4. HERBAL MEDICINE Flashcards
This module covers: • History and background of herbal medicine. • Phytochemistry. • Internal and external herbal applications. • Dosage and herbal medicine safety. • Herbs for: Digestive, liver, respiratory, immune, nervous, cardiovascular, reproductive systems and adaptogens.
1
Q
What are Herbal Medicines?
A
Plants or plant parts (leaves, flowers, seeds, roots, bark) used for medicinal purposes with beneficial therapeutic effects in the body.
There are estimated to be up to 30,000 different medicinal herbs in use globally.
2
Q
What cultures across the world and throughout history have used herbal medicines?
A
‒ Ayurvedic medicine (South Asia).
‒ Chinese medicine (East Asia).
‒ Western herbal medicine (Europe and America).
3
Q
Provide an example of how a medicine was developed from a plant.
A
Metformin for Type 2 diabetes was developed from goat’s rue, a traditional blood sugar-lowering herb.
Aspirin has its origins in willow bark, a herb used for inflammation and pain.
4
Q
In what ways do herbal medicines differ from foods?
A
Foods are most commonly considered for their macro and micronutrient content and are generally consumed in larger amounts (note: many fruits and vegetables also contain phytonutrients).
In contrast, medicinal herbs are used primarily for their concentration of phytochemicals, where small amounts offer therapeutic benefits.
5
Q
What is meant by a ‘primary metabolite’, what do they consist of and why are they important in nutritional medicine?
A
Primary metabolites - compounds in the plant that are needed for the plant to grow and function.
Includes:
– Starch for energy storage.
– Chlorophyll for carbohydrate production.
– Cellulose to withstand cellular pressure.
– Lignin for structural support.
Primary metabolites are important in nutritional medicine e.g., starch provides energy, cellulose and lignin provide digestive fibre.
6
Q
What is meant by a ‘secondary metabolite’? Provide ONE example.
A
Secondary metabolites assist the plants’ survival within their environment e.g., defence against plant pathogens, protection from decomposition, compounds that attract pollinators.
They are pharmacologically active in humans and central to the effects of herbal medicines e.g., coffee beans contain the alkaloid caffeine, a natural pesticide that protects the fruits against insect attacks. In human physiology, caffeine acts as a CNS stimulant.
Tannins in plants e.g., green tea protect the woody parts of the plant from decomposition and insects. Tannins astringe mucous membranes and reduce watery secretions (runny nose, diarrhoea).
7
Q
Every herbal medicine contains a variety of ‘active’ phytochemicals. Therefore, herbs have a range of therapeutic effects or ‘actions’. Describe the effects of chamomile flowers as an example.
A
- Relax the central nervous system and reduce neural activity in states of stress or anxiety.
- Antispasmodic in the digestive system, relieving gas, bloating and colic pains.
- Anti-inflammatory for the skin and digestive tract mucous membranes.
- Anti-ulcer - protects against peptic ulceration.
8
Q
Give an example of an alkaloid and its effects.
A
Berberis vulgaris (berberine).
Strong stimulant effects on the nervous system.
9
Q
Give an example of an anthraquinone and its effects.
A
Cause powerful evacuation
Senna
10
Q
Give an example of a flavonoid and its effects.
A
Hawthorn berry
Anti-oxidant and anti-viral
11
Q
Give an example of a saponin and its effects.
A
Liquorice
Adaptogenic and steroid-like effects
12
Q
Give an example of a tannin and its effects.
A
Astringent (bind to proteins) and dry out wounds
Yarrow
13
Q
Give an example of a terpene and its effects.
A
Lavender
Antispasmodic in the GIT and lungs, antimicrobial
14
Q
In the UK, herbs are regulated by _____
A
the Medicines and Healthcare products Regulatory Agency (MHRA) that runs the Traditional Herbal Registration (THR) scheme. THR products are licensed to treat specified conditions and carry a THR logo.
15
Q
TRUE or FALSE
Some herbal products don’t make medicinal claims and can be recommended by nutritional therapists. You can suggest a higher or lower dosage.
A
FALSE
When using herbal products nutritional therapists must advise clients to follow doses recommended on product labels. You can suggest less, but never more.
16
Q
Discuss herbal infusions: what are they used for, how to make them, dosage and benefits. Give ONE example of what can be used as an infusion and for what condition.
A
Infusions (herbal teas) are used for preparing delicate and / or aromatic leaves and flowers:
- Place herbs in a cup or warmed teapot; add boiled water; infuse for 10–15 minutes; strain.
- Adult dose: 2 tsp of dried or fresh herbs per cup. 3 cups daily. If using tea bags, 2 bags per cup is a medicinal dose.
- Infusions extract water-soluble phytochemicals, are hydrating and good for compliance, as many clients already drink herbal teas.
→ peppermint leaf for IBS
→ chamomile flowers for tension
→ liquorice root for adrenal fatigue
17
Q
Discuss decoctions: what are they used for, how to make them and dosages. Give ONE example of what can be used as a decoction.
A
Decoctions are used for preparing roots, fruits and barks, that need to be ‘cooked’ to extract water-soluble phytochemicals:
* Place herbs in a pan (steel, enamel or glass to avoid chemical reactions with pan material), cover with cold water, bring to a boil, simmer on low heat for 15 minutes, until reduced by 30%, then strain.
* Adult dose: 1 tsp dried herb per cup, 3 cups daily.
→ dandelion root for liver support
→ burdock root for detoxification.
18
Q
Discuss syrups: what are they used for, how to make them, caution and dosages. Give ONE example of what can be used as a syrup.
A
Syrups are thick, sweet medicines for cough and throat remedies, and an easy way for children to take herbal medicines:
* Make a decoction, strain, reduce on low until ½ the water has evaporated.
* Weigh decoction. Add sugar or honey in a ratio of 2 parts sugar to 1 part decoction, stir till dissolved.
* Place in sterilised glass jars, label, store in the fridge.
Syrups last for several months because sugar preserves.
* Adult dose: 2 tsp 3 times daily (children ½–1 tsp).
Caution - sugar increases the risk of diabetes, candida, dental caries!
→ Thyme or aniseed syrup for coughs.
19
Q
Discuss tinctures: how to make them, benefits, variations in strength, dosages and limitations.
A
Tinctures are made by steeping herbs in a mixture of water and alcohol, to extract a wide range of phytochemicals.
Benefits: Concentrated and fast-acting - phytochemicals are extracted in the ethanol (alcohol) so can be readily absorbed, good compliance (easy to take), long shelf-life (up to 5 years) because alcohol halts microbial growth.
Dosage: Tinctures come in different strengths: 1:1 is strongest (1 part herb extracted in 1 part alcohol/water - also called ‘fluid extracts’), 1:2, 1:5 and so on are less concentrated.
Normal adult dose: 5ml / 0.17 fl. oz (100 drops) in a small glass of water 3 x daily before food.
Some herbs are very potent and have lower dosage levels, always check product labels.
Limitations: Not suitable for:
→ recovering alcoholics
→ in some religions
→ inflammatory conditions such as gastritis.
20
Q
Discuss glycerites: how to make them, application to practice, benefits, and limitations.
A
Glycerites are made by steeping herbs in glycerine - a thick sweet liquid derived from fats and oils:
Benefits: Good for clients who cannot consume alcohol (tinctures) or sugar (syrups), but enjoy the sweet taste.
Has a natural ‘syrupy’ texture which makes them good as mouth, throat and chest remedies. It is also a gentle laxative.
Limitations: Glycerine does not extract as many phytochemicals as water / alcohol-based medicines, and it has a relatively short shelf-life of around 3 months. However, the gentle action and sweet taste makes them ideal for children’s medicines.
21
Q
Powders are described as a ‘food form’ of herbal medicine. Discuss the best way to take them, dosage, benefits and limitations.
A
- The whole herb is digested and the small particle size aids assimilation. Can be mixed into foods and drinks (porridge, nut milks, smoothies).
- Herbs high in mucilage such as slippery elm (used for GIT inflammation) are best taken away from foods and medicine as they may reduce absorption.
- Normal adult dose: 1 teaspoon 2 x daily.
- Strong-tasting powders are best taken in capsules.
- Powders and capsules have a relatively short shelf life (max. 1 year) because high surface area increases oxidation.
22
Q
What are standardised extracts and their limitations?
A
Standardised extracts are manufactured to contain a quantified amount of ‘active’ constituents so that medicines are ‘consistent’ and ‘reproducible’ (e.g. milk thistle for ‘silymarin’ content).
They are stronger than traditional extracts, however:
‒ Often made using unnatural solvents.
‒ Sometimes ‘spiked’ with pure phytochemicals.
‒ Do not have a ‘natural’ balance of phytochemicals.
‒ Can resemble pharmaceuticals and are more likely to cause side effects.
23
Q
How are infused oils made compared to essential oils?
A
Infused oils are made by ‘steeping’ or cooking herbs in oil using a double burner to avoid ‘damaging’ the oil. Oil is a good solvent for many phytochemicals.
Essential oils are made by extracting the volatile phytochemicals from herbs by steam distillation.
Highly concentrated plant extracts (not herbal medicines) that are blended into external remedies for their anti-microbial, ‘warming’ and other properties.
24
Q
Calendula oil external applications: when would you recommend to use oil and compress
A
→ Calendula oil for ‘dry’ skin problems and wounds. Has antimicrobial, anti-inflammatory and tissue healing properties.
→ Calendula flower compress for skin conditions.
25
What herb can be used topically as oil / poultice and would benefit a client who came to see you with musculoskeletal inflammation?
→ Comfrey oil for sprains, strains, arthritis. Decreases inflammation; allantoin in comfrey increases cell proliferation to promote healing.
→ Comfrey leaf for poultice for musculoskeletal inflammation.
Traditionally called ‘knit-bone’ as its allantoin content speeds fracture healing.
26
Garlic oil uses
Garlic oil is antimicrobial, especially useful for fungal skin infections.
27
What caution should be applied when using infused oils?
Never apply oils to hot, inflamed skin conditions as oil holds in heat and can worsen skin irritation.
28
Essential oils: dosages and caution
* Maximum 20 drops per 100 g / 3.4 oz preparation.
* Don’t take them internally without specific training.
* Don’t apply ‘neat’ to the skin except for a few drops of tea tree or lavender essential oils for disinfecting cuts and wounds.
29
What is the difference between ointments, creams and lotions? Include how they are made, texture and uses.
**Ointments, creams** and **lotions** have different consistencies and are chosen based on the skin condition:
* Ointments are made by mixing infused oils with beeswax or cocoa butter. *Thick, greasy* texture for *dry, cracked* skin.
* Creams are made by mixing infused oils with water using emulsifying wax. Moisturising texture for *skin complaints and wounds*.
* Lotions are made like creams but contain a lot more water. Thin texture and ‘cooling’ effect, for ‘*hot’, red, inflamed* skin conditions.
30
Compare a poultice and a compress. Provide an example of each.
A **poultice** is an application of crushed herbs applied directly to the skin and held in place with a bandage:
→ *Comfrey leaf* for musculoskeletal inflammation.
→ *Plantain leaf* for skin inflammation, bruises, bites, stings. ↓ inflammation, soothes, promotes healing.
A **compress** is a cloth soaked in herbal infusion or decoction and then applied to the skin.
→ *Calendula flower* compress for skin conditions.
31
Often, a dosage range is given e.g. 1 to 3 tablets daily. What should be considered in determining the appropriate dose?
→ client age,
→ body weight,
→ degree of sensitivity e.g. history of allergy,
→ acute condition (generally higher doses are used),
→ chronic condition (low to moderate dose).
32
Herbal teas dosages: loose and tea bags
* For herbal teas use 2 heaped teaspoons per cup (1 teaspoon for roots and barks).
* For commercial herbal tea bags use 2 per cup, 3 x daily to achieve therapeutic levels.
33
TRUE or FALSE
Children under 2 years are not generally given herbal tinctures
TRUE
liver and immune system are not sufficiently mature
34
What are the important considerations of using herbal medicine with seniors?
Seniors are typically given lower herb doses because *liver* and *immune function decline* in old age.
* Use approximately ¾ dose after the age of 80 years, ½ dose over the age of 90 years.
* An important consideration is to check for *herb-drug interactions*, as many seniors take a range of prescribed medicines.
* Patients with *renal* or *hepatic disease* may have reduced capacity to clear phytochemicals.
35
TRUE or FALSE
All culinary herbs are herbal medicines, even when used at maintenance and therapeutic dosages
TRUE
36
What practical advice could you give to a client on using culinary herbs?
Add *fresh or dried herbs* to green smoothies, salads, soups, stews and curries for their flavour, aroma and medicinal effects.
* *Minimise heat exposure* to retain phytonutrients.
* It is best to use herbs regularly (2–3 times daily) as this keeps herbs working in the system throughout the day.
* Don’t ‘overpower’ recipes with herbs, but always remember that well-chosen culinary herbs are the simplest and most traditional way of incorporating herbal medicine into nutritional protocols.
37
What is the action of bitter herbs for the digestive system? Provide an example.
Stimulates digestive secretions e.g., *gentian, dandelion root*.
38
What is the action of aromatic digestive herbs? Provide an example.
Promotes strong digestion e.g., *cardamom*
39
What is the action of carminative herbs? Provide an example.
Relaxes digestive smooth muscles e.g., *peppermint, fennel.*
40
What is the action of demulcent herbs? Provide an example.
Soothes and heals mucous membranes e.g., *slippery elm*.
41
What is the action of antiemetic herbs? Provide an example.
Reduces nausea and vomiting e.g., *ginger*.
42
Discuss **aloe vera** Aloe barbadensis
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Part used: Inner leaf gel.
* Energetics: *Cool, moist*.
* Key constituents: Polysaccharides.
* Actions and uses:
*Local anti-inflammatory* for:
→ wounds
→ burns
→ GI inflammation
→ ulceration.
Inhibits COX and hence the production of pro-inflammatory PG2 made from arachidonic acid. Speeds up *wound healing* (activates fibroblast collagen synthesis).
* Intake: 25–100 ml / day of juice concentrate, or topically (gel).
* Safety: some products contain traces of laxative constituents (anthraquinones). Avoid in pregnancy unless absence guaranteed.
43
TRUE or FALSE
Aloe vera root, skin and inner leaf gel have the same therapeutic application
FALSE.
Aloe vera root, skin and latex are powerful laxatives. Not to be confused with gentle, healing inner leaf gel.
44
Discuss **cardamon** *Elettaria cardamomum*
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Part used: Seeds.
* Energetics: *Warm, dry*.
* Key constituents: Volatile oil, flavonoids.
* Actions and uses:
*Carminative, gastro-protective*.
→ *weak digestion*, flatulence and bloating.
*Promotes circulation*.
→ blood pressure in *hypertension* (thought to relate to *antioxidant / diuretic* properties).
Demonstrated LOX-inhibiting (*anti-inflammatory*) properties.
* Intake: ½–1 teaspoon daily.
* Safety: Avoid high doses in pregnancy and GORD.
45
What is cardamom used for in traditional Indian recipes?
to stimulate Agni – the ‘digestive fire’.
46
Discuss **chamomile** *Matricaria recutita:*
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Part used: Flowers.
* Energetics: *Neutral*.
* Key constituents: Volatile oil, flavonoids.
* Actions and uses: *Anti-inflammatory* (COX-2 and NF-Κb inhibition), *carminative, antispasmodic, antioxidant, mild sedative*.
→ indigestion gastritis, peptic ulcers, IBS/IBD
→ teething and infantile colic
→ stress, insomnia, anxiolytic (binds to GABA receptors)
→ eczema (topical)
→ diabetes mellitus (inhibits gluconeogenesis and lowers insulin).
* Intake: Infusion (tea) - for therapeutic dose 2 tsp dried herb.
* Safety: allergy to plants of the Asteraceae family.
47
Discuss **fennel** Foeniculum vulgare
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Part used: Seeds.
* Energetics: *Warm*.
* Key constituents: Volatile oil, flavonoids.
* Actions and uses: *Antispasmodic, carminative, expectorant, galactagogue* (appear to regulate the expression of ‘aquaporin’ proteins that facilitate movement of water across mammary cell membranes).
→ indigestion, flatulence, bloating, IBS, poor appetite and digestion
→ colic, infantile colic
→ difficult lactation
→ bronchitis.
* Intake: Infusion (10 mins) of hot water 1-2 tsp crushed seeds/day.
* Safety: Avoid high doses in pregnancy; GORD (relaxes the LOS).
48
What infusion made of 3 of plants would you advise for mild ‘IBS’?
peppermint, fennel and ginger, taken after food.
49
What is galactagogue?
Increases breast milk production
50
Discuss **ginger** (*Zingiber officinale*):
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Part used: Rhizome.
* Energetics: *Warm* (fresh), *hot* (dry).
* Key constituents: Volatile oil.
* Actions and uses: *Antiemetic, carminative, aromatic digestive, anti-inflammatory (inhibits LOX, COX and TNF-α), circulatory stimulant*.
→ weak digestion (a prokinetic)
→ nausea, morning / motion sickness
→ colic
→ poor circulation
→ dysmenorrhoea (↓ inflammation)
→ inflammatory joint pain and arthritis (e.g. OA, RA).
* Intake: 3 tsps. daily (fresh), ½ tsp. daily (dried). Infusions.
* Safety: Caution in peptic ulcers; anti-coagulants (additive effect).
51
Discuss **liquorice** (*Glycyrrhiza glabra*):
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Part used: Root.
* Energetics: *Neutral*.
* Key constituents: Glycyrrhetinic acid, glycyrrhizin.
* Actions and uses:
*Anti-inflammatory* (‘cortisol-like’ effects, e.g. inhibits phospholipase A2), *mucoprotective, demulcent,
adrenal tonic* (potentiates cortisol by suppressing 5-β-reductase , thus increasing the half-life of cortisol), *expectorant, hepatoprotective* (antioxidants), *anti-viral*.
→ GORD, gastritis, peptic ulcers (protects the gastric mucosa - ↑ blood supply and mucus)
→ *H pylori* (inhibit protein synthesis and is anti-adhesive)
→ coughs, sore throat
→ adrenal depletion
→ PCOS (inhibits testosterone production by the ovaries)
→ viral infections (e.g. HSV, EBV – induces interferons)
→ mildly oestrogenic (isoflavone content) – antagonises exogenous oestrogen. Inhibits CYP1B1 (use for high 4-OH and oestrogen dominance; researched for role in triple negative breast cancer).
* Intake: 1 – 2 tsps. daily. Combined with *slippery elm* and *marshmallow* powder for gastritis and ulcers. Can use DGL (Deglycyrrhizinated Liqourice).
* Safety: Avoid in hypertension, oedema, hypokalaemia, congestive heart failure, as well as with cardiac glycoside and diuretic use.
52
Discuss **oregano** Oreganum vulgare
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Part used: Leaves.
* Energetics: *Warm*.
* Key constituents: Essential oils.
* Actions and uses:
*Antispasmodic, antifungal, antibacterial, antiparasitic / helminthic, antioxidant*.
→ GI infections including candidiasis, E. coli, K. pneumonia, B. hominis, H. pylori and salmonella
→ flatulence, bloating.
* Intake: 1–2 teaspoons daily, or as oil capsules.
* Safety: Avoid high doses in pregnancy / when breastfeeding.
Avoid long-term use (it is a powerful antimicrobial). Safe in food.
53
Discuss **peppermint** Mentha x Piperita
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Part used: Leaves.
* Energetics: *Neutral*.
* Key constituents: Volatile oils (e.g. menthol), flavonoids.
* Actions and uses:
*Antispasmodic* (menthol in peppermint blocks calcium channels in GI smooth muscle), *carminative, antimicrobial, antiemetic*.
→ nausea
→ colic
→ flatulence
→ ‘IBS’
→ colds / upper respiratory infections (use steam inhalation)
→ topical analgesic - tension headache, muscular and arthritic pain.
* Intake: Infusion 1 tsp per cup, or as oil capsules.
* Safety: Avoid in GORD (relaxes the LOS) and salicylate sensitivity.
54
Discuss **slippery elm** Ulmus fulva
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Part used: Inner bark.
* Energetics: *Cool, moist*.
* Key constituents: Polysaccharides (mucilage).
* Actions and uses:
*Demulcent*; *soothes the GI and upper respiratory tract*. Also acts as a prebiotic.
→ gastritis
→ peptic ulceration (take before meals)
→ GORD (after meals and before bed)
→ IBD
→ constipation (to bulk the stool)
→ dry coughs, sore throats.
* Intake: 2–3 tsps. daily. Mix into water (approx. 1 tsp: 250 ml water).
* Safety: Take 2 hours away from medicines as it may decrease absorption. Ensure a good intake of water.
55
What combination of herbs would you advise to support the mucosal barrier and soothe the inflamed mucosa?
a combination of powdered mucilaginous herbs that are rich in mucopolysaccharides: Slippery elm (50%), marshmallow root (30%), liquorice root (20%).
56
Name THREE herbs/plants that can be used for H.Pylori
**Liquorice** - inhibits protein synthesis and is anti-adhesive.
**Oregano** - antibacterial.
**Cinnamon** - inhibits urease (combine with liquorice).
**Rosemary** - antibacterial, anti-microbial, anti-biofilm properties.
**Garlic** - anti-bacterial effects.
57
Name THREE herbs/plants that can be used for T2DM.
→ chamomile - inhibits gluconeogenesis and lowers insulin
→ cinnamon - increases insulin receptor sensitivity
→ ginger - improves blood glucose control
→ Korean ginseng - increases insulin sensitivity
58
Name THREE herbs/plants that can be used for hypertension.
→ cardamon - promotes circulation (antioxidant / diuretic properties)
→ ginger - circulatory stimulant
→ garlic - increases nitric oxide
→ astragalus - cardiotonic: hypotensive, antioxidant
59
Name THREE herbs/plants that can be used for GI ulcers.
→ Aloe vera - local anti-inflammatory
→ chamomile - anti-inflammatory
→ liquorice - mucoprotective, demulcent
→ slippery elm - demulcent, soothes GI
60
Name key herbal actions for the liver. Provide an example of each.
* **Hepatoprotective**: Protects the liver e.g., *milk thistle*.
* **Choleretic**: Increases bile production by the liver e.g., *dandelion root*.
* **Cholagogue**: Increases release of stored bile from the gallbladder e.g., *artichoke*.
61
Discuss **globe artichoke** (*Cynara scolymus*):
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Part used: Leaves.
* Energetics: *Cool, bitter*.
* Key constituents: Cynaropicrin (bitter principle).
* Actions and uses:
*Hepatoprotective* (increases antioxidants), *choleretic, cholagogue, bitter, hypocholesterolaemic*.
→ liver disease / damage
→ sluggish digestion (esp. from rich, fatty foods)
→ nausea
→ dyspepsia
→ gallstones
→ chronic constipation
→ high cholesterol and / or triglycerides
→ enhances digestion and absorption.
* Intake: ½–1 tsp. infused x 3 daily. Use bitter herbs before meals.
* Safety: Avoid in pregnancy. Caution with statins - additive effects.
62
Discuss **dandelion root** (*Taraxacum officinale*):
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Part used: Root.
* Energetics: *Cool, bitter*.
* Key constituents: Sesquiterpene lactones.
* Actions and uses:
*Bitter tonic, choleretic, cholagogue, mild laxative, mild diuretic*.
→ dyspepsia (indigestion)
→ constipation
→ appetite loss
→ flatulent colic
→ gall stones
→ cholecystitis (inflammation of the gall bladder)
→ Increases liver AO enzymes.
* Intake: Decoction 1–2 tsp dried herb per cup, 3 cups / day.
* Safety: Avoid in bile duct obstruction and in allergies to plants of the asteraceae family.
AO - Aldehyde oxidase, important for drug metabolism.
63
What part of dandelion is recommended for oedema and hypertension? How can they incorporate it into their diet?
Dandelion leaf is a strong herbal diuretic and is naturally rich in potassium. For oedema and hypertension add 3 fresh leaves to salads or smoothies.
64
Discuss **milk thistle** (*Silybum marianum*):
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Part used: Seeds.
* Energetics: *Neutral*.
* Key constituents: Flavanolignans collectively known as silymarin.
* Actions and uses:
*Hepatoprotective/restorative* (binds with hepatocellular membranes and protects against toxins and carcinogens), *antioxidant* (protects against phase I metabolites - increases glutathione and SOD), *choleretic*.
→ cirrhosis
→ hepatitis
→ fatty liver
→ nausea
→ dyspepsia
→ flatulent colic.
* Intake: 2 tsps. daily. Products as per label.
* Safety: Avoid if allergy to plants of the asteraceae family.
Superoxide dismutase (SOD) - neuroprotective enzyme that converts harmful superoxide radicals (O2−) to the less toxic, hydrogen peroxide (H2O2).
65
Name key herbal actions for the respiratory system. Provide an example of each.
* **Anticatarrhal**: Reduces the formation of catarrh or phlegm (drying it out) e.g., *eyebright*.
* **Diaphoretic**: Promotes sweating to relieve a fever e.g., *cinnamon*.
* **Expectorant**: Facilitates the removal of catarrh e.g., *liquorice*.
* **Anti-microbial**: Destroys infectious micro-organisms e.g., *thyme*.
* **Anti-spasmodic** (broncho-spasmolytic): Relaxes bronchial smooth muscle spasm e.g., *aniseed*.
66
Discuss **thyme** (*Thymus vulgaris*):
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Part used: Leaves, flowers.
* Energetics: *Warm*.
* Key constituents: Volatile oils (thymol, carvacrol).
* Actions and uses:
*Expectorant, antispasmodic, diaphoretic, anti-microbial* *-bacterial, -fungal, -viral* (shown to ↑ bacterial cell membrane permeability), *anti-inflammatory* (inhibits NF-κB, Il-1 and Il-6).
→ colds, sore throat
→ acute and chronic bronchitis / coughs, asthma
→ oral and GI dysbiosis
→ dyspepsia (indigestion).
* Intake: 3–12 g / day dried herb (infusion); a gargle or mouthwash.
* Safety: An infusion is recognised as safe.
67
Discuss **cinnamon** Cinnamomum zeylanicum
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Part used: Inner bark.
* Energetics: *Warm / hot, dry*.
* Key constituents: Volatile oil (4%), tannins.
Actions and uses:
*Warming diaphoretic, antiseptic, carminative, blood sugar regulating*.
→ weak digestion, nausea
→ poor circulation, Raynaud’s
→ diabetes mellitus (increases insulin receptor sensitivity)
→ H. pylori (inhibits urease - combine with liquorice)
→ parasites
→ high cholesterol (reduces TGs and LDL)
→ low mood.
* Intake: 1–2 tsps. daily (added to food or decoct cinnamon quills).
* Safety: Caution with anti-diabetic drugs (additive effect).
68
Discuss **sage** (*Salvia officinalis*):
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Part used: Leaves.
* Energetics: *Warm*.
* Key constituents: Volatile oil (inc. thujone).
* Actions and uses:
*Anti-spasmodic, antimicrobial, anti-cancer* (antiproliferative, angiogenic), *anti-hyperhydrotic* (reduces excess sweating), *antioxidant*.
→ gingivitis
→ respiratory infections e.g., tonsillitis
→ ↑ cognition (↓ breakdown of acetylcholine) - Alzheimer’s
→ menopausal sweats/flushes (cold tea).
* Intake: 3–12 g / day dried leaf (infusion); in mouthwash.
* Safety: Therapeutic amounts contraindicated in pregnancy and lactation except to ↓ milk flow. Long-term use is cautioned (thujone).
69
What is anti-hyperhydrotic?
= reduces excess sweating
70
Discuss **garlic** (*Allium sativum*):
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Parts used: Bulb.
* Energetics: *Hot* (so ↓ if hot constitution/excess heat).
* Key constituents: Sulphur compounds esp. allicin.
* Actions and uses:
*Antibacterial, antifungal, anti-parasitic, immune-boosting* (↑ NK cells and interferons), *mucolytic, antioxidant, ↓ cholesterol, hypotensive* (↑ nitric oxide), *antiplatelet, anti-inflammatory* (inhibits LOX, COX and NF-kB).
→ colds, flu, chronic bronchitis
→ bacterial / fungal infections incl. dysbiosis
→ atherosclerosis, hypertension
→ ↑ cholesterol
→ liver support (↑ GST).
* Intake: Consume 1-2 fresh cloves daily.
* Caution: Anticoagulants, antihypertensives, pregnancy (high doses).
Glutathione S-transferase (GST) - enzyme, involved in detoxification processes.
71
Name key herbal actions for the immune system. Provide an example of each.
* **Immunomodulator**: Balances and strengthens immunity i.e. *Astragalus*.
* **Immune-enhancing**: Increases immune responses i.e. *Echinacea*.
* **Anti-inflammatory**: Reduces inflammation i.e. *Turmeric*.
72
Discuss **astragalus** (*Astragalus membranaceus*):
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Parts used: Root.
* Energetics: *Warm*.
* Key constituents: Triterpenoid saponins.
* Actions and uses:
*Immune modulating / enhancing* (↑ lymphocyte and phagocyte activity, as well as IgA levels), *tonic, adaptogen, cardiotonic* (hypotensive, antioxidant), *anti-cancer* (antiproliferative).
→ chronic/recurrent infections, infection preventative
→ leukopenia
→ post-viral syndrome
→ fatigue
→ mild heart failure.
* Intake: 9–30 g / day dried root. Products as per label.
* Safety: Avoid in acute phases of infection (as its adaptogenic).
73
Discuss **echinacea** (*Echinacea purpurea / angustifolia*):
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Parts used: Root.
* Energetics: *Warm*.
* Key constituents: Alkylamides, polysaccharides.
* Actions and uses:
*immune enhancing / modulating* (alkylamides bind to cannibinoid (CB) receptors, esp. CB2 a possible mechanism of their immunomodulatory properties; activate phagocytes and NK cells; stimulates IL-10 but inhibits TNF-α), *anti-inflammatory* (LOX and COX inhibitors).
→ acute infections – bacterial, viral (e.g., influenza, tonsilitis, UTIs), infection prevention
→ arthritis.
* Intake: 1 tsp 1-3 x daily (decoction).
* Safety: Caution with immunosuppressant drugs.
74
Discuss **turmeric** (*Curcuma longa*):
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Part used: Rhizome.
* Energetics: *Warm*.
* Key constituents: Curcuminoids (esp. curcumin).
* Actions and uses:
*Anti-inflammatory* (regulates inflammatory cytokines and NFkB; inhibits COX-2), *antioxidant* (↑ Nrf2 gene expression), *anticancer* (inhibits VEGFs, induces apoptosis, ↓ inflammation), *antiplatelet, hypolipidaemic, choleretic*.
→ inflammatory conditions (e.g. OA, RA, SLE, ulcerative colitis)
→ liver support protocols
→ neuroprotective (incl. anti-amyloid)
→ eczema, psoriasis.
* Intake: 1-2 tsps. daily. Combine with healthy fats and black pepper
* Caution: Pregnancy, antiplatelet/anticoagulant drugs, chemotherapy.
VEGF - Vascular endothelial growth factor.
75
Name key herbal actions for the nervous system. Provide an example of each.
* **Nootropic**: Enhances brain function e.g., *rosemary*.
* **Nervine**: Relaxes the nervous system e.g., *lavender*.
* **Thymoleptic**: Lifts the mood e.g., *St John’s wort*.
* **Sedative**: Relaxes the nerves and promotes sleep e.g., *valerian*.
* **Anxiolytic**: Alleviates anxiety e.g., *passionflower*.
76
Discuss **ginkgo** Ginkgo biloba
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Parts used: Leaves.
* Energetics: *Neutral*.
* Key constituents: Flavonoids, diterpenes.
* Actions and uses:
*Antioxidant, neuroprotective, nootropic, circulatory stimulant* (↑ microcirculation), *tissue perfusion enhancing* (antagonises ‘Platelet Activating Factor’ by blocking receptors - causing *vasodilation*, protecting against ischaemia).
→ ↑ memory and concentration
→ Alzheimer’s (anti-amyloid), vascular dementia
→ Raynaud’s
→ erectile dysfunction
→ asthma
→ tinnitus.
* Intake: 2 tsps. daily. Products as per label
* Safety: Caution with anti-clotting drugs; stop 1 week pre-surgery.
77
Discuss **lavender** Lavandula angustifolia
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Parts used: Flowers.
* Energetics: *Warm*, bitter.
* Key constituents: Volatile oils.
* Actions and uses:
*Nervine, anti-depressant, anxiolytic* (the essential oil interacts with the limbic system - it is thought to inhibit NMDA and SERT, ↑ serotonin and calming excitatory neuron activity), *antispasmodic, carminative, antimicrobial* (e.g. candida).
→ depression, anxiety, insomnia
→ PMS
→ GI bloating
→ stress headaches.
* Intake: 3–6 g / day dried flower (infusion). Essential oil (e.g. baths).
* Safety: Avoid in pregnancy, breast feeding.
NMDA - N-methyl-D-aspartate, a receptor of glutamate, the primary excitatory neurotransmitter.
SERT - serotonin transporter responsible for terminating its action.
78
Discuss **passionflower** Passiflora incarnata
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Parts used: Leaves, flowers.
* Energetics: *Neutral*.
* Key constituents: Flavonoids, alkaloids.
* Actions and uses:
*Anxiolytic* (mediated via the GABAergic system; inhibits MAO-A), *antispasmodic, mild sedative, hypnotic*.
→ insomnia, anxiety with ‘circular thinking’, agitation
→ tension headache
→ nervous tachycardia
→ neuralgia (nerve pain)
→ drug and alcohol withdrawal (by alleviating anxiety/insomnia)
→ muscle pain / spasms.
* Intake: 1–2 tsps. day dried herb 2–3 x per day (infusion).
* Safety: Avoid in pregnancy and lactation.
MAO-A - monoamine oxidase A, involved in the breakdown of serotonin, epinephrine, norepinephrine, and dopamine.
79
Discuss **rosemary** (*Rosmarinus officinalis*):
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Parts used: Leaves, twigs.
* Energetics: *Warm*.
* Key constituents: Volatile oils, flavonoids.
* Actions and uses:
*Circulatory stimulant, cardiotonic, nootropic, carminative, antispasmodic, antioxidant* (reduces lipid peroxidation), *antimicrobial* (with anti-biofilm properties on various microbes incl. C.albicans and E.faecalis), *hepatoprotective* (↑ Nrf2 expression).
→ to improve memory, concentration or mental performance (cerebral circulation),
→ tension headache.
* Intake: 1-2 tsp dried herb x 3 daily (infusion).
* Safety: Avoid high doses in pregnancy.
80
Discuss **St John's wort** (*Hypericum perforatum*):
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Parts used: Leaves, flowering tops.
* Energetics: *Cool, bitter*.
* Key constituents: Hypericin, hyperforin, flavonoids.
* Actions and uses:
*Antidepressant* (MAO and COMT inhibitor; GABA antagonist), *nervine tonic, antiviral, vulnerary* (used to heal wounds), *antimicrobial* (topically).
→ mild to moderate depression, anxiety, irritability
→ anti-viral (e.g. herpes simplex, shingles, HIV)
→ neuralgia, sciatica
→ insomnia.
* Intake: 2 tsp infused x 3 cups daily, or as per label.
* Safety: Not suitable as sole treatment in severe depression, care with sun exposure (possible photosensitivity at ↑ doses), can ↑ liver clearance of a range of drugs incl. OCP. Avoid with antidepressants.
81
Name key herbal actions for the reproductive system. Provide an example of each.
* **Hormone modulators**: Regulate and balance hormonal activity e.g., *chaste berry*.
* **Emmenagogue**: Promotes menstruation e.g., *Dong quai*.
* **Galactagogue**: Promotes breast milk production e.g., *fennel seeds*.
* **Reproductive tonic**: Promotes reproductive health and fertility e.g., *shatavari*.
* **Anti-prostatic**: Reduces symptoms from the prostate gland e.g., *saw palmetto*.
82
Discuss **black cohosh** Cimicifuga racemosa
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Parts used: Root, rhizome.
* Energetics: *Cool*.
* Key constituents: Triterpenoid glycosides.
* Actions and uses:
*Emmenagogue, oestrogen-modulating* (isoflavone content), *uterine tonic, antispasmodic, antirheumatic*.
→ menopausal symptoms
→ spasmodic dysmenorrhoea
→ PMS
→ osteoarthritis, rheumatoid arthritis
→ cramps.
* Intake: Decoct 1 tsp of dried root per cup of water.
* Safety: Avoid in pregnancy, caution in those with oestrogen-dependent tumours and liver disease.
83
Discuss **chaste berry** Vitex agnus castus
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Parts used: Berry.
* Energetics: *Warm*.
* Key constituents: Flavanoids, iridoid glycosides.
* Actions and uses:
*Prolactin inhibitor and indirectly progesterogenic* (binds to dopamine D2 receptors ↓ prolactin pituitary secretion - in turn ↑ progesterone through normal corpus luteal development), *galactagogue*.
→ PMS
→ luteal insufficiency
→ dysmenorrhoea
→ anovulation
→ hyperprolactinaemia
→ recurrent miscarriage (↓ progesterone)
→ insufficient lactation
→ after OCP to regulate cycle.
* Intake: 1 tsp dried berries decocted 1-2 daily, or as per label.
* Safety: Avoid with progestogenic drugs and HRT.
84
Discuss **dong quai** Angelica sinensis
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Parts used: Root.
* Energetics: *Warm*.
* Key constituents: Essential oil, ferulic acid.
* Actions and uses:
*Uterine tonic* (regulates the HPO axis), *antiinflammatory, ‘blood building/tonic’* (in TCM - 'blood mover', specific for scanty, dark or clotted menstrual blood), *circulatory stimulant, antiplatelet, anti-arrhythmic, mild laxative*.
→ dysmenorrhoea
→ endometriosis
→ menopause
→ PMS
→ irregular or absent periods
→ weakness after the period, after giving birth or while breastfeeding.
* Intake: 4.5–9 g / day dried root, or as per label.
* Safety: Avoid in pregnancy, heavy menses and with anticoagulants.
85
Discuss **shatavari** Asparagus racemosa
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
Translates as ‘she who has a hundred husbands’.
* Parts used: Root, rhizome.
* Energetics: *Cool*.
* Key constituents: Steroidal glycosides, alkaloids.
* Actions and uses:
*Aphrodisiac* (attributable to the testosterone-like effects of key constituents), *galactagogue, adaptogen, anti-inflammatory, demulcent*.
→ menopausal symptoms incl. vaginal dryness
→ infertility or low libido
→ male impotence
→ to promote lactation.
* Intake: 1–2 teaspoons of fine powder or decoct 3–30 g dried root a day. Products as per label.
* Safety: Caution in pregnancy.
86
Discuss **saw palmetto** Serenoa repens
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Parts used: Berry.
* Energetics: *Warm*.
* Key constituents: Fatty acids, phytosterols (beta-sitosterol).
* Actions and uses:
*Anti-androgenic* (↓ conversion of testosterone to DHT by inhibiting 5α-reductase), *anti-inflammatory* (inhibits COX and LOX; lowers TNF and IL-1), *male tonic, antispasmodic*.
→ BPH (slows prostate cell proliferation)
→ ↓ inflammation and oedema
→ ↓ smooth muscle spasm
→ prostatitis
→ cystitis.
* Intake: 1 tsp dried berries 2–3 x daily. Products as per label.
* Safety: Caution with warfarin and avoid in pregnancy.
DHT - Dihydrotestosterone, promotes prostate growth.
BPH - Benign prostatic hyperplasia.
87
What is the difference between adaptogens and tonics? Provide definitions and an example of application in practice.
**Adaptogens** increase resistance to physical, biological, emotional and environmental stressors. Effects are exerted via a range of mechanisms, mediated largely by the HPA axis.
**Tonics** refer to herbs that improve tone, vigour and body function.
Adaptogens conserve energy, while tonics restore energy.
A herb often has both properties.
Adaptogens and tonics are used in a range of health scenarios including *chronic stress, exhaustion, anxiety, chronic illness, post-viral syndrome, compromised immunity, autoimmunity*.
88
Discuss **ashwagandha** Withania somnifera
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
Ashwagandha is the foremost tonic in Ayurvedic medicine.
* Parts used: Root.
* Energetics: *Warm*.
* Key constituents: Steroidal compounds - with anolides.
* Actions and uses:
*Adaptogen, tonic, nervine* (GABA agonist), *mild sedative, anti-inflammatory, immune modulating, anti-anaemic* (blood building).
→ impotence
→ infertility (e.g. in males ― ↑ DHEA, serum LH and testosterone; improves semen and sperm quality)
→ convalescence
→ anaemia
→ arthritis
→ insomnia (esp. those waking early with anxious thoughts)
→ post-viral/CFS.
* Intake: 3–6 g / day dried root (decoction); 1 tsp powder 1‒3 x per week in warm nut milk before bed (especially before bed).
89
Discuss **Korean ginseng** Panax ginseng
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Parts used: Root.
* Energetics: *Hot*.
* Key constituents: Ginsenosides.
* Actions and uses:
*Adaptogenic* (supports HPA axis), *tonic, very stimulating* (avoid at night!), *immune modulating, cardiotonic, male tonic, cognition-enhancing*.
→ debility, convalescence, fatigue
→ stress
→ impotence, male infertility
→ low immunity (lung tonic)
→ to ↑ physical / mental performance
→ Type 2 diabetes (↑ insulin sensitivity).
* Intake: Decoct 1–2 g root / day, or as per label.
* Safety: Avoid long-term use due to stimulating effect, avoid during acute infection, anxiety, and with caffeine, warfarin and MAOIs.
90
Discuss **Siberian ginseng** Eleutherococcus senticosus
* Part used
* Energetics
* Key constituents
* Actions and uses
* Intake
* Safety
* Parts used: Root.
* Energetics: *Warm*.
* Key constituents: Eleutherosides.
* Actions and uses:
*Adaptogen, immune modulating* (↑ T and B Lymphocytes, T-helper cells and NK cells).
→ general debility, physical stress, fatigue, convalescence
→ mild depression
→ chronic immune deficiency
→ to ↑ physical & mental performance
→ tonic for the elderly
→ cancer during chemotherapy and radiotherapy.
* Intake: 2–3 g / day dried root decocted. Products as per label.
* Safety: Avoid during acute stage of infection. Avoid with digoxin.
91
Provide an example of the possible adverse effects of herbs. What advice can you give to a client experiencing serious and mild adverse effects?
- Sensitivity to salicylates (willow bark, meadowsweet, black cohosh).
- Photo-sensitive skin reactions (St John’s Wort).
- GIT disturbances e.g. diarrhoea (schisandra).
If experiencing serious adverse effects from herbs, stop them immediately.
For minor disturbances, stop taking, wait till effect passes, try again at ½ dose. If effect happens again - discontinue.
92
What herbs are contra-indicated in pregnancy? Why should we be cautious about using herbs with breastfeeding? What herbs can be beneficial to breastfeeding mothers?
Herbs are contra-indicated in pregnancy if they:
- Risk-causing birth defects (**teratogens**) e.g. *wormwood*.
- Stimulate menstruation (**emmenagogues**) e.g. *yarrow*.
- Powerfully stimulate evacuation (**purgatives**) e.g. *senna*.
Nursing mothers must be cautious and evaluate safety of herbal medicines.
Phytochemicals may enter breast milk, and could adversely affect the infant.
Certain herbs such as *fennel seed* for increasing milk production are safe.
93
Name FOUR herbs that are considered safe in pregnancy in small doses, if clinically essential.
* *Bilberry (blueberry) fruit* for vascular support.
* *German chamomile* for relaxation, GIT spasm.
* *Cranberry fruit* for the urinary tract.
* *Echinacea* for immunity.
* *Garlic* for cardiovascular, respiratory systems.
* *Ginger* for morning sickness and digestion.
* *Peppermint* for morning sickness, GIT spasm.
All other herbs should be monitored by a qualified herbalist. Never use herbal capsules or herbal supplements in pregnancy.
94
Provide ONE example of additive, antagonistic and beneficial herb / drug / nutrient interaction and their consequences.
* **Additive** e.g. herbs with antiplatelet activity such as *garlic* and *turmeric* used in therapeutic doses at the same time as warfarin could dangerously thin blood.
* **Antagonistic** e.g. *St John’s wort* used at the same time as drugs metabolised by the CYP3A4 enzyme such as the immuno-suppressant, cyclosporine. St John’s wort increases gene expression of CYP3A4 speeding up drug clearance.
* **Beneficial** e.g. *turmeric* has anti-inflammatory properties and may decrease requirements for NSAIDs.
95
What are Narrow Therapeutic Index (NTI) drugs? Provide ONE example.
These drugs may become dangerously toxic or ineffective with only small changes in their blood concentrations: digoxin, phenytoin, lithium and warfarin.
96
What are the most endangered herbal species?
Rhodiola, echinacea (angustifolia), golden seal, Korean ginseng, Siberian ginseng, slippery elm.
