5-1 teaspoons, three times daily 9 9 5 . Duration of Administration Avoid using the leaves for longer than three weeks continuously. Active Constituents The primary active constituents in bilberry berries are flavonoid glycosides: Anthocyanins (particularly glycosides of delphinidin, cyanidin, petunidin, peopnidin, and malvidin), quercetin-3-glucurnide, and hyperoside. Additional constituents in the berries include polyphenols (catechin, epicatechin, and catechol tannins), pectins, and vitamin C. The primary active constituents in bilberry leaves are flavonoids: Quercetin and its glycosides (hyperoquercitrin). Additional constituents include phenolic acids (caffeic, p -coumaric, p - 9 9 5 Blu menthal M. The ABC Clinical Guide to Herbs 2003, 6. 3 8 8 Module Nine hydroxybenzoic, protocatechuic, and melilotic), catechol tannins, leucuanthocyans, and iridoids. Pharmacological Action The astringent tannin components of dried, ripe bilberry fruit are responsible for the potential benefits when used with diarrhea and irritation of the mouth and throat mucosa. Anthocyanadin (anthocyanoside) constituents increase the synthesis of glycosaminoglycans 9 9 6 , decrease vascular permeability, reduce basement membrane thickness, and aid in the redistribution of microvascular blood flow and the formation of interstitial fluid. An anthocyanadin pigment found in bilberry fruit might have anti-ulcer and gastroprotective effects 9 9 7 . Preliminary evidence indicates these constituents are widely distributed in the body after oral administration and are eliminated by the kidneys 9 9 8 . Laboratory research also suggests that anthocyanadins have anti-inflammatory and anti-edema effects 9 9 9 . 996 The extracellullar matrix present in multicellular organism s consists of fibrous proteins embedded in hydrated polysaccharide gels. Glycosamino glycans (G A G s ) are polysaccharides that form a major part of this matrix. G A G s are negatively charged disaccharide repeating units, covalently linked to "core" proteins. They are copolymers of alternating hexosamine (D- Glucosamine/D - Galactosamine) and either L-iduronic ac id or D-Galactose. Grouping dependent on the hexosamine residue results in the classification of GA G s as either Glucosamino glycans or Galactosamino glycans. http:/ / glycores.ncif crf.g o v / glycan/gag.html 9 9 7 The Review of Natural Products by Facts and Comparisons . St. Lo uis, MO: W olters Kluwer Co., 19 9 9 . 9 9 8 Lietti A, Forni G. ?Studies on Vaccinium m yrtillus anthocyano sides. II. As pects of anthocyanins pharmacokinetics in the rat.? Arzneimittelforschung 1 9 7 6 ; 2 6 : 832-5 . 9 9 9 Lietti A, Cristoni A, Picci M. ?Studies on Vaccinium m yrtillus anthocyanosides. I. Vasoprotective and anti-inflammatory activity.? Arzneimittelforschung 1 9 7 6 ; 2 6 : 8 2 9 -32. 3 8 9 Module Nine Bilberry leaves contain polyphenols, tannins, flavonoids 1 0 0 0 , and a relatively high concentration of chromium (9.0 ppm). Preliminary evidence suggests that a bilberry leaf extract might have blood glucose, triglyceride, and cholesterol lowering effects 1 0 0 2 . The chromium in bilberry leaf is theorized to play a role in potential blood glucose lowering activity 1 0 0 3 . Bilberry leaf also contains a glucokinin, neomirtilline, which seems to lower blood glucose 1 0 0 4 . Additionally, some researchers think that flavonoids in bilberry leaf might also be useful for diabetic circulatory disorders 1 0 0 5 . Orally, bilberry is used to improve degenerative retinal conditions, varicose veins, atherosclerosis, venous insufficiency, and hemorrhoids. It is also used orally for angina, diabetes, arthritis, gout, dermatitis, and prevention and for support of gastrointestinal, kidney, and urinary tract imbalances. C l i n i c a l R e v i e w A study involving 30 healthy subjects with normal platelet aggregation investigated the effects of anthocyanins from V. myrtillus administered daily (480 mg or 0.01 oz) against daily intake of ascorbic acid (3g or 0.1 oz) or daily intake of a preparation of the two together. Reduction in platelet aggregation was greater in subjects who received V. myrtillus and was most marked in subjects who received the combined 1000 Fraisse D, Carnat A, Lamaison JL [? P olyp henolic comp o sition of the leaf of bilberry?]. [Article in French]. Ann Pharm Fr 199 6 ; 54(6) : 2 80-3. 1001 Wichtl MW. Herbal Drugs and Phytopharmaceuticals . Ed. N.M. Bisset. Stuttgart: Medpharm GmbH Scientific Publishers, 19 94. 1002 Cignarella A, Nastasi M, Cavalli E, Pu glisi L. ?N o vel lipid-lowering properties of Vaccinium myrtillus L. leaves, a traditional antidiabetic treatment, in several models of rat dyslipidaemia: a com pariso n with ciprofibrate.? Thromb Res 1 9 9 6 ; 84(5) :311- 2 2 . 1003 Wichtl MW. Herbal Drugs and Phytopharmaceuticals. Ed. N.M. Bisset. Stuttgart: Medpharm GmbH Scientific Publishers, 19 94. 1004 Cignarella A, Ibid. 1005 Wichtl MW. Ibid. 3 9 0 Module Nine preparation of V. myrtillus plus ascorbic acid. Platelet aggregation returned to baseline levels 120 days after discontinuation of use. Thirty-one patients with various types of retinopathy were investigated with regard to the effect of anthocyanosides on the retinal vessels. Especially in patients with diabetic retinopathy, a positive influence on the permeability and tendency to hemorrhage was observed. The researchers point out the importance of internal care of the primary disease 1 0 0 6 . In a double blind, placebo-controlled study of 40 participants with early diabetic or hypertensive retinopathy, 50% showed improvements (vs. 20% in control group) from a one-year-long administration of 160 mg or 0.005 oz of bilberry taken twice daily. Patients with exudates deposits improved in 15% of cases (vs. 10% control group) 1 0 0 7 . As mentioned, bilberry fruit may not be as effective when used orally to improve night vision as was once thought. Bilberry fruit extract (160 mg) taken three times daily for 21 days did not appear to improve night visual acuity and contrast sensitivity in men with good vision and normal night vision 1 0 0 8 . M e d i c i n a l U s e s Orally, bilberry is used to improve visual acuity, including night vision, and to support degenerative retinal conditions, varicose veins, atherosclerosis, venous insufficiency, and hemorrhoids. It is also used orally for angina, diabetes, arthritis, gout, dermatitis, and prevention and support of gastrointestinal, kidney, and urinary tract imbalances. 1006 Scharrer A, Ober M. ?Anthocyanoside s in the treatment of retinopathies? [Article in German], Klin Monatsbl Augenheilkd 198 1 May;17 8 ( 5 ) :386- 9 . 1007 Repos si P, Malagola R, De Cadilhac C. ?T he role of anthocyanosides on vascular permeability in diabetic retinopathy. . ? Ann Oftalmol Clin Ocul 198 7 ; 1 1394):357-361. 1008 Muth ER , Laurent JM, Jasper P. ?T he effect of bilberry nutritional sup plementation on night visual acuity and contrast sensitivity. ? Altern Med Rev 2000;5:1 64-73. 3 9 1 Module Nine Topically, it is used for mild inflammation of the mouth and throat mucous membranes. Contraindications Preliminary evidence suggests that bilberry leaf might lower blood glucose and therefore affect any lab test results. Taking bilberry leaf extract with insulin therapy is contraindicated 1 0 0 9 . It also might lower serum triglycerides and affect test results. A d v e r s e E f f e c t s There are no known adverse effects when bilberry is used at the therapeutic dose. Bilberry leaf may be possibly unsafe when the leaves are used orally in high doses or continuously for longer than three weeks. Death can occur with chronic use of 1.5 g/kg/day 1 0 1 0 . There is insufficient reliable information available about the safety of the use of bilberry dried ripe fruit in medicinal amounts 1 0 1 1 . During pregnancy and lactation, bilberry fruit thought to be safe when the fruit is consumed in amounts commonly found in foods. The oral use of the leaves is not recommended due to potential toxicity. Drug and Supplement Interactions There is some suggestion that simultaneous use of bilberry leaf and anti-diabetics might require dosing adjustment of the drugs. As mentioned previously preliminary evidence suggests that bilberry leaf extract might have blood glucose lowering activity; so it is important to monitor clients closely. Bilberry leaf may create a hypoglycemic effect when administered simultaneously with herbs that decrease blood glucose levels, 1 0 0 9 Blumenthal, M. eds. et al. The Complete German Commission E Monographs. A merican Botanical Cou ncil. Au stin, Texas: 19 9 8 . 1010 Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines . Trans. S. Klein. Bo ston , MA: American Botanical Cou ncil, 19 9 8 . 1011 Blumenthal M, Ibid. 3 92 Module Nine including: Devil?s claw, fenugreek, garlic, guar gum, Panax ginseng, psyllium, and Siberian ginseng 1 0 1 2 . The reduction in platelet aggregation seen with bilberry suggests caution in those taking anticoagulant medications such as coumadin, warfarin or Plavix, although there have not been any clinical reports of drug interactions. Regulatory Status Canada: Multiple-ingredient traditional herbal medicines containing bilberry, in tea infusions form, and homeopathic mono-preparations of bilberry are scheduled OTC drugs requiring pre-market registration and assignment of a drug identification number 1 0 1 3 . United Kingdom: Not listed in General Sale List. No monograph in the British Pharmacopoeia . United States: Dietary Supplement 1 0 1 4 . Tincture of the ripe berries is a Class D over-the-counter drug of the Homeopathic Pharmacopoeia of the United States 1 0 1 5 . Module Assessment You are now ready to log in and complete the module assessment online. Refer back to the instructions in Module One if you need to. 1012 Cignarella A, Nastasi M, Cavalli E, Pu glisi L. ?N o vel lipid-lowering properties of Vaccinium myrtillus L. leaves, a traditional antidiabetic treatment, in several models of rat dyslipidaemia: A com pariso n with ciprofibrate.? Thromb Res 199 6 ; 84(5) :311- 2 2 . 1 0 1 3 Health Canada, 2001 1 0 1 4 USC , 19 94 1 0 1 5 HPUS , 19 93 3 9 3 Module Ten Module Ten Module Objectives Upon completion of this module, you will be able to: ? Recall and describe the Latin binomial or scientific name, common name, and family. ? Be able to identify a photograph by the Latin name and common name of the botanicals studied. ? Identify the therapeutic potential of each botanical studied. ? Explain the pharmacological action of each botanical studied. ? List the key recommended uses for each botanical studied. ? Recall the recommended dosage and duration for each botanical studied. ? Recall and describe any contraindications and precautions associated with each botanical studied. ? Recall the regulatory status of each of botanical studied. Module Checklist ? Read and review the module. ? Read any online resources as applicable. ? Ensure you can meet the Module Objectives. ? Complete the module assessment online and respond to another student?s posting as instructed. ? Complete the Module Test. 10 3 9 4 Module Ten V e r b e n a o f f i c i n a l i s Image 59: by user Teco (2009) via flickr.com Taxonomic Notes Common botanical name: European Vervain Family: Verbenaceae C o m m o n N a m e s Blue vervain, common verbena, common vervain, eisenkraut, enchanter?s plant, herb of grace, herb of the cross, holywort, Juno?s tears, ma bian cao, pigeon?s grass, pigeonweed, simpler?s joy, turkey grass, and verbenae herba P r i m a r y U s e s Verbena officinalis is used with angina, respiratory tract diseases like asthma and whooping cough, and for sore throats and other oral and pharyngeal inflammation. 3 9 5 Module Ten Overview Verbena officinalis can be found scattered like a weed in all the temperate regions of the earth. The herb is collected from the wild in southeastern Europe. The leaves can be used in tea or boiled, seasoned, and eaten; the flowers can be used as a garnish 1 0 1 6 . Identifying Characteristics Part Characteristics Leaves Leaves are opposite, and cut into toothed lobes Flowers Small, pale-lilac flowers, blooms June to October Fruit Brown dehiscent fruit that readily falls apart into four nutlets Taste Bitter and sharp Odor Non-odorous P a r t s U s e d Above ground parts C u l t i v a t i o n a n d C o l l e c t i o n Verbena officinalis is a perennial herb that grows 1-2-ft. tall. It prefers full sun, average to rich soils, and is grown throughout temperate North America. European vervain is short-lived. Harvest the leaves and flower tops as the plants bloom. Verbena officinalis self-sows and germinates within three weeks. Once large enough to handle, plants the seedlings into individual pots and plant out in early summer. Division should take place in spring 1 0 1 7 . 1 0 1 6 Facciola. S. Cornucopia - A Source Book of Edible Plants . Kampo n g Publications , 19 90. 1 0 1 7 Plants For a Future accessed 7/24/09: http:/ / w w w . p faf.org/database/plants.p h p ? Verbena+officinalis 3 9 6 Module Ten Dosage and Administration As a decoction, a typical dose is 2-4 g of above ground parts steeped in 150 mL of boiling water for 5-10 minutes, and then strain. Take one cup of tea, three times daily. As a liquid extract (1:1 in 25% ethanol), 2-4 mL, three times daily. As a tincture, (1:1 in 40% ethanol), 5-10 mL, three times daily. As a topical application, there is no typical dose. Duration of Administration Know known. Active Constituents The active constituents in Verbena officinalis include iridoid glycosides (hastatoside, verbenalin (verbanaloside), and verbenin (aucubin)), phenylpropanoid glycosides (acetoside (verbascoside) and eukovoside), and volatile oils (monoterpene components include citral, geraniol, limonene, and verbenone). Additional active constituents include adenosibe, alkaloid, bitters, carbohydrates, beta- carotene, flavonoids, invertin, saponin, and tannic acid. According to preliminary research, the constituent verbascoside has analgesic, antioxidant, hepatoprotective, and sedative effects 1 0 1 81 0 1 9 . The constituent citral is attributed with antitumor effects 1 0 2 0 . 1 0 1 8 Nakamura T, O k u yama E, Ts u kada A, et al. Acteoside as the analgesic principle of Cedron ( Lippia triphylla ) , a Peruvian medicinal plant. Chem Pharm Bull 1 9 9 7 ;45:499- 504. 1 0 1 9 Chiou W F , Lin LC , Chen CF . Acteosid e protects endothelial cells against free radical-induced oxidative stress. J Pharm Pharmacol 2004;56:743-8. 1 0 2 0 Dudai N, Weinstein Y, Krup M, Rabinski T, O fir R. Citral is a new inducer of caspase-3 in tum or cell lines. Planta Med. 2005 May;71 ( 5 ) :484-8. 3 9 7 Module Ten Pharmacological Action Extracts of flavonoids from Verbena officinalis have shown antimicrobial activity against Gram-positive and Gram-negative microorganisms 1 0 2 1 . In an animal study, Verbena officinalis was investigated for its ability to prevent kidney stone formation. Common urolithiasis risk factors were evaluated, including: Citraturia, calciuria, phosphaturia, pH, and diuresis. Results showed Verbena officinalis to have anti-urolithiasis effects attributed to its disinfectant action and the presence of saponins 1 0 2 2 . In addition, Verbena officinalis has shown estradiol and progesterone receptor-binding action in intact human breast cancer cells. In a study more than 150 plants traditionally used by herbalists were investigated for their ability to compete with estradiol and progesterone binding to intracellular receptors for progesterone (PR) and estradiol (ER) in intact human breast cancer cells. Of the herbs tested, the six highest PR-binding herbs were oregano, verbena (European vervain), turmeric, thyme, red clover, and damiana 1 0 2 3 . Medicinal Uses Verbena officinalis is primarily used with angina, inflammation, respiratory tract diseases like asthma and whooping cough, and for sore throats and other oral and pharyngeal inflammation. It also might be effective for tension and stress relief, as well as early stages of fever, as a mouthwash for gum disease, and with inflammation of the gall bladder and jaundice 1 0 2 4 . 1 0 2 1 Hernández NE , Tereschuk ML, Abdala LR. Antimicrobial activity of flavon oids in medicinal plants from Tafí del Valle (Tucum á n , Argentina). J Ethnopharmacol. 2000 Nov ; 73(1- 2 ) :317- 2 2 . 1 0 2 2 Grases F, Melero G, C o sta-Bauzá A, Prieto R, March JG . Urolithiasis and phytotherapy. Int Urol Nephrol. 1994;26 ( 5 ) : 507-1 1 . 1 0 2 3 Zava DT, Dollbaum CM, Blen M. Estrogen and progestin bioactivity of fo ods, herbs, and spices. 1 0 2 4 http:// w w w . h olisticonline.com/Herbal-Med/_Herbs/h300.htm 3 9 8 Module Ten In a 2000 study, petroleum ether, chloroform, and methanol extracts of aerial parts of Verbena officinalis showed anti-inflammatory action. The chloroform extract was the most active. Further investigation of the petroleum ether and chloroform extracts revealed the constituents beta-sitosterol, ursolic acid, oleanolic acid, 3-epiursolic acid, 3-epioleanolic acid, and minor triterpenoids of derivatives of ursolic acid and oleanolic acids 1 0 2 5 . Contraindications European vervain might exhibit hepatic activity and should be used with caution in patients who have compromised liver function or are taking medication metabolized by cytochrome P450 pathways. In animal studies, the monoterpene beta-myrcene altered levels of liver enzymes including those of the CYP2B family 10261027 . Use caution with patients who have hyperactive digestive disorders or are taking gastrointestinal medications or supplements 1 0 2 8 . Avoid use in patients who are trying to become pregnant or who are taking fertility medications or supplements, as some Verbena varieties have been shown to have contraceptive properties 1 0 2 9 . Avoid use in patients with known allergy/hypersensitivity to Verbena officinalis , its constituents, or members of the Verbenaceae family. 1 0 2 5 Deepak M, Handa SS. Antiinflammatory activity and chemical comp o sition of extracts of Verbena officinalis. Phytother Res . 2000 Sep;14(6) :463-5. 1 0 2 6 De-Oliveira AC , Ribeiro-Pinto LF, OttoProc Soc Exp Biol Med . 19 9 8 Mar;21 7 (3):369- 7 8 . SS , Go n çalves A, Paum gartten FJ. Induction of liver mon o o x y genases by beta-myrcene. Toxicology. 199 7 Dec 26; 1 24(2) : 135-40. 1 0 2 7 De-Oliveira AC, Ribeiro-Pinto LF , Paumgartten JR. In vitro inhibition of CY P 2 B 1 mo n o o x y genase by beta-myrcene and other mon oterpenoid comp o u nds. Toxicol Lett. 199 7 Ju n 16 ; 9 2 ( 1 ) :39-46. 1 0 2 8 Castro-Gamboa I, Castro O. Irid oids from the aerial parts of Verbena littoralis ( Verbenaceae). Phytochemistry. 2004 Aug ; 6 5 ( 1 6 ) : 2369- 7 2 . 1 0 2 9 Prakash AO . [Biological evaluation of so me medicinal plant extracts for contraceptive efficacy in females] Contracept Fertil Sex (Paris). 19 8 5 Apr;13(4):649-5 5 . 3 9 9 Module Ten A d v e r s e E f f e c t s When taken in combination with other herbs, European vervain might cause adverse gastrointestinal effects. It also can cause allergic skin reactions 1 0 3 0 when taken orally, as well as contact dermatitis when used topically 1 0 3 1 . In addition, European vervain might have estradiol receptor and progesterone receptor binding activity in human breast cancer cells 1 0 3 2 . Drug and Supplement Interactions None known. Regulatory Status Canada: Approved active ingredient in some OTC Traditional Herbal Medicines and homeopathic medicines, requiring pre-marking authorization. U.K.: Herbal medicine in the General Sale List, Table A (for internal and/or external use) of Schedule 1 (requires full Product License). U.S.: Dietary supplement. Generally Recognized as Safe natural flavoring. Regulated as an allowed flavoring in alcohol 1 0 3 3 . 1 0 3 0 Neubauer N, Marz RW . Placebo-controlled, randomized, double-blind, clincal trial with Sinu pret sugar coated tablets on the basis of a therapy with antibiotics and decongestant nasal drops in acute sinu sitis. Phytomedicine 1 9 94;1:1 7 7 - 8 1 . 1 0 3 1 Del Po z o MD, Gastaminza G, Navarro JA , et al. Allergic contact dermatitis from Verbena officinalis L. Contact Dermatitis 1994;31:200-1. 1 0 3 2 Zava DT, Dollbaum CM, Blen M. Estrogen and progestin bioactivity of fo ods, herbs, and spices. Proc Soc Exp Biol Med . 19 9 8 Mar;21 7 (3):369- 7 8 . 1 0 3 3 McGuffin, M. and eds et all. American Herbal Products Association?s Botanical Safety Handbook . CR C Press. Boca Raton, FL : 19 9 7 . 4 0 0 Module Ten Verbena officinalis is listed as a Class 2b (not to be used during pregnancy) in the American Herbal Products Association?s Botanical Safety Handbook . 4 0 1 Module Ten V i b u r n u m o p u l u s Image 60: by OpiolaJerzy (2006) via Wikipedia.org Taxonomic Notes Common botanical name: Cramp Bark Family: Caprifoliaceae C o m m o n N a m e s Common guelder-rose, crampbark, European cranberry-bush, guelder rose, guelder-rose, high-bush cranberry, and snowball bush P r i m a r y U s e s Viburnum opulus is primarily used as an antispasmodic, garnering the common name ?cramp bark.? Viburnum opulus relaxes a variety of cramps and spasms, including asthma, cramps related to menstruation and pregnancy, and hysteria 1 0 3 4 . It is also effective with neuralgic or spasmodic dysmenorrhea, and as an anti-abortive. 1 0 3 4 Accessed 7/24/09: http:/ / w w w . henriettesherbal.com/eclectic/king s / viburnum - o p ul.html 4 02 Module Ten Overview Viburnum opulus is native to Europe, northern Africa, and northern Asia. Traditionally, the bark has been used with a variety of cramps, including menstrual cramps and arthritis-related cramps. In an in vitro study, the active constituent viopudial was shown to have antispasmodic effects on smooth muscle 1 0 3 5 . Identifying Characteristics 1 0 3 6 Part Characteristics Leaves Three-lobed, three-veined, broadly wedge- shaped or truncate at the base, and broad Flowers White or reddish-white; outer flowers are large and sterile and the inner flowers are small fertile Fruit Red, acid, and ripens late; resembles the cranberry P a r t s U s e d Root and bark Dosage and Administration There is no standardized dosage for cramp bark. Duration of Administration None known. Active Constituents The active constituents in cramp bark are scopoletin and viopudial, which are thought to have smooth muscle antispasmodic effects in 1 0 3 5 Nicholso n JA , Darby TD , Jarboe CH . Viop udial, a hyp otensive and smo oth m u scle antispasm odic from Viburnum opulus. Proc Soc Exp Biol Med . 19 7 2 Ju n ; 140(2) :457- 6 1 . 1 0 3 6 Accessed 7/24/09: http:/ / w w w . henriettesherbal.com/eclectic/king s / viburnum - o p ul.html 4 0 3 Module Ten vitro . In addition, viopudial appears to have cholinergic effects, inhibiting acetylcholinesterase. In animal studies, viopudial caused bradycardia, hypotension, and decreased myocardial contractility 1 0 3 7 . Pharmacological Action In in vitro studies, Viburnum opulus was shown to have disinfectant activity 1 0 3 8 , antioxidant activity 1 0 3 9 , antispasmodic effects on smooth muscle 1 0 4 0 , and increased activity of superoxide dismutase, catalase, and gluthatione peroxidase 1 0 4 1 . Medicinal Uses In a 2008 study, Viburnum opulus was investigated for its antioxidant properties. Water extracts from the fruit, branches, and leaves of Viburnum opulus and Viburnum lantana were tested. The branch extracts of both varieties inhibited superoxide anion in a concentration-dependent manner and all extracts showed a scavenging effect on the DPPH radical 1042 . 1 0 3 7 Nicholso n JA , Darby TD , Jarboe CH . Viop udial, a hyp otensive and smo oth m u scle antispasm odic from Viburnum opulus . Proc Soc Exp Biol Med 197 2 ; 140:457- 6 1 . 1 0 3 8 SMETA N KIN A PP . [DISIN F E C T A N T P R O P E R TIE S OF VIBU R N UM OPU L U S . ] Vestn Dermatol Venerol. 1963 Jul;37:7 5 . 1 0 3 9 Ryz hik o v MA, Ryz hik o va VO . [A p plication of chemiluminescent methods for analysis of the antioxidan t activity of herbal extracts] V opr Pitan. 2006;7 5 ( 2 ) : 2 2 - 6 . 1 0 4 0 Nicholso n JA , Darby TD , Jarboe CH . Viop udial, a hyp otensive and smo oth m u scle antispasm odic from Viburnum opulus. Proc Soc Exp Biol Med . 19 7 2 Ju n ; 140(2) :457- 6 1 . 1 0 4 1 Zayachkivs ka OS, Gz hegotsk y MR, Terletska OI, Lutsy k DA , Yaschenko AM, Dzh ura OR . Influence of Viburnum opulus proanthocyanidins on stress- induced gastrointestinal mucosal damage. J Physiol Pharmacol. 2006 No v ; 5 7 Suppl 5:1 5 5 - 6 7 . 1 0 4 2 Altun ML, Citolu G S , Yilmaz BS , C oban T. Antioxidant properties of Viburnum opulus and Viburnum lantana growing in Turkey. Int J Foo d Sci Nutr. 2008 May;59 (3):1 7 5 - 80. 4 0 4 Module Ten A 2006 animal study showed Viburnum opulus to have potent gastroduodenoprotective activity. This was achieved through an increase in endogenous nitric oxide generation, suppression of lipid peroxidation, and mobilization of antioxidant activity and changes in glycoconjugate content of the gastroduodenal mucosa of rat 1 0 4 3 . Contraindications Due to a lack of safety information, cramp bark is contraindicated for use while pregnant and breast-feeding. A d v e r s e E f f e c t s Avoid use in patients with a known allergy to Viburnum opulus , its active constituents, or members of the Caprifoliaceae family. 1 0 4 3 Zayachkivs ka OS, Gz hegotsk y MR, Terletska OI, Lutsy k DA , Yaschenko AM, Dzh ura OR . Influence of Viburnum opulus proanthocyanidins on stress- induced gastrointestinal mucosal damage. J Physiol Pharmacol. 2006 No v ; 5 7 Su p pl 5:1 5 5 - 6 7 . 4 0 5 Module Ten V i b u r n u m p r u n i f o l i u m Image 61: by use MPF (1989) via Wikipedia.org Taxonomic Notes Common botanical name: Black Haw Family: Caprifoliaceae C o m m o n N a m e s Blackhaw, nanny bush, southern black haw, stag bush, and viburnum P r i m a r y U s e s Viburnum prunifolium is primarily used as an antidiarrheal, antispasmodic, postpartum antispasmodic, tonic, and uterine stimulant, and for use with painful menses and preventing miscarriage. Overview Viburnum prunifolium is a small and stout deciduous tress or shrub native to southern North America. 4 0 6 Module Ten Black haw has a long history of use by Native Americans. It is traditionally used with symptoms and disorders associated with menstruation, pregnancy, and childbirth, such as: Amenorrhea, childbirth (recovery), colic, gastrointestinal cramps, hemorrhage, jaundice, menopausal symptoms, menstrual cramps, miscarriage prevention, post-menopausal symptoms (relief), pregnancy-induced nausea and vomiting, pregnancy problems (limb pain), and uterine disorders. Identifying Characteristics Part Characteristics Leaves Serrated oval leaves Flowers Clustered white flowers Fruit Blue-black berries Taste Bitter and astringent Odor Characteristic, faintly tan-like P a r t s U s e d Root and stem bark Dosage and Administration As a decoction, a typical dose is 2 teaspoons of dried bark boiled in 1 cup of water and simmered for 10 minutes, three times daily. As a tincture (1:5 in 60%), a typical dose is 5-10 mL, three times daily. Duration of Administration None known. Active Constituents The primary active constituents in black haw include coumarins, iridoid glycosiders, oleanolic acid, oxalic acid, salicin, salicylic acid biflavone, scopoletin (thought to be a uterine relaxant 1 0 4 4 ), and tannins. 1 0 4 4 Leung AY , Fo ster S. Encyclopedia of Com m on Natural Ingredients Used in Foo d , Drugs and Cosmetics . 2nd ed. New York, N Y : Jo h n Wiley & So n s , 19 9 6 . 4 0 7 Module Ten In a 2000 study, black haw exhibited spasmolytic activity in the uterus and other smooth muscle, and was shown to cause vasoconstriction 1 0 4 5 . Contraindications Black haw contains oxalic acid; therefore, use caution with patients who have a history of kidney stones. Oxalic acid might increase kidney stone formation in some patients. Avoid use while pregnant. Some evidence suggests black haw has uterine relaxant effects 1 0 4 6 . A d v e r s e E f f e c t s Black haw contains salicylate constituents, which could potentially instigate allergic reactions in individuals with an aspirin allergy or asthma. Drug and Supplement Interactions Simultaneous use of black haw with calcium, iron, and zinc might decrease the mineral absorption from foods. Black haw contains the oxalate oxalic acid, which can bind multivalent metal ions on the gastrointestinal tract and decrease mineral absorption 1 0 4 71 0 4 8 . 1 0 4 5 Upton R, Petrone C, eds. Black Haw Bark, Viburnum prunifolium: Analytical, quality control, and therapeutic monogr aph. American Herbal Pharmacopoeia and Therapeutic Compendium . Santa Cruz, CA : American Herbal Pharmacopoeia. 2000. 1 0 4 6 BAL DINI L, BR AMBILL A G, PA R O DI S. [R E S E A R CH ON THE UT E RIN E A C TIO N O F VIB U R N UM PRU NIFO LIUM.] Arch Ital Sci Farmacol. 1964 Jan;14:55 - 63. 1 0 4 7 Leung AY , Fo ster S. Encyclopedia of Com m on Natural Ingredients Used in Foo d , Drugs and Cosmetics . 2nd ed. New York, N Y : Jo h n Wiley & So n s , 19 9 6 . 1 0 4 8 Agriculture Res Svc. Dr. Du ke's ph ytochemical and ethnobotanical databases. Available at: ww w .ars-grin.g o v /duke/ (Accessed 7 July 19 9 9 ) . 4 0 8 Module Ten Some sources report black haw contains salicin, which is related to acetylsalicylic acid and might cause allergic reactions in people with allergies to aspirin and other salicylates. 4 0 9 Module Ten V i t e x a g n u s - c a s t u s Image 62: by Stan Shebs (2005) via Wikipedia.org Taxonomic Notes Common botanical name: Chaste Tree or Vitex Family: Verbenaceae Common names Agnolyt, agnus castus, agnus-castus, chaste berry, chaste tree berry, chastetree, gattilier, hemp tree, and monk?s pepper P r i m a r y U s e s As an emmenagogue or uterine stimulant 1 0 4 9 , Vitex agnus-castus is used for menstrual irregularities like dysmenorrhea, secondary amenorrhea, metrorrhagia, oligomenorrhea, and polymenorrhea. Vitex agnus-castus is also used with menopausal concerns and premenstrual 1 0 4 9 McGuffin, M. American Herbal Products Association?s Botanical Safety Handbook. CRC Press. Boca Raton, FL : 19 9 7 . 4 1 0 Module Ten syndrome, including cyclical mastalgia and luteal-phase dysfunction (corpus luteum insufficiency). When taken orally, Vitex agnus-castus is used for female infertility, preventing miscarriage in patients with progesterone insufficiency, controlling postpartum bleeding, aiding in expulsion of the placenta, increasing lactation, and treating fibrocystic breasts. It is used for promoting urination, treating benign prostatic hyperplasia (BPH), and reducing sexual desire. Additional uses include: Acne, nervousness, dementia, rheumatic conditions, colds, dyspepsia, spleen disorders, headaches, migraine, eye pain, insomnia, body inflammation, and swelling. Topically, Vitex agnus-castus works as an anthelmintic, expelling parasitic worms, and for insect bites and stings. Overview Vitex agnus castus was well known in ancient times and is featured in Homer?s Iliad . Historians say that monks chewed Vitex agnus-castus parts to make it easier to maintain their celibacy. There also are reports mentioning its use in ancient Greek rituals, especially of the twigs being carried for protection against various dangers or to denote chastity. According to Greek mythology, the Greek goddess Hera, the protectress of marriage, was born under a Vitex agnus-castus bush. Vitex agnus-castus twigs were often used in making wattle fences and baskets in ancient Greece. Hippocrates, in the 4th century BC, suggested use of the plant for inflammation, swelling of the spleen, and to help expel the placenta after birth 1 0 5 0 . Dioscorides, in the first century AD, described its use to ?bring down the milk? and expel menstrual blood, although does not give the part of the plant used. 1 0 5 0 Sno w JM. Vitex agnus-castus L. (Verbenaceae). Protocol J Botanic Med 199 6 ; 1 (4):20-23 4 1 1 Module Ten Identifying Characteristics Part Characteristics Leaves Alternate with 5-9 leaflets up to 4-in. long, dark green on top and gray underneath Flowers Small and lilac, borne on long spikes Fruit Red-black Taste Spicy, pungent, and peppery Odor Aromatic P a r t s U s e d Fruit and seed C u l t i v a t i o n a n d C o l l e c t i o n The Vitex agnus-castus tree is native to the Mediterranean. Vitex agnus- castus can be cultivated from seed or cuttings. Seeds will germinate readily in 14-28 days. Cuttings root easily, especially with bottom heat and misting. Cuttings are best taken before flowering starts, which is usually in June. Do not over-water and use well-drained soil. Cuttings will be ready to transplant in eight weeks. Vitex agnus-castus is a perennial deciduous shrub growing 6-18 feet high with a spread of up to 15 feet, and hardy Zone 6 and potentially parts of Zone 5. Dosage and Administration When taken as a fluid extract, a typical dose would be 1.2-4.0 mL (or 0.5-1.6 teaspoons). As a tincture, 40 drops, once daily with liquid. 4 12 Module Ten For use with premenstrual dysphoric disorder, 20-40 mg daily has been used 1 0 5 1 . Duration of Administration Vitex agnus-castus has been used safely in studies lasting from three months up to one and a half years. Clients may not respond to therapy immediately. Oral administration of 4-12 weeks can be required before there is significant improvement for menstrual disorders. When used with acne, administration for at least eight weeks or more is often required before there is significant improvement. When used for infertility in women, oral administration for at least six months is usually required before there is significant improvement 1 0 5 2 . Active Constituents The fruit of Vitex agnus-castus contains essential oils (limonene, cineole, and sabinene), iridoid glycosides (aucubin and agnoside), flavonoids (primarily castican, orientin, and isovitexin), essential fatty acids (oleic acid, linolenic acid, palmitic acid, stearic acid), and diterpenes 1 0 5 31 0 5 41 0 5 5 , which have antibacterial, antiviral, antifungal, and expectorant properties 1 0 5 6 . 1 0 5 1 Atmaca M, Kumru S, Tezcan E. Fluo xetine versus Vitex agnus castus extract in the treatment of premenstrual dysp h oric disorder. Hum Psychopharmacol Clin Exp 2003;18 :1 9 1 ? 1 9 5 . 1 0 5 2 Pizz orno JE , Murray MT, editors, Textbook of Natural Medicine. Vol 1, 2nd ed. New York, C h urchill Living ston ; 19 9 9 1 : 1020-3, 1395, 15 10. 1 0 5 3 Du Mee C. Vitex agnus castus. Aust J Med Herb 1993;5:63-5. 1 0 5 4 Brow n D. Vitex agnus castus clinical mon o graph. Qtrly Rev Natural Med 1994;2:1 1 1 - 2 1 . 1 0 5 5 Upton R, ed. Chaste Tree Fruit. American Herbal Pharmacopoeia and Therapeutic Compendium . Santa Cruz, CA ; American Herbal Pharmacopoeia 2001:1 -37. 1 0 5 6 http:/ / medical-dictionary.thefreedictionary.com/diterpenes accessed 6/4/09 4 1 3 Module Ten Pharmacological Action The primary action of Vitex agnus-castus has been attributed to its effect on various neurotransmitters and hormones. Vitex agnus-castus seems to affect dopamine, and possibly acetylcholine and opioid receptors 1 0 5 71 0 5 81 0 5 9 . Vitex agnus-castus extracts contain multiple active constituents that seem to have agonistic effects at pituitary dopamine (D2) receptors when used in higher doses. This dopaminergic activity inhibits basal and thyrotropin-releasing hormone (TRH)-stimulated prolactin release 1 0 6 01 0 6 11 0 6 2 . In women with hyperprolactinemia, elevated serum prolactin, Vitex agnus-castus seems to suppress prolactin release. This may normalize luteal phase defects in the menstrual cycle 1 0 6 3 . 1 0 5 7 Wuttke W. Do paminergic action of extracts of Agnus Castus . F orschende Komplementarmedizen 199 6 ;3:329-30. 1 0 5 8 Jarry H, Leonhardt S., G orkow C , W uttke W. In vitro prolactin but not LH and FSH release is inhibited by comp o u nds in extracts of Agnus Castus: direct evidence for a dopaminergic principle by the dopamine receptor assay. E xp Clin Endocrinol 1994;102:448-54. 1 0 5 9 Meier B, Berger D, Hoberg E, et al. Pharmacological activities of Vitex agnuscastus extracts in vitro. Phytomedicine 2000;7:373-81 . 1 0 6 0 Wuttke W. Do paminergic action of extracts of Agnus Castus. Forschende Komplementarmedizen 199 6 ;3:329-30. 1 0 6 1 Jarry H, Leonhardt S., G orkow C , W uttke W. In vitro prolactin but not LH and FSH release is inhibited by comp o u nds in extracts of Agnus Castus : direct evidence for a dopaminergic principle by the dopamine receptor assay. E xp Clin Endocrinol 1994;102:448-54. 1 0 6 2 Wuttke W, Jarry H, Christoffel V, et al. Chaste tree ( Vitex agnus-castus ) - - p harmacology and clinical indications . Phytomedicine 2003;10:348-5 7 . 1 0 6 3 Milewicz A, Gejdel E, Sw oren H, et al. [ Vitex agnus castus extract in the treatment of luteal phase defects due to latent hyperprolactinemia. Results of a randomized placebo-controlled double-b lind study]. [Article in German]. Arzneimittelforschung 1993;43:75 2 - 6 . 4 1 4 Module Ten In healthy men, the hormonal effects of chaste tree seem to be dose dependent. Lower doses of extract of approximately 120 mg per day seem to increase prolactin release, while higher doses seem to suppress prolactin release 1 0 6 4 . However, Vitex agnus-castus does not seem to affect testosterone. In addition, Vitex agnus-castus appears to have antibacterial and antifungal effects. Extracts have shown moderate in vitro activity against Gram-negative and Gram-positive bacteria 1 0 6 5 . Medicinal Uses The therapeutic effects of Vitex agnus-castus have primarily been attributed to its indirect effects on various neurotransmitters and hormones. Vitex agnus-castus seems to affect dopamine and possibly acetylcholine and opioid receptors. Vitex agnus-castus is used orally for premenstrual syndrome, painful menstruation or dysmenorrhea, hyperprolactinemia 1 0 6 6 , corpus luteum insufficiency, and breast tenderness. Other potential uses include acne vulgaris and prevention of miscarriage in the first trimester where there is a progesterone insufficiency. Refer to Contraindications for use precautions. Contraindications Progesterone, 17-alpha-hydroxyprogesterone, testosterone, and epitestosterone have been detected in Vitex agnus-castus flower extract. Androstenedione has been detected in Vitex agnus-castus leaf extract. The German Commission E 1 0 6 7 recommends that women who 1 0 6 4 Merz P, Gorkow C, Schroder A, et al. The effects of a special Agnus castus extract (BP 1095el) on prolactin secretion in healthy male subjects. E xp Clin Endocrinol Diabetes 1 9 9 6 ; 104:447-53. 1 0 6 5 Hossain MM, Paul N, So hrab MH, et al. Antibacterial activity of Vitex trifolia . Fitoterapia 2001;7 2 : 6 9 5 - 7 . 1066 Hyperprolactinemia- increased levels of prolactin in the blood; in wo men it is associated with amenorrhea an d often galactorrhea, and it has been reported to cause impotence in men. 1067 Blumenthal M, Bus se WR , Goldberg A, Gruenwald J, Hall T, Riggins CW , Rister RS (eds.). Kelin S, Rister RS (trans) . The Complete German Commission E 4 1 5 Module Ten experience tension or swelling of the breasts or menstrual disturbances should consult a healthcare provider before using Vitex agnus-castus 1 0 6 8 . Because Vitex agnus-castus has hormone regulating activity, it may hypothetically interfere with the efficacy of oral contraceptives and hormone replacement therapy. A d v e r s e E f f e c t s Orally, Vitex agnus-castus is usually well tolerated and side effects are relatively rare. However, some clients can experience gastrointestinal upset, headache, nausea, itching and urticaria, rash, acne, and intramenstrual bleeding. Some clients have also experienced alopecia, fatigue, agitation, tachycardia, and dry mouth while taking Vitex agnus- castus. Changes in menstrual flow can also occur when Vitex agnus- castus is first started. Allergic reactions can occur in some clients, but typically resolve spontaneously when Vitex agnus-castus is stopped. Vitex agnus-castus may be unsafe during pregnancy and while breast- feeding. Vitex agnus-castus can have uterine stimulant properties and should be avoided during all stages of pregnancy. Some clinicians use Vitex agnus-castus during the first trimester of pregnancy to prevent miscarriage in clients with progesterone insufficiency. However, because it is not known if Vitex agnus-castus is helpful or safe in these clients, its use is controversial. If a decision is made to withdraw Vitex agnus-castus before four months, progesterone levels should be closely monitored 1 0 6 9 . Vitex agnus-castus is thought to be a dopamine agonist and inhibit prolactin secretion. This might result in decreased breast milk production. However, this is controversial. Some clinicians actually use low doses of Vitex agnus-castus to increase milk production with some reports of success. However, until more is known, avoid using Vitex agnus-castus when breast-feeding. Monographs ? Therapeutic Guide to Herbal Medicines . A u stin: A merican Botanical Cou ncil; Bo ston : Integrative Medicine Com m u nications 2000;108 1068 Blumenthal M, Bus se WR , Goldberg A, Gruenwald J, Hall T, Riggins CW , Rister RS (eds.). Kelin S, Rister RS (trans). The Complete German Commission E Monographs ? Therapeutic Guide to Herbal Medicines . A u stin: A merican Botanical Cou ncil; Bo ston : Integrative Medicine Com m u nications 2000;62 -3 1 0 6 9 Blu menthal M. The ABC Clinical Guide to Herbs , 2003, 66 4 1 6 Module Ten Drug and Supplement Interactions Vitex agnus-castus might affect estrogen levels 1 0 7 0 . Women with hormone-sensitive conditions should avoid use, such as breast, uterine, and ovarian cancer, and endometriosis and uterine fibroids. Regulatory Status Canada: Approved active ingredient in several homeopathic remedies requiring pre-marketing authorization. U.K.: Herbal medicine on General Sale List, Table A (internal or external use), Schedule 1 (requires full Product License) U.S.: Dietary supplement or homeopathic medicine depending on dosage form and label statements. Listed as a Class 2b in the Botanical Safety Handbook . 1 0 7 0 Eagon PK , Elm MS, Hunter DS, et al. Medicinal herbs: modulation of estrogen action. Era of Hope Mtg, Dept Defense; Bre ast Cancer Res Prog, Atlanta, GA 2000;Jun 8- 1 1 . 4 1 7 Module Ten W i t h a n i a s o m n i f e r a Image 63: by user Piouswatson (2008) via Wikipedia.org Taxonomic Notes Common botanical name: Ashwagandha Family: Solanaceae C o m m o n N a m e s Ajagandha, amangura, amukkirag, asan, asgand, asgandh, asgandha, ashagandha, ashvagandha, ashwaganda, asoda, asundha, asvagandha, aswagandha, avarada, Ayurvedic ginseng, clustered winter cherry, ghoda asoda, Indian ginseng, kanaje Hindi, kuthmithi, samm al ferakh, turangi-ghanda, winter cherry, withania, and Indian ginseng P r i m a r y U s e s Ashwagandha is primarily used for arthritis, anxiety, chronic liver disease, insomnia, tuberculosis, and tumors. It is also used orally as an aphrodisiac and emmenagogue, and for decreasing inflammation, emaciation, fibromyalgia, hiccups, immunomodulatory effects, improving cognitive function, infertility in men and women, menstrual disorders, and preventing the effects of aging. 4 1 8 Module Ten Topically, ashwagandha is used with backache, hemiplegia, and ulcerations. Overview Ashwagandha can be found in the dry areas of India and the Middle East, and parts of Africa. It has been used with Ayurvedic medicine in India for hundreds of years and is considered an adaptogenic herb, which helps the body adapt to and resist stress. Identifying Characteristics Part Characteristics Leaves Lush green ovate Flowers Small green to yellow flowers that bloom mid to late summer Root Several taproots extend 1 foot with smaller rootlets radiating from below the crown; some roots take on the appearance of ginseng Fruit Red berries with yellow seeds in a papery balloon-like calyx Taste Bitter Odor Unpleasant P a r t s U s e d Root, berries, and leaves C u l t i v a t i o n a n d C o l l e c t i o n Harvest the root in the fall of the first year from January to March. As it can withstand some frost, consider harvesting after the first frost in order to gain as much growth as possible. In one season, it will grow to the size of a large carrot. Ashwagandha is a perennial, but usually grown as an annual. Easily propagated from seed or cuttings, it can be grown in flats and can be transplanted after 12 weeks. Unblemished bright-red fruit is harvested in the late fall and seeds are dried for planting in the following spring. Seeds can be started indoors or directly sown outside after the last frost. Cuttings done in mid to late summer root easily. It is possible to take cuttings in late summer in cell packs and transplant them the 4 1 9 Module Ten next spring. One can also take cuttings from large greenhouse plants in early spring and transplant in the field in summer. Do not plant until the weather has warmed; the shrub will not grow in the cooler spring season. In most areas, June or July is the best time to plant. Plant in well-drained soil with full sun; space plants 1 ft. apart and space the rows 2-3 ft. apart. Ashwagandha requires adequate moisture and fertilizer. It is hardy to Zone 8 but rots in wet winters. Preparation The root is used both fresh and dry. Do not cut up the roots?leave them whole. To dry, lay roots out for several weeks in a dark, warm area with good air circulation. They should dry to about 70% of their original weight (averaging about 45 g each) in two days. Dry, whole root (sealed in light-proof plastic bags) maintain their active smell and therapeutic value for approximately one year. The fresh root tincture is stable for about two years. Dosage and Administration As a powder, a typical dose is 1-6 g daily in capsule or up to 5-10 g as an occasional tonic. As a tonic, a typical dose is ½ - ¾ t (2?4 mL), three times per day. As an extract, a typical dose is 2 T taken up to three times per day. As a decoction, boil ¾ -1 ¼ t (3?6 g) root in water for 15 minutes; drink three cups per day. As a poultice, use topically for sore joints. Duration of Administration Data is lacking here, but there are clinical trails ranging up to 32 weeks with no adverse effects at the correct dosage. While there are no clinical trials available, it is interesting to note that in one trial, 8- 12-year-old children were given 2 g of ashwagandha daily in milk for 60 days with no toxicity reported. Active Constituents The main constituents of ashwagandha are steroidal alkaloids and steroidal lactones. The two main alkaloids are isopelletierine and 420 Module Ten anaferine, and the two primary steroidal lactones are withanolides and withaferins including withaferin A and withanolide D 1 0 7 1 . Both the fruits and roots contain withanolides. Withaferin A has a similar structure to digoxin 1 0 7 2 . Some of the withanolides are structurally similar to ginsenosides from ginseng 1 0 7 3 . The other alkaloids are somniferine, somnine, somniferinine, withananine, psuedo-withanine, tropine, psuedo-tropine, 3-a-gloyloxytropane, choline, cuscohygrine, isopelletierine, anaferine, and anahydrine. The leaves also contain steroidal lactones. 1 0 7 1 Bhattacharya SK , Satyan KS , G h o s al S. Antioxidant activity of glycowithanolides from Withania somnifera. Indian J Exp Biol 199 7 ;35:236-9 . 1 0 7 2 Dasgu pta A, Peterson A, Wells A, Actor JK . Effect of Indian Ay urvedic medicine Ash wagandha on measurement of serum digoxin and 11 com m o nly m o nitored drugs using im m u n oassays: stud y of protein binding and interaction with Digibind. Arch Pathol Lab Med 2007;131:1 2 9 8 -303. 1 0 7 3 Dasgu pta A, Peterson A, Wells A, Actor JK . Effect of Indian Ay urvedic medicine Ash wagandha on measurement of serum digoxin and 11 com m o nly m o nitored drugs using im m u n oassays: stud y of protein binding and interaction with Digibind. Arch Pathol Lab Med 2007;131:1 2 9 8 -303. 421 Module Ten Pharmacological Action Anti-inflammatory The transcription factor NFkappaB plays a critical role in normal and pathophysiological immune responses. In a 2007 study, the leaf extract of Withania somnifera as well as the major constituent withaferin A was shown to potently inhibit NFkappaB activation. The study concluded that Withania somnifera extracts can be considered a novel class of NFkappaB inhibitors, which hold promise as anti-inflammatory agents for use with various inflammatory disorders and/or cancer 1074 . Antimicrobial Withania somnifera glycoprotein (WSG) demonstrated potent antimicrobial activity against the fungi and bacteria tested. Antifungal effects have been demonstrated in that WSG exerts a fungistatic effect by inhibiting spore germination and hyphal 1075 growth in the tested fungi 1076 . Both water and alcoholic extracts of the Withania somnifera root and leaves were found to possess strong antibacterial activity against a range of bacteria, including Salmonella typhimurium , which causes gastroenteritis. In addition, these extracts did not break down the cell 1 0 7 4 Withaferin a strongly elicits IkappaB kinase beta hyperpho s p h orylation concomitant with potent inhibition of its kinase activity. Kaileh M, Vanden Berghe W, Heyerick A, Horion J, Piette J, Libert C, De Keukeleire D, Es sawi T; J Biol Chem . 2007 Feb 16;2 8 2 ( 7 ) :4253-64. Ep ub 2006 Dec 6 1 0 7 5 A hy p ha (plural hyp hae) is a long , branching filamentous cell of a fun g u s . Madigan M; Martinko J (editors). (2005). Brock Biology of Microorganisms , 11th ed., Prentice Hall. ISBN 0131443291. 1 0 7 6 Antimicrobial properties of a non -toxic glycoprotein (W S G ) from Withania somnifera (As h wagandha). Girish KS ,M achiah KD , Us hanandini S, Harish Ku mar K, Nagaraju S, G o vindappa M, Vedavathi M, Kemparaju K J Basic Microbiol. 2006;46(5 ) :365- 74 422 Module Ten membrane of red blood cells, indicating Withania somnifera?s safety for living cells 1077 . Arthritis There are significant increases in the levels of lipid peroxides, glycoproteins, and urinary constituents with the depletion of antioxidant status and bone collagen in arthritic animals. These biochemical markers of inflammation were significantly reduced by oral administration of Withania somnifera root powder 1078 . Cancer Both the crude leaf extract and the active component, withanolide, activated the apoptotic cascade 1079 leading to growth inhibition and death of cultured leukemia cells 1080 . Withania somnifera displayed growth inhibition against human gastric, breast, central nervous system, colon, and lung cancer cell lines 1081 . Deletion or mutation of the androgen receptor renders prostate tumors refractory to anti- androgen protocols, the mainstay of prostate cancer therapy. Withaferin A, a major constituent of Withania somnifera , induced cell 1 0 7 7 Antibacterial efficacy of Withania somnifera (ashwagandha) an indigenou s medicinal plant against experimental murine salmo nellosis Owais M, Sharad KS, Shehbaz A, Saleemuddin M. Phytomedicine. 2005 Mar;12 (3):2 2 9 -35 1 0 7 8 Protective effect of Withania somnifera root po wder in relation to lipid peroxidation, antioxidant status, glycopr oteins and bone collagen on adjuvant- induced arthritis in rats. Rasool M, Varalaksh mi P. Fundam Clin Pharmacol . 2007 Apr;21 ( 2 ) : 1 5 7 - 64. 1 0 7 9 The initiation of a cascade of cellular processes leading to cell death. 1 0 8 0 Withanolide induces apoptosis in HL-60 leukemia cells via mitochondria mediated cytochrome c release and caspase activation. Senthil V, Ramadevi S, Venkatakrishnan V, Giridharan P, Laks h mi BS , Vish wakarma RA, Balakrishnan A Chem Biol Interact. 2007 Apr 5;1 6 7 ( 1 ) : 1 9 -30. Epub 2007 Jan 12 1 0 8 1 Ash wagandhanolide, a bioactive dimeri c thiowithanolide isolated from the roots of Withania somnifera . Subbaraju GV , Vanisree M, Rao CV , Sivaramakrishna C, Sridhar P, Jayaprakasam B, Nair MG. J Nat Prod. 2006 Dec;69 ( 1 2 ) : 1 7 90-2. 423 Module Ten death in androgen-refractory prostate cancer cells. When combined with anti-androgens, Withaferin A inhibits survival of both androgen- responsive and androgen-refractory prostate cancer cells 1082 . Withania somnifera reduces tumor cell proliferation while increasing overall animal survival time. Furthermore, it has been shown to enhance the effectiveness of radiation therapy while potentially mitigating undesirable side effects. Withania somnifera also reduces the side effects of chemotherapeutic agents cyclophosphamide and paclitaxel without interfering with the tumor-reducing actions of the drugs. These effects have been demonstrated in vitro on human cancer cell lines, and in vivo on animal subjects, but there have been no human trials to date 1 0 8 3 . Most of the synthetic chemotherapeutic agents available today are immunosuppressants, cytotoxic, and exert a variety of side effects particularly evident in cancer chemotherapy. Botanical-based immunomodulators are often employed as supportive or adjuvant therapy to overcome the undesired effects of cytotoxic chemotherapeutic agents and to restore normal health. Withania somnifera protects against immunosuppression as evident by significant increase in white cell counts and hemagglutinating, and hemolytic antibody titers 1 0 8 41 0 8 5 . Cardiovascular Damage Withania somnifera exerts a strong cardioprotective effect in the experimental model of heart damage in rats. Augmentation of 1 0 8 2 Par-4-dependent apoptosis by the di etary comp o u nd withaferin A in prostate cancer cells. Srinivasan S, Ra nga RS, B urikhanov R, Han SS, Chendil D. Cancer Res. 2007 Jan 1;6 7 ( 1 ) : 246-53. Ep ub 2006 Dec 21. 1 0 8 3 Ancient medicine, modern use: Withania somnifera and its potential role in integrative oncology . Winters M. Altern Med Rev. 2006 Dec;11 (4):2 6 9 - 7 7 . 1 0 8 4 Antibody titer is a laboratory test that measures the presence and amou nt of antibodies in blood. 1 0 8 5 Immu n o protection by botanical drugs in cancer chemotherapy. Diwanay S, Chitre D, Patwardhan B. J Ethnopharmacol. 2004 Jan;90(1) :49-5 5 . 424 Module Ten endogenous antioxidants 1086 , maintenance of the myocardial antioxidant status, and significant restoration of most of the altered haemodynamic parameters may contribute to its cardioprotective effect 1087 . C holesterol and Blood Lip i d s Hypocholesteremic and antioxidant effects of Withania somnifera were investigated in hypercholesteremic male albino rats. When the root powder of Withania somnifera was added to the diet at 0.75 and 1.5 g/rat/day, hypercholesteremic animals registered significant decreases in total lipids, cholesterol and triglycerides, as well as significant increases in plasma HDL-cholesterol. Further, a significant decrease in lipid-peroxidation occurred, which decreases the blood vessel damage thought to induce arthersclerosis 1 0 8 8 . C ognition and Memory Extracts from 37 Indian medicinal plants were investigated for acetylcholinesterase (AChE) inhibitory activity in vitro . The potent AChE inhibiting methanolic plant extracts included Withania somnifera root. These results partly substantiate the traditional use of these herbs for improvement of cognition 1 0 8 9 . 1 0 8 6 Our antioxidant system includes both antioxidants made in the body (endogenou s ) and antioxidants that we obtain from our diet or sup plements (exogenou s ) . The five important endogenou s antioxidants are superoxide dismutase (sod), glutathione peroxidase, alpha lipoic acid (ala), catalase and coenzy me Q10 (Co Q 10). 1 0 8 7 Mechanism s of cardioprotective effect of Withania somnifera in experimentally induced myocardial infarction. Mohanty I, Arya DS, Dinda A, Talwar KK, Jo s hi S, Gu pta SK. Basic Clin Pharmacol Toxicol. 2004 Apr;94(4):1 84- 90 1 0 8 8 Hypocholesteremic and antioxidant effects of Withania somnifera (D u nal) in hy percholesteremic rats. Visavadiya NP, Narasimhacharya AV . Phytomedicine. 2007 Feb;14(2-3):136-42. Ep ub 2006 May 18 1 0 8 9 Screening of selected Indian medici nal plants for acetylcholinesterase inhibitory activity. Vinutha B, Prashanth D, Salma K, Sreeja SL, Pratiti D, 425 Module Ten D ementia and Alzh e imer?s Dis ease At the present, medication of dementia is limited to symptomatic programs, such as the use of cholinesterase inhibitors. To cure dementia completely, that is regaining neuronal function, reconstruction of neuronal networks is necessary. Withanoside IV from the root of Withania somnifera induced neurite outgrowth in cultured rat cortical neurons. Oral administration of withanoside IV (10 micromol/kg/day) significantly improved memory loss in mice and prevented loss of axons, dendrites, and synapses. These data suggest that orally administrated withanoside IV may ameliorate neuronal dysfunction in Alzheimer?s disease 1 0 9 0 . D iabetes and Aging Modification of collagen such as non-enzymatic glycation 1 0 9 1 and cross- linking plays an important role in diabetic complications and age- related diseases. The activity of ethanolic extract of Withania is comparable to metformin, a known antiglycating agent. Withania Padmaja R, Radhika S, Amit A, Venkateshwarlu K, Deepak M J Ethnopharmacol. 2007 Jan 19 ; 109(2 ) :359- 63. Ep ub 2006 Aug 4 1 0 9 0 Withanoside IV and its active metabolite, somino ne, attenuate Abeta(25 - 35)-induced neurodegeneration. Kubo yama T, To hda C, Ko matsu K. Eur J Neurosci. 2006 Mar;23(6) : 1417- 2 6 1 0 9 1 Glycation (so metimes called non -enzy matic glycosylation) is the result of a sugar molecule, such as fructose or glucose, bonding to a protein or lipid molecule witho ut the controlling action of an enzyme. All blood sugars are reducing molecules. Glycation may occur either inside the body (endogenou s glycation) or outside the body (exo genou s glycation) . En z y me-controlled addition of su gars to protein or lipid molecules is termed glycosylation; glycation is a haphazard process that impairs the functioning of biomolecules, whereas glycosylation occurs at defined sites on the target molecule and is required in order for the molecule to function. Much of the early laboratory research work on fructose glycations us ed inaccurate assay techniques that led to drastic underestimation of the importance of fructose in glycation. Ah med N, Furth AJ. "Failure of com m o n glycation assa ys to detect glycation by fructose." Clin Chem 199 2 ;38:1301-3 426 Module Ten could have a therapeutic role in the prevention of glycation-induced diabetic complications and aging 1 0 9 2 . Immune Stimulation Extract of Withania somnifera selectively induced type 1 immunity, because it guided enhanced expression of T helper cells (Th)1 cytokines interferon (IFN)-gamma and interleukin (IL)-2 while Th2 cytokine IL-4 observed a moderate decline. Withania somnifera supports predominantly Th1 immunity with increase in macrophage functions, which could be useful against the intracellular pathogens and in the management of immune suppressed diseases 1 0 9 3 . N e uro-protection in Stroke Stroke causes brain injury in millions of people worldwide each year. One of the approaches that can be used in limiting the neurological damage after stroke is the use of prophylactic in patients with a high- risk of stroke. The present study was undertaken to investigate the effect of Withania somnifera as a prophylactic in the middle cerebral artery occlusion model of stroke in rats. The protection afforded by W. somnifera could be due to its anti-oxidant effect 1094 . O steoporosis Osteoporosis, characterized by reduction in bone density, is a significant source of mortality among the elderly, particularly in estrogen-deficient women. Withania somnifera root extract contains estrogen-like withanolides for anti-osteoporotic activity. Withania 1 0 9 2 Gok ulakrish nan A, Dhandayuthabani R, Ameethkhan D, Ku mar CV, Ahamed MI. Comp Biochem Physiol B Biochem Mol Biol. 2007 Jan 31; [E p ub ahead of print 1 0 9 3 Malik F, Sing h J, K hajuria A, Suri KA , Satti NK , Sing h S, Kaul MK, Ku mar A, Bhatia A, Qazi GN Life Sci. 2007 Mar 27; 80(16 ) : 1 5 2 5 -38. Ep ub 2007 Jan 25 1 0 9 4 Evaluation of Withania somnifera in a middle cerebral artery occlusion model of stroke in rats Chaudhary G, Sharma U, Jagannathan NR , G u pta. Clin Exp Pharmacol Physiol. 2003 May-Ju n ;30(5- 6 ) :399-404 427 Module Ten somnifera prevented a reduction in bone density in rats and, thus, may be a potential agent for use with osteoporosis 1 0 9 5 . Parkinson?s Oral use of the root extract resulted in a significant improvement in the mice?s behavior and antioxidant status, along with a significant reduction in the level of lipid peroxidation. The results indicated that at least part of the chronic stress-induced pathology may be due to oxidative stress, which is mitigated by Withania. Further studies are needed to assess the precise mechanism to support the clinical use of the plant as an antiparkinson drug 1 0 9 6 . This study in rats demonstrates that the extract of W. somnifera may be helpful in protecting the neuronal injury in Parkinson?s disease 1 0 9 7 . Clinical Trials A nemia Withania increases iron in the blood, boosts respiration, and counters liver toxicity. A year-long, double-blind clinical trial of ashwagandha in 141 male subjects, ages 50-59 years, resulted in significant improvements in hemoglobin, red blood cell count, and decreased serum cholesterol versus controls. More than 70% of the subjects reported improved sexual performance 1098 . In a study with 8-12-year- 1 0 9 5 Withania somnifera improves bone calcification in calcium -deficient ovariectomized rats. Nagareddy PR, Laksh mana M. J Pharm Pharmacol. 2006 Apr;58 (4):5 13-9 1 0 9 6 The neuroprotective effect of Withania somnifera root extract in MPTP - intoxicated mice: An analysis of behavioral and biochemical varibles. Sankar SR, Manivasagam T, Krishnamurti A, Ramanathan M. Cell Mol Biol Lett. 2007 Apr 6; [E p ub ahead of print 1 0 9 7 Neuroprotective effects of Withania somnifera on 6- h ydroxydopamine induced Parkinso nism in rats. Ah mad M, Saleem S, Ah mad AS, A n sari MA,Y o u s u f S, Hoda MN, Islam F.; Hum Exp Toxicol. 2005 Mar;24(3):137-47 1 0 9 8 Kup p urajan K, Rajagopalan SS, Sitora man R, et al. Effect of As h wagandha ( Withania somnifera Dunal) on the process of ageing on hu man volunteers. J ournal of Research in Ayurveda and Siddha 1980;1( 2 ) : 247-2 5 8 428 Module Ten old children who took 2 g daily for two months, ashwagandha increased body weight, iron count, and hand strength. Arthritis In a double-blind crossover study with 42 people with arthritis and rheumatoid arthritis, those taking ashwagandha experienced less stiffness, pain, and general disability than the control group 1 0 9 9 . A controlled drug trial demonstrated the potential efficacy and safety of RA- 11 1 1 0 0 with osteoarthritis of the knees over 32 weeks of therapy 1 1 0 1 . Medicinal Uses The use of ashwagandha in Ayurvedic medicine extends back 3,000- 4,000 years. It has been described in the sacred texts of Ayurveda as a rejuvenating tonic used to strengthen the whole body. In Ayurveda it is used for tumors, inflammation, arthritis, asthma, hypertension and cerebral disorders in the elderly, including memory loss. Evidence suggests that ashwagandha might stimulate respiratory function, cause smooth muscle relaxation, and stimulate thyroid synthesis and/or secretion. Two studies in 2005 and 2006 showed ashwagandha has potential for being helpful in protecting the neuronal injury in Parkinson?s disease 1 1 0 21 1 0 3 . Ashwagandha also has potential as a mood stabilizer for 1 0 9 9 Kulkarni RR , Patki PS , Jo g V P , Gand age SG , Patwardhan B.Treatment of osteoarthritis with a herbomineral fo rmulation: a double-blind, placebo- controlled, cross - o ver study. J Ethnopharmacol. 199 1 May-Ju n ;33(1- 2 ) : 9 1 - 5 . 1 1 0 0 RA- 1 1 (A R T R E X , MEND A R ) , a standard ized multiplant Ayurvedic drug ( Withania somnifera, Boswellia serrata, Zingiber officinale , and Curcuma longa ) 1 1 0 1 A 32-Week Randomized, Placebo-C o ntrolle d Clinical Evaluation of RA - 1 1 , an Ay urvedic Drug, on O steoarthritis of the Knees Cho pra A, Lavin P, Patwardhan B, Chitre D J Clin Rheumatol. 2004 Oct;10(5) : 236-245 1 1 0 2 Ahmad M, Saleem S, Ah mad AS, An sari MA, Yo u s u f S, Hoda MN, Islam F. Neuroprotective effects of Withania somnifera on 6- h ydroxydopamine induced Parkinso nism in rats. Hum Exp Toxicol . 2005 Mar;24(3):137-47. 429 Module Ten clinical anxiety and depression 1 1 0 41 1 0 5 . Immunomodulatory effects have also been noted in both in vivo and in vitro studies 1 1 0 6 . The constituents withaferin-A and withanolide-D seem to cause immunosuppression but other constituents seem to have immunostimulating activity. Ashwagandha also seems to increase bone marrow cell and white blood cell count in radiation-treated animals 1 1 0 7 . Withanolide D exhibits anti-tumor activity 1 1 0 8 . In a double-blind study involving mice, ashwagandha prevented stress- related gastrointestinal ulcers, increased physical endurance, and prevented the depletion of vitamin C and cortisol in stressed animals. Contraindications Ashwagandha may affect thyroid function tests by suppressing thyroid stimulating hormone or increasing triiodothyronine (T3) or thyroxine (T4) values. There is some evidence that ashwagandha might stimulate thyroid hormone synthesis or secretion 1 1 0 9 . 1 1 0 3 Kumar A, Kulkarni SK. Ef fect of BR - 1 6 A (Mentat), a polyherbal formulation on drug-induced catalepsy in mice. Indian J Exp Biol . 2006 Jan;44(1) :45-8 . 1 1 0 4 Bhattacharya SK, Bhattacharya A, Sairam K, Gh o sal S. An xiolytic- antidepressant activity of Withania somnifera glycowithanolides: an experimental study. Phytomedicine. 2000 Dec;7( 6 ) :463-9. 1 1 0 5 Gupta GL, Rana AC.Protective effect of Withania somnifera dunal root extract against protracted social is olation induced behavior in rats. Indian J Physiol Pharmacol . 2007 Oct-Dec;51 (4):345-53. 1 1 0 6 Rasool M, Varalaksh mi P. Imm u n o m odulatory role of Withania somnifera root powder on experimental induced inflammation: An in vivo and in vitro study. Vascul Pharmacol. 2006 Jun ;44(6) :406-10. 1 1 0 7 Davis L, Kuttan G. Ef fect of Withania somnifera on cycloph o s p hamide- induced urotoxicity. Cancer Lett. 2000 Jan 1;148(1 ) : 9 - 1 7 . 1 1 0 8 Kaileh M, Berghe WV , Bo o ne E, Es sawi T, Haegeman G. Screening of indigenou s Palestinian medicinal plants for potential anti-inflammatory and cytotoxic activity. J Ethnopharmacol. 2007 Sep 25 ; 1 13(3):5 10-6. 1 1 0 9 Thyrotoxicosis following the use of ashwagandha] Ned Tijdschr Geneeskd. 2005 Nov 19 ; 149(47): 2 637-8 4 3 0 Module Ten It is also contraindicated in conjunction with sedatives or anxioletics (a substance that reduces anxiety) or if one is suffering from stomach ulcers because of its irritant effect on the gastrointestinal (GI) tract 1 1 1 0 . Do not use during pregnancy. Anecdotal evidence suggests that when used orally, ashwagandha may have abortifacient effects. One study in rats showed a decrease in male sexual function due to ashwagandha 1 1 1 1 . However, in humans, ashwagandha root has historically been noted to have sex-enhancing properties. Orally, ashwagandha seems to be well tolerated at typical doses. A d v e r s e E f f e c t s 1112 Use cautiously in clients: ? With hypotension or taking antihypertensive medications. ? With peptic ulcers due to possible irritation of mucous and serous membranes. ? Taking sedative drugs due to possible potentiation of effects. ? With thyroid disorders due to possible thyroid stimulatory properties. Drug and Supplement Interactions Withania is a sedative, so blending with other sedatives may enhance the sedative action. Theoretically, ashwagandha?s sedative effect may also potentiate the effects of barbiturates, other sedatives, and anxiolytics. It is generally not recommended that it taken with barbiturates. Ashwagandha might decrease the effectiveness of immunosuppressant therapy because of its potential immunostimulating effects. 1 1 1 0 Upton R, ed. Ashwagandha Root (Withania somnifera): Analytical, quality control, and therapeutic monograph . Santa Cruz, C A : A merican Herbal Pharmacopoeia 2000:1- 2 5 . 1 1 1 1 Effect of Withania somnifera root extract on the sexual behaviour of male rats. Asian J Androl. 2002 Dec;4(4):2 9 5 - 8 . 1 1 1 2 Natural Standards Database 4 3 1 Module Ten Regulatory Status The American Herbal Products Association Class 2 B; not to be used during pregnancy. 4 32 Module Ten Z e a m a y s Image 64: by user soltenviva (2007) via flickr.com Taxonomic Notes Common botanical name: Cornsilk Family: Gramineae C o m m o n N a m e s Cornsilk, Indian corn, Indian Corn, maidis stigma, maize silk, stigma maydis, and zea P r i m a r y U s e s Cornsilk is thought to possess diuretic and stone-reducing properties, and is used for: Cystitis, urethritis, nocturnal enuresis, prostatitis, and acute chronic inflammation of the urinary system 1 1 1 3 . 1 1 1 3 Barnes, J., A nderson , L., and Phillipso n , J.D . Herbal Medicines , T hird Edition. Pharmaceutical Press. Lo ndon, 2007. 4 3 3 Module Ten In Chinese medicine, cornsilk is used as a diuretic for congestive heart failure, to treat diabetes, and hypertension. Corn silk is decocted with watermelon peel and bananas. Overview Medicinal cornsilk consists of the dried styles and stigmas of Zea mays , which are collected from the female flowers before pollination and rapidly dried in the shade. Native to Central America, Zea mays is cultivated worldwide; some of the North American supply is cultivated in Mexico and the United States. Identifying Characteristics Part Characteristics Leaves Dried styles and stigmas are filamentous, about .1- .2 mm thick, about 7 in. or longer, and light-yellow to brownish-red Flowers White, situated in the mid-section of the stem in the form of long cobs, and enclosed by glumes with protruding tufts of stigmas; male flowers are in terminal spikes Taste Somewhat sweet Odor Faint and characteristic P a r t s U s e d Dried style and stigma Dosage and Administration 1114 When taken an infusion, a typical dose of dried style and stigma is 4-8 g, three times daily. When taken as a liquid extract, 4-8 mL. 1 1 1 4 Barnes, J., A nderson , L., and Phillipso n , J.D . Herbal Medicines , T hird Edition. Pharmaceutical Press. Lo ndon, 2007. 4 3 4 Module Ten When taken as a tincture (1:5 in 25% alcohol), 5-15 mL, three times daily. Duration of Administration When taken orally, prolonged use might cause hypokalemia 111 5 . Active Constituents The primary active constituents in cornsilk are astringent, cryptoxanthin, which has vitamin A activity, and tannins 1 1 1 6 . Pharmacological Action In a 2005 animal study, Zea mays aqueous extract was investigated for its effect on the urinary excretion of water. Conscious and unrestrained male rats were house in metabolic cages with continuous urine collection for 5 and 3 h. Results showed that water-loaded conscious rats (2.5 ml/100 body wt.), Zea mays aqueous extract has diuretic effects at 500 mg/kg body wt. and kaliuretic at doses of 350 and 500 mg/kg body wt. In water-loaded conscious rats (5.0 ml/100 g body wt.), Zea mays aqueous extract has kaliuretic effects at 500 mg/kg body wt 11 1 7 . Contraindications Cornsilk might have hypotensive effects. Use of cornsilk with other herbs or supplements with hypotensive effects could increase the risk of hypotension. Herbs and supplements with hypotensive effects include: Andrographis, casein peptides, cats claw, coenzyme Q-10, fish oil, L-arginine, lycium, stinging nettle, and theanine, 1 1 1 5 Newall CA , A nderson LA , Philpso n JD . Herbal Medicine: A Guide for Healthcare Professionals . Lo ndon, UK : The Pharmaceutical Press, 19 9 6 . 1 1 1 6 Newall CA , A nderson LA , Philpso n JD . Herbal Medicine: A Guide for Healthcare Professionals. L o ndon, UK : The Pharmaceutical Press, 19 9 6 . 1 1 1 7 Velazquez DV , Xavier HS, Batista JE, de Castro-C haves C. Zea mays L. extracts modify glomerular function and potassium urinary excretion in conscious rats. Phytomedicine. 2005 May;12 ( 5 ) :363-9. 4 3 5 Module Ten Cornsilk is likely safe when consumed in amounts commonly found in foods and medicinally when consumed in appropriate amounts 1 1 1 8 . During pregnancy, cornsilk is likely safe when consumed in amounts commonly found in foods. Avoid use in larger amounts because cornsilk might have uterine stimulant effects 1 1 1 9 . Due to lack of safety information, avoid use while breast-feeding. A d v e r s e E f f e c t s When taken orally, prolonged use might cause hypokalemia 1 1 2 0 . When used topically, people with an allergy to cornsilk, corn pollen, or cornstarch might experience contact dermatitis or urticaria 1 1 2 1 . Drug and Supplement Interactions Cornsilk contains vitamin K and interacts with Warfarin (Coumadin). Patients taking Warfarin should consume a daily amount to maintain consistent anticoagulation 1 1 2 2 . Use caution with antidiabetic drugs because cornsilk might reduce blood glucose levels and interfere with diabetes therapy. Use caution with antihypertensive drugs because cornsilk might cause hypotension and interfere with drugs for hypo and hypertension 1 1 2 3 . 1 1 1 8 McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. B oca Raton, FL : CR C Press, LL C 19 9 7 . 1 1 1 9 Newall CA , A nderson LA , Philpso n JD . Herbal Medicine: A Guide for Healthcare Professionals. L o ndon, UK : The Pharmaceutical Press, 19 9 6 . 1 1 2 0 Newall CA , A nderson LA , Philpso n JD . Herbal Medicine: A Guide for Healthcare Professionals . Lo ndon, UK : The Pharmaceutical Press, 19 9 6 . 1 1 2 1 Newall CA , A nderson LA , Philpso n JD . Herbal Medicine: A Guide for Healthcare Professionals. L o ndon, UK : The Pharmaceutical Press, 19 9 6 . 1 1 2 2 Brinker F. Herb Contraindications and Drug Interactions . 2nd ed. Sandy, O R : Eclectic Medical Publications , 19 9 8 . 4 3 6 Module Ten Do not overuse. Excessive consumption of cornsilk might further compound diuretic-induced potassium loss. An increase in potassium intake might be necessary for some patients because some diuretics may deplete potassium, including: Chlorothiazide (Diuril), chlorthalidone (Thalitone), furosemide (Lasix), and hydrochlorothiazide (HCTZ, Hydrodiuril, and Microzide). Regulatory Status Canada: Approved active ingredient in some Schedule OTC Traditional Herbal Medicines and some homeopathic medicines, requiring pre-marketing authorization. U.K.: Herbal medicine in the General Sale List, Table A (internal or external use) of Schedule I (requiring full product license). U.S.: Dietary supplement. Cornsilk and cornsilk extracts have Generally Recognized as Safe (GRAS) status in the U.S 1 1 2 4 . Module Assessment You are now ready to log in and complete the module assessment online. Refer back to the instructions in Module One if you need to. 1 1 2 3 Newall CA , A nderson LA , Philpso n JD . Herbal Medicine: A Guide for Healthcare Professionals . Lo ndon, UK : The Pharmaceutical Press, 19 9 6 . 1 1 2 4 Wichtl, M. ed. Herbal Drugs and Phytopharmaceuticals: A Handbook for Practice on a Scientific Basis , Third Edition. Medpharm. Boca Raton, FL : 2002. N o / 4 3 7 E xam Information E xam Information Once you have completed all required assessments for each module, only one step remains to complete your course: Your final examination. You will sit your final examination online, where you will find more information about the exam. Some students are nervous about the final examination. Do not be. It is challenging but fair, and if you have worked through all of the course materials and assessments, you are well prepared for the challenge! Questions are taken from your course materials and assessments. Some questions will be similar to what you have covered in assessments, while others will be variations on these. All the examined material is in your course materials. All questions should be answered according to the study materials. Do not rely on outside information to study for your exam. 4 3 8 Resources Resources Conversions and E qui valents In this course, we use mostly American measures. To convert measurements, visit the Virtual Library General Education section for tools and references. G lossary View the terminology guides, available in the online Virtual Library in text and audio format. Refer to them any time you come across a term you do not recognize. If the term is not in the glossary visit MyACHS Connect, the social networking community, and add it to the Help Build a Comprehensive Holistic Health Glossary forum. Online Resources In your online class you will find the following resources: ? ACHS Virtual Library ? ACHS Research Wiki ? ACHS Herb Garden ? ACHS Virtual Tours ? Selected bonus audio lectures, including an herbal terminology audio guide ? Industry contact information ? Selected bonus video clips ? Glossary and interactive glossary review And more! 4 3 9 Index Index A. sinensis , 34 abortifacient, 37, 51, 54, 58, 79, 81, 86, 100, 105, 109, 169, 219, 232, 308, 430 abortion, 168, 303 Accreditation , 14, 15 acne, 24, 412, 414, 415 adaptogen, 61, 112, 116, 117, 245, 249, 259, 294, 295, 298, 299 adaptogenic, 297, 298, 300 Adoxaceae/Sambucaceae , 318 Alchemilla xanthochlora , 31 alopecia areata, 303, 305, 333 Alopecia neurotica , 58 alterative, 20, 154 Alzheimer?s, 112, 161, 357 Alzheimer?s disease, 112, 366, 425 amenorrhea, 39 American Botanical Council, 29, 30, 31, 32, 150, 174, 175, 222, 223, 224, 249, 259, 265, 267, 275, 277, 278, 305 American ginseng, 112, 244, 255, 256, 257, 258, 259, 260, 261 analgesic, 57, 131, 184, 186, 246, 267, 268, 343, 344, 396 anaphylactic shock , 49 Anemia, 427 anethole, 147, 148 Angelica , 33, 34, 35, 36, 37 Angelica sinensis , 39, 40, 42, 43 anthelmintic, 20, 88, 232, 410 anthocyanidins, 374 anthocyanins, 281, 283, 326, 327, 328 anthocyanosides, 385, 388, 390 antibacterial, 66, 102, 108, 109, 138, 139, 227, 228, 238, 241, 309, 313, 321, 356, 363, 381, 412, 414, 421 antibiotic, 65, 105, 123 anticancer, 76, 102, 105, 108, 116, 169, 211, 212, 246, 374 anticoagulant, 46, 59 antidepressant, 290, 308, 354 anti-diabetic, 191, 193, 375 antidiabetic, 292, 307, 358 anti-diabetics, 391 antiestrogenic, 290, 336 antifungal, 186, 191, 193, 227, 228, 247, 306, 309, 412, 414 antihemorrhagic, 79 anti-inflammatory, 24, 28, 36, 53, 57, 66, 74, 95, 105, 109, 123, 148, 162, 163, 182, 184, 185, 186, 188, 197, 267, 276, 278, 283, 303, 309, 324, 327, 331, 335, 337, 347, 363, 368, 369, 373, 381, 388, 398, 421, 429 antimalarial, 178, 191, 193, 225 antimicrobial, 58, 105, 108, 122, 123, 138, 180, 210, 217, 228, 239, 306, 316, 317, 321, 363, 397, 421 anti-oxidant, 426 antioxidant, 64, 66, 116, 157, 227, 228, 239, 240, 246, 282, 283, 291, 293, 299, 303, 306, 307, 308, 309, 324, 328, 363, 368, 369, 374, 382, 396, 403, 404, 422, 424, 427 antioxidants, 299, 308, 371, 374 antiplatelet, 46, 50, 59, 163, 252, 291, 337, 347 anti-platelet aggregation, 157 antiseptic, 37, 48, 56, 79, 94, 147, 275, 303, 331, 332, 348 antispasmodic, 35, 36, 50, 218, 303, 401, 402, 403, 405 antitumor, 102, 109, 138, 210, 229, 246, 316, 396 antiviral, 66, 104, 108, 205, 217, 239, 247, 327, 368, 412 anxiety, 94, 119, 133, 152, 239, 249, 264, 265, 266, 267, 268, 270, 295, 297, 298, 355, 417, 429, 430 anxiolytic, 132, 133, 268 aperient, 136 aphrodisiac, 48, 83, 232, 268, 354, 355, 356, 417 Apiaceae , 33, 39, 47, 74, 82, 145, 150, 215, 216 Apocynaceae, 177 apoptosis, 148, 334, 335, 344, 376, 381, 382 4 4 0 Index Araliaceae, 111, 116, 242, 255 Arecaceae/Palmaceae, 331 arnica, 46, 51, 53, 54, 55, 56, 57, 58, 59, 60 aromatase, 356 aromatherapy, 20, 99 arsenic, 155, 205, 206 arthritis, 39, 48, 94, 112, 137, 152, 157, 183, 185, 188, 232, 234, 365, 366, 369, 386, 389, 390, 402, 417, 422, 428 Ashwagandha, 418, 420, 421, 427, 428, 429, 430 Asian ginseng, 242, 243, 245, 248, 249, 250, 251, 254, 256 Asteraceae, 53, 93 Asteraceae/Compositae, 105, 110, 136, 140, 142, 143, 172, 175 asthma, 36, 83, 94, 156, 161, 173, 249, 319, 349, 359, 362, 363, 365, 394, 397, 401, 407, 428 asthmatics, 362 astringent, 29, 31, 114, 236, 280, 282, 303, 313, 314, 348, 349 atherosclerosis, 45, 112, 259, 339, 385, 389, 390 attention deficit-hyperactivity disorder, 264, 268 Ayurvedic, 62, 83, 126 bacteria, 109, 210, 306, 316, 321, 363, 380 balsam poplar, 274, 275 barbiturates, 271, 430 Berberidaceae, 225 berberine, 225, 227, 228, 229, 230 bilberry, 372, 385, 386, 387, 388, 389, 390, 391, 392 bladder, 85, 123, 126, 127, 132, 137, 173, 188, 268, 300, 375 bladderwrack, 152, 153, 154, 155 blessed thisle, 106 Blessed Thistle, 105 blood, 78 blood glucose, 189, 251, 252, 261, 345, 389, 391 blood glucose levels, 86, 117, 119, 181, 189, 249, 251, 252, 261, 292, 329, 343, 345, 346 blood sugar, 164, 178, 180, 181, 255, 329, 341, 357, 358 blue flag, 195, 196, 197, 198 blueberry, 371, 372, 374, 375, 376 boneset, 136, 137, 138, 139, 140, 141, 142, 144 Brassicaceae, 77, 78, 81, 231 breast cancer, 160, 162, 258, 382, 397, 399 breast-feeding, 45, 51 bronchitis, 34, 36, 112, 137, 145, 149, 152, 172, 173, 215, 216, 232, 234, 239, 240, 249, 280, 313, 315, 319, 339, 359, 363 bugleweed, 221, 222, 223, 224 Bupleurum, 74, 75, 76 calcium, 36, 50, 101, 109, 127, 128, 148, 179, 234, 238, 267, 314, 316, 317 calendula, 52, 58 California Native Americans, 173 California poppy, 52, 86, 120, 131, 132, 133, 134 cancer, 37, 43, 45, 48, 65, 66, 76, 94, 118, 126, 137, 157, 159, 160, 162, 169, 172, 196, 201, 208, 211, 232, 234, 246, 247, 248, 249, 250, 258, 259, 260, 268, 269, 280, 282, 283, 295, 300, 301, 310, 313, 315, 319, 332, 337, 339, 344, 357, 365, 367, 368, 373, 375 Caprifoliaceae , 318, 323, 401, 404, 405 carbohydrates, 115, 122, 123 carcinogenesis, 148 carcinogenic, 43, 45, 143, 148, 211, 363 cardiovascular, 39, 64, 103, 104, 118, 161, 188, 283, 289, 303, 362 carotenoids, 56, 334 cats claw, 365, 366, 367, 368, 369, 370 celery, 46, 47, 48, 49, 50, 51, 52 Celery plant extracts, 50 chamomile, 46, 51, 52, 58 chemopreventive, 157, 160, 310, 381 cherry, 280, 281, 282, 283, 284 childbirth, 188, 236, 239, 249, 259, 349, 406 China, 41, 62, 83 Chinese medicine, 40, 45, 127 cholinergic, 258, 403 Cinnamomum spp, 98 4 4 1 Index Cinnamon, 98, 99, 100, 101, 102, 103, 104 circulation, 58, 85, 218, 236, 239, 372 citral, 107, 236, 245, 396 Cnicus benedictus, 105, 107, 108 CNS depressant, 245, 257, 269, 356, 357 colds, 45, 137, 216, 236, 280, 283, 324 colon carcinoma, 382 coltsfoot, 140, 144, 359, 360, 362, 363, 364 Comopositae, 53 Compositae , 58 constipation, 39, 45, 96 contact dermatitis, 399, 435 contraceptive, 165, 398 contraindications, 8 coronary heart disease, 114, 159 Cotton Root, 165, 167, 168 cottonseed, 165, 166, 168, 169 couch grass, 52, 86, 120, 121, 122, 123, 124 coumarin, 42, 46, 50, 51 coumarins, 36, 42, 43, 56, 64, 115, 116, 406 cramp bark, 379 cranberry, 316, 375 Crassulaceae, 294, 299 cultivated celery, 49 cyclooxygenases, 381 cytotoxic, 108, 138, 160 damiana, 354, 355, 356, 357, 358 dandelion Taraxacum officinale , 20 dementia, 410, 425 Department of Parasitology, 48 dermatitis, 49, 51, 86, 96, 103, 124, 129, 140, 149, 173, 175, 194, 212, 309, 386, 389, 390 devil?s claw, 182, 184, 186, 187, 188 diabetes, 28, 66, 86, 99, 112, 122, 157, 159, 178, 180, 189, 193, 247, 248, 249, 255, 259, 286, 287, 295, 307, 339, 341, 345, 346, 357, 372, 376, 383, 386, 389, 390 diaphoretic, 36, 131, 136, 218, 287, 303, 324, 328 diarrhea, 28, 30, 31, 66, 78, 83, 94, 96, 99, 106, 144, 165, 175, 188, 197, 229, 239, 251, 280, 287, 313, 329, 336, 345, 372, 383, 388 diosgenin, 340, 344 disinfectant, 226 Distance Education and Training Council, 14 diuretic, 28, 36, 48, 50, 66, 88, 91, 105, 112, 122, 129, 130, 131, 137, 142, 143, 176, 178, 190, 195, 196, 197, 234, 236, 249, 252, 259, 275, 313, 314, 319, 320, 324, 328, 329, 331 dong quai, 34, 39, 40, 42, 43, 44, 45, 46 dopamine, 271, 290, 362, 413, 414, 415 dried rhizome, 122, 192, 265, 266 dysmenorrhea, 23, 39, 44, 106, 149, 165, 188, 401, 409, 414 eczema, 29, 196, 232, 234, 303, 340 edema-reducing, 53 Egyptians, 48 elder, 315, 318, 319, 320, 321, 322, 323, 324, 326, 328, 329, 330 Elder fruit, 318 Eleuthero, 111 Eleutherococcus senticosus, 111 Elytrigia repens, 121 emmenagogue, 303, 308, 351, 409, 417 epithelium, 246, 335 Equisetaceae, 125 Equisetum, 125, 126, 127, 128, 129, 130 Equisetum arvense L, 125, 128, 129 Eschscholzia californica, 131, 133, 134 essential oil, 42, 64, 95, 98, 101, 102, 107, 108, 115, 122, 123, 148, 218, 238, 239, 240, 241, 245, 277, 298, 305, 306 estragol, 238 estrogen, 25, 43, 44, 118, 247, 258, 260, 290, 336, 416, 426 estrogenic, 25, 42, 43, 44, 45, 118, 148, 247, 250, 258, 260, 290, 292, 336, 356 Eupatorium perfoliatum, 136, 138, 139 Eupatorium purpureum, 142 Europe, 29, 48, 54, 106, 122, 124, 126 4 42 Index expectorant, 36, 37, 105, 172, 173, 218, 275, 278, 280, 328, 332, 348, 360, 412 False Unicorn, 87, 88, 89 fatigue, 66, 83, 112, 156, 161, 270, 295, 297, 298, 300, 337 female infertility, 410 fennel, 74, 145, 146, 147, 148, 149, 150 fenugreek, 37, 46, 51, 58, 119, 120, 154, 163, 251, 252, 292, 293, 339, 340, 341, 342, 343, 344, 345, 346, 347 fibromyalgia, 112 flatulence, 34, 94, 96, 99 flavonoid glycosides, 64, 387 flavonoids, 56, 62, 64, 84, 101, 107, 108, 115, 123, 128, 138, 168, 174, 184, 193, 195, 197, 222, 298, 316, 326, 328, 334, 342, 356, 361, 387, 389 Foeniculum vulgare, 145 Fringe Tree, 90, 93 Fucaceae, 151, 155 Fucus vesiculosis, 151 fungistastic, 421 furocoumarins, 49, 50 G. barbadense , 166 gallbladder, 90, 188, 234, 303 gallstones, 90 ganoderma, 156, 159 Ganoderma lucidum, 156, 157, 158, 159, 160, 161, 162, 164 Ganodermataceae, 156 garlic Allium sativum , 20 gastroenteritis, 58, 194, 286, 309, 421 gastrointestinal, 28, 89, 96, 99, 102, 109, 154, 176, 184, 188, 195, 212, 234, 235, 278, 351 German Commission E, 29, 30, 31, 32, 149, 150, 174, 175, 188, 222, 223, 224, 233, 265, 269, 275, 277, 278, 305 German Commission E Monographs , 149, 150 German Standard License, 29 Germany, 54 glucose, 35, 76, 86, 99, 115, 117, 119, 123, 178, 179, 180, 181, 189, 223, 228, 249, 251, 252, 259, 261, 292, 329, 341, 342, 343, 345, 346, 375, 376 glucose toxicity, 376 gossypol, 168, 169 Gotu Kola, 82, 83, 84, 85, 86 gout, 47, 126, 142, 188, 239, 280, 303, 319, 340, 386, 389, 390 Gramineae , 432 gravel root, 137, 140, 142, 143, 144 Greeks, 48 gumweed, 172, 173, 174, 175, 176 gymnema, 120, 178, 179, 180, 181 haemostatic, 314, 328 headache, 78 heavy metal, 155 Help Desk, 12, 71 hemorrhoids, 53, 57, 275, 278, 365, 369, 372, 385, 389, 390 hepatic, 38, 180, 265, 317, 398 hepatics, 8 hepatitis B , 75, 159 hepatoprotective , 75, 161, 396 hepatotoxic, 140, 143, 144, 269, 270, 363, 364 hepatotoxic pyrrolizidine alkaloid herbs, 144 hepatotoxicity, 143, 229, 265, 269, 272, 273 hermaphroditic, 217, 320 herpes simplex type II, 112, 115, 117 heteroglycans, 56 HIV, 75 horehound, 220, 283, 360 horsetail, 125, 126, 127, 128, 129, 130 human immunodeficiency virus, 104, 108, 365, 369 hyperactivity, 112, 259 hypercholesteremic, 424 hyperglycemia, 375 hyperglycemic, 307 hyperlipidemia, 113, 295, 341 hypertension, 39, 45, 66, 83, 84, 85, 118, 157, 159, 201, 251, 252, 287, 307, 428, 433, 435 hypoglycemic, 50, 99, 117, 119, 164, 179, 180, 181, 186, 222, 250, 253, 260, 293, 342, 343, 346, 358, 391 hypotension, 42, 78, 162, 163, 251, 364, 369, 403, 430, 434, 435 immunity, 74 4 4 3 Index immunostimulant, 57, 366, 368 infertility, 45, 87, 94, 168 inflammation, 28, 33, 37, 50, 51, 54, 75, 95, 109, 123, 126, 148, 161, 165, 172, 182, 183, 185, 198, 226, 232, 234, 268, 275, 310, 312, 329, 340, 359, 363, 366, 369, 386, 391, 394, 397, 410, 417, 428, 429, 432 inflammations, 57, 372 inflammatory, 57, 89, 109, 161, 185, 234, 235, 246 influenza , 45, 112, 136, 137, 215, 216, 218, 234, 248, 250, 253, 287, 324, 325, 327 insulin, 99, 164, 178, 179, 180, 181, 247, 251, 252, 253, 255, 257, 261, 291, 307, 329, 341, 342, 343, 345, 346, 375, 386, 391 International Fragrance Association, 37 iodine, 152, 153, 154, 155 Iridaceae, 195, 198 iridoid glycosiders, 406 iron , 50 irritant, 58, 195, 198 Italy, 237 Japan, 41, 191, 201, 208, 209, 211 kava, 52, 86, 120, 134, 264, 265, 266, 267, 268, 269, 270, 271, 272, 273 kavalactones, 265, 266, 267, 268, 272 kelp , 154, 202, 205, 206, 207 kidney, 39, 51, 121, 126, 127 kidney stone, 383, 397, 407 kidney stones, 121, 191, 316, 317, 382, 383 kudzu, 120, 251, 286, 287, 288, 289, 290, 291, 292 labor, 168, 188, 201 lactation, 26 lady?s mantle, 28, 29, 30 Lamiaceae , 220, 236, 240, 302, 307 Lamiaceae/Labiate, 220 laminaria, 201, 202, 205, 206, 207 Laminariaceae, 200 Latin, 20 Lauraceae, 98, 103 leaf buds, 275, 277 Learning Goals , 8 Leguminosae, 61, 286, 339 Liliaceae, 87, 348 liver, 29, 32, 39, 57, 64, 65, 66, 74, 75, 90, 94, 126, 132, 134, 143, 156, 157, 161, 180, 188, 195, 197, 198, 229, 234, 240, 247, 258, 265, 269, 270, 290, 295, 303, 317, 326, 343 liver cancer, 382 magnesium, 50 Malvaceae, 165 marshmallow, 360 menopausal, 28, 100 menopausal symptoms, 42, 43, 44, 260, 289 menopause, 23, 45, 87, 249, 287, 289, 292 menstruation, 44, 78, 88, 93, 105, 126, 145, 168, 219, 348, 351, 401, 406, 414 Minor Bupleurum Decoction, 75 miscarriage, 87, 94, 201, 372, 405, 406, 410, 414, 415 mosquito, 48 muscle pain, 53 mutagenic, 143, 363 MyACHS Connect, 12 Native Americans, 126, 127, 137, 216, 229, 275 nausea, 85, 89, 94, 96, 99, 140, 165, 188, 195, 197, 198 neuralgia, 37, 157, 158, 161, 249, 259, 303, 304, 319 nicotine , 129 obesity, 152, 154 oral cancer, 382 Oregon grape, 225, 226, 227, 229 Osha, 215, 216, 217, 219 osteoarthritis, 48, 185, 187, 188, 365, 366, 368, 369 osteoporosis, 127, 128, 427 oxalic acid, 313, 314, 317, 406, 407 pain, 39, 83, 95, 96, 118, 137, 157, 161, 182, 183, 185, 187, 188, 221, 251, 268, 280, 303, 329, 337, 348, 368, 369, 372 pain relief, 188, 348 Panax ginseng, 112 Panax ginseng,, 51, 58, 95, 112, 119, 154, 163, 242, 256 Papaver rhoeas , 132 Papaver somniferum , 132 Papaveraceae, 131 Parkinson disease , 99 4 4 4 Index Parkinson?s, 357 Parkinson?s disease, 427 Pedaliaceae, 182 pentacyclic alkaloid, 366, 367 Piper methysticum, 264 Piperaceae, 264 placebo, 39, 42, 43, 44, 59 Plantaginaceae, 20 platelet aggregation, 37, 42, 46, 51, 57, 58, 95, 119, 154, 246, 251, 252, 291, 292, 337, 341, 346, 364 platelet aggression, 119 PMS, 23, 78 Poaceae/Gramineae, 121, 123 Polygonaceae, 312 Populus balsamifera, 274, 275, 276, 279 poultice, 106, 145, 268, 340, 350 pregnancy, 26, 37, 45, 51, 58, 81, 86, 87, 118, 129, 155, 188, 201, 212, 219, 240, 249, 259, 269, 300, 308, 310, 321, 329, 336, 347, 351, 352, 364, 391, 400, 401, 406, 415, 430, 431, 435 premature ejaculation , 37, 39, 40, 103 proanthocyanidins, 101, 297, 374 prostate, 162, 190, 283, 332, 334, 335, 336, 337 prostate cancer, 422, 423 prostate tumor, 381, 382 Prunus serotina, 280 psoriasis, 38, 85, 94, 196, 226, 227, 229 Pueraria mirifica , 289 Pueraria montana, 286, 287, 289 Pueraria montana var. lobata, 286 puerarin, 287, 289, 290, 291, 292, 293 purgative, 196, 198, 324, 328, 351, 354 pyrrolizidine alkaloids, 140, 143, 144, 363, 364 recommended reading, 9 reishi mushroom, 156, 157, 158, 159, 161, 162 respiratory, 36, 65, 102, 113, 131, 145, 148, 149, 156, 172, 176, 216, 232, 234, 268, 312, 359, 362 respiratory system, 156 rheumatism, 23, 37, 45, 47, 137, 142, 149, 152, 249, 259, 275, 319 rheumatoid arthritis, 48, 232 Rhodiola rosea, 294, 295, 297, 298, 299, 300, 301 Root, 34 Rosaceae, 28, 31, 32, 280 rosemary, 303, 305, 306, 307, 308, 309, 310 Rosmarinus officinalis, 302, 306, 307, 308, 310 rue Ruta graveolens, 238 Rumex acetosa, 312, 314, 316, 317 Salicaceae , 274 Sambucaceae, 323 Sambucus canadensis, 318, 319 Sambucus nigra, 323, 324, 325, 326, 327, 328, 329, 330 saponins, 63, 75, 116, 128, 193, 245, 246, 257, 258, 342, 345, 397 saw palmetto, 331, 332, 333, 334, 335, 336, 337 sedative, 23, 48, 50, 51, 86, 120, 132, 133, 134, 172, 226, 267, 269, 271, 280, 282, 331, 396, 430 Serenoa repens, 331 sesquiterpene lactones, 56, 57 Shepherd?s Purse, 77, 78, 79, 81 shiitake mushroom, 208, 209, 211 snakebites, 222, 236 sore throat, 23, 127, 215, 319, 359 Spain, 237 spasmolytic, 131, 132, 172, 267, 407 steroidal alkaloids, 419 steroidal lactones, 419 stigmas, 433 stimulant, 26, 37, 45, 48, 51, 83, 88, 94, 105, 112, 142, 147, 169, 172, 173, 178, 196, 197, 198, 229, 232, 234, 236, 245, 253, 259, 260, 275, 278, 298, 303, 319, 345, 351 stomach ulcers, 366, 430 stress, 61, 112, 117, 161, 243, 245, 249, 259, 264, 265, 268, 297, 298, 299, 300, 308, 328, 363, 374, 396, 397, 403, 404, 418, 427, 429 stroke, 114, 116, 287, 290, 426 strontium, 101, 154, 155 Student Services, 8, 12, 71, 72 styles, 433 sweet basil, 236, 237, 239, 240, 241 tannins, 25, 31, 56, 107, 109, 128, 197, 316, 317, 326, 356, 367, 380, 387, 388, 389, 406, 434 4 4 5 Index teratogenic, 284 testosterone, 335, 414 tetracyclic alkaloids, 367 The Complete German Commission E Monographs, 29, 30, 31, 32 thyroid, 79, 152, 153, 154, 202, 221, 223, 224, 428, 429, 430 tincture, 35 tonic, 40, 41, 48, 66, 75, 91, 105, 106, 142, 161, 173, 182, 216, 226, 232, 234, 239, 243, 245, 249, 259, 275, 295, 303, 313, 329, 332, 345, 348, 360 toxicity, 32, 48, 50, 58, 66, 112, 126, 129, 140, 143, 144, 176, 269, 357, 363, 364 Trigonella foenum graecum, 339, 340, 344, 345, 346 Trigonella foenum-graecum , 343, 344, 345 Trillium erectum, 348 tuberculosis, 83 Turkey, 234 Turnera diffusa, 354, 355, 356, 357 Tussilago farfara, 359, 361, 362, 363 U.S. Department of Health and Human Services, 154 ulcer, 74 Umbelliferae , 33, 39, 47 Uncaria tomentosa, 365, 366, 367, 368, 369 United States Pharmacopoeia, 137 upland cotton, 165, 166 uric acid kidney stone formation, 383 urinary, 20, 79 urinary tract, 83, 121, 123 urinary tract epithelial cells, 380 urinary tract infection, 268, 379, 381 urinary tract infections, 126, 372, 378, 379, 380, 381, 382 uterine stimulant, 405, 409, 415, 435 uterus, 188, 218, 345, 351 Vaccinium angustifolium, 371, 372, 373, 374, 375, 376 Vaccinium macrocarpon, 378, 379, 380, 381 Vaccinium myrtillus , 372, 376 varicose veins, 53, 57, 59, 82, 349, 372, 385, 389, 390 vasoconstriction, 187, 407 venous, 84, 85, 86 verbascoside, 185, 396 Verbena officinalis, 394, 395, 396, 397, 398, 399, 400 Verbenaceae , 394, 398, 409, 410 Viburnum lantana , 403 viopudial, 402 viral infections, 45, 66, 161, 215 virtual library, 10, 14, 20, 438 vitamin C, 148, 234, 313, 318, 320, 373, 387, 429 Vitex agnus-castus, 409 volatile oil, 42, 56, 109, 123, 138, 153, 193, 195, 197, 198 vomiting, 78, 87, 89, 94, 99 Warfarin, 189, 383, 435 watercress, 232, 234, 235 wild cherry bark, 281, 283 Withaferin A, 420, 422 Withania somnifera, 417, 420, 421, 422, 423, 424, 425, 426, 427, 428, 429, 430 wound healing, 29, 83, 84, 85 yarrow, 58 Zea mays, 432, 433, 434 Zone 3, 35 untitled