Y3 Herbal Therapeutics Flashcards
What are the five risks that could be associated with the use of a herb during pregnancy?
- Toxicity to the mother (which might indirectly impair the health and development of the child)
- Toxicity to the neonate
- Developmental malformation (teratogenesis)
- Increased risk of miscarriage
- Poor postnatal health of child
What is a tonic?
“A tonic is defined as any substance that acts to restore balance, homeostasis or tone to a body system or any aspect of a body system; possessing a bidirectional effect on a body system, tissue or process through which it correct hypo- or hyper-types of deviations from the balanced state” (Mowrey, 1993)
Name three teratogenic plants (Latin names):
Caulophyllum thalictroides, Solanum sp. and Scutellaria baicalensis.
Name three groups of herbs that are contraindicated in pregnancy and give an example for each group.
● The schedule 20 and other restricted herbs (including Phytolacca decandra, Viscum alba and Bryonia dioica).
● Moderate to large amounts of high-level anthraquinone-containing plants such as Cassia senna, Aloes sp., Rheum palmatum etc.
● Herbs traditionally described as emmenagogues, such as Tanacetum vulgare (Tansy), Mentha pulegium (Penny royal), Artemisia absinthium, Juniperus officinalis, Achillea millefolium
● Large doses of plants with high volatile oil content, or their essential oils.
● Herbs with potential oxytocic action e.g.: Cytisus scoparius, Hydrastis Canadensis, Berberis vulgaris and B. aquifolium.
● Apiol-containing plants should not be taken in large quantities, e.g. Apium graveolens and Petroselinum crispum. The seeds contain the most and parsley is stronger than celery.
● Thujone-containing plants such as Thuja occidentalis and Achillea millefolium.
● Herb compounds with an ability to cause oestrogenic activity e.g.: isoflavones, lignans, sterols, saponins, some essential oils such as fennel and clary sage.
What are the 4 steps of creating a treatment plan?
- Decide the main treatment goals, both long term and short term. Ensuring the goals are individual to the patient.
- Decide on the immediate priorities of the treatment – does the patient want to focus on a particular area first?
- Decide what actions are required to meet the treatment goals.
- Choose herbs that have those specific actions with as much overlap as possible. E.g. If you need an antispasmodic and an anti-inflammatory, instead of choosing two herbs you could select one that has both of those actions.
Common reasons for patients not to respond to herbal treatment:
● Compliance
Is the patient taking the correct dose? Is the taste of the medicine off putting? Could the medicine be given in a different form?
● Digestion
If there is a poorly functioning digestive system the gut flora may not be able to act as prodrugs and therefore the absorption of particular herbal constituents will be low. The function of the patient’s liver is also a factor here; if they cannot break down the herbal constituents effectively they will not be getting a dose within the therapeutic range.
● Stress levels
The patient may not be aware of how stress is affecting their symptom picture.
● Chronic conditions
Longer standing conditions may just take longer to respond to herbal medicine or a pharmaceutical drug may be required to bring about a change in the symptom picture.
● Diet
Dietary changes can be difficult to implement but can have a big effect on overall health and therefore without changes here the herbs are always on an uphill struggle to bring about homeostatic changes. Could supplementation be used to aid in the treatment as a short term solution?
● Psychological/Spiritual
Caroline Myss (1997) says “…assuming that everyone wants to heal is both misleading and potentially dangerous. Illness can, for instance, become a powerful way to get attention you might not otherwise receive – as a form of leverage, illness can seem almost attractive. Illness may also convey the message that you have to change your life quite drastically. Because change is among the most frightening aspects of life, you may fear change more intensely than illness and enter into a pattern of postponing the changes you need to make”.
Myss sees illness as not necessarily coming from a negative source, but from a positive spiritual transformation.
● Conditions that benefit from a different therapy/treatment
Some conditions or patients may simply respond better to a different approach/therapy/treatment or practitioner.
The following factors can affect the length of treatment required:
● Age – young people often respond very quickly to treatment and tend towards acute conditions. Elders tend towards more chronic conditions and can take longer to respond to treatment.
● Sensitive people – Some people with an allergic background or drug or food sensitivities may also be very sensitive to herbs. This can mean they need less herb for the same effect.
● Systems involved – digestion and stress related problems tend to respond more quickly whereas hormonal and skin condition can take longer (weeks to months).
What is an example of a herb that can have side effects?
A good example here might be Glycyrrhiza glabra. For some patients, a softening of the stool in chronic constipation will be a beneficial side-effect. Diarrhoea in another patient will be undesirable.
What is the Yellow Card scheme?
“Side effects reported on Yellow Card are evaluated, together with additional sources of information such as clinical trial data, medical literature or data from international medicines regulators, to identify previously unknown safety issues. These reports are assessed by a team of medicine safety experts made up of doctors, pharmacists and scientists who study the benefits and risks of medicines. If a new side effect is identified, the safety profile of the medicine in question is carefully looked at, as well as the side effects of other medicines used to treat the same condition. The MHRA takes action, whenever necessary, to ensure that medicines are used in a way that minimises risk, while maximising patient benefit.” [MHRA Yellow card website]
Suspected adverse events and toxicity are reported to professional associations for collation and then to the MHRA in a collated report. For those practising independently adverse events can be sent directly to the MHRA through their online reporting system.
What are the cautions and contraindications of:
Adonis vernalis
Adonis vernalis
Caution in hypertension.
What are the cautions and contraindications of:
Aspidosperma quebracho-blanco
Aspidosperma quebracho-blanco
Caution as excessive amounts are emeto cathartic.
What are the cautions and contraindications of:
Atropa belladonna
Atropa belladonna
Contraindicated in tachycardia, BPH, paralytic ileus, intestinal atony and obstructions, urinary retention and glaucoma.
Caution with antidepressants as its action may be accentuated. Topical application of the root can result in percutaneous absorption of the alkaloids and result on toxic effects.
What are the cautions and contraindications of:
Cinchona spp.
Cinchona spp.
Cautions. Large doses may cause gastroenteritis. Contraindicated in pregnancy (oxytocic).
What are the cautions and contraindications of:
Colchicum autumnale
Colchicum autumnale
Contraindicated in the senile and the weak, heart or kidney disease.
What are the cautions and contraindications of:
Atropa belladonna
Atropa belladonna
Contraindicated in tachycardia, BPH, paralytic ileus, intestinal atony and obstructions, urinary retention and glaucoma.
Caution with antidepressants as its action may be accentuated. Topical application of the root can result in percutaneous absorption of the alkaloids and result on toxic effects.
What are the cautions and contraindications of:
Colchicum autumnale
Colchicum autumnale
Contraindicated in the senile and the weak, heart or kidney disease.
What are the cautions and contraindications of:
Convallaria majalis
Convallaria majalis
Contraindicated in ventricular tachycardia
What are the cautions and contraindications of:
Datura stramonium
Datura stramonium
Cautions/contraindications as for Atropa belladonna
Contraindicated in tachycardia, BPH, paralytic ileus, intestinal atony and obstructions, urinary retention and glaucoma.
Caution with antidepressants as its action may be accentuated. Topical application of the root can result in percutaneous absorption of the alkaloids and result on toxic effects.
What are the cautions and contraindications of:
Ephedra sinica
Ephedra sinica
Contraindicated in BPH, glaucoma, hyperthyroidism, coronary thrombosis and severe hypertension. Owing to peripheral vasoconstriction, there may be a slight rise in blood pressure. Reported for the alkaloid but not for the herb. Do not give if an MOAI has been taken within 10 days.
What are the cautions and contraindications of:
Gelsemium sempervirens
Gelsemium sempervirens
Contraindicated in cardiac disease, hypotension and myasthenia gravis.
What are the cautions and contraindications of:
Hyoscyamus niger
Hyoscyamus niger
Cautions/contraindications as for Atropa belladonna
What are the cautions and contraindications of:
Aconitum napellus
Aconitum napellus
Cautions-do not apply to unbroken skin.
Maximum dose : no greater than 1 part Aconitum napellus
tincture (BPC 1949) combined with nine parts of lotion.
Which actions could worsen a condition?
Could worsen acute condition.
E.g. action of bitters in biliary obstruction
When might treatment be inappropriate for condition?
Treatment may be inappropriate to condition.
E.g. if very severe fever, especially in children-risk of febrile convulsion
When is it inappropriate to use tinctures?
Pregnant, children and alcoholic patients
Name some herb-drug interactions:
Hypericum perforatum and Ginko biloba (anticoagulant)
What are concerns surrounding drug-drug interactions?
Drug-drug interactions are responsible for at least 10-20% of all adverse drug events reported, and are especially common in the elderly, who are more likely to receive multiple drugs for multiple ailments and have reduced liver and kidney metabolism and elimination capacity.
Which drugs have a narrow therapeutic range?
Anticoagulants: e.g. warfarin, heparin
Antiepileptics: e.g. carbamazepine, phenobarbital, phenytoin
Anaesthetics: local and general
Immunosuppressants: e.g. interferon used in autoimmune disease
Cytotoxic drugs: e.g. chemotherapy drugs used in cancer treatments.
Antidepressants: e.g. lithium and monoamine oxidase inhibitors
Oral contraceptives: especially low dose oestrogen pills
Cardiac drugs / antiarrhythmics: e.g. digoxin
Hypoglycemic drugs: e.g. insulin
Cautions when prescribing Hypericum perforatum:
Cautions when prescribing Hypericum perforatum:
Drugs with a narrow therapeutic range
Antidepressants, including SSRIs
Oral Contraceptives
Standardised concentrated extracts of Hypericum perforatum
Although the potential risks are relatively low, always consider carefully and inform the patient if Hypericum perforatum is included in their medicine.
Cautions when prescribing alongside warfarin:
Check patients are receiving regular blood tests to monitor INR stability.
Avoid herbs with known anticoagulant action e.g. Ginkgo biloba.
Be aware of potential side effects of warfarin toxicity e.g. excess bruising, haemorrhage.
Dosage is dependent on a number of factors:
● A higher dose can be advised if once daily
● The young and the old take less
● Physical status and constitution: age, sex, weight etc.
● Concurrent orthodox or other medication
● Pharmacokinetics – rapid absorption of sugars implies frequent small doses
● Known strength and quality of commercial liquid preparations
● Purpose of medicine – hypnotics s.d nocte; gargles - frequently
● Reflex action. We only need a little to induce it.
● Different effects from small compared to large doses (Acorus calamus/Angelica archangelica mixture. Large doses work as bitters, whereas small doses suppress stomach acid.
● Before meals – constituents are broken down quickly which can be useful in e.g. analgesia, bitter effect, demulcents
● After meals – herbs inducing nausea e.g. Lobelia inflata, Zanthoxylum clava herculis, Turnera diffusa.
● Schedule 3’s – begin with small doses, increasing every 1-4 days to maximum therapeutic effect
● Combinations
● Incompatibilities e.g. tannins and alkaloids-may increase with more combinations
● Conflicting actions
E.g. Stimulant and Sedative.”
What must be kept in mind for Acorus calamus/Angelica archangelica mixture? Large doses work as bitters, whereas small doses suppress stomach acid.
Large doses work as bitters, whereas small doses suppress stomach acid.
Dosage is dependent on a number of factors:
● A higher dose can be advised if once daily
● The young and the old take less
● Physical status and constitution: age, sex, weight etc.
● Concurrent orthodox or other medication
● Pharmacokinetics – rapid absorption of sugars implies frequent small doses
● Known strength and quality of commercial liquid preparations
● Purpose of medicine – hypnotics s.d nocte; gargles - frequently
● Reflex action. We only need a little to induce it.
● Different effects from small compared to large doses (Acorus calamus/Angelica archangelica mixture. Large doses work as bitters, whereas small doses suppress stomach acid.
● Before meals – constituents are broken down quickly which can be useful in e.g. analgesia, bitter effect, demulcents
● After meals – herbs inducing nausea e.g. Lobelia inflata, Zanthoxylum clava herculis, Turnera diffusa.
● Schedule 20’s – begin with small doses, increasing every 1-4 days to maximum therapeutic effect
● Combinations
● Incompatibilities e.g. tannins and alkaloids-may increase with more combinations
● Conflicting actions
E.g. Stimulant and Sedative.”
Which actions are useful to take before meals?
analgesics, bitters, demulcents
Which herbs are best taken after meals?
After meals – herbs inducing nausea e.g. Lobelia inflata, Zanthoxylum clava herculis, Turnera diffusa.
What are cautions surrounding dosage for elderly patients?
A slower metabolic rate and smaller liver mean that standard adult doses are not always suitable for the elderly.
If an elder patient is also taking a large number of pharmaceutical drugs this will also have an effect on the absorption of herbal constituents due to the factors mentioned above.
A reduction in total water volume, and body mass with an increase in body fat means that water soluble drugs in blood and tissue have an increased half life.
The liver is not only reduced in size it also has less blood flow and metabolism of hepatic enzymes is reduced, making the elderly more vulnerable to drug drug and herb drug interactions.
The kidneys also change with age, renal mass and blood flow decrease significantly and this decreases renal elimination. This can lead to toxicity due to reduced renal clearance.
The following factors affect absorption of both pharmaceutical drugs and herbal constituents:
● Smaller surface area of the bowel
● Increase in stomach acid
● Reduction in blood flow to the intestines
What is the recommended dosage for elderly?
The dosage should be 2/3 of the average adult dose, e.g. 10ml daily.
What factors must be considered when treating children?
● “Digestion – children have a slower gastric emptying rate and a shorter intestinal transit time, together with a reduced secretion of bile and pancreatic fluid. These three factors can lead to erratic and unpredictable absorption of medication.
● Body fat – children have a greater percentage of body water compared to body fat – this means that any herbal constituents that are extracted in the aqueous phase are likely to be diluted.
● Liver immaturity – this will affect the metabolism of herbs, drugs and environmental toxins.
● Gut flora- the flora in children is underdeveloped and the body may not be able to convert the herbal constituents (e.g glycosides) into its active form (aglycone)”
What are the two formulas used for calculating children’s dosages?
Youngs formula: age = proportion of adult dose /
age +12
Dillings formula: age = proportion of the adult dose /
20
What does Mills suggest for calculating infant’s dosages?
Fried’s rule: Age in months = proportion of adult dose /150
Points to consider when treating children:
● Compliance – what does the medicine taste like?
● Does the parent want the child to take a tincture with the alcohol content?
● Cold teas are often preferable to warm teas – and can be made into lollies etc
● Glycerites are often uses but long term use can put a strain on the kidneys (Owen, 2010)
● Where babies are breastfed then a normal adult dose administered to the mother will carry into the breast milk within approximately eight hours. When giving the mother medicine for a breastfed baby, make sure you do a thumbnail sketch of her own health. Check for past medical history, any chronic illness, drug history and allergies, it is important that you don’t overlook any potential reactions, interactions or provocation of a chronic condition by simply regarding her as a conduit between the medicine and the baby.
● If a child will not take any herbs orally a herbal bath can pass a small amount into the bloodstream trans dermally.
What are things to consider when treating pregnant patients?
● In general it is safe to prescribe certain herbs during pregnancy if they are absolutely necessary.
● All medication should be kept to a bare minimum during the first trimester, although it is generally safe to treat morning sickness.
● If there is threatened miscarriage then proceed with real caution.
● If there is a past history of threatened miscarriage or difficult conception the herbalist must be extremely careful, especially if the woman complains of a low back pain with bearing down, abdominal pain, vaginal discharge or bleeding, these signs and symptoms should all be read as potential miscarriage.
● Potentially serious complications of pregnancy must be treated conventionally or in conjunction with a conventional practitioner – this is for the herbalist’s protection as well as for the safety of the mother and child.
Name some teratogenic herbs:
- Known teratogens in known teratogenic plants:
● Lupinus (Lupins, Leguminosae family – contain toxic alkaloids e.g. lupinine and sparteine)
● Veratrum (e.g. False hellebore, Indian Poke, Liliaceae family – contain steroidal alkaloids e.g. cyclopamine)
● Conium (e.g. Hemlock, Umbelliferae family – contain piperidine alkaloids e.g. coniine)
● Solanum (e.g. Woody night shade, Solanaceae family – toxic constituents are not well defined).
- Known teratogenic plants with unidentified teratogens:
● Astragalus (Milk vetch, Legumonosae family)
● Nicotiana (Tobacco plant, Solanacea family)
● Ferula (Giant fennel e.g. Asafoetida, Umbelliferae family)
● Trachymene (Didiscus, Umbelliferae family)
- Suspected teratogenic plants:
● Datura (Thorn apple, Solanaceae family)
● Prunus (Rosacea family)
● Sorghum, (Durra, Gramineae family)
● Senecio (Groundsel, Compositae family
Which herbs are considered contraindicated in pregnancy?
Aloe vera ~ Aloes Achillea millefolium ~ Yarrow Acorus calamus ~ Sweet flag Artemisia abrotanum ~ Southernwood Artemisia absinthium ~ Wormwood Artemisia vulgaris ~ Mugwort Barosma betulina ~ Buchu (in large doses) Berberis vulgaris ~ Barberry Cassia senna ~ Senna Caulophyllum thalictroides ~ Blue cohosh Chamaelirium luteum ~ False unicorn root/ Helonias Cinnamonum zeylandicum ~ Cinnamon Dryopteris felix-mas ~ Male fern Gossypium herbaceum ~ Cotton Hydrastis canadensis ~ Goldenseal Juniperus communis ~ Juniper Lycopus species ~ Bugleweed or Gypsywort Mahonia aquifolium ~ Oregon grape Mentha pulegium ~ Pennyroyal Myristica fragrans ~ Nutmeg (except in small culinary doses) Petroselenium crispum ~ Parsley Peumus boldo ~ Boldo Piscidia erythrina ~ Jamaican dogwood Rhamnus catharticus ~ Buckthorn Rhamnus frangula ~ Alder buckthorn Rhamnus purshiana ~ Cascara sagrada Rheum palmatum, R.officinalis ~ Chinese rhubarb, Himalayan rhubarb Rosmarinus officinalis ~ Rosemary Rubia tinctorum ~ Dyer’s Madder Rumex crispus ~ Yellow dock Ruta graveolens ~ Rue Salvia officinalis ~ Sage Senecio aureus ~ Life root Cytisus scoparius ~ Broom Tabebuia impetiginosa ~ Pau D’arco Tanacetum parthenium ~ Feverfew Tanacetum vulgare ~ Tansy Thuja occidentalis ~ Thuja Thymus vulgaris ~ Thyme Urginea species ~ Squill Vinca species ~ Periwinkles (in high doses) Zanthoxylum clava-herculis ~Prickly ash Zingiber officinale~ Ginger
What are the actions of demulcents on the GIT?
Soothing and anti-inflammatory to inflamed surfaces
What are the actions of astringents on the GIT?
astringent - agent that constricts and binds by coagulation of proteins a cell surface
What are the actions of mucous membrane tonics on the GIT?
repair gut hyperpermeability by improving mucosal integrity and in helping to reduce excess mucus and improve tone.
What are the actions of antispasmodics on the GIT?
Ease visceral tension
What are the actions of carminatives?
carminative - causing the release of stomach or intestinal gas
Name some GIT demulcents
Ulmus fulva, Plantago ovata and P. psyllium, Althea officinalis radix, Symphytum officinale herba, Linum usitatissimum, Chondrus crispus, Cetraria islandica
Name some GIT astringents
Agrimonia eupatoria,Geranium maculatum, Potentilla erecta, P. anserina, Geum urbanum, Geranium robertianum.
Name some GIT mucous membrane tonics
Hydrastis canadensis, Glechoma hederacea, Plantago lanceolata, P. major.
Potential caution: Hydrastis canadensis and very dry, sore mucosa; contraindicated in pregnancy
Name some GIT antiinflammatories
Matricaria recutita, Calendula officinalis, Glycyrrhiza glabra, Filipendula ulmaria
Name some GIT antispasmodics
Mentha x piperita, Matricaria recutita, Humulus lupulus, Viburnum opulus
Rosemarinus officinalis, Atropa belladonna, Dioscorea villosa, Melissa officinalis, Valeriana officinalis, Viburnum opulus L
Contraindications: enteric poisoning, bowel obstruction
Name some herbal antacids
Filipendula ulmaria, Acorus calamus.
Carminatives are contraindicated in what condition?
GORD
Name some herbal stimulating laxatives
Rumex crispus, Rhamnus frangula, Rheum palmatum, Cassia senna, Rhamnus purshiana
Care must be taken when prescribing stimulating laxatives as they can cause griping – so always prescribe in conjunction with a carminative. Use only in atonic constipation.
Caution: pregnancy, diarrhoea, spastic constipation, long-term use
Name some benefits of probiotics in IBS?
- enhance gut barrier function
- inhibit pathogen binding
- modulate gut inflammatory response.
- reduce visceral hypersensitivity associated with both inflammation and psychological stress.
- can alter colonic fermentation and stabilise the colonic microbiota.
- improvement in flatulence and abdominal distension with a reduction in IBS symptoms.
What is leaky gut and what conditions is it linked to?
When working properly, our gut lining forms a tight barrier that controls what gets absorbed into the bloodstream. An unhealthy gut lining may have large cracks or holes, allowing partially digested food, toxins, and bugs to penetrate the tissues beneath it. This may trigger inflammation and changes in the gut flora (normal bacteria) that could lead to problems within the digestive tract and beyond.
Associated conditions:
celiac disease, Crohn’s disease, irritable bowel syndrome, other autoimmune diseases (lupus, type 1 diabetes, multiple sclerosis), chronic fatigue syndrome, fibromyalgia, arthritis, allergies, asthma, acne, obesity, and even mental illness.
Name some herbal prebiotics
Ulmus fulva and Althaea officinalis, Taraxacum officinalis radix
What is functional dyspepsia?
Functional dyspepsia (dis-PEP-see-uh) is a term for recurring signs and symptoms of indigestion that have no obvious cause. Functional dyspepsia is also called nonulcer stomach pain or nonulcer dyspepsia.
Functional dyspepsia is common and can be long lasting — although signs and symptoms are mostly intermittent. These signs and symptoms resemble those of an ulcer, such as pain or discomfort in your upper abdomen, often accompanied by bloating, belching and nausea.
Signs and symptoms of functional dyspepsia may include:
- Pain or burning in the stomach, bloating, excessive belching, or nausea after meals
- An early feeling of fullness (satiety) when eating
- Pain in the stomach that may sometimes occur unrelated to meals or may be relieved with meals
Doctors consider it a functional disorder, which means that routine testing may not show any abnormalities. Hence, it is diagnosed based on symptoms.
What is GORD?
Gastro-oesophageal reflux disease (GORD) is a common condition, where acid from the stomach leaks up into the oesophagus. GORD causes symptoms such as heartburn and an unpleasant taste in the back of the mouth.
Symptoms of GORD can include:
• heartburn (an uncomfortable burning sensation in the chest that often occurs after eating)
• acid reflux (where stomach acid comes back up into your mouth and causes an unpleasant, sour taste)
• oesophagitis (a sore, inflamed oesophagus)
• bad breath
• bloating and belching
• feeling or being sick
• pain when swallowing
What makes a patient more susceptible to GORD?
The following factors may increase your risk of developing GORD:
being overweight or obese – this can place increased pressure on your stomach and weaken the muscles at the bottom of the oesophagus
eating large amounts of fatty foods – the stomach takes longer to get rid of stomach acid after digesting a fatty meal and the resulting excess acid may leak up into the oesophagus
smoking, alcohol, coffee or chocolate – these may relax the muscles at the bottom of the oesophagus
pregnancy – temporary changes in hormone levels and increased pressure on your stomach during pregnancy can cause GORD
hiatus hernia – when part of your stomach pushes up through your diaphragm (thin sheet of muscle between the chest and tummy)
gastroparesis – when the stomach takes longer to get rid of stomach acid, which means excess acid can leak up into the oesophagus
certain medicines – some medicines can cause GORD or make the symptoms worse, including calcium-channel blockers (used to treat high blood pressure), nitrates (used to treat angina) and non-steroidal anti-inflammatory drugs (NSAIDs)
What is a Choleretic?
Agent that stimulates bile production by hepatocytes, most are also cholagogues
What is a Cholagogue?
Agent that stimulates the flow of bile. Endogenous: bile acids; exogenous: fatty foods
When are choleretics and cholagogues indicated?
‘Sluggish’ liver, (bilious conditions – nausea, susceptibility to alcohol & fatty foods, headaches, constipation), liver disease, moderates gallbladder disease, non-impacted gallstones, skin or joint disease, autoimmune disease, allergies and many chronic presentations in general.
When are choleretics and cholagogues contraindicated?
Contraindicated in Obstructed bile ducts, acute, severe hepatocellular disease, liver cancer, septic cholecystitis, intestinal spasm or ileus
What are some examples of choleretics and cholagogues?
Best taken before meals in fluid form (bitter taste) short term therapy generally (a few weeks).
Berberis vulgaris, Chelidonium majus, Mentha x piperita, Cynara scolymus, Chionanthus virginicus
What are some examples of bitters?
Pure: e.g. Gentiana lutea, Centaurium erythraea, Menyanthes trifoliata
Aromatic: Cnicus benedictus, Angelica archangelica, Acorus calamus, Artemisia absinthium, Artemisia vulgaris, Artemisia abrotanum
What do Hepatoprotective/hepatic herbs do?
Provide non-specific support for repair & recovery of the liver.
eg. Silybum marianum, Cynara scolymus, Schisandra chinensis, Rosmarinus officinalis.
Which actions should be used in cases of gall bladder stones?
Bitters (Artemesia absinthium, Gentiana lutea) cholerics (Chelidonium, Cynara, Tarax, Sylibum), cholegogues (same), spasmolytics (Vib. op., Corydalis ambigua, Matricaria, Mentha peperita)
