Y3 Herbal Therapeutics Flashcards
1
Q
What are the five risks that could be associated with the use of a herb during pregnancy?
A
- 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
2
Q
What is a tonic?
A
“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)
3
Q
Name three teratogenic plants (Latin names):
A
Caulophyllum thalictroides, Solanum sp. and Scutellaria baicalensis.
4
Q
Name three groups of herbs that are contraindicated in pregnancy and give an example for each group.
A
● 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.
5
Q
What are the 4 steps of creating a treatment plan?
A
- 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.
6
Q
Common reasons for patients not to respond to herbal treatment:
A
● 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.
7
Q
The following factors can affect the length of treatment required:
A
● 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).
8
Q
What is an example of a herb that can have side effects?
A
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.
9
Q
What is the Yellow Card scheme?
A
“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.
10
Q
What are the cautions and contraindications of:
Adonis vernalis
A
Adonis vernalis
Caution in hypertension.
11
Q
What are the cautions and contraindications of:
Aspidosperma quebracho-blanco
A
Aspidosperma quebracho-blanco
Caution as excessive amounts are emeto cathartic.
12
Q
What are the cautions and contraindications of:
Atropa belladonna
A
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.
13
Q
What are the cautions and contraindications of:
Cinchona spp.
A
Cinchona spp.
Cautions. Large doses may cause gastroenteritis. Contraindicated in pregnancy (oxytocic).
14
Q
What are the cautions and contraindications of:
Colchicum autumnale
A
Colchicum autumnale
Contraindicated in the senile and the weak, heart or kidney disease.
15
Q
What are the cautions and contraindications of:
Atropa belladonna
A
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.
16
Q
What are the cautions and contraindications of:
Colchicum autumnale
A
Colchicum autumnale
Contraindicated in the senile and the weak, heart or kidney disease.
17
Q
What are the cautions and contraindications of:
Convallaria majalis
A
Convallaria majalis
Contraindicated in ventricular tachycardia
18
Q
What are the cautions and contraindications of:
Datura stramonium
A
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.
19
Q
What are the cautions and contraindications of:
Ephedra sinica
A
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.
20
Q
What are the cautions and contraindications of:
Gelsemium sempervirens
A
Gelsemium sempervirens
Contraindicated in cardiac disease, hypotension and myasthenia gravis.
21
Q
What are the cautions and contraindications of:
Hyoscyamus niger
A
Hyoscyamus niger
Cautions/contraindications as for Atropa belladonna
22
Q
What are the cautions and contraindications of:
Aconitum napellus
A
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.
23
Q
Which actions could worsen a condition?
A
Could worsen acute condition.
E.g. action of bitters in biliary obstruction
24
Q
When might treatment be inappropriate for condition?
A
Treatment may be inappropriate to condition.
E.g. if very severe fever, especially in children-risk of febrile convulsion
25
When is it inappropriate to use tinctures?
Pregnant, children and alcoholic patients
26
Name some herb-drug interactions:
Hypericum perforatum and Ginko biloba (anticoagulant)
27
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.
28
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
29
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.
30
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.”
31
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.
32
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.”
33
Which actions are useful to take before meals?
analgesics, bitters, demulcents
34
Which herbs are best taken after meals?
After meals – herbs inducing nausea e.g. Lobelia inflata, Zanthoxylum clava herculis, Turnera diffusa.
35
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.
36
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
37
What is the recommended dosage for elderly?
The dosage should be 2/3 of the average adult dose, e.g. 10ml daily.
38
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)”
39
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
40
What does Mills suggest for calculating infant's dosages?
Fried’s rule: Age in months = proportion of adult dose /150
41
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.
42
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.
43
Name some teratogenic herbs:
1. 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).
2. 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)
3. Suspected teratogenic plants:
● Datura (Thorn apple, Solanaceae family)
● Prunus (Rosacea family)
● Sorghum, (Durra, Gramineae family)
● Senecio (Groundsel, Compositae family
44
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
```
45
What are the actions of demulcents on the GIT?
Soothing and anti-inflammatory to inflamed surfaces
46
What are the actions of astringents on the GIT?
astringent - agent that constricts and binds by coagulation of proteins a cell surface
47
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.
48
What are the actions of antispasmodics on the GIT?
Ease visceral tension
49
What are the actions of carminatives?
carminative - causing the release of stomach or intestinal gas
50
Name some GIT demulcents
Ulmus fulva, Plantago ovata and P. psyllium, Althea officinalis radix, Symphytum officinale herba, Linum usitatissimum, Chondrus crispus, Cetraria islandica
51
Name some GIT astringents
Agrimonia eupatoria,Geranium maculatum, Potentilla erecta, P. anserina, Geum urbanum, Geranium robertianum.
52
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
53
Name some GIT antiinflammatories
Matricaria recutita, Calendula officinalis, Glycyrrhiza glabra, Filipendula ulmaria
54
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
55
Name some herbal antacids
Filipendula ulmaria, Acorus calamus.
56
Carminatives are contraindicated in what condition?
GORD
57
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
58
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.
59
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.
60
Name some herbal prebiotics
Ulmus fulva and Althaea officinalis, Taraxacum officinalis radix
61
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.
62
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
63
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)
64
What is a Choleretic?
Agent that stimulates bile production by hepatocytes, most are also cholagogues
65
What is a Cholagogue?
Agent that stimulates the flow of bile. Endogenous: bile acids; exogenous: fatty foods
66
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.
67
When are choleretics and cholagogues contraindicated?
Contraindicated in Obstructed bile ducts, acute, severe hepatocellular disease, liver cancer, septic cholecystitis, intestinal spasm or ileus
68
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
69
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
70
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.
71
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)
72
What herbs are contraindicated in gall stones?
Steroidal saponin-containing herbs ie. Dioscorea villosa and Smilax ornata
73
What are the treatment goals for GORD?
Protect already-inflamed mucosa by shielding it from gastric contents, allowing it time to heal using demulcents.
Encourage effective tissue healing using demulcents and antiinflammatories.
Increase tone of lower oesophageal sphincter using bitters
Encourage stomach to empty its contents into duodenum more efficiently using bitters
Address the patient’s ability to cope with nervous stress, and the effect on GIT tone using nerve tonics and/or adaptogens.
74
Give an example treatment for GORD
```
Rx1
Glycyrrhiza glabra 1:1 20 ml
Matricaria recutita 1:3 25 ml
Filipendula ulmaria 1:3 25 ml
Centaurium erythrea 1:5 5 ml
Verbena officinalis 1:3 25 ml
```
Sig. 5ml tds cum aqua p.c. or i.c. 100 ml per week
Rx2
Ulmus fulva powder – 1tsp before meals (in yoghurt)
75
What are the treatment goals for peptic ulcer?
Protection of the mucosa using demulcents.
Mucous membrane repair using mucous membrane restoratives.
Dealing with Helicobacter pylori infection with antibacterials.
Encouraging effective healing of the ulcerated region with demulcents, anti-inflammatories and mild astringents.
Reducing gastric acidity with bitters and specific herbs.
Encouraging gastric contents to move efficiently through the stomach and duodenum using carminatives.
Address the patient’s ability to cope with stress using nerve tonics, adrenal tonics and adaptogens.
76
Give an example prescription for peptic ulcer
```
Rx1
Glycyrrhiza glabra 1:1 15 ml Calendula officinalis 1:3 25 ml
Agrimonia eupatoria 1:3 20 ml
Matricaria recutita 1:2 15ml
Echinacea spp 1:3 25ml
```
Sig. 5 ml tds cum aqua a.c. 100 ml per week
77
Give an example treatment for duodenal ulcer
```
Rx1
Matricaria recutita 1:3 35 ml
Glycyrrhiza glabra 1:1 15 ml
Echinacea spp. 1:3 25 ml
Calendula officinalis 25% 1:3 10 ml
Calendula officinalis 90% 1:3 15 ml
```
Sig. 5 ml tds cum aqua a.c. 100 ml per week
78
What are the treatment goals for IBD?
* Protecting the mucosa e.g. mucous membrane restoratives
* Reducing inflammation in the GIT e.g. demulcents, mild astringents
* Reducing diarrhoea and bleeding e.g. mild astringents
* Strengthening bowel tone e.g. mild astringents
* Addressing any underlying immune imbalances
* Suggesting changes in the patient’s diet
* Preventing the establishment of infections e.g. immune tonics, gut antimicrobials.
79
What are the treatment goals for IBS?
Limiting spasm in the colon
Encouraging the formation of ‘healthy’ stools (ie. easy to pass, adequate bulk, optimum water content
Addressing inflammation of the mucosa –Supporting liver function
Addressing immunity and gut hyperpermeability
Addressing higher nervous control of digestive function
Excluding possible irritant factors from the diet (e.g. dairy products, wheat products)
Recommending possible relaxation techniques (e.g. yoga, meditation) (Keefer and Blanchard, 2002)
Addressing any stress through the use of nervines, adaptogens and lifestyle changes
Pre and probiotics to help maintain good gut flora
80
What are the treatment goals for cholecystitis?
* Give pain relief through the use of antispasmodics and anti-inflammatories.
* Liver support to improve the flow of bile and gallbladder function
* Nervines to support strain felt in dealing with the pain.
* Caution: Bitters and strong cholagogues are contraindicated because they increase the strength of muscle contraction.
81
What are the treatment goals for cholelithiasis?
* Give pain relief through the use of antispasmodics and anti-inflammatories.
* Give antilithics to help move and/or dissolve the stones.
* Liver support to improve the flow of bile and gallbladder function
* Nervines to support strain felt in dealing with the pain.
* Caution: Bitters and strong cholagogues are contraindicated because they increase the strength of muscle contraction.
82
Name some cardio-trophorestoratives
Crataegus laevigata, syn.oxyacantha, C. monogyna, syn. oxyacanthoides.
83
What are the actions of cardiostimulants?
Increase output of heart, increase tissue perfusion, improve overall effectiveness of CV system in providing O2, removing toxins/waste CO2
84
Name examples of cardiovascular stimulant herbs
Capsicum minimum, Zingiber officinale, Zanthoxylum spp, Ginkgo biloba, Coffea arabica, Rosmarinus officinalis
85
What is the action of heart tonics?
Help functioning of heart, increase force of heart contraction. Commonly contain cardiac glycosides.
86
Name examples of heart tonics
Convallaria majalis, Selenicereus grandiflorus
| Adonis vernalis
87
What are three types of cardiovascular relaxants?
Hypotensives: Crataegus spp, Allium sativum, Coleus forskohlii, Olea europaea, Achillea millefolium, Viscum album
Relaxing nervines: Valeriana officinalis, Viburnum opulus, Tilia spp, Leonurus cardiaca, Scutellaria lateriflora, Leonurus cardiaca etc
Diuretics: Taraxacum officinale fol, (Urtica dioica fol)
88
How are arrhythmias managed?
Alkaloids used in conventional medicine for more serious arrhythmias (derivatives of Papaver, Cinchona)
Benign forms must be ascertain before herbal treatments. Benign palpitations in menopause, tachycardia in hyperthyroid.
89
What herbs are used to regulate heart beat?
Cytisus scoparius, Corydalis ambigua, Stephania tetranda
90
Name some venous tonics
Venous tonics: Hamamelis virginiana (topical use), Aesculus hippocastanum, Melilotus officinalis, Ginkgo biloba, Achillea millefolium, Fagopyrum esculentum
91
Name some microcirculation tonics
Tonics to capillary bed/microcirculation: Zingiber officinalis, Achillea millefolium, Vaccinium myrtillus
Arterial tonics: Zanthoxylum clava-herculis, Ginkgo biloba.
92
Name herbs with antiplatelet and anticoagulant actions
Antiplatelet, anticoagulant: Allium sativum, Ginkgo biloba, Vaccinium myrtillus, Zingiber officinalis, Salvia miltiorrhiza
93
Name hypocholesterolemic herbs
Hypocholesterolemic: Allium sativum, Cynara scolymus, Curcuma longa, Albizia lebbeck
94
What are the causes of insomnia?
Causes of Insomnia
Medical illness e.g. arthritis, heart disease
Psychological illness and drugs used to treat symptoms
Alterations in biological clock e.g. jet lag, shift work
Medications and stimulants e.g. bronchodilators, β-blockers, calcium channel blockers, steroids
Negative conditioning – cycle of: failure- worry-more failure-more worry.
Bad sleep habits – poor sleep hygiene
Stressful events
95
What is the herbal approach to insomnia?
Hypnotics
Nervines
Antispasmodics
Tonics – nerve and adrenal
Day mixes – use an adaptogenic mix for the day time. Withania somnifera is a useful adaptogen that can be included in a night mix.
Consider specific system/organ support
E.g. CVS – Leonorus cardiaca, Melissa officinalis; GIT – Matricaria recutita, Humulus lupulus, Valeriana officinalis; MS – Piscidea erythrina , Piper methysticum (currently restricted).
96
What is the herbal approach to drug withdrawal?
```
Cardiovascular support
Support heart (palpitations etc.) e.g. Leonorus cardiaca, Avena sativa, Melissa officinalis, Passiflora incarnata, Crataegus spp
```
Alteratives and diaphoretics to help support detox e.g. Arctium lappa, Rumex crispus, Galium aparine, Eupatorium perfoliatum, Achillea millefolium, Sambucus nigra.
Bitters.
As well as being tonic and stimulant, bitters will improve digestion and absorption of nutrients.
Tonics
Nervines
Adaptagens
Hepatoprotectives
Hedley (2001) recommends Capsicum spp. and Turnera diffusa for withdrawal from narcotics and Priest and Priest (1983) recommend its use in Delerium tremens.
Avena sativa (as the green, milky oatstraw tincture) is excellent for drug withdrawal.
Passiflora incarnata is particularly useful for hysteria from psychoactive drug use.
Specific herbs that have receptor desensitisers/neurotransmitter effects Passiflora incarnata, Piper methysticum (currently restricted), Salvia officinalis, Scutellaria baiacalensis and Withania somnifera have been shown to act as agonists on central benzodiazepine receptors (Rasmussen, 1997).
97
Name some herbal antidepressants
Hypericum perforatum, Rosa damascena, Verbena officinalis, Turnera diffusa, Melissa officinalis, Avena sativa, Rosmarinus officinalis
98
Name some herbal anxiolytics
Hypericum perforatum, Ganoderma lucidum, Withania somnifera, Avena sativa, Valeriana officinalis, Melissa officinalis, Lavandula angustifolia, Escholtzia californica, Scutellaria lateriflora
99
What is the difference between sedatives and hypnotics
Conventional pharmacology defines a Sedative as reducing nervous activity and a Hypnotic as promoting sleep. However, it is probably misleading to apply the strict pharmacological definitions to them: their effects are much broader in clinical experience (Mills and Bone, 2000). Within the same herb, there is often an overlap in the two actions. E.g. Humulus lupulus, Lactuca virosa, Valeriana officinalis, Passiflora incarnata, Piscidia erythrina, Piper methysticum (currently restricted).
In cases of stress or tension, this group of herbs can help a great deal in alleviating the condition. However, they need to be used carefully, too much tranquillisation, even in herbal medicine, can in time deplete and weigh heavily on the whole nervous system (Hoffman, ‘86).
100
Name some herbal sedatives and hypnotics
Humulus lupulus is contraindicated in depression, as a central nervous system depressant. Valeriana officinalis particularly has a tranquilising effect i.e. relaxing without affecting cognitive function. On the whole, this group works quickly in a prescription and can alleviate some symptoms of anxiety within days or even hours. They should always be prescribed alongside trophorestorative and/or adaptogens to address the underlying problems.
Passiflora incarnata (hypnotic)
101
What are nervous system tonics and trophorestoratives?
Herbs that are tonic and nutritive to the nervous system are essential to any mental health problem prescription, for long lasting benefits, rather than just short term alleviation. These tonics strengthen and restore the tissues directly.
E.g. Avena sativa, Turnera diffusa, Scutellaria lateriflora, Verbena officinalis, Stachys betonica and Hypericum perforatum.
Adrenal tonics such as Glycyrrhiza glabra and Borago officinalis can help to restore depleted adrenals following long term stress or mental illness.
102
What are herbal nervous stimulants?
These herbs stimulate the body’s vitality – through history, greater emphasis was placed on stimulants than in our modern times e.g. Cola vera, Camellia sinensis. These are used as general stimulants, although their use should be restricted long term as they can deplete the adrenals.
More tonic stimulants such as Avena sativa, Turnera diffusa and Rosmarinus officinalis are the only stimulants we tend to use now
103
Name some herbal relaxants/antispasmodics
The most effective antispasmodic herbs in mental health problems are Valeriana officinalis, Viburnum opulus and prunifolium, and Piper methysticum.
104
Why should the liver be treated in mental health conditions?
In Galenic medicine, the seat of melancholy was the liver, and liver herbs have been used traditionally to treat symptoms of depression.
eg. Silybum marianum, Glycyrrhiza glabra and Schisandra sinensis.
105
What is the GAS theory of stress response?
The general adaptation syndrome (GAS), developed by Hans Selye, describes the pattern of responses that the body goes through after being prompted by a stressor. There are three stages: alarm, resistance, and exhaustion.
Alarm – This occurs when we first perceive something as stressful, and then the body initiates the fight-or-flight response (as discussed earlier).
Resistance – If the perceived stress continues, the body stays activated at a higher metabolic level in an effort to offset the persistent stress. The body cannot maintain this level indefinitely, and its resources will eventually deplete.
Exhaustion – Prolonged exposure to the stressor will result in the depletion of the body’s resources, and the resulting wear and tear will suppress the immune system and cause bodily functions to deteriorate. This can lead to a variety of health issues and illnesses, including heart disease, digestive problems, depression, and diabetes.
These changes will occur in the body regardless of whether the perceived stressor is considered eustress (positive or pleasant) or distress (negative or unpleasant). Ultimately, this means that we need to take active steps in managing all of our stressors, as it can build up and potentially cause harm to our health otherwise.
106
What are the 4 types of endocrine tonics?
Hypothalamic-Pituitary axis – Juglans nigra, Verbena officinalis, Eleutherococcus senticosus, Panax ginseng, Withania somnifera, Galega officinalis, Vitex agnus-castus.
Thyroid - Fucus vesiculosus, Lycopus virginicus, Melissa officinalis, Leonurus cardiaca
Adrenal – Glycyrrhiza glabra, Borago officinalis, Verbena officinalis, Ocimum basilicum
Pancreas – Vaccinium myrtillus, Galega officinalis, Allium sativum, Morus nigra (Mulberry), Olea europaea.
107
How do bitters act on the pancreas?
Gentle endocrine stimulation of pancreas.
eg. Taraxacum officinale, Cynara scolymus, Artemisia annua, Centaurea erythraea.
108
When are immune modulators indicated in endocrine dysfunction?
If there is an autoimmune basis to the endocrine disorder.
eg. Astragalus membranaceus.
109
What is the treatment strategy for type 2 Diabetes?
Supporting liver and pancreatic function, to improve insulin resistance and modulated blood sugar levels.
Supporting the cardiovascular system, to help prevent arteriosclerosis and protect against retinal changes.
Nerve tonics and adaptogens to help modify cortisol levels and offer support.
110
What is the treatment strategy for hypothyroidism?
Support and protection for the cardiovascular system, as patients are more at risk of arteriosclerosis
Improve digestive function as the system can become sluggish
Support the nervous system, using nervines and adaptogens to help low mood and fatigue.
111
What is the treatment strategy for hyperthyroidism?
* Modulating thyroid hormone synthesis
* Controlling debilitating symptoms (palpitations, sweating, heat intolerance, irritability, itching, diarrhoea, etc)
* Protecting the heart from the effects of secondary hypertension
* Trying to reduce secondary hypertension
112
What are alteratives for the skin?
Alterative is a traditional term to describe a particularly broad herb action. The term alterative is difficult to define and the effects of alterative herbs are poorly understood.
Alteratives can be defined as improving the elimination of metabolic waste and in so doing restoring normal body functions (homeostasis).
This is probably why they are so successful in treating skin conditions as metabolic disorder is often at the root of skin disease.
They are also traditionally called blood cleansers or depuratives.
113
What are herbal alterative options for the skin?
Arctium lappa is traditionally seen as working on the cellular level to improve metabolism. Modern research is now beginning to confirm this traditional thought as Arctium lappa demonstrates antioxidant and anti inflammatory actions (Wu et al, 2009) It is important to eliminate first rather than just stimulate processing – as this can cause an exacerbation of the condition e.g. an adverse reaction – Arctium lappa is notable for this exacerbation – used carefully and in combination with or preceded by more eliminatory remedies.
Fumaria officinalis, Iris versicolor, Rumex crispus and Scrophularia nodosa.
114
Give examples of lymphatics
Calendula officinalis, Galium aparine, Phytolacca decandra, Trifolium pratense.
115
What are diaphoretics?
Diaphoretics aid the skin in the elimination of metabolites and promote perspiration. Most are peripheral vasodilators- stimulating the sweat glands in part by dilating the blood vessels in the area.
116
Name herbal examples of diaphoretics
Eupatorium perfoliatum, Capsicum minimum, Tilia spp, Achillea millefolium.
117
What are herbal antimicrobials for the skin?
Many herbs contain volatile oils or resins, which are antibiotics and can be used to keep wounds clean.
eg. Calendula officinalis, Plantago lanceolata, Stellaria media, Commiphora molmol.
118
What are herbal astringents for the skin?
Astringents help to contract tissue by precipitating proteins and can thus reduce secretions and discharges. They often contain tannins or resins.
eg. Plantago lanceolata, Calendula officinalis.
119
What are emollients for the skin?
Demulcents/emollients contain mucilage or saponins that are soothing to inflamed mucous membranes.
eg. Symphytum officinale, Stellaria media, Ulmus fulva, Plantago lanceolata.
120
What are refrigerants for the skin?
Poorly defined. Understood to have a cooling effect when applied to the skin possibly due to a demulcent or volatile oil action.
eg. Stellaria media, Mentha piperita, Lavandula officinalis essential oil, Rosa damascena or Hamamelis virginiana aromatic water.
121
What are vulneraries?
Vulneraries are herbs applied externally and aid the body in the healing of wounds and cuts Most of these herbs contain tannins, mucilage or resin.
Stellaria media, Symphytum officinale, Calendula officinalis, Plantago lanceolata, Achillea millefolium.
122
What does acne in diabetic patients sometimes indicate?
Insulin injection required and often resolves
123
What are the treatment goals for acne vulgaris?
Support elimination by supporting the liver, bowel, kidneys, lymphatics, and tissues.
Supporting the immune system via the gut and also any possible allergic response.
Support the nervous system.
Support the hormonal systems.
124
What are the treatment goals of acne rosacea
• Support elimination by supporting the liver, bowel, kidneys, lymphatics, and tissues.
Supporting the immune system via the gut and also any possible allergic response.
Support the nervous system.
Support the hormonal systems.
Support the skin topically to reduce redness and irritation.
Support circulation.
125
What are treatment goals for eczema?
The approach will depend on the type of eczema. When there is an allergic reaction, whether endogenous or exogenous, avoiding or reducing the impact of the allergen is essential. If it is unavoidable (e.g. air-borne), then desensitisation may be required.
Internally, immunomodulators e.g. Urtica dioica, Echinacea spp; alteratives e.g. Arctium lappa, Viola tricolor, Galium aperine; antiallergens e.g Urtica dioica, Matricaria recutita are useful.
Topically refrigerants e.g. Stellaria media, Mentha piperita, antipruritics and vulneraries e.g. Calendula officinalis, Symphytum officinale, antinflammatories e.g. Matricaria, Lavendula can be used.
Oatmeal baths are very soothing and moisturising for the skin. Herbal infusions can be applied as sitz sprays.
If stress were a factor, the use of nervines, particularly antipruritic nervines like Humulus lupulus and Valeriana officinalis would help.
The patient should avoid the use of harsh soaps and anything with artificial scents. Detergent should be pure and liquid, so that no residue is left on clothes.
With the treatment of varicose eczema, a similar approach will help, together with the addition of circularity tonics such as Achillea millefolium, Crataegus spp and Aesculus hippocastanum. Topically astringents can help.
126
What is the treatment goals for psoriasis?
Support elimination by supporting the liver, bowel, kidneys, lymphatics, and tissues.
Supporting the immune system via the gut and also any possible allergic response.
Support the nervous system.
Support the hormonal systems.
Reduce inflammation.
Support liver and gallbladder function specifically with hepatics and bitters.
127
What are the treatment goals for fungal disease?
Support elimination by supporting the liver, bowel, kidneys, lymphatics, and tissues.
Supporting the immune system via the gut.
Support the nervous system.
Topically reduce fungal growth.
128
What should you avoid when treating childhood eczema?
Strong alteratives ie. Arctium lappa, scrofularia nurdosa
Use gentle herbs, avoid flare ups
Essential oils and creams avoided
129
How would you explain to a patient that their skin condition could get worse before it gets better?
Possible for tissues to clear toxins and wastes sooner than the body has ability to eliminate them, and they build up and cause flare up. Important to ensure good elimination before using strong alteratives ie. Arctium lappa.
130
What is the treatment strategy for osteoarthritis?
One of the main approaches in treating OA is to increase the circulation to the joint, as it can be viewed as a cold arthritic condition. Eliminatory remedies can be used to help clear excessive build up of toxic metabolites. Remineralisers are often used to help bone junctions.
Analgesic/antinflammatory herbs used predominantly for OA include Salix alba, Harpagophytum procumbens and Cimicifuga racemosa.
Circulatory herbs would be warming and antiinflammatory and would include Zingiber officinalis, Zanthoxylem clavaherculis and Capsicum minimum.
131
What are some topical applications for OA?
Topical preparations are beneficial, especially for initial symptomatic relief of any pain or stiffness and include Capsicum cream or infused oil of Symphytum with essential oils including Rosemary, black pepper, marjoram and lavender. Gaultheria or oil of Wintergreen is also effective
132
What is the herbal approach to rheumatoid arthritis?
Malaise and tiredness is often a feature with Rheumatoid arthritis, so nervines, adaptogens and adrenal tonics are useful to include. Particularly useful are Glycyrrhiza glabra, Withania somnifera and Avena sativa.
Patients can often be taking a vast cocktail of conventional drugs, some cyto- and hepatotoxic. Liver hepatoprotectives such as Carduus marianus and Schizandra sinesis, together with supporting elimination through herbs and dietary changes will help.
Topical - Depending on the state of the joints, hot packs can be helpful, particularly if stiff. If there is a lot of heat, but no stiffness, cold or ice packs can be used. Massage oils can be very effective, as can Epsom salt baths.
133
What is the treatment strategy for fibromyalgia?
* Help reduce any inflammatory process – through the use of antinflammatories with system affinities to muscle and connective tissue e.g. Zanthoxylem clavaherculis, Apium graveolens, Cimicifuga racemosa
* Improve blood supply to the tissue
* Support detoxification (elimination of toxic metabolites)
* Improve stress and mood (nerve tonics and adaptogens)
* Improve sleep (often a separate sleep mix is appropriate)
* Help with pain relief
* Support the immune system (immunomodulators)
* Address any allergies
134
What are antirheumatics for the MS system?
Many antirheumatics contain natural salicylates, which are anti-inflammatory.
Alteratives, by their very nature, are anti-inflammatory.
135
Name some antitheumatics for the MS system
Salix alba, Filipendula ulmaria, Cimicifuga racemosa, Betula pendula.
Some herbs have a steroid-like action which can help inflammation, including Glycyrrhiza glabra and Dioscorea villosa.
In clinical trials, Curcuma longa has been found to be as effective as NSAIDs in its inflammatory action (Hoppe, 2000 and references therein). Other useful herbs include Boswellia serrata.
136
How are nervines useful in MS conditions?
Relaxants or antispasmodics are useful in painful joint conditions to relieve muscle spasm and can provide relief.
137
Which nervines are indicated in MS conditions?
Viburnum opulus or prunifolium, Piper methysticum (currently restricted), Cimicifuga racemosa, Passiflora incarnata, Scutellaria lateriflora, Valeriana officinalis, Harpagophytum procumbens, Piscidia erythrina. Adaptogenic herbs can be helpful in maintaining energy and stamina and Withania somniferum is antirheumatic.
138
Which analgesics are indicated in MS conditions?
Lobelia (topically), Piscidia erythrina, Gelsemium sempervirens, Cimicifuga racemosa, Harpagophytum procumbens. Corydalis is particularly effective and is often usefully prescribed in a separate pain mix.
139
How are diuretics effective in MS conditions?
Mild diuretics are used mainly to encourage flushing of the whole system. Note that increasing the fluid intake will have the same effect.
140
Which diuretic herb is especially indicated for arthritis?
Juniper (Juniperus communis) is especially good for use in arthritis as it also has bitter principles, which tonify the digestive system. Juniper should not be used with any kind of kidney disease or during pregnancy. It should not be used for more than 6 weeks.
141
Which circulatory herbs are used in MS conditions?
Cooling circulatory herbs: Achillea millefolium, Eupatorium perfoliatum
Warming circulatory herbs: Capsicum minimum, Zanthoxylum clava herculis, Zingiber officinalis, Rosmarinus officinalis.
Tonics: Crataegus spp.
142
Name a rubefacient for the MS system?
Capsicum minimum. Rubefacients increase circulation to the joint through vasodilation, like a “therapeutic inflammation” (Mills and Bone, 2000).
143
What are remineralisers/how do they work in the MS system?
These herbs help develop strong bone and may also contribute to the early repair of cartilage.
144
Give examples of herbal remineralisers
Agropyron repens, Betula pendula, Equisetum arvense, Taraxacum officinale fol and radix, Urtica dioica and Rubus idaeus, particularly for peri-articular changes.
Externally herbs such as Arnica montana and Symphytum officinale foland radix can induce regeneration of cartilage (Kielczynski, 1997).
145
When is nutritive support most important in MS conditions?
Nutrition and revitalisation is more important during the remission stage of the disease, and elimination more important during exacerbation.
Urtica dioica is highly indicated for arthritis, because it shares nutritive, alterative, and diuretic qualities (Bergner, ‘01). Another excellent nutritive herb with mild diuretic properties is Medicago sativa.
146
What role do essential fatty acids have in inflammation? What medicinal herbs contain EFAs? Would you recommend them?
● Omega-3 and Omega-6 work antagonistically at a particular ratio
● Omega-3 reduces inflammatory cells and reduces risk of diabetes
● What medicinal herbs contain EFAs? Flax (Linum usitatissimum) Would you recommend them? Yes. Also contains phytoestrogens.
147
What is the hygiene hypothesis?
Children growing up in rural areas, around animals and in larger families seem to develop asthma less often than do other children. According to the hygiene hypothesis, this is due to increased exposure to particular viruses, bacteria or parasites.
The hygiene hypothesis proposes that childhood exposure to germs and certain infections helps the immune system develop. This teaches the body to differentiate harmless substances from the harmful substances that trigger asthma. In theory, exposure to certain germs teaches the immune system not to overreact.
148
What is the immunomodulatory action of Astragalus mebranaceus?
Huang Qi (Astragalus membranaceus). This herb stimulates virtually every phase of immune system activity. It increases the number of stem cells in the marrow and lymph tissue, and stimulates their development into active immune cells that are released into the body.
149
What are the immunomodulatory actions of Calendula officinalis and Echinacea spp.?
These herbs work with the body’s own defence mechanisms to help resist pathogens, for instance phagocytosis.
150
Which herbs have anti-Platelet Activating Factor (PAF)?
Anti PAF activity in Asthma – Ginkgo biloba, Picrorhiza kurroa. Scutellaria baicalensis – inhibition of prostaglandin production and histamine release and antigen/IgE binding
151
What is the immunomodulatory effect of Albizzia lebbek?
Albizia lebbeck – reduction in histamine release, mast cell stabilising.
152
What is Platelet Activating Factor?
Platelet-activating factor (PAF) is a lipid mediator involved in several allergic reactions. It is released from multiple cells of the immune system, such as eosinophils, neutrophils, and mast cells, and also exerts its effect on most of them upon specific binding to its receptor, becoming a pleiotropic mediator. PAF is considered a potential relevant mediator in allergic rhinitis, with a key role in nasal congestion and rhinorrhoea due to its effect on vascular permeability.
153
Which Adaptogens are hormonal modulators?
Eleutherococcus senticosus, Withania somnifera.
154
What is the germ hypothesis?
Children growing up in rural areas, around animals and in larger families seem to develop asthma less often than do other children. According to the hygiene hypothesis, this is due to increased exposure to particular viruses, bacteria or parasites.
The hygiene hypothesis proposes that childhood exposure to germs and certain infections helps the immune system develop. This teaches the body to differentiate harmless substances from the harmful substances that trigger asthma. In theory, exposure to certain germs teaches the immune system not to overreact.
155
Give examples of the following Expectorants - including stimulating, relaxing, amphoteric and warming:
Stimulating: Primula veris, Viola odorata, Bellis perennis, Glycyrrhiza glabra, Lobelia inflata
Warming: Pimpinella anisum, Zingiber officinale, Capsicum minimum, Cinnamomum zeylanicum, Allium sativum & cepa, Brassica family, Inula helenium, Marrubium vulgare, Sambucus nigra, Thymus vulgaris
Relaxant/demulcent: Asclepias tuberosa, Lobelia inflata, Tussilago farfara, Plantago spp, Verbascum thapsus.
Amphoteric: Lobelia inflata, Tussilago farfara, Equisetum arvense, Verbascum thapsus
156
Which herbs are connective tissue strengtheners of the respiratory system? Traditionally used to increase the integrity of the tissue of the lung
Main example: Equisetum arvense
| Also mucous membrane tonics such as Hydrastis & Plantago lanceolata
157
Which herbs are respiratory antiseptics and enhancers of resistance to infection?
Thymus vulgaris, Inula helenium, Armoracia rusticana, Allium sativum, (Hydrastis Canadensis , Berberis
158
Name some diaphoretic herbs
Sambucus nigra, Tilia app., Achillea millefolium, Eupatorium perfoliatum
159
Name some immune modulatory herbs
Echinacea spp, Phytolacca decandra, Baptisia tinctoria, Astragalus membranaceus, Andrographis paniculata, Picrorhiza kurroa
160
Name some respiratory antispasmodics
The herbs containing Tropane alkaloids are strong spasmolytics Datura stramonium, Atropa belladonna, Hyoscyamus niger. There are many contraindications with this group. Gentler spasmolytic alternatives include:
Thymus vulgaris, Glycyrrhiza glabra, Hyssopus officinalis, Viburnum spp.
161
Name some anti-catarrhal herbs
Anti-catarrhal examples: Plantago lanceolata,Sambucus nigra, Euphrasia spp
Verbascum Thapsus, Solidago virgaurea L
162
What is the action of anti-tussives?
They cause depression of the cough reflex and caution is needed if infection is present. They are best used for dry, unproductive coughs.
163
What constituents do anti-tussives contain?
Demulcents, and soothing expectorants can also help at times.
True antitussives contain: Cyanogenic glycosides e.g. Prunus serotina or opiates e.g Lactuca virosa, Eschscholzia californica
164
What are the types of urinary calculi?
Types of kidney stones include:
Calcium stones. Most kidney stones are calcium stones, usually in the form of calcium oxalate. Oxalate is a substance made daily by your liver or absorbed from your diet. Certain fruits and vegetables, as well as nuts and chocolate, have high oxalate content.
Dietary factors, high doses of vitamin D, intestinal bypass surgery and several metabolic disorders can increase the concentration of calcium or oxalate in urine.
Calcium stones may also occur in the form of calcium phosphate. This type of stone is more common in metabolic conditions, such as renal tubular acidosis. It may also be associated with certain medications used to treat migraines or seizures, such as topiramate (Topamax, Trokendi XR, Qudexy XR).
Struvite stones. Struvite stones form in response to a urinary tract infection. These stones can grow quickly and become quite large, sometimes with few symptoms or little warning.
Uric acid stones. Uric acid stones can form in people who lose too much fluid because of chronic diarrhea or malabsorption, those who eat a high-protein diet, and those with diabetes or metabolic syndrome. Certain genetic factors also may increase your risk of uric acid stones.
Cystine stones. These stones form in people with a hereditary disorder called cystinuria that causes the kidneys to excrete too much of a specific amino acid.
165
What are the treatment strategies in premenstrual syndrome?
Support the liver - The liver is responsible for the turnover of
hormones in the body and can have a significant influence on
hormone-related problems. Many nervines have a marked liver
action e.g. Hypericum perforatum, Verbena officinalis,
Passiflora incarnata, Rosa spp, Scutellaria lateriflora, Stachys
betonica, etc.
Support the Pancreas - If there are signs of glucose intolerance (insulin resistance)
– Galega officinalis, Chionanthes virginicus, Trigonella foenum-graecum and the bitters.
Nervines - See supporting the liver. Also relaxants such as
Valeriana officinalis are helpful here. For PMS related
depression, both Hypericum perforatum and Rosa spp are
particularly applicable.
Relaxing adrenal tonics/adaptogens - Verbena officinalis ,
Borago officinalis and Withania somnifera particularly spring to
mind.
Hormonal modulators - The question of Vitex agnus-castus.
There is no doubt that Vitex agnus-castus is an excellent
herb
for some cases of PMS. But it is also quite a powerful herb and is
often not needed in straight forward cases, and particularly in
young girls, it is better to use less potent herbs such as Alchemilla
vulgaris.
Lymphatics and diuretics - If fluid retention is a feature a timely
lymphatic and/or diuretic would be useful e.g. Galium aparine,
Taraxacum officinale folia.
166
What are the treatment strategies in dysmenorrhea?
Analgesics - A useful analgesic to use here is the schedule 3
herb Gelsemium sempervirens which can be added to pain
mixes. Care must be taken with the dose, it has quite a soporific
effect, so patients should not drive whilst taking.
Antispasmodics/Uterine relaxants - Antispasmodics such as
Viburnum opulus or prunifolium, Valeriana officinalis, Piscidea
erythrina offer symptomatic relief.
Pelvic decongestants - There are many herbs that serve as
pelvic decongestants, increasing circulation to the pelvic area –
such as Achillea millefolium, Angelica sinensis, Lamium album.
Circulatory agents - Try to choose herbs that have an affinity for
the pelvic area such Achillea milefolium, Angelica sinensis, or a
diffuse circulatory stimulant such as Zingiber officinalis.
Hormonal regulators - Achillea millefolium, Alchemilla vulgaris,
Vitex agnus-castus, Angelica sinensis
Prostaglandin inhibition - As Trickey (1998) comments, there is
no herbal tradition for the use of prostaglandin-inhibiting
herbs. However, a number of prostaglandin –inhibiting effects
have been observed for herbs traditionally used for period pain,
notably Zingiber officinalis, Tanacetum parthenium.
167
Outline the herbal approach to menopause
Support the liver - See PMS-Premenstrual syndrome
Nervines – that also support the liver. Also relaxants such as
Valeriana officinalis are helpful here.
In menopause, nervines with a heart action are particularly
appropriate as many women experience tachycardia and
palpitations. E.g. Leonorus cardiaca, Tilia spp, Passiflora
incarnata.
Other herbs for low moods are Rosa damascena, Melissa
officinalis and Hypericum perforatum. In fact, Hypericum
perforatum was listed in very old herbals as being specific for
“menopausal hysteria”.
Hypnotics and sedatives are useful for sleep mixes.
Adrenal tonics/adaptogens - The adrenal glands are particularly
important in menopause, as they start to take over the role of
producing small amounts of androstenedione, which is a
precursor of oestrone, the dominant oestrogen in
post-menopausal women (Tricky, 1998). Menopausal women
are particularly prone to fatigue, and a relaxing adaptogen such
as Withania somnifera, together with relaxant adrenal tonics
such as Verbena are useful here.
Hormonal modulators - Phytoestrogen rich plants such as Salvia
officinalis, Cimicifuga racemosa has been shown to be very
effective for hot flushes, as has Dioscorea villosa. These herbs
are also useful in dealing with night sweats.
The most usual presenting menopausal complaint is “hot
flushes” – flushing and sweating caused by oestrogen
withdrawal, often worse at night. The duration and severity of
flushing varies considerably from woman to woman – with
some experiencing such severe night sweats that they need to
change the sheets in the middle of the night.
Trifolium pratense or Trigonella foenum-graecum can be given
as a tea, juice or tincture to boost dietary intake. Despite the
fact that hot flushes are generally caused by a lack of
oestrogen, Vitex agnus-castus can be beneficial, probably via its
action on the hypothalamus and pituitary gland. Vitex
agnus-castus has dopaminergic activity, which may also help
with the depression and mood changes that often accompany
the menopause. Vitex agnus-castus is also useful in certain
cases of menorrhagia and metrorrhagia where there is a
shortened luteal phase.
168
What is the herbal approach to endometriosis?
Reduction of pain
Address any underlying hormonal imbalances
Support the immune system
Support the nervous system, addressing any stress
Improve circulation and drainage to the pelvic area
The use of antimitotic remedies to restrict growth of
endometrial tissue
Detoxification to improve tissue health
169
What is the herbal approach to uterine fibroids?
Reduction of bleeding through the use of astringent herbs, e.g.
Alchemilla vulgaris, Capsella bursa-pastoris
Address any underlying hormonal imbalances
Support the immune system
Support the nervous system, addressing any stress
Improve circulation and drainage to the pelvic area
The use of antimitotic herbs to restrict growth of endometrial
tissue, e.g. Thuja occidentalis, Chelidonium majus
Detoxification to improve tissue health
170
What is the herbal approach to PCOS?
```
• Supporting the endocrine system – normalising hypothalamic-pituitary-endocrine
function (adaptogens).
```
Hypothalamic-Pituitary axis – Juglans nigra, Verbena officinalis,
Eleutherococcus senticosis, Panax ginseng, Withania somnifera,
Galega offinalis, Vitex agnus-castus.
Thyroid - Fucus vesiculosis, Lycopus virginicus, Melissa officinalis,
Leonorus cardiaca
Adrenal – Glycyrrhiza glabra, Borago officinalis, Verbena officinalis,
Ocimum basilicum
```
Pancreas – Vaccinium myrtillus, Galega officinalis, Allium sativum,
Morus nigra (Mulberry), Olea europea.
```
• Support the Liver
• Hormone modulators e.g.Angelica sinensis,Chamaelerium
luteum*, Vitex agnus-castus
Help reduce cystic growth Anticystic growth e.g. Thuja
occidentalis, Hydrastis canadensis*, Phytolacca decandra
• Use of anti-androgens e.g. Paeonia lactiflora. Glycyrrhiza glabra,
Serrenoa repens, Panax ginseng (Rogers, 2006)
• Support the nervous system through the use of relaxants and
tonics Nervines
171
Name some urinary diuretics
Equisetum arvense, Agropyron repens, Taraxacum folia, Zea mays, Betula pendula and Camellia sinensis.
172
Name some antilithic herbs
Eupatorium graveolens, Collinsonia canadensis, Hydrangea arborescens, Parietaria diffusa, Agropyron repens and Solidago virgaurea.
173
Name some kidney and bladder trophorestoratives
Alchemilla (Aphanes) arvensis, Equisetum arvense, Solidago virgaurea, Parietaria diffusa, Galium aparine, Achillea millefolium.
174
Name some urinary antiseptics
Urinary antiseptics are contraindicated in kidney disease and renal failure.
They include Barosma betulina, Juniperus communis, Betula pendula, Daucus carota, Apium graveolens, Arctostaphylos uva ursi.
175
Name some urinary mucous membrane trophorestoratives
Plantago lanceolata, Althea officinalis folia, Agropyron repens and Zea mays.
176
Name some urinary astringents
Equisetum arvense, Achillea millefolium, Agrimonia eupatoria
177
Name some kidney protective herbs
Astragalus membranaceus,
| Arctostaphylos uva-ursi and Cordyceps.
178
Why must care be used in kidney disease an pungent/aromatic herbs?
Great care is needed in nephropathy, which affects the basement membrane and the delicate structure of the kidney e.g. glomerulonephritis, nephrotic syndrome. Practitioners should proceed with caution in the treatment of these conditions, or in patients with a previous history, particularly avoiding any herbs containing volatile or pungent constituents which may further damage the kidneys.
