Herbal medicine - Lecture 4

Question 1

what are herbal medicines?

Answer 1

Plants or plant parts (leaves, flowers, seeds, roots, bark) used for medicinal purposes

There are estimated to be up to 30,000 different medicinal herbs in use globally

Question 2

Give two examples of moderne medicines derived from plants?

Answer 2

‘Metformin’ for Type 2 diabetes was developed from goat’s rue, a traditional blood sugar lowering herb.

Aspirin has its origins in willow bark (salicylic acid found in the core of willow bark – aspirin depletes glutathione on a regular basis vs the herb the side effects are much lower), a herb used for inflammation and pain.

Question 3

What is the difference between foods and medicinal herbal?

Answer 3

Foods are most commonly considered for their macro and micro- nutrient 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. Greater side effects

Question 4

what is phytochemistry?

Answer 4

Phytochemistry is the study of chemicals derived from plants and includes primary metabolites and secondary metabolites

Question 5

what are primary metabolites? what do they include?x4

Answer 5

Primary metabolites — compounds in the plant that are needed for the plant to grow and function. Normal by products of the plant as a normal part of the plant lifecycle/metabolism.

Includes:
* Starch for energy storage.
* Chlorophyll for carbohydrate production.
* Cellulose to withstand cellular pressure.
* Lignin for structural support.

Question 6

What are secondary metabolites?

Answer 6

Secondary metabolites assist the plants’ survival within its environment e.g., defence against plant pathogens, protection from decomposition, compounds that attract pollinators. Creates variability from plant to plant.

• They are pharmacologically active in humans and central to the effects of herbal medicines

Question 7

What are 6 types of phytochemical and what are their action + herb example

Answer 7

1. Alkaloids = Strong stimulant effects on the nervous system - Berberis vulgaris (berberine)
2. Anthraquinones = Cause powerful evacuation - Senna
3. Flavonoids = Anti-oxidant and anti-viral - Hawthorn berry
4. Saponins = Adaptogenic and steroid- like effects - Liquorice
5. Tannins = Astringent (bind to proteins) and dry out wounds - Yarrow
6. Terpenes = Antispasmodic in the GIT and lungs, antimicrobial - Lavender

Question 8

What is the problem with research on phytochemical vs. herbal practice?

Answer 8

Research on phytochemistry is relatively extensive, though much has been conducted by pharmaceutical companies in their search for new drug constituents:
* Some of this information is useful, however, much is based on animal and in vitro studies which limits its relevance.
* Also consider — research on single phytochemicals does not reflect the fact that herbal medicines contain many chemicals that work together in complex ways to produce therapeutic effects.
* The best research is the evidence that comes from thousands of years of herbal practice!

Question 9

What agency regulated herbal products and what scheme can they be approved by?

Answer 9

In the UK, herbs are regulated by the Medicines and Healthcare products Regulatory Agency (MHRA):
- The MHRA runs the Traditional Herbal Registration (THR) scheme.
- THR certification indicates the herbal medicine meets quality, safety and evidence criteria.
- THR products are licensed to treat specified conditions and carry a THR logo.

Question 10

What two types of application for herbal medicine?

Answer 10

1. Internal applications:
   o Infusions, decoctions, syrups, tinctures, glycerites, powders, capsules, lozenges, standardised extracts.
2. External applications:
   o Oils, creams, lotions, ointments (great as nutrition complement to reduce symptoms – nice combination), poultices, compresses.

Question 11

What are infusion (internal application) best for? What preparation to do for therapeutic dose?

Answer 11

Infusions (herbal teas) are used for preparing delicate and / or aromatic leaves and flowers (using water as an extractor, extracting water soluble constituents):

• Place herbs in a cup or warmed teapot; add boiled water; infuse for 10–15 minutes + cover to avoid losing constituents through evaporation
• Adult dose: 2 teaspoons of dried or fresh herbs per cup. 3 cups daily. If using tea bags, 2 bags per cup is a medicinal dose

Question 12

How to use decoctions (internal application)?

Answer 12

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 boil, simmer on low heat for 15 minutes, until reduced by 30%, then strain. Leave to cool down overnight and then use.
* Adult dose: 1 teaspoon dried herb per cup, 3 cups daily.

Question 13

Internal application of syrups?

Answer 13

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 heat until 1⁄2 the water has evaporated.
* Weigh decoction. Add sugar or honey in ratio of 2 parts sugar to 1-part decoction, stir till dissolved.
* Place in sterilised glass jars, label, store in fridge.
Syrups last for several months because sugar preserves.
Adult dose: 2 teaspoons 3 times daily (children 1⁄2–1 teaspoon).

Question 14

Tincture internal application?

Answer 14

Tinctures are made by steeping herbs in a mixture of water and alcohol (medicinal grade ethanol), to extract a wide range of phytochemicals. Soaked plant matters in medicinal ethanol for 3-4 weeks, strain all the plant matter away and extract all phytochemicals.
* 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.
* 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.
* Alcohol strengths vary: 25% (minimum for preservation), 45% (for essential oils and pigments), 90% (for resins).

Question 15

What dosage for tincture?

Answer 15

• Normal adult dose: 5ml / 0.17 fl. oz (100 drops) in small glass of water 3 x daily before food

Question 16

Glycerites internal application?

Answer 16

Glycerites are made by steeping herbs in glycerine ― a thick sweet liquid derived from fats and oils:
* Good for clients who cannot consume alcohol (tinctures) or sugar (syrups), but enjoy the sweet taste (e.g. children!).
* Has a natural ‘syrupy’ texture which makes them good as mouth, throat and chest remedies. It is also a gentle laxative.
* 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.

Question 17

powders internal application

Answer 17

Powders are a ‘food form’ of herbal medicine:
* 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 => Slippery Elm powder is very good to take.
* 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

Question 18

Standardised extracts internal application

Answer 18

Standardised extracts are manufactured to contain a quantified/guarantied amount of ‘active’ constituents, so that medicines are ‘consistent’ and ‘reproducible’.
* For example milk thistle for ‘silymarin’ content.
* They are stronger than traditional extracts

Question 19

What is the downside of standardised extracts?

Answer 19

• They are stronger than traditional extracts, however:
  o Often made using unnatural solvents.
  o Sometimes ‘spiked’ with pure phytochemicals.
  o Do not have a ‘natural’ balance of phytochemicals.
  o Can resemble pharmaceuticals and are more likely to cause side effects.

Question 20

External application - infused oils

Answer 20

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.
* Calendula oil for ‘dry’ skin problems and wounds. Has antimicrobial, anti-inflammatory and tissue healing properties.
* Comfrey oil for sprains, strains, arthritis. Decreases inflammation; allantoin in comfrey increases cell proliferation to promote healing.
* Garlic oil is antimicrobial, especially useful for fungal skin infections.

Note: Never apply oils to hot, inflamed skin conditions as oil holds in heat and can worsen skin irritation!

Question 21

External application essential oils

Answer 21

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. Always use a carrier oil before using the essential oils !
* 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.
* Can put thyme and lavender in a diffuser to diffuse at night to help with sleep and infections

Question 22

External application Ointments, creams and lotions

Answer 22

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, day or night cream.
* Lotions are made like creams but contain a lot more water. Thin texture and ‘cooling’ effect, for ‘hot’, red, inflamed skin conditions, sun burns. Runnier consistency.

Question 23

External application poultice and compress

Answer 23

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. Traditionally called ‘knit-bone’ as its allantoin content speeds fracture healing.
* 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, eczema, flare up of psoriasis.

Question 24

What to take into account for dosage?

Answer 24

• In determining appropriate dose, consider client age, bodyweight, degree of sensitivity e.g. history of allergy, acute condition (generally higher doses are used), chronic condition (low to moderate dose).

Question 25

What is the dosage for children from 2, 4, 6, 9, 12 and 14 yo?

Answer 25

Children are given lower doses than adults relative to age (maturity of body organs) and body weight:
Children under 2 years are not generally given herbal tinctures (liver and immune system are not sufficiently mature).
* 2 years  1/16 adult dose
* 4 years  1/8 adult dose
* 6 years  1⁄4 adult dose
* 9 years  1⁄2 adult dose
* 12 years  3⁄4 adult dose
* 14 years  full adult dose. At 14 years most people have reached puberty and adult height. For less mature teenagers use 3⁄4 dose.

Question 26

what dosage for older people 80 to 90 yo?

Answer 26

Seniors are typically given lower herb doses because liver and immune function declines in old age.
* Use approximately 3⁄4 dose after the age of 80 years, 1⁄2 dose over the age of 90 years.
*

Question 27

What is important to consider with elderly patients?

Answer 27

An important consideration is to check for herb drug interactions (see next section), as many seniors take a range of prescribed medicines.

Question 28

which patients may have reduced capacity to clear phytochemicals?

Answer 28

Patients with renal or hepatic disease

Question 29

1. In what ways do herbal medicines differ from foods?

Answer 29

Dosage (therapeutical) and cultural views. The poison is always in the dose and that is why in the form of food it is always safer.

Question 30

2. In phytochemistry what is meant by a ‘primary metabolite’?

Answer 30

The metabolites naturally produced by plants for their normal functions. Carbohydrates, lipids, produce as a normal part of lifecycle of the plant

Question 31

3. In phytochemistry what is meant by a ‘secondary metabolite’?

Answer 31

We get the phytochemicals produced by the plant depending on the environment it has been grown and the stress it has been exposed to.

Question 32

4. When using herbal medicine products, what dosage advice must nutritional therapists give their clients?

Answer 32

Always follow manufacturers instruction. If it is a liquid should be 5ml 3x a day.

Question 33

5. What are some of the benefits of using herbal infusions?

Answer 33

Great way to extract water soluble constituent out of the plant, well absorbed, for delicate plant part, portable

Question 34

6. How do herbal decoctions differ from herbal infusions?

Answer 34

With decoction we use woodier plant parts (bark, roots), the part needs to be boiled and simmer for 15min.

Question 35

7. What are the advantages and disadvantages of tinctures?

Answer 35

+ All of the plant constituent has been extracted (water and lipid soluble constituents), + in alcohol so diffuse easily through the gut wall. Reduces the dosage as so concentrated.
- bitter taste, if you cannot have alcohol, children and babies cannot metabolise the alcohol

Question 36

8. When might glycerites be an appropriate form of remedy?

Answer 36

Less sugar, no alcohol. Appropriate for a child, someone who cannot take strong tastes.

Question 37

9. Why are powders described as a ‘food form’ of herbal medicine?

Answer 37

They can be used as part of a dietary protocol. They can be capsulated as well

Question 38

10. Which herbal oil is good for sprains, strains and arthritic joints?

Answer 38

Comfrey leaf

Question 39

What are the 5 Key herbal actions for the digestive system? + example of herb

Answer 39

1. Bitter: Stimulates digestive secretions e.g., gentian, dandelion root.
2. Aromatic digestive: Promotes strong digestion e.g., cardamom.
3. Carminative: Relaxes digestive smooth muscles e.g., peppermint, fennel.
4. Demulcent: Soothes and heals mucous membranes e.g., slippery elm.
5. Antiemetic: Reduces nausea and vomiting e.g., ginger.

Question 40

What are the 3 Key herbal actions for the liver? + example of herb

Answer 40

1. Hepatoprotective: Protects the liver e.g., milk thistle.
2. Choleretic: Increases bile production by the liver e.g., dandelion root.
3. Cholagogue: Increases release of stored bile from the gallbladder e.g., artichoke.

Question 41

What are the 5 Key herbal actions for the respiratory system? + example of herb

Answer 41

1. Anticatarrhal: Reduces the formation of catarrh or phlegm (drying it out) e.g., eyebright.
2. Diaphoretic: Promotes sweating to relieve a fever e.g., cinnamon.
3. Expectorant: Facilitates the removal of catarrh e.g., liquorice.
4. Anti-microbial: Destroys infectious micro-organisms e.g., thyme.
5. Anti-spasmodic (broncho-spasmolytic): Relaxes bronchial smooth muscle spasm e.g., aniseed.

Question 42

What are the 3 Key herbal actions for the immune system? + example of herb

Answer 42

1. Immunomodulator: Balances and strengthens immunity i.e. Astragalus.
2. Immune-enhancing: Increases immune responses i.e. Echinacea.
3. Anti-inflammatory: Reduces inflammation i.e. Turmeric

Question 43

What are the 5 Key herbal actions for the brain/nervous system? + example of herb

Answer 43

1. Nootropic: Enhances brain function e.g., rosemary.
2. Nervine: Relaxes the nervous system e.g., lavender.
3. Thymoleptic: Lifts the mood e.g., St John’s wort.
4. Sedative: Relaxes the nerves and promotes sleep e.g., valerian.
5. Anxiolytic: Alleviates anxiety e.g., passionflower.

Question 44

What are the 5 Key herbal actions for the reproductive system? + example of herb

Answer 44

1. Hormone modulators: Regulate and balance hormonal activity e.g., chaste berry.
2. Emmenagogue: Promotes menstruation e.g., Dong quai.
3. Galactagogue: Promotes breast milk production e.g., fennel seeds.
4. Reproductive tonic: Promotes reproductive health and fertility e.g., shatavari.
5. Anti-prostatic: Reduces symptoms form the prostate gland e.g., saw palmetto.

Question 45

What is the difference between adaptogens and tonics?

Answer 45

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.

Question 46

Name 3 adaptogen/tonic herbs? + uses

Answer 46

Ashwagandha - 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

Korean ginseng - Adaptogenic (supports HPA axis), tonic, very stimulating (avoid at night!) immune modulating, cardiotonic, male tonic, cognition enhancing; debility, stress, impotence, low immunity (lung tonic), fatigue, male infertility, convalescence, to ↑ physical / mental performance, Type 2 diabetes (↑ insulin sensitivity). NOT FOR ANXIOUS CLIENTS

Siberian ginseng - 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

Question 47

5 reproductive herbs name and uses?

Answer 47

Black cohosh - Emmenagogue, oestrogen-modulating (isoflavone content), uterine tonic, antispasmodic, antirheumatic; menopausal symptoms, spasmodic dysmenorrhoea,
PMS, osteoarthritis, rheumatoid arthritis, cramps.

Chaste berry - Hormone modulators, 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).

Dong quai - * Emmenagogue, Uterine tonic (regulates the HPO axis), anti- inflammatory, ‘blood building/tonic’ (increase hemopoiesis -> increase RBC production), circulatory stimulant, anti- platelet, anti-arrhythmic, mild laxative; dysmenorrhoea, endometriosis; menopause, PMS, irregular or absent periods, weakness after the period, after giving birth or while breastfeeding.

Shatavari - Reproductive tonic, Aphrodisiac (attributable to the testosterone-like effects of key constituents), galactagogue, adaptogen, anti- inflammatory, demulcent; menopausal symptoms incl. vaginal dryness, infertility or low libido (menopause symptoms), male impotence, promote lactation. Good for libido. Mild adaptogen.

SAW PALMETTO - Anti-prostatic, 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

Question 48

5 brain / NS herbs name and uses?

Answer 48

GINKGO - Antioxidant (good for vascular inflammation), neuroprotective, nootropic, circulatory stimulant (↑ microcirculation – good for brain, Raynaud’s, Fibromyalgia, erectile dysfunction), tissue perfusion enhancing (antagonises ‘Platelet Activating Factor’ by blocking receptors — causing vasodilation, protecting against ischaemia);

LAVENDER - 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.

PASSIONFLOWER - Anxiolytic (mediated via the GABAergic system; inhibits MAO-A), antispasmodic, mild sedative, hypnotic; insomnia, anxiety with ‘circular thinking’, agitation, tension headache, nervous tachycardia, neuralgia, drug and alcohol withdrawal (by alleviating anxiety/insomnia), muscle pain / spasms. Dread of going to work every day, recurring anxiety circles

ROSEMARY - 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, mood regulation, cognitive issues, early ADHD, concentration. Hepatoprotective for phase II.

ST JOHN’S WORT - Thymoleptic, Antidepressant (MAO and COMT inhibitor; GABA antagonist), nervine tonic, antiviral, vulnerary, antimicrobial (topically); mild to moderate depression (better outcome than an SSRI – nourish the NS), anxiety, irritability, anti-viral (e.g. herpes simplex, shingles, HIV), neuralgia, sciatica, insomnia

Question 49

3 Immune system herbs name and uses?

Answer 49

ASTRAGALUS - Immune modulating / enhancing (↑ lymphocyte and phagocyte activity, as well as IgA levels), tonic, adaptogen, cardiotonic (hypotensive, antioxidant), anti-cancer (anti- proliferative); chronic/recurrent infections, infection preventative, leukopenia, post-viral syndrome, fatigue, mild heart failure. Good for autoimmune types conditions.

ECHINACEA - immune enhancing / modulating (alkylamides bind to cannibinoid (CB – immune modulating) 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. Don’t recommend for someone with an auto-immune condition

TURMERIC - Anti-inflammatory (regulates inflammatory cytokines and NFkB; inhibits COX-2), antioxidant (↑ Nrf2 gene expression), anticancer (inhibits VEGFs (vascular epithelial growth factors), induces apoptosis, ↓ inflammation), antiplatelet, hypolipidaemic, choleretic, inflammatory conditions (e.g. OA, RA, SLE, ulcerative colitis); liver support protocols. Neuroprotective (incl. anti-amyloid). Eczema, psoriasis.

Question 50

4 Respiratory system herbs name and uses?

Answer 50

THYME - 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 (maintenance program – used on a daily basis); sore throat; oral and GI dysbiosis, dyspepsia

CINNAMON - Warming diaphoretic, antiseptic (infection in upper respiratory system especially if added with thyme), carminative, blood sugar regulating (used to regulate BSL); weak digestion, nausea, poor circulation, Raynaud’s (as a hand cream because it is heating and warming), diabetes mellitus (increases insulin receptor sensitivity), H. pylori (inhibits urease — combine with liquorice), parasites, high cholesterol (reduces TGs and LDL), low mood.

SAGE - Anti-spasmodic, antimicrobial (used with thyme and liquorice for cough and throat irritation), anti-cancer (anti- proliferative, angiogenic, prevent angiogenesis), anti-hyperhidrotic (reduces high temperature and excess sweating, menopausal sweat and hot flashes – 2-3 cups of sage tea on ¾ days cycles – adrenaline is the switch for hot flushes so you need to reduce stress), antioxidant; gingivitis; respiratory infections e.g., tonsillitis; ↑ cognition (↓ breakdown of acetylcholine) — Alzheimer’s; menopausal sweats/flushes (cold tea).

GARLIC - Antibacterial, antifungal, anti-parasitic, immune-boosting (↑ NK cells and interferons), mucolytic (break down mucous), antioxidant, ↓ cholesterol, hypotensive (↑ nitric oxide -> vasodilation), antiplatelet, anti-inflammatory (inhibits LOX, COX and NF-kB); colds, flu, chronic bronchitis, bacterial / fungal infections incl. dysbiosis, atherosclerosis, hypertension, ↑ cholesterol, liver support (↑ GST). For wort or verruca (wrap in in a mesh and leave it overnight – don’t expose it directly on the skin)

Question 51

3 Liver system herbs name and uses?

Answer 51

GLOBE ARTICHOKE - 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 (modulate HDL/LDL ratio). Enhances digestion and absorption. Enhance bile production. Helps with constipation too and colon health.

DANDELION ROOT - Bitter tonic, choleretic, cholagogue, mild laxative, mild diuretic; dyspepsia, constipation, appetite loss, flatulent colic, gall stones, cholecystitis. Increases liver AO enzymes. Include in a liver detox protocol.

MILK THISTLE - 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. Help balance between phase I and II liver detox. Increase glutathione. Post detox phase to repair the liver cells or prep for a detox then use milk thistle. Can be used long term for liver conditions

Question 52

9 digestive system herbs name and uses?

Answer 52

ALOE VERA - Local anti-inflammatory for wounds, burns, GI inflammation and ulceration. Inhibits COX and hence the production of pro-inflammatory PG2 made from arachidonic acid. Speeds up wound healing (activates fibroblast collagen synthesis).

CARDAMOM - Carminative, gastro-protective. Traditionally used for weak digestion, flatulence and bloating. Promotes circulation; has shown positive effects on blood pressure in hypertension (thought to relate to antioxidant / diuretic properties). Demonstrated LOX-inhibiting (anti-inflammatory) properties

CHAMOMILE - 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).

FENNEL - Antispasmodic, carminative, expectorant, galactagogue (appear to regulate the expression of ‘aquaporin’ proteins that facilitate movement of water across mammary cell membranes); indigestion, flatulence, bloating, colic, infantile colic, IBS, poor appetite and digestion; difficult lactation, bronchitis.

GINGER - Antiemetic, carminative, aromatic digestive, anti-inflammatory (inhibits LOX, COX and TNF-α), circulatory stimulant; weak digestion (its a prokinetic), nausea, morning / motion sickness, colic; poor circulation, dysmenorrhoea (↓ inflammation). Inflammatory joint pain and arthritis (e.g. OA, RA in combination with turmeric).

LIQUORICE - 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)

OREGANO - Antispasmodic, antifungal, antibacterial, antiparasitic / helminthic (anti worm), antioxidant;

PEPPERMINT - 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).

SLIPPERY ELM - Demulcent; soothes the GI and upper respiratory tract ― gastritis, peptic ulceration (take before meals), GORD (after meals and before bed), IBD, constipation (to bulk the stool), dry coughs, sore throats.

Question 53

4 Safety considerations around herbal medicine

Answer 53

• Adverse effects
• Pregnancy and breast feeding
• Herb-drug-nutrient interactions
• Limits of competence

Question 54

Give 3 example of adverse side effects of herbal medicine ? Why can adverse effect happen?

Answer 54

• Sensitivity for example to salicylates (willow bark, meadowsweet, black cohosh).
• Photo-sensitive skin reactions (St John’s Wort).
• GIT disturbances e.g. diarrhoea (schisandra

Adverse effects are likely if dosage is too high

Question 55

What to do if a client has adverse side effects?

Answer 55

• If experiencing serious adverse effects from herbs, stop them immediately. For minor disturbances, stop taking, wait till effect passes, try again at 1⁄2 dose. If effect happens again — discontinue

Question 56

What herbs are contraindicated in pregnancy and breastfeeding and why? x3

Answer 56

• Risk causing birth defects (teratogens) e.g. wormwood.
• Stimulate menstruation (emmenagogues) e.g. yarrow.
• Powerfully stimulate evacuation (purgatives) e.g. senna.

Question 57

Name 3 herbs that are safe in pregnancy in small dose if clinically essential

Answer 57

• 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.

Never use herbal capsules or herbal supplements in pregnancy.

Question 58

Give an example of additive interaction with herbs?

Answer 58

• 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.

Question 59

Give an example of antagonist interaction with herbs?

Answer 59

• 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.

Question 60

Give an example of beneficial interaction with herbs?

Answer 60

• Some interactions can be beneficial e.g. turmeric has anti- inflammatory properties and may decrease requirements for NSAIDs. Clients are advised to discuss drug changes with GP.

Question 61

Name 3 endangered species of herbs

Answer 61

Rhodiola, echinacea (angustifolia), golden seal, Korean ginseng, Siberian ginseng, slippery elm.
* If you care about the environment (natural and human) use herbs from producers who supply organic, fair trade, cultivated plants.