Archive for April, 2010

Garlic and cardiovascular risk factors

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April 30, 2010 at 11:45 am

Garlic, onions and cardiovascular risk factors. A review of the evidence from human experiments with emphasis on commercially available preparations.
J Kleijnen, P Knipschild, and G ter Riet
Br J Clin Pharmacol. 1989 November; 28(5): 535–544

This interesting review article (Kleijnen et al., 1989) did not unfortunately relate to the state of the art in clinical research concerning garlic in general and certain garlic preparations in particular. In the last 3 years more than one dozen clinical research studies have been performed with concentrated garlic tablets. Dr Kleijnen & colleagues’ review refers to only one of these trials dating from 1985 and studies of other garlic products are similarly excluded. The research program has included studies investigating cholesterol, triglycerides, LDL and HDL, blood pressure, fibrinolysis, blood viscosity, etc. This includes work carried out at different university hospitals, research institutions as well as multi-centre studies with general practitioners. Much of this work has been recently presented at the first International Garlic Symposium in Germany, the results of which have now been published in English and made widely available to the British medical profession in a special supplement of Cardiology in Practice.

A main conclusion of Dr Kleijnen was that large amounts of garlic are needed to prove clinical effectiveness (up to 28 cloves). This did indeed appear to be the case according to early trials using garlic. Certainly few patients would find such a level of daily consumption practical or socially acceptable. Very high levels of garlic clove have in the past been necessary to provide relatively very small amounts of active oils or other derivatives. This follows partly from garlic’s high water content (60%) accounting for much of its bulk and because its active substance allicin rapidly breaks down once created by cutting or crushing. It is now possible to produce dehydrated garlic powder to a standardised level of the allicin mother substance alliin. Moreover production expertise has also developed enabling these ingredients to be preserved within a protected tablet form. These developments have enabled effective clinical work to be undertaken for the first time with a standardised product available at a relatively low and acceptable dosage level. Our studies have been performed with daily dosages of 300-900 mg garlic powder (equivalent to about 1 clove of garlic). We were able to show a mean reduction of blood cholesterol of approximately 10% and of triglycerides 13%.

A second point of criticism was the postulated inherent difficulty of performing double-blind studies with garlic or garlic preparations. This, too, was certainly true in the past but has largely been circumvented by the availability of a tablet product which overcomes the odour and taste problem for most people. We absolutely agree that totally odourless garlic preparations are ineffective, since the medical effects are based on the action of alliin and its sulphur smelling secondary and tertiary products. Control of the odour problem depends on the galenic preparation of garlic powder, so that formation of smelling products occurs in the intestine. At the dosages used in our trials only 5-10% of all patients developed any such garlic ‘signs’. These cases can be easily identified and omitted prior to statistical evaluation thus enabling proper double-blind studies to be conducted. The humble garlic clove is increasingly being shown to have exciting potential as a safe prophylactic for everyday use against cardiovascular risk factors. We do hope that you will be able to incorporate this new information about garlic and garlic preparations in your Journal, and in particular the developments in dosage and double-blind study capability.

Cardiovascular diseases

Treatment of Cardiovascular Disease

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April 27, 2010 at 4:50 pm

In modern China, the two medical systems of Western allopathic medicine and traditional Chinese medicine (TCM) are integrated and operate side by side. Many conventional allopathic doctors now recognize that a combination of Western therapy and TCM has shown better results in improving overall health in patients with cardiovascular conditions than have drugs or surgery alone. Use of traditional Chinese medicine has led to a reduction in total mortality, an increase in the therapeutic effectiveness of drugs, and a decrease in severity of drug side effects, as well as an improvement in quality of life (as a result of smoking cessation, weight control, diet modification, exercise, etc).

Numerous studies have shown that traditional Chinese medicine significantly helps patients with cardiac insufficiency, hyperlipidemia, hypertension, pericarditis, angina pectoris, tachycardia, atherosclerosis, congestive heart failure, and other circulatory conditions. One or more of the following changes have been reported: improved blood circulation, increased oxygen flow and intake, decreased edema and fluid accumulation in tissues, greater cardiac muscle strength, decreased myocardial hypertrophy or enlargement, decreased blockage in arteries, regulation of heart rhythm, lower serum cholesterol and triglycerides, and normal or near normal blood pressure. In holistic medicine and TCM, these effects are described differently: improved qi and blood flow; decrease in blood stasis and qi stagnation; decreased stagnation of cold in the chest; decreased phlegm, fluid, and damp accumulation; supplemented and nourished heart yin; strengthened heart qi; draining of heart fire; harmonized heart connections to other organs (not just anatomically speaking) such as kidneys, lung, pericardium, spleen, gallbladder, and small intestine; and reinforced and invigorated heart yang.

Traditional Chinese medicine has shown promise in surgical patients following coronary bypass, stent, or angioplasty by decreasing pain and promoting relaxation, thus allowing a faster recovery. Additionally, TCM can help relieve many of the adverse effects of cardiovascular drugs. The adverse effects from drugs most commonly seen in our clinic are fatigue, lowered libido, drowsiness, muscle weakness and numbness, liver damage from cholesterol/lipid-lowering drugs, nutritional disturbance and general asthenia from diuretics, headache, dizziness, constipation from calcium channel blockers, rash, gastrointestinal disturbances, and insomnia from antiarrhythmic drugs. Switching drugs may or may not stop these effects. However, adverse effects can become an everyday nuisance to patients, which ultimately decreases compliance to pharmacotherapy.

Physiology and Pathologies of the Heart According to traditional Chinese medicine

In traditional Chinese medicine, the emphasis is placed on a holistic landscape with a mind, body, and spirit interconnection. The Xin, or heart, in TCM is not equal to the heart in Western medicine. The physiological functions of the heart extend beyond those of its anatomical structure. In the ancient Chinese text on internal medicine Nei Jing, the heart is considered the “king” or “monarch” of the body. It is the most important of all the internal organs and is described as the “ruler” of the internal organs. The Nei Jing says, “All the blood is under the control of the heart … the heart governs the blood and the blood vessels, and dominates blood circulation …the blood current flows continuously in a circle and never stops.” These medical thoughts were documented in Chinese texts thousands of years before William Harvey (1573-1657) described the theory of blood circulation.

The above physiological functions are the same as in Western medicine. However, in traditional Chinese medicine the heart has a number of additional interdependent functions.

Heart Qi

Refers to the energetic forces of the heart, and it is this qi that makes the blood flow. Heart qi is the driving force of the heart’s strength, rate, and rhythm and keeps it beating. According to a Chinese medical text, Simple Questions, “If heart qi is strong, the blood vessels will be in a good state and the pulse will be full and regular.”

Heart Yin

Refers to the vital essence and material structures of the heart, including the heart blood. The heart yin is the calming, passive aspect and is the opposite of heart yang. However, it counterbalances the heart yang to ensure proper heart function.

Heart Blood

Refers not only to the western meaning of blood but includes nutrition and nourishment. The outward manifestation of this is the face, particularly the complexion. The heart distributes blood to the entire body, especially to the face, since the face is rich in blood vessels. As mentioned in Nei Jing, “If the heart blood is abundant, the face will have a normal reddish (rosy) complexion and will be moist and bright. If the heart blood is insufficient, the face will be pale and without luster. If the heart blood is stagnant and blocked, the face may be purplish with blue lips.”

Heart Yang

Refers to its vital and dynamic function, the lively and expansive aspect of the heart which includes the heart qi. Heart yang complements heart yin and leads to a healthy heart. Heart yang is prone to coldness, especially in the elderly, and explains why elderly cardiac patients tend not to do well in colder climates. External cold can invade the chest, obstructing the circulation of yang. Patients with weak hearts are more likely to experience cold invading the body and causing chest pain. It is said in another Chinese medical text titled Methods and Rules of Medicine that “In chest obstruction pain of the heart region is caused by yang deficiency and invasion of cold.”

Other Functions of the Heart

Heart opens into the tongue

The tongue is considered to be the “offshoot, sprout, or window” of the heart. The heart controls the color, body, and appearance of the tongue since the tongue is closely related to heart qi and heart blood. This means that if there are pathologies of the heart, they are sometimes discernible in the tongue. In clinical practice, the tongue is a more accurate diagnostic tool than the complexion in women. Most women wear some form of face makeup when they come for an office visit. According to traditional Chinese medicine, the condition of the heart also affects the taste and the speech. Abnormalities of the heart may cause talking excessively, laughing inappropriately, stuttering, or speaking difficulties.

Heart houses the mind and stores the spirit (Shen)

The ancient text Spiritual Axis states, “The heart is the Monarch of the five yin organs and the six yang organs and it is the residence of the Mind….” It is said that the brain controls intelligence and memory, but it is the heart that reflects the inner consciousness, emotions, and the spiritual aspects of a human being. If one’s heart functions normally, then there will be healthy consciousness and sound mental activities. On the other hand, if the heart is diseased, there is a tendency for the Mind not to be rooted and the Shen or spirit is disturbed; then there will be mental restlessness, depression, anxiety, and insomnia and/or disturbed sleep and excessive dreaming.

There is a Chinese phrase known as Jing Shen which I use quite often when teaching at colleges. It is translated as vitality (Jing) and spirit (Shen). I have joked in the classroom that a student with good Jing Shen is alert, energetic, and enthusiastic and has a bright complexion and a twinkle in his/her eyes. This student has the heart for learning.

Heart is related to joy in human emotion

Joy or happiness is beneficial to the heart and improves blood flow. Joy makes the heart qi harmonize, leading to the proper nourishment by the blood to the heart muscles. But if a person is overjoyed, manic, or overly excited, the heart is excessively stimulated. This type of damage to the heart due to an impairment of heart spirit is seen with addicts who take recreational drugs. Similarly, overexcitement can trigger chest pains in a heart attack victim.

Heart meridian and channel system

A text on acupuncture used at the Shanghai College of Traditional Chinese Medicine states that the heart “channel begins in its associated organ, the heart, then emerges through the blood vessel system surrounding the heart, and travels downward across the diaphragm where it connects with the small intestine. A branch of the channel separates the heart and ascends alongside the esophagus to the face where it joins the tissues surrounding the eye. Another branch goes directly from the heart to the lung, then slants downward to emerge below the axilla. From here, the channel descends along the medial border of the anterior aspect of the upper arm, behind the lung and pericardium channels, to the antecubital fossa, where it continues downward to the capitate bone proximal to the palm. It then enters the palm and follows the medial side of the little finger to the finger tip.”

The heart meridian is directly joined to the lungs, small intestine, and kidneys. An example of pathology of heart and lung is congestive heart failure (CHF). The lungs, according to traditional Chinese medicine, are responsible not only for respiration but also for dispersing and descending water and other functions of water/fluid metabolism. In CHF, there is inadequate pumping of the heart due to fluid buildup in the lungs and edema in other tissues. Examples of pathology of the heart and small intestine are intestinal and urinary disorders that can arise from a stressful heart. In my clinical experience, patients often complain about constipation or urinary frequencies after their coronary bypass or angioplasty operations compared to other types of surgery. An example of pathology of heart and kidneys is harder to explain. The TCM concept is that the kidneys are the basic constitution or gate of vitality and the motivating force of all functional activities of the internal organs. When the kidney is weak due to overwork, late nights, inadequate sleep, excessive drug use, frequent pregnancy, febrile illness, bad diet, etc, it cannot support the heart yin. Because of the imbalance, the yin of the kidney is not able to nourish the heart, causing the heart to be stressed and agitated (heart fire). This leads to added pressure to the systemic arterial blood circuit, as in the case of hypertension.

The following two case studies explore treatment strategies in traditional Chinese medicine. Note that the following data are based on Oriental medical theories and reflect traditional Chinese medicine diagnosis and treatment.

Case study 1

Clinic: Center for Integrated Medicine, Visalia, California

Attending doctor: Dr. Kwong

Patient: Mrs. E. is a 48-year-old high school teacher. Ht: 5’8″, Wt: 140 lb

Chief complaints: Dizziness, vertigo, high blood pressure

Medical history: A relatively healthy female with no history of heart, cholesterol, or other circulatory problems was referred by one of her fellow teachers to our clinic. Approximately two months ago, she began to experience daily dizzy spells, chest stuffiness, and frontal headaches. She went to her allopathic physician (Dr. M.) a week later, and he determined that her blood pressure at that time was 165/101. He gave her samples of a blood pressure medication (she did not tell us the specific name). Mrs. E. made a decision not to take the drug. According to Mrs. E., “I was in the doctor’s office no more than seven minutes and he proceeded to write me a prescription and give me a drug. I don’t want anything just to cover my symptom like a bandage. I am more interested in treating the whole body and getting to the root of the problem.”

History of present illness: Patient admits to being under extreme stress the last three months. She was suddenly responsible for her baby granddaughter, whom her drug-addicted son had abandoned. This had drained her both financially and emotionally.

Subjective findings: Her symptoms were fullness/stuffiness of the chest, dizziness, vertigo, distending pain of the head and eyes, disturbed sleep (tossing and turning), night sweat, irritability, dark urine, and sweating palms and feet.

Objective findings: Both arms had wiry and slightly rapid pulse in cun, guan, and chi positions. Tongue showed a red body with red tip, midline vertical crack, and dark engorgement underneath. Eyes were slightly bloodshot. Complexion had a mallor flush. High blood pressure, taken twice in our office (159/100 and one hour later, 156/100). Soreness, tightness, and pain on acupressure points upon palpation of the neck and shoulder, with pain partially relieved upon pressure. Palpation of the abdomen indicated tightness on left side. Other findings were normal.

Western allopathic diagnosis:
1. High blood pressure

2. Essential hypertension

TCM holistic diagnosis:
1. Heart and kidney disharmony

2. Liver yang rising

3. Upward disturbance of liver wind

Treatment plan:
1. Acupuncture twice a week and reevaluate in two weeks. Needle with draining technique. Acupuncture prescription consisted of the following acupoints:

• Nei guan (Pericardium6) located 2 cun above the transverse crease of the wrist, between the tendons m. palmaris longus and m. flexor radialis. I punctured perpendicularly 0.5 to 0.8 inch.

• Shen men (Heart7) located at the ulnar end of the transverse crease of the wrist, in the depression on the radial side of the tendon m. flexor carpi ulnaris. Needle punctured perpendicularly 0.3 to 0.5 inch.

• Feng chi (gallbladder20) located in the depression between the upper portion of m. sternocleidomastoideus and m. trapezius directly below the external occipital protuberance. I angled needle towards nose and punctured 0.5 to 1 inch.

• San yin jiao (spleen6) located 3 cun directly above the tip of the medial malleolus, on the posterior border of the medial aspect of the tibia. Punctured perpendicularly 1 inch.

• Tai xi (kidney3) located in the depression between the medical malleolus and tendo calcaneus at the level with the tip of the medical malleolus. Punctured perpendicularly 0.5 inch.

• Xing jian (liver2) located on the dorsum of the foot between the first and second toes, proximal to the margin of the web. I punctured obliquely 0.3 to 0.5 inch.

• Yintang located midway between the medial ends of the two eyebrows under the glabella. Punctured subcutaneously downward 0.3 to 0.5 inch.

• Qu chi (large intest.11) located when elbow is flexed, in the point at the lateral end of the transverse cubital crease, midway between the radial side of crease and lateral epicondyle of the humerus. I punctured perpendicularly 1 to 1.5 inch.

2. Herbal tea with two doses daily (1 cup PO bid). Modification of the classical prescription Tianma Gouteng yin which consisted of the following herbs: tian ma (3 qian); gou teng (4 qian); zhu ru (3 qian); zhi zi (3 qian); chi shao (3 qian); sang ji sheng (4 qian); fu ling (3 qian); dan shen (4 qian); mu li (5 qian); mudan pi (3 qian); gui ban (5 qian); and xiaku cao (3 qian).

3. Chinese culinary recipes were given along with nutritional guidelines to decrease blood pressure.

4. Auricular herb seed in acupoint, shenmen twice a week.

5. Tai chi and qigong exercises to decrease emotional stress. I recommended these exercises be done daily, but patient was not motivated and did not adhere to the exercise and meditation.

6. Other guidelines: Patient is to take blood pressure readings several times daily and bring her chart to each office visit for evaluation.

Progress notes after two weeks: Her average daily blood pressure was 142/96. She had fewer headaches and only three episodes of dizziness and vertigo. Her chest fullness lessened in intensity, and there was an improvement in sleep. All other symptoms remained the same. We used the same treatment protocol for the next two weeks.

Progress notes after one month: Mrs. E.’s average daily blood pressure was 138/89. A full follow-up evaluation was done at this time. Pulse condition was slippery, wiry in all three positions of her left and right arm. Tongue body was red, and had cracks with no coat. Eyes and complexion were clear. There was less pain upon palpation of shoulder and abdomen. Urine was clear and her overall disposition was improved. I decreased the dosage of the herbal prescription but kept her acupuncture and food therapy at the same level.

Progress notes after two months: Patient was compliant with treatment program. Her average daily blood pressure was 133/82. We tapered her office visits to once a week. Overall, this patient has improved remarkably, and she was switched to herbal pills for blood pressure maintenance. I also instructed her to continue to pay attention to her diet and find ways to relieve her stress. We will follow up in one month. At that time I will refer her to an allopathic physician (not her previous MD) for physical examination.

Angina Pectoris and traditional Chinese medicine

A study in Denmark in 1996 found that the combination of acupuncture, shiatsu and lifestyle changes was helpful in the treatment of patients with angina pectoris. Sixty-nine patients with severe angina pectoris were followed for two years during their treatment period. Forty-nine of these patients were candidates for coronary artery bypass grafting. Treatment with these elements of TCM led to one third fewer deaths in these patients compared to a similar group of patients. Invasive treatment was postponed in 61% of the study patients due to clinical improvement, and there was a reduction of 90% in the annual number of in-hospital days. The researchers concluded that, “The combined treatment with acupuncture, shiatsu, and lifestyle adjustment may be highly cost effective for patients with advanced angina pectoris.”

According to Soren Ballegaard, Director of the Acupuncture Center in Denmark, and lead investigator in the study reported above, there are potential gains to be made when Western medicine is integrated with traditional Chinese medicine. “Within the framework of Western medicine, intervention occurs in the case of disruption, and little emphasis is placed on prevention. By contrast, the overall purpose of traditional Chinese medicine is a life in balance with nature. Traditional Chinese doctors are paid according to their ability to help patients stay healthy. The focus of health care should be on preventive methods, such as diet and exercise.”

Case study 2

Clinic: Center for Integrated Medicine, Hanford, California

Attending doctor: Frank Robbins, LAc

Patient: Mr. R. is a 52-year-old air-conditioning mechanic. Ht: 6’0″, Wt: 220 lb

Chief complaint: High cholesterol

Medical history: Mr. R. has multiple health problems, which are degenerative disk of neck and lower back, hypertension for 15 years, mild arthrosclerosis, sinus allergies, tension headaches (4x/week), and smoked for 30 years (stopped for five years). His drug profile indicates the following medications: Prinivil 20 mg, Soma 350 mg, Vioxx 50 mg, ASA, Flonase NS, and Allegra D. His last office visit to allopathic doctor resulted in a lab test, which included a lipid panel. The following are his results:

• Triglycerides: 129

• Cholesterol: 232

• HDL: 40

• LDL: 166.5

• Chol/HDL ratio: 5.8 (average risk)

His allopathic doctor said he needed to be put on a cholesterol-lowering drug. Mr. R. has some reservation about adding another drug to his regimen. He said that drugs may control his diseases but have done nothing to cure him. Instead they led to fatigue and numbness in his upper extremities; therefore, he decided to try alternative/complementary medicine. Besides this, he was worried about the side effects of a cholesterol-lowering drug. We mentioned that the new-generation drugs may have fewer side effects. Anyhow, he was not satisfied with our answer.

Objective findings: Tongue: thin body with white coat; pulse: thin, weak, slippery; complexion: pale; sweat: spontaneous; diet: poor.

All other TCM systems were normal.

Western allopathic diagnosis:
1. High cholesterol

2. Mild arthrosclerosis

TCM holistic diagnosis:
1. Damp and phlegm accumulation in blood

2. Qi deficiency with blood stasis

3. Kidney yang deficiency

Treatment plan:
1. Herbal medicine prescription consisted of the following herbs: shan zha, gou qi zi, ju hua, ji nei jin, yi mu cao, ze xie, dang gui, chuan xiong, jue ming zi, he shou wu, and hong hua. All were 1.5 qian in strength except for hong hua 0.5 qian to be prepared in tea form.

2. Acupuncture prescription: fenglong (st40), qihai (sp10), zusanli (st36), ren9 (st25).

3. Diet therapy: We recommended that he keep a food diary, and we instructed him on correcting his eating habits. In addition, we gave him Chinese herbal soups to help him lose weight and to lower his cholesterol levels.

4. Daily taoyin exercises that included stretching and walking.

Follow-up: Mr. R. went back to his allopathic physician four months later for another lipid panel. Here are the data: triglycerides, 95; cholesterol total, 179; HDL cholesterol, 55; LDL cholesterol, 107; cholesterol/HDL ratio of 3.3 (less than the average risk).

After reviewing the results, his allopathic physician indicated that Mr. R.’s levels were excellent. Mr. R. now weighs 168 lb and is continuing to lose weight. His diet has also improved. We are now working to improve his back pain.

Clarifying the Treatment Points

1. An aspect of a traditional Chinese medicine physical examination is palpating the pulse on various positions on the wrist. Cun positions reflect the uppermost organ systems such as the heart and lung (the crown to the diaphragm). Guan positions reflect the middle part of the body such as the liver, stomach, and spleen (diaphragm to the navel) whereas the chi positions of the pulse reflect that of the lower part of the body as the kidney (navel to the feet). The nature of the imbalance in a patient’s condition/illness, the area, and the nature of the disease can be determined from the wrist pulse. In Western medicine the pulse reflects the heart’s rate and regularity. In TCM, the pulse reflects not just the heart but can assess the overall condition of the body: the depth, rate, strength, width, rhythm, and other qualities.

2. The dosage or strength of an herb is weighed out on the scale. 1 qian is approximately equal to 3.2 grams. The strength is usually written after the herb’s name (ie, hong hua 0.5 qian). In the herbal prescription, some herbs have a higher strength than others depending on the holistic diagnosis. I like to start with lower doses of certain herbs if patients are on a drug regimen so that it prevents any potential interactions.

3. Acupoints can be written two ways. The name of the acupoints, such as zusanli, or the number st36; st refers to the meridian (stomach in this case) and 36 refers to the 36th acupoint on that meridian. Number 36 means that it follows acupoint number 35 and falls between 35 and 37 along the meridian channel. Some meridians have few acupoints (9 acupoints in the heart meridian as in the diagram) whereas some meridians have many (the urinary bladder has 67 acupoints).

4. Herbal pills are usually used for maintenance therapy. These are small pills that look like the homeopathic remedies and are not taken as a tea. For those individuals who cannot swallow pills (eg, babies and small children) the pills are crushed or dissolved in water. Herbal pills come in a standard formulation and the ingredients cannot be modified. On the other hand, a tea from raw herbs (plant form) used in an herbal prescription is much easier to modify and can be easily changed/adjusted to suit the patient’s specific needs.

5. Chinese nutrition/foods/recipes vary depending on the traditional Chinese medicine diagnosis. Two cardiac patients with the same Western diagnosis may not have the same TCM diagnosis. So the herbs, acupuncture, and food prescription may be different for the two cardiac patients with the same Western diagnosis because their holistic diagnosis is not the same. In general, some foods that I recommend to help blood pressure are tomatoes, celery, shitake and other mushrooms, blueberries, cranberries, lotus root, seaweed, kelp, barley, and aduki beans.

Mental disorders | Tags: Lemon Balm, Passionflower, Valerian

Supplement Used to Treat Sleep Disorders

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April 23, 2010 at 4:40 am

Many dietary supplements have been used to treat sleep disorders, with varying levels of efficacy

Insomnia and related sleep disorders have a major impact on healthcare and society. At any one time, 25%–35% of the population has insomnia. Only one fourth of these people seek medical attention. Insomnia is the primary complaint in 35% of physician office visits. While only 10%–18% of these patients are diagnosed with insomnia and only 14%–16% receive a hypnosedative prescription, approximately half are diagnosed with a comorbid nonsleep-related mental disorder or depression and treated accordingly. A greater cause for concern is that insomnia and sleeplessness result in higher degrees of functional impairment and disability and a higher utilization of medical services.

To treat their insomnia, many people turn to over-the-counter medications. However, some turn to dietary supplements. When Eisenberg conducted a survey of complementary and alternative medicine (CAM) use among the general population, insomnia was ranked eighth among top complaints, and roughly 25% of the patients with insomnia used some form of CAM to treat it. Within this time period, St. John’s wort, kava kava and valerian, which have been used to treat insomnia or related ailments, ranked among the top 12 best-selling dietary supplements. Given the high utilization of dietary supplements, it is important for pharmacists to be familiar with those most commonly used and the safety and evidence for efficacy associated with them.

Many herbs and dietary supplements have been used to treat insomnia (see TABLE 1). However, this article will focus only on the most commonly used herbs. Although they are usually taken orally, some herbs are used in the form of essential oil aromatherapy. Certain herbs, including lavender, hops, lemon balm and chamomile, are incorporated into a small “sleep pillow,” which is placed inside the pillowcase next to the patient’s head so the scent can be used to lure sleep.

Table1. Supplements Used to Aid Sleep*

5-HTP

Butanediol (Bd)

California poppy

Catnip

Coenzyme Q-10

Danshen

Deer velvet

Dill

European mistletoe

Fo-Ti

Folic Acid

Gamma butyrolactone (GBL)

Gamma hydroxybutyrate (GHB)

German chamomile

Ginkgo leaf extract

Ginseng, (American, Asian and Siberian)

Glutamine

Hops

Inositol

Jamaican dogwood

Kava kava

Kudzu

Lavender

Lemon balm

Lemon verbena

Linden flower

Mace

Melatonin

Mugwort

Niacin and niacinamide (vitamin B3)

Nutmeg

Pantothenic acid (vitamin B5)

Passionflower

Potassium

Reishi mushroom

Royal jelly

Saffron

Schisandra

Scullcap

St. John’s wort

Sweet violet

Sweet woodruff

Thiamine (vitamin B1)

L-tryptophan

Valerian

Vetiver

Vitamin B12

* Inclusion of an herb in this list should not be construed as a statement of the herb’s efficacy or safety in the treatment of a sleep disorder. The table is merely intended to inform the pharmacist of the herbs patients may take to self-treat sleep disorders so that they can construct patient history questions accordingly.

Valerian

Valerian (Valeriana officinalis) has a long tradition of use for insomnia. It was included as a sleep aid in the National Formulary until 1950. Multiple small clinical trials have found it superior to placebo in improving the subjective quality and onset of sleep. It also appears to improve mood and decrease early awakening. Its mechanism of action is not currently well-defined, but has been attributed to the valepotriates and the volatile oils, including the sesquiterpenes (particularly valerenic acid) and monoterpenes. In fact, valerian gets its distinctive (“stinky socks”) smell from isovaleric acid, which is produced from the breakdown of valepotriates during the extraction process. However, although valepotriates induce sedation in rats, they are not likely to be present in large enough amounts to be responsible for valerian‘s effects on sleep.

Although valerian is commonly recommended for occasional insomnia, it may be more effective in improving sleep when taken over a longer term. In a trial of 121 patients, the ethanolic valerian extract LI 156 showed no statistically significant effects on sleep over placebo at 14 days, but did show statistically improved clinical results by 28 days, as measured by the Clinical Global Scale (CGI) and the von Zerssen Mood Scale. In another trial, 128 subjects received either 400 mg of freeze-dried aqueous valerian extract or placebo for three nights. The subjects who took valerian reported significant improvements (p < 0.001) in sleep versus placebo. Valerian extract LI 156 (600 mg) was as effective as oxazepam (10 mg) in improving sleep quality when given to 74 patients with insomnia, 30 minutes before bedtime for 28 days. Valerian is generally well-tolerated, although some clinical trials have reported morning sedation. Unlike flunitrazepam (1 mg), a single 600-mg dose of LI 156 did not impair reaction abilities, concentration or coordination. When LI 156 dosing was continued for two weeks, it was no different from placebo in its effects on the same parameters. Nevertheless, registered valerian tincture in Germany is required to include labeling that warns of possible impaired ability to drive or operate heavy machinery. It may also occasionally cause headache or mild GI distress. Hepatotoxicity has been reported with use of sleep aids containing a combination of valerian and skullcap. However, these preparations may have been contaminated by germander (Teucrium sp.), a known hepatotoxin. One case of valerian withdrawal syndrome has been reported, but due to complicating factors, causality could not be determined. Although no formal interaction with alcohol or benzodiazepines has been demonstrated, valerian should not be given with these or other sedative medications due to the potential for additive sedation.

Lavender

Lavender (Lavandula angustifolia) has a long tradition of use as a sedative, particularly in herbal sleep pillows and as a massage oil. An aqueous extract of Lavandula stoechas flowers had sedative, but not hypnotic, effects in mice. It additionally prolonged pentobarbital sleeping time in a manner similar to that of diazepam. The essential oil of L. angustifolia and its constituents linalool and linalyl acetate decreased motility when inhaled by rats in a manner dependent on the amount of time exposed to the oil. These oils also decreased caffeine-induced hyperactivity to near normal activity levels. Activity level was particularly correlated with serum linalool concentrations. When given three minutes of lavender aromatherapy, 40 patients demonstrated increased beta power on EEG (suggesting drowsiness), had less depressed mood and performed math computations more rapidly and accurately. Lavender oil aromatherapy reduced emotional and behavioral stress levels post-cardiotomy in a double-blind, placebo-controlled trial. Massage therapy using lavender essential oil subjectively improved mood and decreased feelings of anxiety in patients admitted to the intensive care unit, but these feelings were not prolonged. The treatment had no effect on physiological stress indicators or observed ability to cope.

Passionflower

Passionflower (Passiflora incarnata, P. coerula, P. edulis) was listed as a calmative agent and sedative in the National Formulary from 1916 to 1936. The above-ground plant parts are used, and it is a common ingredient in sedative-hypnotic drug mixtures in both Europe and the U.S. The active ingredients are not currently defined. The flavonoid component apigenin may bind to benzodiazepine receptors and exert anxiolytic effects without impairing memory or motor skills. The components maltol and ethylmaltol may contribute to sedative activity. When administered orally and intraperitoneally to mice, passionflower extract prolonged sleep and decreased spontaneous locomotor activity. An aqueous extract of P. edulis produced sedative-hypnotic effects in human patients, but was also associated with liver and pancreatic toxicity. When compared to other plant extracts with purported sedative activity, including valerian and German chamomile, P. incarnata demonstrated only some anxiolytic activity.

Melatonin

Melatonin is a hormone secreted by the pineal gland only at night. Its release is controlled by the sympathetic nervous system via the amount of light registered by the eyes during the day. It is FDA-approved for treating circadian rhythm disturbance-related sleep disorders in blind adults and children who have little or no light perception. Oral melatonin may help those patients whose sleep cycle has been disturbed by shift work, jet lag, etc. Traveling patients who received 5 mg of melatonin half an hour before bedtime experienced significantly decreased sleep latency and improved sleep quality while they adapted to the new time zone.However, melatonin may not benefit travelers unless they have crossed as many as eight time zones. Melatonin may also help patients wean themselves off benzodiazepines. Although it is probably safe for short-term use, little is known about its long-term safety. Patients who have depression, schizophrenia, autoimmune diseases, other serious medical conditions, or are pregnant or breast-feeding should avoid the use of melatonin until more is known.

German Chamomile

The dried flowers of German chamomile (Matricaria recutita) are most often taken as a sedative tea. Some of us may remember Peter Rabbit being given this tea by his mother in Beatrix Potter’s classic tale. Although dried chamomile flowers have a long history of use as a mild sedative, no well-controlled clinical studies exist that document any sedative effects. Documented effects in humans appear to be confined to the unexpected induction of deep sleep in 10 of 12 patients who participated in a study of the effects of chamomile on the heart. While laboratory studies suggest anxiolytic activity for the chamomile flavonoid apigenin through central benzodiazepine binding, study results conflict. However, apigenin is probably not the only component responsible for sedative effects.

Chamomile belongs to the family Compositae, which also contains chrysanthemums, asters and ragweed. Patients who are allergic to these plants should be cautious about using chamomile, as a cross-allergy may exist. The true incidence of this is not known. One survey of the scientific literature suggests that German chamomile is no more allergenic than other plants, and that many allergies were due to contamination by dog chamomile (Anthemia cotula). However, cross-allergies have been demonstrated.

Catnip

Nepetalactone, the major component of catnip (Nepeta cataria) volatile oil and the component that induces euphoria in cats, is thought to be responsible for catnip’s sedative effects. It is chemically related to the valepotriates that occur in valerian. However, all of our current evidence is based on animal studies. No trials are available to confirm the effects in humans. Although catnip is probably safe when taken occasionally as tea, it is best to avoid excessive doses. At high doses, it may cause vomiting. A child who ate raisins soaked in catnip tea and chewed on the tea bag developed a stomach ache and irritability, followed by lethargy and a hypnotic state.

Hops

Hops (Humulus lupulus) are most commonly known for the bitter flavor they impart to beer. However, hops also have a long history of use as a sedative in tea and as a component of sleep pillows. The constituent methylbutenol has sedative effects in rats, but its volatility makes it unlikely to be present in high enough concentrations in extracts to be effective. The only dosage form in which it is likely to persist is in sleep pillow mixtures. No human clinical studies of hops aromatherapy currently exist. Allergic reactions to the fresh plant and pollen are possible.

Lemon Balm

Lemon balm (Melissa officinalis) is also a popular component of sedative teas. A volatile oil-free hydroalcoholic extract shows sedative activity in mice by potentiating pentobarbital-induced sleep. A combination of 360 mg valerian extract and 240 mg lemon balm significantly improved sleep quality over placebo in 98 individuals without insomnia in a 30-day study. A valerian-lemon balm combination was comparable to 0.125 mg Halcion, and both were superior to placebo in 20 patients with insomnia in a double-blind, cross-over trial.

Linden or Lime Flower

Linden flower (Tilia sp.) is a popular sedative among Latin American cultures. Sedative properties have been attributed to the volatile oil components citral, citronellal, citronellol, eugenol and limonene. Tilia flower essential oil demonstrated sedative effects when inhaled by mice. An extract of tilia flowers had anxiolytic activity in mice when administered intraperitoneally. Kaemferol was identified as binding to benzodiazepine receptors, but did not have sedative or anxiolytic activity.

Scullcap

Scullcap (Scutellaria lateriflora, Scutellaria bicalensis) is listed in the British Herbal Pharmacopeia and used in the United Kingdom as a sedative. Several compounds, including wogonin, baicalein, scutellarein and baicalin, bind to the benzodiazepine receptor. No evidence supports its sedative effects and studies failed to find sedative activity in animals. Scutellaria has been linked with hepatotoxicity in several case reports, where it was a component of a complex mixture of herbs. However, the mixture was not identified with certainty, and was known to be contaminated with germander.

The Pharmacist’s Role

Because patients frequently use dietary supplements to treat sleep disorders without consulting a physician, pharmacists can play a key role in preventing misadventure. Pharmacists should ask their patients about dietary supplement use and counsel them regarding the issues surrounding their use. One should remember that patients may not be aware of the complexities surrounding dietary supplement use. They may also have turned to dietary supplements when other medical options were exhausted or because they were reluctant to seek help for their problem. Pharmacists should counsel patients on common dosages (TABLE 2) and any interactions with medications they may be taking (TABLE 3).

Table 2. Reported Dosages of Supplements Commonly Used to Treat Sleep Disorders
Supplement	Dosage Form	Standardized Extract	Daily Dosage	Efficacy	Safety	Evidence
Catnip	PO: tea Caps	N/A None	1–2 tsp. in 6 oz. 380 mg	Unknown	(+)	Poor
Chamomile	PO: Flowerheads		2–8 grams	(+)?	(+)	Fair
German	Extract	1%–2% apigenin
		1:1 in 45% alcohol	1–4 mL TID	(+)?	(+)	Fair
	Tea	N/A	3–4 cups	(+)?	(+)	Fair
Hops	PO: strobile	None	0.5-1 g	(+)?	(+)?	Fair
	Extract	1:1 in 45% alcohol	0.5–2 mL	(+)?	(+)?	Fair
	Tea		1 cup	(+)?	(+)?	Fair
	Tincture	1:5 in 60% alcohol	1–2 mL	(+)?	(+)?	Fair
Lavender	PO: tea		1–several	(+)?	(+)?	Fair
	Oil on sugarcube	None	1–4 drops	(+)?	(+)?	Fair
	Topically	N/A	20–100 g steeped in 2 L water, added to bath	(+)?	(+)?	Fair
	Aromatherapy		N/A	(+)	Unknown	Fair
Lemon balm/	PO: leaves	N/A	8–10 g	(+)?	(+)?	Fair
Melissa	Tea		2–6 cups	(+)?	(+)?	Fair
	Tincture	1:5 in 45% alcohol	2–6 mL TID	(+)?	(+)?	Fair
Linden flower/	PO:dried flower	N/A	2–4 g	Unknown	(+)?	Unknown
Tilia flower	Extract	1:1 in 25% alcohol	1–2 mL	Unknown	(+)?	Unknown
	Tea	N/A	1–2 cups	Unknown	(+)?	Unknown
	Tincture	1:5 in 45% alcohol	2–4 mL	Unknown	(+)?	Unknown
Melatonin	tab/cap	N/A	0.3–5 mg	(+)	(+)?	Good
Passionflower	PO: above-ground-parts	None	0.5–2 g TID	(+)?	(+)?	Fair
	Extract	1:1 in 25% alcohol	0.5–1.0 mL TID	(+)?	(+)?	Fair
	Tea	N/A	1 cup BID-TID	(+)?	(+)?	Fair
	Tincture	1:8 in 45% alcohol	0.5–2.0 mL TID	(+)?	(+)?	Fair
Scullcap	PO: above-ground-parts	N/A	1–2 g	Unknown	(+)?	Poor
	Extract	1:1 in 25% alcohol	2–4 mL TID	Unknown	(+)?	Poor
	Tincture	1:5 in 45% alcohol	1–2 mL TID	Unknown	(+)?	Poor
	Tea	N/A	1 cup	Unknown	(+)?	Poor
Valerian	PO: root	N/A	15 g	(+)?	(+)?	Fair
	Extract	N/A	450–900 mg QHS
			or 450 mg TID	(+)	(+)?	Fair
		LI 156	600 mg QHS	(+)	(+)	Fair
	Tea	N/A	1–7	(+)?	(+)?	Fair
	Tincture	1:5 in 45% alcohol	15–20 drops several times daily	(+)?	(+)?	Fair

Conclusion

Sleep disorders are among the most common medical conditions treated with dietary supplements. There are a large number of dietary supplements that have been used traditionally to self-treat sleep disorders. Evidence suggests that certain supplements, such as valerian and melatonin, may benefit patients with specific sleep disorders. However, evidence for most supplements is preliminary or nonexistent. Most patients are not aware of the issues surrounding dietary supplement use and can benefit from pharmacist intervention.

Table 3. Theoretical Dietary Supplement-Drug Interactions
Supplement	Drug	Interaction
Catnip	Barbiturates	Potentiation of effects
Chamomile, German	Antiplatelet agents, anticoagulants Benzodiazepines, sedatives Medications metabolized by CYP3A4*	Additive effects Additive effects German chamomile may inhibit 3A4
Hops	Alcohol, barbiturates, sedatives	Additive effects
Lavender	Barbiturates, chloral hydrate CNS depressants HMG CoA reductase inhibitors	Additive effects Additive effects Potentiate effects due to perilyll alcohol content
Lemon balm	Barbiturates, sedatives Thyroid replacement	Additive effects May counteract effects
Melatonin	Sedatives Immunosuppressants Beta-blockers Fluoxetine Fluvoxamine Isoniazid Nifedipine Verapamil	Additive effects May counteract effects May reverse effects of beta-blockers on sleep Melatonin may improve sleep Fluvoxamine may increase melatonin concentrations Melatonin may improve activity against Mycobacterium Melatonin may decrease effectiveness May increase melatonin excretion in urine
Passionflower	MAO Inhibitor Barbiturates, sedatives	May potentiate activity Additive effects
Valerian	Alcohol, barbiturates, benzodiazepines, sedatives Medications metabolized by CYP3A4	Additive effects Valerian may inhibit 3A4
* Medications metabolized by CYP 3A4 include amiodarone, anticonvulsants (barbiturates, carbamazepine, phenytoin), azole antifungals (fluconazole, itraconazole, ketoconazole), benzodiazepines, birth control pills, calcium channel blockers (diltiazem, felodipine, nifedipine, verapamil), cisapride, corticosteroids, HMG CoA reductase inhibitors (lovastatin, simvastatin), immunosuppressants (cyclosporine, tacrolimus), macrolides (clarithromycin, erythromycin), nefazodone, NNRTIs (delavirdine, nelvirapine), protease inhibitors (indinavir, ritonavir, saquinavir), and rifampin.

Herbal medicine

Chinese Herbal Medicine: Licensed Medical Practitioners

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April 20, 2010 at 11:39 am

Pharmacists and other allopathic clinicians should consult or seek advice about herbs and natural substances from a “qualified” medical practitioner, specifically a traditional chinese medicine (TCM) practitioner designated with a title “L.Ac.” (licensed acupuncturists). In many states including California, Oriental medical practitioners/ L.Ac.’s are the only health care practitioners who are required to study herbal medicine in medical school. Also they must be examined for competency along with a completion of internship in herbal medicine in order to obtain a clinical degree. In addition, these professionals need to pass a state board exam to be specifically licensed to prescribe herbs (Refer to December issue under extent of education and licensing requirements). L.Ac. professionals have extensive training in TCM medical theories, acupuncture, acupressure, tui na massage and other manual therapy, nutrition, medical exercises, tai chi, qi gong, etc. beside herbal medicine. They are considered primary health care providers (requiring no referral from a conventional doctor) and are authorized as physicians practicing within their scope of medicine. Therefore, traditional chinese medicine medical practitioners/L.Ac.’s have more training than someone who undergone a seminar, home-study course, or certificate program in herbal medicine. Even pharmacists or physicians whose conventional education does not have clinical medicinal herbal training. It behooves the pharmacists to consult with a L.Ac. professional about herbs and natural substances instead of relying solely on information given to them from natural product industries, health store clerks or multi-level marketing companies. TCM medical practitioners know the prohibited combinations, dietary incompatibilities, recommended dosages, herb identification, standards and regulations in dispensing herbs, administration, monitoring protocols as well as formulating a holistic diagnosis. They are less interested in selling herbal products, but are more concerned with the therapeutics of the medicine for their patients They realize that chronic conditions, like seasonal allergies, may require a multiple of modalities, such as herbal medicine, acupuncture and moxibustion. It is important for health care professionals to understand herbal medicine beyond its isolated phytochemicals and “cookbook” method of recommending herbs (matching herbal products to symptomatic conditions).

Herbal medicine | Tags: Ginkgo, St. John's Wort

Chinese Herbal Medicine: Side Effects and Interactions

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April 18, 2010 at 11:36 am

Side Effects and Interactions with Herbal Medications

Herbs are natural, but it does not mean they have no side effects. In my numerous lectures to nurses, psychologists, dentists, chiropractic students, medical students, physical therapists, pharmacy students and even business groups, the first concept I emphasize is that traditional chinese medicine (TCM) practitioners do not use herbs in the same manner as a pharmaceutical drug; matching one drug or herb to treat a condition or disease, eg, Ginkgo for memory, ginseng for energy, St. John’s Wort for depression, etc. As mentioned above, TCM uses a formula of herbs. When an herb or formula in a prescription is not achieving the desired effect, other herbs or formulas may be substituted. This allows the Chinese herbal prescription to be very flexible in its effects with virtually no side effects. With Western drugs, the range of options is often quite limited. A tablet drug contains a concentrated potency of chemicals and cannot be changed. Drugs are not as flexible; side effects from drugs cannot be altered by the clinician by changing the tablet. One does not have flexibility with a packaged product.

When Chinese herbs are used correctly in a balanced prescription according to a holistic diagnosis, herbs can be taken side by side with prescription drugs with no interaction. When herbs are used that are not based on a holistic traditional chinese medicine diagnosis, they can potentiate or antagonize the effects of drugs, leading to drug and herb interactions. However, when herbs are prescribed according to a holistic diagnosis, they should not have interactions or side effects. From my own clinical experience, herbs in the Chinese materia medica are safe and highly effective with relatively no side effects when compared to synthetic drugs. Despite all the media and aggressive reports on adverse reactions concerning herbs with drugs, none of the cases mentioned involved a qualified TCM practitioner prescribing traditional herbal formulations to treat any identified Oriental medicine diagnosis. On the other hand, over 100,000 people nationwide die each year from side effects of prescription drugs, and over 695,000 hospitalizations per year are due to adverse drug reactions, according to JAMA.

Herbal medicine

Chinese Herbal Medicine: Energetics of Herbs

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April 16, 2010 at 11:32 am

Mechanisms of Action: Energetics of Herbs

Each herb in traditional chinese medicine (TCM) is categorized according to its natural makeup, having its own specific mechanism of action, or in TCM medical terminology, its energetics or Qi. No two plant species have the same effect upon the body because the natural chemical constitution of every single species is different. Chinese herbs are categorized according to their temperatures, tastes, directions, and therapeutic meridians, and are affected by environmental influences.

Temperatures

Temperatures are considered cold, cool, hot, warm, and neutral. Ttraditional chinese medicine employs the use of thermodynamics, the physiochemical science that deals with heat and energy, ie, the study of the flow of heat and its conversion into energy and vice versa. One example is a heating pad that relaxes the muscles in someone with distention and discomfort of the muscles. Cold and cool herbs such as Bo He (peppermint) have the mechanism to lower fever, inflammation, etc., while hot or warm herbs have properties to warm and stimulate the body. Here is an example of the use of a warm herb: A little girl on a cold Christmas day eats too much ice cream. She develops a terrible stomachache. Her stomachache, due to cold, is alleviated with hot or warm herbs such as Sheng Jiang (ginger root). Some herbs possess variation in temperatures; they have varying degrees of heat and warmth or are slightly cold in nature.

Tastes/Flavors

They are acrid/pungent/spicy, sweet, bitter, sour, salty, bland/no taste. Just like the variation in temperatures, herbs can also possess a combination of flavors, eg, spicy and sweet.

Pungent or spicy herbs have the function to disperse and move. They are diaphoretics and usually work on the respiratory system. Spicy herbs also increase circulation by pushing substances to the surface of the body to be sweated out or evaporated. This taste/flavor has the quality of dispersing stagnant pathogens or congestion and can be used to treat flu, cold-like symptoms, allergies, chicken pox, measles, etc. An example of a herb that belongs to this group is Fang Feng (ledebouriella).
Sweet flavor herbs have the energetic of a tonic or a soothing function. Its function is to nourish the body, to strengthen the patient in cases of weakness, to alleviate pain and spasms, or to harmonize and neutralize certain disease conditions. An example of an herb in this group is Huang Qi (astragalus).
Bitter flavor herbs have the mechanism of action to purge, detoxify, or dry. Bitters can be used to cure inflammation, infection, and toxic diseases as well as parasites. An herb that falls into this category is Niu Bang Zi (burdock seeds), which is often used in herbal prescriptions to treat a sore throat and cough, pharyngitis and acute tonsillitis, or abscesses.
Sour flavor herbs have the energetic function of astrigency, to gather together or coalesce. These herbs are used for conditions that traditional chinese medicine refers to as “leakage.” These conditions are frequent urination, excessive perspiration, diarrhea, premature ejaculation, vaginal discharges, etc. Sour type herbs also help to keep Qi or vital energy from escaping. Wu Wei Zi (fructus schisandra) is an example that can help to replenish Qi, arrest spontaneous sweating, seminal emission, or to stop leukorrhea.
Salty flavor herbs have the mechanism of action to soften, lubricate, or moisten. They have the function of dissolving hard lumps, tumors, and nodules, as well as softening tight muscles and alleviating bad constipation. Hai Zao (seaweed) is often used in a herbal prescription for scrofula conditions, cysts, chronic bronchitis, or lymph-like swellings.
Bland or tasteless herbs have the energetic properties to drain and leech out dampness and wetness. These herbs help to get rid of body fluid congestion or accumulation. They are diuretics and can eliminate excess water. Bland type herbs are often used in a herbal preparation to treat edema, dysuria, skin swelling, abdominal distension, rhinitis, etc.

Functional Orientations

The four directions or the functional orientation of herbs classify herbs in a way that allows them to concentrate on specific areas of the body. They are the following:

Upward directional herbs direct the concentration upward and have the mechanism of action of rising or ascending upwards. These herbs are added to herbal prescriptions that ascend to the upper part of the body to treat headaches, stiff necks, or dizziness. These herbs are also used for prolapse type conditions because they can elevate the Qi from the lower part of the body. An example of this type of herb is Chai Hu (bupleurum).
Downward directional herbs promote the flow of vital energy downward. They have the energetic functions to descend and direct the concentration downward. They are used to sedate a patient who is stressed, worried, nervous or anxious. They are also used in herbal prescriptions to treat dyspepsia, cough, asthma, vomiting, or urinary conditions. Hou Po (magnolia bark) belongs to this group.
Inward directional herbs have the mechanism of action that moves Qi to the interior of the body. These herbs have the affinity to direct its function from the surface to the internal organs. They are used in herbal prescriptions for pneumonia, diabetes, GERD, arthritis, etc. Qin Jiao (gentianae Macrophyllae) is an example of an herb that I have used in a prescription to guide the actions of other herbs inward to the spine and lumbar area.
Outward directional herbs have the opposite effect. These herbs have the energetics to direct Qi from the interior of the body to the surface of the body. Their purpose is to excite and activate the surface of the body. Their focus in dispersing toward the exterior is to open the cutaneous pores, and to promote perspiration, or to mobilize fluids. These herbs are used in prescriptions for bed sores, skin ulcers, osteomyelitis, common colds, etc. Ma Huang (ephedra sinica) is an example.

Keep in mind that most herbs have more than one directional tendency, just as they have a mixture of temperatures and tastes.

Therapeutic Meridians or Functional Sites

In traditional chinese medicine, the physiological coordination of tissues and organs is accomplished by an interconnected web of meridians. I often tell my students it is the body’s freeway system. Instead of using needles on certain acupressure points, as in acupuncture, the herbalist uses herbs to work on areas of the meridian pathway. Each herb acts on a meridian in which the therapeutic action is manifest. Most herbs have a mechanism of action on more than one meridian system such as the stomach and lung meridians, whereas another herb may enter the liver, bladder, and spleen meridian systems.

Environmental Influences

Where, how, and when herbs grow or harvest will influence the chemical constitution or energetic properties of the herb. Herbs can also be characterized by their origin of growth. “Di Dao” literally means “down to earth” and is understood as the original source of the best growth. Certain areas have a particular soil or climate that makes a herb uniquely effective and superior in potency, just as are certain grapes in wine production. That is why traditional Chinese herbal doctors are skeptical of herbs not grown in China because those herbs have not been determined over time to be optimal.

A Question of Balance; a Chinese Herbal Prescription

Medicinal herbs used in traditional chinese medicine are always prescribed to be combined in formulas to enhance their individual properties and actions, in addition to decreasing side effects. An herbal prescription usually involves between 10 to 16 herbs per formula. Some herbs are combined to complement and reinforce each other’s therapeutic action. On the other hand, some herbs are combined so that one herb can weaken, reduce, or neutralize the side effects or toxicity of the other. Many TCM herbal practitioners prefer to use herbs in the plant material form called “raw herbs” rather than pills or tablets. In this way, the prescription can be easily modified by substituting, adding or subtracting from the formula to reach its desirable therapeutic effects. Because the traditional chinese medicine practitioner holds to the Chinese belief that a person must be treated as a whole (mind, body, and spirit), he or she does not treat just symptoms. This is why TCM is considered holistic. The herbs chosen in the prescription not only take into consideration the disease syndrome and its symptoms, but they are tailored to an individual’s body constitution and emotional temperament, in an attempt to identify the systems that are out of balance so that they can be adjusted. Conventional medicine has accustomed us to thinking that if we have condition A, then we take drug B. Western herbalism also followed this same linear approach using a single herb to treat the symptoms or disease.

A typical traditional chinese medicine herbal prescription involves a combination of herbs that has been uniquely tailored to the holistic needs of each patient, eg, the exact nature of the patient’s overall physical and psychological loss of balance. Even though several patients may have similar conditions, their formulas will differ. With Western drugs, the pharmacotherapy is similar or the same for a disease. An example is irritable bowel syndrome (IBS); the Chinese herbal formula, however, uses very different herbs for two people with IBS. In fact, the TCM practitioner will probably vary the formula based upon changes in the overall energetic picture of the individual over time. A formula will be appropriate only for a particular length of time. Because changes should and do occur, a skilled herbal practitioner will monitor changes and adjust the patient’s herbal prescription periodically.

Herbal medicine

Chinese Herbal Medicine: Historical Significance

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April 14, 2010 at 11:30 am

Visiting a Chinese herbal pharmacy is much like being inside a miniature museum of natural science. A nursing student intern once told me this during her first week of clinical rotation at the Center For Integrated Medicine. Tucked away in row after row of tidy drawers are ingredients derived from animal, plant, and mineral sources. The filling of a prescription is a fascinating process to watch. The intern selects each herb ingredient from one of the drawers to be weighed on a Chinese scale. The herbs are laid out on a flat white sheet of paper and after an Oriental medical practitioner reviews the accuracy of the prescription, he or she then neatly wraps it in a bundle and it is given to the patient. In this case it is a patient who has been prescribed an herbal medication for migraine headaches and who is also undergoing acupuncture and massage treatment by this same medical practitioner. The herbal medicine is taken home to be boiled into a “soup” or tea decoction and drunk accordingly.

In Asia, herbal medicine is used first before any other traditional chinese medicine (TCM) modality such as acupuncture, moxibustion, massage, etc. The TCM apothecary is one of the oldest and most efficacious in the world. Western medicine originated with the Romans and Greeks around 200 AD and Western pharmaceuticals only attained their present status in the 1920s with the discovery of penicillin. On the other hand, time-tested Chinese herbal remedies have helped billions of people for nearly 5,000 years and scientists today are still puzzled over their therapeutic effectiveness. More and more Americans are currently using some form of alternative or complementary health therapies, in particular traditional chinese medicine. This series of articles is intended to dispel some of the confusion over herbal medicine that currently exists.

Historical Significance

Over the millennia, Chinese people, using themselves as guinea pigs, have tested plants for their medicinal properties. According to Chinese medical texts, Shen Nung, the father of agriculture/husbandry and leader of an ancient clan, taught the Chinese people how to raise crops and rear domestic animals around 3500 BC. He also showed how to identify various therapeutic herbs to cure an illness. It is written in historical records, “When ancient people suffered from diseases, no therapeutic medicine was known. Therefore Emperor Shen Nung began to taste various herbs and even encountered species of poisonous ones.”

Shen Nung identified the therapeutic value of herbs in a time prior to Chinese written history. His achievements were handed down verbally to following generations. Thus in Traditional Chinese Medicine, Shen Nung is recognized both as the discoverer of natural drugs and as the first pharmacist.

Huang Ti (circa 2800 BC), translated as the Yellow Emperor, is considered to be the father of internal medicine and a patron of TCM doctors. During his reign, he appointed health ministers to take charge of healing by tasting herbs/plants and recording herbal formulas. He advanced the study of physiology, pathology, classification of diseases, systems of acupuncture meridians, etc. The “Nei Jing” (translated as the “Inner Classics”), written years later, is attributed to Huang Ti and is considered the first comprehensive text on internal medicine.

Around 200 AD, Zhang Zhong Jing, revered as a medical saint of traditional chinese medicine, produced a valuable practical text called “Shang Han Lun” or Treatise on Diseases Caused by Cold Factors. This text still relates to present day illnesses, specifically colds, flus, and febrile diseases and their treatment with herbs. A pharmacist called Ko Hung, 300 AD, was famous for his text on herbs that prolonged life and his refining theories in chemistry, discovery of diseases, and herbal treatments for those diseases. He also used an application of herbs on the skin.

A pharmacologist, Tao Hung Ching, 480 AD, compiled records and arranged them into a book attributed to his mentor Shen Nung called Shen Nung Ben Cao Jing, which is translated as Shen Nung’s Classic of Materia Medica. This pharmacopoeia classified 700 herbs into groups, eg, superior/tonifying herbs, general herbs and into seven major categories such as stones, zoological ingredients, vegetables, crops, etc. About 1550 AD, Li Shi Zhen, a physician of natural medicine, compiled another now famous text called Ben Cao Gang Mu, which is a medical pharmacopoeia that catalogued 1,900 herbal substances. He rearranged the materia medica of earlier years according to the binomial system and included some 1,160 plant illustrations.

This manuscript was the most comprehensive classification of herbs at that time. Only a handful of the original editions survive in China and Japan, and one copy is at the Library of Congress, in Washington, D.C. Copies have been reprinted and translated into different languages, first into other Asian languages, then into German, Russian, and later into English. It took B.E. Reid of England 20 years to translate this Chinese herbal pharmacopoeia into English in 1932.

The modern Chinese materia medica contains some 5,800 natural ingredients. Through the years, the Chinese have incorporated herbs from all parts of the world into their materia medica. Herbs that are not Chinese in origin are called “Chinese herbs” because they are prescribed according to Chinese medical theory and TCM pattern diagnosis.

It is necessary for pharmacists to understand Chinese herbology from the standpoint of traditional chinese medicine holistic and natural principles. They should not always evaluate herbal therapy strictly from a Western or allopathic model. In comparison, before one can begin to learn Western or conventional pharmacology, one needs to learn the basic foundation of anatomy, physiology, and chemistry. Therefore, it is important to understand herbal medicine from a perspective of an entirely different medical model.

To begin to understand Chinese herbal pharmacology, one needs to review the framework of traditional chinese medicine established several millennia ago. TCM is a system based on universal natural law; the fundamental principle is that the human body must be balanced within itself and with the cosmos. The concept of “Qi” (pronounced chee or chi) is considered the vital energy or force that is central to traditional chinese medicine thought. The Chinese believe that everything in the universe results from the movements and changes of Qi. Qi is present in all living organisms. Qi circulates in the body along the meridian and channel system that I will discuss in the next article, on acupuncture. Qi also exists in plants, grains, and whole foods. Biosciences have little explanation for Qi, but pharmacists can look into quantum physics to help get a better understanding of this concept.

Mental disorders | Tags: Passionflower, St. John's Wort, Valerian

Are you stressed out?

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April 11, 2010 at 3:05 pm

Sensible about stress

We’ve all at some time or other experienced the tension and anxiety associated with stress. Stress is a part of life. Daily events at work or at home continually bombard us with moments of nerve wrenching distress that our bodies must adjust to and cope with. But stresses need not always be emotional, they can also be environmental (air and water pollution, viral and bacterial exposure, etc.), medical or nutritional. Whether physical or psychological, continued stress can take its toll on our bodies and disease may then become a reality. So how do our bodies cope with the strains of everyday living and how do we tell when we have had enough?

Fight or flight response

According to researchers, normal stress is not a bad thing. In fact, it can be a life-saving response:

increased respiration
cold sweats
raised blood pressure
facial pallor
accelerated heart rate
tense muscles

These symptoms are all ways that the body prepares us to face uncomfortable situations. Without this inbuilt alarm system, our ability to act quickly in the face of fear would be retarded in much the same way as if caught in a building during a fire without an early warning system! When our body presents us with these symptoms, we must then decide whether to meet this challenge head on or to retire from it. For example, if faced with a very large, angry elephant one would hardly pit themselves against such overwhelming danger. The second response would probably be the preferred plan of action in this case. Because these sensations are causing us to make a decision on how best to deal with a perceived danger, they have often been grouped together and called the ‘fight or flight’ response.

How much is too much?

If stress itself is not the problem, then the degree to which we experience it certainly is. When we experience heightened stress over a long period, our bodies have little chance to recover and therefore become less able to combat both physical and mental dangers. The symptoms we experience normally in stressful situations are brought on by an increase in the production of adrenalin in the adrenal cortex. It is adrenalin that is a powerful factor in the conversion of stored body sugar to glucose, providing the extra fuel needed to cope with the impending threat.

Hypoglycaemia

Periods of unremitting stress can cause an enlargement of the adrenal cortex, which allows serious changes in blood sugar levels to occur before the adrenalin can regulate them. An enlarged gland is indicative of this inadequate function. When blood sugar levels fall and the adrenal gland is slow to produce more adrenalin, the result is hypoglycaemia. Belated symptoms such as sweating, rapid heart rate, inner trembling and increased respiration can be initial indications of this. Extreme tiredness can also be a symptom of Hypoglycaemia.

Heart disease and strokes

Heart disease is one of the biggest killers in our country and prolonged and heightened periods of stress can contribute to it. A constant increase in blood pressure – hypertension – is recognised as a factor in heart attacks by placing more strain on the heart muscle. The news about a connection between strokes and stress is similarly disturbing. In a prolonged state of stress, an inadequate blood supply to the brain may cause a blood clot to block blood flow and a stroke can result.

Stomach ulcers

During times of stress, the stomach can produce an excess of the gastric acids normally used to break down food. However, if the stomach is empty, these potent acids may begin to erode the stomach wall, causing deep ulcers.

Stress management

We can go a long way toward warding off both mental and physical disease if we can reduce our stress levels. This is not, however, as easy as it sounds. We are constantly bombarded with outside pressures, as well as the ones we place on ourselves. Escape is not always a desirable or achievable plan of action. A more sensible approach would be to restore and maintain our health. Exercise is of importance, as is our diet. If we skip meals and stay out late, our diet is probably lacking in many of the essential nutrients that can help keep us on top of stress. Supplements can be of value here.

What supplements do we need?

Vitamin A: can boost the immune system by maintaining the health of our natural barriers to disease, the mucous membranes (particularly helpful in the intestine), the lungs and skin.

B Complex Vitamins: are champion stress fighters. They may prevent fatigue and increase stamina. They may also help protect the heart muscle and improve blood circulation. The B Vitamins can also assist those who suffer from headaches, depression and irritability.

Vitamin C: is another immunity booster by its action on the white blood cells and the mucous membranes.

Vitamin E: is most effective in promoting normal blood circulation and may prevent blood clotting.

Magnesium: is one of the main constituents of nerve fibres and may be beneficial in the treatment of headaches, angina and atherosclerosis – the build-up of cholesterol in the arteries.

Zinc: is an important mineral to maintain the body’s immune system and may also help regulate insulin activity.

Potassium Phosphate: is a constituent of nerve and brain cells and has therefore been recommended as a nerve tonic for depression, irritability, mental exhaustion and general fatigue.

L-Tyrosine: is an amino acid used to help control anxiety and depression and promote mental alertness.

Herbs: Valerian (Valeriana officinalis), Passionflower (Passiflora incarnata) and Skullcap (Scutellaria) are herbs which have demonstrated sedative actions and have been used to treat nervous tension and associated insomnia.

The herbs Ginseng and Hypericum (St. John’s Wort) are popular herbs for relieving stress and anxiety.

Formulas

Most health food stores stock formulas that are specifically designed to help the human system cope with stress. They usually contain a broad spectrum of natural nutrients, including anti-stress herbs.

Mental disorders | Tags: St. John's Wort

St. John’s Wort for Depression

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April 7, 2010 at 1:23 pm

An Example of the Problems with Herbal Medicine Regulation in the United States

“For anyone taking antidepressive drugs like Prozac, Paxil, or Zoloft, take heart. Under your doctor’s supervision these insidious drugs can be dosage regulated and diminished, and St. John’s Wort can be started… it’s the way nature intended for you to heal yourself.”

This recent excerpt from a Colorado health food store newsletter epitomizes the concerns many health-care professionals in the United States have regarding the use of crude herbal extracts.

Herbal remedies, or phytomedicines, are regulated as drugs in several European countries, and their costs may even be reimbursed by insurance companies. However, in the United States, the Dietary Supplement Health and Education Act (DSHEA) of 1994 allows herbs to be sold legally so long as no claims for disease treatment are made on the product label. For example, St. John’s Wort can be labeled only with the diffuse claim, “for mental well-being,” although it is clearly being marketed as an antidepressant. However, the DSHEA legislation does not prohibit any variety of claims that are made in the advocacy literature often found near store product displays or in retailer newsletters. In fact, the DSHEA has no requirement for product standardization of any pharmacologically active principle, demonstration of bioavailability or efficacy, or safety assessment when the product is used either alone or in combination with prescription or over-the-counter (OTC) drugs. This lack of legislative requirements provides no financial incentive for manufacturers to conduct such tests because these crude natural products are not patentable. In contrast to the estimated 25% of prescription drugs that are derived from natural products, the active principles in herbal remedies are rarely studied as individual agents; rather, they are regarded as crude extracts that likely contain variable proportions of several agents.

Nonetheless, the popularization of St. John’s Wort (SJW; Hypericum perforatum, L.) as an antidepressant agent peaked this year when a highly supportive article appeared in the May 5, 1997 issue of Newsweek. SJW has fared well, even in the peer-reviewed scientific literature. In 1996, the British Medical Journal published a meta-analysis of several randomized, placebo-controlled trials; these concluded that SJW is indeed more effective than placebo in patients with mild to moderate depression. St. John’s Wort also compared favorably with tricyclic antidepressants like desipramine and amitriptyline in efficacy and side-effect profile, although SJW has yet to be assessed relative to the newer and safer serotonin-selective reuptake inhibitors. Indeed, the authors of the meta-analysis suggested that more widespread trials are clearly indicated because there is some question as to how depression was classified in the retrospective studies (1).

Several concerns about the use of St. John’s Wort have arisen in the health-care community. First, SJW is believed to act as a monoamine oxidase (MAO) inhibitor because of its active principle, an anthraquinone called hypericin. Prescription MAO inhibitors must be used with care because there is a risk of hypertensive crisis when they are taken with over-the-counter sympathomimetics or after ingestion of foods containing high levels of the pressor amine, tyramine. There is justifiable concern for similar interactions with St. John’s Wort. It is recommended for similar reasons that SJW never be taken in combination with any prescription antidepressant.

A second problem is that, like other prescription antidepressants, St. John’s Wort appears to require several weeks of treatment before its antidepressant efficacy is demonstrated. However, the untested bioavailability of SJW preparations, combined with the potential for lot-to-lot variations in components, may render the herb ineffective, even if users are compliant with suggested dosages. Another concern is the potential for St. John’s Wort to act as a mutagen, or a DNA-damaging agent. Hypericin can bind to both DNA and RNA, and it can generate highly reactive compounds when exposed to light. (In fact, hypericin has been documented to cause photosensitivity in livestock.) On the other hand, one report suggests that St. John’s Wort extracts may actually be anti-mutagenic, which potentially results from the presence of antioxidant flavinoids such as quercetin and kaempferol. Obviously, the balance between oxidant and antioxidant abundance in any given St. John’s Wort preparation influences the level of risk associated with its use.

Regardless of whether St. John’s Wort is an effective antidepressant, the primary question to be answered is whether depression can be reasonably classified as a disease for which self-treatment is appropriate. According to the FDA requirements for prescription-to-OTC drug reclassification, candidate agents for self-medication are approved only for disorders that the patient can self-diagnose. Depression can often be mistaken for anxiety or obsessive-compulsive disorder, even by professionals, and each of these conditions requires different types of pharmacotherapy. In fact, some mild to moderate cases of depression may require no drug therapy at all. So, although St. John’s Wort may indeed be effective in the treatment of depression, self-medication may not be the wisest course of action.

What then is a U.S. pharmacist to do when confronted with the task of managing patients who wish to take herbal medicines? Patient education is essential, but it is clear that schools of pharmacy have not provided practitioners with enough information about this growing field. A recent University of Mississippi study revealed that 60% of retail pharmacists learned about herbal medicines from patients, and only 25% of them learned such information in pharmacy school. Self-education is therefore necessary. A recently published book entitled Herbal Medicines: A Guide for Healthcare Professionals (Pharmaceutical Press, London; available in the United States through Rittenhouse Book Distributors, King of Prussia, PA) is an excellent reference book that contains monographs on 141 individual herbs; however, unlike similar books, it details potential interactions with prescription and OTC medications. This reference can therefore serve as an excellent patient counseling tool. Continuing education (CE) programs are also available, such as that offered at the University of Colorado School of Pharmacy. In addition, correspondence CE modules from the University of Texas College of Pharmacy are available through the American Botanical Council (1-800-373-7105).

The bottom line is that, although some herbs may be effective for the treatment of mild, self-limiting conditions, the current state of herbal medicine regulation in the United States makes it advisable for pharmacists to steer patients instead toward OTC products with defined components and reproducible efficacy. Or, patients should be referred to a physician for further guidance. Furthermore, a patient should be discouraged from taking an herbal remedy for any condition that is already being managed with a prescription medication. Should a patient insist on taking an herbal remedy, he or she should be encouraged to keep the packaging on hand for use in the event of an adverse reaction. Suspected adverse reactions to herbs can be reported by telephone to the FDA’s MedWatch program (1-800-332-1088). In addition, the FDA’s Internet homepage (in the food supplements section) can be consulted for up-to-date warnings on the adverse effects of herbs.

Herbs represent the fastest growing area of retail pharmacy. Because they are displayed beside OTC drugs in the pharmacy, it is not surprising that patients are using these agents. However, only about 5% of herbal medicine sales occur in pharmacies; thus, the bulk of purchases are made under the guidance of individuals with variable training in pharmacology and toxicology. In many cases, there is a misconception that the natural origin of these remedies confers inherent safety. On the contrary, many herbal medicines are indeed pharmacologically active agents that are capable of dose-dependent toxicities. Therefore, herbal medicines should be used with the same respect and caution usually associated with the use of other remedies sold in the pharmacy.

Herbs: Uses, Side effects

Hyssop: Uses and Side Effects

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April 3, 2010 at 7:18 am

Hippocrates recommended this herb for inflammation of the chest and throat

Hyssop (Hyssopus officinalis) is an aromatic perennial native to southern Europe and some temperate regions of Asia. It also grows in the U.S., most likely arriving with European immigrants more than 100 years ago. Today, France is the major producer of Hyssop. The plant grows from 1 feet in height and produces blue, red and white flowers. The flowering tops of hyssop are collected in August and dried in the sun.

The name “hyssop” is derived from the Hebrew “ezob” meaning “holy herb.” The use of hyssop as an herbal remedy dates back to Biblical times. In fact, it is mentioned in both the Old and New Testaments as a cleansing agent (although these references may be to other species of hyssop such as Origanum aegypticum or to Origanum syriacum, rather than H. officinalis).

Hyssop has been prescribed for a multitude of medical conditions. It is known as an antispasmodic, expectorant, emmenagogue (i.e., an agent that induces or increases menstrual flow), stimulant and tonic. It is used for cough, bronchitis and chronic catarrh, and has a tonic effect on the digestive, urinary, nervous and bronchial systems. Culpeper recommended allowing the hot vapors of a hyssop decoction to reach the ear by means of a funnel to ease inflammation and tinnitus. He also prescribed hyssop boiled in wine and vinegar for bruises (although he was unclear if this solution could be used internally as well as externally). Both the alcoholic extract and decoction have antifungal effects and inhibit sweating.

There are many nonmedical uses of hyssop as well. The flowers and leaves can be used as flavoring agents in teas, tonics and candy, and as a spice in cooking. Liqueur manufacturers use hyssop as an important constituent of bitter aperitifs like Chartreuse. In addition, the essential oil has been used in perfumes, colognes, soaps, creams and other cosmetics.

Table 1. Selected Commercially Available Hyssop Products in the U.S.
Product Name	Manufacturer	Type	Suggested Dose
Alvita Tea Hyssop	Alvita Tea Company	Tea bag	Steep 3 mins in 1 cup boiling water
Breezy Tea Cleans	Breezy Morning Teas	Tea bag	N/A
Seelect Tea Hyssop	Seelect Herbal Tea	Tea bag	Steep 4-6 mins in 1 cup boiling water
Seelect Tea Hyssop Org	Seelect Herbal Tea	Tea bag	Steep 4-6 mins in 1 cup boiling water
Fresh Hyssop Herb	GAIA Research	Alcoholic extract 48%-53% grain alcohol	30-40 drops
H.P. Hyssop 1 oz	Herb Farm	Alcoholic extract 50%-55% grain alcohol Dry herb/menstruum ratio 1:5	30-40 drops
Nature’s Answer Hyssop	Nature’s Answer	Alcohol-free Contains vegetable glycerin	10-15 drops
Nature’s Answer Hyssop	Nature’s Answer	Low alcohol 12%-14%	10-15 drops
Nature’s Answer Hyssop	Nature’s Answer	Gelcaps 90	N/A
Aura essential oil Hyssop	Aura Cacia Products	Essential oil 100%	Few drops to lotion, massage oil or aromatherapy diffuser

Chemical Constituents

Several chemical constituents of hyssop have been identified. Terpenoids with known pharmacological actions that are found in hyssop include marrubiin, ursolic acid and oleanolic acid. Marrubiin, a bitter diterpenoid, is released when the herb is cooked. It irritates the lining of the throat, causing an expectorant action. Marrubiin also increases the production of bile in laboratory animals. Ursolic acid was found to induce apoptosis in human leukemia cells. This effect may have been a result of enhanced intracellular Ca levels, since lowering the intracellular Calevel by different agents inhibits the apoptotic action of ursolic acid. The antiproliferative action of ursolic acid was also indicated in a mouse melanoma cell line. Both oleanolic acid and ursolic acid have recognized anti-inflammatory and antihyperlipidemic properties. The volatile oil of hyssop is composed of camphor, pinacaphone, thujone, isopinocamphone, alpha- and beta-pinene, alpha terpinene, linalool, and bornylacetate.

Flavonoids found in hyssop, including diosmin and hesperidin, are intensively studied for their antioxidant actions and their role in chronic venous insufficiency (CVI). Daflon 500 (a mixture of diosmin [90%] and hesperidin [10%]) proved to be effective in decreasing glycation in type I diabetic patients. Other characteristic compounds identified in hyssop are hyssopin (a glucoside), caffeic acid, tannins 5%-8%, and resin.

Physiologic Activity and Therapeutic Uses

Soothing the inflamed tissue with herbs rather than expectorants can rapidly ameliorate cough and shorten the duration of respiratory illness.

The infusion has an agreeable flavor and is often used by herbalists to treat pulmonary diseases. Hyssop is commonly combined with horehound to ease sore throats, and to treat asthma and bronchitis. Acute inflammatory conditions of the respiratory system are best treated with herbs that soothe the inflamed tissue rather than strong expectorants. This approach of cough therapy can rapidly ameliorate symptoms and shorten the duration of respiratory illness. A basic herbal tea for cough would contain coltsfoot (Tusslago farfara), marshmallow (Althea officinalis), hyssop (H. officinalis), licorice (Glycyrrhiza glabra) and aniseed (Pimpinella anisum). There are many possible variations of the herbal formula, depending on herbal tradition and the actual respiratory problem. In addition to these herbal remedies, avoiding air pollution, chemical irritants and smoking (both active and passive) can significantly improve recovery time from respiratory problems.

Hyssop is proving to have other therapeutic uses as well. Numerous laboratories are testing various medicinal plants that would interfere with human immunodeficiency virus (HIV-1) at different stages of replication. Early studies showed that crude extracts of hyssop produced antiviral activity against herpes simplex and HIV-1. Kreis et al. concluded that the antiviral activity might result from the caffeic acid content or its derivative. Hyssop leaf extract also proved to be useful in the treatment of Kaposi’s sarcoma.Another research team identified a polysaccharide (MAR-10) that is also a potential agent for the treatment of patients with HIV-1 infection. The polysaccharide MAR-10 exhibited strong HIV-1 activity in several assay systems and had no toxic or inhibitory effect on lymphocyte proportions and function.

Toxicity

A few cases of toxicity resulting from ingestion of hyssop’s essential oil have been reported. The clinical symptoms of hyssop toxicity include convulsive seizures that resemble epileptic fits and vomiting, and may develop within a few minutes to two hours. The commercially available essential oil of hyssop contains pinocamphone and isopinocamphone, which may be responsible for the neurotoxicity; injections of relatively low dosages of these drugs (0.02 mL/kg) proved to be lethal in rats.

Precautions

Although hyssop is generally recognized as a safe herbal remedy, natural flavor or cosmetic product, it should be avoided in pregnancy or hypertension. Long-term use should be discussed with a healthcare professional. Small children should avoid use due to the possible danger of seizures. Patients with seizure disorders should not use hyssop in any form.

Dosage and Preparations

The recommended dosage is 2 g of dried herb infused in boiling water. The patient should drink this preparation three times a day. From liquid extract 1:1 in 25% alcohol, or from tincture 1:5 in 45% alcohol the recommended dosages are from 2-4 mL. It also comes in a capsule form of 450 mg, given once a day as a digestion aid. Other preparations include lozenges, foam bath gel, cleansing cream and moisturizing cream.