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ECHINACEA

*Other Common Name:*	Purple coneflower
*Botanical Names:*	Echinacea angustifolia, Echinacea purpurea
*Family:*	Compositae
*Plant Parts Used:*	Root, aerial parts

PRESCRIBING INFORMATION

Actions	Immune modulating, immune enhancing, depurative, antiinflammatory, vulnerary, lymphatic, sialagogue
Potential Indications	Based on appropriate evaluation of the patient, practitioners should consider prescribing Echinacea root in formulations in the context of: • Treating and preventing upper respiratory tract infections (1,4,5) • Treating and preventing infections in general (5) • Enhancing immune response in healthy individuals (4) • Nasopharyngeal catarrh, respiratory catarrh, chronic bronchitis (5) • Sinusitis, in combination with Thuja and Baptisia (3) • Adjuvant therapy for cancer (5) • Abscess, boils, poorly healing wounds, furunculosis, eczema, psoriasis, mouth ulcers, venomous bites, skin and glandular inflammations (5)

Contraindications No conclusive evidence has been found that using Echinacea for long periods is detrimental or that it is contraindicated in disorders such as autoimmune disease, allergies, and asthma. The risk of allergic reaction to Echinacea itself is very small, especially if preparations of the root are used, given that these are free of pollens. Warnings and Precautions

Caution is advised for transplant patients taking immunosuppressive drugs; short-term therapy only is suggested. Misinformation exists that Echinacea is potentially hepatotoxic because of the presence of pyrrolizidine alkaloids (PAs). However, the PAs found in Echinacea possess chemical structures that are known to be nontoxic.

Allergic reactions, mainly contact dermatitis, may occur rarely in susceptible patients sensitized to Echinacea aerial parts and plants from the Compositae family. The likelihood of Echinacea root preparations causing allergy is very low.

Interactions See the “Warnings and Precautions” section in this monograph. Use in Pregnancy and Lactation

No adverse effects expected.

A prospective, controlled study published in 2000 concluded that gestational use of Echinacea (generally for 5 to 7 days) during organogenesis was not associated with an increased risk of major malformations. No significant differences were found in pregnancy outcome between the study group, including 206 women who had used Echinacea during pregnancy (112 women in the first trimester) and their matched controls.¹

Side Effects Side effects are generally not expected for oral or topical administration. Dosage Flowering tops, aerial parts, root, and whole plant of Echinacea are used medicinally. In traditional herbal medicine, the root was the preferred plant part that Native Americans and the Eclectic physicians used. Only doses for the use of the root of the preferred Echinacea species are provided here. Echinacea purpurea root: Dose per day^* Dose per week^* 3–6 ml of 1:2 liquid extract 20–40 ml of 1:2 liquid extract 4.5–8.5 ml of 1:3 glycetract 30–60 ml of 1:3 glycetract Echinacea angustifolia root: Dose per day^* Dose per week^* 3–6 ml of 1:2 liquid extract 20–40 ml of 1:2 liquid extract Preparations containing a blend of Echinacea purpurea root and Echinacea angustifolia root: Dose per day^* Dose per week^* 3–6 ml of blended 1:2 liquid extracts 20–40 ml of blended 1:2 liquid extracts

* This dose range is extrapolated from the British Herbal Compendium 1992 and the author’s education and experience.

SUPPORTING INFORMATION

REFERENCES

Except when specifically referenced, the following book was referred to in the compilation of the pharmacologic and clinical informationMills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Edinburgh: Churchill Livingstone, 2000.

1 Gallo M, et al. Arch Intern Med. 2000;160(20):3141-3143.

2 Felter HW, Lloyd JU. King’s American dispensatory, ed 18. Portland: Eclectic Medical Publications, 1905. rev 3, reprinted 1983

3 Ellingwood F, Lloyd JU. American materia medica, therapeutics and pharmacognosy, ed 11. Portland: Eclectic Medical Publications, 1983.

4 Vogel VJ. American Indian medicine. Norman, Okla: University of Oklahoma Press, 1970.

5 Awang DVC. Altern Ther Women’s Health. 1999;July:57-59.

6 Rehman J, et al. Immun Lett. 1999;68(2-3):391-395.

7 Barrett B, Vohman M, Calabrese C. J Fam Prac. 1999;48(8):628-635.

8 MacIntosh A et al: Publication in press.

9 Lindenmuth GF, Lindenmuth EB. J Altern Complement Med. 2000;6(4):327-334.

10 Turner RB, Riker DK, Gangemi JD. Antimicrob Agents Chemother. 2000;44(6):1708-1709.

11 Scientific Committee of the European Scientific Cooperative on Phytotherapy [ESCOP]. ESCOP monographs: Echinaceae purpureae radix. Argyle House, Gandy Street, Exeter, Devon, EX4 3LS, United Kingdom: European Scientific Cooperative on Phytotherapy, ESCOP Secretariat, October 1999.

ELDER FLOWER

*Botanical Name:*	Sambucus nigra
*Family:*	Caprifoliaceae
*Plant Part Used:*	Flower

PRESCRIBING INFORMATION

Actions	Diaphoretic, anticatarrhal
Potential Indications	Based on appropriate evaluation of the patient, practitioners should consider prescribing elder flower in formulations in the context of: • The common cold (4,5) • Conditions requiring diaphoresis, such as fevers and influenza (5) • Acute and chronic sinusitis, hay fever (5) • Pleurisy, bronchitis, sore throat, measles (6)

Contraindications None known. Warnings and Precautions None required. Interactions None known. Use in Pregnancy and Lactation No adverse effects expected. Side Effects None expected if taken within the recommended dose range. Dosage Dose per day^* Dose per week^* 2–6 ml of 1:2 liquid extract 15–40 ml of 1:2 liquid extract

* This dose range is extrapolated from the British Herbal Pharmacopoeia 1983 and the author’s education and experience.

SUPPORTING INFORMATION

Traditional Prescribing	Traditional Western herbal medicine uses include: • As a diaphoretic in any condition requiring fever management, including the common cold and influenza (particularly in the early stages); sinusitis, chronic nasal catarrh with deafness,¹ pleurisy, bronchitis, sore throat, measles, fevers, scarlet fever² • Topically for inflammation of the eyes, skin disorders, wounds,² and burns³
Traditional Prescribing	Eclectic physicians regarded warm infusions of Sambucus canadensis, a similar herb, as diaphoretic and warming and cold infusions as diuretic and depurative. Therefore Sambucus canadensis was also used to treat skin infections and liver disorders.³
Pharmacologic Research	• Aqueous extract of elder (part undefined) demonstrated an insulinreleasing and insulinlike activity in vivo (route unknown). The following isolated constituents did not stimulate insulin secretion:lectin, rutin, lupeol, and β-sitosterol.⁴ In an earlier trial, oral administration of aqueous extract of elder (part unknown) did not affect glucose homeostasis under either normal or induced diabetic conditions.⁵ • Aqueous extract of elder (part unknown) increased urine flow and urinary sodium excretion in vivo (route unknown).⁶ A diuretic effect was observed after intragastric administration of elder flower infusion and an extract high in potassium and flavonoids.⁷ • A methanolic extract of elder flower inhibited the biosynthesis of the following cytokines in vitro: interleukin-1α, interleukin-1β, and TNF-α.⁸ Mild antiinflammatory activity was demonstrated after intragastric administration of elder flower extract in an experimental model.⁹ • Intraperitoneal administration of an unsaponifiable fraction of elder flower moderately enhanced phagocytosis in vivo.¹⁰ • Early studies reported that elder flower increased the response of the sweat glands to heat stimuli.^11,¹²
Clinical Studies	• An increase in diaphoresis in healthy volunteers has been reported,¹² although theories suggested that the effect was caused by the large amount of hot fluid consumed.¹³ • In Germany, the Commission E supports using elder flower to treat the common cold.¹⁴

REFERENCES

1 British Herbal Medicine Association’s Scientific Committee. British herbal pharmacopoeia. Bournemouth: BHMA, 1983.

2 Grieve M. A modern herbal. New York: Dover Publications, 1971.

3 Felter HW, Lloyd JU. King’s American dispensatory, ed 18. Portland: Eclectic Medical Publications, 1905. rev 3, reprinted 1983

4 Gray AM, Abdel-Wahab YH, Flatt PR. J Nutr. 2000;130(1):15-20.

5 Swanston-Flatt SK, et al. Diabetes Res. 1989;10(2):69-73.

6 Beaux D, Fleurentin J, Mortier F. Phytother Res. 1999;13(3):222-225.

7 Rebuelta M, et al. Plantes Med Phytother. 1983;17:173-181.

8 Yesilada E, et al. J Ethnopharmacol. 1997;58(1):59-73.

9 Mascolo N, et al. Phytother Res. 1987;1:28-31.

10 Delaveau P, Lallouette P, Tessier AM. Planta Med. 1980;40(1):49-54.

11 Schmersahl KJ. Naturwissenschaften. 1964;51:361.

12 Wiechowski W. Med Klin. 1927;23:590-592.

13 Bisset NG, editor. Herbal drugs and phytopharmaceuticals. Stuttgart: Medpharm Scientific Publishers, 1994.

14 Blumenthal M, et al, editors. The complete German Commission E monographs: therapeutic guide to herbal medicines. Austin: American Botanical Council, 1998.

ELECAMPANE

*Botanical Name:*	Inula helenium
*Family:*	Compositae
*Plant Part Used:*	Root

PRESCRIBING INFORMATION

Actions	Expectorant, diaphoretic, antibacterial, spasmolytic, bronchospasmolytic
Potential Indications	Based on appropriate evaluation of the patient, practitioners should consider prescribing elecampane in formulations in the context of: • Respiratory catarrh and infections (5) • The common cold, influenza, bronchitis, asthma (5) • Possible treatment for peptic ulcer disease and intestinal worms (4a)

Contraindications See the “Use in Pregnancy and Lactation” section in this monograph. Warnings and Precautions Caution is advised in people with known sensitivity to elecampane or to other members of the Compositae family. Interactions None known. Use in Pregnancy and Lactation According to the British Herbal Compendium, elecampane is contraindicated in pregnancy and lactation.¹ However, no substantial basis has been found for this concern. Side Effects Occasional allergic reactions may occur because of sensitivity caused by the sesquiterpene lactones present in elecampane.^2,³ Dosage Dose per day^* Dose per week^* 3–6 ml of 1:2 liquid extract 20–40 ml of 1:2 liquid extract

* This dose range is extrapolated from the British Herbal Compendium 1992 and the author’s education and experience.

SUPPORTING INFORMATION

Traditional Prescribing	Traditional Western herbal medicine uses include: • Catarrhal conditions of the respiratory tract, especially bronchitis, irritating cough in children, tuberculosis, and asthma ^1,^4,⁵ • Sustaining the strength of the patient in chronic disorders of the respiratory tract ⁵ • Dyspepsia, night sweats ⁴ • Internally and externally for skin conditions ⁴
Traditional Prescribing	Eclectic physicians regarded elecampane as an important remedy for irritation of the trachea and bronchi, thus elecampane was used in cases with free and abundant expectoration, teasing cough, and substernal pain, such as severe forms of the common cold and influenza.⁵
Pharmacologic Research	Elecampane root contains sesquiterpene lactones of the eudesmanolide-type:alantolactone, isoalantolactone, and their derivatives.¹ • Elecampane extract demonstrated activity against Mycobacterium tuberculosis in vitro. The eudesmanolides were the active constituents.⁶ Antibacterial activity was demonstrated against organisms that cause brucellosis and anthrax for an elecampane extract (0.5% to 1.0%). Activity against staphylococci and hemolytic streptococci were weakly displayed. No significant results were obtained in vivo for brucellosis or anthrax.⁷ • Elecampane essential oil demonstrated antibacterial activity in vitro against Staphylococcus aureus and Streptococcus pyogenes in concentrations as low as 1.2%.⁸ • Elecampane essential oil demonstrated a relaxant effect on isolated tracheal and ileal smooth muscle.⁹ • Oral or intragastric administration of eudesmanolides increased intra-gastric temperature in an experimental model, which was indicative of increased blood supply and blood flow in the gastric mucosa.¹⁰ • Japanese scientists demonstrated the in vivo anthelmintic properties of the eudesmanolides from elecampane, particularly alantolactone, in the 1940s.^11,¹²
Clinical Studies	• A preparation of isolated eudesmanolides demonstrated ulcer healing properties, relieved symptoms, and improved gastric mucosal circulation in an uncontrolled trial involving 102 patients with peptic ulcer disease.¹³ • Oral administration of alantolactone (9 to 200 mg) to children from 7 to 14 years of age produced a safe, favorable anthelmintic effect for Ascaris infestation.¹⁴

REFERENCES

1 British Herbal Medicine Association. British herbal compendium. Bournemouth: BHMA, 1992.

2 Lamminpaa A, et al. Contact Dermatitis. 1996;34(5):330-335.

3 Alonso Blasi N, et al. Arch Dermatol Res. 1992;284(5):297-302.

4 British Herbal Medicine Association’s Scientific Committee. British herbal pharmacopoeia. Bournemouth: BHMA, 1983.

5 Felter HW, Lloyd JU. King’s American dispensatory, ed 18. Portland: Eclectic Medical Publications, 1905. rev 3, reprinted 1983

6 Cantrell CL, et al. Planta Med. 1999;65(4):351-355.

7 Bulanov PA. Izvest Akad Nauk Kazakh SSR Ser Microbiol. 1949;1:40-46.

8 Boatto G, Pintore G, Palomba M. Fitoterapia. 1994;65(3):279-280.

9 Reiter M, Brandt W. Arzneim Forsch. 1985;35(1A):408-414.

10 Luchkova MM. Fiziolohichnyi Zh. 1977;23(5):685-687.

11 Anon. Japan J Med Sci IV Pharmacol. 1941;13(3):75-93.

12 Anon. Japan J Med Sci IV Pharmacol. 1941;11(2-3):110-112.

13 Luchkova MM. Vrachebnoe Delo. 1978;6:69-71.

14 Ozeki S, Kotake M, Hayashi K. Proc Imp Acad. 1936;12:233-234.

ELEUTHEROCOCCUS

*Other Common Name:*	Eleuthero, Siberian ginseng
*Botanical Names:*	Eleutherococcus senticosus, Acanthopanax senticosus^#
*Family:*	Araliaceae
*Plant Part Used:*	Root

# Alternative name.

PRESCRIBING INFORMATION

Actions	Adaptogenic, immune modulating, tonic
Potential Indications	Based on appropriate evaluation of the patient, practitioners should consider prescribing Eleutherococcus in formulations in the context of: • Enhancing immune function in healthy individuals (2) • Improving mental performance (4) • Improving physical performance (4,5) • Environmental and occupational stress (3,4) • Minimizing the effects of stress in patients subject to chronic illness (4) • Convalescence, including after antibiotic therapy; adjuvant therapy for dysentery (4) • Adjuvant therapy for cancer, to improve immune function and decrease side effects from orthodox therapy (4) • Exhaustion, insomnia, mild depression (4,5)

Contraindications Eleutherococcus is best not used during the acute phase of infections. Although some medical scientists and regulatory bodies consider Eleutherococcus to be contraindicated in hypertension, it also has been used to treat hypertension. Warnings and Precautions None required. Interactions A case of apparent elevated serum digoxin levels attributed to consumption of an unauthenticated “Eleutherococcus” product has been reported. As to whether Eleutherococcus caused a real increase in serum digoxin levels rather than an interference was inconclusive with the test method used. Use in Pregnancy and Lactation No adverse effects expected. Side Effects Russian studies on Eleutherococcus have noted a general absence of side effects. However, care should be exercised in patients with cardiovascular disorders because insomnia, palpitations, tachycardia, and hypertension have been reported in a few cases. Side effects are more likely if normal doses are exceeded.“Ginseng abuse syndrome” with insomnia, diarrhea, and hypertension has been described, but the study did not differentiate between Korean ginseng (Panax ginseng) and Eleutherococcus. Dosage Dose per day^* Dose per week^* 2–8 ml of 1:2 liquid extract 15–55 ml of 1:2 liquid extract

Extracts providing standardized levels of eleutheroside E are recommended. Ideally, aqueous ethanol extracts should contain at least 0.5 mg/ml of eleutheroside E.

Maintenance doses for healthy individuals should be toward the lower end of the dose range, but higher doses should be used for treating illness and for high stress situations, including athletic training.

* This dose range is based on those used in clinical trials.

SUPPORTING INFORMATION

Traditional Prescribing	Uses and properties from TCM include: • To reinforce qi, to invigorate the function of the spleen and kidney, to calm the nerves ¹ • Poor functioning of the spleen and kidney marked by general weakness, fatigue, anorexia, and aching of the lower back and knees ¹ • Insomnia and dream-disturbed sleep ¹
Traditional Prescribing	Traditional Western herbal medicine uses include temporary fatigue, general debility, and chronic inflammatory conditions²
Pharmacologic Research	Key constituents of Eleutherococcus root include the eleutherosides (a chemically diverse group of compounds), triterpenoid saponins, and glycans. • Experimental studies have shown that Eleutherococcus, its components, or both increased stamina and resistance to stressors (heat, cold, immobilization, trauma, surgery, blood loss, increased or decreased barometric pressure, narcotics, toxins, and bacteria), protected against the physical, behavioral, functional, and biochemical effects of stress (oral route), improved learning and memory (oral route), and exerted an immune-enhancing effect in immuno-compromised mice. • Eleutherococcus increased survival and promoted the self-repair mechanism in experimental irradiation studies after intraperitoneal or oral administration. • Eleutherococcus inhibited spontaneous malignant tumors and tumors induced by a number of carcinogens in vivo. Eleutherococcus potentiated the effect of some cytotoxic drugs in vitro, thus reducing the amount of drug needed. • Resistance to bacterial infection was increased in experimental models by prior dosing with Eleutherococcus. However, simultaneous administration with the infecting organism increased the severity of the disease. Antiviral immunity was also stimulated in vivo and in vitro by prior administration of Eleutherococcus. • Eleutherococcus impeded both hypertrophy and atrophy of the adrenal and thyroid glands, reduced blood sugar in hyperglycemia and increased it in hypoglycemia (in vivo by oral route), and normalized both leukopenia and leukocytosis. • Eleutherococcus enhanced the protective effect of the anticoagulant system against coagulant drugs in vivo by oral administration, increased repair in damaged heart muscle, increased the number of mitochondria in cardiac muscle, increased the conversion of fat into glycogen for energy, and countered the effects of cerebral ischemia in experimental models. • Eleutherococcus demonstrated an anabolic effect by stimulating weight gain in vivo when given orally and, in other models, improved egg weight and yield and increased reproductive capacity. • An antitoxic effect has been demonstrated in vivo by the simultaneous administration of drugs or toxins with Eleutherococcus.

Clinical Studies

• A placebo-controlled, double-blind study demonstrated that Eleutherococcus extract improved maximal work capacity by 23.3% in male athletes compared with a 7.5% increase in the placebo group. The dose used was equivalent to 300 mg/day of dried root and contained 2.12 mg of eleutheroside B and 0.48 mg of eleutheroside E. The dose was administered for 8 days. However, Eleutherococcus extract did not increase work capacity in highly trained distance runners in a randomized, double-blind, placebo-controlled trial.

• A randomized, double-blind, placebo-controlled, crossover trial involving nine athletes concluded that Eleutherococcus supplementation at 1.2 g/day for 7 days before each of the two trial periods did not alter steady-state substrate utilization or 10-km cycling performance time.³

• A 40% reduction in lost work days and a 50% reduction in general illness over a 1-year period was observed in a controlled study of 1000 workers in a Siberian factory who received Eleutherococcus. The mean daily temperature of the region was − 5° C (23° F).

• The following results (compared with baseline values) were obtained in healthy volunteers treated with Eleutherococcus extract for 1 month in a randomized, comparative trial:increased cellular immunity, increased oxygen consumption during maximal physical exercise, increased aerobic metabolism of tissues, and decreased blood levels of total cholesterol, LDL-cholesterol, and triglyceride. (The comparison was with administration of Echinacea purpurea aerial parts, which did not produce significant results.)⁴

• Eleutherococcus extract (equivalent to approximately 6 g/day of dried root) significantly increased T-helper cell and natural killer cell numbers in healthy volunteers in a double-blind, placebo-controlled trial.

• In uncontrolled trials, Eleutherococcus extract:

• Improved the performance and stamina of explorers, sailors, deep sea divers, mine and mountain rescue workers, truck drivers, pilots, factory workers, laborers, and cosmonauts

• Increased endurance and concentration in track and field athletes, gymnasts, and weight lifters

• Improved running times by an average of 9% in long-distance runners

• Improved the strength of larger muscles in athletes

• Caused faster activation and greater intensity of perspiration in healthy participants exposed to heat stress

• Accelerated reading time and decreased errors in proofreaders

• Enhanced nonspecific immunity, minimized the side effects from radiation, chemotherapy and surgery, and improved healing and well being in patients with cancer

• Alleviated the effects of protracted disease and lengthened survival time in patients with terminal disease

• Improved well being and lung capacity in patients with chronic bronchitis, pneumoconiosis, and pneumonia

• Improved cardiovascular function and general well being in patients with atherosclerotic conditions and patients with rheumatic heart lesions

• Lowered blood pressure in patients with hypertension and raised it in those with low blood pressure

• Significantly raised blood pressure and peripheral resistance in children with hypotension

• Caused a faster response to medical treatment in children with dysentery

• Alleviated exhaustion, irritability, insomnia, and mild depression

• Assisted resettled people to adapt to their new and harsh environment in the mountainous, desert area of Mongolia, as measured by normalization in the parameters measured, including work capacity ⁵

• Patients with antibiotic-induced diarrhea benefited from Eleutherococcus in a postmarketing surveillance study.

• In Germany, the Commission E supports using Eleutherococcus as a tonic for invigoration and fortification in times of fatigue and debility, reduced capacity for work and concentration, and during convalescence.⁶

REFERENCES

1 Pharmacopoeia Commission of the People’s Republic of China. Pharmacopoeia of the People’s Republic of China, English ed. Beijing: Chemical Industry Press, 1997.

2 British Herbal Medicine Association. British herbal compendium. Bournemouth: BHMA, 1992.

3 Eschbach LF, et al. Int J Sport Nutr Exerc Metab. 2000;10(4):444-451.

4 Szolomicki J, et al. Phytother Res. 2000;14(1):30-35.

5 Zhekalov AN. Rastit Resur. 1995;31(4):87-91.

6 Blumenthal M, et al, editors. The complete German Commission E monographs: therapeutic guide to herbal medicines. Austin: American Botanical Council, 1998.

EUPHORBIA

*Botanical Names:*	Euphorbia hirta, Euphorbia pilulifera^#
*Family:*	Euphorbiaceae
*Plant Part Used:*	Aerial parts

# Alternative name.

PRESCRIBING INFORMATION

Actions	Expectorant, antiasthmatic, spasmolytic, antiprotozoal
Potential Indications	Based on appropriate evaluation of the patient, practitioners should consider prescribing Euphorbia in formulations in the context of: • Congestion and spasm of the respiratory tract, especially chronic bronchitis, laryngitis, asthma, emphysema, and whooping cough (5) • Amebic dysentery and possibly other gastrointestinal protozoal infections (4,6) • Intestinal worms, bowel disorders (6)

Contraindications None known. Warnings and Precautions None required. Interactions None known. Use in Pregnancy and Lactation No adverse effects expected. Side Effects None expected if taken within the recommended dose range. Based on traditional literature, large (undefined) doses of Euphorbia may cause nausea and vomiting,¹ and it may occasionally cause epigastric distress with nausea.² Dosage Dose per day^* Dose per week^* 0.7–2.0 ml of 1:2 liquid extract 5–12 ml of 1:2 liquid extract Clinical studies show that Euphorbia can remove intestinal protozoal parasites.^3,⁴ In chronic cases, 15 to 20 ml of 1:2 extract can be used for up to 7 days’ continuous treatment at a time.

* This dose range is extrapolated from the British Pharmaceutical Codex 1949, the British Herbal Pharmacopoeia 1983, and the author’s education and experience.

SUPPORTING INFORMATION

Traditional Prescribing	Traditional Western herbal medicine uses include: • Asthma, bronchitis, laryngeal spasm, difficult breathing of cardiac disease, tuberculosis, emphysema,^2,⁵ the common cold¹ • Intestinal amebiasis,⁵ intestinal worms, bowel disorders, colic, dysentery, warts⁶
	Aboriginal Australians used Euphorbia for asthma, bronchitis, and emphysema and as a sedative in respiratory conditions, although findings suggest that it was not always effective for asthma.⁶ A decoction of the whole plant was taken as a treatment for debility.⁷
	Euphorbia was official in the NF from 1916 to 1947 and had “some reputation as antiasthmatic.”⁸ Eclectic physicians regarded Euphorbia as a reliable antiasthmatic.²
Pharmacologic Research	Some of the pharmacologic research listed here used “whole plant” extracts, which probably included the root. The roots of Euphorbia species have been traditionally used for their emetic and cathartic properties. This research may not be relevant to Euphorbia extract manufactured from aerial parts. • A polyphenolic-rich extract of Euphorbia whole plant demonstrated antiamebic and spasmolytic activity in vitro.⁹ Aqueous extract of Euphorbia whole plant demonstrated antibacterial, antiamebic, and spasmolytic activity in vitro. These activities support the traditional Congolese use of Euphorbia as an antidiarrheal agent.¹⁰ Freeze-dried decoction of Euphorbia whole plant demonstrated antidiarrheal activity in three experimental models of diarrhea. The flavonoid quercitrin, isolated from Euphorbia, has displayed antidiarrheal activity.¹¹ • A study using an in vitro model verified inhibitory activity against Amoeba proteus for Euphorbia. Aqueous extract of fresh aerial parts demonstrated greater cytotoxic activity than did extracts of dried plant material.¹² • Oral administration of Euphorbia whole plant extract demonstrated significant suppression of parasitemia in a malaria model.¹³ • Water and ethanol extracts of Euphorbia leaf administered by intraperitoneal injection demonstrated a diuretic effect by increasing the rate of urine output and increasing electrolyte excretion.¹⁴ Freeze-dried aqueous extract of Euphorbia aerial parts strongly inhibited the activity of angiotensin converting enzyme (ACE) in vitro and decreased water intake when administered by injection, which is also indicative of ACE inhibition.¹⁵ • Euphorbia extract reduced the release of prostaglandins and inhibited platelet aggregation in vitro. The extract also decreased the formation of carrageenan-induced paw edema (route unknown).¹⁶ Freeze-dried aqueous extract of Euphorbia had analgesic, antipyretic, and antiin-flammatory activity experimentally (most likely by injection). Euphorbia also exerted central analgesic activity. The antiinflammatory activity was stronger in acute models compared with chronic models.¹⁷ Sedative and anxiolytic effects have also been demon-strated.^17,¹⁸ The extract did not protect against induced convulsions, did not cause muscle relaxant effects, and did not have affinity for benzodiazepine receptors. No hypnotic, neuroleptic, or significant antidepressant activity was observed. However, the extract intensified the activity of barbiturates.¹⁹
Clinical Studies	The clinical antiprotozoal activity of Euphorbia has been documented. Initial observations of 53 cases of amebic dysentery demonstrated that a 1:2 extract of Euphorbia quickly and effectively controlled acute symptoms.³ The dosage protocol for adults was 20 ml (equivalent to 10 g of herb) with soup over 3 hours, then 15 ml (7.5 g of herb) with soup over 3 hours, followed by 10 ml (5 g of herb) with soup over 3 hours. Chronic cases also showed benefit, the dose being 20 ml per day. A subsequent trial using a tabletted concentrate of Euphorbia demonstrated a successful outcome in 83% of 150 patients with amebic dysentery. Disappearance of the parasite and pain improvement were rapidly established, and follow-up showed no recurrence after 5 to 12 months.⁴

REFERENCES

1 Grieve M. A modern herbal. New York: Dover Publications, 1971.

2 Felter HW, Lloyd JU. King’s American dispensatory, ed 18. Portland: Eclectic Medical Publications, 1905. rev 3, reprinted 1983

3 Ridet J, Chartol A. Med Trop. 1964;24:119-143.

4 Martin M, et al. Med Trop. 1964;24:250-261.

5 British Herbal Medicine Association’s Scientific Committee. British herbal pharmacopoeia. Bournemouth: BHMA, 1983.

6 Lassak EV, McCarthy T. Australian medicinal plants. North Ryde, NSW, Australia: Methuen Australia, 1983.

7 Aboriginal Communities of the Northern Territory of Australia, Conservation Commission of the Northern Territory. Traditional aboriginal medicines in the Northern Territory of Australia. Darwin, NT, Australia: Conservation Commission of the Northern Territory of Australia, 1993.

8 Vogel VJ. American Indian medicine. Norman, Okla: University of Oklahoma Press, 1970.

9 Tona L, et al. Phytomed. 2000;7(1):31-38.

10 Tona L, et al. Phytomed. 1999;6(1):59-66.

11 Galvez J, et al. Planta Med. 1995;59(4):333-336.

12 Duez P, et al. J Ethnopharmacol. 1991;34(2-3):235-246.

13 Tona L, et al. J Ethnopharmacol. 1999;68(1-3):193-203.

14 Johnson PB, et al. J Ethanopharmacol. 1999;65(1):63-69.

15 Williams LAD, et al. Phytother Res. 1997;11(5):401-402.

16 Hiermann A, Bucar F. J Ethnopharmacol. 1994;42(2):111-116.

17 Lanhers MC, et al. Planta Med. 1991;57(3):225-231.

18 Lanhers MC, et al. J Ethnopharmacol. 1990;29(2):189-198.

19 Lanhers MC, et al. Phytother Res. 1996;10(8):670-676.

EYEBRIGHT

*Botanical Names:*	Euphrasia officinalis, Euphrasia rostkoviana,^#^/⁺^∧ Euphrasia stricta^#^∧
*Family:*	Scrophulariaceae
*Plant Part Used:*	Aerial parts

# Alternative name.

+ Medicinally interchangeable species.

∧ Adopted by the American Herbal Products Association as the new botanical name.¹

PRESCRIBING INFORMATION

Actions	Astringent, anticatarrhal, mucous membrane tonic, antiinflammatory
Potential Indications	Based on appropriate evaluation of the patient, practitioners should consider prescribing eyebright in formulations in the context of: • Catarrhal conditions of the upper respiratory tract, sinusitis, chronic sneezing, hay fever, middle ear problems, sore throat, catarrhal phase of measles, the common cold (5) • Inflammation or infection of the eyes, including conjunctivitis (5)

Contraindications None known. Warnings and Precautions None required. Interactions None known. Use in Pregnancy and Lactation No adverse effects expected. Side Effects None expected if taken within the recommended dose range. Dosage Dose per day^* Dose per week^* 2.0–4.5 ml of 1:2 liquid extract 15–30 ml of 1:2 liquid extract For topical use of eyebright (such as for treatment of conjunctivitis), a solution of approximately 5 to 6 drops of a 1:2 extract is prepared in an eye bath of recently boiled water or saline. The liquid should be allowed to cool before applying to the eye. (Allowing the alcohol to evaporate before applying to the eye is important.)

* This dose range is extrapolated from the British Herbal Pharmacopoeia 1983 and the author’s education and experience.