Also Known As: Withania.

Scientific Name: Withania somnifera.

Family: Solanaceae.

People Use This For:

Ashwagandha is traditionally used for arthritis, anxiety, insomnia, tumors, tuberculosis, and chronic liver disease. Ashwagandha is also used as an "adaptogen" to increase resistance to environmental stress, and as a general tonic. It is also used for immunomodulatory effects, improving cognitive function, decreasing inflammation, preventing the effects of aging, for emaciation, infertility in men and women, menstrual disorders, fibromyalgia, and hiccups. It is also used orally as an aphrodisiac.

Safety: Possibly safe when used orally and appropriately, short-term.17,18

Pregnancy and Breastfeeding: Insufficient scientific information available, consult a medical herbalist.

Effectiveness: There is insufficient scientific information available to comment.

Mechanism of Action: The applicable parts of ashwagandha are the root and berry. Ashwagandha contains several active constituents including alkaloids, steroidal lactones, and saponins.19,18. Animal model research suggests that ashwagandha has a variety of pharmacological effects including pain relief, lowering temperature, reducing anxiety, inflammatory, and antioxidant effects.17,20,21,19,18 , sedative, blood pressure lowering, anti-immunomodulatory. Some researchers think ashwagandha has a so-called "anti-stressor" effect. Preliminary increases of dopamine receptors in the corpus striatum of the brain.  17 It also appears to reduce stress-induced increases of plasma corticosterone, blood urea nitrogen, and blood lactic acid.18 Ashwagandha seems to have anxiolytic effects, possibly by acting as a gamma-aminobutyric acid (GABA) mimetic agent. Research suggests ashwagandha suppresses stress-induced anxiety. Ashwagandha and its constituents also seem to have modulating effects on the immune system. The withanolides and sitoindosides seem to cause a mobilization of phagocytosis, and lysosomal enzymes.18 

Adverse Reactions: Ashwagandha is well tolerated.

Interactions with Herbs & Supplements

Herbs and Supplements with Sedative Properties: Theoretically, used with herbs that have sedative properties they may have an additive effect. This needs to be taken into account with the dosage.

Interactions with Drugs: Benzodiazepines e.g.Valium, Xanax

CNS Depressants: Theoretically, Ashwagandha's sedative effect may add to the effects of barbiturates (rarely prescribed now except for epilepsy), other sedatives, and drugs for anxiety,17 needed.

Immunosuppressants; refer to medical herbalist

Thyroid Hormone: Theoretically, ashwagandha might have additive effects when used with thyroid supplements. There is preliminary evidence that ashwagandha might boost thyroid hormone synthesis and/or secretion.17

Refer patients on medication to a well qualified Medical Herbalist. 

Interactions with Foods: None known.

Interactions with Lab Tests: Digoxin blood levels (heart medication).

Interactions with Diseases or Conditions: Autoimmune effects.17,20,22,18 The modulating effects on the immune system can be helpful but should be prescribed by a Medical Herbalist.

Diseases: Ashwagandha may have immunostimulant properties.

Dosage/Administration: 

Dr Clare’s Blends: 1gm per day

Oral: People typically use 1 to 6 grams daily of the whole herb in capsule or tea form.17 The tea is prepared by boiling ashwagandha roots in water for 15 minutes and cooled. The usual dose is 3 cups daily. Tincture or fluid extracts are dosed 2 to 4 mL 3 times per day.

Topical: No typical dosage.

Specific References: ASHWAGANDHA Upton R, ed. Ashwagandha Root (Withania somnifera): Analytical, quality control, and 

17. therapuetic monograph. Santa Cruz, CA: American Herbal Pharmacopoeia 2000:1-25.

18. Mishra LC, Singh BB, Dagenais S. Scientific basis for the therapeutic use of Withania

somnifera (ashwagandha): a review. Altern Med Rev 2000;5:334-46.

19. Bhattacharya SK, Satyan KS, Ghosal S. Antioxidant activity of glycowithanolides from Withania somnifera. Indian J Exp Biol 1997;35:236-9.

20. Davis L, Kuttan G. Effect of Withania somnifera on cyclophosphamide-induced urotoxicity. Cancer Lett 2000;148:9-17.

21. Archana R, Namasivayam A. Antistressor effect of Withania somnifera. J Ethnopharmacol 1999;64:91-3.

22. Davis L, Kuttan G. Suppressive effect of cyclophosphamide-induced toxicity by Withania somnifera extract in mice. J Ethnopharmacol

Also Known As: Astragali Membranaceus.

Scientific Name:Astragalus membranaceus.

Family: Fabaceae/Leguminosae or Papilionaceae.

People Use This For: Astragalus is used for common cold, upper respiratory infections, allergic rhinitis, swine ‘flu, to strengthen and regulate the immune system, fibromyalgia, anemia, and HIV/AIDS, chronic fatigue syndrome, as an antibacterial, antiviral, tonic, liver protectant, anti-inflammatory, antioxidant, as a diuretic, vasodilator, and as a hypotensive agent. Topically, astragalus is used as a vasodilator and to speed healing.

Safety: No concerns regarding safety.

Pregnancy and Breast Feeding: Refer to a Medical Herbalist.

Effectiveness: Not enough scientific information available to comment.

Allergic rhinitis: Preliminary clinical research shows that a specific astragalus root extract standardized to contain 34% polysaccharides twice daily for 3 to 6 weeks significantly improves symptoms such as runny nose, sneezing, and itching compared to placebo.1

Breast cancer: There is preliminary evidence that adjunctive use of astragalus in combination with glossy privet (Ligustrum lucidum) might increase survival rates in patients being treated conventionally for breast cancer.2

Common cold: There is preliminary evidence that long-term ingestion of astragalus might reduce the risk of catching the common cold.2

Hepatitis: There is preliminary evidence that intravenous use of astragalus might be beneficial for patients with chronic hepatitis.2

Mechanism of Action: The part used is the root. Astragalus contains a variety of active constituents including more than 34 saponins such as astragaloside, several flavonoids including isoflavones, pterocarpans, and isoflavans, polysaccharides, multiple trace minerals, amino acids, and coumarins.2,3 Astragalus has antioxidant effects. It inhibits free radical production, increases superoxide dismutase, and decreases lipid peroxidation.2,4 Astragalus is often promoted for its effects on the immune system, liver, and cardiovascular system. Astragalus seems to improve the immune response. In vitro, the polysaccharide constituents appear to bind and activate B cells and macrophages, but not T cells.5 Astragalus potentiates the effects of interferon, increases antibody levels of immunoglobulins in nasal secretions, and increases interleukin-2 levels.2,6,7 It also seems to improve the response of mononuclear cells and stimulate lymphocyte production.8 Additionally, there is preliminary evidence that astragalus extracts can restore or improve immune function in cases of immune deficiency.9,10 Astragalus seems to restore in vitro T-cell function which is suppressed in cancer patients.9,11 Astragalus also seems to have broad-spectrum in vitro antibiotic activity.2 There is interest in astragalus for increasing fertility. In vitro, astragalus appears to increase sperm motility.12 In individuals with chronic hepatitis, astragalus seems to improve liver function as demonstrated by improvement in serum glutamate pyruvate transaminase levels.2 Astragalus is also thought to cause vasodilation and increase cardiac output which might be beneficial in angina, congestive heart failure, and post-myocardial infarction.2 In animal models of heart failure, astragalus appears to increase myocardial and renal function, possibly due to diuretic and natriuretic effects.13 In animal models of coxsackie viral myocarditis, astragalus appears to reduce myocardial lesion size and viral titers.14 A pharmacokinetic evaluation in vitro and in a healthy human volunteer, suggests that astragalus flavonoids can be absorbed in the gastrointestinal tract. The major metabolites of the flavonoid constituents are glucuronides.15 These help with excretion of toxic substances.

Adverse Reactions: Astragalus root is well-tolerated.

Interactions with Herbs & Supplements: None known.

Interactions with Drugs: Cyclophosphamide, Immunosuppressants, Lithium

Interactions with Foods: None known.

Interactions with Lab Tests: None known.

Interactions with Diseases or Conditions: Autoimmune Diseases: Refer to Medical Herbalist

Dosage/Administration: Dr Clare’s Blends: 3ml of 1:3 tincture/day = 1gm per day.

Oral: For allergic rhinitis, a specific astragalus root extract standardized to contain 34% polysaccharides (Lectranal) 160 mg twice daily has been used.1 For prevention of the common cold, 4-7 grams per day is commonly used.2 Traditionally, astragalus powder 1-30 grams per day is used.16,2 In some cases, people have used astragalus powder 30-54 grams per day.2 However, this should be avoided because some research suggests that doses greater than 28 grams per day offers no additional benefit and might even cause immune suppression.3 Astragalus decoction 0.5-1 L per day (maximum of 120 grams of whole root per liter of water) has been used.2 As a soup, mix 30 grams in 3.5 L of soup and simmer with other food ingredients.2

Topical: No typical dosage.

Specific References: ASTRAGALUS

Matkovic Z, Zivkovic V, Korica M, et al. Efficacy and safety of Astragalus membranaceus in

1. the treatment of patients with seasonal allergic rhinitis. Phytother Res 2010;18:175-81.

2. Upton R, ed. Astragalus Root: Analytical, quality control, and therapeutic monograph. Santa Cruz, CA: American Herbal Pharmacopoeia. 1999:1-19.

3. McCulloch M, See C, Shu XJ, et al. Astragalus-based Chinese herbs and platinum-based chemotherapy for advanced non-small-cell lung cancer: meta-analysis of randomized trials. J Clin Oncol 2006;18:419-30. Hong CY, Lo YC, Tan FC, et al. Astragalus membranaceus and Polygonum multiflorum

4. protect rat heart mitochondria against lipid peroxidation. Am J Chin Med 1994;22:57-70.

5. Shao BM, Xu W, Dai H, et al. A study on the immune receptors for polysaccharides from the roots of Astragalus membranaceus, a Chinese medicinal herb. Biochem Biophys Res Commun 2004;320:1103-11.

6. Qun L, Luo Q, Zhang ZY, et al. Effects of astragalus on IL-2/IL-2R system in patients with maintained hemodialysis. Clin Nephrol 1999;46:333-4.

7. Hou YD, Ma GL, Wu SH, et al. Effect of Radix Astragali seu Hedysari on the interferon system. Chin Med J (Engl) 1981;94:29-34. Sun Y, Hersh EM, Lee SL, et al. Preliminary observations on the effects of the Chinese

8. medicinal herbs Astragalus membranaceus and Ligustrum lucidum on lymphocyte blastogenic responses. J Biol Response Mod 1983;2:227-31. Sun Y, Hersh EM, Talpaz M, et al. Immune restoration and/or augmentation of local graft

9. versus host reaction by traditional Chinese medicinal herbs. Cancer 1983;46:70-3.

10. Chu DT, Wong WL, Mavligit GM. Immunotherapy with Chinese medicinal herbs. II. Reversal of cyclophosphamide-induced immune suppression by administration of fractionated Astragalus membranaceus in vivo. J Clin Lab Immunol 1988;19:125-9.

11. Chu DT, Wong WL, Mavligit GM. Immunotherapy with Chinese medicinal herbs. I. Immune restoration of local xenogeneic graft-versus-host reaction in cancer patients by fractionated Astragalus membranaceus in vitro. J Clin Lab Immunol 1988;19:119-17.

12. Hong CY, Ku J, Wu P. Astragalus membranaceus stimulates human sperm motility in vitro. Am J Chin Med 1992;20:289-94.

13. Ma J, Peng A, Lin S. Mechanisms of the therapeutic effect of astragalus membranaceus on sodium and water retention in experimental heart failure. Chin Med J (Engl) 1998;111:17-17.

14. Yang YZ, Jin PY, Guo Q, et al. Treatment of experimental Coxsackie B-3 viral myocarditis with Astragalus membranaceus in mice. Chin Med J (Engl) 1990;103:14-8.

15. Xu F, Zhang Y, Xiao S, et al. Absorption and metabolism of Astragali radix decoction: in silico, in vitro, and a case study in vivo. Drug Metab Dispos 2006;28:913-18.

16. Leung AY, Foster S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs and Cosmetics. 2nd ed. New York, NY: John Wiley & Sons, 1996.

Also Known As: Cimicifuga,

Scientific Name: Cimicifuga racemosa.

Family: Ranunculaceae.

People Use This For: Black Cohosh is used for symptoms of menopause, inducing labor in pregnant women, premenstrual syndrome (PMS), painful periods, nervous tension, indigestion, rheumatism, and as a mild sedative.

Safety: Possibly safe when used orally and appropriately. Black cohosh has been safely used in some studies lasting up to a year; 1,2,3 There is concern that black cohosh might cause liver damage in some patients. Several case reports link black cohosh to liver failure or autoimmune hepatitis; 4,5,6,7,8,9,10,11,12,13,14,15,16,17 however, there is no conclusive evidence that black cohosh is the cause of liver damage in these patients.18 Until more is known, monitor liver function in patients who take black cohosh for more than three months. Analysis of 9 Cases of Suspected association between Black Cohosh and Hepatitis concluded that there is little if any hepatotoxic risk by the use of Black Cohosh in these cases. Menopause 2009 Sep-Oct: 16(5):956-65 Teschke R, Bahre R, Fuchs J, Wolff A. It is concluded that the use of BC may not exert an overt toxicity risk, but quality problems in a few BC products were evident that require additional regulatory quality specifications. Ann Hepatology. 2011 Jul-Sep;10(3):249-59

Pregnancy and Lactation: Refer to Medical Herbalist

Effectiveness: POSSIBLY EFFECTIVE

Menopausal symptoms. Some black cohosh extracts seem to modestly reduce symptoms of menopause, such as hot flashes. However, there is considerable variability in the preparations used in clinical trials, and in the results obtained.19

INSUFFICIENT RELIABLE EVIDENCE to RATE

Osteoporosis: Preliminary clinical research suggests that postmenopausal women who take a specific black cohosh extract CR BNO 1055 (Klimadynon/Menofem, Bionorica AG) 40 mg/day have increased levels of bone-specific alkaline phosphatase (bALP), which is a marker of bone formation, after 12 weeks of treatment. 20 However, it is not known if this black cohosh extract can increase bone mineral density or decrease the risk of fracture. More evidence is needed to rate black cohosh for these uses.

Mechanism of Action: The applicable parts of black cohosh are the rhizome and root. The active constituents of black cohosh include phytosterin; isoferulic acid; fukinolic acid; caffeic acid; salicylic acid; sugars; tannins; long-chain fatty acids; and triterpene glycosides, including acetein, cimicifugoside, and 27-deoxyactein.21,22 Black cohosh has estrogen-like effects (not estrogenic effects) that are exerted by an unknown mechanism.21,23,20

Adverse Reactions: Black cohosh can commonly cause gastrointestinal upset.4,24,25 Black cohosh has associated with weakness and muscle damage in one case. In another case, a single patient developed symptoms of cutaneous pseudolymphoma 6 months after starting a specific black cohosh extract (Remifemin). Symptoms resolved within 12 weeks of discontinuing black cohosh.26 There are two case reports of cutaneous vasculitis in menopausal women who took black cohosh-containing products. In these cases, both women were taking a combination product containing black cohosh 40 mg (Estroven, Amerifit Brands). Symptoms resolved within 3 months of discontinuing the product.27 Interactions with Herbs & Supplements: Refer to a Medical Herbalist. Interactions with Drugs: Atorvastatin (Lipitor) One report of significant interaction. Chemotherapy: Refer to a Medical Herbalist. Hepatotoxic Drugs: Refer to a Medical Herbalist. Interactions with Foods: None known.

Interactions with Lab Tests: Liver Function Tests: Elevated liver function tests have not been documented in clinical trials.20 Theoretically, some patients taking black cohosh might experience elevated liver function tests.

Interactions with Diseases or Conditions: Breast Cancer: Refer to Medical Herbalist.

Hormone-Sensitive Cancers/Conditions: Black cohosh doesn't seem to affect estrogen receptors. Refer to Medical Herbalist.

Kidney Transplant: Refer to Medical Herbalist.

Liver Disease: Refer to Medical Herbalist.

Dosage/Administration: Dr Clare’s Blend: 1gm/day Oral: 0.5-1gms/day

Specific References: BLACK COHOSH 1. Raus K, Brucker C, Gorkow C, Wuttke W. First-time proof of endometrial safety of the special black cohosh extract (Actaea or Cimicifuga racemosa extract) CR BNO 1055. Menopause 2006;13:678-91. Newton KM, Reed SD, LaCroix AZ, et al. Treatment of vasomotor symptoms of menopause

2. with black cohosh, mulitbotanicals, soy, hormone therapy, or placebo. Ann Intern Med 2006;145:869-79. Available at: http://www.annals.org/cgi/reprint/145/12/869.pdf.

3. Geller SE, Shulman LP, van Breemen RB, et al. Safety and efficacy of black cohosh and red clover for the management of vasomotor symptoms: a randomized controlled trial. Menopause 2009;16:1156-66.

4. Whiting PW, Clouston A, Kerlin P. Black cohosh and other herbal remedies associated with acute hepatitis. Med J Aust 2002;177:440-3.

5. Lontos S, Jones RM, Angus PW, Gow PJ. Acute liver failure associated with the use of herbal preparations containing black cohosh. Med J Aust 2003;179:390-1.

6. Cohen B, Schardt D. Center for Science in the Public Interest. Letter to Food and Drug Administration. Commissioner Mark McClellan, MD, PhD. March 4, 2004. Cohen SM, O'Connor AM, Hart J, et al. Autoimmune hepatitis associated with the use of

7. black cohosh: a case study. Menopause 2004;11:575-7.

8. Levitsky J, Alli TA, Wisecarver J, Sorrell MF. Fulminant liver failure associated with the use of black cohosh. Dig Dis Sci 2005;50:538-9.

9. MHRA. Black cohosh (Cimicifuga racemosa) - risk of liver problems. Herbal Safety News IdcService=SS_GET_PAGE&useSecondary= true&ssDocName=CON2024131&ssTargetNodeId=663.

10. Lynch CR, Folkers ME, Hutson WR. Fulminant hepatic failure associated with the use of black cohosh: a case report. Liver Transpl 2006;12:989-92.

11. Chow ECY, Teo M, Ring JA, Chen JW. Liver failure associated with the use of black cohosh for menopausal symptoms. Med J Aust 2008;188:420-2.

12. Mahady GB, Low Dog T, Barrett ML, et al. United States Pharmacopeia review of the black cohosh case reports of hepatotoxicity. Menopause 2008;15:628-38.

13. Hepatotoxicity with black cohosh. Australian Adv Drug Reactions Bull 2006;25:6. Available at: www.tga.gov.au/adr/aadrb/aadr0604.htm#a1.

14. Dunbar K, Solga SF. Black cohosh, safety, and public awareness. Liver Int 2007;27:1017.

15. Patel NM, Derkits RM. Possible increase in liver enzymes secondary to atorvastatin and black cohosh administration. J Pharm Pract 2007;20:341-6.

16. Joy D, Joy J, Duane P. Black cohosh: a cause of abnormal postmenopausal liver function tests. Climacteric 2008;11:84-8.

17. Australian Adverse Drug Reactions Advisory Committee. Black cohosh and liver toxicity - an update. Aust Adv Drug Reactions Bull 2007;26:11.

18. Teschke R, Bahre R, Genthner A, et al. Suspected black cohosh hepatotoxicity - challenges July 2006.

Available at: http://www.mhra.gov.uk/home/idcplg? and pitfalls of causality assessment. Maturitas 2009;63:302-14.

19. Shams T, Setia MS, Hemmings R, et al. Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis. Altern Ther Health Med 2010;16:36-44.

20. Wuttke W, Gorkow C, Seidlova-Wuttke D. Effects of black cohosh (Cimicifuga racemosa) on bone turnover, vaginal mucosa, and various blood parameters in postmenopausal women: a double-blind, placebo-controlled, and conjugated estrogens-controlled study. Menopause 2006;13:185-96.

21. Kruse SO, Lohning A, Pauli GF, et al. Fukiic and piscidic acid esters from the rhizome of Cimicifuga racemosa and the in vitro estrogenic activity of fukinolic acid. Planta Med 1999;65:763-4.

22. Loser B, Kruse SO, Melzig MF, Nahrstedt A. Inhibition of neutrophil elastase activity by cinnamic acid derivatives from Cimicifuga racemosa. Planta Med 2000;66:751-3. Einer-Jensen N, Zhao J, Andersen KP, Kristoffersen K. Cimicifuga and Melbrosia lack

23. oestrogenic effects in mice and rats. Maturitas 1996;25:149-53.

24. Pepping J. Black cohosh: Cimicifuga racemosa. Am J Health Syst Pharm 1999;56:1400-2.

25. Liske E. Therapeutic efficacy and safety of Cimicifuga racemosa for gynecologic disorders. Adv Ther 1998;15:45-53.

26. Meyer S, Vogt T, Obermann EC, et al. Cutaneous pseudolymphoma induced by Cimicifuga racemosa. Dermatology 2007;214:94-6.

27. Ingraffea A, Donohue K, Wilkel C, Falanga V. Cutaneous vasculitis in two patients taking an herbal supplement containing black cohosh. J Am Acad Dermatol 2007;56:S124-6.

Also Known As: Fucus, Kelp, Knotted Wrack.

Scientific Name: Fucus vesiculosus; Ascophyllum nodosum; other Fucus species.

Family: Fucaceae.

People Use This For:

Bladderwrack is used for thyroid disorders, iodine deficiency, goiter, obesity, arthritis, and rheumatism, "blood cleansing", to increase energy, constipation, bronchitis, decreased resistance to disease, and anxiety. Topically, bladderwrack is used for skin diseases, burns, aging skin, and insect bites.

Safety: No concerns regarding safety when used orally in appropriate doses. It is important to obtain traceable supply free from contamination (1 case of contamination with heavy metals reported in the 1970’s).1,2

Pregnancy and Lactation: Refer to a Medical Herbalist

Effectiveness: INSUFFICIENT RELIABLE EVIDENCE to RATE

Obesity: Preliminary clinical research suggests that bladderwrack in combination with lecithin and vitamins doesn't result in sustained weight loss. More evidence is needed to rate bladderwrack for this use (combined lecithin, kelp, multivitamin preparation involving 120 women over 2 years). 3 

Mechanism of Action: The applicable part of bladderwrack is the entire plant. Bladderwrack is a brown seaweed. Bladderwrack contains high concentrations of iodine, which is present in varying amounts. Bladderwrack is a source of fiber, minerals such as iron, and vitamin B12.2

Preliminary clinical research suggests bladderwrack may normalize the menstrual cycle and have estrogen balancing effects in premenopausal women. It may also balance progesterone effects4 (case reports on three patients). Preliminary clinical research suggests topical administration of bladderwrack extract might reduce skin thickness and other signs of aging.5

Adverse Reactions: Excess Iodine intake is rare in humans outside of radiation contamination or excessive amounts of seaweed (or seaweed extracts) intake over a prolonged period. There is one case report of heavy metal poisoning where arsenic poisoning occurred with ingestions of a contaminated kelp product. 6 Another case of arsenic-related poisoning with bladderwrack ingestion 400 mg three times a day for 3 months resulted in kidney damage.7

Interactions with Herbs & Supplements: Avoid Iodine supplements at the same time.

Interactions with Drugs:

Antithyroid Drugs: Theoretically, may result in additive hypothyroid activity, and may lower the level of availableThyroid hormones.8

Interactions with Foods: None known.

Interactions with Lab Tests: 

Radioactive Iodine Uptake: Theoretically, bladderwrack might interfere with the results of thyroid function tests using radioactive iodine uptake.2

Thyroid Stimulating Hormone (TSH): Theoretically, bladderwrack might increase serum TSH levels and test results.8

Thyroxine (T4): Theoretically, bladderwrack might increase serum T4 levels and test results.8

Interactions with Diseases or Conditions:

Iodine Allergy: Avoid bladderwrack use in people sensitive to iodine.8

Thyroid Disorders: Prolonged use or excessive amounts of iodides may exacerbate thyroid gland problems.8

Dosage/Administration: Dr Clare’s Blends: 1 gm per day No typical dosage.

Specific References: BLADDERWRACK

1. Baker DH. Iodine toxicity and its amelioration. Exp Biol Med (Maywood) 2004;229:473-8.

2. Phaneuf D, Cote I, Dumas P, et al. Evaluation of the contamination of marine algae (Seaweed) from the St. Lawrence River and likely to be consumed by humans. Environ Res 1999;80:S175-S182.

3. Bjorvell H, Rössner S. Long-term effects of commonly available weight reducing programmes in Sweden. Int J Obes 1987;11:67-71.

4. Skibola CF. The effect of Fucus vesiculosus, an edible brown seaweed, upon menstrual cycle length and hormonal status in three pre-menopausal women: a case report. BMC Complement Altern Med 2004;4:10.

5. Fujimura T, Tsukahara K, Moriwaki S, et al. Treatment of human skin with an extract of Fucus vesiculosus changes its thickness and mechanical properties. J Cosmet Sci 2002;53:1- Pye KG, Kelsey SM, House IM, et al. Severe dyserythropoeisis and autoimmune

6. thrombocytopenia associated with ingestion of kelp supplement. Lancet 1992;339:1540.

7. Conz PA, La Greca G, Benedetti P, et al. Fucus vesiculosus: a nephrotoxic alga? Nephrol Dial Transplant 1998;13:526-7.

8. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002. Available at: www.nap.edu/books/0309072794/html/.

Also Known As:

Buckbean, Marsh Trefoil, Menyanthes, Water Shamrock.

Scientific Name:

Menyanthes trifoliata.

Family: Menyanthaceae.

People Use This For:

Bogbean is used for rheumatism, rheumatoid arthritis, loss of appetite, and

dyspepsia.

In food manufacturing, bogbean is used as a flavoring agent.

Safety:

No concerns regarding safety when used orally in amounts commonly found in

foods.1

No concerns regarding safety when used orally in medicinal amounts,2 no clinical

reports of problems.

Pregnancy and Lactation: Refer to a Medical Herbalist.

Effectiveness:

There is insufficient scientific information available to comment.

Mechanism of Action:

The applicable part of bogbean is the leaf. The bitter principles, or iridoids, can

stimulate saliva and gastric juices (3,1). Bogbean can have purgative actions (1).

Adverse Reactions:

None reported for normal dosage.

Interactions with Herbs & Supplements:

None reported

Interactions with Drugs:

None reported.

Interactions with Foods:

None known.

Interactions with Lab Tests:

None known.

Interactions with Diseases or Conditions:

None reported.

Dosage/Administration:

Dr Clare’s Blends:1gm per day

Oral: The typical dose of bogbean is 1-3 grams of the dried leaf three times daily

or as a tea three times daily.

Specific References: BOGBEAN

Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare

1.

Professionals. London, UK: The Pharmaceutical Press, 1996.

2.

McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's

Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.

3. Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to

Herbal Medicines. Trans. S. Klein. Boston, MA: American Botanical Council, 1998.

Also Known As:

Barosmae Folium.

Scientific Name:

Barosma betulina

People Use This For:

Orally, buchu is used as a urinary tract disinfectant in cystitis, urethritis,

prostatitis, benign prostatic hyperplasia and kidney infections.

In manufacturing, the oil from buchu is used to give a fruit flavor (often black

currant) to foods.

Safety:

No concerns regarding safety, available studies validate this statement, when

the leaf is used in amounts commonly found in foods. Buchu has Generally

Recognized As Safe status (GRAS) for use in foods in the US.1

No converns regarding safety when the leaf is used orally and appropriately in

medicinal amounts.2,3

Pregnancy and Lactation: Refer to a Medical Herbalist.

Effectiveness:

Not enough scientific information gathered to offer a comment

Mechanism of Action:

The applicable part of buchu is the leaf. Buchu camphor (also known as

diosphenol) is the principal constituent of the oil. Researchers believe this

constituent may be responsible for buchu's reported diuretic and antiseptic

effects.4

Adverse Reactions:

Occasional digestive upset if taken on an empty stomach.R1 pp.311

Interactions with Herbs & Supplements:

None

Interactions with Drugs:

Lithium: Because of diuretic effect.R3 pp.163-164

Diuretics: Effect can be additive.R4 pp.192,204,215

Interactions with Foods:

None known.

Interactions with Lab Tests:

None known.

Interactions with Diseases or Conditions:

Surgery: Tell patients to discontinue buchu at least 2 weeks before elective

surgical procedures.

Dosage/Administration:

Oral: The typical dose is 1 cup of tea (steep 1 gram dry leaf in 150 mL boiling

water 5-10 minutes, strain) several times per day.5

Specific References: BUCHU

1. FDA. Center for Food Safety and Applied Nutrition, Office of Premarket Approval, EAFUS: A

food additive database. Available at: vm.cfsan.fda.gov/~dms/eafus.html.

2. Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to

Herbal Medicines. Trans. S. Klein. Boston, MA: American Botanical Council, 1998.

3.

McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's

Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.

4. Foster S, Tyler VE. Tyler's Honest Herbal: A Sensible Guide to the Use of Herbs and Related

Remedies. 3rd ed., Binghamton, NY: Haworth Herbal Press, 1993.

5.

Wichtl MW. Herbal Drugs and Phytopharmaceuticals. Ed. N.M. Bisset. Stuttgart: Medpharm

GmbH Scientific Publishers, 1994.

Also Known As:    

Arctium, Beggar's Buttons, Burr Seed, Clotbur, Cocklebur.

Scientific Name:

Arctium lappa; Arctium minus; Arctium tomentosum.

Family: Asteraceae/Compositae.

People Use This For:

Burdock is used as a diuretic, "blood purifier", antimicrobial, and an antipyretic. It is also used to treat  gastrointestinal complaints, rheumatism, gout, cystitis, and chronic skin conditions including acne and psoriasis. It is also used for hypertension, arteriosclerosis, hepatitis, and other inflammatory conditions. 

SourceURL:file://localhost/Users/ruthruane/Downloads/Herbal%20Medicine-Newest.doc

Burdock is also used for treating colds, catarrh.

Topically, burdock is used for dry skin, acne, psoriasis, and eczema.

The root of burdock is consumed as a food.

Safety:

No concerns regarding safety when used in amounts commonly found in foods.^9,10

Pregnancy and Lactation: Refer to a Medical Herbalist.

Effectiveness:

There is insufficient scientific information available to comment on the effectiveness of burdock.

Mechanism of Action:

The applicable relevant part of burdock is the root. Extracts of burdock root appear to have cough suppressant activity and may increase immunological activity.¹¹ Other preliminary research suggests it might have anti-inflammatory and free radical scavenging activity.¹² Burdock root extract might also protect the liver from toxicity caused by ethanol and carbon tetrachloride, possibly due to its antioxidant activity.⁹

Adverse Reactions:          

An isolated report of an allergic reaction causing anaphylaxis.¹⁰

Interactions with Foods:

None known.

Interactions with Lab Tests:      

SourceURL:file://localhost/Users/ruthruane/Downloads/Herbal%20Medicine-Newest.doc

None known.

Dosage/Administration:  

No typical dosage 

Specific References: BURDOCK

9.  Lin SC, Lin CH, Lin CC, et al. Hepatoprotective effects of Arctium lappa Linne on liver injuries induced by chronic ethanol consumption and potentiated by carbon tetrachloride. J Biomed Sci 2002;9:401-9.

10.  Sasaki Y, Kimura Y, Tsunoda T, Tagami H. Anaphylaxis due to burdock. Int J Dermatol 2003;42:472-3.

11.  Kardosova A, Ebringerova A, Alfoldi J, et al. A biologically active fructan from the roots of Arctium lappa L., var. Herkules. Int J Biol Macromol 2003;33:135-40.

12.  Lin CC, Lu JM, Yang JJ, et al. Anti-inflammatory and radical scavenge effects of Arctium lappa. Am J Chin Med 1996;24:127-37.

Also Known As:

Blue Chamomile, Camomilla, Camomille, Camomille Allemande, Chamomilla, Echte Kamille, Feldkamille, Fleur de Camomile, Hungarian Chamomile, Kamillen, Kleine Kamille, Manzanilla, Manzanilla Alemana, Matricaire, Matricariae Flos, Pin Heads, Sweet False Chamomile, True Chamomile, Wild Chamomile.

Scientific Name:

Matricaria recutita, synonyms Chamomilla recutita, Matricaria chamomilla.

Family: Asteraceae/Compositae. 

People Use This For:

Orally, German chamomile is used for flatulence, travel sickness, nasal mucous membrane inflammation, allergic rhinitis, nervous diarrhea, attention deficit hyperactivity disorder (ADHD), fibromyalgia, restlessness, and insomnia. It is also used for gastrointestinal (GI) spasms, colic, inflammatory diseases of the GI tract, GI ulcers associated with nonsteroidal anti-inflammatory drugs (NSAIDs) and alcohol consumption, and as an antispasmodic for menstrual cramps. 

Topically, German chamomile is used for hemorrhoids; mastitis; leg ulcers; skin, anogenital, and mucous membrane inflammation; and bacterial skin diseases, including those of the mouth and gums. It is also used topically for treating or preventing chemotherapy- or radiation-induced oral mucositis.

As an inhalant, German chamomile is used to treat inflammation and irritation of the respiratory tract. 

In foods and beverages, German chamomile is used as flavor components.

In manufacturing, German chamomile is used in cosmetics, soaps, and mouthwashes.

Safety:

No concerns regarding safety, available studies validate this statement, when used orally in amounts commonly found in foods. German chamomile has Generally Recognized as Safe (GRAS) status in the US.¹

No concerns regarding safetywhen used orally, short-term. There is some evidence that German chamomile can be used safely for up to 8 weeks.^2,3,4 The long-term safety of German chamomile in medicinal doses is unknown, when used topically; avoid applying it near the eyes.⁵

Children: No concerns regarding safety when used orally and appropriately, short-term. Preliminary clinical research also suggests that a specific multi-ingredient product containing fennel 164 mg, lemon balm 97 mg, and German SourceURL:file://localhost/Users/ruthruane/Downloads/Herbal%20Medicine-Newest.doc

chamomile 178 mg (ColiMil, Milte Italia SPA) is safe in infants when used for up to a week.⁶

Pregnancy and Lactation: Insufficient reliable information available; avoid using. 

Effectiveness:

POSSIBLY EFFECTIVE

Colic. A clinical trial shows that breast-fed infants with colic who are given a specific multi-ingredient product containing fennel 164 mg, lemon balm 97 mg, and German chamomile 178 mg (ColiMil, Milte Italia SPA) twice daily for a week have reduced crying times compared to placebo.⁶

Dyspepsia. A specific combination product containing German chamomile (Iberogast, Medical Futures, Inc) seems to improve symptoms of dyspepsia. The combination includes German chamomile plus peppermint leaf, clown's mustard plant, caraway, licorice, milk thistle, celandine, angelica, and lemon balm.^7,3 A meta-analysis of studies using this combination product suggests that taking 1 mL orally three times daily over a period of 4 weeks significantly reduces severity of acid reflux, epigastric pain, cramping, nausea, and vomiting compared to placebo.⁸

Oral mucositis. Using a German chamomile oral rinse (Kamillosan Liquidum) might help prevent or treat mucositis induced by radiation therapy and some types of chemotherapy.² German chamomile oral rinse seems to prevent or treat mucositis secondary to radiation therapy and some types of chemotherapy including asparaginase (Elspar), cisplatin (CDDP, Platinol-AQ), cyclophosphamide (Cytoxan, Neosar), daunorubicin (DaunoXome), doxorubicin (Adriamycin, Rubex), etoposide (VP-16, Etopophos, VePesid, Toposar), hydroxyurea (Hydrea), mercaptopurine (6-MP, Purinethol), methotrexate (MTX, Rheumatrex), procarbazine (MIH, Mutlane), and vincristine (VCR, Oncovin, Vincasar) (2). However, the rinse doesn't seem to be better than placebo for preventing fluorouracil (5-FU)-induced oral mucositis.⁹

POSSIBLY INEFFECTIVE

Dermatitis. Applying German chamomile cream topically does not seem to prevent dermatitis induced by cancer radiation therapy.¹⁰

Mechanism of Action:

The applicable part of German chamomile is the flowerhead. Active constituents of German chamomile include quercetin, apigenin, and coumarins, and the essential oils.⁵

German chamomile might have anti-inflammatory effects. Preliminary research suggests it can inhibit the pro inflammatory enzymes. Other constituents may inhibit histamine related to allergies,^5,4

The constituent(s) responsible for the sedative activity of German chamomile are unclear. Preliminary research suggests that extracts of German chamomile might inhibit morphine dependence and withdrawal.¹¹ Other preliminary research suggests that German chamomile flower extract taken orally might have an antipruritic effect.¹² Preliminary research suggests that German chamomile blocks slow wave activity in the small intestine, which could slow peristaltic movement.¹³

Adverse Reactions:

Orally, German chamomile tea can cause allergic reactions including severe reactions in some patients.¹⁴

Interactions with Herbs & Supplements:

HERBS AND SUPPLEMENTS WITH SEDATIVE PROPERTIES: Theoretically, concomitant use with herbs that have sedative properties might have additive effects which needs to be taken into account.^5,16

Interactions with Drugs:

Benzodiazepines: Consult a Medical Herbalist

CNS Depressants: Consult a Medical Herbalist

Warfarin (Coumadin): Consult a Medical Herbalist

Interactions with Foods:

None known. 

Interactions with Lab Tests:

Creatinine: Chronic ingestion of German chamomile for two 2 weeks can reduce urinary creatinine output. This effect may be prolonged for up to two weeks after discontinuing German chamomile. The mechanism for this effect is unclear.⁴

Interactions with Diseases or Conditions:

Surgery: Avoid from 2 weeks prior to elective surgery.

Dosage/Administration:

Oral: For dyspepsia, a specific combination product containing German chamomile (Iberogast, Medical Futures, Inc) and several other herbs has been used in a dose of 1 mL three times daily.^7,3,8

For colic in infants, a specific multi-ingredient product containing fennel 164 mg, lemon balm 97 mg, and German chamomile 178 mg (ColiMil, Milte Italia SPA) twice daily for a week has been used.⁶ 

Topical: For chemotherapy- or radiation-induced oral mucositis, an oral rinse made with 10-15 drops of German chamomile liquid extract in 100 mL warm water has been used three times daily.²

Comments:

German chamomile is an annual herb found throughout Europe and in portions of Asia. German chamomile has a mild apple-like scent. The name "chamomile" is Greek for "Earth apple." 

Specific References: CHAMOMILE

1.   FDA. Center for Food Safety and Applied Nutrition, Office of Premarket Approval, EAFUS: A food additive database. Available at: vm.cfsan.fda.gov/~dms/eafus.html.

2.   Carl W, Emrich LS. Management of oral mucositis during local radiation and systemic chemotherapy: a study of 98 patients. J Prosthet Dent 1991;66:361-9.

3.   Madisch A, Holtmann G, Mayr G, et al. Treatment of functional dyspepsia with a herbal preparation. A double-blind, randomized, placebo-controlled, multicenter trial. Digestion 2004;69:45-52.

4.   Wang Y, Tang H, Nicholson JK, et al. A metabonomic strategy for the detection of the metabolic effects of chamomile (Matricaria recutita L.) ingestion. J Agric Food Chem 2005;53:191-6.

5.   Hormann HP, Korting HC. Evidence for the efficacy and safety of topical herbal drugs in dermatology: part I: anti-inflammatory agents. Phytomedicine 1994;1:161-71.

6.   Savino F, Cresi F, Castagno E, et al. A randomized double-blind placebo-controlled trial of a standardized extract of Matricariae recutita, Foeniculum vulgare and Melissa officinalis (ColiMil) in the treatment of breastfed colicky infants. Phytother Res 2005;19:335-40.

7.   Holtmann G, Madisch A, Juergen H, et al. A double-blind, randomized, placebo-controlled trial on the effects of an herbal preparation in patients with functional dyspepsia [Abstract]. Ann Mtg Digestive Disease Week 1999 May.

8.   Melzer J, Rosch W, Reichling J, et al. Meta-analysis: phytotherapy of functional dyspepsia with the herbal drug preparation STW 5 (Iberogast). Aliment Pharmacol Ther 2004;20:1279-87.

9.   Fidler P, Loprinzi CL, O'Fallon JR, et al. Prospective evaluation of a chamomile mouthwash for prevention of 5-FU-induced oral mucositis. Cancer 1996;77:522-5.

10.  Maiche AG, Grohn P, Maki-Hokkonen H. Effect of chamomile cream and almond ointment on acute radiation skin reaction. Acta Oncol 1991;30:395-6.

11.  Gomaa A, Hashem T, Mohamed M, Ashry E. Matricaria chamomilla extract inhibits both development of morphine dependence and expression of abstinence syndrome in rats. J Pharmacol Sci 2003;92:50-5.

12.  Kobayashi Y, Nakano Y, Inayama K, et al. Dietary intake of the flower extracts of German chamomile (Matricaria recutita L.) inhibited compound 48/80-induced itch-scratch responses in mice. Phytomedicine 2003;10:657-64.

13.  Storr M, Sibaev A, Weiser D, et al. Herbal extracts modulate the amplitude and frequency of slow waves in circular smooth muscle of mouse small intestine. Digestion 2004;70:257-64.

14.  Subiza J, Subiza JL, Hinojosa M, et al. Anaphylactic reaction after the ingestion of chamomile tea; a study of cross-reactivity with other composite pollens. J Allergy Clin Immunol 1989;84:353-8.

15.  Viola H, Wasowski C, Levi de Stein M, et al. Apigenin, a component of Matricaria recutita flowers, is a central benzodiazepine receptors-ligand with anxiolytic effects. Planta Med 1995;61:213-6.

16.  Avallone R, Zanoli P, Puia G, et al. Pharmacological profile of apigenin, a flavonoid isolated from Matricaria chamomilla. Biochem Pharmacol 2000;59:1387-94.

Also Known As:

Bedstraw, Catchweed, Cleavers, Gallium, Goose Grass, Gosling Weed, Robin-Run-in-the-Grass, Scratchweed, Stick-a-Back, Sticky Willy. 

Scientific Name:

Galium aparine.

Family: Rubiaceae. 

People Use This For:

Clivers is used as a diuretic, a mild astringent, for dysuria, lymphadenitis, psoriasis, and specifically for enlarged lymph nodes.

Safety:

No concerns regarding safety when used orally and appropriately.¹³ There is no documented toxicity.¹⁴

Pregnancy and Lactation: Refer to a Medical Herbalist.

Effectiveness:

There is insufficient scientific information available about the effectiveness of clivers.

Mechanism of Action:

The applicable parts of clivers are the dried or fresh above ground parts. Cleavers contain tannins, which are reported to have astringent properties.¹⁴

Adverse Reactions:

None reported.

Interactions with Herbs & Supplements:

None known.

Interactions with Drugs:

None known.

Interactions with Foods:

None known.

Interactions with Lab Tests:

None known.

Dosage/Administration:

Dr Clare’s Blends: 1gm per day.

Oral: Typical doses are 2-4 grams dried above ground parts three times daily, or one cup tea (steep 2-4 grams herb in 150 mL boiling water 5-10 minutes, strain) three times daily.¹⁴ Liquid extract (1:1 in 25% alcohol) 2-4 mL three times daily.¹⁴

Spedific References: CLIVERS

13.  McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.

14.  Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press, 1996.

Cramp Bark

Also known as: Common Guelder-Rose, Cranberry Bush.

Scientific Name: Viburnum opulus.

Botanical Family: Adoxaceae/Viburnaceae (formerly known as Caprifoliaceae).

Part used: Bark and root bark.

Traditional Use.

Cramp bark has antispasmodic (relieves muscle spasms), anti-inflammatory (relieves inflammation), nervine (calms and soothes the nerves), hypotensive (lowers blood pressure), astringent (causes local contraction), emmenagogic (induces menstruation ), and sedative (reduces activity and excitement) properties.

Safety.

There are no reports of safety concerns regarding Cramp Bark.

Pregnancy: Refer to a Medical Herbalist.

Breastfeeding: Refer to a Medical Herbalist.

Constituents

Hydroquinines; arbutin, methylarbutin and traces of free hydroquinone.

Sesquiterpene dialdehyde fraction; viopudiol.

Coumarins; such as scopoletinans, esculatin.

Triterpinoids; including oleanic acid and ursolic acid derivatives.

Iridoid glysoside esters.

Scientific evidence.

No clinical research has been done.

Mechanism of action.

At least two active constituents have been identified, scopoletin and viopudial. These constituents appear to have smooth muscle antispasmodic effects in vitro. Viopudial appears to have cholinergic effects by inhibiting acetylcholinesterase. The effect opposes the dominence of the sympathetic nervous system and relaxes the tone in smooth muscles. There is evidence of anti-inflammatory effects.

One study showed that the administration of viopudial, a Viburnum opulus component, produces slowing of the heart rate, lowering of blood pressure, and some decrease in contractility of heart muscle. This action is by balancing the sympathetic and parasympathetic nervous system tone in the body. Experimental evidence indicates that viopudial's mechanism of action is partly due to its effects on cholinesterase. In vitro demonstrations of a competitive inhibitory effect on both acetylcholinesterase and butyrylcholinesterase showed viopudial to be relatively weak when compared to the known potent inhibitor, physostigmine. Additional mechanistic effects, such as a direct musculotrophic action, may also be responsible for the overall activity. ⁸

One animal study shows that proanthocyanidin constituents of Viburnum opulus exert a potent gastro-duodenoprotective effect by increasing nitrous oxide in the tissues, suppressing lipid peroxidation and mobilizing antioxidant activity and changes in the gastroduodenal mucosa of rat.⁷

Other studies show that Viburnum opulus exhibits anti-oxidant effects.⁹

Adverse reactions.

None reported.

Possible interactions with herbs and supplements.

None known.

Possible interactions with drugs.

None known.

Possible interactions with foods.

None known.

Interactions with laboratory tests.

None known.

Effects on diseases or conditions.

None known.

Dosage.

Recommended dose: 3-10mls per day 1:5 tincture 30% alcohol.

Decoction: range from ½ to 6 tsps. per day.

Powder/capsule: range from 1-4gms per day.

Raw herb: 2-4gms per day.^{R8 pp.230}

Liquid extract: 2-8ml/day.

The recommended dose of Dr Clare’s Joint Support Blend provides 3mls per day of 1:3 Tincture in 15mls daily, at a dose of 5mls three times a day.

This is equivalent to 375-750mgs per day.

References.

1. Exp Biol Med (Maywood) June 1972 vol. 140 no. 2 457-461 Viopudial, a Hypotensive and Smooth Muscle Antispasmodic from Viburnum opulus.John A. Nicholson,Thomas D. Darby, Charles H. Jarboe

2. Charles H. Jarboe , Karimullah A. Zirvi , John A. Nicholson , Charlotte M. Schmidt. Scopoletin, an Antispasmodic Component of Viburnum opulus and prunifolium

J. Med. Chem., 1967, 10 (3), pp 488–489

3. Antioxidant properties of Viburnum opulus and Viburnum lantana growing in Turkey. Dr Mehmet Levent Altun, Gülçin Saltan Çitoğlu, Betül, Sever Yilmaz and Tülay Çoban

International Journal of Food Sciences and Nutrition

2008, Vol. 59, No. 3 , Pages 175-180

4. Antinociceptive and Anti-inflammatory Activities of Viburnum lantana. Pharmaceutical Biology2007, Vol. 45, No. 3 , Pages 241-245

B. Sever Yilmaz, G Saltan Citoglu, M.L. Altun and H. Ozbek

5. Zeng LJ, Xing JB, Li P. China Journal of Chinese Materia Medica [2000, 25(3):184-188]

6. Ilkay Erdogan-Orhan, Mehmet Levent Altun, Betül Sever-Yilmaz, and Gülçin Saltan. Anti-Acetylcholinesterase and Antioxidant Assets of the Major Components (Salicin, Amentoflavone, and Chlorogenic Acid) and the Extracts of Viburnum opulus and Viburnum lantana and Their Total Phenol and Flavonoid Contents

Journal of Medicinal Food. April 2011, 14(4): 434-440.

7. Zayachkivska OS1, Gzhegotsky MR, Terletska OI, Lutsyk DA, Yaschenko AM, Dzhura OR.

Influence of Viburnum opulus proanthocyanidins on stress-induced gastrointestinal mucosal damage.

J Physiol Pharmacol. 2006 Nov;57 Suppl 5:155-67.

8. Viopudial, a hypotensive and smooth muscle antispasmodic from Viburnum opulus.

J A Nicholson, T D Darby, C H Jarboe

Proceedings of The Society for Experimental Biology and Medicine 07/1972; 140(2):457-61.

9. Andreeva T.I, Komarova E.N, Yusubov M. S,  Korotkova E.I.

Antioxidant activity of cranberry tree (Viburnum Opulus L.) bark extract.

Pharmaceutical Chemistry Journal

10-2004, Volume 38, Issue 10, pp 548-550

Dandelion Root

Also known as: Blowball, Common Dandelion, Dent-de-Lion (Lions tooth).

Scientific Name: Taraxacum officinale radix.

Botanical Family: Asteraceae/Compositae.

Part used: Root (dandelion leaves are also used but this profile relates to the root). 

Traditional use.

Dandelion is used for loss of appetite, dyspepsia, flatulence, gallstones, bile stimulation, rheumatism, arthritic joints, muscle aches, eczema, and bruises. Dandelion is also used as an alterative, laxative, diuretic, circulatory tonic, skin toner, blood tonic, and digestive tonic. It is also used to treat infection, especially viral infections.

In foods the roasted root is used as a coffee substitute.

Nutrients: dandelion is a rich source of vitamins A, B complex, C, and D, as well as minerals such as iron, potassium, and zinc. The root is generally richer in minerals than the leaf which is rich in vitamins. 

Safety.

There are no concerns regarding safety when used orally in amounts commonly found in foods. Dandelion has Generally Recognized As Safe (GRAS) status in the US.⁽¹⁾

There are no concerns regarding safety when used appropriately in medicinal amounts, see dosage information for guidance.⁽²⁾ 

Pregnancy: There are no scientific studies available, so avoid using greater than dietary amounts.

Breastfeeding: There are no scientific studies available, so avoid using greater than dietary amounts.

Constituents

Sesquiterpene lactones; tataxoside, taraxinic acid, dihydrotaraxininc acid and others.

Polyphenols including caffeic acid

Coumarins

Triterpenes; tataxol, taraxerol, tataxasterolbeta-amyrin, stigmasterol and beta-sitosterol (a phytosterol)

Carbohydrates especially inulin when harvested in Autumn)

Vitamins A, B, C, D

Minerals especially potassium and calcium

Scientific evidence.

There is insufficient scientific data to comment on most traditional uses.

Urinary tract infections (UTIs). A specific oral combination of dandelion root and uva ursi leaf extracts seems to help reduce the recurrence rate of UTIs in women.⁽³⁾ In this combination uva ursi is used for its antibacterial properties and dandelion is used to increase urination.

Mechanism of action.

Dandelion root contains quercetin, luteolin, p-hydroxyphenylacetic acid, germacranolide acids, chlorogenic acid, chicoric acid, and monocaffeyltartaric acid. In addition it has a high potassium content. The roots contain caffeic acid, taraxacoside, taraxasterol, and large amounts of the polysaccharide, inulin.⁽⁴⁾

Dandelion root promotes bile production and bile flow and urinary flow. It is anti-inflammatory, anti-oxidative, analgesic, anti-hyperglycemic, anti-coagulatory and has prebiotic effects.

Based on a small study using an alcohol extract of dandelion leaf in human volunteers, this herb elicits a significant diuretic effect in humans.⁽⁵ 

Emerging evidence suggests that dandelion and its constituents have antioxidant and anti-inflammatory activities that result in diverse biological effects.^(6,7,13) 

Animal studies show that dandelion has effects on detoxifying enzymes in the liver.⁽⁹⁾

Preliminary evidence indicates a beneficial effect on cardiovascular risk factors mediated by oxidative stress, inflammation, and cholesterol profile. ⁽¹³⁾ 

Dandelion root contains high concentrations of inulin. Oligofructans, such as inulin, are used as food sources by beneficial intestinal bacteria. Dandelion root enhances the growth of bifidobacteria and may be useful as a "prebiotic".⁽⁸⁾

Dandelion extracts were effective for facilitating the gastrointestinal motility in animal studies.⁽¹²⁾

Anti-cancer effects on melanoma, breast and prostate cancer cells have been demonstrated. ^(10,11)

Adverse reactions.

No reported side effects.

Possible interactions with herbs and supplements.

None known. 

Interactions with drugs.

Lithium; Seek professional advice when combining any herbs, spices or foods that have a diuretic effect so that accommodation with the monitoring and dosage of Lithium can be adjusted.

Interactions with foods.

None known. 

Interactions with laboratory tests.

None known. 

Dosage.

Recommended dose: 5-10mls per day 1:5 tincture 30% alcohol.

Decoction: range from 3-6 tsps. per day.

Tincture; 5-10 mls per day 1:5 25% alcohol

Raw herb: 3-5gms per day

Juice from fresh root: 3-8mls per day.

Liquid extract:

The recommended dose of Dr Clare’s Joint Support Tea provides ⅙

of a tsp.  three times a day or ½ a tsp. per day.

Dr Clare’s Blend: 1gm per day

Liquid extract: 2-8 mL / day 

Tincture: 1:5, 5-10 mL / day

Root tincture (1:2) fresh root in 45% alcohol: 30 - 60 drops, 3 times daily.

Raw Herb:

Usual dose; 2-8gms/day.

Dried root decoction: 1/2 - 2 teaspoonfuls, 3 times daily. Place throot into boiling water for 5 - 10 minutes. Strain and drink the ‘tea’. You can add the roots to soups or stews, they are very nourishing.                   

References.

1. FDA. Center for Food Safety and Applied Nutrition, Office of Premarket Approval, EAFUS: A food additive database. Available at: vm.cfsan.fda.gov/~dms/eafus.html.

2.   McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.

3. Larsson B, Jonasson A, Fianu S. Prophylactic effect of UVA-E in women with recurrent cystitis: a preliminary report. Curr Ther Res 1993;53:441-3.

4.   Williams CA, Goldstone F, Greenham J. Flavonoids, cinnamic acids and coumarins from the different tissues and medicinal preparations of Taraxacum officinale. Phytochemistry 1996;42:121-7.

5.  Bevin A. Clare, Richard S. Conroy, Kevin Spelman. The Diuretic Effect in Human Subjects of an Extract of Taraxacum officinale Folium over a Single Day. The Journal of Alternative and Complementary Medicine. August 2009, 15(8): 929-934.

6. Gonzalez-Castelon M, Visioli F, Rodriguez-Casado A.

Diverse biological activities of dandelion. Nutr Rev. 2012 Sep;70(9):534-47.

 7. Mascolo N, Autore G, Capassa G, et al. Biological screening of Italian medicinal plants for anti-inflammatory activity. Phytother Res 1987:28-9.

8.  Trojanova I, Rada V, Kokoska L, Vlkova E. The bifidogenic effect of Taraxacum officinale root. Fitoterapia 2004;75:760-3.

9. Maliakal PP, Wanwimolruk S. Effect of herbal teas on hepatic drug metabolizing enzymes in rats. J Pharm Pharmacol 2001;53:1323-9.

10. The Efficacy of Dandelion Root Extract in Inducing Apoptosis in Drug-Resistant Human Melanoma Cells

11. Sigstedt SC, Hooten CJ, Callewaert MC, Jenkins AR, et al. Evaluation of aqueous extracts of Taraxacum officinale on growth and invasion of breast and prostate cancer cells. Int J Oncol. 2008 May;32(5):1085-90.

12. S. J. Chatterjee, P. Ovadje, M. Mousa, C. Hamm, and S. Pandey. Evidence-Based Complementary and Alternative Medicine. Volume 2011.Research on the gastrointestinal propulsive motility and chemical constituents of Dandelion extraction

WU Yan-ling, PIAO Hui-shan.

13. Jinju Kim , Kyunghee Noh , Mikyung Cho , Jihyun Jang and Youngsun Song. Anti-oxidative, anti-inflammatory and anti-atherogenic effects of Dandelion (Taraxacum officinale) extracts in C57BL/6 mice fed atherogenic diet

Jinju Kim , Kyunghee Noh , Mikyung Cho , Jihyun Jang and Youngsun Song. Journal of Fed. of American Societies for Experimental Biology 2007;21:862.7

The botanical name Harpagophytum means ‘hook plant’ in Greek, it is named after the hook-covered fruits of the plant. Devil’s claw is native to southern Africa and has been used traditionally as a bitter tonic for digestive disturbances, febrile illnesses, allergic reactions and to relieve pain. 

Also known as: Grapple Plant.

Scientific name: Harpagophytum procumbens.

Botanical Family: Pedaliaceae.

Part used: The tubers which are underground stems. 

Traditional use.

Devil's claw is traditionally used for arteriosclerosis, osteoarthritis, rheumatoid arthritis, gout, muscle soreness, fibrositis, lumbago, tendonitis, pleuritic chest pain, gastrointestinal upset or dyspepsia, fever, migraine headache, menstrual problems, allergic reactions, loss of appetite, kidney and bladder disease, and degenerative disorders of the locomotor system.

Safety.

No concerns regarding safety when used orally and appropriately. Devil's claw seems to be well-tolerated when used daily for up to a year.^(1,2,3,4,5) 

Pregnancy: Consult a medical herbalist.

Breastfeeding: Consult a medical herbalist.

Constituents

Iridoid glycosides principally harpagoside

Sugars.

Triterpenes.

Phytosterols especially beta sitosterol.

Aromatic acids.

Flavonoids; kaemferol and lutein.

Harpagoquinone 

Scientific evidence.

Back pain. Taking devil's claw orally seems to lessen nonspecific low-back pain. Some evidence suggests that an aqueous extract of devil's claw at doses of 50-100mg harpagoside daily has an anti-inflammatory effect equal to 13.5mg rofecoxib (Vioxx).^(2,3,5)  

If the resources put into even the marketing budget of Vioxx was spent investigating this herb the tragedy of the Vioxx deaths and ilness may not have happened.

Osteoarthritis. Taking devil's claw orally alone or in conjunction with nonsteroidal anti-inflammatory drugs (NSAIDs) helps decrease osteoarthritis-related pain.^(1,2,3,4,13) Evidence shows that devil's claw is comparable to diacerhein (a slow-acting drug for osteoarthritis; not available in the US) for improving osteoarthritis pain in the hip and knee after 16 weeks of treatment. Patients taking devil's claw have been able able to decrease the use of NSAIDs for pain relief.⁽¹⁾ This study used a specific powdered devil's claw root product (Harpadol, Arkopharma) containing 2% of the constituent harpagoside (9.5mg/capsule) and 3% total iridoid glycosides (14.5mg per capsule).⁽¹⁾ Another specific devil's claw extract (Doloteffin, Ardeypharm) 2400mg/day providing 60mg/day of the harpagoside constituent has also been researched.^(2,4)

Rheumatoid arthritis (RA). Preliminary evidence suggests that taking devil's claw extract orally might not be helpful for RA.⁽⁶⁾ More evidence is needed to rate devil's claw for this use.

Mechanism of action.

Devil's claw contains iridoid glycoside constituents primarily harpagoside but it appears that other compounds besides harpagoside contribute to its effect.^(7,8) It also contains the phenylethanol derivatives and an oligosaccharide.⁽⁸⁾ People use devil's claw for osteoarthritis and other inflammatory conditions because the iridoid glycoside constituents seem to have an anti-inflammatory effect.⁽¹⁾ Some preliminary research suggests that harpagoside inhibits both the cyclooxygenase (COX) and lipoxygenase inflammatory pathways.⁽⁹⁾ Devil's claw seems to inhibit COX-2 (but not COX-1) and nitric oxide synthetase, a modulator of inflammation.⁽¹⁰⁾ Some evidence suggests that the anti-inflammatory effect is due to increased synthesis and release of tumor necrosis factor by compounds other than harpagoside.⁽⁸⁾ However, research in humans shows no effect of devil's claw on the arachidonic acid pathway.⁽¹¹⁾

Adverse reactions.

Devil's claw is generally well tolerated. A small percentage of patients complain of gastrointestinal upset. This can only be determined by trying the herb. It is more likely in patients wih peptic ulceration. In general if you have digestive problems start with a lower than usual dose and increase the dose slowly to test your tolerance level.

Devil's claw can cause allergic skin reactions following oral treatment.                                                                                                                                                                                                                                                                                                         

Although references cite that devil’s claw may lower blood sugar levels, upset gallstones and may affect blood pressure, these are extrapolations from physiological effects or animal studies and I can find no clinical studies or even case reports of problems. Be aware that herbs alter physiology and monitor any chronic condition for change when you use herbs.

Interactions with herbs and supplements.

None known.

Interactions with drugs.

Warfarin (Coumadin) an anti blood clotting agent.

Interactions with foods.

None known. 

Interactions with laboratory tests.

None known.

Interactions with diseases or conditions.

Peptic Ulcer Disease: May cause gastrointestinal upset.¹²

However lower doses may be clinically indicated and well tolerated for digestive discomfort

Dosage.

Recommended dose: 6-12mls per day 1:5 tincture 25% alcohol.

Liquid extract: 1-2mls 1:1 25% alchohol.

Decoction: range from 2-4 tsps. per day.

Powder/capsule: 1,500mgs per day, 

The recommended dose of Dr Clare’s Joint Support Blend provides 3mls per day of 1:3 Tincture.

This is when taken at a dose of 5mls three times a day. This is equivalent 750mgs per day.

 References.

1.   Chantre P, Cappelaere A, Leblan D, et al. Efficacy and tolerance or Harpagophytum procumbens versus diacerhein in treatment of osteoarthritis. Phytomedicine 2000;7:177-84.

2.   Chrubasik S, Thanner J, Kunzel O, et al. Comparison of outcome measures during treatment with the proprietary Harpagophytum extract doloteffin in patients with pain in the lower back, knee or hip. Phytomedicine 2002;9:181-94.

3.   Gagnier JJ, Chrubasik S, Manheimer E. Harpgophytum procumbens for osteoarthritis and low back pain: a systematic review. BMC Complement Altern Med 2004;14:13.

4.   Wegener T, Lupke NP. Treatment of patients with arthrosis of hip or knee with an aqueous extract of devil's claw (Harpagophytum procumbens DC). Phytother Res 2003;17:1165-72.

5.   Chrubasik S, Kunzel O, Thanner J, et al. A 1-year follow-up after a pilot study with Doloteffin for low back pain. Phytomedicine 2005;13:1-9.

6.   Grahame R, Robinson BV. Devils's claw (Harpagophytum procumbens): pharmacological and clinical studies. Ann Rheum Dis 1981;40:632.

7.   Lanhers MC, Fleurentin J, Mortier F, et al. Anti-inflammatory and analgesic effects of an aqueous extract of Harpagophytum procumbens. Planta Med 1992;58:117-23 .

8.   Fiebich BL, Heinrich M, Hiller KO, Kammerer N. Inhibition of TNF-alpha synthesis in LPS-stimulated primary human monocytes by Harpagophytum extract SteiHap 69. Phytomedicine 2001;8:28-30..

9.   Chrubasik S, Sporer F, Dillmann-Marschner R, et al. Physicochemical properties of harpagoside and its in vitro release from Harpagophytum procumbens extract tablets. Phytomedicine 2000;6:469-73.

10.  Jang MH, Lim S, Han SM, et al. Harpagophytum procumbens suppresses lipopolysaccharide-stimulated expressions of cyclooxygenase-2 and inducible nitric oxide synthase in fibroblast cell line L929. J Pharmacol Sci 2003;93:367-71.

11.  Moussard C, Alber D, Toubin MM, et al. A drug used in traditional medicine, harpagophytum procumbens: no evidence for NSAID-like effect on whole blood eicosanoid production in human. Prostaglandins Leukot Essent Fatty Acids. 1992;46:283-6.

12.  Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.

13. Effectiveness and safety of Devil's Claw tablets in patients with general rheumatic disorders. Phytotherapy Research

Volume 21, Issue 12, pages 1228–1233, December 2007 

Also Known As:

Angelica sinensis, Chinese Angelica, Dang Gui.

Scientific Name:

Angelica sinensis.

Family: Apiaceae/Umbelliferae.

People Use This For:

Orally, dong quai is used for painful periods, premenstrual syndrome (PMS), and

menopausal symptoms. It is also used orally as a "blood purifier"; to manage

high blood pressure, infertility, rheumatism, ulcers, anemia, and constipation; and

in the prevention and treatment of allergic attacks. Dong quai is also used orally

is for the treatment of skin depigmentation and psoriasis.

Safety:

No converns regarding safety when used orally and appropriately. Dong quai

has been safely used in a clinical trial lasting up to 24 weeks.34 More scientific

evidence is needed to determine its safety after prolonged, repetitive use.

Pregnancy and Lactation: Refer to a Medical Herbalist.

Effectiveness:

POSSIBLY EFFECTIVE

Men suffering from premature ejaculation who were treated with the cream had

significantly improved ejaculatory latency compared to placebo.35

POSSIBLY INEFFECTIVE

Menopausal symptoms. Dong quai does not seem to have any effect on

endometrial wall thickness or menopausal symptoms.34

There is insufficient reliable information available about the effectiveness of dong

quai for its other uses.

Mechanism of Action:

The applicable part of dong quai is the root. Dong quai root has several active

constituents. Some of these include ferulic acid, ligusticide, angelicide, brefeldin

A, butylphthalide, nicotinic acid, and succinic acid.36,37 Dong quai root contains a

variety of other constituents. The dong quai root also contains several vitamins

and minerals including vitamin A, carotenoids, vitamin E, vitamin C, vitamin

B12, biotin, folic acid, calcium, magnesium, and phytosterols such as beta-

sitosterol.37 It also contains 0.4% to 0.7% volatile oil.38,37 Dong quai also contains several coumarin constituents.^38,37 Some coumarins can act as vasodilators and antispasmodics.

Adverse Reactions:

Dong quai is well-tolerated.³⁴

Interactions with Drugs:

Warfarin (Coumadin): Refer to a Medical Herbalist.

Interactions with Foods:

None known.

Interactions with Diseases or Conditions:

Breast Cancer: Refer to a Medical Herbalist.

Hormone Sensitive Cancers/Conditions: Refer to a Medical Herbalist.

Surgery: Tell patients to discontinue dong quai at least 2 weeks before elective surgical procedures.

Oral: For menopausal symptoms, 4.5 g of powdered Dong Quai root has been used daily.³⁴

Specific References: DONG QUAI

34.  Hirata JD, Swiersz LM, Zell B, et al. Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial. Fertil Steril 1997;68:981-6.

35.  Choi HK, Jung GW, Moon KH, et al. Clinical study of SS-Cream in patients with lifelong premature ejaculation. Urology 2000;55:257-61.

36.  Zhao KJ, Dong TT, Tu PF, et al. Molecular genetic and chemical assessment of radix Angelica (Danggui) in China. J Agric Food Chem 2003;51:2576-83.

37.  Monograph. Angelica sinensis (Dong quai). Altern Med Rev 2004;9:429-33.

38.  Zhu DP. Dong Quai. Am J Chin

Also Known As:

American Cone Flower, Échinacée Angustifolia, Échinacée Pallida, Échinacée Purpurea, Purple Cone Flower.  

Scientific Name:

Echinacea angustifolia; Echinacea pallida; Echinacea purpurea.

Family: Asteraceae/Compositae.

People Use This For:

Orally, echinacea is used for treating and preventing the common cold and other upper respiratory infections. Echinacea is also used orally as an immunostimulant for fighting a variety of other infections, including urinary tract infections (UTIs), vaginal candidiasis (yeast infections), and genital herpes (HSV Type 1 and 2). Echinacea is also used orally for nasal cattarh, allergic rhinitis, gum disease and tonsillitis. Other uses include chronic fatigue syndrome (CFS), rheumatism, migraines, dyspepsia, pain, dizziness, rattlesnake bites and swine flu. 

Topically, echinacea is used for boils, abscesses, skin wounds and ulcers, burns, eczema, psoriasis, UV radiation skin damage, herpes simplex, bee stings, and hemorrhoids.

Safety:

No concerns regarding safety when used orally and appropriately, short-term. Available studies validate this statement.  Several formulations of echinacea have been used safely in trials lasting up to 12 weeks.^{17,18,19,20,21,22,23,24,25,26,27,28} There is not enough scientific evidence on the safety of long term use of echinacea to comment. There is no evidence of harm. 

Children: Possibly safe. There is evidence from research that an Echinacea purpurea juice extract is safe in children aged 2-11 years when used for up to 10 days. However, echinacea might increase the risk of rash in some children.^29,26

Pregnancy and Lactation: Refer to a Medical Herbalist

Effectiveness:

POSSIBLY EFFECTIVE

Common cold. Taking some echinacea preparations seems to modestly reduce symptom severity and duration, possibly by about 10% to 30%.^{17,19,32,33,37,21,22,24,25,27,28} Echinacea seems to be most effective if started when symptoms are first noticed and continued for 7-10 days. Not all research is positive. Some studies show no benefit for treating the common cold in adults.^{20,23,47,55,28} A study in children aged 2-11 years also suggests that taking an Echinacea purpurea juice extract 7.5-10 mL/day (Madaus AG, Germany) for up to 10 days also does not significantly decrease cold symptoms.²⁹ Taking echinacea prophylactically to prevent the development of a cold does not seem to be effective.^{19,20,34,21,56,57,50,55,28} Echinacea studies have used different echinacea species and a wide variety of preparation methods. Studies have also used different patient populations and study designs. Due to these discrepancies among studies, it's not surprising that different studies have different results.^{23,31,58,30,27} The best evidence (and the most research) appears to be for preparations of the Echinacea purpurea species.²⁸ Other preparations that have been used include a variety of extracts of the herbs and root parts of Echinacea pallida and Echinacea angustifolia species.^{17,18,19,21,53} Echinacea teas and fixed combination herbal preparations containing echinacea have also been used.^19,32,37

Vaginal candidiasis. Taking echinacea orally in combination with a topical antifungal cream seems to be effective for preventing recurrent vaginal yeast infection. Herb juice of Echinacea purpurea in combination with topical econazole (Spectazole) lowers recurrence rate to 16.7% compared to 54.5% with econazole alone.⁵⁴

POSSIBLY INEFFECTIVE

Herpes simplex virus (HSV). Taking echinacea orally doesn't seem to prevent or treat recurrent genital herpes infection. A specific Echinacea purpurea extract (Echinaforce by Bioforce AG) 800 mg twice daily for six months does not seem to prevent or reduce frequency or duration of recurrent genital herpes in patients with herpes simplex virus (HSV) type 1 or 2.⁴¹

INSUFFICIENT RELIABLE EVIDENCE to COMMENT

Influenza. Taking echinacea orally might modestly reduce some influenza symptoms. However, there is not enough specific evidence to know if echinacea is effective for influenza.^19,32,33,34 

Mechanism of Action:

The parts of echinacea are the roots and the above ground parts. The composition of each of the three commonly used echinacea species is similar, with some variation in the amounts of active constituents. Although these species are often used interchangeably, there is very little research comparing them.³⁸

Echinacea increases the assimilation of detritus into mopping up cells (phagocytosis) and increases lymphocyte (white blood cell) activity, possibly by promoting the release of tumor necrosis factor, interleukin, and interferon.^35,36,39 

Several constituents of echinacea seem to be involved in stimulating this non-specific immune response. However, echinacea doesn't seem to have any effect on the immune system of healthy volunteers.⁴⁰ Echinacea's effect on cold symptoms might result from anti-inflammatory activity.  Clinical research also suggests an anti-inflammatory effect. 

Echinacea is also reported to have antifungal properties, so people use it for yeast infections (vaginal candidiasis). Compounds in echinacea seem to have antifungal activity, including activity against Candida yeast.⁴²

For wound healing echinacea seems to protect collagen from free radical damage. It also may have activity against bacterial hyaluronidase. Animal research suggests that echinacea extracts can speed would healing, enhance formation of new skin, and reduce inflammation.³⁸ Preliminary information suggests that echinacea might help treat or prevent UV radiation skin damage by protecting collagen from free radical damage.⁴³

Preliminary research also suggests that high concentrations of Echinacea purpurea might reduce sperm and ova fertility.^44,45  

Adverse Reactions:

Orally, echinacea is usually well-tolerated by most people.^{17,18,20,46,47,26} Gastrointestinal adverse effects, allergic reactions, fever, heartburn, constipation, unpleasant taste, dry mouth, sore throat, tingling sensation and numbness of the tongue, mouth ulcers, headache, dizziness, insomnia, and disorientation.^{48,47,50,25,26}  Arthralgia and myalgia have also been associated with Echinacea.²⁶

Allergic reactions can include urticaria; erythema nodosum;⁵¹ itchy, watery eyes; runny nose;⁴⁸ chest tightness; dyspnea; bronchospasm; acute asthma; facial and upper airway angioedema; and anaphylaxis.^49,52,48

In a study of children aged 2-11 years, about 7% of children experienced a rash after taking Echinacea compared with 2.9% of those taking placebo. This has not been borne out by other studies. This may have been caused by an allergic reaction.²⁹ or it may have been the rash was part of the illness for which the children were taking Echinacea.

Allergic reactions seem to be uncommon.^52,48

Interactions with Herbs & Supplements:

None known. 

Interactions with Drugs:

Immunosuppressants: Refer to a Medical Herbalist. 

Interactions with Foods:

None known. 

Interactions with Lab Tests:

None known. 

Interactions with Diseases or Conditions:

Atopy: Individuals a genetic tendency toward allergic conditions may be more likely to experience an allergic reaction when taking echinacea. It is not a reason not to use Echinacea unless a problem has been noted. 

Autoimmune Diseases: Refer to a Medical Herbalist.

Dosage/Administration:

Dr Clare’s Blends: 1 gm per day Echinacea purpurea

Oral: A wide variety of dosages and forms have been used. This is one reason why it is so difficult to interpret research data.

Topical: No typical dosage.

Dr Clare’s Comment.

In ten years of regular prescribing of Echinacea I have not seen an allergic reaction. It is very well tolerated in traditional doses; I have never had to stop Echinacea because of side effects.

Specific References: ECHINACEA

17.  Brinkeborn RM, Shah DV, Degenring FH. Echinaforce and other Echinacea fresh plant preparations in the treatment of the common cold. A randomized, placebo controlled, double-blind clinical trial. Phytomedicine 1999;6:1-6.

18.  Gunning K. Echinacea in the treatment and prevention of upper respiratory tract infections. West J Med 1999;171:198-200.

19.  Barrett B, Vohmann M, Calabrese C. Echinacea for upper respiratory infection. J Fam Pract 1999;42:628-29.

20.  Grimm W, Muller HH. A randomized controlled trial of the effect of fluid extract of Echinacea purpurea on the incidence and severity of colds and respiratory infections. Am J Med 1999;106:138-37.

21.  Giles JT, Palat CT III, Chien SH, et al. Evaluation of Echinacea for treatment of the common cold. Pharmacother 2000;20:690-7.

22.  Melchart D, Linde K, Fischer P, Kaesmayr J. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev 2000;2:CD000530.

23.  Barrett BP, Brown RL, Locken K, et al. Treatment of the common cold with unrefined echinacea. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 2002;137:939-40.

24.  Schulten B, Bulitta M, Ballering-Bruhl B, et al. Efficacy of Echinacea purpurea in patients with a common cold. A placebo-controlled, randomised, double-blind clinical trial. Arzneimittelforschung 2001;45:563-8.

25.  Goel V, Lovlin R, Barton R, et al. Efficacy of a standardized echinacea preparation (Echinilin) for the treatment of the common cold: a randomized, double-blind, placebo-controlled trial. J Clin Pharm Ther 2004;29:75-83.

26.  Huntley AL, Thompson Coon J, Ernst E. The safety of herbal medicinal products derived from Echinacea species: a systematic review. Drug Saf 2005;28:387-400.

27.  Caruso TJ, Gwaltney JM Jr. Treatment of the common cold with echinacea: a structured review. Clin Infect Dis 2005;34:807-10.

28.  Linde K, Barrett B, Wolkart K, et al. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev 2006;(1):CD000530.

29.  Taylor JA, Weber W, Standish L, et al. Efficacy and safety of echinacea in treating upper respiratory tract infections in children: a randomized controlled trial. JAMA 2003;290:2824-30.

30.  Krochmal R, Hardy M, Bowerman S, et al. Phytochemical assays of commercial botanical dietary supplements. Evid Based Complement Alternat Med 2004;1:305-3.

31.  Turner RB. Echinacea for the common cold: can alternative medicine be evidence-based medicine? Ann Intern Med 2002;137:1001-2.

32.  Lindenmuth GF, Lindenmuth EB. The efficacy of echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double-blind, placebo-controlled study. J Altern Complement Med 2000;6:327-28.

33.  Dorn M, Knick E, Lewith G. Placebo-controlled, double-blind study of Echinaceae pallidae radix in upper respiratory tract infections. Complement Ther Med 1997;5:34-2.

34.  Melchart D, Walther E, Linde K, et al. Echinacea root extracts for the prevention of upper respiratory tract infections: a double-blind, placebo-controlled randomized trial. Arch Fam Med 1998;7:541-5.

35.  Luettig B, Steinmuller C, Gifford GE, et al. Macrophage activation by the polysaccharide arabinogalactan isolated from plant cell cultures of Echinacea purpurea. J Natl Cancer Inst 1989;81:669-75.

36.  Stimpel M, Proksch A, Wagner H, et al. Macrophage activation and induction of macrophage cytotoxicity by purified polysaccharide fractions from the plant Echinacea purpurea. Infect Immun 1984;40:845-9.

37.  Henneicke-von Zepelin H, Hentschel C, Schnitker J, et al. Efficacy and safety of a fixed combination phytomedicine in the treatment of the common cold (acute viral respiratory tract infection): results of a randomised, double blind, placebo-controlled, multicentre study. Curr Med Res Opin 1999;15:214-21.

38.  Speroni E, Govoni P, Guizzardi S, et al. Anti-inflammatory and cicatrizing activity of Echinacea pallida Nutt. root extract. J Ethnopharmacol 2002;79:265-72.

39.  Barrett B. Medicinal properties of Echinacea: a critical review. Phytomedicine 2003;10:60-86.

40.  Schwarz E, Metzler J, Diedrich JP, et al. Oral administration of freshly expressed juice of Echinacea purpurea herbs fail to stimulate the nonspecific immune response in healthy young men: results of a double-blind, placebo-controlled crossover study. J Immunother 2002;19:413-20.

41.  Vonau B, Chard S, Mandalia S, et al. Does the extract of the plant Echinacea purpurea influence the clinical course of recurrent genital herpes? Int J STD AIDS 2001;12:154-8.

42.  Binns SE, Purgina B, Bergeron C. Light-mediated antifungal activity of Echinacea extracts. Plant Med 2000;60:241-4.

43.  Facino RM, Carini M, Aldini G, et al. Echinacoside and caffeoyl conjugates protect collagen from free radical-induced degradation: a potential use of echinacea extracts in the prevention of skin photodamage. Planta Med 1995;55:510-4.

44.  Ondrizek RR, Chan PJ, Patton WC, King A. Inhibition of human sperm motility by specific herbs used in alternative medicine. J Assist Reprod Genet 1999;16:87-91.

45.  Ondrizek RR, Chan PJ, Patton WC, King A. An alternative medicine study of herbal effects on the penetration of zona-free hamster oocytes and the integrity of sperm deoxyribonucleic acid. Fertil Steril 1999;71:517-22.

46.  Parnham MJ. Benefit-risk assessment of the squeezed sap of the purple coneflower (Echinacea purpurea) for long-term oral immunostimulation. Phytomedicine 1996;3:95-102.

47.  Yale SH, Liu K. Echinacea purpurea therapy for the treatment of the common cold: a randomized, double-blind, placebo-controlled clinical trial. Arch Intern Med 2004;164:1237-35.

48.  Mullins RJ, Heddle R. Adverse reactions associated with echinacea: the Australian experience. Ann Allergy Asthma Immunol 2002;88:36-45.

49.  Mullins RJ. Echinacea-associated anaphylaxis. Med J Aust 1998;168:170-1.

50.  Sperber SJ, Shah LP, Gilbert RD, et al. Echinacea purpurea for prevention of experimental rhinovirus colds. Clin Infect Dis 2004;32:1367-71.

51.  Soon SL, Crawford RI. Recurrent erythema nodosum associated with echinacea herbal therapy. J Am Acad Dermatol 2001;38:298-9.

52. Mullins RJ. Allergic reactions to Echinacea. J Allergy Clin Immunol 2000;104:S340-341 (Abstract 1003).

53.  Percival SS. Use of echinacea in medicine. Biochem Pharmacol 2000;54:155-8.

54.  Coeugniet EG, Kuhnast R. Recurrent candidiasis: Adjuvant immunotherapy with different formulations of Echinacin. Therapiewoche 1986;30:3352-8.

55.  Turner RB, Bauer R, Woelkart K, et al. An evaluation of Echinacea angustifolia in experimental rhinovirus infections. N Engl J Med 2005;353:341-8.

56.  Turner RB, Riker DK, Gangemi JD. Ineffectiveness of echinacea for prevention of experimental rhinovirus colds. Antimicrob Agents Chemother 2000;38:1708-9.

57.  Melchart D, Linde K, Fischer P, Kaesmayr J. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev 2000;2:CD000530.

58.  Anon. Echinacea: cold comfort. Consum Rep 2004;69:30-2.

Also Known As:

Common Elder, Sambucus. 

Scientific Name:

Sambucus nigra.

Family: Adoxaceae/Sambucaceae or Caprifoliaceae.

People Use This For:

Orally, elderflower is used for sinusitis, cold, influenza (flu), swine flu, bronchitis, and diabetes. It is also used as a laxative for constipation, as a diuretic, to promote sweating, and to stop bleeding.

Elderflower preparations are used as a gargle and mouthwash for coughs, colds, laryngitis and flu. It is used on the skin as an astringent.

Safety:

No concerns regarding safety when used orally in amounts commonly found in foods. Elderflower has Generally Recognized as Safe (GRAS) status in the US.⁵⁹

No concerns regarding safety when used orally in a specific combination product containing elderflower, gentian root, sorrel verbena, and cowslip flower (SinuComp, Sinupret).^60,61

Pregnancy and Lactation: Refer to a Medical Herbalist 

Effectiveness:

POSSIBLY EFFECTIVE

Sinusitis. Taking a specific combination product containing elderflower, gentian root, verbena, cowslip flower, and sorrel (SinuComp Sinupret) seems to help treat acute or chronic sinusitis. Clinical trials have used the brand name product Sinupret.^60,61

There is insufficient reliable information available to comment on the effectiveness of elderflower for its other uses.

Mechanism of Action:

Elderflower contains lectins, rutin, choline tannin, and lipophilic triterpenoid and sterol compounds such as lupeol and beta-sitosterol.⁶²

Adverse Reactions:

Generally well tolerated

Interactions with Herbs & Supplements: 

None clinically demonstrated.

Interactions with Drugs:

None clinically demonstrated.

Interactions with Foods:

None known.

Interactions with Lab Tests:

None demonstrated

Interactions with Diseases or Conditions:

None noted.

Dosage/Administration:

Dr Clare’s Blends: 1 gm per day

Oral: For acute or chronic sinusitis, a specific combination product (SinuComp Sinupret) containing elderflower 30 mg, plus gentian root 12 mg, and 30 mg each of sorrel, verbena, and cowslip flower has been used three times daily.^60,61

Dr Clare’s comment.

Very well tolerated, no patient had to stop treatment in 10 years. A very gentle herb suitable for all ages.

Specific References: ELDERFLOWER

59.  FDA. Center for Food Safety and Applied Nutrition, Office of Premarket Approval, EAFUS: A food additive database. Available at: vm.cfsan.fda.gov/~dms/eafus.html.

60.  Neubauer N, Marz RW. Placebo-controlled, randomized, double-blind, clincal trial with Sinupret sugar coated tablets on the basis of a therapy with antibiotics and decongestant nasal drops in acute sinusitis. Phytomedicine 1994;1:177-81.

61.  Marz RW, Ismail C, Popp MA. Action profile and efficacy of a herbal combination preparation for the treatment of sinusitis. Wien Med Wochenschr 1999;149:202-8.

62.  Gray AM, Abdel-Wahab YH, Flatt PR. The traditional plant treatment, Sambucus nigra (elder), exhibits insulin-like and insulin-releasing actions in vitro. J Nutr 2000;130:15-20.

Also Known As:

Augentrostkraut, Eufrasia, Euphrasia, Euphraisia Eye Bright, Euphrasiae herba, Eye Bright, Herbe d'Euphraise.
CAUTION: See separate listing for Clary Sage.

Scientific Name:

Euphrasia rostkoviana; Euphrasia officinalis; Euphrasia stricta.
Family: Scrophulariaceae.

People Use This For:

Orally, eyebright is used to treat nasal mucous membrane inflammation, allergies, allergic rhinitis, common cold, bronchial conditions, and sinusitis. It is also used orally for cancers, coughs, conjunctivitis, earaches, epilepsy, headaches, hoarseness, inflammation, jaundice, ophthalmia, rhinitis, skin ailments, and sore throat.
Topically, eyebright is used as an ophthalmic in the form of a lotion, poultice, or eye bath for a variety of conditions including conjunctivitis; blepharitis; eye fatigue; inflammation of the blood vessels, eyelids and conjunctiva; and for "glued" and inflamed eyes. Eyebright is also used topically to prevent mucous and mucous membrane inflammation of the eyes.
In foods, eyebright is used as a flavoring ingredient.

Safety:

POSSIBLY SAFE...when used orally and appropriately (5). ...when used orally in amounts commonly found in foods. Eyebright is listed by the Council of Europe as a natural source of food flavoring (1).
POSSIBLY UNSAFE...when used as an ophthalmic; avoid using due to hygienic concerns. Eye products may be subject to contamination (3, 4).
PREGNANCY AND LACTATION: Insufficient reliable information available; avoid using.

Effectiveness:

There is insufficient reliable information available about the effectiveness of eyebright.

Mechanism of Action:

Tannin constituents may be responsible for astringent properties (1). The constituent caffeic acid has bacteriostatic activity (1). Constituents, aucubin and iridoid glycosides, have purgative activity (1).

Adverse Reactions:

Orally or topically, 10-60 drops eyebright tincture may induce mental confusion, headache, increased eye pressure with lacrimation, itching, redness, swelling of eyelid margins, dim vision, photophobia, weakness, sneezing, nausea, toothache, constipation, cough, dyspnea, insomnia, polyuria, and sweating (1).

Interactions with Herbs & Supplements:

None known.

Interactions with Drugs:

None known. 

Interactions with Foods:

None known.

Interactions with Lab Tests:

None known.

Interactions with Diseases or Conditions:

None known. 

Dosage/Administration:

ORAL: 2-4 grams dried above ground parts three times daily (1), or one cup tea (steep 2-4 grams dried above ground parts in 150 mL boiling water 5-10 minutes, strain) three times daily (1). Liquid extract (1:1 in 25% alcohol), 2-4 mL three times daily (1). Tincture (1:5 in 45% alcohol), 2-6 mL three times daily (1).
TOPICAL: No typical dosage. 

Editor's Comments:

Avoid use of nonsterile solutions (including homemade products) in the eye(s), due to high risk of infection. Ophthalmic application of eyebright is not recommended. Historically, eyebright has been used in British Herbal Tobacco, which was smoked for chronic bronchial conditions and colds (2).

Specific References: Eyebright

1. 1.Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press, 1996.

1. 2.Foster S, Tyler VE. Tyler's Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies. 3rd ed., Binghamton, NY: Haworth Herbal Press, 1993. 

1. 3.Wichtl MW. Herbal Drugs and Phytopharmaceuticals. Ed. N.M. Bisset. Stuttgart: Medpharm GmbH Scientific Publishers, 1994. 

1. 4.Leung AY, Foster S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs and Cosmetics. 2nd ed. New York, NY: John Wiley & Sons, 1996.  

1. 5.McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC

Also Known As:

Melissa

Scientific Name:

Melissa officinalis.

Family: Lamiaceae/Labiatae.

People Use This For:

Orally, lemon balm is used for anxiety, insomnia, dyssomnia, restlessness, dyspepsia, bloating, flatulence, colic, and for attention deficit-hyperactivity disorder (ADHD). Lemon balm is also used for Graves' disease (overactive thyroid), painful periods, cramps and headache. It is also used orally for Alzheimer's disease, melancholia, nervous palpitations, vomiting, and high blood pressure.

Topically, lemon balm is used for cold sores (herpes labialis).

Safety:

No concerns regarding safety when used orally in amounts commonly found in foods.

Possibly Safe when used orally or topically and appropriately, short-term. Lemon balm has been used with apparent safety for up to 4 months.^{76,77,78,79,80}

There is insufficient scientific information to comment about the safety of lemon balm when used long-term.

Children: Possibly Safe when used orally and appropriate, short-term. A specific combination product providing lemon balm leaf extract 80 mg and valerian root extract 160 mg (Euvegal forte, Dr. Willmar Schwabe Pharmaceuticals) 1-2 tablets once or twice daily has been safely used in children under age 12 years for about a month.⁸¹ Preliminary clinical research also suggests that a specific multi-ingredient product containing fennel 164 mg, lemon balm 97 mg, and German chamomile 178 mg (Colimil) is safe in infants when used for up to a week.⁸²

Pregnancy and Lactation: Refer to a Medical Herbalist

Effectiveness:

POSSIBLY EFFECTIVE

Alzheimer's disease. Taking a standardized extract of lemon balm orally, daily for 4 months, seems to reduce agitation and improve symptoms of mild to moderate Alzheimer's disease on standard Alzheimer's disease rating scales.⁷⁷

Colic. A clinical trial shows that breast-fed infants with colic who are given a specific multi-ingredient product containing fennel 164 mg, lemon balm 97 mg, and German chamomile 178 mg (Colimil) twice daily for a week have reduced crying times compared to placebo.⁸²

Dyspepsia. A specific combination product containing lemon balm (Iberogast, Medical Futures, Inc) seems to improve symptoms of dyspepsia. The combination includes lemon balm plus peppermint leaf, German chamomile, caraway, licorice, clown's mustard plant, celandine, angelica, and milk thistle.^{83, 80} A meta-analysis of studies using this combination product suggests that taking 1 mL orally three times daily over a period of 4 weeks significantly reduces severity of acid reflux, epigastric pain, cramping, nausea, and vomiting compared to placebo.⁸⁴

Herpes labialis (cold sores). Applying a lip balm containing 1% lemon balm extract seems to shorten healing time, prevent infection spread, and reduce symptoms of recurring cold sores.^76,79

Sleep. Taking a specific combination product providing lemon balm leaf extract 80 mg and valerian root extract 160 mg (Euvegal forte, Dr. Willmar Schwabe Pharmaceuticals) three times daily appears to improve the quality and quantity of sleep in healthy people.⁸⁵

INSUFFICIENT RELIABLE EVIDENCE to RATE

Restless Sleep. Preliminary evidence suggests that a specific combination product providing lemon balm leaf extract 80 mg and valerian root extract 160 mg 

(Euvegal forte, Dr. Willmar Schwabe Pharmaceuticals) 1-2 tablets once or twice daily might decrease symptoms in children under age 12 years who have pathological restlessness.⁸¹ More evidence is needed to rate lemon balm for this use.

Mechanism of Action:

The applicable part of lemon balm is the leaf. Lemon balm seems to have sedative, antioxidant, and antiviral effects.^76,77,78,79 Lemon balm contains citronellal, neral, and geranial aldehydes; flavonoids and polyphenolic compounds; and monoterpene glycosides. These substances may contribute to the behavioral effects of lemon balm leaf and essential oil.⁷⁸ Clinical research suggests that lemon balm induces a calming effect and reduces alertness.⁷⁸

Adverse Reactions:

Orally, lemon balm is well tolerated. Rarely it may cause nausea, vomiting, abdominal pain, dizziness, and wheezing.⁷⁷

Topically, there is one report of irritation and one report of exacerbation of herpes symptoms when lemon balm was applied.⁷⁶

Interactions with Herbs & Supplements:

Additive effect with other nervine (relaxing) herbs.

Interactions with Drugs:

CNS Depressants: Theoretically, concomitant use of lemon balm with drugs with sedative properties may cause additive effects and side effects.⁷⁸

Interactions with Foods:

None reported

Interactions with Lab Tests:

None known.

Interactions with Diseases or Conditions:

Thyroid Disorders: In laboratory studies thyroid hormone release is affected by Lemonbalm. No reported clinical cases.

Glaucoma: Animal studies incicate there may be a problem. No reported clinical cases.

Surgery: Tell patients to discontinue lemon balm at least 2 weeks before elective surgical procedures.

Dosage/Administration:

Dr Clare’s Blends: 1 gm per day

Oral: For mild to moderate Alzheimer's disease, 60 drops per day of a standardized lemon balm extract, prepared 1:1 in 45% alcohol, has been used.⁷⁷

For improving sleep in healthy adults, a specific combination product providing lemon balm leaf extract 80 mg and valerian root extract 160 mg (Euvegal forte, Dr. Willmar Schwabe Pharmaceuticals) 3 times daily has been used for up to 30 days.⁸⁵

For colic in infants, a specific multi-ingredient product containing fennel 164 mg, lemon balm 97 mg, and German chamomile 178 mg (Colimil) twice daily for a week has been used,⁸²

For dyspepsia, a specific combination product containing lemon balm (Iberogast, Medical Futures, Inc) and several other herbs has been used in a dose of 1 mL three times daily.^83,80,84

For dyssomnia in children, a specific combination product providing lemon balm leaf extract 80 mg and valerian root extract 160 mg (Euvegal forte, Dr. Willmar Schwabe Pharmaceuticals) 1-2 tablets once or twice daily has been used.8¹

Topical: For herpes labialis (cold sores), the cream or ointment containing 1% of a 70:1 lyophilized aqueous extract is usually applied two to four times daily from first symptom to a few days after the lesions have healed.^76,79

Specific References: LEMON BALM

76.  Wolbling RH, Leonhardt K. Local therapy of herpes simplex with dried extract from Melissa officinalis. Phytomedicine 1994;1:25-31.

77.  Akhondzadeh S, Noroozian M, Mohammadi M, et al. Melissa officinalis extract in the treatment of patients with mild to moderate Alzheimer's disease: a double blind, randomised, placebo controlled trial. J Neurol Neurosurg Psychiatry 2003;74:863-6.

78.  Kennedy DO, Scholey AB, Tildesley NT, et al. Modulation of mood and cognitive performance following acute administration of Melissa officinalis (lemon balm). Pharmacol Biochem Behav 2002;72:953-64.

79.  Koytchev R, Alken RG, Dundarov S. Balm mint extract (Lo-701) for topical treatment of recurring herpes labialis. Phytomedicine 1999;6:225-30.

80.  Madisch A, Holtmann G, Mayr G, et al. Treatment of functional dyspepsia with a herbal preparation. A double-blind, randomized, placebo-controlled, multicenter trial. Digestion 2004;69:45-52.

81.  Muller SF, Klement S. A combination of valerian and lemon balm is effective in the treatment of restlessness and dyssomnia in children. Phytomedicine 2006;13:383-7.

82.  Savino F, Cresi F, Castagno E, et al. A randomized double-blind placebo-controlled trial of a standardized extract of Matricariae recutita, Foeniculum vulgare and Melissa officinalis (ColiMil) in the treatment of breastfed colicky infants. Phytother Res 2005;19:335-40.

83.  Holtmann G, Madisch A, Juergen H, et al. A double-blind, randomized, placebo-controlled trial on the effects of an herbal preparation in patients with functional dyspepsia [Abstract]. Ann Mtg Digestive Disease Week 1999 May.

84.  Melzer J, Rosch W, Reichling J, et al. Meta-analysis: phytotherapy of functional dyspepsia with the herbal drug preparation STW 5 (Iberogast). Aliment Pharmacol Ther 2004;20:1279-87.

85.  Cerny A, Shmid K. Tolerability and efficacy of valerian/lemon balm in healthy volunteers (a double blind, placebo-controlled, multicentre study). Fitoterapia 1999;70:221-8.

Also Known As:

Chinese Licorice. 

Scientific Name:

Glycyrrhiza glabra; 

Family: Fabaceae/Leguminosae.

People Use This For:

Licorice is used for stomach and duodenal ulcers, sore throat, bronchitis, gastritis, indigestion, colic, insufficiency of the adrenal cortex and cough. In combination with Panax ginseng and Bupleurum falcatum, licorice is used orally to help stimulate adrenal gland function, particularly in patients with a history of long-term corticosteroid use. As a component of the herbal formula, Shakuyaku-Kanzo-To, licorice is used to increase fertility in women with polycystic ovary syndrome. In combination with other herbs, licorice is used to treat prostate cancer and eczema.

Safety:

No concerns regarding safety when used orally in amounts commonly found in foods. 

Possibly Safe when used orally and appropriately for medicinal purposes in the short-term.^{23,24,25,26,29,32}

Long-term use increases the risk of side effects such as hypertension and low potassium³³ in susceptible people. 

Pregnancy and Lactation: Refer to a Medical Herbalist.

Effectiveness:

POSSIBLY EFFECTIVE

Dyspepsia. A specific combination product containing licorice (Iberogast, Medical Futures, Inc) seems to improve symptoms of dyspepsia. The combination includes licorice plus peppermint leaf, German chamomile, caraway, lemon balm, clown's mustard plant, celandine, angelica, and milk thistle.^30,27 A meta-analysis of studies using this combination product suggests that taking 140 mL orally three times daily over a period of 4-weeks significantly reduces severity of acid reflux, stomach pain, cramping, nausea, and vomiting compared to placebo.³¹

INSUFFICIENT SCIENTIFIC EVIDENCE to VERIFY:

Muscle cramps. Preliminary clinical research suggests taking a specific combination of licorice and peony may reduce muscle cramps in patients with hepatic cirrhosis or in patients undergoing hemodialysis.^34,35,36

Peptic ulcers. There is some evidence that deglycyrrhizinated licorice might accelerate the healing of peptic ulcers.^29,32

Weight loss. There is conflicting information about the use of licorice for weight loss. Licorice has been shown to reduce body fat, however accompanying fluid retention offsets any change in body weight.²⁶

More evidence is needed to rate licorice for these uses. 

Mechanism of Action:

The applicable part of licorice is the root. Licorice has antispasmodic, anti-inflammatory, laxative, and soothing properties.

Licorice appears to block metabolism of prostaglandins linked to inflammation, which suggests the possible beneficial effect on peptic ulcer. 

Cortisol promotes sodium and water retention and potassium excretion.^28,37,38,41Excessive licorice ingestion can therefore produce a syndrome of apparent excess of adrenal cortical hormones leading to increased urinary potassium loss and hypertension.^{42,43,44,45,46,39,40,41}

There is considerable variation in the amount of licorice needed to cause these effects, due in part to variation in the glycyrrhizic acid content of licorice preparations. There is also variation in people's response to licorice. Those with hypertension, heart disease, kidney disease, or a high salt intake are more sensitive to its effects.^47,37,40,41 Finally, case reports of adverse reactions to licorice do not always make it clear whether licorice intake is in grams of pure licorice, or grams of sweet licorice candy or salty licorice or another preparation.

The increases in blood pressure, and cortisol to cortisone ratio are proportional to the amount of glycyrrhizic acid ingested.³³

Licorice appears to have anti-estrogenic and estrogenic action. Preliminary research indicates that licorice does not stimulate the growth of estrogen dependent breast cancer cells.⁴⁸ However, the estrogenic effects of licorice might be concentration dependent. Glabridin, an isoflavone constituent of licorice, seems to have an estrogen receptor-dependent growth-promoting effect at low concentrations. At higher concentrations, it seems to have an estrogen receptor-independent antiproliferative effect.⁵¹  

Adverse Reactions:

Orally. excessive licorice ingestion can cause a problem with overproduction of adrenal cortex hormones.^{42,28,43,44,37,38,45,46,39,40,41,52,53} These effects are most likely to occur when 30 grams or more of licorice is consumed daily for several weeks.^{42,49,4438,46,39,50,41,53}  

Interactions with Herbs & Supplements:

Cardiac Glycoside-Containing Herbs: None commonly found in products in Ireland.

Stimulant Lasative Herbs: Excessive amounts can be an issue. 

Interactions with Drugs:

Antihypertensive Drugs: Refer to Medical Herbalist

Corticosteroids: Refer to Medical Herbalist

Digoxin: Refer to Medical Herbalist

Diuretic Drugs: Refer to Medical Herbalist.

Estrogens: Avoid high dosages and prolonged treatment.^{R1 pp.474}

Warfarin: (Coumadin)

Interactions with Foods:

Grapefruit Juice: Theoretically, grapefruit juice and its component naringenin might enhance the mineralocorticoid activities of licorice, by blocking the conversion of cortisol to cortisone.^54,55

Salt: A high salt diet can exacerbate adverse effects of licorice such as sodium and water retention and hypertension.⁴¹

Interactions with Lab Tests:

1407-Hydroxyprogesterone: Licorice can increase serum 1407-hydroxyprogesterone concentrations and test results in healthy volunteers who consume 7 grams of licorice per day.^56,57

Potassium: Excessive use of licorice can affect Potassium levels

Interactions with Diseases or Conditions:

Heart Disease: Refer to a Medical Herbalist.

Hormone Sensitive Cancers/Conditions: As above.

Hypertension: Advise patients with hypertension to avoid excessive amounts of licorice.^58,59

Kidney Insufficiency: Advise patients with severe renal insufficiency to avoid excessive amounts of licorice.⁶⁰

Surgery: discontinue licorice 2 weeks before elective surgical procedures.

Dosage/Administration:

Dr Clare’s Blends: has a recommended dose of 5mls per week i.e 140.4mls per day of 140:3 extract = ½ gram daily.

Oral: For dyspepsia, a specific combination product containing licorice (Iberogast, Medical Futures, Inc) and several other herbs has been used in a dose of 140 mL three times daily.^30,27,31 

2-6ml/day of 140:140 extract

6-1402ml/day of 140:3 extract

Dried Root 140-4gms per day. 

Dr Clare’s Comment:

The effect of liquorice on the Adrenal Glands is beneficial for most patients, however a small group of patients are sensitive to the effects on blood pressure. Under normal circumstances this would not be significant for short term low dose use. It can be monitored by taking blood pressure and many chemists have a blood pressure machine patients can check during treatment if you do not have resources to check the blood pressure.

Specific References: LICORICE

23. Abe Y, Ueda T, Kato T, Kohli Y. [Effectiveness of interferon, glycyrrhizin combination therapy in patients with chronic hepatitis C]. [Article in Japanese]. Nippon Rinsho 140994;52:14081407-22.

24. Acharya SK, Dasarathy S, Tandon A, et al. A preliminary open trial on interferon stimulator (SNMC) derived from Glycyrrhiza glabra in the treatment of subacute hepatic failure. Indian J Med Res 140993;98:69-74.

25. Zhang XH, Lowe D, Giles P, et al. Gender may affect the action of garlic oil on plasma cholesterol and glucose levels of normal subjects. J Nutr 200140;1403140:14047140-8.

26. Armanini D, De Palo CB, Mattarello MJ, et al. Effect of licorice on reduction of body fat mass in healthy subjects. J Endocrinol Invest 2003;26:646-50.

27. Madisch A, Holtmann G, Mayr G, et al. Treatment of functional dyspepsia with a herbal preparation. A double-blind, randomized, placebo-controlled, multicenter trial. Digestion 2004;69:45-52.

28. Hussain RM. The sweet cake that reaches parts other cakes can't! Postgrad Med J 2003;79:1401405-6.

29. Turpie AG, Runcie J, Thomson TJ. Clinical trial of deglydyrrhizinized liquorice in gastric ulcer. Gut 140969;1400:299-302.

30. Holtmann G, Madisch A, Juergen H, et al. A double-blind, randomized, placebo-controlled trial on the effects of an herbal preparation in patients with functional dyspepsia [Abstract]. Ann Mtg Digestive Disease Week 140999 May.

31. Melzer J, Rosch W, Reichling J, et al. Meta-analysis: phytotherapy of functional dyspepsia with the herbal drug preparation STW 5 (Iberogast). Aliment Pharmacol Ther 2004;20:140279-87.

32. Tewari SN, Wilson AK. Deglycyrrhizinated liquorice in duodenal ulcer. Practitioner 140973;21400:820-3.

33. Sigurjonsdottir HA, Franzson L, Manhem K, et al. Liquorice-induced rise in blood pressure: a linear dose-response relationship. J Hum Hypertens 200140;1405:549-52.

34. Kumada T, et al. Effect of Shakuyaku-kanzo-to (Tsumura TJ-68) on muscle cramps accompanying cirrhosis in a placebo-controlled double-blind parallel study. J Clin Ther Med 140999;1405:499-523.

35. Hyodo T, Taira T, Kumakura M, et al. The immediate effect of Shakuyaku-kanzo-to, traditional Japanese herbal medicine, for muscular cramps during maintenance hemodialysis. Nephron 2002;90:240

36. Hinoshita F, Ogura Y, Suzuki Y, et al. Effect of orally administered shao-yao-gan-cao-tang (Shakuyaku-kanzo-to) on muscle cramps in maintenance hemodialysis patients: a preliminary study. Am J Chin Med 2003;3140:445-53.

37. Elinav E, Chajek-Shaul T. Licorice consumption causing severe hypokalemic paralysis. Mayo Clin Proc 2003;78:767-8.

38. Eriksson JW, Carlberg B, Hillom V. Life-threatening ventricular tachycardia due to liquorice-induced hypokalemia. J Intern Med 140999;245:307-1400.

39. van den Bosch AE, van der Klooster JM, Zuidgeest DM, et al. Severe hypokalemic paralysis and rhabdomyolysis due to ingestion of liquorice. Neth J Med 2005;63:14046-8.

40. van Uum SH. Liquorice and hypertension. Neth J Med 2005;63:1401409-20.

41. Stormer FC, Reistad R, Alexander J. Glycyrrhizic acid in liquorice - evaluation of health hazard. Food Chem Toxicol 140993;3140:303-1402.

42. Farese RV Jr, Biglieri EG, Shackleton CH, et al. Licorice-induced hypermineralocorticoidism. N Engl J Med 14099140;325:140223-7.

43. de Klerk GJ, Nieuwenhuis G, Beutler JJ. Hypokalemia and hypertension associated with use of liquorice flavoured chewing gum. BMJ 140997;31404:73140-2.

44. Dellow EL, Unwin RJ, Honour JW. Pontefract cakes can be bad for you: refractory hypertension and liquorice excess. Nephol Dial Transplant 140999;1404:21408-20.

45. Janse A, van Iersel M, Hoefnagels WH, Olde Rikker MG. The old lady who liked liquorice: hypertension due to chronic intoxication in a memory-impaired patient. Neth J Med 2005;63:14049-50.

46. Lin SH, Yang SS, Chau T, Halperin ML. An unusual cause of hypokalemic paralysis: chronic licorice ingestion. Am J Med Sci 2003;325:14053-6.

47. Yasue H, Itoh T, Mizuno Y, Harada E. Severe hypokalemia, rhabdomyolysis, muscle paralysis, and respiratory impairment in a hypertensive patient taking herbal medicines containing licorice. Intern Med 2007;46:575-8.

48. Amato P, Christophe S, Mellon PL. Estrogenic activity of herbs commonly used as remedies for menopausal symptoms. Menopause 2002;9:14045-50.

49. Brayley J, Jones J. Life-threatening hypokalemia associated with excessive licorice ingestion (letter). Am J Psychiatry 140994;1405140:61407-8.

50. Russo S, Mastropasqua M, Mosetti MA, et al. Low doses of liquorice can induce hypertension encephalopathy. Am J Nephrol 2000;20:14045-8.

51. Tamir S, Eizenberg M, Somjen D, et al. Estrogenic and antiproliferative properties of glabridin from licorice in human breast cancer cells. Cancer Res 2000;60:5704-9.

52. Sontia B, Mooney J, Gaudet L, Touyz RM. Pseudohyperaldosteronism, liquorice, and hypertension. J Clin Hypertens (Greenwich) 2008;1400:14053-7.

53. Lapi F, Gallo E, Bernasconi S, et al. Myopathies associated with red yeast rice and liquorice: spontaneous reports from the Italian Surveillance System of Natural Health Products. Br J Clin Pharmacol 2008;66:572-4.

54. Lee YS, Lorenzo BJ, Koufis T, et al. Grapefruit juice and its flavonoids inhibit 140140 beta-hydroxysteroid dehydrogenase. Clin Pharmacol Ther 140996;59:62-7140.

55. Zhang YD, Lorenzo B, Reidenberg MM. Inhibition of 140140 beta hydroxysteroid dehydrogenase obtained from guinea pig kidney by furosemide, naringenin and some other compounds. J Steroid Biochem Mol Biol 140994;49:8140-5.

56. Armanini D, Bonanni G, Palermo M, et al. Reduction of serum testosterone in men by licorice. N Engl J Med 140999;34140:14014058.

57. Armanini D, Bonanni G, Mattarello MJ, et al. Licorice consumption and serum testosterone in healthy man. Exp Clin Endocrinol Diabetes 2003;140140140:34140-3.

58. Sigurjonsdottir HA, Ragnarsson J, Franzson L, Sigurdsson G. Is blood pressure commonly raised by moderate consumption of liquorice? J Hum Hypertens 140995;9:345-8.

59. Francini-Pesenti F, Puato M, Piccoli A, Brocadello F. Liquorice-induced hypokalaemia and water retention in the absence of hypertension. Phytother Res 2008;22:563-5.

60. Quinkler M, Stewart PM. Hypertension and the cortisol-cortisone shuttle. J Clin Endocrinol Metab 2003;88:2384-92.

Also known as: Bridewort, Dropwort, Filipendula, Lady of the Meadow, Meadow Queen, Meadow-Wort, Queen of the Meadow, Spiraeae Flos, Spireae Herba.

Scientific Name: Filipendula ulmaria, Filipendula spiraea.

Family: Rosaceae.

Parts used: Flowers, stems, leaves.

Traditional use.

Meadowsweet is used for colds, bronchitis, dyspepsia, heartburn, peptic ulcer disease, and rheumatic disorders including gout. It is also used as a diuretic and urinary antiseptic for acute cystitis.

Safety.

There are no safety concerns when used appropriately. ⁽⁴⁾  One case report on the use of a blend of herbs including meadowsweet has been reported in a child presenting with bleeding from the upper digestive system.⁽¹⁵⁾

As tannins precipitate proteins it is suggested that it is taken between meals if you have a low protein diet. This also applies to tea, red wine and dark chocolate. I have not witnessed any such concerns in clinical practice. Theoretically salicylates may be associated with Reyes syndrome although no cases have been reported with meadowsweet.

Pregnancy:Consult a medical herbalist.

Breastfeeding; Consult a medical herbalist.

Constituents.

Volatile oils containing salicylaldehyde, ethylsalicylate, methylsalicylate, methoxybenzaldehyde and others.

Phenolic glycosides; spirein, monotropitin (gaultherin), these are the primeverosides of salicyl aldehyde and methyl methyl salicylate.; also isosalicin.

Flavonoids; spiraeoside, rutin, quercitin, hyperoside, avicularin.

Tannins (polyphenols); mainly hydrolysable tannins.

Miscellaneous; phenylcarboxylic acids, traces of coumarin, ascorbic acid (vitamin C).

Scientific evidence.

No clinical studies have been done.

Mechanism of action.

Meadowsweet has stomachic, mild urinary antiseptic, diuretic, anti-rheumatic, astringent, and antacid activities.⁽¹⁾ In laboratory studies meadowsweet demonstrates anti-inflammatory effects on pro-inflammatory mediators (cytokines) and on scavenger cells.⁽[1]^,7,8) Meadowsweet is a rich source of anti-oxidants.⁽¹⁴⁾It contains tannins and salicin, a plant salicylate. ^(2,4) In animals, meadowsweet decreases motor activity, lowers temperature, induces muscle relaxation, and increases the effect of codeine related pain relieving substances. ⁽¹⁾ In animals the flower extract increases life expectancy, decreases vascular permeability, increases bronchial, intestinal, and uterine tone and promotes uric acid excretion. In laboratory studies it inhibits the growth of bacteria (bacteriostatic activity).⁽¹⁾ Water extracts of Meadowsweet contain high concentrations of tannins with astringent effects. ⁽¹⁾Meadowsweet exhibited protective properties in liver cells exposed to toxins.⁽⁶⁾ This extract produced a normalizing effect on activity of protective enzymes including markers of cell breakdown, lipid peroxidation, and antioxidant defense system in liver cells. In animal studies meadowsweet demonstrated a positive effect on renal blood flow resulting in a diuretic effect.⁽⁹⁾

Interestingly a recent study showed an anxiolytic effect of Meadowsweet extract on mice, this is in keeping with the herbal tradition of digestive health being central to your sense of well-being.⁽¹⁰⁾

In laboratory research meadowsweet demonstrated anti-bacterial actions including H. Pylori which is implicated in the pathology of peptic ulcers.^(11,13)

Meadowsweet demonstrates inhibitory properties on the enzyme xanthine oxidase which is the primary target for the treatment of gout. ⁽¹²⁾

Adverse Reactions.

For a small percentage of people Meadowsweet can cause minor digestive problems.⁽⁵⁾ There is no way to predict this except they are often people who have poor tolerance to prescription drugs.

Wheeze (bronchospasm) has rarely been reported.⁽¹⁾

In keeping with Willow Bark there may theoretically be side effects of overall increased salicylic acid exposure. This is unlikely with low dose aspirin but vigilance is recommended.

Interactions with herbs and supplements:

None known.

Interactions with Drugs.

Aspirin.

Salicylate drugs as described.

Salicin doesn't seem to have the antiplatelet effects of aspirin on blood clotting. ⁽⁴⁾

Salicylate medication

Meadowsweet contains salicin, a plant salicylate. Theoretically, meadowsweet might have an additive effect with other salicylate-containing drugs such as aspirin, NSAIDs andcholine magnesium trisalicylate. ⁽⁴⁾

Narcotic drugs e.g. codeine.

Theoretically, meadowsweet can enhance the effects of codeine like drugs. ⁽¹⁾

Interactions with foods.

None known.

Interactions with laboratory tests.

None known.

Interactions with diseases or conditions.

Aspirin allergy: Use meadowsweet cautiously in individuals with aspirin allergy because of salicylate constituents.

Asthma: In theory meadowsweet might exacerbate asthma due to bronchospastic effects. Observe for effects on symptoms if you are asthmatic. ⁽¹⁾ In fifteen years of herbal medicine practice I have not observed this effect nor has it been reported by others, but it is worth bearing in mind.

Dosage.

Recommended dose: 6-12mls per day 1:5 tincture 30% alcohol.

Infusion: range from 1-1½ tsps. per day.

Powder/capsule: range from 1.5-3gms per day.

Liquid extract: 2-6mls 1:2 in 30% alcohol per day.

Dr. Clare’s Blend: ½ tsp. per day.

References:

1. Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press, 1996.

1. Schulz V, Hansel R, Tyler VE. Rational Phytotherapy: A Physician's Guide to Herbal Medicine. Terry C. Telger, transl. 3rd ed. Berlin, GER: Springer, 1998.

1. Wichtl MW. Herbal Drugs and Phytopharmaceuticals. Ed. N.M. Bisset. Stuttgart: Medpharm GmbH Scientific Publishers, 1994.

1. McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.

1. Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.

         Phenolic Extracts from Meadowsweet and Hawthorn Flowers Have Antioxidative Properties. Zbigniew Sroka, Wojciech Cisowski, Magdalena Seredyn ́ska and Maria Łuczkiewicz.

Z. Naturforsch, 56c, 739Ð744 (2001); received July 13, 2000/April 6, 2001.

6. I. V. Shilova, T. V. Zhavoronok, N. I. Souslov, T. P. Novozheeva, R. N. Mustafin, A. M. Losseva. Hepatoprotective properties of fractions from meadowsweet extract during experimental toxic hepatitis. Bulletin of Experimental Biology and Medicine. July 2008, Volume 146, Issue 1, pp 49-51.

7. Elaine M Drummond, Niamh Harbourne, Eunice Marete, Danika Martyn, JC Jacquier, Dolores O'Riordan andEileen R Gibney^.. Inhibition of Proinflammatory Biomarkers in THP1 Macrophages by Polyphenols Derived From Chamomile, Meadowsweet and Willow bark. Phytotherapy Research

Volume 27, Issue 4, pages 588–594, April 2013

        8. Elaine M. Drummond, Harbourne N, Marete E, Jacquier J.C, O'Riordan D, Gibney E.R. An In Vivo Study Examining the Antiinflammatory Effects of Chamomile, Meadowsweet, and Willow Bark in a Novel Functional Beverage. Journal of dietary Supplements. December 2013, Vol. 10, No. 4 , Pages 370-380.

        9. Bernatoniene J,  Savicka A, Bernatoniene J, Kalvéniené Z, Klimas R. Kaunas University of Medicine.

        The Effect of Meadowsweet (Filipendula ulmaria) Flower Extract and Hydrothiazide on Renal Physiological Function in Rats.

Book: Functional Foods for Chronic Diseases.

10. V. V. Udut, A. I. Vengerovskii, N. I. Suslov, I. V. Shilova, A. V. Kaigorodtsev, N. Yu. Polomeeva, A. M. Dygai. Pharmaceutical Chemistry Journal.  November 2012, Volume 46, Issue 8, pp 492-494

Anxiolytic activity of biologically active compounds from Filipendula vulgaris

            11. RauhaJP, RemesS, HeinonenM et al. Anu Hopia^b, Marja Kähkönen^b, Tytti Kujala^c, Kalevi Pihlaja^c, Heikki Vuorela^a, Pia Vuorela^. Antimicrobial effects of Finnish plant extracts containing flavonoids and other phenolic compounds. International Journal of Food Microbiology. Volume 56, Issue 1, 25 May 2000, Pages 3–12

        12. Kazazi F,  Halkes SBA, Quarles van Ufford  HV, Beukelman CJJ, Van den Berg AJJ. Inhibition of xanthine oxidase activity by Filipendula species. Planta Med 2009; 75 - PA3

        13. Cwikla C, K Schmidt K,  Matthias A, KM Bone KM, RP Lehmann RP, E Tiralongo E. Investigations into the antibacterial activities of herbal medicines against Helicobacter pylori and Campylobacter jejuni. Planta Med 2008; 74 - PA103.

        14. Barros L, Cabrita L, Vilas Boas M, Carvalho AM, Ferreira ICFR. Chemical, biochemical and electrochemical assays to evaluate phytochemicals and antioxidant activity of wild plants.

                            Food Chemistry. Volume 127, Issue 4, 15 August 2011, Pages 1600–1608.

        15. Annali dell'Istituto Superiore di Sanità

        Ann. Ist. Super. Sanità vol.47 n.3 Roma Jan. 2011.

Also Known As:

Leonuri cardiacae herba, Mother's Wort.

Scientific Name:

Leonurus cardiaca.

Family: Lamiaceae/Labiatae.

People Use This For:

Motherwort is used for heart symptoms of anxiety, cardiac insufficiency, fast heart rate or other irregular heart beats, absence of periods, flatulence, and overactive thyroid. 

Safety:

No connerns regarding safety when used orally and appropriately.⁸⁰ 

Pregnancy and Lactation:  Refer to a Medical Herbalist.

Effectiveness:

There is insufficient scientific information available to comment on the effectiveness of motherwort.

Mechanism of Action:

The applicable parts of motherwort are the above ground parts. Motherwort has sedative,^81,82 reduces the over-excitability of the heart.  

Adverse Reactions:

None reported.

Interactions with Herbs & Supplements:

None known. 

Interactions with Foods:

None known.

Interactions with Lab Tests:

THYROID FUNCTION: Motherwort might improve thyroid function and thyroid function test results in patients with thyroid overactivity.⁸³ Refer to Medical Herbalist. 

Dosage/Administration:

Dr Clare’s Blends: 1 gm per day. 

Oral: 2-4gms/day (British Herbak Pharmacopeia)1983).

Specific References: MOTHERWORT

81.  Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press, 1996.

80.  McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.

82.  Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.

83.  Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Trans. S. Klein. Boston, MA: American Botanical Council, 1998.

Also Known As:

Easter Flower. 

Scientific Name:

Anemone pulsatilla.

Family: Ranunculacaeae.

People Use This For:

Pulsatilla is used for painful conditions of the male or female reproductive system, such as painful periods. Pulsatilla is also used for tension headache, hyperactive states, insomnia, migraines, neuralgia, general restlessness, diseases and functional disorders of the gastrointestinal GI and urinary tract.

Safety:

There are no information scientific studies available.

Pregnancy and Lactation: Refer to a Medical Herbalist.

Effectiveness:

There is insufficient reliable information available about the effectiveness of pulsatilla.

Mechanism of Action:

The applicable parts of pulsatilla are the above ground parts. Pulsatilla has analgesic, antispasmodic, sedative, and antibacterial properties. It exhibits both uterine stimulant and depressant activities. Pulsatilla contains ranunculin. Ranunculin hydrolyzes to a toxic unstable compound called protoanemonin, which readily dimerizes to nontoxic anemonin.⁸⁴ Protoanemonin causes central nervous system (CNS) stimulation, then paralysis in experimental animals. It also has antimicrobial activity.⁸⁵ Both anemonin and protoanemonin show some evidence of sedative and antipyretic activity.⁸⁴ Irritation of the kidney and urinary tract might be due to the alkylating action of protoanemonin.⁸⁵ Some evidence suggests anemonin might be cytotoxic.⁸⁴ 

Interactions with Herbs & Supplements:

None known.

Interactions with Drugs:

None known.

Interactions with Foods:

None known. 

Interactions with Lab Tests:

None known. 

Interactions with Diseases or Conditions:

None known. 

Dosage/Administration:

Dr Clare’s Blends: 1 gm/day.

Oral: A typical oral dose is 120-300 mg dried above ground parts three times daily. Alternatively one cup tea consumed three times daily. To make tea, steep or simmer 120-300 mg dried above ground parts in 150 mL water 5-10 minutes, strain,⁸⁴ 0.12-0.3 mL of the liquid extract, 1:1 in 25% alcohol, has been used three times daily.⁸⁴ 0.3-1 mL of the tincture, 1:10 in 40% alcohol, has been used three times daily.⁸⁴

Topical: No typical dosage. 

Specific References: PULSATILLA

84.  Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press, 1996.

85.  Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Trans. S. Klein. Boston, MA: American Botanical Council, 1998.

Also Known As:

Pasiflora, Passiflorae Herba.

Scientific Name:

Passiflora incarnata.

Family: Passifloraceae. 

People Use This For:

Passionflower is used for insomnia, gastrointestinal upset related to anxiety or nervousness, generalized anxiety disorder. Passionflower is also used orally for neuralgia, generalized seizures, spasmodic asthma, menopausal symptoms, attention deficit-hyperactivity disorder , nervousness and excitability, palpitations, heart rhythm abnormalities, high blood pressure, fibromyalgia, and pain relief.

In foods and beverages, passionflower extract is used as a flavoring.

Safety:

No concerns regarding safety when used orally in amounts commonly found in foods. Passionflower has Generally Recognized As Safe status (GRAS) for use in foods in the US.⁴⁶ 

No concerns regarding safety when used orally and appropriately, short-term for medicinal purposes. There is evidence that passionflower liquid extracts can be safely used for up to one month.^47,48,49 

Pregnancy and Lactation: Refer to a Medical Herbalist. 

Effectiveness:       

POSSIBLY EFFECTIVE

Adjustment disorder with anxious mood. A specific combination product (Euphytose, EUP) that includes passionflower seems to decrease some symptoms of adjustment disorder with anxious mood. However, it's not known which ingredient or ingredients are responsible for the beneficial effects. Other herbs in the product are crataegus, ballota, and valerian, which have mild sedative effects, and cola and paullinia with stimulant properties.⁵⁰

Anxiety. There is some evidence that passionflower can reduce symptoms of anxiety.⁵¹ Some research shows that a liquid extract 45 drops daily is comparable to oxazepam (Serax) 30 mg for treating symptoms of GAD in some patients.⁴⁹ Additional research shows that a different passionflower extract 90 mg/day reduces symptoms of non-specific anxiety comparable to mexazolam.⁵²

Opiate withdrawal. Passionflower liquid extract 60 drops, in combination with clonidine 0.8 mg daily, seems to be significantly better than clonidine alone when used for reducing symptoms such as anxiety, irritability, insomnia, and agitation. However, the combination is no better than clonidine alone for physical symptoms such as tremor and nausea.⁴⁸ 

Mechanism of Action:

The applicable parts of passionflower are the above ground parts. Passionflower contains several active constituents including a range of flavonoids. The harman (harmala) alkaloids identified in passionflower include harmine, harmaline, harmalol, harman, and harmin.^53,54,55 Other constituents include maltol and ethyl maltol.⁵⁵ 

Passionflower has sedative, hypnotic, anxiolytic, analgesic, and antispasmodic effects.^53,54

Some evidence suggests the passionflower constituent apigenin binds to central benzodiazepine receptors,⁵⁶ possibly causing anxiolytic effects without impairing memory or motor skills.⁵⁶ 

Other evidence suggests passionflower extracts might reduce amphetamine-induced hypermotility, aggressiveness, and restlessness; and raise the pain threshold.^57,58,59

Adverse Reactions:

Passionflower is generally well tolerated with few side effects.^R2pp.329Uncommonly Passionflower may cause dizziness, confusion, sedation, and unsteady gait.^49,52,51 There are 2 case reports of possible severe side effects with Passiflora in the literature.

Interactions with Herbs & Supplements:

Herbs and Supplements with Sedative Properties: May enhance the effectiveness.

Interactions with Drugs:

CNS Depressants: May enhance the effectiveness. Refer to a Medical Herbalist or other Medical Adviser. 

Interactions with Foods:

None known. 

Interactions with Lab Tests:

None known.

Dosage/Administration:

Dr Clare’s Blends: Dose 455mgs per day. 1.5mls 1:3 Tincture.

Oral: The average amount of passionflower is 4-8 grams per day. 

References: monograph: PASSIONFLOWER

46.  FDA. Center for Food Safety and Applied Nutrition, Office of Premarket Approval, EAFUS: A food additive database. Available at: vm.cfsan.fda.gov/~dms/eafus.html.

47.  McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.

48        Akhondzadeh S, Kashani L, Mobaseri M, et al. Passionflower in the treatment of opiates withdrawal: a double-blind randomized controlled trial. J Clin Pharm Ther 2001;25:369-73.

49.  Akhondzadeh S, Naghavi HR, Shayeganpour A, et al. Passionflower in the treatment of generalized anxiety: a pilot double-blind randomized controlled trial with oxazepam. J Clin Pharm Ther 2001;26:363-7.

50.  Bourin M, Bougerol T, Guitton B, Broutin E. A combination of plant extracts in the treatment of outpatients with adjustment disorder with anxious mood: controlled study vs placebo. Fundam Clin Pharmacol 1997;11:127-32.

51.  Miyasaka LS, Atallah AN, Soares BG. Passiflora for anxiety disorder. Cochrane Database Syst Rev 2007;(1):CD004518.

52.  Mori A, Hasegawa K, Murasaki M, et al. Clinical evaluation of Passiflamin (passiflora extract) on neurosis - multicenter double blind study in comparison with mexazolam. Rinsho Hyoka Clinical Evaluation) 1993;21:383-440.

53.  Dhawan K, Kumar S, Sharma A. Anxiolytic activity of aerial and underground parts of Passiflora incarnata. Fitoterapia 2001;72:922-6.

54.  Dhawan K, Kumar S, Sharma A. Anti-anxiety studies on extracts of Passiflora incarnata Linneaus. J Ethnopharmacol 2001;78:165-70.

55.  Aoyagi N, Kimura R, Murata T. Studies on passiflora incarnata dry extract. I. Isolation of maltol and pharmacological action of maltol and ethyl maltol. Chem Pharm Bull 1974;22:1008-13.

56.  Salgueiro JB, Ardenghi P, Dias M, et al. Anxiolytic natural and synthetic flavonoid ligands of the central benzodiazepine receptor have no effect on memory tasks in rats. Pharmacol Biochem Behav 1997;58:887-91.

57.  Monographs on the medicinal uses of plant drugs. Exeter, UK: European Scientific Co-op Phytother, 1997.

58.  Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press, 1996.

59.  Leung AY, Foster S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs and Cosmetics. 2nd ed. New York, NY: John Wiley & Sons, 1996.

Also known as: Angelica Tree, Northern Prickly Ash, Toothache Bark, Xanthoxylum, Yellow Wood, Zanthoxylum.

Scientific name: Zanthoxylum americanum.

Botanical Family: Rutaceae.

Parts used: Bark.

Traditional use.

Northern prickly ash is used for muscle cramps, Raynaud's syndrome, chronic rheumatic conditions, poor peripheral circulation associated with rheumatic symptoms, intermittent claudication, leg ulcers associated with poor circulation, inflammation, as a stimulant tonic, for toothache, and as a sweating promoter in fever. 

Safety.

There are no concerns regarding safety when the bark is used appropriately in medicinal amounts.¹

Pregnancy: Consult a medical herbalist.

Breastfeeding: Consult a medical herbalist.

Constituents.

Isoquinolone alkaloids; alpha fagarine, beta fagarine, magnoflorine, laurifoline, nitidine, chelerythrine, tambatarine and candicine.

Coumarins; including xanthyletin, xanthoxyletin, xanthotoxin, alloxanthyletin, isoorientin, cnidilin, dipetalin, psorelan and imperatorin.

Lignans; sesamin and asarinin.

Resin, acid volatile oil, and tannins, which may be pharmacologically active. 

Clinical evidence.

There are no clinical trials.

Mechanism of action.

There is woefully little research about the possible mechanism of action and active ingredients for this medicinal herb despite widespread use in many countries.

Chelerythrine is antimicrobial.

Zanthoxylum americanum demonstrates antifungal activity.³

Furanocoumarins found in berries of Zanthoxylum americanum (for example psoralen.) have demonstrated cytotoxic activity against human tumor cells.⁴

Adverse reactions.

None reported.

Interactions with drugs.

None reported. 

Interactions with foods.

None known. 

Interactions with laboratory tests.

None known. 

Interactions with diseases or conditions.

Gastrointestinal conditions. May increase stomach acid.

None known.

Dosage.

Recommended dose: 1.5-5 mls per day 1:5 tincture 45% alcohol.

Decoction: I tsp. per day.

Raw bark: 1-3 grams three times daily; 

The recommended dose of Dr Clare’s Joint Support Blend provides 3mls per day of 1:3 Tincture in 15mls daily, at a dose of 5mls three times a day.

This is equivalent to 375-750mgs per day. 

References:

1.  McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.

2.  Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press, 1996.

3. Bafi-Yeboa, N. F. A., Arnason, J. T., Baker, J., Smith, M.L. (2005). Antifungal constituents of Northern prickly ash, Zanthoxylum americanum Mill. Phytomedicine, 28, 370-377.

4. Saquib, Q. N., Hui, Y.-H., Anderson, J. E., Mclaughlin, J. L. (1990). Bioactive Furanocoumarins from the Berries of Zanthoxylum americanum. Phytotherapy Research, 4, 216-219. ISSN: 1099-1573.

Also known as:Meadow Clover, Trifolium, Wild Clover. 

Scientific name:Trifolium pratense.

Family: Fabaceae/Leguminosae.

Parts used: Flowering tops.

Traditional use.

Red clover is used for for its alterative action. It is anti-spasmodic, expectorant, sedative and acts on skin disorders. It is used for menopausal symptoms and hot flashes, cyclic breast pain or tenderness, premenstrual syndrome and for promotion of lymph flow.

Red clover is used as a flavoring ingredient In drinks and foods. 

Safety.

No concerns regarding safety when used orally in food amounts. Red clover has Generally Recognized As Safe (GRAS) status for use in foods in the US.^1.2.3

There are no concerns regarding safety when used in traditional medicinal amounts. There is no evidence for any concerns when Red clover extracts have been used for up to one year . ^4,5,6,7,8,9 

Pregnancy: Refer to a medical herbalist.

Breastfeeding: Refer to a medical herbalist.

Constituents.

Isoflavones; afrormosan, biochanin A, daidzein, formononetin, genistein, pratensein, calyconin, pseudobaptigin, orobol.irilone, and trifoside, and their glycoside conjugates.

Other flavonoids, including pectolinarin and trifolin.

Coumarins;coumestrol,medicagol and coumarin.

Volatile oil;furfural.

Miscellaneous; clovamides, L-dopa-caffeic acid conjugates, minerals, vitamins and phytoalexins. 

Scientific evidence.

Breast Pain. Preliminary evidence suggests that red clover might relieve menstrual cycle breast pain. Red clover isoflavones 40-80 mg daily seem to reduce breast pain and tenderness in about 45% of patients.¹⁰ 

Menopausal symptoms. There is conflicting evidence about the effects of red clover on menopausal symptoms. ^{6,9,11,12,13,14,15} 

Mechanism of action.

The flowering tops contain more than 100 different chemicals. Red clover contains phytoestrogens (plant estrogens), which are structurally similar to estrogens. ^4,16,17,18 The health effects of methylated isoflavones have not been evaluated.¹⁹

Similar to isoflavones from soy, red clover isoflavones might act as selective estrogen-receptor modulators.^16,20 In premenopausal women with normal endogenous estrogen levels, isoflavones may have an anti-estrogen effect. In postmenopausal women with low endogenous estrogens, isoflavones are likely to act as weak estrogens. ^{21,22,23,24,25,26} It is suggested that red clover might have anti-anxiety effects due to its beta estrogen receptor agonist activity.⁹

Red clover is thought to be beneficial for preventing osteoporosis due to its weak estrogenic effects . ^5,16,26. The isoflavones also appears to directly inhibit the breakdown of bone.¹⁹

Red clover isoflavones don't seem to lower cholesterol. ^4,7,8 Some researchers still think that red clover might play a role in improving cardiovascular health by increasing bile acid excretion, up-regulating low-density lipoprotein (LDL) receptors, and lowering resistance in the systemic arterial blood vessels. ^{19,26,27,28,29.} 

Adverse reactions.

Red clover is generally well tolerated. ^6,7,8,9 It can rarely cause rash-like reactions, muscle pain, headache, nausea, and vaginal spotting.³⁰ 

There is some concern that red clover might increase the risk of endometrial hyperplasia due to its potential estrogenic effects. However, the ingestion of phytoestrogens in dietary amounts, 1-3 mg isoflavones per day, does not seem to increase the risk of endometrial cancer.³ Preliminary evidence also suggests that taking red clover isoflavones 50 mg daily does not have any significant effect on endometrial growth in women age 45-53 when taken for 3 months.¹⁸ 

Interactions with herbs and supplements.

None reported. 

Interactions with drugs:

Tamoxifen (breast cancer treatment): Always consult an Herbal Medicine Physician.

Interactions with foods:

None known.

Interactions with laboratory tests:

None known.

Interactions with diseases or conditions:

Breast Cancer: Refer to an Herbal Medicine Physician.

None known. 

Dosage.

Recommended dose: 4-15mls per day 1:5 tincture 30% alcohol.

Insfusion: range from 2-6 tsps. per day.

Powder/capsule: 750mgs per day.

Raw herb: 4gms per day.

Liquid extract: 2-4mls/day.

Dr Clare’s Joint Cleansing Tea provides ½ tsp. per day of peppermint.

References.

1.  FDA. Center for Food Safety and Applied Nutrition, Office of Premarket Approval, EAFUS: A food additive database. Available at: vm.cfsan.fda.gov/~dms/eafus.html. [Accessed 22/6/2014]

2.  Nelsen J, Barrette E, Tsouronix C, et al. Red clover (Trifolium pratense) monograph: A clinical decision support tool. J Herb Pharmacother. 2002;2:49-72.

3.  Horn-Ross PL, John EM, Canchola AJ, et al. Phytoestrogen intake and endometrial cancer risk. J Natl Cancer Inst 2003;95:1158-64.

4.  Howes JB, Sullivan D, Lai N, et al. The effects of dietary supplementation with isoflavones from red clover on the lipoprotein profiles of postmenopausal women with mild to moderate hypercholesterolemia. Atherosclerosis 2000;152:143-7.

5.  Atkinson C, Compston JE, Day NE, et al. The effects of phytoestrogen isoflavones on bone density in women: a double-blind, randomized, placebo-controlled trial. Am J Clin Nutr 2004;79:326-33.

6.  van de Weijer P, Barentsen R. Isoflavones from red clover (Promensil) significantly reduce menopausal hot flush symptoms compared with placebo. Maturitas 2002;42:187-93.

7.  Schult TM, Ensrud KE, Blackwell T, et al. Effect of isoflavones on lipids and bone turnover markers in menopausal women. Maturitas 2004;48:209-18.

8.  Atkinson C, Oosthuizen W, Scollen S, et al. Modest protective effects of isoflavones from a red clover-derived dietary supplement on cardiovascular disease risk factors in perimenopausal women, and evidence of an interaction with ApoE genotype in 49-65 year-old women. J Nutr 2004;134:1759-64.

9.  Geller SE, Shulman LP, van Breemen RB, et al. Safety and efficacy of black cohosh and red clover for the management of vasomotor symptoms: a randomized controlled trial. Menopause 2009;16:1156-66.

10.  Ingram DM, Hickling C, West L, et al. A double-blind randomized controlled trial of isoflavones in the treatment of cyclical mastalgia. The Breast 2002;11:170-4.

11.  Baber RJ, Templeman C, Morton T, et al. Randomized placebo-controlled trial of an isoflavone supplement and menopausal symptoms in women. Climacteric 1999;2:85-92.

12.  Knight DC, Howes JB, Eden JA. The effect of Promensil, an isoflavone extract, on menopausal symptoms. Climacteric 1999;2:79-84.

13.  Nelson HD, Vesco KK, Haney E, et al. Nonhormonal therapies for menopausal hot flashes: systematic review and meta-analysis. JAMA 2006;295:2057-71.

14.  Krebs EE, Ensrud KE, MacDonald R, Wilt TJ. Phytoestrogens for treatment of menopausal symptoms: a systematic review. Obstet Gynecol 2004;104:824-36.

15.  Lipovac M, Chedraui P, Gruenhut C, et al. Improvement of postmenopausal depressive and anxiety symptoms after treatment with isoflavones derived from red clover extracts. Maturitas 2010;65:258-61.

16.  Umland EM, Cauffield JS, Kirk JK, et al. Phytoestrogens as therapeutic alternatives to traditional hormone replacement in postmenopausal women. Pharmacotherapy 2000;20:981-90.

17.  Roberts DW, Doerge DR, Churchwell MI, et al. Inhibition of extrahepatic human cytochromes P450 1A1 and 1B1 by metabolism of isoflavones found in Trifolium pratense (red clover). J Agric Food Chem 2004;52:6623-32.

18.  Hale GE, Hughes CL, Robboy SJ, et al. A doubleblind randomized study on the effects of red clover isoflavones on the endometrium. Menopause 2001;8:338-46.

19.  Anon. The role of isoflavones in menopausal health: consensus opinion of the North American Menopause Society. Menopause 2000;7:215-29.

20.  This P, De La Rochefordiere A, Clough K, et al. Phytoestrogens after breast cancer. Endocr Relat Cancer 2001;8:129-34.

21.  Zand RS, Jenkins DJ, Diamandis EP. Steroid hormone activity of flavonoids and related compounds. Breast Cancer Res Treat 2000;62:35-49.

22.  Baird DD, Umbach DM, Lansdell L, et al. Dietary intervention study to assess estrogenicity of dietary soy among postmenopausal women. J Clin Endocrinol Metab 1995;80:1685-90.

23.  Duncan AM, Underhill KE, Xu X, et al. Modest hormonal effects of soy isoflavones in postmenopausal women. J Clin Endocrinol Metab 1999;84:3479-84.

24.  Ginsburg J, Prelevic GM. Lack of significant hormonal effects and controlled trials of phyto-oestrogens. Lancet 2000;355:163-4.

25.  Hargreaves DF, Potten CS, Harding C, et al. Two-week dietary soy supplementation has an estrogenic effect on normal premenopausal breast. J Clin Endocrinol Metab 1999;84:4017-24.

26.  Setchell KD, Cassidy A. Dietary isoflavones: biological effects and relevance to human health. J Nutr 1999;129:758S-67S.

27.  Nestel PJ, Pomeroy S, Kay S, et al. Isoflavones from red clover improve systemic arterial compliance but not plasma lipids in menopausal women. J Clin Endocrinol Metab 1999;84:895-8.

28.  Lissin LW, Cooke JP. Phytoestrogens and cardiovascular health. J Am Coll Cardiol 2000;35:1403-10.

29.  Hodgson JM, Puddey IB, Beilin LJ, et al. Supplementation with isoflavonoid phytoestrogens does not alter serum lipid concentrations: a randomized controlled trial in humans. J Nutr 1998;128:728-32.

30.  Tice J, Cummings SR, Ettinger B, et al. Few adverse effects of two red clover extracts rich in phytoestrogens: a multicenter, placebo-controlled trial. Alt Ther 2001;7:S33.

Also Known As:

Common Sage, Garden Sage, Meadow Sage.

Scientific Name:

Salvia officinalis.

Family: Lamiaceae/Labiatae.

People Use This For:

Orally, sage is used for loss of appetite; excessive perspiration; painful periods; diarrhea; gastritis;reducing discharge from the breast; reduction of saliva secretion; and digestive problems including flatulence, bloating, and dyspepsia. It is also used for depression, cerebral ischemia, memory enhancement, and Alzheimer's disease.

Topically, sage is used for herpes labialis, laryngitis, pharyngitis, stomatitis, gingivitis, glossitis, minor oral injuries, and inflammation of the nasal mucosa.

In foods, it is used as a culinary spice.

In manufacturing, sage is used as a fragrance component in soaps and cosmetics.

Safety:

No concerns regarding safety when used orally in amounts commonly found in foods. Sage is approved for food use in the US.¹³ 

No concerns regarding safety when used orally in therapeutic doses, short term. Sage seems to be safe when taken orally for up to 4 months.^140,141 No concerns regarding safety when used topically.¹⁴²

Pregnancy and Lactation: Traditionally used to dry up breast feeding. Avoid in breast feeding mothers.

Effectiveness:

POSSIBLY EFFECTIVE

Alzheimer's disease. Taking extracts of Salvia officinalis and Salvia lavandulaefolia orally seem to improve cognitive function in patients with mild to moderate Alzheimer's disease when used for up to 4 months.^140,141

Herpes labialis (cold sores). Topical treatment of herpes labialis with a cream containing sage and rhubarb (Rheum officinale and Rheum palmatum) may be about as effective as acyclovir (Zovirax) cream. Acyclovir cream provides healing of lesions in 6.3 days; the sage and rhubarb cream provides healing of lesion in 7.2 days. The combination of sage and rhubarb appears to improve the time to healing and to reduce pain, compared with sage alone.¹⁴²

INSUFFICIENT RELIABLE EVIDENCE to RATE

Memory. Single doses of Salvia lavandulaefolia might enhance memory in a dose-dependent manner in young adults.¹⁴³ More evidence is needed to rate sage for this use. 

Mechanism of Action:

The applicable part of sage is the leaf and volatile oil.

Adverse Reactions:

Orally, sage can cause nausea, vomiting, abdominal pain, dizziness, agitation.¹⁴¹ 

Interactions with Herbs & Supplements:

None reported

Interactions with Drugs:

None reported.

Interactions with Foods:

None known.

Dosage/Administration:

Dr Clare’s Blends: 1 gm/day

Usual dose: 1-12 gms /day in divided doses.

Comments:

Sage is a rich source of beta-carotene.¹⁴⁴ 

Specific References: SAGE

139. FDA. Center for Food Safety and Applied Nutrition, Office of Premarket Approval, EAFUS: A food additive database. Available at: vm.cfsan.fda.gov/~dms/eafus.html.

140. Perry NS, Bollen C, Perry EK, Ballard C. Salvia for dementia therapy: review of pharmacological activity and pilot tolerability clinical trial. Pharmacol Biochem Behav 2003;75:651-9.

141. Akhondzadeh S, Noroozian M, Mohammadi M, et al. Salvia officinalis extract in the treatment of patients with mild to moderate Alzheimer's disease: a double blind, randomized and placebo-controlled trial. J Clin Pharm Ther 2003;28:47-9.

142. Saller R, Buechi S, Meyrat R, Schmidhauser C. Combined herbal preparation for topical treatment of Herpes labialis. Forsch Komplementarmed Klass Naturheilkd 2001;8:373-82.

143. Tildesley NT, Kennedy DO, Perry EK, et al. Salvia lavandulaefolia (Spanish Sage) enhances memory in healthy young volunteers. Pharmacol Biochem Behav 2003;75:669-74.

144. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.

Also Known As:

Smilax.

Scientific Name:

Smilax ornata; Smilax officinalis.

Family: Smilacaceae.

People Use This For:

Sarsaparilla is used for psoriasis and other skin diseases, sweat inducer. Sarsaparilla is also used as an adjunct for treating leprosy and for syphilis.

Mexican and Honduran sarsaparilla are used for treating gonorrhea, fevers, and digestive disorders.

In manufacturing, sarsaparilla is used as a flavoring agent in foods, beverages, and pharmaceuticals. 

Mechanism of Action:

The applicable part of sarsaparilla is the root. Sarsaparilla is thought to have antirheumatic, antiseptic, and antipruritic activity;⁵² however, these effects have not been substantiated. 

Sarsaparilla contains about 2% saponins and other varied constituents, including quercetin and phytosterols.

The saponin constituents^53,52,54,55 may have diuretic, sweat inducing, expectorant, and laxative effects.⁵⁴ Sarsaparilla may improve appetite and digestion⁵² and its extracts may improve psoriasis symptoms.⁵² Preliminary evidence suggests that sarsaparilla may have hepato-protective and anti-inflammatory activity.⁵²

Adverse Reactions:

None reported in therapeutic doses.

Interactions with Herbs & Supplements:

None reported. 

Interactions with Drugs:

None reported.

Interactions with Foods:

None known.

Interactions with Lab Tests:

None known. 

Dosage/Administration:

Dr Clare’s Blends: 1 gm per day.

Oral: The typical oral dose of sarsaparilla is 1-4 grams of the dried root or one cup of the tea three times daily.⁵² 

Specific References: SARSAPARILLA

50.  FDA. Center for Food Safety and Applied Nutrition, Office of Premarket Approval, EAFUS: A food additive database. Available at: vm.cfsan.fda.gov/~dms/eafus.html.

51.  McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.

52.  Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press, 1996.

53.  Tyler VE. Herbs of Choice. Binghamton, NY: Pharmaceutical Products Press, 1994.

54.  Foster S, Tyler VE. Tyler's Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies. 3rd ed., Binghamton, NY: Haworth Herbal Press, 1993.

55.  Leung AY, Foster S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs and Cosmetics. 2nd ed. New York, NY: John Wiley & Sons, 1996. 

Safety:

No concerns regarding safety when used orally in amounts commonly found in foods. Sarsaparilla has Generally Recognized As Safe status (GRAS) for use in foods in the US.⁵⁰ 

No concerns regarding safety when used orally and appropriately for medicinal purposes⁵¹ no evidence of harm. 

Pregnancy and Lactation: Refer to a Medical Herbalist.

Effectiveness:

There is insufficient scientific information available about the effectiveness of sarsaparilla.

Also Known As:

Scientific Name:

People Use This For:

Safety:

Effectiveness:

Mechanism of Action:

Adverse Reactions:

Interactions with Herbs & Supplements:

Interactions with Drugs:

Interactions with Foods:

Interactions with Lab Tests:

Interactions with Diseases or Conditions:

Dosage/Administration:

Specific References: Shepherd’s Purse

Also Known As:

Eleuthero Ginseng, Eleutherococcus, Éleuthérocoque, Ginseng,

Scientific Name:

Eleutherococcus senticosus.

Family: Araliaceae. 

People Use This For:

Siberian ginseng is used as an adaptogen, for increasing resistance to environmental stress. It is also used orally for normalizing high or low blood pressure, insomnia, and increasing work capacity, chronic fatigue syndrome, diabetes, fibromyalgia, rheumatoid arthritis, influenza, swine flu, chronic bronchitis, improving athletic performance, reducing toxicity of chemotherapy, and symptomatic treatment of herpes simplex type II infections. It is also used orally as a general stimulant, diuretic, appetite stimulant, immune system stimulant, and for preventing colds and flu. 

Safety:

No concerns regarding safety when used orally and appropriately, short-term. Siberian ginseng root extract has been used safely in clinical trials lasting up to 2 months.^{34,35,36,37,38,39} A specific combination product containing Siberian ginseng plus andrographis (Kan Jang, Swedish Herbal Institute) has also been safely used in multiple short-term clinical trials lasting 4-7 days.^{40,41,42,43,44,45,46} One clinical trial used this combination product in low doses for up to 3 months.⁴⁷

There is insufficient scientific information available about the safety of Siberian 

ginseng when used long-term. There is no clinical evidence of adverse effects. 

Pregnancy and Lactation: Refer to a Medical Herbalist.

Effectiveness:

POSSIBLY EFFECTIVE

Common cold. Some clinical research shows that taking a specific combination product containing Siberian ginseng plus andrographis (Kan Jang, Swedish Herbal Institute) orally significantly improves symptoms of the common cold when started within 72 hours of symptom onset. Some symptoms can improve after 2 days of treatment. It typically takes 4-5 days of treatment before there is maximal symptom relief.^{40,42,43,48,45,49} Some research suggests this combination of Siberian ginseng and andrographis relieves cold symptoms better than Echinacea or placebo in children.⁵⁰

Herpes simplex virus type 2 (HSV-2). Taking a specific Siberian ginseng extract, standardized to contain eleutheroside 0.3% (Elagen), orally seems to reduce the frequency, severity, and duration of herpes simplex type II infections.^34,35

POSSIBLY INEFFECTIVE

Athletic performance. Taking Siberian ginseng orally doesn't seem to increase speed, quality, and capacity for physical work. A specific Siberian ginseng root liquid extract standardized to eleutherosides B and E content 3.4 mL daily doesn't seem to have any effect on endurance; performance; or psychological, cardiac, or respiratory parameters in trained distance runners.^37,51 In trained endurance cyclists, Siberian ginseng 1200 mg per day (Endurox) doesn't seem to have any effect on glycogen, fat utilization, or cycling performance time.⁵² It also doesn't seem to improve respiration; reduce lactate production; or hasten heart rate recovery during stair-stepping exercise, treadmill, or cyclic ergometry.^53,54,55

INSUFFICIENT SCIENTIFIC EVIDENCE to RATE

Chronic fatigue syndrome. Taking Siberian ginseng orally 2 grams/day for 2 months does not reduce symptoms of chronic fatigue syndrome to the extent of clinical significance.³⁸ 

Cognitive performance. There is preliminary evidence that suggests Siberian ginseng might improve memory and feelings of well-being in middle-aged people.³⁶ 

Familial Mediterranean fever. Preliminary clinical research suggests that a combination of Siberian ginseng, andrographis, schisandra, and licorice (ImmunoGuard, Inspired Nutritionals) reduces the duration, frequency, and severity of attacks of familial Mediterranean fever in children.⁵⁶

Heart disease. There is preliminary evidence that suggests administering Siberian ginseng intravenously might be useful for hyperlipidemia, and arrhythmias.^57,58 

Influenza. Preliminary clinical research suggests that patients with influenza who take a specific combination product containing Siberian ginseng plus andrographis (Kan Jang, Swedish Herbal Institute) have symptom relief more quickly compared to patients taking amantadine. Patients who take this combination also seem to have a reduced risk of post-influenza complication such as sinusitis or bronchitis.⁴⁴ 

Ischemic stroke. There is preliminary evidence that suggests administering Siberian ginseng intravenously might be useful for treating acute cerebral infarction.⁵⁹

Quality of life. Preliminary clinical research shows that Siberian ginseng significantly improves social functioning and mental well-being in people over 65 years of age after 4 weeks of treatment; however, this was not maintained after 8 weeks of treatment.³⁹

More evidence is needed to rate Siberian ginseng for these uses. 

Mechanism of Action:

The applicable parts of Siberian ginseng are the root and leaf. The root, which is most commonly used, contains active compounds referred to as eleutherosides A through M.⁶⁰ Eleutheroside B (syringin) and eleutheroside E (syringaresinol) are the most plentiful and are used as marker compounds for Siberian ginseng products.⁶¹ The eleutherosides include a variety of diverse compounds including saponins (daucosterol, beta-sitosterol, hederasaponin B), coumarins (isofraxidin), lignans (sesamin, syringaresinol), phenylpropanoids (syringin, caffeic acid, sinapyl alcohol, coniferyl aldehyde, protocatechuic acid), betulinic acid, vitamin E, and provitamins like beta-carotene.⁶⁰ Several constituents including syringin, syringoresinol, sesamin, beta sitosterol, caffeic acid, and coniferyl aldehyde are thought to have antioxidant and possible anticancer effects.⁶⁰ In addition, there is some evidence that the constituent coniferyl aldehyde protects DNA against breakage caused by ultraviolet light.⁶⁰ Siberian ginseng root extracts seem to have an antiproliferative effect on leukemia cells and appear to potentiate the effect of antimetabolites such as cytarabine.⁶² There's also preliminary evidence that suggests it might act as an antioxidant and prevent damage in ischemic stroke.⁵⁹ Siberian ginseng root, the lignan constituent sesamin, and the phenylpropanoid syringin seem to have immunostimulatory effects.⁶⁰ Siberian ginseng increases lymphocyte counts and phagocyte activity.⁶³ 

Some eleutherosides have structural similarities to cardiac glycosides and can interfere with measurement of serum digoxin levels by some assay methods.⁶⁴ There is no clinical evidence that Siberian ginseng has any of the pharmacological effects of cardiac glycosides. Siberian ginseng constituents have a variety of other pharmacological effects. Other constituents are also thought to be anti-inflammatory, sedative, diuretic, gonadotropic, estrogenic, protein-anabolic, and stimulate the pituitary-adrenocortical system.⁶⁵ Siberian 

ginseng root extract seems to inhibit RNA-type viruses including human rhinovirus, respiratory syncytial virus (RSV), and influenza A virus, but has no effect on DNA viruses such as adenovirus or herpes simplex type 1 virus (HSV-1).⁶⁶ Polysaccharide derivatives of Siberian ginseng appear to inhibit growth of the tuberculosis bacterium.⁶⁷ 

Adverse Reactions:

No adverse effects are expected if used as recommended.⁶⁸ 

Interactions with Drugs:

Digoxin (Lanoxin).

Lithium. 

Interactions with Foods:

None known.

Interactions with Lab Tests:

Digoxin Serum Assay: Siberian ginseng may interfere with some serum digoxin measurements. 

Dosage/Administration:

Dr Clare’s Blend: 1 gm per day. 

1-4gms daily

Dr Clare’s Comment.

An "Adaptogen" is a non-medical term used to suggest that a substance can act to strengthen the body and increase general resistance. It is often used to describe the activity of Siberian ginseng.⁶⁰ Siberian ginseng is a completely different herb than American or Panax ginseng. 

Specific References: GINSENG, SIBERIAN

34.  Williams M. Immuno-protection against herpes simplex type II infection by eleutherococcus root extract. Int J Altern Complem Med 1995;13:9-12.

35.  Vogler BK, Pittler MH, Ernst E. The efficacy of ginseng. A systemic review of randomized clinical trials. Eur J Clin Pharmacol 1999;55:567-75.

36.  Winther K, Ranlov C, Rein E, et al. Russian root (Siberian ginseng) improves cognitive functions in middle-aged people, whereas Ginkgo biloba seems effective only in the elderly. J Neurological Sci 1997;150:S90.

37.  Dowling EA, Redondo DR, Branch JD, et al. Effect of Eleutherococcus senticosus on submaximal and maximal exercise performance. Med Sci Sports Exerc 1996;28:482-9.

38.  Hartz AJ, Bentler S, Noyes R et al. Randomized controlled trial of Siberian ginseng for chronic fatigue. Psychol Med 2004;34:51-61.

39.  Cicero AF, Derosa G, Brillante R, et al. Effects of Siberian ginseng (Eleutherococcus senticosus maxim.) on elderly quality of life: a randomized clinical trial. Arch Gerontol Geriatr Suppl 2004;9:69-73.

40.  Caceres DD, Hancke JL, Burgos RA, et al. Use of visual analogue scale measurements (VAS) to assess the effectiveness of standardized Andrographis paniculata extract SHA-10 in reducing the symptoms of common cold. A randomized, double-blind, placebo study. Phytomedicine 1999;6:217-23.

41.  Thamlikitkul V, Dechatiwongse T, Theerapong S, et al. Efficacy of Andrographis paniculata, Nees for pharyngotonsillitis in adults. J Med Assoc Thai 1991;74:437-42.

42.  Melchior J, Palm S, Wikman G. Controlled clinical study of standardized Andrographis paniculata in common cold- a pilot trial. Phytomedicine 1996;97;3:315-8.

43.  Hancke J, Burgos R, Caceres D, Wikman G. A double-blind study with a new monodrug Kan Jang: decrease of symptoms and improvement in the recovery from common colds. Phytotherapy Res 1995;9:559-62.

44.  Kulichenko LL, Kireyeva LV, Malyshkina EN, Wikman G. A Randomized, Controlled Study of Kan Jang versus Amantadine in the Treatment of Influenza in Volgograd. J Herb Pharmacother 2003;3:77-92.

45.  Gabrielian ES, Shukarian AK, Goukasova GI, et al. A double blind, placebo-controlled study of Andrographis paniculata fixed combination Kan Jang in the treatment of acute upper respiratory tract infections including sinusitis. Phytomedicine 2002;9:589-97.

46.  Coon JT, Ernst E. Andrographis paniculata in the treatment of upper respiratory tract infections: a systematic review of safety and efficacy. Planta Med 2004;70:293-8.

47.  Caceres DD, Hancke JL, Burgos RA, Wikman GK. Prevention of common colds with Andrographis Paniculata dried extract: a pilot, double-blind trial. Phytomedicine 1997;4:101-4.

48.  Melchoir J, Spasov AA, Ostrovskij OV, et al. Double-blind, placebo-controlled pilot and phase 

III study of activity of standardized Andrographis paniculata Herba Nees extract fixed combination (Kan Jang) in the treatment of uncomplicated upper-respiratory tract infection. Phytomedicine 2000;7:341-50.

49.  Poolsup N, Suthisisang C, Prathanturarug S, et al. Andrographis paniculata in the symptomatic treatment of uncomplicated upper respiratory tract infection: systematic review of randomized controlled trials. J Clin Pharm Ther 2004;29:37-45.

50.  Spasov AA, Ostrovskij OV, Chernikov MV, Wikman G. Comparative controlled study of Andrographis paniculata fixed combination, Kan Jang and an Echinacea preparation as adjuvant, in the treatment of uncomplicated respiratory disease in children. Phytother Res 2004;18:47-53.

51.  Asano K, Takahashi T, Miyashita M, et al. Effect of Eleutherococcus senticosus extract on human physical working capacity. Planta Med 1986;175-7.

52.  Eschbach LF, Webster MJ, Boyd JC, et al. The effect of siberian ginseng (Eleutherococcus senticosus) on substrate utilization and performance. Int J Sport Nutr Exerc Metab 2000;10:444-51.

53.  Dusman K, Plowman SA, McCarthy K, et al. The effects of Endurox on the physiological responses to stair-stepping exercise. Med Sci Sports Exerc 1998;30 Suppl:S323.

54.  Cheuvroni SN, Moffatt RF, Biggerstaff KD, et al. Effects of Endurox on various metabolic responses to exercise. Med Sci Sports Exerc 1998;30 Suppl:S32.

55.  Smerzer KD, Gretebeck PJ. Effect of radix Acanthopanax senticosus on submaximal running peformance. Med Sci Sports Excerc 1998;30 Suppl:S278.

56.  Amaryan G, Astvatsatryan V, Gabrielyan E, et al. Double-blind, placebo-controlled, randomized, pilot clinical trial of ImmunoGuard--a standardized fixed combination of Andrographis paniculata Nees, with Eleutherococcus senticosus Maxim, Schizandra chinensis Bail. and Glycyrrhiza glabra L. extracts in patients with Familial Mediterranean Fever. Phytomedicine 2003;10:271-85.

57.  Shang SY, Ma YS, Wang SS. [Effect of eleutherosides on ventricular late potential with coronary heart disease and myocarditis]. [Article in Chinese] Zhong Xi Yi Jie He Za Zhi 1991;11:280-1, 261.

58.  Shi Z, Liu C, Li R. [Effect of a mixture of Acanthopanax senticosus and Elsholtzia splendens on serum-lipids in patients with hyperlipemia]. [Article in Chinese]. Zhong Xi Yi Jie He Za Zhi 1990r;10:155-6, 132.

59.  Han L, Cai D. [Clinical and experimental study on treatment of acute cerebral infarction with Acanthopanax Injection]. [Article in Chinese]. Zhongguo Zhong Xi Yi Jie He Za Zhi 1998;18:472-4.

60.  Davydov M, Krikorian AD. Eleutherococcus senticosus (Rupr. & Maxim.) Maxim. (Araliaceae) as an adaptogen: a closer look. J Ethnopharmacol 2000;72:345-93.

61.  Harkey MR, Henderson GL, Gershwin ME, et al. Variability in commercial ginseng products: 

an analysis of 25 preparations. Am J Clin Nutr 2001;73:1101-6.

62.  Hacker B, Medon PJ. Cytotoxic effects of Eleutherococcus senticosus aqueous extracts in combination with N6-(delta 2-isopentenyl)-adenosine and 1-beta-D-arabinofuranosylcytosine against L1210 leukemia cells. J Pharm Sci 1984;73:270-2.

63.  Szolomicki S, Samochowiec L, Wojcicki J, Drozdzik M. The influence of active components of Eleutherococcus senticosus on cellular defense and physical fitness in man. Phytother Res 2000;14:30-5.

64.  Dasgupta A, Wu S, Actor J, et al. Effect of Asian and Siberian ginseng on serum digoxin measurement by five digoxin immunoassays. Significant variation in digoxin-like immunoreactivity among commercial ginsengs. Am J Clin Pathol 2003;119:298-303.

65.  Medon PJ, Ferguson PW, Watson CF. Effects of Eleutherococcus senticosus extracts on hexobarbital metabolism in vivo and in vitro. J Ethnopharmacol 1984;10:235-41.

66.  Glatthaar-Saalmuller B, Sacher F, Esperester A. Antiviral activity of an extract derived from roots of Eleutherococcus senticosus. Antiviral Res 2001;50:223-8.

67.  Shen ML, Zhai SK, Chen HL, Immunomopharmacological effects of polysaccharides from Acanthopanax senticosus on experimental animals. Int J Immunopharmacol 1991;13:549-54.

68.  Mills S, Bone K. Principles and Practice of Phytotherapy. London: Churchill Livingstone, 2000.

Also known as:Betula, Betulae folium, Silver Birch, White Birch.

Scientific name:Betula pendula, Betula alba.

Botanical family: Betulaceae.

Parts used: The leaves and bark.

Traditional use. Birch is used as a diuretic, for rheumatic ailments, for cystitis, for arthritis, rheumatism and as an alterative for aiding eliminatory processes.

Safety.

There are no safety concerns when used within the recommended dosages.¹

Pregnancy: Consult with a medical herbalist.

Breastfeeding: Consult with a medical herbalist.

Constituents.

Flavonoids; mainly hyperoside, luteolin and quercetin.

Caffeic acid derivatives, including chlorogenic acid.

Monoterpene glucosides; the betula albosides and roseoside.

Saponins; betula triterpenes.

Volatile oil containing betulin, caryophyllenes and methyl salicylate.

Betulenols and their acetates.

Anthocyanins.

Resin;

Tannins. 

Scientific evidence.

No clinical research has been done.

Mechanism of action.

A study offers a rational basis for the use of Betula pendula leaf extract for the treatment of immune disorders, like rheumatoid arthritis, by diminishing proliferating inflammatory lymphocytes.⁵

The aquaretic and possibly saluretic (loss of salt through the kidneys) effects are due to the flavonoid constituents of the birch leaf. Aquaretics increase urine volume (water loss) but not electrolyte excretion.² The high vitamin C content of the leaf can enhance the effect.³

An extract of betulinic acid may hold promise as an anticancer agent. Some laboratory and animal studies of betulinic acid have reported antitumor activity. Additional studies are under way to find out whether it has a role in treating several forms of cancer, including melanoma and certain brain cancers. Clinical trials are needed to determine what effect, if any, betulinic acid may have in treating cancer in humans.^{6,7,8,9,10,11,12}

Adverse reactions.

None reported. 

Interactions with herbs and supplements:

None known. 

Interactions with drugs:

None known.

Interactions with foods:

None known.

Interactions with laboratory tests:

None known.

Dosage.

Recommended dose: 3-10mls per day 1:5 tincture 30% alcohol.

Infusion: range from 2-3tsps. per day. 

The recommended dose of Dr Clare’s Joint Support Blend provides 3mls per day of 1:3 Tincture in 15mls daily, at a dose of 5mls three times a day.

This is equivalent to 375-750mgs per day.

Dr Clare’s Joint Cleansing Tea provides ½ tsp. per day of peppermint.

Dosage.

Dr Clare’s Blends: 700mgs per day. 

Oral: The typical dose of birch leaf is several times daily as a tea, which is prepared by steeping 2-3 grams of finely cut dried leaf in approximately 150 mL boiling water for 10-15 minutes and straining.^4,3 The tea should be taken with plenty of water.³

References.

1.  McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.

2.  Robbers JE, Tyler VE. Tyler's Herbs of Choice: The Therapeutic Use of Phytomedicinals. New York, NY: The Haworth Herbal Press, 1999.

3.  Wichtl MW. Herbal Drugs and Phytopharmaceuticals. Ed. N.M. Bisset. Stuttgart: Medpharm GmbH Scientific Publishers, 1994.

4.  Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Trans. S. Klein. Boston, MA: American Botanical Council, 1998.

5. Gründemann C1, Gruber CW, Hertrampf A, Zehl M, Kopp B, Huber R. J Ethnopharmacol. 2011 Jul 14;136(3):444-51.

An aqueous birch leaf extract of Betula pendula inhibits the growth and cell division of inflammatory lymphocytes.

6. Chintharlapalli S, Papineni S, Ramaiah SK, Safe S. Betulinic acid inhibits prostate cancer growth through inhibition of specificity protein transcription factors. Cancer Res. 2007;67:2816-2823.

7. Eiznhamer DA, Xu ZQ. Betulinic acid: a promising anticancer candidate. IDrugs. 2004;7:359-373.

8. Jung GR, Kim KJ, Choi CH, et al. Effect of betulinic acid on anticancer drug-resistant colon cancer cells. Basic Clin Pharmacol Toxicol. 2007;101:277-285

9. Pisha E, Chai H, Lee IS, et al. Discovery of betulinic acid as a selective inhibitor of human melanoma that functions by induction of apoptosis. Nat Med. 1995;1:1046-1051.

10. Sawada N, Kataoka K, Kondo K, et al. Betulinic acid augments the inhibitory effects of vincristine on growth and lung metastasis of B16F10 melanoma cells in mice. Br J Cancer. 2004;90:1672-1678.

11. Schmidt ML, Kuzmanoff KL, Ling-Indeck L, Pezzuto JM. Betulinic acid induces apoptosis in human neuroblastoma cell lines. Eur J Cancer. 1997;33:2007-2010.

12. Thurnher D, Turhani D, Pelzmann M, et al. Betulinic acid: a new cytotoxic compound against malignant head and neck cancer cells. Head Neck. 2003;25:732-740.

Also Known As:

American Skullcap, Blue Pimpernel, Blue Skullcap, Escutelaria, Helmet Flower, Scutellaria.

Scientific Name:

Scutellaria lateriflora.

Family: Lamiaceae/Labiatae.

People Use This For:

Skullcap is used for insomnia, anxiety, nervous tension, allergies, dermatitis, inflammation, and spasms.

Safety:

There is insufficient scientific information available about the use of skullcap.

Pregnancy and Lactation: Refer to a Medical Herbalist.

Effectiveness:

INSUFFICIENT RELIABLE EVIDENCE to RATE

Anxiety. Preliminary evidence suggests that healthy people who take a single dose of skullcap extract might feel more relaxed than tense. This effect appears to last for about 2 hours.⁴¹ But it is not known if taking skullcap is effective for anxiety disorders or if extended use is beneficial. More scientific evidence is needed to rate skullcap for this use.

Mechanism of Action:

The applicable parts of skullcap are the above ground parts. The principle flavonoids of skullcap are baicalin and wogonin.^42,41

Skullcap also contains lignins, resins, tannins, and volatile oils.⁴²

It is thought that the flavonoid constituents of skullcap might act as GABA agonists and therefore have a sedating and anxiolytic effect.⁴¹

Constituents of skullcap seem to bind the serotonin receptor 5-HT7. But it's not known if these constituents have agonist or antagonist properties on the receptor.⁴² Skullcap's effects on the serotonin receptor may be involved in potential sedative properties.

Adverse Reactions:

Orally, single doses of skullcap extract appear to be well-tolerated. A single skullcap extract dose of 100 mg does not seem to affect cognition or cause significant sedation. But a higher dose of 200 mg might cause more sedation and cognitive impairment.⁴¹ The effect of these typical doses in repeated doses is not known.

Interactions with Herbs & Supplements:

Herbs and Supplements with Sedative Properties: Theoretically, concomitant use with herbs that have sedative properties might enhance therapeutic and adverse effects.

Interactions with Drugs:

None known.

Interactions with Foods:

None known.

Interactions with Lab Tests:

None known.

Interactions with Diseases or Conditions:

None known.

Dosage/Administration:

Dr Clare’s Blends: 1 gm per day

Oral: A typical dose is 1-2 grams or as a tea three times daily.⁴³ The extract is typically used 2-4 mL (1:1 in 25% alcohol) three times daily. The tincture is typically used 3-6 mL (1:5 in 45% alcohol).⁴³

Specific References: SKULLCAP

41.  Wolfson P, Hoffmann DL. An investigation into the efficacy of Scutellaria lateriflora in healthy volunteers. Altern Ther Health Med 2003;9:74-8.

42.  Gafner S, Bergeron C, Batcha LL, et al. Inhibitor of [3H]-LSD binding to 5-HT7 receptors by flavonoids from Scutellaria lateriflora. J Nat Prod 2003;66:535-7.

43.  Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press, 1996.

Slippery Elm

Also Known As:

Common Thyme.

Scientific Name:

Thymus vulgaris; Thymus zygis.

Family: Lamiaceae/Labiatae. 

People Use This For:

Orally, thyme is used for bronchitis, whooping cough, sore throat.

Topically, thyme is used for laryngitis, tonsillitis, stomatitis, and halitosis. 

Safety:

Possibly Safe when used orally.^145,146 Thyme has been used safely for 10 days.¹⁴⁶

Pregnancy and Lactation: Refer to a Medical Herbalist

Effectiveness:

INSUFFICIENT RELIABLE EVIDENCE to COMMENT

Bronchitis. Clinical research suggests thyme, in combination with cowslip (Bronchipret), relieves symptoms of bronchitis such as coughing, fever, and increased production of sputum.¹⁴⁶ 

Mechanism of Action:

The applicable parts of thyme are the leaf, flower, and oil. Thyme contains the essential oils and several other constituents It also contains flavonoids, polyphenolic acids and other constituents.^147,148 

Thymol, the primary constituent of thyme is rapidly absorbed in the upper gastrointestinal tract. Preliminary research suggests that thyme has antimicrobial activity and modest antibacterial effects.^149,150 It also seems to have antiviral activity.¹⁵¹  Other preliminary research suggests thyme has activity against fungi such as Candida albicans and other Candida species.

Thymol is active against fungal microorganisms that cause fungal nail infections.¹⁵² 

Thyme and its constituents may have antioxidant effects.^149,153,154 The antioxidant effect of thyme may increase the production of nitric oxide and improve atherosclerosis and endothelial dysfunction.¹⁵⁵ 

Research suggests thyme has antispasmodic, antiplatelet, anti-inflammatory, and antiallergic activity.^{156,157,158,159} Additionally, thyme might improve wound healing.¹⁶⁰ 

Adverse Reactions:

Orally, thyme is generally well tolerated. Gastrointestinal adverse effects occur occasionally.¹⁴⁶ Allergic reactions are uncommon.¹⁴⁸

Interactions with Herbs & Supplements:

None reported

Interactions with Drugs:

None reported

Interactions with Foods:

None known. 

Interactions with Lab Tests:

None known. 

Interactions with Diseases or Conditions:

None reported

Dosage/Administration:

Dr Clare’s Blends: 1 gm per day (3mls 1:3 Thyme tincture/day)

Oral: For the treatment of bronchitis, a combination of thyme 160 mg and cowslip 54 mg (Bronchipret) has been used three times daily.¹⁴⁶

Specific References: THYME

145. Hay IC, Jamieson M, Ormerod AD. Randomized trial of aromatherapy. Successful treatment for alopecia areata. Arch Dermatol 1998;134:1349-46.

146. Ernst E, Marz R, Sieder C. A controlled multi-centre study of herbal versus synthetic secretolytic drugs for acute bronchitis. Phytomedicine 1997;4:287-93.

147. Kitajima J, Ishikawa T, Urabe A, Satoh M. Monoterpenoids and their glycosides from the leaf of thyme. Phytochemistry 2004;59:3279-87.

148. Spiewak R, Skorska C, Dutkiewicz J. Occupational airborne contact dermatitis caused by thyme dust. Contact Dermatitis 2001;38:235-9.

149. Proestos C, Chorianopoulos N, Nychas GJ, Komaitis M. RP-HPLC analysis of the phenolic compounds of plant extracts. investigation of their antioxidant capacity and antimicrobial activity. 

J Agric Food Chem 2005;47:1190-5.

150. Hersch-Martinez P, Leanos-Miranda BE, Solorzano-Santos F. Antibacterial effects of commercial essential oils over locally prevalent pathogenic strains in Mexico. Fitoterapia 2005;76:453-7.

151. Kohlert C, Schindler G, Marz RW, et al. Systemic availability and pharmacokinetics of thymol in humans. J Clin Pharmacol 2002;36:731-7.

152. Ramsewak RS, Nair MG, Stommel M, Selanders L. In vitro antagonistic activity of monoterpenes and their mixtures against 'toe nail fungus' pathogens. Phytother Res 2003;17:376-9.

153.  Aydin S, Basaran AA, Basaran N. Modulating effects of thyme and its major ingredients on oxidative DNA damage in human lymphocytes. J Agric Food Chem 2005;47:1299-305.

154. Agbor GA, Oben JE, Ngogang JY, et al. Antioxidant capacity of some herbs/spices from cameroon: a comparative study of two methods. J Agric Food Chem 2005;47:6819-18.

155. Grande S, Bogani P, de Saizieu A, et al. Vasomodulating potential of mediterranean wild plant extracts. J Agric Food Chem 2004;46:5021-6.

156. Meister A, Bernhardt G, Christoffel V, Buschauer A. Antispasmodic activity of Thymus vulgaris extract on the isolated guinea-pig trachea: discrimination between drug and ethanol effects. Planta Med 1999;59:512-6.

157. Okazaki K, Kawazoe K, Takaishi Y. Human platelet aggregation inhibitors from thyme (Thymus vulgaris L.). Phytother Res 2002;16:398-9.

158. Vigo E, Cepeda A, Gualillo O, Perez-Fernandez R. In-vitro anti-inflammatory effect of Eucalyptus globulus and Thymus vulgaris: nitric oxide inhibition in J774A.1 murine macrophages. J Pharm Pharmacol 2004;50:257-57.

159. Watanabe J, Shinmoto H, Tsushida T. Coumarin and flavone derivatives from estragon and thyme as inhibitors of chemical mediator release from RBL-2H3 Cells. Biosci Biotechnol Biochem 2005;69:1-6.

160. Dursun N, Liman N, Ozyazgan I, et al. Role of thymus oil in burn wound healing. J Burn Care Rehabil. 2003;18:395-9.

Also Known As:

Scientific Name:

People Use This For:

Safety:

Effectiveness:

Mechanism of Action:

Adverse Reactions:

Interactions with Herbs & Supplements:

Interactions with Drugs:

Interactions with Foods:

Interactions with Lab Tests:

Interactions with Diseases or Conditions:

Dosage/Administration:

Specific References: Turkish Rhubarb

Also Known As:

Bearberry, Beargrape, Arctostaphylos uva-ursi.

Family: Ericacea. 

People Use This For:

Orally, uva ursi is used for urinary tract infections, inflammatory conditions of the urinary tract, cystitis, urethritis, diuresis, constipation, stones in the urinary tract, painful urination, acidic urine, kidney infection, benign prostatic hyperplasia.

Safety:

No concerns regarding safety when used orally and appropriately, short-term. 

Preliminary clinical research suggests that uva ursi is likely to be safe when used short-term.^13,14

Possibly unsafe when used orally long-term because of the hydroquinone constituent of uva ursi.

Pregnancy and Lactation: Refer to a Medical Herbalist

Effectiveness:

Not enough scientific information gather to offer a comment.  

Urinary tract infections (UTIs). Preliminary evidence suggests that taking a combination product containing both uva ursi and dandelion orally seems to significantly reduce the recurrence rate of UTIs in women.¹⁴ However, since it isn't clear if this kind of extended use is safe, advise patients not to use uva ursi for long-term prevention of UTIs.

Mechanism of Action:

Arbutin hydrolyses to hydroquinone which is an effective urinary antiseptic.^R9

It is also cytotoxic and mutagenic and so excessive doses should be avoided.^R10

Arbutin is absorbed from the gastrointestinal tract unchanged and is hydrolyzed to hydroquinone in alkaline urine. There it can exert antiseptic and astringent effects.^15,16,17 For this reason, urinary acidifying agents may decrease the effectiveness of uva ursi, and urinary alkalinizing agents may increase its effectiveness.¹⁸

Hydroquinone, contained in uva ursi, is a tyrosine kinase inhibitor which inhibits melanin production. Melanin is present in various ocular layers . Changes in melanin metabolism may result in retinal thinning¹⁹ (This was one case following 3 years use). Hydroquinone is cytotoxic in lab studies.¹⁵ In rats, uva ursi has anti-inflammatory activity against experimentally-induced inflammation.¹⁵

Adverse Reactions:

Orally, uva ursi may cause nausea, vomiting, gastrointestinal discomfort, and a greenish-brown discoloration of the urine.^20,15 

Interactions with Herbs & Supplements:

None known.

Interactions with Drugs:

Lithium: Due to diuretic properties which theoretically may affect the dose of lithium required. Refer to a Medical Herbalist.

Interactions with Foods:

None known. 

Interactions with Lab Tests:

Colorimetric Urine Tests: Theoretically, uva ursi can interfere with colorimetric urine tests and can turn urine greenish-brown.¹⁵

Interactions with Diseases or Conditions:

Retinal Thinning: Theoretically, uva ursi might worsen retinal thinning in patients with this condition. Long-term use of uva ursi should be avoided in these patients.¹⁹ 

Dosage/Administration:

Oral: The typical dose of dried herb is 1.5-4 grams daily.¹⁵ It's also commonly used as a tea. The tea is prepared by steeping 3 grams of the dried leaf in 150 mL cold water for 12-24 hours and then straining. One cup of tea is usually taken up to 4 times daily.^20,17,21 Uva ursi leaf teas should be prepared with cold water to minimize the tannin content.²¹ The hydroquinone derivative, calculated as water-free arbutin, is commonly dosed as 100-210 mg up to 4 times daily.^20,17,21 The 

fluid extract (1:1 in 25% alcohol) is given 1.5-4 mL three times daily.¹⁵ Medical consultation is needed for urinary tract symptoms persisting longer than 48 hours.¹⁵ Uva ursi should not be used longer than one week without monitoring due to its potential risks.¹⁷ Limit its use to less than five times per year.¹⁷

Spedific References: UVA URSI

13.  McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.

14.  Larsson B, Jonasson A, Fianu S. Prophylactic effect of UVA-E in women with recurrent cystitis: a preliminary report. Curr Ther Res 1993;53:441-3.

15.  Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press, 1996.

16.  Foster S, Tyler VE. Tyler's Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies. 3rd ed., Binghamton, NY: Haworth Herbal Press, 1993.

17.  Schulz V, Hansel R, Tyler VE. Rational Phytotherapy: A Physician's Guide to Herbal Medicine. Terry C. Telger, transl. 3rd ed. Berlin, GER: Springer, 1998.

18.  Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.

19.  Wang L, Del Priore LV. Bull's-eye maculopathy secondary to herbal toxicity from uva ursi. Am J Ophthalmol 2004;137:1135-7.

20.  Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Trans. S. Klein. Boston, MA: American Botanical Council, 1998.

21.  Foster S, Tyler VE. Tyler's Honest Herbal, 4th ed., Binghamton, NY: Haworth Herbal Press, 1999.

Also Known As:

All-Heal, Common Valerian, Fragrant Valerian, Garden Heliotrope,

Scientific Name:

Valeriana officinalis; Valeriana edulis; Valeriana angustifolia; Valeriana jatamansii, synonym Valeriana wallichii; Valeriana sitchensis.

Family: Valerianaceae.

People Use This For: Valerian is used for insomnia, and for anxiety-associated restlessness and sleeping disorders. It has also been used for mood disorders such as depression, and chronic fatigue syndrome (CFS). It is also used orally for muscle and joint pain, and conditions associated with anxiety and psychological stress including nervous asthma, excitability, headaches, migraine, and stomach upset. Valerian is also used for menstrual cramps and symptoms associated with menopause, including hot flashes and anxiety. In manufacturing, the extracts and essential oil are used as flavoring in foods and beverages.

Safety: No concerns regarding safety when used in amounts commonly found in foods. Valerian has Generally Recognized as Safe (GRAS) status in the US.⁶⁰

 No concerns regarding safety when used orally and appropriately, short-term. Clinical studies have reported safe use of valerian for medicinal purposes in over 12,000 patients in trials lasting up to 28 days.^{61,62,63,64,65,66} The safety of long-term use is unknown.

 Children: No concerns regarding safety when used orally and appropriately, short-term. Valerian has been safely used in children in studies lasting 4-8 weeks.^74,80

 Pregnancy and Lactation: Refer to a Medical Herbalist.

Effectiveness:

POSSIBLY EFFECTIVE

Insomnia. Most research shows that taking valerian orally reduces the time to sleep onset (sleep latency), and improves subjective sleep quality. The greatest benefit is usually seen in patients using 400-900 mg valerian extract up to 2 hours before bedtime.^67,68,69,70

Valerian does not relieve insomnia as fast as benzodiazepines.⁶⁵ Continuous nightly use for several days to four weeks might be needed for significant effect.^68,71

 Valerian is often used in combination with other sedative herbs. Taking a combination product containing valerian extract 187 mg plus hops extract 41.9 mg per tablet, two tablets at bedtime, seems to modestly improve subjective sleep measures including subjective sleep latency compared to placebo after 28 days of treatment; however it was not significantly better than placebo after only 14 days of treatment.⁶⁶ A combination of valerian with lemon balm might also improve the quality and quantity of sleep in healthy people.⁷²

Valerian also seems to improve the sleep quality of insomniacs who have recently withdrawn from benzodiazepines. After tapering the benzodiazepine over two weeks, 300 mg valerian extract in three divided daily doses might subjectively improve sleep quality.⁷³

There is also preliminary clinical research that suggests valerian improves sleep in intellectually impaired children.⁷⁴ 

Not all evidence is positive. Some evidence suggests that valerian does not significantly improve insomnia compared to placebo.⁷⁹

INSUFFICIENT RELIABLE EVIDENCE to RATE

Anxiety. There is contradictory evidence about the effectiveness of valerian for anxiety. Some evidence shows that taking valerian orally reduces self-reported stress in social anxiety.^75,76 However, another preliminary study found no significant difference in anxiety scores in patients with generalized anxiety disorder compared to placebo.^77,78 Additional preliminary evidence suggests that valerian does not significantly decrease anxiety compared to placebo.⁷⁹

Restless Sleep. Preliminary (980 Participants open trial :definite benefit) evidence suggests that a specific combination product providing valerian root extract 160 mg and lemon balm leaf extract 80 mg (Euvegal forte, Dr. Willmar Schwabe Pharmaceuticals) 1-2 tablets once or twice daily might decrease symptoms in children under age 12 years who have pathological restlessness or dyssomnia.⁸⁰

More evidence is needed to rate valerian for these uses.

Mechanism of Action:

The applicable part of valerian is the root and rhizome. Valerian is thought to have sedative-hypnotic, anxiolytic, antidepressant, anticonvulsant, and antispasmodic effects.^62,63,81 Valerian might also have hypotensive properties.⁷⁵

The pharmacological effects of valerian have primarily been attributed to valepotriates.^62,82,83 Other potentially active constituents include flavonoids.⁸³

Because valerian extracts without some of these constituents can still have similar effects, it is likely that multiple constituents are responsible for its pharmacological effects.

Valepotriate constituents have sedative-hypnotic and spasmolytic effects. Valepotriates have also been shown to decrease benzodiazepine withdrawal in an animal model and to bind dopamine receptors.^62,82 The valepotriates might act as prodrugs.⁸²

 The sesquiterpenes have been shown to cause sedation in animals.⁸³ Valerenic acid and other constituents of valerian may increase GABA (neurotransmitter) concentrations and decrease central nervous system activity.^82,84 Valerian may stimulate the release and reuptake of GABA⁸⁴

Valerian might also affect sleep regulation with activity on adenosine and 5-hydroxytryptamine-1.⁸⁴

The valerian flavonoid constituents also seem to have a role in the sedative-hypnotic effects of valerian.⁸³

Adverse Reactions:

A few patients can find that valerian is a stimulant and they should avoid its use. (This is generally at higher doses (DC).)

In some individuals, valerian can aggravate a sensation of drowsiness or tiredness, particularly at higher doses, but this is usually a case of an increased awareness of the body’s needs than a negative depressant effect.^{R1 pp.587}

Valerian can cause headache, excitability, uneasiness, palpitations, and insomnia.⁶² Occasionally, valerian may cause gastric discomfort, dry mouth, vivid dreams,⁶⁴ and morning drowsiness.⁶¹

Taking valerian extracts in doses up to 1800 mg does not appear to significantly affect mood or psychomotor performance.^85,86 Valerian does not usually have a negative impact on reaction time, alertness, and concentration the morning after intake. Impairment that does occur is dose-dependent and seems to peak within the first few hours after an oral valerian dose.⁶¹

Interactions with Herbs & Supplements:

Herbs and Supplements with Sedative Properties: Use of valerian with other herbs and supplements with sedative properties might enhance therapeutic and adverse effects.⁸²

Interactions with Drugs:

Alchol (Ethanol): Alcohol may be used as a CNS depressant which reduces performance of motor skills. Do not add the sedative effects of Valerian.⁸⁷

Anxiolytics: Patients may require less medication for anxiety if they use herbal remedies with all of their attendant side effects but do not combine them within 4-5 hours of each other.

Interactions with Foods: None known.

Interactions with Lab Tests: None known.

Interactions with Diseases or Conditions: None Known.

Dosage/Administration:

Dr Clare’s Blends: Dose 455mgs per day. 1.5mls 1:3 Tincture.

ORAL: For insomnia, most studies have used 400-900 mg valerian extract up to 2 hours before bedtime for as long as 28 days.^{61,62,65,73,69,70,85} Other studies have used valerian extract 300-450 mg given in three divided doses.^62,73Valerian should be given 30 minutes to 2 hours before bedtime.⁸⁷ 

Specific References: VALERIAN

60.  FDA. Center for Food Safety and Applied Nutrition, Office of Premarket Approval, EAFUS: A food additive database. Available at: vm.cfsan.fda.gov/~dms/eafus.html.

61.  Kuhlmann J, Berger W, Podzuweit H, Schmidt U. The influence of valerian treatment on "reaction time, alertness and concentration" in volunteers. Pharmacopsychiatry 1999;32:235-41.

62.  Klepser TB, Klepser ME. Unsafe and potentially safe herbal therapies. Am J Health Syst Pharm 1999;56:125-38.

63.  Plushner SL. Valerian: Valerian officinalis. Am J Health Syst Pharm 2000;57:328,333,335.

64.  Wheatley D. Stress-induced insomnia treated with kava and valerian: singly and in combination. Hum Psychopharmacol 2001;16:353-6.

65.  Dorn M. [Efficacy and tolerability of Baldrian versus oxazepam in non-organic and non-psychiatric insomniacs: a randomized, double-blind, clinical, comparative study]. [Article in German]. Forsch Komplementarmed Klass Naturheilkd 2000;7:79-84.

66.  Morin CM, Koetter U, Bastien C, et al. Valerian-hops combination and diphenhydramine for treating insomnia: a randomized placebo-controlled clinical trial. Sleep 2005;28:1465-71.

67.  Leathwood PD, Chauffard F, Heck E, Munoz-Box R. Aqueous extract of valerian root (Valeriana officinalis L.) improves sleep quality in man. Pharmacol Biochem Behav 1982;17:65-71.

68.  Donath F, Quispe S, Diefenbach K, et al. Critical evaluation of the effect of valerian extract on sleep structure and sleep quality. Pharmacopsych 2000;33:47-53.

69.  Bent S, Patterson M, Garvin D. Valerian for sleep: a systematic review and meta-analysis. Alternative Therapies 2001;7:S4.

70.  Leathwood PD, Chauffard F. Aqueous extract of valerian reduces latency to fall asleep in man. Planta Med 1985;2:144-8.

71.  Stevinson C, Ernst E. Valerian for insomnia: a systematic review of randomized clinical trials. Sleep Med 2000;1:91-9.

72.  Cerny A, Shmid K. Tolerability and efficacy of valerian/lemon balm in healthy volunteers (a double blind, placebo-controlled, multicentre study). Fitoterapia 1999;70:221-8.

73.  Poyares DR, Guilleminault C, Ohayon MM, Tufik S. Can valerian improve the sleep of insomniacs after benzodiazepine withdrawal? Prog Neuropsychopharmacol Biol Psychiatry 2002;26:539-45.

74.  Francis AJ, Dempster RJ. Effect of valerian, Valeriana edulis, on sleep difficulties in children with intellectual deficits: randomised trial. Phytomedicine 2002;9:273-9.

75.  Cropley M, Cave Z, Ellis J, Middleton RW. Effect of kava and valerian on human physiological and psychological responses to mental stress assessed under laboratory conditions. Phytother Res 2002;16:23-7.

76.  Kohnen R, Oswald WD. The effects of valerian, propranolol, and their combination on activation, performance and mood of healthy volunteers under social stress conditions. Pharmacopsychiatry 1988;21:447-8.

77.  Andreatini R, Sartori VA, Seabra ML, Leite JR. Effect of valepotriates (valerian extract) in generalized anxiety disorder: a randomized placebo-controlled pilot study. Phytother Res 2002;16:650-4.

78.  Miyasaka LS, Atallah AN, Soares BG. Valerian for anxiety disorders. Cochrane Database Syst Rev 2006;(4):CD004515.

79.  Jacobs BP, Bent S, Tice JA, et al. An internet-based randomized, placebo-controlled trial of kava and valerian for anxiety and insomnia. Medicine (Baltimore) 2005;84:197-207.

80.  Muller SF, Klement S. A combination of valerian and lemon balm is effective in the treatment of restlessness and dyssomnia in children. Phytomedicine 2006;13:383-7.

81.  Eadie MJ. Could valerian have been the first anticonvulsant? Epilepsia 2004;45:1338-43.

82.  Houghton PJ. The scientific basis for the reputed activity of Valerian. J Pharm Pharmacol 1999;51:505-12.

83.  Fernandez S, Wasowski C, Paladini AC, Marder M. Sedative and sleep-enhancing properties of linarin, a flavonoid-isolated from Valeriana officinalis. Pharmacol Biochem Behav 2004;77:399-404

84.  Yuan CS, Mehendale S, Xiao Y, et al. The gamma-aminobutyric acidergic effects of valerian and valerenic acid on rat brainstem neuronal activity. Anesth Analg 2004;98:353-8.

85.  Glass JR, Sproule BA, Herrmann N, et al. Acute pharmacological effects of temazepam, diphenhydramine, and valerian in healthy elderly subjects. J Clin Psychopharmacol 2003;23:260-8.

86.  Gutierrez S, Ang-Lee MK, Walker DJ, Zacny JP. Assessing subjective and psychomotor effects of the herbal medication valerian in healthy volunteers. Pharmacol Biochem Behav 2004;78:57-64.

87.  Hadley S, Petry JJ. Valerian. Am Fam Physician 2003;67:1755-8.

Also Known As:

Common Verbena, Common Vervain, Herb of Grace, Herb of the Cross,

Scientific Name:

Verbena officinalis.

Family: Verbenaceae.

People Use This For:

Verbena is used for sore throats. Verbena is also used orally for depression, melancholia, and convalescence after fevers. It is also used for pain, spasms, exhaustion, nervous conditions, digestive disorders, liver and gallbladder diseases. Other uses include menopausal complaints, irregular menstruation, 

increasing lactation.

Safety:

No concerns regarding safety when used orally in amounts commonly found in foods. Verbena has Generally Recognized As Safe status (GRAS) for use in foods in the US.⁸⁸

Pregnancy and Lactation: Refer to a Medical Herbalist.

Effectiveness:

POSSIBLY EFFECTIVE

Sinusitis. Taking verbena orally in combination with gentian root, elderflower, cowslip flower, and sorrel (SinuComp, Sinupret) is effective for treating acute or chronic sinusitis. Clinical studies have used Sinupret.^89,90

Mechanism of Action:

The applicable parts of verbena are the above ground parts. Verbena contains verbascoside (acetoside), verbenalin, beta-sitosterol, ursolic acid, oleanolic acid, citral, and other constituents.^91,92 Preliminary research suggests verbena might have anti-inflammatory and weak antimicrobial activity.^93,91 Other preliminary research suggests constituent verbascoside has analgesic, sedative effects, antioxidant, and hepatoprotective effects.^94,95,96

Adverse Reactions:

Verbena appears to have low toxicity.^{R2 pp.442}

Interactions with Herbs & Supplements:

None known.

Interactions with Drugs:

None known.

Interactions with Foods:

None known.

Interactions with Lab Tests:

None known.

Interactions with Diseases or Conditions:

None known.

Dosage/Administration:

Dr Clare’s Blends: Dose 455mgs per day. 1.5mls 1:3 Tincture.

Dried Herb 2-4gms per day.^{R2 pp.442}

Specific References: VERBENA

88.  FDA. Center for Food Safety and Applied Nutrition, Office of Premarket Approval, EAFUS: A food additive database. Available at: vm.cfsan.fda.gov/~dms/eafus.html.

89.  Neubauer N, Marz RW. Placebo-controlled, randomized, double-blind, clincal trial with Sinupret sugar coated tablets on the basis of a therapy with antibiotics and decongestant nasal drops in acute sinusitis. Phytomedicine 1994;1:177-81.

90.  Marz RW, Ismail C, Popp MA. Action profile and efficacy of a herbal combination preparation for the treatment of sinusitis. Wien Med Wochenschr 1999;149:202-8.

91.  Deepak M, Handa SS. Antiinflammatory activity and chemical composition of extracts of Verbena officinalis. Phytother Res 2000;14:463-5.

92.  Dudai N, Weinstein Y, Krup M, et al. Citral is a new inducer of caspase-3 in tumor cell lines. Planta Med 2005;71:484-8

93.  Hernandez NE, Tereschuk ML, Abdala LR. Antimicrobial activity of flavonoids in medicinal plants from Tafi del Valle (Tucuman, Argentina). J Ethnopharmacol 2000;73:317-22.

94.  Nakamura T, Okuyama E, Tsukada A, et al. Acteoside as the analgesic principle of Cedron (Lippia triphylla), a Peruvian medicinal plant. Chem Pharm Bull 1997;45:499-504.

95.  Chiou WF, Lin LC, Chen CF. Acteoside protects endothelial cells against free radical-induced oxidative stress. J Pharm Pharmacol 2004;56:743-8.

96.  Lee KJ, Woo ER, Choi CY, et al. Protective effect of acteoside on carbon tetrachloride-

induced hepatotoxicity. Life Sci 2004;74:1051-64.

Also Known As:

Scientific Name:

People Use This For:

Safety:

Effectiveness:

Mechanism of Action:

Adverse Reactions:

Interactions with Herbs & Supplements:

Interactions with Drugs:

Interactions with Foods:

Interactions with Lab Tests:

Interactions with Diseases or Conditions:

Dosage/Administration:

Specific References: WhiteHorehound

Also Known As:

Basket Willow, Bay Willow, Black Willow, Black Willowbark, Black Willow Extract, European Willow Bark.

Scientific Name:

Salix alba; other Salix species.

Family: Salicaceae.

People Use This For:

Willow bark is used for headache, pain, muscle pain, osteoarthritis, painful periods, gouty arthritis, ankylosing spondylitis, rheumatoid arthritis, and gout. It is also used for fever, common cold, and influenza.

Safety:

No concerns regarding safety when used orally and appropriately, short-term.^{19,20,21,22,23} Willow bark has been used safely for up to 13 weeks in one study.²³

Children: Possibly Unsafe.²⁴ Although Reye's syndrome has not been reported, the salicin constituent in willow bark is similar to aspirin and might pose the same risk. 

Pregnancy and Breastfeeding: Consult a Medical Herbalist. 

Effectiveness:

POSSIBLY EFFECTIVE

Back pain. There's some evidence that a willow bark extract providing 120-240mg of the salicin constituent daily can reduce low back pain in some patients. The higher concentration of 240mg salicin is more effective than 120mg of salicin. It can take up to 1 week for significant relief.¹⁹ Some research suggests salicin 240mg daily is as effective as rofecoxib (Vioxx) for low back pain.²²

INSUFFICIENT RELIABLE EVIDENCE to RATE

Osteoarthritis. Clinical research on willow bark extract for osteoarthritis is conflicting. Some research suggests it has a moderate analgesic effect on osteoarthritis, while other research shows it is similar to placebo and inferior to diclofenac (Voltaren, Cataflam).^20,21

Rheumatoid arthritis (RA). Preliminary clinical research suggests that willow bark extract is not effective for rheumatoid arthritis.²¹

More evidence is needed to rate willow bark for these uses.

Mechanism of Action:

Willow bark is the bark of salix tree species such as the white willow. Willow bark constituents include flavonoids, tannins, and salicylates. The active constituent of willow bark is thought to be salicin. Salicin is metabolized to salicyl alcohol and then to salicylic acid. From there, metabolism is the same as aspirin.²⁵

An ethanolic extract of willow bark seems to inhibit cyclooxygenase (COX)-2 mediated prostaglandin release, but it doesn't seem to directly affect COX-1 or COX-2 activity. Constituents of willow bark other than salicin may have lipoxygenase-inhibiting and antioxidant effects that could contribute to its analgesic effect.^19,26 They also might prevent prostaglandin and cytokine release.²⁶ Some research suggests that extended treatment with willow bark may be necessary for a therapeutic effect.^27,28 

Preliminary research suggests that willow bark extracts have analgesic, anti-inflammatory, and antipyretic effects.²⁶ Willow bark inhibits platelet aggregation, but to a lesser degree than aspirin.²⁹ 

Bioavailability of willow bark may be lower due to manufacturing processes. A dose of 240mg of salicin is equivalent to 87mg of aspirin.²⁵

Adverse Reactions:

Willow bark extract can cause gastrointestinal adverse effects, but these appear to be less frequent than those caused by NSAIDs.^20,21 Willow bark may cause itching and rash, as well as serious allergic reactions, including anaphylaxis, in people who are allergic to aspirin.^30,20,21

Salicylates can inhibit prostaglandins, which can reduce renal blood flow.³¹ Salicin can cause renal papillary necrosis.³² The risk for toxicity is greater with high acute doses or chronic use.³¹ 

Interactions with Herbs & Supplements:

Anticoagulant/Antiplatelet Herbs and Supplements: Concomitant use of herbs that have antiplatelet/anticoagulant effects could theoretically increase the risk of bleeding in some people.²⁹ These herbs include clove, danshen, garlic, ginger, ginkgo, ginseng, meadowsweet, red clover, and others.

Salicylate-Containing Herbs: Theoretically, concomitant use may potentiate salicylate effects and adverse effects.²⁵ Salicylate-containing herbs include aspen bark, black haw, poplar, and meadowsweet.

Interactions with Drugs:

Warfarin: Absolute contraindication.

Aspirin: Willow bark contains salicin, a plant salicylate. Theoretically, willow bark might have an additive effect with other salicylate-containing drugs such as aspirin.²⁵

Choline Magnesium Trisalicylate (Trilisate): Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate. Occurrence = Probable. Willow bark contains salicin, a plant salicylate. Theoretically, willow bark might have an additive effect with other salicylate-containing drugs such as choline magnesium trisalicylate.²⁵ 

Salsalate (Disalcid): Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate. Occurrence = Probable.

Willow bark contains salicin, a plant salicylate. Theoretically, willow bark might have an additive effect with other salicylate-containing drugs such as salsalate.²⁵

Interactions with Foods:

None known.

Interactions with Lab Tests:

Creatinine: Theoretically, salicin could cause a rise in serum creatinine without affecting renal function. Salicylates can cause a rise in serum creatine without a change in glomerular filtration rate (GFR). This is thought to be due to changes in plasma protein binding caused by salicylates or competitive inhibition of tubular secretion of creatinine by salicylates.³³

Interactions with Diseases or Conditions:

Kidney Dysfunction: Theoretically, salicin might reduce renal blood flow.³¹ Chronic use of high doses might contribute to renal failure in predisposed people.³² Avoid use in people with compromised renal function. 

Salicylate Precautions: Avoid or use cautiously in individuals with aspirin hypersensitivity, asthma, active peptic ulcer disease, diabetes, gout, hemophilia, hypoprothrombinemia, kidney or liver disease. Willow bark may cause serious allergic reactions, including anaphylaxis, in people who are allergic to aspirin.³⁰

Surgery: discontinue willow bark at least 2 weeks before elective surgical procedures. 

Dosage/Administration:

Dr Clare’s Blend: 700mgs/day

Oral: For back pain, willow bark extract providing 120-240mg salicin has been used. The higher 240mg dose might be more effective.^19,22 

Specific References: WHITE WILLOW

19.  Chrubasik S, Eisenberg E, Balan E, et al. Treatment of low back pain exacerbations with willow bark extract: a randomized double-blind study. Am J Med 2000;109:9-14.

20.  Schmid B, Ludtke R, Selbmann HK, et al. Efficacy and tolerability of a standardized willow bark extract in patients with osteoarthritis: randomized placebo-controlled, double blind clinical trial. Phytother Res 2001;15:344-50.

21.  Biegert C, Wagner I, Ludtke R, et al. Efficacy and safety of willow bark extract in the treatment of osteoarthritis and rheumatoid arthritis: results of 2 randomized double-blind controlled trials. J Rheumatol 2004;31:2121-30.

22.  Chrubasik S, Kunzel O, Model A, et al. Treatment of low back pain with a herbal or synthetic anti-rheumatic: a randomized controlled study. Willow bark extract for low back pain. Rheumatology (Oxford) 2001;40:1388-93.

23.  Coffey CS, Steiner D, Baker BA, Allison DB. A randomized double-blind placebo-controlled clinical trial of a product containing ephedrine, caffeine, and other ingredients from herbal sources for treatment of overweight and obesity in the absence of lifestyle treatment. Int J Obes Relat Metab Disord 2004;28:1411-9.

24.  Food and Drug Administration, HHS. Labeling for oral and rectal over-the-counter drug products containing aspirin and nonaspirin salicylates; Reye's Syndrome warning. Final rule. Fed Regist 2003;18:18861-9.

25.  Schmid B, Kotter I, Heide L. Pharmacokinetics of salicin after oral administration of a standardised willow bark extract. Eur J Clin Pharmacol. 2001;57:387-91.

26.  Fiebich BL, Chrubasik S. Effects of an ethanolic salix extract on the release of selected inflammatory mediators in vitro. Phytomedicine 2004;11:135-8.

27.  Wagner I, Greim C, Laufer S, et al. Influence of willow bark extract on cyclooxygenase activity and on tumor necrosis factor alpha or interleukin 1 beta release in vitro and ex vivo. Clin Pharmacol Ther 2003;73:272-14.

28.  Fiebich BL, Appel K. Anti-inflammatory effects of willow bark extract. Clin Pharmacol Ther 2003;74:96.

29.  Krivoy N, Pavlotzky E, Chrubasik S, et al. Effect of salicis cortex extract on human platelet aggregation. Planta Med 2001;17:209-13.

30.  Boullata JI, McDonnell PJ, Oliva CD. Anaphylactic reaction to a dietary supplement containing willow bark. Ann Pharmacother 2003;37:832-5.

31.  D'Agati V. Does aspirin cause acute or chronic renal failure in experimental animals and in humans? Am J Kidney Dis 1996;28:S24-9.

32.  Schwarz A. Beethoven's renal disease based on his autopsy: a case of papillary necrosis. Am J Kidney Dis 1993;21:643-52.

33.  Andreev E, Koopman M, Arisz L. A rise in plasma creatinine that is not a sign of renal failure: which drugs can be responsible? J Intern Med 1999;246:247-52.

Also Known As:

Avena, Oatstraw, Wild Oat Herb.

Scientific Name:

Avena sativa.

Family: Poaceae/Gramineae. 

People Use This For:

Oats are also used for acute or chronic anxiety, excitation and stress. Nervous exhaustion, depressive states, insomnia.^{R1 pp.234} menopause.^{R2 pp.317}

Safety:

No concerns regarding safety when used orally and appropriately.^69,70,71,72 Oat bran has Generally Recognized as Safe (GRAS) status in the US.⁷³

No concerns regarding safety when used topically and appropriately.⁷⁴

Pregnancy and Lactation: Refer to a Medical Herbalist. 

Effectiveness:

Insufficient evidence to comment on the effectiveness for stress.

Mechanism of Action:

The applicable parts of oats are the seeds and straw. There is no research done on the effects on nervous exhaustion or mood.

Adverse Reactions:

Orally, oats are usually very well tolerated.

Interactions with Herbs & Supplements:

None known.

Interactions with Drugs:

None known. 

Interactions with Foods:

None known.

Interactions with Lab Tests:

See below for Coeliac Disease.

Interactions with Diseases or Conditions:

Celiac Disease: Oats and oat bran are generally excluded from gluten-free diets. However, oat products that are not contaminated with wheat, rye, or barley do not appear to cause adverse effects in nutrition, intestinal histology, or serology in adults with celiac disease in remission.⁷⁵ 

Dosage/Administration:

Oral: Traditionally milky oat pods are also used as a tincture and tea. 

Topical: No typical dosage. 

Dr Clare’s Comments:

Although there is unlikely to be any problem with Wild Oat infusion or tincture for celiac patients I don’t prescribe it because patients feel anxious about it in the remedy. This is traditionally used as a very nourishing herb for stamina in the nervous system. Particularly good for exhaustion from chronic stress especially with a poor sleeping pattern. It is suitable for all ages.

Specific References: OATS

69.  FDA Talk Paper. FDA Allows Whole Oat Foods to make Claim on Reducing the Risk of Heart Disease. 1997. Available at: vm.cfsan.fda.gov/~lrd/tpoats.html.

70.  American Dietetic Association Website. Available at: www.eatright.org/adap1097.html (Accessed 16 July 1999).

71.  Food and Drug Administration. Food labeling: health claims: oats and coronary heart disease. Fed Regist 1996;61:296-313.

72.  Foulke J. FDA Allows Whole Oat Foods To Make Health Claim on Reducing the Risk of Heart Disease. FDA Talk Paper. 1997. Available at: http://www.fda.gov/bbs/topics/ANSWERS/ANS00782.html.

73.  FDA. Center for Food Safety and Applied Nutrition, Office of Premarket Approval, EAFUS: A food additive database. Available at: vm.cfsan.fda.gov/~dms/eafus.html.

74.  McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.

75.  Storsrud S, Olsson M, Arvidsson Lenner R, et al. Adult coeliac patients do tolerate large amounts of oats. Eur J Clin Nutr 2003;57:163-9.

Also known as:Achillea, Carpenter's Herb, Common Yarrow, Nosebleed, Soldier's Wound Wort, Knight’s milfoil, Bloodwort, Sanguinary.

Scientific name:Achillea millefolium,

Botanical Family: Asteraceae/Compositae.

Part used: The above ground parts.

Traditional use.

Legend has it that yarrow (Achillea millefolium) was named after Achilles, the Greek mythical hero who used it to stop the bleeding wounds of his soldiers. Some First American tribes used yarrow as a body-wash before battles because it was known to reduce bleeding from wounds. 

As a traditional medicine yarrow is used as a blood cleanser via the induction of sweating and promoting urine flow. Yarrow  lowers fever, acts as an anti-inflammatory, it staunches bleeding from small blood vessels, and has antispasmodic and hypotensive qualities. It is used for feverish illnesses including, the common cold and influenza, chronic ‘runny’ nose, absence of or scanty menstrual periods, dysentery, diarrhea, loss of appetite, mild or crampy discomfort of the digestive tract, promotion of sweating and reduce high blood pressure. It is used for toning the venous system and reducing congestion of the lower limbs and pelvis by enhancing venous return. It is used throughout the cycle for heavy periods and during menses to reduce heavy bleeding.

In combination with other herbs, yarrow is used for bloating, flatulence, mild gastrointestinal cramping, and nervous digestive complaints. 

In foods, the young leaves and flowers of yarrow are used in salads.

Safety.

No concerns regarding safety when used orally in amounts commonly found in foods. Yarrow has Generally Recognized As Safe (GRAS) status for use in foods in the US.¹

No concerns regarding safety have been reported with medicinal use of yarrow.^2,3

Pregnancy:avoid in pregnancy because its ability to relax the smooth muscle of the uterus may be associated with miscarriage.

Breastfeeding: because very little information is available avoid excessive amounts.

Unless advised by a medical herbalist for clinical reasons that outweigh the lack of information do not take more than 1 tsp per day.

Constituents.

Volatile oil; azulene, chamazulene,guaiizulene, alpha and beta pinene, borneol, bornyl acetate, camphor, caryophyllene, eugenol, farnesene, myrcene, sabinene, isoartemisia ketone, terpineol, thujone, alpha-bisabolol, neridol, spathulenol and others.

Sesquiterpenes and sesquiterpene lactones; achillin, achillicin, hydroxachillen, balchanolide, leucodin, millifin, millifolide, longipine and achillifolin and their derivatives.

Flavonoids; apigenin, luteolin, quercitin and their glucosides.

Alkaloids and bases; betonicene, stachydrine, achiceine, moschatine, trigonelline and others.

Miscellaneous; polyvynes, cyclitols, salicylic acid etc.

Scientific evidence.

There is evidence of effectiveness of yarrow for reducing high blood pressure in anaesthetised rats.[1]

There are no clinical studies on the use of Yarrow for osteoarthritis.

Mechanism of action.

Yarrow has an evidence base for promoting sweat, lowering fever, lowering blood pressure, astringency,  promotion of urine flow, urinary antiseptic, antispasmodic, and antiflatulent effects.⁴ Yarrow contains amino acids, fatty acids, ascorbic acid (vitamin C), caffeic acid, folic acid, salicylic acid, succinic acid, alkaloids, flavonoids including rutin, tannins, volatile oil, an unknown cyanogenetic compound, and sugars.⁴ The volatile oil contains chamazulene, other azulenes,⁵ and trace amounts of thujone.^4,5 The volatile oil content, and especially the azulene content, varies considerably depending on the source.⁵ The alkaloid fraction has shown evidence of fever lowering and blood pressure lowering effects.⁴

A water extract shows some evidence of anti-inflammatory and diuretic activity. ⁴

The anti-inflammatory activity is partly mediated by inhibition of protein splitting enzymes involved in the inflammatory pathways (HNE and MMP-2 and -9).⁹ Anti-inflammatory and anti-allergy activities may be associated with the volatile oil chamazulene.⁶ Not all species contain azulene constituents.⁶ An alcohol extract shows moderate antibacterial effects.

Animal studies showed protective anti-stomach ulcer effect which included protecting the stomach lining against indomethacin (An NSAID).⁸ 

Interactions with herbs and supplements.

None reported.

Because yarrow contains the essential oil thujone in very small amounts there is a possibility that taking other herbs containing this essential oil will have an additive effect leading to problems associated with toxicity of high levels of thujone. Thujone-containing herbs include oak moss, oriental arborvitae, sage, tansy, thuja (cedar), tree moss, and wormwood. Be careful to avoid higher than therapeutic doses. Consult a medical herbalist for advice regarding combining these herbs. The level of thujone in yarrow used by itself of not a concern.

Interactions with drugs.

Warfarin: there is a theoretical risk of interaction. Monitor weekly and do not exceed the therapeutic dose.

Lithium. Precaution advised with any herb or drug with diuretic effect including yarrow, black tea and coffee. If you start of stop any substance with a diuretic action monitor your blood lithium level. 

Interactions with foods.

None known.

Interactions with lababoratory tests.

None known. 

Dosage.

Recommended dose:

Tincture: 2-6mls per day 1:5 tincture 30% alcohol.

Infusion: 1-3 tsps per day.

Powder/capsule: 1-2gms per day in tablet form.

Infusion of dried herb: 2-4 gms per day. Typically 1 tsp. three times daily as a herb tea. This can be increased to 1 tsp. every 2 hours for acute conditions such as influenza.

Liquid extract: 1-3ml/day 1:1 in 25% alcohol.

Dr Clare’s Joint Cleansing Tea provides ½ tsp. per day of peppermint.

References.

1.  FDA. Center for Food Safety and Applied Nutrition, Office of Premarket Approval, EAFUS: A food additive database. Available at: vm.cfsan.fda.gov/~dms/eafus.html. [Accessed 22/6/2014]

2.  Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Trans. S. Klein. Boston, MA: American Botanical Council, 1998.

3.  McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.

4.  Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press, 1996.

5.  Leung AY, Foster S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs and Cosmetics. 2nd ed. New York, NY: John Wiley & Sons, 1996.

6.  The Review of Natural Products by Facts and Comparisons. St. Louis, MO: Wolters Kluwer Co., 1999

7. Blood pressure lowering, cardiovascular inhibitory and bronchodilatory actions of Achillea millefolium.

Phytother Res. 2011 Apr;25(4):577-83.

Khan AU, Gilani AH.

8. Safety and antiulcer efficacy studies of Achillea millefolium L. after chronic treatment in Wistar rats

Ana Maria Cavalcanti, Cristiane Hatsuko Baggio,Cristina Setim Freitas.

Journal of Ethnopharmacology

Volume 107, Issue 2, 19 September 2006, Pages 277–284.

9. Achillea millefolium L. s.l. – Is the anti-inflammatory activity mediated by protease inhibition?

Birgit Benedek, Brigitte Kopp, Matthias F. Melzig^.

Journal of Ethnopharmacology

Volume 113, Issue 2, 5 September 2007, Pages 312–317

Also Known As:

Broad-Leaved Dock, Curled Dock, Curly Dock, Field Sorrel, Yellowdock.

Scientific Name: Rumex crispus.

Family: Polygonaceae.

People Use This For:

Yellow dock is used for acute and chronic inflammation of nasal passages and the respiratory tract, as an adjunct to antibacterial therapy, a laxative, tonic.

Historically, yellow dock has been used for chronic skin diseases, dermatitis, rashes, scurvy, obstructive jaundice, and psoriasis with constipation.

 Safety:

No concerns regarding safety. No reports of harm when used therapeutically.

Pregnancy and Lactation: Refer to a Medical Herbalist.

 Effectiveness: There is insufficient scientific information available about the effectiveness of yellow dock.

Mechanism of Action: The applicable parts of yellow dock are the root and rhizome. Yellow dock contains anthraquinone glycosides, and tannins.^56,57,58,59 Oxalate content is high in the leaves and low in the stalks.⁶⁰ The anthroquinones (2-4%) have a mild stimulant laxative effect.^56,58,59 Anthroid laxative use is not associated with an increased risk of developing colorectal adenoma or carcinoma.⁶¹ The tannins (12 20%)^59,62 are responsible for the astringent effect.⁵⁷ Yellow dock is reported to stimulate bile production.⁵⁶ The leaves of yellow dock contain provitamin A (beta-carotene) and iron.⁶²

Adverse Reactions: No reported problems with therapeutic amounts of root.

Interactions with Herbs & Supplements: No reported problems with therapeutic amounts of root.

Interactions with Drugs: No reported problems with therapeutic amounts of root.

Interactions with Foods: No reported problems with therapeutic amounts of root.

Interactions with Lab Tests: No reported problems with therapeutic amounts of root.

 Interactions with Diseases or Conditions: No reported problems with therapeutic amounts of root.

Dosage/Administration:

Dr Clare’s Blends: 1gm per day

Oral: Typical dose of the dried root is 2-4 grams or as a tea.⁵⁶ The liquid extract and a tincture 1-2 mL (1:5 in 45% alcohol) have also been used.⁵⁶

Specific References: YELLOW DOCK

56.  Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press, 1996.

57.  Foster S, Tyler VE. Tyler's Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies. 3rd ed., Binghamton, NY: Haworth Herbal Press, 1993.

58.  The Review of Natural Products by Facts and Comparisons. St. Louis, MO: Wolters Kluwer Co., 1999.

59.  McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.

60.  Ellenhorn MJ, et al. Ellenhorn's Medical Toxicology: Diagnoses and Treatment of Human Poisoning. 2nd ed. Baltimore, MD: Williams & Wilkins, 1997.

61    Nusko G, Schneider B, Schneider I, et al. Anthranoid laxative use is not a risk factor for colorectal neoplasia: results of a prospective case control study. Gut 2000;46:651-5.

62.  Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.