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Valerian

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Valerian is a perennial plant that grows readily in Europe, North America, and northern Asia.

A number of related species have been used by herbalists throughout history, but the exact kinds and amounts of chemical constituents vary.

Valeriana officinalis is the plant used medicinally in Europe, and it has become popular in the United States for treating anxiety and insomnia.

Valerian was used by the ancient Greeks to treat digestive problems such as flatulence and nausea. They also used it for urinary difficulties and to bring on a woman's menstrual period.

These uses-as a diuretic, topical pain reliever, and treatment for intestinal and menstrual cramps-predominated throughout the Middle Ages and up into the sixteenth century.

In medieval times, valerian was used in cooking to flavor stews and soups. It may have played a role in the tale of the Pied Piper. Dr. Varro E. Tyler has suggested that the fellow used aged valerian root, which smells like stinky cheese or dirty old socks, to lure the rats from Hamelin.

Michael Castleman went even farther in speculating that the Pied Piper may have used valerian on the children, presumably to quell any fears, before luring them away with his music.

By the eighteenth century, European herbalists were using valerian for many kinds of nervous disorders. During the 1800s it was especially popular for treating "vapors" in women, with symptoms ranging from "waves of heat and cold" to fear and panic.

The part of the plant used is the rhizome ("root"), which is generally harvested near the end of September when essential oil content is highest.

The fresh root does not smell bad; the distinctive aroma develops as the root dries.

Active Ingredients

Although chemists have isolated a number of compounds from valerian, no single "active ingredient" has been identified.

The essential oil (up to 2 percent of the root) contains valeranone (10 to 21 percent of the oil) and other relatively constant components.

Dried valerian root also contains 0.3 to 0.9 percent of valerenic acid and related compounds.

A category of chemicals called valepotriates has been identified and studied for their activity. Of these, valtrate and isovaltrate seem to be the most relevant and may make up as much as 1 percent of the herb.

Uses

Valerian root is used primarily as a mild sedative to calm restlessness and anxiety and overcome mild insomnia.

At least two double-blind studies have demonstrated that valerian extract can significantly reduce the amount of time it takes people to fall asleep without changing the normal stages of sleep.

Valerian is used in Europe as an antispasmodic, particularly for abdominal cramps due to nervousness and for uterine cramps and menstrual agitation.

It is also used as a mild tranquilizer for people experiencing emotional stress, much as antianxiety drugs are prescribed, and has been prescribed for exhaustion.

Some herbalists have also recommended it for tension headaches, bronchial spasms, and lingering coughs.

Valerian has occasionally been tried as part of a program to take a patient off antidepressants or benzodiazepines, and the herb is sometimes used as a muscle relaxant to treat pain.

Dose

Dose varies with preparation and use. Total daily dose should not exceed 15 g plant material: 15 to 20 drops of tincture (1:5) in water, up to several times a day; or one cup of tea (made by steeping 1 teaspoon of valerian in a cup of hot water for ten minutes) twice a day and at bedtime; or 1 tablespoon of juice three times a day; or 450 mg of extract at bedtime.

Valerian extracts and tinctures should be kept in tightly closed containers away from light.

Special Precautions

Pregnant women should not take valerian.

Since valerian can promote urination, it may not be an appropriate sleep aid for those who must rise frequently to urinate during the night.

It is not generally considered a good practice for a person to take sleeping pills when he or she must drive or operate complex machinery. The degree to which this caution may apply to valerian preparations is unclear.

Adverse Effects

Side effects are exceedingly rare. With prolonged use, headaches, insomnia, agitation, and changes in heart activity have been reported.

It is not clear whether these reactions occurred while the person continued to take valerian root, or whether they might have been a response to sudden withdrawal.

One serious withdrawal reaction has been presented in the medical literature. A fifty-eight-year-old man with heart problems was admitted to the hospital for a biopsy. After the surgery, he developed cardiac complications and delirium, possibly as a consequence of sudden withdrawal from many years of self-treatment with fairly high doses of valerian root extract.

The crisis responded to benzodiazepine administration, pointing up how likely it is that valerian compounds affect the same receptors in the brain as do these antianxiety agents. The authors of the report suggest that patients should not discontinue valerian suddenly.

Test tube studies showing that some components of valerian, especially valepotriates, can be damaging to cells and genetic material raise concern. No one knows if long-term use of valerian is safe.

Possible Interactions

According to reports, valerian root does not interact in a dangerous way with alcohol.

It does, however, interact with barbiturates and should not be coadministered.

Because of the possibility that the herb affects GABA receptors in much the same way benzodiazepines do, patients should be cautioned not to combine it with drugs such as Ativan, Valium, or Xanax.

Stinging Nettle

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Stinging nettle is native to Europe, but it has become established in North America and now grows in Canada and throughout the United States.

It is best known for its ability to provoke an impressive rash (urticaria) that stings for up to twelve hours after contact with the tiny toxic hairs of the plant.

Stinging nettle must have been very popular at one time, because it has so many uses attributed to it by folk medicine.

It is not well known in this country, but in Europe both the leaves and the roots are listed in herbal medicine formularies. The tender shoots are harvested before they develop stinging hairs, cooked, and eaten as a vegetable.

According to tradition, the juice can stimulate hair growth if it is smeared on the scalp.

Active Ingredients

The leaves and other aboveground parts of stinging nettle are collected while the plant is flowering (from June to September). They contain several mineral salts, particularly those of calcium and potassium, as well as silicic acid (1 to 4 percent), some volatile oils, and a mixture of flavonoids (up to 1.8 percent).

Vitamins C and K and several B vitamins are present, with tender shoots being especially rich in vitamin C and carotene. The stinging hairs deliver histamine, formic acid (also found in ant stings), serotonin, and acetylcholine.

In the root, which is used for different purposes, beta-sitosterol and some related compounds make up as much as 1 percent of the material and are probably important in the activity of the herb.

Stinging nettle root also contains a complex of lectins known as Urtica dioica agglutinin (UDA) and several polysaccharides such as glucans and arabinogalactans, which are believed to stimulate the immune system. Other components include lignans, fatty acids, and scopoletin.

Uses

In Europe, stinging nettle leaves and aboveground parts are used to treat problems of the urinary tract. These parts of the plant act as a mild diuretic and are taken with ample amounts of liquid to flush out an inflamed bladder or urinary tract. They are sometimes used to prevent the formation of kidney stones.

A tea or extract of aboveground parts may also be taken as supportive therapy for arthritis pain ("rheumatism").

In addition, a spirit extract may be applied topically to aching joints as a liniment.

Traditionally, stinging nettle was used to treat asthma and cough, speed wound healing, encourage gastric juice secretion, and relieve spasms of the digestive tract. When applied to the scalp, it was expected to reduce oiliness and remedy dandruff.

Clinical evidence to support these folk uses is lacking.

Trials to evaluate its effectiveness for diabetes (another traditional indication) demonstrated that it raises rather than lowers blood sugar.

A double-blind trial was conducted to test stinging nettle's use in allergies (sneezing, sniffling, and runny nose). A majority (57 percent) of the participants found that the herb was better than placebo in treating these symptoms.

Stinging nettle root is an accepted treatment in Europe for benign prostate hypertrophy (BPH, or enlarged prostate).

Test tube studies aimed at understanding how stinging nettle root might work have found a number of mechanisms: sex hormone-binding globulin is substantially (67 percent) less capable of grabbing testosterone and dihydrotestosterone (DHT); epidermal growth factor in prostate cells is inhibited 53 percent by stinging nettle lectins; the extract has anti-inflammatory activity and interferes with an enzyme (Na/K-ATPase) that is necessary for prostate cell growth.

Clinical studies confirm that nettle root extract can improve urine flow and decrease the amount of urine left in the bladder after voiding. Even more important to many men with enlarged prostates, the number of times patients had to get up at night to urinate was significantly decreased.

In some studies, stinging nettle root has been associated with a decrease in prostate size, but other research has failed to confirm this effect.

Dose

For leaves, stems, and flowers: 8 to 12 g herb per day, or its equivalent.

The infusion is made by pouring 2/3 cup boiling water over 3 teaspoons (4 g) of herb, steeping for ten minutes, and straining. This dose is repeated two to four times per day.

For root: 600 to 1,200 mg dried extract per day; or 4 to 6 g daily of dried root taken as an infusion; or 5 ml per day of alcohol-based extract.

To make the tea: Place a heaping teaspoon of the coarsely powdered root in a cup of cold water, bring to a boil, and boil for one minute, then steep for ten minutes. This provides approximately 1.5 g herb.

Stinging nettle may be taken for as long as it is helpful.

Special Precautions

Stinging nettle leaf and aboveground parts should not be used when fluid retention is due to congestive heart failure or kidney problems. Such serious conditions require active medical management.

Pregnant women should not use this herb.

Because stinging nettle leaf appears to raise blood sugar, diabetics should exercise caution and monitor blood sugar carefully if they choose to try this herb. Please discuss this issue with your physician.

Although the symptoms of an enlarged prostate may be alleviated with stinging nettle root, men should not self-diagnose this condition. A medical diagnosis is required to determine that the cause of urinary difficulties may be safely treated with the herb and does not require medical intervention.

Periodic checkups are recommended.

Adverse Effects

Side effects are uncommon for both the aboveground herb and the root. Mild digestive upset has been reported with each.

In addition, some people develop allergic reactions such as rash after taking stinging nettle leaf. If such a reaction occurs, the herb should be discontinued.

Contact with the stinging hairs of the plant can cause pain for twelve hours or more. Anyone collecting the plant material should exercise due caution.

Possible Interactions

No interactions have been reported in the literature.

St. John's Wort

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St. John's wort has long been used in Europe for treating mood disorders and has become very popular in the United States. The plant itself is a perennial native to Europe, but it has adapted well to North America and grows as a weed in many places. (Indeed, it is sometimes called klamath weed or goatweed.)

In the Middle Ages, people noticed that the attractive bright yellow flowers of this herb appeared most profusely (or perhaps made their first appearance) around the feast of John the Baptist at the end of June.

The flowers were gathered and soaked in olive oil. The oil turned bright red after a few weeks' time and was considered a powerful treatment for cuts and scrapes.

Many Crusaders carried "red oil" with them to use to heal the wounds of battle. The plant itself had a reputation going back to Greek and Roman times of being able to protect people against evil spells.

Active Ingredients
The parts of the plant used are the leaves and the flowering tips (flowers and buds) collected when the plant is blooming and dried quickly to preserve their potency.

Hypericin and related compounds, such as pseudohypericin, are characteristic components making up from 0.05 to 0.3 percent of the herb. Concentrations of hypericins differ with the variety of the plant and with how much of the lower leaves and stem are gathered.

St. John's wort also contains the flavonoids kaempferol, quercitin, amentoflavone, and luteolin, and quercitin glycosides hyperoside and rutin. Together these constituents make up from 2 to 4 percent of the plant material.

Nearly 10 percent of St. John's wort is composed of tannins, and approximately 1 percent is a volatile oil. Up to 3 percent of the herb is hyperforin, a chemical structurally similar to an active ingredient of hops. In addition, St. John's wort contains bioflavones and small amounts of procyanidins.

Hypericin was once considered the most relevant of the active ingredients of St. John's wort, but it now seems possible that it is little more than a marker substance. The amounts of hypericin in a product correlate well with the quantities of hyperforin, flavonoids, and procyanidins. One or more of these is probably essential to the action of the herb on the nervous system. Hyperforin also has antibiotic properties.

Uses
In Germany, where doctors often recommend herbs, St. John's wort is prescribed more frequently than Prozac for mild to moderate depression. Many herbal authorities consider this plant especially appropriate for minimizing mood swings associated with menopause.

The antidepressant effect is well established. An overview (meta-analysis) in 1996 examined 23 studies including 1,757 patients and showed that Hypericum is more effective than placebo, with 55 percent of patients improving while taking St. John's wort, compared to 22 percent of the control patients. The herb performed about as well as prescription antidepressants such as amitriptyline or imipramine but resulted in fewer reports of side effects. Most of this research was conducted in Europe.

To assess these results and learn more about optimal dosing and safety of long-term use, the Office of Complementary and Alternative Medicine undertook a major study in the United States.

The multicenter trial compares St. John's wort both to placebo and to Prozac. It is not clear exactly how St. John's wort relieves depression.

Laboratory research has shown that different components have effects on GABA receptors, serotonin, dopamine, and monoamine oxidase. No single mechanism has been isolated, and it may be that more than one pathway is important.

Hypericum extract has been reported to improve sleep, perhaps in part because it increases the brain's output of melatonin at night. One study suggested that treatment with the herb might improve mental concentration and cognitive function in healthy people, but this claim is somewhat speculative.

St. John's wort has both antiviral and broad-spectrum antibacterial activity in the test tube. The component hypericin is being tested to see if it can fight HIV, delaying the onset of AIDS and prolonging survival.

When applied topically, St. John's wort has anti-inflammatory properties. This may explain why red oil was so highly prized as a treatment for wounds, burns, and hemorrhoids.

Topical application is also supposed to help treat vitiligo, a condition in which skin loses its melanin and becomes discolored in patches.

Unlike many anti-inflammatory drugs, Hypericum is reported to combat ulcers.

In folk medicine, St. John's wort has been used to treat diarrhea. The relatively high tannin content may contribute to such an effect. It was also used for rheumatic pains, especially gout, and to deter bed-wetting.

Older antidepressants, such as imipramine, have also been used to treat bed-wetting. St. John's wort has been reported to have immune-modulating effects, stimulating the immune response when it is low, and suppressing it in some conditions when it is overactive. Further research is needed to confirm and explore this unusual property.

Other studies are being planned to test its potential against cancer. One report suggests it may hold promise against glioblastoma, a type of brain tumor.

Dose
The accepted dose is 300 mg of extract (standardized to 0.3 percent hypericin) three times daily.

A tea may also be prepared by pouring one cup of boiling water over 1 or 2 teaspoons of dried herb and steeping five or ten minutes. One or two cups per day might be expected to supply a therapeutic level of St. John's wort.

At least ten days to two weeks should be allowed to determine if there is any benefit from the herbal product. If it does not result in improvement of depression after four to six weeks, St. John's wort should be stopped.

For those who find it helpful, however, there is no limitation on the amount of time it can be taken.

Three standardized products that have been tested in Germany are available here. The brand names are Kira, Movana, and Perika.

Special Precautions
As a general rule, St. John's wort is not recommended for pregnant women. No studies evaluate its safety for the fetus, and it has been reported to increase uterine tone in animals.

Fair-skinned people and those who have reacted badly to sunlight while taking other medications may need to avoid sunshine, tanning lamps, and other sources of ultraviolet light while taking St. John's wort. People using this herb should protect their eyes by avoiding all bright light.

Adverse Effects
Veterinary sources classify Hypericum as a toxic plant because it can induce photosensitivity reactions in livestock. Although this type of reaction is not common in humans, it can occur.

After four weeks of self-treatment, one thirty-five-year-old woman developed stinging pain in the parts of her skin exposed to sunlight. After stopping the St. John's wort, it took two months for her to recover normal sensation in her skin. The physicians reporting this unusual response in a letter to The Lancet hypothesize that the photoactive compound hypericin released free radicals that attacked the myelin protecting the nerves of her skin.

Other people have experienced rash or unexpected sunburn while taking St. John's wort, presumably an expression of phototoxicity. Eyes should be protected from the sun just as skin should be, since hypericin activated by visible light may damage the lens or the retina.

Side effects are generally mild and not common. Some patients have reported digestive upset.

Occasionally people develop allergic reactions to St. John's wort and must stop using it. Very rarely, people experience fatigue or restlessness while being treated with this herb.

One side effect that has not been reported in the literature is urinary retention. We spoke with one young woman who landed in the hospital with this problem after consuming many cups of Hypericum tea. She had been told the herb would help alleviate anxiety, and she figured a flower couldn't do her any harm.

When we spoke with her several weeks after her hospitalization, she was still recovering from the treatment that was necessary for her bladder problem. This is a single anecdote, but it does point up the need to pay attention to dosing recommendations.

Possible Interactions
St. John's wort can reduce the effectiveness of certain birth control pills, perhaps especially the "low-dose" birth control pills that are so popular, which do not have much "margin for error.

The high tannin content of Hypericum suggests that it should not be taken at the same time as iron supplements, as it may interfere with absorption.

Because so little is known about the mechanism of action of St. John's wort, possible interactions with prescription antidepressants can't be ruled out. Switching between antidepressants and herbal treatment calls for medical guidance.

Physicians can find a suggested protocol for gradual substitution of St. John's wort in Hyla Cass's book, St. John's Wort: Nature's Blues Buster.

Most herbal authorities don't think dietary restriction of high-tyramine foods is necessary.

Interactions with aged cheese similar to those seen with MAO inhibitor antidepressants such as Nardil or Parnate have not been reported.

The herbal authority Norman Farnsworth told us one anecdote that suggests that such a reaction may be possible, however. His wife, who was taking St. John's wort, developed a headache and elevated blood pressure after eating some aged cheese.

We suggest that anyone taking St. John's wort pay attention to symptoms that may occur after consuming high tyramine foods, such as aged cheese, pickled herring, and liver paté. If blood pressure rises, he or she should probably avoid these foods in the future.

St. John's wort can speed elimination of certain drugs from the body, which could reduce their effectiveness. This interaction has been reported with the following:

  • Digoxin (Lanoxin) for heart problems
  • Birth control pills
  • cyclosporine (a drug to suppress the immune system for organ transplant patients)
  • Indinavil (drug for HIV and AIDS)
  • Theophylline (for asthma)

Other drugs that might be expected to interact with St. John's wort in a similar way include:

  • amiodorone (Cordorone)
  • Buspirone (BuSpar)
  • Calcium channel blockers such as Cardizem (diltiazem), Plendil (felodipine), Procardia (nifedipine) and Sular (nisoldipine).
  • carbamazipinel (Tegretol)
  • sildenafil (Viagra)
  • "statin" cholesterol-lowering drugs such as Lipitor (atorvastatin), Mevacor (lovastatin) and Zocor (simvastatin).

Doubtless, other medications will be shown to interact with St. John's wort as more research is undertaken.

Certain medications can make a person more susceptible to sun damage. Since hypericin is a photoactive chemical, and St. John's wort can cause phototoxicity in animals (and occasionally in people), it is unwise to take this herb in combination with other medicines or herbs that increase sensitivity to sunburn.

Along the same lines, presumably any treatment for psoriasis that requires timed exposure to UV light should not be undertaken while a person is using St. John's wort.

One reader of "The People's Pharmacy®" column related an experience suggesting that in some circumstances Hypericum may interact adversely with the cough suppressant dextromethorphan: "Last fall I was taking St. John's wort for fibromyalgia. I had a bad cough and started taking cough medicine. After about a day, I experienced something I never had before. I was so weak that I could not sit up. I felt dizzy, nauseated, and clammy. It took me a whole day to get over this feeling."

We have seen no confirmed reports of this interaction, but dextromethorphan interacts dangerously with prescription antidepressants, including MAO inhibitors such as Nardil or Parnate and serotonin-based drugs such as Effexor, Paxil, Prozac, or Zoloft. St. John's wort can prolong the time that laboratory animals sleep when given a narcotic. The significance for humans is unknown.

Slippery Elm

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Slippery elm trees are native to North America and grow in moist but not waterlogged woods of eastern Canada and the United States.

The colonists were familiar with the use of bark from other elm species to treat coughs and sore throats in England and as a poultice for broken bones or wounds. It was also used to treat urinary tract infections. Native Americans used slippery elm bark topically for cuts, cold sores, and boils.

Evidently it was popular as a treatment for bruised "black eyes" and was used during the American Revolution to treat gunshot wounds.

The inner bark next to the wood is collected in the spring.

Old-time herbalist Tommie Bass considered it helpful for the stomach and useful in cough preparations.

The bark is sometimes chewed, frothing in the mouth and releasing the demulcent.

Active Ingredients

Slippery elm bark contains a mucilage.

Other components of the wood include beta-sitosterol and campestrol as well as some calcium oxalate. This inner bark contains only a little tannin.

Uses

Slippery elm bark has been used as a poultice for cuts and bruises, and also for aching joints due to gout or other causes.

Its principal use at this time is for sore throats. It is an ingredient in lozenges sold to soothe throat irritation.

Since sore throat and cough are often linked, slippery elm bark has also been used in cough remedies.

Tommie Bass used to combine slippery elm with wild cherry bark, sweet gum leaves, mullein, and sweetening for a homemade cough syrup. Chewing on the bark itself, if available, is said to produce the same effect and to have a pleasant taste.

The powdered bark may be mixed with liquid and swallowed for mild stomach irritation; it has a reputation for easing both constipation and diarrhea.

Dose

If using a lozenge, instructions on the label should be followed. Sucking on a lozenge gives a more lasting exposure than sipping a tea.

Special Precautions

People with known allergies to elm bark should avoid it.

Adverse Effects

Elm pollen is quite allergenic. The bark may also cause contact dermatitis in sensitive individuals.

Possible Interactions

No interactions have been reported in the literature.

Siberian Ginseng

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This shrub, a Russian relative of China's popular herb ginseng, also grows in northeast China, on the northern Japanese island of Hokkaido, and in Korea. In Russia, it occurs in forest undergrowth and margins.

In China, this herb is called ci wu jia, and this name has appeared on some packaging in the United States as well. It is also referred to as eleuthero, eleuthero-ginseng, or eleuthera.

Other nonscientific names include devil's shrub, shigoka, and touch-me-not, presumably because of its thorns.

Other Chinese herbs have names that can appear similar in transliteration and may be confounded with eleuthero: wu jia pi, the bark of E. gracilistylus; or wu jia, the bark of a totally unrelated plant, Periploca sepium.

This confusion can unfortunately make it difficult to be sure that the eleuthero on the U.S. market in any given package is truly E. senticosus.

The medicinal use of ci wu jia was first described in the early Chinese Herbal Classic of the Divine Plowman around 100 b.c. In traditional Chinese medicine, this herb is considered to improve qi (pronounced chee), treat deficiencies of yang in the spleen and the kidney, and bring bodily functions back to normal.

It has been used in recent decades in northeastern China to treat heart problems, rheumatism, and bronchitis.

Elsewhere in China, eleuthero is believed helpful in maintaining health and increasing vigor, rather like a general tonic. It is readily available, inexpensive, and widely used as a substitute for panax ginseng.

The Chinese use it for a wide range of problems, such as stomachache, headache, women's problems, and impotence. It is also believed useful for maintaining memory into old age.

The part of the plant used is the dried root together with the rhizome.

Most of the research on E. senticosus was conducted in Russia.

Like ginseng, eleuthera has been considered an "adaptogen." In the Soviet Union it was far more widely available than Panax ginseng, which explains the popularity of this substitution. Studies published in the late 1950s and early 1960s were the basis for its approval as a human drug by the Soviet Ministry of Health.

As an adaptogen, it was believed to have minimal side effects and to have nonspecific benefits allowing the person taking it to withstand stress better.

It was also expected to bring bodily functions back toward normal, regardless of the direction of their deviation. Because of the Soviet research, E. senticosus is popular in Russia with many different people whose jobs or athletic endeavors are taxing: soldiers, cosmonauts, athletes, deep-sea divers, and so forth.

Active Ingredients

E. senticosus root contains a number of glucosides, including the glucoside of beta-sitosterol, eleutheroside B1, which is a coumarin derivative, and eleutherosides C, D, E, F, and G. Nonglucoside constituents include l-sesamen and syringaresinol.

Other ingredients of eleuthero root may also be relevant to its activity. They include saponins, flavonoids, and polysaccharides.

At least thirty-five compounds have been identified in the root, and while the constituents of the leaves differ significantly, the leaves are not used medicinally.

Uses

Quite a bit of research has been conducted on the effects of E. senticosus, but most of the studies have been published in Chinese or in Russian.

As already noted, the herb is used in Russia to improve physical performance and to bolster individuals against the mental and physical effects of stress.

A placebo-controlled study in rats failed to confirm that either ginseng or eleuthero could increase the animals" endurance for swimming in cold water. The rats given eleuthero did exhibit more aggressive behavior, however, suggesting a possible effect on the brain.

Eleuthero saponins did, however, increase survival time of oxygen-deprived animals in other experiments.

Saponins extracted from eleuthero can lower blood sugar in mice with experimentally induced diabetes. It appears to have little effect on blood sugar in animals without hyperglycemia.

Eleuthero extracts added to cancer cells in a test tube increase the effectiveness of anticancer drugs. Further studies are needed in animals and in humans before anyone can evaluate whether this activity will prove clinically useful.

Eleuthero compounds have very little ability to protect animals against the harmful effects of radiation.

In healthy humans, however, an injection of eleuthero polysaccharides increased immune system activity, especially boosting the number and activation of T cells.

Eleuthero extracts apparently bind to receptors for estrogen, progestin, glucocorticoids, and mineralocorticoids.

More than 2,200 people have received eleuthero in studies of its effects on atherosclerosis, diabetes, blood pressure abnormalities (both high and low), bronchitis, head trauma, and rheumatic heart disease. The findings in most of these studies were positive, although the herb should not be considered a "cure."

In Germany, eleuthero is approved as a tonic to invigorate a person in times of fatigue, as an antidote to poor concentration and diminished work capacity, and as an aid to convalescence.

In China, it is used to treat the headaches and heart palpitations that result from altitude sickness. Research there has also shown that eleuthero saponins are able to block calcium channels and change the electrical reactivity of heart tissue cultures.

It has a calming effect on the central nervous system and is said to improve digestion.

One interesting study in rats showed that it prevents birth defects, but it has not been tested in pregnant women.

Dose

In healthy people undergoing stress, the dose of E. senticosus ranges from 2 to 16 ml of a 33 percent alcohol extract taken one to three times daily. This offers a wide range of possible dosing.

It is taken for up to sixty days, and then at least two or three weeks elapse before it is taken again.

As many as five courses have been administered to people from nineteen to seventy-two years old in Russian studies.

People suffering from illnesses generally take lower doses. The same alcohol extract would be given in doses from 0.5 ml to 6 ml one to three times per day. They take the herb for one month, then cease taking it for at least two or three weeks before starting again.

Special Precautions

People experiencing acute health crises, such as heart attack or fever, should not take eleuthero.

Eleuthero is not recommended for people with high blood pressure.

Because of research suggesting that eleuthero may lower blood sugar, diabetics should carefully monitor blood sugar if they take this herb. Discuss this issue with your physician.

There is not adequate information to determine if this herb is safe during pregnancy. The most prudent approach is to avoid it.

Adverse Effects

Eleuthero, like Panax ginseng, appears to have a very good safety record. Millions of Russians have taken it over the years, and Chinese people have been taking ci wu jia for centuries.

Side effects, other than mild sedation, do not appear to have been reported. This may reflect the conventions of publishing scientific reports in China and in Russia as much as it demonstrates a true lack of adverse reactions, however.

At least one report of a negative consequence from eleuthero involved a child born with excessive hair. The baby's mother had reportedly been taking a "Siberian ginseng" preparation; however, the herb was not eleuthero after all but Periploca sepium. Eleuthero does not appear to contain compounds likely to cause such an effect (nor, for that matter, does P. sepium).

Expectant mothers should be warned, however, that there is little information on the safety of this herbal medicine during pregnancy so it should not be used.

Possible Interactions

Animal research demonstrated that eleuthero can increase the effects of barbiturates. In theory, then, anyone taking Fiorinal might become more sedated than usual if he or she also took eleuthero.

Eleuthero may increase the effectiveness of antibiotics because it stimulates the immune response.

A Canadian physician reported another potential drug interaction. Her patient, a seventy-four-year-old man on digoxin, had an unexplained increase in serum digoxin levels when tested. The levels remained high after the medicine was discontinued.

When the man stopped taking his "Siberian ginseng," his digoxin levels returned to normal, only to climb again some months later when he began taking the herb again. He had no other signs of digoxin toxicity.

The physician was unable to determine whether the herb had digoxinlike action, or whether it interfered in some way with the test. Dr. Varro E. Tyler has suggested that the herb in question may actually have been P. sepium, which contains glycosides that might potentiate digitalis glycosides.

No other reports of an interaction between digoxin and eleuthero have been published, but for people taking Lanoxin, a plant-derived medicine, it might be prudent to avoid mixing it with medicinal plants such as eleuthero.

Senna

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These two shrubs (sometimes considered variants of a single species, C. alexandrina) have a place in medical history going back to the ninth century when Arabian physicians introduced Europeans to this powerful laxative.

C. senna, in particular, is native to the Nile in Sudan and Egypt and had been used for centuries before Europeans learned about it.

The Arabic word "sena" and the Greek "cassia" both refer to the bark of the plant, which peels back readily. It is, however, the leaves that are used medicinally.

Senna is one of the few herbal medicines approved by the Food and Drug Administration for over-the-counter use; it is probably the most widely used herbal medicine in the United States.

Rather than attempt to make an aqueous extract (tea) of the leaves, it may be easier and more reliable to use a proprietary product of known strength, such as Senexon, Senokot, or Senolax.

Active Ingredients

Senna leaves contain many anthraquinone compounds, including dianthrone glycosides, which make up 1.5 to 3 percent of the herb.

Sennosides A and B, which are rhein dianthrones, and sennosides C and D, which are aloe-emodin derivatives, are also present. Flavonoids, naphthalene glycosides, and beta-sitosterol have been identified.

Uses

Senna is used as a strong laxative. The anthraquinones stimulate the bowel, leading to evacuation after approximately ten hours.

This herb also provokes secretion of fluid and minerals into the large intestine and inhibits their reabsorption. It is suggested for situations in which a soft, easily passed stool is desirable, such as following rectal surgery or in addition to electrolyte solution for people preparing for colonoscopy or barium enema.

When the FDA determined that the hazards of phenolphthalein were unacceptable, several companies replaced the phenolphthalein in their products, such as Ex-Lax and Perdiem Overnight Relief, with senna.

For a more complete discussion of the controversy, see pages 112?113. In our opinion, anthraquinone laxatives such as senna are not appropriate for regular use and can cause problems such as dependence if used too often.

Dose

The usual dose is approximately 20 to 30 mg of anthraquinone derivatives calculated as sennoside B.

If OTC drugs containing senna are used, dosing instructions on the label should be followed.

Senna-containing laxatives should not be used for more than eight or ten days except under medical supervision.

Special Precautions

Pregnant women should not use senna unless directed to do so by a physician.

Senna is not appropriate for children under the age of six.

People with intestinal blockage, undiagnosed stomach pain, or symptoms that might indicate appendicitis must avoid laxatives such as senna.

People with diarrhea and those with inflammatory bowel disease or intestinal ulcers must not use senna.

Adverse Effects

Senna can cause cramping (ranging from mild to severe), nausea, and diarrhea.

The urine may take on a reddish hue, which is harmless.

Serious complications generally occur only with prolonged use, which is not recommended.

Chronic use can lead to a dark discoloration of the lining of the colon and to laxative-induced diarrhea and weakening of the bones (osteomalacia). It may also lead to dependency, undermining the bowel's ability to evacuate without stimulation. This sets up a vicious cycle.

Long-term use of a senna laxative can result in clubbing of the fingers or toes, as well as in loss of appetite and altered nutritional status.

With chronic use, too much potassium and other vital minerals may be lost, which can be very dangerous for those with heart rhythm irregularities.

Asthma and allergy are reported as a consequence of occupational exposure.

Possible Interactions

When potassium levels are reduced, there is a serious danger of interaction with heart drugs such as Lanoxin.

Other potassium-depleting medicines, such as diuretics (hydrochlorothiazide, Lasix, Hygroton, Lozol, Bumex, etc.) and the herbal medicine licorice may interact with senna to increase potassium loss, with consequently greater risk of heart rhythm disturbance.

Because senna reduces gastrointestinal transit time, pills taken the same day may not be absorbed completely.

If the dose of senna is such that the person becomes dehydrated, certain pain relievers such as acetaminophen may become more harmful to the kidneys.

Scullcap

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Scullcap is a member of the mint family and a native of North America, where it thrives in moist woodlands. Common names for it include helmetflower, hoodwort, and mad-dog weed (from its introduction into American medicine in 1773).

A physician in New Jersey, Dr. Lawrence Van Derveer, claimed it was useful in treating hydrophobia (an old term for rabies).

Although he was said to have lost only three patients out of a large number he treated, other doctors were, understandably, less successful in curing rabies with scullcap. (To this date, prompt administration of the rabies vaccine is the only effective treatment.)

A number of related species grow in Asia. At least one of these, S. baicalensis Georgi, has been used in Europe and China (where it is known as huang qin). But although these plants appear to have some active ingredients in common, the ways they are used is very different.

The aboveground parts of scullcap collected during the blooming season (August and September) are dried and used as herb. It is, however, the dried root of huang qin that is used medicinally in China.

Active Ingredients

Scutellaria species contain a number of flavonoid glycosides, including scutellarein, isoscutellarein, wogonin, and baicalin. S. baicalensis root contains baicalein, baicalin, wogonin, and beta-sitosterol.

Uses

Scullcap has traditionally been used in combination with valerian as a mild sedative for anxiety. It has also been used in patent medicines for "female problems."

Tests of scullcap extract did not reveal that it stops muscle spasms or that it slows down animals or makes them sleep. Most studies did not indicate any effect on heart rate or blood pressure, although Japanese scientists found that an extract of S. baicalensis reduced blood pressure in dogs.

The scientific research does not support the use of scullcap as a tranquilizing herb or for the treatment of hormonal problems.

Chinese research has shown, however, that extracts of S. baicalensis root are active against a range of bacteria and that the herb is an effective antiviral agent to treat the flu. It is prescribed for acute tonsillitis and strep throat.

A constituent, baicalin, inhibits HIV-1.

Baicalin also appears to inhibit tumor growth and has strong anti-inflammatory activity.

Both baicalin and baicalein are powerful antioxidants, protecting red blood cells from free radical damage better than vitamin E can. They both show some promise in preventing the oxidation of blood fats, although baicalein appears to be more active here.

Dose

No standard dose of scullcap has been established in the United States or Europe. In China, baicalin is available in 250-mg tablets.

The dose prescribed for viral hepatitis is two tablets three times a day.

The herb is said to be dangerous in overdose.

Special Precautions

In the U.S. market, it is difficult to determine if the scullcap you have purchased actually contains S. lateriflora.

Apparently adulteration is common, and one plant Teucrium, often substituted for scullcap appears to be harmful to the liver.

Adverse Effects

Swallowing scullcap at normal doses does not generally result in serious side effects.

Injection of S. baicalensis extracts, however, can cause fever, muscle pain, and lowered leukocyte count.

In several instances, people taking scullcap have experienced liver damage. Varro E. Tyler hypothesizes that this may be due to adulteration with another herb. The danger of liver toxicity should, however, discourage casual use of the herb.

Possible Interactions

The only interactions reported are from animal studies. The anticancer agents cyclophosphamide and 5-fluorouracil were less toxic and more potent when given together with a scullcap extract.

Saw Palmetto

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Saw palmetto, also called sabal palm, grows in the southeastern United States. Its dark berries were traditionally made into a tea and taken for urinary problems or sexual difficulties.

During much of the nineteenth century, saw palmetto berry extract was included in the National Formulary, a list of acceptable medicines, to treat the symptoms of prostate enlargement. As medicine came to rely more on science, doctors became skeptical about the value of this botanical remedy and it was dropped from the Formulary before 1950.

More recent studies indicate that it is indeed effective for this indication and probably should never have been dropped.

Even men who have saw palmetto growing in their backyards may want to stick with commercial extracts rather than try to make their own tea. The berries do not taste good, and most of the active ingredients appear to be less soluble in water than in alcohol or hexane.

Active Ingredients

Saw palmetto berries contain free fatty acids and plant sterol compounds described as phytosterols or sitosterols, especially beta-sitosterol and some related chemicals. These ingredients appear to modify estrogen receptors and block the conversion of testosterone to dihydrotestosterone (DHT), a more active chemical.

There are also flavonoids and some polysaccharides in the berries, but their activity has not been described. Standardized products contain 85 to 95 percent fatty acids and sterols.

Uses

At least seven controlled studies demonstrate that saw palmetto berry extract is better than placebo for treating symptoms of benign prostate hypertrophy (frequent urination, restricted urine flow, nighttime urination).

In one study, the herb was nearly as effective as the prescription drug Minipress (prazosin) for controlling such symptoms, and in other research it reportedly performed better than the prescription prostate medicine Proscar (finasteride) in reducing symptoms.

Research using ultrasound has shown that saw palmetto berry extract can shrink enlarged prostate tissue.

Animal research has shown that saw palmetto berries may also have anti-inflammatory activity and can help reduce allergic reactions.

The plant has been used traditionally as a diuretic and may also help to stimulate immune response.

The herb's effect on enlarged prostate tissue is by far the most clinically important.

Dose

For early stages of benign prostate enlargement: 320 mg extract daily, in divided doses, or the equivalent of 1 or 2 grams of saw palmetto berries.

Four to six weeks may be required to determine if the herb is helping.

A standardized product used in Germany is available in the United States under the brand name ProstActive.

Special Precautions

Estrogen-like activity and the ability to block testosterone conversion suggest that pregnant women and those who may become pregnant should avoid contact with saw palmetto berry extract, just as they should avoid finasteride.

Men are urged not to treat urinary symptoms without medical diagnosis. Similar symptoms might be caused by a more serious condition, such as prostate cancer, that will not benefit from herbal treatment.

Adverse Effects

Side effects are uncommon, although a few men have reported upset stomach or headache.

At high doses saw palmetto berries or extract may trigger diarrhea or raise blood pressure. Most adverse effects are mild.

Saw palmetto berry extract very rarely causes impotence or lowers libido as Proscar occasionally does.

Possible Interactions

Because saw palmetto berries have both estrogenic and antiestrogenic activity, they are not recommended for women using female hormones for contraception or hormone replacement therapy.

Common sense would also suggest that men taking Proscar or Propecia, drugs that act in a similar manner to saw palmetto berry extract, should avoid the herbal product except under a physician's recommendation and monitoring.

Red Clover

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This familiar plant is native to Europe, northern Africa, and central Asia, but red clover is also grown for pasturage and as a rotation crop in the Americas and Australia. (Nodules on the roots fix nitrogen, enhancing the soil.)

American children traditionally love hunting in a patch of red clover for a rare four-leaf specimen said to cause good luck, but it is the dried flowers that are used in herbal medicine.

Red clover blossoms are believed useful as an expectorant and for the treatment of bronchitis and asthma.

The herb has also been used topically to speed wound healing and treat psoriasis.

Current interest in red clover focuses on its use to relieve menopausal symptoms.

Cattle and sheep grazing too heavily on clover have fertility problems because of their phytoestrogen intake.

Active Ingredients

Red clover contains approximately 0.17 percent phytoestrogens. These include formononetin, genistein, daidzein, and biochanin A.

A volatile oil in the blossoms contains methyl salicylate, among other constituents. Some coumarin derivatives and cyanogenic glycosides have also been isolated.

Uses

The use of red clover extract as a supplement for menopausal women has gained attention through the marketing of an Australian product called Promensil. These pills, introduced in the United States in 1998, contain 40 mg each of isoflavones, in a standardized ratio.

Most of the research supporting red clover isoflavones has been conducted in Australia. The same firm markets a red clover supplement called Trinivin, also containing 40 mg standardized isoflavones, for men with healthy but enlarged prostates.

According to the studies conducted by the manufacturer, Novogen, red clover isoflavones are capable of suppressing hot flashes in perimenopausal women without leading to proliferation in uterine (endometrial) tissue.

A double-blind controlled trial published in the Journal of Clinical Endocrinology and Metabolism (March 1999) demonstrated that red clover isoflavones help keep large blood vessels pliable.

Dose

The usual daily dose contains 40 mg standardized red clover isoflavones. It may take four to six weeks to get the full benefit.

Special Precautions

Pregnant women should not take red clover products until further tests determine whether this is safe. Isoflavones have estrogen-like effects, and estrogens are not recommended during pregnancy.

Adverse Effects

No adverse effects of trifolium isoflavones at the recommended dose have been reported. Blood biochemistry was monitored in some studies and showed no significant changes.

Possible Interactions

No interactions have been reported. It seems illogical, however, to mix Promensil with standard HRT regimens or oral contraceptives, and in theory these compounds could be incompatible.

A red clover extract containing coumarin derivatives might in theory interact with the anticoagulant Coumadin. Close monitoring of prothrombin time or INR is advisable.

Psyllium

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Psyllium seeds (also known as blond psyllium or ispaghula) are derived from a species of plantain that is native to India and Iran.

The seeds are small and reddish-brown, with no distinctive aroma and almost no flavor.

They absorb water and become surrounded with mucilage that has excellent emulsifying power and is prized as a laxative.

Active Ingredients

The main constituent of psyllium seed is dietary fiber. Although the majority of it is insoluble, there is also a fair bit of soluble fiber in the mucilage. This is mostly polysaccharides.

The seeds also contain proteins, other carbohydrates, oil, sterol, and some flavonoids, but the soluble fiber is primarily responsible for its therapeutic action.

Uses

Psyllium is a bulk laxative. The powdered seeds are taken with ample water, and once in the intestine they swell.

This "bulk" encourages defecation, and the mucilage tends to soften the stool and make it easier to pass.

This herb is frequently recommended for the treatment of constipation and is even approved as an over-the-counter drug in the United States under brand names such as Fiberall, Konsyl, Metamucil, Modane Bulk, or Serutan.

In addition to its value for treating chronic constipation, psyllium can be useful in treating diarrhea.

In one study, symptoms of irritable bowel syndrome improved with psyllium administration.

Diarrhea following gallbladder surgery has also been successfully treated with psyllium seed.

Psyllium preparations can reduce pain and bleeding from hemorrhoids.

Psyllium seed has also been used to reduce high levels of cholesterol and triglycerides. In an eight-week trial, total cholesterol decreased by 14 percent and undesirable LDL cholesterol by 20 percent. In studies lasting more than two months, triglycerides came down to just over half the baseline levels.

Psyllium seed is not universally effective in lowering cholesterol, however: twenty children with high cholesterol levels failed to respond, so familial cholesterol conditions may be less amenable to psyllium treatment.

Psyllium seed is also reported to slow the absorption of dietary sugar. This may be beneficial in diabetes, although it is a subtle effect.

Dose

The usual adult dose is 7 g of psyllium seed preparation up to three times a day to a maximum of 30 g per day. It must be taken with at least 8 ounces of water each dose.

Paradoxically, the dose for diarrhea can range even higher to a maximum of 40 g daily.

Children from six to twelve years old are treated with half the adult dose.

It may take two or three days for psyllium to produce the desired effects. Unlike other laxatives, psyllium seed may be used as long as needed without fear of dependence.

Special Precautions

Children under six years old should take psyllium seed or psyllium preparations only under medical supervision.

Psyllium seed is not appropriate for anyone with intestinal blockage.

People allergic to psyllium must avoid it.

Constipation or diarrhea that persists for several days deserves medical attention.

Adverse Effects

The indigestible fiber in psyllium seed can cause flatulence and abdominal discomfort.

Psyllium seed powder can provoke allergies and has caused rare instances of anaphylactic shock.

If psyllium seed is not taken with adequate water, it can clump together in a mass and block the digestive tract. Sufficient fluid is crucial to the safe and successful use of psyllium seed.

Possible Interactions

Psyllium seed may interfere with the absorption of nutrients such as iron, calcium, zinc, or vitamin B12 if it is taken at with meals or with vitamin supplements.

The fiber can also affect the absorption of other medications, including Coumadin, Lanoxin, lithium, or Tegretol. To avoid such problems, it should be taken at least an hour after other medicines.

If psyllium seed reduces or significantly slows the absorption of dietary carbohydrates, the dose of insulin for insulin-dependent diabetics may require adjustment. Please discuss this with your physician.

Pau d'Arco

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Pau d'arco, known as lapacho colorado in Argentina and Paraguay and as ipe roxo in Brazil, is a good example of the lure of the exotic. This South American native has been used medicinally by several indigenous groups.

There are several species of Tabebuia, and most appear to be broad-leaved evergreen trees with very hard wood that resists decay. It may be difficult to determine precisely which species is being sold as pau d'arco tea.

Pau d'arco has a reputation for having been used by the Incas, although it is not native to the high Andes.

It is said to be useful against cancer, diabetes, rheumatism, and ulcers, as well as several other ailments.

Readers of "The People's Pharmacy®" have reported success in using it topically as a soak to cure fungus-ridden toenails. Extracts have been used topically to treat Candida yeast infections.

Overall, however, the research on pau d'arco does not offer strong support for most of the medicinal claims made for it.

The part of the tree used is the inner bark, and the preparation made from it is sometimes termed taheebo.

Active Ingredients

Pau d'arco, or taheebo, contains a number of quinone compounds, including the naphthoquinone lapachol and the anthraquinone tabebuin. These and related compounds are assumed to be the active ingredients.

Uses

Lapachol has antibacterial activity, and a related compound fights off fungus and yeast.

Lapachol has demonstrated activity against malaria, a property that would certainly be useful for people in the areas where Tabebuia species grow wild.

Test tube and animal research in the 1950s and 1960s indicated that taheebo extract and lapachol could slow the growth of certain tumors. The National Cancer Institute subsequently tested lapachol for anticancer activity in humans, with disappointing results.

Some practitioners report anecdotes of marvelous cancer cures, but the Brazilian Cancer Society disavows its use.

In human trials, it was difficult to attain therapeutically active levels of lapachol with oral administration, and when levels did get high enough, most people suffered serious adverse effects such as nausea and vomiting.

Taheebo extract has anti-inflammatory activity, at least in rats. Researchers have also found that it helps animals resist ulcers.

In laboratory studies on human blood cells, lapachol had immunosuppressant effects at higher doses and immunostimulant activity at low doses.

Dose

Standard dose has not been determined.

Special Precautions

Pregnant women should not take taheebo internally because there is no evidence of its safety, although it can provoke adverse reactions.

Pau d'arco should be discontinued before surgery because of the danger of excessive bleeding.

Adverse Effects

Studies of pau d'arco in humans have noted reactions such as severe nausea, vomiting, diarrhea, dizziness, anemia, and bleeding. Administering vitamin K stopped the bleeding.

Possible Interactions

The fact that taheebo causes vitamin K-reversible bleeding strongly suggests that it would interact with anticoagulants such as Coumadin to increase the danger of hemorrhage.

Passion Flower

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Several species of Passiflora are native to the Americas, but the one generally used as a botanical is P. incarnata.

This perennial vine grows wild in the southeastern United States as far north as Virginia and as far west as southeast Kansas. It is sometimes called maypop or apricot vine because of its edible fruits.

The flower reminded Spanish explorers of the Passion of Christ: the three styles represented the three nails, the corona was thought to resemble the crown of thorns, and the ten petals stand for the ten true apostles (Peter and Judas are excluded).

Because of these flamboyant flowers, passionflower is often cultivated in home gardens. P. incarnata should not be confused, however, with the ornamental blue passionflower, P. coerula, which contains toxic compounds.

All of the aboveground parts of P. incarnata are used medicinally.

Active Ingredients

There is some controversy over the exact composition of P. incarnata. Approximately 2.5 percent appears to be flavonoids such as vitexin, orientin, homo-orientin, saponarin, schaftoside, and a few others as glucosides, together with free flavonoids including apigenin, luteolin, quercetin, and kaempferol.

In Europe, passionflower is required to contain not less than 0.8 percent total flavonoids, calculated as vitexin.

The harman alkaloids that have been identified by some chemists are disputed by others. Umbelliferone, scopoletin, and maltol have been reported.

An antifungal, antimicrobial compound dubbed passicol is found in fresh plant matter but dissipates quickly from the dried herb or aqueous extract.

Uses

Passionflower preparations have been used in homeopathic medicines, especially in Europe, to treat insomnia, nervous exhaustion, and pain. The herbal medicine is used for similar problems.

Very little clinical research has been conducted on passionflower, but animal research suggests the herb may affect the nervous system in several ways.

At some doses, the plant may have stimulant properties, but the primary effect seems to be sedative. At high doses (10 mg extract per 10 g body weight in the mouse), passionflower extract can counteract stimulation from methamphetamine.

It may be necessary to utilize the extract for the expected effect: various components have quite different activities. The controversial harman alkaloids are said to be stimulating, but they also relax spasm in smooth muscle, dilate coronary arteries, and lower blood pressure.

Maltol, on the other hand, slowed mice down, relaxed their muscles, and slowed their respiration and heart rate.

Despite the dearth of clinical research, in Europe the herb is used for tension, restlessness, and irritability with mild insomnia. It has also been used for "functional" digestive problems and restlessness in children.

Passionflower is one of the most popular herbal sedatives in the United Kingdom, included as an ingredient in a large number of proprietary herbal mixtures.

Combinations of passionflower, valerian root, and lemon balm are approved in Germany to treat difficulty falling asleep due to nervousness and also nervous unrest.

Perhaps one of the most delightful descriptions of the use of passionflower came from traditional North Carolina herbalist Tommie Bass: "They say it brings people together. After you have lived with someone for many years the little things they do start to bother you. So you take some passionflower leaves and make you a tea. Pretty soon you start to relax and the little things don't bother you so much and you get along just fine."

Given the great popularity of passionflower in Europe and its increasing popularity in the United States, clinical trials to determine its effectiveness would be welcomed.

Dose

Usually 4 to 8 g herb per day, in divided doses, or 1 to 4 ml of tincture.

The infusion is made by pouring 2/3 cup boiling water over 1 teaspoon (2 g) of herb, steeping between five and ten minutes, and straining it. Two or three cups are drunk in a day, with one before bedtime.

Passionflower may be taken for as long as it is helpful.

Special Precautions

Pregnant women should not use this herb without medical supervision.

Passionflower might affect a person's concentration and alertness. Driving or operating complex machinery after taking the herb is not advised.

Adverse Effects

Rare allergic reactions of asthma and runny nose have been reported.

Possible Interactions

No interactions have been reported in the literature, but prudence suggests that passionflower should not be mixed with prescription sedatives such as benzodiazepines (Ativan, Xanax, etc.) or barbiturates, or with other sedative herbs such as kava or valerian.

Oregon Grape

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Barberry, B. vulgaris, was highly regarded as a useful and even necessary herb in Europe from Elizabethan times and through the eighteenth century. The English settlers brought it with them to America, where they extended the name and reputation of barberry to natives of the west and Northwest.

These handsome hollylike plants were originally thought to be species of Berberis but were later determined to belong in their own genus, Mahonia. They all belong to the same plant family.

European barberry was believed to be good for the digestion, especially for the liver and gallbladder.

In America, barberry (European or American) was used for diarrhea and dysentery and considered useful for a range of digestive problems. Its common names include woodsour, sowberry, sour-spine, and pipperidge bush, as well as jaundice berry from the yellow color of the wood.

The active ingredient berberine, along with other alkaloids, imparts the yellow color. Berberine is a constituent common to Berberis and Mahonia species as well as to goldenseal, Hydrastis canadensis.

Oregon grape, which is easily cultivated, has been suggested as a substitute for goldenseal, which is often difficult to find, and has been listed as endangered. Both plants contain berberine and both were used by American Indians.

Oregon grape was said to be helpful in improving the appetite and counteracting general weakness.

Although the purplish berries are edible and rich in vitamin C, the part of the plant used medicinally is the root.

Active Ingredients

The principal constituents of Oregon grape responsible for its activity are the isoquinoline alkaloids, especially berberine, berbamine, isocorydin, and oxyacanthine.

A number of other alkaloids are also present in smaller quantities, to make up a total alkaloid content of almost 3 percent of the root.

Uses

Oregon grape was utilized to treat heartburn, ulcers, and other digestive disorders. There has been little if any modern research to determine a scientific rationale for these traditional uses.

Berberine has antibacterial activity against such important germs as E. coli and N. meningitidis, among others.

In one study, berberine proved effective in treating diarrhea due to toxic pathogens such as cholera. Patients with diarrhea not due to cholera benefited no more from berberine than from placebo.

In a different study, berberine was more helpful than placebo against giardia infections in children.

This compound acts against both amoebas and trypanosomes, medically significant parasites.

Berberine has sedative and anticonvulsant properties. It can also stimulate uterine contractions.

Berbamine has been shown to lower blood pressure. Oregon grape is hardly ever used for these purposes, however, even in herbal medicine.

In Europe, Oregon grape is used topically to treat psoriasis. It is also found in certain homeopathic medicines for psoriasis and dry skin rashes.

Dose

No standard dose of Oregon grape is established.

Special Precautions

Pregnant women should avoid Oregon grape because of evidence that berberine can stimulate uterine contractions in animals.

Adverse Effects

Too much Oregon grape produces diarrhea, kidney inflammation, and undesirable psychological effects of daze and stupor.

Possible Interactions

With its sedative and anticonvulsant properties, Oregon grape probably should not be combined with medicines such as alcohol, barbiturates, or antianxiety drugs such as Ativan (lorazepam) or Xanax (alprazolam).

Because Oregon grape and goldenseal contain such similar ingredients (especially berberine), using them together is irrational.

Milk Thistle

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Milk thistle, also referred to as St. Mary's thistle, lady thistle, or holy thistle, originated in the Mediterranean region and was grown and used as a vegetable throughout Europe. It was brought to the United States and has adapted to life in the wild in California and along the East Coast.

It is a tall plant with large prickly leaves and a reddish purple flower. The sap is white and milky, perhaps explaining at least one of its common names.

The white spots along the ribs of the leaves were said to have been drops of the Virgin Mary's milk. The herb was used in times past to help encourage milk production, but this may have been due to the name and the association.

The medicinal use of milk thistle goes back two thousand years. Pliny the Elder wrote of it, praising its value for "carrying off bile."

Medieval herbalists also made use of this property, and in the sixteenth century English herbalists adopted it. It did not maintain its popularity, however, and by the early twentieth century only homeopaths were familiar with it.

With a renewal of interest in herbal medicines, researchers started to investigate milk thistle scientifically in the 1950s.

The part of the plant that is used is the small hard fruit with the fuzz (technically called "pappus") removed.

Active Ingredients

Silymarin, which makes up from 1 to 4 percent of milk thistle fruits, is itself actually a combination of chemicals called flavonolignans.

In addition to these, the seeds contain fatty acids and flavonoids, including apigenin, quercetin, kaempferol, naringin, and silybonol. The flavonolignans are the active ingredients, and proprietary extracts standardized to 70 percent silymarin are common in Europe.

Uses

Milk thistle extract is occasionally used to stimulate the appetite, but its primary use is for liver and gallbladder problems.

Silymarin in proprietary extracts has been shown, through animal research, to have the ability to protect the liver from a range of toxins, including carbon tetrachloride and the deadly poisons from the death-cap Amanita mushrooms.

It is most effective when given six hours before exposure, although there is some benefit up to thirty minutes after exposure to the toxin. Pretreatment with silymarin also protects animals from liver damage due to alcohol.

Silymarin seems to have a membrane-stabilizing activity that prevents toxins from getting into the cells, perhaps by competing for the receptors, or perhaps through antioxidant action and free radical scavenging. It also stimulates the synthesis of ribosomal RNA, an important step in cell regeneration, and inhibits lipid peroxidation.

If silymarin were able only to prevent liver damage from toxins through pretreatment, it would be quite remarkable but of little practical use to a prudent person. In human cases of mushroom poisoning, however, injections of silybin (a component of silymarin) up to forty-eight hours later can reduce the death rate.

Silymarin appears helpful as supportive treatment for chronic liver inflammation from hepatitis or cirrhosis. Some, but not all, clinical studies have shown measurable improvement in liver function tests when silymarin is given to people with alcohol-induced liver damage.

Silybin has also been tested in animals for its ability to protect the kidney from damage due to drugs such as the chemotherapeutic agent cisplatin. Results of this research were promising and should be confirmed by clinical studies in humans.

Silymarin has anti-inflammatory activity and appears to have beneficial effects on T-lymphocytes, possibly enhancing immunity.

Silymarin may slightly reduce the manufacture of cholesterol in the liver and seems to encourage bile excretion.

Bile duct inflammation responds well to treatment with this herb.

Dose

Milk thistle should not be administered as a tea or as dried herb because silymarin is neither water-soluble nor readily absorbed from the intestinal tract.

Proprietary products standardized to 70 percent silymarin are utilized in Europe at a usual dose of 420 mg daily.

Treatment normally lasts four to eight weeks at a minimum. Trials of three and six months are common.

One standardized product used in Germany is sold in the United States under the brand name Thisilyn.

Special Precautions

Serious liver diseases require medical attention. In one study, silymarin extract lowered blood glucose and glycosylated hemoglobin values in diabetics.

Diabetic patients should monitor blood glucose closely if they take silymarin, as the dose of insulin or other medication may need adjustment. Please discuss this with your physician.

Adverse Effects

Milk thistle has almost no reported side effects.

Concentrated formulations of silymarin may cause diarrhea or digestive upset in perhaps 1 percent of patients.

Allergic reactions such as hives have been reported very rarely.

Possible Interactions

No adverse interactions have been noted.

It has been suggested that silymarin could be used prophylactically by people taking medicines such as acetaminophen that have the potential to damage the liver. We welcome a clinical trial of standardized silymarin extract to evaluate this theory.

Ma Huang

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Ma huang, Chinese ephedra, was used to treat asthma, or at least wheezing, five thousand years ago.

The Herbal Classic of the Divine Plowman described it as an herb of "middle class," referring to its perceived usefulness rather than to a social standing. It has been part of the Chinese herbal pharmacopoeia ever since, and Chinese scientists (K. K. Chen and his colleagues) did some of the early research into its pharmacology early in the twentieth century.

The active component isolated from E. sinica, ephedrine, was a staple of standard medical management of asthma in the United States for several decades.

Although it has been replaced for the most part with newer synthetic compounds, ephedrine is still available over the counter for nasal congestion (as a spray or jelly) and in capsules with or without prescription as a bronchodilator.

There are many species of ephedra, but not all of them contain ephedrine or other active compounds. A native of the American Southwest, E. nevadensis, or Mormon tea, is one that does not.

The part of E. sinica that is used is the dried stem. The roots and the fruits have little or no ephedrine or other alkaloids.

Active Ingredients

The primary active ingredient of ma huang is ephedrine, accounting for 80 to 90 percent of the alkaloid content of the plant.

It also contains related chemicals, such as pseudoephedrine, which is also used in medicines to relieve nasal congestion.

Uses

In China, ma huang was used traditionally to cause sweating and to treat colds and other nasal congestion (most likely due to allergy). E. sinica could still be used to treat coughs and colds, but the synthetic derivatives are readily available in easily controlled doses.

Ephedrine is still used sometimes to treat an acute attack of asthma.

Ephedrine relaxes bronchial muscle but constricts small blood vessels in the arms and legs. This raises blood pressure, an action that is sometimes put to use in treating shock.

Ma huang can lower body temperature, stimulate the brain, and inhibit inflammation. In China, it is one ingredient in a common cold medicine. It also has antiviral and diuretic activity.

Although it has been promoted for weight loss and to improve athletic performance, it has not been shown effective for either purpose, and adverse reactions can be serious.

Dose

The dose of ephedrine for an adult is 25 or 50 mg, two or three times daily.

Herbal preparations are expected to deliver a slightly lower dose, equivalent to 15 to 30 mg total alkaloid, calculated as ephedrine.

Frequent use of ephedrine or ma huang reduces its effectiveness as a bronchodilator.

Special Precautions

Ephedrine can cause uterine contractions; pregnant women should avoid ma huang.

Ma huang can raise blood pressure and accelerate heart rate. Persons with elevated blood pressure or heart disease should not use this herb.

Men with prostate enlargement must avoid ma huang, which can aggravate the condition.

Ma huang is not appropriate for people with glaucoma or pheochromocytoma.

Diabetics should not take ma huang because it complicates blood sugar control.

People with Graves' disease or other hyperthyroid conditions should forgo ma-huang because it can increase metabolic rate and, after four weeks of use, alter the conversion of T4 to T3.

Ma huang may depress the appetite and should not be taken by people with anorexia.

People with insomnia, anxiety, or suicidal tendencies may suffer from possible psychological reactions to this herb.

It may also reactivate stomach ulcers in susceptible individuals.

Ma huang and ephedrine are forbidden by the International Olympic Committee.

Adverse Effects

Headache, insomnia, nervousness or agitation, and dizziness are all potential reactions to ma huang or to ephedrine. It can raise blood pressure and trigger heart palpitations.

Restlessness, vomiting, and difficult urination are additional side effects. Skin reactions indicating sensitivity have been reported.

At high doses, the rise in blood pressure can be alarming. Heart rhythm disturbances may occur, and toxic psychosis is considered possible.

After several deaths were linked to overuse or abuse of ma huang, the FDA restricted its availability.

Possible Interactions

Excess nervous stimulation may occur if ma huang is taken together with caffeine (including guarana, coffee, or tea) or theophylline. Such a combination is also likely to provoke cardiovascular reactions.

Ma huang must not be combined with MAO inhibitors such as Nardil or Parnate. This interaction could send blood pressure dangerously high. Allow at least two weeks to elapse after stopping an MAO inhibitor before taking ma huang.

Ma huang is incompatible with cardiac glycosides such as Lanoxin and with the anesthetic halothane. Serious disruption of heart rhythm may occur.

Ma huang must not be combined with ergot or its derivative ergotamine, or blood pressure could become very elevated.

Licorice

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The roots of this plant are widely used, not only in European herbal medicine but also in the traditional Chinese pharmacopoeia.

In China and parts of Russia, the species used is G. uralensis; it is known in Chinese as gan cao. The scientific name for the genus refers to the sweet taste of the root.

Licorice has been popular for flavoring foods and other medicinal herbs for many centuries. Hippocrates described its medicinal use, as did Pliny the Elder.

A piece of licorice from the eighth century was recently discovered still to contain active principles.

Licorice has been used to treat coughs and colds, and also as a digestive aid.

Although licorice is best known in the United States as a flavor for candy, by far the majority (up to 90 percent) of the licorice imported into the country is actually used to flavor tobacco products.

Just to add to the confusion, some of the licorice candy made in the United States does not rely on licorice for its flavor.

A recent case of licorice overdose, however, demonstrated that the popular candy Twizzlers (the black, not the red) contains some licorice, and natural candies imported from Europe often contain licorice rather than anise or other flavoring agents.

The parts of the plant used are the dried roots and rhizomes, either peeled or unpeeled.

Active Ingredients

Between 6 and 14 percent of the root is the glycoside glycyrrhizin. This calcium or potassium salt of glycyrrhizinic acid is fifty times sweeter than table sugar.

Licorice contains a number of other triterpenoid saponins, along with plant sterols including sitosterol and stigmasterol.

The root also contains several other sugars, including glucose, mannose, and sucrose.

More than thirty flavonoids and isoflavonoids have been identified, including liquiritin and its derivatives.

Some coumarins and an immunosuppressant called LX have also been isolated.

Uses

In Europe, the primary medicinal use of licorice is to treat coughs, colds, and other respiratory infections.

Glycyrrhizinic acid seems to stop the growth of many bacteria and of viruses such as influenza A. It also stimulates the production of interferon.

Chinese researchers agree that licorice is effective against cough and soothes the inflamed tissues of a sore throat. In fact, ancient Chinese texts summarize the uses of licorice rather well: "improve the tone of the 'middle Jiao' [digestive system] and replenish qi, to remove 'heat' and toxic substance, to moisturize the lungs and arrest coughing, and to relieve spasms and pain."

Modern practitioners use different terminology, but the therapeutic benefits are quite similar.

Licorice has also been used extensively as a treatment for ulcers. It prevents the secretion of gastric acid, reduces the activity of pepsin, and inhibits enzymes that dismantle prostaglandins. This leads to higher levels of prostaglandins in the stomach and upper intestine, allowing ulcers to heal more quickly.

The activity of licorice on prostaglandin-regulating enzymes may explain why this herb protects stomach tissue against aspirin-induced damage in rat studies.

A semisynthetic compound (carbenoxolone) derived from licorice has been compared to cimetidine in clinical trials and found less effective (52 percent improving compared to 78 percent on cimetidine). This agent does act to protect the colon, however, and is used to treat ulcerative colitis in China. Carbenoxolone also protects against colon cancer.

Serious side effects that occur with licorice and with carbenoxolone led researchers to develop a deglycyrrhizinated licorice, DGL. In some studies, DGL (under the brand name Caved-S) was just as good as cimetidine at treating ulcers, but not all studies have shown consistently good results.

In Japan, physicians use licorice to treat chronic hepatitis B. Glycyrrhizin interferes with hepatitis B surface antigen and is synergistic with interferon against hepatitis A virus. It is also used at times to treat hepatitis C.

Researchers have also demonstrated that licorice helps protect the liver from damage due to chemotherapy. At low doses, the herb stimulates the liver to manufacture cholesterol and excrete it in bile. This can help lower serum cholesterol levels.

Licorice root has an effect on the organism similar to that of a steroid. It slows the conversion of cortisol to cortisone, which increases and prolongs the action of this steroid hormone produced by the adrenal glands. This physiological activity can explain many of its undesirable effects as well as its medicinal benefits.

In Russia, however, this property is put to use by administering licorice together with prescribed cortisone. This allows for a lower dose of the medication.

Physicians in China may prescribe licorice alone or with cortisol to treat mild cases of Addison's disease, in which the body produces too little of this hormone.

Glycyrrhizin also inhibits an enzyme that inactivates aldosterone, and its chronic use can mimic the serious condition of aldosteronism.

In China, licorice is considered a powerful antitoxin and is used as an aid in the treatment of pesticide poisoning.

It may also curb Plasmodium falciparum, the parasite that causes malaria.

Through its effects on adrenal steroids, licorice exerts anti-inflammatory activity.

The licorice constituent known as LX immunosuppressant is also able to reduce hypersensitivity reactions and prolong the survival time of transplanted tissues.

Glycyrrhizin has antioxidant and antitumor activity, but because of serious side effects it should not be used on a regular basis.

Licorice has been used to ease symptoms of menopause. In one study, licorice attached to estrogen receptors. It did not, however, promote the growth of uterine cells as estrogen does, and it is not frequently used for this purpose in the United States.

Topically, glycyrrhizin has been used in shampoo to treat excess oil secretion of the scalp. It has also been included in ointments used to treat skin inflammations.

Dose

For coughs and colds: approximately 5 g per day (approximately 1 teaspoons licorice root made into tea).

For ulcers and stomach problems: up to 15 g per day.

In China, gan cao extract is given in doses of 5 to 15 ml three times a day.

DGL: 380 to 760 mg twenty minutes before each meal (three times daily).

Licorice should not be used for long-term self-treatment. At low doses, four to six weeks should be the maximum duration. At higher doses, as for treating ulcers, the time frame is correspondingly shorter.

As little as one ounce (approximately 30 g) of natural licorice candy daily may be enough to trigger side effects over a period of weeks or months.

Regular daily intake of 50 g licorice root (corresponding to 100 mg glycyrrhizin) is known to trigger high blood pressure and other problems (see Adverse Effects).

Special Precautions

Pregnant women should not use licorice at medicinal doses. There is a danger of high blood pressure or of a hormone imbalance that would harm the fetus.

People with high blood pressure should avoid the use of licorice, which could aggravate their condition.

Anyone with a heart problem should use licorice only under medical supervision. Potassium depletion caused by licorice is especially hazardous for such patients. Anyone with pre-existing hypokalemia (low potassium) should not take licorice.

People with kidney disease, especially the elderly, may be at increased risk of side effects from this herb.

Gallbladder disease and cirrhosis are considered contraindications for licorice.

Adverse Effects

The consequences of high doses or long-term use of licorice are severe. This herb can cause high blood pressure, low levels of potassium, fluid retention and swelling of the face and limbs, hormonal imbalance, and muscle destruction leading to pain and weakness.

At least one woman experienced loss of libido. Another woman ate too much licorice candy and lost a great deal of potassium; her heart stopped.

Licorice can also change heart rhythms, prolonging QT and PR intervals on an electrocardiogram.

Lethargy and fatigue as well as weakness are part of the picture of licorice toxicity.

Many of the negative symptoms associated with licorice are due to its ability to inhibit the renin-angiotensin system. Elderly people in particular are susceptible to kidney problems as a consequence of licorice.

Paralysis of the legs (and in one case, of all of the limbs) has been reported. A sixty-four-year-old man developed pulmonary edema, signaled by fatigue and trouble breathing, after eating four packages of black Twizzlers licorice candy in three days. This case demonstrates how quickly a serious reaction can arise.

Licorice can reduce thyroid gland activity and lower the basal metabolic rate.

It appears that individuals vary considerably in their susceptibility to adverse reactions from licorice. Some people experience negative symptoms within days, while others may ingest excessive licorice in candy, chewing gum, chewing tobacco, or herbal medicine for months or even years before they realize that they are suffering damaging effects.

Women appear to be somewhat more susceptible than men, and oral contraceptives may increase this sensitivity.

Possible Interactions

Licorice can greatly increase potassium loss due to medicines such as hydrochlorothiazide, Lasix, Hygroton, Lozol, Bumex, and other potassium-wasting diuretics.

Severe potassium loss greatly increases the risk of heart rhythm irregularities, especially in people taking Lanoxin. Amiloride, a potassium-sparing diuretic, is not recommended to counteract the potassium loss caused by licorice.

Because it binds to serum albumin, licorice may interact with other medications that bind to serum albumin as well: ibuprofen, aspirin, and Coumadin. The coumarins in licorice may also potentiate the action of this anticoagulant, possibly leading to unexpected bleeding.

Because of its impact on the thyroid gland, licorice may alter the required dose of levothyroxine (Synthroid, Levothroid, Levoxyl). Likewise, its impact on cortisol may alter the effectiveness and appropriate dose of cortisonelike drugs.

Aldactone (spironolactone) is likely to be affected by the action of licorice on aldosterone. Oral contraceptives may make women more vulnerable to hypertension, potassium loss, fluid retention, and other adverse effects of licorice.

Lemon Balm

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Lemon balm is originally a native of the Mediterranean area and western Asia, but it has long been popular in Western Europe, including England.

Lemon balm is frequently used as an attractive edible garnish, and it can be made into tea. The leaves give off a delightful lemony aroma when they are crushed or torn before the flowers appear, but the taste and odor are altered after flowering.

Lemon balm, which has also been referred to as bee balm, sweet balm, or common balm, is used as a remedy for mild insomnia or for digestive discomfort and gas.

It has traditionally been used in herbal mixtures to disguise less pleasant tastes and smells. This may have given melissa something of a reputation as a cure-all.

The leaves, picked before flowering, are the part of the plant that is used. A cream containing lemon balm extract is used to treat cold sores topically.

Active Ingredients

The leaves of lemon balm contain a relatively small, but variable, amount of essential oil.

Agricultural researchers in New Zealand grew plants with approximately 0.02 percent essential oil.

Lemon balm grown in Spain contains up to 0.8 percent essential oil. The European standard calls for at least 0.05 percent essential oil.

The composition of the oil itself is complex, with more than seventy ingredients. Notable constituents include citronellal, geranial (citral a), and neral (citral b), which together offer most of the characteristic aroma.

Other components include flavonoids, especially apigenin, kaempferol, luteolin, and quercetin. Rosmarinic acid constitutes between 4 and 5 percent of lemon balm leaves, and there are small amounts of caffeic and chlorogenic acids. Triterpene compounds include ursolic and oleanolic acids.

Uses

Lemon balm is taken internally (usually as a tea or infusion) primarily for relaxation. Thus, The PDR for Herbal Medicines declares it is used for "nervous agitation, sleeping problems, and functional gastrointestinal complaints with meteorism" [flatulence]. "Functional" problems are those attributed in part to psychological factors such as stress.

Lemon balm is known to stimulate the production of bile.

A lemon balm extract injected into mice had sedative properties in tests. Very low doses of the extract in combination with a dose of barbiturate too low to sedate a mouse resulted in sleep.

Lemon balm also extended the amount of time mice slept after being given a barbiturate. At high doses, the extract had a pain relieving effect.

In the test tube, lemon balm extract is active against herpes simplex virus, influenza viruses, Newcastle disease, and several other viruses.

It also appears to act as an antioxidant and free radical scavenger. These research results help support the folk use of lemon balm against colds and its modern use against cold sores.

A double-blind clinical trial showed that a 1 percent melissa cream was effective for the topical treatment of cold sores, significantly reducing the size within five days.

Test tube studies also demonstrated that the essential oil can prevent or reverse smooth muscle spasm such as guinea pig ileum or rabbit aorta. This would make it useful for treating stomach cramps or menstrual pain. Rosmarinic acid inhibits inflammation both in the test tube and in rat-paw tests.

Lemon balm lowers TSH levels in animals and has been used to treat Graves' disease (a condition in which the thyroid gland becomes hyperactive). Rosmarinic acid in lemon balm apparently binds to thyrotropin (TSH) and keeps it from connecting with the gland. This action is relatively weak, however.

Dose

The tea is made by pouring 1 cup of hot water over 2 g (about 2 teaspoons) of dried leaf, steeping five to ten minutes, and straining.

Two to three cups daily are usually consumed, and there is no limit on the duration of treatment.

For topical use, a 1 percent cream is applied to the spot from the first tingling hint of a cold sore until it heals, not more than two weeks.

Special Precautions

No studies have established the safety of lemon balm tea or extract for pregnant women and nursing mothers. Because of its antithyroid activity, it is not recommended.

People with thyroid conditions should use lemon balm only under medical supervision.

Adverse Effects

No side effects are reported in the literature.

Possible Interactions

Because of the animal research showing that lemon balm extract can potentiate barbiturate action, the herb should be used only with caution, if at all, in combination with sedatives such as Ambien or benzodiazepines as well as barbiturates such as Fiorinal.

Kava

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Kava (or kava-kava) has an important place in the cultures of many islands of the South Pacific. Traditionally, it was painstakingly prepared and consumed with great ceremony and considered a sacred drink.

It was also used to greet important visitors and in other ceremonial occasions, but elders in the community also drank it in the course of the day.

The name kava carries the meanings of "sour," "bitter," or "sharp," which may be some indication of the taste of the beverage.

Kava's pharmacological activity has led to its increasing popularity in the United States, where the Oceanic steps of chewing or pounding are eliminated, and it is taken in capsule form.

In the Pacific, kava is considered to reduce anxiety without dulling the mind. Oliver Sacks has described his experience in The Island of the Colorblind:

  The roots were all macerated now, their lactones emulsified; the pulp was placed on the sinewy, glistening hibiscus bark, which was twisted around it to form a long, closely wound roll. The roll was wrung tighter and tighter, and the sakau [Pohnpei for kava] exuded, viscous, reluctant, at its margins. This liquid was collected carefully in a coconut shell, and I was offered the first cup. Its appearance was nauseating-grey, slimy, turbid-but thinking of its spiritual effects, I emptied the cup. It went down easily, like an oyster, numbing my lips slightly as it did so...By the time it [the coconut shell] came back to me, the sakau was thinner. I was not wholly sorry, for a sense of such ease, such relaxation, had come on me that I felt I could not stand, I had to sink into a chair.

The part of the plant used is the rhizome. Human saliva makes the effects stronger, which is why traditional preparation techniques started with chewing.

Active Ingredients

A great deal of chemical research has been done on kava, but plants grown in different places appear to vary in composition.

The principal ingredients are alpha-pyrones: methysticin, kawain, dihydromethysticin (DHM), and yangonin, as well as derivatives of these compounds. There are also pigments.

The leaves contain an alkaloid, pipermethystine, which is found in only trace amounts in the roots. Kava alpha-pyrones do not work on the same pathways as narcotics, because the effects can't be blocked by naloxone.

Uses

Although Hawaiian healers used kava for dozens of purposes, there is no question that its use to induce relaxation is not culture-specific.

Tests on animals show that extracts of the drug-but no single identified compound-cause muscle relaxation to the point that animals fall out of revolving cages.

Methysticin and DHM protect animals from muscle convulsions due to strychnine.

Kava was used in Hawaii to reduce anxiety, bring on sleep, counteract fatigue, and treat asthma, arthritis pains, and urinary difficulties.

Kava appears to act as a diuretic, and the root was even used as a weight loss agent.

Medical tests suggest it may be helpful in treating psychosomatic symptoms in menopause.

Kawain acts as a local anesthetic, numbing the lips and mouth. Food eaten after ingesting kava drink cannot be tasted.

Dose

60 to 120 mg kava pyrone equivalent.

Clinically tested: 100 mg dry extract standardized to 70 mg kava lactones three times a day.

Kava should not be taken for more than three months except under a doctor's supervision.

Special Precautions

Kava is inappropriate for pregnant women and nursing mothers.

People with depression should avoid the use of kava.

Common sense dictates not driving or operating complex equipment while under the influence of a sedating plant such as kava.

Adverse Effects

Effects of kava depend on the dose. The mild euphoria produced by low doses does not interfere with the ability to walk in a straight line, run up stairs, or recall information. At higher doses, people may be unable to move about well.

Kava also affects vision by dilating the pupil and may interfere with visual accommodation. Gastrointestinal upset and allergic reactions, as well as a yellowish tint to the skin, have been reported.

Kava abuse has deleterious consequences. Those who take it daily to the point of intoxication may lose weight, develop a distinctive scaly rash, and have lower counts of albumin, protein, bilirubin, platelets, and lymphocytes in the blood.

In rare cases, shortness of breath, possibly indicating pulmonary hypertension, a serious complication, may develop.

Possible Interactions

Kava should never be mixed with alcohol. It can also interact in a dangerous way with other sedative drugs such as barbiturates.

People should not combine it with drugs such as Ativan, Valium, or Xanax. One man who did so actually went into a comalike state.

Combining kava with other sedative herbs, such as valerian, may not be wise.

Juniper

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This small evergreen is one of several juniper species native to the northern hemisphere. It has the distinction, however, of being the principal flavoring for a commonly used alcoholic beverage, gin.

The aromatic "berries" (actually cones of this evergreen) have also been used in herbal medicine for at least three hundred years and perhaps longer.

Apothecaries once used gin as juniper berries are used to treat kidney ailments. More recently, golden raisins soaked in gin have become popular as a home remedy for arthritis (see page 233).

Active Ingredients

Juniper berries contain up to 2 percent volatile oil and 10 percent resin.

The oil contains more than one hundred compounds including monoterpenes such as alpha- and beta-pinene, myrcene, limonene, sabinene, and an alcohol, terpinene-4-ol, which appears to be responsible for the diuretic properties attributed to juniper berries.

The berries also contain as much as 30 percent invert sugar and small amounts of catechins, flavonoids, and leucoanthocyanidins.

Uses

The traditional use of juniper is as a diuretic and to treat conditions of the bladder or kidneys. Diuretic action of the essential oil is well established and attributed to terpinene-4-ol, which increases the filtration rate of the kidney.

Water-based extracts such as tea may not increase urination, although such an extract did lower blood pressure 27 percent in an experiment in rats. At high doses, however, juniper berries or their extract can be very irritating to the kidney.

It is a component of a number of herbal diuretic mixtures available in Europe.

Another traditional use of juniper berries or their extract is to pique the appetite or to aid digestion.

Extracts apparently increase peristalsis and intestinal tone.

Juniper berries were traditionally classified as "carminative," meaning they can relieve flatulence. This use has not been carefully studied.

The Swedes traditionally used juniper berry extracts topically to treat wounds and inflamed joints.

Juniper tar has been used occasionally in combination with other plant tars to treat psoriasis of the scalp.

Test tube studies show that juniper berries can inhibit prostaglandin synthesis, which suggests that the traditional use for easing arthritis pain may have some scientific basis.

In addition, they apparently inhibit platelet-activating factor (PAF), which would discourage blood clots. This is not a traditional use for juniper berries in herbal medicine.

Juniper berry extract also has antioxidant activity.

Animal studies indicate that juniper berries lower blood sugar in experimentally induced diabetes. It has not been tested for this effect in humans.

Dose

The tea is made by pouring 2/3 cup boiling water over 2/3 teaspoon (2 g) of dried berries, steeping for ten minutes, and straining. This dose is repeated three or four times per day.

The best tea is made from berries rubbed through a sieve not more than one day prior to brewing.

For the tincture (1:5 in ethanol): 1 to 2 ml three times a day.

Juniper berries should be used for a maximum of four weeks except under medical supervision.

Special Precautions

Juniper berries can be irritating to the kidneys. People with kidney problems should avoid them.

Pregnant women should not use this herb. Juniper berries might cause uterine contractions; they prevent implantation in female animals.

Diabetics who choose to try this herb should exercise caution and monitor blood sugar carefully.

Juniper berries lower blood sugar in animals and might result in hypoglycemia.

Dried juniper berries should be kept in a tightly closed metal or glass container (not plastic) and away from light. A desiccant similar to the ones found in many vitamin bottles should be included if possible.

Adverse Effects

Juniper berries or essential oil may be irritating to the kidneys. If the urine begins to smell of violets, the dose is too high or the herb has been used for too long, and kidney damage is a danger.

At high doses or over long periods of time, juniper berries can cause digestive distress, blood in the urine, or irritability and jitteriness. A single large dose can cause diarrhea.

As a topical treatment for psoriasis, juniper tar may increase the risk of skin cancer.

People sometimes develop allergies to juniper pollen or juniper berries. Such allergies are more prevalent in those who handle these plant materials.

Possible Interactions

If juniper berries do turn out to lower blood sugar, they would interact with diabetes medicines such as DiaBeta or Glucotrol and possibly with insulin. Close monitoring of blood sugar is advised.

Because of its effect on PAF, juniper berries may interact with anticoagulants such as Coumadin and possibly with other anticlotting drugs such as aspirin, Plavix, or Ticlid to increase the risk of bleeding. We are not aware of any cases, so this possibility remains hypothetical.

Ginkgo biloba also inhibits PAF, so it might be ill-advised to mix these two botanical medicines.

Horse Chestnut

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Horse chestnut trees originated in northern India, the Caucasus, and northern Greece but have long been grown throughout Europe.

Relatives in the same genus grow in the United States as California buckeye (A. californica) and Ohio buckeye (A. glabra). The seeds of these plants are toxic, however.

Horse chestnut bark and leaves, as well as a standardized extract of the seed, are used in Europe.

Active Ingredients

Horse chestnut contains several triterpene glycosides, with aescin predominating in the seeds.

Coumarin glycosides aesculin, fraxin, and scopolin and their corresponding aglycones, aesculetin, fraxetin, and scopoletin, are also found, along with flavonoids such as quercetrin. Allantoin, leucocyanidins, tannins, and the plant sterols sitosterol, stigmasterol, and campesterol have also been identified.

The commercial horse chestnut extract utilized in Germany is standardized to contain from 16 to 21 percent triterpene glycosides (calculated as aescin).

Uses

In folk medicine, horse chestnut teas were used to treat diarrhea and hemorrhoids. Traditional uses for the tea also included arthritis and rheumatic pain and coughs.

It was applied to the skin to treat some sores and rashes. But although a component of the bark (aesculin) is used in sunscreens in Europe, this phytomedicine is rarely used for topical application now.

Standardized horse chestnut extract is considered a valuable aid in treating varicose veins. It inhibits the enzyme hyaluronidase and makes veins less permeable and less fragile. Horse chestnut can improve the tone of veins and increase the flow of blood through them.

Scientific studies (randomized double-blind, placebo-controlled) have shown that horse chestnut can reduce edema.

A clinical study compared horse chestnut extract to compression stockings and placebo for varicose veins. Both the herbal medicine and the stockings significantly reduced edema of the lower legs compared to placebo.

Feelings of tiredness and heaviness, pain, and swelling in the legs were alleviated by the extract, in comparison to placebo.

Horse chestnut extract also is reported to have anti-inflammatory activity.

Dose

Horse chestnut extract (delayed release) is given at a dose of 250 to 312.5 mg twice daily, providing 90 to 150 mg aescin. After improvement, the dose is reduced to 35 to 70 mg aescin daily.

Use for up to twelve weeks has been studied.

One standardized extract that has been studied in Europe is available in the United States under the name Venastat.

Special Precautions

Horse chestnut therapy should be supervised by a knowledgeable health professional due to possible toxicity.

Patients with varicose veins should continue to use the elastic stockings, compresses, or cold water soaks that their doctors recommend in addition to horse chestnut extract.

People with bleeding disorders should avoid horse chestnut. The coumarin glycoside aesculin can exert an anticlotting action.

Adverse Effects

Nausea and gastrointestinal upset have been reported, although they are not common. Itching or other signs of allergic reaction may occur, but serious allergy is uncommon.

Over the course of nearly three decades in Switzerland, horse chestnut use accounted for three reported cases of general allergy and two cases of life-threatening allergic shock.

One man developed liver damage while taking an herbal preparation containing horse chestnut.

Kidney damage has been reported very rarely.

Possible Interactions

The anticlotting action of aesculin may interact with anticoagulant drugs such as aspirin, Coumadin, Plavix, or Ticlid to increase the risk of bleeding. This combination should be avoided.

Hops

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Hops have been used to flavor beer for nearly a thousand years. This plant, a member of the same family as marijuana, is cultivated commercially in England, Germany, the Czech Republic, and the United States, as well as parts of South America and Australia.

The part of the plant used, the cone-like fruits (technically "strobiles") called hops, are harvested in September, at least in the northern hemisphere.

Early medicinal uses of hops came from observation of the pickers. They were said to tire quickly, so the plant was believed to have sedative activity.

The hops were sometimes placed in a pillow to improve sleep. In addition, they have been used to treat a variety of skin conditions.

Some of the folklore surrounding hops pickers suggests that the women are more interested in sex and the men less. This has been interpreted to suggest that hops may have estrogenic activity.

Active Ingredients

The bitter principle humulone is the most important ingredient in brewing beer.

Hops contain approximately 1 percent of a volatile oil and one hundred other compounds including several polyphenols, tannins, and flavonoids.

The specific composition differs from one variety of H. lupulus to another. Many of these compounds break down quickly when exposed to light or air.

Uses

Scientists have recently isolated an ingredient in hops that might account for their mild sedative properties. In Europe, many herbal medicines include hops in a combination designed to promote sleep or relieve anxiety and stress.

Hops extracts are also used to pep up the appetite and stimulate gastric juice secretion. The extracts can calm smooth muscle spasm, which would explain the traditional use of hops to treat intestinal cramps and menstrual pain.

Recent studies demonstrate that some chemicals in hops bind to estrogen receptors in the test tube.

Hops did not stimulate the growth of rat uterine tissue, though, and their use to treat symptoms of menopause has not been clinically verified.

In European folk medicine, a small bag of hops soaked in alcohol was placed on inflamed skin to relieve it. It is unclear whether there is any scientific basis for this practice.

Dose

The dose is 0.5 g before bedtime. This may be taken as part of a prepared herbal medicine, or made into a tea by pouring boiling water over a heaping teaspoon of the dried hops and steeping for ten to fifteen minutes before straining and drinking it.

Special Precautions

Estrogenlike compounds such as those in hops should be avoided during pregnancy.

Adverse Effects

Some people develop contact dermatitis (itchy rash) when exposed to hops.

Possible Interactions

Extract of hops can increase the amount of time a mouse sleeps after being given a barbiturate.

Although the effect of hops is mild, combining this herb with a sleeping pill or antianxiety drug could result in more sedation than expected.

Until the estrogenic activity of hops is further studied, taking this herb in combination with medicines such as oral contraceptives or hormone replacement therapy is an experiment best avoided.

Hawthorn

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Hawthorn is a small thorny tree with white flowers and red berries that grows in England and throughout Europe. C. laevigata is only one species; related species have slightly different chemical profiles but similar medicinal uses.

Although hawthorn was known and used by the Greek physician Dioscorides, it became popular in Europe and the United States toward the end of the nineteenth century.

In countries such as Germany where doctors prescribe herbs and supervise their use, hawthorn is widely employed to treat angina and the early stages of congestive heart failure (New York Heart Association grades I and II).

In the United States, with herbs being utilized primarily as home remedies, hawthorn has been much less well known. Cardiac insufficiency of any degree is not generally considered amenable to hit-or-miss self-treatment, so anyone who chooses to use hawthorn should be monitored carefully.

The portions of the plant used are the leaves, flowers, and berries (haws), standardized for their procyanidin content.

Active Ingredients

Hawthorn flowers, leaves and berries contain from 1 to 3 percent of compounds called oligomeric procyanidins, also called pycnogenols or leucoanthocyanidins.

There are also flavonoids making up about 1 or 2 percent of the herb. The flowers and fruits are richest in total flavonoids and also contain the most hyperoside.

Leaves of C. monogyna also contain measurable amounts of vitexin-rhamnoside. Rutin, other flavonoids, and glycosylflavones are found in much smaller quantities.

Other components include purines, sterols, and amines, some of which may stimulate the heart. In addition, there are orientin glycosides, cyanogenetic glycosides, and saponins.

Uses

Hawthorn dilates blood vessels. This activity helps lower blood pressure, and because it also dilates the coronary vessels, the likelihood of angina is reduced.

Hawthorn does not act quickly enough to be useful once an episode of angina has begun. A separate effect on the heart develops quite slowly, but is favorable, like a mild "heart tonic."

Animal studies suggest that hawthorn extracts can also reduce cholesteroland triglyceride levels . It may also have a normalizing effect on blood sugar, although it is not considered appropriate for treating diabetes.

In Germany it is prescribed for certain irregular heart rhythms and is a component in some geriatric tonics intended for aging hearts that do not yet require digitalis.

Hawthorn extract inhibits thromboxane production (so it might be expected to reduce the risk of blood clots) and also has antioxidant properties.

Dose

The daily dose ranges from 160 mg to 900 mg of hawthorn extract, supplying from 4 to 20 mg of flavonoids (standardized) and 30 to 160 mg of oligomeric procyanidins.

The minimum daily dose should supply 5 mg of flavones (calculated as hyperoside), 10 mg of total flavonoids (again, calculated as hyperoside), or 5 mg of oligomeric procyanidins (calculated as epicatechin).

If the leaves and flowers themselves are used rather than a standardized extract, a tea is made by pouring 2/3 cup of boiling water over a teaspoonful of herb, steeping for twenty minutes, and straining. Two cups a day of such a tea constitutes a usual dose.

The dried herb must be stored in a tightly closed container away from light to preserve its potency.

A treatment period of six weeks is necessary to determine whether hawthorn is having the desired effect. The supervising physician should adjust the dosage as needed.

Special Precautions

There have been inadequate studies to establish that hawthorn is safe for pregnant and nursing mothers; indeed, the extract can reduce uterine tone and should be avoided during pregnancy.

People with serious heart problems and those on other heart or blood pressure medicines should consult their physicians before starting to take hawthorn.

People taking hawthorn must have their blood pressure and heart function monitored.

Adverse Effects

At normal doses, no side effects have been reported. At very high doses, animals become sedated, and people might experience symptoms of low blood pressure, such as dizziness.

Possible Interactions

Hawthorn extracts may increase the activity (but not necessarily the toxicity) of other cardiac tonics such as digitalis. It is not recommended for people whose heart condition is serious enough that they need Lanoxin or other digoxin medications.

Although no other interactions have been reported, prudence suggests caution if hawthorn is to be combined with other heart or blood pressure drugs (such as nitrates or calcium channel blockers).

Since hawthorn inhibits thromboxane synthesis, it may be incompatible with aspirin, which has a similar action. If hawthorn extract is taken together with anticoagulants such as Coumadin, careful monitoring of bleeding time (through PT and INR) is essential. Please discuss these possible interactions with your physician.

Guggul

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Guggul (Goo-gall) is a resin from a tree native to India. This resin has long been used in Ayurvedic medicine, which combined it with other plant products to cleanse and rejuvenate the body, especially the blood vessels and the joints. It was also used for sore throats and digestive complaints.

In Chinese medicine, guggul is known as mo yao and is used to activate blood flow, relieve pain, and speed recovery.

A resin from a related tree, C. myrrha, is the myrrh mentioned in the Bible as one of the gifts the wise men from the East brought to the infant Jesus.

Guggul (also spelled gugul, gugulu, or guggal) is now coming to attention in the United States because of its reputation for lowering cholesterol.

Ayurvedic practitioners probably didn't even know what cholesterol was, much less care about lowering it. But it appears that the resin they used to cleanse blood vessels may indeed have benefit for Westerners with elevated blood lipids.

The greenish resin is harvested in the winter.

Active Ingredients

Guggul contains essential oils, myrcene, Z and E guggulsterones, alpha-camphorene, various other guggulsterones, and makulol.

The Z and E guggulsterones, extracted with ethyl acetate, are the constituents that appear to be responsible for lowering blood lipids.

Uses

Animal studies suggest that guggulsterones can increase the liver's ability to bind "bad" LDL cholesterol, thus taking it out of circulation. Animals given guggul extract and a high-fat, plaque-producing diet had lower blood fats and developed less atherosclerosis than animals given the diet alone.

In some of this research, a combination of guggul and garlic worked better than guggul by itself.

In humans, three months of guggul treatment resulted in lower levels of total cholesterol (average 24 percent) and serum triglycerides (average 23 percent reduction) in the majority of patients.

A double-blind trial comparing guggul to the cholesterol-lowering drug clofibrate found that the two treatments were very similar in their ability to lower total cholesterol (11 percent by gugulipid, 10 percent by clofibrate) and triglycerides (17 percent by gugulipid, 22 percent by clofibrate).

HDL ("good") cholesterol was also altered by gugulipid, increasing in 60 percent of patients, while clofibrate did not have any effect on HDL. Raising HDL and lowering total cholesterol improves the ratio of these blood fats.

Two other placebo-controlled trials in India confirm that guggul can lower total cholesterol and raise HDL.

Guggulsterones are reported to stimulate the thyroid, which might tend to have a beneficial effect on cholesterol for people with underactive thyroid glands.

Guggul also protects the heart: In animals challenged with drugs that damage heart tissue, cardiac enzymes did not change significantly when the experimental animals were pretreated with guggul.

Guggul has also demonstrated anti-inflammatory activity in rats.

Some reports suggest that it helps keep platelets from clumping together to start a blood clot, that it can help break up blood clots (fibrinolytic activity), and that it is an antioxidant.

Dose

The normal dose is one 500-mg tablet, standardized to 25 mg guggulsterones, three times daily.

Measurable changes should be apparent within four weeks for people who will benefit.

Special Precautions

The biggest difficulty in using guggul is said to be finding a reliable standardized product. Quality is quite variable.

Because guggul is reported to stimulate the thyroid, it makes sense to monitor thyroid hormones in people using guggul for long-term treatment.

People with liver problems should use guggul only under the supervision of a physician willing to monitor liver enzymes.

Guggul may not be appropriate for people with chronic diarrhea.

Adverse Effects

Some people in the clinical trials reported mild digestive upset.

There are no other reports of side effects, although increased thyroid gland activity could presumably lead to complications such as nervousness, weakness, palpitations, or eye problems.

Possible Interactions

No drug interactions have been reported.

In theory, guggul might counteract thyroid-suppressing drugs or increase the effect of thyroid hormones such as Synthroid or Levoxyl. Monitoring of thyroid function is prudent.

No interactions with cholesterol-lowering drugs have been observed, but they might be possible. People who use guggul together with cholesterol medications should be monitored carefully by their physician.

Green Tea

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Until a few years ago, tea might have seemed more appropriately addressed in a cookbook than in a book about herbs. This beverage is probably the most frequently consumed in the world after plain water.

To be sure, it has the requisite ancient history, with its use going back more than three thousand years in China. Along with many other Chinese botanical medicines, it was discussed in The Herbal Classic of the Divine Plowman.

A few centuries later, Chinese Buddhists espoused tea because it could help the devout stay awake during long meditations, and Taoists adopted it because it was believed to promote health and longevity. But in the West, tea was more often thought of as simply a soothing hot drink, and it was far more likely to be black tea than green.

Recent research has shown that the Buddhists and the Taoists may have been right. Green tea in particular appears to have certain health benefits.

Green and black tea come from the same plant, but the fermentation process required to turn tea black appears to alter the chemistry of the leaf somewhat. Oolong tea is produced by means of a partial fermentation process.

Although green, oolong, and black are the principal categories for tea, the Chinese classify it in a much more complex fashion, with as many as 330 kinds of tea (cha) recognized. In a typical store offering tea in China, the inventory might include one hundred types of cha.

Active Ingredients

The methylxanthine alkaloids caffeine, theophylline, and theobromine comprise between 1 and 5 percent of tea. These compounds have similar but not identical actions; caffeine is usually the dominant one.

Depending on the variety of tea and the way it was prepared, a cup (a proper six-ounce teacup) may contain from 10 to 50 mg of caffeine.

Low doses of caffeine may actually slow heart rate slightly, while at higher doses this stimulant can speed heart rate or even contribute to mild rhythm abnormalities.

Green tea, like black tea, is rich in tannins. Tannic acids make up 9 to 20 percent of the leaves.

Flavonoids including apigenin, kaempferol, myricetin, and quercetin have also been identified, but at low concentrations. Some flavonoids unique to black tea are theaflavins, theasinensins, thearubigens, and theacitrins.

Another set of flavonoids has been intensively studied recently. These polyphenols (catechins) are not vitamins, but they seem to have strong antioxidant properties.

Epigallocatechin-3-gallate (EGCG) in particular has been identified as capable of protecting experimental animals from radiation damage and possibly reducing the risk of cancer.

Green tea is especially rich in EGCG. With fermentation, many of the polyphenols are oxidized. This alters the composition of black tea in comparison to green tea (which is very similar in composition to the fresh leaves).

Tea appears to concentrate certain minerals in its leaves. Both fluoride and aluminum can be detected.

Uses

Current interest in green tea in the United States has focused mainly on its cancer preventive properties rather than on its flavor, which may be an acquired taste.

Japanese researchers were the first to report that people living in an area where green tea was an important crop were only half or even a fifth as likely to develop cancer as those in an area that did not grow tea.

There seems to be an inverse relationship between drinking tea and developing cancer of the digestive tract or urinary system. One recent epidemiological study in Japan showed that men who drank ten or more cups of green tea daily had a significantly lower risk of lung, liver, colon, or stomach cancer.

EGCG seems to be responsible in large measure for inhibiting the growth of cancer cells and mopping up free radicals that can damage healthy cells.

It also appears to work on the heterocyclic amines that form when meat, poultry, or fish is grilled and keeps them from initiating cancerous changes.

One Chinese study suggests that green tea can counteract the cancer-promoting effects of female hormones on breast tissue. Further research on this possibility is needed.

The polyphenols in green tea are thought to be responsible for its chemopreventive activity. Curcumin seems to act synergistically with green tea in preventing mutations and tumor development.

EGCG also has antibacterial and antiviral activity and stimulates the immune system to produce interleukin-1 and tumor necrosis factor. These and possibly other actions may explain the capacity of EGCG to reduce periodontitis, and this in turn may explain how green tea helps minimize bad breath.

The fluoride found in tea leaves may help explain why tea drinkers are less prone to dental caries. Tea can stain dental enamel, however.

Green tea drinkers are reported to have lower total cholesterol than those who do not imbibe. A special type of tea, Tao Cha, is associated with this benefit and is used in China to treat elevated cholesterol.

More recent research has cast some doubt on this finding, however. In Japan, where the first studies were undertaken, men who drink green tea are more likely to eat a traditional Japanese diet low in fat, while in Norway and Israel, people who choose tea are not drinking unfiltered coffee, a beverage that can elevate cholesterol levels.

Prospective trials have not shown that tea lowers blood lipids. Because tea discourages oxidation of low-density lipoprotein, however, it may help protect against atherosclerosis.

Both green tea and Earl Grey counteracted platelet clumping and prevented coronary blood clots in a dog experiment, but scientists have not been able to demonstrate any anti-platelet effect in humans.

Topical application of EGCG from green tea in animal experiments stopped the development of skin cancer after exposure to a carcinogenic chemical.

Polyphenols from green tea can also protect skin from ultraviolet radiation (UV-B) damage, acting essentially as a natural sunscreen.

Because of its high tannin content, tea has traditionally been used to treat mild diarrhea.

The caffeine content in tea has a stimulant effect on the brain and can increase alertness.

The theophylline content can aid bronchodilation in mild cases of asthma, and the astringent properties of the beverage, applied topically, have been used in China for skin problems.

Dose

There is very little information on a desirable dose of green tea. Approximately 2 g of tea is used with 250 ml of boiling water.

To treat diarrhea, the solution steeps for ten minutes to extract the most tannins. Two to three cups daily are appropriate.

Caffeine dissolves rather quickly in hot water, within approximately two minutes, and one cup can have a stimulant effect.

Large doses of green tea, up to nine or ten cups daily, were associated with cardiovascular benefit in the early epidemiological studies. These results have not been confirmed.

Daily use of green tea by much of the population in China and Japan suggests that no strict time limits on administration need be observed.

Special Precautions

You really have to drink a lot of green tea to get into trouble.

High doses of caffeine have been linked to infertility and birth defects. Large amounts of green tea are therefore not recommended for pregnant women or those attempting to conceive. Caffeine is detectable in breast milk after the mother consumes a caffeine-containing beverage.

The diuretic effects of caffeine and theophylline may put a strain on kidneys with pre-existing problems.

People with ulcers, heart rhythm problems, and clinical anxiety disorders should minimize their intake of caffeine.

Adverse Effects

People who drink excessive amounts of green tea may get too much caffeine. High concentrations of caffeine (hard to achieve with moderate green tea intake) can result in rapid heart rate or altered heart rhythm (PVC), excess fluid elimination, jitteriness, and insomnia.

Chronic use of caffeine can lead to symptoms of headache, sluggishness, and irritability upon withdrawal. Withdrawal has been reported in people who stop drinking as little as two or three cups of coffee daily and therefore might be anticipated in people who suddenly stop drinking many cups of green tea (five or six daily).

Possible Interactions

The tannins in tea can interfere with the absorption of non-heme iron (iron supplements, for example) taken at the same time. Milk added to black tea can reduce the binding capacity of tannins. (Milk is rarely if ever added to green tea.)

Caffeine (65 mg) can increase the analgesic effects of aspirin or acetaminophen.

Antibiotics such as Cipro, Noroxin, or Penetrex, and the ulcer drug Tagamet (cimetidine) can increase the stimulant effects of caffeine. Combining tea with a medication containing theophylline or caffeine could result in too much caffeine and resulting nervousness or insomnia.

Grapeseed

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Seeds of the fruit of the vine, once discarded as waste after the juice was pressed out for wine, have become the source of a popular dietary supplement.

Grapes were first cultivated near the Caspian Sea, and their use as food and drink had spread throughout the Mediterranean world before the Bible was written.

The ancient Greeks believed that wine had wonderful health benefits, and modern science has confirmed that wine has many useful properties. While the benefits of wine may be tarnished by the devastation associated with alcohol abuse, the positive aspects of grape seeds have no such liability.

The French have published much of the research on grape seed extract, but ironically grape seeds were a "second choice." Manufacturers turned to using grape seeds only when peanut skins became unavailable.

Most of the high-quality grape seed extract sold in the United States is manufactured by an Italian company called Indena.

Active Ingredients

The oil pressed from grape seeds contains a number of essential fatty acids and is rich in vitamin E compounds.

The most interesting constituents of grape seeds are the polyphenols (catechins). These tannin compounds, also called procyanidins, leucoanthocyanins, pycnogenols, or oligomeric proanthocyanidins (OPC), are powerful antioxidants. Commercial extracts are generally standardized for OPC content.

Grape leaves and presumably seeds also contain flavonoids, and the skin and seeds are the source of several recently identified compounds known as 5-nucleotidase inhibitors.

Uses

Grape seed oil can be used for cooking. It has an unobtrusive flavor and a high smoking point and is rich in omega-6 fatty acids.

Grape seed extract is used in Europe to improve circulation. It prevents oxidation of blood fats and inhibits enzymes that break down the proteins that make up blood vessels.

Grape seed is believed to benefit cardiac and cerebral circulation. In animals it reduces capillary permeability and presumably has similar activity in humans.

Capillaries may be fragile due to diabetes or other disorders. In four small studies, grape seed extract was better than placebo at improving peripheral circulation as well, resulting in less pain and swelling, fewer nighttime cramps, and less numbness and tingling.

Studies have shown that grape seed extract may slow macular degeneration, improve vision stressed by computer screens or glare, and reduce myopia. Although further research is needed, the results have been promising.

In test tube research grape seed polyphenols stop the growth of Streptococcus mutans, a bacteria that causes tooth decay. They also slow the conversion of sucrose (table sugar) into glucan, and as a consequence of both these actions, grape seed may have a role in maintaining dental health.

Another potential benefit of grape seed extract is anti-inflammatory activity.

Dose

Usual dose for general health maintenance ranges from 50 to 100 mg daily.

To treat illness, doses from 150 to 300 mg per day are recommended.

Special Precautions

No special precautions have been noted.

Adverse Effects

Animal studies indicate that some of the polyphenols are toxic to the liver; other constituents appear to be hepatoprotective, preventing liver damage due to carbon tetrachloride in mice. There are no data that permit evaluation of these effects in humans.

Possible Interactions

Grape seed extract is fairly high in tannin. It might be prudent not to take this herb at the same time as iron supplements, although no interactions have been documented.

Gotu Kola

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This Asian species is reputed to bring long life to the user. According to the Sinhalese proverb: "Two leaves a day will keep old age away."

As the story goes, people in Sri Lanka noticed that elephants, animals known for their longevity, included Centella leaves in their diet. Extrapolation suggested that this creeping herb of Southeast Asian swamps might be good for almost anything that could ail a human, as well.

In Sri Lanka it is eaten as a salad, and in Vietnam it is considered an edible weed. It has been part of Ayurvedic medicine for a long time.

C. asiatica also grows in Madagascar, parts of southern Africa, and some parts of China. In Chinese medicine, it is known as luo de da or ji xue cao and is used to lower fever, promote urination, and "detoxify" the body.

The leaves and other aboveground parts of the plant are used.

Active Ingredients

C. asiatica contains several saponins, including brahmoside and brahminoside, and a number of alkaloids.

Madecassoside and asiaticoside appear to contribute to the plant's medicinal activity. It also contains flavonols, amino acids, fatty acids, sterols, saccharides, and some mineral salts.

Uses

Gotu kola is traditionally used for high blood pressure and to treat nervous disorders.

Chinese research suggests that it slows heart rate as well as lowers blood pressure. It also has some antibacterial activity.

Gotu kola extract (as titrated extract of C. asiatica, or TECA) has been studied for its effect on varicose veins as well as on poor venous circulation in the legs.

The results suggest that the extract can stimulate the synthesis of collagen in the walls of the veins and help them hold their tone and function better.

Other traditional uses of C. asiatica include skin problems, rheumatism, jaundice, and fever. Tests of TECA in animals showed that topical application helped experimental wounds heal faster. Asiaticoside may be responsible.

TECA has also been observed in clinical settings, where it appears to speed healing of surgical incisions and skin ulcers. In one trial it was administered to patients with parasitic infections that damage the bladder. Three-fourths of these patients recovered well, with little or no bladder scarring.

Tantalizing test tube research suggests that a Centella extract can destroy cultured cancer cells. It is far too soon, however, to determine whether it will be useful as an anticancer agent. Animal and eventually clinical studies will be needed.

Madecassoside has anti-inflammatory properties. In a small French study, a few patients with chronic liver disease had measurable improvement while using TECA. The majority of the patients in this group did not benefit, however.

High doses of the extract have a sedative effect on small animals.

Animal research also indicates that some gotu kola constituents can reduce fertility. Although the plant has a reputation as an aphrodisiac, no research supports this use.

Dose

Beyond the proverbial two fresh leaves a day, dosage information is limited.

The usual dose is 0.5 to 1 g three times a day.

The tea is made by pouring 1 cup of boiling water over teaspoon of dried leaves and steeping for ten minutes.

Standardized extract: 60 to 120 mg per day.

Fluid extract (1:1): 2 to 4 ml daily.

C. asiatica should not be used for more than six weeks consecutively.

Special Precautions

Pregnant women should avoid using this plant.

This herb is not appropriate for people with epilepsy.

Because of the possibility of photosensitivity, fair-skinned people and those who have reacted badly to sunlight while taking other medications should avoid sunshine, tanning lamps, and other sources of ultraviolet light while taking gotu kola.

Adverse Effects

Few side effects have been reported.

Contact dermatitis (skin rash) has occurred in some people using TECA topically.

Others, receiving the extract as a subcutaneous injection, developed pain and discoloration at the injection site. At least one person ingesting gotu kola experienced rash over the entire body.

This plant may make susceptible people more sensitive to sunburn and sun damage.

One component of C. asiatica, asiaticoside, may be a skin carcinogen.

Repeated topical application of the extract is not recommended.

Possible Interactions

At high doses, C. asiatica may interfere with oral diabetes medicines.

Gotu kola may raise cholesterol levels and should not be combined with cholesterol-lowering medications such as Lipitor, Lopid, Mevacor, niacin, or Zocor.

It is not known if the sedative effects of gotu kola are synergistic with those of other agents that promote sleep or reduce anxiety. It would be best not to mix C. asiatica with alcohol or drugs such as Ativan, Valium, or Xanax until this is determined.

Goldenseal

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This perennial plant grows wild in wooded areas of North America, from New England to the southern Appalachians, and west to Arkansas and Minnesota. The Cherokee and the Iroquois had many medicinal uses for goldenseal.

Settlers learned some of these traditions, but surprisingly little research has been conducted on the plant (once called yellow root, ground raspberry, or Indian dye). It was a popular ingredient in patent medicines, branded mixtures often sold by traveling medicine shows, after the Civil War.

The use of goldenseal is controversial because the plant has become rare in many areas where it once grew abundantly. "Boom and bust" cycles of goldenseal growth and collection were noted by wildcrafters as long ago as the late nineteenth century, and they continue to this day.

The situation may be more acute at the end of the twentieth century, however, and goldenseal has been listed in the Convention on International Trade in Endangered Species (CITES). It has been suggested that this regulatory action may have actually been an overreaction to a predictable cyclical shortage rather than a true population decline.

The current popularity of goldenseal (which was the fourth most widely sold herb in natural food outlets in 1997) suggests, however, that there may be a potential for overexploitation of this native herb, justifying CITES protection and conservation efforts.

The part of the plant used is the bitter-tasting rhizome ("root").

Goldenseal is frequently sold in combination with echinacea as a nonspecific immune booster. It is unclear whether such a combination is more effective than either herb alone.

Marcey Shapiro, M.D., has suggested that in most cases the benefits of goldenseal might be better gained by using other plants with similar constituents, such as Oregon grape, barberry, and gold thread.

Active Ingredients

The principal components of goldenseal thought to be responsible for its physiological actions are the alkaloids hydrastine (present at concentrations from 2 to 4 percent) and berberine (from 2 or 3 up to as much as 6 percent).

Other alkaloids found in lower concentrations include canadine and hydrastanine.

Uses

Goldenseal root has a reputation for being a "natural antibiotic." Native American groups used it topically for inflammation, and it has been used in folk medicine as an eyewash and a rinse or gargle to relieve sore mouth, sore throat, canker sores, or thrush.

No clinical studies confirm its effectiveness for these purposes.

Several Indian tribes used it for digestive disorders, and berberine has proved effective in treating diarrhea due to toxic pathogens such as cholera.

In another study, it was more helpful than placebo against giardia infections in children.

Hydrastine and berberine lower blood pressure when injected into laboratory animals. Berberine can increase the secretion of bile, and canadine is reported to trigger uterine contractions.

In mice, goldenseal ingredients increase blood flow to the spleen and stimulate the activity of macrophages, blood cells that are an important part of the immune system.

This herb is sometimes used as an "alternative medicine" for strep or sinus infections.

It has been considered for the treatment of certain cancers or HIV, but these uses are still experimental.

Goldenseal's reputation for masking illegal drugs in the urine is completely undeserved. This property is extrapolated from a mystery novel written by an herbal product manufacturer, John Uri Lloyd, at the turn of the century.

His plot called for goldenseal to be confounded with the poison strychnine, but the leap to using the herb to avoid detection of drugs in the urine is itself a creative work of fiction.

Dose

250 to 500 mg two or three times a day, for up to three weeks.

Special Precautions

Pregnant women should avoid goldenseal because of evidence that it can stimulate uterine contractions in animals.

It is inappropriate for newborn babies.

People with heart conditions, bleeding abnormalities, and epilepsy are advised to avoid goldenseal because of its potential to cause serious adverse reactions.

Despite its history as an eyewash, goldenseal solution should not be placed in the eyes.

Adverse Effects

References disagree strongly about the toxicity of this herb. Some published reports caution that long-term use or high doses can result in serious consequences including vomiting, diarrhea, agitation, seizures, hallucinations, uterine contractions, and difficulty breathing.

It has been reported to irritate the mouth, but Steven Foster suggests that such warnings are due to a misinterpretation of a nineteenth-century text on homeopathy. Considering that there is such uncertainty about the severity of potential side effects, it is wise to avoid high doses or prolonged administration.

Ginseng

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Ginseng has been used for more than two millennia in China, where the earliest written description of its use appeared in a medical book written during the Han dynasty, before a.d. 100.

At that time, the expert recommended it for "repairing the five viscera, quietening the spirit, curbing the emotion, stopping agitation, removing noxious influence, brightening the eyes, enlightening the mind, and increasing the wisdom."

It has been a favorite tonic in China ever since then. In 1714, Père Jartoux, a Jesuit missionary who had spent time in Beijing, predicted that "any European who understands pharmacy" would be able to study its chemistry and adapt it as an excellent medicine.

Although the chemistry has been studied, the pharmacology is complicated and elusive. European science still has not been able to explain why the Chinese treasure it so much. Much of the research seems to yield contradictory results.

Traditional Chinese medicine uses a completely different theoretical system. There ginseng is understood as a yang tonic that can increase strength, promote life and appetite, and overcome general debility, blocked qi (pronounced chee), and impotence.

There are several species of ginseng as well as different preparations that strongly influence the quality of the herb.

American ginseng (Panax quinquefolius) is prized in Asia because it is sweeter tasting (rather than sweet-bitter like Panax ginseng) and is considered more yin (cooler) in nature. Panax notoginseng, or sanchi ginseng, is a dwarf variety that is sometimes substituted.

Regardless of species, the part of the plant used is the root. It should be collected in autumn from a plant five or six years old.

Ginseng root may be fresh (preferably at least six years old), "white" ginseng root prepared by simple drying, or red ginseng root prepared by steaming first prior to drying.

Processing methods alter the composition of the final product.

With ginseng drawing prices as high as $500 per wild-crafted root, it is little wonder that adulteration is a concern. Ginseng has become increasingly popular in the United States, with six million people taking it, but some ginseng products on the American market contain very little verifiable ginseng activity.

The American Botanical Council has undertaken a study of many proprietary products and found significant differences among them.

Active Ingredients

Ginseng is full of saponins termed ginsenosides. Approximately thirty of these compounds have been identified, and they appear to be responsible for most of the activity of ginseng. Their chemical structures are similar to those of steroids such as testosterone and estrogen.

The picture is complex, however. Not only do the various species and forms of ginseng have different ginsenoside profiles, the ginsenosides themselves have differing and sometimes opposing actions.

Ginsenoside Rb1, for example, seems to lead to sedation and lower blood pressure, while ginsenoside Rg1 acts as a stimulant and raises blood pressure.

These distinct pharmacological activities and the variation in composition from one piece of ginseng root to another, depending on variety, growing conditions, and processing, probably explain why research results on ginseng are inconsistent. Some commercial products are standardized to 4 percent ginsenosides and others to 7 percent.

Other ingredients of ginseng root may also have important activity. They include essential oil, phytosterol, carbohydrates, amino acids, peptides, vitamins, minerals, and some other ingredients.

Nonsaponin constituents appear to be responsible for the ability of Korean red ginseng root to lower blood sugar in diabetics.

Still other compounds may be responsible for ginseng's apparent ability to stimulate nitric oxide formation, which may explain certain other of its traditional actions, including its reputed ability to help combat impotence.

Uses

The most common use of ginseng in Chinese medicine was (and perhaps still is) as a general tonic, and scientists have devoted a certain amount of effort to studying ginseng as an "adaptogen."

This category, which doesn"t correspond to any widely used pharmaceuticals, implies that ginseng is helpful in counteracting stress.

Indeed, some researchers believe that the benefits of an adaptogen are apparent only when the organism has been stressed to its limits. Despite this, in a well-designed placebo-controlled study, ginseng ingestion for up to ninety-six days did not protect rats exposed to a highly stressful situation, having to swim in cold water.

In animals, ginseng is sedative at low doses and a stimulant at high doses. To some extent this is related to the effects of the different ginsenosides.

Ginsenoside Rb1has a sedative effect and lowers blood pressure. It also has anticonvulsant and analgesic activity, lowers fever and has some anti-inflammatory action.

Ginsenoside Rg1, on the other hand, is a stimulant and raises blood pressure at low doses, while at higher doses it has more sedative activity. At stimulant doses it can also aggravate ulcers and accelerates learning in animals.

Some studies of humans have shown that ginseng standardized extracts can help people react more quickly to both visual and auditory cues, increase concentration, and improve hand-eye coordination. Not all studies have reached similar conclusions.

Ginseng can change body biochemistry, and a careful study of fifty male physical education teachers demonstrated that they were able to do significantly more work (defined in kilogram-meters) after ginseng administration than after placebo.

Maximum oxygen uptake was higher. Holding workload constant, the teachers consumed less oxygen, produced less lactate in their muscles, and had lower heart rates when they had been given ginseng.

A number of other studies have also found that ginseng increased aerobic capacity, reduced lactate levels in the blood, and lowered heart rate during exercise. Many of these studies, however, did not include placebo controls.

Animal studies demonstrate that ginseng extracts can have a protective effect when used to pretreat small mammals undergoing radiation.

Italian pharmacologists have found that pretreatment with a standard ginseng extract (G115) significantly improved immune response to vaccination against influenza compared to placebo pretreatment.

Some glycosides found in red ginseng appear to act as antioxidants. This property might be the foundation for the anticancer effect seen in one study of mice exposed to cancer-causing chemicals.

Those who were given extract of six-year-old red ginseng in their drinking water developed significantly fewer lung tumors after injection with benzo(a)pyrene, a strong carcinogen. Fresh four-year-old ginseng was not protective.

An epidemiological study in Korea suggested that people who use ginseng regularly may be less likely to come down with cancer, but further studies are needed.

Ginseng is reported to lower cholesterol, presumably by accelerating its metabolism and removal from the body. Studies in chickens indicate that low-density lipoprotein (sometimes termed "bad cholesterol") is especially affected.

Ginsenoside Rg2 can keep blood platelets from aggregating, and ginsenoside Ro prevents fibrinogen from being converted to fibrin, an important clotting factor.

At least one active ginseng component inhibits thromboxane and thus might contribute to an anticoagulant effect.

In animals, extracts of Korean red ginseng have helped to control diabetes. One double-blind Finnish study considered the effects of ginseng extract on newly diagnosed human diabetics (non-insulin-dependent).

The investigators found that ginseng improved patients' mood and increased their sense of well-being. People taking ginseng, but not those on placebo treatment, had lower fasting blood glucose and more normal glycosylated hemoglobin levels. Further studies in this field are needed.

Dose

Dose varies depending on the preparation used. A tea may be prepared from teaspoon of dried root (1.75 gm) taken once or, at most, twice daily.

Studies have used doses of 100, 200, 250, or 500 mg of various extract preparations. If there are dosing instructions on the label, they should be followed.

Traditionally, ginseng root is used for extended periods. Some authorities recommend three to four weeks; others specify up to three months.

One standardized product, Ginsana, is the extract G115 that has been used in a number of studies.

Special Precautions

Although ginseng is considered appropriate for pregnant women and newborn babies in many Asian cultures, too little information is available to determine if it is safe.

Because of the research showing that ginseng can lower blood sugar, diabetics should carefully monitor blood sugar while taking ginseng.

Adverse Effects

Ginseng appears to be extremely safe. More than six million Americans take it, not to mention uncounted Chinese people over the centuries, and very few appear to have had any trouble. Insomnia has been a side effect in some of the placebo-controlled studies. In many studies no side effects are reported.

Other side effects are controversial. Too often, the identity and purity of the herbal product are not determined, or there may be confounding factors.

One death is attributed to a ginseng product contaminated with ma huang (ephedra). One survey found that people using large doses of ginseng for two years or more complained of diarrhea, sleeplessness, nervousness, high blood pressure, and skin problems, although they maintained that ginseng use made them more alert and better able to cope.

Many of them were also taking high doses of caffeine and other substances, so it is not possible to sort out whether any of these side effects are truly due to ginseng overdose.

One brief report from Paris concerned a law student who developed a sore throat and took antibiotics for several days. Then, with final exams looming, he turned to ginseng as he would have in his native China.

Within a week he had developed a serious skin reaction known as Stevens-Johnson syndrome and had to be hospitalized. Stevens-Johnson syndrome is sometimes lethal. Fortunately, he recovered completely within thirty days.

The doctors who treated him did not have the ginseng preparation analyzed, but they speculated that it might have been adulterated with a nonsteroidal anti-inflammatory drug that could have been responsible for the reaction. They did not consider the antibiotics a potential trigger, although Stevens-Johnson syndrome is a rare but established reaction to some antibiotics.

It is prudent to stop ginseng and seek medical attention if a rash or major skin redness develops while taking the herb.

Other side effects that have cropped up in ginseng users are breast pain in one woman and vaginal bleeding in another woman seventy-two years of age.

Possible Interactions

Despite research suggesting that ginseng might reduce platelet aggregation, the only reported interaction with Coumadin resulted in a decreased INR (a measure of blood's propensity to clot).

This suggests that ginseng may counteract Coumadin's benefit. People taking this or other anticoagulant medications such as aspirin, Plavix, or Ticlid should exercise caution or avoid taking ginseng. Please discuss your use of ginseng with your physician.

Another potential drug interaction involved a Spanish woman who was taking lithium and amitriptyline for depression. She discontinued these medications and immediately began taking ginseng instead. Within two weeks she suffered a manic episode and was hospitalized.

Her physicians blamed the ginseng, but it may be difficult to determine whether an interaction with the antidepressants or their discontinuation contributed to the manic reaction.

Using ginseng together with the MAO inhibitor phenelzine (Nardil) has also resulted in mania.

A potentially fatal interaction was reported in a man with severe kidney disease. Ten days after he began taking a ginseng preparation that also contained germanium, he was hospitalized with severe edema and high blood pressure.

In the hospital, where he did not have access to his dietary supplements, his diuretic started working again. He lost twenty-five pounds of fluid, and his blood pressure dropped. But after discharge, he resumed taking supplements and once more wound up with fluid retention and hypertension.

The physicians from Vanderbilt and the Veterans Affairs Medical Center in Memphis where he was treated hypothesized that the germanium in the supplements damaged the already compromised kidney and interfered with the action of the furosemide (Lasix).

There is no way to determine whether ginseng itself might have interacted with the man's medications, furosemide and cyclosporine.

Ginkgo

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Ginkgo biloba is one of the most popular botanical medicines in both Europe and America, but Chinese healers take the prize. They have been using this ancient tree for thousands of years to treat asthma and cold injury to fingers and toes, as well as to aid memory.

The roasted seeds were traditionally used in China and Japan for indigestion and intoxication. Getting the seeds to roast required care and knowledge, however, because the fruit smells bad and causes a nasty rash.

Current ginkgo formulations are based on an extract of the leaves picked in the fall, when the concentration of the active ingredients is highest.

Active Ingredients

Ginkgo leaves, like most plant products, contain a complicated mix of compounds. At least forty different flavonoids have been identified, as well as flavonols such as quercitin and kaempferol.

Standardized extracts contain between 22 and 27 percent of such flavonol glycosides. The best-studied of these, an extract produced by a German-French consortium, is standardized to 24 percent flavonol glycosides.

In addition, there are terpene compounds that have been named bilobalide and ginkgolides A, B, C, J, and M, with ginkgolide B perhaps the most active. A standardized extract should contain 6 to 7 percent of these terpene lactones.

One study in the 1980s indicated that the individual components of ginkgo biloba extract (GBE) do not provide the same clinical benefits as the extract itself.

Some researchers believe that for many herbs a single ingredient may provide most if not all of the therapeutic benefit. Ginkgo, however, seems to contain several compounds that work together for maximum effect.

EGb 761, an extract used in many of the better clinical studies, is manufactured by Dr. Willmar Schwabe AG of Karlsruhe, Germany. It is sold in the United States under the brand names Ginkoba, Ginkgo-D, and Ginkgold.

Uses

Ginkgo is the most frequently prescribed botanical medicine in Germany and is popular throughout Europe, both as oral medicine and as injections. It is most often used to treat dementia or memory loss.

A study in the United States demonstrated that it is more effective than placebo in slowing the loss of mental ability due to Alzheimer's disease.

This finding is consistent with the results of a review of placebo-controlled studies, which found that GBE produces a modest improvement in memory test scores roughly similar to that associated with the Alzheimer's disease drug Aricept.

One popular hypothesis to explain this benefit suggests that improved circulation to the brain is important. Another possibility is that ginkgo may help protect brain cells from neurotoxicity.

A minimum of six weeks of treatment is needed to assess whether GBE will prove helpful.

Depression in older people that has not responded to other treatments such as antidepressants or St. John's wort may be an early symptom of mental decline. In Europe, this resistant depression is treated with ginkgo for at least eight weeks.

Ginkgo is also used to treat intermittent claudication, a condition in which inadequate circulation in the legs causes pain when walking. Combination therapy that includes exercise is most effective for this problem.

Other circulatory problems that sometimes respond to GBE are Raynaud's phenomenon and postphlebitis syndrome. Peripheral blood flow increases by approximately 40 to 45 percent after GBE is administered.

Tinnitus, or ringing in the ears, is sometimes caused by drugs, especially aspirin or other salicylates. In animals, ginkgo reduces the behaviors associated with salicylate-induced tinnitus.

Research in people has shown that up to 40 percent of patients with tinnitus attributed to inadequate blood flow to the ear responded to treatment with GBE. They required treatment for two to six months before a response was noted.

Ginkgo may be even more effective for people with vertigo due to inner ear problems.

The traditional Chinese use of ginkgo was to treat asthma, and a double-blind crossover study confirmed that ginkgolides found in GBE can alleviate the inflammation and allergic response that lead to bronchospasm.

Ginkgo has strong antioxidant activity and appears to protect nerves from nitric oxide produced by inflammation. It also helps protect cholesterol in the body from oxidation.

GBE use has been suggested to reduce breast tenderness associated with premenstrual syndrome.

One unusual use of ginkgo has not been studied systematically. Antidepressants like Prozac, Paxil, and Zoloft frequently interfere with a person's ability to achieve orgasm. Psychiatrist Valerie Raskin has recommended ginkgo to reverse this side effect

Dose

For treating dementia: 120 to 240 mg daily, divided into two or three doses.

For intermittent claudication, tinnitus, or vertigo: 120 to 160 mg daily, in two or three doses.

Three brand-name products sold in the United States are essentially the same as German products that have been carefully standardized. They are Ginkoba, Ginkai, and Ginkgold.

Special Precautions

The German information for the prescriber (Commission E Monograph) cautions the health care provider to diagnose the cause of dementia carefully before starting a patient on GBE, so that underlying disease contributing to the confusion and memory loss can be detected and treated.

Pregnant women should be wary of taking any therapeutic herb, including ginkgo, not because we know it to be harmful, but because it has not been proved safe.

Because ginkgo seeds and leaves contain a toxin that can affect nerve cells, people with epilepsy should not take GBE. In theory, it might make anticonvulsant medications less effective.

Anyone considering using ginkgo for a serious condition should check with a physician to avoid harmful interactions with other drugs.

Ginkgo interferes with blood platelets coming together to form blood clots. While this action could be beneficial under some circumstances, it could cause problems for a surgical patient.

Be sure to tell the doctor you are taking ginkgo and discontinue the herb a week or two before surgery.

Adverse Effects

Very few side effects have been reported with ginkgo biloba extract except for complications associated with the interactions below.

Digestive upset, such as indigestion or nausea, has been reported. Taking the herb with food often helps relieve this problem.

Ginkgo may also precipitate bleeding, especially in susceptible individuals or in combination with anticoagulants.

Rarely, people have experienced headache, dizziness, or rash.

The fruit, in particular, is capable of causing contact dermatitis similar to that associated with poison ivy or mango.

Possible Interactions

Ginkgo biloba inhibits platelet-activating factor (PAF) produced by the body. Although this may explain some of its benefits for asthma and circulatory problems, it might also pose a hazard in conjunction with anticoagulants such as Coumadin.

In fact, an elderly woman on Coumadin had a hemorrhagic stroke after two months of ginkgo. Ginkgo might also interact with other anticlotting drugs such as aspirin, Plavix, or Ticlid to increase the risk of bleeding.

Hemorrhage with the combination of ginkgo and aspirin has been reported. We advise against combining arthritis medicines such as ibuprofren (Advil, Motrin IB, etc.) or diclofenac (Cataflam, Voltaren) with prescription blood thinners, and it would also be prudent to avoid adding GBE to any of these medications.

The American Herbal Products Association suggests that ginkgo may interact with MAO inhibitors such as Eldepryl, Nardil, or Parnate.

Because of a concern that ginkgo could possibly make a person more vulnerable to seizures, it probably should not be taken together with other drugs known to increase the risk of seizures.

Antidepressants such as Elavil (amitriptyline), Ludiomil (maprotiline), and Wellbutrin (bupropion) belong in this category, along with the smoking cessation aid Zyban (bupropion).

Ginger

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Ginger is a popular seasoning for foods in many different cuisines.

In China and Southeast Asia where it probably originated, it has also been put to a range of medicinal purposes. It is considered good for the digestion and beneficial against congestion.

One of our favorite home remedies for colds is a cup of ginger tea: Peel a piece of fresh ginger root about the size of your thumb and grate it into a cup.

Pour boiling water over it and steep for five minutes. Strain the liquid into another cup, sweeten to taste with honey, and enjoy the spicy flavor. It does make one feel better, at least for an hour or two.

More research has been conducted on the ability of ginger to prevent motion sickness than on any other aspect of its use. The part of the plant used is the rhizome ("root").

Active Ingredients

The primary active ingredients in ginger are the "pungent principles" that give the plant its special aroma and flavor. These are gingerols and shogaols, gingerdiones and zingerone.

The composition of the volatile oil differs in roots from different locations, however. Zingiberene, ar-curcumene, and bisabolene usually predominate, but gingers from Australia and Japan contain more geranial (citral a) and neral (citral b), with the Australian ginger also carrying camphor and b-phellandrene.

Uses

Chinese fishermen have known for centuries that ginger can stave off seasickness. In the last few decades, this has been confirmed by scientific studies.

In one, ginger (administered in capsules of 940 mg), Dramamine (100 mg), and a placebo (chickweed) were compared for their ability to keep susceptible subjects from becoming nauseated while seated on a spinning chair.

Ginger did better than Dramamine, surprising many physicians. Not all of the subsequent research has led to the same conclusions, but several investigations support these findings.

Another study took place on a passenger cruise ship on rough seas. In this double-blind study, ginger (500 mg every four hours) was equally effective as Dramamine (100 mg every four hours).

Ginger proved significantly better than placebo for a group of naval cadets on a sailing ship in heavy seas and also proved its value in a test conducted among tourist volunteers on a whale-watching cruise.

It is believed that ginger exerts its antinausea properties directly on the gastrointestinal tract, rather than through the central nervous system as most of the familiar motion-sickness medications do.

Ginger has been studied for its ability to prevent nausea and vomiting in other situations.

In two separate investigations of women undergoing gynecological surgery, ginger given before the operation reduced postoperative nausea significantly compared to placebo. The prescription drug metoclopramide (Reglan) was equivalent to ginger in effectiveness.

This property may explain the popularity of ginger ale as a home remedy for nausea in America decades ago, when the beverage actually contained more than trace amounts of ginger. If you can find real ginger ale, 12 ounces is enough to prevent motion sickness and presumably may help ease nausea from other causes as well.

Ginger has also been used in folk medicine for indigestion and to pep up the appetite and get saliva flowing.

It is reputed to prevent flatulence if included in a meal, such as beans, that might cause gas.

In animal studies, shogaol increases the activity of the digestive tract when it is given by mouth.

Extracts containing shogaol and the gingerols can make animal's hearts beat more strongly (cardiotonic) and reduce pain and fever.

Animal studies also show that these compounds can suppress coughs.

Ginger is known to block to some extent the manufacture of prostaglandins in the body. It is reputed to lower cholesterol and keep blood platelets from clumping together.

In addition, a closely related herb, Z. capitatum, which is sometimes used in place of ginger, contains an interferonlike compound that can stimulate immune system activity.

Dose

Minimum dose for an adult is 250 mg. Doses of 500 mg and 940 mg have been used in clinical trials for motion sickness.

For motion sickness, ginger should be taken at least half an hour before departure. It is most effective at preventing nausea and does not work well at calming it once it has begun.

The dose may be repeated every four hours, to a maximum adult dose of approximately 4 gm a day. Candied or fresh ginger might be substituted, but the dose could be difficult to calculate.

Special Precautions

German authorities recommend that pregnant women avoid ginger. Despite its ability to prevent nausea, they state that the herb should not be used for morning sickness.

Components of ginger triggered mutations in bacteria in some tests. In addition, ginger's ability to prevent prostaglandin synthesis and possibly increase bleeding could make it a dangerous drug for a woman in labor.

Ginger is said to increase bile acid secretion. This is the reason people with gallstones or gallbladder disease are advised to avoid the herb unless supervised by a doctor.

Adverse Effects

Like many commonly used culinary herbs, ginger has very few side effects. In clinical trials, heartburn was reported rarely. A few people may develop an allergy to ginger, but this is uncommon.

Possible Interactions

Ginger is said to increase the absorption of other drugs taken with it, but this property does not appear to have been studied extensively, if at all.

Ginger can prolong the amount of time an animal sleeps when given a barbiturate. Because the herb has no detectable effects on the central nervous system itself, the most logical explanation is that it increases the absorption of the sleeping pill.

Because ginger inhibits prostaglandin synthesis and reduces platelet aggregation, caution should be exercised in combining it with other medications that prevent clotting, such as Coumadin, aspirin, Plavix, or Ticlid. The combination could result in unexpected bleeding.

Garlic

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Garlic is valued in many parts of the world for its pungent aroma and flavor. It is possible that garlic's biological activity and popularity in Mediterranean cuisines contribute to the healthful effects of the "Mediterranean diet."

Most investigations of garlic's health benefits have considered its medicinal rather than culinary uses, however.

Medicinal use of garlic goes back to Greek and Egyptian antiquity. Hippocrates prescribed it for leprosy, toothache, and chest pain. Galen considered it a cure-all readily accessible to everyone.

One old tradition holds that garlic protected four convicts from the plague in Marseilles. They were released from prison in 1721 to bury the dead with the expectation that they would succumb quickly. Their survival was attributed to their habit of imbibing garlic juice mixed with vinegar and wine.

Garlic was used in the nineteenth century for tuberculosis and into World War II for disinfecting battlefield wounds.

It is frequently used in an attempt to ward off or treat the common cold.

The herb is available in many forms, including fresh bulbs, oil-based extracts, dried powder, and steam-distilled extracts.

To maximize the anti-cancer activity of fresh garlic in cooking, crush or mince it at least ten minutes before heating.

Active Ingredients

Sulfur compounds give garlic its characteristic pungent aroma and probably account for some of the flavor. They also appear to be responsible for most of the medicinal properties of this herb, although the trace minerals germanium and selenium may also play a role.

An inert compound, alliin, is converted to allicin once the clove is cut or crushed.

In Europe, standardized extracts of garlic are supposed to contain at least 0.45 percent allicin, a compound that breaks down into most of the active components, such as ajoene.

Chemical analysis of garlic products shows that concentrations of sulfur compounds vary enormously.

Uses

Garlic is widely used for its cardiovascular benefits, although the results of two American trials on its ability to lower cholesterol were disappointing.

An analysis of twenty-six other studies showed cholesterol reduced, on the average, by approximately 10 percent.

In some studies, dangerous LDL cholesterol dropped by 16 percent, while other research has shown increases in beneficial HDL with long-term use.

Although the cholesterol-lowering power of garlic appears modest, the herb is reported to reduce oxidation of LDL and seems to have other cardioprotective effects.

Several garlic-derived chemicals can help slow blood clotting by keeping blood platelets from clumping together. In addition, garlic helps to break up or prevent blood clots through fibrinolytic action.

Since many heart attacks and strokes are believed to be caused by spontaneous clots in blood vessels, these anticoagulant actions could be very helpful.

Garlic may also lower blood pressure, but it is less effective in this respect than are medicines. It is helpful, however, in keeping blood vessels to the heart flexible in older people.

Research in rats and dogs also indicates that fresh garlic and garlic extracts can correct certain irregular heart rhythms.

Test tube research has established that garlic extracts are active against a range of bacteria, including such nasties as Staphylococcus aureus and Streptococcus pneumoniae. It is only about 1 percent as active as penicillin, however.

Garlic extract can also fight Helicobacter pylori, a bacterium that causes stomach ulcers. Perhaps garlic should be added to the combination of drugs used to eradicate this bug and cure ulcers, but we'll have to await clinical research to confirm this.

Garlic extracts are comparable to antifungal drugs against fungal infections of the skin and the ear.

One of the most intriguing possibilities for garlic is that regular ingestion may help prevent cancer.

Studies in China comparing people in one region where garlic is commonly eaten (20 grams, or approximately seven cloves a day, on average) with those in another region where daily consumption is less than half a clove found the garlic eaters were much less likely to suffer stomach cancer.

Other studies have indicated that people who eat garlic more often seem less susceptible to stomach or colon cancer.

Animal research confirms that garlic has the potential to improve resistance to tumors, and test tube research shows that garlic can interfere with some cancer-causing chemicals.

Garlic can reduce blood sugar levels and may improve insulin response.

Dose

For cardiovascular conditions: one clove daily, equivalent to 6 to 10 mg of alliin, or 3 to 5 mg of allicin. Treatment is maintained indefinitely.

For common cold prevention/treatment: one clove three times a day, until symptoms resolve.

For a standardized product tested in Germany, look for Kwai. Read product label for proper dosage.

Special Precautions

Because garlic can slow blood clotting, German authorities recommend that patients avoid this herb in the period just prior to and following surgery.

Those with chronic digestive problems should be cautious, because high doses of garlic can irritate the intestinal tract.

Pregnant women should exercise moderation; at high doses, garlic extracts can stimulate uterine contractions in animals.

People with low thyroid function should be aware that concentrated garlic products may keep the thyroid gland from utilizing iodine properly. This could aggravate an underactive thyroid condition.

Adverse Effects

In rats, high doses of garlic led to weight loss and damage to the stomach lining. Humans taking garlic oil at a dose equivalent to twenty cloves daily for three months did not report problems.

Most people appear to tolerate garlic well, but some individuals experience digestive distress.

People who handle garlic products occasionally develop a skin reaction on exposure (contact dermatitis).

Ingesting fresh garlic and most extracts results in a characteristic breath odor. This has been linked to the active sulfur-containing compounds. Parsley is recommended as a home remedy for garlic breath.

Possible Interactions

Although there are no studies of interactions, in theory garlic could increase the risk of bleeding in people taking anticoagulants such as Coumadin, aspirin, Plavix, or Ticlid.

There is also a possibility that this herb could interact with drugs such as DiaBeta or Glucotrol that lower blood sugar. Careful monitoring is suggested for anyone combining garlic products with such prescription drugs.

Garlic appears to inhibit an enzyme called CYP 2E1. In most cases, this interference is welcome, since this enzyme can make carcinogens more dangerous. But CYP 2E1 is also involved in the metabolism of acetaminophen (Panadol, Tylenol, etc.) and a muscle relaxant called chlorzoxazone (Parafon Forte). These drugs could possibly linger longer in people who are taking or eating garlic.

Feverfew

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Feverfew was used by Greek physicians to treat "melancholy," which may have included headaches as well as depression.

The English used it into the seventeeth century for symptoms that might translate today into vertigo, depression, and headache, as well as for lowering fever. It faded from popularity after that, and during the eighteenth and nineteenth centuries was hardly used by herbalists.

It was, however, planted in gardens, perhaps for the small daisylike flowers or because it had a reputation for repelling insects. If that didn't work, it was sometimes used as a balm to ease the itching of insect bites.

In many places it escaped from the garden and now grows as a wildflower in much of the northeastern United States. Only in recent decades has it come back into regular use, primarily to prevent migraine headaches.

Dried leaves and stems, picked while the plant is flowering (July through October), are the parts used.

Active Ingredients

The principal measured component of feverfew is parthenolide, one of several sesquiterpene lactones.

Canadian regulations call for a minimum of 0.2 percent parthenolide in feverfew products, while the French pharmacopoeia specifies a minimum of 0.1 percent. Parthenolide levels vary greatly, but most leaves from feverfew grown in North America contain less than 0.1 percent.

In addition, feverfew contains flavonoid glycosides, particularly apigenin and luteolin. Melatonin has also been reported as a component of feverfew leaves.

How much of the activity of feverfew is due to parthenolide (which is also found in a number of other plants) and how much should be attributed to other compounds has not been determined.

Uses

Feverfew has been studied and found effective for the prevention of migraine headaches, reducing the number of headaches suffered by as much as 70 percent, or reducing the pain and controlling the nausea commonly experienced with such headaches.

Once a migraine headache begins, however, feverfew does not appear to relieve the pain.

A recent review has found that much of the research to determine the effectiveness of feverfew for this purpose was of questionable quality. It does appear likely, however, that the herb has some benefit.

Three trials, at least two of them double-blind, have demonstrated efficacy of the whole leaf. Health and Welfare Canada has approved a standardized feverfew product called Tanacet as a nonprescription drug for migraine prophylaxis.

Feverfew has been linked to several measurable changes in physiology. Extracts of the aboveground parts of the plant can reduce the body's manufacture of prostaglandin, a chemical important in inflammation, by up to 88 percent.

This and other anti-inflammatory activity might explain why the herb has been used to treat psoriasis. Despite this, a clinical trial for rheumatoid arthritis showed no benefit over placebo.

In the test tube, feverfew extracts can keep blood platelets from sticking together and forming clots, so the herb may be useful as a mild anticoagulant. It achieves this through a different chemical pathway than aspirin or other salicylates.

Feverfew also blocks platelets from releasing serotonin, which may help to explain how it works to prevent migraines.

Feverfew extracts also prevent the release of histamine from mast cells, so the plant may be useful in the treatment of allergies. Presumably, it is also expected to lower fever, although there don't appear to be modern clinical studies substantiating this traditional use.

Dose

For the prevention of migraines: chew two to three fresh leaves daily; or take 125 mg of dried herb with 0.2 percent parthenolide. Treatment for at least two months is recommended.

Doses from 50 to 200 mg of dried herb have been used for other indications but recommendations vary widely.

Special Precautions

Feverfew may slow blood clotting, so it is prudent to avoid this herb in the period just prior to and following surgery.

Feverfew is not recommended for pregnant women. In folk medicine it has the reputation for initiating menses.

Women should also refrain from taking feverfew while they are breast feeding, and it is not appropriate for children under two years of age.

Feverfew belongs to the family of asters. Anyone allergic to ragweed or other flowers in the family should probably avoid use of this herb as a sensible precaution.

Adverse Effects

The most common side effect of feverfew appears to be the development of mouth ulcers (canker sores). Approximately 11 percent of the patients treated in one study reported this problem.

A smaller proportion of people chewing fresh leaves of the plant have experienced inflammation of the mouth and tongue, swelling of the lips, and loss of the sense of taste.

Gastrointestinal side effects such as indigestion or flatulence have been reported occasionally but appear to be mild in most cases. More troublesome is a reported increase in heart rate in a few individuals.

People who handle feverfew may develop a skin reaction on exposure (contact dermatitis).

Treatment with feverfew should not be discontinued suddenly. One study with a crossover design documented a rebound syndrome with severe migraines, sleep disturbances, anxiety, and joint stiffness when patients were switched to placebo after having been on feverfew. Gradual dose reduction is advised.

Possible Interactions

Clinical cases of hemorrhage have not been described, but in theory feverfew could increase the risk of bleeding in people taking anticoagulants such as Coumadin, aspirin, Plavix, or Ticlid.

Fennel

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This member of the celery family is a well-known herb native to southern Europe and western Asia, but it was known in ancient China (as xiao hui xiang) as well as in India, Egypt, and Greece.

In the Middle Ages it was prized as a vegetable and indeed is appreciated for its flavor today. Colonists brought it to the New World.

Some herbal references distinguish between sweet and bitter fennel. Although the entire plant is edible, only the fruits ("seeds") and their essential oil are used medicinally.

The fruits are collected in August and September when they are ripe and then dried.

In China, it is considered a "wind-dispelling herb," restoring normal stomach function, dispersing cold, and restoring the flow of qi (pronounced chee). Aside from the specifically Chinese concept of qi, these uses are remarkably similar to those in European herbal medicine.

Active Ingredients

The dried fruits of fennel contain an essential oil (2 percent in sweet fennel, 4 percent in bitter fennel). This oil contains anethole (80 percent in sweet fennel, at least 60 percent in bitter fennel), fenchone, and estragole.

Alpha- and beta-pinene, limonene, and beta-myrcene have also been identified, along with anisaldehyde. The fixed oil present at levels of approximately 20 percent contains oleic acid, vitamin E, and petroselinic acid.

Caffeic acid and its derivatives and flavonoids including quercitin, isoquercitin, and kaempferol compounds occur in sweet fennel.

Uses

In traditional herbal medicine, fennel was used to treat indigestion and flatulence, encourage production of breast milk, improve sex drive, increase urination, and bring on menstrual bleeding.

An extract of fennel demonstrated estrogenic effects in both male and female rats, but this activity has not been utilized further.

In Europe, in addition to digestive complaints, fennel is recommended for colds and congestion.

An extract had measurable anti-inflammatory activity in experiments using rat paws.

In laboratory studies, fennel oil increased movement of the stomach but counteracted spasms of smooth muscle in the gut. Perhaps this activity explains its reputation in treating flatulence.

Findings on the oil's toxicity are contradictory. In one study, the volatile oil aggravated chemical liver damage, but in more recent research an anethol compound protected against chemical toxicity.

Dose

The infusion is made by pouring 2Ú3 cup boiling water over 1 to 2 teaspoons (2 to 5 g) of the dried fruit crushed immediately beforehand, steeping for ten to fifteen minutes, and straining it.

Maximum daily dose is 7 g of fennel.

Fennel infusions may be taken for as long as desired, but stronger forms of the herb such as extracts should not be used for more than two weeks except under medical supervision.

Use of the volatile oil is not recommended.

Special Precautions

Anyone allergic to celery, carrots, dill, or anise should avoid fennel.

Pregnant women should not use fennel oil or fennel extracts, but infusions of fennel seeds are not believed to be harmful.

Adverse Effects

The volatile oil can cause nausea, vomiting, hallucinations, and seizures. Pulmonary edema has also been reported.

Infusions rarely cause side effects of any kind, but the fruits may be contaminated with toxic bacteria.

People who handle fennel may experience exaggerated sunburn or rash on exposure to the sun, as the plant can trigger phototoxicity and contact dermatitis.

Possible Interactions

No interactions have been reported in the literature.

Evening Primrose

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The evening primrose is native to North America, where it grows like a weed. Not really a primrose, it is sometimes called "sun drop."

The large yellow flower opens late in the day and lasts only one evening, then produces lots of small seeds. Presumably, these seeds were carried to Europe early in the history of colonization of North America because evening primrose now grows wild in many parts of the continent.

Evening primrose to be used for herbal medicines is commercially cultivated and carefully bred to yield constant levels of the essential fatty acids in the seeds.

Growers in the United States and Canada alone produce three hundred to four hundred tons of seeds each year.

Oil from the seeds is the only part of the plant currently used, although pre-Columbian people used the entire plant for a variety of conditions.

Active Ingredients

Seeds of the evening primrose are rich in oil that has an unusual makeup of fatty acids.

Approximately 70 percent of the oil is cis-linoleic acid, and as much as 9 percent cis-gamma-linolenic acid (GLA). GLA is an essential intermediate step in the process our bodies use to manufacture prostaglandins.

Despite the fact that most over-the-counter pain relievers and many prescription arthritis medicines work primarily by blocking prostaglandin synthesis, prostaglandins do play an important role in many biochemical reactions. Very few plants contain GLA in any significant quantity.

The oil also contains campestrol and beta-sitosterol.

Uses

Some of the uses for which GLA is promoted are based on biochemical theory. Clinical trials have yielded mixed results in many cases, with the enthusiasm of initial success often fading before placebo-controlled trials.

The strongest evidence for efficacy is in the treatment of atopic dermatitis. In these conditions, the skin is itchy, red, scaly, dry, and inflamed.

Several double-blind, placebo-controlled studies have shown that oil of evening primrose can relieve these bothersome symptoms and reduce patients' reliance on corticosteroid medicines (for example, hydrocortisone cream).

In a meta-analysis of nine studies, the herbal preparation was shown to be significantly better than placebo. In a few other double-blind studies, GLA from evening primrose had no advantage over placebo.

Another condition for which GLA might, in theory, be helpful is premenstrual syndrome. Early research demonstrated that the oil could reduce breast tenderness and cyclical mood swings.

A subsequent Australian study was not able to find that evening primrose oil offered any advantage over placebo treatment for this condition. A trial of GLA for hot flashes associated with menopause found it was no better than placebo.

Evening primrose oil is also said to help lower blood cholesterol levels.

In one placebo-controlled investigation, 4 g daily of Efamol brand evening primrose oil brought down total cholesterol by about 30 percent over the course of three months, while placebo-treated patients experienced a nonsignificant drop in cholesterol.

Other studies also showed Efamol can lower cholesterol and triglycerides and reduce platelet aggregation (a risk factor for blood clots that cause strokes and heart attacks).

Unfortunately, a trial utilizing a different brand of standardized evening primrose oil was unable to demonstrate any significant changes in total cholesterol, triglycerides, or HDL cholesterol.

Evening primrose oil, with and without fish oil, has been tested as a treatment for rheumatoid arthritis. More than three months of treatment with GLA are required to see any response in rheumatoid arthritis.

At least two placebo-controlled trials have shown benefits such as less morning stiffness or less reliance on arthritis pain medicines (NSAIDs).

Biochemical reasoning suggests that GLA plays a crucial role in the brain and nervous system, and evening primrose oil has been recommended as a supportive treatment in multiple sclerosis. Studies of its use for this serious condition have been small, however, and the results inconclusive.

In one study, evening primrose oil stabilized or reversed neurological damage in diabetic patients. If this activity can be confirmed, it would represent an important option in treating this difficult problem.

Evening primrose oil has been tested for a wide variety of other disorders, but in most instances the evidence is unconvincing or requires confirmation by way of placebo-controlled, double-blind studies.

As a result, it is not possible to say for sure whether GLA can be helpful for hyperactive children, people with alcohol-induced liver damage, or people with autoimmune diseases, Sjogren's syndrome or chronic inflammation.

Dose

Evening primrose oil is available in 500-mg capsules. Most of the clinical trials have utilized doses of one or two capsules two or three times a day, with the maximum adult dose of 4 g daily.

Up to three months may be needed to see a response in some conditions.

Special Precautions

No special precautions are necessary.

Adverse Effects

There are no significant side effects reported, except as noted below.

Possible Interactions

Evening primrose oil, and by extension GLA, should not be consumed by schizophrenic patients taking phenothiazine drugs such as Compazine (prochlorperazine), Mellaril (thioridazine), Sparine (promazine), Stelazine (trifluoperazine), Thorazine (chlorpromazine), or Trilafon (perphenazine). The combination may increase the risk of epileptic seizure.

Other drugs, such as Wellbutrin and other antidepressants, may also lower the seizure threshold and thus might interact with evening primrose oil.

Elderberry

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S. canadensis, the American elder, is a large shrub native to North America. It bears white flowers early in the summer and dark, almost black, berries in the late summer.

Both the flowers and the berries have been used as food and for making wine. According to James Duke, "Elder Blow [flower] wine is something special, delicious, with a beautiful pale yellow color."

Presumably American settlers knew the European elder, a plant believed to have magical healing powers, and used the American native in similar ways.

The flowers were formerly prized for use in salves and ointments, and the juice of the berries was valued as a tonic.

S. nigra is found throughout Europe and is still used as a botanical medicine.

Both flowers and berries are used and, in Europe, are considered different herbal medicines.

Active Ingredients

European elder flowers contain 0.03 to 0.3 percent of an essential oil that contains free fatty acids (particularly palmitic acid) and a large number of compounds called alkanes. They also contain at least 0.8 percent flavonoids.

Caffeic acid and derivatives, including chlorogenic acid and p-coumaric acid, have been identified. Traces of a cyanogenic glucoside, sambunigrin, and the triterpenes alpha- and beta-amyrin are also constituents.

American elder flowers may contain similar ingredients, but the essential oil is reportedly richer in linoleic and linolenic acids and lower in palmitic acid.

European elderberries have up to 3 percent tannins. They too contain flavonoids, particularly rutin, isoquercitrin, and hyperoside, and several anthocyanins.

Approximately 0.01 percent of the berries is essential oil, and the seeds contain a number of cyanogenic glucosides, including sambunigrin. Leaves and stems contain more sambunigrin.

Uses

Elder flower tea is used to "break" a fever by bringing on sweating. It is used especially for situations in which the feverish person feels chilled, and the tea is drunk as hot as possible.

A cooled infusion has traditionally been used as a gargle for sore throat.

Elder flowers are believed to have mild diuretic action.

Elderberry juice (made by cooking and pressing the berries) is reported to have laxative as well as diuretic properties.

Traditional herbalists such as Tommie Bass consider it a "wonderful blood purifier."

Research has shown that alpha- and beta-amyrin have hepatoprotective activity in animals.

Sciatica and neuralgia are among the traditional European uses of elderberry juice.

Some multi-ingredient herbal preparations for rheumatic pain in the United Kingdom or in Europe include elder flowers or berry extract.

It is also a component in multi-ingredient concoctions marketed for respiratory complaints.

Probably the most common use of elderberry is to treat colds.

Dose

Elder flowers: A tea is made by pouring 2/3 cup boiling water over 2 teaspoons (3 g) of dried flowers and steeping for about five minutes before straining.

As many as five cups a day might be consumed, particularly in the afternoon and evening. The tea is administered until recovery.

Elder flower preparations: 1.5 to 3 g fluid extract or 2.5 to 7.5 g tincture daily.

Elderberry juice: Tommie Bass suggests a teaspoon of elderberry juice in water four times a day as a tonic.

Special Precautions

Careless handling of elderberry can result in poisoning. Children using peashooters made from the stems of the shrub have suffered, as did a number of people drinking elderberry juice at a picnic in the early 1980s.

The cyanogenic compounds are especially concentrated in the leaves, and Tommie Bass reports using a solution made from elderberry leaves as an effective topical insecticide.

Use of stems and leaves should be avoided.

Prudence suggests that pregnant women and nursing mothers should not use elderberry.

Adverse Effects

Uncooked berries can cause nausea and vomiting.

Unripe fruit, like leaves and stems, may contain dangerously high levels of cyanogenic glycosides.

Large doses of elderberry juice act as a purgative.

Possible Interactions

No interactions have been reported, but this may be due to a lack of research on the topic.

The hepatoprotective properties of elder flowers might prove beneficial in combination with certain medications metabolized by the liver, but this is speculation.

Echinacea

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Echinacea is the name of a genus of native North American plants with reddish or purplish flowers.

There are nine species, but only three of them (E. angustifolia, E. pallida, E. purpurea) are used as botanical medicines. Gardeners may recognize echinacea as the purple coneflower.

Echinacea was used traditionally by many Native American tribes to treat snakebite and many other ailments, and settlers learned of its properties from the Indians.

Most of the research on the chemistry and pharmacology of these plants has been conducted in Europe, where until fairly recently echinacea was a much more popular herb than in the United States.

The current enthusiasm for echinacea derives from research suggesting that it can stimulate the immune system and help fight off viral infections such as colds or influenza.

In this country, echinacea is available primarily as a tincture (alcohol-based extract) or as capsules of dried leaves and stems collected when the plant is in flower.

Capsules of dried root are also marketed. Fresh-squeezed juice, widely used in Germany, is rarely sold here.

Active Ingredients

The three species are not interchangeable, although they may sometimes be confused with one another. Each may have a different balance of active compounds. Of course, the roots also differ from the aboveground parts of the plant, though both are utilized medicinally.

The chemistry of echinacea is complex, and no single ingredient has been identified as primarily responsible for the therapeutic activity.

A caffeic acid glycoside, echinacoside, makes up approximately 0.1 percent of the leaves and stems, which also contain cichoric acid. Fresh echinacea or its juice contains a volatile substance not found in the dried plant material.

The roots of E. angustifolia contain chemicals called alkamides.

Uses

Echinacea has become extremely popular for the treatment of colds, influenza, and other respiratory tract infections.

Although the herb does not seem to kill viruses directly, it is believed to stimulate or modulate the immune system, allowing the host to fight off infection. In one European study, people taking echinacea recovered from their colds four days earlier than those taking a placebo.

Both the root of E. pallida and the aboveground parts of E. purpurea are used in Europe for this purpose. It is usually given just at the first appearance of symptoms, rather than taken daily as a preventive.

One study of three hundred people (in three groups, taking E. purpurea, E. angustifolia, or placebo) over twelve weeks was not able to demonstrate a significant advantage of the botanical medicines over placebo. The authors hypothesize that echinacea might reduce the rate of infection by 10 to 20 percent, undetectable at that sample size.

The herb is given orally or by injection in Germany for other infections as well, including prostatitis and urinary tract infections.

Test tube and animal research has shown that echinacea extracts have significant anti-inflammatory activity.

When applied to the skin, the extract is almost as effective as a potent anti-inflammatory drug, indomethacin, used topically. Topically, the extracts have been used to help hasten the healing of stubborn wounds, eczema, psoriasis, and herpes simplex.

Intriguing research in rats demonstrates an ability of E. purpurea extract to help protect the animals from side effects of radiation. In this study, the animals used up vitamin E in particular more quickly than the rats not receiving echinacea.

To maximize the benefit of the herb, it should be given together with a multiple vitamin. (In Australia, a formulation that includes echinacea, vitamin A, vitamin C, vitamin E, zinc, and garlic is prescribed at the first sign of viral respiratory infection.)

So far as we know, the extract has not been studied in humans undergoing radiation.

Preliminary studies suggest that it may be of some use in treating certain cancers. Much more research is needed on this potential application.

Dose

When fresh-squeezed juice is used, the dose is 6 to 9 ml, or approximately 1½ teaspoons (= 7.5 ml). Other oral formulations should supply the equivalent of 900 mg of the herb daily.

One study indicated that short-term use could boost cell-mediated immunity, but that repeated use over a period of weeks reduced the immune response. This interpretation of the results has been questioned, but most authorities suggest six to eight weeks as the maximum time to take echinacea preparations.

One study using the fresh juice of E. purpurea showed no problems for people taking it for up to twelve weeks. The herb should be stored away from light to maintain potency.

A standardized German product is available in the United States under the brand name EchinaGuard.

Special Precautions

One of the problems with echinacea is that the different species may be confused by people gathering the herb from the wild.

Some commercial products have even been contaminated with plants of a quite different species, Parthenium integrefolium.

As with most herbal products, the possibility of microbial contamination can't be ruled out, so if the medicine is intended for a person with a compromised immune system, it should be administered in a tea made with boiling water.

Many authorities warn against using echinacea for people with autoimmune diseases, multiple sclerosis, or other serious conditions such as tuberculosis, AIDS, or leukemia. These precautions appear to rest on theoretical grounds, and are not universally accepted, but we believe it is prudent to respect them.

Echinacea species belong to the family of asters. Anyone allergic to ragweed or other flowers in the family should probably avoid echinacea products.

One woman in Australia had to rush to the emergency room for treatment of anaphylaxis after taking a commercial echinacea extract. Specific testing confirmed that she had become sensitive to the herb.

Adverse Effects

Side effects have rarely been reported with the use of echinacea.

In a recent study of echinacea extracts for the prevention of colds, 18 percent of the patients taking E. angustifolia, 10 percent of those taking E. purpurea, and 11 percent of those on placebo experienced side effects.

The researchers did not specify what reactions occurred but reported that they were not serious and did not require treatment. Echinacea has an unpleasant aftertaste.

Possible Interactions

Interactions of echinacea with other medications are based on theoretical concerns.

Some of the alkaloids found in echinacea are similar to plant chemicals that can be damaging to the liver. Thus, some doctors suggest that echinacea should not be used with other drugs that can have negative effects on the liver, such as Nizoral, methotrexate, Cordarone, or anabolic steroids.

One reference notes that flavonoids found in E. purpurea affect the enzyme (CYP 3A4) responsible for metabolizing many common drugs.

This is the same enzyme affected by grapefruit, but we do not know if the effect would be clinically important. If it were, medications as varied as cyclosporine, Plendil, Procardia, Sular, Propulsid, Hismanal, Mevacor, Zocor, Tegretol, or Viagra could reach higher levels in the body. Coumadin might also be affected. Monitoring drug response is important.

Dong quai

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The term "dong quai" (a Chinese name that is sometimes transliterated tang-kuei or dang-gui) refers to a plant known either as A. polymorpha var. sinensis or simply as A. sinensis. As the name suggests, this member of the celery family comes out of the traditional Chinese pharmacopoeia.

In China, it is even more widely used than ginseng. It has recently earned itself a considerable following in Australia and the United States.

The root is the part of the plant that is used. Chinese healers make a tea (a "decoction," more properly speaking) and use it for gynecological disorders such as menstrual cramps or irregular menstrual periods.

But the American baby boomers, with their preference for herbal medicines, have made dong quai especially popular as an alternative to HRT for menopausal women.

Active Ingredients

At least six chemicals related to coumarin have been identified in dong quai. These include bergapten, imperatorin, oxypeucedanin, osthole, and psoralen.

Coumarin chemicals may act to dilate blood vessels and to relax smooth muscle (antispasmodic). Osthole is also known to stimulate the brain.

No estrogenic constituent of dong quai has been specifically identified, but research by Patricia Eagon of the University of Pittsburgh has shown that dong quai binds to estrogen receptors. Like estrogen, dong quai also promotes the growth of the lining of the uterus in rats.

Research on humans has not confirmed this activity. There is inadequate information to evaluate whether estrogenic activity of dong quai would increase a woman's risk of breast cancer.

Uses

In China, traditional practitioners prescribe dong quai together with other herbs such as Astragalus.

Tests in small animals suggest that dong quai extract may have some effects on immune function, but the actions appear to be complex and in some respects contradictory. These actions, however, might explain why it has been considered a "blood purifier."

Dong quai has a mildly laxative effect.

At least one of the constituents can stimulate the brain, improving alertness.

Some sources recommend dong quai for the treatment of menopausal symptoms, and women anxious to relieve hot flashes without prescription medications have turned to dong quai as one of the herbal medicines that might help.

A 1997 double-blind, placebo-controlled trial conducted by Kaiser Permanente and published in Fertility and Sterility found, however, that women taking dong quai had just as many hot flashes as women on placebo pills.

Dong quai may be helpful for menstrual cramps, since some components appear to have antispasmodic action. It also dilates blood vessels.

Test tube research suggests that dong quai, in combination with other Chinese herbs, can stimulate the growth of nerve cells. We don't know whether this would produce a significant benefit in a human being.

Dose

The suggested dose is approximately 10 to 40 drops of tincture one to three times daily. It may also be administered as capsules (1,500 mg three times a day in one study) or as a tea.

Different preparations may call for variations on these doses, so read the directions on the packet, or better yet, get personal advice from an experienced practitioner.

Dong quai is expected to provide symptomatic relief rather quickly, perhaps within two weeks or so. Because of the possibility of adverse reactions, long-term use is not recommended.

Special Precautions

Pregnant women should avoid dong quai.

This herb is not appropriate for women with heavy menstrual bleeding or fibroids, as it might make these problems worse. Because it is a laxative, women with diarrhea or bloating should refrain from taking it.

According to women's lore, dong quai works better for intermittent hot flashes than for women who feel hot constantly. The woman who is hot all the time might find that this symptom is exaggerated when she takes dong quai.

Adverse Effects

The furocoumarin compounds in dong quai, especially psoralen and bergapten, can sensitize the skin to the sun, resulting in a severe sunburn or a rash. By themselves, these compounds are also carcinogenic on exposure to light, and experts in their chemistry recommend that people avoid them if possible.

Certainly anyone taking dong quai should stay out of the sun and avoid tanning lamps even though there are no studies showing that people taking dong quai have experienced photosensitivity reactions.

Dong quai is a laxative. For some people, this will be considered an adverse effect.

Possible Interactions

Very little information is available on possible interactions of dong quai with prescription or over-the-counter medicines.

Experts on grapefruit chemistry believe that a furocoumarin in grapefruit is responsible for its effect on the enzyme that metabolizes many medications. No one has studied dong quai to see whether its furocoumarins might have a similar impact.

It is not known whether the coumarins in dong quai might interact with the anticoagulant drug Coumadin, itself a coumarin derivative. To be safe, any woman taking both the herb and the prescription medicine should discuss this situation with her doctor and should have bleeding time (PT and INR) checked frequently, especially when starting or stopping the herb.

Cranberry

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Cranberries are a traditional part of the Thanksgiving feast in America, where V. macrocarpon is part of the native flora. Recent interest in cranberries, however, goes beyond sauce or relish.

A traditional women's belief (or old wives' tale) that cranberry juice can be beneficial for urinary tract infections was discounted by doctors until a study was published in the Journal of the American Medical Association in 1994. Score one for the old wives!

This placebo-controlled, double-blind trial showed that drinking cranberry juice cocktail definitely reduced elderly women's risk of urinary tract infection. Ocean Spray provided both the cranberry juice and the look-alike, taste-alike, cranberry-free placebo juice.

Cranberries are too tart to be palatable without sweetening, but cranberry juice cocktail products have become quite popular.

Some people concerned about their intake of sugar have turned to dried cranberry capsules, although there are no studies yet to confirm that these are equally as active as juice.

The part of the plant that is used is the berry.

Active Ingredients

Cranberries are very rich in anthocyanins. They also contain fructose (fruit sugar) and small amounts of vitamin C and fiber.

Other constituents include catechins and triterpenoids, as well as malic, citric, and quinic acids.

Cranberry also contains an unidentified factor that counteracts bacterial chemicals known as adhesins.

Uses

The principal use of cranberry juice is to prevent urinary tract infections. The antiadhesin activity of cranberry juice seems to keep bacteria from getting a foothold in the lining of the urinary tract.

Some women claim that drinking large quantities of cranberry juice at the first symptoms of cystitis can stop an infection. In most instances, though, once an infection has begun and is causing pain and urgent urination, it requires medical treatment.

Cranberry juice has been used infrequently in conjunction with antibiotics to treat chronic kidney inflammation.

Cranberry juice has also been used in nursing homes to keep the urine of incontinent patients from developing an unpleasant ammonia-like smell. Evidently cranberry juice is able to inhibit the growth of the bacteria that degrade urine to ammonia.

Test tube research at the University of Wisconsin suggests that cranberry juice may help keep LDL cholesterol from oxidizing. If confirmed, this activity would help prevent the development of cholesterol plaques in arteries.

Dose

The dose used in the double-blind prevention trial mentioned above was 300 ml (approximately 10 fluid ounces) per day. In acute urinary tract infections, up to 32 fluid ounces daily may be consumed.

Special Precautions

No special precautions have been noted with cranberries. Diabetics may need artificially sweetened juice, as the usual cranberry juice cocktail is high in sugar.

Adverse Effects

Diarrhea may occur, but it has been reported only with the consumption of a large quantity of juice (roughly 3 to 4 quarts).

Possible Interactions

Although cranberry juice contains some tannins, it has not been reported to interfere with the absorption of iron supplements or other minerals.

In older people with too little stomach acid or in patients taking strong acid suppressors such as Prilosec, vitamin B12 absorption may be impaired. Cranberry juice appears to improve the absorption of this crucial vitamin in such cases.

Chaste Tree Berry

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Chaste tree is a large shrub (up to twenty-two feet tall) native to the Mediterranean and southern Europe. Although it flourishes on moist riverbanks, it is easily grown as an ornamental plant in American gardens, where its attractive blue-violet flowers are appreciated in midsummer.

The Greeks and Romans used this plant to encourage chastity and thought of it as capable of warding off evil.

Medieval monks were said to use the dried berries in their food to reduce sexual desire. As a result, it was also referred to as "monks' pepper."

Although Hippocrates used chaste tree for injuries and inflammation, several centuries later Dioscorides recommended it specifically for inflammation of the womb and also used it to encourage milk flow shortly after birth.

Current use of chasteberry is almost exclusively for disorders of the female reproductive system.

Oddly, the conditions for which it is most commonly recommended, premenstrual syndrome (PMS) and peri- or postmenopausal symptoms such as hot flashes, are associated with completely different hormone imbalances.

Two authors publishing the results of a survey of medical herbalists were led by this observation to suggest that chaste tree should be considered an adaptogen, possibly affecting the pituitary gland.

Usually the dried berries are the part of the plant used. In some Mediterranean countries, leaves and flowering tops are also harvested and dried for use.

Active Ingredients

No one constituent of chaste tree has been isolated as responsible for its medicinal effects.

The berries contain iridoids as glycosides, including aucubin and agnuside.

Flavonoid content is highest in the leaves (up to 2.7 percent) and flowers (nearly 1.5 percent).

The berries contain almost 1 percent of flavonoids such as casticin, isovitexin, orientin, kaempferol, and quercetagetin.

It is perhaps surprising that chaste tree does not contain plant estrogens. Instead, progesterone, hydroxyprogesterone, testosterone, epitestosterone, and androstenedione have been identified in the leaves and flowers.

The essential oil of chasteberry may be responsible for its distinctive spicy aroma. It contains monoterpenes cineol and pinene, along with limonene, eucalptol, myrcene, linalool, castine, citronellol, and others, plus several sesquiterpenes.

An alkaloid, vitricine, is also an ingredient.

Uses

Animal research has shown that extracts of chaste tree berry have an effect on the pituitary gland of rats, reducing prolactin secretion. This has the impact of reducing milk production, exactly the opposite effect suggested by some of the ancient texts.

As a result of these studies, chaste tree has been suggested to treat conditions associated with excess prolactin. In a clinical trial of chasteberry for menstrual cycle abnormalities attributed to too much prolactin, the herb normalized both the cycle and the levels of prolactin and progesterone hormones.

It is also believed helpful for premenstrual breast tenderness, a condition linked to excess prolactin.

Several uncontrolled studies in Germany have shown that chaste tree extracts can reduce symp-toms associated with PMS. In one of these studies, the investigators reported higher blood levels of progesterone as a result of treatment.

If chaste tree can normalize hormone levels, it may be helpful for perimenopausal women with unusually short cycles or heavy bleeding. Dr. Susan Love considers that it may be worth a try.

No clinical studies to date have determined the effectiveness of chasteberry for menopausal symptoms, but many medical herbalists in the United Kingdom use it to treat hot flashes.

These practitioners also prescribe it for female infertility, but there are no data to indicate if chaste tree is helpful for this problem.

Although studies are lacking, the antiandrogenic effect of chaste tree berry is the rationale behind the use of this herb to treat acne in both men and women and its very occasional use to reduce an overactive libido.

Dose

The usual dose is 20 to 40 mg of the herb, or its equivalent.

If using a tincture, take 20 drops one or two times a day. Capsules or tea (one cup) may be used instead if it is more convenient.

Taking chasteberry shortly before bedtime may increase early morning melatonin secretion and improve sleep.

Chaste tree berry is slow acting. Two or three menstrual cycles, or a similar amount of time, may be needed to evaluate the effects.

A standardized product from Germany is available in the United States under the brand name Femaprin.

Special Precautions

Pregnant women should not take chaste tree berry.

Although one study indicated that this herb does not affect the composition of breast milk, nursing mothers are advised to avoid it. Despite its traditional use to increase milk production, the likelihood that the herb suppresses prolactin could make nursing more difficult.

Herbal practitioners may recommend that chaste tree berry not be used by women with hormone-sensitive cancers (breast, uterus). Anyone with such a serious condition should certainly be consulting an expert for advice before self-treating with any herb. Pituitary tumors also come into this category.

Adverse Effects

Side effects are uncommon, but itchy allergic rashes have been reported.

A few patients may experience mild nausea or headaches, especially when starting treatment.

A few women have complained that the length of their cycle changed, and in rare cases women experience heavier menstrual periods.

Possible Interactions

In general, chaste tree berry should not be combined with exogenous hormones such as oral contraceptives or menopausal hormone replacement therapies (Premarin, Prempro, Premphase, Provera, etc.).

Animal experiments indicate that compounds that act on dopamine in the brain may affect or be affected by the herb. Such drugs include Haldol, a medication for psychosis, L-Dopa or Parlodel for Parkinson's disease, Wellbutrin for depression, or Zyban for quitting smoking.

No clinical consequences of interactions have been reported.

Chamomile

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Two different plants carry the common name chamomile. One of them, M. chamomilla, is sometimes referred to as Hungarian, German, or genuine chamomile to distinguish it from C. nobile, Roman or English chamomile.

The older terminology for C. nobile is Anthemis nobilis. These very popular herbs are used almost interchangeably. Their chemistry is somewhat different, however.

Chamomile has a long-standing reputation as being good for almost anything that might ail a body.

Millions of children have learned about one of its most widespread uses, treating indigestion due to dietary indiscretion, from Beatrix Potter's The Tale of Peter Rabbit.

Chamomile has small, white daisylike flowers with a yellow center. The flower is the part of the herb that is used.

Active Ingredients

M. chamomilla: German chamomile flowers contain about 0.5 percent of a volatile oil that is light blue. The most important constituents of the oil are bisabolol and related compounds and matricin.

Bisabolol has significant antispasmodic and anti-inflammatory activity.

Up to half of the oil is chamazulene, formed from matricin during heating.

Flavonoids in the flowers, apigenin and luteolin, are also active. In addition, the coumarins herniarin and umbelliferone may also quell inflammation and quiet smooth muscle spasms.

No single ingredient has been identified as responsible for the benefits of chamomile.

C. nobile: Roman chamomile flowers contain from 0.5 to 2.5 percent essential oil, which does not contain bisabolol.

The flavonoid ingredients are similar, though not identical, to those of M. chamomilla.

Uses

Both types of chamomile have traditionally been used in tea to treat digestive distress including stomachache, cramps, colitis, and flatulence.

Several of the constituents, bisabolol, for example, show antispasmodic activity in the test tube. In animal experiments, bisabolol also protects the stomach against ulcers caused by alcohol or indomethacin (a potent arthritis drug that often causes ulcers).

Another traditional use has been to relieve menstrual cramps.

Chamomile infusions are also used to stimulate the appetite and to aid digestion.

Chamomile tea is considered a mild sleep aid. In one study, it was effective in helping 80 percent of the patients awaiting cardiac catheterization get to sleep.

It is also used as a gentle treatment for fevers. Bisabolol can reduce fever in rats.

The essential oils are not very soluble in water; as a result, the dose of active ingredients delivered in the usual cup of chamomile tea is low.

Dr. Norman Farnsworth of the University of Illinois has suggested, however, that regular use of chamomile tea over an extended period has cumulative benefits.

Chamomile preparations are also used topically for red, inflamed skin and as a mouthwash or gargle. Components of chamomile have antibacterial and antifungal activity.

Both bisabolol and the flavonoids are nearly as active as indomethacin in reducing inflammation in animal tests. Bisabolol helps burns heal faster under experimental conditions.

People with colds sometimes breathe in the vapors from a steaming cup of chamomile tea. This pleasantly aromatic steam is believed to help relieve congestion of the nose and lungs, at least for a short time unless you develop allergies or other symptoms.

Dose

To make the tea, pour approximately 2/3 cup boiling water over 1 or 2 teaspoons dried chamomile flowers and steep at least five minutes.

For digestive problems, drink tea three to four times a day, between meals. There are no limitations on duration of use.

Special Precautions

Chamomile, like feverfew, belongs to the family of asters. Anyone allergic to ragweed, chrysanthemums, or other flowers in the family should probably avoid use of this herb as a sensible precaution.

Allergic reactions have been reported, characterized by abdominal cramps, hives, tongue thickness, swelling of the lips and throat, or difficulty breathing.

Chamomile should not be used to wash out the eyes or the area immediately around the eyes.

Adverse Effects

Ingesting large amounts of dried chamomile flowers can cause vomiting.

Possible Interactions

Interactions have not been reported.

There is a theoretical possibility, however, that taking another medication at the same time as chamomile tea could delay absorption of the other drug.

No interactions with the anticoagulant Coumadin have been reported, but in theory the coumarins in chamomile might potentiate this drug's effect. Careful monitoring of bleeding time (through PT and INR) are recommended if chamomile is to be used together with Coumadin.

Cayenne

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The Capsicum genus originated in the New World but has been adopted into cuisines around the globe.

It contains as many as five species, with an untold number of variants, giving rise not only to the familiar green bell pepper, but also to paprika and a wide range of "hot peppers."

The flavors of these fruits have been much appreciated as spices for a very long time. Archaeologists have found remains of chilies in Mexican sites dating to 7000 b.c., and hot peppers played an important role in Aztec and Maya mythology.

The spiciness of edible peppers varies dramatically. The active ingredient in hot peppers, capsaicin, is so strong that people can detect it at a concentration as low as just one part in eleven million.

Most people have no trouble telling a mild pepper from a torrid one, but it was the medicinal use of cayenne that led to a way to compare them consistently.

When capsaicin is applied to the skin, it provokes a feeling of warmth and stimulates circulation in the area. As a consequence, these fruits are popular ingredients in liniments or rubs for arthritis.

Back in 1912 Wilbur Scoville, a pharmacologist working for Parke Davis, needed to standardize the pepper extract used to make Heet Liniment. He started with an organoleptic scale that required a panel of tasters to measure pepper hotness.

Using Scoville's scale, the capsaicin in a capsicum fruit is currently determined by high-tech machines rather than sensitive palates.

The "hotness" of peppers can range from 3,000 to 5,000 Scoville units for a jalapeño to about 50,000 Scoville units for a cayenne pepper. The very hottest, the habañeros, weigh in at 200,000 to 300,000 Scoville units.

The part of the plant used medicinally is the fruit. To flavor food, it may be used fresh or dried, but in herbal products it is generally dried.

Although referred to as "cayenne," not all botanicals containing C. annuum are derived from the variety that connoisseurs of hot peppers would recognize as cayenne.

As with other plants, growing conditions and variety can alter the composition of capsicum fruit.

Active Ingredients

Capsicum peppers are rich in nutrients, especially vitamin C and a range of carotenes. Not only beta-carotene (which is in abundant supply), but also such compounds as lutein, zeaxanthin, and others are found in these fruits.

But the ingredient that is responsible for most of the medicinal effects of cayenne is capsaicin, a pungent phenolic compound structurally similar to eugenol, a pain-relieving compound found in cloves and some other spices.

Uses

The principal use of both cayenne and of capsaicin derived from it is in topical ointments or creams. Such rubs have long been used to alleviate joint pain due to arthritis or the pain of muscle spasms.

When applied to the skin, capsicum results in a feeling of warmth, which may in some people become a perception of heat or even of burning.

With repeated applications, the capsaicin depletes substance P from nerves in the skin. Because substance P is apparently crucial to the transmission of pain sensation, its depletion results in diminished pain.

This action led to the development of over-the-counter creams containing 0.025 percent capsaicin to treat postherpetic neuralgia, diabetic , and trigeminal neuralgia. A higher-potency product, Zostrix-HP, with three times as much capsaicin, is also available.

Other painful conditions such as phantom limb syndrome, postmastectomy pain, and reflex sympathetic dystrophy are being studied to see if capsaicin can be helpful.

Preliminary research suggests that capsaicin may be helpful for the treatment of cluster headache, and a nasal spray has been tested at Johns Hopkins Asthma and Allergy Center for the treatment of chronic runny nose.

Traditionally, cayenne was recommended to stimulate the appetite and aid digestion.

Although people often think of chili peppers as irritating to the digestive tract, studies in rats have actually shown that pretreatment of the stomach lining with capsaicin solution (similar to Tabasco sauce) prevented damage from subsequent aspirin exposure.

It also prevented damage due to alcohol; this research was carried out in rats, and its applicability to humans is uncertain. Clinicians have established, however, that capsicum ingestion does not slow the healing of ulcers.

Preliminary studies suggest that chili peppers may help lower cholesterol or slow blood clotting. Further research is needed for confirmation of these uses.

Dose

Topical use of capsaicin in over-the-counter or herbal preparations requires repeated applications. Varro E. Tyler suggests four or five applications daily over a period of four weeks.

At least three days of applications are needed to determine the effect. There are no time limits on topical use of cayenne preparations unless you develop a reaction.

Semi-liquid preparations contain 0.02 to 0.05 percent capsaicin; liquids contain 0.005 to 0.01 percent capsaicin; and poultices may contain 10 to 40 g capsaicin and related compounds per square centimeter.

Tolerance of cayenne for internal use varies with the individual. In capsules, the usually recommended dose ranges from 30 to 120 mg three times a day.

Special Precautions

Capsaicin-containing preparations must not be applied to broken skin.

Great care must be taken when handling chili peppers or capsaicin creams. Capsaicin is extremely irritating to the eyes or delicate mucous membranes, and it is not very soluble in water.

As a consequence, using the fingers to apply a rub may mean that touching the eyes much later can result in a painful burning sensation. Handling contact lenses could also result in burning eyes. Use of gloves or an applicator may be advisable.

To remove capsaicin from the hands, milk or vinegar may be more effective than water.

Skin treated with capsaicin should not be bandaged or exposed to heating pads.

People with a history of asthma should take care not to inhale capsicum fumes, which can be irritating to the lungs.

Capsaicin may stimulate the bowel and is not generally considered appropriate for people with irritable bowel syndrome or chronic bowel inflammation.

Adverse Effects

Redness, irritation, stinging, or burning sensations occur in at least 30 percent of people using topical capsaicin preparations, especially when a person has not been applying the cream regularly.

Allergic reactions have been reported on occasion.

Inhalation of powdered cayenne or of fumes from heated or burned chilies can cause coughing or chest tightness in susceptible people.

Ingestion of capsicum fruit can result in burning sensations of the digestive tract. To minimize this problem, reduce the dose, remove the seeds before consuming the peppers, or eat bananas to ease the discomfort.

Possible Interactions

There have been no reports of capsicum interacting with medications.

If indeed this herb has the potential to prolong clotting time, however, people taking Coumadin or other anticoagulants should exercise caution before eating quantities of chili peppers.

Topical application may not pose a threat of interaction.

Some reports suggest that capsicum may interfere with MAO inhibitors such as Nardil or Parnate and with certain blood pressure medications. Capsaicin inhibits liver enzymes (CYP1A2) and thus slows the metabolism of Anafranil, Clozaril, Cognex, Coumadin, imipramine, theophylline, Zyflo, and Zyprexa.

Cat's Claw

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Cat's claw, or uña de gato as it is also called, has piqued many people's interest lately, first because it comes from remote and exotic rain forests, and second, because it is believed to act on the immune system.

Both species referred to as cat's claw are climbing woody vines (lianas) in the Amazon forest. The name refers to the small sharp spines on the stem near the leaf, curved back like a cat's claw.

U. guianensis has been used by native people in South America to treat intestinal problems and to heal wounds.

The bark is used by different tribes for different purposes: Some find it an effective contraceptive, and others use it to treat gonorrhea.

This plant is widely used to relieve the pain of rheumatism and to reduce inflammation, as well as for dysentery and ulcers. This species of cat's claw is preferred in the European market.

U. tomentosa, from the Peruvian headwaters of the Amazon, is often used for arthritis, ulcers, and other intestinal problems.

In addition, it is prized as a general tonic for its "life-giving" properties and is used for certain skin diseases.

The North American marketplace provides the major commercial outlet for this species. The bark is the part of the plant generally used for medicinal purposes.

Active Ingredients

Research on the constituents of uña de gato was begun only a few decades ago. Both species appear to contain alkaloids. U. tomentosa also contains quinovic acid glycosides and some novel triterpenes.

Uses

Traditional use by Amazonian tribes includes the treatment of a number of digestive disorders. Uña de gato is sometimes promoted in the United States to treat problems such as hemorrhoids, gastritis, colitis, ulcers, diverticulitis, and leaky bowel.

These applications appear to be based more on reports of folk medicine from the Amazon than on clinical or animal studies.

In the test tube, most of the alkaloids of U. tomentosa can be shown to activate immune system cells.

Several quinovic acid glycosides are active against various viruses in the laboratory.

Many of these compounds also counteract inflammation caused experimentally in rat-paw tests.

An important alkaloid lowers blood pressure, relaxes and dilates peripheral blood vessels, slows heart rate, and lowers cholesterol. Another acts as a diuretic.

The immune-stimulating effects of U. tomentosa have attracted attention for the possibility that the herb might be useful against cancer or HIV.

Studies of its use in the context of medical treatment of these life-threatening conditions are needed.

Dose

Standard dose information is not available.

Special Precautions

Pregnant women should not take cat's claw because its safety and mode of action have been inadequately studied.

In test tube studies, however, extracts of this herb have not caused mutations in cells; indeed, they appear to protect against mutations.

Adverse Effects

No serious reactions have been reported in the literature.

Possible Interactions

No interactions with other drugs or herbs have been reported in the literature.

Because of the limited information available, it seems prudent not to combine U. tomentosa with other herbs or drugs that affect the immune system such as cortisone-like drugs or cyclosporine.

Cascara Sagrada

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Cascara sagrada, Spanish for "sacred bark," comes from the American buckthorn tree native to the western coast of North America, from California to British Columbia, and as far inland as Montana. The Spanish priests of California may have learned about it from the Indians.

In any event, this laxative was not widely adopted until the nineteenth century. A member of the same genus, R. frangula, is the European buckthorn tree, which had been used at least since 1650.

Cascara sagrada is one of the few herbs approved as an over-the-counter drug by the U.S. Food and Drug Administration. The portion of the plant used is the bark.

Active Ingredients

The main ingredients are anthraquinones.

Emodin and aloe-emodin have also been identified, along with a number of nonlaxative ingredients.

Uses

Cascara sagrada is used as a laxative. The anthraquinones stimulate the bowel, leading to evacuation after approximately six to ten hours.

This herb also provokes secretion of fluid and minerals into the large intestine and inhibits their reabsorption. It is suggested for situations in which a soft, easily passed stool is desirable, such as hemorrhoids or following rectal surgery.

Cascara sagrada is not appropriate for regular use and can cause problems such as dependence if it is used too often.

Studies are being done to see if it is helpful in treating drug overdose, as a way of removing the drug from the lower intestine.

In addition, anthraquinones applied topically can protect skin from ultraviolet damage.

Extracts of R. purshiana can inactivate herpes simplex virus, but this property has not been utilized medically.

Dose

The usual dose ranges from 20 mg to 70 mg daily of the anthraquinones. Products containing cascara sagrada should not be used for more than eight or ten days.

Special Precautions

Fresh bark can cause nausea and vomiting. The bark should be stored for at least a year or undergo heat processing to eliminate this problem.

Pregnant women and nursing mothers should avoid cascara sagrada.

People with intestinal blockage, undiagnosed stomach pain, or symptoms that might indicate appendicitis must avoid laxatives such as cascara sagrada.

People with diarrhea, inflammatory bowel disease, or intestinal ulcers must not use cascara sagrada.

Children younger than twelve with constipation should not be treated with cascara sagrada.

Adverse Effects

Abdominal cramps or diarrhea have been reported.

Chronic use of laxatives may lead to excessive loss of potassium or other electrolytes, which may be dangerous. In addition, anthraquinones can cause pigmentation of the large bowel.

A serious problem associated with chronic use, however, is that a person may become dependent on such a stimulant laxative and become unable to evacuate without it. This leads to problems that resemble ulcerative colitis.

Possible Interactions

If cascara sagrada results in excessive potassium loss, heart rhythm irregularities may occur. This problem could be especially severe for people taking the heart drug Lanoxin.

It would be unwise to use cascara sagrada together with other herbal medicines that can cause potassium loss, such as aloe or licorice.

Medications such as hydrochlorothiazide, Lasix, Hygroton, Lozol, Bumex, and other potassium-wasting diuretics are probably incompatible with cascara sagrada, at least if it were used more than very occasionally.

Cascara sagrada, like other strong laxatives, may reduce the absorption of other medicines taken orally.

Boswellia

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Frankincense, like myrrh, is featured in the Bible story about the three wise men visiting the infant Jesus. Like myrrh, frankincense is a resin from a tree in the family Burseraceae. (Guggul is another resin from Boswellia carteri, a tree in that family.)

Frankincense comes from Boswellia, a tree that grows in Somalia and parts of Saudi Arabia. Boswellia, or Indian frankincense, comes from Boswellia serrata, a tree native to hilly regions of India.

Like guggul, this resin has a long tradition of use in Ayurvedic medicine and is almost unknown in Europe and North American herbal traditions. At least one product sold in health food stores, Boswellin, contains a standardized ethanol extract of boswellia gum.

Active Ingredients

Boswellin is standardized to 60 to 65 percent boswellic acid and its derivatives. These are the primary active ingredients in the gum resin. The volatile oil contains pinene and phellandrene, among other ingredients, and imparts a distinctive fragrance, similar to that of frankincense.

Uses

In Ayurvedic medicine, different parts of B. serrata were traditionally used to treat such varied health conditions as asthma, dysentery, rheumatism, ulcers, and skin disorders.

Extracts of the resin have shown unmistakable anti-inflammatory power in animals, and rats with experimental arthritis responded well to treatment without apparent side effects. Test tube research shows that boswellic acids inhibit a specific enzyme crucial in producing certain chemicals important in the process of inflammation.

A boswellic acid mixture is used in India to treat arthritis. A double-blind crossover study of patients with osteoarthritis demonstrated that a preparation containing B. serrata significantly reduced disability scores and pain, although it did not alter the underlying joint deformity.

The arthritis benefits from boswellic acids may be related to their impact on glycosaminoglycan metabolism; these are the same biochemical pathways affected by glucosamine. Boswellic acid also has an effect on the immune system.

A boswellia gum resin preparation has been studied for the treatment of ulcerative colitis in comparison to sulfasalazine, a standard drug for this condition.

Over the course of six weeks, measures such as blood tests, stool analyses, and tissue pathology showed improvement. Three-fourths of the patients given sulfasalazine went into remission, and 82 percent of those on the resin preparation did so as well.

Dose

The dose utilized in the ulcerative colitis study was 350 mg three times a day. That study lasted six weeks.

Special Precautions

No special precautions are noted.

Adverse Effects

Boswellia has not been shown to cause ulcers, cardiovascular, respiratory, or psychological side effects.

In clinical trials, no side effects experienced by patients were severe enough to require them to stop participating in the study.

Possible Interactions

No interactions have been reported. Limited experience with this botanical medicine in Europe or North America may mean that it has not been widely used in conjunction with pharmaceutical medicines.

Black Cohosh

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This plant, native to North American forests, has a number of popular names: bugbane, black snakeroot, rattleroot, and squaw root.

It sends up graceful tall spires of white flowers; the black in its common name refers to the root or rhizome, as does cohosh, Algonquian for "rough."

Native Americans prized black cohosh and used it for a variety of purposes. The settlers learned about it from the Indians, but by the middle of the nineteenth century it was renowned as being helpful for women's problems, and other uses were more or less forgotten.

Black cohosh was a key ingredient in an immensely popular patent medicine, Lydia E. Pinkham's Vegetable Compound.

Black cohosh has been used for menopausal symptoms in recent years. The portion of the plant used is underground: the rhizome and roots.

Active Ingredients

The main ingredients are triterpene glycosides, especially actein, related compounds, and cimigoside.

Black cohosh also contains tannins, fatty acids, and phytosterols. In a laboratory test of estrogenic activity, black cohosh extract did not bind to estrogen receptors.

Uses

In Europe, black cohosh is used for symptoms such as hot flashes, headaches, psychological difficulties, and weight gain associated with menopause. It is also reputed to be helpful for premenstrual problems and painful menstrual cramps.

American Indians treated sore throats and rheumatism with this herb, but these uses have not been scrutinized by modern medical studies.

Some of the evidence on the clinical effect of black cohosh is impressive.

In one study, sixty women under forty years of age who had undergone hysterectomy were divided into groups. One group got conjugated estrogen (available in the United States under the brand name Premarin), one was given estriol (another form of estrogen), a third received an estrogen-gestagen sequence, and the fourth group of women took a black cohosh extract.

Bothersome symptoms such as hot flashes disappeared slowly, over the course of four weeks, and at that point there was no difference in response among the four groups. This suggests that black cohosh may be as good at treating symptoms of menopause as are conventional estrogen treatments.

Animal research indicates that black cohosh can lower cholesterol and strengthen bone, as estrogen does. These promising results should be confirmed with clinical investigations in women.

Research should also be conducted on whether black cohosh increases the risk of breast or uterine cancer as estrogen can. Studies in the test tube and in animals are inconsistent regarding the effect of black cohosh on uterine tissue.

Dose

The usual daily dose is equivalent to 40 mg of the herb. It may take four weeks to get the maximum benefit; the herb should not be taken for more than six months until there is more information available on long-term effects.

A standardized German product is available in the United States under the brand name Remifemin, to be taken twice a day.

Special Precautions

Although black cohosh is not mutagenic or carcinogenic and does not cause birth defects in animals, authorities caution pregnant women not to use it. There is a report of premature birth associated with the herb and worries that it could trigger miscarriage.

It is not known whether women who have had breast cancer can safely use black cohosh as a substitute for HRT.

Adverse Effects

Stomachache, nausea, or other digestive distress has been reported.

A six-month study in rats at extremely high doses did not produce any toxicity. Overdose in humans has resulted in dizziness, vomiting, headache, increased perspiration, lowered blood pressure, and visual disturbances.

One woman taking a preparation that included black cohosh experienced seizures. Determining whether the herb was related to this event in any way could prove extremely difficult.

Possible Interactions

No interactions have been reported in the literature. It would seem illogical, however, to mix black cohosh with standard HRT regimens, and it could prove incompatible.

Bilberry

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"Bilberry" sounds a lot like "blueberry," and for good reason. The bilberry is a European blueberry. American blueberries are Vaccinium corymbosum. Huckleberries and whortleberries are also closely related.

Although blueberries in the United States are noted primarily for their excellent contributions to pies and jam, in Europe the dried fruit has long been considered an excellent treatment for simple diarrhea. As blueberry pickers may know, imbibing in too many fresh berries may have the opposite effect.

Bilberries have had a long-standing reputation as being good for night vision. Royal Air Force pilots ate bilberry preserves before flying night missions during World War II.

This medicinal food should be investigated further; preliminary studies of bilberry extract hint at several benefits for vision. In general, however, the parts of the plant used medicinally are the dried fruits and the leaves.

Active Ingredients

Early analyses indicated that dried bilberries contained up to 10 percent tannins, which would certainly explain their effectiveness against diarrhea.

More modern methods reveal only about 1.5 percent of the fruit content is tannins. The berries do contain significant amounts of pectin, which may also contribute to calming diarrhea.

Other important constituents include anthocyanidins, invert sugar and fruit acids. Flavonoids include quercitrin, isoquercitrin, hyperoside, and astragaline.

The anthocyanidins may be important in supporting night vision, while the specific contributions of other constituents to the medicinal activity of bilberry have not been identified. The leaves are rich in manganese and chromium and very high in tannins, ranging from 10 to 20 percent.

Uses

The traditional use for bilberry is to take the dried fruit for mild diarrhea. The berries are administered either whole, in which case they are chewed and swallowed, or as tea.

It is important that the fruit be dried; fresh fruit is ineffective or even counterproductive. Dried blueberries might work, however.

Europeans have also used a preparation of bilberry topically to treat sore throats and mild inflammation in the mouth.

An extract of bilberry with 25 percent anthocyanidins is reported to protect blood vessels and prevent swelling due to inflammation.

Research in rabbits and rats suggests that such an extract can reduce blood vessel permeability and help protect against some of the effects of high blood pressure.

Extracts are used in Europe to treat hemorrhoids and varicose veins in pregnant women and the elderly.

One specific anthocyanidin pigment seems to protect the stomach of laboratory animals from experimentally induced ulcers without affecting stomach acid secretion. Instead, the pigment appears to stimulate the production of a protective prostaglandin.

Anthocyanidins have strong antioxidant activity. Preliminary studies suggest that an extract high in anthocyanidins can improve night vision and may slow the development of macular degeneration or cataracts.

It has been suggested as a treatment to help prevent diabetic retinopathy. Further investigation is needed to confirm these benefits.

Like dried bilberries, the dried leaves of the plant have also been used in a tea to treat mild diarrhea or as a gargle for sore throat.

Bilberry leaves have a reputation for being able to lower blood sugar in diabetes, and their high chromium content suggests that they might indeed offer some benefit. Good clinical studies are needed to investigate this possibility.

Dose

The usual dose of dried bilberries is approximately 3 tablespoons a day. To make the tea, boil 1 tablespoon (roughly 10 g) of crushed dried fruits in water for about ten minutes and then strain before drinking. Maximum daily dose is 60 g of dried berries.

In the form of an extract, take 240 to 480 mg daily standardized to 25 percent anthocyanosides, in divided doses.

To make a bilberry leaf tea, pour boiling water over about 11Ú2 teaspoons of dried leaves, steep for five or ten minutes, and strain.

Bilberry tea should not be used as an herbal medicine for more than three or four days. If diarrhea persists, medical attention is required.

Special Precautions

No special precautions are known for bilberry fruit.

Any diabetic who decides to try a bilberry leaf decoction despite the lack of evidence that it is effective should be using other effective treatments and closely monitoring blood sugar.

Adverse Effects

No side effects of dried bilberries have been reported in the literature.

Bilberry leaves may cause serious problems in experimental animals administered large doses over a long time.

In one experiment, the animals stopped eating, developed anemia and jaundice, became agitated, and eventually died. It is possible that the leaves they were given had been adulterated with leaves from another plant.

These serious consequences are enough to suggest, however, that people should not take high doses of bilberry leaf over a long term.

Possible Interactions

No interactions have been reported with bilberries.

Because of the high levels of tannins in bilberry leaf, however, it is possible that it could interfere with the absorption of iron.

Arnica

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Arnica montana is a perennial flowering plant native to southern Russia and other mountainous areas in Europe.

In Germany, A. montana is a protected species, so the pharmacopoeia there includes the very similar species A. chamissonis. (French and Swiss pharmacopoeias do not permit this substitution.)

Vernacular names include leopard's bane and mountain tobacco.

There are also North American species of arnica (A. fulgens, A. sororia, A. latifolia, and A. cordifolia). All these species have attractive yellow daisylike flowers, and all have been used medicinally for centuries.

While the Europeans started using arnica back in the sixteenth century for digestive disorders, to reduce fever, and as a topical treatment for skin disorders, Native American groups were experimenting with other uses.

At one time the entire plant, including the rhizome ("root") was used, but now only the flowers are included in herbal medicines.

American settlers used tincture of arnica to soothe sore throats and improve circulation. The German philosopher Goethe is said to have used arnica tea as a remedy for chest pain.

Current understanding of the potential toxicity of arnica, especially for the heart, has relegated its modern use to external applications and homeopathic tinctures.

*Active Ingredients*

Arnica flowers contain a number of sesquiterpene lactones, with the exact mix and amount of each one varying from one species to another as well as with growing conditions.

European standards specify "not less than 0.7 percent m/m of total lactone sesquiterpenes."

The primary ones are helenalin and related compounds. Acetic, isobutyric, and other carboxylic acids have also been identified.

Typically, a number of flavonoids are also present, including isoquercitrin, luteolin, kaempferol, quercitin, and astragalin.

The pyrrolizidine alkaloids tussilagine and isotussilagine may pose a risk of hepatotoxicity.

The flowers also contain caffeic acid and its derivatives and an essential oil containing fatty acids, carotenoids, and thymol derivatives, along with the coumarins umbelliferone and scopoletin.

*Uses*

Arnica flowers in ointments, creams, or gels are most commonly used for the topical treatment of bruises and sprains. They have also been recommended for inflammation due to insect bites and for stiff, inflamed joints.

Such remedies seem to have a mild anti-inflammatory effect with some ability to relieve pain.

In one double-blind trial, arnica reduced stiffness following a marathon run. Other studies have not demonstrated its superiority to placebo.

Helenalin and dihydrohelenalin have strong antibacterial activity. The European Scientific Cooperative on Phytotherapy suggests that arnica flower preparations may be gargled or applied to canker sores or inflamed gums (gingivitis).

One study of people following dental surgery for impacted wisdom teeth did not show any advantage of arnica flower mouthwash, however. The patients using metronidazole healed more rapidly, while those using arnica had greater inflammation and pain than those on placebo.

It is important not to swallow any arnica solution or gel used in the mouth; be sure to split it out and rinse the mouth out with water.

Arnica polysaccharides seem to stimulate the immune system and other constituents keep blood clots from forming. This property may help explain the traditional belief that arnica improves blood flow and heals bruises.

Despite these activities, traditional internal uses of arnica to stimulate the heart or improve blood flow are far too dangerous for a reasonable person to try them.

*Dose*

Ointments, gels, or creams containing 5 to 25 percent tincture or extract are applied topically according to directions.

For mouth rinse, the tincture is diluted ten times.

Prolonged use is discouraged due to the possibility of developing eczema, edema, or rash.

*Special Precautions*

Arnica flower preparations are appropriate for external use only. They should not be applied to open wounds or broken skin.

Arnica is a member of the aster family. Anyone allergic to ragweed or other flowers in the family should avoid arnica-containing products.

Arnica itself may trigger allergy or contact dermatitis and should be avoided by anyone who has experienced such a reaction to this plant in the past.

Although external applications might not trigger uterine contractions, pregnant women should not use arnica.

*Adverse Effects*

Arnica is considered a poisonous plant. Taken internally, arnica can cause stomach pain, vomiting, diarrhea, and inflammation of the mucous membranes.

At high doses, nervousness, altered pulse, and muscular weakness has been reported. Difficulty breathing may precede cardiac arrest. Deaths have occurred.

Children who have eaten flowers have suffered vomiting, drowsiness, and coma.

Arnica flower extracts have serious toxicity if taken internally. Studies in laboratory animals demonstrated clearly that such preparations harm the heart and significantly raise blood pressure.

Animal studies also confirmed arnica's ability to stimulate uterine contractions.

Topical arnica preparations can cause contact dermatitis or even eczema in people who are frequently exposed to the plant. One gardener suffered chronic eczema of the hands and face until arnica flowers were identified as the allergen.

If rash or swelling occurs on skin that has been exposed to arnica, the preparation should be discontinued immediately.

*Possible Interactions*

If arnica were taken internally, in addition to serious side effects, it would possibly interact with the anticoagulant Coumadin because of the herb's ability to inhibit platelet aggregation.

No interactions with topical arnica preparations have been reported.

Aloe Vera

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There are nearly five hundred species of aloe, a type of plant that originated in southern Africa, near the Cape of Good Hope.

The use of aloe goes back in history. There are pictures of aloe plants on some Egyptian temples. The Greek physician Dioscorides wrote of its benefits to heal wounds and treat hemorrhoids.

Aloes now grow throughout Africa, around the Mediterranean and the Caribbean, and in many countries in South America.

The thick, juicy leaves contain two distinct products that are used medicinally and that need to be distinguished to avoid confusion.

One is the thin clear gel or mucilage that oozes from the middle of a broken leaf.

The other is a bitter latex, referred to as aloe vera juice, derived from the cells just under the surface of the leaf. Their compositions and uses differ.

Active Ingredients

Gel: mucopolysaccharides.

Latex: anthraquinone derivatives, mostly in the form of aloins, with smaller amounts of hydroxyaloins, aloe-emodin, and aloeresins.

Uses

Gel: The mucilage is used topically on wounds and burns to help them heal more rapidly.

Taken internally, it is considered a general tonic. Unfortunately, separation of the gel from the latex for commercial preparations is often incomplete, and the gel may end up with some laxative action due to inadvertent inclusion of latex.

It has been recommended for burns due to radiation, but like most of its uses this one is considered incompletely proved and controversial.

There is no harm in applying fresh gel from a broken leaf to a minor cut or burn, and many people find it soothing. But studies using commercial preparations have not consistently established benefit in speeding wound healing, and there are questions about their chemical stability.

In the test tube, gels from some species of aloe have antibacterial activity. A. vera, however, does not appear to kill many microbes.

In animal studies, injected aloe gel improved circulation and sped wound healing. Both injection and topical application were shown independently to reduce inflammation in animals. Aloe gel blocks bradykinin, which may be how it alleviates pain.

Latex: Aloe latex is a powerful laxative that irritates the intestine. We do not recommend using this product.

Dose

Gel: For external application, a little dab from a broken leaf will do you.

Special Precautions

Latex:

  • Pregnant women must avoid aloe latex; use has been known to trigger abortion or premature birth.
  • Nursing mothers should take this laxative only under medical supervision.
  • Children must not take aloe latex.
  • Women who are menstruating should not use aloe latex, as it may increase blood flow.
  • Aloe latex may be very dangerous when there is an intestinal blockage and must be avoided in such cases.
  • Aloe latex is not appropriate for people with intestinal inflammation such as ulcerative colitis or Crohn's disease, and it should not be taken by people with inflamed hemorrhoids.
  • People with kidney problems should avoid aloe latex.

Adverse Effects

Latex: The most serious difficulties encountered with aloe latex occur at higher than recommended doses or when used for more than a few days.

This laxative herb causes the loss of potassium and other minerals, which over time can result in a loss of muscle tone of the intestine and diminished effectiveness. Frequent use may cause irreversible damage.

Large doses of aloe have caused bloody diarrhea, kidney damage, and even death.

The urine may take on a reddish color after taking aloe latex. This color is harmless; however, with the possibility of kidney damage from large doses or prolonged use, any persistent color in the urine may call for medical diagnosis. Possible Interactions

Low potassium levels can be dangerous in a person taking a heart drug like Lanoxin.

Aloe latex might also be dangerous for anyone taking a diuretic that depletes the body of potassium (Lasix, HCTZ, etc.) because of the additive effect. It should be avoided in such situations.

Aloe latex could reduce the absorption of any pill taken around the same time because it cuts intestinal transit time so drastically.

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