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GENTIAN

Botanical Name: Gentiana lutea
Family: Gentianaceae
Plant Part Used: Root

PRESCRIBING INFORMATION

Actions Bitter tonic, gastric stimulant, sialagogue, cholagogue
Potential Indications
Loss of appetite,* dyspepsia,* asthenia, coated tongue, postprandial bloating, in combination with rhubarb (3)
Stimulating gastric secretion, constipation, flatulence, abdominal fullness,* itching of skin, in combination with rhubarb, cascara, and boldo (3)

Contraindications Gastric and duodenal ulcers,1 hyperacidity,2 gastric inflammation3 Warnings and Precautions None required. Interactions None known. Use in Pregnancy and Lactation No adverse effects expected. Side Effects

Dosage Dose per day** Dose per week**   0.7-2.0 ml of 1:2 liquid extract 5-15 ml of 1:2 liquid extract

* Gentian has also been used in traditional herbal medicine. ESCOP recommends gentian for treating appetite loss and dyspepsia. The Commission E also recommends gentian for abdominal fullness and flatulence. (4,5)

** This dose range is extrapolated from the British Pharmaceutical Codex 1934, the British Pharmacopoeia 1932, and the author’s education and experience.

SUPPORTING INFORMATION

Traditional Prescribing
Pharmacologic Research
Clinical Studies

GINGER

Botanical Name: Zingiber officinale
Family: Zingiberaceae
Plant Part Used: Rhizome

PRESCRIBING INFORMATION

Actions Carminative, antiemetic, peripheral circulatory stimulant, spasmolytic, antiinflammatory, antiplatelet, diaphoretic, digestive stimulant, pungent
Potential Indications

Contraindications According to the Commission E, using ginger is contraindicated in patients with gallstones, except under close supervision. In TCM, dried ginger is used cautiously during pregnancy. A daily dose of 2 g of dried ginger should not be exceeded in pregnancy. Warnings and Precautions The user should proceed with caution in cases of peptic ulceration, gastroesophageal reflux, or other gastric diseases. Interactions Ginger may increase the absorption of pharmaceutical drugs.   Although no problems have been reported in humans, ginger may increase the chance of bleeding. Daily doses of (dried) ginger in excess of 4 g should be prescribed with caution in patients who are already taking blood-thinning drugs such as warfarin or aspirin or who have increased risk of hemorrhage. Use in Pregnancy and Lactation No adverse effects are expected within the recommended dose (0.7 to 2.0 ml of 1:2 liquid extract). A daily dose of 2 g of dried ginger should not be exceeded in pregnancy. Ginger has been successfully used in clinical trials to treat pregnant women with nausea. Side Effects At doses approaching or greater than the maximum recommended dose, a blood-thinning effect and an increase in gastric secretory activity leading to heartburn is possible. Topical application of ginger may cause contact dermatitis in sensitive patients. Occupational allergic contact dermatitis from spices, including ginger, has been reported. Dosage Dose per day* Dose per week*   0.7-2.0 ml of 1:2 liquid extract 5-15 ml of 1:2 liquid extract

* This dose range is extrapolated from the British Pharmaceutical Codex 1934, the British Herbal Pharmacopoeia 1983, the British Pharmacopoeia 1975, and the author’s education and experience.

SUPPORTING INFORMATION

Traditional Prescribing
Amenorrhea,3 dysmenorrhea;2 to improve circulation2
Pharmacologic Research

Clinical Studies
A positive effect was observed for ginger (0.25 to 1.5 g/day) in: two randomized, double-blind, placebo-controlled trials and one randomized, controlled trial7 investigating seasickness; two randomized, double-blind, controlled trials investigating postoperative nausea; one randomized, double-blind, placebo-controlled, crossover trial in vomiting of pregnancy; one double-blind, controlled trial in hyperketonaemia patients; and one uncontrolled trial of psoralen-induced nausea.
Powdered ginger (4 g/day) given to patients with coronary artery disease (CAD) did not affect platelet aggregation, fibrinolytic activity, and fibrinogen levels tested at 11/2 and 3 months. No information was provided for controls. However, a single dose of ginger (10 g) produced a significant reduction in platelet aggregation after 4 hours in patients with CAD in a placebo-controlled trial.

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

2 Felter HW. The eclectic materia medica, pharmacology and therapeutics. Portland: Eclectic Medical Publications, 1922. reprinted 1983

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

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

5 Ernst E, Pittler MH. Br J Anaesth. 2000;84(3):367-371.

6 Jewell D, Young G. Cochrane Database Syst Rev. (2):2000. CD000145

7 Ribenfeld D, Borzone L. Healthnotes Rev Complement Integr Med. 1999;6(2):98.

8 Eden J: Medical Observer July 21, 2000.

9 Lien HC, Sun WM: Digestive Disease Week 2000, San Diego, May 20-24, 2000.

10 Careddu P. HealthNotes Rev. 1999;6:102-107.

11 Bliddal H, et al. Osteoarthritis Cartilage. 2000;8(1):9-12.

12 Altman RD, Marcussen KC. Arthritis Rheum. 2001;44(11):2531-2538.

13 Micklefield GH, et al. Int J Clin Pharmacol Ther. 1999;37(7):341-346.

14 Verma SK, Bordia A. Indian J Med Sci. 2001;55(2):83-86.

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

16 Scientific Committee of the European Scientific Cooperative on Phytotherapy [ESCOP]. ESCOP monographs: Zingiberis rhizoma. Argyle House, Gandy Street, Exeter, Devon, EX4 3LS, United Kingdom: European Scientific Cooperative on Phytotherapy, ESCOP Secretariat, March 1996.

GINKGO

Botanical Name: Ginkgo biloba
Family: Ginkgoaceae
Plant Part Used: Leaf

PRESCRIBING INFORMATION

Actions Antioxidant, antiplatelet activating factor (anti-PAF) activity, tissue perfusion enhancing, circulatory stimulant, cognition enhancing, neuroprotective
Potential Indications

Contraindications None known. Warnings and Precautions Ginkgo should be used with caution in patients on anticoagulant or antiplatelet medication. Interactions Based on some case reports of possible interaction, caution should be exercised when prescribing Ginkgo with warfarin and aspirin. Use in Pregnancy and Lactation No adverse effects expected. Side Effects Dosage Dose per day* Dose per week*   3-4 ml of the standardized (2:1) liquid extract 21-28 ml of the standardized (2:1) liquid extract   Extracts providing standardized levels of ginkgo flavone glycosides are recommended. Ideally, aqueous ethanol extracts should contain 9.6 mg/ml of ginkgo flavone glycosides.   No restriction was found on the long-term use of Ginkgo. However, Ginkgo should be recommended for at least 6 weeks before any assessment of clinical benefit is made.

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

SUPPORTING INFORMATION

Traditional Prescribing No information has been found for the traditional use of Ginkgo leaf. Ginkgo nuts were used in TCM.
Pharmacologic Research

Clinical Studies
A meta-analysis of four randomized, double-blind, placebo-controlled trials found a small but significant effect after 3 to 6 months treatment with 120 to 240 mg/day of standardized Ginkgo extract on objective measures of cognitive function in patients with Alzheimer’s disease. A subsequent randomized, double-blind, placebo-controlled, multicenter trial in patients with mild to severe Alzheimer’s disease or multiinfarct dementia found that, compared with baseline values, treatment with standardized Ginkgo extract (120 mg/day for 26 weeks) slightly improved daily living and social behavior and cognitive assessment. The placebo group showed a statistically significant worsening in all domains of assessment. Regarding safety, no differences between Ginkgo and placebo were observed.3 Two randomized, double-blind trials (included in the previously mentioned meta-analysis) demonstrated that standardized Ginkgo extract improved the cognitive performance and social function of patients with mild to severe Alzheimer’s disease or multiinfarct dementia compared with placebo. No significant difference compared with placebo was observed in the number of patients reporting adverse events or in the incidence and severity of these events. The dosage administered in these trials was 240 mg/day for 24 weeks and 120 mg/day for 52 weeks. A recent meta-analysis found no major differences between standardized Ginkgo extract and four cholinesterase inhibitors (tacrine, donepezil, rivastigmine, and metrifonate) for delaying symptom progression in Alzheimer’s disease or response rate compared with placebo. The authors suggested that all treatments compared were equally efficacious in treating mild to moderate Alzheimer dementia.4
In a randomized, double-blind, placebo-controlled study involving healthy adults, standardized Ginkgo extract (100 mg/day for 30 days) produced a significant improvement in a wide range of cognitive abilities, including long-term memory and abstract reasoning, using the multidimensional aptitude battery. Standardized Ginkgo extract (180 mg/day for 6 weeks) significantly increased cognitive processing speed and subjective ratings of memory improvement, compared with placebo, in cognitively intact older adults (55 to 86 years of age) in a randomized, double-blind, placebo-controlled, parallel-group study.7 The effects of acute doses of standardized Ginkgo extract on memory and psychomotor performance in asymptomatic volunteers aged 30 to 59 years was tested in a randomized, double-blind, placebo-controlled, five-way crossover design. The results confirm that the effects of Ginkgo on cognition are more pronounced for memory, particularly working memory. The most efficacious dose was a single dose of 120 mg and the cognitive enhancing effects were more likely to be apparent in individuals aged 50 to 59 years.8 In a double-blind, controlled, crossover trial, acute administration of standardized Ginkgo extract (240 mg and 360 mg) to healthy young volunteers produced a sustained improvement in attention compared with placebo.9,10 A randomized, double-blind, placebo-controlled trial demonstrated significant improvement in speed of information processing, working memory, and executive processing for healthy volunteers treated with standardized Ginkgo extract.11 A combination containing standardized extracts of Ginkgo (120 mg/day) and Korean ginseng (200 mg/day standardized to 4% ginsenosides) demonstrated improvement in the working and long-term memories of healthy middle-aged volunteers after 14 weeks in a multicenter, double-blind, placebo-controlled trial.12
A review of randomized controlled trials found inconsistent results for Ginkgo in treating patients with tinnitus without accompanying symptoms of cerebral insufficiency.14 A large, double-blind, placebo-controlled trial published in early 2001 found that standardized Ginkgo extract (150 mg/day) was no more beneficial than was placebo in treating tinnitus. The treatment did not significantly affect other symptoms of cerebral insufficiency. Given the positive results of previous trials, the authors suggested that Ginkgo appears ineffective in treating tinnitus alone, but it may be effective in treating tinnitus in patients who also have other symptoms of cerebral insufficiency.15
A randomized, double-blind, placebo-controlled trial found standardized Ginkgo treatment (containing 48 mg/day flavone glycosides for 10 weeks) was unable to prevent the development of the symptoms of winter depression (the most prevalent type of seasonal affective disorder).17 Standardized Ginkgo extract (240 mg/day) improved sleep in patients with major depression. In this open, pilot trial, patients taking the antidepressant trimipramine plus Ginkgo were compared with those taking the drug alone.18

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 Davydov L, Stirling AL. J Herbal Pharmacother. 2001;1(3):65-69.

2 Soholm B. Adv Ther. 1998;15(1):54-65.

3 Le Bars PL, Kieser M, Itil KZ. Dement Geriatr Cogn Discord. 2000;11(4):230-237.

4 Wettstein A. Phytomed. 2000;6(6):393-401.

5 van Dongen MC, et al. J Am Geriatr Soc. 2000;48(10):1183-1194.

6 Cockle SM, Kimber S, Hindmarch I. Phytomed. 2000;7(supp 2):21.

7 Mix JA, Crews WD. J Altern Complement Med. 2000;6(3):219-229.

8 Rigney U, Kimber S, Hindmarch I. Phytother Res. 1999;13(5):408-415.

9 Kennedy DO, Scholey AB, Wesnes KA. Psychopharmacology. 2000;151(4):416-423.

10 Kennedy DO, Scholey AB, Wesnes KA. Phytomed. 2000;7(supp 2):21.

11 Stough C, et al. Int J Neuropsychopharmacol. 2001;4(2):131-134.

12 Wesnes KA, et al. Psychopharmacology. 2000;152(4):353-361.

13 Pittler MH, Ernst E. Am J Med. 2000;108(4):276-281.

14 Ernst E, Stevinson C. Clin Otoloaryngol. 1999;24(3):164-167.

15 Drew S, Davies E. BMJ. 2001;322(7278):73-75.

16 Cesarani A, et al. Adv Ther. 1998;15(5):291-304.

17 Lingaerde O, Foreland AR, Magnusson A. Acta Psychiatr Scand. 1999;100(1):62-66.

18 Hemmeter U, et al. Pharmacopsychiatry. 2001;34(2):50-59.

19 Chung HS, et al. J Ocul Pharmacol Ther. 1999;15(3):233-240.

20 Kudolo G. Altern Ther Health Med. 2001;7(3):105.

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

GLOBE ARTICHOKE

Botanical Name: Cynara scolymus
Family: Compositae
Plant Part Used: Leaf

PRESCRIBING INFORMATION

Actions Hepatoprotective, hepatic trophorestorative, choleretic, cholagogue, bitter tonic, hypocholesterolemic, antiemetic, diuretic, depurative
Potential Indications

Contraindications Closure of the gallbladder Warnings and Precautions Globe artichoke should be used only with professional supervision in cholelithiasis (gallstones). The Commission E advises caution for patients with known allergy to globe artichoke and to other plants of the Compositae family. The likelihood of globe artichoke preparations causing an allergy is very low. Interactions None known. Use in Pregnancy and Lactation No adverse effects expected. Side Effects Clinical trials indicate that the safety and tolerability of globe artichoke is good. Contact with the fresh plant can cause contact dermatitis. No cases of allergic reaction after oral intake have been reported. Dosage Dose per day* Dose per week*   3-8 ml of 1:2 liquid extract 20-55 ml of 1:2 liquid extract

* This dose range is extrapolated from clinical trials.

SUPPORTING INFORMATION

Traditional Prescribing
Jaundice,1,2 hypercholesterolemia, anorexia; as a liver tonic and antitoxic2
Clearing the complexion,2 as a depurative for simple itch in children3
Pharmacologic Research

Clinical Studies

GOAT’S RUE

Botanical Name: Galega officinalis
Family: Leguminosae
Plant Part Used: Aerial parts

PRESCRIBING INFORMATION

Actions Hypoglycemic, antidiabetic, galactagogue
Potential Indications

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. Consumption of goat’s rue by sheep has caused poisoning.1,2 (Toxic doses far exceeded those used therapeutically in humans.) Dosage Dose per day* Dose per week*   4.5-8.5 ml of 1:2 liquid extract 30-60 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
Pharmacologic Research
Key constituents of the aerial parts of goat’s rue include the alkaloid galegine, which is a guanidine derivative.5 In 1927, findings indicated that galegine possessed hypoglycemic properties, which led to the development of the related biguanide drugs. Biguanide drugs, such as metformin, increase the peripheral uptake of glucose by increasing the efficiency of available insulin; that is, they increase insulin sensitivity.6
Oral doses of goat’s rue extract and galegine both reduced blood glucose in an experimental model of diabetes.9 Another study found no hypoglycemic effect for oral goat’s rue extracts in normal or diabetic animals.10
Clinical Studies
Early clinical research demonstrated hypoglycemic activity for goat’s rue.18,19 Unlike the biguanide drugs, the herb did not have unpleasant side effects.19

GOLDEN ROD

Botanical Name: Solidago virgaurea
Family: Compositae
Plant Part Used: Aerial parts

SUPPORTING INFORMATION

Traditional Prescribing
Pharmacologic Research
A proprietary herbal formula containing golden rod, Fraxinus excelsior and Populus tremula (1:1:3), demonstrated antiinflammatory, antipyretic, and analgesic activities in experimental models, including carrageenan-induced edema and adjuvant-induced arthritis (route unknown).79 In the case of the antiinflammatory models, each of the individual herbs also demonstrated activity.9 The antiinflammatory activity is the result, at least in part, of the antioxidant properties of the individual herbal extracts that have been established in several in vitro models.10 Similar to many NSAIDs, the combined extract and individual extracts inhibited dihydrofolate reductase in vitro.8
The flavonoid fraction of golden rod flowers demonstrated diuretic activity after oral administration in an experimental model.12 A low oral dose of an aqueous extract of golden rod containing 0.3% flavonoids produced diuresis and an increase in electrolyte excretion in an experimental model.13,14
An in vitro antifungal effect towards pathogenic species of Candida was demonstrated for triterpenoid saponins from golden rod.16,17 The whole plant did not possess broad-spectrum activity toward Candida spp. and dermatophytes in vitro.18 Essential oil of golden rod demonstrated antimicrobial activity against several bacteria, including Streptococcus faecalis and Escherichia coli, and exerted a strong fungicidal effect on dermatophyte strains in vitro.19
Clinical Studies
Two reviews assessing a formulation containing golden rod, Fraxinus excelsior and Populus tremula, for treating rheumatic conditions, including arthritis, have been published. One review assessed that the randomized, double-blind, controlled trials were of medium methodological quality.22 The formulation demonstrated superior activity compared with placebo and was comparable to NSAID drugs but had a much lower incidence of adverse effects.7,23 The formulation consists of 60% Fraxinus excelsior, 20% golden rod, and 20% Populus tremula and is standardized for salicylates, flavonoids, and coumarins.

REFERENCES

1 Zeller W, de Gols M, Hausen BM. Arch Dermatol Res. 1985;277(1):28-35.

2 Schatzle M, Agathos M, Breit R. Contact Dermatitis. 1998;39(5):271-272.

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

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

7 Klein-Galczinsky C. Wien Med Wochenschr. 1999;149(8-10):248-253.

8 Strehl E, et al. Arzneim Forsch. 1995;45(2):174-176.

9 el-Ghazaly M, et al. Arzneim Forsch. 1992;42(3):333-336.

10 Meyer B, et al. Arzneim Forsch. 1995;45(2):174-176.

11 Melzig MF, et al. Z Phytother. 2000;21(2):67-70.

12 Chodea A, et al. Acta Pol Pharm. 1991;48(5-6):35-37.

13 Schilcher H. Dtsch Apoth Ztg. 1984;124:2429-2436.

14 Schilcher H, Rau H. Urologe B. 1988;28:274-280.

15 Westendorf J, Vahlensieck W. Arzneim Forsch. 1981;31(1):40-43.

16 Hiller K, Bader G: 4th International Congress on Phytotherapy, Munich, Sept 10-13, 1992, Abstract SL 18.

17 Bader G, et al. Pharmazie. 2000;55(1):72-74.

18 Pepeljnjak S, et al. Pharm Pharmacol Lett. 1998;8(2):85-86.

19 Pepeljnjak S et al: International Congress and 48th Annual Meeting of the Society for Medicinal Plant Research and the 6th International Congress on Ethnopharmacology of the International Society for Ethnopharmacology, Zurich, September 3-7, 2000; Abstract P2A/74.

20 Plohmann B, et al. Pharmazie. 1997;52(12):953-957.

21 Bruhwiler K et al: 4th International Congress on Phytotherapy, Munich, September 10-13, 1992; Abstract SL 20.

22 Ernst E, Chrubasik S. Rheum Dis Clin North Am. 2000;26(1):13-27.

23 Bach D, et al. Forsch Med. 1983;101(8):337-342.

24 Scientific Committee of ESCOP (European Scientific Cooperative on Phytotherapy). ESCOP Monographs: Solidaginis virgaureae herba. Exter, UK: ESCOP, March 1996.

GOLDEN SEAL

Other Common Names: Hydrastis, goldenseal
Botanical Name: Hydrastis canadensis
Family: Ranunculaceae
Plant Part Used: Root and rhizome

PRESCRIBING INFORMATION

Actions Antihemorrhagic, anticatarrhal, mucous membrane trophorestorative, antimicrobial, antibacterial, bitter tonic, antiinflammatory, depurative, vulnerary, choleretic, reputed oxytocic
Potential Indications

Contraindications Berberine-containing plants are not recommended for use during pregnancy or for jaundiced neonates. Some reports suggest that golden seal is contraindicated in hypertensive conditions. Warnings and Precautions None required. Interactions Berberine may reinforce the effects of other drugs that displace the protein binding of bilirubin. Rather than possible uterine-contracting effects, this activity might explain the traditional contraindication for berberine-containing herbs in pregnancy. Use in Pregnancy and Lactation Contraindicated in pregnancy. Side Effects At daily doses higher than 0.5 g, berberine may cause dizziness, nose bleeds, dyspnea, skin and eye irritation, gastrointestinal irritation, nausea, diarrhea, nephritis, and urinary tract disorders. Such doses of berberine will not be reached using the recommended liquid doses outlined in this monograph. Dosage Dose per day* Dose per week*   2.0-4.5 ml of 1:3 tincture 15-30 ml of 1:3 tincture   Extracts providing quantified levels of hydrastine and berberine are recommended. Ideally, aqueous ethanol extracts should contain not less than 8 mg/ml of hydrastine and not less than 8 mg/ml of berberine.

* This dose range is extrapolated from the British Pharmaceutical Codex 1934, the British Herbal Pharmacopoeia 1983, the British Herbal Compendium 1992, and the author’s education and experience.

SUPPORTING INFORMATION

Traditional Prescribing
Pharmacologic Research

Clinical Studies

GOTU KOLA

Other Common Name: Indian pennywort
Botanical Names: Centella asiatica, Hydrocotyle asiatica#
Family: Umbelliferae
Plant Part Used: Aerial parts

# Alternative name.

PRESCRIBING INFORMATION

Actions Vulnerary, antiinflammatory, depurative, adaptogenic, nervine tonic
Potential Indications

Contraindications Known allergy. Warnings and Precautions None required. Interactions None known. Use in Pregnancy and Lactation No adverse effects expected. Side Effects Allergic contact dermatitis has been reported from using gotu kola, but it is a low risk treatment. Both the extract and the triterpene constituents are weak sensitizers.1 Dosage Dose per day* Dose per week*   3-6 ml of 1:2 liquid extract 20-40 ml of 1:2 liquid extract   Many of the successful clinical trials used a triterpene fraction of gotu kola at higher doses (approximately equivalent to 2.5 to 7.0 g of leaf per day) than the previously outlined liquid doses. Hence these liquid doses may possibly need to be exceeded to achieve similar results. However, on the other hand, an advantage might exist from using the whole extract rather than an isolated fraction.

* This dose range is extrapolated from the British Herbal Pharmacopoeia 1983. Higher relative doses of the triterpene fraction have been used in most clinical trials.

SUPPORTING INFORMATION

Traditional Prescribing
  Gotu kola has been traditionally used in many countries. In Thailand, the whole plant has been used as a depurative, particularly to treat skin diseases and as a diuretic and antidiarrheal remedy.6 In Indonesia, gotu kola has been used for mouth ulcers and oral thrush.7 In Fijian traditional herbal medicine, gotu kola was employed as a tonic for wasting diseases, such as tuberculosis, stomach problems, and rheumatic swelling and pain. Gotu kola was used both internally and topically to relieve pain.8 In TCM, gotu kola is used for traumatic injuries, boils, urinary stones, and to counteract toxicity and reduce swelling.9 In Hong Kong, gotu kola is also used for hepatitis, measles, the common cold, tonsillitis, bronchitis, and to treat poisoning. External uses include treatment of snakebite and bleeding wounds.10 In South Africa, gotu kola has been employed to treat wounds, cancer, leprosy, fever, and syphilis.11
Pharmacologic Research
The aerial parts of gotu kola contain pentacyclic triterpene ester saponins,12 the most abundant of which is asiaticoside. The triterpenoid content of good quality gotu kola dried herb is commonly 2% to 3% when analyzed by high-performance liquid chromatography (HPLC).13
The triterpene fraction of gotu kola has demonstrated wound-healing activity in many experimental models (by injection, oral, and topical administration). The mechanism of action includes the stimulation of maturation of scar tissue by the increased production of type I collagen (and hence collagen synthesis) and a decrease in the inflammatory reaction and myofibroblast production.15 The constituents also stimulated glycosaminoglycan synthesis16 and acted specifically to shorten the immediate phase of healing.17 Aqueous extract of gotu kola, particularly as a gel formulation, promoted healing in experimental open wounds.18 Oral and topical administration of gotu kola extract produced faster epithelialization and a higher rate of wound contraction in vivo compared with controls.19
Angiogenesis was promoted in isolated tissue.20 Topical asiaticoside enhanced the induction of antioxidants at the initial stage of healing.21
Clinical Studies
Oral administration of TFGK for 60 days demonstrated efficacy in a double-blind, placebo-controlled trial in patients with venous hypertensive microangiopathy.32 In an uncontrolled trial33 and in a randomized, single-blind, placebo-controlled trial,34 TFGK improved symptoms, microcirculation, and capillary permeability in patients with venous hypertension. In another trial, symptoms and ankle edema were improved in patients with venous hypertension after TFGK treatment, with no significant change observed in the placebo group.35 TFGK treatment (120 mg/day) for 6 months was beneficial for diabetic microangiopathy by improving microcirculation and decreasing capillary permeability. This trial was of prospective, randomized, placebo-controlled design.36
TFGK treatment produced significant improvement in symptoms of heaviness in the lower limbs and edema in a randomized, doubleblind, multicenter, placebo-controlled trial involving patients with venous insufficiency of the lower limbs. Two oral doses were trialled (60 mg/day or 120 mg/day) for 8 weeks.37 Benefit was also demonstrated for TFGK treatment of patients with chronic venous insufficiency in an open study.38 In a randomized, double-blind, comparative trial, TFGK demonstrated superior efficacy over hydroxyethylrutoside in treating venous insufficiency.39 In an open trial, TFGK treatment provided an increase in venous return and improvement of symptoms in patients with varicose and postthrombotic syndromes.40 In a controlled, crossover study involving patients with postphlebitic syndrome and venous insufficiency, oral treatment with TFGK provided better results in microcirculatory measurements than treatment with the flavonoids diosmin or hydroxyethylrutoside.41
Treatment with TFGK caused a significant reduction of circulating endothelial cells in patients with postphlebitic syndrome compared with baseline values.43 Oral administration of TFGK and bulking laxatives (when required) produced a beneficial effect in patients with first- and second-degree hemorrhoids in an uncontrolled trial.44
Positive results have been recorded in uncontrolled trials for treating gastric and duodenal ulcers (TFGK, oral),45,46 gastritis (asiaticoside, oral),47 and bladder lesions caused by bilharzial infection (TFGK, injection).48 No benefit was observed for the healing of leg ulcers in patients treated with asiaticoside (by injection) compared with placebo.49 However, positive results were obtained for oral use of TFGK taken for 3 to 8 weeks in 50 patients with leg ulcers.50
Oral treatment with TFGK for an average of 55 days was successful in treating patients with cellulitis.51 After 3 months’ oral TFGK treatment, reduced tendency to sclerosis in cellulitic tissue was observed in a double-blind, placebo-controlled study.52
Gotu kola has been used to treat leprosy patients from very early times and in recent years in both uncontrolled trials5961 and a controlled trial (gotu kola powder or asiaticoside compared with diamino-diphenylsulfone over a period of 1 year).62
Asiaticoside was not successful in treating scleroderma in children.63 However, TFGK demonstrated symptomatic relief in a small group of patients with systemic scleroderma. The 13 patients received TFGK by intramuscular injection ranging from 11/2 months to 11/2 years. Two patients received TFGK orally for a portion of their treatment.64 In another small, uncontrolled trial, oral doses of TFGK improved arthralgia and finger joint movement in scleroderma patients.65

REFERENCES

1 Hausen BM. Contact Dermatitis. 1993;29(4):175-179.

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

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

4 Chopra RN, et al. Chopra’s indigenous drugs of India, ed 2. Calcutta: Academic Publishers, 1958. reprinted 1982

5 Thakur RS, Puri HS, Husain A. Major medicinal plants of India. Lucknow, India: Central Institute of Medicinal and Aromatic Plants, 1989.

6 Farnsworth NR, Bunyapraphatsara N, editors. Thai medicinal plants. Bangkok: Medicinal Plant Information Center, 1992.

7 Dharma AP. Indonesian medicinal plants. Jakarta: Balai Pustaka, 1987.

8 Cambie RC, Ash J. Fijian medicinal plants. Melbourne, Australia: CSIRO Publishing, 1994.

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

10 Chung CH, Li NH. Chinese medicinal herbs of Hong Kong: Chinese-English. Hong Kong: Shang wu yin shu kuan, 1978.

11 van Wyk B-E, van Oudtshoorn B, Gericke N. Medicinal plants of South Africa. Arcadia, South Africa: Briza Publications, 1997.

12 Wagner H, Bladt S. Plant drug analysis: a thin layer chromatography atlas, ed 2. Berlin: Springer-Verlag, 1996.

13 Gunther B, Wagner H. Phytomed. 1996;3(1):59-65.

14 Yoosook C, et al. Phytomed. 2000;6(6):411-419.

15 Widgerow AD, et al. Aesthetic Plast Surg. 2000;24(3):227-234.

16 Maquart FX, et al. Eur J Dermatol. 1999;9(4):289-296.

17 Poizot A, Dumez D. C R Acad Sci Hebd Seances Acad Sci D. 1978;286(10):789-792.

18 Sunilkumar, Parameshwaraiah S, Shivakumar HG. Indian J Exp Biol. 1998;36(6):569-572.

19 Suguna L, Sivakumar P, Chandrakasan G. Indian J Exp Biol. 1996;34(12):1208-1211.

20 Shukla A, et al. J Ethnopharmacol. 1999;65(1):1-11.

21 Shukla A, Rasik AM, Dhawan BN. Phytother Res. 1999;13(1):50-54.

22 Chatterjee TK, et al. Indian J Exp Biol. 1992;30(10):889-891.

23 Tan PV, Njimi CK, Ayafor JF. Phytother Res. 1997;11:45-47.

24 Upadhyay SC, et al. Indian Drugs. 1991;25(6):388-389.

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26 Chen YJ, et al. Biol Pharm Bull. 1999;22(7):703-706.

27 Babu TD, Kuttan G, Padikkala J. J Ethnopharmacol. 1995;48(1):53-57.

28 Diwan PV, Karwande I, Singh AK. Fitoterapia. 1991;62(3):253-257.

29 de Lucia R, Sertie JAA. Fitoterapia. 1997;68(5):413-416.

30 Sakina MR, Dandiya PC. Fitoterapia. 1990;61(4):291-296.

31 Nalini K, Aroor AR. Fitoterapia. 1992;63(3):232-237.

32 Cesarone MR, et al. Minerva Cardioangiol. 1994;42(6):299-304.

33 Belcaro GV, Grimaldi R, Guidi G. Angiology. 1990;41(7):533-540.

34 Belcaro G, et al. Curr Ther Res. 1989;46:1015-1026.

35 Belcaro GV, Rulo A, Grimaldi R. Angiology. 1990;41(1):12-18.

36 Cesarone MR, et al. Angiology. 2001;52(supp 2):S49-S54.

37 Pointel JP, et al. Angiology. 1987;38(1, pt 1):46-50.

38 Capelli R. Giorn Ital Angiol. 1983;1:44-48.

39 Monteverde A, et al. Acta Therapeut. 1987;13:629-636.

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GREATER CELANDINE

Other Common Name: Chelidonium
Botanical Name: Chelidonium majus
Family: Papaveraceae
Plant Part Used: Aerial parts

PRESCRIBING INFORMATION

Actions Choleretic, cholagogue, spasmolytic, mild laxative, antiinflammatory, antiviral (topically), vulnerary (topically)
Potential Indications

Contraindications None known. Warnings and Precautions Given the nature of the alkaloid content of this herb and the reported cases of hepatotoxicity (see the “Side Effects” section in this monograph), long-term use of higher doses (except topical) is not recommended. Interactions None known. Use in Pregnancy and Lactation No adverse effects expected. Side Effects
Several cases of hepatotoxicity14 and one case of hemolytic anemia have been reported after ingesting greater celandine or preparations containing the herb.

Dosage Dose per day* Dose per week*   1-2 ml of 1:2 liquid extract 7-15 ml of 1:2 liquid extract   Short-term use of higher doses up to the equivalent of 3 g per day may be necessary to alleviate gastrointestinal or gall duct cramping pains.

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

SUPPORTING INFORMATION

Traditional Prescribing
Pharmacologic Research
Extracts of greater celandine were shown to have in vitro antiviral activity and antifungal activity against Fusarium strains.9 Fusarium strains have a high resistance to conventional fungicides. Greater celandine alkaloids had significant antimicrobial activity against fungal species and gram-positive bacteria (but not gram-negative bacteria) and inhibited the growth of Trichomonas vaginalis in vitro. The alkaloids sanguinarine and chelerythrine were active against gram-positive bacteria and Candida albicans.
Clinical Studies

GRINDELIA

Botanical Names: Grindelia camporum, Grindelia robusta+
Family: Compositae
Plant Part Used: Aerial parts

+ Medicinally interchangeable species.

PRESCRIBING INFORMATION

Actions Expectorant, spasmolytic, bronchospasmolytic
Potential Indications Based on appropriate evaluation of the patient, practitioners should consider prescribing Grindelia in formulations in the context of respiratory conditions marked by spasm, asthma, whooping cough, bronchitis, dry and irritable cough, and upper respiratory catarrh. (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. The British Herbal Pharmacopoeia 1983 notes that large doses are reported to cause renal irritation.1 This warning may be the result of the presence of saponins.
Dosage Dose per day* Dose per week*
  1.5-3.0 ml of 1:2 liquid extract 10-20 ml of 1:2 liquid extract

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

GYMNEMA

Botanical Name: Gymnema sylvestre
Family: Asclepiadaceae
Plant Part Used: Leaf

PRESCRIBING INFORMATION

Actions Antidiabetic, hypoglycemic, hypocholesterolemic, weight reducing
Potential Indications

Contraindications None known. Warnings and Precautions None required. Interactions None known. Use in Pregnancy and Lactation No adverse effects expected. Side Effects As with all saponin-containing herbs, oral use may cause irritation of the gastric mucous membranes and reflux. Dosage Dose per day* Dose per week*   3.5-11.0 ml of 1:1 liquid extract 25-75 ml of 1:1 liquid extract   One to two ml per day is all that is necessary for reducing sweet-craving and the sweet taste. In the latter case, the extract should be applied directly to the tongue, rinsed off, and swallowed after 1 minute. This procedure can be done at 2- to 3-hour intervals.

* This dose range is extrapolated from traditional Ayurvedic medicine1,3 and the author’s education and experience.

Less may be needed if combined with other antidiabetic herbs. Some cases of diabetes will respond quickly, but best results come after 6 to 12 months of continuous use.

SUPPORTING INFORMATION

Traditional Prescribing
Pharmacologic Research
Key constituents of Gymnema leaves include saponins, which are present as both nonacylated glycosides known as gymnemasaponins and the acylated gymnemic acids.4 Gymnemic acid referred to in the literature is often not defined and most likely refers to the crude saponin fraction or to a mixture of gymnemic acids.
The antisweet principles of Gymnema include the gymnemic acids,5 gymnemasaponins,6 and gurmarin (a peptide).7 Gymnemic acid suppressed the sweet taste of sweeteners in chimpanzees. Gymnemic acid had no effect on the responses to bitter, salty, or sour compounds.8,9
Feeding with Gymnema aqueous extract decreased body weight in fat and lean rats compared with those consuming only the test diet. In addition to lowering blood glucose levels, Gymnema also improved hypertriglyceridemia but not hypercholesterolemia.17 In another study, oral administration of Gymnema extract fractions decreased body weight gain and food intake and increased fecal excretion of cholesterol, total neutral steroids, total bile acids, and cholic acid–derived bile acid.18 Gymnema ingestion produced a significant lowering of cholesterol in a hypertension model.19
Clinical Studies
Several clinical studies verify that pretreatment with Gymnema extract, Gymnema infusion, and gymnemic acid solution reduced the sweet taste of sweeteners.2023 A period of at least 30 seconds was required after tasting the Gymnema infusion for the full sweet-suppression effect to appear.23

REFERENCES

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3 Kapoor LD. CRC handbook of Ayurvedic medicinal plants. Boca Raton, Fla: CRC Press, 1990.

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11 Srivastava Y, et al. Int J Crude Drug Res. 1986;24(4):171-176.

12 Okabayashi Y, et al. Diabetes Res Clin Pract. 1990;9(2):143-148.

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