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Herbal medicine/medical herbalism/phytotherapy

Description

Herbal medicine is the study and use of plants as medicines or food nutrients to restore and maintain good health. Western medical herbalists follow similar diagnostic procedures as orthodox doctors including history-taking, laboratory tests and X-rays necessary, examination and prescription of appropriate remedies. Treatment may consist of four elements: cleansing, detoxification and elimination, with expectorants, laxatives and diuretics; heating and aiding circulation with circulatory stimulants, peripheral vasodilators and aromatic digestives; cooling with bitters to stimulate digestion and febrifuges to reduce temperature; and tonification to nourish and repair with tonic herbs, often combined with convalescence, rest, exercise and diet.

Herbal medicine is found in every society and is probably the oldest form of therapeutic intervention known to humankind. Practitioners, now known as medical herbalists, have also been called ‘wise women’, folk healers or herbista; in other cultures they may be known by a local term, e.g. Mexican curanderas/curanderos, traditional Chinese medicine practitioners or Ayurvedic doctors. Herbalists in England have been allowed to practise under the Herbalists’ Charter awarded by King Henry VIII in 1542; modern practice is voluntarily regulated. Training is monitored, primarily, by the National Institute of Medical Herbalists which was founded in 1864. However, under the above Charter and English Common Law, anyone can practise as a herbalist without formal qualifications, although changes within European complementary medicine regulation may change this in the near future.

Herbal remedies (defined in (2004/27/EC Article 1) are subject to the EU Traditional and Herbal Medicines Directive (2004/24/EC) and Medicinal Products for Human Use (2004/27/EC). The key difference between herbal remedies and orthodox medicine is that orthodox pharmacological drugs are prescribed as a single entity, whereas a herbal prescription will reflect the synergy of the chosen plant remedies and the range of symptoms being presented. In 1978, the German government established the Commission E to investigate and monitor the safety and effectiveness of herbal medicines and a collection of monographs was collated defining their ‘reasonable certainty’ about the safety and effectiveness of herbs, but while they provide valuable information, they should not be regarded as the definitive source on the subject.

There are several methods of administration within herbal medicine. These include: tablets, infusions (leaves and flowers of a plant are steeped in hot water for 20–30 min and then drained); decoctions (made by boiling the bark, roots or woody sections of a plant, cooling and straining) and tinctures (made by steeping plant material in a preparation of alcohol and water at room temperature for up to 2 weeks). Herbs are classified as ‘rising, floating, condensing and sinking’, which reflect the cycles of the moon and seasons and according to whether they are ‘hot, cold, moist, dry or temperate’. In addition, remedies are classified according to their actions, i.e. warming remedies such as vasodilators and circulatory stimulants; cooling remedies such as relaxants and bitters; diuretics; expectorants; alteratives for detoxification and cleansing; tonic and hormonal remedies; and healing remedies.

Constituents of herbal remedies include:

Alkaloids:

the nitrogen-containing constituent, often the basis for orthodox drugs such as morphine and other opiate alkaloids, ergotamine, vincristine and vinblastine.

Flavonoid glycosides:

pigments, usually yellow, with specific pharmacological properties, some being diuretic, antispasmodic, antiinflammatory or antiseptic. According to the state of oxygenation, derivatives include: flavones, flavonols and flavonones.

Furanocoumarins:

photosensitizing compounds.

Glycosides:

secondary plant metabolites which yield one or more sugars on hydrolysis, most commonly glucose.

Isoflavones (phytoestrogens):

naturally occurring, weak constituents which bind to oestrogen receptors where they exert an oestrogenic or anti-oestrogenic action depending on the hormonal status of the person.

Mucilages:

act as a demulcent, soothing and antiinflammatory agent; may also have incidental healing effects, mainly by trapping water to form a protective gel.

Polysaccharides:

complex units based on sugars and uronic acid, thought to have an important role as immuno-enhancing agents.

Resins:

hard, brittle, secretions which soften on heating, soluble in ether or alcohol, chemically diverse; astringent, may stimulate phagocytic activity.

Saponins:

complex steroidal glycosides, regulate hormonal activity, diuretic, antiinflammatory and digestive effects. Can be toxic if given by injection since they cause haemolysis.

Tannins:

phenolic plant constituents having an astringent effect on the body, obtained from old and dying leaves, traditionally used to tan animal skins.

Volatile oils:

hydrocarbons; may have stimulant, antispasmodic, bitter, carminative, antiseptic and relaxing properties.

Herbal medicines, including essential oils, are also classified according to their therapeutic properties.

Adaptogen:

facilitates adaptability, helping to re-balance and restore homeostasis.

Anti-tussive:

suppresses cough reflex.

Astringent:

refers to the binding action of the tannin constituent on mucus membranes to make an antiinfective barrier against external organisms.

Calmative:

induces rest.

Carminative:

reduces flatulence and colic, soothes and settles the gut wall.

Cathartic:

laxative.

Cholagogic:

stimulates flow of bile from the liver.

Circulatory:

stimulates circulation.

Demulcent:

soothing effect on mucous membranes.

Diaphoretic:

stimulates sweat glands by vasodilation.

Digestive tonic:

aids digestion.

Diuretic:

increases diuresis.

Eliminative:

encourages elimination from the body either as a laxative, diuretic, expectorant or diaphoretic.

Emmenagogic:

stimulates uterine bleeding.

Febrifuge:

reduces fever.

Galactogogue:

promotes the secretion of breast milk.

Nervous restoratives:

restores debilitated nervous system following conditions such as depression, nervous exhaustion and general fatigue, some are stimulating and others are relaxing and are used depending on the presenting symptoms.

Vasodilators:

dilates the peripheral blood vessels to improve circulation.

Vulnerary:

aids wound healing.

Safety:

Many people believe that because herbs are natural, they are also safe – and safer than drugs. However, this is not necessarily so and practitioners and patients need to be aware of the potential dangers of mixing herbal remedies with orthodox medication or with other herbs which have similar properties. In addition to their intrinsic therapeutic actions herbal remedies may interfere with the liver’s cytochrome P450 enzyme system and its substrates resulting in increased levels of drugs metabolized by this system, for example: the tricyclic antidepressants, antipsychotics, benzodiazepines, oral hypoglycaemic agents, angiotensin 11 receptor antagonists, proton pump inhibitors, warfarin, non-steroidal antiinflammatories including aspirin, antihistamines. Many herbal remedies are known to have anticoagulant effects and patients should discontinue herbal medicine use at least 2 weeks prior to surgery or invasive procedures to avoid interactions with anaesthesia and other drugs and to prevent postoperative haemorrhage. Children, pregnant and lactating women should not use herbal remedies without expert advice. Herbal tinctures contain alcohol, therefore caution is needed if the patient is a recovering alcoholic, taking antabuse or metronidazole.

Bibliography

Abebe W. Herbal medication: potential for adverse interactions with analgesic drugs. Journal of Clinical Pharmacy and Therapeutics. 2002;27(6):391-401.

Barnes J, Anderson L, Phillipson J. Herbal medicines. London: Pharmaceutical Press; 2002.

Basch E, Ulbricht C. Natural standard herb and supplement handbook. St Louis: Mosby; 2005.

Fetrow C, Avila J. Professional’s handbook of complementary and alternative medicines, 2nd edn. Pennsylvania: Springhouse; 2001.

Gurley BJ, Swain A, Hubbard MA, et al. Clinical assessment of CYP2D6-mediated herb-drug interactions in humans: effects of milk thistle, black cohosh, goldenseal, kava kava, St. John’s wort and Echinacea. Molecular Nutrition and Food Research. 2008;52(7):755-763.

Healey B, Burgess C, Siebers R. Do natural health food stores require regulation? New Zealand Medical Journal. 2002;115(1161):U165.

Hellum BH, Nilsen OG. The in vitro inhibitory potential of trade herbal products on human CYP2D6-mediated metabolism and the influence of ethanol. Basic and Clinical Pharmacology and Toxicology. 2007;101(5):350-358.

Izzo AA, Di Carlo G, Borrelli F, et al. Cardiovascular pharmacotherapy and herbal medicines: the risk of drug interaction. International Journal of Cardiology. 2005;98(1):1-14.

Kleinschmidt S, Rump G, Kotter J. Herbal medications: possible importance for anaesthesia and intensive care medicine. Der Anaesthesist. 2007;56(12):1257-1266.

Marcus DM, Snodgrass WR. Do no harm: avoidance of herbal medicines during pregnancy. Obstetrics and Gynecology. 2005;105(5 Pt 1):1119-1122.

Patra KK, Coffey CE. Implications of herbal alternative medicine for electroconvulsive therapy. Journal of ECT. 2004;20(3):186-194.

Tiran D. The use of herbs by pregnant and childbearing women: a risk-benefit assessment. Complementary Therapies in Nursing and Midwifery. 2003;9(4):176-181.

Vora CK, Mansoor GA. Herbs and alternative therapies: relevance to hypertension and cardiovascular diseases. Current Hypertension Reports. 2005;7(4):275-280.

Woodward KN. The potential impact of the use of homeopathic and herbal remedies on monitoring the safety of prescription products. Human Experimental Toxicology. 2005;24(5):219-233.

Woolf AD. Herbal remedies and children: do they work? Are they harmful? Pediatrics. 2003;112(1 Pt 2):240-246.

Resources

National Institute of Medical Herbalists: www.nihm.org.uk

Selected herbal remedies

Agnus castus (Vitex agnus castus) (also known as Chasteberry, Chaste tree)

Traditional uses:

as a hormonal remedy for menstrual problems resulting from corpus luteum deficiency, including premenstrual syndrome, dysmenorrhoea and menopausal problems.

Principal constituents:

alkaloids, diterpenes, flavonoids, iridoloids.

Evidence:

In vitro, animal and clinical studies support its effect on follicle stimulating hormone and increasing the release of luteinizing hormone and its effect on premenstrual syndrome, cyclic mastalgia, increased lactation and the treatment of acne.

Safety:

Caution regarding concurrent medication, herbs and supplements with similar therapeutic actions, in particular, herbs with diuretic properties which may potentiate the therapeutic effects and concurrent hormonal preparations including the contraceptive pill. Theoretically agnus castus may interfere with dopamine antagonists such as chlorpromazine, haloperidol or fluphenazine.

Bibliography

Braun L. Chasteberry (Vitex agnus-castus). Journal of Complementary Medicine. 2006;5(4):71-73.

Daniele C, Thompson Coon J. Vitex agnus castus: a systematic review of adverse events. Drug Safety. 2005;28(4):319-332.

Dugoua JJ, Seely D, Perri D. Safety and efficacy of chaste tree (Vitex agnus-castus) during pregnancy and lactation. Canadian Journal Clinical Pharmacology. 2008;15(1):e74-e79.

Huddleston M, Jackson EA. Is an extract of the fruit of agnus castus (chaste tree or chasteberry) effective for prevention of symptoms of premenstrual syndrome (PMS)? Journal of Family Practice. 2001;50(4):298.

Hueneke P. Clinical observations on Vitex and ADHD. Journal of the Australian Traditional Medicine Society. 2004;10(1):7-8.

Schellenberg R. Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomised, placebo controlled study. British Medical Journal. 2001;322(7279):134-137.

Webster DE, Lu J, Chen SN. Activation of the mu-opiate receptor by Vitex agnus-castus methanol extracts: implication for its use in PMS. Journal of Ethnopharmacology. 2006;106(2):216-221.

Wuttke W, Jarry H, Christoffel V. Chaste tree (Vitex agnus-castus) – pharmacology and clinical indications. Phytomedicine. 2003;10(4):348-357.

Agrimony (Agrimonia eupatoria) (also known as Church steeple, Liverwort, Stickwort)

Traditional uses:

as an astringent, antiseptic, diuretic, used for urinary incontinence, cystitis, gall bladder disease and colic.

Principal constituents:

acids, flavonoids, tannins, vitamins.

Evidence:

hypoglycaemic, antibacterial (Staphylococcus aureus), immunostimulant and gastrointestinal healing properties.

Safety:

May cause lithium toxicity.

Bibliography

Copland A, Nahar L, Tomlinson CT, et al. Antibacterial and free radical scavenging activity of the seeds of Agrimonia eupatoria. Fitoterapia. 2003;74(1–2):133-135.

Gray AM, Flatt PR. Actions of the traditional anti-diabetic plant, Agrimony eupatoria (agrimony): effects on hyperglycaemia, cellular glucose metabolism and insulin secretion. British Journal of Nutrition. 1998;80(1):109-114.

Kwon DH, Kwon HY, Kim HJ, et al. Inhibition of hepatitis B virus by an aqueous extract of Agrimonia eupatoria L. Phytotherapy Research. 2005;19(4):355-358.

Li Y, Ooi LS, Wang H, et al. Antiviral activities of medicinal herbs traditionally used in southern mainland China. Phytotherapy Research. 2004;18(9):718-722.

Aloe vera (Aloe vera) (also known as Burn plant, Miracle plant)

Traditional uses:

as a laxative, healing agent used for wounds, burns, eczema and psoriasis.

Principal constituents:

mono- and polysaccharides, tannins, sterols, organic acids, enzymes, saponins, vitamins and minerals, carbohydrates and lipids.

Evidence:

Has been shown to have wound healing, hypoglycaemic, anticoagulant and antiinflammatory properties.

Safety:

Chronic oral use may result in electrolyte imbalance. Thought to increase the effects of cardiac glycosides and anti-arrhythmic drugs. Internal use contraindicated in renal and cardiac pathology. May increase risk of haemorrhage in patients with bleeding disorders or on anticoagulants, including aspirin and NSAIDs.

Bibliography

Belfrage B, Malmström R. Several cases of liver affected by aloe vera. Lakartidningen. 2008;105(1–2):45.

Bottenberg MM, Wall GC, Harvey RL, et al. Oral aloe vera-induced hepatitis. Annals of Pharmacotherapy. 2007;41(10):1740-1743.

Choonhakarn C, Busaracome P, Sripanidkulchai B, et al. The efficacy of aloe vera gel in the treatment of oral lichen planus: a randomized controlled trial. British Journal of Dermatology. 2008;158(3):573-577.

Dannemann K, Hecker W, Haberland H. Use of complementary and alternative medicine in children with type 1 diabetes mellitus – prevalence, patterns of use and costs. Pediatric Diabetes. 2008;9(3):228-235.

Duansak D, Somboonwong J, Patumraj S. Effects of Aloe vera on leukocyte adhesion and TNF-alpha and IL-6 levels in burn wounded rats. Clinical Hemorheology and Microcirculation. 2003;29(3–4):239-246.

Kirdpon S, Kirdpon W, Airarat W, et al. Effect of aloe (Aloe vera Linn.) on healthy adult volunteers: changes in urinary composition. Journal of the Medical Association of Thailand. 2006;89(Suppl 2):S9-14.

Kim EJ, Kim HJ, Kim SG. Aloe-induced Henoch–Schonlein purpura. Nephrology (Carlton). 2007;12(1):109.

Luyckx VA, Ballantine R, Claeys M, et al. Herbal remedy-associated acute renal failure secondary to Cape aloes. American Journal of Kidney Disease. 2002;39:E13.

Maenthaisong R, Chaiyakunapruk N, Niruntraporn S, et al. The efficacy of aloe vera used for burn wound healing: a systematic review. Burns. 2007;33(6):713-718.

Merchant TE, Bosley C, Smith J. Phase III trial comparing an anionic phospholipid-based cream and aloe vera-based gel in the prevention of radiation dermatitis in pediatric patients. Radiation Oncology. 2007;2:45.

Reuter J, Jocher A, Stump J. Investigation of the antiinflammatory potential of Aloe vera gel (97.5%) in the ultraviolet erythema test. Skin Pharmacology and Physiology. 2008;21(2):106-110.

Vogler BK, Ernst E. Aloe vera: a systematic review of its clinical effectiveness. British Journal of General Practice. 1999;49:823-828.

Angelica (Angelica sinensis) (also known as Dong quai)

Traditional uses:

as a digestive tonic, antispasmodic, expectorant, diuretic, local antiinflammatory properties used for debilitating illnesses, hepatic conditions, asthma, paediatric respiratory conditions.

Principal constituents:

coumarins, tannins, resin.

Evidence:

Studies indicate that angelica is antiinflammatory, anticoagulant, antimicrobial (Escherichia coli, Streptococcus faecalis, Salmonella typhi).

Safety:

May increase the risk of bleeding in patients with bleeding disorders and potentiate the effects of anticoagulants, including aspirin and NSAIDs. May increase the effects of beta blockers, calcium channel blockers and digoxin.

Bibliography

Anonymous. Angelica sinensis (Dong quai). Alternative Medical Review. 2004;9(4):429-433.

Astegiano M, Pellicano R, Terzi E. Treatment of irritable bowel syndrome: a case control experience. Minerva Gastroenterologica e Dietologica. 2006;52(4):359-363.

Cheema D, Coomarasamy A, El-Toukhy T. Non-hormonal therapy of post-menopausal vasomotor symptoms: a structured evidence-based review. Archives of Gynecology and Obstetrics Review. 2007;276(5):463-469.

Gu Q, Xu JY, Cheng LG, et al. The effect of Angelica sinensis on adhesion, invasion, migration and metastasis of melanoma cells. Zhong Yao Cai. 2007;30(3):302-305.

Lu J, Kim SH, Jiang C, et al. Oriental herbs as a source of novel anti-androgen and prostate cancer chemopreventive agents. Acta Pharmacology Sinese. 2007;28(9):1365-1372.

Piersen CE. Phytoestrogens in botanical dietary supplements: implications for cancer. Integrative Cancer Therapies. 2003;2(2):120-138.

Xin YF, Zhou GL, Shen M, et al. Angelica sinensis: a novel adjunct to prevent doxorubicin-induced chronic cardiotoxicity. Basic Clinical Pharmacology Toxicology. 2007;101(6):421-426.

Arnica (Arnica montana) (also known as Leopards bane, Wolf’s bane)

Traditional uses:

local healing, stimulates peripheral blood supply.

Principal constituents:

alkaloids, amines, coumarins, terpenoids, flavonoids.

Evidence:

Has been shown to be antiinflammatory, antimicrobial (Listeria monocytogenes Salmonella typhimurium, Staphylococcus aureus, Proteus vulgaris, Trichophyton mentagrophytes).

Safety:

For topical application only, not for oral use. It is necessary also to differentiate between the herbal (i.e. pharmacological) preparation and the homeopathic (i.e. highly diluted) remedy.

Bibliography

Kouzi SA, Nuzum DS. Arnica for bruising and swelling. American Journal of Health-System Pharmacy. 2007;64(23):2434-2443.

Lass C, Vocanson M, Wagner S, et al. Anti-inflammatory and immune-regulatory mechanisms prevent contact hypersensitivity to Arnica montana L. Experimental Dermatology. 12 March, 2008. [Epub ahead of print]

Widrig R, Suter A, Saller R, et al. Choosing between NSAID and arnica for topical treatment of hand osteoarthritis in a randomised, double-blind study. Rheumatology International. 2007;27(6):585-591.

Astragalus (Astragalus branaceous) (also known as Huang chi, Milk vetch)

Traditional uses:

used in traditional Chinese medicine to enhance the immune system, diuretic.

Principal constituents:

betaine, betasitoserol choline, glycosides, saponins, polysaccharides.

Evidence:

Trials indicate that astragalus may be antiinflammatory, hypotensive, diuretic, hypoglycaemic, antiviral, antioxidant and have muscle-repairing properties.

Safety:

May interfere with immunosuppressive therapy, contra-indicated in transplant surgery. May increase the risk of bleeding in patients with bleeding disorders and potentiate the effects of anticoagulants. Contraindicated in diabetics. May increase the effects of paralytics such as pancuronium and succinylcholine.

Bibliography

Ahmed MS, Hou SH, Battaglia MC. Treatment of idiopathic membranous nephropathy with the herb Astragalus membranaceus. American Journal of Kidney Disease. 2007;50(6):1028-1032.

Ho JW, Jie M. Pharmacological activity of cardiovascular agents from herbal medicine. Cardiovascular Hematology Agents in Medical Chemistry. 2007;5(4):273-277.

Lee H-J, Lee J-H. Effects of medicinal herb tea on the smoking cessation and reducing smoking withdrawal symptoms. American Journal of Chinese Medicine. 2005;33(1):127-138.

Wang G, Liu CT, Wang ZL. Effects of Astragalus membranaceus in promoting T-helper cell type 1 polarization and interferon-gamma production by up-regulating T-bet expression in patients with asthma. Chinese Journal of Integrative Medicine. 2005;12(4):262-267.

Bearberry (Uva ursi)

Traditional uses:

urinary tract antiseptic, diuretic, used for urinary tract infections.

Principal constituents:

flavonoids, quinines, tannins, terpenoids.

Evidence:

Bearberry has been shown to be antiseptic, antimicrobial (Escherichia coli), antioxidant and diuretic.

Safety:

As bearberry is known to inhibit melanin synthesis, caution should be used; one case report indicates possible toxicity affecting the retina.

Bibliography

Bousová I, Martin J, Jahodár L, et al. Evaluation of in vitro effects of natural substances of plant origin using a model of protein glycoxidation. Journal of Pharmaceutical and Biomedical Analysis. 2005;37(5):957-962.

Cervenka L, Peskova I, Foltynova E, et al. Inhibitory effects of some spice and herb extracts against Arcobacter butzleri, A. cryaerophilus and A. skirrowii. Current Microbiology. 2006;53(5):435-439.

Chauhan B, Yu C, Krantis A, et al. In vitro activity of uva-ursi against cytochrome P450 isoenzymes and P-glycoprotein. Canadian Journal Physiology Pharmacology. 2007;85(11):1099-1107.

Wang L, Del Priore LV. Bull’s-eye maculopathy secondary to herbal toxicity from uva ursi. American Journal of Ophthalmology. 2004;137(6):1135-1137.

Yarnell E. Botanical medicines for the urinary tract. World Journal of Urology. 2002;20(5):285-293.

Newton M, Combest W, Kosier JH. Select herbal remedies used to treat common urologic conditions. Urology Nursing. 2001;21(3):232-234.

Bilberry (Vaccinium myrtillus) (also known as Huckleberry, Whortleberry, Wineberry)

Traditional uses:

for ophthalmic conditions such as to improve visual acuity, for cataracts and retinal conditions; for circulatory problems including varicose veins, atherosclerosis, venous insufficiency and haemorrhoids. It is also used orally for gastrointestinal and urinary disorders. Topically, it is used for inflammation of the mucous membranes in the mouth and throat.

Principal constituents:

anthocyanosides, tannins, flavonoids.

Evidence:

Some studies indicate that bilberry is cholesterol reducing, hypoglycaemic, antispasmodic, antibacterial (Staphylococcus aureus, Escherichia coli, Helicobacter pylori) and affects platelet aggregation. There is some thought that it may improve diabetic retinopathy.

Safety:

Bilberry may increase the risk of bleeding in patients with bleeding disorders and potentiate the effects of anticoagulants, aspirin and non-steroidal antiinflammatory drugs. Avoid in pregnancy as there is insufficient information available on the teratogenic effects. As bilberry may have the potential to lower blood glucose, caution is needed in diabetic patients taking medication to control blood glucose levels.

Bibliography

Chatterjee A, Yasmin T, Bagchi D, et al. Inhibition of Helicobacter pylori in vitro by various berry extracts, with enhanced susceptibility to clarithromycin. Molecular Cell Biochemistry. 2004;265(1–2):19-26.

Choi EH, Ok HE, Yoon Y. Protective effect of anthocyanin-rich extract from bilberry (Vaccinium myrtillus L.) against myelotoxicity induced by 5-fluorouracil. Biofactors. 2007;29(1):55-65.

Kiser AK, Dagnelie G. Reported effects of non-traditional treatments and complementary and alternative medicine by retinitis pigmentosa patients. Clinical Experimental Optometry. 2008;91(2):166-176.

Muth E-R, Laurent J-M, Jasper P. The effect of bilberry nutritional supplementation on night visual acuity and contrast sensitivity. Alternative Medical Review. 2000;5(2):164-173.

Zafra-Stone S, Yasmin T, Bagchi M. Berry anthocyanins as novel antioxidants in human health and disease prevention. Molecular Nutrition Food Research Review. 2007;51(6):675-683.

Black cohosh (Cimicifuga racemosa) (also known as Black snakeroot, Baneberry, Bugwort, Cimicifuga, Phytoestrogen, Rattleweed, Sheng ma, squaw root)

Traditional uses:

popular contemporary use of black cohosh is as a natural form of hormone replacement therapy in the perimenopausal period and for dysmenorrhoea, but it has also been used as an antispasmodic, antiinflammatory and as a vasodilator for muscle cramps and tension.

Principal constituents:

alkaloids, tannins, terpenoids, cimicifugin, racemosin, salicylic acid.

Evidence:

In vitro animal studies and clinical trials indicates hormonal, antiinflammatory, anticoagulant, hypotensive, analgesic and antibacterial (v. Staphylococcus aureus, Escherichia coli) properties.

Safety:

Avoid in pregnancy until term, as it may trigger uterine contractions. Black cohosh may increase risk of bleeding in patients with bleeding disorders or in those on anticoagulants including aspirin and non-steroidal antiinflammatories. May increase the effects of oestrogen supplements and should be avoided in those with hormone-sensitive conditions. There is some evidence to suggest that it may increase metastatic growth in women with breast cancer; caution should be used in women taking Tamoxifen. May be hepatotoxic in large doses or if taken concurrently with medication which has hepatotoxic side-effects. Care should be taken not to confuse black cohosh with blue cohosh (Caulophyllum thalictroides).

Bibliography

Baillie N, Rasmussen P. Black and blue cohosh in labour. New Zealand Medical Journal. 1997;110:20-21.

Chitturi S, Farrell GC. Hepatotoxic slimming aids and other herbal hepatotoxins. Journal of Gastroenterology Hepatology. 2008;23(3):366-373.

Cohen S, et al. Immune hepatitis associated with use of black cohosh: case study. Menopause. 2004;11:575-577.

Davis V L, Jayo M J, Hardy M L et al 2003 Effects of black cohosh on mammary tumor development and progression in MMTV-neu transgenic mice. 94th Annual Meeting of the American Association for Cancer Research, Washington DC

Farnsworth NR, Krause EC, Bolton JL. The University of Illinois at Chicago/National Institutes of Health Center for Botanical Dietary Supplements Research for Women’s Health: from plant to clinical use. American Journal of Clinical Nutrition. 2008;87(2):504S-508S.

Gurley BJ, Swain A, Hubbard MA, et al. Clinical assessment of CYP2D6-mediated herb-drug interactions in humans: effects of milk thistle, black cohosh, goldenseal, kava kava, St. John’s wort and Echinacea. Molecular Nutrition and Food Research. 2008;52(7):755-763.

Joy D, Joy J, Duane P. Black cohosh: a cause of abnormal postmenopausal liver function tests. Climacteric. 2008;11(1):84-88.

Mahady GB, Low Dog T, Barrett ML, et al. United States Pharmacopeia review of the black cohosh case reports of hepatotoxicity. Menopause. 2008;15(4 Part 1):628-638.

Nisbet BC, O’Connor RE. Black cohosh-induced hepatitis. Delaware Medical Journal. 2007;79(11):441-444.

Ruhlen RL, Haubner J, Tracy JK, et al. Black cohosh does not exert an estrogenic effect on the breast. Nutrition Cancer. 2007;59(2):269-277.

Vitetta L, Thomsen M, Sali A. Black cohosh and other herbal remedies associated with acute hepatitis. Medical Journal of Australia. 2003;178:411-412.

Blue cohosh (Caulophyllum thalictroides) (also known as Blue ginseng, Caulophyllum, Papoose root, Squaw root)

Traditional uses:

The primary use of blue cohosh is to stimulate the uterus to induce labour or menstruation, but it is also used as an antispasmodic, laxative and for rheumatic conditions.

Principal constituents:

steroidal saponins, alkaloids, magnoflorine, cystine, laburnine, taspine.

Evidence:

There is considerable evidence of the uterine-stimulating properties of blue cohosh and of its potential side-effects.

Safety:

Blue cohosh is a uterine stimulant and several constituents are potentially teratogenic; use of blue cohosh in pregnancy, especially towards term, can cause life-threatening toxicity in the infant, including stroke and death. Although many nurse-midwives in the USA and some mothers in both the USA and in the UK use blue cohosh to facilitate the onset of labour, they should be advised that this is dangerous; the National Institute of Medical Herbalists in the UK strongly discourages the use of blue cohosh. The taspine constituent is chemically similar to morphine – should not be taken concurrently with morphine and morphine-derivative medications. It may also decrease the effectiveness of anti-diabetic and anti-hypertensive medications. It should be avoided in anyone with a cardiac condition.

Bibliography

Dugoua JJ, Perri D, Seely D. Safety and efficacy of blue cohosh (Caulophyllum thalictroides) during pregnancy and lactation. Canadian Journal of Clinical Pharmacology. 2008;15(1):e66-e73.

Edmunds J. Blue cohosh and newborn myocardial infarction?. Midwifery Today with International Midwife, 52. 1999: 34-35.

Finkel RS, Zarlengo KM. Blue cohosh and perinatal stroke. New England Journal of Medicine. 2004;351(3):302-303.

Jones TK, Lawson BM. Profound neonatal congestive heart failure caused by maternal consumption of blue cohosh herbal medication. Journal of Pediatrics. 1998;132(3 Pt 1):550-552.

Boldo (Peumus boldus)

Traditional uses:

as a digestive and hepatobiliary remedy and for colds, gout, headache, menstrual pain.

Principal constituents:

alkaloids, flavonoids, volatile oil, coumarin, resin and tannin.

Evidence:

Studies indicate diuretic, muscle relaxant, anticoagulant, antioxidant and central nervous system (CNS) inhibition.

Safety:

Boldo is contraindicated in CNS or respiratory disorders and should not be taken concurrently with sedation or with analgesics containing codeine. It may increase the risk of bleeding in patients with bleeding disorders or taking anticoagulants including aspirin and NSAIDs. Boldo has been shown to be hepatotoxic.

Bibliography

Izzo AA, Di Carlo G, Borrelli F, et al. Cardiovascular pharmacotherapy and herbal medicines: the risk of drug interaction. International Journal of Cardiology. 2005;98(1):1-14.

Lambert JP, Cormier J. Potential interaction between warfarin and boldo-fenugreek. Pharmacotherapy. 2001;21(4):509-512.

Monzón S, Lezaun A, Sáenz D, et al. Anaphylaxis to boldo infusion, a herbal remedy. Allergy. 2004;59(9):1019-1020.

O’Brien P, Carrasco-Pozo C, Speisky H. Boldine and its antioxidant or health-promoting properties. Chemico-biological Interactions. 2006;159(1):1-17.

Piscaglia F, Leoni S, Venturi A, et al. Caution in the use of boldo in herbal laxatives: a case of hepatotoxicity. Scandinavian Journal of Gastroenterology. 2005;40(2):236-239.

Boneset (Eupatorium perfoliatum) (also known as Fever wort, Agueweed)

Traditional uses:

Boneset has been used for influenza, acute bronchitis, nasopharyngeal conditions, as a urinary tract antiseptic and diuretic.

Principal constituents:

flavonoids, volatile oil, terpenoids.

Evidence:

Non-clinical studies indicate that boneset may have antibacterial, immunostimulant and antiinflammatory properties.

Safety:

Allergic reactions have been reported, notably in people allergic to chrysanthemums, marigolds and daisies. It is important to avoid confusion with gravel root (Eupatorium purpureum), also known as boneset.

Bibliography

Habtemariam S, Macpherson AM. Cytotoxicity and antibacterial activity of ethanol extract from leaves of a herbal drug, boneset (Eupatorium perfoliatum). Phytotherapy Research. 2000;4:575-577.

Borage (Borago officinalis) (also known as Starflower oil)

Traditional uses:

Borage seed oil is used for rheumatoid arthritis, atopic eczema, seborrhoeic dermatitis in babies and stress. It is particularly popular for premenstrual syndrome and has been used for attention deficit-hyperactivity disorder (ADHD), alcoholism, depression, reducing pyrexia and for preventing heart disease and stroke. Borage is also used as a cardiac tonic, sedative and to increase circulatory capacity and breast milk production.

Principal constituents:

Borage oil contains 18–26% gamma-linolenic acid, an omega-6 fatty acid but the leaves and flowers do not. Alkaloids and mucilages are the other main constituents.

Evidence:

Studies indicate that borage oil has antiinflammatory, central nervous system stimulating and anticoagulant effects.

Safety:

Certain constituents in borage are potentially pneumotoxic, carcinogenic, hepatotoxic and mutagenic. It may decrease efficacy of anticonvulsive therapy, increases risk of temporal lobe epilepsy in schizophrenics. It may also increase bleeding in people with bleeding disorders or in those taking anticoagulants.

Bibliography

Conforti F, Sosa S, Marrelli M. In vivo antiinflammatory and in vitro antioxidant activities of Mediterranean dietary plants. Journal of Ethnopharmacology. 2008;116(1):144-151.

Gilani AH, Bashir S, Khan AU. Pharmacological basis for the use of Borago officinalis in gastrointestinal, respiratory and cardiovascular disorders. Journal of Ethnopharmacology. 2007;114(3):393-399.

Kanehara S, Ohtani T, Uede K, et al. Clinical effects of undershirts coated with borage oil on children with atopic dermatitis: a double-blind, placebo-controlled clinical trial. Journal of Dermatology. 2007;34(12):811-815.

Broom (Sarothamnus scoparius) (also known as Sorghum)

Traditional uses:

Primarily used for digestive disorders, but also as a peripheral vasoconstrictor and for oedema associated with heart failure.

Principal constituents:

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