~.
Foreword H
~,
' *"
the basis of symptoms, without reference to an underlying pattern of disharmony. There was some attempt in the 19th century to take some account of the general constitution of a patient, and some attempt to classify herbs in terms of stimulants and relaxants and so on; but into the 21st century, there has been no satisfactory theory for prescribing herbs. By contrast, the theories of Chinese medicine are well established, encompassing most of human experience, spiritual, emotional, and physical. Many Western practitioners will be surprised to learn that there was a comparable theory system in the herbal medicine of the West that started with Hippocrates in the 5th century BC and was codified by Galen in the 2nd century AD. These Western theories are often remarkably similar to those of Chinese medicine: similarities are not only found in the Galenic system, but also in the later Physiomedical system of the 19th century. For example, in this system, as in Chinese medicine, strong patients are prescribed different herbs from weak patients. The present author's love of the history of herbal medicine has led him to trace its beginnings in ancient Greece and show the development of its theory and practice in the West up to the present day. He draws together the common threads of Western and Chinese tradition, and then uses this new framework of herbal theory to organize the data coming from pharmacological and clinical research. This task needed someone trained in science and skilled in both
used widely throughout the world and in many countries of the East herbal treatment from trained and qualified practitioners is readily available. Sadly, this is not always true in the West. This is a pity, for Western herbs are wonderful, and very effective. For people living in the Western world they have a great advantage over herbs from other countries: they grow here in the West. This means that the plants can be studied at first hand: the way they grow; their preferred habitat; the effect of climate on their therapeutic effectiveness. All can be observed through the changes of the seasons, often in the wild within a few miles of where one lives. They can be gathered in the wild or grown in the garden. All this helps to deepen one's understanding of the nature and action of a herb. From my own 25 years of experience of treating children, I can vouch for the fact that Western herbs can be safe and effective for the treatment of a wide range of pediatric disorders. Nor is the effectiveness of Western herbs limited to children- many of the acute and chronic conditions of adult patients respond well to Western herbs, when these are properly prescribed. So why is it that Western herbs are not more used by health practitioners? The answer lies in the recent absence of any satisfactory theory for prescribing them. For at least 200 years, the ancient Western theories of herbal medicine have been neglected, and herbs have been prescribed mainly on ERBAL MEDICINE IS
IX
Foreword
x
Chinese medicine and Western herbs, with a clear mind to put the whole thing together, and the practicality to test the theories in the clinic. It is not surprising that this has taken a long time, and I am delighted that this book has at last seen the light of day, some 20 years after work first began on the project. There have been many interesting books on herbal medicine written in the last few years, but the present book is exceptional, in containing so much new, and clinically useful
;
....".,
material. For the first time, information on how to use the herbs for different Chinese syndromes has been written down by someone who knows what they are talking about, because they have been using the herbs in clinic for many years. But the information does not stop here. There are complete prescriptions, with analysis of their composition and practical notes on their use, which makes this book stand out in a class of its own. -JULIAN SCOTT, MA, PHD, CERT.Ac. (NANJING)
Preface .. ~
was in science research, which involves two complementary activities. One is the careful gathering of data by close and detailed observation of living material. The other is the attempt to perceive underlying natural patterns within the seeming chaos of the mass of data. These natural patterns can then be represented by theoretical principles, so that the data can be organized, under-
• to classify Western herbs in terms of Chinese values for temperature, taste, actions, and organs entered
stood, and applied. When I first started to study Western herbal medicine in 1973, I was unable to fmd a framework of theoretical principles in the herbal texts then commonly available. There did not seem to be any logical system for matching herbs to disorders or for selecting herbs to form a balanced herb combi-
However, the more I investigated contemporary Western texts, the more I realized that the data they contained derived from a tradition of empirical herb use in the West reaching back over 2000 years. Therefore, I decided to include material from some of the more important materia medica of the past. As I researched the traditional Western texts, it became apparent that there had been a framework of theoretical principles in Western herbal medicine comparable to that in
M
, .....l
y ORIGINAL TRAINING
• to apply the Chinese principles of herb combination to Western herbs • to give illustrative combinations for each herb discussed
nation. In contrast, a similar combination of the close observation and the perception of natural patterns that I had found in science attracted me to Chinese acupuncture. It seemed to me that the framework of theoretical principles of Chinese medicine could also be applied to the use of Western herbs. This idea was reinforced when I started to study Chinese herbal medicine. I began to classify Western herbs in terms of Chinese values of properties, organs entered, actions, and the Chinese syndromes that they could be used to treat. Eventually, I decided to write a book with the following
China. I began to compare and contrast the Western theoretical system with that of the Chinese, and to select elements from each to produce a working synthesis. Early in the writing of this book it became obvious that there was a need to give supporting evidence for any Chinese values assigned to Western herbs. At first I drew this evidence from Western and Chinese traditional texts, but increasingly incorporated data from modern pharmacological and clinical research.
four main aims:
Gradually, the central theme of the book became the integration of theoretical principles from Western tradition, Chinese tradition, and modern pharmacology. This led to a
• to summarize the empirical data on herb use from contemporary Western texts Xl
xii
Preface
complete change in the organization of the material and a total rewrite of the text, which in turn resulted in an additional five years of writing and a book four times its original size..
However, I feel that the extra time and effort have been well worth it, and I have been fascinated by the way that the many different threads of my own past experience and interests have come together in this book.
..
Sources Evidence for statements made
• listed the temperatures and tastes for each herb in the combination so that the reader can check the supporting evidence for these values in the Research and Traditional sources sections of the materia medica chapters
Wherever possible in this book, references to source material are given tor statements made, and over 1,500 references have been cited.
• given PRACTICAL NOTES for each combination, describing its clinical use
SINGLE HERBS In the materia medica chapters of this book, references to support statements made concerning individual herbs are mainly given in the Research and Traditional sources sections.
Translations This book could not have been written in its present form without data from extensive translations from German and Chinese sources.
COMBINATIONS
GERMAN TRANSLATIONS
The materia medica chapters of this book describe and discuss over 150 different herb combinations. A few of these derive from practitioners other than myself, and for these the appropriate references are cited. However, most of the combinations in this book derive from my own experience, and it is therefore not possible to cite references to traditional texts. It is for this reason that I have:
For each herb with a materia medica chapter in this book, translations were made from the following texts in the German language whenever there was information available: Dioscorides, Lonicerus, and Tabernaemontanus. (See Source' abbreviations below for full title).
CHINESE TRANSLATIONS
• explained in detail the principles of herb combination in PART 1 of this book
Similarly, each herb chapter in the materia medica incorporates material from translation of the Chinese Herbal Medicine Dictionary (Zhong yao da ci dian), whenever data was available for a particular herb.
• given my reasoning for the construction of each individual combination according to these principles
xiii
Sources
XlV
Source~9bJiviatioris ~.
." ,"
DIOSCORIDESG Dioscorides P. Kreutterbuch (1610). Reprinted by Verlag Konrad K6lbl, Munchen, Germany
.:iJ>.-
(1960)
The majoritY of sources-bookS and journal articlesthat are referred to in this book, are specific to a particular materia medica chapter, and occur elsewhere infrequendy or not at all. However, a number of basic texts that are frequendy referred to have been assigned an abbreviation, often the names of their authors or editors. This has been done to save
ELLINGWOOD Ellingwood F. American Materia Medica, Therapeutics and Pharmacognosy. 11th edn. (1919). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1994)
cluttering the text with long repeating tides. These abbre-
ESCOP MONOGRAPHS
viations are listed below with their associated full reference. Note: The superscript G indicates that the text is in the German language. The superscript CH indicates that the text is in Chinese.
European Scientific Cooperative
on Phytotherapy: Monographs on the medicinal uses of plant drugs. European Scientific Cooperative on Phytotherapy, Exeter, United Kingdom (1997) EVANS
Evans We. Trease and Evans' Pharmacognosy, 14th
edn. WB Saunders, London, United Kingdom (1996) BENSKY AND GAMBLE Bensky D, G~ble A, Kaptchuck T. Chinese Herbal Medicine Materia Medica. Eastland Press, Seatde, Washington (1986) BHC Bradley PR (ed). British Herbal Compendium, vol I. British Herbal Medicine Association. Bournemouth. United Kingdom (1992) BHP British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983) BOTANICAL SAFETY HANDBOOK
McGuffm M, Hobbs C,
Upton R et al. American Herbal Products Association's Botanical Safety Handbook. CRC Press. Boca Raton, Florida (1997)
FELTER AND LLOYD Felter HW and Uoyd JU. King's American Dispensatory, vols.1 and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1983) Fox Fox W. The Working Man's Model Family Botanic Guide to Health, 7th edn. William Fox, Sheffield, United Kingdom (1878) GERARD Gerard J. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publications, New York, New York (1975) GERMAN COMMISSION E MONOGRAPHS
Blumenthal M
(ed). The Complete German Commission E Monographs: BRUNETON Bruneton J. Pharmacognosy: Phytochemistry Medicinal Plants, 2nd edn. Lavoisier, Paris, France (1999) CHANG AND BUT
Chang H-M, But PP-H (eds). Pharma-
cology and Applications of Chinese Materia Medica, vols. 1 and 2. World Scientific Publishing, Singapore (1986) CHINESE HERBAL MEDICINE DICTIONARyCH
Jiangsu
New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science and Technology Press, Shanghai, China (1975)
Therapeutic Guide to Herbal Medicines. American Botanical Council, Austin. Texas (1998) GRIEVE
Grieve M. A Modern Herbal, vols. 1 and 2. Dover
Publications, New York, New York (1971) GRIGGS
Griggs B. Green Pharmacy: The History and
Evolution of Western Herbal Medicine, 2nd edn. Healing Arts, Rochester, Vermont (1997) HILDEGARD VON BINGEN'S
Bingen's Physica. Healing Arts, Rochester, Vermont (1998)
CHRISTOPHER Christopher JR. School of Natural Healing. BiWorld, Provo, Utah (1976)
KLOSS
CRELLIN AND PHILPOTT Crellin JK, Philpott. J. A Reference Guide to Medicinal Plants. Duke University Press, Durham, North Carolina (1990)
LONICERUS G
Kloss J. Back to Eden, 5th edn. (1939). Reprinted by _
Lifeline Books, Santa Barbara, California (1975) Lonicerus A. Kreuterbuch (1679). Reprinted
by Verlag Konrad Kolbl, MUnchen, Germany (1962) LYLE
CULPEPER Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks, Glenwood, Illinois (1990)
Von Bingen H. Hildegard von
Lyle TJ. Physio-Medical Therapeutics, Materia
Medica and Pharmacy. Originally published Ohio (1897). Reprinted by the National Association of Medical Herbalists of Great Britain, London, United Kingdom (1932)
~.
...
-
Sources MABEY
Mabey R (ed). The Complete New Herbal. Elm
Tree Books, London, United Kingdom (1988) MAILHEBIAU Mailhebiau P. Portraits in Oils. The C.w. Daniel Company, Saffron Walden, Cnited Kingdom (1995) MARTINDALE Reynolds EFJ (ed). Martindale: The Extra Pharmacopoeia, 31st edn. Royal Pharmaceutical Society, London, United Kingdom (1996)
•
MILLS Mills S. The Essential Book of Herbal Medicine. ArkanafPenguin Books, London, United Kingdom (1991) MILLS AND BONE Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal lvledicine. Churchill
xv
PRIEST AND PRIEST Priest AW, Priest LR. Herbal Medication. L.N. Fowler, Romford Essex, United Kingdom (1982) TABERNAEMONTANUSG Tabernaemontanus JT. Krauterbuch (1731). Reprinted by Verlag Konrad K6lbl, Munchen, Germany (1993) TIERRA Tierra M. Planetary Herbology. Lotus Press, Twin Lakes, Wisconsin (1988) TISSERAND AND BALACS Tisserand R, Balacs T. Essential Oil Safety: A guide for Health Care Professionals. Churchill Livingstone, Edinburgh, United Kingdom (1995)
Livingstone, Edinburgh, United Kingdom (2000) MOORE Moore M. Medicinal Plants of the Pacific West. Red Crane Books, Santa Fe, New Mexico (1993) PERRY .P~rry LM.~.Medicinal Plants of East and Southeast Asia. The MIT Press, Cambridge, United Kingdom (1980) POlAR AND MACKINNON Pojar J, MacKinnon A. Plants of the Pacific Northwest Coast: Washington, Oregon, British Columbia and Alaska. Lone Pine Publishing, Redmond, Washington (1994)
...
1
WEISS Weiss RF. Herbal Medicine, English edn. Beaconsfield Publishers, Beaconsfield, United Kingdom (1988) WICHTL Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm, Stuttgart, Germany (1994), from 2nd German edn. Wichtl M (ed) (1989) YEUNG Yeung H-C. Handbook of Chinese Herbs and Formulas vol I. Institute of Chinese Medicine, Los Angeles, California (1985)
"i'll
Terminology 1.
1
bi<.i_
L
Mandarin Chinese tones
Chinese names The following conventions have been adopted in this
book: 1. Chinese herb names EXAMPLE:
lower case with tones gul zhI
a
first tone
starts high and is held steady
a a
second tone
starts in midrange and rises
third tone
starts in lower midrange and drops down before rising
a
fourth tone
starts high and drops down sharply
2. Chinese concept names first letter capitalized, (commonly used) no tones EXAMPLE:
Chinese organs and syndromes
Qi
3. Chinese concept names lower case with tones
ENGLISH NAMES
(less commonly used) EXAMPLE:
The English names of Chinese concepts start with a capitalletter, for example, substances such as Blood, organ systems such as Heart, and syndromes such as Deficiency. For ease of indexing, organ syndromes are written with the organ stated before the type of syndrome. For example, the term Heart Deficient Qi is used throughout in this book, rather than Deficient Heart Qi.
yldu'
4. Chinese formula names lower case and italics, no tones EXAMPLE:
5. Chinese book tides EXAMPLE:
6. Chinese authors EXAMPLE:
liu wei dihuangwan only first letter of first word capitalized, no tones
Abbreviations of organ names
Huang di nei jing first letter of both elements capitalized, no tones
Bladder Gallbladder Heart Intestines
Zhang Zhong-jing
xvii
BL GB
HT IN
Terminology
xvm
Kidney Liver Lung Spleen
Stomach Uterus
KI
LR LU SP ST
UT
Intestines In referring to the use of Western herbs, this book generally uses the term Intestines to represent the combined Chinese organ systems of Large Intestines and Small Intestines, without differentiating between the two. However, in the Gentiania and Centaurium chapter, these herbs are referred to as specifically affecting the Small Intestine organ system. Uterus The term Uterus is used in this book to refer to the Chinese concept of the female reproductive system.
NONSTANDARD CHINESE SYNDROMES Some of the organ system syndromes given in this book are not standard Chinese syndromes, that is, they are not generally listed in classical Chinese texts. Examples are: • Heart Qi Irregularity • Heart Stagnant Qi • Intestines Qi Disturbance • Kidney Stagnant Qi • Kidney fear invades the Heart • Lung Stagnant Qi • Uterus Stagnant Qi I have used these terms to represent common patterns that I have observed in the clinic. Heart Qi Irregularity This syndrome represents irregularity of the Qi of the Heart, especially irregular function of the physical heart organ with predominantly physical signs, such as arrhythmia. It thus differs from Heart Spirit Disturbance, which represents disturbance of the Spirit of the Heart and may include symptoms of mental and emotional imbalance. Herbs such as Crataegus and Leonurus can be said to strengthen and stabilize Heart Qi, and thus treat the syndrome of Heart Qi Irregularity. They thus help to reduce excessive fluctuations in cardiac rhythm, blood pressure, or body temperature (see the chapters on these herbs). Heart Stagnant Qi This term refers to Stagnant Qi of the Heart, which may be associated with poor posture and lack of physical exercise, sadness and depression, frustration and difficulties in relationships,' and difficulty in expressing feelings and affection. Physical symptoms may include a sensation of fullness or obstruction in the chest, dull ache in the chest, and poor peripheral circulation. This syndrome
differs from Stagnant Blood of the Heart in that the latter syndrome is characterized by severe chest pain. Herbs such as Rosmarinus can be used to move Stagnant Qi of the Heart and thus to treat associated depression (see the chapter on this herb). Intestines Qi Disturbance This term refers to a disturbance of the rhythm of intestinal function by such factors as irregular eating habits, laxative abuse, or emotions such as Heart anxiety, Kidney fear, or Liver anger. Associated symptoms include abdominal distension, intestinal colic, borborygmus, flatulence, and irregular bowel movements. Herbs such as Lavandula and Lobelia can be used to calm the Intestines by rela.xing intestinal muscle spasms and restoring normal peristalsis (see the chapters on these herbs). Kidney Stagnant Qi In my opinion, one aspect of Kidney energy is ambition and the desire to achieve. If this energy has no suitable outlet or if it is obstructed, the syndrome of Kidney Stagnant Qi can arise with associated symptoms, such as dysmenorrhea or pain in the kidney area: Kidney Stagnant Qi can also be associated with states of chronic fear. Herbs such as Ruta can be used to move Stagnant Qi of the Kidney and thus to treat associated conditions of pain in the urinary and reproductive systems (see the chapter on this herb). Kidney fear invades the Heart In my opinion, excessive Kidney fear, whether expressed or suppressed, can disturb Heart Spirit, resulting in symptoms such as insomnia, nightmares, nervousness, palpitations, and hysteria. Herbs such as Anemone and Ruta can be used to treat these symptoms by reducing Kidney fear (see the chapters on these herbs). Lung Stagnant Qi This syndrome can be associated with poor posture and lack of physical exercise, chronic asthma or bronchitis, and the emotion of grief, whether expressed or suppressed. Herbs such as Lobelia, which can both stimulate breathing and relax bronchial spasms, can be used to move Lung Qi and relieve symptoms such as the sensation of restricted breathing with fullness in the chest (see the chapter on this herb). Uterus Stagnant Qi This term refers to the Stagnation of Qi in the female reproductive system, which may be associated with poor posture and lack of physical exercise, or with emotional constraint-whether associated with suppressed anger, depression, fear, or grief. The syndrome may be linked to conditions such as amenorrhea, dysmenorrhea with dull aching, irregular menstruation, or premenstrual syndrome with distension and soreness of the breasts. Herbs such as Leonurus or Ruta, which can move the Qi of the Uterus, can be used to treat these conditions (see the chapters on these herbs).
Introduction !'
Aims ofthis book I'·
This book has the following aims:
for beginners to perceive any pattern in the mass of data confronting them. It was hard to differentiate between herbs and thus difficult to select the most suitable herb for the specific needs of a particular patient. For example:
• to provide a clear differentiation between the different herbs presented
• Christopher listed both Achillea and Salvia for fever, nasal catarrh, digestive weakness, flatulence, liver disorders, hemorrhages. ulcers, and hair problems!
• to provide a framework of theoretical principles as a basis for herb choice and herb combination
• Grieve listed both Rosmarinus and Salvia for cough, • to initiate an integration in the use of herbs according to Western tradition. Chinese tradition, and modem
digestive weakness. kidney disorders, headache, poor memory, nervous disorders, and hair problems2
research
• the BHP listed both Lavandula and Rosmarinus for
• to give suitable herb combinations to illustrate the use of each main herb presented
headaches, migraines, myalgia, spasms, flatulent dyspepsia. and depression 3
• to emphasize the importance of safety considerations
I have therefore taken every effort in this book to bring out the unique character of each herb that makes it special and different from the others.
in herbal medicine
CLEAR DIFFERENTIATIO~ BETWEEN HERBS \.-'=-
FRAMEWORK OF THEORETICAL
Perhaps the greatest initial difficulty in studying phytotherapy is learning to differentiate between the different
PRINCIPLES
herbs. In the herbal texts that were readily available when I
At the time I began to study phytotherapy, there did not appear to be a system of theoretical principles for matching herbs to disorders within Western herbal medicine itself. The Galenic system had not been used for almost two centuries-
began to study herbal medicine, the frequency of overlapping uses between the: different herbs often made it difficult
xix
._-,,-.,,~
Introduction
xx
most modern herbalists were unaware of its existence-and the theoretical system of Chinese herbal medicine had not yet become known in the West. At that time, there were attempts to explain herb choice in terms of the paradigms of either Physiomedicalism or conventional Western medicine, neither of which was wholly satisfactory. The materia medica available in the early 1970s, such as the texts of Christopher, Grieve, or the BHP, did not include a theoretical system to explain the choice of single herbs or the logic behind herb combinations.l became determined to write a materia medica that did include such a system. Therefore, every herb that has a materia medica chapter in this book is categorized in terms of temperature, taste, actions, and the organ syndromes that it can treat. For each of these herbs, examples of combinations are given to illustrate the principles of herb combining.
INTEGRATION OF WESTERN TRADITION, CHINESE TRADITION, AND MODERN
nations, few consistently explained the logic behind their herb formulations. Some, for example, Christopher, occasionally justified their combinations in empirical terms, simply stating that a particular combination was effective. Others sometimes gave brief theoretical explanations for their combinations. For example, Shook explained his formula for nephritis and diabetes in terms of a mixture of Physiomedical and conventional medical concepts,6 and Weiss sometimes gave very brief explanations of the combinations 7 he listed in terms of conventional medicine. However, I have not seen a text in the English language, published between 1890 and 1990, in which the illustrative combinations are consistently explained in terms of a system of theoretical principles. In this book, six illustrative combinations are generally given for each of the herbs with a materia medica chapter. These combinations illustrate the principles of combination laid out in PART I of this book and show how the' effects of one herb can be enhanced or moderated by the other herbs in a combination.
RESEARCH The original aim of this book was to provide Chinese values for properties and actions for a number of commonly used Western herbs, and to use the principles of herb combination found in Chinese herbal medicine. However, as the book evolved, its central theme became the integration of Western herbal tradition, Chinese herbal tradition, and modern research, bringing together both empirical data and theoretical principles from these three sources. The categories of temperature and taste used in this book most closely follow the Chinese model, but Western herbal and modern pharmacological concepts have been incorporated. The concepts used for the herbal action categories draw equally on the Western and Chinese herbal systems, with further expansion of understanding from pharmacology and clinical research. One of the most fundamental principles in this book is that of restoring balance within the body by creating a matching balance within a herb combination. This principle is common to both the Western and Chinese traditional systems, and can greatly contribute to the safety of herbal practice, as discussed below.
COMBINATIONS TO I~LUSTRATE HERB USE '
..
Many of the 20th century materia medica of Western herbs in the English language did not include illustrative combinations for most of the herbs presented. 2•3•4•s Of those authors who regularly gave illustrative combi-
SAFETY CONSIDERATIONS IN HERBAL MEDICINE Safety considerations are essential to the practice of herbal medicine. Three chapters are devoted to safety issues in PART I of this book. In addition, relevant cautions, contraindications, and toxicological data are listed for each herb that has its own materia medica chapter. The premise of this book is that it is possible both to maximize the safety of herbal medicine and to increase the availability of beneficial herbs to the public. Safety considerations need not stifle the scope of herbal practice. Indeed, both increased safety and increased clinical effectiveness result when practitioners take greater care with the balance of temperature, tastes, and actions within a combination.
Choice ofherbs in the materia medica There is an average of 15 pages for each herb chapter in the materia medica of this book, thus limiting the number of herbs that can be treated in this degree of detail. The selection of 51 main herbs, from the several hundred that have been in common use in the West, reflects my personal background and preferences, as shown in the following three examples.
Introduction
-
...
XXI
NORTH AMERICAN HERBS
PART I
I have included several herbs native to North America, such as Asclepias, Hydrastis, Lobelia, Myrica, Phytolacca, and Zanthoxylum. These herbs represent the important contribution of the Native American people and of the Physiomedical movement to herbal therapy, and I find them to be amongst the most effective herbs available. They are well known in Britain but are still little used in Europe.
deals with the principles of herb combination in both theory and practice, and with considerations of dose and safety.
MEDITERRANEAN AROMATIC HERBS
-
,
I have also included several aromatic herbs native to the Mediterranean region, such as Lavandula, Rosmarinus, Salvia, and Thymus. These herbs from the Lamiaceae family have high essential oil content. Their aromatic constituents can affect both emotional and mental state, which has made these herbs central to the development of aromatherapy. They are little known in China. and Lavandula and Rosmarinus have been much more commonly used in Europe than in the United States. CARDIOACTIVE HERBS I have included several herbs that can be used to treat cardiac disorders such as cardiac weakness, cardiac arrhythmias, and angina pectoris. Examples are Cinchona, Convallaria, Crataegus, Leonurus, and Sarotharnnus. Two of these herbs, Cinchona and Convallaria, are on Schedule Part III of the Herbal Remedies Order 1977 of the UK, and in my opinion are not suitable for over-the-counter sales. However, they can be useful in the treatment of certain heart disorders, providing all appropriate screening, treatment precautions, and monitoring procedures are taken.
Additional herbs In addition to herbs which have their own chapter in the materia medica, the Additional herbs chapter contains a brief description of 66 further herbs that are included in the combinations discussed in this book.
PART I
PART II PART II, the materia medica, is the heart of this book. Readers are advised to study the preliminary chapter Using the materia medica, which explains how the herb chapters are organized and how they can be used to best effect.
DATA ACCESS Cross references
Herb names cross references In this book, herbs are referred to by their botanical names. Readers who wish to refer to herbs by their English, Pharmaceutical, or Mandarin names will find these in the cross references in the Appendix. However, these cross references contain only a single main page reference for each herb. More detailed page references are to be found in the Index under the herb's botanical name.
Herb combfnation cross references About 150 herb combinations are discussed in this book. The CombinationsChinese syndromes cross reference gives the main page reference for each combination, together with its associated Chinese syndromes. Herb combinations for specific disorders can be accessed using the Disorders-combinations cross reference. Index The Index has been specially designed for ease or access to four main types of data: • herbs • herb actions • disorders • Chinese syndromes
Please read the Index introduction for a detailed explanation ofhow to access these four types ofdata.
References
.How this book is organized 1. Christopher
This book has three main divisions: Herbal medicine in theory and practice • PART II Materia medica • Appendices • PART I
JR. School of Natural Healing. BiWorld, Provo. Utail
(1976)
2. Grieve M. A Modem Herbal, vols. 1 and 2. DoYU Publications, New York, New York (1971) 3. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983)
xxu
Introduction
4. Cook WH. The Physio-Medical Dispensatory, Cincinnati (1869). Reprinted by Eclectic Press. Portland, Oregon (1985)
6. Shook E. Advanced Treatise in Herbology. Enos Publishing. Banning.
5. Hohnes P. The Energetics of Western Herbs. Artemis Press. Boulder. Colorado (1989)
7. Weiss RF. Herbal Medicine. English edn. Beaconsfield Publishers,
California (1992) Beaconsfield. United Kingdom (1988)
~-.
i
Table of Contents FOREWORD PREFACE
Xl
SOURCES
xiii
Materia medica Using the materia medica
161
Achillea
165
Althaea
183
PART I:
Anemone
193
Herbal medicine in theory and practice
Angelica
TERMINOLOGY·" INTRODUCTION ...
I~
PART II:
IX
xvn
xix
History
···3
_
205
Arctium
221
Temperature
19
Arctostaphylos
233
Taste
29
Artemisia
243
57
Asclepias
263
Actions glossary
67
Berberis and Hydrastis
273
Principles of herb combination
83
Calendula
299
Practical herb combination
89
Capsella
309
Actions
-
Dose '"
Capsicum··.·
·······97
·
:
319
Safety
121
Clffilcifuga
339
Safety and the organ systems
139
Cinchona
355
Safety in clinical practice
151
Cinnamomum
371
vii
Table of Contents
VUl
387
Taraxacum
399
Thuja
Crataegus
411
Thymus
Echinacea··:·······························.··
42 5
Turnera
771
Euphrasia
439
Valeriana
781
Filipendula
447
Viburnum
795
Gentiana and Centaurium
455
Zanthoxylum
Glycyrrhiza
473
Zingiber
819
Hamamelis
493
Harpagophytum
503
Additional herbs
837
Juniperus
513
Lavandula .,
527
Leonurus
539
Commiphora Convallaria
Lobelia·····.·············
···········
···········.· .. ···
553
Myrica·····················.············· .. ····.··573
725
····
········739 · .. ·····
·· 757
:
805
Appendices GLOSSARY'"
847
HEALING CRISES ... 851 HERB PROPERTIES ...
853
Phytolacca
587
HERB NAMES ... 859
Piscidia
599
CROSS REFERENCES:
Potentilla
607
Family-botanical names
865
Rheum
619
Botanical-family names
869
Rosmarinus
635
English -botanical herb names .. ,
Ruta
651
Pharmaceutical-English herb names
Salvia
667
Botanical-Mandarin herb names
883
Sambucus
687
Mandarin-botanical herb names
885
Sarothamnus
697
Smilax································ Tanacetum
·
707
715
873
Combinations-Chinese syndromes ... Disorders-combinations ... INDEX ...
899
893
877
887
PART I:
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·Herbal Medicine in Theory and Practice
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History • History ofthe materia medica
ancient Greece and Rome, three of the most influential founders ofWestern herbal medicine can be said to be Hippocrates, Dioscorides, and Galen. Hippocrates developed a complete system of holistic therapies. These were based on a framework of medical theory developed from the new philosophies of his time. In addition, he imbued medicine with an ethical code and a deep sense of humanity. He has been said to have given medROM THE TIMES OF
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The first section discusses the development of the theoretical principles of Western medicine and their basis in early Western philosophy. The second section describes the application of these principles to the classification of herbs according to theoretical properties. The third section chronicles the development of materia medica from ancient Greece to the present day.
icine a soul. Dioscorides was the author of the first Western materia medica that was both thorough and practical.! His book was notable for its clear compilation of empirical herbal knowledge and became the most influential materia medica in Western history. The indications that Dioscorides gave for individual herbs have been copied in subsequent herbal texts
Philosophical principles and medical theories Throughout the world, the earliest forms ofherbal medicine were associated with shamanism and magic. The causative factors of disease were believed to be malevolent spirits, whether these were demons or the ghosts of ancestors. It was believed that these evil influences could be driven off by the shaman using a combination of herbs and magic. Shamanistic herbal medicine remains in use today in many cultures, but it is outside the scope of this book. About 2,500 years ago, in both China and the West, philosophers began to explain their observations of the world around them in terms of the logic of natural laws. This led to an understanding of the origins of disease based on the operation of natUral principles, rather than as a result of supernatural intervention.
right into the 20th century. Galen, in addition to his great contributions to anatomy and physiology, was responsible for producing a detailed theoretical system for classifying and using herbs according to properties and actions. The system associated with his name was used in the West for 15 centuries and provided a theoretical structure in herbal medicine similar to that used in the Chinese medicine tradition. The contributions of these and other authors'to the theory and practice of herbal medicine are discussed under three section headings below: '
• Philosophical principles and medical theories • Classification ofherbs by properties and actions
3
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Combining Western Herbs and Chinese Medicine
In both China and the West, the natural world was explained according to philosophical principles such as: • the existence of a vital force • a duality of complementary polar forces • the operation of a number of'elements' or 'phases of change' In the West, these philosophical concepts began in ancient Greece, and the concepts that developed were incorporated into the theoretical principles of Western herbal medicine.
VITAL FORCE The most basic concept of traditional Western herbal medicine is that of a vital force or life energy that pervades all matter and sustains all the functions of the body. Healing power of life One manifestation of this vital force is the inherent ability of the body to heal itself. This concept of the vis medicatrix naturae has been attnbuted to Hippocrates of Cos, who lived about 400 Be. Hippocrates is regarded by many as the greatest Western physician of all time and the primary founder ofWestern medicine, although the writings attributed to him may be the work of a school, rather than of a single man. 2 One of the basic teachings of the Hippocratic school was that the physician should assist the body to heal itself and should use minimal treatment, avoiding such intrusive modalities as strong drugs or surgery wherever possible. Vital heat of the body The vital force was often associated with the natural heat of the body. In the 2nd century AD, Galen emphasized that this vital heat should be supported in any treatment and should not be diminished. In the 17th century, Culpeper wrote that 'we live by heat and not by cold:3
In the early 19th century, Thomson stated that 'cold or the lessening of the power of heat is the cause of all disease; that to restore heat to its natural state was the only way that health could be produced.'4 In China, the concept of cold as a main origin of disease was emphasized about the 3rd century AD by Zhang Zhong-Jing in his famous work the Shang han za bing lun.s Vitalism and mechanism During the 19th century, the philosophical basis of the sciences and medicine became increasingly mechanistic. Vitalism and mechanism were seen as irreconcilable opposites and the importance of the concept of a life energy declined in1:he new mechanistic medicine that was developing. In herbal medicine, the principle of a vital force was maintained by the North American Physiomedical practitioners, including Lyle, Thurston, and Cook.
In the last 40 years, the increasing popularity of Chinese medicine in the West, with its basis in Qi theory, has brought renewed interest in and understanding of the concept of life energy, and of the fundamental importance of supporting this force in helping the body to heal itself. Mechanism and vitalism can now be seen not as mutually exclusive concepts but as two different views of the same reality. The mechanistic understanding of biochemistry and the vitalistic understanding of life energy are both useful complementary views of reality. PAIRS OF COMPLEMENTARY OPPOSITES In China, Ym- Yang theory, the concept that all phenomena are the result of two opposing forces, may have originated about 4,000 years ago in the Shang dynasty.6 However, the first record of the application of this theory to medicine appears in the Huang di nei jing, of which some parts may have been written about 200 BC.7 The concept of a polarization of reality may have existed in the West for millennia. The principle of complementary opposing principles, such as fire and water, are basic to many cultures. Aristotle may have been one of the first to incorporate it into a new logical philosophy, just as Hippocrates was one of the first to assimilate this very ancient concept into the new medical corpus, about 400 BC. Concept of balance Both the Chinese and Western models of health and disease were based on the concept of balance, whether between two opposites, such as heat and cold, or between a greater number of principles, such as the four humors (see below). Disease was regarded as an imbalance, and herbal or other treatments were aimed at assisting the natural tendency of the body to restore its inherent balance. According to Hippocrates, health depended on a proper balance of heat and cold, and dryness and moisture. If a person had a disorder involving heat and dryness, this would be balanced with food or herbs that were cooling and moistening. This concept of polar opposites was later used by Galen asthe basis for his systematic classification of herbs according to the herbs' properties. His system of grading herbs according to degrees of heat ar:d cold and dryness and moisture remained in use until the 18th century.3 In the early 19th century in North America, the Physiomedical movement of naturopathic herbal therapy developed from the work of Thomson. Its early phase included a duality of treatment principles: stimulate and relax, which can be regarded as a crude analogy to Yin-Yang theory. Later Physiomedical authors developed a more sophisticated understanding, and in 1890 Cook wrote:
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History 'Regularity in periods of alternate labor and rest is characteristic of all vital action...the earliest departure of the tissues from under the full control of the vital force will be in the lack of ability either to relax or to contract some of the tissues as readily as in the healthy state... ' 8
In the late 19th and early 20th century, Western physiologists described the body as a system in oscillating balance with values maintained within narrow limits. This concept was later termed homeostasis, and pathologically large fluctuations in the balance were described in terms of hyperfunction or hypofunction. In modem herbal therapy, treatments aim at strengthening the natural homeostatic mechanism of the body in order to correct any hyper- or hypofunction. This can be regarded as the principles of Hippocrates or of Cook put into modern terminology.
THE ELEMENTS
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In Chinese medicine, according to the theory of the Five Elements, all natural phenomena can be described in terms of transformations between the phases of Fire, Earth, Metal, Water, and Wood. This theory may have had its origins as early as 500 BC,9 but it was first systematized by Zou Yen about the 4th century BC. Medical application of the Five Element correspondences system, linking each phase to associated organs, tissues, and emotions, are given in the Huang di nei jing, possibly written about 200 BC. However, according to Jia De-dao,lo it was not until the Song dynasty (960-1279 AD) that Five Element relationships were commonly used to explain disease processes. In ancient Greece, Empedocles, ",no lived about 450 BC, proposed that everything is composed of the four elements of fire, air, water, and earth, combined in differing proportions. According to Empedodes, these four dynamic principles underlie the transformations observed in both man and nature. The first record of the medical applications of the Greek Four Element theory is found in the writings of Hippocrates in the 5th century BC. Hippocrates linked the four elements to the four seasons and to the four humors of the body (see below). He taught that the four humors vary in strength according to the season, for example, phlegm increases in a man in the winter. because phlegm is the coldest constituent of the body and most closely akin to winter. Each season therefore has its characteristic diseases. I ~ It seems more than coincidence that the very similar theories of Four Elements and Five Elements should arise within about one century of each other in Greece and China, respectively. According to Unschuld," a philosophical impulse may have spread from an unknown source somewhere
5
between Greece and China, and may then have been modified according to the different intellectual environments of the two cultures.
Primary qualities In addition to the theory of the Four Elements-fire, air, water, and earth-both Aristotle and Hippocrates also used the concept of the four primary qualities: hot, cold, dry, and moist. I 2.13 These can be regarded as two pairs of complementary opposites: • hot and cold • dry and moist
Each element was said to incorporate a pair of primary qualities, one relating to temperature and the other relating to humidity. Fire was said to be hot and dry, air to be hot and moist. earth to be cold and dry, and water to be cold and moist. 11 In the medical system of the Hippocratic school, each element, \Yith its associated pair of primary qualities, was assigned a corresponding humor and temperament. This system of element correspondences resembles that of the Five Elements in Chinese medicine, as described in the Huang di nei jingo Elements fire air earth water
Primary qualities
Humor -'c'-Temperament·
hot and dry hot and moist cold and dry cold and moist
yellow bile blood black bile phlegm
choleric sanguine melancholic phlegmatic
The Four Humors In the Hippocratic system, it was believed that the human body was composed of four 'humors' or vital fluids: yellow bile, blood, black bile, and phlegm. Each of the Four Humors was linked to one of the Four Elements and to a pair of primary qualities, as shown in the table. Disease was thought to result from disturbance in the humoral balance. The humors were considered as partly material and partly energetic, similar to the concept of the Substances of Chinese medicine: Qi, Blood, Jing, Spirit, and Fluids. Forerunners of the modem concepts of Qi, Blood, Jing, Spirit, and Fluids can be found in the Huang di nei jing and may date back to the 2nd century BC. I ' The Four Temperaments Each of the four humors was associated with a temperament. Yellow bile was associated with the choleric temperament, blood with the sanguine temperament, black bile with the melancholic temperament, and phlegm with the phlegmatic temperament. The temperament described a person's physical constitution and psychological type. When in balance, each temperament was associated with specific positive qualities, but
6
Combining Western Herbs and Chinese Medicine
when in excess, each temperament was associated with characteristic negative qualities. For example, when in balance, the choleric temperament confers the positive qualities of warmth, activity, and courage, but when in excess, the choleric temperament results in the negative qualities of anger and irritability. The temperament assigned to a particular individual depended on the relative proportions of the four humors in the body-yellow bile, blood, black bile, and phlegm-and on the relative proportions of the primary qualities-heat, cold, dryness, and moisture. For example, in a person of the phlegmatic temperament, the dominant humor would be phlegm, and the dominant qualities would be cold and moist. This has important implications for the maintenance of health or the origin of disease. For example, if a person of the phlegmatic temperament were to consume too much food with the cold and moist qualities, the humor phlegm would become excessive. In the words of Culpeper, the person would become sleepy, dull, slow, heavy, and forgetful, with dreams of floods and water, much spitting and nasal discharge, and a slow and deep pulse. 3 The principle of treatment in such a case would be to reduce the excess of coldness and moisture by providing climate, foods, or herbs that were of the opposite qualities of hot and dry..
Importance oftemperature and humidity in the treatment In the medical system of ancient Greece and Rome, correcting imbalances of humors and temperaments involved correcting imbalances between heat and cold, as well as dryness and moisture. It was for this reason that, in the 2nd century AD, Galen classified herbs so carefully in terms of their degree of temperature, and humidity. This is discussed below in the section Classification ofherbs byproperties and actions. Importance ofhumors and temperaments in the treatment Occasionally, up to the 17th century, Western texts described the therapeutic effect of herbs in terms of correcting humoral imbalances. For example, both Gerard l5 and Culpeper wrote that Berberis could cleanse the body of choleric humors. However, I have not seen any traditional Western text that systematically listed the humors or temperaments associated with each herb. Western herbal texts from the 16th and 17th centuries continued to describe the disorders treated by herbs in terms of pathologies of heat and cold, and moisture and dryness. However, the.texts increasingly described disorders in terms of organ system imbalances rather than imbalances of humors or temperaments. For example, they used terms such as 'excessive moisture in the liver' and 'excessive cold in the stomach:
Similarly, traditional Chinese herbal texts did not generally describe herbs in terms of the Five Elements. Rather, the texts described the herbs in terms of syndromes of Substances, organ systems, and other pathologies, including Heat and Cold.
Classification ofherbs by properties and actions The theoretical approach to herb choice, in any medical paradigm, is based on assigning theoretical property values to each herb. Herbs with the appropriate property values can then be matched to specific syndromes. The evolution of Western herb classification according to temperature, humidity, and action is discussed below. Taste, as a theoretical concept, was of lesser importance in the West than in China. TEMPERATURE The polarity of fire and water was fundamental to ancient Greek philosophy, and in medicine, Hippocrates taught that health depended on a proper balance of heat and cold. Dioscorides was aware of this and sometimes described the general temperature effect of herbs.\ For example, he described Commiphora as warming. However, he did not consistently give herb temperatures in his materia medica, nor did he divide temperature into a number of grades. The systematic classification of herbs according to temperature was done by Galen of Pergamon (130-200 AD), and his model of nine degrees of temperature was influential for over 1,500 years. Galen's temperature classification Galen classified herbs according to nine temperature categories: temperate, hot in the first to the fourth degree, and cold in the first to the fourth degree. During its IS-century reign, the Galenic system went through various modifications. The description of Galenic categories given below comes from A Key to Galen's Method of Physic, written in 1651. This is included in Culpeper's Complete Herbal and English Physician Enlarged 3 and the herb examples given for each temperature category in this chapter are from A Catalogue of Simples in the New Dispensatory in that book.
Temperate These herbs correspond to the neutral category of the Chinese system (see the Temperature chapter) in that they do not have ~arming or cooling effect on the patient, and do not affect the temperature properties of other herbs in a combination to make them either hotter or colder. Temperate herbs were used in diseases lacking pathological man-
History ifestations of either heat or cold. An example is Ziziphus fruit (date).
Hot in the first degree These are herbs that just correspond to the natural heat of the body itself. They do not result in alteration to the body heat unless the body is slightly pathologically cool, in which case they help to restore the natural heat of the body. An example is Petroselinum root (parsley).
Hot in the second degree These herbs are slightly hotter than the natural temperature of the body. They were used to restore balance by their own force and strength when nature alone was unable to do so. An example is the aerial parts of Rosmarinus.
Hot in the third degree These were described as herbs sufficiently heating to inflame and cause fever if inappropriately prescribed. An example is Zingiber root.
Hot in the fourth degree These were described as herbs with the highest degree of heat, capable of causing blistering if topically applied. An example is Allium sativum (garlic).
Cold in the first degree These herbs are the least cold of the four cold categories and the least potentially damaging to the natural heat of the body. They were used to treat conditions that had only a slight degree of pathological heat, especially in children or people with weak. stomachs who it was believed were easily harmed by cold medicines. An example is Arctium leaves.
Cold in the second degree Culpeper listed the use of this category for those with a hot liver and a strong stomach. An example is Taraxacum herb.
Cold in the third degree
Culpeper did not clearly differentiate between herbs cold in the second and third degrees, that is, herbs cold in the third degree simply seem more cooling than those in the second degree in that they are used to treat hotter conditions. He described their use for the 'unbridled heat of choler' in persons with liver heat and a strong stomach. An example is Polygonum bistorta root.
7
and later writers, such as Tabernaemontanus 1i and Culpeper. For example, she classified wormwood as very hot, whilst Dioscorides listed it as warming and T~bernaemontanus listed it as warm in the fIrst degree. Galenic system during the 16th-19th centuries Whilst Culpeper used Galen's temperature system in the section A Catalogue of Simples in the New Dispensatory in his book, he did not consistently use it in the individual entries of his materia medica and often used looser terms such as warming or cooling. More systematic authors, such as Tabernaemontanus and Gerard, consistently used Galen's nine-category system. Since their texts were used as standards into the 18th century, herbal practitioners would have been familiar with Galen's system up t9 that time, even if they did not use it in its full rigor. Use of the Galenic temperature classifIcation system appears to have declined in the West during the 19th century, and no other system of classification of herbs by temperature seems to have replaced it in general use. Physiomedical and Eclectic texts There is considerable overlap between the Physiomedical and Eclectic movements, and both were derived in part from the work of Samuel Thomson (see below). The Physiomedical movement was characterized by belief in a vital force and in the restoration of health by balancing stimulation and relaxation of the body and tissues. The Eclectics were generally medical doctors who specialized in botanic medicine. In their fmal flowering in the late 19th and early 20th centuries, the Eclectic physicians made enormous advances in the detailed knowledge of individual herbs, often incorporating the new biochemical knowledge of the time. They also ma~e advances in botanical pharmacy, that is, in the extraction and processing of botanical preparations. (See Pharmacy and Pharmacognosy by lloyd in Ellingwood's text. IS) It should be noted that neither of these two groups of North American practitioners used a systematic temperature classification.
Physiomedical texts In Physiomedical theory, the fundaCold in the fourth degree Herbs in this category were used 'to stupify the senses' and used, for example, in cases of violent pain. An example is the aerial parts of Hyoscyamus niger (henbane).
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Hildegard von Bingen Not all practitioners used Galen's system. For example, Hildegard von Bingen 16 used a less structured classification, including the categories of very hot, hot, slightly hot, neither hot nor cold, cold, and very cold, which is closer to the Chinese system than to that of Galen. She tended to classify herbs as hotter than earlier writers of the Graeco-Roman era, such as Dioscorides and Galen,
mental principle of treatment was to support the natural heat of the body. Warming herbs played a greater role in treatment than cooling herbs. However, herbs that warm the body were not usually described as warming herbs but as 'stimulating' herbs. Similarly, herbs that cool were not usually described as c;oling herbs but as 'relaxing' herbs. For example, Lyle described Capsicum, Myrica, Zanthoxylum, and Zingiber not as hot herbs but as stimulant herbs, and he described Asclepias not as a cold herb but as a relaxant herb. 19
Eclectic texts Like the Physiomedicalists, the Eclectic authors Felter, lloyd, and Ellingwood did not usually describe herbs
Combining Western Herbs and Chinese Medicine
8
as warming or cooling. However, the Eclectics had a more sophisticated understanding of the multiple actions of individual herbs than the Physiomedicalists, and they considered the division of herbs into stimulants and relaxants less important. For example, the Eclectics described Capsicum as stimulant, but did not specifically classify Asclepias as relaxant. Modem texts Neither the herbal of Grieve of 1931 20 nor the BHP of 198Yl described herbs in terms of warming or cooling, and the division of herbs into stimulants and relaxants, in the Physiomedical sense, is rarely used in these texts. Later works, with a bias towards pharmacology rather than practical instructions for herb use, such as the BHC of 1992~ and the ESCOP monographs of 1996,23 do not describe herbs in terms of temperature. However, Tierra's Planetary Herbology of 1988 24 classified herbs in terms of temperature, using the Chinese temperature grades of hot, warm, slightly warm, neutral, cool. and cold. The temperature values assigned to individual herbs follow the temperature values given in Chinese texts where these are available. I have adopted the same six Chinese temperature divisions. However, in assigning temperature values for herbs discussed in this current text, I have weighed traditional Western and traditional Chinese sources, pharmacological and clinical research, and my own personal experience (see the Temperature chapter).
HUMIDITY In the medical system of Hippocrates, the concept of humidity was of fundamental importance. The four humors and their associated temperaments were each composed of a pair of primary qualities, one relating to temperature and the other relating to humidity. For example, the melancholy temperament, associated with the humor black bile, was based on the pairing of the qualities of cold and dryness. An excess of black bile would involve an excess of cold and dryness, and could be corrected by the use of herbs that were hot and moist in quality. Correcting imbalances of humors and temperaments, therefore, involved correcting an imbalance between dryness and. m()isture as well as an imbalance between heat and cold; accordingly, foods and herbs were classified according to their humidity ~ well as their temperature. It was understoodth~t' foods and herbs~oUld'change their properties deperidirig ~n their o~i~, d~gree of 'fr~~hness, and mode of preparation~For example, in the Sth century BC, Hippocrates classified barley as cold and moistening or cold and drying, depending ~ri the way in which it was prepared. II
In the 2nd century AD, Galen classified herbs according to their degree of humidity as well as their degree of temperature. In his classification, he used the categories of dry in the first, second, third, or fourth degree, and moist in the first, second, -third, or fourth degree. Whilst the classification of herbs as dry or moist remained important in the West into the 18th century, the classification of herbs into specific degrees of humidity never seem to have been regarded as important as degrees of temperature. Hildegard von Bingen generally described herbs as simply drying or moistening. Although he listed herbs according to degrees of moisture in the section A Catalogue ofSimples in the New Dispensatory, Culpeper usually omitted some of the Galenic degrees of moisture. In addition, the individual entries in his materia medica section usually simply stated whether the herb is drying or moistening. Gerard and Tabernaemontanus often classified herbs in terms of degrees of moisture, but they did so less consistently than they classified them in terms of degrees of temperature. Later authors have rarely gone beyond occasional general statements that a herb is drying or moistening. Similarly, in Chinese tradition, herbs are not divided into different grades with respect to humidity. They may, however, be described in general terms as drying or moistening.
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TASTE Dioscorides sometimes described the taste of herbs in his materia medica. For example, he described the berries of Juniperus as sweet and slightly bitter, and Commiphora resin as pungent. However, taste does not appear to have been developed as a theoretical concept in the West as it was in China (see the Taste chapter). It is only recently in the West that the taste and olfactory sensations have been associated with specific therapeutic effects, for example the bitter digestive tonic and aromatic carminative actions.
ACTIONS Since Graeco-Roman times, herbs have been classified in terms of their actions, that is, the type of therapeutic effects they have on the body. Empirical and theoretical actions The names given to actions can be roughly divided into two types: the relatively empirical and the relatively theoretical.
Empirical actions These action names simply state the desired therapeutic effect without implying the mechanism by which it is to be achieved. For example, if the patient has inadequate urination, then the required therapeutic effect isto promote urination.
History
9
Theoretical actions These action names imply a theoretical mechanism by which the effect is ac.llleved. The theoretical cephalicals pectorals cordials stomachicals hepatics splenicals nephriticals hystericals arthriticals
action mechanism is linked to the theories of etiology and pathology used by the particular medical paradigm. For example, in the Physiomedical paradigm, arthritis was often associated with accumulations of toxins in the blood. It was therefore appropriate to use a herb with the alterative action in order to clear the body of toxins and thus relieve the arthritis.
The terms 'cephalics,' 'pectorals: 'cordials,' and 'stomachics' were used in herbal medicine into the 1970s,25 and the term 'hepatics' is still in use as an action category.
Dioscorides In his materia medica, Dioscorides often described a herb in terms of its actions. The names used by Dioscorides for these therapeutic effects reflect his own nature, which was empirical rather than theoretical. The
Actions and specific organ syndromes. In both China and
words representing an action are very close to words for the associated disorder. For example, if the patient has a wound and is bleeding, the appropriate actions are to stop the bleeding and heal the wound. There is no implication of the theoretical mechanism by which the action is effected. Other therapeutic effects mentioned by Dioscorides include promote urination, induce menstruation, and increase lactation. Galen The action categories of Galen are described by Culpeper in Section III of A Key to Galen's Method ofPhysic.3 Some of these, such as 'medicines provoking urine: are like those of Dioscorides in that they simply refer to a therapeutic effect and do not imply a theoretical mechanism via which the effect is attained. Other action categories used by Galen are closely related to theoretical concepts, and their empirical use is not always clear. For example, theoretically, 'emollient' medicines were considered to soften that which is hard, to moisten that 3
which is dry, and 'to warm that which is congealed by cold: However, the exact empirical effect of the emollient action was not clear in Culpeper's account. This was due to his dis-
agreements with other authors over the theoretical definition of this action.
Actions and organs Galen was not merely a theoretician, he was a man of complex nature and many accomplishments..
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He was one of the fathers of modern anatomy and physiology, whose knowledge of anatomy came from his own dissections and whose contributions to physiology came from his own experiments. It is not surprising, therefore, that many of
\
his action categories related to specific organ systems and
1
parts of the body. In section II of his chapter A Key to Galen's Method of
1 !
1
Physic, Culpeper described the following types of medicine that have their action on specific parts of the body:
head lungs heart stomach liver spleen kidney and bladder uterus joints
the West, actions were often linked not only to a specific organ system, but also to a specific organ system syndrome. In China, the first texts giving systematic association between actions and specific organ syndromes were those of Zhang Yuan-Su in the 12th century AD. For example; Zhang Yuan-Su wrote that Coptis (huang lian) drains Heart Fire, and Ligusticum (chuan xiong) disperses the Liver. 26 In the Galenic system described by Culpeper, actions were sometimes associated with specific organ syndromes. For example, Berberis was given to clear liver heat, Chelidonium was given to open obstructions of the liver and gallbladder, and Rosmarinus was given to clear melancholy vapors from the heart. However, individual herbs were not consistently associated with specific organ syndromes in 16th and 17th century Western materia medica. Physiomedical action categories Certain empirical actions, such as diaphoretic, diuretic, and purgative, seem to be basic to all medical systems. However, individual empirical actions were often subdivided into different types, according to their theoretical mechanisms within the particular medical paradigm. The Physiomedical authors subdivided herbal action categories according to their theory of the need to balance stimulation and relaxation. For example, Lyle described Zingiber as a stimulating diaphoretic, Asclepias as a relaxing diaphoretic, Juniperus as a stimulating diuretic, and Eupatorium purpureum as a relaxing diuretic. Eclectic action categories The later Eclectics tended to differ from the Physiomedicalists in that they were generally less influenced by the theory of relaxation and stimulation. and more influenced by recent advances in medical science. The action categories used by the Eclectics reflect their convergence with what is now called 'conventional medicine.' For example, the Eclectic doctor Ellingwood used the categories of sedatives, hypnotics, narcotics, anesthetics, ane.
Combining Western Herbs and Chinese Medicine
10
analgesics in common with the more orthodox doctors of :Us day. However, the Eclectics continued to use action categories associated with holistic practice, such as tonics and alteratives. The tonics were used to strengthen the circulatory and digestive systems, and to help the body to heal itself. The alteratives were used to cleanse the body of the toxins that were seen as the root of many disorders.
Skin
irritants caustics emmolients demulcents protectives
Stomach, liver, and digestive system
emetics antiemetics digestives hepatics astringents carminatives sialagogues antisialogogues apositics dentifrices
_4nticatarrhal action The Eclectics also emphasized the .l1l1portance of the anticatarrhal action. This was linked to :ne theory that oversecretion by the mucous membranes =auld lead to the obstruction of the ducts of the body by =atarrh (phlegm). This catarrhal obstruction could then lead -r:J dysfunction of the respiratory, digestive, hepatobiliary, u:-inary, or reproductive system. They used anticatarrhal =l~bs, such as Hydrastis and Myrica, to strengthen and tone :ne mucous membranes in order to normalize mucus secre::Ion and thus clear catarrhal states.
Antimicrobial
antizymotics deodorants parasiticides antihelmintics
Nutrition and the blood
restoratives alteratives
Miscellaneous
antidotes antagonists hemostatics styptics
~liingwoo'd's
action categories In 1919, the Eclectic practi::lOner Ellingwood listed the following main action categories, .;.argely according to organ systems:
-ervous system
sedatives' depressants excitants stimulants analeptics
::::cretory systems
cathartics diuretics renal sedatives diluents antilithics diaphoretics antihidrotics vesical tonics vesical sedatives
-"".mrt and circulatory system
~nroductive
system
~sDiratory system
cardiacs vasomotors antipyretics aphrodisiacs anaphrodisiacs emmenagogues uterine tonics uterine sedatives oxytocics abortifacients galaetagogues antigalaetagogues acting on respiratory muscles acting on lung tissue acting on mucus membranes
The list is fascinating since it reflects the state of development of herbal medicine at that time, its underlying philosophy, and its theoretical base. It can be seen from the list that many of the action categories in modern Western herbal medicine were already in place by the beginning of the 20th century. (The reader is referred to Ellingwood's text for definitions of the action categories listed.) Terms borrowed from conventional medicine Many of the Western herbal action categories that have been added later in the 20th century have been adopted from conventional medicine. Examples are: antiallergic, antianginal, antiatheromatic, antihypertensive, anti-inflammatory, antimigraine, antioxidant, and hepatoprotective. Some of these terms, for example, 'anti-inflammatory' and 'antihypertensive,' refer to an empirical general effect without specifying the theoretical mechanisms by which they are produced, in terms of the paradigm of biochemistry.
Actions in terms of biochemical mechanism However, conventional medicine often classifies medicines first according to general action group, and then according to the specific biochemical mechanism by which the action is achieved. For example, the term antihypertensive refers to the general action group of medicines used to reduce blood pressure, which can then be subdivided into such categories as:
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History • angiotensin-converting enzyme inlubitors • angiotensin receptor antagonists • beta-blockers • calcium channel blockers • potassium-sparing diuretics • thiazide diuretics • loop diuretics • selective alpha-l adrenergic blockers • antiadrenergic agents
11
inventory from Babylon, the capital city of ancient Mesapotarnia, listed 200 similar substances in the first millennium BC. 28 The early herbals of ancient Greece may have included much material from earlier Egyptian and Mesopotamian records, but only fragments of the latter have survived. This discussion of the historical development of materia medica therefore starts in ancient Greece. ANCIENT GREECE
Application to herbal medicine This system of subdividing actions according to a proposed biochemical mechanism can be applied to the individual active constituents of Western herbs in cases in which the biochemical mechanism of action is known. However, some herbs have more than one active constituent contributing to each action, each with their own biochemical me~hanism. In such cases, it is necessary to evaluate the relative contributions of the different action mechanisms. For example, two different types of chemicals contribute to the antispasmodic action of Thymus vulgaris: • the monoterpenoid phenols thymol and carvacrol • the flavonoids thymonin and cirsilineol The biochemical mechanism of action of the flavonoids may be due to inhibition of calcium ion flow, but the mechanism for the monoterpenoid phenols is not yet known (see the Thymus chapter). As more becomes known of the pharmacology of active constituents, the subdivision of herbal actions according to biochemical mechanism will become more widespread. This can be a positive step forward, providing that preoccupation with mechanistic detail does not replace the holistic approach.
History of materia medica The first great civiliz~tions developed about 3000 BC in the fertile river basins of the Nile, Tigris-Euphrates, Indus, and Huang-Ho. Information on herbs, and the herbs themselves, may have been exchanged in gradual stages via early trade routes. There may have been an exchange between Egypt and Mesopotamia, Mesopotamia and India, and possibly even between India and China. For example. the Ebers Papyrus. written in Egypt about 1500 BC referred to over 500 different substances-:-induding minerals. plants. and animal products-and co~tilils 876 formulations made from these substances. 27 Perhaps due to cultural exchange via the early trade routes, a pharmacy
In addition to his enormous output in virtually every field of knowledge, Aristotle founded a botanic garden in Athens, and wrote a text on plants. Fragments of his book have been found but are too incomplete to gain a detailed picture of this work. Aristotle's botanic garden was inherited by his disciple Theophrastus of Eresos (370-c. 285 BC) who developed the study of plant morphology to a level which w:as not substantially raised until the development of the lenses and the microscope nearly 2,000 years later. 29 His accurate and detailed observation and his insight made a great contribution to the development of scientific botany and facilitated accurate naming and description of medical herbs by later authors. The earliest Greek text on medicinal plants and their effects on the body may have been the Rhizotomikon written in the 4th century BC by Diodes of Caryatos, a disciple of Aristotle. 30 In the 1st century BC, an illustrated herbal was produced by Crataeus, the physician of King Mithridates of Pontus, but only fragments of the text have survived. 3O ANCIENT ROME Dioscorides The most famous text on herbal medicine surviving from the ancient Graeco-Roman world was the De Materia Medica of Pedanius Dioscorides in the 1st century AD. Dioscorides was a doctor traveling with the Roman armies of Emperor Nero. He brought together the existing information on medical substances and described each one in a clear, accurate, and practical manner. Dioscorides' excellent work remained the standard text until the great expansion of herbal knowledge in the 16th century. Even then, his work was regarded as authoritative and was continually quoted by later herbalists. For example, Dioscorides described the berries of Juniperus as slightly warming, astringent, sweet, and slightly bitter. and noted their use to treat stomach pain. bloating and gripes, chest diseases and cough. decreased urination, cramps, and uterine pains. About 1,500 years later. Culpeper used this description almost word for word. Even more remarkable. all of the indications of Dioscorides for
12
Combining Western Herbs and Chinese Medicine
Juniperus were repeated by the American herbalist Jethro Kloss in his text of 1939. 31 Whether American herbal practitioners know it or not, the entries for some herbs in standard American texts, such as those by Kloss and Christopher, have a basis in the material set down in the 1st century AD by Dioscorides, the founding father of Western phytotherapy. It is interesting that the first book in China with systematic descriptions of individual herbs was also written about the 1st century AD. This was the Shen nong ben cao jing, (Classic ofthe Materia Medica), written by unknown authors. Both this book and the materia medica of Dioscorides described herbs in practical terms, rather than in terms of magic. Also, both books were empirical rather than theoreti.:al. Neither book consistently classified herbs in terms of theoretical properties and linked these to therapeutic effects. This theoretical systematization began in China about 600 AD with the Yao xing ben cao (Materia Medica of Medicinal Properties), and in the West in the 2nd century AD with the work of Galen. Pliny Another Roman author who was much quoted by 16th and 17th century herbalists was Pliny the Elder (23-79 AD). His Historia Naturalis was compiled in the 1st century AD from the work of many Greek and Roman authors. This Lext perpetuated many earlier errors, and Pliny himself may .nave had no direct experience as a physician. However, his work was a great storehouse of information, and as Stearn ?oints out, it 'was of great importance in the medieval and Renaissance period as the major surviving work of Latin a..,tiquity. Many Greek concepts and plant names came to the notice of lQth century herbalists through the Latin of ":J.. )'9 _llilY· -
Pliny sometimes listed the medical uses of plants. For ~ple, Tabernaemontanus wrote that, according to Pliny,
::;entiana lutea is a good stomach remedy taken with water -v.rhen there is a fever or taken with wine when there is no :Ever. Also, Culpeper wrote that, according to Pliny, Salvia ?rocureth women's courses, and stays them from coming :lawn too fast.' However, the contribution of Pliny was more D botany; especially to botanical terminology; than to herbal :nedicine. ::'alen of Pergamon Galen has been described as 'the most .::illuential man and one of the most prolific writers in med..::al history.'32 In the 2nd century AD,he made extraordinary =::mtributions to the knowledge of anatomy and physiology, ~d wrote on the circulation of the blood, pulse diagnosis, ...nd the physiology of the brain and nervous system. In addition to his undeniable talent for observation and ==periment, Galen had a perhaps overly strong theoretical :.ent. He systematized the theories of Hippocrates -and
Aristotle, and used his very structured system to produce a very detailed classification of herbs according to theoretical properties (see the discussion on Temperature above). The application of his system profoundly influenced later materia medica. The great gift of Galen to Western herbal medicine was to provide a classification of herbs according to theoretical principles, comparable to those employed in Chinese herbal medicine (see above). Unfortunately, Galen produced a theoretical framework for herbal medicine that was perhaps overly complex and rigid, and he had a tendency to force the facts to fit this framework. If there had been an immediate successor to Galen with a more critical and flexible approach, the history of medicine and of phytotherapy may have taken a very different course.32 This was not the case, and Galen's death in 200 AD was followed by the decline of Roman civilization, culminating in the sacking of Rome by the Vandals in 455 AD. According to one author, 'in all history there is no full stop more emphatic than the death of Galen. For fifteen centuries after his death, Galen's doctrines carried almost the authority of scripture.'32 Throughout the Middle Ages in Christian Europe, from the fall of Rome to the Renaissance in the 15th century, there were no great innovations or expansions in the theory of herbal medicine.
. i¥o'"
-..:..:.
MIDDLE AGES During the Middle Ages, the shock and uncertainty following the fall of Rome and the destabilization of Western civilization may have contributed to the closed mind-set that inhibited questioning and critical investigation. The desire to preserve the doctrines of the past led to a stifling of innovation in the present. In the Christian world, to question the words of Aristotle was tantamount to questioning the authority of the Church and was strongly discouraged. The three main groups who kept herbal medicine alive in the West in the Middle Ages were the physicians of the Islamic world, the healers in the Christian monasteries, and the uneducated herbal practitioners. Islamic physicians The years following the fall of Rome up to about 1000 AD have been called the Dark Ages, and they were a nadir for the development of philosophy, science, and medicine iIi Christian Europe. However, these years saw the birth and flowering of Islamic culture. and the preservation . of Graeco-Roman science and medicine within the Islamic countries.)y·~e_.9th century. the works of Hippocrates, DioscoIides~_aIidGalen had been translated into Arabic.
Rhazes Islamic medicine was at first inspired by the teachings of the Hippocratic school, which emphasized preven-
History tion and minimally intrusive treatment. This was reflected in the writings of the Persian physician Ar-Rhazi (869-925 AD) who became known as Rhazes in the West. He wrote that 'where a cure can be obtained by diet, use no drugs, and 30 avoid complex remedies where simple ones will suffice:
Avicenna One of the most celebrated Moslem physicians was the Persian Ibn Sina (980-1037), known in the West as Avicenna. His book, the Canon of Medicine,33 was a magnificent compilation of Graeco-Roman and Islamic medicine, and became a standard text, not only in the Islamic world, but later in Christian Europe as well. Avicenna was perhaps more influenced by Galen than by Hippocrates, and like Galen, he had a tendency to favor elaborate theoretical systems. The writings of Avicenna gave such an impression of completeness and authority that, combined with his championing of Aristotle and Galen, they were readily accepted:in medieval Europe. This had the unfortunate result of ~inforcing the dogmatic adherence to the Galenic system within the Christian countries.
Islamic materia medica and pharmacy The Islamic physicians greatly enlarged the range of herbs used by the Greeks and Romans. They added many medicinal plants from North Africa, Arabia, and Persia, and herbs and spices brought via the trade routes from India and the Far East. They may have introduced the carminative spices Eugenia (cloves) and Myristica (nutmeg), and the purgative use of Cassia (senna) and Rheum (rhubarb). The materia medica of Ibn Baitar (died 1248) listed more than 2000 substances. About 1750 were plants, the others were animal products and minerals..l-I This expansion of the materia medica was a true contribution by the Arabian doctors. However, Islamic pharmacists began to produce increasingly complex herb combinations containing expensive and exotic ingredients and involving elaborate preparation. This highly profitable practice was continued by European apothecaries from the 12th century onwards, and such herbal treatment rapidly became beyond the reach of all but the rich (see the section on Culpeper below). Christian monasteries During the Dark Ages in Christian Europe, the monasteries were one of the few places where learning was preserved and where ordinary people could receive medical treatment. One of the duties of monastic life, laid down by Benedict of Nursia in the 6th century, was caring for the sick. Some of the monks and nuns were encouraged to study herbs and the'preparation of medicines; and to become familiar with the works of Hippocrates, Dioscorides, and Galen.30 In the 12th century, a Benedictine abbess of the Rhine-
13
land wrote one of the most important herbals of the Middle Ages. This was Hildegard von Bingen, and her main medical text is known today as Physica. 16 Her book is clearly written and contains a wealth of practical experience. Whilst she described herbs as hot or cold and moist or dry, she did not use the elaborate nine-grade classifications of Galen for degrees of heat or moisture. However, she sometimes described herbs in terms of treating imbalance of the humors or temperaments, especially of phlegm and melancholy. Uneducated herbalists So far this discussion has focused on the written tradition of Western herbal medicine. Whilst the materia medica of Dioscorides was based on empirical knowledge, the medicine practiced by followers of Galen emphasized prescribing herbs according to theoretical principles. This found its extreme manifestation in the Arabian elaborations of the Galenic system with their complex multiherb prescriptions. In the Middle Ages, most people were poor and could not read, so that Galenic medicine was beyond their reach. Unless treated in the monasteries by educated monks or nuns, the only herbal medicine available to the majority was that supplied by uneducated persons, whose knowledge of herbs came from oral tradition and personal experience. These empirical practitioners kept alive a detailed and practical knowledge of the use of single herbs, also known as 'simples: This folk knowledge may often have been recorded in writing by more literate colleagues and formed an important source for both medieval and Renaissance materia medlca. RENAISSANCE The Renaissance is the term applied to the period irl the 14th-16th centuries when there was a rebirth of the irlvestigative spirit and a questioning of religious and other dogmas in Christian Europe. As with the 5th century Be irl ancient Greece, there was an increase in intellectual activity and an advancement of science and invention, in addition to new developments in art and literature. This renewed interest irl detailed observation, objective description, and experimentation gave new life to the study of herbal medicine. In Germany, new herbals were written by Otto Brunfels (1530), Hieronymus Bock (1539), and Leonhard Fuchs (1543). What distinguished these works from those of earlier herbalists was the very detailed description of each plant and the more accurate illustrations (see Publishers Note in Gerard. 15 ) In the second half of the 15th century, some of the most famous books on herbal medicirle were published. In 1583, the Flemish author Rembert Dodoens published his second
Combining Western Herbs and Chinese Medicine
14
and larger herbal, and in 1588, Jakob Dieter of Bergzabern, under the name of Tabernaemontanus, compiled one of the greatest materia medica of all time. In England, the most popular herbal was that of John Gerard published in 1597. The text of Gerard's herbal was based on a translation into English of Dodoens herbal of 1583, and most of the illustrations were from Jakob Dieter's herbal of 1588. 17 Tabernaemontanus Jakob Dieter was a doctor and pharmacist, and a student of Hieronymus Bock. Dieter wrote what has been claimed to be the most comprehensive Western herbal: the 1,660 pages of the 1731 edition of this book, revised by Hieronymus Bauhinus, contain more than 3,000 herb studies and about 2,500 illustrations. I, This wonderful book contains very thorough descriptions of the plants, with a discussion of their many names in different languages and extraordinary detail of their practical use. It classifies the temperature and humidity of each her~ a~co_r
17
TH
AND 18
TH
CENTURIES
During these centuries in Germany, the most influential herbal text appears to have been that of Tabernaemontanus, whilst in Britain, the most popular materia medica were the Gerard-Johnson herbal of 1633 and Culpeper's herbal of 1652. However, during the 18th century in Europe, advances in the study of herbs came not so much from new materia medica, but from the advances in plant taxonomy that culminated in the system of Carl Linnaeus. In North America, the 17th and 18th centuries saw an increased use of Native American herbs by the settlers. In this time. there were the beginnings of the integration of the use of indigenous herbs and European herbs that can be seen in the North American materia medica of the later 19th century. Gerard In 1633, the Gerard herbal was revised and enlarged by Thomas Johnson. He was a more rigorous scholar than Gerard who corrected Gerard's errors and added material from his own botanical observations and from European herbals published after 1597. The Gerard-Johnson herbal described about 800 plants more than the original Gerard text, bringing the tqtal to about 2,850 plants. Like the materia medica by Tabernaemontanus, the Gerard-Johnson herbal classified herb: te!Dperature and moisture according to Galen'ssystem,:an,~,~s~~et.iInesthe herbal described the effect of the herb in t~rin.s correcting the balance of the humors and temperaments.~stnot as thorough as the work of Tabernaemontanus,the herbal is
of
nevertheless a most useful book and remained for many years the most detailed materia medica in the English language. Culpeper Nicholas Culpeper can be said to have made five great contributions to herbal medicine. Firstly, he wrote an excellent materia medica in which the properties and uses of the individual herbs were so clearly and vividly described that his book is still one of the most clinically useful texts available. Secondly, in 1651, Culpeper wrote a clear description of Galen's principles of herb prescription (A Key to Galen's Method of Physic), which appears to be the only adequate description of Galen's work on herbal medicine currently available in English. Thirdly, Culpeper is famous for simplifying and demystifying the medicine of the day. This included the translating of Latin into English. Latin had been used as a means to keep medical knowledge in the hands of the privileged few, and away from the populace. As a result of Culpeper's efforts, simple remedies could be understood and used by the ordinary people. Fourthly, Culpeper objected to the expensive and complicated herbal formulations of the day. He wanted to teach people to use herbs that grew in England and were inexpensive and readily available. He believed that English herbs '-'.' were best fitted for English bodies, and he did not include -, v. expensive foreign herbs in his materia medica. Cinnamon, cloves, nutmeg, and even pepper and ginger did not have ~~ individual entries in the materia medica section of Culpeper's book. Fifthly, through his interest in astrology, Culpeper linked each herb to a specific planet. This can sometimes be useful since it can give an understanding of the direction of energy of the herb. For example, a herb governed by the sun, such as Rosmarinus, is likely to have a warming and outward- ~ " dispersing or centrifugal energy. This is comparable to the descriptions of herbs in terms of direction of energy found in Chinese medicine. '-
Culpeper as a source for modern herbal texts Culpeper was strongly influenced by Dioscorides, to whom he often ref- _ ered. The brevity, clarity, and practicality of Dioscorides probably appealed strongly to Culpeper. Often, the wording of the herb uses in Culpeper's materia medica suggests that _ these were taken with very little alteration from Dioscorides'
text. . '. In his turn, Culpeper has had an enormous influence on __ m~y, modern herbal· texts. A Modern Herbal, written by Mary' Grieve in 1931, refers extensively to Culpeper. The classic American herbal text School of Natural Healing pub- __ lished in 1976 by John Christopher,zs included many herb
History indications that seem to have been directly lifted from Culpeper. For example, Culpeper wrote that Juniperus berries 'strengthen the brain exceedingly, help the memory, and fortify the sight by strengthening the optic nerves.' Christopher wrote that this herb 'is a strengthener of the brain, memory and optic nerve.' Many modern herbal texts in the English language, whether British or American, contain material from Culpeper's herbal, and much of this material derives from the materia medica of Dioscorides. Both practitioners and their patients owe a debt to these dedicated physicians. Linnaeus Correct plant identification is absolutely essential to safe and effective herbal medicine. This requires detailed and accurate plant description and a consistent system of plant naming. It is not always possible to be sure of the identity of plants referred to in the Graeco-Roman texts. For example, what Galen called Oxycantha appears to have been Berberis, whilst what Dioscorides called Oxycantha may have been Crataegus. Even in 16th and 17th century texts such as those by Tabernaemontanus and Gerard and Johnson, nomenclature can sometimes be confusing and identity uncertain. For example, the Gerard-Johnson herbal refered to Berberis as Spina acida or Oxycantha. The Swedish naturalist Carl Linnaeus (1707-1778) is the man associated with the introduction of a consistent system of nomenclature and identification for plants and animals. His works Species Plantarum (1753) and Genera Plantarum (1754) have been accepted by international agreement as the starting point for botanical nomenclature. Botanical names published before 1753 are termed 'pre-Linnaean' and are not recognized unless they were adopted by Linnaeus in 1753 or r later, or adopted by subsequent authors. ' North America The early settlers in North America, from the 17th century onwards, may have brought with them both oral and written herbal traditions from their countries of origin. Thus they may have had access both to European folk medicine and, via writers like Culpeper, to herbal knowledge from Graeco-Roman physicians, such as Dioscorides. They may also have brought with them European herbs in the form of seeds or ~ttings, but on arrival in America, they would come into contact with the herbs of the New World and with the herbal knowledge of the Native Americans. An early benefit of Native American herb knowledge was the use of spruce beer as a cure for scurvy, first recorded in 1652. Spruce beer was used by Captain Cook to prevent and cure scurvy in his long sea voyages in the late 18th cen-
T
r
tury.36 The early pioneers may have been living in conditions similar to those of the Native Americans themselves and
15
were too distant from towns to benefit from conventional medical assistance. As a result, they probably used a combination of European and Native American herbal medicine. However, the first American herbal, written by Samuel Stearns in 1772, rarely quoted Native American sources directly and revealed the author's ignorance of the ways in which the plants were used by the indigenous peoples. 30 It was not until the early 19th century that indigenous American herbs started to be popularized and Native American herbal knowledge to be generally acknowledged in print.
19 TH
CENTURY
The 19th century in North America was the time of the development of the Physiomedical and Eclectic movements of American herbal therapy. These movements integrated the use of both indigenous and European herbs. Thomson During the 19th century in North America, much conventional medicine consisted in giving massive doses of calomel (mercurous chloride) and draining the patient of huge amounts of blood. These crude and dangerous procedures assisted the growth of herbal medicine since this offered a less harmful and more effective alternative. Samuel Thomson (1769-1843) popularized the use of a system of naturopathic and herbal procedures, which appear to integrate the methods of Hippocrates with the practices of the Native Americans. However, whilst Thomson acknowledged and revered Hippocrates, he did not acknowledge the Native Americans as the source of much of his materia medica and methodology.30 More than a third of the 65 herbs listed by Lloyd as the main herbs used by Thomson are native to North America. 37 These include such famous American herbs as Hamamelis, Hydrastis, Lobelia, Myrica. and Zanthoxylum. The two herbs most frequently used by Thomson were Capsicum and Lobelia-the Yang and Y"m of his systemCapsicum to stimulate and Lobelia to relax. Thomson believed that all diseases are caused by cold and used: Capsicum to support the natural warmth of the body; he used a combination of Capsicum and Lobelia to manage fever. Thomson also emphasized the importance of clearing: the body of all obstructions and of all accumulated toxins. This was done by using diaphoretics and steam baths to produce sweating, and by the use of emetic and purgative herbs. Lyle The work of Thomson and his contemporaries provided the inspiration and the foundation for both the Physiomedical and Eclectic movements. In 1897, Lyle prod.uced the work Physio-Medical Therapeutics, Materia: Medica, and Pharmacy, which described the principles c£ Physiomedical treatment. It also provided an. extensive:
16
Combining Western Herbs and Chinese Medicine
materia medica in which herbs were not only described in terms of their uses but also in terms of the Physiomedical explanation of their effects on the body. For example, Myrica is described as a 'positive, diffusive, stimulating, astringent alterative and tonic... In hot infusion it gradually arouses the circulation and favors an outward flow of blood: Lyle's terminology was used by Priest and Priest in their book on Physiomedical herbal medicine written in 1982. 38 For example, they describe Myrica as 'positive diffusive stimulant-arouses circulation: In 1898, the revised edition of King's American Dispensatory was produced by Felter and Lloyd. 39 Felter and Lloyd
In my opinion, this is the greatest work on herbal medicine in the history of North America, ranking with the text of Tabernaemontanus as one of the greatest materia medica of all time. The 2,200 pages of this work integrate knowledge from five main sources. There is data derived from the mate. .ria medica of Dioscorides, from European folk medicine, from Native American tradition, from the extensive empirical testing of the herbs by the Eclectic practitiQners, and from the biochemical research of the times. A surprising amount of phytochemical and pharmacological knowledge existed in the late 19th century and was utilized by the Eclectics. For example. Stenhouse extracted the alkaloid sparteine from Sarothamnus in 1853,39 and in 1898, Felter and Lloyd described the use of sparteine to treat cardiac disorders such as cardiac weakness, arrhythmia, and cardiac edema.
20
TH
CENTURY
The Eclectic movement continued into the 20th century with the publication of such excellent materia medica as that of Ellingwood in 1919. However, following the Flexner report of 1910, the Physiomedical and Eclectic colleges were gradually driven out of business, and by 1938, they had all 30 closed. The Physiomedical and Eclectic movements greatly declined, and medicine became increasingly dominated by the new pharmaceuticals.
on Physiomedical principles and almost half the herbs taught were American. However, the American influence was not the only one on the British herbalists, and it is significant that the coat of arms of the NIMH is supported on one side by an ancient Egyptian physician and by a Native American herbalist on the other. In addition to the blending of the traditions of the Old and the New World, the Institute began to incorporate the concepts of modern Western medicine and phytopharmacology that were gaining ground in the late 19th century. All three of these influences on British phytotherapy are reflected in the BHP of 1983. British Herbal Pharmacopoeia This book was a milestone in the development of herbal medicine in Britain and was originally published in three sections between 1971 and 1974. The therapeutic sections of this work were compiled by Fletcher Hyde and can be said to represent the distilled wisdom of the senior practitioners of the NIMH. The BHP was the first scientific materia medica for trained practitioners published in Britain, superceding Grieve's text A Modern Herbal, originally published in 1931. The latter work is a useful source of information, and its historical data on individual herbs can be fascinating. However, it was written as much for the general public as for the trained practitioner, and by 1970, its biochemical information was out of date. Christopher's text Following the first installment of the BHP in 1971 in Britain, a materia medica of a very different kind was published in the United States, in 1976. This was School of Natural Healing by John Christopher, which was a text of North American naturopathic herbal medicine in the tradition of Thomson and Jethro Kloss. The BHP and Christopher's text both share the background of the Physiomedical tradition and the use of herbs indigenous to North America. However, the BHP illustrated the beginning of the trend in European phytotherapy to include increasing amounts of scientific data at the expense
The National Institute of Medical Herbalists From about 1840 onward, knowledge of American herbs and the teachings of the Physiomedicalists and Eclectics was spread in
of data on traditional use. For example, the entry for Lavandula in the BHP contained more than twice as much data on scientific aspects as on traditional therapeutics. Christopher was not interested in research data. He was a clinician and teacher who provided an invaluable wealth of
England by American lecturers such as Coffm and Beach.
practical information on the use of individual herbs. His
This knowledge was absorbed by the British herbal practitioners, who incorporated it into their practice and training.
materia medica is one of ~e very few that illustrate the actions and uses of each herb by giving a variety of combinations that include that herb. The combinations are given with practical notes on their use. Some of them are from earlier practitioners, such as Coffm. Lyle, Shook, and Nowell, but most of them may derive from Christopher himself.
In 1864, they founded the National AssoCiation of Medical Herbalists, which later became the National Institute of Medical Herbalists, the NIMH. As Mills has pointed out,4O up to the late 1970s, training for British herbalists was baSed
i
History
.~
Later texts
In the last 25 years, it can be said that there have
been three main influences on phytotherapy in the West: traditional Western herbal medicine, traditional Chinese herbal medicine, and phytopharmacological research. Some texts have concentrated on a description of the active constituents of medical plants,2z.41 or on pharmacological and clinical research. 4. 23 Others have begun to describe herbs in terms of both western and Chinese traditional medical theory.H.42 The challenge for materia medica of the immediate future ,:.1
is to utilize the positive contributions of all three paradigms.
'-'
This can broaden and deepen understanding of the individual herbs, so that they can be used more effectively and for a wider range of applications.
17
18. Ellingwood F. American Materia Medica, Therapeutics and Pharmacognosy. Hth edn. (l919). Reprinted by Eclectic Medical Publications. Sandy, Oregon (1994) 19. Lyle TJ. Physio-~!edical Therapeutics, ~!ateria Medica and Pharmacy. Originally published in Ohio (l897). Reprinted by the National Association of Medical Herbalists of Great Britain, London, United Kingdom (1932) 20. Grieve M. A Modern Herbal. vols. 1 and 2. Dover Publications, New York. New York (1971) 21. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983) 22. Bradley PR (ed). British Herbal Compendium, vol. 1. British Herbal Medicine Association, Bournemouth, United Kingdom (1992) 23. European Scientific Cooperative on Phytotherapy: Monographs on the Medicinal Uses of Plant Drugs. European Scientific Cooperative on Phytotherapy, Exeter, United Kingdom (1997) 24. Tierra M. Planetary Herbology. Lotus Press. Twin Lakes, Wisconsin (1988)
References 1. Dioscorides P. Kreutterbuch (1610). Reprinted by Verlag Konrad'K6lbl. Miinchen, Germany (1960) 2. jouanna j, Hippocrates. john Hopkins University Press, Baltimore, Maryland (1999) ,.0;1<'
3. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Reprinted by Meyerbooks. Glenwood, Illinois (1990) 4. Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone. Edinburgh. United Kingdom
.~
(2000) 5. Mitchell M. Feng Yeo Wiseman N (eds). Shang Han Lun: On Cold Damage. Paradigm Publications, Brookline. Massachusetts (1999) 6. Porkert M. The Theoretical Foundations of Chinese Medicine. MIT Press. Cambridge. Massachusetts (1974) 7. Unschuld PU. Medicine in China: A History of Ideas. University of California Press, Berkeley. California (1985) 8. Cook WH. The Science and Practice of Medicine. Cincinnati (1893) 9. Needham j. Science and Civilization in China. vol. 2. Cambridge University Press. Cambridge, United Kingdom (1956) 10. Kaptchuk TJ. The Web That Has No Weaver. Congdon and Wedd. New York. New York (1983)
Ii.
jones WHS (trans!). Hippocrates vol. IV. Harvard University Press, Cambridge, Massachusetts (1998)
12. Waterfield R (trans!).Aristode: Physics. Oxford University Press, New York. New York (1999) 13. Tobyn G. Culpeper's Medicine. Element Books. Rockport, Massachusetts (1997)
27. Ackerknecht EH. Therapeutics: from the Primitives to the Twentieth Century. Hafner Press, New York. New York (1973) 28. Sigerest HE. Man and Medicine. WW Norton, New York, New. New York (1932) 29. Stearn WT. Botanical Latin, 4th edn.. Timber Press, Pordand, Oregon (1992) 30. Griggs B. Green Pharmacy: The History and Evolution of Western Herbal Medicine, 2nd edn. Healing Arts, Rochester, Vermont (1997) 31. Kloss T. Back to Eden, 5th edn. (1939). Reprinted by Lifeline Books. Santa Barbara, California (1975) 32. Wingate P. The Penguin Medical Encyclopedia. Penguin Books Ltd, Middlesex, United Kingdom (1976) 33. Bakhtiar L. The Canon of Medicine (al-Qanun fi'l-tibb): Avicenna. Kazi Publications Inc. Chicago, Illinois (1999) 34. Garrison FH. History of Medicine. WB Saunders. Philadelphia, Pennsylvania (1913.1968) 35. Blunt W. The Compleat Naturalist A Life of Linnaeus. William Collins. London, United Kingdom (1971) 36. Price AG (ed). The Explorations of Captain James Cook in the Pacific. Dover Publications. New York. New York (1971) 37. Lloyd JU. The Life and Medical Discoveries of Samuel Thomson. Lloy
ro.
39. Felter H¥i, Lloyd King's American DispenS
15. Gerard J. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas johnson. Dover Publica-
40. Mills S. The Essential Book of Herbal Medicine. ArkanaIPenguin Books. London, United Kingdom (1991)
16. Von Bingen H. Hildegard von Bingen's Physiea. Healing Arts, Rochester. Vermont (1998) 17. Tabernaemontanus JT. Krauterbuch (1731). Reprinted by Verlag Konrad Kolbl. Miinchen. Germany (1993)
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26. Bensky D, Gamble A. Chinese Herbal Medicine Materia Medica. Easdand Press, Seattle, Washington (1986)
14. Veith I (transl). The Yellow Emperor's Oassie of Internal Medicine. University of California Press. Berkeley, California (1972)
tions. New York, New York (1975)
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25. Christopher JR. S<:hool of Natural Healing. BiWorld, Provo. Utah (1976)
41. Bisset NG (ed).lkrbal Drugs and Phytopharmaceuticals. English edn. Medpharm, stuttgart, Germany (1994). from 2nd German edn. Wichti M (ed) (1989) 42. Holmes P. The Energetics of Western Herbs. Artemis Press. Boulder; Colorado (1989)
Temperature O
principles of Western and Chinese traditional medicine is the concept of the bal-
NE OF THE FUNDAMENTAL
ance of heat and cold. The etiology and pathology of disease can be discussed in terms of the imbalance of heat and cold within the body, and sYndromes can be classified in terms of degrees of heat and cold. If herbs are also classified in terms of heat and cold, then herbs can be chosen to match disorders in order to correct the temperature balance of the body and restore
Terminology In this book, the terms 'heat' and 'cold' begin with a lowercase letter unless they specifically refer to a Chinese syndrome or concept, in which case, they begin with an uppercase letter: 'Heat'and 'Cold:
Temperature classification ofherbs
health.
For over 2,000 years, herbs have been divided into different temperature categories in both China and the West. In Chinese medicine, herbs are commonly divided into the five
Temperature classification of syndromes
temperature categories hot, warm, neutral, cool, and cold. l The additional category of slightly warm is also sometimes used.
In the terminology of traditional herbal medicine, the word 'temperature' refers to the degree of heat or cold manifested by the syndrome. It does not necessarily refer to body temperature, although this factor may be included. If the condition is classified as warm or hot, this general-
Various temperature classification systems have been used in the West, the most famous being that of Galen. He divided herbs into nine temperature categories: temperate; hot in the first, second, third, and fourth degree; and cold in the first, second, third, and fourth degree (see History chapter).
ly refers to systemic or local subjective sensations of heat, raised body temperature, or local areas hot to the touch, and often redness. This condition may be associated with hyper-
This book classifies herbs as hot, warm, neutral, cool, or cold, and sometimes uses the category of slightly warm for herbs intermediate between warm and neutral. The concept
function. If the condition is classified as cool or cold, this generally refers to systemic or local subjective sensations of cold, low-
of variable temperature is also introduced to describe herbs that can have more than one temperature effect, as discussed later in this chapter.
ered body temperature, or local areas cool to the touch, and often pillor. This condition may be associated with hypo-
function.
19
Combining Western Herbs and Chinese Medicine
20
Matching herbs to syndromes
cold. Culpeper summarized the Western tradition when he
As Galen pointed out, the temperature properties of herbs do not refer to the herbs themselves but to their effect on the human body.2 Herbs are classified by temperature in order to treat syndromes of specific degrees of heat and cold. A simple system for matching herbs and syndromes is shown in the table.
'{ beseech you to take notice of this, that seeing our bodies are nourished by heat, and we live by heat, no cold medicines are friendly to the body ... children, and such people whose stomachs are weak, are easily hurt by cold medicines:!
Herb
Syndrome hot warm neutral cool cold
cold cool neutral warm hot
These correspondences seem obvious, but failure to match correctly the temperatures of herbs and syndromes is one of the most common causes of adverse effects in herbal medicine. For example, if the practitioner incorrectly diagnoses the patient's syndrome as cold when it is cool and prescribes hot herbs instead of warm ones, the treatment may produce a syndrome of heat. Alternatively, the practitioner may correctly diagnose the patient's syndrome as cool and give warm herbs, but omit to tell the patient to stop taking the warm herbs as soon as there are no longer symptoms of cold. Continued use of the warm herbs may again re~ult in overcorrection and in symptoms of heat. It is therefore most important to have a thorough understanding of the principles of balancing heat and :old.
\'\TESTERN PRINCIPLES OF BALANCING HEAT AND COLD Traditional Western systems for the temperature classiiication of herbs rest on the following four principles of tem?erature balancing: • support the vital force • support the natural power of the body to heal itself • support the heat of the body • give only the minimum treatment to restore the temperatur~ b~ance ,
.
wrote:
Give only the minimum treatment to restore the temperature balance It was considered most important to use only herbs of a temperature just sufficient to correct the temperature imbalance of the body. This was considered especially important when using cold medicines. For example, if the patient had a slightly warm condition, they would require only herbs that are cold in the first degree in terms of Galen's classification system (see the History chapter). If the practitioner were to use herbs that are cold in the second and third degree, this might damage the vital force, the heat of the body, and the natural ability of the body to heal itself. This might result in the production of a syndrome of cold more serious than the original mlld heat condition.
!!!"J
Examples for the main temperature categories /
The categories of hot, warm, slightly warm, neutral, cool, and cold are discussed in this section, and examples of the herbs in each of these categories are given. The examples used are herbs that are discussed in either the individual materia medica chapters or the Additional herbs chapter of this book. Each of the individual materia medica chapters of this book gives the reasoning for assigning the specific temperature value for the title herb in the Limitations and Traditional sources sections of the chapter.
.j
HOT HERBS The following herbs are classified as hot in this book:
Capsicum
acrid
HT. SP, ST. IN, LU
Cinnamomum (bark)
acrid, sweet. aromatic
Sp' ST, IN, LU, HT, KI, UT
.
These principles are discussed hi the History chapter; the ~:ond two are also briefly reviewed here. .
.
:"l,'"
."{
2,npport the heat of the body Western medical tradition :~eved that warmth was the essential characteristic of life, ..:.td that in the human body, heat must predominate over
Zanthoxylum acrid. aromatic, (bark) 'it..;·:': _7'"''''''''0 bitter
HT, Sp,ST,IN
zanthoxylum (berries)
acrid, aromatic. bitter
HT, Sp, ST, IN
Zingiber (dried)
acrid, aromatic
LU, Sp, ST, IN, HT, UT
Zingiber (fresh)
acrid, aromatic
LU, Sp,ST, IN, UT
._l
Temperature Hot herbs are those that can have a strong warming effect on the body and are specifically used to treat cold disorders. Hot herbs can be especially associated with the following Western actions (shown in italics and then followed by the corresponding Chinese actions):
21
Herb . Rosmarinus
aromatic. bitter.
A.Qel-t.t'i·'
Sanguinaria,
,bitter. acrid ~"···"'iJw"'·tc. vc..-..().O.. C'O' .... o/r: Schisandra sour
LU, HT, LR HT, KI, LU. LR
-uC)w~c\ac...
• metabolic stimulant • circulatory stimulant • warming diaphoretic • warming antirheumatic • counterirritant
tonify Yang of Kidney, Heart, or Spleen warm and move Qi and Blood clear Wmd Cold Damp clear Wmd Cold Damp, warm and move Qi and Blood topical irritant
Not all hot herbs have all these actions to the same degree. Also, each hot herb in the table above has its characteristic range of actions and uses. For example, a specific use of Capsicum is as a metabolic stimulant to tonify Heart Yang, and a specific use of Cinnamomum bark is to tonify Kidney Yang. Zanthoxylum is a circulatory stimulant that is specific for moving Qi and Blood to the extremities, and a specific use of fresh Zingiber is as a warming diaphoretic to clear Wind Cold. Caution Hot herbs should be used with caution since their excessive, prolonged, or inappropriate use may change a pathology of cold into a pathology of heat. Combinations with only hot herbs are rare. These herbs are usually combined with warm, neutral, variable-temperature, or even cool herbs, for a more gentle and gradual correction of the temperature imbalance. This will avoid adverse effects due to temperature overcorrection and the resulting oscillations between pathologies of cold and heat.
SymplocarPus . O:u,~ • ~O"",,,,",,,, Turnera )a~"""
HT. LR, Sp' ST, IN
acrid
LU,LR
bitter. aromatic, acrid
KI,Sp,IN
Warm herbs are those that can have a moderate warming effect on the body and that are specifically used to treat cool disorders. Warm herbs can be especially associated with the following Western actions (shown in italics and then followed by the corresponding Chinese actions):
• warming tonic • carminative • warming antispasmodic • warming expectorant
tonify Qi and Yang move Qi of Spleen and Intestines move Qi and relax spasms clear Lung Phlegm Cold
In addition, some warm herbs can act as metabolic stimulants, circulatory stimulants, or warming antirheumatics, but generally to a lesser degree than hot herbs. Each of the warm herbs listed in the table has a characteristic range of actions and uses. For example, Turnera is specific as a warming tonic for Qi and Yang of the Kidney, whilst Elettaria relaxes spasms and is specific as a carminative to move the Qi of the Spleen and Intestines. A specific use of Angelica archangelica is as a warming expectorant, whilst A. sinensis is more often used as a warming tonic for Qi and Blood.
WARM HERBS The following herbs are classified as warm in this book: Herb
Taste
Organs
bitter, acrid. aromatic
LU. Sp' ST,IN. HT
sweet., aromatic. bitter
HT, LR, SPoUT
Cinnamomum twigs
acrid, sweet, aromatic
HT, LU, BL
Citrus aur.
acrid, aromatic, bitter
LU. Sp'ST,IN
Angelica arc. Angelica sin.
Qtll<'''',
',io -
C'\
r'.-<.'o<:,c-,:f.. .
SLIGHTLY WARM HERBS The following herbs are classified as slightly warm in this book: Herb
Taste
Organs
sweet
Sp,LU
sour, sweet
HT
aromatic. 51. acrid
ST, IN, KI. LR
aromatic. 51. sour, 51. acrid
KI, BL. SP, IN. LU. LR
Lavandula A~fo;.ttl1~
aromatic, bitter, 51. acrid
HT, LR, IN
Panax gin.
sweet, 51. bitter
KI, HT, SP, LU
Petroselinum
aromatic, 51. acrid
KI, BL,IN
Astragalus
As~m20
Crataegus
Foeniculum \\1\\(''''0
Juniperus .z{,.,....'~-lO
Commiphora
bitter, acrid
HT. ST, IN. LU. UT
clettaria
aromatic, acrid
ST,IN
Ephedra
acrid, sl, bitter
LU,HT
Eupatorium per.
bitter, acrid, aromatic
LU
~en~ha pul.
aromatic
HT,IN, UT
Mynca
acrid, sour, bitter
ST, IN, LR, GB, HT, LU
'Tt;.<;;;;,.ft.(..
G.Qd.a"ff'~"'l '0
tupo.~I'-'t> c~b
-01:°/';<"'1
,
b~' . . ~t~l(l)-~·~_,t., .'~')\~~ii:'C
(n,·~~(
Sc0 oc<
Trigonella \~\'u~('i'
bitter, 51. sweet, - 51. acrid
SP,IN. LU
Combining Western Herbs and Chinese Medicine
22
Slightly warm herbs are used to treat disorders that are intermediate between neutral and cool. which have only a few mild manifestations of cold. Herbs that are classified as slightly warm may have warming tonic, carminative, warming antispasmodic, or warming expectorant actions. like the warm herbs, but with a milder warming effect. For example, Lavandula is a less warming and less stimulant antidepressant than Rosmarinus. and Juniperus is a less warming and less stimulant expectorant than Sanguinaria.
NEUTRAL HERBS The following herbs are classified as neutral in this book:
Neutral herbs are those that do not affect the temperature of the body or of the herbs with which they are combined. They are especially used to treat neutral-temperature conditions or mi..'Ced conditions of heat and cold. Combinations used to treat mixed conditions may include warm, neutral, and cool herbs. The neutral herbs form a stable 'center' in a combination, reducing the likelihood of temperature oscillations by the body. Neutral herbs can be associated with the following Western actions (shown in italics and then followed by the corresponding Chinese actions): • astringent
stabilize and bind
• anticatarrhal
no exact Chinese equivalent
• antispasmodic
move Qi and relax spasms
• emmenagogue
no exact Chinese equivalent
• diuretic
drain Damp
• neutral tonic
tonify Qi and Blood, rather than
Agrimonia
sour, 51. bitter
LU, IN. BL, UT
Agropyron
sour, 51. sweet
BL
Avena
sweet
Sp,HT, KI
Ballota
bitter, sour
ST
Capsella
sour
ST, IN, BL, UT
Caulophyllum
bitter
UT
Chamaelirium
bitter, sour
UT
Convallaria
bitter, 51. sweet
HT, KI, BL
Galium
sour, 51. bitter
KI, BL
Geranium
sour
ST,IN, UT
Glechoma
sour, bitter
LU
Hydrangea
bitter, sour
BL
Hypericum
sour, 51. sweet
HT, KI, LR
Leonurus
sour, 51. bitter
HT. UT
Lycium
sweet
LR, KI
Marrubium
bitter
LU,SP
Mitchella
51. sour
UT
Molasses
sweet, 51. bitter
SP
Panax qui.
sweet, 51. bitter
LU, ST, KI
Ae5culus
bitter, sour
SP
Parietaria
bitter
KI, BL
Althaea
sweet, 51. bitter
LU, ST, IN, BL
Passiflora
51. bitter
HT, LR
Arctium (root)
51. acrid, 51. bitter
LU, IN, KI, BL
Prunus
bitter, aromatic
LU, HT
Arctium (seeds)
acrid, 51. bitter
LU, IN, KI, BL KI, BL
YangorYm Each of the neutral herbs listed in the table has its characteristic range of actions and uses. For example, both Agrimonia and Mitchella are neutral-temperature astringents, but Agrimonia is a more general-purpose astringent, whilst Mitchella is specific for the female reproductive system. Both Convallaria and Sarothamnus are neutral herbs with cardiac tonic, antiarrhythmic, and cardiac diuretic actions. Sarothamnus differs from Convallaria in being specific for cardiac weakness with hypotension.
COOL HERBS The following herbs are classified as cool in this book: Herb
_>:-Taste
-,; 'Organs
Pseudostellaria
sweet, 51. bitter
Sp,LU, HT
Arctostaphylos
bitter, sour
Quercus
sour, bitter
IN
Bert:>eri5
bitter
LR, GB, Sp' ST, LU
UT,IN
Calendula
bitter
ST,IN LR, GB,IN
Rubus
bitter, sour
Sarothamnus
bitter
HT, Kl, BL
Chelidonium
bitter, 51. acrid
Serenoa
sweet, sl. sour
KI, BL, SP
Chrysanthemum
sweet, 51. bitter
LU,LR
Cimicifuga
acrid, 51. bitter, 51. sweet
KI, LR, UT
Cinchona
bitter
HT, SP
Urtica
acrid
LU,BL
Viburnum
51. bitter, 51. sour
UT
Vinca
sour
BL,UT
bitter, 51. acrid
LR,UT
sweet
BL
sweet
Sp,ST
',---'
Vitex Zea Ziziphus
"'f
Curcuma (rhizome) acrid, bitter
LR, GB, HT
Echinacea
acrid, bitter, 51. sweet
LU, BL
Equisetum
51. bitter, 51. sweet
BL
Temperature '--"~-.'~
·····~-':::.~_C'.7·--""·:.---~
Herb :··-:~=:-:":::;::Taste·:~--~:::::,,:::=~·.:.-::· Organs .::.:~-7:: :::~~:C::-:.:
23
COLD HERBS
The following herbs are classified as cold in this book:
bitter, acrid
lU
Filipendula
sour, bitter
ST. IN, Bl
Harpagophytum
bitter
Sp'ST
Hydrastis
bitter
S~
Iris
bitter
lR, GB,IN
Mahonia
bitter
lR, GB, Sp' ST, lU
Matricaria
sl. bitter, sl. aromatic
ST,IN, HT
Nepeta
aromatic, acrid
lU,lN, HT
Ophiopogon
sweet, sl. bitter
HT,lU, ST
Phytolacca
acrid
lU
Plantago
sour, sl. bitter
lU,lN
Polygonum
sour, sl. bitter
lU,lN
Rhamnus
bitter
IN,ST,lR
Rumex
bitter, sl. sour
LR,IN
Salvia mil.
bitter
HT,lR, UT
Sambucus
acrid, sl. bitter
LU
Sanguisorba
sour, bitter
IN, UT
• antipyretic
clear Excess Heat
Scrophularia
sl. bitter
lU
clear Damp Heat, Heat Toxin
sl. bitter
lR, KI, Bl
• strong antimicrobial
Smilax Tanacetum
bitter
lR
• anti-inflammatory
clear Damp Heat, Excess Heat
Valeriana
bitter, sweet
HT, lR, ST, IN
• sedative
Viola ado.
sour, sweet, bitter
LU,Bl
sink Heart Spirit Disturbance or Liver Hyperactive Yang
Viola tri.
sour, sweet, bitter
LU,Bl
Euphorbia
IN,lU,lR,GB,Bl,UT
Cool herbs are those that can have a moderate cooling effect on the body and are specific for treating warm disorders. Cool herbs can be especially associated with the following Western actions (shown in italics and then followed by the corresponding Chinese actions):
• antimicrobial
clear Damp Heat
• anti-inflammatory • cooling alt~rative
clear Damp Heat or Deficiency Heat clear Damp Heat or Heat Toxin
• cooling anticatarrhal
clear Phlegm and Heat
• cooling diaphoretic
clear Wmd Heat
• tranquilizer
calm Heart Spirit Disturbance or Liver Hyperactive Yang
Each of the cool herbs listed in the table has its characteristic range of actions and uses. For example, both Matricaria and Sambucus are cool herbs with anti-inflammatory and" anticatarrhal action, but the specific target area of Matricaria is the gastrointestinal system, whilst that of Sambucus is the sinuses. Both Althaea and Arctostaphylos can be used as cool anti-inflammatory herbs for the urinary system, but Althaea has demulcent action, whilst Arctostaphylos is more strongly antimicrobial.
Anemone
bitter
HT,KI
Asclepias
bitter
LU
Baptisia
bitter
LU
Humulus
bitter
HT,lR,lN
Piscidia
bitter
HT,lR
Pulsatilla
bitter
IN, ST, LR
Cold herbs are those that can have a strong cooling effect on the body and are specific for treating hot disorders. Cold herbs can be especially assoCiated with the following Western actions (shown in italics and then followed by the corresponding Chinese actions):
Cold herbs may have antimicrobial, anti-inflammatory, and alterative actions, like the cool herbs, but they can have a stronger cooling and sedating effect on the body. Caution Cold herbs should be used with caution or they may depress metabolism and reduce the ability of the body to heal itself. Combinations with only cold herbs are rare, and these herbs are usually combined with some warm herbs to moderate their potential ill "effects.
Variable temperature Variable herb temperature is a concept that can help to resolve some of the apparent contradictions regarding herb temperature, can broaden and deepen understanding of the mechanism of herb action, and can contribute to both greater flexibility and greater precision in herb combining. The majority of herbs have one main temperature effect, for example, Asclepias is cold, Cinnamomum bark is hot, and Agrimonia is neutral. However, some herbs can have a range of potential temperature effects, just as they can have a range of potential actions. Which of the potential temperature effects manifests in a specific situation depends on the condition of the patient and on the temperatures of the other herbs in the
24
Combining Western Herbs and Chinese Medicine
combination. These herbs are referred to in this book as
• one active constituent may have variable-temperature
variable-temperature herbs.
effects • different active constituents may have different temperature effects
Example Achillea millefolium is classified in this book as a warm-cool variable-temperature herb, that is, it can have a range of potential temperature effects that include warm, neutral, and cool.
Warm
Achillea can act as a warming diaphoretic if the patient has a cool condition, such as influenza with chills associated with Wind Cold, especially if Achillea is combined with warming diaphoretics, such as Zingiber.
One active constituent may have variable-tempera~e effects For example, Gentiana is classified as a variabletemperature herb with a temperature range of neutral-cool. The bitter secoiridoids in Gentiana may be responsible for both potential temperature effects of this herb: the neutral, bitter digestive tonic action and the cool anti-inflammatory action. Which of these two potential secoiridoid actions manifest itself will depend on the syndromes of the patient.
Neutral Achillea can act as a neutral bitter tonic if the patient has a neutral condition, such as weak digestion without signs of either heat or cold associated with Spleen Deficient Qi, especially if Achillea is combined with neutral, bitter digestive tonics, such as Marrubium.
Cool Achillea can act as a cooling diaphoretic if the patient has a warm condition, such as influenza with fever associated with Wmd Heat, especially if Achillea is combined with cooling diaphoretics, such as Sambucus.
DETERMINANTS OF TEMPERATURE
If a combination contains variable-temperature herbs, their effective temperature will be determined by the state of the patient and by the other herbs in the combination. For example, as shown below, in the combination Achillea: influenza + sore throat, the overall temperature of the combination is cool. This is because the variable-temperature herbs, Achillea and Mentha, can both have a cooling effect in the context of a Wind Heat condition, especially when they are combined with a cooling herb, such as Sambucus. -- .-. -
Herb
,-:-~ .. ~J:,:"",""-f.:.;10;~';'~~ ~':."I'!~''''f~:·;.'?'(·-~ t;;I:·~~:-
.. Daily.. dose,:". rerrifjernture .. -... '- .
. - '.",.,. ,-'"
Achillea Mentha pip. Sambucus
.
-
6g 3g 3g
.
-,'
...~
".""".'
warm-cool warm-cool cool
.;
---- .!~'.-
•
--7-~.~ "~;'c'-
Taste '
"-
acrid, bitter acrid. aromatic acrid, 51. bitter
MECHANISM OF
Different active constituents may have different temperature effects In the case of Achillea, it may be that the sesquiterpene lactones are responsible for the cooling antiinflammatory action and that monoterpenoids, such as camphor, are responsible for the warming diaphoretic action.
VARIABLE TEMPERATURE AND HOMEOSTASIS In addition to their ability to treat conditions involving mixed signs of heat and cold, some variable-temperature herbs can have a normalizing effect specifically on body temperature. If the patient'$ body temperature is pathologically low or high, these herbs can have a warming or cooling effect, respectively, and help to normalize body temperature. Thus, they can be said to assist in the body's homeostasis. For example, Lobelia has been found to be effective both in cases of extreme coldness and in high fever. Whether this homeostatic effect is due to the alkaloid constituent lobeline, or whether different constituents are responsible for separate warming and cooling effects is not known. Salvia officinalis is another herb that can be used to alter body temperature. It can be used as a warming herb for headaches or muscle aches associated with sensations of cold, and it can be used as a cooling herb for menopausal hot flashes. Salvia has a complex biochemistry, and the mechanism of its warming and cooling effects is not yet known.
VARIABLE-TEMPERATURE HERBS
VARIABLE TEMPERATURE The phenomenon of variable. t~mperature must have its basis in the biochemistry ofplant.a~,tive constituents. However, there is insufficient data .at present to go beyond speculation. Two of the factors that may contribute to variable temperature are:
The table below shows herbs that have been classified in this book as having variable temperature. Each of the herbs marked with an asterisk"" has a separate chapter in the materia medica of this book in which the reasoning behind the variable-temperature status is discussed in the Traditional sources section.
Temperature
Warm-cool Achillea*
acrid. bitter
LU. SP,HT. UT
Artemisia abs. *
bitter. aromatic.
LR.SP,UT
Artemisia vul. *
aromatic. bitter
LR. SP, UT
Hyssopus
acrid. aromatic
LU,HT
Lobelia *
acrid
LU, IN. HT. UT
Mentha pip.
acrid. aromatic
LU, ST, IN, LR
Ruta*
bitter. aromatic
KI. LR. HT. UT
Salvia off. *
aromatic, acrid
LU. HT, LR, UT
Thuja*
acrid. aromatic. bitter
LU, HT. BL, UT
Thymus*
aromatic
LU, BL. HT. UT
Centaurium*
bitter
SP, ST. 51, LR, GB
Euphrasia*
acrid. sour. bitter
LU
Gentiana*
bitter
SP, ST. 51. LR, GB
Neutral-cool
sweet
ST, IN, LU, KI. HT
Hamamelis*
sour. sl. bitter
SP, IN
Populus
bitter, sour
Sp, ST, IN. LR. BL
Potentilla*
sour. bitter
IN
Rheum*
bitter. sour
IN.ST, LR. HT
Taraxacum*
bitter
KI, BL. LR. GB, ST. IN
Glycyrrhiza*
Cool-cold
25
in lower doses, Rheum can act as a bitter digestive tonic to treat weak digestion and poor appetite associated with Spleen Deficient Qi. In this situation, it can have a moderate cooling action, if any. At higher doses, Rheum can have a strong cooling effect, for example, for a patient with severe gastritis associated with Stomach and Liver Heat.
Differences of opinion on herb temperature No perfect system for the classification of herbs by temperature has been devised. There have been differences of opinion on the temperature classification of specific herbs not only in different countries and in different centuries, but also between different authorities in the same time and place. This range of opinion can be found in both Western and Chinese herbal medicine.
WESTERN HERBAL MEDICINE For example, the temperature values given for Artemisia absinthium (wormwood) in different Western texts range from very hot to hot in the first degree:
Three main groups of variable-temperature herbs are discussed in this book: • warm-cool • neutral-cool • cool-cold Warm-cool These herbs can have either a warming or cooling effect, depending on the patient's condition. They may also have a neutral-temperature effect when they are used to treat conditions without signs of either heat or cold. In this case, they do not change the temperature balance of ,. ',~.
the patient. The example of Achill~a is given above. Neutral-cool These herbs can have either a neutral-temperature effect or a cooling effect depending on the patient's condition. For example, Glycyrrhiza can have a cooling antiinflammatory action if the patient has a hot condition, such as gastritis associated with Stomach Heat. However, if the patient has a neutral condition, such as exhaustion without signs of heat or cold associated with Kidney Deficient Qi, Glycyrrhiza can have a neutral-temperature effect. Cool-cold These herbs can have either a moderately cooling or strongly cooling effect, depending on the patient's condition and the dose in which they are used. For example.
.. - ~-,'--. :":(.
--;··~~~;~;)~·r:;r"f.r;"-;.~'_
Author
Assigned temperature
von Bingen 3
very hot
Gerard'
hot in the second degree
Tabernaemontanus S
hot in the first degree
CHINESE HERBAL MEDICINE Students reading a basic text on Chinese herbal medicine that is published in the West may see only one temperature listed for a specific herb. What they may not know is that such Western texts are brief summaries of much more detailed texts in the Chinese language, which may give not merely a consensus of opinion on the temperature of each herb. but a range of opinion from different classical texts. For example. for Angelica pubescens (du hu6), the range of opinion on its temperature from the Chinese sources summarized in the Chinese Herbal Medicine Dictionarl includes warm, slightly warm. neutral. and slightly cool.
EXPLANATION The differences of opinion on the temperature classification of a herb may be due to one or more of the following fucto~:
~
26
Combining Western Herbs and Chinese Medicine
• different traditions of use • a single herb contains both warming and cooling constituents • chemical differences in different samples of the same herb • differences in human populations Different traditions of use Different temperature values for the same herb may arise even when there are no appreciable chemical differences between different populations of the same species. The different values are simply due to different traditions of use for the same herb. For example, in the Western tradition, Commiphora has been used as a warming carminative for weak digestion with signs of cold. In the Chinese tradition, this herb (mb y1lO) has been used as a neutral-temperature herb for epigastric and abdominal pain. A single herb contains both warming and coo14lg constituents Some herbs contain some constituents with potentially cooling effect and other constituents with potentially warming effect. For example, some varieties of Achillea millefolium contain both potentially warming camphor and potentially cooling sesquiterpene lactones, and thus can have a variable-temperature effect. This may be one of the reasons why in the past Achillea has been classified in the West sometimes as slightly hot and sometimes as cold in the first degree (see the Achillea chapter). Chemical differences in different samples of the same herb These chemical differences may arise from a number of factors, including: • genetic differences in populations of the same species • different methods of cultivation • different methods of preparation
Genetic differences in populations ofthe same species In some cases, chemical differences between different herb populations of the same species may account for the difference of opinion on the temperature of the same herb. For example, Valeriana officinalis has been considered cooling by some herbal practitioners in Europe and warming by some practitioners in the USA. This difference of opinion may be linked to known chemical differences between the different geographical populations of this herb, associated with variations in chromosome number (see the Valeriana chapter).
grown with artificial light in a greenhouse and harvested before maturity. The first Salvia sample may tend to be more warming (see the Salvia chapter).
Different methods of preparation Use of the fresh or dried herb, variation in the time and temperature of storage, and differences in the method of preparation can make significant chemical differences between samples of the same species. For example, both fresh ZingIber (shengjiang) and dried Zingiber (gan jiang) can be classified as hot in Chinese medicine, but the dried herb is considered more warming to the Interior. There are real chemical differences between fresh and dried ginger that underlie this difference in temperature effects (see the Zingiber chapter). As another example, the temperature of Panax ginseng can vary considerably with the country of origin and the method of processing. Ginseng cured in rock candy-white ginseng (bcii shenF--can be used to treat Qi and rm Deficiency and can be classified as cooling. Ginseng cured by steaming-red ginseng (h6ng shen}-can be used to treat Qi and Yang Deficiency and can be classified as warming.
Caution Failure to make these temperature distinctions between different preparations of the same herb can result in adverse effects for the patient. Differences in human populations The perceived temperature effect of a herb may vary with differences in the physiology and pathology of human populations that result from differences in genetics, climate, and life-style. For example, until relatively recently, the bulk of the population in China lived in the countryside, did much physical work, lived in unheated housing, ate small amounts of home-grown food with little meat, and had relatively little medication. Such rural populations tend to have more syndromes of Deficiency and Cold. In contrast, the bulk of the population in some Western countries is urban, does very little physical exercise, lives on junk food with potentially harmful additives, and takes prolonged multiple medication. Such urban populations tend to have more syndromes of Stagnation, Deficiency Heat, and Retained Pathogen. The temperature effect of herbs on the body is likely to be different in these two populations. For example, in the urban population Panax ginseng is more likely to produce adverse effects involving Heat.
Different methods of cultivation There may he important chemical differences in samples of a single herb species due to differences in methods of cUltivation and time of harvesting. For example, a sample of Salvia officinalis grown in its natural habitat in a warm, dry climate and harvested at maturity will have a greater amount of monoterpenoids and a different chemical spectrum than a sample of the same species
References 1. Bensky D, Gamble A. Chinese Herbal Medicine Materia Medica. -Eastland Press, Seattle, Washington (1986)
~'"
-
-
Temperature 2. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks. Glenwood. Illinois (1990) 3. Von Bingen H. Hildegard von Bingen's Physica. Healing Arts, Rochester. Vermont (1998) 4. Gerard J. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publi-
'_L
,
r I
27
cations, New York, New York (1975) 5. Tabernaemontanus IT. Krauterbuch (1731). Reprinted by Verlag Konrad Kolbl,Munchen. Germany (1993) 6. Jiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science and Technology Press, Shanghai. China (1975)
...
Taste Taste as a herbal property This refers to a theoretical system for classifying herbs according to the type of effect they have on the body. Herbs can then be selected according to the taste property to correct specific types of imbalance. For example, according to Chinese herbal theory, sweet herbs often have tonic action so that they are often selected to treat Deficiency patterns.
Concepts oftaste
...
This chapter introduces a new approach to the theory of taste, drawing on concepts from Chinese medicine, Western herbal tradition, and modern biochemistry. This movement towards an integrated approach can increase theoretical understanding and widen the clinical application of the taste concept in herbal therapy. It can also help to resolve some of
The importance of experience It is very valuable for practitioners of herbal medicine to taste and take the herbs that they use. In this way, they can compare and contrast the theoretical taste properties of each herb used with its tastes in the mouth and with its effects on their own bodies. For each herb with an individual materia medica chapter in this book, its tastes in the mouth and its taste properties are discussed separately in the section on Traditional
the apparent contradictions between the Chinese and \Vestern concepts of taste.
TASTE IN THE MOUTH AND TASTE AS A PROPERTY There are two overlapping concepts of taste: taste in the mouth and taste as a herbal property. Over the centuries, the different tastes that substances have in the mouth have been associated with different herbal effects.
sources.
Taste in the mouth
The classification of herbs in terms of taste can facilitate herb choice in two main ways:
IMPORTANCE OF THE TASTE PROPERTY
This relates to taste as a sensation-to
what the herb actually tastes like in the mouth and on the tongue. This subjective experience has a foundation in physiology and biochemistry. There may be individual variations in the quality and intensity of the taste experience, and there may be cultural differences relating to differences in linguis-
• by providing a simple overview of herbal groups • by acting as a sophisticated method for the mutual balancing of herbs in a combination
tic concepts or patterns ofnutrition. However, there is a general consensus of experience and most people experience quinine as bitter, honey as sweet, cayenne as acrid, and ,", lemons as sour.
29
Overview Dividing herbs according to their taste properties gives the practitioner about five herb groups to choose from when assessing a situation. This is a more manageable number of groups for getting a preliminary overview than
-,
Combining Western Herbs and Chinese Medicine
30
the 20 to 30 action categories, and it is not as restrictive as would be the two choices offered by the Yin-Yang division. For a more detailed classification, each taste can be subdivided into action categories, as discussed in the individual taste sections below. Balance At the basic level of herb combination, herbs can be selected according to their action categories to match the patients syndromes. In addition to this, at a more sophisticated level of herb combination, taste properties can be used . to optimize the balance between the herbs in the combination. This is discussed in the Balancing the tastes section in this chapter, which contains a table of the 20 main taste combinations that can be used in the clinic. It is also discussed in the Taste section of the Principles of herb combination chapter.
CHINESE AND WESTERN CONCEPTS OF TASTE
sidered to be a taste, but in this book, I have used it as such (see discussion in the Aromatic section), I have not included the salty taste property of Chinese medicine since I fmd this taste to be rare in the Western herbs that I use in clinical practice. I have included the astringent property with the sour taste property since there is such a close overlap between the two. Finally, the Chinese category of bland is not used as a taste property in this book.
CHANGING CONCEPTS OF TASTE Concepts of taste property are currently in the process of change and expansion due to input from three different sources: Chinese herbal tradition, Western herbal tradition, and modern biochemistry. Each of these three systems can make valuable contributions to the understanding of taste, and each has its limitations or blind spots. It is important to keep an open mind in order to see beyond the limitations of each system if a useful integration is to be achieved in the future.
This section very briefly introduces the Chinese and Western concepts of taste and the taste classification used in this book. These are discussed in greater detail in the sections on the individual tastes. Chinese herbal tradition In Chinese medicine, there are two main taste classifications; one is associated with Chinese herbal tradition, and the other is associated with Five Element theory. In both classifications, there are five main taste properties: bitter, sweet, acrid, sour, and salty. However, the effects associated with each of the five tastes are not necessarily identical in the herbal and the Five Element models. For example, in the herbal model, bitter is often associated with clearing Heat and Damp, whereas in the Five Element model, it is associated with tonifying the Heart. Also, in the herbal model, the additional properties of aromatic, astringent, and bland are often used together with the five tastes. Western herbal tradition In the West, the Galenic system described each herb in terms of its temperature (whether warming or cooling) and moisture (whether drying or moistening), and the body parts on which the herb acts. However, in this system, there was less emphasis on the taste property than in Chinese herbal medicine. More recently in Western herbal medicine, individual taste sensations have been associated with specific herbal effects, for example, bitter with the digestive tonic action and aromatic with the . , . '. carminative action. ........ . . ,:
",
This book The five taste properties used in this book are bitter, sweet, sour, acrid, and aromatic. I am aware that in Chinese medicine, the aromatic property is not strictly con-
Chinese herbal tradition The Chinese herbal system of taste properties gives a framework of clear, simple concepts for classifying herbs and matching them to syndromes. Perhaps most importantly, it contributes a system of matching herbs with each other according to taste to produce a balanced combination. The limitation of the Chinese system is that it has remained relatively static for a long time, without further evolution of its concepts. As in the history of the Galenic system in the West, respect for the authority of tradition may have reduced rigorous critical investigation and discussion, and slowed the evolution of ideas. Western practitioners are reevaluating the concepts of traditional Western phytotherapy in the light of the theories of Chinese medicine. Perhaps it is time for Chinese practitioners to reevaluate the concepts of taste in view of ideas from Western herbal tradition and from modern biochemistry. This would be especially valuable in the case of the aromatic, bitter, and sweet properties. Western herbal tradition In the West, from the time of Galen to Culpeper, concepts of taste were not as clearly developed or as well organized as in China. However, Western herbal therapy has more recently made major contributions in this area with respect to understanding and utilization of the bitter and aromatic concepts. This is discussed in the individual sections on these tastes. Biochemistry and taste On the one hand, the concepts of taste from Chinese and Western herbal tradition can contribute to the application of phytopharmacology to clinical
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Taste practice. On the other hand, concepts and detailed information from phytochemistry and phytopharmacology can help to give breadth and depth to the understanding of taste. Contribution of taste to biochemistry There is a vast number of individual active herb constituents. 'Whilst these can be organized into major chemical groups, such as phenols and steroids, there is as yet no clear and simple system in phytopharmacology to match individual constituents, or even major chemical groups, to the syndromes of the patient. The structured framework of the taste concept can be used to give some organization to the apparent chaos of the biochemical data. To the degree that active constituents can be classified in terms of taste, they can be linked to herb actions and thus to the treatment of specific syndromes. For example, if a constituent is bitter, it may have one or more of the potential actions associated with this taste, for example,
it may function as a digestive tonic. Contribution of biochemistry to taste Research on active constituents and their pharmacological effects have demonstrated new practical uses for phytochemicals with a specific taste. For example, some chemicals with the sweet taste have been shown to have immunoregulatory effect. In addition, each t:tste can be subdivided into groups according to its chemical type and pharmacological effect. For example, sweet phytochemicals can be divided into the
following groups:
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• nutrient carbohydrates • demulcent mucopolysaccharides • immunopolysaccharides • adaptogenic triterpenoid saponins The contribution of new practical uses and a system of subdivision of the taste types can lead to a more profound understanding of taste and a wider clinical application of each taste group.
Bitter The bitter taste sensation follows stimulation of the bitter taste receptors on the tongue. Substances differ in the intensity of the bitter sensation they evoke and are sometimes given bitterness values. For example, the most abundant bitter secoiridoid in Gentiana root is gentiopicroside with a bitterness value of about 12,000. However, the most important bitter component in Gentiana root is amarogentin, which, although only present in tiny amounts, nonetheless has a bitterness value of 58,000,000 (see the Gentiana chapter).
31 CHINESE HERBAL TRADITION According to the Five Element theory, the bitter taste tonifies the Heart. However, most of the herbs classified as bitter in modern Chinese materia medica are not listed as tonifying the Heart, and in the herbal tradition, bitter is more associated with reducing Excess conditions. For e.xampIe, it can be associated with the following actions: l • drains Damp • clears Heat • drains downward • purges stools • clears Lung Phlegm Drains Damp In some circumstances, the bitter property can be associated with draining Damp regardless of whether the Damp is associated with Heat or Cold. 2 It should be noted that not all herbs that drain Damp and promote urination are classified as bitter; some are sweet, like Zea (yu mi xu), or sweet and bland, like Poria (m ling). Clears Heat In some circumstances, the bitter property can be associated with clearing Heat from the organ systems, whether Heat from Stomach or Heart, or Damp Heat from Liver or Bladder. Many herbs that are listed as clearing Wind Heat, Summer Heat, Heat, Heat in the Blood, Damp Heat. or Heat Toxin are classified as bitter. For example, Coptis (huang Han) can cool the Blood, clear Heat Toxin, clear Heat in the Heart or Stomach, and clear Damp Heat in the Intestines. However, not all herbs that clear Heat do have the bitter property. Gypsum (shi gao) is sweet and acrid, Lophatherum (dan zhli ye) is sweet and bland, and Calcitum . (han shui shi) is acrid and salty. Drains downward In some circumstances, the bitter property can be associated with the tendency to move Qi downwards as in the following actions: • redirects Lung Qi to treat cough, for example, Prunus armeniaca (xlng ren) • redirects Intestines Qi to treat constipation, for example, Rheum (cia huang) • drains Heart Heat out through the unne, for example, Akebia (mil tong) Purges stools Whilst most herbs listed as bitter are not purgatives. most herbs in the laxative, purgative, and cathartic categories of Chinese medicine are classified as bitter. Most of these bitter herbs that move stool are cold or cool and are especially appropriate for constipation due to Heat, for example, Rheum, Cassia (fan xie ye), and Aloe (1ti hul).
Combining Westet:n Herbs and Chinese Medicine
32
Clears Lung Phlegm In some circumstances, the bitter property can be associated with dissolving Phlegm and relieving cough. Prunus armeniaca is an example of a warm, bitter antitussive, and Euphorbia (ze qI) is an example of a cool, bitter, and acrid expectorant. Bitter herbs that clear Phlegm are often also acrid (see the Acrid section in this chapter).
Summary of Chinese tradition Whilst the Five Element theory proposes a tonic action for the bitter taste, the herbal tradition emphasizes its reducing: downward-moving, and drying effects. \NESTERN HERBAL TRADITION In the last century of Western herbal tradition, the bitter taste has been associated with the following actions: • bitter digestive tonic • bitter general tonic • bitter cholagogue and hepatic Bitter digestive tonic In the Western tradition, bitter herbs have been used to treat the lack of appetite and digestive weakness.3.4·5.6 More recendy, it has been suggested that bitter herbs may help to treat malabsorption, gastrointestinal infection, and food allergies (see the Biochemical perspective section below). Bitter general tonic The general tonic effect of the bitter herbs may largely depend on their digestive tonic action. In terms of Chinese medicine, it can be said that some bitter constituents can tonify and move the Qi of the Spleen, Stomach, and Intestines, and thus indirectly help to tonify Qi and Blood. In the Western tradition, bitter herbs have been used to treat exhaustion, anemia, weight loss, and associated muscular weakness and mus~ular atrophy.3.4.5.6 It has recendy been suggested that bitter herbs may help to strengthen the immune system.7 Bitter cholagogue and hepatic Bitter herbs have a tradition of use in the West to strengthen the secretion and flow of bile, and to treat disorders of the liver and gallbladder.3.4. 5.6. 7 Expressing this Western use in terms of Chinese medicine, it can be said that some bitter herbs can tonify and move the Qi of the Liver and Gallbladder. ,Other actions of bitter herbs The main emphasis in the use of bitterherbs in the,West has been on ~eir general tonic, digestive tonic, cholagogue, and hepatic actions. However, herbs with the bitter taste are found in other Western action groups, especially the following:
• antimicrobial, antipyretic, and anti-inflammatory • cardiotonic • tranquilizer These are discussed in the section Combining the Western and Chinese perspectives below. BIOCHEMICAL PERSPECTIVE Bitter herbs, or more precisely, bitter constituents, can be said to have three main levels of activity: • general bitter effects • effects shared by members of a particular chemical group • effects specific to an individual chemical General bitter effects All substances that stimulate the bitter taste receptors at the back of the tongue may set off a cascade of events in the gastrointestinal and hepatobiliary systems. These may include stimulation of appetite, flow of saliva, flow of digestive secretions from the stomach, intestines, and pancreas, and stimulation of the secretion and flow of bile (see the Research section in the chapters on Artemisia and Gentiana). Increase in bile flow may then have a laxative effect. This subject has been reviewed by Mills and Bone/ who noted that reduced gastric secretion can lead to abnormal bowel flora, malabsorption of nutrients, and an increased tendency to enteric infection. By increasing gastric secretion, bitter herbs may thus help to treat these conditions. In addition, reduced gastric secretion may lead to the inadequate breakdown of polypeptides. This may result in an increase in potential antigens and an increase in allergic responses related to foods. By increasing gastric secretion, bitter herbs may therefore help in the prevention and treatment of food allergies. It was also suggested that bitter herbs may assist in the normalization of blood sugar levels and the stimulation of the immune function. Effects shared by members of a particular chemical group In addition to the general bitter effect, each substance may then have additional effects characteristic of the chemical group to which it belongs. For example, the quinoline alkaloid group, to which quinine and quinidine belong, can have antimalarial and cardioregulatory effects. Many different chemical groups can produce the bitter taste sensation. For example, each of the following groups contains some substances with the bitter taste: monoterpenoids, sesquiterpenoids; sesquiterpene lactones, diterpenoids, triterpenoids, iridoids, flavonoids, and alkaloids. This great variety of chemical types may explain why bitter herbs can have such a wide range of actions.
-,...
Taste Effects specific to an individual chemical Each bitter substance may have effects that are specific to its unique individual structure. For example, within the quinoline alkaloid group, quinidine is a stronger antimalarial than quinine and has more risk of cardiotoxicity (see the Cinchona chapter).
lvlultiple effects of a single bitter chemical It is interesting that some bitter chemicals can have most of the actions that have been associated with bitter herbs above. For example, the alkaloid berberine, present in Berberis and Hydrastis, has been reported to have choloretic, hepatic, antimicrobial, anti-inflammatory, cardiotonic, and respiratory effects. It would be interesting to determine if a specific chemical structure can be associated with this range of actions and if this structure can also stimulate the bitter taste receptors.
33
General tonic exhaustion anemia weight loss muscular weakness muscular atrophy weak immune system Digestive tonic lack of appetite digestive weakness malabsorption gastrointestinal infection food allergies
Hepatobillary tonic
COMBINING WESTERN AND CHINESE PERSPECTIVES The Western emphasis on tonification and the Chinese herbal emphasis on reducing and cooling seem to be irreconcilable opposites, but they can be regarded as just the two
depression epigastric and abdominal distension nausea intolerance of fatty foods reCOliery from habitual overeating recovery from substance abuse recovery from prolonged medication gallstones constipation
Antimicrobial infections such as: recurring respiratory infections acute bacillary dysentery urogenital infections boils AntI-Inflammatory inflammatory disorders such as: gastritis colitis cystitis arthr,itis Antipyretic disorders with fever such as: acute influenza acute tonsillitis mononucleosis malaria some chronic fatigue syndromes
ends ofa spectrum ofbitter actions. -·-tonifies Qi.~.:~b~esQi ... clears H~at
.
';,'--
T~e
~
..
':--.''; ~-..,~"':":~--'-~
action of moving Qi acts as the bridge between tonifying
Qi and clearing Heat. Stagnant Qi can be associated with Deficient Qi, as in exhaustion and depression, or it can be associated with accumulation of Heat and Damp, as in recurring diarrhea with sensations of heat. In more complex conditions, Stagnant Qi can occur with patterns of both Deficiency and Heat, as in some cases of weak digestion with chronic gastrointestinal inflammation. Bitter herbs, depending on their temperature, can be used in all of these situations. Six potential bitter actions The table below shows six of the main potential actions of bitter herbs, together with some of their associated uses. These six actions can be divided into two groups as follows:
• tonic actions:
general, digestive, and hepatobiliary tonic
• cooling actions: r:'
antimicrobial, antiinflammatory, and antipyretic
The tonic actions are associated with tonifying Qi and moving Qi, and the cooling actions are associated with clearing Heat and moving Qi.
Which of these actions manifests in a particular situation will depend on the state ofthe patient, on the other herbs in the combination, and on the temperature ofthe bitter herbs. Use of bitters for hepatobiliary stagnation In Chinese medicine, the syndrome of Stagnation of Liver Qi can have many manifestations and ramifications. These include depression, nausea, indigestion with epigastric and abdominal distension or discomfort, gallstones,.constipation, intolerance of fatty foods, and recovery from substance abuse or prolonged multimedication. By moving Liver Qi, bitter herbs can therefore assist in the treatment of a wide range of conditions. (See the Research sections in the Berberis and Gentiana chapters for hepatobiliary effects of bitter active constituents.) Western use of bitter herbs to treat hot conditions It is interesting to note Culpeper's use of the bitter herb Berberis to cleanse the body of 'choleric humors' (associated with anger), to clear heat from the liver and .from the blood, and to treat jaundice, itching skin disorders, boils, and fever. 8 Also, Lonicerus wrote that Berberis is good for headache if it is a result of heat and acidity from gallbladder disease. 9 In Chinese medicine terms, this would be equivalent to clearing Heat or Damp Heat from the Liver-Gallbladder, clearing the resulting Blood Heat or Damp Heat from the skin, and reducing Liver Hyperactive Yang associated with Liver-Gallbladder Qi Stagnation.
Combining Western Herbs and Chinese Medicine
34
Antimicrobial. antipyretic. and anti-inflammatory actions
strong downward effect on it, and they are cool or cold in
In Chinese herbal tradition. the main emphasis for the bitter herbs is on clearing Heat and Damp. In terms of Western herbal medicine. this translates into the antimicrobial. antiinflammatory. and antipyretic actions. It is not stated in Western tradition that bitter herbs are specific for infections, inflammations, and fever. However, bitter herbs have been used just as much for these disorders as they have been used for general debility, atonic digestion, and hepatobiliary weakness. (See the Research sections in the Berberis and Gentiana chapters for antimicrobial. antipyretic, and antiinflammatory actions of bitter active constituents.)
temperature. Additional actions of bitter herbs Two further actions associated in the Chinese herbal tradition with the downward~moving aspect of the bitter taste have been noted above: purgative and antitussive actions.
Purgative In China, the bitter taste is also associated with .the purgative action, that is. to direct Intestines Qi downward and move the stool. Whilst most of the purgative herbs used in the West have a bitter taste. such as Rhamnus and Rheum, these actions are not generally regarded as specific to the bitter taste.
Alterative action of bitters In my opinion, certain bitter herbs have the capacity to treat recurring fever by their alterative action of clearing toxins from the body or, in Chinese medicine terms, by clearing Retained Pathogens. The three bitter effects of tonifying Qi, moving Qi. and clearing Heat can combine to do the following:
• tonifies Qi
• moves Qi
helps to strengthen the natural ability of the body to clear pathogens from the system and to prevent further infection helps to clear pockets of Stagnation with accumulation of pathogens and toxins that may act as foci for recurring infections
• clears Heat can allow the Qi and Ym to rebuild to speed convalescence This is discussed in the Cinchona chapter in the section
Possible mechanism ofantipyretic effects. Bitters herbs and the Heart There are two very different groups of bitter herbs with effects on the Heart: one group has tonic action, and the other has a calming. reducing, and cooling action.
Tonics The bitter taste is said to tonify the Heart in the Chinese Five Element tradition, and there is a minor tradition in Western herbal therapy that states that the heart can be strengthened by bitter herbs. Some of the cardiotonic herbs used in the West have a bitter taste, such as Cinchona. Convallaria. Leonurus, and Sarothamnus, but other cardiotonic herbs, such as Crataegus, are not appreciably bitter. These cardiotonic bitter herbs can be said to tonify and stabilize Heart Qi, and ijiost of them are more or less neutral in temperature. Tranquilizers Most Western herbs that have a strong tranquilizing action also have the bitter taste, for example, Anemone, Gelsemium, Humulus, Piscidia, and Valeriana. These herbs can be said to calm the Heart Spirit by having a
Antitussive Two other actions associated with the bitter taste in the Chinese herbal tradition are the antitussive action, that is. directing Lung Qi downward, and the expectorant action, that is, clearing Lung Phlegm. In the West, whilst some herbs with antitussive and expectorant action have a bitter taste, such as Marrubium, these actions are not linked specifically to the bitter taste.
DIRECTION OF ENERGY OF BITTER HERBS The effect of a bitter herb on the direction of energy movement depends on its specific actions and the organs it affects. Stomach and Intestines In the Western view, bitter substances can stimulate the bitter taste receptors, thus increas- - • ing gastrointestinal and hepatobiliary secretions. This can be described as a tonic effect that can assist in the normalization of the natural downward movement in the stomach and intestines. This is a different emphasis from the downward movement proposed by the Chinese herbal tradition. which can involve purgative and diuretic actions, with an overall reducing effect on the body. Liver and Gallbladder Stimulation of hepatobiliary function can be said to include dispersal of Liver Stagnant Qi. This movement is not limited to the downward direction since it can have upward, downward. and horizontal components. Some bitter constituents, for example, the bitter constituents of Piscidia, can reduce the disturbed upward movement of Liver Yang, to treat headaches and migraines. Heat clearance In the West, bitter herbs are commonly used as antimicrobials, anti-inflammatories, and antipyretics, and these actions can be related to the action of clearing Heat in Chinese -medicine. However, these Western actions are not necessarily associated with the clearance of Heat by downward movement via the stools and urine, as proposed for the bitter taste in the Chinese herbal tradition.
Taste Heart In the Chinese Five Element tradition, the bitter taste is said to tonify the Heart, but no specific effect on the direction of energy movement is proposed. The same is true of the Western concept of the cardiotonic effect of bitters. However, the bitter herbs with tranquilizing action can be described as having a downward-directing effect on the pathological upward movement of Heart Spirit or Liver Yang.
Summary Bitter herbs, or more specifically bitter constituents, may help to normalize the natural downward movement in the stomach and intestines, and help to spread Liver Qi. They may also have one or more of the following effects, depending on their specific chemical structure: • nondirectional antimicrobial, antipyretic, and antiinflammatory actions • nondirectional cardiotonic action • downward-directing tranquilizing action • downward-directing diuretic or purgative action
TEMPERATURE OF BITTER HERBS In itself, the bitter property tends to be either neutral, as in some of the digestive tonics, cardiotonics, and tranquilizers; or cooling, as in some of the antimicrobials, antipyretics, anti-inflammatories, and sedatives. Warm bitter herbs generally have bitter combined with acrid, for example, Myrica and Sanguinaria. The wide variation in temperature among Western herbs with the bitter taste, from warm to cold, is illustrated by the following examples: Temperature warm
neutral
Examples Myrica for patterns of Deficiency, Stagnation, and Cold, such as exhaustion and depression with sensations of cold Marrubium for patterns of Deficiency and Stagnation, with or without Heat or of Cold, such as a weak cough with sensations of obstruction in the chest
neutral~ool
Gentiana for patterns of Deficiency and Stagnation with some Heat. such as weak digestion with gastroenteritis
cool
Berberis for patterns of Stagnation and Heat with or without some Deficiency, such as cholecystitis with sensations of heat
cold
Asclepias for patterns of Excess Heat. with or without Stagnation, and in the absence of DefIciency. such as acute respiratory infections with fever
CAUTIONS Chinese herbal tradition
It must be clearly understood
35 that in the Chinese herbal tradition, cautions and contraindications for bitter herbs depend on their temperature, rather than on the bitter quality itself.
Cool or cold bitter herbs Chinese contraindications for Cold Deficient patterns of the Spleen and Stomach, especially with diarrhea, are related to the temperature, rather than to the bitter property itself. Cool or cold bitter herbs are contraindicated or to be used with caution for Cold Deficient conditions of the Spleen and Stomach, especially with loose stools or diarrhea. However, sweet cold herbs may be similarly contraindicated for Cold Deficient patterns of the Spleen and Stomach since it is not the taste but the cold temperature that is damaging to the Spleen. Warm 'or hot bitter herbs In contrast to cooling bitter herbs, warming bitter herbs may be indicated for Cold Deficient patterns of the Spleen and Stomach. For example, Evodia (wti zhii yti) is indicated for diarrhea from Cold Deficient Spleen and Kidneys. Warm bitter herbs are generally contraindicated for Heat patterns, especially Deficiency Heat associated with Deficient Ym. Western herbal tradition Some texts contraindicate certain bitter herbs in cases of gastric ulceration or hyperacidity due to the possibility that they may increase the secretion of gastric acid and aggravate these conditions. However there is evidence to suggest that these herbs can reduce rather than increase the potential for gastric irritation (see the Toxicology section in the Gentiana chapter).
Sour In the mouth, the sour taste and the astringent effect can be differentiated as follows:
• sour taste • astringent effect
'sharp: acid taste oflemon juice or vinegar puckering or drying effect on the mouth and tongue
The sour taste is not necessarily accompanied by a puckering effect, nor is the astringent effect necessarily accompanied by a 'sharp' taste.
CHINESE HERBAL TRADITION In the Five Element tradition, the sour taste is said to tonify the Liver. In the Chinese herbal tradition, the concepts of sour (suan) and astringent (se) are very close. Most of the herbs in the astringent action group are classified as sour, although there are exceptions, and the main manifestation of the sour taste is the astringent action.
36
Combining Western Herbs and Chinese Medicine
Astringency is associated with firming and stabilizing the Qi to hold things in their proper place. This includes not only the prevention of leakage of fluids and of organ prolapse, but also the stabilization of the organ functions, including their mental and emotional aspects. By firming and stabilizing the Qi, the astringent action can counteract three related pathologies: • Deficiency of the holding function of Qi • Excessive dispersal of Qi • Qi not holding Spirit firm Deficiency of the holding function of Qi This is Deficiency of a very specific function of Qi-not the warming, moving, or activating aspect-but the special function of holding things firm and stable and in their proper place. If this function of Qi becomes weakened, then there may be leakage of fluids through cell walls, leakage of blood from capillaries, loss of sweat through the pores, leakage of urine or stool through atonic sphincters, and the prolapse of organs. Excessive dispersal of Qi If the condensing and concentrating function of Qi is weak, there may be an excessive, dispersing, outward movement leading to loss of energy from the body and to a diffusive and scattering effect on the Qi. If the Defensive Qi becomes less dense and more diffuse, it is easier for pathogens to enter the body, resulting in chronic or recurring illnesses. If the Qi of the Kidney becomes more diffuse or scattered, mental concentration becomes more difficult, and it may become more difficult to focus the will to get things done. Qi not holding Spirit firm Weakness in the capacity of Qi to hold the Spirit firm and stable may result in the disturbed upward movement of energy in the body, with symptoms such as mental or emotional instability, anxiety, insomnia, and palpitations. Schisandra is an example of a herb that can be used to counteract all three of these pathologies since it can:
• reduce excessive dispersal ofQi to treat excessive sweating and reduce the side effects of dispersing herbs, such as Ephedra
• strengthen the holdingfunction of Qi to treat urinary frequency, diarrhea, and vaginal discharge
• strengthen the holdingfunction ofQi to firm and stabilize Heart Spirit to treat insomnia and palpitations
,WESTERN HERBAL TRADITION . , Sour taste There does not appear to have been a clear concept of the sour taste in the West comparable to that of Chinese medicine. However, Gerard 10 described the juice of
the lemon as 'sharp' and stated that it 'cutteth, divideth, and maketh thin, gross, tough, and slimy humors? Lemon juice has been used in Western folk medicine to cleanse the liver and to treat liver and gallbladder disorders. In Britain, greasy fish and chips are usually drenched with vinegar, and this can be associated with the sour taste assisting the liver to deal with this intake of oily food. 11
Astringent action Lonicerus and Tabernaemontanus used the term 'ziehen zusammen' (to draw together) to describe herbs, such as Achillea, that are used to stop hemorrhages and the leakage of stool, sperm, or vaginal discharge. Christopher described astringents as 'herbs that influence the vital contractility of cell walls, condense the tissues, make them denser and firmer, and arrest discharges.' The emphasis in the West is on what can be called the material aspects of astringency, that is, on preventing the leakage of the fluids and holding the organs in their proper place. Western astringent herbs are therefore used internally to treat disorders, such as diarrhea, bleeding, discharges, urinary incontinence, and organ prolapse, and locally to treat varicose veins, hemorrhoids, wounds, and ulcers. Western herbal therapy does not appear to possess a concept comparable to the Chinese idea of the energetic aspect of astringency in terms of firming the energies of organ systems and stabilizing the mind and emotions.
BIOCHEMICAL PERSPECTIVE Sour taste The sour taste sensation may result from the stimulation of the sour taste receptors by hydrogen ions. Sour-tasting compounds are often carboxylic acids, such as acetic acid (as in vinegar), citric acid (as in lemon juice), and oxalic acid (as in Rumex). Tannin astringents Local astringent effects, and the puckering sensation produced by many astringents on the mouth and tongue, are most commonly associated with tannins (see the Potentilla chapter).
Bioavailability of tannins This topic has recently been reviewed/ and in the present state of knowledge, it appears that intact tannin molecules have poor bioavailability. This is perhaps fortunate since intact hydrolyzable tannins in the blood have been reported to be hepatotoxic. However, the bowel flora breaks down tannins into smaller phenol molecules that can be absorbed through the gut wall into the blood and can have antioxidant effects in the body. Therefore, whilst tannins can have local astringent and antihemorrhagic effects on the mucosa of the mouth, stomach, or intestines, there is currently no evidence to indicate that they can produce these effects at sites remote from the
Taste
37
gut. It is therefore necessary to verify traditional claims for tannin-containing herbs that they can treat disorders such as hemoptysis, menorrhagia, or urinary incontinence. It is possible that the products of tannin breakdown in the gut may contribute to astringent and antihemorrhagic effects at sites remote from the gut, but this has yet to be demonstrated.
Relatively material aspect This refers to the relatively more
Nontannin-containing astringents Substances other than tannins may have local astringent or antihemorrhagic ef-
nins.
fects, as for example in the following herbs:
Relatively energetic aspect This refers to the relatively more
• Calendula
antihemorrhagic and vulnerary actions may be due to resinous constituents
• Capsella
antihemorrhagic action may be due to
• Capsicum • Commiphora
a peptide antihemorrhagic action may be due to the amide capsaicin antihemorrhagic and vulnerary actions may be 9,ue to both resinous and polysaccharide constituents
Equisetum and Hydrastis also have astringent or antihemorrhagic actions, and have not been reported as containing appreciable quantities of tannins. Astringent mechanisms Three possible components of the astringent mechanism can be summarized as follows. 1. Tannins or other chemicals may have local effects on the gut mucosa, following oral administration, or on the surface of the body, following topical application. 2. Substances may be absorbed through the gut wall and travel in the bloodstream to target tissues remote from the gut. 3. Substances may first strengthen the function of the organ systems, resulting in indirect astringent effects. For example, in terms of Chinese medicine, Schisandra may reduce diarrhea by first firming Kidney Qi, or Astragalus may treat diarrhea by first tonifying the Qi and Yang of the Spleen. However, there is as yet no data linking astringency to the systemic effects of plant constituents.
COMBINING WESTERN AND CHINESE PERSPECTIVES The discussion below links elements from Chinese medicine and Western herbal tradition. 1\vo aspects of astringency Sour herbs can be said to manifest two main aspects of astringency, the relatively material and the relatively energetic.
material manifestations of astringency, such as reduction of leakage of fluids and treatment of organ prolapse. In the West, astringent herbs are used to treat these more material aspects. Most Western astringent herbs can be classified as sour, such as Geranium and Vinca, or sour and bitter, such as Polygonurn and Sanguisorba, and most of them contain tan-
energetic manifestations of astringency, that is, stabilizing organ functions, especially their mental and emotional aspects, to treat such disorders as palpitations and dreamdisturbed sleep. Western contribution The contribution of the Western herbal tradition lies not so much in theoretical concepts of astringency, but in the development of the use of a wide range of astringent herbs. For example, Myrica can be used as a warming, anticatarrhal astringent to treat diarrhea with mucus in the stools and sensations of cold. Polygonurn bistorta can be used as a cooling, demulcent, anti-inflammatory astringent to treat diarrhea with intestinal inflammation and sensations of heat. Up to the present, there have been few research studies on the mechanism of astringency, and of these studies, most have focused on the tannins. In the future, research studies may reveal a variety of astringent mechanisms, involving both local and systemic astringent effects. Chinese contribution The specific contribution of Chinese medicine is in regard to the relatively energetic aspects of astringency, especially the use of sour astringent herbs in the treatment of mental and emotional disorders. In terms of Chinese medicine, if the Qi does not perform its function of firming and stabilizing the energies of the organ systems, their normal rhythm and direction of movement may become disturbed, as in the irregular upward movement of Heart Spirit Disturbance. Cardioregu1ators and nervines The Chinese concepts of the energetic aspects of astringency can be applied to the Western action concepts of cardioregulators and nervines. Herbs with these actions can be used to strengthen and stabilize the function of the coronary and nervous systems, respectively. In some of these herbs: the sour astringent property may contnbute to the stabilizing effect
.
Cardioregulator . In terms of Western herbal medicine, a cardioregu1a~r ca:n be defined as a herb that by strengthening the heart can stabilize i~ function and treat conditions such as arrhythmia. labile blood pressure, and fluctuations in energy and. body temperature. In terms of Chinese medi-
38
Combining Western Herbs and Chinese Medicine
cine, a cardioregulator can be said to tonify Heart Qi, and, by doing so, firm and stabilize Heart Qi to treat the syndrome of Heart Qi Irregularity. The two main cardioregulatory herbs listed in this book are Crataegus and Leonurus. Both have a sour taste in the mouth and are ascribed the sour astringent taste property in this book. They can be said to have astringency with respect to the specific function of firming and stabilizing Heart Qi. A cardioregulator can be said to treat problems of the coronary system (Heart Qi Irregularity), rather than the nervous system or the mind and emotions (Heart Spirit Disturbance), and Crataegus is a good example of this. However, in addition to tonifying and stabilizing Heart Qi, Leonurus can also calm Heart Spirit Disturbance. It can thus be used to treat anxiety in addition to cardiac weakness and arrhythmia.
Nervines These can be defined as herbs that tonify and stabilize the nervous system. They can be used to treat depression and emotional instability, especially when these are . associated with physical, emotional, and mental exhaustion. In terms of Chinese medicine, nervines can be said to tonify the Qi or Y'm of the Kidney, and the Qi, Y'm, or Blood of the Heart, and to firm and stabilize Heart Spirit. Some nervine herbs have a sour taste in the mouth and can be assigned the sour astringent taste property, for example, Hypericum and Schisandra. In my opinion, both these herbs can firm and stabilize Kidney Qi. This can reduce the diffusing, dispersing, and disturbing effect of fear on the Kidney itself, and lessen the disturbing effect of fear on the Heart. They can also firm and stabilize Heart Spirit, and can thus be used in combinations for enuresis and dream-disturbed sleep associated with fearfulness and anxiety. DIRECTION OF ENERGY The astringent property can be said to hold things firm, stable, and in their proper place. It can be seen as a passive effect of maintenance, rather than an active effect that moves energy in a particular direction. It can, thus, control excessive outward movement of energy and fluids, but it does not in itself produce an active inward (centripetal) movement of energy. It can also control the excessive disturbed upward movement of energy, but it does not actively direct energy downward.
TEMPERATURE The,~~tionof Qi t? hold things firm and in their proper place is not, in itself, associated with either warming or cooling effects. Most of the astringent herbs that have been classifiedin this book as only sour or slightly sour are neutral in temperature, for example, Capsella and Geranium.
Herbs classified as having both the sour and bitter tastes are also mainly neutral, for example, Agrimonia and Quercus. Some .herbs with both the sour and bitter tastes are listed as neutral-cool or cool, and this may be associated with the anti-inflammatory bitter constituents, as in Filipendula and Hamamelis. Sour astringent herbs that are warming, such as Myrica and Schisandra, are not common, and the warming effect of both these herbs may be due to the acrid constituents.
CAUTIONS Chinese herbal tradition Astringent herbs are contraindicated for Exterior conditions that are not fully cleared since astringents will reduce the outward dispersive movement needed to clear Exterior pathogens through the body surface. This includes skin rashes that are in the process of expressing. In apparent contradiction to this, Schisandra has been used for allergic skin disorders. However, I do not generally use Schisandra in the acute stage of allergic skin disorders associated with Wmd Heat. I use Schisandra in the chronic or remission phase associated with Kidney Deficient Qi. For example, in this book, Schisandra is not included in the combination Arctium: recurring urticaria: acute phase, but it is included in Arctium: recurring urticaria: remission phase. Astringent herbs are also contraindicated in Chinese medicine for Interior Stagnation since they may reduce the dispersing, moving effect required to clear the Stagnation. Warm astringents, such as Schisandra, are especially to be avoided in cases of Interior Stagnation with Heat. Western herbal tradition Astringent herbs are contraindicated when it is necessary to allow toxins to clear from the body via sweat, urine, stools, or discharge. Also, there are specific cautions to be used for astringent herbs with a high tannin content (see the Toxicology section in the Potentilla chapter).
Sweet In the Chinese herbal tradition, the sweet taste is associated with the taste that rice gives in the mouth on chewing; it is not associated with the intensely sweet sensation of sugar, as in the West. This cultural difference explains why some Chinese herbs that are listed as having the sweet property do not taste sweet to Westerners. For example, PanaX ginseng is listed as sweet and slightly bitter in property. However, to most Western people, brought up on massive amounts of sweet foods and candies, the taste in the mouth is primarily bitter, and not all Westerners can detect a sweet taste.
Taste CHINESE HERBAL TRADITION Five Element tradition In this tradition, the sweet taste is said to tonify the Spleen and is linked with Earth. This element can act as the center reference point to which other things are linked and around which they have their movement, giving them stability and balance. The material solidity and weight of the Earth element can be associated with a dampening of excessive movement away from the central position and, therefore with a moderation of extremes. Earth and the sweet taste can also be associated with nourishment, especially of the material aspect of Qi. Herbal tradition In this tradition, the following effects have been associated with the sweet taste property:! • tonic • moistening • antispasmodic ,.; '" • harmonizing of emotions • harmonizing of other herbs • moderation of other herbs
Tonic In Chinese medicine, the sweet taste is associated mainly with the ability to tonify Qi, Blood, ¥m, or Yang. It is especially associated with the nourishing function of Oi. that is, the capacity to increase the solid substance of the body. A good example of a herb with this effect is Ziziphus fruit (da zao). Moistening Closely associated with the nourishing action of the sweet taste is its moistening effect-the ability to tonify Fluids. For example, Pseudostellaria (tai z1 shen) and Ophiopogon (mai men dong) are used for their moistening effect.\2
Antispasmodic Some herbs with the sweet taste can reduce muscle spasms and alleviate pain. This is said to be due to the sweet taste nourishing the rm of the tendons and thus relaxing the muscles. l Glycyrrhiza is such a herb. Angelica sinensis (dang gui) can also relieve pain, and this may result partly from its ability to tonify the Blood. nourish the muscles. and relieve spasms. However, the analgesic effects of this herb may be primarily due to the ability of its acrid constituents to move Blood Stagnation.
Harmonizing ofemotions According to Yang, the moderate
stTeet
taste gives it the ability to harmonize the quality of the emotions and reduce stress, and Lilium brownii (bcii he) and Rehrilannia (shu dl huang) can be used to do this.\ (See the discussion'In the Combining the Western and Chinese perspectives section below.) ,
,'~
.,'
.-
Harmonizing of other herbs Some sweet substances can act
39 as a stabilizing central focus for the other herbs in a combination and can bring together and harmonize their different effects. Glycyrrhiza (gan cao) is the most common example of this.
Moderation of other herbs Substances with the sweet taste can moderate the effects of other herbs. For example, Glycyrrhiza can moderate the harsh effects of other herbs, such as the burning sensation of acrid Capsicum on the mucus membranes. Sweet herbs can moderate the speed and intensity of the effects of other herbs, making their effects less rapid and violent and more moderate and longer lasting. 1 For example, the sweet herb Serenoa can be used to moderate the Yang tonic action of Panax ginseng and Turnera. As a result, the body can incorporate this Yang energy ina smooth and steady fashion, rather than in a short burst that may result in imbalance and side effects.
WESTERN HERBAL TRADITION The theory of taste properties was not as well developed in the West as in China. In addition, the sweet taste was not associated directly with elaborate theoretical concepts. The fruits of Ficus carica, the fig, and Ziziphus jujube, the date, are examples of sweet herbs that were used from ancient times in the West. Both of these fruit were used for their nutritive action and as demulcents to treat respiratory disorders. 1J Althaea and Ulmus are examples of sweet herbs that are currently used in the West for their demulcent and nutritive action. 5,14
BIOCHEMICAL PERSPECTIVE Herbs that are classified as sweet in this book generally contain one or more of the following four types of constituent: • nutritive constituents • mucopolysaccharides • immunopolysaccharides • adaptogens Nutritive constituents The nutritive aspect of the sweet tonic action goes beyond simply supplying sweet nutrients in the form of sugars and starches. It also involves strengthening the natural ability of the body to make Qi and Blood and form tissue. This may involve herb constituents, such as minerals and vitamins, that may act as cofactors and facilitate the anabolic processes of the body. For example, Ziziphus fruit contains calcium, phosphorus, and iron, and the vitamins A, Bz, and C. in addition to sugars and starches.
Combining Western Herbs and Chinese Medicine
40
Mucopolysaccharides Demulcent herbs contain abundant mucopolysaccharides that can form a slippery gel and have a soothing and protective effect on inflamed mucus membranes. Althaea. Plantago major, and Viola are examples of herbs with demulcent action based on mucopolysaccharides, and these herbs can be used for conditions involving inflammation, soreness, and dryness of the respiratory mucosa. (See the Althaea chapter.) Immunopolysaccharides Polysaccharides from the following herbs have been reported to have an immunomodulatory effect: Althaea, Angelica, Calendula. Echinacea, Thuja, and Viburnum (see the chapters on these herbs). This can be regarded as a specific aspect of the Qi tonic action, related to the concept of tonifying Defensive Qi. There is some debate as to the effectiveness of the socalled immunopolysaccharides in vivo. However, it may be that these constituents help herbs, such as Echinacea or Thuja, to increase the resistance of the body to infection. Adaptogens This term refers to herbs or herb constituents that can enhance endurance and strengthen the natural ability of the body to adapt to environmental shocks and stresses. This is a specific aspect of the Qi tonic action that enables the body to maintain homeostasis even under adverse conditions. The active constituents that are responsible for the adaptogenic effect are often triterpenoid saponins. These chemicals can have multiple effects on the body and can strengthen the ability of the following systems to adapt to stresses: • Kidney (nervous and endocrine systems) • Heart (cardiovascular system) • Liver (hepatoprotective system) Examples of sweet tonic herbs with adaptogenic action based on triterpenoid saponins are Astragalus (astragalosides), Glycyrrhiza (glycyrrhizin), and Panax ginseng (ginsenosides). COMBINING WESTERN AND CHINESE PERSPECTIVES The discussion below combines elements from Chinese medicine, Western herbal tradition, and biochemistry, and is • organized under the following headings: • tonic • demulcent • stabilization of the emotions ":~" , • moderation of other herbs Tonic The main effect associated with the sweet taste is the tonic action. However, the tonic action of the sweet taste is
different in nature from the tonic action of the bitter or acrid tastes. Unlike the acrid and bitter tastes, the sweet taste is not associated with increasing movement and dispersing Qi Stagnation. The tonic action of the sweet taste is especially associated with strengthening the material aspect of Qi. Sweet tonics aid the formation of Blood, Yin, and Fluids, and some sweet tonics, such as Serenoa and Ziziphus, can be used to assist in weight gain. Some sweet tonics can strengthen the ability to adapt to environmental stresses and the ability to resist infection. However, these herbs are more for maintaining the stability of the homeostatic mechanism and the integrity of the body's defense system. They do not necessarily tonify Yang in the sense of increasing warmth and movement. Many of the herbs in the Yang tonic group that do strengthen these aspects are either not sweet or have taste properties in addition to sweet, such as acrid and bitter. Demulcent In the Chinese tradition, some sweet tonic herbs are said to help to generate Fluids and thus have a moistening effect, for example, Ophiopogon. Such herbs can be used to treat conditions involving dryness, soreness, and inflammation of the mucous membranes. In the Western tradition, demulcent herbs, such as Althaea, are used for similar conditions, but their effect has been explained in terms of supplying mucilage to the body, rather than by increasing the generation or secretion of Fluids. It is possible that some herbs may have both mucilagesupplying and Fluid-generating effects, or that these two effects are part of the same phenomenon. For example, Althaea is listed as a demulcent in the West and Ophiopogon as a Fluid tonic in China, but both herbs can be used to treat dryness and inflammation of the respiratory mucosa with dry cough and thick sputum that is difficult to expectorate. Stabilization of the emotions The sweet taste can be associated with the Earth element. The damp, heavy, static nature of the sweet taste can be utilized to reduce excessive or disturbed movement of energy, and to stabilize, balance, and harmonize the flow of the emotions. For example, the calming nature of Valeriana may be partly due to the heavy nature of its sweet property, which helps to weigh down the disturbed upward movement of Heart Spirit or Liver Yang that can be associated with anxiety or anger, respectively. I often combine Valeriana with the sweet herb Glycyrrhiza to emphasize this function of the sweet taste. ), . As another example, Cra~~egus h,as a cardioregulatory action that enabl~s it to stabilize"fluctuations in Heart Qi resulting in arrhythmia, energy fluctuations, or emotional lability. I consider the cardioregulatory action of Crataegus to be due paitly to its sour property that can firm Heart Qi
Taste and partly to its sweet property that emphasizes stability around a center point by dampening movement toward the extremes. Moderation of other herbs In a similar way, sweet herbs can moderate the extremes of other herbs in a combination and provide a stable central pivot for their actions. For example, if the patient has both anxiety and depression associated with Deficiency, the following combination could be used: Herb
Ratio
Temperature
Taste
Lavandula Passiflora Hypericum Avena Serenoa Rosmarinus Zingiber
1 1 1 1 0.5 0.5 0.5
51. warm neutral neutral neutral neutral warm hot
aromatic, bitter 51. bitter sour, 51. sweet sweet sweet, 51. sour aromatic, bitter, acrid acrid, aromatic
Th~ sweet taste ofAvena, Hypericum, and Serenoa forms the stable central point of this combination. Lavandula and Passiflora have a calming action to treat anxiety, and Rosmarinus and Zingiber have a stimulant action to treat depression. The sweet herbs will moderate movement toward the extremes of anxiety or depression, reducing any tendency to overcorrection by Lavandula and Passiflora on the one hand or Rosmarinus and Zingiber on the other.
DIRECTION OF ENERGY OF SWEET HERBS In terms of the Five Elements, the sweet taste maintains the movement of energy stable around the center, and dampens movement toward the extremes. It can be said to weigh down excessive or disturbed upward movement, and to reduce excessive outward dispersing movement of energy. However, in high doses, some of the sweet adaptogenic herbs, such as Astragalus, Glycyrrhiza, and Panax ginseng can aggravate or produce excessive or disturbed upward movement of Heart Spirit or Liver Yang. For example, in excessive doses and in susceptible persons, Glycyrrhiza can aggravate hypertension. At high doses, the adaptogenic action becomes a Yang tonic effect with increased upward movement, overriding the heavy nature of the sweet property that tends to control this effect.
TEMPERATURE OF SWEET HERBS In itself, the sweet taste can be associated with the neutral temperature and can be used to stabilize fluctuations in the temperature of the body. Some sweet herbs are classified as cool, but these usually also have the bitter taste in its anti-inflammatory aspect, for example, Althaea, Ophiopogon, and Viola. Herbs with the sweet taste that are classified as warm or hot usually also have the acrid taste, for example, Cinnamomum.
41 CAUTIONS General cautions In Chinese medicine, sweet herbs are avoided or used with caution in the following patterns: • Exterior Excess • Interior Stagnation • Damp • Phlegm Manifestations of the last three patterns include sensations of heaviness, feelings of lethargy and depression, mental heaviness and dullness, digestive stagnation, loss of appetite, nausea, bloating, weight gain, and catarrhal conditions. Specific cautions There are specific cautions and contraindications for different types of sweet herbs. For example,
• Astragalus can have warming and drying effect and so should be used with caution in cases ofYin Deficiency with Heat signs
• Ophiopogon is a sweet herb that is moistening and cooling and is therefore inappropriate for patterns of Deficiency with Cold and Damp
• Panax ginseng is a sweet herb with a stimulating and upward movement effect on the energy and is therefore to be avoided in cases of Heart Spirit Disturbance or Liver Hyperactive Yang
Acrid In the mouth and on the tongue, the acrid or pungent taste can be associated with a range of related sensations, including the severe burning of Capsicum, the prickling of Lobelia, and the tingling of Echinacea or Zanthoxylum. The acrid taste is sometimes referred to as pungent or spicy.
CHINESE HERBAL TRADITION According to the Five Element tradition, the acrid taste tonities the Lung. In the Chinese herbal tradition, the characteristic function of the acrid property is moving and dispersing. It can move Stagnation of Qi and Blood and disperse pathological factors associated with the Stagnation, such as Exterior Wmd, Toxin, or Retained Pathogen. The acrid property can promote Fluid metabolism and help to move and disperse accumulation of Damp or Phlegm.
The acrid property is not necessarily warming. Cool, acrid herbs can be used to disperse Heat, and warming, acrid herbs can be used to disperse Cold.
42
Combining Western Herbs and Chinese Medicine
Three well-known acrid categories In the Chinese herbal tradition, the acrid taste is commonly associated with the following three herb categories: • cool, acrid herbs that clear Exterior Wind Heat • warm, acrid herbs that clear Exterior Wind Cold • acrid herbs that warm the Interior Action groups containing acrid herbs Acrid herbs are not just found in the three well-known categories mentioned above, they are also found in other Chinese action categories. A more complete list is as follows: • clear Heat • clear Wind Heat • clear Wind Cold • clear Wind Damp • transform Phlegm and stop cough • open the Orifices • transform Dam~ i ~ . • regulate the Qi • move the Blood • warm the Interior • tonify Yang • external application Clear Heat In Chinese medicine, the acrid taste occurs in action categories where it might not be expected, for example, the action categories of herbs that clear Heat (drain Fire) and clear Heat Toxin. In these cold. acrid herbs, the moving and dispersing functions of the acrid property are important to assist in the complete clearance of Heat from the body to prevent the possibility of some Heat lingering in the body as a Retained Pathogen. The acrid and cooling properties combine to move Stagnation of Qi and disperse the associated accumulation of Heat and Toxin. l For example. in Chinese medicine, Prunella (xia kii dlO) is a cold, acrid herb that can clear Liver Heat with hypertension and headache, and also disperse Phlegm Heat to treat neck lumps and goiter. Houttuynia (yU xing dio) is a cold acrid herb that can clear Heat Toxin and treat swellings and abscesses. and can clear Lung Phlegm Heat to treat lung abscess or cough. Clear Wmd Heat Herbs with this action can be said to assist in the dispersing function of the Lung, move Stagnation in the surface channels, and disperse Wind Heat and Retained Pathogen. The acrid and cooling properties combine to move Stagnation of Qi and disperse the Wind Heat. Some acrid, cooling diaphoretics are also bitter, and the bitter property may assist the acrid in clearing Heat. For example, in Chinese medicine, Arctium seeds (niu bang ZI) can be used for acute urticaria with feverishness and sore throat.
Clear Wmd Cold Herbs with this action are commonly used in acute respiratory or other infections when chills are dominant to fever and there is pain and sensations of cold in the head, neck, or body. The warming and acrid properties combine to disperse Stagnation, Wmd, and Cold from the surface channels, and often increase or regulate sweating. For example, in Chinese medicine, Angelica dahurica (bai zhi) can be used for acute common cold with headache, sinus congestion, and sensations of cold; and fresh Zingiber (sheng jiang) can be used for acute influenza with chills and cough with copious sputum. Clear Wmd Damp The function of the acrid property in these herbs is to move Stagnation of Qi and Blood in the channels of the muscles, tendons, and joints, and to disperse the Wind and Damp associated with the Stagnation. These acrid herbs can thus be used to treat pain or restriction of movement associated with inflammation of the muscles, tendons, and joints. Some are warming, acrid herbs to disperse Wind Damp Cold, for example, Angelica pubescens (dli huo), and others are cooling, acrid herbs to disperse Wmd Damp Heat, for example, Gentiana macrophylla (qin jiao). li'ansform Phlegm and stop cough A specific aspect of the moving and dispersing function of the acrid taste is to dissolve and disperse Phlegm. l One application of this is to treat wheezing and cough. Once again, the acrid property can be used to treat patterns of either Heat or Cold:
• Pinellia (ban xia) has both the warming and acrid properties that can be used to treat cough associated with Lung Phlegm Cold
• Euphorbia helioscopia (ze qi) has both the cooling and acrid properties that can be used to treat cough or wheezing associated with Lung Phlegm Heat Open the orifices Another application of the capacity of the acrid taste to dissolve and disperse Phlegm is its ability to clear so-called insubstantial Phlegm from the channels. This can assist the aromatic property to open the orifices and revive the Spirit. Aromatic and acrid herbs have been used in Chinese medicine to treat severe acute conditions such as febrile delirium or coma from cerebrovascular accidents, for example, Secretio Moschus (she xiang). Some of these herbs have also been used to treat chronic conditions such as dizziness, deafness, mental dullness, poor memory, or disorientation, for example, Acorus (sm chang pu). li'ansform Damp In Chinese medicine, the herbs in the transform Damp group are most commonly associated with the aromatic property; but they are also acrid in taste, and nearly all are warm in temperature. These herbs are used to revive the Spleen, move Stagnation in the Spleen and Stomach, and transform Damp.
{ .. i
Taste The dispersing and moving functions of the acrid taste complement the lightening and penetrating functions of the aromatic property. Together they can counteract the heavy, deadening characteristics of Damp that can be associated with stagnation, accumulation, and obstruction. For example, Atractylodes lancea (cang zhu) is a warm, acrid, aromatic herb that can treat disorders associated with Spleen Damp, for example, loss of appetite, nausea, epigastric distension, and diarrhea. This herb is especially useful to treat Damp patterns because its aromatic property can transform Damp, its bitter taste can drain Damp downwards, and its dispersing acrid taste can assist both of these processes.
I
.~
Regulate the Qi Due to the moving and dispersing function of the acrid taste, many herbs in the regulates the Qi action category have the acrid property. Most of these herbs are acrid and warm. For example, the mature peel of Citrus reticulata (chen pi) can move Stagnation of Spleen and Stomach Qi to treat nausea with epigastric and abdominal distension. Move the Blood Many of the herbs in this action category have the acrid property, which helps them to disperse and move Blood Stagnation. Most of the acrid herbs that move the Blood are warming. An example is Ligusticum (chuan xiong), which can be used for pain in the chest, sides, or lower abdomen. However, some of the acrid herbs that move the Blood are cooling, for example, the tuber of Curcuma longa (yil jIn), which can be used for chest pain associated with Heart Stagnant Blood and Heart Phlegm Heat. Warm the Interior The acrid and warming properties tend to accentuate each other. The acrid property is moving and dispersing, and the warming property is activating and moving, and can loosen Stagnation, especially that due to Cold. The two properties can combine to produce a rapid, stimulating, and dispersing effect. Most herbs that warm the Interior also warm the Middle Burner and are specific for clearing Cold from the Spleen and Stomach. For example, dried Zingiber (gan jiang) can be used to treat vomiting, epigastric pain, or abdominal pain, when these are accompanied by sensations of cold. A few of the herbs that warm the Interior can warm and strengthen the Kidney. For example, Cinnamomum bark (roil gul) is an acrid herb that can be used for weak back, urinary frequency, and impotence with sensations of cold. These herbs may also warm and strengthen the Yang of the Heart. Tonify the Yang Some~f the herbs' iIi the tonifi~~.th~' Yang group are warming and acrid. However, these herbs are usually also sweet, bitter, or salty. In itself, the acrid taste may be quickly and temporarily stimulating, but it usually needs
43 other properties to add the slow tonic component. For example, the slower, heavier, nourishing characteristics of the sweet taste can provide a good balance to the quick, moving, and dispersing aspects of the acrid taste. For example, Eucommia (dil zhong) has both the acrid and sweet properties. The sweet taste tonifies chronic Deficiency of the ~idney and Liver, and strengthens the sinews and bones to treat weakness in the lower back and legs. The moving and dispersing function of the acrid taste assists circulation of Qi and Blood in these areas to complement the sweet tonic function. External application Many of the substances in this category have the acrid property, and some of these substances are acrid and hot, for example, camphor (zhang nilo). This herb is applied topically in sprains and trauma to reduce pain and swelling associated with Blood stasis. WESTERN HERBAL TRADITION The acrid taste has not been developed as a well-defined theoretical concept in the West as it has in China, and there is not such a clear association of specific actions with the acrid taste. The main action associated with the acrid taste in the West is the circulatory stimulant action. However, there is a wide range of Western action categories that contain herbs with the acrid taste. These are discussed in the Combining the Western and Chinese perspectives section below. Circulatory stimulants These can be defined as herbs that can stimulate or tonify heart function, improve circulation, and warm the body. Some, for example, Capsicum, can specifically increase coronary circulation; some, for example, Zanthoxylum, can specifically increase peripheral circulation; and others for example, fresh Zingiber, are specific for warming the surface of the body. BIOCHEMICAL PERSPECTIVE The acrid taste sensation is not associated with a specific type of taste receptor on the tongue. It is a more general effect, following stimulation of sensory nerve fibers in the mouth or tongue. This may be similar to the counterirritant and local analgesic effect of some acrid substances on the skin. As with the bitter taste, the acrid taste is not limited to one type of chemical. Substances with the acrid taste can be found in various groups of plant constituents, for example, monoterpenoids, phenols, amides, and isothiocyanates. However, the bitter taste sensation on the tongue is followed by a specific sequence of physiological events, but no such sequence is yet known for the acrid taste. This may be partly due to the lack of a specific taste receptor for acrid.
44
Combining Western Herbs and Chinese Medicine
As noted previously, the pharmacological effects associated with the sweet taste can be divided into different groups, each group of effects associated with a different type of chemical. For example the adaptogenic tonic function of the sweet taste can be associated mainly with triterpenoid saponins. This detailed differentiation is not yet possible for the acrid taste. Actions of acrid constituents reported by research Some of the Western actions listed in the table below as associated with the acrid taste have been reported for specific acrid constituents. However, in herbs with multiple tastes, it can be very difficult to decide which pharmacological effects can be attributed to each taste. This is especially so when a single constituent possesses more than one taste, for example, camphor can be classified as both acrid and aromatic. Capsicum is thus a useful herb for study since acrid appears to be its only appreciable taste. Both Capsicum and its main pungent constituent, the amide capsaicin, have been reported to have antimicrobial, circulatory stimulant, digestive tonic, adrenal tonic, and topical irritant and analgesic effects (see the Capsicum chapter). Zingiber is a more complex herb to study since it can be hard to separate the acrid and aromatic effects, and because it has a number of different types of pungent constituents. The following effects have been reported for Zingiber's pungent constituents, the gingerols and shogaols: cardiotonic, thermogenic (warming), digestive stimulant, antispasmodic, antiemetic, antidiarrheal, and antitussive (see the Zingiber chapter).
COMBINING WESTERN AND CHINESE PERSPECTIVES The table below shows a range of Western actions that can be associated with the acrid property along with their nearest equivalent Chinese action concept. Understanding the role of the acrid property in these different action groups gives a deeper appreciation of the nature of the acrid concept. Each action is discussed below in terms of the different aspects of the acrid property, of which the most fundamental are moving and dispersing.
• antimicrobial, alterative
clear Heat
• cooling diaphoretic
clear Wind Heat
• warming diaphoretic
clear Wind Cold
• antirheumatic, antiarthritic
clear Wind Damp
• anticatarrhal, expectorant, antitussive
transform Phlegm and stop cough
.. -~
• resuscitant. anticonvulsant
open the Orifices
• carminative
transform Damp, regulate the Qi
• antispasmodic. analgesic
move the Blood
• circulatory stimulant
warm the Interior
• tonic
tonify the Yang
• counterirritant
external application
Antimicrobial and alterative (clear Heat) In Chinese medicine, in some circumstances, the moving and dispersing functions of the acrid property can result in a cooling effect by clearing Heat of various kinds. This can apply to some Western acrid herbs in the following action categories:
LOBELIA antipyretic
clear Excess Interior Heat and Wind Heat
CAPSICUM anti-inflammatory
clear Heat associated with Interior Stagnation
THUJA antimicrobial
clear Damp Heat and Heat Toxin
PHYTOLACCA alterative
clear Damp Heat. Heat Toxin. and Retained Pathogen
Some antimicrobial and alterative acrid herbs are classified as warming, such as Capsicum and Thuja, others as cooling, such as Phytolacca, and others as variable-temperature herbs, such as Lobelia. In each case, it is the moving and dispersing functions of the acrid property that results in the clearance of Heat Diaphoretic (clear Exterior Wmd) Western herbs with the diaphoretic action, that is, inducing or increasing perspiration, can be divided into cooling diaphoretics and warming diaphoretics.
Cooling diaphoretic In herbs with this action, for example, Nepeta, the dispersing function of the acrid property can be said to assist clearance of Wind Heat. In some cooling diaphoretics, the Heat-clearing function of the bitter property assists the acrid dispersing function to remove Heat from the system. Such acrid and bitter diaphoretic herbs often also have the alterative action of clearing Retained Pathogen from the surface of the body, for example, Achillea. Warming diaphoretic Herbs that have the warming diaphoreticaction often also have the circulatory stimulant
Taste action, for example, fresh Zingiber. Both these actions are associated with the warming, stimulating, moving, and dispersing aspects of the acrid property. In the diaphoretic action, these acrid functions are active more at the surface of the body, and in the circulatory stimulant action, more in the interior. Antirheumatic and antiarthritic (clear Wmd Damp) In herbs with these actions, the moving and dispersing functions of the acrid property can be said to clear Wind and Damp, and associated Stagnation, from the channels of the muscles and joints. In some Western herbs with these actions, for example, Arctium and Phytolacca, the dispersing aspect of the acrid property can have a cooling effect by dispersing Heat. In other Western herbs with these actions, for example, Myrica and Zanthoxylum, the acrid property is combined with a warming, circulatory stimulant effect. Anticatarrhal, expectorant, and antitussive (transform Phlegm and stop cough) In Chinese medicine, the moving and dispersing functions of the acrid property can be associated with the functions of penetrating, dissolving, and dispersing Phlegm. These acrid functions can contribute to the Western anticatarrhal, expectorant, or antitussive actions. Anticatarrhals reduce excessive secretion and accumulation of mucus by the mucous membranes, wherever these may be in the body, but do not necessarily initiate the cough reflex. Expectorants have the more specific function of promoting the coughing up of phlegm, and antitussives can reduce excessive coughing. There is no exact equivalent of the anticatarrhal action in Chinese medicine. It is not the same as the action transforming Damp since the anticatarrhal action does not necessarily depend on stimulating the Spleen, but rather on a local effect on the mucous membranes. However, there may be some overlap between the two actions. In the Western herbal tradition, Sambucus is an example of a cooling acrid anticatarrhal that can be used for sinusitis, and Euphorbia hirta is a cooling acrid expectorant that can be used for bronchitis. Angelica archangelica can act as a warming acrid expectorant for cough with watery sputum or as a warming anticatarrhal for sinusitis. Lobelia is an example of an acrid antitussive herb that can be used for hot or cold conditions. . Resuscitant and anticonvulsant (open the orifices) In Chinese herbal medicine terms, the acrid functions of penetrating, dissolving, and dispersing Phlegm from the channels can complement the functions of the aromatic property of transforming Phlegm, opening the orifices, and reviving the Spirit.
In Western tradition, the acrid herbs Lobelia and Symplocarpus were components of the Antispasmodic tincture beloved of the Physiomedical and Eclectic practitioners. This combination, or Lobelia as a single herb, were given for fainting and for loss of consciousness associated with asphyxia, drowning, concussion, or apoplexy. They were also given for infantile convulsions, epilepsy, and febrile delirium. These acrid herbs can be said to combine the actions of dearing Phlegm and opening the orifices with extinguishing Wind and stopping tremors. Carminative (transform Damp and/or regulate the Qi) Herbs with this action are usually warming and are usually not only aromatic but also acrid. These tWo properties combine to regulate Qi, move Food Stagnation, and, in some cases, transform Damp and Phlegm. The digestive stimulant aspect of the carminative action may be more due to the acrid property, and the smooth muscle relaxant aspect may be more associated with the aromatic property. For example, Elettaria is a warming, acrid, aromatic herb that can be used for loss of appetite, flatulence, and intestinal colic, and can be said to regulate Qi and relax spasms. Angelica archangelica and Juniperus are aromatic and acrid herbs that can regulate Qi and, in addition, transform Damp. They can be used to treat loss of appetite and flatulence with sensations of heaviness in the limbs and body. Antispasmodic and analgesic (move the Blood) Some Western herbs that possess only the acrid taste, such as Capsicum and Lobelia, can be used as antispasmodics and analgesics both when taken internally and when used as external applications. This can be related to the acrid function of moving Qi and Blood and dispersing local areas of Blood stasis. For example, both Capsicum and Lobelia can be used for angina pectoris, postnatal pain, or local trauma. Circulatory stimulant (warm the Interior) In herbs with this action, the stimulating and moving aspects of the acrid property are associated with a strong warmirig effect. Such herbs stimulate the cardiovascular system and warm the body. This group contains the hottest herbs used internally in the West and includes Capsicum, Cinnamomum, Sanguinaria, Zanthoxylum, and Zingiber. It is interesting that Capsicum, the hottest of these herbs, has 1;leen used to equalize the distribution of heat in the body, to reduce fever or to treat certain patterns ofhypertension with sensations of heatin the head and upper body (see the Capsicum chapter). Redistribution or clearance of Heat can be associated with the dispersing function of the acrid property.
46
Combining Western Herbs and Chinese Medicine
The circulatory stimulant category has no exact equivalent in Chinese medicine, the closest category being that of herbs that warm the Interior. However, the· emphasis for most of these herbs is on warming the Spleen and improving digestion, rather than warming the Heart and improving circulation. A few of the herbs in the action category of moving the Blood can be described as circulatory stimulants in terms of Western tradition, for example, Commiphora (mb yao). However, circulatory stimulants have the specific function of strengthening coronary or peripheral circulation and warming the body. Herbs in the category of moving the Blood do not necessarily do this. Rather, they have the function of relieving pain due to Blood Stagnation, wherever it may be in the body and regardless of whether it is associated with Cold or Heat. Tonic (tonify Yang) When combined with the warming property, the acrid property is normally associated only with rapid stimulating, moving, and dispersing effects. Warming acrid herbs that also have a more gradual tonic action usually also have an additional taste. such as sweet or bitter. For example, Cinnamomum is warming, acrid, and sweet. and Turnera is warming, acrid, and bitter. However, Capsicum is a good example of a warming acrid herb that has only the acrid taste property but can have a more long-lasting tonic action in addition to its rapid stimulant effects. Counterirritant (external application) It may be that one aspect of the acrid property is its capacity to irritate the tissue and thereby initiate the natural local healing process. This can stimulate local circulation of Qi and Blood in the tissues and reduce pain and swelling due to blood stasis. Capsicum and Lobelia are examples of acrid counterirritants used in the West as topical applications for sprains and injuries.
DIRECTION OF ENERGY The function of the acrid taste is moving and dispersing and its direction of movement is outward. The acrid property is light and moving, and therefore likely to accentuate the upward movement of other light and moving energies. such as Heart Spirit and Liver Yang. It can counteract the heavy, dulling, downward effect of Damp. Acrid and wiU'lning The outward dispersing movement is accentuated if the acrid herb. is also warming. However. different acrid, warming herbs can vary greatly in their effects, as shown by. the difference between-Ephedra and Capsicum. '..,' '.'". .'0-' .• .
Ephedra This is an example of a warming. acrid herb with such a strong dispersing effect that there is the potential of loss of energy through the body surface and of depletion of
Lung and Kidney Qi. Ephedra can also accentuate irregular .: upward movement of energy and aggravate Heart Spirit Disturbance or Liver Hyperactive Yang, resulting in hypertension with sensations of heat in the upper body.
":c=:
Capsicum This is a powerful warming acrid herb with a very different effect on the movement of energy from Ephedra. Although it can have a strong dispersing effect. Capsicum does not accentuate disturbed upward movement. In fact. it tends to equalize the circulation of Qi and Blood throughout the body, so that it can be used to treat certain forms of hypertension with heat in the head and face.
TEMPERATURE Especially in the West, the acrid taste is often associated with the warming property. Certainly the moving dispersing nature of acrid is more comparable to the nature of the warming property than it is that to the nature of the cooling property. However: acrid resembles bitter in that neither of these tastes is necessarily linked to any particular temperature. Although acrid is perhaps more often associated with the warming property and bitter with the cooling, both tastes can be associated with any of the temperature categories. from hot to cold.
CAUTIONS General cautions The key function of acrid is moving and dispersing. Therefore, herbs with a strong dispersing effect of the type that can result in depletion or disturbance of energy, for example, Ephedra, are contraindicated or to be used with caution in cases with severe Deficiency of Qi or Disturbance of Spirit. However, this does not necessarily apply to acrid herbs that have a strong dispersing effect but are less likely to lead to depletion. For example, Achillea can have an acrid dispersing effect, but this is balanced by both tonic and astringent actions. . Specific cautions The specific indications of an acrid herb will depend on its temperature, its tastes, other than acrid, and its specific actions. For example, a hot acrid herb such as Capsicum would generally be contraindicated for peptic ulcers with Stomach Heat, and a cool acrid herb such as Echinacea should be used with caution for exhaustion with Deficiency and Cold in the Spleen, Stomach, and Intestines.
/.
.·Aromatic
. In the case. of the aromatic property. the sense of taste overlaps with the sense of smell. Aromatic substances are generally partially volatile at room temperature. and any
Taste effect they may have on the body may be partly via stimulation of taste receptors and partly via stimulation of olfactory receptors.
CHINESE HERBAL TRADITION The Five Element taste correspondences did not include aromatic, and in the Chinese herbal tradition, the aromatic property (xiang) was not strictly regarded as a taste.
47 substances can be used either to revive consciousness and treat coma, or to calm febrile delirium and help to reduce spasms and convulsions. Again, most of these aromatic substances also have the acrid property, which may contribute to the capacity to penetrate Phlegm. Some are warming, for example, Liquidambar resin (sii. he :dang), and others are cooling, for example, ox gallstone (nili huang).
Herbs that regulate the Qi Some of the herbs in this categoFunctions of the aromatic property The aromatic property is similar to the acrid in that it has moving and dispersing functions. However, to a greater degree than acrid, the aromatic property is considered to be lightening, penetrating, awakening, and reviving. The aromatic property is especially used when the Spleen fails to digest the food and metabolize Fluids properly, resulting in the accumulation of Damp and Phlegm. The aromatic property can:
• awaken the Spleen to transform Damp • penetrate the turbidity of Damp • lighten the effect of the heaviness of Damp on the body and the mind
• revive the Heart Spirit and open the orifices Actions associated with the aromatic property In Chinese herbal medicine, two groups of herbs are specifically associated with the aromatic property: • aromatic herbs that transform Damp • aromatic substances that open the orifices In addition, there are aromatic herbs in the category of herbs that regulate the Qi.
Aromatic herbs that transform Damp The aromatic property of these herbs awakens the Spleen to transform Damp, penetrates the turbidity of Damp, and lightens the effect of the heaviness of Damp on the digestive system and the body in general. These herbs are used to treat loss of appetite, nausea, vomiting, abdominal distension, and diarrhea when these are associated with indications of Damp, such as lethargy and sensations of heaviness and dullness in head, body, and limbs. The aromatic herbs in this group are also acrid and most of them are warm. fhese three properties combine to move Stagnation and to disperse Damp and Cold, as in, for example, Agastache (hub xiang) and Eupatorium fortunei (pei lcin).
Aromatic substances that open the orifices The aromatic property of these substances is said to penetrate the turbid Phlegm that is clouding and obstructing the sensory orifices and to revive the Heart Spirit. Phlegm can have either a dulling or a disturbing effect on the mind. Therefore, these
ry have the aromatic property and can move Stagnant Qi in the Spleen, Stomach, or Intestines to treat such complaints as belching, nausea, vomiting, and epigastric or abdominal distension and pain. A good example is the mature peel of Citrus reticulata (chen pi). Regulating Qi and transforming Damp are two actions that can have similar effects. The difference between the two is that Qi regulators are specific for intestinal spasms and pain linked to Stagnation of Qi, whilst herbs that transform Damp are specific for abdominal distension and diarrhea with lethargy and sensations of heaviness linked to Damp. The action of regulating the Qi is more connected to the moving, relaxing, and calming aspects of the aromatic property, and the action of transforming Damp is more related to awakening the Spleen and penetrating and lightening Damp. Clarifying terminology Herbs that are aromatic in smell and in property are not always classified as aromatic in the materia medica of Chinese herbs. Rather, an examination of these texts reveals that these herbs are treated as follows: 1. Some herbs are not classified as aromatic in the list of
properties for their materia medica entry, but are included in the chapter relating to aromatic herbs that transform Damp and/or the chapter relating to aromatic substances that open the orifices. For example, Agastache (huQ xiang) and Eupatorium fortunei (pei hin) are included in the Aromatic Herbs that Transform Dampness chapter in Bensky and Gamble, but are both listed only as acrid in the text of Yeung. 2. Some herbs are not classified as aromatic in the list of properties for their materia medica entry and are not included in the two 'aromatic' chapters, but are described as aromatic elsewhere in the text. For example, camphor (zhang nao) is listed only as acrid in Bensky and Gamble, and in Yeung, but is described in both books as an aromatic herb to open the orifices. 3. Some herbs are not classified as aromatic in the list of properties for their materia medica entry and are not included in the two 'aromatic' chapters. In addition, they are not described as aromatic in the text, but nevertheless, they have a strong aroma and have actions that can
Combining Western Herbs and Chinese Medicine
48
be linked to the aromatic property, for example, Angelica dahurica (bai zhI) and Ligusticum (chuan xiong). One recent text by a Chinese author has listed these herbs as aromatic in property.l
WESTERN HERBAL TRADITION Fragrant herbs are found especially in three main Western action categories: • carminatives • tranquilizers • antidepressants Carminatives Culpeper wrote that one of the herb properties that strengthens the stomach and assists digestion is the aromatic property. Carminatives can be defined as aromatic herbs that aid digestion, excite peristalsis, promote the expulsion of gas from tlle gastrointestinal tract, and relieve the pain caused by flatuleilce:These herbs are aromatic because of their relatively high content of volatile oils. Examples are: Elettaria and Pimpinella. Tranquilizers Many of the herbs used in the West to treat insomnia, calm anxiety, and relax nervous and muscular tension are rich in aromatic oils. Many of these herbs are from the family Lamiaceae, for example, Hyssopus, Lavandula, Melissa, Mentha pulegium, Nepeta, Rosmarinus, Salvia, and Thymus. Culpeper recommended Lavandula, for example, for'tremblings and passions of the heart: and Tabernaemontanus listed it for palpitations. Antidepressants Aromatic herbs have a long tradition of use for treating melancholy and lowness of mood. For example, Culpeper described the following herbs for these conditions:
• Melissa
causes the heart to become merry and drives away troublesome cares and thoughts from the mind that arise from melancholy • Rosmarinus can drive melancholy'vapours' from the heart and refresh the spirits and make them lively and active • Salvia can quicken the senses and treat lethargy in those persons who are dull and heavy of spirit
WESTERN AROMATHERAPY
and permeate the body, bringing a wonderful sense of light- .-ening and well-being. The subject feels temporarily raised above the darkness and heaviness of the clouds to where the sun is shining and the atmosphere is clear and peaceful. The tension and cares of daily life seem to fall away, allowing the soul to expand. Lonicerus and Tabernaemontanus used Lavandula, Rosmarinus, and other aromatic herbs as steam inhalations or as steam baths to treat both internal and external ailments. Culpeper described the use of two or three drops of the oil extracted from Lavandula or Rosmarinus to be taken internally or applied to the temples and nostrils. He used these oils for the physical, emotional. and mental conditions for which he recommended these herbs. He warned that these aromatic oils should be used with caution and in small amounts since their nature is very quick, piercing, and subtle. The traditions of using aromatic herbs for emotional and mental disorders. and of us~g concentrated ()~s have existed for a long time in Western herbal medicine. In recent years, aromather~py has developed and expanded these traditions, and the interest in the medical use of aromatherapy has given impetus to the isolation of individual aromatic constituents and to the study of their pharmacological effects.
BIOCHEMICAL PERSPECTIVE Aromatic substances may have their pharmacological effects by stimulating both the olfactory receptors in the nasal membranes and the taste receptors on the tongue. In addition, they may stimulate receptors in interior tissues of the body, following absorption through the nose, mouth, gut, or skin. Whilst there appear to be several different types of olfactory receptors, each sensitive to a different group of odors, there do not appear to be taste receptors that are specific for aromatic substances. However, aromatic compounds can have one or more of the main tastes, especially acrid or bitter. Three levels of the aromatic effect As with bitter compounds, aromatic constituents can be said to have three main levels of activity: • effects shared by aromatic compounds in general • effects shared by members of a particular chemical group _. effects specific to individual chemicals
'F~r ih6us~ds-ofyears;in all Cultures, the inhalation ~f
Effects shared by aromatic compounds in general For example,
fragrances has been used to change mood and state of consciousness. As a subjective experience, the fragrance of an aromatic substance can change the nature of the air itself
those aromatic substances whose scent is generally experienced as fragrant and pleasing generally have the common effect of lifting and lightening a person's mood. This effect
---
Taste may follow stimulation of a variety of types of olfactory receptors and may be mediated by the limbic system.
Effects shared by members of a particular chemical group An aromatic substance may have additional effects that are characteristic of its chemical type. This may be either by stimulation by a specific type of olfactory receptor, following inhalation of a volatile substance, or by chemical reaction within the body, following oral administration. For example, the monoterpenoid ketones, such as camphor and pulegone, may be especially linked to calming or antidepressant effects, whilst the monoterpenoid phenols, such as carvacrol and thymol, may be especially associated with the antimicrobial action. However, whilst there has been considerable speculation suggesting that each of the different groups of monoterpenoids has a different spectrum of characteristic pharmacological effects, it should be pointed out that there is very little research data to support such a clear differentiation. Effects specific to individual chemicals There can be considerable differences in pharmacological effect between monoterpenoids in the same chemical group, for example, within the monoterpenoid ketone group: • fenchone is an antitussive • valerone is a sedative • camphor can be a stimulant
COMBINING WESTERN AND CHINESE PERSPECTIVES Definition of aromatic
An aromatic herb can now be
defined in the following terms: • it is fragrant and has a relatively high essential oil content • it has one or more of the following energetic effects: dispersing, lightening, moving, opening • it has one or more of the following actions: carminative, tranquilizer, antidepressant, resuscitant Carminative There is considerable overlap between the Western concept of carminative and the Chinese concepts of aromatic herbs that transform Damp and herbs that regulate the Qi of the Spleen, Stomach, and Intestines. These concepts all deal with the treatment of digestive disorders, especially those concerned with epigastric or abdominal distension and discomfort.
I I
Carminatives and Damp The Western concept of carminative does not emphasize the clearance of Damp. However, certain aromatic herbs used in the West as carminatives can
49 be used to stimulate the Spleen and to clear Damp and Phlegm from the body. Two good examples are Angelica archangelica and Juniperus. both of which are drying in nature. These herbs can be used not only to treat flatulence and intestinal colic, but also to assist in the treatment of edema, obesity, general catarrhal conditions, and rheumatism associated with Exterior and Interior Damp and Cold.
Normalizing effect of carminatives on the gut In terms of Chinese medicine, the carminative action can be associated with the regulation of the Qi in the Spleen, Stomach, and Intestines. In terms of Western physiology, carminatives can be said to have a normalizing effect on the muscle of the gut. They can both relax intestinal spasms to normalize muscle tone and stimulate the gut to normalize peristalsis. They do not have an antispasmodic effect to the point of flaccidity, nor do they stimulate peristalsis to the point of producing spasms and pain. In fact~ carminatives can be given to counteract the griping caused by purgatives. For example, the essential oil of Cinnamomum cassia has been reported both to increase gastrointestinal secretion and to stimulate digestive action, and also to relieve intestinal spasms (see the Cinnamomum chapter). Carminative and tranquilizer effects Some aromatic herbs and herb constituents can have both an antispasmodic action on the smooth muscle of the gut and a tranquilizing effect on the central nervous system. For example, Lavandula can be used for intestinal colic and anxiety. Also, the aromatic constituents of Cinnamomum can relieve intestinal spasms and have. sedative and anticonvulsant effects. It is not yet possible to separate the mechanisms of these antispasmodic and tranquilizer effects. Tranquilizer Aromatic herbs, such as Lavandula, Mentha pulegium, and Salvia, can be used to treat both anxiety and insomnia as well as headaches and migraine. In terms of Chinese medicine, they can be said to calm Heart Spirit and Liver Yang and thus control disturbed upward movement of theQi. The mechanism of these effects can give an insight into the nature of the aromatic property. It does not control the upward movement by firming the Qi, as do sour herbs, nor by weighing it down by its heavy nature, as do sweet herbs, nor by having a sedative action on consciousness, as do some bitter constituents. Rather, by its calming and lightening nature, the aromatic property can gently relax internal tensions, and by its moving and dispersing nature, the aromatic property can dissipate the pressure of constrained energy that may contribute to the disturbed upward movement.
\
50
Combining Western Herbs and Chinese Nledicine
Antidepressant Aromatic herbs, such as Lavandula, Mentha piperita, Rosmarinus, and Thymus, can be used to treat melancholy and lowness of mood. In terms of Chinese medicine, these herbs can be said to treat depression associated with Stagnation of the Heart, Liver, or Lung Qi. They may also have a tonic effect on the Heart or Spleen that may assist in the treatment of depression associated with Deficiency, but the antidepressant effect of the aromatic property is not so much linked to this tonic effect. Rather, the aromatic property has its effect on depression by lightening heaviness, lifting mood, relaxing constraint, and calming the mental and emotional disturbance that may be associated with depression.
Aromatic and acrid The antidepressant effect of the aromatic property is different from that of the acrid. Acrid is more Yang, dynamic, stimulating, and especially more moving. It can stimulat~ the Heart to increase the driving force to move Blood through the vessels and penetrate stasis of the Qi and Blood. A good example of an acrid antidepressant is provided by Capsicum. Aromatic is more Ym, relaxing, calming' and especially, more lightening. Lavandula is a good example of an aromatic herb that can relieve depression by its lightening, relaxing, and gently dispersing effects. Normalizing the effect ofaromatics on the mind and emotions Just as aromatic herbs can have a combination of relaxant and stimulant effects on the gut, thus, normalizing its function, so they can have a combination of relaxant and stimulant effects on the central nervous system and the emotions. In fact, it is in the nature of the aromatic property to have this dual effect. The calming and relaxing nature of the aromatic property can help to treat emotional disturbance, and its lightening and dispersing nature can help to treat depression, especially when the depression is associated with either Stagnation or Disturbance of energy. Resuscitant The use of aromatic herbs as resuscitants is not common in the West, and most Western resuscitant herbs have the acrid property, for example, Lobelia and Capsicum. However, the use of aromatic herbs in the treatment of chronic emotional and mental imbalance is one of the great contributions of Western herbal medicine. In contrast, in Chinese medicine, aromatic substances are used as resuscitants to treat acute conditions of dulling of consciousness, such as apoplectic coma, or are used for acute conditions of disturbance of consciousness, such as febrile delirium or convulsions. There does not appear to be a strong Chinese tradition of using the aromatic property to treat chronic mental and emotional imbalance. Acorus (shi chang pu) is an aromatic herb that can be
\
-_ .. _-~==-.\
used for chronic forgetfulness, mental dullness, or disorientation associated with Phlegm obstructing the sensory orifices and dulling the Spirit. However, its capacity to penetrate Phlegm may be as much due to its acrid taste as to its aromatic property.
DIRECTION OF ENERGY As discussed above, both the acrid and aromatic properties have a moving, dispersing nature and an outward effect on the direction of energy movement. However, acrid is more strongly dynamic in moving Qi and Blood through the vessels and in penetrating Blood stasis or obstruction by Phlegm. Strong acrid herbs, such as Ephedra, can cause excessive outward movement so that energy is lost through the body surface, or it can cause disturbed upward movement. Aromatic herbs have a gentler moving and dispersing effect, and a more relaxing and calming effect. As a result, they can be used to reduce disturbed upward movement. They are characterized by their lighte~ing effect on the body so that they can form a natural counter to treat heaviness of mood and the effects of excessive Damp.
TEMPERATURE Aromatic herbs are mainly warm in temperature, and many of these are also acrid. The few Western aromatic herbs that are cool, such as Matricaria or Nepeta, are also to some degree bitter, and the bitter constituents may contribute to the cooling property. A number of herbs with the aromatic property are listed as variable-temperature herbs in this book and classified as warm-cool, for example, Mentha piperita. This herb is used in both Chinese and Western tradition as a cooling diaphoretic to clear Wind Heat, and this effect is associated with its acrid property. In addition, it has been used in the West since the time of Dioscoridesl 3 as a warming carminative for cold conditions of the stomach, and this effect is associated with its aromatic property. This use has continued, especially in the Spanish-speaking world, for example, in South America 14 and the Philippines. 15
::
CAUTIONS In Chinese medicine, aromatic substances that open the orifices are considered to be scattering in nature and have the potential of draining the source Qi 12. In my opinion, this does not apply to aromatic herbs used in the West as carminatives, tranquilizers, or antidepressants, such as Lavandula, Mentha, Rosmarinus, Salvia, or Thymus.
'-.l
Taste If aromatic herbs are also acrid and warming, they should be avoided in cases of Excess or Deficiency Heat unless the aromatic herbs are combined with other properties. Aromatic herbs that are warming and drying, such as Angelica archangelica, should be avoided in cases of Yin Deficiency and Dryness unless they are moderated by moistening herbs, such as Althaea or Glycyrrhiza.
51 'Effectof.taste;,cont.'·'" ......----.-- ..--------...-----.----~.::=_..::_=.:. Aromatic • lightening effect counteracts heaviness of mood or the dulling, heavy, downward effect of Damp • dispersing, relaxing, and calming effect clears constraint and stagnation, and reduces disturbed upward movement.
TEMPERATURE
Comparison summary In this summary, the following features of the taste properties are compared in table format • direction of energy • temperature • contraindications
A particular taste is not necessarily linked to a particular temperature. This is especially true of the bitter and acrid tastes. Although many bitter herbs are cooling and many acrid herbs are warming, both these taste properties can be associated with temperatures ranging from hot to cold. It depends on the individual herb. For example, Evodia (wti zhii yIi) is a hot herb with the bitter taste, and Prunella (xia kii cao) is a cold herb with the acrid taste.
DIRECTION OF ENERGY The effect of the different taste properties on the direction of energy movement is summarized in the table below. It can be seen that some tastes may have a variety of different effects. Which effect manifests in a particular situation depends on the state of the patient and on the specific chemical structure of the constituent(s) responsible for the taste.
,',
.;....
, ::.<:~-~:~=,._~~
Bitter • range from hot to cold • mainly neutral or cooling - neutral, as in some of the digestive tonics, cardiotonics, and tranquilizers
- cooling, as in some of the antimicrobials, antipyretics, anti-inflammatories, and sedatives
Effect of taste on the direction of energy movement"
Sour/astringent
Bitter • nondirectional antimicrobial, antipyretic, and antiinflammatory action • nondirectional cardiotonic action • spreads Liver Qi • normalizes the natural downward movement in the stomach and intestines • downward-directing tranquilizing action • downward-directing diuretic or purgative action
Sourjastrlngent .........-
• warm bitter herbs generally also have the acrid taste
• holds things firm, stable, and in their proper place, thus, controlling excessive outward or upward movement of energy and fluids
Sweet • maintains the movement of energy stable around the central point of balance and dampens movement toward the extremes
• mainly neutral • if the herb has both sour and bitter tastes, then it is mainly neutral or cooling • if the herb has both sour and acrid tastes, then it is mainly warming Sweet • mainly neutral • if the herb has both sweet and bitter tastes, then it is mainly neutral or cooling • if the herb has both sweet and acrid tastes, then it is mainly warming Acrid • ranges from hot to cold • most are warming, some are variable-temperature (warm-cool), and some are cooling Aromatic
• weighs down excessive or disturbed upward movement
• mainly warm in temperature and these are usually aromatic and acrid
• reduces excessive outward dispersing movement of energy
• the few that are cool are aromatic and bitter
Acrid
.
• increases movement of Qi and Blood through the vessels • disperses energy outward • accentuates upward movement of other light and moving energies, such as Heart Spirit and liver Yang • counteracts the heavy, dulling, downward effect of Damp
CAUTIONS It is important to remember that cautions or contraindications for a particular taste may depend more on the temperature of a particular herb with that taste, than on the taste property itself.
52
Combining Western Herbs and Chinese Medicine In some cases the contraindications for one taste can be overcome by utilizing the moderating effects of another taste property; this topic is dealt with in the next section.
Bitter • warm or hot bitter herbs are generally contraindicated for Heat patterns • cool or cold bitter herbs are generally contraindicated for Cold Deficient patterns of the Spleen and Stomach, especially with diarrhea • some texts contraindicate certain bitter herbs for gastric ulceration or hyperacidity since they may increase the gastric acid secretion, but see the discussion in the Toxicology section of the Gentiana chapter
Sour/astringent • Exterior conditions that are not fully cleared, including skin rashes that are in the process of expressing • during a treatment to clear toxins from the body via sweat, urine, stools, or discharge • Interior Stagnation, including Stagnation with Damp, and, in the case of warm astringents, Interior Stagnation with Heat • long-term use of herbs with high tannin content; see the Toxicology section in the Potentilla chapter
Sweet • Exterior Excess • Interior Stagnation • Damp • Phlegm • therefore, to be used with caution in cases of sensations of heaviness, feelings of lethargy and depression, mental heaviness and dullness, digestive stagnation, loss of appetite, nausea, bloating, weight gain, and catarrhal conditions
Acrid • herbs with a strong dispersing effect, of the type that can result in depletion or disturbance of energy, such as Ephedra, are contraindicated in cases with severe Deficiency of Qi or Disturbance of Spirit
Aromatic • aromatic substances that open the orifices are considered to be scattering in nature and have the potential to drain the source Qi • aromatic herbs that are also acrid and warming should be used with caution in cases of Excess or Deficiency Heat • aromatic herbs that are warming and drying should be used with caution in cases of Yin Deficiency and Dryness
TASTE + COMBINATION
+ sour/astringent (support)
Balancing the tastes Each taste has its specific range of uses and its specific disadvantages. Tastes can be combined so that one taste can support the beneficial effects of another to maximize the clinical effectiveness or moderate the potential adverse effects of another to minimize side effects. As an example of support, the warming and moving aspects of the acrid taste can support the digestive tonic aspect of the bitter taste. As an example of moderation, the aromatic function to revive the Spleen and transform Damp can moderate the potential adverse effect of sweet tonics to produce Stagnation and Damp. Optimizing the balance of the taste properties can be an important part of creating effective herb combinations. An example of taste balancing is given in the Taste section in the chapter Principles ofherb combination. In balancing the tastes, it is possible either to pick one herb with both the required tastes or to pick two herbs, each with one of the required tastes. For example, if bitter and acrid are required to stimulate digestion, either Rosmarinus can be selected, which has both tastes, or bitter Gentiana can be combined with a suitable amount of acrid Capsicum.
:-,
'I 1 ,-,.,1
f:"l
. I
-~ """""
._~
Note The term support is used here in a general sense to indicate the strengthening of the effect of one action by another. Support could be by the specific processes of either complementarity or emphasis, but this differentiation is not made in this section. Complementarity and emphasis are described in the Principles ofherb combination chapter. ~-.
BALANCING TASTES TABLE For each taste, shown in upper case in a gray bar in the left-hand column, a description of its support or moderation by each of the other four tastes is given with a herb example. The Taste aspect column lists which specific aspect of the main taste is being supported or moderated. For example, for the bitter taste, this column shows whether it is the digestive tonic, tranquilizer, and cardiotonic, hepatobiliary, or purgative aspect that is under discussion.
TASTE ASPECT
DESCRIPTION
HERB EXAMPLES
bitter digestive tonic
the sour/astringent property can enhance the digestive tonic aspect of bitter by maintaining the Integrity of the gut wall
bitter Gentiana combines with sour astringent Agrimonia to treat weak digestion with malabsorption
Taste TASTE + COMBINATION
TASTE ASPECT
DESCRIPTlON
53 HERB EXAMPLES , '.'-'."':"=::-:::!
•
~~~4'!':
BITTER, CaNT. bitter tranquilizer
the sour/astringent property can support the tranquilizer aspect of bitter by firming the energy of the Heart to stabilize the emotions
bitter Passiflora combines with sour astringent Schisandra to treat difficulty in concentration with fearful anxiety
bitter cardiotonic
the sweet property can support the cardiotonic aspect of bitter by nourishing the Heart
bitter Convallaria combines with sweet Glycyrrhiza to treat exhaustion from cardiac weakness
bitter tranquilizer
the heaviness of the sweet property can support the tranquilizer aspect of bitter by weighing down irregular upward movement of energy
bitter Valeriana combines with sweet Glycyrrhiza to treat anxiety, restlessness, and headache
bitter digestive tonic
the sweet property can reduce gastric irritation from excessive secretion of gastric acid resulting from gastric stimulation by bitter herbs
bitter Cinchona combines with sweet demulcent Althaea to reduce the possibility of gastric irritation
bitter digestive tonic
the acrid property can support the digestive tonic aspect of bitter by warming and moving the Qi of the Spleen, Stomach, and Intestines
bitter Gentiana combines with acrid Capsicum to treat weak digestion with sensation of cold in the epigastrium
bitter hepatobiliary anti-inflammatory
the warming acrid properties can moderate potential adverse effects of the cooling bitter properties on the Spleen
cooling bitter Berberis combines with warming acrid Zingiber to reduce the possibility of impaired digestion and absorption
bitter tranquilizer
the aromatic property can complement the tranquilizer aspect of bitter by its lightening, dispersing, relaxing, and calming functions
bitter Anemone combines with aromatic Mentha pulegium to treat anxiety and headache with feelings of desperation
bitter purgative
the relaxing function of the aromatic property can moderate the potential purgative aspect of bitter to produce intestinal spasms
bitter Rheum can be combined with aromatic Foeniculum to reduce the possibility of intestinal colic
reduce leakage of fluids
the cooling and bitter properties can support the sour astringent property in cases of leakage associated with Heat
neutral astringent Quercus can be combined with cool bitter Hydrastis to treat diarrhea with sensations of buming on defecation
stabilize emotions
the sweet property can nourish the Heart and weigh down disturbed upward movement of energy to support the stabilization of emotions by sour
sour Hypericum combines with sweet Avena to treat nervous exhaustion with emotional lability
reduce leakage of fluids
the demulcent sweet property can moderate the potentially irritating effect of tannin-containing astringents on the gut wall
sour Potentilla combines with sweet demulcent Althaea to treat diarrhea with colitis
(support)
reduce leakage of fluids
the warming and acrid properties can support the sour astringent property in cases of leakage associated with Cold
sour Geranium combines with acrid Myrica to treat diarrhea with sensations of cold in the abdomen
+ aromatic
stabilize emotions
the calming and relaxing functions of the aromatic property can support the sour astringent function to firm and stabilize the Heart Spirit
sour Hypericum combines with aromatic Mentha pulegium to treat daytime anxiety and enuresis with nocturnal terrors
+ sour/astringent (support)
+ sweet (support)
(moderate)
+ acrid (support)
(moderate)
+ aromatic (support)
(moderate)
SOUR. + bitter (support)
+ sweet (support)
(moderate)
+ acrid
--
I
r
(support)
54
Combining Western Herbs and Chinese Medicine
TASTE + COMBINATION
TASTE ASPECT
DESCRIPTION
HERB EXAMPLES
sweet nutrient tonic
the digestive tonic aspect of bitter can supPOrt the uptake and utilization of the sweet tonic, thus enhancing the tonification of Qi and Blood
sweet nutrient molasses combines with bitter Gentiana to treat poor appetite with weight loss and anemia
sweet demulcent
the anti-inflammatory and antimicrobial aspects of bitter can complement the sweet demulcent action
sweet demulcent Althaea combines with bitter Arctostaphylos to treat cystitis with infection and burning sensation on urination
sweet demulcent
the wound healing and hemostatic effects of astringency can complement the sweet demulcent anti-inflammatory effect
sweet demulcent Althaea combines with sour Capsella to treat peptic ulceration with bleeding
sweet adaptogenic
the warming, moving, acrid effects complement the sweet adaptogenic effects to treat hypofunction while maintaining homeostasis
sweet Panax ginseng combines with acrid Cinnamomum bark to treat reduced stamina with sensations of cold
sweet immunoregulator
the dispersing acrid function of clearing Retained Pathogens complements the immuneregulatory aspect of sweet to strengthen Defensive Qi
sweet Echinacea combines with acrid Achillea to treat recurring respiratory conditions with fever
sweet nutrient tonic
the moving nature of acrid can moderate the tendency of sweet to produce digestive stagnation
sweet Serenoa combines with acrid Capsicum to treat debility with poor appetite, lethargy, abdominal sensations of fullness and cold
sweet nutrient tonic
the aromatic function to revive the Spleen and transform Damp can moderate the tendency of sweet to produce fat and mucus
sweet Ziziphus fruit combines with aromatic Citrus to treat debility in persons with tendency to weight gain and chronic sinusitis
acrid diaphoretic
the cooling and bitter properties can help the dispersing nature of acrid to clear Wind Heat from the body surface
acrid Sambucus combines with bitter Achillea to treat influenza with fever
(support)
acrid circulatory stimulant
the sour function of tonifying the liver can support the acrid function of moving Stagnation and dispersing Damp and Phlegm
acrid Zanthoxylum combines with sour Myrica to treat sluggish liver function with lethargy and sensations of heavi· ness and cold
(moderate)
acrid diaphoretic
the sour astringent property to hold fluids and energy in the body can moderate the excessive loss of energy by the dispersing function of acrid
acrid Ephedra combines with astringent Schisandra to reduce possible excessive sweating and weakening of Defensive Qi
acrid metabolic stimulant
the steadying, slowing aspects of the sweet property can convert the rapid, stimulant effect of acrid to a more moderate and sus· talned tonic action
acrid Cinnamomum bark combines with sweet Serenoa to treat exhaustion with emaciation and sensations of cold
acrid stimulant antidepressant
the gentle dispersing, calming, and relaxing nature of the aromatic property can moderate the rapid, stimulant, acrid antidepressant effect
acrid and stimulant Rosmarinus combines with more aromatic and calming Lavandula to treat depression with nervous tension
SWEET
+ bitter (support)
(support)
+ sour (support)
+ acrid (support)
(moderate)
+ aromatic (moderate)
ACRID
+ bitter (support)
+ sour
+ sweet (moderate)
+ aromatic (moderate)
_t:.-,
Taste TASTE + COMBINATION
55
TASTE ASPECT
DESCRIPTION
HERB EXAMPLES
aromatic carminative
bitter stimulates secretion of gastrointestinal enzymes and bile to complement the aromatic stimulation of appetite and peristalsis
aromatic Mentha piperita combines with bitter Gentiana to treat weak digestion with loss of appetite. abdominal distension and flatulence
aromatic antidepressant
the sour astringent function of firming and stabilizing the emotions complements and moderates the moving. lightening, and antidepressant functions of the aromatic property
sour astringent Schisandra combines with aromatic Lavandula to treat emotional lability with depression and emotional constraint
aromatic tranquilizer
the tonic aspect of sweet can nourish the Heart and Liver. thus helping to calm the Spirit and Yang, and complement the relaxing aspect of aromatic
aromatic Lavandula combines with sweet Ziziphus to treat nervous headache associated with Deficient Qi and Blood
aromatic anticatarrtlal
acrid can penetrate and move the Phlegm and complement the aromatic function of transforming Damp and Phlegm
aromatic Thymus combines with acrid Thuja to treat catarrhal obstruction of the respiratory and urogenital system
AROMATIC
+ bitter (support)
+ sour (moderate)
+ sweet (support)
+ acrid (support)
References .....
1. Yang Yi-fan. Chinese Herbal Medicines. Churchill Livingstone, Edinburgh, United Kingdom (2002)
9. Lonicerus A. Kreuterbuch (1679). Reprinted by Verlag Konrad K6lbl, Munchen, Germany (1962)
2. Yeung H-C. Handbook of Chinese Herbs and Formul~s, vol. 1. Institute of Chinese Medicine, Los Angeles, California (1985)
10. Gerard J. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publications, New York. New York (1975)
3. Felter HW, lloyd JU. King's American Dispensatory, vols. I and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications. Sandy. Oregon (1983) 4. Ellingwood F. American Materia Medica. Therapeutics and Pharmacognosy, 11th edn. (1919). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1994) 5. Christopher JR. School of Natural Healing. BiWorld, Provo, Utah (1976) 6. Weiss RF. Herbal Medicine, English edn. Beaconsfield Publishers. Beaconsfield, United Kingdom (1988) 7. Mills S. Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone, Edinburgh, United Kingdom (2000) 8. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks, Glenwood. Illinois (1990)
11. Tabernaemontanus IT. Krauterbuch (1731). Reprinted by Verlag Konrad K6lbl, Miinchen, Germany (1993) 12. Bensky D, Gamble A. Chinese Herbal Medicine Materia Medica. Eastland Press, Seart!.e, Washington (1986) 13. Grieve M. A Mod= Herbal, vols. 1 and 2. Dover Publications. New York, New York (1971) 14. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983) 15. Dioscorides P. Kreutterbuch (1610). Reprinted by Verlag Konrad K61bl. Munchen, Germany (1960) 16. Bejar E et al (eds). Herbs of Southern Ecuador. LH PreSS, Spring Valley, California (2001) 17. Pardo de Tavera TH. Plantas Medicinales de Philipinas. Ayala Foundation, Makati City. Phillipines (2000)
.-~.
Actions· herb can be defined as the types of therapeutic effects it has on the body. This is in contrast to the uses or indications of a herb, which refer to the disorders it can be used to treat. An indication refers to a practical result, whilst an action refers to the process by which that
T
to tonify the intestines and move the stool, and a herb with a tonic laxative action can be chosen, such as Turnera • constipation with dryness principles of treatment are to moisten the intestines and move the stool, and a herb with a moistening laxative action can be chosen, such as Linum (flaxseeds) • constipation with excessive heat principles of treatment are to clear the heat and move the stool, and a herb with a cooling purgative action can be chosen, such as Rheum
HE ACTIONS OF A
result is achieved.
Action concept
,
1-
Actions can be regarded as the bridge between theory and practice. They link the theoretical concepts of etiology, pathology, syndrome classification, principles of treatment, and principles of herb choice with the practical end resultthe treatment of a particular disorder.
ACTIONS REFLECT THE MEDICAL PARADIGM
EXAMPLE If a patient has constipation, for example, the simplest approach would be to bypass the action concept and pick any herb that has constipation as one of its indications. However, the problem with this simplistic approach is that constipation, like most other disorders, may have a variety of etiologies and pathologies and may be associated with various different syndromes. In the theory of traditional Western phytotherapy, for example, constipation may be associated with weakness, dryness, or excessive heat in the intestines and in the body as a whole. The principles of treatment and the herb action . chosen will depend on the specific syndrome as follows:
i
• constipation with weakness principles of treatment are
57
The names of some action categories simply refer to a practical therapeutic effect without implying the mechanism by which this effect is achieved and without linking the action to the theoretical concepts of the medical paradigm. For example, the word 'diuretic' simply refers to the therapeutic effect of increasing urination. However, the names of many action categories reflect the underlying philosophy and theoretical principles of the medical paradigm to which they belong. Often, general categories, such as diuretic, diaphoretic, and tonie, are divided into more specific subcategories. In each of these, the action name is preceded by a qualifying word that implies the action mechanism and links the action concept to the theories of the specific paradigm. Thi~ is shown in the following examples, in which the qualifyIDg word has been put in italics:
Combining Western Herbs and Chinese Medicine
58
• in conventional medicine, the general category of diuretics is divided into such categories as osmotic diuretics or thiazide diuretics, according to the proposed physiological or biochemical mechanism • in Western Physiomedical tradition, the general category of diaphoretics is divided into stimulating diaphoretics and relaxing diaphoretics, according to the Physiomedical theory of stimulation and relaxation • in Chinese herbal tradition, the general category of tonics is divided into Qi tonics, Blood tonics, Yin tonics, and Yang tonics, according to Chinese theories of Qi and Blood and Yin and Yang ACTIONS, PROPERTIES, AND ORGAN SYNDROMES Actions and properties In the herbal traditions, some action categories have names that do not include reference to either temperature or taste, as in the action names 'purgative' or 'drain Damp: However, other action categories have names that link the concepts of action, temperature, and taste, as in the term 'warming acrid herbs that release the Exterior:
from the liver or the Chinese action concept of tonifying Spleen Qi. The evolution of action concepts that refer to organ systems or specific organ syndromes is briefly discussed in the History chapter.
Classification ofherbs by action Herbs can be organized into groups according to their action. The table below shows some of the main action groups from Western herbal medicine, together with their approximate Chinese action equivalent. However, there is never a complete equivalence between the action categories of different paradigms. For example, there is no exact Chinese equivalent of the Western anticatarrhal action category, and there is no exact Western equivalent of the Chinese transform Damp action category. The equivalents shown in the table are only approximations, and the reader is· referred to the Action glossary chapter for a more detailed discussion of Western and Chinese equiva-
Actions and organ syndromes In the herbal traditions, some action categories refer to therapeutic effects on a particular organ system, for example, the action categories of circulatory stimulant and digestive tonic. Other action categories refer to the treatment of a specific organ syndrome, for example, the old Western action concept of clearing heat
Diaphoretic
.
lents. How the modern herbal action categories evolved in the West, from the time of Dioscorides in the 1st century AD to the present day, is discussed in the History chapter. ACTIONS AS A CRITERION OF HERB CHOICE Herbs are described and classified by their actions so that the appropriate herbs can be selected to treat a specific
clear the surface disperse Wind Cold disperse Wind Heat
Zingiber (fresh) Sambucus
Antirheumatic, antiarthritic
disperse Wind Damp
Angelica archangelica
Antipyretic, etc.
clear Heat clear Heat clear Damp Heat and Heat Toxins clear Heat and Damp Heat clear Damp Heat and Heat Toxins
Asclepias Baptisia Filipendula Taraxacum (root)
laxative, purgative
drain Downwards
Rheum
Diuretic
drain Damp
Parietaria
Carminative
transform Damp or regulate Qi
warming diaphoretic cooling diaphoretic
antipyretic antimicrobial anti-inflammatory alterative
transform Damp regulate the Qi of the Stomach and Intestines
Expectorant, etc. expectorant antitussive anticatarrhal
transform Phlegm and stop cough transform Phlegm stop cough no exact Chinese equivalent
Juniperus Citrus aurimtium
Euphorbia hirta Prunus serotina Hydrastis
-" Actions
59
Antispasmodic antiasthmatic
regulate Q; regulate Lung Qi
Ephedra
Analgesic antianginal
move the Blood move Heart Blood and relieve pain
Crataegus
Emmenagogue tonic emmenagogue hormonal emmenagogue stimulant/antispasmodic emmenagogue
tonity and regulate the Uterus* tonify the Uterus regulate Uver Qi move Uterus Qi and Blood
Chamaelirium Vitex Leonurus
Circulatory stimulant
warm the Interior
Capsicum
Tonic general tonic
tonitying herbs tonify Qi tonify Blood tonify Yin and Auids tonify Yang • tonify Spleen and Stomach Qi tonify Heart Qi
Glycyrrhiza molasses Althaea Turnera Gentiana Convallaria
Astringent antidiarrheal antihemorrhagic
stabilize and bind, stop bleeding stabilize and bind stop bleeding
Geranium Vinca
Nervlneand sedative nervine tranquilizer, sedative
calm the Spirit nourish the Spirit settle and calm the Spirit
Avena Valeriana
Anticonvulsant, etc. antispasmodic, anticonvulsant antimigraine agent
extinguish Wind and stop tremors extinguish Wind and stops tremors calm Uver Yang
Lobelia Tanacetum
Resuscitant, anticonvulsant
(aromatic substances that) open the orifices
Acorus
Antihelmlntic
expel parasites
Artemisia absinthium
Topical
external use
Calendula
moistening and demulcent tonic antidepressant, aphrodisiac digestive tonic cardiotonic
* The action category of herbs that tonify and regulate the Uterus is not standard to Chinese convention and has only been inserted in the table to give a Chinese approximation to the corresponding Western action.
condition. However, actions are not the sole criterion of herb choice. The chapter Principles of herb combination describes how herbs are combined according to considerations of action, temperature, taste, and organ syndromes.
Working with actions The following basic concepts are fundamental to working with herb actions in the clinic: • range of potential actions • normalizing actions • action groups . • primary and secondary actions
RANGE OF POTENTIAL ACTIONS Usually, herbs do not have just one action. Rather, they have a range of potential actions. For example, Achillea can
have nine or more different actions, among them the antipyretic, anticatarrhal, alterative, bitter digestive tonic, and diaphoretic actions (see the discussion in the Achillea chapter). Which of these actions manifest in a particular situation may depend on the patient's condition. For example, the antipyretic action is absent or minimal unless there is a fever.
NORMALIZING ACTIONS Some individual herbs can have two actions that are apparently opposite in their effects. For example, Lobelia can have a stimulant or relaxant action on the smooth muscles of the bronchi, intestines, or uterus, depending on the initial state of the patient (see the detailed discussion in the Lobelia chapter). Rather than descnbe such herbs as either stimulant or relaxant, it might be more accurate to descnbe them as having a normalizing or regulatory action. Other examples are Crataegus, which can normalize either hyper- or hypo-
-
Combining Western Herbs and Chinese Medicine
60
.
/~I
:r:~~t,
tension, and Lavandula, which can have either a calming or an antidepressant action. depending on the patient's state.
ACTION GROUPS
the herb or herbs with that action can be used in higher __ ~ o.,£'';;;: doses than herbs with secondary actions. For example, in the combinations discussed in this book, nerbs with the desired primary actions are often used at t\-vice the dose of herbs with secondary actions, assuming that the herbs are of equal potency (see the section Factors affecting dose in the Dose
.-_.~-
VYhen a herb has more than one action. some of these actions may work together in groups to meet the needs of the situation. For example. Achillea can be used to treat recurring fever, in which case the diaphoretic action can work together with the antipyretic and alterative actions. The diaphoretic action increases sweating and can clear Wmd Heat from the Exterior, the antipyretic action can help to clear Excess or Deficiency Heat from the Interior, and the alterative action can clear Retained Pathogen from the body to prevent recurrence of febrile episodes. (These action groups are discussed in greater detail in the Achillea chapter.)
chapter).
Action contraindications There are situations in which specific herb actions are contraindicated or need to be applied with caution. Whether or not an action is contraindicated in a particular situation depends not only on the action itself, but also on the specific characteristics of the individual herb. These characteristics include the strength of the action for the particular herb, and the properties of temperature and taste.
PRiMARY AND SECONDARY ACTIONS Four factors determine which actions are of primary and which of secondary importance in any given situation: • the herb itself • the context of a specific patient's condition • the context of a specific herb combination • the dose The herb itself If a herb has multiple actions, some of these are usually regarded as more important than others. In the case of Achillea, for example, the diaphoretic action is generally regarded as of primary importance and the bitter digestive tonic action is regarded as secondary. Therefore, Achillea is more commonly used to treat respiratory infections with fever and chills than it is to treat digestive weakness. The context of a specific patient's condition The state of the patient's health plays an important role in determining which actions of a particular herb are dominant. For example, if Achillea is used in a case in which digestive weakness is severe and feverishness only mild, the bitter digestive tonic action is likely to be of primary importance and the diaphoretic action of secondary importance. The context of a specific herb combination VVhich actions are dominant for a particular herb depends upon the herbs with which it is combined. For example, the bitter digestive tonic action of Achillea is generally regarded as secondary. However, if Achillea is combined with other herbs for which
this action is prim;u-y, such as~i#}}~e~~~~thi~;~~d Gentiana, the bitter digestive tonic action. of. Achillea can - fi' . - ' , ' become of primary importance. Dose
If an action is required to be of primary importance,
STRENGTH An action may not be contraindicated in itself, but only when it is particularly strong. For example, Iris has mild purgative action and is appropriate for constipation in weak patients, whilst Cassia fruit (senna) has much stronger purgative action, and may in some circumstances be contraindicated for weak patients.
TEMPERATURE If a specific action category is required in a particular case, it is important to match the temperature value of a herb with this action to the temperature requirements of the patient. For example, tonics are generally appropriate to treat conditions of Deficiency, but a warming tonic is generally contraindicated for hot patterns, such as Deficient Yin with Deficiency Heat. This situation requires a cooling tonic. However, a warming tonic may, in certain cases, be used in a mixed temperature situation, if it is used in relatively small amounts, and its warming effects are balanced and moderated by the other herbs in the combination (see
Temperature chapter). TASTE If a specific action category has been selected. it may be necessary to match the taste value of a herb with this action to the requirements of the patient and to the taste balance requirements of the herb combination. For example, a sweet tonic may be contraindicated in a case of digestive weakness and general debility if this occurs
.. '
,":~.,..
,..."lI~"
-:,.2~
Actions
61
the potential adverse effects of another herb to minimize side effects.
with obesity, lethargy, and abdominal distension from Spleen Qi Deficiency with Qi Stagnation, Damp, and Phlegm. In this situation, a tonic herb with acrid, aromatic, and bitter taste properties would be more appropriate. However, a sweet tonic may be appropriate in some cases of this kind, if it is used in relatively small amounts, and if its potential for aggravating Qi Stagnation and accumulation of Damp and Phlegm is balanced and moderated by the other herbs in the combination (see Taste chapter).
Support For example, the circulatory stimulant action can support the diaphoretic action, resulting in increased perspiration. Either a herb with both these actions, such as Zingiber, can be chosen, or a herb with diaphoretic action, such as Achillea, can be combined with a herb with circulatory stimulant action, such as Capsicum.
Note The term 'support' is used here in a general sense to indicate the strengthening of the effect of one action by another herb. Support could be by the specific processes of either complementarity or emphasis, but this differentiation is not made in this section. Complementarity and emphasis are described in the chapter on Principles of herb combina-
MINIMIZING POTENTIAL SIDE EFFECTS In many cases, the potential side effects of a particular action can be avoided or reduced by the moderating effect of another action. For each action listed in the Balancing actions table below, an example is given of a second action that can moderate the side effects of the first action. This information can be great value in the clinic.
tion. Moderation For example, the antispasmodic action can moderate the tendency of the purgative action to produce intestinal spasms as a side effect. For example, Rheum can be combined with Foeniculum so that the purgative action of Rheum is moderated by the antispasmodic action of Foeniculum.
Balancing actions in a herb combination Some actions usefully complement each other's effects, whilst other actions work in opposition. In designing a balanced herb combination, actions can be combined so that one action can support the beneficial effects of another action to maximize their clinical effectiveness or moderate
BALANCING ACTIONS TABLE For each action shown in the left-hand column, a description of its support or moderation by additional actions is given with a herb example.
~
Action
Additional actions .. .
Description...'..
Herb example
anticatarrhal
assists in the clearance of toxins by reducing excessive accumulation of mucus
Hydrastis
circulatory stimulant
assists in the clearance of toxins by increasing circulation and clearing obstructions
Myrica
detoxicant
reduces adverse effects of accumulated toxins released by alteratives
Glycyrrhiza
demulcent
soothes inflammation due to accumulated toxins released by alteratives
Viola
'
Alterative (support)
.....
~-
(moderate)
Analgesic (support)
(moderate)
.....................................•.•................................................................ antispasmodic
reduces muscle spasms that are contributing to the pain or resulting from it
Viburnum
tranquilizer
calms nervous tension that is aggravating pain or resulting from it
Anemone
nervine tonic
treats the mental and physical exhaustion associated with chronic pain
Avena
circulatory stimulant
moderates the potential depressing effect of a sedative analgesic action on metabolism
Rosmarinus
62
1,
Combining Western Herbs and Chinese Medicine
Antiarthritic (support)
(moderate)
Anticatarrhal (support)
(moderate)
Antidepressant (support)
(moderate)
Antihypertensive (support)
(moderate)
diaphoretic
treats the effects of exposure to wind and damp, eliminates toxins from the body in the sweat
Zingiber
cirCUlatory stimulant
increases circulation and clears obstruction, stimulates clearance of toxins
Zanthoxylum
anti-inflammatory, analgesic, antipyretic
relieves pain and swelling, treats acute febrile episodes
Populus
alterative
clears toxins from the joints and assists in the detoxification of the liver, reducing inflammation
Taraxacum
tonic
treats the anemia resulting from gastric irritation by antiinflammatory drugs
Gentiana
detoxicant
assists in the detoxification, reducing inflammation from toxins released by antiarthritics
. Glycyrrhiza
............................................................................................................................................................................................................. stimulates local circulation, reduces local inflammation, reduces mucus accumulation
Capsicum
circUlatory stimulant
stimulates circulation, thereby stimulating clearance of toxins and obstructing phlegm
Zanthoxylum
carminative
stimulates the digestion, reduces the formation of phlegm
Angelica arc.
alterative
clears toxins and pathogens that are causing excessive mucus secretion
Thuja
demulcent
moderates the tendency of some anticatarrhals to dry the mucus membranes
Polygonum
. ',' counterirritant
...•...............•..•..•...............................•.............................................. circulatory stimulant
supports the antidepressant effect by stimulating the heart and circulation
Capsicum
tonic
makes the stimulant antidepressant effect more gradual, stable, and sustained
Serenoa
tranquilizer
moderates potential for overstimulation
Passiflora
........................•....•.•..•.•......•............................................................ antiatheromatic, antilipidemic
assists in the treatment of hypertension due to hyperlipidemia and atheroma
Commiphora
tranquilizer, sedative
assists in the treatment of hypertension associated with nervous tension
Valeriana
antispasmodic, anticonvulsant
assists in the treatment of hypertension associated with muscular spasms or apoplexy
Lobelia
antimigraine
treats the hypertension associated with headaches or migraines
Lavandula
nervine
treats the hypertension associated with physical and' nervous debility
Viscum
cardioregulator' ,. , .
normalizes blood pressure, reducing the possibility of hypotension or blood pressure oscillations
Crataegus
circulatory stimulant
normalizes blood pressure, reducing the possibility of hypotension from sedative antihypertensives
Capsicum
Actions
63
Anti-inflammatory (support)
(moderate)
antiallergic
assists in the treatment of inflammatory disorders with an allergic component
Ephedra
antimicrobial
assists in the treatment of inflammatory disorders with infection
Arctostaphylos
astringent
assists in the healing of inflamed mucosa. reduces discharge or bleeding from the inflammation
Hamamelis
demulcent
moistens and soothes dry, inflamed mucosa
Althaea
analgesic
assists in the treatment of pain associated with inflammatory disorders
Salix
tonic
assists in the treatment of inflammation associated with systemic weakness
Glycyrrhiza
warming carminative
moderates potential weakening effects on digestive system of anti-inflammatory herbs with cooling effect
Zingiber
......•............................... •............. .................................................. ~~
Antispasmodic (support)
(moderate)
tranquilizer. sedative
treats spasms associated with nervous tension or fear
Anemone
nervine tonic
treats mental and physical exhaustion due to chronic pain
Avena
circulatory stimulant
moderates potential depressing effect on metabolism of antispasmodic herbs with sedative action
Rosmarinus
........................................................................................................ Antitussive (support)
(moderate)
Astringent (support)
(moderate)
expectorant
facilitates the expectoration to relieve nonproductive cough with sticky mucus
Marrubium
anticatarrhal
reduces the excessive secretion and accumulation of mucus
Thymus
demulcent
moistens and soothes inflamed mucosa, thereby facilitating expectoration
Viola
antispasmodic
reduces excessive bronchial spasms that may inhibit expectoration
tranquilizer
calming effect supports an antitussive action. especially in nervous coughs
Prunus
circulatory stimulant
moderates the dulling of consciousness from sedative antitussives
Zingiber
carminative
moderates digestive stagnation and increased mucus due to moistening demulcent antitussives
Pimpinella
. Lobelia
......................................................................................................... . Achillea
tonic
normalizes cell permeability and increases muscle tone to reduce leakage and prolapse
anti-inflammatory
reduces discharge by reducing inflammation
Hydrastis
anticatarrhal
reduces discharge by reducing excessive mucus secretion
Myrica
antimicrobial alterative
reduces discharge and treats diarrhea by destroying microorganisms and clearing toxins
Berberis
demulcent
reduces potential irritant effect of tannin astringents
Althaea
Combining Western Herbs and Chinese Medicine
64
Bitter digestive (support)
(moderate)
Carminative (support)
(moderate)
circulatory stimulant
stimulates and speeds digestion. especially if there is Stagnation of Qi from Cold
Capsicum
astringent
can normalize gut permeability to complement stimulation of the digestion by bitters
Agrimonia
demulcent
moderates any potential irritant effect from stimulation of gastric acid secretion by bitters
Althaea
......••.•...•.....................•...............•••......•.............•............................. cirCUlatory stimulant
supports a stimulant effect on digestion and peristalsis. reduces Stagnation of Qi from Cold
Capsicum
bitter digestive
supports the stimulation of the appetite and peristalsis
Rosmarinus
antispasmodic
supports a relaxing effect on gut spasms
Lobelia
moistening sweet tonic
moderates any potential drying effect from anticatarrhal or diuretic carminatives
Glycyrrhiza
....•...........•.•................................... ..........................................• Circulatory stimulant (support)
cardiotonic
provides a gradual and sustained energy increase to complement the stimulation of the circulation
Cinchona
(moderate)
demulcent
counteracts the tendency of some acrid circulatory stimulants to irritate the gastric mucosa
Glycyrrhiza
Demulcent
• • • • • • • • • • • • " . " . " . " . " •• " . " . " •• " .""" fit" " """"""
analgesic anti-inflammatory
complements the anti-inflammatory action of demulcents
Filipendula
(moderate)
carminative
counteracts the digestive stagnation and increased mucus from sweet, moistening demulcents
Citrus
(support)
(moderate)
Diuretic (support)
(moderate)
.
a""" """"."" """ " " """. """,,"" """"""""""""""""""""."""""""""" •• "
(support)
Diaphoretic
~
'""""""""""""""""""" """""""""""" " " """""""."""" , "" "" """" "
..
.
"" " " ",," "" ",,"" ""
circulatory stimulant
stimulates peripheral circulation, supports diaphoresis and the clearance of toxins
Capsicum
anticatarrhal
reduces excessive secretion and accumulation of mucus in respiratory infections
Sambucus
antipyretic
reduces fever and lowers the body temperature
Nepeta
alterative
eliminates toxins from the body in the sweat
Achillea
tonic
strengthens the immune system to clear lingering pathogens and to resist further infection
Echinacea
astringent
moderates excessive sweating to avoid weakening the body
Salvia off.
••.••...•.•.••......•.•.•••.•...•.•..................................................................... circulatory stimulant
can stimulate the urinary sy&tem, clear obstruction, and accentuate the diuretic effect
Zingiber
tonic
can tonify the urinary system and strengthen the diuretic effect
Panax gin.
mineral supplement
moderates the effect of mineral loss as a result of diuresis
Taraxacum
Actions
65
Emmenagogue (support)
(moderate)
bioavailability enhancer
can act as a 'carrier' or 'messenger' and enhance the bioavailability of other herbs
Zingiber
circulatory stimulant
can support the use of emmenagogues for conditions with sensations of abdominal cold
Capsicum
tonic
assists in the treatment of reproductive weakness associated with atrophy or hypofunction
Serenoa
stimulant
assists in the treatment of lack of sexual interest associated with depression
Tumera
antispasmodic
assists in the treatment of uterine spasms
Viburnum
tranquilizer
assists in the,treatment of gynecological disorders associated with nervous tension
Saivia off.
astringent
moderates potential excessive bleeding from stimulant emmenagogues
Vinca
.............................. r
_
..
Expectorant (support)
(moderate)
circulatory stimulant
stimulates bronchial circulation and supports the movement ' and clearance of mucus
Sanguinaria
anticatarmal
reduces the excessive secretion and accumulation of mucus
Thuja
demulcent
moistens and soothes inflamed mucosa, thereby facilitating expectoration
Glycyrrhiza
antispasmodic
reduces excessive bronchial spasms that may inhibit expectoration
Lobelia
antiemetic
moderates potential nausea from stimulant expectorants, such as Lobelia
Zingiber
............................................................................................................................................................................................................ Hepatic and cholagogue
circulatory stimulant
improves the circulation in the liver, enhancing clearance of toxins
Capsicum
antioxidant
can contribute to both hepatoprotective and antilipidemic effects
Artemisia, spp.
antispasmodic
assists in the treatment of spasms and pain of the biliary system
Chelidonium
anti-inflammatory alterative
treats hepatobiliary inflammatory conditions associated with accumulation of toxins
Berberis
detoxicant
can assist in the protection against toxins released by the action of alterative hepatics
Glycyrrhiza
(support)
(moderate)
Purgative (support)
(moderate)
........•............................................................................................... cholagogue
increases the secretion of bile, which has a laxative action
Iris
circulatory stimulant
supports the stimulant action of purgatives on atonic bowel
capsicum
tranquilizer
reduces nervous tension that may be contributing to intestinal spasms and obstruction
Valeriana
carminative
moderates potential intestinal colic due to p'urgatives
Foeniculum
demulcent
moderates potential irritation of the intestinal mucosa due to purgatives
Glycyrrhiza
--~--K~L
Combining Western Herbs and Chinese Medicine
66
Sweet tonic (support)
(moderate)
Tranqulllzer (support)
(moderate)
bitter digestive tonic
assists in the absorption of sweet tonics by stimulating the digestive and hepatic function -
Gentiana
circulatory stimulant
stimulates digestion and speeds the assimilation and delivery of nutrients to the cells
Capsicum
carminative
reduces digestive stagnation and sensations of heaviness due to the sweet tonics
Elettaria
............................................................................................................................................................................. nervine
strengthens and stabilizes the nervous system to complement the tranquilizer effect
Avena
cardioregulator
strengthens and stabilizes the cardiovascular system to complement the tranquilizer effect
Crataegus
antidepressant
complements the tranquilizer effect for patients with both depression and anxiety
Thymus
circulatory stimulant
moderates any potential dulling of consciousness from stronger tranquilizers
Rosmarinus
-
Actions glossary Western herbal a.ction ca~egories .discussed in this glossary, the followmg details are given
OR EACH OF THE
P
where appropriate: • synonyms (within parentheses) • defmition and uses • herb examples • types (subcategories) • Chinese equivalent • differentiation from other categories
necessarily strengthen the adaptive capacity. Adaptogens are a subdivision of tonics with the specific quality of strengthening the ability to adapt to stress. Alteratives (blood purifiers and depurants) These are herbs that can clear toxins fro.m the body by increasing the processes of elimination and detoxification. They are used for disorders involving the accumulation of toxins, for example, acute sepsis, arthritis, recurring infections, skin disorders, and the sequelae of chemo- or radiotherapy. They can also be used to assist in detoxification programs for alcohol, drugs, or prolonged medication. For example,
Adaptogens See also Tonics. These are herbs that can enhance the ability of the body to adapt to chemical, physical, emotional, or mental stress. These herbs can enhance the strength and speed of performance under stress, and enhance the speed at which the body returns to normal function after stress. Examples include Astragalus, Eleutherococcus, Panax ginseng, Schisandra, and Withania.
• Achillea
can assist in the clearance of toxins through the skin by diaphoresis
• Phytolacca
can assist in the clearance of toxins from the lymph system
• Taraxacum
can assist in the clearance of toxins via its diuretic and laxative actions
Chinese equivalent There is no exact equivalent to the al-
Chinese equivalent The adaptogenic action can be said to
terative action in Chinese medicine. Perhaps the nearest equivalent action categories are clear Retained Heat, clear Damp Heat, and clear Heat Toxins. It should be noted that the concept of toxins as a main cause of disease, involving cleansing as a major treatment principle, is stronger in Western herbal tradition than in Chinese medicine.
be a subdivision of the Qi tonic action. One of the most important functions of Qi is the capacity for a rapid and appropriate adaptation to environmental stimuli, with rapid subsequent return to the balance between Ym and Yang.
Adaptogens, stimulants, and tonics Stimulants rapidly in-
Analeptics See also Stimulants. Once known as restoratives or resuscitants, these are sub-
crease the activity of the body, but their long-term use may result in depletion or destabilization. Tonics gradually and cumulatively increase the strength of the body but do not
stances that can restore consciousness following fainting or
,
67
Combining Western Herbs and Chinese Medicine
68
coma. In conventional medicine, analeptics that stimulate the central nervous system have been used to counteract the effect oflarge doses of narcotics. In the Western herbal tradition, Lobelia has a tradition of use as a resuscitant to treat the loss of consciousness from fainting, apoplexy, or concussion. It was used either as a single herb or in combinations such as the Antispasmodic tincture (see the Lobelia chapter).
Chinese equivalent The action category of aromatic substances that open the orifices is used to clear Phlegm from the sensory orifices and revive Heart Spirit, and to treat such disorders as apoplectic coma and febrile delirium. Analgesics (anodynes) These are substances that reduce the conscious perception of pain. Three main types are: • anti-inflammatory analgesics • narcotic analgesics • tranquilizing analgesics
Anti-inflammatory analgesics These can relieve pain by reducing inflammation, generally without dulling consciousness. They may also have an antipyretic action. One group used in conventional medicine is the nonsteroidal anti-inflammatories (NSAIDs), which includes the salicylates. Filipendula. Populus. Salix, and Viola are examples of herbs with the anti-inflammatory analgesic action; they contain compounds that can be converted in the body to salicylic acid.
Narcotic analgesics The narcotic analgesics reduce pain but may also produce dullness or drowsiness. One group used for severe pain in conventional medicine is the opiates. such as codeine and morphine. None of the herbs discussed in this book have a narcotic analgesic action.
Tranquilizing analgesics Some substances can assist in the treatment of pain because of their tranquilizing or sedative action, especially when the pain is linked to muscle spasms associated with nervous tension. Tranquilizers calm without necessarily dulling consciousness. Sedatives calm and may also have a dulling effect on consciousness, but not so severe a dulling effect as narcotic analgesics. Piscidia and Valeriana are examples of herbs that can have antispasmodic and analgesic effects in addition to their tranquilizing"action. At high doses. these herbs may have some sedatiVe'effects.' Analgesics and anesthetics ArialgesicS relieve pam;Without necessarily'removing all sensation or'dulling consCiousness. Anesthetics abolish sensation in a specific area (local anesthetics) or in the whole body (general anesthetics).
Chinese equivalent Herbs with the analgesic action can be found in the move the Blood action category. especially when the pain is associated with Blood stasis from trauma or internal causes. Analgesics are also found in the regulate Qi category. but in this case, pain is linked to Qi Stagnation. which may be associated with muscle spasms. such as intestinal colic. Anodynes
See Analgesics.
Antacids See also Antiulcer agents. In conventional medicine. antacids are substances that are used to treat peptic ulceration by neutralizing the hydrochloric acid in the gastric secretions. In Western herbal tradition, the term antacid has been used rather vaguely, to include antiulcer herbs for which a gastric acid neutralization mechanism has not been demonstrated or which indeed have their antiulcer effect by a different route, such as demulcent or anti-inflammatory actions.. The term antacid is therefore not used in this book and the more general term of antiulcer is preferred. There is no exact equivalent action category to antacid in traditional Chinese medicine. Antiabortives These are herbs that have a tradition of use during pregnancy of reducing the risk of miscarriage. Examples are Mitchella, Rubus, and Viburnum.
Chinese equivalent In Chinese medicine. herbs with a tradition of antiabortive action are found in various action categories. For example. Artemisia argyi (al ye) is in the category of herbs that stop bleeding. and Dipsacus (xu duao) is in the group of herbs that tonifyYang. Antianginals These are herbs that have a tradition of use of relieving chest pain due to heart disease. Examples are Capsicum, Convallaria. Crataegus. and Leonurus.
Chinese equivalent In Chinese medicine, herbs with this action are found mainly in the move the Blood category. Their specific action is to move Heart Blood. Antiarrhythmics See also Cardiotonics and Cardioregulators. These are herbs that have a tradition of use of treating cardiac arrhythmia. Examples are Cinchona. Convallaria, Crataegus, Leonurus, and Sarothamnus.
Chinese equivalent In Chinese medicine, herbs with this action are found in various action categories. including toni'fy Qi. tonify Blood, tonify rm, stabilize and bind. and calm the Spirit. Antiarthritics These are herbs that can relieve inflammation, stiffness. and pain of the joints. The term antirheumatic is an older. less specific term referring to herbs that relieve
-
Actions glossary inflammation, stiffness, and pain of the muscles and/or joints. Antiarthritics can be used for such disorders as rheumatoid arthritis, osteoarthritis, psoriatic arthritis, and gout. Antirheumatics can be used for these disorders. In addition, they can be used for myalgias, such as those occurring in muscular rheumatism associated with exposure to wind, cold, and damp, or in chronic fatigue and fibromyalgia syndromes. Examples of herbs that can be used to treat inflammation, stiffness, and pain of the muscles and/or joints are Angelica archangelica, Filipendula, Harpagophytum, Populus, Salix, and Zanthoxylum.
Types of antiarthritics The table shows examples of different types of antiarthritics.
ZING1BER diaphoretic antiarthritic
clear Wind. Cold-, Damp
ZANTHOXYLUM circulatory stimulant antiarthritic warm and move Qi and Blood POPULUS antipyretic antiarthritic
clear Heat. clear Wind Heat
HARPAGOPHYTUM anti-inflammatory antiarthritic
clear Damp Heat
ARCTIUM alterative antiarthritic
clear Heat Toxin
Chinese equivalent In terms of Chinese medicine, herbs with the antiarthritic and antirheumatic actions are especially found in the clear Wind Damp action category. They are also found in the categories shown in the table above. Antiasthmatics These are antispasmodic herbs that are specific for treating the bronchial spasms of asthma. Examples are Ephedra and Lobelia.
Chinese equivalent In Chinese medicine, herbs with this action are found mainly in the category of herbs that relieve cough and wheezing, and also in the regulate Qi and release the Exterior categories. Antiatheromatics See also Antilipidernics. These herbs can help to prevent the formation of atheroma, or they can help to disperse an existing atheroma. Examples are Angelica sinensis, Commiphora, Crataegus, and Salvia miltiorrhiza.
Chinese equivalent In terms of Chinese medicine, such herbs can be said to clear Phlegm accumulation and obstruction from the arteries and to move the Blood. Herbs with this action are found in the move the Blood and tonify the Blood categories.
69
Antibacterials See Antimicrobials. Antibiotics
See Antimicrobials.
Anticatarrhals These are herbs that can reduce excessive mucus secretion or mucus accumulation. They can therefore clear mucus obstruction in the ducts and passages of the body, and indirectly help to reduce inflammation and infection. They can be used, for example, for nasopharyngeal catarrh, phlegmy cough, asthma with bronchitis, some cases of conjunctivitis or otitis media, diarrhea with mucus in the stools, urinary infections with cloudy urine, and some cases of prostatitis or salpingitis. Examples include Achillea, Angelica archangelica, Echinacea, Euphrasia, Hydrastis, Myrica, Plantago Ianceolata, Sambucus, Sanguinaria, and Thuja.
Chinese equivalent There is no exact Chinese equivalent of the anticatarrhal action. This reflects the special emphasis that Western herbal tradition of the last century has placed on the concept of phlegm blocking the secretory ducts and passages of the body and producing potential sites of inflammation and infection. There is some overlap between the anticatarrhal effect and the action of transform Damp. The latter is mainly used to treat digestive disorders such as nausea or abdominal distension when these occur with a sensation of heaviness in the limbs or body. These symptoms are similar to those of chronic catarrhal gastric and intestinal catarrh, as described by the Eclectic practitioners. However, the anticatarrhal action specifically refers to the capacity to reduce secretion by the mucous membranes lining the ducts of the body. Also, anticatarrhals are not necessarily aromatic herbs that transform Damp and Phlegmthey may be acrid or bitter in taste-and they do not necessarily have a drying effect. Anticatarrhal, expectorant, and antitussive Anticatarrhals do not necessarily promote the cough reflex, as do expectorants, or reduce the cough reflex, as do antitussives. Anticoagulants See under Antithrombotics. Anticonvulsants These are herbs that can assist in the treatment of convulsions, for example, febrile convulsions or epilepsy. They may also assist in the treatment of tremors and spasms of the skeletal muscles. sudden loss of consciousness, hemiplegia, facial paralysis, aphasia, and other signs of cerebrovascular accident. Examples of Western herbs with a tradition of use of assisting in the treatment of convulsions are Cimicifuga, Lobelia, Scutellaria, and Valeriana.
Combining Western Herbs and Chinese Medicine
70
Chinese equivalent These herbs can be said to calm Liver Wind and Liver Hyperactive Yang. They may also calm Heart Spirit and clear Phlegm from the sensory orifices. They are mainly found in the categories of herbs that extinguish Wind and stop tremors, calm the Spirit, and open the orifices.
Chinese equivalent In terms of Chinese medicine, the equivalent group is that of herbs that expell'arasites. Antihemorrhagics
See Astringents.
Antihyperlipidemics
See Antilipidemics.
Anticonvulsants, resuscitants, and antispasmodics Resuscitants can be used to restore consciousness following fainting or coma, but both resuscitants and antispasmodics do not necessarily reduce convulsions. However, there is overlap between the three action categories, and some herbs can produce all three effects, for example, Lobelia. Antidepressants See also Stimulants. These are herbs that can be used to treat lowness of mood, whether it is associated with bipolar states, premenstrual or postnatal depression, seasonal affective disorder, the side effects of medication or drugs, or illnesses such as chronic fatigue synch:ome. The following herbs are specific for depression, although, as shown in the list, they are effective as a result of differing actions: • Avena, Hypericum • Panax ginseng • Turnera • Capsicum • Rosmarinus
nervine adaptogen, stimulant stimulant circulatory stimulant hepatic
Antihypertensives (hypotensives)
These are herbs that
can help to reduce high blood pressure. The antihypertensive effect may involve antilipidemic, antiatheromatic, antithrombotic, cardioregulatory, vasodilatory, tranquilizing, or sedative actions.
Types ofantihypertensives The table shows examples of different types of antihypertensives. •. w ....~.
.. - .<~
. ' ••. ~.'. •
Chinese action _"
RHEUM alterative antihypertensive
clear Heart and Liver Heat, clear Heat Toxins
CRATAEGUS antiatheromatic antihypertensive move Blood. clear Heart Phlegm VALERIANA sedative antihypertensive
calm Heart Spirit and Liver Yang
Chinese equivalent There is no exact equivalent of this category in Chinese medicine. Herbs with antidepressant effect are found in the categories of herbs that tonify Qi, tonify Yang, and calm the Spirit.
LOBELIA anticonvulsant antihyperter.sive
extinguish Wind and stop tremors
VISCUM nervine antihypertensive
tonify
Kidn~y
and Liver Qi
Antiemetics These are herbs that help to prevent, reduce, or stop nausea and vomiting, including travel sickness and vomiting during pregnancy. Examples are Ballota, Matricaria, Mentha, and Zingiber.
Chinese equivalent There is no exact Chinese equivalent of
Chinese equivalent These herbs are said to calm Rebellious
found in various action categories. Some are shown in the
Stomach Qi and are mainly found in the action categories of herbs that transform Dampness, regulate Qi, and relieve food Stagnation.
table, and additional categories include herbs that clear the
Antifungals
See Antimicrobials.
the antihypertensive action, and herbs with this effect can be
Exterior and herbs that tonify Yang. Anti-inflammatories These are herbs that can reduce inflammation either in the body as a whole or in specific organ
Antigalactagogues (galactophygics) These are herbs that have a tradition of use of decreasing lactation. An example is Salvia officinalis.
systems or tissues. They can be used to treat inflammatory
Antihelmintics (vermifuges) These herbs are, used for infestation by intestinal worms (helminths), such as tapeworms (cestodes) or roundworms (nematodes). Examples are Artemisia absinthium and Dryopteris felix-mas. The latter herb can have side effects in high doses, and there may be local restrictions on its use.
Examples are Althaea, Berberis, Echinacea, Euphrasia, Fili-
disorders such as rhinitis, sinusitis, gastritis, enteritis, colitis, cystitis, salpingitis, vaginitis, arthritis, and dermatitis. pendula, Glycyrrhiza, Hamamelis, Harpagophytum, Hydras- tis, Matricaria, Populus, Salix, Symphytum, and Viola.
Types of anti-inflammatories The table shows examples of different types of anti-inflammatories.
Actions glossary
ECHINACEA antiallergic anti-inflammatory
clear Wind Heat
FILIPENDULA analgesic anti-inflammatory
clear Heat
BERBERIS antimicrobial anti-inflammatory
clear Heat Toxin
HAMAMELIS astringent anti-inflammatory
ALTHAEA demulcent anti-inflammatory
71
Antimicrobials (antibiotics, antiseptics) These are herbs that can treat infection by inhibiting the growth of microorganisms. They include herbs that have antiviral (some), antibacterial (many), antifungal (some), or antiprotozoal (some) actions. antiviral antibacterial antifungal antiprotozoal
• Echinacea • Arctostaphylos • Calendula • Cinchona
stabilize and bind
tonity Yin and Fluids, clear Heat
Chinese equivalent There is no exact Chinese equivalent of the anti-inflammatory action, and, as shown in the table, herbs with this effect can be found in various Chinese action categories. Antilipidemics (antihyperlipidemics)
See also Anti-
atheromatics. These herbs can reduce hyperlipidemia, that is, raised lipid levels in the plasma, whether of triglycerides or cholesterol. Research studies have reported antilipidemic action for Achillea, Angelica sinensis, Capsicum, Cinnamomum bark, Commiphora, Crataegus, Glycyrrhiza, Rheum, Salvia miltiorrhiza, and Zingiber (see the chapters on these herbs).
Chinese equivalent Herbs with antimicrobial action can be found especially in the clear Heat, clear Damp Heat, clear Heat Toxin, clear Wind Heat, and clear Wind Cold action categories. Antimigraine agents These are herbs that can be used for the treatment of headache or migraine. The term 'antimigraine agents' is used in conventional medicine rather than in the Western herbal tradition. Headaches or migraines can be associated with many factors, including exposure to cold wind, trauma, sinus obstruction, nervous tension, and hypertension.
1Ypes of antimigraine agents The table shows examples of different types of antimigraine herbs. . Western action
Chinese action
ANGELICA ARC.
Chinese equivalent There is no exact Chinese equivalent of the antilipidemic action, but herbs with this effect can be found in various Chinese action categories, including cool and transform Phlegm Heat, warm and transform Phlegm Cold, drain downward (purgative), relieve food stagnation, move the Blood, warm the Interior, tonify Qi, and tonify Blood.
F
Antilipidemic and antiatheromatic The antilipidernic action may help to prevent atheroma, but not all herbs with the antilipidemic action are necessarilyantiatheromatic. Antilithics These are herbs that can help to dissolve or discharge biliary or urinary gravel or stones. Examples are: • Berberis, Chelidonium, Taraxacum • Hydrangea, Parietaria, and Zea
cholelithiasis urinary stones
Demulcent, anti-inflammatory, anticatarrhal, alterative, and antispasmodic actions may all contribute to the antilithic effect.
Chinese equivalent Antilithics are mainly found in the action category of herbs that drain Damp, but a few are also found in the relieve food Stagnation, move the Blood, and tonify Yang categories.
anticatarrhal antimigraine
clear Phlegm (in the head)
BERBERIS hepatic antimigraine
move Liver Qi, clear Liver Heat
SCUTELLARIA anticonvulsant antimigraine
extinguish Wind and stop tremors
PASSIFLORA tranquilizing antimigraine
calm Heart Spirit and Liver Yang
VISCUM nervine antimigraine
tonity Kidney and Liver Qi
Chinese equivalent There is no exact Chinese equivalent of the antimigraine action. As shown in the table, herbs that treat headache and migraine are found in various categories. Antineoplastics
See Antitumor agents.
Antioxidants This term has been adopted from modern research literature and refers to substances that can neutralize harmful oxygen-bound free radicals produced by disease, drugs, or toxic chemicals. Many herbs have been reported to have an antioxidant action, including Cinnamomum, Glycyrrhiza, Rosmarinus, and Zingiber.
Chinese equivalent There is no exact equivalent of this action in Chinese medicine, and herbs with antioxidant
Combining Western Herbs and Chinese Medicine
72
effect are found in various Chinese action categories, including the warm the Interior and tonify Qi categories. Antiparasitics These are herbs that prevent or destroy parasites. The term antiparasitic lacks specificity, and more specific terms, such as antihelmintic, are often preferred. See Antipyretics.
Antiperiodics
Antiplatelet agents Antiprotozoals
carminative
LEONURUS antispasmodic emmenagogue
See Antimicrobials.
Chinese equivalent Herbs with antipyretic action can be found especially in the clear Heat, clear Damp Heat, clear Heat Toxin, clear Wind Heat, and clear Wind Cold action categories. See Antimicrobials.
Antispasmodics (spasmolytics, relaxants) The term 'antispasmodic' sometimes refers to herbs that relax: spasms in the smooth muscle of the viscera. A broader defmition is the relief of spasms in smooth, cardiac, or striated muscle. Which definition is used depends on the author of the specific text.
Normalizing action Some antispasmodics do not simply relax: smooth muscle spasms, but have a normalizing effect on the degree of contraction and on contraction rhythms of smooth muscle. For example, carminatives can both relax: intestinal spasms to normalize muscle tone and stimulate the gut to normalize peristalsis. They do not have an antispasmodic effect to the point of flaccidity, nor do they stimulate peristalsis to .the point of producing spasms and pain (see the Lobelia chapter)..
Types of antispasmodics The table shows examples of different types of antispasmodics. .
antianginal
LOBELIA anticonvulsant antispasmodic VALERIANA sedative antispasmodic
move the Blood (in the Uterus) •
relieve cough and WheeZing
move Heart Blood
extinguish Wind and stop tremors calm Heart Spirit
Chinese equivalent There is no exact Chinese equivalent of the antispasmodic action, but herbs with this action can be found in the Chinese categories shown in the table.
-~.
Antithrombotics These are herbs that can prevent the formation of blood clots (thrombi). There is a number of related action categories that have been used in conventional Western medicine: these can reduce platelet aggregation, thus reducing blood coagulation and the formation of clots • anticoagulants these can reduce blood clotting, not necessarily by inhibiting platelet aggregation, but by other mechanisms such as the inhibition of the activity of thrombin • thrombolytics these can disperse clots once they are formed, in contrast to an antithrombotic that prevents their formation
• antiplatelet agents
Achillea and Crataegus have traditions of use of assisting _ in the treatment of cerebral and coronary thrombosis, respectively. According to research studies, the following herbs have been reported to have antiplatelet effect: Angelica _ sinensis, Berberis, Capsicum, Cirmamomum bark, Commiphora, Hydrastis, Leonurus heterophyllus, Rheum, Salvia miltiorrhiza, Zanthoxylum, and Zingiber (see the chapters on these herbs).
Normalizing effects on blood coagulation The anticoagulant and antihemorrhagic effects appear to be opposite. However, some herbs and their constituents, for example, Capsicum and its main active constituent capsaicin, can have either anticoagulant or antihemorrhagic,e,ffects, depending on the st~te of the patient. S~ch he~b's:app~ to h~ve,a' normalizing effect on blood coagulation. ,
EPHEDRA antiasthmatic
regUlate Qi
HAMAMELIS
See Antithrombotics.
Antipyretics (febrifuges) These are herbs that reduce fever and lower body temperature. Examples are Achillea, Asclepias, Artemisia absinthium, Berberis, Cinchona, Salvia, and Zingiber. Antiperiodics are a subdivision of antipyretics. They can prevent the periodic recurrence of fever or diseases, such as malaria. Examples are Berberis and Cinchona. The antipyretic action of lowering fever and reducing body temperature may be produced via a direct effect on the central temperature-lowering mechanism of the body. However, in some herbs with antipyretic effect; the diaphoretic, antimicrobial, or alterative actions may also help to lower the body temperature.
Antiseptics
ELmARIA
,.
Chinese equivalent There is no exact Chinese equivalent of
Actions glossary the antithrombotic action, and herbs with this action can be found in various Chinese categories, including move the Blood, warm the Interior, and tonify Blood. Antitumor agents (antineoplastics) In this book, the antitumor action refers to a herb with a tradition of use of retarding the development of benign or malignant growths. In conventional medical terminology, this would include a variety of the following overlapping action categories:
• eytotoxics • antimitotics • antimetabolites
damage or destroy cells inhibit cell division and growth interfere with cell metabolic reactions by combining with the enzymes responsible for them
In Western herbal tradition, the main action associated with the antitumor effect is the alterative action. Most of the herbs listed as antitumor agents also have an alterative action, for examplti,'Arctium, Phytolacca, Thuja, and Viola.
Chinese equivalent There is no exact equivalent of the anti-
-
tumor action in Chinese medicine. Some of the herbs recently used in China to treat cancer are in the clear Heat Toxin group, which interestingly is the nearest equivalent to the Western alterative action. Other herbs with antitumor effect are found in the cool and transform Phlegm Heat and move the Blood categories. Antitussives These are herbs that can relieve coughing, whether by calming the central nervous system, influencing the coughing reflex, soothing inflammation of respiratory mucosa, reducing excessive mucus secretion, or by other mechanisms. Antitussives can be used for whooping cough, chronic dry cough, or nervous cough, depending on the additional actions of the particular herb. Examples are Althaea, Glycyrrhiza, Lobelia, Prunus, Thymus, and Viola.
,
~
..
I !
Types of antitussives The table shows examples of different types of antitussives.
~-
ANGELICA ARC.
anticatarrtlal antitussive
r r T
ALTHAEA demulcent antitussive
no exact equivalent tonify Yin and Auids. clear . Heat
LOBELIA
antispasmodic antitussive
regulate Qi
PRUNUS
tranquilizing antitussive
.calm Heart Spirit
. "',:'
Chinese equivalent Antitussive herbs are found especially in the Chinese category of herbs that transform Phlegm and stop cough. They are also found in the categories shown in the table. Antiulcer agents See also Antacids. These are herbs that can be used in the prevention and treatment of peptic ulcers. They may reduce secretion of gastric acid or have a protective or anti-inflammatory effect on the mucosa. Herbs with a tradition of use in the West of treating peptic ulcers include Althaea, Calendula, Filipendula, Glycyrrhiza, Hydrastis, Syrnphytum, and Ulmus.
Chinese equivalent There is no exact equivalent of this category in Chinese medicine, but herbs with antiulcer action can be found in the categories of herbs that stop bleeding as well as herbs that stabilize and bind. Antivirals Anxiolytics Aperients
See Antimicrobials. See Tranquilizers. See Laxatives.
Aphrodisiacs These are herbs with the reputation of increasing sexual desire and sexual performance. Examples are Panax ginseng, Serenoa, and Turnera.
Chinese equivalent In Chinese medicine, herbs with aphrodisiac action are found mainly in the tonify Yang action category, although Panax ginseng is in the category of herbs that tonifyQi. Aromatic digestives
See Carminatives.
Astringents The word astringent is derived from the Latin 'stringere: to bind. When astringents, especially tannins, are in contact with mucous membranes or with wounds on the surface of the body, they can bind with proteins in both the mucus and the surface cells. This can result in shrinkage and in reduction of membrane permeability. This process can help to reduce excessive loss of fluids from the body, whether the fluids are in the form of sweat, mucus secretions, blood, urine, or feces. Astringents can be used for excessive sweating, rhinitis, sinusitis, diarrhea, urinary frequency or incontinence, and for discharges from the reproductive system. When the astringent action reduces bleeding, the herbs are termed antihemorrhagics or hemostatics and can be used for disorders such as epistaxis, hematemesis, hemoptysis, hematuria, and menorrhagia. Examples are Agrirnonia, Alchemilla, Capsella, Cinnamomum, Geranium, Hydrastis, Myrica, Polygonum, Potentina, Quercus, Sanguisorba, and Schisandra.
1Jpes of astringents The table shows examples of different
CAPSICUM
counterirritant antitussive
73
no exact equivalent ;';.'.
types of astringents.
"\
Combining Western Herbs and Chinese i\1edicine
74
-_"~f-w~~~rri~6tlC:ri~;~{;/tT":-~h~1~~chiri:~~tfn~~~~~:~~ -
_.
-) -
..
. ..,
Blood cleansers
See Alteratives.
Blood purifiers
See Alteratives.
....
""., ii' "£* G .Jb+;,¥..... ~-. ..• ~-....
----
H.~
ACHILLEA anticatarrhal astringent
no exact equivalent
ARCTOSTAPHYLOS antimicrobial astringent
clear Heat
POLYGONUM demulcent astringent
tonify Yin and Auids. clear Heat
CINNAMOMUM BARK tonic astringent
tonify Spleen and Kidney Yang
Chinese equivalent Astringent herbs are found especially in the Chinese category of herbs that stabilize and bind, and in the categories shown in the table. Antihemorrhagics are found especially in the category of herbs that stop bleeding. Herbs that firm and stabilize the Spirit The astringent action usually refers to the reduction in the loss of physical material, specifically fluids. However, the concep! of astring~nt action can be extended to include the concept of firming energy that is overly dispersed, scattered, or disturbed, especially that of the Heart and Kidney. This aspect of astringency can be used to treat insomnia, anxiety, palpitations, and scattered thinking. This topic is discussed in the section on Sour in the Taste chapter. Bitter digestive tonics These are herbs with a marked bitter taste in the mouth. The bitter constituents can stimulate the bitter receptors on the tongue, causing a cascade of events, involving stimulation of appetite, gastrointestinal digestive secretion, bile secretion, and peristalsis. Bitter digestive tonics can increase the efficiency of digestion, absorption, and assimilation. They can, therefore, be used to treat anorexia and loss of appetite, atonic digestion, malnourishment associated with impaired digestion and absorption, food allergies and intolerance, and impaired digestion with gastrointestinal inflammation. This topic is discussed in the Bitter section in the Taste chapter. Examples are Artemisia absinthium, Centaurium, Cinchona, Gentiana, and Populus.
Chinese equivalent There is no comparable theory, proposing bitters as digestive tonics, in Chinese medicine. The bitter digestive tonic action can be said to involve tonifying and moving the Qi of the Spleen, Stomach, Intestines, Liver, and Gallbladder. Bitters See also Bitter digestive tonics. This term refers t~ bitter tasting herbs and is sometimes . . used as a synonym for bitter digestive tonics. The term 'bitters' is ge~~rally a~oided in this book'sinte many different actions can be associate with the bitter taste, and the more specific term 'bitter digestive tonics' is preferred.
Cardiac diuretics
See Cardiotonics and Diuretics.
Cardioregulators See also Tranquilizers. Cardiotonics can be defined as herbs that can strengthen .--'-'.~ heart function and treat cardiac weakness with exhaustion. I use the term 'cardioregulators' for herbs that not only strengthen the heart, but by doing so, stabilize its function and treat conditions involving arrhythmias or fluctuations in blood pressure, body temperature, energy, and mood. Some cardioregulators have a normalizing effect on the heart, and can be used to treat both hyper- and hypofunction. Examples are Crataegus and Leonurus.
Chinese equivalent There is no exactly equivalent Chinese action category. Like the cardiotonics, the cardioregulators can tonify Heart Qi. By doing this, they can stabilize Heart Qi irregularity. Like the antiarrhythmics,_ ~ey. can be use~_ for cardiac arrhythmias, but in addition, they have the further effect of treating hyper- or hypoactivity of heart function, or of reducing oscillations between extremes ofYm and Yang. I therefore use them for conditions such as bipolar syndrome, emotional lability, the temperature fluctuations of menopause, or the energy fluctuations of some cases of chronic fatigue. Cardiotonics These are herbs that can strengthen heart function and can be used to treat disorders associated with cardiac weakness, such as exhaustion, hypotension, arrhythmias, and edema. Examples are Capsicum, Cinchona, Convallaria, Crataegus, Leonurus, Panax ginseng, and Sarothamnus.
Chinese equivalent There is no exactly equivalent Chinese action category, but cardiotonics can be said to tonify Heart Qi. Cardiotonics with antiarrhythmic action may also stabilize Heart Qi Irregularity (see Syndromes), and cardiotonics with diuretic action may tonify both Heart and Kidney Qi. Capsicum is an example of a herb that can give both shortterm stimulation to Heart Yang and long-term tonification to Heart Qi. Carminatives (aromatic digestives) These are aromatic herbs that can aid digestion, stimulate peristalsis, promote the expulsion of gas from the gastrointestinal tract, and relieve the pain due to flatulence. These herbs are aromatic due to their relatively high content of volatile oils. The normalizing effect of carminatives on gut muscle tone and motility has been described under Antispasmodics above. Examples are Angelica archangelica, Cinnamomum bark, Citrus, Elettaria, Foeniculum, Juniperus, Lavandula, Rosmarinus, and Zingiber.
"
Actions glossary Chinese equivalent There is no exact Chinese equivalent to the carminative action. The closest are those herbs in the regulate Qi action category that rela.x: and move the Qi of the St~mach and Intestines. There is overlap between the uses of carminatives and herbs that transform Damp, but the carminatives are not necessarily associated with Damp disorders. This topic is discussed in the Aromatic section in the Taste chapter. Cathartics
75
the normal body processes to reduce inflammation and infection. Counterirritants can be used as gargles or mouthwashes for such complaints as chronic laryngitis or gum disorders. They can be applied topically as poultices, plasters, oils, or liniments for disorders such as osteoarthritis, myalgias, sprains, or unbroken chilblains. Examples are Brassica nigra seeds (black mustard), Capsicum, Lobelia, Sanguinaria, and the fresh leaves ofUrtica (stinging nettle).
See under Laxatives.
Chinese equivalent There is no exact equivalent of the Choloretics
See Cholagogues and choloretics.
Cholagogues and choloretics One definition is that chloretics stimulate the secretion of bile by the liver cells and cholagogues stimulate the £low of bile from the gallbladder and bile ducts into the duodenum. However, most choloretic herbs also have a cholagogue action, and not all traditional texts distinguish between the two actions. Many texts refer to . the cholagogue action in the treatment of all disorders of the biliary system, such as cholecystitis, cholelithiasis, and cholangitis. Most herbs with choloretic and cholagogue action have a bitter taste, for example, Berberis, Chelone, Chelidonium, Chionanthus, Gentiana, Leptandra, and Taraxacum. However, some herbs that have these actions do not have the bitter taste, for example, Zingiber (see the chapter on this herb).
Chinese equivalent Herbs with choloretic and cholagogue action are mainly found in the drain Damp and clear Damp Heat categories. Circulatory stimulants These herbs stimulate the circulation and warm the body. They can increase the efficiency of heart function, coronary circulation, and peripheral circulation to treat circulatory disorders, including arthritis aggravated by cold, Raynaud's syndrome, and Buerger's disease. Examples are Angelica archangelica, Capsicum, Cinnamomum, Myrica, Sanguinaria, Thuja, Zanthoxylum, and Zingiber.
Chinese equivalent This category has no exact equivalent in Chinese medicine. The closest category is that of herbs that warm the Interior. However, most of the herbs in the warm the Interior category warm the Spleen and improve digestion, rather than stimulate the Heart and improve circulation (see the Acrid section in the Taste chapter). Counterirritants See also Rubefacients. These are herbs that are used to irritate the surface of the body or the mucus membrailes of the mouth ~r sinuses, thus initiating wound healing responses and increasing blood supply to the area. This irritant effect may clear st~gnation in the area, remove accumulated wastes and toxins, and assist
counterirritant action in Chinese herbal medicine, but compounds with this action are found in the category of substances for External application. Also, the techniques of cupping and gua sha are based on a sin1ilar p~inciple.
Vesicants These are a subdivision of the counterirritant category. They were employed in the past to produce blisters on the skin, which could then be pierced and drained, to release toxins from the area. An example is mustard oil, which can produce almost instantaneous blistering on the skin. A similar principle underlies the use of moxibustion to produce blisters or cupping over an acupuncture point that has been pierced for bleeding.
Caution Piercing of blisters has an obvious risk of infection, and the vesicant technique lies outside the scope of this book. Demulcents See also Emollients. These are herbs with a high mucopolysaccharide content that can have a soothing and protective effect on inflamed mucus membranes of the gastrointestinal system. This is termed the 'direct demulcent effect: They may also have this effect on inflamed mucus membranes distant from the gut, for example, in the respiratory and urinary systems, and this is termed the 'indirect' or 'reflex demulcent effect: Demulcents can therefore be used for conditions involving inflan1ffiation of mucosa such as gastritis, enteritis, colitis, dry cough, bronchitis, and cystitis. Examples are Althaea, Plantago, Polygonum, Ulmus, and Viola.
Chinese equivalent There is no exact equivalent of the demulcent action in Chinese medicine. Most herbs with this action can tonifyYm and Fluids and also clear Heat. Deobstruants This is an old term for herbs that can clear obstructions in the body. The concept of obstruction to movement, whether ofblo<;>d or of the products of digestion, is an old one in Western medical theory. For example, Culpeper recommended Rosmarinus for opening obstructions of the liver. He warned against using medicines that are too binding to the liver since these may result in liver obstruction and hinder the circulation of the blood.
Combining Western Herbs and Chinese Medicine
76
The deobstruant action overlaps with the alterative and circulatory stimulant actions in moving stagnation and clearing accumulations and blockages. Examples are Lobelia, Myrica, Phytolacca, Smilax, and Zanthoxylum.
Chinese equivalent The deobstruant action has a very broad definition and there is no exact equivalent of such a general action in Chinese medicine. However, the concept of moving Stagnation to clear accumulation and obstruction is fundamental to Chinese medicine, and more specific action categories that include a deobstruant effect include the groups of herbs that clear Wmd Heat, clear Wmd Cold, clear Wind Damp, regulate the Qi, and move the Blood. Depurants
See Alteratives.
Types ofdiaphoretics The table shows examples of different types of diaphoretics. • -
,_ :~~~s~e~nc~~~~?~~';~!' ic,,-:_~'c
~~
... ,Chinese action' ..
NEPETA antipyretic diaphoretic
clear Wind Heat, clear Interior Excess Heat
ZINGIBER (FRESH) circulatory stimulant diaphoretic
clear Wind Cold
ANGELICA ARC. antirheumatic diaphoretic
clear Wind Damp
ACHILLEA alterative diaphoretic
clear Exterior Wind, clear Retained Pathogen
SAMBUCUS anticatarrhal diaphoretic
clear Exterior Wind, clear Lung Phlegm
Chinese equivalent The diaphoretic herbs are mainly found in the Chinese categories of clear Wind Heat, clear Wind Cold, and clear Wind Damp. Diaphoretics and antipyretics The antipyretic action does not necessarily involve diaphoresis. It may result from other physiologiCal "inechiulisms. Conversely, the diaphoretic action does not necessarily reduce fever. Diuretics
Types of diuretics The table shows examples of different types of diuretics. Western action'
Chinese
action'
CONVALLARIA
Diaphoretics (sudorifics) These are herbs that can increase sweating. This can be used to regulate body temperature so that during fever, diaphoretic herbs may have an antipyretic effect. The diaphoretic action can also have an aIterativ~'effectsin~~l~creased~~eating ~ help to eliminate toxins from the body surface. The diaphoretic action and its related antipyretic and alterative effects can be used in the treatment of acute fever, recurring fever, rheumatism, or arthritis.
,!.
substance that can increase excretion of urine. However, in Western herbal tradition, the term 'diuretic' has been appliecf'-····· to any herb used for disorders of the urinary system, whether urination is increased or not. In this book, the term 'diuretic' is used in the limited sense, so that diuretics are herbs used to treat edema or reduced urination. Examples are Arctium, Juniperus, Parietaria, Petroselinum, Taraxacum, and Zea.
The limited definition of diuretic is that it is a
cardiac diuretic
no exact equivalent
JUNIPERUS antimicrobial diuretic
drain Damp, clear Damp Heat, clear Heat Toxins
ZEA demulcent diuretic
drain Damp, tonity Yin, clear Heat
TARAXACUM alterative diuretic
drain Damp, clear Damp Heat, clear Heat Toxins
Chinese equivalent Diuretic herbs are found especially in the Chinese category of herbs that drain Damp. Emetics These are herbs that can induce vomiting. Promotion of vomiting was one of the main therapeutic methods in both traditional Western and Chinese medicine. In Western herbal medicine, vomiting was seen as one of the ways to help the body to eliminate toxins. Examples of emetics are Cephaelis, Lobelia (at high doses), and Urginea. In the past, herbal practitioners had to deal with more severe acute illnesses than today. In addition, patients were often more robust in constitution and more willing and able to take strong treatment modalities such as vomiting and purging. Emesis is now rarely used in Western herbal therapy. Emmenagogues The old definition of an emmenagogue was that of a herb that can stimulate menstruation and, in the language of Culpeper, 'procure women's courses: A more recent definition of emmenagogue is that of a herb that can normalize menstruation by assisting the self-regulating capacity of the female reproductive system. This includes the normalization of the muscle tone and rhythms of contraction of the uterus. This book uses the term 'emmenagogue' in this latter sense. The following categories have been used to describe emmenagogues: • tonic emmenagogues • antispasmodic emmenagogues
Actions glossary • stimulant emmenagogues • normalizing emmenagogues
Tonic emmenagogues These can gradually strengthen the uterus and be used for conditions associated with uterine weakness, for example, amenorrhea or habitual miscarriage. Herbs with this effect often also have an astringent action so that they can be used for uterine prolapse. Examples are Chamaelirium, Mitchella, and Rubus. In terms of Chinese medicine, these herbs can be said to tonify the Qi and Blood of the Uterus and to have a firming and binding action upon it.
Antispasmodic emmenagogues These can be used to relieve uterine muscle spasms and the associated pain. Herbs with this effect can be used for dysmenorrhea, excessive uterine spasms in pregnancy, and postnatal pain. Herbs with nonspecific antispasmodic action, such as Piscidia and Valeriana, can be used for these disorders. However, Viburnum can be described as an antispasmodic emmenagogue since it has a specific action on the uterus. In terms of Chinese medicine, these herbs can be said to move the Qi and Blood of the Uterus and relieve pain.
Stimulant emmenagogues These can be used to initiate
77
The expectorant action can be said to include one or more of the following effects: • promotion of the coughing action • increase of the ciliary action • reduction of mucus viscosity Expectorant herbs may also have the additional effects of reducing excessive mucus secretion and relaxing bronchial spasms. However, these two effects have been given separate action categories in this book: the anticatarrhal and antispasmodic actions, respectively. Expectorants are used to reduce mucus obstruction of the bronchioles and treat acute or chronic bronchitis with influenza, pneumonia, or asthma.
Types of expectorants Some of the main types of expectorant are given below, together with examples.
CEPHAEUS, URGINEA stimUlating expectorant.
LOBELIA
uterine contractions to treat amenorrhea (for example, Mentha pulegium) or delayed labor (for example, Hydrastis). In terms of Chinese medicine, these herbs are mainly in the category of herbs that move the Blood.
PRIMULA, INULA, MARRUBIUM
Normalizing emmenagogues Some herbs can act as anti-
antipyretic expectorant
spasmodic emmenagogues or stimulant emmenagogues, depending on the initial state of the uterus. These herbs can be said to have a normalizing effect on the uterus. Examples are Leonurus and Lobelia (see the chapters on these herbs). This category is not specified in Chinese medicine.
expel Phlegm by inducing vomiting
normalizing expectorantt
antispasmodic expectorant
transform Phlegm, regulate Qi
transform Phlegm, regulate Qi
ASCLEPIAS transform Phlegm Heat
GRINDELIA, HYSSOPUS sedative expectorant
transform Phlegm, calm the Spirit
GLYCYRRHIZA, VIOLA demulcent expectorant
stoP. cough and moisten dryness
ANGELICA ARC., COMMIPHORA
Emollients See also Demulcents. Emollients have a soothing anti-inflanunatory effect at the surface of the body. Some emollients, such as Althaea and Symphytum, contain mucopolysaccharides, while other emollients, such as olive oil, linseed oil, and flaxseed oil, contain oils.
F-
I
Expectorants The simplest defmition is a substance that can promote the coughing up of phlegm. However, a fuller definition of the expectorant action can be given in terms of bronchial physiology. The walls of the bronchioles are lined with ciliated mucosecretory epithelia and are provided with smooth muscle tissue. The mucus can trap particles from the air, which are then transferred up the bronchioles to the throat by the beating of the cilia and are coughed up by the coordinated action of the smooth muscle layer. The bolus of mucus can then be coughed out or swallowed.
anticatarrhal expectorant
transform Phlegm, transform Damp
• Stimulating expectorants can have an emetic action in high doses.
t Normalizing expectorants can have a stimulant or antispasmodic effect. depending on the state of the patient.
Chinese equivalent These herbs belong to the category of transform Phlegm and stop cough. Febrifuges
See Antipyretics.
Galaetagogues These are herbs that have a tradition of use of increasing milk secretion. Examples are Foeniculum, Pimpinella, Verbena, and Vitex. Ga1actophygics Hemostatics
See Antigalactagogues.
See Astringents.
78
Combining Western Herbs and Chinese Medicine
Hepatics This term is often used in a general sense for herbs that can strengthen and regulate hepatobiliary function, and that can be used to treat disorders of either the liver or the gallbladder. Based on the Western understanding of the range of liver function, hepatics may be appropriate in the following situations: • to strengthen and regulate the immune system • to treat combined gastrointestinal and hepatobiliary disorders • to treat liver disease and its sequela • to treat the sequelae of stress on the liver from excess consumption of fatty foods, alcohol, or other drugs, or from prolonged medication • to treat exposure to toxins and pollutants • to assist the antitumor activity of the liver Examples are Artemisia absinthium, Berberis, Rosmarinus, and Taraxacum.
Chinese equivalent ·"·There is no exact Chinese equivalent of this action. Herbs that can strengthen and regulate hepatobiliary function can be said to have one or more of the following Chinese actions on the Liver and Gallbladder: • tonify Oi, Blood, Yang, or Y"m • move Stagnant Oior Blood • clear Heat, Cold, Damp, or Phlegm Hepatoprotectives This term has been adopted from modern research by some recent herbal texts. The hepatoprotective action can be seen as a specific aspect of the hepatic action, consisting of the capacity to protect the liver against damage by toxic chemicals and other potentially harmful factors. Examples are Juniperus, Myrica, Schisandra, and Zingiber.
Chinese equivalent There is no exact Chinese equivalent of this action. Herbs with the hepatoprotective effect can be found in various Chinese action categories, including clear Heat Toxins, move the Blood, warm the Interior, tonify Oi, and stabilize and bind. Hepatoprotective and antioxidant Hepatoprotective effects are sometimes based on antioxidant processes occurring in the liver, for example, Artemisia absinthium and Curcuma have been reported to have hepatoprotective effects by lowering lipid peroxidation. Hypnotics See also under Tranquilizers. These are substances that are used to promote sleep. IIYP,otensives .
See Antihypertensives.. .
Laxatives These are substances that promote 'or facilitate bowel movement, and are generally used to treat or prevent constipation. The group of substances that facilitate bowel
movements is sometimes divided into three grades, in order of increasing strength: -laxatives • purgatives • cathartics
Laxatives Sometimes called aperients, the laxatives have a relatively gentle action on the bowel and are used for mild constipation, especially weak patients. For example, Glycyrrhiza is a mild, demulcent, anti-inflammatory laxative, Plantago seeds can act as a bulk. laxative, and Berberis and Taraxacum are bitter hepatics that promote bowel movement by increasing bile flow.
m
Purgatives These herbs have a stronger action on the bowel. They generally stimulate bowel movement by stimulating the lining of the intestines and causing stimulation of the smooth muscle of the bowels. They may cause intestinal cramping unless combined with antispasmodics such as Foeniculum or Zingiber. One of the main groups of purga~ .. tives are the herbs that contain anthraquinones, for example, Aloe, Cassia (senna pods); Rhamnus purshiana (cascara bark), and Rheum. Cathartics Sometimes called drastic purgatives, or simply drastics, these herbs have a very strong effect on bowel movement, producing violent peristalsis, drastic diarrhea, maybe with incontinence, and often severe intestinal pain. Another name for cathartics was hydragogues, that is, substances producing a watery.~owel movement. Cathartics were used, both in the West and in China, to remove fluids from the body in cases of severe edema, and this use continues in Chinese medicine. Cathartics are now rarely used in Western herbal medicine because of their weakening effect on the patients. Narcotics
See Tranquilizers.
Nervines See also under Tranquilizers. These have also been called nerve tonics, nervine tonics, nervous trophorestoratives, and nervine trophorestoratives. Nervines are herbs that can tonify and stabilize the nervous and endocrine systems, thereby stabilizing and normalizing the mental-emotional balance. Nervines can therefore be ~ used for either lowness of mood or emotional disturbance, especially when these are associated with physical, mental, and emotional debility. Examples include Avena, Cimicifuga, Hypericum, and Salvia officinalis.
Chinese equivalent .. The nearest equivalent in Chinese medicine is the action category herbs that of nourish the Heart and calm the Spirit. These herbs tonify Heart Oi, Blood, or Y"m. However, some nervines may also tonify the Oi and Y"m of the Kidney and Liver.
Actions glossary Avena (oats endosperm) is an example of a sweet nervine that can be said to tonify the Qi and Till of the Heart and Kidney and also to tonify Spleen Qi. Hypericum and Schisandra are examples of sour, astringent nervines that can firm and stabilize the Qi of the Kidney and Heart. Nutritives See also Tonics. These are sweet tonics that provide nourishment to build body tissues, whether in the form of sugars and starches or minerals and vitamins. Examples include Althaea, Avena (endosperm), Serenoa, Trigonella, Ulmus, and Ziziphus (fruit). Oxytocics These are herbs that can stimulate uterine contractions to facilitate or induce labor, for example, Hydrastis. These herbs should obviously not be taken at earlier stages of pregnancy. Parasiticides See Antiparasitics. Partus praeparator This term is used by the BHP for herbs that can be used to facilitate childbirth and help prevent miscarriages. They can be used to strengthen and normalize the function of the reproductive system prior to conception and in some cases during pregnancy. Examples are Chamaelirium, Mitchella, and Rubus.
Chinese equivalent In Chinese medicine, these might most closely correspond to the action categories of herbs that firm and bind or stop bleeding.
I.".
Purgatives
See Laxatives.
Relaxants
See Antispasmodics.
Rubefacients See also Counterirritants. These are substances that, if applied topically, increase capillary circulation at the surface, producing redness (hyperemia). They are thought to draw blood from deeper areas, thus relieving congestion and inflammation. An exampIe is Capsicum. Sedatives
See Tranquilizers.
Sialogogues These are herbs that stimulate the flow of saliva. Herbs with very bitter constituents, such as Cinchona and Gentiana, often have this action. Spasmolytics See Antispasmodics. Stimulants Seealso Tonics. These are herbs that can rapidly increase one or more body functions. The effect may be short term, rather than cumulative, and in the case of some of the stronger stimulants, prolonged use may decrease, rather than increase, body function. ' ' , ' H , ' ,
79
The stimulant action can be included in suitable combination with other action categories in the treatment of exhaustion and depression. It can also be utilized in the treatment of atonic conditions of the gastrointestinal or reproductive systems, such as loss of appetite, atonic digestion, atonic constipation, or lack of sexual drive and interest. Stimulants may have their effect via the cardiovascular, central nervous, or endocrine systems. Some herbs, for example, Panax ginseng, may affect all three systems.
Strength of stimulant action Herbs can be roughly divided into three levels according to the strength of their stimulant action: • strong • medium • mild
Strong Caffeine-based herbs, such as Cola (kola nut) and Ilex (yerba mate), have been used in the past as antidepressants for short-term use. However, in my opinion, long-term use of such herbs should be avoided since it can lead to weakening and destabilizing of the patient's energy. Capsicum can act as a strong stimulant to the cardiovascular, digestive, and other systems, but it also has a tonic action so that it is suitable for long-term use. Medium Rosmarinus and Turnera can have stimulant action via their effects on the central nervous system. Rosmarinus may also have an additional stimulant effect via the cardiovascular system, and Turnera may also have an additional stimulant effect via the endocrine system. These herbs may be suitable for long-term use, providing their specific cautions for use are observed. Mild Lavandula, Salvia officinalis, and Thymus may have mild stimulant action on the central nervous system. However, the aromatic constituents of these herbs can also have a tranquilizing action. Whether these herbs, or their aromatic constituents, have a stimulant or a tranquilizing action may depend on the state of the patient (see the discussion on camphor in the section on Research in the Rosmarinus chapter). Stimulants and tonics The difference between a stimulant and a tonic can be merely a matter of time and dose. Some herbs have an initial stimulant effect, followed by, or grading into, a tonic effect. For example, Capsicum can have a rapid, strong stimulant effect followed by a niilder long-term tonic action. Some herbs have a tonic effect in smaller doses, and a stimulant effect in higher doses. For example, Panax ginseng can gradually increase energy over a period of time in smaller doses, whereas in larger doses it can have a rapid more
80
Combining Western Herbs and Chinese Medicine
strongly energizing effect, which in susceptible persons can destabilize the balance of both energy and emotions. Styptics These are herbs that can be applied topically to reduce bleeding at the surface of the body, for example, Calendula. See Diaphoretics.
Sudorifics
Thrombolytics See Antithrombotics. Tonics See also Adaptogens, Nutritives. and Stimulants. These can be defined as substances that can strengthen the body as a whole or one or more of its functions. Tonics are characterized by a gradual. cumulative strengthening of function.
tranquilizers can calm Heart Spirit Disturbance or Liver. Hyperactive Yang directly, rather than by nourishing the Qi, Blood. or Yin of the Heart or Liver.
Tranquilizers, sedatives, and hypnotics Tranquilizers These herbs can have a calming effect without necessarily dulling consciousness or inducing drowsiness and sleep. The term sedative is sometimes used synonymously with tranquilizer, but it is often used to refer to a substance that calms, but may have a dulling effect on consciousness. This distinction between tranquilizers and sedatives is blurred by the fact that some of the minor tranquilizers used in conventional medicine may dull the consciousness.
Types of tonics Some of the main types of tonics as well as Sedatives In this book, when the term tranquilizer is
examples are shown in the table.
GENTIANA digestive tonic
tonify Spleen Qi. tonify Qi and Blood
ROSMARINUS hepatic tonic
tonify and move Liver Qi, tonify and move Spleen Qi
CRATAEGUS cardiac tonic
tonify Heart Qi, move Heart Blood
AVENA nervine tonic
tonify Heart and Kidney Qi and Yin, tonify Spleen Qi
CHAMAELIRIUM uterine tonic
tonify Qi and Blood of the Uterus. firm Uterus Qi
Tranquilizers Also called anxiolytics, these are substances that can have a calming effect without necessarily inducing dullness, drowsiness, or sleep. Some texts in conventional medicine distinguish between the major tranquilizers, used to treat severe mental disorders, and the minor tranquilizers, used to treat anxiety and nervous tension. In this book, the term tranquilizer. as applied to herbs, refers to the minor tranquilizing action only. Herbs with the tranquilizing action can be used to treat anxiety. They can also be used to treat such problems as insomnia, palpitations, headaches, or muscle tension and pain when these are associated with nervous tension. Examples of herbs that can have it tranquilizing a~i6n are Anemone, Humulus, Lavandula, Mentha pulegiuin, Passiflora, .Piscidia. .'and Valeriana... :: "
"
'
,
;'-:'~
'~.
Chinese equivalent The nearest equivalent in Chinese medicine is the category of herbs that calm the Spirit. More specifically, the herbs listed in the previous paragraph as
referring to a herb, it indicates that it can calm with no, or minimal, dulling of consciousness. The. term sedative refers to a herb that calms but produces mild to moderate dulling of consciousness. The distinction may be a matter of dose. The stronger herbal calming agents may have a tranquilizing effect at lower doses and a sedative effect at higher doses, for example, Piscidia or Valeriana.
Hypnotics These herbs can be defined as substances that can promote drowsiness and sleep. In conventional medicine, hypnotics have been described as intermediate between sedatives and narcotics. The difference between the three groups may, in some cases, be only one of dose. For example, the barbiturates have been used at low doses as sedatives to relieve anxiety, at intermediate doses as hypnotics to promote sleep, and at higher doses as narcotics to produce unconsciousness or anesthesia.
Tranquilizers, nervines, and cardioregulators Tranquilizing herbs can be defined as those that calm without necessarily having a dulling effect on consciousness, and which can have a direct calmm'g effect on the nervous system, rather than an
indirect calming effect via tonification. Nervines and cardioregulators (see the definitions above) can have a calming effect, but this effect is indirect, via tonification of the nervous or cardiovascular systems, respectively.
Tranquilizers and antidepressants Some herbs have the capacity to normalize emotional balance, so that they can be used as either tranquilizers or antidepressants, depending on the patient's needs and on the herbs with which they are combined. Some herbs do this indirectly by strengthening and stabilizing the function of the nervous or cardiovascular systems. These herbs are the nervines (such as Avena) and
Actions glossary the cardioregulators (such as Crataegus), respectively. Other herbs can have a direct calming or stimulant antidepressant action on the central nervous system. For example, Rosmarinus and Turnera can have some calming action but are predominantly stimulants to treat depression. Lavandula can have some antidepressant action, but the herb is predominantly a calming herb to treat anxiety and insomnia. Trophorestoratives Uterine tonics
\'
See Nervines.
See Emmenagogues.
Vermifuges Vesicants
81 See Antihelmintics. See under Counterirritants.
Vulneraries These are herbs that can proinote healing of wounds. The vulnerary action may involve the capacity to promote the regeneration of cells and tissues, especially of connective tissue, cartilage, and bone. This vulnerary action may be combined with astringent, antihemorrhagic, antiinflammatory, and antimicrobial effects. Examples are Calendula, Commiphora, Hypericum, and Symphytum.
Principles of herb combination herb combination form the bridge between the diagnosis and the choice of herbs. The patient can be diagnosed in terms of syndromes, and herbs can be selected with actions to match these syndromes. This is the basic level of herb combination. At a more sophisticated level of herb combination, herbs can be chosen not only to match the syndromes of the patient but also to coordinate with each other, in terms of temperature, taste, and herb interactions, to form a balanced combination. The better the mutual balance of the herbs in a combination, the more readily the pathologies can be corrected with minimum disturbance to the body and with maximum enhancement of the natural ability of the body to heal itself. To create a balanced and effective herb combination, it is important to apply the following principles:
T
\:.i
• use herb pairs or trios as the basis for the combination
HE PRINCIPLES OF
• follow the cautions and contraindications for each herb
Primary and secondary syndromes Many patients have complex chronic conditions, and it may emerge from the diagnosis that the patient has up to 12 or even more different syndromes, in terms of Chinese medicine. This complexity can be confusing and the practitioner has to start somewhere. It is necessary to form a treatment plan and decide which syndromes are of relatively greater importance (primary syndromes) and which are of relatively lesser importance (secondary syndromes). The decision as to which syndromes are primary and which are secondary is made partly according to which disorders are most important to the patient, and partly according to medical principles, such as the optimum sequence for treating 'root' and 'branch' in the specific case.
• differentiate the patient's syndromes into those of primary and secondary importance • match herb actions to the patient's syndromes and ensure a balance between the different herbal actions in the combination
Example A patient's main complaint is cardiac weakness with exhaustion. This is associated with Heart Deficient Qi, in terms of Chinese medicine. In addition, the patient complains of chronic insomnia, but this is more recent and of lesser importance to the patient. The insomnia is associated with Heart Spirit Disturbance. In this simple example, the primary syndrome is Heart Deficient Qi, and the secondary syndrome is Heart Spirit Disturbance. ..
• match herb temperatures to the patient's syndromes and ensure a balance of temperature in the combination • match herb tastes to the patient's syndromes and ensure a balance of tastes in the combination • use the principles of herb interaction to create a balanced combination
~
83
84
. ~. \
Combining Western Herbs and Chinese Medicine
Actions The actions of a herb are the types of therapeutic effects it has on the body (see the Actions chapter). Actions sometimes relate to the treatment of a particular organ system or even a specific organ syndrome. For example, in terms of Chinese medicine, if the patient has exhaustion associated with Heart Deficient Qi, herbs can be selected with the action of tonifying Heart Qi. In Western herbal tradition, such herbs would be said to have a cardiotonic action.
to ensure that there is a maximum balance between the herbs included in the fmal combination. This is done to .. =: maximize the herb combination's effectiveness and minimize the herb combination's side effects. The provisional combination can be screened in terms of the following factors: -~
• temperature • taste • herb interactions • contraindications
Temperature
PRIMARY AND SECONDARY ACTIONS AND HERBS Having decided which syndromes are of primary importance and which are of secondary importance, the practitioner can then select herbs with the appropriate actions to correct these syndromes. The factors that determine which actions are of primary importance and which are of secondary importance in a specific situation is discussed in the section Working with actions in the Actions chapter. In the example above, the patient has Heart Qi Deficiency as the primary syndrome and Heart Spirit Disturbance as the secondary syndrome. Crataegus can be chosen as a primary herb for this patient, since it has the primary action of tonifying Heart Qi. Passiflora can be chosen as a secondary herb for this patient, since it has the primary action of calming Heart Spirit Disturbance. However, a herb may be considered primary in one situation and secondary in another. For instance, in contrast to the example above, a different patient has the main complaint of chronic insomnia, associated with Heart Spirit Disturbance. For this second patient, cardiac weakness and exhaustion, associated with Heart Deficient Qi, is of more recent origin and of lesser importance. In this situation, Passiflora can be used as a primary herb, since the action of calming Heart Spirit is of primary importance. Crataegus can be used as a secondary herb, since the action of tonifying Heart Qi is of secondary importance.
The concept of temperature is discussed in detail in the Temperature chapter. In practice, it is important to consider two main aspects of the temperature balance of a combination: • overall temperature • range of temperature
OVERALL TEMPERATURE The overall temperature of a herb combination is the result of the temperatures of all the herbs in the combination. It will primarily depend on the number andarnount of herbs in each temperature category. The overall temperature of a combination should be a reflection of the overall temperature of the patient's syndromes.
Example The patient has influenza with mild fever and sore throat, associated with Wind Heat and Heat Toxin. The overall temperature value of the patient's syndromes is warm. Therefore, a herb combination with an overall temperature value of cool is required. The combination Achillea: influenza + sore throat can be used. In this combination, the variable-temperature herbs, Achillea and Mentha, can both have a cooling effect in the context of the Wind Heat condition, especially when they are combined with the cooling herb Sambucus. , . ,"-'
A PROVISIONAL COMBINATION Once the practitioner has decided which syndromes are primary and which are secondary, and which actions are appropriate to correct them, a provisional list of herbs can be made on the basis of a selection of herbs according to -their actions. However, this is merely the preliminary stage of herb combination. .. -' - . Screening the provisional combination The provisional list of herbs can be subjected to a series of screens or fIlters
Herb Achillea Mentha pip. Sambucus
"'--~
.." ~-
--")<:"r~':..r·-11;;';.o··
...... ~
-- . Daily dose .. ·.Temperature/·,·..... Jaste+,·;~·t~·"' . '.- ...I,.I<,'i;;.i'; .. h:b- .. ~fj .....
6g 3g 3g
warm-cool warm-cool cool
~-,
acrid, bitter acrid, aromatic acrid, sl. bitter
RANGE OF TEMPERATURE Many combinations contain some herbs that are warming and some herbs that are cooling. There are two main reasons for this:
~.
Principles of Herb Combination • mixed patterns of Heat and Cold • moderation of extremes Mixed patterns of Heat and Cold The patient may have hot patterns in some organs and cold patterns in others.
l~
Example The patient has chronic irritability, depression, and sensations of heaviness and heat, which can be aggravated by fatty foods and alcohol. However, less frequently, the patient can have abdominal distension with sensations of cold, aggravated by the consumption of excessive amounts of raw or cold foods. The primary syndromes are Liver Stagnant Qi and Liver Damp Heat, but the patient also has the secondary syndrome of Spleen Deficient Qi with Cold. A herb combination is therefore required with a majority of cooling herbs to clear Liver Damp Heat, but also with one or more warming herbs to warm the Spleen. The combination Artemisia: food intolerances + heat sensations can be used. The majority of the herbs, Artemisia, Berberis, Taraxacum, and Hydrastis, combine to cool Liver Damp Heat, and the secondary herb'~, Zingiber and Mentha, can combine to warm the Spleen. -' ._',":' '.'__ ' ,.":_._~_ ...,,
Herb Artemisia Berberis Taraxacum Hydrastis Mentha pip. Zingiber Glycyrrhiza
Ratio
~ -.t,~ ...., ..,.-:~ "';:;-,;,',"" "~'~"'fr't}!W'("'~.t:!'!cf":-t:·-.-.'!:",,
.:Te~peratur~ :;;;)~~t~}£~~;.t.+,j~~J warm-cool cool cool-cold cool warm-cool hot neutral-cool
1 1 1 0.5 0.5 0.5 0.5
bitter, aromatic bitter bitter bitter aromatic, acrid acrid, aromatic sweet
Moderation of extremes In practice, combinations for patients with hot conditions are rarely composed of cold herbs only. Cold and cool herbs may be predominant in such a combination, but there are generally also warm or hot herbs in lesser number and amount to balance and moderate the effects of the cooling herbs on the body.
Example The patient has acute influenza with fever and cough associated with Wind Heat and Lung Heat, and the overall temperature of the syndrome is hot. The combination Asclepias: influenza + fever may be appropriate, in which the leading herb Asclepias is cold. However, the hot secondary herb fresh Zingiber is included to moderate the potentially depressing effect of cold Asclepias on the patient's metabolism. (See the Asclepias chapter for cautions on the use of this combination.)
Asclepias Achillea Lobelia Zingiber (fresh)
6g 6g 0.6g 3 slices
cold warmcool warmcool hot
'bitter acrid, bitter acrid . acrid, aromatic
85
Similarly, even if the patient's overall tempera~e classification is cold, combinations are rarely composed of hot herbs only. The concept of temperature is discussed in detail in the Temperature chapter.
Taste Temperature gives one approach to balancing a combination, and taste gives a different but complementary perspective. Once the provisional combination has been screened according to considerations of temperature, it can be screened according to taste. As with herb actions, the nature and relative importance of the patient's syndromes will decide which taste properties are of primar:y importance in a combination and which are of secondary importance.
Example The patient has recurring fever with postfebrile debility associated with both cardiac and digestive weakness. In Chinese herbal medicine terms, the patient has Retained Pathogen producing the recurring fever and also Deficient Qi of both the Heart and Spleen. Since the bitter taste can be associated with antipyretic, cardiotonic, and digestive tonic actions, it is likely to be the most important taste in a combination selected to treat this patient. However, to produce a balanced combination, the bitter taste would be generally combined with other taste properties to complement and moderate its effects. The combination Cinchona: recurring fever + cardiac weakness can be used for this patient. Herb
Ratio
Temperature.
Taste
Cinchona Achillea Echinacea Crataegus Pseudostellaria Glycyrrhiza Zingiber
1 1 1 1 1 0.5 0.5
cool warm-cool cool 51. warm neutral neutral-cool hot
bitter acrid, bitter acrid, bitter, 51. sweet sour, sweet sweet, 51. bitter sweet acrid, aromatic
BALANCING THE FIVE TASTES The combination Cinchona: recurring fever + cardiac weakness is a good example of the balancing of the five tastes and of the relationship between tastes and actions. In brief, the bitter, sweet, and acrid tastes can be regarded as primary. the bitter taste being the most important, and the ~our and aromatic tastes are of secondary importance. The contribution of each taste to the final balance of this combination is discussed here.
Bitter In ~ combination, the bitter taste property can be
Combining Western Herbs and Chinese Medicine
86
associated with three different actions, shown in the table with their associated temperatures and herbs: Action
Temperature
bitter cardiotonic
cool
Cinchona
bitter digestive tonic
neutral
Achillea, Cinchona
bitter antipyretic
cool
Achillea, Echinacea, Cinchona
Sweet In this combination, the sweet polysaccharides of Echinacea may be associated with the immunoregulatory action, or in Chinese herbal medicine terms, they can tonify the Defensive Qi. The sweet constituents of Crataegus, Glycyrrhiza, and Pseudostellaria may support both the cardiotonic and digestive tonic actions, or in Chinese herbal medicine terms, the three herbs tonify the Heart and Spleen Qi. Acrid If this combination is used during the acute febrile phase, the acrid property is of primary importance in clearing both Wind Heat and Retained Pathogen from the surface. This is associated with the diaphoretic and antimicrobial actions of Achillea, Echinacea, and Zingiber. However, during the remission phase, the diaphoretic aspect of the acrid property is of secondary importance. Sour The sour taste, contributed by Crataegus, is of secondary importance in this combination and is associated with a cardiotonic action, that is, with the tonification and stabilization of Heart Qi. Aromatic The aromatic property, contributed by Zingiber, is also of secondary importance and is associated with the carminative action, that is, with warming and moving the Qi of the Spleen, Stomach, and Intestines to assist in the digestion. Concepts of taste are discussed in detail in the Taste chapter, which contains the clinically useful table Balancing
the tastes.
Principles ofherb interaction Assessment in terms of the principles of herb interaction provides the third stage of screening. This is done to check the mutual balance of the herbs in the provisional combination. In this book, four main types of beneficial interactions between herbs are discussed: • complementarity • emphasis • extension • moderation
COMPLEMENTARITY One herb can be said to complement another when the two herbs have the same action, but operate via different mechanisms. There are two main types of complementarity: • two herbs can have the same action via very different routes • two herbs can have the same action by mechanisms that are slightly, but significantly, different Complementarity by very different mechanisms In this case, the herbs have similar end results but attain those results by completely different routes. They, thus, complement each other's effects.
Example Both Gentiana and blackstrap molasses can be used for debility with anemia. Both can be said to tonify the Qi and Blood, but they do this by very different mechanisms. Gentiana can act as a bitter tonic to stimulate the appetite, digestion, and absorption, thus tonifying the Spleen and indirectly tonifying Qi and Blood. Molasses can act "as a sweet tonic to supply nutrients such as sugars and minerals, and thus strengthens the Qi and Blood by a more direct route.
_"'i
~
~-:~
Complementarity via slightly different mechanisms The two herbs can have the same actions via similar chemical mechanisms, perhaps even involving constituents from the same chemical group. However, there may be small, but important, differences in the chemistry of their respective active constituents. These chemicals may be different enough to affect different receptor sites in the tissues. The two herbs may each do something that the other cannot, and thus, they have complementary effects.
Example Both Astragalus and Glycyrrhiza can have a sweet adaptogenic tonic action. This may be due to the presence of pentacyclic triterpenoid saponins. In Astragalus, the main saponins are the astragalosides, and in Glycyrrhiza, the main saponin is glycyrrhizin. Both astragalosides and glycyrrhizin may have an adaptogenic action. They have chemical similarities, but they are sufficiently different so that they may affect different receptor sites and thus achieve their adaptogenic effects by somewhat different pathways. EMPHASIS Most herbs can have a number of different actions. For a particuiar h~rb, which of these pot~~tial actions manifest or predominate in a particular situation depends in part on the other herbs with which it is combined. To emphasize a specific action of one herb, it can be combined with another --
Principles of Herb Combination herb for which that action is primary.
Examples For Angelica archangelica, the circulatory stimulant action is of secondary importance. However, this action can be emphasized by combining Angelica archangelica with Zanthoxylum, for which the circulatory stimulant action is of primary importance. Similarly, for Matricaria, the tranquilizing action is secondary. However, this action can be emphasized by combining Matricaria with Passiflora, for which this action is primary. EXTENSION Each herb has a limit to its range of actions. The addition of a second herb can extend the range of actions of the pair beyond the limitations of the first herb. In this book, the principle of extension refers to a pair of herbs with a common action to which one or both herbs contribute an additional action. :.-,':"'1
Example Achillea and Asclepias can both have an antipyretic action and are a specific pair for acute respiratory infections with fever. In addition to the common antipyretic action, Asclepias can extend the range of the pair beyond the limitations of Achillea by contributing the expectorant, bronchial antispasmodic, and tranquilizing actions. Conversely, Achillea can extend the range of the pair beyond the limitations of Asclepias by contributing the bitter digestive and general tonic actions. MODERATION One herb can be said to moderate another herb when it reduces the potential adverse effects of the other herb in the body. The potentially adverse effects of a particular herb may be associated with its temperature, taste, actions, or toxic effects. Temperature For example, taken long-term, the cooling anti-inflammatory herb Berberis may aggravate a condition of Spleen Deficiency with Cold. The hot herb Zingiber may be used to moderate this potentially adverse effect. Taste For example, taken long-term, the sweet tonic herb Lycium may aggravate a condition of Stagnation of Qi with Damp. The aromatic herb Citrus may be used to moderate this potentially adverse effect. The Balancing the tastes table in the Taste chapter gives many examples of using one taste to moderate another. Action For example, taken long-term, the sedative and analgesic herb Piscidia may aggravate a condition of Defi-
87
cient Heart and Kidney Qi, that is, it may depress the function of the cardiovascular and nervous systems. The cardiovascular and nervous stimulant herb Rosmarinus may be used to moderate this potentially adverse effect. The Balancing actions table in the Actions chapter gives many examples of using one action to moderate another. Toxicity Alterative herbs, such as Arctium and Taraxacum, taken in large doses, may result in the release of accumulated toxins into the system at a rate beyond the ability of the body to detoxify or excrete. This may trigger or aggravate inflammatory conditions. Demulcent anti-inflammatory herbs, such as Althaea, may help to relieve resulting inflammation, and hepatoprotective and detoxicant herbs, such as Glycyrrhiza and Zingiber. can moderate resulting toxic effects. NEGATIVE HERBAL INTERACTIONS In Western herbal tradition, less emphasis is placed on the mutual incompatibility and antagonism of herbs than in China. From the viewpoint of phytopharmacology, it is theoretically possible that there may be negative interactions between the constituents of one herb and another. However, when herbs are used in combination, balanced according to their temperature and taste, and in the therapeutic doses recommended in this book, negative interactions may be unlikely.
Herb pairs and trios as the basis for combinations Herb pairs, trios, or even foursomes, can often be used as a useful starting point in building a balanced combination. HERB PAIRS A herb pair. in this context, refers to two compatible herbs, frequently used together, which complement, emphasize, extend, or moderate each other's actions. The herb pair can be said to be a basic unit of herb combination, and each of the materia medica chapters in this book gives examples of useful pairings of the title herb. Pair Examples The following examples of herb pairs illustrate the principles of complementarity, emphasis, extension, and moderation:
• Echinacea + Baptisia Both herbs are general-purpose antimicrobials that complement each other by inhtbiting microbial growth via different chemical routes. Also, they extend each other's uses into different areas:
88
Combining Western Herbs and Chinese Medicine
.. :.-:'~
:-<;;.
Baptisia is specific for infections of the throat and lymph system, and Echinacea is specific for infections of the sinuses or bronchi.
• Myrica + Capsicum The primary actions of Myrica are anticatarrhal and astringent. Thecirculatory stimulant action is of secondary importance, but this <:lction can be emphasized by combining Myrica with Capsicum, for which the circulatory stimulant action is primary.
Herb Rheum Rhamnus Foeniculum Zingiber
....
Ratio
Temperature
Taste ...
1.5 1.5 0.5 0.5
cool-cold cool 51. warm hot
bitter, sour bitter aromatic, 51. acrid acrid. aromatic
-
-
• Rheum + Foeniculum Rheum is the primary herb in this pair and is used as a purgative to treat constipation. It is frequently paired with Foeniculum since the carminative action of the latter can moderate the tendency of Rheum to produce intestinal spasms when used in high doses.
ADVANCED HERB COMBINING In advanced herb combination, herb pairs, trios, or foursomes from a preexisting combination can be combined with others from another preexisting combination to form a new combination that is specific for the patient's needs. This is discussed in the next chapter Practical herb combination.
HERB TRIOS By adding a comp,atible single herb, a herb pair can be expanded to form a herb trio. Trio Examples The herb pair Crataegus + Convallaria, used to treat cardiac arrhythmia, can be expanded to the following trios:
• Crataegus + Convallaria + Cinchona This trio treats cardiac arrhythmia with digestive weakness.
• Crataegus + Convallaria + Sarothamnus This trio treats cardiac arrhythmia with cardiac edema.
• Crataegus + Convallaria + Leonurus This trio treats cardiac arrhythmia with anxiety. In each trio, all three herbs can treat cardiac weakness and arrhythmia, but the third herb gives a different additional emphasis to the combination.
Contraindications Screening in terms of temperature, taste, and actions is the first step in ensuring the safety of a herb combination. The final step in the screening process is to check for specific herb cautions and contraindications, especially in the context of the patient's specific syndromes and any conventional drugs that have been prescribed. This topic is also discussed in the chapters Practical herb combination and Safety in clini-
cal practice. Examples Three examples of herbs with contraindications in certain situations or above specific dose levels are:
• Cinchona
contraindicated for cinchonism or thrombocytopenia
• Glycyrrhiza
high doses are contraindicated for hypertension or hypokalemia contraindicated for intestinal obstruction or abdominal pain of unknown origin
• Rhamnus HERB FOURSOMES The addition of two compatible pairs can result in the formation of four herbs as a functional unit. Example Rheum + Rhamnus is a pair of primary purgative herbs for acute or chronic constipation, and Foeniculum + Zingiber is a pair of primary herbs for intestinal spasms and flatulence. .. " .. These four herbs' together make up the combination Rheum:,acu~~ ,ccmstipation.. In this combination, Rheum + Rhamnus is the primary pair to treat acute constipation. Foeniculum + Zingiber is the secondary pair since its dose is only one-third that of the primary pair. Its role is to moder-
i
ate the potential spasmodic action of Rheum and Rhamn~:.. ~~;~ on the intestines. . .
The cautions and contraindications on the use of the herbs that are included in the combinations in this book are given in: • the materia medica chapters for those herbs with a chapter of their own • the table in the Additional herbs chapter for those herbs that do not have a chapter of their own
It is the responsibility of the practitioner to to be aware of the cautions on the use of the individual herbs, comparing as many sources as possible, and referring to primary research data when this is available.
'I
Practical herb combination T
HERE ARE TWO
Using a preexisting combination
main approaches to practical herb com-
bination. Practitioners can select a preexisting combination, or they can create a new one. In either case, the same principles of herb choice apply that were discussed in the previous chapter. The herbs that are combined must match the syndromes of the patient and also interact with each
There are three main possibilities: • using a preexisting combination without alteration • modifying a preexisting combination
other to produce a balanced combination.
• combining elements of different preexisting combinations
Checklist USING A PREEXISTING COMBINATION Answering the questions in the following checklist can help the practitioner to ensure that the combination selected is
WITHOUT ALTERATION A preexisting combination can be used unaltered if it is a good match for the patient's syndromes. If the condition of the patient changes, the initial combination chosen may no
well balanced, effective, and safe.
1. Which disorders are primary and which are secondary?
longer be appropriate and must be stopped, modified, or replaced by a different combination.
2. Which herbal actions match the patient's syndromes?
Example The patient has a history of allergic asthma and is now in the acute phase. The patient has moderately severe wheezing and occasional coughing. The Lung pulse is wiry and the tongue is slightly purple. The diagnosis is Stagnant and Rebellious Lung Qi. The preexisting combination Lobelia: acute asthma (Lung Stagnant Qi) can be used to treat these syndromes and this patient's condition. .
3. What are the temperature requirements of the combination? 4. What is the optimum balance of taste properties? 5. Which herb interactions can be utilized? 6. Which herb pairs or trios can form a useful starting point? 7. Are there contraindications for this patient?
89
90
Combining Western Herbs and Chinese Medicine
;-Hert)7~~~~iid~tCff¥~~~~~;~J~T~~t~rfJ~~~'c~
. '.0:
Ephedra Lobelia Prunus Glycyrrhiza
1 1 1 1
warm warm-cool neutral neutral-cool
acrid, 51. bitter acrid bitter, aromatic sweet
Caution
Before using this combination, it is necessary to work through the questions in the checklist at the start of this chapter (see also the two examples in the section Creating a new combination). For this combination, it is especially important to read the practical notes in the Lobelia chapter, and the precautions and restrictions on the use of Ephedra in the Additional herbs chapter.
MODIFYING A PREEXISTING COMBINATION If a preexisting combination does not exactly match a situation, or if it ceases to do so, it can be suitably ~odified. Modification refers to relatively minor alterations to the constituent herbs and their doses, reflecting relatively small changes in the treatment aims of the combination. The modified combination thus retains its original core identity. If the alterations to the constituents and treatment aims become so radical that the combination loses its core identity, this is no longer regarded as a modification, but as a change to a different combination. A combination can be modified in four main ways: • addition of one or more herbs • removal of one or more herbs • replacement of one or more herbs • change of the dose of one or more herbs
Thymus Prunus Lobelia Glycyrrhiza
1 1 0.5-1 0.5-1
warm-cool neutral warm-cool neutral-cool
aromatic bitter, aromatic acrid sweet
Caution Before using this combination, it is necessary to work through the questions in the checklist at the start of this chapter (see also the two examples in the section Creating a new combination). For this combination, it is especially important to read the practical notes in the Lobelia chapter. Example 2: addition and dose change The patient has allergic asthma as the primary disorder, and allergic urticaria as a secondary disorder. The signs and symptoms are otherwise as for the previous patient with asthma. The diagnosis is Stagnant and Rebellious Lung Qi as the primary syndrome, with Exterior Wmd and Kidney Qi Deficiency, associated with the allergic urticaria, as the secondary syndromes. The following modification of Lobelia: acute asthma can be used:
Ephedra Lobelia Prunus Schisandra Arctium (seeds) Glycyrrhiza
1 1 1 0.5 0.5 0.5
warm warm-cool neutral warm cool neutral-cool
acrid, 51. bitter acrid bitter, aromatic sour acrid, 51. bitter sweet
• Ephedra, Lobelia, and Prunus remain in the combination with their dose unchanged since the primary problem is asthma, associated with Lung Stagnant and Rebellious Qi
The following two examples illustrate these four types of modification. Example 1: removal and replacement The patient does not have asthma but instead has a spasmodic, dry cough. The Lung pulse is wiry and the tongue is slightly purple. The diagnosis is that of Stagnant and Rebellious Lung Qi. The previous combination of Lobelia: acute asthma could be modified by removal of Ephedra, which is not necessary in this case since there is no asthma. This would leave the herbs Lobelia, Prunus, and Glycyrrhiza, which can be used together to treat spasmodic, dry cough. However, a stronger combination would be made by the replacement of Ephedra with Thymus, which is specific for spasmodic cough and combines well with each of the other three herbs. This new combination is described as Thymus: spasmodic cough (Lung Rebellious Qi) in the chapter on
Thymus.
• Schisandra and Arctium are added, in lesser amounts than the primary herbs, to treat the secondary condition of allergic urticaria (Arctium combines with Ephedra to clear External Wind)
• Schisandra
combines with Glycyrrhiza to strengthen the Kidney and Heart Qi, thereby reducing the potentially depleting effect of Ephedra and allowing for a reduced dose of Glycyrrhiza relative to the original combination.
Caution
Before using this combination, it is necessary to work through the questions in the checklist at the start of this chapter (see also the two examples in the section Creating a new combination). For this combination, it is especially important to read the practical notes in the Lobelia chapter, and the precautions and restrictions on the use of Ephedra in the Additional herbs chapter.
~
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Practical Herb Combination
91
COMBINING ELEMENTS OF DIFFERENT PREEXISTING COMBINATIONS A new combination can be made by using herbal units from two to three preexisting combinations. These herbal units can be single herbs, herb pairs, herb trios, or even larger groups of herbs. If appropriate, other herbs, which are not in the preexisting combinations can be included in the new combination.
1 1 1 1
0.5-1 0.5-1 0.5 5-10
warm warm-cool sl. warm cold warm neutral hot hot
aromatic, bitter, acrid aromatic, acrid aromatic, bitter, 51. acrid bitter sweet, aromatic, bitter sweet acrid, aromatic acrid
drops
Example The patient has recurring headaches, which can be triggered by any factor that aggravates either of her chronic conditions of anxiety and anemia. The headaches may occur with sensations of cold either at the body surface or within the body. The pulse is wiry, especially in the Liver position, and somewhat choppy and irregular. The tongue is pale and slightly thin. The diagnosis is as follows:
• Primary syndrome
Liver Hyperactive Yang
• Secondary syndromes
Liver Deficient Blood Heart Spirit Disturbance Exterior Cold Interior Cold
The patient requires a balanced herb combination that will address these syndromes and the patient's specific symptoms. Neither of the two preexisting combinationsLavandula: headache + anxiety and Salvia: headache + anemia -meets all the requirements of the patient.
Lavandula: headache + anxiety
Salvia: headache + anemia
Liver Hyperactive Yang + Heart Spirit Disturbance
Liver Hyperactive Yang + Liver Deficient Blood
Lavandula
1
Salvia off.
1
Salvia off.
1
Rosmarinus
Mentha pul.
1
Artemisia abs.
Anemone
1
Angelica sin.
Valeriana
1
Lycium (fruit)
Glycyrrhiza
0.5 0.5
Valeriana
1 1 0.5-1 0.5-1 0.5-1 0.5
Zingiber
Rosmarinus Salvia Lavandula Anemone Angelica sin. Lycium Zingiber Capsicum
Zingiber
The Lavandula combination treats the anxiety but not the anemia, and the Salvia combination treats the anemia, but may not be sufficient to tre~t the anxiety. The new combination below incorporates elements from both preexisting combinations.
As shown in the table below, the new combination contains herbs that treat all the syndromes and symptoms of the patient. It contains Anemone and Lavandula to treat anxiety associated with Heart Spirit Disturb.ance, taken from the preexisting Lavandula combination. It also contains the sweet tonics Lycium and Angelica and the aromatic bitters Rosmarinus and Salvia, taken from the preexisting Salvia combination. Both these pairs can treat anemia associated with Liver Deficient Blood. In addition, the new combination contains Capsicum, which was not present in either of the preexisting combinations' to treat Interior Cold, and to assist Zingiber in clearing Exterior Cold. Herbs "",:" ,'," " Hyperactive Liver Yang
headache (non-specific)
Lavandula, Rosmarinus, Salvia, (Anemone)
Heart Spirit Disturbance
anxiety
Anemone, Lavandula, (Salvia)
Liver Deficient Blood
anemia
Lycium, Angelica sin., Rosmarinus, Salvia
Exterior Cold
sensations of cold at surface
Interior Cold
sensations of internal cold
_ Zingiber
Capsicum
Caution Before using this combination, it is necessary to work through the questions in the checklist at the start of this chapter (see also the two examples in the next section: Creating a new combination). Note for beginners Creating a new combination by combining elements of different preexisting combinations is an advanced technique. If the technique is used by those who are inexperienced in herbal medicine, it can easily result in an assortment of ill-matched fragments rather than in a carefullypalanced and harmonious combination. . Beginners are recommended first to become thoroughly familiar with the properties of the individual herbs and with the principles of herb combination. They can then develop
--- \
.. :::?,"!
Combining Western Herbs and Chinese Medicine
92
their skills by using preexisting combinations, with simple modifications where appropriate, and by learning to create simple new combinations from first prinCiples.
Creating a new combination
• tonify Heart Yin and clear Deficiency Heat herbs with this action, such as Salvia officinalis, Salvia miltiorrhiza, and Ophiopogon, are required to treat the primary syndromes of Heart Deficient Ym and Heart Deficiency -Heat associated with hot flashes, insomnia, and night sweats
• calm Heart Spirit herbs with this action, such as When creating a new combination to match the specific syndromes of the patient, it is necessary to work through the sequence of questions in the checklist at the start of this chapter. This is illustrated by the following two examples, the first with no mistakes and the latter with mistakes. AN EXAMPLE WITH NO MISTAKES In this first example, for simplicity, no mistakes are made in the herb selection. The second example is more complex since it gives examples of mistakes that can be made at each stage of the herb selection process. Signs and symptoms The patient is a woman whose main complaints are exhaustion, which is sometimes accompanied by arrhythmia when the exhaustion is severe, and menopausal hot flashes. She also has insomnia. and night sweats, but these are of lesser importance. Although she has hot flashes, at other times she can feel slightly cold. Her pulse is slightly rapid and slightly irregular, thin, and forceless. Her Heart pulse especially is lacking in force. Her tongue is slightly red and thin, but it also has tooth marks, especially at the tip. Primary and secondary syndromes A simplified diagnosis for this patient is that she has three primary syndromes: Heart Deficient Qi, Heart Deficiency Ym, and Heart Deficiency Heat. The Heart Deficient Qi manifests in exhaustion from cardiac weakness with occasional arrhythmia. The Heart Deficiency Heat is associated with Heart Deficient Ym and manifests in menopausal hot flashes. In addition to these three primary syndromes, and resulting from them, she has the secondary syndrome Heart Spirit Disturbance, manifesting in insomnia. In addition to these three primary syndromes, and resulting from them, she has the secondary syndrome of Heart Spirit Disturbance, manifesting in insomnia. Actions
Herbs with the following actions are required:
• tonify and stabilize Heart Qi ·'~herbs with this aCti<:)ll,' such as Crataegus and Leonurus, are required to treat the primary syndrome of Heart Deficient Qi associated with cardiac weakness, exhaustion, and arrhythmia
Anemone, are required to treat the secondary syndrome of Heart Spirit Disturbance associated with insomnia There is considerable overlap between these actions and herbs. For example, Anemone can both calm Heart Spirit and clear Heat, and Leonurus can both tonify Heart Qi and calm Heart Spirit. Provisional combination These six herbs can be listed as a provisional combination, which can now be evaluated in terms of their temperature, taste, herb interactions, and herb pairs.
Crataegus Leonurus Salvia off. Salvia mil. Anemone Ophiopogon
1 1 1 1 1 1
51. warm neutral warm-cool cool cold cool
sour, sweet sour, 51. bitter aromatic, acrid bitter bitter sweet, 51. bitter
Temperature During hot flashes, the temperature of the patient's syndromes can be classified as warm-hot, but at other times it can be classified as neutral-cool. The sensations of heat are associated with Heart Deficient Yin and Heart Deficiency Heat. The occasional slight sensations of cold, and the phenomenon of fluctuating temperature, can be associated with Heart Deficient Qi. The combination therefore requires not only cool or cold herbs to clear the Heat, but it also requires neutral herbs and variable-temperature herbs to help stabilize the temperature fluctuations. Of the herbs listed in table above, Anemone is cold, Ophiopogon and Salvia miltiorrhiza are cool, Crataegus and Leonurus are neutral or close to it, and Salvia officinalis can have warm-cool temperature effects depending on the situation. These herbs, in combination, can thus have a balanced and appropriate temperature effect for this patient. Tastes This combination illustrates a balance between the five taste properties, the primary tastes being sweet, sour, and bitter, and the secondary tastes being aromatic and acrid.
• sweet
sweet constituents of Crataegus may assist tonification of Heart Qi, and sweet constituents of Ophiopogon may assist tonification of Heart Yin
Practical Herb Combination • sour
sour constituents of Crataegus and Leonurus may help to firm and stabilize Heart Qi
• bitter
bitter constituents of Anemone, Ophiopogon, and Salvia miltiorrhiza may help to clear Heart Heat and to calm Heart Spirit
• aromatic aromatic constituents of Salvia officinalis may help to calm Heart Spirit to treat insomnia
• acrid
in the specific case of Salvia officinalis, acrid constituents may regulate the surface of the body and help to normalize body temperature
Herb interactions and herb pairs The provisional combination illustrates the use of the principles of herb interaction, that is, complementarity, emphasis, extension, and moderation. It also illustrates the use of various useful herb pairs, four of which are briefly considered here.
Crataegus + Leonurus I
•
These two herbs complement each other in tonifying and firming Heart Qi. They also extend each other's cardiotonic action into different areas: Crataegus is specific for arrhythmia with exhaustion, and Leonurus is specific for palpitation with nervous tension.
Salvia officinalis + Anemone Both of these herbs can help to clear Heart Deficiency Heat in the treatment of menopausal hot flashes. The tranquilizing action of Salvia is secondary, but it can be emphasized by Anemone, for which this action is primary. The potentially warming and moving aromatic constituents of Salvia can help to moderate the tendency of Anemone to have cooling and sedative effects on metabolism.
Salvia officinalis + Ophiopogon These two herbs complement each other in tonifying Heart rm and clearing Heart Deficiency Heat in the treatment of excessive sweating, for example, during menopause. Ophiopogon can extend this effect by tonifying the Fluids, to reduce the effects of dehydration, and Salvia can extend it by helping to tonify Blood, to nourish the Spirit and thus treat the insomnia.
Salvia officinalis and Salvia miltiorrhiza These two herbs complement each other in clearing Heart DeficiencY Heat tq treat menopausal hot flashes and insomnia. S. officinalis extends this effect by its surfaceactive effect of regulating sweating.
T
Contraindications This is a carefully balanced combination in terms of the actions, temperatures, tastes, and inter-
93
actions of the herbs. Potential adverse effects of moist sweet Ophiopogon and cold sedative Anemone are unlikely to manifest themselves because of the moderating effects exerted by the other herbs in the combination. However, the trio, Leonurus, Salvia officinalis, and Salvia miltiorrhiza, are inadvisable if there is excessive menstrual bleeding or if there is a likelihood of conception. Also, this is a theoretical example, and for a real patient, practitioners are advised to read carefully the cautions for all the herbs in any combination to be used. Conclusion The provisional combination has stood up to screening in terms of temperature, taste, interactions, and contraindications, and is ready for use.
AN EXAMPLE WITH
MISTAKES
This example assumes that the practitioner makes essentially the correct diagnosis but makes .errors of emphasis in deciding which syndromes are of primary importance and which are of secondary importance. This results in the incorrect choice of herbs. Signs and symptoms The patient complains of exhaustion, some sensations of cold in the extremities, lethargy, a sensation of heaviness in the limbs, and a tendency to weight gain. His pulse is empty, especially at the Spleen position, and slightly empty at the Kidney position. The pulse does not have the hard and sharp feel of the wiry quality, but feels instead congested and sluggish. It is also somewhat slippery and slightly slow. The tongue is slightly pale, with tooth marks, and a moist white coat. Primary and secondary syndromes decides that:
The practitioner
• the primary syndromes are Spleen Deficient Qi, Spleen Deficient Yang, and Kidney Deficient Yang • the secondary syndrome is Spleen not transforming Fluids
Mistakes Spleen Deficient Qi is in fact primary. However, the other primary syndromes are Spleen Stagnant Qi and Spleen Damp. In this case, Spleen Deficient Yang and Kidney Deficient Yang are not primary syndromes, but rather, they are secondary syndromes. For this patient, the slightly slow pulse, the moist white tongue coat, the weight gain, and the cool extremities are not primarily signs of Deficient Yang. Rather, they are primarily due to Spleen Qi Stagnation and obstruction of the channels by Damp.
Note: The practitioner's error of emphasis may seem obvious. However, when seeing a patient for the first time, there
94
Combining Western Herbs and Chinese Medicine
is often such a wealth of diagnostic data that it is hard to perceive any clear patterns. It can be hard for the practitioner to know where to begin, and it can be especially difficult to decide which syndromes are primary and which are secondary. Actions The practitioner chooses three herbs with the action of tonifying Spleen and Kidney Yang and three herbs with the action of tonifying Spleen and Kidney Qi, resulting in the Provisional combination shown below.
Mistakes There is an unnecessarily large number of Yang tonics, Kidney tonics, and sweet nutrient tonics for the Spleen. These mistakes are discussed in more detail below. There are not enough moving and drying herbs with anticatarrhal, carminative, and circulatory stimulant action. Provisional combination
Panax ginseng (red) Cinnamomum bark Turnera Serenoa Glycyrrhiza Ziziphus
1.5 1.5 1.5 1 1 1
warm hot warm neutral neutral-cool neutral
sweet, sl. bitter acrid, sweet. aromatic bitter, aromatic, acrid sweet, sl. sour sweet sweet
Temperature The practitioner diagnoses the overall temperature of the patient as cool-cold, and chooses a herb combination that is warm-hot in its overall temperature. The warming herbs in the provisional combination are specifically aimed at tonifying the Yang of the Kidney and Spleen.
Mistakes
The coolness of the extremities in this case is primarily due to Spleen Qi Stagnation and obstruction of the channels by Damp, and not due to Yang Deficiency and Cold. It is more accurate to say that the overall temperature of the patient is slightly cool so that the herb combination's overall temperature should be only slightly warm. Also, if warming herbs are used in the combination, they should be: • aimed at moving the Qi and clearing Damp obstruction, rather than warming the Kidney • balanced with cool herbs to maintain the overall temperature at only slightly warm Tastes There is a large number of sweet nutrient tonics in the provisional combination. This is slightly offset by Cinnamomum and Turnera, which have acrid and aromatic properties. " '.
\-.1.
Mistakes As a result of the initial error of emphasis in differential diagnosis, the practitioner makes two important mistakes in the choice of taste properties.
... _~-~~=".
1. Stagnation and Damp obstruction are primary syn- .. '::: dromes. The first mistake is therefore the choice of too many sweet tonics, which may increase the Stagnation and Damp. aggravating the exhaustion. lethargy, and weight gain. The acrid and aromatic properties of Cinnamomum and Turnera are not 'enough to moderate this effect of the sweet tonics since these herbs do not primarily move Qi and clear Damp obstruction. There should be fewer sweet and moistening herbs. such as Serenoa. Glycyrrhiza. and Ziziphus, and more aromatic and drying herbs. such as Angelica archangelica and Juniperus, in order to assist the Spleen in transforming Fluids (see the Preferred combination below).
2. The second error provides an excellent example of the importance of choosing the correct aspect of a particular taste property (see the Acrid section in the Taste chapter for a more complete discussion of this point). The practitioner chooses herbs with the warming and stimulating aspects of the acrid property. In this situation, warming and stimulating acrid herbs such as red ginseng. Cinnamomum bark, and Turnera. can create Interior Heat that can combine with Stagnation and Damp to produce Damp Heat syndromes, resulting in symptoms such as irritability, eczema, cystitis, prostatitis, or other inflam, matory disorders. This patient requires herbs that have the moving, dispersing. penetrating. and drying aspects of the acrid property, such as A. archangelica, Phytolacca, and Zanthoxylum (see Preferred combination below). Herb interactions The practitioner is focusing on complementarity rather than moderation, and this is a mistake. In this situation. these two principles of herb interaction are of equal importance. It is important to have moving and drying herbs that complement each other's effect, but it is of equal importance to use cooling herbs to moderate warming herbs as well as moving herbs to moderate sweet tonic herbs. (Complementarity and moderation are principles of herb interaction that are described in the chapter Principles
ofherb combination). Pairs and trios The provisional combination contains such excellent pairs as Panax + Cinnamomum, Turnera + Serenoa. and Glycyrrhiza + Ziziphus (see the Cinnamomum, Glycyrrhiza. and Turnera chapters). It also contains two important trios:
• Panax + Cinnamomum + Turnera warming stimulants to tonify Yang
• Serenoa + Glycyrrhiza + Ziziphus moistening, sweet tonics to tonify Qi
Practical Herb Combination
95
Mistakes
The provisional combination in itself In the case of a patient
moving Stagnation, and clearing Damp. This illustrates an important principle.
for whom the practitioner's diagnosis were correct, the provisional combination would still be too extreme for a first prescription. It contains three warming stimillants and three moistening sweet tonics, which is too many for a first prescription. It would be safer if the combination had the following balance:
Unfortunately, these pairs and trios are inappropriate in this situation since they focus on tonifying Yang and Qi, rather than tonifying the Spleen to transform Damp,
Before using a trio ofherbs, each of which has the same action, it is essential to ensure that the diagnosis is correct.
If the wrong action has been selected, the use of a trio will multiply that mistake three-fold. Contraindications In addition to the use of moist sweet _ tonics in a situation of Stagnation and Damp, there is the specific caution on the use of Panax: ginseng for patients with Qi Stagnation or constraint. Panax: ginseng, and especially red ginseng, may aggravate conditions of Qi constraint and produce unpleasant sensations of heat and obstruction in the chest (see the Additional herbs chapter). This may be aggravated by the use of the trio of herbs Panax:, Cinnamomum, and Turnera, which stimulate and warm, rather than disperse Stagnatio~. Summary of the mistakes Two questions are raised by the
• 2 warming stimulants to tonify Spleen and Kidney Yang, such as Panax: ginseng and Turnera • 2 moistening sweet tonics to tonify Spleen Qi, such as Glycyrrhiza and Serenoa • 1-2 herbs to move Spleen Qi and transform Damp, such as Citrus and Juniperus Even if these last two herbs were in lesser amounts than the first four, they help to prevent the tendency of the sweet tonics to aggravate patterns of Stagnation and Damp. It should be emphasized that the provisional combination is not incorrect in itself. However, it is more appropriate for a later prescription when the practitioner has noted the reactions of the patient to previous prescriptions, and is more certain of the diagnosis. Preferred combination The following combination fits the correct diagnosis and satisfies screening according to temperature, taste, herb interactions, and contraindications.
discussion above: i~
_
• what would be the overall effect of the mistakes made in herb selection for this patient? • would the provisional combination be appropriate for a different patient, for whom the practitioner's diagnosis is correct?
}:;t'_
Overall effect of the mistakes The essential diagnostic error is that Deficient Yang of Spleen and Kidney are not primary syndromes in this case. The key primary syndromes are Spleen Stagnant Qi and Spleen Damp. This diagnostic error results in the incorrect choice of herbs with the following effects on this patient:
• an excess ofwarming and sweet stimulant herbs increases Stagnant Qi, Damp, and Heat, resulting in inflammatory disorders, such as eczema or cystitis, or emotional disorders, such as irritability or depression with sensation of disturbance and constraint in the chest
• an excess ofmoistening and sweet tonic herbs '¥i {
I
T
increases Damp and associated Stagnation, resulting in aggravation of the original symptoms of exhaustion, lethargy, and weight gain; in addition, there may be obstruction of sinuses or bronchi by excessive production of mucus
Herb
Ratio Temperature Taste
Astragalus Zanthoxylum (bark) Angelica arc. Juniperus
1.5 1 1 1
51. warm
Phytolacca Arctium (root)
1 1
cool cool
hot warm 51. warm
sweet acrid, aromatic, bitter bitter, acrid, aromatic aromatic, 51. acrid, 51. sour acrid 51. acrid, 51. bitter
Actions The moistening sweet tonics in the previous combination-Serenoa, Glycyrrhiza, and Ziziphus-have been replaced with the more drying sweet Spleen tonic Astragalus. The metabolic stimulant Yang tonics-red ginseng, Cinnamomum bark, and Turnera-have been replaced by the anticatarrhal circulatory stimulant Zanthoxylum and by Angelica archangelica and Juniperus, which have anticatarrhal, diuretic, and carminative actions. Juniperus also has the secondary action of tonifying the Kidney. In this combination, Phytolacca and Arctium assist Zanthoxylum, Angelica, and Juniperus to clear obstruction of the channels by Damp and Phlegm.
Temperature The overall temperature of the preferred combination is slightly warm. Hot Zanthoxylum and warm Angelica are balanced by cool Arctium and cool Phytolacca.
96
Combining Western Herbs and Chinese Medicine
...-'~i&\
This matches the slightly cool overall temperature of the patient. Also. the warming herbs in the preferred combination are aimed at moving Stagnation and clearing Damp obstruction. rather than at tonifying Kidney Yang. which might aggravate the patient's condition.
Pairs and trios In the case of the preferred combination•. _-',,~~~ " the pairs and trios are appropriate to the patient's condition. -~ .:~;,.._~ ;- .. '=,' For example, Zanthoxylum. Angelica, and Juniperus, are a .. trio of herbs that can tonify Spleen Qi. stimulate the Spleen to transform Damp. move Spleen Qi Stagnation. and clear·.'·•. ~ ~
Tastes The taste balance of the preferred combination differs from the provisional combination in the following ways:
obstruction from Stagnation and Damp in the channels. ..'7...,,,,.; Zanthoxylum and Angelica are a pair of herbs that can be . 1:'; used for poor peripheral circulation associated with lethargy. sensations of heaviness in the limbs. weight gain. and patterns of Damp.
• herbs with the moistening sweet property-Serenoa. Glycyrrhiza. and Ziziphus-are removed from the combination • herbs with the aromatic property of stimulating the Spleen to transform Damp-Zanthoxylum, Angelica, and Juniperus-are added • herbs with the warming. stimulant. Kidney Yang tonic aspect of the acrid property-Cinnamomum. Panax, and Turnera-are removed from the combination • herbs with the dispersing, penetrating, Damp-clearing aspect of the acrid property-Zanthoxylum, Angelica. Juniperus. Phytolacca. and Arctium-are added Herb interactions The preferred combination has a better balance between complementarity and moderation. Cool Phytolacca and Arctium moderate the warming effects of Zanthoxylum and Angelica. The aromatic herbs. Zanthoxylum, Angelica. and Juniperus. moderate the sweet tonic Astragalus.
:"~
Contraindications Since the patient is a male. the caution :-~ on the use of Juniperus during pregnancy does not apply. However. some texts recommend caution on the use of Juniperus in patients with renal inflammation (see the chapter on Juniperus). If the Preferred combination were taken long-term. the .~" .::-~-*'} patient should be monitored for increasing signs of dryness• . y..:;~ _.-.. .. since Angelica archangelica and Juniperus together can have a drying effect. It is theoretically possible that their prolonged use might result in signs such as dryness and soreness of nose and throat, even in a patient with an initially Damp pattern. If this were a real patient. the cautions on each of the herbs in the preferred combination would have to be checked in detail (see materia medica chapters). Otherwise, the preferred combination is correct and ready to use. '--:-;";':~:
~ '
Dose T
with the topics of dose, dose form, and administration. These terms are defined as follows:
HIS CHAPTER DEALS
• dose the quantity of herb prescribed within a particular time period, for example, the daily dose refers to the quantity of herb given in 24 hours, which may be divided into several individual doses
cate two opposite approaches to dosing. The reductionist approach derives from the mechanistic and reductionist philosophy that underlies modern conventional medicine. The holistic approach, on the other hand, derives from the vitalistic and holistic philosophy that is the basis of traditional medicine in both China and the West. Focus of controversy The difference in the two approaches lies mainly in their response to the natural variability and the chemical complexity of plant material.
• dose form
the form in which the herb material is prepared and dispensed to the patient, whether as an infusion, decoction, tincture, powder, or other form
Variability of plant material There may be considerable variation in the type and quantity of active constituents between different samples of the same herb. This can be due to both genetic and environmental variation. This can mean that the therapeutic effect of a specific dose of the herb can be variable, even on the same patient, because the dose may
• administration the method in which the preparation is used, whether orally, by injection, by topical application, by steam inhalation, or by another method Further definitions are given in the Glossary.
contain variable quantities of the key active constituents.
Dose controversies
Phytochemical complexity It is not common for a herb to
The main emphasis of this chapter is on the practical
have a single pharmacologically active constituent. It is more
aspects of dose and dispensing. However, dose is one of the most controversial topics in herbal medicine, and two dose
usual for a herb to have a number of different active constituents that contribute to its therapeutic effects.
controversies are briefly discussed below:
Reductionist approach Adherents of this approach see both the natural variability and the chemical complexity of plant material as a disadvantage. Their response is to try to . isolate a single active constituent to be used as a criterion of standardization (see the Safety chapter). Different batches of herb material can then be assayed to determine if the marker active constituent is within accepted levels. If only standardized material is used, then it is possible to be more precise
• reductionist approach versus holistic approach • controversy of the minimum dose
REDUCTIONIST APPROACH VERSUS HOLISTIC APPROACH I have used the terms 'reductionist' and 'holistic' to indi-
97
98
Combining Western Herbs and Chinese Medicine
about the actual quantity of the selected active component in a dose of herbal medicine. More precise limitations on dose range can then be set, and the effect on the patient is more predictable. Holistic approach In this approach, the variability of plant material is not seen as a disadvantage, but as a fundamental manifestation of the life force. Adherents of this approach accept the variability of plant material, in both quantity and type of active constituents, and see natural genetic variability as an important resource. They tend to adopt a more flexible approach to dose in response to variability both in the plant material and in the human response to phytotherapy. In the holistic approach, the fact that a single herb may have several different active constituents is not seen as a disaJvantage but as a benefit. Adherents of this approach believe that the different active constituents may support and moderate each ot4er's actions to produce a safer, more balanced, and, in some cases, more powerful overall effect than that of a single isolated chemical.
Flexible dosing The reductionist approach emphasizes accurate measurement of dose, precise limitations on dose range, and standardization of plant material. The holistic approach is not so much concerned with these criteria of accuracy. The response of this approach to the natural variability and the chemical complexity of plant material is the flexible adjustment of dose according to result. This was true of some of the very experienced practitioners of the past, especially those who were less academic and more 'hands-on.' For example, as Crellin and Philpott pointed out, precise measurement of herbal material was not a Icature in the practice of the Appalachian herbalist, the late Tommie Bass. He adjusted dosage according to the degree of rdief of the patient's symptoms. l
.-:-_ -t.---~
CONTROVERSY OF THE MINIMUM DOSE The minimum therapeutic dose is the minimum amount of a herb that is likely to produce a therapeutic effect in the majority of patients, in the opinion of a particular authority.. A dose that is too small to have a therapeutic effect is termed a subtherapeutic dose.
In modern Western herbal medicine, there are two main philosophies regarding the size of the minimum therapeutic herb dose. These may be termed the 'higher dose approach' and the 'lower dose approach: This topic has recently been reviewed by Mills and Bone in Principles and Practice of
Phytotherapy: Modern Herbal Medicine. 2 The higher dose approach The majority of herbal texts support the higher dose approach. They generally recommend, for the average nontoxic herb, doses of 0.5-4 grams of the dried herb, three times per day, or doses of at least 1-4 ml of 1:5 tincture of the herb, three times per day. The table below shows support for the higher dose approach from: • representatives of the Eclectic movement, such as Felter and Lloyd3 and Ellingwood4 • modern representatives of the Physiomedical movement, such as ChristopherS • European pharmacopoeias and expert committee texts 7 such as the BHp6 and the Commission E monographs • Chinese herbal medicine texts, such as Bensley and Gamble8 What is evident from the table is a surprising uniformity of dose, considering that the texts listed represent different times, different traditions, and different cultures. In addition, there is support for the higher dose approach from pharmacological and clinical research. 2 HIGHER DOSE APPROACH TEXTS
Combined approach Both the flexible and the precise approaches make valuable contributions that can be incorporated into a combined approach. This approach accepts the concept of vital energy, the importance of natural variability, and the chemical complexity of plant material. In addition, the combined approach accepts the need for safety in the use of herbal medicine and welcomes the adoption of correct standardization and quality control of herb material (sec the Safety chapter). However, the combined approach looks forward to the not-so-distant future when it maybe possible to standardize a herb not just in terms of a single active chemical, but in terms of each of its main active constituents. This would combine the advantages of both standardizing herbs and of using the full spectrum of active ingredients.
Daily doset American Felter and Lloyd Ellingwood Christopher
Bass 1 Tierra 9
British Grieve10
BHP SHC 11 German Weiss 12 Commission E Wichtl 13
0.65-2 g* 0.65-2 g* 2-3 g (infusion) 10 g (decoction) 4-6 g 1-5g
0.65-3.5
g*
* *
6-9 g 30 g
12-18 g 3-15 g
*
1-4 g 1-4 g
3-12 g 3-12 g
2-6 g (infusion) 0.66-3.3 g
6-18 g 2-10g
1-5g
3-15 g
_,.. i ~-I
,
--'."~ z:~,
Dose .-.-
.-~:,::,7:::'
Text
._
.7
:!h!'··
_
Individual :doset::=;~;:
. -, ' " (3
Chinese medicine Bensky and Gamble
t
.'<_·. • ~_.;:.:·::_::":.:':~··:'
:.~. _:_::::.:~::;,
per clay):,
1-3.3g
.. '';'".''''
',;:~:
__.;".:;~...... ;~..
~~~~-.+'~=-~ '-=~
Dailydose't::~
3-10 g
Unless specifically stated, the dose figures: • may refer to the use of the herb as powder (to be taken in water), infusion, or decoction; it is not always clear from the text which dose form is intended • refer to the use of dried herbs in all cases except Bass, who sometimes used dried and sometimes fresh herbs • given in grams have been converted in some cases from other measurements; for example, the figures for Felter and Lloyd, Ellingwood, and Grieve have been converted from grains and drachms to grams (see the Weights and measures section)
*It is not clear from the text whether the dose referred to is a daily dose or an individual dose (to be taken a number of times per day).
Lower dose approach This approach uses doses of one or a few drops of tinctUres of 1:5 strength or less. This contrasts with the higher dose approach which generally uses doses in excess of 1-4 mlof 1:5 tincture, three times per day.2.6,1l The lower dose approach may have originated in Europe as a side branch of homeopathy and in America as a side branch of the Eclectic movement. The lower dose approach has two main variants: using lower concentration tinctures or using concentrated tinctures.
Lower concentration tinctures In Europe, some homeopaths use drop doses of herbal mother tinctures. 2 In America, the Eclectic doctor John Scudder originated a branch of Eclectic tradition using drop doses of tinctures from the fresh plant, which he called 'specific medicines: 14• 1s Concentrated tinctures The Eclectic pharmacist Uri Lloyd believed that both drop doses and Scudder's tinctures were inadequate. 4 He developed a series of very concentrated fluid preparations which he also called 'specific medicines' or 'specifics.' However, these were quite different from the specific medicines of Scudder, and it was claimed that Lloyd's preparations were up to eight times more potent than ordinary 1:5 tinctures. 14
(-
I I
When Lloyd's specifics were used, as they occasionally were, in single drop doses, this would fall within the range of the lower dose approach. However, the upper end of Lloyd's dose range exceeds the upper limits of the higher dose approach. The doses for specifics given by Ellingwood4 o~ by Felte'r and lloyd) are generally between 1-60 drops three times per day. Thisis' a"maximum of 180 drops per day, which is approximately 9 ml. If Lloyd's specifics were really 8 times stronger than ordinary 1:5 tincture, this would be the equivalent of 72 ml of 1:5 tincture per day.
99 Author's position For the average nontoxic herbs, I generally use individual doses of 0.5-5 g dried herb three times per day or individual doses of 0.5-5 ml of 1:5 tincture three times per day. These dose figures apply to a herb when it is used by itself; they do not apply when a herb is used in a combination with others. It is important to distinguish between these two situations, which are discussed in the subsection Dose for infusions of more than one herb in the section on Dose form below.
DOSE AND COMMON SENSE Different people have different dose requirements, and for a particular patient, dose requirements may vary with time and circumstances. Some commonsense guidelines for dose are given below: • use the least dose required to get the desired therapeutic effect • in chronic cases, start at the minimum therapeutic dose for 1 to 3 days so that the patient's body can become accustomed to the herbs, and then raise the dose to halfway between the minimum and maximum therapeutic dose levels • use the herbs for the minimum time before reducing the dose (this time may be 3 days for an acute situation or 2 to 4 weeks for a chronic situation); if this reduction still produces the same therapeutic effect, keep this reduced dose • increase the dose if the symptoms return (alternatively, modify the herb content of the combination or change to a completely different combinati~n) • vary the dose to meet the changing requirements of the patient
Factors affecting dose Each of the following factors can affect a herb's dose: • philosophy of dose size • specific herb • quality of a sample • dose form • number of herbs in the combination • type and stage of illness • age of the patient • tolerance of the patient to herbs in general • tolerance of the patient to a specific herb • t a s t e ' '.
100
Combining Western Herbs and Chinese Medicine ,;;!,:-r.-
PHILOSOPHY OF DOSE SIZE The effect of the philosophical approach on the dose has already been discussed in the section on Dose controversies.
This book adopts the combined approach with respect to the precise versus flexible controversy, and follows the higher dose approach with respect to the controversy of minimum dose.
dried herb of 2:1.5) Practitioners should be aware that aro- ..~?'; matic oils may vary greatly in strength and that the use of -.-:C •. :.~._ aromatic oils is outside the scope of this book.
--
_.~
fresh herb dried herb 1:5 tincture Lavender oil
2-4 g 1-2 g 2-4 ml 0.06-0.2 ml
SPECIFIC HERB Herbs can be roughly divided into three groups according to dose (data is from the BHP for the dose of dried herbs): Group
. . Exa·mple·>;:<.. :~; •.. ..... ;,..-..
Dose
. .• . - .. 'i·-~
~ ~
.;.;.".~
average dose herbs
about 1-4 g, three times per day
Calendula
higher dose herbs
about 4-10 g, three times per day
Taraxacum leaf
lower dose herbs
about 0.1-1 g, three times per day
Convallaria
The majority of herbs fall into the average dose range. Some herbs in the lower dose range have local regulations governing their maximum dose. For example, Convallaria is on Schedule Part III of the Supply of Herbal Remedies Order 1977 of the UK, with maximum dose limitations of 0.15 g, three times per day.
QUALITY OF A SAMPLE The quality of a particular sample of herb material can affect the dose. If a sample of dried herb is old or of poor quality, it will generally require an increase in dose to counter this. If the sample is of especially good quality, it may require a decrease in dose. For example, I normally use about 0.6 g of dried Lobelia as a daily dose. However, I once got a batch of excellent quality Lobelia that was stronger than the previous sample. I therefore reduced the daily dose of the new material to 0.45 g since this had the same effect as 0.6 g of the previous material.
NUMBER OF HERBS IN THE COMBINATION The dose of a particular herb can depend on the number of other herbs with which it is combined. Generally, the dose of a herb prescribed by itself is higher than when it is prescribed with other herbs as part of a combination. This is discussed later in this chapter in the following subsections:
• Dose in the section on Infusions and decoctions • Problems with 1:5 multiherb tinctures in the section on Tinctures and liquid extracts TYPE AND STAGE OF ILLNESS The daily dose and the frequency of dosing of a herb may depend on whether the illness is acute, subacute, or chronic. For example, Christopher recommended Mentha piperita infusion for acute influenza with fever. Initially, the patient would be given 1 teacup (very roughly 150 ml) of hot infusion every 30-45 minutes until there was free perspiration, and then 2 tablespoons (roughly 15 ml) every 1-2 hours thereafter.
AGE OF THE PATIENT For the purposes of dose size, patients can be divided into different groups according to age. The proportion of the dose size for the different age groups relative to the standard adult dose is shown in the table, with figures for individual doses of 1:5 tinctures of average nontoxic herbs. These figures can be compared with those .in the table of Proportionate doses at different ages on page 2154 of Felter and Lloyd. 3
DOSE FORM The dose form can greatly affect the dose required. As discussed below, each different dose...form h~ itsa~v:antages and disadvantages. For example,dosesfordiff'erent preparations of Lavandula are shown in the. table. (Th~ 'fi~es for all . . .. , ' but the fresh herb are from the BHP. The. ~esh herl> figures are calculated according to Christopher's ratio of fresh to ,"
",'
TOLERANCE OF THE PATIENT TO HERBS IN GENERAL Human variability Some patients require higher levels of herbs in order to have a therapeutic effect, while other people require lower amounts. This is why there is a therapeutic dose range.
-'
Dose
Age
-" __~ "
101
,~__ p.roportiori',~f__ Jndlyigual dqsi.~Qf~~,lndiyiclua~" ~~~~;6f"'" -:: , "-adult dose
infants 6-12 months infants 1-2 years children 2-5 children 6-10 teens 11-18 adults elderly
0.01-0.1 0.02-0.2 0.2-0.5 0.5-0.75 0.75-1 1 0.5-0.75
0-0
1 :5 tincture'ii'i'ml-: -1:5 tincture fri::aropsF 0.05-0.5 ml O.l-lml 1-2.5 ml 2.5-3.75 ml 3.75-5 ml 5ml 2.5-3.75 ml
1-10 drops 2-20 drops 20-50 drops 50-75 drops 75-100 drops 100 drops 50-75 drops
experienced to some degree by a substantial proportion of the patients. In contrast, idiosyncratic reactions can be defined as unusual, rare, and unexpected reactions.
Side effects Within the recommended therapeutic dose range, the majority of the herbs listed in the BHP do not have *Assumes 20 drops per ml (see the Weights and measures section below). side effects. However, there is an appreciable number of herbs that can have moderate side effects at the top of their However, the human reaction range seems to be wider dose range, and a few herbs that can have more severe side than the recommended dose range for many herbs. For effects if used at the upper end of their dose range with example, the BHC sets 3-5 ml of 1:5 tincture as the dose patients for whom they are not suited. range for an individual dose of Valeriana. In my experience, Side effects can mostly be avoided if practitioners obsome people react to as little as 0.5 ml, whilst others require serve the herb cautions and contraindications. If a patient as much as 10 ml for a therapeutic effect. It seems that they has a pattern for which there is a caution for a specific herb, have a natural tolerarice to herbs in general or to one or it may still be possible to use it at lower doses. However, if more herbs in particular. the patient has a pattern for which the herb is contraindicated, it may not be possible to use it at all. Caution Although, in my experience, those people that require such large doses do not usually experience side effects, Moderation Even if a herb has side effects in some cases all precautions must be taken, and such high doses should be when used by itself, it may be possible to use it either at full used only for the minimum time. or reduced dose when it is combined with another herb that Patients with lowered tolerance of medication A patient with weak general health or weakness and hypersensitivity of the gastrointestinal or hepatobiliary system may have difficulty with foods, herbs, and allopathic medications. If herbal medicine is appropriate in a specific situation of this kind, a reduced dose is necessary.
General and digestive weakness In the case of general debility or gastrointestinal hypersensitivity, it may be initially advisable to use a dose 0.25-0.5 that of the usual one for the patient's age range. If there are no problems at this dose, then, if appropriate, the dose can be raised after about a week.
modera~es its potentially adverse effects.
For example, a patient has headaches and exhaustion. Piscidia at a dose of 1ml of 1:5 tincture, three times per day, removes the headache but aggravates the exhaustion due to its sedative action. However, when this dose of Piscidia is taken with 1 ml of 1:5 tincture of Rosmarinus, the headache is removed without aggravation of the exhaustion. This is because the stimulant action of Rosmarinus moderates the sedative action of Piscidia.
Caution The technique of moderation should be used with circumspection and not be taken as a license to ignore cautions and contraindications.
Liver disorders If the patient has a severe liver disease or is currently taking potentially hepatotoxic conventional medication, it is advisable that the initial dose be very small if herbal medicine is appropriate. For example, if the usual dose of a herb is 5 ml of 1:5 tincture three times per day, the starting dose could be 0.5 ml once per day. This could gradually be increased if there are no side effects. Regular liver function testing may be advisable in such cases (see the Safety chapter).
TOLERANCE OF THE PATIENT TO A SPECIFIC HERB Some herbs have potential side effects, especially at the upper end of their therapeutic dose range, which can be
Partial replacement Another method of reducing side effects is that of partial substitution. The herb with side effects is reduced in dose and the same dose of another herb with a similar action is added. For example, a patient has exhaustion with digestive weakness and sensations of cold. Cinnamomum bark at a dose of 2 ml of 1:5 tincture, three times per day, improve.s the symptoms, but has the side effect of a flushed face and uncomfortable sensations of heat. However, when the dose of Cinnamomum bark is reduced to 1 ml and 1 ml of 1:5 tincture of dried Zingiber is added, the symptoms improve and there are no side effects. This is because ZingIber has digestive and circulatory stimulant action, as does Cinnamomum bark, but Zingiber has a more diffusive effect on the
.-
. Combining Western Herbs and Chinese Medicine
102
. ~)~1 - .. _____
-
1
-~=
-
-
circulation, so that it does not have the side effects of Cinnamomum. Idiosyncratic reactions People can have idiosyncratic reactions, allergic or otherwise, to just about anything, including such staples as milk, bread, carrots, and apples. I once had a patient who was made more excited by Scutellaria, and another patient who became more nauseous by the use of Mentha piperita. If there is an idiosyncratic reaction to a particular herb, or even to an entire herb family, such as the Asteraceae, lowering the dose may not be enough in some cases. However, it is usually possible to substitute another herb to which the patient does not have an idiosyncratic reaction. TASTE ',"
A few patients have a,n aversion to strong-tasting herbs, especially those that ar~,b#ter,~our,or acrid. This is especially the case for decoctiorirand to a lesser extent for infusions and tinctures. This can meanthatthed~se of strong-tasting herbs has to be reduced for these patients. In some cases, the patients will take the herbs if they are in smaller, more frequent doses, or if the taste is masked by taking the herbs with milk, fruit juice, honey, or licorice, or mixed with food. However, some practitioners are concerned that masking of a particular taste in the mouth may reduce the effect of the associated taste property. For example, if a bitter herb is used to stimulate the secretion of digestive enzymes, coating the tongue with a layer of milk or honey may impair the function of the bitter taste receptors. Many of the herbal combinations that I dispense are carefully balanced according to taste properties to produce specific effects. When this is the case, I ask that the patient not use masking substances to ensure that these do not interfere with the desired taste effects.
• infusions and decoctions • tinctures and fluid extracts
.~
-
...
_. --'<~~l -::.u.,.
• powders • pills, capsules, and concentrates There are various other oral dose forms, such as fresh juices, stabilized juices, and essential oils, but these are outside the scope of this book.
Infusions and decoctions Infusions are teas made by pouring boiling water on fresh or dried herbs and allowing then to steep without simmering or boiling. Decoctions are teas that are made by simmering or boiling herbs in water, and they are usually made from dried herbs. SUITABILITY OF INFUSIONS AND DECOCTIONS Infusions These may be suitable for lighter, softer plant material, such as leaves and flowers, from which the active principles are more easily extracted than from the denser, harder bark and roots.
Volatile constituents Infusions are especially suitable when the main active principles are volatile and would be lost by simmering or boiling. Plants with important volatile ingredients are particularly found in the diaphoretic, circulatory stimulant, carminative, and tranquilizing action categories. Decoctions These are especially suitable for plant parts such as roots, stems, and the denser leaves and fruit that require more powerful extraction than is possible with infusions,
----!"""':
Decoction/infusion Some herbs that have volatile oils as the
Dose form This book is primarily concerned with dose forms that are administered orally. The preparation and administration of topical forms such as liniments, ointments, and poultices is not discussed. The use of nonoral internal forms such as boluses and, douches i~ only briefly discussed (under the heading Combining oraJ and otherforms ofadministration at the end of the Clinical'efamples,5ection below). For information. onthe,p~o~uction,;an,d.rii~inistrationof nonoral fonus, please/'refer to::'oth~i~1texis;such"" as' those by . Christophe~ and Tierra.9 .. :." ',. .' Oral dose forms are discu~s~d b~low in the following four sections: ' ,.:.~.'
main active ingredients should not be simmered with the decoction but should be added to the decoction after the heating is stopped and the decoction is allowed to steep for a suitable time. This technique is termed decoction/infusion. PREPARATION METH0D Some practitioners prefer using glass, enamel, ceramic, or earthenware vessels for the preparation of infusions and especially of decoctions. Other practitioners use stainless steel, but avoid iron, copper, and especially aluminum. This may be more due to concern over toxicity from high levels of these minerals l6 than concern over possible reduction of the activity of the herb's active constituents by the mineral.
' :;Jt.
Dose Infusions
Steeping The vessel should have a well-fitting lid, whether it is a teapot, a pan, or a wide-necked vacuum flask. The vessel is warmed with a little boiling water, which is then discarded. The herbs are put in the vessel, and boiling water, which has just been brought to a rolling boil, is then poured on the herbs. The lid is placed on the vessel, and the herbs are steeped.
Straining and pressing After steeping, the liquid is strained and the herbs can be pressed firmly to release any further liquid, which is also strained off. The herbs can then be discarded and the liquid drunk as required. Decoctions
There are many variations of the decoction
method.
Soaking Generally, the herbs to be decocted are soaked for at least 30 minutes in ~e water in which they are to be boiled. I prefer to soak them overnight.
Simmering After soaking, the water containing the herbs is
t.....'.
quickly brought to a boil, and the heat reduced to simmer the decoction for the required time. The pan lid can be kept on if it is desired to minimize the loss of volatile components, or it can be left off if it is desired to reduce the volume of the liquid.
Straining and pressing
L-
After simmering, the liquid is strained, and as with infusions, the herbs can be pressed firmly to release any further liquid, which is also strained off. The herbs can then be discarded, and the liquid drunk as required.
PREPARATION TIME The quantity of some of the active constituents extracted and the types of constituents extracted - the extraction profile - will depend on the length of time of steeping or simmering. Infusions Herbs are generally steeped for 5-20 minutes in an infusion.
Extraction prOfile Some aromatic herbs may only need 5-7 minutes to extract' the volatile oils on which their activity primarily depends. Longer infusion may change the chemical prome of the extraction as increasing amounts o~ the volatile' oils are lost to the air; as a result, the infusion becomes less aromatic'aridmore bitter. For example, if Mentha pulegium is steeped for more than 7 minutes, the tranquilizing action of this herb may be reduced since it primarily depends on its volatile constituents.
103 Other herbs may need a longer steeping time of up to 20 minutes to extract some of their nonvolatile active ingredients. In the case of a multiaction herb, such as Achillea, the length of steeping time depends on which action is required. If the bitter tonic action of Achillea is needed, it should be steeped for 20 minutes, to increase the extraction of nonvolatile bitter constituents. Decoctions The simmering time can vary between 5 minutes and 1 hour.
German practice The monographs in Herbal Drugs and Phytopharmaceuticals 13 indicate that some German practitioners prefer infusions to decoctions. In the few cases in which they use decoctions, for example, for hard materials, such as Gentiana root or Ratanhia root, they use short decoction times of 5-15 minutes.
John Christopher The German approach contrasts with that of Christopher, who recommended decoction times of 15-60 minutes. He used longer decoction times for harder plant material in order to extract the active components more thoroughly. He also used longer decoction times when he wished to reduce the volwne of liquid for convenience of administration.
Chinese practice Chinese tradition also uses longer decoction times-about 30 mmutes for the first simmering and 20 minutes for the second.
Extraction profile This may change with decoction time: The extraction of some chemicals may be maximal with shorter simmering times while others will be maximal with longer simmering times. Some chemicals may be progressively driven off, for example, the aromatic oils, or increasingly changed and inactivated by heating, for example, the anthraquinones. Texts on Chinese medicine may reco~ mend that Rheum should not be cooked for longer than 10 minutes. This may be because the laxative anthraquinones are increasingly denatured by heat, leaving an increasing quantity of astringent tannins to dominate the extraction profile. Herbs decocted last In Chinese tradition, herbs with aromatic constituents are often added to the decoction about 5 minutes before the end of the simmer~g process to reduce the loss of volatile oils. This 5-minute decoction technique for aromatic herbs can be used for Western herb combinations and is especially suitable for moderately aromatic herbs, such as Achillea or Zingiber, since their full,spectrum of active ingredients may not be released by infusion. However, herbs such as Mentha pulegium or M. piperita. which have a greater proportion of volatile active constitu-
"' 1 1 wate/~::'-j~ .~ . .. _.. ,
----
~
104
Combining Western Herbs and Chinese Medicine
ents, are best added after the heat has been turned off and the decoction is allowed to steep. This combination of the decoction and infusion techniques minimizes volatile oil loss.
REHEATING Infusions For herbs that do not depend so much on volatile components, such as Taraxacum leaf, the daily amount can be prepared at one time. The infusion can be reheated, if required, for subsequent individual doses. This can be done on low heat, so that the liquid does not simmer or boil, in a pan with a well-fitting lid. For herbs with volatile components, such as Mentha pulegium, it is better to avoid reheating in order to minimize the loss of volatile oils. For optimum effect, each individual dose of such an infusion should be freshly prepared, but for convenience, sufficient infusion for one day can be made at one time and kept warm',~ a vacuum flask. Decoctions If enough decoction for one day is prepared, it can be kept warm in a vacuum flask. However, if two days supply is made up, and especially if the weather is hot, it is preferable to refrigerate the liquid and to reheat the doses as required. I reheat decoctions on the cooker, rather than use a microwave, but this is a matter of preference. Some decoctions used in acute conditions, such as Asclepias: acute respiratory disorders + fever, can be so effective that only 1-3 doses may be required. It may therefore be wasteful to make up more than a I-day supply.
.c .•
Stronger infusions 1 oz of dried herb per pint of represents the daily dose for a single herb (representing
-,~~!! -, about three individual doses). This is approximately 30 g ""~ ,.,~",,:W.
of herb in 500 ml of water. This means that the infusion,':~ ~repared according to the second system is about five-::-:-:o~a.~ tlffies stronger than the first. ... --.::::!!""
Author's position I generally use 1 heaped teaspoon per cup of water for an individual dose, which is approximately 3 g of herb in 150 ml of water. If there are three individual doses, then the daily dose represents about 9 g of herb. However, acute situations may require 5-10 cups per day, which represents 15-30 g of herb per day.
Dose for infusions
Dose for infusions of a single herb There are two main approaches to the strength of an infusion: • 1 teaspoon of dried herbs per cup of water l3 • 1 oz of dried herbs per pint of water6
Some texts suggest using the first system for weaker infusions and the second system for stronger infusions. 17 Whether a weaker or a stronger infusion is required depends on the herb and on the situation. ,.:.,:' .~ : -:. '
Weaker infusions' .I,level teaspoon of dried herb per cup of water represents'an 'individual dose for a single herb. This is approximately 2 g of herb in 150 ml of water. If there are three individual doses, the daily dose represents about 6 g of herb.
.~
.~~
Measurement equivalents There can be considerable confusion over the different systems of weights and measures. The table below summarizes some common measurement equivalents, based on the assumption that an individual dose of one heaped teaspoon of dried herb weighs 3 g.This topic is discussed in detail in the Weights and measures section
;"~
-~~-
..,.~
-'-';
....':.j.; .:
.~
-.~;-.~--~
later in this chapter.
?~~~mN!~~~~iXi~~~i:~~1¥[~~S:'ic;:~~~!~~:~~~l~' Measurement' ,,:~~of a single herb ,T.' :' Dally dose of .co~:,::. system"'; ;:';/"">(3doses'perday)'" a single herb"I} teaspoons and cups
1 heaped tsp herb per cup water
3 heaped tsp herb per 3 cups water
grams and milliliters
3 g herb per 150 ml water
9 g herb per 450 ml water
ounces and pints
0.1 oz herb per 5 fl. oz water
0.3 oz herb per pint water
DOSE The philosophy of dose has been discussed above, and this book generally follows the higher dose approach.
j
Dose for infusions of more than one herb Infusions are generally made from one, two, three. or at the most four herbs, since infusions are generally used for relatively simple acute or chronic situations. When a herb is used as a single herb, its dose is generally larger than when it is used in combination with other herbs. This is because. in a combination, its actions are assisted by the actions of the other herbs. For example, when I use Achillea as a single herb in an infusion, I use an individual dose of about 3 g. When using Achillea in combination with other herbs. I use less; thus, an individual dose of the combination Achillea: influenza + sore throat contains 2 g of Achillea. in addition to 1 g of Mentha and 1 g of Sambucus. Dose. for decoctions , The two main approaches to the. ...... strength of a decoction are the same as those for an infusion: "
• 1 teaspoon of dried herbs per cup of water 6 • 1 oz of dried herbs per pint of water
l3
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'_~f
-~"
.-
=
Dose However, the difference is not as extreme as it might at first appear. The 1 oz ofherbs per pint ofwater does not necessarily represent a daily dose. Rather, it may represent the amount of herbs to be taken during 2-3 days. For some of his decoctions, Christopher recommended a dose of 3 tablespoons per day, not 3 cups per day. Also, the figure of 1 oz (approximately 30 g) often refers not to a single herb but to the combined weight of all the herbs in the decoction. Most of my decoctions contain 4-8 herbs. The individual dose of each average dose herb in a combination is about one teaspoon (approximately 2 g). At three individual doses per day the daily dose of each herb is 6 g. If there are 5 herbs in the decoction, each at 6 g per day, then the total quantity of herbs in a daily dose is 30 g.
Note:
Christopher recommended 1.5 pints of water for a decoction, as opposed to his recommendation of 1 pint for an infusion. This was to allow for loss due to evaporation of 0.5 pints since he generally simmered or boiled decoctions for 20-60 minutes.
Average, higher, and lower dose herbs Herbs differ in their strength, so that their doses may be very different. Whilst the daily dose of an average dose herb is about 9 g of dried material, the daily dose of the higher dose herb Taraxacum leaf is 12-30 g, and the maximum daily dose of the lower dose herb Convallaria is 0.45 g.
ADVANTAGES OF INFUSIONS AND DECOCTIONS Cheapness and accessibility Throughout history, infusions or decoctions of fresh or dried herbs have made herbal medicine available to ordinary people who could not afford the expensive herbal preparations provided for the rich. This also applies today when there is a danger in some Western countries that therapeutic doses of herbal preparations, for example, tinctures, are priced beyond the reach of a large proportion of the population. Not only are dried herbs generally the cheapest form of herbal medicine, but those with access to the countryside can gather fresh herbs, and those with a garden, a city plot. or even a window box, can grow them.
: .... -
Link to the natural world Some modern sedentary societies are becoming increasingly out of touch with the world of nature. The use of dried and especially fresh herbs is an excellent way to begin to reconnect with the energy of the natural world that can be such an imp~rtant part of the process of healing. To walk in the woods and fields. to get to know the plants, and to gather them and to use them can bring a sense of peace and fulfillment that is not normally found in a bottle of pills or tincture.
105 Therapeutic value of water Infusions and decoctions are the dispensing forms that combine the therapeutic effects of herbs with the therapeutic effects of water. Water in itself can be cleansing and healing to the system, and the combined cleansing effect of herbs and water can be utilized in the treatment of conditions involving accumulation of toxins and waste materials in the body. Infusions or decoctions are therefore especially appropriate for diaphoretic, diuretic, laxative, and alterative herb combinations. Extraction profile Infusions and decoctions are appropriate to extract active constituents that are water soluble, for example, tannins and polysaccharides. They are therefore appropriate to use for astringent herbs containing tannin, such as Potentilla, for herbs containing demulcent mucopolysaccharides, such as Althaea, and for herbs containing nutritive polysaccharides, such as Chondrus. Whilst decoctions are inappropriate for herbs in which the key acti,ve constituents are aromatic oils, infusions can be an excellent medium for these herbs since the heat of infusions releases some of the aromatic oils from the plant material, allowing these aromatic compounds to be both ingested and inhaled. For example, the wonderful smell of Mentha pulegium infusion can be relaxing even without drinking the tea. Such infusions effectively combine herbal medicine and aromatherapy. Treatment of patterns of Cold The warmth of a hot infusion or decoction can be an important element in the treatment of Cold Deficient or Stagnant conditions of the Spleen, Lungs, or Heart. The warmth of the water combines with the warmth of the carminatives, diaphoretics, or circulatory, stimulants respectively, to treat these patterns. The warmth can have a diffusive, relaxing, and comforting effect on the mind and body. Treatment of patterns of Dryness Infusions or decoctions of herbs containing demulcent mucopolysaccharides, such as Althaea and Viola, are an excellent way to combine the moistening and rehydrating effects of water with the soothing, demulcent. anti-inflammatoryaction of mucopolysaccharides. These can be used to treat patterns of Deficient Ym and Dryness, whether of the respiratory, digestive, or urinary systems.
DISADVANTAGES OF INFUSIONS AND DECOCTIONS Taste If the herbs are unpleasant in taste, some patients may prefer a different dispensing form since there is a relatively large volume of liquid to ingest with infusions or
Combining Western Herbs and Chinese Medicine
106
decoctions (see the subsection on Taste in the section on Factors affecting dose above). However, many patients become accustomed to the bitter taste of decoctions and have good compliance. Convenience Infusions, and especially decoctions, a~e a relatively inconvenient form. If the patients are exhausted, lazy. impatient, or forgetful, or if they have an extremely busy life, they may prefer a more convenient form such as tinctures or capsules. However, the discipline and the routine of making and taking decoctions can be an important first step in learning to care for self and in stabilizing a chaotic lifestyle. Extraction profile Water is a poor solvent for some types of constituents, such as resins. Herbs that have a high proportion of resinous constituents, such as Commiphora or Grindelia, are generally extracted with 90% alcohol.
Infusions These are especially unsuitable for compounds with low solubility in water since the plant material only has a short exposure to water and there is no simmering.
Decoctions To maximize extraction of constituents with low water solubility, the plant material can be presoaked for at least 30 minutes in cold water, and preferably overnight. The mix is then simmered for at least 30 minutes to maximize extraction. and in some cases. can be simmered for an hour or more. Preservation Dried herbs lose their quality more quickly than some other dose forms. tinctures for example, and are also more susceptible to fungal and insect invasion. Dried herbs should be discarded if they do not have their characteristic smell and taste, or if they are looking 'old and graY:
Tinctures and llquid extracts I have experimented with various strengths of tinctures and with various types of liquid extracts, but the bulk of my own experience has been with 1:5 tinctures. Therefore, the different types of tinctures and extracts are briefly compared below, but the emphasis of this book is on 1:5 tinctures. COMPARISON OF TINCTURES AND EXTRACTS Three groups of preparations are compared below: • 1:5 tinctures • 1:2 liquid extracts • 1:1 liquid extracts
1:5 Tmctures Tinctures are made by the process known as '-:-= maceration, that is, by soaking the herb material in a mixture _ ' of water and another solvent, usually ethyl alcohol (ethanol), but sometimes vinegar or glycerol. The term 'tincture' in this book refers to water/ethanol tinctures unless otherwise stated. Tinctures can be of various strengths, ranging from 1:10 to 1:3.The ratio refers to the quantity of herb to the quantity of solvent. Therefore the higher the second figure of the ratio. the weaker the tincture. For example. 5 ml of a 1:5 tincture was made with 1 g of dried herb. whilst 5 ml of a 1:10 tincture was made with 0.5 g of dried herb. Tinctures weaker than 1:5, for example, 1:10 tinctures, can be inconvenient since the patient has to take a greater volume of ethanol tincture. Theoretically, 1:4 and 1:3 tinctures would be more convenient to use than 1:5 since the patient could take a lesser volume of ethanol tincture, providing that these higher concentration tinctures genuinely extracted proportionally more active constituents than a 1:5
_'1 ~'_'
i
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-1
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tincture. 1:2 liquid extracts Preparations that are more concentrated than 1:3, that is, 1:2 and 1:1, are called liquid extracts (fluid extracts). Whilst tinctures are usually made by so~g (maceration), extracts are made by percolation. 1:2 extracts are the highest concentration that can be prepared by cold percolation without using concentration by heat or by vacuum. 2 Theoretically. 1:2 extracts should be 2.5 times stronger than 1:5 tinctures, but I have not yet seen independent research data that demonstrates that 1:2 extracts genuinely contain 2.5 times as much of a range of different active
-..
f"
ingredients than 1:5 tinctures. 1:1 liquid extracts These were traditionally made by the process of reserved percolation. but are now usually made by reconstituting soft or powdered concentrates. In either case, procedures involving vacuum or heat are involved. Equivalents Theoretically, a 1:1 extract should contain five times the quantity of active ingredients than a 1:5 tincture. However. research has shown that the heating and vacuum techniques involved in making 1:1 extracts can cause the loss of active constituents. IS For example, vacuum concentration of Matricaria extract caused the loss of up to half of the aromatic oil content. 19 For herbs with active constituents that may be lost in heating or vacuum procedures, such as aromatic oils or phenols, 1:2 extracts, or'even 1:5 tinctures. may be equal to or even preferable to 1:1 extracts. I do not use 1:1 liquid extracts for aromatic herbs such as __ Lavender, Rosmarinus, Salvia, or Thymus. I have smelled
Dose and tasted various 1:1 extracts, and I have yet to find one that smells and tastes of the full range of aromatic constituents as strongly as a good quality 1:5 tincture. In myopinion, if I cannot smell and taste the characteristic aromatic constituents with which I am familiar, either they are not there or they are denatured.
107 from the catalogue of East West Herbs,23 except that of Panax, which is from their data on the bottle label. Since ethanol can act as a preservative, the usual minimum strength of ethanol is 25%. Below this percentage. there may be microbial growth.
OTHER SOLVENTS ETHANOL AS A SOLVENT Wine has been used since antiquity, both as a medicine and
Two of the main alternative solvents to ethanol are glycerol and vinegar.
as a solvent.
Glycerol
Western tradition In the twelfth century. Hildegard von Bingen20 used cooking in wine as one of her main methods of preparing herbal medicines and recommended wine by itself as a warming tonic for a variety of disorders. Chinese tradition Wine itself is regarded as tonifying. with the ability to move Stagnant Qi and Blood. Tinctures (jiii.) were made by soaking herbs in wine. and to this day. tonic wines are popular in Chinese culture. as they were in the West in my grandmother's generation. In America, in the past, herbal medicines were sometimes made with moonshine whisky as the solvent. I Percentage of ethanol The water and ethanol mixture can extract a wide range of chemicals, but what constitutes the optimum percentage of ethanol is a matter of dispute.19.21.22 The optimum percentage of ethanol varies depending on the type of active constituent. Some manufacturers use 25% ethanol for the majority of their tinctures. This strength may be optimal to extract water-soluble constituents, such as mucopolysaccharides, tannins, and some of the glycosides. For example••the bark of Viburnum prunifolium contains viburnin, a bitter glycoside. According to one research report, an extract of Viburnum bark using 30% ethanol was reported to be five times more spasmolytic than an extract using 60% ethanol.:!:! % ethanol
Active constituents
25%
mucopolysaccharides tannins glycosides
Althaea Quercus Viburnum pru.
45%
aromatic oils alkaloids
Rosmarinus Cinchona
60%
alkaloids steroidal saponins
Lobelia Panax gin.
90%
resins'
Commiphora
1-
Other glycosides, aromatic oils, alkaloids, and many saponins may be more efficiently extracted at higher percentages, between 45-60%. Resins are. usually extracted with 90% ethanol. The ethanol percentages in the table above are
This compound has the following advantages:
• it is a better solvent than ethanol for water-soluble chemicals, such as mucopolysaccharides • it can be used by those who prefer not to take ethanol in any form • it is sweeter in taste than ethanol and therefore more palatable to some • it may be milder and more soothing to the digestive system than ethanol However, glycerol has the following disadvantages: • it is not as effective a preservative as ethanol • it is not as effective a solvent for many active constituents as ethanol • it may be less warming and moving than ethanol, and more likely to aggravate Damp conditions because of . its sweeter property and heavier nature Vmegar Like wine. vinegar has been used for centuries both as a medicine in itself and as a medium for herbal preparations. Hildegard von Bingen recommended a small amount of vinegar to cleanse the body and help digestion. and she used vinegar as an extracting medium in a variety of her herbal preparations. Apple cider vinegar is often preferred in modern vinegar extracts. Vinegar is especially used for extracting alkaloids, for example, the alkaloids of Lobelia and Sanguinaria. However, vinegar is not as effective a solvent as ethanol for other active constituents.
DOSE OF 1:5 TINCTURES OF A SINGLE HERB This depends on which of the following three dose groups the herb belongs to (data is from the BHP):
average
about 1-4 ml, three times per day
Agrimonia
higher
about 5-15 mi. three times per day
Agropyron
lower
about 0.5-1 ml, three times per day
Convallaria
108 . .
Combining Western Herbs and Chinese Medicine
PROBLEMS WITH 1:5
WHAT IS THE MINIMUM DOSE?
MULTIHERB TINCTURES
BHP minimum dose The basic premise from which this problem arises is that of the BHP minimum dose. However, it may be that the BHP figures were referring to single herb. prescriptions, rather than multiherb combinations. In a combination, lesser amounts of a particular herb can be used since its actions are supported by the actions of the other herbs. The example of Achillea is given in the subsection Dose for infusions ofmore than one herb above.
The individual dose of 1:5 tincture recommended by the BHP for the average nontoxic herb is 1-4 mI. Many practitioners use an average of 5 mI of 1:5 tincture as the standard individual dose of a herb combination. This means that if five herbs are combined, there is 1 mI of each herb in a 5-mI individual dose of the combination. Each herb is ,then at the lower end of the range recommended by the BHP as an individual dose. If there are more than five herbs in the combination, then there is less than 1 mI of each herb in a 5-mI individual dose of the combination. Each individual herb is then below the minimum BHP dose and may have no therapeutic effect. Lower dose herbs This problem does not apply to the use of 1:5 tinctures of lower dose herbs, since the minimum individual dose of theSe herbs is about 0.3-0.5 mI. Even if there were 10 such herbs in a combination, resulting in 0.5 mI as the quantity of each herb in an individual dose of the combination, this would still be at or above the minimum individual dose for each herb. Higher dose herbs However, the problem is acute for the higher dose herbs, since the individual dose of just one of these herbs can be greater than the figure of 5 mI for an individual dose of a combination. For example, the individual dose of 1:5 tincture for Agropyron is 5-15 mI. Such herbs might therefore be better taken as decoctions or infusions. Otherwise, if 5 such herbs were together in a combination, each with an individual dose of 5-15 ml, the individual dose of the total combination would be 25-75 ml of tincture. If the solvent for the 1:5 tincture were 45% ethanol, 75 ml of the tincture, three times per day, would be ~quivalent to more than one bottle of wine. Average dose herbs Mills and Bone are concerned that, when using 1:5 tinctures for multiherb combinations, the quantities of the individual herbs may be below therapeutic leve1. 2 If the individual dose of the total combination were kept at 5 ml, then it is only possible to have between 1-5 herbs in a combination, if BHP minimum doses for average dose herbs are to be observed. Mills and Bone recommend 1:2 liquid extracts to overcome this problem. The only way·to increase the number of herbs in a combination, when using 1:5 tincture, is to raise the individual dose of the herb combination above 5 mL However, above the dose of 10.ml of tincture, three times per day, the quantity of alcohol the patient would have to consume would be very high, especially if the percentage of alcohol in the tincture is greater than 25%.
Mills and Bone minimum dose These authors are at the high end of the higher dose approach discussed earlier in this chapter, and many practitioners would not agree with their high figures for minimum dose. For 1:5 tinctures, they tend to recommend higher doses than the BHP. For example, the BHP gives 0.5-1 ml as the individual dose of 1:5 tincture of Harpagophytum, whereas Mills and Bone give it as 5-10 ml. In the case of Harpagophytum, they base this higher dose on data from clinical trials (see the Harpagophytum chapter). However, such clinical data on minimum dose is not available for the majority of herbs. Need for further research More systematic research on the minimum and maximum doses for commonly used herbs is essential for the development of herbal medicine. In addition, a range of independent studies on the comparative extraction profIles of 1:1 and 1:2 liquid extracts, and 1:5 tinctures is important to determine the comparative efficiency of extraction for these methods with respect to different types of active constituents.
FLEXIBLE PRESCRIBING One solution to the problem of using 1:5 tincture for multiherb combinations is that of flexible prescribing. My standard individual dose for a total herb combination using 1:5 tinctures is 5 ml. The average number of herbs in my combinations is about six. which gives about 0.83 ml as the individual dose for each herb in the combination. However, various methods can be used to increase this dose when required. For example: • increase the individual dose of the combination from 5 ml (l teaspoon) to 7.5 ml (1.5 teaspoons). which raises the quantity of each herb in an individual dose of the combination from about 0.83 ml to 1.25 ml • increase the ratio of a particular herb in the combination from equal ratio with the other herbs to double, which raises the quantity of that herb in a individual dose of the combination from 0.83 ml to 1.66 ml*
-. ..
Dose • increase both the combination dose to 7.5 ml and the proportion of a particular herb to double, which raises the quantity of that herb in a individual dose of the combination to 2.5 ml • prescribe a particular herb separately from the combination, so that individual doses of up to 7.5 ml of that herb can be given, if appropriate (as with Valeriana in the Clinical examples section below)
'-"
-
*This means that the dose each of the other herbs is now less than 0.83 ml, unless two of the other herbs are only present in 0.5 ratio. In the example below, Astragalus is used at double ratio, whilst Glycyrrhiza and Zingiber are used at half ratio.
Astragalus Echinacea Achillea Cinchona Glycyrrhiza Zingiber
....,....,,-
~-
2 '1 1 1
0.5 0.5
ADVANTAGES OF TINCTURES AND LIQUID EXTRACTS Convenience Tinctures and fluid extracts can be very convenient. There is no preparation for the patient, they can easily be carried with the patient wherever they go, and, because of the relatively small volumes required, compared to infusions and decoctions, they can be easy to use for children and infants. Taste Because of the lesser volume, unpleasant tasting herbs can more easily be taken in tincture form than as decoctions. Preservation Providing they are kept in brown glass bottles out of direct sunlight in a cool place, tinctures in 25% ethanol or higher will usually keep for years. Dried herbs are more likely to lose their effectiveness in a shorter time or become invaded by fungi or insects. Extraction profile Tinctures or liquid extracts with 4560% ethanol are suitable for extracting chemicals, such as aromatic oils, alkaloids, and saponins, and tinctures of 90% ethanol are effective for extracting resins and oleoresins. Treatment of Cold. Damp. Deficiency; and Stagnation In itself, ethanol can be said to be warming, drying, tonifying, and moving. In terms of Chinese medicine, it can therefore be a favorable medium for treating Cold, Damp, Deficient, or Stagnant patterns. This does not mean that ethanol tinctures
109 are inappropriate for the treatment of patterns of Heat, Dryness, or Excess since suitable cool moist herbs can override the nature of the ethanol, especially if the tincture is taken with plenty of water.
DISADVANTAGES OF TINCTURES AND LIQUID EXTRACTS Ethanol Some patients prefer not to take ethanol, whether for religious reasons, because they had an alcohol addiction, or because they do not like the taste of ethanol. They may fmd glycerol extracts acceptable, but these are not suitable for herbs containing resins or aromatic oils. At least some of the ethanol can be evaporated from a tincture by putting an individual dose of the tincture in a cup and then fllling about three-quarters of the cup with boiling water. This method is not so suitable for herbs containing volatile oils, since these will tend to evaporate with the ethanol. Very few children have taste problems with the small amounts of alcohol present in children's doses of 1:5 tincture, providing the tinctures are taken in the appropriate dose for their age, diluted with water, and mixed with fruit juice, milk, or food. Extraction profile Tinctures are not as effective as decoctions in extracting water-soluble chemicals, such as tannins and mucopolysaccharides. Diaphoretic treatments Hot infusions or decoctions are best for diaphoresis, for example, to treat acute influenza and fever. Tinctures are not as effective even if they are taken with large amounts of hot water. ' Alterative treatments Since ethanol is inherently warming and drying, tinctures are not as appropriate for alterative treatments, although they can be used. For these treatments, infusions or decoctions are best since the water and herbs combine in their cleansing effects.
Powders The term 'powders' in this context refers to powdered dried herbs rather than to powdered concentrated extracts.
ADVANTAGES OF POWDERS Flexibility Powders, like infusions, decoctions, tinctures, and liquid extracts, have the advantage of flexibility. Powders of individual herbs can be mixed to make tailor-made combinations for individual patients. This is not generally done
110
Combining Western Herbs and Chinese Medicine
with pills and capsules since the practitioner would have to make up separate batches of pills or capsules for each patient
Pills, capsules, and concentrates
visit.
PILLS AND CAPSULES
Convenience Powders and tinctures are convenient in that the patient only has to mix them in water. The amount and temperature of the water depends on the patient's condition.
Pills and capsules are convenient and do not have problems with taste. However, they have the huge disadvantage of being fixed in composition, so that they cannot be matched to the specific needs of an individual patient. This means that they cannot replace the more flexible dose forms, such as infusions, decoctions, and tinctures. It is theoretically possible to mix powders to make capsules that are specific for the needs of a patient at a particular time. However, it is so time-consuming as to be impractical. There are certain combinations that are so well balanced that they can be used as a useful preliminary or as an adjunct to more specific herbal treatment. A good example is Christopher's lower bowel tonic (now called Dr. Christopher's ......,.""" Fen-L-Bee), which is available in capsules. However, even this excellent formula is not appropriate for everyone and may need modification or to be replaced with more individually tailored combinations.
For example, if it is necessary to produce diaphoresis, the powder can be taken with a greater amount of hot water. If a sedative effect is required, the powder can be taken with a lesser amount of cold water. Slow release Powders can have the advantage of slow release of active constituents, which can be advantageous for the treatment of colon problems since constituents, such as tannins, are still being released when the powder reaches the colon. Extraction profile A possible advantage of powders is that all the constituents reach the digestive system, rather than only those that are soluble in water or alcohol. In contrast, decoctions, for example, are poor at extracting resins. Therefore, a lesser amount of resins will reach the digestive system if herbs are taken in the form of decoctions, than if herbs are taken in the form of powder. However, it is not
known how efficiently the digestive system extracts the various types of active constituents from the powder that reaches the gut.
DISADVANTAGES OF POWDERS Digestive disorders
In terms of Chinese medicine, many
patients have Deficient Spleen patterns. In my opinion, powders, pills, and capsules may be difficult for them to digest and absorb, particularly if they are already taking medication or nutritional supplements in this form, since this will place an additional load on the weak Spleen. Infusions, decoctions, and tinctures extract the active ingredients, which then enter the body in solution. With powders, the body has to do the extraction, and if the Spleen is weak, this process may be inefficient and may put further stress on the weak Spleen. Powders can be taken with warm water, but unless they actually dissolve, the problem remains. Aromatic constituents Powders may not be the best form in which to take herbs with aromatic constituents. Such herbsare better taken as infu.sions, when the oils are released by the heat of the infusion, or as ethanol tinctures, which are the most efficient common means of extracting volatile constituents and making them available to the body.
CONCENTRATES The use of concentrates has already been briefly mentioned under the heading of 1:1 liquid extracts. Whether the concentrates are given as liquids or in solid form, their disadvantage is that active constituents may be lost or denatured during the heating or vacuum processes. Concentrates may therefore be especially unsuitable for herbs containing volatile or heat-labile active constituents. If the concentrates are made into tablets, there is further chance of denaturing of active constituents during the stages of this process. In addition, the number of additives and adulterants are likely to increase.
Advantages and disadvantages ofthe different dose forms The advantages and disadvantages of the different dose forms that are discussed in the text above, are summarized _ in the following table:
Infusions and decocllons • cheapness and accessibility
taste
• link to the natural.world.
lack of convenience
• therapeutic value of water
unsuitable for water-insoluble constituents, such as resins
• infusions suitable for . volatile constituents '
preservation
Dose
111 For example, all of the following items can be said to have a dried herb equivalent of 1 g:
• decoctions suitable for water-soluble constituents, such as polysaccharides and tannins
• 1 ml of 1:1 liquid extract • 2 ml of 1:2 liquid extract • 5 ml of 1:5 tincture • 10 ml of 1:10 tincture
• treatment of patterns of Cold • treatment of patterns of Dryness • diaphoretic treatments • alterative treatments Tinctures and liquid extracts
l~
__
• convenience
unsuitable for patients who h~ problems with alcohol
• taste
less suitable for water-soluble ccr.s:itue~ts, such as polysaccharides and tannins
• preservation
less suitable for diaphoretic treatments
• suitable for ethanol-soluble constituents, such as essential oils, alkaloids, resins, and saponins
less suitable for alterative treatments
• treatment of patterns of Cold and Damp, Deficiency, and Stagnation
limitations on the number of herbs in a combination
• convenience
unsuitable for patients with digestive disorders
• slow release of active constituents
less suitable for volatile cor.stituents
Pills and capsules lack of flexibility: it is not possible to match them to the specific needs of the individual patent
• slow release of active constituents
WEIGHT OF ACTIVE CONSTITUENTS PER UNIT OF PRODUCT
Powders
• convenience
However. the phrase dried herb equivalent can be misleading. The four items above are equivalent in that they all derive from 1 g of dried herb starting material. However, they are not necessarily equivalent in terms of the amounts and relative proportions of the active constituents that they contain. This is due to the fact that extraction efficiency for the different types of active constituents is not equal between the different extraction methods and the different ratio strengths, as reported by research studies.18.19.21.22
digestive disorders; less suitable for volatile ccr,stituents
Equivalence of dose
A more informative method of comparing the different dose forms would be to state the amount (in milligrams) of each of the main active constituents contained in one gram or one milliliter of the dose form. This kind of data is rarely available at present, but may become increasingly available in the future, since it is a useful way to compare the different dose forms. However, this approach is not without difficulties, as described below.
Extraction before or after ingestion Dose forms can be divided into two groups according to when the active constituents are extracted from the raw plant material: • extraction occurs before the dose form is taken into the body • extraction occurs after the dose form is taken into the body
Extraction before ingestion In dose forms such as infusions, In the absence of research data, it is difficult to compare doses between the different dose forms. Three alternative approaches to this comparison are: • dried herb equivalent • weight of active constituents per unit of product • therapeutic efficiency
DRIED HERB EQUIVALENT Mills and Bone have suggested the use of the concept of
1 i
dried herb equivalent in order to make dose comparisons. The dried herb equivalent derives from the product ratio, which expresses the weight of original dried herb material to the weight or volume of finished product.
decoctions, tinctures, fluid extracts, and solid concentrates, the active constituents are mainly extracted from the raw plant material before ingestion. The extract is swallowed and the residue of the original solid raw material is discarded. It is possible to compare these dose forms by assaying the weights of active constituents per unit of extracted product.
Extraction after ingestion In dose forms such as cut fresh herbs, powdered dried herbs taken in water, or powdered dried herbs taken in capsules, the extraction process takes place in the digestive system, after the raw herb material has been ingested. It is not possible to compare these dose forms, either with each other or with dose forms where· extraction takes place prior to ingestion, since there is no standardized method for assaying extraction efficiency after ingestion.
.•
-:;;;;,;;-
112
Combining Western Herbs and Chinese Medicine
Multiple active constituents A few herbs may have one main active constituent, such as capsaicin in the case of Capsicum. However, most herbs have multiple active constituents, and the effectiveness of the herb may depends on the balance between a number of different active constituents which may complement and moderate each other's effects. If the relative levels of the different main active constituents extracted vary between the different dose forms, the therapeutic effectiveness of these dose forms may also vary. Inactivated constituents If a particular extraction process makes a constituent less absorbable or pharmacologically less active, it is not possible to get accurate data on the weight of active constituents that are actually available per unit of product. THERAPEUTIC EFFICIENCY Compari~on in terms of the weight of active constituents per unit of product can be useful for dose forms in which the active constituents are mainly extracted from the plant material before ingestion. However, perhaps the only way in which it is possible to compare these dose forms with dose forms in which the active constituents are mainly extracted from the plant material after ingestion, is in terms of therapeutic efficiency, that is, in terms of reduction of specific signs and symptoms.
It would be useful in the future for research studies to compare the relative therapeutic efficiency of the different types of dose forms to determine which are most suitable for different types of patients and different disorders.
Timing of the dose STANDARD PROCEDURE For chronic conditions, I usually advise patients to take their herbs as a daily routine, usually three times per day, and preferably at set times. For optimum absorption, this can be on a more-or-Iess empty stomach, 1 hour before meals or between meals. For acute conditions, herbs may need to be taken much more frequently, and at any time. BITTERS AS APERITIFS ••<.
.L·.
If bitter herbs, or herbs which are both bitter and aromatic, are taken with the specific intention of enhancing appetite and increasing the efficiency of digestion and absorp-
------
,
tion, they may best be taken 15-30 minutes before the meal. .. _ _. ~ This is the principle of aperitifs, which are notgenercill -::~ gulped down in one swallow, but are sipped slowly and ""..,... pleasantly before the meal to prepare the mind and body for''''':' .• digestion. _:...~ Bitter prescriptions used in this way should als9 be;I.~ sipped slowly, and it is up to the ingenuity of the practitioner ---.:.~ to combine the bitter and aromatic tastes to make these prescriptions more palatable and therefore more likely to be sipped slowly by the patient. For example, Gentiana can be combined with Rosmarinus, Citrus, and a little Zingiber to make for a more palatable prescription.
y..
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HERBS TAKEN AFTER MEALS
If the patient fmds that herbs in general or some herbs in particular, such as Capsicum, tend to produce gastric discomfort if taken on an empty stomach, then they can be __ taken after meals. The gastric irritant effect of such herbs can ,_, also be reduced by combining them with sweet demulcent herbs, such as Althaea and Glycyrrhiza. TIMES FOR STIMULANT AND CALMING HERBS The best time for herbs with both tonic and stimulant action is in the morning and early afternoon. Stimulant herbs, such as Rosmarinus and Panax ginseng, may aggravate insomnia if taken after about 5 PM. Herbs with potentially sedative action, such as Valeriana or Piscidia, may be best taken in the afternoon or evening since they may aggravate drowsiness and lethargy if taken in the morning. Many patients suffer from depression in addition to anxietyand insomnia. I commonly give such patients two bottles of tincture: the 'morning' bottle of an antidepressant combination and the 'afternoon' bottle of a calming combination. The tonic and stimulant combination can be taken before breakfast, before lunch, and again, if required before 5 PM. The calming combination can be taken before bed and again in the night on waking if required.
Duration ofthe prescription The length of time for which a particular herb or herb combination is prescribed depends partly on whether the patient's condition is acute or chronic. Generally, acute conditions require short-term treatment and chronic conditions require long-term treatment. The duration of a'prescription for a chronic condition also depends on the rate of improvement of the patient.
;-;-.::i.-
::¥ '.~
Dose SHORT-TERM PRESCRIPTIONS These are appropriate for acute conditions. They are also appropriate for herbs with constituents that have potentially cumulative side effects. the risk of which is therefore increased by long-term use. For example. there is the possibility that long-term use of herbs with high tannin content. such as Potentilla. may cause constipation or reduce the absorptive efficiency of the intestines. These problems are less likely with short-term use. For example. if Potentilla is included in a combination for a patient with acute diarrhea. once the diarrhea is substantially reduced. Potentilla can be replaced in the combination by a milder astringent with a lower tannin content. such as Alchemilla or Capsella.
LONG-TERM PRESCRIPTIONS WITH BREAKS The use of breaks in pre.scriptions for long-ter:m use maybe advantageous in situati~ns where there is either declining therapeutic effect or the risk of cumulative side effects. Declining therapeutic effect During long-term treatment, the reaction of the patient's body to the herbs may sometimes decrease and the clinical effectiveness of the herbs may decline. Regular breaks in treatment can help to reduce this phenomenon of declining effectiveness. For example. the patient can take the herbs for 2-4 weeks and then come off the herbs for 1 week before starting them again. An example of this is the use of Valeriana as a single herb for patients with insomnia. If the effectiveness of Valeriana declines, there can be a I-week break in taking this herb. If the effectiveness of Valeriana does not decline. this may be unnecessary. This technique is not appropriate for herbs•.such as Vitex. which may need to be taken for a number of months continuously to establish their effect. Cumulative side effects If the patient takes a specific herb or herb combination for long periods without a break there may be an increased possibility of cumulative side effects. For example, if Piscidia is taken long-term for chronic pain. there is the possibility that it may depress metabolism in an exhausted patient. Regular breaks in treatment can help to reduce the chance of cumulative negative effects.
113 between Valeriana and Humulus than to use either herb continuously. Valeriana can be used until its effect begins to decline, then Humulus can be used until it starts to be less effective. then Valeriana can be used again, or there can be a break in the use of herbs.
Clinical examples This section gives some examples of selecting suitable dosage and dose forms to meet the needs of different clinical situations.
TINCTURE OF A SINGLE HERB Many modern patients have complex combinations of syndromes. When treating such patients. many herbalists do not use single herbs, but use several herbs in combination that are carefully balanced to address these multifactorial situations. However, there are circumstances in which a single herb is appropriate. for example. when a herb is specifically appropriate for a particular disorder or when it has to be taken at a specific time. Vitex agnus-castus exemplifies both of these situations. Vitex is often given as a single herb for menstrual or menopausal problems to correct hormonal imbalance. It is usually given in the morning as one dose of about 2.5 rnl of 1:5 tincture. The single herb prescription ofVitex may be the only herbal treatment necessary. unless other herbs are required to treat specific syndromes or symptoms. Example A patient h~s menopausal problems with severe anxiety, night sweats. and insomnia. She can be prescribed Vitex as a single herb. at 2.5 ml of 1:5 tincture every morning. to regulate hormonal imbalances. In Chinese terms, Vitex can be said to regulate the Qi of the Liver, Kidney. and Uterus. In addition to the Vitex as a single herb. the patient can take 5 rnl of 1:5 tincture of the combination Salvia: menopausal hot flashes,· three times per day. This combination is specific to treat the anxiety, night sweats. and insomnia by clearing Heart Heat and tonifying Heart Deficient yoill.
HERBS GIVEN SEPARATELY TO LONG-TERM USE WITH ALTERNATIONS
ENABLE VARIABLE DOSE
If there is declining therapeutic effect during long-term prescription. one technique is to use breaks in treatment, but another way of dealing with this is to alternate between two herbs with similar effect. For example. for patients with chronic insomnia, it may be more effective to alternate
It is sometimes convenient to supply certain herbs as separate single tinctures so that their dose can be varied according to the patient's need without affecting the dose of the main herb combination. Capsicum and Valeriana are given as examples.
114
Combining Western H~Tbs and Chinese Medicine
Capsicum When prescribing Capsicum in tincture form, I usually give it as a single tincture, separate from the main tincture combination, and advise the patient to take between 5-20 drops of the 1:5 Capsicum tincture, with each individual dose of the main medicine. This enables the patient to vary the amount of Capsicum to find their own individual tolerance level of this herb, which may vary from time to time, even for the same patient If the Capsicum were included in the main combination and the patient found the level of Capsicum too high to tolerate, then a whole bottle of medicine would be wasted.
tincture is 1 drop, the second dose is 2 drops, the third is. 4. drops, the fourth is 8 drops, the fifth is 16 drops, and so on. In other words, the dose is doubled each time, until the required dose level is reached for the age of the child (see subsection on Age ofthe patient in the section Factors affect-ing the dose above). This enables the child to become accustomed to the taste
Example A patient has arthritis with poor peripheral cir-
Taste Starting with 1 drop is a great way of avoiding problems with taste, but if these persist, even though the tincture is mixed with a little water, milk, or fruit juice, a half ratio of Glycyrrhiza or Foeniculum can be added to the combination. Alternatively, the drops of tincture can be mixed with a
culation and sensations of cold in the body and limbs. The patient can be prescribed 5 ml of 1:5 tincture of the combination Zanthoxylum: arthritis + cold extremities, three times per day. Capsicum tincture can be given in a separate bottle so that the requisite number of drops of Capsicum can be added to each dose of the main medicine. Valeriana I sometimes give Valeriana as a single tincture, separate from the main tincture combination. I advise the patient to take between 0.25-1 teaspoon (about 1.25-5 ml) of the 1:5 Valeriana tincture, with each individual dose of the main medicine. This enables the patient to vary the amount of Valeriana taken according to the level of stress they are experiencing in their lives at a particular time. If the stress levels are higher, they can increase the dose of the Valeriana, and if the stress levels are lower, they can reduce the level of Valeriana or stop taking Valeriana altogether at that time. In this way, they can vary Valeriana without necessarily having to vary the dose of the main combination, as they would have to do ifValeriana were included with the other herbs.
Example A patient has premenstrual nervous tension, irregular menstruation, dysmenorrhea, and anxiety. She can be prescribed 5 ml of 1:5 tincture of the combination Leonurus: menstrual disorders + anxiety, three times per day. In addition, she can take 1.25-5 ml of 1:5 Valeriana tincture, with each individual dose of the main medicine and vary the amount of Valeriana depending on the severity of her anxiety.
PRESCRIBING FOR CHILDREN When treating babies and children, I generally use the dose form of 1:5 ethanol tinctures. Providing the following system is adopted, there is rarely a problem with this form. Start with 1 drop··' When prescnbing for babies or children up to about 10-years old, I advise parents to usethe following system. Each individual dose of the tincture is mixed with a little water, milk, or fruit juice. The first dose of the
of the herbs gradually, and this approach is successful in the great majority of cases. If the baby or young child is given the full dose for its age from the beginning, it may decide it does not like the taste, and then resist each further dose.
little honey. Example A teething baby is fretful and hot with disturbed sleep. The parents are advised to use a 1:5 tincture of Matricaria and Passiflora, in equal proportion, three times per day-midday, afternoon, and when the baby wakes teething in the night. The dose is started at one drop, in the usual way, and increased to a maximum of 10 drops for an individual dose. After 4 days there is a definite improvement, but this does not improve further by the end of 10 days, and the baby is still fretful at night with disturbed sleep. Rather than increase the dose of this combination above the level of 10 drops per individual dose, an equal proportion of Anemone is added to the combination, to treat the pattern of Heart Heat underlying the nocturnal restlessness. The initial individual dose is 5 drops, increasing to 10 drops after two days. There is further improvement in sleep, with decrease in heat and restlessness. After 2 weeks on the combination with Anemone, the baby is put back on the first combination, which proves adequate at 10 drops per individual dose.
VARIATION OF DOSE WITH TIME A good example of changing dose with time is the use of Christopher's lower bowel tonic for patients with chronic constipation and habitual overuse of laxatives. This combination is usually given in capsule form, as described for the combination Rheum: chronic constipation.
Initial dose An initial individual dose can be two '00' capsules, taken with a glass of organic apple juice, three times per day. Should the stool become too loose, the individual dose can be reduced to one '00' capsule, three times per day.
-
;:?---'
Dose However, the dose may often need to be increased up to as much as five capsules three times per day, in order to get normally soft, well-formed bowel movements. Long-term dose The dose should not be reduced too much or too soon. For example, if an individual dose of three capsules was needed to normalize defecation, this dose can be maintained for about 2 weeks, unless the stools become too loose. The individual dose can then be reduced to two capsules, and this long-term dose can be maintained for about 2-3 months, unless the stool becomes too loose, to cleanse the body and to rebalance bowel function after years of constipation and laxative abuse. To taper off the bowel tonic, the dose can gradually be reduced to one capsule three times per day, down to one capsule per day, and then none. Dietary improvements can accompany the process.
115 patient is advised to take the third dose for the second day and then stop taking the herbs. Herb Asclepias Echinacea Achillea Prunus Glycyrrhiza Lobelia Zingiber (fresh)
- Daily dose 6g 6g 4g 4g 3g 0.6 g* 3 slices
Temperature
Taste
cold cool warm-cool neutral neutral-cool warm-cool hot
bitter acrid, bitter acrid, bitter bitter, aromatic sweet acrid acrid, aromatic
*The UK daily maximum dose for dried Lobelia is 0.6 g; see the Dose section in the Lobelia chapter. This is a good example of a combination for an acute condition that is taken for a maximum of 3 days. If the acute condition does not clear by this time, the combination is not appropriate, and the diagnosis needs to be reassessed and a different combination given.
TRANSITIONS BETWEEN ACUTE, SUBACUTE, AND CHRONIC CONDITIONS For patients with fluctuation between acute, subacute, and chronic phases of illness, dose and dose form often need to be adjusted depending on the illness phase. Example: influenza and bronchitis A patient has a history' of recurring acute influenza and bronchitis, and chronic cough and tiredness. The dosage and dose form can be varied according to the phase of the illness, as follows:
• acute phase • subacute phase • chronic phase
"""--
decoction/infusion tincture/infusion tincture
Note: The combinations given below for the subacute and chronic phases only appear in this section and do not appear in the materia medica chapters of this book. .
Acute phase: decoction/infusion
In the acute phase, the patient has fever and severe painful coughing with yellow or green phlegm, which antibiotics do little to improve. The combination Asclepias: acute respiratory disorders + fever can be given during the acute phase, in the form of a decoction/infusion as described in the Asclepias chapter. Briefly, the Achillea is packed separately from the other herbs. The technique of decoction/infusion is as follows: One daily dose of all the herbs except Achillea is gently simmer~d for 20 minutes in about 500 ml of water. The heat is turned off and the Achillea added to the decoction and allowed to infuse for 10 minutes. The patient is advised to take an individual dose of about 150 ml of the hot decoction/infusion three times per day. Since the acute condition clears after a day and a half, the
Subacute phase: tincture/infusion After 2 days on the acute combination, most of the Lung Phlegm Heat and W md Heat are cleared, and the acute symptoms are gone. The patient has the subacute symptoms of occasional feverishness, persistent cough with white or slightly yellow phlegm, and irritability, associated with Retained Pathogen, Lung Phlegm, and some Liver Heat. The following 1:5 tincture can be given during the subacute phase, mixed with Achillea infusion. Herb ""'''''''"'''''''Ratio .... Temperature,., Taste . . ·.·';"b';,~""·,· ..··-· Berberis Echinacea Phytolacca Glechoma Prunus Glycyrrhiza Lobelia
1 1 1 1
0.5 0.5 0.5
cool cool cool neutral neutral neutral-cool warm-cool
bitter acrid. bitter, 51. sweet acrid sour, bitter bitter, aromatic sweet acrid
During the subacute phase, the patient takes 5 rnl of the combination, three times per day. Each dose is taken in a cup of hot Achillea infusion. This is made by pouring about 150 ml of boiling water on about 3 g of Achillea herb in a cup, and allowing it to steep for about 10 minutes. The hot Achillea infusion helps to clear Retained Pathogen from the body and to carry th~ other herbs more quickly than if the tincture were taken in cold water. Berberis and Echinacea also help to clear Retained Pathogen, and Berberis clears Liver Heat. Phytolacca and Glechoma clear Lung Phlegm, and Prunus, Glycyrrhiza, and Lobelia treat the cough.
Chronic phase: tincture After 2 weeks on the subacute prescription, the patient has no feverishness, but now is in the
116
Combining Western Herbs and Chinese Medicine
chronic phase, with weak cough and exhaustion, associated with Lung Phlegm and Lung Deficient Qi. The following 1:5 tincture is given for this chronic condition, at the dose of 5 ml in a glass of water, three times per day.
Thuja Angelica arc. Marrubium Hydrastis Panax qui. Ophiopogon Zingiber (dried)
1 1 1 1 1 1 0.5
wann~ool
wann neutral cool neutral cool hot
acrid, aromatic, bitter bitter, acrid, aromatic bitter bitter sweet, 51. bitter sweet, 51. bitter acrid. aromatic
Arctostaphylos Althaea Hydrastis Vinca Mitchella Rumex Zingiber (dried)
cool cool cool neutral neutral cool hot
bitter, sour sweet, 51. bitter bitter sour sl. sour bitter acrid, aromatic
the bolus. It is a modification of Christopher's vaginal bolus formula.
Thuja, Angelica, Marrubium, and Hydrastis, assisted by
--
Arctostaphylos
Zingiber, combine to tonify Lung Qi and help the Lung to
Althaea
disperse Lung Phlegm. Panax quinquefoilum and Ophiopo-
Hydrastis
gon tonify Lung Qi and rm. After taking this prescription
Mitchella
for 1 month, the patient's cough and exhaustion are considerably improved.
Rumex
COMBINING ORAL AND OTHER FORMS OF ADMINISTRATION Herb combinations taken orally can be used at the same time as the following forms:
• topical applications such as liniments, ointments, and
Stellaria
Ratio
Temperature
Taste
1.5 1.5 1 1 1 1
cool
bitter, sour
cool
sweet, 51. bitter
cool
bitter
neutral cool
51. sour 51. bitter
cool
bitter
A suitable amount of the combination of finely powdered dried herbs is mixed with cocoa butter to form vaginal boluses (see Christopher,s p. 478, for instructions on making boluses). A bolus is inserted in the vagina at bedtime and left overnight, held in place with a sanitary napkin. In the morning, the herb powder from the melted bolus can be flushed out of the vagina with a douche of Berberis decoction at body temperature.
Douche A decoction of Berberis is made by simmering 2
poultices
• preparations for orifices such as drops for the nose, eyes or ears; or suppositories, boluses or douches for the anus or vagina Detailed discussion of these applications is outside the scope of this book, and the reader is recommended to read Christopher's text. A
teaspoons (about 6 g) of Berberis powder in 1 pint (about 500 ml) of water for about 15 minutes. The liquid is filtered, for example, through coffee filter paper, to remove all particles of powder, and allowed to cool. This can be used as a vaginal douche as required.
Duration of treatment
A week is the minimum for this combination of tincture, bolus, and douche. The patient can then have 2 days without any herbs, before repeating the treatment for another week. This whole cycle of 7 days on, 2 days off can be repeated for 2 months or more as required.
woman has recurring cystitis, vaginitis with leukorrhea, and anogenital herpes, associated with Damp Heat in Liver-Gallbladder, Liver channel, and Bladder. She is prescribed a com-
Weights and measures
bination of forms fOf this condition: oral tincture, vaginal bolus, and vaginal douche: ..
Tincture She is prescribed the combination Arctostaphylos: vaginitis as 5 ml of 1:5 tincture in a glass of water, three times per day.
~1!'"
Bolus The following herb combination is used to prepare
Herb
Example: Combining tinctures, boluses, and douches
1.5 1.5 1 1 1 1 1
Different systems of weights and measures are described and compared below. Some potential points of confusion are clarified, for example, " • the differences between US customary units and apothecary units of weight
Dose
117 tern of apothecary units. This was a system of weights used in a pharmacy, in which an ounce equaled 480 grains, and a pound equaled 12 ounces,3 as opposed to the US customary system, in which an ounce equals 437.5 'grains and a pound equals 16 ounces. In the US customary system, 1 dram =1.77 grams, but in the apothecary system 1 dram" = 3.89 grams. In the US customary system, 1 ounce = 28.3 grams, but in the apothecary system, 1 ounce = 31.1 grams. 25
• the differences between US customary units and Imperial (British) units of capacity • variations in household units of capacity, such as cups, teaspoons, and drops The definitions and figures used below derive mainly from The Concise Oxford Dictionari~ and from Websters II
New College Dictionary.25 UNITS OF WEIGHT
"The word dram can also be written drachm or drach-
mao
Metric units
Chinese units and metric conversions Originally, one Wing was equal to 31.25 g, but from 1979, a simplified system has been used: 8
1 milligram (mg) = 1000 micrograms (!Jog) 1 gram (g) = 1000 mg 1 kilogram (kg) = 1000 g
.:.j
Units ofconcentration These are usually expressed as mglkg or glkg, but there are two other systems: • that expressed as percent (%) • that expressed as parts per million (ppm), that is, parts per 106
1 If (10 Mol 1 fen (10 If)
0.03 g (30 mg)
1 qian (10 fen)
3g
1 liang (10 qianl 1 jin (16 liang)
30 g
0.3 g (300 mg)
For example, since 1 kg = 1,000,000 mg, then
..
1--;<;
;
10 mg,tkg 100 mg,tkg 19,tkg
%
ppm
0.001% 0.01% 0.1%
10 ppm 100 ppm 1000 ppm
UNITS OF CAPACITY Metric units
US customary units
1 deciliter (dl) = 100 milliliters (ml) 1 liter (1) = 1000 milliliters
1 dram (dr) = 27.34 grains (gr) 1 ounce (oz) = 16 dr 1 pound (1b) = 160z Metric and US/Imperial conversions For the following measurements US and Imperial units are equivalent. _. !-:~"----...... _--. ~ ;
~.:...:--.-~--:-~"1
.
-
64.8 mg
1 dram
1.77g
1 ounce
28.3 g
(1 oz is often rounded off to 30 gl
1 pound
454 g
(lib is often rounded off to 500 g)
.--:".---
Metric weight and volume conversions. Assuming that the liquid is water, one milliliter weighs one gram and one liter weighs one kilogram. US customary units
,"
Metric"· - ._- -- ..
1 grain
480g
._---_.
~--
_._.-._-"---_._-
~-.;.--_.-
-.
1 fluid dram (fl. dr) = 1 fluid o~ce (fl.oz) = 1 pint (p) = 1 quart (qu) = 1 gallon (gal) =
60 minims 8 fl. dr 16 fl. oz 2 pints = 32 fl. oz 4 quarts = 128 fl.oz
.:..;--;-.~
Imperial units The Imperial units· of capacity follow the same hierarchy as the US capacity units above. However: 1 milligram
0.015 gr
1 gram
0.564 dr (15 gr)
1 gram
0.0350z
1 kilogram
2.21b
Apothecary weights
Some older books may use the sys-
• there are 20 fluid ounces in an Imperial pint, as opposed to 16 fluid ounces to a US pint • US units of capacity for pint, quart and gallon are smaller than their Imperial equivalents, but the US units of capacity for fluid ounce, fluid dram, and minim
Combining Western Herbs and Chinese Medicine
118
are bigger than their Imperial equivalents, as shown in the metriclUS/lmperial conversion table below Christopher Weiss Wichtl
MetriclUS/lmperial capacity units conversions CONVERSION TO METRIC
from US 1 minim 1 fluid dram 1 fluid ounce 1 pint 1 quart 1 gallon
0.0616 ml 3.7 ml 29.57 ml 473 ml 946 ml 3.781
0.059 ml 3.55ml 28.41ml 568ml 1.1361 4.5461
oz
5 (-8) fl. oz
Spoons The usual US convention is that one teaspoon is 5 m!' so that there are three 5-ml calibrated teaspoons to one 15-ml calibrated tablespoon. However, definitions vary, and uncalibrated teaspoons found in kitchens vary in size. For example, according to Christopher,
There are standard US units and equivalents, and when a calibrated domestic measuring tool is used, there will be approximate uniformity. However, when an uncalibrated. domestic utensil, such as a cup is used, there can be considerable variation, as discussed below.
1 teaspoon = about 4 ml 2 teaspoons = 1 dessertspoon of about 8 ml 4 teaspoons = 1 tablespoon of about 16 ml Cups) spoons, and equivalents As stated above, the 'cup' measure used in this book is 150 ml (5 fl. oz), as opposed to the US cup unit of240 ml (8 fl. oz).
Cups A 'cup' measurement from a calibrated US domestic measuring utensil is dermed as 8 fl. oz (about 240 ml), but uncalibrated domestic cups used by patients to drink their herb infusions and decoctions may vary in volume. Also, the volume will depend on how full the cup is filled. For example, an uncalibrated teacup filled to the brim may be only about 7 fl. oz or less, (about 200 ml) and filled to about 1'4 full may be about 5 fl.oz (about 150 ml). A coffee mug is about 8 fl. oz (about 240 ml) filled to the brim and filled to about %full is about 6 fl. oz (about 180 ml).
Drops This is also a rather variable measurement. According to the Shorter Oxford Dictionary, a drop is defined either as the smallest quantity ofliquid that falls in a spherical form or, with respect to dispensing, the smallest separable quantity of liquid. This dictionary also defines a minim as one-sixtieth part of a fluid dram-about one drop. Drops and minims Some authors, for example, Christopher, equate one drop with one minim. However, as Felter and Lloyd state, a drop is not necessarily equal to one
Different herbal authorities give different values for a cup, for example:
Cups _--
5 fl.
• 150 ml (5 fl. oz) is the estimate used in this book for a 'cup' measure
HOUSEHOLD UNITS OF CAPACITY
Spoons
6 fl. oz
For the purpose of dispensing herbal infusions or decoctions, I think that a % full teacup is probably a realistic estimate of what the average patient uses for an individual dose of infusion or decoction. Therefore,
-from Imperial
• 1 fluid oz is often rounded off to 30 ml • 1 pint is often rounded off to 500 ml
US
180 ml 150 ml 150 (-250) ml
_,~-o'_ -Auid ounces:, ,; : Pints
Milliliters (ml)
ml rounded off -
1/2 teaspoon
2.5ml
1 teaspoon
5ml
1 tablespoon
15ml
2 tablespoons
1 fl.
- ------------- - - - - - - - - - - -
oz
------------
30 ml
2 fl.
oz
59.14 ml
60ml
4 fl.
oz
118.3 ml
120 ml
177.4 ml
180 ml
6 fl. oz 1 cup
29.57 ml -
-Sfl.oz
- - - - _..
-_
....
_-_...
_-~-----,._._----~---'-._._-------------_
0.5 pint
236.6 ml
240 ml 500 ml
2 cups
16 fl. OZ
1 pint
473ml
4 cups
32 fl. OZ
2 pints (1 quart)
946ml
. 1 liter
..
__._----.
i-.-
Dose minim. A drop may be more or less than one minim, depending on the nature of the fluid and of the container from which it is dropped. Drops and teaspoons Both Christopher and Tierra state that there are 60 drops per teaspoon. However, Christopher's teaspoon is about 4-5 mI, whilst Tierra's teaspoon is 5 ml. I found that the droppers from both the 2-oz glass bottles and the 4-oz plastic bottles that I use in my clinic give about 100 drops to 5 ml. The figures in the table are approximations, and proportions of a teaspoon have only been entered down to one-quarter since further fractions are unlikely to have any meaningful accuracy. Drops
ml
5 ml teaspoon
100 drops 75 drops 50 drops 25 drops 20 drops 10 drops 5 drops 2 drops 1 drop
5ml 3.75 ml 2.5ml 1.25 ml 1ml 0.5ml 0.25ml 0.1ml 0.05ml
1
Gentiana root Humulus strobules Lavandula flowers Mentha pip. folium Matricaria flowers Pimpinella seeds Trigonella seeds Valeriana root
3.5 g 0.4 g 0.8 0.6 g 1g 3.5 g 4.5 g 2.5 g
Range Average
0.4-4.5 g
2g
The average weight of herb in a level5-rnl spoon, for the herbs shown in the table, is 2 g. Very approximately, the average weight of herb in a heaped 5-ml teaspoon is 3 g. This means that a level 15-ml tablespoon will contain about 6 g of the average herb, and a heaped tablespoon will contain about 9 g. However, as seen from the table, there is a considerable range in the density of the herb material. A level table.spoon of Humulus strobules weighs 1.2 g and a level tablespoon of Trigonella seeds weighs 135 g. Also, what constitutes a 'heaped' spoon is variable, depending on how high it is heaped. It can vary from about one and a half to two times the capacity of a level spoon.
0.75(%) 0.5 (Y2) 0.25(%)
Handfuls In earlier times, herbs were sometimes measured by handfuls. I Again. a handful will depend on whether
These figures can be a useful guide in prescribing for children. However, I always give a range of dose from which parents, working from the low end, can find the number of drops that has optimum therapeutic effect for their child.
US HOUSEHOLD
119
just the palm or the whole hand is covered, the size of the hand, and on how high it is heaped. Very approximately, I find a handful, a heaped 'palmful: to be about double a level tablespoon. that is about 12 g.
UNITS OF WEIGHT
Spoons used as a measure of weight
References
Some herbal texts use
the teaspoon as an approximate measure of weight. There is considerable variation in the size of teaspoons found in the home, which are often less than 5 rnl. Even if a level 5-rnl
1. Crellin JK. Philpott J. A Reference Guide to Medicinal Plants. Duke University Press, Durham, North Carolina (1990)
2. Mills S, Bone K. Principles and Practice of Phytotherapy: Modem
spoon is used, the weight of a level teaspoon of herb will
Herbal Medicine. Churchill Livingstone, Edinburgh, United Kingdom
depend on the density of the herb, and in some cases on how
(2000)
finely it is powdered. In a dispensary, in many cases, some of the herbs used are roughly cut, some are finely cut, and some are finely powdered. The figures in the table below come from the Wichtl text, which usually gives the weight of one level 5-ml teaspoon of the herb in the Making the Tea section of the monograph for each herb.
3. Felter HW, Lloyd ju. King's American Dispensatory, vols. 1 and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1983) 4. Ellingwood . F. American Materia Medica, Therapeutics and Pharmacognosy, 11th edn. (1919). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1994)
5. Christopher (1976)
JR.
School of Natural Healing. BiWorld, Provo, Utah
6. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983)
Achillea herb Althaea root Angelica arc. root Artemisia wI. herb
1.5g 3g 1.5g 1.2g
7. Blumenthal M (ed). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council, Austin, Texas (1998) 8. Bensky D, Gamble A. Chinese Herbal Medicine Materia Medica. Eastland Press, Seattle, Washington (1986)
120
Combining Western Herbs and Chinese Medicine
9. Tierra M. Planetary Herbology. Lotus Press, Twin Lakes, WISCOnsin (1988)
17. Mabey R (ed). The Complete New Herbal. Elm Tree Books. Londol1':::~ United Kingdom (1988)
10. Grieve M. A Modern Herbal. vols. 1 and 2. Dover Publications. New York. New York (1971)
18. Van Es MJ. Some Applications of the Spray-dryer in Gallenical Pharmacy. Ph.D. thesis. Utrecht Universiry. Netherlands (1953)
11. Bradley PR (ed). British Herbal Compendium, vol. 1. British Herbal Medicine Association. Bournemouth. United Kingdom (1992)
19. Munzel K, Huber K. Pharmaceutica Acta Helvetica 36:194-204 (1961)' -
12. Weiss RF. Herbal Medicine, English edn. Beaconsfield Publishers. Beaconsfield. United Kingdom (1988) 13. Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm. Stuttgart. Germany (1994). from 2nd German edn. Wicht! M (ed) (1989) 14. Felter HW. The Eclectic Materia Medica, Pharmacology, and Therapeutics. 18th edn. (1922). Reprinted by Eclectic Medical Publications. Sandy. Oregon (1994)
20. Von Bingen H. Hildegard von Bingen's Physica. Healing Arts, Rochester, Vermont (1998) 21. Meier B. Planta Medica 57(suppl. 2):A26 (1991) 22. Balansard G. Chausse D. Boukef K et al. Plantes Medicinales et Phytotherapie 17(3):123-132 (1983) 23. East West Herbs. Price List and Catalogue. East West Herbs. Kingham, United Kingdom (1993)
15. Scudder JM. Specific Medication and Specific Medicines. Scudder Bros Co, Cincinnati, Ohio (1913)
24. Sykes JB (ed). The Concise Oxford Dictionary of Current English. 6th edn. Oxford Universiry Press, Oxford. United Kingdom (1976)
16. IGrschmann G. Nutrition Almanac. 4th edn. McGraw Hill, New York, New York (1996)
25. Webster's II New College Dictionary. Houghton Mifflin. Boston, MA (1995)
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Safety are essential to the practice of herbal medicine. However, safety considerations need not stifle the scope of clinical practice; rather, they can be used to enhance the effectiveness of herbal treatments whilst reducing the risk to the patient. Safety is discussed in this book in three chapters: ONSIDERATIONS OF SAFETY
C
tain and extend the availability of beneficial herbs to the public. THREE OPINIONS There are three main opinions regarding ~e safety and availability of herbal products.
• Safety • Safety and the organ systems • Safety in clinical practice Safety This chapter reviews the debate on the safety and availability of herbs, discusses measures to improve the safety of herbal medicine, and investigates reports of adverse herb reactions. Safety and the organ systems This chapter discusses herbal contraindications and adverse reactions in each of the main organ systems-in terms of both Western and Chinese medicine.
• herbs are safe • herbs may be unsafe • maximize both herb safety and availability Herbs are safe Many herbal practitioners and many members of the general public are of the opinion that herbs are safe. Therefore, they believe that their availability should not be restricted, at least when they are supplied by practitioners specifically qualified in herbal medicine. Holders of this opinion believe that exaggeration of the risks of herbal medicines may result in legislation that increasingly restricts the availability of beneficial herbs to the public.
Safety in clinical practice This chapter presents a checklist of eleven measures for the practitioner to use in the clinic to improve the safety of ~erbal practice. Each measure is discussed with examples.
Herbs may be unsafe The opposing opinion, held by many members of the medical profession, is that herbs are not safe or may later prove to be unsafe. This group also generally believes that herbs have little or no therapeutic benefit. Therefore, if there is any doubt about the safety of a herb, its availability should be restricted.
Safety and availability
Maximize both safety and availability The first two opinIt is the premise of this book that every effort should be
ions represent the opposite extremes, neither of which can be definitively proved by data. There is a third opinion, held
made to improve the safety of herbal medicine and to main-
121
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Combining Western Herbs and Chinese Medicine
by a growing number of practitioners and scientists according to which it is possible to maximize both the safety and availability of herbal products. They believe that it is possible to increase the safety of both herbal products and herbal practice. This will reduce the frequency of adverse reactions and thereby reduce the risk of restrictive legislation. They are also working to increase the quantity and quality of data on the positive effects of herbs and make this data available to legislators. Increasing the knowledge of the benefits of herbs will also reduce the risk of restrictive legislation.
may genuinely reflect the relative safety of herbal therap~ ...__ adverse reaction reporting has not been satisfactory in the past, and measures are being taken to remedy this • adverse reaction data can be very valuable. but each case needs to be evaluated carefully to determine if it is the herb or another factor that caused the adverse reaction • poor quality control in the manufacture of herb products may have been a major factor contributing to adverse herb reactions, but since quality control is being steadily improved, there may be a reduction in adverse reactions and an increase in herb safety
TOPICS OF DEBATE IMPORTANCE OF MULTIPLE Four of the main topics that feature in the debate on the safety and availability of herbs are: • risk of adverse herb reactions • importance of multiple active constituents • qualityofherball'ractitioners • risk:benefit ratio
These four topics are discussed below in terms of each of the three main opinions listed above. RISK OF ADVERSE HERB REACTIONS Herbs are safe • herbs have been used worldwide by millions of people for centuries, and there are surprisingly few reports of adverse reactions • very few plants currently used as herbs have been reported by research to have serious adverse reactions in humans when they are used within their recommended therapeutic dose ranges Herbs are unsafe • adverse reactions may not have been satisfactorily reported in the past • no satisfactory format for reporting adverse reactions from the use of herbs has yet been established • there have been a number of reports in the medical literature suggesting adverse reactions from herb use • there is particular concern over damage done by the long-term use of herbs, which may initially show no adverse r~ac~ons but maylead to cumulative, perhaps irrevers.i?l~~~~age . . Maximizing safety and availability • whilst the relatively few reports of adverse herb reactions
ACTIVE CONSTITUENTS Herbs are safe • herbs have far fewer adverse reactions than allopathic medicines because herbs tend to have multiple active constituents that can buffer and moderate each other's effects Herbs are unsafe • because herbs can contain so many potentially active constituents, it is possible that one or more of these constituents may have potentially harmful effects • there can be considerable variability in the quantity of key active constituents from batch to batch of herbal material, so that the effect on the patient of a standard amount of the herb is less predictable Maximizing safety and availability • the argument that herbs contain many active constituents and that one or more of these may have potentially harmful effects can also be applied to foods, but unless a herbal constituent is proved to be harmful-at therapeutic doses ofthe herb-it is no more logical to limit the availability of the herb than to limit the availability of a foodstuff • standardization of herbal material can reduce batch-tobatch variability and increase safety, but this should be done using multiple markers-perhaps one marker from each of the herb's main active constituent groups
QUALITY OF HERBAL PRACTITIONERS Herbs are safe • herbs are safe, when prescribed by a qualified herbal practitioner since they can be matched to the specific individual needs of the patient
Safety Herbs are unsafe • there is no recognized minimum level of training, and prescription of herbal products by inadequately trained individuals may result in adverse reactions Maximizing safety and availability • improvements in the minimum level of training of herbal therapists will decrease adverse reactions and reassure legislators • if the practitioner is well-trained and so has detailed knowledge of the potential side effects of a herb for a particular patient. it may be possible to gain the benefits of the herb whilst minimizing potential side effects
RISK:BENEFIT RATIO Herbs are safe • in some cases, herbs can be just as effective as conventional drugs or even more effective • herbs have fewer adverse reactions than conventional drugs because herbs can strengthen the self-regulatory capacity of the body, whilst drugs tend to suppress specific symptoms and, in doing so, may suppress and disturb the natural metabolism Herbs are unsafe • herbal remedies do not have any real benefit
• if there is any doubt as to the safety of a herb or even one of its constituents, even if the doubt comes from theoretical considerations rather than adverse clinical reports, the use of that herb should be restricted Maximizing safety and availability • research data is accumulating demonstrating the benefits of individual herbs, and in most cases, the data emphasizes their safety when they are used within their therapeutic dose ranges i\
• for most herbs, the available evidence suggests that the benefits outweigh the risks, and this evidence can be presented by the herbal profession to the regulatory
123
benefit assessment to herbal products that they do to pharmaceuticals. They believe that in the case of herbal products• regulators tend to exaggerate the risks and ignore the benefits of herbal medicines.\ This topic is further discussed in the next section In perspective and in the section Improving interpretation ofadverse reaction data later in this chapter.
In perspective Many practitioners and many members of the public believe in the right to choose herbal therapy. They regard herbal knowledge as a treasure house of over 2000 years of medical experience. They believe that in a society increasingly alienated from the natural world, herbal therapy provides them with an important link to living things and to the earth. They find it ironic and unacceptable that a therapy, which they 'consider to be much safer than conventional medication and more supportive to the body, should be restricted due to exaggeration of its risks and ignorance of its benefits. Whilst the bulk of this chapter deals with the investigation of adverse reactions to herbal products, it is useful to put this discussion of the risks of herb use in the context of the dangers from other substances ingested in modern life. Herb products can be compared on the one hand with food and drink, and on the other with conventional medications.
HERBS) FOOD) AND DRINK The adverse effects of excessive consumption of coffee, tea, salt, and sugar are well known2 and are greater than those of the majority of herbal medicinal products. What is less well known is that many common vegetables also contain potentially toxic constituents. For example:3 • beans can contain toxic lectins • cabbages contain glucosilinates that can convert to toxic nitriles • potatoes can contain poisonous alkaloids when the tubers turn green
authorities Regulating authorities assess conventional medicines according to risk:benefit ratio and allow a certain statistical level of adverse drug reactions, providing that the benefit seems to outweigh the risk. However, many herbal practitioners believe that regulatory bodies do not always apply the same standards of risk:
However, these vegetables are generally regarded as safe, even when they are consumed in large quantities. Although they may contain chemicals that are potentially toxic in themselves, these chemicals are not normally present at levels that present a risk to the public. The same principle can be applied to herbs (see the discussion in the section Improving
interpretation ofadverse reaction data).
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Combining Western Herbs and Chinese Medicine
HERBS AND CONVENTIONAL MEDICATIONS Side effects from conventional medications are far more common and can frequently be more severe than those from herb products, as illustrated by the comparisons below between a herb and a comparable conventional medication: • digoxin and Crataegus • diazepam and Valeriana
DIGOXIN AND CRATAEGUS Both the cardiac glycoside drug digoxin and the herb Crataegus can be used to increase the force of the myocardial contraction and reduce arrhythmias. Their risks and benefits can be compared as follows: Digoxin The data given below on the negative effects of digoxin is from Martindale. 2
Side effects Digoxin commonly produces side effects because there is only a narrow margin between the therapeutic and toxic doses. These may include headache, facial pain, fatigue, weakness, dizziness, and mental confusion. Toxic doses may produce cardiac arrhythmias and may result in heart failure.
Drug interactions Digoxin can interact with many other types of drugs, including alpha blockers, antiarrhythmics, antibacterials, antiepileptics, antifungals, antimalarials, antineoplastics, immunosupressants, benzodiazepines, calciumchannel blockers, diuretics, nonsteroidal anti-inflammatories, and sympathomimetics. Some of these interactions can have serious consequences.
Fatalities In massive overdose, digoxin can result in progressive hyperkalemia, which can be fatal. Crataegus This herb is an excellent example of a herb that does not have side effects because it has a homeostatic or normalizing effect on the body. It can therefore be used to treat both hyper- and hypoactive states of the cardiovascular system (see the Crataegus chapter).
Comparison studies When compared with a digoxin preparation, Crataegus was reported to increase erythrocyte flow rate and decrease leukocyte endothelial adhesion in the vascular network of the rat. 4 In a study on isolated guinea pig hearts, digoxin was reported to shorten the effective refractory period, whilst Crataegus lengthened it. 5 Thus Crataegus has less risk of causing arrhythmias than digoxin and may even have ~tiarrhythmic action. Side effects ..No significant side effects have been reported. Drug interactions No adverse herb-drug interactions have
been reported for this herb. In fact, Crataegus has been reported to reinforce the beneficial effect of cardiac glycosides in increasing the force of heart contraction without increasing glycoside toxicity.6
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Fatalities No overdose effects have been reported. DIAZEPAM AND VALERIANA Both the benzodiazepine drug diazepam and the herb Valeriana can be used to treat anxiety and insomnia. Their risks and benefits can be compared as follows: Diazepam The data given below on the negative effects of ....... diazepam is from Martindale.!
Side effects The most common side effects of diazepam are
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sedation, drowsiness and ataxia. Side effects can also include depression, confusion, amnesia, slurred speech, headache, vertigo, visual disturbances, tremor, gastrointestinal disturbances, and urinary system disorders. Respiratory depression and hypotension occasionally occur with high dosage, and some patients experience a paradoxital excitation that may include such symptoms as aggression and disinhibition.
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Dependence and withdrawal Physical dependence may develop, with severe and distressing withdrawal symptoms, which may include dizziness, tinnitus, headache, hypertension, irritability, insomnia, anxiety, palpitations, tachycardia, vomiting, and abdominal cramps.
Drug interactions Enhanced sedation or respiratory and cardiovascular depression may occur if diazepam is given with other CNS-depressant drugs.
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Fatalities During the years 1980-1989,891 fatal poisonings in Britain were attributed to overdosing with benzodiazepines used alone. Valeriana
Comparison studies In a double-blind study with 100 patients suffering from moderate anxiety, a preparation of-Valeriana combined with Hypericum was shown to be more effective than diazepam and to have fewer side effects. 7
Side effects
The side effects of therapeutic doses of Valeriana are occasional and mild, Valeriana has no general contraindications, and there are no reports of adverse reactions either during pregnancy and lactation (see the Valeriana chapter). One study compared Valeriana with flunitrazepam, a_ benzodiazepine with similar general properties to diazepam. s The authors reported that the flunitrazepam group showed impairment of perlormance on the morning follow-
Safety ing medication, whilst the valerian group reported only a very slight impairment of vigilance.
Drug interactions There are no clinical reports of herb-
125
and saponins, chromatographic analysis of both types of compounds is required for identification and standardization.9
drug interactions with Valeriana, although it would be prudent not to combine high doses of Valeriana with alcohol or sedatives prior to operating machinery (see the Valeriana chapter).
The use of multiple markers For herbs with multiple active constituents, the use of multiple markers would give a more complete and accurate assessment of herb effectiveness and herb safety. As an initial step, it might be possible to select
Dependence and withdrawal I have not seen reports of
three to four main active constituents. or to select one constituent from each main chemical type present, for example, one flavonoid, one saponin, and one volatile oil.
dependency or withdrawal symptoms with Valeriana.
Fatalities
I have not seen reports of fatalities with Vale-
riana.
Definition of standardization The term standardization, as
Necessary improvelnents Improvements in five key areas would go a long way to reduce doubts about herb safety: • improvements in quality control for the manufacture of herb products • restriction of certain herbs to qualified practitioners only • improvements in the level of training of herbal practitioners • improvements in recording of adverse reactions • improvements in interpretation of adverse reactions
QUALITY OF HERB PRODUCTS This topic is discussed in two parts: Standardization and
used above, is taken to indicate the assaying of different batches of herb material to determine if the marker active constituents are within acceptable levels. It may also include the use of standardized preparation and extraction procedures in the manufacture of a herbal product. In this context. it does not mean the addition of a previously isolated chemical to the herb material to produce an artificial standard level of that compound, for example, the addition of caffeine to products made from Cola species. This is not standardization, but adulteration. Other quality issues Some of the adverse reactions occurring with the use of herbal products may be due to poor quality control in their production. Standardization has already been discussed. This section is concerned with: • general manufacturing standards • misidentification and substitution • contamination and adulteration
Other quality issues. l.~ __
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Standardization The concern is that even if the herb material is correctly identified, down to the species, or if necessary, the subspecies, there may be an unacceptable degree of variability in the quantity of active constituents from one batch of the herb to another. To minimize this, one or more active constituents are selected as markers, and the quantity of these markers in a batch of herbs is assessed. for example. by chromatography, to determine if the quantity is within the acceptable minimum-maximum range of standardization.
Disadvantages of a single marker
The pharmacological activity of a herb may depend not on a single constituent, but on a complex of mutually re~ating chemicals. If only one active constituent is used as a marker for purposes of standardization. this may not give an accurate picture of the overall effectiveness of the herb. For example, Wagner et al. point out that since the therapeutic effect of Astragalus species (huang qi) may be due to a synergism of flavonoids
General manufacturing standards if herbal products are manufactured according to the full code of pharmaceutical GMP (Good Manufacturing Practice). this gives a baseline of quality control; it is a legal requirement in some countries.
Misidentification and substitution Misidentification can occur when laypersons gather herbs without adequate knowledge of plant identification. An example of incorrect identification resulting in adverse effects is given in the section
Examples ofadverse reports. Misidentification is less common in the manufacture of herb products, but substitution has been an accepted part of herbal supply in both China and the West. It is now less acceptable since some substitutes have been identified as higher risk herbs. For example. in the past. Teucrium species were commonly used as substitutes for Scutellaria. 1o This is no longer acceptable since Teucrium chamaedrys has been reported to have a hepatotoxic effect. ll
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Combining Western Herbs and Chinese Medicine
Contamination and adulteration To maximize safety, it is necessary to include testing for the following: • microbial contamination • contamination with heavy metals • contamination with unacceptable levels of pesticide and herbicide residues • contamination of a nontoxic herb with a toxic herb during harvesting • adulteration with conventional drugs To maintain quality control, these tests need to be performed on a regular basis. The future As standards of manufacture of herbal products continue to improve, problems of misidentification, substitution, contamination, and adulteration are likely to decline. Increased herbal safety and less adverse reaction reports should help to decrease the demand for restrictions on the availability of herbs.
QUALITY OF PRACTITIONERS
If the supply of certain herbs is to be restricted to practi- - '" tioners only, this raises the question of the quality of practitioner training in herbal medicine. In some Western countries, it may be that a large number of practitioners prescribing ----".0-' herbal treatment do not have a level of training that is sufficient either to diagnose or to prescribe effectively and safely. Necessary measures As long as a significant part of the herbs supplied to the public comes from individuals with inadequate diagnostic and herbal training, government regulators are more likely to restrict the use of herbs. If phytotherapy is to survive as a profession, it is essential that certain measures be taken.
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Minimum training and external examination Rather analogous to the development of acupuncture in the United States, one possibility is to set a minimum level of training for courses on Wes.tern herbal medicine and to have an external national or state examination.
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RESTRICTION OF CERTAIN HERBS TO QUALIFIED PRACTITIONERS ONLY OTC sales It is likely that the majority of Western herbs supplied to the public in the West are at present bought overthe-counter (OTC), that is, from retail stores or by mail order. The vast majority of OTC sales are without a prior full diagnosis by a practitioner qualified in herbal medicine.
Membership and registration Those who pass the examination are then eligible for membership in a professional phytotherapy organization with a code of ethics 'and a consumer complaints procedure. They may then also be eligible for licensing and registration on a state or national basis, having satisfied these authorities as to the adequacy of other aspects - <:;7' of their training, such as, for example, a basic minimum of training in Western medicine. ;;" ..
When aTe sales are inappropriate For those herbs without side effects when taken within the therapeutic dose range, aTC sales may be appropriate. However, in my opinion, aTC sales are inappropriate for those herbs that can have potentially severe side effects for some persons, just above or even within the therapeutic dose range.
Accreditation for schools An external accreditation and inspection procedure for schools of herbal medicine could be installed to ensure quality of both theoretical and clinical training.
Supply by practitioners only Some countries, for example, the United Kingdom, have a list of restricted herbs that may not be supplied on demand by retail outlets but may be supplied to patients by a practitioner, subsequent to a professional consultation. (see the Regulation of herb use section below). There are maximum dose restrictions on these herbs.
In the past, the reporting procedures for adverse herb reactions have been unsatisfactory. In some countries, gov- ernment regulators may have tended to feel that the herbal profession has no concept of evaluation of safety, does not care about safety, or is too disorganized to act effectively. This has increased the possibility of restrictive legislation.
Reducing risk of restrictive legislation In my opinion, herbs such as Cinchona, Convallaria, Ephedra, and Gelsemium, are not suitable for aTC sales. If such herbs were restricted to qualified practitioner use only, as they are in the United Kingdom, there would be l~ss adverse reactions and less likelihood of a total restriction on the availability of these very useful herbs to the public.
Progress made Escap (the European Scientific Coopera- _ tive on Phytotherapy) has been involved in the improvement of adverse reaction reporting in Europe. This project brings together scientists, herbalists, and manufacturers from the_ European countries. ESCOP has a web site for online reporting of adverse reactions:
REPORTING OF ADVERSE REACTIONS
www.escop.com/phytonethtm
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Safety In Britain, the National Institute of Medical Herbalists (NIMH) issues adverse reaction report forms to its members, which include the vital questions 'Was the patient rechallenged?' and 'Did the reaction recur?' The NIMH web site is currently: www.nimh.org.uk/
Future needs Individual practitioners can contribute to the survival of herbal medicine by sending adverse herb reaction and herb-drug interaction data to the collecting bodies in their particular country. The accumulation and promulgation of data on adverse reactions is essential to a practitioner's understanding of herbs, to the fair regulation of herb products, and most of all to the safety of the public. However, it is also essential that the reporting of an adverse reaction is objective and accurate, and clearly determines that the adverse reaction was brought on by the herbs and not by another factor. This is discussed in the next section.
Improving interpretation of adverse reaction data This subject is discussed under four main headings: • increasing objectivity • excluding factors other than the herb itself • investigating reactions apparently due to the herb itself • distinguishing between actual clinical adverse reactions and the theoretical possibility of adverse reactions
INCREASING OBJECTIVITY The media of both complementary and conventional medicine may sometimes be less than objective in the reporting of adverse reactions. There may be a natural inclination among some herbal practitioners to play down adverse reaction data, and there may be a tendency in some medical journals to play it up. There has been some less than rigorous reporting in medical journals, in which herbal remedies were implicated in adverse reactions without sufficient evidence. 3• 12
Any report of adverse reactions requires thorough investigation before public pronouncement is made or restriction on availability is imposed. Objectivity can be increased by applying the following basic principles of scientific investigation to an adverse reaction publication:
127 • full citation of all relevant primary sources • thorough assessment of reports • caution in extrapolation from a single report • caution in generalizing from one species to a genus • careful exclusion of the effects of factors other than the one under study (see the next section) Full citation of all relevant primary sources If any statement is to be made in a book or journal about the toxicity or adverse reactions of a herb, it is essential to cite full references to the primary sources. This has not always been done in the past.
German Commission E Monographs This text, published in English translation in 199813 did not 'include any references to the literature used by the Commission in assessing the safety of the herbs discussed. EXAMPLE 1: The monograph on Echinacea angustifolia stated that this herb is not to be used internally in systemic diseases such as multiple sclerosis, AIDS, HIV infection, and other autoimmune diseases. According to Mills and Bone, there are no clinical studies that document adverse effects resulting from the use of Echinacea in any of these conditions. 3
The monograph on Smilax states that taking preparations of this herb leads to gastric irritation and temporary kidney impairment. The editors of the English translation of the Commission E monographs pointed out that they could find nothing in the scientific literature that substantiated this assertion. 13 EXAMPLE 2:
Examples such as these led one author to question whether some of the statements on herb safety made by the Commission were actually based on clinical research or on theoretical speculation. In his opinion, the failure to cite primary sources makes the Commission E monographs unsuitable as a basis for regulation ofherb availability.14 Thorough assessment of reports No public pronouncement on herbal safety should be made on the basis of an uninvestigated anecdotal report of a clinical incident. Any report of adverse reactions to a herb requires rigorous investigation of methodology, record keeping, data, conclusions made, and experimental design and statistical interpretation of data, where appropriate. Caution in extrapolation from a single report A basic principle of scientific research is never to accept fully the data and conclusions of a single investigation. It is preferable to weigh a single report against research by other investigators before coming to a provisional conclusion, and it is wise
128
Combining Western Herbs and Chinese Medicine
always to be prepared to change this conclusion in the light of new data. Caution in generalizing from one species to a genus Because one species in a genus is reported to have adverse reactions, it does not mean that other species in the genus will also have that effect. For example, there has been a report of hepatotoxicity in rats for Teucrium chamaedrys,1I but another Teucrium species was shown to have hepatoprotective effect in mice. IS Different species in a genus may have different profiles of active constituents and thus have different pharmacological effects. If one species has been reported to have adverse effects, it may be necessary to investigate other species in the genus, but each species must be assessed separately.
Adverse drug-drug interactions An adverse reaction may be . __ due to a negative interaction between a herb and a drug that the patient is taking concurrently. However, when investigating this possibility, it is important to consider the possibility of an adverse drug-drug interaction between two of or more of the conventional medications that the patient is taking.
INVESTIGATING REACTIONS APPARENTLY DUE TO THE HERB ITSELF After the exclusion of other factors, the following key question can help to determine whether the reaction is due to the herb product itself:
Do the symptoms decline when the patient stops taking the product and increase when the patient is 'rechallenged: that is, when administration ofthe product is resumed?
EXCLUDING FACTORS OTHER THAN THE HERB ITSELF One of the most fundamental principles of scientific investigation is the exclusion of the effects of factors other than the one under study. Before it is possible to say that a herb product can cause adverse reactions, it is necessary to exclude the following alternative possible causes of the reaction. These may include: • adverse reactions from conventional medicines or change in type or dose of conventional medicines • changes in intake of drugs, such as coffee, alcohol, tobacco, cocaine, or other 'recreational' drugs • changes in nutritional pattern, fasts, mega-doses of nutritional supplements, or excessive amounts of'junk' food • changes in life situation, such as change of partner, promotion, demotion, or bereavement, with accompanying shocks, grief, or changes in level of stress Only the first of these alternative causes is discussed below. Reaction due to conventional drugs It is essential in the reporting of adverse reactions to make careful note of the conventional drugs that the patient was taking at the time of the reaCtion:" . It is espeCially important to record recent changes in the type or dose of conventional medications. For example, an increase 'in ,the dose of the antidepressant drug venlafaxine hydrochloride may be accompanied by nausea, headache, insomnia, somnolence, anxiety, vomiting, hypertension, and skin rashes. 2
Caution Suitable precautions should be taken if the patient is rechallenged, and rechallenge may not be appropriate if the symptoms are severe. See the Monitoring section in the chapter on Safety in clinical practice. Is the reaction due to the herb product or to the herb itself? After a rechallenge, it may appear that the herb product is responsible for the adverse reaction. However, it may be that the reaction is due to the product rather than to the herb itself. The product may contain misidentified or substituted herb material, or it may suffer from contamination or adulteration. If the factors of misidentification, substitution, contamination, or adulteration of the product can be excluded, it may appear that the adverse reaction is due to the herb itself. It is then important to determine: • whether the herb was taken within the recommended therapeutic dose range or whether it was taken in overdose • whether the herb was taken in one of the recommended dose forms of phytotherapy, such as dried powder, infusion, decoction, tincture, or fluid extract, or whether it was taken as an essential oil or with added concentrated isolated active constituents (see the next section) • whether the herb was taken by the recommended administration methods of phytotherapy, such as orally or topically, or whether it was taken by inappropriate forms, such as injection If the herb was taken in inappropriate dose, dose form, or administration method, then the adverse reaction may not be relevant to situations in which the herb is used in an appropriate manner.
•.•. J
Safety DISTINGUISHING BETWEEN CLINICAL AND THEORETICAL ADVERSE REACTIONS It is sometimes not clear in the literature as to whether the author is referring to an adverse reaction to a herb that has actually occurred in the clinic or to the theoretical possibility of an adverse reaction. It is most important to distinguish between the two. Theoretical possibility of an adverse reaction The possession of an active constituent that in some cases may confer toxicity does not mean that a herb possessing this constituent will necessarily produce adverse reactions. Toxicological experiments may not give data that is fully relevant to humans using the herb itself when the herb is administered orally within the therapeutic dose range. This is because these experiments often: • use cell cultures or animals rather than humans • use isolated constituents rather than the herb itself • use doses far in excess of the human therapeutic dose range • use substances administered by injection rather than oral administration This topic is further discussed in individual materia medica chapters, such as those on Artemisia, Berberis, Cinchona, Lobelia, and Salvia. It is also discussed in the section
Herb-drug interactions below.
Examples of adverse reports The examples of adverse reports discussed below are used to illustrate the principles of interpretation of adverse reaction data. These reports are divided into two groups: • adverse reactions which appear to have been due to causes other than the herb itself, such as incorrect identification, adulteration, and overdose • adverse reactions which appear to have been due to the
129
prepared from what his parents thought was Tussilago farfara (coltsfoot). However, it was found that the parents had erroneously gathered Adenostyles alliariae, a plant that contains much more hepatotoxic pyrrolizidine alkaloids than Tussilago. 16 Although the boy recovered completely after 2 months, this example illustrates both the importance of correct plant identification for the patient, and the importance of verifying plant identity in adverse reaction reports. Substitution and adulteration Between 1990 and 1992, over 30 patients in Belgium developed renal failure after taking a slimming preparation which was supposed to contain Stephania tetranda (him fang ji), but in fact contained Aristolochia fangchi (guang fang ji). The renal failure may in part have been due to the potentially toxic constituent aristolochic acid present in the Aristolochia (see the discussion in Adverse reactions from the herb itselfbelow). However, on investigation it was found that the slimming preparation contained not just Aristolochia, but also conventional synthetic drugs. It was suggested that the tragedy was due to a herb-drug interaction. 17 Dose in excess of the recommended maximum Glycyrrhiza is a safe herb at the recommended daily dose for the dried herb of 3-12 g per day,lOand providing that the cautions on its use are observed (see the Glycyrrhiza chapter}. An adverse reaction to Glycyrrhiza was reported for an II-year-old boy with hypoparathyroidism and Addison's disease who developed pseudohyperaldosteronism from an excessive daily intake of 300-400 g of Glycyrrhiza. After complete withdrawal of Glycyrrhiza, all symptoms of hypermineralocorticoidism diminished and growth velocity increased. 18 This is an example of a herb that is safe within the therapeutic dose range, but not when it is taken in massive overdose. Use of concentrated forms There have been reports of adverse effects from the use of the alkaloids quinine and quinidine as isolated chemicals.2 Although the herb Cinchona contains these alkaloids, I have not seen reports of adverse reactions to the use of Cinchona as a dried herb or tincture when it is used within its recommended therapeutic dose range. The. possible reasons for lack of adverse reactions to Cinchona are discussed in the chapter on this herb.
herb itself
Note Some herbs appear in both groups.
ADVERSE REACTIONS FROM THE HERB ITSELF
ADVERSE REACTIONS FROM CAUSES OTHER THAN THE" HERB ITSELF Misidentification An IS-month-old boy developed venoocclusive liver disease after long-term consumption of a tea "
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Aristolochia fangchi This herb, guang fang jI, has been associated with cases of renal failure in Belgium between 1990 and 1992, as noted above under the heading of Sub-
stitution and adulteration.
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Combining Western Herbs and Chinese Medicine
Studies ofmedical records A recent Belgian statistical analysis of medical records between 1990 and 1992 reported that the results confrrmed that regular ingestion of Aristolochia species extracts wascausally involved in the onset of chronic interstitial nephropathy leading to end-stage renal disease. 19 However, an epidemiological study in France found a large difference between France and Belgium in the frequency of cases of nephropathy that could be associated with the intake of Aristolochia fangchi. This was despite the fact that similar preparations prescribed at the same doses were widely used in France as well as Belgium. The authors suggested that the difference in the frequency of adverse effects between the two countries might be due to an unrecognized factor that promotes the toxicity of aristolochic acid (see below) and is peculiar to the Belgian prescriptions. 20
Pharmacological studies A study on rats reported that daily, subcutaneous injections of aristolochic acid (AA) could induce chroriiC interstitial renal fibrosis. A daily dose of 10 mg/kg of AA induced interstitial fibrosis. However, it should be pointed out that this is equivalent to 600 mg of AA for a 60 kg human?l Another study reported that high doses of orally administered decoction ofAristolochia manshuriensis could induce renal failure in rats. 22
Summary The number and severity of the cases in Belgium justify the restriction of the supply of herbs with an appreciable content of AA, pending thorough investigation. However, whilst Aristolochia fangchi may have been a contributing factor in the Belgian tragedy, it has been suggested that another factor or factors potentiated the adverse effect of the AA. t7.20 It would also be valuable to determine if AA has adverse effects when it is administered orally at levels equivalent to
those in therapeutic doses of Aristolochia fangchi or an equivalent herb. The pharmacological studies noted above used amounts of AA or Aristolochia herb in excess of therapeutic levels. Teucrium chamaedrys This herb, known as germander, has been associated with liver disease in several studies. 23.24. 2S.26 In some cases, the patients recovered after discontinuing the herb preparation, and in four cases, rechallenge resulted in recurrence of liver injury or hepatitis. 23 • 24 Hepatotoxicity of Teucrium chamaedrys was demonstrated in isolated rat hepatocytes and may be due to furanoditerpenoids. II However, it was reported that a different species of Teucrium, T. stocksianum, cm have hepatoprotective effect. Pretreatment with an ethanolic extract of this herb significantly ameliorated paracetamol-induced liver damage in mice. ls
-_.:~.::.-
As discussed above, Teucrium illustrates the principle of the danger of generalizing from one species in a genus to another since they may have different spectra of active constituents. However, if one species has adverse effects linked to a specific toxic constituent and that constituent is found in another species of the same genus at similar or higher levels, this could be grounds for a temporary ban on the second species, pending full investigation. Symphytum This herb, comfrey, was one of the most widely used and respected herbs for both internal use, such as inflammation and ulceration of the stomach and intestines, and external use, such as wound healing. In recent years, the supply of Symphytum in some countries has been restricted due to the presence of toxic pyrrolizidine alkaloids (PAs). These chemicals, subsequent to their breakdown in the body to toxic pyrroles, have been associated with liver damage resulting in hepatic venoocclusive disease (VOD).
Cases with adverse reactions A review published in 1996 reported that, worldwide, there had only been four cases 27 reported of PA poisoning involving Symphytum species. These are briefly reviewed since they illustrate the difficulty of separating the herb itself from other possible causative
\i;•..•
factors when studying adverse reactions. CASE 1: This case was an example of dose in excess of the recommended maximum, which was given by the BHP as 6-12 g per day. This case was of a 47-year-old woman who drank up to 10 cups of Symphytum tea per day in addition to 'taking comfrey pills by the handful, which continued for more than a year: 28 CASE 2: This case was that of a 49-year-old woman who developed ascites subsequent to taking comfrey-pepsin tablets. 29.3o However, it is not clear to what degree the ascites was due to the Symphytum since she was also taking Mu-16 tea, which also contained PAS. 27 CASE 3:
A 14-year-old boy suffering from Crohn's dis31
ease developed VOD, which was ascribed to Symphytum. However, he was also taking prednisolone. Some drugs affect the levels of cytochrome P-450 enzyme and thus increase the levels of toxic pyrrole in the liver. 27 If this were so for prednisolone, then this case would be an example of an adverse herb-drug interaction, rather than a simple adverse herb reaction. CASE 4: The death of a young man from liver failure was ascribed to Symphytum,32 but this man was predominantly vegetarian and ate in binges of, for example, grapes or cashews lasting for days. It has been suggested that protein malnutrition may have increased his susceptibility to very 27 small amounts ofPAs.
Safety Minimizing PA content Some Syrnphytum species contain less toxic PAs than others, for example, S. officinale has lower levels of toxic PAs than S. x uplandicum, and the PA levels of S. tuberosum are lower still. Also, leaf samples have much less PAs than roots, and in addition, the use of extracts of Symphytum rather than powder greatly decreases the PA concentration. It has therefore been suggested that, if extracts of the leaves of the Symphytum species with lower PA content are used, the PA levels would be so low as to make liver damage unlikely, even with long-term use. It has also been suggested that low PA varieties of S. officinale could be developed and then propagated vegetatively by root division. 27
Risk.·benefit ratio
Considering that millions of people
worldwide have been taking Symphytum, four adverse reaction reports might be dismissed as idiosyncratic reactions. However, the concern of legislators is that PA damage to the hepatoeytes may occur without signs or symptoms until serious liver damage has occurred. Symphytum is an excellent example of different interpretations of the risk:benefit ratio of a therapeutic substance. The conventional drug acetaminophen in high doses can cause similar damage to the hepatoeytes as the toxic PAs, but the legislators are obviously of the opinion that the risk of adverse reactions is outweighed by the advantages of the drug. Herbal practitioners, on the other hand, think that the great benefits of Symphytum outweigh its very rare adverse effects, but the legislators are unaware of these benefits and therefore take only the risk factor into account in assessing the risk:benefit ratio. Herbal practitioners believe that Syrnphytum is especially appropriate in cases in which the conventional drug involves a much higher risk of adverse effects than does this herb. For example, in the treatment of arthritis in the elderly, Symphytum has less risk of adverse effects than conventional nonsteroidal anti-inflammatory drugs, which can result in
131
FDA restriction. There was already concern over the widespread inappropriate use of this herb for weight loss and as a stimulant 'recreational drug' ('herbal ecstasy'). 34 As with the case of Symphytum, the case of Ephedra illustrates several important principles. This is a potent herb with a number of potential side effects (see notes on this herb in the Additional herbs chapter). The following is therefore important: • the practitioner should be thoroughly familiar with the cautions and contraindications for the use of Ephedra • the practitioner should perform a full differential diagnosis to determine whether the patient has any syndromes for which Ephedra is either contraindicated or indicated but with special caution or at a lower dose • the practitioner should be thoroughly familiar with the therapeutic dose range of Ephedra • the practitioner should be thoroughly familiar with the herbs that can be combined with Ephedra to moderate its potential side effects In my opinion, Ephedra is a most useful herb that should remain available to qualified health practitioners and that should not be restricted to a maximum dose level at which it no longer has therapeutic effects. However, for the safety of the public and to restrain inappropriate use of this herb, it is my opinion that its supply should be restricted to qualified health practitioners, as it is in the UK under Schedule Part III of the Supply of Herbal Remedies Order 1977. If the use of this and similar herbs is not restricted to practitioners, it is likely that legislators will either ban its supply or restrict its maximum dose to a subtherapeutic level.
Herb-drug interactions
and Western herbal medicine. In my opinion, it is one of the best herbs for asthma and can also be effective for allergic rhinitis and allergic skin conditions.
One substance can be said to interact with another if it modifies the absorption, availability, metabolism, or excretion of the other substance; thus increasing or decreasing its concentration at its final reactive site. For example, one substance might modify the reaction mechanism of another by stereochemical modification of its receptor site.
In America, the FDA restricted the sale of products of Ephedra sineca (rna huang) following a case of acute hepati-
TYPES OF INTERACTION
death due to severe gastric bleeding. 2' Ephedra sineca
This is an important herb in both Chinese
tis allegedly due to the use of Ephedra. Some have suggested that Ephedra was unlikely to be the cause of the hepatitis in this case since Ephedra is not generally associated with hepatotoxicity; rather, the possibility of adulteration of the product should have been considered. 33 However, the case of hepatitis may have been only the precipitating factor in the
Interactions can be divided into four main types:
• positive:
- one substance increases the beneficial effects of another - one substance decreases the side effects of another
;;;
132
Combining Western Herbs and Chinese Medicine
• negative:
- one substance decreases the beneficial effects of another - one substance increases the side effects of another
POSITIVE INTERACTIONS Herb-herb interactions The art of herbal medicine is to combine herbs so that they increase each other's beneficial effects and decrease each other's side effects, where these exist. The theory and practice of utilizing herb-herb interactions is discussed in the chapters Principles ofherb combination and Practical herb combination. Herb-drug interactions Herbs can be said to have a positive interaction with a drug when they either: • increase the beneficial effect of the drug • reduce its side effects
Increase beneficial effects There is little information at present available on this important topic. In the future, herbs may be more widely used to increase the beneficial effects of conventional drugs, as suggested by the following research studies. CIMICIFUGA. This herb has been reported to enhance the antiproliferative effect of tamoxifen on human breast cancer cells.35 CRATAEGUS This herb has been reported to reinforce the beneficial effect of cardiac glycosides of increasing the force of heart contraction without increasing the side effects of the glycosides.6
Decrease side effects
It is already common practice in phy-
totherapy to prescribe herbs to counter the side effects of conventional medication, as shown by the following examples: REDUCTION OF INFLAMMATION Anti-inflammatory herbs, such as Althaea, Filipendula, and Glycyrrhiza can be given to reduce gastric inflammation and ulceration caused by some conventional nonsteroidal anti-inflammatory drugs. REDUCTION OF NAUSEA AND VOMITING Antiemetic herbs, such as Ballota, Mentha piperita, and Zingiber, can be given to reduce the nausea and vomiting caused by some chemotherapy medications for cancer.
NEGATIVE HERB-DRUG INTERACTIONS Please see the previous sections in this chapter:
• Necessary improvements: Reporting adverse reactions
• Improving interpretation ofadverse reaction data For each of the herbs with its own materia medica chapter in this book, available information on interactions is given in the Toxicology and Cautions sections. Distinguishing clinical adverse reactions from theoretical possibilities There is a paucity of information available on the important topic of negative herb-drug interactions, and relatively few herb-drug interactions have actually been demonstrated in the clinic. Many herb-drug interactions discussed in the literature are merely concerned about the theoretical possibility of an adverse reaction and have not been clinically demonstrated. For example, Mills and Bone presented a table of possible herb-drug interactions, but emphasized that the great majority
ofthe interactions listed in the table were only theoretical. 3 These theoretical concerns are usually raised because a herb contains constituents that may have adverse interactions with conventional drugs when they are taken as isolated
chemicals. Applicability of studies on isolated chemicals Interaction data from studies on isolated active constituents can be valuable as a guide to possible herb-drug interactions to be watched for and avoided. However, the occurrence of negative interactions using isolated constituents does not necessarily mean that these interactions will ever occur when the
herb itselfis used within the therapeutic dose range. Buffering systems in the plant When the herb itself is taken. an individual constituent may be part of a complex of buffering and moderating chemicals that may reduce the tendency of that constituent to cause side effects or herb-drug interactions. If the constituent is administered as the isolated chemical. without this buffering system, adverse reactions are more likely.
Generic interactions may not apply to herbs Sometimes statements of possible negative interactions are given in terms of generic action categories of conventional drugs. For example, it is often stated that vasoconstrictors and vasodilators may interact with antihypertensives. However, herbs with these generic action categories often have a different and more complex mechanism than their conventional equivalents. Their effect is often milder and tends to be selfbalancing. For example, Crataegus can act as a vasodilator, but it tends to h~ve a normalizing effect on the cardiovascular system and on blood pressure, depending on the initial state of the patient (see the Crataegus chapter). It is therefore less likely than a conventional vasodilator to have adverse effects by potentiating an antihypertensive drug.
."",
Safety EXAMPLES OF REPORTS OF NEGATIVE HERB-DRUG INTERACTIONS Angelica sinensis There has been one report of the potentiation of warfarin, but see the Cardiovascular system section in the next chapter. Capsicum A rat study reported that orally administered doses of Capsicum annuum extract of 100 or 300 mg/kg per day for 4 weeks reduced salicylate bioavailability after oral administration of aspirin. 36 However, this is equivalent to 6-18 g of Capsicum extract for a 60 kg human, in contrast to the daily dose of 90-360 mg per day of dried Capsicum recommended by the BHP.
'.~-
Cinchona One or both of the Cinchona constituents quinine or quinidine may have adverse interactions with other antiarrhythmics (especially cardioactive glycosides), ~-blockers, antihistamines, anticoagulants, and drugs to treat ulcers (see the Cinchona chapter). I have not seen research evidence that these drug interactions occur when using therapeutic doses of Cinchona bark. However, it is prudent to use caution. Also, in my opinion, the supply of Cinchona should be limited to health practitioners, as it is in the UK. Convallaria There is evidence that cardiac glycosides may have adverse interactions with a number of other drugs, including ACE (acetylcholinesterase) inhibitors, antiarrhythmic agents, anthranoid laxatives, antiepileptics, antifungals, antimalarials, calcium channel blockers, diuretics, muscle rela.xants, and nonsteroidal anti-inflammatories. 2 Convallaria contains cardioactive glycosides, but 1 have not found any adverse drug interaction data for Convallaria as a herb when it is used within its therapeutic dose. In fact, one study on the treatment of the aging heart reported a positive interaction. The authors reported an increased tolerance of digitalis glycosides through combined treatment with Convallaria glycosides. 37 However, it is prudent to use caution. In the UK, the supply of Convallaria is limited to health practitioners (see the chapter on this herb). Glycyrrhiza The following herb-drug interaction data has been reported for Glycyrrhiza.
Prednisolone It has been reported that Glycyrrhiza can increase plasma levels of prednisolone by inhibiting the metabolism of this drug by the enzyme 11 ~-hydroxysteroid dehydrogenase.38.39.40 Glycyrrhiza may thus potentiate the negative effects of prednisolone, such as hypokalemia, edema, and hypertension. However, Glycyrrhiza has also been reported to potentiate the positive effects of corticosteroids
133
and to reduce some of their adverse effects (see the Glycyrrhiza chapter). Cases of hypokalemia hav~ been reported in patients taking Glycyrrhiza preparations while taking thiazide diuretics. In two of these cases, the patient was taking overdose levels of Glycyrrhiza: In one case, the patient was taking 200 g of licorice per day,4\ and in the other report, the patient was taking 3 liters of licorice tea per day.42 It would be prudent to use caution in prescribing Glycyrrhiza whilst patients are taking prednisolone or thiazide diuretics (see the Glycyrrhiza chapter).
Thiazide diuretics
Hypericum There have been reports of herb-drug interactions involving Hypericum perforatum. It has ~een suggested that Hypericum may influence cytochrome P-450 (CYP) enzymes, especially CYP3A4, thus affecting the metabolism of certain drugs. This subject has recently been reviewed. 43 However, the authors of the review point out that the evidence of CYP induction or inhibition by Hypericum is conflicting. For example, it has been reported that the naphthodianthrone constituents of Hypericum, hypericin and pseudohypericin, may induce CYP3A4. However, another Hypericum constituent, the flavonoid quercetin, has been reported to inhibit CYP3A4. The authors of the review suggest that the synergistic effect of the combined constituents in the whole plant extract may have a balancing effect on CYP enzymes. The review assessed evidence for reported interaction of Hypericum with the following conventional drugs: • HIV protease inhibitors • HIV non-nucleoside reverse transcriptase inhibitors • warfarin • cyclosporin • oral contraceptives • anticonvulsants • digoxin • theophylline" • selective serotonin re-uptake inhibitors • triptans • benzodiazepines The review gave a useful checklist for practitioners, including screening and monitoring procedures, and cautions and contraindications for Hypericum when the patient is concurrently taking conventional drugs. Panax ginseng The following herb-drug interaction data has been reported for P. ginseng.
Digoxin One review mentioned that ginseng can interact with digoxin."'" However, the only research report that 1 have
134
Combining Western Herbs and Chinese iVIedicine
seen was a study in which 45 patients with class IV cardiac function were divided into three groups: digoxin. ginseng. and digoxin + ginseng. The greatest improvement was seen in the third group. and the authors concluded that ginseng and digoxin had a synergy for the treatment of congestive heart failure. and that ginseng was an effective and safe adjuvant. 45
Phenelzine One review listed an interaction between Panax and phenelzine.4-I However. my search of the Internet PubMed website did not find any research studies that demonstrated this interaction. Warfarin One report claimed that there is an interaction. and another report stated that there is not (see the Cardiovascular system section in the next chapter). Potentilla This herb contains tannins. It has been reported that tannins can reduce the absorption of thiamine and iron (see the Toxicology section in the chapter on Potentilla). but I have not seen any reports of adverse herb-drug interactions for Potentilla. However, it would be prudent to use caution in prescribing Potentilla. or other herbs with a high tannin content. for patients who are deficient in iron or thiamine. or who have reduced intestinal absorptive function. . Rheum According to the ESCOP monograph on Rheum. long-term laxative abuse can result in hypokalemia. which may potentiate the action of cardiac glycosides (see the Rheum chapter). However, I have not seen evidence that Rheum can cause hypokalemia or that it has negative herbdrug interactions when it is used within its therapeutic dose range. Salvia miltiorrhiza There are reports that this herb can potentiate the anticoagulant effects of warfarin (see the Cardiovascular system section in the next chapter). Sarothamnus This herb contains the amine tyramine. Concurrent ingestion of tyramine and MAO inhibitors can result in hypertension. I have not seen research evidence that Sarothamnus preparations can have adverse interactions with MAO inhibitors or indeed with any other drug. However. it would be prudent to exercise caution with concomitant administration of Sarothamnus and MAO inhibitors. Zingiber There has been concern that Zingiber may aggravate bleeding problems in humans (see the Zingiber chapter). However. according to one recent review of the literature. there is no evidence that Zingiber has an interaction with warfarin. 46 According to a recent rat study. Zingiber had no effect on warfarin-induced changes on blood coagulation. and the authors concluded that Zingiber is pharmacologically safe in this respect. 47
Regulation ofherb use In the last 50 years there has been increasing concern over the safety of herbal medicine. This has led to an increase in legislation regulating or restricting the supply of . herbs to the public. This in turn caused concern amongst those of the public that use herbal remedies and amongst herbal practitioners because they fear that the availability of herbs will become increasingly limited. Regulatory authorities decide whether to restrict the availability of a herb product largely on the basis of their perceptions of its risk:benefit ratio. Many herbalists believe that past restrictions have often been made on the basis of distorted perceptions of this ratio. They believe that regulatory authorities tend to exaggerate the risks and ignore the benefits.
THE NEED FOR COOPERATION Both the herbal profession and government regulators are working for the benefit and safety of the public. Each have specific responsibilities in what can be a cooperative effort. Responsibility of the herbal profession As discussed earlier in this chapter. it is the responsibility of herb product manufacturers and of herbal practitioners to make the nec- _. essary safety improvements in order to reduce the risk of adverse reactions. It is also their responsibility to make available to the regulatory authorities increased numbers of reputable research studies that demonstrate the benefits of individual herbs used. Responsibility of the regulatory authorities As discussed earlier in this chapter, it is the responsibility of the regulating agencies to make the necessary improvements in their interpretation of adverse reaction data. It is also their responsibility to study the available data on herb benefits more thoroughly and with a more open mind than they have done in the past. They can then make more objective assessments of risk:benefit ratios. If they are not seen by the public as acting ._ fairly in considering these ratios, the public may lose trust in the regulating bodies.
NATIONAL REGULATORY STATUS This section deals with existing regulations governing the availability ofherbs at a natlon311evel in Australia, the United Kingdom. and the United States.
Regulations governing the availability of a specific herb -
Safety may change at any time, and it is the responsibility of the individual practitioner to be aware of the regulations in their particular country.
complex and confusing. Five main groups of regulations are summarized below:
Australia Herbal medicines are governed by federal law (Therapeutic Goods Act and Regulations) and State and Territories legislation (Standard for the Uniform Scheduling of Drugs and Poisons). Part 4 of Schedule 4 of the Therapeutic Goods Act and Regulations lists herbs that are considered relatively more toxic. These herbs are not restricted to practitioners only, but they can only be included in OTC sales after prior evaluation and approval by the Complementary Medicines Evaluation Committee; this may be refused on grounds of safety.
• Dietary Supplements Health and Education Act 1994 (DSHEA)
Herbs in this book The only herbs included in combinations in this book that are listed in Part 4 of Schedule 4 are Phytolacca decandra and Mentha pulegium.
Information The relevant website is: http://www.health.gov.au/tga/
United Kingdom Herbal medicines are governed by the Medicines Act of 1968 and subsequent supplementary legislation to this act, such as:
• Substances that are generally recognized as safe (GRAS)
• Dietary Supplements Associated with Illness and Injuries (by the FDA) • Current Import Alerts (FDA) • Prohibited Substances (FDA)
GRAS Until 1994, the Food and Drug Administration (FDA) regulated dietary supplements (including herb materials) as foods. The term GRAS was used by the FDA to refer to foods generally recognized as safe fOf human consumption. However, GRAS status is linked to intended use. For example, rosemary is on the FDA list Spices and other natural seasonings and flavorings. This means that the FDA confers GRAS status on rosemary when it is used as a spice, but does not necessarily confer GRAS status if it is usedfor another purpose, such as a herbal medicine. Therefore, herbs are not described in terms of GRAS status in this book since their intended use is clearly therapeutic.
• The Medicines (General Sale List) No. 2129
DSHEA By the Dietary Supplements Health and Educa-
• The Medicines (Supply of Herbal Remedies) Order 1977 No. 2130
tion Act of 1994, separate provisions were made for the supply of dietary supplements. However, there is a distinction made between dietary supplements and drugs, which are regulated by the FDA. A dietary supplement cannot be claimed to 'diagnose, treat, cure, or prevent any disease.' Such a claim would be illegal under FDA regulations. There is no list of substances recognized as dietary supplements under the 1994 Act. Therefore, this book cannot describe herbs as 'listed as a recognized DSHEA dietary supplement?
General Sale List Herbs on this list are those available for general sale.
Supply of Herbal Remedies Schedule Part III of the'Medicines (Supply of Herbal Remedies) Order 1977 governs the supply by the herbal practitioner of herbal remedies to patients subsequent to a consultation, as defined in the schedule. Herbs in schedule Part III have maximum dose restrictions when supplied by a herbal practitioner and are not available for OTC sale. L--
135
Dietary Supplements Associated with Illness and Injuries This FDA list includes: • Ephedra species
mahuang
• Larrea tridentata
chaparral
• Lobelia inflata
lobelia
• Magnolia species
magnolia
• Pausinystalia yohimbe
yohimbe
• Salix species
willow bark
Information The New Herbal Practitioner (volume 4, num- , ber 3 of April 1978) contains the article Herbal Practitioner's Guide to the Medicines Act 1968 by Fletcher Hyde.48
• Species uncertain
'jin bu huan' *
• Stephania species
stephania
• Symphytum species
comfrey
United States In the United States, the regulations governing the supply of substances used in herbal therapy are both
• Teucrium species
germander
Herbs in this book The herbs included in combinations in this book that are listed in Schedule Part III are Chelidonium, Cinchona, Convallaria, Ephedra, and Lobelia. Cinchona, Convallaria, and Lobelia have their own materia medica chapters, and Chelidonium and Ephedra are discussed in the Additional herbs chapter.
*tones unknown
Combining Western Herbs and Chinese Medicine
136
Except in the case of Symphytum, which the FDA has advised manufacturers to remove from the market, this list does not represent an official FDA fmding that these substances are unsafe or that they are restricted in use by the FDA. The presence of a substance on this list indicates that the FDA has concerns about its safety and that a firm markets the substance at its own risk.
10. British Herbal Pharmacopoeia. British Herbal Medicine Association._._=-~ West Yorks, United Kingdom (1983) : : :..;.;;;; "-....
11. Lekehal M. Pessayre D. Lereau JM. et al. Hepatology 24(1):212-218
~.
-......
(1996) ._- .~;... c.'
12. De Smet PAGM.Ned T Geneeskd 138:2516-2517 (1994)
13~ Blumenthal M (ed)~ The Complete German Commission E '.~.7'".~: :__~\ Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, Texas (1998)
Current Import Alerts (FDA) The herbal materials on the
14. Treasure J. Eur J HerbMed 5(1):38-43 (2000)
current FDA Import Alert list (which means that these substances may be 'detained') are:
15. Rasheed RA. Ali BH, Bashir AK. General Pharmacol 26(2):297-301 (1995) 16. Sperl W, Stuppner H, Gassner 1, et al. Eur J Pediatrics 154(2):112-116
• plantain because of contamination with Digitalis • any herbal material containing aristolochic acid
Prohibited Substances (FDA)
The following herbal materi-
als are on the current FDA list Substances prohibited from use in food: calamus (Acorus calamus), coumarin (in tonka beans), safrole (in sassafras). SummaryPractitioneis' of herbal therapy in the United States should avoid the use of herbs on the FDA 'Prohibited substances' or 'Import alert' lists. The FDA has advised manufacturers to remove Symphytum species from the market. It is advisable to use caution when prescribing herbs that are on the FDA list of Dietary Supplements Associated with Illness and Injuries, and practitioners are advised to read the information given by the FDA on these herbs: However, since the FDA does not give references to research reports to substantiate its warnings, practitioners may wish to investigate the research evidence themselves.
Information The FDA website is:
(1995) 17. Violon c.J Pharmaceutique Belge 52(1):7-27 (1997) 18. Doeker BM,Andler W. Horm Res 52(5):253-255 (1999) 19. Martinez MC, Nortier J, Vereerstraeten P, Vanherweghem
JL. Nephrol
Dial Transplant 17(3):408-412 (2002) 20. Stengel B. Jones E. Nephrologie 19(1):15-20 (1998) 21. Debelle FD. Nortier]I., De Prez EG. et al. J Am Soc Nephrol13(2):4~1: .......~~ 436 (2002) .. :...:..;;-~.. 22. Qiu Q, Liu ZH. Chen HP, et al. Acta Pharmacol Sin 21(12):1129-1135 (2000) 23. Pauwels A, Thierman-Duffaud D, Azanowsky JM. et al. Gastroenterol Clin Bioi 16(1):92-95 (1992) 24. Larrey D. Vial T, Pauwels A et al. Ann Intern Med 117(2):129-132 (1992) 25. Mostefa-Kara N, PauwelsA. Pines E,et al. Lancet 340(8820):674 (1992) 26. Loeper J, Descatoire V, Letteron p. et al. Gastroenterology 106(2):464472 (1994) 27. DenhamA.Eur J Herb Med 2(3):27-38 (1996) 28. Bach N. Thung SN.Schaffner EAm J Med 87(1):97-99 (1989) 29. Ridker PM. Ohkuma S. McDermott WV, et al. Gastroenterol 88(4):1050-1054 (1985)
http://www.fda.gov/
30. Huxtable RJ. Luthy J. Zweifel U. New England J Med 315(17):1095 (1986)
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33. Nadir A. Agrawal S. King PD, et al. Am J Gastroenterol 91(7):1436-
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., ...:......,:.
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43. Broughton A, Denham A. Eur I Herb Med 5(2):19-26 (2000)
47. Weider MS,Sigwart K. J EthnopharmacoI73(3):513-520 (2000)
44. Bonie! T, Dannon P. Harefuah.140(8):780-783,805 (2001)
48. Hyde F. Herbal Practitioner's Guide to the Medicines Act 1968 New Herbal Practitioner 4(3) (1978)
45. Ding DZ, Shen TK, Cui yz. Zhongguo Zhong Xi Yi lie He Za Zhi
-_.:"';§
-",....-~
.~~.,
-:-~-+~-,
"'::-=~
:
-
Safety and the organ systems contains examples of adverse herb reactions that have actually occurred, and that illustrate the problems in interpreting adverse reaction data. This chapter gives examples of adverse herb reactions for each of the main organ systems. It includes both reports of adverse herb reactions that have actually occurred, and theoretical concerns over potential adverse herb reactions, although these may never have been reported clinically for
BALANCING TEMPERATURE, TASTE,
the specific herb. This chapter brings together information on actual or potential adverse herb reactions from two main sources:
SCREENING BY CHINESE ORGAN
T
HE PREVIOUS CHAPTER
AND ACTIONS Balancing herb combinations to maximize safety and using moderating herbs to minimize side effects is discussed in the following chapters: Temperature, Taste, Actions, and
Practical herb combination.
SYNDROMES Both the patient's disorders and the potential side effects of herbs can be classified in terms of the Chinese organ syndromes. Then, if the patient has a specific syndrome, for
• modern research: reports from both clinical and pharmacological studies
• Chinese herbal medicine: traditional cautions and
example, Heart Spirit Disturbance, herbs that may aggravate this syndrome can be avoided or used with caution.
contraindications
The advantage of the Chinese paradigm is that each organ syndrome can encompass not only physical, but also emotional and mental manifestations. For example, the syn-
Chinese contribution to herb safety
drome of Heart Spirit Disturbance can include physical heart arrhythmias, emotional overexcitement, and poor mental concentration.
Chinese medicine has made great contributions to the
Herbs that may increase Heart Spirit Disturbance, for example, Ephedra or Panax ginseng, may aggravate one or more of these potential physical, emotional, or mental manifestations. Knowledge of a herb's potential side effects in
safe use of herbs especially in two areas: • minimizing adverse reactions by carefully balancing temperature, taste, and actions
terms of Chinese medicine can thus form an additional screening process to ensure herbal safety.
• minimizing adverse reactions related to specific Chinese · organ syndromes
139
140
Combining Western Herbs and Chinese Medicine
CHINESE SYNDROME SUMMARY TABLE The following table gives examples of herbs that may aggravate or induce the Chinese organ syndromes listed. These herbs should therefore be avoided or used with caution when the patient has a tendency to the syndrome listed.
Respiratory system WESTERN DATA 1have not seen reports of negative effects of herbs on the respiratory system when the herbs are used within the therapeutic dose range as orally administered infusions, decoctions, or tinctures.
• Lung Lung Deficient Qi
Ephedra
CHINESE MEDICINE
Lung Phlegm and Damp
Glycyrrhiza Lycium Ophiopogon Ziziphus
The main cautions and contraindications come under the syndromes of:
Lung Dryness
Angelica arc.
• Spleen/Stomach Deficient Spleen with loose stools
Rheum Taraxacum
Deficient Spleen + Cold
Baptisia Hydrastis Pulsatilla chinensis Sanguisorba
Deficient Spleen + Damp
Avena Glycyrrhiza Lycium Ophiopogon Pseudostellaria Ziziphus
Stomach Rebellious Qi
Lobelia
Stomach Heat
capsicum Cinnamomum
• Liver/Gallbladder Liver Hyperactive Yang
Liver Deficient Qi + Liver Stagnant Qi
Astragalus Cimicifuga Ephedra Panax gin. Rumex Taraxacum Arctium
• Heart Heart Heat
Cinnamomum Panax gin.
Heart Spirit Disturbance
Ephedra Panax ginseng Rosmarinus
Heart Stagnant Qi
• Lung Deficient Qi • Lung Phlegm • Lung Dryness Lung Deficient Qi Herbs that strongly disperse Lung Qi, such as Eph~dra, are to be avoided or used with caution for patients with Lung Deficient Qi and Deficient Defensive Qi. This is especially so if there is profuse sweating or if the herbs are used in high doses or for long periods of time. This is because such herbs may dissipate and further weaken the Qi. Lung Phlegm Although not specifically contraindicated in some Chinese medicine texts, 1 generally avoid the use of moist, sweet tonics, such as Ophiopogon and Ziziphus, for patterns of Lung Phlegm involving accumulation of Damp and Phlegm linked to Spleen Stagnation. The use of such herbs may increase the amount of mucus secreted by the mucus membranes and hinder the dispersing function of the Lung. Lung Dryness Angelica dahurica (bai zhl) is contraindicated in Chinese medicine for cases with Yin Deficiency because it is very drying. In cases of Lung Deficient Yin with Lung Dryness, I use caution when using the warming, drying anticatarrhal herbs such as Angelica archangelica. Too much of such herbs can result in dryness and soreness of the respiratory mucous membranes.
Gastrointestinal system
Panax gin.
• Kidney Deficient Kidney Yin + Heat
Cinnamomum Ephedra Panax gin. SChisandra
Deficient Kidney Yang
Ephedra Piscidia
Negative gastrointestinal reactions are perhaps the most -common side effects for herbal products taken orally. They may include indigestion, burning sensation in the epigastrium, nausea or even vomiting, abdominal distension and pain, and diarrhea or constipation. The majority of these negative reactions can be avoided by the following measures:
Safety and the organ systems • using caution with herbs that can disturb the digestive system, such as circulatory stimulants and laxatives • using moderating herbs to minimize potentially negative effects of the primary herbs • using caution with patients with weak or sensitive digestive systems • starting with the minimum dose of the herbs and slowly increasing the dose
WESTERN DATA Tannin-containing herbs It has been reported that preparations of isolated tannins may inhibit digestive enzymes, reduce the absorption of iron and thiamine, produce gastrointestinal irritation, and cause constipation. However, other studies have reported that tannins have antiulcer action (see the Potentilla chapter). It is advisable to avoid the prolonged use of high doses of herbs with a high tannin content, especially in patients with a tendency toward digestive weakness, gastrointestinal irritability, or constipation. Bitter digestive tonics Some texts contraindicate the bitter digestive tonic herbs Gentiana and Centaurium for peptic ulcer and hyperacidity. However, there is evidence that in some circumstances, these herbs can reduce, rather than increase, gastric ulceration (see the Gentiana chapter). If gastric ulceration is associated with gastric hypersecretion, it may be advisable to use strongly bitter herbs with caution. Use of emetics and cathartics
Past use In the past, emesis and catharsis were popular therapeutic methods, and certain herbs were prized for their powerful emetic or cathartic action. Nowadays, the techniques of emesis and catharsis are rarely used in the West. It is interesting that what was seen by one generation as valued therapeutic effects should be seen by the next generation as adverse reactions.
Potential emetic effects Some expectorant herbs in current use, for example, Lobelia and Sanguinaria, may have an emetic effect at high doses. It is therefore advisable to start at the lower end of the standard dose range for the desired expectorant action. This will reduce the likelihood of nausea in sensitive patiel1ts~ Potential cathartic effects The cautions and contraindications to be used with purgative herbs are described in the chapter on Rheum.
141
CHINESE MEDICINE The main cautions and contraindications come under the syndromes of: • Deficient Spleen with Cold • Deficient Spleen with Damp and Stagnation • Stomach and Intestines Heat In addition, herbs with potential purgative effects, such as Rheum, should be used with caution for patients with Deficient Spleen Qi with a tendeqcy to loose stools. Herbs with potential emetic effects at high doses, such as Lobelia, should be used with caution for patients with Stomach Rebellious Qi and a tendency to nausea. Deficient Spleen with Cold Herbs that are cold or even cool should be used with caution in cases of Deficiency and Cold in the Spleen, Stomach, and Intestines. In some cases, this may be related to their strong antimicrobial action, which has the negative effect of destroying beneficial gut bacteria. This may be the case for Pulsatilla chinensis (bai tou weng) and Baptisia. In other cases, it may be due to the downward-draining (laxative) action of the herb, for example, in the case of Taraxacum mongolicum (pu gong ying) and T. officinale. Deficient Spleen with Damp and Stagnation Herbs with the sweet taste property, especially those with a known moistening effect, should be used with caution if the patient has a Deficient Spleen with a tendency to Stagnation and Damp. High doses of these herbs may aggravate these syndromes and their accompanying symptoms. For example, Ophiopogon and Ziziphus may aggravate signs like lethargy, obesity, and chronic nasopharyngeal catarrh. Stomach Heat Herbs that are hot or even warm in temperature should be used with caution in patients who have Heat in the Stomach or Intestines. Generally, herbs, such as Capsicum or even Zingiber and Cinnamomum, should be avoided or should be used with caution if there are such symptoms as burning sensations and pain in the epigastrium, or the patient has a history of diarrhea with burning sensation on defecation (see the chapters on these herbs).
Hepatobiliary system WESTERN DATA: HEPATOTOXICITY One of the greatest areas of concern in the discussion of herbal safety is that of hepatotoxicity, especially if the toxicity is asymptomatic until the point when the liver damage is serious and irreversible.
.."" 142
Combining Western Herbs and Chinese Medicine
Herbs in general There has been concern that herbs in general are a likely cause of hepatotoxicity. This subject has been reviewed by McLeod et al.,1 who published a preliminary report of a clinical trial to determine if the use of herb products could contribute to hepatotoxicity. Statistical analysis was performed on the results ofliver tests on 81 patients takiDg herbal medicine. The conclusion was that the use of herbal medicine in the clinic is unlikely to cause significant and consistent elevation of serum enzymes or to cause hepatotoxicity. Chinese herbs for skin disorders There have been reports of hepatotoxicity following herbal treatment for skin disorders with Chinese herb combinations.!.J·4 In three cases, after discontinuing the herbs, liver function returned to normal. 2•4 Due to the variation in the herb content of the formulas, no one herb could be implicated, the reactions were not apparently dose-related, and it was suggested that the reactions were idiosYncrati~? ' Tannin-containing herbs There have been reports of acute hepatotoxicity associated with the past use of barium enemas containing tannic acid as a result of the absorption of large amounts of tannic acid directly into the bloodstream from the colon. These adverse effects occurred using tannic acid as an isolated chemical, and it has been stated that such effects are highly unlikely when using tannin-containing herbs. s It is prudent to avoid the long-term use of herbs with a high tannin content. However, in perspective, it should be noted that the daily intake of tea in countries such as Britain results in a far higher tannin intake than any recommended dose of tannin-containing herb (see the Potentilla chapter). Herbs containing pyrrolizidine alkaloids Potential hepatotoxicity associated with plants containing toxic pyrroIizidine alkaloids has been recently reviewed,1.6.7 and the specific case of Symphytum is discussed in the section Examples of adverse reports in the previous chapter. Teucriurn chamaedrys The potential hepatotoxicity of this lerb is discussed in the section Examples of adverse reports n the previous chapter. arrea tridentata. There have been reports of hepatotoxicy associated with tbe;irigestion' ~f Larrea tridentata (chapTal). The American Herbal Products Association reviewed lur of these·cases.. ni~y proposed that the report~d toxicity as due to idiosyncratic reactions in persons with preexist19 liver conditions. 7 In perspective, it has been noted that ver 200 tons of Larrea were consumed over 20 years in the SA,s yet only a few cases of liver damage were reported.1
There have been more recent reports associating the use" of 1. tridentata with hepatotoxicity, usually characterized by cholestatic hepatitis. 9.10 However, a retrospective clinical study published in 2001 did not report signs of liver damage from the use of Larrea and proposed that relatively small intakes of Larrea tincture are safe when it is prescribed by a trained botanical practitioner. ll The authors recommended that Larrea should be used with caution in patients with a history of liver disease.
1_"
In perspective As pointed out in three reviews, 1.6.7 the reports of hepatotoxicity associated with herbs, such as Larrea and Syrnphyturn, are very rare considering the enormous amounts of these herbs that have been consumed in the past. However, all three reviews recommend caution in the use of the herbs. As noted by Denham,6 many conventional medications can have hepatotoxic effects at high doses but remain on the market. The topic of perceived risk:benefit ratio is discussed in the previous chapter in the section Examples of adverse reports under Symphytum.
~~,
,
Practitioner precautions Safety considerations for the use of herbs for patients with impaired liver function is discussed in the next chapter, Safety in clinical practice.
CHINESE MEDICINE The main cautions and contraindications corne under the syndromes of: • Liver Hyperactive Yang • Liver Deficient Qi with Liver Stagnant Qi Liver Hyperactive Yang This pattern may have various manifestations, including high blood pressure, dizziness, headache, irritability, impatience, and mental restlessness. Any herb, for example, Ephedra or Panax ginseng, that can aggravate Liver Hyperactive Yang may aggravate one or all of the symptoms, and should be avoided or used with caution if the patient tends to experience these symptoms. I also recommend caution when using Astragalus or Cimicifuga species in the case of patients with Liver Hyperactive Yang since these herbs can have the action of raising the Qi (see the Cimicifuga chapter). Liver Deficient Qi with Liver Stagnant Qi I have not seen examples of herbs that are contraindicated for this combination of syndiomes in texts on Chinese medicine. However, in my opinion, there are two main situations in which herbs should be used with caution when the patient has the syndromes of Liver Deficient Qi and Liver Stagnant Qi. Firstly, if there is a history of poor liver function, there
.
'~
~"
-
--Safety and the organ systems may be reduced tolerance to herbal medicine. Whilst herbs may slowly improve liver function, it is wise to initially use low, or even very low, doses of herbs. Secondly, if alterative herbs, such as Taraxacum and Rumex, are used in high doses, toxins may be released from the tissues at a greater rate than can be metabolized and detoxified by the weakened liver. This may result in negative reactions such as the aggravation of inflammatory conditions. The use of herbs in these situations is discussed in the next chapter, Safety in clinical practice.
Cardiovascular system WESTERN DATA It may be necessary to use certain herbs with caution in
the case of patients taking anticoagulant medication Or patients with hypertension or cardiac arrhythmias.
143
Hypertension Of the herbs discussed in this book, there have been suggestions that the following may aggravate or induce hypertension: Ephedra, Glycyrrhiza, Hydrastis, Panax ginseng, and Sarothamnus.
Ephedra A review of 140 adverse effect reports for Ephedra showed that hypertension was the single most frequent adverse effect.16 This herb is generally to be avoided in cases of hypertension (see the Additional herbs chapter).
Glycyrrhiza Research reports indicate that high doses of Glycyrrhiza may result in hypertension (see the Glycyrrhiza chapter). This herb is therefore contraindicated in high doses for moderate hypertension and even in low doses for patients with severe hypertension.
Hydrastis The BHp 17 recommended avoiding the use of this herb in hypertension, but there does not appear to be any research evidence to support this suggestion (see the Berberis and Hydrastis chapter).
Panax ginseng Higher doses of this herb have been reportAnticoagulant effects Of the herbs discussed in this book, there have been suggestions that the following herbs may potentiate the anticoagulant effect of warfarin: Angelica sinensis, Panax ginseng, Salvia miltiorrhiza, and Zingiber.
ed to cause hypertension. IS This is especially the case at excessive doses, when taken over long periods, and in susceptible persons (see the Additional herbs chapter).
Angelica sinensis I have seen only one research report that
cation for this herb, 17.I~ut I have not seen any research data to substantiate this claim (see the Sarothamnus chapter).
indicated that this herb may potentiate the anticoagulant action of warfarin. 12 In this study, rabbits received 4 glkg of orally administered A. sinensis extract per day. This is equivalent to 240 g per day for a 60 kg human and is far in excess of the therapeutic dose. L:.•.
Panax ginseng A recent review of the literature 13 mentioned one case report associating ginseng use with decreased warfarin anticoagulation effect. However, an in vivo rat study reported that there was no significant impact of ginseng on the pharmacokinetics or pharmacodynamics of 14 warfarin when they were concomitantly administered.
Salvia miltiorrhiza Reports of possible interaction between this herb and the anticoagulant drug warfarin were reviewed by Chan in 2001. 15 It was concluded that this herb can enhance the anticoagulant effect of warfarin and should be avoided by patients who are taking this drug.
Zingiber As discussed in the Zingiber chapter, this herb may have different effects on platelet aggregation, depending on the situation. According to one review, Zingiber has not been reported to result in 'bleeding problems in humans. However, the authors· recommend that daily doses of this herb exceeding 4 g should be used with caution for patients with increased risk of hemorrhage or who are taking bloodthinning drugs, such as aspirin or warfarin. 5
Sarothamnus Hypertension has been listed as a contraindi-
Cardiac arrhythmia
Cinchona, Convallaria, and Sarothamnus There have been theoretical concerns that these herbs, which can be used to treat cardiac arrhythmia, may, in certain circumstances, aggravate this disorder. Isolated constituents from these herbs, such as quinine from Cinchona or sparteine from Sarothamnus, may aggravate cardiac arrhythmias or have the potential for adverse . herb-drug interactions. However, these adverse effects were observed when the isolated constituents were administered at levels greatly in excess of those found in therapeutic doses of the herb (see the Cinchona and Sarothamnus chapters). I have not seen any research reports of adverse effects when these herbs are administered orally as infusion, decoction, or tincture within the therapeutic dose range. Nor have I seen reports of herb-drug interactions for these herbs resulting in cardiac arrhythmias (see the materia medica chapters of these herbs). However, in my. opinion, these herbs should be used with caution, and it might be advisable to restrict their supply to health practitioners specifically trained in herbal medicine.
Ephedra This herb has been associated with adverse effects, including palpitations and tachycardia,16 and is generally to
Combining Western Herbs and Chinese Medicine
144
be avoided in cases of hypertension (see the Additional herbs
Aristolochia
chapter).
NEPHROTOXICITY The potential nephrotoxicity of Aristolochia is discussed in the section Examples ofadverse reports
CHINESE MEDICINE
in the previous chapter.
Chinese contraindications for cardiovascular disorders mainly relate to cardiac arrhythmia and hypertension when these disorders are associated with Heart Spirit Disturbance and Liver Hyperactive Yang. Therefore, herbs, for example, Ephedra and Panax ginseng. that may aggravate or induce these syndromes should generally be avoided. In high doses and in susceptible persons, Glycyrrhiza may cause hypertension. In Chinese medicine, Glycyrrhiza is contraindicated in cases of Excessive Damp, and since Damp is one possible cause of hypertension, this might explain the hypertensive effect of this herb. However, it is also possible that Glycyrrhiza may aggravate hypertension by overstimulating Kidney Qi.
Urinary system
CARCINOMA A recent review of the literature reported evidence that aristolochic acid (AA) can have carcinogenic effects in both animals and humans. The authors recomH mended a ban on botanicals containing AA. However, it would be valuable to determine whether AA has carcinogenic effects at dose levels equivalent to those in AAcontaining herbs, such as Aristolochia.
CHINESE MEDICINE I have not seen specific cautions and contraindications for Kidney-Bladder patterns involving urinary disorders in texts on Chinese medicine. However, I would not generally use herbs that warm the Interior and tonify Kidney Yang in cases of urinary disorders for patients with patterns of Excess Heat, Deficiency Heat, or Damp Heat. Such herbs include Cinnamomum bark and Panax ginseng.
WESTERN DATA Individual herbs
Reproductive system
Juniperus There has been one report suggesting that Juniperus berries may cause renal irritation,20 but this has not yet been clearly demonstrated by research. It has been suggested that misidentification21 or contamination22 may have been responsible for some of the earlier adverse reaction reports for this herb. However, it might be prudent to avoid Juniperus tinctures or aqueous extracts until further data is available (see the Juniperus chapter).
Petroselinum The Commission E monograph on parsley herb and root contraindicated this herb for inflammatory kidney conditions, but no references were given to support this claim. It may have been based on theoretical speculation regarding the presence of the potentially toxic constituent apiol in the essential oil fraction of this herb. This concern needs to be put in perspective since parsley is a commonly used culinary herb. The lowest fatal daily dose of apiol has been reported as 0.77 g per day. taken for 14 days.23 Since parsley leaf essential oil contains about 20% of apiol,21 the equivalent dose of essential oil would be approximately 3.85 g per day. Assuming that the dried herb contains about 1% of the essential oil. the equivalent dos~ of dried herb would be approximately 385 g.This assumes th~t efficiency of extraction of apiol fr~m the'herb by the body is 100%. However, the dose of dried Petroselinum root recommended by the BHP was only 6-12 g per day.
WESTERN DATA: GENERAL There is a paucity of research data on this topic. Many of the recommendations, cautions. and contraindications given in the literature on the use of herbs for reproductive disorders, or during pregnancy and lactation, appear to be based on theoretical considerations, rather than evidence from research. The main areas of concern are that: • specific herbs given during menstruation may aggravate blood loss • specific herbs given to regulate menstruation may occasionally disturb the endocrine balance • specific herbs given during pregnancy may cause miscarriage or fetal abnormalities • specific herbs given during lactation may cause infantile illness • specific herbs may aggravate or induce carcinoma of the breasts or of the female reproductive system The topic of carcinoma is dealt with separately in the section Western data: carcinoma below.
~.
Safety and the organ systems Blood loss during menstruation The concern that specific herbs may aggravate blood loss during menstruation is not as strong in traditional Western phytotherapy as in Chinese phytotherapy. Therefore, this topic is discussed under the heading Chinese medicine below. Disturbance of the endocrine balance There has been one report that Vitex agnus-castus may have contributed to the disturbance of reproductive hormone balance in a woman undergoing unstimulated in vitro fertilization treatment. 25 However, the results of two uncontrolled clinical trials indicated that Vitex is beneficial in the treatment of female infertility.26.27 According to Mills and Bone, Vitex may aggravate pure spasmodic dysmenorrhea when this is not associated with PMS, possibly via the effect of this herb on progesterone levels. However, they note that Vitex is usually beneficial for spasmodic dysmenorrhea associated with PMS and for congestive dysmenorrhea. Pregnancy: general The following commonsense guidelines for practitioners can be followed during pregnancy: • prescription of herbal medicine during pregnancy is inadvisable unless the practitioner is specifically trained in phytotherapy and has had at least two years pf subsequent clinical experience • herbal medicine is best avoided during pregnancy unless it is to treat an acute condition or a disorder of pregnancy itself; herbal treatment of chronic disorders can be postponed until after the delivery • it is prudent to use the minimum dose necessary to obtain therapeutic effect and to observe the cautions and contraindications for individual herbs, especially those with specific restrictions on use during pregnancy What little data there is on the potential adverse effects of herbs during pregnancy mainly relates to the risk of miscarriage. There is very little information on fetal toxicity or fetal developmental abnormalities caused by the use of herbs.
145
Herb
Pregnancy
Breastfeedlng ..-, ........ .:-: .....:';~ ~ _... ~~~ ...'H-"-""'~ .. _-,.
Angelica archangelica
'.·'r,
:"';":~~
·;-,.... :.,;,~--tr
T
Artemisia absinthium
~~ernlsia·abrotan~.~.'~':'.' Asclepias
Capsicum ...
".~'--:.'"
',
.
Caulophyllum Chamaelirium
.~im5!!~~~,-_c;~, ,'.
,,','
Cinchona
Commiphora 'ccirivallaria
~:""~.·4~~.......,.-,," ';.~... ;{.:~,-!.W'..Aa; ..':"":<... _,:•...•• _
T #,."-.,,,,"",""K.'; .
Hydrastis JUniperus .~:~ i;"'_' , " 3'1-," -.• ~..:;.- .. ~,,'
,': .•
.
>.,.' .:~-;.., "-':_;"i".-" , ~
Leonurus species
Mentha pulegium
T
-Petroselln~ni-~:"~"~~··
T
Phytolacca
Potentilla T-
Rosmarinus
RUta' Salvia species
T
~J~~':':2::~">c,,._~!.",~ ..,,-_~_2_~~~~~~ Tanacetum
Pregnancy: herb list The herbs marked with a "f" in the table are those mentioned in this book that have had cautions or contraindications listed for their use during pregnancy in one or more journals or texts (including this book).
In perspective
For the majority of the herbs listed in the table, their proposed cautions or contraindications are un-
substantiated by research.
~Thuj3-'::.:>~i;:-~:~'.;;·":~;:;-:·- • .... _:_lo-~ ..
'.'
_~.'~~._;~'.':".'
Vitex
Zingiber
T Herbs marked with this symbol are contraindicated in pregnancy and/or lactation, or have cautions on their use during these times.
Combining Western Herbs and Chinese Medicine
146
Juniperus A research study using an ethanolic extract of the berries reported abortifacient activity in rats.
28
Zingiber The Commission E monograph on this herb stated that Zingiber should not be used for morning sickness. However, the editor of the English translation of the Commission E monographs pointed out that a review of the research literature could not justify this caution. In fact, research data indicates. that Zingiber may be of value in reducing vomiting during pregnancy (see Zingiber chapter).
Herbs to prevent miscarriage Some of the herbs in the table, such as Chamaelirium and Lobelia, have a tradition of use during pregnancy to strengthen the uterus or to prevent miscarriage.~9 They are only included in the table since, in my opinion, any herb with a regulatory effect on uterine contractions should be used with caution during pregnancy and should only be prescribed by experienced and qualified practitioners of phytotherapy.
Importance of the dose Some of these herbs in the table may be appropriate for use in pregnancy, providing their specific dose recommendations are followed. For example, it may be prudent to avoid high doses of Glycyrrhiza during pregnancy, especially if there is a history of high blood pressure, but according to Mills and Bone, doses of up to 3 g per day are likely to be safe.
Importance of syndrome Some of these herbs may be appropriate for use in pregnancy, providing that their use is avoided for patients who have specific syndromes that may be aggravated by the particular herb. For example, I have not seen any adverse reports on the use of Capsicum in pregnancy. It may be appropriate to use this herb in pregnancy except for patients with syndromes of Interior Heat. Lactation There is very little research data on the effect of herbs on the infant, when these are taken through the mother's milk. The herbs marked with a T in the table above are contraindicated or to be used with caution during lactation because of theoretical concern over the possibility of active constituents passing into the breast milk. For example, the ESCOP monograph on Rheum did not recommend the use of this herb during lactation. However, two studies have reported that the active constituent rhein does not have a laxative effect on infants when taken by nursing mothers. 30• 31 It was found that the amount of rhein transmitted to the infant was 0.3% of the rhein intake of the mother, which the authors pointed out is far below the oral rhein dose necessary for inducing a laxative effect. 3l
ing types of herbs should be used with caution during menstruation:
_cooling herbs especially for patients with Cold in the Uterus
_ downward-draining herbs especially for patients with Deficient Qi and Yang
_herbs that move the Blood especially for patients with heavy menstrual flow However, if the menstrual flow is absent or less than normal, it may be appropriate to use herbs that move Stagnant Blood in the Uterus throughout the whole cycle, including menstruation itself, until the flow is at a satisfactory level for the patient. The Chinese concept of moving Stagnant Blood in the Uterus has some degree of overlap with the Western herbal concept of stimulant emmenagogue, which refers to herbs with the potential of stimulating uterine contractions. In my opinion, herbs of this type are generally best avoided during menstruation itself if the flow is heavy, and should be used with caution if the flow is normal. Herbs of this type listed in the table above include: - Artemisia absinthium - Artemisia abrotanum - Caulophyllum - Cimicifuga - Commiphora - Hydrastis - Juniperus - Lobelia - Mentha pulegium - Petroselinum - Ruta -Salvia - Sarothamnus - Thuja
Pregnancy According to Chinese medicine, some herbs that invigorate the Blood and clear Blood Stagnation are contraindicated or to be used with caution during pregnan- _ cy, for example: - Commiphora (mb yao) - Curcuma longa tuber (yiI jin) - Leonurus heterophyllus (yl mil ci'iO)
WESTERN DATA: CARCINOMA CHINESE MEDICINE Menstruation
According to Chinese medicine, the follow-
Concern about the possibility that herbs may aggravate or induce carcinoma is largely of recent origin, and was not a-
Safety and the organ systems major consideration of traditional Western or Chinese medicine. This section therefore concentrates on evidence from recent pharmacological and clinical research. Inhibition or stimulation of cancer cells? below, there is evidence that:
As discussed
• some herbs may inhibit breast or uterine carcinoma • some herbs may aggravate or promote the growth of breast or uterine carcinoma • some herbs may either inhibit or promote carcinoma, depending on the methodology of the experiment, including the type ofliving material used, and the dose of the herb material For some herbs, there is evidence that some constituents may inhibit and other constituents may promote carcinoma. Relevance of research studies Promotion of carcinoma in cell cultures or animal studies using overdose levels of isolated constituents does not necessarily mean that infusions, decoctions, and tinctures of the dried herb are carcinogenic when used in the therapeutic dose range. Angelica sinensis One mouse study reported that a polysaccharide from A. sinensis had strong antitumor activity.32 A study using an in vitro culture system reported antiestrogenic activity for A. sinensis. B A third study reported that A. sinensis significantly stimulated the growth of MCF-7 cells, a human breast cancer cell line. This stimulation was independent of estrogenic activity.34 Cimicifuga racemosa Isolated fukinolic acid (2-E-caffeoylfukiic acid) was reported to have estrogenic activity as shown by increased proliferation of an estrogen dependent MCF-7 cell system. 3; However, a more recent study using the MCF-7 cell system reported that an isopropanol extract of Cimicifuga significantly inhibited estrogen-induced proliferation of MCF-7 cells. In addition, the proliferationinhibiting effect of tamoxifen was enhanced by the Cimicifuga extract. According to the authors, the data suggested a nonestrogenic or estrogen-antagonistic effect on human breast cancer cells. 36 An in vivo mouse study reported that a Cimicifuga extract does not stimulate breast cancer cells that are estrogenreceptor positive. The authors concluded that Cimicifuga might be a safe remedy for the treatment of menopausal symptoms in women with a history of breast cancer in which hormone-replacement therapy is contraindicated. 37 (See also the discussion in the Cimicifuga chapter). Glycyrrhiza An in vivo animal study reported that the isolated Glycyrrhiza constituents glabrene and isoliquiritigenin
147
both had a biphasic effect on the growth of breast tumor cells. Both showed an estrogen receptor-dependent growthpromoting effect at lower concentrations (l On~l-l O!lM), and an estrogen receptor-independent antiproliferative effect at higher concentrations (> 15f.l.M).38 However, a study using MCF-7 human breast cancer cells reported that Glycyrrhiza did not significantly stimulate the growth of these cells. 34 Also, a study on estradiolinduced carcinogenesis in mice suggested that Glycyrrhiza may be a promising preventative agent for endometrial cancers (see the Glycyrrhiza chapter). Panax ginseng One study reported that P. ginseng significantly stimulated the growth of MCF-7 human breast cancer cells. This stimulation was independent of estrogenic activity.34 However, an earlier study using MCF-7 cells reported that ginsenoside Rh2 significantly inhibited the cell growth in a concentration-dependent manner. 39 Also, an animal study reported that P. ginseng preparations inhibited the growth of both mammary and uterine tumors. 40 Panax quinquefolium A series of in vitro stL>
Nervous system and behavior WESTERN DATA The main concerns are with stimulant herbs that overexcite the nervous system or sedative herbs that depress its function. Stimulant herbs Herbs of this type, such as Cola, !lex, Ephedra, and Panax ginseng, may overexcite the nervous system when taken in excessive doses. They may even have adverse effects when taken within the therapeutic dose range in susceptible persons. They have the potential to aggravate or induce mental, emotional, and physical restlessness, inability to concentrate, insomnia, palpitations, fearfulness, anxiety, panic attacks, irritability, aggressive behavior, emotionallability, and manic episodes (see the section on Stimulants in the Actions glossary).
148
Combining Western Herbs and Chinese Medicine
It is therefore essential that these herbs are only prescribed when appropriate. Chinese differential diagnosis can act as an important screening process to identify patients with syndromes for which these herbs are inappropriate (see Chinese medicine below).
Valeriana nor Piscidia should be used prior to driving or operating machinery if the patient has also taken alcohol or sedative drugs.
Sedative herbs There has been concern .that herbs with sedative action can depress the nervous system and induce or aggravate drowsiness, inattention, lack of coordination, or depression. The tranquilizing herbs mentioned in this book that generally have the strongest calming action are Anemone, Humulus, Piscidia, and Valeriana. In higher doses, these may have a mild to moderate sedative effect.
In terms of Chinese medicine, adverse herb effects on the nervous system and behavior can include the following:
Anemone I have not seen reports of negative herb reactions for therapeutic doses of preparations of dried Anemone. This includes the ability to drive and use machines (see the Anemone chapter).
• warming herbs may aggravate patterns of emotional disturbance associated with Heat
Humulus . . ~c~~rdin.g.~~.~_e.ESCOP monograph on Humulus (Lupuli flos), there are no special warnings or precautions required for the use of therapeutic doses of infusions or tinctures of this herb. No toxic effects have been reported, and there is no effect on the ability to drive or use machines. 44 Piscidia No adverse effects have been reported when this herb is used within the therapeutic dose range, but, in my opinion, it is possible that Piscidia may produce sensations of mental dullness in high doses. Ecclectic texts reported adverse reactions to overdose (see the Piscidia chapter). Valeriana There have been reports of somnolence the morning after taking Valeriana root preparations. 4s • 46 However, a more recent, controlled study concluded that the residual sedative effects (hangover) observed in some earlier studies cannot be confirmed for Valeriana at the recommended doses. 47 This study reported a very slight impairment ofvigilance 1-2 hours after administration ofValeriana. There have been no reports of adverse interactions between Valeriana and conventional drugs or alcohol. However, there has been one report of reversible negative reactions to an overdose of Valeriana (see the Valeriana chapter). Summary There have not been any reports of adverse reactions or adverse herb-drug reactions with Anemone, Humulus, Piscidia, or Valeriana when these herbs are taken at therapeutic dose levels. However, it is prudent to start administration of these herbs at the lower end of the therapeutic dose range. With respect to driving or operating machinery, it may be inadvisable to take Valeriana immediately before these .. activities, depending on the dose and the strength of the patient's reaction to this herb. In my opinion, neither
CHINESE MEDICINE
• stimulants may increase disturbed upward movement of energy • stimulants may aggravate symptoms of Qi constraint in the chest
• prolonged use of stimulants may exhaust Kidney Qi • prolonged use of sedatives may damage Kidney and Heart Yang • inappropriate use of moistening sweet tonics may aggravate depression associated with Damp and Phlegm Disturbance of upward movement As discussed above, stimulant herbs, such as Ephedra and PanaX ginseng, may aggravate or induce mental and emotional disturbance associated with Heart Spirit Disturbance or Liver Hyperactive Yang. Aggravation of Qi constraint In my experience, the use of Panax: ginseng in some patients with preexisting constraint of Qi in the chest may result in unpleasant sensations of obstruction in the chest with emotional distress. This is especially likely if the constraint is associated with Heart Stagnant Qi. Panax: tends to increase the upward movement of Qi. When this reaches the constrained Qi in the chest, it does not clear the Stagnation. Rather, it may aggravate the sensation of obstruction and pressure, and create a disturbance of movement within the Qi of the chest. Aggravation of Heat syndromes Inappropriate use of warming Kidney Yang tonics, such as Cinnamomum bark, may aggravate syndromes of Heat associated with '1m Deficiency of the Kidney and Heart, and increase symptoms of restlessness, insomnia, and emotional disturbance. Exhaustion of Kidney Qi Prolonged use of stimulant herbs, such as Cola, Ephedra, and Ilex, may eventually deplete the Kidney Qi, resulting in exhaustion and depression. In the case of exhaustion of Kidney Qi and Yang, there may be depression with apathy and sensations of cold; in the case of exhaustion of Kidney Qi and Yin, there may be depression with restless anxiety and sensations of heat.
Safety and the organ systems Aggravation of Kidney and Heart Yang Deficiency Inappropriate use of cooling herbs that calm Heart Spirit Disturbance and Liver Hyperactive Yang may aggravate depression associated with Yang Deficiency of the Kidney and Heart. This inappropriate use may occur when the pattern of Kidney Deficient Yang is masked by a simultaneous pattern of Deficient Kidney Yin or by a severe acute painful condition. For example, if the cold herb Piscidia is given for acute trigeminal neuralgia, it is important to check the pulse and tongue and patient history to determine if there is an underlying Kidney Deficient Yang pattern. If so, it may be necessary to moderate the potentially depressing effect of Piscidia on metabolism and emotions by adding Capsicum or Rosmarinus to the combination. Aggravation of Damp and Phlegm Excessive or inappropriate use of moistening sweet tonics, such as Glycyrrhiza, Lycium, or Ziziphus, may aggravate lethargy and depression. This is especially likely in patients with a tendency to Spleen Qi Stagnation and accumulation of Damp and Phlegm.
149
18. Siegel RK. JAMA 241(15):1614-1615 (1979) 19. Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm, Stuttgart. Germany (1994). from 2n d German edn. Wichtl M (ed) (1989) 20. Czygan F-C. Z Phytotherapie 8:10 (l987) 21. Tisserand R. Balacs T. Essential Oil Safety A Guide for Health Care Professionals. Churchill Livingstone. Edinburgh. United Kingdom (1995) 22. European Scientific Cooperative on Phytotherapy: Monographs on the Medicinal Uses of Plant Drugs (monograph on Juniperus fructus). European Scientific Cooperative on Phytotherapy. Exeter. United Kingdom (1997) 23. Lowenstein L. Ballew DH. Canadian MedAssoc J 78:195-198 (1958) 24. Arlt VM. Stiborova M. Schmeiser HH. Mutagenesis 17(4}:265-277 (2002) 25. Cahill DJ, Fox R. Wardle PG et al. Hum Reprod 9(8):1469-10170 (1994) . 26. Propping D. Katzorke T. Z Allge Med 63(31):932-933 (1987) 27. Propping D, Katzorke T. Belkien 1. Therapiewoche 38(41}:2992-3001 (1988) 28. Agrawal OP et al. Planta Medica 39:98-101 (1980) 29. Christopher JR. School of Natural Healing. BiWorid. Provo. Utah (1976) 30. Faber P. Strenge-Hesse A. Pharmacology 36(Suppll):212-220 (1988)
References
31. Faber P. Strenge-Hesse A. Geburtshilfe Frauenheilkd 49(11} :958-962 (1989)
1. McLeod D. Bone K. Morgan M. European J Herbal Med 2(3}:39-50 (1996) 2. Graham-Brown R. Lancet 340:673 (1992)
33. Rosenberg Z. Rosenberg RS. Jenkins DJ et al. Clin Chim Acta 312(l2}:213-219 (200l)
3. Penharic L, Shaw D. Leon C et al. Veterinary and Human Toxicology 37(6):562-566 (1995)
34. Amato P. Christophe S. Mellon PL. Menopause 9(2}: 145-150 (2002)
4. Kane JA. Kane SP. Jain S. Gut 36(1}:146-147 (1995)
35. Kruse SO. Lohning A. Pauli GF et aI. Planta Med 65(8}:763-764 (1999)
5. Mills S. Bone K. Principles and Practice of Phytotherapy: Modern
36. Bodinet C. Freudenstein J. Breast Cancer Res Treat 76(1):1-10 (2002)
Herbal Medicine. Churchill Livingstone. Edinburgh. United Kingdom (2000) 6. Denham A. European J of Herbal Med2(3):27-38 (1996) 7. McGuffin M, Hobbs C. Upton R et al. American Herbal Products l.,
32. Choy YM. Leung KJ."I. Cho CS et al. Am J Chin Med 22(2):137-145 (1994)
Association's Botanical Safety Handbook. CRC Press. Boca Raton. Florida (199i)
37. Freudenstein J. Dasenbrock C, Nisslein T. Cancer Res 62(12}:34483452 (2002) 38. Tamir S, Eizenberg M. Somjen D et al. J Steroid Biochem Mol Bioi 78(3}:291-298 (200l) 39. Oh M.Choi YH.ChoiS et aI. Int J OncoI14(5):869-875 (1999)
J Korean Med
8. Blumenthal M. HerbalGram 28:38 (1993)
40. Bespalov VG. Alexandrov VA. Limarenko AY et al. Suppl:S42-53 (2001)
16
9. Batchelor ....'B. Heathcote J. Wanless IR. Am J GastroenteroI90(5):831833 (1995)
41. Duda RB. Taback B, Kessel B et al. Ann Surg Oncol 3(6):515-520 (1996)
10. Sheikh NM, Philen RM. Love LA. Arch Intern Med 157(8):913-919 (1997)
42. Duda RB. Zhong Y. Navas Vet aL J Surg Oncol72(4):230-239 (1999)
11. Heron S, Yarnell E. J Altern Complement Med 7(2):175-185 (2001)
43. Duda RB. Kang SS. Archer SY et al. (2001)
12. Lo AC. Chan K. Yeung JH. Woo KS. Eur J Drug Metab Pharmacokinet 20(l}:55-60 (1995)
44. European Scientific Cooperative on Phytotherapy: Monographs on the
13. Vaes LP,Chyka PA.Ann Pharmacother 34(12):1478-1482 (2000) 14. Zhu M, Chan KW. Ng LS et al. (1999)
J Pharm
Pharmacol 51(2):175-180
J Korean Med
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Medicinal Uses of Plant Drugs (monograph on Lupuli flos). European Scientific Cooperative on Phytotherapy. Exeter. United Kingdom (l997)
15. Chan TY.Ann Pharmacother 35(4}:501-504 (2001)
45. Leathwood PD. Chauffard F. Heck E et al. Pharmacol Biochem Behav 17:65-71 (l982)
16. Haller CA, Benowitz NL.N Eng! JMed343(25):1833-1838 (2000)
46. Leathwood PD, Chauffard F. Planta Med 51:144-148 (1985)
17. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983)
47. Gerhard U, Linnenbrink N. Georghiadou C et al. Schweiz Rundsch Med Prax85(15}:473-481 (19%)
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Safety in clinical practice is easier for the practitioner to distinguish between adverse drug reactions. drug-drug interactions, adverse herb reactions, and adverse herb-drug interactions.
the following checklist to minimize adverse reactions stemming from the use of herbs:
RACTITIONERS CAN USE
P
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Correct differential diagnosis
3. .decide iffurtherili~9J.is.~,~gtH!~~~i¥?\l1;;~~>J 4. decide if herbal tr~tm~t is app~pnate·c::ii!ii2,~;
Errors in diagnosis are likely to result in an incorrect choice of herbs. with possible aggravation of preexisting conditions or the production of new ones. Errors in diagnosis include errors ofemphasis in deciding which of the patient's syndromes are of primary and which are of secondary importance. as discussed in the Practical herb combination chapter.
_··'-~-_:·~;··'~;i~~~~~~j¥~.~~1~~~~~*~~~~~J 5. prescribe a bal~cedh~rb~~b~a~i~~ ,. :.~ c. 6. follow cautions and contraindications .
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Further specialist diagnosis
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If the patient has symptoms that may represent a potentially serious condition and the patient has not yet been seen by a conventional medical specialist. this should be done
Full medical history
before commencing herbal treatment.
During the first patient visit. it is important to take a full medical history. including details of all prescribed and selfprescribed conventional medicines. herbs. and food supplements. At the start of each subsequent patient visit. the practitioner should determine if there have been any changes in the substances taken by the patient, including changes in dose. If this is done, should there be any negative reactions. it
Situations in which herbal treatment is inappropriate There may be laws in a particular country or state that restrict herbal treatment of certain conditions, at least by practitioners who are not medical doctors. However,. on 1.", -
151
~,.;.
Combining Western Herbs and Chinese Medicine
152
therapeutic as opposed to legal grounds, whilst specific disorders may be contraindicated for individual herbs, it is not easy to list disorders that are contraindicated for herbs in
general. The decision whether or not to use herbs is generally decided on a case-by-case basis by the individual practitioner, often depending on the level of their training and eXperience.
This topic is discussed in the chapter Practical herb combination. The Taste and Actions chapters contain tables showinghow potential side effects may be avoided by the use of moderating herbs.
.Cautions and contraindications for 'specific herbs and specific pa~ients
EXAMPLES Pregnancy Some practitioners avoid the use of herbs in general during pregnancy. Other practitioners use herbs during this time to treat disorders of pregnancy, but avoid or minimize the use of herbs for conditions that are not pregnancy-related. These practitioners use appropriate precautions and avoid herbs for which pregnancy is a specific contraindication (see the discussion and table in the Safety and the organ systems chapter). Liver damage Similarly, some practitioners avoid the use of herbs for weak patients who have liver damage. However, other practitioners consider that certain types of herbs, such as the hepatoprotectives, can be specifically helpful in assisting in the improvement of liver function for some patients of this type. This is discussed in the Prevention of adverse reactions section below. Patients on multiple medication A patient who is exhausted and depressed from prolonged or severe illness and already has to take many conventional medications may not have the energy or interest to take further medications of any kind. In such cases, it is often preferable to wait until there is a reduction in the number of drugs before prescribing herbal medicine. Patients undergoing changes in medication If the patient is on multiple medication and is in the proc.ess of changing drug doses, or changing from one group of conventional drugs to another, it is prudent to let some time elapse before commencing herbal therapy. This gives time for the following effects to resolve themselves: • adverse reactions to the change in drug dose • withdrawal effects from the first group of drugs • initial adverse reactions to the second group of drugs
Once the herb combination has been screened in terms of actions, temperature, and taste, the next step in the screening process is to determine whether any of the herbs in the provisional combination have cautions or contraindications, especially in the context of the patient's specific syndromes.
CAUTIONS AND CONTRAINDICATIONS DATA In this book, data on cautions, contraindications, and herb-drug interactions is given for each herb in the materia medica chapters. There is additional information in the Safety and the Safety and the organ systems chapters on herbs that have cautions or contraindications: • during pregnancy and lactation • for specific Chinese syndromes • due to the possibility of adverse herb-drug interactions
Informed patient choice If the practitioner is considering using a herb that may have side effects for a specific patient, the patient should be clearly informed of the benefitrisk ratio so that they can make an informed choice. The patient also should be informed of the nature of any potential side effects so that they can report them to the practitioner as soon as possible, should they occur. The patient can be asked to reduce the dose or to stop taking the herbs if side effects are experienced, as appropriate (see Side effects acceptable to the patient in the section Management of adverse reactions below).
Balancing herb combinations
Prevention ofadverse reactions
To ensure that a herb combination is effective and safe, it should be properly balanced in terms of: herbal actions, temperature, taste, and the principles of herb interaction.
The possibility of adverse reactions can be minimized by ensuring that the following factors are appropriate to the specific needs of the patient
Safety in Clinical Practice • dose level • dose form • timing of the dose • duration of the prescription • breaks in the treatment • alternation between prescriptions • use of moderating herbs
153
the herb for a short-term only. If long-term treatment is necessary, then the possibility of cumulative side effects can be reduced by either: • having regular breaks in the herb treatment • alternating between two herbs with a similar effect
BREAKS IN THE TREATMENT' -DOSE LEVEL As discussed in the Dose chapter, the following com- monsense guidelines can be followed: • use the least dose required to get the desired therapeutic effect • in chronic cases, start at the minimum therapeutic dose and then raise the dose as appropriate • use the herbs for the minimum time at the standard dose before reducing the dose, if appropriate • increase the dose only if the symptoms return • vary the dose to meet the changing requirements of the patient Data on the dose range of individual herbs is given in the materia medica chapters.
-DOSE FORM The dose form used should be appropriate to the partic~ ular patient. For example, tinctures are unsuitable for an alcoholic patient, and powders may be unsuitable for a patient with weak digestion. Infusions or decoctions would _be the preferred forms for such patients (see the table in the section Advantages and disadvantages of the different dose forms in the Dose chapter).
TIMING OF THE DOSE Appropriate timing of the dose can reduce the possibili:y -of negative reactions. For example, if the patient takes a tonic prescription containing Rosmarinus and Turnera just before ~. bed, they may experience restlessness. and insomnia. If the patient takes the combination earlier in the day and never 'ater than 5 PM, it is possible to get the full beneficial effect _ Nithout the negative reaction (see the section Timing of the dose in the Dose chapter). ~DURATION OF THE PRESCRIPTION
The length of time for which a particular herb or herb :ombination is prescribed can be varied to minimize side ~ effects, as discussed in the Dose chapter. Even when a herb 'las potential side effects, these can often be avoided by using
When a herb or herb combination is taken long-term, it may be possible to minimize potential side effects by having regular breaks in the treatment. This is discussed in the section Duration ofthe prescription in the Dose chapter. .
ALTERNATION BETWEEN PRESCRIPTIONS Another method of minimizing potential side effects during long-term treatment is to alternate between herbs or herb combinations. This is discussed in the section Duration ofthe prescription in the Dose chapter.
USE OF MODERATING HERBS Moderating herbs can be included in a combination to minimize potential ~ide effects by balancing the temperature, tastes, and actions of the other herbs in the combination. The Taste and Actions chapters contain tables for balancing tastes and actions, respectively, by using moderating herbs. A specific example of the use of moderating herbs is given under the heading Use of additional herbs to treat side effects in the section Management ofadverse reactions below.
EXAMPLE OF PREVENTIVE MEASURES: PATIENTS WITH LIVER DISORDERS Herbs should be either be avoided or used with especial caution for patients with preexisting liver damage or liver carcinoma, or who are currently taking potentially hepatotoxic conventional medication. If the type or dose of the hepatotoxic drugs is in the process of being changed, herbal therapy is contraindicated until the drug regime is stabilized. Liver tests An initial liver function test may be advisable as a baseline before commencing herbal therapy. Further liver tests can then be used to monitor positive or negative changes due to the herbs or due to herb-drug interactions. The herbal practitioner may wish to work in close association with the patient's general medical practitioner or medical specialist. Dose level If the liver function is impaired, it is advisable for the initial dose of herbal medicine to be very small. For
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example, instead of the standard dose of 5 ml of 1:5 tincture three times per day, the starting dose could be 0.5 ml once per day, which can gradually be increased if there are no side effects. Dose form Especially if the hepatic weakness is associated with past alcohol abuse, it may be better to prescribe herbs as aqueous infusions or decoctions, rather than as alcoholbased tinctures or liquid extracts. Restricted use of alterative herbs The use of standard doses of alterative herbs is contraindicated in cases of severe liver damage. Alterative herbs may release toxins from the tissues into the bloodstream, which may put a strain on the detoxification capacity of a weak or damaged liver. However, it may be possible to use very low doses of alterative herbs providing special procedures are taken. The first step is to strengthen the liver by the use of small quantities of:
• bitter tonics with hepatoprotective effects, but no alterative action, such as Artemisia species, Gentiana, and Rosmarinus
• sour/astringent hepatoprotective herbs, such as Schisandra
• sweet tonics with hepatoprotective and detoxicant effects, such as Glycyrrhiza
• acrid herbs with hepatoprotective and detoxicant effects, such as Zingiber Once the use of such herbs has begun to improve liver function, it may be appropriate to add very small amounts of alteratives to the combination.
Monitoring Monitoring can be done by the practitioner, by the patient, and by conventional medical testing.
PATIENT The patient can be asked to keep a record of the following: • any suspected side effects or adverse herb-drug interactions, noting such details as the severity and the time and date the symptoms occurred • any changes to prescribed or self-prescribed conventional medication, herbs, or food supplements • any changes in the level oflife stresses that may have been responsible for the symptoms Rechallenge If it is appropriate and if the patient agrees, the herbs can be taken again, at a lower dose and/or in a different form if preferred, to determine if the symptoms recur. The patient should be asked to keep in contact with the practitioner during this process and to stop the herbs immediately if the adverse effect recurs. A rechallenge may not be appropriate for herbs with potentially severe adverse effects even if the dose is greatly reduced. .
CONVENTIONAL MEDICAL TESTS There are certain circumstances in which laboratory tests can give useful information to the herbal practitioner on changes in specific parameters. The example of liver function testing is mentioned above in the section on
Prevention ofadverse reactions. Varying treatment strategy according to test results Herbal therapy is increasingly being used as an adjunct to the treatment of carcinoma and to moderate the adverse effects of chemotherapy. Some antineoplastic agents cause bone marrow depression with reduction in the numbers of various types of white blood cells. It is useful to the herbal practitioner to see regular blood cell data printouts in order to decide on the appropriate herbal prescription. For example, if the white blood cell count has markedly fallen, it may be more appropriate, in terms of Chinese medicine, to tonify the Blood and to tonify Defensive Qi, rather than to clear Damp Heat and Retained Pathogen.
PRACTITIONER The practitioner should check for signs and symptoms of any potential side effects that are to be expected with the specific herbs and the specific patient. Monitoring is essential for herbs with the possibility of severe adverse reactions. Three of the herbs that have their own materia medica chapter in this book. Cinchona. Convallaria. and Lobelia. are on Schedule Part III of the United Kingdom (see the section Regulation ofherb use in the Safety chapter). For these herbs, special details of screening and monitoring are given (see the chapters on these herbs).
Management ofadverse reactions EXCLUSION OF OTHER POSSIBILITIES It is necessary to. distinguish between symptoms arising from adverse herb reactions to correct treatment and symptoms due to the following alternative possibilities: "
• inco':;'ect diagnosis:
see the section An example with mistakes in the Practical herb combination chapter
l
Safety in Clinical Practice • herb-drug interaction:
see the section on this topic in the Safety chapter
• healing crisis:
see Healing crises in the Appendix
SIDE EFFECTS ACCEPTABLE TO THE PATIENT
155
• reduce the dose • change the dose form • change the of timing of the dose • replace one or more herbs in the combination • partially replace one or more herbs in the combination • use additional herbs to treat the side effects • use breaks in treatment • alternate between prescriptions
The practitioner and patient may decide to continue with the herb if the patient is obtaining benefits that out-
Reduce the dose
weigh the side effects but only:
sure that can be taken to reduce side effects is to reduce the dose of the prescription. The optimum situation is that the reduction of dose removes the side effects without decreasing the beneficial effects of the herbs. However, reduction of dose may reduce the beneficial effects as well as the negative effects. Nevertheless, it may be possible to find a reduced dose at which the levels of both the beneficial and negative effects are acceptable to the patient. The topic of adjusting dose levels to meet the changing needs of the patient is discussed in detail in the Dose chapter in the sections Factors affecting dose and Clinical examples.
if the side effects are mild to moderate. For example, in the short-term treatment of acute bronchitis with a herb combination including Lobelia, some patients may experience mild nausea. This is a common side effect of Lobelia, especially for patients who easily experience nausea. This is acceptable to most patients if the bronchitis is greatly improved. Caution If a herb has side effects, the decision whether or not to continue treatment depends on the type of negative reaction. For example, the commonest side effect of Lobelia is nausea, and, more rarely, vomiting. Providing that this herb is not used for very weak or pregnant patients, these effects are not, in themselves, life threatening. In contrast, in the case of Cinchona, a theoretically possible side effect is cardiac arrhythmia. If this were to occur, even if it were only of mild to moderate severity, the herb should be discontinued immediately since it is theoretically possible for arrhythmia to progress to a life-threatening cardiac condition. However, it should be noted that there have been no reports of adverse reactions to Cinchona when taken within the therapeutic dose range (see the Cinchona chapter).
SIDE EFFECTS UNACCEPTABLE
Reduce the dose of the prescription The most obvious mea-
Reduce the amounts ofindividual herbs in the prescription One possibility is to reduce the dose of the entire combination. Another possibility is to reduce the amount of the individual herb or herbs in the combination that are likely to be producing the side effects. For example, if the combination Lobelia: acute asthma is used, a few patients may experience restlessness or insomnia from the Ephedra. Reducing the dose of the entire combination may result in a large decrease in the beneficial effects of the combination. Herb
Ratio
Temperature
Taste
Ephedra Lobelia Prunu5 Glycyrrhiza
1 1 1 1
warm warm-cool neutral neutral·cool
acrid, 51. bitter acrid bitter, aromatic sweet
TO THE PATIENT
The first step is to stop the herbs. The side effects may then decline and disappear. If they do not and they are severe, the practitioner should proceed as described in the section below on Treatment of severe
adverse reactions. If the side effects are not severe and if the patient is bene- . fiting from the specific.herb combination, the patient may wish to try the combination again, providing that measures are taken by the practitioner to reduce the side effects. These measures may include the following:
An alternative is to keep the dose of the entire combination at the previous level but to reduce the ratio of Ephedra in the combination to 0.75 or 0.5. This may maintain the benefits whilst decreasing the side effects to an acceptable level. If reduction of the ratio of Ephedra results in a decrease of the side effects but also markedly decreases the benefits, the technique of partial replacement may be preferable to simply reducing the amount of the individual herb (see below).
Change the dose form
reactions.
See the section Prevention ofadverse
Combining Western Herbs and Chinese Medicine
156
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Change the timing of the dose See the section Prevention ofadverse reactions. Replace one or more herbs in the combination If the side effects are likely to be due to an individual herb or herbs in the combination, these can be replaced by other herbs. The latter should have similar actions and indications as the herbs they are replacing, but not their specific side effects. For example, the patient has asthma associated with profuse bronchial phlegm, rather than allergic asthma without profuse phlegm. In this case, if the patient is known to experience side effects with Ephedra, a combination based on Lobelia: acute asthma can be used, in which Ephedra is replaced by Euphorbia hirta.
Euphorbia Lobelia Prunus Glycyrrhiza
1 1 1 1
cool war~ol
neutral neutral-cool
bitter, acrid acrid bitter, aromatic sweet
Partially replace one or more herbs If the patient has allergic asthma without profuse phlegm, replacement of Ephedra with Euphorbia may result in an unacceptable decrease in beneficial effects. If this is the case, then partial replacement of Ephedra may be preferable to total replacement. A modification of Lobelia: acute asthma can be used in which the ratio of Ephedra is reduced to 0.5 and Ephedra is partially replaced with Euphorbia hirta at a ratio of 0.5. \ ~ ..,"
Herb
Ratio'
Temperature
Taste
Ephedra Euphorbia Lobelia Prunus Glycyrrhiza
0.5 0.5
warm cool warm-cool neutral neutral-cool
acrid, sl. bitter bitter, acrid acrid bitter, aromatic sweet
1 1 1
Another example of partial replacement is given in the section on Tolerance of the patient for a specific herb in the Dose chapter. Use additional herbs to treat the side effects The use of moderating herbs to prevent side effects is discussed in the chapters on Temperature, Taste, and Actions. The following example illustrates the use of moderating herbs to treat side effects.
Example A patient has allerii~ asthma, and the conibina~ tion Lobelia: acute asthma is effective at removing asthiriatic symptoms. However, in this patient, Ephedra incre~s the patient's preexisting symptoms of anxiety (Heart Spirit
Disturbance) and exhaustion (Kidney and Heart Qi Defi-=__ ~: ;, ciency). The patient is pleased by the improvement and . wishes to continue with the combination if it can be modified so that the side effects are removed or reduced to an acceptable level. Schisandra is added to the combination, at a ratio of 0.5, to tonify and firm Kidney and Heart Qi and thus reduce both exhaustion and anxiety. Anemone is also added, at a ratio of 0.5, to reduce anxiety by calming Kidney fear and Heart Spirit Disturbance.
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Ratio
Temperature
Taste
Ephedra Lobelia Prunus Glycyrrhiza Schisandra Anemone
1 1 1 1
warm warm-cool neutral neutral-cool warm cold
acrid, sl. bitter acrid bitter, aromatic sweet sour bitter
0.5 0.5
The patient may then experience the full benefits of the original combination without its side effects. If the side effects are reduced but not sufficiently, then the ratios of Anemone and Schisandra may be increased from 0.5 to 0.75 or even to 1. Use breaks in treatment See Duration of the prescription in the Dose chapter. Alternate between prescriptions scription in the Dose chapter.
See Duration of the pre-
TREATMENT OF SEVERE ADVERSE REACTIONS The procedures for treatment of severe adverse herb reactions, whether due to therapeutic levels of dose or to overdose, can be summarized as follows:
• stop the herbs • get emergency conventional medical treatment Stop the herbs Prior to commencing the herbal treatment, it is prudent to advise the patients to stop taking the herbs immediately if there is any severe adverse reaction, whether it is obviously due to the herbs or not. They should also stop herbal treatment immediately even if the adverse reactions occur only , in mild form if there is'the possibility that they might progress to a seriouscondition (see the discussion on Cinchona in Side effects acceptable to the patient above).
In case of emergency The treatment of severe and lifethreatening situations is usually outside the scope of the gen-
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Safety in Clinical Practice eral herbal practitioner, and requires immediate notification and intervention of emergency medical facilities.
REPORTING OF ADVERSE REACTIONS
157
It is ideal ifboth the patient and practitioner keep a record of the details of any suspected adverse reactions or herbdrug interactions. This is discussed in the Necessary improvements section in the Safety chapter.
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PART II:
Materia'- Medica
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Using the materia medica in the study of herbal therapy, and the most important one, is learning to make a clear differentiation between the uses of the different herbs. This requires a very thorough understanding of the properties, actions, and uses of each herb. Without a detailed knowledge of the differences between herbs, especially those with similar uses, the choice of herbs for a combination will be imprecise or even incorrect, and clinical effectiveness will be reduced.
T
HE HARDEST PART
Main herbs In this materia medica, each chapter, except the last, is devoted to a single herb and is organized into sections as shown below in Chapter organization. Each section is designed to present the herb from a different perspective. This is done to bring out the essence of what makes the herb unique and to show the different facets of its nature and its
Two ways to use the materia medica The materia medica can be used in two main ways: • for an in-depth study on a particular herb • as a reference text for finding specific information IN DEPTH STUDY Readers may wish to obtain a thorough understanding of a particular herb. They may wish to read the whole chapter, follow up concepts and data by reading primary sources, check the tastes of tinctures and decoctions of the herb, and tryout combinations that include this herb in their clinical practice.
As A REFERENCE TEXT
Additional herbs
Readers may wish to use the materia medica as a reference to get information on specific topics. For example, for a particular herb, they may wish to find information on its Chinese properties, traditional Western uses, or biochemical constituents.
Herbs that do not have individual chapters, but are included in one or more of the combinations in this book, are briefly descnbed in the last chapter of the materia medica, entitled Additional herbs.
Caution If practitioners are going to use a herb in their clinical practice, they are advised to familiarize themselves, in detail, with the sections on Toxicology, Dose, and Cautions in the chapter on that herb.
range of use.
161
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Combining Western Herbs and Chinese Medicine
Actions as coordinating theme . In each main chapter of the materia medica, the herb actions are used as a coordinating theme to link data from Western herbal tradition, Chinese medicine, and biochemistry. • in the What is special section, the Western actions and uses of the herb are discussed in terms of its Chinese actions
Research Constituents Pharmacological and clinical research Research verification of traditional actions Toxicology Dose Cautions Regulatory status ~
• in the Traditional sources section, there is a bulleted list of the traditional Western actions, and each action is then discussed in detail • this can be compared with the bulleted list and discussion in the Pharmacological and clinical research section to see how far the traditional actions have been supported by modem research
Traditional sources Properties Organs Actions Comparison ofWestern and Chinese use (when appropriate) References
..
.
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.;~~._ . ••
Chapter section,outline Each Materia medica chapter is organized in sections as follows: Introduction Names Use in the West Use in China What is special about the herb Properties and meridians Key to understanding the herb Chinese actions Western actions Western uses . Direction of energy Typical case example Limitations ofthe herb Temperature Taste Actions Herb pairs (including that herb) Caution Pairs Combinations Caution Individual combinations Comparison of combinations Other combinations (including that herb)
.i;...
Chapter section commentary INTRODUCTION In this book, herbs are referred to by their botanical name. Alternative names are given in the chapter introduction, together with the plant family and plant part used. For the Mandarin name, the phrase 'not used' indicates that the species used in the West is not in common use in China, and is not included in the Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) from Jiangsu New Medicine Institute, published by Science and Technology Press, Shanghai, China (1975). Chinese characters are generally only given: • for herbs with their own individual chapter in the materia medica, and not for herbs in the Additional . herbs chapter • for Western species if the herb has an entry in the
Chinese Herbal Medicine Dictionary • for Chinese species if they are in the same genus as a species used in the West and have comparable use This nomenclature information is followed by a general introduction to the history of use of the herb in the West and, if applicable, in China.
WHAT IS SPECIAL ABOUT THE HERB Properties and organs (meridians entered) are listed, and the key to understanding the herb is given briefly in italics to
',;
Using the Materia Medica pinpoint what makes this lerb special and different from other herbs. Actions and uses The main Chinese actions for the herb are listed and the Western uses are then described in terms of
the numbered Chinese actions. Direction of energy Where this is appropriate, the effect of the herb on the direction of energy movement in the body is described. Typical case example The signs and symptoms of a hypothetical patient are described, a diagnosis is given, and the reasons for choosing the herb are listed.
LIMITATIONS Defining the limitations of a herb can give a clearer understanding of what it can and cannot do. The limitations to the range of temperature effects, taste properties, and actions are discussed, and for some of the herbs, examples are given of situations in which other herbs would be preferable.
HERB PAIRS For a particular herb, suitable combination with another herb can extend its range of use beyond its limitations or moderate its potential side effects. Clinically effective examples are given. The herb pair can be seen as the basic unit of herb combination. This section lays the foundation for the discussion of combinations that follows.
COMBINATIONS Over 150 herb combinations are discussed in the materia medica chapters. Most of these derive from my own experience - see Evidencefor statements made under Sources in the Front matter of this book. Individual combinations In most cases, six combinations are discussed to illustrate the use of the herb. Each of these combinations is described in a table and text.
Table In the combination table, the complete range of temperature and taste values is given for each herb. However, not all may be applicable to the specific situation described. For a particular herb, which temperature and taste values manifest in a particular situation depends on the individual needs of the patient and on the properties of the other herbs with which it is combined. If the combination is to be prepared from dried herbs, the dose in grams is given for each herb. If the combination
163
is to be taken in the form of a tincture or fluid extract, then the ratio of each herb in the combination is given, since tinctures can be of different strengths, 1:1, 1:2, 1:3, and so on (see the Dose chapter). If Capsicum is given as a tincture, the amount is listed in drops to be added to the main combination. This is based on the assumption that Capsicum is given in a separate bottle from the bottle of the main combination tincture.
Text The combination is then discussed with respect to its Chinese syndromes and Western uses and, if it is appropriate, with practical details of its administration and precautions. Comparison of the combinations The comparison of the combinations is arranged in pairs, each with two tables and accompanying text. This is done simply because it is easier on the eye and mind to compare two items at a time, rather than to be confronted with one complex table of six combinations. The comparisons may be both within and between the pairs. Other combinations This section lists examples of other combinations that include the herb. It is not always a complete list since in the case of a herb such as Zingiber, a complete list would include over 80 combinations.
RESEARCH Constituents The major chemical groups of pharmacologically active constituents are listed and then discussed. Pharmacological and clinical research Research studies are organized by the herb's action (effect). Data from this section can then be compared with the Traditional sources section later in the chapter.
Caution As discussed in the Safety chapter, some in vitro, in vivo. and even clinical studies may have limited applicability to humans taking therapeutic doses of the whole herb. This is especially true of studies using isolated constituents rather than the whole herb, and of studies using administration by injection rather than by an oral route. Wherever possible, the reader is advised to refer to the primary sources cited in the References section. Research verification of traditional actions The traditional actions that have been supported by research are listed, as are additional effects demonstrated by research studies. Toxicology Data on toxicology is given for the herb where it is available. A distinction is made between effects reported for the whole herb as opposed to its essential oil or isolated constituents.
--,;:;...
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Combining Western Herbs and Chinese Medicine
It is most important to keep a sense of perspective in this section. For example, I have often converted figures given in mg/kg from animal studies to mg for a 60-kg human. In many cases, it is then obvious that toxic effects only arise at dose levels far higher than the recommended herbal therapeutic dose (see Interpretation ofresearch data).
Caution The regulatory status of herbs is constantly changing, and it is the responsibility of the practitioner in a particular country or state to be familiar with their local regulations.
DOSE
A range of opinions on the properties, associated organs. and range of actions is presented from traditional Western texts, especially from Germany. Britain. and the USA. The Chinese Herbal Medicine Dictionary (see Books chapter) has been used as the main source for information on traditional Chinese material. The properties. associated organs. and actions are discussed. Information on the actions from traditional sources can be compared with research data in the Research section. When the herb is used in both the West and China. the two traditions of use are compared. This may be for the same species or for different species of the same genus.
The dose for the dried herb and tincture, and the initial dose and duration of administration are given. The figures for dose are usually cited from the BHP or BHC. If I use doses differing from these, then my doses are cited also. Please read the chapter on Dose for a detailed discussion of this topic.
CAUTIONS Where applicable, data is given on Western and Chinese contraindications, cautions on use during pregnancy and lactation, side effects, overdose, and herb-drug interactions. In a few cases, especially when the herb is on Schedule Part III of the Supply of Herbal Remedies Order 1977 of the UK, details on screening, treatment precautions, and monitoring are given. Please read the chapter on Safety for a discussion of this topic.
REGULATORY STATUS Australia It is stated whether the herb is included in Part 4 Schedule 4 of the Therapeutic Goods Act Regulations (meaning, there are restrictions on its use). United Kingdom It is stated whether the herb is on the General Sale List (meaning, it is generally available) or on Schedule Part III of the Supply of Herbal Remedies Order 1977 of the UK (meaning. there are restrictions on its use). United States It is stated whether the herb was listed, at the time of writing. by the FDA as a prohibited substance. as subject to an import alert. or as a substance with a warning on its use. Please read the section on Regulatory status in the chapter on Safety for a discussion of this topic.
TRADITIONAL SOURCES
REFERENCES The references given in this book can be divided into two types: journals and basic reference texts. Journals References to journals are usually specific to one chapter. To save space, the references to journals are given without the names of the articles. Where references to a journal are incomplete. because they were taken from another text that did not cite their full details. the reference the citing text is given. Basic reference texts A. number of basic reference texts are quoted in most of the ~ateria medica chapters in this book. Such basic texts are given a superscript reference number only on their first mention.
Abbreviations Some of these basic texts are given abbreviations. such as 'BHP' for the British Herbal Pharmacopoeia . Others are given brief designations such as 'Grieve' for A Modern Herbal by M. Grieve. The reader is referred to the explanation of reference notations given in Sources in the front matter of this book.
Achillea Botanical name Achillea millefolium L. Family Asteraceae (Compositae) Pharmaceutical name Millefolii herba cum flore Part dried aerial parts with flowers English yarrow German Schafgarbe French millefeuille Mandarin yang sill cao (5f f :¥-) aerial parts ofA. millefolium L.
• diaphoretic and antipyretic for the common cold, influenza, and fever
• anticatarrhal for sinusitis or sinus congestion with headache
• bitter digestive tonic and cholagogue for loss of appetite and biliary disorders
• gastrointestinal anti-inflammatory and antispasmodic for indigestion, epigastric distension, flatulence, and intestinal colic • antihypertensive for hypertension and sequelae of CVA • diuretic and urinary antiseptic for urinary retention or cystitis • emmenagogue for amenorrhea or menstrual irregularities • astringent and antihemorrhagic for urinary incontinence, diarrhea, menorrhagia, or leukorrhea • vulnerary and topical anti-inflammatory for slow-healing wounds and skin inflammations
Achillea is a fascinating herb. Study of Achillea can show how the use of a herb in the Roman armies of the emperor Nero has been continued down a line of tradition to the present day; how differences in the use of a herb can be linked to chemical differences relating to variation in chromosome number; and how Native American use can be related both to traditional Chinese medicine and to modern biochemistry. Use in the West Yarrow has been used in Europe since at least the time of Dioscorides.\ As a doctor with the Roman army, he used it for healing wounds, an important use for soldiers, hence the old name wound wort. He wrote 'pound the leaves and put them on a fresh wound to close and heal it, to clear heat and inflammation from the wound, and to congeal the blood: Dioscorides also used Achillea for dysentery, which until relatively recently, whether associated with cholera or other causes, killed as many soldiers as did steel and lead. Yarrow now has one of the widest ranges of applications of any herb used in the West. It is used for disorders of the respiratory, digestive, hepatobiliary, cardiovascular, urinary, and reproductive systems. For example, it can be used as a:
Yarrow is one of my favorite herbs. On mountain walks, I have found that chewing the freshly gathered leaves can reduce the dizziness of altitude sickness, allay the weakness of sunstroke and the effects of dehydration, and give increased endurance. The fresh leaves also seem to clear the mind and help concentration. Use in China According to Perry,! the uses of A. millefolium seem to have originated in European folk medicine, with subsequent transfer to the East. The nature of the entry for yang sill cao in the Chinese Herbal Medicine Dictionary' also gives this impression. It did not list the meridians entered, but it gave much information on chemical constituents and pharmacology.
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Combining Western Herbs and Chinese Medicine
166 Species and subspecies
CHINESE ACTIONS
Nomenclature The name Achillea millefolium has been applied to a complex of barely distinguishable species or subspecies, which have evolved by polyPloidy (changes in chromosome number). This has resulted in some confusion in nomenclature. 4 Unless otherwise stated, the name Achillea is used in this chapter to means A. millefoliu~, without differentiation between the different subspecies (see discussion at the start of the section on Research).
In terms of Chinese medicine, Achillea, as used in the West, can be said to have three main actions:
Chromosome number and chemical differences What is interesting to the herbal practitioner is that differences in chromosome number between the A. millefolium subspecies are often accompanied by important chemical differences,s which, in their turn, may lead to differences in temperature, actions, and uses. This is discussed in this chapter: • in the Limitations section under Circulatory stimulant • in the Research section under Constituents • in the Traditional sources section under Temperature
What is special about Achillea
I. clear Exterior Wind II. tonify Deficiency III. clear Heart Phlegm
WESTERN ACTIONS Achillea can be said to have three main action groups, which are listed below and related to their corresponding Chinese action:
• diaphoretic • tonic • antihypertensive
clear Exterior Wind tonify Deficiency clear Heart Phlegm
The individual actions included in each of the three main Western action groups are shown in the table below, and the leading action in each group has been italicized: Chinese actions '.- .-. I. clear Exterior Wind
diaphoretic antipyretic anticatarrhal alterative
II. tonify Deficiency
The key to understanding Achillea is that it is a variabletemperature herb with a very wide range of potential actions and uses. This is associated with its unusually wide range of active constituents, including essential oils, sesquiterpene lactones, flavonoids, alkaloids, polyacetylenes, sterols, phenolic acids, coumarins, and tannins.
tonic bitter digestive tonic astringent tonic emmenagogue
III. clear Heart Phlegm
antihypertensive antilipidemic antithrombotic circulatory stimulant
VARIABLE TEMPERATURE
ACTION GROUPS
Achillea can be said to have a range of potential temperature effects from cool to warm. Whether Achillea acts as cool, neutral, or warm in temperature can depend on the situation:
Achillea is a good example of an herb with multiple actions in which the actions may work together in groups. _ Three Western action groups are discussed below.
In terms of Chinese medicine, Achillea millefolium, as used in the West, can be said to be a warm-cool, acrid, and bitter herb that has its main effects on Lung, Spleen, Heart, and Uterus.
• cool • neutral • warm
diaphoretic and antipyretic for influenza or fever to clear Wind Heat bitter digestive tonic for atonic digestion to tonify Spleen Qi diaphoretic and anticatarrhal for influenza with sinus- headache .. and chills to clear Wind Cold Damp
The temperature effect manifested can also .depend on the herbs with which Achillea is combined.
Diaphoretic Whilst the diaphoretic action of Achillea may be primary, it is usually modified by one or n:ore of the other actions of this herb, so tha: the actions work together as a group. The diaphoretic action may be modified by one or more of the following actions: • antipyretic • anticatarrhal • alterative • circulatory stimulant • bitter digestive tonic
Achillea Examples of action pairs are given below. but in practice, three or more actions may be in simultaneous operation. In each example, the Chinese actions are linked to the corresponding Western actions.
Diaphoretic + antipyretic For example, Achillea can be used for influenza with fever. The diaphoretic action, increased sweating. can help to clear \V"md Heat from the Exterior. The antipyretic action can help to clear Wind Heat from the Exterior and Excess Heat or Deficiency Heat from the Interior. Diaphoretic + anticatarrhal For example, Achillea can be used for influenza with sinus congestion. The diaphoretic action can help to clear Wind Cold from the Exterior and the anticatarrhal action can help to clear Phlegm from the head and reduce sinus congestion and associated sinus headache. Diaphoretic + alterative For example, Achillea can be used to treat recurring fever. The diaphoretic action can help to clear Wind from the Exterior, to treat the acute phase, and the alterative action can help to clear Retained Pathogen from the body surface, thus helping to prevent recurrence of the condition. Diaphoretic + circulatory stimulant For example. Achillea can be used to treat influenza with poor circulation at the body surface. The diaphoretic action of Achillea to clear Wind Cold from the Exterior may be assisted by its capacity to dilate the peripheral arteries and increase blood flow to the surface. In Chinese terms, this can be described as moving Qi and Blood in the surface channels and vessels. Diaphoretic + bitter digestive tonic For example, Achillea can be used to treat influenza with debility associated with digestive weakness. In this situation. Wind invasion may be facilitated by Deficiency of Defensive Qi. By acting as a bitter digestive tonic, Achillea may help to tonify Spleen Qi and also Defensive Qi, thus reducing Wind invasion. This can complement the diaphoretic action of clearing Exterior Wind. Tonic Achillea can be said to have four aspects to its tonic action, which are shown below with their Chinese equiva-
167
Digestive and general tonic The bitter digestive tonic action of Achillea, which increases the efficiency of digestion and assimilation, may indirectly result in general tonic action. In Chinese medicine terms. tonifying the Spleen can lead to an increase in Qi and Blood. Immune system tonic The general tonic action of Achillea. which strengthens Qi and Blood, can combine with its diaphoretic and circulatory stimulant actions at the surface of the body to strengthen the circulation of Defensive Qi. This reduces Wind invasion, leading to a reduction in the number of recurring respiratory infections. Convalescent tonic The tonic, alterative, and antipyretic actions of Achillea can combine to treat recurring subacute fever or chronic feverishness and speed postfebrile recovery. Achillea can help to tonify Yin and clear Deficiency Heat associated with Deficient Yin. It can also help to clear Retained Pathogen, thus normalizing the circulation of Defensive Qi and assisting recovery. Antihypertensive The following actions of Achillea may combine to normalize the function of the circulatory system and contribute to an overall antihypertensive effect: • circulatory stimulant • anticatarrhal and antilipidemic • antithrombotic
Circulatory stimulant Achillea has a tradition of use to dilate the peripheral arteries. increase the flow of blood to the surface, 'equalize the circulation; and thus help to lower blood pressure. Anticatarrhal and antilipidemic These actions can combine to reduce excessive lipid levels in the blood and to reduce deposition of fatty material on the walls of the arteries. Reduction of atherosclerosis may assist treatment of hypertension. In terms of Chinese medicine, the anticatarrhal and antilipidernic actions can result in a reduction of Phlegm in the body and in the vessels. This can assist in the reduction of Heart Phlegm and improve circulation of Heart Blood.
lents:
-,-
Antithrombotic Formation of atheroma may limit blood circulation and predispose to thrombosis. Achillea may help to reduce thrombosis by reducing excessive blood lipids, and may help to treat associated hypertension.
I. bitter digestive tonic
tonifies Spleen Deficient Qi
II. general tonic
tonifies Qi and Blood
III. immune system tonic
tonifies Defensive Qi
WESTERN USES
IV. convalescent tonic and
tonifies Yin clears Deficiency Heat clears Retained Pathogen
The Western uses of Achillea relate to its three main Chinese action groups:
antipyretic
168
Combining Western Herbs and Chinese Medicine .- ---.": -
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Chinese actions ·~-'c-:=:::':::-Westemuses --:-:-.: '~--.~:-::-:::::, ···c.;- 7 I. clears Exterior Wind
colds, influenza, acute fever, recurring fever, low-grade fever, rhinitis, sinusitis, sinus headache, bronchitis
II. tonifies Deficiency
exhaustion, anemia, poor appetite, postfebrile debility, debility with night sweats, chronic fatigue sync drome, atonic amenorrhea, loose stools, atonic menorrhagia
III. clears Heart Phlegm
poor peripheral circulation, hypertension with atherosclerosis, sequelae of eVA
Other uses Achillea can have the following secondary actions and uses: • antispasmodic for abdominal distension, intestinal colic, and flatulence .• anti-inflammatory for gastroenteritis • cholagogue for hiliary disorders • diuretic and urinary anti-inflammatory for inflammation and catarrh of the urinary tract • emmenagogue for amenorrhea or irregular menstruation • astringent and antihemorrhagic for excessive sweating, diarrhea, menorrhagia, or leukorrhea • vulnerary and topical for slow-healing wounds, skin inflammations, nosebleeds, varicose veins, hemorrhoids
DIRECTION OF ENERGY When taken as copious hot infusions, Achillea is an excellent example of a surface-active herb with an outward, diffusive, opening effect. However, when taken cold, other effects may become dominant, such as the tonic or diuretic actions, and the outward movement is reduced.
TYPICAL CASE EXAMPLE Signs and symptoms The patient has debility, poor appetite, poor peripheral circulation, frequent colds and influenza, which usually occur with sinus congestion and sinus headache. She also has recurring subacute febrile episodes and some night sweats, especially when she is particularly tired. She also tends to have amenorrhea.
and accumulation of Phlegm, with some Stagnation of Qi -:c.:. _"~-: ~_ and Blood. A mix of Deficiency, Stagnation, and Phlegm -'~~ Damp in the Uterus may be contributing to the amenorrhea.~:-' Choice of Achillea This herb can clear Exterior Wind to treat the influenza, clear Phlegm to treat the sinusitis, clear Retained Pathogen to treat the recurring febrile episodes, tonify Spleen Qi to treat poor appetite and debility, tonify Defensive Qi to reduce the incidence of Wind invasion, and move Qi and Blood to treat the poor peripheral circulation.
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Limitations ofAchillea TEMPERATURE Although Achillea can be used for high fever, it is not a cold herb in the sense that it depresses the metabolism of the body. Therefore, its range has been classified in this !?ook as warm-cool, rather than warm-cold. Also, it can be termed warm in the sense that it can help to clear Wind Cold from the surface, but it is not an herb that can rapidly increase body temperature, such as Capsicum or Zingiber.
TASTE The predominant taste properties of Achillea are acrid and bitter. This distinguishes Achillea from Berberis, for example, which is simply bitter, or from Rosmarinus, which is bitter, acrid, and aromatic. Acrid taste property Achillea is an acrid herb to clear Pathogens from the Exterior, rather than an acrid herb to warm the Interior. Bitter taste property Like Gentiana or Centaurium, Achillea can act as a bitter digestive tonic. However, it is not as effective a bitter anti-inflammatory for the digestive and hepatobiliary systems as Berberis or Hydrastis.
ACTIONS
The pulse is empty, especially at the superficial depth, and is also slippery and slightly wiry. The tongue is flabby, pale, and slightly purple, with a greasy white coat.
Diaphoretic Achillea is an excellent diaphoretic with a very wide range of complementary actions. However, for maximum diaphoretic effect, it should be taken as a hot infusion and combined with warmer diaphoretics, such as Zingiber.
Diagnosis There is Deficient Qi, especiallyDeficient Defensive Qi, which allows for frequent Wind invasions. There is some Retained Pathogen, a slight amount of Deficient Yin,
Antipyretic Achillea cools the body by diaphoresis and by increasing peripheral circulation, rather than by sedation of metabolism. It is especially useful for fever accompanied by
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Achillea Deficiency and Stagnation. For acute severe fever with Excess, a colder more sedative herb, such as Asclepias, may be preferred. Anticatarrhal Achillea is specific for oversecretion of mucus by the membranes of the upper respiratory system as seen in acute or subacute cold or influenza. I do not consider Achillea as effective an anticatarrhal for the gastrointestinal, hepatobiliary, or urogenital systems as is Hydrastis. Alterative The main alterative action of this herb is characteristically linked to its diaphoretic, and anticatarrhal actions. It is not an alterative in the sense that it is a strong cleanser of liver or kidneys, like Tara..xacum.
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Digestive tonic The bitter digestive tonic action of Achillea can be used to treat debility during convalescence, recurring febrile episodes with debility, and anorexia occurring with amenorrhea. However, Gentiana or Artemisia may be more effective for digestive and hepatobiliary weakness. Circulatory stimulant The term circulatory stimulant is an approximation.in the case of Achillea. This herb is not a hot acrid herb to warm the Interior like Capsicum or Zingiber. The effect of Achillea on peripheral circulation may be due to the combination of its diaphoretic, mild circulatory stimulant, antihypertensive, and alterative actions.
Camphor and chromosome number The strength of the warming circulatory stimulant action of Achillea may depend partly on the camphor content, and this may vary with the chromosome number of the subspecies. The hexaploid subspecies of Achillea can contain 0.2-1% essential oil, of which camphor can be 18%, whereas the tetraploid subspecies do not contain appreciable amounts of camphor.6 One of the reasons that Rosmarinus is a stronger warming circulatory stimulant than Achillea may be that Rosmarinus contains more camphor than Achillea: Rosmarinus has 1-2.5% essential oil, of which 15-25% can be camphor.7 Astringent and hemostatic Achillea has mild astringent properties anq has been used as a vulnerary for bleeding wounds, fistulas, ulcers, diarrhea, leukorrhea, menorrhagia, melena, and epistlUis. I do not consider Achillea as effective as Quercus or Potentilla, or even Geranium or Capsella, and I would use it as a secondary astringent or hemostatic. Emmenagogue I consider this to be a secondary action of Achillea. Artemisia abrotanum would be more effective both as a bitter tonic and as an emmenagogue for amenorrhea with anorexia and exhaustion.
169
Antihypertensive Achillea has not been reported to produce significant rapid reductions in blood pressure. Rather, it can be used long-term to assist gradual reduction of hypertension, especially when this is associated v:rith atherosclerosis and thrombosis.
Achillea paired with other herbs Discussion of the limitations of each of the main actions of Achillea can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Achillea beyond its limitations as a single herb. The basic unit of herb combination is the herb pair. Twelve pairings of Achillea with other herbs are briefly explained below. CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair. Achillea + Eupatorium perfoliatum
Influenza + myalgia Warm Eupatorium emphasizes the warming diaphoretic action of Achillea to dear Wmd Cold. Eupatorium is specific for influenza with a deep aching sensation. Achillea + Salvia officinalis
Influenza + headache Achillea can treat headache via its diaphoretic and anticatarrhal actions. Salvia is specific for headache and for muscle ache at the surface of the body associated with a combination of Exterior Wmd and nervous tension. Achillea + Angelica archangelica
Influenza + sinus congestion Warm, dry Angelica emphasizes the anticatarrhal diaphoretic action of Achillea to clear Wind Cold and Phlegm Damp from the head and sinuses.
Caution This pair is potentially drying and should be used with caution for patients with a tendency to dryness of the sinuses. Achillea + Mentha piperita
Influenza + sore throat Cool Mentha emphasizes the potential action of Achillea to clear Wind Heat and contributes its own specific antiinflammatory effect on the throat. Therefore, this pair can be used to treat influenza with laryngitis.
Combining Western Herbs and Chinese Medicine
170 Achillea + Asclepias
Influenza +fever Cold Asclepias emphasizes the antipyretic action of Achillea and contributes expectorant, antispasmodic, and sedative actions. Therefore, this pair can treat acute pleurisy or bronchitis. Achillea + Echinacea
Recurring influenza Echinacea emphasizes the anticatarrhal, alterative, and diaphoretic actions of Achillea to clear Retained Heat and treat recurring respiratory infections. Also, both herbs can act as tonics to speed recovery after a fever or infection.
phasizing the bitter digestive tonic action of Achillea. Artemisia can also strengthen the emmenagogue action of Achillea so that the pair can be used to treat amenorrhea with anemia. Achillea + Capsella
Menorrhagia + debility Capsella emphasizes the astringent and hemostatic -";'\ actions of Achillea to reduce diarrhea or abnormal uterine bleeding. Achillea can help to treat debility by acting as a bitter digestive tonic.
Achillea combinations
Achillea + Pseudostellaria
Debility + low-grade febrile episodes Moist, sweet Pseudostellaria complements the bitter . digestive tonic action of Achillea and moderates its slightly drying effect. Therefore, this pair can be used for postfebrile recovery. Achillea + Marrubium
Six Achillea combinations are discussed below:
1. influenza + sore throat
Wind Heat
2. influenza + sinusitis
Wind Cold Damp
3. recurring fever + exhaustion
Retained Pathogen + liver Deficient Qi
4. recurring fever + respiratory infection
Retained Pathogen + Deficient Defensive Qi
5. amenorrhea + exhaustion
Deficient Blood and Qi --
6. atherosclerosis + hypertension + cold extremities
Heart Phlegm Cold + Heart Stagnant Qi
Debility + digestive weakness Bitter Marrubium emphasizes the bitter digestive tonic action of Achillea and directs Achillea to the Lungs where the expectorant action of Marrubium adds to the anticatarrhal diaphoretic action of Achillea. This pair can be used for digestive and general weakness with bronchial phlegm. Achillea + Zanthoxylum
Debility + poor circulation Warm Zanthoxylum emphasizes the anticatarrhal, circulatory tonic, diaphoretic, and antirheumatic actions of Achillea. As a result, this pair can treat weak patients with rheumatism or arthritis and poor peripheral circulation. Achillea + Crataegus
CAUTION
Before using any of the combinations below, it is importanr •., to be familiar with the cautions listed for each herb in the combination. 1. Influenza + sore throat
Wind Heat
Hypertension Herb
Crataegus can be said to direct Achillea to the heart and circulatory system, and emphasizes its antiatheromatic, antithrombotic, and antihypertensive actions. This pair can be used to treat cardiac weakness and exhaustion, poor circulation, labile blood pressure, hypertension, and the sequelae of CVA. A~ea + Artemisia spp~
Amenorrhea + debility The Artemisia species, especially A. absinthium, are aromatic bitter herbs that can indirectly tonify Blood by em-
Achillea Mentha pip. Sambucus
Daily dose
Temperature
Taste
6g 3g 3g
warm-cool warm-cool cool
acrid, bitter acrid, aromatic acrid. sl. bitter
GENERAL This is one of the best-known infusions for acute cold: or influenza associated with Wind Heat, and has been rec:: ommended by Grieve,S Christopher,9 and the BHP.IO Christ opher used either Sambucus nigra or S. canadensis. In tht context of a Wind Heat condition, the overall temperature is-
---
Achillea cool. For cold conditions, Zingiber can be added. This is an acrid combination to clear Exterior Wind with secondary bitter and aromatic properties to normalize digestion. USE
• acute cold or influenza • acute influenza with sore throat • influenza with acute rhinitis PRACTICAL NOTES
The amount of herbs given in the table is enough to make about 3 cups of infusion (see the chapter on Dose). The herbs are steeped in boiling water for about 10-15 minutes, then strained and drunk warm. The hot infusion is given in large amounts, for example, 0.5-1 cup, every 0.5-2 hours, until the patient is perspiring freely. The patient should be well wrapped in warm clothes and in bed. If more than 3 cups of this tea are required in a single day-and this is quite common-more infusion can be made. This combination should break the cold or influenza within 1-2 days. If it does not, then a different combination or treatment is required. This combination is for short-term use only, during the acute phase.
Caution. Patients should be warned that, once they are perspiring freely, they should keep warm and avoid exposure to cold and wind, or the condition may be worsened.
171 • acute bronchitis with sinusitis
PRACTICAL NOTES
The amount of herbs given in the table is enough to make about 3 cups of infusion (see the chapter on Dose). The herbs are steeped in boiling water for about 10-15 minutes, then strained and drunk warm. The hot infusion is given in large amounts, for example, 0.5-1 cup may be given every 0.5-2 hours until the patient is perspiring freely and there is relief of sinus congestion and headache. The patient should be well wrapped in warm clothes and in bed. If more than 3 cups of this tea are required on the fIrst day, more infusion can be made. Once the symptoms improve, ha~f a cup can be taken three times per day for up to 3 days. After 3 days, it may be appropriate to change to a less diaphoretic combination.
Caution Patients should be warned that, once they are perspiring freely, they should keep warm and avoid exposure to cold and wind, or the condition may be worsened. 3. Recurring fever + exhaustion
Retained Pathogen + Liver Deficient Qi Herb Achillea Artemisia abs. Gentiana
2. Influenza + sinusitis
Berberis
Wind Cold Damp
Pseudostellaria Glycyrrhiza Zingiber
Herb Achillea Angelica arc. Sambucus Euphrasia Zingiber
Daily dose
Temperature
Taste
3g 3g 3g 3g 3 slices
warm-cool warm cool neutral-cool hot
acrid, bitter bitter, acrid, aromatic acrid, 51. bitter acrid, sour, bitter acrid, aromatic
GENERAL This combination can be used as a strong infusion for Wind Cold invasion with Phlegm Damp. It is a warm combination that can be used for Wind Cold patterns. For Wind Heat patterns, Angelica and Zingiber can be removed and Echinacea added. This is a combination that is acrid both in the sense of clearing Exterior Wind and in the sense of warming the Interior. USE
• acute influenza with sinus congestion and headache
Ratio
Temperature
1 1 1 1 1 0.5 0.5
warm-cool
acrid, bitter
warm-cool
bitter, aromatic
neutral-cool
bitter
cool
bitter
neutral
sweet, 51. bitter
Taste
neutral-cool
sweet
hot
acrid, aromatic
GENERAL This combination is for Retained Pathogen associated with Liver DefIcient Qi. The combination treats recurring fever with exhaustion associated with weakness of liver function and the inability of the liver to complete detoxification. The overall temperature of the combination is neutral to treat warm, neutral, cool, or mixed conditions. The acrid property assists clearance of Retained Pathogen at the surface, the bitter property assists strengthening of the Liver to assist in the detoxification, and the sweet property has a tonic function. USE
• recurring febrile episodes with exhaustion following a disease such as malaria, drug abuse, or prolonged multimedication
.. ,ojj -~-\
",;,;;,.
Combining Western Herbs and Chinese Medicine
172
F• • exhaustion with recurring infections as in some patterns of chronic fatigue syndrome • exhaustion with gastrointestinal and hepatobiliary weakness after a fever
• recurring low-grade fever and respiratory infections
,~.~~~-::-=--J
• postfebrile exhaustion
4. Recurring fever + respiratory infection
Retained Pathogen + Deficient Defensive Qi
l:'~rpJ.~;i~:g~i1~~~ii~~i~Jt~EL;I~,~~e~~~~
0.5 0.5 0.5
'"
.'::"';j;-
This combination can be taken as 2.5-5 ml of 1:5 tincture in quarter of a cup of warm water, three times per day. It can be taken for 1-2 months, with appropriate breaks and modifications during the subacute or remission phase. During the acute phase, Pseudostellaria can temporarily be omitted from the combination.
1 1 1 1
~
with exhaustion as seen in some patterns of chronic -... wc,fatigue syndrome, fibromyalgia, or H I V _ : ~ ~
PRACTICAL NOTES
Achillea Echinacea Thymus Pseudostellaria Panax qui. Glycyrrhiza Zingiber
,>:::
."-~
warm-cool cool warm-eool neutral neutral neutral-eool hot
acrid, bitter acrid, bitter, sl. sweet aromatic sweet, sl. bitter sweet, sl. bitter sweet acrid. aromatic
PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of warm water, three times per day. It can be taken for 1-2 months, with appropriate breaks and modifications during the subacute or remission phase. During the acute phase, Glycyrrhiza can be omitted from the combination and the proportion of Pseudostellaria reduced to 0.5. Alternatively, a combination for Wind invasion, such as a modification of Achillea: influenza + sore throat, may be more appropriate, depending on the diagnosis.
"" ~"
...
-.
-"'~'-
5. Amenorrhea + exhaustion
Deficient Blood and Qi
.-_.,-~.
~.;"'"
'$
GENERAL
This combination is for patterns with a mixture of the following syndromes: • Retained Pathogen • Deficient Defensive Qi • Deficient Lung Qi • Deficient Kidney Qi • Deficient Fluids This is a more or less neutral-temperature combination. whi~h can be used for neutral-warm conditions. The acrid constituents help to clear Retained Pathogen from the surface, the sweet constituents tonify Defensive Qi, Lung, and Kidney, and the bitter constituents help to strengthen digestion. This combination is especially useful for postfebrile exhaustion or the remission phase of recurring fever when these conditions are associated with Deficient Qi and Fluids. For recurring respiratory infections turning into lingering bronchitis, Thymus: recurring respiratory infection would be a more appropriate combination. For postfebrile exhaustion with digestive weakness, Cinchona: digestive weakness + postfebrile exhaustion would be more suitable. USE
During the subacute or remission phase for:
GENERAL
This combination is·for Deficient Spleen, Deficient Qi and Blood, and Deficient and Stagnant Qi and Blood of the Uterus, with some Disturbance of Spirit. It is a neutral combination, which can be used for warm, neutral, or cool conditions. It is a bitter and aromatic combination in which the bitter taste is associated with tonification of the digestive and circulatory systems, and the aromatic property contributes to the moving and relaxing effects. USE -'
• amenorrhea with anorexia. atonic digestion, and anemia • amenorrhea with debility and nervous tension PRACTICAL NOTES
Although his combination can be taken as an infusion, it is most conveniently taken as 5 rnl of 1:5 tincture in quarter of a cup of warm water, three times per day. The combination can be used. with appropriate breaks and modifications, _, for up to 2 months.
Achillea 6. Atherosclerosis + hypertension + cold extremities
Heart Phlegm Cold + Heart Stagnant Qi Herb"
. "'~:Ratio".Temperature . Taste-
Achillea Crataegus Salvia mil. Angelica sin. Zanthoxylum (bark) Commiphora Zingiber Capsicum
1 1 1 1 1
warm-cool sl. warm cool warm
1
warm
acrid. bitter sour. sweet bitter sweet. aromatic, bitter acrid, aromatic, bitter
hot
0.5 5-20 drops
acrid, bitter acrid. aromatic
hot hot
acrid
GENERAL
This combination is for Heart Stagnant Qi and Blood with Phlegm and Cold obstructing the channels and vessels of the Heart and body. It is a hot combination for cold or cool conditions. The acrid and aromatic properties are important to warm and move Qi and Blood and to clear Cold and Phlegm from the channels; they are assisted by individual constituents in Commiphora, Crataegus, and Salvia.
173
1. This infusion is an excellent general diaphoretic, antipyretic, and anticatarrhal combination. Achillea is the primary herb and the strongest diaphoretic and antipyretic of the three. Sambucus emphasizes the anticatarrhal action of Achillea and directs its action toward the sinuses. Mentha has an anti-inflammatory action on the throat and a carminative action on the digestive system. Also, both Achillea and Mentha can assist the liver function in order to speed recovery.
2. Combination No.2 differs from combination No.1 by being specifically directed to the sinuses and head. Also, the previous combination is especially for Wind Heat, whilst the warming and drying herbs Angelica and Zingiber make this combination more for sinusitis with Wind Cold, Damp. and Phlegm. Achillea, Euphrasia, and Sambucus also help to clear Phlegm from the head and sinuses. 3. Recurring fever +. exhaustion
4. Recurring fever + respiratory infection
Retained Pathogen + Liver Deficient Qi
Retained Pathogen + Deficient Defensive Qi
'Heib':~' ·~·;~/";:5~~ti6>·
USE
• tendency to atherosclerosis with hypertension • chest pain from heart disease with cold extremities PRACTICAL NOTES
This combination can be taken as 2.5-5 ml of 1:5 tincture in quarter of a cup of warm water, three times per day. The Capsicum is given in a separate bottle so that the requisite number of drops of Capsicum can be added to each dose of the main medicine. It can be taken, with appropriate breaks and modifications, for 1-2 months, providing the patient is monitored for aJ:.ly adverse reactions to Capsicum and for any adverse increase in symptoms of heat.
COMPARISON OF THE SIX ACHILLEA COMBINATIONS 1. Influenza + sore throat
2. Influenza + sinusitis
Wind Heat
Wind Cold Damp
Achillea
6g
Achillea
Mentha pip.
3g
Angelica arc.
Sambucus
3g
Sambucus Euphrasia
3g 3g 3g 3g
Zingiber
3 slices
Gentiana Berberis Pseudostellaria
1 1 1 1 1
Glycyrrhiza Zingiber
0.5 0.5
Achillea Artemisia abs.
Herb Achillea Echinacea Thymus Pseudostellaria Panax qui. Glycyrrhiza Zingiber
1 1 1 1
0.5 0.5 0.5
3. Artemisia. Gentiana, and Berberis, assisted and mod-
erated by Zingiber and Glycyrrhiza, can tonify and move Liver Qi, clear accumulation of Liver Heat and Liver Damp Heat, and help to clear Heat Toxins and Retained Pathogen from the body. Achillea and Zingiber can help to clear Retained Pathogen from the body surface, and, with Pseudostellaria and Glycyrrhiza, can help to strengthen the energy of the body and thus of the body surface. 4. Combination No.3 focuses on clearing Retained Pathogen by strengthening the Liver, whilst combination No.4 focuses primarily on tonifying Deficiency of the Lung and Kidney. Achillea, Echinacea, Thymus, and Zingiber are included to clear Retained Pathogen from the surface, to clear Lung Phlegm and to tonify the Lung. The sweet herbs Pseudostellaria, Panax, and Glycyrrhiza, as a group, can tonify both Lung and Kidney Qi. Strengthening the Lung and Kidney can help to clear Pathogens from the surface and the Lung, thus, assisting in the recovery and reducing the incidence of both febrile episodes and infections.
Combining Western Herbs and Chinese Medicine
174 5. Amenorrhea + exhaustion
6. Atherosclerosis + hypertension + cold extremities
Deficient Blood and Qi
Heart Phlegm Cold + Heart Stagnant Qi
Herb
Achillea Artemisia abs. Ruta Leonurus Angelica sin. Gentiana Zingiber
Ratio 1 1 1 1 1 1 1
-
;Herb
Ratio
Achillea Crataegus Salvia mil. Angelica sin. Zanthoxylum (bark) Commiphora Zingiber Capsicum
1 1 1 1 1 1 0.5 5-20 drops
...
,.~
5. Artemisia, Ruta, and Leonurus are the primary herbs in combination No.5, which makes this combination specific for amenorrhea with _exhaustion and nervous tension. Artemisia and Gentiana provide the main bitter tonic action, helping to treat anemia, supported by Achillea, which also has a secondary emmenagogue effect. The sweet, bitter, and aromatic constituents of Angelica sinensis may combine to strengthen the blood. Zingiber warms and moves Qi and Blood in the Uterus and directs other herbs to this system. 6. This combination lacks the emmenogogues Artemisia, Ruta, and Leonurus, present in combination No.5. Instead it contains Salvia and Crataegus, which combine with Achillea to reduce formation of atheroma, the fatty degeneration of the inner coat of arteries, thus reducing cerebrovascular or cardiovascular incidents. Commiphora, Zanthoxylum, Zingiber, and Capsicum together can reduce the incidence of Phlegm obstruction of the channels and warm and move the Blood to improve peripheral circulation. Achillea, Crataegus, and Capsicum can combine to reduce hypertension. OTHER ACHILLEA COMBINATIONS
• Asclepias: acute respiratory disorders + fever • Asclepias: influenza + fever • Capsella: menorrhagia + anemia • Crataegus: atherosderosis + hypertension • Hamamelis: varicose veins • Salvia: excessive sweating + exhaustion • Salvia: headache + myalgia
Research In taxonomy, the phrase sensu lato (s.1.) can mean interpretation of a species in the broad sense. The phrase sensu stricto (s.s.) can mean interpretation of a species in the narrow sense. 1I
";':;'"k-'-
...
~
'-=-~.-=..--
The name Achillea L. s.1. refers to A. millefolium in the."C:.::: ._~, broad sense, without differentiation between the subspecies. The name A. millefolium L. s.s. refers to A. millefolium L. ssp. millefoliurn, which is the most widespread subspecies. Research reported under the name 'A. millefolium' may refer to A. millefolium s.s. or it may refer to any number of other Achillea species which have been more recently and narrowly defined. 4 CONSTITUENTS The following constituents have been reported: • essential oil • sesquiterpene lactones • flavonoids • alkaloids • tannins • other Essential oil Achillea can contain 0.2-1 % essential oil, which may contain 0-50% chamazulene. 12 The percentage of chamazulene and the general composition of the essential oil fraction vary greatly with the chromosome number of the plant material.
Hexaploid plants The most common subspecies of Achillea is A. millefolium L. ssp. millefolium, which is hexaploid and has no chamazulene. 13 The main components of the essential oil of hexaploid plants are oxygenated monoterpenes, especially linalool (26%) and camphor (18%), with some ~ borneol and 1,8-cineole.5
Tetraploid plants The main components of the essential oil _ of tetraploid plants are generally sesquiterpenes, mainly chamazulene (about 25%) and ~-caryophyllene (11-22%).5 Tetraploids may also contain monoterpenoids such as ~- _ pinene (23%) and a-pinene (5%).14 Usually, only tetraploid plants contain chamazulene. 15 Sesquiterpene lactones The guaianolide sesquiterpene achillicin (8-acetoxyartabsin)is considered to be the main prochamazulene. 16 Matricin is sometimes cited in the literature, but has not been found. 17 Flavonoids A. millifolium may contain apigenin and luteolin and their glucosides.' 8 A. pannonica has been reported ~ to contain rutin and glucosides of apigenin, luteolin, and acacetin. 19 Alkaloids Achillea can contain a range of alkaloids and other bases, mainly achilleine (betonicine or L-4-hydroxystachydrine) as well as stachydrine, betaine, and choline. 20 Tannins
Achillea can contain 3-4% tannins. 21
"'" -Achillea Other Achillea also contains polyacetylenes, triterpenes, sterols (including f)-sitosterol), coumarins. and phenolic acids (including salicylic and caffeic acids).21 Wichtl also listed the cyanogenic glycoside prunasin.
175
Antihypertensive and antilipidemic
A recent doubleblind
placebo-controlled clinical trial using tincture of A. wilhelmsii C. Koch demonstrated antihypertensive and antilipidemic effects. 15-20 drops twice daily of placebo or A. wilhelmsii tincture were given to the patients for over 6 months. Within this time, there was a significant decrease in triglycerides, total cholesterol, and LDL cholesterol, and an
PHARMACOLOGICAL AND CLINICAL RESEARCH
increase in HDL cholesterol. A significant decrease was
The following effects have been reported:
observed in diastolic and systolic blood pressure. 3l
• antibacterial and antifungal • anti-inflammatory • antispasmodic • antihypertensive and antilipidemic
hypertension, including cerebral and coronary thromboses, but I have not yet seen research support for antithrombotic
• choloretic • astringent and hemostatic
folium may help to clear blood clots and also help to reduce
• antitumor • antispermatogenic
The BHp32 listed Achillea for thrombotic conditions with
activity. Mabey3 suggested that the flavonoids in A. milleblood pressure by dilating the peripheral arteries, that the alkaloid fraction may also lower blood pressure, and that the I
Antibacterial and antifungal Extracts of A. millefolium have demonstrated antimicrobial activity against a range of bacteria. Z2 Essential oil from A. fragrantissima was found to have inhibitory effect on various bacteria and Candida albicans. 23 Linalool, found at up to 26% of the essential oil fraction in hexaploids. which are the most common subspecies of A. millefolium. has been shown to inhibit 17 types of bacteria and 10 fungi. 24 Extract of A. atrata subsp. multifida was shown to inhibit Candida albicans and Bacillus subtHis in vitro. Some flavones isolated from this plant were shown to inhibit C. albicans, whilst other flavones inhibited B. subtilis as well. 25 Anti-inflammatory Chamazulenes and prochamazulenes have demonstrated anti-inflammatory activity.26 Sesquiterpene lactones from A. setacea, rupicolin B and 1l,13-dehydrodeacetylmatricarin, have shown anti-inflammatory activity.27 According to Wichtl,I7 the a-methylene-y-lactone group is essential for the anti-inflammatory activity of the sesquiterpene lactones. Topical administration of a preparation of A. millifolium has demonstrated anti-inflammatory activity in rodents, attributed to a protein-carbohydrate complex. 26 A study using rats demonstrated anti-inflammatory activity of an A. santolina ethanol extract. 28 In a study using mice, it was found that the chloroform extract ofA. ageratum, and also of its components stigmasterol and ~-sitosterol, had topical anti-inflammatory effect, more in the acute than in the chronic phase.29 Antispasmodic Antispasmodic action may be due to flavonoids,4 including apigenin.26 Cirsili~l, a flavone isolated from A. fragrantissima, can have a concentration-dependent relaxing effect on isolated rat ileum. 30
cyanogenic glycoside may slow the heart beat via the vagus nerve. Choloretic
The BHC stated that the bitter properties are
due to the sesquiterpene lactones and the alkaloids. Choloretic activity has been demonstrated in animal experirnents. 34 Astringent and hemostatic The alkaloid achilleine has a hemostatic action. 4 The 3-4% tannins may also contribute to the astringent and hemostatic action (see discussion on tannins in the chapter on Potentilla). Antitumor
Three new sesquiterpenoids from A. millefoli-
urn, achimillic acids A, Band C. showed antitumor effect in mice. 3; Antispermatogenic
Extracts of A. millefolium showed antispermatogenic effect in mice. 36
RESEARCH VERIFICATION OF TRADITIONAL ACTIONS The following traditional actions have been supported by research: bitter digestive tonic (choloretic effects), antihypertensive, and antihemorrhagic. Additional effects demonstrated by research The following additional effects have been reported as discussed above: antibacterial. antifungal, anti-inflammatory, antilipidemic, antispasmodic, antitumor, and antispermatogenic effects.
TOXICOLOGY >.
This is a generally safe herb. A rare instance of yarrow allergic contact dermatitis has been reported, which is thought to be due to the guaianolide peroxide. a-peroxy-achifolide. 37
._------176
Combining Western Herbs and Chinese Medicine
Tisserand and Balacs38 suggested caution in the oral uSe of the essential oil of the camphor chemotype of Achillea. However, since the essential oil constitutes only 0.2-1 % of the dried herb, the camphor content may be unlikely to cause adverse effects in the infusion or tincture.
Goods Act Regulations of Australia. Achillea is not currently--:#.~ listed by the FDA (USA) as a prohibited substance, as subject~...,.._ to an import alert, or as a substance with a warning on its.;::... use.
Traditional sources
Dose Temperature
Tincture Both the BHP and the BHC recommended 2-4 ml of 1:5 tincture, three times per day.
Variations of opinIon The Chinese Herbal Medicine Dictionary classified Achillea millefolium as cold, but this
Can start at the standard dose.
Duration Generally suitable for long-term use, but large quantities of strong Achillea infusion are generally for acute conditions andJor short-term use only.
Cautions These cautions apply to the infusion and the tincture. The use of the oil is outside the scope of this book. Western contraindications The BHC mentioned a rare hypersensitivity to Achillea or to other members of the Compositae. Wichtl described this allergy as itching, inflammation, and formation of vesicles on the skin, in which case the intake of Achillea should be stopped. I have not yet seen this reaction. Chinese contraindications No contraindications were given in the Chinese Herbal Medicine Dictionary. Although I have not seen this reported elsewhere, I have found that strong infusions of Achi)lea can have a drying effect in a few people in some situations, for example, in individuals with sinusitis ac~ompanied by Lung D"eficient Y'm with Dryness. Pregnancy and lactation Side effects Overdose
No adverse reports.
Not reported. No adverse reports.
Interactions
No adverse reports.
herb does not seem to have had a strong tradition of use in Chinese medicine. In Germany, Hildegard von Bingen39 in the 12th century listed Achillea as slightly hot and dry. Tabernaemontanus listed it as drying and astringent and described it as having a temperate warmth with a cooling effect. 40 In England, Gerard41 classified Achillea as'meanely cold: Culpeper42 classified it as cold in the first degree and also considered it to be drying and binding. The variable temperature of Achillea Tabernaemontanus may have been the first to notice the variable temperature of Achillea when he described it as having a temperate warmth with a cooling effect. In this book, Achillea is classified as warm-cool, because, in my experience, it can be used for influenza and acute sinus conditions associated with either
Wind Heat or Wind Cold. Temperature and the needs of the body Whether Achillea has a cooling, neutral, or even warming temperature effect may depend on the needs of the body. If there is a hot condition, this may evoke a cooling effect; if there is a neutral condition, neither a cooling nor warming effect may be evoked; whilst if there is a cool condition, this may evoke a warming effect. According to Dr. Cole of Seattle,43 when there is raised temperature, Achillea has a diaphoretic effect, but when there is no abnormal temperature, it has only a diuretic action. Achillea can have cooling antipyretic and antiinflammatory actions, but according to Mills, +I it does not have this cooling effect in nonfebrile states and may even help to increase the body temperature if it is low.
Regulatory status
Temperature and biochemistry These different potential effects may be linked to different constituents. For example,
Please read the Regulatory status section in the chapter on Safety. .
the chamazulenes and prochamazulenes may be involved in a cooling effect and camphor may be involved in either cooling or warming effects, depending on the situation.
Achillea (yarrow) is on the UK General Sale List, and it is not included in Part 4 of Schedule 4 of the Therapeutic
~+:
PROPERTIES
Dried herb Both the BHP and the BHC recommended 2-4 g of dried herb, three times per day.
Initial dose
...
Temperature and chromosome number The differences of
.....,.
Achillea opinion on the temperature of Achillea may also be linked to the differences in chemical composition of the different subspecies. For example, in hexaploids, potentially warming camphor can be 18% of the essential oil fraction, and cooling sesquiterpenes are found in relatively lesser amounts. Tetraploids have higher levels of sesquiterpenes and camphor is not listed as a main ingredient.3 Therefore, if hexaploid material were used, the physician might conclude that Achillea was slightly warming, whilst if they had used tetraploid material, they might conclude it was slightly cooling.
177
Spleen
dyspepsia loss of appetite bitter tonic bitter aromatic for loss of appetite
Christopher SHC Weiss 46 Wichtl
Heart
thrombotic conditions with hypertension hypertension
SHP SHC
There is no information given in the Chinese Herbal Medical Dictionary for the meridians entered by A. millefolium (yang shi cao).
Taste
Taste in the mouth Yarrow is described in Wichtl as some-
I
~....
-
what bitter and faintly aromatic. I find fresh yarrow to be strongly bitter, definitely acrid, and somewhat aromatic. I find that the intensity of the taste of yarrow is greater in plants from warm climates or alpine meadows with sunny exposure, and less in plants grown in places with little sun and heat, such as Seattle, USA. The acrid taste may be due to the essential oils, and according to the BHC, the bitter taste is due to the sesquiterpene lactones and the alkaloids. The Chinese Herbal Medicine Dictionary classified Achillea millefolium as bitter and acrid in taste property, but that listing may be based on Western use, rather than Chinese tradition.
Taste properties Achillea millefolium, as used in the West, can be classified as acrid in the sense of clearing Exterior Wind from the surface of the body. Tabernaemontanus said that it was the bitter taste that gives yarrow a temperate warmth with a cooling effect. This is a fascinating statement because it implies the multiple functions of the bitter taste property. The pharmacology section of the A. millefolium entry in the Chinese Herbal Medicine Dictionary stated that the bitter taste of this herb can tonify the stomach. This statement may be following Western concepts of the physiological effect of the bitter taste.
ORGANS In terms of Chinese medicine, Achillea, as used in the West, can be associated mainly with disorders of the followingorgans:
Lung
colds hemoptysis respiratory catarrh colds and fever
Fox KlOSS
45
Christopher SHp32
ACTIONS Evidence from traditional sources for the following actions of Achillea is discussed below: • diaphoretic and antipyretic • anticatarrhal • alterative • bitter digestive tonic • circulatory stimulant • antihypertensive and antithrombotic • astringent and antihemorrhagic • emmenagogue • diuretic • antidiabetic Diaphoretic and antipyretic Hildegard von Bingen recommended Achillea for fever, and Tabernaemontanus gave a combination of yarrow and sage for malaria. The Eclectic doctor William Fox, writing in 1878, listed Achillea as a diaphoretic and said that there is not a single herb that has done so much good. He said th~t for a cold, take a strong tea of yarrow and have a hot brick wrapped up in a vinegar cloth applied to the feet, to produce sweat and to remove the cold.47 In 1898, Felter and Lloyd48 mentione.d that the isolated component achilleine, from Achillea, had been used in Southern Europe as a substitute for quinine in the treatment of intermittent fever. Ellingwood listed Achillea for fever, and both Kloss and Christopher recommended Achillea for colds, influenza, fever, and eruptive diseases, such as measles, chicken pox, and smallpox. The BHP listed Achillea as a diaphoretic and antipyretic for fever and the common cold. Anticatarrhal Ellingwood recommended Achillea for oversecretion by the mucous membranes due to atony or inflammation. Felter and Lloyd listed Achillea for leukorrhea with profuse discharge due to atonic or inflamed vaginal mucous membranes, and both Kloss and Christopher listed it for mucous discharges from the bladder. Christopher rec-
178
Combining Western Herbs and Chinese Medicine
ommended Achillea for influenza, respiratory catarrh, and congestive headache. I have found that a hot infusion of Achillea can relieve influenza with sinus congestion and sinus headache, associated with the pattern of Wind Cold Damp invasion.
ascribe this action to Achillea based on a combination of the anticatarrhal, antihypertensive, and antithrombotic actions, which were listed above, and an antilipidemic effect, which 3l has been reported by recent research.
Alterative Both Kloss and Christopher listed Achillea as an alterative herb, and according to Christopher. it can purify the blood of waste material. Both Weiss and Wichtllisted Achillea as a bitter herb that can stimulate secretion of bile, and Christopher stated that it can regulate liver function. However, its most powerful alterative action may be through the skin rather than the liver. Ellingwood stated that, in intermittent or bilious fever, Achillea can cause profuse sweating, which can discolor the bedclothes. Christopher also emphasized the use of copious hot infusions of Achillea to discharge impurities through the skin. I use it for conditions of recurring low-grade fever or for skin disorders or rheumatism when these disorders are associated with retention of toxins at the surface of the body, in the skin, muscles, or joints.
Wounds and ulcers Dioscorides prescribed pounded yarrow to put on a fresh wound to clear it from heat and in.fJ.ammation and to congeal the blood. Lonicerussl gave Achillea wine for both internal and external wounds and injuries. Hildegard von Bingen recommended Achillea for clearing putrid matter from ulcers and wounds, and Culpeper listed Achillea for inflamed wounds, moist ulcers, leukorrhea, and gonorrhea. It seems that the drying astringent, antihemorrhagic, and vulnerary actions of Achillea are assisted in this by its anti-inflammatory, antimicrobial, and
Bitter digestive tonic Tabernaemontanus prescribed a decoction of yarrow in wine for lack of appetite. He recommended that the patient drink a mug of the warm decoction every morning on an empty stomach. Lyle49 described Achillea as a tonic for the appetite, digestive organs, and the general system. He recommended it in cold infusions as a tonic in convalescence from fever, from nervous prostration, and in phthisis (pulmonary tuberculosis) and night sweats. Felter and Lloyd recommended Achillea for gastric and intestinal atony and for flatulence and spasms. Wichtllisted it as a bitter aromatic for loss of appetite and to stimulate the secretion of bile. He also listed it for gastrointestinal inflammation, diarrhea, flatulence, and colic. The German Commission E monograph listed Achillea for loss of appetite. 50 Circulatory stimulant Lyle stated that Achillea in hot infusions can arouse capillary circulation, and Christopher stated that it can equalize the circulation. Mills noted that this herb can be used as a diffusive vasostimulant, and, according to Mabey, Achillea encourages blood flow to the skin, dilating the peripheral arteries and helping to lower blood pressure. Antihypertensive and antithrombotic The BHP gave the specific indications for Achillea as thrombotic conditions with hypertension, whether the thromboses are cerebral or coronary in origin. Mabey listed Achillea for hypertension and for blood clots. and Mills noted its use for lowering moderately high blood pressure. The antiatheromatic action of Achillea is not mentioned in the traditional texts. However, it seems reasonable to
Astringent and antihemorrhagic
alterative actions. Diarrhea and dysentery Dioscorides recommended yarrow decoction for dysentery. Tabernaemontanus gave a combination of yarrow and plantain as an enema for dysentery and listed yarrow powder in red wine for cramps due to dysen-
tery or diarrhea. Culpeper also recommended this herb for bloody dysentery, menorrhagia, and urinary incontinence. However, Felter and Lloyd stated that it can be used for various types of hemorrhage when the bleeding is small in amount. They listed Achillea for hemorrhoids with bloody or mucoid discharges. Kloss recommended it for diarrhea and dysentery and especially for diarrhea in infants. Hemoptysis Tabernaemontanus prescribed yarrow with tormentil (that is, Potentilla erecta) for hemoptysis associat-
ed with pulmonary tuberculosis. Emmenagogue Menorrhagia and leukorrhea Dioscorides said that yarrow . can be made into a suppository with wool and put in the vagina to reduce excessive menstrual flow. Tabernaemontanus recommended yarrow decoction in wine for heavy menstrual flow and prescribed suppositories made from fresh yarrow
for leukorrhea. Culpeper listed Achillea as drying and binding and recommended it for menorrhagia and leukorrhea. Ellingwood listed Achillea for leukorrhea with profuse discharge from enfeebled mucus membranes. Amenorrhea and infertility Felter and Lloyd listed Achillea for atonic amenorrhea. Christopher, BHP, and Mabey all listed Achillea for amenorrhea. In my opinion, this herb can be included in prescriptions for amenorrhea or infertility when there is Deficient Qi and Blood, and a possibility of obstruction of the channels of the Uterus by Phlegm.
Achillea Diuretic Whether Achillea acts as a urinary astringent or as a diuretic may depend on the needs of the patient.
Achillea to reduce urination Culpeper listed this herb for urinary incontinence, and Christopher recommended it for enureSIS,
Achillea to increase urination Tabernaemontanus listed fresh yarrow juice and wine vinegar for urinary retention. Elingwood listed it for deficient renal action, Bright's disease, and edema, and Felter and Lloyd listed it for stranguary and urinary suppression. The BHP listed Achillea as a diuretic and urinary antiseptic. The tannins may be involved in the urinary astringent action, and the essential oils may be involved in the diuretic action. The asparagin listed by Mills as a possible diuretic component of Achillea is not mentioned by the BHC or by Wichtl as a component.
Hematuria Tabernaemontanus listed various Achillea combinations for blood in the urine. Urinary stones Tabernaemontanus also prescribed various Achillea combinations for difficult urination with gravel or stones in the urinary tract. Antidiabetic In an ethrlobotanical survey in Israel, A. fragrantissima was found to be used for treatment of diabetes. 52
COMPARISON OF WESTERN AND CHINESE USE OF ACHILLEA A. millefolium is a major herb in the Western tradition, but a minor one in Chinese medicine. The two traditions are compared under the following headings: • diaphoretic and antipyretic • anticatarrhal and alterative • general tonic and bitter digestive tonic • circulatory stimulant and antihypertensive • astringent and antihemorrhagic • emmenagogue Diaphoretic and antipyretic Achillea is one of the most commonly used herbs in the West for common colds, influenza, and fever. It is not an important herb for these disorders in China, although one text cited in the Chinese Herbal Medical Dictionary listed A. millefolium to clear Wmd and to promotes sweating. Anticatarrhal and alterative Achillea is an important herb in the West to treat catarrhal states of the respiratory system,
179
especially when associated with Wind invasion. This use is not listed in the Chinese Herbal Medical Dictionary. The alterative use of Achillea is more important in,China, and yang shi dio is said to clear Heat and Toxin and treat ulcers and boils. General tonic and bitter digestive tonic The use of Achillea as a tonic is far more common in the West than in China. However, one text cited in the Chinese Herbal Medical Dictionary listed Achillea as a tonic, and another text listed it for Deficient Ym 'steaming bone syndrome: Circulatory stimulant and antihypertensive Although the Chinese Herbal Medical Dictionary listed Achillea as harmonizing the Blood, for example, for traumatic injuries, this herb is not commonly used in China for circulatory disorders. Astringent and antihemorrhagic In the West, Achillea is frequently used as an astringent or antihemorrhagic for a wide range of disorders, including nosebleeds, bleeding hemorrhoids, diarrhea, leukorrhea, and menorrhagia. Achillea is listed as an astringent in the Chinese Herbal Medical Dictionary, for example for bleeding hemorrhoids, but it does not appear to be frequently used. Emmenagogue Achillea is not used as a primary emmenagogue in recent Western tradition, but is commonly used as a secondary herb to treat a variety of womens' disorders. Yang sm dio is listed as a herb for irregular menstruation, but is not often seen in Chinese formulas for gynecological disorders. NATIVE AMERICAN USE OF ACHILLEA Achillea has been widely used by the Native Americans, and it is interesting to classify some of these uses in terms of Chinese actions and to speculate on their basis in phytochemistry.
Native American use and Chinese actions In the table below, the data on·Native American use comes from Plants of the Pacific Northwest Coast by Pojar and MacKinnon:53 Native American use and phytochemistry
As part of ongoing studies on the herbal remedies of the Micmac and Malecite Indians, the sterols and triterpenes of Achillea were investigated. ~-sitosterol was identified as the major sterol and a-amyrin as the major triterpene of this plant. The authors suggested that the effectiveness of Achillea may be partly due to the presence of these compounds, since many sterols and triterpenes exhibit a wide range of pharmacological effects.54
180
Combining Western Herbs and Chinese Medicine NATIVE AMERICAN USE
19. Kasaj D. Krenn L. Prinz S.et al. Z Naturforsch 56(7-8):521-525 (2001}::::•.• -
-chi~;s~':~citk;~":::'~~;:"~;~6f '~'~;'="'Tri6e(i)~~":::: clears Exterior Wind
colds
Klallam
clears Heat
colds and coughs measles
NU~hah-nulth
Squamish
---;-:;~~
..•~
20. Pailer M, Kurnp WG.Arch. Pharm 293:646-654 (1960)
21. Steinegger E. Hansel R. T13 (1988) [cited in Bradley PR (ed). British:~
~:~~~::~.e~~:i<:~d~:~i:~~)7erbalMedicine ASSOCiation,. ,_~~.~~.~·.:.·~~.l .,.,~.
22. Orzechowski G. Pharmazie in unserer Zeit 1:43 (1972) 23. Barel S. Segal R, Yashphe J. J EthnopharmacoI33(1-2):187-191 (1991)
clears Phlegm clears Retained Heat
bronchitis
Nuxalk
blood purifier
Cowichan
24. Pattnaik S, Subramanyarn YR, Bapaji M et al. Microbios 89(358):39-46
"'lo.--
QuinaUlt Sqaxin
astringent, stops bleeding
styptic diarrhea sore throat gargle
Saanich Snohomish Tsimshian
27. Zitterl-Eglseer K, Jurenitsch J, Korhammer S et al. Planta
childbirth
Ditidaht, Makah
28. Al-Hindawi MK. AI-Deen IH, Nabi ~H et al. J Ethnopharmacol
26. Bradley PR (ed). British Herbal Compendium. vol. 1. British Herbal ~edicineAssociation. Bournemouth. United Kingdom
···~t~.
(1992) ~ed
29. Gomez ~A. Saenz ~T. Garcia MD et al. Z Naturforsch [C] 54(11):937-941 (1999) 30.
~ustafa
EH,Abu ZM,Abdalla S. Gen PharmacoI23(3):555-560 (1992)
31. Asgary S, Naderi GH, Sarrafzadegan N et al. Drugs Exp Clin Res
~Unchen,~any(1960)
2. Perry L~. ~edicinal Plants of East and Southeast Asia. The MIT Press, Cambridge, United Kingdom (1980) 3. Jiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science and Technology Press, Shanghai, China (1975) 4. Chandler RF, Hooper SN, Harvey MJ. Botany 36:203-223 (1982) 5. Hofmann L. Fritz D. Nitz S et aI. Phytochemistry 31 :537-542 (1992) 6. FaIkAJ. Bauer L, Bell CL et al. Uoydia 37:598-602 (1974) 7. Formacek Y, Kubeczka K. J. Wiley. Chichester (1982) [cited in Bisset
26(3):89-93 (2000) 32. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983) 33. ~abey R. The Complete New Herbal. Elm Tree Books, London, United Kingdom (1988) 34. Chabrod E et al. Soc Bioi 108:1100 (I931)
35. Tozyo T. Yoshimura Y, Sakurai K et al. Chem Pharm Bull 42(5):10961100 (1994) 36. Montanari T. de Carvalho JE. Dolder H. Contraception 58(5):309-313 (1998) 37. Rucker G,Manns D.Breuer J.Arch Pharm 324(12):979-981 (1991)
NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn.
38. Tisserand R, Balacs T. Essential Oil Safety: A Guide for Health Care
Medpharm. Stuttgart, Germany (1994). from 2nd German edn. Wicht! ~ (ed) (1989)]
Professionals. Churchill Livingstone, Edinburgh, United Kingdom
8. Grieve~. A ~odern Herbal, vols. 1 and 2. Dover Publications, New York. New York (1971)
39. Von Bingen H. Hildegard von Bingen's Physica. Healing Arts,
9. Christopher JR. School of Natural Healing. BiWorld, Provo, Utah (1976)
40. Tabernaemontanus JT. Krauterbuch (1731). Reprinted by Verlag
10. British Herbal Pharmacopoeia. British Herbal ~edicine Association. West Yorks, United Kingdom (1983)
41. Gerard J. The Herbal or General History of Plants: The complete 1633
11. Stearn WT. Botanical Latin, 4th edn.. Timber Press. Portland, Oregon (1992) 12. Carnat AP, Larnaison JL. Phytotherap 24:238 (1990) 13. Oswiecimska M. Planta ~ed 25:389-395 (1974) 14. Haggag ~Y, Shal'aby AS. Verzar-Petri G. Planta Moo 27:361 (1975) 15. Kastner U etal. Sci. Pharm 60:87 (1992); 61:47 (1993) 16. Cuong B, Gacs-Baitz E, Radics L et al. Phytochemistry 18:331-332 (1979)
,.'.
57(5):444-446 (1991)
26(2):163-168 (1989)
1. Dioscorides P. Kreutterbuch (1610). Reprinted by Verlag Konrad Kolbl,
~.
25. Aljancic1, Vajs Y,Menkovic N et al. J Nat Prod 62(6):909-911 (1999)
general tonic stomach tonic
...References
;~
......
(1997)
tonifiers and moves Spleen and Uver Qi
regUlates Uterus
.i!~L
(1995)
Rochester, Vermont (1998)
Konrad Kolbl, MUnchen, Germany (1993) Edition as Revised and Enlarged by Thomas Johnson. Dover Publications, New York, New York (1975) 42. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. ~eyerbooks, Glenwood, Illinois (1990) 43. Ellingwood F. American Materia Medica, Therapeutics and Pharmacognosy, 11 th edn. ( 1919). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1994) 44. Mills S. The Essential Book of Herbal ~edicine. ArkanalPenguin Books, London, United Kingdom (1991)
17. Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn.
45. Kloss J. Back to Eden, 5th edn. (1939). Reprinted by Lifeline Books, - Santa Barbara. California (1975) .
~edpharm, Stuttgart Germany (1994), from 2nd German edn. Wicht! ~ (ed) (1989) .
46. Weiss RF. Herbal Medicine, English edn. Beaconsfield Publishers. Beaconsfield, United Kingdom (1988)
18. Ulubelen A, Okusuz S, Schuster A. Phytochemistry 29:3948-3949 (1990)
47. Fox W. The Working ~an's ~odel Family Botanic Guide to Health, 7th edn. Wtlliam Fox. Sheffield, United Kingdom (1878)
;~(f~f~:
..,i
Achillea 48. Felter HW, lloyd )U. King's American Dispensatory, vols. 1 and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications. Sandy, Oregon (1983) 49. Lyle TJ. Physio-Medical Therapeutics. Materia Medica and Pharmacy. Originally published Ohio (1897). Reprinted by the National Association of Medical Herbalists of Great Britain. London, United Kingdom (1932)
.....
...
50. Blumenthal M (ed). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council, Austin, Texas (1998)
181
51. Lonicerus A. Kreuterbuch (1697). Reprinted by Verlag Konrad Kolbl. MUnchen. Germany (1962) 52. Yaniv Z. Dafni A. Friedman Jet ai. J Ethnopharmacol19(2):145-151 (1987) 53. Pojar J. MacKinnon A. Plants of the Pacific Northwest Coast: Washington, Oregon. British Columbia and Alaska. Lone Pine Publishing. Redmond. Washington (1994) 54. Chandler RF. Hooper SN. Hooper DL et al. J Pharrn Sci 71(6):690-693 (1982)
-It'
Althaea Botanical name Althaea officinalis L. Family Malvaceae Pharmaceutical name Althaeae radix Part dried peeled roots collected in the autumn from plants at least 2 years old English marshmallow German Eibisch French guimauve Mandarin A. officinalis 1. is not used shU kui gen (Ij is the root of A. rosea
list the meridians entered. This suggests that this herb was not in frequent use in China.
What is special about Althaea In terms of Chinese medicine, Althaea can be said to be a cool, sweet, and slightly bitter herb that has its main internal effects on the Lung, Stomach, Intestines, and Bladder.
**)
The key to understanding Althaea is that it is a cooling and moistening mucilaginous herb with demulcent and emollient actions. It can be used especially to treat inflammatory conditions associated with patterns of Deficiency Heat in the Lungs, Stomach, Intestines, and Bladder, partly by clearing the Heat and partly by tonifying Yin.
Use in the West
Althaea officinalis This perennial herb is native to Europe and Western Asia, growing in damp locations. The therapeutic properties of Althaea have been known since antiquity and possibly from prehistoric times. A flower of an Althaealike plant was found in a Neanderthal grave in Iraq with other plants with potentially therapeutic effects.· The family name, Malvaceae, was derived from the Greek malake, meaning soft, referring to the therapeutic properties of the mallows in softening and healing. 2 Its generic name Althaea was derived from the Greek word altho, meaning to cure. All mallows contain much mucilage, and in past times, Arabian doctors used the leaves as a poultice for inflammations.
CHINESE ACTIONS In terms of Chinese medicine, Althaea, as used in the West, can be said to have four main groups of actions:
1. stop cough clear Lung Deficiency Heat tonify Lung Ym
Althaea rosea Hollyhock is a native of China. According to II. clear Stomach Deficiency Heat tonify Stomach Ym
Lyle,3 the roots and flowers of hollyhock are demulcent and have been substituted for A. officinalis". He wrote that A. rosea does not contain as much mucilage as A. officinalis, but it has a greater effect on the bladder and kidneys.
III. clear Intestines Heat moisten the Intestines
Use in China The entry in the Chinese Herbal Medicine Dictionarl for A. rosea (shu kui gen) is brief and does not
IV. clear Bladder Heat or Damp Heat tonifyKidneyYm
183
184
-----._".c,~
Combining Western Herbs and Chinese Medicine
The main Western actions of Althaea are shown here in terms of its four main Chinese actions: Chinese actions I. stop cough, clear Lung Deficiency Heat, and tonify Lung Yin
..
Limitations ofAlthaea
WESTERN ACTIONS
. -, Western actions ' antitussive respiratory demulcent anti-inflammatory
II. clear Stomach Deficiency Heat and tonify Stomach Yin
demulcent anti-inflammatory sweet nutritive tonic
III. clear Intestines Heat and moisten the Intestines
demulcent anti-inflammatory
IV. clear Bladder Heat or Damp Heat, tonify Kidney Yin
urinary demulcent anti-inflammatory
...
_~;
',",'~ .'.~
TEMPERATURE Althaea is classified as cool in this book. It can be used. ";]l.~ for hot, warm, or neutral conditions. -. ;:~¥
TASTE Althaea is classified in this book as sweet and slightly bitter. Its sweet taste can be associated with a nutritive and.:'" moistening Yill tonic action, rather than with adaptogenic or ,',,::' energizing effects as in Panax ginseng. Althaea more closely resembles Ophiopogon (mai men dong) in its taste properties and actions. The slight bitter taste of Althaea may contribute to its' 'I cooling, anti-inflammatory action, but this herb does not': have appreciable bitter digestive tonic effect. .::~~~= ~,
WESTERN USES, The Western uses of Althaea can be related to its four main Chinese actions:
ACTIONS Anti-inflammatory The anti-inflammatory action of Althaea is of the demulcent type, which is a result of the high mucilage content of this herb. Althaea is not so much """"t,. antimicrobial anti-inflammatory, like Berberis, or an astringent anti-inflammatory, like Potentilla. The demulcent antiinflammatory action of Althaea is especially felt on the . -..c-, mucosa of the respiratory, gastrointestinal, and urinary sys~ tems.
a.n'·
I. stop cough, clear Lung Deficiency Heat, and tonify Lung Yin
dry sore throat, irritant dry cough, bronchitis
II. clear Stomach Deficiency Heat and tonify Stomach Yin
gastritis, gastric ulcer
III. clear Intestines Heat and moisten the Intestines
enteritis, colitis, dry constipation
IV. clear Bladder Heat or Damp Heat, and tonify Kidney Yin
urinary tract inflammation, prostatitis
DIRECTION OF ENERGY Althaea does not have a marked directional effect on the movement of energy.
TYPICAL CASE EXAMPLE Signs and symptoms The patient has recurring dry sore throat, dry irritant cough, gastritis, dry constipation, and cystitis. Diagnosis The patient has generalized Deficient Yill with Deficiency Heat, affecting specifically the Lung, Stomach, Intestines, and Bladder.
Antitussive Althaea has an antitussive action via its moistening, demulcent, and anti-inflammatory properties, rather than via antispasmodic or sedative effects, like Prunus or Lobelia. Although Althaea is sometimes listed as an expectorant, it does not seem to have anticatarrhal action or the ability to initiate coughing, as does Lobelia. Laxative Althaea is sometimes listed as a laxative, but this laxative action may derive from its moistening and antiinflammatory effects on the bowel, rather than a direct laxative effect. Vulnerary Althaea can be used for wounds, burns, and inflammatory skin conditions, but it does not have the strong astringent and antihemorrhagic effect of high-tannin herbs, such as Potentilla. Rather, it may assist wound healing by forming a protective mucilaginous layer on the surface.' -' .-- ~
•
Choice of Althaea This herb can tonify the Yill of the Lung and Stomach, especially to clear Deficiency Heat in those organs, and it can also clear Heat in the Intestines and Bladder.
.
.. " '.·.1'1 ~~
.'
Althaea paired with other herbs::;~!}~ ;'
A discussion of the limitations of each ofthc{n-i~ih''. actions of Althaea can be useful in clarifying just what'this":" ,
'
•••.. , ";;(l:;..f<,
--
Althaea herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Althaea beyond its limitations. The basic unit of herb combination is the herb pair. Six pairings of Althaea are briefly explained below.
CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair. Althaea + Viola tricolor
Cystitis Both herbs are anti-inflammatory demulcents, which can be used for dry sore throat, dry irritant cough, and cystitis with burning urination associated with Damp Heat or Deficiency Heat in the Bladder. Althaea contains more demulcent mucilage, and Viola contains salicylate anti-
185
Althaea is a moistening, cooling demulcent as a result of its mucilage content, and Marrubium is an expectorant and antispasmodic, which is associated with the bitter constituent marrubiin. This pair can be used for bronchitis with nonproductive cough. Althaea + Potentilla
Diarrhea These herbs are very different and complement each other's actions. Althaea is a typical mucilaginous, demulcent anti-inflammatory, and Potentilla is a classic high-tannin astringent and antihemorrhagic. Althaea has the reputation of moderating any potentially irritant effects of the tannins. These herbs can be combined for intestinal or colonic inflammations.
AJ~aeaconabUnations
inflammatories in addition to mucilage. .--i
Four Althaea combinations are discussed in detail below: Althaea + Polygonum
Colitis Both herbs are listed by the BHP as mucilaginous demulcents, and they both have tannin. However, Althaea has more mucilage and less tannin, and Polygonum has less mucilage and more tannin. Althaea and Polygonum can be paired for inflammatory disorders of the colon with diarrhea, which can benefit from the combination of demulcent and astringent actions. Althaea + Glycyrrhiza
Laryngitis + dryness Both herbs are moistening anti-inflammatories, which can soothe dry sore throat and treat hoarseness or loss of voice. They can also be combined to treat gastritis or peptic ulcers, and enteritis or ulcerative colitis. Althaea + Ophiopogon
Gastritis These herbs are similar. Both are sweet and slightly bitter, and can act as moistening, cooling Yin tonics to treat Deficiency Heat in the Lung or Stomach. They can be combined for dry sore throat, dry cough, gastritis, and gastric ulcers. Both herbs can have a tonic effect to treat emaciation associated with Deficient yoffi. Althaea + Marrubium
Chronic cough Both herbs are antitussive but via different mechanisms.
1. dry cough
Lung Deficiency Heat + Lung Deficient Yin
2. gastritis
Stomach Deficiency Heat + Stomach Deficient Yin
3. colitis
Intestines Heat
4. cystitis
Bladder Heat + Kidney Deficient Yin
CAUTION
Before using any of the combinations below, it is important to be familiar with the cautions listed for each herb in the combination. ALTHAEA AS A DECOCTION Mucopolysaccharides are the key constituents of Althaea, and they are more effectively extracted in water than in alcoholic tincture. Therefore, Althaea is not used as a tincture in the four combinations belo\v. Also, in cases of inflammation and dryness, the higher fluid intake of the decoction is preferable to the minimal fluid intake of the tincture. In combination Nos. 2 and 4, all the herbs are decocted. In the other two combinations, Althaea is first prepared as a decoction, and then the other herbs in the combination are mixed together as tinctures and added to the Althaea decoction. This is partly because some of the herbs are generally used as an infusion rather than a tincture and others are better prepared as a high-alcohol tincture to extract the resins.
186
Combining Western Herbs and Chinese Medicine
1. Dry cough
sweet taste is associated with the moistening and Ym tonk function, and the bitter taste is associated with clearing Heat.
Lung Deficiency Heat + Lung Deficient Yin Herb
Ratio
.Temperature
Althaea Viola trio Prunus
10 approx. 1 1
cool cool neutral
Marrubium Ophiopogon Glycyrrhiza
1 1 1
neutral cool neutral-cool
Taste sweet, sl. bitter sour, sweet, bitter bitter, aromatic bitter sweet, sl. bitter sweet
GENERAL
This combination is for Lung Deficiency Heat with Lung Deficient Yin. The overall temperature is cool to treat warm conditions. For hot conditions, a cold respiratory herb, such as Asclepias, would need to be added. The dominant taste is sweet, associated with moistening and demulcent effects. The bitter taste is secondary, and is associated with cooling and anti-inflammatory effects. USE
USE
• gastritis or gastric ulcer with burning sensation or pain in the epigastrium PRACTICAL NOTES
The herbs are put in a pan containing about 750 ml of cold water, and the mixture is brought to a boil and simmered very gently for 15 minutes. The decoction is strained and the remaining liquid pressed out of the herbs in the pan. This provides 1 day's supply of decoction. which can be taken, when cool, in three individual doses of one cup. The combination can be used short-term for acute episodes, but it can also be taken long-term, at halfdose, for chronic conditions, unless the use of Glycyrrhiza needs to be restricted for a particular patient (see Glycyrrhiza). 3. Colitis
• dry, irritant, nonproductive cough, maybe with a dry, sore throat and thirst
Intestines Heat ~ ~."
;"'''''l-''.>:.:_
-.• ~.'.;' or.
Herb
PRACTICAL NOTES
Dried, cut Althaea root can be made as a decoction (see Dose), and 5 ml of a mixture of the tinctures of the other herbs can be added to 1 cup of the Althaea decoction for each of the three daily doses. This combination can be used for acute conditions, but there is usually an underlying chronic condition. Therefore, the combination may need to be taken for 1 to 2 months.
Caution This combination contains the moist, sweet herbs Althaea, Viola, Ophiopogon, and Glycyrrhiza. It is therefore not appropriate for patterns of accumulated Damp and Phlegm in the Lung.
Stomach Deficiency Heat + Stomach Deficient Yin
-H~b'~'-Y'0r:!;~o~il~d~:~~,··\:(:cT~:~~~riiture Glycyrrhiza Hydrastis
";/.::
10 approx. 1 1 1 1
0.5
.
.
:~.-. -';;'.:;.\:l"!.;:.~.~?;'?'Xi;'~:-r~-:,; :'~'~_ ~:~~?~!:-'?r~-: ;~ ;;~,?, :~t~
.. Temperature '.:.Taste '.' cool cool neutral-cool cool cool neutral-cool
.
sweet, 51. bitter sour, sl. bitter sour, 51. bitter bitter bitter sweet
GENERAL
This combination is for patterns of Heat or Damp Heat in the Intestines. The overall temperature is cool to treat warm or hot conditions. The sweet taste is associated with the demulcent action, the sour taste with the astringent action, and the bitter taste with anti-inflammatory and antimicrobial actions. USE
2. Gastritis
Althaea Ophiopogon
Althaea Polygonum Hamamelis Calendula Hydrastis Glycyrrhiza
•
. Ratio -
12 g 8g 4g 1-2g
cool cool neutral-cool cool
.·:.T~st~ sweet, sl. bitter sweet, sl. bitter sweet bitter
GENERAL.,' "':..':~" :·:('."i,
Thisco~binationis for Stomach Heat with Stomach Deficient Yui';The overall temperature is cool, and thus it can be used for warm or hot conditions. In this combination, the
• colitis with bleeding or mucus-containing diarrhea PRACTICAL NOTES
Dried, cut Althaea root can be made as a decoction (see Dose), and 5 ml of a mixture of the tinctures of the other herbs can be added to 1 cup of the Althaea decoction for each of the three daily doses. There is then approximately ten times as much Althaea as each of the other herbs in the mixture. This combination can be used for acute conditions, but there is ~sually an underlying chronic condition. Therefore, the combination may need to be taken for 1 to 2 months.
Althaea ..
Y::::~:: '.~:: _~:'~'~c J;;.~' ~;:::
4. Cystitis
Bladder Heat + Kidney Deficient Yin '''I
187
Daily do~e
Herb
Temperature
Taste
"
Althaea Viola trio Zea Agropyron Ophiopogon Arctostaphylos
3g 3g 3g 3g 3g 3g
cool cool neutral neutral cool cool
sweet, sl. bitter sour, sweet, bitter sweet sour, sl. sweet sweet, sl. bitter bitter, sour
GENERAL
This combination is for patterns of Heat or Damp Heat in the Bladder, with Kidney Deficient Yin and Kidney
Herb" """, Ratio
Ijerb'_
Althaea Viola trio Prunus Marrubium Ophiopogon Glycyrrhiza
10 approx.
Althaea
1 1 1 1 1
Ophiopog~n
-:" ......;'~~,'>._- ;,>:-...::.~:~_~::.~.s:;:~
Glycyrrhiza Hydrastis
~~_})aily'_d_q.:'.~,~
12 g 8g 4
g
1-2 g
1. Althaea, Viola and Glycyrrhiza are moistening, demulcent, anti-inflammatory, and antitussive herbs to treat dry cough. Prunus and Marrubium are antitussive, antispasmodic, and expectorant herbs, and Prunus has a mild tranquilizing effect. Ophiopogon and Glycyrrhiza can tonify Lung Yin and Fluids, supported by the other two moist herbs, Althaea and Viola.
Deficiency Heat. The overall temperature is cool to treat warm conditions. For hot conditions, neutral Agropyron would need to be replaced by colder herbs, such as Hydrastis or Berberis. The sweet taste is associated with the 'lm tonic and the demulcent actions, the sour taste with the astringent action, and the bitter taste with anti-inflammatory and antimicrobial actions. USE
• urinary tract inflammations and infections, accompanied by tiredness, restlessness, and sensations of heat
2. Prunus and Marrubium direct the previous combination to the Lung. Combination No.2, however, is specific for _gastric inflammation. Glycyrrhiza can increase the rate of mucus secretion by the gastric endothelium, and together with the mucilage in Althaea, this can assist in the formation of a protective layer on the gastric mucosa. Althaea, Ophiopogon, and Glycyrrhiza together can tonify Stomach 'lm, and Hydrastis can clear Stomach Heat. 3. Colitis
4. Cystitis
Intestines Heat
Bladder Heat + Kidney Deficient Yin
'--. PRACTICAL NOTES
The herbs are put in a pan containing about 750 ml of cold water, and the mixture is brought to a boil and simmered very gently for 15 minutes. The decoction is strained and the remaining liquid pressed out of the herbs in the pan. \-,
This provides 1 day's supply of decoction, which can be taken, when cool, in three individual doses of about one cup.
Herb
Ratio
Althaea Polygonum Hamamelis Calendula Hydrastis Glycyrrhiza
10 approx. 1 1 1 1
0.5
Althaea Viola trio Zea Agropyron Ophiopogon Arctostaphylos
3g
3g 3g 3g
3g 3g
The combination can be used short-term for acute episodes, but it can also be taken long-term for chronic conditions.
Caution
Since all the herbs but Arctostaphylos can act as
sweet tonics, this combination may be unsuitable for patients with patterns of Spleen Deficiency and Stagnation with accumulation of Damp and Phlegm, manifesting as obesity, catarrhal conditions, and lethargy.
COMPARISON OF THE FOUR ALTHAEA COMBINATIONS 1. Dry cough
2. Gastritis
Lung Deficiency Heat + Lung Deficient Yin
Stomach Deficiency Heat + Stomach Deficient Yin
3. The sweet herbs Althaea and Glycyrrhiza both have a demulcent anti-inflammatory and Yin tonic actions. The sour herbs Polygonum and Hamamelis, with higher tannin content, are both antidiarrheal and antihemorrhagic, supported by resin-based Calendula with its antimicrobial, antiinflammatory, and vulnerary action. Hydrastis is a bitter antimicrobial and anti-inflammatory, which can normalize mucus membrane function to treat colitis. 4. Whilst the previous combination is designed to treat colon inflammation, this combination is made specific for the urinary system by the soothing urinary anti-inflammatory herbs Zea and Agropyron, and the strong urinary antimicrobial, anti-inflammatory herb Arctostaphylos. All the herbs except Arctostaphylos are sweet in nature, and can combine to tonify Kidney 'lm.
;;r._
188
Combining Western Herbs and Chinese Medicine
OTHER ALTHAEA COMBINATIONS Other combinations that contain Althaea include the following:
• Arctostaphylos: vaginitis • Gentiana: digestive weakness + gastrointestinal inflammation
Research CONSTiTUENTS • mucopolysaccharides • flavonoid glycosides • other Mucopolysaccharides Althaea contains 5-10% mucopolysaccharides, consisting of a mixture of arabinans, glucans, arabinogalactans, and galacturonorhamnans. 5 Flavonoid glycosides These include the glucosides of hypolaetin and isoscutellarein.6 Other Althaea also contains starch (37%), pectin (11%), sucrose (10%), fat (1.7%), up to 2% asparagine/ tannins,s small amounts of phenolic acids such as caffeic acid,6 and a small amount of sterols. 9 PHARMACOLOGICAL AND CLINICAL RESEARCH • • • •
anti-inflammatory immunoregulatory antitussive hypoglycemic
Anti-inflammatory An ointment contalning aqueous Althaea root extract (20%) and dexamethasone (0.05%) was superior to the two individual substances in reducing skin irritation in rabbits. 10 Althaea root extract stimulated phagocytosis and released oxygen radicals and leukotrienes from human neutrophils. 11
-
C-'::Ii
muco::_.-~f'ir-
Hypoglycemic Intraperitoneal administration of polysaccharides isolated from Althaea root reduced plasma · mlce. . 15 g1ucose 1eve1s m
~~"":"
-
MECHANISM OF DEMULCENT AND EMOLLIENT ACTIONS Demulcents Traditionally, demulcents were defined as herbs, often with a high content of mucopolysaccharides, which have a soothing and protective effect on inflamed mucus membranes. The demulcent effects can be said to be of two types:
• direct demulcent effect • indirect or reflex demulcent effect
on the gastrointestinal system on the respiratory or urinary systems
Direct demulcent effect It is thought that the mucilage from herbs like Althaea root covers the mucosa, especially of the mouth and pharyngeal cavity, to give protection from local irritants. 16 Mucilage from the leaves of Plantago major has been shown to have protective effect against aspirin-induced gastric ulcer in rats. Ii
Indirect, reflex, demulcent effect It has been demonstrated that oral administration of Althaea preparations can reduce the amount and intensity of coughing. 13 Since mucopolysaccharide molecules are too large to be absorbed and transported to the respiratory system, the question of how demulcent herbs exert their anti-inflammatory effects on the respiratory mucosa and musculature has been raised. Mills and Bone ls have suggested that the soothing effect of the mucilage on the upper digestive tract can produce a reflex effect on the tracheobronchial muscles, possibly mediated by the vagus nerve. A similar effect is known to work in reverse, in which acid reflux from the lower esophagus can trigger coughing or nocturnal asthma. Mills and Bone proposed that a similar mechanism may explain the use of mucilagecontaining herbs for inflammatory conditions of the urinary system.
Immunoregulatory Althaea root extract induced the release of cytokines, interleucin 6, and tumor necrosis factor from monocytes. Isolated mucopolysaccharides from Althaea root increased the phagocytic activity of macrophages in mice when administered intraperitoneally at 10 mglkg.12
Emollients These substances were defmed as having a soothing anti-inflammatory effect at the surface of the body. Some emollient herbs, such as Althaea and Symphytum, contain mucopolysaccharides. Other emollients are oilbased, such as olive, linseed, and flaxseed oils.
Antitussive Oral administration of either Althaea root extract or isolated mucopolysaccharides reduced the intensity and amount of coughing in cats. 13 A cold macerate of Althaea root inhibited mucociliary transport in isolated frog, ciliated, esophageal epithelium. 14
RESEARCH VERIFICATION OF TRADITIONAL ACTIONS There is research evidence for the general anti-inflammatory, topical anti-inflammatory, and antitussive actions of
-
,-."..
.... -
Althaea Althaea, but there is no clear mechanism for the demulcent effect in the respiratory system. There is research evidence for protection against gastric irritation and ulceration by Althaea and its isolated mucopolysaccharides, and in this sense, there is evidence for the gastric demulcent action of Althaea. I have not seen evidence to support demulcent antiinflammatory action in the intestines or in the urinary system. The evidence for a nutritive tonic action for Althaea root is based on both its imrnunoregulatory effects and the fact that it has been used as food throughout the centuries.
189
flammatory skin conditions or as a poultice for wounds and ulcers. Vaginal bolus Dried powdered Althaea root is included in Christopher's vaginal bolus combination for vaginal inflammatory conditions. 20
Cautions Western contraindications None reported.
Additional uses suggested by research Hypoglycemic action has been demonstrated by research, as discussed above.
Chinese contraindications None reported, but since this is a moist nutrient herb, I would not generally prescribe it for patients with marked patterns of Damp. Pregnancy and lactation No adverse reports.
TOXICOLOGY I have not found data showing toxic effects by this herb.
Side effects None reported. Overdose No adverse reports.
f.~
Dose Dried herb per day. 19
Interactions According to one text, absorption of other drugs taken simultaneously may be retarded. 16
The BHP listed 2-5 g of dried root, three times
Regulatory status
Decoction I recommend that about 15 g of dried Althaea root is soaked in about 750 ml of cold water for 1 hour. The water is brought to a boil and simmered very gently for about 15 minutes. The decoction is strained, and the remaining material is pressed to release more liquid. The dose is 1 cup of warm decoction taken three times per day. According to Felter and Lloyd, since 'the decoction soon decomposes or becomes mouldy and acid, it should always be made in small quantities, not more than one or two pints at a time, according to the temperature of the weather.' Cold infusion According to the wording of the German Standard License, cited in Wichtl, about 150 ml of cold water is poured over a tablespoon (15 g) of dried Althaea root, allowed to stand for 30 minutes with frequent stirring, and then strained. One cup can be drunk. several times per day and should be freshly prepared each time. The tea can be gently warmed before drinking. Liquidextract The BHP listed 2-5 ml of 1:1 extract in 25% alcohol, three times per day.
Initial dose Can start at the standard dose. Duration Can be taken on a long-term basis. Topical uses
Can be used as an ointment (5-10%) for in-
Please read the Regulatory status section in the chapter on Safety. Althaea is on the UK General Sale List (Statutory Instrument Order 1977 No. 2129 to the Medicines Act 1968). Althaea is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Althaea is not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
Traditional sources PROPERTIES Temperature Some of the older texts did not practice what they preached with respect to their classification of the temperature of Althaea. Hildegard von Bingen21 classified marshmallow, which she called ybischa, as hot and dry, but recommended it for fever. According to Lonicerus,22 marshmallow is hot, but he listed it for burns to remove the heat. Tabernaemontanus23 wrote that marshmallow root is 'warm and dry in the beginning of the second degree: but then listed it for burning urination and for thirst. Culpeper4 classified the roots of mallows in general as temperate in heat, but listed them for hot agues and for hot choleric disorders. Also,
190
Combining Western Herbs and Chinese Medicine
according to Culpeper, mallows are governed by the planet Venus. This implies that they are moist and cool in nature. The main entry in the Chinese Herbal Medicine Dictionary classifies Althaea rosea root (shU klii gen) as cold, although one text cited listed it as slightly cold. Althaea officinalis root is classified as cool and moist in this book since it is specific for dry inflamed conditions of the mucous membranes. Tierra25 also classified this herb as cool in temperature. Taste
Taste in the mouth The BHP listed the taste of Althaea root as sweet. I found that a sample of the dried root tasted sweet and slightly bitter, and gave a mucilaginous sensation in the mouth. Taste properties The Chinese Herbal Medicine Dictionary classified A. rosea root (shu kill gen) as sweet. Tierra listed A. -officinalis root as sweet and bitter. In terms of Chinese medicine. the taste properties of A. officinalis root, as used in the West, are listed in this book as sweet and slightly bitter. associated with the tonic and antiinflammatory actions, respectively.
ORGANS In terms of Chinese medicine, the root of A. officinalis, as used in the West. can be associated mainly with disorders of the following organs: Organ
Examples ·of uses.
Source:
Lung
cough, laryngitis respiratory catarrh with irritating cough gastritis excoriations of the bowels, abdominal pain enteritis dribbling and painful urination cystitis
Christopherl° BHp 19
Stomach Intestines
Bladder Uterus
BHP Culpeperl4 BHP Dioscorides 26 BHP
inflamed swellings of the genitals Dioscorides vaginal irritation Christopher
The Chinese Herbal Medicine Dictionary did not list the meridians entered for A. rosea root (shU klii gen).
ACTIONS AND USES The main Western traditional actions of this herb are: • respiratory demulcent and antitussive • gastrointestinal demulcent • urinary demulcent and diuretic • emollient (topical demulcent)
• nutritive tonic
--
• other
..... .u --~
Respiratory demulcent and antitussive Lonicerus wrote that marshmallow seed cures coughs that are due to heat, helps to expectorate phlegm, and treats tightness of the chest. According to Tabernaemontanus, marshmallow leaves simmered in milk and consumed warm are good for all different types of coughs. Culpeper listed marshmallow for pulmonary tuberculosis, pleurisy, and other diseases of the chest and lungs due to heat. Christopher recommended Althaea for hoarseness, cough, and bronchitis. Wichtllisted Althaea root as an antitussive, especially for irritable coughs and catarrhal inflammation of the throat. Gastrointestinal demulcent Dioscorides recommended marshmallow seed decoction for diarrhea and dysentery. Culpeper wrote that mallows can treat abdominal pain coming from hot, choleric or offensive humors. and Gerard stated that marshmallow could treat bloody diarrhea and its associated pain. According to Felter and Lloyd,27 Althaea root can treat gastrointestinal irritation and inflammation, dysentery and diarrhea. Christopher recommended Althaea not only for diarrhea and dysentery, but also for chronic constipation. The BHP listed Althaea root as specific for peptic ulcer. and the BHC listed it for gastroenteritis, peptic ulcers, enteritis. and common and ulcerative colitis. Urinary demulcent and diuretic According to Dioscorides, marshmallow can be used to treat dribbling and painful urination, and urinary stones. Lonicerus said that marshmallow root can increase urination and that the seeds can help to expel kidney stones and soothe burning urination. Culpeper wrote that mallows may ease the pain of kidney and bladder stones by opening the passages and making them more slippery, so that the stone may descend more easily. Felter and Lloyd described Althaea as a demulcent and diuretic for inflammation of the kidneys or bladder. for painful and difficult urination. retention of urine. and hematuria. The BHP listed Althaea leaves for cystitis, urethritis. and urinary gravel or stones. Emollient (topical demulcent) Dioscorides used marshmallow preparations for wounds. insect bites, burns. swellings, abscesses, and ulcers, and for heat-type swellings of the anus or genitals. Lonicerus recommended marshmallow simmered in vinegar as a mouthwash for teeth and gum problems, and applied to the skin for acne. According to Felter and Lloyd. Althaea poultices applied to wounds. accompanied by internal use of the decoction, can help to prevent gangrene. The BHP listed Althaea leaf combined with Ulmus in fomentation, poultice. or ointment for wounds. ulcers, boils, and eczema.
'.~'"
-
.. Althaea
191
Nutritive tonic Christopher listed Althaea as a nutritive for weak digestion and malnutrition. Tierra listed this herb as a nutritive and a Yin tonic. Althaea is one of the herbs in common use in the West that can be regarded as a sweet Yin tonic, comparable to Chinese Ym tonics such as Ophiopogon (mil.i men dong). According to Grieve, the roots of Althaea and of other mallows have been used as food by the Egyptians, Romans, and Chinese.
6. Gudej J. Planta Medica 57:284-285 (1991)
Other Lonicerus recommended simmering the root with wine and drinking it to cure fractured bones or internal damage that are a result of beatings and punches.
10. Beaune A. Balea T. Therapie 21:341-347 (1966)
7. Benigni R. Capra C, Cattorini PE.l:51-52[Tl] (1962). {cited in Bradley PR (ed). British Herbal Compendium, vol 1. British Herballvledicine Association. Bournemouth. United Kingdom (1992) I 8. Bieloszabska FW, Czhucha K. Farm Polska 22:173-176 (1966); abstract found in ChemAbstr 65:8671 (1966) 9. Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm. Stuttgart Germany (1994), from 2nd German edn. Wichd M (ed) (1989)
11. Scheffer J, Konig W. Phytotherapie-Kongress, Lubeck-Travemunde Oct 3-6 Abstract P9 (1991) 12. Wagner H. Proksch A. Irnmunostimulatory drugs of fungi and higher
COMPARISON OF WESTERN AND CHINESE USE OF ALTHAEA SPECIES Whilst A. officinalis is one of the main demulcent antiinflammatory herbs used in the West, A. rosea (shu klii gen) seems to be only of minor importance in Chinese medicine. The actions of A. rosea are listed in the Chinese Herbal Medicine Dictionary as clearing Heat and cooling the Blood. A. rosea does not appear to be used as a moistening nutritive herb to tonify Ym and clear Deficiency Heat, as is A. officinalis in the West. Unlike A. officinalis, A. rosea does not appear to be used for respiratory problems. Although A. rosea is used in China for hematemesis, this m~y not be identical to its use in the West as a demulcent for gastritis and gastric ulcer. The use of A. rosea for intestinal inflammatory disorders is not listed in the Chinese Herbal Medicine Dictionary. However, this text listed A. rosea for urinary problems and hematuria, which is similar to the Western tradition for A. officinalis.
plants. In: Wagner H. Hikino H. Farnsworth NR (ed). Economic and Medicinal Plant Research. vol. 1. Academic Press, London. United Kingdom 113-153 (1985) 13. Nosal'ova G. Strapkova A, Kardosova A et al. Pharmazie 47:224-246 (1992) 14. Mi1ller-Limmroth W,Frohlich H-H. Fortschr Med 98:95-101 (1980) 15. Tomoda M.Shimizu N, Oshima Y. Planta Med 53:8-12 (1987) 16. Althaea. In:Hansel R. Keller K. Rimpler H et al. (ed). Hagers Handbook. 5th edn. voL 4: Drogen A-D. Springer-Verlag, Berlin-Heidelberg, Germany. pp 233-239 (1992) 17. Obolentseva GV. Khadzhai Yal, Vidyukova Al et al. Bulletin of Experimental Biology and Medicine 77:256-257 (1974) 18. Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone, Edinburgh. United Kingdom (2000) 19. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks. United Kingdom (1983) 20. Christopher JR. School of Natural Healing. BiWorld. Provo, Utah (1976) 21. Von Bingen H. Hildegard von Bingen's Physica. Healing Arts. Rochester. Vermont (1998)
References 1. Lietava I. J EthnopharmacoI35(3):263-266 (1992) 2. Grieve M. A Modern Herbal, vols. 1 and 2. Dover Publications. New York. New York (1971) 3. Lyle TJ. Physio-Medical Therapeutics, Materia :-'ledica and Pharmacy. Originally published Ohio (1897). Reprinted by the National Association of Medical Herbalists of Great Britain. London. United Kingdom (1932) 4. Jiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science and Technology Press, Shanghai. China (1975) 5. FranzG. Planta Med 14:90-110 (1966)
22. Lonicerus A. Kreuterbuch (1679). Reprinted by Verlag Konrad Kolbl, Miinchen. Germany (1962) 23. Tabernaemontanus IT. Krauterbuch (1731). Reprinted by Verlag Konrad Kolbl. Miinchen, Germany (1993) 24. Culpeper N. Culpeper's Complete Herbal & English Physician Enlarged. Meyerbooks, Glenwood, Illinois (1990) 25. Tierra M. Planetary Herbology. Lotus Press. Twin Lakes, Wisconsin (1988) 26. Dioscorides P. Kreutterbuch (1610). Reprinted by Verlag Konrad Kolbl. Miinchen. Germany (1960) 27. Felter HW and lloyd IU. King's American Dispensatory, vols 1 and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications. Sandy, Oregon (1983)
-,...
--
Anemone Botanical name Anemone pulsatilla L. (Pulsatilla vulgaris Miller), or Anemone pratensis L. (Pulsatilla pratensis Miller) Family Ranunculaceae Pharmaceutical name Anemonae herba (Pulsatillae herba) Part dried aerial parts English pasque flower, wind flower German Kiichenschelle French anemone pulsatilla Mandarin A. pulsatilla L. is not used bai tou weng is the root of Pulsatilla chinensis Bge. (Anemone chinensis Bge.) Use in the West A. pulsatilla is a small perennial native to Europe and parts of Asia, which has had centuries of herbal use in Europe. However, it is essential to distinguish between the use of the fresh plant. which releases protoanemonin upon crushing, and the use of the dried plant, in which the protoanemonin is converted by the drying process to anemonin. Protoanemonin can be an irritant and is potentially toxic in high doses, whereas anemonin does not appear to have these adverse effects. There appear to be two different traditions: one using the fresh plant, and the other using preparations of the dried plant. However, it is not always clear whether writers are referring to the use of fresh or dried material.
chewing the fresh plant or using its juice.ln the late 19th and early 20th century. American Eclectic authors, such as Felter and Lloyd3 as well as Ellingwood,4 clearly recommended the use of fresh material. Tierra5 followed this tradition by using the instructions given by Felter and Lloyd for making a tinc. ture of the fresh plant
Use of preparations from dried material Recent British texts, such as the BHP,6 BHC/ and Mabey,S recommended the use of preparations from dried material. The BHP noted that the fresh plant should not be used. and Mabey described the fresh plant as poisonous. Dose is all-important. Both Ellingwood as well as Felter and Lloyd used small doses of tincture or fluid extract made from fresh material. These low doses, for example, 1-15 drops of the fluid extract, were used to avoid the adverse effects that can occur at high doses. Since I have only used preparations from dried plant material, the descriptions of properties, herb pairs, and combinations in this chapter refer to the dried material unless otherwise stated.
Homeopathic tradition During the late 19th century. Anemone (Pulsatilla) was used by the homeopathic practitioners for conditions such as fearfulness, anticipation, and dread of calamity, and fear of trouble or death. Some of the indications given by the Eclectics for preparations of the homeopathy. fresh material seem to have been adopted Practitioners currently using the dried material need to
from
Use ofpreparations from fresh material European writers in the 16th and 17th century, such as Culpeper l and Gerard2 appear to have been using the fresh material, for example,
be aware that indications given for Anemone in the literature
193
..........
,
:~.
194
"'~~"I
Combining Western Herbs and Chinese Medicine
may be relevant to homeopathic or fresh preparations, but may not necessarily apply to the dried material.
Nomenclature
The names Anemone or A. pulsatilla are used in this chapter to indicate material from either A. pulsatilla or A. pratensis. In addition, the term "anemonin» referred to by earlier writers such as Ellingwood or Grieve9 appears to be not anemonin, but the acrid irritant protoanemonin. Use in China The Chinese Herbal Medicine Dictionary'° has an entry for bai tou weng, the root of Pulsatilla chinensis (Bge) Reg. (Anemone chinensis Beg.) This herb is mainly used in China for diarrhea and dysentery associated with Damp Heat or Heat Toxin.
Calm Kidney fear Fear from Deficiency, instability, or·;·~~· overstimulation of the Kidney can destabilize Heart Spirit - ~.~;...... and can also result in Stagnation of the flow of Qi through the Kidney and Bladder channels, and the channels of the.~.c: male and female reproductive systems. This can result in .!~ menstrual irregularities, painful conditions of the male or female reproductive systems, or sexual difficulties associated with nervous tension and fear. Actions on other organs Anemone can be used to treat headache and migraine. It may do this as much by calming the Heart and by acting as a general sedative, antispasmodic, and analgesic as by calming Liver Hyperactive Yang. Similarly, Anemone can be combined with other herbs to treat asthma, but may do this more by calming Kidney fear and Heart anxiety, than by having a direct relaxing effect on the bronchial muscles and moving Stagnation of Lung Qi.
What is special about Anemone WESTERN ACTIONS In terms of Chinese medicine, A. pulsatilla, as used in the West, can be said to be a cold, bitter herb that has its main effects on the Heart and Kidney.
The main Western actions of Anemone are shown here in terms of its two main Chinese actions: .
The key to understanding Anemone is that it is a herb with tranquilizing, antispasmodic. and analgesic actions, which is specific to calm nervous tension linked to anxiety or fear, and to treat spasms or pain associated with this nervous tension. It is also specific for conditions of insomnia, restlessness, overexcitement, or hyperactivity linked to sensations ofheat. CHINESE ACTIONS In terms of Chinese medicine, A. pulsatilla, as used in the West, can be said to have two main actions: I. calm Heart Spirit Disturbance II. calm Kidney fear Calm Heart Spirit Disturbance Anemone can calm Heart Spirit Disturbance in general, but especially when associated with the following two patterns:
..../ .-
.Chinese actions I. calm Heart Spirit Disturbance
tranquilizer sedative
II. calm Kidney fear
tranquilizer
Tranquilizer and sedative action Anemone is not a sedative in the sense that it dulls the consciousness so that physical activities are impaired, nor does it induce sleep by causing stupor. It appears to have its effects by calming nervous tension, so that the best categorization of its action might be as a tranquilizer, rather than a sedative.
WESTERN USES The main Western uses of Anemone can be related to its two main Chinese actions: Chinese actions
• Heart Excess or Deficiency Heat • Kidney fear The pattern of Heart Heat is generally associated with mental and physical restlessness, hyperactivity, and sensations of heat. It may be associated with the unpleasant feelings of anxiety and mental disturbance, with the temporarily more pleasant feelings of overexcitement and overenthusiasm, or with alternations between the two. These emotions or mental states may be accompanied by physical Heart signs, such as chest pain, arrhythmias, or palpitations, and stammering or other speech difficulties.
Western uses
..
~
I. calm Heart Spirit Disturbance
restlessness with sensations of heat, menopausal hot flashes, insomnia, overexcitement, hyperactivity, bipolar disorders, anxiety, panic attacks
II. calm Kidney fear
menstrual irregUlarity, headache. asthma associated with fearfulness. fright, or shock; feelings of desperation and mental pressure associated with excessive ambition, fear of failure, or loss of control
DIRECTION OF ENERGY Anemone can reduce disturbed upward movement of Qi
Anemone from Disturbance of Heart Spirit, Kidney fear, or Liver Hyperactive Yang.
TYPICAL CASE EXAMPLE Signs and symptoms The patient has had chronic anxiety, palpitations, and insomnia, with sensations of restlessness and heat both day and night. These have become worse with the onset of menopause, and the hot flashes with sweating have become severe. She has had a history of occasional chest pain and severe dysmenorrhea, and a tendency to periods of overenthusiasm, during which she can overload herself with work and projects, resulting later in feelings of desperation due to the pressure of overwork. The pulse is rapid and slightly irregular, and is thin and wiry especially in the Heart and Kidney positions. The tongue is thin with a red tip and red spots.. Diagnosis The patie~t has ~o~c patterns of: • Deficiency Heat linked to Deficient Y"m of the Heart and Kidney • Disturbance of Heart Spirit linked to both Heart anxiety and Kidney fear • Stagnation of Qi in the Heart and Kidney Choice of Anemone This herb is specific for Heart Spirit Disturbance linked to Heart Heat and can treat chronic restlessness, insomnia, anxiety, and overenthusiasm linked to these patterns, especially when accompanied by sensations of heat. It can also treat painful conditions, such as chest pain or dysmenorrhea, linked to Stagnation of Qi in the Heart or Kidney channels due to fear.
ACTIONS Tranquilizer Anemone can have a strong calming effect and can treat insomnia, restlessness, .and hyperactivity linked to overexcitement, anxiety, or fear. I consider this herb specific for Heart Spirit Disturbance linked to Heart Heat. I do not use this herb for the following conditions unless it is combined with other herbs: • patterns of Cold and Deficiency • depression, unless accompanied by restlessness and signs of Heat • Liver Hyperactive Yang linked to Stagnation of Liver Qi rather than to Heart Spirit Disturbance Antispasmodic and analgesic I do not use Anemone as a general-purpose antispasmodic and analgesic, as I would, for example, Lobelia. While Anemone has a tradition of use for spasms and pain in the head, chest, and reproductive system, it has not been used as much for pain in the gastrointestinal system or in the muscles of the limbs.
Anemone paired with other herbs Discussion of the limitations of each of the main actions of Anemone can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Anemone beyond its limitations. The basic unit of herb combination is the herb pair. Twelve pairings of Anemone are briefly explained below.
Limitations ofAnemone
,.
CAUTION TEMPERATURE
.
195
In this book, Anemone is classified as cold. It is specific for Heart Spirit Disturbance associated with Heart Excess or Deficiency Heat. However, for Heat in other organs, other herbs are more suitable.
TASTE The bitter taste of Anemone can be associated mainly with its capacity to clear Heat and calm the Heart. There is also tradition of use as an antimicrobial, thus linking the bitter t~ste -to the capacity to drain Damp Heat and clear Heat Toxin-In the case of Anemone, the bitter constituents do not seem to act as tonics or regulators of the gastrointestinal or hepatobiliary systems.
a
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair. Anemone + Crataegus
Emotional lability Crataegus can stabilize both physical and emotional manifestations of Heart Qi disturbances to stabilize the heartbeat, energy, and mood. Anemone can calm the Heart Spirit and clear Heart Heat so that this herb pair can be used to treat bipolar disorders, emotional lability, or menopausal hot flashes with palpitations. Anemone + Convallaria
Palpitations
196
Combining Western Herbs and Chinese Medicine
Convallaria can stabilize the physical function of the Heart to treat arrhythmias and palpitations associated with heart disease or exhaustion. Anemone can calm the Heart so that this pair can be used to treat arrhythmias or palpitations with nervous tension or nervous exhaustion. Anemone + Leonurus
Menopausal neurosis Both herbs are specific for menopausal problems and complement each other's actions. Leonurus is more for exhaustion. cardiac weakness, and emotional lability, and Anemone is more for restless overexcitement or anxiety with hot flashes.
Anemone + Rnta
._ _--
_.•... .._........
Dysmenorrhea
~
--;,O::.1r
Ruta can move Stagnation of Kidney Qi. and Anemone can reduce the Kidney fear that may give rise to this Stagnation. Ruta also has an effect on the reproductive system so . _-~~ that this pair can be used to treat amenorrhea, infertility, irregular menstruation, dysmenorrhea, or sexual difficulties associated with nervous tension. The pair can also be used for headache, especially those associated with premenstrual or menopausal syndromes. Anemone + Hypericum
Menopausal disorders + depression Anemone + Passiflora
Insomnia Both herbs can be used for restless insomnia with dreamdisturbed sleep, anxiety or panic attacks, and palpitations or headache associated with nervous tension. Anemone is stronger in both its calming and cooling effects.
Hypericum can have a tonic action on the Kidney so that this pair can be used to treat nervous tension and exhaustion associated with depression. Both herbs are specific for menopausal conditions, especially those associated with hot· flashes from Deficiency Heat of Kidney and Heart. Anemone + Glycyrrhiza
Anemone + Lavandula
Anxiety + depression Lavandula is slightly warming. moving, and antidepressant so that it can complement and moderate the cooling and sedative actions of Anemone. This pair can be used to treat nervousness and anxiety concurrent with depression. This pair can also be used for headache, especially for cases in which Liver Hyperactive Yang is combined with Heart Spirit Disturbance. Anemone + Valeriana
Migraine Both herbs can calm Heart Spirit Disturbance, and Anemone can help Valeriana to calm Liver Hyperactive Yang. Since both herbs can clear Heat, they are specific for headache with sensations of heat in the head and face, accompanied by restlessness, overexcitement. or sensations of mental emotional tension and pressure.
Nervous tension + exhaustion Glycyrrhiza can tonify both the Kidney and Heart to assist in the treatment of Heart Spirit Disturbance associated with Deficiency. Its tonic action can moderate the sedating effect of Anemone, and the two herbs, usually in combination with others, can be used for nervous tension combined with nervous exhaustion. Anemone + Zingiber
Dysmenorrhea + sensations ofcold Zingiber is often paired with Anemone since its warming. stimulating actions balance the cooling, sedating actions of Anemone. Also, the diffusive diaphoretic action of Zingiber assists in the dispersal of disturbed Qi that has accumulated due to the stagnating effects of nervous tension. Anemone + Lobelia
Anemone + Mentha pulegium
Anxiety + fearfulness Both herbs can calm Heart Spirit Disturbance and Kidney fear so that the pair can treat restlessness, anxiety. panic attacks, nervousness, and feelings of tension, desperation, and fear. These psychological symptoms may be accompanied by physical manifestations, such as heart pain, headache, difficulty breathing, or dysmenorrhea. .
Asthma + nervous tensio'1 Both herbs are calming, antispasmodic. and analgesic. Lobelia has a specific effect on the bronchial muscles so that this pair can be used for asthma or other breathing difficulties associated with fear or nervous tension. The pair can also be used for dysmenorrhea associated with Stagnation of Kidney Qi due to chronic fearfulness or acute fright or shock.
Anemone
197
Anemone combinations Six Anemone combinations are discussed below. , . --.
Combination
Lavandula Anemone Schisandra Lobelia Prunus Ephedra Glycyrrhiza
Heart Spirit Disturbance
2. menopausalhotfiashes
Heart Heat + Heart Deficient Yin
3. asthma + anxiety
Heart Spirit Disturbance + lung Stagnant Qi
This combination is the same as Lavandula: asthma + anxiety and is discussed under that heading.
4. headache + anxiety
Liver Hyperactive Yang + Heart Spirit Disturbance
4. Headache + anxiety
5. exhaustion + fear
Kidney Deficient Qi + Kidney fear
Liver Hyperactive Yang + Heart Spirit Disturbance
6. dysmenorrhea + fear
Kidney Stagnant Qi + Kidney fear
CAUTION
Before using any ofthe combinations below, it is important to be familiar with the cautions listed for each herb in the com-
bination. 1. Insomnia
Herb Lavandula Valeriana Anemone Glycyrrhiza
Ratio·
Temperature
Taste
1 1 1
sl. warm cool cold neutrai-{;ool
aromatic, bitter, sl. acrid bitter, sweet bitter sweet
0.5
2. Menopausal hot flashes
Heart Heat + Heart Deficient Yin
Salvia off. Salvia mil. " Leonurus Anemone Ophiopogon Glycyrrhiza Valeriana
• !emperature
51. warm warm-cool warm cold cool neutral-cool hot
1 1 1 1 1 0.5 0.5
Taste
':~~"~;;:'h'
.'
aromatic, bitter, 51. acrid aromatic, acrid, bitter aromatic bitter bitter, sweet sweet acrid, aromatic
5. Exhaustion + fear
This combination is the same as Lavandula: insomnia and is discussed under that heading.
Herb
Lavandula Salvia off. Mentha pul. Anemone Valeriana Glycyrrhiza Zingiber
Ratio
This combination is the same as Lavandula: headache + anxiety and is discussed under that heading.
Heart Spirit Disturbance
I~
1 1 0.5 0.5
aromatic, bitter, 51. acrid bitter SOur acrid aromatic, bitter acrid, 51. bitter sweet
1. insomnia
Herb .::"
L..,;,:,,;"
sl. warm cold warm warm-{;ool neutral warm neutral-{;ool
1 1 1
Ratio
Temperature
Tas~e"
1 1 1 1 1 0.5 0.5
warm-cool cool neutral cold cool neutral-{;ool cool
aromatic, acrid bitter sour, sl. bitter bitter sweet, 51. bitter sweet bitter, sweet
This combination is the same as Salvia: menopausal hot flashes and is discussed under that heading. 3. Asthma + anxiety
Heart Spirit Disturbance + Lung Stagnant Qi
Kidney Deficient Qi + Kidney fear
Herb"".::~ Ruta Anemone Hypericum Serenoa Schisandra Ophiopogon Glycyrrhiza Zingiber
":' "
~,~~. ~-:-
.. ·~F -
-.,f~~"":--.'-::,"-':·~'":::::~~?·~::''.:~~_·,'~~·~~''''':'··-;'::l
Ratio
Temperature"
1 1 1 1 1 1 0.5 0.5
warm-cool cold neutral neutral 51. warm cool neutral-{;ool hot
-~Taste .
bitter, aromatic bitter sour, 51. sweet sweet, 51. sour sour sweet, 51. bitter sweet acrid, aromatic
This combination is the same as Ruta: exhaustion + fear and is discussed under that heading. 6. Dysmenorrhea + fear
Kidney Stagnant Qi + Kidney fear
:~r~!~~~~I~roe~~i~~;f~l~T~~~7~:::g;.~·7~~ Anemone 1 Ruta 1 Mentha pul. 1 lobelia 1 Viburnum 5PP. 1 Zingiber 1 Capsicum 5-20 drops
cold warm-cool warm warm-cool neutral hot hot
bitter _ bitter, aromatic aromatic acrid 51. sour, 51. bitter acrid, aromatic acrid
Combining Western Herbs and Chinese Medicine
198 GENERAL
This combination is for situations in which Kidney Qi has become Stagnant, resulting in lower back pain, difficult urination, amenorrhea, infertility, dysmenorrhea, or related Kidney organ or meridian disorders. This combination is specifically for situations in which Kidney Qi Stagnation is associated with obstruction of the movement of Qi in the Kidney and Bladder channels by fear. The overall temperature of the combination is warm so that it can be used for cool to cold conditions. Bitter, aromatic. and acrid herbs combine to calm the fear and move the Qi. USE
• dysmenorrhea with pain radiating to the back, maybe lower back pain, dysuria. depression, desperation, or fearfulness PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of warm water or in a cup of hot Mentha pulegium infusion three times per day. Capsicum can be given in a separate bottle so that the requisite number of drops of Capsicum can be added to each dose of the main medicine. The Mentha infusion is made by pouring one cup of boiling water over two teaspoons of dried Mentha and allowing it to steep in a covered vessel for about 7 minutes. This combination can be taken daily for 1 to 3 months, with appropriate breaks and modifications. The dose can be increased temporarily to 7.5 ml, three times per day, from about 3 days before menstruation to the time that menstruation pain ceases.
Caution This combination should not be taken if there is a chance of conception.
COMPARISON OF SIX ANEMONE COMBINATIONS 1. Insomnia
2. Menopausal hot flashes
Heart Spirit Disturbance
Heart Heat + Heart Deficient Yin
Herb
- Ratio
Lavandula Valeriana Anemone
1 1 1
Glycyrrhiza
0.5
Herb -. .
Ratio
Salvia off. Salvia mil. Leonurus Anemone Ophiopogon
1 1 1 1 1
Glycyrrhiza
0.5 0.5
Valeriana
1. In this effective symptomatic combination for insomnia, Anemone and Valeriana are the stronger calming herbs.
Lavandula contributes a tranquilizing effect, but it balances _.. _:~ this with mild tonifying and moving actions. The sweet· . heavy property of Glycyrrhiza emphasizes the sweet heaviness of Valeriana, but this grounding effect is moderated by the moving and lightening action of the Lavandula essential oils. 2. Both Salvias can clear Heart Deficiency Heat and help to tonify Deficient Heart Yin and Blood. They can also act as emmenagogues to regulate menstruation. S. officinalis is specific for menopausal sweating and combines with Leonurus and Anemone to treat menopausal disorders. Anemone and Valeriana can clear Heart Heat and calm Heart Spirit, and Ophiopogon and Glycyrrhiza combine to tonify Yin.
3. Asthma + anxiety
4. Headache + anxiety
Heart Spirit Disturbance + Lung Stagnant Qi
Liver Hyperactive Yang + Heart Spirit Disturbance
3. Lobelia, Prunus, and Ephedra combine to open the
Lung and relieve bronchial spasms. Lavandula and Anemone combine to calm the mind and emotions, supporting the antispasmodic herbs. Schisandra firms Lung and Heart Qi to calm anxiety and moderate the stimulating and dispersing effects of Ephedra on the energy of the Lung and Heart. 4. Lavandula, Salvia, and Valeriana are combined for headache associated with both Liver Hyperactive Yang and Heart Spirit Disturbance. Mentha and Anemone combine to treat nervous tension associated with Heart Spirit Disturbance and Kidney fear. Glycyrrhiza helps to stabilize the Heart and Kidney, and Zingiber helps to disperse Qi Stagnation resulting from nervous tension. 5. Exhaustion + fear
6. Dysmenorrhea + fear
Kidney Deficient Qi + Kidney fear
Kidney Stagnant Qi + Kidneyfear
Ruta Anemone
1 1
Anemone Ruta
1 1
Anemone
199
Protoanemonin A. pulsatilla may contain about 2.8%
Herb· Hypericum Serenoa Schisandra Ophiopogon Glycyrrhiza Zingiber
Mentha pul. Lobelia Viburnum spp.
1 1 1 1 0.5 0.5
Zingiber Capsicum
1 1 1 1 5-20 drops
5. Ruta and Anemone are paired to calm Kidney fear and the feeling of desperation that can be associated with selfimposed unrealistic goals and a fear of failure or loss of control. Hypericum, Serenoa and Schisandra possess the sour property to firm Kidney Qi, and these three herbs also possess the sweet property that can tonify Kidney Qi and Yin when assisted by Glycyrrhiza and Ophiopogon. 6. Ruta and Anemone are paired to calm Kidney fear as
in the previous combination. However, since the emphasis in this combination is on pain, rather than on exhaustion as in No.5, the tonic herbs in No.5 have been replaced in this combination by the antispasmodic herbs Mentha, Lobelia, and Viburnum. Zingiber and Capsicum assist the antispasmodic action of the other herbs and dear Stagnation of Qi in
ranunculin, and about 1% protoanemonin can be obtained by steam distillation. 12 However, protoanemonin is unstable, and as the plant material dries, it dimerizes to form anemonin. n
Anemonin The toxicity sometimes observed with fresh material from A. pulsatilla is due to ranunculin and protoanemonin, but this toxicity disappears as the material dries since anemonin is nontoxic.l~ Triterpenoid saponins The aerial parts of A. pulsatilla can contain 0.2-0.75% triterpenoid saponins. 1S According to Chang and But,16 the roots of P. chinensis have been reported to contain up to 9% triterpenoid saponins. The lupane-type triterpenic acid, pulsatillic acid, and the lupane-type triterpene saponins, pulsatilloside A, B, and C, have been isolated from the roots of Pulsatilla chinensis. 17• 18 Other The aerial parts of A. pulsatilla contain tannins,19 essential oil,l) the calcium salts of chelidonic arid succinic acids, and flavonoids. 7 The roots of Pulsatilla chinensis have been reported to contain the lignans pinoresinol and ~ peltatin. 20
the Uterus due to Cold.
COMPARISON OF CONSTITUENTS OF OTHER ANEMONE COMBINATIONS Other combinations that contain Anemone include the following:
• Leonurus: menstrual disorders + anxiety • Ruta: chronic fatigue syndrome + palpitations • Ruta: nightmares • Thymus: enuresis
Research CONSTITUENTS
A. PULSATILLA AND P. CHINENSIS . Fresh material from both species contains protoanemonin, and dried material from both species contains anemonin. What is vital to determine are the relative amounts of protoanemonin and anemonin in preparations from dried material of different ages from A. pulsatilla herb and P. chinensis root. There appears to be a much larger amount of triterpenoid saponins in the root of P. chinensis than in the herb of A. pulsatilla, and various constituents have been reported for P. chinensis root that have not been noted in A. pulsatilla, such as the lignans pinoresinol and ~-peltatin, okinalin, and okinalein.
The following constituents have been reported: ·lactones • triterpenoid saponins • other Lactones
Ranuneulin 'Several species in the Ranunculaceae family contain the lactone glycoside ranunculin, which is present in the undamaged fresh plants. When the tissues are crushed, ranunculin is hydrolyzed enzymatically to the aglycone protoanemonin. 11
PHARMACOLOGICAL AND CLINICAL RESEARCH ON A. PULSATILLA The following effects have been reported: • antibacterial • antifungal • antipyretic • antispasmodic .• sedative • antimutagenic
Combining Western Herbs and Chinese Medicine
200
Antibacterial I have not found data on the antibacterial activity of A. pulsatilla extracts. Research on the antibacterial activity of the isolated constituents protoanemonin and anemonin is discussed in the section Pharmacological and clinical research on P. chinensis below. Antifungal Protoanemonin was reported to have antifungal activity,21 and protoanemonin, isolated from Pulsatilla alpina, was reported to have in vitro antifungal effect.22 Antipyretic Anemonin was reported to be the main compound responsible for the antipyretic activity of Pulsatilla alpina subsp. apiifolia. 23 Antispasmodic Early studies on A. pulsatilla reported antispasmodic activity,15 and according to Bruneton, I~ protoanemonin is thought to be antispasmodic. Sedative Early studies on A. pulsatilla reported sedative activity, IS and both anemonin and protoanemonin were reported to participate in the sedating effect of Pulsatilla alpina subsp. apiifolia.23 Antimutagenic Protoanemonin was identified as the factor responsible for the antimutagenic effect of Ranunculus and Anemone species against the strain E. coli B/rWP2trp.24
PHARMACOLOGICAL AND CLINICAL RESEARCH ON P. CHINENSIS The following effects have been reported: • antibacterial • antifungal • antiprotozoal • cardiotonic • anticarcinoma • antimutagenic
due to the breakdown of protoanemonin into anemonin. -~._ ~, =This implies that the breakdown is slow and that there may be variable amounts of protoanemonin in dried plant material. It is therefore necessary to obtain clearer data on: • whether anemonin has antibacterial action in A. pulsatilla or P. chinensis • how much protoanemonin remains in a decoction or tincture of the dried material of A. pulsatilla or P. chinensis Antifungal
This has already been discussed under
Pharmacological and clinical research on A. pulsatilla. In addition, P. chinensis preparations were reported by early Chinese study to have an effect against certain skin fungi. 31 Antiprotozoal Early research in China reported that P. chinensis preparations were effective against Trichomonas vaginalis. 32 P. chinensis preparations have been reported effective in clinical studies on the treatment of diarrhea due to Giardia lamblia or Trichomonas. 33 Cardiotonic Early studies reported that the aerial parts of P. chinensis have a cardiotonic action,34 and the cardiotonic constituents were reported to be okinalin and okinalein.35.36 Anticarcinoma An early study in China reported that intravenous injection of protoanemonin had an effect against squamous cell carcinoma, undifferentiated carcinoma, and melanoma of the lung. 37 In a more recent study, pulsatillic acid, a lupane-type triterpenic acid from P. chinensis, showed cytotoxic activity against P-388 Lewis lung carcinoma and human large cell lung carcinoma. 17 Antimutagenic
This has already been discussed under
Pharmacological and clinical research on A. pulsatilla. COMPARISON OF PHARMACOLOGICAL
Antibacterial
AND CLINICAL RESEARCH ON A.
Herb extracts The fresh juice,2s decoction,26 and alcohol
PULSATILLA AND
extract of Pulsatilla chinensis were reported to have antibacterial activity in vitro. A clinical study reported that a decoction of the fresh herb of P. chinensis was effective in the treatment of bacillary dysentery.28
P. CHINENSIS
The pharmacological and clinical research discussed above can be summarized to show the effects demonstrated for anemonin (A), protoanemonin (B), and dried material of A. pulsatilla (C) or P. chinensis (D):
Isolated constituents Protoanemonin has been reported to have antibacterial activity,29 but anemonin has been reported to lack antibacterial activity.30 However, according to Chang and But,16 both protoanemonin and anemonin have strong antibacterial activity. The BHC stated that protoanemonin is not found in dried material of A. pulsatilla. However, Chang and But reported that long dry storage renders P. chinensis less toxic
antibacterial
ari~i~ngal ~.':'tipr_~!~zoa~
._.
antipyretic.... __ . antispasmodic _.. - -----. ...._ _... - -
.. , •..
._.. _ ..__.
v
Anemone
;;,~"
sedative
..;
..;
..;
cardiotonic antimutag~nic
antitumor
..;
..; ..;
201
is a total of 6 doses. An individual dose is thus approximately 2.5-5 g. This is about twenty times greater than the individual dose of 0.12-0.3 g of dried A. pulsatilla listed by the BHP. (1 have not found clear data in Western texts on the dose in grams of fresh A. pulsatilla.) Dried herb
TRADITIONAL ACTIONS
A. pulsatilla I have not seen reports of adverse effects for preparations made from dried aerial parts of A. pulsatilla when taken in therapeutic doses.
The antimicrobial. antispasmodic, and sedative actions of either the dried herb or isolated anemonin or protoanemonin have been verified. The analgesic and emmenagogue actions have not yet been demonstrated for the dried material. nor have the nervine. antidepressant. and anticatarrhal actions. which. in any case. may only apply to the
P. chinensis According to Chang and But. both the decoction of P. chinensis and its saponins are of low toxicity. and no significant side effects have been reported for administration of the standard dose of the decoction. The LD 50 of the fluid extract of P. chinensis root in mice by intraperineal injection was reported as 60 glkg.38
RESEARCH VERIFICATION OF
fresh material. Additional effects d~monstrated by research Antimutagenic and antitumor effects have been reported for pro-
Dose
toanemonin.
TOXICOLOGY Protoanemonin The LD 50 of protoanemonin in mice was reported to be 190 mg/kg. 22 which is 11.4 g of protoanemonin for a 60 kg human. Fresh herb
A. pulsatilla According to Felter and lloyd. when preparations of the fresh material of A. pulsatilla are taken internally in overdose. there may be gastric irritation with a sense of rawness. burning. and pain in the stomach, attempts to vomit. and marked prostration. Toxic doses may produce stupor. coma. and convulsions. However. assuming that fresh A. pulsatilla contains about 1% of protoanemonin. then to ingest the 11.4 g of protoanemonin listed under Protoanemonin above. a person would have to consume about 1.14 kg of the fresh herb.
P. chinensis According to Chang and But. the crushed fresh P. chinensis emits a str~ng irritating odor due to the release of protoanemonin. which can strongly irritate the skin and mucosa. causing lachrymation. sneezing. and coughing. Ingestion ofthe crushed fresh herb may result in salivation. gastrointestmal irritation:vomiting. and abdominal pain. In severe cases. there Olay be nephritis. hematuria. heart faill;U'e. and death from respiratory failure. How~v~r. the therapeutic dose listed in the Chinese Herbal Medicine Dictionary for the fresh root of P. chinensis (bai t6u weng) is 0.5-1 liang. (15-30 g). Assuming that this amount of herb is a supply for 2 days, at 3 doses per day. this
Dried herb The BHP listed 0.12-0.3 g of dried herb. three times per day. Tmcture The BHP listed 0.3-1 ml of 1:10 tincture in 40% alcohol. three times per day.
Initial dose Can start at standard dose. providing cautions are observed. Duration Can be used for one month or more. providing cautions are observed.
Cautions Western contraindications I have not seen contraindications for preparations of the dried material when used in therapeutic doses. However. I do not use this herb for cases involving weakness with sensations of cold unless combined with a warming circulatory stimulant. such as Zingiber. Chinese contraindications Diarrhea and dysentery from Cold and Deficiency are contraindications for P. chinensis when used in Chinese therapeutic doses. which are about 20 times higher than those listed by the BHP for A. pulsatilla. Pregnancy and lactation No adverse reports are known for preparations of the dried material when used in therapeutic doses. The BHC contraindicated using the herb during pregnancy. but the fresh material was used during pregnancy by the Eclectics (see Traditional sources). Ability to drive and use machines No adverse reports.
Combining Western Herbs and Chinese Medicine
202
Side effects None reported, but see Western contraindications.
Overdose According to the BHC, overdose may irritate the stomach and cause vomiting, but this may be referring to the fresh plant rather than the dried material.
sweet. In this book, A. pulsatilla, as used in the West, is classi.:..'~~fi fied as bitter in terms of Chinese medicine, in the sensethat .~ it can be used to calm the Heart Spirit, especially in patterns of Excess or Deficiency Heat. ORGANS
Interactions None reported.
Regulatory status Please read the Regulatory status section in the chapter on Safety. Anemone (pulsatilla) is on the UK General Sale List (Statutory Instrument Order 1977 No. 2129 to the Medicines Act 1968). Anemone is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Anemone is not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
Traditional sources PROPERTIES Temperature The temperature listed for A. pulsatilla will depend on whether the author is referring to preparations from fresh or dried material. Gerard listed the temperature of the plant he called Pulsatilla vulgaris or pasque flower as hot and dry. From the entries on the anemones in both Gerard and Culpeper, it appears that the fresh material was used. According to Felter and Lloyd, an acrid volatile constituent is emitted when the fresh plant is bruised, which is sufficiently powerful to produce lachrymation or vesication if the plant material is kept in contact with the skin for an extended period. The main entry ·in the Chinese Herbal Medicine Dictionary classified the dried root of P. chinensis as cold. One subsidiary text cited listed it as cold, but did not specify the part used or whether it is fresh or dried. A. pulsatilla, as used in the West, is classified in this book as cold since it can be used for patterns of Excess or Deficiency Heat. Taste Taste in the mouth According to Felter and Uoyd, the fresh plant produces a numbing, tingling sensation when chewed. I found a 1:10 tincture of the dried plant in 25% alcohol to taste slightly sour, slightly bitter, and slightly acrid. Taste propertie~The main entry of the Chi~ese Herbal Medicine Dictionary classified the foot of P. chinensis as bitter, although one subsidiary text cited listed it as bitter and
In terms of Chinese medicine, Anemone, as used in the West, can be associated mainly with disorders of the following organ systems:
organ"':- i'Ei~~pie~'of"use's -.
Heart
Kidney
't
nervousness, hysteria hyperactive states, insomnia
Felter and Lloyd
unnatural fear
Felter and Lloyd
BHP
The main entry in the Chinese Herbal Medicine Dictionary listed P. chinensis as entering the Large Intestine, Liver,"and Stomach meridians, However, a subsidiary text cited listed the Heart and Kidney. ACTIONS Evidence from traditional sources for the following ..... actions of Anemone is discussed below: • antimicrobial • antispasmodic • analgesic • sedative • nervine • anticatarrhal • emmenagogue Antimicrobial Neither Felter and Lloyd nor Ellingwood _. listed preparations of the fresh plant as an antimicrobial. However, the BHP listed the dried material as antibacterial,recommended it for boils and skin eruptions associated with bacterial infection, and noted its combination with Echinacea or Baptisia for skin diseases and septicemia. Also, themain use of the dried material from P. chinensis in China is as an antimicrobial for bacterial or protozoal dysentery. Antispasmodic Felter and Lloyd listed the fresh material for asthma, whooping cough, and dysmenorrhea. The BHF listed the dried material as an antispasmodic and noted itt_ use for asthma and dysmenorrhea. Analgesic According to Felter and Lloyd, preparations 0 the fresh material can be used for painful conditions, espe-=-cially for those associated with debility, but also for thosp associated with acute inflammation. The BHP listed thl dried material as an analgesic and gave its specific indication .
Anemone as painful conditions of the male or female reproductive system. Sedative Ellingwood listed the use of the fresh material for hysteria or hysterical convulsions. Felter and Lloyd noted its use for sadness, depression, gloom, brooding over real or imagined troubles, tendency to look on the dark side of life, tendency to weep, nervous restlessness, unnatural fear, and real or imaginary cardiac conditions. The BHP listed the dried material as a sedative that can be used for insomnia, hyperactive states, and tension headache. Nervine The fresh material is said to have warming, tonic nervine, and antidepressant actions, but these actions are not listed for the dried material, which is more generally regarded as a sedative. Ellingwood noted the use of the fresh material for nervous exhaustion with feeble pulse, cold extremities, and generally relaxed physical condition. Felter and Lloyd wrote that, in therapeutic doses, the fresh material 'increases the power and regulates the action of the heart, and gives a better character to the pulse rate, particularly slowing the irritable, rapid and feeble pulse due to nervous depression.' Anticatarrhal Culpeper said that 'the leaves being stamped and the juice snuffed up the nose, purges the head mightily: so does the root being chewed in the mouth, for it procures much spitting, and brings away many watery and phlegmatic humours, and is therefore excellent for the lethargy.' Felter and Lloyd noted the use of the fresh material for thick discharges from mucous surfaces, stomach disorders from indulgence in fats and pastries, thick tongue coat with a greasy taste, acute nasal catarrh, frontal headache from nasal catarrh, chronic conjunctivitis with yellow discharge, and leukorrhea. Emmenagogue According to Felter and Lloyd, the fresh material can be used for amenorrhea or dysmenorrhea in nervous and anemic patients with chilliness as a main symptom. They recommended it for sluggish, ineffectual or weak labor pains, and Ellingwood wrote that preparations of the fresh material were excellent during pregnancy in small, frequent doses for nervousness or hysteria. The result is a feeling of general relaxation and an atonic condition, facilitating a normal and easy labor. The BHP recommended dried Anemone in combination with other herbs for menopausal disturbances.
203
dried root of Pulsatilla chinensis (Anemone chinensis): A. pulsatilla is mainly used for conditions with nervous tension, and P. chinensis is mainly used for bacterial or protozoal dysentery. A. pulsatilla The main use of A. pulsatilla dried material in the West is as a sedative, antispasmodic, and analgesic for fearfulness, restless insomnia, nightmares, anxiety, panic attacks, and hysteria, as well as for asthma, headache, and menopausal disorders or dysmenorrhea associated with nervous tension.
P. chinensis The main use of bai tou weng is for diarrhea and dysentery associated with Damp Heat or Heat Toxin. It is also noted in the main entry of the Chinese Herbal Medicine Dictionary for alternating fever and chills associated with dysentery, and for heat-type bleeding such as nosebleeds or bleeding hemorrhoids. Subsidiary texts cited listed swollen throat, lumps in the neck or abdomen, and boils as indicators.
References 1. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks. Glenwood, Illinois (1990) 2. Gerard J. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publications, New York, New York (1975) 3. Felter HW, Lloyd JU. King's American Dispensatory, vols. 1 and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1983) 4. Ellingwood F. American Materia Medica, Therapeutics and Pharmacognosy,llth edn. (1919). Reprinted by Eclectic Medical Publications, Sandy. Oregon (1994) 5. Tierra M. Planetary Herbology. Lotus Press. Twin Lakes. Wisconsin (1988) 6. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks. United Kingdom ( 1983) 7. Bradley PR (ed). British Herbal Compendium. vol. 1. British Herbal Medicine Association, Bournemouth. United Kingdom (1992) 8. Mabey R (ed). The Complete New Herbal Elm Tree Books, London, United Kingdom (1988) 9. Grieve M. A Modern Herbal, vols. 1 and 2. Dover Publications. New York. New York (1971) 10. Jiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science and Technology Press. Shanghai. China (1975) 11. HillR. van Heyningen R. Biochem J 49:332-335 (1950
COMPARISON OF WESTERN AND CHINESE USE OF ANEMONE SPECIES
12. Pourrat A. Lejeune B. Besse-Bergier FX. J Pharm Belg 35:277-280 (1980) 13. Baer H. Holden M. Seegal BC. J Bioi Chern 162:65-68 (1946)
There is a marked difference between the use of preparations of the dried aerial parts of Anemone pulsatilla and the
14. Bruneton J. Pharmacognosy: Phytochemistry Medicinal Plants, 2nd edn. Lavoisier. Paris. France (1999)
.
_,
_. ....-.
~.
204
Combining Western Herbs and Chinese Medicine
15. Benigni R. Capra C. Cattorini PE. voU 1158-1164 (T1} {l964} 16. Chang H-M. But PP-H (cds). Pharmacology and Applications of Chinese Materia Medica. vols. 1 and 2. World Scientific Publishing. Singapore (1986) 17. Ye WC. Ii NN. Zhao SX et al. Phytochemistry 42(3):799-802 (1996) 18. Ye W. He A. Zhao S et al. J Nat Prod 61(5}:658-659 (1998)
28. Traditional Chinese Medicine Department, Xiaoxian People's Hospital._ " Anhui Yixue (Anhui Medical Journal) (2}:63 (1977) ~ .-~~
29. Blasco R. Wittich RM. Mallavarapu M et al. J Bioi Chem 270(49):
~-~-
29229-29235 (1995)
~.-.~'
30. Hifny Saber A. Mahran GH. EI-Alfy T. Planta Medica 16:231-238.:·?i. (1968)
- .:::.~~
19. Hagers Handbuch. Band VI A 975-978 (T II} (1977)
31. Cao RL et al. Chinese Medical Journal {l2}:781 (1962)
20. Mimaki Y.Kuroda M.AsanoT etaLJNatProd62(9}:1279-1283 (1999)
32. Pharmaceutics Section. Shanghai First Medical College. Abstracts of the 1959 symposium of Shanghai First Medical College p 41 (1959)
21. Mares D.Mycopathologia 98(3}:133-140 (1987) 22. Martin ML. San Roman L, Dominguez A. Planta Med 56(l}:66-69 (1990)
33. Chen WZ. Bulletin of Zhejiang College of Traditional Chinese
23. Martin ML, Ortiz de Urbina AY, Montero MJ et al. J Ethnopharmacol 24(2-3}:185-191 (1988)
34. Goto. Nihon Yakuho (6}:7 (1930)
24. Minakata H. Komura H. Nakanishi K et al. Mutat Res 116(3-4):317322 (1983) 25. Yan GH et al. Chinese Pharmaceutical Bulletin 8(2}:57 (1960) 26. WangWS et al. Chinese Pharmaceutical Bulletin 7(10}:522 (1959) 27. WangWSetal.ActaBotanicaSinica3(2}:121 (1954)
"'~7~
Medicine (4}:15 {l977}
35. Goto. Nihon Yakuho (7):5 (1930) 36. Kodama. Japan Centra Revuo Medicina 34:377 (1932) 37. Pilot Production Unit, Shanghai No 17 Pharmaceutical Factory. Pharmaceuticallndustry (6}:3 (1974) 38. Pharmacology Section. Henan Medical College. Acta Academiae Medicinae Henan (5}:19 (1959)
.,...;
Angelica
....
...
Botanical names Angelica archangelica 1. Family Apiaceae (Umbelliferae) Pharmaceutical name Angelicae archangelicae radix cum rhizomate Part dried roots and rhizomes English (garden) angelica German Engelwurz French angelique Mandarin A. archangelica 1. is not used bai zhl (a If.) is the root of A. dahurica Benth. et Hook. (or other species) diing gui (1; tf) is the root of A. sinensis (Oliv.) Diels. du huo W~ i~) is the root of A. pubescens Maxim. (or other species)
Use in China There is no entry for A. archangelica in the Chinese Herbal Medicine Dictionary.s The three Angelicas most commonly used in Chinese medicine are those listed above.
What is special about Angelica In terms of Chinese medicine, A. archangelica, as used in the West, can be said to be a warm herb with aromatic, bitter, and acrid properties, which has its primary effect on the Lung, Spleen, Stomach, Intestines, and Heart.
The key to understanding Angelica is that it is a warming, drying herb that can stimulate the respiratory, digestive, and cardiovascular systems to treat conditions associated with Interior Deficiency, Cold, Damp, and Phlegm. It can also help to clear Exterior Wind, Cold, and Damp.
Use in Europe Angelica is a biennial herb, native to Northern Europe and Asia, which is now naturalized in North America. The petioles are used as 'candied angelica' in confectionery, and the seeds with their aromatic and bitter taste are used in aperitifs such as Vermouth and liqueurs such as Benedictine and Chartreuse. Angelica has had medicinal use since ancient times. Dioscorides l used it to treat respiratory disorders and stomach problems, and this tradition of use has been continued to the present day. '---
Angelica can be used to: • stimulate the Spleen to transform Damp • stimulate the Lung to clear Phlegm and Damp • clear Phlegm and Damp from the head • clear Phlegm and Damp from the channels ofthe muscles and joints I use Angelica for phlegm in the lungs, and for phleg~ in the sinuses with nasal congestion, sinus headache, or postnasal drip. I also use it in combinations to treat a general body tendency to phlegm and obesity associated with Interior Deficien~~Q)ld, Damp, and Phlegm.
Use in North America A. archangelica has been more commonly used in Europe than in North America, where other species, for example, A. atropurpurea, 2.3 A. arguta, and A. pinnata\ have often been employed for indications that are similar to those ofA. archangelica.
205
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Combining Western Herbs and Chinese Medicine
206
.6~j~es~~ ~~Of!~'.~:~:~:-'~'::~~ .;;--'-'_:~~_~;~t~i~-~~~~-y7311 ~;~!'~
CHINESE ACTIONS
.:'U~
In terms of Chinese medicine, A. archangelica, as used in the West, can be said to have the following actions:
IV.
warm and move Intestines
V. warm and move Heart
1. clear Wind Cold Damp II. clear Lung Phlegm Cold IU. warm and tonify the Spleen to transform Damp and Phlegm IV. warm and move Intestines Stagnant Qi V. warm and move Heart Stagnant Qi Clear Wind Cold Damp Angelica can be said to clear Wind, Cold, and Damp from the: • body surface, especially from the head and sinuses • muscles and joints Warm and move Heart Stagnant Qi Angelica can be said to act as a circulatory stimulant to move Stagnant Qi and Blood, especially at the periphery of the body, and as a mild cardiotonic. It does not so much move Stagnant Blood to remove pain.
WESTERN ACTIONS The main Western actions of A. archangelica are shown here in terms of its five main Chinese actions: ~
... ' ~.- -":' . ',~" "\.:'"
cold extremities. general weakness
\-;; -_.~~::
DIRECTION OF ENERGY Dispersing effect
The aromatic and acrid constituents of
Angelica can be said to have a warming and moving effect, spreading the Qi in an outward direction. This dispersing effect is not only in the Interior, for example, to move Heart Qi, but also outwards to the surface as a circulatory stimulant, antirheumatic, and diaphoretic.
Comparison with Rosmarinus The dispersing effect of Rosmarinus is in the Interior rather than at the surface. Also, the stimulating, lightening, spreading and opening effect of,:=.}'.... Rosmarinus is greater on the mind and emotions than that·~:~~_ ' of Angelica, which has greater physical effect on the head by drying Damp and Phlegm and opening sinus obstruction. Also, Angelica can treat headache from sinus obstruction and invasion ofWmd Cold Damp. However, it does not have the control over upward movement as does Rosmarinus, which can treat headache due to Liver Hyperactive Yang.
:'..",-,v,;s;,-,:~:·~:-·,<,:
.Chinese actions '"
-.
Western actions
I. clear Wind Cold Damp
diaphoretic antirheumatic
II. clear Lung Phlegm Cold
expectorant anticatarrhal
III. warm and tonity the Spleen
to transform Damp and Phlegm
carminative bitter digestive tonic
warm and move Intestines Stagnant Qi
carminative antispasmodic
IV.
Stagnant Qi
V. warm and move Heart
Stagnant Qi
circulatory stimulant cardiotonic
TYPICAL CASE EXAMPLE Signs and symptoms A patient has chronic bronchitis and sinusitis, with debility and recurring influenza. The patient feels cold in limbs and body, dislikes cold and damp, and has a heavy sensation in the head, poor appetite, slow digestion, and tendency to weight gain. In addition, starchy or greasy foods seem to increase the amount of phlegm in the nose and chest. The pulse is generally slippery arid flooding with underlying emptiness at the Spleen and Lung positions. The Heart pulse is empty and slightly wiry. The tongue is pale and slightly purple. with tooth marks and a moist white greasy
WESTERN USES
coat. The main Western uses of A. archangelica are shown here in terms of its five main Chinese actions: ..f....-':.w~"""..-__:.. ,-... .-.~ ....... w-
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II. clearLuqg ~hl~grTl Cold.('~ III.
warm and tonity the Spleen to transform Damp and Phlegm
influenza with sinusitis. rheumatism sinusitis. bronchitis digestive weakness. general weakness. anorexia nervosa, obesity
•
intestinal colic. flatulence
Diagnosis
The patient has:
• Deficient Spleen Qi, allowing accumulation of Damp and Phlegm • Deficient Lung Qi, allowing easy invasion of the Lung by Wind Cold and Damp and resulting in accumulation of Phlegm Cold in the Lung • Heart Deficient Qi and Heart Stagnant Qi, which can both be associated with sensations of cold in the body and limbs
Angelica Choice of Angelica This herb can clear both Wind Cold and Damp from the Exterior. and accumulated Phlegm Cold from the Lung. It can tonify, warm, and dry the Spleen to tonify the Qi and Blood, and also transform Damp and Phlegm. It can warm and move Heart Qi to improve the circulation.
Limitations ofAngelica TEMPERATURE Angelica is a warm herb that is specific for cool patterns. It is not warm enough to treat cold patterns unless it is combined with hot herbs such as Capsicum, Cinnamomum, or Zingiber. Angelica is not appropriate for warm patterns unless it is balanced by cool or cold herbs, and it would not generally be used for hot patterns.
TASTE Acrid Angelica is acrid in the sense of clearing Wind, Cold, and Damp from the surface, and also in the sense of warming the Interior. In Western terms, it is both a warming diaphoretic and a circulatory stimulant, and therefore not appropriate for patterns ofWind Heat. Aromatic The essential oil constituents of Angelica may be involved in its diaphoretic, circulatory stimulant, carminative, and antispasmodic actions. However, Angelica does not seem to have the mental stimulant and antidepressant actions of Rosmarinus or Turnera, or the sedative action of Lavandula. Bitter Angelica is a moderately bitter herb. It is not as bitter as, for example, Artemisia. Genticma, or Hydrastis. Nor does Angelica have such a strong effect on the hepatobiliary system as do those three herbs.
207
Circulatory stimulant Angelica is warm. but not hot. So for cold conditions it would need to be combined with hot herbs. It is specific for poor circulation with digestive weakness and chronic bronchitis, especially in cases where there is an accumulation of Cold. Damp, and Phlegm. It would not be appropriate for someone with cold extremities who also has Deficient Yin and Dryness. Carminative and antispasmodic Angelica can relax intestinal spasms and reduce Damp and Phlegm, but it is neither strongly sedative nor antidepressant. If abdominal discomfort and obesity are associated with anxiety or depression. it would need to be combined with other antispasmodic herbs. such as Rosmarinus for depression or Lavandula for anxiety. Bitter digestive tonic and regulator Angelica is only a moderately strong bitter, so if strong bitter tonic action is requir.ed, Angelica would need to be combined with Cinchona or Centaurium. for example. Also, it is a warming bitter tonic and therefore may not be appropriate for mixed conditions of Deficiency and Heat, such as digestive weakness associated with gastrointestinal inflammation, for which Gentiana would be more suitable.
Angelica paired with other herbs Discussion of the limitations of each of the main actions of Angelica can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Angelica beyond its limitations. The basic unit of herb combination is the herb pair. Six pairings of Angelica are briefly explained below.
CAUTION ACTIONS Diaphoretic action Angelica is a warming, drying diaphoretic for Wind Cold Damp patterns, but which is not suitable for Wmd Heat or Wmd Dryness.
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair. Angelica + Achillea
Influenza + sinusitis Expectorant action Angelica is a warming, drying expectorant and anticatarrhal for Lung Phlegm with Cold and. Damp. It is therefore not appropriate for Lung Phlegm with Heat and Dryness. For example, it would be inappropriate for a dry, irritant cough. with scanty, yellowish sputum. However, it is an excellent herb for chronic bronchitis ~th . debility associated with digestive or circulatory weakness, provided that there are no signs of Heat or Dryness.
Being paired with Achillea emphasizes the diaphoretic action of Angelica so the two herbs can be used to treat colds and influenza with moderate fever. Angelica emphasizes the anticatarrhal action ofAchillea and directs this activity especially to the head and sinuses. Accordingly, these herbs can . be used together for acute sinus congestion or sinus headache accompanying influenza.
----Combining Western Herbs and Chinese Medicine
208
Angelica combinations
Angelica + Thuja
Chronic bronchitis + cold sensations Angelica and Thuja have both expectorant and circulatory stimulant actions so that they can be paired for bronchial congestion with poor peripheral circulation. In terms of Chinese medicine, they can clear Lung Phlegm Cold and warm, tonify, and move Heart Qi. Both herbs can be used for rheumatism with poor peripheral circulation and Interior Damp and Phlegm. Angelica + Zingiber
Digestive weakness + flatulence The acrid constituents of Zingiber can combine with those of Angelica to induce sweating and clear Exterior Wind Cold conditions, and the aromatic constituents of both herbs can combine to relax muscle spasms in the intestines. The unique combination of bitter, aromatic, and acrid constituents makes Angelica an ideal herb for Spleen Deficiency with Cold and Damp. Angelica and Zingiber can also have a warming expectorant action in patients with patterns of Lung Phlegm Cold. Angelica + Zanthoxylum
Arthritis + cold sensations Both herbs are circulatory stimulants. which can be used to strengthen peripheral circulation. Angelica emphasizes both the surface-active and the anticatarrhal actions of Zanthoxylum. As a result, these herbs can be combined to treat rheumatism or arthritis associated with a combination of Exterior and Interior Cold and Damp. Angelica + Phytolacca
Chronic sinusitis + obesity Both herbs can have a drying action to clear Damp and Phlegm, but Angelica is warming, whilst Phytolacca can have a cooling effect. These herbs can be paired for catarrhal conditions of both the sinuses and bronchi, and for Phlegm and Damp obstructing the channels, as in some forms of rheumatism and arthritis. They can also assist weight loss, providing the patient also adopts suitable exercise and nutritional regimes.
..
..
~----~._~
Six Angelica combinations are discussed below:
Wind Cold Damp
1. influenza + sinusitis
2. chronic bronchitis + cold sensations Lung Phlegm Cold + Spleen Deficient Yang
3. digestive weakness + flatulence
Spleen Deficient Qi + Damp + Phlegm
4. arthritis + cold extremities
Stagnant Qi and Blood + Cold in the channels
5. sinusitis + obesity
Lung Phlegm Damp + Spleen Damp
6. depression + obesity
Heart Stagnant Qi + Spleen Damp
CAUTION
Before using any ofthe combinations below, it is important to be familiar with the cautions listed for each herb in the combination.
1. Influenza + sinusitis
Wind Cold Damp Herb
Daily -dose Temperature Taste_
3g 3g 3g Sambucus 3g Euphrasia Zingiber (fresh) 3 slices
Achillea Angelica arc.
warm-eool warm cool neutral-eool hot
acrid. bitter bitter. acrid, aromatic acrid, sl. bitter acrid, sour, bitter acrid, aromatic
This combination is the same as Achillea: influenza + sinusitis and is discussed under that heading.
2. Chronic bronchitis + cold sensations
Lung Phlegm Cold + Spleen Deficient Yang
Angelica + Rosmarinus Taste _
Chronic depression Culpeper wrote that Angelica can strengthen the heart and fortify it against poison, and Rosmarinus can refresh the spirits, make them lively and active, and drive melancholy 'vapors' from the heart. Although Angelica is not a primary herb for depression, it can help Rosmarinus warm, move, and disperse Heart Qi, especially when it is obstructed by Phlegm and Damp.
Commiphora Thymus Angelica arc. Prunus Lobelia Glycyrrhiza Zingiber Capsicum
1 1 1 1 1
0.5 0.5 5-20 drops
warm
bitter, acrid
warm-cool warm
aromatic bitter, acrid, aromatic
neutral
bitter, aromatic
warm-eool neutral-cool
acrid
hot
sweet acrid, aromatic
hot
acrid
.. ,·,Angelica This combination is the same as Commiphora: chronic bronchitis + cold sensations and is discussed under that heading. 3. Digestive weakness + flatulence
Spleen Deficient Qi + Damp + Phlegm "~~ ~ "':~;"'~..,~:'"
Herb
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. Ratio
Juniperus Angelica arc. Artemisia abs. Gentiana Citrus (ripe peel) Zingiber
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209
may also be some Deficient Yang of the Lung and Spleen. The overall temperature is warm-hot to treat cool or cold conditions. Capsicum can be omitted, if required, to reduce the overall temperature of the prescription. The acrid and aromatic properties combine to warm and move the Qi of the Lung and Spleen to transform and disperse Damp and Phlegm.
.. ':,:-:~~."', •.r:.
Temperature :~aStey"'; -; of
'1
1 1 1 1 0.5
sl. warm warm warm-cool neutral-cool warm
aromatic, 51. acrid, sl. sour aromatic, bitter, acrid aromatic, bitter bitter acrid, aromatic, bitter
0.5
hot
acrid, aromatic
This combination is the same as Juniperus: digestive weak+ flatulence and is discussed under that heading.
n~s
4. Arthritis + cold extremities
Stagnant Qi and Blood + Cold in the channels
USE
• chronic sinusitis and/or bronchitis with one or more of the following: - lethargy, sensations of heaviness in body and limbs - mental cloudiness and dullness - catarrhal deafness - cloudy discharges -edema PRACTICAL NOTES
This combination can be taken as 5-7.5 ml of 1:5 tincture in quarter of a cup of warm water three times per day. This combination is designed for long-term use.
Caution This combination is warm-hot in temperature
This combination is the same as Zanthoxylum: arthritis + cold extremities and is discussed under that heading.
and is not suitable for either Heat patterns or mixed patterns of Heat and Cold. The patient should be monitored for appearance of adverse Heat signs, and if these occur, the prescription should be stopped or modified. Also, see the cautions for all the herbs in the prescription. This combination is in no way suggested as a treatment for obesity. Rather, it is designed to treat an overall pattern of Lung Phlegm Damp and Spleen Deficient Qi with accumulation of Damp and Phlegm, of which obesity may be one of many signs.
5. Sinusitis + obesity
6. Depression + obesity
Lung Phlegm Damp + Spleen Damp
Heart Stagnant Qi + Spleen Damp
1 Zanthoxylum (bark) 1 Populus Harpagophytum 1 1 Angelica arc. 1 Angelica sin. 0.5 Zingiber 5-20 drops Capsicum
..
hot
acrid, aromatic, bitter
neutral-cool cool warm warm hot hot
bitter, sour bitter bitter, acrid, aromatic sweet, aromatic, bitter acrid, aromatic acrid
I
-.
Herb'c .-":.-:',
.,
Angelica arc. Zanthoxylum (berries) Juniperus
1 1
warm hot
bitter, acrid, aromatic acrid, aromatic, bitter
1
51. warm
Phytolacca Thuja Myrica Zingiber Capsicum
1 1 1
cool warm-cool warm hot hot
aromatic, 51. acrid sl. sour acrid acrid, aromatic, bitter acrid, sour, bitter acrid, aromatic acrid
0.5 5-20 drops
.
- '~'
Angelica arc. Zanthoxylum (berries) Juniperus
Ratio'
Temperature ' Taste
-
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.
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1 1
warm hot
bitter, acrid, aromatic acrid, aromatic, bitter
1
51. warm
aromatic, 51. acrid, sl. sour aromatic, bitter, acrid bitter, aromatic, acrid sweet, sl. bitter, acrid, aromatic acrid
Rosmarinus 1 Turnera 1 Panax gin. 1 Zingiber 0.5 Capsicum 5-20 drops
warm warm sl. warm hot hot
GENERAL
GENERAL
This combination is for Lung Phlegm Damp and Spleen Deficient Qi with accumulation of Damp and Phlegm. There
This combination is for Heart Stagnant Qi, Heart Deficient Qi, and Spleen Deficient Qi with accumulation of Damp
::;5-.-;' ..
:~
.- .....
Combining Western Herbs and Chinese Medicine
210
and Phlegm. There may also be some Deficient Yang of the Heart and Spleen. The overall temperature is warm to treat cool or cold conditions. Capsicum can be omitted, if required, to reduce the overall temperature of the prescription. The acrid and aromatic properties combine to warm and move the Qi of the Heart and Spleen to transform and disperse Damp and Phlegm. USE
• chronic depression, sadness, and loneliness, with one or more of the following: - sensations of cold -lethargy, sensations of heaviness in body and limbs - mental cloudiness, mental dullness -edema PRACTICAL NOTES:
This combination ~ be taken as 5-7.5 ml of 1:5 tincture in quarter of a cup of water, three times per day. This combination is designed forlong-term use.
~cc
~~
1. All the herbs in combination No.1 can clear Exterior·: -~:~ . Wind, especially When this is associated with obstruction of .."~
the sinuses by Phlegm. Angelica and ZiI1giber are warming herbs to clear Wind Cold, and Angelica is a drying antica~ _. tarrhal herb for Lung Phlegm Damp. -~:-::.!"",-
7".....:;~__ :
2. Combination No. 1 is specific for clearing Wind Cold from the surface and Phlegm Cold from the sinuses. Combination No.2 has more of an effect on the Interior. Commiphora combines with Angelica to clear Lung Phlegm and warm and tonify both Spleen and Heart. Prunus, Lobelia, Glycyrrhiza, and Thymus combine to give expectorant yet antispasmodic and antitussive actions.
3. Digestive weakness + flatulence
4. Arthritis + cold extremities
Spleen Deficient Qi + Damp + Phlegm
Stagnant Qi and Blood + Cold in the channels
Juniperus Angelica arc. Artemisia abs. Gentiana Citrus (ripe peel) Zingiber
Zanthoxylum (bark) Populus Harpagophytum Angelica arc. Angelica sin. Zingiber Capsicum
warm
Caution
This combination is warm-hot in temperature and is not suitable for either Heat patterns or mixed patterns of Heat and Cold. The patient should be monitored for appearance of adverse signs of Heat, restlessness, or irritability, and if these occur, the prescription should be stopped or modified. Also, see cautions for all the herbs in the prescription. This combination is in no way suggested as a treatment for obesity. Rather, it is designed to treat an overall pattern of Heart Stagnant Qi and Spleen Deficient Qi with accumulation of Damp and Phlegm, of which obesity may be one of many signs.
ANGELICA COMBINATIONS 1. Influenza + sinusitis
2. Chronic bronchitis + cold sensations
Wind Cold Damp
Lung Phlegm Cold + Spleen Deficient Yang
3g 3g 3g 3g 3 slices
Commiphora Thymus Angelica arc. .: Prunus Lobelia Glycyrrhiza Zingiber Capsicum
1 1 1 0.5 0.5
1 1 1 1 0.5 0.5
5-20 drops
3. Juniperus and Angelica are warming, drying aromatic herbs that are used here for the loss of appetite with digestive weakness, tiredness, and phlegmy cough. Artemisia and Gentiana are bitter herbs to stimulate the appetite; they are supported by the bitter constituents of Angelica. Citrus and Zingiber help the Spleen to transform Phlegm and to treat phlegmy cough.
COMPAR.ISON OF THE SIX
Achillea Angelica arc. Sambucus Euphrasia Zingiber (fresh)
1
1 1 - 1 1 1 0.5
0.5 5-20 drops
4. All the herbs in combination No.4 can be used to treat arthritic and rheumatic disorders. Zanthoxylum, A. archangelica, Zingiber, and Capsicum make this combination specific for cases involving Wind, Cold, Damp, and Phlegm, with poor peripheral circulation and sensations of cold. Both Angelicas can move Stagnant Qi and Blood. However, A. archangelica is relatively more for clearing Exterior Wind from the channels of the muscles and joints, and A. sinensis is relatively more for tonifying Blood to prevent further entry of Exterior Wind. Harpagophytum and Populus can act as general-purpose antiarthritics for inflammation, pain, and immobility, but they are also specific for patterns involving Wind Cold Damp, and Damp Heat. They enable this combination to be used for mixed patterns of Cold and Heat.
.
...-.
Angelica 5. Sinusitis + obesity
6. Depression + obesity
Lung Phlegm Cold + Spleen Damp
Heart Stagnant Qi + Spleen Damp
Angelica arc. zanthoxylum
Angelica arc. Zanthoxylum
1 1
(berries)
(berries) Juniperus Phytolacca Thuja Myrica Zingiber Capsicum
1 1
Juniperus
1 1 1 1
Rosmarinus Tumera
0.5
Panax gin. Zingiber
5-20 drops
Capsicum
1 1 1 1
0.5
tial oil content of A. sinensis as 0.2-0.4%, of which 45% is ligustilide.
Monoterpenes
Monoterpene hydrocarbons make up 8090% of the essential oil of A. archangelica, with the follOWing as the main components:8 • a-pinene, 14-31% • ~-phellandrene, 13-28% • a-phellandrene, 2-140/0
Sesquiterpenes Wichtllisted ~-caryophyllene,~-bisabo lene, bisabolol, and various macrocyclic lactones for A. archangelica.
5-20 drops
5. Combinations No.4 an.d No.5 have Angelica, Zanth-
oxylum, Zingiber, and Capsicum in common to warm and move Qi and Blood. However, combination No.5 also has Juniperus, Thuja, Myrica, and Phytolacca to transform and disperse Phlegm and Damp in the sinuses, bronchi, and body in general to treat chronic respiratory catarrh with obesity. 6. Combinations No.5 and No.6 have Angelica, Zanthoxylum, Juniperus, Zingiber, and Capsicum in common. However, instead of Phytolacca, Thuja, and Myrica to clear Lung Phlegm Cold, combination No.6 contains the antidepressant herbs Rosmarinus, Turnera, and Pan ax. Angelica can assist Rosmarinus to warm and move Heart Stagnant Qi.
""'--
211
Furanocoumarins Over 20 furanocoumarins have been listed for A. archangelica, including bergaptan, xanthotoxin, angelicin, and archangelicin.9 Bergaptan is also found in the roots of A. pubescens. 1o and A. dahurica. 11 Coumarins A. archangelica has been reported to contain. osthole and umbelliferone. 8 Ostholeis also present in A. pubescens. 12 Phenolic carboxylic acids Wichtl listed phenolic carboxylic acids as components of A. archangelica. Ferulic acid is a component of A. sinensis. 13 Other A. archangelica
This herb has been reported to contain the flavanone archangelenone, tannins, sitosterols, fatty acids, and saccharose.6
OTHER ANGELICA COMBINATIONS
A. sinensis According to Chang and But, A. sinensis con-
Other combinations that contain A. archangelica include the following:
tains 40% sucrose, sitosterol, vitamins A and E, vitamin B12, nicotinic acid, folic acid, folinic acid, and biotin. Recent studies have reported polysaccharides with gastrointestinal protective effects from A. sinensis. 14
• Juniperus: phlegmy cough • Myrica: chronic sinusitis
PHARMACOLOGICAL AND
Research CONSTITUENTS The following constituents have been reported: • essential oil ·furanocoumarins • coumarins • phenolic carboxylic acids • other Essential oil Wichtl6 gave the essential oil content of A. archangelica as 0.35-1.9%. Chang and Bue listed the essen-
CLINICAL RESEARCH The following effects have been reported for Angelica species or for isolated constituents: • antimicrobial • anti-inflammatory and analgesic. • antispasmodic • antiasthmatic and antibronchitic
• emmenagogue • sedative • cardiovascular effects • antiatherogenic • anticoagulant
212
Combining Western Herbs and Chinese i\1edicine
-~'~
--:--~:;:~~~ _.<.~
• antianemic • central nervous system effects • hepatoprotective • immunoregulatory • antitumor and antimutagenic Antimicrobial An antimicrobial effect was reported for an A. dahurica decoction,15 and a weak antimicrobial action was reported for an A. sinensis decoction. 16 An early study reported that the coumarin umbelliferone could inhibit Brucella Spp.,17 and a more recent study reported that umbelliferone may have potential as an antiviral agent. 18 Anti-inflammatory and analgesic
Furanocoumarins and coumarins An in vivo mouse study reported that the furanocoumarin bergapten from A. dahurica has an anti-inflammatory effect. 11 Bergapten and the coumarin umbelliferone from A. pubescens showed both anti-inflammatory and !'Jlalgesic_effeets!1~10 rng/kg, and the coumarin osthole and the furanocoumarin xanthotoxin showed anti-inflammatory activity. 10 Monoterpenes and sesquiterpenes a-pinene, ~-pinene,19 and a-pinene and ~-caryophyllene,2°were reported to have anti-inflammatory effects in animal studies. ~-caryophyllene was reported to inhibit induced gastric mucosal injuries in rats, whilst hardly affecting the secretion of gastric acid and pepsin. 21 Extracts and polysaccharides An A. archangelica extract was reported to have antiulcerogenic action against chemically induced gastric ulcers in rats, with reduced acid output, increased mucin secretion, and a decrease in leukotrienes. 11 An extract of polysaccharides from the root of A. sinensis was reported to prevent induced gastric mucosal damage in 14 rats. A further study found that A. sinensis crude extract enhanced gastric ulcer healing in rats and promoted wound repair in cultures of gastric epithelial cells. 23 Antispasmodic
Essential oils from Angelica root were
reported to have a relaxant effect on guinea-pig tracheal and ileal smooth muscles.24 The coumarin osthole isolated from A. pubescens had a relaxant action on guinea-pig trachea, which the authors concluded was a result of inhibiting cyclic-AMP and cyclicGMP phosphodiesterases. 25 Osthole isolated from A. pubescens was also reported to have a vasorelaxant effect on rat thoracic aorta, which the authors concluded was the result of the calcium-blocking properties of osthole and of raising levels of cyclic-GMP in the muscle. 12 Vasorelaxant activity was also reported for a methanolic extract of A. furcijuga and for khellactone-type coumarins
isolated from the plant. 26 An ethanol extract of the rootso!~ ~:.c~·::';·. A. keiskei and chalcones isolated from it were reported to reduce induced constriction in rat aortic rings.!7
_.;~
Antiasthmatic and antibronchitic An ether extract of A. sinensis was reported to be effective in the treatment of sta:~ . tus asthmaticus, with beneficial results appearing in 2-10 hours and control being established in 12-48 hours. 28 Beneficial results were also reported using an injection of A. sinensis root preparations in the treatment of bronchial asthma. 29 Another study reported the efficacy of oral administration of A. sinensis root extract in the treatment of chronic bronchitis complicated by pulmonary emphysema or pulmonary heart disease at the early or remission stage. 30 An A. pubescens decoction was reported to have antitussive and antiasthmatic effects: 7% had marked effects, whilst 66% showed some response. 31 Emmenagogue Experiments with A. sinensis root extracts showed a biphasic, regulatory effect on animal uteri. 32 essential oils inhibited contraction, and the nonvolatile fraction increased uterine contraction. The action of the herb on the uterus also depended on the state of the organ. Intravenous administration of ferulic acid, which is a component of A. sinensis, was shown to have an inhibitory effect on movement of rat uterus in situ. 33
The
Estrogenic activity In an early study in China, A. sinensis was reported to have no estrogenic action in mice, as judged by the vaginal smear examination, nor did uterine weight increase following use of the herb. 34 In a recent in vitro study, A. sinensis showed only weak binding to estrogen receptors, only weak effect on progesterone receptors, and only weak induction of the estrogen-inducible presenelin-2 gene in 530 breast cancer cells. 35 A double-blind, randomized, placebo-controlled trial was conducted to assess the effect of A. sinensis on vaginal cells and on endometrial thickness in postmenopausal women. It was concluded that used alone, A. sinensis does not produce estrogen-like responses in endometrial thickness or vaginal maturation, and was no more effective than the placebo in relieving menopausal symptoms. 36 Sedative An A. pubescens decoction was reported to have sedative and hypnotic effects when administered either intragastrically or intraperitoneally to mice or rats. 37 Both an ether extract of A. sinensis and the essential oils of this herb were reported to have a sedative effect. 38 Both the extract of Japanese Angelica rooe9 and ligustilide or butylidenephthalide extracted from this plant promoted sleep in mice. 40 Cardiovascular effects
Antiarrhythmic
Angelica injection was reported to have
,::_.--'-~
~.-
Angelica protective effect against arrhythmia in rats, using the myocardial ischemic reperfusion modeL H Antihypertensive An A. sinensis extract was reported to lower arterial blood pressure in dogs whilst at the same time reducing the resistance of the coronary, cerebral, and femoral arteries, and increasing peripheral blood flow. 42 The coumarin osthole, contained in A. archangelica and A. pubescens, was reported to have antihypertensive effects in vivo, ~3 and an extract of A. sinensis was reported to reduce pulmonary arterial pressure in patients with pulmonary hypertension.o\-I Antiatherogenic Injections of A. sinensis in rabbits were reported to inhibit aorta atherogenesis by decreasing the serum triglyceride concentration.~5 It has been reported that A. sinensis can protect human vascular endothelial cells from the effects of oxidized low-density lipoproteins in vitro, supporting the antiatherogenic effect of this herb. 46 Anticoagulant A. sinensis decoction was reported to suppress induced platelet aggregation in rats. ~7 It has been reported that osthole can inhibit platelet aggregation in vitro.~3 In vitro studies with an A. sinensis extract reported that this herb can reduce the aggregation, deformation, and osmotic fragility of human erythrocytes.-l8 !_.
Antianemic It has been suggested that the reported antianemic effect of A. sinensis may be partly due to its content of vitamin B 12, folic acid, nicotinic acid, and biotin. 49 Central nervous system effects Using the passive avoidance test, A. sinensis root extracts were reported to reduce amnesia in rats induced by various drugs.3{) Hepatoprotective The methanolic extract from the roots of A. furcijuga and its isolated coumarin and polyacetylene constituents were reported to have hepatoprotective effects and to inhibit nitrous oxide production in vitro. 51 It was found that A. sinensis polysaccharides can reduce induced liver injury in mice.5~.53 Immunoregulatory Ange1an, a polysaccharide from A. gigas, potentiated immune function. 54 A low molecular weight polysaccharide from A. sinensis showed antitumor activity in Ehrlich Ascites tumor-bearing mice and immunostimulating activities, both in vitro and in vivo.55 Antitumor and antimutagenic A carbon tetrachloride extract of A. japonica inhibited cell growth of human gastric adenocarcinoma (MK-l). Presumably the active constituents were the furanocoumarins. 56 Antimutagenic properties of A. archangelica
213
extracts were reported using the micronucleus test in murine bone marrow cells.57
RESEARCH VERIFICATION OF TRADITIONAL ACTIONS The following traditional actions of Angelica have been supported by research: antiulcer, expectorant, emmenagogue, hepatic, and antitoxin. It should be pointed out that the evidence for these actions comes from research on Angelica species other than A.archangelica~This means that there is as yet no evidence to support any of the traditional actions for A. archangelica specifically. Additional effects demonstrated by research The following additional effects have been reported for Angelica species or for their isolated constituents: antimicrobial, antiinflammatory, analgesic, sedative, antispasmodic, antiasthmatic, antiarrhythmic, antihypertensive, anticoagulant, antilipemic, antianemic, immunoregulatory, and anticancer. It would seem that the clinical uses of the Angelica species can be greatly expanded.
TOXICOLOGY An important distinction A careful distinction needs to be made between the use of: • therapeutic doses of Angelica as an infusion, decoction, or tincture • Angelica essential oil • isolated components ofAngelica, such as bergaptan Reports of toxic or adverse effects for pure constituents from Angelica, or for its essential oil, do not necessarily apply to the use of infusions, decoctions, or ethanolic tinctures of the root of this plant, when used in the recommended therapeutic doses. This is because the pure constituents and the essential oil represent much higher levels of a potentially toxic constituent than are found in the herb itself, and because other constituents in the herb may protect against potentially toxic effects. A. archangeIica root preparations I have not found information on toxicity or adverse effects of preparations of A. archangelica when taken within the recommended dose range. According to the German Commission E monograph,58 no contraindications and no herb-drug interactions are known for this herb.
Photosensitivity I have not Seen research evidence to show that preparations of A. archangelica root can cause photosensitivity when taken within the recommended dose range.
214
Combining Western Herbs and Chinese Medicine
However. the furanocoumarin bergaptan has been reported to have phototoxic effects. although it has been suggested that due to the negligible solubility of furanocoumarins in water, no risk of phototoxic effects is likely from the tea. 59 If the practitioner prefers. the patient can be advised to avoid prolonged sunbathing or other exposure to intense UV irradiation during the period of treatment with preparations of this herb, as recommended in the Commission E monograph. However, to keep a sense of perspective, the amount of furanocoumarins in A. archangelica root appears to be about the same as in a lemon peel, which is commonly used to flavor foods and drinks. A. archangelica oil In phototoxicity tests, distinct positive results were obtained with as little as 3.125% oil. 60 The International Fragrance Association recommended that if Angelica oil is applied to the skin in preparations containing over 3.9% of the oil, the skin must not be exposed to sunlight or sunbed rays for 12 hours. 61 Phototoxicity is primarily due to the presence of bergapten. Isolated constituents The furanocoumarin bergaptan has been reported to have phototoxic effects,62 and may increase the damaging effects of ultraviolet light, although it can also protect against them. 63
"-
Pregnancy and lactation No adverse effects reported, but .'~ Moore 4 suggested avoidance of Angelica in pregnancy, - 'c:,~ although he considered it 'not particularly a stin,lulant to the ,.,~ uterus: -,.~:7 Side effects None reported, but see Photosensitivity and,,' . ',_ ':'-:'.:£. Duration above. A~
-.:.'M'
Overdose No adverse reports, but see Duration above. Interactions No adverse reports for A. archangelica. There has been one report that A. sinensis significantly increases the anticoagulant effect of warfarin in rabbits. 65 However, the dose levels of A. sinensis used were far in excess of the human therapeutic dose.
.:-.:........... ,
_.,-
Regulatory status
.-
on SafetY'°:t~ A. archangelica (angelica root) is on the UK General Sale List (Statutory Instrument Order 1977 No. 2129 to the Medicines Act 1968). Angelica root is not included in Part 4
~=
i'Jfl-~ ---o:c.
Australia. Angelica root is not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
Traditional sources
Tincture The BHP listed 0.5-2 ml of 1:5 liquid extract (in 50% alcohol), three times per day.
There is no entry for A. archangelica in the Chinese Herbal Medicine Dictionary. The values of the properties of
Can start at the standard dose. A. DAHURICA baf zhl
A. PUBESCENS
du hu6
A. SINENSIS dang gul . ~...':~,;,' ,~,?~::-~
Properties (range of opinion)
.-
.';.
Temperature
Western contraindications
None reported.
Chinese contraindications A. archangelica is not listed in the Chinese Herbal Medicine Dictionary, but since I consider this herb to be both warming and drying, I would avoid its use for persons with patterns of Heat and/or Dryness, especially in the Lung.
_2~
of Schedule 4 of the Therapeutic Goods Act Regulations of-,=~
SPECIES USED IN CHINESE MEDICINE
Cautions
.--
. ~:~r:l.
Dried herb The BHp6-l listed 1-2 g of the dried root, three times per day.
Duration I have not seen any restrictions recorded in texts, but I would avoid prolonged use of this herb for persons with sensations of heat and/or dryness in the head and face.
~
. -=-C'..::j::-;,
Please read the Regulatory status section in the chapter::'T~
Dose
Initial dose
..
>'-~-o:
main text subsidiary texts
warm
wann 1. neutral 2. slightly warm 3. slightly cool
warm 1. slightly warm 2. very warm
acrid acrid, slightly sweet
bitter. acrid sweet
sweet, acrid 1. sweet 2. bitter
LU, Sp' ST 1. ST. LR. LU 2. LV, ST, LR
KI. BL 1. KI, HT 2. LU,KI 3. SI, UB, LV, KI 4. HT, LV, KI, US
HT, LV, SP 1. PC, SP. LV 2. HT. LV. LU
Taste main text subsidiary texts
Meridians main text subsidiary texts
Angelica the three species most commonly used in Chinese medicine are listed in the species comparison table below. Note For each herb, the Chinese Herball·yfedicine Dictionary often included material not only from one main text, but also from various subsidiary texts. Values from both the main text and the subsidiary texts used by Chinese Herbal Medicine Dictionary are given in the table (next page, top) to show the range of opinions. It can be seen from the table that there is a considerable range of opinions on the values for the temperature, the taste, and especially the meridians entered. PROPERTIES OF A. ARCHANGELICA Temperature According to Dioscorides, the roots, leaves, and seeds of Angelica have warming properties, and Culpeper66 recommended it for cold disorders. Both Lonicerus67 and Gerard 68classified A. archangelica as hot and dry in the third degree, but Tabernaemontanus69 considered it to be hot in the third degree and dry in the second. It is classified in this book as warm rather than hot because it does not have a strong heating effect on the body. Taste in the mouth The BHP described the taste of A. archangelica root as sweet, becoming slightly bitter and astringent. According to Wichtl, the taste is 'first aromatic, then acrid, bitter, and lastingly pungent' I found samples of both the dried root and a 1:5 tincture in 45% alcohol to be slightly sweet and mucilaginous, slightly sour and astringent, definitely aromatic, bitter, and with a lingering pungent taste and tingling sensation on the tongue. The tincture was relatively more aromatic and the dried material was relatively more bitter. Taste properties
Aromatic A. archangelica is classified in this book as aromatic because it can be used as a warming and drying carminative to stimulate the digestive system and treat flatulence and colic. Acrid This book classifies A. archangelica as acrid since it can have both a warming diaphoretic action at the surface of the body and a warming action in the interior. Bitter A. archangelica is used as a bitter digestive tonic in European tradition. Mills70 suggested that the bitterness of the fur3?ocoumarins provides the digestive tonic action. Sweet A. archange1ica is not classified as sweet in this book. It does have saccharose as a constituent, but A. archangelica does not smell or taste as sweet as A. sinensis, and is not generally used as a nutritive tonic. A. archangelica is classified as drying whilst A. sinensis is relatively more moistening.
215
ORGANS In terms of Chinese medicine, Angelica, as used in the West, can be associated mainly with disorders Of the following systems: Examples of use
Source ..
Spleen. Stomach
bitter digestive tonic
Wichtl
Intestines
intestinal flatulence and colic
Commission E monograph
lung
expectorant and antispasmodic for bronchial asthma
BHP
Heart
peripheral vascular disease
BHP
Uver
problems of the liver
Gerard. Culpeper. Kloss
Organ
There is no entry for A. archangelica in the Chinese Herbal Medicine Dictionary. ACTIONS The following traditional actions are discussed: • diaphoretic • cardiotonic • circulatory stimulant • antirheumatic • carminative • anticatarrhal • expectorant and antiasthmatic • bitter digestive tonic • emmenagogue • diuretic • hepatic • antitoxin Diaphoretic Dioscorides recommended Angelica for fever, and Gerard said that it could be used for infections from 'evil and corrupt air: driving them out by urine and sweat. Lyle71 wrote that the seeds of A. atropurpurea have diaphoretic and antiperiodic action and can be used for acute fever and colds. Both Grieve72 and Mills listed A. archangelica as a diaphoretic for feverish conditions, Mabey3 recommended it in hot infusion as a diaphoretic for colds, and TierraH listed it as a warming diaphoretic for colds and influenza. Cardiotonic Gerard wrote that Angelica is beneficial to the heart, and Tabernaemontanus said that Angelica root strengthens the heart if it is weak due to cold. Culpeper wrote that Angelica 'resists poison by defending and comforting the heart, blood and spirits: and Parkinson echoed this statement. Kloss also wrote that Angelica can strengthen the heart.
..~.~~ ..
216
Combining Western Herbs and Chinese Medicine
Circulatory stimulant Lonicerus wrote that Angelica warms the body. According to Tabernaemontanus, Angelica can be used for internal injuries due to trauma from falls or blows, since 'it breaks congealed blood and removes it: He said that Angelica can 'warm the head and brain and prevent a stroke in old, cold people: Angelica is listed in Mabey as a circulatory stimulant to warm cold hands and feet and for anemia. The BHP listed it to treat peripheral vascular disease. It is interesting that research on A. sinensis has reported that this herb can increase peripheral blood flow and treat early stage thromboangiitis obliterans and anemia. Antirheumatic Culpeper wrote that Angelica eases all pains and torments coming from cold and wind, and Felter and Lloyd as well as Grieve recommended this herb for chronic rheumatism and gout. The BHP listed Angelica for rheumatic diseases. Carminative Dioscorides recommended Angelica for flatulence, and Lonicerus listed it for stomach aches due to cold. Culpeper wrote that Angelica can warm a cold stomach, help digestion, and relieve the results of overeating. According to Tabernaemontanus, Angelica can increase the appetite and is good for dampness in the stomach, heartburn, stomach acidity, and pain in epigastrium or abdomen. The BHP listed Angelica for flatulent dyspepsia, and Mabey stated that this herb warms and stimulates digestion and treats indigestion, colic, and flatulence. Anticatarrhal I have not found reference to an anticatarrhal action in traditional texts. However, I use A. archangelica as a warming, drying, aromatic herb to: • stimulate the Spleen to transform Damp • stimulate the Lung to clear Phlegm and Damp • clear Phlegm and Damp from the head • clear Phlegm and Damp from the channels of the muscles and joints I use A. archangelica not only for phlegm in the lungs, but also for phlegm in the sinuses with nasal congestion, sinus headache, or postnasal drip. I also use it in combinations to treat a general body tendency to phlegm and obesity, associated with Interior Deficiency, Cold, Damp, and Phlegm. Expectorant and antiasthmatic Gerard said that A. archangelica attenuates and thins tough phlegm, and helps asthma by dissolving ~d expectorating the phlegm. Tabernaemontanus wrote that Angelica can treat chronic coldtype coughs, wheezing, and shortness of breath because it softens and loosens thick phlegm, allowing it to be easily expectorated. Culpeper recommended Angelica for all dis-
_~-
-~' '. .
---.;".-.
• .-"'C.;;'.,
...•..
, ..-
.
-. -'~.~·~i _. .. eases of the lungs, including pleurisy, cough, and shor·tri~~.=::.. ,.-,l!'@
of breath. ::.,::' Felter and Lloyd listed A. archangelica as a stimulant to_~~' the respiratory mucous surfaces to treat chronic bronchitis~··'d..~ The BHP listed it as specific for bronchitis with vasculaD. deficiency, and it is interesting to note that A. sinensis has~-~¥i been reported to help chronic bronchitis complicated by ..~__ pulmonary heart disease. '/c",,' _.~
Bitter digestive tonic According to both Gerard and Tabernaemontanus, Angelica can increase the appetite, and both Gerard and Culpeper wrote that A. archangelica opens obstructions of the liver and spleen. Tabernaemontanus said that powdered Angelica root can warm the liver and treat .. '" congestion in this organ. Wichtl stated that Angelica stimulates gastric and pan-"':f:fji _.. creatic secretions. The BHP listed it for anorexia nervosa.·,;-~ ". According to Mills, 'there is probably no better convalescel1~;.;~;'.~ remedy in the Western materia medica: .• -,:~ ;: --.-.,.~
Emmenagogue Dioscorides, Lonicerus, Tabernaemontan~ us, and Culpeper all listed Angelica as a herb to induce menstruation. In addition, Tabernaemontanus noted its use in helping with difficult labor and postnatal pains, and Culpeper recommended it to expel the afterbirth. Lyle recommended a hot infusion of A. atropurpurea for dysmenorrhea, especially in nervous women. According to Mabey, the antispasmodic action of Angelica can assist the treatment of dysmenorrhea, and it can gently promote the onset of menstruation. I do not use A. archangelica as a primary emmenagogue. Diuretic Dioscorides recommended Angelica for edema and for diseases of the kidneys and bladder. Lonicerus listed this herb for dribbling urination, and Culpeper noted the use of Angelica for the stranguary or the stoppage of urine. The BHP listed it as a diuretic, and its traditional use in Germany as a diuretic is noted in Wichtl. Hepatic Tabernaemontanus recommended Angelica for conditions of cold and stagnation in the liver, and Culpeper wrote that it opens obstructions of the liver and spleen. The German Commission E monograph listed the cholagogic action for this herb, and Wichtl noted that Angelica is included in German herbal combinations for the biliary system. Antitoxin Dioscorides listed Angelica for snake bites, and both Lonicerus and Tabernaemontanus recommended it to drive out poisons and to treat the plague. Culpeper wrote that Angelica could treat epidemic: diseases, and resist poisons. Interestingly, Yeung75 mentioned that A. dahurica has shown antimicrobial action and has been used in China as an antitoxin for snake bites.
Angelica
Comparison ofWestern and Chinese use ofAngelica species The actions and uses of A. archangelica, A. dahurica (bai zhl), A. pubescens (dti hu6), and A. sinensis (dang guI) are compared below, viewed through the perspective of taste.
TEMPERATURE All four herbs are classified as warm.
TASTE A. archangelica is classified in this book as aromatic, bitter, and acrid. There is some variation of opinion regarding the taste properties assigned to the three Chinese species, but generally A. dahurica is regarded as acrid, A pubescens as bitter and acrid, and A. sinensis as sweet, acrid, and bitter. Acrid
All four herbs are classified as acrid, but their acrid
properties can manifest in different ways:
A. archangelica • clears Wind Cold, Damp, and Phlegm from the surface, either from the sinuses and head (to treat influenza with sinusitis) or from the channels of the muscles and joints (to treat arthritis with sensations of cold)
L
• clears Interior Cold, Damp, and Phlegm associated with Deficient Qi and Yang of Lung, Spleen, and Heart to treat chronic bronchitis or sinusitis with digestive weakness or disorders of peripheral circulation
A. dahurica The acrid property can clear Wind, Cold, and Damp from the surface, especially in the head and face, to treat frontal headache and sinusitis.
A. pubescens The acrid property can clear Wmd, Cold, and Damp from the surface, primarily from the channels of the muscles and joints in the lower back and legs to treat arthritis, and secondarily from the head to treat acute headache.
A. sinensis A. sinensis is not used much as an acrid herb to clear the surface, although its acrid property can have a mild warming effect on the Interior. Acrid and aromatic constituents of A. sinensis may combine to produce the ability of this herb to treat circulatory disorders, menstrual irregularities, and painful injuries associated with the pattern of Stagnant Blood. Aromatic There is a distinct smell common to the four Angelica species, but in addition, each has its own characteristic aroma. These similarities and differences in fragrance
217
may be based on similarities and differences in the composition of the essential oils. Whilst only A. archangelica is classified as. aromatic, A. dahurica, especially, seems to combine aspects of both acrid and aromatic properties in that it can be used to clear Damp and Phlegm. For example, it is used to treat Damp Cold in the Lower Burner and phlegm congestion in the sinuses. A. archangelica manifests its aromatic property by its ability to: • warm, tonify, and move Spleen Qi to transform Damp and Phlegm and treat chronic sinus or bronchial catarrh with obesity and lethargy • warm and move Spleen Qi to treat flatulence and intestinal spasms Bitter The bitter property of A. archangelica manifests itself in its use as a bitter digestive tonic to treat poor appetite, anorexia nervosa, and digestive weakness. The traditional Western use of A. archangelica fa'r anemia may be associated partly with its cardiotonic action and partly with the bitter digestive tonic effect. Although A. pubescens and A. sinensis are listed as bitter, they have not had wide use in China in the treatment of digestive weakness. Sweet All four Angelicas can have some sweetness in the mouth, and both A. dahurica and A. pubescens have been classified as sweet or slightly sweet in property in some Chinese texts. However, the sweetest in the mouth and the Angelica species most commonly associated with the sweet property is A. sinensis. This herb is regarded as a sweet tonic for the Blood to treat a variety of chronic or recurring conditions based on Blood Deficiency, such as: • eczema from Deficient Blood with Wmd invasion • arthritis from Deficient Blood with invasion of Wind, Cold, and Damp • constipation from Deficient Blood with Intestines Dryness • amenorrhea from Deficient Blood with Stagnation of Qi and Blood in the Uterus
ORGANS AND CHANNELS A. dahurica
This herb is specific for acute sinusitis and
frontal headache due to Wind invasion of the Lung and of the Yang Ming (Large Intestine and Stomach) channels. A. pubescens This herb is specific for leg, back, and head pain associated with Wind invasion of the Bladder and Kidney channels.
218
Combining Western Herbs and Chinese Medicine
A. archangelica This herb can be used for sinusitis and for arthritis, but it is not specifically associated with the Yang Ming channels as is A. dahurica or with the Bladder and Kidney channels as is A. pubescens. A. archangelica can be said to enter the Lung, Spleen, and Heart, associated with its use for respiratory, digestive, and peripheral circulatory disorders. A. sinensis This herb is listed as entering the Heart, Liver, and Spleen, associated with its ability to tonify and move the Blood. In this book, it is also associated with the Uterus.
26. Matsuda H. Murakami T. Nishida N et al. Chern Pharm Bull 48(0);1429-1435 (2000) 27. Matsuura M. Kimura Y, Nakata K et al. Planta Med 67(3):230-235 (2001) 28. Nanguang District Office for Prevention and Treatment of Chronic Bronchitis et al. Abstracts on the Prevention and Cure of Four Diseases (Jiangsu Medical Association) (6):67 (1978) 29. Angelica sinensis Research Unit. Second Teaching Hospital of Hubei Medical College. Health Journal of Hubei (5):64 (1977) 30. Antibronchitis Pilot Area. Fanxian Health Bureau. Henan Zhongyi Xueyuan Xuebao (Journal of Henan College of Traditional Chinese Medicine) (2):30 (1978) 31. Wuhan Fourth Hospital. Wuhan Journal of New Traditional Chinese
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19. Lorente I, Ocete MA, Zarzuelo A et al. J Nat Prod 52(2):267-272 (1989)
51. Matsuda H. Murakami T. Kageura T et al. Bioorg Med Chern Lett
20. Martin S. Padilla E. Ocete MA et al. Planta Med 59(6):533-536 (993) 21. Tambe Y, Tsujiuchi H. Honda G et al. Planta Med 62(5):469-470 (996) 22. Khayyal MT. el-Ghazaly MA. Kenawy SA et al. Arzneimittelforschung 51(7):545-553 (2001) 23. Ye YN. Liu ES. Shin VY et al. Biochem PharmacoI61(1l):1439-1448 (2001) 24. Reiter M. BrandtW.Arzneimittelforschung 350A):408-414 (1985) 25. Teng CM. Lin CH. Ko FN et al. Naunyn Schmiedebergs Arch PharmacoI349(2):202-208 (1994)
8(6):2191-2196 (1998) 52. Ding H. Peng R.Yu I. Zhonghua Gan Zang Bing Za Zhi 9 (Suppl):50-52 (2001) 53. Ye YN. Liu ES. Li Yet al. Life Sci 69(6):637-646 (2001) 54. Han SB. Kim YH. Lee CWO Immunopharmacology 400 ):39-48 (1998) 55. Choy YM. Leung KN. Cho CS et al. Am J Chin Med 22(2):137-145 (994) 56. Fujioka T, Furumi K. Fujii H et al. Chern Pharm Bull 47(1):96-100 (1999)
-;+-,
,.---
Angelica
219
57. Salikhova RA. Poroshenko GG. Vestn Ross Akad Med Nauk (1):58-61 (1995)
67. Lonicerus A. Kreuterbuch (1679). Reprinted by Verlag Konrad Kolbl, Miinchen, Germany (1962)
58. Blwnenthal M (ed). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council.
68. Gerard J. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publications. New York. New York (1975)
Austin. Texas (1998) 59. Schimmer O. Planta Med 47:79 (1983) 60. Opdyke DLJ. Food and Cosmetics Toxicology 13 (1975) [cited in Tisserand R, Balacs T. Essential Oil Safety: A guide for Health Care Professionals. Churchill Livingstone, Edinburgh. United Kingdom (1995)] 61. Tisserand R. Balacs T. Essential Oil Safety: A Guide for Health Care Professionals. Churchill Livingstone. Edinburgh, United Kingdom (1995) 62. Zaynoun ST et al. Contact Dermatitis 3:225-239 (1977)
69. Tabernaemontanus JT. Krauterbuch (1731). Reprinted by Verlag Konrad Kolbl, Miinchen. Germany (1993) 70. Mills S. The Essential Book of Herbal Medicine. Arkana. London, United Kingdom (1991) 71. Lyle TJ. Physio-Medical Therapeutics, Materia Medica and Pharmacy. Originally published Ohio (1897). Reprinted by the National Association of Medical Herbalists of Great Britain, United Kingdom (1932)
63. Young AR et al. Pigment Cell Research 1:350-354 (1988)
72. Grieve M. A Modern Herbal, vols. 1 and 2. Dover Publications. New York, New York (1971)
64. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983)
73. Mabey R (ed). The Complete New Herbal. Elm Tree Books. London. United Kingdom (1988)
65. Lo AC, Chan K. Yeung JH et al. Eur J Drug Metab Pharmacokinet 20( 1):55-60 (1995)
74. Tierra M. Planetary Herbology. Lotus Press.. Twin Lakes, Wisconsin (1988)
66. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks.. Glenwood, lllinois (1990)
75. Yeung H-C. Handbook of Chinese Herbs and Combinations. vol. 1. Institute of Chinese Medicine. Los Angeles.. California (1985)
Arctium
...,
\,;,.. .... --
Botanical name Arctium lappa L. (A. majus Bernh.) or A. minus Bernh. Family Asteraceae (Compositae) Pharmaceutical name Arctii radix (Bardanae radix = Lappae radix) Part air-dried root English burdock German GroBe Klette French bardane Mandarin niubanggen (4-1H~) istherootsofA.lappaL. niu bang zi (4=-f -f) is the seeds of A.lappa L.
I use the seeds more for conditions that are relatively more superficial, such as allergic urticaria associated with Wind Heat, and the root more for conditions that are relatively more interior, such as chronic psoriasis associated with Stagnant Blood and Phlegm. Use in China Niu bang zl refers to the seeds of A.lappa L. and is mainly used to clear Wind Heat and treat sore throat with the common cold; to promote the eruption of rashes in diseases such as measles; to clear Heat Toxin to treat boils, tonsillitis, or mumps; and to moisten the Intestines and treat constipation.
Use in the West Burdock is a biennial native to Europe and Asia which has become naturalized in North America. The main herbal use of burdock in the West has been as an alterative and diuretic to treat skin conditions and urinary disorders. I have happy childhood memories of throwing the clinging burrs of this plant onto the clothes or hair of the children in front of me on country walks, and it appears that Culpeper himself found this temptation irresistible.
What is special about Arctium In terms of Chinese medicine, Arctium, as used in the West, can be said to be a cool herb that has its main effects on the Lung, Large Intestine, Kidney, and Bladder. Arctium root is classified in this book as slightly acrid and slightly bitter, and Arctium seeds as acrid and slightly bitter.
The key to understanding Arctium is that it is an alterative herb that can be used to treat:
Parts used The parts used in the West have been the root and seeds, and to a lesser degree the leaves. European use has tended to emphasize the root, and early American use by the Eclectics emphasized the seeds. Since the root and seeds taste definitely different in. the mouth, the seeds being considerably more acrid, there may be a genuine difference between the two parts in constituents and in therapeutic effects, but no detailed research has yet been done.
• acute and chronic skin disorders such as urticaria, eczema, psoriasis; acne, and boils • inflammatory conditions such as arthritis, gout, rheumatism, and lymphadenitis • toxic conditions following cancer therapy, prolonged multimedication treatments, drug abuse, or overindulgence in food and drink
221
222
Combining Western Herbs and Chinese Medicine _.~.%?1_
Chinese '~ctions':;'-'-~-:~ ·····"·:;:Weslerri2.uses :- .-,----: -:~~:~:~~~,_~-'
CHINESE ACTIONS In terms of Chinese medicine, Arctium, as used in the West, can be said to have the following actions: I. clear Wind Heat and Retained Pathogen II. clear Heat Toxin III. assist the Kidney and Bladder to drain Damp Clear Wind Heat and Retained Pathogen In the West, Arctium has not been commonly used for treating acute throat conditions with fever, as in Chinese medicine. However, it can be used as in China to clear a combination of Wmd Heat and Heat Toxin from the skin,to remove rashes, sometimes by temporarily encouraging their expression. Clear Heat Toxin Arctium can be used to clear Heat Toxin or a combination of Heat Toxin with: • Wind Heat • Retained Pathogen • Damp Heat Assist the Kidney and Bladder to drain Damp This is only a secondary function of Arctium. but it contributes to its cleansing action since toxins can be cleared through increased urination.
WESTERN ACTIONS
Western actions
I. clear Wind Heat and Retained Pathogen
alterative dermatological agent
II. clear Heat Toxin
alterative anti-inflammatory dermatological agent antiarthritic
III. assist the Kidney and Bladder to drain Damp
recurring urticaria, allergic eczema
II. clear Heat Toxin
eczema, psoriasis, acne, boils, arthritis, rheumatism, gout, lymphadenitis, adjunct to cancer therapy
III. assist the Kidney and Bladder to drain Damp
secondary herb for cystitis or obesity with edema
diuretic urinary anti-inflammatory alterative
The alterative action is the primary effect of Arctium that is utilized in the West. especially the dermatological and antiarthritic aspects of the alterative action.
:~'\
--~~.
DIRECTION OF ENERGY In terms of Chinese medicine. Arctium can have two directional effects on the energy of the body. First, it can clear Wind Heat and Retained Pathogen from the surface. but not necessarily by diaphoresis alone. Rather. it may loosen the pathogens from their sites of entry or accumulation. and flush them from the tissues via the blood and lymph systems. In some cases. it can encourage rashes to the surface. thus clearing lingering conditions. Secondly. Arctium is a mild diuretic and laxative that can assist the clearance of toxins from the body via the urine and the stools by draining them downward. The surface-cleansing. diuretic. and laxative actions are integral parts of the overall alterative effect of
~-
this herb.
TYPICAL CASE EXAMPLE
The main Western actions of Arctium are shown here in terms of its three main Chinese actions: Chinese actions
I. clear Wind Heat and Retained Pathogen
Signs and symptoms The patient has acute urticaria. which is brief in duration but recurs regularly. mild but chronic arthritis, and occasional cystitis and dysuria. There is a history of recurring tonsillitis and of severe teenage acne. The pulse is slightly slippery. with a feeling of congestion rather than wiriness. especially in the third position. The tongue has red dots and a somewhat yellow coat. especially at the back. Diagnosis The patient has a combination of Wind Heat, Retained Pathogen. Heat Toxin. Stagnant Qi, and maybe Damp Heat. Choice of Arctium treat:
This herb is chosen because it can
• urticaria with Wind Heat, Retained Pathogen. and Heat Toxin
WESTERN USES
~ arthritis with Heat Toxin and Damp Heat
The main Western uses of Arctium are shown here in terms of its three main Chinese actions:
• dysuria with Bladder Stagnant Qi. Damp Heat, or Heat Toxin
,
.-.:.
223
Arctium
Limitations ofArctium
the mouth. especially when compared with defmitely bitter herbs such as Achillea. Cinchona, Gentiana, Hydrastis, or Rosmarinus.
TEMPERATURE In this book, Arctium is classified as cool and is more appropriate for warm conditions, although it can be used for hot, neutral, or cool conditions if it is suitably combined with other herbs. TASTE Both Arctium root and Arctium seeds are classified in this book as slightly bitter, in that they can act as mild antiinflammatories to clear Heat and also as mild bitter tonics for the digestive system. Arctium seeds are classified in this book as acrid in that they can help to clear pathogens from the surface of the body. Arctium root is classified as slightly acrid, and its surfac~-active effect may be weaker than that of the seeds. In my opinion, Arctium is a herb which is best used in combination with others, rather than as a single herb. ACTIONS Diaphoretic Although Arctium may in some circumstances assist in the manifestation of unexpressed rashes, its ability to clear surface pathogens may generally be accomplished by increasing the release of toxins into the local blood and lymph capillaries, rather than by a diaphoretic action out through the skin. Alterative In the West, Arctium is used as an alterative, which can clear Heat Toxin and Retained Pathogen specifically from the skin, joints, and lymph system. It does not have such a strong tradition of use to clear toxins from the Liver as do Taraxacum or Berberis. Diuretic Arctium has a long tradition of use to increase urination and clear obstruction and inflammation from the urinary system. However, I do not use it as a primary herb for these effects. Instead, I use it as a secondary herb to support other urinary herbs. Laxative Although Arctium seeds are used as a moistening laxative in Chinese medicine, probably because of their oil content, Arctium is only regarded as a mild laxative in the West. The mild laxative and diuretic actions of Arctium are mainly used in the West to support its primary alterative action. Tonic In the West, there is a tradition of use of Arctium as a tonic, but this use is of secondary importance. Neither Arctium seeds nor Arctium root taste particularly bitter in
Arctium paired with other herbs Discussion of the limitations of each of the main actions of Arctium can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Arctium beyond its limitations. The basic unit of herb combination is the herb pair. Twelve pairings of Arctium are briefly explained below. CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair. Arctium seeds + Ephedra
Acute urticaria Both herbs can move Wind invasion from the surface of the body, specifically in the case of allergic or nonallergic urticaria or eczema. In addition, Arctium can assist clearance of Retained Pathogen and Heat Toxin, which are responsible for recurring acute episodes. Arctium + Urtica
Acute urticaria These herbs can combine to clear Wind Heat from the surface and to clear Retained Pathog~n and Heat Toxin. In addition, Urtica has had traditional use in the West to strengthen the Blood, and this can help to prevent further Wind invasion. Arctium + Mahonia
Chronic eczema Both herbs can help to clear Retained Pathogen and Heat Toxin from the body, and Mahonia is specific for clearing Liver-Gallbladder Damp Heat, which results in chronic Damp Heat eczema. Arctium + Harpagophytum
Chronic arthritis + heat sensations Harpagophytum is specific for rheumatism, arthritis, or gout linked to Damp Heat. It is assisted in this by Arctium. In addition, Arctium can help to clear Retained Pathogen and Heat Toxins from the joints, and to drain these pathogenic factors from the body via the urine.
Combining Western Herbs and Chinese Medicine
224 Arctium + Taraxacum
Detoxification regimes This has long been a traditional spring cleansing combination in Britain and can be used to augment detoxification programs. Both herbs are alteratives with diuretic and mild laxative action, which can be used to clear Damp Heat and Heat Toxins from the body in the treatment of: • joint or skin disorders • sequelae of drug abuse • sequelae of prolonged multimedication treatments • sequelae of radio- or chemotherapy for cancer Arctium + Iris
Skin disorders + constipation Iris is specific for chronic skin disorders associated with sluggish liver function and constipation, or, in Chinese terms, Liver Stagnant Qi with Intestines Stagnant Qi and accumulation of Damp Heat and Heat Toxin. Arctium and Iris combine for chronic skin disorders such as acne, boils, and eczema. Arctium + Rheum
Arctium and Viola together can be used: • for eczema, boils, and acne • for lymphadenitis • as an adjunct to cancer therapy Arctium + Phytolacca
Boils
_. - .... .,..~
Phytolacca is an alterative herb, which can move Stagnant Qi to clear accumulation of Damp, Phlegm, and Heat Toxin in the skin and tissues. Phytolacca and Arctiurn can be combined: • for chronic psoriasis, acne, and boils • for rheumatism and arthritis • as an adjunct to weight loss programs, providing a cleansing diet is also adopted Arctium + Baptisia
Boils + infection Baptisia is a strong antimicrobial and a lymphatic alterative herb, which can be combined with Arctium to treat infections associated with boils, throat disorders, or lymphadenitis.
Acute psoriasis Rheum can help to clear Heat in the Blood and Heat Toxins, and it can combine with Arctium seeds to treat acute psoriasis, eczema, or acne rosacea with red, hot, painful skin lesions. Rheum, assisted by Arctium, can help to clear Heat out of the body through the stool. Arctium + Scrophularia
Arctium combinations SixArctiurn combinations are discussed below: Combination
Arctium + Smilax
Chronic psoriasis Smilax is specific for acute or chronic psoriasis, and Arctium can assist it to clear Heat Toxin and Damp, thereby treating itching, dry, scaly skin. Arctium + Viola
Acne Viola tricolor or V. odorata can combine with Arctium to clear Heat Toxin, and the Viola species can also clear Damp Heat.
Chinese syndromes
1. recurring urticaria (acute phase)
Wind Heat + Retained Pathogen
2. recurring urticaria (remission
Retained Pathogen + Deficient Blood
Acute eczema Scrophularia is specific for acute skin disorders with Heat in the Blood and bright red rashes with sensation of heat and severe itching. Arctium seeds can combine with Scrophularia to treat acute eczema due to Heat in the Blood or chronic eczema due to accumulation of Heat Toxin.
-
phase)
3. chronic eczema
Damp Heat + Deficient Blood
4. acute psoriasis
Heat in the Blood + Heat Toxin
5. arthritis + heat sensations
Damp Heat in the channels
6. cancer therapy adjunct
Stagnant Qi + Damp Heat + Heat Toxin
CAUTION
Before using any of the combinations below, it is important to be familiar with the cautions listed for each herb in the combination. 1. Recurring urticaria (acute phase)
Wind Heat + Retained Pathogen
,~
Arctium
Arctium (seeds) Arctium (root) Hydrastis Echinacea Urtica Ephedra
1 1 1 1 1
0.5-1
225
Arctium (seeds) Mahonia
cool
acrid, sl. bitter
cool
sl. acrid, sl. bitter
cool cool
bitter acrid, bitter, sl. sweet
warm-cool
acrid
Angelica sin. Ziziphus
acrid, sl. bitter
GIycyrrhiza
warm
Urtica
Schisandra
GENERAL
This combination is for recurring skin disorders in the acute phase caused by an acute attack of Wind Heat in a person with chronic Retained Pathogen and possibly also some Heat Toxin and Damp Heat. The residual pathogenic factors present in the body surface, blood, and interior predispose the person to recurring acute episodes of red, itchy rashes that may quickly come and go. These are regarded as a manifestation of Wind Heat in Chinese medicine. The aim of this combination is to clear Wind and Heat from the surface, to relieve itching, and to begin to clear Retained Pathogen from the surface and body. The overall temperature of the combination is cool to treat warm or moderately hot conditions. Although Ephedra is a warm herb, it is included because it is specific for allergic disorders associated with Wind invasion of the body surface. The important properties are acrid to clear the surface and bitter to clear Heat. USE
..
•
• acute phase of recurring allergic or nonallergic urticaria or eczema with red, itchy rashes that may quickly come and go, and may be of variable location PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of water, three times per day. This combination is for the acute phase of the condition only, and as soon as the redness and itching have subsided, this combination can be replaced by a combination that treats the remission phase of the condition, such as combination No.2 below.
Caution • practitioners are reminded that there may be local restrictions on the use or dose of Ephedra, and should be aware of the cautions on the use of this herb • especially during the initial use of this combination, the precautions for the use of alterative herbs and co~binationsshould be observed-see chapter on
Safety: Cautions on the use ofalteratives. 2. Recurring urticaria (remission phase)
Retained Pathogen + Deficient Blood
1 1 1 0.5 0.5 0.5 0.5
cool
acrid, sl. bitter
cool
bitter
warm-cool
acrid
warm
sweet, aromatic, bitter
neutral neutral-cool
sweet sweet
warm
sour
GENERAL
The previous combination is for the acute phase of recurring skin disorders in which the dominant pattern is Wind Heat with underlying Retained Pathogen. This combination is for the remission or chronic phase of skin disorders, in which the dominant pattern is ;Retained Pathogen with Deficient Blood. The aims of this combination are to: • clear Retained Pathogen • clear Heat Toxin and Damp Heat • tonify Blood and Nutritive (Y"mg) Qi • tonify and firm Kidney and Lung Qi The overall temperature is neutral to cool to treat neutral or warm conditions. The acrid and bitter properties assist in the clearance of Retained Pathogen and Heat from the surface and interior of the body; the sweet property tonifies the Blood, Kidney, and Lung Qi; and the sour property firms the Qi of the Kidney and Lung. In Chinese medicine, an important principle in the treatment of skin disorders with Wind invasion is to strengthen the Blood and the Nutritive Qi, thereby strengthening the surface of the body in order to reduce the occurrence of Wind invasion. Also, many ca~es of chronic allergy with asthma, rhinitis, or skin rashes, have underlying Kidney Deficiency, so that strengthening and firming the Kidney can also strengthen the circulation of Defensive and Nutritive Qi at the body surface. USE
• remission or chronic phase of recurring allergic or nonallergic urticaria or eczema with red, itchy rashes that may quickly come and go, and may be of variable location PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of water, three times per day. This combination is for the remission or chronic phase of the condition, and can be taken for 1-2 months with appropriate breaks and modifications. Should the acute phase return, this remission phase combination is stopped, and the acute phase combination above is used until the symptoms are
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Combining Western Herbs and Chinese Medicine
226
...
~
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considerably improved. Then the acute phase combmation is stopped, and the chronic phase combination can be resumed.
5. Arthritis + heat sensations
3. Chronic eczema
Damp Heat in the channels
Damp Heat + Deficient Blood Herb
Ratio
Herb
Temperature
Taste
cool cool cool cool warm-cool warm neutral-cool
acrid, sl. bitter bitter bitter sour, sweet, bitter acrid sweet, aromatic. bitter sweet
Arctium (seeds) 1 Mahonia 1 Iris 1 Viola trio 1 Urtica 1 0.5-1 Angelica sin. Glycyrrhiza 0.5
Harpagophytum Berberis Taraxacum Arctium (root) Filipendula Angelica sin. Glycyrrhiza
Ratio
Temperature
Taste: , , ,', "-',;~
1 1 1 1 0.5 0.5 0.5
cool cool cool-cold cool cool warm neutral-cool
bitter bitter bitter sl. acrid, sl. bitter sour, bitter sweet. aromatic. bitter sweet
."
-'
This combination is the same as Harpagophytum: arthritis + heat sensations and is discussed under that heading.
GENERAL
This combination is for chronic or recurring patterns of Wmd Heat, Heat, or Damp Heat lodging in the skin, occurring with underlying Deficiency of Blood, Qi, or rm. The overall temperature is cool to treat chronic warm conditions. For cases of acute eczema associated with Heat in the Blood, this combination can be replaced by Berberis: acute eczema. The acrid and bitter constituents can clear Wind Heat, Heat, and Damp Heat, and the sweet constituents can tonify Deficiency. USE
• chronic or recurring eczema with dry skin, especially with a history of prolonged corticosteroid use PRACTICAL NOTES
Caution Especially during the initial use of this combination, the precautions for the use of alterative herbs and combinations should be observed-see chapter on Safety: Cautions on the use ofalteratives. 4. Acute psoriasis
Heat in the Blood + Heat Toxin
~~~~~2!~~~!~tit;~~;~J.~,~~;i~:;~" 1 1 1 1 1 1 0.5
--:.: .
cool cool cool cool cool-cold cool-cold neutral-cool
6. Cancer therapy adjunct
Stagnant Qi + Damp Heat + Heat Toxin
Thuja Viola odo. Phytolacca Hydrastis Taraxacum Arctium (root) Glycyrrhiza Zingiber
1 1 1 1 1 1 0.5 0.5
warm-cool cool cool cool cool-cold cool neutral-cool hot
acrid. aromatic sour, sweet. bitter acrid bitter bitter sl. acrid, sl. bitter sweet acrid, aromatic
adjunct and is discussed under that heading.
COMPARISON OF THE SIX ARCTIUM COMBINATIONS 1. Recurring urticaria (acute phase)
2. Recurring urticaria (remission phase)
Wind Heat + Retained Pathogen
Retained Pathogen + Deficient Blood
Arctium (seeds) Arctium (root) Hydrastis Echinacea Urtica Ephedra
Arctium (seeds) Mahonia Urtica Angelica sin. Ziziphus Glycyrrhiza Schisandra
',-' ~
sl. bitter sl. bitter acrid, sl. bitter bitter bitter bitter, sour sweet
~":".:;::'I':"-
.:;~.
This combination is the same as Thuja: cancer therapy
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of water three times per day for 2-3 months with appropriate breaks and modifications.
Smilax Scrophularia Arctium (seeds) Mahonia Taraxacum Rheum' Glycyrrhiza
This combination is the same as Smilax: acute psoriasii~ and is discussed under that heading.~':·~
1 1 1 1 1 0.5-1
1 1 1 0.5 0.5 0.5
0.5
~:
Arctium 1. Arctium seeds are more for the surface and are paired here with Arctium root, which is more for the interior. Arctium seeds, Arctium root and Echinacea can clear Wind Heat, Retained Pathogen, and Heat Toxin. Hydrastis is included to clear Retained Pathogen and Damp Heat, specifically in cases of allergic skin disorders, especially with Heat in the Stomach, Intestines, or Liver. Urtica and Ephedra combine to clear Wmd from the surface in the specific case of acute allergic or nonallergic skin rashes.
2. The emphasis of the previous combination for acute urticaria is to clear Exterior Wind; therefore, Ephedra is an important herb in the combination. Since the emphasis of this combination is to tonify the Blood and Nutritive Qi, Angelica and Ziziphus are included. In addition, Glycyrrhiza and Schisandra tonify and firm Kidney Qi. Both combinations contain herbs to clear Retained Pathogen, Heat Toxin, and Damp Heat. Whilst the previous combination contains Hydrastis for its antiallergic action, this combination contains Mahonia to clear Damp Heat and Heat Toxins from the surface, Blood, and Liver. 3. Chronic eczema
4. Acute psoriasis
Damp Heat + Deficient Blood
Heat in the Blood + Heat Toxin
Herb';';
Arctium (seeds) Mahonia Iris Viola trio Urtica Angelica sin. Glycyrrhiza
Ratio 1 1 1 1 1 0.5-1 0.5
Herb
Smilax Scrophularia Arctium (seeds) Mahonia Taraxacum Rheum Glycyrrhiza
" Ratio.' 1 1 1 1 1 1 0.5
3. This combination is similar to the previous combination for the remission phase of urticaria. However, whilst the previous combination contains the tonics Ziziphus and Schisandra, this combination contains Iris to clear Damp Heat and Heat Toxins from the system via the Liver and Intestines, and Viola to clear Heat Toxins and Deficiency Heat. This combination for the chronic phase can also be compared with Berberis: acute eczema for acute skin disorders with Liver-Gallbladder Damp Heat and some Heat in the Blood. 4. Smilax makes this combination specific for psoriasis. Scrophularia, Taraxacum. and Rheum in combination are included to clear Heat in the Blood. Arctium and Taraxacum combine to clear Heat through urination, and Rheum and Taraxacum combine to clear Heat through the stools. All the herbs in this combination combine to clear Heat Toxin.
227
5. Arthritis + heat sensations
6. Cancer therapy adjunct
Damp Heat in the channels
Stagnant Qi + Damp Heat + Heat Toxin
Herb
_ Ratio' .
Harpagophytum Berberis Taraxacum Arctium (root) Filipendula Angelica sin. Glycyrrhiza
1 1 1 1
0.5 0.5 0.5
Herb
Thuja Viola odo. Phytolacca Hydrastis Taraxacum Arctium (root) Glycyrrhiza Zingiber
1 1 1 1 1 1 0.5 0.5
5. Harpagophytum is the leading herb for treating arthritis from Damp Heat in the joints. Berberis, Taraxacum and Arctium assist this by clearing Damp Heat from the Liver and from the body in general. Filipendula and Glycyrrhiza clear Stomach Heat associated with long-term use of nonsteroidal anti-inflammatory medications, and A. sinensis treats Deficient Blood associated with blood loss from gastric ulceration associated with the side effects of anti-inflammatory medications. 6. Thuja, Viola, and Phytolacca have a reputation for retarding the growth of tumors. Thuja, Viola, Phytolacca, Hydrastis, Taraxacum, and Arctium are alterative herbs that can help to clear Retained Pathogen, Damp Heat, and Heat Toxin, thus, helping to reduce the side effects of radio- or chemotherapy. Glycyrrhiza can assist detoxification and act as an anti-inflammatory and a tonic. Zingiber moderates the effects of the cooling herbs and helps to stimulate circulation and digestion.
OTHER ARCTIUM COMBINATIONS Other combinations that contain Arctium include the following:
• Calendula: lymphadenitis • Echinacea: boils + infection • Phytolacca: chronic acne • Smilax: arthritis + psoriasis
CONSTITUENTS The following constituents have been reported for A. lappa: • acetylenic compounds • terpenoids
228
Combining Western Herbs and Chinese Medicine
• phenolic acids ·lignans • other Acetylenic compounds The root of Arctium contains about 0.002% of acetylenic compounds of two types: • polyacetylenic Cll alkynenes, mainly trideca-lil-diene3,5,7,9-tetrayne 1 • sulfur-containing acetylenic compounds with two thiophene rings, mainly arctinone-a. together with related arctinols, arctinal, and arctic acids2 Terpenoids The roots of Arctium contain about 1% essential oil, containing over 60 compounds, especially the bitter sesquiterpene lactones dehydrocostus lactone and 11, 13dihydrodehydrocostus lactone.3 Phenolic acids The root contains 1.9-3.65% polyphenols, including caffeic, chlorogenic, isochlorogenic, and other acids. 4 Lignans The seeds contain lignan dimers and oligomers, mainly arctiin, with lesser amounts of artigenin,s and neoarctin B.6 The root also may contain arctiin. (Arctlin is broken down to its aglycone artigenin by rat large intestine flora.)' Other
Arctium root also contains:
• phytosterols, including sitosterol and stigmasterol4 • inulin up to 45%8 . • mucilage, including a xyloglucan of repeating oligosaccharide units9 • tannins4 • y-guanidino-n-butyric acid in small amounts8 Root, leaves, and seeds The different parts of Arctium appear to be characterized by different constituents:
• roots • leaves • seeds
acetylenic compounds arctiopicrin, a bitter sesquiterpene lactone of germacranolide type lO lignans
PHARMACOLOGICAL AND CLINICAL RESEARCH The following effects have been observed for A.lappa: • aritiniicrobiat • anti-inflammatory • hepatoprotective • antioxidant
.i.
• antidiabetic • diuretic • antiplatelet • antitumor and antimutagenic
-~
-
...
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...
~.
--_:.--~~ "7.~.::
Antimicrobial
According to Bruneton, II Arctium has' ".'
antimicrobial and antifungal actions that are linked to the polyacetyleneic compounds. No reference was given, but Bruneton may have been referring to the bacteriostatic action attributed to polyacetylenes reported by Schulte et al. 1
,.=
Anti-inflammatory Arctium seeds were reported to have protective effect against gastric ulcer. 12 Subcutaneous administration of Arctium extracts was reported to decrease carrageenan-induced rat paw edema. 13 Hepatoprotective The same study reported protection by .. , subcutaneous administration of Arctium extracts against carbon te~a~oride~~duced liver damage in rats. 13 Antioxidant The same study suggested that the antiinflammatory and hepatoprotective effects may be due to the antioxidative activity of Arctium. 13 A further study suggested that Arctium could reverse the decrease in glutathione or cytochrome P-450, associated with liver damage caused by carbon tetrachloride or acetarninophen. 14 Antidiabetic A hypoglycemic effect has been listed by Bensky and Gamble ls and by Yeung, 16 but no references were given. Arctium root extracts were reported to reduce blood sugar levels in rats and raise carbohydrate tolerance. 17 In one recent study, 6.25% by weight of Arctium was administered in the diet of normal and streptozotocin-induced diabetic mice for 28 days. After the administration of 200 mg/kg of streptozotocin, Arctium was reported to aggravate the diabetic condition. 18 Diuretic A diuretic effect is listed in Yeung, but no reference is given. Antiplatelet Arctium extract and various of its lignans were found to have inhibitory effect on the binding of platelet-activating factor to rabbit platelets. 19 Antitumor and antimutagenic The lignan arctiin, isolated from the seeds of Arctium and administered in the diet to rats at doses of 0.02% or 0.2% arctiin, was reported to have protective effect on induced carcinogenesis particularly in the mammary gland. However, arctiin may have a weak _ cocarcinogenic influence on induced hepatocarcinogenesis. 20 Arctium extracts showed antitumor activity against -~ human hepatoma HepG2 cells in vitro and against mouse
Arctium sarcoma 180 cells in vivo. Arctiin and arctigenin showed strong cytotoxicity against HepG2 cells.2\ Also, arctiin and arctigenin showed strong antitumor activity against induced mouse skin tumors, and arctigenin exhibited potential anti22 tumor activity in induced mouse pulmonary tumors. Finally, a factor isolated from Arctium reduced the mutagenicity of a range of mutagens. 23
229
USE OF ARCTIUM Western contraindications None reported. Chinese contraindications Arctium seeds are contraindicated in patients with diarrhea associated with Deficient Qi and in patients with open sores and carbuncles. IS Pregnancy and lactation No adverse reports. None reported, but see chapter on Safety:
Side effeCts RESEARCH VERIFICATION OF
Cautions on the use ofalteratives.
TRADITIONAL ACTIONS
Overdose
The following traditional actions of Arctium have been supported by research: diuretic, gastrointestinal anti-inflam-
No adverse reports, but see chapter on Safety:
Cautions on the use ofalteratives. Interactions
No adverse reports.
matory, and antitumor. Additional effects demonstrated by research The following additional effects have been reported as discussed above: antimicrobial, antioxidant, hepatoprotective, antidiabetic, antiplatelet, and antimutagenic. TOXICOLOGY I have not found information on the toxicity of Arctium.
Dose Dried herb The BHp24 listed 2-6 g of the dried root, three times per day. Both Lyle!5 and Christopher6 wrote that the seeds of Arctium are best crushed or ground just before decoction to increase the extraction of the constituents. Tincture The BHP listed 8-12 ml of 1:10 tincture (45% ethanol), three times per day. When I use Arctium tincture in combination with the tinctures of about five other herbs, the amount of Arctium tincture in each 5-10 ml of the mixture is about 1-2 ml. Initial dose
Please read the Regulatory status section hi the chapter on Safety. Arctium (burdock) is on the UK General Sale List (Statutory Instrument Order 1977 No. 2129 to the Medicines Act 1968). Arctium is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Arctium is not currently listed by the FDA (USA) as a prolubited substance, as subject to an import alert, or as a substance with a warning on its use.
Traditional sources Nomenclature In the old sources, the Latin name for burdock are Arctium, Lappa, Personata, and Bardana; the older English names include burre docke, clot burre, and clod bur; and the older German name is generally Gross Kletten. PROPERTIES
Can start at the standard dose, but see
Cautions on the use ofalteratives in the chapter on Safety. Duration
Regulatory status
No restriction known.
Cautions USE OF ALTERATIVE HERBS Precautions for the use of alterative herbs and alterative combinations are discussed in the chapter Safety in Clinical Practice and in the appendix Healing Crises.
Temperature According to Lonicerus,27 the green leaves can clear Heat. Culpeper8 described the leaves as coolIng and moderately drying. Gerard!9 classified the root as slightly hot and the seeds as hot and dry. Arctium seeds are variously classified in Chinese medicine as cool15 or cold. 16 The root of Arctium is classified as cool in this book in line with its ability to clear Heat Toxin and treat such disorders as tonsillitis, boils, and inflammation of the joints. Taste
Taste in the mouth: seeds I found a 1:5 tincture of the seeds (mu bang zl) in 25% alcohol to be acrid and bitter, definitely
...
...
~
Combining Western Herbs and Chinese Medicine
230
.:.i~:i
:--~..
;
-c'::].:;:;::: _:~:13d
but not strongly, and also slightly sour. I found a sample of dried seeds (niu bang zl) to have a strongly acrid taste and slightly numbing sensation that lingered in the mouth and on the tongue. The seeds were also between slightly bitter and bitter in taste, and slightly sour. Grieve 30 described the roots as sweetish and mucilaginous, and the leaves as somewhat bitter. The BHP described the root as mucilaginous and slightly bitter, and the leaves as bitter. I found a 1:5 tincture of the root in 25% alcohol to be slightly sweet, slightly acrid, slightly bitter and slightly sour, and a sample of organically grown dried root to be mucilaginous, slightly sweet, slightly bitter, and slightly sour.
. Taste in the mouth: root
• respiratory anti-inflammatory
~
.. -:::-_-'::~
• tonic • other The two actions of Arctium most emphasized in the past and present in the West are the alterative and the diuretic actions. Alterative
Dioscorides33 recommended Arctium leaves as
a poultice to heal old ulcers, and Lonicerus wrote that the green leaves can be used to clear heat, and that burdock can be used 'to heal wounds with a lot of pus and rotten flesh: and 'to soften hard swellings and to pull out evil substances
fied in Chinese medicine as acrid and slightly bitter lS or acrid and bitter.16 Arctium seeds are classified in this book as acrid and slightly bitter.
and pus.' Felter and lloyd listed burdock root as an alterative for rheumatism, gout, venereal disease, and leprosy, and the seeds as a diuretic alterative for boils and styes on the eye~
used in the West, is classified as slightly acrid and slightly bitter, but since its acridity in the mouth is considerably less than the seeds, it may also follow that the surface-clearing acrid property of the root is less pronounced than that of the seeds. I use the seeds rather than the root for acute skin conditions involving Wind Heat, such as allergic urticaria.
In terms of Chinese medicine, Arctium lappa, as used in the West, can be associated mainly with disorders of the following systems:
feeble cutaneous circulation; scaly, dry' eruptions; and psoriasis. Lyle classified burdock root as a soothing, demulcent, tonic, alterative and lymphatic that could be used for all skin disorders. Christopher recommended burdock root for:
• lymphatic congestion • an aid for the removal of excess fatty tissue According to Priest and Priest,34 burdock is specific for
Examples of use
Source
skin
smooth beautiful skin styes on the eyelids
Lonicerus Felter and Lloyd 31
joints
gout rheumatism, sciatica
Felter and Lloyd Lyle
make the skin smooth and beautiful, Felter and lloyd listed burdock for impaired nutrition of the skin, and Grieve wrote
Kidney, Bladder
kidney stones edema
Tabemaemontanus 32 Grieve
that the influence of the seeds on the skin, restoring smooth-
Intestines
aperient
Christopher
mended the use of Arctium for skin disorders in children and wrote that it can improve poor skin following chicken
Niu bang zi, the seeds of A.lappa, are described as entering the Lung and Stomach in Chinese medicine. ls
ed burdock root for eczema, psoriasis, rheumatism, and gout.
Skin tonic Lonicerus recommended burdock ointment to
ness, is due largely to their oily nature. Julian ScouJ 5 recom-
pox.
Adjunct to cancer therapy Christopher listed burdock root ACTIONS
for cancer, and Mills and Bone36 noted the use of burdock in alterative combinations used as adjuncts to cancer therapy.
The following traditional actions are discussed: • alterative • diuretic • gastrointestinal anti-inflammatory
~-
• itches, rashes, eczema, psoriasis, boils, sores, wounds,
skin eruptions on the head, face, and neck, and the BHP listOrgan
....
lids, and for skin diseases. They listed burdock as specific for
and burns • rheumatism, gout, and sciatica
ORGANS
~
.~~~
• laxative • diaphoretic
Taste properties: seeds Arctium seeds are variously classi-
Taste properties: root In this book, the root of Arctium, as
..
Diuretic Gerard quoted Apeleius as recommending the juice of the leaves to promote urination and to treat pains in the bladder. Culpeper noted the use of the seeds in breaking urinary stones and in assisting their expulsion in the urine.
-.-.
Arctium According to Felter and Lloyd, the seeds increase renal activity, relieve urinary tract irritation, and assist in the elimination of 'morbid products,' so that they can be used for edema and painful urination due to renal obstruction. The BHP listed A. lappa root as a diuretic that can be used for cystitis. This herb has also had traditional use as a diuretic in Germany4 and in France. 'l Gastrointestinal anti-inflammatory Gerard noted the use of burdock root for windy or cold stomach, and Felter and Lloyd recommended Arctium seeds for catarrhal and apthous ulcerations of the digestive tract, and for dyspepsia. Grieve wrote that an infusion of burdock leaves can strengthen and tone the stomach for chronic indigestion.
231
COMPARISON OF WESTERN AND CHINESE USE OF ARCTIUM
Actions----;'--- Western uses dermatological agent
rough dry skin, eczema, psoriasis, boils, ulcers
antiarthritic, antirheumatic
arthritis, gout, rheumatism, sciatica
other alterative
adjunct to cancer therapy
diaphoretic
Respiratory anti-inflammatory Tabernaemontanus noted the use of Arctium for wheezing and to cleanse the chest when coughing up blood and pus, and Gerard listed burdock for ulcers of the lungs and for spitting blood. According to Felter and Lloyd, the seeds can be used for bronchial irritation and cough, and Christopher wrote that the root can be used for pulmonary diseases. Laxative Some texts mention a tradition of use as a laxative (aperi~nt),4.11.26 but this has not been considered a primary action of this herb. Indeed, according to Lonicerus, burdock seeds can help to stop diarrhea and dysentery. Diaphoretic In the West, Arctium has not been used much as a diaphoretic and older texts, such as Lonicerus, Tabernaemontanus, Gerard, and Culpeper either do not mention or do not emphasize the diaphoretic action. Felter and Lloyd listed the use of Arctium seeds as a diaphoretic. but they did not describe any application of this action. Christopher mentioned the diaphoretic action of Arctium root or seeds, and listed the root for colds and fever. Tonic This is not a primary action of burdock and is only mentioned by a few authors. Gerard wrote that an extract of burdock root in wine strengthens the back, and according to Christopher, Arctium root can be used as a nutritive tonic. The BHP listed Arctium root for anorexia nervosa.
Chinese uses 15,16. boils due to Heat Toxin, incomplete expression of rashes
mumps or abscesses and ulcers of tongue and mouth due to Heat Toxin sore throat or tonsillitis due to Wind Heat + Heat Toxin
diuretic
secondary use for edema, cystitis
laxative
mild laxative action secondary to alterative use
constipation with Dryness
In Chinese medicine, the main actions of niu bang zi, Arctium seeds, are to clear Heat Toxin and/or Wind Heat to treat inflammations and infections of the throat and skin. In the West, there is a long tradition of using Arctium to clear heat and toxins from the surface of the body, as in China, but there is also a tradition of using Arctium seeds to nourish and moisten the skin. This is rather like the Chinese tradition of using the seeds to moisten the Intestines. In the West, there is a long tradition of using Arctium for urinary problems and for arthritic or rheumatic disorders, which is not well known in China. A Chinese tradition of use that is not emphasized in the West is that of using Arctium for inflammatory conditions of the throat, but there is an old tradition of use using it for bronchial conditions, which is not emphasized in China.
References 1. Schulte KE, Rucker G, Boehme R. Arzneim Forsch 17:829-833 (1967)
2. Washino T, Yoshikura M, Obata S. Agric Bioi Chern 50:263-269 (1986)
Other
3. Washino T, lwabuchi H, Yoshikura M et al. Nippon Nogeikagaku Kaisi 59:389-395 (1985)
Sexual tonic Gerard said that Arctium stalk 'increases seed
4. Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm, Stuttgart. Germany (1994). from 2nd German edn. Wicht! M (ed) (1989)
and stirs up lust,' and Tabernaemontanus wrote that the root increases the hbido.
5. Sun WJ.ShaZH.Gao H.Yao Xue Xue Bao 27(7):549-551 (1992)
Nervine For7 wrote that Arctium seeds are a good nervine that can be used for spasms, convulsions, epilepsy, and fits.
6. Wang HY.YangJS. Yao XueXue Bao 28(12): 911-917 (1993)
Christopher listed Arctium seeds as a nervine, but did not discuss this use.
8. Mockle JA and Sr. Patrick de l' Assomption. Acta Phytotherapeutica 7:101-114 (1960)
7. Nose M, Fujimoto T. Takeda T et al. Planta Med 58(6):520-523 (1992)
232
Combining Western Herbs and Chinese Medicine
9. Kato Y. Watanabe T. Biosci Biotechnol Biochem 57(9):1591-1592 (1993) 10. Suchy M. Herout V. Sorm F et al. Collect Czech Chern Commun 22:1902-1908 (1957) 11. Bruneton J. Pharmacognosy: Phytochemistry Medicinal Plants. 2nd edn. Lavoisier. Paris. France (1999) 12. Os'kina OA. Pashinskii VG. Kanakina TA et al. Eksp Klin Farmakol 62(4):37-39 (1999) 13. Lin CC.Lu JM. Yang JJ et al.Am J Chin Med 24(2):127-137 (1996) 14. Lin SC. Chung TC. Lin CC.et al.Am J ChinMed 28(2):163-173 (200) 15. Bensky D. Gamble A. Chinese Herbal Medicine Materia Medica. Eastland Press. Seattle, Washington (1986)
25. Lyle TJ. Physio-Medical Therapeutics. Materia Medica and Pharmaq',_ Originally published Ohio (1897). Reprinted by the NationaE~.~ Association of Medical Herbalists of Great Britain. London. United .
"h .
.~"1'"
Kingdom (1932) 26. Christopher JR. School of Natural Healing. BiWorld. Provo, (1976)
tJ~~'::':: .•. ·;; ~.'. ....,:._:
27. Lonicerus A. Kreuterbuch (1679). Reprinted by Verlag Konrad Kolbl, Miinchen, Germany (l962)
".
.~.~;::,':~
',::iii '-, c;~
28. Culpeper N. Culpeper's Complete Herbal and English Physician:'i:'.-rEnlarged. Meyerbooks, Glenwood. Illinois (1990) ~~
i
29. Gerard J. The Herbal or General History of Plants: The Complete 1633 . '.:.:.L.,.r. '.." Edition as Revised and Enlarged by Thomas Johnson. Dover '''~''.
'·'et:.~~
Publications, New York. New York (1975)
16. Yeung H-C. Handbook of Chinese Herbs and Formulas. vol. 1. Institute of Chinese Medicine. Los Angeles, California (1985)
30. Grieve M. A Modern Herbal. vols. 1 and 2. Dover Publications, New
17. Lapinina O. Sisoeva TF. Farmatsevt. Zh. (Kiew) 19:52 (1964) [dted in Bi.~set NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm. Stuttgart. Germany (1994). from 2nd German edn. Wichtl M (ed) (1989)]
31. Felter HW. Uoyd JU. King's American Dispensatory. vols. 1 and 2. 18th .. . ~f:..':."::" edn. (1898). Reprinted by Eclectic Medical Publications, sand:,_~L~::
18. Swanston-Flatt SK. Day C. Flat PR et al. Diabetes Res 10(2):69-73 (1989)
Oregon (1983)
.•
:~~
...,
32. Tabernaemontanus JT. Krauterbuch (1731). Reprinted by Verlag Konrad Kolbl, Miinchen, Germany (1993) 33. Dioscorides P. Kreutterbuch (1610). Reprinted by Verlag Konrad Kolbl, .
19. lwakarni S. Wu JB, Ebizuka Yet al. Chem Pharm Bull 40(5):1196-1198 (1992) 20. Hirose M, Yamaguchi T. Lin C et al. Cancer Lett 155(1):79-88 (2000)
';;'"
York. New York (1971)
Miinchen. Germany (1960)~t~L~ 34.
~~~:dA~:~:: ~~8~;rbal Medication. L.N. Fowler, Romford Essex,,~{~':lt .--.,~t"~
21. Moritani S. Nomura M, Takeda Yet al. Bioi Pharm Bull 19(11):15151517 (1996)
35. Scott
22. Takasaki M, Konoshima T. Komatsu K et al. Cancer Lett 158(1):53-59 (2000)
36. Mills S, Bone K. Principles and Practice of Pbytotherapy: Modern
23. Morita K. Kada T. Namiki M. Mutat Res 129(1):25-31 (1984)
J. Natural Medicine for Children. Unwin Paperbacks, London.,;:~
United Kingdom (1990) Herbal Medicine. Churchill Livingstone, Edinburgh. United Kingdom _'2~ (2000)
, '''''i-~. ·:';":.~:~f
24. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983)
37. Fox W. The Working Man's Model Family Botanic Guide to Health. 7th .• :~ :;~ edn. William Fox, Sheffield, United Kingdom (1878) ." .,'.~ !\".
~.
.....,.
Arctostaphylos Botanical name Arctostaphylos uva-ursi (1.) Spreng. (A. officinalis WlIIlIl1.) Family Ericaceae Pharmaceutical name Uvae ursi foliwn Part dried leaves English bearberry German Barentraube French busserole Mandarin A. uva-ursi (1.) Spreng. is not used
What is special about Arctostaphylos In terms of Chinese medicine, Arctostaphylos, as used in the West, can be said to be a cool, sour, and bitter herb that has its main effects on the Kidney and Bladder.
The key to understanding Arctostaphylos is that it is an antimicrobial, anti-inflammatory, and astringent herb that is specific for urinary tract infections, especially those with alkaline urine. It can also be used as an antimicrobial, anti-inflammatory, and astringent for prostate, vaginal, or uterine disorders.
Use in the West A. uva-ursi is a low-growing evergreen shrub found throughout the Northern hemisphere in America, Europe, and Asia. According to Grieve,1 it was used in the 13th century by the Welsh physicians of the Myddfai, and in the 18th century by Gerhard of Berlin. However, I could not fmd reference to this herb in Dioscorides,2 Lonicerus,3 Tabernaemontanus,4 Gerard,S or Culpeper,6 and the common use of this herb to treat urinary problems may have been introduced to Europe from America in the late 19th century. The Northwestern Native American group, the Haida, used the leaves of Arctostaphylos as a diuretic in kidney diseases and urinary tract infections, 7 and this herb was used by Physiomedical and Eclectic practitioners to treat urinary problems at least since the early 19th century. In 1878 Fox8 wrote that uva-ursi 'has ~o equal in chronic inflammation of the kidneys and bladder:
CHINESE ACTIONS In terms of Chinese medicine, Arctostaphylos, as it is used in the West, can be said to have two main actions: 1. clear Damp Heat in the Lower Burner II. stop bleeding and discharges WESTERN ACTIONS The main Western actions of Arctostaphylos are shown here in terms of its two main Chinese actions: .."...,.."...._._-.~-
I. clear Damp Heat in Lower Burner
Use in China A. uva-ursi is not listed in the Chinese Herbal Medicine Dictionary,9 Perri,lo or Chang and BUt. 11
233
antimicrobial anti-inflammatory diuretic antilithic
234
Combining Western Herbs and Chinese Medicine
II. stop bleeding and discharges
astringent anticatarrhal antimicrobial anti-inflammatory
Anticatarrhal Arctostaphylos may help to reduce catarrh in the urogenital system, that iS,oversecretion and accumulation of phlegm with obstruction and/or discharge. However, this effect may be via the antimicrobial and antiinflammatory actions of Arctostaphylos, rather than by directly increasing the ciliary action of epithelial cells. It may also be that the astringent action of Arctostaphylos contributes to an anticatarrhal effect, and this herb has had a tradition of use as a tonic for the wall of the bladder and the passageways of the urinary system.
WESTERN USES
II. stop bleeding and discharges
·~·it·
Choice of Arctostaphylos This herb is specific for urinary _'~ tract infections, but whilst of value in the short-term treat-';'=ment of acute infections as an antimicrobial, other herbs will be needed for this patient for the long-term correction of the underlying causes of the Stagnation of Qi, which may be the" ~ origin of the accumulation of Damp Heat.
Limitations ofArctostaphylos TEMPERATURE In this book, Arctostaphylos is classified as cool, but can be used for hot, ~arm, neutral, or cool conditions if combined with appropriate herbs. It would not normally be sufficient to treat hot conditions unless combined with colder herbs, such as Baptisia.
TASTE
The main Western uses of Arctostaphylos can be related to its two main Chinese actions:
I. clear Damp Heat in Lower Burner
c:.::=-..:'3;"·,
urinary tract infections, prostate infections, vaginitis. cervicitis blood or mucus in the urine, abnormal uterine bleeding, leukorrhea
Arctostaphylos is classified as sour and bitter in this book. It is sour in the sense of being an astringent, rather than a tonic for the Liver, and it is bitter in the sense of dearing Heat, rather than acting as a bitter digestive tonic.
ACTIONS Antimicrobial and anti-inflammatory The primary use of Arctostaphylos is as an antimicrobial and anti-inflammatory, specifically for infections and inflammations of the urogenital system. For infections and inflammations of other systems, other herbs are generally more effective.
DIRECTION OF ENERG Y This herb does not have a marked directional effect on the circulation of energy in the body. It may act as a mild diuretic with an associated downward movement of Fluids, but it can also act as a mild astringent, helping to restrain discharge or bleeding from the urogenital systems.
TYPICAL CASE EXAMPLE Signs and symptoms The patient has recurring bouts of acute cystitis with burning sensation and pain on urination, and frequent, though less severe, urinary discomfort between these bouts. The pulse is slightly wiry in the third positions, and this wiriness increases during the acute episodes, when the pulse rate may also increase. The tongue is slightly red with a slightly yellow, greasy coat, the redness and yellowness increasing during the acute periods. Diagnosis The patient has Damp Heat and Stagnation of Qi in the Lower Burner.
Astringent The secondary use of Arctostaphylos is as an astringent to tone mucous membranes, reduce excessive discharge, and reduce bleeding from the urogenital systems of_ ". both male and female. However, despite its relatively high tannin content, it does not have common use as a general astringent and antihemorrhagic for other systems. Anticatarrhal Arctostaphylos may help to reduce catarrh in the urogenital system that is producing obstruction and/or discharge. However, the anticatarrhal action is sec-·ondary to the antimicrobial and anti-inflammatory effects, and the anticatarrhal activity of this herb is mainly limited to the urogenital system.
Arctostaphylos paired with other herbs Discussion of the limitations of each of the main actions
f: Arctostaphylos of Arctostaphylos can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Arctostaphylos beyond its limitations. The basic unit of herb combination is the herb pair. Six pairings of Arctostaphylos are briefly explained below.
CAUTION
Any urinary condition with hematuria or female reproductive disorder with bloody or purulent discharge requires diagnosis and/or treatment from an appropriate specialist in conventional medicine prior to treatment with herbal therapy. Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair.
235
or cystitis. Thuja can also be used to treat recurring respiratory infections with accumulation of phlegm and may have antiviral, anticatarrhal, and expectorant actions. Arctostaphylos and Thuja can be combined to treat urinary infections associated with respiratory infections. Arctostaphylos + Juniperus
Cystitis + arthritis Juniperus can have antimicrobial, anti-inflammatory, and diuretic actions, so that it can be paired with Arctostaphylos for urinary tract infections. Juniperus can also be used for recurring respiratory conditions or arthritis and rheumatism. Arctostaphylos + Rumex
Vaginitis + leukorrhea Arctostaphylos + Althaea
Cystitis + gastrointestinal inflammation Althaea is a demulcent anti-inflammatory that can be used for inflamed mucosa of the respiratory, gastrointestinal, or urogenital systems. Althaea can complement the antimicrobial, anti-inflammatory, and astringent actions of Arctostaphylos to treat urogenital inflammations, especially if there is generalized inflammation in the body, with gastrointestinal irritation, for example. Arctostaphylos + Echinacea
Urinary tract infections Echinacea is a general-purpose antimicrobial that can complement the urogenital system-specific antimicrobial action of Arctostaphylos. This pair can be used also when acute urinary infections are associated with acute respirato-
Rumex is an alterative that can be used for chronic infectionsand inflammations of the urogenital system associated with accumulation of Damp Heat and Heat Toxin. It can be combined with Arctostaphylos in oral preparations and in vaginal boluses or douches to treat vaginitis and leukorrhea.
Arctostaphylos combinations Six Arctostaphylos combinations are discussed below: .......
_----~--.,-
...... - ... ..."...••.. ,. _~-
'~~;.;,..:;.
1. urinary infection + heat sensations
Bladder Damp Heat
2. cystitis + hematuria
Bladder Damp Heat + Bleeding from Heat
3. cystitis
Bladder Heat + Kidney Deficient Yin
4. cystitis + recurring respiratory infection
Retained Pathogen + Bladder Damp Heat
ry infections. Arctostaphylos + Hydrastis
Urinary infections + hematuria Hydrastis is a general-purpose antimicrobial and antiinflammatory that can complement the specific action of Arctostaphylos on the urogenital system. Hydrastis is anticatarrhal and antihemorrhagic, and can combine with Arctostaphylos to treat conditions with:
..
Combination
5. prostatitis 6. vaginitis
+ infection
Damp Heat in Lower Burner Damp Heat in Lower Burner
CAUTION • mucus or blood in the urine • infection, inflammation, and discharge of the male or female genital areas Arctostaphylos + Thuja
Cystitis + respiratory infections Like Arctostaphylos, Thuja can have both astringent and diuretic actions. and the two herbs canbe used to treat enuresis
Any urinary condition with hematuria or female repro~ ductive disorder with bloody or purulent discharge requires diagnosis and/or treatment from an appropriate specialist in conventional medicine prior to treatment with herbal therapy. Before using any ofthe combinations below, it is important to be familiar with the cautions listed for each herb in the combination.
Combining Western Herbs and Chinese Medicine
236
1. Urinary infection + heat sensations
USE
Bladder Damp Heat
• acute urinary tract inflammations and/or infections with burning sensation on urination • acute urinary tract inflammations and/or infections
Arctostaphylos Baptisia Echinacea Hydrastis Zingiber
sour, bitter bitter acrid, bitter, sl. sweet bitter acrid, aromatic
cool cold cool cool hot
1 1 1 1 0.5
with bleeding PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of water, three times per day. If there is hematuria, as soon as this is consistently reduced, this com-
GENERAL
This combination is for Excess patterns of Damp Heat or Heat. The overall temperature is cool to treat hot or warm conditions. Zingiber has been included to disperse Heat to the surface, and to moderate the effect of the cool herbs in the treatment of mixed conditions of Heat and Cold, or of temporary Excess Heat with underlying Deficiency. Zingiber can be omitted or rep~;lced by Glycyrrhiza in purely Excess Heat patterns. if required. The dominant taste is bitter to clear Heat.
--
bination can be replaced with a more tonic combination. such as combination No.3 below.
Duration of prescription
If the hematuria is not improved within one week, the combination should be modified or a different combination may be required. If, for example, the pattern of bleeding proved to be one of Spleen Deficiency and Cold rather than one of Heat. then Arctostaphylos and . Hydrastis could be replaced by Astragalus and Cinnamomum bark.
USE
• acute urinary tract infections with feverishness or sensations of heat
3. Cystitis
Bladder Heat + Kidney Deficient Yin .' '~:.
PRACTICAL NOTES
This combination is for acute conditions, and can be taken as 5 m1 of 1:5 tincture in quarter of a cup of water, three times per day, for up to 1 week. As soon as the symptoms of burning pain on urination and sensations of heat are consistently reduced, this combination can be replaced with a less cool and more tonic combination. such as combination No.3 below.
_ ~'.'- :;'./';,'J; ~:;;:";;2:;.-:.r:~Y~\.::;,.~~ ~"~:-',::;:'~.,~,:j '.;;.~ ..... --:.:~-,~;--/~ .._:~
Daily dose ': Temperature: -Taste. , " : '--, :, . '_-.-.-,--, ,_
Herb
-
Althaea Viola trio Zea Agropyron Ophiopogon Arctostaphylos
3g 3g 3g 3g 3g 3g
-."
sweet, sl. bitter sour, sweet, bitter sweet sour, sl. sweet sweet, sl. bitter bitter, sour
cool cool neutral neutral cool cool
This combination is the same as Althaea: cystitis and is discussed under that combination.
2. Cystitis + hematuria 4. Cystitis + recurring respiratory infection
Bladder Damp Heat + Bleedingfrom Heat "',; >':'?::: ~:~
"'-,~_-', "-'~l -: "~.'.~,'-""j:;:'.:'--~'L!-:::';~";:.:~~~';_
Herb,
...
:~
Retained Pathogen + Bladder Damp Heat
',' .},~a~i?.:·Tempercltur~);Tast~:,:::
Arctostaphylos Hydrastis Polygonum Plantago Ian. (leaves) Equisetum Capsella
1 1 1 1 ,1 1
cool cool cool cool cool neutral
bitter, sour bitter sour, bitter sour, sl. bitter sl. bitter, sl. sweet sour
GENERAL
This combination is'forBia:clder Damp Heat with bleeding due to Heat. The overall temperature is cool to treat hot or warm conditions. The dominant tastes are bitter to clear Heat and Damp Heat. and sour to reduce bleeding by astringency.
Temperature Taste ..
Juniperus 1 Arctostaphylos 1 Thymus 1 Thuja 1 Echinacea 1 Hydrastis 1 Zingiber 0.5
51. warm cool warm-cool warm-cool cool cool hot
aromatic, sl. acrid, 51. sour sour, bitter aromatic acrid, aromatic, bitter acrid, bitter, sl. sweet bitter acrid, aromatic
This combination is the same as Juniperus: cystitis
+
recurring respiratory infection and is discussed under that heading.
Arctostaphylos
237
from the following six-herb combination, which is a modification of Christopher's vaginal bolus formula.
5. Prostatitis + infection
Damp Heat in Lower Burner
Ratio
Herb Herb
Ratio Temperature Taste
Thuja
1
warm-<:ool
acrid. aromatic. bitter
Arctostaphylos
1
cooi
1 1 1 1
51. warm
bitter. sour aromatic. 51. acrid, 51. sour
cool
bitter
neutral
bitter, sour 51. bitter, 51. sweet
Juniperus Hydrastis Hydrangea Equisetum
cool
This combination is the same as Thuja: prostatitis + infection and is discussed under that combination.
Arctostaphylos Althaea Hydrastis
1.5 1.5 1
Herb
Ratio
Mitchella Stellaria Rumex
1 1 1
The douche can be a decoction of a single herb such as Berberis. Hydrastis was commonly used in the past, but Berberis can be used as a much cheaper substitute.
COMPARISON OF THE SIX ARCTOSTAPHYLOS COMBINAT.IONS
6. Vaginitis
Lower Burner Damp Heat
Arctostaphylos Althaea Hydrastis Vinca Mitchella. Rumex Zingiber (dried)
1.5 1.5 1 1 1 1 1
cool
bitter. sour
cool
sweet. 51. bitter
cool
bitter
neutral
sour
neutral
51. sour
cool
bitter
hot
acrid. aromatic
1. Urinary infection + heat sensations
2. Cystitis + hematuria
Bladder Damp Heat
Bladder Damp Heat + Bleedingfrom Heat
Hertr~;1gr?1~Ratio "··r'·~·-···
Arctostaphylos Baptisia Echinacea Hydrastis Zingiber
1 1 1 1 0.5
GENERAL
This combination is for Damp Heat in Lower Burner with some Heat Toxin. The overall temperature is cool to treat warm, neutral, or mixed conditions. Fresh Zingiber is included to disperse Heat ounvard to the surface, and to moderate the cool herbs, especially in patterns with underlying Deficiency and Cold. The dominant taste is bitter to clear
Ratio'
Herb
-...., .
1 1 1 1 1 1
Arctostaphylos Hydrastis Polygonum Plantago Ian. (leaves) Equisetum Capseila
I. This combination is for acute, severe Excess patterns of Damp Heat or Heat and contains four cool, bitter antimicrobial herbs, moderated by Zingiber. This combination is only to be taken for up to a week, and as soon as symptoms of pain and heat are consistently reduced, it can be replaced by the next combination.
Heat, supported by sour to astringe discharge. USES
• inflammation and/or infection of vagina or cervix, with discharge • urinary inflammation and/or infection with discharge. • anogenital herpes simplex (acute phase)
2. This combination is to treat urinary inflammation and! or infection associated with Bladder Damp Heat, and to treat hematuria associated with Heat Arctostaphylos and Hydrastis are paired as antimicrobials; Polygonum and Plantago are paired as mucilaginous, demulcent, anti-inflammatory and antihemorrhagic herbs for the urinary system; and Equiseturn and Capsella are paired for their antihemorrhagic action.
PRACTICAL NOTES
This combination can be taken as 5ml of 1:5 tincture in about quarter of a cup of water, three times per day. It can be taken, with appropriate breaks and modifications for 2-4
3. Cystitis
4. Cystitis + recurring respiratory infection
Bladder Heat + Kidney Deficient Yin
Retained Pathogen + Bladder Damp Heat
weeks.
Bolus and douche This tincture may be accompanied by vaginal bolus and/or douche, as descnbed in the Examples section in the chapter Dose. The vaginal bolus can be made
Althaea Viola trI.
3g 3g
Juniperus Arctostaphylos
1 1
-
c~
Combining Western Herbs and Chinese Medicine.:=,ii.~ .
238
..
=:~
vmca.::'iif'
Zea Agropyron Ophiopogon Arctostaphylos
3g 3g 3g 3g
Thymus Thuja Echinacea Hydrastis Zingiber
acts as a demulcent anti-inflammatory. and Hydrastis. and Mitchella together have tonic. astringent. and anti-· ...' catarrhal effect on the mucus membranes of the reproductive system. Rumex is an alterative herb that can help to clear Damp Heat and Heat Toxins from the body. to reduce inflammation in the reproductive system.
1 1 1 1
0.5
3. Of the four strong antimicrobial herbs present in combination No. I, orily Arctostaphylos is retained in combination No.3. The strong antimicrobial herbs Baptisia. Echinacea. and Hydrastis are replaced by the anti-inflammatory herbs Althaea. Viola, Zea. Agropyron. and Ophiopogon. These anti-inflammatory herbs can help to tonify Kidney Ym and clear Deficiency Heat. This combination can be taken for 1-2 months, since Arctostaphylos is a small proportion of the whole and is moderated by the demulcent herbs. 4. Combination No.4 contains herbs for both the urinary and respiratory systems. All the herbs in this combination except Zingiber can have strong antimicrobial action. Arctostaphylos and Juniperus are specific for the urinary system. but Juniperus can also combine with Thymus, Thuja, and Echinacea to treat recurring respiratory infections due to Retained Pathogen. and to clear treat cough and bronchial obstruction due to Lung PWegm. 5. Prostatitis + infection
6. Vaginitis
Lower Burner Damp Heat
Damp Heat in Lower Burner
Research CONSTITUENTS The following constituents have been reported: • hydroquinone derivatives • polyphenols (tannins) • other Hydroquinone derivatives The main constituent is arbutin (hydroquinone mono-~-D-glucoside) which is usually 612%,12 but there is seasonal variation and it can be as high as 17%.13 There is also a smaller amount of methyl arbutin (up to 4%) and some free hydroquinone and methylhydroquinone. H Polyphenols These can be 10-15% and are mainly gallotannins, which are galloyl esters of glucose.1 5 There are also 16 ellagic acid, catechin. and anthocyanidin derivatives. Other These include the phenolic glucoside piceoside, flavonoids. phenolic acids. the iridoid glucoside monotropein, and triterpenes. 1i
Herb
..
-
Thuja Arctostaphylos Juniperus' Hydrastis Hydrangea Equisetum
Ratio 1 1 1 1 1 1
Herb Arctosta phylos Althaea Hydrastis Vinca Mitchella Rumex Zingiber (fresh)
Daily Dose 4.5 g 4.5 g
3g 3g 3g 3g 3 slices
5. This combination is for prostate inflammation and infection with signs of Heat and without appreciable Deficiency. Thuja. Arctostaphylos. Juniperus, and Hydrastis can have antimicrobial, anti-inflammatory, and anticatarrhal action on the urinary system, and Hydrangea, and Equisetum are specific for prostatitis. 6. Both combination No.6 and combination No.5 are for Damp Heat in the Lower Burner. But whilst combination No. 5 is for prostate infection. combination No.6 is for vaginal inflammation and/or infection. Arctostaphylos and Hydrastis have antimicrobial action, as in combination No.5, but in combination No.6, Althaea
PHARMACOLOGICAL AND CLINICAL RESEARCH The following effects have been reported: • antimicrobial • anti-inflammatory • urinary antimicrobial and anti-inflammatory • diuretic • nephroprotective • antidiabetic • antitussive • antimelanin Antimicrobial Arctostaphylos extract,18 and arbutin and hydroquinone. 19 have all shown antibacterial activity in vitro. The aglycone of piceoside. p-hydroxyacetophenone, 20 showed antibacterial action although piceoside did not. Anti-inflammatory Arctostaphylos extract has been reported to have an anti-inflammatory effect in mice. and both the Arctostaphylos leaf extract and arbutin isolated from it
Arctostaphylos increased the anti-inflammatory effect of prednisolone. 21 Arbutin also increased the anti-inflammatory action of indomethacin on carageenin-induced edema and adjuvantinduced arthritis.~2
Antidiabetic One study reported that consumption of a diet containing Arctostaphylos may counter some of the symptoms of streptozotocin diabetes in mice, but without affecting glycemic control.33
Urinary antimicrobial and anti-inflammatory
Antitussive Oral administration of arbutin at 50 mg/kg was reported to inhibit induced cough reflex. 34
Arbutin metabolism Arbutin may be the main constituent responsible for antibacterial activity in the urinary system.
-.
239
Arbutin is hydrolysed by the intestinal flora to its aglycone hydroquinone, which is in turn metabolized to its glucuronate and sulphate esters, which can then be excreted in the urine. 23 Arbutin and hydro quinone are not found in appreciable amounts in the urine. It has been suggested that, at an alkaline pH, the glucuronate and sulphate esters can release small amounts of hydro quinone, which has antibacterial effect.24
Antimdanin Both Arctostaphylos extract and arbutin have been reported to inhibit melanin synthesis by both tyrosinase and autoxidation. 35 It has been suggested that the leaves of Arctostaphylos species can be used as whitening agents for the skin. 36
RESEARCH VERIFICATION OF TRADITIONAL ACTIONS
Hydroquinone and urine pH The urine of a healthy individual on a diet including meat ranges from pH 4.5-6, although the pH of the urine of a vegetarian may be higher. Certain organisms associated with urinary tract infections, such as Proteus species or Klebsiella species,::; may produce a urine pH of >7 due to the degradation of urea with release of ammonia. 26 This pH may be high enough (about pH 8) to result in hydroquinone release and antimicrobial activity. Other bacteria responsible for urinary infections do not degrade urea and therefore do not raise pH appreciably. In such cases, it has been suggested that it may be beneficial to administer sodium bicarbonate27 or lJral28 along with Arctostaphylos in order to raise the pH sufficiently to ensure release of hydroquinone. This suggestion is based on the hypothesis that hydroquinone release in alkaline urine is the main cause of the antimicrobial action of Arctostaphylos, and although there is some evidence for this hypothesis,24 it has not yet been definitively confirmed. The only double-blind, placebo-controlled randomized clinical trial so far reported investigated the effectiveness of a combination of Arctostaphylos ,and Taraxacum to treat cystitis. 29 Although this combination was shown to be effective and without side effects, it cannot give information on the effectiveness of Arctostaphylos itself, since the activity may have been due to the Taraxacum. Diuretic One study reported that oral administration of Arctostaphylos infusion to healthy rats did not significantly increase urination or alter calcium and citrate levels,30 but another study reported that aqueous extracts of Arctostaphylos led to an increase in urine flow. 31 Nephroprotective It has been reported that an Arctostaphylos extract, at a dose of 25 mg/kg, had a marked antibacterial and nephroprotective effect in rats with acute bacterial pyelonephritis caused by E. coli. 32
The following traditional actions have been supported by research: antimicrobial, anti-inflammatory, diuretic, antidiabetic, and antitussive. The astringent and antilithic actions have not yet been supported by research. The BHC states that the high tannin content causes an astringent action, but does not support this statement with references. Additional effects demonstrated by research Arctostaphylos extracts have been reported to inhibit melanin synthesis, so that this herb may have the potential to treat hyperpigmentary disorders.
TOXICOLOGY An important distinction Whilst hydroquinone can have toxic effects at a high enough dose,37 a careful distinction needs to be made between the use of: . • therapeutic doses ofArctostaphylos as an infusion or tincture • arbutin as an isolated chemical • hydroquinone as an isolated chemical Although one model of the antimicrobial action of Arctostaphylos is based on the concept of release of small amounts of hydroquinone in the urine at high pH. a pilot clinical study found no free hydroquinone in the urine of volunteers. 38 Arctostaphylos According to the ESCOP monograph on Arctostaphylos, no toxicity data, reports of carcinogenicity, or reports of overdose are available for this herb, and it has been shown to be non-mutagenic in the Ames test and in the Bacillus subtilis rec-assay.39 According to Mills and Bone, short-term use of Arcto-
-~::~os~~IDw~huti~= ::::::O::::eros :~:::n::~::nt:atment ili~ beth an~:C. mili
· e th e urme. . 45 agents to alkaliniz
pregnancy and lactation.
Arbutin Arbutin did not induce mutations in concentrations of up to 10'2 M in a gene mutation assay, and there was no induction of micronuclei in bone marrow following oral administration of arbutin at 0.5-2 g/kg.-IO Hydroquinone
~
.,,~,a_
._"~
Duration According to the ESCOP monograph on Arcto- "~~. staphylos, treatment should be continued until complete_ ~:,o~~""'" ~. appearance of symptoms, up to a maximum of 2 weeks~ ~"': . Until more is known, it may be prudent to avoid the long-term .,:-....;:. ~ use of this herb at higher therapeutic doses, see Toxicology. '~'", ~ ..
LD;Q The oral LD so of hydroquinone in 2% aqueous solution has been reported as 320-550 mglkg in a variety of animals: l
Carcinogenicity and mutagenicity Hydroquinone is nonmutagenic in the Ames test, but can induce chromosome aberrations in eukaryotic cells, and, when administered by intraperitoneal injection in vivo, has induced raised micronucleus incidences.40 Topical use Whilst no side effects have been reported for topical creams containing Arctostaphylos, depigmenting creams containing hydroquinone may cause hyperpigmentation42 or allergic dermatitis. 43 Duration of use According to Mills and Bone, Arctostaphylos is not suitable for prolonged use due to its tarmin content. However, this statement is based on theoretical considerations of the potential effects of tarmins, rather than on research evidence for Arctostaphylos used within therapeutic doses.
Cautions ._,.'::
Western contraindications According to the German Commission E monograph,46 no contraindications are known for this herb. According to the BHC, this herb is contrain- ;~;i;~ ~ dicated for kidney disorders, but no references were given to<~ " support this. Indeed, there is a tradition of use to treat kidney~"1-. "1 disorders, and one research study has reported a nephro-..,· ' . 32 protective"effect for A r c t o s t a p h y l o s ..'~ ' ~.; y~; , - •••
Chinese contraindications
None known for A. uva-ursi.
Pregnancy and lactation Until more is known about the amount of hydroquinone released from Arctostaphylos in humans, it is prudent to avoid the use of this herb in pregnancy and lactation, see Toxicology.
-:~~ .....,...-..
Side effects According to Wicht!, this herb may cause nausea or vomiting in patients with delicate digestion.
~
The chemical that may give rise to greater toxicity concern than the tannins is hydro quinone. It is necessary to determine the amounts of hydroquinone and potentially toxic derivatives released in the body from arbutin. It is also necessary to determine whether these levels are sufficient to have toxic effects either long or short-term in humans. It may be that the amount of hydroquinone released from therapeutic doses of Arctostaphylos in the human body is toxic to the bacteria responsible for urinary tract infections, but not to humans. However, until more is known on this topic, it may be prudent to limit Arctostaphylos to relatively short-term use.
Overdose No reports on overdose known,39 see Toxicology.
Dose
Regulatory status
Dried herb The BHp H listed 1.5-4 g of the dried herb, three times per day.
Please read the Regulatory status section in the chapter. on Safety. Arctostaphylos is on the UK General Sale List, and it i~ not included in Part 4 of Schedule 4 of the Therapeutic Ci?0ds Act Regulations of Australia. Arctostaphylos is not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its, .. .... .. use.
Tincture The BHC listed 2-4 ml of 1:5 tincture in 25% alcohol, three to four times per day. Initial dose
Can start at the standard dose.
Method of administration
It may be beneficial to drink
6,
Interactions
• if the assumption that Arctostaphylos works best at an alkaline pH is correct, it would be better to avoid treatments that increase urine acidity whilst using Arctostaphylos as a urinary antimicrobial • theoretically, the high tannin levels in Arctostaphylos might interfere with the absorption of various nutrients, but this has not been reported for this herb in practice
~'.'
"
-,.
;;~t
i
--
Arctostaphylos
,
Traditional sources The recorded use of this herb seems to have begun with the early Eclectics, and to have been transferred from them to Britain and Europe.
• tonic astringent • diuretic • antilithic • antidiabetic • antitussive • other
PROPERTIES
Antimicrobial and anti-inflammatory
Temperature In this book, Arctostaphylos is classified as cool, associated with its antimicrobial and anti-inflammato-
Urinary disorders
ry properties. Taste
Taste in the mouth The BHP described Arctostaphylos as slightly bitter and astringent. I found a 1:5 tincture in 25% alcohol to be bitter and sour, with a slightly puckering astringent sensation in the mouth.
Taste properties Arctostaphylos is classified in this book as sour, associated with its astringent action, and bitter, relating to its antimicrobial and anti-inflammatory effect to clear Damp Heat in the lower body.
241
Fox recommended Arctostaphylos for inflammations and ulcerations of the kidneys and bladder, Felter and Lloyd listed it for chronic irritation of the bladder and for chronic disorders of the kidneys and urinary passages, and Ellingwood49 noted its use for cystitis, pyelitis, and pyelonephritis. Christopher recommended Arctostaphylos for kidney and bladder congestion or ulceration and for chronic nephritis, and the BHP listed this herb for cystitis, urethritis, and pyelitis, and gave its specific indication as 'acute catarrhal cystitis with dysuria and highly acid urine:
Reproductive disorders Felter and Lloyd listed Arctostaphylos for gonorrhea, and Christopher also recommended it for syphilis and uterine ulceration. Tonic astringent
ORGANS In terms of Chinese medicine, Arctostaphylos, as used in the West, can be associated mainly with disorders of the following organs:
Kidney, Bladder
back pain cystitis
Christopher" BHP
Uterus
leukorrhea uterine hemorrhage
Felter and L1oyd48 Christopher
Lung
cough bronchitis
Felter and Lloyd Christopher
A. uva-ursi is not listed in the Chinese Herbal Medicine
Urinary disorders According to Felter and Lloyd, Arctostaphylos is specific for urinary problems with: • 'feeble circulation and lack of innervation in the urinary tract' • mucous or bloody secretions • feeling of weight and dragging in the loins and perineum, when not due to prostatic enlargement According to Ellingwood, Arctostaphylos is specific for 'relaxed conditions of the bladder walls, to which it imparts tone and induces normal contraction: Felter and Lloyd also wrote that Arctostaphylos could be used for enuresis, and Christopher described two enuresis combinations including this herb.
Dictionary.
Reproductive disorders Both Felter and Lloyd and Christ-
ACTIONS
opher listed Arctostaphylos for leukorrhea and menorrhagia. Christopher also recommended it for prostate weakness.
The main tradition of use of Arctostaphylos has been as an antimicrobial, anti-inflammatory, and astringent herb primarily for the treatment of Urinary disorders, and secondarily for the treatment of certain reproductive disorders, such as leukorrhea, gonorrhea, uterine ulceration, and uterine hemorrhage. The following actions are discussed separately, although the antimicrobialJanti-inflammatory, tonic astringent, and anticatarrhal actions may work in combination: • antimicrobial and anti-inflammatory
Other Both Felter and Lloyd and Christopher listed Arctostaphylos for chronic diarrhea and dysentery, and Christopher noted its use for hemorrhoids. Diuretic Christopher recommended this herb for cardiac dropsy, the BHP listed it as a diuretic, and it has had a tradition of use in France as a diuretic. 28 Antilithic Felter and Lloyd wrote that Arctostaphylos could lessen deposits in the urine, and both Christopher and the BHP noted its use for urinary calculi.
242
Combining Western Herbs and Chinese Medicine ._.;'~~~~~
Antidiabetic Felter and Lloyd, Ellingwood, and Christopher listed this herb for diabetes. Interestingly, a research study recently reported a similar effect.
22. Matsuda H. Tanaka T. Kubo M. Yakugaku Zasshi 111(4-5):253-25$':':-~ :
Antitussive Felter and Lloyd listed Arctostaphylos for chronic laryngitis and cough, and Christopher recommended it for bronchitis.
24. Frohne D. Planta Medica 18:1-25 (1970)
(1991) 23. Kedzia B. Wrocinski T. Mrugasiewicz K et al. Med Dosw Mikrobiol 27:305-314 (l975) -----
25. Baron EJ. Peterson LR. Finegold SM. Bailey and Scott's Diagnostic Microbiology. 9th edn. Mosby Year Book. St Louis. Missouri pl06
'---
(1994)
Other In 1878, Fox recommended Arctostaphylos for lumbago and pains in the back, and this use was mentioned by Christopher, who also listed this herb for rheumatism and anemia.
References 1. Grieve M. A Modern Herbal. vol. 1 and 2. Dover Publications, New York. New York (l971) 2. Dioscorides P. Kreutterbuch (1610). Reprinted byVerlag Konrad Kiilbl. Miin~en. Germl1!ly (1960) 3. Lonicerus A. Kreuterbuch (1679). Reprinted by Verlag Konrad Kiilbl, Miinchen. Germany (1962)
26. Bouchier lAD. Morris JS (eds). Clinical skills - a system of clinical examination. 2nd edn. WB Saunders. London, United Kingdom p243 (1982) 27. Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm. Stuttgart. Germany (1994). from 2nd German edn. Wicht! M (ed) (1989) 28. Mills S. Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone, Edinburgh, United Kingdom (2000) 29. Larsson B. Jonasson A. Fianu S. Curr Ther Res Clin Exp 53(4):441-443 (1993) 30. Grases F. Melero G. Costa-Bauza R et al. Int Urol NephroI26(5):507c . 511 (1994) 31. Beaux D. Fleurentin J, Mortier F. Phytother Res 13(3):222-225 (1999)
4. Tabernaemontanus JT. Krauterbuch (l731). Reprinted by Verlag Konrad Kiilbl. Miinchen. Germany (1993)
32. Nikolaev SM. Shantanova LN, Mondodoev AG et al. Rastitel'Nye Resursy 32(3):118-123 (1996)
5. Johnson. Dover Publications. New York. New York (1975)
33. Swanston-Flatt SK. Day C. Bailey CJ et al. Acta Diabetol Lat 26(1):5155 (l989)
6. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks. Glenwood. Illinois (1990) 7. Pojar J, Mackinnon A. Plants of the Pacific Northwest Coast Washington, Oregon. British Columbia and Alaska. Lone Pine Publishing. Redmond. Washington (1994) 8. Fox W. The Working Mans Model Family Botanic Guide to Health. 7th edn. William Fox. Sheffield. United Kingdom (1878) 9. Jiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science and Technology Press. Shanghai. China (1975) . 10. Perry LM. Medicinal Plants of East and Southeast Asia. The MIT Press. Cambridge. United Kingdom (1980)
34. StrapkovaA, Jahodar L.Nosalova G.Pharmazie 46(8):611-612 (1991) 35. Matsuda H. Nakamura S. Shinomoto H et al. Yakugaku Zasshi 112(4):276-282 (l992) 36. Matsuda H. Higashino M. Nakai Y et al. Bioi Pharm Bull 19(1 ): 153-156 (1996) 37. NowakAK.ShilkinAB,JeffreyGP. Lancet 345:1187 (1995) 38. Paper DH. Koehler J. Franz G. Pharm Pharmacol Lett 3:63-66 (l993) 39. European Scientific Cooperative on Phytotherapy: Monographs on the medicinal uses of plant drugs. (Monograph on Uvae ursi folium) European Scientific Cooperative on Phytotherapy. Exeter. United Kingdom (1997)
11. Chang H-M, But PP-H (eds). Pharmacology and Applications of Chinese Materia Medica. vols. 1 and 2. World Scientific Publishing. Singapore (1986)
40. Mueller 1, Kasper P. Mutat Res 360 (3):291-292 (1996)
12. Sticher 0, Soldati F and Lehmann D. Planta Medica 35:253-261 (1979)
43. Engasser PG. Maibach HI. J Am Acad DermatoI5(2):143-147 (1981)
13. Shnyakina GP. Sedel'nikova V, and Tsygankova NB. Rastit Resur. 17:568-571 (1981); through Chern Abstr 96:3668 (1982)
44. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983)
14. Hansel R. Keller K. Rimpler H (ed) et al. Arctostaphylos. In: Hagers Handbuch der Pharmazeutischen Praxis. 5th ed. vol. 4: Drogen A-D. Berlin: Springer-Verlag. Germany 328-338 (1993)
45. Frohne D. Aractostaphylos uva-ursi (1.) Spreng. (Barentraube). Bonn: Kooperation Phytopharmaka. Unpublished report (1977)
15. Haslam E, LilleyTH, Cai YI et al. Planta Medica 55:1-8 (l989) 16. Wahner C,Schonert J and Friedrich H. Pharmazie 29:616-617 (1974)
41. Woodard G. Hagan CE, Radomski J1. Fed Proc 8:348 (1949) 42. Howard KL. Ferner BB. Cutis 45(3):180-182 (1990)
46. Blumenthal M (ed). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin. Texas (l998)
17. Bradley PR (ed). British Herbal Compendium, vol. 1. British Herbal Medicine Association. Boumemouth. United Kingdom (1992)
47. Christopher JR. School of Natural Healing. BiWorld, Provo, Utah .. (1976)
18. Holopainen M. Jabodar L. Seppanen-Laakso T et al. Acta Pharm Fenn 97(4):197-202 (1988) .
48. Felter HW and lloyd Jv. King's American Dispensatory, vols 1 and 2; .. 18th edn. (1898). Reprinted by Eclectic Medical Publications. Sandy,':'"'
19. Robertson JA.Howard LA.J ClinMicrobio125(1):I60-161 (1987) 20. Jahodar 1, Kolb I. Pharmazie 45(6):446 (1990) 21. Kubo M. Ito M. Nakata H et al. Yakugaku Zasshi 110(1):59.67 (1990)
Oregon (1983) 49. Ellingwood F. American Materia Medica. Therapeutics and Pharmacognosy.llth edn. (1919). Reprinted by Eclectic Medical Publications~ Sandy. Oregon (1994)
Artemisia Botanical name Artemisia spp. Family Asteraceae (Compositae) Pharmaceutical name Absinthii herba (A. absinthium L.) Artemisiae vulgaris herba (A. vulgaris L.) Artemisiae abrotani herba (A. abrotanum L.) Part dried leaves and flowering tops English wormwood (A. absinthium L.) mugwort (A. vulgaris L.) southernwood (A. abrotanum L.) German Wermut (A. absinthium L.) Gewohnlicher BeifuB (A. vulgaris L.) Eberraute (A. abrotanum L.) French absinthe (A. absinthium L.) armoise commune (A. vulgaris L.) aurone male (A. abrotanum L.) Mandarin A. absinthium L. is not used A. abrotanum 1. is not used al ye ()t~) is the leaves of A. vulgaris L.
because A. vulgaris has considerably less essential oil and a weaker bitter taste than A. absinthium. A. abrotanum seems to have been used more in Britain and North America than in France and Germany, and of the three Western Artemisia species, has been regarded as specific for menstrual problemsY A. absinthium in particular has specific application to some of the Widespread disease patterns of modern life: • recurring low-grade fever with exhaustion, as in some cases of chronic fatigue syndrome and fibromyalgia • food intolerances and digestive disorders • recovery from drug abuse or prolonged multi-medication • menstrual disorders with nervous tension and depression
Nomenclature The three Artemisia species commonly used in the West, A. absinthium, A. vulgaris, and A. abrotanum, are not differentiated in the text below. unless specifically stated. Also, in the text below, the words i\rtemisia species' or 'Artemisia spp: refer to these three Western species, and not to the Oriental species, unless stated otherwise.
Use in the West The two main species of Artemisia used in the West are A. absinthium (wormwood) and A. vulgaris (mugwort). although A. abrotanum (southernwood) has been used to a lesser degree. These three Artemesia species are perennial herbs or shrubs that are often strongly aromatic and bitter tasting, and are found throughout Europe, Asia,
Other species used A. vulgaris var. Douglasiana is listed by Moore for chronic gastritis and gastric ulcers, craving for fats, and dysmenorrhea. s The Native Americans used A. tridentata for colds and as a soak for sore feet. 6
and North America. A. absinthium has been used in the West since the time of Dioscoridesl for gastrointestinal, hepatobiliary, and gynecological disorders. and these uses have continued up to the present day. According to Wichd, 2 A. vulgaris has the same uses as A. absinthium, but the action is weaker, perhaps
Use in China Artemisia'is used in Chinese medicine in three main forms: qing hao, yin chen hao, and al yeo The actions and uses of these three species are discussed later in this chapter under Comparison of Artemisia species used in
China and the West.
243
Combining Western Herbs and Chinese Medicine
244
Qing hao This is generally the aerial parts of A. apiacea Hance,',8 although it has also been listed as A. annua L. (sweet wormwood).9,lO A. annua is also sometimes used under the name of huang hua hao. 11 IT n chen hao This is generally the young shoots and leaves of A. capillaris Thunb., although other species can be used, for example, the shoots of A. scoparia Waldst. et Kit.(yin chen).lO Ai yit According to Chang and But, al ye is the leaves of A. argyi LevI et Vant., and al ye has formerly been misidentified as A. vulgaris L. lO However, other authors 7•8 have included A. vulgaris as a possible source for al yeo
Other Chinese species The entire plant of A. anomala S. Moore is referred to as liu jl nu, and specifically used for Stagnant Blood problems, whether postnatal pain or fractures and sprains.7
Western species used in China A. vulgaris, known in the West as mugwort is sometimes used in China as al ye.A. absinthium and A. abrotanum are not listed in the Chinese Herbal
Medicine Dictionary.1I
II. tonify and move Spleen and Liver Qi III. move Liver Qi and calm Yang and Heart '....;;:~,,-
IV. regulate the Uterus
CI:~
abSinthi~~Li
::t::;s;::ogen In my opinion, A. can treat recurring and chronic fever, partly by helping to~~;.,t clear Retained Pathogen. This action may be linked to iiS;]~ ability to strengthen and move Liver Qi, and clear Liver!. ~~~. Damp Heat. Tonify and move Spleen and Liver Qi The Artemisia'~~' species, especially A. absinthium, can strengthen gastrointestinal and hepatobiliary function and help to move obstruction in these systems. Move Liver Qi and calm Yang and Heart By moving Liver~'''·· Stagnant Qi, Artemisia can help to treat depression and irii.;~. ~. tability. By calming Liver Hyperactive Yang and Heart Spirj,t.: . Disturbance, Artemisia can help to treat headache, restless~:::: ness, and anxiety. Regulate the Uterus Artemisia species can help to regulate':,· the Uterus by their tonifying, moving, and calming effects.. :±~{
• tonifying
by strengthening the Spleen and Liver, M::'~.: misia species can toniEy the Qi and Blood of· the Uterus..·,;~ Artemisia species may help to move Stagn~~~' Qi and Blood of the Uterus, both directly and •
n
:h.~
What is special about Artemisia • moving In terms of Chinese medicine, the Artemisia species used in the West can be said to be warm-cool in temperature and bitter and aromatic in their taste property. They have their primary effects on the Liver, Spleen, and Uterus.
The key to understanding the Artemisia species used in the West is that they are aromatic bitter herbs that can be specifically useful to treat: • chronic or recurring low-grade fever associated with debility, as in some cases ofchronicfatigue syndrome and fibromyalgia • weakness ofthe digestive and hepatobiliary systems, as in some cases ofpoor appetite, food intolerances, or cholecystitis, sequellae ofdrug abuse or prolonged multimedication • menstrual irregularities, such as amenorrhea and premenstrual syndrome, especially when they are associated with nervous tension CHINESE ACTIONS In terms of Chinese medicine, the Artemisia species, as used in the West, can be said to have five main actions: I.
clear Heat, clear Retained Pathogen
• calming
by moving Liver Qi '" by calming the Liver and the Heart, Art:~ ;;~ misia species can help to treat uterine spasIIl.s·";~~ and menstrual irregularities . :-:ii
;<,tl!JJ&
.'i.~~)~~
WESTERN ACTIONS
The main actions of the Artemisia species as used in the":!! • . ....-=!< West are shown here in terms of the five main Chmese .', . _"h'~~; actions:
r'
"!,-?I'!
·:~;i
Chinese actions ',' .. -. '.. " ~"
":'ii~f~
'... . .. :-a
"... .i~i:i~"
-"4_~'''''
I. clear Heat, clear Retained Pathogen
r~-~~
~-'-.~~
antimicrobial antipyretic antimalarial
II. tonify and move Spleen and Liver Qi
III. move Liver Qi, calm Liver and Heart
IV. regulate the Uterus
emmenagogue
V. expel parasites
vermifuge
-
"
.... ;~
--. 245
.Artemisia WESTERN USES The Western uses of the Artemisia species can be related to their five main Chinese actions:
Western uses
Chinese actions I. clear Heat, clear Retained Pathogen
recurring or chronic fever, malaria
II. tonify and move Spleen and Liver Qi
postfebrile debility, digestive weakness, anemia, intolerances of foods and medicines, cholecystitis
III. move Liver Qi, calm Liver and Heart
premenstrual irritability and depress;on, headache, petit mal
IV. regulate the Uterus
amenorrhea, infertility, menstrual irregularities, especially associated with nervous tension thread worm or round worm infestation
V. expel parasites
Low-grade fever A. absinthium can be included in combinations to treat low-grade fever associated with debility, as in some cases of chronic fatigue syndrome and fibromyalgia. In terms of Chinese medicine, the following actions of A. absinthium may contribute to this specific use: • clears Retained Pathogen • clears Liver Damp Heat • moves Liver Stagnant Qi
.=
In addition, the aromatic and bitter constituents of A. absinthium may help to speed postfebrile recovery by tonifying and moving the Qi of both the Spleen and Liver. Food intolerances By strengthening the ability of the liver to metabolize wastes and toxins, A. absinthium can help to treat food intolerances and disorders resulting from chronic overindulgence in food and drink, drug abuse, or prolonged multimedication.
Diagnosis She seems to have Deficient Spleen and Liver Qi, associated with the poor appetite and weak digestion; Stagnation of Liver Qi associated with intolerance of fatty foods and alcohol; Deficient Blood, associated with the pale face, lips and tongue, amenorrhea, headache after menstruation, and thin, choppy pulse. The recurring low-grade fever may be associated with both Deficient Blood, Deficient Yin, and Deficiency Heat (rapid pulse and red tongue tip). The preference for warm food and drink may be associated with Cold in the Stomach and Intestines. The premenstrual headache, irregular menstruation, and wiry pulse may be associated with a combination of Liver Stagnant Qi and Liver Hyperactive Yang. Choice of Artemisia This herb can: • treat recurring low-grade fever associated with Deficient Yin and Blood • tonify and warm Deficient Qi of the Spleen and Liver to assist in the tonification of Qi and Blood • tonify and move Liver Stagnant Qi, and in Western terms, protect the liver and enhance the function of the liver to metabolize and detoxify adequately • move and regulate Liver Qi and control Liver Hyperactive Yang to treat menstrual probleIn;s associated with nervous tension and Stagnation of Qi and Blood in the Uterus
Limitations ofArtemisia TEMPERATURE
DIRECTION OF ENERGY Artemisia species do not have a strong directional. effect on the movement of energy. However, they can have the following moderate directional effects: • calm the disturbed upward movement of Heart Spirit, Liver Yang, or LiverV{md • move Stagnation of Qi in the Liver and Gallbladder
TYPICAL CASE EXAMPLE Signs and symptoms
digestion, and intolerance of fatty foods and alcohol. She is weak and thin with a pale face and lips, and recurring lowgrade fever, but prefers warm food and drink. She has irregular menstruation or amenorrhea, and headache both premenstrually and after menstruation. Her pulse is thin, choppy, slightly rapid, and slightly wiry at the Liver position. Her tongue is pale, thin, and dry, with a red tip.
The patient has poor appetite, weak
A. absinthium is classified in this book as being a variable-temperature herb because it can be used to treat warm or cold conditions. However, it is mainly used for warm or hot conditions that are systemic, for example, fever or feverishness associated with Retained Pathogen and Deficiency Heat. It is not so much used for either Wind Heat or for Heat in specific organs, except for Damp Heat in the Liver. A. absinthium has only a mild warming capacity, for example, as a wa.rnii.ngcmninative for Cold Stomach patterns. A. vulgaris is similar, except that it may be a more neutral herb with a narrower temperature range and milder cooling or warming effects.
246
CombiningWestern Herbs and Chinese Medicine
TASTE A. absinthium is a strongly bitter herb that can be used as a bitter tonic and regulator of both gastrointestinal and hepatobiliary systems. These bitter effects are complemented by its aromatic property, which is the result of a relatively high essential oil content. A. vulgaris is less bitter and less aromatic in the mouth, which may mean that both its bitter and aromatic taste properties are weaker. ACTIONS
Emmenagogue Artemisia can be used for menstru.al·dis-':':~?,!! orders linked to nervous tension (Liver Hyperactive Yang '0;~'" or Disturbance of Heart Spirit), to anemia and debility .. :;:-~.
(Deficient Blood), or to ~epress~on (Liv~r Stagnation). HOW::£S. ~ ever. I find it more applIcable In treatmg amenorrhea and ~'I!j infertility. and less in treating dysmenorrhea.' ~. . ..::..'
.]'~
Vermifuge The BHP listed infestation with Enterobius or Ascaris as the specific indication for A. absinthium.
..;"':~
Artemisia paired with other herbs
Antipyretic A. absinthium is used especially for recurring low-grade or intermittent fever, or chronic feverishness or heat sensations linked to Retained Pathogen and Deficiency Heat. I do not use it for fever associated with Excess Heat. Also, it is not so much a surface-active herb that can disperse Exterior Wind by diaphoresis, like Achillea.
Discussion of the limitations of each of the main actions of Artemisia can be useful to clarify just what this herb can ~~.F: and cannot do. However. suitable combination with other \.-,.. herbs can extend the range of use of Artemisia beyond its limitations. The basic unit of herb combination is the herb. _ pair. Twelve pairings of Artemisia are briefly explained
General tonic In the West, A. absinthium has a tradition of use to strengthen the blood. In Chinese medicine terms, this may be a result of the strengthening effects of its bitter and aromatic constituents on the Spleen. It is not a sweet Blood tonic like Angelica sinensis or Lycium.
below.
Digestive tonic Artemisia species have a tradition of use as bitter and aromatic tonics and regulators of the gastrointestinal and hepatobiliary systems. A. absinthium is one of the strongest bitter tonics, although its aromatic carminative and intestinal antispasmodic action may not be quite as strong as Lavandula or Rosmarinus. Hepatic Both A. absinthium and A. vulgaris have a tradition of use for liver and gallbladder disorders, and research has reported hepatoprotective and cholagogic actions for A. absinthium. I use these two herbs specifically for sluggish conditions of the liver related to prolonged multimedication, substance abuse, or food intolerances. I use them as secondary herbs for gallbladder problems, in distinction to A. capillaris (yin chen hao), which is specific for gallbladder disorders. For Liver patterns associated with Heat, I would replace Artemisia with Taraxacum. and for Liver patterns associated with Cold. I would replace it with Rosmarinus. Tranquilizer and anticonvulsant There is a tradition of use of Artemisia for headache (Liver Hyperactive Yang). convulsions (Liver Wind), and anxiety (Disturbance of Heart Spirit). In my opinion, the calming action ofArtemisia is of secondary importance. I use it especially for nervous tension linked to menstrual disorders, such as premenstrual headache or amenorrhea.
·.: .. .
.~-
CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair. Artemisia + Achillea
Recurringfever Both herbs can treat fever from Retained Pathogen with Deficient Yin and Deficiency Heat. However. Achillea can also clear Wind Heat and tonify Defensive Qi, whilst Artemisia is a stronger tonic of the Spleen. Liver. and Blood. These actions can assist postfebrile recovery. Artemisia + Cinchona
Postfebrile debility This pair can treat fever from Retained Pathogen with Deficient Yin and Deficiency Heat. Artemisia is a stronger tonic for the Liver. whilst Cinchona has specific tonic and regulatory action on the Heart. Both herbs have a bitter digestive tonic action that can assist the recovery. Artemisia + Agrimonia
Malabsorption syndromes Agrimonia is mildly bitter and can complement the bitter digestive tonic effect of Artemisia. Also, Artemisia can reduce food intolerances as a result of its effect on the liver, and Agrimonia can treat food allergies via its astringent effect on the intestinal mucosa. Together. the two herbs can strengthen digestion, absorption, and assimilation.
:
:.,...;:-.
Artemisia Artemisia + Gentiana
Anemia Gentiana emphasizes the bitter digestive tonic action of Artemisia to treat exhaustion and anemia arising from digestive weakness associated with Spleen Qi Deficiency. Also, the aromatic constituents of Artemisia contribute a warming carminative action and a mild calming effect. Artemisia + Berberis
Cholecystitis Both herbs can tonify Liver Qi Deficiency and move Liver Qi Stagnation to treat depression, exhaustion, food intolerances, and digestive disorders. Since Berberis is a cool herb, this pair can be used to drain Liver-Gallbladder Damp Heat, for example, to treat cholecystitis.
Artemisia + Rosmarinus Food intolerances This pair is specific for Liver Qi Stagnation with Cold to treat depression, food intolerances, or the results of overmedication. Both herbs are bitter and aromatic, and Rosmarinus contributes the acrid property to warm the Interior. Also, both herbs can be used for headache with depression and nervous tension, but Rosmarinus is a stimulant herb that should be used with caution in cases of insomnia.
Artemisia + Lavandula Headache + nervous tension This pair can be used for nervous tension headache with insomnia or anxiety, rather than depression since Lavandula is more calming than Rosmarinus. Both herbs have aromatic properties that can reduce intestinal spasms associated with nervous tension.
Artemisia + Salvia officinalis Premenstrual syndrome This pair can be used for premenstrual headache and stiff shoulders associated with nervous tension. Both herbs can control Liver Hyperactive Yang, reduce Deficiency Heat, and tonify the Blood. Salvia can also reduce muscle tension at the surface of the body associated with Liver Stagnant Qi and Cold. Both herbs have emmenagogue action to regulate the Uterus.
Artemisia + Ruta Amenorrhea + nervous tension These herbs are specific for emotional disturbance associated with menstrual or sexual problems. They are specific for premenstrual headache or amenorrhea with nervous tension and can be used as mild anticonvulsants to assist in the treatment of petit mal associated with amenorrhea.
247 Artemisia + Cimicifuga Dysmenorrhea + depression
Both these herbs have a tradition of use to treat headache, nervous excitability, and convulsions. Both herbs can have calming and emmenagogue effects. The two herbs complement each other. Cimicifuga may have a somewhat stronger antispasmodic action than Artemisia to treat dysmenorrhea, and Artemisia may have a stronger effect to move Liver Qi Stagnation and treat depression. Artemisia + Ophiopogon
Low-grade fever Artemisia species may reduce the rewrrence of fever partly by moving Liver Qi Stagnation and partly by helping to clear the Liver of toxins. The bitter anti-inflammatory property of Ophiopogon helps to clear Heat to relieve lowgrade fever, and its sweet property helps to tonify Yin. The bitter tonic aspect of Artemisia can help to treat postfebrile debility. Artemisia + Angelica sinensis
Amenorrhea + anemia Artemisia can tonify Blood as a result of its bitter and aromatic effects on the Spleen and Liver. Angelica sinensis has secondary aromatic and bitter properties, but primarily its sweet constituents may tonify the Blood. Both herbs can tonify and move Qi and Blood in the Uterus to have a mild emmenagogue effect. They are specific for amenorrhea with Deficient Blood.
Artemisia combinations Six Artemisia combinations are discussed below:
syndromes
Combination
Chinese
1. recurring fever + exhaustion
Retained Pathogen + Liver Deficient Qi
2. poor appetite + anorexia
Deficient Spleen Qi + Deficient Blood and Qi
3. headache + anemia
Liver Hyperactive Yang + Liver Deficient Blood
4. food intolerances sensations
+ heat
5. premenstrual syndrome + headache + nervous tension 6. amenorrhea
+ nervous tension
Liver Stagnant Qi + Liver Damp Heat Liver Stagnant Qi + Liver Hyperactive Yang Uterus Stagnant Qi and Blood + Heart Spirit Disturbance
248
Combining Western Herbs and Chinese Medicine ::=::=-::::7:'-:"-:::7':;-::-:-'7~::-::::::::::-::;:':-~ __
CAUTION
Before using any ofthe combinations below, it is important to be familiar with the cautions listedfor each herb in the combination. 1. Recurring fever + exhaustion
Retained Pathogen + Liver Deficient Qi Herb Achillea Artemisia abs. Gentiana Berberis Pseudostellaria Glycyrrhiza Zingiber
~
Temperature<-·
Artemisia abs.
1
warm-cool
bitter, aromatic
Berberis Taraxacum
1 1
cool cool-cold
bitter bitter
Hydrastis Mentha pip. Zingiber Glycyrrhiza
0.5 0.5 0.5 0.5
cool warm-cool hot neutral-cool
bitter acrid, aromatic acrid, aromatic sweet
-
-
.
,Taste"-~·';jf;~OOiiiii·~ ----~-:!-.;
.
--,:-~
··imiil
':'"=":.:::: _ .. :.:
Temperature
Taste
GENERAL
1 1 1 1 1 0.5 0.5
warm-cool warm-cool neutral-cool cool neutral neutral-cool hot
acrid, bitter bitter, aromatic bitter bitter sweet, 51. bitter sweet acrid, aromatic
This combination is for Stagnation and Deficiency of Liver Qi with inadequate metabolism of wastes and toxins and accumulation of Damp Heat. The overall temperature is cool, but the combination includes a half proportion of Zingiber so that it can be used for mixed conditions of Heat and Cold. For patterns of Heat in the absence of Cold, the Zingiber can be removed. The bitter constituents are associated with tonifying Liver Qi, moviIig Liver Qi, and draining Heat and Damp. The acrid and aromatic constituents help to move Stagnation of Liver Qi and in some cases, in Western terms, can enhance liver metabolism.
2. Poor appetite + anorexia
Spleen Deficient Qi + Deficient Blood and Qi
Gentiana Centaurium Artemisia abs. Trigonella Glycyrrhiza Zingiber
. -
Ratio
Ratio
This combination is the same as Achillea: recurringfever + exhaustion and is discussed under that heading.
Herb
. _.:_:::"~-:::~=. .
-Hem"' ....
Ratio - Temperature
Taste
1 1 1 1 0.5 0.5
bitter bitter aromatic, bitter bitter, sl. sweet, sl. acrid sweet acrid, aromatic
neutral-cool neutral-cool warm-cool 51. warm neutral-cool hot
This combination is the same as Gentiana: poor appetite + anorexia and is discussed under that heading.
USE
• tiredness, depression, and digestive disorders associated with prolonged substance abuse or multimedication • chronic food intolerances, involving headache, nausea, and a bitter taste in the mouth PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of water, three times per day. This combination is designed for long-term use.
Caution
3. Headache + anemia
Liver Hyperactive Yang + Liver Deficient Blood
Herti~:'.;,~:· :<::':~R~ti'o'f~;:Temp=e;'~ture' Salvia off. Rosmarinus Artemisia abs. Angelica sin. Lycium Valeriana Zingiber
1 1 1
0.5-1 0.5-1 0.5-1 0.5
warm-cool warm warm-cool warm neutral cool hot
Taste' aromatic, acrid aromatic, bitter, acrid bitter, aromatic sweet, aromatic, bitter sweet bitter, sweet acrid, aromatic
This combination is the same as Salvia: headache + anemia and is discussed under that heading. 4. Food intolerances + heat sensations
Liver Stagnant Qi + Liver Damp Heat
For patients with impaired liver function, or those taking potentially hepatotoxic conventional medication, the screening, monitoring, and treatment precautions discussed in the section on Liver disorders in the chapter on Safety should be observed. 5. Headache + premenstrual syndrome + depression
Liver Hyperactive Yang + Liver Stagnant Qi
Salvia off. Rosmarinus
1 1
Lavandula Artemisia abs. Ruta Zingiber Mentha pip. Glycyrrhiza
warm-cool warm sl. warm
arc-matic, acrid aromatic, bitter, acrid aromatic, bitter, sl. acrid
1 1 1 0.5 0.5
warm-cool warm-cool hot warm-cool neutral-cool
bitter, aromatic bitter, aromatic acrid, aromatic acrid, aromatic SW'eet
I\}~P :;\~~.
J ••
--
Artemisia
249
This combination is the same as Salvia: headache + premenstrual tension + depression and is discussed under that heading. 6. Amenorrhea + nervous tension
Uterus Stagnant Qi and Blood + Heart Spirit Disturbance .'
Herb
Ratio
Temperature
Artemisia abs. Ruta Salvia off. Leonurus Mentha pul. Zingiber Glycyrrhiza
1 1 1 1 1 0.5 0.5
warm-cool warm-cool warm-cool neutral warm hot neutrakool
aromatic, 51. bitter bitter aromatic, acrid sour, 51. bitter aromatic acrid, aromatic sweet
Achillea Artemisia abs. Gentiana Berberis Pseudostellaria Glycyrrhiza Zingiber
1 1 1 1 1
0.5 0.5
Gentiana Centaurium Artemisia abs. Trigonella Glycyrrhiza Zingiber
1 1 1 1
0.5 0.5
1. Artemisia, Gentiana, and Berberis, assisted and mod-
erated by Zingiber and Glycyrrhiza, can tonify and move Liver Qi, clear accumulation of Liver Heat and Liver Damp Heat, and help to clear Heat Toxins and Retained Pathogen from the body. Achillea and Zingiber can help to clear Retained Pathogen from the body surface and, ~ith Pseudostellaria and Glycyrrhiza, help to strengthen the energy of the body
,-+-.
GENERAL
and thus of the body surface.
This slightly warm combination combines five tastes to regulate the Uterus and to calm nervous tension. It can act by a combination of effects to:
2. In combination No.1, Artemisia is combined with Achillea to treat recurring fever. In combination No.2, bitter and aromatic Artemisia combines with bitter Centaurium
• move Stagnant Qi and Blood in the Uterus • mildly tonify Qi and Blood, to help to stabilize the emotions • strengthen, stabilize, and calm the Heart • mildly tonify the Kidney and calm Kidney fear USE
• amenorrhea with nervous tension PRACTICAL NOTES
and Gentiana to stimulate the appetite and digestion. In this combination, Trigonella and Glycyrrhiza combine as sweet tonics, and Trigonella has a tradition of use to assist weight gain.
3. Headache + anemia
4. Food intolerances + heat sensations
Liver Hyperactive Yang + Liver Deficient Blood
Liver Stagnant Qi + Liver Damp Heat
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of warm water, three times per day.
Herb
Alternatively, a slice of fresh ginger can be simmered gently in 1 cup of water in a covered pan for about 10 minutes. The heat is turned off, 2 teaspoons of Mentha pulegium are added, the lid replaced, and the herbs steeped for 5 minutes. The hot liquid can then be strained into a cup, and 5 rnl of a mixture of 1:5 tinctures of the other herbs in the combina-
Salvia off. Rosmarinus Artemisia abs. Angelica sin. Lycium Valeriana Zingiber
tion (Artemisia, Ruta, Salvia, Leonurus, and Glycyrrhiza) can be added to the liquid in the cup. This dose is taken 3 times
Ratio 1 1 1 0.5-1 0.5-1 0.5-1 0.5
Herb Artemisia abs. Berberis Taraxacum Hydrastis Mentha pip. Zingiber Glycyrrhiza
Ratio 1 1 1 0.5 0.5 0.5 0.5
3. Artemisia is combined with the aromatic herbs Rosmarinus and Salvia to tonify Blood. Artemisia and Rosmar-
per day.
inus are bitter aromatic herbs that can increase Blood by acting as Spleen digestive tonics, andR:osmarinus and Salvia
COMPARISON OF THE SIX
can assist in the tonification of Blood by acting as calming
ARTEMISIA COMBINATIONS
herbs to reduce worry, which will indirectly increase the ef-
1. Recurring fever +
2. Poor appetite +
exhaustion
anorexia
Retained Pathogen + Liver Deficient Qi
Spleen Deficient Qi + Deficient Blood and Qi
ficiency of the Spleen to make Blood. Valeriana, Rosmarinus, Salvia, and Artemisia combine to calm Liver Hyperactive Yang and treat headache. Angelica sinensis can tonify the Blood of Spleen, Heart, and Liver, and Lycium can tonify Liver Blood and Kidney Jing.
--
Combining Western Herbs and Chinese Medicine
250
4. All the herbs in combination No.4 combine to move Liver Stagnant Qi and assist the liver in its metabolizing and detoxifying actions, allowing this combination to treat intolerances to foods and medications, and to assist in the recovery from prolonged multimedication or substance abuse. In distinction to the combination Rosmarinus: food intolerances + cold sensations, this combination contains Berberis, Taraxacum, and Hydrastis to clear and cool Liver Heat and Damp Heat
Research
1 1 1 1
essential oil
Uterus Stagnant Qi and Blood + Heart Spirit Disturbance
Ruta
1 1 0.5 0.5
Zingiber Mentha pip. Glycyrrhiza
Artemisia abs. Ruta Salvia off. Leonurus Mentha pul. Zingiber Glycyrrtliza
1 1 1 1 1 0.5 0.5
combine to move Liver Stagnant Qi and treat depression, and to calm Liver Hyperactive Yang and treat headache. Salvia can also help Artemisia and Ruta to regulate menstruation. Mentha, Zingiber, and Glycyrrhiza help the other herbs to regulate Liver Qi. 6. In combination No.6, all the herbs except Glycyrrhiza combine to move Qi and Blood in the Uterus and regulate menstruation to treat amenorrhea. Also, all the herbs, except Glycyrrhiza and Zingiber, combine to calm Heart Spirit and Liver Yang. Ruta and Mentha pulegium are specific for amenorrhea and infertility associated with Stagnation of Qi due to Kidney fear.
OTHER ARTEMISIA COMBINATIONS Other combinations that contain Artemisia include the following:
• Berberis: cholecystitis '. Leonurus: amenorrhea • Leonurus: palpitations + anemia • Rosmarinus: food intolerances + cold sensations • Ruta: infertility + obesity
""·;~·7.~
---.. . -:~.:!'-. ~Iga~s:)~
:-~
~
_2¥'f-
0.2-1.5%
0.03-0.3%
composition is highly variable, and anyone of the following can be over 40% of essential oil, depending on the origin: thujones, sabinyl acetate, chrysanthenyl acetate, orepoxyocimene
composition is highly variable, and the main component can be cineole, camphor, linalool or thujone, depending on the origin
bitter substances 0.150.4%, main component is absinthin (0.2-0.28%), also contains artabsin, anabsinthin, matricin, and peleolides
vulgarin (=tauremisin)
various flavonoids
various flavonoids
..
_-...,.
h,.~~_ :~~f:I~, '.-
flavonoids
1.9% (including aesculetin and umbeliferone)
coumarins
other
5. Artemisia and Ruta are paired primarily to regulate menstruation and secondarily to calm Liver Hyperactive Yang and treat headache. Salvia, Rosmarinus, and Lavandula
.- .~~
- . :,:-..-~' . . -
_Constituent*- A. absinthium
sesquiterpene lactones Salvia off. Rosmarinus Lavandula Artemisia abs.
~';;;~lA
Western species of Artemisia
5. Headache + premenstru- 6. Amenorrhea + al syndrome + depression nervous tension
Liver Hyperactive Yang + Liver Stagnant Qi
.-'.:~'"!:~-
CONSTITUENTS
polyacetylenes
polyacetylenes
*The data in this table is from Wichtl. The symbol«-" does not necessarily mean absence of a constituent. In this instance, it may merely mean that information is not available. Essential oil
Amount The amount of essential oil in Artemisia varies greatly both between the species and between samples of the same species: the Chinese species A. annua may have up to 4%,9 A. absinthium 0.2-1.5%, and A. vulgaris 0.03-0.3%.2 This compares with the aromatic herbs Lavandula 1-3%, Rosmarinus 1-2.5%, and Salvia 1-2.5%.
Composition According to Wichtl, thujones may be the main components in the essential oil fraction in some samples of A. vulgaris, but according to Bruneton,9 thujones only occur in trace amounts in A. vulgaris or are absent. In fact, he wrote that the French Pharmacopoeia requires verifying the absence of thujone in a hexane extract of A. vulgaris, distinguishing this species from A. verlotorum Lamotte, with which it may be confused. Sesquiterpene laetones Judging by the taste in the mouth of the three Western species, A. absinthium either has a greater quantity of bitter chemicals or its bitter components are more intensely bitter than those in A. abrotanum or A. vulgaris.
Artemisia
251
Chinese species ofArtemisia
A. argyi Constituent* essential oil
(al ye) 0.2-0.4% cineole (30%), terpinen-4-<>I, ~aryophyllene, camphor. borneol. Iinalool. artemisia alcohol
sesquiterpene lactones
A.annua (qlng hao).·
A. capillaris (yIn cMn hao)
up to 4%9 artemisia ketone (64 %),9 camphor. cineole, caryophyllene, thujone
0.23% f}pinene, capillarin, capillene, capillin, capillone
artemisinin (0.01-0.08%)9 -
up to 1.98% scoparone
coumarins flavonoids
various flavonoids
various flavonoids
other
polyalkynes
caffeic acid
"The data in this table is from Chang and But,IO unless otherwise stated. The symbol"-" does not necessarily mean absence of a constituent. In this instance, it may.merely mean that the information is not available.
Comparison of A. absinthium and A. vulgaris It may be that A. absinthium has both stronger warming activity, associated with a higher essential oil content, and stronger cooling activity, associated with a higher sesquiterpene bitter content, than A. vulgaris. A comparative pharmacological and clinical research survey of these two' herbs would be both fascinating and useful.
.
PHARMACOLOGICAL AND CLINICAL RESEARCH: WESTERN SPECIES The following effects have been reported for Western species of Artemisia: • antimicrobial • antimalarial • antihelminthic • anti-inflammatory • antipyretic • analgesic • antispasmodic • gastric secretory • cholagogic and digestive tonic • hepatoprotective • antidiabetic • emmenagogue • antifertility Antimicrobial Essential oil from A. absinthium diluted 1:1000 showed in vitro antibacterial activity against Staphylococcus aureus and antifungal activity against Candida albicans. 12
Antimalarial Two homoditerpene peroxides from A. absinthium showed antimalarial activity against P. falciparum in vitro. 13 Antihelminthic Powdered shoots of A. herba-alba showed antihelminthic activity in Nubian goats. 14 Anti-inflammatory The essential oil of A. caerulescens subsp. Gallica showed anti-inflammatory, analgesic, and antipyretic action in rats andmice. 15 Antipyretic A sterol from A. absinthium tincture alleviated yeastinduced fever in rabbits. 16 Antipyretic effects have been reported by others. 15.17
Analgesic Isothujone from the essential oil of A. absinthium showed analgesic effects in mice,18 and the essential oil of A. caerulescens subsp. Gallica showed analgesic effects in rats and mice. 15 Antispasmodic Flavonols isolated from A. abrotanum showed antispasmodic effect on induced contractions of guinea pig trachea. 19 An extract of A. caerulescens subsp. Gallica has been demonstrated to have a bronchodilatory effect in guinea pigs. 20 Gastric secretory Oral administration of absinthin in dogs resulted in increased gastric secretion and acidity, but this did not occur if the absinthin was administered directly to the stomach by gavage. This suggests that the stimulation of gastric secretion by this bitter chemical depends on a reflex action from oral administration. 21 •22 Cholagogic and digestive tonic Intravenous injection of a decoction corresponding to 5 g of A. absinthium resulted in a 3-fold increase in bile secretion in dogs. 23 • 24 A. absinthium tincture administered by gavage resulted in increased bilirubin and cholesterol in the duodenal fluid in humans. 25 Hepatoprotective
Extracts of A. absinthium were found to
have preventative and curative effeE:ts on acetaminophenand carbon tetrachloride-induced hepatotoxicity in mice andrats. 26 Antidiabetic Extracts of A. pallen~ and of A. herba-alba28 were found to have significant blood glucose-lowering effect in diabetic rats; it also protected against body weight loss in the same diabetic animals. 28
";'U
252
Combining Western Herbs and Chinese Medicine
Emmenagogue There is a paucity of Western research data on this topic; see the data on Chinese species. Abuse with high doses of A. absinthium has been reported to produce abortions. 2J
.:.:~:r·::
.
-~-_
....
oil was reported to inhibit histamine release from guinea pig.~ 38 .-... pulmonary tissue after antigen challenge. _~
Antispasmodic
Scoparone The coumarin scoparone (6,7-dimethoxycouAntifertility Oral administration of A. absinthium tincture resulted in an anti-implantation effect in rats. 29
PHARMACOLOGICAL AND CLINICAL
marin) has been shown to relax smooth muscle,39 and scoparone extracted from A. capiIIaris can increase coronary flow and heart rate in the isolated perfused heart. It has also been suggested that scoparone has antianginal action. 40
RESEARCH: CHINESE SPECIES
Sesquiterpenes The sesquiterpene ketones moxartenolide
The following effects have been reported for Chinese species of Artemisia: • antimicrobial • antimalarial • anti-inflammatory and antipyretic • antiallergic • antispasmodic • cholagogic • hepatoprotective • antilipemic • anticoagulant • emmenagogue Antimicrobial In vitro experiments showed that decoctions of A. argyi (al ye) had mild antimicrobial action, but that fumigation had a stronger antimicrobial effect.:lO A. capillaris (yin chen hao) decoction showed antibacterial action,31 and essential oil preparations from A. capillaris inlubited growth of epidermal myceIia. 32 Qinghao acid is reported to be one of the antibacterial constituents from A. annua. 33 Flavones from A. giraldii have demonstrated antimicrobial activity. J.4 Antimalarial Artemisinin is the main antimalarial agent from A. annua (qing hao) and can range from 0.01-0.08%, depending on the source. It is selectively toxic to various species of Plasmodium in vitro and in vivo, including chloroquine-resistant strains. 7 No serious adverse effects have been reported, and the artemisinin derivatives have an established role in the treatment of multidrug-resistant falciform malaria. 35 A. indica contains flavonoids that have shown in vitro activity against P. falciparum. 36 Anti-inflammatory and antipyretic A. capillaris was reported to have antipyretic effect in rabbits. 7A. annua extracts showed anti-inflammatory and antipyretic activity, with scopoletin being one of the anti-inflammatory constituents. 33 Antiallergic A. argyi was reported to treat allergic rhinitis, allergic dermatitis, urticaria, and drug allergy.37 A. argyi leaf
from A. argyi inhibited induced contractions in isolated rat arterial strips.41
Antiasthmatic Antiasthmatic, expectorant, antitussive, and antiallergenic effects have been demonstrated with A. argyi preparations in laboratory animals. 38.42 Clinical studies with A. argyi derivatives have been shown to be effective in the treatment of chronic bronchitis. 43 Several components may be responsible for these effects. For example, cineole is believed to have an effect on the respiratory system, terpinen-4-ol aerosol has been shown to reduce wheezing,U and 13-caryophyllene has antiasthmatic and antitussive effects.45 13-caryophyllene itself was found to lack antiasthmatic activity, but its degeneration product in gastric acid was found to be active.<16 Cholagogic A. capillaris, A. anethoides, and A. haichowenesis were found to have cholagogic activity,47 and 6,7-dimethoxycoumarin was found to be one of the choloretic and cholagogic principles in A. capillaris. 48 Hepatoprotective Decoctions of A. capillaris had hepatoprotective effect in mice against carbon tetrachlorideinduced hepatitis. 7 Extracts of A. asiatica were found to have hepatoprotective activity in mice and rats, which the authors suggested might involve prevention of lipid peroxidation and preservation of hepatic glutathione (GSH) levels. 49 Antilipemic The Chinese herb A. scoparia has been reported as hypolipidemic. Scoparone (6,7-dimethoxycoumarin) purified from this plant has been reported to reduce total cholesterol and triglycerides, and to retard pathomorphological changes in hypercholesterolemic rabbits, possibly as a result of antioxidation activity, inhibition of tyrosine kinases, or potentiation of prostaglandin generation. 39 Anticoagulant 13-sitosterol and eupatillin from A. argyi showed marked inhibition of platelet aggregation. 50 A. capil- . laris has also been shown to have anticoagulant effect. 51 Emmenagogue Extracts of A. capillaris have a stimulant effect on the isolated uteri of nonpregnant rabbits and on those of postnatal guinea pigs. 52 Decoctions of A. argyi leaf excited the isolated uterus of rabbits. 53
--~-
Artemisia RESEARCH VERIFICATION OF TRADITIONAL ACTIONS From the research summarized above on herb extracts or isolated constituents, there is support for the following traditional actions of Artemisia species. Western Artemisia species Antimicrobial, antipyretic, antimalarial, bitter digestive tonic, cholagogue, hepatic (hepatoprotective), antispasmodic, emmenagogue, and vermifuge. Chinese Artemisia species Antimicrobial, antipyretic, antimalarial, cholagogue, hepatic (hepatoprotective), antispasmodic, and emmenagogue.
ADDITIONAL EFFECTS DEMONSTRATED BY RESEARCH The following additional effects have been demonstrated by research, as discussed above. Western Artemisia species Anti-inflammatory, analgesic, antidiabetic, and antifertility. Chinese Artemisia species
Antiallergic, antilipemic, and
anticoagulant. ........
'
TOXICOLOGY ~-
Important distinctions A careful distinction needs to be made between the use of: • therapeutic doses of Artemisia as an infusion or tincture • Artemisia essential oil • isolated components of Artemisia, such as thujone Reports of adverse effects from the use of pure Artemisia constituents or the essential oil do not necessarily apply to the use of infusions or ethanolic tinctures of the root of this plant, when the latter are used in the recommended therapeutic doses. This is because the pure chemicals and the essential oil represent much higher levels of the potentially toxic constituent than are found in the herb itself. Also, other constituents in the herb may protect against the potentially toxic effects of a particular constituent. For e.xample, thujone is the constituent that has aroused the most concern regarding toxicity. If we assume that dried A. absinthium contains 0.2-1.5% essential oil, and that this essential oil may consist of about 40% thujone, then, with respect to the amount of thujone: • the essential oil is 67-500 times stronger than the dried herb
253
• pure thujone is 170-1250 times stronger than the dried herb Artemisia infusion It has been reported that dilute aqueous extracts of A. absinthium contain only trace amounts of the oil. 2,5-I Artemisia alcoholic tinctures Since more thujone may be present in alcoholic extracts than in aqueous infusions, some countries restrict the supply of alcohol tinctures of Artemisia species. 2 Other countries require that the maximum concentration of active constituents, especially thujone, is stated on the label of any tincture of Artemisia species, especially if the alcohol concentration is over 30%,9 Thujone content of A. absinthium tinctures According to Tisserand and Balacs,55 both the UR and Ee 'standard permitted proportion' of a- and/or ~-thujone in food flavorings is 0.5 mg/kg of food. This can be compared with the amount of thuione in 1 rnl of A. absinthium tincture. Whilst some individuals may consume up to 1 kg of food at a sitting, patients can be informed not to exceed the stated individual dose of 1 rnl of 1:5 A. absinthium tincture iD. 45% alcohol, three times per day. 1 g of dried A. absinthium herb may contain 0.2-1.5% essential oil. This is equivalent to about 2-15 mg of essential oil. Up to 40% of this essential oil may be thujone, so that 1 g of dried herb may contain 0.8-6 mg of thuione. If this 1 g of dried herb were made into a 1:5 tincture (in 45% ethanol for example), 1 rnl of this tincture would contain 0.16-1.2 mg of thuione, providing that all the thuione were extracted. Thus, the amount of thuione in an individual dose of combination tincture (0.16-1.2 mg) may be approximately the same or even less than the figure of 0.5 mg given above for the permitted amount of thuione per kg of food. It would be helpful if all Artemisia tinctures had the concentration of thujone on the label. It would then be clear that the quantities of thujone in therapeutic doses of the tincture are far below the chronic toxicity test levels in rats, equivalent to 600 mg per day of thujone for a 60 kg human, discussed below.
Artemisia essential oil The use of A. absinthium essential oil is restricted in many countries. The minimum convulsive dose in cats was reported to be 0.03-0.04 rnl of a 1:20 alcoholic dilution of the essential oil, when administered by intravenous injection. 20 This is approximately equivalent to 300 mg of essential oil for an adult human. However, data on intravenous injection of the essential oil of A. absinthium may have limited relevance to oral intake of therapeutic doses of its infusion and tincture. Adverse effects in humans
According to Tisserand and
Combining Western Herbs and Chinese Medicine
254
Balacs, toxic signs of an overdose of the essential oil of A. absinthium include: vomiting, convulsions, vertigo, insomnia, and nightmares. Additional signs listed in the Wichtl monograph include stomach and intestinal cramps, retention of urine, and, in severe cases, renal damage. Unfortunately, the Wichtl monograph did not state whether these adverse effects are from overdose of pure thujone, essential oil, or herbal extracts. Since I have not seen reports of demonstrations of adverse effects specifically from the dried herb, infusion, or tincture ofA. absinthium, I think it is likely that the Wichtl data related to pure thujone and/or the oil. Thujone Acute oral LD3Q When taken orally, in an acute toxicity test,
the LD so of thujone
«1 and~) in rats was 19 mglkg.55
In toxicity tests on rats, daily oral administration of thujone at 10 mg/kg produced convulsions by the 38th day (after consumption of 380 mg of thujone) in 5% of the rats. 56 This would be equivalent to a daily dose of 60~ mg of thujone for a 60 kg human. This is more than 100 times the amount of thujone in the daily dose of three m1 of 1:5 Artemisia tincture in 45% ethanol. Chronic toxicity test in rats
Mechanism of thujone toxicity
of the nineteenth century, there was increasing concern ove~~.~" adverse effects of chronic use, and the term absinthism waS ..•
coined to describe an addictive pattern with hallucinations. ,,~,~~ ';~'.~~ Thujone was thought to be the main cause of the toxicit.ty, but this idea has been criticized. It has been suggested that the thujone levels in absinthe are below the level at which adverse effects have been reported in thujone research studies. It has also been suggested that other chemicals were more likely causes of absinthism, including the 75% alcohol and also the possible methanol in absinthe. 60 In any case, the levels of thujone in absinthe are far high- ._, er than they are in therapeutic doses of infusions or tinctures of A. absinthium. Absinthe was prepared by distillation of A. ·o"::Ti"" ..absinthium and alcohol to concentrate A. absinthium essen- ::-~;~~-c tial oil in the end product. This is in contrast to tinctures of A. absinthium, which are made by cold maceration and extraction, that is, without distillation.
It has been reported that
thujone blocks the receptor of y-aminobutyric acid (GABA), a substance which inhibits neurotransmission in the central nervous system. Blocking the GABA receptors makes it easier for signaIs to get through. Therefore, if thujone is present in a high enough concentration, convulsions may result. 57 Since the different Artemisia species have different levels of thujone, and some may not contain this chemical at all, it is important to distinguish between them. According to Wichtl, A. vulgaris may have thujone as the main component of the essential oil fraction, but Bruneton states that A. vulgaris has no thujone or only traces, unless it is confused with A. verlotorum. In any case, A. vulgaris only contains 0.03-0.3% essential oils, compared to 0.2-1.50/0 for A. absinthium. Thujone in the Artemisia species
Thujone-Jree extracts It is apparently possible to prepare thujone-free extracts of A. absinthium by using suitable extraction techniques with water, ethanol 30% (v/v),ss or supercritical carbon dioxide.59 However, this raises two
questions. First, it is not yet known how much of the therapeutic activity of A. absinthium depends on thujone. Second, it is not certain how much of the other active constituents will be removed or damaged by the thujone-extraction process. Artemisia and absinthe
jone toxicity and the use of Artemisia derives from excessiVe';~ ~, and chronic use of the drink absinthe, a green liqueur origi---':"C~,;-~ nally distilled in 1854 from wine and wormwood. Absinthe _",~;: became popular with artists and writers, but in the latter half-j;i :,
Much of the concern about thu-
Dose Dried herbs
1-2 g of dried herb, three times per day. 4
Tmeture I would recommend that the maximum dose for 1:5 tincture of A. absinthium in 45% ethanol is 1 ml, three times per day. However, the BHP listed 1-2 ml of 1:1 liquid extract in 25% alcohol, three times per day. Initial dose
Can start at the standard dose.
Duration Can be used long-term, within therapeutic dose, and with appropriate breaks in the treatment, providing there are no signs of thujone's side effects. Tuning of dose Can be taken 0.5-1 hour before meals for anorexia, and taken warm after meals for dyspepsia,61 otherwise it can be taken between meals.
Caution The data below applies to the infusion. No contraindications are listed for the liquid extract by the BHP. The use of the oil is outside the scope of this b o o k . · , Western contraindications None reported, though some authors have recommended caution in cases of gastric hyperacidity since this is a very bitter substance.62
-"
Artemisia Chinese contraindications
For the Chinese species:9
255
Regulatory status
• A. annua
contraindicated for postnatal women with Deficient Blood or Cold Deficient Spleen
• A. capillaris
contraindicated for jaundice with Deficient Qi in the Middle Burner
• A. argyi
use with caution in patients with Heat in the Blood or Deficient Tm
A. absinthium and A. abrotanum are not listed in the Cl1inese Herbal Medicine Dictionary. A. vulgaris is sometimes used as al ye, so that the contraindications for at ye may apply. Pregnancy and lactation A. absinthium is contraindicated by some authors during pregnancy or lactation. 62
Please read the Regulatory status section in the chapter on Safety. A. absinthium (woodworm) and A. vulgaris (mugwort) are on the UK General Sale List. They are not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Artemisia species are not currently listed by the FDA (USA) as prohibited substances, as subject to an import alert, or as substances with a warning on their use.
Traditional sources ARTEMISIA SPECIES USED
Side effects None are reported when used as an infusion or decoction within the therapeutic dose of 1-1.5 g of drug per 150 ml of water, up to three times daily.!·!l Overdose No available data on A. absinthium herb,62 but an overdose of the oil may cause central nervous system disturbances with convulsions and paralysis and can be fatal. High doses have been reported to produce abortions.!3 Antifertility effects were reported when rats took an extract of A. absinthium in 50% alcohol, at 200 mg/kg body weight for 7 days.!; This amount would constitute an overdose in humans.
IN CHINESE MEDICINE The values of the properties of the three species of Artemisia most commonly used in Chinese medicine are compared in the table below, using data from the Chinese Herbal Medicine Dictionary. Note For each herb, the Chinese Herbal Medicine Dictionary often included material not only from one main text, but also from ~arious subsidiary texts. Values from both the main text and the subsidiary texts cited by the Chinese Herbal Medicine Dictionary are given in the table to show the range of opinion.
Toxicity See above.
PROPERTIES: ARTEMISIA
Interactions
SPECIES USED IN THE WEST
None reported.
A. APIACEA
A. ARGYl
A. CAPILLARIS
Qlng hao
al
ye
Yin chen hao
main text
cool
warm
cool
subsidiary texts
1. cold
1. slightly warm
1. neutral 2. slightly cold
main text
bitter, acrid
bitter, acrid
bitter, acrid
subsidiary texts
1. bitter
1. bitter 2. bitter, acrid
1. bitter 2. bitter, sweet
main text
LR,GB
SP,LR, KI
LR, Sp, BL
subsidiary texts
1. Sp, ST
1. Sp, LV, KI
2. GB, LV, TW, HT 3. HT,KI
2. Sp,KI, LU 3. ST, LV, HI, KI
1. BL 2. ST, SP,BL 3. LV, KI
....,.
Properties temperature
taste
meridians entered
Temperature There is considerable variation of opinion in the traditional Western texts: from neutral to very hot. Dioscorides classified the Artemisia species as warming and thinning. According to Hildegard von Bingen 63 , both wormwood (A. absinthium) and mugwort (A. vulgaris) are very hot. Lonicerus 6-l wrote that A. abrotanum is hot in the first degree and dry in the second degree. He said that A. abrotanum and A. absinthium mostly have similar effects, and that Galen said these herbs can be used interchangeably. Tabernaemontanus65 listed A. absinthium as warm in the first degree and drying in the third, and A. vulgaris as warm in the third degree and dry in the second degree. Gerard66 listed both wormwood and mugwort as hot and dry in the second degree, and Culpepe~7 listed wormwood
--
Combining Western Herbs and Chinese Medicine
256
as hot and dry in the first degree, 'just as hot as your blood and no hotter: However, Tabernaemontanus listed A. vulgaris for malarial fever, and both Gerard and Culpeper listed A. absinthium for agues (malaria). This suggests that this herb can have a cool-cold temperature effect in certain situations. In this book. the Western Artemisia species are considered to be variable-temperature herbs and are classified as warm-cool since they can have cooling or warming effects.
Cooling effect A. absinthium, has a tradition of use for fever and malaria, and research studies have reported antimicrobial. antipyretic, and antimalarial actions for this herb. This would suggest that A. absinthium can act as a cooling herb for warm and hot conditions.
Warming effect In old Western texts, A. absinthium is classified as a warming herb for cold disorders ofthe liver. spleen, and stomach. Al ye (A. argyi or A. vulgaris) is classified as warm in Chinese medicine, and can be used for Cold disorders of the Uterus. Tabernaemontanus classified A. vulgaris as a warmer herb than A. absinthiUm. It would appear that A. absinthium, and to a lesser extent A. vulgaris, can act as a variable-temperature herb for either warm or cool conditions. The temperature effect that is manifested will depend on the patient's needs and on the herbs with which Artemisia is combined. Taste
Taste in the mouth The BHP listed the taste in the mouth of A. absinthium as bitter, of A. vulgaris as slight, and of A. abrotanum as aromatic. Wichtllisted the taste in the mouth of A. absinthium as aromatic and intensely bitter and of A. vulgaris as spicy and somewhat bitter. I tasted the following 1:5 tinctures and found them to be: A. absinthium-aromatic and very bitter; A. vulgarisslightly bitter, slightly aromatic, and slightly sweet; and A. abrotanum-bitter and slightly aromatic.
Taste property A. absinthium and A. vulgaris are generally classified as aromatic bitters in Europe6&.69 because of their aromatic carminative and bitter tonic actions. A. absinthium has the strongest bitter taste in the mouth and the highest aromatic oil content. For these reasons, it is my preferred species for general use. In this book, all three Artemisia species are classified as aromatic, A. absinthium is classified as bitter, and A. abrotanum and A. vulgaris as slightly bitter. ORGANS': ART'EMISIA' SPECIES USED IN THE WEST The Artemisia species used in the West are linked in this
book mainly with the following organs (the specific~. pIes are for A. absinthium):
liver and Gallbladder
cleanse choleric dampness, remove evil dampness in the liver cleanse the body of choler
Culpeper
Spleen. Stomach and Intestines
warms a cold stomach anorexia. nervous dyspepsia
Lonicerus
Uterus
promotes menstruation, induces labor, helps to expel the afterbirth infertility, dysmenorrhea from cold
Dioscorides
urinary retention dropsy, bladder and kidney stones
Dioscorides Tabernaemontanus
Kidneys and Bladder
BHP .rt,: ....
-'
Tabernaemontanus
ACTIONS: ARTEMISIA SPECIES USED IN THE W E S T . ) } ~, Evidence from the Western traditional sources for the·/·L,,"', following actions of Artemisia species are discussed below: -_. :::, • antipyretic and antimalarial • tonic • carminative • tranquilizer • anticonvulsant • hepatic and cholagogue • antidote • emmenagogue • sexual regulator • vermifuge • diuretic • expectorant Antipyretic and antimalarial Culpeper listed A. absinthium for agues. Tabernaemontanus recommended A. vulgaris for malarial fever and A. absinthium for chronic fever and malarial fever. Felter and Lloyd 70 listed A. absinthium for 'malarial intermittents', and Christopher listed it for intermittent fever. A. annua (qfng hao) is used in Chinese medicine for Summer Heat disorders, especially with low fever, and it is interesting that Dioscoricles recommended A. absinthium as a summer drink to promote health and longevity. '. Tonic Culpeper recommended A. abrotanum as a hair tonic. Felter and Lloyd listed A. absinthium for atonic states of the gastrointestinal tract or the female reproductive system.
'~",
Artemisia Grieve 71 wrote that A. absinthium is a nervine tonic, especially useful for the falling sickness and good for weak digestion and debility. Christopher recommended A. absinthium as a nervine tonic and a digestive tonic for atonic and debilitated conditions.
Bitter digestive tonic Both A. absinthium and A. vulgaris have been used in Europe and America as bitter digestive tonics to stimulate the appetite and digestion.2. 9.68 Blood tonic Tabernaemontanus recorded the use of A. absinthium for anemia, and about three hundred years later, Tierra72 also listed this herb for anemia. Convalescent tonic Hildegard von Bingen wrote that A. absinthium can prevent sickness of the lungs. According to Grieve, both A. abrotanum and A. vulgaris were used in the past to ward off infection. Weiss recommended A. absinthium as a general tonic to enhance resistance, for example, for influenza and for postinfection debility linked to atony of the stomach and gallbladder. He recommended A. absinthium tea, taken regularly for 2-4 weeks, for postoperative or postinfeetion debility, for example, after pneumonia. I use A. absinthium as a main herb for recurring febrile states with exhaustion, for example, chronic fatigue syndrome, both to clear Retained Pathogen and as a digestive and hepatic tonic. Carminative Both Lonicerus and Tabernaemontanus recommended A. vulgaris to warm a cold stomach and to treat congestion of the spleen due to cold. Culpeper said that A. artemisia improves the appetite, treats surfeits (food stagnation from over-eating), and can treat colic. According to Tabernaemontanus, A. absinthium can treat vomiting and sea sickness, and A. vulgaris can treat vomiting and also dysentery. In 1772, Dr. John Hill wrote that A. absinthium strengthens the digestion, corrects acidity, and supplies gall where it is deficient. It treats sickness after meals and indigestion with fullness and wind. 71 The Commission E monograph listed A. vulgaris for vomiting, colic, diarrhea, and constipation. Tranquilizer Dioscorides recommended A. absinthium for palpitations. Grieve noted its use as a nervine and mental restorative, and that its occasional, rather than habitual, use can treat highly nervous temperaments. Parkinson and Withering 71 both used it to treat hysteria and hysterical fits. The Commission E monograph on A. vulgaris recorded use of the root for neurasthenia, depression, hypochondria, and general irritability, which might be seen in terms of Chinese medicine as assoCiated with Liver Stagnant Qi and! or Liver Hyperactive Yang; It also listed the root for restless~ ness, insomnia, anxiety, and hysteria, which might be associated with Disturbance of Heart Spirit in terms of Chinese medicine.
257
Headache Hildegard von Bingen, and later Tabernaemontanus, recommended A. absinthium for headache. Christopher gave it for headache and migraine. Anticonvulsant Lonicerus said that the juice of A. absinthium mixed with wine can prevent strokes. Gerard recommended A. vulgaris for the shaking of the joints of palsy. Kloss listed A. v:t1garis for epilepsy, and Christopher listed A. absinthium for the same disorder. The Commission E monograph noted traditional use of A. vulgaris in Germany for convulsions in children and for epilepsy. It is interesting that A. absinthium which has been used to treat convulsions, when used in therapeutic doses, can produce convulsions when taken as a large overdose of the essential oil. Hepatic and cholagogue Dioscorides said that A. absinthiurn can eliminate via the bowels the gall that lingers in the stomach and belly, and can be used for aches and. pains of the liver. Culpeper said that it cleanses the body of choler. Tabernaemontanus wrote that A. absinthium could cleanse choleric dampness out through the bowels and remove evil dampness in the liver and spleen. He also wrote that A. absinthium and A. vulgaris can be used for jaundice or for weakness, congestion, or enlargement of the liver due to cold, and that A. absinthium can treat diseases of the liver, especially if there are tumors or hard knots. It is interesting that A. capillaris (yin chen hao) is used in Chinese medicine for jaundice from either Damp Heat or Damp Cold. Both Kloss and Christopher listed A. absinthium for bilious and liver disorders. The BHP referred to both A. absinthium and A. vulgaris as choloretics, and the Commission E monograph listed their use to stimulate secretion of bile. According to Weiss, A. absinthium is one of the best remedies for biliary weakness. Antidote Dioscorides said that A. absinthium can protect against indulgence and drunkenness, and can act as an antidote to hemlock and poisonous spider bites. Hildegard von Bingen wrote thatA. vulgaris can attract and remove the rotten matter in food or drink (to treat food poisoning). Tabernaemontanus said that A. vulgaris could get rid of poisons from foods or the bites of poisonous animals. Culpeper recommended fresh A. vulgaris for the 'overmuch taking of opium' and for mushroom poisoning. Tabernaemontanus noted the use of A. absinthium for drunkenness and as an antidote to poisoning from opium or white lead. Emmenagogue The Artemisia species used in the West appear to have a regulatory effect on the tone and rhythm of contraction of uterine muscle. Artemisia species appear to have three main emmenagogue effects:
----
-~
258
Combining Western Herbs and ChineseMedicine
.. .
m.~. •J
cold, resemblmg the use of A. argYl m Chmese medlcme-o",~ " Bruneton noted the traditional use of mugwort in France for-;~
etonifying e stimulating and moving e calming and antispasmodic Which of these effects predominates may depend both on the state of the patient and on the Artemisia species used. A. absinthium may be relatively more stimulant, whilst A. argyi or A. vulgaris are relatively more tonifying. This difference in effect may depend not only on the relative thujone content, but also on other chemical differences. Tonic emmenagogue In China, it was mainly A. argyi that was used as an emmenagogue, and Chinese medicine emphasized its ability to warm and tonify Cold and Deficient conditions of the Uterus to treat prolonged menstrual bleeding, dysmenorrhea, infertility, and threatened miscarriage. In the West, there has recently been more emphasis on the stimulating and moving action of the Artemisia species upon the uterus, for amenorrhea, delayed labor, and retained placenta. However, there is also a long tradition of use of the Western Artemisia species for treating conditions of weakness and cold in the uterus. Tabemaemontanus wrote that A. vulgaris warms the reproductive organs and can treat infertility due to cold. and recommended it on a daily basis for infertile women to strengthen the uterus and help them conceive. Felter and Lloyd listed A. absinthium for amenorrhea and leukorrhea resulting from debility, and Christopher listed A. abrotanum for menorrhagia.
painful menstruation. _. ;;.:;:-" The Commission E monograph on A. vulgaris listed itS~:::: ~
traditional use in Germany for menstrual problems~~. irregular menstruation, as an aid to promote circulation,and~:;:' . as a sedative. The BHP gave the specific indication of A. ab-1~ ~ rotanum as amenorrhea associated with neurosis. I use A. :-' }~." absinthium combined with Ruta for teenagers with both amenorrhea and petit mal epilepsy, and also for premenstrual syndrome with headache and nervous tension. Some authors suggested avoidance of one or more of the Western Artemisia species during pregnancy. For example, Tierra contraindicated A. __ absinthium and A. abrotanum during pregnancy, but not A;'::o::, _ vulgaris. However, I have not seen research data showing 7:-:,: that infusions or tinctures of the three Western ArteIIlis.i~_;£J;c species can induce abortion when taken in therapeutic
Abortifacient or antiabortifacient?
dose.- .-
Indeed, Christopher recommended A. absinthium for morning sickness. The concerns about A. absinthium in particular . may relate to cases of abortion resulting from overdose of ::~ the essential oil, rather than therapeutic doses of the infusion or tincture. However, I would recommend that A, absinthium is avoided in pregnancy until more data is available. In Chinese medicine, neither A. annua or A. capillaris are contraindicated in pregnancy by either Bensky and Gamble or Yeung. Indeed, A. argyi is listed by the former text as spe:: ", cific for threatened miscarriage. .
Stimulant emmenagogue Dioscorides wrote that A. vulgaris could bring back menstruation, induce labor, and help to expel the afterbirth. Lonicerus said that A. vulgaris can get rid of old blood from overdue menstruation. A. absinthium. A. abrotanum, and A. vulgaris are all listed by Culpeper or Gerard to promote menstruation. Culpeper wrote that A. vulgaris can assist labor, expel the afterbirth, and treat 'the obstructions and inflammations of the mother: Kloss wrote that A. vulgaris is a safe emmenagogue for
young girls with suppressed menstruation, and Christopher gave the following combination for menstrual obstruction occurring in amenorrhea or dysmenorrhea: Herb
.
_
A. abrotanum (southernwood)
Ratio _ .__ 1
A. yulgaris (mugwort)
1
Mentha pulegium (pennyroyal)
1
"
This combination was previously listed hi Grieve. Tabernaemontanus listed A. vulgaris for uterine pains that result from
Calming and antispasmodic emmenagogue
""'t...
Sexual regulator Hildegard von Bingen said that if a man is sexually excited so that his sperm arrives at the point of emission, but is retained within his body and causes him to become ill, he should take a combination of Ruta and A. absinthium. The harmful mucus that was retained in him is then discharged with the urine and feces. This is discussed further in the chapter on Ruta under Traditional sources (Actions). Lonicerus noted the use of A. vulgaris for 'cold women: and Tabernaemontanus recommended it for lack of libido
due to cold. Vermifuge Tabernaemontanus listed A. absinthium for worms in children, and Gerard recommended both A. absinthium and A. abrotanum to expel worms. According to -:-:-c-Weiss, A. absinthium is not very effective against worms, and - . A. cina (Levant wormseed) is more effective.
Diuretic Dioscorides, Lonicerus, and Tabernaemontanus all said that A. vulgaris can alleviate urinary retention and dissolve kidney stones. Lonicerus recommended application of A. abrotanum oil under the navel to increase urination. It '-~
--
Artemisia is interesting to compare this use with the acupuncture use of Ren 6, especially with the use of direct moxa (A. argyi or A. vulgaris) on Ren 6. The moxibustion and Lonicerus' application will drive similar essential oils into the skin. Kloss 73 listed A. vulgaris for gravel and stones in the kidneys and bladder, and Christopher recommended it for cystitis. Expectorant Antiasthmatic, ant~tussive, expectorant, and antiallergic effects have been reported for A. argyi (al ye) by Chinese research, and this herb is now used for cough and asthma. It is interesting that Lonicerus recommended A. abrotanum for consumption of the lungs due to cold and A. vulgaris to soothe the cough and cleanse the lungs. Tabernaemontanus listed A. absinthium as a cleansing expectorant for lung diseases.
259
stituents may be involved in the antipyretic effect, and bitter and aromatic constituents may strengthen the digestive and hepatobiliary systems, respectively, to speed postfebrile recovery.
Comparison with A. capil/aris Like yin chen bao, A. absinthium can be included in combinations to treat hepatobiliary disorders associated with either Heat or Cold. I use A. absinthium in combinations to treat food intolerances and recovery from drug abuse or prolonged multimedication. A. absinthium can be said to have a wider application than A. capillaris in that A. absinthium can be used not only for patterns of Liver-Gallbladder Damp Heat or Cold, but also for patterns of Deficiency and Stagnation of Qi affecting the Liver, Gallbladder, Spleen, and Stomach. These may present with reduced appetite, digestive weakness, and indigestion.
Comparison with A. argyi Al ye (A. argyi or A. vulgaris) is COMPARISON OF WESTERN AND CHINESE USE OF ARTEMISIA SPECIES The actions and uses of the three Chinese species, A. apiacea (qing hao),A. capillaris (yin chen bao), andA. argyi (al ye); and of the Western species, as represented primarily by A. absinthium, are compared below. A. apiacea Qing hao is generally listed as cool or cold in temperature, and is traditionally used for fever associated with Summer Heat, Deficiency Heat, or Deficient Blood. It is used now also for malaria. A. capillaris Yin chen hao is generally listed as neutral or cool in temperature. Traditionally, it is mainly used to clear Damp Heat or Damp Cold from the Liver and Gallbladder to treat jaundice, hepatitis, and cholecystitis; although it can also be used for intermittent fever and chills. A. argyi Al ye ( A. argyi or A. vulgaris) is generally listed as warm in temperature and traditionally is mainly used to warm and tonify the Uterus to treat dysmenorrhea, threatened miscarriage, menorrhagia, or infertility associated with . Cold and Deficiency. Artemisia species used in the West A. absinthium, A. vulgaris, and A. abrotanum can all be described as warm-cool in temperature, and are compared in turn with each of the three main Chinese Artemisia species.
-'+ :,'.
J(~ ~':::Ol"
'
Comparison with A. apiacea Qing hao has been used in China for fever of various types and etiologies. A. abSinthill!D has been ~d in the West to treat recUrring fever'and. inter~ '. ,
- ' .'':.
J
'.
• .••-'.
mittent fever such as malaria. I use A. absinthium in combinations to treat low-grade chronic or r~curringfever in patien~ with chronic fatigue syndrome or fibromyalgia. Bitter con-
mainly used for women's disorders involving Cold and Deficiency, such as threatened miscarriage. There is a longstanding tradition in the West to use A. vulgaris for conditions of weakness and cold in the uterus, such as infertility and weak libido. However, there is also a tradition since the time of Dioscorides, to use it to stimulate menstruation, facilitate labor, and expel the afterbirth. A. absinthium and A. abrotanum can also be used to treat amenorrhea, infertility, and dysmenorrhea, but may be more of a stimulant than A. vulgaris, and should be avoided during pregnancy. I also use A. absinthium to treat premenstrual tension and headache in patterns of Liver Hyperactive Yang with Liver Stagnant Qi.
References 1. Dioscorides P. Kreutterbuch (1610). Reprinted by Verlag Konrad Kolbl, Miinchen, Germany (1960)
2. Bisset NG (ed). Herbal Drugs and Phytopharrnaceuticals. English edn. Medpharm. Stuttgart. Germany (1994) from 2nd German edn. Wicht! M (ed) (1989)
3. Christopher JR. School of Natural Healing. BiWorid. Provo. Utah (1976) 4. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks. United Kingdom (1983)
5. Moore M. Medicinal Plants of the Pacific West. Red Crane Books, Santa Fe. New Mexico (1993) 6. Parish R. Coupe R,lloyd D (005). Plants of Southern Interior British Columbia and the Inland Northwest. Lone Pine Publishing, Vancouver. Canada (1996) 7. Bensky D, Gamble A. Chinese Herbal Medicine Materia Medica, Easdand Press.. Seattle.Washington (1986) 8. Yeung H-C. Handbook of Chinese Herbs and Formulas. vol. 1. Institute of Chinese Medicine. Los Angeles, California (1985)
--~-\
1IIIJo:;"\
260
Combining Western Herbs and Chinese Medicine
9. Bruneton I. Pharmacognosy: Phytochemistry Medicinal Plants, 2nd edn. Lavoisier, Paris. France (1999)
41. Yoshikawa M. Shimada H. Matsuda H et aL Chern Pharm Bull 44(9): ":"-:; 1656-1662 ( 1 9 9 6 ) " ' " : "
10. Chang H-M, But PP-H (eds). Pharmacology and Applications of Chinese Materia Medica. vols. 1 and 2. World Scientific Publishing. Singapore (1986)
42. Hubei Institute of Combined Western and Traditional Chinese Medicine et al. Selected Research Information on Traditional Chinese
II. Jiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science and Technology Press. Shanghai. China (1975)
43. Pharmaceutical Industry (4-5):51 (1977)
Medicine. p 31 (1975)
,,.',.: , ~.,...., . '~i"';;
44. Coordinating Research Group for Artemisia Leaf-Oil Therapy of Bronchitis. Zhejiang Zhongyiyao (Zhejiang J Trad Chin Med) 4(1):16 - -
14. Idris UE.Adam SE. Tartour G.Nad InstAnim Health Q 22(3):138-143 (1982) 15. Moran A. Martin ML. Montero MJ et al. I EthnopharmacoI27(3): 307317 (1989)
45. Zhejiang Institute of Traditional Chinese Medicine. Compiled Information on Science and Technology. Zhejiang Institute of Traditional Chinese Medicine. p 27 (1979) 46. Bian RL. Private consultation (1980) [cited in Yeung H-C. Handbok of Chinese Herbs and Formulas vol. 1. Institute of Chinese Medicine. Los Angeles, California (1985) J
16. Ikram M.ShafiN,Mir I et al. PlantaMed 53:389 (1987)
47. Zhang LH, Wang JZ. Zhou XB et al. Chung Kuo Chung Yao Tsa Chili
17. Khattak SG, Gilani SN. Ikram M. I EthnopharmacoI14:45-51 (1985)
18(9):560-561.575 (1993)
18. Rice KC. Wtlson RS.J Med Chem 19:1054-1057 (1976)
48. Mashimo K et al. Chemical Abstracts 62:3302g (1965)
19. BergendorffO, Sterner O. Planata Med. 61(4):370-371 (1995)
49. Ryu BK,Ahn BO,Oh TY et al.Arch Pharm Res 21(5):508-513 (1998)
20. Moran A. Carron R. Martin ML et al. Planta Med. 55(4):351-353 (1989)
so.
21. Hansel R, Kel1er K. Rimpler H et al (ed). Hagers Handbuch der Pharmazeutischen Praxis, 5th ed, vol. 4. Orogen A-D. Springer-Verlag, Berlin-Heidelberg. Germany, pp 357-377 (1992) 22. Kreitmair H. Pharmazie 6:27-28 (1951)
51. Cardiovascular Diseases Research Unit, Second Teaching Hospital of Zhejiang Medical ColIege. Preliminary Repon on Artemisia Therapy of Coronary Disease. In: Proceedings of the 1979 National Symposium on Coronary Disease. Shanghai, China (1979)
23. Gessner O. Gift- und Arzneipflanzen von Mitteleuropa. 3rd ell. Carl Winter Universitatsverlag. Heidelberg, Germany pp 258-260 (1974)
52. Yang ZW et al. Abstracts of the Symposium of the Chinese Society of Physiology (Pharmacology). Chinese Society of Physiology P 120
(1992)
(1964) 53. Sun ZM. Yunnan Medical JournaI3(2):64 (1961)
25. Baumann JC. Med Mschr 29:173-180 (1975)
54. Weiss RF. Lehrbuch der Phytotherapie, 7th ed. Hippokrates-Verlag.
27. Subramoniam A, Pushpangadan P. Rajasekharan S et al. J EthnopharmacoI50(l):13-17 (1996) 28. al-Shamaony L, al-Khazraji SM, Twaij HA. J EthnopharmacoI43(3): 167-171 (1994) 29. Rao VSN, Menezes AMS, Gadelha MGT. Fitoterapia 59:17-20 (1988) 30. Li B et al. Chinese J Surgery (9):787 (1965) 31. Cheng H et al. New Chinese Medicine (8):35 (1964) 32. Microbiology Section, Pharmacologoy Department of Sichuan Institute of Chinese Materia Medica. Sichuan Communications on Chinese Traditional and Herbal Drugs (3):28 (1976) 33. Huang L, Liu JF, Liu LX et al. Chung Kuo Chung Yao Tsa Chili 18(1):44-48.63-64 (1993) 34. Zheng WF, Tan RX. Yang L et al. Planta Med 62(2):160-162 (1996) 35. White NT. Trans R SocTrop Med Hyg 88(suppll):S3-4 (1994) 36. Chanphen R, Thebtaranonth Y, Wanauppathamkul S et al. J Nat Prod 61(9):1146-1147 (1998)
Stuttgart, Germany pp 84.146-8, 296 (1991) 55. Tisserand R, Balacs T. Essential Oil Safety: A Guide for Health Care Professionals. Churchill Livingstone. Edinburgh, United Kingdom (1995) 56. Pinto-Scognamiglio W. Boll Chim Farm 106:292-300 (1967) 57. Hold KM. Sirisoma NS. Ikeda T et al. Proc Nat! Acad Sci USA. 97(8):3826-3831 (2000) 58. Tegtmeier M, Harnischfeger G. Eur J Pharm Biopharm 40:337-340 (1994) 59. Stahl E.Gerard D.Planta Med 45:147 (1982) 60. Baggott M Information from Internet site. that is, http://www.sepulchritude.comJchapelperilouslabsinthelabsinthe-faq.htrnl 61. Steinegger E. Hansel R. In: Pharmakognosie. 5th ed. Springer-Verlag, Berlin-Heidelberg. Germany, pp 286. 295-297 (1992) 62. European Scientific Cooperative on Phytotherapy: Monographs on the Medicinal Uses of Plant Drugs. European Scientific Cooperative on Phytotherapy. Exeter. United Ki:1gdom (1997) 63. Von Bingen H. Hildegard von Bingen's Physica.. Healing Arts. Rochester.
37. ShaOJling District Coordinating Research Group for Artemisia LeafOil Therapy of Allergic Diseases. Chin Trad Herbal Drugs Cornm (1):43 (1975)
64. Lonicerus A. Kreuterbuch (1679). Reprinted by Verlag Konrad Kolbl,
38. Pharmacology Section. Zhejiang Medical Col1ege. Pharmaceutical Industry (11 ):5 (1977)
65. Tabernaem~ntanus IT. Krauterbuch (1731). Reprinted by Verlag Konrad Ktilbl. Miinchen, Germany (1993)
39. Hoult JR, Paya M. Gen PharrnacoI27(4):713-722 (1996)
66. Gerard J. The Herbal or General History of Plants: The complete 1633 edition as'- revised and enlarged by Thomas Johnson. Dover
40. Yamahara J, Kobayashi G, Matsuda H et al. Chern Pharm Bull 37(5): 1297-1299 (1989)
.J
Zhong Y, Cui S. Chung Kuo Chung Yao Tsa Chili 17(6):353-354.383,~"-'~
24. Hansel R. Phytopharmaka, 2nd eli. Springer-Verlag. Berlin-Heidelberg. Germany.p 125 (1991)
26. Gilani AH, Janbaz KH. Gen PharmacoI26(2):309-315 (1995)
"
(1978)
12. Kaul VK. Nigam SS. Dhar KL. Indian J Pharm 38:21-22 (1976) 13. Rucker G. Manns D, Wtlbert S. Phytochem 31:340-342 (1992)
~.~-":. ~ . .
Vermont (1998) Miinchen. Germany (1962)
Publications. New York. New York (1975)
Artemisia 67. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks, Glenwood, lllinois (l990)
edn. (1898). Reprinted by Eclectic Medical Publications, Sandy, Oregon (l983)
68. Weiss RF. Herbal Medicine, English edn. Beaconsfield Publishers, Beaconsfield, United Kingdom (1988)
71. Grieve M. A Modern Herbal. vols. 1 and 2. Dover Publications, New York, New York (1971)
69. Blumenthal M (ed). The Complete German Commission E Mono-
72. Tierra M. Planetary Herbology. Lotus Press, Twin Lakes, Wisconsin (l988)
graphs: Therapeutic Guide to Herbal Medicines. American Botanical Council, Austin, Texas (1998) 70. Felter HW, lloyd ju. King's American Dispensatory, vols. 1 and 2, 18th
\.
!
"
261
73. Kloss j. Back to Eden, 5th edn. (l939). Reprinted by Lifeline Books, Santa Barbara, California (1975)
~.~ ~
to., .
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Asclepias Botanical name
There may be pharmacological and therapeutic differ-
Asclepias tuberosa L.
Family Asclepiadaceae Pharmaceutical name Asclepiadis tuberosae radix Part dried underground parts English pleurisy root, butterfly weed German Knollige Seidenpflanze French asch~piade tubereuse Mandarin A. tuberosa L. is not used; lian sheng gul zl hua (:it 1. ti .:r-1t.) is the aerial part ofA. curassavica L.
ences between A. tuberosa and the milkweeds since the milkweeds get their name from a milky latex that is absent in A. tuberosa. Also, whilst A. tuberosa has a specific tradition of use for acute severe lung disorders, A. incarnata was noted for its strengthening effect on the heart and its use as a strong diuretic in edema.s A. curassavica is a native of Central and South America that was not much used by the Eclectics. However, as early as 1881, they were aware that it contained the glucoside asclepiadin and that it had a strengthening effect on the heart. 2
Use in the West
Use of A. tuberosa in the United States Asclepias tuberosa is a perennial native to the United States of America that grows most abundantly in the South, but its range continues up the Eastern states. According to Grieve,l pleurisy root was one of the most important of the Native American remedies, and according to Felter and Lloyd,C it was one of the most common indigenous medicines employed by the early Eclectics. In the early 19th century Bigelovr reported that it was much used in the Southern states for pulmonary disorders, including pneumonia, pleurisy, and catarrh. In 1878, Fox~ wrote that he considered pleurisy root unequalled as a single herb for lung inflammations, pleurisy, difficult breathing, tightness of the chest, and catarrh of the lungs.
Use ofAsclepias species in Europe A. tube~osa was not known in Europe until it was imported from the United States, probably in the early 20th century. In his herbal of 1633, Gerard6 mentioned the introduction to England of an Asclepias from the United States. However, since this plant had milky juice, it is unlikely that it was A. tuberosa, although it might have been A. syriaca. In any case, the plant was too recently introduced for Gerard to be able to comment on its uses. Milkweeds were known in Europe since the time of Dioscorides,7 who noted their use mainly for abdominal pains or as antidotes to poisons. These uses were also reported by
ias have'been used in the United States, including:
Gerard (swallow-woorts in old English) and by Tabernaemontanus (Schwalbenwurz in old German).8 The Roman, British,
• A. syriaca L. (A comuti), common milkweed
and German traditions did not appear to include the use of the milkweeds for respiratory or cardiac disorders.
• A. incarnata L., swamp milkweed • A. curassavica, blood flower (milkweed blood flower = bloodweed)
Use in China The Chinese Herbal Medicine Dictionarl has an entry for A. curassavica L. (lian sheng gul zl hua).
Other species used in USA Various other species of Asclep-
263
264
Combining Western Herbs and Chinese Medicine
However. the main entry is cited from a relatively recent text. and the herb appears to be found more commonly in texts that cover provincial herbs in the South and Southwest of China. Also. since the texts do not list the meridians entered, it would appear that it is has not had wide traditional use in Chinese medicine. It has been used in China for tonsillitis. bronchitis, lung infections. urinary tract infections, and to reduce bleeding in menorrhagia or from external injuries.
What is special about Asclepias In terms of Chinese medicine, Asclepias tuberosa. as used in the West, can be said to be a cold, bitter herb that has its main effects on the Lung.
The key to understanding Asclepias is that it is a relaxing antipyretic herb. with expectorant. antispasmodic, and antiinflammatory actions on the lungs. It is perhaps the most effective Western herb for acute lower respiratory conditions with fever.
CHINESE ACTIONS In terms of Chinese medicine. Asclepias. as used in the West, can be said to have two main actions: 1. clear Wmd Heat and Lung Heat II. clear Lung Phlegm Heat
WESTERN ACTIONS The main Western actions ofAsclepias are shown here in terms of its two main Chinese actions:
11. clear Lung Phlegm Heat
acute bronchitis with fever. pleurisy, pneumonia
DIRECTION OF ENERGY During a fever. a hot decoction of Asclepias can help the movement of Qi and Blood toward the surface and promote or increase diaphoresis to assist in the reduction of the body temperature. It can facilitate the up\\ard movement of expectoration. where there is congestion of the bronchi by phlegm, and it has the reputation of dispersing serous exudate by effusion in pleurisy.
TYPICAL CASE EXAMPLE Signs and symptoms The patient has occasional bouts of acute influenza with fever (and antibiotics have had limited effect) and occasional episodes of acute bronchitis with fever and a hard. dry, painful cough. The pulse is normally somewhat empty, but during the acute episodes, it becomes more rapid and flooding, though never truly full. The tongue is pale with some red spots in the Heart and Lung areas. Diagnosis The patient has chronic Deficient Qi with some Heat in the Lung and Heart. and. in the acute episodes. has invasion of Wind Heat with Interior Lung Heat.
.f';
Choice of Asclepias This herb is specific for acute influenza or acute bronchitis with fever. Since this patient has some degree of Deficiency, Asclepias should be combined with Zingiber to moderate the sedative and dispersing effects of Asclepias, which in any case should only be given for up to 3 days.
Limitations ofAsclepias I. clear Wind Heat and Lung Heat
relaxant diaphoretic antipyretic
TEMPERATURE
WESTERN USES
In this book, Asclepias is classified as cold. It is specific for hot conditions of the respiratory system and for fever in general. It can be used for warm conditions or for mixed conditions of heat and cold with heat dominant. but in these two situations, it may be appropriate to combine it with Zingiber to maintain a temperature balance.
The Western uses of Asclepias can be related to its two main Chinese actions:
TASTE
II. clear Lung Phlegm Heat
expectorant bronchial anticatarrhal bronchial antispasmodic bronchial anti-inflammatory
I. clear Wind Heat and Lung Heat
acute influenza with fever, acute fever
Bitter'> The bitter taste of Asclepias can be associated mainly with its capacity to clear Heat. However. in view of recent research data, it may be that some of the bitter components act as bitter tonics for the Heart.
-....-::
Asclepias ACTIONS
Asclepias can have a rapid and powerful effect on the acute respiratory disorders, for which it is specific. However, it is an effective herb with a relatively narrow range of uses, unlike Lobelia, for example, which can treat acute respiratory disorders as being effective for many other different ailments as well. Diaphoretic and antipyretic Asclepias is a relaxing and sedative diaphoretic, that was recommended by the Eclectics for sthenic (Excess) conditions with hot skin and strong pulse, and not for asthenic (Deficiency) conditions with cold skin and weak pulse. Expectorant and anticatarrhal The main use of Asclepias is as an expectorant and anticatarrhal during acute conditions of Lung Phlegm Heat, with a tight and painful cough and difficulty breathing. Asclepias was used in the past for lingering catarrhal conditions of the lungs or gastrointestinal tract, but this use has declined.
~,
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Antispasmodic and sedative Although the main application of the antispasmodic and sedative actions of this herb has been for acute respiratory conditions with fever and bronchial spasms, it was also used in the past for nervous irritability in children with gastric disturbances or flatulent colic. However, there are differences of opinion on this topic, and Christopher1o wrote that Asclepias is not recommended for children because of its powerful action.
Asclepias paired with other herbs Discussion of the limitations of each of the main actions of Asclepias can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Asclepias beyond its limitations. The basic unit of herb combination is the herb pair. Six pairings of Asclepias are briefly explained below. CAUTION
Asclepias tuberosa can be effective in the treatment of acute bronchitis, pleurisy, and pneumonia, especially when these are recurring conditions and the use of antibiotics are of limited effect. However, Asclepias should not be used as a substitute for necessary conventional diagnosis and treatment, especially in severe or life-threatening conditions. Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair.
265 Asclepias + Capsicum
Pneumonia + exhaustio{l Asclepias is a relaxant 4iaphoretic specific for acute pneumonia, and Capsicum is a stimulant diaphoretic of general application. In my opinion, Asclepias should not be used in cases of Deficiency unless its cooling, sedative effects are balanced by the warming, stimulant effects of a herb such as Capsicum. Asclepias + Zingiber
Influenza + fever Asclepias and Zingiber form a powerful diaphoretic combination to treat fever. Zingiber is a diffusive, stimulant diaphoretic that can assist Asclepias in promoting sweating and can moderate its sedative effect. Asclepias + Achillea
Acute bronchitis + sinus congestion Both herbs are diaphoretics that can clear Wind Heat and treat fever. The effect of Asclepias to clear phlegm in the bronchi is complemented by the action of Achillea to clear sinus congestion. Also the tonic and astringent actions of Achillea moderate the relaxing and sedative effects of Asclepias. Asclepias + Echinacea Acute bronchitis + infection The combination of the diaphoretic, antipyretic, antispasmodic, expectorant, and anticatarrhal actions ofAsclepias with the antimicrobial and anticatarrhal actions of Echinacea can be most effective in treating acute lung disorders with infection and accumulation of phlegm in the respiratorysystem. Asclepias + Lobelia
Acute bronchitis + painful cough In my opinion, this is the most effective pair of herbs for acute respiratory disorders with fever, difficult expectoration, painful cough, tightness or pain in the chest, and nervous restlessness or anxiety. Both herbs have antipyretic, expectorant, anticatarrhal, antispasmodic, and sedative actions. Asclepias + Prunus
Painful dry cough Although Asclepias is not specifically an antitussive herb, it can be used to assist antitussive herbs, such as Prunus, because of its expectorant, anticatarrhal, antispasmodic, and sedative actions. Prunus is specific for dry, spasmodic, irritant or nervous cough.
266
Combining Western Herbs and Chinese Medicine
Asclepias combinations Three Asclepias combinations are discussed below: ·Combinati6n~f~;;::- ..
1. influenza + fever
Wind Heat + lung Heat
2. acute respiratory disorders + fever
lung Phlegm Heat + Wind Heat
3. bronchitis + heat sensations
lung Phlegm Heat + liver Heat
CAUTION
Asclepias tuberosa can be effective in the treatment of acute bronchitis, pleurisy, and pneumonia, especially when these are recurring conditions and antibiotics are of limited effect. However, Asclepias should not be used as a substitute for necessary conventional diagnosis and treatment, especially in . severe or life-threatening conditions. Before using any ofthe combinations below, it is important to be familiar with the cautions listed for each herb in the combination.
Wind Heat + Lung Heat
Asclepias Achillea lobelia Zingiber (fresh)
- :....\ .• :->
. Daily dose. Temperature 6g 6g 0.6 g* 3 slices
cold warm-cool warm-cool hot
'''''-,
Decoction/infusion This prescription is most effective as a":!7~ ~ decoction/infusion. To make the daily dose, all the herbs:;; except A~hillea .are decocted by simmerin.g them gentlYf
ficient boiling water can be added to a portion of the cool '. decoction to make it w a r m . ' . ~':5:; .•
;'i~J
Duration ofprescription Three to four single doses can ~~:~1;;;:_ taken per day, for a maximum of 3 days. If this combinati
Self-help This combination may induce sweating, lowering-:-:nii
allow the body to heal i t s e l f . . . .. ~.'
bitter acrid, bitter acrid acrid, aromatic
Caution
GENERAL
This combination is for Wind Heat with Lung Heat in the Interior; The dominant herb, Asclepias is cold, and Achillea and Lobelia can have cooling effect in this combination and situation. Although Zingiber is a hot herb, its acrid property can assist in the clearance of Wind Heat when combined with the other herbs. The overall temperature is therefore cool to treat warm or hot conditions. Some of the bitter constituents of Asclepias and Lobelia may have Heat clearing action, but other bitter constituents in these herbs may have a tonic effect on the cardiac or digestive systems..
This is a balanced prescription. in which:
• warm Zingiber moderates cold Asclepias • Achillea acts as a cooling diaphoretic and as a bitter tonic and astringent However, this combination is not appropriate for very weak patients with profuse sweating that does not relieve the fever. In addition, for some people, the amount ofLobelia in this combination may cause nausea after the first dose. In this case, the patient can reduce the subsequent doses in the 3-day prescription by half. Once the level of the patient's tolerance to Lobelia is known, on future occasions., the amount of Lobelia in the prescription can be reduced by a quarter to one half. 2. Acute respiratory disorders + fever
Lung Phlegm Heat + Wind Heat
USE
• acute fever, acute influenza with fever
I
Reheating Rather than reheating the herbal liquid, suf-
Taste
*The UK daily maximum dose for dried Lobelia is 0.6 g; see the Dose section in the Lobelia chapter.
,
:~-.;.'=~
the body temperature and reducing the fever. During this phase, it is important that the patient keep warm and avoid exposure to cold draughts. The combination may also produce drowsiness, and it is advisable that the patient rest to
1. Influenza + fever
Herb
PRACTICAL N O T E S . : : : · - - , : , £
Asclepias Echinacea
6g 6g
cold cool
bitter acrid, bitter, sl sweet
Asclepias
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Herb - -~:.;/Daiiydose::~.Te·mpemiure-:;Taste;-~~= ~~~;_·; 4g 4g 3g 0.6 g* 3 slices
Achillea Prunus Glycyrrhiza Lobelia Zingiber (fresh)
warm-cool neutral neutral-cool warm-cool hot
acrid. bitter bitter, aromatic sweet acrid acrid, aromatic
"The UK daily maximum dose for dried Lobelia is 0.6 g; see the Dose section in the Lobelia chapter.
GENERAL
This combination is for conditions of Lung Phlegm Heat, and there may also be Wind Heat and generalized Interior Excess Heat. The overall temperature of the combination is cool, and the dominant tastes are bitter and acrid to clear the surface and clear Heat. USE
• acute respiratory disorders, such as influenza, bronchitis, pleurisy, or pneumonia, with fever, cough, difficult expectoration, and chest tightness or pain PRACTICAL NOTES
These are the same as for the previous combination,
267
PRACTICAL NOTES
Decoction This prescription is most effective as a decoction. To make the daily dose, all the herbs are decocted by simmering gently for 15-20 minutes in about 750 ml of water in a covered pan. The mixture is then strained and the remaining liquid pressed out of the herbs in the pan. This provides a day's supply of decoction, which can be taken in three individual doses of one cup. The liquid is drunk as warm as can be comfortably tolerated and the patient retires to bed, rests, and keeps warm.
Reheating Rather than reheating the herbal liquid, sufficient boiling water can be added to a portion of the cool decoction to make it warm.
Duration of prescription Three to four single doses can be taken per day for a maximum of 3 days. If this combination is appropriate, it is usually rapidly effective, relieving most of the symptoms of cough and fever after three to five single doses. Self-help It is important that, after taking the decoction, the patient keep warm and avoid exposure to cold draughts. The combination may also produce drowsiness and it is advisable that the patient rest to allow the body to heal itself.
Caution This combination is for Excess Heat patterns. It is 3. Bronchitis + heat sensations
Lung Phlegm Heat + Liver Heat
Herb
Daily dose
Asclepias Echinacea Berberis Hydrastis Prunus Glycyrrhiza Lobelia
5g 5g 4g 3g 4g 2g 0.6 g*
- Temp~rature cold cool cool cool neutral neutral-cool warm-cool
Taste bitter acrid, bitter, sl. sweet bitter bitter bitter, aromatic sweet acrid
'The UK daily maximum dose for dried Lobelia is 0.6 g; see the Dose section in the Lobelia chapter.
GENERAL
This combination is for acute or chronic respiratory infections associated with Lung Phlegm Heat with Liver Heat. The overall temperature is cool to treat hot conditions and the dominant taste properties are bitter and acrid. USE
• acute or chronic bronchitis, pleurisy or pneumonia with fever or sensations of heat, yellow or green phlegm, and maybe a barking cough, headache, restlessness, and irritability
not appropriate, unless modified, for very weak patients with patterns of Deficiency. For some people, the amount of Lobelia in this combination may cause nausea after the first dose. In this case, the patient can reduce the amount of subsequent doses in the 3day prescription by half. Once the level of the patient's tolerance to Lobelia is known, on future occasions, the amount of Lobelia in the prescription can be reduced by a quarter to one half. COMPARISON OF THE THREE ASCLEPIAS COMBINATIONS 1. Influenza + fever
Wind Heat + Lung Heat The four herbs in this combination combine to produce a strong diaphoretic and antipyretic effect to treat influenza with fever.
2. Acute respiratory disorders + fever Lung Phlegm Heat + Wind Heat Whilst this combination contains the same four herbs as combination No.1, that is, Asclepias, Achillea, Lobelia, and fresh Zingiber, it also contains Echinacea as an antimicrobial
-
-
----_._._--_._-_.._-------------
,.~iid: i
Combining Western Herbs and Chinese Medicine
268
and anticatarrhal, and Prunus as a calming antitussive. Echinacea and Prunus change the emphasis of the combination from WlOd Heat to Lung Phlegm Heat. 3. Bronchitis + heat sensations
-Lung Phlegm Heat + Liver Heat Achillea and Zingiber are present in combinations No.1 and No.2 as diaphoretics to clear Wind Heat. In combination No.3, they are replaced with Berberis and Hydrastis, which change the emphasis of the combination from W lOd Heat to Lung Phlegm Heat and Liver Heat.
Research There is very little data currently available on the constituents of A. tuberosa and pharmacological research or clinical studies on A. tuberosa.
.•..
---~.I- -.-.-"~ ~ -
.-_:",,_"-
.'
.. ,~
A study on the aerial parts of A. incarnata reported .'.~~ ~ pregnane glycosides, with aglycones that include ikemagecln;--<:"T \ lineolon, and isolineolon,18 and a study on the roots of A. incarnata reported 32 pregnane glycosides and 2 cardenolidesi:::: ~ frugoside and gofruside. 19 . -. --~::"'.::>T
34
I
Flavonoid glycosides The flowers of A. syriaca were reported 2D
to contain quercetin and its glycosides.
Phenolic acids The phenolic acids hydroxybenzoic, coumaric, protocatechuic, and caffeic acids were confirmed in the leaves and flowers of A. syriaca. The flowers also contained gallic acid, and the leaves also contained vanilic and chlorogenic acids. 21 Other
The leaves of A. fruticosa have been reported to
contain megastigmane glucosides.
22
PHARMACOLOGICAL AND CLINICAL RESEARCH
CONSTITUENTS
• cardiotonic
In 1881, A. curassavica was reported to contain the glucoside asclepiadin, with cardioactive properties.2 Asaclepiadin was also listed as a constituent of A. tuberosa in the BHP lI of 1983. More recent studies have reported the following constituents:
• antifungal
• cardiac glycosides • flavonoid glycosides • phenolic acids • other Cardiac glycosides Cardiac glycosides consist of a steroidal aglycone and a sugar moiety that is usually an oligosaccharide. The cardiac activity is linked to the aglycone, but the sugar moiety may enhance and modify the cardiac activity of the aglycone by modifying its polarity.12 According to Bruneton, cardiac glycosides have a relatively limited distribution in the plant kingdom in a fairly small number of genera, and many of these genera are in the Asclepidaceae. The cardiac glycosides in the Asclepias species are of the pregnane and the related cardenolide types.
A. tuberosa
Recent studies have identified 5 cardenolide glycosides 13 and 16 pregnane glycosides, including glycosides of ikemagenin and lineoloIl, from the roots of A. tuberosa.1 4
Other Asclepias species The cardenolide asclepin was i~lated from A. curassavica. 15 The cardiac glycoside gomphoside was isolated from A. fructicosa,16 and a later study found A. fruticosa to contain 22 cardenolide glycosides and 9 pregnane glycosides.1 7
Cardiotonic Asclepin, a new cardenolide from A. curas- -"'" savica, increased the myocardial contractility both in normal and hypodynamic heart muscle. The cardenolide is more IS potent than digoxin and has a wider safety margin. A -" potent inotropic activity was also reported for gomphoside, a cardiac glycoside from A. fructicosa.
16
Antifungal Latex sap from A. curassavica was found to _ inhibit the growth of Candida albicans, partly by activating fungal cell wall breakdown. 23
RESEARCH VERIFICATION OF TRADITIONAL ACTIONS From the research summarized above, there is no direct or indirect support for the traditional actions: diaphoretic,antipyretic, expectorant, anticatarrhal, anti-inflammatory, ":'"' antispasmodic, or sedative. Additional effects demonstrated by research A cardio--' tonic effect has been reported for A. fructicosa and A. curassavica, and an antifungal effect for A. curassavica. Thes{ effects have not yet been reported for A. tuberosa, although;this plant has also been shown to contain cardenolide glyco- ~. sides.
TOXICOLOGY I have not yet found toxicological information for A. tuberosa. Felter and Lloyd regarded A. tuberosa as a saf
Asclepias herb without contraindications, and Christopher wrote that it is quite harmless in correct doses. However, Christopher did not recommend it for children because of its powerful action and wrote that a more stimulating diaphoretic should be used when the skin is cold and the pulse is weak. Both Christopher and the BHP noted that very large doses of A. tuberosa are reputed to cause vomiting or diarrhea.
Dried herb The BHP listed 1-4 g of dried herb, three times per day. For acute conditions, I use about 2-3 g of Asclepias dried herb, three times per day, for 1 to 3 days. Tincture The BHP listed 1-5 ml of 1:10 tincture in 45% alcohol, three times per day. Initial dos.e Can start at the standard dose, providing cautions are observed. Duration For acute conditions, it can generally be used for up to 3 days.
Caution Western contraindications To be used with caution or combine it with stimulant herbs, such as Zingiber or Capsicum, in cases ofweakness. Contraindicated in cases of severe weakness with sensations of cold. None found.
Pregnancy and lactation Although I have not seen any reports of adverse effects, I would not use this herb during pregnancy or lactation. Ability to drive and use machines Side effects
No adverse reports.
None are known in the therapeutic dose.
Overdose Reputed to cause diarrhea and vomiting in very large doses, see Toxicology.
.
Traditional sources Temperature Gerard classified the milkworts (swallowwoorts) as hot and dry, and Tabernaemontanus listed them as moderately warm and dry, but these Asclepias species were not A. tuberosa. The main entry of the Chinese Herbal Medicine Dictionary classified A. curassavica (lian sheng gul zi hua) as cold. In this book, A. tuberosa, as used in the West, is classified as cold since its main use is as a relaxing, sedative diaphoretic and antipyretic for hot febrile conditions. Taste
Taste in the mouth According to Felter and Lloyd, A. tuberosa has a somewhat bitter, and somewhat acrid taste. I found a 1:5 tincture in 25% alcohol to have a fragrance and taste resembling a single malt whisky, but also a definitely bitter aftertaste that may deter the bibulously inclined. It also had a slight acrid and aromatic taste. A sample of the dried herb tasted bitter, slightly acrid, and aromatic. Taste properties The main entry of the Chinese Herbal Medicine Dictionary classified A. curassavica (lian sheng gul zi hua) as bitter. In this book, A. tuberosa, as used in the West, is classified as bitter in terms of Chinese medicine, in the sense of clearing Heat. However, it may later be found that this herb also has a bitter cardiotonic effect. ORGANS In terms of Chinese medicine, A. tuberosa, as used in the West, can be associated mainly with disorders of the followingorgans: Organ
-- Examples of use, . _'. _ , .., Source
Interactions None are known. Lung
......
Regulatory status
-I
Act 1968). A. tuberosa is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. A. tuberosa is not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
PROPERTIES
Dose
Chinese contraindications
269
Please read the Regulatory status section in the chapter on Safety. Asclepias tuberosa is on the UK General Sale List (Statutory Instrument Order 1977 No. 2129 to the Medicines
influenza, bronchitis, pneumonia. pleurisy
Priest and Priest,2'
Stomach, Intestines
gastralgia, colic carminative
Christopher
Kidney, Bladder
urethritis, cystitis, nephritis diuretic for kidney problems
Lyle 25 Christopher
BHP BHP
The Chinese Herbal Medicine Dictionary did not list meridians entered for A. curassavica.
..
270
Combining Western Herbs and Chinese Medicine
ACTIONS The main traditional actions discussed are: • diaphoretic and antipyretic • expectorant and anticatarrhal • antispasmodic and carminative • sedative • diuretic • other Diaphoretic and antipyretic According to Felter and Lloyd, A. tuberosa may be used to promote diaphoresis no matter how high the degree of the fever and even though the patient may be already perspiring freely. According to Christopher, 'pleurisy root influences the skin and the circulation by relaxing the capillaries, thereby relieving the heart and arteries of undue tension. and stimulating a slow and steady perspiration, wherein the exces~ive heat is grad~ally eased: Priest and Priest described A. tuberosa as a peripheral and capillary relaxant that influences the flow toward the surface, and Christopher recommended this herb for all types of fever and for eruptive diseases. Expectorant and anticatarrhal A specific use of Asclepias is for acute respiratory disorders with bronchial phlegm and difficult expectoration, difficult breathing. and dry. painful coughs. Ellingwood recommended A. tuberosa for pleurisy with exudation to promote rapid dispersal of the effusion. and Felter and Llyod noted the use of A. tuberosa for the sweating of pulmonary tuberculosis. Christopher. Priest and Priest. and the BHP all listed A. tuberosa for influenza. bronchitis. pleurisy. and pneumonia. A. tuberosa has also been used for chronic cough and catarrhal states. However. this seems to have been of lesser importance. Antispasmodic and carminative
Bronchial antispasmodic Ellingwood prescribed this herb for tight and painful coughs with difficult respiration, and Felter and Lloyd recommended it for bronchial spasms in constricted cough and asthma. They also listed it for pericardial pains and intercostal neuralgia.
Carminative Dioscorides, Gerard. and Tabernaemontanus noted the use of the milkweeds for abdominal pain. but knew nothing of the use of A. tuberosa. Felter and Lloyd recommended pleurisy root for indigestion due to weakness of the stomach, catarrhal states of the gastrointestinal system, or nervous afflictions. They also recommended it for gastric disturbances or flatulent colic in children.
-
~.
!
=&J
--~:::~c:i_
conditions of the nervous system, and Felter and-Lloyd.::: 1 noted its use for nervous irritability in children. Christopher--::::''''- \ described pleurisy root as a slightly sedative nervine and as a cardiac depressant. According to Priest and Priest, this herb.,c."" can slow the heartbeat. . ~"> Diuretic Tabernaemontanus quoted Matthiolus as recommending swallow-woort for edema. Felter and Lloyd noted ",_,,1 that A. tuberosa has been used for edema, but is not as efficient as other diuretics. Christopher listed pleurisy root as a diuretic for kidney disorders but did not often include it in diuretic combinations. Other Tabernaemontanus recommended the milkweeds for amenorrhea, and Christopher listed pleurisy root for amenorrhea and dysmenorrhea.
COMPARISON OF WESTERN AND CHINESE USE OF ASCLEPIAS SPECIES .. _,;;~,c>'Cc;, A. tuberosa was one of the most favored herbs of the Eclectic physicians of North America and is still regarded today by some practitioners as perhaps the most effective herb for acute respiratory infections with fever. In contrast, A. curassavica (lian sheng gul zi hua) has not been widely used in China. A. tuberosa has been used specifically in the West for fever accompanying influenza, bronchitis, pleurisy or pneumonia. A. curassavica has been used in China to clear Heat, move the Blood, and stop bleeding. It has been employed to treat tonsillitis, bronchitis. lung infections, and urinary tract infections. and to reduce bleeding in menorrhagia or external injuries.
References 1. Grieve M. A Modern Herbal. vols. 1 and 2. Dover Publications, New
York. New York (1971) 2. Felter HW and lloyd Ju. King's American Dispensatory. vols. 1 and 2. - ~". i 18th edn. (1898). Reprinted by Eclectic Medical Publications. Sandy. Oregon (l983) 3. Bigelow J. American Medical Botany. vol. 2. Cummings and Hilliard, Boston. Massachusetts, p 63 (l817-182l) 4. Fox W. The Working Man's Model Family Botanic Guide to Health. 7th edn, William Fox. Sheffield, United Kingdom (1878) 5. Ellingwood F. American Materia Medica. Therapeutics and Pharmacognosy, 11th edn. (l919). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1994) 6. Gerard J. The He{bal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publications. New York. New York (1975) 7. Dloscorides P. Kreutterbuch (l610). Reprinted by Verlag Konrad Kolbl. '..
Sedative
Lyle recommended pleurisy root for irritable
Milnchen. Germany (1960)
Asclepias 8. Tabernaemontanus IT. Krauterbuch (1731). Reprinted by Verlag Konrad K61bl. Munchen, Germany (1993) 9. Jiangsu :-Jew Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science & Technology Press, Shanghai, China (1975) 10. Christopher JR. School of Natural Healing. BiWorld, Provo, Utah (1976) 11. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983) 12. Bruneton J. Pharmacognosy: Phytochemistry Medicinal Plants, 2nd edn. Lavoisier. Paris, France (1999)
271
16. Chiu FC, Watson TR. I Med Chern 28(4):509-515 (1985) 17. WarashinaT.Noro T. Phytochemistry 37(1):217-226 (1994) 13. Warashina T. Noro T. Phytochemistry 53(4):485-498 (2000) 19. Warashina T, Noro T. Chern Pharm Bull 48(4):516-524 (2000) 20. Sikorska M,Matlawska I. Acta Pol Pharm 57(4):321-324 (2000) 21. Sikorska M. Matlawska I, Glowniak K, et al. Acta Pol Pharm 57(1):6972 (2000) 22. Abe F. Yamauchi T. Chern Pharm Bull 48(12): 1908-191I (2000) 23. Giordani R, Moulin-Traffort I. Regli P. Mycoses 34( 1-2):67-73 (1991) 24. Priest AW, Priest LR. Herbal Medication. L.N. Fowler. Romford Essex, United Kingdom (1982)
13. Abe F. Yamauchi T. Chern Pharm Bull 48(7):991-993 (2000) 25. Lyle TI. Physio-Medical Therapeutics. Materia Medica and Pharmacy. 14. Abe F, Yamauchi T. Chern Pharm Bull 48(7):1017-1022 (2000)
Originally published Ohio (1897). Reprinted by the National Asso-
15. Patnaik GK, Dhawan BN. Arzneimitte\iorschung 28(7):1095-1099
ciation of Medical Herbalists of Great Britain, London. United Kingdom (1932)
(1978)
r
Berberis and Hydrastis This is essentially two chapters rolled into one. However, to avoid duplication and to compare and contrast two similar herbs, Berberis and Hydrastis are discussed together in this chapter. I find it fascinating that two herbs that are from different plant families and that are so very different in growth and form should be so similar in their actions and uses. The similarities are based on the presence in both plants of a single powerful active constituent, the isoquinoline alkaloid berberine. The differences in their actions and uses may largely depend on the differences in their other isoquinoline alkaloids.
writer Averroes. 2 Berberis has been used in the West at least since the time of Galen, and Gerard used this herb for excessive heat in the liver, heat in the stomach, and heat in the blood. 3 The early Eclectic practitioners of the United States used this herb as a blood purifier, and for jaundice, urinary inflammations, and diarrhea. 2 In recent Western herbal tradition, Berberis has been regarded as specific for disorders of the hepatobiliary system, such as jaundice, cholecystitis, and cholelithiasis.4 I also use this herb for recurring fever or infections, and for intolerances to foods or medications associated with weak or sluggish liver function.
BERBERIS VULGARIS
Related species
Mahonia aquifolium, commonly called Oregon grape, was once called Berberis aquifolium, but is now put in the genus Mahonia of the Berberidaceae. This tall, handsome shrub with glossy, spiny leaves is native to the western United States and has some uses that are similar to barberry. Oregon grape was used by the Native Americans to make a bright yellow dye for basket materials and internally as a medicine. 5 Medical use of Oregon grape was popularizedin North America in the 1880s by the Eclectic physician James Bundy and by the herbal product manufacturer Parke, Davis and Co. of Detroit. 2 Later Eclectic physicians used this herb mainly for skin disorders.2.6
Botanical name Berberis vulgaris L. Family Berberidaceae Pharmaceutical name Berberidis cortex Part dried root and!or stem bark English barberry German Berberitze French epine-vinette Mandarin san ke zhen (+~) is the stem or root bark from Berberis species: see below Use in the West The species of Berberis most commonly used in the West is Berberis vulgaris, often called barberry and sometimes called berberry. It is a spiny deciduous shrub indigenous to Europe.but generally it is distnbrited through North Anierica, North Atrica. and temperate Asia. l .. ;' The name berberys, meaning a shell, may have been the Arabic word given to the fruit by the twelfth centUry medical
Use in China Species used:· The Chinese Herbal Medicine Dictionarf has an entry for san ke zhen, which refers to bark from the roots and stems of Berberis sargentiana Schneid., B. brachypoda
273
1
274
Combining Western Herbs and Chinese Medicine
_:_-:~~~~'~1 ' T.. i. -•• ~:i"i';"""
Maxim., B. dictyophlla Franch. var. pruinosa Schneid., or B. diaphana Maxim. There are various other entries for Berberis species, for example, xiao bo, which refers to B. amurensis Rupr., B. poiretii Schneid., B. thunbergii DC.(B. japonica Hort.), B. wilsonae Hemsl., B. sibirica Pall., B. anhweiensis Ahrepdt., B. subacuminata C. K. Schneid.. (B. bicolor Levl.), or B. vulgaris.
Actions and uses According to the Chinese Herbal Medicine Dictionary, san ke zhen can clear Damp Heat and Heat Toxin, and can be used for blood in the urine, jaundice, sore throat, and red eyes. According to Chang and But,S san ke zhen can clear 'latent heat syndrome (Retained Pathogen manifesting with Heat) such as tenesmus due to dysentery, pharyngolaryngitis, jaundice, and cough due to pathogenic heat in the lungs:
HYDRASTIS CANADENSIS Botanical name Hydrastis canadensis L. Family Ranunculaceae Pharmaceutical name Hydrastidis rhizoma Part dried rhizomes English golden seal German Kanadische Gelbwurzel French hydraste du Canada Mandarin H. canadensis L. is not used Use in the West Hydrastis canadensis, golden seal, is a small perennial he.rb, native to the eastern part of North America, where it was used in the past by the Cherokee peoples9 as a dye, and externally for the treatment of sores. IO Since the 1840s, Hydrastis became one of the most important herbs of the Eclectic practitioners of North America. Lyle described Hydrastis in 1897 as 'the king of tonics to the mucous membrane: II The Physiomedical and Eclectic practitioners of the late nineteenth and early twentieth century stressed its ability to treat catarrhal conditions of the mucous membranes, associated with atony or with inflammation and infection. It was used for catarrhal states of the respiratory, gastrointestinal, urinary, or reproductive systems. It was also used as an antihemorrhagic and as a bitter digestive tonic. Although Miller introduced it into England in 1760, under the name of Warnera, its cultivation was limited to botanical gardens. I Its use was not mentioned by the European practitioners Dioscorides,12 Lonicerus,13 Tabernaemontanus,14 Culpeper,ls or Gerard. 3
An endangered species By 1850, this herb had become commercially important, and by 1905, the weight of the annual supply was estimated at about 200,000 pounds. I Hydrastis has been overharvested for many years and has now become one of the top five herbal supplements in the worldwide
market. 16 This has reduced its range and numbers to such a -::'-,~':= '. point that some have considered it to be an endangered' ..,...'\ species. 17
Use of cultivated material It is the recommendation of this book that wild Hydrastis should not be used, because of the . -~, risk to the species, and that cultivated Hydrastis should be used instead. Organic material may be preferred. However, practitioners are advised to test its quality both by taste and ~~, by its effect on the practitioners themselves since adulteration of Hydrastis has been common in the past because of its high price relative to, for example, Berberis. r" OTHER BERBERINE-CONTAINING PLANTS Berberis and Hydrastis are compared in this chapter with two other berberine-containing plants that are important in Chinese medicine: Phellodendron amurense (huang bai) and Coptis chinensis (huang lian). These comparisons. are discussed in Constituents and also in Sources.
What is special about Berberis and Hydrastis Berberis In terms of Chinese medicine, Berberis vulgaris can be said to be a cool, bitter herb. It has its main effect on the Liver and Gcllbladder, and can also have an effect on the Spleen, Stomach, Intestines, Lung, Bladder, and Uterus.
The key to understanding Berberis is that it can be used to treat: • recurring fever and infections • acute or chronic inflammatory conditions ofthe hepatobiliary system. urinogenital system. and skin • intolerances to foods or medications associated with weak or sluggish liver function Hydrastis In terms of Chinese medicine, Hydrastis canadensis can be said to be a cool, bitter herb. It has its main effect on the Stomach, Intestines, Lung, and Uterus, and can also have an effect on the Liver, Gallbladder, Spleen, and Bladder.
The key to understanding Hydrastis is that it can be used to treat: • catarrhal conditions ofthe mucous membranes ofthe. . respiratory, gastrointestinal, urinary. or reproductive systems associated with either atony or inflammation • disorders ofthe female reproductive system such as abnormal uterine bleeding or dysmenorrhea
w.
Berberis and Hydrastis
275
Alterative In terms of Chinese medicine, the alterative action of Berberis can be associated with the following effects:
CHINESE ACTIONS In terms of Chinese medicine, Berberis and Hydrastis, as used in the West, can be said to have the following main actions: Hvdrastis
Berberis I. clear Retained Pathogen II. clear Lung Heat III. clear Liver-Gallbladder Damp Heat IV. move Liver Stagnant Qi
I. clear Lung Phlegm II. clear Stomach Heat III. clear Intestines Damp Heat and Phlegm IV. clear Lower Burner Damp Heat and Phlegm V. reduce bleeding VI. regulate Uterus Qi and Blood
WESTERN ACTIONS The main Western actions of Berberis and Hydrastis are shown in the table below in terms of the main Chinese actions: Comparison of Berberis and Hydrastis Simply speaking, it could be said that the characteristic actions for Berberis are its hepatic, alterative, and antipyretic actions, and the characteristic actions for Hydrastis are its anticatarrhal, antihemorrhagic, and emmenagogue actions. Berberis
Hepatic and cholagogue The specific character of Berberis is to tonify and move Liver Qi, and to clear Liver Heat and Liver Damp Heat.
• clears Retained Pathogen • moves Liver Stagnant Qi • clears Liver Heat and Liver Damp Heat • clears Heat in the Blood and Heat Toxin
Antipyretic Berberis is an antimicrobial and alterative that can clear Retained Pathogen from the Interior of the body, thus reducing the incidence of febrile episodes. Its ability to move Liver Stagnation and to clear Liver Damp Heat may greatly contribute to its alterative action. However, Berberis is not a diaphoretic to clear Exterior Wind from the surface. Hydrastis
Anticatarrhal According to Western tradition, the specific action of Hydrastis is to regulate secretion by mucous membranes' especially to reduce discharge or excessive mucous secretion, to reduce inflammation or infection of those membranes, and to reduce bleeding arising from damage to the mucosa. Antihemorrhagic Hydrastis is commonly used to treat abnormal uterine bleeding. However, it is not an astringent in the sense of the tannin-containing herbs Geranium, Potentilla, or Quercus. Its antihemorrhagic effects on abnormal uterine bleeding may depend as much on its antimicrobial, anti-inflammatory, and emmenagogue actions as on a direct styptic effect.
HYDRASTIS
BERBERIS Chinese actions
Western ,actions
Chinese actions
Western actions
I. clear Retained Pathogen
antimicrobial alterative antipyretic
I. clear Lung Phlegm
antimicrobial anticatarrhal anti-inflammatory
II. clear Lung Heat
antimicrobial anti-inflammatory antipyretic
II. clear Stomach Heat
anti-inflammatory antiulcer antihemorrhagic
111. clear Liver-Gallbladder Damp Heat
hepatic anti-inflammatory alterative dermatological agent antiarthritic
Ill. clear Intestines Damp Heat and Phlegm
antimicrobial anti-inflammatory anticatarrhal antihemorrhagic
IV. move Liver Stagnant Qi
bitter digestive tonic hepatic cholagogue mild laxative
IV. clear Lower Burner Damp Heat and Phlegm
antimicrobial anti-inflammatory anticatarrhal antihemorrhagic
V. reduce bleeding
anti-inflammatory antihemorrhagic
VI.- regulate Uterus Qi and Blood
emmenagogue
, I
--~-<~.•
-I
_ ..
Combining Western Herbs and Chinese Medicine
276
Emmenagogue Hydrastis can be used to control abnormal uterine bleeding and to treat leukorrhea associated with atony, inflammation, or infection. It can also be used to regulate and normalize the tone of the uterine smooth muscle so that Hydrastis can both reduce the muscle spasms of dysmenor- rhea and induce regular contractions in delayed labor.
WESTERN USES The table below shows the Western uses of Berberis and Hydrastis and their main Chinese actions. Inappropriate use of Hydrastis Golden seal has become one of the world's most overused herbs. It has, for example, been promoted to the public as a tonic or to relieve colds and influenza. According to Bergner, less than 10% of the use of Hydrastis in the United States is clinically appropriate. IS In my opinio!?-, ~~!i~~~~~_~pp!
---~?
Bitter digestive tonic There are other bitter herbs that may be more effective than Hydrastis as digestive bitter tonics, for example, Gentiana, Centaurium, Cinchona, or Artemisia absinthium.
1
Hepatic and cholagogue Unless there is a catarrhal con~~~:~~ 'I tion of the hepatobiliary system, other herbs, such as Berberis, ---.~ \ Rosmarinus, or Taraxacum may be more effective. Antimicrobial and anti-inflammatory Unless there isa -~~i~S""\ catarrhal condition of the mucous membranes, other ber- -.-,.;;- ~ berine-containing plants, such as Berberis or Mahonia, can be at least as effective as Hydrastis for conditions with infection or inflammation, such as acute bronchitis with fever,
.;~.
,
:~,
eczema, or arthritis. In my opinion, Hydrastis is not appropriate for acute early-stage colds and influenza, which would require herbs like Achillea or Echinacea, unless there is an underlying catarrhal condition of the respiratory mucosa. Substitution difficulties However, there are situations for which Hydrastis is specific, at least according to its traditional use, and for which substitution is more difficult. These involve its anticatarrhal, antihemorrhagic and emmenagogue -,~-.~,,"",,-",=.
actions. Anemopsis californica (yerba mansa) has been recommended by Moore as a substitute for Hydrastis when an as20 tringent and mucous membrane tonic is required. Felter and lloyd recommended Yerba mansa for diarrhea, cough, and lung problems, but they did not list Yerba mansa as a bitter digestive tonic or for liver and gallbladder problems, as they listed Hydrastis.
DIRECTION OF ENERGY Substitutes for Hydrastis Golden seal is often used when other herbs would be cheaper and more effective in providing a specific herbal action.
I
~
Neither Berberis nor Hydrastis are herbs that have an outward movement, bringing energy to the surface. However, they can treat surface conditions, for example, those that involve Heat in the Blood, such as eczema. Both have the capacity to move Stagnation of Qi in the body, especially that of the Middle Burner. Both can have a downward draining action, which can include a mild laxative effect.
HYDRASTIS
BERBERIS
Chinese actions
Western uses sinusitis, catarrhal deafness, bronchial phlegm
I. clear Retained Pathogen
recurring febrile conditions
I.
II. clear Lung Heat
acute bronchitis with fever
II. clear Stomach Heat
gastritis, peptic Ulcer, gingivitis
III. clear liver-Gallbladder Damp Heat
hepatobiliary disorders, skin disorders, arthritis
III. clear Intestines Damp Heat and Phlegm
constipation, cfiarrhea, giardiasis, mucous colitis. ulcerative colitis
IV. move Liver Stagnant Qi
intolerances to foods or medications, constipation
IV, clear Lower Burner Damp Heat and Phlegm
cystitis, prostatitis, leukorrhea
V.
abnormal uterine bleeding
clear Lung Phlegm
reduce bleeding
VI. regulate Uterus Qi and Blood
dysmenorrhea. delayed labor
--
Berberis and Hydrastis TYPICAL CASE EXAMPLE: BERBERIS Signs and symptoms The patient is restless, irritable, and sometimes depressed. The patient has recurring subacute febrile episodes, various intolerances to foods and medications, pains in the hypochondriac region, and recurring eczema. The pulse is rather forceless, slightly rapid, and wiry in the Liver position. The tongue is red at the edges, but generally pale and purplish, with a greasy yellow coat. Diagnosis • Liver Qi Deficiency and Liver Stagnant Qi • Retained Pathogen • Damp Heat in the Liver and Gallbladder. Choice of Berberis Berberis is chosen since it can tonify and move Liver Qi, clear Retained Pathogen, and clear LiverGallbladder Damp Heat.
TYPICAL CASE EXAMPLE: HYDRASTIS Signs and symptoms The patient has poor appetite and an occasional burning sensation in the epigastrium. He has chronic nasopharyngeal and bronchial catarrh, occasional diarrhea with a bad smell, and occasional mucous in the stools. He has recurring cystitis with a burning sensation and cloudy urine, and prostatic enlargement. The pulse is slippery and slightly empty, and wiry in the Spleen and Liver positions. The tongue is slightly red with a yellow greasy coat. Diagnosis • Deficiency and Stagnation of Spleen Qi and Liver Qi • Lung Phlegm • Damp Heat and Phlegm in the Bladder • occasional Stomach Heat, Intestinal Damp Heat, or Phlegm in the Intestines Choice of Hydrastis Hydrastis is chosen since it can tonify and move Spleen and Liver Qi, and clear Heat, Damp Heat, or Phlegm from the Lungs, Stomach, Intestines, and Bladder.
Limitations of Berberis and Hydrastis TEMPERATURE Both Berberis and Hydrastis can be classified as cool rather than cold. Both have a long tradition of use as bitter tonics for weak digestion and debility, and both can be used for neutral conditions or mixed conditions of Heat and Cold,
277
providing they are combined with warm or hot herbs, such as Rosmarinus or Zingiber.
TASTE Berberis and Hydrastis are bitter herbs without other appreciable taste properties.
ACTIONS Antipyretic Berberis can be used specifically to clear Retained Pathogen, but if this is accompanied by Wind invasion, other herbs, such as Achillea, must be added for that factor. Hydrastis can be specific for nasal catarrh, whether acute or chronic, but if this is accompanied by Wind invasion, other herbs, such as Sambucus, must be added. Alterative Berberis is one of the main alterative herbs, mainly focused on the liver. It can be used for a variety of conditions associated with impurities in the body, ranging from skin disorders and arthritis to the sequelae of chemotherapy. Hydrastis has a stronger tradition of use as an anticatarrhal than as an alterative. It has been used more for patterns where the flow of Qi is obstructed by accumulation of Phlegm than for Heat and Heat Toxin in the Blood. However, both of these herbs are focused on the Liver rather the Kidney, and if a diuretic alterative is required, herbs such as Taraxacum or Arctium would be preferred. Hepatic and cholagogue Berberis is one of the main herbs to tonify and regulate the hepatobiliary system, since it also has anti-inflammatory and alterative actions on this system. Hydrastis has not had such a strong tradition of use for liver and gallbladder problems unless they are of a catarrhal nature. However, both these herbs are' cool in temperature, and if a warming herb is required for the Liver, then Rosmarinus is more appropriate. Bitter tonic Since Berberis and Hydrastis are cool bitter herbs, they would not be the best choice for neutral to cold patterns of digestive weakness. In this case, either neutralcool bitter herbs, such as Centaurium or Gentiana, or warm bitter herbs, such as Rosma~inus, would be preferred. Berberis and Hydrastis are specific for mixed conditions of Heat or Damp Heat in the Liver-Gallbladder and Intestines, with some Deficiency and Stagnation of both Liver and Spleen. Anticatarrhal Berberis does not have a strong tradition of use as an anticatarrhal, whilst this action is the primary characteristic of the traditional use of Hydrastis. However, Hydrastis is a~cool herb that, some authors believe, may damage the gut flora, if taken long-term. In addition, for cool or cold conditions, a warming anticatarrhal such as Myrica would be preferable.
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Antidiarrheal Berberis is specific for diarrhea associated with gastrointestinal inflammation and with bacterial or protozoal infections, that is, with Heat, Damp Heat, or Heat Toxin patterns. Its main antidiarrheal effect may be via its anti-inflammatory and antimicrobial actions rather than a direct a'stringency. Hydrastis is similar, with the added dimension that it treats diarrhea associated with mucus in the stools and intestines. If a strong tannin-based astringent is required, then Geranium, Potentilla, or Quercus would be preferred. If an astringent with both tannin and mucopolysaccharide is required, to both astringe, and soothe the mucus membranes, Berberis and Hydrastis would be inadequate, and herbs such as Polygonum could be used. Antihemorrhagic Berberis does not have a strong tradition of use as an antihemorrhagic. Its old use for the 'bloody flux' (dysentery) may be more connected with its antimicrobial action than with'an' antihemorrhagic effect. Hydrastis has a long tradition of use as an antihemorrhagic, but it is often limited to abnormal uterine bleeding. It is a cool antihemorrhagic specific for Heat patterns of bleeding. If a neutral herb with wider antihemorrhagic application is required, Capsella or Geranium are preferred. Emmenagogue Berberis is not widely used as an emmenagogue. Hydrastis is used to treat leukorrhea and abnormal uterine bleeding, and to regulate or initiate uterine contractions, thus treating dysmenorrhea or delayed labor. It is not generally used to tonify or move the Qi and Blood of the Uterus to treat amenorrhea, irregular menstruation, or premenstrual tension, nor is it generally regarded as correcting hormonal imbalances, as does Vitex. Hydrastis may be used, in combination with other herbs, to treat catarrhal patterns of amenorrhea or infertility in which the tubes are obstructed by Phlegm.
Berberis paired with other herbs Discussion of the limitations of each of the main actions of Berberis can be useful to clarify just what this herb can and cannot do. However. suitable combination with other herbs can extend the range of use of Berberis beyond its limitations. The basic unit of herb combination is the herb pair. Twelve pairings of Berberis are briefly explained below. CAUTION
' "
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair.
Berberis + Achillea
~".,":'
Recurring influenza Berberis can clear Retained Pathogen, and Achillea can clear Retained Pathogen and Wmd Heat. This pair can be used in the' acute or subacute stage when there are signs of Wind invasion mixed with patterns of Interior Heat. Both herbs can act as bitter tonics to assist convalescence, and Berberis can specifically treat Deficiency or Stagnation of LiverQi. Berberis + Cinchona
Recurringfever Both herbs can clear Retained Pathogen and treat recurring febrile conditions, for example, in some types of chronic fatigue syndrome. Both herbs can act as bitter digestive tonics to assist convalescence, and Cinchona can help to tonify HeartQi. Berberis + Asclepias
Acute bronchitis + fever This pair can be used for Lung Heat or Lung Phlegm Heat, especially when there is a recurring underlying pattern of Liver Heat, with yellow or green bronchial phlegm, barking cough, fever, restlessness, and irritability. Asclepias is a cold antipyretic expectorant, specifically for acute bronchitis, pleurisy, and pneumonia, and Berberis can act as an antipyretic antimicrobial and anti-inflammatory. Berberis + Hydrastis
Urogenital inflammatory conditions Both herbs contain berberine, which can act as an antimicrobial and anti-inflammatory for urogenital conditions. The use of one part Berberis to one part Hydrastis, as opposed to just using Hydrastis, saves money and also complements the Hydrastis alkaloids canadine and hydrastine with the Berberis alkaloids palmitine and jatrorrhizine. Canadine and hydrastine may be involved in the anticatarrhal action of Hydrastis. Berberis + Taraxacum
Anger + restlessness Berberis can be paired with Taraxacum to treat patterns of Liver Heat with sensations of heat, restlessness, anger, headache, and constipation. Both Taraxacum and Berberis have a mild laxative property, but Taraxacum also has diuretic activity. Therefore, this pair can be used in alterative combinations to drain Heat from the body via both the bowels and the bladder.
...
Berberis and Hydrastis Berberis + Rheum
Berberis + Zingiber
Chronic constipation
Hypochondriac pain + digestive weakness
Both herbs can be used as antimicrobials in the treatment of dysentery and diarrhea. However, they can both be used for chronic constipation, although Berberis is a mild laxative, whilst Rheum has purgative capability. Berberis, Hydrastis, and Rheum are combined in Christopher's Lower Bowel Tonic for normalizing bowel function. Berberis and Rheum can also be combined to treat acute skin conditions with very red, itchy, painful skin, associated with Heat in the Blood.
279
When Berberis is used to treat Liver invasion of the Spleen, hot Zingiber is commonly used to moderate the potentially adverse effects of cool Berberis on patterns of Spleen Deficiency and Cold. Berberis can move Liver Stagnation and counteract its effect on the Spleen. Zingiber assists Berberis in moving Stagnation of Liver Qi. It also warms and moves Spleen Qi. Berberis + Capsicum
Exhaustion + depression Berberis + Iris
Eczema + constipation These herbs can both move Liver Stagnant Qi and have the specific ability of treating skin disorders associated with sluggish liver function and constipation, especially if the herbs are used with Mahonia. Berberis + Harpagophytum
Arthritis + heat sensations Berberis is not a specific herb for arthritis, but its alterative and anti-inflammatory actions can assist the more specific antiarthritic herb Harpagophytum. This is especially so when there is a chronic underlying pattern of Liver Stagnation and Heat.
When Liver Stagnation is associated with Interior Cold, Berberis can still be used, often in combination with Rosmarinus, to move Liver Stagnation. However, Capsicum can be added to clear the Interior Cold that is aggravating the Liver Stagnation.
Hydrastis paired with other herbs Discussion of the limitations of each of the main actions of Hydrastis can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Hydrastis beyond its limitations. The basic unit of herb combination is the herb pair. Twelve pairings of Hydrastis are briefly explained below.
Berberis + Artemisia absinthium
Food intolerances Berberis is a cool and bitter herb, and A. absinthium is a bitter and aromatic herb that can be warming or cooling, depending on the situation. This pair is specific for treating intolerances to foods or medications, excessive consumption of rich food and alcohol, or prolonged multimedication. Both herbs can tonify and move Liver Qi, and Berberis especially can clear Liver Heat and Damp Heat. Berberis + Rosmarinus
Depression + indigestion These herbs moderate each other, and cool Berberis balances warm Rosmarinus. They can therefore be used together for neutral-temperature conditions or mixed conditions of Heat and Cold. Both herbs can move Stagnation of Liver Qi and can be combined for poor appetite, sluggish digestion, lethargy, depression, headache and food intolerances associated with Liver Stagnant Qi. Rosmarinus can also calm Liver Hyperactive Qi, and Berberis can clear Liver Damp Heat.
CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair. Hydrastis + Euphrasia
Sinusitis This is an excellent pair of anticatarrhal and anti-inflammatory herbs to treat acute or chronic catarrhal conditions of the nose, sinuses, Eustachian tubes, and eyes. The pair can be taken internally and used as an eyewash for conjunctivitis. Euphrasia can be used to clear Wind Heat and Phlegm, and Hydrastis can clear Lung Heat, Stomach Heat, and Phlegm. Hydrastis + Echinacea
Acute bronchitis This pair can be used to treat acute bronchitis with Lung Phlegm Heat. Both herbs are antimicrobial, anti-inflammatory, and anticatarrhal. Echinacea directs Hydrastis to the
.-....
_~ 1
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Lung and can clear Wind Heat, and Hydrastis is specific for inflammations and infections of the mucous membranes with oversecretion of phlegm. This pair is not recommended for long-term use, especially for those with patterns of Spleen Deficiency and Cold since it may weaken the gut flora.
--~-:
associat~i;;_
rhagic action. They can be combined for bleeding with duodenal ulceration with blood in the stools or for~b~-::"'..;.;,~ normal uterine bleeding. Hydrastis may have its effects on _.".... the mucous membranes as a result of its alkaloids, whilst ~ Geranium has its astringency action as a result of its tannins._ ~-=-:.::; -
..;\~
Hydrastis + Myrica Hydrastis + Thuja
Chronic bronchitis The expectorant action of Thuja complements the anticatarrhal action of Hydrastis, and warm acrid Thuja complements and moderates cool bitter Hydrastis. In addition to treating chronic bronchial phlegm, these herbs can also be paired to treat amenorrhea or infertility associated with PWegm and Damp in the Uterus.
Mouth infections : ..
~
Hydrastis is a cool anticatarrhal and antihemorrhagic, and Myrica is a warming anticatarrhal and astringent. These herbs complement and moderate each other and can be used together in combinations for colitis or diarrhea. They can be used as a gargle for mouth or throat infections, or as a snuff for sinus catarrh. Hydrastis + Arctostaphylos
Hydrastis + Filipendula
Gastritis Both herbs can treat gastric inflammation and ulceration associated with Stomach Heat. Both are cooling anti-inflammatories. Whilst Hydrastis works via alkaloids, Filipendula has its effect by a combination of salicylates, flavonoids, and tannins.
Urinary tract infections These herbs are a complementary pair of antimicrobials to treat urinary infections. In addition, Hydrastis assists in the normalization of mucous membranes. Hydrastis and Arctostaphylos can also be used internally for prostatic inflammations and infections; and as a vaginal bolus or douche for Trichomonas or Candida infections.
Hydrastis + Althaea
Hydrastis + Vmca
Gastritis + colitis
Abnormal uterine bleeding
Hydrastis can normalize mucous membrane secretions and treat their infection and inflammation. Althaea is a cooling demulcent, which can complement the anti-inflammatory action of Hydrastis on gastrointestinal mucous membranes. It can also be combined with Hydrastis for irritating cough or cystitis. Hydrastis + Polygonum
Colitis These herbs can be paired for either irritable bowel syndrome (mucous colitis) or ulcerative colitis. Both are antiinflammatories. Whilst Hydrastis is an antimicrobial and anticatarrhal, with alkaloids as its main active constituents, Polygonum is a demulcent anticatarrhal and astringent, with flavonoids, mucopolysaccharides, and tannins as its main active constituents. Hydrastis + Geranium
Duodenal ulcer + melena Both herbs can have antihemorrhagic action. Hydrastis is a cool herb, more for bleeding with Heat patterns, and Geranium is a neutral herb with a multipurpose antihemor-
Both herbs are antihemorrhagics specific for abnormal uterine bleeding. They can also be used for leukorrhea, either taken internally, or as a douche or vaginal bolus. Hydrastis + Viburnum
Dysmenorrhea These two herbs are specific for dysmenorrhea, Viburnum has antispasmodic action on uterine muscle, whilst Hydrastis has a normalizing effect on uterine muscle tone. Hydrastis + Lobelia
Delayed labor This is one of the most famous pairs of the Physiomedicalists and beloved of John Christopher, who included these herbs in his combinations for: hay fever, constipation, kidney disorders, female reproductive conditions, and many others. He often combined this pair with both Capsicum and Zingiber. " 'These herbs can regulate the tone of the bowel smooth muscle and normalize the secretion of the bowel mucosa. Also, both Hydrastis and Lobelia can regulate uterine contractions and can be used for dysmenorrhea or delayed labor.
Berberis and Hydrastis 281
Berberis combinations
This combination is the S:l1\\e ~s " ../ .
"
heat sensatIons and IS dlscuss~d
'
' • ~( (\rhl.~
\lthi '"
tl· I
(; l
llTOllchitis + .
\ill \l"hhng.
Six Berberis combinations are discussed below: 3.C:hole'l'stitis
Liver-Gallbladder Damp Helll Retained Pathogen + Uver Deficient Qi
1. recurring fever + exhaustion
2. bronchitis + heat sensations
Lung Phlegm Heat + Liver Heat
3. cholecystitis
Liver-Gallbladder Damp Heat
4. acute eczema
Uver-Gallbladder Damp Heat
5. arthritis + heat sensations
Damp Heat in the channels + Liver Damp Heat
6. food intolerances + heat
Uver Stagnant Qi + Uver Damp Heat
sensations
CAUTION Before using any ofthe combinations below, it is important to be familiar with the cautions listed for each herb in the combination.
Retained Pathogen + Liver Deficient Qi ,'Ratio
Herb
\0
Achillea Artemisia abs. Gentiana Berberis Pseudostellaria Glycyrrhiza Zingiber
1 1 1 1 1
0.5
O.S
""-
Berberis Taraxacum Chelidonium Artemisia abs. Glycyrrhiza Zingiber
Ratio
Tempemtut\')
1 1 1 1
cool
Taste ~~-
cOOI·c~'t\t
cool
O.S 0.5
wnrm'~:\\\'1
nelltrnl \~\','I hot
..
'--~.. -
.........
--
hitter Ilitter \littor. si. acrid ~roll1at\c, bitter Swcot :\crld. i1romatic
GENERAL
This combination is lIsl'd I" 'I· , I ' . l l.lI .l\.'cl'-(Jallbladder Damp Heat and to tomfy and m"w II ('I' , ie ( \)\ the Liver and GalibI add er. The overall tcmpCI'i\t II I' 'I . I '. ~ ~ WI' , and Ihe dominant taste property IS billcr. lint 'I' 'I '"" ,11l~1 ll'I' balances cool ~araxacum.
USE
• cholecystitis PRACTICAL NOTES
1. Recurring fever + exhaustion
~.,~
'~-.,.-
Herb
"'-.~-~~~'
Temperature warm-cool warm-cool neutral-cool cool neutral neutral-cool hot
........,.
'-·.;:~~te· acrid. bitter bitter. aromatic bitter bitter sweet. sl. bitter sweet acrid. aromatic
This combination is the same as Achillea: recurring fever
This prescription can be tah'\Il~ " I ' . . , .. /111 1l11:5111l(tureina littl e warm water, three times PCI' day. The combination can be lakl'\1 'II . • . • WI I ,'ppl'llpnale breaks and modificatlOns, for 2-4 wcck~ It i •• ~ 1IC11 i'I'Pl'llprialc during pregnancy. Any severe or rcclll'l'ill~ hel I I 'I' . , • 1.\ I I 11 IMy lhsordcr reqUlres conventlOnal mcdl~'" illll'lltjllll "1'1' I. . • • i:. ild . 1I~ lei h combmatlon IS lor m to modcrJtc chrnnk I) . ' . , . ' . . I 1l.1.I 11 1'11ll:\ dlOb.:ystitis an d 1S g1ven only after (onvcnlillll.tl . I'. I . ' . . . " IIlel Il:a diagnosis has '" eliminated the pOSSibility of scriO'I"' ,,1.11')( Illnll~,
Caution •
+ exhaustion and is discussed under that heading. 4. Acute eczema
Liver-Gallbladder Damp Heal
2. Bronchitis + heat sensations
Lung Phlegm Heat + Liver Heat ~ -..
Herb Asclepias Echinacea Berberis Hydrastis Prunus Glycyrrhiza Lobelia
Herb
.'-~"_.' .~. -.--- .~-.r T'f:"-~r .:.... - ....... -:-_~':'- ...._ ~.,/.".;~~~:;;.:._:~ .......: :.. ~~.~
Dailydose._:_Jerr1~rature Taste' '">:~~~"~~ sg sg
4g 3g 4g 2g 0.6g*
cold cool cool cool neutral neutral-cool warm-cool
bitter acrid. bitter. sl. sweet bitter bitter bitter, aromatic sweet acrid
*The UK daily maximum dose for dried Lobelia is 0.6 g; see the Dose section in the Lobelia chapter.
Berberis Mahonia Iris Taraxacum Rumex Rheum Glycyrrhiza
Ratio
Temp6rutu(lj
1 1 1 1 1 1
r.ool cool
O.S
cOlli cookoll) cool COOICIlllJ neutfUl <;(",1
Taste !/llIm bitter bill!1r biller
bitter, sl. sour bitter, sour 'iWoet
GENERAL
This combination is for Dalll/l If .. . . .c"I, With ~()me Blood Heat or Heat TOXin. There may h•. I . l: ifll Utll crlYlng pattern of
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282
Liver-Gallbladder Damp Heat with some Liver Heat. The overall temperature of the combination is cool-cold, and the combination is for warm to hot conditions. The dominant taste property is bitter to clear Heat.
This combination is the same as Artemisia: food intoler~~,.= __1ii ances + heat sensations and is discussed under that heading. ---~~ ·~c·;;;
COMPARISON OF THE SIX
USE
BERBERIS COMBINATIONS • acute severe eczema with severe itching and hot, dry, red skin • acute severe eczema with fluid-filled blisters PRACTICAL NOTES
This combination is most conveniently taken as a 1:5 tincture at doses of 5 ml in a glass of cold water, three times per day. This combination is for acute conditions and is not designed to be taken long-term. As soon as the severe itching, redness, and sensations of heat have considerably reduced, this combination can be replaced by a combination for chronic eczema, such as Arctium: chronic eczema.
Caution Especially during the initial use of this combination, the prec~utions for the use of alterative herbs and combinations should be observed; see the chapter on Safety: Cautions on the use of alteratives. This combination should not be taken during pregnancy and is not suitable for those with weak digestion associated with patterns of Spleen Deficiency and Cold. 5. Arthritis + heat sensations
Damp Heat in the channels + Liver Damp Heat H e r b : : '~Ratio
Temperature
Taste
Harpagophytum Berberis Taraxacum Arctium (root) Filipendula Angelica sin. Glycyrrhiza
cool cool cool-cold cool cool warm neutral-cool
bitter bitter bitter 51. acrid, sl. bitter sour, bitter sweet. aromatic, bitter sweet
1 1 1 1 0.5 0.5 0.5
This combination is the same as Harpagophytum: arthritis + heat sensations and is discussed under that heading. 6. Food intolerances + heat sensations
Liver Stagnant Qi + Liver Damp Heat
Artemisia abs. Berberis Taraxacum Hydrastis Mentha pip. Zingiber Glycyrrhiza
i 1 1 0.5 0.5 0.5 0.5
warm-cool cool cool-cold cool warm-cool hot neutral-cool
bitter, aromatic bitter bitter bitter aromatic, acrid acrid, aromatic sweet
1. Recurring fever + exhaustion
2. Bronchitis + heat sensations
Retained Pathogen + Liver Deficient Qi
Lung Phlegm Heat + Liver Heat .,.::'
Herb
Ratio
Herb
Daily dose
Asclepias
5g
Echinacea
5g 4g 3g 4g
Achillea Artemisia abs. Gentiana Berberis Pseudostellaria Glycyrrhiza
1 1 1 1 1 0.5
Prunus Glycyrrhiza
Zingiber
0.5
Lobelia
Berberis Hydrastis
."
.. "1-
2g 0.6g
1. The acrid constituents of Achillea and Zingiber can clear Exterior Wind. The bitter constituents of Berberis, Achillea, Artemisia, and Gentiana can have antipyretic effect. The bitter constituents can also assist postfebrile recovery via a bitter digestive tonic action on the Spleen that results in strengthening Qi and Blood. pseudostellaria and Glycyrrhiza are sweet tonics for postfebrile exhaustion with
Deficient Qi. 2. Achillea and Zingiber are present in comb~ation No. 1 as diaphoretics to clear Exterior Wrnd. In combination No.2, Berberis and Hydrastis place the emphasis of the combination on clearing Lung Phlegm Heat and Liver Heat. Asclepias and Lobelia act as antipyretics to clear Lung Heat and Lung Phlegm Heat, and Prunus and Glycyrrhiza can moisten the Lung and soothe the cough.
3. Cholecystitis
4. Acute eczema
Liver-Gallbladder Damp Heat
Liver-Gallbladder Damp Heat
Berberis Taraxacum
Berberis Mahonia
Chelidonium Artemisia abs. Glycyrrhiza Zingiber
1
1 1 1 0.5 0.5
Iris Taraxacum Rumex Rheum
1 1 1 1 1 1
Glycyrrhiza
0.5
..
'-..
-Berberis and Hydrastis 3. In this combination the first four herbs can tonify and move Liver Qi and clear Liver-Gallbladder Damp Heat, to treat cholecystitis. The cooling, downward-draining effect of the first three bitter herbs is moderated by the warming, moving effect of the aromatic and acrid constituents of Artemisia and Zingiber. The sweet anti-inflammatory and detoxicant Glycyrrhiza helps to prevent any potential aggravation of symptoms from toxins that Taraxacum and Berberis help to release into the system from the liver and tissues. 4. Combinations No.3 and No.4 both contain Berberis and Taraxacum, and are both useful to clear Liver-Gallbladder Damp Heat. However, whilst combination No. 3 contains Chelidonium and Artemisia to treat cholecystitis, combination No.4 contains Mahonia, Iris, Rumex, and Rheum to treat acute eczema. Berberis and Mahonia are a pair of similar herbs that complement each other's actions in clearing Liver Damp Heat and Heat Toxins. Iris and Rumex: assist Berberis and Mahonia in moving Liver Stagnation and treat skin disorders linked to constipation. Rheum can help to clear Heat in the Blood and drain out toxins through the stools.
5. Arthritis + heat sensations
6. Food intolerances + heat sensations
Harpagophytum Berberis Taraxacum Arctium (root) Filipendula Angelica sin. Glycyrrhiza
Ratio 1 1 1 1 0.5 0.5 0.5
Herb Artemisia abs. Berberis Taraxacum Hydrastis Mentha pip. Zingiber Glycyrrhiza
6. The aromatic constituents of Artemisia, Mentha, and Zingiber, and the bitter constituents of Artemisia, Berberis, Tara.'. (acum, and Hydrastis combine to tonify and move Liver Qi. This strengthens liver metabolism, especially the capacity to metabolize accumulated wastes and toxins, resulting in an increased capacity to deal with foods and medications. Combination No.6 can be compared with Rosmarinus: food intolerances + cold sensations, which has less cooling and more warming herbs.
OTHER BERBERIS COMBINATIONS Other combinations that contain Berberis include:
• Capsicum: hypertension + heat sensations • Potentilla: acute diarrhea + heat sensations • Rheum: chronic constipation • Valeriana: hypertension + headache
Hydrastis combinations Six Hydrastis combinations are discussed below: Combination
. Chinese syndromes
1. chronic sinusitis
Lung Phlegm Heat
2. peptic ulcer
Stomach Heat
3. colitis
Intestines Heat
Ratio
4. urinary infection + heat sensations
Bladder Damp Heat
1 1 1
5. menorrhagia + heat sensations
Bleeding from Heat
6. dysmenorrhea
Uterus Stagnant Qi and Blood
Damp Heat in the channels + Liver Stagnant Qi + Liver Damp Heat Liver Damp Heat Herb
283
0.5 0.5 0.5 0.5
5. Combinations No.4 and No.5 contain Berberis and Taraxacum and are both useful to clear Liver Damp Heat. However, whilst combination No. 4 contains Mahonia, Iris, and Rumex for eczema, combination No.5 contains Harpagophytum and Filipendula for rheumatism. Harpagophytum is the leading herb in treating arthritis from Damp Heat in the joints. Berberis, Taraxacum, and Arctium assist this action by clearing Damp Heat from the Liver and from the body in general. Filipendula clears Stomach Heat and helps to heal damage to gastric mucosa associated with long-term use . of nonsteroidal anti-inflammatories, and Angelica treats Deficient Blood associated with blood loss from the gastric damage.
CAUTION
Before using any of the combinations below, it is important to be familiar with the cautions listed for each herb in the combination. 1. Chronic sinusitis
LungPhlegm Heat
EUphrasia Echinacea Sambucus Hyssopus Hydrastis Glechoma Phytolacca
1 1 1 1 1 1 1
neutral-cool cool cool warm-cool cool neutral cool
acrid, sour, bitter acrid, bitter, sl. sweet acrid, sl. bitter acrid, aromatic bitter sour, bitter acrid
-
:>3!H
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284
~.~.
c __
tis and is discussed under that heading.
This combination is the same as Capsella: menorrhagia +. :.;~ heat sensations and is discussed under that heading. ·~~.-·-S~_
2. Peptic ulcer
6. Dysmenorrhea
Stomach Heat
Uterus Stagnant Qi and Blood
This combination is the same as Euphrasia: chronic sinusi-
Herp-j;~':; <~;.;Ratio.
Calendula Filipendula Hydrastis Valeriana Ophiopogon Glycyrrhiza
-Tem'perature - .- .Taste .-' bitter sour, bitter bitter bitter, sweet sweet, sl. bitter sweet
cool cool cool cool cool neutral-cool
1 1 1 1 1 0.5
This combination is the same as Calendula: peptic ulcer and is discussed under that heading.
,-i.
Herb . Thymus Mentha pul. Viburnum Lobelia Zingiber (fresh)
3g 3g 3g 0.6g* 3 slices
war~ool
warm neutral warm-cool hot
aromatic aromatic sl. bitter, sl. sour acrid acrid, aromatic
=
-
"The UK daily maximum dose for dried Lobelia is 0.6 g: see the Dose section in the Lobelia chapter.
This combination is the same as Thymus: dysmenorrhea
3. Colitis
and is discussed under that heading.
... !!t'
Intestines Heat .~
'.- -:. -
Herb
~""'1'"'Z"'"~~~;5~'-'"
:"u,_, .-
->--' ,Ratio
Althaea Polygonum Hamamelis Calendula Hydrastis Glycyrrhiza
~~-~o:-~.-~:
.-'.
Temperature. _. Taste
10 approx. 1 1 1 1
0.5
cool cool neutral-cool cool cool neutral-cool
sweet, sl. bitter sour, sl. bitter sour, sl. bitter bitter bitter sweet
This combination is the same as Althaea: colitis and is discussed under that heading.
COMPARISON OF THE SIX HYDRASTIS COMBINATIONS
1. Chronic sinusitis
2. Peptic ulcer
Lung Phlegm Heat
Stomach Heat
Herb 4. Urinary infection + heat sensations
Bladder Damp Heat Herb Arctostaphylos Baptisia Echinacea Hydrastis Zingiber
'-Ratio 1 1 1 1 0.5
Temperature
Taste
cool cold cool cool hot
sour, bitter bitter acrid, bitter, sl. sweet bitter acrid, aromatic
This combination is the same as Arctostaphylos: urinary infection + heat sensations and is discussed under that heading.
Euphrasia Echinacea Sambucus Hyssopus Hydrastis Glechoma Phytolacca
.Ratio.· . -·'·l ....•..-··,·-{···'" 1 1 1 1 1 1 1
Calendula Filipendula Hydrastis Valeriana Ophiopogon Glycyrrhiza
1 1 1
1 1
0.5
1. All the herbs in this combination can combine to treat nasopharyngeal catarrh associated with Lung Phlegm Heat. Euphrasia, Echinacea, Sambucus, and Hyssopus can combine to clear Wind Heat, and Hydrastis can clear Stomach Heat affecting the sinuses. 2. Hydrastis is the only herb shared by combinations
5. Menorrhagia + heat sensations
No. 1 and No.2. It can function in both combinations to
Bleedingfrom Heat
clear Stomach Heat. However, whilst Hydrastis also clears Lung Phlegm in combination No.1, in No.2, it helps to reduce gastric bleeding and to heal damaged gastric mucosa.
Capsella Vinca Hydrastis Sanguisorba Polygonum
1 1 1 1 1
-
neutral' neutral cool cool cool
sour sour bitter sour, bitter sour, sl. bitter
Calendula contributes astringent, vulnerary, and anti-inflammatory actions; Filipendula contains both astringent tannins and anti-inflammatory salicylates; and Hydrastis contains alkaloids, which are antimicrobial and anti-in-
Berberis and Hydrastis flammatory and can normalize the function of mucous membranes. Ophiopogon and Glycyrrhiza can act as anti-inflammatoryagents and as tonics for Stomach Ym. Valeriana has tranquilizing, antispasmodic, and analgesic actions.
3. Colitis
4. Urinary infection + heat sensations
Intestines Heat
Bladder Damp Heat
Herb
Ratio
Herb
Ratio
Althaea Polygonum Hamamelis Calendula Hydrastis Glycyrrhiza
10 approx. 1 1 1 1 0.5
Arctostaphylos Baptis:a Echinacea Hydrastis Zingiber
1 1 1 1 0.5
\-.
No.3, Hamamelis and Polygonum are specific for intestinal inflammation. The sweet herbs Althaea and Glyeyrrhiza have demulcent anti-inflammatory and Ym tonic actions. The sour herbs Polygonum and Hamamelis, have a higher tannin content, and are both antidiarrheal and antihemorrhagic. They are supported by resin-based Calendula with its antimicrobial, anti-inflammatory, and vulnerary action. Hydrastis is a bitter antimicrobial and anti-inflammatory which can normalize mucus membrane function to treat colitis. 4. Arctostaphylos directs this combination to the urinary system, where it can treat acute, severe Excess patterns of
Damp Heat or Heat. It contains four cool, bitter antimicrobial herbs, which are moderated by Zingiber. This combination is only to be taken for up to a week, and as soon as symptoms of pain and heat are consistently reduced, it can be replaced by a less cold and more tonic combination, such as Althaea: cystitis.
6. Dysmenorrhea
Bleedingfrom Heat
Uterus Stagnant Qi + and Blood ~~J-:W\l:!4~r~f~:
;.~". ;;:-0~ Daily' dose~ "i.: l~f' l~,;.' ..... .."...:: i'.•
Vinca
Hydrastis Sangulsorba Polygonum
1 1 1 1 1
OTHER HYDRASTIS COMBINATIONS Hydrastis occurs in manyWestem herb combinations. In this book, other combinations that contain Hydrastis include:
• Althaea: gastritis • Arctium: recurring urticaria (acute phase) • Arctostaphylos: cystitis + hematuria • Arctostaphylos: vaginitis • Euphrasia: catarrhal deafness • Gentiana: digestive weakness + gastrointestinal inflammation • Rheum: chronic constipation • Thuja: amenorrhea + catarrhal conditions • Thuja: prostatitis + infection • Viburnum: postnatal pain + bleeding
Research CONSTITUENTS Berberis vulgaris and Hydrastis The data in the table on Berberis vulgaris comes from Mills and Bone/ l except for the data marked *, which comes from Mabey.22 The data on Hydrastis comes from the BHC. 23
5. Menorrhagia + heat sensations
Capsella
5. In combination No.3, Hamamelis is an astringent specific for the colon, and in combination No.5, Ymca is an astringent and antihemorrhagic specific for the reproductive system. In combination No.5, Capsella acts as a neutral-temperature general-purpose astringent, and Hydrastis, Sanguisorba, and Polygonum are cooling antihemorrhagics. 6. In this combination, Thymus is combined with the warming sedative herb Mentha pulegium. Both herbs can warm and move Stagnant Qi and Blood in the Uterus, but Mentha is more useful for dysmenorrhea or amenorrhea from shock or nervous tension, whilst Thymus is more useful for dysmenorrhea or amenorrhea associated with Damp or Phlegm or for dysmenorrhea associated with Damp Heat. Viburnum, Lobelia, and Zingiber have an antispasmodic effect on the Uterus.
3. In combination No.2, Filipendula and Ophiopogon are specific for gastric inflammation, whilst in combination
,
285
-I"
Thymus Mentha pul. Viburnum
3g 3g 3g
Lobelia Zingiber (fresh)
O.6g 3 slices
......
Other Berberis species According to Chang and But/4 the chemical compositions of the many species of Berberis are very similar. The major constituents being berberine, palmitine, and jatrorrhizine. Other constituents include columbamine, isotetrandine, and magnoflorine. They state that each species also contains unique constituents, for example, B. vulgaris contains berberrubine and B. juliana contains julianine.
286
Combining Western Herbs and Chinese Medicine
C~~-~tlt~~~~:~L~~~;~::~iberiS .~.~ :-~~~-:~H~~StiS7.~~~::--·::- -: •
"., • . "
, •.•.• -.~
...,.,
.• '"'.....,.....''":'~ ..-...
isoquinoline alkaloids • berberine
"."
'1".
~ .• ~·--··T·~~·,-·.
.
up to 13%
2.5-6%
up to 6%
1.7·4.5%
• hydrastine
_ ·'4,',·"
1.5-4%
(~hydrastine)
• canadine (tetra· hydroberberine)
0.5%
• other isoquinolines
jatrorrhizine, palmitine, oxyacanthine
other
resins. fats, starch. tannin*
canada line, hydrastidine, isohydrastidine, (S)-corypalmine, (S)- isocorypalmine, berberastine, l-<:l·hydrastine chlorogenic acid, resins starch, sugar, lipids, small amount of essentialoil
Coptis and Phellodendron Both Coptis fr0!U the family Ranunculaceae and Phellodendron from the family Rutaceae contain berberine. According to Chang and But: • huang lian is the rhizome of Coptis chinensis Franch., C. deltoides Cheng et Hsiao, or C. teetoides C. Y. Cheng (c. teeta Wall.) • huang bai is the bark of Phellodendron amurense Rupr. or P. chinense Schneid. The data in the table is from Chang and But: COPTIS SPECIES ( huang lian )
PHELLODENDRON SPECIES (huang bai)
Constituents berberine
5-8%
1.6-4%
other isoquinoline alkaloids
coptisine, worenine, palmitine. columbamine
phellodendrine, magnoflor· ine. palmitine. jatrorrhizine
lactones
obakulactone, obakunone
obakulactone, obakunone
PHARMACOLOGICAL AND CLINICAL RESEARCH: BERBERIS The following effects have been reported: • antibacterial • antifungal • antiprotozoal • antipyretic
• anti-inflammatory • smooth muscle regulator • antidiarrheal • hepatic and choloretic • antidiabetic • cardiovascular effects • blood clotting regulator • respiratory effects • central nervous system effects • immunoregulatory • cytotoxic and antitumor Antibacterial Berberis rariflora has shown antibacterial activity against gram (+) bacteria,25 and berberine and palmitine have demonstrated antimicrobial activity against Bacillus subtilis and Salmonella enteriditis.26 Berberine from Hydrastis canadensis was shown effective against multiple drug-resistant Mycobacterium tuberculosis,2i and berberine chloride produced a clear inhibitory effect agairist a number" of human intestinal bacteria, including Bifidobacterium longum, B. bifidum, Clostridium perfringens, and C. paraputrificum. 28 Berberine antimicrobial mechanism Berberine sulfate had no effect on the bacterial growth of Escherichia coli, but it did reduce the adhesion of uropathogenic E. coli to erythrocytes and epithelial cells. The decreased adhesion may be due to the ability of berberine to inhibit the production of fimbriae, the hair-like projections on the surface of the bacteria. The authors suggested that the anti-infectious activity of berberine sulfate in E. coli-induced urinary tract infections may be mediated by suppression of fimbriae production. 29 Synergy in antibacterial action An interesting example of synergy between plant constituents was reported, in which the antimicrobial action of berberine was potentiated by the multidrug pump inhibitor, 5'-methoxyhydnocarpin. Multidrug resistance pumps (MDRs) protect microbial cells from both synthetic and natural antimicrobial chemicals. Berberine alkaloids are readily extruded by the NffiRs, but some of the Berberis species that produce berberine also synthesize the MDR pump inhibitor 5'-methoxyhrdnocarpin. This chemical has no antimicrobial activity in itself, but it strongly potentiates the antimicrobial action of berberine, for example, against Staphylococcus aureus. 3O Berberine and Retained Pathogen Eye drops of sulfacetamide was reported as more effective than 0.2% berberine in treating patients with trachoma stages I and II caused by Chlamydia trachomatis. However, with sulfacetamide, Chlamydia remained in the conjunctiva and relapses oc-
Berberis and Hydrastis curred, whilst with berberine, the conjunctiva tested negative for Chlamydia and no relapses occurred.31 Nevertheless, in treatment of trachoma stage IIa or IIb, 0.2% berberine eye drops removed Chlamydia in only 50% of patients. The results were better when berberine was combined with neomycin. 32 Antifungal Berberine sulfate at concentrations of 10-25 mg/ml inhibited the growth of various fungi, including Aspergillus flavus, A. fumigatus, and Candida albicans. 33 Antiprotozoal Berberine from B. aristata has been shown effective against Leishmania donovani in hamsters, markedly reducing the parasitic load and proving less toxic than pentamidine. 34 Berberine hydrochloride showed antiprotozoal activity against Entamoeba hystolytica in vitro,35 and berberine sulfate inhibited the growth of E. hystolytica, Giardia lamblia, and Trichomonas vaginalis in vitro. 36 A clinical trial on chil~enwith giardiasis showed that berberine compared favorably with the other antigiardial drugs investigated.37
Antimalarial Patients with chloroquinine-resistant malaria
..
were treated with pyrimethamine used in combination with either berberine hydrochloride, tetracycline, or cotrimoxazole. Pyrimethamine was more effective in clearing the parasite when used in combination with berberine than when used in combination with the other antimicrobial agents.38 Antipyretic An early study reported antipyretic effect of Berberis decoction in rabbits,39 but a later study reported that extracts of Berberis in water, chloroform, and hexane lacked antipyretic activity.40 Anti-inflammatory Both an ethanol extract of the root of Berberis vulgaris and the alkaloid berberine showed antiinflammatory activity in animal experiments. 4\ The antiinflammatory action of berberine may be partiy due to the inhibition of DNA synthesis in activated lymphocytes. 42 A study on colitis induced in rats reported that oral administration of berberine for one week at 15 mg/kg per day reduced damage to the rectal mucosa. 43 Smooth muscle regulator Some studies have indicated that Berberis extracts or berberine can increase the tone or contractions in smooth muscle, whilst other studies have indicated that Berberis or its alkaloids can have antispasmodic activity. As with other herbs, for example, Lobelia, whether there is a stimulant effect, no effect, or antispasmodic activity may depend on the dose and on the initial state of tone and contraction of the smooth muscle involved.
Variation of effect with dose Low concentrations of palmi- 'C...:::
tine and jatrorrhizine (0.001-0.002%) increased motility of
287
isolated intestines, whereas higher concentrations (over 0.01 %) increased their muscular tension and inhibited movement.-I-I
Stimulation of contractions A study in 1948 reported that Berberis tincture increased contractions in isolated rabbit 45 intestine. According to a study in 1961, berberine, palmitine, and jatrorrhizine caused marked contractions of isolated mouse uterus. -l6 However, other studies reported the opposite effect, see the section on Smooth muscle regulator for Hydrastis below. A more recent study reported that berberine could produce contractions in isolated guinea-pig ileum. 47
Antispasmodic activity Berberine reduced carbachol-induced contractions in isolated gastric fund1;lS muscle, mainly by inhibiting extracellular calcium entry induced by carbachol. Berberine has been demonstrated to have a relaxing effect on the isolated rat aorta, which is dependent on the presence of endothelium.~ A later study suggested that berberine could act by different mechanisms, at both the endothelium and underlying smooth muscle by inducing vasorelaxation. 49 . Antidiarrheal
Mechanism
Diarrhea may be reduced by various effects, including, but not limited to the following:
• antimicrobial • anti-inflammatory • antispasmodic
• antisecretory • absorptive
inhibits the diarrhea-inducing microorganisms reduces inflammation of the intestinal mucosa reduces intestinal contractions and delays small intestine transit. time reduces the secretion of fluids into the intestines increases the absorption ofwater or electrolytes
Berberine reduced diarrhea in mice and inhibited spontaneous peristalsis in the rat intestine. 50 Small intestine transit time in healthy humans was·delayed by oral berberine.51 Berberine inhibited intestinal secretion caused by E. coli heat-labile enterotoxins. 52
Clinical trials Studies on patients with diarrhea induced by E. coli or Vibrio cholerae showed that berberine can be effective in acute diarrhea from E. coli infection, but not in the case of diarrhea from V. cholerae.s3.54
Laxative Some texts, such as the BHP. suggested that Berberis should be avoided in diarrhea, perhaps because it was thought that the ability of Berberis to increase bile secretion might have a mild laxative effect.
~-..,;,:,
Combining Western Herbs and Chinese MediCine:-:""~~'
288
In terms of Chinese medicine. long-term use of this cool, bitter herb might be contraindicated for cases of Cold Deficient Spleen with diarrhea unless it was combined with a hot herb, such as Zingiber. However. recent research suggests that Berberis can be an effective antidiarrheal herb. at least in the case of acute diarrhea associated with bacterial or protozoal infection. see above. Hepatic and choloretic
Liver cirrhosis Oral administration of berberine at 600-800 mg per day corrected raised tyramine levels in cirrhotic patients. 55
Choloretic The BHC stated that berberine has choloretic action. Two studies reported that preparations from B. amurensis and B. vulgaris increased bile flow and relieved pain and inflammation in gallbladder diseases such as chronic cholecystitis. ~6. 57 #;"
Antidiabetic Oral doses of 0.3-0.5 g berberine three times per day were administered for 1-3 months in an uncontrolled study of patients with type II diabetes mellitus. The major symptoms of diabetes were reduced. blood pressure was normalized. and blood lipids decreased. perhaps due to berberine assisting recovery and normalization of 13-cells of the pancreatic islets. 58 Cardiovascular effects
Antihypertensive According to Chang and But, berberine, palmitine. berbamine. jatrorrhizine, magnoflorine, and oxycanthine all have antihypertensive effect. A study in 1999 reported that the berberine derivative 6-protoberberine has an antihypertensive effect in spontaneously hypertensive rats. 59
Cardioregulatory A study on patients with congestive heart failure reported that berberine intravenous infusion at the rate of 0.2 mg/kg per minute for 30 minutes resulted in cardiotonic effect. Intravenous berberine at 1 mg/kg was reported to block arrhythmias in rabbit ventricular muscles. Finally. the alkaloid 7 -O-demethylisothalicberine, isolated from B. chilensis, was reported as having cardiodepressor effects on isolated guinea-pig atria. 60 Blood clotting regulator Berberine has been reported to have anti-ischemic activity. In one rat study, berberine inhibited platelet aggregation and reduced thromboxane B2 lev61 els. Also, Berberis aristata root extract inhibited aggregation of platelets in rabbits. 62 However. berberine sulfate was reported to increase the thrombocyte number. decrease the activity of factor VIII, and promote blood coagulation in rats and mice.
Antithrombocytopenic Berberine sulfate increased platelet .'~ count in patients with primary and secondary thrombocy- .~~ topenia. 63 Respiratory effects Berberis preparations have been shown to be effective in chronic bronchitis in the elderly,6ol and berbamine was shown to arrest further development of lung lesions in rats with experimental silicosis.65 Berberine was reported to have an effect in the treatment of pulmonary tuberculosis,66 bronchitis,67 pneumonia,68 and lung abscess.69 Central nervous system effects Administration of berberine at 0.1 or 0.5 gJkg for 7 or 14 days had a significant antiamnesic effect on rats. in which amnesia had been induced by scopalomine.;u Immunoregulatory Berbamine was reported to be effective in treating leukopenia resulting from chemo- or radiotherapy.71 Berbamine has" also shown immunosuppressive effects. helping to prevent the rejection of skin transplants in mice. which indicates its potential use in clinical transplantation. 72 Cytotoxic and antitumor Berberine has been reported to activate the cytostatic activity of macrophages against tumor cells,7J and berberine sulfate has been reported to inhibit the tumor-promoting activity of teleocidin in mouse skin carcinogenesis.74 Both berberine and aqueous extract of Coptis rhizomes, which contain berberine. were reported to inhibit proliferation of human esophageal cancer cells. 75 The enzyme cyclooxygenase-2 is active in colon tumorigenesis, and berberine was reported to inhibit cyclooxygenase-2 transcriptional activity in colon cancer cells. 76
PHARMACOLOGICAL AND CLINICAL RESEARCH: HYDRASTIS Examination of the differences between Hydrastis and Berberis Hydrastis and the herbs used in Chinese medicine, Coptis (huang lhin) and PhelIodendron (huang hai), all contain the isoquinoline alkaloid berberine and may therefore manifest the pharmacological effects noted for berberine in the section on Berberis above. However, in addition to berberine, Hydrastis contains other alkaloids, such as canadine and hydrastine. not present in large amounts in Berberis. It will be interesting to determine whether there are any real differences in the therapeutic effects of Hydr!lstis and Berberis, and if there are, whether these differences can be explained in terms of the differences in pharmacological activity between berberine. canadine. and hydrastine. Pharmacological effects of Hydrastis In addition to the pharmacological effects associated with berberine noted for
Berberis and Hydrastis Berberis above. the following effects have been reported for extracts of Hydrastis rhizome or for the isolated alkaloids canadine and hydrastine: • antiparasitic • anti-inflammatory • smooth muscle regulator • cardioregulator • regulation ofblood clotting • central nervous system effects • bitter digestive tonic • antidiabetic • immunoregulatory Antiparasitic It was reported that d-hydrastine has a profound adverse intracellular effect on experimental Echinococcus granulosus cysts in miCe and that it may be a useful drug for treating hyatidosis. n Anti-inflammatory .. Hydrastinine chloride was used in eye drops. in combination with synephrine and chlorhexidine, to treat allergic conjunctival hyperthermia and eyestrain from environmental irritations.9 Smooth muscle regulator
Uterus Hydrastis is listed as an oxytocic by the BHP in the sense that it may induce or accelerate labor by stimulating contraction of the uterine muscles. Various texts list Hydrastis as contraindicated in pregnancy on the basis of this information, for example, the BHC. However, this belief does not appear to be wholly supported by research. According to one study. berberine, palmitine. and jatrorrhizine caused marked contraction of isolated mouse uterus,z; but another study reported that berberine caused a slow decrease of the tone, amplitude, rate, and response to acetylcholine in rat uterus. In the latter study. Hydrastis extract as well as a combination of berberine and hydrastine produced a decrease in tone and amplitude of uterine contraction, whilst hydrastine by itself produced an increase in the rate of contraction, Vvith slowly decreasing tone and amplitude. The author suggested that Hydrastis is really a uterine sedative. even though it is often regarded as a uterine stimulant.78 In another study. Hydrastis extract as well as a total crude Hydrastis alkaloid extract showed antispasmodic effect on isolated mouse uterus/9 An ethanolic extract of Hydrastis showed a reversible relaxant effect on spontaneous contractions in nonpregnant rat uterus, and on contractions induced by oxYtocin, serotonin and acetylcholine.so The BHC listed tetrahydroberberine (canadine) as a stimulant to uterine muscle. but gives no reference to support this statement. Synergy between the alkaloids The ability of the Hydrastis alkaloids to inhibit adrenaline-induced contractions was
289
investigated in a study using rabbit aorta strips. The authors proposed a synergistic action between berberine. tetrahydroberberine. and canadaline, and they sugge.sted that other compounds in the plant, especially hydrastine. counteract the adrenolytic effect of these three alkaloids. 8l Another study reported that tetrahydroberberine had a weak vasorelaxing effect on high potassium- or norepinephrine-induced contraction of rat aorta. 82
Ileum smooth muscle The Hydrastis alkaloids berberine. hydrastine. tetrahydroberberine. and canadaline initiated contractions in isolated guinea pig ileum, but the strength of the contractile activity differed from one alkaloid to another. 29 Tetrahydroberberine. tetrahydropalmitine, and tetrahydrojatrorrhizine all showed antispasmodic activity on mouse intestines. 27 Trachea smooth muscle A total ethanolic extract of Hydrastis had a relaxant effect on carbachol-treated, precontracted, isolated guinea pig trachea. It was suggested by the authors of that study that berberine, ~-hydrastine, and tetrahydroberberine may have a relaxant effect by interacting with adrenergic and adenosinic receptors. 83 Cardioregulator Canadine (=tetrahydroberberine = THB) and tetrahydropalmitine (THP) reduced the magnitude of myocardial infarction in rats,84 and THB showed a potent antifibrillatory effect in rodents, which may be due to its blockade of potassium, calcium. and sodium currents. 85 Regulation of blood clotting In the past, hydrastine hydrochloride and hydrastinine hydrochloride were used in various forms in treating uterine hemorrhage. 86 THB has been reported to be a potent inhibitor of platelet aggregation in vitro and in vivo and to have potential as an antithrombotic drug. 87 Central nervous system effects The action of THB as a dopamine receptor antagonist was investigated in rat hippocampal pyramidal neurons. It was concluded that THB noncompetitively inhibits the acetylcholine-induced potassium current in a concentration-dependent manner, suggesting that the effects ofTHB on the central n'ervous system are not solely a result of a blockade of dopamine receptors. 88 Bitter digestive tonic Hydrastis has, been reported to have a bitter digestive tonic effect in that it was found to increase salivary volume and gastric secretion.89 Antidiabetic One study reported that consumption of a diet containing·Hydrastis significantly reduced the hyperphagia and polydipsia associated with streptozotocin-induced diabetes in ~ice, but did not significantly alter plasma . glucose or insulin concentrations.90
Combining Western Herbs and Chinese Medicine
290
Immunoregu1atory Rats treated with Hydrastis extract and subsequently injected with an antigen showed an increase in the primary IgM response, suggesting that Hydrastis may enhance immune function by increasing antigen-specific immunoglobulin production.91
ated up to 0.5 g.At doses above 0.5 g. berberine has beenre-'--:: ported to cause gastrointestinal irritation, nausea, diarrhea, -:-'~ dizziness. nosebleeds, dyspnea, skin and eye irritation, ne-.' phritis, and urinary tract disorders. In addition, one death.::::...-: was reported from berberine overdose. Unfortunately. no ref- -~-E:;:, ., erences were quoted for this data. .,
RESEARCH VERIFICATION OF
Short- and long-term use of the herbs A recent review of available data on Berberis and Hydrast~l concluded that:
TRADITIONAL ACTIONS Berberis The following traditional actions of Berberis have been supported by research: antimicrobial. antipyretic. gastrointestinal anti-inflammatory. antidiarrheal. antidiabetic. hepatic, choloretic, cardiotonic. and nervine. The following traditional actions have not yet been supported by research: bitter digestive tonic, laxative. and emmenagogue. Hydrastis
The following traditional actions of Hydrastis
have~~e~~pported by research: antimicrobial, anti-inflam-
matory, bitter dig~sti~~ tonic.c~di~~egulator,and emmenagogue. ,The following traditional actions have not yet been supported by research: antidiabetic, hepatic, choloretic, anticatarrhal, laxative, and nervine. There is no research evidence for Hydrastis itself. but there is evidence that its constituent berberine can have antidiabetic, hepatic, choloretic, and nervine effects. Additional effects demonstrated by research
Berberis The following additional effects of Berberis have been reported and are discussed above: antispasmodic. antihypertensive, blood clotting regulator. antithrombocytopenic. antibronchitic. antiamnesiac. immunoregulatory, and antitumor. Hydrastis The following additional effects of Hydrastis have been reported and are discussed above: smooth muscle regulator, blood clotting regulator, and dopamine antagonist.
TOXICOLOGY An important distinction Since the level of any individual alkaloid, such as berberine. is usually less than 5% of the total, reports of adverse effects following administration of high levels of a pure alkaloid may not be applicable to administration of preparations of the whole herb.
LD so Whilst the oral LD so of berberine in mice is 0.329 g!k9', ~e oral LD so of,Hydrastis canadensis extract in mice is .. 92 " , 1.6.2,!¥~g. These are equivalent to doses of 19.7 g ofberberll1~ and 97.2 g of Hydrastis for a 60 kg human. Use of the pure alkaioids According to the German Commission E monograph on this herb,93 berberine is well toler-
• no adverse effects are to be expected from oral administration of either Berberis or Hydrastis when used within the recommended dosage. • Berberis and Hydrastis may be taken long-term if they are used within the recommended dosage
.,
-
I
Pregnancy There is contradictory information on the use of Berberis and Hydrastis in pregnancy. Some modern texts, such as the BHP and Mills and Bone, recommended avoiding the use of either Berberis or Hydrastis during pregnancy. However. the BHP did not support this statement with refer--/./ 94 ences, although Mills and Bone referred to De Smet et al. As discussed above, some research studies reported that berberine is a uterine stimulant while others reported that it is a uterine antispasmodic. It may be that the effect of berberine depends on whether the uterine muscle is relaxed, normal, or contracted. Three studies have reported that Hydrastis extracts have relaxant or antispasmodic effect on uterine '-' '. muscle rather than a stimulant effect. In the Traditional sources section below, it can be seen that Berberis is not a herb that has generally been used in pregnancy. but four different texts are listed that record the use of Hydrastis to treat pregnancy disorders.
In view of this information, it would be prudent to avoid the use of • Berberis in pregnancy since this herb is not specific for treating disorders during pregnancy • Hydrastis in pregnancy unless the practitioner is experienced in both the use ofHydrastis and in the treatment ofdisorders during pregnancy
Dose Dried herb The BHP listed 1-2 g of the dried herb of Berberis vulgaris. three times per day. and 0.5-1 g of the dried herb of Hydrastis. three times per day. Ymcture The BHP listed 2-4 ml of 1:10 tincture (in 60% alcohol) of Berberis vulgaris, three times per day, and 2-4 ml of 1:10 tincture (in 60% alcohol) of Hydrastis, three timesper day.
",
..--
___ Berberis and Hydrastis I do not usually prescribe either Berberis or Hydrastis as single herbs, but in combination with other herbs. In a single 5 ml dose of 1:5 tincture of a combination of about five herbs, I would generally include about 1 ml of Berberis or 0.5-1 ml of Hydrastis. Initial dose
Both herbs can be started at the initial dose
Duration Both herbs can be taken long-term within the recommended dose range.
Cautions Western contraindications The following conditions have been contraindicated by one or more texts or reports (with the responsible plant in parentheses): • jaundiced neonates (berberine-containing plants)95 • hypertension (Hydrastis),4 but no reference was given for this statement: two research studies have reported antihypertensive effects for berberine (see above) • diarrhea (Berberis),4 but no reference was given for this statement: four research studies have reported antidiarrheal effects for berberine (see above) Chinese contraindications No contraindications are given in the Chinese Herbal Medicine Dictionary for Berberis (san ke zhen). Hydrastis is not listed. However, I would not use either of these herbs in patterns of Spleen Deficient Qi with Cold unless they were combined with warmer herbs, such as Rosmarinus, Zingiber. or Capsicum. Also. whilst I sometimes include Berberis in combinations for diarrhea due to Damp Heat, I do not generally include it in combinations for diarrhea due to Spleen Deficient Qi and Cold. Pregnancy and lactatio~ Some texts record the use of Hydrastis in pregnancy, whilst others contraindicate the use of either Hydrastis or Berberis at this time; see the discussion under Pregnancy in the Toxicology section. Side effects No adverse effects are to be expected from either Berberis or Hydrastis when they are taken in the recommended doses. Overdose Nausea or vomiting has been recorded, and it is the belief (as yet unsubstantiated) of some authors that prolonged high doses of Hydrastis may damage the gut flora, resulting in malnutrition. This belief may be linked to Chinese medicine theory in that excessive doses of cooling herbs may weaken the Spleen. Interactions No adverse reports.
291
Regulatory Status Please read the Regulatory status section in the chapter on Safety. At the time of this writing: • both Berberis (barberry bark) and Hydrastis (golden seal) are on the UK General Sale List • neither herb is included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia • neither herb is currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use
Traditional sources NOMENCLATURE According to Gerard. Galen made a distinction between Oxyacantha, the barberry bush, and Oxyacanthus, the hawthorn tree. However, what Dioscorides called Oxyacantha is not barberry, but rather. it is the plant that Galen called Oxyacanthus, or hawthorn. Gerard also used the name Spina acida for barberry. PROPERTIES Temperature Culpeper described barberry as a herb to clear the body of hot conditions, and both Lonicerus96 and Gerard classified this herb as cold and dry in the second degree. Lonicerus said that Berberis is good for all diseases in the body that are due to heat because it brings down blood heat and helps treat hot ulcers. In the Chinese Herbal Medicine Dic.tionary. the Berberis species used as san ke zhen are classified as cold. In this book, Berberis vulgaris, Mahonia aquifolium, and Hydrastis are all classified as cool, associated with their anti-inflammatory, antimicrobial. antipyretic, and alterative actions. Taste
Taste in the mouth The BHP described Berberis vulgaris, Mahonia aquifolium and Hydrastis as bitter in taste. I found samples of dried Berberis and Mahonia to have a moderately bitter taste, and a sample of dried Hydrastis to taste more strongly bitter. I found that 1:5 tinctures of Berberis vulgaris and Mahonia aquifolium in 25% alcohol tasted mildly bitter, and 1:10 tincture of Hydrastis in 60% alcohol tasted more strongly bitter. Taste property In the Chinese Herbal Medicine Dictionary. the Berberis species used as san ke zhen are classified as bitter in property. In this book, Berberis vulgaris. Mahonia aquifolium, and Hydrastis are all classified as bitter. -
..
,~
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Combining Western Herbs and Chinese Medicine
292
-'t;~ ~
William Fox in 1878 and by Felter and Lloyd in 1898...~'~.;. Christopher wrote that it is an excellent tonic for delicate and "::;. weak people, particularly children, to treat anemia and general malnutrition. In terms of Chinese medicine, these indi---·.cations can be said to represent tonification of Spleen arid :'.~'~, 98
ORGANS In terms of Chinese medicine, Berberis and Hydrastis, as used in the West, can be associated mainly with disorders of the organs shown in the table below. The Chinese Herbal Medicine Dictionary does not have an entry for Hydrastis canadensis, and does not list meridians entered for the Berberis species used as san lee zhen.
Stomach Qi, with the result of tonifying Qi and Blood. Finally, according to Ellingwood, Mahonia aquifolium stimulates digestion and absorption, and thus improves general
~
.-..,-
nutrition. ACTIONS
Hydrastis
Evidence from the traditional sources for the following actions of Berberis vulgaris and Hydrastis canadensis are discussed below: • bitter digestive tonic • nervine • antidiabetic • cardiovascular tonic • gastrointestinal anti-inflammatory • hepatobiliary • anticatarrhal • laxative and antidiarrheal • astringent and antihemorrhagic • antimicrobial and antipyretic • alterative and dermatological agent • emmenagogue • topical
Felter and Lloyd wrote that Hydrastis is bitter and induces increased salivation, sharpens the appetite, and aids digestion when it is indicated. It is a tonic for feeble states of the alimentary tract in infants and children, and for convalescence from debilitating illnesses. However, Felter and Lloyd also wrote that, as a bitter tonic, Hydrastis is not as effective as Gentiana, but is more applicable to debilitated conditions of mucous membranes. Christopher recommended Hydrastis as a tonic for general debility. Nervine Lyle recommended a preparation of Hydrastis and Humulus in equal parts to stimulate, sustain, and tone the spinal nerves. Kloss listed a combination of Hydrastis, Humulus, and Scutellaria for the same purpose. Christopher gave the same combination for spinal nerves and epilepsy. Antidiabetic
Kloss recommended Hydrastis for diabetes.
Bitter digestive tonic
Cardiovascular tonic
Berberis Both Gerard and Lonicerus said that Berberis
Berberis Lonicerus said that Berberis can strengthen the
improves the appetite. This herb was also listed as a tonic by
heart and relieve discomfort around the heart.
HYDRASTIS
BERBERIS
General
fever
Christophe,-97
Lung
intermittent fever. influenza
Christopher
upper respiratory catarrh bronchitis
BHP Christopher
Spleen
poor appetite
Gerard
anorexia
BHP
Stomach
hot stomach
Gerard
peptic ulcers
BHP
Intestines
constipation, chronic diarrhea, dysentery
Christopher
obstinate constipation, convalescence from diarrhea
Felter and Lloyd
Uver-Gallbladder
liver heat, jaundice
Gerard
jaundice, cholelithiasis
Ellingwood
Bladder
cystitis
Felter and Lloyd
cystitis
Christopher
Uterus
leukorrhea
Lonicerus
dysmenorrhea menorrhagia
BHP SHC
Topical
itches, boils
Culpeper
eczema, pruritis eye inflammations
BHP BHC
-
~.
Berberis and Hydrastis ,
,
Hydrastis
According to Felter and Lloyd, Hydrastis can increase arterial tension and the blood pressure in the capillaries; accordingly. it can be used to overcome blood stasis. They wrote that it gives tone to the heart muscle. Kloss wrote that Hydrastis equalizes the circulation and, combined with Capsicum, can relieve and strengthen the heart. Both Lyle and Christopher said that Hydrastis tones the venous circulation. Lyle added that its influence is also on the arterial circulation, but that this is only secondary. Gastrointestinal anti-inflammatory
Berberis Gerard wrote that Berberis cools hot stomachs. However, this herb is not listed as often for gastritis, peptic ulceration, or intestinal inflammation or ulceration as Hydrastis.
Hydrastis Felter and Lloyd stated that Hydrastis is specific for catarrhal states of the mucous membranes when unaccompanied by acute inflammation. However, later authors have tended to use Hydrastis for acute gastrointestinal inflammation. For example, it was listed by Christopher for acute alimentary inflammation and by the BHP for gastritis, peptic ulceration, and colitis. I have found that one strong dose of Hydrastis can give immediate relief for acute acid indigestion, associated in terms of Chinese medicine with
\ I
Stomach Heat.· Hepatobiliary
Berberis According to Galenic principles, the choleric temperament is prone to the emotion of anger. If the choleric aspect of the temperament is in excess, the person is of irritable disposition, angry without cause, and prone toward having troubled sleep and dreams of fighting. Culpeper described Berberis as a herb to clear the excess of choler from the body and to treat diseases that are caused by excess of choler, such as yellow jaundice, itches, and boils. He recommended Berberis for heat of the liver, heat of the blood, and hot agues. Both Lonicerus and Gerard wrote that Berberis decreases the heat in the liver, and Lonicerus said that Berberis is good for headache if it is due to heat and acidity from gallbladder disease. In the Western herbal medicine of the last fifty years, it is Berberis, rather than Hydrastis, that has been listed as a specific herb for hepatobiliary problems. Christopher recommended Berberis for gallbladder problems and liver complaints, and the BHP listed it for cholecystitis, cholelithiasis, and jaundice. Chang and But listed the use of Berberis species in China to relieve pain an~ inflammation in gallbladder disease. .
Hydrastis Ellingwood listed Hydrastis for hepatobiliary disorders, but emphasized the role of Hydrastis in normaliz-
293
ing the mucous membranes of the bile duct and in treating catarrhal problems of the liver and gallbladder. Neither the BHP nor the BHC listed Hydrastis for hepatobiliary problems. Anticatarrhal
Berberis Berberis is not described by Felter and Lloyd or by Christopher as a regulator of mucous membranes, or as an anticatarrhal.
Hydrastis Felter and Lloyd stated that the specific indication of Hydrastis is for catarrhal states of the mucous membranes, and they recommended it for: • subacute and chronic inflammatory conditions with increased mucus secretion • atonic conditions of the mucous membranes with increased mucus secretion • nasopharyngeal catarrh with dry, parched conditions of the mucous membranes They listed Hydrastis for catarrhal disorders in the following systems: • respiratory system • gastrointestinal system • hepatobiliary system • urinary system • reproductive system • eyes • ears It is difficult to separate the anticatarrhal effect of Hydrastis from its antimicrobial and anti-inflammatory actions. For example, Hydrastis is listed by Christopher for nasal catarrh, bronchitis, cystitis, leukorrhea, and gonorrhea. The BHP listed it for otorrhea, catarrhal deafness, and conjunctivitis. In any of these disorders, excessive mucous secretion or discharge may be linked to inflammation and infection. Laxative and antidiarrheal
Berberis Lonicerus listed Berberis for diarrhea, and both Gerard and Culpeper recommended it for the bloody flux (dysentery). Felter and Lloyd listed Berberis both as a laxative for constipation and as an astringent for dysentery. Christopher similarly listed it for constipation, chronic diarrhea, and dysentery. William Fox, in 1878, mentioned that in large doses, Berberis can be used as a laxative. Grieve, in 1931; said that Berberis can be used as a mild purgative for constipation when taken in larger doses than appropriate for tonic use.
Hydrastis Ellingwood listed Hydrastis for constipation that is a result of either excess or weakness, and Christopher rec-
Combining Western Herbs and Chinese Medicine
294
ommended it for chronic constipation from a sluggish liver. Mills99 pointed out that, since bile is a natural laxative, herbs that stimulate bile production may assist in the treatment of constipation, especially if this is associated with hepatic stagnation. He wrote that Hydrastis can be both gently laxative, partly due to its ability to increase bile secretion, and astringent. Thus, Hydrastis can be used for some cases of diarrhea, especially when this is associated with gastrointestinal infection and inflammation. Both Berberis and Hydrastis are components of Christopher's famous Lower Bowel Tonic used to cleanse and tone the bowel, and to normalize bowel function. Astringent and antihemorrhagic
Berberis Berberis is not generally used as an astringent or antihemorrhagic.Its effects in diarrhea or leukorrhea are due to its antimicrobial, anti-inflammatory, and alterative actions, rather than to astringency.
Hydrastis The astringent action of Hydrastis has three main facets:
• antidiarrheal • anticatarrhaI • antihemorrhagic
diarrhea and dysentery sinus catarrh, bronchial catarrh, conjunctivitis, leukorrhea abnormal uterine bleeding, gastric bleeding, ulcerative colitis
The antidiarrheal and anticatarrhal aspects have been discussed above, and the antihemorrhagic action will now be considered. Ellingwood recommended Hydrastis as the best remedy for menorrhagia and metrorrhagia. He wrote that it is useful in postnatal hemorrhage but is rather slowacting and, therefore, inadequate when immediate results are required. Felter and Lloyd also listed it for hemorrhage from uterine fibroids and endometritis. The BHP noted Hydrastis for menorrhagia and postnatal hemorrhage.
mended Hydrastis for convalescence from protracted fever,-~~ but did not emphasize its use for fever themselves. For exam- .. "~. pIe, Felter and Lloyd wrote that Hydrastis probably has little to recommend it in the treatment of malarial disorders. The use of Hydrastis for colds, influenza, and intermittent fever was emphasized by later authors, such as Kloss and Christopher. Alterative and dermatological agent
Berberis According to Gerard, Berberis can clear heat in the blood, stomach, or liver. Culpeper recommended it to clear the body of choleric humors and to treat itches, ringworms, and boils. Felter and Lloyd noted that Berberis tea was taken during the spring months as a blood purifier, and Lyle listed the alterative action for this herb. Mahonia aquifolium has been regarded as a more specific herb for dermatological conditions than Berberis vulgaris. However, I use either of these herbs for skin disorders, especially when these conditions are linked to patterns that would be described in Chinese medicine as Deficiency and Stagnation of Qi of the Liver-Gallbladder and Liver-Gallbladder Damp Heat.
Hydrastis According to Felter and lloyd, Hydrastis can help acne, acne rosacea, or boils when these skin conditions are dependent on gastric difficulties. Emmenagogue
Berberis Lonicerus wrote that Berberis can be used to clean the uterus and remove old leukorrhea. and to reduce heavy menstrual flow. However, most texts do not associate Berberis with the emmenagogue action.
Hydrastis The uses of Hydrastis for women's disorders can be divided into three main groups: • astringent and antihemorrhagic • regulator of uterine muscle tone and contractions • use in pregnancy
Antimicrobial and antipyretic
Astringent and antihemorrhagic The use of Hydrastis as an
Berberis Gerard listed Berberis for choleric agues, and
anticatarrhal astringent for leukorrhea and an anti-inflammatory antihemorrhagic for abnormal uterine bleeding have already been discussed.
Culpeper listed it for hot agues. Felter and Lloyd and also Christopher recommended Berberis for fever, and the BHP listed it for malaria and leishmaniasis. Chang and But stated that san ke zhen, the various Berberis species used in China, are mainly indicated in 'Latent Heat' syndromes, such as dysentery, pharyngolaryngitis. and cough due to Heat in the Lung. They stated that the various types of Berberis species contain similar types of constituents with antipyretic, Latent Heat-clearing, antiinflammatory, and detoxicant actions.
Hydrastis
Felter and Lloyd as well as Ellingwood recom-
Regulator ofuterine muscle tone and contractions Hydrastis has been used to normalize uterine muscle tone and to normalize the rhythm of uterine contractions. For example, Christopher recorded its use as a uterine antispasmodic to treat dysmenorrhea and as a uterine stimulant to initiate normal uterine contractions in delayed labor. In both cases, it can be combined with Lobelia since both herbs can optimize the function of the uterine muscle, depending on its initial state.
-
Berberis and Hydrastis Use in pregnancy Kloss recommended small but frequent doses of Hydrastis to treat nausea in pregnancy, and Christopher also used Hydrastis for this purpose. According to Gladstar,lOO Hydrastis should be used with caution in pregnancy. She wrote that, whilst large doses stimulate the uterine muscles and may cause premature contractions, small amounts (one capsule, three times per day) can be used during pregnancy for morning sickness or to fight infections and colds. The BHP entry on Hydrastis noted that this herb should be avoided in pregnancy. In the entry on Viburnum prunifolium, however, the BHP suggested the combination of Viburnum, Hydrastis, and Chamelirium for threatened miscarriage. Again, I would suggest that Hydrastis is not used during pregnancy unless the practitioner has considerable experience both in the use of Hydrastis, and in treating womens'disorders. Topical
Berberis Felter and Lloyd recorded the use of Berberis decoction as a wash for sores on children's lips, apthous sore mouth, and chronic ophthalmia. However, Berberis is not used as often as an external application as is Hydrastis.
Hydrastis Ellingwood recommended Hydrastis as a: • gargle for ulcerated sore mo~th, gingivitis, and tonsillitis • wash for leukorrhea • wash for anal eczema with rectal ulcers or fissures Christopher also listed it as a: • wash for eye inflammations • snuff for offensive nasal catarrh • toothpowder for pyorrhea • wash for itching, burning skiri in eruptive diseases
295
crobials and anti-inflammatories to treat inflammation and infection in the gastrointestinal and hepatobiliary systems, and to treat diarrhea or constipation. Both herbs can he used as bitter tonics and regulators for the gastrbintestinal and hepatobiliary systems. Differences The main active constituents of Berberis and Hydrastis are isoquinoline alkaloids, and the main alkaloid is berberine in the case of both herbs. However, Berberis also contains the isoquinoline alkaloids jatrorrhizine, palmitine, and oxyacanthine, and Hydrastis also contains the alkaloids hydrastine and canadine. The differences in traditional use between the two herbs may relate to the differences in their alkaloid content. In my opinion, Berberis is relatively more active on the Liver and Gallbladder than is Hydrastis, and Hydrastis is relatively more active on the Stomach, Intestines, and Lung than is Berberis. Berberis is more appropriate for Liver Stagnant Qi, Liver Heat, and Liver-Gallbladder Damp Heat, and Hydrastis is more useful for Heat, Damp Heat, or Phlegm in the Stomach, Intestines, or Lung. Berberis can be more effective for recurring febrile conditions associated with Retained Pathogen, such as in chronic fatigue syndrome, and Hydrastis can be more effective for sinus or bronchial phlegm. Both herbs can be used for conditions of Damp Heat in the lower abdomen, such as diarrhea, giardiasis, mucous colitis, or leukorrhea, but Hydrastis is often preferred for these conditions because of its reputedly stronger anticatarrhal, astringent, and antihemorrhagic actions. Berberis has a stronger tradition of use as an alterative herb to treat skin disorders and arthritis, and Hydrastis reputedly has a stronger regulatory or initiatory effect on uterine contractions to treat dysmenorrhea or delayed labor.
• ointment for chapped hands , ,~
COMPARISON OF BERBERIS AND HYDRASTIS The similarities and differences discussed below reflect my own opinion, which is based on the pharmacological research and historical sources given in this chapter and on my own clinical experience. Similarities There is some overlap between Berberis and Hydrastis, both in constituents and pharmacology, and in traditions of use. Both herbs contain the isoquinoline alkaloid berberine. which has antimicrobial, anti-inflammatory, antidiarrheal, laxative. and choloretic effects. and the capacity to regulate the tone and contractile activity of smooth muscles. Both herbs can therefore be used as cool, bitter antimi-
COMPARISON OF WESTERN AND CHINESE USE OF BERBERIS SPECIES Use in the West Since the 16th century, Berberis has been used in the West to: • strengthen the stomach and liver and treat poor appetite • clear heat from the liver to treat choleric agues, headache, yellow jaundice, itches, and boils • clear heat from the stomach to treat thirst, constant vomiting, and constipation In the last century, Berberis has been used especially to treat conditions associated with weakness, sluggishness, and inflammation of the hepatobiliary system, such as jaundice, cholecystitis, cholelithiasis, and skin disorders.
296
Combining Western Herbs and Chinese Medicine
Use in China Although the Chinese Herbal Medicine Dictionary entry on Berberis species (san ke zhen) quoted older texts, it does not list the meridians entered, and it does not appear that this herb has had such an extensive tradition of use in China as in the West. The Chinese Herbal Medicine Dictionary listed the actions of Berberis as clearing Heat, clearing Damp, cooling the Blood. and moving Blood Stagnation. It gave the uses of Berberis as sore and swollen throat, red eyes, jaundice. diarrhea, and hematuria, all of which could be associated with Liver-Gallbladder Heat or Damp Heat and pain and swelling from trauma. An extended range of use From a combination of the concepts of Western Galenic medicine and traditional Chinese medical theory, and from research studies on Berberis, an extended potential range of actions and uses appears:
• clearing Retained Pathogen to treat recurring febrile conditions, such as in chronic fatigue syndrome; fibromyalgia, or malaria • clearing Lung Phlegm Heat to treat acute or recurring bronchitis. especially when accompanied by Liver Heat • clearing Liver Heat to treat hypertension, headache, anger, irritability, restlessness, and heat sensations • clearing Liver-Gallbladder Damp Heat and general Damp Heat to treat inflammations and infections such as acute diarrhea, cholecystitis. cystitis, vaginitis, eczema, or arthritis • tonifying and moving the Qi of the Liver, Spleen, and Intestines to treat depression, poor appetite, indigestion, food intolerances. and recovery from prolonged multimedication or drug abuse
COMPARISON OF BERBERIS, HYDRASTIS, PHELLODENDRON, AND COPTIS All four herbs contain berberine. giving them a basic common group of actions and uses, but each herb has a characteristic spectrum of other isoquinoline alkaloids, which may partially explain their specific uses.
and Bladder meridians, and is mainly used for Damp Heil' l -,.~= "" disorders of the Lower Burner, such as urinary disorders,::;,,= . .. diarrhea, dysentery, and leukorrhea. It is also used for jaun_J_"- . dice and for Kidney Deficiency Heat patterns, such as night .~;;;: 7 . 101 102 sweats and afternoon fever and sweatIng. . _ ":::' ~ ~
_.:~
:~;
Coptis This herb differs from Phellodendron in that it -i; " specific for disorders of the Upper and Middle Burners, :;:~ ~ especially for patterns of Heart Heat, such as insomnia and -~;:-:';J restlessness, and Stomach Heat. such as gastritis. acid regurgitation. and bad breath. Coptis resembles Hydrastis both in its anti-inflammatory effects on the Stomach and Intestines and in its use for bleeding disorders due to Heat. In the most simplistic reduction, the specific uses of these herbs can be said to be:
• Berberis • Hydrastis
Liver-Gallbladder disorders Lung. Stomach, Intestine, and ... Uterus disorders Bladder and Kidney disorders . _. .-=-_~_~~;'5~} Heart and Stomach disorders ~~
• Phellodendron • Coptis
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Berberis This herb is characteristically used for LiverGallbladder patterns of Deficient Qi. Stagnant Qi, Heat. or Damp Heat, such as poor appetite. indigestion, cholecystitis, headache. hypertension, irritability, anger. or depression.
8. Chang H-M. But PP-H (eds). Pharmacology and Applications of Chinese Materia Medica. vols. 1 and 2. World Scientific Publishing. Singapore (1986)
Hydrastis This herb is specifically used for problems of inflammation, infection, or oversecretion by the mucous membranes, espec~ally of the Lung, Stomach, Intestines. Bladder. or Uterus, such as sinusitis, bronchitis. gastritis, colitis, cystitis, leukorrhea, or menorrhagia.
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Phellodendron This herb is listed as entering the Kidney
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\
r'1
Berberis and Hydrastis
I
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39. N"Jkoronow M.Acta Polon Pharm 3:23-56 (1939)
Medical Research Communications (3):27 (1978) 14(1):45-51
(1985) 41. Ivanovska N, Philipov S. Int (1996)
(Central Hospital of Qiqihar Railways) (26):22 (1975)
69. ZhengZ et al.Chin J IntMed 11(7):567 (1963)
38. Sheng WD. Jiddawi MS. Hong XQ et a!. East AIr Med J 74(5):283-284
J Ethnopharmacol
64. Bronchitis Prevention and Treatment Research Unit, Central Hospital of Qiqibar Railways. Information on Medical Science and Technology
67. Zhang DF et aI. Chin J IntMed 7(9):900 (l959)
35. Dutta NK,Iyer SN.J IndMedAssOc 50(8):349-352 (l968)
40. Khattak SG. Gilani SN, Ikrarn M.
63. Chekalina SI. Umurzakova RZ. Saliev KK et al. Gematol Transfuziol 39(5):33-35 (1994)
J Immunopharmacol 18(10):553-561
42. Ckless K, Schlottfeldt JI., Pasqual M et al. J Pharm Pharmacol 47(12A):1029-1031 (l995)
72. Luo CN, Lin X, Li WI( et a!. J Ethnopharmacol59(3):211-215 (1998)
73. Kumazawa Y, ltagakl 6(6):587-592 (1984)
A. Fukumoto M et a!. Int J Immunopharmacol
74. N"lShinO H,Kitagawa K,Fujiki H et aI. Oncology 43(2):131-134 (l986) 75. Iizuka N.Miyarnoto K,Okita K eta!. Cancer Lett 148(1):19-25 (2000)
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76. Fukuda K, Hibiya Y, Mutoh M et al. I EthnopharmacoI66(2):227-233 (1999)
91. Rehman J. Dillow 1M. Carter SM et al.lmmunol Lett 68(2-3):391~395.:cc~ (1999) ,~,~ '\
77. Ye YC. Chen QM. Hai P et al. Chung Kuo Yao Li Hsueh Pao 10(2):185-
92. Haginiwa J. Harada M. Yakugaku Zasshi 82:726-731 (1962)
187 (1989)
.,~~
..
':-,
_:~.
---;;,;!;;,,_':. .",;;~i.a
93. Blumenthal M (ed). The Complete German Commission--E..,.,.:-::::·i: Monographs: Therapeutic Guide to Herbal Medicines.
Americih -:-,:
78. Gibbs OS. Fed Proc 6:322 (1947) 79. Haginiwa I, Harada: M. Yakugaku Zasshi 82:726-731 (1962)
Botanical Council. Austin, Texas (1998)
.•
. .
"'
"~l
-_., "'-..•.
80. Cometa MF,Abdel-Haq H. Palrnery M. Phytother Res 12(suppll):S83585 (1998)
94. De Smet PAGM. Keller K, Hansel Ret al (eds). Adverse Effects of -
81. Palrnery M. Cometa MF, Leone MG. Phytother Res 10(suppll):547549 (19%)
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82. Chen IS, Chen n,ChangYL et al. I Nat Prod 62(6):833-837 (1999) 83. Abdel-Haq H. Cometa MF. Palmery M et al. Pharmacol Toxicol 87(5):218-222 (2000)
96. Lonicerus A. Kreuterbuch (1679). Reprinted by Verlag Konrad Kolbl, Milnchen. Germany (1962) 97. Christopher JR. School of Natural Healing. BiWorld, Provo, Utah (1976)
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98. Fox W. The Working Man's Model Family Botanic Guide to Health. 7th edn. William Fox. Sheffield, United Kingdom (1878)
::--~ ;~~~ --, "i.
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86. Evans WC. Trease and Evans' Pharmacognosy. 14th edn. WB Saunders, London, United Kingdom (1996)
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100. Gladstar R. Herbal Healing for Women. Fireside, New York. New York -'';;:;'~ l (1993) --,-., -'-
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101. Bensky D. Barolet R. Chinese Herbal Medicine Formulas and Strategies. Eastland Press. Seattle, Washington (1990)
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Books, London. United Kingdom (199l).:.>,~J -;~y,:
102. Yeung H-C. Handbook of Chinese Herbs and Formulas vol. 1. Institute of Chinese Medicine. Los Angeles. California (1985)
;".-...J
Calendula Botanical name Calendula officinalis L. Family Asteraceae (Compositae) Pharmaceutical name Calendulae flos Part dried ligulate florets or dried composite flowers English marigold German Ringelblume French souci Mandarin jin zhan ju (~~~) is the flowers of C. officinalis Use in the West Calendula officinalis is an annual herb with characteristic bright orange flowers that is native to Southern, Central, and Eastern Europe. Calendula has had herbal use in Europe at least from the time of Hildegard von Bingen! in the 12th century, who used it for skin disorders of the head. In the 17th century; Stevens wrote that marigold 'cureth the trembling of the harte' and is specific for red eyes, headache, toothache, jaundice, and the ague (malaria).! Calendula is now used topically in the West for cuts, burns, eczema, and other skin inflammations; and internally
What is special about Calendula In terms of Chinese medicine, Calendula is a cool, bitter herb that has its main effects on the Stomach and Intestines, an? at the surface of the body. Calendula can be said to clear Heat or Heat toxin.
The key to understanding Calendula is that it is a bitter herb that can have antimicrobial, alterative, anti-inflammatory, astringent, and vulnerary actions. It can be used topically for wounds or inflamed skin lesions, and internally for peptic ulcers and inflamed lymph nodes. CHINESE ACTIONS In terms of Chinese medicine, Calendula, as used in the West, can be said to have three main actions:
1. topical astringent II. clear Stomach Heat III. clear Retained Pathogen and Heat Toxin
for peptic ulcers, enlargement or inflammation of the lymph nodes, amenorrhea, and dysmenorrhea. 3
WESTERN ACTIONS
The main Western actions of Calendula are shown here in terms of its three main Chinese actions:
Use in China Although the flowers of C. officinalis are listed in the Chinese Herbal Medicine Dictionary· as jin zhan ju, the fact that there is no meridian data given for this herb, no range ofopinion given on its properties, and no Chinese texts quoted suggest that this herb is not widely. used in China and does not have a long tradition of use in Chinese medical theory.
I. topical astringent
299
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II. clear Stomach Heat
anti-inflammatory antiulcer astringent vulnerary
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anti-inflammatory alterative lymphatic
.
Calendula, when taken internally, has three main actions: gastrointestinal anti-intlammatory, lymphatic alterative, and astringent.
WESTERN USES The Western uses of Calendula can be related to its three main Chinese actions:
Choice of Calendula This herb can be used to clear H~ -:;f;:z;;;a in the StOIpach and Intestines, and to clear Heat from the ':~~f ' ,. skin. It is specific for both peptic ulceration and intlamma-.':;'~;;'" tory skin lesions.1I1 addition to internal administration, top~.';:.:::;,; : ical applications of Calendula can be applied to the skin and~~~ to the anus, and an anal douche of Calendula can be used fo~=;. ...." --.~the proctitis, if r e q u i r e d . - f l c. -::'~i!
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Limitations of Calendula TEMPERATURE In this book, Calendula is classified as cool and can be used to treat warm-hot conditions. For hot conditions, it would be combined with other cooling herbs, such as Hydrastis or Baptisia.
TASTE I. topical astringent
cuts. burns. sunburn, pruritis, insect bites. varicose veins
II. clear Stomach Heat
peptic ulcer. gastrointestinal bleeding
III. clear Retained Pathogen and Heat Toxin
lymphadenitis
In this book, Calendula is classified as bitter in the sense of a bitter anti-inflammatory, but not in the sense of a bitter digestive tonic.
DIRECTION OF ENERGY Calendula is a herb with rather local effects, whether on the surface of the body or on the gastric endothelium. It does not seem to have effects that involve moving energy inward, outward, upward, or downward.
TYPICAL CASE EXAMPLE Signs and symptoms The patient has recurring burning pain in the epigastrium and sometimes also in the abdomen. The patient occasionally has a little dark blood in the stools, and medical investigation has detected gastritis with gastric ulceration. The patient has recurring eczema on the body, with red itchy lesions, recurring proctitis, and anal eczema. The pulse is slightly rapid. It is also thin and slightly wiry, especially in the Stomach position and in the third positions, which can relate to the Intestines. The tongue is thin and red, especially in-the middle and towards the back, with a thin dry yellow coat. Diagnosis The patient has Stomach and Intestines Heat with Stomach Deficient Ym. There is also some Heat in the Blood, a result of the Heat in the Stomach and Intestines, that is surfacing as red itchy rashes.
ACTIONS Topical Calendula has specific topical use for cuts, burns, scalds, sunburn, insect bites and stings, itchy, red skin rashes, and varicose veins. For other topical applications, other . herbs may be preferable. For example, Commiphora may be preferred for mouth, gum, and throat disorders. Astringent Calendula is specific for healing wounds and erosions on the skin or in the lining of the stomach, intestines, or vagina. It is not a general-purpose astringent to treat diarrhea or bleeding from the lungs or bladder. Anti-inflammatory Calendula is specific for gastrointestinal inflammation, especially for peptic ulceration, and for skin inflammations. For inflammation in other systems, other herbs are preferred. Alterative Calendula is an alterative in the sense that it can clear Heat in the Blood indirectly by clearing Heat in the Stomach or the Intestines. It can also clear Retained Pathogen and Heat Toxin, but only in the specific case of the lymph system. It is not used as a general-purpose alterative.
Calendula paired with other herbs Discussion of the limitations of each of the main actions of Calendula can be useful to clarify just what this herb can
Calendula and cannot do. However, suitable combinations with other herbs can extend the range of use of Calendula beyond its limitations. The basic unit of herb combination is the herb pair. Six pairings of Calendula are briefly explained below.
CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair. Calendula + Commiphora
Fungal infections Commiphora complements the antifungal actions of Calendula so that these herbs can be used together in topical applications to treat fungal infections of the skin, nails, or vagina. The antifungal effects of both herbs may be related to their resin content. CalendUla + Hamamelis
...
Varicose veins This pair has both astringent and anti-inflammatory action when used as a lotion or compress for varicose veins or hemorrhoids, and can be taken internally to reinforce the effect of the topical application. This pair can also be used to treat gastrointestinal bleeding. Calendula + Hydrastis
Eczema This pair can be used as a lotion or an ointment for red, itching skin lesions, for pruritis of the anus or vulva, and for purulent otitis media. Both herbs have strong anti-inflammatory and antimicrobial actions in addition to their astringent effects. Calendula and Hydrastis are also specific for gastritis associated with the pattern of Stomach Heat. Calendula + Symphytum
Wounds This is perhaps the most effective pair of herbs for wound healing, applied as a compress or a poultice. The vulnerary effect of Symphytum depends on a combined effect of mucilage, tannins, and resins, and on the special effect of allantoin on wound healing. Calendula + Geranium
301 Calendula + Baptisia
Lymphadenitis Baptisia is a powerful antimicrobial that is also specific for inflammations or infections of the lymph system. In Chinese medical terms, Calendula and Baptisia can be paired to clear Retained Pathogen and Heat Toxin from the body. This pair is specific to treat lymphadenitis or throat infections.
Topical uses of Calendula Calendula can be used for acute or chronic inflammatory skin lesions including: anal eczema bruises burns chafing cuts diaper rashes eczema festering sores
hemorrhoids indolent ulcers insect bites scalds sore nipples, , sunburn varicose veins wounds
The infusion, rather than the tincture, can also be used as an eyewash for conjunctivitis. However, my first choice would be an eyewash made from a decoction of Euphrasia and Hydrastis. A Calendula infusion can be used as a mouthwash or gargle for infections of the gums, mouth, or throat. However, my first choice would be Commiphora or the pair of Commiphora and Myrica.
COMBINATIONS OF CALENDULA FOR TOPICAL APPLICATION Calendula can be used by itself for the specific topical indications above, or combined with the following herbs: • with Comrniphora tincture as a lotion or compress for fungal infections of the skin, nails, or vagina • with Hamamelis as an anti-inflammatory and astringent compress for varicose veins or itching hemorrhoids • with Hydrastis as an ointment for vaginal irritation • with Stellaria as an ointment for itching skin rashes Calendula can be given internally as well as topically to support its topical action.
Gastric inflammation and bleeding Geranium is a tannin:"rich astringent and antihemorrhagic that is specific for peptic ulceration. In this pairing, the astringent effect of the tannins from Geranium combines with the astringent and vulnerary actions of the resins in Calendula.
Calendula combinations Three Calendula combinations for internal use are discussed below:
Combining Western Herbs and Chinese Medicine
302
1. peptic ulcer
Stomach Heat
2. peptic ulcer + bleeding
Stomach Heat + Bleeding from Heat
3. lymphadenitis
Retained Pathogen + Heat Toxin
Calendula Alipendula Hydrastis Geranium Capsella Glycyrrhiza
1 1 1 1 1 0.5
cool cool cool neutral neutral neutral-cool
bitter sour, bitter bitter sour sour sweet
CAUTION
GENERAL
Before using any ofthe combinations below, it is important to be familiar with the cautions listed for each herb in the combination.
This combination is for patterns of Stomach Heat with bleeding due to Heat. The overall temperature is cool, but the combination can be used to treat both warm and hot conditions. The bitter taste can be associated with the anti-inflammatory action in Calendula, Filipendula, and Hydrastis; the sour taste is associated with astringency in Filipendula, Geranium, and Capsella; and the sweet taste in Glycyrrhiza is associated with the demulcent anti-inflammatory action.
1. Peptic ulcer
Stomach Heat
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USE Calendula Rlipendula Hydrastis Valeriana Ophiopogon Glycyrrhiza
1 1 1 1 1
0.5
cool cool cool cool cool neutral-cool
bitter sour, bitter bitter bitter, sweet sweet, sl. bitter sweet
GENERAL
This combination is for patterns of Stomach Heatwith Stomach Deficient Ym. The overall temperature is cool, but the combination can be used to treat both warm and hot conditions. The bitter taste is associated with the anti-inflammatory action in Calendula, Filipendula, Hydrastis and Ophiopogon; the sour taste is associated with astringency in Filipendula; and the sweet taste in Ophiopogon and Glycyrrhiza is associated with the tonification of Stomach Yin. USE
• gastritis • gastric or duodenal ulceration PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of water, three times per day. It can be used for acute or subacute situations, and can be taken for 2-4 weeks until the severity of the epigastric discomfort is reduced. During remission, this combination can be replaced by a more tonic combination. 2. Peptic ulcer + bleeding
Stomach Heat + Bleeding from Heat
• gastric or duodenal ulceration with bleeding PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of water, three times per day. It can be used for acute or subacute situations, and can be taken for 2-4 weeks until the severity of pain and bleeding are reduced. During remission, this combination can be replaced by a more tonic combination. 3. Lymphadenitis
Retained Pathogen + Heat Toxin
Calendula Thuja Arctium (root)
1 1 1
cool warm-cool cool
bitter acrid, aromatic, bitter
Phytolacca Baptisia Glycyrrhiza
1 1 0.5
Zingiber
0.5
cool cold neutral-cool hot
acrid bitter sweet acrid, aromatic
sl. acrid, 51. bitter
GENERAL
This combination is for patterns of Retained Pathogen and Heat Toxin with Stagnation of Qi and AcCumulation of Damp and Phlegm in the lymph system. The overall temperature is cool, so that this combination can be used for warm conditions. For hot conditions the Zingiber may be removed. Otherwise, the Zingiber is included to moderate the effect -of the cool herbs and to help to move Qi and assist in the
Calendula dispersal of pathogens and toxins. In this combination, bitter and acrid properties combine to give antimicrobial, alterative, and anti-inflammatory effects. USE
• infection and inflammation of the lymph system, with enlargement oflymph nodes PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of water, three times per day. It can be used for acute or subacute situations. Baptisia is a cold herb that should not be given for more than 1-2 weeks. If it is required to use this combination for longer periods, then Baptisia can be replaced with Galium, for example. COMPARISON OF THE THREE CALENDULA COMBINATIONS 1. Peptic ulcer
Stomach Heat ·Calendula contributes astringent, vulnerary, and antiinflammatory actions; Filipendula contains both astringent tannins and anti-inflammatory salicylates; and Hydrastis contains alkaloids that are antimicrobial and anti-inflammatory and that can normalize the function of mucous membranes. Ophiopogon and Glycyrrhiza can act both as anti-inflammatory agents and tonics for Stomach Yin. Valeriana has tranquilizing, antispasmodic, and analgesic actions.
303
Research CONSTITUENTS Calendula contains resinous substances and other compounds, including the following: • essential oil • triterpene alcohols • sesquiterpines • flavonol glycosides • saponins • other Essential oil The ligulate florets can contain up to 0.12% essential oil, and the inflorescence receptacles up to 0.4 %, including menthone, isomenthone, and caryophyllene. s Triterpene alcohols tero1.6
These include faradiol and taraxas-
Sesquiterpines The sesquiterpene lactone calendulin, mentioned in the literature, does not occur; calendulin is identical to loliolide, a xanthophyll degradation product. 7 Flavonol glycosides These include glycosides of isorhamnetin and quercetin.s Saponins Calendula contains 2-10% bisdesmosidic saponins, especially calendulosides A, C, and E.9 Other Calendula also contains immunoregulatory polysaccharides, bitter substances, tannins, sterols, polyacetylenes, pheny1carboxylic acids, carotenes, and xanthophyll.1O
2. Peptic ulcer + bleeding
Stomach Heat + Bleedingfrom Heat This combination is similar to the previous one, but the antihemorrhagics Geranium and Capsella have been used instead of calming Valeriana and tonifying Ophiopogon since the emphasis of this combination, No.2, is on reducing bleeding. 3. Lymphadenitis
Retained Pathogen + Heat Toxin This combination is quite different from the previous two. Calendula, Thuja, Arctium, Phytolacca, and Baptisia are specific for the lymph system and together, they can have antimicrobial, alterative, and anti-inflammatory effects. Glycyrrhiza is included both as an anti-inflammatory and to assist the body in dealing with the toxins. Zingiber is present to activate the circulation, to assist in the dispersal of toxins that have accumulated locally, and to moderate the effect of the cool and cold herbs.
PHARMACOLOGICAL AND CLINICAL RESEARCH The following effects have been reported: • antimicrobial • anti-inflammatory • choloretic • antilipidemic • uterotonic • vulnerary • immunoregulatory • antimutagenic and antitumor
Antimicrobial Antiviral Calendula flower tincture has demonstrated antiviral activity against influenza virus and against herpes simplex virus. \I Triterpenoid saponins from C. arvensis have demonstrated an antiviral effect in vitro against vesicular stomatitis virus. 12
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Antibacterial Water-alcohol extracts of C. officinalis showed
Components of the vulnerary action Antimicrobial, anti:~~'~;,~ ~
antibacterial activity.13
inflammatory, alterative, and astringent effects may be involved in the vulnerary action of Calendula. Wound heal-
Antifungal A 10% methanol extract showed antifungal activity.14
Antiprotozoal Extracts from the flowers have shown trichomonocidal activity, for which oxygenated terpenes were considered responsible. 15 Anti-inflammatory A lyophilized extract inhibited induced anti-inflammatory effects and leukocyte inmtration in rats,16 and both water-alcohol and COl extracts showed topical anti-inflammatory action in mice. 17 Triterpene alcohols from C. officinalis, including helianol, showed marked anti-inflammatory activity in mice,18 and triterpenoids have been shown to be the most important anti-inflammatory principle of the CO2extract, with 60 Ilg of free faradiol corresponding to 50 !Jg ofindomethacin. 19 Another study showed that .tl1e triterpene alcohol faradiol was more active than its esters and than '!'-taraxasterol. Faradiol showed the same anti-inflammatory effect as an equimolar dose of indomethacin. 2o
Gastrointestinal anti-inflammatory Calenduloside B, a new triterpene glycoside from the roots of C. officinalis, showed an antiulcerous effect. 2l Calendula was included in a combination for chronic nonspecific colitis, resulting in the normalization of defecation. 22 Choloretic A choloretic action of a flavonoid extract has been reported. 23 Antilipidemic An isolated saponin fraction administered orally at a dose of 50 mg/kg reduced serum lipid level in hyperlipemic rats. 24.25 Uterotonic Calendula infusion was reported to show uterotonic action in isolated rabbit uteri.26 Vulnerary Polysaccharide fractions from aqueous extracts were reported to enhance phagocytosis in mice,27 and isolated polysaccharides from Calendula flowers were shown to stimulate phagocytosis in human granulocytes.9A combination of C. officinalis extract with allantoin was used to treat skin wounds in rats, and the preparation markedly stimulated physiological regeneration and epithelialization. 28
ing will be improved by: • a reduction of infection and excessive inflammation • enhanced phagocytosis, which is associated with polysaccharide fractions from Calendula and which might be seen as an alterative or cleansing effect Both the tannins and the resinous components may contribute to astringency, which will result in a reduction in bleeding and an improvement in wound healing. The formation of a protective polysaccharide layer may also assist the healing process. Immunoregulatory Water-soluble heteroglycan polysaccharides from C. officinalis showed significant immunostimulating activity in mice. 30 Two arabinogalactans and a rhamnoarabinogalactan from C. officinalis flowers were reported to stimulate phagocytic activity in human granulocytes. IO
Anti-HIV In vitro studies with an organic extract from C. officinalis flowers showed the extract to be relatively nontoxic to human lymphocytic Molt-4 cells; however, this extract had potent anti-HIV activity.31 Antimutagenic and antitumor A fraction that includes triterpenes reduced the development of ascites and increased survival time in mice inoculated with Ehrlich mouse carcinoma. 32 In addition, four saponins from C. arvensis showed antimutagenic activity in the Salmonella microsomal assay.J3
RESEARCH VERIFICATION OF TRADITIONAL ACTIONS There is research support for the antimicrobial, vulnerary, gastrointestinal anti-inflammatory, choloretic, and emmenagogue actions, but I have not seen evidence to support the antihemorrhagic, dermatological, lymphatic, carminative, cardiotonic, or tranquilizing actions. Additional uses suggested by research Antilipidemic, immunoregulatory, and antimutagenic effects have been reported, as discussed above.
Formation of polysaccharide layers In ex vivo studies with porcine buccal membranes, polysaccharides from C. officinalis showed strong bioadhesion to the epithelial tissue, forming a distinct polysaccharide layer on the apical membrane surface. 29 The authors suggest that such effects may be partially responsible for the therapeutic effects of mucilagecontaining plants on irritated buccal membranes.
TOXICOLOGY Acute toxicity An LD so of 375 mglkg has been reported for 34 intravenous administration of aqueous extracts in mice. This is equivalent to intravenous administration of 22.5 g for a 60 kg human. Also, administration in herbal therapy is not intravenous, but oral.
Calendula Chronic toxicity No symptoms of toxicity were shown by administration of aqueous extract of Calendula flowers in mice)4 or in hamsters at a dose of 150 mg/kg for over 18 months,!5 There were no toxic symptoms in rats given calenduloside B orally at 200 mg/kg for 2 months. 2 \ According to the authors, the compound does not have local irritation properties and shows relatively low hemolytic activity and insignificant toxicity. Sensitizing potential Weak skin sensitization has been shown experimentally, but no clear incident of contact dermatitis has been reported. 56 The Draize primary mucosa irritation test with rabbit eye showed that the mucosa tolerated Calendula.57
I.
Mutagenicity and carcinogenicity Four saponins from C. arvensis were demonstrated nontoxic and nonmutagenic at doses of 400 micrograms.53 An oral dose of 150 mg/kg Calendula flower extract was shown to be noncarcinogenic in rats over a period of 22 months. 55
Dose INTERNAL USE Dried herbs
The BHP listed 1-4 g of dried florets, three
times per day. r--~
Tincture The BHP listed 0.3-1.2 ml of 1:5 (90% ethanol) tincture, three times per day. Initial dose Duration
Can start at the standard dose.
305
Mills gave the following recipe: Simmer lanolin (anhydrous wool fat) with as much dried Calendula flowers as it can take for 20-30 minutes, then sieve off the flowers and agitate until the ointment is cool and set.59
Cautions Western contraindications Known sensitivity to members of the Asteraceae (Compositae) family. Chinese contraindications None found. Pregnancy and lactation No adverse reactions known. 40 Ability to drive and use machines Side effects
No adverse reports.
See Sensitizing potential in Toxicology.
Overdose None known. Interactions
None known.
Regulatory status Please read the Regulatory status section in the chapter on Safety. . Calendula (marigold flowers) is on the UK General Sale List, and is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Calendula is·not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
Generally suitable for long-term use.
Traditional sources TOPICAL USE PROPERTIES
Tincture 1:5 tincture in 90% ethanol can be applied as such for wounds. 58 Compresses According to the German Standard Licence, quoted by Wichtl, infusion can be made by adding 2-3 g of dried flowers to ISO ml of boiling water and straining after 10 minutes. Linen or similar material is then soaked in the infusion and placed on the wound, and the dressing is changed several times per day. Alternatively, compresses can be soaked in a 1:5 tincture diluted 1:3 with freshly boiled water.38
Eyewash The infusion should be used rather than the tincture. Ointment
A 2-5% Calendula ointment can be used. 58
Temperature Hildegard von Bingen listed Calendula, which she called ringula, as cold and moist. Lonicerus41 wrote that Calendula can remove dampness and warm a cold stomach, but he also wrote that it can remove heat and redness of the eyes. Tabernaemontanus42 stated that Calendula is dry in nature and warm in the second degree. Gerard43 listed Calendula flowers as hot, almost in the second degree, but recommended a Calendula wash for red, inflamed eyes, and Culpeper44 gave Calendula as a wash for hot swellings. In the Chinese Herbal Medicine Dictionary, C. officina:lls (jin zhan j11) is classified as neutral, but this herb does not appear to have been thoroughly used or studied in Chinese medicine. Calendula is classified in this book as cool due to its demonstrated anti-inflammatory effects.
Combining Western Herbs and Chinese Medicine
306 Taste
Taste in the mouth According to the BHP, Calendula has a slightly aromatic odor and a salty and slightly bitter taste. My own tasting revealed a more complex situation, reflecting the multiple constituents of this herb. A sample of dried Calendula flowers smelt slightly sweet and, on chewing, I experienced a slightly bitter, slightly salty, and slightly acrid taste with a soapy and mucilaginous sensation in the mouth. 2 ml of a 1:5 (90% ethanol) tincture mixed with 10 ml of water had a slightly resinous odor with a slightly bitter, slightly salty, slightly acrid, and slightly resinous taste as well as a slightly sticky resinous sensation. The difference between the dried flowers and the tincture may reflect the relatively higher proportion of polysaccharides in the dried flowers and the relatively higher proportion of resins in the tincture.
Taste properties In the Chinese Herbal Medicine Dictionary, . C. officinalis (jin zhan jn) is classified as bland, but this classification may not be based on a thorough understanding of the herb. In my opinion, the primary taste property of Calendula is bitter, associated with its cooling anti-inflammatory action. ORGANS In terms of Chinese medicine, Calendula officinalis, as used in the West, can be associated mainly with disorders of the following organs: Organ -
_. EXamples of use"
Stomach and Intestines
duodenal ulcer gastrointestinal bleeding
BHP Mills and Bone
Liver and Gallbladder
hepatic congestion gallstones
Ellingwood'S
Heart
strengthens the heart trembling of the heart
Culpeper, Gerard Grieve
Uterus
vaginitis, leukorrhea amenorrhea, dysmenorrhea
Felter and L1oyd 47 BHP
Lyte40
The main organs, for which Calendula is prescribed in the West, are the Stomach and Intestines. The Chinese Herbal Medicine Dictionary has no meridian data for this herb. ACTIONS The main actions of this herb are: • antimicrobial, antitoxin, and alterative • antihemorrhagic • topical • vulnerary
• dermatological • lymphatic • gastrointestinal anti-inflammatory • carminative • hepatic and cholagogue • cardiotonic and tranquilizer • emmenagogue
,.-.:~~
Antimicrobial, antitoxin, and alterative Hildegard von Bingen recommended Calendula against poison, and Gerard said that it could withstand poison and be good against pestilent agues. According to Ellingwood, Calendula is an antiseptic that can prevent the formation of pus and prevent suppuration in cases where there is a chronic tendency for its formation. --'-~','
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Antihemorrhagic The BHP listed Calendula as having antihemorrhagic action and as being used for epistaxis. Topical Lonicerus considered Calendula to be more useful for external than internal usage. He said that Calendula water applied to the eyes in the morning and evening can remove heat from red eyes. Gerard recommended Calendula infusion to remove the inflammation and pain of red and watery eyes. Tabernaemontanus wrote that the powder from the flowers wrapped in cotton and applied to the teeth soothes tooth pain. Ellingwood wrote that Calendula is mainly used as a topical herb for bruises, sprains, cuts, recent wounds, festering sores, severe burns, varicose veins, and open sores. Vulnerary In 1898, Felter and Lloyd quoted Dr. W. J. Clary as recommending Calendula as a local remedy after surgical operations. If applied constantly, as a diluted tincture, it reduces the incidence of suppuration and gangrene, and assists in wound healing. Ellingwood wrote that Calendula hastens the healing of wounds and causes the scar to form without contraction of the tissues. Dermatological Felter and Lloyd listed Calendula for chafing and skin rashes of infants, eczematous and ulcerative skin diseases, and stubborn acne. The BHP listed Calendula for sebaceous cysts and anal eczema, and gave acute or chronic inflammatory skin lesions as specific indications. Lymphatic The BHP gave enlarged or inflamed lymph nodes as a specific indication for this herb. Gastrointestinal anti-inflammatory The BHP listed duodenal ulcer as a specific indication for Calendula and also listed Calendula for proctitis. Past German traditional use for gas~ tritis is noted in Wichtl. Mills listed Calendula for infection or erosion of the upper gastrointestinal system, especially if there is ble'eding into the gUt. 39
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Calendula Carminative According to Tabernaemontanus, Calendula flowers in wine can remove dampness and warm the stomach. Hepatic and cholagogue Stevens, as quoted by Grieve, listed Calendula for headache, red eyes, jaundice, and the ague. Ellingwood, as well as Felter and Lloyd, recommended Calendula for hepatic or splenic congestion. Lyle considered Calendula a moderate hepatic and noted its use for biliousness, jaundice, and gallstones. Past traditional use in Germany for cholecystitis and cholangitis was noted in Wichd. Cardiotonic and tranquilizer Stevens in 1699, quoted by Grieve, noted the use of Calendula 'to strengthen and comfort the harte' and also wrote that it 'cureth the trembling of the harte.' Gerard said that Calendula could gready strengthen the heart and could be used to treat trembling of the heart. Culpeper said that it could comfort the heart and spirits, and expel any pestilentiaLquality that might annoy them. He used a recipe of the flowers in lard with turpentine and rosin, applied to the chest, to help the heart in fever, whether pestilential or not.
,r
Emmenagogue Tabernaemontanus wrote that Calendula could be taken in wine for palpitations in women with delayed menstruation, and that it can be used to regulate menstruation, whether it is too heavy or too light. Gerard quoted Fuchs in stating that Calendula can promote menstruation or expel the afterbirth. Felter and Lloyd noted the use of Calendula for suppressed menstruation, vaginitis, endocervicitis, all uterine and vaginal abrasions, gonorrhea, and leukorrhea, and for the pain and tenderness of excoriated nipples. The BHP listed Calendula as an emmenagogue herb for amenorrhea or dysmenorrhea.
307
References 1. Von Bingen H. Hildegard von Bingen's Physica. Healing Arts,
Rochester. Vermont (1998) 2. Grieve M. A Modem Herbal, vol 1 & 2. Dover Publications, New York, New York (1971) 3. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983) 4. fiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science and Technology Press, Shanghai. China (1975) 5. Gracza L. Planta Med 53:227 (1987) 6. Wllkomirski B. Phytochemistry 24:3066 (1985) 7. Willuhn G, Westhaus RG. Planta Med 53:304 (1987) 8. Vidall-Ollivier E et aI. Planta Med 55:73 (1989) 9. Vidal\-Ollivier E et al. J Nat Prod 52:1156 (1990) 10. Varljen J. Liptak A. Wagner H. Phytochemistry 28:2379 (1989) 11. Bogdanova NS, Nikolaeva IS, Scherbakova LI et aI. Farmakol Toksikol 33:349-355 (1970) . 12. De Tommasi N. Conti C. Stein ML. Planta Med 57(3):250-253 (1991) 13. Dumenil G, Chernli R, Balansard G et aI. Ann Pharm Fr 38:493-499 (l980) 14. Wolters B. DtschApoth Ztg 106:1729-1733 (1966) 15. Fazakas B, Racz G. Farmacia 13:91-93 (1965) 16. Shipochliev T, Dimitrov A. A1eksandrova E. Vet Sci (Sofia) 18:87-94 (1981) 17. Della Loggia R, Becker H.lssac 0 et aI. Planta Med 56:658 (1990) 18. Akibisa T, Yasukawa K. Oinuma H et aI. Phytochemistry 43(6):12551260 (1996) 19. Della Loggia R, TubaroA,Sosa S et aI. Planta Med6O:516-520 (1994) 20. Zitterl-Egiseer K. Sosa S, Jurenitsch , et al. J Ethnopharmacol 57(22):139-144 (1997) 21. latsyno AI, Belova LF. Lipkina GS et aI. Farmakol ToksikoI41(5):556560 (1978) 22. Chakurski I. Matev M. Koichev A et aI. Vutr Boles 20(6}:51-54 (1981) 23. Isakowa TJ. Farmatsiya 5:31 (1980)
COMPARISON OF WESTERN AND
24. Samochowiec L. Herba Pol 29:151-155 (1983)
CHINESE USE OF CALENDULA
25. Wojcicki J, Samochowiec L. Herba Pol 26:233-237 (1980) (Abstract found in CA 1981;95:1808985)
In the case of Calendula, litdecomparison can be made in view of the paucity of information in the Chinese Herbal Medicine Dictionary since this herb appears to be one which is not gready used or understood in China. According to the Chinese Herbal Medicine Dictionary, Calendula officinalis (Jin zhan ju) cools the blood and stops. bleeding, and can be used for stomach cold and pain, abdominal hernia, abdominal masses, flatulence, and intestinal bleeding. This is interesting, since Lonicerus also listed Calendula for a cold stomach, and more recent Western texts have listed Calendula for peptic ulceration.
26. ShipochlievT.VetMed Nauki 18(4):94-98 (1981) 27. Wagner H, Prokscb A, Riess-Maurer 1 et aI. Arzneim-ForschlDrug Res 34:659-661 (1984) 28. Klouchek-Popova E. Popov A. Pavlova N et aI. Acta Physiol Pharmacol Bulg8(4):63-67 (1982) 29. Schmidgall J, Scbnetz E, Hensel A. Planta Med 66(1):48-53 (2000) 30. Wagner H. Proksch A. Riess-Maurer 1 et al. Arzneimittelforschung 35(7):1069-1075 (1985) 31. Kalvatchev Z, Walder R. Garzaro D. Biomed Pharmacotber 51(4):176180 (1997) 32. Boucaud-Maitre Y. Algernon 0, Raynaud J. Pharmazie 43:220-221 (1988)
-
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308
Combining Western Herbs and Chinese Medicine
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,
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,
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'
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33. Elias R, De Meo M, Vidal-Ollivier E et al. Mutagenesis 5(4):327-331 (1990)
41. Lonicerus A. Kreuterbuch (1679). Reprinted by Verlag Konrad Koibf e--~ '", Munchen, Germany (1962) ~'''''7:'-m-
34. Manolov P, Boyadzhiev Tsv, Nikolov P. Eksperim Med Morfol 3:41-45 (1964)
42. Tabernaemontanus IT. Krauterbuch (1731). Reprinted by Verlag Konrad Kolbl, Munchen, Germany (1993)
35. Avramova S, Portarska F, Apostolova B et al. Med Bioi Inf 4:28-32 (1988)
43. Gerard J. The Herbal or General History of Plants: The Complete 1633 "::~, Edition as Revised and Enlarged by Thomas Johnson. Dover ~ •.~;.
36. Hausen BM. AlIergiept1anzen Pt1anzenallergene: Handbuch und Atlas der allergie-induzierenden Wild- und Kulturpflanzen. Landsberg, Munchen: Ecomed Verlagsgesellschaft 83-84 (1988)
44. Culpeper N. Culpeper's Complete Herbal & English Physician Enlarged. Meyerbooks, Glenwood, Illinois (1990)
37. Isaac O. Die Ringelblume. Botanik, Chemie, Pharmakologie, Toxikologie, Pharmazie und therapeutische Verwendung. Stuttgart: W lSSenschaftliche Verlagsgesellschaft 65-66 (1992) 38. Willuhn G. Dtsch Apoth Ztg 132:1873-1883 (1992) 39. Mills S. The Essential Book of Herbal Medicine. Arkana, London, United Kingdom (1991) 40. European Scientific Cooperative on Phytotherapy: Monographs on the medicinal uses of plant drugs. European Scientific Cooperative on Phytotherapy, Exeter, United Kingdom (1997)
I
~,~.~
I
.. ;: ""
Publications, New York, New York ( 1 9 7 5 ),'-~ '
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45. Ellingwood F. American Materia Medica, Therapeutics and Pharmacognosy, 11th edn. (1919). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1994) 46. Lyle TI. Physio-Medical Therapeutics. Materia Medica and Pharmacy. Originally published Ohio (1897). Reprinted by the National Association of Medical Herbalists of Great Britain, London, United
11""'\
Kingdom (1932) 47. Felter HW, lloyd JU. King's American Dispensatory, vols 1 and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1983)
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Capsella
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Botanical name Capsella bursa-pastoris 1. Family Brassicaceae (Cruciferae) Pharmaceutical name Capsellae herba or Bursae pastoris herba Part dried aerial parts English shepherd's purse German Hirtentischel French bourse-a-pasteur Mandarin jl di Of-~) is the entire plant of C. bursa-pastoris L.
Dictionary: The sources cited in this work include not only provincial works, but also older classic texts. It seems that this herb has a long tradition of use, although it has not been a major herb in Chinese medicine. It is not listed in Bensky and GambleS or in Chang and But,6 but it is listed in Yeung' for hemorrhage, edema, and hypertension.
What is special about Capsella In terms of Chinese medicine, Capsella, as used in the West, can be said to be a neutral, sour herb, which has its primary effect on the Uterus, with secondary effects on the Stomach, Intestines, and Bladder.
Use in Europe Capsella is an annual or biennial herb, growing up to 80 cm in height on waste ground. 1 It is a native of Europe and is naturalized now in many countries. Z The common name shepherd's purse derives from the resemblance of the flat seed pods to 'an old fashioned common leather purse: 3 The alternative names of sanguinary and Herba sanguinariae relate to its long tradition of use to treat hemorrhages of all kinds. There has long been controversy oyer the degree of its effectiveness as an antihemorrhagic, which seems to be linked to whether the fresh or dried plant is used, and to how long it is kept in storage. This may in turn relate to the relative antihemorrhagic effectiveness of the active constituents in the fresh plant and their breakdown products on drying and storage (see the discussion in the section on Sources). Clarification of this un_certainty should be an important priority in further research on this herb.
The key to understanding Capsella is that it is a neutraltemperature, antihemorrhagic herb primarily used for excessive uterine bleeding, with secondary use as an anti-inflammatory astringent for gastric irritation and bleeding, diarrhea with bleeding, and cystitis with or without hematuria. CHINESE ACTIONS In terms of Chinese medicine, Capsella, as used in the West, can be said to have the following actions: 1. reduce bleeding II. astringent .
WESTERN ACTIONS
Use in China The entire plant of C. bursa-pastoris (1.) Medic. is listed as jl c~I in the Chinese Herbal Medicine
The main Western actions of Capsella are shown here in terms of its two main Chinese actions:
309
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310
Combining Western Herbs and Chinese Medicine
Chinese:actiorts-::::::---
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I. reduce bleeding
antihemorrhagic anti-inflammatory
II. astringent
astringent antihemorrhagic anti-inflammatory
--- -c:...
Capsella can be used even for hot or cold conditions, provid-":"~ ~ ing it is suitably combined with other herbs. -~~ ,
TASTE Capsella is a sour herb, limited mainly in its .use to reducing bleeding and diarrhea.
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WESTERN USES
ACTIONS
The main Western uses of Capsella are shown here in terms of its two main Chinese actions: Chinese actions I. reduce bleeding
II. astringent
Western uses abnormal uterine bleeding, gastric bleeding, diarrhea with bleeding, bleeding hemorrhoids, hematuria diarrhea, cystitis
DIRECTION OF ENERGY In terms of Chinese medicine, Capsella can reduce the leakage of Blood or Fluids, but it does not have marked directional effects on the flow of energy. TYPICAL CASE EXAMPLE
Antihemorrhagk Whilst Capsella has a tradition of use that includes healing wounds, nosebleeds, hemoptysis, hematemesis, and melena, its main use is as an antihemorrhagic for excessive uterine bleeding. Also, Capsella is a neutral-temperature antihemorrhagic and may not be sufficient to treat bleeding associated with Heat or Cold unless it is combined with cooling antihemorrhagics such as Sanguisorba or warming antihemorrhagics such as Myrica.
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Anti-inflammatory Although it is not its primary action, this herb can be used to treat gastric, intestinal, uterine, or urinary inflammatory conditions, especially if these are associated with bleeding.
Diagnosis The patient has Sinking of Spleen Qi with Deficient Blood.
Capsella paired with other herbs
Choice of Capsella This herb is specific for uterine hemorrhages and diarrhea, of what used to be called the chronic, passive type. This corresponds, in terms of Chinese medicine, to uterine hemorrhages or diarrhea associated with Sinking of Spleen Qi and Spleen not holding Blood. For this patient, Capsella would need to be combined with herbs that tonify the Spleen and Blood, such as Astragalus and Angelica sinensis.
Discussion of the limitations of each of the main actions of Capsella can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Capsella beyond its limitations. The basic unit of herb combination is the herb pair. Six pairings of Capsella are briefly explained below.
CAUTION
In this book, Capsella is classified as neutral and can be used for warm, neutral, cool, or mixed conditions. In fact,
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Astringent The primary use of this herb is to reduce bleeding, but it can also be used as a secondary herb to treat diarrhea or leukorrhea.
Urinary agent Capsella has a tradition of use in the West as a mild diuretic and as a urinary anticatarrhal, anti-inflammatory, and antimicrobial. However, I regard these as secondary actions of this herb compared to its primary action as a urinary antihemorrhagic.
TEMPERATURE
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Signs and symptoms The patient has a history of prolonged and heavy menstrual bleeding, with chronic exhaustion and some dizziness and blurred vision after menstruation. She has a tendency to diarrhea and to anemia. Her tongue is pale, thin, and dry, and her pulse is thin, choppy, and deep.
Limitations of Capsella
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Patients with hemorrhages require conventional medical diagnosis and may require conventional medical treatment prior to the use ofherbal therapy as an adjunct to conventional medical procedures. Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair.
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Capsella
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311
Capsella + Hydrastis
Capsella combinations
Menorrhagia + heat sensations Both herbs are specific for uterine hemorrhage, such as menorrhagia, metrorrhagia, and postnatal bleeding, and Hydrastis is a bitter, cooling anti-inflammatory and antimicrobial that is specific for uterine hemorrhage due to Heat. Both herbs can also be used for gastric bleeding, intestinal bleeding, and cystitis with hematuria. Capsella + Polygonum
Cystitis Both herbs can be used for urinary inflammatory conditions and for abnormal uterine bleeding. Polygonum is a cool herb that can be used for urinary or uterine bleeding associated with Heat. Capsella + Potentilla
Diarrhea + bleeding Potentilla is a relatively high-tannin, general-purpose astringent and antihemorrhagic, which can combine with Capsella to treat acute severe diarrhea with bleeding. Capsella + Ymca
Four Capsella combinations are discussed below: --~ ~--";
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Combination -" 1. severe menorrhagia
various syndromes
2. menorrhagia + heat sensations
Bleeding from Heat
3. menorrhagia + exhaustion
Spleen not holding Blood + Kidney Deficient Qi
4. menorrhagia + anemia
Spleen not holding Blood + Deficient Blood
CAUTION
Patients with hemorrhages require conventional medical diagnosis and may require conventional medical treatment prior to the use ofherbal therapy as an adjunct to conventional medical procedures. Before using any ofthe combinations below, it is important to be familiar with the cautions listed for each herb in the combination. 1. Severe menorrhagia
Various syndromes
Bleeding during pregnancy Both herbs, especially Vinca, are specific for excessive uterine bleeding and can form the basis of combinations for menorrhagia, bleeding during pregnancy, and postnatal bleeding.
Capsella Vinca Geranium Quercus
1 1 1 1
neutral neutral neutral neutral
sour sour sour sour. bitter
GENERAL
Capsella + Astragalus
Menorrhagia + exhaustion Astragalus can be used to treat bleeding associated with exhaustion and with the syndromes of Spleen Deficient Qi, Sinking of Spleen Qi, and Spleen not holding Blood. According to research, Capsella can have uterotonic action and has a specific tradition of use for uterine hemorrhage. ___ J
Capsella + Cinnamomum bark
Menorrhagia + cold sensations Hot Cinnamomum can be combined with neutral Capsella to treat diarrhea or" excessive uterine bleeding with sensations of cold associated, in terms of Chinese medicine, with Kidney Deficient Qi and Yang. Cinnamomum appears to have astringent and antihemorrhagic actions in addition to treating the underlying patterns of Spleen and Kidney Yang Deficiency.
This combination is a first aid prescription for severe, abnormal uterine bleeding from various etiologies. The overall temperature is neutral, but the temperature of the combination can be modified by the addition of other herbs, according to the needs of the situation. The dominant taste is sour associated with the antihemorrhagic action. USE
• severe, abnormal uterine bleeding, including menorrhagia. metrorrhagia. and postnatal bleeding PRACTICAL NOTES
This combination can be taken as 2.5 ml of 1:5 tincture. in quarter of a cup of water, every two hours. This combination is designed for short-term use only, and assoon as the bleeding has subsided, it can be replaced by a more tonic combination, such as Capsella: menorrhagia + exhaustion or Capsella: menorrhagia + anemia, if appropriate.
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312
..
Caution Both Geraniwn and Quercus contain relatively high amounts of tannin, so that this combination may not be appropriate to be used in high doses long-term; see the Toxicology and Cautions sections in the chapter on Potentilla for a discussion of tannins. 2. Menorrhagia + heat sensations
Bleedingfrom Heat Herb Capsella Vinca Hydrastis Sanguisorba Polygonum
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GENERAL
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This combination is for menorrhagia with exhaustion "'0; associated with Spleen not holding Blood and Kidney:;;~ Deficient Qi. There may also be Deficient Blood. The overall~ -: temperature of the combination is warm to treat cool or cold.~Yi conditions. The dominant tastes are sour to stop bleeding '.'.f-:$it and sweet, aromatic, and acrid to tonify, warm, and move the";'~ ': Qi of the Kidney and Uterus. ':~~_:~ .- .... USE
Temperature
Taste
neutral neutral cool cool cool
sour sour bitter sour, bitter sour, sl. bitter
1 1 1 1 1
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• abnormal uterine bleeding (including menorrhagia. metrorrhagia, bleeding in pregnancy, and postnatal bleeding) with exhaustion and sensations of cold; maybe lwnbar pain, urinary frequency, tinnitus, and poor concentration
GENERAL
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PRACTICAL NOTES
This combination is for menorrhagia with heat sensations associated with bleeding due to Heat. There may be syndromes of Heat, Deficiency Heat, Heat in the Blood, Damp Heat. Heat Toxin, and/or Stagnation of Qi and Blood. The overall temperature of the combination is cool to treat warm or hot conditions. The dominant tastes are sour to stop bleeding and bitter to clear Heat. USE
• abnormal uterine bleeding, including menorrhagia, metrorrhagia, and postnatal bleeding, with sensations of heat and bright red or dark red blood .
This combination'can be taken as 5 m.l of 1:5 tincture in. quarter of a cup of hot water, three to four times per day whilst the bleeding occurs. After the bleeding has subsided. continue at half-dose for 1-2 weeks before modifying or replacing the combination.
4. Menorrhagia + anemia
Spleen not holding Blood + Deficient Blood Herb
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of water, three to four times per day. This combination is designed for relatively short-term use, not more than 1-2 weeks, and as soon as the bleeding has subsided, this combination can be modified or replaced.
Caution This combination is not appropriate for patterns of Deficiency and Cold.
,---
Caution This combination is not appropriate for patterns of Heat or Excess.
---_...
PRACTICAL NOTES
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Capsella Vinca Achillea Agrimonia Urtica Angelica sin. Myrica Capsicum
Ratio
Temperature Taste
1 1 1 1 1 1 1 5-20 drops
neutral neutral warm-<:ool neutral warm-<:ool warm warm hot
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sour sour acrid. bitter sour, sl. bitter acrid sweet, aromatic. bitter aaid. sour, bitter acrid
GENERAL
3. Menorrhagia + exhaustion
Spleen not holding Blood + Kidney Deficient Qi .;".
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1.5
:1,.5 1.5 1 1 0.5 0.5
neutral neutral 51. warm warm 51. warm neutrak:ool hot
sour sour sweet sweet. aromatic. bitter sweet, sl. bitter sweet acrid, sweet, aromatic
This combination is for menorrhagia v.'ith anemia associated with Spleen not holding Blood and Deficient Blood. If the menorrhagia, resulting from Spleen not holding Blood, is associated with Cold rather than with Deficient Blood, Myrica: menorrhagia + cold sensations is a more appropriate combination. The overall temperature of the combination is warm to treat cool or cold patterns, but Myrica and/or Capsicum can be omitted if a neutral or warm condition is treated. The sour constituents are to stop bleeding, and the sweet con- __ stituents, assisted by the bitter, aromatic. and acrid con-
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Capsella
313
stituents, tonify the Blood. The acrid constituents can dis,."
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perse Cold. USE r-;
• abnormal uterine bleeding (including menorrhagia, metrorrhagia, bleeding in pregnancy, and postnatal bleeding) with exhaustion, anemia or low red blood cell count, and maybe sensations of cold
Capsella Vinca Astragalus Angelica sin. Panax gin. Glycyrrhiza Cinnamomum (bark)
1.5 1.5 1.5 1 1 0.5 0.5
Capsella Vinca Achillea Agrimonia Urtica Angelica sin. Myrica Capsicum
1 1 1 1 1 1 1
5-20 drops
PRACTICAL NOTES
The herbs in this combination, other than Capsicum, are conveniendy taken as 5 ml of a 1:5 tincture, in quarter of a glass of warm water, three times per day. Drops of 1:5 Capsicum tincture can be added from a separate botde, as required. This combination can be taken whilst bleeding occurs. After the bleeding has subsided, it can be continued at half-dose for 1-2 weeks before modifying or replacing the combination.
Caution This combination is not appropriate for patterns of Heat or Excess.
COMPARISON OF THE FOUR . CAPSELLA COMBINATIONS f·
1. Severe menorrhagia
Various syndromes Herb Capsella Vinca Geranium Quercus
1 1 1 1
Capsella Vinca Hydrastis Sanguisor1:>a Polygonum
bark, which reduces bleeding by warming and tonifying both Spleen and Kidney Qi. Panax and Glycyrrhiza are included to tonify Kidney Qi.
4. This combination replaces the Kidney tonic herbs Cinnamomum, Panax, and Glycyrrhiza, with the Blood tonic herbs Achillea and Urtica, which also have antihemorrhagic action. Agrimonia is included as a mild antihemorrhagic, which can also act as a mild bitter tonic to assist the more bitter Achillea in tonifying Blood.
Capsella is also found in the following combinations:
Bleedingfrom Heat Herb
Astragalus, which reduces bleeding by raising Spleen Qi to assist the Spleen in holding the Blood, and Cinnamomum
OTHER CAPSELLA COMBINATIONS
2. Menorrhagia + heat sensations
Ratio
3. This combination also contains Capsella and Vinca, like the previous two combinations. However, it includes
Ratio
• Arctostaphylos: cystitis + hematuria • Calendula: peptic ulcer + bleeding • Myrica: menorrhagia + cold sensations
1 1 1 1 1
Research CONSTITUENTS
1. Geranium and Quercus are relatively high-tannin, general-purpose antihemorrhagic herbs. Capsella and Vinca are antihemorrhagics with a lower tannin content and are more specific for uterine hemorrhages. 2. This combination contains Capsella and Vinca, like the previous combination, but replaces the high-tannin, first aid, neutral-temperature antihemorrhagics, Geranium and Quercus, with three cooling antihemorrhagics, Hydrastis,
The following constituents have been reported: l • flavonoids: including luteolin and quercetin 7rutinosides and luteolin 7-galactoside • glucosinolates: including sinigrin (2-propenylglucosinolate) • amino acids: including proline and an antihemorrhagic peptide8
Sanguisorba, and Polygonum.
• potassium salts
3. Menorrhagia + exhaustion
• vitaminC • saponins: previously reported; their presence is now uncertain
Spleen not holding Blood + Kidney Deficient Qi
4. Menorrhagia +
anemia Spleen not-holding Blood + Deficient Blood
• amines: previously reported; their presence is now uncertain
314
Combining Western Herbs and Chinese Medicine'
The pharmacologically important constituents appear at present to be luteolin, quercetin, sinigrin, and possibly the antihemorrhagic peptide.
PHARMACOLOGICAL AND CLINICAL RESEARCH
.
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Cardiovascular Both luteolin and quercetin showed rel~:~j. .\ 18 ant effects on rat isolated thoracic aortas. In a study in ..,.~ : which corneal blood vessels were chemically induced to pro-. c.'~' liferate, luteolin was found to inhibit the corneal angiogene-::~-"-: sis in vivo. The authors suggested that such flavonoids in the S~ diet may help to prevent neovascular disease of the eye. 19 ",
Antihemorrhagic Capsella extracts have been reported to ~'~ ..
The following effects have been reported for Capsella preparations or for isolated constituents: • antimicrobial • anti-inflammatory and antiallergic • antioxidant • anti-HIV • cardiovascular • antihemorrhagic • uterotonic • antitoxin • antitumor Most of the effects reported below are using isolated constituents of Capsella. It is not yet clear whether the level of these constituents is sufficiently high in the plant to confer these same effects to Capsella herb extracts. Antimicrobial
Capsella Extracts of C. bursa-pastoris and alkaloids and flavonoids from this species showed antimicrobial activity. It was suggested that the alkaloids might be yohimbine and ergocristine, and that the flavonoids might include diosmin.9 Sinigrin Studies on sinigrin found it to be relatively innocuous to the microorganisms tested,lo.1I but its hydrolysis products, isothiocyanates, thiocyanates, and nitriles, inhibited the growth of a range of bacteria. II Quercetin and luteolin Both these flavonoids showed inhibitory activity against methicillin-resitant Staphylococcus aureus, using the disc-diffusion assay and the broth dilution assay.12 Luteolin was reported to be a potent antileishmanial agent, and both luteolin and quercetin reduced the splenic parasite burden in animal models. 13 Anti-inflammatory and antiallergic It has been reported that luteolin inhibits proinflammatory cytokine production in murine macrophages l4 and inhibits the IgE antibodymediated biphasic cutaneous reaction in mice. IS Antioxidant Both luteolin and quercetin have been shown to have antioxidant effects using the DNA protective method. 16 Ariti-HIV The flavanol quercetin showed potent inhibitory activity against the human immunodeficiency virus (HIV)-l protease using fluorescence and HPLC assays. The flavone luteolin showed moderate activity. 17
have an antihemorrhagic action, which was thought to be 8 due to a peptide with in vitro oxytocin-like activity.
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Uterotonic Experiments with isolated rodent uterus tissue reported that Capsella infusion increased the uterine muscle tone.: o Antitoxin Fumaric acid was isolated as the active compo- .. ~?; nent of C. bursa-pastoris in enhancing the recovery of mouse:~ --, and chick embryo cells from the toxic effects of a variety of •,.~.;.w chemicals.21 - .. Antitumor
Fumaric acid In the same study, fumaric acid inhibited the growth of Ehrlich tumor in mice.
5"'"/.)-.
~J: .".~. <-.~
Sinigrin In another study, sinigrin was reported to inhibit rat tongue carcinogenesis induced by 4-nitroquinoline 122 oxide, both in the initiation and postinitiation phases. Flavonoids Leutolin was reported to inhibit arylamine Nacetyltransferase activity in human liver tumor cells (cell '" 24 line J5),23 and in human and mouse leukemia cells. Quercetin and luteolin were shown to inhibit estrogeninduced proliferation of human breast carcinoma MCF-7 cells. 2S RESEARCH VERIFICATION OF TRADITIONAL ACTIONS The following traditional actions of Capsella have been supported by research on Capsella extracts or isolated constituents: antihemorrhagic, antimicrobial, anti-inflammatory, and antitumor. Additional effects demonstrated by research The following additional effects have been reported for isolated constituents of Capsella, as discussed above, but not as yet for the herb itself: antiallergic, antioxidant, anti-HIV, uterotonic, and antitoxin.
TOXICOLOGY I have not found any information on the toxicity of Capsella bursa-pastoris.
~~'-t
r::
Capsella ,- -.- ~~
Dose
-
Dried herb
The BHp 26 listed 1-4 g of the dried herb, three
times per day. Tincture The BHP listed 1-4 ml of 1:1 liquid extract (in 25% alcohol), three times per day.
315
In this book, Capsella is listed as neutral in temperature. However, the temperature of this herb may depend on whether the sample is fresh or dry, and on how long the dried material has been stored since chemical changes occur during the drying and storage. Taste
Taste in the mouth The BHP described Capsella as punInitial dose
Can start at the standard dose.
Duration No restrictions are known.
Caution Western contraindications None reported. Chinese contraindications
None listed in the Chinese
Herbal Medicine Dictionary. Pregnancy and lactation No adverse reports. Side effects None reported. Overdose No adverse reports.
gent, Wichtl described it as somewhat acrid and bitter, and Felter and lloyd wrote that it has a pungent, biting taste that is lost by drying. I found a 1:5 Capsella tincture in 25% alcohol to be sour and slightly bitter, with a somewhat unpleasant taste.
Taste properties The main text cited in the Chinese Herbal Medicine Dictionary classified jl cal as sweet. However, two subsidiary cited texts classified it as astringent and as sweet and acrid. Capsella is classified as sour in this book associated with its astringent and antihemorrhagic actions. However, both the taste in the mouth and the taste properties of this herb may depend on whether the sample is fresh or dry, and on how long the dried material has been in storage.
Interactions No adverse reports. ORGANS
"
Regulatory status Please read the Regulatory status section in the chapter on Safety. Capsella (shepherd's purse) is on the UK General Sale List and is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Capsella is not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warn- _ ing on its use.
Traditional sources . PROPERTIES 27
Temperature Gerard reported that Matthiolus said that Capsella is cold and dry, but then wrote that Lobel said that Capsella was hot and dry because of its sharp taste. Gerard himself did not list a temperature for this herb, but both Culpeper8 and Tabarnaemontanus2'.l listed it as cooling and drying. The main text cited in the Chinese Herbal Medicine Dictionary classified jl cal (the entire plant of C. bursa-pastoris) as neutral. However. two subsidiary cited texts classified it as warm and as cool-neutral.
In terms of Chinese medicine, Capsella, as used in the
West, can be associated mainly with disorders of the following organ systems: Organ
Examples of use
Source
Uterus
heavy menstrual bleeding uterine hemorrhage
Tabernaemontanus BHP
Stomach
inflamed stomach hematemesis
Lonicerus 3O BHP
Intestines
chronic diarrhea, bleeding hemorrhoids
Felter and Lloyd
Bladder
hematuria acute catarrhal cystitis
Ellingwood 31 BHP
The main text cited in the Chinese Herbal Medicine Dictionary listed jl cal (the entire plant of C. bursa-pastoris) as entering the Liver, but a subsidiary text cited listed it as entering the Liver, Small Intestine, and Lung. ACTIONS The following traditional actions are discussed: • antihemorrhagic • astringent • antimicrobial
316
1
Combining Western Herbs and Chinese Medicine
• anti-inflammatory • urinary agent • antitumor
Anti-inflammatory Both Culpeper and Gerard recom:"~~,-2 ~ mended Capsella for inflammations, Lonicerus listed it for:'::'-;~~ \ an inflamed stomach, and both Ellingwood and Felter and ... ..0::',
Lloyd noted its use for atonic dyspepsia. Antihemorrhagic Lonicerus said that Capsella is better for stopping bleeding than any other herb, and Gerard wrote that it can be used for bleeding in any part of the body. Culpeper recommended this herb for spitting blood, bloody diarrhea, bloody urine, menstrual hemorrhage, and external bleeding wounds. In 1769, William Lewis32 wrote that 'there does not appear to be any foundation for the strong styptic virtues for which this herb has been generally recommended: However, Capsella enjoyed a renaissance with the Eclectics in North America in the late 19th century. Ellingwood listed itS use for mild gastric, intestinal, urinary, and uterine hemorrhages; and Felter and Lloyd noted that it could be very efficient for hematuria and could also be used for other types of chronic hemorrhage. Felter and Lloyd wrote that Capsella is specific for 'menorrhagia with too frequent and long continued, or constant, colorless discharge: According to Kloss,33 Capsella can be used for all internal hemorrhages, and 'has been successful in such cases when all other remedies have failed: He recommended Capsella for bleeding of the lungs, as did Grieve who also listed it for nosebleeds. The BHP gave the specific indication of Capsella as uterine hemorrhage and also listed it for gastric and urinary bleeding. According to Rosemary Gladstar,34 fresh Capsella is one of the best herbs to stop hemorrhage, is specific for excessive menstrual flow, can be used for bleeding during pregnancy, and is excellent for excessive bleeding after childbirth. Both Michael Tierra3s and Michael Moore 36 recommended fresh Capsella for menorrhagia and for postnatal bleeding. Astringent Lonicerus, Tabernaemontanus, and Culpeper all listed Capsella for diarrhea. Ellingwood wrote that Capsella can be used for 'diarrhea both acute and chronic, dysentery, and bleeding piles: Felter and Lloyd gave one of its specific uses as chronic diarrhea, and Kloss, Grieve, and the BHP all listed it as an antidiarrheal. Bruneton37 noted the use of Capsella in France to 'relieve the subjective symptoms of venous insufficiency such as fullness in the legs, and the symptoms of hemorrhoids: The use of this herbs for hemorrhoids and varicose veins is also list,ed in Mabey.38 Antimicrobial The BHP listed Capsella as a urinary antiseptic, but I have not found any other references to an antimicrobial action.
. ::-::::~~ '"
Urinary agent Both Lonicerus and Tabernaemontanus ~~~r-I recommended Capsella to increase urination, and Lyle wrote that it increases the flow of urine and relieves atonic and sluggish conditions of the urinary system. According to Ellingwood, it can act as a mild diuretic and as a urinary anti-inflammatory, especially in conditions in which uric acid or phosphates produce urinary irritation. Felter and Lloyd listed it for a 'constant desire to urinate, with deposits of phosphates: Grieve wrote that Capsella increases the flow of urine and is an important remedy for catarrhal conditions of the bladder or ureters, and in ulcerated conditions and abscesses --, ~ of the bladder. She wrote that it is specific for white mucous __ ::: matter in the urine, giving speedy relief. The BHP listed ,...::=.:. Capsella as an urinary antiseptic for acute catarrhal cystitis. Tierra recommended it for difficult urination, and Moore listed it for hyperuricemia (also known as hyperuricacidernia). Antitumor Ellingwood noted the use of Capsella to treat nonmalignant abdominal tumors in women, which is ipteresting in light of the antitumor effects reported by research on the isolated Capsella constituents fumaric acid, sinigrin, quercetin, and luteolin; see the section on Pharmacological and clinical research above.
A
DOUBLE CONTROVERSY
.- The efficacy of Capsella William Lewis in 1769 was not the only author to question the efficacy of Capsella. Weiss 39 wrote that there was considerable dispute as to whether Capsella really has an effect on uterine hemorrhage. According to his summary of the research, Capsella definitely has antihemorrhagic properties, but they are inconsistent. He suggested two possible explanations for the inconsistencies: • the hemostatic action is not due to the plant. but to a white fungus commonly found upon it so that only plants with the fungus have hemostatic properties • the active principles 'only form in the drug after some time, through the conversion of other principles, and are lost again as further conversions occur on extended storage' According to Wichtl, the maximum activity of Capsella extracts is supposed to be reached 3 months after preparation.
Capsella Use of fresh or dried material Felter and lloyd noted that the pungent taste of the fresh herb is lost on drying, and wrote that the fresh herb is decidedly more active than the dried. The Capsella tincture recommended by Lyle was made from the green herb, and both Tierra and Gladstar recommended tincture made from fresh material. Moore listed the use of fresh herb tincture or recently dried herb tincture. However, Grieve wrote that when dried and infused, Capsella is one of the best specifics for hemorrhages, and the BHP described the use of the dried material. Future research Using a series of samples of Capsella, from freshly cut green plant to dried material 6 months in storage, it would be useful to compare any changes in the levels of active constituents, such as sinigrin, luteolin, or specific peptides, with changes in effectiveness as an antihemorrhagic. This research could determine the optimum time of storage at which to prepare tinctures of this herb.
COMPARISON OF WESTERN AND CHINESE USE OF CAPSELLA Capsella is one of the main antihemorrhagic herbs used in the West, especially for uterine hemorrhage. Although Capsella has a long tradition of use in China, it does not appear to have been such an important herb in China as in the West. According to Yeung, )1 cal can clear heat from the Blood and eliminate heat through urination. Yeung listed jl cal for hematuria, uterine bleeding, edema, and hypertension. According to the main text cited in the Chinese Herbal Medicine Dictionary jl cal harmonizes the Spleen, benefits urination, stops bleeding, and brightens the eyes. The herb is used for edema, diarrhea, melena, uterine bleeding, and eye pain and redness. According to one subsidiary text cited., jl . cal can tonify the Spleen. The Western and Chinese actions and uses of Capsella are compared under the following headings:
317
astringent both in China and the West, especially for diarrhea with blood in the stool. Capsella appears to have been more used as an astringent for varicose veins and hemorrhoids in the West than in China. Anti-inflammatory Capsella has an old tradition of use in the West for inflammations, for example, of the stomach, whereas in China it has been used for red, painful eyes. Urinary agent Capsella has been used as a diuretic and urinary anti-inflammatory in both China and the West, but the diuretic use is more emphasized in China.
References 1. Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm. Stuttgart. Germany (1994), from 2nd German edn. Wicht! M (ed) (1989) 2. Felter HW; Lloyd JU. King's American Dispensatory, vols. 1 and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1983) 3. Grieve M. A Modern Herbal. vols. 1 and 2. Dover Publications, New York, New York (1971) 4. Jiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science and Technology Press. Shanghai. China (1975) 5. Bensky D, Gamble A. Chinese Herbal Medicine Materia Medica. Eastland Press, Seattle.Washington (1986) 6. Chang H-M, But PP-H (eds). Pharmacology and Applications of Chinese Materia Medica. vols. 1 and 2. World Scientific Publishing, Singapore (1986) 7. Yeung H-C. Handbook of Chinese Herbs and Formulas, vol. l. Institute of Chinese Medicine. Los Angeles, California (1985) 8. Kuroda K, Takagi K. Nature 220:707 (1968) 9. El-Abyad MS. Morsi NM, Zaki DA et al. Microbios 62(250):47-57 (1990) 10. KyungKH,FlemingHP.JFoodProg60(1):67-71 (1997) 11. BrabbanAD. Edwards C. J Appl Bacterial 79(2):171-177 (1995) 12. Xu HX. Lee SF. Phytother Res 15(1):39-43 (2001) 13. Mittra B.SahaA,Chowdhury ARetal. Mol Med 6(6):527-541 (2000)
• antihemorrhagic • astringent • anti-inflammatory • urinary agent Antihemorrhagic Capsella has had general use as an antihemorrhagic, and specific use as a uterine antihemorrhagic, iri both China and the West. However, it seems to have been a more frequently used herb in the West than in China. Also, it has been more used for gastric bleeding in the West than in China.
14. Xagorari A, Papapetropoulos A, Mauromatis A et al. J Pharmacol Exp Ther296(1):181-187 (2001) IS. Kimata M, Inagaki N, Nagai H. Planta Med 66(1):25-29 (2000) 16. Romanova D. Vachalkova A. Cipak L et al. Neoplasma 48(2):104-107 (2001) 17. XuHX, WanM, Dong H et al. Biol Pharm Bull 23(9):1072-1076 (2000) 18. Chan Ee. Pannangpetch P, Woodman 01. J Cardiovasc Pharmacol 35(2);326-333 (2000) 19. JoussenAM,RohrschneiderK,ReichlingJ etal.ExpEye Res 71(5):483487 (2000) 20. ShipochlievT. Vet Med Nauki 18(4):94-98 (1981)
Astringent
Capsella has been used as an antidiarrheal
21. Kuroda K.AkaoM.Gann 72(5):777-782 (1981)
,".-0:,'-
318
Combining Western Herbs and Chinese Medicine
22. Tanaka T, Kojima T, Morishita Yet al. Jpn J Cancer Res 83(8):835-842 (1992)
-~'"",
32. Lewis W. An Experimental History of the Materia Medica. Potts, __ Dublin, Eire (1769)
23. Chen JC, Chung JG, Lin KM. Cytobios 102(400):95-106 (2000) 24. Li YC, Hung CF, Yeh IT et al. Food Chern ToxicoI39(7):641-647 (2001) 25. Han D, Tachibana H, Yamada K. In Vitro Cell Dev Bioi Anim 37(5): 275-282 (2001) 26. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983) 27. Gerard J. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publications. New York, New York (1975) 28. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks, Glenwood, Illinois (1990) 29. Tabernaemontanus
.. c~
JT.
Krauterbuch (1731). Reprinted by Verlag
Konrad Kolbl, Miinchen. Germany (1993) 30. Lonicerus A. Kreuterbuch (1679). Reprinted by Verlag Konrad Kolbl, Milnchen, Germany (1962) 31. Ellingwood F. American Materia Medica, Therapeutics and Pharmacognosy, 11th edn. (1919). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1994) -
. -",~
.
_I
,""'~
33. Kloss J. Back to Eden. 5th edn. (1939). Reprinted by Lifeline Books, Santa Barbara, California (1975) 34. Gladstar R. Herbal Healing for Women. Fireside. New York, New York (1993)
-.
35. Tierra M. Planetary Herbology. Lotus Press, Twin Lakes, Wisconsin (1988) 36. Moore M. Medicinal Plants of the Pacific West. Red Crane Books, Santa Fe,New Mexico (1993) 37. Bruneton J. Pharmacognosy: Phytochemistry Medicinal Plants, 2nd --, ',-j
edn. Lavoisier, Paris. France (1999) 38. Mabey R (ed). The Complete New Herbal. Elm Tree Books, London. United Kingdom (1988) 39. Weiss RF. Herbal Medicine, English edn. Beaconsfield Publishers, Beaconsfield, United Kingdom (1988)
-
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Capsicum Botanical name
cepts and experience, the Physiomedical and Eclectic practitioners of North America developed the use of Capsicum as a general, circulatory, and digestive stimulant and tonic. Today, Capsicum is the main warming circulatory stimulant used in the West, with applications to disorders of the respiratory, digestive, cardiovascular, urinary, reproductive, musculoskeletal, nervous, and endocrine systems.
Capsicum species
Family Solanaceae Pharmaceutical name
Capsici fructus
Part dried ripe fruit English cayenne, chillies German Cayennepfeffer, Chilipfeffer French piment de Cayenne Mandarin 130 jiao is the ripe fruit of Capsicum
Part used According to Evans,3 the dried ripe fruits of Capsi-
species
cum annuum var. minimum (Miller) Heiser, and smallfruited varieties of C. frutescens L. are commonly used.
Use in the West Capsicums may be native to the American continent and may have been used as herbal medicines in
Nomenclature The nomenclature of the various Capsicum
1
antiquity by the Maya of Central America. According to Crellin and Philpott,2 the 1552 Aztec herbal, the Badianus Manuscript, referred to the use of Capsicum for toothache and scabies. Capsicums were mentioned in 1494 by Chanca, a doctor
species and their varieties can be confusing. Bruneton listed C. annuum L. and C. frutescens L. as separate species, and listed their hybrids as C. chinense, C. pubescens, and C. pendulum. However, according to the Chinese Herbal Medicine Dictionary,lO C. annuum L. is identical to C. frutescens L.
who sailed with Columbus. 3 The Portuguese may have brought cayenne pepper to India, and according to Grieve, Capsicum was introduced to Britain from India in 1548.~
Use in China The main entry for Capsicum in the Chinese Herbal Medicine Dictionary is under C. frutescens L. (130 jiao). There is also a brief entry under Capsicum frutescens L var. conoides (Mill.) Bailey (zhl ,tian jiao). Although reference is made to 130 jiao in the Chinese Herbal Medicine Dictionary, Capsicum is not one of the most used herbs in Chinese medicine, and this is reflected by the wide variety of opinion on its temperature in the Chinese texts cited.
Whilst Capsicums were used as spices in Europe in the 16th and 17th centuries, British and German herbalists, such as S
Culpeper,; Gerard,6 Lonicerus/ and Tabernaemontanus
do not seem to have been experienced in their use. Gerard wrote that ginnie pepper (Capsicum) was said to warm the
,,'
stomach and aid digestion, and to dissolve cold swellings. In 'the early 19th century Samuel Thompson proposed that the origins of disease are mainly associated
with
What is special about Capsicum ,.
a
reduction of the vital heat of the body. Therefore, the aim of his treatment was always to restore this vital heat, usually involving the use of Capsicum.9 Building on Thompsons con-
In terms of Chinese medicine, Capsicum, as used in the West, can be said to be a hot herb, and its main taste property
319
'I' ~
320
Combining Western Herbs and Chinese Medicine
......
~~:/
is acrid. Capsicum is used mainly to warm the Interior but also, to a lesser degree, to clear the Exterior of Wind Cold Damp. It has its main effect on the Heart, Spleen, Stomach. Intestines. and Lung systems. It may have effects on the Kidney system, but these are not yet clear.
sarily lead to long-term depletion or destabilization of system. On the contrary, it tends to fulfill the definition of a"..!ji [ tonic by resulting in a gradual. cumulative. and prolonged~§;1 increase in the function of one or more organ systems or the=;t' body as a whole. . .-~Ll
The key to understanding Capsicum is that it can have both a rapid. transient stimulant action and a more gradual, cumulative tonic action. It can act as a circulatory stimulant internally and as a counterirritant externally to move Stagnation of Qi and Blood. By moving Stagnation, it can help to clear accumulation of Wind, Cold, Damp, Phlegm, Retained Pathogen, Heat. or Heat Toxin.
Circulatory stimulant Capsicum has a tradition of use in ~fJi;. the West as a circulatory stimulant. In the specific case of-.~ 1 Capsicum. the circulatory stimulant action may include a number of overlapping effects. It may: ..;,
CHINESE ACTIONS In terms of Chinese medicine. Capsicum. as used in the West. can be said to have five main actions: I. II. Ill. IV:
v:
clear Heat move Qi and Blood tonify Qi and Yang clear Wind Cold Damp topical
.'.~;
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--ld
i.~~ ~
• increase coronary circulation to relieve angina and to "~:~. strengthen weak heart function • increase systemic circulation to warm the body as a whole, including the extremities; or to disperse locally accumulated Heat by moving Stagnation and equalizing circulation • increase circulation to the surface of the body, inducing .. ~. diaphoresis to clear Exterior Cold or clear Interior Heat ··~~C Using a hot herb to clear Heat
WESTERN ACTIONS The main Western actions of Capsicum are shown here in terms of its five main Chinese actions: Chinese actions I. clear Heat
circulatory stimulant and equalizer antihypertensive
II. move Qi and Blood
antianginal circulatory stimulant
III. tonify Qi and Yang
stimulant tonic cardiotonic antidepressant
IV. clear Wind Cold Damp
diaphoretic circulatory stimulant antirheumatic
V. topical
counterirritant analgesic antimicrobial
Tonic In my opinion. Capsicum has both stimulant and tonic actions. If a stimulant is defined as a substance that causes a rapid and transient increase in mental or physical activity, metabolic rate, or body temperature. then Capsicum meets this requirement. However. unlike some stimulants. such as the amphetamine group. Capsicum does not neces-
In terms of Chinese theory Capsicum is a hot herb that is mainly used to stimulate and tonify Qi and Yang, and to move Qi and Blood to clear both Interior and Exterior Cold and Damp. However. in certain cases, it may be used to disperse Interior Excess Heat that is accumulating as a result of Stagnation. For example, chronic emotional frustration and blockage in life and relationships may be associated with Stagnation of Heart and Liver Qi, which may then generate ...•
Heart and Liver Heat. This Heat may rise up the body. producing sensations of heat, congestion, discomfort. and even pain in the face and head. There may also be raised blood pressure. In certain cases. Capsicum may disperse the Heat accumulating in the upper body by stimulating the systemic circulation so that local Stagnation of Qi and Blood and local accumulation of Heat are dispersed. Caution Careful screening and monitoring are needed for the use of this technique.
This technique of using a hot herb to clear Heat is not appropriate for all patients with hypertension or even all patients with hypertension associated with the syndromes of Heart and Liver Heat. The suitability of this technique depends on the relative strengths of two effects: • Capsicum stimulates the circulation to move the Stagnation and to disperse the accumulated Heat • Capsicum increases the body Heat If the first effect is dominant, the technique may be appropriate since the underlying condition and the symptoms both improve. However. if the second effect is dominant. the
.~
.~.
r-,
Capsicum
I t
technique may be inappropriate since the symptoms may be aggravated, whilst the underlying condition is not resolved. See Capsicum: hypertension + heat sensations, and see Cau-
tions section. In terms of Physiomedical theory Christopher said that Capsicum regulates the flow of blood from the head to the feet, equalizing the blood circulation, so that it can be used to treat either low or high blood pressure. This empirical use of Capsicum for normalizing blood pressure can be related to the concepts of Physiomedicalism. In 1842, Beach discussed the concept of equalizing the circulation. In 1879, this idea was further developed by Cook, who emphasized the interaction between the circulatory and nervous systems, and the importance of normalizing the balance of these systems in cases of hyper- or hypofunctioning of the systems. 11
.~
... Counterirritant In terms of Chinese medicine, Stagnation of Qi and Blood may occur in a local area of the body surface. Associated with the Stagnation, there may be accumulation ofWmd, Cold, Damp, Phlegm, Retained Pathogen, Heat, or Heat Toxin in that area. In Western terms, there may be pain, swelling, edema, inflammation, infection, pus, or skin lesions. The irritant effect of an herb such as Capsicum increases the local movement of Qi and Blood so that the accumulated Pathogens are dispersed and cleared from the area. In Western terms, Capsicum stimulates the local blood vessels and nerve supply, initiating a wound-healing response. Transient irritation and discomfort is associated with stimulation of the local restorative processes of the body.
Using a hot herb to clear Heat: topical effects As with the circulatory stimulant action of Capsicum, the counterirritant action can also clear Heat in certain cases, if the inflammation is resulting from Stagnation. By dispersing the Stagnation of Qi and Blood, Capsicum can disperse the accumulation of Heat. Capsicum can also have a direct antimicrobial action. Warming antimicrobial A common conception of an antimicrobial substance is that it may kill microorganisms or inhibit their growth, and that it is cold in nature with a detrimental effect on the metabolism of the body or its beneficial gut flora. This may be true, not only of many conventional antibiotics, but also, to a lesser extent, of some of the cold bitter antimicrobial herbs, such as Baptisia or Hydrastis. However, some herbs with antimicrobial action are warm (Commiphora) or hot (Capsicum or Allium) in nature. These warm antimicrobials are especially useful for internal use when there are Cold Deficient patterns,.either in the body as a ';hole or of the Spleen in particular.
321
Local analgesic After a transient irritant effect with burning sensation and discomfort, Capsicum can act as a local analgesic for a wide variety of painful local conditions of the body surface, including arthritis, diabetic neuropathy. unbroken chilblains, and psoriasis. WESTERN USES The main Western uses of Capsicum can be related to its five main Chinese actions: Chinese actions .
Western uses .
I. clear Heat
agitation, insomnia, sensations of heat, hypertension
II. move Qi and Blood
angina, poor peripheral circulation, depression
III. tonify Qi and Yang
exhaustion
IV. clear Wind Cold Damp
influenza, rheumatism
V. topical
local pain, chronic sore throat
DIRECTION OF ENERGY Capsicum can be said to have a moving, spreading effect on the circulation of Qi and Blood, specifically improving circulation both within the heart and within the body as a whole. Its effect of moving Qi and Blood outward to the surface may not be so marked as with Zingiber, and its effect of moving Qi and Blood to the extremities may not be so marked as with Zanthoxylum. However, it has a tradition of use for equalizing the circulation throughout the body, which is more marked than that of either Zingiber or Zanthoxylum, so that Capsicum may be used for either hypo- or hypertension. TYPICAL CASE EXAMPLE Signs and symptoms The patient is exhausted and depressed with sensations of cold in both the body and limbs and sensitivity to cold and damp. In addition, the patient has occasional palpitations or chest pain when tired, weak digestion and abdominal distension, weak cough with much white phlegm, and poor muscle tone with muscle aches aggravated by cold. The pulse is empty, deep, and slow, and the tongue is wide, flabby, pale, and moist. Diagnosis The patient. has Deficient Qi and Yang of the Heart, Lung, and Spleen; Stagnant Qi of Heart, Lung, and Spleen; and invasion of Exterior cold and Damp combining with Interior Cold and Damp. Choice of Capsicum Capsicum is specific for tonifying Qi and Yang of the Heart, Lung, and Spleen; for moving Stag-
322
Combining Western Herbs and Chinese Medicine
nant Qi of the Heart, Lung. and Spleen; and for dispersing Exterior and Interior Cold and Damp.
weak lower back, weak knees, urinary frequency ~~~~~~i tinence, daybreak diarrhea, spermatorrhea. or impotence. :. -,;L;,. '
Limitations of Capsicum
Spleen Qi and Yang Capsicum can act as a stimulant an(?::~:~ ;; tonic to the digestive system, but it is specific for cool or-coi~t: . conditions. It can be used combined with cold or cool herbs : for mixed conditions of Heat and Cold, but it should be used :':¢' _ . . '. -'.... 01 with caution in cases of gastrointestinal inflammation. - :-'~:.
~;;;:;'7:_~~
TEMPERATURE Capsicum is a hot herb that is generally used for cool or cold conditions, either for Interior Cold arising from Deficiency or for Interior Cold that is combined with an Exterior Cold invasion. There are a few situations in which Capsicum can act as a hot circulatory stimulant or as a hot counterirritant to treat hot conditions, but this is a small part of its use.
TASTE Capsicum is a hot, acrid herb that is mainly used to treat Interior Cold conditions. It can also be used to treat Exterior Cold. usually when it is combined with a more diffusive herb such as fresh Zingiber. ACTIONS Stimulant and tonic
Heart Qi and Yang Initially, in Physiomedicalism, Capsicum was believed to have its stimulant effects first on the heart and circulatory system, and then on other organs via the heart. Later in Physiomedicalism, with the development of the concept of a close relationship between the circulatory and nervous systems. Capsicum was considered to have its stimulant action via both the circulatory and nervous systems. Kidney Qi and Yang Interestingly, I have not found any research confirmation of direct effects of Capsicum on the heart. However, one study has reported that capsaicin enhanced adrenaline secretion by the adrenal medulla in rats (see Research). If this report were representative, then, in terms of Chinese medicine, Capsicum might be said to stimulate Kidney Yang. However, I feel that one research report is scarcely enough to found a theory and look forward with interest to further studies. It is interesting to survey which of the classic Kidney Deficient ~ang complaints have been traditional indications for Capsicum in the West. Capsicum has been used for the more general Deficient Yang complaints of exhaustion, depression, and sensations of cold, which could be associated with the Heart just as much as with the Kidney. However, it does not have a strong tradition of internal use in the West for the specific Deficient Kidney Yang complaints of sore and
:-.··fl~
'
Antidepressant Capsicum can be used to treat depression, ';-.:,.;,;:tt but only of certain types. It is specific for Deficiency and ~~1i ~ Stagnation of Heart or Lung Qi. It can be used, in combina~ :~,\k; tion with other warming and moving herbs, such as Rosmarinus, to assist in the treatment of depression associated with Stagnation of Liver Qi with Cold and Damp. .
~<~.,
Antihypotensive and antihypertensive Capsicum can he <,used to assist in the treatment of hypotension when it is, combined with such herbs as Sarothamnus. Panax ginse.ng;c.·-; and Crataegus. Less commonly. it can be used to treat hypertension when it is combined with acrid diffusive herbs, such ~,.;,tf'~" as Zingiber, and with cold bitter herbs, such as Berberis o~-J1--'.;; Taraxacum. Treating Heat patterns with hot herbs can be ~~~i effective, but must always be done with caution. -c:"~,,, ~ "}:',
Antianginal Capsicum can be used to treat angina pectoris in the specific situation of Heart Stagnant Blood with Cold. Recent evidence that capsaicin may reduce plasma levels of fatty acids and cholesterol may suggest a wider applic~tio.~ of Capsicum in the treatment of heart disease. Diaphoretic and antirheumatic Capsicum has a tradition of use as a warming, stimulant diaphoretic in the treatment of colds, chills, influenza, and rheumatic and arthritic conditions associated with cold. Whilst its action is more central and less diffusive than Zingiber, Capsicum can be combined with that herb to stimulate both central and peripheral cir- -"., culation. Capsicum as a single herb is perhaps more effective __ for muscular pain than joint pain, but it can assist the effects of herbs that have a specific action on the joints, such as - ",",' Zanthoxylum, Angelica archangelica, or Angelica pubescens. Antimicrobial Capsicum is mainly used as an antimicrobial; a mouthwash or gargle containing Capsicum have been used to treat infections of the mouth and throat. It is not so much used as an internal antiseptic anymore, although it has demonstrated some antibacterial action. Topical counterirritant and local analgesic Capsicum has a long tradition of use as a counterirritant for local painful conditions of the body surface, specifically those with local Stagnation of Qi and Blood. It is not generally used in the anus, vagina, or nasal cavity because of the transient but severe discomfort it produces.
._ ...--l 1li"-------- .-----Capsicum
Capsicum paired with other herbs Discussion of the limitations of each of the main actions of Capsicum can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Capsicum beyond its limitations. The basic unit of herb combination is the herb pair. Twelve pairings of Capsicum are briefly explained below.
CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair. Capsicum + Crataegus
Cardiac weakness + angina Both herbs can tonify -Heart Qi and move Stagnant Heart Qi and Blood to normalize heart function and blood pressure. In addition, Capsicum can tonify Heart Yang to stimulate the circulation. warm the body, and treat depression.
323
abdominal distension. sluggishness, and lethargy, and exhaustion • warm and tonify Liver Qi and Yang, and to move Liver Stagnant Qi to treat hypochondriac pain. digestive disorders, and depression Capsicum + Hydrastis
Digestive weakness + atonic constipation Hot, acrid Capsicum and cool, bitter Hydrastis combine to stimulate and tonify the appetite, digestion, and bowel function. Both herbs can have antimicrobial effect against pathogenic bacteria, and warm Capsicum balances the potentially inhibiting effects of cool Hydrastis on the beneficial gut flora. Capsicum + Myrica
Hepatic weakness These herbs can combine as circulatory stimulant diaphoretics to treat colds, influenza, and poor peripheral circulation. They can also combine to treat patterns of obstruction by Cold Phlegm Damp in the Liver, such as food intolerances, digestive disorders, or depression; or in the Intestines, such as atonic constipation or mucous colitis.
Capsicum + Sanguinaria
Capsicum + Zingiber
Depression + cold extremities
Bronchial phlegm
Both herbs can act as hot acrid antidepressants, but see Cautions for Sanguinaria. They are circulatory stimulants, cardiotonics, and mucolytics that can be combined for bronchitis with poor peripheral circulation. In addition, they can both act as hot counterirritants, for example, for chilblains or chronic sore throats. Capsicum + Panax ginseng
Exhaustion + depression Capsicum is a hot and acrid herb that can stimulate and tonify Heart, Lungs, Spleen, Intestines, and certain aspects of Kidney function. Ginseng is a warm, sweet, adaptogenic herb that can tonify the Qi and Yang of all the organs. The two herbs can combine to tonify Qi and Yang of the Heart and Kidney to treat exhaustion and depression. Capsicum + Rosmarlnus
Cardiac weakness + depression Capsicum and Rosmarinus combine to: • warm and tonify Heart Qi andYang, and to move Stagnant Heart Qi to treat cardiac weakness and depression • warm and tonify Spleen Qi and Yang, and to move Stagnant Spleen and Intestine Qi to treat weak digestion,
This pair of circulatory stimulants can be combined to treat many disorders, including influenza, bronchial phlegm, digestive weakness with flatulent colic, atonic constipation, hepatic weakness and sluggishness, and dysmenorrhea or rheumatism associated with cold sensations. Capsicum is a stronger stimulant for the heart and has a more central effect, whilst Zingiber is more diffusive and has more of an effect on the body surface. Capsicum + Lobelia
Asthma + bronchitis Capsicum and Lobelia were the basic herb pair of the Physiomedical practitioners, emphasizing stimulation and relaxation, respectively. These acrid herbs were combined for fever, with the intent that Capsicum would support the vital energy and clear cold or stimulate the metabolism; and that Lobelia would balance Capsicum by relaxing the body and reducing the fever if it became too high. In the treatment of chronic asthma and bronchial phlegm, these herbs combine to stimulate the disp~rsing action of the Lung, whilst relaxing the bronchioles. They can be also combined in the treatment of angina pectoris, atonic constipation with intestinal spasms, and dysmenorrhea due to spasms and cold.
Combining Western Herbs and Chinese Medicine
324 Capsicum + Rheum Atonic constipation
These two herbs can be paired for atonic constipation associated with cold. Capsicum moderates the tendency of Rheum to produce intestinal colic and may also stimulate the circulatory and nervous supply of the Intestine. Also, these herbs may be combined to clear Heart and Liver Heat arising from Stagnation. Acrid, hot Capsicum disperses Heat from the local accumulation throughout the system. and bitter, cold Rheum drains Heat downwards. Capsicum + Achillea Influenza
Achillea can emphasize the potential diaphoretic action of Capsicum, and Capsicum can emphasize the circulatory stimulant action of Achillea and its ability to disperse Wind Cold Damp. Capsicum + Zanthoxylum Rheumatism + cold extremities The circulatory stimulant effect of Capsicum is more on the heart and body, whilst that of Zanthoxylum is more on the peripheral circulation. The two herbs can have a complementary action, for example, in the treatment of cardiac weakness with cold hands and feet, or in arthritis associated with exposure to cold and damp. Capsicum + Commiphora Chronic sore throat Capsicum can act as a counterirritant to stimulate the movement of Qi and Blood in Stagnant areas of chronic inflammation and infection of the mucous membranes. Both herbs are warming antimicrobials and circulatory stimulants. and Commiphora can have astringent and wound-healing effects.
Topical uses of Capsicum Capsicum can be used for topical application as the finely powdered dried herb, olive oil extract of the dried herb. infusion, or diluted tincture. It can be used for bleeding wounds. sore throat, sprains, rheumatism, neuralgia, cold feet, and unbroken chilblains. It can have a strong transient burning sensation when in contact with the skin, and especially when in contact with the mucosa. See Cautions section.
Bleeding wounds Christopher 12 recommended filling· cc ,_ bleeding wounds with cayenne powder to stop the blee~g~.~..:..J and facilitate healing.:i~ :-':""~~.a~
Sore throat Stubborn cases of chronic sore throat can bi~:,o,= treated with a gargle of 20-40 drops of Capsicum 1:5 tincture::: . in qu~ter of a ~ass. of water. Christopher recommended the.~ , followmg combmatlon for sore throat: "?.-l .u",:·
Herb Salvia off. tea apple cider vinegar sea salt honey Capsicum powder
··:·:~-~r
Amount 0.5 pint 2 tablespoons 2 tablespoons 2 tablespoons 1teaspoon
~
.F
"~"~~~
The instructions are to prepare the Salvia infusion, steep +~ the Capsicum in the infusion, and then mix the other in- . ;:'iL.:j gredients. A mouthful of the final mixture can be used as a - '''.' _ gargle, 4 to 12 times per day. A further 1-2 tablespoons can'':'::.. f,;. be swallowed after spitting out the gargle. -~'rT '~-;T~~
Sprains, rheumatism, neuralgia
I use the following com-.r::;j.T1\ -.... ~;~ !~ bination:.;::~. ", Herb Olive oil Capsicum powder Lobelia powder
Amount 50 ml 0.5 teaspoon 0.5 teaspoon
This topical application can be made by soaking the . Capsicum and Lobelia powders in the olive oil for 2-4 weeks with occasional stirring. The fluid can then be flltered. The mixture can be massaged into the affected area. then a piece of cotton containing the mixture can be placed on the affected area and held in place overnight with a bandage. This can be covered by waterproof material to prevent the oil from staining clothing or contacting sensitive parts of the body. Caution Fingers should be washed carefully after applying' the oil to avoid contact with the eyes or other sensitive parts.
Cold feet and unbroken chilblains Christopher recommended a few grains of Capsicum powder be sprinkled ~ the shoes or socks. but warned that too much may produce too much heat and give a burning sensation. Capsicum may be applied to unbroken chilUains as a lotion or ointment. COMBINATIONS OF CAPSICUM FOR TOPICAL APPLICATION Capsicum can be used by itself for the specific topical indications mentioned above or combined with the followingherbs:
-Capsicum • Commiphora or Baptisia: as an antiseptic gargle for sore
325
1. Hypertension + heat sensations
Heart Heat + Liver Heat
throat
• Lobelia: for sprains and rheumatism Capsicum can also be given internally as well to support its topical action.
Capsicum combinations Six Capsicum combinations for internal use are discussed below: Uses
.
-
........... --" .. ,' '-,--"", ":-'
.~-_
..
,
~-
-.
1. hypertension + heat sensations
Heart Heat + Uver Heat
2. angina pectoris + cold sensations
Heart Stagnant Blood + Heart Deficient Yang
3. depression + bronchitis
Heart Stagnant Qi + Lung Stagnant Qi
4. cardiac weakness + depression
Heart Deficient Yang + Kidney Deficient Yang
5. chronic bronchitis + cardiac weakness
Lung Phlegm Cold + Heart Deficient Qi
6. digestive weakness + cold sensations
Spleen Deficient Qi + Spleen Deficient Yang
CAUTION
Before using any ofthe combinations below, it is important to be familiar with the cautions listed for each herb in the combination.
Herb
~- ..-- -Ratio."'
~·'·'·_--~:"'_·~;'·:_-·""r
Capsicum Zingiber Lobelia Berberis Taraxacum Rheum
.•• _ ...•..• _.
20-50 drops
1 1 1 1 1
.-Temperature
-
hot hot warm-cool cool cool-cold cool-cold
_'.O~ _. Taste -
acrid acrid, aromatic acrid bitter bitter bitter, sour
GENERAL
This combination is used to disperse Heat and thereby calm the Spirit. The overall temperature may be warm, but the combination includes both hot acrid herbs to equalize the circulation and thus assist in the clearance of Interior Heat, and cold bitter herbs to drain the Heat. . USE
• certain types of hypertension, with sensations of heat, pressure, and discomfort in the cheeks, face, and head; whole face red and malar area may be purplish red • acute or chronic agitation, restlessness, and insomnia associated with strong sensations of heat PRACTICAL NOTES
The herbs other than Capsicum are conveniently taken as 5 ml of a 1:5 tincture in quarter of a glass of warm water, three times per day. Drops of 1:5 Capsicum tincture can be added from a separate bottle or 0.25-1 teaspoon of powdered Capsicum can be mixed in with the contents of the glass instead.
Initial dose of Capsicum The patient can start with 5 drops DISPENSING CAPSICUM SEPARATELY It is advisable to dispense Capsicum separately from the other herbs in the combination so that the patient can add varying doses of Capsicum as needed. Each dose of the other herbs may be conveniently taken as 5 ml of a 1:5 tincture in quarter of a glass of warm water. Drops of 1:5 Capsicum tincture can be added from a separate bottle, or 0.25-1 teaspoon of powdered Capsicum can be mixed in with the contents of the glass instead. It is always best to start with a low dose of Capsicum and work up to a higher dose. If there are any mild undesirable effects, the amount of Capsicum can be temporarily or permanently reduced. If there are any more severe adverse effects relating to the Capsicum, the Capsicum should be stopped immediately. If it is appropriate, the patient can continue with the other herbs in the combination.
of Capsicum per individual dose of the main tincture and work up to 20-50 drops, depending on the individual's tolerance of Capsicum and absence of adverse effects.
Duration ofthe prescription This combination can be taken, with appropriate cautions, breaks, and modifications for one to several weeks. The Capsicum can be steadily increased up to the maximum dose as appropriate for the patient. As soon as the symptoms show a consistent improvement, the dose of Capsicum can be slowly reduced until 'the patient finds the minimum dose of Capsicum that will maintain the improvement. When agitation, facial redness, and severe sensations of heat are much reduced or absent, it may be appropriate to use a different combination. Caution This combination can work well as a temporary measure for certain individuals with Heart and Liver Heat, but it must not be prescribed without careful screening and
--I I
326
Combining Western Herbs and Chinese Medicine
monitoring (see Cautions section). It should be withdrawn if there is any aggravation of the existing symptoms of agitation or heat sensations, gastric irritation, or appreciably raised pulse rate or blood pressure.
dominant taste property is acrid, supported by the dispers~~ ing effect of the aromatic property. The bitter property may--~~ assist in the tonification of the Heart. ..;.-_. USE
Use with Valeriana Some individuals with severe agitation or nervous tension may find it beneficial to take this Capsicum combination concurrently with 5 mI, three times per day, of 1:5 tincture of either: • Valeriana as a single herb • Valeriana and Anemone in equal proportion However, the cautions on Valeriana should be observed,
• depression, grief, bereavement • sensation of discomfort, fullness or obstruction in the chest • cold extremities, maybe chronic bronchial congestion with white phlegm PRACTICAL NOTES
2. Angina pectoris + cold sensations
The herbs other than Capsicum are conveniently taken as 5 ml of a 1:5 tincture in quarter of a glass of warm water, three times per day. Drops of 1:5 Capsicum tincture can be added from a separate bottle, or 0.25-1 teaspoon of pow- .•. dered Capsicum can be mixed in with the contents of the
Heart Stagnant Blood + Heart Deficient Yang
glass instead.
especially if using Valeriana grown in the United States.
Convallaria 1 Crataegus 1 Salvia mil. 1 Zanthoxylum 1 (bark) Panax gin. 0.5 Lobelia 0.5 Capsicum 5-20 drops
neutral 51. warm cool hot
bitter, 51. sweet sour, sweet bitter acrid, aromatic, bitter
51. warm warm-cool hot
sweet. 51. bitter acrid acrid
This combination is the same as Convallaria: angina pectoris + cold sensations and is discussed under that heading.
3. Depression + bronchitis
Heart Stagnant Qi + Lung Stagnant Qi Herb Capsicum Crataegus Rosmarinus Zanthoxylum (bark) Zingiber Thuja Sanguinaria
Ratio
Temperature Taste
1040 drops 1 1 1
hot 51. warm warm hot
acrid sour. sweet aromatic. bitter. acrid acrid. aromatic. bitter
1 0.5-1 0.5-1
hot warm-cool warm
acrid. aromatic aromatic, acrid. bitter acrid, bitter
GENERAL
This combination is for conditions with Heart Stagnant Qi and some Lung Stagnant Qi. There may also be some Lung Phlegm Cold. The combination is hot in its overall temperature and is therefore for cool to cold patterns. The
. .~-.!¥
Duration of prescription This combination can be taken. with appropriate cautions, breaks and modifications for one to several weeks. The Capsicum can be steadily increased up to the maximum dose appropriate for the patient. As soon as the symptoms show a permanent improvement, the dose of Capsicum slowly can be reduced until the patient fmds the minimum dose of Capsicum that will maintain the improvement. When depression and sensations of obstruction in the chest are much reduced or absent, it may be appropriate to use a milder combination. Caution This combination can work well for certain individuals with Heart and Lung Stagnant Qi, but it must not be prescribed without careful screening and monitoring (see Cautions for Capsicum. Sanguinaria, and Thuja). It should be withdrawn if there is any aggravation of the depression, gastric irritation, or if there is an uncomfortable restlessness or symptoms of heat. 4. Cardiac weakness + depression
Heart Deficient Yang + Kidney Deficient Yang .
Herb --•.•_._.. Ratio·..· .. · .. Temperature . Taste .....~.._~ .. _.~ Crataegus 1 Convallaria 1 Panax gin. 1 Turnera 1 Cinnamomum . 1 (bark) Glycyrrhiza 0.5 Capsicum 5-20 drops
51. warm
neutral 51. warm warm hot
sour. sweet bitter sweet, 51. bitter bitter. aromatic. acrid acrid. sweet. aromatic
neutral-cool hot
sweet acrid
This combination is the same as Crataegus: cardiac weak- ness + depression and is discussed under that heading.
Capsicum 5. Chronic bronchitis + cardiac weakness
Lung Phlegm Cold + Heart Deficient Qi . Ratio
Herb Thuja Thymus Lobelia Prunus Crataegus Sanguinaria Glycyrrhiza Capsicum
. _, ~~l!1P~rature - -Taste
1 1 1 1 1
warm-cool warm-cool warm-cool neutral sl. warm
0.5 0.5
warm neutral-cool hot
5-20 drops
acrid, aromatic. bitter aromatic acrid bitter, aromatic sour, sweet bitter, acrid sweet acrid
This combination is the same as Thuja: chronic bronchitis + cardiac weakness and is discussed under that heading. 6. Digestive weakness + cold sensations Spl~en Deficient Qi + Spleen
Stagnant Yang
::~~. '.'~-""~~:~'~'"~'~-''-[
Herb
.. ,
"~Ratio
n I
L
body surface. Zingiber directs the dispersive action of Capsicum to the surface. Lobelia emphasizes the relaxing aspect of this circulatory balancing action. Berberis, Taraxacum, and Rheum are cold, bitter herbs that can drain Heat downward and out of the body and help to clear accumulated Heat Toxins from the body. By redistributing the Qi, Blood, and Heat, this combination can relieve congestion and pain in the face and head. 2. In combination No.1, Capsicum moves Stagnant Qi and Blood to disperse Heat. In combination No.2, Capsicum acts as a warming circulatory stimulant to move Stagnant Qi and Blood and disperse Cold. Convallaria, Crataegus, Salvia, and Capsicum act together to move Stagnant Qi and Blood in the Heart itself, and Capsicum and Zanthoxylum combine to increase circulation at the periphery. Convallaria, Crataegus, Panax, and Capsicum combine to tonify Heart Qi.
::::-:-: .- "'" .- :'" ':-:-:;r: _;__ ":<;,v.;
"'{Temperature Taste:. <
Rosmarinus Gentiana Panax gin. Citrus (ripe peel) Glycyrrhiza Zingiber Capsicum
327
:1"
",<, ~., -I
i.,
I. '_ - '
-
warm neutral-cool sl. warm warm 0.5 neutral-cool 0.5 hot 0.5 5-20 drops hot
1 1 1
•
aromatic, bitter, acrid bitter sweet, sl. bitter bitter, aromatic sweet acrid, aromatic acrid
This combination is the same as Rosmarinus: digestive weakness + cold sensations and is discussed under that heading..
COMPARISON OF THE SIX
3. Depression + bronchitis
4. Cardiac weakness + depression
Heart Stagnant Qi + Lung Stagnant Qi
Heart Deficient Yang + Kidney Deficient Yang
Herb
Ratio
Herb
Capsicum
10-40 drops
Crataegus
Crataegus
1
Convallaria
Rosmarinus Zingiber
1 1 1
Thuja
0.5-1
Sanguinaria
0.5-1
Zanthoxylum
.Ratio
1 1 Panax gin. 1 Turnera 1 Cinnamomum (bark) 1 Glycyrrhiza Capsicum .
0.5 5-20 drops
CAPSICUM COMBINATIONS
I'
L
1. Hypertension + heat sensations
2. Angina pectoris + cold sensations
Heart Heat + Liver Heat
Heart Stagnant Blood + Heart Deficient Yang
Capsicum Zingiber Lobelia Berberis Taraxacum Rheum
20-50 drops
1 1 1 1 1
Convallaria Crataegus Salvia mil. zanthoxylum (bark) Panax gin. Lobelia Capsicum
1 1 1 1
0.5 0.5 5-20 drops
1. Although Capsicum is a hot herb. it is used here in combination No.1 to disperse Heat by stimulating the circulation to redistribute Heat around the body, including to the
3. Combination No.3 can treat depression associated with Stagnation of the Qi of Heart and Lung. Capsicum, Crataegus, Rosmarinus, Thuja, and Sanguinaria combine to move Heart Stagnant Qi and to disperse Cold. Zanthoxylum and Zingiber help to distribute Qi and Blood to the periphery and thus to disperse central stagnation. Thuja, Sanguinaria, Capsicum, and Zingiber help to tonifj Lung Yang and to move Lung Stagnant Qi, thus treating bronchitis. 4. Whilst combination No.3 treats depression associated with Qi Stagnation of the Heart and Lung, combination No. 4 treats depression associated with Yang Deficiency of the Heart and Kidney. This combination therefore contains herbs to warm and tonify both the Heart and Kidney: Convallaria, Panax, Turnera, and Cinnamomum. Whilst combination No.3 contains Thuja and Sanguinaria to treat bronchitis, No.4 contains Convallaria to tonify the Heart.
_:~
--~
328
Combining Western Herbs and Chinese Medicine
5. Chronic broncmrls + cardiac weakness
6. Digestive weakness + cold sensations
Lung Phlegm Cold + Heart Deficient Qi
Spleen Deficient Qi + Spleen Deficient Yang .--:.. ••.<;.::.':::,.:[-'-.... -'
Ratio
Herb Thuja
Herb
,...~
-.- O;;''':-~~-'.;:-l:~~~~
. Ratio
. ".. '
1 1 1 1 1
Rosmarinus
Zingiber
Glycyrrhiza
0.5 0.5
0.5 0.5 0.5
Capsicum
5-20 drops
Capsicum
5-20 drops
Thymus Lobelia Prunus Crataegus Sanguinaria
Gentiana Panal{ gin. Citrus (ripe peel) Glycyrrhiza
1 1 1
5. In contrast to combination No.3, which primarily treats depression and secondarily treats bronchitis, this combination has chronic bronchitis as its primary indication. The' first four herbs in this combination, Thuja, Thymus, Lobelia, and Prunus treat bronchitis associated with Lung Phlegm Cold. Crataegus, Sangumaria, Capsicum, and Thuja combine to treat the secondary objective of cardiac weakness. 6. Combination No.4 contains Crataegus and Convallaria for cardiac weakness. Combination No. 5 contains Thymus and Thuja to treat bronchial weakness. This combination, No.6, contains Rosmarinus and Gentiana as bitter digestive tonics. The aromatic constituents of Rosmarinus, Citrus, and Zingiber can combine to move Stagnant Spleen Qi, and the acrid components of Capsicum, Zingiber, and Rosmarinus can combine to warm Spleen Yang.
• capsaicin, 69% • dihydrocapsaicin,22% • nordihydrocapsaicin,7% • homocapsaicin, 1% • homodihydrocapsaicin, 1% Capsaicin is sometimes termed an alkaloid. It is an amide of the phenol vanillic acid. 13 Twelve diterpenoid glycosides (geranyllinalool derivatives), named capsianosides, were isolated from C. annuum fruits. Four steroidal glycosides (furostanol glycosides), named capsicosides., were isolated from C. annuum varieties. IS Capsicum also contains thiamine, ascorbic acid 0.1-0.5%, red carotenoids such as capsanthin and capsorubin, and fixed oil.!
I.
PHARMACOLOGICAL AND CLINICAL RESEARCH The following effects have been reported: • topical counterirritant and analgesic • antimicrobial • changes in gastric inflammation • changes in gastric secretion • changes in appetite and gastrointestinal transit time • changes in metabolic rate • cardioregulatory effects • blood coagulation effects • lipid regulation • antitumor Topical counterirritant and analgesic
Mechanism ofcapsaicin C-fiber sensory (afferent) neurons, OTHER CAPSICUM COMBINATIONS Other combinations that contain Capsicum include the following:
• Achillea: Atherosclerosis + hypertension + cold extremities • Angelica: depression + obesity • Juniperus: mental dullness • Myrica: chronic diarrhea + digestive weakness • Myrica: chronic fatigue syndrome + cold extremities • Myrica: menorrhagia + cold sensations • Rheum: chronic constipation
Research CONSTITUENTS The pungent principle of C. annuum is composed oe
which contain neuropeptides such as substance P, mediate a wide variety of physiologic responses, including chemogenic pain, thermoregulation, and neurogenic inflammation. Capsaicin can activate, and then, at higher doses and longer times, desensitize this class of neurons. 16 Capsaicin may affect C fibers by interacting with vanilloid receptors, but rat studies indicate complex mechanisms for the release of substance P and other neuropeptides in response to capsaicin application. 17 Application of capsaicin to the skin initially causes a burning sensation, which then converts to that of a local anesthetic as capsaicin inhibits neurotransmission by C fibers. Capsaicin induces release of substance P and then inhibits its reuptake, resulting in its depletion. In vitro studies in rats showed that C-fiber-evoked nerve discharges were reduced by the systemic application of capsaicin. 18
Uses of capsaicin Many studies have shown the effectiveness of topical application of capsaicin for local pain man- -agement, usually applied three to four times per day as a
~-
Capsicum 0.025% or 0.075% cream. In 1998, Hautkappe et al. stated
..
that capsaicin is known to be a safe and effective pain management adjunct for rheumatoid arthritis, osteoarthritis, neuralgias, and diabetic neuropathy. 19 They analyzed data from 33 reports on the efficacy of capsaicin for other conditions. They concluded that capsaicin is also effective for painful conditions such as psoriasis, pruritis, and cluster headaches; it is also often helpful for the itching and pain of postmastectomy pain syndrome, oral mucositis, cutaneous allergy, loin pain-hematuria syndrome, neck pain, amputation stump pain, and skin tumors. The authors pointed out that a problem for many of the studies analyzed was the absence of a 'burning placebo: such as camphor. Intravesical installation of capsaicin has been reported to be a promising treatment method for certain cases of overactive bladder. A possible meChanism may be capsaicin desensitization of C-fiber afferent neurons, which may be responsible for the sign~ that trigger detrusor overactivity.20 Antimicrobial Plain and heated extracts of Capsicum species showed varying degrees of inhibition against Bacillus cereus, B. subtilis, Clostridium sporogenes, C. tetani, and Streptococcus pyogenes. 21 High concentrations of capsaicin, isolated from Capsicum species fruits, showed varying degrees of inhibition against a range ofbacteria.22 It has been reported that capsaicin can inhibit Helicobacter pylori in vitro, but an in vivo study with humans did not show that capsaicin had any effect on H. pylori. 23 Changes in gastric inflammation In 1984, a study by Kumar et al. showed that an intake of 3 g per day of chili powder did not affect patients with duodenal ulcers receiving antacids. H In 1987, Myers et al.Jound considerable variation between individuals, but that, generally, meals containing 1.5 g of red pepper caused signs of gastric mucosal damage comparable to those caused by a 625 mg dose of aspirin. 25 In 1988, Graham et al. showed that intragastric administration of 30 g Capsicum showed no damage to the gastric or duodenal mucosa in healthy subjects, whilst 1,950 mg (1.95 g) of aspirin producedmultiple gastric erosions. 26 In 1987, Holzer reported that capsaicin appeared to protect the gastric mucosa against alcohol or aspirin damage in rats. 27 In 1995, one study with patients with peptic ulcers suggested that the use of chili may have a protective effect against peptic ulcer. 28 Another study with healthy humans showed that chili can protect against aspirin-induced gastroduodenal mucosal injury.29 In rats, capsaicin-sensitive sensory nerves may be involved in a local defense mechanism against gastric ulcer. . However, excessive capsaicin use resulted in tachyphylaxis and appeared to hinder this defense mechanism. 30 .
329
Changes in gastric secretion One study reported that Capsicum can increase gastric acid secretion. 31 A more recent study found that aqueous extracts of Capsicum annuum increased gastric acid secretion in rats to about seven times the basal rate, but that this increase was significantly reduced in injured stomachs.32 Changes in appetite and gastrointestinal transit time In a 1983 study with rats by Monsereenusorn, both Capsicum and capsaicin resulted in a steady increase of food intake throughout the experimental period of 60 days, although growth rate was reduced.33 A study with humans indicated that intake of chili with breakfast can decrease the appetite before lunch.3~ The differences in the results of these experiments may reflect not only the differences between rats and humans, but also the fact that the rat experiment focused on changes over 60 days, whilst the human experiment focused on changes within the same day. In a human study, the addition of 20 g of chili powder to a meal resulted in a slower rate of gastric emptying, whilst the rate of transit of the whole gut was faster. 35 Changes in metabolic rate In Monsereenusorn's 1983 experiment, rats were fed by stomach tube with either 50 mglkg of capsaicin per day, or 0.5 g/kg of Capsicum fruit per day. The rats' growth rate was reduced, although their food intake was' increased. Capsaicin has been reported to increase energy expenditure in the body and to raise metabolic rate, with possible potential use for weight regulation. 36 Capsaicin was reported to increase catecholamine secretion from the adrenal medulla of rats, especially that of adrenaline. 37 Cardioregulatory effects Capsicum has a long tradition of use in many countries to warm the body and to stimulate circulation. However, there is a paucity of research data on the cardiovascular effects of Capsicum and capsaicin. A study using rat ventricular myocytes reported that capsaicin produces a prolongation of the ventricular action potential, associated with differential inhibition of potassium currents. 38 A study using rat atrial myocytes reported an inhibitory effect of capsaicin on voltage-activated sodium current, that may modify the electrical and contractile function of the rat heart. 39 It was reported that capsaicin increased heart rate in rats and increases modulation of sympathetic nervous system activity.4O Blood coagulation effects Capsicum and capsaicin have been reported to both anticoagulant and antihemorrhagic effects.
Anticoagulant
Antiplate1et, antithrombotic, and fibrinolytic effects have been reported. Capsaicin was reported to
330
:ii
inhibit the ability of platelets to aggregate in response to thrombin, platelet-activating factor, or calcium ionophore. 41 The antiplatelet action of capsaicin was reported to be due to its action on the cell membrane.-u Capsaicin at a dose of 25 mglkg was reported to prevent death caused by ADPinduced acute pulmonary thromboembolism in mice, while aspirin and indomethacin had no effect at 200 mglkg. The antithrombotic effect of capsaicin was thought to be due to inhibition of platelet aggregation. 43 Capsicum was reported to increase fibrinolytic activity in humans on oral administration. 44
Antihemorrhagic Capsicum45 and capsaicin-l6 have been reported to reduce hemorrhage caused by snake venom from Bothrops species. Intragastric capsaicin has been reported to protect against aspirin-induced bleeding in the rat gastric mucosa. 47 Lipid regulation. Capsaicin was shown to decrease the total biliary free fatty acid concentration in rats. 48 In a previous study, rats were fed by stomach tube with C
RESEARCH VERIFICATION OF TRADITIONAL ACTIONS From the research summarized above using Capsicum extracts or isolated constituents, there is support for the following traditional actions: general stimulant and tonic, digestive stimulant and tonic, antimicrobial, antihemorrhagic, analgesic, and topical counterirritant. Additional effects de~onstrated by research These include: protection against peptic ulcer, reduction of plasma trigiycerides and cholesterol, antithrombotic, and antitumor action.
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Combining Western Herbs and Chinese Medicine ~
TOXICOLOGY
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The Botanical Safety Handboolf~ classified Capsicum as =~ an herb that can be safely consumed when used appropriate- -~-~~r ly. The only adverse effect listed by this book is that excessr;e;-~~ oral doses of Capsicum may cause gastrointestinal irritation _~~1 in sensitive individuals. -,'17 .. -.:::~: _.... \
i
Gastrointestinal inflammation As discussed above, whilst _~o~ the study by Myer et al. reported gastric mucosal damage in some individuals, other studies on animals and on humans;;;-, have reported either no adverse effect on gastroduodenal . ::1,,: mucosa or else a protective effect against inflammation and damage caused by aspirin or alcohol. Lyle 53 wrote in 1897 that high doses of Capsicum can -"-1! cause hiccuping and cramping. According to Ellingwood, 54._,:. writing in 1919,high doses of Capsicum can causevomiting"'c}~-l "2 \ purging, inflammation of the stomach and intestines, and,:T;-i dizziness and debility of the nervous system. However,;:.::_t.f~: according to Kloss,55 Capsicum should not be classed with -~'E black pepper, mustard, or vinegar since these will irritate a sore, ulcerated stomach, whilst cayenne will heal it Dermal or mucous membrane inflammation
Dermal Capsaicin creams are increasingly widely used in conventional medicine as topical counterirritants with analgesic effect in painful conditions. No adverse effects are listed in the 31st edition of Martindale: The Extra Pharmacopoeia56 for use of capsaicin cream at 0.025% or 0.075%. Some local irritation is to be expected, but the cream should not be applied to broken or irritated skin. Higher concentrations, such as 1%, have been reported to be neurotoxic and to result in thermal hyperalgesia. 5i
Mucous membranes Capsicum preparations may produce a transient burning sensation if it is in contact with the lips, mouth, nose, or eyes. However, Capsicum can be used as a gargle for chronic laryngitis,58 and intranasal capsaicin is being studied for the treatment of nonallergic rhinitis. 59 Capsicum preparations are not generally used in contact with the mucous membranes of the rectum or vagina, not due to any report of adverse effects, but because of discomfort. Instillation of capsaicin into the bladder can treat overactive bladder, but capsaicin may be replaced by resiniferatoxin since the acute pain and irritation associated with capsaicin . bladder treatments are a deterrent to widespread use. 20
Dose INTERNAL USE Driedherb
Different texts give a range of dose recommen-
Capsicum
~\-
dations. The BHP recommended 30-120 mg, three times per day. and Christopher recommended 0.25-1 teaspoon. three times per day. For acute situations such as heart attack or hemorrhage, he recommended 1 teaspoon of Capsicum powder in 1 cup of hot water.
Pregnancy and lactation I have not seen adverse reports, but I would not use Capsicum during pregnancy to treat patients with patterns of Heat. I generally do not use Capsicum to treat the mother during lactation if either the, mother or child have patterns of Heat.
Tincture The BHP gave 0.06-0.2 ml of 1:3 tincture in 60% alcohol, three times per day. I generally recommend 5-20 drops of 1:5 Capsicum tincture when added to 5 ml of tincture of the main herb combination, taken in quarter of a glass of water. In certain cases of hypertension, extreme facial .. heat, or depression, 2.5-5 ml of 1:5 Capsicum tincture in half a glass of hot water may be appropriate as a temporary measure (see Cautions).
Side effects Sensation of burning or discomfort in the epigastrium in some patients.
Initial dose It is best, in chronic conditions, to start with a small dose of Capsicum and gradually increase the dose to the maximum level tolerated by the patient.
TOPICAL USE
Duration Capsicum can be used for one or more months, providing the cautions are observed. However, the dose can be reduced as the condition improves, so that Capsicum is not taken unless needed. Mode of dispensing According to Christopher, Capsicum should be used as an infusion rather than a decoction because its effectiveness is reduced when it is simmered. r--
331
Overdose
See Side effects.
Interactions Ingestion of chili pepper was reported to reduce salicylate bioavailability after oral administration in rats. 60
There may be a transient burning sensation following topical use of Capsicum preparations. Whilst Capsicum has been used in the past for disorders of the eyes, nostrils, genitals, and anus, contact of Capsicum with these areas is generally avoided due to transient discomfort which may be severe.
SCREENING Before prescribing Capsicum, it should be determined whether the patient has ever had:
TOPICAL USE Capsicum can be used topically as the finely powdered dried herb, olive oil extract of the dried herb, infusion, or diluted tincture, as appropriate. It can be used for bleeding wounds, sore throat. sprains, rheumatism, neuralgia, cold feet, and unbroken chilblains. See Topical uses ofCapsicum.
TREATMENT PRECAUTIONS
Cautions
The following precautions should be taken during treatment:
INTERNAL USE These cautions apply to the infusion and the tincture. Western contraindications Capsicum can be used in some cases of gastroduodenal inflammation or ulceration, but it should only be done so using the cautions and monitoring regime outlined below. If there are persistent sensations of epigastric discomfort, the use of Capsicum should be stopped. If a patient has reported prolonged adverse skin reactions to the previous use of Capsicum or capsaicin topical applications, Capsic~ dermal application is not appropriate. Chinese contraindications
• persistent or extreme epigastric discomfort with therapeutic or culinary use of a Capsicum preparation • persistent and extreme sensations of heat or raise in blood pressure with a Capsicum preparation • persistent or extreme dermal irritation with a Capsicum or capsaicin topical application
Heat from
rm Deficiency.4
• always start on the lower end of the dose range, and gradually increase this to the higher end of the dose range but only if this is necessary • reduce the dose or stop the Capsicum if an adverse reaction develops during treatment; if the reaction is temporary, once it is gone, it may be possible gradually . to raise the dose to its previous value • if there is a history ofgastrointestinal inflammation, Capsicum can be prescn1>ed with demulcent antiintlammatories, such as Althaea or Glycyrrhiza, to moderate any potentially irritant effects
Combining Western Herbs and Chinese Medicine
332
• never take Capsicum unless it is needed. reducing the dose as the patient improves • ask the patient not to use Capsicum or other hot spices in food whilst taking Capsicum as a herb. and in particular avoid the use of condiments that combine Capsicum with vinegar Kloss said that Capsicum is not as irritating to the stomach as black pepper. mustard. or vinegar. and I have found that the irritant effects of Capsicum seem to be potentiated by the vinegar in acid pickles and sauces. Herbs that moderate the potential adverse effects of Capsicum In some cases. in wh~ch its use is appropriate, Capsicum can cause or aggravate gastrointestinal inflammation with a burning sensation or pain. Sweet demulcent herbs tend to reduce this adverse effect so that Capsicum may still be used, in some cases, if it is combined with these herbs. Glycyrrhiza and Althaea can both be effective in moderating the unpleasant effects of Capsicum. This effect can be demonstrated by taking 30 drops of 1:5 Capsicum tincture in a little water. The resulting burning sensation can then be greatly reduced by taking half a teaspoon of 1:5 Glycyrrhiza tincture in a little water.
MONITORING During the course of internal treatments that include Capsicum, the patient should be monitored for any signs or symptoms of gastric irritation or extreme heat sensations. If the patient is being treated with Capsicum for hypertension, the screening procedures and treatment precautions should be observed assiduously. In particular, the blood pressure should be taken on a regular basis, and the intake of Capsicum should be stopped if there is anything more than a transient and moderate rise in blood pressure following a Capsicum treatment. During the course of topical application of Capsicum, the patient should be monitored for any signs or symptoms of extreme or prolonged dermal irritation.
Regulatory status Please read the Regulatory status section in the chapter
onSafety. Capsicum is on the UK General Sale List, and it is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act R~gulations of Australia. Capsicum is not currently listed by the FDA (USA) as a prohibited substance, as subject to an impo~t alert, or as a substance with a warning on its use.
Traditional sources PROPERTIES Temperature Capsicum may have been introduced into;:; Britain from India around 1548.3 In 1633, Gerard descnbed .some Capsicum species (Ginnie pepper) as hot and dry in the fourth degree. Tabernaemontanus quoted Matthiolus as classifying Capsicum as hot and dry in the fourth degree. The consensus of opinion for the temperature of C. frutescens (la jiao) in the texts quoted in the Chinese Herbal Medicine Dictionary is hot. However, the range of opinion varies from warm to very hot. ';'"l.~' -
.~
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Taste
Taste in the mouth The BHP described Capsicum as . extremely pungent, and I would defInitely concur. The·t degree of burning sensationin the mouth varies consider~, ably with the variety of Capsicum used and is mainly relat~ :~ to the percentage of capsaicin in the fruit, which can excee3 :2::1"'~ - t'. • 6 . . . . . '-,:
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.
ORGANS
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In terms of Chinese medicine, Capsicum, as used in the West, can be associated mainly with disorders of the followingorgans:
Heart
cardiotonic
Lyle, Ellingwood, Christopher, Priest and Priest
Lung
expectorant
Kloss, Christopher
Spleen-Stomach
digestive stimulant
EllingWood, BHP, Gerard, Felter and U~1
Intestines
flatulence, intestinal colic
BHP, Christopher .
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According to the Chinese Herbal Medicine Dictionary,~; <~~: frutescens (la jiao) enters the Spleen and H e a r t . . ',~,;:'" .
ACTIONS
.
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Changm'g tradition of use Capsicum did not seem to be, ,'~ ~" , much used or understood by Lonicerus or Tabernaemon~ "":~~: . .;~~":;\!;
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Capsicum tanus. They both reported that Capsicum could increase urination to treat edema, and Tabernaemontanus said that mix:ed with honey, and used on the skin, Capsicum can be used for eczema or to heal hard and cold swellings. The use of Capsicum in the West as a general, circulatory and digestive stimulant and tonic seems to have been popularized by the Physiomedical and Eclectic movements in North America, starting in the eighteenth century. Evidence from the traditional sources for the following actions of Capsicum are discussed below: • enhancer of other herbs • general stimulant and tonic • circulatory stimulant and cardiotonic • digestive stimulant and tonic, and carminative • antispasmodic • antimicrobial • antipyretic • diaphoretic and antirheumatic • bronchial stimulant and expectorant • antihemorrhagic • counterirritant and analgesic Enhancer of other herbs Kloss wrote that Capsicum increases the power of all other agents. Christopher said that Capsicum is an activator, carrier, and 'accentuator' of other herbs. According to Mills and Bone,62 the pungent component of black pepper, piperine, has been shown to enhance the bioavailability of other agents. 63 .&-I.65.66 The authors speculate that the old Physiomedical concept of erthancement of the effect of other herbs by Capsicum may similarly have a foundation in the pharmacology of the pungent constituent capsaicin. General stimulant and tonic In terms of Physiomedicalism, Capsicum can be said to: • support the vital force • increase the vital warmth of the body • normalize the body temperature in both febrile and chronic conditions • stimulate and then equalize circulation and normalize blood pressure • regulate the balance between the circulatory and nervous systems Capsicum can be said to have a rapid. transient ~timulant effect, followed by a gradual, cumulative tonic effect. These general stimulant and tonic effects may be mainly via the circulatory, nervous, and digestive systems. Lyle wrote in 1919 \hat the influence of Capsicum is permanent and extends to every organ via its primary effect on
333
the circulation: first the heart, then the arteries, the capillaries, and the nerves. Felter and Lloyd wrote that Capsicum can be used for the debility of young and old, but is particu1arly useful in old people when the body heat is low, vitality depressed, and reaction sluggish. Ellingwood specified Capsicum for atonic conditions with muscular overrelaxation. Christopher recommended Capsicum for fatigue, debility, and lethargy. The BHP listed debility as a specific indication for Capsicum.
Warming stimulant and tonic In terms of Chinese medicine, Capsicum can warm the Interior and help to clear Exterior Wind Cold invasion. In common with Zhang Ii, the author of the Shang Han Lun, Thomson believed that th~ origins of disease are mainly associated with cold, that is, with a reduction of the vital heat of the body. Therefore, the aim of his treatment was always to restore this vital heat. Capsicum was an important p~t of this treatment. 9 At the onset of a cold, when there are chills, cold and clammy feelings, and damp and cold feet, Kloss recommended that Capsicum should be taken in full dose. Christ0pher listed cayenne for chills, colds, and cold extremities; and Priest recommended Capsicum for chills and colds, and for people who are very sensitive to cold and damp.
Sexual tonic Ellingwood noted the use of Capsicum in combinations for impotence.
Nervine Ellingwood said that Capsicum is indicated for general weakness with impairment of nerve influence. According to Felter and Lloyd, Capsicum can be used for nervous prostration and can sustain the nervous system, when given in delirium tremens.
Tranquilizer
Ellingwood recommended Capsicum for delirium tremens to produce a sedative influence, which results in quiet, rest, and frequendy in deep sleep. He also listed Capsicum for opium, morphine, and cocaine addiction. Felter and Lloyd also noted the use of Capsicum in delirium tremens to steady the patient and to promote a sound sleep. Christopher listed Capsicum for delirium tremens and for acute palpitations.
Antidepressant Felter and Lloyd gave marked depression and debility as a specific indication for Capsicum. According to Lyle, Capsicum, given in very small doses, is sustaining in nervous depression. John Christopher was not generally a man for very small doses, and did, on occasion, recommend doses of one or more teaspoons of Capsicum in warm water for depression. Kloss wrote that 'there are many languid people who need something to make the fire of life burn more brighdy:
334
Combining Western Herbs and Chinese Medicine
Circulatory stimulant and cardiotonic Lyle stated that Capsicum is the most powerful and persistent heart stimulant known. It increases arterial force, enlarges its caliber, and slightly increases its frequency. He said that Capsicum by itself is not very diffusive. It is quite local in its influence, but is gradually permeating. Ellingwood wrote that the influence of Capsicum on the circulation is more marked in its local than its constitutional or central effects. It influences general capillary tone, but only increases the action of the heart in extreme cases and in large doses. He wrote that it barely increases the pulse beat, although it materially alters its character, and it does not influence the appreciable temperature. Christopher said that cayenne influences the heart immediately, then gradually extends its effects to the arteries, capillaries, and nerves. He said that the frequency of the pulse is not increased, but that it becomes stronger. According to Priest and Priest, Capsicum is a vasomotor stimulant that stimulates the heart and increases arterial force and frequency. He described its action as being 'centrifugal and extending to the capillaries; and indicated it for general lethargy. He said that Capsicum is the best general tonic for both sides of the heart, but must be used conservatively in cases of poor trophic reserve so that low blood pressure is not raised at the expense of unduly increasing the pulse rate. The BHP listed Capsicum for insufficiency of peripheral circulation.
Cardioregulator and antihypertensive Christopher said that Capsicum regulates the flow of blood from the head to the feet. Capsicum equalizes blood circulation and normalizes blood pressure so that it can be used to treat high or low blood pressure. Antianginal Felter and Lloyd listed Capsicum for angina pectoris with cold extremities, cool perspiration, and great nervous prostration. Christopher recommended it for heart trouble and heart attacks. Mills and Bone included Capsicum in their list of herbs used for angina. Digestive stimulant and tonic, and carminative Gerard wrote that Capsicum warms the stomach and helps the digestion. Ellingwood listed Capsicum for reduced peptic secretions and inactive liver, and for atonic dyspepsia and flatulent colic. Felter and Lloyd reported that, in the atonic dyspepsia of dipsomania, Capsicum removes the craving for alcohol, prevents the morning sickness and vomiting, restores gastric tone, and promotes digestion. The BHP gave Capsicum as a specific for atony of the digestive organs, especially in old age, and listed it for flatulent dyspepsia in t.~e absence of inflammation and for intestinal colic.
Antispasmodic Lyle said that Capsicum with Lobelia:is an.i:~ i excellent antispasmodic. According to both Kloss and' 7~ Christopher, Capsicum is useful for cramps and pains in the '~~:" stomach and bowels. The BHP listed Capsicum as a anti~-:;~~ . spasmodic and noted its use for intestinal colic. ;." -;:-:;;~ . ---""~"--:~.-?:.oi.'. Antimicrobial Capsicum was listed as an antiseptic by ':~j . . 67 Lyle, Kloss, Christopher, the BHP, and MillS. According t o _ Kloss, Capsicum is antiseptic and therefore a valuable gargle for ordinary sore throat or diphtheria. Research has shown that both Capsicum and capsaicin can have antimicrobial effect. Antipyretic Capsicum has been used for fever by herbalists worldwide, especially by the Physiomedical and Eclectic herbal practitioners of North America. It was used for fever --;';: at various stages and of various t y p e s : : • putrescent stage • intermittent"fever • prostrating fever • low-grade fever
Putrescent stage Lyle recommended Capsicum in all . 'putrescent stages: whether of typhus, typhoid, diphtheria, -.;;~ scarlatina malignans, and wherever there is absorption of pus. In such cases, it reduces the frequency of the pulse but -,;.;, increases its volume and firmness. Intermittent fever According to Ellingwood, in the treatment of intermittent fever, Capsicum can greatly increase the effect of quinine. One part Capsicum combined with three parts quinine produce better antiperiodic effects than ten parts quinine, in extreme cases of ague, especially if the ill- _ ness is accompanied with general torpor. Prostrating fever Ellingwood recommended Capsicum for the stage of collapse of exhausting fever and of cholera.Capsicum is also recommended for yellow fever and typhus, where there is great relaxation and muscular weakness, sluggishness of the nervous system, torpor and insensibility,lov.-- '.;~ muttering delirium, and tendency to coma. Felter and Lloyd listed it for cholera with cold extremities, cool perspiration and prostration. Low-grade fever Felter and Lloyd, as well as Kloss pre· scribed Capsicum for low-grade fever. According to Mills Capsicum was used to induce a therapeutic fever, thereby clearing subfebrile, congestive or catarrhal states. Diaphoretic and antirheumatic Capsicum was used as ...-. warming, stimUlant diaphoretic by the Physiomedicalists and Eclectics, since the time of Thomson, to treat cold: influenza, low-grade fever, intermittent fever, cholera, dipr.theria, scarlet fever, typhoid fever, or yellow fever. It was used
i--4J
Capsicum
.."
335
specifically for exhausted states with sensations of cold. Felter and Lloyd listed Capsicum for tired. painful muscles and stiffened joints in the elderly. Christopher said that it was effective for atonic gout and rheumatism.
that 'the patient should be warned of its potency: The BHP listed the topical use of Capsicum for neuralgia, rheumatic pain. and lower back pain.
Bronchial stimulant and expectorant According to Kloss. Capsicum can be used for coughs where there is abundant secretion of mucus in the respiratory passages since it increases the strength of expectoration. Christopher combined cayenne, slippery elm bark, lemon, and honey for coughs, including for tuberculosis, and recommended the application of a liniment of cayenne and apple cider vinegar for lung congestion. Fox listed the use of cayenne for bleeding of the lungs.
COMPARISON OF WESTERN AND CHINESE USE OF CAPSICUM Capsicum was one of the most favored herbs of the Physiomedical and Eclectic physicians of North America. Capsicum is still regarded by many practitioners of Western herbal medicine as the most effective of the circulatory stimulant herbs. It therefore is included in a large number of herbal combinations. In contrast, lil jiao (C. frutescens) has not been so widely used in mainstream Chinese medicine.
Antihemorrhagic
Internal bleeding In 1878, Fox wrote that Capsicum can be used to stop bleeding of the lungs,6a and in 1919, Lyle prescribed Capsicum to prevent postnatal hemorrhage. Felter and Lloyd recommended it for passive hemorrhage. especially uterine bleeding, such as postnatal hemorrhage. and also for dysentery with bloody stools. Kloss said that Capsicum combined with Myrica are ideal in treating uterine hemorrhages. Christopher recommended a teaspoon of Capsicum in a glass of extra-warm water to stop acute hemorrhage from the nose. lungs, stomach, or uterus.
External bleeding Kloss said that Capsicum can be put in a fresh wound or an old ulcer. Christopher said that for external bleeding. Capsicum can be taken internally or the powder can be placed directly on the wound. He wrote that. though the wound is deep enough to expose the bone. the wound may be filled with cayenne, and it will stop the bleeding and heal well. Topical counterirritant and analgesic Scudder recommended powdered Capsicum, sprinkled inside the stockings, for cold feet. For toothache or dental caries, Felter and Lloyd prescribed 1-2 drops of the tincture on cotton, applied to the affected part for immediate relief. They also recommended the tincture for:
r 1•
• unbroken chilblains, rubbed into the chilblain daily, to produce a strong tingling, until the problem is improved • soreness or ulceration of the throat, or for hoarseness from atony of the vocal cords • chronic ophthalmia. or chronic or indolent ulceration of the cornea Christopher listed Capsicum, in combination with other herbs, for eye problems. His combination for early stage cataracts contains one-eighth part cayenne. He also recommended Capsicum ointment for hemorrhoids, but he said
Circulatory stimulant and cardiotonic One of the main uses of Capsicum in the West is as a circulatory stimulant and cardiotonic to treat angina pectoris, exhaustion from cardiac weakness, low body temperature, and depression. In terms of Chinese medicine, this could be described as the ability to move Stagnation of Heart Qi and Blood, and to tonify Heart Qi and Yang. Although one of the texts cited by the Chinese Herbal Medicine Dictionary stated that C. frutescens (lil jiao) can 'move the Blood; the circulatory stimulant and cardiotonic actions of Capsicum do not seem to' be important in Chinese medicine. Digestive tonic and carminative In the Western tradition, Capsicum can act as both a tonic and a stimulant to the gastrointestinal system, as well as an antispasmodic. It has been used to treat weak digestion or atonic constipation, especially in the elderly, as well as flatulence and intestinal colic. In terms of Chinese medicine, this could be described as the ability to tonify and move the Qi of the Stomach and Intestines. According to the Chinese Herbal Medicine Dictionary, C. frutescens (lil jhio) can warm the Middle, dispel Cold, and clear Food Stagnation. It can be used to treat poor appetite, stomach pain from Cold Stagnation, vomiting, and diarrhea. Chinese medical use emphasizes the warming and moving effects of Capsicum on the digestive system, rather than the tonifying action that is also emphasized in the West. Other actions and uses Capsicum is listed as a diaphoretic in the We~t, and has been used to clear Wind and promote sweating in China. It has been described in the West as an anticatarrhal and alterative to treat excessive secretion by mucous membranes due to weakness. Similarly, the Chinese Herbal Medicine Dictionary listed its use for moving Stagnation, Phlegm, and Damp.
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Combining Western Herbs and Chinese Medicine
336
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~
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(1998) 51. SurhYJ.LeeE.LeeJM.MutatRes402{1-2):259-267(1998)
_ -,"
52. McGuffin M, Hobbs C, Upton R et al. American Herbal Products Association's Botanical Safety Handbook. CRC Press. Boca Raton (1997) 53. Lyle TI. Physio-Medical Therapeutics. Materia Medica and Pharmacy. Originally published Ohio (1897). Reprinted by the Nationa' Association of Medical Herbalists of Great Britain. London, Unitec Kingdom (1932) 54. Ellingwood F. American Materia Medica. 'Iberapeutics and Pharmacognosy. 11th edn. (1919). Reprinted by Eclectic Medical PublicatiOn! Sandy. Oregon (1994) 55. Kloss J. Back t~ Ed~n, 5th edn (1939). Reprinted by Lifeline Books. Santa Barbara. California (1975) 56. Reynolds EFI (ed). Martindale: The Extra Pharmacopoeia, 31st edrr.Royal Pharmaceutical Society. London, United-Kingdom (1996)
Capsicum 57. Robertson DRC, Geroge CF. Br Med Bull 46:113-123 (1990) 58. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983)
337
63. Allameh A, Sexena M, Biswas Get al. Cancer Letters 61(3):195-199 (1992)
59. Lacroix jS et al. Clin Exp Allergy 21:595-600 (199 I)
64. Bano G, Rainia RK, Zutshi U et al. European Journal of Clinical Pharmacology 41(6):615-617 (1991)
60. Cruz L, Castaneda-Hernandez G, Navarrete A. Can J Physiol Pharma-
65. Shoba G, Joy D, Joseph T et aI. Planta Medica 64(4}:353-356 (1998)
col 77(6}:441-446 (1999) 61. Felter HW, lloyd jU. King's American Dispensatory, vols. 1 & 2, 18th edn (1898). Reprinted by Eclectic Medical Publications, Sandy, Oregon (l983) 62. Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone, Edinburgh, United Kingdom (2000)
66. Atal CK, Zutshi U, Rao PG. Journal of Ethnopharmacology 4(2):229232 (1981) 67. Mills S. The Essential Book of Herbal Medicine. ArkanalPenguin, London, United Kingdom (199 I} 68. Fox W. The Working Man's Model Family Botanic Guide to Health, 7th edn. William Fox, Sheffield, United Kingdom (1878)
....,
Cimicifuga Botanical name Cimicifuga racemosa (1.) Nutt. (Actaea racemosa 1.) Family Ranunculaceae Pharmaceutical name Cimicifugae radix cum rhizomate Part dried rhizome and roots English black cohosh German Cimicifuga French actee agrappes Mandarin C. racemosa (1.) Nutt. is not used; sheng ma (1o$.) is the rhizome of other Cimicifuga species: see below
1,'-'-'
Use in the West C. racemosa is an attractive perennial native to North America, growing to 2 m in height, with characteristic long, white flower spikes. The roots and rhizomes are collected in the autumn. Due to an increase in the popularity of this herb, it is now endangered in parts of the USA, and practitioners are requested to use cultivated material, rather than material gathered from the wild.
by the Eclectic physicians, especially for such disorders as: • acute fever, eruptive fever, rheumatic fever • headache, neuralgia, myalgia, arthritis • hysteria, chorea, tic douloureux, epilepsy • gynecological and obstetric problems
Use in Europe Dioscorides/ Lonicerus,4 Tabernaemontanus.5 and Gerard6 did not refer to Cimicifuga. The use of this herb in Europe may have been popularized by the American Eclectic physicians who lectured in England in the late 19th century. Since the 1950s, research has been done mainly in Germany on prod\lcts derived from Cimicifuga. such as Remifemin, to treat menopausal and menstrual disorders. so that most published clinical trials are in German. Use in China According to Chang and But,' sheng ma may be the rhizome of C. heracleifolia Kom., C. dahurica (Turcz.) Maxim., or C. foetida 1. Sheng ma is used in Chinese medicine for: 8
Use in North America Black cohosh was used by the Native
• common cold with headache and sore throat • promoting the eruption of measles • headache with gingivitis and stomatitis • prolapse of the rectum or uterus
Americans for rheumatism, arthritis. and gynecological and obstetric problems. According to Felter and Lloyd, I its medical uses were first recorded by Barton in 1801 for 'putrid sore throat. itch, and in diseases of women: From 1832. King popularized the use of this herb under the name of Macrotys, and in 1852. Clapp 2 described Cimicifuga as one of the most valuable of the indigenous North American medical plants. Felter and Lloyd wrote that black cohosh is 'a very active, powerful and useful remedy that appears to fulfil a great number of indications: Black cohosh was much used
What is special about Cimicifuga In terms of Chinese medicine. c. racemosa, as used in the West. can be said to be a cool, acrid, slightly bitter, and
339
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b~eeoe::~::::~erm :0:~::~:::::~mosa ilie w~ bem.
C
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and Uterus systems.
The key to understanding Cimicifuga is that it can strengthen and regulate the muscular, nervous, and hormonal systems to treat a range ofconditions, including muscular rheumatism, muscle spasms and tremors, convulsions, tinnitus, headache, and menstrual and menopausal disorders. CHINESE ACTIONS In terms of Chinese medicine, the range of actions of C. racemosa presents a complex picture. An hypothesis to clarify and explain the interlinked actions of this herb is discussed in the section Energetics ofCimicifuga. It is proposed that the main current Western uses of C. racemosa are founded on four main groups of actions, in terms of Chinese medicine: 1.
move Stagnation of Qi in the Muscle channels; clear Wmd andJ?amp Heat in the Muscle channels
II. calm Liver Hyperactive Yang and Liver Wmd; '. tonify theY"m andQi of Kidney and Liver III. clear Deficiency Heat; tonify the Y"m and Qi of Kidney and Liver IV. tonify Deficiency and calm Irregularity of Uterus Qi; tonify the Y"m and Qi of Kidney and Liver Move Stagnation of Qi in the Muscle channels
Clear Wind and Damp Heat in the Muscle channels
The acrid property of Cimicifuga and that of Lobelia may act in a similar way to treat muscular rheumatism by clearing Wind and Damp from the Muscle channels and by moving Stagnation of Qi and Blood. Also, the bitter property of Cimicifuga may help to clear Damp Heat.
Calm Liver Hyperactive Yang and Liver Wmd
Tonify the Yin and Qi ofKidney and Liver C. racemosa has a tradition of use in the West of treating such manifestations of Liver Hyperactive Yang and Wind as headache, muscle spasms, tics, tremors, convulsions, and epilepsy. In my opinion, this use is founded on the ability of this herb to tonify the Yin and Qi of the Kidney and Liver, and thus to calm and control the irregular upward movement of Qi. In therapeutic doses, and in some situations, C. racemosa can calm upward movement associated with Liver Hypera~tive r~ng. In other situations, especially in high doses, it can caUse or aggravate Liver Hyperactive Yang. This is disc'ussed below. Clear Deficiency Heat
Tonify the Yin and Qi of Kidney and Liver The most com-
m
may
menopausal hot flashes. In my opinion, C. racemosa is mosri'l" '~~-' likely to be successful when the hot flashes are associated '~~';'t"; .........., with Deficiency Heat originating mainly from Deficient Y"m~..... , of the Kidney and Liver. Tonify Deficiency and calms Irregularity of Uterus Qi
Tonify the Yin and Qi ofKidney and Liver Hormonal regulator In terms of Western medical science, :'I!1+.: C. racemosa can treat menstrual and menopausal disorders:-ll
~e::~~s:f°t~~tsf:~i~~7r~p~~~::t~:~~:~:e~~I~~:;~~i:~'~iT Chinese medicine, it may be said that C. racemosa: • tonifies the Y"m and Qi of Kidney and Liver • tonifies the Y"m and Qi of Uterus • moves Uterus Qi and Blood • normalizes irregular movement of Uterus Qi
Regulator of uterine muscle contraction In addition to'-llie ';:0"-"';' indirect effect on the uterine musculature via hormonal reg-~4;.,.. , ... "':~~
.7
ulation, C. racemosa may have a direct effect on the uterme~. " : muscles. C. racemosa can have a normalizing effect on th~': function of the uterine muscles, the type of direct effect de~jr~ pending on the initial state of the patient. If there are exces'--"=:S~7 sive spasms, as in dysmenorrhea, labor, or postnatal pain, ..... ~ then C. racemosa can have an antispasmodic effect. If theieli:' . is a lack of uterine muscle activity, then C. racemosa can be used as a uterine stimulant to initiate contraction, as in:,£Z~" ... delayed labor. The Chinese Cirnicifuga species used as sheng""'~= rna can treat uterine prolapse, which would be associated in'" Western terms with loss of uterine muscle tone.
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.
WESTERN ACTIONS The main Western actions of Cimicifuga are shown here in terms of its four main Chinese actions:
I. move Stagnation of Qi in the Muscle channels; clear Wind and Damp Heat in the Muscle channels
cooling diaphoretic cooling antirheumatic anti-inflammatory analgesic
II. calm Liver Hyperactive Yang and Liver Wind; tonify the Yin and Qj of Kidney and Liver
calming nervine antispasmodic anticonvulsant analgesic
III. clear Deficiency Heat; tonify the Yin and Qi of Kidney and Liver
emmenagogue hormonal regulator nervine
IV. tonify Deficiency and calm Irregularity of Uterus Qi; tonify the Yin and Qi of Kidney and Liver
antispasmodic emmenagogue" ;-: stimulant emmenagogue . "'"'\ ;;t "'~Y'._~.~ hormonal regulator ;:' ':i;~~T.~:
Cimicifuga WESTERN USES The Western uses of Cimicifuga can be related to its four main Chinese actions: Chinese actions-
~
...
341
It would be interesting to determine if the Chinese Cimicifuga species can also calm Hyperactive Yang in such patients or whether there is a genuine difference in effects between the Cimicifuga species used as sheng ma and C. racemosa, based on differences in their active constituents.
--Western uses
Therapeutic doses may aggravate Hyperactive Yang How-
I. move Stagnation of Qi in the Muscle channels; clear Wind and Damp Heat in the Muscle channels
muscular rheumatism, rheumatoid arthritis, myalgia
II. calm Liver Hyperactive Yang and Liver Wind; tonify the Yin and Qi of Kidney and Liver
headache (especially those associated with premenstrual syndrome), tinnitus, tics, tremors, convulsions (especially those associated with menstrual irregularities)
III. clear Deficiency Heat; tonify the Yin and QI of Kidney and Liver
menopausal disorders (especially hot flashes), menopausal disorders occurring with rheumatic disorders
IV. tonify Deficiency and calm IrregularitY of Uterus Qi; tonify the Yin and Qi of Kidney and Liver
premenstrual syndrome, amenorrhea, irregular menstruation, dysmenorrhea (especially occurring with headache, muscular spasms, or convulsions), infertility, postnatal pain
ENERGETICS OF CIMICIFUGA An hypothesis to explain the actions, uses, and contraindications of the species of Cimicifuga used in both China and the West is outlined below under the following headings: • regulation of the upward movement of Qi • tonification of Kidney and Liver Qi and rm • regulation of the surface • Yang tonic effects Regulation of the upward movement of Qi The species of Cimicifuga used in the West and in China appear to be able to regulate the upward movement of Qi and Yang. This may be accomplished especially via regulation of the movement ofYang Qi by the Du and Bladder channels, and by the channels and organs of the Kidney and Liver. Whether Cimicifuga reduces or strengthens the upward movement ofYang Qi may depend on the dose and on the constitution of the patient.
Therapeutic doses may calm Hyperactive Yang In my experience, C. racemosa in therapeutic doses may tonify the Kidney and Liver and thus help to calm Liver Hyperactive Yang and Wmd. This can reduce headache or muscle spasms and tremors. This may be especially in patients in whom Deficiency is dominant to Excess in the upper body.
ever, in Chinese medicine, the Cimicifuga species used as sheng ma are contraindicated in patients with either 'hyperactive fire'S or Excess in the upper body and Deficiency in the lower body.9 In certain patients, both Western and Chinese species of Cimicifuga can cause mild to moderate headache or sensations of pressure, heat, and restless discomfort in the head, even in lower therapeutic doses. In my experience, these patients tend to be those in whom Excess of Hyperactive Yang and/or Heat in the upper body is dominant to Deficiency.
Overdose may cause Hyperactive Yang Signs of overdose with either the Western or Chinese species may include severe headache, vertigo, and tremors, indicating that Cimicifuga has aggravated or caused Liver Hyperactive Yang and Wmd. Therapeutic doses may alleviate the Sinking of Qi The Chinese species of Cimicifuga used as sheng ma, but not C. racemosa, have a tradition of use to treat prolapse of the rectum or uterus by raising the Yang Qi. In the case of patients with Deficiency and sinking of Qi and Yang, sheng ma, in therapeutic doses, may increase the upward movement ofYang Qi without causing Hyperactive Yang or Liver Wind. Again, it would be interesting to determine if the Western species C. racemosa could be effectively substituted for sheng ma in such patients or whether there are genuine differences in effects between C. racemosa and the Chinese species, due to their chemical differences.
rm
In myopinTonification of Kidney and Liver Qi and ion, the ability of C. racemosa to nourish the Qi and rm of the Kidney and Liver may contribute to its capacity to: • calm Liver Hyperactive Yang to treat headache • nourish the muscles to treat spasms, tics, and tremors • nourish the nervous system to treat tinnitus, nervous overexcitability, and convulsions • nourish and regulate the hormonal system to treat menstrual and menopausal disturbances The regulation of the female reproductive hormonal system can be seen, in terms of Chinese medicine, as the regulation of the Qi ofthe Kidney, Liver, and Uterus. Regulation of the surface In terms 'of Chinese medicine, the Western and/or Chinese Cimicifuga species have been used to:
------=a-~ 342
Combining Western Herbs and Chinese Medicine
.
.
~--~i
• move Stagnant Qi and Blood in the body surface, especially the Muscle channels, to treat myalgia • clear Wmd Heat from the surface of the body to treat influenza or fever
and some Deficiency Heat of the LIver and Heart. She m~~ have Deficiency, Stagnation, and Irregularity of Qi of the',",:• Uterus. She may also have Liver Deficient Blood contribut- .~~."', ing to the Liver Hyperactive Yang and Wind.. --'---,
• clear Heat and Toxin from the surface to promote the expression of rashes in eruptive fever • clear Wmd, Damp, and Heat from the surface of the body to treat muscular rheumatism
Choice of Cimicifuga This herb is specific for headache:"'~' muscle spasms and tremors, and menstrual disturbances:~c
Yang tonic effects The Cimicifuga species used as sheng rna can be used to tonify Yang only in the sense of raising Yang Qi to treat prolapse. Western and Chinese Cimicifuga species are not used to tonify Yang in the sense of increasing the energy, warming the body, or increasing sexual function. Yang adverse effects The Cimicifuga species may have adverse effects such as increase in Hyperactive Yang, increase of Heat in the upper body, and pathological erections.9
associated with: • Liver and Kidney Deficient Ym and Qi • Liver Hyperactive Yang and Wmd • Deficiency, Stagnation, and Irregularity of Uterus Qi
If there is also Deficient Blood, then other herbs need to be added since Cimicifuga does not have a Blood tonic action.
Limitations of Cimicifuga .,-,.,.....
DIRECTION OF ENERGY
TEMPERATURE
Cimicifuga can direct the Qi outward through the surface of the body, or it can regulate the upward movement of YangQi.
Cimicifuga is a cool herb that can be used for neutral or warm conditions. For cool or cold conditions, it would need to be combined with other suitable herbs. Cimicifuga needs to be used with care in hot conditions since it can aggravate these conditions in certain cases; see the Cautions section.
Outward direction In terms of Chinese medicine, the Western and/or Chinese Cimicifuga species have been used to clear Wind Heat, Wind Damp, Heat and Toxin, and Stagnation of Qi and Blood from the surface of the body. Upward direction Cimicifuga species can regulate the upward movement of Yang Qi. The effects depend on the dose, on the state of the patient, and possibly on the species of Cimicifuga used. C. racemosa can reduce or increase the deleterious upward movement of disturbed Yang Qi to treat or aggravate headache or dizziness. The species of Cimicifuga used as sheng rna can increase the upward movement of Yang Qi to treat prolapse of the rectum or uterus or to aggravate headache or dizziness.
TYPICAL CASE EXAMPLE Signs and symptoms The patient sometimes has premenstrual syndrome with headache, irregular menstruation, or occasional amenorrhea. She has a tendency to muscle spasms, tics of the facial· m~s~les, ne~vo~s tension and overexcitability. Her pulse is slightly rapid and wiry, and is . empty, especially in the Liver, and Kidney positions. Her (- tongue is pale purple with some red dots at its tip and edges, and has a sligh~ tremor. Diagnosis The patient has Deficient Qi and Yin of the Kidney and Liver, with Liver Hyperactive Yang and Wind,
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TASTE Acrid C. racemosa is not generally used in the West as a diaphoretic to clear Wind Heat and treat colds and influenza, as sheng rna is used in China, and neither C. racemosa nor the Chinese Cimicifuga species are used to warm the Interior. Like Lobelia, C. racemosa is acrid in the sense that it can move Qi and Blood in the Muscle channels to have an anti-inflammatory, antirheumatic, and analgesic effect. Bitter C. racemosa is classified in this book as slightly bitter' in the sense that it can help to clear Wmd Heat, Heat and Toxins, and Damp Heat from the surface channels and assist in the clearing of Deficiency Heat from the Interior. Sweet C. racemosa is classified in this book as slightly sweet, in the sense that it can help to tonify the rm and Qi of the Kidney and Liver.
ACTIONS Antirheumatic Cimicifuga can move Qi and Blood, and help to clear Wind and Heat from the surface channels to treat muscular rheumatism, myalgia, or rheumatoid a{·thritis. I would only use it in combination with other herbs for arthritis without muscular inflammation.
,.----Cimicifuga Nervine Cimicifuga can be regarded as a tonic only in the limited sense of nourishing the muscles, the nervous system, and the hormonal system. Antispasmodic and analgesic Cimicifuga can relieve spasms and pain specifically related to: • muscular rheumatism with Stagnation of Qi and accumulation ofWmd, Damp, and Heat in the Muscle channels • headache with Liver Hyperactive Yang and Kidney and LiverYm and Qi Deficiency • uterine pain with Stagnation of Qi and Blood in the Uterus In other cases of spasms and pain, other herbs may be
343
spasmodic tincture beloved by Physiomedical practitioners (see Lobelia: Antispasmodic tincture). Both herbs can have antispasmodic, analgesic, tranquilizing, and anticonvulsant action, and can be used to treat muscular aches and pains, and also dysmenorrhea and postnatal pain. Cimicifuga + Valeriana
Headache + muscle tremors Ellingwood recommended this pair of herbs to treat chorea, and Valeriana was also a component of some versions of the Antispasmodic tincture. This pair can be used to treat Liver Hyperactive Yang and Liver Wind associated with nervous irritability, convulsions, muscle tremors and spasms, and headache.
more appropriate. Tranquilizer and anticonvulsant Cimicifuga is best used for nervous overexcitability and convulsions associated with Liver Wmd arising fra'~ Deficiency of Kidney and Liver Ym. In other cases of inflammation or irritation of the nervous system, other herbs may be more appropriate.
,... '-
Emmenagogue and hormonal regulator Cimicifuga is specifically indicated for menstrual, obstetric, or menopausal irregularities associated with: • Deficient Yin and Qi of the Kidney, Liver, and Uterus • Stagnation and Irregularity of Uterus Qi For other disorders of the female reproductive system, for example, those linked to Deficient Blood, Stagnant Blood, or Disturbance of Heart Spirit, other herbs may be more appropriate.
Cimicifuga + Salvia officinalis
Premenstrual headache Both herbs can help to calm Liver Hyperactive Yang to treat headache and muscle spasms. They can also regulate the Uterus to treat amenorrhea, irregular menstruation, premenstrual syndrome, and menopausal hot flashes. Cimicifuga + Hypericum
Menopausal hotflashes In my opinion, this pair of herbs can tonify the Qi and Yin of the Kidney and Liver, and regulate the hormonal balance to treat menopausal hot flashes associated with nervous exhaustion and irritability. Avena has a similar function and can be added to this pair. Cimicifuga+Ruta
Cimicifuga paired with other herbs Discussion of the limitations of each of the main actions of Cimicifuga can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Cimidfuga beyond its limitations. The basic unit of herb combination is the herb pair. Nine pairings of Cimicifuga are briefly explained below.
CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair.
Cimicifuga + Lobelia Myalgia Cimicifuga and Lobelia were components of the Anti-
Amenorrhea + petit mal epilepsy Both herbs have the ability to regulate the hormonal balance and stimulate menstruation. They are especially appropriate in cases of Deficient Qi and Yin of the Kidney and Liver with Liver Hyperactive Yang and Wind resulting in petit mal epilepsy or a tendency to muscle spasms, tremors, or convulsions. Artemi~ia absinthium has a similar function and can be added to this pair.
Cimicifuga + Caulophyllum Dysmenorrhea These herbs were used by the Native Americans for disorders of menstruation and pregnancy, and can be combined for amenorrhea, dysmenorrhea, or rheumatism. Caulophyllum is somewhat more of a uterine tonic, and Cimicifuga is somewhat more of a uterine stimulant, although there is overlap of function.
Combining Western Herbs and Chinese Medicine
344 Cimicifuga + Thuja
1. Premenstrual syndrome + headache
Amenorrhea
Liver Hyperactive Yang + Uterus Stagnant Qi and Blood
Whilst Caulophyllum is especially appropriate for amenorrhea with Deficient Qi and Blood of the Uterus, Thuja is more of a uterine stimulant to treat C!Jllenorrhea associated with Stagnant Qi and Blood of the Uterus, especially if combined with Phlegm. Thuja and Cimicifuga can be paired to treat either amenorrhea or rheumatism. Cimicifuga is a cooling, anti-inflammatory antirheumatic, and Thuja is a warming antirheumatic with circulatory stimulant and anticatarrhal actions. Cimicifuga + Harpagophytum Both herbs can have cooling, anti-inflammatory effects and can be paired to treat muscular rheumatism and rheumatoid arthritis associated with Wmd Heat and Damp Heat. Cimicifuga makes this pair specific for rheumatism linked to hormonal imbalance. Cimicifuga + Zanthoxylum
Tinnitus
acrid, sl. bitter, sl. sweet " bitter, aromatic bitter. aromatic aromatic, acrid aromatic, bitter, sl. acrid aromatic sl. bitter
This combination is to treat Liver Hyperactive Yang with Uterus Stagnant Qi and Blood. The overall temperature is, more or less neutral, and the combination can be used to
;;}1y'-J
treat warm, neutral, or cool patterns with minor modifica- ,,~:;~ tion. Acrid, aromatic, and bitter constituents contribute tO~'J'~~ calming the Liver Hyperactive Yang and to regulating the~-;-::t~J flow of Qi and Blood in the Uterus. -,;..~ USE
Both herbs have a tradition of use for treating tinnitus: Cimicifuga may tonify the Kidney and Liver to calm Liver Hyperactive Yang, and Zanthoxylum may clear Phlegm obstruction in the head and ears. Both herbs can also treat rheumatism. Cimicifuga contributes anti-inflammatory and analgesic actions, and Zanthoxylum contributes a peripheral circulatory stimulant action.
Cimicifuga combinations Four Cimicifuga combinations are discussed below:
1. premenstrual syndrome + headache
cool warm-cool warm-cool warm-cool sl. warm warm neutral
1 1 1 1 1 1 1
GENERAL
Rheumatoid arthritis
Combination
Cimicifuga Ruta Artemisia abs. Salvia off. Lavandula Mentha pul. Passiflora
Chinese syndromes, Liver Hyperactive Yang
• premenstrual syndrome and headache, maybe with irritability, nervous tension, or overexcitability PRACTICAL NOTES
This combination can be taken as 2.5-75 mI of 1:5 tincture in quarter of a cup of warm water, three times per day. During the time of premenstrual symptoms, and in the 5 days before it, the individual dose can be 5-7.5 mi. At other times during the cycle. the dose can be reduced to 2.5-5 mi. It may be necessary to take the combination for several months, but once there has been considerable improvement in the premenstrual symptoms, it may be possible to take reduced individual doses of 2.5-5 ml just during the premenstrual period, but not during the rest of the cycle.
+ Uterus Stagnant Qi and Blood 2. amenorrhea + convulsions
Uterus Stagnant Qi and Blood + Liver Wind
3. menopausal disorders + exhaustion
Kidney Deficient Yin + Liver Deficient Yin
4. menopausal disorders + rheumatism
Heart Deficient Yin + Damp Heat
CAUTION
Before using any of the combinations below, it is important to be familiar with the cautions listed for each herb in the combination.
2. Amenorrhea + convulsions
Uterus Stagnant Qi and Blood + Liver Wind
Cimicifuga Ruta Artemisia abs. Caulophyllum Valeriana Lobelia Hydrastis Zingiber
1 1 1 1 1 0.5 0.5 0.5
cool warm-cool warm-cool neutral cool warm-cool cool hot
acrid, sl. bitter, sl. sweet bitter, aromatic bitter. aromatic bitter bitter. sweet acrid bitter acrid. aromatic
fi
Cimicifuga GENERAL
This combination is for Stagnation and Irregularity of the flow of Qi and Blood of the Uterus system, with Liver Hyperactive Yang and Liver Wind. It is a more or less neutral combination that can be used for warm, neutral, or cool patterns, with suitable modification. Acrid, aromatic, and bitter constituents contribute to moving and regulating Uterus Qi and Blood, and to calming Liver Hyperactive Yang and Wmd. USE
The following menstrual disorders, when associated with petit mal or other recurring fits, convulsions, or muscu-
345
• bitter constituents to clear Heat and calm the Spirit • acrid, aromatic, and hitter constituents to move and regulate Uterus Qi and Blood USE
• hot flashes, exhaustion, restlessness, overexcitability, anxiety, nervous tension PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of warm water, three times per day. It can be taken for several months, with appropriate breaks and modifications.
lar spasms: • amenorrhea • delayed menstruation
4. Menopausal disorders + rheumatism
Heart Deficient Yin + Damp Heat
• irregular menstruation • premenstrual disturbances 1 have found combinations including Cimicifuga to be useful for teenagers with amenorrhea associated with nervous tension, emotional disturbance, and petit mal. PRACTICAL NOTES
.
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of warm water, three times per day throughout the cycle. The combination can be taken, with appropriate breaks and modifications for several months.
Kidney Deficient Yin + Liver Deficient Yin
Cimicifuga Hypericum Avena Ruta Anemone Lycium Serenoa Glycyrrhiza
. Ratio
'Temperature Taste·/.:J:· . .
1 1 1 1 0.5-1 0.5-1 0.5-1 0.5
cool neutral neutral warm-cool cold neutral neutral neutral-cool
1 1 1 1 1 1 1 0.5
cool cool neutral-cool neutral warm-cool cool cool cool
acrid, 51. bitter, 51. sweet bitter bitter, sour bitter acrid, aromatic bitter sour, sweet, bitter sweet, sl. bitter
GENERAL
This combination is for Heart Deficient Yin and Heart Deficiency Heat, with Damp Heat in the Muscle channels. It is a cool combination to treat warm-hot patterns. This combination contains:
3. Menopausal disorders + exhaustion
Herb
Cimicifuga Harpagophytum Populus Caulophyl1um Salvia off. Salvia mil. Viola trio Ophiopogon
I
acrid, sl. bitter, sl. sweet sour, sl. sweet sweet bitter, aromatic bitter sweet sweet, sl. sour sweet
GENERAL
This combination is for Deficient Kidney and Liver Ym with Deficiency Heat, and for Deficiency, Stagnation, and Irregularity of the flow of Qi and Blood in the Uterus. It is a cool combination that can be used for warm patterns. This combination contains: • sweet tonic constituents to treat Ym, Qi, and Blood
• bitter constituents to clear Heat and calm the Spirit • sweet constituents to tonify Yin • acrid, bitter, and sour constituents to clear Damp Heat from the Muscle channels • acrid, aromatic, and bitter constituents to move and regulate Uterus Qi and Blood USE
• hot flashes, tiredness, restlessness, overexcitability, feverish sensations, aching and stiffness in the muscles and maybe the joints PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of warm water, three times per day. It can be taken for several months, with appropriate breaks and modifications.
Combining Western Herbs and Chinese Medicine
346
3. Combination No.3 differs from the other three CiIni-:<· cifuga combinations since it contains the sweet tonics Avena, Lycium, Serenoa, and Glycyrrhiza, which together can tonify ~~ the Y"m and Qi of the Kidney and Liver to treat exhaustion..~:_;-=- ~ Cimicifuga, Hypericum, and Avena are specific to treat men-._.~ opausal disorders. Anemone is specific to treat menopausal hot flashes associated with Heat in the upper body, resulting in restlessness, irritability, and anxiety. Ruta combines with Cimicifuga to regulate hormonal imbalance and to calm Liver Hyperactive Yang.
COMPARISON OF THE FOUR CIMICIFUGA COMBINATIONS 1. Premenstrual syndrome + headache
2. Amenorrhea + convulsions
Liver Hyperactive Yang + Uterus Stagnant Qi and Blood
Uterus Stagnant Qi and Blood + Liver Wind
Cimicifuga Ruta Artemisia abs. Salvia off. Lavandula Mentha put. Passiflora
Cimicifuga Ruta Artemisia abs. Caulophyllum Valeriana Lobelia Hydrastis Zingiber
1 1 1 1 1 1 1
4. Combination No.4 is designed to treat menopausal ~ disorders occurring with rheumatism or rheumatoid arthritis. Harpagophytum and Populus are used specifically for .:~~~. arthritis and rheumatism, and Cimicifuga and Caulophyl- ;;~;M¥ lum have the double function of regulating hormonal imbal..:-~:I ~ -.1!l-'-' ance, to assist tr~atment of meno~ausal disorders, and of '. o.f\_~~·' treating rheumansm. The two SalV1as can treat menopa~_ cf~ hot flashes by clearing Heart Deficiency Heat and can assist .•~ in the treatment of rheumatism by moving Stagnation of Qi - -7~' and Blood in the channels. Viola and Ophiopogon help to tonify Yin and clear Deficiency Heat, and Viola contains anti-inflammatory constituents to treat rheumatism and ..
1 1 1 1 1 0.5 0.5 0.5
:t-
1. Cimicifuga, Ruta, Artemisia, Salvia officinalis, and Mentha pulegium are all herbs that can move and regulate the Qi and Blood of the Uterus system to treat menstrual disorders and also calm Liver Hyperactive Yang to treat headache and muscle spasms. Lavandula and Passiflora are included to calm Liver Yang and Heart Spirit and treat headache and nervous excitability.
arthritis. :''S-\'
,:;~
Research
2. Both combinations No.1 and No.2 contain Cimicifuga, Ruta, and Artemisia to regulate menstruation and calm Liver Hyperactive Yang. However, combination No.1 contains Lavandula and Passiflora to treat headache and nervous excitability, whilst combination No.2 contains Lobelia and Valeriana for convulsions and spasms, and Caulophyllum and Hydrastis to promote menstruation. Cimicifuga, Caulophyllum, Ruta, and Artemisia can all be used for women suffering from both amenorrhea and petit mal or other fits, convulsions, or spasms.
3. Menopausal disorders + exhaustion
4. Menopausal disorders + rheumatism
Kidney Deficient Yin + Liver Deficient Yin
Heart Deficient Yin + Damp Heat ~ift1:f:;;:--=~:;;::"=,:;C'Ratio=;~";; .~'."~:,:'::""-_.
Cimicifuga Hypericum Avena Ruta Anemone Lycium Serenoa Glycyrrhiza
1 1 1 1
0.5-1 0.5-1 0.5-1 0.5
.
.
Cimicifuga Harpagophytum - Populus Caulophylum Salvia off. Salvia mil. Viola trio Ophiopogon
1 1 1 1 1 1 1 0.5
CONSTITUENTS • triterpene glycosides • isoflavones • aromatic acids • other Triterpene glycosides These contain a cyclopropane ring and are of the cycloartane type, related to cycloartenol. They are mainly the xylosides actein (aglycone: acetylacteol) and cimicifugoside (aglycone: cimigenol). Cimicifugoside is also called cimigoside. IO• 11 Isoflavones
:
.
Formononetin has been isolated.
12
Aromatic acids These were reported to include isoferulic acid and salicylic acid. 13 A more recent study reported that hydroxycinnamic acid esters of fukiic acid and piscidic acid were isolated from a 50% ethanolic extract obtained from the rhizomes of C. racemosa. Besides 2-E-caffeoylfukiic acid (fukinolic acid), 2-E-feruloylfukiic acid (cimicifugic acid A), 2-E-isoferuloylfukiic acid (cimicifugic acid B), 2-E-feruloylpiscidic acid (cimicifugic acid E) and 2-E-isoferuloylpiscidic acid (cimicifugic acid F), free caffeic, ferulic and isoferulic acids were isolated. 14
------.-Cimicifuga Other These include 15-20% resins (cimicifugin),15 tannins, fatty acids, starch, and sugars. 16
347
acid-induced writhing reaction in mice 19 and that a C. simplex rhizome extract administered intragastrically at 2 g/kg also had analgesic action. 20 Again, I regard these as very high doses.
PHARMACOLOGICAL AND CLINICAL RESEARCH: GENERAL EFFECTS The following effects have been reported for herb extracts of Cimicifuga species or their isolated constituents:
!"" "".,
• antiviral • antibacterial • antipyretic and hypothermic • anti-inflammatory • analgesic • antispasmodic • anticonvulsant • hypotensive and peripheral vasodilator • antidiarrheal • antihyperglycemic Antiviral Administration of isoferulic acid at a dose of 0.5 mg per day was reported to markedly improve the survival rate and reduce the body weight loss in mice infected with lethal influenza virus pneumonia. 17 Antibacterial Sheng ma was reported to inhibit the growth 18 of Mycobacterium tuberculosis in vitro. Antipyretic and hypothermic Intragastric administration of C. dahurica rhizome extract at 1 g/kg lowered normal body temperature in rats. (This very high dose is equivalent to 60 g for a 60 kg human.) Also antipyretic action was reported against fever caused by a mixed typhoid and paratyphoid vaccine. 19 A similar antipyretic action was also reported using an extract of C. simplex rhizome at 2 g/kg, and using
Antispasmodic C. dahurica is reported to contain vissaminol and visnagin. Vissaminol at 5 x 1O-5/ml was reported to reduce intestinal spasms induced by acetylcholine chloride or histamine hydrochloride. The potency of visnagin was about one third that of vissaminol. The antispasmodic strengths of these two chemicals were reported as respectively one tenth and one third that of the opium alkaloid papaverine. 23 Anticonvulsant An alcoholic extract of C. dahurica rhizome was reported to reduce camphor- or strychnine-induced convulsions in mice. 23 •24 Hypotensive and peripheral vasodilator Intravenous administration of Cimicifuga extract at 1 mg/kg showed hypotensive activity in rabbits. Intravenous administration of a Cimicifuga extract in humans did not show a hypotensive effect, but a peripheral vasodilatory action was reported, even in subjects with peripheral arterial disease. 25 A recent clinical study on the cardiovascular effect of C. racemosa in male patients with hypertension indicated that C. racemosa may help to prevent myocardial infarction. 26 Antidiarrheal A study using mice reported that Cimicifuga extract inhibited 5-hydroxytryptophan-induced diarrhea. 27 Antihyperglycemic Isoferulic acid extracted from the rhizome of C. dahurica has been reported to have in vivo ability to lower plasma glucose in spontaneously diabetic rats. 28
cimicifugoside.2°
PHARMACOLOGICAL AND CLINICAL
Anti-inflammatory Ferulic acid and isoferulic acid have been described as the main active components of an extract of the rhizome of C. heracleifolla, an anti-inflammatory preparation frequently used in Japanese traditional medicine. Ferulic acid and isoferulic acid had an inhibitory effect on the production of macrophage inflammatory protein-2 in response to respiratory syncytial virus infection in a mouse macrophage cellline. 21 It was also reported that, when it was administered orally 30 minutes before a substance P injection, a methanol extract of C. dahurica, at a dose of 200 mg/kg, inhibited the substance P-induced itch-scratch
RESEARCH: HORMONAL EFFECTS
response. 22 ,
Analgesic It was reported that intragastric administration of C. dahurica rhizome extract at 1 glkg could reduce acetic
• anatomical and physiological effects • hormonal effects • active constituents • synergistic effects • bone protective effects • treatment of menopausal symptoms • antitumor • selective estrogen receptor modulators Anatomical and physiological effects An early study with rats and mice reported that long-term injections of C. racemosa extract increased uterine weight and established menstrual cycles in juvenile and climacteric animals. 29 A later study showed no uterotrophic or estrogenic effects in
""\
348
Combining Western Herbs and Chinese Medicine
rats and mice administered with C. racemosa extract. 30 However, it was recently reported that in immature female mice, the uterine weight increased with increasing dose of C. racemosa, between 75-300 mglkg, after 14 days of administration of the herb. Also, the days of estrus were significantly prolonged in the 300 mglkg group.3. Hormonal effects Cimicifuga extracts reduced serum luteinizing hormone (LH) levels but did not change the levels of follicle stimulating hormone (FSH) or prolactin in ovariectomized rats. 32 Remifemin is an ethanolic extract of the rhizome of
Bone protective effects It has been reported that ethanolC_. I extracts of C. foetida and C. heracleifolia and the trite~e:;'"". .\ glycoside mixtures from these species can reduce bone re- .::~." absorption. For example, the extracts decreased serum cal~-'l~
';
cium levels by inhibiting bone tu.mover.in low di~tarj~:l.~ cium rats. Experiments on ovanectomized rats mdicated,'~~' . that extracts of C. foetida and C. heracleifolia may be able to'~ ":'\ 36
'."
reduce bone loss due to hormonal changes.
.:;"k-
i
ci'~
Treatment of menopausal symptoms Remifemin Most of the clinical trials have not been done with C. racemosa as such, but with the product Remifemin.
Cimicifuga racemosa, used especially in Germany to relieve climacteric hot flashes. The effects of this preparation on LH and FSH secretion of menopausal women were investigated. After 8 weeks of treatment, LH but not FSH levels were significantly reduced in patients receiving the Cimicifuga extract.33
The dose of C. racemosa equivalent used in these Rernifemin trials was considerably less than the dose of C. racemosa '..• ~ used by most British and Australian practitioners, in some .- . cases, one tenth that of the traditional dose. P , lS Also, some'of:~ );
Active constituents The identities and mechanisms of the constituents responsible for the hormonal effects of C. racemosa are not yet clear.
Measurement of results The Kupperman Index (KI) has .".-\'f" been widely used as a measurement of menopausal symp- ');"''¥'f['
Triterpene glycosides It has been assumed that the triterpene glycosides, such as cimicifugoside, have an effect on the hypothalamus-pituitary system, resulting in secondary effects on the reproductive system and on the central and peripheral nervous systems.).l Formononetin The isoflavone formononetin did not reduce serum levels of LH in ovariectomized rats, but showed activity in the estrogen receptor assay,12 suggesting that it may act as an estradiol antagonist by binding to, but not activating, the receptor. 3S Other Different fractions of a lipophilic extract of C. racemosa were tested· for their ability to reduce LH secretion in ovariectomized rats and to compete in vitro with 17 -~ estradiol for estrogen receptor binding sites. 33 Three types of endocrinologicallyactive compounds were obtained: • constituents that do not bind to the estrogen receptor, but suppress LH release • constituents that bind to the estrogen receptor and also suppress LH release • compounds that bind to the estrogen receptor, but without an effect of LH release Synergistic effects Fromthe study above, it was concluded that the LH-suppressive effect of the C. racemosa extracts observed in menopausal women and ovariectomized rats is caused by at least three different synergistically acting compounds.
.~
,:t., ,.
these trials may have been sponsored by the maker of the product.3s .....:..:..
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IJ
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~-
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toms, for example, hot flashes. The Hamilton Anxiety S~~. --~~ ~ ~"~/1 :.:. (HAMA) measures physical and emotional manifestations . ~~ :.:;:, ~
of anxiety. The Self-Assessment Depression Scale (SDS) evaluates 20 characteristic symptoms as a measure of depresSion. Clinical trials
This topic has been recently reviewed,37.38
and only three trials are discussed here. An open controlled clinical study for 12 weeks compared the effects of: • 80 drops of standardized C. racemosa tincture per day • 0.625 mg of estrogen per day • 2 mg of diazepam per day A decrease in menopausal and depressive symptoms was measured by the KI and SDS evaluations, respectively. Cimicifuga was regarded as at least as effective as the estrogen and better than the diazepam. 39 A randomized, double-blind, placebo-controlled 12week clinical trial compared the effect of four tablets per day of standardized C. racemosa extract, 0.625 mg per day of conjugated estrogens, or a placebo. Again, improvements in menopausal and psychological symptoms were shown according to the KI and HAMA evaluations, respectively. Cimicifuga appeared to be more effective than estrogen, at the doses used, and the Cirnicifuga group showed significant . >. improvement in proliferation of vaginal epithelium.40 A 24-week, randomized, open trial was performed with patients under 40 years old with menopausal symptoms who had had a hysterectomy, but who had at least one intact
Cimicifuga ovary. In the study, the patients received either four tablets per day of standardized C. racemosa extractor three types of estrogen therapy regimens. Menopausal symptoms showed an improvement in all four groups, by KI evaluation, but there were no significant differences between the groups.~1 Antitumor Estrogen can stimulate the growth of mammary tumor cells in patients with estrogen receptor-positive breast carcinoma. However, Cimicifuga extract did not stimulate the growth of mammary tumor cells in vitro. Indeed, it had an inhibitory effect on proliferation at a dose of 2.5 I-lglml.42 Tamoxifen is an estrogen antagonist that binds with the estrogen receptors and is used in the treatment of breast cancer. When tamoxifen and Cimicifuga were administered together, the tumor cells were inhibited to a greater degree than would occur with either substance administered singly.43
..
I'
Selective estrogen receptor modulators (SERMs) SERMs are chemicals that can .selectively act as an estrogen antagonist in some estrogen-sensitive tissues, for example, the uterus and/or breast, but can act as an estrogen agonist in other tissues, with estrogen-like effects on, for example, the skeleton and plasma lipoproteins. Currently, tamoxifen is the SERM most widely used for tne treatment of breast cancer. However, its side effects, which cah include increased risk of endometrial hyperplasia and carcinoma, have promoted a search for the 'ideal' SERM.~
r~-·
Raloxifene is a SERM that has antiestrogenic effect on breast tissue, and estrogen-like effects on the skeleton, preventing bone loss at all skeletal sites. It can decrease breast cancer, has no effect on the risk of endometrial cancer, and can prevent osteoporosis. 45 It has been suggested that plants used for the treatment of hormonal conditions, such as Cimicifuga, may act as SERMs, that is, they may be used to treat menopausal symptoms and osteoporosis without increasing long-term risks of breast or endometrial cancer. 46,47
RESEARCH VERIFICATION OF TRADITIONAL ACTIONS From the research summarized above on Cimicifuga extracts or isolated constituents, there is support for the traditional actions of antipyretic, anti-inflammatory, analgesic, antispasmodic, and anticonvulsant. Additional effects demonstrated by research The following additional effects have been reported discussed above: antibacterial, hypotensive, antidiarrheal, and antihyperglycemic.
as
349
COMPARISON OF WESTERN AND CHINESE SPECIES There is, as yet, insufficient research data for a comparison of C. racemosa, as used in the West, with the species of Cimicifuga used in China.
TOXICOLOGY It has been reported that standardized C. racemosa extract tested negative for genotoxic-mutagenic activity and chronic toxicity.48 A recent review stated that 'the safety prome of black cohosh is positive, with low toxicity, few and mild side effects, and good tolerability.'49 Adverse effects In clinical trials with Remifemin, the main side effects appeared to be headache, weight gain, and gastric complaints. These occurred more frequently in the first 3 weeks of treatment and were rarely so distressing as to reduce patient compliance. According to Mills and Bone, high doses of C. racemosa can cause a frontal headache with a dull, full or bursting sensation, and overdose is potentially dangerous with possible vertigo and visual and nervous disturbances.
Dose There are two approaches to dose: the traditional, as represented by the BHP,so for example, and what is described here as the 'modern' approach. The latter relates especially to clinical trials with the German product Remifemin. Dried herb The BHP listed 0.3-2 g of the dried herb, three times per day (0,9-6 g per day). The BHC adopted the lower dose range of the 'modern' approach of 40-200 mg of dried rhizome per day. Tincture The BHP listed 2-4 ml of 1:10 tincture in 60% alcohol, three times per day (6-12 ml per day). The BHC adopted the lower dose range of the 'modern' approach of 0.4-2 ml of 1:10 tincture of C. racemosa in 60% alcohol, per day. I generally use Cimicifuga in combination with other herbs and so effectively prescribe about 1 ml of 1:5 Cimicifuga tincture, three times per day. This dosage of about 3 ml per day is intermediate between the traditional and 'modern' approaches for 1:10 tincture.
Initial dose Can start at the standard dose, providing the cautions are observed. Duration Can be used for several months, providing cautions are observed.
Combining Western Herbs and Chinese Medicine
350
Traditional sources
Cautions Western contraindications C. racemosa extracts have been reported to inhibit the proliferation of mammary tumor cells in vitro, but the doses used were lower than those employed by most British and Australian herbal practitioners (see discussion above). Until long-term clinical trials have been carried out using traditional doses of C. racemosa rather than lower doses of a herbal product, it may be prudent to avoid the use of C. racemosa in women with estrogen-dependent breast carcinoma. Chinese contraindications The Cimicifuga species used as sheng rna are contraindicated in: 9 • patterns of Excess Heat • patterns of Heat due to Deficient Y'm • patterns of Excess in the upper body with Deficiency in the lower body • fully erupted measles • patients with difficulty breathing Pregnancy and lactation C. racemosa has been used to assist birth, but otherwise, it is perhaps best avoided during pregnancy, although it was recommended by Felter and Lloyd' as an excellent partus praeparator (that is, preparing for childbirth) if it is given for several weeks before confinement.
PROPERTIES Temperature
Sheng
--
rna is classified as coo1
9
or colds in -':--
Chinese medicine. However, it is interesting to note that it is
.~"
~e~;;::t~:~ed for 'hyperactive fire'S and for Heat from'-Li C. racemosa is classified in this book as cool since it has had traditional use in the West for fever and inflammatory conditions of the joints and muscles. However, it can be used for warm, neutral, or cool conditions if suitably combined with other herbs. Taste in the mouth The BHP described the taste of C. racemosa as bitter and acrid. I found a 1:5 tincture of black cohosh in 60% alcohol to give a slightly soapy sensation in the mouth and to taste slightly bitter and slightly acrid, producing a slightly numbing clove-like sensation on the: tongue. I found that a sample of sheng rna (the root of an unspecified Cimicifuga species) also gave a soapy sensation and had an acrid taste, but was somewhat more bitter than the tincture. Taste properties Sheng rna is classified as sweet, acrid, and slightly bitter in Chinese medicine. In this book, C. racemosa, as used in the West, is classified as acrid, slightly bitter, and slightly sweet.
Side effects Some patients experience transient headache in the first 3 weeks of treatment.
Acrid The acrid property of C. racemosa resembles that of Lobelia in that it can:
Overdose Headache, vertigo, visual and nervous disturbances, nausea, and vomiting have been reported for C. racemosa. Headache, dizziness, tremors, gastroenteritis, vomiting, and pathogenic erections have been reported for sheng
ma.
9
.
Interactions A potentially beneficial interaction has been reported in that C. racemosa preparations can augment the antiproliferative action of tamoxifen on breast cancer cells (see above).
• clear Wind Heat and Heat from the surface to treat fever • clear Heat Toxin from the surface to promote the expression of rashes in eruptive fever and to treat throat disorders • clear Wind Heat and Wind Damp from the Muscle channels to treat rheumatism • move Stagnation of Qi and Blood in the Muscle channels to relieve pain The first two of these uses are no longer current in the West, although they are important in China for the Cimi-
Regulatory status Please read the Regulatory status section in the chapter on Safety. C. racemosa (Cimicifuga) is on the UK General Sale List, and it is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. C. racem~sa is not currently listed by the'FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
cifuga species used as sheng rna.
Bitter The bitter property of C. racemosa is associated with: • clearing Wind Heat in common colds, influenza, or rheumatism • clearing Damp Heat in rheumatism and rheumatoid arthritis • clearing Heat Toxin eruptive fever • clearing Deficiency Heat in menopausal hot flashes
r-
i
--
Cimicifuga The most common Western use is for menopausal hot flashes, the secondary use is for rheumatic disorders, and the other two uses are more common for the Chinese species of Cimicifuga than for C. racemosa.
Sweet In my opinion, the sweet property of C. racemosa is associated with tonification of Kidney and Liver Yin and Qi. Thus, the sweet property can indirectly help to calm Liver Yang and Wind and treat headache, muscle spasms and tremors, and convulsions. The sweet property can also help to nourish and regulate the Uterus (the female reproductive system, including its hormonal balance) and treat menstrual, obstetric, and menopausal disorders.
ORGANS
,
I
.,
In terms of Chinese medicine, Cimifuga, as used in the West, is associated mainly with disorders of the following systems: Organ
- ·Exan'lpleS?!:U~e -. _
Source S1
Uterus
amenorrhea dysmenorrhea
Eilingwood
Liver
muscular spasms, chorea, convulsions, epilepsy liver and kidney disorders
Felter and Lloyd
Kidney. Bladder
infertility occipital headache. lumbago
Felter and Lloyd Christopher
Lung
asthma whooping cough
Lyle S4
BHP
Kloss,52 ChristopherS3
BHP
Sheng rna is considered to enter the Lung, Spleen, Stoms ach, and Large Intestine channels.
ACTIONS Evidence from the traditional sources for the following actions of C. racemosa are discussed below: • antipyretic and diaphoretic • alterative • anti-inflammatory and antirheumatic • analgesic and antispasmodic • antitussive and antiasthmatic • nervine, tranquilizer, and anticonvulsant • emmenagogue and hormonal regulator Antipyretic and diaphoretic According to Ellingwood, C. racemosa can be used for acute fever in the early stage when there is a general tired feeling with aching of the muscles, chills, and a greater or lesser degree of fever. He also recommended this herb for the characteristic aching pains of rheumatic fever. Felter and lloyd noted that C. racemosa can
351
produce diaphoresis in febrile diseases, and listed it for eruptive fever, especially in children, and also for intermittent fever. Alterative Lyle wrote that Cimicifuga can act as a diaphoretic when given in hot infusion for eruptive diseases. He also described this herb as an alterative that can purify the blood and cleanse the circulation so that the eruption will not be so intense. Anti-inflammatory and antirheumatic Ellingwood recommended Cirnicifuga for acute inflammatory disorders of all kinds, for example, gonorrhea. Felter and Lloyd recorded its use for inflammations of the eyes, including acute conjunctivitis. Felter and Lloyd listed Cimicifuga for acute muscular rheumatism. Ellingwood wrote that 'if the condition be absolutely confined to the joint and does not involve muscular structure, it is not of as much value: The BHP listed Cirnicifuga for muscular rheumatism and rheumatoid arthritis. Analgesic and antispasmodic Lyle described Cimicifuga as a good antispasmodic, and Felter and lloyd listed this herb for headache, stiff neck, backache, spinal pain, neuralgia, dysmenorrhea, pain in the testes, and aching sensations in the prostate. They described its use for 'eye strain giving rise to headache, and associated with a sensation of stiffness in the ocular muscles, or a bruised feeling in the muscles of the frontal region: Christopher recommended it for occipital headache and lumbago, and the BHP noted its use for intercostal myalgia and sciatica. Antitussive and antiasthmatic According to Ellingwood, Cimicifuga is used for coughs, especially irritant coughs, to increase the bronchial secretions and to stimulate expectoration. Christopher recommended this herb for cough, whooping cough, and asthma, and the BHP listed it as an antitussive for whooping cough. Nervine, tranquilizer, and anticonvulsant Lyle described Cimicifuga as a 'relaxing and stimulating diffusive nervine: and these words were repeated by Priest and Priest,55 who also described this herb as a 'meningeal relaxant and cerebrospinal trophorestorative: Felter and Lloyd listed Cimicifuga for nervous excitability, hysteria, tic douloureux, delirium tremens, periodic convulsions, and epilepsy linked to menstrual disturbances. In addition to these, Christopher recommended it for insomnia, palpitations, and high blood pressure. Both Priest and Priest and theBHP listed Cimicifuga for chorea and tinnitus aurium. Emmenagogue and hormonal regulator Cimicifuga has had the following main emmenagogue indications:
-\ 352
Combining Western Herbs and Chinese Medicine.
• antispasmodic for uterine or ovarian pain • uterine stimulant/relaxant for amenorrhea and infertility • uterine regulator for obstetric conditions • hormone regulator • sexual stimulant or tonic
Caution
Cimicifuga appears to be able to normalize the muscular tone and rhythm of contractions of the uterus so that these are appropriate to the stage of menstruation or preg~ancyof the patient. However, there is the possibility that
large doses may initiate labor. Therefore, some modern texts suggest the avoidance of this herb during pregnancy except to assist labor. Antispasmodic for uterine or ovarian pain Regarding Cimicifuga, Felter and Lloyd wrote that 'in dysmenorrhea it is surpassed by no other drug, being of greatest utility in irritative and congestive. c;:onditions of the uterus and appendages.' They also recommended it in painful conditions resulting from imperfect menstruation. Ellingwood, Christopher, and the BHP all listed this herb for dysmenorrhea.
i) .--:::.1
done especially m Germany WIth products derIved rrom,;J!"ffi _,~ Cimicifuga, such as Remifemin, and is summarized in the·t;~~ . , Pharmacological and clinical research section above. -~:;,t_.
Sexual stimulant or tonic According to Felter and Lloyd.-=
'1
King used the preparation cirnicifugin, derived from C. race~-2"'W
I
mosa, in the treatment of frigidity. Felter and Lloyd wrote'::~ -: that 'the venereal propensity in man is said to be stimulated -'.-;r~ by Cimicifuga,' and interestingly, Bensky and Gamble noted ' 'pathogenic erections' as a possible sign of sheng rna toxicity. :'~
:';"',
~
COMPARISON OF WESTERN AND CHINESE USE OF CIMICIFUGA SPECIES The Western uses of C. racemosa are radically different from the Chinese uses of the Cirnicifuga species used as sheng rna. -~,£~.
Western use
This can be discussed under two main head~~;' ;:
ings: • emmenagogue and hormonal regulator • antispasmodic and nervine
Uterine stimulant/relaxant for amenorrhea and infertility Lyle, Felter and Lloyd, Ellingwood, and Christopher all listed this herb for amenorrhea, and Felter and Lloyd also noted its use for infertility. Cimicifuga may promote menstruation not only by tonic and stimulant effects, but also by relaxing uterine muscle spasms associated with nervous tension, emotional disturbances, and a tendency to spasms and convulsions. Both Ellingwood and Felter and Lloyd listed it for amenorrhea associated with epilepsy.
Uterine regulator for obstetric conditions Both Felter and Lloyd and Ellingwood noted the use of this herb in three main stages of pregnancy: • as a partus praeparator, when given several weeks before confinement, to facilitate an uncomplicated pregnancy and labor • as a partus accelerator to regulate uterine contractions during childbirth so as to strengthen normal contractions, but reduce irregularity a..Tld spasms • to relieve the afterpains of childbirth and to calm 'the general excitement of the nervous system after labor' According to Tierra,56 Cimicifu~ can be combined with other parturient herbs such as squaw vine and raspberry during the last two weeks of pregnancy to facilitate child-
Emmenagogue and hormonal regulator The main current Western use of C. racemosa is as an emmenagogue and hormonal regulator to treat disorders of menstruation and menopause. This is not a traditional use of sheng rna.
Antispasmodic and nervine The secondary uses of C. racemosaare as: • an antispasmodic, analgesic, and antirheumatic to treat myalgia, headache, or rheumatism • a calming nervine and anticonvulsant to treat nervous overexcitability, tinnitus, or convulsions Again. these are not traditional uses of sheng rna. There is overlap in that sheng rna can be used to treat headache, but this is headache associated with either Wmd Heat or Heat in the Stomach and Large Intestine (Heat in the Yang Ming). C. racemosa is used more for the type of headache associated with either hormonal disturbances or nervous tension with muscle spasms and/or tremors. In terms of Chinese medicine, this type of headache can be associated with Deficient Qi and Yin of the Kidney and Liver with Liver Hyperactive Yang. Chinese use
This can be discussed under the following
headings:
birth.
Hormone regulator Since the 1950s, research has investigated the use of Cimicifuga as a hormonal regulator for menstrual and menopausal disorders. This research has been
• Wind Heat • Heat Toxin • Stomach Heat • Sinking ofYang Qi
i[:.-:
Cimicifuga Wind Heat Sheng rna can be used for common cold with headache and sore throat associated with Wmd Heat. Whilst C. racernosa was used in the past for acute and intermittent fever, it has not had wide use for common cold or influenza.
Heat Toxin
Sheng rna has been used in China to clear Heat and Toxin in the Blood to assist in the treatment of measles, to encourage bringing the rash of measles to the surface, and to treat sore throat. Whilst C. racemosa was used in the West in the 19th century to 'cleanse the blood: to reduce the severity of the eruptions in eruptive fever, and to treat 'putrid sore throat' and scrofula, these uses had declined by the 20th century.
Stomach Heat Sheng rna can be used to clear Heat and Toxin affecting the Stomach and Large Intestine, presenting with gingivitis, stomatitis, or headache. Although C. racemosa was occasionally used in the past for dyspepsia, this was related to digestive weakness rather than to burning pain in the epigastrium with gingivitis. Sinking ofYang Qi Sheng rna is much used in Chinese medicine to treat the Sinking of Qi and Yang (with Deficient Spleen and Stomach Qi) associated with chronic diarrhea, rectal prolapse, or uterine prolapse. It is also given to guide other herbs upward. This is quite different from the use of C:racemosa to calm disturbance from the irregular upward movement of Liver Wind and Yang, linked to Deficiency of Kidney and Liver Qi and Yin. See the discussion in the section Energetics of
Cimicifuga.
353
10. Harnischfeger G, Stolze H.rn: Bewahrte Pflanzendrogen in Wissenschaft und Medizin. pp 13-20. Notamed Verlag, Melsungen, Germany (1983) 11. Hostettmann K. Marston A. Chemistry and Pharmacology of Natural Products: Saponins. p 280. Cambridge University Press, Cambridge. United Kingdom (1995) 12. larry H. Harnischfeger G. DUker E. Planta Medica 51:316-319 (1985) 13. Benigni R, Capra C, Cattorini PE. voU; 310-313 [Til (1962) [cited in Bradley PR (ed). British Herbal Compendium. vol. 1. British. Herbal Medicine Association. Boumemouth. United Kingdom (1992) I 14. Kruse SO,LohningA.PauliGF etal. Planta Med 65(8):763-764 (1999) 15. Wagner H, Bladt S. Plant Drug Analysis: A Thin Layer Chromatography Atlas, 2nd edn. p 336. Springer-Verlag. Berlin. Germany (1996) 16. Bradley PR (ed). British Herbal Compendi';lm. vol. I. British Herbal ~ledicine Association. Bournemouth, United Kingdom (1992) 17. Sakai S, Ochiai H. Mantani Net al. Mediators Inflamm 10(2):93-96 (2001) 18. Leptospirosis Prevention and Treatment Research Unit. Scientific Research Compilation. 3rd edn. Chengdu College of Traditional Chinese Medicine, China. p 71 (1972) 19. Shibata M.l Pharma Soc lapan 95:539 (1975) 20. Shibata M. J Pharma Soc lapan 97(8):911 (1977) 21. Sakai S. Kawamata H. Kogure T et al. Mediators Inflarnm 8(3):173-175 (1999)
22. Tohda C. Kakihara Y. Komatsu K et al. Bioi Pharm Bull 23(5):599-601 (2000)
23. Ito Met al. Chemical and Pharmaceutical Bulletin 24(4):58 (1976) 2-\. Nikolvskaia BS et al. Chemical Abstracts 56:9375c (1962) 25. Genazzani E, Sorrentino L Nature 194:544-545 (1962) 26. Kielczynski W. The Modern Phytotherapist 2(1): 1-8 (1998)
References 1. Felter HW. Lloyd lU. King's American Dispensatory. vols. 1 and 2. 18th edn. (1898). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1983)
27. Yoo lS. lung JS, Lee TH et al. Korean l Pharmacogn 26(4):355-359 (1995) 28. Liu 1M. Chi TC,Hsu FLetal.Planta Med 65(8):712-714 (1999) 29. Gizycki H. Z Exptl Med 113:635-644 (1944) 30. Einer-Jensen N, Zhao l. Andersen KP et al. Maturitas 25(2):149-153 (1996)
2. Clapp A. Trans Amer Med Assoc 5:689-906 (1852)
31. LiuZ.Yang Z,ZhuM etal. Wei ShengYan Jiu 30(2):77-80 (2001)
3. Dioscorides P. Kreutterbuch (1619). Reprinted by Verlag Konrad Kolbl, Miinchen, Germany (1960)
32. JarryH.Harnischfeger G. Planta Med 51(1):46-49 (1985)
4. Lonicerus A. Kreuterbuch (1679). Reprinted by Verlag Konrad Kolbl, MUnchen. Germany (1962)
34. PethoA.Arztl Praxis 39:1551-1553 (1987)
5. Tabernaemontanus IT. Krauterbuch (1731). Reprinted by Verlag Konrad Kolbl. Miinchen, Germany (1993) 6. Gerard l. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas lohnson. Dover Publications, New York, New York (1975) 7. Chang H-M, But PP-H (eds). Pharmacology and Applications of Chinese Materia Medica, vols. 1 and 2. World Scientific Publishing, Singapore (1986)
33. Duker EM, Kopanski 1, larry H et al. Planta Med 57(5):420-424 (1991)
35. larry H, Gorkow CH. Wuttke W. In: Loew D. Rietbrock N (eds) Phytopbarmaka in Forschung und klinischer Anwendung. pp 109-110. SteinkopffVerlag. Darmstadt, Germany (1995) 36. Li lX, Kadota S. Li HY et al. Phytomedicine 3(4):379-385 (1996-1997) 37. Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone. Edinburgh. United Kingdom (2000)
38. Hunter A.Europ J Herbal Med5(1):19-25 (1999-2000) 39. Warnecke G. Med Weh 36(22):871-874 (1985)
8. Yeung H-C. Handbook of Chinese Herbs and Formulas, vol. 1. Institute of Chinese Medicine, Los Angdes. California (1985)
40. Stoll W. Tberapeutikon 1:23-31 (1987)
9. Bensky D, Gamble A. Chinese Herbal Medicine Materia Medica. Eastland Press, Seattle. Washington (1986)
41. Lehmann-Willenbrock E, Riedel HH. Zentralbl Gynakolll0(10):61l618 (1988)
.,.'--
354
Combining Western Herbs and Chinese Medicine
42. Nes.sdhut T. Schellhase C, Dietrich R et al. Arch Gynecol Obstet 254( 14):817-818 (1993) 43. Nesslhut T. Expert Forum on German products-: Report and Results from Endocrinology Expert Forum in Luneburg. May 1993. Available from Schaper and Brummer GmbH and Co., Salzgitter (Ringelheim), Germany 44. Dhingra K. Cancer Invest 19(6):649-659 (2001) 45. Fontana A. Delmas PD. Curr Opin Rheumatol13(4):333-339 (2001) 46. Liske E.AdvTherapy 15(1):45-53 (1998) 47. Trickey R. Women Hormones and the Menstrual Cycle: Herbal and Medical Solutions. Allen and Unwin, Sydney, Australia (1998)
West Yorks, United Kingdom (1983)
:,,------.;.;~~ -~~:~~~~ --;:--~~~
.-.-._......-.. 51. Ellingwood F. American Materia Medica. Therapeutics and~~~i
Pharmacognosy. 11th edn. (1919). Reprinted by Eclectic Medical Publications. Sandy. Oregon (1994) 52. Kloss J. Back to Eden. 5th edn. (1939). Reprinted by Lifeline Books;:?";~_ , Santa Barbara. California (1975) - --~:;;;-; 53. Christopher JR. School of Natural Healing. BiWorid. Provo, Utah (1976) .~"~
54. Lyle T}. Physio-Medical Therapeutics. Materia Medica and Pharmacy. Originally published Ohio (1897). Reprinted by the National Association of Medical Herbalists of Great Britain. London, United Kingdom (1932)
48. Liske E.Duker E.Ars Medici 83(7):426-430 (1993)
55. Priest AW, Priest LR. Herbal Medication. L.N. Fowler. Romford Essex,
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56. Tierra M. Planetary Herbology. Lotus Press. Twin Lakes. Wisconsin
SO. British Herbal Pharmacopoeia. British Herbal Medicine Association.
\
United Kingdom (1982) (1988)
__,
1·~
I
Cinchona Botanical name Cinchona pubescens Vah! (C. succirubra Pavon), C. calisaya Wedd. Family Rubiaceae Pharmaceutical name Cinchonae cortex Part dried bark English Jesuit's bark, Peruvian bark German Chinarinde French quinquina Mandarin jin jile (~j.~) is the bark of Cinchona species
Cinchona is on Schedule Part III of the Supply of Herbal Remedies Order 1977 of the UK, with maximum dose limitations. In my opinion, this is a very useful herb, but it is not suitable for over-the-counter sales for therapeutic purposes. Considerations of safety might suggest restriction of its use to health practitioners qualified and licensed in herbal therapy. Please read the sections on Dose and Cautions in this chapter, and the general discussion in the chapter on Safety. Caution
In the second half of the nineteenth century, cultivation was begun in India and Java, and in 1986, it was estimated that up to 10,000 tons of the dried bark were used per year. 4 Cinchona was an important herb for the Eclectic practitioners of North America. Felter and LloydS described Cinchona as 'a therapeutic agent of inestimable value: and both Lyle6 and Felter and Lloyd listed Cinchona for fever and digestive weakness. Cinchona had been used as early as the 18th century to treat cardiac arrhythmia. 7 Ellingwood8 used quinine derived from Cinchona to strengthen the action of the heart. In Europe, Cinchona became used for a wide range of disorders, and the BHP of 19839 listed Cinchona for malaria, splenomegaly, general weakness, anorexia nervosa, dyspepsia, cramps, myalgia, and as a prophylactic for influenza.
Species used The BHC of 1992 reported that C. pubescens was the most used species at that time, although other species and hybrids were also used for the extraction of quinine, for example, C.ledgeriana Moens ex Trimen, C. calisaya Wedd., and C. officinalis L. However, according to a more recent publication, C. calisaya from Ecuador is the main species currently used. 10
Use in the West Cinchona, native to South America, was introduced to Europe from Peru by the Jesuits in the 1630s to treat malaria, hence the names Peruvian bark or Jesuit's bark. It was included in the London Pharmacopeia of 1677,1 but the identity of the plant remained unknown, and it was not until 1742 that Linneus created the genus Cinchona.2 The use of Cinchona steadily increased, and since the bark was originally obtained by f~lling the ~d trees, these were exterminated in many areas by the end of the 18th century.'
Use in China The Cinchona species used in China as jin ji
Ie include: • Cinchona pubescens Vah! • C. ca1isaya Wedd. • C.ledgeriana Moens. • C. officinalis L.
355
Combining Western Herbs and Chinese Medicine
356
The description of properties and uses of jin ji Ie. mainly for malaria. given in the Chinese Herbal Medicine Dictionary is very brief. II This suggests that this is not a herb with a long history of practice and theoretical understanding in Chinese medicine. but rather a herb introduced from the West. with adoption of Western uses.
of appetite and weak digestion. Cinchona has also been ~ed :7';; :' as a bitter general tonic to treat general debility, for example~::~1 following illness or fever. ."~>
i:iti
Cardioregulator The antiarrhythmic effects of Cinchona .~. and of its alkaloids have been known for a long time,12 and .~"r~. \ some herbal authorities have proposed that Cinchona 13 or '~o,-.M::' -,~
quinines strengthens the action of the heart.
"'::. ...
What is special about Cinchona WESTERN USES Cinchona is a cool, bitter herb. that has its main effects on the Heart and Spleen.
The key to understanding Cinchona is that it is a strongly bitter herb that can have antimalarial, antipyretic. cardioregulatory, and digestive tonic actions. It can be used for some acute fever, recurring subacute fever, and for postfebrile recovery.
....
The Western uses of Cinchona can be related to its three main Chinese actions: Chinese actions
Western uses .
I. clear Retained Pathogen
malaria, recurring febrile episodes (as in chronic fatigue syndrome or fibromyalgia), influenza
CHINESE ACTIONS
II. tonify Spleen Qi
In terms of Chinese medicine, Cinchona, as used in the West, can be said to have three main types of action:
poor appetite, atonic digestion, anorexia nervosa, debility
III. tonify and stabilize Heart Qi
arrhythmias, exhaustion from cardiac weakness
I. clear Retained Pathogen II. tonify Spleen Qi III. tonify and stabilize Heart Qi
Chronic fatigue syndrome and fibromyaigia has a tradition of use in the West for:
WESTERN ACTIONS The main Western actions of Cinchona are shown here in terms of its three main Chinese actions:
I. clear Retained Pathogen
antipyretic antimicrobial antimalarial
II. tonify Spleen Qi
bitter digestive tonic bitter general tonic
III. tonify and stabilize Heart Qi
cardioregulator antiarrhythmic cardiotonic
Antipyretic The Cinchona alkaloids quinine and quinidine have been demonstrated to have specific antimalarial action (see Research), but their general antibiotic action is less well documented. There is little research data on the antipyretic action of quinine, but both Cinchona and quinine have been used to treat a range of different febrile conditions, including periodic fever, afternoon fever. and influenza. Bitter tonic The most consistently reported ~e of Cinchona in recent herbal texts is as a bitter digestive tonic to treat loss
.; .,.
Cinchona
• recurring fever associated with debility. especially afternoon fever • low-grade fever with nocturnal perspiration This capacity can be utilized in the treatment of recurring low-grade febrile conditions, as in some patterns of chronic fatigue syndrome and fibromyalgia. Cinchona is especially useful in treating chronic fatigue syndrome and fibromyalgia since it can also treat the muscle aches, digestive weakness, cardiac weakness, and cardiac instability that are often associated with these disorders,
POSSIBLE MECHANISM OF ANTIPYRETIC EFFECTS Cinchona can be used to treat acute influenza, but: • it is not a diaphoretic herb • it is not a typical herb to clear Exterior \\Tmd from the surface during the Tai Yang stage • it is not a specific herb for the Lung. In terms of Chinese medicine, I propose that the anti-. pyretic action of Cinchona and the use of Cinchona in the treatment of febrile disorders may include the following effects:
~.~
357
Cinchona • clears Epidemic Toxin • treats Shao Yang stage fever • clears Deficiency Heat • reduces adverse effect of Heat on the Heart • clears Retained Pathogen • indirectly tonifies Defensive Qi Clears Epidemic Toxin Epidemic Toxin, or Epidemic Pathogen (yl du), may enter the Membrane Source (ma yuan), as in some forms of malaria. The Membrane Source is considered to be at the half-Exterior, half-Interior level of the body and is connected to the muscles externally and the viscera internally.14 It may be that Cinchona, in Chinese terms, clears the Epidemic toxin that has lodged in the Membrane Source, or, in Western terms, kills the malarial parasite. Treats Shao Yang stage fever In Shao Yang stage fever, the Pathogenic factor is active between the Exterior and the Interior, presenting with alternating fever and chills, as in some forms of malaria. Cinchona clears the Pathogenic Factor from the Shao Yang level, where it is located too deep in the body to be released by diaphoresis through the body surface, but not deep enough to be released through the bowels by laxative action. Clears Deficiency Heat There is a Western tradition of use of Cinchona for afternoon fever and fever with nocturnal sweating that can be explained in terms of Chinese Medicine as clearing Retained Heat and clearing Deficiency Heat associated with Deficient Yin.
\_-
Reduces adverse effect of Heat on the Heart The Heat from severe, protracted, or frequent fever may damage or destabilize Heart Qi and Heart rm, especially in individuals with a constitutional tendency to Heart Deficient Qi and Yffi. By clearing Heat and the Retained Pathogen that can give rise to Heat, Cinchona can help to prevent weakness or destabilization of the Heart system. Clears Retained Pathogen Retained Pathogen may be lingering in the body at whatever level or location, for example, in the muscles. When this Retained Pathogen is activated, whether by Wind invasion, emotional stress, allergen, or other factors, there may be manifestations of fever or inflammation. In Chinese terms, this may be seen as Wind Invasion and Retained Pathogen transforming into Heat. In Western terms, this can be seen, for example, in some forms of chronic fatigue syndrome or fibromyalgia during the recurring acute and subacute febrile episodes. antimicrobia~ or alterative In Western terms, Cinchona may have an antimicrobial action and destroy lin-
Antipyretic,
gering dormant pathogenic microorganisms. Cinchona may also have an alterative action to cleanse toxins from the tissues that would otherwise act as potential foci of inflammation or as precipitators of a cascade of pyrogenic effects. Indirectly tonifies Defensive Qi Cinchona may do this by: • clearing Heat and Residual Pathogens from the body, helping to break the cycle of fever and weakness, and allowing the body to recover and rebuild its strength • tonifying the Spleen and improving the appetite, digestion, and perhaps absorption, so that more Qi, Defensive Qi, and Blood can be formed • tonifying and stabilizing the Heart to increase and stabilize the circulation of Defensive Qi and Blood DIRECTION OF ENERGY Cinchona may clear Epidemic Pathogen, clear Retained Pathogen, tonify the Spleen, and tonify and stabilize Heart Qi, but it does not seem to have any marked directional effect: up, down, out, or in. A possible mechanism of action of Cinchona is discussed below. TYPICAL CASE EXAMPLE Signs and symptoms The patient is exhausted and weak, with palpitations, especially when tired, poor appetite and weak digestion, occasional nocturnal leg cramps, and recurring influenza often with muscle aches, or other subacute febrile episodes. The patient sometimes has night sweats, especially when particularly tired. In general, the pulse is empty, especially at the superficial depth. The Spleen position is empty and the Heart position is empty and irregular. The tongue is flabby, pale, and sIightlydry. Diagnosis Deficient Qi of the Spleen and Heart combine to produce exhaustion and debility. Spleen Deficient Qi results. in the digestive weakness, and the palpitations are associated with I-Ieart Deficient Qi. The night sweats may be linked to a minor Deficiency of Heart rm. There appears to be Retained Pathogen, which is causing the recurring febrile episodes and together with the Deficiency of Defensive Qi, is facilitating Exterior Wmd invasion, resulting in influenza. Choice of Ci.J?chona Cinchona can tonify the Spleen to strengthen the appetite and digestion, which in turn will strengthen Qi, Blood, and Defensive Qi. Cinchona can tonify and stabilize Heart Qi to increase energy and reduce heart beat irregularities. Cinchona may also assist patterns of Heart Deficient rm and Deficiency Heat when these are
-.-._-
358
Combining Western Herbs and Chinese Medicine
linked to Retained Heat Pathogen. By reducing Retained Pathogen, Cinchona can treat recurring febrile episodes and reduce the incidence of influenza or other illnesses arising from the interaction of Exterior Wind invasion and Retained Pathogen.
Limitations ofCinchona TEMPERATURE Although Cinchona can be used for fever, it is not a cold herb in the sense that it depresses the metabolism of the body. Indeed, it can have a tonic action on both the heart and digestive systems. Therefore, its temperature has been classified in this book as cool, rather than cold.
TASTE The predominant taste property'of Cinchona is bitter, which can be associated with its cardiotonic, digestive tonic, and antipyretic actions. Cinchona has a slightly sour taste and some astringency in the mouth. However, it does not seem to have appreciable us~ as an astringent, although a greater level of astringency might be expected, considering its 8% tannin content.
.}
.:.~.
• the patient is not taking medications with which .. ,~1 ..- ._ .. \ Cinchona may have serious herb-drug interactions (see~..,..; ~_:r
Caution)
..
_.=_~ .~ Whilst precautions are sensible, I have not seen'researChi--', evidence of either adverse reactions or herb-drug reactiorii!T when using Cinchona, as opposed to its isolated alkaloids;~ .:; Further precautions are discussed in Caution. .;:."'0 -,~::-- .., As an antiarrhythmic and cardiotonic, Cinchona has an ',,:,advantage over Crataegus, Leonurus, Convallaria, or Saro_ tharnnus because of its antipyretic action and its ability to~-.,-" clear Retained Pathogen. Cinchona can be used for heart' c. :' weakness or mild arrhythmias associated with recurring .i low-grade febrile conditions, for example, as seen in some -" cases of chronic fatigue syndrome or fibromyalgia. Digestive tonic Cinchona can be used as a bitter digestiV'e~: ::. tonic, especially when the digestive weakness is combined'=' . with: • recurring low-grade fever • postfebrile debility • cardiac weakness or mild cardiac arrhythmias However, should a warming, bitter tonic be required for ", the Spleen and Heart, Cinchona can be replaced with Rosmarinus.
ACTIONS Antimalarial Cinchona bark, as opposed to quinine preparations, is rarely used in the treatment of malaria today. Antimicrobial Whilst the antimicrobial action may contribute to the use of Cinchona in the treatment of febrile conditions, Cinchona is not currently used as a major herbal general-purpose antibiotic. Antipyretic The antipyretic action of Cinchona has been discussed above. Taking aside the Epidemic Toxin-clearing or antimalarial action of Cinchona, the Heat-clearing, or directly antipyretic action may only be moderate. Its ability to clear Retained Pathogen may be linked as much to its antimicrobial and/or alterative action as to a direct antipyretic effect. Antiarrhythmic and cardiotonic Cinchona can be used in cases of mild arrhythmia or for debility with cardiac weakness, especially for patterns of Heart Deficient Qi or Heart Deficient Yin with Deficiency Heat, providing that: • the patient has had the requisite cardiological examinations, and that herbal therapy is appropriate • the patient does not have disorders that contraindicate the use of Cinchona (see Cautions)
Cinchona paired with other herbs .., Discussion of the limitations of each of the main actions of Cinchona can be useful to clarify just what this herb can_; and cannot do. However, suitable combination with other herbs can extend the range of use of Cinchona beyond its limitations as a single herb. The basic unit of herb combina- -;.;,) tion is the herb pair. Twelve pairings of Cinchona with other herbs are briefly explained below.
CAUTION
Patients with suspected heart disorders require conven-~. tional diagnosis. Cinchona can be used with other herbs as adjunct to conventional West~rn treatment if appropriate, but herbal therapy is not meant as a substitute for conventional_ diagnosis and treatment. Also, practitioners should be aware of potential herb-drug interactions. Before using any of the herb pairs below, it is important to._ be familiar with the cautions listed for each herb in the pair. This is especially true for Cinchona, which is included in Schedule Part III ofthe Supply ofHerbal Remedies Order 1977ofthe United Kingdom.
an .
Cinchona Cinchona + Achillea
Recurring influenza Since both herbs clear Retained Pathogen, the pair can be used for acute and subacute fever, and for postfebrile recovery. Achillea can complement Cinchona by treating Exterior Wind invasion. Cinchona + Populus
Recurringfever + myalgia Since both herbs clear Retained Pathogen and tonify the digestive system, the pair can be used to treat subacute fever and aid in postfebrile recovery. Also, both herbs can be used for muscle aches or pains.
359
or night sweats. Cinchona can clear Retained Pathogen and help Ophiopogon to tonify Heart Yin and clear Heart Deficiency Heat. Cinchona + Pseudostellaria
Postfebrile recovery This pair can be used for postfebrile recovery or in the remission phase of recurring low-grade febrile patterns. Cinchona can clear Retained Pathogen and act as a bitter tonic to the Heart and Spleen, and Pseudostellaria is a sweet herb that can tonify Qi and moisten Dryness. Cinchona + Panax ginseng
Exhaustion + depression Cinchona + Zanthoxylum
Cardiovascular weakness + myalgia Cinchona can be used for muscle aches associated with recurring febrile episodes and for cardiac weakness. Zanthoxylum can be used for muscle aches or pains associated with poor peripheral circulation. Cinchona + Berberis
Recurringfever + reduced hepaticfunction Both herbs can be used to treat recurring febrile episodes, and Berberis can complement Cinchona by tonifying and moving Liver Qi so that toxins are metabolized to reduce the level of potential pyrogens.
,
.
Cinchona + Gentiana
Debility + digestive weakness ~:
t
--1.
-<
Both herbs can act as bitter digestive tonics. Gentiana can complement Cinchona by also acting as a mild gastrointestinal anti-inflammatory, to clear Heat in the Stomach and Intestines. Some authors contraindicate these herbs in the case of gastric or duodenal ulcerations (see Cautions). Cinchona + Salvia officinalis
.,
Debility + fluctuating body temperature
<
This pair of herbs can be used for low-grade fever with muscle aches and for feverishness with night sweats. The pair can also be used for general and cardiac weakness with fluctuations between sensations of heat and cold, as can occur, for example, in some patterns of chronic fatigue syndrome. Cinchona + Ophiopogon
Recurringfever + night sweats These herbs can be used during low-grade fever or in the remission phase to treat sensations of heat in the afternoon
This pair can be used to treat exhaustion with depression and cardiac weakness when there are no signs of Heat or of Liver Hyperactive Yang which might be aggravated by the ginseng. Both herbs can tonify the Heart and Spleen. Cinchona + Capsicum
Cardiac weakness + sensations ofcold Capsicum can strengthen and stabilize heart action. In addition, it can act as a moderating herb to reduce the possibility of cinchonism with cardiac disturbance, resulting from the quinidine content of Cinchona (see Research). It can also complement Cinchona by tonifying the Yang of the Heart and Spleen to improve coronary and peripheral circulation. According to Ellingwood, Capsicum can greatly increase the effect of quinine in the treatment of intermittent fever. He noted that one part Capsicum combined with three parts quinine produce better antiperiodic effects than ten parts quinine, in extreme cases of ague, especially if the illness is accompanied with general torpor. Cinchona + Crataegus
Cardiac weakness + debility Both herbs can tonify and regulate Heart Qi to stabilize heart function and treat debility, for example, in some cases of chronic fatigue syndrome. Crataegus is a herb that can normalize heart function and can be used as a moderating herb to reduce the possibility of cardiac disturbance associated with cinchonism. Cinchona + Leonurus
Cardiac arrhythmia + weakness . Since Leonurus can be used for palpitations and arrhythmias associated with anxiety, it is another herb that can be used as a moderator to reduce chances of cardiac distur-
Combining Western Herbs and Chinese Medicine
360
bance due to cinchonism. Also, Cinchona and Leonurus act as a pair to strengthen the Heart and treat arrhythmias.
CAUTION ON COMBINING CINCHONA AND CONVALLARIA Awareness of possible negative effects Although not discussed as a pair above, Cinchona and Convallaria are sometimes used together to treat cardiac weakness associated with Heart Deficient Qi and cardiac arrhythmias associated with Irregularity of Heart Qi. However, there are possible rare side effects, or overdose effects, for both these herbs. There is also the theoretical possibility of various herbdrug interactions for both herbs, although there are no clinical reports of interactions when using the herbs as opposed to using the isolated constituents. Nor are there any reports of herb-herb interactions with Cinchona and Convallaria. Practical use In practice, it is wise to first use these herbs separately, and to check for any side effects before using Cinchona and Convallaria in a combination at the same time. If there are no side effects to either herb, and the patient is not taking conventional medications that might interact with either herb, the two herbs can be used together, provided the patient is monitored for possible side effects.
Cinchona combinations Six Cinchona combinations are discussed below: Combination ."/" :..,: .
Chinese syndromes
1. recurring fever + myalgia
Retained Pathogen + Wind Heat
2. recurring fever + night sweats
Retained Pathogen + Heart Deficient Yin
3. recurring fever + cardiac weakness
Retained Pathogen + Heart Deficient Qi
4. digestive weakness + postfebrile exhaustion
Spleen Deficient Qi
5. cardiac arrhythmia + recurring fever Heart Qi Irregularity + Retained Pathogen 6. cardiac weakness + digestive weakness
Heart Deficient Qi + Spleen Deficient Qi
CAUTION
Patients with suspected heart disorders require conventional diagnosis. Cinchona can be used with other herbs as an adjunct to conventional Western treatment if appropriate, but
herbal therapy is not meant as a substitute for convention . ; diagnosis and treatment. Also, practitioners should be aware ~l~'~. potential herb-drug interactions. . ;;;;.,,,,.;,., Before using any of the herb pairs below, it is important to.:::':~:~ , be familiar with the cautions listed for each herb in the p~it~0 ' This is especially so for Cinchona which is included in Scheduie~' Part III of the Supply of Herbal Remedies Order 1977 of the!'- ~, United Kingdom. ··~it,;;
'
.;
1. Recurring fever + myalgia
Retained Pathogen + Wind Heat Herb Cinchona Populus Achillea Crataegus Zanthoxylum (bark) Zingiber Glycyrrhiza
Ratio 1 1 1 1 1 0.5 0.5
Temperature
Taste
cool neutral-eool warm-eool sl. warm hot hot neutral-eool
bitter
._..."..
~~.
bitter. sour .. acrid. bitter . "J!!: sour. sweet . ":.'"j,":-:"j acrid. aromatic,~itt:r j~ acrid. aromatic . ..~ :..,
sweet ·;W4
GENERAL
-_1t~:.· , .. .
-'i;~V~i:~
,.;:~;~
This combination is for patterns of Retained Pathogen . "% with some Exterior Wind and with some Deficient Qi and Deficient Defensive Qi, associated with recurring febrile episodes and muscle aches. The myalgia may be associated with: • Deficiency and Stagnation of Qi in the Muscle channels • activation of Retained Pathogen in the muscle layer with local release of heat • Exterior invasion by Wind and Damp
~
_ ..~:~~o;-
,...
This combination is neutral in balance, although it con...../ tains both cooling and warming herbs. Cinchona, Achillea, and Populus are bitter herbs that combine to clear Retained '~.' .,.,.., Pathogen and to treat the associated fever or local inflamma- ... tion. Zanthoxylum and fresh Zingiber are warming, acrid herbs that combine to move Stagnant Qi in the Muscle chan- . nels and disperse Exterior Wind Cold and Damp. The sweet tonic property of Crataegus and Glycyrrhiza combines with the bitter tonic property of Cinchona, Achillea, and Populus to tonify chronic Deficiency, assisting the recovery and strengthening the Defensive Qi. USE
• recurring febrile episodes with muscle aches • chronic fatigue syndrome or fibromyalgia with recurring febrile episodes PRACTICAL NOTES
The combination can be taken as 5 ml of 1:5 tincture in half a glass of hot water, three times per day. For situations in
Cinchona
361
which the febrile episodes and muscle aches recur frequently, for example, every few days, this combination can be given until the remission period is 1 to 2 weeks. This combination can then be taken during acute or subacute febrile episodes only, and a somewhat more tonic combination, such as Cinchona: recurring fever + cardiac weakness, can be
Cinchona Achillea
1 1
cool warm-cool
bitter
Echinacea
1 1 1
cool
acrid, bitter, 51. 5weet sour, sweet
taken during the remission phase.
Glycyrrhiza
0.5 0.5
neutral-cool
Crataegus Pseudostellaria Zingiber
Retained Pathogen + Heart Deficient Yin Herb
Ratio
Temperature
Taste
Cinchona
1 1 1 1 1
cool sl. warm
bitter sour, sweet
warm-cool warm-cool
acrid, bitter
Salvia off. Ophiopogon Glycyrrhiza Zingiber
0.5 0.5
cool neutral-cool hot
hot
sweet, sl. bitter sweet acrid, aromatic
GENERAL
2. Recurring fever + night sweats
Crataegus Achillea
sl.warm neutral
acrid, bitter
This combination is for patterns of debility following fever that can be linked to Heart Deficient Oi with some Retained Pathogen. The principle of treatment is primarily to tonify and secondarily to clear Retained Pathogen. This combination is neutral in temperature and has an
sweet, sl. bitter
almost equal balance of sweet and bitter tonics. Achillea. Cinchona, and Echinacea contain bitter constituents that can clear Retained Pathogen.
sweet acrid, aromatic
USE
aromatic, acrid
GENERAL
This combination is for patterns of Retained Pathogen with Deficient Yin and Deficiency Heat. Achillea and Salvia act as cool herbs in this situation, therefore the overall balance of the combination is cool. The bitter constituents of
• postfebrile debility • remission stage of recurring febrile episodes PRACTICAL NOTES
Cinchona, Achillea, and Ophiopogon have cooling action, and the sweet constituents of Crataegus, Ophiopogon, and
The combination can be taken as 5 m1 of 1:5 tincture in quarter of a glass of warm water. three times per day. Providing the patient experiences no side effects from Cinchona, this combination can be used to treat long-standing Defi-
Glycyrrhiza have a tonic action on Yin and Oi. The acrid constituents of Achillea, Salvia, and Zingiber help to disperse
ciency. It may need to be given. with appropriate breaks and modifications, for 1 to 2 months.
out through the surface the Heat that has accumulated either from Interior Deficiency or in the muscles as a result of acti-
4. Digestive weakness + postfebrile exhaustion
vation of Pathogen.
Spleen Deficient Qi
USE
• recurring fever with night sweats • chronic feverishness in afternoon or at night • chronic debility with heat sensations and occasional low-grade fever PRACTICAL NOTES
The combination can be taken as 5 m1 of 1:5 tincture in quarter of a glass of warm water, three times per day. This combination can be given for a minimum period of 2 weeks, extending up to a month. because it is given for conditions
Cinchona Gentiana Panaxgin.
1 1 1
0.5 Glycyrrhiza 0.5 Cinnamomum (bark) 0.5
Citrus (ripe peel)
cool
bitter
neutral-cool
bitter
51. warm
sweet, 51. bitter
warm
acrid, aromatic, bitter
neutral-cool hot
sweet acrid, aromatic, sweet
GENERAL
This combination is for Spleen Deficient Oi with general
involving chronic Deficiency ofY'm and Oi.
Oi Deficiency, and maybe some Retained Pathogen. The overall temperature is slightly warm, but the combination
3. Recurring fever + cardiac weakness
can be used to treat warm, neutral, cool, or mixed patterns. The bitter constituents of Cinchona and Gentiana can help to clear Retained Pathogen and Deficiency Heat, and can
Retained Pathogen + Heart Deficient Qi
Combining Western Herbs and Chinese Medicine
362
also combine with the bitter constituents of the other herbs to tonify the digestion. The sweet constituents have a tonic action on the Spleen, and the aromatic and acrid constituents can warm and move Spleen Qi.
The overall temperature of the combination is ne ~'" t Bitter, sour, and sweet tastes all contribute to the tonificatioti~~~;';r-_i and regulation of Heart Qi, and some bitter constituents of.,.. ~:'. Cinchona and Achillea can clear Retained Pathogen. ~.->
USE
USE
...
• arrhythmias or palpitations with debility or occasional .
• general and digestive weakness, postfebrile or other
low-grade fever PRACTICAL NOTES
The combination can be taken as 5 ml of 1:5 tincture in quarter of a glass of warm water, three times per day. It can be taken 15 minutes before meals to stimulate the appetite and digestion. Unless there are side effects from Cinchona, it can be taken, with appropriate breaks and modifications, for 1 to 3 months. HISTORICAL NOTE
General tonic and digestive tonic combinations that include Cinchona have been used in both America and Europe, for example: CHRISTOPHER (1976)13
PRACTICAL NOTES
The combination can be taken as 5 ml of 1:5 tincture in .~ quarter of a glass of warm water, three times per day. This is a combination for chronic Irregularity and Deficiency of Heart Qi either due to constitutional weakness or as a result ~, of fever or other illness. Providing the patient experiences no, .' side effects from Cinchona, this combination may need to be'::~) "'given, with appropriate breaks and modifications, for 1 to 2~; _.,::./~~~
months.
6. Cardiac weakness + digestive weakness
Heart Deficient Qi + Spleen Deficient Qi
WEISS (1988)'5
~r::::-'''':~;; 'R~ij'~}i Cinchona Gentiana Citrus aur. Jateorhiza Glycyrrhiza Capsicum
Cinchona Gentiana Citrus aur. Cinnamomum (bark)
1 1 1 1 1
6 2 2 1
0.1 approx.
The Weiss combination is sometimes called Compound Cinchona tincture. Jateorhiza is a bitter digestive tonic herb.
Leonurus Crataegus Cinchona Achillea Panax gin. Glycyrrhiza Zingiber
1 1 1 1 1
neutral 51. warm cool
0.5 0.5
neutral-<:ool hot
wa~ool
51. warm
sour, bitter sour, sweet bitter acrid, bitter sweet, 51. bitter~ .. -·_·.· sweet acrid, aromatic
~~1 ~~
This combination is the same as Leonurus: cardiac weak-
ness + digestive weakness and is discussed under that heading.
5. Cardiac arrhythmia + recurring fever
Heart Qi Irregularity + Retained Pathogen COMPARISON OF THE SIX CINCHONA COMBINATIONS Cinchona Achillea Gentiana Crataegus Leonurus Passiflora Glycyrrhiza
1 1 1 1 1 1
0.5
cool warm-cool neutral-<:ool 51. warm neutral neutral neutral-<:ool
bitter acrid. bitter bitter sour, sweet sour, 51. bitter 51. bitter sweet
1. Recurring fever + myalgia
2. Recurring fever + night sweats
Retained Pathogen + Wind Heat
Retained Pathogen + Heart Deficient Yin
Cinchona Populus Achillea Crataegus Zanthoxylum Zingiber Glycyrrhiza
Cinchona Crataegus Achillea Salvia off. Ophiopogon Glycyrrhiza Zingiber
GENERAL
This combination is for arrhythmias or palpitations . from Irregularity of Heart Qi plus so~e Retained Pathogen, which, when aCtivated, can aggravate the Irregularity of Heart Qi. The primary principle of treatment is to regulate and tonify Heart Qi, and the secondary is to clear Retained Pathogen.
1 1 1 1 1
0.5 0.5
1 1 1 1 1
0.5 0.5
.. ,
Cinchona 1. Cinchona, Achillea, and Populus combine to treat recurring fever and to clear Retained Pathogen. Cinchona. Populus, and Zanthoxylum combine to treat myalgia. Achillea, Zanthoxylum, and Zingiber together can disperse Exterior Wind Cold and Damp invading the muscles, especially if the combination is taken either as a decoction or as a tincture in hot water.
2. Combinations No. 1 and No. 2 contain Cinchona, Achillea, Zingiber, and Glycyrrhiza. Combination No. 1 includes Populus and Zanthoxylum to treat muscle aches, but combination No.2 combines Salvia and Ophiopogon to tonify Heart Ym and to clear Heart Deficiency Heat to reduce sweating. Cinchona, Crataegus, Salvia, Ophiopogon, and Glycyrrhiza can combine to tonify Heart Qi and Yin. This can stabilize the Heart and help to prevent lability of temperature, energy, and emotion.
f;·,-
rr-
,
-
{~
3. Recurring fever + cardiac weakness
4. Digestive weakness + postfebrile exhaustion
Retained Pathogen + Heart Deficient Qi
Spleen Deficient Qi
Herb
Ratio
Cinchona Achillea Echinacea Crataegus Pseudostellaria Glycyrrhiza Zingiber
1 1 1 1 1
0.5 0.5
Herb
Cinchona Gentiana Panaxgin. Citrus (ripe peel) Glycyrrhiza Cinnamomum (bark)
:R:~ti~';; 1 1 1
0,5 0.5 0.5
363
5. Cardiac arrhythmia + recurring fever
6. Cardiac weakness + digestive weakness
Irregularity ofHeart Qi + Retained Pathogen
Heart Deficient Qi + Spleen Deficient Qi
Cinchona Achillea Gentiana Crataegus Leonurus Passiflora Glycyrrhiza
1
1 1 1 1
1
0.5
H~rt;-'7::;~:-c--:' c •.
Ratio"::;':
Leonurus Crataegus Cinchona Achillea Panax gin. Glycyrrhiza Zingiber
1 1
cc
1 1
1
0.5 0.5
5. Cinchona, Crataegus, and Leonurus combine to tonify and regulate Heart Qi. Leonurus and Passiflora calm Heart Spirit, and the sweet components of Glycyrrhiza and Crataegus help to nourish and stabilize Heart Spirit. Cinchona and Achillea help to clear Retained Pathogen. Crataegus, Leon': mus, and Passiflora also moderate possible cardiac irregularity due to cinchonism. 6. Both combinations No.5 and No.6 contain Cinchona. Crataegus, Leonurus, Achillea, and Glycyrrhiza. However, combination No.5 contains Gentiana to assist Cinchona in clearing Retained Pathogen and Passiflora to calm Heart Spirit Disturbance. Combination No.6 contains Panax and Zingiber to warm and tonify Heart and Spleen Qi. Ginseng might be inappropriate in combination No.5 since it might aggravate Heart instability and obstruct clearance of the Retained Pathogen.
OTHER CINCHONA COMBINATIONS 3. Whilst combination No.2 is used to treat Heart Deficient YIn, combination No.3 is used to treat Heart Deficient Qi. Ophiopogon, which was included in combination No.2 to treat postfebrile Deficient Yin, has been replaced by Pseudostellaria to treat postfebrile Deficient Qi. Echinacea has been included in this combination to clear Retained Pathogen and to assist in the tonification of Defensive Qi.
Other combinations that contain Cinchona include the following:
• Salvia: excessive sweating + exhaustion • Zanthoxylum: muscle cramps + cold extremities
Research 4. Combination No.4 is used to tonify, warm, and move Spleen Qi, whilst combination No.3 is used to tonify the Qi of the Heart and Spleen and to clear some Retained Heat. Therefore, combination No. 4 lacks the Achillea for Retained Heat and the Crataegus for Heart Deficiency which are present in combination No.3. Instead, combination No. '4 has Citrus to move Stagnant Spleen Qi and to transform Damp. In combination No.4, Panax ginseng replaces the Pseudostellaria found in combination No.3 since Panax ginseng is less moistening and a stronger Qi tonic.
CONSTITUENTS • alkaloids • triterpenic glycosides
• tannins • free acids • essential oil Alkaloids Cinchona bark contains 5-15% alkaloids. There may be more than 30 alkaloids present, of which the most
--_._---~_--,...
364
Combining Western Herbs and Chinese Medicine
important are quinoline alkaloids. These are the stereoisomers quinine and quinidine and their demethoxy derivatives, cinchonidine and cinchonine, respectively.2 Triterpenic glycosides A mixture of bitter triterpenic glycosides, sometimes referred to as quinovin, constitutes up to 2%.'.16 Wichtl l7 listed the presence of quinovic acid. Tannins Cinchona bark contains up to 8% of catechol tannins l7 and related compounds. Free acids acid.'
These constitute up to 8%, especially quinic
Essential oil Cinchona bark only contains about 0.005% essential oil, of which about 11% is 2-hexyl 3-maleic anhydride. 2
.'T.
., Antipyretic
8...
,
Quinine is mildly antipyretic and analgesic. 2.
~.,
PHARMACOLOGICAL AND CLINICAL RESEARCH The following effects have been reported: • antimicrobial • antimalarial • antipyretic • antiarrhythmic • bitter digestive tonic • antispasmodic • hepatoprotective
- .. ,:.:.,
Antiarrhythmic
Quinidine and its salts are classified as:
. ,:!J.if;~.
_.:.~;.>
channel blockers • subclass Ia antiarrhythmic agents, in that they slow the rate of change of the depolarization phase of the action potential and moderately prolong the repolarization phase l9
Antimicrobial Quinine is toxic to many bacteria and other unicellular organisms. IS
They can be used for the management of atrial fibrillation and ventricular and supraventricular arrhythmias, but other drugs are usually preferred. 19.5 The effects of quinine on the heart are similar to those of quinidine, but are less powerful. 24
Antimalarial The alkaloid quinine has antimalarial action on the erythrocytic forms, as far along as the young trophozoite stage, ofPlasmodium falciparum, P. vivax, and P. mal-
Bitter digestive tonic The bitter alkaloids and bitter quinovin can cause an increase in the production of saliva and gastric secretions, and increase appetite. 25
ariae. Older trophozoites and schizonts are resistant in vitro. It has no or little effect on the gametophytes, sporozoites, or tissue stages. 2
Antispasmodic The alkaloids are antispasmodic,14 and quinine has been used in the treatment of night cramps.19
Quinine is now the treatment of choice for chloroquineresistant or multidrug-resistant strains of malaria. 19 It has been suggested that the possibility of the development of quinine-resistant strains can be reduced by combining quinine with other antimalarial drugs. 20 Research on the Cinchona alkaloids with the intention of developing drugs to treat Plasmodium strains resistant to chloroquine has shown that the stereochemical properties of the Cinchona alkaloids determine the effectiveness of their antimalarial activity.21 An in vitro comparison of the antimalarial activity of the Cinchona alkaloids agairist Plasmodium falciparum has shown that quinidine and then cinchonine were the most effective. Thus the (+) stereoisomers, quinidine and cinchonine, were more effective than the
.1f
• class I antiarrhythmic agents, in that they are sodium
This use of quinine may be based on its neuromuscular junction blocking activity.26 Hepatoprotective A study in mice has shown that pretreatment with Cinchona alkaloid gave a partial protection ~ to carbon tetrachloride-induced hepatotoxicity.27
RESEARCH VERIFICATION OF TRADITIONAL ACTI.ONS :; From the research on isolated constituents summarized--above, there is support for the following traditional actions: antimalarial, antimicrobial, antipyretic, antiarrhythmic, bitter digestive tonic, hepatic (hepatoproteetive), and antispas~- modic. However, no research data yet is available to support
~:{
----
i··
Cinchona
these actions using the herb as opposed to the isolated constituents. Additional effects demonstrated by research It is interesting that there is research evidence for all the traditional actions of Cinchona, except cardiotonic. However, there are no additional effects demonstrated by research as yet.
TOXICOLOGY An important distinction A careful distinction needs to be made between therapeutic doses of Cinchona the herb and doses of quinine or quinidine taken as pure chemicals. Cinchona I have not found research data on adverse reactions to Cinchona bark as opposed to the isolated chemicals quinine and quinidine. Theoretically, there is the possibility that quinine or quinidine hypersensitivity or mild cinchonism could occur.with Cinchona bark. However, according to Hyde,28 recorded cases of cinchonism resulted from the use of the isolated alkaloids and not from therapeutic doses of Cinchona bark. The following may partly explain why Cinchona bark is less likely to have adverse effects than the isolated alkaloids: • dosag~ considerations • buffering in the whole herb • use in multiherb combinations
Dosage considerations The oral dose of quinine salts for falciparum malaria is usually 0.6 g (600 mg) every 8 hours for 7 days.19 Assuming that 3 doses of quinine salts were given in 24 hours, this is a total of 1.8 g. The dose of Cinchona bark recommended by the BHC is 0.9-3 g per day. Assuming the total alkaloid content of the bark were 10%, and assuming that all of the alkaloids were quinine, which is not the case, this might represent doses of quinine of less than 0.09~0.3 g per daily dose. This means that standard allopathic doses of quinine as a pure chemical may be at least 6-20 times greater than the amount of quinine in therapeutic doses of Cinchona bark.
Buffering in the whole herb It may be that the adverse effects of isolated quinine or quinidine are buffered when preparations of the whole plant are used. Buffering may occur since quinine and quinidine occur together with over 30 other alkaloids, and also triterpenoids, tannins, free acids, and a small quantity of essential oils.
Use in multiherb combinations When used by holistic herbal practitioners, Cinchona is commonly given as part of a multiherb combination. 10 In this situation, possible adverse effects of Cinchona may be moderated and buffered by the other herbs.
365
Quinine and quinidine Concerns regarding the administration of quinine and quinidine can be considered under the following headings: • cinchonism • quinine and quinidine hypersensitivity • quinine- or quinidine-induced thrombocytopenia • pregnancy • lactation • anxiogenic activity of quinine
Cinchonism Quinine or quinidine in therapeutic doses may sometimes produce cinchonism. The mild form of cinchonism includes headache, nausea, tinnitus, impaired hearing, and visual disturbances. More severe symptoms of cinchonism may include vomiting, diarrhea, abdominal pain, and vertigo. Extreme cinchonism, following acute overdose of quinine or quinidine, may produce central nervous system disturbances and cardiotoxicity with conduction disturbances, dysrhythmias, and hypotension, resulting in cardiac arrest and circulatory failure, which may be fatal. 19 Quinine and quinidine hypersensitivity Erythema with intense itching is the most common symptom for patients with hypersensitivity to quinine or quinidine, and may occur even after small doses of these alkaloids. Less commonly, cinchonism may also occur.
Quinine- or quinidine-induced thrombocytopenia This may be a hypersensitivity reaction to these alkaloids29.30 that may occur even at very low concentrations. For example, quinine is sometimes added to tonic waters to give a bitter taste, with a maximum concentration of70 Ilglml.~ It has been reported that quinine-induced thrombocytopenia has been precipitated in previously sensitized persons by beverages containing quinine at concentrations as low as 20 Ilglml.31 Anxiogenic activity of quinine Clinical reports, suggesting that quinine use in malaria can be followed by anxiety and apprehension, led to a study in rodents. The study found that quinine could produce anxiety within a certain dose range, but could cause central nervous system depression on increasing the dose. 32 Pregnancy
Quinine According to Martindale,19 'pregnancy in a patient with malaria is not generally regarded as a contraindication to the use of quinine: and the WHO considered quinine to be safe when used in normal therapeutic doses during pregnancy.33 According to Bruneton,2 in pregnant patients with malaria, quinine is reserved for cases that are resistant to chloroquinine.
366
Combining Western Herbs and Chinese Medicine
According to Martindale,19 large doses of quinine can result in abortion, but no references were cited. In 1983, it was reported that in four cases in which quinine was used in an attempt to induce abortion, this was only achieved in one case. Also, a review of the literature suggested that quinine is an ineffective abortifacient, even when taken in toxic doses.:l4 It was reported that, in standard doses, quinine does not increase the risk of abortion or of preterm delivery, nor is it teratogenic. 35 Quinine dihydrochloride was given intravenously to 12 women with severe falciparum malaria in the third trimester of pregnancy. The initial dose consisted of 10 or 20 mg salt/kg over 4 hours and was followed by 10 mg saltlkg every 8 hours until patients were fit to swallow, when quinine sulphate tablets were given. It was reported that uterine activity showed little or no change despite rising quinine concentrations. Hypoglycaemia and hyperinsulinaernia developed in 7 patien~, il! ~.J?~for.e. q!J:inine was started. The authors stated that the important toxic effect of quinine in late pregnancy is not an oxytocic action but rather its capacity to release insulin. 36 Cinchona The herb is contraindicated in pregnancy by the BHP, the BHC, Wichtl, and the German Commission E monograph, presumably due to the presence of quinine. However, I have not seen any research reports of adverse effects of Cinchona in pregnancy when this herb is taken within the therapeutic dose range. Also, as stated above:
• it has been reported that standard doses of quinine do not increase risk of abortion and effect little or no change in uterine activity • the standard allopathic dose of quinine is 6-20 times greater than the amount of quinine in a therapeutic dose of Cinchona bark Therefore, whilst practitioners may prefer to avoid the use of Cinchona in pregnancy until more data is available, the available evidence does not suggest risk is attached to use of Cinchona bark within the therapeutic dose range listed by the BHP. Lactation Quinine has been reported to be excreted into breast milk in small amounts,37 but the American Academy of Pediatrics considered that the use of quinine is probably compatible W!th breast feeding. 38 '
INTERACTIONS Cinchona According to Hyde, Cinchona alkaloids are precipitated by alkaline remedies, although the sediment may be taken up by adding Gum Acacia mucilage. In addition, Cinchona is said to be incompatible with iodides and salicylates, although no references are given. 25
There is no clinical date to indicate that the drug interi~ I tions of quinine and quinidine occur when using therapeu-"""'t:.; tic doses of Cinchona bark. However, considering the data below on the interactions of quinine and quinidine, it is per:'.::=: ~ haps wise to use caution if Cinchona is to be used atth(~'fC1 same time as the following drugs, especially digoxin. ~:"; Quinine and quinidine Antiarrhythmics Quinidine has been shown to cause an 39 increase in serum digoxin concentration. Quinidine may also increase the plasma concentrations of other antiarrhythmics, for example, flecainide acetate. Conversely, the antiarrhythmic amiodarone may increase plasma levels of quinidine, increasing the risk of toxicity. 19
.~
!
~-blockers
Quinidine interactions with both timolol and atenolol have been noted. 19 Antihistamines According to Martindale,19 ventricular arrhythmias have been associated with astemizole and terfena-':: dine, so that the concurrent use of these antihistamines should be avoided with any other drug that also has arrhyth-
..
--,.j •....
mogenic potential, including quinidine. Anticoagulants Quinine can enhance the effect of antico- --:' agulants such as warfarin. In one report, it was necessary to reduce warfarin dose after a high intake of tonic water con- "'" 4
taining quinine. Antiulcer drugs quinidine. 19
0
i
Cimetidine can result in raised levels of ...,
Dose Under Schedule Part III of the Supply of Herbal Remedies Order 1977 of the United Kingdom, the maximum permitted dose of Cinchona is: • dried herb • tincture
250 mg of dried herb, three times per day (daily total of 750 mg) 2.5 ml of 1:10 tincture, three times per day (daily total of 7.5 ml)
-~.~
.
However, four main European texts exceed these maxi""-~ mum figures:
• BHP • BHC • BHC • Wichtl
0.3-1 g of dried bark, three times per day (daily total of 0.9- 3 g) 0.3-1 g of dried bark, three times per day (daily total of 0.9-3 g) . 2-4 ml of 1:10 tincture, three times per--'! day (daily total of 6-12 ml) 1 g of dried bark before each meal (if 3 doses, a daily total of 3 g)
• Commission E 41 1-3 g of dried bark per day
-
Cinchona Initial dose It may be preferable to start at the minimum dose for the first 2 weeks and then proceed to the full dose, providing the patient does not report any adverse effects, such as hypersensitivity or cinchonism.
/
Duration Providing that the patient is regularly monitored for any adverse reactions, this herb can be used, with appropriate breaks and modifications, for 2 to 3 months.
Cautions Western contraindications Contraindicated in cases of cinchonism, quinine or quinidine hypersensitivity, or thrombocytopenia. Contraindicated by some texts for gastric or duodenal ulcers,17 although others recommended Cinchona for hyperchlorhydria. 7
Quinidine The following cautions apply to quinidine,
~.
though not necessarily to Cinchona: contraindication for complete heart block, extreme caution with incomplete heart block and uncompensated heart failure, and caution with patients with myasthenia gravis since it can aggravate the symptoms. 19 Chinese contraindications
367
• has ever had cinchonism, quinine or quinidine hypersensitivity. or thrombocytopenia • is pregnant TREATMENT PRECAUTIONS The following precautions can be taken during the treatment • use Cinchona within the recommended dose range, and use it initially at a lower dosage • use Cinchona for only short periods or give regular breaks in the herbal treatment • alternate the use of Cinchona in a combination with another herb with similar effect, for example, Achillea or Convallaria • never use Cinchona as a single herb but always combine it with herbs likely to moderate any possible adverse effects, such as Capsicum. Leonurus. or Crataegus MONITORING During the course of a herbal treatment that includes Cinchona. the patient should be monitored for:
None known.
Pregnancy and lactation Contraindicated in pregnancy, but may be used in lactation. 2 Ability to drive and use machines
No adverse reports.
Side effects Adverse reactions have been reported for quinine and quinidine, but not for Cinchona (see Toxicology). Overdose Adverse reactions have been reported for quinine and quinidine, but not for Cinchona (see Toxicology). Management of adverse reactions In the case of severe adverse reactions, medical advice and assistance should be sought immediately. Interactions Quinine or quinidine, though not necessarily Cinchona used within the therapeutic dose range, may have adverse interactions with other antiarrhythrnics, especially cardiaactive glycosides, ~-blockers, antihistamines, anticoagulants, and drugs to treat ulcers (see above). SCREENING Before prescribing Cinchona. it should be determined whether the patient: • is taking any medications that include quinine or quinidine • is taking any medications that may interact with the quinoline alkaloids
• symptoms of cinchonism. especially for heart rhythm irregularities • symptoms of quinine or quinidine hypersensitivity. especially skin erythema and pruritis • increased bleeding, which can be a sign of thrombocytopenia
Regulatory status Please read the Regulatory status section in the chapter on Safety. Cinchona is on the UK General Sale List (Statutory Instrument Order 1977 No. 2129 to the Medicines Act 1968) with a maximum individual dose of 50 mg. It is also on Schedule Part III of the Supply of Herbal Remedies Order 1977 with a maximum dose of 250 mg. three times per day. However. the BHP of 1983 and the BHC of 1992 gave a dose range for the dried bark of 0.3-1 g. three times per day. Also. the German Commission E monogr~ph on Cinchona41 gave an average daily dose of 1-3 g of the dried bark, which can mean three doses of O.3-1g per day. Cinchona is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Cinchona is not currently listed by the FDA (USA) as a prohibited substance. as subject to an import alert, or as a substance with a warning on its use.
368
Traditional
s::::g WesternHerbs:::::e MediCine_:~.
~i~.~
Evidence from traditional sources for the following tions of Cinchona is discussed below:~'-'
PROPERTIES
:2_~~"~~
Temperature Cinchona is classified in this book as cool, but not cold. This is partly because it can act as a tonic to the heart and the digestion, and partly because of the nature of its antipyretic action, as discussed below. Felter and Lloyd ~2 said that when Cinchona is swallowed, a sensation of warmth is experienced in the stomach, which gradually spreads over the whole trunk. I have not found this myself, using up to 6 rnl as a single dose of C. calisaya tincture. Also, Ellingwood8 recommended quinine for amenorrhea due to cold. Cinchona is classified as cold in the Chinese Herbal Medicine Dictionary. However, the brevity of the entry for this herb suggests that it is not much used or understood in China. Taste Taste in the mouth According to the BHP, Cinchona has a slight odor and a bitter and astringent taste. According to Wichtl. Cinchona has a slight odor and is bitter and slightly astringent. A 1:5 tincture of C. calisaya that I tested had a definite fragrance and tasted bitter. It also had a mildly sour taste and astringent sensation. The fragrance is presumably due to the essential oil fraction, the bitter taste may be due to the alkaloids and quinovin,18 and the sour and astringent taste is perhaps due to the tannins and related compounds. Taste property Cinchona is classified as bitter in this book. Bitter constituents may be responsible for the digestive tonic, cardioregulator, and antipyretic effects. One text cited in the Chinese Herbal Medicine Dictionary described Cinchona as slightly acrid, and another described it as acrid and bitter. However, these descriptions may reflect a lack of familiarity by Chinese herbalists with this herb.
ORGANS In terms of Chinese medicine, Cinchona. as used in the West, is associated mainly with disorders of the follOWing organ systems:
Heart
palpitations tiredness due to heart weakness
Prinz,12 Nattel 7 Ellingwood, Christopher
Spleen
digestive weakness enlarged spleen
Christopher, BHP Christopher, BHP
Liver
congestion of the liver
Ellingwood
-:
• antimicrobial • antimalarial • antipyretic • antiarrhythmic • cardiotonic • bitter digestive tonic • hepatic, cholagogue • nervine • antispasmodic • emmenagogue
. ...-":'
.. ,::~ ..
'':'~.
Antimicrobial The BHC listed quinine as toxic to many.;' bacteria and other unicellular organisms. Felter and Lloyd, '. Ellingwood, and Christopher all listed Cinchona as an anti~.: septic. The BHP listed Cinchona as a gargle for pharyngitiS.-" Antimicrobial and circulatory stimulant Ellingwood listed Cinchona as a stimulating antiseptic for topical use where ~ . there is reduced capillary circulation, as in sluggish ulcers,' old sores, threatened gangrene, and chilblains. Antimicrobial and alterative According to Christopher, Cinchona increases the excretion of waste products, preventing putrefaction. Ellingwood used Cinchona both as a nasal douche and internally for chronic catarrh with fetid dis-.:" . ~ , charge. . ,....:~.4...~-y,:'
Antimalarial Cinchona was introduced to Europe in the 1630s as an antimalarial drug. This use continues to this day, is listed by most herbal texts,8.5.13.9 and is supported by research as discussed above. Antipyretic According to Ellingwood, quinine salts are specific for the reduction of fever in malaria. He stated that it is of no use in typhus, typhoid, and other protracted fever since it may increase the temperature rather than reduce it. According to Lyle,43 giving quinine during 'febrile excitement' can increase the excitement. However, Felter and Lloyd have a different opinion, perhaps because they are describing Cinchona bark rather than quinine salts. They recommend Cinchona for: • all febrile and eruptive diseases with periodicity • remittent and intermittent fever • afternoon febrile conditions • chronic disorders with periodicity, great debility, or nocturnal perspiration
.. ~._:-:=:~
Christopher also recommended Cinchona for fever of all ':;i~r~ types. The BHP listed Cinchona as an antipyretic that can be ."j':'~>
Cinchona used in the prevention of influenza, the BHC noted its use for feverish infections, and Mabey stated that Cinchona is used to treat fever in general.4-l Both Bruneton and Martindale listed quinine as a mild antipyretic and analgesic, which is included in various combinations for the symptomatic treatment of the common cold and influenza. Antiarrhythmic As early as the 1700s, Cinchona bark was used to treat palpitations.7 Purified quinine became a standard part of cardiac therapy in the second half of the 19th century, and in 1918, the use of quinidine was introduced to treat arrhythmias. 12 However, the antiarrhythmic action is not mentioned in Ellingwood, Felter and Lloyd, Grieve, Christopher, Hyde, the BHP, the BHC, Weiss, Wichtl, or Tierra;U Mabey is one of the few texts to mention the use of Cinchona to treat arrhythmias.
2,)
Cardiotonic According to Ellingwood. quinine strengthens the action of the h~irt. Christopher wrote that small doses of Cinchona increase heart action, while large doses act as a cardiac depressant. Bitter digestive tonic Ellingwood wrote that qumme strengthens the stomach, Felter and Lloyd said that Cinchona strengthens the digestion, and Christopher listed Cinchona for atonic digestion, indigestion, general debility and convalescence. The BHP listed Cinchona for anorexia nervosa, dyspepsia, and hyperchlorhydria. The German Commission E monograph listed it for lack of appetite or for dyspeptic complaints, such as flatulence and distension.
369
Antispasmodic Christopher recommended Cinchona for the treatment of acute rheumatism, and the BHP listed it as an antispasmodic for myalgia and cramps. Quinine has been used in conventional medicine for nocturnal leg cramps. Emmenagogue Ellingwood recommended quinine to induce contraction in cases in which labor has been prolonged due to weakness. He also listed quinine for postnatal hemorrhage and for amenorrhea due to cold. However, neither Ellingwood nor Felter and Lloyd listed Cinchona bark for induction oflabor or the treatment of amenorrhea.
COMPARISON OF WESTERN AND CHINESE USE OF CINCHONA SPECIES Cinchona is a frequently used herb in the West, but a minor herb in China. In the West it has a tradition of use for: • fever~ recurring fever, malaria, and postfebrile debility • poor appetite and digestive weakness • cardiac weakness and cardiac arrhythmias • cramps and muscle aches In China, Cinchona has been an infrequently used herb with the main indication of malaria.
References 1. Grieve M. A Modem Herbal, vols 1 and 2. Dover Publications, New
York, New York (1971)
Hepatic and cholagogue Ellingwood recommended quinine for chronic congestion of the liver, Wichtl mentioned the occasional inclusion of Cinchona in cholagogue combinations, and research has indicated hepatoprotective effects from the Cinchona alkaloids.27 However, this herb is not listed as an important hepatic or cholagogue, and I do not use it as such.
2. Bruneton J. Pharacognosy: Phytochemistry Medicinal Plants, 2nd edn. Lavoisier, Paris, France (1999)
Nervine Lyle described Cinchona as a stimulating nervine for the central, sympathetic, and peripheral nervous systems. Ellingwood listed quinine as a stimulant to the heart and nervous system. Felter and Lloyd wrote that Cinchona invigorates the nervous and muscular systems in diseases of general debility. Cook described Cinchona as a slowastringent stimulant to the nervous system. 46 Christopher repeated this statement, and listed Cinchona for neuralgia and nervous disorders.
6. Lyle n. Physio-Medical Therapeutics, Materia Medica and Pharmacy. Originally published Ohio (1897). Reprinted by the National Association of Medical Herbalists of Great Britain, London, United Kingdom (1932)
Use of Cinchona in the treatment of multiple sclerosis The
10. Denham A. The European Journal of Herbal Medicine 4(3):19-28 (1999)
use of Cinchona in multiherb prescriptions for multiple sclerosis has been reported. lO In one case, small doses of Cinchona, 5 m1 per week, were used.
3. Evans WC. Trease and Evans' Pharmacognosy, 14th edn. WB Saunders, London, United Kingdom (1996) . 4. McHale D. The Cinchona Tree. Biologist 33:45-53 (1986) 5. Felter HW and lloyd JU. King's American Dispensatory, vols 1 and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1983)
7. Nattel S. Singh BN.Am J Cardiol84(9A):l1R-19R (1999) 8. Ellingwood F. American Materia Medica, Therapeutics and Pharmacognosy, 11th edn. (1919). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1994) . 9. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983)
11. Jiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science &: Technology Press, Shanghai, China (1975)
- Combining Western Herbs and Chinese Medicine
370
12. PrinzA. Wien Klin Wochenschrl02(24):721-723 (1990) 13. Christopher (1976)
JR.
School of Natural Healing. BiWorld, Provo, Utah
30. Bird MR, O'Neill AI. Buchanan RR. Pathology 27(2):136-139<'~~? 31. Murray JA. et al. Br Med J 2:1551-1552 (1979) 32. Bhattacharya SK, Mitra SK.lndian I Exp Bioi 30(1 ):33-37 (1992)
,.,j.
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14. Bensky D, Barolet R, Chinese Herbal Medicine Formulas and Strategies. Eastland Press, Seattle, Washington (1990)
33. WHO. Practical chemotherapy of malaria: report of a WHO scieDtilii:;';;':~
15. Weiss RF. Herbal Medicine, English edn. Beaconsfield Publishers, Beaconsfield, United Kingdom (1988)
34. Dannenberg At, Dorfman SF, Johnson J. South Med I 76(7): 846-849
16. Tschesche R, Duphorn I, Snatzke G. Leibigs Ann. Cheml (Annalen) 667:151-163 (1963) 17. Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm, Stuttgart, Germany (1994), from 2nd German edn. Wicht! M (ed) (1989) 18. Bradley PRo British Herbal Compendium, vol. 1. British Herbal Medicine Association, Bournemouth, United Kingdom (1992) 19. Reynolds EFI. Martindale: The Extra Pharmacopoeia, 31st edn. Royal Pharmaceutical Society, London, United Kingdom (1996) 20. Amabeoku GJ. CentAfr J Med 37(10):329-333 (1991)
group. WHO Tech Rep Ser 805 1990
(1983) ',.~~
35. Phillips-Howard PA, Wood D. Drug Saf 14(3):131-145 (1996)
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36. Looareesuwan S, Phillips Re, White NJ et al. Lancet 2(8445):4-8 (1985)
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37. Phillips RE et al. BrT Clin PharmacoI21:677-683 (1986)
38. Committee on Drugs, American Academy of Pediatrics. PediatricS' .~~ 84:924-936 (1989)'-'~ ..~.:
39. Mordel A et al. Clin Pharmacol Ther 53:457-462 (1993)
3~
40. Clark DJ. Br Med J 286:1258 (1983)
41. Blumenthal M. The Complete German Commission E Monogia~~-;~
21. Karle JM, Bhattacharjee AI<. BiQ()rg Med Chem 7(9):1769-1774 (1999)
Therapeutic Guide to Herbal Medicines. American Botanical CoUricit".
22. Wesche DL,BlackJ.JTJ:Op MedHyg93(3):153-159 (1990)
Austin, Texas (1998)
,
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23. WHO. WHO Tech Rep SCr 805 (1990) .,+\~
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24. Jaeger A, et al. Med ToxicoI2:242-273 (1987) 25. DAB 9-Kommentar. BlUld 2, 1157-1164 [T8] (1987). [cited in Bradley PR (ed). British Herbal Compendium, vol 1. British Herbal Medicine Asso~tion, Bournemouth, United Kingdom (1992)] 26. Pinn G. Aust Fam Physician 27(10):922-923 (1998) 27. You X, Mulchinski Ea, Aarwal AK. Res Commun Chern Pathol Pharmacol84(2):223-32 (1994)
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42. Felter HW, lloyd JU;King's American Dispensatory, voL 2, 18th~":-: ,", '- '-""--'~-?!i'~" (1898). Reprinted by Eclectic Medical Publications, Sandy, Orego~,_;.~ (1983) .' >' .,.. 43. Lyle TJ. Physio-Medical Therapeutics, Materia Medica and (1897). Reprinted by The National Association of Medical of Great Britain, London, United Kingdom (1932)
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. .,',
44. Mabey R. The Complete New Herbal. Elm Tree Books, London, United Kingdom (1988)
28. Hyde FE Herbal Practitioner's Guide to the Medicines Act 1968. New Herbal Practitioner 4(3) (1978)
45. Tierra M. Planetary Herbology. Lotus Press, Twin Lakes. w~co~·:~r~kr. (1988) _ :;c,~.1
29. Shah BH, Nawaz Z, Virani SS et al. Biochem Pharmacol56(8):955-960 (1998)
46. Cook WHo The Physio-Medical Dispensatory. Cincinnati Reprinted by Eclectic Press. Portland, Oregon (1985)
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best to keep the price of cinnamon high by limiting supply, for example, by confining the Ceylonese cinnamon plantations to restricted plots.
Cinnamomum cassia and C. verum
Family Lauraceae Pharmaceutical name Cinnamomi cassiae cortex Part dried bark English cinnamon German Chinesischer Zimt French canelle de Chine Mandarin the parts of Cinnamomum species used are: gul pi (ll It) is the bark of young branches gut zhi (tl:tt) is the young twigs rou gul (~:.ti) is the bark of mature trees
Species used in the West Three main species are used: • C. cassia Nees (C. aromaticum Nees) • C. verum J. Presl (c. zeylanicum Blume =C. zeylanicum Nees) • C.laureirii Nees
C. cassia This is known as Chinese cinnamon, false cinnamon, or cassia. The plant is cultivated in the southwest of China, in Guangxi and Guandong provinces, and the drug used in the West is the dried bark, which often still has some of its cork and cortical parenchyma attached.
Use in the West Dioscorides l classified cinnamon as a warming herb for digestive, urinary, respiratory, and menstrual disorders. Cinnamon is now mainly used in the West for the common cold and influenza, poor appetite and indigestion, nausea and vomiting, flatulence and intestinal colic, and diarrhea. The cinnamon bark that was known in Roman times was probably C. cassia and was most likely obtained from China, where this herb had been known since about 2700 BC.2 There was no reference to collection of cinnamon in Ceylon until
C. verum This is known as Ceylon cinnamon, Echter Kanel, and cannellier de Ceylan. This drug is the dried bark from the 2-3 centimeter thick branches of approximately 6-year old trees, which are kept as bushes by coppicing. The bark is
the 13th century. According to Fernand BraudeP, Dutch spice traders entered Ceylon, the 'cinnamon isle: in 1638. Braudel quotes a Dutch ship captain as reporting that 'the shores of the island . are full of it, and it is the best in all the Orient: when one is downwind of the island, one can still smell cinnamon eight leagues out to sea: In the 17th century, the Dutch did their
371
cleared of both ~e outer cork and the underlying parenchyma by scraping. Bark from approximately 2-year old root suckers of older plants may also be used. The plant may be native to Sri Lanka, from where the drug is mainly imported. There are various traditional grades of Ceylon cinnamon, which are described, together with the methods for cultivating, collecting, and preparing the material, by W. C. Evans.2
C. laureirii This is known as Saigon cinnamon and grows in the mountainous districts of Annam. The plant is closely
Combining Western Herbs and Chinese Medicine
372
What is special abouf~7.---:,:"~,o Cinnamomum
related to C. cassia and more closely resembles the bark of C. cassia than that of C. verum. 2 In the past, Saigon cinnamon has been used more in the United States than in Britain.
Nomenclature It is not always clear which of these three species is referred to in Western texts. My experience is mainly of using C. cassia, so that in discussions below on the Western use of Cinnamomum, the term Cinnamomum refers to C. cassia, unless otherwise stated. Species used in China C. cassia Pres1. is the main species used in China, although other species are also used, such as: • C. burmanii (Nees) B1. (c. chinensis B1.) • C. japonicum Sieb. (c. pedunculatum Nees) • C.laureirii Nees (Saigon cinnamon) • C. wilsonii Gamble
Different preparations .Whilst gu1 zhi is commonly C. cassia Pres1., gul pi may be C.. burmanii (Nees) BL, C. japonicum Sieb., or C. wilsonii G~ble.6 Lower quality rou gul is generally C. cassia Pres1., whilst the far more expensive, higher quality preparation is generally C.laureirii Nees (Saigon cinnamon from Annam).
Medical uses The two main preparations of Cinnamomum used in Chinese tradition are gu1 zhi and rou gut Although they overlap in function, they can be distinguished as follows:'
• gul zhi is used especially for invasion of the body surface by Exterior Wind Cold, particularly in cases with Deficiency at the body surface • rou gul is used especially for Interior Cold with Deficient Yang of the Kidney or Spleen Gul pi is somewhat similar in action to rou gul, but milder, and less effective as a tonic for KidneyYang. It is especially used to warm the Spleen and Stomach to treat gastrointestinal pain associated with Cold.6
In terms of Chinese medicine, Cinnamomum cassia",:". used in the West, can be said to be a warming herb, the twigs being warm in temperature, and the bark hot. Its main tast€:,., properties can be said to be acrid, sweet, and aromatic. It has . A,,: its main effect on the Spleen, Stomach, and Intestines, and ~~ also on the Lung, Heart, Kidney, and Uterus.
The key to understanding Cinnamomum cassia is that its acrid, sweet, and aromatic properties can act in combination. • the acrid and sweet properties can combine in. the twigs to both warm and tonify the surface ofthe body, and in the bark to both warm and tonify the Interior • the acrid and aromatic properties can combine to increas~'fi circulation of Qi and Blood, clear Interior Cold, and relaX;~ smooth muscle contraction to treat intestinal colic, ' ',,:', dysmenorrhea, or chest pain due to heart disease CHINESE ACTIONS In terms of Chinese medicine, Cinnamomum, as used in the West, can be said to have six main actions: I. II. III. IV.
regulate Stomach and Intestines Qi warm and tonify Spleen and Stomach Qi clear Wind Cold and tonify the Exterior tonify Heart Yang, an~ warm and move Heart Qi and
Blood V. tonify Kidney Yang VI. warm and move Qi and Blood in the Uterus
WESTERN ACTIONS The main Western actions of C. cassia are shown here in terms of the six main Chinese actions:
Problems of supply Since the time of ancient Rome, there have been problems with obtaining high quality Cinnamomum bark. When this has been available, it was often prohibitively expensive. At the time of this writing, one US supplier offers 'regular' rou gul at $3 per pound and 'Vietnam' rou gul at $73 per pound. The clinical effectiveness of lower quality Cinnamomum may be considerably less than that of high quality, and gul pi, which may not perform fully the traditional functions of rou gul, is used when the latter is not available or when it is prohibitively expensive. According to Lonicerus,8 Galen said that double the amount of 'common' Cinnamomum should be used when 'noble' Cinnamomum was not available.
I. regulate Stomach and Intestines Qi
carminative antispasmodic astringent antidiarrheal
II. warm and tonify Spleen and Stomach Qi
carminative tonic
III. clear Wind Cold and tonify the Exterior
tonic diaphoretic circulatory stimulant antiarthritic
IV. tonify Heart Yang, and warm and move Heart Qi and Blood
cardiotonic circulatory stimulant antianginal
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V. tonify Kidney Yang
VI. warm and move Qi and Blood in the Uterus
tonic diuretic stimulant emmenagogue astringent
The main Western uses of C. cassia can be related to its six main Chinese actions: . -'. , Western uses
I. regulate Stomach and Intestines Qi
abdominal pain, flatulence, nausea, vomiting, diarrhea
II. warm and tonify Spleen and Stomach Qi
loss of appetite, epigastric discomfort
III., clear Wind Cold and. tonify the Exterior
colds and influenza with persistent perspiration and weakness, arthritis and cold extremities
IV. tonify Heart Yang, and
palpitations with exhaustion, angina pectoris
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warm and move Heart Qi and Blood
V. tonify Kidney Yang
VI. warm and move Qi and
edema, oligUria, dysuria, cold weak back and knees, impotence with exhaustion amenorrhea, dysmenorrhea
Blood in the Uterus
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Choice of Cinnamomum A combination of equal parts of Cinnamomum twigs and Cinnamomum bark is chosen to tonify the surface and clear Exterior Wind Cold, to tonify the Yang of the Spleen, Heart, and Kidney, and to warm the Interior.
Limitations of Cinnamomum
WESTERN USES
Chinese actions
373
TEMPERATURE Cinnamomum twigs In Chinese medicine, Cinnamomum twigs (gul zhI) are classified as acrid and warm rather than hot Therefore, if a more warming diaphoretic is required, fresh Zingiber may be preferred. Cinnamomum bark In Chinese medicine, Cinnamomum bark (rou gul) is classified as acrid and hot. However, much of the rou gul that is available is derived from C. cassia, rather than from C. laureirii from Annam. It is not clear whether the lower grade C. cassia bark is warm or hot. Bark sold as gul pi is probably merely warm. Should a very hot herb be required, Capsicum is much cheaper than good quality Cinnamomum and is generally as good or better. However, if the problem specifically involves Deficient KidOey Qi and Yang, or the patient has a poor tolerance of Capsicum, then rou gul is preferable.
DIRECTION OF ENERGY
TASTE
There is an overlap in the direction of energy of the tvvigs and bark. Both can clear Wind Cold at the surface so that both can be used for influenza. Both can be used to warm the Interior and to move Stagnation of Qi and Blood in the Interior, for example, in the Heart or Ute~. However, the twigs are relatively more surface-active to dear Exterior Wind Cold and to tonify the surface, whilst the bark is relatively more warming and tonifying to the Interior.
Acrid taste This has been discussed under temperature.
TYPICAL CASE EXAMPLE Signs and symptoms The patient is pale and exhausted, with poor appetite and slow digestion, abdominal distension, edema, loose stools worse with tiredness, and cold extremities, back and lower abdomen. The patient also has recurring influenza with chills predominating, sweating without improvement of the condition, and occasional mild chest pain and palpitations that is made worse ~~ ~us tion. Diagnosis The patient has Deficient Qi of the swface and Deficient Yang of the Spleen, Lung, Heart, and Kidney.
Aromatic Cinnamomum bark shows some of the actions associated with the aromatic property, that is, it can be drying, warming, moving, and antispasmodic. However, it does not show appreciable stimulant or tranquilizing effects on the central nervous system as do some aromatic herbs, such as Lavandula and Rosmarinus. Sweet Cinnamomum twigs show a warming sweet tonic action at the surface of the body, and Cinnamomum bark shows a warming sweet tonic action in the Interior. However, this sweet tonic action is balanced by the outward moving action of the acrid and aromatic properties. Therefore, if a more heavy and stabilizing aspect of the sweet tonic action is preferred, Cinnamomum would need to be combined with other herbs. Also, Cinnamomum bark tonifies the energetic aspect rather than the structural aspect of Qi. It is a warming Yang tonic, rather than a Qi or Blood tonic. If a more substantial sweet tonic is required, herbs such as Angelica sinensis or Serenoa would be more appropriate.
374
Combining Western Herbs and Chinese Medicine
ACTIONS Canpinative Good quality Cinnamomum bark is specific for poor appetite and indigestion associated with Deficiency of Spleen and Kidney Yang. If good quality Cinnamomum bark is not available, Panax ginseng combined with dried Zingiber can be used as a substitute. If the problem is Deficient Spleen Qi and Yang with Cold in the Stomach, then Capsicum is generally as good or better than Cinnamomum, and is considerably cheaper. Antispasmodic Dried Zingiber may be equally effective as an antispasmodic for flatulence and abdominal pain, and is cheaper than high quality Cinnamomum. Antiemetic Again, dried Zingiber may be used as a substitute for Cinnamomum bark for vomiting associated with Cold, unless the Zingiber proves to be ineffective. Cinnamomum bark may be more effective than Zingiber in cases of Cold and Deficiency since it is sweeter and has a stronger tonic action. Antidiarrheal The antidiarrheal action of Cinnamomum bark is especially linked to diarrhea associated with Deficiency of Spleen and Kidney Yang. Cinnamomum would not be appropriate for diarrhea due to Damp Heat. Diaphoretic Cinnamomum twigs are used specifically for patterns of Exterior Wind Cold with Deficiency at the surface. If a diaphoretic is needed for Exterior Excess Wmd Cold, then Ephedra would be more appropriate, and if a diaphoretic were required to clear either Wind Cold or Wind Heat, then Achillea or Salvia leaves would be required. Antiarthritic Cinnamomum twigs are specific as a circulatory stimulant and antiarthritic for patterns of Exterior Wind Cold Damp with surface Deficiency, and maybe Interior Deficiency of Yang. Cinnamomum twigs would not be appropriate for Wind Heat or Damp Heat arthritis, and would not be adequate for arthritis associated with Deficient Blood. Antianginal Cinnamomum twigs may assist in the treatment of chest pain due to heart disease when this is linked to Stagnation of Heart Qi and Blood and Deficiency of Heart Yang. It might not be appropriate for angina with Heat or Excess patterns. Cardiotonic Cinnamomum bark can help to treat shortness of breath or palpitations associated with Deficient Qi and Yang of the Heart system. However, it has a warming, stimulating effect on the Heart, and if a cardiotonic is required with a normalizing effect, then Crataegus, Leonurus, Convallaria, or Sarothamnus would be more suitable.
Diuretic Although Cinnamomum bark has some an~JIlE.~~ --:_ crobial action, it is mainly its action as a Spleen and Kidn:ey:~"\.......-.- i Yang tonic that allows it to treat edema, oliguria, or urinary ~ ~ discomfort. .-;~"'f.1.:.i; ~
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Tonic Good quality Cinnamomum bark can act as an acrid.. sweet tonic for Deficient Yang of the Spleen, Heart, or ....'•~:,:E: .1;:" Kidney. However, by itself, it is not adequate to tonify Qi or '~"~l Blood. ~:"::-!'I Emmenagogue Cinnamomum bark may be appropriate in patterns of infertility, amenorrhea, dysmenorrhea, or uterine bleeding associated with Deficiency of Kidney Yang, and Stagnation of Qi and Blood in the Uterus from Deficiency and Cold. It may also have a normalizing effect on uterine muscle tone. However, it does not appear to have an effect on hormone regulation, like Vitex, or a strong stimulant effect on uterine contractions.
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with other herbs Discussion of the limitations of each of the main actions of Cinnamomum can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Cinnamomum beyond its limitations. The basic unit of herb combination is the herb pair. Twelve pairings of Cirmamomum are briefly explained below.
CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair. Cinnamomum + Ephedra
Asthma aggravated by cold This pair has been made famous in the Chinese formula rna huang tang. Cinnamomum twigs reinforce the warming diaphoretic effect of Ephedra, but the sweet tonic action of the Cinnamomum twigs at the surface moderates the potentially weakening dispersing action of Ephedra. This pair can be used for acute colds, influenza, coughs, and asthma associated with Excess patterns of Wind Cold invasion. Cinnamomum + Zingiber
Influenza Both Cinnamomum twigs and fresh ginger have a sweet tonic property that can help to harmonize Defensive Qi and
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Nourishing Qi, and strengthen the surface to prevent further invasion. Both are tonic diaphoretics, but Zingiber is relatively more hot and diffusive, whilst Cinnamomum twigs are relatively more tonic. This pair can also be used for arthritis aggravated by invasion of Wind Cold. Cinnamomum + Capsicum .
Angina pectoris Cinnamomum twigs can be combined with Capsicum to tonify Heart Yang and to move Stagnant Qi and Blood in the heart vessels and relieve pain. Capsicum is a hotter herb and a more powerful heart stimulant; it is the dominant herb in this pair. This pair can also be used for arthritis associated with both Exterior and Interior Cold.
375
or abdominal pain and prolapse, resulting from Cold and Stagnation in the Spleen and Liver and/or Cold and Deficiency of the Spleen and Kidney. Cinnamomum + Glycyrrhiza
Exhaustion Cinnamomum bark and Glycyrrhiza can be combined to treat Deficient Qi and Yang of the Kidney and/or Heart with exhaustion, sensations of cold in the body and limbs, and impotence or palpitations linked to exhaustion. Glycyrrhiza nourishes Kidney Qi. and in Western herbalism. has been used for adrenocorticoid insufficiency linked to longterm use of steroids. Cinnamomum tonifies Kidney Yang, and the two herbs are linked by their sweet tonic capacity, Glycyrrhiza for Qi, and Cinnamomum bark for Yang.
Cinnamomum + Zanthoxylum
Poor peripheral circulation Cinnamomum twigs paired with Zanthoxylum can warm and move Stagnation of Qi and Blood in the channels of the joints and muscles as a result of an invasion of Wind Cold and Damp. Zanthoxylum emphasizes the ability of Cinnamomum to improve peripheral circulation. Zanthoxylum is the stronger peripheral circulatory stimulant. and the Cinnamomum contributes a sweet tonic action to the surfaceQi. Cinnamomum + Salvia miltiorrhiza
Angina pectoris In this pair. Cinnamomum twigs can assist Salvia miltiorrhiza to move Stagnant Heart Qi and Blood to relieve pain. Cinnamomum twigs are warm and Salvia is cool. So this pair can be used for warm, neutral. cool, or mixed conditions involving heart pain or uterine pain. Cinnamomum + Angelica sinensis Arthritis aggravated by cold
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Cinnamomum twigs and Chinese angelica combined can tonify both Qi and Blood at the surface. preventing further Wind Cold invasion. They can also move Stagnation of Qi and Blood in the muscles and joints. relieving pain and stiffness. Cinnamomum has the relatively stronger acrid warming effect. and Angelica has the relatively stronger sweet tonic action. Cinnamomum + Foenicu1um
Intestinal colic andflatulence In Chinese medicine, both Cinnamomum bark and fennel seeds are classified as acrid warming herbs for the Spleen. Liver, and Kidney. They can be combined for infantile wind and colic. abdominal pain and flatulence in adults.
Cinnamomum + Panax ginseng
Exhaustion and depression As with the previous pair. Cinnamomum bark and ginseng can tonify the Kidney and Heart. The difference between Glycyrrhiza and Panax is that the former herb is a Qi tonic, whilst the latter can tonify both Qi and Yang. The pair Cinnamomum and Panax ginseng is specific for exhaustion. depression. impotence, and weak back associated with Deficient Qi and Yang of the. Kidney; or for exhaustion, depression. palpitations and shortness of breath associated with Deficient Qi and Yang of the Heart. This pair is contraindicated if there are Heat signs.
Cinnamomum + Turnera
Impotence Cinnamomum bark and Turnera would not normally be used as a pair, unless in combination with other herbs, since both herbs tonify the energetic. rather than the structural. aspect of QL If they are used as an isolated pair to treat a Deficient person. they might not result in any sustained improvement. and indeed might give a brief stimulus followed by a decline or destabilization of the energy. This pair would normally be combined with herbs that tonify the structural aspects of Qi. such as Glycyrrhiza or Serenoa. Cinnamomum + Serenoa
Exhaustion and weight loss Whilst Cinnamomum bark has some sweet tonic property. it is a tonic more for the structural than the energetic aspect of the tonic action. Serenoa provides more solidity and nourishment so the two herbs can form a complementary pair. They can be used to treat exhaustion with weight loss, impotence. or prostate enlargement linked to Deficient Qi and Yang of the Kidney and Spleen.
Combining Western Herbs and Chinese Medicine
376 Cinnamomum + Schisandra
LTrinaryfrequensv Cinnamomum bark and Schisandra both have tonic and astringent actions. They can .be combined to treat diarrhea or urinary frequency linked to Kidney.Deficient Yang with Kidney Qi not Firm. They can also be paired for asthma with Kidney Deficient Yang and Cold in which the Kidney fails to grasp the QL
Potentilla 1 Hamamelis 1 Cinnamomum (bark) 1 Schisandra 1 0.5-1 Panax gin. Glycyrrhiza 0.5 0.5 Zingiber
neutral-cool neutral-cool hot warm sl. warm neutral-cool hot
sour, bitter sour. sl. bitter . acrid. sweet, arom sour sweet. sl. bitter
sweet acrid. aromatic
GENERAL
Cinnamomum combinations Six Cinnamomum combinations are discussed below:
1. intestinal colic + cold
Intestines Stagnant Qi + Cold
sensations
2. chronic diarrhea + cold
Kidney Deficient Yang + Cold
sensations
3. arthritis + cold extremities· + exhaustion
Deficient Qi and Blood + Cold in the channels
4. angina pectoris
Heart Stagnant Blood
5. sexual debility + cold
Kidney Deficient Yang
sensations
6. amenorrhea + cold
Uterus Stagnant Qi and Blood + Cold
sensations
CAUTION
Before using any of the combinations below, it is important to be familiar with the cautions listed for each herb in the combination.
This combination is for chronic diarrhea associated wiili~ Deficiency of Kidney and Spleen Yang and Interior Cold. The'C'~::1Vit(' overall temperature is warm. and the combina~on is for Cold . " Deficiency patterns. The sour taste property contributes"S_~ astringent action, the acrid property is warming, the sweet c.;,'" \ property is tonic, and the aromatic property counterac" intestinal spasms and pain by relaxing the smooth muscles.~· USE
• chronic diarrhea with exhaustion and sensations of cold "-:l.:~~ PRACTICAL NOTES
This combination is most conveniently given as 1:5 trn'c:'j ture at doses of 5 ml in quarter of a glass of water, three times' . ~~:: per day, or five times per day if there is an acute severe ',,\ ~'';
episode of diarrhea,. Once the diarrhea begins to imprOV~~~b'"" the frequency and SiZe of the doses can be reduced. How- .;.i~. ever, since the diarrhea is based on a chronic conditi~n ~t F Deficient Yang of the Spleen and Kidney, it may be unwiSetoc.~~ :._, stop the combination prematurely. Eventually, the amounts c~~~j of Potentilla and Hamamelis in the combination can be ';:~"';-'''~. reduced and the amount of Panax increased. ... 3. Arthritis + cold extremities + exhaustion
Deficient Qi and Blood + Cold in the channels 1. Intestinal colic + cold sensations
Herb"
Intestines Stagnant Qi + Cold
Foeniculum 1 Zingiber 0.5 Cinnamomum (bark) 0.5 lobelia 0.5 Glycyrrhiza 0.5
sl. warm hot hot warm-cool neutral-cool
aromatic. sl. acrid acrid. aromatic acrid. sweet, aromatic acrid sweet
This combiriation'is the same as Zingiber: intestinal colic
+ cold sensations and is discussed under that heading. 2. Chronic diarrhea + cold sensations
Kidney Deficient Yang + Cold
Zanthoxylum (bark) Achillea Cinnamomum (twigs) Angelica arc. Angelica sin. Glycyrrhiza Zingiber (fresh)
1 1 1 1 0.5 0.5 0.5
hot warm-cool warm warm warm neutral-cool hot
acrid, aromatic, bitter acrid. bitter acrid, sweet, aromatic bitter. acrid, aromatic sweet. aromatic, bitter, sweet acrid. aromatic
GENERAL This combination is for Deficiency of Qi and Blood wi". Cold in the channels. There may be both Exterior Wmd Cog and Damp and some Interior Cold associated with gener~. Deficient Yang. There may also be some Spleen Deficie~\;~ " Yang and Qi with digestive weakness. The overall temper~;':,,:~~~., '. 1~'fA'lf, ld ture is warm, and the combination is for patterns of CO:i"!,t .
Cinnamomum and Deficiency. The acrid and aromatic properties warm and move Qi and Blood in the channels, and clear Wind, Cold, and Damp from the surface. The sweet and bitter properties tonify the Stomach and Spleen. USE
• chronic or recurring arthritis with cold extremities, exhaustion, and weak digestion
377
:Bk~i:B¥~~,~~R~i~~~~~kt~i~~1t~r~~';.·~:-~~_... Thuja Artemisia vul. Ruta Panax gin. Turnera Cinnamomum (bark) Zingiber
1 1 1 1 1 1 0.5
warm-cool warm-cool warm-cool 51. warm warm hot hot
acrid, aromatic, bitter aromatic, 51. bitter bitter, aromatic sweet, 51. bitter bitter, aromatic, acrid acrid, sweet, aromatic acrid, aromatic
PRACTICAL NOTES
GENERAL
5 ml of a 1:5 tincture of a combination of all the herbs except Zingiber can be taken in a cup of warm ginger decoction, three times per day. Ginger decoction can be made by gently simmering 3 slices of fresh ginger in 3 cups of water
This combination is for Uterus Stagnant Qi and Blood with Cold, and is usually accompanied by Kidney Deficient Yang. The overall temperature is warm. The acrid and aromatic taste properties combine to disperse Interior Cold and move the Qi and Blood in the Uterus. The sweet and acrid properties combine to tonify Kidney Yang. The bitter constituents may include chemicals that regulate the Uterus.
for 15 minutes.
Caution This combination is for patterns of Cold and Deficiency and is not appropriate for patterns of Heat and Excess.
USE
• amenorrhea or infertility with exhaustion and sensations of cold
4. Angina pectoris
Heart Stagnant Blood PRACTICAL NOTES
Crataegus Convallaria leonurus Salvia mil. Angelica sin. lobelia Cinnamomum (twigs)
1 1 1 1 1 0.5 0.5
51. warm neutral neutral cool
warm warm-cool
warm
sour, sweet bitter, 51. sweet sour, 51. bitter bitter sweet, aromatic, bitter acrid acrid, sweet, aromatic
This combination is the same as Crataegus: angina pectoris and is discussed under that heading.
This combination is most conveniently taken as 5 ml of 1:5 tincture in quarter of a glass of warm water, three times per day. If the Cinnamomum bark is of high quality, its proportion can be reduced to 0.5. Providing appropriate cautions are taken with Artemisia, Cinnamomum, Panax, Ruta, Thuja, and Turnera, this combination can be taken, with appropriate breaks and modifications, for 1-3 months if required.
Caution This combination should not be taken if there is a chance of conception.
5. Sexual debility + cold sensations
Kidney Deficient Yang
COMPARISON OF THE SIX CINNAMOMUM COMBINATIONS
Herb Turnera Serenoa Panax gin. Schisandra Cinnamomum (bark) Zingiber Glycyrrhiza
1 1 1 1 1 1 0.5
warm
bitter, aromatic, acrid sweet, 51. sour sweet, 51. bitter warm sour hot acrid, sweet, aromatic acrid, aromatic hot neutrak:ool sweet neutral 51. warm
This combination is the same as Turnera: sexual debility + cold sensations and is discussed under that heading. 6. Amenorrhea + cold sensations
Uterus Stagnant Qi and Blood + Cold
1. Intestinal colic + cold sensations
2. Chronic diarrhea + cold sensations
Intestines Stagnant Qi + Cold
Kidney Deficient Yang + Cold
Foeniculum Zingiber Cinnamomum (bark) lobelia Glycyrrhiza
1 0.5 0.5 0.5 0.5
Potentilla Hamamelis Cinnamomum (bark) Schisandra Panaxgin. Glycyrrhiza Zingiber
1 1 1 1 0.5-1 0.5 0.5
------------------~----------
--_ ..
_-
--_ .. _-----
--------._---_._._..... ~'
~-;...~-
Combining Western Herbs and Chinese Medicine
378
1. Combination No. 1 is used to relax spasms of the smooth muscle of the intestines to relieve pain and to allow normal peristalsis to clear gas and remove distension. Foeniculum, Zingiber, and Cinnamomum are warming, aromatic carminatives that make this combination specific for abdominal pain and distension associated with Cold in-the Intestines. Lobelia and Glycyrrhiza can be used as antispasmodics for patterns of either Heat or Cold. 2. The emphasis in combination No.1 is to relieve intestinal spasms, but the emphasis of combination No.2 is to reduce diarrhea and tonify Kidney Yang. Potentilla and Hamamelis are the two sour astringent herbs for acute or chronic diarrhea. Cinnamomum, Panax, and Glycyrrhiza together can tonify the Qi and Yang of the Spleen and Kidney. Schisandra is a sour herb that can firm Kidney Qi to treat diarrhea, and Zingiber is present to assist the warming action of Cinnamomum on the Spleen and Kidney. 3. Arthritis + cold extremities + exhaustion
4. Angina pectoris
Deficient Qi and Blood + Cold in the channels
Heart Stagnant Blood
Herb
...
__ '~"?5,_L" Ratio
zanthoxylum 1 Achillea 1 Cinnamomum (twigs) 1 Angelica arc. 1 Angelica sin. 0.5 Glycyrrhiza 0.5 Zingiber (fresh) 0.5
Crataegus Convallaria Leonurus Salvia mil. Angelica sin. Lobelia Cinnamomum (twigs)
1 1 1 1 1 0.5 0.5
3. The acrid and aromatic herbs Zanthoxylum, Cinnamomum, Angelica archangelica, and Zingiber together warm and move Qi and Blood in the channels to treat arthritis due to Wind Cold and Damp, and also warm and tonify the Stomach and Spleen to aid digestion. The sweet constituents of Cinnamomum, Angelica sinensis, Glycyrrhiza, and fresh Zingiber tonify the Spleen, and tonify and regulate the surface Qi. Achillea clears the surface, moves Qi and Blood, and acts as a bitter tonic for digestion in combination with the bitter constituents of the Angelicas. 4. All the herbs in combination No.4, especially Crataegus, Convallaria, and Salvia, move Heart Qi and Blood to relieve pain. Crataegus, Convallaria, and Leonurus tonify and stabilize Heart Qi to relieve heart arrhythmias and palpitations. Salvia miltiorrhiza root combines with Crataegus to clear Heart PWegm to treat atherosclerosis. Lobelia and Cinnamomum twigs combine to relax spasms of the cardiac muscle and relieve pain.
5. Sexual debility + cold sensations
6. Amenorrhea + cold sensations
Kidney Deficient Yang
Uterus Stagnant Qi and Blood + Cold
Ratio
Herb
Turnera Serenoa Panax gin. Schisandra Cinnamomum (bark) Zingiber Glycyrrhiza
1 1 1 1 1 1 0.5
Herb Thuja Artemisia vul. Ruta Panax gin. Turnera Cinnamomum (bark) Zingiber
1 1 1 1 1 1
--.
0.5
5. In combination No.5, the first pair of herbs, Turnera and Serenoa, tonify Kidney Yang and Qi. Turnera tonifies more the energetic aspect, and Serenoa tonifies more the structural aspect of Kidney Qi. The second pair» Panax. and ~. Schisandra, tonify and firm Kidney Qi. Cinnamomum bark,-', :~'t~: supported by Zingiber, tonifies Kidney Yang and clears ~-_ Interior Cold. Glycyrrhiza emphasizes the structural tonic aspect of Serenoa to help integrate properly the increase in Yang or Heat into the system. 6. Combination No.5. consists primarily of Kidney Yang tonic herbs. Combination No.6 also contains the Kidney Yang tonic herbs Cinnamomum, Panax, and Turnera in common with combination No.5, but also contains herbs to move Stagnant Qi and Blood in the Uterus. Thuja, Cinnamomum, and Zingiber are circulatory stimulant herbs that in combination can have a warming and stimulant effect on the Uterus. Together, Thuja, Artemisia, and Ruta can stimulate and regulate the reproductive function. OTHER CINNAMOMUM COMBINATIONS
The following additional combinations further illustrate the range of uses of Cinnamomum:
• Capsella: menorrhagia + exhaustion • Cinchona: digestive weakness + postfebrile exhaustion • Crataegus: cardiac weakness + depression • Hamamelis: diarrhea + bleeding • Myrica: chronic diarrhea + digestive weakness • Rosmarinus: postnatal depression + exhaustion
Research CONSTITUENTS
• essential oil • other
Cinnamomum Essential oil C. verum contains 0.5-2.5% essential oil, which is mostly composed of phenylpropane derivatives: 9
• main • other
cinnamaldehyde (cinnamic aldehyde) 65-80%, eugenol up to 10%, and trans-cinnamic acid hydroxycinnamaldehyde,o-methoxycinnamaldehyde, cinnamyl alcohol, cinnamyl acetate
Other C. verum contains tannins, mucilage, procyanidins, and traces of coumarin.9 There may also be calcium oxalate and starch. Comparison of Cinnamomum species C. cassia bark can contain up to 90% cinnamaldehyde and very little eugenol. C. cassia bark also contains mono- and sesquiterpenoid glycosides, such as cassioside and cinnamanoside. C. cassia bark contains more starch than C. verum. 4 According to Evans, C. cassia contains about 10% mucilage as opposed to 1.6-2.9% for C. verum. PHARMACOLOGICAL AND CLINICAL RESEARCH The following effects have been reported:
...
379
Candida albicans. 14 Cinnamic acid showed inhibitory activity against Pityrosporum ovale, suggesting the use of cinnamic acid in preparations for prevention of dandruff. IS
Antiparasitic Cinnamomum leaf oil was reported effective against head lice (Pediculus humanus capitis).16 Antipyretic It was reported that a gul zhi decoction, cinnamaldehyde, and sodium cinnamate had a hypothermic action in mice with normal body temperature, and an antipyretic action in rabbits with typhoid or paratyphoidinduced feverY It was thought that these substances caused cutaneous vasodilation, regulated blood circulation, and directed blood flow towards the surface, thus promoting heat dissipation and diaphoresis. IS
Gastrointestinal effects
Antiulcer Cinnamaldehyde was reported to suppress the formation of ~~ess ulcers in mice. 19 Aqueous extracts of C. cassia bark were reported to have antiulcer activity?O Bruneton reported that one study attributed the antiulcer effect of, C. cassia bark extracts to 3-(2-hydroxyphenyl)-propanoic acid, whilst another study attributed antiulcer activity to cassiocide and cinnamanoside.
• antimicrobial and antiparasitic • antipyretic • gastrointestinal effects • cardiovascular effects • central nervous system effects • antiallergic
".
• antioxidant • antimutagenic Antimicrobial and antiparasitic
Antibacterial Cinnamomum bark oil was reported to be
. 0"
inhibitory against many oral bacteria. Io Cinnamaldehyde was tested on various human intestinal bacteria and was a potent inhibitor of Clostridium perfringens and Bacteroides fragilis, but not of Lactobacillus acidophilus. 1I Methylene chloride extracts of Cinnamomum were found to inhibit the growth of Helicobacter pylori in vitro. 12 In contrast, in a pilot study of patients infected with H. pylori, an alcohol extract of Cinnamomum, at a concentration of 80 mg per day as a single agent, was reported to be ineffective in eradicating H. pylori. 13 However, it should be mentioned that the dose of Cinnamomum tincture given was 40 mg twice daily, whereas the BRP recommended 0.5-1 g of the dried bark of C. cassia thrice daily.
Antifungal Cinnamomum bark oil, and specifically cinnamaldehyde, were reported as toxic, in vitro, against a number of fungi responsible for respiratory tract mycoses, including
Gastrointestinal motility The oil of C. cassia has been reported to produce weak stimulation of the gastrointestinal tract, increasing salivary and gastric secretion, and strengthening digestive action. It can also relieve intestinal spasms. 21 Bruneton stated that cinnamaldehyde may decrease gastric and intestinal motility, but did not give a reference. Antiabsorption An aqueous Cinn3;momum extract was reported to lower absorption of alanine from the rat intestine, perhaps by permeating the membrane of enterocytes (an intestinal epithelial cell) and inhibiting the Na( +)-K( +)ATPase, which provides the driving force for many transport processes. 22 Cardiovascular effects
Cardiotonic C. cassia bark decoction was reported to increase coronary flow in isolated guinea-pig hearts and improve acute myocardial ischemia in rabbits. 23 According to Bruneton, cinnamaldehyde can have a respiratory and myocardial stimulant effect in dogs (no reference given).
Antihypertensive Bruneton wrote that the hypotensive effect of cinnamaldehyde in guinea-pigs and dogs may be due to a peripheral vasodilating effect, but he did not give a reference. He may be referring to a study by Chen et al. in 1980.24
Anticholesterol
Cinnamomum bark was reported to decrease cholesterol levels in rats. 25
._~
380
Combining Western Herbs and Chinese Medicine
Anticlotting CinnarnC?mum bark extract was reported to inhibit platelet aggregation in rats when administered intravenously, but not intragastrically.18 Cinnamomum bark was reported to decrease platelet count in rats. 2S Cinnamaldehyde was reported to dose-dependently reduce human platelet aggregation, perhaps by suppressing the release of arachidonic acid and reducing the formation of thromboxaneA2. 26
• therapeutic doses of Cinnarnomum as an infusion, _=~--decoction, or tincture - - --,-':.0.;.-::• Cinnarnomum essential oil • isolated components of Cinnamomum • oral administration as opposed to intravenous injectionc : LDso
Essential oil The LD so of the essential oil of C. cassia and of -::;'" '
..
Central nervous system effects
C. verum have been listed as 2.8 mUkg and 3.4 mUkg, res- pectively.32
Sedative Bruneton listed a sedative effect of cinnarnalde-
Cinnamaldehyde The LD so of the isolated constituent
hyde in mice, but gave no reference. He may have been referring to a study by Harada in 1972, using doses of 250-500 mglkg.17
narnaldehyde in mice by intravenous, intraperitoneal, and intragastric administration, was reported as 0.13,0.61, and 2.2 glkg, respectively. 17
Anticonvulsant Injection of cinnamaldehyde at 500 mglkg
Adverse effects
in mice delayed the death of animals from strychnineinduced convulsions. 2?
Cinnamomum bark extract According to Wichtl, there are no adverse effects when the bark of C. verum is used properly. According to Hager, large doses of Cinnarnomum bark or";-~'7 moderate doses of Cinnarnomum oil may result in tachycar- -"7-;: dia and increased peristalsis, respiration, and perspiration, probably by stimulating the vasomotor center. This follows a central sedative phase with sleepiness and depression.9
Adrenergic An in vitro study with guinea-pig ileum reported that cinnarnaldehyde could have a stimulatory effect on noradrenaline secretion, perhaps by depolarizing the membrane and, thus, leading to a calcium-dependent and cyclic AMP-related release of noradrenaline from noradrenergic terminals. 28 Antiallergic Diterpenes from the bark of C. cassia have been reported to have antiallergic activity.29 Antioxidant Extracts of the bark of C. verum demonstrated antioxidant activity.30
cin~
essential oil of C. verum or of C. cassia should not be used in therapy, either externally or internally. The essential oil of -i- ,.... C. verum may act as a moderate dermal irritant, as a strong -- _::-~ dermal sensitizer, or as a moderate mucous membrane irri'~·:4 ~. tant. 33
Cinnamaldehyde
RESEARCH VERIFICATION OF
Cinnamic acid Whilst cinnamaldehyde is a powerful skin
The following traditional actions have been supported by research on Cinnarnomum extracts or isolated constituents: antimicrobial, carminative, antispasmodic, diaphoretic and antipyretic, and cardiotonic. Additional effects demonstrated by research The following additional effects have been reported as discussed above: antiulcer, antihypertensive, anticholesterol, anticlotting, sedative, anticonvulsant, adrenergic, antiallergic, antioxidant, and antimutagenic.
TOXICOLOGY An important distinction A careful distinction needs to be made between the use of:
::.~'::::.::i--
Essential oil Tisserand and Balacs recommended that the
Antimutagenic Cinnamaldehyde was reported to have an antimutagenic effect against certain chemical mutagens using Escherichia coli. 3l
TRADITIONAL ACTIONS
.'Z::i:'-
Cinnamaldehyde, as an isolated chemical, may depress rat liver glutathione levels 34 and should therefore be best avoided if the patient is already taking paracetarnol (acetaminophen).
sensitizer and may depress glutathione levels, cinnamic acid does not deplete hepatic glutathione,32 nor is it sensitizing to healthy skin, although it can sensitize some patients who already have eczema.3S As a result, cinnamic acid has been suggested for cosmetic preparations for dandruff. IS
Pregnancy De Smd6 wrote that Cinnamomum does not present a special risk in pregnancy and that reports of abortion 3?38 did not include specific documentation. However, from the Chinese perspective, Cinnamomum would,be contraindicated for those pregnant women who have Excess Heat patterns or Deficient Yin with Heat signs.
Dose Different texts give a range of dose recommendations.
Cinnamomum Dried herb
The BHp39 listed 0.5-1 g, three times per day.
Tincture The BHP listed 2-4 ml of tincture (unspecified), three times per day. Initial dose If the Cinnamomum bark is of high quality, it is best to start with half the minimum dose and only increase the dose up to the maximum therapeutic level if it is necessary. Duration Providing there are no side effects, Cinnamomum can be taken for up to 1 month.
Caution Western contraindications Whilst side effects are uncommon with therapeutic doses of Cinnamomum twigs, maximum therapeutic doses of Cinnamomum bark may result in sensations of heat and restlessness in a few people, especially if the bark is of high quality and the person already has heat signs. Chinese contraindications • C. cassia twigs are contraindicated in warm febrile
diseases, Deficient Yin with Heat signs, and Heat in the Blood with vomiting • C. cassia bark is contraindicated in Deficient YOm patterns with Heat signs and should be used cautiously during pregnancy
381
Sale List, and it is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Cinnamomum bark is not currently listed by tht! FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
Traditional sources PROPERTIES Temperature Dioscorides described Cinnamomum as warm, Lonicerus described it as hot in the third degree and dry in the second, and Tabernaemontanus.j() described it as hot and dry in the third degree. Gerard41 recommended Cinnamomum bark for cold diseases of the stomach and intestines. The traditional Chinese values for the temperature 'of the different forms of C. cassia in Chinese usage can be summarized: • rougul • gulpi
hor
• gulzhi
warm7
warm6
Pregnancy and lactation Some texts contraindicate Cinnamomum bark during pregnancy, but this appears to be without adequate substantiation; see the discussion in
Dryness Hildegard von Bingen42 said that, although Cinnamomum contains a little moisture, its heat is so strong that it suppresses dampness. She said that Cinnamomum can dissolve the noxious 'humours' that can make the head feel heavy and dull. Dioscorides said that it thins thick phlegm, and Lonicerus said that it can remove evil dampness. Lonicerus and Tabernaemontanus classified Cinnamomum as drying.
Toxicology.
Taste
Ability to drive and use machines
~o
adverse reports are
known. Side effects Aggravation of heat sensations and restlessness are possible in persons who already have these symptoms. Overdose Massive overdose may result in excessive sweating and tachycardia; see the discussion in Toxicology. Interactions
None reported.
Regulatory status
Taste in the mouth Wichtl described C. verum as having a characteristic and pleasantly aromatic odor, and a taste that is pungently spicy, slightly sweet, mucilaginous, and only slightly sharp. I found C. cassia twigs (gul zhi) to have a characteristic sWeet and aromatic odor, and a sweet, acrid, and aromatic taste. I also detected a slight puckering sensation in the mouth, which I have come to associate with tannins. I found a sample of gul zhi tincture to have a mildly aromatic odor and to have a definitely sweet and mildly acrid taste. A sample of gul pi (bark of young branches) tincture was slightly weaker in odor and slightly weaker in the sweet and acrid tastes than gul zhi.
Taste property In Chinese medicine, both the twigs and Please read the Regulatory status section in the chapter on Safety. Cinnamomum (cinnamon bark) is on the UK General
bark of C. cassia are descnbed as acrid and sweet. The barks of C. verum, or of C. cassia, as used in the West, are listed in this book as acrid, sweet, and aromatic.
--
~-!
·..·m.....-
Combining Western Herbs and Chinese Medicine
382
• the acrid taste property may be associated with the ability of C. cassia twigs to disperse cold at the surface and with the ability of C. cassia bark to warm the Interior • the sweet taste property may be associated with the ability of C. cassia twigs to tonify the surface and with the ability of C. cassia bark to tonify the Interior • the aromatic taste property may be associated with the essential oil content and with the carminative, antispasmodic, and antihypertensive actions of this herb ORGANS In terms of Chinese medicine, Cinnamomum, as used in the West, can be associated mainly with disorders of the following organs:
• carminative and antispasmodic • antiemetic • antidiarrheal • diaphoretic and antimicrobial • expectorant and antitussive • antiarthritic • cardiotonic
~~.~
:::.-"~~ ,'.Yi.-'6iiii
.~.;.-~~
.c-:'<:'i;.!'
::,.~"'!
"
...
• diuretic • emmenagogue General tonic Tabernaemontanus said that Cinnamomum strengthens all the organs, and Felter and lloyd listed it as a stimulant and tonic. Mills and Bone listed Cinnamomum for convalescence from febrile disease. They suggested that circulatory stimulants such as Cinnamomum may promote defensive immune activities in many cases of acute infections. 46
'-
.;<-_.~.~
Spleen. Stomach
stomach aches gastritis, nausea
Tabemamontanus . BHP
Intestines
pains flatulent colic. diarrhea
Gerard BHP
Lung
cough influenza
Dioscorides BHP
Heart
strengthens the heart
Lonicerus
Kidney
dropsy. kidney diseases
Dioscorides
Uterus
amenorrhea retention of afterbirth postnatal bleeding
Dioscorides Lonicerus Felter and Uoyd43
The data in the table above relates to C. cassia since I have found this to be more readily available than C. verum. I use Cinnamomum bark, rather than Cinnamomum twigs, for disorders of Spleen, Stomach, Intestines, and Uterus. According to Yeung, gul zhi, gul pi. and rou gul enter the following channels: • gul zhi enters the Heart, Lung, and Bladder • gul pi enters the Heart, Liver, Spleen. and Kidney • rou gul enters the Spleen, Kidney, Liver, and Bladder In my opinion, the channels Cinnamomum enters and the strength of its actions will depend on the quality and strength of the particular sample of Cinnamomum, whether it is gul zhi, gul pi, rou gul, or other. ACTIONS Evidence from the traditional Western sources for the following actions of Cinnamomum are discussed below: • general tonic • digestive tonic
Digestive tonic Gerard said that Cinnamomum comforts ::i~' the weak cold stomach. The BHP listed C. verum for anorex. ia, and Bruneton listed its traditional French use of facilitating weight gain. Carminative and antispasmodic Gerard said that Cinnamomum eases pains of the intestines that result from cold. Felter and Lloyd listed Cinnamomum for flatulence, intestinal colic, and diarrhea. The BHP gave the specific indication for C. cassia bark of flatulent colic with distension. Antiemetic Felter and Lloyd suggested Cinnamomum for ,.,. nausea and vomiting, and the BHP listed C. cassia as an antiemetic and recommended it for dyspepsia and nausea. Antidiarrheal EllingwoodH and also Felter and Lloyd recommended Cinnamomum for diarrhea, and the BHP listed C. cassia for diarrhea with tormina (colic), and C. verum for infantile diarrhea. Diaphoretic and antimicrobial Grieve 45 listed Cinnamomum as an antiseptic. The BHP listed it as an antimicrobial and antihelminthic and noted the use of Cinnamomum bark for common cold and influenza. Expectorant and antitussive Dioscorides recommended Cinnamomum for cough. Lonicerus said that it soothes cough and treats rhinitis resulting from a cold. Cinnamomum bark has a tradition of use in the West in the treatment of bronchitis46 and has been used as a warming expectorant.47 Antiarthritic Hildegard von Bingen recommended Cinnamomum for patients who are paralyzed by rheumatism (gicht), and Gerard listed it for coldness of the sinews and all pains of the joints.
f'"
I
Cinnamomum
383
i
Cardiotonic
Lonicerus said that Cinnamomum can
strengthen the heart. Diuretic Dioscorides, Lonicerus, and Tabernaemontanus recommended Cinnamomum for dropsy and for diseases of the kidneys.
L
Emmenagogue Dioscorides said that a suppository made from Cinnamomum bark and placed in the vagina could be used to induce menstruation or labor. According to Ellingwood, writing in 1919, midwives and nurses gave a strong infusion of Cinnamomum to control postnatal hemorrhage and for flooding during miscarriage and in menorrhagia. It is best in hemorrhage resulting from uterine atony or as seen in a flaccid womb after delivery. It restores uterine muscle tone and promotes normal uterine contractions in labor. Felter and Lloyd recommended Cinnamomum tincture for postnatal hemorrhage and for uterine hemorrhage, given in doses of 4 ml in sweetened water and repeated every 5,10, or 20 minutes as required.
COMPARISON OF WESTERN AND CHINESE ,.
,
USE OF CINNAMOMUM SPECIES The Western and Chinese traditions of use are compared below under the following headings: • diaphoretic and antimicrobial • expectorant and antitussive • antiarthritic • general tonic • gastrointestinal actions • cardiovascular actions • diuretic • emmenagogue
Cinnamomum in Chinese medicine is more specific. Gut zhi can be used in combinations for acute pains in joints and limbs, especially the shoulders, associated with Wind Cold Damp, and for chills and pain in the extremities in Deficient Yang patients with arthritic disorders. Rou gut can be used in combinations, for example, du hu6 ji sheng tang, for chronic arthritis associated with both Exterior Wind Cold and Interior Deficiency of the Qi and Yang. 48 General tonic Cinnamomum bark has a tradition of use as a general tonic from ancient times to the present day. In Chinese medicine, gut zhi can be used as a tonic for the surface. Rou gut can be used as a tonic for Spleen, Kidney, and Heart Yang, and is appropriate for exhaustion, impotence, and sensations of cold. Gastrointestinal actions This topic is discussed under the following headings: • digestive tonic • carminative • antiemetic • antidiarrheal
Digestive tonic In Western tradition, Cinnamomum has been used for a weak, cold stomach, and in Chinese medicine, rou gut can be used for loss of appetite associated with Deficiency and Cold in the Stomach and Spleen.
Carminative In Western tradition, Cinnamomum has been used for intestinal distension and pain, and in Chinese medicine, rou gut can be used for abdominal pain associated with Cold Deficient Spleen.
Antiemetic This is more of a Western use than a Chinese use of Cinnamomum.
Antidiarrheal Cinnamomum bark has a tradition of use
Diaphoretic and antimicrobial Cinnamomum has been used to treat common cold and influenza in both the Western and Chinese traditions. In the Western tradition, the bark of C. cassia has been classified as a general diaphoretic and antimicrobial. The Chinese use of gul zhi (Cinnamomum twigs) for common cold and influenza is more specific, and this herb is especially used for Wind Cold patterns with -. Deficiency in the surface, in which sweating occurs without any improvement in the patient's condition.
for diarrhea and intestinal colic in the West, and rou gut is used in Chinese medicine for diarrhea associated with Deficient Yang of the Spleen and Kidney.
Expectorant and antitussive Cinnamomum bark has been used in the West for cough and bronchitis. and rou gul (bark of mature trees) can be used in Chinese medicine for asthma resulting from an inability of the Kidney to grasp Qi.
Cinnamomum bark can strengthen the heart, but this has not been a common use in the West. In Chinese medicine, gUt zhi can be used for palpitations from Heart Deficient Yang, and rou gui can be used for palpitations and shortness of breath due to Deficient Heart and Kidney?
Antiarthritic There is an older tradition of use of Cinnamomum in the West for joint pains. Again, the use of
Cardiovascular actions This topic is discussed under the following headings: • cardiotonic • antianginal
Cardiotonic There is an old Western tradition that
Antianginal This use is not emphasized in Western tradi-
384
Combining Western Herbs and Chinese Medicine
tion, but gul zhI can be used in Chinese medicine to treat chest pain associated with Heart Deficient Yang and Heart Stagnant Blood.7 Diuretic Cinnamomum bark was much used in the West for edema and kidney diseases from Roman times to the 17th century, but this use has declined in recent times. Rou gul is used in Chinese medicine for urinary retention and urinary discomfort from Kidney Yang Deficiency.
9. Hager. vol. 4 P 54 (1973); vol. 4 p 884 (1992) [cited in Bisset NG (e. ,". Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm;"'~ , Stuttgart. Germany (1994). from 2nd German edn. Wicht! M (ed)'?':'~~~! (1989)} 10. Saeki Y. Ito Y, Shibata M et al. Bull Tokyo Dent Coil 39(3}:129-135 c=.~:;
(1989}.:'-:~.\
11. Lee HS,Ahn ¥J.J Agric Food Chern 46(l}:8-12 (1998)
".
12. Tabak M, Armon R. Neeman 1. J Ethnopharmacol 67(3):269-2n !
(1999)
i "ir->l
13. Nir Y. Potasman 1, Stermer E et al. Helicobacter 5(2}:94-97 (2000)
Emmenagogue Cinnamomum bark has a long tradition of use in the West for such disorders as amenorrhea, delayed labor, menorrhagia, and postnatal hemorrhage. In Chinese medicine, rou gul can be combined with Angelica sinensis for amenorrhea or dysmenorrhea associated with Cold and Deficiency in the Chong and Ren channels.7
Summary The Western and Chinese uses of Cinnamomum are similar. The following differences can be summarized: • Chinese tradition differentiates between the twigs, which are more active at the surface, and the bark, which is more active in the Interior • Chinese tradition is more specific in stating that the diaphoretic use of Cinnamomum is for patterns of surface Deficiency • Chinese tradition includes the use of Cinnamomum for impotence linked to Deficient Kidney Yang • Chinese tradition emphasizes the use for heart weakness and for heart pain • Western tradition emphasizes the use for intestinal spasms and for vomiting
14. Singh HB, Srivastava M, Singh AB et al. Allergy 50(12):995-999 (1995) 15. Baroni A, De Rosa R, De Rosa A et al. Dermatology 20l(4}:332-336 (2000) 16. Veal L.Complement Ther Nurs Midwifery 2(4}:97-101 (1996) 17. Harada Met al. Journal of the Pharmaceutical Society of lapan 92(2}: 135 (l972) 18. Chang H-M, But PP-H (eds). Pharmacology and Applications of Chinese Materia Medica. vols. 1 and 2. World Scientific Publishing. Singapore (1986)
.,~'ly{.
19. Harada. Dai 8 Kai Wa-Kan-Yaku Koen Shu (Cinnamomum cassia "'''"''''t. . bark) (1974) [cited in: Chang H-M, But PP-H (eds). Pharmacology and Applications of Chinese Materia Medica. vols. 1 and 2. World Scientific Publishing. Singapore (1986) I 20. Akira, T. et al. Planta Med 440 (1986). Listed by Evans WC. See above. 21. Hosano. Kampo no Rinsho 23(9):3 (1976) 22. Kreydiyyeh Sl, Usta I. Copti R. Food Chern Toxicol 38(9}:755-762 (2000) 23. Chen Yet al. Information on Medical Science and Technology (Zhuang Autonomous Region Institute of Materia Medica. Guangxi) (15}:39 (1979) 24. Chen Y et al. Abstracts of the First National Symposium on Cardiovascular Pharmacology, p 16 (1980) [cited in: Chang H-M, But PP-H (eds). Pharmacology and Applications of Chinese Materia Medica, vots. 1 and 2. World Scientific Publishing, Singapore (1986) J 25. Onderoglu S. Sozer S, Erbil ~\1 et al. J Pharm PharmacoI51(1l}:1305-
References
1312 (1999) 26. Takenaga M. Hirai A. Terano T et al. I Pharmacobiodyn 10(5}:201-208 (1987)
1. Dioscorides P. Kreutterbuch (1610). Reprinted byVerlag Konrad Kolbl. Miinchen, Germany (1960) 2. Evans WC. Trease and Evans' Pharmacognosy. 14th edn. WB Saunders. London, United Kingdom (1996) 3. Braudel F. Civilization and Capitalism 15th-18th Century, vol. Ill. The Perspective of the World. University of California Press, Berkeley, California (1992) 4. Bruneton J. Pharmacognosy: Phytochemistry Medicinal Plants. 2nd edn. Lavoisier, Paris. France (1999) 5. Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm. Stuttgart Germany (1994) from 2nd German edn. Wicht! M (ed) (1989) 6. Yeung H-C. Handbook of Chinese Herbs and Combinations. vol. 1. Institute of Chinese Medicine, Los Angeles, California (1985) ·7. Beitsky D, Gamble A. Chinese Herbal Medicine Materia Medica. Eastland Press, Seattle, Washington (1986) 8. Lonicerus A. Kreuterbuch (1679). Reprinted by Verlag Konrad Kolbl. Miinchen, Germany (1962)
27. Takato Metal. Jap I Pharmacognosy 39(2}:160 (1975) 28. ChengJT, Liu 1M, HuangWC et al. Life Sci 66(1l}:981-990 (2000) 29. Nohara et al. Phytochemistry 24:1849 (1985) [cited by: Evans WC. Trease and Evans' Pharmacognosy. 14th edn. WB Saunders, London, United Kingdom (1996) 1 30. Mancini-Filho J, Van-Koiij A, Mancini DA et al. Boll Chirn Farm 137 (1l}:443-447 (1998) 31. Ohta T. Watanabe K, Moriya M et al. Mol Gen Genet 192(3}:309-315 (1983) 32. Opdyke DLI. Food and Cosmetics Toxicology 13 (1975) [cited in Tisserand R. Balacs T. Essential Oil Safety: A guide for Health Care Professionals. Churchill Livingstone. Edinburgh. United Kingdom . (1995)] ,~
33. Tisserand R. Balacs T. Essential Oil Safety: A guide for Health Care ·{Y'; Professionals. Churchill Livingstone. Edinburgh, United Kingdom (1995) 34. Swales NJ. Caldwell I. Human Exp Toxicology 10:488-489 (1992)
Cinnamomum 35. Opdyke DLJ. Food and Cosmetics Toxicology 16 (1975) [cited in Tisserand R. Balacs T. Essential Oil Safety: A guide for Health Care Professionals. Churchill Livingstone. Edinburgh. United Kingdom (1995)J 36. De Smet. P.A.G.M. et al., eds Adverse Effects of Herbal Drugs l. Springer-Verlag. New York, New York (1992) 37. List PH. Horhammer L. Hagers Handbuch der Pharmazeutischen Praxis. 7 vols. Springer-Verlag. New York. }lew York (1973-1979) 38. Roth L et al. Giftpflanzen. Pflanzengifte [Poisonous Plants and Plant Toxins]. Ecomed. Munich. Germany (19S4)
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42. Von Bingen H. Hildegard von Bingen's Physica. Healing Arts, Rochester. Vermont (1998) 43. Felter HW. Uoyd JU. King's American Dispensatory. vols. 1 and 2. 18th edn. (1898). Reprinted by Eclectic Medical Publications, Sandy. Oregon (1983) 44. Ellingwood F. American Materia Medica, Therapeutics and Pharmacognosy, 11th edn. (1919). Reprinted by Eclectic Medical Publications, Sandy. Oregon (1994) 45. Grieve M. A Modern Herbal. vols. 1 and 2. Dover Publications. New York, New York (1971)
39. British Herbal Pharmacopoeia. British Herbal ~Iedicine Association. West Yorks, United Kingdom (1983)
46. Ziment 1. Respiration 58(Suppl1):37-42 (1991)
40. Tabernaemontanus JT. Krauterbuch (1731). Reprinted by Verlag Konrad Kolbl. Miinchen. Germany (1993)
47. Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone. Edinburgh. Untied Kingdom (2000)
-n.
Gerard J. The Herbal or General History of Plants: The complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publications, New York, New York (1975)
48. Yeung H-C. Handbook of Chinese Herbs and Combinations, vol. 2. Institute of Chinese Medicine. Los Angeles, California (1985)
l
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Commiphora Botanicalname Comrniphora molmol Engler Family Burseraceae Pharmaceutical name Myrrha Part air-dried oleogum resin from the bark of Commiphora species English myrrh German Myrrhe French myrrhe Mandarin mo yao (~1. ~) is the resin of Commiphora species Use in the West Commiphora species are native to Abyssinia, Somalia, Sudan, and Yemen, and myrrh is imported from these countries. l The myrrh-producing Commiphora species are shrubs with resin ducts in the bark, which, when damaged, release a pale yellow liquid that hardens to a red-
proximation of the sound of either the word myrrh or the older word murra. In 1931, Grieve2 wrote that the best myrrh probably came from Somalia, was shipped to Bombay, and from there was exported to Europe and China. The tradition of use of myrrh in China may have derived in part directly from Middle Eastern traditions, and may later have incorporated European traditions of use as well. Mo yao is used in Chinese medicine to move Stagnant . Blood to reduce pain and swelling. It is used for chest pain, abdominal pain, dysmenorrhea and amenorrhea, pain from trauma, abdominal masses, and topically for nonhealing sores. Nomenclature The nomenclature for the Commiphora species is confusing. 6 C. molmol Engler is sometimes regarded as synonymous with:
dish-brown mass. The resin is commercially available as irregular rounded grains or l~ps.l.2 Myrrh has been used in the West for thousands of years
• C. myrrha (Nees) Engler var. molmol Engler • C. myrrha Holmes • Balsamodendron myrrha (Nees)
for incense and perfumes, and was used by the ancient Egyptians for embalming and fumigations.! The word myrrh is
Myrrh is also obtained from C. abyssinica (Berg) Engler (C. madagascariensis Jacq.) and C. schimperi (Berg) Engler.7 Guggul (variously spelled guggal or gugul) resin used in Ayurvedic medicine is prepared from C. mukul.8
derived from the Greek word murra, which is itself of Semitic origin.) In the 1st century AD, Dioscorides" used myrrh as a warming, drying astringent for respiratory, gastrointestinal, and reproductive disorders, and to help with the healing of wounds and ulcers. These uses have continued to this day.
What is spe'cial about Commiphora
Use in China Resin of C. myrrha Engler or Balsamodendron ehrenbergianum Berg. is used in Chinese medicine as mo yao, myrrh resin. s The name ma yao may be an ap-
In terms of Chinese medicine, Commiphora, as used in the West, can be said to be a warm, bitter, and acrid herb,
387
~.,
388
Combining Western Herbs and Chinese Medicine
which has its main effects on the Heart, Stomach, Intestines, Uterus, and Lung, and on the body surface as a topical agent.
The key to understanding Commiphora is that it is not only an effective topical astringent and vulnerary, but it can also be used internally as a useful secondary herb to strengthen the circulation and digestion, and to treat certain patterns ofchronic bronchitis.
CHINESE ACTIONS
...
In terms of Chinese medicine, Commiphora, as the West, can be said to have four main actions: '
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1. topical astringent II. warm and move Qi and Blood to clear Cold III. warm, tonify, and move the Qi of the Stomach and Intestines IV. clear Lung Phlegm Cold
NEW CONCEPTS OF COMMIPHORA Some recent European texts give the impression that the herbal use of Commiphora is largely restricted to topical applications, for example, for cuts, pharyngitis, and gingivitis.9, 10, I,ll However, a study of other sources of information suggests that Commiphora is an underused herb with much potential for a wider range of future applications. The integration of three main sources could contribute to its extended range of use: • North American Eclectic tradition • Chinese medical tradition • modem pharmacological and clinical research All three sources include the topical use of myrrh for wounds and ulcers, but each of these sources gives a different emphasis on the internal use. Integrating these three perspectives can lead to a broader and deeper understanding of this herb, and to a greatly expanded range of use.
WESTERN ACTIONS
I. topical astringent
antimicrobial anti-inflammatory anticatarrhal astringent
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.
II. warm and move Qi and Blood to clear Cold
circulatory stimulant
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III. warm, tonity, and move the Qi of the Stomach and Intestines
bitter digestive tonic carminative antispasmodic anticatarrhal
IV. clear Lung Phlegm Cold
expectorant anticatarrhal
~~~~~;~~gue
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Three different perspectives of internal use
North American Eclectic tradition This tradition emphasized the use of myrrh for chronic conditions of weakness of the circulatory, digestive, and respiratory systems, marked by exhaustion and catarrh.
Commiphora, when taken internally, has three main _._.. actions: circulatory stimulant, digestive tonic, and expectorant. In terms of Chinese medicine, Commiphora, as used in the West, can be said to treat Deficiency, Cold, and Phlegm in the Heart, Stomach, Intestines, and Lung.
Chinese medical tradition This tradition emphasized the use of myrrh for chest, epigastric, abdominal, or uterine pain, or pain from trauma or arthritis, associated with the pattern of Stagnant Blood.
WESTERN USES The Western uses of Commiphora can be related to its four main Chinese actions:
Modern pharmacological and clinical research As discussed in the Research section, research data has supported the traditional Western actions of antimicrobial, antilipidemic, bitter digestive tonic, and expectorant. There is also research confirmation of the analgesic, antispasmodic, and antianginal actions, in support of Chinese traditions of use. The following additional effects have been demonstrated by research: antipyretic, anti-inflammatory, antiulcer, antihyperglycemic, antithrombotic, and antimutagenic. One important potential use of Commiphora is in herbal combinations to lower blood lipid and cholesterol levels and to prevent or reduce atherosclerosis.
I. topical astringent
wounds, abrasions, mouth ulcers, gingivitis, pharyngitis
II. warm and move Qi and Blood to clear Cold
cardiac weakness with exhaustion and poor peripheral circulation, amenorrhea
III. warm, tonity, and move the Qi of the Stomach and Intestines
digestive weakness with ex- .: haustion and cold sensation in the epigastrium
IV. clear Lung Phlegm Cold
chronic bronchitis with profuse sputum and sensations of cold
~
Commiphora DIRECTION OF ENERGY Commiphora can warm and move the Qi and Blood of the Heart, help to clear obstruction by Cold and Phlegm in the channels, and assist in the movement of Qi and Blood outward to the extremities. It can also warm and move the Qi and Blood of the Stomach, Intestines, and Uterus.
TYPICAL CASE EXAMPLE Signs and symptoms The patient is pale and tired, and has sensations of cold in the epigastriwn and in the hands and feet. Blood tests show high levels of LDL (low-density lipoprotein) and of total cholesterol, and there is a familial tendency to atherosclerosis. The patient also has a history of chronic bronchial phlegm. The pulse is slightly slow, and is empty and slippery, especially in the Heart, Spleen, and Lung positions. The tongue is flabby. pale. and slightly purple. with a white greasy coat. Diagnosis The patient has Stagnation of Qi and Blood with Phlegm Cold in the Heart and body. and has Deficiency of Spleen and Lung Qi with accwnulation of Lung Phlegm Cold. Choice of Commiphora This herb can be used for cardiac weakness with poor peripheral circulation associated with hyperlipidemia and a tendency to atherosclerosis. It can also be used for gastric and pulmonary weakness associated with chronic bronchial catarrh.
Limitations of Commiphora TEMPERATURE Warming effect In this book. Commiphora is classified as warm and can be used for cool conditions or to support hot herbs in the treatment of cold conditions. By itself. it is not generally sufficient for cold conditions. Cooling effect It can also be used for inflammations ~d infections, for example. of the mouth and gums. In these situations. although it may ultimately have a cooling effect in reducing local inflammation. this cooling effect is indirect. Rather.1ike Capsicwn. the anti-inflammatory action of Comrniphora may depend on a local stimulation of circulation in the tissues. I do not therefore regard it as a cooling herb.
TASTE Acrid Comrniphora can be said to be acrid in the sense
389
that it can have a warming action, mainly in the Interior, but also in the limbs. I do not regard it as capable of warming the Interior as hotter herbs such as Capsicum, Zingiber, or Zanthoxylum. Bitter The bitter taste of Commiphora may be linked to both a digestive tonic and a cardiotonic action. However, I do not use Commiphora as a primary bitter tonic for the heart or digestive system, but rather as a secondary herb in combination with others.
ACTIONS Topical Commiphora has specific topical use in the West for wounds and abrasions, as a gargle for throat disorders, and as a mouthwash for mouth ulcers or gingivitis. For other topical applications. other herbs may be preferable, for example, • Hydrastis for pruritus • Calendula for sunburn • Quercus for bleeding hemorrhoids • Capsicwn for unbroken chilblains Circulatory stimulant Commiphora can be used as a secondary herb for cardiac weakness with cold body and poor peripheral drculation to assist primary circulatory stimulants such as Capsicum or Zanthoxylwn. Research has documented the antilipidemic and antiatheromatic effects of Commiphora, indicating its important potential of use in circulatory disorders. Bitter digestive tonic and carminative Commiphora has a tradition of use as a stimulant and tonic to the digestive system. but I do not use Commiphora as a primary bitter tonic or carminative for the digestive system. Rather. I use it as a secondary herb in combination with other herbs. Expectorant and anticatarrhal Commiphora has a tradition of use as a warming expectorant and anticatarrhal specifically for chronic bronchitis with profuse sputum that is difficult to expectorate; the patient's condition is generally also associated with exhaustion. However. I do not use Commiphora as a primary general-purpose expectorant.
Commiphora paired with other herbs Discussion of the limitations of each of the main actions of Commiphora can be useful to clarify just what this herb
Combining Western Herbs and Chinese Medicine
390
can and cannot do. However, suitable combination with other herbs can extend the range of use of Commiphora beyond its limitations. The basic unit of herb combination is the herb pair. Twelve pairings of Commiphora are briefly explained below~
CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair.
Commiphora + Salvia miltiorrhiza
Atherosclerosis + thrombosis
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Both herbs have been reported to have antilipidemic, ,,~. antiatheromatic, and antithrombotic effects so that they cah.:-,:,~"""" be paired to help prevent coronary and cerebral thrombosiS:' Commiphora is warm and Salvia is cool so that the two~;;~.{~{ herbs complement and moderate each other's effects. The~';~' ~ two herbs can also be used to treat dysmenorrhea or amen- .~~,,.-,Y""":'l, orrhea associated with Stagnant B l o o d . , < ' "
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Commiphora + Calendula
Commiphora + Achillea
Fungal infections
Hypertension + hyperlipidemia
Commiphora and Calendula can be paired as antifungal herbs for topical application to treat fungal infections of the skin or nalls. The antifungal effects of both herbs may be related to their resin content. Commiphora + Hydrastis
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This pair can be used to treat hypertension associated "_ with hyperlipidemia and thrombosis, and to help prevent ':~:st coronary and cerebral thrombosis. Achillea can treat hyper-'.!i~r tension, and Commiphora can help to clear Heart Phlegm~~; .~ -'.~ Cold. Also, both herbs can act as bitter digestive tonics.J.o,'t§t-, treat general debility. ' :~"1!
Halitosis This pair can be taken internally for bad breath or used as an ointment for hemorrhoids. Commiphora is a warm antimicrobial astringent and Hydrastis is a cool antimicrobial astringent. The two herbs complement and moderate each other's effects. Commiphora + Baptisia
Tonsillitis These herbs can be paired as an antimicrobial gargle for severe acute tonsillitis. Both herbs are specific for the throat area, and the warming astringent vulnerary Commiphora balances the powerful cold antimicrobial Baptisia. Commiphora + Hamamelis
Bleeding hemorrhoids Commiphora is a warming antimicrobial astringent and vulnerary with a high resin content, and Hamamelis is a cooling anti-inflammatory astringent and antihemorrhagic with a high tannin content. This pair can be applied externally for bleeding hemorrhoids or internally f6r loose stools with mucus in the absence of inflammation. Commiphora + Crataegus Angina pectoris Both herbs can have an antianginal, antilipidemic. and cardiotonic effect. Crataegus has the stronger cardiotonic and antianginal actions, and Commiphora contributes a warming anticatarrhal action to assist in the clearance of Heart Phlegm Cold.
Commiphora + Zanthoxylum
Poor peripheral circulation Zanthoxylum is the dominant herb in this pair, being specific for poor peripheral circulation. This pair can be used for cold extremities concurrent with digestive weakness and sensations of cold in the epigastrium. Commiphora caIl assist in the treatment of poor peripheral circulation by its
'c..:',.,
antiatheromatic action. Commiphora + Myrica
Diarrhea + mucus in the stools Both herbs can have a circulatory, stimulant, and warming anticatarrhal action. They combine to treat loose stools with mucus associated with Deficiency, Cold, and Phlegm in the Stomach and Intestines, and to treat low~red metabolism -with sensations of cold in the body and limbs. Commiphora + Capsicum Acute or chronic laryngitis This pair can be used as a gargle for the throat and can also be swallowed to treat acute or chronic laryngitis. Both ' herbs are antimicrobial. Commiphora is an astringent, and'" Capsicum is a powerful local counterirritant. The pair can be taken internally, for example, for a com,-;/ bination of cardiac and digestive weakness. Capsicum is the,;~ dominant herb in this pair, being much hotter than Commi-;: phora and a stronger stimulant to the circulatory and diges- , tive systems.
r-
i
Commiphora Commiphora + Thymus
Chronic bronchitis + laryngitis These herbs can be combined as an antimicrobial, antitussive, and astringent gargle to treat laryngitis or tonsillitis. Taken internally, they can be combined for chronic bronchitis or bronchial asthma associated with Lung Deficient Qi and Lung Phlegm Cold. Commiphora + Marrubium
Chronic bronchitis + digestive weakness Both herbs can act as expectorants to treat bronchitis with nonproductive cough, and as bitter digestive tonics to treat weak digestion and exhaustion. In addition, Commiphora can have a warming carminative action on the digestive system to complement its bitter tonic effect. Marrubium has both expectorant and antispasmodic actions.
TOPICAL AND INTERNAL USE Felter and Uoyd l3 noted the important principle of giving myrrh preparations internally to accompany their topical use. For example, to treat indolent ulcers, a combination including Commiphora and Myrica can be taken internally to reinforce the effect of the external application. For bleeding hemorrhoids, associated in Chinese terms with the pattern of Spleen not holding Blood, a combination including Commiphora and Hamamelis can be taken internally. After using Commiphora as a mouthwash or gargle, I generally advise patients to swallow the liquid so that the topical effect is reinforced by internal action, even if an additional internal preparation is not given.
Commiphora combinations
The specific topical indications of Commiphora are for cuts and small wounds, cracks on the hands, gingivitis, and mouth or tongue ulcers whether due to Deficiency or Heat in terms of Chinese medicine.
Three Commiphora combinations for internal use are discussed below:
FOR TOPICAL APPLICATION Commiphora can be used by itself for the specific indications above, or it can be combined with the following herbs: • with Hydrastis as a mouthwash for gingivitis or mouth ulcers (especially due to Stomach Heat) • with Capsicum as a gargle for chronic pharyngitis or laryngitis (especially due to Deficiency) • with Salvia officinalis and Baptisia as a gargle for tonsillitis • with Calendula as a lotion for fungal infections of the skin or nails • with Myrica as a fme powder or lotion for indolent or gangrenous ulcers • with Hamamelis as a wash or ointment for bleeding hemorrhoids
,.
dered myrrh as a tooth powder, to be dusted on slow-healing ulcers, or to be blown onto throat lesions.
Topical uses of Commiphora'
COMMIPHORA COMBINATIONS
if
391
DISPENSING Commiphora can be used topically as the undiluted tincture, or it can be diluted for use as a gargle or mouthwash (see Dose). Currently, topical applications in the West usually involve the tincture. However. in the past, the powder was also used. For example, Christopher12 recommended pow-
Combinations .
Chinese syndromes
1. atherosclerosis + hypertension
Heart Phlegm Cold + Heart Stagnant Qi
2. intestinal colic + cold extremities
Stagnant Qi and Blood + Intestines Cold
3. chronic bronchitis + cold sensations
Lung Phlegm Cold + Spleen Deficient Yang
CAUTION
Before using any of the combinations below, it is important to be familiar with the cautions listed for each herb in the com-
bination. 1. Atherosclerosis + hypertension
Heart Phlegm Cold + Heart Stagnant Qi Herb
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Ratio ';Temperature/;;Taste -.;:..--;-;-
Achillea 1 Crataegus 1 Salvia mil. 1 Angelica sin. 1 zanthoxylum 1 (bark) Commiphora 1 Zingiber 0.5 Capsicum 5-20 drops
':-"'-C-
warm-cool 51. warm cool warm hot
acrid, bitter sour, sweet bitter sweet, aromatic, bitter acrid, aromatic. bitter
warm hot hot
acrid, bitter acrid, aromatic acrid
392
This combination is the same as Achillea: Atherosclerosis + hypertension + cold extremities and is discussed under that heading. 2. Intestinal colic + cold extremities
Stagnant Qi and Blood + Intestines Cold .~_7._
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Combining Western Herbs and Chinese Medicine
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Zanthoxylum 1 (berries) Myrica 1 Achillea 1 Crataegus 1 Commiphora 1 Glycyrrhiza 0.5 Zingiber 0.5 Capsicum 5-20 drops
Temperature . Taste hot
acrid, aromatic, bitter
warm warm-cool sl. warm warm
acrid, sour, bitter acrid, bitter sour, sweet bitter, acrid
neutral-cool hot hot
sweet acrid, aromatic acrid
PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture ~ quarter of a cup of warm water, three times per day. Thc:~"- Capsicum is given in a separate bottle so that the reqUlSi _:::::-number of drops of Capsicum can be added to each dose'cii the main medicine. It can be taken for 1 month, with the appropriate cautions, breaks, and modifications. When ih~t: symptoms are reduced or when remissions become more frequent, this combination can be used during a recurrence, while a more tonic combination can be used during the " remission phase, such as Juniperus: phlegmy cough.
Caution This combination is warming and somewhat drying, and is not generally appropriate for patients with patterns of Heat.
This combination is the same as Zanthoxylum: Intestinal colic + cold extremities and is discussed under that heading.
COMPARISON OF THE THREE
3. Chronic bronchitis + cold sensations
1. Atherosderosis + hypertension
Lung Phlegm Cold + Spleen Deficient Yang
Heart Phlegm Cold + Heart Stagnant Qi
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Herb" .. ··:::,Rati2.,:~':Temperature Taste Commiphora 1 Thymus 1 Angelica arc. 1 Prunus 1 Lobelia 1 Glycyrrhiza 0.5 Zingiber 0.5 Capsicum 5-20 drops
warm warm-cool warm neutral warm-cool neutral-cool hot hot
bitter, acrid aromatic bitter, acrid, aromatic bitter, aromatic acrid sweet acrid, aromatic acrid
GENERAL
This combination is for: • Lung Phlegm Cold with Lung Deficient Qi • Spleen Deficient Qi and Yang with Cold and Stagnation There may also be some Heart Deficient Yang and Heart Stagnant Qi and Blood. The overall temperature of the combination is warm, and it can be used for cool or cold conditions, depending on the amount of Capsicum added to the other herbs. The acrid, aromatic, bitter, and sweet tastes each contribute to the expectorant action and to the tonic action on the digestive system. USE
• chronic bronchitis or bronchial asthma with profuse sputum that is difficult to expectorate; maybe purulent sputum or exhaustion from expectoration; maybe cold extremities and cold body
COMMIPHORA COMBINATIONS
Achillea, Crataegus, Salvia miltiorrhiza, and Angelica sinensis combine with Commiphora to provide antihyper- _ tensive and antiatheromatic effects. Zanthoxylum, Capsi-.::~~] cum, and Zingiber are hot herbs with circulatory stimulant action, which can be combined to strengthen and balanc~:, coronary and peripheral circulation. .' •...."" . .,~
2. Intestinal colic + cold extremities
Stagnant Qi and Blood + Intestines Cold
\:.rr.
As in combination No.1, this combination has Com- ,.-'~~~":; --'«~#' miphora, Crataegus, Achillea, Zanthoxylum, Zingiber, an~:,:~:,~ Capsicum to treat weak coronary and peripheral circulation. .;~.. However, in this combination, Myrica and Zanthoxylum~; have been added to clear Cold from the Stomach. Salvia·ana-.'! Angelica have been omitted since the emphasis of combination No.2 is not on hyperlipidemia. In combination No.1, Zanthoxylum bark is included since this is preferred for circulatory problems, and in this combination Zanthoxylum berries are included since these are preferred for digestive problems. Glyeyrrhiza has beeh ... added to combination No.2 to protect the stomach from tJ:iE2::'~ potenti;llly irritating effect of the hot herbs. ~.),':.
.t,.
lt-; .
3. Chronic bronchitis + cold sensations
Lung Phlegm Cold + Spleen Deficient Yang This combination combines Commiphora with the .~~ spasmodic antitussives Thymus, Lobelia, and Prunus.'ThY:'
Commiphora mus, Lobelia, Angelica, and Zingiber can also have an expectorant effect. Conuniphora, Angelica, Zingiber, and Capsicum can also have a carminative and circulatory stimulant action.
• antianginal • antispasmodic • analgesic • antimucosecretory
OTHER COMMIPHORA COMBINATIONS
• astringent and vulnerary • antimutagenic
393
Another combination that includes Commiphora is:
• Salvia: acute tonsillitis
Research CONSTITUENTS The composition of myrrh is complex and incompletely understood. Myrrh can be said to contain:l~ • 25-40% alcohol-soluble resin • 3-8% essential oil . • 30-60% water-soluble gum • other Alcohol-soluble resin According to Wichtl> little is known about the constitution of the resin. I According to Evans,15 most of the resin is ether soluble, and the ether-soluble part of the resin contains commiphoric acids> the esters of another resin acid, and two phenolic resins. The smaller etherinsoluble fraction contains heerabomyrrholic acids. Essential oil The main components are furanosesquiterpenoids. Furanoeudesma-1,3-diene is a main constituent (19%) of the oil, together with furanoeudesma-1,4-diene-6one and lindestrene.16 Water-soluble gum The water-soluble gum is mainly composed of acidic polysaccharides, especially galactose> 4-0methyl-glucuronic acid, and arabinose> and about 18% protein. 17 Other C. abyssinica contains sterols such as cholesterol, ~ sitosterol, and campestero1.6
PHARMACOLOGICAL AND CLINICAL RESEARCH The following effects have been reported: • antimicrobial • antipyretic • anti-inflammatory • antiulcer • digestive tonic • antihyperglycemic • antilipidemic • antithrombotic
Antimicrobial Antimicrobial,18 antibacterial,19 and antifungal5.19 effects have been discussed, but references were not given. Antipyretic C. molmol has been reported to have significant antipyretic activity in mice, using either an ethanolic or a petroleum ether extract of myrrh, at a dose of 500 mg/kg body weight. 20 Anti-inflammatory C. molmol has been reported to have anti-inflammatory effects in mice/o. 21 and C. mukul has shown anti-inflammatory and antiarthritic effects in rats 22 and in rabbits. 23 Antiulcer Pretreatment with an aqueous suspension of C. molmol oleogum resin at doses of 250, 500, and 1000 mg/kg body weight provided dose-dependent protection against mucosal damage caused by 80% ethanol or indomethacin in rats.24 Digestive tonic Myrrh (mo yao) has been reported to stimulate gastrointestinal motility.5 Antihyperglycemic Treatment of normal and diabetic rats with aqueous extract of myrrh lowered fasting blood glucose levels in both groups, and in the oral glucose tolerance test, the aqueous extract significantly increased glucose tolerance in both normal and diabetic animals. 25 Antilipidemic Preparations of myrrh (mo yao) were reported to lower serum cholesterol and prevent plaque formation in male rabbits with diet-induced hypercholesterolemia.5Antilipidemic activity was also reported in dogs, with a progressive decrease in the levels of triglycerides> cholesterol, and phospholipids following administration of guggul resin from C. mukul. 8 Administration of an ethyl acetate extract of C. mukul to rats significantly prevented a rise in serum cholesterol and triglyceride levels caused by an atherogenic diet, and gave significant protection against dietinduced atherosclerosis. 26 Antithrombotic Antithrombotic effects of C. molmol have been reported in mice.27 Antianginal In human trials, a combination of C. mukul and Inula racemosa was reported to be superior to nitroglycerin in reducing chest pain and dyspnea associated with angina. 2lI
.
. ·~~:.. .=-_.~" ,.,,;."';"~
394
Combining Western Herbs and Chinese Medicine
- ,-."
Antispasmodic T-cadinol from 'scented myrrh: the resin of C. guidotti Chiov., was reported to have a smooth musclerelaxing effect on the isolated guinea pig ileum and an inhibitory effect on cholera toxin-induced intestinal hypersecretion in mice. 29
RESEARCH VERIFICATION OF
Analgesic Bruneton reported an analgesic action by C. molmol in mice, which was attributed to the sesquiterpenes. 30 He may have been referring to the study in which an analgesic effect was demonstrated in mice after oral administration of ground myrrh at a dose of 1 mglkg of body weight. JI Furanoeudesma-1,3-diene isolated from myrrh showed analgesic activity in mice when administered by intracerebroventricular injection at 1.25 mg/kg or orally at 50 mg/kg. The authors demonstrated that furanoeudesma1,3-diene interacted with the brain opioid receptors, displacing the specific binding of [JH]-diprenorphine to rat brain membrane. J2
gesic, and vulnerary. I have not seen evidence to support the _,::' anticatarrhal, circulatory stimulant, carminative, emmena-' "
Antimucosecretory Inhibition of both bronchial and uterine secretion has been reported byYeung,19 but no references were provided. Astringent and vulnerary
Astringent The oleoresin of C. molmol has been thought to have astringent properties,18 but one author claimed that myrrh is not an astringent since there is no local precipitation of protein and hence no formation of a protective surface layer of coagulated cells. JJ Constituents responsible for astringency Commiphora resembles Calendula in that neither herb contains tannins. Therefore, their astringent, styptic, or antihemorrhagic actions must be due to other compounds. Both herbs contain polysaccharides and resins. The formation of a distinct polysaccharide layer on epithelial tissue by the polysaccharides from Calendula has been demonstrated (see Calendula). It may be that the astringent and vulnerary effects of these herbs is partly due to an addition of a protective layer from both resins and polysaccharides.
..'.. '::'::-:"--:~
:"H~";'
.:.,;.,;. I ...•. .... ...:., ~
TRADITIONAL ACTIONS
1
"'."~
.
The following traditional actions have been supported_;~~:::"i_ by research on Commiphora extracts or isolated constitu:-~=;"~ ~ ents: bitter digestive tonic, expectorant, antilipidemic, anal.: .• :~:~ -,
gogue, or astringent traditional actions. Additional uses suggested by research Antipyretic, antiinflammatory, antiulcer, antithrombotic, antianginal, antispasmodic and antimutagenic effects have been reported, suggesting that Commiphora is a greatly underused herb in the West with many possible important applications.
TOXICOLOGY . .
..'-::-~"E::'
Oral dose The acute oral LD so of myrrh oil has been esti~' mated as 1.65 glkg, and myrrh and its essential oil are reported to be nonirritating, nonsensitizing, and nonphototoxic when applied to animal or human skin. 37 According to the ESCOP monograph on myrrh,lO in the absence of formal _, clinical studies, it is clear from the ethnopharmacological evidence that myrrh has been extensively used internally and topically without apparent adverse effects. Cautions on the use of resins According to Mills and Bone,18 long-term prescription of resins. in general, is unadvisable, and according to Tierra,38 resins are difficult to eliminate and can cause minor damage to the kidneys if taken long-term. However, the application of these remarks to the long-term use of therapeutic doses of myrrh is unknown. Mutagenicity
Treatment with 125-500 mg/kg of C. molmol showed no mutagenicity in mice. 39
Dose
Vulnerary It has been reported that myrrh from C. abyssinica has stimulated phagocytosis in the reticuloendothelial system in mice. 34
Dried resin Myrrh is usually taken as a tincture in the _ West,l whilst in Chinese medicine 3-9 g is the dose given for
Antimutagenic Experiments in mice showed C. molmol to have antitumor activity equivalent in potency to the cytotoxic drug cyclophosphamide. The authors recommended the use of C. molmol in cancer therapy on the basis of its nonmutagenic, antioxidative and cytotoxic potential found in their study.35 C. molmol was reported to be cytotoxic to Ehrlich solid tumor cells in mice..l6
Tincture (oral) The BHp40 listed 1-2.5 ml of Myrrh Tinc- ture BPC 1973 (1:5 tincture in 90% ethan'ol), three times per day. For internal use, I generally use 0.5-1 ml of 1:5 Com-_ miphora tincture in 90% ethanol, in combination with the tinctures of 5-7 other herbs, three times per day.
a 2-day supply.19
Initial dose (oral)
Can start at the standard dose.
Commiphora lO
Duration (oral) The ESCOP monograph on myrrh gave no restriction on the duration of administration. Theoretically, the presence of resins might limit long-term use, but practically, no adverse reports are known for C. molmol as
395
not currendy listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
used in Western therapeutic doses. Gargle or mouthwash The BHC recommended 5 ml of tincture in a glass of water. For short-term use for acute conditions, a more concentrated gargle or mouthwash can be used if preferred. ll
Topical The German Commission E monograph recommended dabbing the affected area with the undiluted tincture, two to three times per day.
Traditional sources PROPERTIES Temperature Commiphora is classified as warming in Ayurvedic medicine,42 and in 12th century Germany, Hildegard von Bingen43 listed myrrh as hot and dry. According to Dioscorides, myrrh is warming and drying, and Lonicerus" wrote that it is hot and dry in the second degree. Felter and Lloyd described myrrh as a stimulant that can augment the
Cautions Western contraindications None reported. Chinese contraindications
heat of the body and cause gastric heat and burning if taken in large doses. 1o
Excessive uterine bleeding is
given as a contraindication for mo yao (at Chinese doses).s Pregnancy and lactation According to the ESCOP monograph on myrrh, no data is available on the use of Commiphora (at Western doses of the tincture) during pregnancy and lactation. Mo yao at Chinese doses is contraindicated
The main entry in the Chinese Herbal Medicine Dictionary45 listed C. molmol (mo yao) as neutral, but a cited newer text listed it as warm. The latter text may have been influenced by Ayurvedic or Western opinion. The usual temperature effect of Commiphora is given in this book as warm, although in certain circumstances myrrh can have antimicrobial, antipyretic and anti-inflammatory effects.
during pregnaney.5
Taste
Side effects According to the ESCOP monograph on myrrh, no undesirable effects have been reported. Oral use of undiluted tincture may result ina transient burning sensation
Taste in the mouth Dioscorides described myrrh as pungent in taste, and Lonicerus described it as bitter, pungent,
in the mouth. Overdose According to the ESCOP monograph, no toxic effects had been reported. However, Ellingwood41 wrote that, in overdose, myrrh could be emetic and cathartic, and Felter and Lloyd noted that excessive doses could produce a burning sensation in the epigastrium. Interactions
None reported.
1o
and very aromatic. The BHP gave the taste as bitter and acrid. I found that the 1:5 (90%) ethanol tincture diluted in water had a slight fragrance that was ~omewhat acrid and resinous, and a taste that was bitter, acrid, and astringent rather than sour, with a sweet undertaste and a puckering, sticky resinous sensation in the mouth.
Taste properties The main entry in the Chinese Herbal Medicine Dictionary listed C. molmol (mo yao) as bitter, but a newer Chinese text cited classified it as acrid and bitter.
Flammability Since the tincture is 90% ethanol, it should be protected from fire.
Regulatory status Please read the Regulatory status section in the chapter on Safety. Commiphora (myrrh) is on the UK General Sale List, and it is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Commiphora is
Again, the latter text may have been influenced by European opinion. In my opinion, the primary taste properties of Comrniphora are acrid, associated with its warming circulatory stimulant and anticatarrhal actions, and bitter, associated with its digestive tonic and cardiotonic actions.
ORGANS In terms of Chinese medicine, Commiphora, as used in the West, can be associated with disorders of the following organs:
Combining Western Herbs and Chinese Medicine
396
--
\
In Ayurvedic medicine, Commip~ora from~. IJ.lo~~~~=-:;#_ said to reverse the aging process, reJuvenate the bodyaila~ ;;; • : --,:!:"..3i!: mind, and work more on the blood, whereas guggul from C._;t::..~ mukul is said to have a stronger action on the nerve~t?_t!c:at~::~~_ neurasthenia and nervous disorders.
.
~:
Heart
strengthens the heart cardiac stimulant
Ellingwood Christopher
Stomach and Intestines
low appetite and weak digestion
Ellingwood
carminative
BHP
Lung
chronic bronchitis
Ellingwood, Felter and Lloyd
Uterus
amenorrhea or leukorrhea with exhaustion
Ellingwood, Felter and Lloyd
The main entry in the Chinese Herbal Medicine Dictionary listed C. molmol (mo yao) as entering the Liver, but three other texts cited show the following range of opinion: • Spleen and Kidney • Heart and Liver • Liver ACTIONS The main actions of this herb are: • antimicrobial • circulatory stimulant and general tonic • digestive tonic and carminative • anticatarrhal and expectorant • analgesic • emmenagogue • astringent and vulnerary Antimicrobial Commiphora is listed as an antiseptic by Christopher, the BHP, and the BHC, and as an antimicrobial by the BHP and by Mills and Bone. Circulatory stimulant and general tonic
Circulatory stimulant and cardiotonic According to Ellingwood, Commiphora is specifically indicated for extreme asthenia with weak circulation, weak pulse, and cold skin. He said that it strengthens the power of the heart and increases warmth and vigor. Christopher wrote that Commiphora is a cardiac stimulant that quickens the heart action, increases the circulation. and stimulates the flow of blood to the capillaries. Antilipidemic According to Mills,46 there is a French tradition of using Commiphora to reduce blood cholesterol. General tonU: Felter and Lloyd recommended Commiphora for enfeebled conditions of the body and reported its use for some cases of anemia. Christopher listed it for anemia. general debility. prostration. shock. and collapse.
Digestive tonic and cannative Felter and Lloyd prescribed-" Commiphora for gastric atony with a full pale tongue. Ac~ cording to Ellingwood, it can increase peptic secretion and stimulate appetite, digestion. absorption, and assimilation. He wrote that it can be used to treat atonic dyspepsia in the absence of inflammation, especially with excessive mucous discharge from the bowels. Grieve wrote that it could be used as a digestive tonic to 'excite the appetite and the flow of gastric juice: "'I According to Lonicerus. Commiphora simmered in wine:4j~ .1 warms the stomach and helps the digestion. Christopher ~:~~~~~. wrote that it gives a warm and pleasant sensation to the ~} ;;; stomach, and the BHP and Wichtllisted it as a carminative-,-, i '" ~~:;:r:~.'-:~ __ _
Anticatarrhal and expectorant According to Dioscorides~ -,
'7:-)
..~:
Commiphora can be used for nasal congestion, chronic.;~~""1 cough, difficult breathing, pleurisy, and chest pain. Lonicerus:.~~~.j
:;~easth:~r~~:c~:;e:e~::~:~::::::::::e:::::~;~f~~: debility and excessive mucous secretions. and Ellingwoodlisted it for atonic conditions of the mucous membranes. .~~, According to Ellingwood, if mucous secretion is deficient or excessive, Commiphora tends to normalize the function of the mucous membranes as follows: • ..;..,; • as an expectorant. it may stimulate secretion from underactive bronchial mucous membranes • as an anticatarrhal, it may normalize the function of membranes that are oversecreting mucous, as in bronchial catarrh. catarrh of the bladder, or leukorrhea
"
1
Grieve described Commiphora as an expectorant used for bronchitis and chronic catarrh. Analgesic In Chinese medicine. Commiphora is used to move Stagnant Blood and relieve pain, as in chest pain or dysmenorrhea, and both Dioscorides and Lonicerus included chest pain as an indication. However. the use of Commiphora as an analgesic was not prevalent in the West. Emmenagogue Dioscorides wrote that Commiphora can be used in combination with other herbs to induce menstruation and labor. Lonicerus noted its use for infertility. Felter and Lloyd. Ellingwood, and Christopher recommended it for amenorrhea and leukorrhea. Astringent and vulnerary Dioscorides wrote that Commiphora is drying and astringent and helps with wound healing and the regrowth of flesh. He recommended it to strength-
_ "'-<
f ;
Commiphora en the teeth and gums, for bad breath, as an underarm deodorant for bad smells, and for pus from heat-type ear ulcers. Many texts list Commiphora as an astringent, despite the comment of Hansel (see Research: astringent).33 However, Commiphora is not so much used anymore as an astringent to stop diarrhea or an antihemorrhagic to stop bleeding. Its reported astringent action may be associated with a complex of different effects.
Antimicrobial, anti-inflammatory, and anticatarrhal The antimicrobial and anti-inflammatory actions are a foundation for wound healing, and they are also basic to the normalization of epithelial function associated with an anticatarrhal action. The use of Commiphora by Dioscorides and Lonicerus for diarrhea and dysentery might have been as much based on its antimicrobial action as on its astringent effect. Circulatory stimulant and counterirritant It is possible that the systemic circulatory stimulant action may be accompanied by a counterirritant action on the local tissues, which increases local capillary circulation to help to move local stagnation and accumulation of toxins. A stimulation of phagocytosis by C. abyssinica has been reported; see Research. Astringent Commiphora seems to have an efficient local astringent action. It can be the most effective of all the topical herbs for problems such as skin cracking of the hands and for gingivitis. The sticky. puckering sensation that it has in the mouth and the speed with which it can heal cuts and cracks in the skin suggest the formation of an astringent layer. More research in this area is needed. COMPARISON OF WESTERN AND CHINESE USE OF COMMIPHORA This is discussed under the following headings: • circulatory stimulant • carminative • anticatarrhal and expectorant • emmenagogue • topical Circulatory stimulant (moves Heart Stagnant Qi and Blood) In Chinese medicine. mo yao is said to move the Blood, but it is mainly used as an analgesic. for example. for head and other injuries. pain in the bones and tendons. chest pain. epigastric pain. lower abdominal pain. and dysmenorrhea. It is not so much used. as it was in the Eclectic and Physiomedical traditions in the West. to warm. stimulate. and tonify Heart Qi and Yang to treat exhaustion with poor circulation and sensations of cold.
397
Carminative In Chinese practice, mo yao can be used for epigastric or abdominal pain from Stagnant Qi and Blood. Commiphora is not so much used, as it has been in Western tradition, as a warming carminative for weak appetite, digestion, absorption, and assimilation, with signs of cold. Anticatarrhal and expectorant For about two thousand years. Commiphora has a tradition of use in the West in the treatment of nasal and bronchial catarrh and other respiratory disorders. There does not appear to have been a comparable tradition in China. Emmenagogue In Chinese medicine, Commiphora is used to move Stagnant Blood to treat amenorrhea and dysmenorrhea.It is not so much used, as it is in Western tradition. for amenorrhea or le~rrhea associated with underlying patterns of weakness (Deficiency). In fact. one opinion cited by the Chinese Herbal Medicine Dictionary contraindicated mo yao for painful gynecological conditions when these are associated with Deficiency. Topical Commiphora is used in China to promote healing of wounds and of chronic nonhealing ulcers. just as it is in the West. but it does not seem to be used as much as in the West for mouth ulcers. gingivitis. and pharyngitis.
References 1. Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn.
Medpharm. Stuttgart, Germany (1994) from 2nd German edn Wichtl M (ed) (1989) 2. Grieve M. A Modern HeJ:"bal, vols. 1 and 2. Dover Publications, New York, New York (1971) 3. Sykes JB (ed). Concise Oxford Dictionary. 6th edn. Oxford. United Kingdom (1976) 4. Dioscorides P. Kreutterbuch (1610). Reprinted by Verlag Konrad Kolbl. Miinchen. Germany (1960) 5. Bensky D. Gamble A. Chinese Herbal Medicine Materia Medica. Eastland Press, Seattle.Washington (1986) 6. Martinetz D, Lohs K and Janzen J. Weihrauch und Myrrhe: Kulturgeschichte und wirtschaftliche Bedeutung; Botanik, Chemie. Medizin. Stuttgart: WlSSenschaftliche Verlagsgesellschaft. p 236 (1988) ISBN 38047-1019-0 7.•DAB 9-Kommentar [TSI (1988) [cited in Bradley PR (ed). British Herbal Compendium. vol 1. British Herbal Medicine Association. Bournemouth, United Kingdom (1992») . 8. Dixit VP, Joshi S. Shinha Ret al. Biochem Exp Bioi 16(4):421-424 (1980) 9. Bradley PR (ed). British Herbal Compendium, vol. 1. British Herbal Medicine Association. Bournemouth. United Kingdom (1992) 10. European Scientific Cooperative on Phytotherapy: Monographs on the Medicinal Uses of Plant Drugs. European Scientific Cooperative on Phytotherapy. Exeter, United Kingdom (1997)
398
Combining Western Herbs and Chinese Medicine
11. Blumenthal M (ed). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Counci\,Austin. Texas (1998) 12. Christopher JR. School of Natural Healing. BiWorid. Provo. Utah (1976)
32. Dolata Pt Moneti G Pieraccini G et al. Phytotherapy Res 10 (SuppLl);_'_.~:;' .-J
S81-S83 (1996)
~
~_._-~
.
,.
33. Hansel R. Pharmazeutische Biologie (Spe-zieller Teil). Springer. Berlin 190 [cited in Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals_ ---~
English edn. Medpharm. Stuttgart. Germany (1994). from 2nd
13. Fdter HW. Lloyd JU. King's American Dispensatory; vols. 1 and 2. 18th edn. (1898). Reprinted by Eclectic Medical Publications. Sandy. Oregon (1983)
34. Delaveau P. Lallouette P. Tessier AM. Planta Medica 40:49-54 (1980)
14. Tucker AO. Econ Bot 40:425-433 (1986)
35. Qureshi S. AI-Harbi MM. Ahmed M.\,l et al. Cancer Chemother
15. Evans We. Trease and Evans' Pharmacognosy, 14th edn. WB Saunders, London. United Kingdom (1996) 16. Brieskorn CH. Noble P. Phytochemistry 22:187-189 (1983)
German edn. WichtiM (ed) (1989»)
PharmacoI33(2):130-138 (1993) 36. al-Harbi M..\,{. Qureshi S. Raza M et al Chemotherapy 40(5):337-347 (1994)
17. Jones JKN.Nunn JR. I Chern Soc 3001-3004 (1955) 37. Opdrke DLI. Food Cosmet Toxico114:621 (1976) 18. Mills S. Bone K. Principles and Practice of Phrtotherapy: Modern Herbal Medicine. Churchill Livingstone. Edinburgh. United Kingdom (2000) 19. Yeung H-C. Handbook of Chinese Herbs and Formulas, vol. 1. Institute of Chinese Medicine. Los Angeles, California (1985) 20. Tariq M.Ageel~.Al~Yahya MA et al Agents Actions 17(3-4):381-382 (1986) 21. AttaAH.AlkofahiA.J Ethnopharmacol60(2):1l7-124 (1998) 22. Duwiejua M. Zeitlin II. Waterman PG et al. Planta Med 59(1):12-16 (1993) 23. Sharma IN.Arzneimittelforschung 27(7):1455-1457 (1977)
38. Tierra M. Planetary Herbology. Lotus Press. Twin Lakes. Wisconsin (1988) 39. al-Harbi MM. Qureshi S. Ahmed MM et al. Am J Chin Med 22(1):7782 (1994) 40. British Herbal Pharmacopoeia. British Herbal Medicine Association.' West Yorks, United Kingdom (1983) 41. Ellingwood F. American Materia Medica. Therapeutics and Pharmacognosy.llth edn'(1919). Reprinted by Eclectic Medical Publications, Sandy. Oregon (1994)
24. al-Harbi MM. Qureshi S. Raza M et al. I Ethnopharmacol 55(2):141150 (1997)
42. Frawley D. Lad V. The Yoga of Herbs: An Ayurvedic Guide to Herbal
25. AI-Awadi FM. Gumaa KA. Acta Diabeto124:37-41 (1987)
43. Von Bingen H. Hildegard von Bingen's Physica. Healing Arts, Roch-
26. Lata S. Saxena KK. Bhasin V et al. J Postgrad Med 37(3):132-135 (1991) 27. OlajideOA.Phytother Res 13(3):231-232 (1999)
Medicine. Lotus Press, Twin Lakes. WISConsin (1986)
ester, Vermont (1998) 44. Lonicerus A. Kreuterbuch (1679). Verlag Konrad Kolbl. Miinchen. Germany (1962)
28. Miller AL.Altern Med Rev 3(6):422-431 (1998) 45. liangsu New Medicine Institute. Chinese Herbal Medicine Dictionary 29. Claeson P. Andersson R. Samuelsson G. Planta Med 57(4):352-356 (1991) 30. Bruneton I. Pharmacognosr: Phytochemistry Medicinal Plants. 2nd edn. Lavoisier. Paris. France (1999) 31. Dolara P. Luceri C. Ghelardini C et al Nature 379:29 (1996)
(Zhong yao da ci dian) Science and Technology Press. Shanghai. China (1975) 46. Mills S. The Essential Book of Herbal Medicine. Arkana/Penguin Books. London, United Kingdom (1991)
::l
Convallaria ... Botanical name Convallaria majalis L. Family Liliaceae Pharmaceutical name Convallariae herba Part dried leaves English lily of the valley German Maiglockchen French muguet Mandarin C. majalis L. is not used ling Ian (#-:t.) is the entire plant of C. keiskei Miq.
Convallaria is on Schedule Part III of the Supply of Herbal Remedies Order 1977 of the UK. with maximum dose limitations. In my opinion. this is a very useful herb, but it is not suitable for over-the-counter sales, and considerations of safety might suggest restriction ofits use to health practitioners qualified and licensed in herbal therapy. Please read the sections on Dose and Cautions in this chapter, and the general discussion in the chapter on· Safety.
Caution
Part used The BHplO gave the dried leaves as the part used, but Weiss ll listed the flowers and herb, and the Commission E monograph12 recommended the dried aerial parts harvested during the flowering season. Some earlier writers, such as Ellingwood and GrieveD listed the whole plant, and Felter and Lloyd6 listed the rhizome. Weiss considered the red berries to be toxic. Use in China The Chinese Herbal Medicine Dictionari 4 has an entry for ling lan, the entire plant of C. keiskei Miq. However, the entry did not list the meridians entered and did not offer any differing opinions on its properties. It gave more information on its pharmacology than on traditional data, and the uses section reads as if it was copied from a Western herbal text. All this gives the impression that this herb does not have a long tradition of use in Chinese medicine, but that its use derives largely from Western tradition.
Use in the West Convallaria is a small herbaceous woodland plant native to Europe, North America. and Western Asia with characteristic white, bell-shaped flowers and a beautiful fragrance. I According to Gerard, 2 lily of the valley was mentioned in the Herbal of Apuleius written in the 4th century. This herb has a long history of use in Europe for heart disorders, for which it was employed by Matthiolus,3 Tabernaemontanus,4 Culpeper,s and Gerard. In the United States, Eclectic practitioners such as Scudder,6 Lyle,7 Ellingwood,8 and later Kloss9 used it for cardiac disorders, especially those accompanied by edema.
What is special about Convallaria In terms of Chinese medicine, Convallaria majalis, as used in the West, can be said to be neutral in temperature, bitter, and slightly sweet. It has its main effect on the Heart and to a lesser extent on the Kidney and Bladder system.
The key to understanding Convallaria is that its specific action is to strengthen and normalize heart function to treat cardiac weakness, cardiac edema, and cardiac arrhythmias.
399
------ - - - - - - - - -
---
400
-
-
Combining Western Herbs and Chinese Medicine
CHINESE ACTIONS
linked to Heart Deficient Qi. Convallaria can have arioimal'::~ f ..... izing or regulatory effect on the heart in that it can be used . '''''~ .
In terms of Chinese medicine, Convallaria, as used in the West, can be said to have three main actions:
to treat:
,~
• bradycardia or tachycardia • hypotension or hypertension
1. tonify Heart Qi and Kidney Qi II. stabilize Heart Qi III. move Heart Blood
Stabilize Heart Qi Convallaria is used especially to stabilize the physical action of the heart and treat Irregularity of Heart. Qi, as in arrhythmia. It is not so much used to calm the mind and emotions and treat Heart Spirit Disturbance,
Antianginal In terms of Chinese medicine, Convallaria can be used for angina pectoris from Heart Stagnant Blood, especially when it is associated with Heart Deficient Qi.
Move Heart Blood Convallaria moves Heart Blood in the sense of moving Stagnation of Qi and Blood in the heart and chest to reduce chest pain due to heart disease, rather than in the sense of stimulating peripheral circulation.
WESTERN ACTIONS The main Western actions of Convallaria are shown here in terms of the three main Chinese actions: 'Westernactioris
~.'"
-:'-~-:" .~-~
cardiotonic nervine antihypotensive diuretic
II. stabilize Heart Qi
cardioregulator antiarrhythmic
III. move Heart Blood
antianginal
Cardiotonic The cardiotonic action may be the dominant action of Convallaria. underlying the other three main actions: cardioregulator, cardiac diuretic, and antianginal. The cardiotonic action may be used to treat cardiac weakness accompanied by exhaustion, low blood pressure, cardiac edema, or cardiac weakness following a prolonged or severe illness. Cardioregulator Convallaria is specific for strengthening and normalizing the heart function to treat cardiac arrhythmias or palpitations, especially when the cardiac weakness is
..~ .\~~
.
--
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WESTERN USES The Western uses of Convallaria can be related to its
-,7'-
three main Chinese actions:
I. tonify Heart Qi and Kidney Qi
cardiac weakness with . eXhaustion, hypotension, or edema
II. stabilize Heart Qi
arrhythmias
III. move Heart Blood
angina pectoris
as in ~ety and palpitations.
I. tonify Heart Qi and Kidney Qi
.... ~.~;:;
£/%1:
Tonify Heart Qi and Kidney Qi Convallaria is primarily a tonic for Heart Qi. It is now mainly used for Kidney Deficient Qi when this syndrome is found in combination with Heart Deficient Qi, as in cardiac edema. Convallaria is not much used for edema anymore unless it is associated with cardiac weakness.
Chinese actions::
..;~
'-'~--
DIRECTION OF ENERGY Apart from helping to drain fluid downwards, Convallaria does not have a marked outward, inward, upward, or downward effect on the direction of Qi movement. Rather, can be said to have a tonifying and stabilizing effect on Heart. Qi, and a moving and regulating effect on the coronary circulation.
TYPICAL CASE EXAMPLE Signs and symptoms The patient has exhaustion and some ankle edema, occasional arrhythmia, and occasional discomfort in the chest. The pulse is slow and empty, especially at the Heart and Kidney positions. The tongue is slightly pale and flabby. Diagnosis The patient has Deficiency of Heart Qi with some Deficiency of Kidney Qi, associated with the exhaustion and edema, and Irregularity of Heart Qi, associated with the arrhythmia and palpitations. The discomfort in the chest may be associated with Heart Deficient Qi and Stagnant '-i'
Heart Blood.
Choi~e of Convallaria
,.\
.~f.
-
,~.
Convallaria can be selected to toni~ .~~ fy Deficiency of the Heart and Kidney Qi, to normalize Ir~ .. regularity of Heart Qi, and to help move Stagnant Heart Qi .;;) and Blood.
\
Convallaria
Limitations of Convallaria TEMPERATURE Convallaria is listed in this book as neutral so that it can be used for hot, warm, neutral, cool, or cold patterns when it is combined with an appropriate herb to adjust the temperature balance of the combination.
'TASTE Bitter taste property The bitter taste of Convallaria in the mouth may be associated with both bitter cardiotonic and digestive tonic actions. However, the bitterness of Convallaria is relatively mild compared to Gentiana so that Convallaria is not generally used asa bitter digestive tonic. Sweet taste property The slighdy sweet taste of Convallaria may be associated in Western terms with its cardiotonic and nervine tonic actions, and in Chinese terms with its ability to nourish the Heart and to strengthen and stabilize Heart Qi. ACTIONS Cardiotonic Convallaria has an important cardiotonic action, and as a result. the herb can be used to treat cardiac weakness with exhaustion. hypotension. edema. or dyspnea. However. it appears to be more of a tonic of Heart Qi. rather than of Heart Yang, Heart Ym. or Heart Blood. Nevertheless. it can be included in combinations to treat these syndromes, providing that it is combined with the appropriate herbs.
-~
Cardioregulator Convallaria has a tradition of use for heart arrhythmias and palpitations from at least the late 19th century to the present day. Ellingwood said that Convallaria was conducive to rest and sleep. but this herb is not so much used as a tranquilizer to calm disturbance of Heart Spirit. like Passiflora or Leonurus. but as a herb to regulate and normalize the function of the heart organ.
401
of Chinese medicine, this could be interpreted as strengthening Heart, Kidney, or both. However, Convallaria is most commonly used as a nervine when there is Deficiency of Heart Qi with or without some disturbance of Heart Spirit.
Convallaria paired with other herbs Discussion of the limitations of each of the main actions of Convallaria can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Convallaria beyond its limitations. The basic unit of herb combination is the herb pair. Six pairings of Convallaria with other herbs are briefly discussed below. CAUTION
Patients with suspected heart disorders require conventional diagnosis. Convallaria can be used with other herbs as an adjunct to conventional Western treatment if appropriate. but herbal therapy is not meant as a substitute for conventional diagnosis and treatment. Also, practitioners should be aware ofpotential herb-drug interactions. Before using any of the pairs below, it is important to be familiar with the cautions listedfor each herb in the pair. This is especially so for Convallaria and Cinchona. which are both included in Schedule Part III ofthe Supply ofHerbal Remedies Order 1977 ofthe United Kingdom. Convallaria + Panax ginseng
Cardiac weakness + exhaustion Both Convallaria and Panax ginseng can tonify Heart Deficient Qi and increase the force of the heart contractions. Convallaria can also normalize heart function and reduce arrhythmias. and Panax can tonify the Qi of the Kidney and Spleen to support the Heart. Convallaria + Sarothamnus
Cardiac diuretic This herb is specific for edema linked to heart weakness. but it is not generally used as a diuretic in the absence of heart involvement.
Antianginal Whilst Convallaria may not be the herb of choice for angina pectoris. it can be included as a secondary herb in cases of chest pain due to heart disease. especially when there is concurrent cardiac weakness. arrhythmias. or edema.
r-
Nervine Culpeper said that Convallaria could be used to strengthen the brain and to strengthen the memory. In terms
Cardiac weakness + hypotension Both herbs can be used for cardiac weakness with hypotension and exhaustion. Sarothamnus is contraindicated for hypertension cases. Both herbs are specific for cardiac edema. and both herbs can ?e used for tachycardia. Convallaria + Cinchona
Cardiac weakness following severe or chronic illness This pair can both tonify Heart Qi and clear Retained Pathogen associated with febrile or inflammatory illnesses.
Combining Western Herbs and Chinese Medicine
402
Also, Cinchona can act as a bitter digestive tonic to assist recovery. Both herbs have contraindications and possible interactions with conventional drugs. They should be used with caution in the countries and under the regulations that permit their use.
CAUTION
~::~'._-.:.~~ "'''''C''''~''
Patients with suspected heart disorders require conven 2 " ''1~''', ...''! tional diagnosis. Convallaria can be used with other herbs as '., an adjunct to conventional Western treatment if appropriate;;:~~:_:~~= but herbal therapy is not meant as a substitute for convention-~:~)t __, al diagnosis and treatment. Also, practitioners should be aware' ofpotential herb-drug interactions. Before using any of the combinations below, it is important to be familiar with the cautions listed for each herb in the combination. This is especially true for Convallaria, which is included in Schedule Part III ofthe Supply ofHerbal Remedies Order 1977 ofthe United Kingdom. ,Co,".'
Convallaria + Leonurus Cardiac arrhythmias This pair can treat arrhythmias and palpitations by strengthening the heart and by normalizing its function. Also; Leonurus has a tranquilizing action to calm anxiety and treat palpitations, and is indicated in menopausal disorders.
_.-::~,
1. Cardiac weakness + depression
Heart Deficient Yang + Kidney Deficient Yang
Convallaria + Taraxacum Cardiac edema Convallaria is specific for cardiac edema. Taraxacum is not specific for cardiac edema, but it is a general diuretic. In addition, Taraxacum .is rich in potassium, which can compensate for the possible increased potassium loss due to the diuretic action of Convallaria. Convallaria + Crataegus Angina pectoris Convallaria and especially Crataegus can be used to move Stagnant Heart Blood associated with chest pain due to heart disease. Also, both these herbs can strengthen the heart and normalize heart function.
sour. sweet bitter. sl. sweet sweet. 51. bitter bitter. aromatic. acrid acrid. sweet. aromatic
sl. warm Crataegus 1 neutral Convallaria 1 sl. warm 1 Panax gin. warm 1 Turnera hot Cinnamomum 1 (bark) neutral-cool 0.5 Glycyrrhiza 5-20 drops hot Capsicum
sweet acrid
This combination is the same as Crataegus: cardiac weakness + depression and is discussed under that heading.
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2. Cardiac weakness + cardiac edema
Heart Deficient Qi + Kidney Deficient Qi + Damp H:~;~fB~
Convallaria combinations Six Convallaria combinations are discussed below:
1. cardiac weakness + depression
Heart Deficient Yang + Kidney Deficient Yang
2. cardiac weakness + cardiac edema
Heart Deficient Qi + Kidney Deficient Qi + Damp
3. cardiac arrhythmia + hypotension
Heart Qi IrregUlarity + Kidney Deficient QI
4: cardiac arrhythmia + restlessness
Heart Qi Irregularity + Heart Deficient Yin ... . .
5. palpitations + anxiety
Heart Spirit Disturbance + Heart Qi Irregularity
6. angina pectoris + cold sensations
Heart Stagnant BloOd + Heart Deficient Yang
,'
. :fd.t~
Convallaria Crataegus Sarothamnus Taraxacum Parietaria Juniperus Zingiber
1 1 1 1 1 1 1
neutral 51. warm neutral cool-cold neutral 51. warm hot
bitter. 51. sweet sour. sweet bitter bitter bitter aromatic. 51. acrid. 51. sour acrid. aromatic
GENERAL This combination is used primarily to tonify Heart Qi and secondarily Kidney Qi, and to drain and transfor~ Damp. The overall temperature is approximately neutral, but the combination can be modified to treat hot, warm, cool, or cold conditions. The downward draining aspect of ~~': diuretic action may be associated with the bitter prop~~,of/,,'~i Taraxacum, Parietaria, and Convallaria. The aromatic and,·' acrid properties of Juniperus and Zingiber may help to' transform Damp. .
Convallaria USE
• cardiac weakness, exhaustion, cardiac edema, maybe arrhythmias or chest discomfort PRACTICAL NOTES
ing on the screening and monitoring procedures for Convallaria and Sarothamnus, the combination can be taken, with appropriate breaks and modifications, for several months.
Heart Qi Irregularity + Kidney Deficient Qi
Panax gin. Schisandra Glycyrrhiza Zingiber
51. warm
1 1 1 1 1 1
neutral neutral neutral
51. warm
0.5 0.5
warm neutral-<:ool hot
sour, sweet bitter, 51. sweet bitter sour, sl. bitter sweet, sl. bitter sour sweet acrid, aromatic
This combination is the same as Crataegus: cardiac arrhythmia + hypotension and is discussed under that heading. 4. Cardiac arrhythmia + restlessness
Heart Qi Irregularity + Heart Deficient Yin Herb
Ratio
Salvia mil. Ophiopogon
1 1 1 1 1 1
Glycyrrhiza
0.5
Convallaria Crataegus Leonurus Salvia off.
·Temperature
Taste-' . ',. bitter, sl. sweet
51. warm
sour, sweet sour, sl. bitter
cool cool neutral-<:ool
PRACTICAL NOTES
5. Palpitations + anxiety
Heart Spirit Disturbance + Heart Qi Irregularity
Lavandula
1
sl. warm
aromatic, bitter, 51. acrid
Valeriana
1
ceol
bitter, sweet
Anemone
1
cold
bitter
Leonurus
neutral
sour. sl. bitter
Crataegus
1 1
sl. warm
sour, sweet
Convallaria
1
neutral
bitter. 51. sweet
Glycyrrhiza
0.5
neutrak:ool
sweet
This combination is the same as Lavandula: palpitations
neutral neutral warm-<:ool
• cardiac arrhythmias, cardiac weakness, exhaustion, and restlessness; maybe chest pain or discomfort, insomnia, or palpitations
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of warm water, three times per day. Depending on screening and monitoring procedures for Convallaria, the combination can be taken, with appropriate breaks and modifications, for several months.
3. Cardiac arrhythmia + hypotension
Crataegus Convallaria Sarothamnus Leonurus
warm conditions. The sweet and bitter constituents may contribute a cardiotonic effect, the sour constituents may help to firm and stabilize Heart Qi, and the aromatic and other constituents may combine to give a calming effect. USE
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of warm water, three times per day. Depend-
:-,--
403
+ anxiety and is discussed under that heading. 6. Angina pectoris + cold sensations
Heart Stagnant Blood + Heart Deficient Yang
aromatic, acrid bitter sweet, sl. bitter sweet
,,'
Convallaria Crataegus
GENERAL
. OJ
Heart Qi Irregularity refers to irregularity of the function of the heart, specifically a disturbance in the rhythm of the heartbeat. This may have a physical origin that is not necessarily associated with emotional disturbance. On the other hand, physical arrhythmias related to Heart Qi Irregularity may in some cases be associated with emotional and mental symptoms related to Heart Spirit Disturbance. . This combination is for Heart Qi Irregularity and Heart Deficient rm, and may be accompanied by some Heart Spirit Disturbance. It is a slightly cool combination for neutral or
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Herb .~'.:=..~. Ratio4!:-i:.::,..:,.;relllperature.,.Taste.
Salvia mil. zanthoxylum
1 1 1 1
neutral
bitter, 51. sweet
51. warm
sour, sweet
cool
bitter
hot
acrid, aromatic, bitter
(bark) Panax gin.
0.5
sl. warm
sweet, sl. bitter
Lobelia
0.5
warm-<:ool
acrid
Capsicum
5-20 drops
hot
acrid
GENERAL
This combination is for Heart Stagnant Blood with Heart Deficient Yang. It is a warm combination for cool or cold conditions. The bitter and sweet components, supported by the acrid and aromatic constituents, can tonify Heart Qi and
.,,;~
Combining Western Herbs and Chinese Medicine
404
~,;
-~·7~~~ .~
,-:._·_:=-"::~':"~l
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Yang, and the acrid and aromatic components can help to relax spasms and stimulate the circulation in the heart and body. USE
• chest pain due to heart disease with cold sensations in body and extremities PRACTICAL NOTES
The herbs other than Capsicum are conveniently taken as 5 ml of a 1:5 tincture in quarter of a glass of warm water, three times per day. Drops of 1:5 Capsicum tincture, from a separate bottle, can be mixed with the contents of the glass.
2. In both combination No.1 and combination No.:2;'-c::o; ~ Crataegus and Convallaria can strengthen the heart func- .. tion. In combination No.2, Convallaria and Sarotharnnus, assisted by the diuretics Taraxacum, Parietaria, and Junipel)lS, _. _ are combined to treat cardiac edema. 3. Cardiac arrhythmia + hypotension
4. Cardiac arrhythmia + restlessness
Heart Qi Irregularity + Kidney Deficient Qi
Heart Qi Irregularity + Heart Deficient Yin
Herb
Schisandra
Ophiopogon
1 1 1 1 1 1
Glycyrrhiza
0.5
Glycyrrhiza
0.5
Zingiber
0.5
with appropriate breaks and modifications, for several months. This combination can be used as an adjunct to conventional treatment, together with appropriate nutritional, exercise and stress management regime1l. To gauge the effectiveness of the combination, a criteria of improvement can be set for the patient, such as the frequency and severity of pain, or the amount of a standardized exercise that can be performed prior to becoming short of breath.
Leonurus
1. Cardiac weakness + depression
2. Cardiac weakness + cardiac edema
Heart Deficient Yang + Kidney Deficient Yang
Heart Deficient Qi + Kidney Deficient Qi + Damp ~
Herb Crataegus Convallaria Panax gin. Tumera Cinnamomum
1 1 1 1 1
(bark) Glycyrrhiza Capsicum
Convallaria Crataegus Sarothamnus Taraxacum Parietaria Juniperus
0.5 5-20 drops
.....
Zingiber
. Ratio·· 1 1 1 1 1 1 1
Ratio
Convallaria
Crataegus
CONVALLARIA COMBINATIONS
Herb
1 1 1 1 1 1
Depending on screening and monitoring procedures for Capsicum, Convallaria, and Lobelia, the combination can be taken,
COMPARISON OF THE SIX
Ratio
Convallaria Sarothamnus Panax gin.
Crataegus Leonurus Salvia off. Salvia mil.
~.
3. Both combination No.2 and combination No.3, contain Crataegus, Convallaria, and Sarothamnus for cardiac weakness. Combination No. 2 also contains the diuretics Taraxacum, Parietaria and Juniperus for cardiac edema. The emphasis in combination No.3 is on hypotension, and it therefore contains the trio Sarothamnus, Panax. and Glycyrrhiza to raise the blood pressure. Leonurus can tonify Heart Qi, calm Heart Spirit Disturbance, and buffer the hypertensive effect of Sarothamnus, Panax, and Glycyrrhiza. 4. Both combination No.3 and combination No.4 contain Crataeg~s, Convallaria, and Leonurus to treat cardiac weakness and cardiac arrhythmia. Combination No.4 also contains the trio Salvia officinalis, Salvia miltiorrhiza, and Ophiopogon to tonify Heart Yin, clear Heart Deficiency Heat. and calm Heart Spirit Disturbance. 5. Palpitations + anxiety
6. Angina pectoris + cold sensations
Heart Spirit Disturbance + Heart Qi Irregularity
Heart Stagnant Blood + Heart Deficient Yang
1. Crataegus and Capsicum can tonify Heart Deficient
Yang and Turnera can tonify Kidney Deficient Yang. Convallaria, Panax, Cinnamomum. and Glycyrrhiza can together tonify both the Heart and Kidney. Crataegus and Convallaria are specific for cardiac weakness, and Panax and Turnera are specific for depression associated with Kidney Deficient Yang.
Lavandula Valeriana Anemone Leonurus Crataegus Convallaria Glycyrrhiza
1 1 1 salvia mil. zanthoxylum (bark) 1
1 1 1 1 1 1
Convallaria
0.5
Crataegus
Panax gin.
0.5
Lobelia
0.5
Capsicum
5-20 drops
Convallaria 5. Again, this combination contains Crataegus, Convallaria, and Leonurus to treat cardiac weakness and cardiac arrhythmia. However, it also includes Lavandula, Valeriana, Anemone, and Glycyrrhiza (which make up the combination Lavandula: insomnia) to calm Heart Spirit Disturbance and treat the associated anxiety and palpitations.
6. Convallaria, Crataegus, Salvia, Lobelia, and Capsicum combine to warm and move Stagnation of Qi and Blood in the chest to relax the spasms and relieve heart pain. Zanthoxylum and Capsicum are specific to assist the circulation to the extremities, and Panax and Capsicum help to treat Heart Deficient Yang. OTHER CONVALLARIA COMBINATIONS The following additional combinations further illustrate the range of uses of Convallaria:
• Crataegus: angina pectoriS • Crataegus: cardiac arrhythmia + exhaustion
Research CONSTITUENTS
...
• cardenolide glycosides • flavonoids • saponins • asparagin Cardenolide glycosides According to Bruneton, the dried flowering tops of C. majalis contain 0.1-0.5% cardenolides. 1 The main glycoside is convallatoxin, which on hydrolysis gives strophanthidin and (-)-rhamnose. C. majalis contains nearly forty minor cardenolide glycosides associated with nine different aglycones.IS. 16. 11 C. keiskei, the Japanese lily of the valley, contains glycosides of convallagenin. 14 According to Bruneton, convallatoxin is a very active glycoside, but is poorly absorbed by the intestine. Only about 10% is absorbed. However, according to Weiss,1I the other constituents in Convallaria aid in the absorption of convallotoxin. Flavonoids Weiss reported work done by Karting, Hiermann, and Vrecer showing that Convallaria contains eight different flavonoids with cardiovascular effect. According to Mabey,18 the flavonoids assist in the dilation of the arteries. Saponins According to Bruneton, the flowering tops contain saponins, and according to Evans, the roots contain the saponin convallamaroside.
405
Asparagin According to Mabey,. Convallaria contains asparagin, which may assist the diuretic action of this herb. PHARMACOLOGICAL AND CLINICAL RESEARCH There is very little research data available on Convallaria. Various statements have been made on the pharmacological and clinical effects of Convallaria, but have not been supported by research references. Mills '9 reported Hyde as stating that Convallaria has a slow onset cardioactivity and a low toxicity. Mabey stated that this herb increases the force of the heart beat, whilst slowing and regularizing the heart rate: According to Weiss, Convallaria can be used for mild to medium forms of heart failure, but Ca.nrlot replace digoxin for severe forms. However, for mild cardiac weakness where there is bradycardia and hypersensitivity to digoxin, as in some senile heart conditions' Weiss considered Convallaria to be a valuable alternative to digoxin. According to the Commission E monograph,12 Convallaria has positive inotropic effect, economizes heart function, lowers raised left ventricular diastolic pressure, is a tonic for the veins, natriuretic and kaliuretic. However, the authors did not cite the research articles that support these statements. Stropanthidin It has been reported that stropanthidin, the aglycone of convallatoxin, at 1 Ilglml, increased the rate of tension development in heart muscle. 20 A study reported that the administration of stropanthin to animals with cardiopulmonary insufficiency increased the contractility of the right ventricle, increased the intensity of diastolic relaxation of both ventricles, and increased pressure in the pulmonary artery.21
RESEARCH VERIFICATION OF TRADITIONAL ACTIONS Cardiotonic effects have been reported for isolated stropanthidin, but the relevance of this information to oral administration of therapeutic doses of Convallaria has not yet been determined. . Additional effects demonstrated by research None have yet been reported. TOXICOLOGY In my opinion, this is a useful herb, which generally can be used safely, providing the therapeutic indications, the
Combining Western Herbs and Chinese Medicine
406
therapeutic dose ranges, and the therapeutic cautions are observed. According to Bruneton, there are few reports of serious toxicity, and they usually occur when the roots and rhizomes of this plant are confused with those of an edible species. The paucity of research data on Convallaria makes it difficult to interpret the cautions and contraindications listed, for example, by Hyde and by the Commission E monograph, which unfortunately lack research references. The Commission E approved the use of Convallaria for mild cardiac insufficiency, heart insufficiency due to old age, and chronic cor pulmonale. However, it contraindicated its use in cases of potassium deficiency. It should be noted that Hyde suggested that hypokalemia can be avoided by the intake of grapes or Taraxacum leaves. Finally, the Commission E monograph listed arrhythmias as a possible side effect of this herb, but the BHP listed cardiac arrhythmias as an indication for the use of Convallaria. According to Hyde. although the action of Convallaria may resemble that of digitalis, there have been no reports of extra systoles or bradycardia when Convallaria is used within the therapeutic dose range. However, he suggested that this herb should be avoided in ventricular tachycardia and noted that an overdose is reputed to cause nausea and vomiting. I have not observed nausea, vomiting, or arrhythmias, when this herb is used within the therapeutic dose range. Interactions Mills and Bonel l listed a number of drugs that interact with cardiac glycosides in general, including ACE inhibitors, antiarrhythmic agents, anthranoid laxatives, antiepileptics, antifungals, antimalarials, barbiturates, betablockers, calcium channel blockers, digoxin, diuretics, muscle relaxants, nonsteroidal anti-inflammatories, steroids, and antiulcer drugs. However, these negative interactions may relate specifically to digoxin. Convallotoxin and the other Convallaria cardenolide cardiac glycosides may not suffer from these same interactions, especially when they are used in the context of the whole plant and not as isolated chemicals. I have not found any adverse drug interaction data for Convallaria as a herb.
Dose Under Schedule Part III of the Supply of Herbal Remedies Order 1977 of the United Kingdom, the maximum permitted dose of Convallaria is:
• dried herb • tincture
150 mg of dried herb, three times per day (daily total of 450 mg) 1.2 ml of 1:8 tincture, three times per day (daily total of 3.6 ml)
,"7.
•
_::_:=:3 _ _._.~::·~1~
the~'~
Initial dose If preferred, this can be as low as 0.1 of maximum dose, rising to the maximum dose, providing the patient does not report any adverse effects.
'7
~
Duration Providing that the patient is regularly monitored for any adverse reactions, this herb can be used for several months.
Cautions Western contraindications Convallaria should be avoided in cases of hypokalemia. 12 Hyde advised against the use of this herb in cases of ventricular tachycardia.
. ...
Chinese contraindications According to the Chinese Herbal Medical Dictionary, ling Ian (the entire plant including Convallaria keiskei aerial parts and roots) is toxic in high doses. However, this text gives the therapeutic dose of ling _,.,. ".~ Ian for decoction as 3-9 g (1-3 qian}.Assuming that this dose,~0~, represents a 2-day supply, this is a daily dose of 1.5-4.5 g, which is 3.3-10 times greater than the maximum dose of Convallaria permitted under Schedule Part III of the United Kingdom. Pregnancy and lactation No side effects are known, apart from those listed in Western contraindications above, but I would avoid this herb during pregnancy and lactation. Side effects The German Commission E monograph listed nausea, vomiting, and cardiac arrhythmias, but according to Hyde, there is no clinical evidence for extrasystoles or bradycardia when Convallaria is used within its therapeutic dose range. Overdose According to Hyde, an overdose can reputedly cause nausea, vomiting, diarrhea, and intestinal colic. Interactions The Commission E contraindicated the use of Convallaria with digitalis glycosides, but no references are given in support of this. This text also suggested that the simultaneous administration of quinidine, calcium, saluretks, laxatives, or the protracted use of glucocorticoids increases the herb's effectiveness and also results in an increase in the number of adverse side effects; again, no references are given to support these statements. SCREENING Before prescribing Convallaria, it should be determined whether the patient: • has ever had adverse reactions to Convallaria • has ever had adverse reactions to a cardioactive glycoside
--
Convallaria • is taking any cardioactive glycosides, such as digoxin • has low potassium levels due to the intake of diuretics • is pregnant TREATMENT PRECAUTIONS
407 The Chinese Herbal Medicine Dictionary listed ling hill
(c. keiskei) as warm, but this herb does not appear to have
been studied extensively in China. C. majalis, as used in the West, is classified in this book as neutr~l in temperature in terms of Chinese medicine since it can be used for warm, neutral, or cool conditions.
The following precautions can be taken during treatTaste
ment: • use Convallaria within the recommended dose range and start at a lower dosage • use Convallaria initially for only short periods or give regular breaks in the herbal treatment • alternate the use of Convallaria in a combination with that of another herb, such as Sarothamnus • never use Convallaria as a single herb, but always combine it with herbs J.&ely to moderate any possible adverse effects, such as Capsicum, Leonurus, or Crataegus MONITORING During the course of herbal treatments that include Convallaria, the patient should be monitored for: • symptoms ofheart rhythm irregularities • symptoms of hypokalemia • nausea
Regulatory status
Taste in the mouth Tabernaemontanus said that the root is slightly astringent and the flowers are bitter in taste. Kloss described Convallaria as sweet and mucilaginous, and the BHP described the dried leaves of C. majalis as sweet at first, becoming bitter. My taste impression of a 1:5 (250/0 alcohol) tincture of C. majalis was that it was sweet and bitter. My taste impression of a sample of fresh ieaf from a growing plant taken in May, before flowering, was that it was bitter, slightly sweet, definitely mucilaginous, and slightly sour and acrid.
Taste ·property .. The Chinese Herbal Medicine Dictionary listed ling Ian (C. keiskei) as bitter and sweet. C. majalis, as used in the West, is classified in this book as bitter and slight1y sweet in terms of Chinese medicine. ORGANS The Chinese Herbal Medicine Dictionary did not list the meridians entered by C. keiskei. In this book, C. majalis, as used in the West, is considered to have its primary action on the Heart, with a secondary action on the Kidney.
Please read the Regulatory status section in the chapter on Safety. Convallaria is included in Schedule Part III of the Supply of Herbal Remedies Order 1977 of the United Kingdom, and it is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Convallaria is not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
Traditional sources PROPERTIES Temperature Lonicerus23 said that Convallaria (Lilium convalium, Meyenblwnen) is cold and damp in the second degree, and could be used for inflammations of the eyes or the liver. Tabernaemontanus, on the other hand, wrote that Convallaria (Lilium convalliwn, Mayblumlein) is warm and dry in nature. Gerard said that Convallaria (Lillium covalliwn, Convalllily, May lily) is hot and dry.
ACTIONS Evidence from traditional sources for the following actions of Convallaria are discussed below: • cardiotonic • cardioregulator • cardiac diuretic • antianginal • nervine and anticonvulsant • alterative Cardiotonic Matthiolus recommended this herb for the heart and brain, and both Culpeper and Gerard said that Convallaria comforts the heart. Tabernaemontanus recommended Convallaria for the heart, brain, reason, and memory to bring back speech and to resuscitate people who have fainted. Ellingwood reported in 1919 that Convallaria increases the power of the heart, slows a rapid and feeble pulse. and corrects the heart rhythm. The BHP listed the specific indication of Convallaria as congestive heart failure with edema.
408
Combining Western Herbs and Chinese Medicine
Cardiac weakness with exhaustion Ellingwood listed Convallaria for 'bicycle heart from overstrain: and for 'asthmatic breathing from enfeebled heart: TierraH noted the use of Convallaria for neurasthenia.
Cardiac weakness with hypotension Felter and Uoyd listed Convallaria for diminished arterial pressure, and Wiess gave a combination, including Convallaria, Gentiana and Nux vomica, for arterial hypotension. A combination that includes Convallaria and Sarothamnus is given above.
Cardiac weakness and depression Culpeper recommended Convallaria to comfort the heart and the vital spirits, and Ellingwood listed it for general depression.
Cardiac weakness subsequent to infection Ellingwood listed Convallaria for cardiac weakness following protracted fever or severe acute inflammation, especially of the respiratory system. Felter and Uoyd suggested that Convallaria's effectiveness at treating the aftereffects of a severe illness was partly due to a tonic effect on the appetite and digestion.
Cardiac weakness with cardiac asthma Ellingwood listed Convallaria for asthma from cardiac weakness, Felter and lloyd for dyspnea of cardiac origin, Lyle for asthmatic breathing from an enfeebled heart, and Priest and Priest for cardiac asthma and dyspnea. The BHP listed Convallaria for cardiac asthma, which, in terms of Chinese medicine, may relate to the Kidney function of receiving Qi from the Lung. Cardioregulator Felter and Lloyd listed this herb for heart irregularities, arrhythmias, and palpitations. Grieve stated that it slows the disturbed action of a weak, irritable heart whilst at the same time increasing its power. Weiss listed it for heart arrhythmias, especially bradycardia. The BHP and Mills 19 also listed Convallaria for arrhythmias. According to Madaus,25 digitalis is better in cases of dropsy and severe cases of heart congestion, but Convallaria is better for nervous heart problems, such as those occurring in menopause, pregnancy, or during excessive physical activity. Cardiac diuretic Tabernaemontanus recommended this herb to increase urination. Felter and Lloyd, writing in 1898, said that the Russians first used Convallaria in the treatment of edema. In 1931, Grieve also reported that Russian peasants used Convallaria for certain forms of cardiac edema. Felter and Lloyd, Lyle, Ellingwood, Grieve, Priest and Priest, and the BHP listed Convallaria as a diuretic for cardiac edema. Madaus stated that, according to FilhoudLavergne, Convallaria increases urination, but that, according to Leclerc, Convallaria is not an important remedy for increasing urinary output, but that it is good for sedating nervous agitation of the heart.
.,\&= ~
AntianginaJ Priest and Priesr6 listed Convallaria for angi-~ ._'" nal syndromes, Weiss gave a combination that includes~ • Convallaria and Crataegus for arteriosclerosis with anginal c' pain, and Tierra listed it for heart pains associated with heart. "::::'~ disease. ""7~~~
0.=
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Nervine and anticonvulsant Grieve quoted Dodoens ';;}~ (1560) in saying that Convallaria strengthens the memory and comforts the heart. Culpeper said that it comforts the - "I heart and the vital spirits, and treats apoplexy, palsy, and lost speech. Kloss, probably following Culpeper's lead, re- . ,••j commended this herb to strengthen the brain and make the thoughts clearer, and to treat dizziness, vertigo, palsy, apoplexy, convulsions, and epilepsy. Ellingwood listed Convallaria for general depression to assist in the rest and sleep, ._ and to induce 'a general sense of improved well-being: Tierra.~":;t~ recommended it for neurasthenia and nervous sensitivity. ~ .. ~.,..., Madaus stated that, according to Paracelsus, Convallaria:~ d can be used for apoplexy and for shaking of the limbs, aD.«:::5.ii' according to von Haller, the blossoms can be used to strength~ en the nerves to treat palpitations, loss of speech, fainting,~, vertigo, apoplexy, and paralysis. ,..:.,';=.
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Alterative According to Ellingwood, Convallaria can be used for rheumatism, especially with heart involvement, so that it can be used for rheumatic carditis or pericarditis. He stated that in these disorders, Convallaria not only strengthens the heart, but also assists in the elimination of toxins that cause the inflammation. This proposed alterative action may enable Convallaria to assist in the recovery from febrile and inflammatory diseases by clearing Retained Pathogen.
COMPARISON OF WESTERN AND CHINESE USE OF CONVALLARIA SPECIES C. majalis is one of the main herbs used in the West for cardiac weakness, cardiac edema, cardiac arrhythmias, and hypotension. It is therefore of considerable clinical importance, whereas C. keiskei is a minor herb in Chinese medicine. According to the main entry in the Chinese Herbal Medicine Dictionary, the actions of ling Ian (C. keiskei) are to: • warm the Yang • move the Blood • promote urination • prevent Interior Wind The uses listed in the Chinese Herbal Medicine Dictionary are a weak heart, tachycardia, edema, and exhaustion. These are the standard uses of C. majalis quoted
"
Convallaria in Western herbal texts. Also listed in the Chinese Herbal Medicine Dictionary are menorrhagia and leukorrhea, which is interesting since older European texts such as Tabemaemontanus note the use of C. majalis for gynecological and obstetric disorders.
References
409
10. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks. United Kingdom (1983) 11. Weiss RF. Herbal Medicine. English edn. Beaconsfield Publishers. Beaconsfield. United Kingdom (1988) 12. Blumenthal M (ed). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin. Texas (1998) 13. Grieve M. A Modern Herbal. vols. 1 and 2. Dover Publications, New York, New York (1971) 14. fiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary
1. Bruneton J. Pharmacognosy: Phytochemistry Medicinal Plants, 2nd edn. Lavoisier, Paris, France (1999) 2. Gerard J. The Herbal or General History of Plants: The complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publications, New York. New York (1975) 3. Matthiolous P. Kreuterbuch. Verlag Konrad Kolbl, Mlinchen. Germany (1626) 4. Tabernaemontanus IT. Krauterbuch (1731). Verlag Konrad Kolbl, Miinchen, Germany (1993) 5. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks. Glenwood, illinois (1990) 6. Felter HW, Lloyd JU. King's American Dispensatory. vols. 1 and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications, Sandy. Oregon (1983)
n.
Physio-Medical Therapeutics, Materia Medica and Pharmacy. 7. Lyle Originally published Ohio (1897). Reprinted by the National Association of Medical Herbalists of Great Britain, London. United Kingdom (1932)
...
(Zhong yao da ci dian) Science and Technology Press, Shanghai, China (1975) 15. Evans WC. Trease and Evans' Pharmacognosy, 14th edn. WB Saunders. London. United Kingdom (1996) 16. Schenk B. Junior p. Wichtl M. Planta Med40(1):1-11 (1980) 17. Sa.xena VK et al. J Nat Prod 55:39 (1992) 18. Mabey R (ed). The Complete New Herbal. Elm Tree Books, London, United Kingdom (1988) 19. Mills S. The Essential Book of Herbal Medicine. Arkana/Penguin Books, London, United Kingdom (1991) 20. Sonnenblick EH. J Gen Physiol50(3):661-676 (1967) 21. Frantsuzova SB, Antonenko 11. Krivelevich VI. Farmakol Toksikol 48(4):87-92 (1985) 22. Hyde F. Herbal Practitioner's Guide to the Medicines Act 1968 New Herbal Practitioner 4(3) (1978) 23. Lonicerus A. Kreuterbuch (1679). Verlag Konrad Kolbl. Munchen, Germany (1962) 24. Tierra M. Planetary Herbology. Lotus Press, Twin Lakes. Wisconsin (1988) .
8. Ellingwood F. American Materia Medica, Therapeutics and Pharmacognosy, 11th edn. (1919). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1994)
.25. Madaus G. Lehrbuch der Biologischen Heilmittel; Nachdruck der Ausgabe Leipzig (1938). Mediamed. Ravensburg, Germany (1987)
9. Kloss J. Back to Eden, 5th edn. (1939). Reprinted by Lifeline Books. Santa Barbara, California (1975)
26. Priest AW, Priest LR. Herbal Medication. L.N. Fowler, Rom£ord, United Kingdom (1982)
~;,-
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Crataegus Botanical name Crataegus monogyna Jacq. or C. laevigata (Poiret) DC (C. oxyacanthoides Thuill. == C. oxycantha auct.) Family Rosacea Pharmaceutical name Crataegi fructus. Crataegi folium, . or Crataegi flos Part dried fruit, leaves, or flowers English hawthorn German Weilldorn French aubepine Mandarin C. monogyna Jacq. and C.laevigata (Poiret) DC are not commonly used shan zha (J.r:t!) is usually the fruit of other Crataegus
attention until the beginning of the 20th century. 6 Felter and Uoyd,7 published in 1898, did not have a separate entry for Crataegus and reported the novel use of this herb for cardiac disease in a footnote. Lyle,S published in 1897, had a brief discussion on the use of Crataegus for heart disease, but this seems to represent early reports from other workers, rather than Lyle's own experience. In 1896, Dr. Jennings of Chicago reported the successful use of Crataegus in various forms of heart disease. Ellingwood,9 published in 1919, had a large section discussing the reports of Jennings and other doctors on the effectiveness of hawthorn for cardiac disorders. In the latter half of the 20th century, research evidence had accumulated on the effectiveness of Crataegus and its
species: see below
active constituents in the treatment of cardiac disorders.
Use in the West Hawthorn is a thorny deciduous shrub or small tree with white flowers followed by dark red berries. It is common in most temperate regions of the Northern hemi-
Crataegus may now be the most widely used herb for ischemic heart disease in the West.
sphere. Nowadays, the main use of Crataegus in the West is for cardiovascular disorders, but this was not always the case. Dioscorides l used hawthorn berries to reduce diarrhea or heavy menStrual flow, Lonicerus2 used the flowers for diarrhea, and Tabernaemontanus3 used hawthorn for kidney stones. Gerard4 and Culpepe~ did not list Crataegus for heart problems. and their entries on this herb were brief. Culpeper used it for kidney stones and dropsy, and Gerard recommended it for diarrhea and menorrhagia. The medical use of hawthorn declined during the 18th and 19th centUries, and did not regain widespread medical
tion. For example, the berries were used more in Britain10 and
Part used The part used varies with the country and tradithe flowers, or the flowers and leaves, were used more in Germany.1l·12 Western research has tended to focus on Crataegus leaves and flowers, whilst Chinese research has tended to focus on the berries. 13 Use in China have been: 13
The main species used in China as shan zM
• Crataegus pinnatifida Bge. var. major N.E. Br. • Crataegus cuneata Sieb. et Zucco The main traditional indication was indigestion associated
411
,-.~: _.~
.~~t._
Combining Western Herbs and Chinese Medicine
412
with Food Stagnation from eating too much meat. However, especially following Western usage and subsequent Chinese research, Crataegus species have been increasingly used in the treatment of heart disease in China since the 1950s.1 4
Preparation and parts used The fruit of the Crataegus species employed in China can be ripe, unripe, or charred, depending on the patient's problem: 15 • ripe fruit (shan zha rau) • unripe fruit (shan zha) • charred fruit (shan zha rem)
abdominal distension and pain diarrhea abnormal bleeding and dysentery
What is special about Crataegus In terms of Chinese medicine, the species of Crataegus used in the West can be said to be slightly warm, sour, and sweet, and to have their main effect on the Heart.
The key to understanding Crataegus is that in addition to moving Stagnant Heart Blood, clearing Heart Phlegm, and tonifying Deficient Heart Qi, it can also stabilize and calm the Heart system.
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Chinese medicine with Stagnant Heart Blood. This pattemJ~""'~ may be linked with Heart Phlegm so that the antianginal antiatheromatic actions o v e r l a p , ' .--~ .
and'-::; ~ ..,.~~.
Antiatheromatic Crataegus can be used as an antiathero;~;; ~. . . . .,./.~, matlc to treat atherosclerosls of the coronary or perIpheral. :~Tr arteries, which in Chinese medicine terminology can be . :d1·~ associated with Heart Phlegm. This pattern may be linked with Disturbance of Heart Spirit or Liver Hyperactive Yang ..... so that the antiatheromatic and antihypertensive actions
'ft;; .;.
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overlap.
'C.
Cardioregulator Cardioregulators are herbs that normal-"'~-::""" ize heart function, helping to bring either hyper- or hypofunction back to normal. The cardioregulatory action of Crataegus presents a potentially large range of application·.~,;S~'~ ...... ~~.~-~
-~;.~
Cardiotonic The cardioregulatory action of Crataegus~?- ~'] overlaps with its cardiotonic action. Thus, this herb is applic-:.~ able in many situations' of mixed Deficiency and Distui.:!~P:::· bance of the Heart system. These may present with a mixture -~':~" of physical, emotional, and behavioral problems._'~\~1!'. '.
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WESTERN USES The Western uses of Crataegus can be related to its four main Chinese actions:
CHINESE ACTIONS Chinese actions
In terms of Chinese medicine, Crataegus, as used in the West, can be said to have four main types of action: I. II. III. IV.
move Heart Blood clear Heart Phlegm stabilize Heart Qi tonify Heart Qi
I. move Heart Blood
chest pain due to heart disease
II. clear Heart Phlegm
hypertension with atherosclerosis
III. stabilize Heart Qi
energy fluctuations, temperature fluctuations, labile blood pressure, cardiac arrhythmias, palpitations. insomnia. emotional lability, hyperactivity, attention deficit, bipolar disorders
IV. tonity Heart Qi
exhaustion
WESTERN ACTIONS The main Western actions of Crataegus are shown here in terms of its four main Chinese actions:
.- ~
NEW CONCEPTS IN THE USE OF CRATAEGUS
I. move Heart Blood
antianginal
II. clear Heart Phlegm
antiatheromatic
III. stabilize Heart Qi
IV. tonity Heart Qi
. cardioregulator antihypertensive cardioregulator tranquilizer cardiotonic
Antianginal Crataegus can be used as an antianginal to treat ~hest pain due to heart disease, which is associated in
Crataegus and the heart Past usage of Crataegus in the West has been in relation to the Western concept of the heart. As a result, this herb has been used mainly for physical symptoms associated with heart disease. The Chinese concepts ::~):'>~ of Heart Qi and Heart Spirit can be used to extend the use of)?';':" Crataegus to the treatment of disorders involving not onlY.;~~ , the physical component, but also emotional and behavioral -:~~~, ':. .-.' ' components. ' . ,t,·? In terms of Chinese medicine, the Western species of!;;" Crataegus can be said to strengthen the Heart and to help :f\~< ~.
Crataegus normalize the Y'm-Yang balance of the Heart function, reducing fluctuations between Heart Deficient Y'm and Heart Deficient Yang. This can stabilize the movements of both the Heart Qi and Heart Spirit. Taste properties of Crataegus The taste properties of Crataegus may be integral to its effect in stabilizing Heart Qi and Spirit.
_--
.. .
~~.
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Sour property
Some herbs with a sour property can be used to firm the Qi and Spirit of the Heart. The gathering or astringent action of such herbs can reduce the dispersing, scattering, and destabilizing effects of physical or emotional stresses, especially the effects of anxiety or fear. Herbs with this type of sour property may include Crataegus, Hypericum, Leonurus. and Schisandra. These herbs may be used to treat both disorders of physical origin, such as some instances of cardiac arrhythmias and fluctuations in energy or blood pressure, and disorders of psychological origin, such as insomnia, night terrors, enuresis, anxiety, and palpitations.
Sweet property
In Chinese medicine, the Heart Spirit is regarded as. the lightest and most active energy in the body, and therefore, it is the one most prone to disturbed and excessive movement. The sweet property can help to stabilize the Heart partly by its nourishing effect, and partly by weighing down ind grounding the Heart Spirit due to its qualities of heaviness and material solidity. This effect may contribute to the capacity of Crataegus to treat Irregularity of Heart Qi as in arrhythmias linked to physical causes, and also to treat Heart Spirit Disturbance as in palpitations of emotional origin.
An expanded use for Crataegus . Hawthorn can have very wide application because of the increasing need of people in modern society-whether it be children, teenagers, adults, or the elderly-for herbs with stabilizing action. By reducing the fluctuations in both the physical manifestations of Heart Qi and the psychological manifestations of Heart Spirit, Crataegus can help to treat fluctuations in heart function, energy, temperature, or mood. ' Crataegus for all ages Providing that the disorder is linked to Deficiency, Stagnation, or instability of Heart Qi, Crataegus can be used for: • children with debility and hyperactivity • teenagers with attention deficit disorder or bipolar diSorders . "
• chronic fatigue syndrome patients with fluctuations in energy from low to normal (or occasionally high) • menopausal patients with fluctuations in body temperature and emotional lability
413
• adults with heart pain, labile blood pressure, cardiac arrhythmias, palpitations, or insomnia • elderly patients with degenerative heart conditions
DIRECTION OF ENERGY Crataegus can have three main effects on the direction of energy: • opening and moving effect within the coronary circulation • stabilizing and grounding effect on Heart Qi and Spirit, associated with its sweet property • firming effect on Heart Qi and Spirit, associated with its sour property The combination of these three effects tends to regulate and normalize the movements of Heart Qi and Spirit to prevent either Stagnation or Irregularity.
TYPICAL CASE EXAMPLE Signs and symptoms The patient is weak, with frequent fluctuations in energy, palpitations that are worse when tired, cold hands and feet, and occasional pain in the heart area. There are also fluctuations in mood from normal to sad, depressed, or apathetic, which are usually associated with the fluctuations in the energy. The pulse is empty, slightly slippery and slightly wiry, especially at the Heart position. The tongue is pale, flabby, and slightly trembling, with some greasy white coat. Diagnosis The patient has Deficiency and instability of Heart Qi and Spirit, resulting in the tiredness, palpitations, and fluctuations of energy and mood. Some Stagnation of Heart Qi and Blood, and maybe Heart Phlegm, may contnbute to the pain in the heart area and to the poor peripheral circulation. Choice of Crataegus Crataegus can be selected primarily to tonify and stabilize Heart Qi and Spirit, and secondarily to move Heart Qi and Blood, and to clear Heart Phlegm.
Limitations ofCrataegus TEMPERATURE Although Crataegus is listed as slightly warm, it can be used for hot, warm, neutral, cool, or cold patterns when it is combined with an appropriate herb to adjust the temperature balance of the combination.
--
,\;-'!';
414
Combining Western Herbs and Chinese Medicine
TASTE Sour taste property Crataegus is sour in the sense that it can fIrm Heart Qi. It is not generally used to fIrm the Qi of the Lungs or Kidney, like Schisandra. Although Gerard quoted Dioscorides as using Crataegus berries for hemorrhages, this herb is not used much today for this purpose. However, in China, partially charred Crataegus fruit is used for hemorrhage and dysentery. Sweet taste property In terms of the 'Elements within Elements' concept of the Five Element hypothesis, Crataegus is sweet in the sense that it can tonify the Earth Element within the Fire Element, the Heart, to stabilize and normalize Heart Qi and Spirit. It is not so much a sweet tonic for the Spleen or for organ systems other than the Heart.
Crataegus paired with other herbs . Discussion of the limitations of each of the main actions of Crataegus can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Crataegus beyond its limitations. The basic unit of herb combination is the herb pair. Twelve pairings of Crataegus with other herbs are
Antianginal Crataegus can reduce chest pain due to heart disease over a period of time. It is not an instantaneous pain reliever.
CAUTION
Cardioregulator Crataegus can regulate and stabilize Heart Qi and normalize heart function, giving this herb a wide range of potential applications. Tranquilizer Crataegus may have constituents that are reported to have mild calming properties. However, rather than having a direct tranquilizing action, Crataegus' main calming effect appears to be indirect, resulting from the fIrming effect of its sour taste property and the stabilizing effect of its sweet taste property. Crataegus stabilizes Heart Qi more than it directly calms Heart Spirit. ' Antidepressant Crataegus does not appear to have a direct antidepressant effect. Rather, by stabilizing Heart Qi and normalizing the function of the Heart system, Crataegus can assist in the treatment of swings between overexcitement and depression. Unlike Rosmarinus, which moves Heart Qi to relieve depression, the action of Crataegus to move Heart
c-:.~~
Cardiotonic Crataegus is a tonic for the Heart, rather than.~·t:;:'~ a tonic for any other organ. Also, Crataegus tonilles Heart~~~::: Qi, rather than Heart Blood, Yin, or Yang. If Heart Blood, o:~~ ,,' Yin, or Yang require tonifIcation, other herbs can be used ..X.:~ instead of Crataegus or they can be added to it.
briefly explained below.
Antihypertensive Relieving hypertension is a by-product of Crataegus' affect on heart function and atheromatous plaque formation. Crataegus does not so much calm Liver Hyperactive Yang directly and relieve hypertension, like Valeriana.
.
Ql and Blood appears to be more on the physlcallevekthat ~,~ :::: is, it relieves heart pain. . ,- ' .":"7:
ACTIONS
Antiatheromatic Crataegus can be used to reduce cholesterol and triglyceride levels, and to reduce or pre~ent formation of atheromatous plaques in the arteries to help in the treatment of heart and circulatory disease; see the Research section. Studies are needed to determine the strength, scope, and limitations of this action.
.
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Patients with suspected heart disorders require conven- " tional diagnosis. Crataegus can be used with other herbs as an adjunct to conventional Western treatment, if appropriate, but herbal therapy is not meant as a substitute for conventional diagnosis and treatment. Also, practitioners should be aware of potential herb-drug interactions. Before using any ofthe combinations below, it is important..:... 5""""" to be familiar with the cautions listed for each herb in the combination. . Crataegus + Convallaria
Angina pectoris Convallaria complements the action of Crataegus to '" move Heart Qi and Blood in treating chest pain resulting from heart disease and to stabilize heart function. Convallaria, and to a lesser extent Crataegus, may also assist in the treatment of cardiac edema. Crataegus + Achillea
Atherosclerosis The antiatheromatic action of Crataegus and the anticatarrhal action of Achillea may combine to clear Phlegm from the vessels to treat atherosclerotic conditions. Crataegus + Tilia
Hypertension Crataegus and Tilia may be combined to treat atherosclerosis, and Tilia may help to control the Liver Hyperactive Yang associated with hypertension.
Crataegus
415
Crataegus + Passiflora
Crataegus + Zanthoxylum
Palpitations
Exhaustion + poor peripheral circulation
The tranquilizing action of Passillora may add to the cardioregulatory action of Crataegus to calm and stabilize Heart Qi and Spirit, helping in the treatment of palpitations. Crataegus + Leonurus
Labile blood pressure Crataegus and Leonurus work together to regulate and tonify Heart Qi, thus stabilizing blood pressure fluctuations. Leonurus also has a calming action on the Heart Spirit. Crataegus + Avena
Bipolar disorders By tonifying the Qi of both the Spleen and Kidney, Avena can help Crataegus to tonify Heart Qi and thus stabilize the Yin-Yang b;tiance of the Heart. This effect can be employed in the treatment of einotionallability, bipolar disorders, and menopausal mood swings. Crataegus + Hypericum
Crataegus can strengthen the heart to treat exhaustion and improve coronary circulation by its antiatheromatic action. These effects are complemented by the warming circulatory stimulant action of Zanthoxylum on the peripheral circulation. Crataegus + Capsicum
Exhaustion + depression This pair can treat exhaustion and depression with sensations of cold associated with DefIciency of Heart Qi and Yang.
Crataegus combinations Six Crataegus combinations are discussed below:
Combi~~tion
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._~
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_.~_.,-,
• .'>
-
Chine~;syn~romes
Menopausal disorders Crataegus and Hypericum both have the sweet taste property to stabilize Heart Qi anc,t the sour property to fIrm Heart Qi. They can be combined in the treatment of depression with anxiety, menopausal mood swings with depression, and panic attacks and night terrors.
1. angina pectoris
Stagnant Heart Blood
2. atherosclerosis + hypertension
Heart Phlegm Heat + Heart Stagnant Qi
3. cardiac arrhythmia + exhaustion
Heart Qi Irregularity + Heart Deficient Blood
4. bipolar disorders
and Yang
Exhaustion + hypotension These herbs can be paired in the treatment of hypotension since Sarothamnus increases blood pressure, whilst Crataegus by itself tends to normalize it. Crataegus can mod- . erate the potentially hypertensive action of Sarothamnus, and Sarothamnus can help in the treatment of cardiac edema.
Heart Spirit Disturbance
+ Heart Deficient Yin
Crataegus + Sarothamnus 5. cardiac arrhythmia + hypotension
Heart Qi Irregularity + Kidney Deficient Qi
6. cardiac weakness + depression
Heart Deficient Yang + Kidney Deficient Yang
CAUTION Crataegus + Cinchona
Postfebrile debility Cinchona can assist Crataegus in tonifying Heart Qi. It can also clear Retained Pathogen and tonify the Spleen, thus, helping in postfebrile recovery. Crataegus + Salvia officinaIis Chronic fatigue syndrome or fibromyalgia ,~
-=J. ~
Patients with suspected heart disorders require conventional diagnosis. Crataegus can be used with other herbs as an adjunct to conventional Western treatment, if appropriate, but herbal therapy is not meant as a substitute for conventional diagnosis and treatment. Also, practitioners should be aware of potential herb-drug interactions. Before using any ofthe combinations below, it is important to be familiar with the cautions listedfor each herb in the com-
Crataegus can stabilize Heart Qi to treat exhaustion and reduce fluctuations in energy and mood. Salvia can stabilize body temperature and perspiration. and reduce restlessness and chronic low-grade feverishness from Heart DefIcient
bination.
rm.
Heart Stagnant Blood
I. Angina pectoris
Combining Western Herbs and Chinese Medicine
416
GENERAL
.....
7:
"::;'='t~
... This combination is for Heart Phlegm Heat and Heart "';j.:" Stagnant Qi. The overall temperature of the co'mbination is_~' cool to treat hot and warm conditions. The bitter constit-~ ~ uents can clear Heat. and the acrid and aromatic constit-;~-: -.",...~~
Crataegus Convallaria Leonurus -Salvia mil. Angelica sin. Lobelia Cinnamomum (twigs)
1 1 1 1 1 0.5 0.5
51. warm neutral neutral cool warm warm-cool warm
sour, sweet bitter. 51. sweet sour. 51. bitter bitter sweet, aromatic, bitter acrid acrid. sweet, aromatic
uents can clear P h l e g m . . .
-1--;:-
USE GENERAL
This combination is for chest pain from heart disease associated with Heart Stagnant Blood and some Heart Deficient Blood. The combination is more or less neutral and would need to be modified for hot or cold patterns. It is an interesting mix of bitter. sour. sweet. and acrid constituents. The acrid constituents may contribute warming, opening. moving. and relaxing effects upon the heart muscle and circulation. The bitter constituents may tonify the Heart and have ~ anaig~sic effect. The sweet constituents can tonify Heart Blood. and the sour property may help to firm Heart Qi and stabilize the heart function.
• tendency to atherosclerosis with sensations of Heat. including heart disease. hypertension. or cerebrovascular accident PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in, quarter of a cup of water. three times per day. The combina-.. tion can be taken. with appropriate breaks and modifica- ':~ tions. for several months. Herbal therapy can be used con~.,-,4;r~: currently with conventional medical treatment as well as'''' with appropriate nutritional. exercise, and stress management regimes.
USE
• chest pain as a result of a heart disease
Heart Qi Irregularity + Heart Deficient Blood
PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of warm water. three times per day. Depending on screening and monitoring procedures for Convallaria and Lobelia, the combination can be taken, with appropriate breaks and modifications. for several months. Herbal therapy can be used concurrently with conventional medical treatment as well as with appropriate nutritional. exercise. and stress management regimes. To gauge the effectiveness of the combination, a criteria of improvement can be set for the patient. such as the frequency and severity of pain. or the amount of standardized exercise done before the patient becomes short ofbreath.
2. Atherosclerosis + hypertension
Heart Phlegm Heat + Heart Stagnant Qi
Crataegus Achillea Angelica sin. Salvia mil. Curcuma (rhizome) Rheum
1 1 1 1
51. warm warm-cool warm cool cool
sour, sweet acrid, bitter sweet, aromatic, bitter bitter acrid, bitter
0.5-1
cool-cold
bitter, sour
1
3. Cardiac arrhythmia + exhaustion
Crataegus Convallaria Leonurus Passiflora Salvia off. Salvia mil. Angelica sin. Zingiber
1 1 1 1 1 1 1 0.5
51. wprm neutral neutral neutral warm-cool cool warm hot
sour, sweet bitter. 51. sweet sour. 51. bitter 51. bitter aromatic, acrid bitter sweet, aromatic. bitter acrid. aromatic
GENERAL
This combination is for Heart Qi Irregularity with Deficiency of Heart Blood, and there may be some Heart Spirit Disturbance. The overall temperature is more or less neutral to treat warm. neutral. or cool conditions. The different bitter constituents can have cardiotonic, cardioregulatory, and mildly calming action. The sour constituents can. firm Heart Qi and have a stabilizing effect on heart function. The sweet constituents can tonify Heart Blood and Qi and have a calming and grounding effect. USE
• heart rhythm irregularities or palpitations. especially associated with tiredness and/or nervous tension
{~
Crataegus
I
PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of warm water, three times per day. Depend-
ing on screening and monitoring procedures for Convallaria, the combination can be taken, with appropriate breaks and modifications, for several months.
417
For phases in which depression is dominant, Rosmarinus can be added to the combination or given separately. However, reduce its dose or remove it if its addition leads to an increase in excitement or an aggravation of the insonmia. For phases in which overexcitement or anxiety is dominant, Anemone can be added to the combination or given separately. However, reduce its dose or remove it if its addition is associated with increased depression.
4. Bipolar disorders
Heart Spirit Disturbance + Heart Deficient Yin and Yang
5. Cardiac arrhythmia + hypotension
Heart Qi Irregularity + Kidney Deficient Qi Herb
Ratio
Temperature
Taste
51. warm
sour, sweet
neutral
sweet
neutral
sour, 51. bitter
Crataegus Convallaria
Serenoa
1 1 1 1 1 1
Glycyrrhiza
0.5
Herb Crataegus Avena Leonurus Lavandula Hypericum
51. warm
aromatic, bitter, 51. acrid
Sarothamnus
neutral
~our.
Leonurus
neutral
sweet, 51. sour
Panaxgin.
neutral-cool
sweet
SChisandra Glycyrrhiza
51. sweet
GENERAL
This combination is for Heart Spirit Disturbance with oscillations between Heart DeficientY'm and Heart Deficient Yang. There may also be Deficient Y'm and Yang of the Kidney. The combination is neither strongly sedative nor strongly stimulant. Its goal is to nourish and stabilize Heart Qi, Y'm, and Yang, to stabilize the Yin-Yang balance of the Heart, and to reduce the oscillations between Heart Deficient Y'm and Heart Deficient Yang. The overall temperature is more or less neutral, and the dominant taste properties are sweet, to nourish and stabilize Heart Spirit, and sour, to firm Heart Spirit. The aromatic property of Lavandula helps to treat depression linked to Stagnation of Heart Qi and helps to prevent Stagnation of Qi arising from the sweet tonics Avena, Serenoa, and Glycyrrhiza. USE
• bipolar disorders • emotional lability with exhaustion, as in some types of chronic fatigue syndrome • oscillations between depression and overexcitement, exhilaration, or anxiety, as in menopausal mood swings
Zingiber
Ratio 1 1 1 1 1 1
0.5 0.5
Temperature
Taste
sl. warm
sour, sweet
neutral
bitter, sl. sweet
neutral
bitter
neutral
sour, sl. bitter
sl. warm
sweet, 51. bitter
warm
sour
neutral-cool
sweet
hot
acrid, aromatic
GENERAL
This combination is for Heart Qi Irregularity with Deficient Qi of the Heart and Kidney. This is a slightly warm combination suitable for a neutral-cool condition, and if there are signs of heat or cold arising from Deficiency, then the combination would need to be modified. However, for severe signs of cold associated with Heart Deficient Yang, Crataegus: cardiac weakness + depression would be more appropriate. Sour, sweet, and bitter tastes each contribute to the cardiotonic action of this combination. USE
• cardiac arrhythmia with exhaustion and hypotension • hypotension with exhaustion and depression PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in . quarter of a cup of warm water, three times per day. Depend-
ing on screening and monitoring procedures for Convallaria and Sarothamnus, the combination can be taken, with appropriate breaks and modifications, for several months.
PRACTICAL NOTES
Caution The presence of Sarothamnus, Panax ginseng, and Glycyrrhiza makes this combination contraindicated for
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of warm water, three times per day. The combination can be taken, with appropriate breaks and modifications, for several months.
patients with either hypertension or labile blood pressure with periodic hypertension. In particular, patients should be monitored for an increase in blood pressure and for any heart rhythm irregularities.
-
..
•~~~ :~;",~.~
Combining Western Herbs and Chinese Medicine
418 6. Cardiac weakness + depression
COMPARISON OF THE SIX
Heart Deficient Yang + Kidney Deficient Yang
CRATAEGUS COMBINATIONS
.....
.
.....~~;.~~
._..
-
.....
-~~~
"7
.-.•"Y,...-'?i!tC ...
,o_-:.._~_~
Crataegus Convallaria Panax gin. Turnera Cinnamomum (bark) Glycyrrhiza Capsicum
1 1 1 1 1
sl. warm neutral sl. warm warm hot
0.5 drops
neutral-cool hot
5-20
sour, sweet bitter, sl. sweet sweet, sl. bitter bitter, aromatic, acrid acrid, sweet, aromatic sweet acrid
GENERAL
This combination is for Deficient Yang of the Heart and Kidney, and maybe also for Deficient Yang of the Spleen and Lung. It is a warm-hot combination, depending on the number of drops of Capsicum added. The 'acrid constituents warm and move the Qi and Blood, and the sweet, sour, and bitter constituents have cardiotonic effects. USE
• exhaustion with cold body, depression, edema, and maybe chest pain due to heart disease PRACTICAL NOTES
The herbs other than Capsicum are conveniently taken as 5 ml of a 1:5 tincture in quarter of a glass of warm water, three times per day. Drops of 1:5 Capsicum tincture can be added from a separate bottle, or 0.25-1 teaspoon of powdered Capsicum can be'mixed in with the contents of the glass instead.
Initial dose of Capsicum The patient can start with 5 drops of Capsicum per individual dose of the main tincture and work up to 20 drops, depending on the individual's tolerance of Capsicum and absence of adverse effects.
1. Angina pectoris
2. Atherosclerosis + hypertension
Heart Stagnant Blood
Heart Phlegm Heat + Heart Stagnant Qi ~: ,¥:,'~~""
Ratio
Herb Crataegus Convallaria Leonurus Salvia mil. Angelica sin.
1 1 1 1 1
~~~~~i~omum (twigs) ~:~
···'A:~·:
Herb Crataegus Achillea Angelica sin. Salvia mil. Curcuma
1 1 1 1 1
Rheum
0.5-1;~f%tl~
-...
1. Crataegus, Convallaria and Leonurus move Heart Qi
,';~.r;
and Blood to relieve pain, and tonify and stabilize HearfQi ~,:.:;~~. to relieve heart arrhythmias and palpitations. Salvia miltior- " . rhiza root combines with Crataegus to clear Heart Phlegm,,~.~~;; thus treating atherosclerosis, and combines with Angelica to. :;';f\~;, tonify Heart Blood. Lobeli~ and Cinnamomum twigs com-I~ bine to relax spasms of the cardiac muscle and relieve pain.c...,!Z: 2. Both combinations No.1 and 2 include the pair Crataegus and Salvia miltiorrhiza.In combination No.1, the primary role of this pair is to move Heart Blood and relieve pain, and the secondary role is to clear Heart Phlegm and reduce atherosclerosis. In combination No.2, the primary role of Crataegus and Salvia, assisted by Achillea, is to clear Heart Phlegm. Curcuma and Salvia combine to clear Heart Phlegm Heat, and Rheum is a cooling herb that has been found in research studies to reduce both cholesterol levels and hypertension. 3. Cardiac arrhythmia + exhaustion
4. Bipolar disorders
Heart Qi Irregularity + Heart Deficient Blood
Heart Spirit Disturbance + Heart Deficient Yin and Yang
Crataegus Convallaria Leonurus Passiflora Salvia off. Salvia mil. Angelica sin. Zingiber
Crataegus Avena Leonurus Lavandula Hypericum Serenoa Glycyrrhiza
Duration of the prescription This combination can be taken, with appropriate breaks and modifications, for one to several months depending on screening and monitoring proce-
dures for Convallaria. Capsicum can be steadily increased up to the maximum dose as appropriate for the patient. As soon as the symptoms show a consistent improvement, the dose of Capsicum be slowly reduced until the patient finds the
can
minimum dose of Capsicum that will maintain the improvement.When agitation, facial redness, and severe sensations of heat are much reduced or absent, it may be appropriate to use a different combination.
1 1 1 1 1 1 1 0.5
1 1 1 1 1 1
0.5
3. Combination No.3 treats arrhythmia and exhaustion by combining the following actions:
Crataegus • general Blood tonic: Angelica, Salvia officinalis, and
heart function and treat any cardiac edema. Panax, Turnera,
Salvia miltiorrhiza • cardiotonic and cardioregulator: Crataegus, Convallaria,
and Glycyrrhiza tonify the Kidney in order to tonify the Heart, and Cinnamomum twigs and Capsicum can warm and move Heart Qi and Blood to relieve Heart pain.
and Leonurus • tranquilizer: Passiflora and Leonurus 4. The herbs in combination No.4 nourish and stabilize Heart function. Crataegus and Leonurus work together to stabilize Heart function. thus, reducing the manifestation of extremes; Leonurus and Lavandula calm Heart Spirit; Avena and Hypericum treat both anxiety and depression by stabilizing the Heart; and Avena, Serenoa, and Glycyrrhiza stabilize the Heart by torrifying Kidney and Spleen Qi. In combination No.3. Passiflora is included to calm anxiety. but it does not treat depression. Therefore, in combination No.4, Passiflora is replaced by Lavandula. which although it has a calming action, can also be used to treat depression.
..
419
5. Cardiac arrhythmia + hypotension
6. Cardiac weakness + depression
Heart Qi Irregularity + Kidney Deficient Qi
Heart Deficient Yang + Kidney Deficient Yang
Convallaria Sarothamnus Leonurus Panax gin. Schisandra Glycyrrhiza Zingiber
The following additional combinations further illustrate the range of uses for Crataegus:
• Achillea: Atherosclerosis + hypertension + cold extremities • Capsicum: depression + bronchitis • Cinchona: recurringfever + night sweats • Convallaria: angina pectoris + cold sensations • Convallaria: cardiac weakness + cardiac edema • Lavandula: palpitations + anxiety • Myrica: chronicfatigue syndrome + cold extremities • Salvia: excessive sweating + exhaustion • Thuja: chronic bronchitis + cardiac weakness
Research CONSTITUENTS
Herb Crataegus
OTHER CRATAEGUS COMBINATIONS
Turnera Cinnamomum (bark)
1 1 1 1 1
Glycyrrhiza
0.5
Capsicum
5-20 drops
1 1 1 1 1 1
Crataegus Convallaria
0.5 0.5
Panax gin.
5. In contrast to combination No.3, combination No.5 is not so much concerned with calming, but with strengthening heart function. It does not contain calming herbs, such as Passiflora (combination No.3) or Lavandula (combina-
,. oligomeric procyanidins • flavonoids • amines • other Oligomeric procyanidins Tannins are polyphenols that can be divided into two main groups: the 'hydrolyzable tannins' and the 'condensed tannins' which Me less easily hydrolyzed. Procyanidins are a group of condensed tannins that are related to the flavonoids. Oligomeric procyanidins (OPCs), also called leucoanthocyanidins or pycnogenols, are polymers of the monomers catechin and epicatechin.
tion No.4). Instead. it contains herbs that tonify Heart Qi and treat hypotension, such as Sarothamnus and Panax gin-
Crataegus contains 1-3% 0 PCs, of which the structure is only partly determined. The number and types of OPCs are
seng.
relatively similar for all five species of Crataegus that are recognized in Germany.16 The main OPCs are procyanidin B-2
6. Combination No.5 is a slightly warm combination to treat Deficient Qi, whilst combination No.6 is both more of a stimulant and more warming to treat Deficient Yang. This combination would be completely inappropriate for depression alternating with excitement or depression coexisting with anxiety. Crataegus does not in itself tonify Heart Yang, but it can be used to treat cardiovasc~ weakness with sensations of cold when it is paired with Panax ginseng or with Caps~cum. Panax ginseng and Turnera are paired to treat depression associated with Deficiency. Convallaria can strengthen the
(a dimer of epicatechin), and procyanidin C-1 (a trimer of epicatechin). Substantial quantities of epicatechin are also found. 17 OPCs may have some degree of astringency. However, since protein binding increases with the degree of polymerization, the astringency of dimers may be relatively low. Flavonoids The composition of the 1-2% flavonoids differs with each Crataegus species and also varies between the leaves and flowers. II According to Bruneton, the main flavonoid in the leaves is hyperin (the 3-galaetoside of quercetin),
420
Combining Western Herbs and Chinese Medicine
whilst 2-0-rharnnosylvitexin (a flavone-C-glycoside) is the main flavonoid in the flowers. Amines
Some of the amines have cardiotonic action. 19
Other Crataegus also contains catechols, phenolcarboxylic acids (especially chlorogenic acid), triterpene acids, purines, and sterols. 20
-
• increase revascularization of the finer vessels in rats_with~ , 31 myocardial infarction "'~:;;;=
.-
~:~ . ~~~~
A study with over 1000 patients with cardiac insufficiency NYHA stage II, treated with Crataegus extract showed~T:;:=-. improvement in fatigue and exercise dyspnea and an in--..': creased tolerance of exercise. 32 Another study showed an . ..:.;:~ increase in the patients' work capacity and a reduction in ~._/:~_. '-. :'. '1
PHARMACOLOGICAL AND CLINICAL RESEARCH The following effects have been reported: • antianginal • antilipidemic and antiatheromatic • cardioprotective • cardiotonic and cardioregulator • antiarrhythmic, tranquilizer, and antihypertensive • diuretic • anti-inflammatory • antioxidant • antitumor Antianginal Crataegus monogyna has been reported to have antianginal action. 21 In one Chinese study, an alcoholic extract of Crataegus was reported to reduce the chest discomfort of angina pectoris. 22 Antilipidemic and antiatheromatic In a Chinese study, in which rabbits were given a Crataegus extract, both triglyceride and cholesterol levels were reduced, and the dimensions of atheromatous plaques were reduced. n An Indian study with rats fed an atherogenic-inducing diet reported that Crataegus tincture prevented cholesterol accumulation in the liver by enhancing in situ cholesterol degradation to bile acids and by suppressing in situ cholesterol synthesis. 24 Cardioprotective Pretreatment of rats with Crataegus powder produced a reduced lactate dehydrogenase release in isolated rat hearts, suggesting preservation of the myocardial cell membrane and protection from myocardial damage. 25 Cardioprotective effects were reported in rat studies using an extract free from flavonoids but rich in OPCS. 26 Cardiotonic and cardioregulator Animal studies have shown that Crataegus preparations can: • increase the force of heart contraction27 • increase coronary blood flowU • increase myocardial tolerance to oxygen deficiency and decrease peripheral vascular resistance29 • increase peripheral blood flow to skeletal muscles30
~
blood pressure.33 A recent randomized, placebo-controlled,' "'1',",,;" double-blind clinical study used a Crataegus extract stan· ". dardized to 18.750/0 OPCs with outpatients suffering from/~~ _ congestive heart failure NYHA stage II. The effect of the' "_;I~ herbal extract on exercise tolerance was determined using a bicycle exercise routine. The data showed that the Crataegus extract was safe, well tolerated, and clinically effective in these patients.34
Main active constituents The OPCs and the flavonoids are .,., the constituents considered mainly responsible for the car~ c-~~~] diotonic and cardioregulatory effects, but other substances, . :;=:~-,-,,: such as the amines, are also thought to be involved. 12 As is '04 the case for most herbs, the actions of Crataegus appear to depend on the combined effects of several different con'; stituents. 12 Antiarrhythmic, tranquilizer, and antihypertensive Pretreatment with Crataegus extract helped in the prevention of perfusion arrhythmias in rat hearts. 35 Crataegus preparations showed some sedative effects in mice. 36• 37 In a recent study, an infusion of a 70% methanol extract of the flowering tops of Crataegus meyeri was reported to reduce the severity of arrhythmias induced by a period of myocardial ischemia in open-chest anaesthetized male Wistar rats. 38 Similar results have been found in humans. Crataegus extract has been shown to reduce heart arrhythmias and palpitations, and to reduce blood pressure in patients with cardiac insufficiency.31.39 Diuretic Ankle edema and nocturia were reduced in patients with cardiac insufficiency.32 Anti-inflammatory A triterpene fraction from a hexane extract of Crataegus, containing cycloartenol as the main component, showed anti-inflammatory effect in different models in rats and mice. 20 Whether the level of cycloartenol in Crataegus alcohol and water tinctures or in decoctions, is sufficient to have an anti-inflammatory effect is not known. , Antioxidant Animal experiments with Crataegus extracts have shown an antioxidant effect,40 and the OPCs appear to ' be the most active antioxidant constituents.41 Antitumor Crataegus extract demonstrated cytotoxic activity against cultured larynx cancer cells.42
Crataegus RESEARCH VERIFICATION OF TRADITIONAL ACTIONS All the traditional actions of Crataegus have been supported by research on Crataegus extracts or isolated constituents: antianginal, antiatheromatic and antilipidemic. cardiotonic, cardioregulator, antiarrhythmic, tranquilizer, antihypertensive, and diuretic. Additional effects demonstrated by research The following additional effects have been reported as discussed above: cardioprotective, anti-inflammatory, antioxidant, and antitumor effects have been demonstrated in vitro, in vivo, or in clinical studies. TOXICOLOGY
421
Tincture The BHP listed 1-2 rnl of 1:5 tincture of Crataegus fruit in 45% alcohol, three times per day (daily dose 00-6 mi). Mills and Bone listed 7.5-17.5 ml of 1:5 tincture of Crataegus fruit per day and stated that higher doses than these may be required for the effective control of hypertension.
Initial dose Can start at the standard dose. Duration According to Mills and Bone, there is no restriction on the long-term use of Crataegus, and if it is used to treat heart conditions, it may need to be prescribed for a minimum of 2 months.
Caution Western contraindications None reported.
According to Bruneton, Crataegus 'has no acute toxicity, and no major side effects, drug interactions, or contraindications are known: No o~gan toxicity was shown at 100 times the standard human dose of Crataegus extract (standardized to 18.750/0 OPCS),43 and standard mutagenic tests were reported to be negative. 44
Chinese contraindications Shan zha is used with caution in Deficient Spleen patterns in the absence of Food Stagnation or with patients with acid regurgitation.
Pregnancy and lactation No adverse reports. Side effects No significant adverse effects have yet been reported.
INTERACTIONS Overdose No adverse reports. Animal studies Crataegus has been shown to be more effective than digoxin in increasing circulatory efficiency45 and has been shown to reinforce the effect of cardiac glycosides in increasing the force of heart contraction without increasing glycoside toxicity.46 Crataegus has also been shown to be less likely to cause arrhythmias than digoxin. On the contrary, Crataegus has been shown to have antiarrhythmic action.47 Clinical studies In one trial, most patients continued their usual medication, including antihypertensives, diuretics, and cardiac glycosides, through the study, and no adverse interactions between Crataegus and the allopathic mediations were reported.48 Other studies involved patients who had previously been treated unsuccessfully with digoxin alone. These patients showed improvement when relatively low doses ·of glycoside were used in combination with Crataegus.49.50
Dose Dried herb The BHP listed 0.3-1 g of dried fruit, three times per day (daily dose of 0.9-3g). Mills and Bone43 1isted 1.5-3.5 g of dried flower, leaf, or fruit per day.
Interactions No adverse herb-drug reactions have yet been reported. As discussed above in Toxicology, Crataegus has been reported to have a beneficial interaction with cardiac glycoside. Crataegus may reinforce some of the beneficial actions of cardiac glycoside drugs without increasing their side effects. Consequently, it may be possible for the dose of these drugs to be reduced (only to be done by the doctor who prescribed them). Also, as discussed above in Toxicology, one study reported that there were no adverse reactions between Crataegus and the antihypertensives or diuretics taken by the patients in the trial.
Regulatory status Please read the Regulatory status section in the chapter on Safety. Crataegus is not in either the General Sale List or the Schedule Part III of the Supply of Herbal Remedies Order 1977 of the United Kingdom. It is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Crataegus is not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
Combining Western Herbs and Chinese Medicine
422
Traditional sources PROPERTIES Temperature Crataegus is not mentioned by Hildegard von Bingen,S' and neither Gerard nor Culpeper gave a temperature for this herb. According to Bensky and Gamble, the fruit of the Crataegus species used in China as shan zha is listed as slightly warm. In this book, the species of Crataegus used in the West are classified as slightly warm in terms of Chinese medicine. Taste
Taste in the mouth Wichtl described the taste of Crataegus as sweetish, slightly bitter, and astringent. The astringency of Crataegus species may be related to the OPC content. In one of my seminars, the consensus was that a 1:5 tincture of Crataegus in 45% alcohol scored 1.5 for sour and 1.5 for sweet, using a scoring system of 0-3.
Taste property Lonicerus and Tabemaemontanus described Crataegus as drying and stopping. Gerard described its fruit' as very astringent, and Gerard and Culpeper used it as an astringent for hemorrhages. Chinese texts list shan zha as sour and sweet. 52 In this book, the species of Crataegus used in the West are classified as sour and sweet, relating to its cardiotonic and cardioregulatoryactions. ORGANS Heart In America, in 1896, Jennings reported the use of Crataegus for angina pectoris, tachycardia, palpitations, and cardiac edema. In the first two decades of the 20th century, other doctors confirmed Jenning's claims and recommended Crataegus for heart weakness, enlarged heart, and neurasthenia.
• astringent • diuretic :7~:·~·
Antianginal Jennings in 1896, Weiss in 1960, Priest and ,",'j"" Priest in 1982,53 and the BHP of 1983 all reported the use of :~. Crataegus for angina pectoris.~:~_ Antiatheromatic Ellingwood in 1919 reported the use of . -~~~='" , Crataegus for arteriosclerosis. Researchers in China in 1977 ·'-,,1 reported the use of Crataegus preparations for hyperlipidemia,54 and the BHP of 1983 recommended Crataegus for arteriosclerosis and thromboangiitis obliterans (also known as Buerger's disease). Cardiotonic and cardioregulator The German Commission E monographS5 listed the use of Crataegus for 'decreasing cardiac output as described in functional Stage II ofNYHA:
-~
.... ;,
~.
Cardiac weakness in the young and old Weiss called Crataegus the drug of choice for the aging heart. Ellingwood , i.., ~~ reported the uSe of Crataegus not oilly for heart problems in . the elderly but also for nervous weakness in young people resulting from violent overstraining or prolonged extreme nervous tension.
Cardiac weakness and depression Ellingwood reported the use of Crataegus as a general tonic and not just as a cardiotonic. He felt that it could act as a tonic for the central nervous system to treat gloomy forebodings and to give a general sense of well being.
Cardiac weakness subsequent to infection Weiss also recom~ mended Crataegus for myocardial weakness following infectious diseases such as influenza, pneumonia, diphtheria, and scarlet fever.
Cardiac weakness with hypertension The BHP gave the specific indication of hypertension with myocardial weakness.
Kidney-Bladder Both Gerard and Culpeper listed Crataegus for urinary stones, and Culpeper recommended it for edema (dropsy). It is interesting that Crataegus has been reported to treat edema and nocturia in patients with cardiac insufficiency; see Research.
Tranquilizer and antihypertensive Jennings reported the use of Crataegus for palpitations, tachycardia, vertigo, or apoplexy when it is associated with cardiac disease. Ellingwood reported it for neurasthenia from prolonged nervous tension. Priest and Priest and the BHP listed Crataegus for arteriosclerosis and hypertension. According to Bruneton, Crataegus has been used traditionally in France to treat insomnia in adults and children, and nervousness and palpi-
ACTIONS
tations in adults.
Evidence from the traditional sources for the following . actions of Crataegus are discuSsed below:
Astringent Dioscorides recommended a juice made from the berries to reduce diarrhea or heavy menstrual flow, and Lonicerus prescribed a tincture of the flowers or a decoction of the berries in wine for diarrhea.
• antianginal . '. • antiatheromatic • cardiotonic and cardioregulator • tranquilizer and antihypertensive
... :,,,
-".
Diuretic Tabemaemontanus listed Crataegus for kidney stones, and Culpeper listed it for dropsy.
_l',.'!i'>
--
..
~ ~
Crataegus COMPARISON OF WESTERN AND CHINESE USE OF CRATAEGUS SPECIES Crataegus is of great importance in the West since it is the main herb used to assist the conventional treatment of heart disease as a result of its antianginal, antiatheromatic. cardiotonic, cardioregulator, antihypertensive, and tranquilizer properties. Whilst the use of shan zha for heart disease is increasing in China, the main traditional Chinese use of shan zha was to treat abdominal distension and pain associated with the syndrome of Food Stagnation. Shan zha has a tradition of use in Chinese medicine to move Stagnant Blood and masses in the abdomen. treating postnatal abdominal pain or amenorrhea. The astringent action of the unripe, toasted, partially charred, or charred fruit was also used for diarrhea or excessive bleeding. Since the time of Dioscorides, there was a tradition of use in the West for Crataegus as an astringent to treat diarrhea and menstrual bleeding, but this use has declined.
References 1. Dioscorides P. Kreutterbuch (1610). Reprinted by Verlag Konrad Kolbl.
\,-
423
13. Chang H-M, But PP-H (eds). Pharmacology and Applications of Chinese Materia Medica, vols. 1 and 2. World Scientific Publishing, Singapore (1986) 14. Huang. Shanghai Zhongyiyao Zazhi (Shanghai J Trad Chin Med) (l ):30 (L955) Cited in: Chang H-M. But PP-H (eds). Pharmacology and Applications of Chinese Materia Medica, vols. 1 and 2. World Scientific Publishing. Singapore (1986) 15. Bensky D, Gamble A. Chinese Herbal Medicine Materia Medica. Eastland Press, Seattle, Washington (1986) 16. Schiissler M. HoW J.Dtseh Apoth Ztg 132:1327 (1992) 17. Bruneton J. Pharmacognosy: Phytochemistry Medicinal Plants, 2nd edn. Lavoisier, Paris, France (1999) L8. Hecker-Niediek A. Thesis. Univ Marburg (1983) [cited in Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm. Stuttgart, Germany (1994). from 2nd German edn. Wicht! M(ed) (1989)] 19. Wagner H,Grevel J. Planta Med (45):98 (1982) 20. Hobbs C, Foster S. Herbal Gram (22):21 (1990) 21. Ahumada C, Saenz T, Garcia D et al. J Pharm PharmacoI49(3):329-331 (1997) 22. Coronary Disease Research Group, 202nd Hospital of Shenyang Military Region. Medical Information (202nd Hospital of Shenyang Military Region) (1-2):20 (1975) 23. Pharmacology, Pathology. and Combined Western and Traditional Chinese Medicine Research Units. Jiangsu College of New Medicine. Compiled Information (Jiangsu College of New Medicine) (2):76 (1975)
Moochen. Germany (1960) 2. Lonicerus A. Kreuterbuch (1679). Reprinted by Verlag Konrad Kolbl. Munchen. Germany (1962) 3. Tabernaemontanus JT. Krauterbuch (1731). Reprinted by Verlag Konrad Kolbl. MOOchen, Germany (1993) 4. Gerard J. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publications. New York, New York (1975) 5. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks, Glenwood, Illinois (1990) 6. Crellin JK, Philpott J. A Reference Guide to Medicinal Plants. Duke University Press. Durham, North Carolina (1990) 7. Felter HW, Lloyd Ju. King's American Dispensatory. vols. 1 and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1983) 8. Lyle TJ. Physio-Medical Therapeutics, Materia Medica and Pharmacy. Originally published Ohio (1897). Reprinted by the National Association of Medical Herbalists of Great Britain, London, United Kingdom (1932) 9. Ellingwood F. American Materia Medica, Therapeutics and Pharmacognosy,11th edn. (1919). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1994) 10. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983) 11. Weiss RF. Herbal Medicine, English edn. Beaconsfield Publishers, Beaconsfield, United Kingdom(1988) 12. Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medphann, Stuttgart, Germany (1994), from 2nd German edn. Wichtl M (ed) (1989)
24. Rajendran S, Deepalakshmi PD, Parasakthy K et al. Atherosclerosis 123(1-2):235-241 (1996)
25. AI Makdessi S, Sweidan H, Mullner S et al. Arzneimittelforschung 46( 1):25-27 (1996) 26. Chatterjee SS, Koch E, Jaggy H et al. Arzneim-Forsch 47(7):821-825 (1997) 27. Leukel A, Fricke U, Holzl J. Planta Med 52:545-546 (1986) 28. Ammon HPT, Handel M. Planta Med43(2) :105-120 (1981) 29. Loew D. ESCOP 3rd International Symposium: European Harmony in Phytotherapy, Scheveningen. The Hague, 18th March 1994; cited in Br J Phytother 3(3):140 (1993/1994) 30. Stepka W; WmtersAD. Lloydia36:436 (1973) 31. Guendjev Z. Arzneim Forsch 27(8):1576-1579 (1977) 32. Tauchert M. Gildor A. Lipinski J. Herz 24(6):465-474;discussion p 475 (1999) 33. Schmidt U, KuhnM. Ploch Met al. Phytomed 1:17-24 (1994) 34. Zapfejun G. Phytomedicine 8(4):262-266 (2001) 35. al Makdessi S, Sweidan H, Dietz K et al. Basic Res CardioI94(2):71-77 (1999) 36. Della Loggia R, TubaroA, Redaelli C.RivNeuroI5H5):297-310 (1981) 37. Della Loggia Retal.Sci Pharm 51:319 (1983) 38. Garjani A, Nazamiy.eh H. Maleki N et al. Phytother Res 14(6):428-431 (2000) 39. Chaoan County Health Bureau. Guangdong Medical Information (11):44 (1977) [cited in Chang H-M, But PP-H (eds). Pharmacology and Applications of Chinese Materia Medica. vols. 1 and 2. World Scientific Publishing, Singapore (1986) J
1
424
Combining Western Herbs and Chinese Medicine
40. Bahorun T. Gressier B, Trotin F et al. Arzneim-Forsch 46(11):10861090 (1996)
:;jjjJ'; _ ...---i~l
Principles and Practice of Phytotherapy: Modern Herbal Churchill Livingstone, Edinburgh, United Kingdom (2000)J
~~~i~~:.;.:/
42. Saenz MT.Ahumada MC, Garcia MD. Z Naturforsch [C] 52(1-2):42-44 (1997) 43. Mills S. Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone. Edinburgh, Untied Kingdom (2000) 44. Schlegelmilch R, Heywood R. J Am Coil Toxicol13(2):103-111 (1994) 45. Ernst F-D. Reuther G, Walper A. Munch Med Wochenschr 136(suppl 1):S57-S59 (1994) 46. Trunzler G. Schuler E.Arzneim Forsch 12:198-202 (1962)
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41. Bahorun T. Trotin F. Pommery J et al. Planta Med 60(4):323-328 (1994)
_~
.~~~.. i
50. Jaursch U. Landers E,Schmidt Ret al.Med Welt 27:1547-1552 (1969)
:....~:,;-
'-,
51. Von Bingen H. Hildegard von Bingen's Physica. Healing Arts. Rochester•.. ~ :~~
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Vermont (1998)
52. Yeung H -C. Handbook of Chinese Herbs and Combinations. vol. Institute of Chinese Medicine. Los Angeles. California (1985) 53. Priest AW. Priest LR. Herbal Medication. L.N. Fowler. Romford United Kingdom (1982)
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54. Health Bureau, Wuhan Revolutionary Committee. Experimental Studies and Clinical Observations on Fructus Crataegi (No 40 paper of the seminar in medicine and health) p 3 (1977) [cited in Chang H-M. But PP-H (eds). Pharmacology and Applications of Chinese Materia Medica. vols. 1 and 2. World Scientific Publishing. Singapore (1986»)
47. Joseph G. Zhao Y. Klaus W.Arzneim-Forsch 45(12):1261-1265 (1995) 55. Blumenthal M (ed). The Complete German Commission E Mono48. Iwamoto M.Ishizaki T.Sato T. Planta Med 42(1):1-16 (1981) 49. Wolkerstorfer H. MMW 108:438-441 (1966) [cited in Mills S, Bone K.
graphs: Therapeutic Guide to Herbal Medicmes. American Botanical Council. Austin. Texas (1998)
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Echinacea Botanical name Echinacea species . Family Asteraceae (Compositae) Pharmaceutical name Echinaceae radix Part dried root: see below English echinacea (coneflower) German Purpursonnenhut French echinacee Mandarin Echinacea species are not used
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Use in the West The Echinacea species are herbaceous perennials indigenous to the Central and South West United States.! Large amounts of this herb are now cultivated for herbal use, mainly in North America and some in Europe. The Native Americans are reported to have used Echinacea for snakebite2 and for a range of uses, including influenza and chronic sores.3 However, Felter and Lloyd4 stated in 1898 that there was no written record of the medicinal use of Echinacea species prior to about 1880. They reported that Dr. Meyer wrote to Prof. King in 1886 of his experiences with the root of a herb that was later identified as E. angustifolia. King experimen~ed with this herb and reported success in the treatment of a range of disorders including obstinate nasopharyngeal catarrh, chronic leg ulcers, vaginalleukorrhea with ulceration, and bee or wasp stings with very extensive swelling. Acc~rding to Crellin and Philpott,S although Echinacea
inacea, along with Hydrastis and Panax ginseng, is now one of the most popular herbal over-the-counter products in the West, and in my opinion, is one of the most inappropriately used and overprescnbed herbs. See the discussion below in
Appropriate use ofEchinacea. Species used Three species are used in Western herbal therapy:
• E. angustifolia DC • E. purpurea (L) Moench. • E. pallida (Nutt.) Nutt.
narrow-leafed purple coneflower broad-leafed purple coneflower pale purple coneflower
Mixtures of more than one of these species are sometimes used. It has been suggested that E. pallida is less effective than the other two species. This may be associated with the fact that the isobutylamide active constituents, responsible for the characteristic tingling in the mouth of herbal samples, are mainly absent from E. pallida.6
. Part used Most texts refer to the root of one or more of these three Echinacea species, but the stem, herb, or mixtures of one or both of these with the root are sometimes used. I have only used the dried root or tincture of the root, and cannot comment on the use of other parts.
had become very fashionable by 1910, its popularity had greatly declined by about 1928, and it did not again become popular again until the 19~Os. Due to marketing hype, Ech-
Use in China Echinacea is not listed in the Chinese Herbal Medicine DictionarY' or in Perry.8
425
I
:--1
Combining Western Herbs and Chinese Medicine
426
What is special about Echinacea In terms of Chinese medicine, Echinacea, as used in the West. can be said to be a cool, acrid, bitter, and slightly sweet herb that has its main effects on the Lung, Bladder, skin, and body in general.
The key to understanding Echinacea is that it is a generalpurpose antimicrobial and alterative herb that can be used for: • treating acute severe infections, often with fever, such as respiratory infections, urinary infections, or boils • treating chronic lower-grade infections and catarrhal conditions. such as rhinitis. sinusitis, bronchitis. or leukorrhea • preventing recurring infections associated with debility by clearing pathogens and by strengthening the natural resistance ofthe body
II. clear Wind Heat and clear Retained Pathogen
diaphoretic antipyretic anti-inflammatory alterative
III. clear Lung Heat and Lung Phlegm Heat
antimicrobial antipyretic anti-inflammatory anticatarrhal
IV. clear Heat Toxin
antimicrobial anti-inflammatory dermatological agent alterative adjunct to cancer therapy
V. clear Bladder Damp Heat
antimicrobial anti-inflammatory alterative anticatarrhal
WESTERN USES CHINESE ACTIONS
The main Western uses of Echinacea are shown here in
In terms of Chinese medicine, Echinacea. as used in the West, can be said to have five main actions: I. clear Retained Pathogen and tonify and regulate Defensive Qi II. clear Wind Heat and clear Retained Pathogen III. clear Lung Heat and Lung Phlegm Heat IV. clear Heat Toxin V. clear Bladder Damp Heat
terms of its five main Chin~se actions:
I. clear Retained Pathogen and tonify and regulate Defensive Qi
prevention of recurring respiratory infections (such as in chronic fatigue syndrome)
acute respiratory infections. >,2"~ allergic rhinitis ... ..,~ .~
III. clear Lung Heat and Lung Phlegm Heat
acute bronchitis. pleurisy. or pneumonia with fever; chronic sinusitis or bronchitis
IV. clear Heat Toxin
septicemia. gangrene. boils. abscesses, leukorrhea
Oear Wmd Heat and clear Retained Pathogen Echinacea is a cool, acrid herb that may clear Wmd Heat from the surface, and in addition remove the lingering Retained Pathogen that may be contributing to recurring infections. inflammations. and allergic conditions.
V. clear Bladder Damp Heat
The main Western actions of Echinacea are shown here in terms of its five main ChiIie~e' actions:
~
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I. clear Retained Pathogen and tonify and regulate Defensive Qi
'Of:-~
antimicrobial' alterative immunoregulator tonic
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II. clear Wind Heat and clear Retained Pathogen
Clear Retained Pathogen and tonify and regulate Defensive Qi The acrid property of Echinacea may assist in the recovery of Defensive Qi by clearing Retained Pathogen. and the sweet property may assist in the clearance of Retained Pathogen by tonifying Defensive Qi.
WESTERN ACTIONS
.__ !'it
acute or recurring urinary infections
.; '""7~
.
Clear Retained Pathogen and tonify Defensive Qi I do ,~ not generally use Echinacea to tonify Defensive Qi unless the ""'" patient also has Retained Pathogen, Wind Heat, or Heat Toxin that needs to be cleared from the body. In my opinion, '''\.....'' .
Echinacea is specific for conditions that, in Chinese medicine. could be described as pathogens lingering in the body. . In Western terms, this can be seen as the chronic pres<:~' j
e~ce of potenti~ypatho~enic microorganisms ~ the body;~~t~ WIth accumulation of toXIC products from th~ IIl1croorg~:t:{!;1 (;: isms or from the body's reaction to them. The'se produ~; t·· "~.r-": ',.. :..,.'..;>4,1,;Q may have pyrogenic, inflammatory, or allergic effects,or m~ contribute to autoimmune disorders. By clearing both th~,i::c microorganisms and toxins, Echinacea can have benefici31,;, "J!i:"~ ;':"';"-'!-o:'
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Echinacea effects on conditions involving lowered body resistance with recurring infections and fever, recurring respiratory allergies, or recurring inflammatory conditions.
427
Prevention of recurring infection Two separate effects may contribute to the ability of Echinaceato assisting in the prevention of recurring infections: • antimicrobial and alterative
ApPROPRIATE USE OF ECHINACEA In my opinion, Echinacea can be appropriate in three main types of situation: • severe acute infection, often with fever • chronic infection or inflammation, often with catarrh or discharge • prevention of recurring infection, especially in weakened patients
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Sometimes a patient may receive three different combinations, each containing Echinacea: one for the acute stage, one for the chronic stage, and one for the remission stage of the illness. The stage of the illness will determine the following factors: • dose • duration of the prescription • herbs with which it is combined
I.-~--
Severe acute infections For these conditions, higher doses can be used for short periods. For example, the combination Asclepias: acute respiratory disorders + fever contains relatively large amounts of Echinacea, and I generally limit the use of this combination to 3 days. According to Tierra, Echinacea can be taken every hour or two du~ing the acute stage of inflammation, tapering off as the symptoms improve. When Echinacea is used for shorter periods and at higher doses, its ability to treat more severe acute conditions can be emphasized by combining it with herbs such as:
• Asclepias for respiratory infections with fever • Baptisia for tonsillitis, urinary infections, or boils with infection Chronic infections with catarrh For these conditions, such as chronic sinusitis, moderate doses can be used for longer periods. For example, the combination Euphrasia: chronic sinusitis contains moderate amounts of Echinacea and can be used for 1-4 weeks until the severity of the symptoms is reduced. When Echinacea is used for an intermediate period and at moderate doses, its ability to treat chronic catarrhal conditions with inflammati()n or infection can be emphasized by combining it with ~erbs such as:
• Arctostaphylos • Hydrastis • Thuja
, ....
for chronic urinary infections or leukorrhea for chronic sinusitis for chronic bronchitis
• tonic
Antimicrobial and alterative Echinacea may indirectly enhance the natural defenses of the body, and speed recovery, by clearing microorganisms and associated toxins from the system. In Chinese medicine terminology, this means that Echinacea can indirectly help with the recovery of Defensive Qi by clearing Retained Pathogen, Wind Heat, and Heat Toxins from the body.
Tonic Echinacea may directly strengthen the immune system. In Chinese terminology, it may directly tonify Defensive Qi. It is not yet clear which of these two effects is dominant, but in any case, I do not consider Echinacea to be primarily a tonic li~rb. Therefore, I do not generally include Echinacea in combinations to treat exhaustion unless the exhaustion is at least partly due to recurring infection, inflammation, or fever associated with Retained Pathogen. Combinations for prevention ofrecurring infection For weakened patients with recurring infection, I generally combine Echinacea with herbs to reinforce the antimicrobial and alterative actions of Echinacea, such as Achillea, Berberis, or Cinchona; and with herbs to reinforce the tonic action of Echinacea, such as Astragalus, Panax quinquefolium, or Pseudostellaria. If infection is dominant, then relatively more alterative, antimicrobial herbs are included in the combination; and if weakness is dominant, then relatively more tonics are included.
Dose and duration I would not generally give Echinacea as a single herb for more than 2 weeks. However, when it is used in moderate doses, in a combination with a good balance of alteratives and tonics, such as Achillea: recurringfever + respiratory infection, Echinacea can be given for 1-2 months.
DIRECTION OF ENERGY Echinacea can be said to have an outward effect on the movement of Qi in that it can clear Wmd Heat and Retained Pathogen out through the surface of the body, and help to clear Lung Phlegm.
TYPICAL CASE. EXAMPLE, Signs and symptoms The patient has a tendency to recurring respiratory infections, specifically common cold or in-
I
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Combining Western Herbs and Chinese Medicine
428
:-.~·T
fluenza with feverish sensations, which may linger as chronic sinusitis or bronchitis with yellow phlegm and a bad taste. Sometimes the respiratory infections are accompanied by urinary infections. The patient has low resistance to infections and also exhibits general debility, tiredness, and slow wound healing. The pulse is empty and slippery, especially in the Lung position. The tongue is pale with some red spots. especially at the back, and a yellowish greasy coat. Diagnosis The patient has Deficient Defensive Qi with Retained Pathogen, recurring Wmd Heat invasions, and a tendency to Lung Phlegm Heat and also to Bladder Damp Heat. Choice of Echinacea This herb is specific for conditions involving Deficient Defensive Qi, Retained Pathogen, Wind Heat, Lung Phlegm Heat, and Bladder Damp Heat.
Limitations ofEchinacea TEMPERATURE In this book. Echinacea is classified as cool and can be used for warm or hot conditions. It can be used for neutral or cool conditions, provided it is combined with other herbs.
TASTE Echinacea is classified in this book as acrid, bitter, and slightly sweet. It is acrid in the sense of clearing Wmd Heat, Retained Pathogen, Heat Toxin, and Lung Phlegm. It is not acrid in the sense of warming the Interior. ACTIONS Antimicrobial Echinacea can be used as an antimicrobial to treat acute or recurring infections. It is cool in temperature. If a warming antimicrobial is required, Commiphora or Capsicum are preferred. Diaphoretic and antipyretic Echinacea may have some diaphoretic action. However, if a herb with stronger diaphoretic action is required, Achillea might be more suitable, and if a warming diaphoretic is indicated, Zingiber would be more appropriate. Echinacea has had a tradition of use as an antipyretic, especially in cases of general septicemia and in respiratory infections such as bronchitis. pleurisy, or pneumonia. Anti-inflammatory and antiallergic Echinacea can act as an anti-inflammatory in cases of respiratory or urogenital inflammation associated with infection. In cases of inflam-
mation not associated with infection, other types of ~~?'::;;:~_ inflammatory may be more suitable, such as: • Althaea • Hamamelis
• Filipcndula
with mucilages with tannins with salicylates
Alterative Echinacea is an alterative that clears microorganisms, and the accumulated toxins associated with their presence, from the body to treat recurring infections, whether respiratory. urinary, or dermatological in origin. It is not used so much to cleanse the liver, as is Berberis, the kidneys, as is Taraxacum, or the bowel, as is Rheum. Anticatarrhal Echinacea can treat catarrhal conditions of the respiratory system, especially when they are associated _ with infections or allergies. It is not so much an expectorant anticataHhal like Lobelia. If a warming anticatarrhal is required, Thuja would be more appropriate. Vulnerary and topical I use Echinacea much more internally than topically. I prefer Baptisia for tonsillitis; Commi- _,", phora for problems of the tongue and gums, and for wounds; Myrica more for slow-healing ulcers; Calendula more for skin rashes; and Hamamelis more for hemorrhoids. Tonic I use Echinacea to assist in the tonification of Defensive Qi and strengthen the body's resistance to infection, but mainly in situations of recurring infection. in whichthere is a need for clearing Retained Pathogen and maybe also Heat Toxin. I do not use Echinacea in situations of Deficiency with Cold in the absence of Retained Pathogen-' and Heat Toxin, unless it is combined with other more warming herbs. Antitumor I include Echinacea in some combinations to be used as an adjunct to cancer therapy, especially for patienc with weakened resistance due to chemo- or radiotherapy;-, which corresponds in Chinese medicine terminology to Deficient Defensive Qi with Retained Pathogen and Hea Toxiri..
Echinacea paired with other herbs Discussion of the limitations of each of the main action_ of Echinacea can be useful to clarify just what this herb can and cannot do. Howe~er, suitable combination with othe herbs can extend the range of use of Echinacea beyond it,--,-, limitations. The basic unit of herb combination is the herb . pair. Twelve pairings of Echinacea are briefly explaine, below.
Echinacea CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair. Echinacea + Asclepias
Acute respiratory infections + fever Both herbs can assist treatment of acute respiratory infections with fever, such as influenza, bronchitis, pleurisy, and pneumonia. Echinacea is the stronger antimicrobial and alterative, and Asclepias is the stronger antipyretic and antispasmodic expectorant. Echinacea + Baptisia
Boils + infection Both herbs are general-purpose antimicrobials. Baptisia is perhaps colder in nature and the stronger antimicrobial, especially of the throat and lymph system. Echinacea is the stronger anticatarrhal and is specific for infections of the sinuses or bronchi. Both herbs can be used for infected boils or for urinary infections. Echinacea + Hydrastis
Sinusitis with purulent discharge Both herbs are antimicrobial anticatarrhals that can be used to clear Heat in the Lungs and Stomach with yellow sinus discharge and bad breath. Hydrastis is a broader anticatarrhal with gastrointestinal and hepatobiliary applications in addition to the respiratory and urogenital applications that it shares with Echinacea. Echinacea + Arctostaphylos
Leukorrhea Echinacea is a general-purpose antimicrobial, and Arctostaphylos is an antimicrobial limited in use to the urogenital system. They can be combined for such disorders as urinary infections and infections of the male or female reproductive systems, with or without discharge.
429
The previous five herbs paired with Echinacea are cool or cold in nature, but Thymus can act as a warming or cooling herb. Echinacea and Thymus can be paired to clear Wind Heat, Retained Pathogen. and Lung Phlegm, treating recurring influenza or bronchitis with catarrhal conditions of the sinuses or bronchi. Echinacea + Achillea
Recurringfever Achillea is the stronger diaphoretic, and Echinacea is the stronger antimicrobial. Both herbs have the ability to clear Retained Pathogen from the body surface to reduce recurrence of infection. and both herbs can tonify the Defensive Qi to aid convalescence and prevent further infection. In addition, Achillea is a strongly bitter herb that can tonify the Qi and Blood by strengthening the digestive system. Both herbs are anticatarrhal with an effect on the head region. Echinacea + Thuja
Adjunct to cancer therapy Both herbs can clear Heat Toxin and Retained Pathogen, and can be used as adjuncts in cancer therapy. In addition, Echinacea can help to strengthen the immune system and Thuja is reputed to have antitumor activity. Echinacea and Thuja can also be used to treat respiratory and urinary infections, and the warming effect of Thuja can balance and moderate the cooling effect of Echinacea. Echinacea + Ephedra
Allergic rhinitis Echinacea is cooling and Ephedra is warming, but both herbs can be effective in treating allergic rhinitis. Ephedra is more of a general-purpose antiallergenic that can also be used for allergic asthma or allergic urticaria, whilst Echinacea is more specific for nasal allergies, especially those with infection and catarrh. Echinacea + Panax quinquefolium
i
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1. I
Echinacea + Euphrasia
Chronic sinusitis Echinacea is the stronger antimicrobial, but Euphrasia is an anti-inflammatory, astringent, and anticatarrhal, specific to the sinuses, eyes, and ears. Both herbs can have antiallergic action and can be used together for allergic rhinitis, sinusitis, influenza with nasal obstruction, conjunctivitis, and catarrhal deafness. Echinacea + Thymus
Recurring respiratory infections
Recoveryfrom fever These very different herbs can be combined to treat exhaustion following febrile infections or to treat chronic bouts of weakness with recurring infections, such as those seen in some cases of chronic fatigue syndrome during the remission phase. Both herbs have sweet constituents, but the sweet constituents of Echinacea seem to tonify Defensive Qi, whilst those of Panax tonify Qi and Fluids. In addition to strengthening the resistance of the body. Echinacea can also help to clear potential Pathogens and their toxins from the system.
Combining Western Herbs and Chinese Medicine
430 Echinaeea + Astragalus
Prevention ofinfections This is a common combination in over-the-counter products. These herbs are very different: Echinacea is cooling and has an outward direction of movement, whilst Astragalus is somewhat warming, tends to stabilize the body surface, and has an upward direction of movement. I tend to use Echinacea to prevent infections by clearing Wmd Heat, Retained Pathogen, and Heat Toxins from the body, and to use Astragalus to prevent infections by strengthening and stabilizing the Defensive Qi and tonifying the Qi in general. The two herbs can sometimes be combined, but their pairing is not always appropriate.
Achillea Echinacea Thymus Pseudostellaria Panax qui. Glycyrrhiza Zingiber
0.5 0.5 0.5
Both herbs can have effect at the surface of the body. Echinacea c~-cl~~rWtrid Heat and Retained Pathogen. and Zingiber can clear Wind Cold. Echinacea and Zingiber can both have anticatarrhal action and can be combined to clear catarrh in the sinuses or bronchi. The warming action of Zingiber can be used to moderate the cooling effect of Echinacea, so that the antimicrobial or anticatarrhal actions of Echinacea can be utilized in cool conditions, or in mixed conditions of Heat and Cold.
--
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2. Acute allergic rhinitis
Wind Heat ,Ratio ,Temperature
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, Influenza with sinus congestion
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This combination is the same as Achillea: recurring fever + respiratory infection and is discussed under that heading.
Herb '
Echinaeea + Zingiber
"'>:>"'acrid, bitter acrid, bitter, sl. sweet ~~',",,--"""~ aromatic ~":'c,sweet, sl. bitter .-.... ...; .. ' sweet, sl. bitter sweet acrid, aromatic
warm-cool cool warm-cool neutral neutral neutral-cool hot
1 1 1 1
Euphrasia Ephedra Urtica Echinacea Sambucus Glycyrrhiza
1 1
1 1 1
0.5
.- _.
." .' .'
.
neutral-cool warm warm-cool cool cool neutral-cool
acrid, sour, bitter acrid, sl. bitter acrid
--,;:', c:-:'c:.::::::;::': acrid, bitter, sl. sweet acrid, sl. bitter sweet
This combination is the same as Euphrasia: acute allergic .. rhinitis and is discussed under that heading. 3. Acute respiratory disorders + fever
Lung Phlegm Heat + Wind Heat
Echinacea combinations Six Echinacea combinations are discussed below: Combination
Chinese syndromes
1. recurring fever +
Retained Pathogen + Deficient Defensive Qi
respiratory infection 2. acute allergic rhinitis
Wind Heat
3. acute respiratory disorders + fever
Lung Phlegm Heat + Wind Heat
4. chronic sinusitis
Lung Phlegm Heat
5. boils + infection
Heat Toxin
6. urinary infections + heat sensations
Bladder Damp Heat
Asclepias Echinacea Achillea Prunus Glycyrrhiza Lobelia Zingiber (fresh)
6g 6g 4g 4g 3g 0.6 g* 3 slices
cold cool warm-cool neutral neutral-cool warm-cool hot
bitter acrid, bitter, sl. sweet acrid, bitter bitter, aromatic sweet acrid acrid, aromatic
*The UK daily maximum dose for dried Lobelia is 0.6 in the Lobelia chapter.
g; see the Dose section
This combination is the same as Asclepias: acute respiratory disorders + fever and is discussed under that heading. 4. Chronic sinusitis
Lung Phlegm Heat CAUTION
Before using any ofthe combinations below, it is important to be familiar with the cautions listed for each herb in the com-
bination. 1. Recurring fever + respiratory infection
Retained Pathogen + Deficient Defensive Qi
.
"'"
;.~~.
Euphrasia Echinacea Sambucus Hyssopus Hydrastis Glechoma Phytolacca
1 1
l' 1 1 1 1
. neutral-cool cool cool warm-cool cool neutral cool
acrid, sour, bitter acrid, bitter, sl. sweet acrid, sl. bitter acrid, aromatic bitter sour, bitter acrid
Echinacea This combination is the same as Euphrasia: chronic sinusitis and is discussed under that heading. 5. Boils + infection
Heat Toxin Herb
,.
Echinacea Baptisia Arctium (seeds) Taraxacum Rheum
Ratio
Temperature ,~ Taste
1 1 1 1 1
cool cold cool cool-cold cool-cold
•• >
. • . ".
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acrid. bitter. sl. sweet bitter acrid. sl. bitter bitter bitter. sour
GENERAL
This combination is for the accumulation of Heat Toxin and maybe also Damp Heat and Phlegm in the channels supplying the skin. The overall temperature is cool-cold to treat warm-hot conditions. The bitter constituents can clear Heat Toxin and Damp Heat, and th~ acrid constituents, in this case, can help to clear Phlegm. USE
• acne or boils with infection PRACTICAL NOTES
This combination can be taken as 5-10 ml of 1:5 tincture in quarter of a cup of water, three times per day for 1-2 weeks. It is a relatively short-term prescription for acute' conditions, and as soon as the redness, heat sensations, swelling, and pain of the boils have been appreciably reduced, this combination can be replaced with a more long-term combination such as Phytolacca: chronic acne.
Caution This is a strongly antimicrobial combination that is cool-cold in terms of Chinese medicine. It may have a temporary laxative effect, and it is not appropriate for: • long-term use • patients with debility and weak digestion associated with patterns of Deficient Qi and Cold in the Spleen and Intestines
6. Urinary infection + heat sensations
Bladder Damp Heat
Arctostaphylos Baptisia Echinacea Hydrastis Zingiber
1 1 1 1
0.5
cool cold cool cool hot
sour. bitter bitter acrid. bitter. sl. sweet bitter acrid. aromatic
This combination is the same as Arctostaphylos: urinary infection + heat sensations and is discussed under that heading.
431
COMPARISON OF THE SIX ECHINACEA COMBINATIONS 1. Recurring fever + respiratory infection
2. Acute allergic rhinitis
Retained Pathogen + Deficient Defensive Qi
Wind Heat
Herb
Ratio
Achillea 1 Echinacea 1 Thymus 1 Pseudostellaria 1 Panax qui. 0.5 0.5 Glycyrrhiza Zingiber 0.5
Herb Euphrasia Ephedra Urtica Echinacea Sambucus Glycyrrhiza
Ratio 1 1 1 1 1
0.5
1. This combination is primarily used to treat Deficiency of Defensive Qi and Deficiency of the Qi of Lung and Kidney. Achillea, Echinacea, Thymus, and Zingiber are included to clear Retained Pathogen from the surface, to
clear Lung Phlegm, and to tonify the Lung. The sweet herbs Pseudostellaria, Panax, and Glycyrrhiza, as a group, can tonify both the Lung and Kidney Qi. Strengthening the Lung and Kidney can help to clear pathogens from the surface and the Lung, thereby assisting in the recovery and reducing the incidence of both febrile episodes and infections.
2. All the herbs in this combination can be used for acute allergic conditions involving rhinitis and/or conjunctivitis. Ephedra is included despite its warm temperature since it can be the most powerful of the antiallergenic herbs. Euphrasia and Sambucus are specific for rhinitis, and the anti-inflammatory and anticatarrhal actions of these herbs are supported by Echinacea and Urtica. Echinacea may contribute antiviral and antibacterial effects.
3. Acute respiratory disorders + fever
4. Chronic sinusitis
Lung Phlegm Heat + Wind Heat
Lung Phlegm Heat
Herb Asclepias 6g 6g Echinacea 4g Achillea 4g Prunus 3g Glycyrrhiza Lobelia 0.6g Zingiber (fresh) 3 slices
Euphrasia Echinacea Sambucus Hyssopus Hydrastis Glechoma Phytolacca
.... ".-:,Ratio .::,:. ·c.:·.·. 1 1 1 1 1 1 1
Combining Western Herbs and Chinese Medicine·
432
3. Achillea and Echinacea are also included in combination No.1. which also contains the sweet tonics Pseudostellaria, Panax quinquefolium, and Glycyrrhiza to strengthen the Defensive Qi. In combination No.3, Achillea and Echinacea are combined with Asclepias and Lobelia to treat fever and to clear Lung Phlegm Heat. Prunus combines with Lobelia and Glycyrrhiza to treat cough. 4. Both combination No.2 and combination No.4 contain Euphrasia and Echinacea, but this combination does not contain Ephedra, Sambucus, and Urtica for Exterior Wind. Instead, combination No.4 contains Sambucus. Hyssopus, Phytolacca, Glechoma, and Hydrastis. which can combine to treat chronic nasopharyngeal catarrh. Hyssopus and Glechoma also have an expectorant action. so this combination can be used for upper respiratory catarrh accompanied by some lower respiratory congestion. Combination No.2 is for problems ofthe nose and eyes, whilst combin.a~on No.4 is for disorders of the nose and bronchi.
• Juniperus: cystitis + recurring respiratoryinfection~::':~::'~;::"£2 : . ..'.. ?"' -,;;.._~" • Thymus: recurring respiratory infection -"..._r~~~-"
Research CONSTITUENTS The following constituents have been reported: • alkylamides • caffeic acids and esters • polysaccharides • essential oil • other Alkylamides At least 20 alkylarnides (alkarnides) are present, mainly isobutylamides of C l1 -C 16 straight chain fatty . acids with olefinic or acetylenic bonds.6 A recent study found that, whilst chopping and drying had little effect on the levels of alkylamides in E. purpurea roots, levels of all alkylamides fell by over 80% during storage at 24°C for 64
5. Boils + infection
6. Urinary infection + heat sensations
weeks. 9
Heat Toxin
Bladder Damp Heat
Caffeic acids and esters
Echinacea Baptisia Aretium (seeds) Taraxacum Rheum
1 1 1 1 1
Arctostaphylos Baptisia Echinacea Hydrastis Zingiber
1 1 1 1 0.5
5. This combination is for acute conditions of acne or boils with infection. Whilst Echinacea and Baptisia are general-purpose antimicrobials to treat infection, the other three herbs are more specific for removing Heat from the skin. 6. Both combination No.5 and combination No.6 contain the strong general-purpose antimicrobials Echinacea and Baptisia. However, whilst combination No. 5 contains Arctium, Taraxacum, and Rheum to clear Heat from the skin, combination No.6 contains Arctostaphylos and Hydrastis, which are both specific for clearing Heat and Damp Heat from the Bladder and from the lower body. OTHER ECHINACEA COMBINATIONS Echinacea is also included in the following combinations:
• Arctium: recurring urticaria (acute phase) • Asclepias: bronchitis + heat sensations
These include:
• echinacoside 0.5-1 %10 (absent in E. purpurea) • chichoric acid 0.34%11 (significant only in E. purpurea) • cynarin, a quinic acid derivative10 (in E angustifolia ' only) Polysaccharides There'appeal-'to be,~o;main types: 12 ' • a heteroglycan with an average molecular weight of about 35,000 • an arabinorhamnogalactan with an average molecular weight of about 450,000 Essential oil Humulene 13 and 1,8-pentadecadiene 14 have been found in the roots of American coneflower. Other These include: • 0.3% betaine (glycine-betain)'5 • phytosterols such as ~-sitosterol • inulin. reducing sugars, and fatty acids • nontoxic pyrrylozidine alkaloids in trace amounts A recent analysis of several Echinacea market products found variation in the betaine content, ranging from 0.04 to 0.64%.16 Species differences A recent study found that extracts of the roots of the three main Echinacea species differed markedly in their contents of characteristic compounds: 17
• E. purpurea
.chichoric acid and verbascoside (acteoside) predominate
_,
Echinacea • E. angustifolia • E.pallida
cynarine and dodeca tetraenoic acid isobutylamide predominate echinoside and 6-0caffeoylechinacoside predominate
PHARMACOLOGICAL AND CLINICAL RESEARCH The following effects have been observed using extracts of Echinacea species or their isolated constituents:
1-::-
• antimicrobial • relief of respiratory infections • anti-inflammatory • antioxidant • wound healing • antihyaluronidase activity • immunoregulatory • antitumor However, this discussion does not include:
:........
• animal or human studies in which Echinacea is used in combination with other herbs • clinical studies on the injection of Echinacea juice Antimicrobial
iIlIi
General Polyacetylenes extracted from the roots of E. angustifolia or E. purpurea were reported to have antimicrobial activity against E. coli and Pseudomonas aeruginosa.1 8 A 90% reduction of Leishmania parasites, achieved by intracellular lysis, was reported for arabinogalactan isolated from E. purpurea.
19
Antiviral An aqueous extract of E. purpurea demonstrated in vitro inhibition of influenza, herpes, and poliovirus. 20 Another in vitro study with root extracts of the three Echinacea species showed antiviral activity to the herpes simplex virus and to the influenza virus. Increases in the levels of a- and 13- interferon were reported. 2I However, a recent placebo-controlled, double-blind, crossover trial using Echinoforce, a product extracted from E. purpurea, showed no significant benefit in the treatment of recurrent genital herpes. 22 In contrast, echinoside was reported to have antiviral activity against the vesicular stomatitis virus in the plaque reduction assay with L-929 mouse cells. 23
Antifungal An E. purpurea extract was reported to inhibit Epidermophyton interdigitale in vitro.24 The equivalent of 4.5 m1 per day of expressed juice of the aerial parts ofE. purpurea were administered in combination with an antifungal cream in an uncontrolled clinical study on recurrent candidiasis. It was reported that recurrence was reduced in the
433
patients taking both the Echinacea preparation and the cream compared to those receiving antifungal cream only.2S Relief of respiratory infections Melchart et al. reviewed the literature on the treatment of the common cold and upper respiratory tract infections in 1994, and found the quality of the methodology of most of the studies to be low. 26 The findings of a more recent review by Giles et aI. were as follows: 'Twelve clinical studies published from 1961-1997 concluded that echinacea was efficacious for treating the common cold, but the results are unclear due to inherent flaws in study design. Five trials were published since 1997; two showed that echinacea lacked efficacy for treating and preventing upper respiratory tract infection symptoms, and .three concluded that it was effective in reducing the frequency, duration, and severity of common cold symptoms. Again, these results are unclear because of methodological uncertainties, such as small populations and use of non-commercially available, non-standardized dosage forms. Although evidence for echinacea's efficacy is inconclusive, it appears to be safe: 27
A more recent placebo-controlled, randomized, doubleblind, clinical trial studied the effectiveness of the product Echinacin prepared from E. purpurea in relieving common cold symptoms. The median time of illness was 6 days in the Echinacin group compared to 9 days in the placebo group. The authors concluded that Echinacin was well tolerated and clinically effective in alleviating the symptoms of the commoncold.28 Anti-inflammatory
Extracts Topical application of Echinacea extract was reported to be more effective than the topical nonsteroidal antiinflammatory drug benzydamine in reducing edema in the croton oil mouse ear test.29
Expressed juice A postmarketing survey of 4500 German patients reported that an ointment containing Echinacea juice was effective in a variety of skin disorders. 30
Polysacchrides The anti-inflammatory activity of a polysaccharide fraction obtained from Echinacea angustifolia roots has been examined using the carrageenan paw edema and the croton oil ear tests. Intravenous administration of the polysaccharide fraction (0.5 mglkg) almost inhibited the carrageenan-induced edema over 8 hours, and topical application of the polysaccharide fraction inhibited mouse ear edema induced by croton oil. The polysaccharide fraction also reduced the leukocytic infiltration of the croton oil dermatitis, evaluated histologically and by measuring peroxidase activity. Topically, the polysaccharide fraction appears to be slightly inferior'in potency than indomethacin. The authors suggested that the anti-inflammatory activity of E.
434
Combining Western Herbs and Chinese Medicine
angustifolia resides in its polysaccharides.31 The fraction with a molecular weight between 30,000 and 100,000 was the most active in inhibiting the edema of the croton oil test. 32
Alkylamides Polyunsaturated alkylamides isolated from E. angustifolia were reported to possess in vitro inlubitory activity in cyclooxygenase (sheep seminal microsomes) and 5lipoxygenase (porcine leukocytes) assays. Activity appeared to depend on the particular structure of the alkylamide. 33 Antioxidant Methanol extracts of freeze-dried roots of E. angustifolia, E. pallida, and E. purpurea were reported to suppress the oxidation of human low-density lipoprotein. 34 In another study, the free radical-induced degradation of Type III collagen was dose-dependently inhibited by Echinacea caffeic acids and esters (echinacoside, cmcoric acid, cynarine, caffeic acid, and chlorogenic acid). The ICso ranged from 15-90 ~. The authors suggested that topical Echinacea prepat"ations may be of use in the prevention or treatment of skin damage by UVA/UVB radiation, in which oxidative stress plays a crucial role. 35 Wound healing Incisions made.in the flank of guinea pigs were treated daily with an ointment containing expressed juice of Echinacea herb, with significant improvement in wound healing compared to the control animals. 36 In another study, edema and subcutaneous hemorrhage were reduced in experimental wounds by the application of patches containing expressed juice of the aerial parts of E. purpurea. The authors reported that the rate of necrosis of skin flaps was decreased by an increase in peripheral circulation. 37 Antihyaluronidase activity A study to identify the constituents responsible for the antihyaluronidase activity of Echinacea found that caffeic acids and esters, extracted from E. angustifolia roots, especially cmcoric acid, had antihyaluronidase activity in vitro. 38 Especially when Echinacea is used as a topical application, antihyaluronidase activity may help to increase the resistance of tissue to the spread of certain infections. In combination with an increase in the number of fibroblasts, this may facilitate connective tissue regeneration, especially of skin tissue. 30 Immunoregulatory See the discussion in Toxicology on the use of Echinacea in autoimmune diseases.
Extracts . Ethanolic extracts of the three main Echinacea species were found to stimulate phagocytosis in an in vitro granulocyte test. Interestingly, the same result was obtained' when the extracts were administered orally to mice. 39 In another study, extracts of E. purpurea were evaluated for their capacity to stimulate cellular immune function in
.-
_..,:.:~,:r;C'rr
normal individuals and in patients with either chronic_~~ fatigue syndrome or acquired immunodeficiency syndrome~-=ifdi. (AIDS). Echinacea significantly enhanced natural killer cell function and also significantly increased antibody-dependent cellular cytotoxicity of peripheral blood mononuclear .. cells from all subject groups. The authors concluded that extracts of Echinacea purpurea enhance cellular immune function of peripheral blood mononuclear cells both from normal individuals and patients with depressed cellular immunity.40 In yet another study, rats were continuously treated with Echinacea root extract over a period of 6 weeks. The rats were injected with the novel antigen keyhole limpet hemocyanin. Immunoglobulin production was monitored over the 6 week period. The Echinacea-treated group showed a significant augmentation of their primary and secondary IgG response to the antigen, suggesting Echinacea may enhance immune function by increasing antigen-specific immunoglobulin production.41
Caffeic acids and esters Oral administration of chicoric acid from Echinacea roots increased phagocytic activity in vivo.42 L-chicoric acid has been reported to have antiviral activity against HIV-1 in cell cultures, partly by inhibiting HIV integrase activity.H
Polysaccharides
Purified polysaccharides prepared from Echinacea purpurea have been reported to bepotent activators of macrophages. In addition, the production and secretion of oxygen radicals and interleukin-1 by macrophages was increased by the exposure to the purified polysaccharides. 44 Acidic arabinogalactan, a highly purified polysaccharide from plant cell cultures of Echinacea purpurea, with a molecular weight of 75,000, was effective in increasing the cytotoxicity of macrophages against tumor cells and microorganisms, for example, Leishmania enriettii. Furthermore, this polysaccharide induced macrophages to produce tumor necrosis factor (1"NF-alpha), interleukin-1 (IL-1), and interferon-beta 2.H According to Mills and Bone, these in vitro results may not be relevant to in vivo situations following oral administration because of gastrointestinal breakdown and other factors. They also suggest that the amount of polysaccharides in extracts with over 50% alcohol will be negligible. 30 Antitumor AKR/J mice were given oral doses of powdered leaves from Echinacea purpurea three times weekly for 8 weeks (7.5 mg/mouse per week). Proliferation of endogenous recombinant murine leukemia viruses in the thymus was markedly inhibited as compared with untreated controls. These suppressive effects on spontaneously occurring
.-,
~-"
Echinacea leukemia may depend on enhancement of nonspecific immune or cellular immune systems by the E. purpurea preparation. 46 In another study, daily dietary administration of Echinacea purpurea root extract to normal mice for as little as one week resulted in significant elevations of natural killer cells (immune cells that are cytolytic to virus-containing cells and many tumor cells). A further study with leukemic mice, reported that three months after the onset of leukemia, all the major hemopoietic and immune cell lineages in the bone marrow birth site of the E. purpurea-treated mice were normal. 47 RESEARCH VERIFICATION OF TRADITIONAL ACTIONS The following traditional actions have been supported by research using either Echinacea extracts or isolated constituents: antimicrobial (including the relief of respiratory infections), anti-inflammatory, vulnerary, tonic (immunoregulator), and antitumor. Additional effects demonstrated by research The following additional effects have been reported as discussed above: antioxidant and antihyaluronidase activity. TOXICOLOGY Single dose toxicity I have not found data for the LD so of the root. Single oral or intravenous doses of the expressed juice ofE. purpurea herb caused no toxicity in rats or mice at the maximum administrable dose. The LD 50 of the herb in mice is therefore over 30 glkg orally and over 10 glkg intravenously.48 Repeated dose toxicity Oral administration to rats of 0, 0.8, 2.4, or 8 gJkg of expressed juice of Echinacea herb daily for 4 weeks produced no relevant changes.48 Autoimmune disorders The German Commission E monograph49 stated that Echinacea is not to be used for progressive systemic diseases such as tuberculosis, leukosis, collagenosis, multiple sclerosis, AIDS, HIV infection, and other autoimmune diseases. However, Mills and Bone have criticized this statement, and have pointed out that there are no clinical studies that document an adverse effect resulting from Echinacea use in any of these conditions. In their view, the long-term use of Echinacea is at least not harmful in autoimmune disorders and is probably beneficial.
An important distinction The suggestion that Echinacea may have adverse effects in autoimmune diseases by enhancing immune function is unsubstantiated by clinical research. 30 The suggestion appears to be based on the theoretical prem-
435
ise that any enhancement of immune activity may be harmful in autoimmune diseases. This may not apply in all cases even to isolated chemicals with immunostimulant effect. It is less likely to apply to Echinacea root or herb, which has a range of different therapeutic actions, due to a range of different active constituents, that may enhance, modify, and moderate each others' effects. Echinacea is not merely an immunostimulant. In terms of Chinese medicine, it can be said to clear Wind Heat, Retained Pathogen, Heat Toxin, Lung Heat, Lung Phlegm, and Bladder Damp Heat, and to tonify Defensive Qi. In terms of Western herbal therapy, Echinacea can have antimicrobial, antipyretic, anti-inflammatory, vulnerary, alterative, anticatarrhal, and tonic actions. It has been proposed that one causative factor of autoimmune disease may be inappropriate reactions to infective microorganisms. so In cases where this was a major etiological factor, the ability of Echinacea to reduce the numbers of microorganisms chronically present in the body and to reduce the accumulation of toxins resulting from microbial presence would be likely to be beneficial rather than detrimental to the patient. In my opinion, it may be more accurate to refer to Echinacea as an immunoregulator rather than an immunostimulant. This herb may, by a number of different mechanisms, help the immune,system return to normal function, rather than merely act as an immunostimulant.
Echinacea combined with other herbs Trained herbal practitioners do not tend to prescribe'Echinacea as a single herb. Rather, they prescribe it in balanced combinations with other herbs that can enhance or modify its effects. In this way, different combinations containing Echinacea can be used according to the specific needs of the·patient. See the discussion above in Appropriate use ofEchinacea. Asthma An article suggested that Echinacea may aggravate asthma by increasing the eytokine called tumor necrosis factor-alpha (TNF-alpha), which can increase the inflammatory process in asthma. SI However, in vitro studies may have little relevance to oral administration of Echinacea; see the Immunoregulatory: polysaccharides subsection above. In fact, a clinical study has reported that oral administration of an Echinacea preparation had no significant effect on the levels of cytokine production by lymphocytes, including TNFalpha. 52 Mutagenicity No mutagenicity or carcogenicity was shown for the juice of E. purpurea by in vitro and in vivo tests.48 Pregnancy The results of a recent study suggested that gestational use of Echinacea during organogenesis is not associated with an increased risk of malformations. s3
Combining Western Herbs and Chinese Medicine
436
Herb-drug interactions Both Mills and Bone and the ESCOP monographs on EchinaceaS4 stated that there were no interactions known (at the time of writing).
Dose Dried herb The BHP listed 1 g of the dried root, 3 times per day. For acute, severe respiratory infections, I use 2 g of the dried root, 3 times per day, in decoction, combined with other herbs. See Asclepias: acute respiratory disorders + fever. However, I only use such a prescription for a maximum of 3 days. Mills and Bone wrote that for acute conditions, higher doses of Echinacea can be used on a short-term basis. For example, up to 10-15 g of E. angustifolia root, or its equivalent in liquid or tablet preparations, can be taken per day. Tmcture The BHP listed 1-2 ml of 1:5 tincture (45% alcohol), three times per day, and the BHC listed 2-5 ml of 1:5 tincture (45% ethanol), three times per day. I gener;illy use Echinacea in combination with other herbs, and so effectively prescribe about 1 ml of 1:5 Echinacea root tincture, three times per day. For acute severe infections, especially with fever, I prefer to use Echinacea as a decoction rather than as a tincture or tablet.
Pregnancy and lactation
No adverse reports..
Side effects These are not generally expected for oral ~r topical administration. Contact dermatitis may occur rarely ,~~~~. in susceptible patients.30 See Western contraindications. ..... Overdose No adverse reports. Interactions
No adverse reports.
Regulatory status Please read the Regulatory status section in the chapter on Safety. Echinacea is on the UK General Sale List, and it is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Echinacea is not currently listed by the FDA (USA) as a prohibited substance, as subject to
_""" , !
.. L~;#'~',
an import alert, or as a substance with a warning on its use. ._,..;::~~
Traditional sources PROPERTIES Temperature Echinacea is classified in this book as cool due to its antipyretic and anti-inflammatory actions.
Duration There is no evidence to suggest that long-term use of Echinacea will have an adverse effect on immune function. 30 However, this is a herb that I tend to prescribe mainly for acute and subacute conditions. I therefore do not tend to prescribe combinations containing Echinacea for longer than 2 months. See the discussion above in Appro-
Taste in the mouth The BHP described the taste of Echinacea root as initially sweet, then bitter, followed by a tingling sensation on the tongue. I found a 1:5 tincture of E. angustifolia root in 45% alcohol to have a sweetish musty smell and a strongly acrid taste, producing a strong tingling sensation on the tongue. It also tasted slightly sweet and slightly bitter. A sample of the root of E. angustifolia tasted even more acrid and more bitter than the tincture, and slightly
priate use ofEchinacea.
sweet.
Initial dose
Can start at the standard dose.
Cautions Western contraindications Echinacea should be used with caution in patients with known allergy to members of the Asteraceae (Compositae). See the discussion on autoimmune disorders and asthma in Toxicology above. Chinese contraindications Echinacea species are not listed in the Chinese Herbal Medicine Dictionary. However, in terms of Chinese medicine, I regard Echinacea as a cool , herb, and I would not prescribe Echinacea long-term for conditions of Cold accompanying Deficiency, unless it were combined with sufficient warming tonic herbs.
1
Taste properties Echinacea can be said to be acrid, bitter, and slightly sweet in terms of Chinese medicine.
Acrid Echinacea is acrid in the sense of clearing Wind Heat, Retained Pathogen, and Heat Toxin from the surface. As with Lobelia and Phytolacca, the acrid property of Echinacea may assist its anticatarrhal action and help it to clear Phlegm from the sinuses and bronchi.
Bitter The bitter property of Echinacea may be related more to clearing Heat, Damp Heat, and Heat Toxin than to tonifying the digestive system.
Sweet The sweet taste may be linked to the ability to torrify the Defensive Qi and to strengthen and regulate the resistance of the body to infection and inflammation.
-r,
Echinacea ORGANS In terms of Chinese medicine. the root of Echinacea. as used in the West, can be associated mainly with disorders of the following organ systems:
tonsillitis. nasopharyngeal catarrh, bronchial catarrh prevention of colds and influenza
Felter and Lloyd
Bladder
urethral infection and discharge prostatic enlargement urogenital infections
Ellingwood Christopher's ESCOP
skin
eczema, boils, chronic ulcers. wounds, bites and stings urticaria
Christopher
septicemia allergies. infectious mononucleosis, chronic fatigue syndrome
SHP Mabey
Lung ~.:.
r--'''''' ~~
~,J
~
!.:."",:
other
SHC
Mabey56
Echinacea is not listed in the Chinese Herbal Medicine
Dictionary.
ACTIONS The following traditional actions are discussed: • antimicrobial • antipyretic • anti-inflammatory • alterative • anticatarrhal • vulnerary and topical • tonic • antitumor Antimicrobial Felter and Lloyd classified Echinacea as an antiseptic and alterative for septicemia. injuries complicated by a septic infection, and fever from septic infection, including puerperal fever. With the development of the germ theory of disease and of microbiology, the term antiseptic was replaced by the term antimicrobial, and Echinacea was seen to have specific antiviral, antibacterial, antifungal, and antiprotozoal actions. The BHC listed chronic viral and bacterial infections and septicemia as indications for Echinacea, and Mabey gave infective mononucleosis and 'postviral syndrome' (chronic fatigue syndrome) as indications. Antipyretic Ellingwood noted the use of Echinacea for typhoid fever, puerperal fever, and septic fever. In addition, Felter and Lloyd wrote that it was used for eruptive fever and epidemic influenza. Christopher recommended it for fever in general and specifically for diphtheria.
437
Anti-inflammatory The BHC listed Echinacea as an antiinflammatory, and Mabey listed it, for example, for tonsillitis, gingivitis, urticaria, and allergies. However. it is difficult to separate the anti-inflammatory effect of Echinacea from its antimicrobial, antipyretic, alterative, and anticatarrhal actions. Alterative KlOSS 57 described Echinacea as an excellent blood cleanser to clear the body of poisons, toxins, and pus, for example, in the treatment of snake bites, blood poisoning. or gangrene. Felter and Lloyd recommended it for septicemia and wrote that it is especially indicated for ulcerated and fetid mucous surfaces and for foul discharges with weakness and emaciation. Anticatarrhal Felter and Lloyd listed Echinacea for catarrhal disorders of the nose, pharynx, and bronchi, and for leukorrhea with offensive discharge. The BHP listed Echinacea for nasopharyngeal catarrh. Vulnerary and topical Felter and Lloyd reported the use of Echinacea, administered simultaneously both internally and topically, for poisonous bites and stings, septic wounds, chronic sores, and abscesses. Ellingwood listed Echinacea for ulcerated sore throat. stomatitis. and bed sores, and Christopher recommended it for tonsillitis, bad breath, and gingivitis. Tonic Felter and Lloyd wrote that Echinacea could help with convalescence in cases of influenza with great debility and that it could be used for ulceration or discharges with weakness and emaciation. Both Felter and Lloyd as well as Christopher stated that Echinacea could improve the digestion and appetite. Christopher classified this herb as a stimulant and tonic, and also listed it as an aphrodisiac for impotence. Grieve 58 also listed an aphrodisiac action for Echinacea.
Enhancement of body resistance Both Priest and Priest, and Weiss,59 wrote that Echinacea can increase the natural resistance of the body to infections. According to Mills and Bone, Echinacea may modulate immune function in allergy and autoimmune disorders, mainly by acting on nonspecific immunity. by enhancing the body's resistance to infections, especially those of the upper respiratory tract, and by assisting in the recovery from chemotherapy. AntituDlQr Felter and Lloyd, Ellingwood, Grieve, and Christopher all listed Echinacea as an aid in the treatment of cancer. Mills and Bone note the potential of Echinacea to treat patients with weakened immunity undergoing chemotherapy, based on research evidence. See the Antitumor subsection in Pharmacological and clinical research above.
438
. Combining Western Herbs and Chinese Medicine
References
31. Tubaro A, Tragni E. Del Negro P et aI. J Phann PharmacoI39(7):S6Z';c
.
-.------c':~
569 (1987)
'::.':..·~'
1. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks. United Kingdom (1983) 2. Ellingwood F. American Materia Medica. Therapeutics and Pharmacognosy. 11th edn. (919). Reprinted by Eclectic Medical Publications. Sandy. Oregon (994) 3. Foster S. Duke J. Medicinal Plants. Houghton Mifflin. Boston. Massachusetts (1990) 4. Felter HW. Lloyd JU. King's American Dispensatory. vols. 1 and 2. 18th edn. (898). Reprinted by Eclectic Medical Publications. Sandy. Oregon (983)
32. Tragni E. Galli CL. Tubaro A et aI. Pharmacol Res Commun Suppl _' ~ :;. 5:87-90 (1988)-:"~ ":"""4:~;33. Muller-Jakic B, Breu W. Probstle A et aI. Planta Med 600):37-40 (1994);;' 34. Hu C.KittsDD. J Agric Food Chern 48(5):1466-1472 (2000) 35. FacinoRM.CariniM.Aldini G et aI.PlantaMed 61(6):510-514 (1995) 36. Kinkel HJ. Plate M. Tiillner H-U.Med Klin 79:580-583 (984) 37. Meissner FK.Arzneim-Forsch 37(1):17-18 (1987) 38. Facino RM. Carini M. Aldini G et aI. Farmaco 48(10):1447-1461 (1993)
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5. Crellin JK. Philpott J. A Reference Guide to Medicinal Plants. Duke University Press. Durham. North Carolina (1990)
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6. Bauer R. Remiger P. Planta Medica 55:367-3il (1989)
40. See DM. Broumand N. Sah! L et aI.lmmunopharm:Kology 35(3):229235 (1997)
7. Jiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science and Technology Press, Shanghai. China (975) 8. Perry LM. Medicinal Plants of East and Southeast Asia. The MIT Press. Cambridge. United Kingdom (980) 9. Perry NB. van Klink JW. Burgess EJ et aI. Planta Med 66(1):54-56 (2000) 10. Bauer R. Khan IA. Wagner H. Planta Medica 54:426-430 (1988) 11. Becker H. Hsieh WCh. Z Naturforsch 40c:585-587 (1985) 12. Wagner H. Proksch A. Riess-Maurer I et at. Arzneim-Forsch 35:10691075 (1985)
42. Bauer R. Remiger P. Jurcic K et al. Z Phytother 10:43-48 (1989) 43. Pluymers W. Nearnati N. Pannecouque C et aI. Mol Pharmacol: ~~---_..~58(3):641-648 (2000) .f'.:c:; 44. Stimpel M. Proksch A. Wagner H et aI. Infect lmmun 46(3):845-849 (1984) 45. Luettig B. Steinmuller C. Gifford GE et aI. J Nat! Cancer Inst 81(9):669675 (1989) 46. Hayashi I. Ohotsuki M. Suzuki I et aI. Nihon Rinsho Meneki Gakkai Kaishi 24(1):10-20 (2001)
14. Voaden DJ. Jacobson M. J Medicinal Chern 15:619-623 (1972)
47. Currier Nt, Miller Sc. J Altern Complement ~Ied 7(3):241-251 (2001)
15. Soicke H, Gorier K. Krtiger D. Fitoterapia 59:73-75 (988)
48. Mengs U. Clare CB. Poiley JA. Arzneim-ForschlDrug Res 41(Il):10761081 (1991)
17. Sloley BD. Urichuk LJ. Tywin C et aI. J Pharm Pharmacol 53(6):849857 (2001) 18. Schulte KE. Ruecker T. Perlick J. Arzneim- Fotsch 17:825-829 (1967) 19. Bauer R. Wagner H. Echinacea Species as Potential Immunostimulatory Drugs. In: Farnsworth r-.""R et aI. (eds) Economic and Medicinal Plant Research. vol. 5. Academic Press. London. United Kingdom pp 292-296. 304, 306 (1991)
49. Blumenthal M (ed). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin. Texas (1998) 50. Bone KM.Modern Phytotherapist 1(2):15-27 (1995)
20. MayG, Willuhn G.Arzneim-Forsch 28:1-7 (1978)
51. Sharp R. Echinacea a Danger to Asthmatics. Medical Observer. 8 August, 1997:1 [cited in Mills S. Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone. Edinburgh. United Kingdom (2000»)
21. Beuscher N. Bodinet C. Willigma I et aI. Z Phytother 16(3):157. 165166 (1995)
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54. European Scientific Cooperative on Phytotherapy: Monographs on the Medicinal Uses of Plant Drugs (monograph on Echinaceae purpureae herbal. European Scientific Cooperative on Phytotherapy. Exeter United Kingdom (1997)
24. Jung H-D. Schroder H. Arch Dermat Syphilis 197:130-144 (1954) 25. Coeugniet EG. Kilhnast R. Therapiewoche 36:3352-3358 (1986) 26. Melchart D. Linde K. Worku F et aI. Phytomed 1:245-254 (1994) 27. Giles JT. Palat CT 3rd. Chien SH et aI. Pharmacotherapy 20(6):690-697 (2000) 28. Schult~n B. Bulitta M. Ballering-Bruhl B et aI. Arzneirnittelforschung 51(7):563-568 (2001) 29. Tragni E. Tubaro A. Melis C et aI. Food Chern Toxicol 23(2):317-319 (1985) 30. Mills S. Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone. Edinburgh. United Kingdom (2000)
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13. Bauer R. Wagner H. Z Phytotherapie 9:151-159 (1988)
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...<~..;;~
t(¥: ...
(2000)
55. Christopher JR. School of Natural Healing. BiWorId. Provo. Utah (1976) 56. Mabey R (ed). The Complete New Herbal. Elm Tree Books. London. United Kingdom (988) 57. Kloss J. Back to Eden. 5th edn. (939). Reprinted by Lifeline Books. Santa Barbara. California (1975) 58. Grieve M. A Modern Herbal. vols. 1 and 2. Dover Publications. New York. New York (1971) 59. Weiss RF. Herbal Medicine. English edn. Beaconsfield Publishers, Beaconsfield. United Kingdom (1988)
Euphrasia Botanical name .Euphrasia species Family Scrophulariaceae Pharmaceutical name Euphrasiae herba Part dried aerial parts English eyebright German Augentrost French euphraise Mandarin mang xiao ml cao (-c' Hf. :¥-) is the aerial part of E. maximowiczii Wettst.; :riao rnl cao (+ *:¥-) is the aerial part of E. regelii Wettst. Use in the West Euphrasia is a small annual herb indigenous to Europe and North America's grasslands and heaths. According to Grieve, I Dioscorides, Pliny, Galen, and the Arab physicians did not mention Euphrasia. However, in the 14th century, Gordon, Arnoldus Villanovanus, and Matthaeus Sylvaticus recommended it for eye diseases. In the 17th century, Culpeper wrote that 'if this herb were used as much as it is neglected it would half spoil the spectacle makers trade: Euphrasia has been one of the most important herbs in the European tradition for eye disorders, but it does not seem to have been such an important herb for the Physiomedical or Eclectic practitioners in North America. It is given brief mention in Felter and LloydJ and Ellingwood,4 6 but is not discussed by Klosss or Christopher.
Use in China
There are only brief entries in the Chinese Herbal Medicine DictionarY for mang xiao mi cao (the aerial parts of E. maximowiczii Wettst.) and xiao mI cao (the aerial parts of E. regelii Wettst.), and these herbs do not appear to be in common use in China. In fact, the main entry on xiao ml cao is quoted from a text of commonly used herbs in Tibet, and the common name in Tibetan is given.
What is special about Euphrasia In terms of Chinese medicine, Euphrasia, as used in the West, can be said to be neutral-cool iIi temperature; acrid, sour, and bitter in taste; and with its main effects on the Lungs, nose, ears, and eyes.
The key to understanding Euphrasia is that it is a herb that can have anticatarrhal, astringent, or anti-inflammatory action on the mucous membranes of the eyes, nose, Eustachian tubes, and ears, to treat conditions ofexcessive discharge or inflammation in these areas. CHINESE ACTIONS In terms of Chinese medicine, Euphrasia, as used in the West, can be said to have three main actions:
Nomenclature According to Wichtl/ the classification of the genus Euphrasia in the literature can be both variable and contradictory. Various Euphrasia species are used, especially E. rostkoviana Hayne, which is sometimes considered to be equivalent to E. officinalis 1.
I. clear Wmd Heat II. clear Lung Phlegm Heat III. clear Lung Phlegm
439
Combining Western Herbs and Chinese Medicine
440
~ ";. "
;;,;.;:......
..~,-~~~
.
':-:-'i.
WESTERN ACTIONS The main Western actions of Euphrasia are shown here in terms of its three main Chinese actions: -- - --.' .. .. -.... '. Ch'inese~aions-:'"~'-'~c,
an eyewash by this patient.
.
~
inflammations of the eyes, ears, nose, and throat. Eupluiisii_ alone may not be enough to clear Liver Heat from the ~-:i? and for this syndrome, Euphrasia may be combined with ;.~~~ _ Hydrastis. Euphrasia can be taken internally and'also used.~:::~':;-..·
Western actions
I.
clear Wind Heat
anti-inflammatory anticatarrhal astringent
II.
clear Lung Phlegm Heat
anti-inflammatory anticatarrhal astringent
TEMPERATURE
tonic anticatarrhal astringent
be used as a:
III.
clear Lung Phlegm
The Western uses of Euphrasia can be related to its three main Chinese actions: .~
- ,.,' ' , ' , '
. - :-.
~~
.
• neutral tonic astringent and anticatarrhal for neutral-
.. ' -
l. clear Wind Heat
TASTE Euphrasia is classified in this book as:
.' ., ,'"
Chinese'':,.. •.actiorii"o~~c:.: _.. _.._._ ,::-'1-'.' ".:":.~ ;.:~._~';<:£7.
Euphrasia is classified as neutral-cool in this book. It can
temperature disorders • cool anti-inflammatory astringent for warm disorders
WESTERN USES
I'::' - • -:. -
Limitations ofEuphrasia
Western uses
acute allergic rhinitis, acute conjunctivitis
II.
clear Lung Phlegm Heat
rhinitis. sinusitis, nasopharyngeal inflammation
III.
clear Lung Phlegm
sinusitis, catarrhal deafness
DIRECTION OF ENERGY Euphrasia does not so much influence the movement of energy in a specific direction. Rather, it has local antimicrobial, anti-inflammatory, astringent, and tonic effects on the mucous membranes of the eyes, ears, nose, and throat that combine to reduce excessive discharge.
TYPICAL CASE EXAMPLE Signs and symptoms The patient has recurring allergic rhinitis and conjunctivitis associated especially with a raised pollen count or dust mites. They also have recurring and lingering styes, redness and irritation of the eyelids, and chronic sinusitis with postnasal drip and hearing loss due to phlegm in the eustachian tubes. The pulse is slippery, especially in the Lung position, and the tongue is red, especially in the Lung and Liver areas. Diagnosis The patient has Lung Phlegm Heat, some Liver Heat, and recurring Wind Heat invasion. Choice of Euphrasia This herb can clear Wind Heat and Lung Phlegm Heat, especially as they relate to catarrhal
• acrid, from its capacity to clear wind heat • sour, from its astringent action • bitter, from its anti-inflammatory action
ACTIONS Anti-inflammatory The main use of Euphrasia as an ~~: . inflammatory and antimicrobial agent is in the treatment~... of inflammations and infections of the eyes, ears, nose, and throat. For inflammation and infection in other systems, different herbs would be preferred. Astringent and anticatarrhal The main use of Euphrasia as an astringent is for excessive discharges from the mucous membranes of the eyes, ears, and nose. Although Euphrasia has been used as a general-purpose anticatarrhal astringent in the past, for example, for leukorrhea or diarrhea, I would prefer other herbs for this purpose. Tonic Euphrasia may act as a tonic mainly in certain limited situations: • for atonic mucous membranes of the eyes, ears, and nose • for visual weakness due to weakness of the eye muscles and n e r v e s · • for disorders due to central neuronal degeneration, such as dementia
Euphrasia paired with other herbs Discussion of the limitations of each of the main actions
Euphrasia of Euphrasia can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Euphrasia beyond its limitations as a single herb. The basic unit of herb combination is the herb pair. Six pairings of Euphrasia are briefly explained below.
CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair. Euphrasia + Sambucus
Acute rhinitis Both herbs can act as cool anti-inflammatory anticatarrhals for acute rhinitis. Sambucus is more diaphoretic and Euphrasia is more astringent. Sambucus is specific for the nose, and Euphrasia is specific for the eyes. The two herbs can be combined for allergic rhinitis with conjunctivitis.
441
bial agent and is specific for normalization of mucous membrane function. The two herbs can be used together as a wash for eye disorders with discharge associated with either inflammation or Deficiency or as a nasal wash for sinus problems with inflammation and infection. Euphrasia can clear Wmd Heat from the eyes and nose, and Hydrastis can be used for patterns of Lung, Stomach, or Liver Heat invading the nose or eyes. Euphrasia + Zanthoxylum
Catarrhal deafness Whilst Euphrasia and Hydrastis can be paired for Heattype disorders of the eyes, ears and nose, Euphrasia and Zanthoxylum can be paired for catarrhal disorders of the ears associated with accumulation of Phlegm from Spleen Deficient Qi and accumulation of Phlegm Cold in the Lung. Both herbs can be used for catarrhal deafness.
Topical uses ofEuphrasia
Euphrasia + Echinacea
Sinus infection Both herbs can act as cool anti-inflammatory anticatarrhals for sinus inflammation. Echinacea is the stronger antimicrobial agent, and Euphrasia is more astringent. These herbs can be combined for inflammation and infection of the sinuses and eustachian tubes, with catarrhal deafness. Euphrasia + Glechoma
Nasopharyngeal catarrh Both herbs are anticatarrhal astringents, Glechoma being useful for both nasopharyngeal catarrh and bronchitis. Euphrasia acts more on the upper respiratory tract, but both herbs can be used for catarrhal deafness, and Glechoma has been listed for tinnitus. Euphrasia + Euphorbia
Sinusitis + bronchitis Both herbs are cooling anticatarrhal agents, but Euphorbia acts more on the lower respiratory tract whilst Euphrasia acts more on the upper respiratory tract. Euphorbia can be used as an expectorant, antispasmodic; and antiasthmatic for bronchitis or bronchial asthma. The two herbs can be combined when there is phlegm in both the upper and lower respiratory tracts, for example, for sinusitis and bronchitis. Euphrasia + Hydrastis
Conjunctivitis + sinusitis Both herbs are cooling, anti-inflammatory, anticatarrhal, and astringent. In addition, Hydrastis is a strong antimicro-
The specific topical indication of Euphrasia is for eye disorders. It can also be used for disorders of the mucous membranes of nose, mouth, or throat. The preparation and dose for topical applications of Euphrasia is discussed under
Dose. Eyes Euphrasia is specific as an eyewash or as a compress for eye problems such as tiredness, inflammation, infection, discharge, and styes or swellings of the eyelids. Nose Euphrasia can be used as a nasal douche for profuse nasal discharge, as in rhinitis or sinusitis. According to Lyle, 9 it is a tonic astringent that is not too drying to the nasal mucous membranes. Mouth and throat Euphrasia can be used as a mouthwash or gargle for hoarseness, cough, sore throat, or other disorders of mouth and throat.
EUPHRASIA COMBINATIONS FOR TOPICAL APPLICATIONS Euphrasia can be used by itself for the specific topical indications above, or it can be combined with the following herbs: • with Hydrastis for eye problems, including those associated with Deficiency, Lung Phlegm, Stomach Heat, or Liver Heat • with Calendula for eye problems, especially those associated with Wmd Heat
Combining Western Herbs and Chinese Medicine
442
Euphrasia can be given internally as well as topically to support its topical action.
Euphrasia combinations Three Euphrasia combinations for internal use are discussed below: Combination
Chinese Syndromes
1. acute allergic rhinitis
Wind Heat
2. sinusitis + heat sensations
Lung Phlegm Heat
3. catarrhal deafness
Lung Phlegm Cold
CAUTION Before using any ofthe combinations below, it is important to be familiar with the cautions listedfor each herb in the combination. 1. Acute allergic rhinitis
Wind Heat
or.HY~~~~ ......
eyewash of Euphrasia combined with Calendula tis can be used in addition to the oral combination.
-;o~~~
Caution Special precautions are required with the use of Ephedra (see Cautions for this herb). '_.-.-"'".~'--
2. Sinusitis + heat sensations
Lung Phlegm Heat Herb Euphrasia Echinacea Sambucus Hyssopus Hydrastis Glechoma Phytolacca
Ratio
Temperature
Taste
1 1 1 1 1 1 1
neutral-cool cool cool warm-cool cool neutral cool
acrid, sour, bitter acrid, bitter, sl. sweet acrid, sl. bitter acrid, aromatic bitter sour, bitter acrid
.-.~,~-
:ti
.."
GENERAL ,.
USE Euphrasia Ephedra Urtica Echinacea Sambucus Glycyrrhiza
1 1 1 1 1
0.5
neutrakool warm warm-cool cool cool neutral-cool
acrid, sour, bitter acrid, sl. bitter acrid acrid, bitter, sl. sweet acrid, sl. bitter sweet
GENERAL
This combination is for Wind Heat perhaps with some Lung Phlegm Heat, and the overall temperature of the combination is cool. It can thus be used for warm disorders. The acrid taste clears Wind Heat, and the bitter taste assists in the clearance of Heat. USE
• allergic or other acute rhinitis conditions, with or without conjunctivitis
• inflammation or infection of the sinuses or Eustachian tubes, sensations of heat, maybe sinus headache PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of water, three times per day. It can be used for acute or subacute conditions or chronic conditions in the initial phase. It can be taken for 1-4 weeks until the severity of the symptoms is reduced. A different combination can then be used. If there is profuse nasal discharge or conjunctivitis or another eye inflammation, a nasal douche of Euphrasia, or Euphrasia combined with Hydrastis, can be used in addition to the internal combination. 3. Catarrhal deafness
Lung Phlegm Cold PRACTICAL NOTES .
This combination can be taken as 5 ml of 1:5 tincture in quarter of ~ cup of warm water, three times per day. It is for acute epis~des of a recurring chronic condition. It can be taken for 3-7 days, until the severity of the symptoms is reduced. During the subacute phase or remission, a different combination can be used. If there is conjunctivitis or another eye inflammation, an
. Euphrasia
1
1 Sambucus 1 Hydrastis 1 Glechoma Zanthoxylum (berries) 1 0.5 Citrus (ripe peel) 0.5 Zingiber
neutral-cool cool cool neutral hot warm hot
. _..
_.-.~
This combination is for Lung Phlegm Heat, perhaps with Wind Heat, Stomach Heat, or Liver Heat. The overall temperature of the combination is cool to treat warm or hot conditions. The dominant taste is bitter to clear Heat. The acrid taste assists in the elimination of Phlegm.
acrid, sour, bitter acrid, sl. bitter bitter sour, bitter acrid, aromatic, bitter aromatic, bitter, acrid acrid, aromatic
"-
I
.
Euphrasia GENERAL
This combination is for patterns of Lung Phlegm Cold with Spleen Deficient Qi. The overall temperature is warm to treat cool conditions. For cold conditions, Capsicum can be added. The acrid and aromatic tastes combine to warm and stimulate both the Spleen to transform Phlegm and the Lung to disperse Phlegm Cold. USE
• catarrhal deafness with sinusitis or bronchitis
443
3. Catarrhal deafness
Lung Phlegm Cold The previous combination is for Lung Phlegm with Heat, but this combination is for Lung Phlegm with Cold. This combination has Euphrasia, Glechoma, and Hydrastis for nasopharyngeal catarrh in common with the previous combination, but this combination also contains Zanthoxylum berries, Zingiber, and Citrus, which together warm and stimulate the Spleen, to transform Phlegm and the Lung to disperse it. Sambucus, Euphrasia, Zanthoxylum, and Glechoma have traditionally been used to treat catarrhal ear disorders.
PRACTICAL NOTES
This combination can be taken as 5 m1 of 1:5 tincture in quarter of a cup of hot water, three times per day. It can be used for acute, subacute, or chronic conditions. It can be taken for up to 4 weeks, until the severity of the symptoms is reduced. During remission a different combination can be used.
Research CONSTITUENTS The following constituents have been reported: • iridoid glycosides • flavonoid glycosides • other
COMPARISON OF THE THREE EUPHRASIA COMBINATIONS
Iridoid glycosides Euphrasia contains iridoid glycosides such as aucubin, catalpol, euphroside, and ixoroside. 'o
1. Acute allergic rhinitis
Flavonoid glycosides apigenin glycosides. 11
Wind Heat All the herbs in this acute allergic rhinitis combination can be used for acute allergic conditions involving rhinitis and/or conjunctivitis. Ephedra is included despite its warm temperature since it can be the most powerful of the antiallergenic herbs. Euphrasia and Sambucus are specific for rhinitis, and the anti-inflammatory and anticatarrhal actions of these herbs are supported by Echinacea and Urtica. Echinacea may contribute antiviral and antibacterial effects. 2. Sinusitis + heat sensations
Lung Phlegm Heat This combination contains Euphrasia and Echinacea just like combination No.1, but it does not contain Ephedra, Sambucus, and Urtica for Exterior Wind. Instead, this combination contains Sambucus, Hyssopus, Phytolacca, Glechoma, and Hydrastis, which can combine to treat chronic nasopharyngeal catarrh. Hyssopus and Glechoma also have expectorant action, so this combination can be used for upper respiratory catarrh accompanied by some lower respiratory congestion. The previous combination is for problems of the nose and eyes, whilst this combination is for disorders of the nose and bronchi.
Euphrasia contains quercetin and
Other Euphrasia contains tannins, lignans, and phenolcontaining carboxylic acids such as caffeic acid. t2 PHARMACOLOGICAL AND CLINICAL RESEARCH The following effects have been reported: • antimicrobial • anti-inflammatory • antispasmodic • hepatoprotective • granulation promoting • neuron regenerating • antitumor Antimicrobial Although aucubin itself did not show antiviral activity in vitro, when it was mixed with the enzyme that releases the aglycone aucubigenin from the glycoside, it had antiviral activity against hepatitis B. t3 Also, the aglycone aucubigenin was shown to have antimicrobial action against a number of bacteria, including Escherichia coli, and a small number of fungi. t4 Anti-inflammatory Administered orally at 100 mg/kg, aucubin had an anti-inflammatory effect in mice. Topical
444
Combining Western Herbs and Chinese Medicine
application of aucubin to induced mouse ear edema also demonstrated an anti-inflammatory effect. IS It has been suggested that the anti-inflammatory action of aucubin in mice may be a result of a selective inhibition of the TX-synthase enzyme. 16 Antispasmodic Aucubin in the peracylated form has shown to have an antispasmodic effect on induced contractions of both rat uterus and rat vas deferens in vitro. 17 Hepatoprotective Aucubin showed high hepatoprotective activity in vivo against carbon tetrachloride-induced hepatic damage in mice and had strong antidotal effects on mushroom poisoning in dogs administered with aqueous extract of Amanita virosa.1 8 An in vitro study with isolated rat hepatocytes showed that aucubigenin inhibited cytochrome P-450 but that aucubin did not. The authors suggested that the reported hepatoprotective effect of aucubin against carbon tetrachloride may be due to the aglycone aucubigenin, which may be formed by hydrolysis in the gut. 19 Granulation promoting Granuloma formation and collagen synthesis were increased by the administration of a methanol extract of the fresh cortex of Eucommia ulmoides, and aucubin was found to be one of the main active components."O Neuron regenerating Aucubigenin promoted neuronal cell differentiation in neuron cell cultures, an essential stage in the regeneration of nerve tissues. This has possible application to the treatment of dementia since this disorder is characterized by progressive neuronal degeneration. 21 Antitumor Aucubin was reported to have no antitumor activity in mice at a dose of 100 mg/kg when administered by intraperitoneal injection. However, administration of the aglycone of aucubin at the same dose did have antitumor effect. 22
TOXICOLOGY
..
-'.:~~.---"-
-~~·~·.""""'II
According to Mills and Bone,23 no toxic effects have been . _ reported from the use of eyebright.
0.
;~
?~~;!lF-
~~~~"::"
....
Dose Dried herbs
The BHpH listed 2-4 g of dried herb, three
times per day. Tincture
The BHP listed 2-6 ml of 1:5 tincture in 45%
alcohol, three times per day. Initial dose Duration
Can start at the standard dose. Can be taken long-term.
Topical use 5-10 g of dried herb can be gently simmered in ._,,_. "'" about 150 ml of water for 10-15 minutes, carefully straine~:.7-";~~·_ of all particles, and transferred to a sterile container. The liq~;~:i,c uid can be used at body temperature as an eyewash or nasal douche several times per day, as required. For a hot compress for styes, a pad of muslin can be dipped in the hot dec~ction, lightly wrung out, and applied to the stye as hot as is comfortable. The decoction should be made fresh every day to maintain sterility, especially when it is used for topical eye applications.
Cautions Western contraindications
None known.
Chinese contraindications
None are given in the Chinese
Herbal Medicine Dictionary for mang xiao m1 cao or xiao mi cao. Pregnancy and lactation
RESEARCH VERIFICATION OF
-
No adverse reports.
Ability to drive and use machines
No adverse reports.
TRADITIONAL ACTIONS I have not yet seen research studies using preparations of Euphrasia the herb. All evidence for therapeutic effects is indirect. coming from studies on aucubin or aucubigenin. These chemicals have demonstrated anti-inflammatory and neuron tonic effects, but no astringent or anticatarrhal actions. Additional uses suggested by research Antimicrobial, antispasmodic, hepatoprotective, granulation promoting, and antitumor effects have been demonstrated for aucubin or aucubigenin.
Side effects Overdose
None known. No adverse reports.
Interactions
No adverse reports.
Regulatory status l . .r
Please read the Regulatory status section in the chapter on Safety. Euphrasia (eyebright) is on the UK General Sale List,
J
Euphrasia and it is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Euphrasia is not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning
445
Lung (nose)
Eyes
on its use.
cough,hoarseness sinusitis conjunctivitis eye fatigue
Ears
earache, catarrhal deafness
Traditional sources PROPERTIES Temperature According to Gerard,23 eyebright is hot and dry. Tabernaemontanus~6 wrote that it is warming and dry27 ing, but he recommended it for hot eye diseases. Lonicerus said that eyebright can only be used for eye diseases that are hot. The Chinese Herbal Medicine Dictionary listed mang xiao mi cao (E. maximowiczii Wettst.) as cold and xiao mi cao (E. regelii Wettst.) as cool, but these are not commonly used herbs in China. Euphrasia, as used in the West, is classified in this book as neutral-cool in temperature since, based on its traditional use, it appears to have two aspects to its anticatarrhal and astringent actions: • neutral tonic for the eyes • cool anti-inflammatory for the eyes Taste Taste in the mouth The taste is described by the BHP as slightly astringent and by Wichtl as slightly bitter. I found a
1:5 tincture in 25% alcohol to have a sweet, slightly sour odor, and a taste that was slightly sour, slightly bitter, slightly acrid, and slightly sweet. I found a sample of dried cut herb to have very little odor, and a taste that was definitely acrid, slightly sour, slightly bitter, and slightly sweet. Taste properties The Chinese Herbal Medicine Dictionary
lists both mang xiao mi cao (E. maximowiczii Wettst.) and xiao mi cao (E. regelii Wettst.) as bitter, but these herbs do not appear to have had a thorough energetic evaluation in terms of Chinese medicine. In this book, Euphrasia, as used in the West, is classified as acrid, sour, and bitter. It has the acrid capacity to clear Exterior Wind (especially Wind Heat), the sour astringent property, and the bitter, cooling antiinflammatory capacity.
ORGANS In terms of Chinese medicine, Euphrasia, as used in the West, can be associated mainly with disorders of the followingorgans:
Felter and Lloyd
BHP BHP Wichtl Felter and Lloyd, Ellingwood
The Chinese Herbal Medicine Dictionary listed mang xiao mi cao (E. maximowiczii Wettst.) as entering the Lung, Spleen, and Large Intestine meridians, but did not give meridians for xiao mi cao (E. regelii Wettst.). ACTIONS The main Western traditional actions of this herb are: • anticatarrhal • astringent • anti-inflammatory • tonic Anticatarrhal, astringent, and anti-inflammatory These three actions are closely linked and are discussed together. Culpeper wrote that this herb can be used for all infirmities of the eyes that cause dimness of sight, and Gerard recommended Euphrasia for darkness and dimness of vision. Lyle listed Euphrasia as a mild, stimulating, astringent tonic especially for the mucous membranes "wherever there is too free discharge, whether it be of the bladder, urethra, bowels, or bronchi." He recommended it for cholera infantum, leukorrhea, gonorrhea, cystic catarrh, and catarrhal ophthalmia, and especially for atonic congestions and inflammations of the eyes. Felter and Lloyd classified Euphrasia as a slightly tonic astringent and anticatarrhal, specifically for the mucous membranes of nose, ears, and eyes. They gave the specific indications for this herb as acute catarrhal disorders of the eyes, nose, and ears, including profuse, thin, watery nasal discharge with the common cold. They cited Scudder as rec, ommending this herb for "secretion of acrid mucous from eyes and nose with heat and pain in frontal sinus." Ellingwood recommended Euphrasia for cough, hoarseness, and catarrhal sequela of measles, such as catarrhal conjunctivitis, catarrhal deafness, and chronic nasal catarrh. He wrote that in the so-called snuffles of very young infants, sID drops of Euphrasia tincture may be put in half a cup of water, and a teaspoon be given every 10-30 minutes. The BHP listed Euphrasia as an anticatarrhal, astringent, and anti-inflammatory herb for conjunctivitis and sinusitis. Its traditional use in Germany is noted in Wichtl, internally
446
Combining Western Herbs and Chinese Medicine
for coughs and hoarseness, and as local applications for styes and inflammation or fatigue of the eyes.
4. Ellingwood F. American ~ateria Medica, Therapeutics. and. Pua,'Jn"_''''' cognosy, 11th edn. (1919). Reprinted by Eclectic Medical Publi~' ;' .. ".-
Tonic Tabernaemontanus, Culpeper, Gerard, Lyle, and Felter and Lloyd emphasized the tonic action of Euphrasia, either on weak eyes and dimness of vision or for catarrhal conditions of the eyes due to atonic mucous membranes. Wichtl noted traditional use of Euphrasia in Germany for functional visual disturbances of muscular or nervous origin, and both Tabernaemontanus and Culpeper recorded the use of this herb not only for weak sight. but also for a weak brain or memory. This is interesting in view of recent research data that aucubin can be used for neuron regeneration and may be of use in the treatment of dementia due to neuronal degeneration.
5. Kloss J. Back to Eden. 5th edn. (1939). Reprinted by Lifeline Boob, .;;~:~ Santa Barbara, California (1975) .. -~:, :;;~.
Sandy,Oregon (1994)
•.
6. Christopher JR. School of Natural Healing. BiWorld, Provo. Utah';
7.
~::e:)
NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm, Stuttgart. Germany (1994), from 2nd German edn, Wicht!
'.~~i: :':~'c
M (ed) (1989) 8. Jiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science & Technology Press, Shanghai. China (1975) 9. Lyle TJ. Physio-Medical Therapeutics, Materia Medica and Pharmacy (1897). Reprinted by The National Association of }'Iedical Herbalists of Great Britain. London, United Kingdom (1932) 10. Kr6likowska M.Acta Polon Pharm 17:23 (1960). Roczn. Chern 41:529
COMPARISON OF WESTERN AND CHINESE USE OF EUPHRASIA SPECIES
(1967) 11. MatIawska I, Sikorska M, Kowalewski Z. Herb Polon 31: 119 (1985) 12. Harkiss KJ and Tmunins P. Planta Med 23:342 (1973)
In the case of Euphrasia. little comparison can be made in view of the paucity of information in the Chinese Herbal Medicine Dictionary. According to this text, mang xiao mi cao (the aerial parts of E. maximowiczii Wettst.) clears Heat, releases toxins and is used to treat swollen and sore throat, cough from lung inflammation, and mouth sores. xiao mt cao (the aerial parts of E. regelii Wettst.) clears Heat and is used to treat thirst from Heat patterns, restlessness, headache, and difficulties in urination. However, these herbs do not appears to have had great use or study in China. These Chinese species of Euphrasia do not seem to have been used as topical or internal treatments for either eye disorders or catarrhal disorders of the upper respiratory system, such as acute rhinitis or chronic sinusitis, which have been the most important indications for Euphrasia species in the West.
13. Chang I. Phytother Res 11:189-192 (1997) 14. Rombouts JE. Links J. Experientia 12(2):78-80 (1956) 15. Recio M, Giner RM, Manez S et al. Planta Med 60:232-234 (1994) 16. Bermejo Benito P, Diaz Lanza AM, Silvan Sen AM et al. Planta Med 66(4):324·328 (2000) 17. Ortiz de Urbina AV, Martin ML, Fernandez B et al. Planta Med 60:512515 (1994) 18. Chang 1M. Res Commun Mol Pathol Pharmacol 102(2):189-204 (1998) 19. Batholomaeus A, Ahokas J. Toxicol Lett 80:75-83 (1995) 20. Li Y, Kamo S, Metori K et al. Bioi Pharm Bull 23(1):54-59 (2000) 21. Matsurni Y, Katsunori H, Kenzo C et al. Bioi Pharm Bull 17(12):16041608 (1994) 22. Isiguro K, Yamaki M, Takagi S et al. Chern Pharm Bull 34(6):2375-2379 (1986) 23. Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone, Edinburgh, United Kingdom (2000)
References 1. Grieve M.A Modern Herbal, vols. 1 & 2. Dover Publications, New York, New York (1971) 2. Culpeper N. Culpeper's Complete Herbal & English Physician Enlarged. Meyerbooks, Glenwood, Illinois (1990) 3. Felter HW, lloyd IU. King's American Dispensatory, vols. 1 & 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1983)
24. British Herbal Pharmacopoeia. British Herbal Medicine Association, West Yorks, United Kingdom (1983) 25. Gerard J. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publica· tions,NewYork, New York (1975) 26. Tabernaemontanus IT. Krauterbuch (1731). Reprinted by Verlag Konrad Kolbl, Miinchen, Germany (1993) 27. Lonicerus A. Kreuterbuch (1679). Reprinted by Verlag Konrad Kolbl, Milnchen, Germany (1962)
-u-'~-
i
[
Filipendula Botanical name Filipendula ulmaria (1.) Maxim. Family Rosaceae Pharmaceutical name Spiraeae herba or Spiraeae flos Part dried aerial parts or flowers English meadowsweet German MadesuB French reine-des-pres Mandarin F. ulmaria (1.) Ma:'ci.m. is not used Use in the West Filipendula is native to Europe, where it has had a long tradition of herbal use. Once called meadwort, it has been used for centuries in Europe as an ingredient of mead, wine, or beer. Beers once had true nutritional and healing value, and Grieve l gives an old recipe for a beer made from the herbs meadowsweet, yarrow, dandelion, and nettles mixed with yeast and honey. Variations on this recipe, which include agrimony or lavender, are given by Buhner in Sacred and Herbal Healing Beers. 2 Culpepe~ used Filipendula, which he called queen of the meadows, as an antiinflammatory, astringent, and antihemorrhagic for inflammation of the eyes, vomiting, colic, diarrhea, leukorrhea, and 'all manner of bleedings.' In the West, Filipendula is now mainly used for gastritis and peptic ulcer, and also has a tradition of use for the common cold, rheumatism and arthritis, 4 acute catarrhal cystitis, and diarrhea. 5 Filipendula is also found in North America, but has not been widely used in the USA as a herbal medicine. It is not mentioned by the American authors Christopher,6 Ellingwood/ Felter and Lloyd,8 Kloss,9 or Lyle,IO although it is
Use in China
There is no entry for Filipendula in the Chinese Herbal Medicine Dictionary,12 and it would seem that this herb is not a part of the Chinese materia medica.
What is special about Filipendula In terms of Chinese medicine, Filipendula can be said to be a cool, sour, and bitter herb, which has its main internal effects on the Stomach, Intestines, and Bladder.
The key to understanding Filipendula .is that: • it is primarily an anti-inflammatory herb which can be used to treat inflammation in specific organs, especially the stomach or bladder • it can also be used to treat generalized inflammatory conditions manifesting in one or more areas, including the joints, the stomach, or the bladder • it has a secondary astringent action that supports the anti-inflammatory action, as in the treatment ofgastrointestinal inflammation with diarrhea CHINESE ACTIONS In terms of Chinese medicine, Filipendula, as used in the West, can be said to have three main actions: I. dear Stomach Heat II. dear Heat in the muscles and joints III. dear Bladder Heat
briefly discussed by Tierra. I1
447
Combining Western Herbs and Chinese Medicine
448 WESTERN ACTIONS
However, it is not specifically a Ym tonic and may need to be:~~~~ combined in this case with herbs such as Althaea and~'~::J~
The main Western actions of Filipendula are shown here in terms of its three main Chinese actions:
Ophiopogon.
-"'"!~':t!=
:~
Limitations ofFilipendula I. clear Stomach Heat
anti-inflammatory astringent
II. clear Heat in the muscles
anti-inflammatory antirheumatic antiarthritic
and joints
III. clear Bladder Heat
anti·inflammatory astringent
WESTERN USES
TEMPERATURE Filipendula is classified as cool in this book. It can be used for warm or hot conditions. However, for severe conditions of Heat, it may need to be combined with other herbs, such as Hydrastis or Humulus.
,:,
TASTE
The main Western uses of Filipendula can be related to its three main Chinese actions:
Filipendula is classified in this book as sour, associated with its astringent action, and bitter, associated with its anti- , ,~,~ inflammatory action. It does not seem to have such a strong ';7oii=-
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;"
.; ".fJ;"
, ' : ' , -"
·';~·;':>'~:.__~1-E:·:<;::;:~./
C~inese~<:!ion~L
Western uses
I. clear Stomach Heat
gastritis. peptic ulcers
II. clear Heat in the muscles
rheumatism, arthritis
astringent action associated with the sour taste as Potentilla, for example, nor does it have such a strong antimicrobial action associated with the bitter taste as Berberis.
urinary tract inflammations
ACTIONS
and joints
III. clear Bladder Heat
DIRECTION OF ENERGY Filipendula does not so much direct the movement of energy in a specific direction. Rather, its effect is to clear Heat or Damp Heat either from specific areas or from the body in general.
TYPICAL CASE EXAMPLE
Anti-inflammatory Filipendula can be effective in treating inflammations of the stomach, bladder, muscles or joints. It is not often used to treat inflammatory conditions of other , systems, for example, respiratory or hepatobiliary condi-·..·. , . tions. The anti-inflammatory action of Filipendula appears to be linked to the combined effect of its three main groups of constituents: salicylates, flavonoids, and tannins. However, there are certain limitations on its anti-inflammatory action:
Signs and symptoms The patient has recurring gastritis with a burning sensation in the epigastrium that is relieved by eating and aggravated by coffee and tea. They frequently have an acid taste in the mouth, a mild sensation of heat, irritation, and discomfort in the stomach and intestines, and occasional mild diarrhea with a slight sensation of heat. The patient occasionally has a sensation of heat and some stiffness in the joints of the hands and feet. The pulse is slightly rapid and thin, and wiry in the Stomach position. The tongue is thin and red, and has a thin, yellow, greasy coat, especially in the back. Diagnosis The patient has Stomach Deficient Yin with Deficiency Heat, some Damp Heat in the Intestines, and some Damp Heat in the joints. Choice of Filipendula This herb can clear Heat and Damp Heat from the Stomach, Intestines, Bladder, and joints.
• it is not as much a demulcent, mucilaginous, antiinflammatory agent as Althaea • it is not as much a Ym tonic, anti-inflammatory agent as Ophiopogon • it is not as much an antimicrobial, alkaloid, antiinflammatory agent as Hydrastis Astringent Filipendula has a high hydrolyzable tannin content and can be used for diarrhea in children. However, it does not have as strong a tradition of use as a general-purpose astringent as, for example, Capsella, Geranium, Potentilla, or Quercus. Diaphoretic and antipyretic Filipendula has been used, especially in France and Germany, for colds, influenza, and fever. However, I prefer Achillea as a diaphoretic and antipyretic for these disorders, and do not use Filipendula unless
•"
Filipendula there are also signs of gastrointestinal inflammation, urinary inflammation, or inflammation in the muscles or joints. Diuretic Especially in France and Germany, Filipendula has a tradition of use as a diuretic to increase urination. However, I prefer Taraxacum or Petroselinum as a diuretic and do not use Filipendula to increase urination unless there are also signs of urinary inflammation, especially accompanied by rheumatism, gout, or arthritis. Alterative Filipendula has been used as a mild alterative. I might use Filipendula as an anti-inflammatory for the kind of generalized inflammatory condition that the patient might describe as, "My whole system .iust feds too acid, and I need to drink a bucket of bicarbonate, fizz tor half an hour, and feel better:' However, unlike Taraxacum or Berberis, I do not consider Filipendula to be a liver or blood cleansing alterative herb. Analgesic In France, Filipendula has been used as a mild analgesic for headache and toothaches, possibly due to its salicylate constituents. I have not used it for this purpose, so I cannot comment.
Filipendula paired with other herbs The discussion of the limitations of each of the main actions of Filipendula can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Filipendula beyond its limitations. The basic unit of herb combination is the herb pair. Six pairings of Filipendula are briefly explained below.
CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair. Filipendula + Glycyrrhiza
Peptic ulcer Both herbs contain anti-inflammatory constituents: Filipendula contributes salicylates, flavonoids and tannins, and Glycyrrhiza contributes triterpenoid saponins. Both herbs are specific for gastritis, peptic ulcers, or gastrointestinal inflammatory disorders. Filipendula + Ophiopogon
Gastritis + thirst Both herbs can clear Stomach Heat and treat gastric inflammation. Ophiopogon can also tonify Stomach Yin,
449
assist in the generation of Fluids, and relieve thirst and dry mouth associated with Stomach Heat. . Filipendula + Viola
Cystitis Both herbs can have anti-inflammatory action on the urinary system and can be used to treat cystitis and urethritis. Viola has sweet and mucilaginous constituents that can act as both Ym tonics and demulcents for the urinary system. These herbs can also help to treat gout and arthritis linked to Damp Heat. Filipendula + Arctium
Gout Arctium has alterative and diuretic actions, which are supported by Filipendula. The two herbs in combination can have an anti-inflammatory effect on conditions such as gout and arthritis. Filipendula + Harpagophytum
Arthritis Harpagophytum is specific for arthritis associated with Damp Heat in the joints and is assisted by Filipendula, especially in cases of arthritis linked to gastric hyperacidity or recurring generalized inflammatory conditions. Filipendula + Populus
Arthritis + anemia Both herbs have anti-inflammatory and antiarthritic action, probably as a result of their various salicylate constituents. Populus is also a bitter digestiv~ tonic herb with a tradition of use for digestive and hepatic weakness with anemia. The two herbs can be paired for cases of arthritis with exhaustion and anemia resulting from blood loss due to gastric damage.
Filipendula Combinations Two Filipendula combinations are listed below: Combination 1. peptic ulcer
Stomach Heat
2. arthritis + exhaustion
Damp Heat + Deficient Yin
CAUTION
Before using any ofthe combinations below, it is important to be familiar with the cautions listed for each herb in the combination.
Combining Western Herbs and Chinese Medicine
450 1. Peptic ulcer
Stomach Heat • __•
-
0• • • •
..":,::",:.,,,,_,_.
_.:>".,;:",~.=
Herb:. ...::.,_"',.; Ratio., '.• Ternperature':·:--::TJa,~~~--';0-::~,~~:
Ophiopogon
1 1 1 1 1
Glycyrrhiza
0.5
Calendula Filipendula Hydrastis Valeriana
cool cool
bitter sour, bitter
cool
bitter
cool
bitter, sweet
cool neutral-cool
sweet. 51. bitter sweet
tion, Harpagophytum, Arctium, Viola, and FilipeIidula~: act as anti-inflammatory herbs to treat gout, arthritis,-or rheumatism. Arctium and Viola can also act as alteratives to ;.clear Damp Heat and Heat Toxins from the body.
Research CONSTITUENTS The following constituents have been reported:
This combination is the same as Calendula: peptic ulcer and is discussed under that heading.
• flavonoid glycosides • phenolic glycosides • essential oil
2. Arthritis + exhaustion
• tannins • other
Damp Heat + Deficient Yin
Harpagophytum Arctium (root) Populus tre. Viola trio Filipendula Ophiopogon Glycyrrhiza
1 1 1 1
0.5 0.5 0.5
cool
bitter
cool neutral-cool
51. acrid,s!. bitter
cool cool cool neutral-cool
bitter, sour sour, sweet, bitter sour, bitter sweet. 51. bitter sweet
This combination is the same as Harpagophytum: arthritis + exhaustion and is discussed under that heading.
Flavonoid glycosides Filipendula contains about 1% of. .~" flavonoid glycosides, which are mainly glycosides of qu~r,'::~~ cetin: spiraeoside in the flowers and avicularin and hyperoside in the leaves. 13 Phenolic glycosides This is mainly spiraein, the primeveroside of salicylaldehyde, in the flowers, and monotropitin, the primeveroside of methyl salicylate, in the flowers and leaves. 14 Essential oil Filipendula contains about 0.2% essential oil. When the oil is steam-distilled from the flowers, it contains about 75% salicylaldehyde, 3% phenylethyl alcohol, 2% ben~· .,;;.,;;.;. zyl alcohol, 2% anisaldehyde, and 1.3% methyl salicylate. IS
COMPARISON OF THE TWO FILIPENDULA COMBINATIONS 1. Peptic ulcer
Stomach Heat All the herbs in this combination are indicated for gastritis and peptic ulcers. Calendula and Hydrastis are astringent anti-inflammatory herbs that can clear Stomach Heat and help to heal damaged gastric mucous membranes. Filipendula, Ophiopogon, and Glycyrrhiza have a gastrointestinal anti-inflammatory effect, and Ophiopogon and Glycyrrhiza can help to tonify Stomach Yin. Valeriana can clear Stomach Heat and has calming and antispasmodic actions. 2. Arthritis + exhaustion
Damp Heat + Deficient Yin Both combinations contain Filipendula and Ophiopogon. This pair of herbs can clear Heat, Damp Heat, or Deficiency Heat, and act as anti-inflammatory agents for the stomach, intestines, bladder, muscles and joints. Ophiopogon and Glycyrrhiza can also tonify Yin. In this combina-
Tannins Filipendula contains 10-15% tannins. According to Bruneton,16 these include gallic and hexahydroxydiphenic esters of glucose, and rugosin-D. Other On tasting a 1:5 (25%) tincture of Filipendula, I experienced a definite sweet taste, suggesting the presence of appreciable sugars or starches, and a slight mucilaginous sensation in the mouth, suggesting the presence of mucopolysaccharides. I have not seen any references for these substances in the literature. PHARMACOLOGICAL AND CLINICAL RESEARCH The following effects have been reported: • antimicrobial • anti-inflammatory • antiulcer • immunoregulatory • anticoagulant • antitumor
...
...
r i
Filipendula ~-
Antimicrobial In vitro studies have reported antimicrobial activity for Filipendula extracts against a variety of pathogenic bacteria.17.18.19 Gallotannins have been reported 20 - to have a bactericidal effect on Streptococci in vitro.
--
r~
I
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r
Anti-inflammatory It has been stated that Filipendula has an anti-inflammatory activity that was attributed to salicylate aglycones derived from phenolic glycosides such as monotropitin. 2! Antiulcer Filipendula decoctions were effective in preventing acetylsalicylic acid-induced stomach lesions in rats and promoted healing of stomach lesions induced by ethanol,l2 Both condensed tannins 23 and hydrolyzable tannins2~ have been shown to inhibit acid secretion. Immunoregu1atory An ethyl acetate extract of the flowers inhibited the classic pathway of complement activation, but this could not be linked to the presence of tannins. flavonoids. or salicylates, suggesting that other compounds may be linked to the immunoregulatory effects. 23
I' 1.'
\
Anticoagulant Oral administration of preparations of flowers or seeds of Filipendula have shown anticoagulant activity both in vitro and in vivo. 26 Antitumor Local administration of Filipendula decoction resulted in 39% reduction in the frequency of induced squamous-cell carcinoma of the cervix and vagina in mice. The same authors reported that cervical dysplasia was reduced in 67% of patients treated with Filipendula ointment.27
451
Salicin Willow bark from Salix species, and poplar bark from Populus tremuloides, both contain the phenolic glycoside salicin. which does not damage the stomach, but which is split by the gut flora into salicyl alcohol (saligenin) and glucose. The salicyl alcohol is absorbed and oxidized in the blood and liver to salicylic acid, which is the main active form. 29.30 Although not as active as the synthetic drug acetylsalicylic acid, salicylic acid in the bloodstream can have antipyretic, anti-inflammatory, antirheumatic, and analgesic actions. Filipendula salicylates It may be that the salicylaldehyde glycosides in Filipendula, such as spiraein and monotropitin, are converted to salicin in the stomach or small intestine, as indeed is the salicylaldehyde glycoside salicortin in willow bark. The salicin is then converted to salicyl alcohol in the gut, and then to salicylic acid in the blood and liver. However, no pharmakinetic data is yet available. Combined anti-inflammatory effect of Filipendula constituents The anti-inflammatory and other effects of the salicylates in Filipendula may be enhanced, buffered, or modified by the other main groups of constituents, such as the hydrolyzable tannins and the flavonoid glycosides. Unlike orally administered salicylic acid, which has a detrimental effect on the gastric lining, the Filipendula constituents have beneficial effects on the -gastric lining, possibly because of the interactions of the different constituents.
RESEARCH VERIFICATION OF TRADITIONAL ACTIONS
THERAPEUTIC IMPORTANCE OF THE FILIPENDULA SALICYLATES
~.
According to Mills and Bone,28 salicylic acid was first isolated in 1839 from the flower buds of Filipendula. The drug salicylic acid was later synthesized, but it tended to cause considerable damage to the gastric lining. Acetylsalicylic acid was then introduced in an attempt to reduce gastric side effects. and the name aspirin derived from Spiraea. the old generic name for meadowsweet. However, acetylsalicylic acid still has adverse effects on the gastric mucosa. Whilst the isolated chemicals salicylic acid and acetylsalicylic acid can have detrimental effects on the gastric lining. preparations of Filipendula herb and some of the naturally occurring salicylate compounds can have a beneficial effect on the gastric mucosa. Indeed Filipendula preparations have been shown to reduce acetylsalicylic acid-induced gastric lesions.
Filipendula preparations have been shown to have generalized anti-inflammatory and specific antiulcer effects, but there is as yet no direct evidence to show that Filipendula can act as a gastrointestinal astringent, urinary anti-inflammatory or diuretic, analgesic, antirheumatic, or diaphoretic. Filipendula contains salicylic acid precursors, and acetyl salicylic acid is known to have antipyretic, anti-inflammatory, antirheumatic, and analgesic actions. Although salicylic acid may not be as potent as acetylsalicylic acid, the presence of salicylic acid precursors is indirect evidence for these actions. Additional uses suggested by research Antimicrobial, immunoregulatory, anticoagulant and antitumor effects have been demonstrated. TOXICOLOGY According to an animal research study, aqueous and alcoholic extracts of Filipendula do not have toxic effects. 3!
452
Combining Western Herbs,and Chinese Medicine
Dose
Tincture The BHP listed 2-4 ml of 1:5 tincture in 45% alcohol, three times per day.
sweet or queen of the meadows, and it is enteredjn,Cul under queen of the meadows. Gerard' classified Filip~~;h~lt herb as cold and dry, and Culpeper wrote that this herb is"~' under the dominion ofVenus, by which he generally indieat~, .~'~!!~ ~ ed that a herb was cooling and often also moistening.' .... .,., Filipendula is not entered in the Chinese Herbal Medicin;} . Dictionary. In this book, Filipendula is classified as·S0iif -",... a cool anti-inflammatory, and in Chinese terms, it can b;~i . described as moderating Heat in the Stomach, Bladder, o~ . joints.
Initial dose
Taste
Dried herbs The BHP listed 4-6 g of dried herb, three times per day. Filipendula can be used as an infusion, so that boiling water is poured over 4-6 g of the herb, and after 10 minutes, the liquid is strained off. The resulting infusion can be drunk warm or cold.
Duration
Can start at the standard dose. Can be taken long-term.
Cautions Western contraindications Mills and Bone28 suggested, on theoretical groun4s, that this herb may be used with caution by those patients with a known salicylate sensitivity because the type and amount of salicylates in this herb are unlikely to affect such patients. Chinese contraindications This herb is not used in China. Pregnancy and lactation
_.-':;:~'-
Taste in the mouth The taste is described by Wichtl4 as as-_, tringent and bitter. I found a 1:5 tincture in 25% alcohol to have a fragrant and sweet odor, and a sour, bitter, and slightly sweet taste. The tincture felt mucilaginous in the mouth, and _', ..",. had only a slight amount of the gritty or flour-like sensation;!" "~ produced by some other tannin-containing tinctures, such ·~l!~l' as that of Potentilla.
Taste properties Gerard described Filipendula as binding. . _. This herb is not entered in the Chinese Herbal Medicine._. ',7'.J3;:' . '::."i:'z:t... Dictionary. Filipendula is classified in this book as bitter, ',;~ii; associated with its cooling anti-inflammatory action, and ',J!~ sour, associated with its astringent a c t i o n . - ">:;;l~
-----
No adverse reports.
Ability to drive and use machines No adverse reports.
ORGANS
Side effects
In terms of Chinese medicine, Filipendula, as used in the '. West, can be associated mainly with disorders of the followmgorgans:
Overdose
None known. No adverse reports.
Interactions No interactions are known for this herb. Mills and Bone suggested, again on theoretical grounds, that this herb be used with caution by those patients who are taking warfarin or similar medication, due to salicylate content.
Regulatory status Please read the Regulatory status section in the chapter on Safety. Filipendula (meadowsweet) is on the UK General Sale List, and is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Filipendula is not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
Stomach
vomiting heartburn
Culpeper BHP
Intestines
diarrhea with bleeding diarrhea in children
Gerard BHP
Bladder
cystitis diuretic
BHP Bruneton
muscles and joints
rheumatic pains arthritic pains33
BHP BHC
other
agues influenza, fever
Gerard Bruneton
The Chinese Herbal Medicine Dictionary did not list Filipendula. ACTIONS
Traditional sources PROPERTIES Temperature
Gerard 32 called this herb Regina prati, mede-
The main Western traditional actions of this herb are: • gastrointestinal anti-inflammatory • gastrointestinal astringent • urinary anti-inflammatory
Filipen.dula • diuretic • diaphoretic • antiarthritic
453
3. Culpeper N. Culpeper's Complete Herbal & English Physician Enlarged. M~ooks, Glenwood, lllinois (1990) 4. Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm, Stuttgart, Germany (1994), from 2nd German edn. Wicht! M (ed) (1989)
• analgesic • other Gastrointestinal anti-inflammatory The BHP listed Filipendula for atonic dyspepsia with heartburn and hyperacidity, and as a specific for prophyla.'<:is and treatment of peptic ulcer. The BHC listed this herb as an anti-inflammatory for gastritis and peptic ulceration. Culpeper noted the use of Filipendula for vomiting, and for this disorder, the BHP recommended the combination of Filipendula with Ballota. Gastrointestinal astringent Both Culpeper and Gerard listed Filipendula for bloody diarrhea, and the BHP listed this herb as an astringent for diarrhea in children.
5. British Herbal Pharmacopoeia. British Herbal Medicine Association, West Yorks, United Kingdom (1983) 6. Christopher JR. School of Natural Healing. BiWorld, Provo, Utah (1976) 7. Ellingwood F. American Materia Medica, Therapeutics and Pharmacognosy, 11th edn. (1919). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1994) 8. Felter HW and lloyd }U. King's American Dispensatory, vols. 1 and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1983) 9. Kloss J. Back to Eden, 5th edn. (1939). Reprinted by Lifeline Books, Santa Barbara, California (1975) 10. Lyle TI. Physio-Medical Therapeutics, Materia Medica and Pharmacy.
Urinary anti-inflammatory The BHP listed Filipendula as a mild urinary antiseptic for acute catarrhal cystitis. Diuretic Grieve listed Filipendula for stranguary and for dropsy, and Bruneton reported traditional use of this herb as a diuretic in both France and Germany. Diaphoretic Grieve, the BHP and the BHC gave the impression that the main use of Filipendula in Britain is for gastrointestinal problems. According to both Wicht! and the German Commission E monograph,34 the main use of this herb in Germany is as a diaphoretic for colds and chills.
IIlOIIi
~
:""'''1
~~
-
...
:ilIiJ
~
.
-
:..~
... ~
11. Tierra M. Planetary Herbology. Lotus Press, Twin lakes, Wisconsin (1988) 12. jiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science & Technology Press, Shanghai, China (1975) 13. Horhammer L, Hansel R and Endres W. Arch Pharm (Weinheim) 289/61:133-140 (1956) 14. Meier B, Lehmann D, Sticher 0 et al. Dtsch Apoth Z18 127:2401-2407 (1987)
Antiarthritic The BHP listed Filipendula for rheumatic muscle and joint pains, and the BHC noted its use for rheumatic or arthritic pains internally or topically. Bruneton noted its traditional use in France for minor joint pains, and its use for arthritis or rheumatism in German folk medicine is reported in Wicht!.
15. Lindeman A, Jounela-Eriksson P and Lounasmaa M. Lebensm WISS TechnoI15:286-289 (1982)
Analgesic Bruneton noted the use of Filipendula in France as an analgesic for headache and toothaches.
19. Rauha IP, Remes S, Heinonen M et al. Int J Food Microbiol56(1):3-12 (2000)
16. Bruneton I. Pharmacognosy: Phytochemistry Medicinal Plants, 2nd edn. Lavoisier, Paris, France (1999) 17. Csedo K, Monea M, Sabau M et al. Planta Med 59(suppl 7):A675 (1993) 18. Kallman S. Svensk Botanisk Tidskrift 88(2):97-101 (1994)
20. Wu-Yuan CD, Chen CY, Wu RT.I Dent Res 67(1):51-55 (1988) '~
i1
Originally published Ohio (1897). Reprinted by the National Association of Medical Herbalists of Great Britain, London, United Kingdom (1932)
a..o ~
......
Other Gerard recommended an infusion of Filipendula flowers as eyedrops to remove burning and itching and to clear the sight. According to Grieve, Filipendula gives "the . bowels some degree of nourishment" and is a mild alterative "frequently used in infections of the blood:'
21. Bezanger-Beauquesne L,PinkasM, TorckM etal. [T2] (1980). [cited in Bradley PR (ed). British Herbal Compendium. vol. 1. British Herbal Medicine Association, Bournemouth, United Kingdom (1992») 22. Barnaulov OD, Denisenko PP. Farmakol Toksikol 43(6):700-705 (1980) 23. Ezaki N, Kato M, Takizawa N et al. Planta Medica 51:34-38 (1985) 24. Murakami S, Isobe Y, IGjima H et al. Planta Medica 57:305·308 (1991)
References 1. Grieve M. A Modern Herbal, vols. 1 & 2. Dover Publications, NewYork, New York (1971) 2. Buhner SH. Sacred and Herbal Healing Beers. An Imprint of Brewers Publications. Boulder, Colorado (1998)
25. Halkes SBA, BeukeIman q, Kroes BH et al. Phytother Res 11:518-520 (1998) 26. Liapina LA. Koval'chuk GA. Izv Akad Nauk Ser Bioi (4):625-628 (1993) 27. Peresun'ko AP, Bespalov VG. Limarenko AI et al. Vopr Ookol 39(712):291-295 (1993)
Combining Western Herbs and Chinese Medicine
454
28. Mills S. Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone, Edinburgh. United Kingdom (2000) 29. Steinegger E and Hovel H. Pharm Acta Helv 47:222 (1972)
-";":
32. Gerard J. The Herbal or General History of Plants: The Complete'l633.
Edition as Revised and Enlarged by Thomas
Johnson~"D~='ler'-'"..:';:;.-;,:iiii..~~,:_~_~._
Publications. New York. New York (1975)
",.
33. Bradley PR (ed). British Herbal Compendium. vol, 1. British Herbal
Medicine Association. Bournemouth. Untied Kingdom (1992) 30. Meier B. Liebi M. Z Phytotherap 11:50 (1990)
31. Barnaulov 00, Boldina IG. Galushko VV et al. Rastite!'Nye Resursy 15(3):399-407 (1979)
34. Blumenthal M (ed). The Complete German Commission E
Monographs: Therapeutic Guide to Herbal Medicines. American . Botanical Council. Austin. Texas (1998)
L..:..:J
1--
Gentiana and Centaurium. Gentiana lutea and Centaurium erythraea are herbs from the family Gentianaceae that are similar both in biochemistry and Western tradition of use. They are discussed together in this chapter and are compared with the Chinese herbs Gentiana macrophylla and G. scabra. GENTIANA
Botanical name Gentiana lutea 1. Family Gentianaceae Pharmaceutical name Gentianae radix Part dried root English (yellow) gentian German Enzian French gentiane jaune Mandarin G.lutea 1. is not generally used: see below Use in the West Gentiana lutea is a tall herb (1-1.5 m) that grows wild in the mountainous areas of Europe, usually at altitudes of between 1000-2500 m. l The yellow flowers of this plant give it its specific name, from the Latin luteus (yellow). According to Grieve,2 the natural range of yellow gentian does not extend to the British Isles, but it can readily be grown there from seed. The roots are mainly obtained from wild plants coming from France, Spain, and the Balkans. There are some plantations in France, and also in Germany (where the plant is fully protected),J but the plants can only be harvested after 7-10
Dioscorides for disorders of the stomach and liver, and for inflammations of the eyes. In the 17th century, Culpeper used gentian to strengthen the appetite and digestion, treat jaundice, and strengthen the heart. Poor appetite and weak digestion remain the principle indications for Gentiana in Europe today, although it is sometimes also used for gastrointestinal pain, nausea, or hepatobiliary disorders. According to Bruneton, other European gentian species, such as G. pannonica Scop., G. punctata 1., and G. purpurea 1., 'have been used in a similar way to G.lutea.
Use in North America In the first half of the 19th century, Bigelow,4 Rafinesque,5 and Griffiths6 reported that the American species G. catesbaei (Sampson's ~nakeroot) and G. quinquefolia (stiff gentian, ague weed) were as therapeutically effective as the European species G. lutea. In 1898, Felter and Lloyd' listed the following indications for the three herbs: • G. lutea
• G. quinqueflora • G. ochroleuca
for loss of appetite, weak digestion, intermittent fever, postfebrile recovery, and exhaustion for chronic gastrointestinal atony, headache, liver disorders, jaundice for dyspepsia, dysentery, chronic catarrhal disorders, fever
Use in China
Species used G. lutea is not a plant commonly used in
years. l
Chinese medicine. It is listed in the index of Chang and ButS as ou 16ng dan, but it does not have a separate entry in either
Use in Europe In the 1st century AD, Gentiana was used by
455
Combining Western Herbs and Chinese Medicine
456
.
Chang and But or the Chinese Herbal Medicine Dictionary.9 The two main Gentiana species used in Chinese medicine are noted in the table, using data from Chang and But:
.. ,
-
treat hepatitis, cholecystitis, fever, headache, tonsilli~,~4'~" ..' toothache. However, ai lei is not an important plant' in"~~ China, and the work cited by the Chinese Herbal Medicine
Dictionary is a text on provincial herbs.
(f..tt.)
16ng dan cao (.£JI!.1j.)
Mandarin
qfn jiao
Part used
root
root
Alternative species
G. crassicaulis Duthie, G. tibetica King, G. dahurica Fisch.
G. triflora Pall., G. regescens Fransch
Actions and uses These are discussed in the Traditional sources section. G. macrophylla (qin jiiio) is used to treat arthritis, low-grade fever, or jaundice; and G. scabra (l6ng dim cao) is used to treat jaundice, eye and ear inflammations, genital pain or itching, headache, spasms, and convulsions.
CENTAURIUM Botanical name Centaurium erythraea Rafn Family Gentianaceae Pharmaceutical name Centaurii herba Part dried flowering aerial parts English centaury German Tausendgiildenkraut French petite centauree Mandarin C. erythraea is not used: see below Use in the West Centaury is a small annual or biennial herb growing in meadows or forest clearings in North America and Europe,2 and in northern Africa and Western Asia. lO Gerard 10 reported that Pliny called Centaurium fel terrae or gall-of-the-earth due to its bitterness. The name felwort, which Gerard used for the gentian family, may derive from this. According to Grieve, Erythraea, the old generic name for centaury, is derived from the Greek erythros (red) due to the red color of its flowers. According to Gerard, Dioscorides and Galen used centaury to clear excessive choleric humor from the body. Both Gerard and Culpeper used it for obstructions of the spleen, liver, and gallbladder, and Culpeper also used it for anemia, pains in the joints, and convulsions. Centaurium is now mainly used in the West for loss of appetite and atonic digestion, or, less commonly, for hepatobiliary weakness. Species used in China C. erythraea is not used in Chinese medicine. The Chinese Herbal Medicine Dictionarl l has an entry for iii lei, the entire plant of C. pulchellum Druce var. altaicum Kitag. et Hara, otherwise known as C. meyeri (Bge.) Druce. This plant is used to clear Heat and Toxin to
What is special about G.lutea and Centaurium These herbs are similar in properties, actions and uses, and in terms of Chinese medicine, can be said to be neutralcool in temperature and bitter in taste property. Their primary effects can be said to be on the Spleen, ~tomach, and Smalllntestine, and their secondary effects are on the Liver and Gallbladder.
The key to understanding Gentiana and Centaurium, is that: • by acting as neutral, bitter, digestive tonics, they can indirectly strengthen the body in general to treat exhaustion and ro'eakness • by acting as cool, bitter, digestive anti-inflammatories, they can reduce gastrointestinal inflammation and indirectly improve the efficiency ofdigestion and absorption CHINESE ACTIONS In terms of Chinese medicine, G.lutea and Centaurium, as used in the West, can each be said to have two main actions:
!!...
1. tonify the Qi of the Spleen, Stomach, and Small Intestine II. clear Heat from the Stomach and Small Intestine
WESTERN ACTIONS ii~"
The main Western actions of G.lutea and Centaurium are shown here in terms of the two main Chinese actions: ~
1. -
-.'
~'T~":~T=;.;,-;:':;:·:.{';~
Western actions' ":'!.. .•
Chinese actions '-f
><'
"f-
:>-: . £
I. tonify the Qi of the Spleen. Stomach, and Small Intestine
bitter digestive tonic
II. clear Heat from the Stomach and Small Intestine
bitter gastrointestinal anti-inflammatory
•• '
Tonic actions
Bitter digestive tonic action Both Gentiana and Centaurium have had a long tradition of use in the West as digestive tonics. As discussed in the Research section, the bitter principles of Gentiana and Centaurium have been shown to:
,
I-
i
Gentiana and Centaurium • increase gastric secretions and thereby stimulate appetite and digestion • increase the secretion of bile by the liver and the flow of bile from the gallbladder into the duodenum
General tonic action In terms of Chinese medicine, it can be said that strengthening digestion and absorption by tonifying the functions of Spleen, Stomach, and Small Intestine will indirectly increase both Qi and Blood. Indeed, Gentiana and Centaurium have had a long tradition of use in the West as general tonics for exhaustion, anemia, and recovery from fever and chronic illnesses. If the digestion is weak, then there will tend to be general Deficiency of Qi and Blood, with lowered resistance to disease, recurring infections, and lingering chronic illnesses. It has been reported that low gastric acidity may result in: • poor nutrient absorption ll • abnormal bowel flora 13 • increased susceptibility to bacterial and parasitic enteric infections 13 • allergic asthma 12
('
I
v--
By normalizing gastric acidity, Gentiana and Centaurium may indirectly help to correct these disorders. It has also been reported that G.lutea may strengthen the immune system; see Research. Anti-inflammatory actions Gentiana and Centaurium can be used for gastrointestinal conditions in which weakness is combined with inflammation. In Chinese terms, the inflammation may arise from Deficiency and Stagnation of Qi in the Stomach and Small Intestine turning into Heat. If there is inadequate secretion of gastric acid and pepsin, there may be inadequate sterilization of the stomach contents, resulting in bacterial infection. Also, if there is inadequate breakdown of proteins and other large molecules, the incompletely digested products may act as antigenic material; and if the gut wall is damaged by inflammation, these substances may have increased entry to the bloodstream, with subsequent allergic effects.
WESTERN USES The Western uses of Gentiana and Centaurium can be related to the two main Chinese actions:
I. tonify the Qi of the Spleen, StomaCh, and Small Intestine
poor appetite, digestive weakness, epigastric discomfort, nausea, malabsorption syndromes, weight loss, exhaustion, anemia, postfebrile exhaustion, excessive swings in blood sugar levels
II. clear Heat from the Stomach and Small Intestine
457
gastrointestinal inflammations and infections, food allergies and intolerances
TYPICAL CASE EXAMPLE Signs and symptoms The patient is thin and pale with chronic poor appetite, weak digestion, epigastric discomfort, and exhaustion. The patient also has multiple food allergies and intolerances, and low resistance to infections. The pulse is thin, forceless and choppy, and slightly wiry at the SpleenStomach and Liver-Gallbladder positions. The tongue is thin and pale with tooth marks. Diagnosis The patient has Deficient Qi and Blood associated with Deficient Qi of the Spleen, Stomach, and Small Intestine. There is also some Stagnant Qi of the SpleenStomach and Liver-Gallbladder systems. Choice of Gentiana or Centaurium These herbs can tonify and move the Qi of the Spleen, Stomach, and Small Intestine, and to a lesser degree of the Liver and Gallbladder to stimulate and normalize the digestion, absorption, and assimilation of food.
Limitations ofGentiana and Centaurium TEMPERATURE These herbs are classified in this book as neutral-cool variable-temperature herbs. They can be used as: ~ n~utral
bitter digestive tonics for warm, neutral, or cool patterns of digestive weakness • cool bitter digestive anti-inflammatories for warm conditions Which temperature effect is evoked will depend on the patient's needs and on the other herbs with which Gentiana or Centaurium is combined. Neutral bitter digestive tonic To use Gentiana or Centaurium for warm or cool patterns of digestive weakness, it is best to combine them with cool or warm herbs, respectively. Cool bitter digestive anti-inflammatory Gentiana and Centaurium are cool rather than cold, so for hot patterns of digestive inflammation, it may be necessary to combine them with colder bitter anti-inflammatories, such as Berberis or Hydrastis.
Combining Western Herbs and Chinese Medicine
458 TASTE
CAUTION
The primary taste property of Gentiana and Centaurium is bitter. If other taste properties are required in addition to
Before using any of the herb pairs below, it is Important"t~;-c~:.: be familiar with the cautions listed for each herb in the pt:Jir._-~~~~-:¥fi -i
..
_-;~-{-~~
bitter, then other herbs will need to be combined with Gentiana or Centaurium. For example, for bitter combined
Gentiana + molasses
with aromatic, Gentiana can be combined with Artemisia
Anemia + weight loss
absinthium or Rosmarinus.
ACTIONS
thq
These herbs complement each other's action since both tonify Blood and Qi, but by different mechanisms. Gentiana is a bitter digestive tonic, and molasses is a sweet nutritive tonic.
Digestive tonic
Gentiana and Centaurium are mainly ton-
ics for the gastrointestinal system, or, in terms of Chinese medicine, the Spleen, Stomach, and Small Intestine. Although both herbs have been listed in older texts for liver and gallbladder problems, modern herbal books do not emphasize this use. I only use them as secondary herbs for this purpose in combination with herbs that are specific for Liver and Gallbladder, such as Artemisia absinthium,
Gentiana + Angelica sinensis
Anemia + exhaustion Gentiana is a bitter digestive tonic, and Angelica is sweet herb, which is also slightly aromatic, acrid, and bitter, and which can tonify and move the Blood. The two herbs can combine to treat anemia and exhaustion.
Rosmarinus, or Taraxacum.
Gentiana + Panax ginseng
General tonic
Exhaustion + digestive weakness
Gentiana and Centaurium can indirectly
tonify the Qi and Blood by strengthening the appetite, digestion, absorption, and assimilation. They are bitter tonics, and, if sweet, aromatic or sour tonic actions are required, other herbs will need to be combined with Gentiana or Centaurium.
Cardiotonic Although Culpeper wrote that gentian can comfort the heart, there is not a major tradition of use of either Gentiana and Centaurium as heart tonics in the West.
Centaurium paired with other herbs Centaurium and Gentiana are very similar in their indications, and Centaurium is less commonly used. Therefore, to avoid duplication, no Centaurium herb pairs are described. However, Centaurium could be substituted for Gentiana in the Gentiana herb pairs described below.
Gentiana paired with other herbs Discussion of the limitations of each of the main actions of Gentiana can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of this herb beyond its limitations. The basic unit of herb combination is the herb pair. Twelve pairings of Gentiana are briefly explained below.
This pair of herbs can tonify Qi by different mechanisms. Gentiana is a bitter digestive tonic and Panax is an adaptogenic tonic, which is specific for tonifying the Kidney. These herbs can be used together to treat exhaustion from Qi Deficiency of both Spleen and Kidney. Gentiana + Centaurium .
Poor appetite + digestive weakness Gentiana and Centaurium are a pair of herbs giving an excellent example of similar herbs that complement each other's effects. These two herbs are chemically similar, but not identical. Their chemical differences may enable them to do the same job of bitter digestive tonic via different routes. Gentiana + Cinchona
Postfebrile exhaustion Both Gentiana and Cinchona can act as bitter digestive tonics, and both can be used as general tonics for postfebrile weakness. Both herbs can be used to treat intermittent fever, although Cinchona is more effective at treating this than Gentiana. Cinchona can also act as a bitter tonic and regulator of heart function. Gentiana + Crataegus
Digestive weakness + cardiac weakness These herbs complement each other since they can both act as general tonics to treat exhaustion. However, Gentiana is more for digestive weakness associated with Spleen
H
-
-_-
-
Gentiana and Centaurium Deficient Qi, and Crataegus is more for cardiac weakness associated with Heart Deficient Qi. Gentiana + Artemisia absinthium r-;:
Digestive weakness + hepatic weakness Gentiana is bitter, and Artemisia is bitter and aromatic. Both herbs can tonify and move Spleen Qi and indirectly tonify Blood. Artemisia can also tonify and move LiverGallbladder Qi, so that this combination 'can be used for poor appetite and weak digestion with poor digestion of fats or other signs of sluggish liver function. In addition, Artemisia can regulate the Uterus, so that Artemisia and Gentiana can be combined to treat amenorrhea with anemia. Gentiana + Rosmarinus
Digestive weakness + sensations ofcold Both Gentiana and Rosmarinus can act as bitter digestive tonics. However, Gentiana is neutral in temperature, and so is complemented by Rosmarinus, which can act as a warming aromatic carminative and antispasmodic. Gentiana and Rosmarinus can be combined to treat digestive weakness with retention of food in the stomach, epigastric distension and discomfort, flatulence, intestinal colic, and sensations of cold. Gentiana + Taraxacum
Hepatobiliary disorders
"~,..
_;0
Taraxacum is a cold, bitter herb to move Stagnant LiverGallbladder Qi and drain Liver-Gallbladder Heat. Gentiana is only a secondary herb for Liver-Gallbladder disorders, which is mainly used when hepatobiliary problems are combined with gastrointestinal weakn,ess.
tion, and can increase the efficiency of the gut membrane, both as a barrier to potentially allergenic substances and as an interface for absorption of nutrients. Gentiana + Althaea
Gastrointestinal inflammation Both herbs can have anti-inflammatory action, Gentiana as a cool bitter, and Althaea as a cool sweet demulcent. Also, both herbs can act as tonics, with Gentiana as a bitter digestive tonic and Althaea as a sweet nutritive tonic. This pair can be used for gastrointestinal inflammatory conditions linked to gastrointestinal weakness and general debility.
Centaurium combinations Centaurium and Gentiana are very similar in their indications, and Centaurium is less commonly used. However, to avoid duplication, no Centaurium combinations are described. However, Centaurium could be substituted for Gentiana in the Gentiana combinations described below.
Gentiana combinations Six Gentiana combinations are discussed below. Note that in this discussion, the term 'Spleen Deficient Qi' has been used as an abbreviation for 'Spleen, Stomach, and Small Intestine Deficient Qi:' Combinations
Chinese syndromes.
1. digestive weakness + anemia
Spleen Deficient Qi Deficient Blood
2. poor appetite + anorexia
Spleen Deficient Qi + Deficient Blood and Qi
3. recurring fever + exhaustion
Retained Pathogen + Liver Deficient Qi
4. nausea + digestive weakness
Spleen Deficient Qi + Stomach Rebellious Qi
5. food intolerances + cold sensations
Liver Stagnant Qi + Cold
6. digestive weakness + gastrointestinal inflammation
Spleen Deficient Qi + Intestines Heat
Gentiana + Hydrastis
Gastrointestinal inflammation and infection The bitterness of Hydrastis supports the digestive tonic action of Gentiana, but the presence of cold Hydrastis emphasizes the anti-inflammatory and antimicrobial action of this pair. Hydrastis can also regulate mucus secretion by gastrointestinal epithella, thereby. treating catarrhal conditions, and it can act as an antihemorrhagic, thereby treating gastrointestinal bleeding. Gentiana + Agrimonia
~
I
-
459
+
Malabsorption syndromes The slight bitterness of Agrimonia reinforces the bitter digestive tonic action of Gentiana, and Agrirnonia also acts as an anti-inflammatory astringent to treat enteritis and colitis. Together, the two herbs can stimulate appetite and diges-
CAUTION
Before using any ofthe combinations below, it is important to befamiliar with the cautions listed for each herb in the combination.
Combining Western Herbs and Chinese Medicine
460 1. Digestive weakness + anemia
GENERAL
Spleen Deficient Qi + Deficient Blood Herb
-~ -.....
--: Ratio -.
Molasses Gentiana Citrus (ripe peel) Elettaria
4-8 2 1 0.5
Temperature ·,Taste -- .. ---_... -.- - -. ,
neutral neutral-cool warm warm
sweet, sl. bitter bitter acrid, aromatic, bitter aromatic. acrid
:-';"-:-":'"':'~"_...::t ... :JiI\fIII!J~
This combination stimulates appetite and digestio~·l:>y·c.21E! tonifying and moving the Qi of the Spleen, Stomach~_~d;:':-~:~':~ Small Intestine (thus tonifying Qi and Blood). Theo!era11~ temperature is slightly warm, and the main taste propertie"sc.:::;~;: .. that stimulate appetite and digestion are bitter and aromatic.- ·-:~;;;;i: -"- :'.' ~::[f.:.,-; ~".~~
USE
• poor appetite, weak digestion, exhaustion, anorexia
GENERAL
This combination tonifies Blood and Qi by tonifying and moving the Qi of the Spleen, Stomach, and Small Intestine. The overall temperature of the combination is slightly warm, so the combination can be used for neutral or cool patterns. The primary herbs are sweet molasses, which provides the nutrients, and bitter Gentiana, which stimulates digestion and appetite. In this combination, sweet, bitter, aromatic, and . . acrid properties combine to give the tonic action.
PRACTICAL NOTES
This combination is most conveniently taken as 5 ml of 1:5 tincture in half a glass of water, three times per day. Providing that appropriate precautions are taken with Artemisia (for example, Artemisia is contraindicated dU!ing· pregnancy), this combination can be taken, with the appro- . priate breaks and modifications, for several months. 3. Recurring fever + exhaustion
combined with Acorus and Zingiber as a stomach remedy. Grieve prescribed a tincture made from Gentiana, Citrus (orange) peel, and bruised Elettaria (cardamon) seeds, at the ratio of 4:2: 1, in brandy as a stomach tonic. The combination above is based on Christopher's14 Gentian and sweet flag tonic (sweet flag = Acorus calamus).
Retained Pathogen + Liver Deficient Qi
USE
• poor appetite and weak digestion with anemia and exhaustion, gastrointestinal discomfort, maybe some emaciation PRACTICAL NOTES
Half a cup of boiling water is added to 1-2 teaspoons of blackstrap molasses, and to this is added 5 ml of tincture of Gentiana, Citrus, and Elletaria. The liquid is stirred to dissolve the molasses, and drunk warm, three times per day. This combination can be taken, with appropriate breaks and modifications, for 1-2 months.
2. Poor appetite + anorexia
Herb neutral·cool neutral·cool warm-cool sl.warm neutral-cool hot
Achillea Artemisia abs. Gentiana Berberis Pseudostellaria Glycyrrhiza Zingiber
1 1 1 1 1 0.5 0.5
warm-cool warm-cool neutral-cool cool neutral neutral-cool hot
-_.: -------..{;,:f.~;:
acrid, bitter bitter. aromatic bitter bitter sweet. sl. bitter . sweet acrid, aromatic
This combination is the same as Achillea: recurring fever + exhaustion and is discussed under that heading. 4. Nausea + digestive weakness
Spleen Deficient Qi + Stomach Rebellious Qi Herb
Ratio
Temperature
Taste
Gentiana Zingiber
1 1
neutral-cool hot
bitter acrid, aromatic
GENERAL
Spleen Deficient Qi + Deficient Blood and Qi
1 1 1 1 0.5 0.5
.~.. ..:.'~'~~. 'v.""" .
History Tabernaemontanus 13 recommended Gentiana
Gentiana Centaurium Artemisia abs. Trigonella Glycyrrhiza Zingiber
.,m'· [SF
·.;. ..
bitter bitter aromatic, bitter bitter, sl. sweet, sl. acrid sweet acrid, aromatic
This combination is for nausea or vomiting associated with Deficient Qi of the Spleen and Stomach with Rebellious Stomach Qi. The overall temperature is warm, and the bitter, aromatic, and acrid properties combine to strengthen digestion and reduce nausea. USE
• acute nausea and vomiting
c. C
__
~·l
f""
II . -Gentiana and Centaurium • chronic nausea associated with digestive weakness PRACTICAL NOTES
In acute situations, 2.5-5 ml of the 1:5 tincture of this combination can be taken every 30 minutes in quarter of a cup of warm water. It can be taken as three doses per day in milder cases of nausea. This combination is no substitute for emergency medical treatment in the case of severe and/or prolonged vomiting, which may be linked to a serious condition. 5. Food intolerances + cold sensations
Liver Stagnant Qi + Cold
Artemisia spp. Gentiana Citrus (ripe peel)
• enteritis • mucus colitis • malabsorption syndromes with food allergies and intolerances • chronic diarrhea with digestive weakness PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in half a glass of water, three times per day. If the combination is used as a tincture, Althaea should be prepared as a decoction or a cold infusion stabilized with alcohol, and not as Althaea tincture (see Dose). If the entire combination is to be prepared as a decoction, the herbs can be simmered for 15 minutes, with Matricaria added after the heat has been turned off, and then left to steep for 15 minutes.
warm
aromatic, bitter, acrid
·1 1
warm-<:ool
bitter, aromatic
COMPARISON OF THE SIX
neutral-<:ool
0.5
bitter acrid, aromatic, bitter
GENTIANA COMBINATIONS
1
Rosmarinus
461
Glycyrmiza
0.5
warm neutra\-<:ool
Zingiber
0.5
hot
sweet acrid, aromatic
S.20 drops
hot
acrid
1. Digestive weakness + anemia
2. Poor appetite + anorexia
Spleen Deficient Qi + Deficient Blood
Spleen Deficient Qi + Deficient Blood and Qi
6. Digestive weakness + gastrointestinal inflammation
Molasses Gentiana
4-8 2
Gentiana Centaurlum
Spleen Deficient Qi + Intestines Heat
Citrus (ripe peel)
1
Artemisia abs.
Elettaria
0.5
Trigonella
1
Glycyrrhiza
0.5
Zingiber
0.5
Capsicum
This combination is the same as Rosmarinus: food intol-
erances + cold sensations and is discussed under that heading.
~~
Herb
'--r·-
Gentiana Agrimonia Matricaria Hydrastis Althaea Glycyrrhiza
L-.-_
1·
Ratio
Temperature
Taste
1 1 1 0.5 0.5 0.5
neutral-<:ool
bitter
neutral
sour, sl. bitter
cool
sl. bitter, sl. aromatic
cool
bitter
cool
sweet, sl. bitter
neutral-<:ool
sweet
GENERAL
This combination clears Deficiency Heat ill the Stomach and Small Intestine, and tonifies the Qi of the Spleen, Stomach, and Small Intestine. The temperature is slightly cool, and the anti-inflammatory action is derived from both the bitter and sweet anti-inflammatory herbs. The astringent action is associated with the sour property. USE
• gastrointestinal inflammations and infections associated with digestive weakness
1 1 1
1. Molasses provides the more Yin, structural, nutrient aspect, and Gentiana contributes the relatively more Yang, energetic, stimulant aspect in this complementary pair of Blood tonics. The bitter property of Citrus supports the digestive bitter tonic action of Gentiana, and the aromatic properties of Citrus and Elletaria combine to awaken the Spleen, and to warm and move Stagnant Qi in the Stomach and Small Intestine. 2. In the previous combination, molasses and Gentiana tonify Blood by two very different mechanisms. Molasses is a sweet nutritive tonic and Gentiana a bitter digestive tonic. In combination No.2, Centaurium and Gentiana act as bitter tonics to stimulate the appetite and digestion by a similar. but not identical, mechanism. In addition, Trigonella and Glycyrrhiza combine as sweet tonics, and Trigonella has a tradition of use of assisting in weight gain.
Combining Western Her~s and Chinese Medicine
462 .3. Recurring fever + exhaustion
4. Nausea + digestive weakness
Retained Pathogen + Liver Deficient Qi
Spleen Deficient Qi + Stomach Rebellious Qi
cially liver detoxification. This combination can be used.!o "c~ treat disorders associated with weak and sluggish livernm~~~~~~~ tion and accumulation of toxins, as seen in cases of over... ... indulgence in rich foods, alcohol, and drugs; sequelae of liver .. '.''';;<~;; "'., disease; or side effects of prolonged multimedication. Cap_···~·cc",c sicum and Zingiber emphasize the warming and moving effect of Rosmarinus on the Liver, differentiating this combination from Artemisia:food intolerances + heat sensations. ,:>~-.
-- .Ratio
Herb Achillea Artemisia abs. Gentiana Berberis Pseudostellaria Glycyrrhiza Zingiber
1 1 1 1 1 0.5 0.5
Gentiana Zingiber
1
1
3. Combination No. 2 contains Gentiana, Artemisia, Glycyrrhiza, and Zingiber to strengthen the appetite and digestion. These same herbs are present in combination No. 3, but they fulfill rather different roles. Artemisia, Gentiana, and Berberis, assisted and moderated by Zingiber and Glycyrrhiza, can tonify and move Liver Qi, clear accumulation of Liver Heat and Liver Damp Heat, and help to clear Heat Toxins and Retained Pathogen from the body. Achillea and Zingiber can help to clear Exterior Wind and Retained' Pathogen from the body surface, and with Pseudostellaria and Glycyrrhiza, can help to strengthen the energy of the body.
4. Gentiana can be used for nausea associated with digestive weakness and general debility, and acts as a bitter tonic and regulator of the digestive and hepatobiliary system. Zingiber is an acrid and aromatic herb that is specific for nausea associated with patterns of Stagnant Qi and Cold in the Stomach and Intestine. Together, the two herbs can treat nausea associated with Deficient Qi of the Spleen and Liver, combined with Stagnant Qi and Cold in the Stomach and Intestines. 5. Food intolerances + cold sensations
6. Digestive weakness + gas-
Liver Stagnant Qi + Cold
Spleen Deficient Qi + Intestines Heat
trointestinal inflammation
..Herb Rosmarinus Artemisia abs. Gentiana Citrus (ripe peel) Glycyrrhiza Zingiber Capsicum
1 1 1 0.5
0.5 0.5 5-20 drops
Gentiana Agrimonia Matricaria Hydrastis Althaea Glycyrrhiza
. Ratio 1 1 1
0.5 0.5 0.5
5. Rosmarinus, Artemisia, Gentiana, and Citrus tonify and move Liver Qi to strengthen liver metabolism and espe-
~
-
6. Rosmarinus and Artemisia make combination No.5 specific for the Liver, and Capsicum and Zingiber make it specific for patterns of Cold. Gentiana and Agrimonia make combination No.6 specific for Deficiency patterns of Spleen and Intestines, and Matricaria, Hydrastis and Althaea make it specific for patterns of Heat in the Stomach and Intestines.
OTHER GENTIANA COMBINATIONS Other combinations that contain Gentiana include:
• Achillea: amenorrhea + exhaustion • Cinchona: cardiac arrhythmia + recurring fever • Cinchona: digestive weakness + postfebrile exhaustion • Juniperus: digestive weakness + flatulence • Rosmarinus: digestive weakness + cold sensations
Research .",
CONSTITUENTS: G. LUTEA • secoiridoids • oligosaccharides • xanthones • phenolic acids • alkaloids • other Secoiridoids At 1-4%, the main bitter secoiridoid glycoside is gentiopicroside (=gentiopicrin). Swertiamarin and sweroside are also present. These secoiridoids have bitterness values of about 12,000. 15 The aglycoside amarogentin is only present at 0.049-0.084%, but it is the most important bitter component, because of its extreme bitterness value of 58,000,000. 16 Oligosaccharides Oligosaccharides include bitter-tasting gentianose and gentiobiose (5_8%).17 Xanthones Xanthones constitute approximately 1%, mainly gentisin, isogentisin and gentioside.1 8 Phenolic acids These include gentisic, caffeic, protocatechuic, and other acids. 19
..
.....
-.~
Gentiana and Centaurium Alkaloids The alkaloids described in the literature are probablyartifacts. J Other
G. lutea contains traces of essential oil,zO phytosterols, and pectins. J
463
but the alkaloids previously reported to be present in Gentiana, including gentianine, are now thought to be artifacts.
PHARMACOLOGICAL AND CLINICAL CONSTITUENTS: CENTAURIUM
The following effects have been reported:
• secoiridoids • xanthones • phenolic acids • alkaloids
• antimicrobial • antipyretic • anti-inflammatory
• other Secoiridoids The main bitter secoiridoid glycoside is swertiamarin. with smaller amounts of gentiopicroside (=gentiopicrin) and sweroside. These secoiridoids have bitterness values of about 12,000. 15 Centapicrin and deacetyl
[~
RESEARCH: G. LUTEA AND CENTAURIUM
centapicrin are extremely bitter sweroside esters with bitterness values of about 4,000,000. 21 Other iridoids present are the dimeric secoiridoid centauroside and secologanin.22 Xanthones There are various methoxylated xanthones, including eustomin and 8-dimethyl eustomin. 2J
• immunostimulatory • bitter digestive tonic • cholagogic • hepatoprotective • antispasmodic • central nervous system depressant • antioxidant • antitumor Antimicrobial Extracts of Gentiana root have been reported to have selective antifungal activity.28 Bruneton stated that swertiamarin and gentiopicrin are
Phenolic acids These include p-coumaric, ferulic, protocatechuic, sinaptic, vanillic,24 hydroxyterephthalic, and 2,5dihydroxyterephthalic acids.25 Alkaloids Centaurium contains the secoiridoid alkaloid gentianine. 26 Other
Centaurium also contains phytosterols and triter-
penoids.
27
CONSTITUENTS: COMPARISON OF GENTIANA AND CENTAURIUM Secoiridoid bitters
Both plants contain secoiridoid bitters
of two main types: bitter and intensely bitter.
Antipyretic A dry aqueous Centaurium extract showed antipyretic activity in rats after administration by gavage in a yeast-induced fever test.J1 . Anti-inflammatory In the same study with rats, a topically applied cream containing Centaurium extract showed transdermal anti-inflammatory activity, and Centaurium extract administered orally reduced polyarthritic inflammation. Jl
and sweroside, with bitterness values of approximately 12,000; in Gentiana, the main secoiridoid bitter is gentiopi-
When administered orally, a dry ethanolic extract of Centaurium reduced induced pawedema. J2 A group of patients with gastrointestinal inflammatory conditions, for example, ulcerative colitis or morbus Crahn,
croside, and in Centaurium, the main secoiridoid bitter is
and raised secretory IgA levels were treated with 20 drops of
swertiamarin.
Gentiana tincture three times per day for eight days. This resulted in a lowering of the secretory IgA levels.JJ
Bitter Both plants contain gentiopicroside, swertiamerin,
~• .i1
_antibacterials, but no reference was given. Isolated protocatechuic acid inhibited selected bacteria and fungi. 29 Amarogentin may have clinical application in the treatment of leishmaniasis, and showed no toxicity in animal experiments.3D
Intensely bitter Gentiana contains small amounts of amarogentin, with a bitterness value of 58,000,000. Centaurium contains small amounts of centapicrin and deacetyl centapicrin, with bitterness values of approximately 4,000,000.
Immunostimulatory Extracts of Gentiana root have been reported to stimulate the phagocytic activity of human lym-
Other Gentiana contains bitter oligosaccharides, and both plants contain xanthones, phenolic acids, and phytosterols. Centaurium contains the secoiridoid alkaloid gentianine,
Bitter digestive tonic Gentiana infusion stimulated the secretion of small intestine enzymes when administered by mouth to sheep.35 In healthy humans, gastric secretion was
phoeytes.~
464
Combining Western Herbs and Chinese Medicine
stimulated by Gentiana root tincture containing 0.2 g of the drug. 36 It was reported that the bitter chemicals of Centaur-
tiana, was converted by human intestinal bacteria intovari-·::-".. ous metabolites, of which one was gentianine. However>the'::~~_:
ium may stimulate the secretion of gastric juice and bile by a reflex mechanism, thereby enhancing the appetite and digestion. 37 .38
significance of this fmding is unclear, principally because this chemical was only produced by a few species of bacte-.
The bitter principles of Gentiana root, in common with bitter substances in general, may stimulate the appetite and digestion by two main mechanisms:
Antioxidant Protocatechuic acid showed antioxidant activity comparable to that of caffeic acidY Protocatechuic acid is present in both Gentiana lutea and Centaurium, and
• indirect • direct
via the taste buds via the gastric lining
Indirect It has been proposed that there is a nerve reflex mechanism initiated by bonding of the bitter substances with the bitter receptors on the taste buds at the back of the tongue. This stimulation of the bitter receptors may result in an increase in vagal stimulation. This may result in an increased secretion of gastric acid and pepsin. 39 Gentiana tincture increased gastric acid secretion by 30% when given by mouth to dogs. The action was entirely local since the tincture was prevented from reaching the stomach of the dogs.28
ria.
caffeic acid is reported as present in G.lutea. Antitumor Protocatechuic acid inhibited colon tumor development in rats. 48 Dietary protocatechuic acid reduced 50 oral carcinogenesis49 and bladder carcinogenesis in rats. It 5 also reduced hamster cheek pouch carcinogenesis ! and carcinogenesis in the stomach, colon, and liver in other animals.52•S3 One study reported that in lower doses, protocatechuic acid inhibited mouse skin tumors, but with high doses, protocatechuic acid was reported to enhance mouse skin . '. tumor development. 54
PHARMACOLOGICAL AND CLINICAL
Direct Bitters may exert a direct effect on the gastric lining,
RESEARCH:
resulting in increased gastric secretion. A recent study reported that a concentration-dependent increase in gastric acid production was observed when isolated stomach cells were exposed to Gentiana root extract at concentrations of 10-100 l1g/m1.39
AND
Cholagogic It was reported that Gentiana root tincture increased and prolonged the emptying of the gallbladder in healthy humans. This was observed using X-ray contrast and was interpreted as a cholagogic effect. 36 Hepatoprotective Gentiopicroside showed hepatoprotective effects in mice. 40 • 41 In rats, ethanolic extracts of G. olivieri significantly prevented the elevation of plasma and hepatic malondialdehyde formation (evidence of lipid peroxidation) in acute liver injury induced by carbon tetrachloride. 42 Antispasmodic Swertiamarin demonstrated anticholinergic activity, inhibiting carbachol-induced colon contraction in rats.43 Gentiopicroside from G. spathacea inhibited both spontaneous contractions and contractions induced by histamine, acetylcholine, and other chemicals in isolated guinea pig ileum. 44 Central nervous system depressant The secoiridoid alkaloid gentianine inhibited spontaneous movement activity in mice and increased hexobarbital-induced sleep.4s Swertiamarin, which is present in both Gentiana and Centaurium, but is only a minor secoiridoid bitter in Gen-
..,i'
46
G. MACROPHYLLA (QIN JIAO)
G. SCABRA
(LONG DAN CAO)
The following effects have been reported: • antimicrobial • anti-inflammatory • hyperglycemic • choloretic and hepatoprotective • hypotensive • central nervous system depressant Antimicrobial
Both G. macrophyllaS5 and G. scabra56.57.s8
have been reported to have antimicrobial action. The methyl ester of 2-methoxyanofinic acid from G. macrophylla was 59 shown to inhibit the growth of Candida albicans. Anti-inflammatory In experiments in China, gentianine 60 has been reported to reduce paw edema in rats. Rat paw edema has been reported to be reduced by gentianine or peritoneal injection of G. scabra.6l.S 7 Injection of G. macrophylla preparations, calculated as containing 10 mg gentianine per 2 ml ampoule, were reported as effective in the treatment of rheumatoid arthritis.
62
Hyperglycemic Gentianine injections in mice raised blood glucose. The effect was dose-dependent and did not occur in adrenalectomized animals or with adrenergic blocking agents, suggesting that the effect was mediated by the · h' re1ease 0 f epmep rme. 63 Choloretic and hepatoprotective
G. scabra has been re-
~,--\
Gentiana and Centaurium ported to have choloretic action in rats, and hepatoprotective action in mice. 57 Hypotensive Gentianine was reported to have brief hypotensive and bradycardic effects in dogs and rabbits/>' and intravenous injection of G. scabra was reported to have a brief hypotensive effect in rabbits. 65 Central nervous system depressant G. macrophylla and gentianine were reported to have a calming effect in mice.66.67 Isolated gentianine in mice inhibited spontaneous movement activity and increased hexobarbital-induced sleep.45 RESEARCH VERIFICATION OF TRADITIONAL ACTIONS:
G. LUTEA
AND
CENTAURIUM The following traditional actions have been supported by research for G. lutea and Centaurium or their isolated constituents: G. I~ea!., Genta,uri\Jffi",.,;; j antipyreti~
465
Additional effects demonstrated by research for G. macrophylla and G. scabra Both G. macrophylla and G. scabra are reported to have antimicrobial action, and gentianine has been reported to have hyperglycemic and central nervous system depressant action. TOXICOLOGY Extracts of G.lutea show no toxicity and are usually well tolerated.68 Rats given 1.6 mlIkg oian extract including G. lutea for 13 weeks did not show adverse reactions to the extract. Also, no effect was recorded on reproductive capacity, and no teratogenic effect was observed in rabbits. 69 Gastric irritation Some texts contraindicate Gentiana and Centaurium for peptic ulcers, and for hyperacidity.70. 27 However, there is evidence to suggest that, in some circumstances, these herbs can reduce rather than increase the potential for gastric irritation. Gentiana extract perfused into the stomach of anaesthetized rats increased gastric secretion in a dose-dependent manner. However, in higher doses, it increased gastric pH from 4.25 to 4.85. Also, at doses of 0.5 mlIkg, approximating to 30 ml for a 60 kg human, this Gentiana extract did not increase the incidence of gastric ulceration. 68
..
general tonic (immunostimulatory) digEls!iye_tol1i~
When gentianine was administered to rats at 100 mg!kg,
hepatic, cholagogue
approximating to 6 g for a 60 kg human, it showed anti-
(gastrointestinal] anti-inflammatory antirheumatic
Additional effects demonstrated by research for G.lutea and Centaurium The following have been reported for both G. lutea and Centaurium: antimicrobial, antispasmodic, anti-oxidant and antitumor. Gentianine, present in centaury, but not in gentian, has been reported to have central nervous system depressant and hypotensive effects.
ulcerogenic activity in the water-immersion stress test. It also showed an inhibitory action against gastric secretion..s This is interesting in view of the suggestion by Weiss that bitters can reduce the negative effect of higher mental activity on digestion, resulting from chronic stress. 71 If gastric ulcers are associated with atrophic gastritis, then the bitter taste may be beneficial. However, if the gastric or duodenal ulcers are associated with gastric hypersecretion, it may be advisable to use bitters with caution.
RESEARCH VERIFICATION OF TRADITIoNAL ACTIONS: AND
G. MACROPHYLLA
G. SCAB RA
The following traditional actions have been supported by research for G. macrophylla and G. scabra or their isolated constituents:
=
1'; .:
. G. macrophylla
anti-inflammatory
~
antirheumatic
~
~
~
~
Gentiana extract showed weak mutageclcity
and isogentisin, which may have similar action to querticin, which is considered safe. 28 Extracts of C. erythraea have shown weak mutagenicity with some strains of S. typhimurium but not others,n.73 but more recent Ames tests reported anti-mutagenic effects. Also the xanthones eustomin and 8-demethyleustomin inhibited mutagenicity.74 LD50
~
ht!P
hypotensive
.G.scabra
Mutagenicity
on the Ames test with some strains of Salmonella typhimuriurn. This is attributed to low levels of the xanthones gentisin
The acute oral LD 50 of G. lutea extract for mice was
reported as 25 rnlIkg, which approximates to 1500 ml for a 60 kg human.
466
Combining Western Herbs and Chinese Medicine
Dose Dried herb
The BHp75 listed:
- G.lutea: 0.6-2 g of dried herb, three times per day - C. erythraea: 2-4 g of dried herb, three times per day
Gentiana (gentian) and Centaurium (centaury) are:on _.._._ - ;;:.;.;...... the UK General Sale List, and are not included in Part 4 of ,.. ~"~J;" .,.~
Schedule 4 of the Therapeutic Goods Act Regulations of. Australia. Gentiana and Centaurium are not currently listed . .\~;: ,., by the FDA (USA) as a prohibited substance, as subject to an'-'7;~t,;import alert, or as a substance with a warning on its use. .'." -~,.".~ --.~";;-=
Tmcture The BHP listed: - G.lutea: 1-4 ml of 1:5 tincture in 45% alcohol, three times per day. - C. erythraea: 2-4 ml of 1:1 liquid extract in 25% alcohol, three times per day. Tuning of dose According to Mills and Bone, to stimulate appetite, dose can be 15 minutes before meals, sipped slowly to prolong the taste stimulus. For other purposes, dose can be after or between meals. 76 Initial dose
Can start at standard dose.
Duration Can be used long-term, within therapeutic dose and with appropriate breaks in treatment, providing there are no signs of adverse effects. Bitterness sensitivity So-called 'supertasters' are especially sensitive to strong tastes, such as the bitter taste. n The dose of bitter herbs such as G.lutea or C. erythraea can be adjusted to the bitterness sensitivity of the individual. This reduces unpalatability and may avoid nausea, due to extreme perception of bitterness.
Traditional sources: Chinese C. erytraea is not used in Chinese medicine. The properties listed in the Chinese Herbal Medicine Dictionary for C.
pulchellum (iii lt~i) are cold and bitter, but this herb does not seem to be used much in mainstream Chinese medicine. G.lutea is not a plant commonly used in Chinese medi., cine. It has been called 6u long dan,8 but it does not have a separate entry in either Chang and But or the Chinese Herbal
Medicine Dictionary. For both G. scabra and G. macrophylla, the table below gives the opinion of the main text and the subsidiary texts cited by the Chinese Herbal Medicine Dictionary. This illustrates the range of opinion on the properties of these two herbs in Chinese medicine: GENTIANA SCABRA ( 16ng dan cao )
GENTIANA MACROPHYLLA ( qfn jiao ) .~.',
Cautions Western contraindications Some texts contraindicate gastric or duodenal ulcers and hyperacidity: but see discussion in Toxicology above. Chinese contraindications Pregnancy and lactation
Temperature main text subsidiary texts Taste main text subsidiary texts
None reported. No adverse reports.
Side effects None reported for C. erythraea; occasional headache have been reported for G.lutea.28 Overdose None reported for C. erythraea; overdose of G. lutea may result in nausea or even vomiting. 28
Meridians main text subsidiary texts
cold cold to very cold
neutral neutral to slightly warm
bitter bitter to very bitter. slightly sour, acrid
bitter, acrid bitter. acrid
LR.GB LR. GB, KI. SP,ST
LR,GB,ST LR, GB, ST, U, SI
Although many different actions and uses are given for both these Gentiana species in the Chinese Herbal Medicine
Dictionary, the main actions and uses are: Toxicity G.lutea and C. erythraea are considered safe herbs within therapeutic dose range: see above.
G. mac~ophylla:
Interactions
• to clear Wind Damp to treat arthritis
None reported.
• to clear Deficiency Heat to treat low-grade fever
Regulatory status Please read the Regulatory status section in the chapter on Safety.
• to clear Damp Heat to treat jaundice
G. scabra • to clear Liver-Gallbladder Damp Heat to treat jaundice and inflammations of eyes, ears, skin, or genitals
'-;...-/
Gentiana and Centaunum • to clear Liver Excess Heat to treat headache, red eyes, spasms, convulsions
Traditional sources: Western Temperature Traditional texts: Gentiana According to Dioscorides,78 gentian roots are warming and astringent in nature, but he also said that it could be used for heat-type swellings and heat in the eyes. Hildegard von Bingen79 classified yellow gentian as fairly hot, but then recommended it for fever of the stomach. Umicetus80 wrote that gentian is hot and dry in the third degree. Tabernaemontanus said that it is warm to the third degree and dry to the second, but he also recommended it for malarial fever. Gerard said that gentian is a hot herb for cold diseases. Culpeper81 wrote that it is excellent for all cold diseases, including cold diseases of the joints, but he also wrote that it could treat agues. It would seem that, although Gentiana has generally been classified as a warm herb, it has also been used to treat heat patterns, such as fever.
the dried root as initially sweet and then bitter, and Wichtl described the taste as sweetish and then persistently and intensely bitter. I found samples of both the dried root and 1:5 tincture of G. lutea to be bitter in taste. The taste of Centaurium is described as bitter by the BHP, and described as very bitter by Wichtl. Taste property The taste property of both Gentiana lutea and Centaurium erythraea can be said to be bitter in terms of Chinese medicine.
ORGANS See table below. ACTIONS
Traditional texts: Centaurium Gerard wrote that small centaury is hot and dry in the second degree. Culpeper said that the herb of small centaury was hot in the second degree, but he also wrote that it could purge choler and treat agues.
EI
This book: Centaurium and Gentiana In this book, both herbs are classified as having variable temperature, which can be neutral or cold, on the basis of their modern range of use. Their main modern uses are as either neutral bitter digestive tonics or as cool bitter digestive anti-inflammato-
ries. Taste Taste in the mouth Lonicerus and Tabernaemontanus described Gentiana as bitter. The BHP described the taste of L_
Evidence from the traditional sources for the following actions of Gentiana and Centaurium are discussed below: • antipyretic • general tonic • bitter digestive tonic • hepatic, cholagogue • gastrointestinal anti-inflammatory • antiemetic • other Antipyretic Hildegard von Bingen recorded the use of gentian for 'stomach fevers', Tabernaemontanus for malarial fever, and Culpeper for agues. Christopher listed both Gentiana and centaury for fever and intermittent fever. An old English name for centaury was feverwort, reflecting its long tradition of use to treat fever, especially intermittents. Recently, Centaurium extract has been reported to have antipyretic action in rats, see Research. General tonic Culpeper wrote that Gentiana can refresh those who are over-weary with travel. According to Ellingwood,85 Gentiana can be used for debility from protracted
G. LUTEA
C. ERYTHRAEA
- Source
Organ
467
Examples of use'
stomach illnesses stomach aches, congestion of the spleen gastrointestinal atony
Dioscorides Tabemaemontanus
stomach weakness, anemia loss of appetite, dyspesia
Christopher 82 Commission E 83
BHP
anorexia
BHP
• Liver, Gallbladder
liver illnesses congestion of the liver cholagogue
Dioscorides Tabemaemontanus BHP
obstructions of liver and gallbladder yellow jaundice liver and gallbladder disease
Culpeper Gerard Mabey8"
• Heart
heart weakness and pain comforts the heart
Hildegard von Bingen Culpeper
strengthens the heart
Christopher
• Spleen, Stomach
468
Combining.Western Herbs.and Chinese Medicine
disease. Scudder wrote that" the specific indication of Gentiana is a sense of depression referred to the epigastric region, and associated with a sense of physical and mental weariness. 7 Christopher said that Centauriurn is an excellent general tonic, especially for debility in delicate and elderly persons.
Postfebrile exhaustion Gerard recommended the use of Centaurium for long and lingering agues. Ellingwood listed Gentiana for exhausting fever of malarial origin, as a rapid restorative to the system, when the periodicity has been resolved by quinine. According to Felter and Lloyd, Gentiana can be used to 'increase the appetite, after protracted fever, where the powers of life are depressed and recovery depends upon the ability to assimilate food'. Anemia According to both Culpeper and Gerard, Centauriurn can be used for the green sickness (anemia). Ellinwood noted the use of Gentiana for anemia, and Christopher wrote that both Gentiana· and Centauriurn can be used for anemia and for general debility. According to Mabey, Centaurium has general use in Europe for anemia. Heart tonic There is a tradition, both in China and in Europe, that bitter substances can tonify the heart. Hildegard von Bingen said that yellow gentian can be used to strengthen the heart, to treat heart pain. Culpeper wrote that Gentiana comforts the heart and preserves it against 'faintings and swoonings: Felter and Lloyd wrote that Gentiana can give more force to the circulation, and Christopher wrote that Centaurium can strengthen the heart. TranqUilizer/antidepressant According to Mabey, Sebastian Kniepp recommended Centaurium for melancholy, and to calm the nerves. Interestingly, isolated Gentianaine has been reported to have central nervous system depressant effects in mice, see Research. Bitter digestive tonic The traditional use of Gentiana and Centaurium, which has been continuous over centuries and is the main use today, is that of a digestive tonic. Dioscorides and Tabernaemontanus both recommended Gentiana for stomach problems. Culpeper said that it strengthens the stomach, helps digestion and restores the appetite. Ellingwood reported the use of Gentiana for dyspepsia of the aged, and for gastric insufficiency of infants and children. According to Bruneton, both Gentiana and Centaurium have a tradition of use in France for loss of appetite, and according to Wichtl, both herbs have a tradition of use in Germany to stimulate appetite and digestion. Both Gentiana and Centaurium are used in various bitter aperitifs, to stimulate appetite before a meal, and in bitter liqueurs to settle the stomach and assist digestion after a meal.
Hepatic, cholagogue Since the time of Dioscorides....Gcit~':"~ tiana has been listed for liver problems. Culpeper wrotethcii'" ~:~: Centaurium purges choleric and gross humors, opens.-rt~ obstructions of the liver, gall and spleen, and eases pains in .. ~~:.:=: the side. He said that Gentiana opens obstructions of the-~ liver, helps pains in the sides, and treats yellow jaundice. ~.~~~~: Gerard said that Gentiana can treat those with 'evil livers and .. bad stomachs', and remove obstructions of the liver. He ..'-~~; .:' ':~.~ wrote that the ability of Gentiana to cleanse and remove .;;;,,;:" obstructions comes from its bitter quality. Gerard quoted Galen as saying that Centaurium can remove choler, and ··
~
-;r...!
and treat yellow jaundice. Both Gentiana and Centaurium have had a tradition of use for liver and gallbladder problems from ancient times until at least the eighteenth century. However, although the :;:$~f BHP listed Centaurium for anorexia with hepatic weakness, -~~,and Gentianaas a cholagogue, other herbs, such as ~~rberi~ and Taraxacum, are now more used for hepatobiliary disor•
-·--:-~"'i"".-:",
ders. Gastrointestinal anti-inflammatory Pliny, as quoted by Tabernaemontanus, said that Gentiana can be taken as a stomach remedy when there is a fever, and Hildegard von Bingen gave Gentiana in warm wine for fever in the stomach. Tabernaemontanus recommended Gentiana for stomach aches, and Gerard listed it for bad stomachs. Christopher listed both Gentiana and Centaurium for indigestion, and the BHP indicated both herbs for dyspesia. According to Mabey, Gentiana is useful for gastrointestinal inflammation, and research has indicated that Gentiana tincture can be used to treat gastrointestinal inflammatory disorders. Antiemetic Tabernaemontanus recommended Gentiana for stomach diseases with inability to keep the food down. Ellingwood wrote that Gentiana was sometimes of great value for vomiting in pregnancy. Other The following additional actions have been reported for Gentiana and Centaurium: • antirheumatic • agent for eye disorders
Antirheumatic Culpeper wrote that Gentiana can treat lameness in the joints either from cold or evil lodgings, and that Centaurium can be used for all old pains of the joints, such as gout and cramps: Gerard recommended Centaurium for sciatica, and both Ellingwood and Felter and Lloyd recommended Gentiana for gout. Centauriurn extract has been reported to reduce arthritic inflammation in rats; see Research.
h· :
Gentiana and Centaurium Agent for eye disorders According to Dioscorides, Gentiana can be used for heat in the eyes. Culpeper recommended the juice of Centaurium herb to treat 'dimness, mists and clouds that offend or hinder sight', which may relate to blurred vision or floaters linked to Deficient Blood.
G. G. MACROPHYLLA AND G.
COMPARISON OF CENTAURIUM AND LUTEA WITH SCABRA
Both G. lutea and Centaurium have been considered as warming herbs by the older Western texts. Neither of these herbs have a tradition of use which is so clearly aimed at Heat patterns as is the cold G. scabra. They are more like G. macrophylla, classified as neutral or slightly warm in older Chinese texts. These four herbs are compared under the following main headings: • digestive and general tonic • gastrointestinal anti-inflammatory • antipyretic • hepatic and cholagogue • antiemetic • antirheumatic • agent for eye disorders Digestive and general tonic The main use of Centaurium and G.lutea in the West is as bitter digestive and general tonics. In terms of Chinese medicine these two herbs can be said to tonify Spleen, Stomach, and Small Intestine. By doing this, they can indirectly tonify Qi and Blood, to treat anemia, exhaustion, and postfebrile debility. G. macrophylla and G. scabra do not have this reputation in Chinese medicine. Gastrointestinal anti-inflammatory Centaurium and G. lutea are used in the West as bitter gastrointestinal antiinflammatories to treat gastroenteritis and malabsorption syndromes. G. macrophylla and G. scabra do not have this usage. Antipyretic Centaurium and G.lutea have been used in the West for intermittent fever by practitioners from Dioscorides to Christopher, although this use has temporarily declined. G. macrophylla is used in China for fever associated with Deficiency Heat and Deficient Yin. For example, afternoon fever and other low-grade fever, such as can follow prolonged illness.86 Hepatic and cholagogue Centaurium and G. lutea have been used in the West for atonic and obstructed conditions of liver and gallbladder from the time of Dioscorides to the present day. In terms of Chinese medicine, these two herbs
469
can be said to tonify and move Qi of Liver and Gallbladder. The emphasis on the use of the Chinese species is rather different. G. scabra is specifically used for Heat patterns of the Liver: • Liver-Gallbladder Damp Heat with jaundice, genital rashes, or leukorrhea • Liver Excess Heat with hypertension, headache, or red eyes G. macrophylla can be used for Damp Heat jaundice, but this is not its main use. Antiemetic G.lutea has been used in the West for nausea and vomiting, but this use has not been reported for Centaurium, G. macrophylla, or G. scabra. Antirheumatic Centaurium and G. lutea have both been used in the West for rheumatic pains, although this use has temporarily declined. This is interesting to compare with the Chinese traditional use of G. macrophylla for Wind Damp arthritis and cramping of the extremities. Agent for eye disorders G. scabra is recommended for red, swollen, sore eyes associated with patterns of either LiverGallbladder Damp Heat or Liver Excess Heat. Dioscorides used gentian for heat in the eyes, but this use has declined in the West. Culpeper used small centaury for dimness of vision. In Chinese terms this can be related to Phlegm misting vision or declining vision linked to Deficient Blood. This use is not common for the Chinese species of Gentiana.
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52. Tanaka T. Kojima T. Kawamori T et al. Cancer 75 (6 Suppl):1433-1439
60. Song ZY et al. Acta Physiologica Sinica 22(3):201 (1958)
phytotherapy. Munich. Germany Abstract SL36. 10-13 Sept (1992)
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2342 (1995)
30. Medda S. Mukhopadhyay S. Basu MK. J Antimicrob Chemother 44(6):791-794 (1999)
34. Schmolz M. In: Abstracts qf the 4th and International Congress on
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(1978)
64. Liu GT et al.Acta Physiologica sinica 23(3):203 (1959) 65. Wang WX et al. Selected theses of Dalian Railways Medical College. p 41 (1960) 66. Liu GT et al.Acta Physiologica Sinica 23(3):203 (1959) 67. Chen XY. Acta Physiologica Sinica 23(4):311 (1959) 68. LeslieGB.Medita8:31-47(1978) 69. Leslie GB. Swiss Med 1:43-45 (1979)
Gentiana and Centaurium medicinal uses of plant drugs (monograph on Gentiana lutea).
79. Von Bingen H. Hildegard von Bingen's Physica. Healing Arts. Rochester. Vermont (1998)
European Sdentific Cooperative on Phytotherapy, Exeter, United
80. Lonicerus A. Kreuterbuch (1679). Reprinted by Verlag. Konrad Kolbl.
70. European Scientific Cooperative on Phytotherapy: Monographs on the
Kingdom (1997) 71. Weiss RF. Planta Medica 14 (supp):128-132 (1966) 72. SchimmerO, Kn1ger A, Paulini H et al. Pharmazie49:448-451 (1994)
81. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks, Glenwood, Illinois (1990)
cal drugs. In: Knudsen I. editor. Genetic toxicology of the diet. New York: Alan R Liss, pp 63-72 (1986)
83. Blumenthal M (ed). The Complete German Commission E Mono-
74. Schimmer O.Mauthner H. Planta Med 62:561-564 (1996) 75. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983) 76. Steinegger E. Hansel R. Enzianwurzel. In: Pharmakognosie. 5th ed. Springer-Verlag, Berlin, Germany pp 595-599 (1992) 77. Bartoshuk L'vl, Duffy VB, Reed D et al. Neuroscience and Behaviorual Reviews 20(1):79-87 (1996) 78. Dioscorides P. Kreutterbuch (1610). Reprinted by Verlag Konrad K6lbl, Miinchen. Germany (1960)
i
MUnchen. Germany (1962)
82. Christopher JR. School of Natural Healing. BiWorld, Provo, Utah (1976)
73. G6ggelmann W, Schimmer O. Mutagenic activity of phytotherapeuti-
~
471
graphs: Therapeutic Guide to Herbal Medicines: (monograph on Centaurium erythraea). American Botanical Council, Austin, Texas (1998) 84. Mabey R (ed). The Complete New Herbal. Elm Tree Books, London. United Kingdom (1988) 85. Ellingwood F. American Materia Medica, Therapeutics and Pharmacognosy, 11th edn. (1919). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1994) 86. Bensky D. Gamble A. Chinese Herbal Medicine Materia Medica. Eastland Press, Seattle, Washington (1986)
Glycyrrhiza Botanical name Glycyrrhiza glabra 1. (Liquiritia officinalis) Family
Fabaceae (Leguminosae)
Pharmaceutical name Liquiritiae radix (Glycyrrhizae radix.) Part
ulcers. II This led to a steady increase in pharmacological research on Glycyrrhiza and its constituents, resulting in the wider herbal use of licorice. The current main applications of this herb in the West are for gastritis, peptic ulcer, sore throat, cough, bronchitis, and adrenocortical insufficiency.
dried unReeled roots and stolons
English German French
Varieties used Several varieties of G. glabra are used in the West, including: 12
licorice (liquorice) Siillholz reglisse
Mandarin
• G. glabra var. typica Regel et Herd (Spanish licorice)
G. glabra 1. is not commonly used; gan cao
• G. glabra var. glandulifera Waldst. et Kit (Russian licorice)
(i:I-:¥-) is the root of mainly G. uralensis Fischer et DC.
• G. glabra var. violacea Boiss (Persian, Anatolian, or Turkish licorice)
Use in the West Glycyrrhiza glabra is a tall perennial herb native to the Mediterranean region, Central to Southern Russia, and Asia Minor to Iran. I It has been used in the West since the time of ancient Egypt. 2 In the 3rd century BC, the Greek philosopher Theophrastus recorded the use of a sweet root from Scythia for dry cough and other respiratory disorders.) In the 1st century AD, the Roman natural historian Pliny described licorice under the name of Scythia herba,4 and Dioscorides named the plant Glycyrrhiza from the Greek glucos (sweet) and riza (root).) He recommended it for respiratory, gastric, and urinary diseases. The herbal use of licorice may have declined somewhat by the 19th century.6 For example, licorice was used by the Eclectic physicians of North America. but it was not one of their major herbs. It has relatively brief entries in Lyle,7 Felter and Lloyd, 8 and Ellingwood,9 and no entry in Kloss. IO However, in the late 1940s, the Dutch doctor Revers began clinical studies on the use of licorice to treat gastric
Nomenclature Glycyrrhiza is ued in this chapter to mean G. glabra, unless otherwise stated. Use in China Gan cao is obtained mainly from G. uralensis Fischer et DC. and also from several other Glycyrrhiza species, including G. glabra. 13 The use of gan cao was recorded in the Shen nong ben cao jing,14 which may have been compiled in the 1st century AD. IS The main use of gan cao in Chinese medicine is to moderate the effect of the other herbs in a combination and to harmonize and balance the prescription. For this reason, gan cao is included in the majority of Chinese herbal formulas and is perhaps the most widely used herb in Chinese medicine. It is also used as a secondary tonic for the Spleen, and to moisten Lung Dryness, and clear Heat Toxin from the throat.
473
474
Combining Western Herbs and Chinese Medicine
What is special about Glycyrrhiza In terms of Chinese medicine, G. glabra, as used in the West can be said to be a neutral-cool, sweet herb that has its main effects on the Stomach, Intestines, Lung, Kidney, and Heart.
The key to understanding Glycyrrhiza is that it can act as a: • moistening, demulcent anti-inflammatory to treat inflammations of the respiratory or gastrointestinal mucosa • adrenocortical tonic • strengthener and stabilizer ofthe heartfunction • detoxicant and moderator ofthe effects ofother herbs and drugs
Glycyrrhiza as a herbal moderator In both Western and-:~ .,. Chinese medicine, one of the most important actions of Gly- -';~:;::~
cyrrhiza is to moderate, harmonize, and balance the effects of other herbs. Glycyrrhiza can moderate the potential of: • purgatives such as Rhamnus and Rheum to produce intestinal cramping • bitters such as Harpagophytum to produce gastric irritation • acrid herbs such as Capsicum or Lobelia to irritate the mouth and throat • stimulants such as Ephedra or Panax ginseng to destabilize Heart Spirit • alteratives to release toxins faster than they can be metabolized or excreted
WESTERN USES CHINESE ACTIONS In terms of Chinese medicine, Glycyrrhiza, as used in the West, can be said to have the following actions:
The main Western uses of Glycyrrhiza are shown here in terms of its six main Chinese actions: .
I. II. III. IV.
moisten Lung Dryness and clear Lung PWegm dear Stomach and Intestines Heat tonify Kidney Qi tonify and stabilize Heart Qi
V. counteract the effects of toxins
_:-~'_.~
I. moisten lung Dryness and clear lung Phlegm
II. clear Stomach and Intestines Heat
Western actions demulcent anti-inflammatory antitussive expectorant demulcent anti-inflammatory antiulcer antispasmodic
III. tonity Kidney Qi
tonic adrenocorticotropic action anti-inflammatory antiallergic
IV. tonity and stabilize Heart Qi
cardiotonic cardioregulator
V. counteract the effects of toxins
alterative detoxicant
r-
VI. moderate the effects of other herbs
herbal moderator detoxicant
_ .• -.~
':'--"'-~'·'''-~'~.m~,c:
dry sore throat, dry cough, difficult expectoration, bronchitis
II. clear Stomach and Intestines Heat
gastritis, peptic ulcer, colitis, NSAIDs* and corticosteroids side effects
III. tonify Kidney Qi
cortisone side effects, cortisone withdrawal, exhaustion, allergies, weight loss, Addison's disease
IV. tonify and stabilize Heart Qi
arrhythmias, palpitations, insomnia, bipolar disorder, menopausal emotional lability
WESTERN ACTIONS
Chinese actions
~._-'
~e~t~fJWS:~. ~,. ;;.c.;.,.;.,.,;).:;,~;}1
I. moisten lung Dryness and clear lung Phlegm
VI. moderate the effects of other herbs
The main Western actions of Glycyrrhiza are shown here in terms of its six main Chinese actions:
J,"'--':"?::--_; ..!-.':.-\l.•,'''';.;--
.Chinese actions
V. counteract the effects of toxins VI. moderate the effects of other herbs
cancer therapy side effects
reduces potential side effects
*NSAIDs = nonsteroidal anti-inflammatory drugs
EXTENDING THE RANGE OF USE OF GLYCYRRHIZA Using concepts derived from pharmacological and clinical research data as well as from traditional Chinese medicine, it is possible to extend the Western traditional range of use for G. glabra. These extra uses are discussed under the following headings: • Glycyrrhiza for the side effects of NSAIDs • Glycyrrhiza for adrenocortical insufficiency • Glycyrrhiza for the side effects of corticosteroids • cardioregulatory and calming effects of Glycyrrhiza
Glycyrrhiza Glycyrrhiza for the side effects of NSAlDs Two of the groups of drugs commonly used for inflammatory conditions, the NSAIDs and corticosteroids, can in some cases irritate the gastric lining and initiate or aggravate gastric ulceration and bleeding. Glycyrrhiza can help to reduce these adverse drug reactions. In addition, Glycyrrhiza has been included in herbal anti-inflammatory combinations for arthritis and rheumatism, for example, see Harpagophytum: arthritis + heat sensations. In some cases, the use of these herbal combinations containing Glycyrrhiza can allow a reduction in the dose of anti-inflammatory drugs, with a resulting decrease in their side effects. Glycyrrhiza for adrenocortical insufficiency In Chinese medicine, gan cao is considered to tonify the Qi, especially the Qi of the Spleen, and according to the Shen nong ben cao jing, gan cao can be used to help weight gain ('grow the flesh'). Gan cao is also used to tonify Heart Qi, but it is not specifically used as a Kidney tonic in Chinese medicine. In the West, G. glabra or its constituents have been used to treat adrenocortical insufficiency, both in Addison's disease and in some cases of chronic fatigue syndrome involving symptoms similar to mild glucocorticoid insufficiency; see the Research section below. Gan dio is now also used in China to treat Addison's disease. 16 In Chinese medicine terms, this use of Glycyrrhiza can be described as tonifying Kidney Qi. Although I do not use Glycyrrhiza as a primary herb to tonify Kidney Qi, I frequently use it as a secondary herb for this purpose, combined with such primary Kidney Qi tonics as Pana..x ginseng, Turnera, and Serenoa. For example, I include Glycyrrhiza in the following combinations for exhaustion and chronic fatigue associated with Kidney Deficiency:
• Ruta: exhaustion + fear • Ruta: chronic fatigue syndrome + palpitations • Turnera: exhaustion + sexual debility Glycyrrhiza for the side effects of corticosteroids The use of Glycyrrhiza to treat the gastric side effects of corticosteroid drugs has already been mentioned. Glycyrrhiza has also been reported to: • reduce the side effects of cortisol on the adrenal system (see Research) • assist, as part of a herbal combination, in the withdrawal from corticosteroid drugs and aid in the recovery from their use The prolonged use of corticosteroid creams for skin disorders can lead to thinning and atrophy of the skin. I frequently use Glycyrrhiza in herb combinations to treat the
475
recovery phase of skin disorders following long-term use of steroid creams. For example, I use Glycyrrhiza combined with Ziziphus jujube in the combination Arctium: recurring urticaria (remission phase). In such cases, the tonic effect of Glycyrrhiza on the Kidney may be combined with a tonic effect on the Spleen, helping to nourish and moisten the skin and the flesh. Cardioregu1atory and calming effects of Glycyrrhiza
An extrapolation from Chinese medicine In Chinese medicine, gan dio is used as a sweet tonic to strengthen Heart Qi and treat both irregularities of heart rhythm and palpitations. Glycyrrhiza does not have a tradition of use as a cardiotonic or cardioregulator in the West. However, extrapolating from the use of G. uralensis in Chinese medicine, I use G. glabra in combinations to treat Heart Deficient Qi, either when it is associated with Heart Qi Irregularity and arrhythmias, or when it is associated with Heart Spirit Disturbance and palpitations, insomnia, or bipolar syndrome. In my opinion, G. glabra may exert a stabilizing effect on Heart Qi and Heart Spirit by tonifying the Qi of the Heart, Spleen, and Kidney.
Glycyrrhiza for arrhythmias I use Glycyrrhiza as a supplementary herb to augment the effect of such primary cardiotonics as Crataegus, Convallaria, Cinchona, or Leonurus, for example, in combinations to strengthen the Heart and Kidney and stabilize the Heart Qi as in Crataegus: cardiac
arrhythmia + hypotension. Glycyrrhiza for bipolar disorders In Five Element theory, the sweet taste is associated with the Earth Element, which in turn can be associated with the qualities of physical solidity, stability, and the central position betWeen extremes. In my opinion, some herbs with a sweet taste can be used to tonify the Qi in order to stabilize fluctuations between the Ym and Yang. For example, although I do not regard Glycyrrhiza as a primary herb for bipolar or menopausal disorders, I use it as a supplementary herb, often combined with Serenoa, to reduce fluctuations between Ym and Yang in such combinations for bipolar or menopausal disorders as Crataegus: bipo-
lar disorders. Glycyrrhiza for palpitations and insomnia I also associate the Earth Element and the sweet taste with the qualities of heaviness and inertia so that sweet herbs such as Glycyrrhiza can be used to nourish the Heart Spirit and to weigh it down, reducing a disturbance or irregularity of its movement. Although I do not consider Glycyrrhiza to be a tranquilizer, I use it to augment the calming action of Valeriana and include it as a supplementary herb in combinations to stabilize and calm Heart Spirit, such as Lavandula: insomnia or Lavandula: palpitations + anxiety.
"-
476
Combining Western Herbs and Chinese Medicine
DIRECTION OF ENERGY
ACTIONS .....
Glycyrrhiza can be said to have a tonifying, stabilizing, and centralizing effect on the movement of Qi in conditions involving Heart Qi Irregularity or Heart Spirit Disturbance.
Demulcent anti-inflammatory Glycyrrhiza is used as a ., .:.~~-:;; moistening demulcent anti-inflammatory, mainly for the.;,:::~ ~.'" gastrointestinal and respiratory systems. In the West, it ~_~~. as a urinary anti-inflammatory, but this use is not so common today. ---\
TYPICAL CASE EXAMPLE Signs and symptoms The patient is exhausted and has a history of gastritis and peptic ulcers. The patient also has rheumatoid arthritis and, accordingly, has been using NSAIDs and corticosteroids for a long period. This medication has aggravated the gastric inflammation, and the corticosteroids have led to dryness, thinning, and fragility of the skin. The pulse is slightly rapid, thin, forceless, and choppy, especially in the third positions, and wiry in the Stomach position. The tongue is thin, pale, and drywith some redness in the center. Diagnosis The patient has Stomach Deficient Yin with Stomach Deficiency Heat and Deficient Fluids as well as Kidney Defici~nt Qi. Choice of Glycyrrhiza This herb is specific for the following conditions: • Stomach Heat • Stomach Deficient Fluids • Deficient Kidney Qi • adverse effects ofNSAIDs and corticosteroids Glycyrrhiza can also assist in the treatment of rheumatoid arthritis.
Limitations of Glycyrrhiza TEMPERATURE In this book, Glycyrrhiza is classified as neutral-cool. It can act as a neutral herb, but for hot, warm, cool, or cold conditions, it would need to be combined with other herbs of the appropriate temperature. It can also act as a cooling anti-inflammatory.
TASTE Glycyrrhiza is classified in this book as sweet and can act as a sweet demulcent or as a sweet tonic. It does have a slight bitter taste and, some bitter constituents (see Research: Constit~ts). H&wever, it is not generally classified as bitter, although it can have cooling anti-inflammatory and detoxicant actions.
,
was.
Expectorant and antitussive Glycyrrhiza is not so much a stimulant, relaxing expectorant or an antitussive. Instead, it is a herb that can aid expectoration by loosening viscid mucus by its moistening effect and by its soothing antiinflammatory effect on irritated mucosa. Antispasmodic Glycyrrhiza is not a primary antispasmodic for the smooth muscle of either the bronchi or intestines, but it can supplement the action of primary antispasmodics such as Lobelia. Mild laxative Glycyrrhiza can act as a mild moistening,. demulcent' laxative for constipation associated with Dryness or Heat in the Intestines. However, it is more frequently used in laxative combinations as a mild antispasmodic to counter intestinal spasms caused by purgative herbs such as Rheum or Rhamnus. Tonic I do not consider Glycyrrhiza to be a primary herb to tonify the Spleen, Heart, or Kidney, but I frequently use it as a supplementary herb in tonic prescriptions for these organs. This is especially so for conditions associated with adrenocortical insufficiency, chronic fatigue syndrome, or recovery from prolonged corticosteroid treatment. Tranquilizer I do not consider Glycyrrhiza to have a tranquilizing effect. However, I frequently use it as a supplementary herb to assist primary herbs to stabilize Heart Qi in cases of cardiac arrhythmia or to calm and stabilize Heart Spirit in cases of palpitations, insomnia, or bipolar disorder. Detoxicant This use of Glycyrrhiza is emphasized more in China than in the West, but I use Glycyrrhiza to assist in detoxification when the patient is undergoing radio- or chemotherapy, or is taking higher doses of alterative herbs. Moderator of other herbs In my opinion, the most important use of Glycyrrhiza is as a supplement to the actions of primary herbs or as a moderator of their effects. This is discussed in Traditional sources.
Glycyrrhiza paired with other herbs Discussion of the limitations of each of the main actions of Glycyrrhiza can be useful to clarify just what this herb can and cannot do. However, suitable combination with other
Glycyrrhiza
477
I·
herbs can extend the range of use of Glycyrrhiza beyond its limitations. The basic unit of herb combination is the herb pair. Twelve pairings of Glycyrrhiza are briefly explained below.
assist treatment of bipolar syndrome, or menopausal disorders in cases involving oscillation between Deficient Yin and Deficient Yang. Glycyrrhiza + Prunus
CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair. Glycyrrhiza + Althaea
Dry cough Both these herbs are moistening antitussives to treat dry cough. However, Glycyrrhiza is more moistening, demulcent, and anti-inflammatory, whilst Prunus is more antispasmodic and tranquilizing.
Colitis Both herbs can be used as sweet nutritive tonics, moistening demulcents, and anti-inflammatories. They can be used for dry sore throat, dry cough, gastritis, peptic ulcer, and colitis. Glycyrrhiza + Ophiopogon
Gastritis + thirst Both herbs are predominantly sweet in property, and both are moistening. As a pair, they are specific for gastritis or peptic ulcer with Stomach Deficient rm, Stomach Dryness, and Stomach Deficiency Heat; or for chronic dry sore throat, dry cough, or bronchitis with Lung Deficient Yin, Lung Dryness, and Lung Deficiency Heat. In addition, this pair of sweet herbs can help to treat palpitations and anxiety associated with Deficiency of Heart Qi and Yin.
Glycyrrhiza + Zingiber
Moderators ofother herbs This is the most common pair of herbs in Chinese medicine. Fresh ginger and licorice can help to strengthen Defensive Qi, reduce gastritis, aid expectoration, reduce the adverse effects of other herbs, and assist in the detoxification of drugs and poisons. Glycyrrhiza + Lobelia
Irritant cough These herbs can be paired to treat irritant cough, with Glycyrrhiza being moistening and demulcent, and Lobelia being counterirritant and antispasmodic. Glycyrrhiza can help to moderate the potentially irritant effects of acrid herbs such as Lobelia and Sanguinaria.
Glycyrrhiza + Pseudostellaria
Glycyrrhiza + Harpagophytum
Chronic fatigue syndrome
Rheumatoid arthritis
Both herbs are sweet tonics for Qi and Fluids. They can be combined for postfebrile convalescence or as neutral sweet tonics to stabilize fluctuations between Yin and Yang due to Deficient Qi, as in the fluctuations of energy, temperature, blood sugar, and mood observed in some cases of chronic fatigue syndrome and fibromyalgia. However, they are moist herbs that need to be avoided in patients with accumulation of Damp and Phlegm. Glycyrrhiza + Panax ginseng
Exhaustion + depression These herbs can be combined to treat exhaustion, depression, or shortness of breath as a result of Deficient Qi and Yang of the Kidney, Heart, and Lung.
Harpagophytum is a primary anti-inflammatory for rheumatism, arthritis, and gout. Glycyqhiza can act as a secondary anti-inflammatory and it also moderates the potentially irritant effect of Harpagophytum on the gastric lining when this herb is used at high doses. Glycyrrhiza + Rheum
Constipation Rheum is the primary purgative herb, and Glycyrrhiza can be used as a mild moistening la.'<:ative to supplement the effect of Rheum, especially in cases of constipation with dryness and inflammation. Glycyrrhiza can help to reduce the potentially cramping effect of Rheum on the intestines. Glycyrrhiza + Ephedra
Glycyrrhiza + Serenoa
Bipolar syndrome Neither of these herbs is specific for bipolar syndrome. However, they can be combined to tonify Spleen, Kidney, and Heart Qi, and thus stabilize the Ym-Yang balance and
Allergic asthma Glycyrrhiza is not a primary herb for asthma, but it has been used as a supplementary herb for allergic and inflammatory conditions. Also, it is a sweet herb that can help to tonify the Qi of the Heart and Kidney, and to reduce the
478
Combining Western Herbs and Chinese
draining and destabilizing effect of Ephedra on these sys-
Medicine,' ,_
This combination is the same as Althaea: dry cough and:- -.~. . . ,c::':'.!V
is discussed under that heading.
terns. Glycyrrhiza + Valeriana
Insomnia
2. Peptic ulcer
Glycyrrhiza is not a calming herb as such. However, the
Stomach Heat
sweet property of Valeriana can be enhanced by the sweet property of Glycyrrhiza to provide a heaviness and material base to help stabilize Heart Spirit. In my experience, this effect can enhance the sedative action of Valeriana, and I often use Valeriana and Glycyrrhiza together in combinations to nourish and calm Heart Spirit.
Glycyrrhiza combinations
.-<1'>,. . ,..,--""-:-"..,-----
Herb Calendula Filipendula Hydrastis Valeriana Ophiopogon Glycyrrhiza
1 1 1 1 1
0.5
•
Temperatti"re··
Taste
cool cool cool cool cool neutral-eool
bitter sour, bitter bitter bitter, sweet sweet, sl. bitter sweet
This combination is the same as Calendula: peptic ulcer and is discussed under that heading.
Eight Glycyrrhiza combinations are discussed below: Combination
Chinese syndromes .
1. dry cough
Lung Deficiency Heat + Lung Deficient Yin
2. peptic ulcer
Stomach Heat
3. colitis
Intestines Heat
4. cardiac arrhythmia + hypotension
Heart Qi Irregularity + .Kidney Deficient Qi
5. insomnia
Heart Spirit Disturbance
6. arthritis + heat sensations
Damp Heat in the channels
3. Colitis
Intestines Heat
7. recurring urticaria (remission phase) Retained Pathogen + Deficient Blood 8. cancer therapy adjunct
Stagnant Qi + Damp Heat + Heat Toxin
Althaea Polygonum Hamamelis Calendula Hydrastis Glycyrrhiza
cool cool neutral-eool cool cool neutral-cool
10 approx. 1 1 1 1
0.5
sweet, sl. bitter sour, sl. bitter sour, sl. bitter bitter bitter sweet
This combination is the same as Althaea: colitis and is discussed under that heading.
4. Cardiac arrhythmia + hypotension
Heart Qi Irregularity + Kidney Deficient Qi
CAUTION Before using any ofthe combinations below, it is important to be familiar with the cautions listed for each herb in the combination. 1. Dry cough
Lung Deficiency Heat + Lung Deficient Yin Herb'· Althaea Viola tri. Prunus Marrubium Ophiopogon Glycyrrhiza
.. Ratio··. Z 10 approx. 1 1 1 1 1
Temperature
cool cool neutral neutral cool neutral-eool
Crataegus Convallaria Sarothamnus Leonurus Panax gin. Schisandra Glycyrrhiza Zingiber
1 1 1 1 1 1 0.5 0.5
sl.warm neutral neutral neutral sl. warm warm neutral-cool hot
sour, sweet bitter, sl. sweet bitter sour, sl. bitter sweet, sl. bitter sour . sweet acrid, aromatic
This combination is the same as Crataegus: cardiac arsweet, sl. bitter sour, sweet, bitter bitter, aromatic bitter sweet, sl. bitter sweet
rhythmia + hypotension and is discussed under that heading.
5. Insomnia Heart Spirit Disturbance
Glycyrrhiza
479
This combination is the same as Thuja: cancer therapy adjunct and is discussed under that heading. Lavandula Valeriana Anemone Glycyrrhiza
1 1 1
51. warm cool cold
aromatic, bitter, 51. acrid
0.5
neutral-eool
sweet
bitter, sweet bitter
COMPARISONS OF THE EIGHT' GLYCYRRHIZA COMBINATIONS
This combination is the same as Lavandula: insomnia and is discussed under that heading. 6. Arthritis + heat sensations
Damp Heat in the channels Herb Harpagophytum Berberis Taraxacum Arctium (root) Filipendula Angelica sin. Glycyrrhiza
Temperature
Taste
2 1 1 1
cool
bitter
cool cool-eold cool cool warm neutral-eool
bitter bitter 51. acrid, 51. bitter sour, bitter sweet, aromatic, bitter sweet
This combination is the same as Harpagophytum: arthritis + heat sensations and is discussed under that heading. 7. Recurring urticaria (remission phase)
Retained Pathogen + Deficient Blood Herb Arctium (seeds) Mahonia Urtica Angelica sin. Ziziphus (fruit) Glycyrrhiza Schisandra
Ratio
1 1 1
0.5 0.5 0.5 0.5
. Temperature'Taste cool
acrid, 51. bitter
cool warm-eool warm
bitter acrid sweet, aromatic, bitter sweet
neutral neutral-eool warm
sweet sour
This combination is the same as Arctium: recurring urticaria (remission phase) and is discussed under that heading. 8. Cancer therapy adjunct
Stagnant Qi + Damp Heat + Heat Toxin Herb Thuja Viola odo. Phytolacca Hydrastis Taraxacum Arctium (root) Glycyrrhiza Zingiber
Ratio
Temperature
Taste
1 1 1 1 1 1
warm-eool cool
acrid, aromatic, bitter
0.5 0.5
..
2. Peptic ulcer
Lung Deficiency Heat + Lung Deficient Yin
Stomach Heat
Herb
Ratio
0.5 0.5 0.5
1. Dry cough
..
sour, sweet, bitter
cool
acrid
cool cool-eold cool
bitter bitter sl. acrid, 51. bitter
neutral-eool hot
sweet acrid, aromatic
Althaea Viola tri. Prunus Marrubium Ophiopogon Glycyrrhiza
Ratio 10 approx. 1 1 1 1
1
Herb Calendula Filipendula Hydrastis Valeriana Ophiopogon Glycyrrhiza
Ratio
1 1 1
1 1
0.5
1. Althaea, Viola, and Glycyrrhiza are moistening, demulcent, anti-inflammatory, and antitussive herbs to treat dry cough. Prunus and Marrubium are antitussive, antispasmodic, and expectorant herbs, and Prunus has a mild tranquilizing effect. Together, Ophiopogon and Glycyrrhiza, supported by the other two moist herbs, Althaea and Viola, can tonify Lung rm and Fluids.
2. In combination No.1, Ophiopogon and Glycyrrhiza are included to act as moistening, anti-inflammatories, and tonics for the Lung. In combination No.2, they can act as moistening, anti-inflammatories, and tonics for the Stomach. Calendula contributes astringent, vulnerary, and anti-inflammatory. actions. Filipendula contains both astringent tannins and anti-inflammatory salicylates. Hydrastis contains alkaloids that are antimicrobial and anti-inflammatory and can normalize the function of the mucous membranes. Valeriana has tranquilizing, antispasmodic, and analgesic actions. 3. Colitis
4. Cardiac arrhythmia + hypotension
.Intestines Heat
Heart Qi Irregularity + Kidney Deficient Qi
Herb Althaea Polygonum Hamamelis Calendula Hydrastis Glycyrrhiza
Ratio 10 approx.
1 1 1 1
0.5
Ratio' Crataegus Convallaria Sarothamnus Leonurus Panax gin. Schisandra Glycyrrhiza Zingiber
1 1 1 1 1 1
0.5 0.5
Combining Western Herbs and Chinese Medicine
480
~:~'"::i·,t:a.",%-~.-":'-;;;;:;';"~~'
3. In combination No.1, Althaea and Glycyrrhiza are included to act as moistening, demulcent, anti-inflammatories for a dry cough. In combination No.3, they are included to act as demulcent anti-inflammatories for the Intestines. The sour herbs Polygonum and Hamamelis, with their higher tannin content, are antidiarrheal and antihemorrhagic. The action of both are supported by the resin-based Calendula with its antimicrobial, anti-inflammatory, and vulnerary actions. Hydrastis is a bitter, antimicrobial, and anti-inflammatory herb, which can normalize mucus membrane function to treat colitis.
4. In combination No.4, Glycyrrhiza helps Crataegus, Convallaria, Sarothamnus, Leonurus, Panax, and Schisandra in tonifying and stabilizing Heart Qi, and assists Convallaria, Panax, Sarothamnus, and Schisandra in tonifying the Kidney to reinforce the stabilization of the Heart.
5. Insomnia
6. Arthritis + heat sensations
Heart Spirit Disturbance
Damp Heat in the.channels Ratio
Herb Lavandula Valeriana Anemone Glycyrrhiza
1 1 1 0.5
Harpagophytum Berberis Taraxacum Arctium (root) Filipendula Angelica sin. Glycyrrhiza
2 1 1 1 0.5 0.5
0.5
5. The emphasis of combination No.4 is on strengthening the heart and stabilizing heart rhythm by tonifying the Heart and Kidney systems. In combination No.5, the emphasis is more on calming and less on tonification. In this effective symptomatic combination for insomnia, Anemone and Valeriana are the stronger calming herbs. Lavandula contributes a tranquilizing effect but balances this with mild tonifying and moving actions. The sweet heavy property of Glycyrrhiza emphasizes the sweet heaviness ofValeriana, but this grounding and stabilizing effect is moderated by the moving and lightening action of the Lavandula essential oils. 6. Harpagophytum is the leading herb in treating arthritis from Damp·Heat in the joints, tendon~d muscles. Be~beris, Taraxacum, and Arctium assist in this by clearing Damp Heat from the Liver and from the body in general. Filipendula and Glycyrrhiza treat gastric inflammation or ulceration associated with long-term use of NSAIDs and/or corticosteroids. Glycyrrhiza helps in the recovery from the other adverse effects of corticosteroids and also prevents potential irritation of the gastric lining by prolonged high
doses of Harpagophytum. Angelica sinensis treats Defici.ep.t....:~:~-:-. Blood associated with blood loss from NSAIDs- or cortico- .. _~.~~ ~,
steroid-induced gastric bleeding.
7. Recurring urticaria (remission phase)
8. Cancer therapy adjunct
Retained Pathogen + Deficient Blood
Stagnant Qi + Damp Heat + Heat Toxin
Herb Arctium (seeds) Mahonia Urtica Angelica sin. Ziziphus (fruit) Glycyrrhiza Schisandra
,.,
Ratio 1 1 1 0.5 0.5 0.5 0.5
Thuja Viola ado. Phytolacca Hydrastis Taraxacum Arctium (root) Glycyrrhiza Zingiber
1 1 1 1
1
...,
,
""1
1 0.5 0.5
7. In combination No.6, Glycyrrhiza acts as an anti-inflammatory for arthritis to assist in the antiarthritic action. In combination No.7, Glycyrrhiza assists and moderates the alterative action of Arctium, Mahonia, and Urtica to clear accumulated toxins from the skin and body. Glycyrrhiza also helps Angelica and Ziziphus to tonify Qi and Blood, and it helps Schisandra to tonify the Kidney. These effects can help to counteract the thinning and drying effect on the skin of the prolonged use of corticosteroid creams. 8. Thuja, Viola, and Phytolacca have a reputation for retarding the growth of tumors. Thuja, Viola, Phytolacca, Hydrastis, Tara."'{acum, and Arctium are alterative herbs that can help to clear Retained Pathogen, Damp Heat, and Heat Toxin, thus, helping to reduce the side effects of radio- or chemotherapy. Glycyrrhiza can assist in this detoxification and can act as an anti-inflammatory' and a tonic. Zingiber also assists in the detoxification, moderates the effect of the cooling herbs, and helps to stimulate circulation and digestion. -
OTHER GLYCYRRHIZA COMBINATIONS Glycyrrhiza, like Zingiber, is a multipurpose herb that is present in many combinations. The following examples give an idea of the wide range of uses of this herb:
• Achillea: recurring fever + exhaustion • Asclepias: acute respiratory disorders + fever • Berberis: acute eczema • Cinchona: recurringfever + cardiac weakness • Crataegus: bipolar disorders • Euphrasia: acute allergic rhinitis
.• 1
Glycyrrhiza \
.'
• Gentiana: poor appetite + anorexia • Lobelia: acute asthma • Rheum: gastritis + constipation • Ruta: chronic fatigue syndrome + palpitations • Ruta: exhaustion + fear • Turnera: exhaustion + sexual debility • Valeriana: colitis + nervous tension • Zingiber: intestinal colic + cold sensations
481
• glycyrrhetic acid =glycyrrhetinic acid Thus, the term glycyrrhizin has been used by some authors as a synonym of glycyrrhizic acid, and by other authors specifically to indicate the calcium and potassium salts of glycyrrhizic acid. Flavonoids G. glabra contains over 30 flavonoids, which may be about 1% of the constituents, such as:1
• flavones
Research PHYLOGENETIC RELATIONSHIPS OF GLYCYRRHIZA SPECIES The nucleotide sequences of the ribulose-1,5-bisphosphate carboxylase/oxygenase large subunit gene (rbcL) were investigated to determine the phylogenetic relationships of six Glycyrrhiza species. Two groups were proposed: • G. glabra, G. uralensis, and G. inflata, which produce glycyrrhizin as a major saponin • G. echinata, G. macedonica and G. pallidiflora, which produce macedonoside C as a major saponin Among the three glycyrrhizin-producing species, only two nucleotide substitutions were observed between the rbcL sequences of G. glabra and G. uralensis, and the sequence of G. uralensis was identical to that of G. inflata, indicating that G. uralensis and G. inflata are closely related. I?
CONSTITUENTS The following constituents have been reported for G. glabra: • triterpenoid saponins • flavonoids • polysaccharides • other Triterpenoid saponins These may be 2-15% of the constituents l and consists mainly of glycyrrhizic acid (2-6%),18 which is the 3-0-diglucuronide of 18-~-glycyrrheticacid. Glycyrrhizic acid occurs as a mixture of potassium and calcium s.alts known as glycyrrhizin. 19 Glycyrrhizin is about 50 times sweeter than sugar and is responsible for most of the sweetness of G. glabra.
Nomenclature The literature can be a little confusing due to the use of different synonyms by different workers: • glycyrrhizic acid = glycyrrhizinic acid = glycyrrhizin
• isoflavones • chalcones
including liquiritin (and its aglycone liquiritigenin) and glabrol neoliquiritin, hispaglabridin, and glabridin20 including isoliquiritin (and its aglycone isoliquiritigenin) and licochalcones
Polysaccharides Two acidic arabinogalactans 21 and a neutral arabinogalactan 22 have been reported. Other
G. glabra also contains the following constituents:
• starch 25-30%23 • glucose and sucrose 3-10%23 • asparagine 1_2%12 • bitter principles, such as glycyramarin, which occurs especially in the outer tissues, so that it is mainly removed in the peeled material12 • coumarins: including herniarin and umbelliferone l • sterols: including ~-amyrin, sitosterol, stigmasterol I Interspecies differences Root samples of G. uralensis, G. glabra, and G. inflata were analyzed by high-performance liquid chromatography and the species were differentiated on the the basis of their phenolic constituents:H • G. uralensis' licopyranocoumarin, glycycoumarin, and/or licocoumarone, which were not found in the samples of the other two Glycyrrhiza species • G. glabra
• G. inflata
glabridin and glabrene, which were not found in the samples of the other two Glycyrrhiza species licochalcones A and B, which were not found in the samples of the other two Glycyrrhiza species
PHARMACOLOGICAL AND CLINICAL RESEARCH Note The discussion below is a relatively bri~f summary of the extensive research literature on Glycyrrhiza, and the reader is referred to the review by Gibson,25 and to the recent review by Mills and Bone.26 The following effects have been observed using extracts of Glycyrrhiza species or their isolated constituents:
482
Combining Western Herbs and Chinese Medicine
• antimicrobial • antiviral • anti-inflammatory • antiulcer • antispasmodic • cardioregulatory • antitussive and expectorant • immunoregulatory • choloretic • hepatoprotective and antitoxic • antilipidemic and antiatheromatic • antioxidant • antitumor and antimutagenic • effect on reproductive hormones • effect on glucocorticoid metabolism • effect on mineralocorticoid metabolism Antimicrobial
General The following isoflavonoids from G. glabra demonstrated significant antimicrobial activity in vitro: hispaglabridin A, hispaglabridin B, 4'-O-methylglabridin, glabridin, glabrol and 3-hydroxyglabro1.20 Antiprotozoal Intraperitoneal administration of licochalcone A at doses of 2.5 and 5 mglkg of body weight per day completely prevented lesion development in BALB/c mice infected with Leishmania major. The authors suggested the possibility of development of licochalcone A as a new drug against leishmaniases. 27 Licochalcone A, isolated from G. uralensis, inhibited the in vitro growth of both chloroquine-susceptible (3D7) and chloroquine-resistant (Dd2) Plasmodium falciparurn strains in a 3H-hypoxanthine uptake assay. Licochalcone A, administered either intraperitoneally or orally to mice for 3 to 6 days, protected the mice from otherwise lethal P. yoelii infection. The authors suggested that licochalcone A might be developed into a new antimalarial drug. 28 Antifungal Compared with normal mice, MAIDS mice (mice infected with LP-BMS murine leukemia virus) exhibited an increase up to 100 times greater in susceptibility to infection with Candida albicans. The administration of glycyrrhizin to the MAIDS mice eliminated this increase in susceptibility, decreasing the level of infection to that observed in normal mice. 29 Antiviral
General Glycyrrhizin has been reported to have in vitro antiviral activity against varicella-zoster virus30 and herpes simplex virus type_I. 31 Intraperitoneal administration of glycyrrhizin was reported to reduce morbidity and mortality
__
of mice infected with lethal doses of influenza virus,.A.i~-=~ l:::::"c (H2N2).32 7";;f~1t~
Anti-HIV Glycyrrhizin at a dose of 400-1600 mg per day:::;-~= -(7.2-30.8 mglkg per day) was administered intravenous1yfor;~:;;~:C a period of more than a month, on six separate occasions, to._~Zit~~; three hemophiliacs with AIDS. Human immunodeficiency __ ~&_._ virus type 1 (HIV-1) p24 antigen was detected at the begin- '~ ning of five of the six treatment courses. VITal antigen was . not detected at the end of or during three of the five treatment courses and decreased to a low level in the two other courses, suggesting that glycyrrhizin might inhibit HIV-1 replication in vivo. 33 In addition, a diprenylated bibenzyl compound isolated from the leaves of G. lepidota was reported to show moderate activity against HIV-1 in vitro. J.l Antihepatitis Twelve months of intravenous administration of glycyrrhizic acid, in the form of the product Remefa . - .. #_.... \ S, wa.s reported to have beneficial effects in patients with':-~1:t;__ :.I chronic viral hepatitis B.35 Intravenous administration o(~ glycyrrhizin, in the form of the Japanese product SNMC, has been reported to be of benefit in the treatment of viral ·hepatitis. 36 Applicability of in vitro data Orally administered glycyrrhizic acid is almost completely hydrolyzed by intestinal bacteria and reaches the systemic circulation as glycyrrhetic acid. 37 According to Mills and Bone, glycyrrhizic acid inhibits viral growth but glycyrrhetic acid does not. Therefore, Mills and Bone have suggested that oral administration of glycyr- . rhizic acid will not have systemic antiviral effects, although it could act as a topical antiviral agent,26 Anti-inflammatory
Internal administration The mechanisms of the anti-inflammatory effects reported for glycyrrhizin and glycyrrhetic acid remain unclear. An animal study reported that glycyrrhetic acid has anti-inflammatory activity and the authors proposed that it may inhibit the migration of white cells into sites of inflammation. 38 Glycyrrhizin was found to inhibit prostaglandin E2 production by activated rat peritoneal macrophages in vitro. The authors considered it likely that the anti-inflammatory activity of glycyrrhizin depends, at least in part, on its inhibitory effect on the production of prostaglandin E2. 39 The isoflavone glabridin was reported to have antiinflammatory effects in vitro in rodent studies. Glabridin has been shown to inhibit superoxide anion production and cyclooxygenase activity.40 Topical administration Topical anti-inflammatory activity has been reported for Glycyrrhiza extract,41 glycyrrhizin,42 glycyrrhetic acid,43 and licochalcone A. 44
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-~..
I
-
..
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Glycyrrhiza Antiulcer The oral administration of Glycyrrhiza extract at (500 mg/kg) significantly prevented gastric mucosal damage induced by 70% ethanol in rats and increased the surface mucin content. 45 A Glycyrrhiza extract was reported to have antiulcerogenic activity against indomethacin-induced gastric ulcers in rats, associated with a reduced acid output, an increased mucin secretion, an increase in prostaglandin E2 release, and a decrease in leukotrienes. The effect on pepsin content was rather variable and did not seem to bear a rela-
'.
tionship with the antiulcerogenic activity.46 Glycyrrhiza extract, in the form of the Japanese product FmlOO, was reported to increase plasma secretin concentration, thereby increasing pancreatic bicarbonate output in humans. 47 A later study suggested that the antiulcer effect of FmlOO may be due to its ability to release secretin and that the inhibitory action of secretin on gastric acid secretion is 48 partly mediated by endogenous prostaglandins. It is not yet clear which constituents are responsible for the antiulcer effects of Glycyrrhiza. Whilst both glycyrrhizic acid and glycyrrhetic acid have been reported to have antiulcer activity, it appears that flavonoids, and possibly other constituents, may also playa part. 26 Antispasmodic According to Wichtl, the antispasmodic action reported for Glycyrrhiza has been attributed to some of its flavonoids, in particular liquiritigenin as well as isoliquiritigenin.\ This statement may be referring to an early study in China that reported that isoliquiritigenin had antispasmodic action on the smooth muscle of animal intestines, 49 but glycyrrhizin and glycyrrhetic acid did not. A recent study using endothelial-free rat aortic rings precontracted with phenylephrine found that isoliquiritigenin induced a concentration-dependent relaxation. 50 Cardioregulatory The chalcone isoliquiritigenin increased the force of contraction in rat ventricular heart muscle, which is thought to be due to an accumulation of cyclic AMP.51 Antitussive and expectorant An antitussive effect was reported for a Glycyrrhiza extract.52 Oral doses of a glycyrrhetic acid preparation were reported to have an antitussive effect similar to codeine.53 Glycyrrhiza was reported to promote pharyngeal and bronchial secretion, leading to easier expectoration.54 Immunoregulatory
General Oral administration of 50 mgfkg per day of Glycyrrhiza extract or intraperitoneal administration of glycyrrhetic acid at 5 mg/kg per day enhanced the recovery of leukocyte count, lymphocyte count, and cellular immunity in gamma ray-irradiated mice. 55
483 It was reported that ~-glycyrrhetinic acid is a potent
inhibitor of the classical complement pathway in humans, and this inhibition was dependent on the conformation of the compound since the alpha form was not active. Detailed mechanistic studies revealed that ~-glycyrrhetinic acid acts at the level of complement component C2. 56
HIV A study reported that a G. uralensis extract, in the form of the Chinese product Glyke, resulted in immunological improvement as measured by the T4:T8 ratio and T4 counts. High-dose glycyrrhizin, in the form of intravenous administration of the Japanese product SNMC, was reported to be of benefit in the treatment of hemophiliacs with HIV infection.57 Choloretic Recent studies indicated that licorice extract, administered either orally or intravenously, has a choloretic effect in rats.;s Hepatoprotective and antitoxic
Hepatoprotective It was reported that oral administration of a Glycyrrhiza extract at 1 gikg or glycyrrhizin at 23 mgikg activated glucuronidation in rats, thereby possibly influencing the detoxification of drugs in the rat liver. A study on carbon tetrachloride-induced hepatotoxicity in rats reported that when glycyrrhizin was administered orally it had a hepatoprotective effect, but when it was administered intraperitoneally, it did not have a hepatoprotective effect. When glyeyrrhetinic acid was admi~tered intraperitoneally, it also had some hepatoprotective effect. Both glycyrrhizin and glycyrrhetic acid inhibited ~-glucuronidase.s9. Antitoxic Early studies with mice reported that Glycyrrhiza extract or glycyrrhizin had significant detoxicant action against chloral hydrate, strychnine, urethane, cocaine, arsenobenzene, and mercurous chloride.60 Glycyrrhizin was also reported to be effective against snake venom, and against the lethal effect of diphtheria and tetanus toxinS. 61 It has also been reported that glycyrrhizin can have a protective effect against saponin toxicity, and, as a nonhemolytic saponin, can reduce lysis of erythrocytes by saponins in vitro.62 Antilipidemic and antiatheromatic Glycyrrhiza was administered to hypercholesterolemic rats and reported to have hypocholesterolemic and hypolipidemic actions. 63 A study using cultured rabbit hepatocytes suggested that glycyrrhizic acid exerts hypocholesterolemic action by stimulating cholesterol conversion into bile acids without any effect on cholesterol synthesis.64 Lysosomal phospholipase A2 activity is increased in the aorta of hypercholesterolemic rats, arid this increase in phospholipase A2 activity results in the lysis. of lysosomes (and
-_.-
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484
~-
.
.;._~_~i~
Combining Western Her:~.~.and Chinese Medicine
the subsequent destruction of the cell). However, glycyrrhizin stabilized the lysosomes by inhibiting phospholipase A2 activity, thereby protecting the tissue from degradation. 65
below the toxic level, was reported to decrease chemicall£~~ .~. induced mutation frequencies in vivo.' ° '::':3::~
Antioxidant Atherosclerotic apolipoprotein E-deficient mice were given dietary supplementation oflicorice (200 ILg per day) or the isoflavone glabridin (20 ILg per day) for 6 weeks. This reduced the susceptibility of the low-density lipoprotein (LDL) to oxidation and reduced the atherosclerotic lesions. These results could be explained by an absorption and binding of glabridin to the LDL particle and subsequent protection of the LDL from oxidation. In another study, the susceptibility of LDL before and after licorice intake was determined in an ex vivo human study. The LDL, isolated from the plasma of 10 normolipidemic subjects who were orally supplemented with 100 mg per day licorice for 2 weeks, was more resistant to oxidation than was LDL isolated from the same individuals before licorice supplementation.66
Estrogen It was reported that glycyrrhetic acid can antago;:~::?~~;£~ nize some of the effects of exogenously administered estro-..- -t~i~ ~ ...
Antitumor and antimutagenic
General Glycyrrhetic acid but not glycyrrhizic acid, inhibited the specific binding of I2-0-tetradecanoylphorbol-13acetate (TPA) to mouse epidermal membrane fractions. Data suggested that glycyrrhetic acid directly binds to the TPA receptor, resulting in competitive inhibition with the tumor-promoting agent. The inhibitory effect of glycyrrhetic acid on TPA binding to a membrane receptor may playa role in preventing tumors in vivo. 61
Breast cancer The estrogenic properties of glabridin, the major isoflavonoid in Glycyrrhiza root, were tested in view of the resemblance of its structure and lipophilicity to those of estradiol. The results indicated that glabridin is a phytoestrogen, binding to the human estrogen receptor and stimulating creatine kinase activity in rat uterus, certain bones, and cardiovascular tissues. The stimulatory effects of 2.5-25 ILg glabridin per animal were similar to those of 5 ILg estradiol per animal. Glabridin alsQ demonstrated growth-inhibitory actions on human breast cancer cells.68
Endometrial cancer Proto-oncogenes such as c-fos and c-
'0
jun are known to relate to cell proliferation and differentiation. Glycyrrhiza was found to suppress estradiol-I? ~ induced expression of c-fos/jun in uterine corpus and inhibited N-methyl-N-nitrosourea and estradiol-I? ~ induced endometrial carcinogenesis in mice. It was suggested that Glycyrrhiza may be a promising preventative agent for endometrial cancers.69
Antimutagenic Glycyrrhiza extract, at concentrations well
i
-''-:·C.:·~F~~-;.;
Effect on reproductive hormo~es
~ _~~~ _~
~~3':,.
gen but has no action on the effects of natural levels of estro- . _~);\- :-gen. '1 In a recent study, Glycyrrhiza extracts showed on1y~fi$' .., weak estrogen receptor binding and weak induction of the estrogen-inducible gene presenelin-2 in S30 breast cancer cells. n This contrasts with the report that Glycyrrhiza can suppress estradiol-induced gene expression in the uterus and inhibit endometrial cancer; see Endometrial cancer above. It may be that any estrogenic effect of Glycyrrhiza may be due not so much to glycyrrhizin or glycyrrhetic acid, but to glabridin and other constituents; see Breast cancer above.
Testosterone A study on steroid production in the rat ovary~" reported that glycyrrhetic acid and glycyrrhizin decreased : testosterone production, perhaps by affecting testosterone synthesis from delta 4-androstenedione.13
~
.~~-~:
Effect on glucocorticoid metabolism
Inhibition of cortisol breakdown Glycyrrhiza constituents may potentiate the effects of cortisol by inhibiting the enzymes responsible for cortisol breakdown. For example, when glyeyrrhetic acid or glycyrrhizin were administered to ~ rat liver preparations, 5 ~-reductase activity was significantly suppressed. It was presumed that this suppression of 5 ~reductase activity may delay the clearance of corticosteroids arid prolong the biological half-life of cortisol, resulting in the synergism of action of these steroids and glycyrrhetic acid or glycyrrhizin. 14 Also, it was reported that glycyrrhetic acid can inhibit the breakdown of cortisol to cortisone by 15 II-~-hydroxysteroiddehydrogenase in humans.
Glycyrrhiza moderation of cortisone treatment Although glycyrrhizin has been reported to potentiate the beneficial anti-inflammatory effect of cortisol,'6 it can also reduce some of its side effects, such as its inhibitory effect on ACTH synthesis.17 In addition, the antiulcer action of Glycyrrhiza may help to reduce the potentially ulcerogenic effect of cor- .' . tisone treatment. I
Effect on mineralocorticoid metabolism
Summary of effects The effects of glycyrrhizin and glycyrrhetic acid on mineralocorticoid metabolism can be summarized as follows: • do not have appreciable intrinsic mineralocorticoid effects • do not have appreciable effect on aldosterone
.~.!
•.' ,
Glycyrrhiza metabolism • have their effects on mineralocorticoid metabolism at least partly via inhibition of cortisol breakdown In summary, Glycyrrhiza, or its constituents glycyrrhizin or glycyrrhetic acid, can inhibit the enzyme 11-~-hydroxys teroid dehydrogenase that converts cortisol to cortisone. This may result in a high level of cortisol in the kidney, activating type-l mineralocorticoid receptors and may result in pseudohyperaldosteronism, with sodium retention, potassium depletion, edema, hypertension, and weight gain. The pathogenesis of pseudohyperaldosteronism from Glycyrrhiza was evaluated in SL"'{ male volunteers taking 7 g of a commercial preparation of Glycyrrhiza for 7 days, corresponding to an intake of 500 mg per day of glycyrrhizic acid. It was concluded that the pseudohyperaldosteronism from Glycyrrhiza is initially related to decreased activity of l1-~-hydroxysteroiddehydrogenase. Afterwards, a direct effect of Glycyrrhiza derivatives on mineralocorticoid receptors also became evident, more so in some cases than in others. iS
Addison's disease This disorder results from an inadequate secretion of corticosteroid hormones by the adrenal cortex, which can result in a craving for licorice confections. Glycyrrhiza extract, either alone or prescribed together with cortisone, can help to maintain electrolyte balance in Addison's disease. 79 However, the ingestion of an enormous amount of licorice (300-400 g per day) was associated with the development of pseudohyperaldosteronism in an II-year old boy.so An early study in China on four cases of Addison's disease reported that 15. rnl per day of gan dio (root of mainly G. uralensis) extract increased the patients' strength, blood pressure, and serum sodium, and decreased skin pigmentation. However, the use of gan dio alone could not prevent the development of crises in severe and advanced cases wherein the addition of corticosteroid was mandatory.81.82 Other early studies in China reported that glycyrrhizin and glycyrrhetic acid could have a beneficial effect in this disease. It was found that their maintenance dose could be gradually reduced after several weeks of continuous treatment as the patients developed increased sensitivity to these compounds. The maintenance dose varied with different individuals, and in some cases the eventual dose was only one tenth of the initial dose. 83.84
Hyperkalemia from hypoaldosteronism A dose of 150 mg/ day glycyrrhizin was found to reduce serum potassium levels in a study on eight patients with hyperkalemia due to selective hypoaldosteronism in diabetes mellitus patients. Glycyrrhizin was considered to be a safe treatment for this disorder.85
485
RESEARCH VERIFICATION OF TRADITIONAL ACTIONS The following traditional actions have been supported by research on Glycyrrh.i:z:a extracts or isolated constituents: antitussive, expectorant, anti-inflammatory, antiulcer, antispasmodic, tonic (adrenocortical insufficiency), antitoxic, and topical anti-inflammatory. Additional effects demonstrated by research The following effects have been reported as discussed above: antimicrobial (including antiviral), cardioregulatory, immunoregulatory, hepatoprotective, antilipidemic and antiatheromatic, antioxidant, hormonal regulator (including that of corticosteroids and estrogen), and antitumor. From this list, it would appear that although Glycyrrhiza has had a wide range of uses in the past, both in China and the West, it may have even more potential uses in the future.
TOXICOLOGY An important distinction
Most reports of adverse effects caused by Glycyrrhiza have been associated with very high intake of licorice as sweets (candies), as discussed below, and not with the administration of Glycyrrhiza infusion, decoction, or tincture when they are prescribed within the recommended therapeutic dose range. Overdose As examples of overdose, the following cases were associated with excessive licorice consumption: • pulmonary edema: consumption of 1020 g of licorice in 3 d aysS6 • myopathy: consumption of 1 kg of licorice sweets per week87 • pseudohyperaldosteronism and growth retardation in an II-year old boy taking 300-400 g licorice per da~ Investigation of the dose High doses of Glycyrrhiza have been known to cause hypertension, hypokalemia, and other adverse effects via the inhibition of the breakdown of cortisol by ll-~-hydroxysteroid dehydrogenase. The following studies investigated the dose of glycyrrhizin required to produce adverse effects. One study found great individual variation in the susceptibility to glycyrrhizic acid. In the most sensitive individuals, a regular daily intake of no more than about 100 mg glycyrrhizic acid, which corresponds to no more than 50 g liquorice sweets (assuming a content of 0.2% glycyrrhizic acid), seemed to be enough to produce adverse effects. Most individuals who consumed 400 mg glycyrrhizic acid daily experienced adverse effects.88
486
Graded daily doses of dried, aqueous extract of Glycyrrhiza root, containing 108,217,380 and 814 mg of glycyrrhizin, were administered to four groups of six healthy volunteers of both sexes for 4 weeks. In healthy subjects, only the highest doses of Glycyrrhiza led to untoward effects. These untoward effects were favored by the presence of preexisting subclinical disease, such as arterial hypertension, or by the taking of oral contraceptives. Side effects were less common and less pronounced than those previously reported after the intake of glycyrrhizin taken alone or as a flavoring agent in confectionery products.89 Variation in response to Glycyrrhiza The considerable variation in the blood pressure response of individuals to glycyrrhizin raised the question of whether there is a group within the population that is sensitive to glycyrrhizin, due perhaps to a deficiency in 11-~-hydroxysteroid dehydrogenase. However, this idea is not supported by the following study. Healthy volunteers consumed Glycyrrhiza in varying doses, 50-200 g per day, for 2-4 weeks, corresponding to a daily intake of 75-540 mg glycyrrhetic acid. This led to a systolic blood pressure increase of 3.1-14.4 mm Hg. Even doses as low as SO g of Glycyrrhiza (75 mg glycyrrhetic acid) consumed daily for 2 weeks can cause a significant rise in blood pressure. There does not seem to be a special group of responders since the degree of individual response to Glycyrrhiza consumption followed the normal distribution curve.90 It is worth noting that the lowest dose of Glycyrrhiza used in this study was SO g per day in comparison with the maximum therapeutic dose of 12 g per day listed by the BHP.9\ Carcinogenicity Tumors were not induced in mice by long-term administration of glycyrrhizin,92 and patients with previous breast cancer did not show adverse effects following oral doses of glycyrrhetic acid of 0.02-0.04 mmol! kg.93 Pregnancy In a study using a sample of 1,049 Finnish women and their infants, heavy glycyrrhizin exposure (over 500 mg per week) during pregnancy did not significantly affect birth weight or maternal blood pressure. However, it was significantly associated with lower gestational age. 94 I have not seen evidence to suggest that Glycyrrhiza or its constituents can counteract or augment the effects of contraceptive drugs. The German Commission E monograph95 contraindicated Glycyrrhiza in pregnancy, but this may relate to the doses of 5-15 g per day recommended by the Commission E. In contrast, doses of up to 3 g per day are likely to be safe. 26 Herb-drug interactions effects of: 26
.. _-~...;,....
Combining Western Herbs and Chinese Medicine
Glycyrrhiza may potentiate the
• cortisone drugs • potassium-depleting drugs, such as thiazide diureticS;~'-t-::::-" the potassium loss may increase sensitivity to -=~¥:-5, cardioactive glycosides
Dose Dried herb The BHP listed 1-4 g of dried root, three times per day (equivalent to 3-12 g per day). The German Com:;:;;' mission E monograph listed 5-15 g of root per day, which it;, , equates to 200-600 mg of glycyrrhizin. I rarely prescribe Glycyrrhiza as a single herb. When __. using dried Glycyrrhiza in decoctions with other herbs, I" _:,::i1. generally include between 1-4 g of Glycyrrhiza pe~ day. ~ ,. '.',
...,
dose is lower than the doses recommended by the B~fo~ Commission E.
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Tmeture The BHP listed 2-5 ml of liquid'e:rtr;ct:"th~t:"" times per day. I generally use Glycyrrhiza 1:5 tinctureiil2S~ alcohol, in combination with about 5 other herbs, and in haIf or full proportion to the other nerbs. This means that a 5 m,l individual dose of the tincture of the combination c~n~; :.', about 0.5-1 ml of Glycyrrhiza tincture. Again, the amounr~:~~r:" used is lower than the BHP recommended dose. ;;7;' ,,'-:,:"'.
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Initial dose It is possible to start at the standard dose~, '~'. the patient has hypertension, and if the prescription"?!"': Glycyrrhiza is considered appropriate, a lower dose mafb~'i#J.'~: given initially. ":~~Z; --._ ..
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High doses Glycyrrhiza should not be used at high doses':,~'~: > for a long period of time. ~ t;;;;'H -":-';"':1;
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Low doses The German Commission E monograph fuUit~~· , ..,..... the dose to 5-15 g per day to 4-6 weeks without medical advi~~·'~j.;-:{f but had no objection to the use of root equivalent up to a d3ilY.. . dose of 100 mg of glycyrrhizin (2.5 g of root per day). ..: ·:".·-it~JMy maximum daily dose of 3 ml of 1:5 tincture isap:;'l~tF proximately equivalent to 0.6 g of root per day. Such relatively •"~" ~ .. low doses can be taken long-term,26 providing there areno,".~. contraindications to the use of Glycyrrhiza. ., ~.J)"'"~~
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.'.: ..J r>~"~Y·1~((
High doses Glycyrrhiza is contraindicated in high do~e~,~ot~~!}~ hypertension, hypokalemia, or pseudohyperaldosteron~s~:(:'H ., -',1''1,·"
Low doses
Glycyrrhiza should be used with caution, if at 311,.,'
GlycYrrhiza
487
even at low doses, in cases of hypokalemia., pseudohyperaldosteronism, or severe hypertension. Low doses of Glycyrrhiza may be appropriate in some cases of moderate hypertension,
den. The plant descnbed as English .liquorice by Cul}?eper96 may therefore have been a variety of G. glabra.
providing blood pressure is monitored and Glycyrrhiza is
PROPERTIES
combined with hypotensive herbs. Chinese contraindications
Gan cao (mainly G. uralensis)
is contraindicated in cases of Excess Damp, nausea, or vomiting. Pregnancy and lactation Contraindicated in high doses, 26 but doses of up to 3 g per day are likely to be safe. See Preg-
nancy in Toxicology section above. Side effects In prolonged use at high doses, signs comparable to pseudoaldosteronism, with hypertension, hypokalemia, and sodium and water retention, may occur. These side effects are unlikely to happen at doses ofless than about 2.5 g of root per day (equivalent to 100 mg per day of glycyrrhizin). See Toxicology. Overdose
See Side effects.
Interactions
Glycyrrhiza may potentiate the effects of cor-
Temperature According to Tabernaemontanus,97 'licorice has a temperate nature, its warmth being almost similar to the warmth of the human body. And since it has a sweet taste, it is believed to be moist.' However, he recommended licorice for 'hot stomach' and burning urination. Gan cao (G. uralensis) is classified in Chinese medicine as neutral when it is taken raw and warm when it is toasted. IS However, one of the actions of raw gan cao is to clear Heat and detoxify Heat Toxin. G. glabra, as used in the West, is classified in this book as a variable-temperature herb, with a range of temperature effects from neutral to cool.
Neutral effects G. glabra can be used as a neutral Qi tonic for the Kidney, and it can be used as a neutral antitussive for hot, warm, neutral, cool, or cold Lung conditions.
Cooling effects One of the main Western uses of G. glabra is for gastritis or peptic ulcer, and in my opinion, it can be used specifically for patterns of Stomach Heat.
tisone drugs and of potassium-depleting drugs, such as thiazide diuretics. See Toxicology.
Taste
Taste in the mouth The BHP described the taste of G.
Regulatory status Please read the Regulatory status section in the chapter on Safety. Glycyrrhiza (liquorice) is on the UK General Sale List, and is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Glycyrrhiza is not currently listed by the FDA (USA) as a prolubited substance, as subject to an import alert, or as a substance with a warning on its use.
Traditional sources
glabra root as sweet and faintly astringent, and is described in Wichtl as very sweet and mildly aromatic. I found both a sample of dried raw gan dio and a sample of G. glabra 1:5 tincture in 25% alcohol to be sweet, slightly bitter, and slightlyacrid in taste. The bitter taste may partly be due to the bitter principles, such as glycyramarin, mentioned in Trease and Evans. l !
Taste properties Gan do is classified as sweet in Chinese medicine. IS G. glabra, as used in the West, is classified as sweet in this book, associated with its tonic, immunoregulatory and demulcent actions. G. glabra might also be considered to have a mild bitter property, associated with its antiinflammatory action and slightly bitter taste in the mouth. However, it has not been classified as bitter in this book.
NOMENCLATURE
ORGANS
According to Gerard, the plant used by Dioscorides was G. echinata, called hedge-hogge licorice by Gerard. The lic-
In terms of Chinese medicine, the root of G. glabra, as used in the West, can be associated mainly with disorders of the following organ systems:
orice used as a herb in Europe at the time of Gerard was called G. vulgaris, common licorice, by him, and was presumably a variety of G. glabra. Licorice has been cultivated in England at least since the 16th century, and Gerard wrote that he had plenty in his gar-
Stomach
'hot stomach' chronic gastritis, peptic ulcer
Dioscorides
BHP
488
Combining Western Herbs and Chinese Medicine
Intestines
pain of the intestines in diarrhea duodenal ulcer, mild laxative
Felter and Uoyd BHP
Lung
sore throat cough, phlegm in the chest
Dioscorides Tabernaemontanus
Kidney
kidney pains, 'sand in the urinary tract'
Dioscorides
adrenocortical insufficiency, Addison's disease
BHP
Gan dio, usually G. uralensis, has been described as entering all 12 channels, especially the Spleen and Lung. 15 ACTIONS The following traditional actions are discussed: • demulcent expectorant • gastrointestinal anti-inflammatory • urinary anti-inflClmmatory • antispasmodic • mild laxative • tonic • detoxicant • moderator of other herbs • topical Demulcent expectorant Dioscorides used licorice for raw, sore throats, and Tabernaemontanus wrote that the property of licorice is to moisten, to soothe sore throat and cough, and to soften the viscous phlegm in the chest. Lonicerus98 recommended licorice for wheezing, consumption, and hemoptysis, and Culpeper listed it for dry cough, hoarseness, and shortness of breath. Christopher99 wrote that licorice soothes and heals inflamed mucous membranes, and cleanses catarrhal conditions, especially those of the respiratory tract. The BHP described Glycyrrhiza as a demulcent and expectorant, and listed it for bronchitis and bronchial catarrh. Gastrointestinal anti-inflammatory Both Dioscorides and Tabernaemontanus used licorice to quench thirst and treat a 'hot stomach: Tabernaemontanus also used it to soothe hunger and relieve heartburn, and Lonicerus listed it for stomach ulcers. Gerard wrote that licorice could be used for the heat of the stomach or the mouth, and for mouth ulcers. It is interesting that this ancient use of licorice is not
mentioned by the Eclectic writers Lyle, Felter and Lloyd. or Ellingwood. Christopher wrote that licorice was used for gastric ulcers, and that it 'soothes, lubricates, and nourishes the intestinal tract: but his main emphasis was on respirato-
ry problems. Current European use of licorice is maiIllyc for.:. .' c, gastric inflammation or respiratory disorders. The BHP gavr~:::~ gastric or duodenal ulcer as the specific indications of this ..::~~~_~~~
herb.
. ; ......=--":"-
Urinary anti-inflammatory Dioscorides wrote that licor;. ice was used for sand in the urinary tract and pain in the kidneys. Lonicerus recommended it to cleanse the kidneys and bladder, increase urination, and soothe bladder pain. Tabernaemontanus listed licorice for burning urination and for dribbling urination. Gerard noted the use of licorice for ulcerations of the kidneys and bladder, and Culpeper used it for 'heat of urine: Felter and Lloyd listed licorice for irritation of the urinary organs, and Christopher listed it for urinary affections, but these authors did not emphasize this use. The use of licorice for urinary inflammations is not mentioned by Grieve, the BHP, the BHC, or the German Commission E monograph, and this use seems to have temporarily declined in the West.
• ".>:.
,::;:;.;;. -:-~'"
.• _-; ......!:,.
. -_.~-
,,;..~_ --,., ..~.
Antispasmodic Felter and Lloyd recorded the use of licorice for intestinal pain during diarrhea. The B'HP listed licorice as a antispasmodic, and Bruneton noted its use in France as an antispasmodic component of laxative herb teas. Mild laxative Christopher wrote that 'licorice is one of the oldest, mildest, and yet most efficient laxatives, and is especially safe for delicate or constipated children, or for adults ...who are unable to take stronger herbal laxatives: Glycyrrhiza is listed as a mild laxative by the BHP. Tonic
Nutritive Lonicerus wrote that licorice could be used for people who are losing weight, and Felter and Lloyd listed licorice as a nutritive. Adrenocorticotropic The BHP listed Glycyrrhiza for adrenocortical insufficiency and for Addison's disease, and gan dio extract has been reported to treat the debility and hypotension associated with this disease; see Research, Detoxicant This action is rarely mentioned in the Western tradition of use for G. glabra, but it is considered an important action for gan dio in Chinese medicine. It has stimulated research in China, which has shown that gan cao has detoxicant activity against a wide variety of chemicals (see Res~arch).
In my opinion, G. glabra also can enhance detoxification and reduce inflammation caused by toxins. I use this herb to assist with detoxification, for example: • during and after radio- or chemotherapy treatment for carcinoma
I_
_.~~ ';'is;~:_
.~
..
Glycyrrhiza • when using alterative herbs, such as Taraxacum or Arctium, that may release wastes into the bloodstream faster than they can be detoxified or excreted Moderator of other herbs
Chinese tradition
The sweet and neutral properties of raw gan cao are considered to have a harmonizing and moderating effect on the other herbs in a combination. Gan cao is used to moderate extreme effects of hot or cold herbs, and -'- 'make violent herbs more gentle.' In addition, because it is considered to enter all the primary channels, it can lead other herbs into these channels.
Western tradition
ls
G. glabra is used to:
• cover the taste of bitter herbs9 •99 • moderate the potential of purgatives to cause intestinal spasms23 •99 • moderate the potential irritation caused by acrid herbs such as Lobelia or Sanguinaria9 Topical I rarely use G. glabra as a topical application, but there is a tradition of using it as such going back to Dioscorides, Lonicerus, and Gerard, who used it for wounds and ulcers. Gan cao is also sometimes used in Chinese medicine as an external wash for rashes and abscesses. There has been an increasing number of research reports supporting the effectiveness of topical. applications of Glycyrrhiza extracts, glycyrrhizin, glycyrrhetic acid, and other constituents; see
Research. COMPARISON OF WESTERN AND CHINESE USE OF GLYCYRRHIZA SPECIES This discussion is divided into three parts: • common uses • Chinese uses • Western uses Common uses Glycyrrhiza has had the following traditional uses in both China and the West: • cough • moderator of other herbs • muscle spasms
Cough In the Chinese medicine tradition, gan d.o is considered neutral in temperature and has therefore been used for either hot or cold Lung patterns. However, it is used especially to moisten the Lungs to treat dry cough associated with Lung Dryness, which may be associated with Lung Heat. Similarly, in the Western tradition, G. glabra has been used to moisten hoarseness and dry cough. However, in the Western tradition, G. glabra has also been used to soften and
489
loosen viscous phlegm to treat bronchial catarrh in patterns equivalent to Lung Phlegm in terms of Chinese medicine. Gan cao is less used in Chinese medicine to treat Lung Phlegm, and it is avoided in patterns of Lung PhlegtiJ. Damp since it is considered a moist herb that might aggravate the production and accumulation of Phlegm. Moder~tor
of other herbs Glycyrrhiza is used in both tradi-
tions to moderate the effects of other herbs. In Chinese practice, it is used more'as a messenger for other herbs and as a neutral herb to moderate the effects of hot and cold herbs. In Western practice, it is used more to cover the taste of bitter herbs, reduce spasms resulting from purgatives, and reduce the irritation from acrid herbs such as Lobelia.
Muscle spasms
Glycyrrhiza is used as an antispasmodic more in China than in the West. In China, it is used not only for intestinal spasms, but also for cramps in the lower legs. In the West, it is sometimes used as a secondary herb for intestinal spasms, "for example, as an antispasmodic component of herbal laxative combinations. Chinese uses The following three applications of Glycyrrhiza are common in China and rare in Western tradition: • tonifies the Spleen • tonifies the Heart • clears Heat and Heat Toxin, acting as an antidote
Tonifies the Spleen In Chinese medicine, gan cao is used to tonify the Spleen, but it is a supplefuentary herb for this rather than a leading herb. Nevertheless, gan cao is included in more tonic combinations in China than in the West. G. glabra has had an occasional use in the West as a nutritive tonic, but this is not a common Western medicine use. Tonifies the Heart Gan cao is considered to tonify Heart Qi to treat irregular or intermittent pulse, or palpitations. IS. 16 I have not seen a reference to this use in the Western tradition.
Clears Heat and Heat Toxin, acting as an antidote Glycyrrhiza is used to treat inflamed sore throat in the West, but mainly when it is associated with dryness. In China, gan d.o is used to treat sore throat, especially when it is associated with Heat Toxin. Gan dio can also be used internally or topically for skin disorders associated with Damp Heat or Heat Toxin, such as rashes, acne, or boils. Gan cao has a tradition of use in China as an antidote against a variety of toxic substances, and this tradition is less common in the West. Western uses The following two uses of Glycyrrhiza are common in the West, but not in Chinese tradition. However, they are found increasingly in more recent Chinese texts, being incorporated from Western tradition and research:
Combining Western Ht;rbs and Chinese Medicine
490
".~.::;:~~~
• gastritis and peptic ulcer • adrenocortical insufficiency
15. Bensky D, Gamble A. Chinese Herbal Medicine Materia M"-;Eastland Press, Seattle, Washington (1986) ' . :;-.'d~"";;;'-~
---,.
.,..~.
16. Yeung H-C. Handbook of Chinese Herbs and Formulas. vo!. 1.
Gastritis and peptic ulcer This is one of the most common uses of G. glabra in Western herbal therapy. In Chinese medicine terms, it can be described as clearing Stomach and/or Intestines Heat, either of the Excess or Deficiency type. This not listed as a main traditional use in China.
was
Adrenocortical insufficiency Whilst gan dio has been described as entering all the primary channels, it is not considered to have a primary function as a Kidney tonic, although it is included in some Kidney tonic formulas. In the West, following research findings, G. glabra or its constituents have been used to treat Addison's disease or, more commonly. to reduce the side effects of cortisone and to reduce adverse effects following cortisone withdrawal.
Institute of Chinese Medicine. Los Angeles, California (1985)
"" ..
17. Hayashi H, Hosono N. Kondo M et al. Bioi Pharm Bull23(5):602~';:-;;:~~. (2000) ---:~;'~'': ":-"-~'="'·7·{~~
18. Sticher 0, Soldati F. Pharm Acta Helv 53:46-52 (1978) 19. DAB 9-Kommentar. Band 3,3187-3192 [T8] (1988) [cited in Bradley PR (ed). British Herbal Compendium. vo!.1. British Herbal Medicine Association, Bournemouth. United Kingdom (1992)) 20. Mitscher LA, Park YH. Clark D et al. JNat Prod 43(2):259-269 (1980) 21. Tomoda M. Shimizu N. Kanari M et al. Chem Pharm Bull 38:16671671 (1990) 22. Shimizu N, Tomoda M. Kanari M et al. Chem Pharm Bull 38:30693071 (1990) 23. Bruneton J. Pharmacognosy: Phytochemistry Medicinal Plants, 2nd edn. Lavoisier, Paris. France (1999) 24. Hatano T. Fukuda T, Liu YZ et al. Yakugaku Zasshi 11(6):311-321 (1991)
References 1. Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm, Stuttgart, Germany (1994). from 2nd German edn. Wicht! M (ed) (1989)
25. Gibson MR.lloydial4l(4):348-354 (1978) 26. :-'1ills S. Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone, Edinburgh. United Kingdom (2000)
27. Chen M. Christensen SB. Theander TG. Antimicrob Agents Chemother 38(6):1339-1344 (1994)
2. Shibata S. Yakugaku Zasshi 120(10):849-862 (2000)
28. Chen M, Theander TG, Christensen SB et al. Antimicrob Agents
3. Grieve M. A Modern Herbal. vols. 1 and 2. Dover Publications, New York, New York (1971)
29. Utsunomiya T, Kobayashi M. Ito Metal. Clio lmmunoI95(2):145-155
4. Gerard J. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publications, New York, New York (1975) 5. Dioscorides P. Kreutterbuch (1610). Reprinted by Verlag Konrad Kolbl, Miinchen, Germany (1960) 6. Crellin JK. Philpott J. A Reference Guide to Medicinal Plants. Duke University Press, Durham. North Carolina (1990)
Chemother 38(7):1470-1475 (1994) (2000) 30. Baba M,Shigeta S.Antiviral Res 7(2):99-107 (1987)
31. Hirabayashi K, Iwata S. Matsumoto H et al. Chem Pharm Bull 39(1):112-115 (1991) 32. Utsunomiya T, Kobayashi M, Pollard RB et al. Antimicrob Agents Chemother 41(3):551-556 (1997) 33. Hattori T, Ikematsu S. Koito A et aI. Antiviral Res 11(5-6):255-261
7. Lyle TJ. Physio-Medical Therapeutics, Materia Medica and Pharmacy. Originally published Ohio (1897). Reprinted by the National Association of Medical Herbalists of Great Britain, London, United Kingdom (1932)
34. Manfredi KP, Vallurupalli V. Demidova M et al. Phytochemistry
8. Felter HW, Lloyd JU. King's American Dispensatory, vols. 1 and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications. Sandy, Oregon (1983)
36. Matsunami H, Lynch SV, Balderson GA et al. Am J Gastroenterol
9. Ellingwood F. American Materia Medica, Therapeutics and Pharmacognosy, 11th edn. (1919). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1994)
(1989) 58(1):153-157 (2001) 35. Eisenburg J. Fortschr Med 110(21):395-398 (1992) 88(1):152-153 (1993) 37. Krahenbuhl S, Hasler F, Krapf R, Steroids 59(2):121-126 (1994) 38. Capasso F, Mascolo N. Autore G et al. J Pharm Pharmacol 35(5):332335 (1983)
10. Kloss J. Back to Eden, 5th edn. (1939). Reprinted by Lifeline Books, Santa Barbara, California (1975)
39. Ohuchi K. Kamada Y, Levine L et al. Prostaglandins Med 7(5):457-463
11. Revers FE. Ned Tijelschr Geneeskd 92:2968-2973 (1948)
40. Yokota T. Nishio H, Kubota Y et aI. Pigment Cell Res 11(6):355-361
(1981) (1998)
12. Evans WC. Trease and Evans' Pharmacognosy, 14th edn. WB Saunders, London, United Kingdom (1996)
41. Murav'ev lAo Mar'iasis ED. Krasova TG et al. Farrnakol Toksikol
13. Saitoh T, Kinoshita T, Shibata S. Chem Ph~rm Bull 24:1242-1245 (1976)
42. Tanaka H. Hasegawa T, Matsushita M et al. Ophthalmic Res 19(4):213-
14. Sun Feng-yi, Sun Xing-yan (eels). Divine Husbandman's Classic of the Materia Medica (Shen nong ben cao jing). Wu Shu Press. Taipei, Taiwan (1985)
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46(1):59-62 (1983) 220 (1987) 43. Tee1ucksingh S, Mackie AD. Burt D et al. Lancet 335(8697):1060-1063 (1990)
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Glycyrrhiza 44. Shibata S, Inoue H, Iwata S et aI. Planta Med 57(3):221-224 (1991) 45. Goso Y. Ogata Y. Ishihara K et aI. Comp Biochem Physiol C Pharmacol Toxicol Endocrinoll13(1):17-21 (1996) 46. KhayyaI MT, el-Ghazaly MA, Kenawy SA et aI. Arzneimittelforschung
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51(7):545-553 (2001) 47. Shiratori K, Watanabe S, Takeuchi T. Pancreas 1(6):483-487 (1986) 48. Takeuchi T, Shiratori K, Watanabe S et aI. J Clin Gastroenterol13(Suppl 1):S83-87 (1991)
77. Kumagai A, Asanuma Y, Yano S et aI. Endocrinol Jpn 13(3):234-244 (1966) 78. Armanini D, Lewicka S, Pratesi C et aI. J Endocrinol Invest 19(9):624-
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51. Wegener JW, Nawrath H et aI. Eur J PharmacoI326(l):37-44 (1997)
80. Doeker BM, Andler W. Horm Res 52(5):253-255 (1999)
52. Shanghai First MedicaI College et aI. MedicaI pharmacology. People's
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82. Lou FQ et aI. Chinese ~ledicaI 10urnaI 42(12):Il47 (1956) 83. K AK et a1. Chinese MedicaI lournaI.42(7):665 (1956). [cited in Chang H-M, But PP-H (eds). Pharmacology and Applications of Chinese Materia Medica, vols. 1 and 2. World Scientific Publishing, Singapore (1986)] 84. Zhong XL. Chinese MedicaI lournaI 42(7):669 (1956) 85. Murakami T, Uchikawa T. Life Sci 53(5):PL63-68 (1993) 86. Chamberlain Jj,Ablonik 12. West I Med 167(3):184-185 (1997) 87. Chataway SI, Mumford 594 (1997)
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643-645 (1977) 63. Sitohy MZ, eI-Massry RA, eI-Saadany SS et aI. Nahrung 35(8):799-806 (1991) 64. Novikov DK, Mukhamedova NA, Lakeev IV et al. Biokhimiial 57(6):897-903 (1992) 65. Shiki Y, Sasaki N. Shirai K et al. Am I Chin Med 14(3-4):138-144 (1986) 66. Fuhrman B,Buch S,Vaya I et al.Am I Clin Nutr 66(2):267-275 (1997) 67. Kitagawa K, Nishino H, Iwashima A et al. Oncology 43(2):127-130 (1986) 68. Tarnir S. Eizenberg M, Somjen D et aI. Cancer Res 60(20):5704-5709 (2000) 69. Mori H,Niwa K,Zheng Q et aI.Mutat Res 480-481:201-207 (2001) 70. Hrelia P, Fimognari C, Maffei F et aI. Phytother Res IO:S101-S103 (1996) 71. Kraus SD, KarninskisA.Exp Med Surg 27(4):411-420 (1969) 72. Liu I, Burdette IE, XU H et al. J Agric Food Chern 49(5):2472-2479 (2001) 73. Takeuchi T, Nishii 0, Okamura T et aI. Am I Chin Med 19(1):73-78 (1991)
91. British HerbaI Pharmacopoeia. British HerbaI Medicine Association. WestYor!<s, United Kingdom (1983) 92. Kobuke K, Inai K, Nambu S et aI. Food Chern Toxico! 23:979-983 (1985) 93. Vogel VG, Newman RZ, Ainslie N et aI. Proc Am Assoc Cancer Res 33:A1245 (1992) 94. Strandberg TE, larvenpaa AL, Vanhanen H, et aI.Am J Epidemiol 153(11)1085-8 (2001) 95. Blumenthal M (ed). The Complete German Commission E Monographs: Therapeutic Guide to HerbaI Medicines. American BotanicaI Council, Austin, Texas (1998) 96. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks, Glenwood, Illinois (1990) 97. Tabernaemontanus IT. Krauterbuch (1731). Reprinted by Verlag Konrad Kolbl, Miinchen, Germany (1993) 98. Lonicerus A. Kreuterbuch (1679). Reprinted by Verlag Konrad Kolbl, Miinchen, Germany (1962) 99. Christopher JR. School of NaturaI HeaIing. BiWorld, Provo. Utah (1976)
~
-~
Hamamelis Botanical name Hamamelis virginiana L. Family Hamamelidaceae Pharmaceutical name Hamamelidis cortex or Hamamelidis folium Part dried bark or leaves English witch hazel German Hamamelis French hamamelis Mandarin H. virginiana L. is not used; jl hua ye is the stems and leaves of H. chinensis R. Br.
leaves of Hamamelis chinensis, in the Chinese Herbal Medicine Dictionary.lo However, since the meridians entered
(;J1!:it. ~)
Use in the West Hamamelis virginiana is a shrub or small tree native to the Eastern part of North America. l It was used by the Native Americans as an infusion for colds and sore throats2 and as a poultice for painful swellings.3 Hamamelis was used extensively by the Eclectic practitioners as a tonic astringent and antihemorrhagic and as a topical anti-inflammatory. For example, Felter and Lloyd~ listed its use for diarrhea, dysentery, excessive mucous discharges, leukorrhea, uterine and anal prolapse, hemorrhoids, varicose veins, and passive hemorrhages, especially of the gastrointestinal and urogenital systems. However, Hamamelis was not known in Europe before knowledge of its use was imported from the United States, and it is not mentioned in Dioscorides,s Lonicerus,6 Tabernaemontanus,7 Culpeper,8 or Gerard. 9
are not given for this herb and since the texts cited are mainly regional herb compendia, this does not seem to be a main herb in China. The leaves seem to be less used than the flowers, jl hua, or the root, jl hua gen. However, the leaves,)1 hua ye, are mentioned in this chapter for purposes of comparison, since the leaves of H. virginiana are often used interchangeably with the bark in the West. The actions listed for jl hua ye are to clear Heat, move the Blood, and to stop bleeding; and it is used for diarrhea, tendon injuries from trauma, and bleeding from trauma.
What is special about Hamamelis In terms of Chinese medicine, Hamamelis can be said to be a neutral-cool, sour and slightly bitter herb that has its main effects on the Spleen and Intestines. It can help the Spleen to hold the Blood and reduce the Sinking of Spleen Qi.
The key to understanding Hamamelis is that it is an antiinflammatory herb that also has tonic astringent and antihemorrhagic action. It can restore the tone of tired and overrelaxed mucus membranes, muscles, capillaries, and veins. It can be used internally for diarrhea with passive bleeding or excessive mucus discharge, and topically for muscle aches, varicose veins, prolapsed organs, and hemorrhoids.
Part used The dried bark and the dried leaves are now used almost interchangeably in the West for therapeutic purposes. Use in China There is an entry for jl hua ye, the stems and
493
Combining Western Herbs and Chinese Medicine
494 CHINESE ACTIONS
In terms of Chinese medicine, Hamamelis, as used in the West, can be said to have two main actions:
1. topical astringent II. internal astringent In terms of Chinese medicine, the internal astringent action treats the following syndromes:
third position, which can correspond to the Intestines.j~li" . ~. '--:~'.'~:'._.'--~. tongue is pale and flabby.',;-?:~::::t." "."-~~~Jf"' •
L"
Diagnosis The patient has Spleen Deficient Q~ with Spleen Qi sinking and Spleen not holding Blood. Choice of Hamamelis This herb can be used to treat Spleen Qi sinking and Spleen not holding Blood, and can specifically be used for diarrhea with bleeding or mucus, hemorrhoids, anal prolapse, and varicose veins.
...
-
....,:--;
• Spleen Qi Sinking • Spleen not holding Blood
Limitations ofHamamelis WESTERN ACTIONS The main Western actions of Hamamelis are shown here in terms of its two main Chinese actions: "',oc.-;-'..<:,:: . --:-" -""-'"":,",,"---,.. ~._.:,~.
• .-',.
--_. '; -
~.-
...
~
·~~i,'!"~!.~f!l.,:,~ns \:;-'\.,L~
I. topical astringent
anti-inflammatory tonic astringent tonic antihemorrhagic
II. internal astringent
anti-inflammatory tonic astringent antidiarrheal antihemorrhagic
TEMPERATURE Hamamelis is classified as neutral-cool in this book since it has a tradition of use as a tonic astringent on the one hand and as an anti-inflammatory astringent on the other. It can ';-;4;t' .,.. be used for warm, neutral, or cool conditions when it is suit~:' ,,:;~~·-t ably combined with other herbs. However, if a warm astrin. gent is required, Myrica or Commiphora may be preferred. . "c>. ~!"" If a cool astringent is required for internal use, Hydrastis may be more suitable. However, Hamamelis can be effective as a cooling topical anti-inflammatory for red, itchy, and -P\' t~i'_': inflamed skin conditions (see Research). i'~-
WESTERN USES
TASTE
The Western uses of Hamamelis can be related to its two main Chinese actions:
Hamamelis is classified in this book as sour in associa'~ tion with its action as a tonic astringent, and slightly bitter in association with its cooling anti-inflammatory action.
,
-'"
Western uses -
I. topical astringent
bruises, muscle aches, varicose veins, hemorrhoids
II. internal astringent
diarrhea with bleeding or mucus in the stools, prolapsed organs, varicose veins
DIRECTION OF ENERGY The tonic astringent effects of Hamamelis tend to keep fluids inside the body and organs up in their proper position.
TYPICAL CASE EXAMPLE Signs and symptoms The patient has chronic diarrhea that occasionally contains blood or mucus; medical tests have excluded carcinoma or other serious conditions. The patient is pale and tired, with poor muscle tone, a tendency to hemorrhoids and anal prolapse, and varicose veins. The pulse is empty, especially in the Spleen position and in the
ACTIONS Topical Hamamelis has specific topical use for bruises, muscle aches, varicose veins, and bleeding hemorrhoids. For other topical applications, other herbs may be preferable, for example: • Calendula for cuts, burns, scalds, sunburn, insect bites and stings, and itchy red skin rashes • Commiphora for mouth, gum, and throat disorders Internal astringent Hamamelis is specific for diarrhea with mucus, bleeding, hemorrhoids, or anal prolapse.
Tonic astringent Hamamelis is a tonic astringent and antihemorrhagic for conditions of general debility with overrelaxed muscle and venous tone. For diarrhea or bleeding associated with Heat patterns, other astringents would be preferred, such as Sanguisorba. Astringent for the intestines Hamamelis is an astringent
Hamamelis that is most effective on the lower gastrointestinal system. For astringent effects on other systems, other herbs may be preferable, for example, • Salvia officinalis for hyperhydrosis • Euphrasia for profuse nasal discharge • Equisetum for urinary frequency Anti-inflammatory Hamamelis can not only act as an astringent, but it can also relieve inflammation, itching, and pain at the body surface, and the inflammation of colitis. However, for inflammatory conditions of other systems than the skin or intestines, other herbs may be preferred, for ex-
Hamamelis + Plantago lanceolata
Hemorrhoids with bleeding and irritation Plantago is a cooler herb than Hamamelis. It can strengthen Hamamelis' antihemorrhagic action and its anti-inflammatory effect. These two herbs can be combined for colitis. Hamamelis + Agrimonia
Diarrhea Both herbs are neutral astringents that can treat both diarrhea and mucus colitis. Agrimonia is also a mild bitter tonic for the digestive system. Hamamelis + Myrica
ample, • Filipendula for gastritis • Hydrangea for prostatitis • Phytolacca for lymphadenitis
Hamamelis paired with other herbs Discussion of the limitations of each of the main actions of Hamamelis can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Hamamelis beyond its limitations. The basic unit of herb combination is the herb pair. Six pairings of Hamamelis are briefly explained below.
CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair. .
,.
495.
Hamamelis + Aesculus hippocastanum
Varicose veins Both herbs are specific for varicose veins. They can be applied as an ointment or compress' and can also be taken internally. However, Aesculus should not be applied to broken skin. (For details on the uSe of Aesculus, see Mills and Bone. lI ) Hamamelis + Calendula
Inflammatory skin conditions These two herbs can be used for inflammatory skin conditions with redness, swelling, and itching, and for burns, sunburns, and scalds. This pair can also be used for varicose veins, administered both topically and internally. Calendula is the cooler of the two herbs and strengthens the antiinflammatory effect of Hamamelis.
Mucus colitis Myrica is a warm circulatory stimulant as well as an astringent and anticatarrhal, which can be combined with Hamamelis to treat loose stools with mucus associated with Cold Phlegm in the Stomach and Inte;tines. Hamamelis + Hydrastis
Pruritis Hamamelis can be combined with Myrica to treat cool or cold conditions, or with Hydrastis to treat warm or hot conditions. For example, this pair can be used for anal or genital pruritis associated with patterns of Damp Heat in the skin as seen in some cases of herpes simplex.
Topical uses of Hamamelis The specific topical indications of Hamamelis are bruises, muscle aches, varicose veins, and bleeding hemorrhoids. However, it can also be used for anal eczema, cuts, wounds, burns, sunburn, scalds, sore nipples, and inflammatory skin lesions such as eczema on the body, anus, or genitals.
COMBINATIONS OF HAMAMELIS FOR TOPICAL APPLICATIONS Hamamelis can be used by itself for the specific topical indications above, or it can be combined with the following herbs: ,. with Hydrastis and Euphrasia for conjunctivitis • with Aesculus for varicose veins • with Calendula for varicose veins or for red, hot, itchy skin lesions • with Ranunculus ficaria or Plantago major for hemorrhoids
Combining Western' Herbs and Chinese Medicine
496
---0"
Hamamelis can be given internally as well as topic311y to support its topical action.
Hamamelis combinations Three Hamamelis combinations for internal use are discussed below:
or bleeding is severe and acute, I-ml doses can be -iahiii.:in:,~:;::;;a: warm water every 30 or 60 minutes until the ,diarrhea or";:':! bleeding is reduced. The doses can then be lowered to the normal level. This combination can be used for acute .or, subacute situations, and can be taken for 1-2 weeks until ,?~_ the diarrhea and bleeding are reduced. During remission, a tonic combination can be taken. Efi. "'.~
..
~
2. Colitis + mucus in the stools
Intestines Phlegm Damp + Spleen Deficient Qi Spleen Qi sinking + Spleen not holding Blood
1. diarrhea + bleeding
2. colitis + mucus in the stools 3. varicose veins
Intestines Phlegm Damp Spleen Deficient Qi
..
-.
Herb
Ratio
Temperature
Taste
Myrica
1 1 1 1 1 0.5-1 0.5-1
warm neutral-cool cool cool neutral
acrid, sour, bitter sour, sl. bitter
+
Spleen Qi sinking
CAUTION'
Before using any ofthe combinations below, it is important to be familiar with the cautions listedfor each herb in the combination.
Hamamelis Polygonum Plantago Ian. Agrimonia Hydrastis Zingiber
cool hot
.. -
sour. sl. bitter sour, sl. bitter sour, sl. bitter ' bitter acrid. aromatic
This combination is the same as Myrica: colitis + mucus in the stools and is discussed under that heading.
1. Diarrhea + bleeding
Spleen Qi Sinking + Spleen not holding Blood
3.Varicose veins
Spleen Qi sinking Hamamelis Potentilla Geranium Astragalus Glycyrrhiza Cinnamomum (bark)
1 1 1 1
0.5 0.5
neutral-cool neutral-{;ool
sour, sl. bitter sour, bitter
neutral 51. warm neutral-cool hot
sour sweet sweet acrid, aromatic, sweet
GENERAL
This combination is for patterns of Spleen Deficient Qi with Spleen Qi Sinking and Spleen not holding Blood. The overall temperature of the combination is warm since this combination is for patterns of Deficiency, which may be accompanied by some Cold. It is not appropriate for diarrhea or bleeding associated with Heat. The first three herbs are sour astringents to reduce diarrhea and bleeding in the Intestines, the sweet herbs tonify and raise the Spleen Qi, and the acrid Cinnamomum warms the Spleen. USE
• diarrhea with bleeding, maybe prolapsed hemorrhoids PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of water, three times per day. If the diarrhea
Hamamelis Calendula Aesculus Achillea Crataegus zanthoxylum (bark) Zingiber
1 1 1 1 1 1 0.5
neutrak:ool
sour, 51. bitter
cool cool warffi-{;ool 51. warm hot
bitter bitter, sour acrid. bitter sour, sweet acrid, aromatic, bitter
hot
acrid, aromatic
GENERAL
This combination is for patterns of Spleen Qi Sinking with some Spleen Qi Deficiency and some Stagnation of Qi and Blood. Although local Stagnation of Qi and Blood may in some cases arise from systemic Deficiency. this local Stagnation can in some cases give rise to Heat. This can be accompanied by varicose vein int1ammation 'and itching. The overall temperature of the combination is warm. The combination contains both cool or neutral, sour and bitter astringents specific for varicose veins, and warm and hot acrid herbs to warm and stimulate the Spleen and the circulation of Qi and Blood. USE
• varicose veins with aching, pain. and swelling
.,.
Hamamelis PRACTICAL NOTES
This combination can be taken as 5 m1 of 1:5 tincture in quarter of a cup of water, three times per day. The combination can be taken, with appropriate cautions, breaks, and modifications, for 1-2 months. A compress of a diluted tincture containing Hamamelis, Calendula, and Aesculus can be applied topically to the varicose veins several times per day as required, especially if there is local inflammation and itching. Aesculus should not be applied to broken skin. (For details of the use of Aesculus, see Mills and Bone. ll )
COMPARISON OF THE THREE HAMAMELIS COMBINATIONS
497
move Spleen Qi, assisting Hamamelis in treating poor venous and muscle tone associated with the pattern of Spleen Qi sinking. Myrica is included in combination No. 2 as an antidiarrheal and anticatarrhal astringent, but it has been replaced by Zanthoxylum in this combination since the latter herb is more effective at treating the peripheral circulatorysystem. OTHER HAMAMELIS COMBINATIONS Other combinations that contain Hamamelis include the following:
• Althaea: colitis • Rosmarinus: irritable bowel syndrome + cold sensations • Valeriana: colitis + nervous tension
1. Diarrhea + bleeding
Spleen Qi sinking + Spleen not holding Blood Hamamelis, Potentilla, and Geranium are neutral or cool sour astringents to reduce diarrhea and bleeding. Astragalus can tonify and raise Spleen Qi, and combines with Hamamelis for prolapsed organs, diarrhea, and bleeding associated with Spleen Qi sinking. Glycyrrhiza can help to treat loose stools associated with Spleen Deficient Qi and also can also help to relieve intestinal spasms. Cinnamomum can warm and tonify the Spleen and treat the diarrhea associated with Spleen Deficient Yang. 2. Colitis + mucus in the stools
Intestines Phlegm Damp + Spleen Deficient Qi In the previous combination, Astragalus and Cinnamomum were included to tonify, warm, and raise Spleen Qi to reduce diarrhea and bleeding. In this combination, Astragalus and Cinnamomum have been replaced by Myrica and Zingiber as warm acrid herbs to clear Phlegm Cold in the Intestines. In this combination, Myrica, Hamamelis, and . Polygonum are included as astringents to treat diarrhea, and Myrica, Hamamelis, Polygonum, and Hydrastis are anticatarrhals to clear Phlegm. Hydrastis, Polygonum, and Plantago can clear Heat if there is a mixed condition with Heat secondary to Cold. 3. Varicose veins
Spleen Qi sinking The emphasis of this combination is on varicose veins, for which Hamamelis, Calendula, and Aesculus are specifically indicated. These herbs are assisted byAchillea, Crataegus, and Zanthoxylum to strengthen the circulatory system as a whole. Zanthoxylum and Zingiber can tonify, warm, and
Research CONSTITUENTS • tannins
• flavonoids • essential oil • other Hamamelis bark contains 3- 10% tannins, being a mixture of hamamelitannin (digalloylhamamelose), gallitannins, condensed catechins, and procyanidins. 11
Tannins
FIavonoids The leaves contain various flavone glycosides with quercetin, kaempferol, and myricetin as the aglycones. 12 These flavonoids are not listed in Wichtl 13 for the bark. Essential oil Hamamelis leaves contain 0.01-0.5% essential oil,14 and the bark contains essential oil with a sesquiterpene as the main component. 15 Other The bark also contains soft fats and waxes 16and may contain saponins. 17 Comparison of bark and leaves According to Mills and Bone,1I the bark has relatively more hydrolyzable tannins and the leaves have relatively more condensed tannins. According to Hager,17 the leaves do not contain hamamelitannino The bark contains relatively more phenylpropanoids and sesquiterpenoids in the essential oil, and the leaves contain relatively more monoterpenoids. 18 PHARMACOLOGICAL AND CLINICAL RESEARCH The following effects have been reported:
-Iii
498
Combining Western Herbs and Chinese Medicine
• antimicrobial • anti-inflammatory • analgesic • antioxidant • vasoconstrictor • antimutagenic Antimicrobial An extract of Hamamelis bark showed antiviral activity against Herpes simplex virus type 1, which may be associated more with the procyanidins than the hamamelitannin. 19 Hamamelis also has exhibited bacteriostatic activity against Gram-negative bacteria.! Anti-inflammatory
General A 1:5 (70% ethanol) tincture of Hamamelis leaf was not effective for the acute phase of carrageenan-induced rat paw edema, but the:tincture significantly inhibited the chronic phase.20 Hamam~~s. ~xtract alsoshoweq anti-inflammatory action in the crt>t6'obUea-r-edema test in mice. 19
UV-induced skin inflammation' The presenceof 10%,Hamamelis in a sun lotion put on after exposure to UVB increased the anti-inflammatory effectiveness of the lotion.21 A mild anti-inflammatory effect was demonstrated on humans with erythema induced by UV irradiation. The anti-inflammatory effect was less than that seen with 1% hydrocortisone cream but more than that seen with unmedicated cream. 22
Hemorrhoids and anogenital problems In clinical trials, Hamamelis bark preparations have been reported to improve painful anogenital skin lesions 23 and itching, painful, and bleeding hemorrhoids.2~ A double-blind trial on patients with grade 1 hemorrhoids showed that Hamamelis bark salve showed greater reduction in itching, soreness, and bleeding than the corticosteroid salve. 25 Another clinical trial showed Hamamelis bark ointment and corticosteroid ointment to be equal in effectiveness, except that the Hamamelis ointment was more effective at relieving the itching. 26
Eczema and dermatitis An uncontrolled clinical trial suggested that Hamamelis leaf extract could relieve chilblains, eczema in the flexure of the joints, eczema of the neck and throat, and eczema of the trunk. 27 Clinical trials with Hamamelis preparations also showed improvement in the redness, itching, and scaling of atopic dermatitis,za and in severe atopic eczema.29 Analgesic Hamamelis water was shown to be equally effective as ice or Epifoam in producing analgesia for episiotomy during forceps delivery.3D Antioxidant Hamamelitannin and its related compound gallic acid demonstrated protective effects on damage to
skin fibroblasts in mice induced by UVB irradiation:-cBo compounds showed potent scavenging action against actiVe":;;:-,__'= , oxygen radicals generated by UVB irradiation, but ham- ;_~ •. amelitannin had a greater protective activity againstd~~ge;::.~ 31 32 from superoxide anions than gallic acid. . Theautho.ri,;., suggested that Hamamelis has potential use as an anti~ ',-"e'''''' 33 wrinkle or antiaging preparation for the skin. . ,."'
"~""'"
,,.,
Vasoconstrictor Intravenous administration of Hamamelis leaf extract into isolated rabbit arteries showed vasoconstrictive effects.~ In a study with humans, topical application of an extract of Hamamelis leaf reduced skin temperature, 35 which was interpreted as a vasoconstrictive effect. It was suggested that the mild anti-inflammatory effect of Ham-~_., amelis cream following erythema induced by UV irradiation ._,~.. •• • J6 might be due, at least in part, to a vasoconstrictive action. _:::2~ .... ,_':~'~
:--.~'
_
..
c\-
:~.~-:~~.
~utag~c Pro~~ from Ham.amelis bark sh~~.::~1A
antimutageruc properties agamst aromatIC compounds.con-;.-© ~ taining nitro groups. The antimutagenic effect increased '---"; , --;,.:,. with the increased degree of polymerization of the pro- ;'","'l:_ .~:~ cyanidins.37 ;i ;.
;;~CONSTITUENTS RESPONSIBLE FOR THE ASTRINGENCY .~-, ::r.~
This is not clearly understood since Hamamelis water is -- -~~¥.j: a steam distillate that does not contain the astringent tannins,z·38 yet can have astringent effect. --"..~, " """!"
RESEARCH VERIFICATION OF TRADITIONAL ACTIONS The main traditional actions of Hamamelis are its antiinflammatory, astringent, vasoconstrictor, and muscle tonic actions. The anti-inflammatory and vasoconstrictor actions are supported by research evidence, but I have not yet seen evidence to support the astringent or muscle tonic actions. Additional uses suggested by research Antimicrobial, analgesic, antioxidant and antimutagenic effects have been demonstrated by research, which has also emphasized: • the ability of Hamamelis to treat in£1ammatOFy skin disorders • the possibility of protection of the skin from the adverse effects of sunlight • the possibility of the us~ of Hamamelis as an antiwrinkle or antiaging preparation for the skin
TOXICOLOGY Contact dermatitis
Rare contact dermatitis has been re-
Hamamelis ported. 39 In a study with over 1,000 patients, four reacted to an ointment with 25% Hamamelis, but twO of these four also reacted to the wool fat in the ointment base.-!O
499
Interactions Tannins may inhibit the absorption of B vitamins and minerals.
Mutagenicity Hamamelis has not been identified as a mutagen in in vitro studies. 41
Regulatory status Please read the Regulatory status section in the chapter
Tincture The BHP listed 2-4 rnl of 1:1 liquid extract (45% ethanol) tincture of the dried leaves, three times per day.
on Safety. Hamamelis is not on the UK General Sale List, nor is it is on Schedule Part III of the Supply of Herbal Remedies Order 1977 of the UK. Hamamelis is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Hamamelis is not currently .listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
Initial dose Can start at the standard dose unless the patient has a susceptibility. to tannins, in which case the dose can be reduced.
Traditional sources
Dose ORAL USE Dried leaves The BHp4! listed 2 g of dried leaves as infusion, three times per day.
Duration Caution should be taken with long-term use because of the presence of tannins.
TOPICAL USE Suppositories 0.1-1 g of powdered leaf or bark in suppositories, one to three times per day.11 Rectal douche A rectal douche (rectal injection) of the decoction can be used for diarrhea, hemorrhoids, or rectal bleeding. 43 Compresses or washes Decoction from 5-10 g of drug per ll 250 ml of water,44 or Hamamelis water BPC can be used. Ointment This can be made containing 10% of liquid extract and applied daily as required..;5
Cautions Western contraindications None known, but caution should be taken when treating individuals with a history of contact dermatitis to Hamamelis. Chinese contraindications
None were found.
Pregnancy and lactation No adverse reports. Side effects Gastric irritation may occur in susceptible patients. 13 Rare contact dermatitis can occur with topical use (see Toxicology). Overdose
No adverse reports.
PROPERTIES Temperature According to the Chinese Herbal Medicine Dictionary, jl hua ye (the stems and leaves of Hamamelis chinensis) is classified as cool,'although other sources were cited that stated that it ranged from cool to slightly warm. However, this is not a main herb in Chinese medicine, and in any event, H. chinensis and H. virginiana may have basic pharmacological differences. H. virginiana can be used either as a neutral tonic astringent for diarrhea or as a cooling topical anti-inflammatory for skin inflammations. Taste
Taste in the mouth According to the BHP, Hamamelis is astringent and bitter. According to Felter and Lloyd,46 the bark and leaves are somewhat fragrant, and, when chewed, they are at first somewhat bitter, definitely astringent, leaving a pungent, sweetish taste that lingers. A 1:5 (25% ethanol) tincture of the bark tasted primarily sour to me, with slight bitterness.
Taste properties According to the Chinese Herbal Medicine Dictionary, jl hua ye is classified as sweet, bitter, and astringent. However, this is not a main herb in Chinese medicine, and H. chinensis and H. virginiana may have basic pharmacological differences. . In my opinion, the primary taste property of Hamamelis is sour, associated with its astringent action. However, the astringent and tonic actions are closely linked for Hamamelis, and the bitter taste may contribute a tonic aspect to the astringency.
500
Combining Western Herbs and Chinese Medicine
ORGANS
gave the specific indication of diarrhea with hemorrh~i~L:._~
In terms of Chinese medicine, Hamamelis, as used in the West, can be associated mainly with disorders of the followingorgans:
Astringent for the female reproductive system
......•• _.
,"-:.,;.,..,-:.;;;;;~~ .,.,.~
"':'f:~""';:r~~:-'-:~:'-~~~",,?~
••. ~~_:.;:_~ ... ,~; or-:-",-:-:
. - .'::",'
"7*- '.~':,,", .~-~ •.-: .• -r :-_~-~.. ~
".-
.Qrgal)... ~
Exampleof..Use ;•. '. ..Source., ... ··c ... -'. - ',"
Spleen and Intestines
diarrhea, mucus colitis, hemorrhoids
BHP
varicose veins
Christopher
leukorrhea. uterine prolapse. uterine hemorrhage
Felter and Uoyd
threatened abortion
Christopher
• -1'.. , . . .
-
Uterus
. '."," i '
·-.~·
~
The Chinese Herbal Medicine Dictionary does not list the meridians entered for jl hua yeo
ACTIONS The main traditionalictions of this herb are: • anti-inflammatory • astringent • vasoconstrictor • muscle tonic The Eclectics had a profound understanding of Hamamelis and regarded it as a tonic astringent and antihemorrhagic that could restore the tone of tired and overrelaxed muscles, veins. and mucus membranes. They also used it to treat diarrhea, bleeding, and excessive discharges from atonic mucus membranes. In Chinese terms, these conditions . can be seen as Spleen Deficient Qi with Spleen not holding up the organs, and Spleen not holding in the Blood. Anti-inflammatory Felter and Lloyd recorded the topical use of Hamamelis for abrasions, cuts, sprains, bruises, swellings, and skin rashes. Ellingwood 47 recommended Hamamelis for topical inflammations, including burns, and for inflammations of mouth and throat. Astringent Felter and Lloyd classified Hamamelis as a tonic astringent for 'passive diarrhea' and 'passive bleeding: They said that Hamamelis taken both internally and externally arrests the oozing of blood from mucus surfaces, as in noninflammatory hematuria. They also listed it for hemoptysis, hematemesis, and other hemorrhages, including hemorrhages in the eyeball, and ecchymosis of the eyelids and conjunctiva.' Ellingwo()d recommended Hamamelis for excessive catarrhal discharge fromoverrelaxed mucus membranes and for diarrhea with pWegm in the stools. The BHP listed Hamamelis as an anti-inflammatory astringent and antihemorrhagic that can be used for diarrhea and mucus colitis, and
Felter and •. :~'Z!E~ Lloyd listed this herb for leukorrhea associated with exces- ..C~_· sive relaxation of the uterine and vaginal walls, andq\lo~.i· Howe as recommending Hamamelis for uterine hemorrhclg~<~L _ ._~: with exhaustion after an abortion. Howe used Hamamelis in .. ,.~;4 the early months of pregnancy, and Christopher used it in ': "0. . ~~'i cases of threatened miscarriages. >-:.~,
Vasoconstrictor Felter and Lloyd stated that Hamamelis has a tonic and stimulant action on the venous coats so that this herb can treat disorders with excessive relaxation of the venous structures, such as varicose veins, hemorrhoids, and ... ~ bleeding. Grieve wrote that Hamamelis extract applied to a burst varicose vein can quickly stop the bleeding and that an .;.) anal douche of Hamamelis infusion can be used for intem3l ",~ bleeding hemorrhoids. . ... -.~~-""~
i::ri
.
•".:~_'~.;_:, °Z";:,"·}?"
Muscle tonic Ellingwood recommended Hamamelis for .':~':~ r an aching, bruised, or sore sensation of the muscles, for. " .
._~~~:~7%~
example, from cold or exposure, or from violent muscular"~" exertion. He recommended that following a difficult child-' '\~ (,,,.
~:a~:~:g~~e~:s:~~~~ ~~s::~:::~:~~~;e~: g:~ ".:;:~~ Lloyd listed Hamamelis for excessive relaxation of the muscles associated with anal or uterine prolapse, and for dull ",. ,,~:f;~:';~:~'F;· aching pain in the rectum, pelvic area, or female organs.. ' --;:7~"::':
COMPARISON OF WESTERN AND
CHINEs~t,:J~7,j:.
USE OF HAMAMELIS S P E C I E S " In the case of Hamamelis, little comparison can be made in view of the paucity of information in the Chinese Herbal Medicine Dictionary. According to the Chinese Herbal Medicine Dictionary, jl hua ye (the stems and leaves of I;I. chinensis) clears Heat, moves the Blood, and stops bleeding. It can be used to reduce diarrhea, reduce bleeding from cuts, and treat bleeding and tendon injuries from trauma. However, this herb appears to be one that has not been greatly used or understood in China. In addition, it does not seem to have had wide use as a vasoconstrictor, muscle tonic, or anti-inflammatory as in the West. Again, unlike the Western use, it appears that Hamamelis has not been used in China to treat bleeding or diarrhe~ • resulting from Deficiency.
References J. Pharmacognosy: Phytochemistry Medicinal Plants.2nd edn. Lavoisier. Paris, France (1999) . "",
1. Bruneton
r~
I
i Hamamelis 2. Foster S, Duke J. Medicinal Plants. Houghton Mifflin, Boston, Massachusetts (1990)
23. Seeberger J. ZAl1g Med 55(29):1667-1668 (1979) 24. Moosmann EB. Fortschr Med 109(116):5-6 (1991)
3. Grieve M. A Modern Herbal, vols 1 and 2. Dover Publications, New York, New York (1971) 4. Felter HW and Uoyd
501
JU. King's American Dispensatory, vols 1 and 2,
18th edn. (1898). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1983) 5. Dioscorides P. Kreutterbuch (1610). Reprinted by Verlag Konrad Kolbl, Munchen, Germany (1960) 6. Lonicerus A. Kreuterbuch (1679). Reprinted by Verlag Konrad Kolbl, MOOchen, Germany (1962) 7. Tabernaemontanus JT. Krauterbuch (li31). Reprinted by Verlag Konrad Kolbl, Miinchen, Germany (l993) 8. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks, Glenwood, Illinois (1990) 9. Gerard J. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publications, New York, New York (l975) 10. Jiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science and Technology Press, Shanghai, China . (1975) 11. Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone, Edinburgh, United Kingdom (2000)
25. Moosmann EB. Fortschr Med 109(116):7-8 (1991) 26. Knoch HG, Klug W, Hubner WD. Fortschr Med 110(8):69-74 (1992) 27. Wokalek H. Deut DermatoI5:498-506 (1995) 28. Swoboda M,Meurer J. Z Phytother 12:114-117 (1991) 29. Korting HC, Schafer-Korting M, Klovekorn W et al. Eur J Clin PharmacoI48(6):461-465 (1995) 30. Moore W,James DK, JObst Gynecol10(1):35-39 (1989) 31. Masaki H,Atsumi T,Sakurai H. Bioi Pharm Bull 18(1):59-63 (1995) 32. Masaki H,Atsumi T,Sakurai H.J DermatolSci 10(1):25-34 (1995) 33. Masaki H, Sakaki S, Atsuirni T et al. Bioi Pharm Bull 18(1):162-166 (1995) 34. Balansard P, Faure F, Balansard G et al. Therapie 27(5):793-799 (1972) 35. DiemunschA-M,Mathis C. STP Pharma 3:111-114 (1987) 36. Hormann HP, Korting HC. Phytomed 1(2):161-171 (1994) 37. Dauer A, Metzner P, Schimmer O. Planta Med 64(4):324-327 (1998)
I
38. Mabey R (ed). The Complete New Herbal. Elm Tree Books, London, United Kingdom (1988) 39. Granlund H. Contact Derm 31:195 (1994) 40. Bruynzeel DP, Van Ketel WG, Young E et al. Contact Derm 27(4):278279 (1992)
12. Egger K, Reznik H. Planta 57:239 (1961) 13. Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. Eng\lsh edn. Medpharm, Stuttgart, Germany (1994), from 2nd German edn. Wichd M (ed) (1989) 14. MesserschrnidtWArzneirnittel Forsch 18:161 (1968) 15. Jowett HAD, Pyman FL. Pharm J 91:129 (l913)
41. McGregor DB, Brown A, Cattanach P et al. Environ Mol Mutagen 11(1):91-118 (1988) 42. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983) 43. Christopher JR. School of Natural Healing. BiWorld, Provo,Utah (1976)
16. Griittner F. Arch Pharm 236:278 (1898) 44. Hansel R, Keller K, Rimpler H, Schneider G ed. Hamamelis. In: Hagers 17. Hager 5:12 (1976); 5:372 (1993) [cited in Bisset NG (ed) Herbal Drugs and Phytopharmaceuticals. Eng\lsh edn. Medpharrn, Stuttgart, Germany (1994), from 2nd German edn. Wichd M (ed) (l989)} 18. Engel R,Gutmann M, Hartisch C et al. Planta Med 64:251-258 (1998) 19. Willmar SA. Planta Med 62(3):241-245 (1996) 20. Duwiejua M, Zeidin 11, Waterman PG et at J Pharrn Pharmacol46:286290 (1994) 21. Hughes-Formella BJ, Bohnsack K, Rippke F et al. Dermatology 196(3):316-322 (1998)
=
22. Korting HC, Schafer-Korting M, Hart H et al. Eur J Clin Pharmacol 44(4):315-318 (1993)
Handbuch der Pharmazeutischen Praxis, 5th ed., vol. 5. SpringerVerlag, Berlin, Germany, pp 367-384 (1993) 45. Pharmaceutical Society of Great Britain. Hamamelis. In: British Pharmaceutical Codex 1973. Pharmaceutical Press, London, United Kingdom p 218 (1973) 46. Felter HW and Uoyd JU. King's American Dispensatory, vols 1 and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1983) 47. Ellingwood F. American Materia Medica, Therapeutics and Pharmacognosy, 11th edn (1919). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1994)
p
~"--
Harpagophytum Botanical name
Harpagophytum procumbens DC.
Family Pedaliaceae Pharmaceutical name Harpagophyti radix Part dried transverse slices of the secondary tubers English devil's claw German siidafrikanische Teufelskralle
Use in China Harpagophyturn doesnot have a tradition of use in China and is not listed in the Chines~ Herbal Medicine Dictionary S or in Chang and But.6
What is special about Harpagophytum
French harpagophytum Mandarin H. procumbens DC. is not used Use in the West Harpagophytum is a xerophilous perennial indigenous to the Kalahari savannas of Southern Africa,
In terms of Chinese medicine, Harpagophytum, as used in the West, can be said to be a cool and bitter herb, which has its main effects on the joints, tendops, and muscles, and on the Spleen and Stomach. /
usually growing on the iron oxide-rich soils in semidesert areas. l It is an unusual plant, with 'long stems lying flat on the ground, large reddish trumpet-like flowers, and the characteristic woody fruits with hooked projections that gave it the
The key to understanding Harpagophytum is that it is an anti-inflammatory and analgesic herb that has specific use for pain and immobility associated with inflammatory disorders ofthe joints and muscles.
name of devil's claw. The primary root may reach 2 m in depth, and the spreading secondary root system bears tubers that may be up to 500 g in weight. 2 The origins of the traditional use of this plant are as yet
CHINESE ACTIONS
unknown. Currently, the peoples of Southern Africa use it internally as a bitter tonic in digestive disorders, as an anal-
In terms of Chinese medicine, Harpagophytum, as used in the West, can be said to have the following actions:
gesic, including for the pain of labor, and for fever. Topically, it is used for treating ulcers, wounds, and boils.
1. clear Damp Heat in the channels II. tonify and move the Qi of the Spleen and Stomach
According to Weiss,3 G. H. Mehnert, who had observed its use in South Africa, was the first to introduce Harpagophytum into Europe. However, its introduction
to Europe
has also been attributed'to Yolk. It has since gain~~ a repu~
WESTERN ACTIONS
tation in the West as an anti-inflammatory and analgesic, with the specific indication of arthritis and rheumatism.
The main Western actions of Harpagophytum areshown here in terms of its two main Chinese actions:
4
503
...
--
Combining Western Herbs and Chinese Medicine
504
slow digestion, and gastroenteritis. The pulse is usually=,.~';-'::G)\ slightly wiry and slightly slippery, and becomes more rapid"--;~_ ~ I. clear Damp Heat in the channels
II. tonify and move the Qi of the Spleen and Stomach
anti-inflammatory analgesic antiarthritic antirheumatic bitter digestive tonic anti-inflammatory
Clear Damp Heat in the channels Harpagophytum can be used to treat inflammatory disorders of the muscles, tendons, joints, and bones, involving pain and stiffness. In Chinese medicine, these disorders are termed bi syndromes (Painful Obstruction), and Harpagophytum can be associated with one or more of the following actions: • clears Damp Heat in the channels • clears Wind Damp (Heat) in the channels • moves Qi and Blood,in the channels In my opinion, Harpagophytum is more for cases of Painful Obstruction involving Heat than for cases involving Cold. Harpagophytum can be used in herbal combinations for cases of Painful Obstruction involving Cold, but only if it is suitably combined with warming circulatory stimulant herbs, such as Zanthoxylum, Zingiber, or Capsicum.
and flooding during the arthritic episodes. The tongue is :;:;~: pale and slightly purple, with red spots in the middle and -~ ,-" ,··.c'--"""d! " back, and a yellowish greasy coat also in the middle and "7'::1 ' back . _.~.
Diagnosis The patient has Damp Heat in the channels of the joints with some Stagnant Qi and Damp Heat in the Stomach and Intestines, and some Spleen Deficient Qi. Choice of Harpagophytum This herb is specific for inflammatory conditions of the joints, associated in Chinese medicine with Damp Heat, and can also be used to assist in the treatment of Deficiency, Stagnation, and Damp Heat in the Stomach and Intestines.
LhnrtationsoffIarpagophynun TEMPERATURE In this book, Harpagophytum is classified as cool and is more appropriate for warm conditions, although it can be used for hot, neutral, cool, or even cold conditions if it is suitably combined with other herbs.
WESTERN USES The main Western uses of Harpagophytum are shown here in terms of its two main Chinese actions:
TASTE Harpagophytum is classified in this book as bitter in th~;· it can reduce inflammation and, in Chinese medicine terminology, clear Damp Heat from the channels of the joints and muscles. I
I. clear Damp Heat in the channels
arthritis. gout. myalgia, back pain. rheumatism
II. tonify and move the Qi of Spleen and Stomach
poor appetite. dyspepsia
ACTIONS
DIRECTION OF ENERGY In terms of Chinese medicine, Harpagophytum does not appear to have a marked 'directional effect on the movement of energy. It may improve the circulation of Qi and Blood in the channels of the joints, tendons, and muscles, and it may strengthen the movement of Qi in the Stomach and Intestines, and perhaps in the Liver and Gallbladder as well.
TYPICAL CASE EXAMPLE Signs and symptoms The patient has recurring arthritis with pain, stiffness, and some sensations of heat in the affected joints. There is a chronic tendency to poor appetite,
Anti-inflammatory and analgesic Whilst there have been reports of the use of this herb in Southern Africa, Germany, and Britain for headache, migraine, and neuralgias, its most common use in the West is for inflammatory disorders of the joints, muscles, and tendons. It can be used in suitable combination with warming peripheral circulatory stimulants such as Zanthoxylum to treat arthritis or rheumatism with sensations of cold, but in my opinion, it is specific for arthritis and related disorders with sensations of heat. Bitter digestive tonic Harpagophytum has a definitely bitter taste in the mouth and a tradition of use as a bitter tonic for poor appetite or for dyspepsia from sluggish digestion. However, I would only use this herb for atonic digestion if the condition was secondary to and associated with arthritis or related problems.
Harpagophytum Hepatic and choloretic Harpagophytwn does not have a tradition of use as a primary hepatic or choloretic. and I would not use it for these actions unless they were required to support its primary use as an antiarthritic herb.
Harpagophytum paired with other herbs Discussion of the limitations of each of the main actions of Harpagophytum can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Harpagophytum beyond its limitations. The basic unit of herb combination is the herb pair. Six pairings of Harpagophytum are briefly explained below.
505
Harpagophytum + Viola
Chronic arthritis + cystitis Viola is a cooling alterative and demulcent herb. which can be used to treat inflammatory conditions of the joints, urinary system, stomach, or skin. It can be combined with Harpagophytum to treat arthritic conditions accompanied by gastritis, urinary tract inflammations, or eczema. Harpagophytum + Filipendula
Arthritis + gastritis The primary action of Filipendula is as a gastrointestinal anti-inflammatory, and this herb has a secondary action as an antiarthritic. Filipendula is often combined with Harpagophytum since so many patients with artliritis or rheumatism have gastritis as a side effect from prolonged use of anti-inflammatory drugs. Harpagophytum + ZanthOxylum
CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listedfor each herb in the pair. Harpagophytum + Smilax
Rheumatoid arthritis + psoriasis Harpagophytum can be used as a general-purpose antiinflammatory for arthritis, rheumatism. and gout. Smilax is specific for joint and skin conditions associated with Heat Toxin and Damp Heat. The two herbs can be combined to treat psoriatic arthropathy or other chronic conditions involving inflammation of both the skin and joints.
..
I
Harpagophytum + Berberis
Arthritis + irritability Berberis can move Liver Stagnant Qi to assist in the clearance of Liver Heat and Liver Damp Heat. It can be combined with Harpagophytum in cases in which Damp Heat in the joints is linked to Liver Damp Heat, with a bitter taste in the mouth, sensations of heat in the head, and irritability (whether expressed or suppressed). Harpagophytum + Populus
Arthritis + cold extremities Zanthoxylum is a warming; acrid. aromatic herb with circulatory stimulant and·antirheumatic actions. It can be used to treat joint disorders involving poor peripheral circulation with Qi and Blood Stagnation and accumulation of Wmd, Cold, Damp, and Phlegm. Although Harpagophytum is a cooling anti-inflammatory, it can act as a symptomatic, general-purpose antiarthritic herb and can be combined with Zanthoxylum to treat cold patterns of arthritis, or patterns in which Cold is mixed with a lesser amount of Heat.
Harpagophytum combinations Four Harpagophytum combinations are discussed below:
1. arthritis + heat sensations
Damp Heat in the channels
2. arthritis + psoriasis
Damp Heat + Heat Toxin
3. arthritis + exhaustion
Damp Heat in the channels + Deficient Yin
4. arthritis + cold extremities
Stagnant Qi and Blood + Cold in the channels
Arthritis + feverishness
~
...•:
-_. -,
Populus is a cool. bitter herb, which can be used to treat febrile episodes~ feverishness, or sensations of heat associated with mixed patterns of Deficiency Heat, Wmd Heat, and Damp Heat. It can also fultction as a bitter digestive tonic to speed convalescence and treat debility. Populus can be combined with Harpagophytum for cases of arthritis with feverishness and debility.
CAUTION
Before using any ofthe combinations below, it is important to befamiliar with the cautions listedfor each herb in the combination.
Combining Western Herbs and Chinese Medicine
506 1. Arthritis + heat sensations
combination and to start with a half dose of the combination
Damp Heat in the channels
for the first few days.
Herb '..-'-- . Ratio·-Temperature~:·~Jaste-c":''':--;_:';'-· ..
•".:. '-'~-'~~;'._~."-:--~_, .-i•. "1'''~'~'!"':'_''~_'_'';-'~-:;'':'''-'
Harpagophytum . 1. 1. Berberis Taraxacum 1. Arctium (root) 1. Filipendula 0.5 Angelica sin. 0.5 Glycyrrhiza 0.5
=-:~-~'''~~=:l'''-~~''.~f''''''~'''''~i.~
cool cool cool-cold cool cool warm neutral-cool
.. ';:~t ..;j,
bitter bitter bitter 51. acrid,s!. bitter sour, bitter sweet. aromatic, bitter sweet
GENERAL
This combination is for accumulation of Damp Heat and/or Wind Damp (Heat) in the channels of the joints, tendons, and muscles, associated with Qi and Blood Stagnation. There may also be:
2. Arthritis + psoriasis
Damp Heat + Heat Toxin
Smilax Scrophularia Harpagophytum Filipendula Mahonia Arctium (root) Taraxacum Glycyrrhiza
1. 1. 1. 1. 1. 1. 1. 0.5
cool cool cool cool cool cool cool-cold neutral-cool
51. bitter 51. bitter bitter sour, bitter bitter 51. acrid,s!. bitter bitter sweet
This combination is the same as Smilax: arthritis
+ psoriasis
and is discussed under that heading. • Liver-Gallbladderpamp H~~t :t_.Liv~r s.tagn~t 9,i._ .. '. • Kidney Deficient Qi from long-term corticosteroid use • Stomach Heat from prolonged use of nonsteroidal antiinflammatories (NSAIDs) • Deficient Blood from NSAID-induced gastric bleeding The overall temperature is cool, and the combination is for warm-hot conditions. The dominant taste property is bitter. The sweet constituents can act as either tonics or antiinflammatories, and the sour property of Filipendula can have an astringent effect.
3. Arthritis + exhaustion
Damp Heat in the channels + Deficient Yin
Harpagophytum Arctium (root) Populus Viola trio Filipendula Ophiopogon Glycyrrhiza
1. 1. 1. 1. 0.5 0.5 0.5
cool cool neutral-cool cool cool cool neutral-cool
bitter 51. acrid, 51. bitter bitter, sour sour, sweet, bitter sour, bitter sweet,s!. bitter sweet
USE GENERAL
• recurring arthritis, rheumatism, or gout with heat sensations in the joints, especially with a history of prolonged use of corticosteroids and NSAIDs PRACTICAL NOTES
This combination can be taken as 5-10 ml of 1:5 tincture in quarter of a glass of water, three times per day.
General caution The combination can be taken, with appropriate breaks and modifications, for 1-2 months, but is not appropriate in pregnancy or, unless modified, for patients with Cold Deficient Spleen patterns.
Caution on the use of alteratives Patients with this pattern may have large am~unts of Retained Pathogen and Heat Toxin accumulated in the joints and in the system in general. Berberis., Taraxacum, and Arctium may have a cleansing effect, releasing these toxins into the blood. If they accumulate in ~e blood faster than they can be eliminated from the system, the arthritis may be temporarily aggravated. It is therefore advisable to drink plenty of water whilst taking this
This combination is for accumulation of Damp Heat and/or Wind Damp Heat in the channels of the joints, tendons, and muscles, associated with Deficient Yin and Deficiency Heat. There may also be: • Kidney Deficient Qi and Y'm from long-term corticosteroid use • Stomach Deficiency Heat from prolonged use of NSAIDs The overall temperature is cool, and the combination is for warm conditions. The dominant taste property is bitter, associated with the anti-intlammatoryand antipyretic actions. The bitter constituents can also act as digestive tonics to help with convalescence. The dominant function of the sweet constituents is to tonify Yin, but some sweet constituents can also have an anti-inflammatory action. USE
• recurring arthritic or rheumatic disorders with heat
--~
r-,
Harpagophytum
) i
sensations in the joints or muscles, feverish sensations especially in the afternoon or nighttime, exhaustion, maybe gastritis, and often a history of prolonged use of corticosteroids and NSAIDs PRACTICAL NOTES
t .. ~:.
I·,·>
l':::_
This combination can be taken as 5-10 ml of 1:5 tincture in quarter of a glass of water, three times per day.
507
1. Harpagophytum is the leading herb in treating arthritis from Damp Heat in the joints, tendons, and muscles. Berberis, Taraxacum, and Arctium assist in this by clearing Damp Heat from the Liver and from th~ body in general. Filipendula clears Stomach Heat associated with long-term use ofNSAIDs, and Angelica treats Deficient Blood associated with blood loss from NSAID-induced gastric bleeding. 2. This combination contains Harpagophytum, Arctium,
General caution The combination can be taken, with appropriate breaks and modifications, for 1-2 months, but it is not appropriate in pregnancy or, unless modified, for patients with Cold Deficient Spleen patterns.
Caution on the use of alteratives See the comment on the flrst combination, Arthritis + heat sensations. However, side effects from the alterative herbs are less likely in this combination because of the moderating effect of the demulcent anti-inflammatories 9phiopogon andViola.
and Taraxacum for Damp Heat arthritis, and Filipendula and Glycyrrhiza for Stomach Heat gastritis, in common with combination No.1. However, this combination also contains Smilax, Scrophularia, and Mahonia, which are specific for Heat Toxin skin disorders. 3. Arthritis + exhaustion
4. Arthritis + cold extremities
Damp Hea~ in the channels + Deficient Yin
Stagnant Qi and Blood + Cold in the channels
4. Arthritis + cold extremities
Stagnant Qi and Blood + Cold in the channels
~H~~;ti~~~~.:'~~~~fratiir~·iTh~t~";·~;T{r;~W;~'?:~~
;;.c.",...
~
Zanthoxylum (bark) Populus Harpagophytum
r
,..:0.-
Angelica arc. Angelica sin. Zingiber Capsicum
1
hot
1 1 1 1
neutral-cool cool
0.5 5-20 drops
warm warm hot hot
acrid, aromatic, bitter bitter, sour bitter bitter, acrid, aromatic sweet, aromatic, bitter acrid, aromatic acrid
This combination is the same as Zanthoxylum: arthritis + cold extremities and is discussed under that heading.
COMPARISON OF THE FOUR HARPAGOPHYTUM COMBINATIONS
Harpagophytum
1
zanthoxylum (bark)
Arctlum (root)
1 1 1
Populus
0.5 0.5 0.5
Angelica sin.
1
Zingiber
0.5 5-20 drops
Populus Viola trio Filipendula Ophiopogon Glycyrrhiza
Harpagophytum
1 1 1
Angelica arc.
1
Capsicum
3. Combination No.1 is more appropriate for Heat patterns, not necessarily with exhaustion, but with some Deficient Blood. This combination is more useful for pat-
terns of Deflciency Heat with Deficient ~m and exhaustion. This combination has Viola and Ophiopogon to tonify the Y'm and clear Deficiency Heat. Viola can have antiarthritic action, and Ophiopogon can combine with Filipendula and Glycyrrhiza to reduce gastric inflammation. Populus combines with Harpagophytum as a cool, bitter antiarthritic, and combines with Ophiopogon to reduce feverishness and febrile episodes associated with Deficiency Heat.
1. Arthritis + heat sensations
2. Arthritis + psoriasis
Damp Heat in the channels
Damp Heat + Heat Toxin
4. Whilst the previous three combinations are appropriate for arthritis with sensations of heat in the joints and
'Herb?-:~:~~ff~Vi:::~:::
'Herb' ~ -"--- ---- --Ratio-
body, this combination is appropriate for arthritis with sensations of cold. Zanthoxylum, Angelica archangelica,
Harpagophytum
1
Berberis
1 1 1
Smilax Scrophularia
Taraxacum ArctIum (root) Filipendula Angelica sin. Glycyrrhiza
0.5 0.5 0.5
Harpagophytum Filipendula Mahonia Artlum (root) Taraxacum Glycyrrhiza
1 1 1 1 1 1 1
0.5
Zingiber, and Capsicum make this combination suitable predominantly for cases involving Wind, Cold, Damp, and Phlegm with poor peripheral circulation and sensations of
as
cold. Harpagophytum and Populus can act general-purpose antiarthritics for inflammation, pain, and immobility, but they are also specific for patterns involving Damp Heat.
Combining Western Herbs and Chinese Medicine
508
Research CONSTITUENTS The following constituents have been reported: • iridoid glycosides • sugars • other Iridoid glycosides H. procumbens contains 0.5-3% iridoid glycosides, mainly harpagoside (the cinnamyl ester of harpagide) and smaller amounts ofharpagide and procumbide.7 H. zeyheri contains harpagoside and 8-p-coumaroylharpagide.8 Sugars Starch and high molecular weight polysaccharides are absent, but lower molecular weight sugars make up to 50% of the dry weight. The tetrasaccharide stachyose predominates (up to 46%);\"ith lesSer amounts of raffuiose, sucrose, and monosaccharides.9 Other Harpagophytum tubers also contain: • triterpenes, mainly oleanic acid, 3~-acetyloleanic acid, and ursolic acid lo • flavonoids such as kaempferol and luteolinII • phenolic acids such as caffeic acid and chlorogenic acid l2 • phytosterols, mainly ~-sitosterol, stigmasterol, and their glycosidesII
PHARMACOLOGICAL AND CLINICAL RESEARCH The following effects have been observed: • anti-inflammatory • analgesic • antiarthritic • cardioregulator • hypotensive • antiarrhythmic • digestive Anti-inflammatory Intraperitoneal pretreatment with Harpagophytum aqueous extract, at doses of 100-400 mg/kg, showed anti-inflammatory effects against carrageenan-induced edema in rats. At 400 mg/kg, Harpagophytum was more effective than pretreatment with indomethacin at 10 mglkg. Pure harpagoside appeared to be ineffective as aD. anti-inflammatory. Interestingly, the Harpagophytum extract showed no activity after pretreatment with 0.1 N hydrochloric acid, and the authors suggested that preparations of Harpagophytum for oral administration
-.
could be coated to protect them from stomach acid. 13 c·:-:::.:;;,~ Another study reported that, whilst intraperitoneal-~;-""~__
intraduodenal pretreatment with Harpagophytum extracts-2~~ showed anti-inflammatory effects against ca~rageenan::::~;::~; ~ induced edema in rats, administration by gavage did not produce anti-inflammatory effect, regardless of the dose.-;'~*'· This was attributed to inactivation of the HarpagoPhytutli·:·~[' -~ extract by the acid pH of the stomach. 14 .. .,.c'-1;~)
:t
.
A study using the primary human monocyte model of:,_~;,' peripheral inflammation reported that Harpagophytum ·<~i~ ... extract had anti-inflammatory properties. However, har- ':'-'~.!r"~ pagoside and"harpagide did not exhibit this action. 1s .' "r:«
Analgesic Oral administration of Harpagophyturn extracts .. in mice failed to produce a consistent analgesic effect,I6 but ni •.iK;;~~; intraperitoneal administration of Harpagophytum aqueoUs -:?2. ~ extract to mice, at doses of 100-400 mglkg, showed dose-:;:;; , dependent peripheral·analgesic effects in the writhiIig tese~};. Pure harpagoside at 10 mglkg also had an analgesic effect. 13 ":" "
~.
Antiarthritic An open. study that included 630 patients -. -:;~~. with arthritic conditions reported improvement in 42-85%-~~""?- of the patients, depending on the site of the arthroses, after 6'~'?o'-cijo 1'1 ~
months of treatment with Harpagophyturn. This was given as an aqueous extract containing 2.5% iridoid glycosides, at a daily dose of 3-9 g, divided into three doses. Even at the ." highest dosage level, no side effects were noted other than .' -;~~. mild gastrointestinal disturbances. 17 • ~_ •. ,;;,;";,,:",,,;;;;;r-:~
...
;~,
In a double-blind placebo-controlled study, 50 arthritic patients were given 3-week courses of two capsules, three times daily; each capsule contained 400 mg of a waterethanol extract of Harpagophyturn standardized to 1.5% of iridoid glycoside. Harpagophytum produced a decrease in the severity of pain, which was greater in the moderate cases
-
than in the more severe cases. 18 Another double-blind placebo-controlled study on 89 patients with articular pain, tested the efficacy of a 2-month course of two capsules, three times daily, containing 335 mg of Harpagophytum powder, with an iridoid glycoside content of 3%. Harpagophyturn produced a significant decrease in pain and increase in mobility. No side effects or changes in biological parameters were observed in the 2-month peri- .. od. 19 A recent randomized double-blind trial compared the,~~t.:t.~ efficacy and safety of Harpagophyturn in the treatment of .:;,:;;;'; hip and knee osteoarthritis with the slow-acting drug di"·'.,gt; .. acerhein. After 4 months, Harpagophyturn at 2.61 g perd~r ;F~, was reported at least as effective as diacerhein at 100 mg per .• day. Also, the Harpagophytum group had a lower rate:o( ·:t~_.
adverse effects and required less supplementary analgesic
,.-.; -;
-' 509
.HarpagqpbYJHtrl and fewer supplementary medications. lO
Mechanism of antiarthritic effect The identities of the active constituents of Harpagophytum are still uncertain, and the mechanism of the antiarthritic effect of this herb has not been established.
Iridoids as active constituents Whilst the iridoid glycosides, especially harpagoside. are often regarded as the principle active constituents, there are conflicting reports on the efficacy of these iridoids as anti-inflammatories and analgesics: • harpagoside failed to protect against carrageenaninduced inflammation in rats at levels equivalent to 400 mg of dried root 13 • harpagoside and harpagide did not show antiinflammatory properties uSing the primary human monocyte modeP5 • intraperitoneal administration of pure harpagoside at 10 mglkg had analgesic effect iIi mice13 -
Effect ofgastric acid on Harpagophytum In animal studies.
\W I
..
intraperitoneal administration of Harpagophytum showed an anti-inflammatory effect, but exposure of Harpagophytum to stomach acid appeared to reduce or remove the anti-inflammatory property. Consequently, it has been suggested that enteric-coated dosage forms might be necessary for oral administration of Harpagophytum. 13, 14 However, clinical studies found oral administration of Harpagophytum to have significant anti-inflammatory action. The effect of gastric acid on the anti-inflammatory effects of the active constituents of Harpagophytum in humans requires further study.
Intestinal metabolism of iridoids It has been reported that harpagoside, harpagide, and 8-p-coumaroylharpagide are transformed into the pyridine monoterpene alkaloid aucubinine B by human fecal flora,21 but the relative roles of harpagoside and its intestinal breakdown products in the antiarthritic effect in humans' are still unclear. Effects on prostaglandin synthesis Unlike most NSAIDs, Harpagophytum does not appear to have its anti-inflammatory effect by blocking prostaglandin synthesis. Cyclo-oxygenase is one of the main enzymes required for the synthesis of prostaglandins, and an in vitro study reported that the activity of this enzyme is unaltered by Harpagophytum.22
~ . . ,:
A1s~, a clinical stUdy reported that Harpagophytum had no significant effects on the following mediators of acute inflammation: prostaglandin Ez. thromboxane B2.6-ketoprostaglandin Fla , and leukotriene B4. The authors concluded that, at least in healthy humans and under the conditions of the experiments, Harpagophytum lacks the effects on
arachidonic acid metabolism characteristic of the NSAIDs given for arthritis.23 However, a more recent study reported that Harpagophytum and harpagoside showed anti-inflammatory effects by interacting with eicosanoid biosynthesis, and that there was a close relationship between serum harpagoside levels and the inlubition ofleukotriene biosynthesis.24
Summary of the antiarthritic effects In animal studies, Harpagophytum extracts demonstrated both anti-inflammatory and analgesic effects when administered by intraperitoneal injection, but not when it was administered by an oral route. However, in clinical trials. Harpagophytum extracts demonstrated antiarthritic effects when administered orally. Finally, in animal studies. both harpagoside and harpagide failed to show anti-inflammatory activity, but intraperitoneal administration of harpagoside had an analgesic effect. ••
_
_0
Cardioregulator In vitro rabbit experiments using a H. procumbens methanolic extract showed a mild decrease in heart rate and a mild positive inotropic effect at lower doses. but a marked negative inotropic effect at higher doses. The positive inotropic effect of harpagoside was stronger than that of the extract, but harpagide had a considerable negative inotropic effect.25 Hypotensive A methanol ext~act of H. procumbens given to normotensive rats resulted in a dose-dependent reduction of blood pressure. The decrease was only significant at higher doses (dried extract =400 mglkg) given by gavage. Also, isolated harpagoside was less active than doses of the extract containing equivalent quantities of harpagoside. 25 Antiarrthymic In both in vitro and in vivo rat experiments, H. procumbens extract showed a protective action against arrhythmias induced by aconitine, calcium chloride, and epinephrine-chloroform. In a further rat in vitro study, both a methanolic extract of H. pro.cumbens and harpagoside showed a dose-dependent protective action toward hyperkinetic ventricular arrhythmias induced by reperfusion.26 Digestive The bitterness value of Harpagophtyum, determined by the DAB 10 method, ranges from 5,000-12,000.27 This compares with bitterness values of about 10,000 for Gentiana and 15,000 for Artemisia absinthium. From 3-year clinical observations, using Harpagophytum decoctions of one teaspoon of the herb to 2 cups of water, patients were reported to show improvement in appetite. flatulence, small intestinal disorders, constipation, and diarrhea.21
Combining Western Herbs and Chinese Medicine
510 COMPARISON OF AND
H. PROCUMBENS
H. ZEYHERI
Constituents Harpagoside is the main iridoid for both H. procumbens and H. zeyheri, whilst 8-p-coumaroylharpagide is a representative iridoid of H. zeyheri only. For commercial extracts, the ratio of harpagoside to 8-p-coumaroylharpagide may be intermediate between the ratios for the two species, since commercial extracts may be prepared from mixtures of both species. z9
Pharmacology The aqueous extracts of both species have been reported to show similar anti-inflammatory and analgesic properties.~9
Doses of Harpagophytum for loss of appetite or dyspep' ... ~ are often less than a third of the doses for arthritic disorde~:~'~~~ Digestive disorders For example. for digestive disorders,;·-:r·, the BHC listed 0.5 g of dried tuber in decoction, or 1 mf of~~. 1:5 tincture (in 25% alcohol), three times per day. . u:;}$~:, t:--
Arthritic and related disorders The BHC listed 1.5-2.5 g of dried tuber in decoction, or 1-2 ml of 1:1 liquid extract (in 25% alcohol), three times per day for arthritic disorders. I do not usually prescribe Harpagophytum as a single herb, but in combination with other antiarthritic herbs. For example, if a patient takes 5-10 ml as an individual dose of the combination Harpagophytum: arthritis + heat sensations, as a 1:5 tincture, each individual dose will contain about 1-2
RESEARCH VERIFICATION OF
rnl of Harpagophytum 1:5 tincture.
TRADITIONAL ACTIONS
Changes in Harpagophytum dosing Doses of Harpa-
The following traditional actions of H. procumbens have been supported by research: anti-inflammatory, analgesic, antiarthritic, and bitter digestive tonic and regulator. Additional effects demonstrated by research The following additional effects have been reported as discussed above: cardioregulator, antiarrhythmic, and hypotensive.
.;-.:..~
Human studies A recent clinical study using oral administration of the equivalent of 6 g of Harpagophytum daily for 1 month did not find clinical side effects or adverse hematological or biochemical changes. 31 A later clinical study also found no evidence for Harpagophytum-related side effects except possibly for mild and infrequent gastrointestinal symptoms. 3Z
Dose There are two levels of dose for Harpagophytum: • for digestive disorders • for arthritic and related disorders
.'---
gophytum in the treatmen~of arthriti~ and relat~d.~~o!.~~rs #~~~; have increased from those listed by the BHp33 in 1983 to those listed by the BHC in 1992 and Mills and Bone in 2000. For example, the BHP listed 0.1-0.25 g of dried tuber, three times per day, in contrast to the BHC recommendation of 1.5-2.5 g, three times per day. This is due to the use in· post1983 clinical research studies of Harpagophytum doses of up to 6 g per day.31
TOXICOLOGY Animal studies Aqueous and ethanolic extracts of Harpagophytum, and the isolated iridoids harpagoside and harpagide have shown very low toxicity in both acute and subacute tests with rodents. 30· 16 One rat study reported no significant hematological or gross pathological changes after 3 weeks of oral administration of 7.5 g/kg of Harpagophytum. Also no hepatotoxic effects were observed after 1 week of oral treatment with 2 glkg. The acute intraperitoneal LD so in mice for harpagoside was reported as 1 glkg, and that of harpagide as greater than 3.2 glkg.30
....'
Initial dose If the BHC dose!quantities are used, I would recommend starting at the lo~er end of the dose range. Duration No restriction is known. Some authors recom19 mended treatment for at least 2-3 months for arthroses.
Cautions Western contraindications Some texts have advised 34 against using Harpagophytum in cases of peptic ulcers.31 . This recommendation appears to be based on theoretical grounds since it is thought that the bitterness of Harpagophytum may increase gastric acid secretion. I have not seen data to suggest that peptic ulceration is aggravated by Harpagophytum. Chinese contraindications None reported. Pregnancy and lactation No adverse reports. Side effects Some texts do not list any side effects,3s but one report mentioned mild gastrointestinal disturbances, especially at high dosage levels. 17 Overdose No adverse reports.. Interactions
No adverse reports.
--_....,.1
Harpagophytum
Regulatory status
ACTIONS
Please read the Regulatory status section in the chapter on Safety. Harpagophytum is not in the UK General Sale List (Statutory Instrument Order 1977 No.2129 to the Medicines Act 1968).36 However, neither is it in Schedule Part III of the
The following traditional actions are discussed: • anti-inflammatory and analgesic • bitter digestive tonic • hepatic and choloretic
Supply of Herbal Remedies Order 1977 No. 2130. Harpagophytum is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Harpagophytum is not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
Anti-inflammatory and analgesic This heading also includes the antiarthritic and antirheumatic actions. According to Mills and Bone, traditional use of Harpagophytum by the peoples of Southern Africa included pain in labor, febrile illnesses, migraine, allergic reactions, and digestive disorders. The BHP of 1983 listed its use in Britain for arthritis, gout, lumbago, myalgia, and rhe~matism, and the 1988 English edition of Weiss mentioned the use of
Traditional sources
Harpagophytum in Germany for arthritis, rheumatoid arthritis, low back pain due to spondylosis, neuralgia, and headache.
There is little information available on the traditional use of Harpagophytum by the native peoples of Southern Africa, and this herb has had only recent popular use in Europe and in America, and is not listed in Chinese texts.
PROPERTIES Temperature Harpagophytum is classified as cool in this book in line with its anti-inflammatory and antipyretic applications. Taste
Taste in the mouth The BHP reported the taste as astringent and bitter, but I found the predominant taste of a 1:5 1·.
511
Bitter digestive tonic The use of Harpagophytum as "a bitter digestive tonic for poor appetite and dyspepsia has been noted by several authors. 3•4•11 Hepatic and choloretic It has been reported that drinking Harpagophytum tea for several days can improve disorders. of the upper small intestine that are accompanied by disorders of the gallbladder or pancreas. 37 Harpagophytum tea has also been used to treat the local enteritis in duodenal diverticulitis. 3 According to Weiss, Hoppe treated patients with Harpagophytum tea and noted reduction in raised cholesterollevels. Weiss suggested the potential benefit of this plant for older patients with rheumatic disorders, obesity, and hyperlipemia.
tincture of Harpagophytum in 60% alcohol to be bitter.
Taste properties Harpagophytum is classified in this book as bitter in line with its use as both a bitter anti-inflammato-
References
ryand a bitter digestive tonic. 1. Bruneton J. Phannacognosy: Phytochemistry Medicinal Plants, 2nd edn. Lavoisier, Paris, France (1999)
ORGANS In terms of Chinese medicine, Harpagophytum tubers, as used in the West, can be associated mainly with disorders of the joints, tendons, and muscles, and with atonic condi-
Stomach, Spleen
3. Weiss RF. Herbal Medicine. English edn. Beaconsfield Publishers, Beaconsfield, United Kingdom (1988)
4. Bisset NG (ed). Herbal Drugs and Phytopharmacel!ticals. English edn. Medpharm. Stuttgart, Germany (1994), from 2nd German edn. Wichtl M (ed) (1989)
tions of the digestive system:
joints, muscles
2. Van Wyk B-E, Van Oudtshoorn B, Gericke N. Medicinal Plants of South Africa. Briza Publications, Arcadia, pp 144-145 (1997)
5. Jiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science and TechIiology Press, Shanghai. China (1975)
arthritis, gout. myalgias, rheumatism. neuralgia. headache
BHP Weiss
painful arthroses, tendinitis
BHC
6. Chang H-M. But PP-H (eds). Pharmacology and Applications of Chinese Materia Medica. vols. 1 and 2. World Scientific Publishing, Singapore (1986)
dyspepsia, poor appetite
BHC, Wicht!
7. Stieber O. Dtseb Apoth Ztg 117:1279-1284 (1977)
512
Combining Western Herbs and Chinese Medicine
8. Baghdikian B. Lanhers MC, Fleurentin I et al. Planta Med63(2):171176 (1997)
23. Moussard C. Alber D. Toubin MM et al. Prostaglandins Leukotrieliet Essential Fatty Acids 46:283-286 (1992) . , -._--
9. Czygan F-C. Kriiger A. Schier W et al. DtschApoth Ztg 117:1431-1434 (1977)
24. Loew D. Mollerfeld I, Schrodter A et al. Clin Pharmacol 69 (S:3 ) S6- 364 ( _"00 1)
10. Tunmann P and Bauersfeld H-I.Arch Pharmaz 308:655-657 (1975) 11. Bradley PR (ed). British Herbal Compendium. vol 1. British Herbal Medicine Association. Bournemouth. United Kingdom (1992)
..
25. Circosta C. Occhiuto F, Ragusa S et al. I 274 (1984)
T
~':-~'" . .-e,",.'.i.§;i="
_"",~.2::.
EthnOPharmaCOIll(3).~~.~.-.~ •.~ .
. :.;j.
,
.'\
~,,~:.~,
....~..
26. Costa De Pasquale R. Busa G, Circosta C et al. I Ethnopharma 13(2):193-199 (1985)
12. Ficarra P. Ficarra R. Tommasini A et al. Boll Chim Farm 125:250-253 (1986)
27. Czygan F-C. KrUger A. Schier Wet al. Dtsch Apoth Ztg 117:1431':.::#;,.
13. Lanhers MC. Fleurentin I. Mortier F et al. Planta Med 58:117-123 (1992)
28. Zimmerman w: ZAllgemeinmed 54:1178-1184 (1976)
14. Soulimani R. Younos C. Mortier F et al. Can I Physiol Pharmacol 72:1532-1536 (1994)
29. Baghdikian B. Lanhers MC, Fleurentin I et al. Planta Med 176 (1997)
15. Fiebich BL. Heinrich M, Hiller KO et al. Phytomedicine 8(1):28-30 (2001)
30. Van Haelen M, Van Haelen-Fastre R, Samaey-Fontaine I et al. Phytotherapy 5:7-13 (1983) .
16. ErdosA. Fontaine R. Friehe H et al. Planta Med 34(1):97-108 (1978)
31. Chrubasik S, Zimpfer CH, Schutt U et al. Phytomed 3(1):1-10 (1996)
17. Belaiche P. Phytotherapy 1:22-28 (1982)
32. Chrubasik S, Junck H. Breitschwerdt H et al. Eur I Anaesthes,i,o}
18. Guyader M. Les Plantes Antirhumatismales. ~tude historique et pharmacologique. et etude clinique du nebulisat d'Harpagophytum procumbens DC chez 50p~ti~n~ ~siques' suivis' ~ ~ce hospitalier. [Dissertation]. Universite Pierre et Marie Curie. Paris. France (1984) 19. Lecomte A. Costa IP. 37°2 Le Magazine 15:27-30 (1992). [cited in: European Scientific Cooperative on Phytotherapy: Monographs on the medicinal uses of plant drugs. (monograph on: Harpagophyti radix) European Scientific Cooperative on Phytotherapy. Exeter. United Kingdom (1997) I 20. Leblan D. Chantre P, Fournie B. loint Bone Spine 67(5):462-467 (2000)
.
~.~
Ther d",:,;.,i.-,.
(1977),;·~~j
.'.
.~·o~
63(2):171;':i~~
'.:'''~~A,
16(2):118-129 (1999)
-'~_!~-;
33. British Herbal Pharmacopoeia. British Herbal Medicine Association:"~ West Yorks, United Kingdom (1983) .- .. : ... ,0_
..
- - - - . -
34. Hansel R, Keller K, Rimpler H et al. In: Hagers Handbuchder,<,:.; Pharmazeutischen Praxis, 5th ed. vol. 5:384-390 Drogen E-p ,"Springer-Verlag. Berlin, Germany (1993),
35. Blumenthal M (ed). The Complete German CommisSion7E~ Monographs: Therapeutic Guide to Herbal Medicines. Americ~i:'::"'i~ Botanical Council, Austin. Texas (1998) '·---~.i 36. Hyde F. Herbal Practitioner's Guide to the Medicines Act 1968 ~c:1f <:~ic Herbal Practitioner 4(3) (1978).!;::~;t
.,
-"'- •.li:,. ..... ..£""'"
21. Baghdikian B. Guiraud-Dauriac H. Ollivier E et al. Planta Med 5(2):164-166 (1999) 22. Whitehouse LW, Znamirowska M. Paul 129(3):249-251 (1983)
q.
Can Med Assoc
37. Zimmermann W. 33 Dtsch KOI~gr fUr anti. Fortbildung, Ber!!n,~:-~:"' Germany (1984) [cited in Bisset NG (ed). Herbal Drugs _~~~.".~. Phytopharmaceuticals. English edn. Medpharm, Stuttgart. Germany:';,;" (1994), from 2nd Germanedn. Wicht! M (ed) (1989)]
.~ .~.:-.':.=-
~'-~~-~ .--~;
I
,
1-
Juniperus r~·
L~
..
;.~
Botanical name Juniperus communis L. Family Cupressaceae Pharmaceutical name Juniperi fructus Part dried ripe fruit English juniper German Wacholder Frenc..'t genevrier Mandarin J. communis L. is not used; du song shi (;f±.tk~) is the dried ripe fruit of J. rigida Sieb. et Zucco Use in the West The species used in the West is Juniperus communis, a small shrub growing in mountainous areas and sandy moors, widely distributed through the Northern hemisphere in Europe, North America, and northern Asia. 1 Its most famous commercial use is to flavor gin. In the 1st century AD, Dioscorides2 used Juniperus to increase urination and to treat stomach pains, bloating, coughs, and dysmenorrhea. Culpepex-3 had many uses for this herb, including poor appetite, weak digestion, flatulence, intestinal colic, cough, shortness of breath, edema, difficult urination, amenorrhea, facilitation of labor, gout, sciatica, weak vision, and poor memory. Many of these uses have continued up to the present day. For example, the BHP of 19834 listed Juniperus for digestive weakness, flatulent colic, acute or chronic cystitis (in the absence of renal inflammation), and rheumatic pain in the
terpenoid sabinyl acetate, needs to be distinguished from J. sabina (savin) and J. pfitzeriana, which do contain appreciable amounts of this chemical.5 Use in China The Chinese Herbal Medicine Dictionarl has an entry for du song shi (du song zi), the dried ripe fruit of J. rigida Sieb. et Zucco This herb grows on sunny mountain slopes in poor, dry, sandy soil in the northern provinces of China: Hebei, Henan, Shandong, Shanxi, Jiaxi, Gansu, and Inner Mongolia. The ripe fruit are harvested in October and then dried in the shade. The fruit of this plant are not mentioned in some traditional materia medica, and even the Dictionary of Chinese Herbal Medicine does not list the temperature or taste properties for this herb. It would seem that its use is mainly local in the North of China and that it has come into a small degree of recent use in other parts of China, probably due to the study of indications for J. communis in Western texts. Du song sm is mainly used to clear Wmd and eliminate Damp, and to treat arthritis and edema. According to Perry,7 the leaves of J. chinensis have been used in China interchangeably with Thuja orientalis.
What is special about Juniperus
joints or muscles.
In terms of Chinese medicine, Juniperus communis can be said to be slightly warm in temperature and aromatic, slightly sour, and slightly acrid in taste. It has its main effect on the Kidney-Bladder, Spleen, Intestines, Lung, and Liver systems.
Species used in the West In this chapter, the word Juniperus refers to J. communis, unless otherwise stated. J. communis, which is not known to contain the potentially toxic mono-
S13
Combining Western Herbs and Chinese Medicine
514
The key to understandingJuniperus is that it can act as a: • urinary antimicrobial and anti-inflammatory to treat recurring urinary disorders • diuretic to treat edema • warming and drying carminative to treat loss ofappetite or intestinal colic CHINESE ACTIONS In terms of Chinese medicine) Juniperus) as used in the West) can be said to have four main actions: I. II. III. IV.
clear Bladder Damp Heat drain Damp transform Damp and Phlegm relax Intestinal spasms
"":','""--~
~
I. clear Bladder Damp Heat
recurring urinary infections': ~7~, and inflammations
11. drain Damp
edema, oliguria
111. transform Damp and Phlegm
loss of appetite, weak or~ ~T;~ slow digestion, mental-:::~~;;_~ dullness, phlegmy cough "~cC<~
IV. relax Intestinal spasms
flatulence, colic
-
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DIRECTION OF ENERGY
.
.~~~
Juniperus does not have marked effect on the upward or outward movement of energy. When it act$ as a diuretic) it can be said) in Chinese terms) to have a downward draining
",.~-)
~~.~~[;):~.:.
effect.
• :-~ ...
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:
WESTERN ACTIONS The main Western actions of Juniperus are shown here in terms of its four main Chinese actions:
TYPICAL CASE EXAMPLE Range
patie~ts: I. clear Bladder Damp Heat
antimicrobial anti-inflammatory
11. drain Damp
diuretic
111. transform Damp and Phlegm
carminative anticatarrhal mental stimulant
IV. relax Intestinal spasms
carminative antispasmodic
Actions on the urinary system Juniperus can be described as a stimulant diuretic for edema and oliguria (also called hypouresis) and as a urinary antimicrobial and anti-inflammatory for cystitis and urethritis. Recent opinions regarding the past concern on the use of Juniperus in inflammatory kidney conditions are discussed in Toxicology. Carminative and anticatarrhal Juniperus has a long tradition of use as a warming carminative to stimulate and strengthen digestion and relax intestinal spasms. It has also been used as a warming anticatarrhal to clear phlegm from the digestive and respiratory systems) and from the head to 'strengthen the" brain arid the-memory' and to dispel melancholy.
_ The Western uses of Juniperus can be related to its four main Chinese actions:
.~
Juniperus can be used to treat two main typeso.f··:~7.;.
.
,.:~ii ~;'f·
• patients with Deficiency) Cold) Damp) and Phlegm) for~"i~-·--?'~_!I!'" example) edema and weak digestion .-' -~/'• patients with Deficiency) Damp, and Heat) for example) , cystitis These two types may overlap. Signs and symptoms This patient is of the first type, being _~:~ tired, lethargic, mentally dull) and slightly depressed. The patient has poor appetite) weak and slow digestion, recurring flatulence and colic) a tendency to chronic phlegmy cough, and repeated respiratory infections. The patient also has chronic edema and a recurring ache and weakness in the --: lower back. The abdomen and lower back feel cold and . damp. The pulse is empty and slippery, especially in the .'. ' Kidney, Spleen) and Lung positions. The tongue is pale and flabby with a moist white coat. Diagnosis The patient has Deficient Qi of the Kidney) Spleen, and Lung with accumulation of Damp and Phlegm,""_ ~, and Stagnation of Qi in the Spleen and Intestines. Choice of Juniperus Juniperus can help to warm and tonify the Qi of the Kidney, Spleen, and Lung) to drain Danip and tJ.:ansform Damp and Phlegm. This can reduce ederoa~
improve the digestion) energy) and mental cl.ari~; re~~;~~~1k, Lung Phlegm; and strengthen the Lung to reSIst infectlons,:~"'-: Juniperus can also relax intestinal spasms and reduce flatu~·.:' ' lence.
Juniperus
Limitations of Juniperus 1-"':'"
TEMPERATURE
.... t
In this book. Juniperus is classified as slightly warm and can be used for cool conditions. for example. it can act as a mildly warming herb to assist the Spleen in transforming Damp and Phlegm. However. for a cold condition. it may be necessary to combine it with Cinnamomum. Capsicum. or Zingiber. It can also be used for inflammations and infections of the respiratory or urinary systems. associated with mild patterns of Heat or Damp Heat. Rather like Capsicum. Juniperus may ultimately have a cooling effect in these situations because of its antimicrobial action and its ability to stimulate local circulation in the tissues. thereby reducing local inflammation. I do not regard Juniperus as a cooling herb. and for hot inflammatory conditions. it may be advisable to combine it with a cooling herb. such as Arctostaphylos.or Hydrastis.
TASTE Aromatic The primary taste property of Juniperus can be said to be aromatic. probably as a result of its aromatic monoterpenoids; however. see the discussion on taste in Traditional sources. The main aromatic property of Juniperus seems to be associated with assisting the Spleen in transforming Damp. In my experience. it is not as effective an aromatic antispasmodic as Rosmarinus or Lavandula in treating intestinal colic due to stress. Acrid Juniperus is classified in this book as slightly acrid in the sense of warming the Interior. However. to treat patterns of Cold. Juniperus would need to be combined with warmer herbs, such as Capsicum. ZingIber. or Zanthoxylum. Sour Juniperus is classified in this book as slightly sour It has a sour taste in the mouth, which, although of lesser strength. may be related to .an astringent property shared with Schisandra. Both herbs can have an effect on the mind by firming and tonifying Kidney Qi. Juniperus does not have the strongly puckering effect ill the mouth as does Potentilla, for example, and Juniperus is not generally used as an astringent for diarrhea or bleeding.
ACTIONS Urinary antimicrobial and anti-inflammatory Although Juniperus can be used for some cases of urinary inflammation or infection, associated in Chinese medicine terms with Damp Heat, it is essentially a warming herb. This can be
515
advantageous if the patient has a Cold Deficient Spleen, which has been damaged by colder urinary antiseptics, such as Hydrastis. However. if a stronger ant~microbial effect is required and especially if there are pronounced Heat signs, Juniperus may need to be combined with colder herbs such as Arctostaphylos. Baptisia. or Hydrastis. For a discussion of possible cautions on the use of Juniperus for urinary conditions, see Toxicology. Diuretic Juniperus can be used as a warming aromatic diuretic, which can also assist a Cold Deficient Spleen in transforming Damp, unlike, for example, the cold bitter diuretic Taraxacum. If a warm diuretic combination is appropriate. Juniperus can be combined with the warm aromatic diuretic Angelica archangelica. If a colder diuretic combination is required. Juniperus can be combined with cold Taraxacum, or Juniperus can be omitted from the combination. Carminative Juniperus can be used as a warming and drying herb to assist a Cold Deficient Spleen in tr~SfQ1:"ming Damp and Phlegm. It can be used as an aromati~ herb to improve the appetite and treat a weak and slow digestive system. However. for cold rather than cool conditions, 'it may need to be combined with hot herbs, such as Capsicum. To improve the appetite, it may need to be combined with herbs that are not only aromatic, but also bitter, such as Artemisia and Rosmarinus. Juniperus has a tradition of use to treat coughs and to disperse thick phlegm in the chest. However, for this purpose, Juniperus is best combined with herbs that have a more specific anticatarrhal and expectorant action, such as Angelica archangelica, or a more specific antitussive action, such as Prunus. Juniperus has a tradition of use of treating mental dullness. However. I would only use it for this purpose in combination with other herbs, such as Schisandra and Rosmarinus. Antispasmodic Juniperus can be used for flatulence and intestinal colic, especially in cases of Spleen Deficient Qi with Stagnation. Cold, and Damp. If the pain is severe, Juniperus would need to be combined with stronger antispasmodics, such as Lobelia. or if the stress is severe. it would need to be combined with stronger antispasmodic and tranquilizing carminatives, such as Lavandula, or :with sedatives. such as Valeriana or Humulus.
Juniperus paired with otherherbs Discussion of the limitations of each of the main actions of Juniperus can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Juniperus beyond its
---.-
._------
Combining Western Herbs and Chinese Medicine
516
Juniperus + Angelica archangelica
limitations. The basic unit of herb combination is the herb pair. Twelve pairings of Juniperus are briefly explained below.
Digestive weakness + bronchial catarrh Both herbs are diuretics, and both herbs can act as warm- •. "':" ing, drying, aromatic carminatives that can help a Deficient;.:.'~ , Cold Spleen transform Damp and Phlegm. Angelica also the bitter taste property, which can stimulate digestion and. .:~. ': treat poor appetite. Angelica is the stronger expectorant and' .~t:7 . anticatarrhal, and Juniperus is the stronger diuretic. "-' ~
has':;;:"..a
CAUTION
Before using any ofthe combinations below, it is important to be familiar with the cautions listed for each herb in the combination.
Juniperus + Schisandra
Mental dullness
Juniperus + Arctostaphylos
Recurring urinary infections and inflammations
Both herbs have a sour taste, although it is more marked in Schisandra, which may help to firm and tonify Kidney Qi, thus, firming the mind and treating poor concentration or scattered thinking. The aromatic property of Juniperus mar···? :. act as a cerebral stimulant to increase mental clarity aDd~ assist in the treatment of mild depression. - .......
Both herbs have antimicrobial action in urinary disorders. However, they complement each other in that Juniperus is a warming aromatic, which can help the Spleen transform Damp and Phlegm, whilst Arctostaphylos is a cooling, slightly bitter urinary antiseptic and astringent.
:_,.::~~.,
Juniperus + Turnera
Juniperus + Viola tricolor
Mental tiredness and dullness
Recurring urinary inflammations
Both Turnera and Juniperus are warm aromatic herbs with a tradition of use of strengthening the central nervous system. Therefore, they can be combined for mental tiredness, mental dullness, and mild depression, which would be associated in Chinese medicine terms with Kidney Deficient
Both herbs can have anti-inflammatory action on the urinary system, but the mucopolysaccharide content ofViola may moderate any potentially irritating effect of Juniperus on the urinary system epithelia. Viola may also support the diuretic action of Juniperus, although the diuretic action of Viola is under dispute.
QiandYang. Juniperus + Thuja
• "."::.-j'
Recurring respiratory and urinary infections
Juniperus + Petroselinum root
Edema Parsley root can combine with Juniperus either as a carminative for flatulent dyspepsia, as a diuretic for edema, or as a urinary antimicrobial for urinary infections.
Both herbs can be used for urinary infections and inflammations. Both herbs can be used for bronchial infections and catarrh, but Thuja is the stronger expectorant. Juniperus + Thymus
-;'.
Recurring respiratory infections + cough
Juniperus + Parietaria
Edema Parietaria can be combined with Juniperus for oliguria or edema, and for cystitis with dysuria. Parietaria can be used for urinary calculi, and Juniperus is also recommended by some older texts for urinary stones. Juniperus + Taraxacum
Juniperus and Thymus can be combined as antimicrobials to prevent and treat recurring respiratory infections. In Chinese medicine terms, they can combine to clear the Retained Pathogen associated with some patterns of recurring respiratory infections. Thymus also has antitussive, antispaS~ modic, and expectorant action, which can be supported by the actions of Juniperus to assist the Spleen in transforming Damp and Phlegm, and dispersing Lung Phlegm.
Edema .
.
-
Warm aromatic Juniperus and cold bitter Taraxacum can complement each other as diuretics for edema or oliguria. The herbs differ in that Juniperus is more for the Kidney-Bladder and Spleen, whilst Taraxacum is more for the Kidney-Bladder and Liver-Gallbladder.
Juniperus + Citrus
Phlegmy cough
.~
;:p:~;, .
.;.,).,
Both Juniperus and Citrus can move Stagnant Spleen Qi . and help the Spleen to transform Damp and Phlegm to treat poor appetite, flatulence, abdominal distension, and intesti- .~
Juniperus nal colic. These herbs can be combined for coughs associated with the accumulation of Lung Phlegm Damp, when the Spleen is not transforming Phlegm and the Lung is not dispersing it properly. Either the ripe peel of the dried bitter orange, C. aurantium, as used in the West, or chen pi, the peel of C. reticulata, as used in China. can be combined with Juniperus for phlegmy cough.
Juniperus + Mentha pulegium Intestinal colic
517
However, it is important that practitioners review the evidence for themselves. They can then either: • avoid the use of Juniperus for patients with a history of renal damage or renal inflammatory conditions • act with caution in prescribing this herb in these situations, using the screening, monitoring, and combining procedures suggested in the Cautions section of this chapter 1. Cystitis + recurring respiratory infection
Retained Pathogen + Bladder Damp Heat
Both herbs can act as warming aromatic carminatives to treat intestinal colic. Juniperus is more drying to reduce
r&:
b._
Damp and Phlegm, and Mentha is more antispasmodic and calming. Both these herbs have a tradition of use for amenorrhea resulting from cold and can be combined for that .purpose, although Mentha is more effective than Juniperus~
Juniperus combinations ",
H~~. /:.__ , .. Ratio }emperature Tas~ Juniperus Arctostaphylos Thymus Thuja Echinacea Hydrastis Zingiber
1
1 1 1 1 1
0.5
. 51. warm cool wal'lTH:ool wal'lTH:ool cool·. cool hot
aromatic,s!. acrid, 51. sour sour, bitter aromatic acrid, aromatic, bitter acrid, bitter, 51; sweet bitter acrid, aromatic
GENERAL
Six Juniperus combinations are discussed below:
This combination is used to:
1. cystitis + recurring respiratory infection
Retained Pathogen + Bladder Damp Heat
2. edema
Kidney Deficient Qi + Damp
3. digestive weakness + flatulence
Spleen Deficient Qi + Damp + Phlegm
4. phlegmy cough
Lung Phlegm Damp Spleen Deficient Qi
+
Spleen Deficient Qi Kidney Deficient Qi
+
5. mental dullness
6. intestinal colic
+ anxiety
• clear Retained Pathogen from the body, especially from the respiratory and urinary systems • clear Bladder Damp Heat • clear Wmd Heat and Lung Phlegm The overall temperature is more or less neutral to treat warm, neutral, or mixed conditions. Zingiber is an acrid herb to clear Wmd invasion from the surface and to help to disperse Interior Heat out to the surface. USE
• recurring urinary infections • recurring respiratory infection with urinary infection
Intestines Stagnant Qi + Intestines Qi Disturbance
CAUTION
Before using any ofthe combinations below, it is important to be familiar with the cautions listedfor each herb in the combination.
PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of water, three times per day. Alternatively, it can be taken as an infusion/decoction with Thymus added after the other herbs have been decocted for 15-20 minutes and the heat has been turned off.
traindicate Juniperus communis for inflammatory kidn:ey
This combination can be taken at the first signs of either respiratory or urina..., infection for up to 2 weeks. After that
disorders. Recent investigations have not found clear evidence to support these contraindications, and this· is dis-
time, a more tonic combination, one that does not include Arctostaphylos, can be used.
cussed in Toxicology. It may even be appropriate to use Juniperus communis for renal infectiOIis and inflammations, as indeed was done by some Eclectic practitioners.
Caution This combination should not be taken during pregnancy since it includes herbs that are contraindicated at that time.
In the past, there was a tendency in textbooks to con-
Combining Western Herbs and Chinese Medicine
518
~--··.----'7;
warm. Aromatic ,and acrid herbs combine to war~~J~'> ,. ~ stimulate the Spleen to dry Damp; aromatic and bitter herbs':;-"~r_ combine to stimulate appetite and digestion; aromatic, acrid, ~.;.y"
2. Edema
Kidney Deficient Qi + Damp
and bitter herbs combine to move Stagnation, Juniperus Parietaria Taraxacum Urtica Panax gin. Cinnamomum (twigs) Zingiber
1 1 1 1 1
0.5
neutral cook:old warm-cool 51. warm warm
aromatic, 51. acrid, sl. sour bitter bitter acrid sweet, sl. bitter acrid, sweet, aromatic
0.5
hot
acrid, aromatic
51. warm
GENERAL
This combination is for Damp accumulating in the lower Burner, associated with Stagnation of Qi in the Lower Burner and with Deficiency of Spleen and Kidney Qi and Yang. The combination is warm and can be used for cool conditions;'Aromatic, acrid, and bitter constituents contribute to the diuretic effect; sweet, bitter, aromatic, and acrid constituents contribute to the tonification of the Spleen; sweet and acrid constituents assist in the tonification of Kidney Qi and Yang. USE
• edema or oliguria with tiredness and maybe lower back weakness and pain PRACTICAL NOTES
3. Digestive weakness + flatulence
Spleen Deficient Qi + Damp + Phlegm
Juniperus Angelica arc. Artemisia abs. Gentiana Citrus (ripe peel) Zingiber
Ratio 1 1 1 1
0.5 0.5
_. -,
USE
• loss of appetite, weak digestion, slow digestion, tiredness .-4;; "": . wi; . and lethargy, maybe chronic sinus or bronchial phlegm .. •.,£, ~
PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of water, three times per day. It can be taken, with appropriate cautions, breaks, and modifications, for up
_J ...
\
-
.~.
to 1 month. 4. Phlegmy cough
Lung Phlegm Damp + Spleen Deficient Qi Herb
- Ratio . Temperature Taste
Juniperus Thymus Angelica arc. Marrubium Citrus (ripe peel) Zingiber
1 1 1 1 0.5 0.5
51. warm
aromatic, 51. acrid, 51. sour
warm-cool warm neutral warm hot
aromatic aromatic, bitter, acrid bitter' acrid, aromatic, bitter acrid, aromatic
GENERAL
This combination can:
This combination can be taken as 5 rnl of 1:5 tincture in quarter of a cup of water, three times per day. It can be taken, with appropriate cautions, breaks, and modifications, for up to 1 month.
Herb
, ,._
Temperature Tasteo·.;~ 51. warm warm warm-cool neutral-cool warm hot
,F:- ,
aromatic, 51. acrid, 51. sour aromatic, bitter, acrid aromatic, bitter bitter acrid, aromatic, bitter acrid, aromatic
• tonify Lung Qi to disperse Phlegm accumulating in the Lung • tonify Spleen Qi to transform Damp and Phlegm • clear Retained Pathogen from the Lung to reduce recurring respiratory infection The overall temperature is warm to treat cool or cold conditions. The aromatic herbs Juniperus, Thymus, Angelica, Citrus, and Zingiber together have a warming drying effect and can reduce both Damp and Phlegm. The bitter herb Marrubium tonifies the Spleen, and also acts as an expectorant to clear Phlegm from the Lung. USE
• chronic phlegmy cough. chronic nasal phlegm, tiredness, lethargy, weak digestion
GENERAL
This' combination is for conditions in which a Deficient, Cold Spleen is not properly transforming Fluids. This may result in digestive weakness associated with Stagnation of Qi in the Spleen and Intestines, and accumulation of Damp and Phlegm. The overall temperature of the combination is
PRACTICAL NOTES
This ~ombination can be taken as 5 ml of 1:5 tincture in .•:-' quarter of a cup of warm water, three times per day. It can be taken, with appropriate cautions, breaks, and modifications, for up to 1 month.
-
Juniperus 5. Mental dullness
GENERAL
Spleen Deficient Qi + Kidney Deficient Qi
This combination is for Intestines Stagnant Qi with Intestines Qi Disturbance. and is related to any combination of the following syndromes:
Herb
Ratio 1 1 1
Juniperus Schisandra Panax gin. Turnera Rosmarinus Zingiber Capsicum
1 1 1 5-20 drops
Temperature Taste 51. warm
aromatic,s!. acrid, 51. sour
warm 51. warm
sour sweet,s!. bitter
warm warm
bitter. aromatic, acrid aromatic, bitter, acrid
hot hot
acrid. aromatic acrid
GENERAL
• Cold • Heart Spirit Disturbance • Intestines Phlegm Damp lfthe Lavandula were replaced byViburnum, this combination could also be used for dysmenorrhea associated with cold and nervous tension. USE
This combination is for mental dullness associated with Spleen Deficient Qi and Yang, with Damp and Phlegm obstructing the mind. and with Kidney Deficient Qi and Yang. The overall temperature is warm for treating cool or cold conditions. The aromatic and acrid properties awaken the Spleen. dear Damp. Phlegm. and Cold. and dear the mind. The sour property firms Kidney Qi and firms the mind to treat scattered thinking with difficulty concentrating.
f
519
USE
• mental dullness. mental tiredness. poor concentration. scattered thinking. mild depression PRACTICAL NOTES
This combination can be taken as 5 rnl of 1:5 tincture in quarter of a cup of warm water. three times per day. Capsicum can be given in a separate bottle so that the requisite number of drops of Capsicum can, be added to each dose of the main medicine. The combination can be taken, with appropriate cautions. breaks, and modifications, for up to 1
• intestinal colic. flatulence. and abdominal distension • dysmenorrhea with chill and/or fearful nervous tension PRACTICAL NOTES
This combination is for acute or subacute conditions. and can be taken as 5 rnl of 1:5 tincture in quarter of a cup of warm water. three times per day. It can be taken, with appropriate cautions. breaks, and modifications. for up to 1 month. If the intestinal colic or dysmenorrhea is due to cold. the combination can be taken as a decoction or infusion. Lobelia and fresh Zingiber can be simmered very gently for 15 minutes. Then the heat turned off, the crushed Juniperus berries. crushed Foeniculum seeds,'and other herbs are added, and the mixture allowed to steep for 10 minutes. For acute cases, at least one cup of the combination should be drunk hot, three times per day. until the pain subsides.
COMPARISON OF THE SIX JUNIPERUS COMBINATIONS
month.
Caution This combination contains warming stimulant \ 1--
'-
herbs and is not appropriate for patients with mental restlessness. anxiety, insomnia. hyPertension. or signs of heat.
1. Cystitis + recurring respiratory infection
2. Edema
Retained Pathogen + Bladder Damp Heat
Kidney Deficient Qi + Damp
6. Intestinal colic + anxiety
Intestines Stagnant Qi + Intestines Qi Disturbance
Juniperus Arctostaphylos ~us
Thuja Juniperus Foenicuium Mentha pul. Lavandula Lobelia Zingiber
1 1 1 1
sl. warm
aromatic. sl. acrid. $1. sour
sl. warm
aromatic, 51. acrid
warm
aromatic
sl. warm
aromatic, bitter, 51. acrid
0.5 0.5
warm-cool
acrid acrid, aromatic
hot
Echinacea Hydrastis Zingiber
1 1 1 1 1 1 0.5
Juniperus Parietari~
Taraxacum
Urtlca Panax gin. . Cinnamomum (twigs) Zingiber
1 1 1 1 1
0.5 0.5
1. All the herbs in No. 1 except Zingiber can have strong antimicrobial action. Arctostaphylos and Juniperus are spe-
Combining Western Herbs and Chinese Medicine
520
cific for the urinary system, but Juniperus can also combine with Thymus, Thuja. and Echinacea to treat recurring respiratory infections as a result of Retained Pathogen. This combination is similar to Thymus: recurring respiratory infection except that Glechoma and Glycyrrhiza, present in that combination to assist expectoration of phlegm, have been replaced in this combination by the urinary antimicrobial and diuretic herbs Arctostaphylos and Juniperus.
2. Juniperus, Parietaria, and Taraxacum are primary diuretics, and Urtica can assist the diuretic effect. Panax and Cinnamomum, assisted by Zingiber, can tonify and warm the Kidney and Bladder to promote urination. This combination is similar to Convallaria: cardiac weakness + cardiac edema in that both combinations contain Juniperus, Parietaria, Taraxacum, and Zingiber. However, Convallaria: cardiac weakness + cardiac edema also contains Con.~~~,~ _S.~~~s, ~~.a:.e specific for cardiac edema, whilst this combination contains Urtica to drain Damp and dear Phlegm in the channels.
6. Intestinal colic + anxieti_~~
Deficient Spleen + Kidney Deficient Qi
Intestines Stagnant Qi + ·c:.'i"'~ Intestines Qi Disturbance .• 2;;;:,'"
Juniperus Schisandra Panax gin. Turnera Rosmarinus Zingiber Capsicum
Juniperus Foeniculum Mentha pul. Lavandula Lobelia Zingiber
1 1 1 1 1 1 5-20 drops
1 1 1 1 0.5 0.5
5. Juniperus, Turnera. Schisandra. and Panax combine to tonify and firm Kidney Qi. Juniperus, Rosmarinus, Capsicum!, ".;;.;r' and Zingiber combine to stimulate the Spleen and to tr~~ :~~. i_ form Damp and Phlegm. especially as it affects the mu;.~t~~_ " This combination differs from combinations No.3 and 4 iIi,;; ", that it include~ the mental" stimulants Schi~andri,opciilri;~:~,~ f Turnera, and Rosmarinus.
,_._ ;
- •.;::; ..." ;.;;4.. c
3. Digestive weakness +
4. Phlegmy cough
flatulence
Spleen Deficient Qi + Damp + Phlegm
Juniperus ',' Angelica arc. Artemisia abs. Gentiana Citrus (ripe peel) Zingiber
1 1 1 1 0.5 0.5
Lung Phlegm Damp + Spleen Deficient Qi
Th~us
Angelica arc. Marrubium Citrus (ripe peel) Zingiber
1 1 1 1 0.5 0.5
3. Juniperus and Angelica, assisted by Artemisia, combine as warm, drying aromatic herbs for loss of appetite with weak and slow digestion, tiredness, lethargy, and phlegmy cough. Artemisia and Gentiana are bitter herbs to stimulate the appetite. Citrus and Zingiber help the Spleen to transform Phlegm and treat phlegmy cough. 4. In this combination. Juniperus and Thymus combine as antimicrobial herbs to prevent and treat recurring respiratory infections, and Angelica and Marrubium combine as herbs that can tonify both the Spleen and Lungs to prevent and clear bronchial phlegm. As in, combination No.3, Citrus and Zingiber help the Spleen to tr.ansform Phlegm and treat phlegmy cough. However, the bitter' tonics Artemisia and Gentiana make combinati~n No.3 specific for digestive problems, whilst the expectorants'Marrubium and Thymus make combination No. 4 specific for respiratory problems.
i
_".:"~,~~f!-~~
6. Juniperus, Foeniculum, and ZingIber can combine as:>~~'i'!·· warming carminative herbs to move Stagnant Spleen and /!)~ ,:, Intestines Qi, and to relax intestinal spasms. Mentha and ~...,..,-_ Lavandula combine as calming antispasmodic herbs to treat the effect of nervous tension on intestinal spasms. Lobelia is specific for spasms of the smooth muscles, thereby relieving pain.
Juniperus
"
5. Mental dullness
OTHER JUNIPERUS COMBINATIONS Other combinations that contain Juniperus include:
• Angelica: depression + obesity • Angelica: sinusitis + obesity • Thuja: prostatitis + infection
Research CONSTITUENTS • essential oil • other Essential oil
Juniperus communis contains between 0.5-
2% essential oils, with up to 70 components, mainly monoterpenoids:8 • a- arid 13-pinene 16.5-80% (mainly a-pinene) • sabinene 0.2-50% .limonene 1-12% • terpinen-4-ol up to 5%
0,..-
r-
I \
Juniperus
'u.o,..;'
Some authors include myrcene, at approximately 120/0, as a major constituent.s There may be sesquiterpenes, such as 9 caryophyllene and cadinene, present only in trace amounts. other
....._I
L.
PHARMACOLOGICAL AND CLINICAL RESEARCH The following effects have been reported:
,
L
l~
f
I. ' -
was a significant diuretic effect. with the infusion producing the strongest response. 21 This might suggest that the most potent diuretic constituent of Juniperus is not in the essential oil fraction.
Juniperus berries may also contain:!
• up to 30% sugars (glucose and fructose) • catechol tannins 3-5% • flavonoids, and leucoanthocyanidins
r
521
• antimicrobial • anti-inflammatory • analgesic • diuretic • hypoglycemic • appetite stimulant Antimicrobial Terpinen-4-01 and a-pinene have both been shown to have antimicrobial effects against Staphylococcus aureus, S. epidermidis, and Propionibacterium, and are thus of use in acne due to these bacteria. 10 Terpinen4-01 has been shown effective against trypanosomes." Its antiseptic effect has been reported to be associated with increased white blood cell activation.U but this is probably only a partial explanation of its antimicrobial mechanism. Anti-inflammatory The anti-inflammatory activity demonstrated for a-pinene has been reported to require the integrity of the adrenal glands. 13 Animal experiments have shown that terpinen-4-01 may be a valuable antiulcer agent and that secretion of gastric acid was lowered by this chemical. 14 Analgesic Reports have indicated that ~-myrcene can have analgesic effects.15, 16.17 However, it has been suggested that ~ myrcene does not exert its analgesic effect by an anxiolytic activity on the central nervous system,16 but via a peripheral mechanism different from that of the aspirin-like drugs. Ii Diuretic A study in 1957 showed that subcutaneous injection into rats of either Juniperus communis oil or terpinen4-01 isolated from the oil produced diuresis with increased amounts of potassium, sodium, and chloride ions. IS Oral administration of aqueous infusion of Juniperus to rats increased chloride excretion in rats, 19 rabbits, and mice,2° increasing urinary output by 38% in mice.20 A study in 1998 showed that Juniperus infusion, Juniperus essential oil, and terpinen-4-01 all produced an initial antidiuretic effect. However, on repeated doses, there
Hypoglycemic Dried berries of J. communis were demonstrated to retard the development of streptozotocin-induced diabetes in mice. 22 In addition, the administration of Juniperus decoction was observed to reduce blood glucose levels and the mortality inde:{C in streptozotocin-induced diabetic rats, and to prevent loss of body weight.23 Appetite stimulant In veterinary medicine, Juniperus has been reported to stimulate feeding. 24 Choloretic and hepatoprotective It was reported that feeding rats a diet containing Juniperus oil improved rates of bile flow. Juniperus oil also reduced reperfusion injury by improving the hepatic microcirculation in livers undergoing oxidant stress.25
RESEARCH VERIFICATION OF TRADITIONAL ACTIONS· The following traditional actions are supported by research on Juniperus or its isolated constituents: antimicrobial, anti-inflammatory, diuretic. and appetite stimulant. Additional effects demonstrated by research The following additional effects have been demonstrated: analgesic effects due to ~-myrcene and hypoglycemic effects with Juniperus.
TOXICOLOGY An important distinction A careful distinction needs to be made between the use of: • therapeutic doses of Juniperus as an infusion, decoction, or tincture • Juniperus essential oil • isolated components ofJuniperus, such as a-pinene, ~-myrcene,and terpen-4-01 The debate J. communis hasoften been contraindicated in textbooks for two main conditions:26.27,28,29.30 • renal disease • pregnancy Christopher said that Juniperus should not be used in acute inflamed renal conditions unless it is combined with demulcent herbs.31 However, studies have been performed to check the validity of these contraindications,32.33 and especially for the essential oil, the validity of these contraindica-
522
Combining Western Herbs and Chinese Medicine
tions has been challenged. Some of the adverse effects reported for J. communis berries in the past are thought to be due to: • use of parts other than berries • misidentification • contamination
long-term administration of terpen-4-01 in mice was.r~P9~f ed to cause no pathological changes.41:':~.::~;:;: ..
Summary Whether or not tinctures or aqueous extracts of,".,;~. the ripe berries of J. communis can cause ren'al irritati().~~.::;;';:::·, when taken in therapeutic doses, it appears that the essential.".~:~..."..... oil and its isolateci constituents do not. If tincture or aqueous .
Use ofplant parts other than the berries Two pregnant cows
extracts do cause renal irritation, it must be via a constituent
fed huge doses of ground dried leaves of J. communis (approximately 5 kg per day) aborted after 8 and 10 days. This was thought to be due to isocupressic acid, which constitutes 2% of dried Juniperus leaves.34 Isocupressic acid is not listed as a constituent of the berries of J. communis. l •s
not present in the essential oil. Whilst a renal irritant effect
Misidentification J. communis must be carefully distinguish-
Pregnancy and reproductive capacity
ed from J. sabina (savin) or J. fitzeriana. This is because 2053% of the essential oil fraction of J. sabina and 2-17% of the essential oil fraction of J. pfitzeriana consists of the potentially toxic compound sabinyl acetate.2 This che~cal has not been reported for J. communis. Some authors believe that misidentification of J. sabina for J. communis has led to the mistaken belief that the essential oil of J. communis is toxic and abortifacient.s The essential oil of J. sabina has been reported to have an embryotoxic effect in rodents.3s Sabinyl acetate as an isolated chemical apparently can be embryotoxic, fetotoxic, teratogenic, and abortifacient3s.36.37.38
Use ofthe infusion or tincture Ethanolic and acetone extracts of berries of J. communis have shown antifertility effects in rats,42.43 and an ethanolic extract showed abortifacient activ-
for Juniperus berries does not yet appear to be clearly demonstrated by primary sources, it might be prudent to avoid their use in cases of renal irritation until further data is available.
ity in rats~42
Use of the essential oil Tisserand and Balacs stated that there is no evidence that the essential oil is responsible for the adverse effects reported for the aqueous and acetone extracts. If there are potentially toxic chemicals in the berries, these would appear to be in fractions other than the essential oil. According to Tisserand and Balacs, all the major components of}. communis essential oil are apparently non-
Contamination Some authors have suggested that some of
toxic at therapeutic doses of the essential oil.
the earlier adverse effects reported may have been related to contamination of the samples ofJuniperus with turpentine. I ,39
Use of isolated essential oil components
~-myrcene
did not"··,~·· '.~
Renal disease
show peri- or postnatal development toxicity in rats up to 250 mg/kg body weight,4-I which Tisserand and Balacs point-
Use ofthe infusion or tincture Whilst Juniperus berries have
ed out is equivalent to a human dose of 135 g of Juniperus
been suspected of causing renal irritation,40 this does not yet appear to be clearly demonstrated by primary sources.
Use of the essential oil No adverse renal effects were shown in a 1997 animal study, and the authors suggested that there was no foundation to statements that J. communis essential oil can c;ause renal irritation, providing that high quality essential oil from ripe berries is used. 33 Other authors stated that no evidence could be found to support the contraindication of therapeutic oral dosages of the essential oil of J. communis in renal disease. s
oil. ~-Myrcene did not show toxic effects on fertility in male or female rats, or on general reproductive performance up to 300 mglkg.45
The ingredient with apparent abortifacient action, present in the ethanolic extract of Juniperus but not in the essential oil, is as yet unknown.
Summary Therefore, whilst there seems to be no evidence to support contraindicating the essential oil in pregnancy, it would be wise to contraindicate the infusion and tincture until more is known of the identity of the abortifacients and
Use of isolated essential oil components According to Tis-
especially the amount of these chemicals required to pro- .
serand and Balacs, the essential oil of J. communis does not contain any chemicals that would seem to give cause for concern. Forexainple, these authors stated that the level of apinene in the esSential oil of J. communis should not be cause for concern. It requires extremely large amounts of a-pinene to produce adverse effects such as kidney damage, bronchitis, and central nervous system depression. Also,
duce adverse effects. LD 50
LD so aqueous extract Administered by intraperitoneal:~ injection in mice, the LD so of a lyophilized aqueous extract of J. communis berries was 3 glkg body weight,46 which is equivalent to 180 g for a 60 kg human.
,,'
Juniperus
523.
LD so of essential oil Oral administration of J. communis
Interactions
essential oil to rats gave an LD so of 6.28 glkg,47 which is equivalent to about 375 g for a 60 kg human.
SCREENING
LDso of isolated essential oil components The LD so of terpinen-4-ol was 0.75 mlIkg in mice by subcutaneous injection, and 0.78 mllkg by intramuscular injection, and the LD so in rats following intramuscular injection was 1.5 1
mllkg: The acute oral toxicity of ~-myrcene was reported as low in rodents, and an approximate lethal oral dose (ALD) was reported as 5.06 glkg body weight for mice and over 11.39 glkg for rats. For a 60 kg human, this is equivalent to 300 g and 683 g of ~-myrcene, respectively.-13
No adverse reports.
Before prescribing Juniperus, it should be determined whether the patient: • has ever had a renal inflammatory condition • is pregnant
TREATMENT PRECAUTIONS The following precautions can be taken during treatment: • avoid the use of Juniperus in pregnancy or in clear cases of renal irritation
Dose
iL
Dried herbs Different texts give a range of dose recommendations for the infusion. Christopher gave a daily dose of about 30 g of crushed Juniperus to 500 ml of water (about 1 ounce to 1 pint water), and recommended about 200 ml, three times per day. The BHP ~ted an infusion made with the equivalent of 15 g of berries i.D. 300 ml of water, taken in three doses of 100 ml per day. The monograph on Juniperus in Wichtl recommended 2 g of crushed berries to 150 ml of water. I consider this dose rather low. Tincture The BHP listed 1-2 ml of 1:5 tincture in 45% alcohol, three times per day. Initial dose Can start at the standard dose, providing that cautions are observed. '
\=-
Duration Can be used up to 1 month, providing that cautions are observed.
Cautions These cautions apply to the infusion and the tincture. Western contraindications the discussion in Toxicology.
Renal inflammation, but see
• use Juniperus within the recommended dose range and initially at a lower dosag~ if there is any possibility of renal inflammation, even though signS of this are lacking . • use Juniperus for no longer than 1 month • never use Juniperus as a single herb, but. where appropriate, combine it with urinary demulcent herbs likely to moderate any possible irritant effect, such as Agropyron, Althaea, or Zea
MONITORING During the course of a herbal treatment that includes Juniperus, the patient should be monitored for any signs or symptoms of renal irritation.
Regulatory status ' Please read the Regulatory status section in the chapter on Safety. Juniperus (juniper) is on the UK General Sale List. and it is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Juniperus is not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
Chinese contraindications None reported.
Pregnancy and lactation See the discussion in Toxicology. Side effects ·possibl~ aggraktion ~ cases of renai inflammation, but see the disCussion in Toxicology.
I:=..
Overdose No adverse reports.
Traditional sources PROPERTIES The temperature and taste values discussed below relate to J. communis as used in the West. No temperature or taste
524
Combining Western Herbs and Chinese Medicine
properties are listed for J. rigida (dil sOng shi) in the Chinese Herbal Medicine Dictionary, suggesting that this herb has not had a long tradition of use in Chinese medicine. Temperature According to Dioscorides,49 Juniperus is slightly warming. Hildegard von Bingen50 wrote that Juniperus is more hot than cold, and Lonicerus51 descnbed Juniperus as warm and dry in the third degree. Gerard5z and Tabemaemontanus 53 both quoted Galen as writing that Juniperus is warm and dry in the third degree, and that the berries are also hot, but not altogether as dry. Culpepe~ wrote that the berries are hot in the third degree and dry in the first. Juniperus is classified in this book as slightly warm. Taste
Taste in the mouth Dioscorides said that the berries are sweet and slightly bitter, with an astringent property. Loniceros d~cnbed Juniperus as astringent The BHP wrote that Juniperus has a sweet taste and aromatic odor, and Wichtl described the berries as sweet, aromatic, and spicy in taste. In my own tastings, I found the dried berries to be sweet, sour, aromatic, slightly bitter, slightly acrid, and slightly salty. To me, Juniperus resembles the fruit of Schisandra chinensis (Wli wei zi), which also has all the flavors, but Schisandra is more sour and less aromatic. The aromatic taste of Juniper may relate to the essential oils, the sweet taste to its high sugar content, and the sour taste to the catechol tannins.
Taste properties Juniperus is classified in this book as aromatic, and slightly acrid. It is also classified as slightly sour, and, like Schisandra, it may have an astringent effect on Kidney Qi in that it can be used to firm the mind and treat poor concentration and mental dullness. ORGANS In terms of Chinese medicine, J. communis, as used in the West, is associated mainly with disorders of the following organs:
Kidney-Bladder
increases urination, dysuria, urinary stones cystitis
Dioscorides
Spleen
strengthens the stomach increases appetite
CUlpeper Christopher
Intestines
bloating and colic flatulent colic
Dioscorides
cough cough, shortness of breath. consumption
Dioscorides Culpeper
Lung
Culpeper
BHP
ACTIONS ~,.
~
._-_.~-
..•.• ~ .~.!' ~ :;,;,~,;,:~.p,",
Evidence from the traditional sources for the following- ."_.~. actions of Juniperus are discussed below: • antimicrobial • anti-inflammatory • diuretic • carminative • antitussive and anticatarrhal • mental stimulant • other Antimicrobial Lonicerus wrote that Juniperus or the smoke from burned Juniperus wood could cleanse evil air. Tabernaemontanus wrote that the berries can be chewed in times of plague to withstand the poisonous air. Gerard said that the smoke of the leaves and wood drives away infections and corruption of the air that bring the plague and conta-,.-, gious diseases. According to both .K1oss55 and Christopher,:,:_,~~"; Juniperus is excellent as a spray or fumigation for a room in which there has been a patient with an infectious disease. Christopher also recommended chewing Juniperus or gargling with a strong infusion to "immunize" oneself agaUisi infection. Gerard reported the use of water in which Juniperus had been steeped as a regular drink to promote constant good health. Weiss56 recommended concentrated Juniperus juice ~. as a tonic for children, especially if they are prone to colds and sore throats. Both the BHP and Mills and Bone listed Juniperus as a --I'""?'!t!t urinary antiseptic. In addition, both a-pinene and terpinen4-01 have shown antimicrobial action. Anti-inflammatory Ellingwood57 recommended Juniperus for chronic cystitis, pyelitis and pyelonephritis, and wrote that it can quickly relieve renal hyperemia, preventing the development of structural change or the advancement of nephritis. He reported that after acute nephritis, due to direct causes or following such severe diseases as scarlet fever or diphtheria, when the active inflammation has subsided, the use of this herb will normalize renal secretion. Felter and LloydS3 recommended Juniperus for chronic cystitis and for pyelitis and pyelonephritis, especially in old people. The BHP gave the specific indication of Juniperus as cystitis in the absence of renal inflammation. Culpeper and Tabemaemontanus both listed Juniperus for urinary stones. Diuretic Dioscorides, Culpeper, and Gerard listed Juniperus as a diuretic for edema. Ellingwood recommended . . . ,.". Juniperus as a diuretic and as a soothing kidney remedy'for feeble or aged patients with a persistent sensation of drag:" . ging or weight across the kidneys. An infusion of Juniperus :."" '~.,
.~,; ~~>t,:
..".."
IJ \
Juniperus and watermelon seeds 1:1 has been reported to cure ascites in children. 58 The BHP, Bruneton, and Wichtl reported the traditional use of Juniperus as a diuretic in Britain, France,
Carminative
Antirheumatic Lonicerus recommended Juniperus sim-
Warming and drying herb for Damp and Phlegm Tabernae-
mered in wine for sciatica or loin aches; Tabernaemontanus for sciatica; Culpeper for gout and sciatica; and Kloss for gout, sciatica and, rheumatism. Christopher recommended Juniperus combined with gravel root (Eupatorium purpureum) for gout, rheumatism, and backache; Weiss listed it for chronic arthritis or gout, and the BHP listed the topical use of Juniperus for rheumatic pain in joints or muscles.
Improves appetite and digestion Dioscorides wrote that Juniperus is good for the stomach, Lonicerus said that it warms the stomach, and Culpeper said that it strengthens the stomach. Christopher sai~ that it increases the appetite arid aids digestion, the BHP and Wichtllisted it as a carminative, and Bruneton recorded its traditional use in France of stimulating the appe.tite.
Reduces intestinal spas'ms Dioscorides, Lonicerus, Taberna-
.. -~
,
.,.~
t.
Hepatic Gerard and Tabernaemontanus quoted Galen as saying that Juniperus cleanses the liver and kidneys. Grieve listed it as a diuretic for cardiac or hepatic edema.
humors.
j
Felter and Lloyd listed it for leukorrhea and gonorrhea.
and Germany.
montanus quoted Galen as writing that Juniperus is warming and drying, and can disperse thick, cold, and viscous phlegm. Gerard wrote that it can thin clammy and gross
i.
525
montanus, Culpeper, Gerard, and Grieve listed Juniperus for flatulence, abdominal distension, and intestinal colic. Antitussive and anticatarrhal Dioscorides and Lonicerus recommended Juniperus for cough, and Tabernaemontanus listed it as an expectorant for phlegm in the chest and for children with shortness of breath, heavy breathing, and occasional hemoptysis. Culpeper recommended this herb for cough, shortness of breath, and consumption, and Gerard gave it for childrens' coughs with tough phlegm and some blood. Kloss appears to be quoting Culpeper since he listed Juniperus for 'cough, shortness of breath, and consumption. Christopher gave this herb for chest problems. Mental stimulant Culpeper said that Juniper 'strengthens the brain, helps the memory and fortifies the sight by strengthening the optic nerves: Kloss paraphrased Culpeper, when he wrote that Juniperus strengthens the brain, nerves, and vision, and Christopher used similar phrasing when he listed it to 'strengthen the brain, memory and optic nerve: Kloss combined Juniperus and Ruta (l: 1) for any kind of head problem, and he recommended Juniperus, Acorus calamus, and Zanthoxylum (l: 1: 1) for palsy. (Please note that there may be restrictions on the use ofAcorus in some countries.) Other
Emmenagogue Dioicorides recommended Juniperus for uterine pain, Tabemaemolltanus listed it to expel a stillbirth, and Culpeper recommended it to assist a safe and speedy delivery to pregnant women. Christopher gave an infusion of Juniperus for amenorrhea from cold and exposure, and
COMPARISON OF WESTERN AND CHINESE USE OF JUNIPERUS Whilst the berries of J. communis have had a tradition of common use in the West for about 2000 years; J. rigida (dil song sm') has not been used much in Chinese medicine. No data on temperature, taste, or meridians is given in the Chinese Herbal Medicine Dictionary, and the small quantity of information on actions and uses appears to follow Western tradition, rather than an independently developed Chinese medical tradition. J. rigida is listed in the Chinese Herbal Medicine Dictionary mainly to clear Wmd and drain Damp to treat rheumatism and edema.
References 1. Bruneton J. Pharmacognosy: Phytochemistry Medicinal Plants, 2nd
edn. Lavoisier, Paris, France (1999) 2. Dioscorides P. Kreutterbuch (1610). Reprinted by Verlag Konrad Kolbl, Miinchen, Germany (1960) 3. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks, Glenwood,l\linois (1990) 4. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983) 5. TJSSerand R, Balacs T. Essential Oil Safety A Guide for Health Care Professionals. Churchill Livingstone, Edinburgh, United Kingdom (1995) 6. fIangsu New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science and Technology Press, Shanghai, China (19i5)
7. Perry LM. Medicinal Plants of East and Southeast Asia. The MIT Press. Cambridge, United Kingdom (1980) 8. Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm, Stuttgart Germany (1994), from 2nd German edn Wichd M (ed) (1989) 9. Leung AY, Foster S. Juniper berries. In: Encyclopedia of common natural ingredients used in food, drugs and cosmetics. 2nd ed. John Wiley, New York, New York pp 325-327 (1996)
Combining Western Herbs and Chinese Medicine
526
10. Raman A. Weir U. Bloomfield SF. Lett Appl Microbiol 21(4):242-245 (1995)
.35. PagesNetal.PlantaMedica55:144-146 (1989)
_ ••.
37. Pages Net al. Phytotherapy Research 6(2):80-83
12. Budhiraja SS, Cullum ME, Sioutis SS et al. J Manipulative Physiol Ther 22(7):447-453 (1999)
39. European Scientific Cooperative on Phytotherapy: Monographs on
14. Matsunaga T, Hawegata C, Kawasuji T et al. Bioi Pharm Bull 23(5):595598 (2000)
;,~.j.~
36. Pages N et aL Journal of Ethnopharmacology 27(3):94-96 (1989)
11. Mikus J, Harkenthal M, Steverding D et al. Planta Med 66(4):366-368 (2000)
13. Martin S. Padilla E,Ocete MAetal.Planta Med 59(6):533-536 (1993)
..
---'~'-"-'-"''''''''-'-.'--~
38. Pages N et al. Planta Medica 54:296-298 ( 1 9 8 8 ) _ . -- -.. __.. .. -,...
the'.. ccc:_
medicinal uses of plant drugs (monograph on Juniperus fu;.~tusj.c·c';~ European Scientific Cooperative on Phytotherapy, Exeter. United Kingdom (1997) 40. Czygan F-C. Z Phytotherapie8:10 (1987)
15. Rao VS, Menezes Am, Viana GS. J Pharm PharmacoI42(12):8n-878 (1990)
41. Janku I, Hava M, Kraus R. Arch Exp Path Pharmakol 238:112-113
16. da-Silva VA, de-Freitas JC. Mattos AP et al. Braz J Med Bioi Res 24(8):827-831 (1991)
42. Agrawal OP et al. Planta Medica 39:98-101 (1980)
17. Lorenzetti BB, Souza GE, Sarti SJ et al. I EthnopharmacoI34(l):43-48 (1991) 18. Janku I. Hava M. Motl O. Experientia 13:255-256 (1957)
(1960)
43. Prakash AO et al. Acta Europaea Fertilitatis 16(6):441-448 (1985) 44. Delgado IF, Nogueira AC, Souza CA et al. Food Chern Toxicol 31(9): 623-628 (1993)
19. Vollmer H, Hubner K. Naunyn-Schmiedebergs Arch Exp Path PharmakoI186:592-605 (1937)
45. PaumgarttenF}. De-Carva1ho RR. Souza CA et al. Braz JMed BioI Res
20. Vollmer H, Weidlich..R. Naunyn-Schmiedebergs Arch Exp Path PharmakoI186:574-583 (1937)
46. Lasheras B, Turillas P, Cenarruzabei.tia E. Planta M~~ ~~yt~~e~ 20:219-226 (1986)
21. Stanic G. Samarzija I. B1azevik N. Phytotherapy Research 12: 494-497 (1998)
47. von SkrarnlikE.Pharmazie 14:435-445 (1959)
22. Swanston-Flatt SK. Day C, Bailey CJ et al. Diabetologia 33(8):462-464 (1990)
31(7):955-965 (1998)
48. Paumagartten FJ. Delgado IF, Alves EN et al. Braz J Med Bioi Res
23(9):873-8n (1990)
F, Gamez MJ, funenez I et al. Planta Med 60(3):
49. Dioscorides P. Kreutterbuch (1610). Reprinted byVerlag Konrad KoIbL
24. Hager. vo1.5.p 333 (1976); vol 5.p 571 (1993) [cited in BissetNG(ed).
SO. Von Bingen H. Hildegard von Bingen's Physica. Healing Arts, Roch-
23. Sanchez de Medina 197-200 (1994)
Herbal Drugs and Phytopharmaceutica\s. English edn. Medpharm. Stuttgart. Germany (1994). from 2nd German edn. Wicht! M (ed) (1989») 25. lones SM, Zhong Z, Enomoto N. et al. Hepatology 28(4):1042-1050 (1998) 26. List PH, Herhammer L. Hager's Handbuch der Pharmazeutischen Praxis, vols. 2-6. Springer.Verlag. Berlin, Germany (1976)
MUnchen, Germany (1960)
ester.Vermont (1998) 51. Lonicerus A. Kreuterbuch (1679). Reprinted by Verlag Konrad Kolbl. MUnchen. Germany (1962) 52. Gerard J. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas lohnson. Dover Publications, New York, New York (1975) 53. Tabernaemontanus JT. Krauterbuch (1731). Reprinted by Verlag
27. De Smet PAGM, Keller K, Hansel R et al. Adverse Effects of Herbal Drugs, vol. 2. Sprinter-Verlag. Heidelberg, Germany (1992) 28. Chandler RF. Canadian Pharmaceutical Journal 119:563-566 (1986)
Konrad Kelbl. MUnchen, Germany (1993) 54. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks, Glenwood. Illinois (1990)
29. Duke J A. Handbook of Medicinal Herbs. CRC Press, Boca Raton. Florida (1985) 30. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983) 31. Christopher JR. School of Natural Healing. BiWorld, Provo, Utah (1976)
55. Kloss
J. Back to Eden, 5th edn (1939). Lifeline Books, Santa Barbara,
California (1975) 56. Weiss RF. Herbal Medicine, English edn. Beaconsfield Publishers, Beaconsfield, United Kingdom (1988) 57. Ellingwood F. American Materia Medica, Therapeutics and Pharma-
32. Schilcher H. Hell BM. Z Phytotherapie 15:205-213 (1994)
cognosy. 11th edn (1919). Reprinted by Eclectic Medical Publications.
33. Schilcher H, Leuschner F. Arzneimittel-Forschung 47(7):855-858 (1997)
Sandy, Oregon (1994)
34. Gardner DR, Panter KE, James LF. Vet Hum Toxicol 40(5):260-263 (1998)
58. Felter HW, Lloyd JU. King's American Dispensatory, vols. 1 and 2, 18th edn (1898). Reprinted by Eclectic Medical Publications, Sandy. Oregon (1983)
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Botanical name Lavandula angustifolia Mill. subsp. angustifolia (1. officinalis Chaix. =1. vera DC) Family Lamiaceae (Labiatae) Pharmaceutical name Lavandulae flos Part dried flowers English lavender German Lavendel French lavande Mandarin Lavandula species are not used
andula oil is now much used in aromatherapy. For example, the oil of 1. vera can be used for insomnia, palpitations, cardiac arrhythmia, and tachycardia.s
Use in North America According to Grieve, the Pilgrim / Fathers took Lavandula with them to their new home in America, but its medicinal use has been less widespread in the United States than Europe. It is not mentioned by the American authors Ellingwood,6 Christopher,7 or Tierra,8 and has only a brief mention in Felter and Lloyd,9 and in Kloss. IO
Use in the West Lavandula is an aromatic shrub native to the low mountains of the Mediterranean region. It is grown in this area on a large scale, and the flowers are imported from France, Spain, Bulgaria, and former Yugoslavia.
Lavandula species used Three main groups of Lavandula are used in herbal medicine and perfumery as sources of the flowers and the essential oil: II • Lavandula angustifolia Mill. subsp. angustifolia (Lofficinalis Chaix =1. vera DC.), sometimes known as true lavender
Use in Europe According to Grieve, I Lavandula was used
=
by the Romans as a perfume for the bath and was used medi. cinally in Europe in the Middle Ages. Culpeper listed it for weakness of the stomach, intestinal colic, obstructions of the liver, reduced urination, headache, palpitations, faintness, giddiness, palsy, convulsions, and aploplexy. Most of these uses have been continued to the present day, and it has remained one of the most important and widely used aromatic herbs. Lavandula has current traditional use in Britain for headache, intestinal colic, and depression. 3 In Germany it has traditional use as a calming herb for nervous excitement, nervous exhaustion, and insomnia; and is also employed as a carminative, antispasmodic, cholagogue, anddiuretic.~ Lav-
• Lavandula spica DC. (1.latifolia Medik.), known as spike lavender or broad-leaved lavender • the lavandins, which are hybrids of the two species above, for example, 1. x intermedia Emeric ex Loisel (1. hybrida Reverchon ex Briq.) According to Bruneton,lI Lavandula stoechas 1. is no longer used. Use in China Lavandula is more used in the West than in the Orient, and it is not listed in either Perryl2.or the Chinese
Herbal Medicine Dictionary.13
527
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What is specialabO::::;; Herbs ::=e::::~ h~~n h~;a
528
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digestive disorders linked to depression.)
In terms of Chinese medicine. Lavandula angustifolia can be said to be slightly warm in temperature. and aromatic, bitter. and slightly acrid in taste properties. It can be said to have its main effect on the Heart. Liver, and Intestines.
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WESTERN USES
The key to understanding Lavandula is that it can: • calm Heart Spirit Disturbance to treat insomnia, anxiety. and palpitations • calm Liver Hyperactive Yang to treat nervous tension, headache, and migraine • calm Heart, Liver, and Intestines to treat abdominal discomfort with intestinal spasms from nervous tension These primary actions are complemented by the secondary action of Lavandula to move Heart Stagnant Qi and Liver Stagnant Qi to assist in the treatment ofdepression. CHINESE ACTIONS
anxiety, insomnia. palpitations, asthma
II. calm Liver Hyperactive Yang
headache with nervous tension
III. calm Intestines Qi Disturbance
intestinal colic, irritable bowel syndrome
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IV. move Heart Stagnant Qi and Liver Stagnant Qi
indigestion, depression: ':-{~;'~, anxiety-depression. bi"~' ,"" polar disorder
Asthma The use of Lavandula as a calming herb for rest-~: lessness. insomnia. palpitations. and cardiac arrhythmias-.l"-L"'?'· ... associated with anxiety is well known. This herb can also bejti~ used for cases of asthma involving anxiety and nervous terii.f~~~ } sion (Heart Spirit Disturbance in terms of Chinesemedf:~~"L."" ~~. ,~~ ~.:':'::.'_":':~:,f-'
In terms of Chinese'medicine, Lavandula, as used in the West. can be said to have four main actions: 1. II. III. Iv.
I. calm Heart Spirit Disturbance
calm Heart Spirit Disturbance calm Liver Hyperactive Yang calm Intestines Qi Disturbance move Heart Stagnant Qi and Liver Stagnant Qi
WESTERN ACTIONS The main Western actions of Lavandula are shown here in terms of its four main Chinese actions:
Headache and migraine
Lavandula can be used for headache,'}l:'
associated with:
'"~ ...
,-
• Liver Hyperactive Yang + Wind Cold and/or . Interior Cold • Liver Hyperactive Yang + Liver Stagnant Qi • Liver Hyperactive Yang + Heart Spirit Disturbance
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Because this herb is somewhat warming. it may not be appropriate for headache with signs of heat. I. calm Heart Spirit Disturbance
tranquilizer
II. calm Liver Hyperactive Yang
tranquilizer
III. calm Intestines Qi Disturbance
tranquilizer antispasmodic carminative
IV. move Heart Stagnant Qi and Liver Stagnant Qi
antidepressant mild circulatory stimulant
Tranquilizer The calming action of Lavandula may have its effect on the Heart. Liver or Intestines. depending on the needs of the patient. Antispasmodic ' The antispasmodic action of Lavandula on the intestines may be linked to the tranquilizing effect on the central nervous system and to the anti-inflammatory action. which has been demonstrated by research.
Initable bowel syndrome Lavandula is an excellent herb for this disorders. since it can reduce the effect on the In~--'-'" testines of Liver Hyperactive Yang. Liver Stagnant Qi, or Heart Spirit Disturbance. It also appears to have a direct ,'.T'"' ". , antispasmodic effect on the intestines. Bipolar disorder Lavandula is a useful herb in the treat--, ment of bipolar disorders because it can have both calming.c ~c_ and antidepressant effects. For the same reason. it can,1:>~~~ used for depression with insomnia or anxiety. ;'1:"",,--
DIRECTION OF ENERGY
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Lavandula has a calming effect on the disturbed move,': ment of Heart Spirit and a controlling effect on the upWaJ:~'~t movement of Liver Hyperactive Yang. However, it also has :1~"
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Lavandula
--
mild moving effect on Stagnant Heart and Liver Qi, although this movement does not have a strong outward component.
marinus. Lavandula can also have a mild effect as an acrid herb to warm the Interior.
Interior rather than Exterior effect Like Rosmarinus, but unlike Salvia officinalis, Lavandula has more an effect on the Interior of the body, when it is taken internally.
ACTIONS
Combination of moving and tranquilizer actions Both Lavandula and Rosmarinus have the capacity to move and spread Stagnant Qi, and the capacity to calm disturbed Qi. However, whilst Rosmarinus is relatively Yang and stimulating, Lavandula is relatively Y'm and calming.
TYPICAL EXAMPLE Signs and symptoms The patient has chronic nervous tension, with palpitations, anxiety, restlessness and insomnia; recurring headache; and irritable bowel syndrome. Although tense and nervous, the patient has a tendency to depression. The pulse is wiry, especially"in the Liver, Heart, and third positions (which can represent the Intestines). It is also slightly irregular. The tongue is slightly trembling. Diagnosis The patient has Heart Spirit Disturbance, Liver Hyperactive Yang, Intestines Qi Disturbance, and some Stagnation of Heart and/or Liver Qi.
..
529
Choice of Lavandula Lavandula can be selected to calm Heart Spirit Disturbance to treat palpitations, anxiety, restlessness and insomnia; calm Liver Hyperactive Yang to treat recurring headache; calm Intestines Qi Disturbance to treat irritable bowel syndrome; and gently move Stagnation of Heart and Liver Qi to treat depression.
Limitations ofLavandula TEMPERATURE Lavandula is listed in this book as slightly warm so that it can be used for warm, ne~tral, cool, or cold patterns when combined with the appropriate herbs to adjust the temperature balance of the combination. It should not be used for patterns of Heat and Excess unless it is combined with reducing and cooling herbs such as Humulus, Piscidia, or
Tranquilizer and anticonvulsant Both Lavandula and Rosmarinus can have a calming effect on Liver Hyperactive Yang, but Lavandula has a stronger tranquilizing action on the Heart than Rosmarinus. Neither Lavandula nor Rosmarinus is an appropriate tranquilizer for hot patterns. However, since Lavandula is not as warm a herb as Rosmarinus, it can be used as a tranquilizer even in warm patterns, providing it is combined with suitable proportions of cool or cold herbs. Lavandula was used in the past as an anticonvulsant herb for convulsions, apoplexy, and trembling and stiffening of the limbs. Although it is no longer much used as a primary herb for such conditions, it can be a useful secondary herb for their prevention or for the treatment of their sequelae. . .. Antidepressant and nervine Lavandula does not have such a warming and stimulating effect on the Heart and Liver as does Rosmarinus. However, Lavandula is more appropriate than Rosmarinus in mixed patterns of mild depression and nervous tension, associated, for example, with digestive disorders or headache. Lavandula has also; been used as a nervine (central nervous system tonic) to treat nervous exhaustion. .Antispasmodic and carminative Like Rosmarinus, Lavandula can have a calming effect on Intestines Qi Disturbance. It is primarily used to treat abdominal distension or discomfort and gas. However, Lavandula is not such a warming herb as is Rosmarinus, and therefore is not as effective a carminative stimulant to the Spleen. Hepatic and cholagogue Although there has been a long tradition of using Lavandula for hepatobiliary disorders, it is a secondary herb for such complaints. Lavandula is not as strong a hepatic and cholagogue herb, as for example, Rosmarinus.
Lavandula paired with other herbs
Valeriana.
TASTE N ~-
.
The primary taste of Lavandula is aromatic. This herb has a bitter taste in the mouth, and may have mild bitter tonic effects on the digestive and and hepatobiliary systems, but this is not a primary action of this herb, as it is for Ros-
Discussion of the limitations of each of the main actions of Lavandula can be useful to clarify just what this herb can and cannot do. However, suitable combination with oth~r herbs can extend the range of use of Lavandula beyond its limitations as a single herb. The basic unit of herb combination is the herb pair. Twelve pairings of Lavandula are briefly explained below.
Combining Western Herbs and Chinese Medicine
530 CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair.
Cool Nepeta balances slightly warm Lavandula· sou:tliat';,-e~ this pair can be used for warm-cool conditions. - u.~~::~:
Lavandula + Mentha piperita
Nervous exhaustion + nervous tension
This combination is specific for Liver Stagnant Qi invading the Stomach and Intestines with epigastric and abdomi~ nal discomfort and distension accompanied by depression.
Salvia and Lavandula both calm Liver Hyperactive Yang
Nervous exhaustion + insomnia
Lavandula + Leonurus
Nervous exhaustion + palpitations This pair is specific for nervous heart conditions with anxiety, palpitations, and nervous exhaustion. The bitter cardiac tonic constituents of Leonurus combine with the calming aromatic constituents of Lavandula.
Lavandula is slightly w~ming, it is balanced by Salvia, w~*-,~::i£~: in this situation is cooling and specific for hot flashes" . . Lavandula + Valeriana
Irritable bowel syndrome Both herbs have antispasmodic action on the intestines, and both have a central nervous system calming effect. Lavandula is a tranquilizer and Valeriana can act as a mild sedative, so they can be used together when Lavandula alone is not sufficiently strong in its calming effect. Lavandula + Passiflora
Insomnia in children Passiflora is more gentle than Valeria~a in its calming effect. Lavandula and Passiflora are specific for nervous restlessness and insomnia in children, when only a gentle tranquilizing action is required.
Migraine
Headache + nervous tension Tanacetum is a cool and acrid tranquilizer so it can treat This is a pairing ofYm and Yang. Both herbs are specific for headache associated with Liver Hyperactive Yang, but Rosmarinus is more stimulating to treat depression associated with Liver and Heart Stagnant Qi, and Lavandula is more calming to treat restless nervous tension associated with Heart Spirit Disturbance. ",','
headache or migraine from either Liver Hyperactive Yang or Exterior Wind, when it is combined with s.ome signs of Heat. Lavandula and Tanacetum can be combined for headache from Liver Yang and Exterior Wind in conditions ranging from neutral to warm in temperature.
<';"7
Lavand~+ Nepeta
Lavandula +Anemone
Intestinal colic in children
Anxiety
This combination of aromatic herbs is specific for nervous indigestion, insomnia, or headache, especially in children.
--~
Lavandula + Tanacetum Lavandula + Rosmarinus
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Insomnia + nervous tension to treat headache and Heart Spirit to treat nervous insomnia.
Verbena is specific for debility with depression due to Liver Stagnant Qi. It can be combined with Lavandula for depression, nervous exhaustion, and nervous headache.
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Lavandula + Salvia officinalis
This pair can be used when menopausal hot flashes ocCur . with headache, insomnia, and nervous tension. Although
Nervous exhaustion + depression
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Lavandula + Ophiopogon
Lavandula + Verbena
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Abdominal distension + depression
These herbs can be paired for neutral-warm patterns of insomnia, nervous exhaustion, and nervous tension that are linked to disturbance of stomach or intestines. Ophiopogon can act as a sweet nervine tonic for exhaustion. It can also act as a cooling anti-inflammatory herb with slightly calming effect. Lavandula can have antispasmodic action on the intestines.
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Lavandula + Avena
This pair can be used to treat conditions of nervous exhaustion, nervous tension, and depression that are associated with neutral-temperature patterns. The slightly warm Lavandula balances the slightly cool Avena. The aromatic, calming action of Lavandula complements the sweet, nervine tonic action of Avena.
...
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Anemone is a cold sedative herb that can be used for restlessness,anxiety, insomnia, or migraine with signs of
---. Lavandula Heat. Lavandula and Anemone can be used for overexciteI L
_
ment of the heart with palpitations and feelings of desperation, and for patterns that are neutral to warm in temperature.
LAVANDULA AND ROSMARINUS PAIRS COMPARED The differences in the pairings of these herbs reflect the
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GENERAL
This combination is an effective symptomatic combination for insomnia due to Heart Spirit Disturbance. The overall temperature is neutral to cool, so that this combination can be used for warm or neutral patterns. For cool patterns, Zingiber can be added. The aromatic, bitter, and sweet properties each contribute to the calming action. USE
essentially tranquilizing action of Lavandula and the essentially stimulating action of Rosmarinus. For example, Lavandula can be paired with the cool tonic Ophiopogon to tonify and calm, whilst Rosmarinus can be paired with the warm tonic Panax ginseng to tonify and stimulate.
-LavandUlacombinations
1. insomnia
Heart Spirit Disturbance
2. palpitations + anxiety
Heart Spirit Disturbance Heart Qi Irregularity
3. asthma + anxiety
Heart Spirit Disturbance + Lung Stagnant Qi
4. headache + anxiety
I.i'ier Hyperactive Yang + Heart Spirit Disturbance
5. irritable bowel syndrome +
,Intestines Qi Disturbance + Intestines Heat
heat sensations
+
'-
Heart Spirit Disturbance + liYer Stagnant Qi
6. anxiety + depression
CAUTION
Before using any ofthe combinations below, it is important to befamiliar with the cautions listedfor each herb in the combination. I. Insomnia
Heart Spirit Disturb,.ance
Lavandula valeriana Anemone Glycyrrhlza
1 1 1 0.5
sl.
warm
aromatic, bitter, sl. acrid
cool
bitter, sweet
cold
bitter
neutral-cool
sweet
• acute or periodic insomnia, especially with anxiety or palpitations PRACTICAL NOTES
This combination can be taken as 5 ml of a 1:5 tincture in quarter of a cup of warm water about 1 hour before bed. Another 5 ml can be taken on waking in the night, if there is difficulty in getting back to sleep. The amount of each dose be increased temporarily to 7.5 or even 10 ml in severe acute insomnia, and then decreased to 2.5 ml as the insomnia becomes less severe. This is a symptomatic combination that can be taken for up to two weeks. When the insomnia improves, this combination can be replaced by a combination to treat the under- / lying causes of the insomnia. Should the severity of the insomnia increase temporarily, this symtomatic combination can be used again until the insomnia is once more under control
can
Six Lavandula combinations are discussed below:
L
531
2. Palpitations + anxiety
Heart Spirit Disturbance + Heart Qi Irregularity Herb Lavandula Valeriana Anemone Leonurus Crataegus Convallaria Glycyrrhiza
1 1 1 1 1
sl.warm cool cold neutral sl. warm neutral
aromatic. bitter, sl. acrid bitter, sweet bitter sour. sl. bitter sour, sweet bitter, sl. sweet
0.5
neutral-cool
sweet
·1
GENERAL
This combination is specifically for palpitations and anxiety from Heart Spirit Disturbance with Heart Qi Irregularity. and some Heart Qi Deficiency. The overall temperature is more or less neutral, so that this combination can be used for warm, neutral, or cool conditions when it is appropriately modified. The bitter and aromatic taste properties can calm Heart Spirit Disturbance to treat anxiety, and the sour and sweet properties can stabilize Heart Qi Irregularity to treat irregularities ofheart beat
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Combining Western·Herbs and Chinese Medicine
532
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4. Headache + anxiety
USE
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• cardiac arrhythmias, palpitations, and anxiety, maybe with insomnia PRACTICAL NOTES
Liver Hyperactive Yang + Heart Spirit Disturbance _
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This combination can be taken as 5 ml of a 1:5 tincture in quarter of a cup of warm water, three times per day. It is for chronic conditions, and can be taken for one to two months with appropriate cautions, breaks, and modifications.
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Salvia off. Mentha pul. Anemone Valeriana Glycyrrhiza Zingiber
1 1 1 1 1
0.5 0.5
51. warm
aromatic, bitter, 51. acrid
warm-cool
aromatic, acrid
warm
aromatic
cold
bitter
cool
bitter. 5weet
neutral-cool
sweet
hot
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.~~.:~
- .:-.
:
GENERAL
3. Asthma + anxiety
Heart Spirit Disturbance + Lung Stagnant Qi
Lavandula Anemone Schi5andra Lobelia Prunu5 Ephedra Glycyrrhiza
1 1 1 1 1
0.5 0.5
51. warm cold warm
aromatic, bitter, 51. acrid bitter
wa~ool
acrid aromatic acrid, 51. bitter 5weet
neutral warm neutrakool
50ur
GENERAL
This combination is for Liver Hyperactive Yang with some Heart Spirit Disturbance and some Kidney fear. The overall temperature is more or less neutral, so that the combination can be used for warm, neutral, cool, and cold patterns of headache, when appropriately moditied. The combination contains both aromatic and bitter constituents
:"n . _~. " --_:.~ t€ '-:.- --"-'7-el
~
-.
with calming e f f e c t . - ' : T -,.--
USE
• headache or migraine associated with irritability, anxiety, or fear 1 C
This combination is for asthma with nervous tension or anxiety associated with Heart Spirit Disturbance and Lung Stagnant Qi. The overall temperature is neutral to slightly warm, so that this combination can be used for warm, neutral, or cool conditions when it is appropriately modified. In this combination, the acrid property can open the Lung, the aromatic and bitter properties can calm the Heart, and the sour and sweet tastes can stabilize the Heart. USE
• asthma or breathing difficulties linked to anxiety • panic attacks with dyspnea
PRACTICAL NOTES
This combination can be taken as 5ml of 1:5 tincture in quarter of a cup of warm water, three times per day. Lavandula, Salvia, Glycyrrhiza and Zingiber combine to treat underlying Deficiency and Stagnation, so that this combination can be used for one to two months, with appropriate precautions, breaks, and modifications. 5. Irritable bowel syndrome + heat sensations
Intestines Qi Disturbance + Intestines Heat Herb . ~_<.
Ratio
Lavandula
1 1 1 1
-Temperature
,Taste
PRACTICAL NOTES
This combination can be taken as 5 ml of a 1:5 tincture in quarter of a cup ofwarm water, three times per day.
Nepeta Matricaria Valeriana
Caution This combination contains Ephedra, and all precautions for the use of Ephedra should be observed. If there are cardiac arrhythmias, hyperactivity, or hypertension, Ephedra can be removed and substituted with Valeriana. Ephedra is included in this combination to treat asthma even though there is some anxiety, since it is balanced by the calming herbs, and since this combination is only to be taken during the spell of asthma or breathing difficulty. It is not to be taken during the remission phase.
51. warm
aromatic. bitter. 51. acrid
cool
aromatic, acrid. 51. bitter
cool
51. bitter, 51. aromatic
cool
bitter. sweet
0.5-1 0.5-1
cool
bitter
Lobelia
warm-cool
acrid
Glycyrrhiza
0.5
neutral-cool
sweet
Hydrastis
GENERAL
This ~ombination is for irritable bowel syndrome with Intestines Qi Disturbance and some Intestines Heat, plus Heart Spirit Disturbance and/or Liver Hyperactive Yang. The overall temperature is cool to treat warm patterns.
./"
r-'
Lavandula
i
I \ _~ '-,
Although Lavandula is slightly warm, it is included since it is specific for irritable bowel syndrome, and since it is balanced by the cool herbs. The antispasmodic action may be due to the aromatic constituents in Lavandula, Nepeta, and Matricaria; the bitter constituents of Valeriana; and the acrid
533
priate precautions, breaks, and modifications. If stress levels are high, Valeriana and Humulus can be added temporarily.
COMPARISON OF THE SIX LAVANDULA COMBINATIONS
constituents in Lobelia.
1. Insomnia
USE
,.
• irritable bowel syndrome with sensations of heat,
Heart Spirit Disturbance
restlessness, and nervous tension Ratio PRACTICAL NOTES
This combination can be taken as :; ml of a 1:5 tincture in quarter of a cup of warm water, three times per day. This combination can be used for one to two months, with approI
Lavandula Valeriana Anemone Glycyrrhiza
Lavandula Valeriana Anemone Leonurus Crataegus Convallaria Glycyrrhiza
1 1 1
0.5
priate precautions, breaks, and modifications.
~ 6. Anxiety + depression
. i
t::r
r
b
1 1 1
0.5-1 0.5 0.5 0.5
sl. warm warm-cool neutral warm warm-cool neutral-cool hot
0.5
1. In this effective symptomatic combination for insom-
Heart Spirit Disturbarn:e + Liver Stagnant Qi
Lavandula Salvia off. Verbena Rosmarinu5 Mentha pip. Glycyrrhiza Zingiber
1 1 1 1 1 1
aromatic, bitter, 51. acrid aromatic, acrid 51. bitter aromatic, bitter, acrid aromatic, acrid sweet acrid, aromatic
nia, Anemone and Valeriana are the strongest calming herbs. Lavandula contributes a tranquilizing effect, but balances this with mild tonifying and moving actions. The sweet heavy property of Glycyrrhiza emphasizes the sweet heaviness ofValeriana. However, this grounding effect is moderat- / ed by the moving effect of the Lavandula essential oils, which can produce a sensation oflightness of spirit.
with Heart Spirit Disturbance, and maybe Liver Hyperactive
2. This combination for palpitations and anxiety includes all four herbs from combination No.1, but adds Crataegus, Convallaria, and Leonurus to regulate and strengthen Heart Qi. Therefore, whilst combination No. 1 is more for short-term or occasional use, combination No.2 can be used long-term to strengthen and regulate the Heart.
Yang, and for depression associated with Liver Stagnant Qi. The overall temperature is warm, so that the combination
3. Asthma + anxiety
4. Headache + anxiety
Heart Spirit Disturbance + Lung Stagnant Qi
Liver Hyperactive Yang + Heart Spirit Disturbance
GENERAL
This combination can be used for mild anxiety associated
can be used to treat neutral or cool conditions, and the dominant taste property is aromatic, which can have both calming and antidepressant effects. The acrid property of Ros-
;i
marinus and Zingtber can reinforce the moving and spreading effect of the aromatic property. USE
• mild anxiety with depression and debility • anxiety and depression with nausea and flatulence • nervous tension and depression with mild headache PRACTICAL NOTES
This combination can be taken as 5 ml of a 1:5 tincture in quarter of a cup of warm water, three times per day. This combination can be used for one to two months, with appro-
-
Lavandula Anemone Schisandra Lobelia Prunus Ephedra Glycyrrhiza
"r',
"r·;'-'."':-""
Ratio _!_ "~
1 1 1 1 1
0.5 0.5
~':-
0;).-._; .
Lavandula Salvia off. Mentha pul. Anemone Valeriana Glycyrrhiza Zingiber
1 1 1 1 1
0.5 0.5
3. Lobelia, Prunus, and Ephedra combine to open the Lung and relieve bronchial spasms. Lavandula and Anemone combine to calm the mind and emotions to support the antispasmodic herbs. Schisandra firms Lung and Heart Qi to
-----_.- --_.-
Combining Western Herbs cirid Chinese Medicine
534
calm anxiety and moderate the stimulating and dispersing effects of Ephedra on the energy of Lung and Heart. 4. Lavandula, Salvia, and Valeriana are combined for headache associated with both Liver Hyperactive Yang and Heart Spirit Disturbance. Mentha pulegium and Anemone combine to treat nervous tension associated with Heart Spiiit Disturbance and Kidney fear. Glycyrrhiza helps to stabilize Heart and Kidney, and Zingiber helps to disperse Qi Stagnation resulting from nervous tension. 5. Irritable bowel syndrome + heat sensations
6. Anxiety + depression
Intestines Qi Disturbance + Intestines Heat
Heart Spirit Disturbance + Liver Stagnant Qi
• Cimicifuga: premenstrual syndrome + headache • Leonurus: menstrual disorders + anxiety • Piscidia: insomnia + muscle spasms • Rosmarinus: headache +facial neuralgia • Rosmarinus: irritable bowel syndrome + cold sensations .. • Ruta: nightmares • Salvia: headache + PMS + depression
Research CONSTITUENTS The following constituents have been reported: • essential oil • tannins • other Essential oil The flowers contain 1-3% essential oil, maiii':---··";;~T""
Lavandula Nepeta Matricaria· Valeriana Hydrastis Lobelia Glycyrrhiza
1 1 1 1 0.5-1 0.5-1 0.5
Lavandula Salvia off. ' Verbena Rosmarinus Mentha pip. Glycyrrhiza Zingiber
1 1 1 0.5-1 0.5 0.5 0.5
5. This combination for irritable bowel syndrome resembles combination No.3 for asthma and anxiety in that both patterns involve smooth muscle spasms associated with nervous tension, and Lavandula, Lobelia and Glycyrrhiza are common to both combinations. However, in combination No.5, Nepeta combines with Lavandula and Matricaria to treat intestinal smooth muscle spasms and nervous tension affecting intestinal function. Hydrastis can normalize and heal inflamed or damaged mucous membranes. Glycyrrhiza relieves intestinal spasms and is a soothing, demulcent antiinflammatory for the mucous membranes. 6. This combination is an excellent illustration of the combination of how the Western aromatic herbs Lavandula, Mentha piperita, Rosmarinus, and Salvia can be combined ,to produce both calming and antidepressant actions. Zingiber plays an important role in assisting the aromatic herbs in the movement of Stagnant Qi and in diffusing internal nervous tension outwards to the surface. Verbena is a bitter herb that can both tonify and move Liver Qi, and have both calming and antidepresSaD.t effects. OTHER LAVANDULA COMBINATIONS Other combinations that contain Lavandula include the following:
ly the terpenoid ester linaloyl acetate (30-55%) and the:~ terpenoid alcohollinalool (20-35%), an isomer of geranioL~ ~:~!7JJl. In the research literature, linaloyl acetate seems to be syn_~~T-' onymous with linalyI acetate and linalool with linalol. Also:·~ present are ~-ocimenes (5-15%), cineole (0.3-1.5%), a-terpi/..~ neol (0.3-1%), camphor (0.2-0.5%), and limonene (O.l~ O.5%).ll Tannins The· flowers contain 5-10% tannins, which may be derived from rosmarinic acid.4 Other present.
Coumarin, flavonoids, and phytosterols are also 4
CHEMICAL DIFFERENCES BETWEEN THE LAVENDER SPECIES There are interesting differences in the constituents of the three main types of lavender used. The figures in the table below are taken from Bruneton. 11 Lavandin appears intermediate in its constituent balance between L. angustifolia and L. spica.
It
LA.VENDER SPECIES
<3%
28--38%
25-38%
25-50%
25-35%
camphor
0.2-0.5%
8--20%
6-8%
cineole
0.3-1.5%
20-35%
4-7%
linaloyl acetate
25-45%
!inalool
These chemical differences between the lavender species are utilized in aromatherapy. According to Mailhebiau," L.
.,f"
~~
..
,.
Lavandula angustifolia is more used for its calming effects on the heart. and L. spica is used more as a heart tonic. resembling the variety of Rosmarinus rich in camphor. 1. spica is also preferred for lung complaints. resembling the variety of Rosmarinus rich in cineole. These differences in use can be linked to the constituents as follows: • the more linaloyl acetate. the greater the calming action • the more camphor. the greater the stimulant action • the more cineole. the greater the decongestant action
PHARMACOLOGICAL AND
Sedative Up to 600 mg/kg of 1. stoechas flowers did ~ot have a hypnotic effect in mice. but made the animals relaxed and dull. Like diazepam. the extract prolonged the pentobarbital sleeping time in mice. 19 A significant interaction of lavender oil with pentobarbital may exist since the sleeping time is increased. 23 Linalool has demonstrated a dosedependent sedative effect on the CNS, including hypnotic, anticonvulsant. and hypothermic properties. Linalool has been reported to have inhibitory effects on acetylcholine release and on the channel open time in the mouse neuromuscular junction.24 Hyperactivity, induced in mice by caffeine injection. was reduced to nearly normal motility by inhalation of linalooL15
CLINICAL RESEARCH The following effects have been reported for extracts of Lavandula or for its isolated constituents: • antimicrobial • acaricidal • anti-inflammatory • antispasmodic and anticonvulsant • anesthetic • sedative • antioxidant
i
L
-
Antioxidant An extract of 1. angustifolia, as well as its phenolic components, showed protective effects against lipid peroxidation.26
RESEARCH VERIFICATION
OF
TRADITIONAL ACTIONS From the research summarized above, there is direct or indirect support for the following traditional actions: tranquilizer, carminative (antispasmodic), and anticonvulsant.
Antimicrobial Lavandula essence showed activity against bacteria. filamentous fungi. and yeasts.'· Linalool was shown to be the most effective of five aromatic constituents tested against bacteria and was also effective against fungL's
Additional effects demonstrated by research In addition, the following effects have been reported: antimicrobial, acaricidal, anti-inflammatory. anesthetic, and antioxidant.
Acaricidal The oil of L angustifolia Miller. and linalool were shown to have powerful acaricidal activity against Psoroptes cuniculi. a mite of rabbits. '6
TOXICOLOGY
Anti-inflammatory Coumarin from L.latifolia Vill. showed weak anti-inflammatory activity in rats, and caryophyllene oxide from this plant showed inlubitory activity on histamineinduced contraction of guinea pig ileum.17 Antispasmodic and anticonvulsant L angustifolia showed antispasmodic effect on smooth muscle and skeletal muscle in rats. 18 Linalool showed anticonvulsant activity and an inhibitory effect on glutamate binding in the rat cortex.19.20 A study from Pakistan noted that 1. stoechas has a long tradition of use as an antispasmodic and anticonvulsant. and reported that a tincture of L stoechas flowers had anticonvulsant effect in mice and antispasmodic action in rabbits, which is probably associated with its calcium channel blocking ability.2'
An important distinction A careful distinction needs to be made between the use of: • therapeutic doses of Lavandula as an infusion or tincture • 1. angustifolii"essential oil (as distinct from the essential oil of other Lavandula species) • isolated components of Lavandula Reports of toxic or adverse effects for pure constituents from Lavandula, or for its essential oil, do not" necessarily apply to the oral administration of infusions, decoctions, or ethanolic tinctures of this herb, when used in the recommended therapeutic dose.
Lavandula infusion or tincture According to the German Commission E monograph,27 there are no knownc~)J:~tra indications, side effects, or interactions for Lavandula as an . ." .. infusion or tincture within therapeutic doses. -~
Anesthetic Essential oil of L. angustifolia, linalool and linalyl acetate. all showed a dose-dependent local anesthetic effect in both rats and rabbits. 22
'
Lavandula essential oil According to TJSSerand and Balacs,21 the essential oil of L. angustifolia has only very mild toxicity
Combining Western Herbs and Chinese Medicine
536
and skin irritation potential, and has no sensitization or phototoxicity effects. However, they suggest that, due to their camphor content, the essential oils of Lavandula x intermedia and 1. stoechas should be used with caution in epilepsy, fever, and pregnancy.
Linalool, linaloyl acetate, and cineole • linalool is nontoxic, nonirritant, and nonsensitizint9 • there is no evidence of toxicity for linalyl acetate28 • cineole is nontoxic, nonirritant, and nonsensitizing-"9
Camphor The probable human lethal dose of camphor has been suggested as 50-550 mglkg,3O which is 3-33 g for a 60 kg human. This is approximately 100,000 times greater than the amount of camphor in a 5 ml dose of 1:5 1. angustifolia tincture (approximately 0.025-0.15 mg).
Dose Dried herbs The BHP listed 1-2 g of dried herb, three times per day. Tincture The BHP listed 2-4 ml of 1:5 tincture in 60% alcohol, three times per day.
Initial dose Can start at standard dose. Duration Can be used long-term.
Cautions
Regulatory status Please read the Regulatory status section in· the chapter on Safety.' Lavandula (lavender) is in the UK General Sale List and it is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations ofAustralia. Lavandula is not current1y listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
Traditional sources PROPERTIES Temperature Hildegard von Bingen31 listed Lavandula as hot and dry, and Gerard classified it as hot and dry in the third degree. Gerard32 said that it is good for cold diseases-of the head, especially those which originate not from an abundance of humours, but mainly from cold only. Culpeper also recommended lavender for cold disorders of the head. Tabernaemontanus33 said that lavender is warm and dry in the second degree, and is a 'subde' substance. Both Gerard and Culpeper warn against the use of lavender for patients with excess of humours and blood because of lavender's hot and subde nature. In this book, Lavandula is classified as slighdy warm, but not as warming and stimulating as Rosmarinus. This may be related to the fact that 1. angustifolia contains 0.2-0.5% camphor compared to 15-25% camphor in Rosmarinus. Taste
These cautions apply to the infusion and the tincture. The use of the oil is outside the scope of this book. Western contraindications None reported. Chinese contraindications None reported. However, Lavandula can have a mild warming effect, and so should be used with caution or avoided in syndromes of Excess Heat. Pregnancy and lactation No adverse reports. Side effects None reported.
Taste in the mouth According to Wichd, lavender has an aromatic scent and a bitter taste. I found both a sample of dried flowers of Lavandula and a 1:5 tincture of Lavandula in 45% alcohol to have an aromatic scent and an acrid, bitter. and aromatic taste. Taste properties Tabernaemontanus said that, according to Fernelius, lavender is slighdy pungent and slighdy bitter, and very slighdy astringent. Lavandula has been classified in this book as aromatic, bitter, and slighdy acrid. • aromatic
the dominant property, associated with carminative, antispasmodic, and calming actions
• bitter
not as strong as Rosmarinus: for example, Weiss 34 stated that Lavandula does have cholagogue action, but is only of secondary importance in the treatment of biliary conditions
Overdose None reported. Toxicity No adverse reports for the use of infusion or tincture. Interactions The essential oil may potentiate the sedative effect of pentobarbital,24 but the less concentrated tincture may not necessarily have this interaction.
\ I
t
.. Lavandula • acrid
r--
mildly warms the Interior (a mild circulatory stimulant and antidepressant in terms of Western herbal terminology)
ORGANS
L I
f_
In terms of Chinese medicine, Lavandula, as used in the West, can be associated mainly with disorders of the following organs:
Calming Heart Spirit Tabemaemontanus listed Lavandula
I
i
Heart
restores speech palpitations
lonicerus35 Tabernaemontanus
Uver
headache. convulsions, apoplexy jaundice cramps, trembling and stiffening of the limbs
Culpeper
Stomach aches
lonicerus. Tabemaemontanus Commission E
Spleen, Stomach, Intestines
nervous disorders of stomach and intestines
Lonicerus Tabemaemontanus
ACTIONS Evidence from the traditional sources for the following actions of Lavandula is discussed below: • nervine • antidepressant • tranquilizer • anticonvulsant • carminative • hepatic and cholagogue • emmenagogue • diuretic • antiparasitic • antirheumatic • topical
!
...
lia (1. vera), which he called female lavender, can have a tonifying action, but is also calming, whilst 1. spica (male lavender), with its higher camphor content, can have a heart tonic effect resembling Rosmarinus. Tranquilizer The tranquilizing effect of Lavandula can be divided, in terms of Chinese medicine, into calming Heart Spirit and calming Liver Hyperactive Yang.
re'
-~.
537
Nervine Lonicerus said that lavender is good for all types of brain diseases due to cold. Tabernaemontanus said that, according to Femelius, lavender is a noble remedy for chronic . cold diseases of the head, brain, and nerves since it strengthens, vitalizes, and warms them. Wichd listed Lavandula for nervous exhaustion (and for resdessness, excitement, and insomnia). Antidepressant The BHP listed Lavandula for depressive headache, and gave depr~ssive states associated with digestive dysfunction as its specific indication. The BHP suggested the combination of Lavandula with Rosmarinus, Avena, and Cola for depression. Mailhebiau wrote that L angustifo-
for palpitations. Culpeper recommended it for the trembUngs and passions of the heart, and for faintings and swoonings. Weiss considered it to be a mild sedative, and Wichtl described its application as a mild sedative for restlessness, excitement, nervous exhaustion, and sleep disturbances. Mailhebiau recommended the oil of 1. angustifolia to regulate the heart for palpitations, arrhythmia, and tachycardia. He also recommended the oil of L. angustifolia for childhood insomnia, blended with almond oil.~d massag~d onto the solar plexus, the soles of the feet, or along the spine.
Calming Liver Hyperactive Yang Gerard and Culpeper recommended lavender for headache due to cold. The BHP listed it for depressive headache, and suggested its combination with Cyp~pedium and Valeriana for migraine. Anticonvulsant According to Lonicerus, the flowers are very effective for strokes and can be used to restore speech. Tabemaemontanus said lavender can be used for treating complete and partial strokes; he mentioned Fernelius and Rondeletion, who praised its use for paralysis. Fernelius wrote that lavender can be used for vertigo attacks, cramps. sleeping sickness, trembling and stiffening of the limbs, and against paralysis. Gerard, Culpeper, the BHp, and Ma1>ey'6 recommended Lavandula for headache. Culpeper listed Lavandula for faintings, convulsions, and apoplexy. Carminative Lonicerus recommended Lavandula for stomach aches. Tabemaemontanus said that, according to Macer, lavender warms and strengthens the stomach and the appetite, and expels winds or bloating from the body, strengthens the heart, and cleanses the kidneys. The German Commission E monograph listed Lavandula for stomach and intestinal disorders of nervous origin. Hepatic and cholagogue Lonicerus said that Lavandula can be used for jaundice. Tabemaemontanus recommended it for a congested cOld liver. He said that it can open the liver and is effective for treating jaundice. Culpeper said that lavender frees the liver and spleen from obstructions. Wichd noted its traditional use in Germany as a cholagogue.
-
i
Combining Western Herbs and Chinese Medicine
538
Emmenagogue Tabernaemontanus said that, according to Macer, lavender can induce menstruation and warm the uterus. Used in steam baths, or powders. lavender can strengthen the uterus and can be used for inducing labor and easing labor pains. Lonicerus recommended lavender to induce menstruation and to expel the afterbirth. Culpeper said that lavender 'provokes women's courses, and expels the dead child and afterbirth:
11. Bruneton J. Pharmacognosy: Phytochemistry Medicinal Plants, edn. Lavoisier. Paris, France (1999)
2nd--:_:_'---'~ ' ....".
12. Perry LM. Medicinal Plants of East and Southeast Asia. The MIT Press. Cambridge. United Kingdom (1980) 13. Jiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary -__::.• ;~ . (Zhong yao da ci dian) Science Be Technology Press. Shanghai (1975) _ :~_ 14. Larrondo JV. Agut M, Calvo-Torras MA. Microbios 82(332):171-172 (1995) 15. Pattnaik S. Subramanyarn YR. Bapaji M et al. Microbios 89(358):39-46 (1997)
Diuretic Lonicerus said that the flowers simmered in wine and ingested while warm increase urination, and Tabernaemontanus said that lavender can be used for dropsy. Wicht! recorded its traditional use in Germany as a diuretic.
16. Perrucci S. Cioni PL, Flamini G et al. Parassitologia 36(3):269-271 (1994) 17. Shimizu M. Shogawa H. Matsuzawa T et al. Chem Pharm Bull 38(8):2283-2284 (1990) 18. Lis-Balchin }'l. Hart S. Phytother Res 13(6):540-542 (1999)
Antiparasitic Lonicerus said that to prevent lice, simmer lavender in water, drink the decoction, and wear a shirt that has been soaked in this water since the smell of lavender prevents lice. Martindale37 noted the use of lavender oil as an insect repe~t
._.
19. Elisabetsky E. ~larschner J. Souza DO. Neurochem Res 20(4):461-465 (1995) 20. Elisabetsky E. Brum LF. Souza DO. Phytomedicine 6(2):107-113 (1999) 21. GilaniAH.Aziz N. Khan MA et al. J Ethnopharmacol71(1-2):161-167 (2000)
Antirheumatic The BHP listed L. angufitifolia (L. officinalis) as an antirheumatic and suggested its combination with Filipendula and Cirnicifuga in rheumatism.
22. Ghelardini C. Galeotti N. Salvatore G et al. Planta Med 65(8):700-703
Topical Lonicerus recommended lavender for ulcerative stomatitis and for soothing toothaches. The BHP recommended the use of lavender oil as a linament in myalgia or intercostal neuralgia.
24. Re L,Barocci S. Sonnino S et al. Pharmacol Res 42(2):177-182 (2000)
(1999) 23. Guillemain J. Rousseau A. Delaveau P. Ann Pharm Fr 47(6):337-343 (1989)
-References 1. Grieve M. A Modern Herbal. vols. 1 and 2. Dover Publications, New York, New York (1971) 2. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks, Glenwood, Illinois (1990) 3. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983) 4. Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm, Stuttgart, Germany (1994), from 2nd German edn. Wicht! M (ed) (1989) 5. Mailhebiau P. Portraits in Oils. The C.W. Daniel Company. Saffron Walden. United Kingdom (1995) 6. Ellingwood F. American Materia Medica. Therapeutics and Pharmacognosy, 11th edn. (1919). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1994) 7. Christopher JR. School of Natural Healing. BiWorld, Provo. Utah (1976) 8. Tierra M. Planetary Herbology. Lotus Press. Twin Lakes, WlSCOnsin (1988) 9. Felter HW.!U1d lloyd JU. King's American Dispensatory. vols. 1 and 2. 18th edn. ·(1898i.Reprinted by Eclectic Medical Publications. Sandy, Oregon (1983) 10. Kloss J. Back to Eden, 5th edn. (1939). Reprinted by Lifeline Books, Santa Barbara. California (1975)
25. Buchbauer G, Jirovetz L. Jager Wet al. Z Naturforsch [C] 46(1112):1067-1072 (1991) 26. Hohmann J. Zupko I. Redei 0 et al. Planta Med 65(6):576-578 (1999) 27. Blumenthal M (ed). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council, Austin. Texas (1998) 28. Tisserand R. Balacs T. Essential Oil Safety: A guide for Health Care Professionals. Churchill Livingstone.. Edinburgh. United Kingdom (1995) 29. Opdyke DLJ. Food and Cosmetics Toxicology 13 (1975) [cited in Tisserand R. Balacs T. Essential Oil Safety: A guide for Health Care Professionals. Churchill Livingstone. Edinburgh, United Kingdom (1995)] 30. Opdyke DLJ. Food and Cosmetics Toxicology 16 (1978) [cited in Tisserand R. Balacs T. Essential Oil Safety: A guide for Health Care Professionals. Churchill Livingstone, Edinburgh.· United Kingdom (1995») 31. Von Bingen H. Hildegard von Bingen's Physica. Healing Arts, Rochester. Vermont (1998) 32. Gerard J. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publications. New York, New York( 1975) 33. Tabernaemontanus JT. Kriiuterbuch (1731). Reprinted by Verlag Konrad Kolbl, Miinchen. Germany (1993) 34. Weiss RF. Herbal Medicine. English edn. Beaconsfield Publishers, Beaconsfield, United Kingdom (1988) 35. Lonicerus A.~euterbuch (1679). Reprinted by Verlag Konrad Kolbl, Miinchen. Germany (1962)
3~.
Mabey R
(~d)'.Th~ -Co~plete New Herbal. Elm Tree Books. London.
United Kingdom (1988) 37. Reynolds EFJ (ed). Martindale:'The Extra Pharmacopoeia. 31st edn. Royal Pharmaceutical Society. LOndon. United Kingdom (1996)
ft"!'.
-,'.
~.
Leonurus ~.
I_=-
BotaniCal name: Leonurus cardiaca L. Family: Lamiaceae (Labiatae) Pharmaceutical name: Leonuri cardiacae herba cum £lore Part: dried aerial parts and flowers English: motherwort German: Herzgespann French: agripaume Mandarin: 1. cardiaca 1. is not used; yi mil dio (~~1t) is the aerial part of1. heterophyllus Sweet
,-
Use in the West Leonurus cardiaca is a herbaceous perennial native to Europe, and its dried flowers and leaves have been used in the West for two main groups of illnesses: women's diseases and disorders of the heart system. According to Culpeper, I this herb may have been called cardiaca because it was used to treat heart problems and motherwort because it was used for menstrual, natal, and postnatal disorders.
use of Leonurus as an antidepressant tonic for the heart system and said that there is no better herb to strengthen the heart, relieve melancholy, 'and make a merry, cheerful, blithe soul: Later Western texts, since the time of the Eclectics, have emphasized the use of Leonurus as a calming tonic herb for restlessness, excitability, and debility of the nervous system, with insomnia or palpitations. Combining these two traditions of use, Leonurus has been used to treat both depression and anxiety by strengthening and normalizing the function of what can either be described as the heart or the nervous system.
Use for imbalances of both the heart and uterus A characteristic Western use of Leonurus is for situations in which female reproductive disorders are combined with heart disorders, whether physical or emotional. For example, Culpeper recorded the use of Leonurus for postnatal depression, and Ellingwood2 listed it for menstrual problems with nervous tension.
Use for both physical and emotional heart symptoms More
ca.o
recently, traditional Western use has focused on the more physical manifestations of imbalance of the heart system, for example, cardiac weakness with exhaustion, tachycardia, or hypertension. However, earlier Western practitioners, such as Culpeper, had a concept of the heart that was very similar to that of the Heart organ system of Chinese medicine. They saw the _heart not just as a physical system, but also as the seat of the vital spirit, consciousness, and the emotions. They used Leonurus not just for tightness in the chest, heart pain, and palpitations, but also for melancholy and fear.
Use in China There is an entry for yl mil in the Chinese Herbal Medicine Dictionary,3 and this usually refers to the aerial parts of L. heterophyllus Sweet. Other species used are:~
• 1. heterophyUus Sweet f.leucanthus C.Y. Wu et H.W. Li • L. sibiricus L. • L. turkestanicus V. Krecz. et Kuprian The tradition of use for 1. heterophyllus in China is predominantly for women's disorders, although there has been some use for urinary disorders and as an external applica-
Use for depression and anxiety Culpeper emphasized the
539
::ro, _
~~
MtionM
:,o:::~ro:::nro~erbS.n.d:::::ed::::c ~aU'tion.
Heart system disorders is not generally recorded, although modern Chinese research has reported the effectiveness of yi mil do in the treatment of physical heart disease. 4
ro, mating
hypote~sion, ~ut c~ntrain~cated for·'''~:,"",,:.,''''m,e-' exhaustiOn with raised blood pressure ... "~. can treat exhaustion associated with ,,-;c;"'~.:..._.:.- . either hypotension or hypertension~~'='::'\ more calming than Crataegus and is""':'" ., ,.~-
•
Crataegus
• Leonurus
What is special about Leonurus
generally ~sed to treat e~austionwith-:~r: ", hypertension, but can still be used to ':'''
....
In terms of Chinese medicine, Leonurus cardiaca, as used in the West, can be said to be neutral, sour, and slightly bitter, and to have its main effect on the Heart and the Uterus.
- ... '.
The key to understanding Leonurus is that it can: • normalize the action of the heart, acting as a tonic, antidepressant, tranquilizer, or antianginal, depending on the situation • normalize the tone and activity ofuterine muscle, stimulating uterine contraction or relieving uterine spasms, depending on the situation • be usedfor patients with simultaneous disorders ofthe heart andfemale reproductive systems
WESTERN USES The Western uses of L. cardiaca relate to its four main:~r: .. ~
'-;~:?'~
Chinese actions:
I. tonify Heart Qi
cardiac weakness and debility, chronic fatigue syndrome, pos~'. .' . natal exhaustion . , • ""'"'.' . '-t-.-,,·'·:":. ..·;
II. calm Heart Spirit
palpitations, tachycardia. 10-'.:-;7,;'" somnia, panic attacks; anxletY:''\~c:<,,; bipolar disorders, attention ~.::~!l;l" deficit disorder ., ""
III. move Heart Qi and Blood
angina pectoris, prevention of:;·:·e;·d
~.
CHINESE ACTIONS In terms of Chinese medicine, Leonurus cardiaca, as used in the West, can be said to have four main types of action:
cardiac disease
IV. move Uterus Qi and Blood
I. II. III. IV.
tonify Heart Qi calm Heart Spirit move Heart Qi and Blood move Uterus Qi and Blood
.•.
Leonurus for all ages
~ ~-;--.:t·-
.'
o'
'.'
!:~~'
amenorrhea. dysmenorrhea•.•'''' . ':c;fi;'" menopausal disorders;especialIy when they are associated with i,....nervous tension-ci':::~~~' .:.:0,_.:';:....
-:+,'lJr .-
Leonurus, like Crataegus. caD. be
used for all ages, for example for:
WESTERN ACTIONS The main Western actions of Leonurus are related to its four main Chinese actions:
• panic and restless insomnia in children • attention deficit or bipolar disorders in teenagers • menstrual disorders, postnatal depression, or menopausal anxiety in women • degenerative heart conditions with exhaustion in the.,. elderly
I. tonify Heart Qi
cardiotonic
II. calm Heart Spirit
tranquilizer cardioregulator antihypertensive
III. move Heart Qi and Blood
antianginal
IV. move Uterus Qi and Blood
stimulant emmenagogue antispasmodic emmenagogue . tranquilizing emmenagogue
Cardiotonic Leonurus is similar to Crataegus or SarothamnUs inf"..that it can be used. for exhaustion associated with heart weaktless. The three herbs can be differentiated as follows:
Leonurus can be used for some of the most important·'·.....~_..,.- and widespread disorders occurring in modern societies: . ':'::-:::-~ • treatment of heart disease • chronic fatigue syndrome • energetic and emotional lability • anxiety disorders • bipolar disorders • menstrual disorders with anxiety • menopausal disorders • postnatal disorders
•
,1_."
._-"--
.... ~
..
..... : ........
":",!~'.-'''''--'':'''~ \.~ \..-
."' .J~\!-.=r.~::::.~;<~ ·~i::;~~j,:.~:-y.f.;;3,
. .•
,. -, :.~~:~~J~ .~:.~;.:
",\
~ ...
_Leonurus Treatment of heart disease Leonurus can have wide application in the treatment and prevention of heart disease. It can be included in combinations to assist in the treatment of: • debility associated with cardiac weakness • cardiac arrhythmias • chest pain due to heart disease • hypertension or labile blood pressure associated with
i~
heart disease
541
energy. body temperature, emotions, or blood pressure, and with palpitations and anxiety. Postnatal disorders Culpeper wrote that Leonurus 'makes women joyful mother of children, and settles their wombs as they should be: Leonurus can be used for postnatal disorders involving exhaustion, depression, anxiety, pain, or bleeding.
DIRECTION OF ENERGY
• anxiety associated with heart disease • recovery from myocardial infarction or heart surgery Chronic fatigue syndrome
Leonurus can be used to assist
in the recovery from postfebrile debility associated with cardiac weakness, and it can be used to treat exhaustion associated with cardiac weakness in chronic fatigue syndrome,
The sour property of Leonurus can have a firming effect on Heart Qi and Heart Spirit, so that Leonurus can help to control disturbed upward movement of energy. However, this effect does not suppress the flow of Qi. In addition, Leonurus can have a moving effect on Stagnant Qi and Blood, and even a mild antidepressant action.
fibromyalgia, or simple burn-out. Energetic and emotional lability By strengthening and stabilizing Heart Qi: i.~onurus can help to reduce excessive oscillations in: • energy • blood pressure • body temperature • mood This can be of use in treating such oscillations in children, teenagers, adults, and the elderly. Anxiety disorders
Leonurus is not a strong sedative herb,
but it can have a strengthening, stabilizing, and calming action on the Heart to assist in the treatment of restlessness, insomnia. anxiety, and panic attacks in patients of all ages. Bipolar disorders
Leonurus can help in the treatment of
patterns involving Heart Deficient Qi with an oscillation and Heart Deficient Yang. It is between Heart Deficient
rm
an ideal herb to assist in the treatment of bipolar disorders since it is· neither too sedative nor too stimulant. It can be combined with other herbs that also have this ability, such as
TYPICAL CASE EXAMPLE Signs and symptoms The patient has debility, palpitations that are worse when tired, and occasional pain in the heart area. She has a history of scanty and irregular menstruation, and now has menopausal hot flashes and fluctuations between anxiety and depression. Her pulse is empty and irregular, especially at the Heart position where it is also slightly wiry. It is slightly wiry at the third position, which ,can be linked to reproductive function. The tongue is pale, flabby, and slightly trembling. Diagnosis The patient has Heart Deficient Qi, associated with the debility; slight Stagnant Heart Qi and Blood, associated with the slight heart pain and the depression; and Heart Spirit Disturbance, associated with the anxiety and palpitations. There is also Stagnation of Qi and Blood in the Uterus, associated with the history of scanty and irregular menstruation. Choice of Leonurus Leonurus can be selected to tonify Heart Qi, to move Heart Qi and Blood, to calm Heart Spirit, and to regulate the Qi and Blood of the Uterus.
Crataegus, Lavandula, and Serenoa. Menstrual disorders with anxiety
Since Leonurus can
both calm and regulate the Heart and stimulate and regulate the Uterus, it is specific for menstrual disorders associated with stress and anxiety. Menopausal disorders
Leonurus can be useful in.meno-
pause since it regulates not only the Uterus and the menstrual cycle, but also the Heart lind the emotions. It is specifically useful for menopausal disorders with Heart Deficient Qi and
rm
an oscillation between Heart Deficient and Heart Deficient Yang. I use it for menopausal patients with lability of
LilnrtationsofLeonurus TEMPERATURE 1. cardiaca was classified as warm by Gerard5 and Culpeper, and 1. heterophyllus was classified as cool in the Chinese Herbal Medicine Dictionary. However. I have not found 1. cardiaca to have either a warming or a cooling effect, and L. cardiaca is classified as neutral in this book. It can be used for warm, neutral, or cool conditions when it is used in combination with the appropriate herbs.
._.:." ./J~ 542
Combining Western Herbs and Chinese Medicine
TASTE Sour taste property Although Leonurus cardiaca is sour in the mouth. it appears to be sour in property only with respect to firming Heart Qi. and not with respect to firming the Qi of the Lungs or Kidney. like Schisandra. Also. although L. cardiaca has 5-9% tannin content. it is not generally listed as an astringent. In fact. Ellingwood listed it as a laxative. Bitter taste property L. cardiaca has a slightly bitter taste in the mouth, perhaps partly due to the bitter bufenolide glycosides. It can be said to have a bitter property mainly in regard to its cardiotonic action. although a mild digestive tonic action has been reported.
Antianginal
Leonurus can be used to reduce chest paiil-" --::.;.;
due to heart disease when it is taken over a period of time and as an adjunct to allopathic medicine. However. for this purpose, it is best used in combination with other herbs. Emmenagogue
Stimulant emmenagogue Leonurus can be used as a stimulant emmenagogue to move Stagnant Qi and Blood of the Uterus and to treat amenorrhea. irregular and scanty menstruation. or infertility. Since it is neutral in temperature, it may be necessary to combine it with a warm or hot emmenagogue, such as Zingiber. for cool or cold conditions. or with a cooling emmenagogue. such as Hydrastis, for warm or hot conditions.
ACTIONS Cardiotonic In terms of Chinese medicine, L. cardiaca, as used in the West, can be said to be a tonic more for the Heart than for any other organ. However. it tonifies Heart Qi, rather than Heart Blood, ¥ m. or Yang, for which other herbs would be more suitable. The Chinese concept of a tonic for the Heart system, translated into Western terminology, can include the strengthening and stabilization ofboth the heart and central nervous system function. Leonurus has been listed in Western texts as a cardiotonic, nervine tonic, and digestive tonic. These three tonic actions combine to give a general tonic effect, so that this herb can be used to treat, for example, postfebrile debility. The digestive tonic action may be the least important action.
Antispasmodic emmenagogue Leonurus can be used as an antispasmodic emmenagogue to relax uterine spasms, relieve pain, and allow normal flow of Qi and Blo()d in the Uterus. However. it is not as strong an antispasmodic as Lobelia. nor is it an analgesic. like Anemone or Piscidia. It can be combined with these herbs when appropriate.
Tranquilizing emmenagogue As a tranquilizing emmenagogue. Leonurus is specific for menstrual problems with Heart Spirit Disturbance. It is not so effective for menstrual problems with Liver Hyperactive Yang, and Artemisia. Ruta. or Salvia would be better in that case.
Leonurus paired with other herbs
Tranquilizer Leonurus has been used in the West for its tranquilizing action to treat anxiety. restlessness. insomnia. and hysteria, especially when these symptoms accompany heart disorders. women's disorders. or both. However. it is a mild tranquilizer and cardioregulator. rather than a sedative. If a stronger tranquilizing action is required. Anemone could be used. and if a sedative action is required. Valeriana or Piscidia would be more appropriate.
Discussion of the limitations of each of the main actions of Leonurus can be useful to clarify just what this herb can and cannot do. However. suitable combination with other herbs can extend the range of use of Leonurus beyond its limitations. The basic unit of herb combination is the herb pair. Twelve pairings of Leonurus are briefly explained below.
Cardioregulator Leonurus can be used to treat palpitations and disturbances of heart rhythm linked to cardiac weakness, nervous stress, or both. However, it is best combined with Crataegus to treat fluctuations in energy. body temperature. or mood.
Before using any of the herb pairs below. it is important to be familiar with the cautions listed for each herb in the pair.
Antihypertensive In terms of Chinese medicine, Leonurus calms Heart Spirit Disturbance rather than Liver Hyperactive Yang so that it is used to treat hypertension related to the Heart rather than to the Liver. to treat palpitations rather than headache, and to treat anxiety rather than anger.
These herbs work together to strengthen the heart function and to increase the available energy of the body. Also. Leonurus is specific for stabilizing and calming the heart, and Panax ginseng is specific for strengthening the nervous
CAUTION
Leonurus + Panax ginseng
Exhaustion + heart disease
and endocrine systems.
-
,""',,.
·--·-Leonurus Leonurus + Cinchona
Postfebrile debility Both Leonurus and Cinchona can strengthen and regulate heart function, and both can be used for fever and postfebrile debility. Cinchona can also act as a bitter digestive tonic, and Leonurus can calm febrile anxiety. Leonurus + Salvia officinalis
Chronic fatigue syndrome
c:
Leonurus can stabilize the Heart to reduce fluctuations in energy and mood. Salvia is specific for regulating the body's temperature and perspiration, reducing hot flashes, and assisting in the treatment of muscle aches. Leonurus + Passiflora
Palpitations The tranquilizing action of Passiflora may add to the tranquilizing and cardioregulatory action of Leonurus to calm and stabilize Heart Qi and Spirit to treat palpitations.
r,.......
L ) !
L-.:=
These herbs are both uterine stimulants to move Qiand Blood in the Uterus and to promote menstruation. In addition, both herbs can treat cardiac weakness. Leonurus + Hydrastis
Postnatal disorders Both herbs can have stimulant emmenagogue effect to treat lochioschesis (retention ofthe lochia; also called lochiostasis) and antispasmodic emmenagogue action to treat postnatal pain. Hydrastis can also reduce postnatal bleeding, and Leonurus can treat postnatal anxiety and depression. Leonurus + Ruta
Menstrual disorders + anxiety
This pair of stimulant and antispasmodic emmenagogue herbs nicely complement each other since Leonurus calms the Heart and Ruta calms the Kidney and Liver. Also, Ruta is a bitter aromatic digestive tonic, and Leonurus is a sour and slightly bitter cardiotonic.
Leonurus + Lavandula
Leonnrus + Hypericum
Anxiety
Menopausal disorders
This is an effective pair for treating anxiety, restlessness, and insomnia due to Heart Spirit Disturbance. Leonurus strengthens Heart Qi, and Lavandula calms Liver Hyperactive Yang. Leonurus + Crataegus
L
543
This pair can be used to treat menopausal disorders, especially those associated with anxiety, depression, and emotionallability. Hypericum can treat menopausal depression. Leonurus can help to treat fluctuations in energy, emotions, and body temperature by stabilizing the heart's function.
Bipolar disorders Both these herbs tonify and stabilize Heart Qi and Heart Spirit, partly due to their sour taste properties. Leonurus has a calming action and is slightly antidepressant. Leonurus + Salvia miltiorrhiza
Leonurus combinations Six Leonurus combinations are discussed below:
...c6rribi~~~ .
-:---....-~~._.....,..---_.-
Angina pectoris Both herbs can treat chest pain due to heart'disease, and both can have a calming effect. Salvia is better for pain and for thrombosis, and Leonurus is better for calming anxiety.
_.....'---
1. cardiac weakness + digestive weakness 2. palpitations
+ anemia
Heart Deficient Qi + Spleen Deficient Qi Heart Spirit Disturbance Deficient Blood
+
Leonurus + Viburnum
3: anxiety
Heart Spirit Disturbance
Dysmenorrhea
4. menstrual disorders + anxiety
Uterus Stagnant Qi and Blood + Heart Spirit Disturbance
5. amenorrhea
Uterus Stagnant Qi and Blood + Uterus Deficient Qi and Blood
6. postnatal pain + anxiety
Uterus Stagnant Qi and Blood + Heart Spirit Disturbance
Both these herbs can be used to treat dysmenorrhea. Leonurus is more for regulating menstruation and ~ing nervous tension. ViburnUm is more effective for relaxing uterine spasms. ;
Leonurus + Thuja
Amenorrhea
., ......
-.'
~
-544
. Combining Western Herbs and Chinese Medicine
CAUTION
GENERAL
Before using any ofthe combinations below, it is important to be familiar with the cautions listed for each herb in the combination.
This is a combination for Heart Spirit Disturbance .--... Heart Deficient Blood. The overall temperature is neutialJQ~-;~~treat warm, neutral, or cool conditions. Sour, bitter. aromatJ' ie, and sweet constituents combine to strengthen and calni-_.. ~ ........:
._
Wi~-::'-
~-
"?"
the H~art, and ~weet, bitter, aromatic, and acrid constituenu.:tl ~ combme to tonify the Blood';';~1f_
1. Cardiac weakness + digestive weakness
Heart Deficient Qi + Spleen Deficient Qi
-'_.>,;~.
I~' f :';."
USE
Leonurus Crataegus Cinchona Achillea Panax gin. Glycyrrhiza 7.ingiber
1 1 1 1 1
neutral sl. warm cool warm-cool sl. warm neutral-cool hot
0.5 0.5
sour, sl. bitter sour, sweet bitter acrid, bitter sweet, sl. bitter sweet acrid, aromatic
• palpitations or heart rhythm irregularities associated with anemia and tiredness, and maybe insomnia PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture i n " .- . quarter of a cup of water, three times per day. It can be taken.~ , for several months, with suitable cautions, breaks. and modi-:;:;;=~
.
GENERAL
.;;;'~
fications.
This combination is for Heart Deficient Qi with Spleen Deficient Qi. The overall temperature is slightly warm so that .this combination is especially useful for neutral to cool conditions, although it can be modified for warm or cold patterns. The bitter constituents of Cinchona, Achillea, Panax, and Leonurus may have both cardiotonic and digestive tonic action, and the sweet constituents of Panax, Crataegus and Glycyrrhiza may also tonify Heart and Spleen Qi. The sour properties of Crataegus and Leonurus helps to firm Heart Qi.
......._..
_".L_., ,:.,. ''-,~_:'.-,-,,~
~.~~
'"
3.An:xiety
Heart Spirit Disturbance I"ffl'b!~~~'!'tb'~~~~!\''kj~11~~~~
'f.!,~fb.~~;i3~t~C[~tJ~li'!.~~~tu~e~f.;Ta~~~~/='~~~t~~~~~1
Leonurus Lavandula Anemone Valeriana Glycyrrhiza
1 1 1
0.5-1
0.5
neutral sl. warm cold cool neutral-cool
sour, sl. bitter aromatic, bitter, 51. acrid bitter bitter, sweet sweet
GENERAL USE
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of water, three times per day. It can be taken for several months, with suitable cautions, breaks, and modifications.
This is a combination to treat anxiety associated with Heart Spirit Disturbance. The overall temperature is neutral, and the combination contains an interesting balance of the bitter, sweet, sour. and aromatie taste effects. The bitter taste here may contribute both cardiotonic and tranquilizing effects. The sweet taste may help to weigh down and stabilize Heart Spirit. The sour property may have a firming or centripetal effect on Heart Spirit, which is balanced by the moving and slightly centrifugal effect of the aromatic property.
2. Palpitations + anemia
USE
• exhaustion as a result of heart disease, with weak digestion and poor appetite PRACTICAL NOTES
Heart Spirit Disturbance + Deficient Blood ---
•
_0, •••• _ . - .
..-..- __... _
- . - - . . • • ------.~-.'__r-
._
~H~rb.~j~;,;~~~~~Jg:~T~W~~~~-'OTaste;'7~~~~ Leonurus 1 neutral Crataegus 1 sl. warm Salvia off. ".' ',,<,·1 . , warm-cool Salvia mil. 1 cool Artemisia abs. 1 warm-cool Angelica sin. 1 warm Valeriana 0.5-1 cool Glycyrrhiza 0.5 neutral-cool
sour, sl. bitter sour, sweet aromatic, acrid bitter bitter, aromatic sweet, aromatic, bitter bitter, sweet sweet
• restless anxiety, maybe with palpitations • insomnia, dream-disturbed sleep • panic and hysteria
PRACTICAL NOTES
-·::/iil:
This combination can be taken as 5 ml of 1:5 tincture in i,::'~~{' quarter of a cup of water. three times per day. It can be taken for several months. with suitable cautions, breaks, and modi- .. fications. For phases when anxiety is more acute, the propor'.~-:"
r-'
I
I
545
LeOnUTUS7'-"" tion ofValeriana can be raised to 1 or 1.5. The original combination can be resumed when the anxiety has reduced. 4. Menstrual disorders + anxiety
Uterus Stagnant Qi and Blood + Heart Spirit Disturbance
Leonurus Ruta Artemisia abs. Lavandula Mentha pul. Anemone Zingiber
i'
i"'"
r-~
....
1 1 1 1 1 0.5-1
0.5
neutral
warm-cool warm-cool sl. warm warm
sour, sl. bitter bitter. aromatic bitter. aromatic aromatic. bitter, sl. acrid aromatic bitter acrid, aromatic
cold hot
GENERAL
This combination is for menstrual disorders with anxiety as a result of Ute~.StagnantQi and Blood and Heart Spirit Dis~b~~.Th~'overaIi temperature of the combination is slightly warm. but the combination can be used for cold. neutral. or even warm conditions with slight modifications. Bitter. aromatic, and acrid properties combine to move Stagnant Qi and Blood of the Uterus. and sour. bitter. and aromatic constituents may contribute to the calming effect.
coOl.
Leonurus Thuja Artemisia abs. Chamaelirium Caulophyllum Zingiber
1 1 1 1 1 1
neutral warm-cool warm-cool neutral neutral hot
sour, sl. bitter a'crid, aromatic, bitter bitter, aromatic bitter. sour bitter acrid, aromatic
GENERAL
This combination is for amenorrhea associated with Stagnation of Qi and Blood in the Uterus with Deficient Qi and Blood of the Uterus. The overall temperature is warm. but the combination can be used for cold. cool, neutral, or even warm conditions with slight modiQcations. The stimulant emmenagogue action may be primarily associated with the aromatic components. especially the monoterpenoid thujone in Thuja and Artemisia. The tonic emmenagogue action may be primarily associated with the bitter components in Chamaelirium and Caulophyllum. USE
• amenorrhea • infertility • scanty and irregular menstruation PRACTICAL NOTES
USE
~.
L
• delayed menstruation associated with shock or emotional stress • premenstrual tension associated with anxiety or palpitations • irregular menstruation associat~dwith nervous tension
'_.
PRACTICAL NOTES
iI
, .
This combination can be taken as 5 ml of 1:5 tincture in
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of water. three times per day. It can be taken for several months, with suitable cautions. breaks. and modifications. Caution If this combination is used for infertility. it should be stopped before there is any attempt 'at conception since Artemisia absinthium. Leonurus. and Thuja are contraindicated during pregnancy by some authors.
~.
-.
]
quarter of a cup of warm water. three times per day. Alternatively. each individual dose can be taken as 5 ml of 1:5 tincture in a cup of Mentha pulegium (pennyroyal) infusion. three times per day. The infusion is made by pouring one cup of boiling water over two teaspoons of dried M. pulegium and allowing it to steep in a covered vessel for about 7 minutes. This combination should not be decocted since the important essential oil constituents from Artemisia. Lavandula, Mentha pulegium. and Ruta would be lost. It can be taken da¥r}or several months. with appropriate breaks and modifications.
I
-...
~
6. Postnatal pain + anxiety
Uterus Stagnant Qi and Blood + Heart Spirit Disturbance
Leonurus Hydrastis
Salvia mil. Salvia off. Angelica sin. Z1ngiber
GENERAL ":
5. Amenorrhea
Uterus Stagnant Qi and Blood + Uterus Deficient Qi and Blood
1 1 1 1 1 1
"
" . ,,-;:,',
neutral cool cool warm-cool '.'
sour, sl. bitter bitter , bitter
warm
aromatic, acrid sweet, aromatic. bitter
hot
acrid, aromatic ~.
- ..
~.'
, This combin~tio~ ~ for Uterus Stagnant Qi and Blood with Heart Spirit Disturbance. The overall temperature is slightly warm. but the combination can be used for cold.
'"':'.
'A,* - - - ; ; - -
u
Cambining Western Her!J;ahd Chinese Medicine ..
546------- --
cool, neutral, or even warm conditions with slight modifications. Bitter, aromatic, and acrid properties combine to move the Stagnant Qi and Blood of the Uterus, and sour, bitter, and aromatic constituents may contribute to the calming effect.
...~_~;.:
2, is primarily' for Heart Spmt DIsturbance Wlth secondary~ . ._-.,.,.,.. Deficiency of Blood. Leonurus, the two Salvias, and Val- ';.~"~~. eriana can combine to calm the Heart, and sweet Angelica, ,:~:~ bitter Artemisia, and aromatic Salvia can combine to to~~.' the Blood. ' ,.' ,
'0
•
"-'-'7~
.
.,~~ ,,~.
USE
4. Menstrual disorders + anxiety
3. Anxiety • postnatal pain with anxiety and/or depression • lochioschesis with pain and mild bleeding
Heart Spirit Disturbance
Uterus Stagnant Qi and Blood
+ Heart Spirit Disturbance
PRACTICAL NOTES ~.-;'~ "If .... 0:"'-"
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of water, three times per day. It should not be given for more than 2 weeks without a reassessment of the situation. It is primarily used to assist complete descent of the placenta, 'and to reduce spasms and pain. Continued
ble~ding ~r,~~c:!:i_
_"-."."
Herb Leonurus Lavandula Anemone Valeriana Glycyrrhiza
.,_--<;'....", ...... ,., • ~ ....
('!'< :~{n'••'~ .•. ~
Ratio'/ Leonurus
1 1 1
0.5-1
0.5
Ruta Artemisia abs. Lavandula Mentha pul. Anemone Zingiber
1 1
~' ,"~':',,~~~r~,Tr.;
1 , 'O.5-1.F',,~-U~~':
0.5
3. This is a simple combination for anxiety. It is for Heart Spirit Disturbance without appreciable Deficiency so.~f~[ does not have the tonic herbs present in the 'previous combinations. This combination is identical to Lavandula: ,+,.c insomnia with the addition of Leonurus to calm the Heart. ,.,:1~'
two.
COMPARISON OF THE SIX
.. -.'.",
LEONURUS COMBINATIONS
'\~ ..... :~
",;,.,.,;,~_.!',.
4. Both combinations No.4 and No.3 contain Leonurus,~~,
1. Cardiac weakness-f: digestive weakness
2. Palpitations + anemia
Heart Deficient Qi + Spleen Deficient Qi
Heart Spirit Disturbance + Deficient Blood
Lavandula, and Anemone to ,calm Heart SpiriL .fi?~~~!",~~r emphasis of combination No.4 is on moving and regu1ating~~~, Qi and Blood in the Uterus. Therefore, Leonurus has been :-'C,,~ combined with the stimulant and antispasmodic emmena- .. ,. ' gogues Ruta, Artemisia, and Mentha pulegium. The tran-_ i::,
Herb ' Leonurus Crataegus Cinchona Achillea Panax gin. Glycyrrhiza Zingiber
1 1 1 1 1
Leonurus Crataegus Salvia off. Salvia mil. Artemisia abs.
0.5 0.5
Angelica sin. Valeriana Glycyrrhiza
1 1 1 1 1 1
0.5-1
whiclicansirengthe~ldigestion,'and Panax and Glycyrrhiza are sweet herbs;\'Vhich can tonify the Spleen, The main emphasis of thiS ~mbiriation is on cardiac weakness and exhaustion: ThereD1~y)e palpitations,'but if these are'dominant, then the next cti;bhlation is more appropriate. ~.' r~~~:~ :\;.'~·~,r:.}~'~~\~-:·'
/:.'
•
emmenagogue actions.
.
':2"'The-previo'ils'combination was especially for Deficiency, particularly Deficiency of Qi. This combination, No.
~_.
_--..,.....:.r.
......." -.. :jJ~ ,,:,.:;:i,F-
5. Amenorrhea
6. Postnatal pain + ' anxiety
Uterus Stagnant Qi and Blood + Uterus Deficient Qi and Blood
Uterus Stagnant Qi and Blood + Heart Spirit Disturbance'_., '
Leonurus Thuja Artemisia abs. Chamaelirium Caulophyllum Zingiber
Leonurus Hydrastis Salvia mil. Salvia off. Angelica sin. '
0.5
1. All the' herbs in this combination can work together to tonify the Heart. Cinchona and Achillea are bitter herbs.
,
quilizing herbs Lavandula and Valeriana, included in combi- ~:-~ nation No.3, have been omitted from combination No.:4;-~ since they have been replaced with Ruta, Artemisia, alld "~t,-_ Mentha pulegium, which can have both tranquilizing and'-jf::
1 1 1 1 1 1
Zingiber
1
.
'""• 547.' sides"apparently bufenolides.9 Although these glycosides have a structure similar to cardiac glycosides, they do not have the 14-hydroxy group, which confers hi~ cardioactivity.1O
5. Combinations No.4 and No.5 can move and regulate Qi and Blood in the Uterus. In contrast to combination No. 4, combination No.5 has the secondary aim of tonifying the Uterus, rather than calming Heart Spirit. Therefore, Leonurus is combined with the tonic emmenagogues Chamaelirium and Caulophyllum, and the calming herbs Lavandula and Anemone are not included.
Diterpenoids 1. cardiaca contains leocardin. 11 Tannins L. cardiaca contains 5-9% tannins, mainly derivatives of pyrogallol and catechin.9
6. In this combination, Leonurus has been combined with Hydrastis, Salvia officinalis, and Salvia miltiorrhiza since these herbs can treat lochioschesis and relieve postnatal uterine pain. In addition, Hydrastis is specific for postnatal bleeding or discharge with infection. Thuja and Artemisia, included in combination No.5, are replaced by Hydrastis and the two Salvias in combination No.6 since the latter three herbs are more specific for lochioschesis.
Other 1. cardiaca also contams: • triterpenes, mainly ursolic acid12 • flavonoids, mainly quercetin and apigenin glycosides ll • caffeic acid 4-rutinoside1 4
PHARMACOLOGICAL AND .
~.-
CLINICAL RESEARCH
O'!B:~:R LEONU~US C~MBINA:T~ONS
: The following effects have been reported:', .
Other combinations that contain Leonurus include the following:
• cardioregulator, cardioprotective, and anticoagulant • antihypertensive and tranquilizer
• Achillea: amenorrhea + exhaustion • Cinchona: cardiac arrhythmia + recurringfever • Crataegus: angina pectoris • Crataegus: bipolar disorders • Crataegus: cardiac arrhythmIa + hypotension • Rosmarinus: postnatal depression + exhaustion • Ruta: chronicfatigue syndrome + palpitations • Salvia: menopausal hotflashes
• antispasmodic • uterlD.e'smnUIant • diuretic Cardioregl1lator, cardioprotective, and anticoagulant In animal studies in China, yi mil do (the entire plant of1. heterophyllus) was reported to decrease the area of experimentally produced myocardial infarctions,15 increase coronary flow, decrease heart rate, and antagonize platelet aggregation. 16 A later study in China reported a protective effect in cerebral ischemia in animals and favorable results in cases of coronary heart disease. 17 In 1991, a study with rabbits demonstrated that prehispanolone from 1. heterophyllus could act as a platelet aggregation antagonist. IS
Research CONSTITUENTS The following constituents have been reported:
Antihypertensive and tranquilizer Early research reported sedativ~"~d hypoten~ive effects in animals. 19 Animal experiments in China with extracts of L. heterophyllus20 and leonurine4 reported brief hypotensive effects. Experiments with frogs reported a central nervous system depressant effect.io" ~ ...
• alkaloids • iridoid glycosides • bufenolide glycosides • diterpenoids • tannins • other
Antispasmodic The alkaloid leonurine was reported to relax contraction of rat aortic arterial rings induced by vari-
Alkaloids In 1. cardiaca, these are. L-:stachydrine6 and leonurine.7 The entire plant of L. heterophyllus (yi mil do) contains about 0.01-0.04% leonurine in addition to stachy4
,~t;"
L p.-1
drine.
.
Otis ~~~~}~'.- _'.
~ ,'~~,~>:~;,~{:~~~;,~;,~,.:~.{;,:~~[i:~~i~;~.'~"+:,:~;; ", ~_~~"
Irldoid glymsides L. cardiaca a side leonuride. Bufenolide glycosides
roDtuns :thf~doid .glYC0 7 ~ -, c: :;-~'~:::~~~t~~:.<'·:~
i','
1. cardiaca contiuIiS bitter"gIyco-
'2::.-~,; ..- "r' -~ ·~·:~l\i·:""t·.
",
."
U!;~~~.:~~;~~n!, .'Yl ~ilcio decoction stimulated the is~ ··lated ut~,9f nonpregnant rabbitS and those in early and lat::: ..•• _.. _ . _ pre~aJ?:¢Y~ well as the postnatal period. 4 Yl mil cllO prepara.t!o~~~o9nstimulateduterine specimens in a simi• larmannet although the effect of yi mn do was weaker than ''-'.~~~.~':J~\.',~.';.J;
.
..
~:
'."'~'.f.\"'~$"'
~.,
Combining Western Herbs and Chinese Medicine
548
that of oxytocin. 20 A study in 1979 showed that the constituent in L. artemisia responsible for uterine stimulant action was leonurine. 22 A study in 1995 found that a decoction of L. sibiricus stimulated mouse uteri in vitro by activating H -1 receptors and a-adrenergic receptors in the uterus. 23 Decoctions of yi mil do were reported to be as effective as ergotamine in stimulating contraction of postnatal uteri. 20 In a clinical study, normal fertile women were given an oral dose of L. artemisia decoction equivalent to 30 g dry weight. An increase in uterine pressure was reported in 41.3% of the women. 24 Diuretic Clinical studies have reported yi mil ca.o assisted in the treatment of acute glomerulonephritis 25 and edema due to acute or chronic nephritis. 26 A study on the uterostimulant effect of L. artemisia reported a side effect of diuresis. 24
Cautions
-'.-
.....
~~""
'--:_L-
Western contraindications None are known. However._:~?:, since Leonurus can promote menstruation, it would be pm": ':::-:f:J~c dent to avoid this herb or to use it with caution when treat- '~;m~ ing patients with a history of heavy menstrual bleeding. Chinese contraindications The following contraindications are given for L. heterophyllus (yi mil do):20 • contraindicated during pregnancy • caution in patients with Deficient rm or Blood There is no entry' for L. cardiaca in the Chinese Herbal .. Medicine Dictionary. The contraindications listed for L. heterophyllus may not necessarily apply to L. cardiaca, sincE: there are major differences in the use of these two herbs, as discussed in the section Comparison of Western and Chinese ._.' __. , use of Leonurus species. The differences can be summarized -.-':-:::'7''' , (-~
as follows: RESEARCH VERIFICATION OF TRADITIONAL ACTIONS From the research summarized above on extracts of Leonurus species or their constituents, there is evidence for the following Western traditional actions: cardioregulator, tranquilizer, antihypertensive, emmenagogue, and diuretic. Additional effects demonstrated by research Antispasmodic, anticoagulant, and cardioprotective effects have been demonstrated in animal studies. TOXICOLOGY According to Chang and But, L. heterophyllus (yl mil cao) has a low toxicity. They reported the LD;o of preparations of the herb injected in mice as 30-60 glkg, and the LD so of the total alkaloids in mice as 0.57 glkg.
• L. heterophyllus is used in China especially for menstrual disorders associated with Stagnant Blood • 1. cardiaca is much used in the West for menstrual or menopausal disorders associated with Heart Deficient Qi and Heart Spirit Disturbance The caution on the use of L. heterophyllus in patients with Deficient Yin or Blood can relate to further depletion of .J Blood and Yin by aggravation of blood loss in menstruation.··;":-_"", L. cardiaca should indeed be used with caution for patients with a history of menorrhagia. However, if patients have Deficient Yin or Blood, but do not have a tendency to heavy menstrual bleeding, then the use of L. cardiaca may be appropriate in such conditions as menopausal flushes with restlessness and nervous tension linked to Deficient rm. Pregnancy and lactation
nancy by some texts, but see below. None reported. 26 •29
Side effects
Dose Dried herb According to the BHp27 and the BHC,28 2-4 g of dried herb, three times per day.
Contraindicated during preg-
Overdose
No adverse reports.
Interactions
No adverse reports.
LEONURUS IN PREGNANCY Tincture The BHP stated 2-6 ml of 1:5 tincture in 45% alcohol, three times per day. The BHC listed 4-10 ml of 1:5 tincture in 25% alcohol, three times per day. Initial dose
Can start at the standard dose.
Duration Leonurus is safe for long-term use and may need to be used for at least 2 weeks.
There are some major differences of opinion, largely relating to whether L. cardiaca is seen as a stimulant of contractions of the gravid uterus or as an cintispasmodic to normalize irregular contractions and treat false labor pain or difficult labor: • Lyle30 said that this herb should not be used in
Leonurus
--
:
tj
pregnancy or for those with too free menstruation • Kloss3 \ said that motherwort has an excellent effect if taken during pregnancy • The BHP recommended Leonurus with Ballota for false labor pains • Gerard and Culpeper recommended motherwort for difficult labor • Gladstar31 listed Leonurus for the last few days of pregnancy to prepare the uterus for childbirth, but wrote that its menstruation-promoting properties make its use undesirable throughout pregnancy In the absence of adequate research using Leonurus cardiaca preparations at doses within the therapeutic range, it may be safer to avoid the use of this herb during pregnancy except for difficult labor.
549
West, can be associated mainly with disorders of the followingorgans: Organ
Examples of use
Source
Heart
relieve heart pain thin and dissolve viscous blood in the arteries cardiac weakness, simple tachycardia
Lonicerus Tabemaemontanus
promotes menstruation amenorrea menopausal disorders
Gerard
Uterus
BHP
BHP Mabey
The main text cited in the Chinese Herbal Medicine Dictionary listed L. heterophyllus ~ entering the
Chinese texts
Pericardium and Liver meridians, but other texts cited also listed the Heart. Spleen, and Kidney.
i
Traditional sources PROPERTIES
~ (---
Temperature Lonicerus 33 said that Leonurus is hot and dry in the second degree, and Tabernaemontanus34 said that it is hot in the second degree and dry in the third degree. Gerard said that Leonurus (Cardiaca) was hot and dry in the second degree, and Culpeper wrote that motherwort could warm and dry cold humours. The main entry of the Chinese Herbal Medicine Dictionary classified yl mu cao (L. heterophyUus) as cool, but a quoted subsidiary text classified it as warm. In this book, L. cardiaca, as used in the West, is classified as neutral and is used for warm, neutral, or cool coriditions when combined with appropriate herbs. Taste
Taste in the mouth On tasting a 1:5 tincture in 25% alcohol of L. cardiaca, I found it to b~ sour and slightly bitter in the mouth. Using a scale of 0-3, I would score it 2 for sour and 1 for bitter. Taste properties Tabernaemontanus described this herb as bitter, and Gerard described Cardiaca as cleansing and binding, but did not list a taste. The main entry of the Chinese Herbal Medicine Dictionary classified the aerial parts of L. heterophyllus as acrid and bitter. However. one source cited described it as acrid and sweet. In this book, L. cardiaca, as used in the West, is classified as sour and slightly bitter.
ORGANS '"i:c..
In terms of Chinese medicine, L. cardiaca. as used in the
ACTIONS Evidence from the traditional sources for the following actions of Leonurus are discussed below: • cardiotonic, antidepressant, and general tonic • cardioregu1ator • antihypertensive and antispasmodic • tranquilizer • antianginal • emmenagogue • links between cardioregulator and emmenagogue actions • other actions Cardiotonic, antidepressant, and general tome There are reports in classical Chinese literature of the use of yl mil cao as a general tonic and to uplift the spirit. 35 Culpeper recommended Leonurus to strengthen the heart and relieve melancholy. Lyle said that the cold infusion of Leonurus is a good tonic. improving the appetite and assisting digestion. Ellingwood listed Leonurus for general debility. weak digestion. and as a heart tonic to normalize heart action. Christopher descnbed Leonurus as a herb that can calm and tonify the heart and nervous system, and that can be used as a tonic for nervous exhaustion or for recovery from debilitating fever. Cardioregulator Lonicerus recorded the use of Leonurus for treating heart ,palpitations. Its use by Culpeper to treat both heart-related depression and palpitations illustrates the normalizing and regulatory effect of Leonurus on the heart. Lyle noted that this herb could have either a stimulating or a relaxing effect. Ellingwood noted its use to strengthen and normalize heart function, to calm excitability, and to
Combining Western Herbs and Chinese Medicine
550
treat palpitations. The BHP listed this herb not only for 'cardiac debility and effort syndrome: but also for tachycardia and cardiac symptoms associated with neurosis. Antihypertensive and antispasmodic Lonicerus listed Leonurus for paralyzed limbs. and Tabernaemontanus noted its use for cramping and paralysis of the limbs. Christophe~ noted the use of this herb for cramps. spasms. chorea. fits. and epilepsy. The BHC listed Leonurus as a hypotensive herb on the evidence of research from both China and the West. Tranquilizer Culpeper listed motherwort for palpitations, and Tabernaemontanus said that it could be used for children who are always frightened and whose hearts are always beating very strongly. Lyle noted the use of motherwort for hysteria and palpitations. and Felter and Lloyd36 listed it for all chronic diseases accompanied by resdessness. wakefulness. and disturbed sleep. Kloss recommended motherwort for nervous complaints. hysteria. delirium. palpitations. fainting. and sleeplessness. Priest and Pries~7 described Leonurus as a diffusive. stimulating, and relaxing antispasmodic nervine, and recommended its use for nervousness. hysteria. insomnia. and palpitations linked to chlorosis (a disorder associated with iron-deficiency anemia).
Treatment of thyroid patients Weiss38 recorded the use of Leonurus for treating the symptoms of palpitations and tachycardia in hyperthyroid patients. Antianginal Lonicerus reported the use of Leonurus in combination with other herbs for alleviating heart pain and improving heart blood, and wrote that the herb and root can be pounded and put on the chest to open the chest and relieve chest tightness. The BHP listed Leonurus for angina pectoris in its Index to Therapeutic Indications. Emmenagogue Summarizing Western sources. there are three main aspects to the emmenagogue action of Leonurus: • tonic • stimulant • antispasmodic
Tonic emmenagogue In the traditional Western terminology, a tonic emmenagogue is one that treats uterine atony and weakness, or in Chinese medicine terms, it treats Deficient conditi<;ms of the Uterus. According to Christopher,39 Leonurus is a tonic to the female reproductive system that can be used for uterine atony. Stimulant emmenagogue This is an emmenagogue that can initiate uterine contractions or promote the flow of blood from the uterus. This relates to the Chinese concept of mov-
ing Stagnant Blood in the Uterus. Tabemaemontanus, Gerard.c.·:= and Culpeper recommended motherwort to promote menstruation. and Lyle wrote that Leonurus is 'useful in amenorrhea and in dysmenorrhea when congestion is present:
Antispasmodic emmenagogue Stagnant Blood in the Uterus may result from Deficient Qi. from a lack of movement in the lower abdomen due to poor posture and lack of exercise. or it may be associated with uterine muscle spasms. Use of an antispasmodic emmenagogue can relax the spasms so that the Qi and Blood can flow freely through the channels. allowing normal uterine function. Both Gerard and Culpeper listed motherwort for difficult childbirth, and both Christopher and the BHP listed Leonurus as an antispasmodic. Christopher listed Leonurus for dysmenorrhea, and Gladstar listed it for pain from menstruation or childbirth. One important cause of spasms can be nervous tension so that the antispasmodic emmenagogue action can be linked to the tranquilizing action as discussed below. Links between cardioregulator and emmenagogue actions
Antidepressant and emmenagogue actions The Galenic sys- - ~, tern described by Culpeper viewed the heart as the seat of the vital spirit and of the natural affections of man. One form of what we would call depression was described as a languishing of the vital spirits or the afflicting of the heart by melancholy vapors. Herbs such as motherwort could be,; .' used to refresh the spirits and make them lively and active. .c-_ These actions could be described in Chinese medicine terms"as strengthening and moving the Heart Qi and Spirit to increase the emotion of joy. Culpeper linked the effects of motherwort on the heart to its effects on the female reproductive system when he said that this herb can settle the womb and make women joyful mothers of children. Ellingwood recommended Leonurus for uterine disorders., with depression (morbid sensibility). '''' r;o--.'
Tranquilizing and emmenagogue actions Later authors noted the special application of the tranquilizing effect of Leonurus on the heart to women's disorders. Ellingwoodc~' recommended Leonurus for dysmenorrhea with nervous excitability and for uterine disorders with depression (morbid sensibility), and Mabey listed it for postnatal anxiety.; ... Antidepressant and tranquilizing actions in menopause .... Tierra40 listed Leonurus for menopausal disorders.':aM Mab ey4\ listed Leonurus for menopausal anxiety. Mills'~g}'i_ Bone stated that Leonurus for the hot flashes and sweatiD.g ~f.."", menopause. and Gladstar included it in a combination for~ menopausal hot flashes. .:~
Leonurus I use Leonurus' as one of the main herbs for menopausal disorders. Its strengthening, regulatory, and calming effects on the cardiac, nervous, and reproductive systems make it specific for the treatment of the fluctuations of energy, body temperature, and mood common in menopausal disorders. Other actions Antipyretic Ellingwood listed Leonurus as a diaphoretic 'somewhat like Asclepias: Grieveu stated that Leonurus was a diaphoretic that was extremely useful for fever with nervousness and delirium. Potter's Cyclopedia recommended this herb for recovery from fever, and Christopher listed it as a diaphoretic for low fever, influenza, colds, and chills, and for recovery from debilitating fever. Julian Scott recommended its use in children's fever, as a tonic and to calm panic sensations. 43 Diuretic Tabernae~ontanus reported that Leonurus was used for urinary s~d and stones, and Gerard and Culpeper listed Leonurus as a diuretic.
Dermatological agent Moore recommended Leonurus for skin hypersensitivity. shingles, and herpes..w
COMPARISON OF WESTERN AND CHINESE USE OF LEONURUS SPECIES Heart disorders On of the two main uses of 1. cardiaca in the West is for physical and emotional manifestations of heart system imbalance. Traditional Chinese texts do not generally mention the use of yi mil cao (1. heterophyllus) as a cardiotonic, cardioregulator, antidepressant, tranquilizer, antihypertensive, or antianginal agent.
1 !
L::
Emmenagogue In Chinese tradition, the main use of yi mil cao is for disorders of the female reproductive system associated with Stagnation of Blood and Qi in the Uterus, such as irregular menstruation, scanty menstruation, infertility, premenstrual abdominal pain, dysmenorrhea, or postnatal abdominal pain associated with lochioschesis. Yl mil cao is not so much used for female disorders associated with Deficiency, as is 1. cardiaca in the West. 1. cardiaca has a tradition of use in the West for combined disorders of the heart and female reproductive system. This tradition does not appear to exist for yi mil cao. Diuretic Traditional Chinese texts list yi mil cao as a diuretic for edenia;'especially with blood in the urine, and modern Chinese research has reported the use of yl mil cao to treat edema associated with kidney disease. Although this is comparable with the old tradition of use of L. cardiaca for edema in the West, motherwort is no longer much used as a diuretic.
551
Dermatological agent In China, yi mil cio has been used since ancient times as an external application for itching skin disorders. 55 Yeung45 reported a traditional use of the herb as a detoxicant for purulent abscesses. Research has reported antibacterial and antifungal actions. Perry reported that the whole plant of 1. artemisia is used for genital bleeding with dryness, -l6 and yi mil cao has been successfully used in the treatment of urticaria. 41 In contrast, L. cardiaca does not have a strong tradition of use as a dermatological agent in the West.
References 1. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks, Glenwood, Illinois (1990) 2. Ellingwood F. American Materia Medica. Therapeutics and Pharmacognosy. 11th edn. (1919). Reprinted by Eclectic Medical Publications. Sandy. Oregon (1994) 3. Jiangsu New Medicine Institute. chiIiese Herbal Medicine Dictionary (Zhong yao da ci dian) Science and Technology Press, Shanghai. China . (1975) 4. Chang H-M, But PP-H (eds)~ Pharmacology and Applications of Chinese Materia Medica, vols. 1 and 2. World Scientific Publishing. Singapore (1986) 5. Gerard J. The Herbal or General History of Plants; The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publications, New York, New York (1975) . 6. van Eijk J1. Pharm Weekblad 87:38-41 (1952) 7. Gulubov AZ. Chervenkova VB. Plovdin Mat Fix Khim Bioi 8:129-132 (1970); article summarized in Chern Abstract 74:39177 (1971) 8. Weinges K. Kloss P. Henkels W-D. Liebigs Ann Chern 566-572 (1973) 9. Hagers Handbuch. Band V:483-486 [Tll) (1976) [cited in Bradley PR (ed). British Herbal Compendium. vol. 1. British Herbal Medicine Association. Boumemouth, United Kingdom (1992)) 10. NahrstedtA.Z Phytotherapie 6:101-109 (1985) 11. Malakov p. Papanov G, Jakupovic J et a1. Phytochemistry 24:2341-2343 (1985) 12. Reuter G. Diehl HJ. Pharmazie 25:586-589 (1979) 13. Kartnig T. Gruber A, Menzinger S. J Nat Prod 48:494 (1985) 14. Tschesche R. Diederich A. Jha HC. Phytochemistry 19:2783 (1980) 15. Xiyuan Hospital of the Academy of Traditional Chinese Medicine. Xinyiyaoxue Zazhi (J Trad Chinese Med) (7):57 (1978) 16. Coronary Disease Coordinating Research Group. Shanghai College of Traditional Chinese Medicine. Xinyiyaoxue Zazhi (J Trad Chinese Med) (10):68 (1980) . 17. Kuang PG. Zhou XF. Zhang FY et al. JTrad Chin Med 8:37-40 (1988) 18. Lee CM. Jiang LM, Shang HS et a1. Br J Pharmacoll03(3):1719-1724 (1991) 19. Benigni R. Capra C. Cattorini PE. 2:810-816 [Tl) (1964) [cited in Bradley PR (ed). British Herbal Compendium. vol 1. British Herbal Medicine Association, Boumemouth. United Kingdom (1992») 20. Bensky D, Gamble A. Chinese Herbal Medicine Materia Medica. Eastland Press, Scattle. Washington (1986)
552
Combining Western Herbs and Chinese Medicine
21. Chen Cx. Kwan CY. Life Sci 68(8):953-960 (2001)
35. HuS.Am J Chin Med4(3):219-237 (1976)
22. Cheng KF. Yip CS. Yeung HW et al. Experientia 35(5):571-572 (1979)
36. Felter HW, Lloyd JU. King's American Dispensatory. vols. 1 and 2, 18th' . .....
23. Shi M. Chang L. He G. Chung Kuo Chung Yao Tsa Chib 20(39):173-175 and 192 (1995) 24. Chan WC. Wong YC. Kong YC et al. Am (l983)
J Chin Med 11:(1-4):77-83
25. Yao YC et at J Trad Chinese Med (4):26 (1966) 26. Lin PS. JTrad Chinese Med (6):18 (l959) 27. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983) 28. Bradley PR (ed). British Herbal Compendium. vol. 1. British Herbal Medicine Association. Bournemouth, United Kingdom (1992) 29. Western Sichuan Institute of Health. Xi'nan Yaokan (Southern J Pharmacy) 2(1):233 (1952) 30. Lyle TJ. Physio-Medical Therapeutics. Materia Medica and Pharmacy. Originally published Ohio (l897). Reprinted by the National Association of Medical Herbalists of Great Britain, London. United Kingdom . (1932)
edn. (1898). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1983) 37. Priest AW. Priest LR. Herbal Medication. L.N. Fowler. Ro~ord.~--"~;;;~~ United Kingdom (1982) 38. Weiss RF. Herbal Medicine. English edn. Beaconsfield Publishers, . Beaconsfield. United Kingdom (l988) 39. Christopher JR. School of Natural Healing. BiWorid. Provo, Utah (1976) 40. Tierra M. Planetary Herbology. Lotus Press. Twin Lakes, WISCOnsin (1988) 41. Mabey R (ed). The Complete New Herbal. Elm Tree Books, London, United Kingdom (1988) 42. Grieve M. A Modern Herbal. vols. 1 and 2. Dover Publications, New York. New York (l971) 43. Scott J. Natural Medicine for Children. Unwin Paperbacks, London, United Kingdom (1990)
31. Kloss J. Ba~ to Eden. 5th edn. (1939). Reprinted by Lifeline Books. Santa Barbara. California (l975)
44. Moore M. Medicinal Plants of the Pacific West. Red Crane ~ks,
32. Gladstar R. Herbal Healing for Women. Fireside. New York, New York (1993)
45. Yeung H-CO Handbook of Chinese Herbs and Formulas. vol. l.lnstitute of Chinese Medicine, Los Angeles. California (1985)
33. Lonicerus A. Kreuterbuch (l679). Reprinted by Verlag Konrad Kolbl. Miinchen. Germany (1962)
46. Perry LM. Medicinal Plants of East and Southeast Asia. The MIT Press,
34. Tabernaemontanus IT. Krauterbuch (1731). Reprinted by Verlag Konrad Kolbl. Miinchen. Germany (1993)
47. Shanghai College of Traditional Chinese Medicine. Studies on Chinese Proprietary Medicine (4):47 (1980)
Santa Fe. New Mexico ( 1 9 9 3 ) ' :
Cambridge. United Kingdom (1980)
';'-,'
.. ';
Lobelia Botanical name Lobelia inflata L. Family Lobeliaceae (included in Campanulaceae) Pharmaceutical name Lobeliae herba Part dried aerial parts English lobelia German Lobelie French lobelie Mandarin L. inflata L. is not used; ban bian lian (.filL j{) is the entire plant. including the roots, of L. chinensis Lour.
ides,2 Lonicerus,3 Tabernaemontanus,-l Culpeper,s or Gerard.6
Other species In 1852, Clapp wrote that L. cardinalis has similar medical properties to 1.inflata but was much weaker and seldom used. 7 According to Felter and Lloyd, 1. cardi- _ nalis L. (red Lobelia) has been used as an antihelminthic, nervine, and antispasmodic, and L. siphilitica L (blue Lobelia) has been used as a diaphoretic, emetic, cathartic. diuretic. and antisyphilitic. However, the authors wrote in 1898 that these species were seldom used in medicine. Use in China According to the Chinese Herbal Medicine Dictionary,8 L chinensis Lour. (L. radicans Thunb.) is the species most commonly used as ban bian lian in China, mainly as a diuretic for edema and ascites, and also for treating skin disorders and poisonous bites. According to Perry, it is used as snuff to treat asthma in Thailand and to clean the blood and treat rheumatism or syphilis in Indochina.' .
Lobelia is on Schedule Part III of the Supply of Herbal Remedies Order 1977 of the UK, with maximum dose limitations. It is also included in the FDA (USA) document: Illnesses and Injuries Associated with the Use of Selected Dietary Supplements. In my opinion, this is a very useful herb, but it is not suitable for over-the-counter sales, and considerations of safety might suggest restriction ofits use to health practitioners qualified and licensed in herbal therapy. Please read the sections on Dose and Cautions in this chapter and the general discussion in the chapter on Safety.
Caution
f:
Lobelia: an underused herb Lobelia is an underused herb in most countries of the West, partly due to ignorance of the range and potency of its beneficial effects, and partly due to exaggeration of its toxicity. The range of Lobelia's beneficial effects is discussed throughout this chapter, and precautions to be taken in its use are discussed in the sections on Toxicology and Cautions.
Use in the West Lobelia inflata is an annual herb native to eastern North America. According to Felter and Lloyd,l it was known to the Penobscot Native Americans and was also extensively used by the people of New England long before Samuel Thomson popularized its uSe in the early 19th century. Lobelia was one of the most important herbs in both Physiomedical and Eclectic practice in the United States, but it was unknown in Europe before knowledge of its use was imported from America, and it is not mentioned in Dioscor-
CHANGING TRADITIONS OF USE Early use Lobelia was used. in high doses, as an emetic in
553
554
Combining Western Herbs and Chinese Medicine ...
_--~1"'::1-;
.--
..
the early 18th century and probably even before. In 1751, John Bartram listed a Lobelia (possibly L. siphilitica) for management of venereal disease. 1o Lobelia inflata was being used to treat asthma as early as 1810 and was introduced to the English medical profession by Reece in 1829. 11 Use by the Physiomedicalists and Eclectics By the late 19th century, Lobelia was one of the most valued herbs of the Physiomedical and Eclectic practitioners and was being used internally to treat a very wide range of disorders, including: • fever, pneumonia, pleurisy, asthma, bronchitis, whooping cough, sore throat • cardiovascular weakness, angina pectoris, hypertension, palpitations • spasms of the esophagus, nausea, indigestion, constipation, intestinal colic • dysmenorrhea, difficult labor • muscular spasms, convulsions, epilepsy, loss of consciousness • inebriation, poisoning • slow appearance of rashes in eruptive disorders Topical application included: skin rashes, sprains, injuries, neuralgias, rheumatism, and ear ache. Current European use Despite the transmission of information from America to England by the Physiomedicalists and Eclectics in the 19th century, the BHP of 1983 12 gave the impression that Lobelia has a narrow range of use in Britain, restricted to asthma and bronchitis, with topical application for rheumatic nodules. The BHC 13 gave a range of use only slightly wider than the BHP: asthma, chronic bronchitis, spastic colon, and spastic muscle conditions. In other European countries, such as Germany and Switzerland, the use of Lobelia remains minimal, often with an exaggerated view of its toxicity. A return to full range of use It is the aim of this chapter to present a wide range of uses for Lobelia and to encourage responsible practitioners in its use so that this most valuable herb can once again be of benefit to a greater range and greater numbers ofpatients. However, this chapter is aimed at qualified and registered health practitioners only, and indeed there are arguments for restricting the use of Lobelia to this group. Any prescription of Lobelia by practitioners should be based on a detailed knowledge of the cautions regarding its use; see Toxicology and Cautions.
What is special about Lobelia In terms of Chinese medicine, Lobelia can be said to be a variable-temperature herb, which can have warming or cool-
-'
ing effects, depending on the patient's condition. Its main -:=-=:~-o: taste property can be said to be acrid, mainly in the sense of . a counterirritant and partly to clear the surface. It has its main effect on the Lung, Intestines, Uterus, and Heart. 0
The key to understanding Lobelia is that, in lower doses, it can have a normalizing effeCt on certain functions ofthe body, especially on: • respiration rate • amount of bronchial mucus • tone and rhythm ofcontractions ofbronchial smooth muscle
The effects of Lobelia on the body are complex, involving a number of different interacting actions. Even the effects of just one of its constituents, lobeline, can be complex, involving opposite initial and later effects, and different reactions at different doses. See Research.
NORMALIZING EFFECTS OF LOBELIA Physiomedicalism and Y'm-Yang In a simplistic explanation of Physiomedicalism in terms of Chinese theory, it could be said that Lobelia represents Ym, whilst Capsicum represents Yang: Yang
Lobelia (relaxant)
Capsicum (stimulant)
°
Lobelia and Capsicum were often given separately, or combined in varying proportions, to restore the balance of function, that is, the Yin-Yang balance. Y'm and Yang effects of Lobelia Although Lobelia is Yin relative to Capsicum, it can manifest both relatively Yin and relatively Yang aspects: 00
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Yin
Yang
antipyretic antispasmodic antihypertensive tranquilizer anticonvulsant analgesic
counterirritant emetic respiratory stimulant antidepressant expectorant
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Lobelia can also help to normalize smooth muscle tone and rhythm of contraction in the gastrointestinal tract and the uterus. It can be used as an antispasmodic and analgesic in cases of chest pain due to heart disease, spasms of the limb muscles, and painful external injuries.
Yin
-,
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°
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Lobelia and the Y'm-Yang balance The oscillating balance between Yin and Yang can be expressed in Western medi-
Lobelia cine by the concept of homeostasis. A lack of homeostasis is manifested by a failure to maintain the changing balance within narrow limits, resulting in hypo- or hyperfunction, or a pathogenic alternation between these two extremes. Lobelia can have a normalizing effect and can be used in the treatment of either hypo- or hyperfunction to restore homeostasis, the Yin-Yang balance.
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Early concepts of the normalizing effects of Lobelia Using their own terminology, the Physiomedicalist and Eclectic practitioners of North America deVeloped a sophisticated understanding of the normalizing effects of Lobelia. In 1869, Cook wrote that Lobelia can equalize the circulation and relieve tension of the blood vessels, whether the case is one of inflammation or fever. By rela:cing the circulatory apparatus, Lobelia allows.a full outward flow of blood with diaphoresis. This results in greater softness and fullness of the pulse, with reduced heart excitability. Because of all this, the secretions of the skin, liver, and kidneys are reestablished. 14 In 1919, Ellingwood wrote the most perceptive description of the normalizing action of Lobelia. He said that Lobelia acts directly on the regulating centers of the system: those of heat, of the circulation, and ofthe motor and sensory nervous system. It normalizes blood pressure and treats either depression of function or overstimulation of function, restoring normal functioning in a smooth and harmonious manner. 15 Lobelia assists the vital force within the body to reassert itself and to regain control of the functions of every organ. According to Ellingwood, other agents may temporarily Whip up the force of one function or another, but Lobelia helps the body to assume control of the whole.. . In 1939, Kloss wrote that Lobelia is dual in its activity, being both a relaxant and a stimulant. He wrote that, in large doses, Lobelia relaxes and must be followed by a stimulant such as Capsicum. According to Christopher, Lobelia is a selective herb, selecting which way to go; he called it a 'thinkingherb: Influence of other herbs on the normalizing effects of Lobelia At first sight, it seems that hot and cold herbs can have opposite effects on Lobelia, for example, Asclepias having a Ym effect and Capsicum having aYang effect:
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• Asclepias is a cold herb that can emphasize the Y"m aspect of Lobelia, reinforcing its potentially cooling, relaxing, and calming actions so that it can treat fever, muscle spasms, and nervous stress • Capsicum is a hot herb that can emphasize the Yang aspect of Lobelia, reinforcing its potentially counterirritant, stimulant, antidepressant, and expectorant actions
555
However, in contrast to Capsicum, fresh Zingiber is a hot herb which can, in some ways, have a relatively Y"m effect on the actions of Lobelia. The diffusive diaphoretic action of Zingiber can help to disperse Interior Heat out through the surface of the body and to clear Exterior Wind invasion, thus emphasizing the potentially Y"m cooling action of Lobelia. Also, Zingiber can reinforce the potentially Y"m antispasmodic action of Lobelia to relax overcontracted muscles.
Yin in Yang and Yang in Yin Even though Capsicum has relatively greater central stimulant and relatively less outward diffusive action than Zingiber, it still has a dual nature. For example, under certain circumstances, Capsicum can be used as a circulatory equalizer to produce the Yin effect of reducing hypertension. Therefore, it might be more accurate to say that both Lobelia and Capsicum can have both Y"m and Yang effects. In Capsicum, the Yang effects usually predominate, whilst in Lobelia, the Ym effects are more common. However, whethe.r Y"m or Yang effects are manifested depends on the state of the patient and on the herbs with which Lobelia or Capsicum are combined. CHINESE ACTIONS
In terms of Chinese medicine, Lobelia, as used in the West, can be said to have six main actions:
I. clear Lung Phlegm n. regulate Lung Qi III. regulate Heart Qi and Blood IV. regulate Uterus Qi and Blood V. regulate Intestines Qi VI. topical WESTERN ACTIONS
The main Western actions of Lobelia are shown here in terms of its six main Chinese actions:
I. clear Lung Phlegm
antipyretic antispasmodic expectorant counterirritant
II. regUlate Lung Qi
antitussive antlasthmatic tranquilizer
III. regulate Heart Qi and Blood
antispasmodic antihypertensive tranquilizer
IV. regUlate Uterus Qi and Blood
antispasmodic tranquilizer
556
Combining Western Herbs and Chinese Medicine ·~r~~~~;;~-
movement of the following substances depends on nonnal~-_o~ tone and normal rhythm of contraction of smooth muscles: V. regulate Intestines Qi
antispasmodic laxative counterirritant tranquilizer
VI. topical
counterirritant anti-inflammatory analgesic
• air or mucus in the bronchioles • food in the stomach and small intestine • stool in the large intestine • blood in menstruation • fetus in childbirth
Some of the Western actions of Lobelia are discussed below under the following headings: • respiratory actions • normalizing effect of Lobelia on smooth muscle • antiemetic and emetic actions • counterirritant action Respiratory actions At lower therapeutic doses, as opposed to higher emetic doses. Lobelia can have a normalizing effect on respiratory function. especially on: . • respiratory rate • secretion and movement of bronchial mucus • tone and rhythm of contraction of bronchial smooth muscle Lobelia may have this normalizing effect via a number of mutually complementary potential actions:
If muscle tone is either hypo- or hypertonic, movement through the hollow structures may be reduced. If the muscle tone is hypotonic, the normal rhythm of contraction is less and movement is reduced. If the muscle tone is hypertonic, this may constrict the hollow structures, and this spasm may interfere with the normal rhythm of contraction. resulting in a reduction or cessation of movement. At lower therapeutic doses, as opposed to higher emetic doses, Lobelia can have a normalizing effect on the function of the bronchioles, gastrointestinal system, and uterus by ,. normalizing tone and rhythm of contraction in the smooth muscles. Some examples are shown in the table:
bronchial system
atonic bronchial tunction with accumulation of phlegm
bronchial spasms with asthma or spasmodic cough
stomach and small intestine
atonic digestion with poor appetite
intestinal colic
respiratory stimulant
it can increase the volume and frequency of respiration
large intestine
atonic constipation
spasmodic constipation, maybe with pain
stimulant expectorant
it may assist in the expulsion of phlegm by promoting the cough reflex and by increasing ciliary activity of the mucous membranes
uterus
delayed labor as a result of uterine atony
delayed labor as a result of uterine spasms
counterirritant and mucolytic
it may irritate the mucous membranes, stimulating increased production of a thinner mucus, making the phlegm more fluid and easier to expectorate
antitussive
it may reduce coughing by removing obstructing phlegm, reducing spasms, and calming nervous tension
bronchial antispasmodic
it can relax the bronchioles, facilitating expulsion of phlegm and allowing increased air flow
The first three actions are relatively more Yang and the last two are relatively more Ym. Two or more of these actions may combine together. and which actions are evoked will depend on the state of the patient Normalizing effect of Lobelia on smooth muscle
Normal
Antiemetic and emetic actions It has been reported that Lobelia has an antiemetic action at low doses, whilst it can have an emetic action at high doses. Counterirritant action The concept of the counterirritant action is discussed in detail in the chapter on Topical action. Lobelia can have irritant effect on the skin or the mucOUS membranes. This can stimulate local circulation and: • assist dispersal of accumulated wastes and toxins • reducing local inflammation • clear accumulation of phlegm and normalize mucous secretion This whole process, from the initial irritant effect to the reduction of inflammation or catarrhal congestion. is termed the counterirritant action.
.
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I Lobelia
557
LlinrtationsofLobelia
WESTERN USES
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The Western uses of Lobelia can be related to its six main Chinese actions: Chinese actions
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I, clear Lung Phlegm
acute respiratory disorders with fever. chronic respiratory disorders
II. regulate Lung Qi
asthma. cough
III, regUlate Heart Qi and Blood
angina pectoris. hypertension
IV. regUlate Uterus Qi and Blood
dysmenorrhea, pain in labor
V, regUlate Intestines Qi
abdominal pain. irritable bowel syndrome, constipation
I
VI. topical
rheumatism, sprains, neuralgias
TEMPERATURE Normalizing effect of Lobelia Lobelia can be said to be a variable-temperature herb that can have warming or cooling effects, depending on the patient's condition. A simpler view of Lobelia is that it is a neutral herb that can be used for neutral, warm, or cool conditions. Topical effects of Lobelia Lobelia can have an initial warming effect on an area of the body due to its local counterirritant and circulatory stimulant action. This is followed by an eventual cooling effect as improved local circulation and wound healing activity reduce local inflammation.
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TASTE DIRECTION OF ENERGY Lobelia tends to have a normalizing effect on the movements of energy in the body, unless it is taken in high doses, which can result in emesis. It can help to normalize the distribution of energy:
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• if disturbed energy has accumulated in the head or upper body, for example, in hypertension or convulsions • if smooth or skeletal muscles are in spasm, for example, in dysmenorrhea or spasms in the limbs • if there is topical stagnation of energy associated with inflammation. for example, in injury or skin disorder • if energy is not circulating sufficiently to the surface of the body, for example, in fever or cold hands and feet
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TYPICAL CASE EXAMPLE Signs and symptoms The patient has chronic bronchitis with weak cough, white sputum, weak breathing, and occasional dyspnea. She has irritable bowel syndrome and dysmenorrhea, often aggravated. by nervous tension. Her pulse is slippery, slightly wiry, and often flooding in the Lung position. Her tongue is pale, flabby, slighdy purple, with a thick white coat. Diagnosis The patient has Lung Phlegm, Lung Deficient Qi, Lung Stagnant Qi, and Disturbance and Stagnation of Qi of both the Intestines and Uterus.
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Choice of Lobelia Lobelia is chosen to stimulate respiration, clear phlegm, relax the bronchioles, and normalize the tone and rhythm of contraction of the smooth muscle of the intestines and uterus. Lobelia can also have a mild calming effect on the central nervous system to reduce the effect of nervous tension on bronchi, intestines, and uterus.
Lobelia has a priCkling sensation in the mouth and throat, rather than a burning sensation or spicy, pungent taste. Its main taste property can be said to be acrid. As an acrid herb, it can: • act as a topical counterirritant and circulatory stimulant • mildly clear the surface and help to expel Exterior.Wmd However, Lobelia is not a strong diaphoretic. such as fresh Zingiber. Neither is it a hot circulatory stimulant, such as Capsicum, or a Kidney Yang tonic, such as Cinnamomum bark.
ACTIONS Antipyretic In the time of the Physiomedicalists and the Eclectics, Lobelia was used extensively to reduce temperature in fever. This use has declined with the advent of antibiotic drugs. However, the combination of Lobelia and Asclepias can still be effective in treating fever associated with respiratory conditions, even when anubiotic drugs have had no effect or only limited success. Expectorant Lobelia is one of the most effective expectorants, and can be used, in suitable combination with other herbs, for bronchial phlegm conditions with either Phlegm Heat or Phlegm Cold, and with either Excess or Deficiency. It can be used to stimulate respiratory function or to relax spasms of the bronchi. Antiasthmatic Lobelia can be an excellent antiasthmatic and is specific for' bronchial spasms with phlegm. For allergic asthma or asthma associated with Wmd Cold invasion, Ephedra can be more effective, but the two herbs can be combined for increased effect.
-
Combining Western Herbs and Chinese Medicine
558
Antitussive Lobelia can be an effective antitussive in conditions of severe spasms. such as whooping cough or croup. If the cough is related to Deficient Y"m and Dryness. then Glycyrrhiza and Ophiopogon are more appropriate. although these herbs can be combined with Lobelia. Tranquilizer and antihypertensive Lobelia may have a calming effect but only in certain situations. It is not a general-purpose tranquilizer for insomnia and anxiety. such as Anemone. Passiflora. or Valeriana. Lobelia may have a secondary calming action in the treatment of respiratory fever. asthma. nervous spasmodic coughs, chest pain due to heart disease, dysmenorrhea. limb muscle spasms, or convulsions. It may be an antihypertensive mainly in the sense of equalizing the circulation, similar in some ways to the antihypertensive effect of Capsicum, with which it can be paired. . Antispasmodic and analgesic In addition to its ability to relax spasms in bronchial muscles, Lobelia can be used for chest pain-due to heart disease. intestinal colic, and dysmenorrhea, and for cramps and spasms in the limbs. It is only a secondary herb for chest pain due to heart disease. but it is a primary herb fo~ pain due to intestinal or uterine spasms. Counterirritant Lobelia can have a counterirritant effect internally on mucous membranes and topically on the skin. An initial irritant effect may result in stimulation oflocal circulatory and nervous supply, and may assist in wound healing, and in reducing local inflammation. infection. and pain. However, if a hot counterirritant is required, Capsicum, rather than Lobelia can be used.
Lobelia paired with other herbs Discussion of the limitations of each of the main actions of Lobelia can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Lobelia beyond its limitations. The basic unit of herb combination is the herb pair. Twelve pairings of Lobelia are briefly explained below. CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair.
medicalism, both herbs can have a diffusive and relaxant action. Of the two herbs. Asclepias is colder and more diffusive. whilst Lobelia is a variable-temperature herb, which can have a normalizing effect. instead of a diffusive action. Lobelia + Angelica archangelica
Acute or chronic bronchial phlegm Both herbs can have anticatarrhal, expectorant. and mild diaphoretic actions, and can be used for acute or chronic bronchial conditions with persistent, sticky phlegm. Angelica is a warming. drying herb. which can have circulatory stimulant and digestive tonic actions. It can therefore be used for chronic bronchial phlegm when this is associated with circulatory or digestive weakness. Lobelia is a stronger expectorant and antispasmodic so that it can be used for bronchitis with sticky phlegm and dyspnea. Lobelia + Thuja
Chronic bronchial phlegm Both Lobelia and Thuja can have counterirritant action. which can have an anticatarrhal effect. Compared to Lobelia, ,.. Thuja can have more of a stimulant action on the nervous system. heart, or uterine muscle. However. Lobelia is the - -, more powerful expectorant. This pair can be used for bronchial phlegm with cardiac weakness or for bronchial and general phlegm conditions combined with prostatitis. Lobelia + Ephedra
Asthma In my experience. Lobelia plus Ephedra is the most effective herb pair for asthma, providing the cautions for both herbs are observed. These two herbs are the foundation for my most successful asthma combinations. Both herbs are powerful bronchial antispasmodics and are specific for asthma. Lobelia has a moderating influence on the tendency of Ephedra to overstimulate the nervous system and also contributes its counterirritant expectorant action to the pair. Lobelia + Prunus Irritant or nervous cough This is an excellent pair for dry, irritant, or nervous coughs, usually with the addition of Glycyrrhiza. Both Lobelia and Prunus can have antispasmodic, antitussive. and tran- quilizing actions.
Lobelia + Asclepias
Acute respiratory disorders with fever Both herbs can have antipyretic, expectorant, antispasmodic, and tranquilizing actions, and can be combined for acute bronchitis, pleurisy. or pneumonia. In terms of Physio-
lobelia + Crataegus
Angina pectoris I use this pair to assist in the normalization of heart action and in the normalization of coronary and peripheral--
Lobelia circulation. This pair can be used to reduce chest pain resulting from heart disease and to treat hypertension. I
1- • --
Lobelia + Capsicwn
Topical for neuralgia and injuries This pair can also be used to assist in the normalization of circulation to reduce chest pain due to heart disease and to treat hypertension, often with the addition of Crataegus. Capsicum combined with Lobelia is specific to treat Lung Phlegm Cold patterns with cough, copious white phlegm, and sensations of cold. Lobelia and Capsicum can also be combined as a topical application to treat bruising and injuries with muscle pain and unbroken skin. Lobelia + Zingiber
Dysmenorrea with sensations ofcold !~
The addition of the diffusive diaphoretic fresh Zingiber to Lobelia emphasizes its diffusive and relaxant actions, whilst the addition of Capsicum emphasizes the stimulant action of Lobelia and moderates its potential sedative action on the nervous system. Zingiber and Lobelia can be combined as antispasmodics for either intestinal colic or dysmenorrhea with sensations of cold.
559
have anticatarrhal, astringent, antihemorrhagic, anti-inflammatory, and antimicrobial actions on the mucous membranes. Also, both herbs can help to normalize the tone of smooth muscles and the rhythm of smooth muscle contractions, such as those of peristalsis. Lobelia + Rheum
Constipation Lobelia can have a mild laxative action, which may be partly related to its counterirritant and local circulatory stimulant effects. It is often paired with Rheum, either for constipation cases with intestinal spasms or for moderating the potential cramping effect of Rheum. It is also used with Rheum in cases of irregular bowel action associated with nervous tension to normalize the bowel action. These two herbs are used together in the combination Rheum: chronic
constipation. HERBS THAT MODERATE THE POTENTIAL ADVERSE EFFECTS OF LOBELIA In some cases Lobelia can cause or aggravate nausea. In such cases, it may be helpful to combine it with a little Zingiber and/or Glycyrrhiza.
Lobelia + Mentha pulegiwn
Dysmenorrea with nervous tension These herbs can be paired to give a diffusive, antispasmodic, and tranquilizing effect in the treatment of intestinal colic or dysmenorrhea. Lobelia + Valeriana
Intestinal colic
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Both herbs can have an antispasmodic effect on both smooth and skeletal muscles so that they can be paired to treat dysmenorrhea, intestinal colic, or muscle spasms in the limbs. Both herbs can also have a tranquilizing action, although that ofValeriana is generally considerably stronger. These herbs were paired as anticonvulsants by the Physiomedicalists and Eclectics in the Antispasmodic tincture for cramps, spasms, convulsions, and epilepsy (see below).
Topical uses ofLobelia In my opinion, the main external use of Lobelia is as a lotion, compress, or oil for sprains, rheumatism, or neuralgia. I use an oil made from olive oil and powdered Lobelia and Capsicum, see Topical uses of Capsicum and the Cautions section for Lobelia.
Lobelia combinations Six Lobelia combinations for internal use are discussed below. followed by the old Physiomedical combination Anti-
spasmodic tincture: Combination·
.., Chinese syndromes ~,.;, ... --~
Lobelia + Hydrastis
Gastrointestinal disorders -'
Lobelia and Hydrastis were another favorite pair of the Physiomedica1ists for gastrointestinal inflammation, constipation, intestinal colic, dysmenorrhea, and difficult childbirth. Both herbs can affect the mucous membranes. Lobelia can have a counterirritant action on the membranes, which can stimulate local circulation and help to clear local condi.tions ofstagnation and accumulation of toxins. Hydrastis can
1. acute respiratory disorders + fever
Lung Phlegm Heat + Wind Heat
2. acute asthma
Lung Stagnant Qi
3. spasmodic cough
Lung Rebellious Qi
4. angina pectoris
Heart Stagnant Blood
5. dysmenorrhea
Uterus Stagnant Qi and Blood
6. intestinal colic + anxiety
Intestines Stagnant Qi + Intestines Qi Disturbance
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Combining Western Herbs and Chinese Medicine
560
Caution See Additional herbs chapter for cautions for~,-::::::
CAUTION
Before using any ofthe combinations below, it is important to be familiar with the cautions listed for each herb in the combination. 1. Acute respiratory disorders + fever
Lung Phlegm Heat + Wind Heat
Asclepias Echinacea Achillea Prunus Glycyrrhiza Lobelia Zingiber (fresh) 3
g
cold cool warm-cool neutral 4g neutral-cool 3g warm-cool 0.6 g* thin slices hot 6
6g 4g
bitter acrid, bitter, sl. sweet acrid, bitter bitter, aromatic sweet acrid acrid, aromatic
*The UK daily maximum dose for dried Lobelia is 0.6 g; see the Dose section '' in the Lobelia chapter.
Ephedra. In some cases. the side effects of Ephedra may be reduced by the addition of an equal portion of Schisandra, Passiflora, or Anemone to the combination, as appropriate. Nausea is a possible side effect of Lobelia. but this side effect is unlikely with the amount of Lobelia in this combination. especially since Glycyrrhiza and Prunus are also present. However. if nausea is present. this might be avoided by taking smaller, more frequent doses of the combination. As always. if there are any severe side effects specifically caused by the combination. the combination should be stopped and the incident recorded and reported. However, I have never had reports of severe adverse effects to this combination, when taken in the recommended dose. '
2. Acute asthma
Lung Stagnant Qi - . , , ..... -, ~
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Ephedra Lobelia Prunus Glycyrrhiza
1
1 1 1
warm warm-cool neutral neutral-cool
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3. Spasmodic cough
Lung Rebellious Qi ~:
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This combination is the same as Asclepias: acute respiratory disorders + fever and is discussed under that heading.
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Ratio "TelTlfle.ratllre._", ',:Ja.st~'·~;~~>:}>C~ aromatic bitter, aromatic acrid sweet
warm-cool neutral warm-cool neutral-cool
1 1 0.5-1 0.5-1
Thymus Prunus Lobelia Glycyrrhiza
This combination is the same as Thymus: spasmodic cough and is discussed under that heading.
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acrid, sl. bitter acrid bitter, aromatic sweet
GENERAL
This combination is for Stagnant and Rebellious Lung Qi associated with asthma. The overall temperature is slightly warm, but the combination can be used for warm, neutral, or cool patterns. and, with appropriate modification. for hot and cold patterns also. The dominant taste property is acrid.
4. Angina pectoris
Heart Stagnant Blood Temperature Taste'-'
Ratio
Herb
Crataegus Convallaria Leonurus Salvia mil. Angelica sin. Lobelia Cinnamomum (twigs)
sour. sweet bitter. sl. sweet sour sl. bitter, bitter sweet, aromatic, bitter acrid acrid, sweet. aromatic
sl. warm neutral neutral cool warm warm-cool warm
1 1 1 1 1
0.5 0.5
USE
• acute phase of allergic or bronchial asthma
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This combination is the same as Crataegus: angina pec-
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toris and is discussed under that heading.
PRACTICAL NOTES
This combination is most conveniently given as a tincture at doses of 2.5-5 ml in quarter of a glass of water, three times per day. Whilst the tinctures of the other herbs can be 1:5, as usual. the tincture of Lobelia should be 1:10 or 1:8. Children should be given reduced doses; see the chapter on
5. Dysmenorrhea
Dose.
Thymus Mentha pul. Viburnum Lobelia Zingiber (fresh)
This combination is for the acute phase only. for relief of wheezing. During a remission phase. or a mild chronic phase. a different combination should be given.
---
Uterus Stagnant Qi and Blood - ';...,; .. ;:O:~.~:~'::~ -'.-_.,
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3g 3g 3g 0.6 g*
warm-cool warm neutral warm-cool
3 slices
hot
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aromatic aromatic sl. bitter, sl. sour acrid acrid, aromatic .,
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Lobelia 'The UK daily maximum dose for dried Lobelia is 0.6 g; see the Dose section in the lobelia chapter.
This combination is the same as Thymus: dysmenorrhea and is discussed under that heading. ~ r~
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Herb
Ratio' Temperature Taste
Juniperus Foeniculum Mentha pul. Lavandula Lobelia Zingiber (fresh)
1 1 1 1 0.5 0.5
aromatic, sl. acrid, sl. sour aromatic, sl. acrid aromatic aromatic, bitter, 51. acrid acrid acrid, aromatic
sl. warm sl. warm warm sl. warm warm-cool hot
COMPARISON OF THE SIX
2. Acute asthma
Lung Phlegm Heat + Wind Heat
1 1 1 1 1 0.5 0.5
3. Combination No.3 is identical to combination No.2 except that Thymus has replaced Ephedra. This changes the emphasis of the combination from relieving bronchial spasms in asthma to clearing obstructing phlegm and relieving bronchial spasms in cough. Also, Thymus is somewhat calming' whereas Ephedra is a circulatory and central nervous system stimulant. 4. The role of Lobelia in combination No.4 is to assist Crataegus, Convallaria, and Salvia in moving Heart Qi and Blood, in relaxing muscle spasms, and in relieving chest pain. Lobelia also assists the calming action of Leonurus.
-
.
' . "
Asclepias Echinacea Achillea Prunus Glycyrrhiza Lobelia Zingiber (fresh)
5. Dysmenorrhea
6. Intestinal colic + anxiety -
Uterus Stagnant Qi and Blood
Intestines Stagnant Qi + Intestines Qi Disturbance
Lung Stagnant Qi ..
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Crataegus Convallaria Leonurus Salvia mil. Angelica sin.
LOBELIA COMBINATIONS
disorders + fever
L.",..
0.5-1 0.5-1
Intestines Stagnant Qi + Intestines Qi Disturbance
1. Acute respiratory
\
1 1
Lobelia Cinnamornurn (twigs)
This combination is the same as Juniperus: intestinal colic
~~
Thymus Prunus Lobelia Glycyrrhiza
6. Intestinal colic + anxiety
+ anxiety and is discussed under that·heading.
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561
6g 6g 4g 4g 3g
Herb . Epl)edra Lobelia Prunus Glycyrrhiza
Ratio 1 1 1 1
0.6 g 3 thin slices
1. Asclepias, Echinacea, Achillea, Lobelia, and Zingiber combine to dear Exterior Wind Heat, Retained Pathogen, Lung Heat, and Lung Phlegm Heat. Asclepias, Lobelia, Prunus, and Glycyrrhiza combine to relax bronchial spasms and reduce cough and chest pain.
2. Although three of the four herbs in combination No.2 are present in combination No.1, the presence of Ephedra gives .this combination a different emphasis. Ephedra and Lobelia combine to relax bronchial spasms and relieve acute allergic or bronchial asthma. 3. Spasmodic cough
4. Angina pectoris
Lung Rebellious Qi
Heart Stagnant Blood
Thymus Mentha pul. Viburnum Lobelia Zingiber (fresh)
3g 3g 3g
0.6g 3 slices
Juniperus Foeniculurn Mentha pul. Lavandula Lobelia Zingiber (fresh)
1 1 1 1 0.5 0.5
5. Combination No.5 combines Thymus with the warming sedative herb Mentha pulegium. Both herbs can warm and move Stagnant Qi and Blood in the Uterus. M. pulegium is more for dysmenorrhea or amenorrhea from shock or nervous tension. Thymus is more for dysmenorrhea or amenorrhea associated with Damp or Phlegm or dysmenorrhea associated with Damp Heat. Viburnum, Lobelia, and Zingiber have an antispasmodic effect on the Uterus. 6. Combination No 6 contains the antispasmodic group Mentha, Lobelia, and Zingiber in common with combination No.5. In this combination No.6, Juniperus, Foeniculum, and Zingiber combine as warming carminative herbs to move Stagnant Spleen and Intestine Qi and clear Intestines Phlegm Damp. Also, Mentha and Lavandula combine as calming antispasmodic herbs to treat the effect of nervous tension on intestinal spasms.
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Combining Western Herbs and Chinese Medicine
562
ANTISPASMODIC TINCTURE The following Lobelia tincture was beloved of Physiomedical practitioners from Fox16 to Christopher:!7 Ratio
Herb Lobelia Symplocarpus Scutellaria Cimicifuga Commiphora Capsicum
1 1 1 1 1
0.5
Temperature
Taste
warm-eool warm cool cool warm hot
acrid acrid bitter acrid, 51. bitter. 51. sweet bitter, acrid acrid
GENERAL
This combination was given by Christopher, but the combination and the wording that was used are identical to those of Wuliam Fox in 1878. In Chinese terms, the syndromes treated include Liver Wind, Disturbance of Heart Spirit, and Collapse of Qi. The antispasmodic and anticonvulsant effects of the first four herbs are balance.d by the warming circulatory stimulant action of Commiphora and Capsicum. The temperature balance is warm, and the predominant taste properties are acrid and bitter. USE
The indications given by Fox and by Christopher are lockjaw, epilepsy, convulsions, delirium tremens, fainting, hysterical attacks, fits, cramps, apoplexy, and 'suspended animation: PRACTICAL NOTES
The instructions from Fox and Christopher are: • for persons above twenty years of age: 1 teaspoon in half a cup ofwarm water, sweetened, three times per day (Fox) • for children: 10 drops in a tablespoon of warm water sweetened, as required (Fox) • for convulsions in babies: 1-2 drops on the tip of the finger put into the baby's mouth for infantile convulsions (Christopher)
OTHER LOBELIA COMBINATIONS Lobelia, like Capsicum, is included in many of the combinations of herbal therapists who have been influenced by the Physiomedical and Eclectic practitioners of North America. Sincethis includes the author, other combinations in this book that contain Lobelia include the following:
• Anemone: dysmenorrhea +fear • Asclepias: bronchitis + heat sensations • Capsicum: hypertension + heat sensations • Convallaria: angina pectoris + cold sensations
__ '_;'-o~~ .•·' '.
---.-'-'::,;-;:::'~
-
--- •. _.. • Lavandula: asthma + an;'Ciety • Piscidia: insomnia + muscle spasms • Rheum: chronic constipation • Rosmarinus: irritable bowel syndrome + cold sensations" • Thuja: chronic bronchitis + cardiac weakness • Viburnum: postnatal pain + bleeding • Zanthoxylum: muscle cramps + cold extremities
_--_.-
'--'-':o.:.=;_~.r~
....
-------'~--
~)
Research CONSTITUENTS • alkaloids • carboxylic acids • triterpenoid saponin Alkaloids Lobelia inflata contains 0.2-0.6% of piperidine alkaloids, principally lobeline, with smaller amounts of lobelanine and lobelanidine. l8 Many related alkaloids' have -.--been identified. l9 Carboxylic acids Chelidonic acid and ~,~-phenyloxypro pionic acid have been isolated. 20 Triterpenoid saponin ~-amyrin palmitate has been isolated from the leaves of L. inflata. 2\
PHARMACOLOGICAL AND CLINICAL RESEARCH The main active constituent of Lobelia appears to.be. lobeline. Possible mechanisms for the effects of lobeline are examined, followed by a discussion of the following effects that have been reported for extracts of Lobelia herb or for its pure constituents: • respiratory effects • hypotensive • sedative • central nervous system stimulant and antidepressant • learning effects • analgesic • anti-inflammatory • emetic • Ia.'mtive • antivenom • dermatological effects
"
• other Mechanism of lobeline The pharmacological effects'.i>f.~ , Lobelia inflata may be mainly associated with the piperidine>' alkaloid lobeline, which has some peripheral and ,central., effects similar to those of nicotine,22 though its strength has '
r-
r
Lobelia been reported to be only one twentieth to one fifth of the
It-
latter.
Range of effects Lobeline has been said to have an initial stimulant action. followed by an inhibitory action, on the autonomic nervous system, adrenal medulla, various centers of the medulla oblongata (especially the vomiting center), neuromuscular junctions, and chemoreceptors of the carotid and aortic bodies.23
Respiratory stimulant Within the therapeutic dose range,
-
•
lobeline acts on the chemoreceptors of the carotid body to . ul' · produce a re fl ex stirn atlOn 0 f teh respuatory cent er. 24.-'5 The strength of lobelanidine as a respiratory stimulant was reported as only half that of lobeline. 26 It has been reported that, in cats, the stimulation of the carotid body by lobeline has a greater effect on the activity of the hypoglossal nerve than on the activity of the phrenic or recurrent laryngeal neryes. 27
Calcium ion channel antagonist It has been reported that
•
lobeline inhibits the calcium current in cultured neurons from rat sympathetic ganglia. 28 At high concentrations, lobeline acts as a nonselective calcium channel antagonist, blocking pre- and postjunctional calcium ion channels.29
•
Norepinephrine release According to the same study, multi-
•
ple cellular mechanisms mediate the effect of lobeline on the release of norepinephrine. Lobeline showed a complex effect, which varied with dose and temperature. At lower concentration (10 IlM), it increased 3H-norepinephrine release. and at high concentration (100 and 300 IlM), the evoked release was abolished. Lobeline inhibited in dosedependent manner the uptake o£3H-norepinephrine into rat hippocampal synaptic vesicles and purified synaptosomes. 29
Nicotine agonist or nicotinic receptor antagonist? In the past, lobeline has been classified as a nicotine agonist, but more recent studies have suggested that lobeline does not act as a nicotinic agonist, but alters presynaptic dopamine storage by potently inhibiting dopamine uptake into synaptic vesicles. 30 It has been suggested that, in rats, lobeline is a shortacting antagonist of the nicotinic acetylcholine receptors that mediate the effects of nicotine on mesolimbic dopamine activity and locomotor stimulation.31 An in vitro study with rat material demonstrated that lobeline inhibits the effect of nicotine and suggested that lobeline acts as a nicotinic reA
l .
ceptor antagonist.32 Respiratory effects
Respiratory stimulant Lobeline produced an increase in the tidal volume and frequency of the respiration of seven mature healthy horses. All the horses tolerated the lobeline-
563
stimulated hyperpnea well, at doses of 0.15-0.3 mg! kg. 33 In twelve healthy calves, lobeline enhance~ ventilation in a dose-dependent manner, up to 0.25 mg/kg. The authors concluded that lobeline administration is a safe. and in fact the preferred, way of studying maximum ventilation in calves. 34
Bronchodilatory Lobeline has been described as an ~-adre nergic bronchodilator,3s and lobeline administered by inhalation was reported to reduce bronchial constriction caused by pilocarpine or acetylcholine. 36
Antismoking effect Oral administration of lobeline hydrochloride or sulfate has been used as a srpoking deterrent. However, two reviews of reports on the use of lobeline to assist in smoking cessation stated that there is no evidence from long-term trials that lobeline can aid in smoking cessation. 37.38 Hypotensive In anaesthetized dogs, L. radicans extract produced hypotension when administered by intravenous injection, but it took ten to twenty times the injected dose when the same extract was administered into. the duodenum.39 One report found that the intravenous injection ofL. radicans decoction at low dose produced a transient increasein blood pressure. 24 Another report found that high doses of L. radicans alkaloids resulted in a transient stimulant action on isolated frog and rabbit hearts, followed by cardiac depression. 4O Sedative One study reported that lobeline, at the time of maximal effect, produced in a dose-dependent manner motor impairment, decreased locomotor activity, and decreased body temperature in mice. 41 It has been reported that ~-amyrin palmitate, isolated from the leaves of L. inflata, may possess a sedative action in mice. It elicited a doserelated reduction in locomotor activity and antagonized locomotor stimulation by methamphetamine. 42 Central nervous system stimulant and antidepressant However, the same authors also reported antidepressant effects of ~-amyrin palmitate in mice, involving a release of 3H_ norepinephrine in mouse brain synaptosomes. By releasing norepinephrine from newly synthesized pools, ~-amyrin palmitate might activate noradrenergic activity.43 Rats treated for 3 weeks with lobeline sulfate showed an increased general activity in a one-arm radial maze. 44 Learning effects The effect of lobeline on the performance of learning and memory tasks may be similar to those of nicotine. Lobeline at doses between 1.9-19 Ilmollkg improved both memory and learning in rats.4S
-,
564
Combining Western Herbs and Chinese Medicine
,
---~~~~;~: - .. _-'l"!~.~.
_. - '.'-:~~-~¥
Analgesic Lobeline has been reported to show analgesic activity.41 In another study in mice, lobeline enhanced nicotine-induced antinociception in a dose-related manner.46 Anti-inflammatory Three new piperidine alkaloids isolated from L.laxiflora have shown anti-inflammatory activity in mice. 47 Emetic Intramuscular injection of lobeline caused vomiting in cats and dogs.-18 Laxative 1. radicans decoction was reported to produce a mild laxative action. 39 Antivenom 1. radicans preparations have been reported to have protective action against cobra venom. 49 Dermatological effects 1. radicans preparations have been reported to assist in the treatment of various skin disorders, including early stage carbuncles, tinea manuum and capitis, subacute eczema, and herpes zoster. 40 Other In vitro studies have reported that L. radicans decoction can have inhibitory action against some pathogenic fungi,SO and against Staphylococcus aureus and E. coli.sl In addition, intraperitoneal injection of 1. radicans decoction was reported to shorten bleeding time in mice. 21
COMPLEXITY OF LOBELIA EFFECTS Lobelia may have a wide range of effects on the central nervous system and on the neuromuscular, respiratory, cardiovascular, and other systems. The pharmacological mechanisms of the effects of the Lobelia constituents on these systems are complex, and the effects can be divided into: • initial or later effects • low dose or high dose effects • effects dependent on physiological or pathological state • effects of constituents other than lobeline Initial or later effect Research studies have reported lobeline to have an initial stimulant action followed by an inhibitory action. Clinical observations by Eclectic physicians have shown that, at doses high enough to produce emesis, Lobelia first produces strong emesis, accompanied by a prostration that is of short duration. This is then followed by a sense of ext!eme satisfaction and repose. Low dose or high dose effects In traditional use, for example, as reported by Ellingwood,15 Kloss,52 and Christopher, Lobelia can be a stimulant in small doses and relaxant in larger doses. Research indicates that lobeline can increase norepinephrine release at lower concentrations, whilst abol-
ishing the evoked release at high concentrations. It has also -:;~~:>~ J .. '""' .. .....,..,... been reported that ~-amyrin palmitate can initiate nOradrenergic activity by increasing release of norepinephrine (see above). Effects dependent on physiological or pathological state High enough doses of Lobelia can have effects even on healthy individuals. For example, lobeline can increase respiratory volume and activity even in healthy horses, and high doses of Lobelia or lobeline can induce emesis even in healthy animals or humans. However, as discussed in the section on Western actions, the direction of action of Lobelia, at therapeutic doses, can depend on whether the person has a hypo- or hyperfunctional pathology. For example, if the person has atonic bronchial function with accumulation of phlegm, Lobelia can have a stimulant action, but if the person has a hypertonic state, such as bronchial spasms with asthma or spasmodic cough, then Lobelia can have a relaxant action. Effects of constituents other than lobeline Most studies have been on lobeline rather than on preparations of Lobelia species or on other constituents. Although it may prove that lobeline is the most important active constituent, the pharmacological activity of 1. inflata is not limited to that of lobeline. The other piperidine alkaloids may also be of importance. For example, lobelanidine has shown activity similar to lobeline. The other alkaloids may have additional effects complementary or antagonistic to lobeline, so that the whole herb has a wider range of actions and a more balanced effect than lobeline as an isolated chemical. The isolation and study of ~-amyrin palmitate has shown that it is unwise to close the book on 1. inflata with an emphasis on lobeline. ~-amyrin palmitate itself appears to have complex effects on the central nervous system, including calming, stimulant, antidepressant, and learning enhancing activity. The multiple effects of ~-amyrin palmitate may combine with the multiple effects of lobeline and of the other active ingredients, to explain the diversity and complexity of the effects of the whole herb.
RESEARCH VERIFICATION OF TRADITIONAL ACTIONS From the research summarized above on extracts of Lobelia herb or isolated constituents, there is support for the following traditional actions: respiratory stimulant, bronchial antispasmodic, antihypertensive, tranquilizer, analgesic, emetic, antitoxin and antivenom, and dermatological agent. Additional effects demonstrated by research As discus-
Lobelia sed above, these include antimicrobial, anti-inflammatory, and enhancement of memory and learning. TOXICOLOGY Exaggeration of toxicity In the opinion of many herbal practitioners, there has been exaggeration of the toxicity of Lobelia inflata since the time of Thomson. 1898: Felter and Lloyd wrote that the emetic action of Lobelia is so quick and strong that the contained alkaloid could not produce fatality under normal circumstances. They wrote that if Lobelia were given in extremis, the resulting exhaustion from repeated emesis would very likely hasten death, but death would be more likely due to exhaustion from vomiting, than from poisoning. 1976: Christopher wrote that 'Lobelia may be given in either small or large doses, at shorter or longer intervals, and without any fear of harm to the system: 1978: HydeS) wrote in the Herbal Practitioner's Guide to the Medicines Act of 1968 that large doses of Lobelia present little hazard since copious vomiting follows vertigo and prostration.
"
~
[ b-
1988: Tierra s4 wrote that he had not found Lobelia to be toxic even when it was used in emetic doses; see Tradi-
tional sources. 1997: The editors of the Botanical Safety Handbookss wrote that they found no substantiated evidence ofsevere symptoms or death produced by Lobelia inflata.
565
of lobeline, 'result in respiratory depression, as well as sweating, rapid heart rate, hypotension, and even coma and death: It states that 'as little as 50 mg of dried herb or a single milliliter of Lobelia tincture has caused these reactions: However, it does not make clear which of these adverse reactions may be produced by Lobelia as opposed to lobeline or if these reactions were produced by intravenous or oral administration of lobeline. It is interesting to compare these statements with the report of the editors of the Botanical Safety Handbook that found no substantiated evidence of severe symptoms or death produced by Lobelia inflata.
Future statements on adverse effects It would be most helpful if the FDA or other bodies or indiviquals making statements on the reported adverse effects of a herb: • differentiated between the herb and isolated constituents • differentiated between oral and intravenous administration • gave full references to primary sources on statements made, enabling others to check the quality and applicability of the research or clinical reports Intravenous injection If Lobelia or lobeline are administered orally, there may be the built-in safety mechanism thatexcessive doses will rapidly result in vomiting, which will help to eject some of the lobeline from the system. If the lobeline is injected directly into the bloodstream, potentially toxic lobeline effects may be more rapid. This route of administration prevents the possibility of ejection of lobeline by emesis.
Lobelia herb
Isolated lobeline Administration oflobeline as an isolated chemical may have a quantitatively different effect from the administration of Lobelia tincture or decoction containing the same amount of lobeline, and research to quantify this difference would be most useful. The lobeline contained in Lobelia may be bound in a form not so readily available as the isolated chemical. Also, it is possible that the effects of lobeline may be moderated by the effects of the other active constituents.
Oral administration Chang and But reported in 1986 that
Adverse effects Overdose effects from intravenous injections
there were no significant toxic reactions from the oral administration of Lobelia radicans even after prolonged use.
oflobeline were reported to include tachycardia, conduction block, convulsions, vomiting, hypotension, and respiratory arrest. However, these reactions were described as generally transient. 2\
An important distinction made between the use of:
A careful distinction milst be
• oral administration of therapeutic doses of Lobelia as an infusion, decoction, or tincture • intravenous injections as opposed to oral administration • isolated components of Lobelia, such as lobeline
iIumanIatality . There was a report of a death following inhalation of a herbal asthma product containing Lobelia,56 but this product also contained Datura stramonium, which ,is a herb with higher potential toxicity than Lobelia.
FDA statements The FDA of USA has included Lobelia in its document'Illnesses and Injuries Associated with the Use of Selected Dietary Supplements: It notes that highe'r doses
. In a study on lobeline sulfate in rats, over a three week period, no changes were observed in weight, rectal temperature, tail-flick, and motor coordination. Intravenous injections of lobeline hydrochloride into humans at 12 !1g!kg, produced sensations of choking or pressure in the throat or upper chest. A dry cough appeared at 24.3 !1g1kg.s7 Injec-
566
Combining Western Herbs and Chinese Medicine
tions of lobeline of 37-73 J.lglkg in humans (equivalent to 2.2-4.4 mg of lobeline per 60 kg human) produced dosedependent sensations of respiratory discomfort in the throat and upper chest, but did not impair motor performance.58 Lobeline content of therapeutic doses of Lobelia According to the UK Schedule Part III, the maximum daily dose of dried Lobelia is 600 mg (three individual doses of 200 mg). Lobelia inflata has been reported to contain 0.20.6% piperidine alkaloids, see Constituents above. Assuming that there is approximately 0.2-0.5 % lobeline in a sample of dried Lobelia herb, then the recommended daily dose of approximately 600 mg of Lobelia would contain 1.2 to 3 mg of lobeline. In the study by Gandevia et al.,58 approximately 2 to 4 mg oflobeline per 60 kg human evoked transient respiratory discomfort, which is within the therapeutic dose range of dried Lobelia. However, these figures refer to intravenous injections of isolated lobeline, and as discussed above, this is not comparable to an equal quantity of lobeline, when administered orally in the form of Lobelia tincture, infusion, or decoction. Pregnancy There is a lack of research information on this important topic. A range of statements exists in the literature. Some texts, such as the BHC, simply contraindicated Lobelia in pregnancy, and some authors recommended it for the management of labor, but contraindicated it in pregnancy.59 However, I have not seen evidence to substantiate this contraindication. Christopher specifically recommended Lobelia for threatened miscarriage and included Lobelia in his Prenatal Tea, which he recommended in the last 6 weeks before birth. It is not clear why Lobelia has been contraindicated in pregnancy. It may be because it was thought to be a uterine stimulant. However, in my experience. Lobelia appears to function more as a uterine relaxant. It may also be because high overdoses of Lobelia may cause severe vomiting, which may weaken the mother or increase the likelihood of miscarriage.
Common sense I would suggest that health practitioners do not use Lobelia in pregnancy unless they: • are specifically trained and qualified in Western herbal medicine • observe the dose, screening, treatment precautions, and monitoring procedures outlined in this chapter • have previous experience in treating women's disorders • have previous experience with the use of Lobelia • have previous experience in treating the specific patient, with knowledge of her reaction to herbs
Dose Dried herb
UK Schedule Part III According to Schedule Part III of the Supply of Herbal Remedies Order 1977 of the UK, the maximum dose of dried Lobelia permitted to herbal practitioners is 200 mg, in infusion, three times per day. This is a total of 600 mg per day.
Herbal texts
In contrast to the Schedule III maximum dose, the BHP gave a dose of the dried herb of 0.2-0.6 g by infusion or decoction. three times per day, making a daily dose of 0.6- 1.8 g. Christopher recommended approximately 0.2-0.65 g of powder per dose.
This book Since I am currently practicing in the USA not the UK, and since I have long experience with the use of Lobelia, I sometimes use 0.5-1.5 g Lobelia per day, shortterm, for acute conditions only. However, this dose is for use by experienced qualified herbal practitioners only, and only if allowed by local regulatory laws. In the tables in this book for herb combinations including dried Lobelia I have put the maximum daily dose figure_ of 0.6 g (600 mg) derived from the UK Schedule Part III. Tmcture
UK Schedule Part III According to Schedule Part III of the Supply of Herbal Remedies Order 1977 of the UK, the maximum dose of tincture of Lobelia is: • 1.6 ml of 1:8 tincture, three times per day (total of 4.8 rol
per day) • 2 rnl of 1:10 tincture, three times per day (total of 6 rnl per day)
Herbal texts The BHP listed: .0.6-2 rnl of 1:8 Lobelia tincture in 60% alcohol, three times per day (total of 1.8-6 rnl per day) • 1-4 rnl of 1:10 Lobelia tincture in dilute acetic acid, three times per day (total of 3-12 rnl per day)
This book The doses given in this book for herbal combinations, including 1:10 Lobelia tincture, are within the maxi- ~ mum of 6 rnl per day of 1:10 Lobelia tincture required by UK Schedule Part III. For example, the combination Lobelia: acute asthma has equal ratios of four herbs. The ma.'cimumdose of this combination is 15 rnl per day. One quarter of this is Lobelia, that is 3.75 rnl, which is within the 6 rnl maximum daily dose required by UK Schedule Part III.
Initial dose It is best to start with a low dose and gr~dually increase the dose up to the maximum therapeutic level toler- __ ated by the patient or up to the maximum legal level in a particular country or state.
!'
Lobelia Duration Providing there are no side effects, Lobelia can be taken long-term. Mode of dispensing Lobelia can conveniently be dispensed as an infusion, but I generally prescribe it as a tincture or as a decoction.
Cautions These cautions apply to oral administration of the decoction or the tincture of Lobelia inflata by appropriately trained and qualified health practitioners. The use of lobeline as an isolated chemical, or intravenous injections oflobeline or Lobelia preparations, are outside the scope ofthis book. Western contraindications Whilst doses of Lobelia below normal therapeutic level may reduce nausea and may help debility, higher doses of Lobelia are not recommended for patients with a tendency to nausea and vomiting, or with debility. Chinese contraindications The Chinese Herbal Medicine Dictionary wrote that L. chinensis is contraindicated for any Deficiency syndrome. However, the relevance of this statement to Western therapeutic doses of L. intlata is doubtful, since the dose listed in Bensky and Gamble for L. chinensis is 7.5~ 15 g per day, as opposed to the UK Schedule Part III maximum dose of 0.6 g for L. intlata. Pregnancy and lactation Some texts contraindicate Lobelia in pregnancy, but whilst this appears to be without substantiation, I would suggest that health practitioners do not use Lobelia in pregnancy unless they fulftl the requirements discussion in Toxicology. I would not generally advise the use of this herb whilst breast-feeding. Ability to drive and use machines No adverse reports.
~
,~.~,~
.< <
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~.'
TREATMENT PRECAUTIONS The following precautions can be taken during treatment: • always start on the lower end of the dose range, and gradually increase this to the higher end of the dose range, and only if this is necessary • where appropriate, combine Lobelia with herbs likely to moderate any potential side effects of Lobelia, such as Zingiber, which tends to reduce nausea, or Capsicum, which tends to assist debility • reduce the dose or stop the administration of Lobelia if an adverse reaction develops during treatment; if the reaction is temporary, once gone, it may be possible gradually to raise the dose to its previous value
MONITORING During the course of an internal treatment that includes Lobelia, the patient should be monitored for any signs or symptoms of nausea, vomiting, headache, dizziness, or other side effects.
Regulatory status Please read the Regulatory status section in the chapter on Safety. Lobelia is on Schedule Part III of'the Supply of Herbal Remedies Order 1977 of the UK, with maximum dose limitations; see Dose. It is also included in the FDA (USA) document 'Illnesses and Injuries Associated with the Use of Selected Dietary Supplements: Lobelia intlata herb is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of AuStralia.
Overdose Vomiting, profuse perspiration, hypothermia, and hypotension: but see discussion in the Toxicology section.
In my opinion, this is a very useful herb, but it is not suitable for over-the-counter sales. Considerations of safety might suggest restricting its use to health care practitioners qualified and licensed in herbal therapy.
None known.
Traditional sources
SCREENING Before prescribing Lobelia, it should be determined whether the patient:
~',
• has a tendency to nausea or vomiting • is very debilitated • is pregnant or breast-feeding
Side effects Transient prickling or tight sensation in the throat, coughing, nausea, or even vomiting in susceptible individuals. Some individuals may have nausea even at low doses of Lobelia.
Interactions
~'::
567
• has ever had any side effects from previous treatment with Lobelia preparations
PROPERTIES Temperature
Ban bian lliin, the entire plant, including the
roots, of 1. chinensis, is classified as neutral in the Chinese
Combining Western Herbs and Chinese Medicine
568
~-·"'~,,-.·_~·.~--7·-':-:''I'-~.~-<.:'':'~:.
~.
;:;y
Herbal Medicine Dictionary. The aerial portion ofL. inflata is
organ'·' ExafTij:>les'of use· ,,:
classified in this book as a variable-temperature herb since it can have either warming or cooling effects, depending on the state of the patient:
Uterus
difficult labor dysmenorrhea
.Ellingwood Christopher
Liver
spasmodic affections of the limbs epilepsy, convulsions
Felter and Lloyd -
• warming for cases of cold extremities, pallor, and prostration • cooling for cases of high fever and inflammation Taste
c
..
-~:--- ;:._~
source·.-:·~:;;,~ti
.~.,..
Christopher
.
~~-;.
The Chinese Herbal Medicine Dictionary does not list meridians entered for L. chinensis.
Taste in the mouth Felter and Lloyd gave an excellent description of the effects of Lobelia if swallowed, to which I can attest. It gives an acrid, prickling, persistently pungent sensation in the throat, with slight nausea and a feeling of warmth and distension along the esophagus and in the stomach. The BHP described the taste as acrid.
Taste property L. chinensis (ban bian lian) is classified as sweet by the main source cited in the Chinese Herbal Medicine Dictionary, but one subsidiary text cited listed it as acrid. In this book, L. inflata, as used in the West, is classified as acrid in terms of Chinese medicine. The acrid property of Lobelia can manifest in one or more of three ways: • warms the interior, increasing circulation to the surface and periphery, for certain patterns of Interior Cold or Collapse ofYang • assists in bringing rashes to the surface and clears heat at the surface for certain patterns ofWmd Heat with Heat in the Blood or Heat Toxin • counterirritant effect, promoting local increase of circulation when applied topically for certain patterns of local Stagnation of Qi and Blood
ORGANS In terms of Chinese medicine, Lobelia, as used in the West, is associated mainly with the Lung, Heart, Stomach, Intestines, and Uterus, and, to a lesser extent, with the Liver:
Lung
asthma, bronchitis cough, croup, whooping cough
BHP Christopher
Heart
angina pectoris acute heart failure, tachycardia
Felter and Lloyd Ellingwood
Stomach
emetic antiemetic
Kloss Christopher
Intestines
atonic constipation, intestinal obstructions obstinate constioation
Felter and Lloyd Ellinl!Wood
ACTIONS See discussion on Changing traditions ofuse at the beginning of this chapter. . Evidence from the traditional sources for the following actions of Lobelia are discussed below: • respiratory effects . • antipyretic • cardiovascular effects • tranquilizer and anticonvulsant • antispasmodic and analgesic • laxative • emetic • antiemetic • diuretic • uterine antispasmodic • resuscitant • antitoxin • dermatological effects • other topical effects Respiratory effects
Lobelia has a variety of potential
effects on the respiratory system:
-t·,.,
• respiratory stimulant • stimulant expectorant • counterirritant • antitussive • bronchial antispasmodic The first three effects are relatively more Yang and the last two are relatively more Yin. Two or more of these effects may combine together, and which effects are evoked will depend on the state of the patient.
Respiratory stimulant The BHP listed Lobelia as a respira- '-_. tory stimulant, and this action is supported by modem research in that Lobelia increases the tidal volume and frequency of respiration.
Stimulant expectorant In 1878, Fox wrote that there is no medicine as effective as Lobelia in removing tough, hard,
Lobelia
-
569
and ropy phlegm from asthmatic and consumptive persons. Christopher and the BHP listed Lobelia as an expectorant.
Cardiovascular effects
Counterirritant Felter and Lloyd stated that Lobelia improves innervation and circulation to treat congestive conditions. They gave Lobelia for all chronic forms of sore throat, especially when it is ulcerated, and for irritation of the respiratory tract. Kloss said that Lobelia is specific for all conditions where there is a morbid condition of the mucous membranes.
prompt effect of Lobelia on angina pectoris has been known for 50 years or more. He recommended Lobelia for a sensation of weight, heaviness, tightness, and pain in the chest. Felter and Lloyd also listed Lobelia for angina pectoris and heart pain. Kloss noted the use of Lobelia for angina pectoris, heart pain, and oppression of the chest and difficult breathing. Christopher recommended Lobelia for angina pectoris, heart excitability and palpitations.
Antianginal Ellingwood, writing in 1919, said that the
Antitussive Felter and Lloyd listed Lobelia for dry, hard or barking coughs. Christopher recommended Lobelia for cough, croup, and whooping cough.
Bronchial antispasmodic According to Fox, Buder wrote in
i ~,
1810 that a tablespoon of acid tincture (presumably in vinegar) of Lobelia relieved his severe asthma within four minutes. According to Evans, Lobelia was recommended for asthma by Cuder in 1813. Ellingwood wrote that in spasmodic asthma, the benefits are almost immediate, but small doses are oflitde or no benefit. Christopher wrote that Lobelia is an effective antispasmodic for overcontraction of the esophagus, larynx, trachea, and bronchial passages. He recommended Lobelia for asthma and bronchitis. The BHP listed Lobelia as an antiasthmatic and antispasmodic fo~ asthma or bronchial asthma. Antipyretic
Normalizing action on temperature Ellingwood recognized a remarkable normalizing effect of Lobelia on the metabolism and temperature of the body. He noticed that it could be effective both in cases of extreme coldness and exhaustion. and in cases of profound heat stroke in which the temperature was 106°F and above.
Fevers Fox regarded Lobelia as an indispensable medicine ! I
h.,
_"
for fever. Kloss wrote that Lobelia can be used for the treatment of fever, such as pleurisy, pneumonia, peritonitis, hepatitis, meningitis, or nephritis. Both Kloss and Christopher recommended enemas of Lobelia with Nepeta for fever. Kloss gave the enemas morning and evening, even if the patient was delirious. Felter and Lloyd gave Lobelia for fever and colds, and Christopher listed Lobelia for colds and cold sweats. L. radicans is used in Chinese medicine for Heat Toxin patterns such as tonsillitis, and L. inflata was listed by Ellingwo
Acute respiratory conditions with fever Lyle60 recommended Lobelia, Asclepias, and Zinglber for pulmonary conges~on. Christopher included Lobelia in combinations for. acute bronchitis. pleurisy, and pneumonia. For example, he recommended an infusion of Lobelia and Asclepias for pleurisy.
Cardiotonic Ellingwood recommended Lobelia for heart conditions with feebleness or lack of tone or muscular power. However, he said that this herb should be used with caution in chronic heart disease with hyPertrophy, valvular deficiency, and other structural defects. Kloss wrote that when the heart becomes weak, Lobelia is a restorative, and following its use, the pulse becomes strong and natural. Christopher listed heart weakness as an indication for Lobelia.
Antihypertensive According to Ellingwood, Lobelia treats high blood pressure by restoring normality of cardiovascular function. Kloss noted its use for high blood pressure. Tranquilizer and anticonvulsant
Tranquilizer Ellingwood said that Lobelia can quiet the nervous system and treat hysteria. Kloss wrote that Lobelia is excellent for very nervous patients. Christopher listed lobelia as a sedative nervine for heart excitability, palpitations, nervousness, nervous dyspepsia, and hysteria. Anticonvulsant Ellingwood wrote that Lobelia, alone or combined with Capsicum, can be used for epilepsy, the convulsions of meningitis, hysterical conVulsions, eclampsia, or infantile convulsions. Christopher also recommended this herb, or the Antispasmodic tincture containing it, for epilepsy or convulsions. For infantile convulsions, he recommended 1-2 drops of Antispasmodic tincture on the tip of the finger and placed in the baby's mouth. Felter and Lloyd said that Lobelia has been used for the violent convulsions of strychnine poisoning. Antispasmodic and analgesic Ellingwood said that Lobelia can be used for spasms of all types; including asthma, whooping cough, tetanus, spasms of the glottis, abdominal cramps, and violent pains in labor due to spasms of the uterus. He said that Lobelia relieves pain due to spasms of any type, including pain from renal or biliary stones, because of its generally relaxing effect. Felter and Lloyd suggested Lobelia for infantile colic, and Christopher recommended it for spasms in the spine, muscles, chest, or genital
organs.·,··'.
570
Combining Western Herbs and Chinese Medicine
Laxative Stimulant, counterirritant, and antispasmodic effects combine to allow Lobelia to assist normalization of bowel muscle tone, peristalsis, and mucous membrane secretion. Felter and lloyd said that Lobelia increases peristalsis, and noted its use for intestinal atony, habitual constipation, intestinal obstructions, and fecal impaction.
ize uterine contractions and to reduce excessive spasms, rigidity, and pain. Christopher said that many births have been greatly eased by the use of Lobelia despite the mother's past history of difficult deliveries. I have had s.uccess with Lobelia combined with Hydrastis for delayed labor and painful uterine spasms.
Emetic One of the main uses of Lobelia, both by the Native Americans and the early Physiomedicalists, was in high doses as an emetic. Emesis was a standard and reputable herbal technique and was seen as cleansing to the body. According to Felter and Lloyd, Lobelia-induced emesis was accompanied by profuse perspiration and by short-lived prostration, and immediately followed by a sense of extreme satisfaction and repose.
Threatened miscarriage Christopher had an antimiscarriage combination, sometimes called False Unicorn and Lobelia combination, which consisted of just Chamelirium
Lobelia emetic for acute asthma Christopher used Lobelia as an emetic to relieve acute asthma attacks and to cleanse the system of phlegm and other obstructing or toxic materials. He taught that, when used as an emetic, Lobelia should' " be preceded by a stimulating tea, such as peppermint or cayenne. For a Lobelia emetic, Tierra recommended about two quarts of warm mint tea to be taken whilst administering Lobelia, and stated that he had good results with Christopher's Lobelia emetic treatment for acute asthma attacks. Tierra wrote that, on several occasions, he has given a teaspoon of Lobelia tincture, even up to three to four times in succession, every 10 minutes, to induce vomiting. There were no side effects after vomiting, and the patient felt calm and relaxed. Antiemetic For prompt relief from nausea or persistent vomiting, Ellingwood prescribed 10 drops of Lobelia in half a glass of water, with a teaspoon of this mixture taken every 10-15 minutes. Felter and Lloyd listed Lobelia for nausea, especially for an oppressive headache with nausea. Christopher recommended Lobelia in small doses for gastric irritation or vomiting. Diuretic The main use of L. radicans in Chinese medicine is as a diuretic for edema and ascites. It is interesting that L. cardinalis is listed by Felter and Lloyd for edema, and Ellingwood reported the use of L. inflata for anuria. Uterine antispasmodic Although Lobelia may have a normalizing effect on the uterus, its action seems to be more relaxant than stimulant.
Dysmenorrhea Christopher recommended Lobelia combined with Mentha pulegium for dysmenorrhea. Difficult labor According to Ellingwood, Felter and Lloyd, and Kloss, Lobelia can be most effective in labor to normal-
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and Lobelia. I have had success with Lobelia, combined with Vinca and Viburnum, for threatened miscarriage with cramping and bleeding. However, I would suggest that practitioners do not use Lobelia in pregnancy unless they have: • experience with treating women's disorders • experience with the use of Lobelia • previous experience in treating the specific patient, with a knowledge of her reaction to herbs Resuscitant Ellingwood reported the use of Lobelia for asphyxia and drowning, and for syncope from apopiexy or concussion. Kloss wrote that Lobelia can be used to normalize feeble circulation, with cold extremities and pale face. He also recommended Lobelia for severe shock. Christopher listed Lobelia for fainting and drowning. Lobelia is a key ingredient in the Antispasmodic tincture discussed in the Lobelia combinations section. Antitoxin An important action of L. radicans noted in Chinese medicine is to detoxify poisons. For example, it can be used internally or topically for snake bites or wasp stings. Ellingwood reported the successful use of L. inflata in severe poisoning by strychnine, ptomaine, alcohol, or toadstools. Dermatological effects For L. radicans, Chinese medicine lists clearing Heat and cooling the Blood. According to Felter and Lloyd, L. inflata was used in the treatment of eruptive disorders, such as chicken pox, measles, and scarlet fever, to encourage rashes to the surface when the rash is slow in appearing. The authors also recommended Lobelia as a local wash for rashes associated with eczema, urticaria, erysipelas, or herpes. Kloss listed Lobelia in combination with other herbs for abscesses, boils, and carbuncles. Christopher listed Lobelia for boils and for skin irritation from eczema, poison ivy, or poison oak. Other topical effects Felter and Lloyd recommended a liniment containing Lobelia and Capsicum and other herbs, for rheumatism and neuralgias. Kloss prescribed a hot poultice of Lobelia for external applications such as rheumatism. Christopher listed Lobelia for bruises, swellings, and rheumatism. For earache, he prescribed a few drops of warm
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Lobelia Lobelia tincture in the ear, which should then be plugged with cotton wool. For immediate relief of pain of an injury, such as a hammer blow on the finger, he recommended immediately soaking the injured part in Lobelia tincture.
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COMPARISON OF WESTERN AND CHINESE USE OF LOBELIA SPECIES
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The traditions of use of L. inflata in the West and of L. chinensis (ban biiin lian) in China are very different. Also, the Chinese daily dose of 7.5-15 g for L. chinensis is 12.5-25 times the daily dose of 0.6 g set by the UK Schedule Part III. The differences in use and dose suggest that there are definite chemical differences between the two Lobelia species. The main use of L. inflata in the West is as a stimulant expectorant, counterirritant, antitussive, and bronchial antispasmodic to treat respiratory disorders, such as asthma and bronchitis. The next main group of uses is as an antispasmodic for myalgia, angina pectoris, and intestinal and uterine pain. The antihypertensive, tranquilizer, and anticonvulsant actions are linked to the antispasmodic effects. None of these actions and uses are replicated in the Chinese tradition for L. chinensis. The main actions listed for L. chinensis are to promote urination, clear Heat and Heat Toxins, and cool the Blood. This herb is mainly used for edema and ascites, acute tonsillitis, sores with pus, damp rash, eczema, and poisonous bites (snakes, scorpions, bees, and leeches). In the West, L. inflata has had only minor use as a diuretic for edema and an antidote to poisoning.
References 1. Felter HW, Lloyd Ju. King's American Dispensatory, vols. 1 and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications, Sandy. Oregon (1983) 2. Dioscorides P. Kreutterbuch (1610). Reprinted by Verlag Konrad Kolbl, Munchen. Germany (1960) 3. Lonicerus A. Kreuterbuch (1679). Reprinted by Verlag Konrad Kolbl. Mlinchen, Germany (1962) 4. Tabernaemontanus JT. Krauterbuch (1731). Reprinted by Verlag
Konrad Kolbl, Mlinchen. Germany (1993) 5. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks, Glenwood. Illinois (1990) 6. Gerard J. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publications, New York, New York (1975) 7. Clapp A. Amer Med Assoc 5:689-906 (1852) 8. Jiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong 180 da ci dian) Science and Technology Press. Shanghai, China (1975)
571 9. Perry LM. Medicinal Plants of East and Southeast Asia. The MIT Press, Cambridge. United Kingdom (1980)
10. Crellin IK. Philpott I. A Reference Guide to Medicinal Plants. Duke University Press, Durham. North Carolina (1990) 11. Evans WC. Trease and Evans' Pharmacognosy. 14th edn. WB Saunders, London. United Kingdom (1996) 12. British Herbal Pharmacopoeia. British Herbal Medicine Association.
West Yorks United Kingdom (1983) 13. Bradley PR (ed). British Herbal Compendium, vol I. British Herbal Medicine Association, Bournemouth, United Kingdom (1992) 14. Cook WHo The Physio-Medical Dispensatory, Cincinnati (1869). Reprinted by Eclectic Press, Portland, Oregon (1985) 15. Ellingwood F. American Materia Medica. Therapeutics and Pharmacognosy. lith edn (1919). Reprinted by Eclectic Medical Publications, Sandy. Oregon (1994) 16. Fox W. The Working Man's Model Family Botanic G~de to Health. 7th edn. William Fox, Sheffield. United Kingdom (1878) 17. Christopher JR. School of Natural Healing. BiWorld, Provo, Utah (1976) 18. Karawya MS, Abdel-Wahab SM. Zaki AY. JAOAC 54: 1423-1425 (1971) [cited in: Bradley PR (ed). British Herbal Compendium. voll. British Herbal Medicine Association. Bournemouth, United Kingdom (1992») 19. Hagers Handbuch. Band V:551-559[Tlll (1976) 20. Benigni R. Capra C. Cattorini PE. 2:867-880 [TI) (1964) [cited in Bradley PR (ed). British Herbal Compendium. vol 1. British Herbal Medicine Association, Bournemouth, United Kingdom (1992») 21. Subarnas A. Oshima Y,Sidiketal.J Pharm Sci 81(7):620-621 (1992) 22. Reynolds EFJ (ed). Martindale: The Extra Pharmacopoeia, 31st edn. Royal Pharmaceutical Society, London. United Kingdom (1996) 23. Dipalma JR (ed). Drill's Pharmacology in Medicine. 4th edn. McGrawHill. p 713 (1971) 24. Feng GH et al. Chinese Medical Journal 44(11):1047 (1958) 25. Hansel R,Haas H. [T7](1984) [cited in:BradleyPR (ed).British Herbal Compendium, vol 1. British Herbal Medicine Association, Bournemouth, United Kingdom (1992) J 26. Wieland H et al.Arch Exp Path Pharm 92:195 (1922) 27. van Lunteren E, Haxhiu MA. Mitra Jet al. JAppl PhysioI56(3):737-745 (1984) 28. Toth PT. VIZi ES. Eur J PharmacoI363(1):75-80 (1998) 29. Santha E, Sperlagh B, Zelles T et aI. J Pharmacol Exp Ther 294(1):302307 (2000) 30. Teng 1, Crooks PA, Dwoskin LP. JNeurochem 71(1):258-265 (1998)' 31. Benwell ME. Balfour OJ. Br J PharmacoI125(6):1115-1119 (1998) 32. Miller DK. Crooks PA, Dwoskin LP. Neuropharmacology 39( 13):26542662 (2000) 33. Marlin DJ. Roberts CA. Schroter RC et al. Equine Vet J 32(3):200-207 (2000) 34. Bureau F, Coghe J. Uystepruyst CH et al. Vet J 157(3):309-314 (1999) 35. Bruneton J. Pharmacognosy: Phytochemistry Medicinal Plants, 2nd edn. Lavoisier. Paris (1999) 36. Sollmann T. A Manual of Pharmacology and Its Applications to Therapeutics and Toxicology. 8th edn. WB Saunders Co. pp 466-467 (1957) 37. Stead LF. Hughes JR. Cochrane Database Syst Rev (2):C0000124 (2000)
-572 38. Gourlay SG, McNeil
Combining Western Herbs and Chinese Medicine .~5~ 50. Sun QLet al. Chinese lournalofDermatology4(3):196 (1956) 7'::::'~::::::~~:=''i .
n. Med I Aust 153:699-707 (1990)
39. XingWRetal.Chinese Medical Journal 44(2):137 (l958) 40. Chang H-M, But PP-H (eds). Pharmacology and Applications of Chinese Materia Medica, vols. 1 and 2. World Scientific Publishing, Sing~pore (l986)
51. Lingling District Sanitation and Antiepidernic Station. Hunan Yiyao Zazhi (Hunan Medical Journal) (5):55 (1974)
53. Hyde F. Herbal Practitioner's Guide to the Medicines Act of 1968. New Herbal Practitioner 4(3) (1978)
42. Subarnas A, Tadano T, Oshima Yet al. J Pharm Pharmacol45(6):545550 (l993)
54. Tierra M. Planetary Herbology. Lotus Press, Twin Lakes, WISConsin
44. Sopranzi N, De Feo G, Mazzanti G et al. Clin Ter 137(4):265-268 (l991) 45. Decker MW, Majchrzak MI, Arneric SP. Pharmacol Biochem Behav 45(3):571-576 (1993) 46. Flammia D, Dukat M, Damaj MI et al. J Med Chern 42(l8):3726-3731 (l999) 47. Philipov S, Istatkova R, Ivanovska N et al. Z Naturforscb 6):311-317 (1998)
ICl
53(5-
48. Laffan R et al. JPharm Exp Therap 1~~(4):468 (l957) 49. Sixth Department, Hunan Institute of Medical and Pharmaceutical Industry. Chinese Traditional and Herbal Drugs Communications (2)34 (l979)
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52. Kloss I. Back to Eden, 5th edn (l939). Reprinted by Lifeline Books, Santa Barbara, California (1975)
41. Damaj MI, Patrick GS, Creasy KR et al. J Pharmacol Exp Ther 282(1):410-419 (1997)
43. SubarnasA, Tadano T,Nakahata N et al. Life Sci 52(3):289-296 (l993)
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(1988) 55. McGuffin M, Hobbs C, Upton R et al. American Herbal Products Association's Botanical Safety Handbook. CRC Press, Boca Raton, Florida (l997) 56. Mclaren G Br Med J 4(628):456 (1968) 57. Raj H, Singh VK,Anand A et al. J Physiol482(Pt 1):235-246 (l995) 58. Gandevia SC, Buder JE, Taylor JL et al. J Physiol 511(Pt 1):289-300 (l998)
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59. Denham A. Eur J Herbal Med4(3):19-28 ( l 9 9 9 ) ' - - ' ' ' -
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60. Lyle Physio-Medical Therapeutics, Materia Medica and Pharmacy~ .. Originally published Ohio (1897). Reprinted by the National Asso-' ciation of Medical Herbalists of Great Britain, London, United
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Myrica Botanical name Myrica cerifera L. Family Myricaceae Pharmaceutical name Myricae cortex radicis Part dried root bark English Bayberry German Wachsmyrte French arbre asuif Mandarin M. cerifera L. is not commonly used; yang mei (;fh~) is the root or stem bark of other Myrica species: see below
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Use in the West
Use in North America The main species used in the West is Myrica cerifera, which is an evergreen shrub native to the Eastern areas of North America, I from Canada to Florida.2 The herb consists of the dried root bark collected in the autumn. According to Crellin and Philpott, Palmer in 1696 may have been referring to M. cerifera, when he recommended a decoction of the roots for flux. In 1737, Bricknell noted the use of the root bark as a diuretic and to open obstructions, and in 1804, Barton promoted Myrica as an astringent. 3 Myrica was one of the main herbs used by Thomson and was an important herb for subsequent Physiomedical and Eclectic practitioners. It was used especially as a circulatory stimulant, anticatarrhal, and astringent. According to Fox,4 writing in 1878.bayberry is 'the best cleansing medicine ever discovered: Klosss wrote that it is 'one of the most valuable and useful herbs,' and Christophe~ said that 'bayberry and lobelia are considered by many as the most useful herbs in botanic medicine:
Use in Europe M. cerifera was not known in Europe before knowledge of its use was imported from the United States and it is not mentioned in Dioscorides,7Lonicerus,8 Tabernaemontanus, 9 Culpeper, 10 or Gerard. 1I Other Myrica species According to Foster and Duke,12 M. gale L. (sweet gale), and M. pensylvanica Lois!. (bayberry) have similar uses as M cerifera. Michael Moore l3 listed similar uses for M. californica (California wax myrtle, Pacific bayberry), although he wrote that M. cerifera, when recently collected, is more warming and contains more myricinic acid resin than M. californica.
Potential confusion According to Grieve, H the name 'bay_ berry' has been used as a synonym for Pimenta acris (P. racemosa), otherwise known as wild cinnamon or West Indian bay, which in the past was used to produce 'bay rum' and 'oil of bayberry.' Use in China The main species used in China are:
• yang mei gen root of M. rubra Sieb. et Zucco • yang mei shu stem or root bark of M. esculenta Buch.Ham. There seems to have been a history of use of the Myrica species according to the principles of traditional Chinese medicine, but mainly in the Southern provinces. There is a lack of uniformity of opinion on the properties of Myrica (see Traditional sources), and a large proportion of the entries in the Chinese Herbal Medicine Dictionary simply seem to mirror Western traditional uses. lS This suggests that Myrica
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has not been a primary herb in traditional Chinese medicine. The uses listed by Perry16 for M. rubra Sieb. et Zucco in Japan and China closely resemble the uses of M. cerifera in the West. According to Perry, a decoction of the bark of M. rubra has been used for stomach disorders, as a strengthening diuretic, as a cardiac tonic, and as an astringent for dysentery or for wounds and ulcers.
What is special about Myrica In terms of Chinese medicine, Myrica cerifera can be said to be a warm, acrid, sour, and bitter herb that can have effects on the Stomach, Intestines, Liver-Gallbladder, Heart, Lung, and reproductive systems.
The key to understanding Myrica is that it can act as a mild circulatory stimulant, a mild digestive tonic, and as a warming anticatarrhal astringent. In Chinese medicine terms, it can be said to warm and move Qi and Blood, to clear Phlegm and Cold, and to act as an astringent herb to reduce diarrhea or bleeding.
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Liver and Gallbladder Qi, especially when it is associated with obstruction by Phlegm and Cold. Warm and astringe the Intestines
Myrica can be used to
treat: . __ ..
Astringe discharges and reduce bleeding
Myrica can act
as: • a warming, anticatarrhal, astringent to reduce discharges, such as leukorrhea associated with Cold, Deficiency, and Phlegm • an astringent and circulatory stimulant to heal chronic ulcers • a warming antihemorrhagic to treat excessive uterine bleeding associated with Deficiency and Cold
WESTERN ACTIONS
In terms of Chinese medicine, Myrica, as used in the West, can be said to have six main actions:
The main Western actions of Myrica are shown here in terms of its six main Chinese actions:
warm and moves Qi and Blood clear Lung Phlegm Cold warm, tonify, and move Spleen and Stomach Qi warm, tonify, and move Liver and Gallbladder Qi warm and astringe the Intestines astringe discharges and reduce bleeding
Warm and move Qi and Blood Myrica can not only warm and move the Qi and Blood in the channels, it can also help to clear obstruction of the channels by Phlegm, Damp, and Cold. This can help to warm the surface and interior of the body, the extremities, and the muscles and joints. Clear Lung Phlegm Cold Myrica can assist the dispersing function of the Lung to clear acute Wind Cold or chronic accumulation of Phlegm and Cold in the sinuses or bronchi. Warm, tonify, and move Spleen and Stomach Qi Myrica can act as a warming bitter tonic to the digestive system to treat Deficiency and Stagnation of Spleen and Stomach Qi, especially when it is associated with accumulation of Phlegm and Cold. Warm, tonify, and move Liver and Gallbladder Qi The acrid, bitter, and sour constituents of Myrica may each con-
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• acute diarrhea associated with Cold • chronic diarrhea associated with Cold and Phlegm • chronic diarrhea associated with Spleen Deficient Qi, Sinking of Spleen Qi, and Cold
CHINESE ACTIONS
I. II. III. IV. V. VI.
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Chinese actions I. warm and move Qi and Blood
circulatory stimulant mild warming diaphoretic antirheumatic
II. clear Lung Phlegm Cold
mild warming diaphoretic warming anticatarrhal
III. warm, tonity, and move Spleen and Stomach Qi
warming bitter digestive tonic warming anticatarrhal
IV. warm, tonity, and move Liver and Gallbladder Qi
warming bitter hepatic tonic warming anticatarrhal
V. warm and astringe the Intestines
warming astringent warming anticatarrhal
VI. astringe discharges and reduce bleeding
warming astringent warming anticatarrhal warming antihemorrhagic vulnerary
WESTERN USES The main Western uses of Myrica can be related to its six main Chinese actions:
Myrica
I. warm and move Qi and Blood
II. clear Lung Phlegm Cold
recurring influenza, recurring sinusitis, chronic bronchial phlegm
III. warm, tonify, and move Spleen and Stomach Qi
poor appetite and weak digestion with cold sensations
IV. warm, tonify, and move Liver and Gallbladder Qi
digestive weakness, lethargy, depression, cholecystitis with sensations of heaviness and cold
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low body temperature, cold extremities, myalgia or rheumatism aggravated by cold
V. warm and astringe the Intestines
acute or chronic diarrhea with debility and sensations of cold
VI. astringe discharges and reduce bleeding
slow-healing ulcers, leukorrhea, sore throat, menorrhagia
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Chronic fatigue syndrome Myrica can be useful in cases of chronic fatigue syndrome or fibromyalgia with one or more of the following manifestations:
575
The pulse is slow, empty, and slippery. especially in the Spleen and Lung positions. The tongue is pale and flabby. . with a thick, white. greasy coat. Diagnosis
The patient has:
• Qi and Blood Stagnation in the channels with accumulation of Cold • Lung Deficient Qi with Phlegm Cold in the Lung • Spleen Deficient Qi with Phlegm Cold in the Intestines Choice of Myrica This herb is specific for sensations of cold in the interior, at the surface, and at the extremities. although it is usually used in combination with more strongly warming herbs such as Capsicum or Zingiber. Myrica is a warming stimulant anticatarrhal. which is specific for acute or chronic patterns of Phlegm Cold. Myrica can also act as a warming. anticatarrhal astringent to treat mucus in the stools or as a warming antihemorrhagic to treat bleeding hemorrhoids associated with Deficiency and Cold.
Limitations ofMyrica
• low body temperature and poor circulation • myalgia aggravated by CQld and damp • recurring catarrhal conditions, such as sinusitis or
TEMPERATURE
bronchitis • chronic digestive weakness and loose stools with
Myrica is a mildly warming herb. which needs to be combined with hotter herbs such as Capsicum or Zingibei' to treat cold conditions.
sensations of cold
IGT Topical use This herb can be most effective in the treatment of slow-healing ulcers, as discussed in Topical uses ofMyrica below. The circulatory stimulant and astringent actions of Myrica may combine to produce this topical healing effect
TASTE
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DIRECTION OF ENERGY
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Myrica has mild circulatory stimulant and mild diffusive diaphoretic activity that dir~cts the movement of Qi and Blood outward to the surface of the body. However, its main effects are usually in the Interior of the body as a warming anticatarrhal, astringent, or antihemorrhagic.
Sour and bitter Myrica can be said to be sour in the sense of being an astringent and antihemorrhagic, and bitter in the sense of being a mild stimulant to the digestive and hepatobiliary systems.
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TYPICAL CASE EXAMPLE Signs and symptoms The patient is pale and overweight, with sensations of cold, especially at the surface of the body and the extremities. The patient also has chronic sinus and bronchial phlegm; recurring influenza with sensations of cold and aching in the muscles, and nasopharyngeal catarrh; a tendency to diarrhea with mucus in the stools; and occasional bleeding hemorrhoids.
Acrid Myrica can be said to be acrid in the sense that it can have mildly warming action both at the surface and in the Interior.
ACTIONS Diaphoretic Myrica is only a mild diaphoretic and is usually used for this purpose in combination' with stronger diaphoretics, such as Capsicum or Zingiber. Circulatory stimulant Myrica has a tradition of use as a mild circulatory stimulant, which can help to warm the body, especially at the surface. It is usually combined with stronger circulatory stimulants, such as Zanthoxylum. Tonic Myrica has a tradition of use to strengthen atonic mucous membranes. It can also act as a mild tonic to the
Combining Western Herbs and Chinese iYfedicine
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digestive and hepatobiliary systems, but this tonic action is of secondary importance to its anticatarrhal and astringent actions. Anticatarrhal Myrica is an important anticatarrhal for the upper respiratory, gastrointestinal, hepatobiliary, and reproductive systems. It is a warming, stimulant herb, which can be used for cool patterns. For cold patterns, it needs to be combined with hotter herbs. It is not appropriate for hot conditions, although it can be combined with cool anticatarrhals, such as Hydrastis, to treat warm conditions. Myrica is an anticatarrhal, but it does not have general use as an expectorant. Myrica may need to be combined with expectorant herbs, such as Euphorbia or Marrubium, if a combination of astringent and expectorant actions are required. Astringent and antihemorrhagic Myrica is an important astringent and antihemorrhagic because it is a warming, mildly stimulant herb, which can be used for patterns of discharge or bleeding involving Deficiency and Cold. However, its astringent and antihemorrhagic effects are usually strengthened by combining it with other astringent herbs, such as Potentilla or Quercus. For warm or hot patterns of discharge or bleeding, it can be replaced by cooling astringents, such as Sanguisorba. Topical Used as a finely powdered single herb, Myrica is specific for slow-healing ulcers because of its combination of astringent and stimulant properties. It can also be effective for mouth, gum, and throat problems, usually combined with other herbs, such as the powerfully counterirritant Capsicum or the strongly antimicrobial Commiphora.
Myrica paired with other herbs Discussion of the limitations of each of the main actions of Myrica can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Myrica beyond its limitations. The basic unit of herb combination is the herb pair. Twelve pairings of Myrica are briefly explained below.
a stronger diaphoretic than Myrica, with which it can be.:.~~:: paired to emphasize the circulatory stimulant and diaphor- :.~~ etic actions of this herb. Myrica contributes anticatarrhal and astringent actions to the pair, which can be used for _... chronic low body temperature aggravated by exposure to cold.
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Myrica + Zingiber
Influenza Capsicum and Myrica can be used for sensations of cold in the interior and at the exterior of the body. Zingiber and Myrica are more specific for sensations of cold at the surface of the body associated with influenza of the Wind Cold type. Myrica + Zanthoxylum
Cold extremities If Capsicum primarily treats cold in the interior and Zingiber cold at the surface, Zanthoxylum is more for cold in the limbs and extremities. Also, both Zanthoxylum and Myrica can have anticatarrhal effect to treat disorders ranging from catarrhal deafness to rheumatism associated with Phlegm and Damp in the channels. Myrica + Sanguinaria
Depression + indigestion Both herbs have circulatory stimulant and anticatarrhal action. Sanguinaria also has antispasmodic action, enabling this pair to be used for bronchial and nasal catarrh in patients . ".~:'.;"", with poor circulation. Snuff made from a fine powder of these two herbs can be used for sinus congestion. Both of these herbs were mentioned by the Eclectics to treat sluggish liver function and to clear catarrhal obstruction of the bile ducts. They can be used for the pattern of Liver Stagnant Qi with Cold and Damp, with lethargy, depression, and impaired digestion. Myrica + Thuja
Prostatitis Like Sanguinaria, Thuja can be used for bronchitis with cardiac weakness. However, in combination with Myrica, it can be also be used for prostatitis associated with accumulation of Phlegm in the urinary and reproductive systems.
CAUTION
Myrica + Angelica archangelica
Before using any of the herb pairs below, it is important to . be familiar with the cautions listedfor each herb in the pair.
Influenza + sinus congestion
Myrica + Capsicum
Low body temperature Capsicum is a stronger central circulatory stimulant and
Both Myrica and Angelica are anticatarrhal herbs with mild diaphoretic and circulatory stimulant actions, although Angelica is more drying than Myrica. Therefore, this pair can be used for influenza with sinus congestion associated with Cold, Damp, and Phlegm. Since Angelica is both an
Myrica
j
expectorant and antispasmodic. these herbs can also be combined for chronic bronchitis with poor peripheral circulation. Angelica is also a bitter digestive tonic and aromatic carminative. Accordingly. Angelica and Myrica can be combined for loss of appetite or obesity from Spleen Deficiency and Stagnation associated with Damp and Phlegm.
577 Myrica + Commiphora
Gingivitis Both herbs are warming, circulatory stimulant, anticatarrhal astringents. which can help in wound healing. Commiphora is also antimicrobial. and the two herbs can be combined as a gargle for mouth ulcers. gingivitis. and pharyngitis.
Myrica + Phytolacca
Chronic nasopharyngeal catarrh Both herbs can have anticatarrhal action. and Myrica and Phytolacca can be combined for chronic nasopharyngeal catarrh or for rheumatism associated with Phlegm and Damp obstructing the channels. Phytolacca is not a warming circulatory stimulant like Zanthoxylum. but is specific for inflammatory conditions of the lymph system. Myrica + Polyg~num
Mucous colitis Myrica is a warming. stimulant. anticatarrhal astringent. and Polygonum is a cooling. demulcent, anticatarrhal astringent. The two herbs complement each other in the treatment of diarrhea or colitis with inflammation and oversecretion of mucus. Myrica + Hydrastis
-,.
Leukorrhea
!
c:=;-
..
Myrica is a warming, stimulant. anticatarrhal antihemorrhagic. and Hydrastis is a cooling. antimicrobial. anticatarrhal antihemorrhagic. The two herbs complement and balance each other in the treatment of intestinal or uterine .disorders with bleeding and discharge. Myrica and Hydrastis can also be combined as a snuff for nasal congestion. Myrica + Urtica
f
Menorrhagia
&
Urtica can have anticatarrhal. anti-inflammatory and
I
antihemorrhagic actions. It can be combined with Myrica to treat acute or chronic conditions of the sinuses. intestines. or uterus with inflammation. mucous discharge. or bleeding.. Myrica + Potentilla
Diarrhea Potentilla is a strong general-purpose astringent for diarrhea or bleeding. The warming. stimulant. astringent Myrica can be combined with Potentilla to treat diarrhea. dysentery. melena. leukorrhea. or menorrhagia when these disorders are associated with Cold.
Topical uses ofMyrica Slow-healing ulcers This herb can be most effective in the treatment of slow-healing ulcers. Finely powdered Myrica can be dusted on the surface of the ulcer to cover its entire surface; a light bandage is then applied. If on later inspection. the crust of powder has broken and there is renewed oozing. additional Myrica can be dusted over the oozing area and a new bandage can be applied. This can be successful even for large oozing ulcers in the elderly. and the topical application of Myrica can be accompanied by prescription of an appropriate Myrica combination to be taken internally. Nasal catarrh The finely powdered bark can be used as snuff for nasal catarrh and nasal polyps. either by itself or combined with Hydrastis and/or Sanguinaria. However. I find that Myrica powder can give lasting relief from sinus obstruction in some patients. but it gives only temporary relief in others. In some patients. it may even result in dryness of the sinuses. Gargle for mouth and throat disorders An infusion. decoction. or diluted tincture of Myrica can be used to make a rinse or gargle for spongy or bleeding gums. or for a sore or ulcerated throat. However. I generally prefer Commiphora for tooth and gum disorders. and Salvia and/or Capsicum for throat disorders. Douche for leukorrhea A decoction or infusion of Myrica at body temperature can be used to cleanse and tone the vaginal membranes to treat leukorrhea.
Myrica combinations Six Myrica combinations for internal use are discussed below:
1. chronic fatigue syndrome + cold extremities
Stagnant Qi and Blood + Deficient Qi and Blood
. ~t;;;ii
--=-=-
._~\i..~
Combining Western Herbs and Chinese Medicine-~~~J1.'
578
C6~b'i';;atib'ri-:-:'::::-:-:::'::--- - 'h--··ctiirieie:-sy;;ci"r6:m~s:·:~':-::: Lung Phlegm Damp + Spleen Damp
2. sinusitis + obesity
be-~.
three times per day. Drops of 1:5 Capsicum tincture can added from a separate bottle. It can be taken, with appropri- . -'::;~ ate cautions, breaks, and modifications for' one to several weeks.
Liver Stagnant Qi + Cold + Damp and Phlegm '
Caution This is a warming combination, and if the patient has Deficient Ym, in addition to Deficient Yang, this combi-
4. colitis + mucus in stools
Intestines Phlegm Damp + Spleen Deficient Qi
5. chronic diarrhea +
Spleen Deficient Qi + Spleen Qi Sinking
nation may aggravate signs of Deficiency Heat. The patient must therefore be monitored for increased redness of the tongue and for increased restlessness or uncomfortable sen-
3. depression + digestive disorders
digestive weakness
6. menorrhagia + cold
Spleen not holding Blood Cold
sensations
~u~~ -:;i7'~~~-
-
-
-~-
.
sations of heat.
- ,,' ',,'f-;r-
+
2. Sinusitis + obesity
Lung Phlegm Damp + Spleen Damp
CAUTION
Before using any of the combinations below, it is important to be familiar with the cautions listed for each herb in the combination.
Angelica arc. Zanthoxylum (berries) Juniperus
1. Chronic fatigue syndrome + cold extremities
Stagnant Qi and Blood + Deficient Qi and Blood Herb
-
Ratio
Temperature
Myrica 1 Zanthoxylum (bark) 1 Crataegus 1 Angelica sin. 0.5-1 Panax qui. 0.5-1 Glycyrrhiza 0.5 Zingiber 0.5 Capsicum 5-20 drops
warm hot 51. warm warm
Taste
Phytolacca Thuja Myrica Zingiber Capsicum
1 1
warm hot
bitter, acrid, aromatic acrid, aromatic, bitter
1
51. warm
aromatic, 51. acrid, 51. sour acrid acrid, aromatic, bitter acrid, sour, bitter acrid, aromatic acrid
1 1 1 0.5 5-20 drops
cool warm-cool warm hot hot
acrid, sour, bitter acrid, aromatic, bitter sour, sweet sweet, aromatic, bitter
sweet, sl. bitter neutral neutral-cool sweet acrid, aromatic hot acrid hot
GENERAL
This combination is to treat Stagnation of Heart Qi and Blood associated with Deficient Qi and Blood, and with Heart Deficient Yang and Cold. The overall temperature is warm, and the dominant taste property is acrid to warm the Interior and to bring the warmth to the surface and to the extremities. The sweet and sour tastes help to tonify the Heart, and the bitter and aromatic tastes help to tonify the Spleen to make Qi and Blood. USE
• chronic fatigue syndrome or fibromyalgia with exhaustion and sensations of cold in the body, surface, and extremities, and aches in the muscles
This combination is the same as Angelica: sinusitis + obe- _ sityand is discussed under that heading. 3. Depression + digestive disorders
Liver Stagnant Qi + Cold + Damp and Phlegm Herb
Ratio
1 Myrica 1 Sanguinaria 1 Rosmarinus 1 Artemisia abs. Citrus (ripe peel) 0.5 0.5 Zingiber 5-20 drops Capsicum
Temperature warm warm warm warm-cool warm hot hot
Taste acrid, sour, bitter bitter, acrid aromatic, bitter, acrid bitter, aromatic acrid, aromatic, bitter acrid, aromatic acrid
GENERAL
This combination is for conditions of Liver Stagnant Qi with obstruction of the Liver and the body in general by Cold, Damp, and Phlegm. The overall temperature of the combination is warm and it is unsuitable for warm or hot conditions. Acrid, aromatic, and bitter properties combine to warm, tonify, and move the Liver Qi, and to clear Cold, Phlegm, and Damp.
PRACTICAL NOTES
The herbs other than Capsicum are conveniently taken as 5 ml of a 1:5 tincture in quarter of a glass of warm water,
USE
• depression, tiredness, and lethargy with sensations of
'-
C I
Myrica
579
5. Chronic diarrhea + digestive weakness
heaviness and cold in body and limbs; sluggish digestion with abdominal distension and diS{:omfort; maybe weight gain
Spleen Deficient Qi + Spleen Qi Sinking Herb
Ratio
Temperature
Taste
1 1 1 1 1 0.5-1
warm neutral warm-cool sl. warm sl. warm hot
acrid, sour, bitter sour, sl. bitter acrid, bitter sweet sweet, sl. bitter acrid, sweet, aromatic
PRACTICAL NOTES
;~ r
The herbs other than Capsicum are conveniently taken as 5 ml of a 1:5 tincture in quarter of a glass of warm water, three times per day. Drops of 1:5 Capsicum tincture can be added from a separate bottle. This combiIiation is for chronic conditions and may be taken, with appropriate cautions, breaks, and modifications, for 1-2 months.
Myrica Agrimonia Achillea AstragalUS Panaxgin. Cinnamomum (bark) Capsicum
Caution This is a warming combination. The patient should therefore be monitored for the development of adverse heat sensations.
HISTORY
Intestines Phlegm Damp + Spleen Deficient Qi
I ,-'-.
Myrica Hamamelis Polygonum Plantago Ian. Agrimonia Hydrastis Zingiber
,.,Ratio -,,: ........
., ,:Temperature
1 1 1 1 1 0.5-1 0.5-1
warm neutrak:ool cool cool neutral cool hot
Taste .. -.- ... , ' ~
.
"
acrid, sour, bitter sour, sl. bitter sour, sl. bitter sour, sl. bitter sour, sl. bitter bitter acrid, aromatic
GENERAL
I
acrid
This combination is derived from a combination for diarrhea listed by William Fox in 1878, containing Myrica and Agrimonia. I have replaced the Rubus (raspberry leaves) in his combination with Capsicum and Cinnamomum, making my combination of less general application than his, but more specific for diarrhea with signs of Cold.
4. Colitis + mucus in stools
Herb"
5-20 drops hot
This combination can clear Phlegm Damp or Heat and Damp Heat from the Intestines. The overall temperature is more or less neutral, but the combination contains both warming herbs to clear Phlegm 'and Damp, and cooling herbs to clear Heat. The acrid property helps to transform and clear Phlegm, the bitter taste assists in the clearance of Heat and Damp Heat, and the sour property has an astringent effect. USE
• chronic diarrhea or colitis with mucus in the stools PRACTICAL NOTES
Whilst this combination can be used as a decoction or infusion, it is conveniently taken as 2.5-5 ml of 1:5 tincture in guarter of a glass of water, three times per day. It is useful for chronic conditions and can be taken for one month, with appropriate cautions, breaks, and modifications. Sometimes, with Myrica preparations, there can be an initial increase in the mucus in the stools since the alterative action may precede the astringent effect. This temporary condition may last for 1-2 days.
GENERAL
This is an astringent combination to reduce diarrhea, especially diarrhea due to Spleen Deficient Qi, Spleen Oi Sinking, and Cold. It is a warming combination for diarrhea with Cold. The acrid constituents help to warm the Spleen and Intestines, the sour constituents astringe, and the swe~t constituents, assisted by the bitter and aromatic constituents, tonify the Spleen. USE
• chronic diarrhea or loose stools with digestive weakness. sensations of cold. exhaustion and a desire to lie down PRACTICAL NOTES
The herbs other than Capsicum are conveniently taken as 5 ml of a 1:5 tincture in quarter of a glass of warm water, three times per day. Drops of 1:5 Capsicum tincture can be added from a separate bottle. This combination is for chronic diarrhea and digestive weakness associated with exhaustion, and may need to be taken for 1-2 months. However, as soon as the bowel movements normalize, the astringent herbs in the combination can be reduced or omitted. 6. Menorrhagia + cold s~nsations
Spleen not holding Blood + Cold
Vinca
Capsella
1 1
neutral neutral
sour sour
Combining Western Herbs and Chinese Medicine
580
Myrica Zingiber Capsicum
1 0.5 5-20 drops
warm
acrid, sour, bitter acrid, aromatic acrid
hot hot
GENERAL
This is an antihemorrhagic combination to reduce abnormal uterine bleeding, especially if linked to patterns of Spleen not holding Blood combined with Cold in the Uterus. The overall temperature is warm, and the main taste properties are acrid and sour. USE
• abnormal uterine bleeding with cold sensations PRACTICAL NOTES
The herbs other than Capsicum are cQnveniently taken as 5 ml of a 1:5 tincture in quarter of a glass of warm water, three times per day. Drops of 1:5 Capsicum tincture can be added from a separate bottle. This combination is for an acute or subacute condition. Once the bleeding and the sensation of cold is reduced, this .combination can be replaced by Capsella: menorrhagia + exhaustion, which is similar to the combination above, but contains the tonic herbs Astragalus. Panax, and Angelica sinensis.
Caution No chronic abnormal uterine bleeding should be treated without a previous conventional specialist examination to exclude serious conditions. This combination is contraindicated for patterns involving Heat. Also, even initially Cold conditions should be monitored to ensure that they do not convert to Heat.
COMPARISON OF THE SIX MYRICA COMBINATIONS 1. Chronic fatigue syndrome + cold extremities
2. Sinusitis + obesity
Stagnant Qi and Blood + Deficient Qi and Blood
Lung Phlegm Damp + Spleen Damp
Myrica Zanthoxylum (bark) Crataegus Angelica sin. Panax qui. Glycyrrhiza Zingiber Capsicum
Angelica arc. zanthoxylum (berries) Juniperus Phytolacca Thuja Myrica 1 Zingiber Capsicum
1 1 1 0.5-1 0.5-1 0.5 0.5 5-20 drops
1 1 1 1
1
0.5 5-20 drops
2. Both this combination and combination No.1 contam .~. the circulatory stimulants Myrica, Zingiber, and Capsicum. Combination No.1 also contains the tonic herbs Crataegus, Angelica sinensis, Panax, and Glycyrrhiza, whilst combination No.2 contains the anticatarrhals Angelica archangelica, Juniperus, Phytolacca, and Thuja to clear Damp and Phlegm. In this book, Zanthoxylum bark is considered more acrid and the stronger circulatory stimulant, whilst the berries are considered more aromatic and the the stronger carminative. In combination No.1, Zanthoxylum bark is used to treat cold extremities, whilst in combination No.2, the berries are used to assist the Spleen to transform Damp. 3. Depression + digestive disorders
4. Colitis + mucus in stools
Liver Stagnant Qi + Cold + Damp and Phlegm
Intestines Phlegm Damp + Spleen Deficient Qi
...
~
"~~rl;; Myrica Sanguinaria Rosmarinus Artemisia abs. Citrus (ripe peel) Zingiber Capsicum
1 1 1 1 0.5 0.5 5-20 drops
Myrica Hamamelis Polygonum Plantago Ian. Agrimonia Hydrastis Zingiber
1
1 1 1 1 0.5-1 0.5-1
3. Myrica and Sanguinaria were noted by the Eclectics as herbs to clear hepatobiliary catarrh. They are both warm, circulatory stimulant, anticatarrhal herbs that can warm and move Liver Qi and clear Cold and Phlegm. Rosmarinus, Artemisia, and Citrus are bitter and aromatic herbs, which can move Liver Qi, and, when combined with Zingiber an<:l, Capsicum, can clear obstruction of Liver Qi due to Cold. 4. Combination No.3 is for the Liver, and combination No.4 is for the Intestines. Myrica, Hamamelis, and Polygonum are astringent to treat diarrhea, and Myrica, Hamamelis, Polygonum, and Hydrastis are anticatarrhal to clear Phlegm. Myrica and Zingiber are paired as warm acrid herbs to clear Phlegm Cold in the Intestines, and Hydrastis, Polygonum; and Plantago can clear Heat if there is a mixed condition with Heat secondary to Cold. 5. Chronic diarrhea + digestive weakness
6. Menorrhagia + cold sensations
Spleen Deficient Qi + Spleen Qi Sinking
.Spleen not holding Blood + Cold
-~
'.--1
Myrica Herb-:::,;~~~~,-",,,uRatio ".. ~ Myrica Agrimonia Achillea Astragalus Panax gin. Cinnamomum (bark) Capsicum
P
1-
1 1 1 1 1
~HertJ:-. .:,~.,~: ~C'~,~Rcilig;¥~~ .'#*--
Vinca Capsella Myrica Zingiber Capsicum
,'"j
1 1 1
0.5 5-20 drops
0.5-1 5-20 drops
5. Combination No.4 contains the cooling anticatarrhal and anti-inflammatory herbs Hydrastis, Hamamelis, Polygonum, and Plantago. Combination No.5 contains the warming herbs Capsicum and Cinnamomum, and the tonic herbs Astragalus and Panax:, to treat diarrhea with Sinking of Spleen Qi and some Cold.
~
~,~~
6. Both combinations No.5 and No.6 treat "leakages" associated with Cold. Combination No.5 contains Agrimonia and Achillea to assist Myrica to treat diarrhea, and the tonic herbs Astragalus and Panax in treating Sinking of Spleen Qi. Combination No.6 contains Vmea, which is specific for abnormal uterine bleeding, supported by Capsella for bleeding associated with Spleen Deficient Qi.
OTHER MYRICA COMBINATIONS Other combinations that contain Myriea include the following:
• Capsella: menorrhagia + anemia • Potentilla: acute severe diarrhea • Rosmarinus: irritable bowel syndrome + cold sensations • Thuja: amenorrhea + catarrhal conditions • Zanthoxylum: prostatitis + cold sensations
Research CONSTITUENTS • flavonoids • terpenoids • diarylheptanoids • resin • tannin • other Flavonoids The BHP reported that M. cerifera contains myricitrin, the glycoside of the flavonoid myricetin: M. ser17 rata has been reported to contain various chalcones. Terpenoids The root bark of M. cerifera has been reported to contain the triterpene myricadiol. 18 The twigs of M. cerifera contain an oleanane triterpinic acid named myrica
581
acid. 19 Three new triterpenoids, myriceric acid A, myriceric acid C, and myriceric acid D, were isolated from M. cerifera.20 Diarylheptanoids Myricanone, and myricanol and five of its glycosides were isolated from the stem bark of M. rubra, and myricanone and galeon were isolated from the stem of M. gale var. tomentosa. 2 \ Resin According to the BHP, M. cerifera contains myricinic acid, an acrid astringent resin. Tannin Tannic and gallic acids are given as constituents for M. cerifera by the BHP. Other The BHP listed a red coloring material and a small amount of essential oil as constituents for M. cerifera. The isolation of the pentacyclic triterpene taraxerol and taraxerone were reported from M. cerifera root bark. \8
PHARMACOLOqICAL AND CLINICAL RESEARCH The following effects have been reported: • antimicrobial • hepatoprotective and cholagogue • antioxidant • antiandrogen • antimelanin • antitumor Antimicrobial Antibacterial and antifungal activity has been reported for the chalcones (a gIOUP of flavonoids) from M. serrata.\7 Hepatoproteetive and cholagogue A methanol extract of the bark of M. rubra demonstrated bo"th hepatoprotective and cholagogue activity in rats,22 and preparations of M. nagi showed hepatoproteetive action in mice.23 Antioxidant M. nagi preparations were reported capable of reducing cumene hydroperoxide-induced cutaneous oxidative stress and toxicity.23 Antiandrogen M. rubra tincture showed in vitro testosterone 5-a-reductase inlubitory activity, and in vivo antiandrogenic activity in rodents. Three constituents were identified as the main active principles: the diarylheptanoids myricanone and myricanol, and myricetin. 24 Antimelanin An ethanol extract of the dried leaves and bark of M. rubra inhibited melanin biosynthesis in vitro. Quercetin, myricetin, and myricetin 3-0-rhamnoside from the leaves also showed an inhibitory effect. The authors suggested that this herb might be used as a whitening agent for the skin in cases ofhyperpigmentation.2S
_
Combining Western Herbs and Chinese Medicine
582
Antitumor The flavonoid glycoside myricitrin was reported to have inhibitory effects on tumor promotion in mice, and the authors of this study suggested that this may be at least partly due to activation of immune responses against tumors. 26 Myricitrin is present in M. cerifera. RESEARCH VERIFICATION OF TRADITIONAL ACTIONS From the research summarized above on Myrica extracts or isolated constituents, there is as yet no support for the traditional actions of: diaphoretic, circulatory stimulant, digestive tonic, anticatarrhal, astringent, antihemorrhagic, and topical agent. Additional effects demonstrated by research The following effects have been reported as discussed above: antimicrobial, hepatoprotective, cholagogue, antioxidant, antiandrogen, antimehmin, and antitumor.
caution for patients with a tendency to nausea:on~t , ._-.-.:-_,-:.. ---:-,=",~;::;g:::;:~ herbal remedies. .-..~:'.:"-'-:::=-"'.-; .....__ ."'-';:'i'-~:
Chinese contraindications ifera.
There is, as yet, insufficient research data for a comparison of the species of Myrica used in the West with those used in China. TOXICOLOGY I have not found information on the toxicology of Myrica. The only suggestion of an adverse reaction to an overdose is the recommendation by Kloss and Christopher to use high doses of Myrica as an emetic to treat narcotic poisoning.
. '''-~:~-~~.:3:*~.
Pregnancy and lactation Christopher recoIJUllended ba;;~·~t~?~ berry as an excellent tonic for the uterus, especially during pregnancy. However, despite the fact that I have not seen any contraindications for this herb in pregnancy or reports of adverse effects, it might be advisable to use caution in this situation. Side effects No adverse reports. Overdose No adverse reports, but the past use of high doses of this herb as an emetic would suggest nausea or vomiting as potential effects of an overdose.
Dried herb The BHP listed 0.6-2 g of the powdered bark, by infusion or decoction, three times per day. Tmcture The BHP listed 0.6-2 ml of 1:1 liquid extract in 450/0 alcohol, three times per day. I generally use Myrica in combination with other herbs, and so effectively prescribe about 1 ml of 1:5 Myrica tincture, three times per day. Initial dose Can start at the standard dose, providing cautions are observed. Duration Can be used up to 1 month, providing cautions are observed.
Cautions Western contraindications None known. To be used with
..• -....... -
Regulatory status Please read the Regulatory status section in the chapter on Safety. Myrica (bayberry) is on the UK General Sale List and it is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Myrica is not curr~ntly listed by the FDA (USA) as a prohibited substance, as subject. a warning o~J~, .• ".~:o<. to an import alert, or as a substance~th . ,. use.
Traditional sources PROPERTIES
Dose
.
Interactions No adverse reports.
COMPARISON OF WESTERN AND CHINESE SPECIES
None are known for M. cer-:"'~'.:":::f" ..- _.-..._ - -
Temperature M. rubra
Of the three texts cited in the Chinese Herbal Medicine Dictionary, two listed yang mei gen (M. rubra) as warm and one listed it as cool.
M. cerifera Ellingwood 27 specified M. cerifera for patients with subnormal temperature, and Christopher listed it for reviving the heat of the body. Bayberry is classified as warm in this book. Taste
Taste in the mouth The BHP described the taste of Myrica as bitter and astringent, becoming pungent and acrid. I found that a 1:5 tincture in 45% alcohol tasted sour, bitter, and acrid. It had a strong puckering sensation in the mouth and left a gummy, resinous coating on the teeth and tongue. Chewing the dried cut root had a similar result. Like some
Myrica other tannin-containing herbs, such as Polygonurn and Potentilla, Myrica seems to have a taste in the mouth that can be described either as on the borderline between sour and bitter, or as a mi.xture of the two tastes.
Taste properties The three texts cited in the Chinese Herbal Medicine Dictionaryl5 each give different taste properties for yang mei gen: '~
,
I
• acrid, bitter, astringent • sour, slightly astringent • acrid, sweet
(,,;,: I
This relatively unusual lack of uniformity suggests that this herb has not had a long and extensive tradition of use in Chinese medicine. M. cerifera is classified in this book as acrid due to its mild warming effect, sour due to its astringency, and bitter associated with its tonic and cholagogic effects.
~
!-
583
Diaphoretic Lyle29 described Myrica as a diffusive stimulant and wrote that a hot infusion of bayberry assists perspiration, especially if it is combined with Zingiber. Kloss reported that the tea, taken warm, promotes perspiration and can be recommended for colds when it is ~ombined with yarrow, catnip, sage, or peppermint. Christopher listed this herb for fever, chills, and influenza, and the BHP descnbed bayberry as a mild diaphoretic. Circulatory stimulant In 1879, Lyle wrote that Myrica in hot infusion gradually arouses the circulation and helps an outward flow of blood. Felter and Lloyd gave atony of the cutaneous circulation as a specific indication for this herb. According to Christopher, Myrica has a persisting influence on the arterial and capillary circulation, and can help to revive the heat of the body and treat cold extremities. Michael Moore wrote that M. californica can stimulate blood supply through vasodilation. Both Felter and Lloyd and Priest and Priest recommend Myrica for cases of feeble venous action.
ORGANS
Composition Powder Many of the older American texts,
In terms of Chinese medicine, Myrica cerifera, as used in the West, can be associated mainly with disorders of the fol-
including Fox, Lyle, Kloss, and Christopher, listed versions of Composition Powder. This combination contained Myrica, and one version was:
lowing organs:
Botanical name
= ACTIONS Evidence from the traditional sources for the following actions of Myrica cerifera are discussed below:
..
.
c.
• diaphoretic • circulatory stimulant • digestive tonic • anticatarrhal, deobstruant, and alterative • astringent and antihemorrhagic • topical
. Englishnai'ne_;;:t:~"Part;k;;,: -::.~" ,: Ratio;' '.',
:'.--_.
,',
:- __
••
,:;'-',:_:'0_',·
".
C,·
Myrica cerifera
bayberry
root bark
16
Tsuga canadensis
Eastern hemlock
inner bar\<
Zingiber officinalis
ginger
rhizome
Eugenia aromatica
cloves
buds
Capsicum species
cayenne
fruit
8 8 1 1
The aim of this combination was to treat loss of inner heat and remove obstructions due to cold. It was used, for example, for sudden colds, influenza, fever, and cold hands and feet. It was also used for diarrhea or pain in the stomach and intestines. Christopher's instructions for its use were to put 1 teaspoon of a fine powder of the herbs in half a cup of boiling water, and drink it when it is sufficiently cooL Honey or sugar can be added if preferred. The patient should be well wrapped up in bed. Tsuga canadensis (Pinus canadensis = Abies canadensis) can be difficult to obtain. Accordingly, Moore listed a variant of the Composition Powder that has the same herbs as above (though in different proportions), but omits the Tsuga. Digestive tonic Lyle listed bayberry as a tonic. Both Felter and Lloyd as well as Ellingwood wrote that it can strengthen the digestion and assist in the production ofblood. According to both Felter and lloyd and Christopher, Myrica can act as a tonic for the digestion, mucous membranes, and uterus.
Combining Western Herbs and Chinese Medicine
584
Myrica and fibromyalgia Ellingwood recommended Myrica for weak patients with subnormal temperature, slow pulse, muscular soreness and aching of the limbs, with poor appetite and unrefreshing sleep. This description fits some patterns of chronic fatigue syndrome and fibromyalgia. Anticatarrhal, deobstruant, and alterative Fox described Myrica as the best cleansing medicine ever discovered, and both Fox and Kloss used it as a gargle for putrid sore throats. Ellingwood recommended Myrica to counteract the effect of mercury. and both Kloss and Christopher wrote that bayberry is an excellent emetic after narcotic poisoning. According to Christopher, Myrica can cleanse and restore the mucous secretions to normal function. It was used by Physiomedical practitioners, such as Ellingwood, Felter, and lloyd, for chronic weakness of the mucous membranes, as in catarrhal states of the gastrointestinal, hepatobiliary, and reproductive systems. For example, they used it for chronic gastritis, mucous colitis, certain patterns ofjaundice and cholelithiasis, and leukorrhea. Christopher recomm~nded Myrica for nasal catarrh and for catarrhal deafness, and prescribed an infusion of Myrica and Polygonum for mucous discharges from ears, nose, urethra, or vagina. Astringent and antihemorrhagic Myrica root bark can be described as a warming, tonic, anticatarrhal astringent. Both Lyle and Christopher point out that, although Myrica is astringent, it does not dry the mucous membranes, as do some other astringent agents. In fact, it can moisten the mouth, make the nose run, or temporarily increase mucous discharge in the stool, depending on the situation. Astringent and antihemorrhagic uses of Myrica have been listed by the following authors: • Pox
diarrhea and dysentery
uterine prolapse • Lyle chronic or atonic diarrhea • Ellingwood • Felter and Lloyd spongy and bleeding gums,
• Christopher • Mabey
leukorrhea hemorrhage from the lungs, bowels, or uterus postnatal hemorrhageJO
Kloss combined Myrica with Capsicum for menorrhagia. In terms of Chinese medicine, this pair would be for menorrhagia associated with Uterus Stagnant Qi and Blood plus Cold. Topical
Slow-healing ulcers Both the BHP and Christopher recommend dusting finely powdered Myrica bark onto slow-healing wounds or ulcers.
Nasal catarrh or nasal polyps The finely powdered bar~~::;;:::~~-"';;#;;;:: been used as snuff for nasal catarrh and nasal polyps. It ~~~-:;~~ be combined with finely powdered Hydrastis (Christopher) or with finely powdered Sanguinaria (Ellingwood).
cali
Gargle for mouth and throat disorders Christopher recom~ mended Myrica decoction as a rinse or gargle for spongy or bleeding gums or for a sore or ulcerated throat.
Douche for leukorrhea Christopher used a douche of Myrica tea at body temperature to cleanse and tone the vaginal membranes.
COMPARISON OF WESTERN AND CHINESE USE OF MYRICA SPECIES M. cerifera (bayberry) was one of the most important herbs of the Physiomedical and Eclectic practitioners oL7"_~i__~ North AIDerica. In contrast, the species of Myrica used in ... ~. China do not appear to have common use in Chinese medi..; cine. Western use M. cerifera is used as a mild circulatory stimulant, a mild digestive tonic, and a warming anticatarrhal astringent. It has application for general debility with: • low body temperature and poor peripheral circulation .. • myalgia or rheumatism aggravated by cold and damp -• poor appetite or digestive weakneSs with chronic 100se_~'eM__. stools or diarrhea • sluggish liver function with digestive disorders and depression • chronic catarrhal conditions such as sinusitis or bronchitis with sensations of cold • chronic discharges, or slow-healing ulcers This makes Myrica a useful herb to treat patterns of chronic fatigue syndrome and fibromyalgia associated with . Deficiency, Cold, and Phlegm. Chinese use The Chinese Herbal Medicine Dictionary stated that yang mei gen (M. rubra) regulates the Qi, transforms Blood stasis, and stops bleeding, and can be used to treat stomach pain, vomiting, hernia, vomiting blood, bleeding hemorrhoids, bleeding from trauma, bruising from trauma, toothache, scalds, ulcers, and scabies. Yang mei shu, the stem bark of M. esculenta,is described as neutral and astringent to reduce inflammation and bleeding, and can be used to treat stomach pain, enteritis, diarrhea, dysentery, and menorrhagia. It may be that the uses of M. rubra and M. esculenta in China are based largely on the Western tradition of use.
-
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Myrica
References 1. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983) 2. Felter HW,lloyd TV. King's American Dispensatory. vols. 1 and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1983) 3. Crellin JK, Philpott J. A Reference Guide to Medicinal Plants. Duke University Press, Durham. North Carolina (1990)
i
l.",;..-
4. Fox W. The Working Man's }'lodel Family Botanic Guide to Health, 7th edn. William Fox. Sheffield, United Kingdom (1878) 5. Kloss J. Back to Eden, 5th edn. (1939). Reprinted by Lifeline Books. Santa Barbara, California (1975) 6. Christopher JR. School of ~atural Healing. BiWorid. Provo. Utah (1976)
L._-
8. Lonicerus A. Kreuterbuch (1679). Reprinted by Verlag Konrad Kolbl, MUnchen, Germany (1962) 9. Tabernaemontanus JT. Kr1iuterbuch (1731). Reprinted by Verlag
,
Konrad Kolbl, MUnchen, Germany (1993) 10. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks, Glenwood,lllinois (1990) 11. Gerard J. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publications, New York, New York (1975) 12. Foster S. Duke
J.
Medicinal Plants. Houghton Mifflin. Boston,
Massachusetts (1990) 13. Moore M. Medicinal Plants of the Pacific West. Red Crane Books, Santa Fe. New Mexico (1993)
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I
l~
L ..
15. Jiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science & Technology Press, Shanghai. China (1975) 16. Perry 1M. Medicinal Plants of East and Southeast Asia. The MIT Press, Cambridge, United Kingdom (1980) 17. Gainer S,Wolfender JL,Mavis S et al. Planta Med 62(1):67-69 (1996) 18. Paul BD,Rao GS,KapadiaGJ.J Pharm Sci 63(6):958-959 (1974) 19. Nagai M, Sakurai N. Yurnoto N et al. Chem Pharm Bull 48(10):14271428 (2000) 20. Sakurawi K, Yasuda F, Tozyo T et al. Chem Pharm Bull 44(2):343-351 (1996) 21. Inoue T. Yakugaku Zassbi 113(3):181-197 (1993) 22. Ohta S. Sakurai N. Karnogawa A et al. Yakugaku Zasshi 112(4):244-252 (1992) 23. Alam A, Iqbal M, Saleem M et (2000)
aI. Pharmacol Toxicol 86(5):209-214
7. Dioscorides P. Kreutterbuch (1610). Reprinted by Verlag Konrad Kolbl, MUnchen, Germany (1960)
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14. Grieve M. A Modern Herbal. vols. 1 and 2. Dover Publications, New York, New York (1971)
24. Matsuda H. Yamazaki M, Matsuo K et 263 (2001)
aI. Bioi Pharm Bull 24(3):259-
25. Matsuda H, Higashino M, Chen W et aI. BioI Pharm Bull 18(8):11481150 (1995) 26. Yasukawa K, Takido M, Takeuchi M et al. Chem Pharm Bull 38(3):774776 (1990) 27. Ellingwood F. American Materia Medica, Therapeutics and Pharmacognosy, 11th edn. (1919). Reprinted by Eclectic Medical Publications, Sandy. Oregon (1994) 28. Priest AW, Priest LR. Herbal Medication. L.N. Fowler, Romford Essex. United Kingdom (1982) 29. Lyle TJ. Physic-Medical Therapeutics, Materia Medica and Pharmacy. Originally published Ohio (1897). Reprinted by the National Association of Medical Herbalists of Great Britain, United Kingdom (1932) 30. Mabey R (ed). The Complete New Herbal. Elm Tree Books, London. United Kingdom (1988)
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Phytolacca 1'" I
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Botanical Dame Phytolacca americana L. (P. decandra L.) Family Phytolaccaceae Pharmaceutical Dame Phytolaccae radix Part dried root parts English poke root German Amerikanische Kermesbeere French phytolaque Mandarin mei shang lil (~Illi I!i) is the root of Phytolacca species Use in the West Phytolacca is a large herbaceous perennial native to the Eastern and Central states of the USA. It was used by the Native Americans for such disorders as arthritis, rheumatism, and mastitis,1 r.nd has been described in North American herbal texts since the beginning of the 19th century.~ It was one of the most-used herbs of the Eclectic physicians, and although their traditions of use for this plant were transmitted to Britain, probably i? the late 19th century, its use is little known on the European continent. There appear to be tWo different traditions, one using fresh plant material, and the other using preparations of the dried root. Although it is not always clear whether some writers are referring to the use of fresh or dried material, it is important to be aware of the fact that the fresh material can have a hj.gher level of toxicity. Indeed, according to some modern texts, the fresh material should not be used. 3
ed the use of preparations from dried material. According to Mabey, the fresh plant is poisonous, and Mills and Bone) believed that tinctures of the fresh plant should be used with extreme caution. if at all. Since my own experience is mainly with preparations from dried plant material, the descriptions of properties, herb pairs, and combinations in this chapter refer to the dried material unless otherwise stated.
Use of preparations from fresh material Texts by American herbal practitioners have tended to emphasize use of the fresh root. According to Felter and Lloyd,6 'this root loses its medicinal properties with age, consequently only recent material should be used for making the fluid preparations.' Lyle' recommended small and frequent doses of the fresh root for rheumatism, and stated that 'the dried root is of but little value.' Christophet wrote that 'there is probably no other herb that deteriorates as rapidly with age as poke root; therefore, it is recommended that the fresh root be dug and used for each preparation, or that it be made into a fluid extract or tincture promptly after gathering and cleaning.' Both Tierra9 and Moore 'o have recommended the use of the tincture of the fresh root. Use in China Shang lil is the dried root of any of the following Phytolacca species: P. acinosa Roxb., P americana 1., or P. esculenta Van Hout. It is mainly used internally for Excess patterns of oliguria, edema, and ascites. and externally for sores and boils. II
Use ofpreparations from dried material Recent British texts such as the BHP,4 Mabey,S and Mills and Bone recommend-
587
Combining Western Herbs and Chinese Medicine
588
What is special about Phytolacca
WESTERN ACTIONS
. -
_ •. " ' - _ '
•
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e •
. . '..:..~." i.-·Xc-'
The main Western actions of Phytolacca are shown here . '.'~,:=" In terms of Chinese medicine. P. americana, as used in the West, can be said to be a cool, acrid herb that has its main effects on the Lung and the channels of the skin, muscles, and tissues.
The key to understanding Phytolacca is that it is an anticatarrhal and alterative herb that, in Chinese terms, can move Stagnant Qi and clear Phlegm, Retained Pathogen, and Heat Toxins in the Lung, and also in the channels of the skin, muscles, and tissues. It can therefore assist the treatment of such disorders as nasopharyngeal catarrh, recurring or lingering phlegmy respiratory conditions, fatty lumps, swollen lymph glands, prostatic enlargement, amenorrhea in the obese, mumps, tonsillitis, boils, psoriasis, and rheumatism. CHINESE ACTIONS In terms of Chinese medicine, P. americana, as used in the West. can be said to have three main groups of actions: I. clear Lung Phlegm and clear Retained Pathogen II. clear Heat Toxin III. move Qi and clear Phlegm and Damp Phytolacca and Retained Pathogen Phytolacca can help clear Retained Pathogen, especially when the condition is associated with Stagnant Qi, Damp, and Phlegm. It can therefore be used to treat recurring or lingering phlegmy conditions of the sinuses or bronchi. This may be associated with low energy and depression. and there may be swollen lymph nodes. These recurring inflammations or infections with phlegm may follow such diseases as mumps or whooping cough in children, or may be associated with some types of chronic fatigue syndrome in adults. In some cases, there may be lingering Heat Toxin in addition to the Stagnant Qi, Phlegm. and Retained Pathogen. Phytolacca and Phlegm Phytolacca can be used for any combination of the following conditions associated with Stagnant Qi and the accumulation of obstructing Phlegm and Damp:
• phlegm in the channels: skin disorders, rheumatism, arthritis, lymph gland enlargement, or prostatic enlargement • excessive mucous secretions: nasopharyngeal catarrh, leukorrhea, amenorrhea, or infertility • fat: fatty lumps in the flesh or obesity
in terms of its three main Chinese actions: Chinese actions I. clear Lung Phlegm and Retained Pathogen
anticatarrhal alterative
II. clear Heat Toxin
alterative antirheumatic dermatological agent
III. move Qi and clear Phlegm and Damp
anticatarrhal alterative deobstruant antirheumatic dermatological agent
WESTERN USES The main Western uses of Phytolacca can be related io";'-'7'~':~ its three main Chinese actions: Chinese actions I. clear Lung Phlegm and Retained Pathogen
nasopharyngeal catarrh. recurring respiratory infections
II. clear Heat Toxin
tonsillitis, mumps, ~ '-:'..~~'.'t phadenitis. boils, canCer'~':~"~_ therapy adjunct'" 'A'
III. move Qi and clear Phlegm and Damp
psoriasis. rheumatism;' ·.··,.:c:...::;}.:, prostatic enlargement.- - . -\ ,c~c.,:", amenorrhea, infertility .. --~ .-
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DIRECTION OF ENERGY In higher doses, such as those used in China, but not,~,.~\~;.< the West, Phytolacca can drain downward, expelling water '=>;i::';' through the urethra and anus. In the lower doses. such~_>_~~ .. those used therapeutically in the West, Phytolacca can move Qi obstruction when linked to obstruction by Phlegm and Damp. but does not have a marked directional effect on the flow of energy.
TYPICAL CASE EXAMPLE Signs and symptoms The patient has recurring respiratory"'~~'''''· infections, which end in lingering nasopharyngeal catarrh;'.?! They are lethargic, with a sensation of heaviness and dull.;~:t: ness in the limbs and body, and occasion~ muscl~~~5~~t~: They have a history of swollen lymph glands, boils, and l~~i:~ii~;':' orrhea. The pulse is slippery, and the tongue is slightly pale,,~} . and slightly purple, and has a slightly yellow greasy coat... '''?: ~r.
Phytolacca Diagnosis The patient has Lung Phlegm with Stagnation of Qi, Damp, and Phlegm in the channels, and some Qi Deficiency and Heat. Choice of Phytolacca
This herb is specific, not only for
recurring and lingering Lung Phlegm conditions, but also for obstruction of the channels of the skin, muscles, and flesh by Qi Stagnation, Damp, and Phlegm.
Limitations ofPhytolacca TEMPERATURE In this book, Phytolacca is classified as cool. For conditions of Excess Heat, as in acute severe tonsillitis, I would combine it with colder herbs, such as Baptisia.
TASTE Phytolacca is an acrid herb that, like Lobelia, can clear
589
herbs can extend the range of use of Phytolacca beyond its limitations. The basic unit of herb combination is the herb pair. Twelve pairings of Phytolacca are briefly explained below.
CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair. Phytolacca + Echinacea
Recurring respiratory infections This pair can be used for recurring respiratory infections resulting in lingering nasopharyngeal catarrh, when this problem is associated with Retained Pathogen and accumulation of Phlegm and Damp in the Lung. Echinacea can tonify the Defensive Qi and clear both Retained Pathogen and Lung Phlegm. Phytolacca can move Stagnant Qi and dear Retained Pathogen and Lung Phlegm in both the Lung and channels.
Phlegm obstruction. It is not an acrid herb in the sense of clearing E..uerior Wind from the surface, like Achillea, or in
Phytolacca + Euphrasia
the sense of warming the Interior, like Zanthoxylum.
Sinusitis
ACTIONS Anticatarrhal Phytolacca is an anticatarrhal herb, like Lobelia, but its expectorant properties are not as strong as Lobelia's. Phytolacca is a cooling, alterative, anticatarrhal herb, like Hydrastis, but without the antihemorrhagic action of the latter herb. Alterative
Phytolacca is an alterative, which can treat com-
binations of any of the following pathogenic factors: • Stagnation of Qi • Retained Pathogen • Phlegm and Damp • Heat Toxin However, it does not have specific action on the Liver like Berberis or Taraxacum, and it does not move Stagnant Blood, like Salvia miltiorrhiza.
These two cool, acrid herbs are specific for catarrhal conditions of the sinuses and Eustachian tubes, and can assist in the treatment of both catarrhal headache and catarrhal deafness. The two herbs have complementary effects: Euphrasia can clear Wmd Heat, and Phytolacca can clear Heat Toxin. Phytolacca + Angelica archangelica
Sinusitis + bronchitis Both herbs can dry Damp and dear Phlegm. Phytolacca is cool while Angelica is warm. They can be combined for the simultaneous presentation of sinusitis and bronchitis where both display profuse mucus production. They can also be used for rheumatism or arthritis associated with obstruction of the channels by Phlegm and Damp. Since both these herbs are drying, they should not be used in catarrhal patterns with Dryness. Phytolacca + Glechoma
Nasopharyngeal catarrh
Phytolacca paired with other herbs --j
~
Discussion of the limitations of each of the main actions of Phytolacca can be useful to clarify just what this herb can and cannot do. However, suitable combination with other
Both these herbs are strongly anticatarrhal, and Glechoma is also an expectorant. Therefore, this pair can be used for phlegm in the sinuses with postnasal drip and phlegm in the bronchi. Glechoma is more for phlegmy cough, and Phytolacca is more for throat conditions with inflammation or infection.
Combining Western Herbs and Chinese Medicine
590 Phytolacca + Thuja
Adjunct to cancer therapy Both herbs have an acrid taste and can have anticatarrhal and alterative actions. They can move Qi and clear Phlegm, Damp, Retained Pathogen, and Heat Toxin. They can be used as an adjunct to cancer therapy and to reduce the side effects of radio- or chemotherapy. They can also be used for phlegmy respiratory conditions, the aftereffects of immunizations, rheumatism, or psoriasis. Phytolacca + Baptisia
Acute tonsillitis Both herbs can clear Heat Toxins and treat acute tonsillitis or boils, and both herbs are specific for disorders of the lymph system. Baptisia is the colder herb with a stronger antimicrobial action, and Phytolacca is the more effective anticatarrhal. Phytolacca + Arctium
Acne Both herbs have alterative, antirheumatic, and dermatological actions and can be used for rheumatism, arthritis, boils, acne, or psoriasis associated with Qi Stagnation, Phlegm, Damp, and Heat Toxin. In addition, Arctium can stimulate renal and hepatobiliary function to assist in its alterative action.
enlarged lymph nodes, but they can also be used for skin disorders associated with Stagnation of Qi with accumulation of Damp and Phlegm, or for fatty lumps in the skin. Galium has an anti-inflammatory action on the urinary system, and the two herbs can be used together for prostatitis with inflammation and dysuria. Phytolacca + Myrica
Amenorrhea + obesity Both herbs are anticatarrhals which can treat obstruction due to the accumulation of mucus secretions in the sinuses, and also in the reproductive system. The two herbs may be paired in combinations used to treat amenorrhea, infertility, or prostatitis when these disorders are associated with accumulation of Phlegm and Damp. Patients with this pattern may be overweight, with chronic respiratory catarrh, lethargy, and a heavy and dull sensation in their limbs and body. Phytolacca + Zanthoxylum
Arthritis + sensations ofcold Although Phytolacca is a cool herb, it can be used for myalgias or arthritis, even if there are sensations of cold, when Phytolacca is combined with the hot herb Zanthoxylum. The latter herb is a circulatory stimulant which can be used for rheumatism or arthritis associated with poor peri- pheral circulation.
Phytolacca + Iris .
Skin disorders + constipation Iris is specific for skin disorders associated with constipation and sluggish liver function. It has been combined with Phytolacca since the time of the Eclectics to treat skin disorders such as psoriasis, boils, abscesses, and ulcers. The two herbs can also be used to treat lingering infections in children with chronic phlegm and swollen lymph glands associated with Retained Pathogen and accumulation of Lung Phlegm. Phytolacca + Smilax
Psoriasis Smilax is used as a specific herb for psoriasis both in China and the West. The two herbs can be combined for the chronic phase of psoriasis when this disorder is associated with Stagnation of Qi and Blood and obstruction by Damp, Phlegm, and Heat Toxin in the channels of the skin.
Phytolacca combinations Six Phytolacca combinations are discussed below: Combination
Chinese syndromes
1. chronic sinusitis
Lung Phlegm Heat
2. tonsillitis
Wind Heat + Heat Toxin
3. cancer therapy adjunct
Stagnant Qi + Damp Heat + Heat Toxin
4. lymphadenitis
Retained Path9gen + Heat Toxin
5. chronic psoriasis
Stagnation of Qi and Blood + Phlegm
6. chronic acne
Heat Toxin + Phlegm
CAUTION Phytolacca + Galium
Lymphadenitis These two herbs are specific for lymphadenitis with
Before using any ofthe combinations below, it is important to be familiar with the cautions listed for each herb in the combination.
Phytolacca
591
1. Chronic sinusitis
Lung Phlegm Heat Phytolacca Herb Euphrasia Echinacea Sambucus Hyssopus
Ratio
1 1 1 1
Temperature
Taste
neutral-cool
acrid, sour, bitter
cool
acrid, bitter, 51. sweet
cool
acrid, 51. bitter acrid, aromatic
warm-cool
1 1
cool neutral
bitter
Glechoma Phytolacca
1
cool
acrid
Hydrastis
Baptisia GIycyrrhiza Zingiber
Mahonia
Wind Heat + Heat Toxin
Phytolacca Thuja
Salvia off.
1
Baptisia Commiphora
1 1 1
Phytolacca
0.5 0_5
neutral-eool hot
acrid, aromatic
sweet
Stagnation of Qi and Blood + Phlegm
Smilax
Temperature
bitter
5. Chronic psoriasis
2. Acute tonsillitis
Ratio
acrid
cold
This combination is the same as Calendula: lymphadenitis and is discussed under that heading.
Herb
Herb
cool
sour, bitter
This combination is the same as Euphrasia: chronic sinusitis and is discussed under that heading.
."
1 1
Ratio
Temperature
1 1 1
cool
51.bitter
cool
bitter
cool
acrid
1 1
warm-cool hot
acrid, aromatic, bitter
Taste
Taste
Zanthoxylum (bark)
warm-eool
aromatic, acrid
Salvia mil.
1
bitter
cool
cold
bitter
Zingiber
0.5
warm cool
bitter, acrid
hot
acrid, aromatic
acrid
This combination is the same as Salvia: acute tonsillitis and is discussed under that heading.
acrid, bitter, aromatic
This combination is the same as Smilax: chronic psoriasis and is discussed under that heading.
6. Chronic acne 3. Cancer therapy adjunct
Heat Toxin + Phlegm
Stagnant Qi + Damp Heat + Heat Toxin Herb Herb Thuja Viola odo. Phytolacca Hydrastis Taraxacum Arctium (root) Glycyrrhiza Zingiber
Ratio
Temperature
Taste
Phytolacca Galium
1 1
cool
acrid
neutral
sour, 51. bitter
sour, sweet, bitter acrid
Viola trio
cool
sour, sweet, bitter
cool
bitter
Taraxacum
cool-eold
bitter
Mahonia
cool neutral-eool
51. acrid, 51. bitter
Glycyrrhiza
1 1 1 1 1
5weet
hot
acrid, aromatic
Ratio
Temperature
Taste
1 1 1 1 1 1
warm-eool
acrid, aromatic, bitter
cool cool
0.5 0.5
Aretium (root)
cool
51. acrid, 51. bitter
cool-cold
bitter
cool
bitter
neutral-eool
sweet
GENERAL
4. Lymphadenitis
This combination is for accumulation of Heat Toxin, Damp Heat, and Phlegm in the channels supplying the skin. The overall temperature is cool to treat chronic warm-hot conditions. For cases of acne or boils associated with an acute hot condition, this combination can be replaced by
Retained Pathogen + Heat Toxin
Echinacea: boils + infection.
This combination is the same as Thuja: cancer therapy adjunct and is discussed under that heading.
Herb Calendula Thuja Arctium (root)
Ratio:,Temperature c~ -.Taste·~'"
1 1 1
51. bitter
cool warm-eool
acrid, aromatic, bitter
cool
51. acrid, 51. bitter
The bitter constituents can clear Heat Toxin and Damp Heat, and the acrid constituents can help to clear Phlegm.
USE • chronic acne or boils
Combining Western Herbs and Chinese Medicine
592 PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of water three times per day for 2-3 months with appropriate breaks and modifications. For cases in which the chronic acne is associated with hormonal imbalance, in addition to this combination, the patient can also take 2.5 ml of 1:5 tincture of Vitex agnuscastus every morning, if appropriate (see Vitex chapter).
Caution • this combination is not appropriate for long-term use for patients with debility and weak digestion associated
3. Cancer therapy adjunct
4. Lymphadenitis
Stagnant Qi + Damp Heat + Heat Toxin
Retained Pathogen + Heat Toxin .. '" ..... .. Herb---;-_·_-'-Ratio ,-
Herb.·
RatiO
Thuja Viola odo. Phytolacca Hydrastis Taraxacum Aretium (root) Glycyrrhiza Zingiber
1 1 1 1
1 1
0.5 0.5
..~,
Calendula Thuja Arctium (root) Phytolacca Baptisia Glycyrrhiza Zingiber
'~--".~-.
1 1 1 1
1
0.5 0.5
with patterns of Spleen Deficient Qi and Cold
COMPARISON OF THE SIX
3. Thuja, Viola, and Phytolacca have a reputation for retarding the growth of tumors. Thuja, Viola, Phytolacca, Hydrastis, Taraxacum, and Arctium are alterative herbs that can help to clear Retained Pathogen, Damp Heat, and Heat Toxin to reduce the side effects of radio~ or chemotherapy. Glycyrrhiza can assist detoxification and act as an antiinflammatory and tonic. Zingiber moderates the effect of the cooling herbs and helps to stimulate circulation and diges-
PHYTOLACCA COMBINATIONS
tion.
• during the initial use of this combination, the precautions for the use of alterative herbs and combinations should be observed-see the section Cautions on the use of
alteratives in the chapter on Safety
1.ChronicsUnusitis
2. Acute tonsillitis
Lung Phlegm Heat
Wind Heat + Heat Toxin
Herb .. ,-' ,;.:;., Ratio
Herb
Ratio
Euphrasia Echinacea Sambucus Hyssopus Hydrastis Glechoma Phytolacca
Salvia off. Baptisia Commiphora Phytolacca
1 1 1 1
1 1 1 1 1 1 1
1. All the herbs in this combination can help clear Lung
4. Both this combination and the previous combination contain the alterative herbs Phytolacca, Thuja, and Arctium to clear Damp, Phlegm, and Heat Toxins. In this combination for lymphadenitis, Calendula and Baptisia are included since these herbs are specific for lymph system disorders. In combination No.3, Viola is included for its reputed antitumour action and Hydrastis and Taraxacum are included to assist the liver to clear toxins from the body that result from chemotherapy. 5. Chronic psoriasis
6. chronic acne
Stagnation of Qi and Blood + Phlegm
Heat Toxin + Phlegm
Phlegm. Euphrasia, Echinacea, Sambucus, and Hyssopus can help to clear Wind Heat in acute sinusitis; Phytolacca and
Herb
Ratio
Herb
Ratio
Echinacea can clear Retained Pathogen in recurring sinu-
Smilax Mahonia Phytolacca Thuja Zanthoxylum Salvia mil. Zingiber
1 1 1 1 1 1
Phytolacca Galium Viola tri. Arctium (root) Taraxacum Mahonia Glycyrrhiza
1 1 1
sitis; and Hydrastis, Glechoma, and Phytolacca can clear Lung Phlegm in chronic sinusitis. 2. The four herbs in this combination can clear Heat Toxin to treat tonsillitis. Warming Commiphora balances cold Baptisia to avoid aggravating Cold Deficient Spleen patterns. Phytolacca helps to clear Phlegm, Damp, and Heat Toxins from the throat and from the lymph system. Whilst
0.5
1 1 1 1
5. Smilax and Mahonia make this combination specific
combina No.1 can be taken long-term for chronic conditions, this combination is for acute tonsillitis and should not
for psoriasis. Phytolacca and Thuja are for psoriasis with Stagnation of Qi and obstruction of the channels by Damp and Phlegm, and Zanthoxylum and Salvia miltiorrhiza are
be taken for more than 5 days without monitoring.
for psoriasis with Stagnant Blood.
--~"';;:'.
Phytolacca 6. The previous combination contains Thuja, Zanthoxylum, and Salvia to move Stagnation of Blood and Qi. These herbs are absent from this combination, which contains instead Galium, Arctium, Viola, and Taraxacum, which combine to treat acne associated with Phlegm and Heat Toxin. This combination contains Glycyrrhiza to cool and detoxify, whilst the previous combination contains Zingiber to warm and move Qi and Blood.
OTHER PHYTOLACCA COMBINATIONS The following additional combinations further illustrate the range of uses of Phytolacca:
• Angelica: sinusitis + obesity • Ruta: infertility + obesity • Thuja: prostatic enlargement + sexual debility • Thymus: bronchitis + sinusitis
Research CONSTITUENTS The following constituents have been reported: • triterpenoid saponins • poke weed antivii"al protein • poke weed mitogen • other Triterpenoid saponins contain phytolaccosides.1
Phytolacca has been reported to 2
Poke weed antiviral protein (PAP) This is an anti-HIV protein that can be isolated from the leaves or seeds of P. americana. 13 Poke weed mitogen (PWM)
This is a lectin (protein that
binds to a specific carbohydrate in glycoproteins) present in P. americana.!l Other The BHP listed the following constituents for P. americana: the alk2loid phytolaccine, phytolaccic acid, resins, tannins, and sugars. Chang and But listed the following constituents for shang lil, P. acinosa: acidic steroidal saponins, phytolaccine, oxyristic acid, jaligonic acid, large amounts of potassium nitrate, and phytolaccatoxin (mainly in the fresh plant). An antifungal peptide has been reported to be present in the seeds of P. americana,14 and the neolignans, isoamericanol A and americanol A, have been isolated from the seeds of P. americana. IS
593
PHARMACOLOGICAL AND CLINICAL RESEARCH The following effects have been reported: • antibacterial • antifungal • antiviral • immunoregulatory • anti-inflammatory • expectorant • antitussive • diuretic • antimutagenic Antibacterial Decoctions and tinctures of P. acinosa have been reported as having antibacterial activity against some species of Shigella. 16 Antifungal Early research in China reported that an aqueous extract of shang lil was effective against some skin fungi,17 and more recently, a peptide from the seeds of P. americana showed broad-spectrum antifungal activity.14 Antiviral Poke weed antiviral protein (PAP) has broadspectrum antiviral activity in vitro, including against HIV. 18 PAP may be clinically useful both as a nonspermicidal, intravaginal microbicide and as a prophylactic antiviral agent against infective viruses in semen before assisted reproductive procedures are performed. 13 Immunoregulatory Poke weed mitogen (PWM) has been recommended for mitogen immunotherapy for HIV infection. 19 Anti-inflammatory A triterpenic acid preparation from shang IiI showed a strong anti-inflammatory action on rat paw edema,20 and intraperitoneal injection of crude saponin preparations from Phytolacca inlubited acute paw edema in rats. 2! Expectorant A study on rabbits showed that shang III decoction administered either intragastrically or intraperitoneally had expectorant activity and could enhance movement of the intratracheal cilia of rabbits, thereby increasing the speed of mucus transport,22 Antitussive Administration of shang IiI decoction or of its saponins had only a weak antitussive effect in mice, but the alkaloid fraction had a strong antitussive affect when administered intragastrically.23 In clinical studies, shang IiI preparations were more effective as expectorants and antitussives than as antiasthmatics, and were effective for nonasthmatic forms of bronchitis, but less effective for bronchitis of the asthmatic type. 24
~~-
594
_~~ :.,:=:
Combining Western Herbs and Chinese Medicine
Diuretic Perfusion of toad kidney with shang lil extract caused a marked increase in urine output. 2S Antimutagenic Given by injection, PWM by itself, that is, unassisted by ancillary therapy, has shown curative effects for metastatic malignancies in dogs and cats. 19 RESEARCH VERIFICATION OF TRADITIONAL ACTIONS
and tachycardia,28 and there have been reports of caIdiat'~'-_.:-.:::.~ disorders and even fatality.II.29 In one Chinese clinical study, chronic bronchitis patients were given shang lil as a honey pill or as an ethanol extract tablet. There were no pronounced adverse effects, and only a few patients developed dryness of the nasopharynx or gastrointestinal symptoms, which usually disappeared spontaneously in 3 to 5 days. In this study, the t.ardiovascular system, liver, and kidneys did not display significant toxic
Although the term "anticatarrhal action" was not explicitly used, preparations of the dried root of shang lil have been reported to have expectorant and antitussive actions. Antifungal effects have been reported for preparations of shang lil and for a peptide constituent of P. americana.
effects. 23
Additional effects demonstrated by research Antibacterial, antiviral, immunoregulatory, anti-inflammatory, diuretic, and antimutagenic effects have been reported for P. americana, for Chinese Phytolacca species, and for isolated constituents of these plants.
Lack ofspermicidal activity PAP was shown to be nontoxic
TOXICOLOGY Tinctures of P. americana can be used with safety within the therapeutic dose range, but both P. americana and P. acinosa can be toxic when used outside this range. Fresh material is regarded as more toxic than dried material, and one text has suggested that liquid extracts made from dried material may be stronger and potentially more toxic than tinctures. 3 Effect on animals One early study reported that large oral doses ofliquid extracts impaired liver function, but not kidney function, in rabbits. 26 According to later studies, no heart, lung, liver, or kidney abnormalities were detected in pathological examination of rats fed a decoction of 5 glkg for 3 weeks, or in rats administered an ethanol extract at 3.6 glkg for 30 days. The ethanol extract did not aggravate carbon tetrachloride-induced hepatic lesions. Oral administration of the ethanol extract to cats resulted in vomiting at doses of 2.5-10 glkg, the severity of the vomiting increasing with dose. Oral doses of 1 glkg in dogs resulted in vomiting. 16.24
Lymphocyte stimulation PWM stimulates lymphocyte production in vitro, and severe toxic reaction to an ingestion of an excessive dose of P. americana showed an increase in lymphocyte count. 29
to human sperm and to female genital tract epithelial cells even at a concentration 2000 times higher than its IC(50) value against HIV_1. 13 Fresh material There i~ a tradition in some parts of the USA of eating the parboiled young shoots of poke weed as a salad. This is reputed to be safe, providing that the shoots are gathered in early spring and are boiled twice.
Age of fresh material According to Felter and Lloyd, the young green shoots are gathered in the spring before the leaves have developed. These authors reported that the leaves become cathartic as they mature, and it may be that potentially toxic chemicals accumulate in the leaves.
Boiling of fresh material It has been reported that prolonged boiling reduces the toxicity of fresh material. Toxic effects were reported after ingestion of what were described as 'properly cooked young shoots: 30 However, Crellin and Philpotf point out that the leaves in this case were picked on the 11th of July, which does not follow the tradition that only young shoots picked in early spring can be eaten. Topical application Fresh preparations have produced skin inflammation,31 and introduction of a Phytolacca extract into the eyes of rabbits has produced conjunctival irritation. 26
Use as molluscicide It was reported that water treated with molluscicidal concentrations (approximately 50-100 mglliter) of P. dodecandra water extract probably do not affect reproduction in mice. 27
Dose PREPARATIONS FROM DRIED
Effect on~umans Signs following an overdose can include an initial burning sensation in the mouth and throat, followed a few hours later by severe nausea, vomiting, and diarrhea. This may be followed by hypotension, prostration,
.'~~-
.'.c:..:.;~~
P. AMERICANA Dried herb The BHP listed 0.06-0.3 g of dried root, three times per day as the therapeutic dose.
-
--
Phytolacca Tincture The BHP listed 0.2-0.6 ml of 1:10 tincture in 45% alcohol, three times per day. I generally use 0.4-0.8 ml of tincture, three times per day. Initial dose Can start at the lower standard dose, provided cautions are observed. Duration Can be used for 1 month or more, provided cautions are observed.
PREPARATIONS FROM DRIED SHANG LU The dose of shang lil, which can be P. americana or other Phytolacca species, has been given as 1-3 qian,32 which is 3-9 grams. This may refer to six individual doses (three per day for two days) of 0.5-1.5 g, which is over five times greater than the individual dose of 0.06-0.3 g given by the BHP.
PREPARATIONS FROM FRESH MATERIAL It should be noted that, whilst the American tradition of use has been more of preparations made from the fresh material, the British tradition of use has been more of the dried material. Fresh material may be more toxic, and if used:
• it should be used with greater caution than the dried material • the recommended maximum dose for fresh material preparations should not be exceeded • the patient should be monitored for any adverse effects • the administration of the herb should be stopped immediately if there are adverse effects Tincture Christopher's instructions for production of the tincture were to soak one pound of fresh and coarsely ground poke root in half a gallon of 40% alcohol for 2 weeks and then filter the mixture. His recommended dose was 10 drops three times per day, with the caution not to exceed the stated dose since this herb is potent. Tierra cautioned against overdosing and recommended two to five drops of tincture of the fresh root, two or three times daily. However, if this causes nausea, the patient should stop the treatment and begin again with smaller doses. Moore also listed the use of the tincture of the fresh root in doses similar to those of Tierra.
595
Western contraindications As with some other alteratives, spots or mild skin rashes, or an increase of phlegm in the nose or chest, may occur in a few cases in the first few days of taking this herb as toxins are cleared from the body. Mills and Bone contraindicated the use of this herb in cases of lymphocytic leukemia, see Toxicology. Chinese contraindications The use of shang 11.1 is restricted in Chinese tradition to conditions of extreme Excess. However, the doses used for Phytolacca species in Chinese 32 medicine are 5 _10 33 times greater than those used for P. americana in the West. At the lower doses used in the West for P. americana, I would not prescribe this herb in cases where there is Deficient Yin with signs of Dryness unless'it is combined with moistening herbs, such as Glycyrrhiza. Pregnancy and lactation Contraindicated, 3but no references were given to support this statement. Side effects According to Julian Scott,34 there is the possibility that Phytolacca may aggravate enuresis in children. Overdose An overdose of this herb can be toxic, see Toxicology, and medical advice should be sought immediately. Interactions
None known.
SCREENING
Phytolacca should not be prescribed if the patient: • is pregnant or breastfeeding • has severe gastrointestinal irritation • has a history of lymphocytic leukemia
TREATMENT PRECAUTIONS P. americana should be used within the recommended dose range, and initially it should be used at the lower therapeutic dosage.
MONITORING During the course of a herbal treatment that includes P. americana, the patient should be monitored for:
Cautions for Phytolacca preparations from dried material
• signs of gastrointestinal irritation, such as gastric discomfort, nausea, or vomiting, that occur when they take the herbal preparation
Since my experience is mainly with tinctures made from the dried material, the cautions given here relate only to the dried material of PI americana.
• weakness, dizziness, hypotension, headache, or tachycardia that occur when they take the herbal preparation
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Combining Western Herbs and Chinese Medicine
If any of these occur, beyond the appearance of mild and transient gastric discomfort or nausea, the herbs should be stopped.
Regulatory status Please read the Regulatory status section in the chapter on Safety. Phytolacca (poke root) is in the UK General Sale List. It is included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. This restricts the OTC sales of Phytolacca products, but does not directly affect practitioners of herbal medicine. 3 Phytolacca is not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
Traditional sources PROPERTIES Temperature The temperature of P. americana will depend on whether the fresh or dried material is used. The fresh material used both internally and topically can have an irritant action. Therefore, its initial effect would seem to be warming. Irritant or toxic effects are not normal for therapeutic doses of preparations made from the dried material of P. americana, which is classified in this book as cool in temperature in terms of Chinese medicine. Shang IiI, the Phytolacca species used in China, is classified in Chinese texts as cold, but the Chinese doses are over five times those used in the West. Taste
Taste in the mouth The BHP described the dried root as acrid in taste. I found that a 1:5 tincture of the dried plant in 45% alcohol tastes slightly acrid, slightly bitter, and slightly sweet. The dried root tasted predominantly acrid, and also slightly sweet and slightly bitter. Taste properties Shang IiI is described as bitter in taste in Chinese texts, but P. americana, as used in the West, is classified in this book as acrid in taste in the sense that it can clear Phlegm obstruction, like Lobelia or Thuja, which are also classified as acrid. ORGANS In terms of Chinese medicine, Phytolacca, as used in the West, is associated mainly with the Lung and the channels of the muscles and skin:
Lung
Muscle channels
skin
respiratory catarrh recurring respiratory infections
BHP" scott34
rheumatism chronic rheumatism
Lyle7
chronic eczema acne
Felter and L1oyd6
BHP BHP
One text listed shang IiI as entering the Spleen and Kidney channels3; and another as entering the Spleen, Lung, and Bladder meridians. 32 ACTIONS • anticatarrhal • alterative • dermatological agent • antifungal and antiparasitic Anticatarrhal Felter and Uoyd recommended fresh P. americana for acute and chronic catarrhal disorders, and listed it for nasal catarrh, cough from inflamed or irritated sore throat, granular conjunctivitis, and leukorrhea. Christopher listed the fresh material for obesity, and according to Julian Scott, the dried material can speed up fat metabolism and can be used to treat overweight children. He also recommended dried P. americana for recurring respiratory infections in children with thick phlegm and swollen neck glands. The BHP listed dried P. americana for inflamed and chronic conditions of the upper respiratory tract with chronic catarrh. Alterative Felter and Uoyd listed fresh P. americana for tonsillitis, laryngitis, mumps with testicular involvement, soreness of the mammary glands or mastitis, painful, enlarged lymph glands, rheumatism, and arthritis. Christopher reported use of the fresh material for hardened liver and scanty flow of bile, goiter, bony enlargements from direct injury, and malignant tumors. The BHP noted the use of the dried root internally for adenitis, tonsillitis, mumps, mastitis, lymphadenitis, and chronic rheumatism, and externally as a poultice for mammary abscess and mastitis. Dermatological agent According to Felter and Lloyd, fresh P. americana can be used for chronic eczema, psoriasis, boils, varicose and other leg abscesses. They wrote that for skin diseases, this herb should be used both internally and topically. Ellingwood noted the internal use of fresh Phytolacca for eczema, especially that of a dry character with cracks or fissures in the skin, and for psoriasis. .
Phytolacca Antifungal and antiparasitic Felter and Lloyd recommended the use of the fresh material both internally and topically for tinea (fungal infection) and scabies (mite infestation). The BHP listed ointment made from the dried material for not only for acne, but also for tinea and scabies.
597
10. Moore M. Medicinal Plants of the Pacific West. Red Crane Books, Santa Fe. New Mexico (1993) 11. Chang H-M, But PP-H (eds). Pharmacology and Applications oi Chinese Materia Medica, vols. 1 and 2. World Scientific Publishing, Singapore (1986) 12. Tang W. Eisenbrand G. Chinese Drugs of Plant Origin. SpringerVerlag, Berlin, Germany. pp 763-775 (1992)
COMPARISON OF WESTERN AND CHINESE
13. D'Cruz 01, Uckun FM.Fertii Steril75(1):106-114 (2001)
USE OF PHYTOLACCA SPECIES
14. Shao F, Hu Z, Xiong YM et al. Biochirn Biophys Acta 1430(2):262-268 (1999)
P. americana is the main species used in the West and is also one of the Phytolacca species used in China as shang lil. However, the doses of dried Phytolacca root used in Chinese medicine are over five times larger than those used in the West for P. americana, and the primary use of shang lil is as a strong diuretic for ascites and edema. Shang IiI is also used to treat lumps and tumors, and as an external application for skin lesions, as is P. americana in the West. However, it does not seem that shang IiI is widely used internally in China for the treatment of respiratory catarrh, recurring respiratory infections, throat problems, rheumatism, arthritis, lymph disorders, breast disorders, and skin disorders, as P. americana is used in the West.
References 1. Foster S, Duke J. Medicinal Plants. Houghton Mifflin, Boston. Massachusetts (1990) 2. Crellin IK. Philpott J. A Reference Guide to ~ledicinal Plants. Duke University Press, Durham, North Carolina (1990) 3. Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone. Edinburgh. Untied Kingdom (2000)
15. Fukuyama Y, Hasegawa T. Toda M. Chern Pharm Bull 40(1):252-254 (1992) 16. Shaanxi Coordinating Group for Basic Clinical Research of Chronic Bronchitis. Shaanxi :Vledical Journal (3):31 (1973) 17. Cao RL et a1. Chinese Journal of Dermatology (4):286 (1957) 18. Turner NE, Hwang DI, Bonness M. Proc Natl Acad Sci USA 94(8): 3866-3871 (1997) 19. Wimer BM, Mann PL. Cancer Biother Radiopharm 15(6):629-644 (2000) 20. Sick WW. Chemical Abstracts 80:141071n (1974) 21. Woo WS. Shin KH. Kang SS. Soul Tachakkyo Saengyak Yonguso Opjukjip 15:103-106 (1976) 22. Pharmacology Section, Xi'an Medical College. Acta Academiae Medicinae Xi'an (1):27 (1976) 23. Shaanxi Coordinating Group for Basic Clinical Research of Chronic Bronchitis. Chinese Traditional and Herbal Drugs Communications (1):13 (1973) 24. Xianyang District (Shaanxi) Science and Technology Group. Xianyang Science and Technology-Special Edition on Prevention and Treatment of Chronic Bronchitis with Yeluobo Gen (Internal Information) (1975) 25. Masuzawa H.ChemicalAbstracts37:1772(9) (1943) 26. Macht D1. J Am Pharm Assoc Sci Ed 26:594-599 (1937) 27. MamoE,WorkuM.Contraception35(2):155-161 (1987) 28. Lewis WHo Smith PRo JAMA 242(25):2759-2760 (1979)
4. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, l1nited Kingdom (1983)
29. Roberge R. Brader E, Martin Mlet al. Ann Emerg Med 15(4):470-473 (1986)
5. Mabey R (ed). The Complete New Herbal. Elm Tree Books, London, United Kingdom (1988)
30. Lawrence Rev. ~at. Prod., quoting Morbidity and Mortality Weekly Report 30:65 (1981)
6. Felter HW and lloyd Jv. King's American Dispensatory. vols. 1 and 2. 18th edn. (1898). Reprinted by Eclectic Medical Publications. Sandy. Oregon (1983)
31. Mitchell J. Rook A. Botanical Dermatology: Plants and Plant Products Injurious to the Skin. Greengrass, Vancouver p 513 (1979)
7. Lyle TJ. Physio-Medical Therapeutics. Materia Medica and Pharmacy. Originally published Ohio (1897). Reprinted by the National Association of Medical Herbalists of Great Britain. London, United Kingdom (1932)
32. Bensky D. Gamble A. Chinese Herbal Medicine Materia Medica. Eastland Press, Seattle. Washington (1986) 33. jiangsu New :-'Iedicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science and Technology Press, Shanghai, China (1975)
8. Christopher JR. School of Natural Healing. BiWorld, Provo, Utah (1976)
34. Scott J. Natural Medicine for Children. Unwin Paperbacks, London, United Kingdom (1990)
9. Tierra M. Planetary Herbology. Lotus Press, Twin Lakes. Wisconsin (1988)
35. Yeung H-C. !-Iandbok of Cpinese Herbs and Formulas. vol. 1. Institute of Chinese Medicine. Los Angeles, California (1985)
___IF'i
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Piscidia Botanical name Piscidia piscipula (L.) Sarg. (P. erythrina 1.) Family Fabaceae (Leguminosae) Pharmaceutical name Piscidiae radicis cortex Part dried root bark English Jamaica dogwood German Gemeiner Fischfanger French cornouiller de jarnaIque Mandarin P. piscipula (L.) Sarg. is not used Use in the West Jamaica dogwood is a small tree native to the West Indies. The first reference I found to the herbal use of its root bark is by Felter and Lloyd,' writing in 1898. They described its use as an analgesic for migraine, toothache, earache, painful muscle spasms, abdominal pain, renal pain, and dysmenorrhea; and as a calming herb for insomnia, hysterical convulsions, and delirium tremens. In addition to these indications, Ellingwood2 reported the use of Piscidia for 'inflammatory fever' and 'inflammatory rheumatism: and for spasmodic coughs. Piscidia was not listed by Lyle.) The herb was presumably introduced into Britain by the Eclectics in the early 20th century. The BHP~ listed its use as an analgesic and sedative for migraine, neuralgia, dysmenorrhea, and insomnia due to neuralgia or nervous tension, and the BHC also listed it for sleep disorders. The herb does not appear to be well known in Germany, and it is not mentioned in Weiss,6 Wichtl/ or the German Commission E mono-
But,l1 and it seems that the use of this herb is not known in China or other countries of the Orient.
What is special about Piscidia In terms of Chinese medicine, Piscidia, as used in the West, can be said to be a cold, bitter herb. which has its main effects on the Heart and Liver.
The key to understanding Piscidia is that it has two main, uses: to treat insomnia and to relieve pain, especially when these conditions are associated with nervous tension. CHINESE ACTIONS In terms of Chinese medicine. Piscidia. as used in the West; can be said to have three main actions: I. calm Heart Spirit Disturbance II. calm Liver Hyperactive Yang III. relieve pain Relieve pain The biochemical mechanism, by which Piscidia has its analgesic effect. is not known, but, in simple terms, it seems to act by sedation rather than by stimulation. It appears to relieve pain more by sinking Heart Spirit or Liver Yang, than by moving Stagnation of Qi and Blood. If the patient has a pattern of Deficiency, Stagnation. or Cold. I generally combine the sedative Piscidia with a tonifying, moving, and warming herb. such as Rosmarinus.
graphs. 8 Use in China
Piscidia does not have an entry in the Chinese Herbal Medicine Dictionary,9 Perry,1O or Chang and
599
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600
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Combining Western Herbs and Chinese Medicine
'~::~-'
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WESTERN ACTIONS The main Western actions of Piscidia are shown here in terms of its three main Chinese actions: Chinese actions
w~,~.::;:.~~
. should be combined with both Rosmarinus and Zingiber to->'E-"'ET warm and move the Qi. In addition, the Piscidia combination should be followed by a tonic combination as soon as the pain levels are reduced.
Western actions
I. calm Heart Spirit Disturbance
tranquilizer hypnotic
II. calm Liver Hyperactive Yang
tranquilizer antispasmodic
III. relieve pain
analgesic antispasmodic tranquilizer
Limitations of Piscidia TEMPERATURE Piscidia is a cold herb for warm or hot conditions, but it can be used for cool or even cold patterns, provided it is suitably combined with warming, stimulant herbs and provided it is only taken for short periods of time.
WESTERN USES The main Western uses of Piscidia can be related to its three main Chinese actions: Chinese actions
Western uses
I. calm Heart Spirit Disturbance
insomnia
II. calm Liver Hyperactive Yang
migraine. muscle spasms
III. relieve pain
neuralgia. dysmenorrhea
There is overlap between the three categories of use. For example, there may be a painful condition, in which both Heart Spirit Disturbance and Liver Hyperactive Yang are involved, with nervous tension, muscle spasms, and pain.
DIRECTION OF ENERGY Piscidia appears to direct disturbed energy downward and to calm the irregular upward movement of Heart Spirit or Liver Yang and Liver Wind.
TYPICAL CASE EXAMPLE Signs and symptoms The patient has a history of recurring migraines, is exhausted from the pain of the migraines and the resulting insomnia, has a haggard-looking and pale face, and cold extremities. The pulse is wiry and flooding, but with underlying emptiness. The tongue is pale and slight1y purple with some red spots. Diagnosis The dominant syndromes are Liver Hyperactive Yang and Heart Spirit Disturbance with under.lying DeficientQi. Choice of Piscidia This herb is specific for Liver Hyperactive Yang and Heart Spirit Disturbance, treating both the migraine and the insomnia. However, in this case with Deficient Qi manifesting as exhaustion and cold, Piscidia
TASTE In this book, the bitter taste of Piscidia is associated mainly with its capacity to calm the Heart or Liver and clear Heat, but is not considered to have a bitter digestive tonic action.
ACTIONS Antispasmodic and analgesic Whilst a part of the antispasmodic and analgesic actions of Piscidia may be indirect and resulting from its calming effect on nervous tension, I consider this herb more specifically analgesic than Valeriana, for example. However, for pain related to intestinal spasms, I would use Valeriana in preference to Piscidia. Tranquilizer and hypnotic As with Valeriana, I use Piscidia for conditions ranging from Excess to Deficiency and from Heat to Cold. However, I use it especially for conditions of Excess, Heat, or Excess and Heat together when they are associated with nervous tension. I do not use it for patterns of Deficiency, Stagnation, or Cold unless it is combined with stimulant, moving, or warming herbs. For example, • for insomnia with Deficiency, I would combine it with Lavandula • for headache with Liver Stagnant Qi, I would combine it with Rosmarinus • for neuralgia with Cold, I would combine it with Zingiber or Capsicum
Piscidia paired with other herbs Discussion of the limitations of each of the main actions of Piscidia can be useful to clarify just what this herb can and cannot do. However, suitable combination with other
Piscidia herbs can extend the range of use of Piscidia beyond its limitations. The basic unit of herb combination is the herb pair. Six: pairings of Piscidia are briefly explained below.
601
painful conditions of the female or male reproductive system, such as dysmenorrhea, ovarian pain, or testicular pain. Piscidia + Zingiber
CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair. Piscidia + Valeriana
Headache + irritability Both herbs can calm nervous tension. Valeriana can be used for nervous tension associated with anger and Liver Heat or worry and Stomach Heat. Therefore, Piscidia and Valeriana together can be used for headache with gastritis, flushed face, anger, and worry.
Neuralgia + cold sensations In this pair, Piscidia is combined with the warming diffusive stimulant Zingiber. The herbal pair can be used to treat headache, migraine, trigeminal neuralgia, postherpetic neuralgia, or other painful conditions in cases in which the patients also have weakness and sensations of cold in the limbs or body.
Piscidia combinations Three Piscidia combinations are discussed below:
Piscidia + Rosmarlnus
Headache +' depression Piscidia and Rosmarinus make up a second herbal pair for treating headache. Whilst Valeriana officinalis tends to be cooling and sedating, Rosmarinus is warming, tonifying, and moving. Rosmarinus can moderate the sedative action of Piscidia so that the pair can be used to relieve pain in patterns of Deficiency, Stagnation, and Cold.
.C~mbination _. '.' .
_._~ ...Chinese.syndromes. _.. • .... _+ .••
Lavandula is calming, but it also has a mild warming and antidepressant effect, which counteracts the cooling, sedative action of Piscidia. This pairing enables Piscidia to be used for insomnia and neuralgia linked to nervous tension without aggravating the depression associated with mild Deficiency and Stagnation of Qi.
-
.
. ..:...: ..... -:..:.~: ..
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1. insomnia + muscle spasms
Heart Spirit Disturbance + Stagnant Qi and Blood
2. headache + facial neuralgia
Uver Hyperactive Yang + Stagnant Qi and Blood in channels
3. dysmenorrhea + nervous tension
Uterus Stagnant Qi and Blood + Heart Spirit Disturbance
Piscidia + Lavandula
Insomnia + neuralgia
.
CAUTION
Before using any of the combinations below, it is important to be familiar with the cautions listed for each herb in the combination. I
1. Insomnia + muscle spasms
Heart Spirit Disturbance + Stagnant Qi and Blood Piscidia + Anemone
Insomnia + fearful dreams Anemone can be used for Heart Spirit Disturbance linked to Kidney fear. Piscidia can therefore be combined with Anemone for disturbed sleep with fearful dreams or nocturnal panic attacks. However, since both of these herbs are cold, warming herbs such as Lavandula and Zingiber would need to be added to treat cases with patterns of Deficiency and Cold. Piscidia + Lobelia
Dysmenorrhea Piscidia is more of a sedative and analgesic, and Lobelia is more of an antispasmodic; the pair balances relaxation and stimulation. Thus, the two herbs can be combined for
Herb Piscidia Valeriana lavandula lobelia Zingiber
Ratio
Temperature
Taste
1 1 1
cold cool 51. warm warm-cool hot
bitter bitter. sweet aromatic, bitter, 51. acrid acrid acrid, aromatic
0.5 0.5
GENERAL This combination is for Heart Spirit Disturbance with Stagnation of Qi and Blood in the channels. There may also be some Cold in the channels. The overall temperature is more or less neutral, but the combination contains cooling bitter constituents to calm the Spirit, and warming acrid and aromatic constituents to warm and move the Qi in the channels to relieve spasms.
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602
Combining Western Herbs and Chinese Medicine
USE
• insomnia with muscle spasms or pain associated with accumulated nervous tension; the spasms could be in the muscles of the neck, jaw, diaphragm, or calves
days before menstruation and also during menstruation.~~... ~~ This combination specifically relieves pain associated with muscle spasms and nervous tension. Once menstruation has stopped, this combination can be replaced by a more tonic or more regulatory combination.
PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of hot water before bed and, if necessary, on waking in the night. Once the insomnia, nervous tension, and muscle spasms are reduced, this combination can be replaced by a more tonic combination. 2. Headache + facial neuralgia
Liver Hyperactive Yang + Stagnant Qi and Blood in channels Herb Rosmarinus Lavandula Valeriana Piscidia Lobelia Glycyrrhiza Zingiber
Ratio·- Temperature
Taste
1 1 1 1
aromatic, bitter, acrid aromatic, bitter, 51. acrid bitter, sweet bitter acrid sweet acrid, aromatic
0.5 0.5 0.5
warm 51. warm cool cold warm-cool neutral-cool hot
This combination is the same as Rosmarinus: headache + nervous tension and is discussed under that heading. 3. Dysmenorrhea + nervous tension
Uterus Stagnant Qi and Blood + Heart Spirit Disturbance Herb Piscidia Anemone Mentha pul. Lobelia Zingiber
Ratio
Temperature
Taste
1 1 1
cold cold warm warm-cool hot
bitter bitter aromatic acrid acrid, aromatic
0.5 0.5
GENERAL
This combination is for Uterus Stagnant Qi and Blood plus Heart Spirit Disturbance. There may also be some Liver Hyperactive Yang and/or Kidney fear. The overall temperature is more or less neutral but the combination contains cold, bitter herbs to calm the Spirit and warming, acrid, and aromatic herbs to relieve uterine muscle spasms. USE
COMPARISON OF THE THREE PISCIDIA COMBINATIONS 1. Insomnia + muscle spasms
Heart Spirit Disturbance + Stagnation of Qi and Blood Piscidia, Valeriana, and Lavandula combine to calm anxiety and promote sleep, and all five herbs can combine to relieve muscle spasms and pain associated with nervous tension. Valeriana and Piscidia are more sedative analgesics, whilst Lavandula, Lobelia, and Zingiber in combination can relieve muscle spasms by normalizing muscle tone and by stimulating the flow of Qi and Blood in the Muscle channels.· __ .c._ 2. Headache + facial neuralgia
Liver Hyperactive Yang + Stagnant Qi and Blood in channels Both the previous combination and this combination contain Piscidia, Valeriana, Lavandula, Lobelia, and ZingIber. The difference between the two combinations lies in the inclusion of Rosmarinus in combination No.2. Rosmarinus is not only specific for headache, but its circulatory stimulant action can moderate the sedative action of Piscidia, enabling this combination to be used for patterns of mixed Excess and Deficiency. Rosmarinus is too stimulant to be included in combination No.1 for insomnia. ' 3. Dysmenorrhea + nervous te~sion Uterus Stagnant Qi and Blood + Heart Spirit Disturbance This combination is similar to the first combination in that both contain Piscidia, Lobelia, and Zingiber to relieve muscle spasms associated with nervous tension. The presence of Anemone and Mentha pulegium makes this combination specific for pain in the reproductive system associated with emotional stress.
OTHER PISCIDIA COMBINATIONS The following additional combination further illustrates the range of uses of Piscidia:
• Valeriana: hypertension + headache
• dysmenorrhea aggravated by nervous tension
Research
PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of hot water three times per day, for a few
CONSTITUENTS The following constituents have been reported:
.Piscidia
antitussive, antipyretic, and anti-inflammatory actions of Piscidia have some research support, but the data is limited.
• isoflavonoids • organic acids • other Isoflavonoids main types: 12
603
P. piscipula contains isoflavonoids of four
• isoflavones with the typical three-ring structure, mainly erythbigenin, piscidone, and piscerythrone • isoflavones with an additional oxygenated chromene ring, mainly ichthynone, and jamaicin • an isoflavone with an additional furan ring, lisetin • rotenoids with a five-ring structure, including rotenone and millettone Organic acids These include piscidic, fukiic, and methylfukiic acids, which are derived from tartaric acid. 13
Additional effects demonstrated by research effect for Piscidia has been reported.
An antifungal
TOXICOLOGY It has been reported that P. piscipula has negligible toxicity in (warm-blooded) animals,16 although this herb has been used as a poison for fish and insects since rotenone inhibits the initial stages of mitochondrial respiration in these animals. 2l However, in 1919, Ellingwood reported that toxic doses Piscidia can reduce heart action and resp,iration, and in extreme cases cause respiratory or heart failure and death.
Other P. piscipula also contains about 2% tannins and ~ sitosterol.'s H
PHARMACOLOGICAL AND CLINICAL RESEARCH The following effects have been reported: • sedative • hypotensive • antispasmodic • antitussive • antipyretic • anti-inflammatory • antifungal The very small amount of published information on pharmacological and clinical research on Piscidia can be summarized as follows: Piscidia preparations Animal studies by Aurousseau et al. in the 1960s reported sedative, hypotensive, antispasmodic, antitussive, antipyretic, and anti-inflammatory actions for P. erythrina. 16 More recent animal studies by Della Logia et al. have reported sedative li and antispasmodic l8 actions for P. erythrina, and proposed the isoflavones as the antispasmodic principles. It has been reported that P. piscipula has inhibitory action against fungi responsible for skin infections in humans. 19
Dose Dried herb The BHC listed 2-4 g of dried root bark, three times per day. Tincture The BHC listed 5-15 ml of 1:5 tincture in 45% alcohol, up to three times per day. Initial dose
Can start at lower therapeutic dose.
Duration Can be used for 1 month or more, provid~d cautions are observed.
Caution Patients who are exhausted but force themselves to function, and perhaps do not admit or realize the degree of their tiredness may initially feel tired on taking calming herbs, such as Piscidia. This sensation is uS.lally temporary while their system takes the rest necessary for recovery. However, if the tiredness persists, even when more stimulant herbs, such as Lavandula and Zingiber, are combined with Piscidia, the combination should be stopped and a different main herb, such as Valeriana or Humulus, should be used.
Rotenone This chemical has a papaverine-like action, and antispasmodic, hypotensive, and myocardial effects have been reported in vitro and in vivo. 20
Western contraindications In cases of weakness with sensations of cold or of depression in the absence of restlessness and anxiety, I would not prescribe high doses of Piscidia unless it was q)mbined with warming, stimulant, or moving herbs.
RESEARCH VERIFICATION OF
Chinese contraindications None known.
TRADITIONAL ACTIONS The hypnotic, tranquilizer, analgesic, antispasmodic,
Pregnancy and lactation No adverse reports known, but I would not recommend this herb at these times.
• Combining Western Herbs and Chinese Medicine
604
Ability to drive and use machines No adverse effects are known. However, prudence would suggest that, if patients were to take doses of Piscidia at the high end of the therapeutic range, they should first take it for a few days when they are not operating machinery to determine if they have any drowsiness or mental dullness. If they have these symptoms, then they should not take this herb when using machines.
Some individuals might experience drowsiness following high doses of Piscidia, in which case the dose can be reduced or another herb prescribed.
the West, is classified as bitter in terms of Chinese medicin~~~-:';=.,.;:';;~ relating to its capacity to calm the Heart and Liver and to clear Heat. ORGANS In terms of Chinese medicine, Piscidia, as used in the West, is associated mainly with disorders of the Heart and Liver:
Side effects
Overdose I do not have recent information on this herb, but older texts reported that an overdose can lead to a reduction in respiratory or heart action and, in extreme cases, to death from respiratory or heart failure. 1. 2 In case of adverse effects from overdose, medical advice should be sought immediately. . Interactions None are known, but it would be prudent to avoid high doses of Piscidia while taking sedative or hypnotic substances prior to driving or operating machinery.
Organ
Exampie~ of use ..
Heart
insomnia. nervous excitability insomnia from nervous tension
Felter and Lloyd
muscle spasms, tics migraine
Felter and Lloyd
Liver
. -<'
Source
Please read the Regulatory status section in the chapter on Safety. Piscidia (Jamaica dogwood) is in the UK General Sale List. It is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Piscidia is not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
Traditional sources PROPERTIES Temperature I have not found direct statements on the temperature of Piscidia in the literature. It is classified in this book as cold due to its sedative and reportedly antipyretic actions. Taste The BHP described Piscidia as having a faint odor and a bitter and acrid taste. I found a 1:5 tincture in 25% alcohol to have a woody odor and a bitter and acrid taste. On chewing, I found that a sample of dried wildcrafted material tasted more bitter and less acrid than the tincture, and slightly mucilaginous. In this book, P. piscipula, as used in
-
BHP BHP
In addition to specific actions on the Heart and Liver, Piscidia has a tradition of use in the West as a general anal- "_" gesic to relieve pain in the head, face, gallbladder, kidneys, intestines, or uterus. Piscidia is not listed in the Chinese
Herbal Medicine Dictionary. ACTIONS
Regulatory status
-
Piscidia has two main uses, that is, to assist sleep and to control pain. The following actions are discussed: • hypnotic and tranquilizer • analgesic • antispasmodic and antitussive • antipyretic and anti-inflammatory Hypnotic and tranquilizer Felter and Lloyd listed Piscidia for insomnia linked to nervous unrest, nervous excitability, or insanity. Ellingwood wrote that it can be used for insomnia in both sthenic (Excess) and asthenic (Deficiency) conditions, and that it 'will produce quiet and restful sleep, when the insomnia is due to nervous excitement, mental worry, or anxiety, and in elderly persons and children: The BHP described Piscidia as a sedative and anodyne, and gave its specific indication as insomnia due to neuralgia or nervous tension. Analgesic Felter and Lloyd noted the use of Piscidia to relieve painful conditions, such as muscle spasms, joint pain, pain of bone fractures, migraine, toothache, painful eye and ear disorders, intestinal pain, kidney pain, dysmenorrhea, false labor pains and threatened abortion, and pain of carcinoma. Ellingwood recommended the use of Piscidia in labor since it 'controls erratic pains and conduces to quiet and rest, and overcomes rigidity by its specific relaxing or antispasmodic influence, although it does not interfere with the normal uterine contractions: He also listed Piscidia for facial
-
Piscidia
605
neuralgia, gallbladder pains, and ovarian neuralgia. The BHP and the BHC listed the use of Piscidia for neuralgia,
5. Bradley PR (ed). British Herbal Compendium, vol. 1. British Herbal Medicine Association, Bournemouth, United Kingdom (1992)
migraine, and dysmenorrhea.
6. Weiss RF. Herbal Medicine, English edn. Beaconsfield Publishers, Beaconsfield, United Kingdom (1988)
Antispasmodic and antitussive Felter and Lloyd cite the use of Piscidia for muscle spasms, spasmodic coughs, whooping cough, asthma, tics, hysterical convulsions, and delirium tremens. Ellingwood recommended this herb for the irritating persistent cough of bronchitis and the night cough and restlessness of pulmonary tuberculosis. I·,'
Antipyretic and anti-inflammatory Felter and Lloyd noted the use of Piscidia as a diaphoretic, and Ellingwood listed it for inflammatory fever of any kind and for inflammatory rheumatism. There has been one research report of an antipyretic and anti-inflammatory effect for Piscidia.
7. Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm, Stuttgart, Germany (1994), from 2nd German edn. Wichd M (ed) (1989) 8. Blumenthal M (ed). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council, Austin, Texas (1998) 9. Jiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science and Technology Press, Shanghai, China (1975) 10. Perry L\1. Medicinal Plants of East and Southeast Asia. The MIT Press, Cambridge, United Kingdom (1980) 11. Chang H-M, But PP-H (eds). Pharmacology and Applications of Chinese Materia Medica, vols. 1 and 2. World Scientific Publishing, Singapore (1986) 12. Falshaw CP, Ollis WD. Moore lA, et al. Tetrahedron Supp!. 7:333-348 (1966) 13. HellerW and Tamm C. HelvChimActa 58:974-979 (1975)
References JU. King's American Dispensatory, vols. 1 and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications. Sandy,
1. Felter HW and lloyd
Oregon (1983) 2. Ellingwood F. American Materia Medica, Therapeutics and Pharmacognosy, lith edn. (1919). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1994) 3. Lyle TJ. Physio-Medical Therapeutics, Materia Medica and Pharmacy. Originally published Ohio (1897). Reprinted by the National Association of Medical Herbalists of Great Britain, London, United Kingdom (1932) 4. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983)
14. Benigni R, Capra C, Cattorini PE. 2:1113-1120 [1] (1964). [cited in Bradley PR (ed). British Herbal Compendium, vol. 1. British Herbal Medicine Association, Bournemouth, United Kingdom (1992}1 15. Stamm OA, Schmid H, Biichi J. Helv Chim Acta 41:2006-2021 (l958) 16. Aurousseau M, Berny C, Albert O. Ann Pharm Franc 23:251-257 (1965) 17. Della Loggia R, TubaroA, Redaelli C. RivNeuroI51(5):297-310 (l98l) 18. Della Loggia R, Zilli C, Del Negro P, et al. Prog Clio BioI Res 280:365368 (1988) 19. Caceres A, Lopez BR, Giron MA et al. JEthnopharmacol31(3):263-276 (199l) 20. Santi R, Ferrari M, Toth E.n Farmaco Ed Sci 21:689-703 (1966) 21. Bruneton J. Pharmacognosy: Phytochemistry Medicinal Plants. 2nd edn. Lavoisier, Paris, France (1999)
Potentilla .j
Botanical name
Potentilla erecta (1.) Raeusch.
(P. tormentilla Stokes) Family Rosaceae Pharmaceutical name Tormentillae rhizoma Part dried rhizome (separated from the roots) I English common tormentil German Tormentill French tormentille Mandarin P. erecta (1.) Raeusch. is not used jIn jIn bang (~~#-) is the aerial part ofP. reptans 1. var. sericophylla Franch. Use in the West
Potentilla erecta This species grows as a low herb with a preference for acid soils and is widespread throughout Central and Northern Europe. l The rhizomes of Potentilla can contain over 20% tannins, and the roots have been used in the past for tanning leather, for example, in the Orkney Islands. Cut or broken surfaces of the fresh rhizome quicklr become red, and in Lapland this plant has been used to produce a red dye.~ Culpepe2 wrote that tormentil 'is most excellent to stay all kinds of fluxes of blood or humours in man or woman, 4 whether at nose, mouth, or belly.' In 1878, William Fox wrote that tormentil'is very useful in all cases of bowel complaints, cholera, dysentery, and diarrhoea ... it is the very '" best remedy in use for bloody flux.' Potentilla has been used to this date in both Europe and America as an antidiarrheal and general astringent.
P. canadensis Felter and Lloyd3 mentioned P. canadensis 1. (also listed as dwarf cinquefoil or five-finger) as growing in North America, and listed the root decoction as a tonic and astringent used for fever, night sweats, intestinal disorders, internal hemorrhages, including menorrhagia, bleeding gums, and an ulcerated mouth and throat. The root decoction was used by the Native Americans for diarrhea. 6 P. anserina This plant, known as silverweed, is widely distributed in temperate regions throughout the world. It is distinguished from P. erecta by the soft white hairs on the lower surface of the leaves that give the undersides a silvery appearance, hence the old name Argentina from the Latin argentum. 2 P. anserina and P. erecta have similar astringent properties. P. reptans This plant, also known as five-finger or cinquefoil, has been used since the time of Dioscorides to treat intermittent fever and has had more recent use as an astringent for diarrhea or sore throat. 2 Use in China There is an entry for jin jin bang, the aerial parts of P. reptans 1. var. sericophylla Franch., in the Chinese Herbal Medicine Dictionary! However, it does not list the meridians entered, and there are no additional texts cited for temperature or taste properties. The uses of jin jin bang are listed as dry coughs from Deficiency and leukorrhea from Deficiency. It does not seem that the use of this herb is a direct import from the West. Rather, it appears that there has been a tradition of use for this herb in China, but that it has never been of wide importance.
607
Combining Western Herbs and Chinese Medicine
608
What is special about Potentilla
DIRECTION OF ENERGY
In terms of Chinese medicine, Potentilla can be said to
The astringent and specifically the antidiarrheal and antihemorrhagic actions of Potentilla tend to keep fluids
be a neutral-cool, sour. and bitter herb, which has its main internal effects on the Intestines as an astringent to reduce diarrhea and bleeding. It can be used internally or topically as a general-purpose astringent and antihemorrhagic.
The key to understanding Potentilla is that it is a strong astringent herb with a high tannin content, which is neutral in temperature. It can be used for either Heat or Cold patterns of diarrhea and intestinal bleeding, whether they are acute or chronic.
inside the body.
TYPICAL CASE EXAMPLE
~~:~~,.
,
Signs and symptoms The patient has had acute diarrhea for over two days. The stools have a bad smell, and there is a burning sensation in the anus after defecation. The pulse is slightly rapid, flooding, and slippery. The tongue is red with a thick greasy yellow coat. Diagnosis
The patient has Damp Heat in the Intestines.
CHINESE ACTIONS
Choice of Potentilla This astringent herb can be used to treat acute diarrhea associated with Damp Heat in the
In terms of Chinese medicine. Potentilla, as used in the West, can be said to have two main actions:
Intestines.
Limitations of Potentilla
1. topical astringent II. internal astringent
TEMPERATURE In terms of Chinese medicine. the internal astringent action can treat the following syndromes: • Spleen Qi sinking with Spleen not holding Blood • Damp Heat in the Intestines
WESTERN ACTIONS The main Western actions of Potentilla are shown here in terms of its two main Chinese actions: Chinese actions
"Western actions
I. topical astringent
astringent antihemorrhagic
II. internal astringent
astringent antidiarrheal antihemorrhagic
WESTERN USES The Western uses of Potentilla can be related to its two main Chinese actions:
Potentilla is classified as neutral-cool in this book. It can be used for warm, neutral, or cool conditions when it is suitably combined with other herbs. However, if a warm astringent is required, Myrica or Commiphora may be preferred, and if a cool astringent is required for internal use, Hydrastis or Sanguisorba may be more suitable. .. .-"•. ,~~
TASTE Potentilla is classified in this book as sour and bitter, associated with its strong astringent action. The bitter constituents may have some anti-inflammatory action. Potentilla is not generally regarded as a bitter digestive tonic.
ACTIONS Topical and local astringent Potentilla can be used topically or locally for cuts, wounds, sore and inflamed eyes, sore or ulcerated mouth and throat, varicose veins. prolapsed anus, bleeding hemorrhoids, prolapsed uterus, or leukorrhea. However, for specific topical applications, other herbs may be preferable, for example:
• Calendula I. topical astringent
varicose veins. bleeding hemorrhoids
• Commiphora • Hamamelis
II. internal astringent
severe acute diarrhea, diarrhea with bleeding
• Hydrastis
cuts; burns, scalds, sunburn. insect bites and stings. and itchy red skin rashes mouth, gum, and throat disorders bruises, myalgia, varicose veins, prolapsed anus, and prolapsed uterus conjunctivitis, ear infections, and pruritis
-~
Potentilla - Internal astringent Potentilla has been used as a generalpurpose astringent and antihemorrhagic. However, I consider it to be mainly an astringent and antihemorrhagic for the -- Intestines and to a lesser extent for the Uterus. It is specific rfor diarrhea that is acute or severe, for diarrhea with intestinal bleeding, or for diarrhea with bleeding hemorrhoids. Although it is a more or less a neutral herb, it can be used != for diarrhea with Cold or Heat patterns when it is combined lc with suitable herbs. For long-term treatment of chronic diarrhea with Spleen Deficiency, milder astringents such as Ii'''' Agrimonia or Alchernilla may be preferred. c~
c
609
Research in the Berberis chapter). In Chinese medicine terms, Berberis can be used for diarrhea associated with Damp Heat in the Intestines. The strong astrin$ent action of Potentilla combines with the powerful antimicrobial action of Berberis to treat acute diarrhea. Hydrastis can replace Berberis vulgaris, if preferred, since Hydrastis has antimicrobial action linked to berberine and since it can also normalize the intestinal mucous membranes. Potentilla + Rheum
Acute diarrhea
~.
Potentilla paired with other herbs Discussion of the limitations of each of the main actions of Potentilla can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Potentili~-beyond its limitations. The basic unit of herb combination is the herb pair. Six pairings of Potentilla are briefly explained below.
CAUTION
If the diarrhea is acute and severe or if it is prolonged and severe, immediate conventional medical investigation and treatment is necessary. If the diarrhea is chronic but of recent onset with blood in the stools, conventional medical investigation is advisable to exclude severe disorders such as carcinoma ofthe bowel. Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair.
~
Whilst Rheum can have a laxative effect in high doses, in lower doses, it can also have an astringent effect, due to its tannin content, which can combine with the astringent action of Potentilla. Potentilla + Geranium
Diarrhea with bleeding Both herbs are neutral astringents, which can have both antidiarrheal and antihemorrhagic action on the gastrointestinal system. When suitably combined with other herbs, this pair can be used for either Damp Heat diarrhea or Deficiency diarrhea. Potentilla + Hamamelis
Diarrhea with bleeding Hamamelis is specific for diarrhea and bleeding from sinking of Spleen Qi with the Spleen not holding Blood. Hamamelis and Potentilla can be paired for diarrhea and bleeding associated with Deficiency.
Potentilla + Pulsatilla chinensis
Potentilla + Cinnamomum
Protozoal diarrhea
Diarrhea + sensations ofcold
Pulsatilla chinensis, bai tou weng, is specific for diarrhea due to Entamoeba histolytica or Giardia lamblia, or in terms of Chinese medicine, diarrhea due to Damp Heat and Heat Toxin in the Intestines. Potentilla is paired with Pulsatilla as a strong antidiarrheal astringent. In addition, the tannins in Potentilla may have antimicrobial action. (Berberis vulgaris can replace Pulsatilla, if preferred, since berberine sulfate has been shown to inlubit both Entamoeba histolytica and Giardia
Cinnamomum bark is used in both Western and Chinese traditions for diarrhea. In Chinese medicine terms, it is specific for diarrhea associated with Spleen and Kidney Deficient Yang with Interior Cold. Cinnamomum can be paired 'with Potentilla for acute or for severe, chronic diarrhea with sensations of cold in the body, especially in the abdomen and back.
lamblia.) Potentilla + Berberis
Acute diarrhea Berberis has been reported effective for acute bacillary dysentery, and berberine has been shown to inhibit intestinal secretion caused by bacterial toxins (see the section on
Topical uses of Potentilla Potentilla can be used in a topical or local application as the finely powdered dried herb, an undiluted decoction or infusion, or a diluted tincture, as appropriate. It can be used for cuts, wounds, sore and inflamed eyes, sore or ulcerated
'c.
',:"-.:'~-:~" -
•.•."&ol
.-:~~-.
Combining Western Herbs and Chinese Medicine
610
mouth and throat, varicose veins, prolapsed anus, bleeding hemorrhoids. prolapsed uterus. or leukorrhea. See Cautions section. Potentilla may not be the herb of choice For many topical applications, I do not regard Potentilla as the preferred herb. Other herbs that may be more specifically suitable for most topical applications are listed in Limitations: Actions above. Christopher's applications of Potentilla He used this herb topically for: 8
,."
."_ •• -:::;'l:."
: ...~
•
. ,: --
"
:
... :~!'....
.-:-:-:;-~ _..__22£
CAUTION
'-.
4
T? III
" --'--; .....51.._
If the diarrhea is acute and severe or if it is prolonged and;,';!L~~ severe, immediate conventional medical investigation and.:;(::!Jil~~. treatment is necessary. If the diarrhea is chronic but of recent<. onset with blood in the stools, conventional medical investiga~'~t.'"<:,, tion is advisable to exclude severe disorders such as carcinoma.....,·~~·;t~,,-.. .. of the bowel. --~.~( Before using any ofthe combinations below, it is important ',.-, to be familiar with the cautions listed for each herb in the combination. -:.,~~ ~
• cuts or wounds as a powder or a lotion made from the fluid extract
• sore and inflamed eyes as a cotton pad moistened with infusion or decoction held on the closed eyes • sore or ulcerated mouth and throat as a gargle of undiluted decoction • varicose veins as a compress soaked with the undiluted decoction • prolapsed anus or bleeding hemorrhoids anal insertion of tampon soaked in undiluted decoction or anal douche • prolapsed uterus or leukorrhea vaginal insertion of tampon soaked in undiluted decoction or vaginal douche COMBINATIONS OF POTENTILLA FOR TOPICAL APPLICATION Potentilla can be used by itself for the specific topical indications above, or combined with the following herbs: • with Ranunculus or Hamamelis for hemorrhoids • with Aesculus or Calendula for varicose veins Potentilla can be given internally as well as topically to support its topical action.
1. Acute severe diarrhea
Various syndromes
H~rt/'"
: ....
Potentilla Polygonum Geranium Myrica
R~ti~:/~T;";;,;;.;.,,.;·~;§ti;%" • . 1 1 1 1
neutrak:ool cool neutral warm
t
~:~~
...-
sour. bitter sour. sl. bitter '"''''''''\~}~+, sour sour. bitter, acrid
GENERAL
This combination is a first aid treatment to reduce severe diarrhea regardless of whether it is acute or prolonged, or whether it is an Excess, Deficiency, Heat. or Cold pattern, o~ ,. a mixture of these patterns. The combination is neutral in )~j-f~ temperature so that it can be used for warm, neutral, or cool.,:~t:;~ conditions. It can be modified to treat hot or cold condi.,~'TiJi,'." tions, for example, by replacing Myrica with Sanguisorba fo~ •• ~~'1f.' a hot condition or by adding Zingiber for a cold conditiori·,L&~: For diarrhea of a more specific type. Potentilla combinations No.2, 3. or 4 may be more appropriate. The sour taste cone fers the astringent action, and the bitter taste can help to clear Heat in the case of Polygonum, or it can help to tonify , the Spleen when combined with the acrid taste of Myrica.
History This combination is based on a combination for dysentery given by Fox4 in 1878.
Potentilla combinations Four Potentilla combinations for internal use are discussed below:
USE
• first aid treatment for severe diarrhea of various types and etiologies PRACTICAL NOTES
Combination
Chinese syndromes
1. acute severe diarrhea
Various syndromes
2. acute diarrhea + heat sensations
Intestines Damp Heat
3. protozoal diarrhea
Intestines Damp Heat + Heat Toxin
4. diarrhea + bleeding
Spleen Qi sinking + Spleen not holding Blood
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of water, three times per day. If the diarrhea is more severe and acute, I-ml doses can be taken in water every hour or 30 minutes until the diarrhea is declining. The doses can then be reduced to the normal level. This combination is for acute situations and can be taken for 1-5 days until the diarrhea is reduced. A different combination can
'-
\" Potentilla then be taken to treat the underlying causes of the diarrhea and to strengthen and normalize gastrointestinal function.
Caution
This combination is for severe acute or severe prolonged diarrhea only; long-term use is contraindicated.
Caution This combination is for severe, acute diarrhea only and is contraindicated for: • long-term use • predominantly Deficient and/or Cold conditions
2. Acute diarrhea + heat sensations
3. Protozoal diarrhea
Intestines Damp Heat
Intestines Damp Heat + Heat Toxin
Herb
i-
611
Potentilla Sanguisorba Berberis Rheum Zingiber
Ratio
Temperature
Taste
Herb
1 1 1
neutral-cool cool cool cool-cold hot
sour, bitter sour, bitter bitter bitter, sour acrid, aromatic
Pulsatilla chi. Hydrastis Polygonum Potentilla Zingiber
0.5 0.5
Ratio
Temperature
Taste
1 1 1 1
cold cool cool neutral-cool hot
bitter bitter sour, sl. bitter sour, bitter acrid, aromatic
0.5
GENERAL
GENERAL
This combination is for acute diarrhea or dysentery with Damp Heat in the Intestines. It can be used for mixed conditions of Excess and Deficiency, and of Damp Heat and Cold, but only if the Excess and Damp Heat are predominant. In Western terms, this may be diarrhea due to food poisoning, dietary excesses, or bacterial infection. The overall temperature is cool to treat warm conditions. Zingiber is included since diarrhea is often associated with mL"{ed conditions of Damp Heat and Cold, and also since it treats intestinal spasms. To treat Damp Heat patterns in the absence of Cold or Deficiency, Zingiber can be removed or its ratio can be reduced to 0.25. The sour taste confers astringent action, the bitter taste helps to clear Damp Heat, and the aromatic property can regulate the Qi of the Intestines.
This combination is for patterns of Damp Heat and Heat Toxin in the Intestines, specifically linked to protozoal or bacterial infection. The overall temperature is cool to treat warm or hot conditions. Zingiber is included since this type of diarrhea is often associated with mixed conditions of Damp Heat and Cold, and also since it treats intestinal spasms. Some of the bitter constituents help to clear Damp Heat and Heat Toxins, and in Western terms, the bitter herbs Pulsatilla and Hydrastis can have antiprotozoal and antibacterial action. The sour taste confers antidiarrheal action, and the aromatic property can regulate the Qi of the Intestines. USE
• diarrhea due to amoebiasis, giardiasis, or bacterial infection
USE PRACTICAL NOTES
• acute diarrhea with burning sensation in the anus after defecation, maybe feverishness or sensations of heat, maybe nausea or vomiting, maybe abdominal discomfort or pain • acute diarrhea with bleeding or with bleeding hemorrhoids PRACTICAL NOTES
This combination can be taken as 2.5 ml of 1:5 tincture in quarter of a cup of water, three to six times per day, until the diarrhea is declining. The doses can then be reduced to three times per day. This combination is for acute situations and can be taken for 1-5 days until the diarrhea is reduced. During remission, a different combination can be taken. If the diarrhea does not abate sufficiently and rapidly, this combination can be replaced by Potentilla combination No.1 or the patient should be referred to an allopathic physician for conventional treatment.
This combination can accompany conventional treatment for giardiasis or amoebic dysentery. It can be taken as 5 ml of 1:5 tincture in quarter of a cup of water, three times per day, until the diarrhea is declining. The doses can then be reduced to 2.5 ml, three times per day. This combination is for acute situations and can be taken for 1-5 days until the diarrhea is reduced. D\lIing the chronic phase, a more tonic combination can be taken. Pulsatilla chinensis is specific for diarrhea from protozoal or bacterial infection. However, it is not so appropriate for Damp Heat diarrhea associated with other factors, for example, for diarrhea from dietary excesses, for which Rheum may be more suitable.
Caution This combination is for severe, acute diarrhea only and is contraindicated for: • long-term use • predominantly Deficient and/or Cold conditions.
Combining Western Herbs and Chinese Medicine
612 4. Diarrhea + bleeding
ife~5:~:;R~1~"~:::~5 . ,
Spleen Qi sinking + Spleen not holding Blood
Hamamelis
Potentilla
1 1 1 1
Zingiber
0.5
Glycyrrhiza
Pulsatilla chi. Hydrastis
Herb
Polygonum
Hamamelis Potentilla Geranium Astragalus Glycyrrhiza Cinnamomum
1 1 1 1
neutral-<:ool
sour, sl. bitter
neutral-<:ool
sour, bitter
neutral
sour
sl. warm
sweet
0.5 0.5
neutral-<:ool
sweet
hot
acrid, aromatic, sweet
Potentilla Geranium Astragalus Cinnamomum (bark)
(bark)
This combination is the same as Hamamelis: diarrhea + bleeding and is discussed under that heading.
1 1 1 1
"
0.5 0.5
3. Pulsatilla chinensis and Hydrastis can be used as antiprotozoals for amoebae- or Giardia-based diarrhea, Polygonum and Potentilla are astringents, and Hydrastis and Polygonum can help to normalize the function of intestinal mucosa. Zingiber can moderate the potentially damaging effect of cold Pulsatilla on the Spleen and assist in the treatment of intestinal spasms. This is the most specific of the '. four Potentilla combinations.
COMPARISON OF THE FOUR .4. This combination differs from the three previous " combinations since it is specific for diarrhea associated with"~-:":"-'-'-c
POTENTILLA COMBINATIONS
1. Acute severe diarrhea
2. Acute diarrhea + heat sensations
Various syndromes
Intestines Damp Heat Herb
Potentilla Polygonum Geranium Myrica
1 1 1 1
Potentilla Sanguisorba Berberis Rheum Zingiber
Ratio 1 1 1
0.5 0.5
1. All four herbs are primarily astringents: Potentilla and
Geranium are neutral, general-purpose, tannin-based astringents, which can be used for hot or cold conditions. Polygonum is a cool astringent for intestinal inflammation. It has demulcent properties because of its mucilage content. Myrica is a warming astringent, which can have warming and tonifying actions on the digestive system because of its acrid and bitter components. 2. The previous combination is a first aid astringent combination to treat severe acute or prolonged diarrhea of various etiologies. This combination is made specific for acute diarrhea associated with Damp Heat by the presence of the cooling antimicrobial, anti-inflammatory, and alterative herbs Berberis and Rheum, and by the cooling antidiarrheal herb Sanguisorba. 3. Protozoal diarrhea
4. Diarrhea + bleeding
Intestines Damp Heat + Heat Toxin
Spleen Qi sinking + Spleen not holding Blood
Cold and Spleen Deficiency. Astragalus can tonify and raise Spleen Qi, and combines with Hamamelis for .prolapsed organs, diarrhea, and bleeding associated with Spleen Qi sinking. Glycyrrhiza can help to treat loose stools associated with Spleen Deficient Qi. It can also help to relieve intestinal spasms. Cinnamomum can warm and tonify the Spleen and treat diarrhea associated with Spleen Deficient Yang.
OTHER POTENTILLA COMBINATIONS Another combination that contains Potentilla is:
• Cinnamomum: chronic diarrhea + cold sensation
Research CONSTITUENTS • condensed tannins • hydrolyzable tannins • other Condensed tannins P. erecta contains 15-20% tannins, of which about 70% are of the condensed (catechol) type, In addition to the polymers, there are monomers and dimers (for example, flavan-3-ols and procyanidins), and some trimers. 9 Hydrolyzable tannins About 30% of the total tannin content of P. erecta is hydrolyzable tannins, mainly ellagitannins, including agrimoniin (a dirneric ellagitannin), 10 and gallic acid, ellagic acid, and catechol gallates.
.
"
Potentilla Other P. erecta also contains the pseudosaponin tormentoside (aglycone = the triterpene tormentillic acid), quinovic acid, phenylpropanes, II and traces of essential oil.
PHARMACOLOGICAL AND CLINICAL RESEARCH There is little research data available on extracts of Potentilla. Most of the available data comes from studies on isolated constituents, specifically the tannins, for which the following effects have been reported: • antimicrobial • astringent and antidiarrheal • antiulcer • antihemorrhagic and vulnerary • antioxidant • antitumor and antimutagenic • anti-HIV Antimicrobial Tannins can combine with proteins in mucosecretory epithelial cells or in open wounds at the body surface to protect the surface from inflammation by irritant chemicals or from invasion by microorganisms. According to Bruneton;2 tannins have demonstrated antibacterial and antifungal effects. and condensed tannins have been reported to inhibit the intestinal hypersecretory activity of cholera toxin. 13 Gallotannins have been reported to have a bactericidal effect on Streptococci in vitro. 14 Astringent· and antidiarrheal According to Mills and Bone, when tannins are in contact with mucous membranes, they can bind with proteins in both the mucus and the surface cells. This can reduce membrane permeability and have an antidiarrheal action partly by reducing the secretions. Also, the coagulated protein layer may protect gut sensory nerve endings from stimuli, thus reducing peristalsis. Tannins may further reduce diarrhea by their antimicrobial action on infecting organisms and by neutralizing inflammatory proteins. 15 Antiulcer This effect has been shown for a black tea extract l6 and for condensed tannins in mice. 17 Also, the hydrolyzable tannin moiety ellagic acid has been shown to inhibit acid secretion. IS Antihemorrhagic and vulnerary In the past, tannin sprays were used to treat severe burns since the eschar, that is, the tannin-protein complex formed at the burn site, acted as a protective semipermeable membrane: 9 According to Bruneton, tannins can enhance tissue regeneration by preventing external invasions of the healing tissue and by limiting fluid loss.
613
Antioxidant According to Bruneton, many tannins, in particular the hydrolyzable tannins, inhibit lipid peroxidation in rat liver mitochondria induced by ADP and ascorbic acid. Tannins differ in the strength of their inhibitory action against lipid peroxidation, and ellagitannins are generally the strongest inhibitors. 2o Antitumor and antimutagenic According to Bruneton, some ellagitannins reduce the mutagenicity of certain carcinogens and inhibit the transplantation of experimental tumors. In one study, tannic acid was cultured together with tumor cells originating from human malignant tumors, and significant suppression was observed. 21 Tannic acid has also been reported to suppress gene expression of mouse mammary tumor virus,22 and a low-dose dietary administration of tannic acid has shown a preventive activitY against hepatoma in mice. 23 Anti-HIV Newly discovered hydrolyzable tannins, shephaginins A and B, were shown to inhibit human immunodeficiency virus (HIV-1) reverse transcriptase,24 and condensed tannins were found to inhibit human immunodeficiency virus (HIV-1) protease. 25 Relevance of in vitro studies with tannins The bioavailability of tannins, the amount absorbed into the blood following oral intake, is low. Mills and Bone therefore question the relevance of in vitro studies with tannins to clinical application following oral intake, and this reservation applies to the studies with HIY. However, recent studies suggest that in certain circumstances oral administration can be effective to some degree. For example, tannins were shown to protect against skin tumor formation in mice, when applied topically or injected intraperitoneally. When the tannins were administered by force feeding, they did not inlubit the yield of tumors at the end of the experiment, but they did delay tumor appearance by six weeks. 26 Also, the effectiveness of dietary administration of tannic acid against hepatoma in mice 23 seems to suggest that sufficient amounts of tannic acid or its derivatives are reaching the blood stream to produce definite results. In addition, it is possible that interaction of tannins with the gut mucosa may initiate responses that are independent of blood transport of tannins. P. erecta According to the Wicht! monograph, 1 P. erecta is a good astringent because of its high tannin content. Other effects have been reported, including antiviral, antiallergic, antihypertensive, immunoregulatory, and interferon-inducing actions. 10 Comparison of P. erecta and P. anserina P. anserina contains 6-100/0 tannins,27 compared to P. erecta which can con-
614
Combining Western Herbs and Chinese Medicine
tain 15-20%. P. anserina also contains compounds of unknown structure with antispasmodic action. 28 Therefore, this herb has been used in treating dysmenorrhea29 and has been used for diarrhea with mild cramping, according to the German Standard License as quoted in Wichtl.
RESEARCH VERIFICATION OF TRADITIONAL ACTIONS The main traditional actions of Potentilla are those of an astringent and antihemorrhagic, specifically antidiarrheal and intestinal antihemorrhagic and vulnerary. Whilst the astringent, antidiarrheal, and vulnerary actions of tannins have been supported by research, I have not yet seen evidence for the astringent action of Potentilla.
ed application to short-term, therapeutic doses of Poten ~. Also, for everyone of the categories of adverse efIe~t~ii~ea,-"~~;;iit;;~iIi:~et,et for tannins below, there are reports of bene~cial tannin .~.~. ..... effects in the same category. .. .
Adverse gastrointestinal effects Long-term intake of a t~:::
nin-containing diet was reported to inhibit the digestive'~;~ enzymes of the small intestine mucosa in broiler cockerels.)' . It has been suggested that the effect of tannins on lowering nutrient utilization in ducks was partly due to their inhibito- . ..... ry action on intestinal brush-border-bound amino acid :Td~~{ transporter proteins. 32 It has been noted that prolonged ;'.~;~;; intake of tannin-containing foodstuffs or herbs may some. times result in gastrointestinal irritation or constipation in humans. Nevertheless, although tannins have been implicat- .. ,~. ed in gastrointestinal inflammation by some studies, antiul-c'·..· cer activity has been demonstrated, as noted above.
Additional uses suggested by research Evidence for the following actions is discussed above: antimicrobial, antiulcer, antioxidant, antimutagenic, and anti-HIV effects.
TOXICOLOGY An important distinction A careful distinction needs to be made between the use of:
• therapeutic doses of Potentilla as an infusion, decoction, or tincture • isolated components of Potentilla, such as tannic acid or other tannins Caution is advisable in the use of any herb with a tannin content in excess of 10%. However, it may not be appropriate to restrict the use of the herb itself when the herb is used within the therapeutic doses as an infusion, decoction, or tincture because of adverse effects reported for tannic acid or other tannins as isolated constituents. It is possible that the nontannin constituents that are also present in the whole herb have moderating and buffering activity on any potential adverse effects of the tannins. Potentilla the herb According to the wording from the German Standard License, which is quoted by Wicht!, there may be irritation of the stomach or even vomiting in susceptible patients after taking P. erecta preparations, and irritable stomach conditions may be aggravated by the use of P. anserina. Tannins According to Bruneton, the potential toxicity of tannins to humans is not very well known. Most of the known adverse tannin effects have been specifically recorded for tannic acid, and include gastrointestinal irritation, hepatotoxicity, and kidney damage. 3o These may have limit-
Decreased absorption One study reported
.
th~t _te'LC:QI.l.:..~:;;'i1.
sumption does not affect iron absorption in rats unless tea ·"'''·:';.~f: and iron are consumed at the same time. 33 Tannins havebeen reported to react with thiamine and decrease its absorption.34
Adverse renal effects Tannic acid has been implicated kidney damage, but rhubarb and other tannin-containmg herbs were reported to reduce the levels of uremic toxins in rats with renal failure. 35 . ..
"._ ..
Hepatotoxic effects Local applications of tannic acid prepa:;~,.. rations were once used to heal burns and open wounds, but:t'_~. this practice was stopped since toxic levels of tannic add:~~~::5: were in some circumstances absorbed through the skiJ:1:.__' Tannic acid was once added to the barium sulfate mixture . used in barium enemas, but this practice was prohibited by the FDA in the USA following deaths caused by acute hep~~ totoxicity.36 It was thought that large quantities of tannic acid were absorbed into the blood via the colon. Although hepatotoxic effects have been reported for tannic acid, -oral administration of the tannin geraniin was reported to lower lipid peroxide levels in rats with liver injury.37 According to Mills and Bone, these toxic effects are very unlikely to happen with the use of tannin-containing herbs. However, it would be prudent to avoid long-term use of high doses of herbs with a tannin content of over 10%, such as Potentilla or Quercus.
Carcinogenic effects One study reported carcinogenic effects following the subcutaneous injection of tannin-containing!, herbal teas in rats. This may not have great relevance to the ~, short-term oral use of therapeutic doses of tannin~containing herbs in humans. Also, other studies have reported anti20 mutagenic and antitumor activities for tannins.
-
,-- ..
Potentilla In perspective It is important to view reports of adverse reactions of tannins in the context of the high tannin content of ordinary foods and drinks, such as tea. Camellia sinensis L., the tea plant, can contain 10-20% tannins, a similar level to Potentilla. In countries such as Britain or India, the intake of 10-15 cups per day, every day for a lifetime, of very strong tea infusions is by no means uncommon. In comparison, high tannin herbs such as Potentilla are recommended at 3-5 cups per day for short-term use only.
615
Mouthwash or gargle The decoction or diluted tincture of Potentilla can be used as a mouthwash or gargle for sore or ulcerated mouth and throat. Anal and vaginal use John Christopher used Potentilla infusion or decoction both internally and as a douche or on a tampon for bleeding and internal hemorrhoids, prolapsed anus, prolapsed uterus. or leukorrhea.
Douche For bleeding and internal hemorrhoids or leukorrhea, 3-4 ounces of decoction can be injected into the anus or vagina, as appropriate. and retained as long as possible.
Dose ORAL USE Dried herb The BHP listed 2-4 g of dried bark, three times per day.38 For diarrhea, 2-4 g of dried powdered Potentilla can be suspended in red wine and taken three to four times a day.! Decoction To make one dose, about one teaspoon (about 2-3 g) of dried herb is put in about 150 m1 cold water. This can soak overnight if there is time. The water is then brought to a very gentle boil and simmered for 5-10 minutes. The heat is then turned off and the mixture is steeped for a further 5-10 minutes. The decoction is strained and drunk warm or .cold as required. Prolonged boiling has been reported to cause hydrolysis of the ellagitannins and reduced astringent activity.39 Tincture The BHP listed 2-4 rnl of 1:5 tincture in 45% ethanol, three times per day.
Initial dose Can start at half the standard dose to determine the tolerance of the patient's digestive system to the tannins. Frequency of dose In acute diarrhea or menorrhagia, frequent small doses can be given, for example, 1 rnl every hour or 30 minutes, until the fluid loss is checked. Conventional medical investigation and treatment may be required for conditions that last more than 3-4 days. Duration It is advisable to avoid long-term use at high doses because of the high tannin content.
Topical and local uses of Potentilla -....:;
..
Potentilla can be used as a topical or local application for cuts. wounds, sore and inflamed eyes, sore or ulcerated mouth and throat, varicose veins, prolapsed anus, bleeding hemorrhoids, prolapsed uterus, or leukorrhea.
Tampon For a prolapsed anus or prolapsed uterus. a tampon can be saturated with the decoction and allowed to remain as long as possible in the anus or vagina, as appropriate. Caution Although I have not seen any adverse reports for Potentilla. there have been adverse reports for the rectal use of tannic acid; see Toxicology. Therefore. long-term vaginal or anal use of Potentilla is to be considered with caution because of the high tannin content of this herb. Potentilla can also be given internally to support its topical or local action.
Cautions Western contraindieations tion.
Contraindicated for constipa-
Chinese contraindications None reported. Pregnancy and lactation No adverse effects are known, but caution when using herbs with high tannin content is advisable.
Side effects Stomach irritation, nausea, or even vomiting may Occur in some susceptible patients. Christopher suggested that Potentilla and similar astringents be combined with mucilaginous herbs such as Althaea. This can help to reduce tannin-induced gastrointestinal irritation. Overdose Same as for Side effects. See also Toxicology fQr the adverse effects of tannins taken as isolated chemicals. Interactions None are reported for the herb, but tannins, as isolated chemicals, may inhibit absorption of iron and of thiamine, as noted in Toxicology.
Regulatory status Please read the Regulatory status section in the chapter on Safety.
Combining Western Herbs and Chinese Medicine
616
Potentilla is on the UK General Sale List and is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Potentilla is not currently listed by the FDA (USA) as a prohibited substance, as subject to an
Taste properties In terms of Chinese medicine, P. ere~]i°c~,., • used in the West, can be said to be sour and bitter. Accordiftg. .:., :~;:.c::, to the Chinese Herbal Medicine Dictionary, jin,jin bang is classified as sweet.
import alert, or as a substance with a warning on its use. ORGANS
In terms of Chinese medicine, Potentilla, as used in the West, can be associated mainly with disorders of the follow-
Traditional sources
ingorgans: Nomenclature
The nomenclature for P. erecta and P. anse-
rina in the older texts can be confusing, and is summarized in the table below.
··-:s~
Examples of use·
Spleen and Intestines
chronic diarrhea, passive hemorrhages
Felter and Lloyd
hemorrhoids, prolapsed anus
Christopher
PROPERTIES 40
Temperature Hildegard von Bingen classified tormentil (dornella) as cold, and Gerard41 wrote that Tormentilla (setfoile) has very little heat, is dry in the third degree, and has binding quality. (This is assuming that dornella and setfoile are identical to Potentilla erecta.) Culpeper classified tormentil as temperate (neutral), but some of the indications for which he listed this herb involved heat, for example, fever or redness of the eyes. Tabemaemontanus wrote that P. erecta is dry in the third degree without noticeable heat. According to the Chinese Herbal Medicine Dictionary, jin jin bang, the aerial parts of P. reptans, is classified as neutral. I have classified P. erecta as neutral-cool, as used in the West, since it may in some cases act as a cooling antimicrobial and anti-inflammatory astringent to the intestines. Taste
Taste in the mouth The BHP listed the taste of P. erecta as astringent. I found a deep red 1:5 tincture of P. erecta in 25% alcohol to have a marked rose-like fragrance and to have a sour and bitter taste, with a thick, slightly resinous, floury or gritty sensation in the mouth.
. Source'<;;~ : .... .•
Organ
Uterus
~
threatened miscarriage prolapsed uterus
The Chinese Herbal Medicine Dictionary did not list meridians entered for jin jin bang. ACTIONS The main traditional actions of this herb are: • topical astringent • internal astringent
.. .. '"
-"
... --'-
~ ..• ~-"
• other Topical astringent Tabernaemontanus listed the topi~:l,,~~_:= ... use of P. erecta for nosebleeds, mouth infections, ulcerat~C~ tongue, rotten gums, loose teeth, and bad breath. He ~o.., • wrote that it can be used for leukorrhea, bleeding hemor'rhoids, and gout, and can help to cleanse and heal wounds and remove associated swelling. Culpeper noted the use.of. : tormentil for sores; foul ulcers of the mouth or genitals; skin eruptions; and redness, pain, watering, or itching of the eye~ .. Christopher recommended P. erecta for inflammations or ulcerations of the mouth, throat, and eyes; the discharges of leukor42
language
P. erecta
P. anserina
modern Latin
Potentilla erecta
Potentilla anserina
old Latin
Tormentilla (Gerard) Tormentilla (Lonicerus) Tormentilla (Tabernaemontanus)
Argentina (Gerard) Potentilla (Lonicerus) Anserina (Tabernaemontanus)
throat and mouth problems,
modern English
tormentil
silverweed
naemontanus, P. erecta is good for dysen:
old English
tormentil. septfoil (CUlpeper) tormentil, setfoile (Gerard)
silverweed, wild tansy (Gerard)
modern German
Tormentillwurzelstock
Silberkraut
old German
Tormentill (Lonicerus) Tormentill (Tabernaemontanus)
Genserich (Lonicerus) Giinserich (Tabernaemontanus)
rhea or gonorrhea; and gangrene. Th.e,.B_~~ ... listed P. erecta as an astringent gargle for
Internal astringent
According to Taber- .-',.;'
tery and diarrhea, and can help to heal the~ ':'.~' damaged intestines. He noted its use .~~J;ji::'{;.t bleeding hemorrhoids, excessive menstnial.:'i::':' bleeding, and strengthening the fetus and~'" preventing a miscarriage. Culpeper wrote -,
(~
i
Potentilla that tormentil is excellent at stopping all kinds of fluxes of blood or fluids, whether in the nose, the mouth, or the abdomen. He also listed it for urinary incontinence and for threatened abortions. Gerard listed it for all bleedings, including hemoptysis, hematuria, and menorrhagia. Weiss~3 wrote that P. erecta is our most useful herb with astringent properties. He listed it for diarrhea from acute and subacute enteritis and colitis, summer diarrhea, or paratyphoid diarrhea. The BHP listed P. erecta for acute diarrhea and for ulcerative colitis. Other
Antipyretic and alterative Tabernaemontanus wrote that P. erecta can be used for rheumatism because it is drying. He said that it maintains the good damp in the body, preventing it from becoming rotten, and drains out the bad damp. For example, P. ereda root marinated in wine can drain damp from the uterus and increase fertility. According to Culpeper, tormentil was used to expel poison and to treat the plague, fever, or other contagious diseases such as measles. Gerard wrote that it was much used for contagious diseases since it promotes sweating and strongly resists putrefaction. Felter and Lloyd wrote that P. canadensis was used for fever and night sweats.
Tonic Tabernaemontanus wrote that P. erecta is very good for strengthening the heart, and according to Lonicerus, the root strengthens all internal organs.
Hepatic Both Culpeper and Gerard wrote that P. erecta can open obstructions of the liver and treat jaundice.
617
herb is listed as a Y"m tonic to clear Deficiency Heat, generate fluids, and stop thirst. It is used to treat cough from Deficiency, and leukorrhea from Deficiency and exhaustion. It is interesting that there is a tradition of use in the West for P. canadensis and P. reptans, and to a lesser extent P. erecta, for treating fever, although this is not necessarily equivalent to the tonification ofYin and clearing of Deficiency Heat.
References 1. Bisset NG (ed). Herbal Drugs and Phytopharrnaceuticals. English edn. Medpharm, Stuttgart Germany (1994), from 2nd German edn. Wicht! M (ed) (1989) 2. Grieve M. A Modern Herbal, vols. 1 and 2. Dover Publications, New York, New York (1971) 3. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks, Glenwood, lllinois (1990) 4. Fox W. The Working Man's Model Family Botanic Guide to Health, 7th edn. William Fox, Sheffield, United Kingdom (1878) 5. Felter HW, Lloyd JU. King's American Dispensatory, vaIs. 1 and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications, Sandy. Oregon (1983) 6. Foster S, Duke J. Medicinal Plants. Houghton Mifflin, Boston, Massachusetts (1990) 7. Jiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science and Technology Press, Shanghai, China (1975) 8. Christopher JR. School of Natural Healing. BiWorid. Provo. Utah (1976) 9. Byung-ZunA.DtschApoth Ztg 113:1466 (1973) 10. Lund K, Rirnpler H. Dtsch Apoth Ztg 125:105 (1985) 11. Enge W, Herrmann K. Pharmazie 12:162 (1957)
COMPARISON OF P. ERECTA AND P. ANSERINA Both Lonicerus.w and Tabernaemontanus placed more emphasis on the ability of P. anserina (silverweed), rather than P. erecta (tormentil), to treat pains of the stomach, intestines, and abdomen, and to get rid of worms. However, both authors placed more emphasis on the antipyretic and tonic actions of P. erecta rather than P. anserina.
12. Bruneton J. Pharmacognosy: Phytochemistry Medicinal Plants, 2nd edn. Lavoisier. Paris, France (1999) 13. Hor M, Rirnpler H, Heinrich M. Planta Medica 61:208-212 (1995) 14. Wu-Yuan CD, Chen CY, Wu RT. J Dent Res 67(1):51-55 (1988) 15. Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone. Edinburgh, United Kingdom (2000) 16. Maity S. Vedasiromoni JR, Ganguly DK. J Ethnopharrnacology 46: 167174 (1995) 17. Ezaki N. Kato M, Takizawa N et al. Planta Medica 51:34-38 (1985)
COMPARISON OF WESTERN AND CHINESE USE OF POTENTILLA SPECIES
18. Murakami S.lsobe Y. Kijima H et al. Planta Medica 57:305-308 (1991) 19. Root-Bernstein RS. Lancet 2:1168 (1982) 20. Okuda T, Yoshida T, Hatano T. Planta Med 55(2):117-122 (1989)
P. erecta (tormentil) has been one of the most commonly used high-tannin astringents and ant~emorrhagics in the West, especially for diarrhea. In contrast, P. reptans (jin jin bang) has not been so widely used in mainstream Chinese medicine. The Chinese Herbal Medicine Dictionary did not list P. reptans (jin jin bang) for bleeding or diarrhea. Instead, this
21. Kamei H, Koide T. Hashimoto Y et al. Cancer Biother Radiopharm 14(2):135-138 (1999) 22. Uchiurni F, Sato T, Tanuma S. JBioi Chern 273(20):12499-12508 (1998) 23. Taitzoglou lA, Tsantarliotou MP. Nepka C et al.In VIVO 14(6):767-771 (2000) 24. Yoshida T.lto H. Hatano T et (1996)
aL Chern Pharm Bull 44(8):1436-1439
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Combining Western Herbs and Chinese Medicine
25. Ma C. Nakamura N. Hattori M et al. J Nat Prod 63(2):238-242 (2000) 26. Gali-Muhtasib HU. Yamout SZ, Sidani MM. Nutr Cancer 37(1):73-77 (2000) 27. Bate-Smith E<:'Linn J. Soc (Bot) 58:39 (1961)
37. Okuda T, Yoshida T. Hatano T. Chemistry and Biological Ai::ti.itYof;~~~; Tannins in Medical Plants. In: Wagner N, Farnsworth NR (eds) EcoD.· ..~~ omic and Medical Plant Research, vol. 5. Academic' Press. LondOD. United Kingdom (1991)
28. Smetana W. Fischer R. Pharm Zentralh 102:624 (1963)
38. British Herbal Pharmacopoeia. British Herbal Medicine Association.; West Yorks, United Kingdom (1983)
29. Bliss ARet al. JAm Pharm Assoc 29:299 (1940)
39. Lund K. Rimpler H. Dtsch Apoth Ztg 125:105 (1985)
30. McGuffin M. Hobbs C. Upton R et al. American Herbal Products Association's Botanical Safety Handbook. CRC Press. Boca Raton, Rorida (1997)
40. Von Bingen H. Hildegard von Bingen's Physica. Healing Arts, Rochester. Vermont (1998)
31. AhmedAE,SmithardR, EllisM. Br JNutrition 65:189-197 (1991) 32. King D. Fian MZ,Ejeta G etal.Br Poult Sci 4l(5):630-639 (2000) 33. South PK. House WA, Miller DD. Nutrition Research 17(8):1303-1310 (1997) 34. Ruenwongsa P, Pattanavibag S. Experientia 38:787-788 (1982) 35. Yokozawa T. Fujioka, Oura H et al. Phytotherapy Research 9:1-5 (1995) 36. Eshchar J. Friedman G. Digestive Diseases 19(9):825-829 (1974)
41. Gerard J. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publications. New York, New York (1975) 42. Tabernaemontanus JT. Krauterbuch (1731). Reprinted by Verlag Konrad Kolbl, Miinchen, Germany (1993) 43. Weiss RF. Herbal Medicine. English edn. Beaconsfield Publishers, Beaconsfield. United Kingdom (1988) 44. Lonicerus A. Kreuterbuch (1679). Reprinted by Verlag Konrad KOlbl. Miinchen, Germany (1962)
II
Rheum Botanical name
Rheum palmatum 1. and/or
R. officinale Balli. Family Polygonaceae Pharmaceutical name Rhei radix Part dried underground parts English rhubarb German Rhabarber French rhubarbe de Chine Mandarin da huang (:J;;."*) is the underground part of Rheum species Use in the West Chinese rhubarb is a tall, herbaceous perennial native to Northwestern China and Tibet. The dried underground parts of R. palmatum, of R. officinale, of hybrids of these two species, or of mixtures of any of these may be used.\ The best grades come from wild or cultivated plants grown at high altitudes; the 6-10 year-old plants being harvested in autumn or spring.! Chinese rhubarb is not the same plant as garden rhubarb, R. rhaponticum, which is more easily cultivated in Europe, and is used as food rather than as medicine. In the past, R. palmatum and R. officinale were used commercially under various names: Chinese, East Indian, Turkey, and Russian rhubarb. However, according to Grieve,3 they all came from China and Tibet, and the different names merely indicated the' route by which the herb reached the European market. For example, Turkey rhubarb reached Europe overland via Asiatic Turkey, and East Indian rhubarb came by sea via Singapore and other East Indian ports. Rhubarb may have been used medicinally since antiquity,
but according to Gerard, 4 Galen did not write about the laxative action of rhubarb because it was not used for this purpose in the West in Galen's time (2nd century AD). Gerard wrote that Paulus Aegineta may have been the first to use the purgative action of rhubarb, and that the Arabian physicians that followed him used it mainly to purge choler and phlegm. It is fascinating that several of the uses of rhubarb noted in Gerard have been supported by modern research, for example, • astringent for diarrhea or laxative for constipation • protective effect on the hmgs • protective effect on the kidneys • hepatoprotective and choloretic effect Use in China Da huang consists of the dried underground parts of R. palmatum 1., R. officinale Balli., or R. tanguticum Maxim. ex. Balf.5 Da huang has had traditional use as a purgative for constipation, an astringent for dysentery, and an antihemorrhagic for bleeding. It has been used especially to clear Heat, Heat in the Blood, Damp Heat, and Heat Toxin in order to treat disorders associated with these patterns.
What is special about Rheum In terms of Chinese medicine, Rheum, as used in the West, can be said to be a cool-cold, bitter, and sour herb, which has its main effects on the Large Intestine, Stomach, Liver, and Heart.
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Combining Western Herbs and Chinese Medicine
620
The key to understanding Rheum is that it can have multiple actions, some of them seemingly opposite. For example, it can: • have a laxative Qr an antidiarrheal effect • move blood stasis or have an antihemorrhagic action • be used to drain Excess conditions or to assist in tonification ofDeficiency The range of actions that are manifested will depend on the patient's condition, on the dose, and on the other herbs with which Rheum is combined.
CHINESE ACTIONS
WESTERN ACTIONS The main Western actions of Rheum are shown here in terms of its five main Chinese actions: Chinese actions I. move stool
laxative anti-inflammatory
II. clear Heat
antihypertensive anti-inflammatory
III. astringe, clear Damp Heat
astringent antimicrobial anti-inflammatory
IV. clear Heat in the Blood and reduce bleeding
antimicrobial anti-inflammatory alterative dermatological agent antihemorrhagic
V. tonify and move Qi of Liver and Spleen
bitter digestive tonic hepatic and choloretic
In terms of Chinese medicine, Rheum, as used in the West, can be said to have five main groups of actions:
1. II. III. IV. V.
move stool clear Heat astringe, clear Damp Heat clear Heat in the Blood and reduce bleeding tonify and move Qi of Liver and Spleen
Clear Heat In terms of Chinese medicine, Rheum can clear Heat from the Stomach and Intestines. In my opinion, its downward draining effect can also help to clear Heat associated with the Heart or Liver. The Heat in these organ systems may be associated with physical causes, such as excessive alcohol intake or reactions to medications, or it may be associated with emotional stagnation or disturbance. Heat arising from the organ systems may result in Heat in the Blood. This, in turn, may result in bleeding due to Heat or in acute, red skin lesions.
Stomach Heat I use Rheum in combinations to assist clearance of Excess Heat of the Stomach in some cases of severe gastritis or peptic ulcers, and in some cases of bad breath or gingivitis.
.
WESTERN USES
......."\
The Western uses of Rheum can be related to its five main Chinese actions: Chinese actions I. move stool
constipation
II. clear Heat
gastritis, peptic ulcer, hypertension
III. astringe, clear Damp Heat
diarrhea, gastroenteritis
IV. clear Heat in the Blood and reduce bleeding
acute red skin lesions, hemorrhages
v.
digestive weakness, sluggish hepatobiliary function
tonify and move Qi of Liver and Spleen
The four main uses of rhubarb in the West are:
Liver Heat I use Rheum in combinations to assist clearance of Excess Heat of the Liver in some cases of hypertension with restlessness, anger, sensations of heat, and redness of the whole face.
Heart Heat I use Rheum in combinations to assist clearance of Excess Heat of the Heart in some cases of hypertension with restlessness, overexcitement or anxiety, sensations of heat, and redness of the whole face. Move the Blood Whilst Rheum is regarded as an important herb to move the Blood in Chinese medicine, this action is not frequently utilized in the Western use of rhubarb.
• to treat constipation • to normalize bowel function (in combination with other herbs) • to treat diarrhea (when associated with the pattern of Damp Heat) • to stimulate digestion and the secretion of bile I also use Rheum in combinations to treat gastritis or peptic ulcer, hypertension or agitation with sensations of heat, and acute skin diseases. Normalization of bowel function
The different actions of
,.
\
r Rheum Rheum-antimicrobial, anti-inflammatory, laxative, astringent, bitter digestive tonic, hepatic, and choloretic-together tend to normalize bowel function, providing that it is not used in high doses since that would make the laxative effect predominant. This normalizing tendency can be increased when Rheum is used in combination with other herbs that moderate and extend its effect. Diarrhea The following different actions of Rheum also contribute to its use in the treatment of diarrhea and dysentery:
\
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-
• antimicrobial action helps to destroy the pathogens in bacterial dysentery • alterative and la;<:ative actions help to clear toxins from bacteria or food poisoning from the system • anti-inflammatory action reduces irritation to the intestinal mucosa • astringent and antihemorrhagic actions reduce the leakage of fluids and blood from the colon epithelium • bitter tonic and hepatic actions help to restore normal gastrointestinal and hepatobiliary function Gastritis and peptic ulceration The 1731 edition ofTabernaemontanus 6 noted the use of rhubarb for stomach ulcers. This action has been supported by recent research, as discussed later. The antimicrobial, anti-inflammatory, astringent, alterative, and laxative actions of Rh~um combine to assist healing of peptic ulceration. In Chinese terms, it can clear Stomach Heat both directly and via the bowel. Hypertension with sensations of heat I have not found reference to the use of Rheum to treat hypertension in either Western or Chinese texts, but this effect has been reported by research done on Rheum in China. I use Rheum in combinations for hypertension when it is accompanied by sensations of heat and pressure in the head and face, restlessness, agitation, anxiety, overexcitement, or anger, associated with patterns of Excess Heat in the Heart, Liver, or Stomach and Intestines. Acute skin disorders Although Rheum is listed as an alterative in Western tradition, it has not had extensive use as a dermatological agent in the West. It is used in Chinese medicine to treat acute, red, hot, itching skin eruptions associated with Heat in the Blood and Heat Toxin. This can include acute forms of eczema, psoriasis, acne rosacea, and boils.
DIRECTION OF ENERGY In terms of Chinese medicine, as a laxative and as a herb that drains Heat, the direction of movement of Rheum is downward. However, this herb also has antidiarrheal and antihemorrhagic actions that modify its downward tendency.
621
TYPICAL CASE EXAMPLE Signs and symptoms The patient has always tended to constipation, which can vary in severity. During the acute phases, the patient has hard dry stools and some rectal bleeding. This may be accompanied by distension and discomfort of both the epigastrium and abdomen, bad breath, and a bitter taste in the mouth. The patient has recurring eczema with red lesions, and a sensation of heat in the skin. The pulse is usually slightly rapid and wiry and slightly flooding in the Stomach position and both third positions. The tongue is slightly red, becoming redder with a dry yellow coat during the acute phase. Diagnosis The patient has Heat and Stagnation in the Stomach and Intestines, with some Heat in the Blood and/or Heat Toxin associated with the eczema. Choice of Rheum This herb can move Stagnation and clear Heat in both Stomach and Intestines, and act as a laxative to move the stool. It can also help to clear Heat Toxins and Heat in the Blood, which may be contributing to the red skin lesions and the rectal bleeding.
Limitations of Rheum TEMPERATURE In this book, Rheum is classified as cool-cold. In Chinese medicine, Rheum is generally used for hot or warm patterns, although it can be used for neutral, cool, or even cold patterns of constipation if it is combined with herbs of the appropriate temperature.
TASTE Rheum is classified as bitter and sour in this book. It is bitter in the sense of clearing Heat, and it has also had secondary use as a bitter digestive tonic in the West. The sour taste is associated with its astringency and with its antidiarrheal and antihemorrhagic actions.
ACTIONS Laxative Unless it is used in higher amounts than the recommended laxative dose, rhubarb has a relatively gentle laxative effect. Aloe, for example, has a considerably stronger laxative effect as a result of its higher anthraquinone content and therefore has more restrictions and cautions on its use than rhubarb. Rhubarb can be used for hot, warm, neutral, cool, or cold patterns of constipation, and for constipation
622
Combining Western Herbs and Chinese Medicine
associated with Excess or Deficiency, providing it is appropriately combined with other herbs. Normalizer of bowel function If Rheum is used in relatively low doses and in combination with other herbs that moderate and extend its normalizing effect, it can be valuable in restoring healthy bowel function for patients with a history of chronic constipation and laxative dependency, excessive intake of food and drink, or prolonged multimedication. However, at higher doses, the laxative effect of Rheum becomes predominant, and it may itself become the source of dependency.
.. -
----_ .. _._---
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- - - - - -
Rheum + Rhamnus purshiana
Constipation Rhamnus purshiana resembles Rheum in that it contains anthraquinones and has a laxative effect of similar strength. However, Rhamnus differs in having less tannins than Rheum, and consequently, it does not have a comparable antidiarrheal action. The two herbs are commonly combined for acute or occasional constipation when used in higher doses, or to normalize bowel function when used in lower doses. Rheum + Potentilla
Antidiarrheal At higher doses, the laxative action predominates. Even at lower (laxative) doses, rhubarb is not appropriate for all types of diarrhea. It is specific for cases of diarrhea associated, in terms of Chinese medicine, with patterns of Damp Heat, for example, diarrhea linked to bacterial infection or food poisoning. Bitter digestive tonic and choloretic I do not use Rheum primarily as a bitter digestive tonic or choloretic, but these secondary actions can be useful complements to the more important laxative, bowel normalizing, or antidiarrheal actions. Gastrointestinal anti-inflammatory and antiulcer I use Rheum as an important secondary herb for acute severe gastritis or for stomach ulcers to clear Excess Heat in the Stomach. I would not use this herb for these disorders in the absence of Stomach Excess Heat. Antihypertensive I am not aware of Rheum being used specifically for hypertension in either Western or Chinese herbal traditions. However, research studies have reported an antihypertensive effect. I only use Rheum to treat hypertension when this is associated with Excess Heat of the Liver or Reart.
Rheum paired with other herbs Discussion of the limitations of each of the main actions of Rheum can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Rheum beyond its limitations. . The basic unit of herb combination is the herb pair. Twelve pairings of Rheum are briefly explained below. CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair.
Acute diarrhea with sensations ofheat The antimicrobial, anti-inflammatory, and laxative actions of Rheum can combine to clear toxins from the bowel. The mild astringent and antihemorrhagic actions of Rheum can complement the stronger astringent and antihemorrhagic actions of Potentilla. Together these herbs can treat diarrhea that is associated, in Chinese medicine terminology, with Damp Reat and Heat Toxins.
--
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Rheum + Capsicum
Constipation + digestive atony These two herbs can be used to treat constipation with digestive atony and sensations of cold, which are associated, in Chinese medicine terminology, with Deficient Yang of the Spleen and Intestines and Interior Cold. They can also be used together in some cases of hypertension or agitation associated with Heart and Liver Heat. Capsicum helps to disperse the Heat and normalize circulation, and Rheum helps to drain Heat downward and reduce hypertension. Rheum + Zingiber
Constipation + colic Zingiber is commonly combined with Rheum in combinations for either constipation or diarrhea, partly to moderate Rheum's cool nature and partly to minimize any intestinal spasms that Rheum might cause. In addition, the bitter principles of Rheum and the aromatic principles of Zingiber can work together to stimulate the appetite and digestion to assist in the recovery from chronic constipation or severe diarrhea. Rheum + Foeniculum
Constipation + colic Foeniculum is specific for flatulent colic and is commonly combined with Rheum or Rhamnus in combinations for constipation to reduce potential griping caused by the anthraquinone laxatives. Since Zingiber is warmer than
-
Rheum Foeniculum, Foeniculum can be substituted for Zingiber when a less warming herb is preferred. Rheum + Lobelia
Normalization ofbowel function
I
The laxative, astringent, antimicrobial, anti-inflammatory, and alterative actions of Rheum can combine to normalize bowel function, and the stimulant and relaxant actions of Lobelia can help to normalize bowel muscle tone, peristalsis, and transit time. Rheum + Hydrastis
Normalization ofbowel function Hydrastis has antimicrobial, anti-inflammatory, and antihemorrhagic actions, and can help to normalize mucus secretion by intestinal epithelia. Its bitter constituents can also strengthen the function of both the stomach and liver. Toge~er with Rheum, it can assist in the normalization not just of the bowel, but of the whole gastrointestinal system.
623 Rheum + Scrophularia
Acute psoriasis Scrophularia is specific for acute sk.i..I} disorders associated with Heat in the Blood. It can also be used for chronic skin disorders associated with Heat Toxin. Rheum and Scrophularia can be combined to treat acute skin disorders with Heat in the Blood combined with Heat in the Stomach and Large Intestine, such as acute psoriasis or eczema with a history of gastritis and constipation. Rheum + Glycyrrhiza
Acute gastritis Glycyrrhiza is a demulcent, anti-inflammatory, and antispasmodic with mild laxative action. Ii: can be combined with Rheum to treat inflammatory conditions of the stomach and small intestine, such as gastritis, peptic ulceration, or gastroenteritis.
Rheum + Berberis
Rheum combinations
Exhaustion + edema In terms of Chinese medicine, Berberis can assist Rheum to: • clear Damp Heat and treat diarrhea • clear Liver Heat to treat hypertension or gastritis from Liver Heat invading the Stomach Berberis is antimicrobial and anti-inflammatory, and its alterative action can also strengthen hepatobiliary function and, in Chinese medicine terms, tonity and move Liver Qi. "
Rheum + Taraxacum
Gastritis + constipation In terms of Chinese medicine, both these herbs can clear Excess Heat from the Stomach, Intestines, or Liver, and they can clear Heat Toxin. Taraxacum can clear Heat both by its diuretic action and by its mild laxative effect Rheum and Taraxacum can be combined to treat gastritis and constipation associated with Heat in the Stomach and Intestines. They can also be used to treat hypertension by clearing Heat.
Six Rheum combinations are discussed below: Chinese syndromes. . 1. acute constipation
Intestines Stagnant Qi
2. chronic constipation
Intestines Stagnant Qi Intestines Deficient Qi
3. acute diarrhea + heat sensations
Intestines Damp Heat
4. gastritis + constipation
Stomach Heat + Liver Heat
5. hypertension + heat sensations
Heart Heat + Liver Heat
6. acute psoriasis
Heat in the Blood + Heat Toxin
+
CAUTION Before using any of the combinations below, it is important to be familiar with the cautions listed for each herb in the combination.
Rheum + Aretium
Acute eczema Gi
Both herbs can assist in the clearance of Heat Toxins and Heat in the Blood, and Aretium is specific for skin problems. Therefore, the two herbs can be paired to treat acute eczema, psoriasis, acne rosacea, or boils when the skin lesions are red, hot, itchy, and painful. The diuretic and alterative actions of Aretium combine with the laxative and alterative actions of Rheum to drain Heat and Toxins downward.
1. Acute constipation
Intestines Stagnant Qi Ratio '. Temperature
Taste
Rheum Rhamnus
1.5 1.5
bitter, sour bitter
Foeniculum Zlngiber
0.5 0.5
cool-cold cool sl. warm hot
aromatic. sl. acrid acrid. aromatic
Combining Western Herbs and Chinese Medicine
624 GENERAL
This combination is for acute or occasional constipation associated with Intestines Stagnant Qi. There may also be one or more additional syndromes, such as the following: • Liver Stagnant Qi • Stomach and Intestines Heat • Intestines Deficient Y"m and Dryness • Intestines Deficient Qi and Yang
secondary syndromes such as Liver Stagnant Qi, Stomach and Intestines Heat. Intestines Deficient Y"m and Dryness, and!or Intestines Deficient Qi and Yang. The overall temperature of the basic combination is cool, although the cooling effect of the two main laxative herbs is moderated by Capsicum and Zingiber. The dominant taste is bitter, associated in this case with the laxative anthraquinones and the anti-inflammatory berberidine alkaloids. USE
Additional syndromes may require modification of the basic combination. The overall temperature of the basic combination is cool, although the cooling effect of the two main herbs is moderated by Zingiber. The dominant taste is bitter. associated in this case with the laxative anthraquinones and with the potential to clear Heat.
• reduced bowel tone and function following chronic constipation associated with laxative dependency, extreme dieting as in anorexia or bulimia, drug abuse, prolonged multimedication, or chronic illness • reduced bowel tone and function associated with sluggish liver function
USE PRACTICAL NOTES
• acute or occasional constipation of various etiologies PRACTICAL NOTES
This combination can be taken as 2.5-5 ml of 1:5 tincture in quarter of a cup of water, three times per day. Once bowel movements are established, this combination can be replaced by a more balanced combination to normalize the bowel action and to treat underlying syndromes.
Caution This combination is for short-term use only to initiate bowel movements in acute or occasional constipation. It should not be used for more than 1-2 weeks and should be reduced or stopped if it causes excessive watery discharge. See the Cautions section in this chapter.
2. Cbronic constipation Intestines Stagnant Qi + Intestines Deficient Qi '
....
_-_.-.--~-
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Herb
Ratio
Temperature
Taste
Rheum Rhamnus Berberis Hydrastis Lobelia Rubus Zingiber Capsicum
1.5 1.5 1
cool-cold cool cool cool warm-cool neutral hot hot
bitter, sour bitter bitter bitter acrid bitter, sour acrid, aromatic acrid
1 1 1 1
1
GENERAL
This combination is a modification of Christopher's combination that was originally called the Lower Bowel Tonic. In Chinese terminology, it is for Stagnation and Deficiency of Intestines Qi. which may be accompanied by one or more
This combination can be taken as powdered dried herbs in '00' gelatin capsules. The initial dose is two to three capsules, three times per day. This can be increased up to six capsules, three times per day initially until daily bowel movements are established. One to three capsules, three times per day, can then be taken for up to 3 months, with regular monitoring of the patient. The combination can then be gradually tapered off.
Caution
Although the combination may initially cause loose bowels or even diarrhea as an integral and acceptable part of the cleansing and normalizing process, the capsules should be reduced or stopped temporarily if the diarrhea is severe or if it continues for more than 3 days. Plenty of fluids such as organic apple juice, organic grape juice, and water should be taken each day if there is considerable temporary fluid loss. See the Cautions section in this chapter. It is not the intention to replace laxative dependency with dependency on this combination. Accordingly, in addition to taking these capsules, the patient must also adopt a suitable regular regime of exercise, correct any poor posture, and make appropriate changes to the intake of nutrients and fluids. 3. Acute diarrhea + heat sensations
Intestines Damp Heat Herb':~7 y; , Ratio ,
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Potentilla Sanguisorba Berberis Rheum Zingiber
, ..
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2 1 1
0.5 0.5
Temperature
Taste
neutral-cool cool cool cool-cold hot
sour. bitter sour, bitter bitter bitter. sour acrid. aromatic
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625
Rheum This combination is the same as PotentilIa: acute diarrhea
+ heat sensations and is discussed under that heading.
6. Acute psoriasis
Heat in the Blood + Heat Toxin
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4. Gastritis + constipation
Herb
Stomach Heat + Liver Heat
Smilax Scrophularia Arctium (seeds) Mahonia Taraxacum Rheum Glycyrrhiza
Rheum Taraxacum Hydrastis Ophiopogon Glycyrrhiza
1 1
1 1 1
Temperature
Taste
cool-cold cool-cold cool cool neutral-cool
bitter, sour bitter bitter sweet, sl. bitter sweet
Ratio
Temperature
Taste
1 1 1 1 1 1
cool cool cool cool cool-cold cool-cold neutral-cool
sl. bitter sl. bitter acrid, sl. bitter bitter bitter bitter, sour sweet
0.5
This combination is the same as Smilax: acute psoriasis and is discussed under that heading.
GENERAL
This combination is for Heat in the Stomach, Liver, and Intestines with both Intestines Stagnant Qi and Stomach and Intestines Deficient Ym and Dryness. The overall temperature is cool to treat hot or warm conditions, and the dominant taste is bitter to clear Heat. The sweet taste is associated
COMPARISON OF THE SIX RHEUM COMBINATIONS I. Acute constipation
2. Chronic constipation
Intestines Stagnant Qi
Intestines Stagnant Qi + Intestines Deficient Qi
here with tonifying the Yin and moistening Dryness. USE
• recurring gastritis with thirst and constipation, maybe bitter taste in the mouth, bad breath, and irritability PRACTICAL NOTES
This combination can be taken as 5 rnl of 1:5 tincture in quarter of a cup of water, three times per day. Once symp-
Herb
Ratio'
Rheum Rhamnus Foeniculum Zingiber
1.5 1.5
0.5 0.5
Herb Rheum Rhamnus Berberis Hydrastis Lobelia Rubus Zingiber Capsicum
1.5 1.5 1 1 1 1 1 1
toms such as epigastric pain and burning sensation are significantly reduced, this combination can be replaced with a less draining and more tonifying combination, such as
Althaea: gastritis. Caution This combination can be used whenever there is a recurrence of the problem, but it is not designed to be taken
1. Combination No.1 is for short-term use only because of the relatively large amount of anthraquinone-containing laxative herbs Rheum and Rhamnus, since the purpose of the combination is mainly to initiate defecation. Foeniculum and Zingiber moderate the cooling action of the laxatives and also counteract their tendency to produce griping.
for more than 2 weeks at a time. 5. Hypertension + heat sensations
Heart Heat + Liver Heat Herb
Ratio
Temperature
Taste
Capsicum Zingiber Lobelia Berberis Taraxacum Rheum
2(}..50 drops
hot hot warm-cool cool cool-cold cool-cold
acrid acrid, aromatic acrid bitter bitter bitter, sour
1 1 1 1 1
This combination is the same as Capsicum: hypertension
+ heat sensations and is discussed under that combination.
2. Combination No.2 can be used over a longer period since its function is not merely to initiate defecation, but also to normalize bowel tone and function. Rheum and Rhamnus are included as laxatives as in the previous combination, but the combination has several other actions that combine to normalize the bowels: • Berberis and Hydrastis move Liver Qi and clear Liver Heat • Hydrastis and Rubus tone and normalize mucous membranes • Lobelia and ZingIber normalize intestinal muscle tone and contraction rhythm • Zingiber and Capsicum stimulate circulation and nervous irmervation of the bowels
Combining Western Herbs and Chinese Medicine
626 3. Acute diarrhea + heat sensations
4. Gastritis + constipation
Intestines Damp Heat
Stomach Heat + Liver Heat .,. Ratio·
Potentilla Sanguisorba Berberis Rheum Zingiber
2 1 1 0.5 0.5
Rheum Taraxacum Hydrastis Ophiopogon Glycyrrhiza
1 1 1 1 1
3. Combination No.3 is for short-term use only due to the potentially constipating effect of the relatively large amount of the astringent Potentilla. Rheum is present in this combination at its lower (astringent) dose, and both Rheum and Berberis have strong antimicrobial, anti-inflammatory, and alterative actions. Zingiber is present to moderate the cooling effect of the bitter herbs and to reduce intestinal cramping associated with diarrhea. 4. In combination No.4, the three bitter herbs, Rheum, Taraxacum, and Hydrastis, clear Heat from the Stomach, Intestines, and Liver to relieve gastric inflammation. In addition, they all have varying degrees of laxative action to relieve constipation. The two sweet herbs, Ophiopogon and Glyeyrrhiza, have anti-inflammatory action on the Stomach and Intestines, but they are also sweet tonics, which can tonify Yin and moisten the Intestines to relieve constipation associated with Deficiency Heat and Dryness.
5. Hypertension + heat sensations
6. Acute psoriasis
Heart Heat + Liver Heat
Heat in the Blood + Heat Toxin
jfJ~~~s.~J~1;'l!~g;~~t~ Capsicum Zingiber Lobelia Berberis Taraxacum Rheum
2().SO drops 1 1 1 1 1
Smilax Scrophularia Arctium seeds Mahonia Taraxacum Rheum Glycyrrhiza
1 1 1 1 1 1 0.5
5. Although Capsicum is a hot herb, it is used in combination No. 5 to disperse Heat by stimulating the circulation to redistribute Heat around the body, including to the body surface. Zingiber directs the dispersive action of Capsicum to the surface, and Lobelia emphasizes the relaxing aspect of this circulatory balancing. Berberis, Taraxacum, and Rheum are cold bitter herbs, which drain Heat downward and out of the body, and help to clear accumulated Heat Toxins.
Together these effects can assist in the treatment o~ .1l~ii'::" tension and agitation, anxiety, overexcitement, or aiiger;~·;~.;.:",~· associated with Heart and Liver Heat. ''''r:~.~:'
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6. The presence of Smilax, Scrophularia, Arctium, and Mahonia make combination No.6 specific for skin problems associated with Heat in the Blood and Heat Toxin. Arctium, Mahonia, and Taraxacum have a mild laxative action, which can combine with the laxative action of Rheum to clear toxins out of the body via the bowel, and Arctium and Taraxacum are cooling diuretics.
OTHER RHEUM COMBINATIONS Other combinations that contain Rheum include the following:
• Berberis: acute eczema • Echinacea: boils + infection • Valeriana: hypertension + headache
Research CONSTITUENTS The following constituents have been reported: • hydroxyanthracene derivatives • stilbenes • tannins • other Hydroxyanthracene derivatives These are usually 3-5% but can be up to 12%. The composition of the hydroxyanthracene fraction is complex and variable, consisting of anthraquinone glycosides (60-80%), dianthrone glycosides (10-25%), and small amounts of free aglycones. 7
Anthraquinone glycosides These are based on the five aglycones:; • emodin • aloe-emodin • rhein • chrysophanol • physcion
Dianthrone glycosides These are also known as sennosides and are formed by dimerization of homodianthrone glycosides or heterodianthrone glycosides. 7 Stilbenes These are phenolic compounds with two benzene rings separated by an ethene bridge. Rhubarb contains about 1% stilbene glucosides, mainly rhaponticin and 4-0methyl-piceid.8
-"'"'"'
--~.;
Rheum Tannins These are 5-10% and are of both the condensed (procyanidin) type and the gallotannin type. Galloyl esters are also present.' Other These include: flavonoids (2-3%),' starch, and calcium oxalate.I
PHARMACOLOGICAL AND CLINICAL RESEARCH I >--
The following effects have been reported: • antimicrobial • anti-inflammatory and antiallergic • analgesic • antiulcer • pulmonary protective • renal protective • hepatoprotective and choloretic • anticholesterol • antihypertensive • antiplatelet and antihemorrhagic • antidiarrheal • laxative • calcium regulator • dermatological agent • antioxidant • antimutagenic Antimicrobial
Antiviral An early study reported inhibitory action of Rheum decoction against the influenza virUS,9 and a more recent work reported that the minimum inhibitory dose of lo R. officinale extract for herpes simplex virus is 100 Ilglml.
Antibacterial Early studies reported that Rheum extracts have antibacterial action against a range of bacteria, and that anthraquinone glycosides, such as rhein, emodin, or aloeemodin, also had antibacterial effect. l1 For example, Salmonella typhi was sensitive to 50 f1g/ml of rhein. II More recently, Rheum preparations were reported to inhibit Bacteroides fragilis. 13
Antifungal Early Chinese research reported that Rheum extracts were inhibitory against a range of pathogenic fungi,14 and more recent research reported that the anthraquinone glycosides rhein, aloe-emodin, physcion, and chrysophanol inhibited Candida albicans and other pathogenic fungi.IS
Antiprotozoal Early research indicated that Rheum extract at 1:5000 and 1:1000 concentration was lethal to Entamoeba hystolytica and Trichomonas hominis. 16 More recent research reported that emodin inhibits Trichomonas vaginatis in mice. 17
627
Anti-inflammatory and antiallergic The stilbene glucoside rhaponticin is metabolized by the human intestinal bacteria to rhapontigenin, which can exhibit antiallergic activity. 18 Another study reported that oral administration of a methanol extract of R. undulatum or its isolated stilbene constituents rhapontigenin or piceatannol showed antiallergic activity in rats. 19 Rheum preparations have also been reported to inhibit hypersensitivity responses in mice20 and to have topical anti-inflammatory effect against different skin disorders. 21 Analgesic Galloyldihydrocinnamoylglucose, one of the tannin components of rhubarb, was reported to have both analgesic and anti-inflammatory actions.22 Antiulcer A clinical study in China reported that alcoholic extracts of Rheum were effective in the treatment of bleeding from gastric or duodenal ulcers.23 Pulmonary protective Rheum extracts were reported to have a protective effect against induced acute lung injury in rats,z· significantly reducing the edema of the lung tissue, the red blood cell and plasma protein exudation, and neutrophil infiltration. These findings indicate a protective action on the vascular epithelium and alveolar epithelium.25 Renal protective R. officinale preparations were reported to: • reduce the effects of renal hypertrophy in rats with induced diabetesZ6 • reduce proteinuria and the severity of glomerulosclerosis in rats submitted to a subtotal nephrectomi 7 • inhibit the synthesis and secretion of fibronectin and the accumulation of extracellular matrix in rats with mesangioproliferative glomerulonephritis28 • inhibit the proliferation of renal tubular cells in vitro29 • assist in the treatment of chronic renal failure in humans30 The rhubarb tannins epicatechin 3-0-gallate and procyanidin B-23-0-gallate were reported to decrease blood levels of urea nitrogen in rats, but procyanidin C-13-0-gallate increased blood levels of urea nitrogen. 31 The same workers found that epicatechin 3-0-gallate and procyanidin B-23-0-gallate increased glomerular filtration rate, renal plasma flow, and renal blood flow in rats with induced renal failure, but that procyanidin C-13-0-gallate worsened renal function. 32 Hepatoprotective and choloretic An early study reported that rhubarb increased the secretion of bile and its content of
628
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Combining Western Herbs and Chinese Medicine ... -.•..
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bilirubin and bile acid. 33 A recent clinical study in China reported that rhubarb preparations were effective in the treatment of infantile cholestatic hepatitis syndrome, promoting recovery of liver function and bile secretion.J.1 Anticholesterol Alcohol extracts of rhubarb were reported to have a beneficial effect in cases of obesity complicated with hypertension and lipemia. 35 In cholesterol-supplemented mice, a diet containing fiber from R. rhaponticum stalks resulted in lowering of plasma and hepatic cholesterol levels. 36 In a clinical study with hypercholesteremic men, the subjects were given 27 g of ground rhubarb stalk fiber per day for 4 weeks. This resulted in lowered serum cholesterol levels.3; It was reported that galloyl esters from rhubarb are potent inhibitors of rat squalene epoxidase, a key enzyme in cholesterol biosynthesis.38 Antihypertensive An early study reported that extracts of R. officinale and of R. palmatum, and the isolated anthraquinone rhein had antihypertensive action. 39 A recent clinical study in China reported that low doses of processed rhubarb of 0.75 g per 'day had good prophylactic action on pregnant women at risk of pregnancy-induced hypertension. 40 Antiplatelet and antihemorrhagic Rheum appears to exhibit both antiplatelet and antihemorrhagic activity, which may correlate with its traditional actions of 'moves Blood Stagnation' and 'stops bleeding: respectively. According to an early Chinese report, Rheum facilitated blood coagulation by reducing coagulation time and capillary permeability.41 Early clinical studies reported antihemorrhagic action, for example, a rhubarb preparation was reportedly effective for hemoptysis, and the anthraquinone . glycoside chrysophanol was used to treat thrombocytopenia, epistaxis, and abnormal uterine bleeding.42.43 More recently, induced hemorrhagic pancreatitis in rabbits was treated with a rhubarb preparation, resulting in both a reduction of hemorrhage and inhibition of platelet aggregation in the treatment group.44 The stilbene rhapontigenin (derived from the stilbene glucoside rhaponticin by bacterial breakdown in the human intestine) was reported to inhibit platelet aggregation induced by arachidonic acid or collagen. 45 Another study on rhaponticin present in the aerial parts of R. palaestinum reported antiplatelet activity.46 Antidiarrheal At low doses (0.1-0.3 g), the astringent effect of the tannins is dominant and rhubarb can be used to treat diarrhea, whilst at higher doses (l-4 g), the laxative effect of the anthraquinones is dominant and rhubarb can be used to treat constipation.
Laxative The dihydroxyanthracene derivatives can ha;~;~~;'i~ a laxative effect. The anthraquinone glycosides are not ab:' -. .--..."~.,.
_-;; ;.,
sorbed in the upper digestive tract, but they are broken down by the bacteria of the colon to the active aglycones (anthrones) at the site of action. 47 From studies on isolated sennosides, it appears that there are two distinct mechanisms involved in the laxative effect: 48 • increase in motility of the large intestine, with accelerated transit time, which will indirectly reduce fluid absorption • increase in fecal fluid volume due to an increase in fluid secretion A study using the anthraquinone emodin Oli' the isolated smooth muscle of guinea pigs reported that doses lower than 29.6 mumols/L enhanced contraction but doses higher than 29.6 mumols/L reduced contraction, in a dose-dependent manner. It was suggested that emodin has a biphasic effect on smooth muscle that is linked to changes in calcium ion concentration. 49 However, studies on isolated individual anthraquinones do not give a full picture of the mechanism of the laxative effect when using rhubarb as the herb, since there may be interactions between the different constituents, especially between the hydroxyanthracene derivatives, the tannins, and the stilbenes. Calcium regulator Emodin was found to increase the levels of free calcium ions in both isolated rat liver cellsso and in rat brain,;\ but sennosides or Rheum polysaccharides decreased the free calcium levels. The authors concluded that rhubarb has different kinds of regulatory actions in both liver and brain cells. It was reported that the addition of rhubarb stalk powder up to a level of 5% in a diet did not have a detrimental effect on calcium bioavailability.52 Dermatological agent Early clinical studies in China reported that rhubarb was effective in the treatment of dermatitis,53.54 impetigo, eczema, leg ulcer, and herpes zoster. 55.56 Antioxidant Methanol extracts of rhubarb and stilbenes showed radical scavenging activity, but anthraquinones and sennosides did not.;; Antimutagenic
Both Rheum extract and emodin showed
a dose-dependent decrease in induced mutagenicity in Salmonella typhimurium TA98,58 and another study reported antimutagenic activity for the anthraquinones of R. officinale. 59
~I
Rheum
629
\-
RESEARCH VERIFICATION OF TRADITIONAL ACTIONS The following traditional actions have been supported by research: laxative, antidiarrheal, antihemorrhagic, gastrointestinal anti-inflammatory (antiulcer), respiratory antiinflammatory (pulmonary protective), renal protective, hepatic and choloretic, dermatological agent, and deobstru,-·r~::'
i
Additional effects demonstrated by research
The follow-
ing effects have been reported: antiviral, antibacterial, antifungal, antiprotozoal, hepatoprotective, anticholesterol,
I
antihypertensive, calcium regulator, antioxidant, and antimutagenic, as discussed above.
As an antihypertensive or dermatological agent Rheum can • Heart or Liver Heat associated with hypertension • Heat in the Blood and Heat Toxin associated with acute skin disorders In such cases, I generally use Rheum in combination with five to seven other herbs, with each herb having a ratio of 1. Very approximately, this is equivalent to 0.6 g of dried Rheum per day, assuming three 5 ml doses of the combination tincture per day.
TOXICOLOGY Dried herb,. The ESCOP monograph on rhubarb of 1999 reported that there were no studies on the single dose toxicity, repeated dose toxicity, reproductive toxicity, or carcinogenicity of rhubarb preparations. 60 However, one study reported that the cytotoxicity of an ethanol extract of R. officinale is very low. 10 Isolated anthraquinones
vidual dose, or 0.3 g per day, assuming three 5 ml doses of the combination tincture per day.
be used to clear either:
ant (analgesic).
I
,
tinctures for this purpose, I generally use a ratio of 0.5 for rhubarb in a combination of five to seven other herbs, with each of the other herbs having a ratio of 1. Very approximately, this is equivalent to 0.1 g of dried Rheum for an indi-
Epidemiological studies suggest
that there is no risk of colon or rectal cancer in humans from the use of anthranoid laxatives. 61 The isolated anthraquinones emodin, aloe-emodin, physcion, and chrysophanol have shown some genotoxicity in vitro, but all in vivo genotoxicity studies were negative. 62 Rhein and sennosides A and B gave negative results using in vitro and in vivo tests for
As a laxative When using Rheum to treat constipation, I generally use it in a combination with two to three other herbs, each having a ratio of 1, or in a combination of five to seven other herbs, with Rheum having a ratio of 2 and each of the other herbs having a ratio of 1. Very approximately, three 5 ml doses per day of such a combination are equivalent to 1 g of dried Rheum. This is at the low end of the daily dose foi constipation, that is, in some cases it may be necessary to increase each individual dose of tincture temporarily to 7.5 ml or even 10 .ml initially until defecation begins to be normalized. It may be preferred to use the dried herb rather than the tincture in such cases.
mutagenicity.63
Initial dose Can start at the standard dose.
Dose Dried herb
As an astringent or bitter digestive tonic The BHC listed 0.1-0.3 g of the dried herb per day.
As 'a laxative The BHC listed 1-4 g of the dried herb per day, usually t3.ken at bedtime, or preparations standardized to contain 30-100 mg of hydroxyanthracene derivatives.
Preparation of dried herb If the laxative effect is required, the dried root can be taken as a powder, either in capsules or as an infusion steeped for a few minutes in water. It should
Duration
As a laxative According to the BHC, stimulant laxatives should not be used for periods of more than 2 weeks without medical advice. In my opinion, this statement applies to Rheum only when it is used in sufficiently high doses to produce a laxative effect, that is, in the dose range of 1-4 g or more per day.
In combinations to normalize bowels function
According to
Christopher, the combination originally known as Christopher's Lower Bowel Tonic (see Rheum: chronic constipation above) may need to be taken for several'months to normal-
not be decocted as heat destroys the laxative effect.
ize bowel function. At a maintenance dose of three to six gelatin capsules ('00') per day, this is approximately equiva-
Tmcture
lent to 0.4-0.8 g of anthraquinone-containing herbs (Rheum
As an astringent or bitter digestive tonic When using 1:5
and Rhamnus) per day.
Combining Western Herbs and Chinese Medicine
630
Cautions Western contraindications These include abdominal pain of unknown origin, intestinal obstruction, or severe dehydration states with electrolyte depletion. Whilst the BHC listed gastroenteritis as an indication for Rheum, some texts contraindicate this herb for inflammatory colon diseases such as Crohn's disease and ulcerative colitis.64 In my opinion, Rheum should not be given in higher (laxative) doses in cases of colon atony. However, it may be appropriate for this condition when it is given both in lower doses and in combination with moderating herbs that restore colon tone and function. Chinese contraindications for:
Rheum is contraindicated
65
• Exterior patterns • Deficient Qi or Blood patterns • Cold Deficient Spleen and Stomach patterns Pregnancy and lactation Some authors do not recommend Rheum in pregnancy and lactation, although no adverse reactions have been reported; see below. Children One text contraindicates the use of Rheum for children under 10 years of age, but other practitioners have recommended rhubarb for children; see below. Side effects Some patients may experience mild abdominal discomfort or pain, which can often be avoided by combining Rheum with antispasmodic carminative herbs such as Foeriiculum or Zingiber, see Rheum paired with other herbs. In addition, there may be a yellow or reddish brown coloration of the urine, which is not considered clinically significant.66 Overdose The main manifestations are abdominal pain and severe diarrhea. The fluid and electrolyte loss should be replaced. Interactions Hypokalemia may result from fluid and electrolyte loss from prolonged laxative abuse. Hypokalemia may then potentiate the action of cardiac glycosides and interact with antiarrhythmic dr1,1gs. Hypokalemia may be further aggravated by the concomitant use of other drugs such as the diuretic thiazide and adrenocorticosteroids. 60 However, I have not seen evidence that Rheum can cause hypokalemia, or that Rheum has a negative reaction with thiazide diuretics.
USE OF LAXATIVES Potential adverse effects of stimulant laxatives, Chronic diarrhea from the prolonged use of stimulant laxatives, such as the anthraquinones, may result in excessive loss of water and electrolytes, especially potassium. Also, the colon may become atonic and nonfunctioning, and there may be laxative dependence. Prolonged use of anthraquinone laxatives may cause pigmentation of the colon, but this is harmless and reversible after discontinuation of the laxative. Laxative abuse Before laxatives are prescribed for a subjective diagnosis of constipation, it is necessary to obtain a thorough medical history. Many cases of so-called.constipation involve overconcern about frequency of defecation,laxative abuse, and laxative dependency. Before using herbal therapy, it is necessary to determine if the constipation is genuine and whether or not it is associated with a serious illness requiring treatment by a specialist. It is also necessary to diagnose the patient accurately in terms of Chinese medicine since constipation may be associated with: • Intestines Heat • Deficient rm and Dryness • Intestines Stagnant Qi • Liver Stagnant Qi • Deficient Qi and Yang • Other syndromes Each of these may require different herbs and herb combinations. Laxatives in the context of self-help The use of laxatives should be minimal, and it is essential that the patient adopt a balanced nutrition with sufficient roughage and adequate fluid intake, and exercise regularly. Once the brief use of laxatives has initiated adequate bowel movements, laxatives should be tapered off and balanced herbal combinations should be started, which restore normal bowel tone and function. Balanced combinations to normalize bowel function The prolonged use of Rheum as a stimulant laxative, in doses of 1-4 g or more, may be detrimental to the bowels. However, in my opinion, when Rheum is used in doses of less than 1 g per day in a balanced combination with herbs that moderate the effect of Rheum and normalize bowel tone and function, it can be beneficial to the bowels. Indeed, prolonged use of such combinations may be necessary to establish normalization of bowel function in cases of chronic constipation associated with illness, laxative abuse, or irregular nutritional
Rheum habits. See the discussion on Rheum: chronic constipation above. USE OF RHEUM DURING
631
digestive and intestinal troubles. Julian Scotf3 has listed the use of small doses (5-20 drops of tincture per day) of the anthraquinone-containing herb Rhamnus for <;:hildren as a gentle laxative.
PREGNANCY AND LACTATION Pregnancy According to the ESCOP monograph on Rheum, there are no reports of adverse effects on mother or fetus during pregnancy when Rheum is used in the recommended dose, and all in vivo genotoxicity and mutagenicity studies were negative. However, the authors wrote that Rheum is not recommended in pregnancy since they do not consider that there are as yet enough studies on genotoxicity to eliminate a possible risk.
f'" I
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f
I
Ir··
t
,I
Lactation According to Martindale,67 anthraquinone derivatives may be excreted in the milk of lactating mothers, but if the normal dosage is used, the concentration of anthraquinone derivatives is usually insufficient to affect the nursing infant. One report found that Rheum intake by the mother did not have a laxative effect of Rheum in breast-fed babies.68 However, the ESCOP monograph did not recommend the use of Rheum during lactation until more data is obtained. Historical use In the past, authors have recommended Rheum during both pregnancy and lactation. Lonicerus69 wrote that Rheum can be used for old and young, for pregnant women and new mothers. According to Tabernaemontanus, Fernelius, and Matthiolus, Rheum can be used safely for young children and pregnant women, providing that the dosages are modest. Ellingwood70 said that Rheum can be given to the nursing mother if it is necessary to relax the infant's bowels, and Felter and Lloyd71 recommended a Rheum preparation to treat the nursing sore mouth of infants. Christopher~ included Rheum in a combination for nausea in pregnancy, in which Rheum is simmered for 10 minutes, which would have the effect of reducing the laxative action. As a result, the astringent action is proportionally stronger. USE OF RHEUM FOR CHILDREN
,"'
Felter and lloyd wrote, 'rhubarb is much used as a laxative for infants, in many infantile diseases; its mildness and tonic qualities rendering it particularly applicable, especially when enfeebled digestion and irritation of the alimentary canal are present: Christopher recommended Rheum as a laxative tonic for children and infants, and for infantile
Regulatory status Please see the Regulatory status section in the chapter on Safety. Rheum (rhubarb rhizome) is on the UK General Sale List and is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Rheum is not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
Traditional sources PROPERTIES Temperature Lonicerus wrote that rhubarb is warm and dry in the second degree, although some thought it warm and dry in the first degree. However, Gerard considered that rhubarb is of a mixed temperature. Rheum, da huang, is classified as cold in Chinese medicine, but is classified as coolcold in this book since it can be used to clear Heat, in terms of Chinese medicine, and as a bitter digestive tonic in Western herbal therapy. The temperature effect of Rheum may depend on the dose, with higher doses having a stronger cooling effect. Taste
Taste in the mouth According to the monograph in Wichtl,74 Rheum has a slightly bitter taste. I found a 1:5 tincture of R. palmatum in 25% alcohol to have a sweet, aromatic' and musty scent, and a sweet, sour, and slightly bitter taste. I found a sample of dried R. officinale to have a sour, slightly sweet, and slightly bitter taste. Taste properties Rhubarb is classified as bitter and sour in this book. The bitter taste is associated with its cooling antimicrobial, anti-inflammatory, alterative. and antihemorrhagic actions, and the sour taste is associated with its astringent action. ORGANS In terms of Chinese medicine, Rheum, as used in the West, can be associated mainly with disorders of the followingorgans:
Combining Western Herbs and Chinese Medicine
632
....
-.:-:"':~~.~.
• the digestive tonic action corrects the accompanying
- J':~~:!-~_~;; 0·· ..
atonic indigestion Large Intestine
constipation diarrhea
Lonicerus Tabernaemontanus
Stomach
stomachic gastroenteritis
Wicht! SHC
Liver
jaundice choloretic
Christopher Weiss 75
Rheum (da huang) is listed by Yeung76 as entering the Large Intestine. Stomach. Spleen. and Liver.
-..---
",:
_ _-
...
~ .
Antihemorrhagic Lonicerus wrote that Rheum can be used for hemoptysis or bloody diarrhea, or when a person is bleeding due to an injury. Gerard noted that Rheum. used in small amounts and combined with other astringents. could reduce excessive menstrual bleeding. Bitter digestive tonic Both Lonicerus and Tabemaemontanus wrote that Rheum can strengthen the stomach and . liver. The BHC noted the use of Rheum. in lower doses. as a stomachic due to its bitter taste.
ACTIONS The following traditional actions are discussed: • laxative • antidiarrheal • antihemorrhagic • bitter digestive tonic • gastrointestinal anti-inflammatory • hepatic and cholagogue • alterative • dermatological agent and antirheumatic • deobstruant (analgesic) and emmenagogue • diuretic and urinary anti-inflammatory • respiratory anti-inflammatory • antipyretic Laxative According to Lonicerus. Rheum heals all diseases that can be caused by constipation, and both Tabemaemontanus and Gerard mentioned the laxative action of this herb. The German Commission E monograph recommended it for constipation and for situations requiring defecation with soft stool, such as anal fissures, hemorrhoids, and after rectal operations. Antidiarrheal According to Tabemaemontanus. Matthiolus said that the root of Rheum has a mixed nature and properties because on the one hand. it has opening. dispersing. and purging actions. and on the other hand, it has constipating and astringent actions. He noted that in order to use Rheum to purge without constipating. the infusion rather than the decoction should be used since boiling removes the purging power of this herb. Both Gerard and Lonicerus recommended Rheum for bloody dysentery. According to Christopher. it is an especially valuable remedy for diarrhea due to irritating matter in the bowels since: • the laxative action removes the irritating substance • the astringent action checks the diarrhea and tones the bowels
Gastrointestinal anti-inflammatory Tabemaemontanus wrote that Rheum could be used to treat stomach ulcers. and the BHC listed it for gastroenteritis. In terms of Chinese medicine. this anti-inflammatory action of Rheum may often be linked to patterns of Heat in the Stomach and Intestines. For example. Felter and lloyd gave the following ,--.-, conditions as specific indications for the use of this herb: • gastrointestinal irritation with nausea and vomiting. and an elongated tongue reddened at the tip and edges • gastrointestinal irritation with nervous irritability. restlessness. screaming. and convulsive muscular contractions This latter description is similar to that of the Chinese pattern of acute fever with constipation. abdominal distension. mental confusion. and delirium associated with Excess' , .. Heat in the Stomach and Intestines. Hepatic and cholagogue Gerard wrote that Rheum is good for jaundice and other disorders of the liver and gallbladder since 'it removeth stoppings out of the conduits: Lonicerus said that it can be used for congestion of the liver. Lyle stated that Rheum is a stimulating tonic to the liver and bile ducts. and Christopher listed its use for jaundice and for biliousness with sluggish liver. Weiss wrote that 'rhubarb is often added to good effect to liver/gallbladder remedies. to enhance the choloretic effect: Alterative According to Gerard, the Arabian physicians used Rheum to purge choler downwards and also to purge phlegm. Tabernaemontanus stated that it purges the body of excessive bile. and Lonicerus wrote that it cleanses the blood. Dermatological agent and antirheumatic Although several authors stated that Rheum can have alterative action, few record the uses for this action. Felter and lloyd noted its use for gout and rheumatism with constipation. Christopher n listed a Rheum combination for rheumatism. and Tierra recommended it for skin eruptions from faulty elimination.
... .. -.;'
Rheum Deobstruant (analgesic) and emmenagogue Tabernaemontanus noted the use of Rheum for liver tumors, Christopher listed it for abdominal pains, and Tierra recommended it to counteract blood clots and promote menstruation.
indeed, rhubarb is contraindicated for Cold Deficient Spleen and Stomach. Finally, the use of Rheum to treat high fever, hemorrhages associated with Heat in the Blood, or painful conditions associated with Stagnant Blood is more widespread in China than in the West.
Diuretic and urinary anti-inflammatory Gerard recommended Rheum for inflammations of the kidneys and bladder, and Lonicerus noted its use for dropsy.
References
Respiratory anti-inflammatory Gerard noted the use of Rheum for pleurisy and inflammation of the lungs.
(
633
Antipyretic Lonicerus listed Rheum for chronic fever, Gerard recommended it for tertian fever, and Tabernaemontanus noted its use for fever associated with too much bile.
I. Evans WC. Trease and Evans' Pharmacognosy, 14th edn. WB Saunders, . London. United Kingdom (1996)
2. Bradley PR (ed). British Herbal Compendium, voll. British Herbal Medicine Association. Bournemouth, United Kingdom (1992) 3. Grieve M. A Modern Herbal, vols. 1 and 2. Dover Publications, New York. New York (1971) 4. Gerard I. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publications, New York, New York (1975)
COMPARISON OF WESTERN AND CHINESE USE OF RHEUM As can be seen from the table, Rheum is mainly used in Chinese medicine to clear Heat of various types and in a variety of disorders. The primary recent use of Rheum in the . West has been as a laxative, with frequent secondary use as an antidiarrheal, bitter digestive tonic, or choloretic. Rheum has not been used in the West so much as an herb to clear Heat, but as an herb to regulate the function of the Large Intestine, Stomach, and Liver. The bitter digestive tonic and choloretic actions are not emphasized in Chinese medicine;
5. Chang H-M, But PP-H (eds). Pharmacology and Applications of Chinese Materia Medica, vois. I and 2. World Scientific Publishing. Singapore (1986) 6. Tabernaemontanus }T. Krauterbuch (1731). Verlag Konrad Kolbl. Miinchen. Germany (1993)
7. Engelshowe R. Pharm Unserer Zeit 14:40-49 (1985) 8. Kubo I and Murai Y. J Nat Prod 54:1115 (1991) 9. Chen QH et al. Xinyiyaoxue Zazhi (Journal of Traditional Chinese Medicine) (5):34 (1974) 10. Wang Z, Wang G, Xu H et al. Zhongguo Zhong Yao Za Zhi 21 (6):364366.384 (1996) II. Nanjing College of Pharmacy. Chinese Traditional Pharmacy. vol.2. Zhejiang People's Publishing House. China P 172 (1976)
12. Chen QH et al. Acta Pharmaceutica Sinica 11(4):258 (1964)
Actions
Western uses
Chinese uses
laxative (higher doses)
constipation
constipation with Heat in the Stomach and Intestines. constipation from other etiologies
13. Cyong IC, Matusmoto T. Arakawa K et al. I EthnopharmacoI19:279-283 (1987) 14. Cao SN et al. Chinese Medical Journal 48(12):781 (1962) 15. Agarwal SK. Singh 55. Verma S et al. J Ethnopharmacol72(1-2):43-46 (2000)
antidiarrheal (lower doses)
acute or chronic diarrhea
diarrhea or dysentery with Damp Heat
antihemorrhagic
various hemorrhages (older use)
various hemorrhages with Heat in the Blood
17. Wang HH.J Ethnopharmacol40 (2):111-116 (1993)
antipyretic
fever (older use)
fever with Heat in the Stomach and Intestines
18. Kim DH. Park EK. Bae EA et al. BioI Pharm Bull 23(7):830-833 (2000)
deobstruant (analgesic)
infrequent use in the West
amenorrhea. dysmenorrhea. pain. traumas, or lumps with Stagnant Blood
19. Matsuda H. Tomohiro N, Hiraba K et al. BioI Pharm Bull 24(3):264-267 (2001)
alterative and dermatological agent
skin eruptions
acute red skin lesions with Heat in the Blood and/or Heat Toxin
20. Ma 1. Zhong Xi Yi fie He Za Zhi 11(7):418-419,390 (1991)
hepatic and cholagogue sluggish hepatobiliary jaundice with Damp Heat, not so much function. jaundice used as a choloretic (older use)
21. Cuellar MI. Giner RM, Recio MC et al. Fitoterapia n(3):22i-229 (2001)
bitter digestive tonic (lower doses)
digestive weakness
16. Kajo 1. Chemical Abstracts 47:1780 (1958)
22. Nonaka GI. Nishioka I, Nagasawa T et al. Chern Pharm Bul29:2862 (1981) 23. Zhou H, fiao D. Zhong Xi Yi fie He Za Zhi 10(3): lSO151,131-132 (1990)
I
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57. Matsuda H. Morikawa T. Toguchida I et aI. Bioorg Med Chem 99(1):41-50 (2001) 58. Lee H. Tsai SJ.Food Chern ToxicoI29(11):765-770 (1991) 59. Sun M, Sakakibara H, Ashida H et al. Biosci Biotechnol Biochem 64(7):1373-1378 (2000) 60. European Scientific Cooperative on Phytotherapy: Monographs on the Medicinal Uses of Plant Drugs (monograph on Rhei radix). European Scientific Cooperative on Phytotherapy, Exeter. United Kingdom (1997) 61. Kune GA. Causes and Control of Colorectal Cancer. Kluwer Academic Publishers, Boston-Dordrecht-Londong pp 179-190 (l996) 62. Heidemann A, Volkner W. Mengs U. Mutat Res 367:123-133 (1966) 63. Heidemann A. Miltenburger HG; Mengs U. Pharmacology 47(Suppl . 1):178-186 (1993) 64. Hansel R. Keler K. Rimpler H et al. Rheum. In: Hagers Handbuch der Pharmazeutischen Praxis, 5th ed. vol.6: Orogen P-Z. Berlin-Heidel-
-
berg: Springer-Verlag, Germany pp 411-439 (1994) 65. Bensky 0, Gamble A. Chinese Herbal Medicine Materia Medica. Eastland Press. Seattle, Washington (1986) 66. Tedesco HAm J GastroenteroI80:303-309 (1985) 67. Reynolds EFj (ed). Martindale: The Extra Pharmacopoeia, 31st edn. Royal Pharmaceutical Society, London. United Kingdom (1996) 68. Faber P, Strenge-Hesse A. Pharmacology 36(SuppI.1 ):212-220 (1988) 69. Lonicerus A. Kreuterbuch (l679). Reprinted by Verlag Konrad Kolbl. Miinchen, Germany (l962) 70. Ellingwood F. American Materia Medica. Therapeutics and Pharmacognosy, 11th edn. (l919). Reprinted by Eclectic Medical Publications. Sandy, Oregon (1994) 71. Felter HW, Lloyd Jv. King's American Dispensatory, vols. 1 and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications, Sandy, Oregon (l983) 72. Christopher JR. School of Natural Healing. BiWorid. Provo, Utah (l976) 73. Scott J. Natural Medicine for Children. Unwin Paperbacks, London, United Kingdom (1990) 74. Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm, Stuttgart, Germany (1994), from 2nd German edn. Wichtl M (ed) (l989) 75. Weiss RF. Herbal Medicine, English edn. Beaconsfield Publishers. Beaconsfield, United Kingdom(1988) 76. Yeung H-C. Handbook of Chinese Herbs and Combinations, vol. 1. Institute of Chinese Medicine. Los Angeles, California (1985) 77. Tierra M. Planetary Herbology. Lotus Press, Twin Lakes, Wisconsin (1988)
----I
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Rosmarinus Botanical name Rosmarinus officinalis L. Family Lamiaceae (Labiatae) Pharmaceutical name Rosmarini folium Part dried leaves English rosemary German Rosmarin French romarin Mandarin mi die xiang (~i!.t-) is the aerial part of R. officinalis L. Use in the West Rosemary is a bushy shrub that belongs to the group of very aromatic herbs, native to the Mediterranean, that also includes lavender, sage, and thyme. These herbs from the Larniaceae family have high essential oil content (1-3%) and have been central to the development of the practice of aromatherapy. Their mere fragrance is pleasing, uplifting, and calming, and for Europeans, these herbs seem to hold the distillation of Mediterranean sunshine. Rosemary in particular can have a warming and stimulating effect, and it is not surprising that in his astrological classification of herbs, Culpeper I placed rosemary under the
intestinal colic, headache, weak heart with palpitations, nervous disorders, and depression. The BHP of 1983~ listed Rosmarinus for headache and migraine, 'flatulent dyspepsia with psychogenic tension: and depression with general debility and cardiovascular weakness.
Use in North America Rosmarinus has been much more extensively used in Europe than in North America, and Felter and Lloyd5 wrote that rosemary was seldom used in the United States except as a perfume for ointments and liniments. This herb is not mentioned by Ellingwood6 or Christopher/ and has only a very brief entry in Lyle.8 Use in China The Chinese Herbal Medicine Dictionary has an entry for mi die xiang, the aerial parts of R. officinalis L. It is listed for headache and for strengthening the Stomach. Although the main entry is taken from an older text, no meridians are listed, and more information is given in the Chinese Herbal Medicine Dictionary for pharmacology than for traditional data. This suggests that Rosmarinus has not been a widely used herb in China.
dominion of the sun.
Use for physical and psychological disorders Rosemary has
What is special about Rosmarinus
been used as a medicinal herb in Europe at least since the time of Dioscorides2 and has had a tradition of use for both physical and psychological disorders. It was listed by Culpeper not only for physical problems of the stomach, intestines, and liver, but also for melancholy, lethargy, weak memory, and dullness of the mind and senses. In 1931, Grieve) reported the use of rosemary for poor appetite,
In terms of Chinese medicine, Rosmarinus officinalis can be said to be warm in temperature; aromatic, bitter, and acrid in taste properties; and to have its main effect on the Heart, Liver, Spleen, Stomach, and Intestines.
The key to understanding Rosmarinus is that it can:
635
Combining Western Herbs and Chinese Medicine
636
.~:~!:.."-
• tonify, warm, and move the Qi ofthe Heart, Spleen, and Liver to treat exhaustion, depression, and digestive disorders • calm Liver Hyperactive Yang to treat headache • calm and regulate Intestinal Qi to treat intestinal spasms CHINESE ACTIONS In terms of Chinese medicine, Rosmarinus, as used in the West, can be said to have five main actions:
I. II. III. IV.
tonify and move Heart Qi tonify and move Spleen Qi tonify and move Liver Qi calm and regulate Intestines Qi V. calm Liver Hyperactive Yang
Rosmarinus can be used to assist in the treatment of sOme' --.·~-L=-c~_2 of the most widespread disorders occurring in modem sod- ---r."..= eties. The following disorders are discussed below: • heart disease • postoperative recovery • chronic fatigue syndrome • depression • postnatal disorders • digestive disorders • recovery from drugs or multimedication • headache and migraine Heart disease As a secondary herb, Rosmarinus can have wide application in the treatment and prevention of heart disease. It can be included in combinations to assist in the treatment of:
WESTERN ACTIONS The main Western actions of Rosmarinus are shown here in terms of its five main Chinese actions: Chinese actions .: I. tonify
~nd
'
.... -'
move Heart Qi
II. tonify and move Spleen Qi
Western actions antidepressant circulatory stimulant bitter digestive tonic carminative
Ill. tonify and move Liver Qi
bitter digestive tonic hepatic cholagogue antidepressant
IV. calm and regulate Intestines Qi
antispasmodic tranquilizer
V. calm Liver Hyperactive Yang
tranquilizer
• debility associated with cardiac weakness • poor circulation associated with cardiac weakness • hypotension associated with cardiac weakness • depression associated with cardiac weakness • recovery from myocardial infarction or heart surgery However, Rosmarinus is not suitable for patients with patterns involving Heart Excess Heat with severe agitation, restlessness, or sensations of heat. Postoperative recovery Rosmarinus can be included in . combinations to assist in postoperative recovery since it can: • stimulate and tonify Heart to improve circulation, energy, and mood • stimulate and tonify Spleen to improve appetite, digestion, and absorption • stimulate and tonify Liver to improve metabolism and
WESTERN USES
assist in detoxification The Western uses of Rosmarinus can be related to its five main Chinese actions: Chinese actions
. Western uses
Chronic fatigue syndrome Rosmarinus can be used to treat exhaustion in chronic fatigue syndrome or fibromyalgia by strengthening the cardiovascular, gastrointestinal, and hepatobiliary systems. However, Rosmarinus is not suitable for patients with patterns involving Excess or Deficiency Heat, or with oscillations in body temperature or blood
I. tonify and move Heart Qi
cardiac weakness. poor circulation, exhaustion, hypotension. depression
II. tonify and move Spleen Qi
poor appetite, anorexia nervosa, atonic digestion. retention of food
pressure.
depression, intolerance to fats, alcohol. or medications
associated with any combination of the following Chinese
Ill. tonify and move Liver Qi
IV. calm and regulate Intestines Qi
V. calm Liver Hyperactive Yang
nervous indigestion, nervous flatulence headache, migraine
Depression
Rosmarinus can be used to treat depression
syndromes: • Deficiency and Stagnation of Heart Qi • Deficiency and Stagnation of Liver Qi • Deficiency and Stagnation of Spleen Qi
1
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Rosmarinus It may be helpful in treating depression from Deficiency and Stagnation of Heart Qi when this is associated with mild Heart Spirit Disturbance. However, Rosmarinus may be too strong a stimulant to treat depression linked with severe anxiety, agitation, or restlessness, and is not generally suit1-
'"
However, it is not appropriate for headache associated with Liver Heat or Stomach Heat. Also, unless rosemary is combined with Kidney tonic herbs, it may not be effective for headache associated with Liver Hyperactive Yang and Kidney Deficient Qi or Y'm.
able for manic depression. Postnatal disorders Rosmarinus can be included in combinations to treat postnatal exhaustion and depression, especially if there are sensations of cold. If there are sensations of heat and restlessness, rosemary may not be appropriate.
I
637
Digestive disorders Rosmarinus is specific for digestive disorders associated with either Deficiency plus Cold or with depression plus nervous tension. It can be used for: • poor appetite or anorexia nervosa • weak digestion or the results of overeating • flatulence and intestinal colic • food intolerances By strengthening both the gastrointestinal and hepatobiliary function, Rosmarinus can assist in the treatment of food intolerances. It can aid specifically in the digestion of greasy or fatty foods, but it can also help those patients with weak digestive systems who can only tolerate a narrow range of foods. Recovery from drugs or multimedication Rosmarinus has been shown to have hepatoprotective action and to enhance liver function (see Research). Providing the patient does not have marked heat signs, I often include Rosmarinus
DIRECTION OF ENERGY In terms of Chinese medicine, Rosmarinus can be said to have a moving and dispersing effect on Heart Qi in the chest and on Liver Qi in the chest and abdomen. In addition, it can have a controlling effect on disturbed upward movement of Liver Yang. The effect of Rosmarinus on the direction of energy movement is compared below with the effects of: • the Chinese herb Bupleurum • the Western aromatic herbs Salvia and Lavandula Rosmarinus and Bupleurum Chai hu, the root of Bupleurum species, is used in Chinese medicine to spread Stagnant (constrained) Liver Qi. However, chai hu also has the potential to strengthen the upward movement of Qi, and in some patients, this can aggravate Liver Hyperactive Yang and result in headache. The Western aromatic herbs Rosmarinus, Lavandula, and Salvia officinalis can all have a spreading (dispersing) effect on Stagnant Qi of the Liver or Heart. However. instead of increasing the upward movement of Qi, these herbs can control pathological upward movement of Liver Yang. They are therefore specific in the treatment-ofheadache associated with patterns of constraint such as depression or nervous tension.
in combinations to assist: • recovery from prolonged overindulgence in food and drink • recovery from drug abuse • recovery from prolonged multimedication
Rosmarinus, Salvia officinalis, and Lavandula These three herbs can all move Stagnant Qi of the Liver or Heart. and can all control Liver Hyperactive Yang. However. their effects can be differentiated as follows:
Salvia This herb has a stronger dispersing effect at the surHowever, special precautions must be taken in the herbal therapy of patients with reduced liver function or those currently taking potentially hepatotoxic conventional medication, if indeed these patients are treated with herbs at all; see the section Treatment of liver disorders in the chapter on
Safety. Headache and migraine Rosmarinus can be used for the treatment of headache an~ migraine of the following types: • Liver Hyperactive Yang with Liver Stagnant Qi • Liver Hyperactive Yang with Liver Stagnant Qi and Interior Cold • Liver Hyperactive Yang with Deficient Blood • Liver Hyperactive Yang with Spleen Deficient Qi
face of the body than Lavandula or Rosmarinus so that it can be used to regulate sweating and to relax spasms in the surface muscles due to a combination of Liver Stagnant Qi and Exterior Wind Cold. However. Salvia can also help to normalize body temperature by clearing Heart Heat. for example, in its use to treat menopausal hot flashes.
Lavandula Whilst Salvia is relatively more active in the surface layers of the body. Lavandula has a dispersing effect on Liver and Heart Qi that is more in the Interior. Also. Lavandula is the most effective of the three herbs in calming the disturbed upward movement of Heart Spirit and thus treating anxiety, restlessness. and insomnia.
Rosmarinus Of the three herbs. Rosmarinus has the strong-
Combining Western Herbs and Chinese Medicine
638
est stimulating and moving effect on the Interior. It is also warming, so that it can be used for depression associated with Stagnation of Qi of Heart and Liver combined with Cold.
TYPICAL CASE EXAMPLE Signs and symptoms The patient is tired and depressed, with indigestion and abdominal distension that is worse with tiredness, nervous tension, or depression. The patient has problems digesting fatty foods and has occasional headaches that are aggravated by stress. The pulse is empty and wiry, especially in the Spleen, Liver, and Heart positions. The tongue is pale and slightly purple, has tooth marks, and can sometimes have a slight tremble. Diagnosis The patient has Deficiency and Stagnation in the Spleen and Liver as well as disturbance of Stomach and Intestinal Qi, and occasional Liver Hyperactive Yang. Choice of Rosmarinus The bitter, aromatic, and acrid properties of Rosmarinus can tonify, move, and warm the Qi and Yang of the Spleen, Liver, and Heart to treat tiredness and depression. Tonifying and moving Liver Qi can improve the digestion of fatty foods. Rosmarinus can treat headache by calming Liver Hyperactive Yang and it can treat nervous indigestion and abdominal distension by regulating the Stagnation of Qi, or calming the Disturbance of Qi, in the Stomach and Intestines.
Limitations of Rosmarinus
• calms and relaxes the Intestines to treat flatu1en~-~d=:::-~;:~5 intestinal spasms ' "'"77-!JfJ • moves Stagnation of Heart and Liver Qi to treat depression
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However, Rosmarinus is not so much aromatic in the sense that it can transform Damp. If such a herb is required, Angelica archangelica or Juniperus would be more appropriate. Bitter Rosmarinus can act as a bitter digestive tonic. It is an excellent example of a herb that combines the bitter, aro.... matic, and acrid properties. For example, it can have warming, stimulating, and moving effects on the Qi of the Spleen and Liver to treat digestive and hepatobiliary weakness and \""1 congestion. However, if a cooling bitter anti-inflammatory were required, then Gentiana or Berberis would be preferred. It is possible that some of the bitter constituents of ----t'-Rosmarinus contribute to a cardiotonic a c t i o n . ' ._~_-c~~~ !'fAcrid Rosmarinus is acrid only in the sense of warming the Interior, It is not generally used to clear Exterior Wmd from the surface of the body, for which purpose the related herb Salvia officinalis would be preferred.
ACTIONS Limitations on the following actions are below: • cardiotonic, circulatory stim~ant, and antidepressant • bitter digestive tonic and carminative • hepatic and cholagogue • tranquilizer • antispasmodic and carminative
TEMPERATURE Cardiotonic, circulatory stimulant, and antidepressant "' Rosmarinus is a warm herb that is specific for cool patterns. It would not be enough for cold patterns, and if it is used in a combination for such a pattern, hot herbs like Capsicum or Zingiber should be added. Rosmarinus is not appropriate for warm patterns unless it is balanced by cool or cold herbs, and it would not generally be used for patterns of Excess Heat.
TASTE Rosmarinus can be said to be primarily aromatic, but the bitter and acrid properties are also important. Aromatic The following effects can be said to be manifestations of the aromatic property of Rosmarinus: • stimulates the Spleen and Stomach to strengthen the appetite and digestion
Cardiotonic Rosmarinus can be used as a secondary herb to warm and tonify the Qi and Yang of the Heart to treatexhaustion and depression. However, it does not have a _ -',", strong tradition of use as a primary cardiotonic, nor is there research evidence to suggest this action. Rosmarinus is not known to strengthen the heart to the same degree as the primary cardiotonics Cinchona, Convallaria, Crataegus, Leonurus, or Sarothamnus. Nor does it have the cardioregulatory effects of these herbs to treat arrhythmias. Circulatory stimulant Rosmarinus may be a mild circulatory stimulant, possibly partly due to its camphor and borneol content, but it does not have such a strong effect on coronary circulation as Capsicum or on peripheral circulation as Zan- thoxylum. Rosmarinus moves Heart Qi rather than Heart Blood. Therefore, it is not a primary herb for chest pain due to heart disease, as are Crataegus and Salvia miltiorrhiza.
.-'...
~;
Rosmarinus Antidepressant Culpeper recommended Rosmarinus for melancholy of the heart, and Rosmarinus can be used as a primary herb to treat depression due to Stagnation of Liver or Heart Qi. As discussed above, it is not an appropriate herb for depression involving patterns of severe Heart Spirit Disturbance or Heat.
~
Bitter digestive tonic and carminative Rosmarinus combines aromatic, bitter, and acrid properties, \vhich makes it specific for digestive weakness associated with Deficiency, Stagnation, and Cold. Hepatic and cholagogue Rosmarinus is a most useful herb in that it can warm, tonify, and move Liver Qi. It can therefore be used to treat, for example, • digestive disturbances and food intolerances • recovery from prolonged multimedication or substance abuse • depression However, it is specific for cool patterns. Therefore, for warm patterns, Rosmarinus would need to be balanced with cool herbs, such as Berberis or Hydrastis. Tranquilizer The main use of Rosmarinus as a tranquilizer is to calm Liver Hyperactive Yang to treat headach~ and migraine. Because of its stimulant action, Rosmarinus is not generally suitable for calming Disturbance of Heart Spirit. However, it can be used in some cases of anxiety-depressiQn if it is combined with Lavandula or with stronger sedatives than Lavandula, such as Anemone, Humulus, or Valeriana. Antispasmodic and carminative Lack of movement in the Intestines may result from weakness, associated with Deficiency and Stagnation of Spleen and Intestine Qi, or it may derive from intestinal spasms, associated with Disturbance of Intestinal Qi linked to nervous tension. Rosmarinus can be used for either situation, but it is not generally appropriate for hot patterns, although it may be used in some warm patterns if it is suitably combined with cool herbs.
Rosmarinus paired with other herbs Discussion of the limitations of each of the main actions of Rosmarinus can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Rosmarinus beyond its limitations. The basic unit of herb combination is the herb pair. Twelve pairings of Rosmarinus are briefly explained below.
639
CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair. Rosmarinus + Panax ginseng
Exhaustion + depression Rosmarinus can be an excellent complement and moderator for sweet tonic herbs. Its bitter tonic and warm aromatic stimulant actions on the digestive system tend to reduce the tendency of sweet tonics to give rise to Stagnation and Damp. Rosmarinus and Panax ginseng can be used to treat exhaustion and depression associated with Deficient Heart Qi and Yang. Panax ginseng can also tonity Kidney Qi and Yang, which Rosmarinus does not do, and Rosmarinus can act as a warming carminative and bitter tonic to stimulate digestion. Rosmarinus can partially moderate the tendency of Panax to aggravate Liver Hyperactive Yang. Rosmarinus + Angelica sinensis
Exhaustion + anemia These herbs complement each other by assisting in the tonification of Blood by different mechanisms. The sweet constituents of Angelica sinensis, supported by its acrid, aromatic, and bitter components, can tonify the Blood. The acrid, aromatic, and bitter constituents of Rosmarinus can warm, move, and tonify Spleen and Liver Qi and indirectly help to increase Blood. Also, Rosmarinus can indirectly help to tonify Blood by calming worry and thus normalizing Spleen function. Rosmarinus + Berberis
Depression Warm Rosmarinus and cool Berberis can be combined to harmonize the Liver and treat depression. Both herbs can move Liver Stagnant Qi via their bitter constituents. Rosmarinus can warm and move Liver Stagnant Qi, and Berberis can drain Liver Damp Heat, so that this herb pair can be used for depression with mixed syndromes of Heat and Cold. Rosmarinus + Piscidia
Headache + exhaustion Here Rosmarinus is combined with a bitter herb of a different type. Both Rosmarinus and Piscidia can control Liver Hyperactive Yang to treat headache. Warm Rosmarinus moderates the potentially depressive effect of cold Piscidia on the metabolism, and without this moderating effect, Piscidia might be contraindicated in cases of headache combined with exhaustion.
Combining Western Herbs and Chinese Medicine
640 Rosmarinus + Artemisia
Rosmarinus + Zingiber
Hepatic weakness + food intolerances
Flatulence + intestinal colic
This pair can tonify and move Liver Qi, and, in Western terms, enhance the activity of liver enzymes to increase metabolic efficiency and assist in detoxification. This will assist in the treatment of intolerances to food or drugs and assist in the recovery from prolonged multimedication. Both herbs have aromatic and bitter constituents, but Rosmarinus is the primary aromatic herb, and Artemisia is the primary bitter herb. Rosmarinus + Crataegus
Cardiac weakness + depression Associated with its sour and sweet taste properties, Crataegus is the primary cardiotonic and cardioregulator. Rosmarinus assists Crataegus in these actions and is the primary antidepressant in this pair as a result of its capacity to warm and move Heart Qi. Crataegus complements this with its ability to move Heart Blood and relieve pain.
Rosmarinus is an aromatic bitter herb that cCU?- also warm the Interior. This acrid warming property can be emphasized by combining it with the hot acrid herb ZingIber. Also, both herbs can have a regulatory and antispasmodic action on the Intestines to treat abdominal distension, flatulence, and intestinal colic. Rosmarinus + Zanthoxylum (berries) -:.,
Intestinal colic + cold sensations Both herbs are acrid, aromatic, and bitter. They can be combined to warm, stimulate, and tonify the Spleen and Stomach, and to warm, move, and relax the Qi of the Intestines. Rosmarinus and Zanthoxylum can be paired to treat intestinal colic with cold sensations, not only in the abdomen, but also in the body and extremities.
.'
-,.'
Rosmarinus + Capsi~ Rosmarinus + Salvia officinalis
Headache + myalgia These aromatic herbs complement each other's actions. Both herbs can calm Liver Hyperactive Yang to treat headache, and both herbs can move Liver Stagnant Qi. However, whilst Rosmarinus moves Liver Qi more in the Interior to treat, for example, depression, Salvia moves Liver Stagnant Qi more at the surface to treat muscle tension and pain. Rosmarinus + Lavandula
Headache + nervous tension Rosmarinus is relatively more stimulant and Yang, and Lavandula is relatively more tranquilizing and Y"m. The two herbs can be combined as a Yin-Yang pair to treat headache and indigestion associated with both depression and nervous tension. Rosmarinus + Turnera
Impotence + depression Both herbs can have a stimulant and antidepressant effect. The antidepressant action of Rosmarinus on the Heart and Liver is complemented by Turnera, which can treat depression, especially if associated with Kidney Deficiency. Both herbs can have a secondary calming action in addition to their primary antidepressant action and so can be used as a pair for sexual problems associated primarily with depression and secondarily with nervous tension.
Poor circulation + depression Capsicum is a hot acrid herb with a powerful capacity to warm the Interior and to move Stagnant Heart Blood. Rosmarinus can move Heart and Liver Qi to treat depression and digestive weakness and stagnation. These herbs can be combined to treat poor coronary and.peripheral circulation with heart pain, exhaustion, depression, and digestive weakness.
Rosmarinus combinations Six Rosmarinus combinations are discussed below:
1. postnatal depression + exhaustion
Deficient Qi and Blood + Heart Stagnant Qi
2. digestive weakness + cold sensations
Spleen Deficient Qi + Spleen Deficient Yang
3. food intolerances + cold sensations
liver Stagnant Qi + Cold
4. digestive disorders + depression
liver invades Spleen
5. irritable bowel syndrome + cold sensations 6. headache + facial neuralgia
-,,-1
Intestines Qi Disturbance
+ Cold liver Hyperactive Yang + Stagnant Qi and Blood in the channels
l\ ... o \
\;
Rosmarinus
Spleen and Stomach. The hot acrid herbs Capsicum, Zingiber, and Zanthoxylum make this a warm combination for cool or cold conditions. The aromatic constituents move Stagnation of Qi in Stomach and Intestines, and the sweet and bitter constituents tonify Spleen and Stomach Qi.
1. Postnatal depression + exhaustion
Deficient Qi and Blood + Heart Stagnant Qi Herb
. Ratio _. Temperature ,·Taste.
Rosmarinus Salvia off. Leonurus Astragalus Angelica sin.
1 1
1 1
0.5 0.5 0.5 0.5
Glycyrrhiza Zingiber Cinnamomum (bark)
,... !
L
r
L.
warm warm-cool neutral 51. warm warm neutral-cool hot hot
641
aromatic, bitter, acrid aromatic, acrid sour,s!. bitter sweet sweet, aromatic, bitter sweet acrid, aromatic acrid, sweet, aromatic
USE
• loss of appetite and weak digestion from eating too much cold foods • atonic digestion with exhaustion and maybe depression • atonic digestion with abdominal distension PRACTICAL NOTES
GENERAL
This combination is for Deficient Qi and Blood with Heart Stagnant Qi. There may also be some Heart Deficient Yang. The overall temperature is warm so that the combination is used mainly for neutral-cool patterns. The bitter, sour, and sweet constituents can combine to tonify the Heart, and the aromatic and acrid properties can move Stagnant Heart Qi.
This combination can be taken as 5 ml of J:5 tincture in quarter of a cup of warm water, three times per day, with Capsicum given in a separate bottle so that the requisite number of drops of Capsicum can be added to each dose of the main medicine. This combination.can be taken for long periods with the appropriate cautions, breaks, and modifications. In addition, the patient should avoid cold foods and drinks.
USE
• postnatal depression and exhaustion with sensations of cold
3. Food intolerances + cold sensations
Liver Stagnant Qi + Cold
PRACTICAL NOTES
Herb .
This combination is best taken as 5 ml of 1:5 tincture in quarter of a cup of hot water, three times per day. This combination can be taken for long periods with the appropriate cautions, breaks, and modifications. Patients with this pattern usually benefit from moderate daily exercise to tonify and move Heart Qi. However, too much or too arduous exercise may further weaken Heart Qi.
Rosmarinus Artemisia abs.
. Ratio .~~,Terrip~rature~' Jaste
Gentiana Citrus (ripe peel) Glycyrrhiza Zingiber Capsicum
1 1 1
warm
0.5 0.5 0.5
warm
5-20 drops'
warm-cool neutral-cool
aromatic, bitter, acrid bitter, aromatic bitter acrid, aromatic, bitter
hot
sweet acrid, aromatic
hot
acrid
neutral-cool
GENERAL
2. Digestive weakness + cold sensations
Spleen Deficient Qi + Spleen Deficient Yang ..
Ratio
Herb
1 1 1 0.5 0.5
Rosmarinus Gentiana Panax gin. Glycyrrhiza Zanthoxylum (berries) Zingiber Capsicum
0.5 5-20 drops
Temperature
Taste
. ,
- -';:~~'. t -....·
This combination is for Stagnation of Liver and Gallbladder Qi. There may also be: • Deficiency of Liver and Gallbladder Qi • Cold and Damp in the Liver • Deficiency and Stagnation of Spleen Qi
warm neutral-cool 51. warm neutral-cool hot
aromatic, bitter, acrid
sweet acrid, aromatic, bitter
The overall temperature is warm to treat cool or cold conditions. The dominant taste properties in the combination are aromatic, bitter, and acrid.
hot hot
acrid, aromatic
USE
bitter sweet,s!. bitter
acrid
GENERAL
This combination is for Deficiency of Qi and Yang of the
• intolerances, of foods or drugs, with cold sensations • recovery from prolonged substance abuse or prolonged multimedication • digestive weakness with cold sensations
-.. . . -,.~~cr..'
Combining Western Herbs and Chinese Medicine
642
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of warm water, three times per day, with Capsicum given in a separate bottle so that the requisite number of drops of Capsicum can be added to each dose of the main medicine. This combination can be taken for long periods with the appropriate cautions. breaks. and modifications. In addition. the patient should avoid cold foods and drinks.
Caution See the section Treatment of liver disorders in the chapter on Safety. 4. Digestive disorders + depression
Liver invades Spleen : ,• ·C·· ."-:". '.~ ··~r··-',·~· ~.~--~ ::',";,-;5:- , . - ::.' Herb;:J'':'~:':'i:+Ratio''':::':''~' 'Temperature' Taste
.-;,-.,~ ... -..-:;:"y....,.J~,'l.'_~~f~';'.;;"':''::'·,_~·.-::,'.fi:--''''I..':''~ ,__ , •. ",:-'. ,', _...•
Glycyrrhiza Zingiber Capsicum
0.5 0.5 5-20 drops
_ ....
5. Irritable bowel syndrome + cold sensations
PRACTICAL NOTES
Rosmarinus 1 1 Verbena Artemisia abs. 1 Mentha pip. 0.5
--,-' _----_.-
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warm neutral
aromatic, bitter, acrid sl. bitter
warm-cool warm-cool
bitter, aromatic acrid, aromatic
neutral-cool hot hot
sweet acrid, aromatic acrid
GENERAL
This combination can be used for the syndromes of Deficiency and Stagnation of Liver Qi with the Liver invading the Spleen. resulting in Deficiency and Stagnation of Spleen Qi. This is a warm combination for cool-cold patterns. The bitter. aromatic. and acrid taste properties are combined to tonify and move the Qi of both the Liver and Spleen. USE
• general debility and poor appetite. associated with chronic illness or anorexia nervosa • depression, lethargy. sluggish digestion, and food intolerances • depression and worry with distension and discomfort in the epigastrium or lower abdomen
Intestines Qi Disturbance + Cold Herb Rosmarinus Lavandula Hamamelis Myrica Lobelia Glycyrrhiza Zingiber
0.5 0.5
warm warm-cool
aromatic, bitter, acrid· aromatic, bitter, sl. acrid sour, sl. bitter acrid, sour, bitter acrid
neutral-cool
sweet
hot
acrid, aromatic
GENERAL
This combination is for Disturbance of Intestinal Qi with Interior Cold. There may also be Disturbance of Heart Spirit. Liver Hyperactive Yang. and Liver Stagnant Q1. The overall temperature is warm to treat cool or cold patterns. The dominant taste properties are acrid and aromatic to warm. move. relax. and calm Intestinal Qi. The sour property can have an astringent effect on the mucous membranes to reduce diarrhea or excessive mucous secret~on. USE
• irritable bowel syndrome with sensations of cold • abdominal distension with nervous tension and sensations of cold PRACTICAL NOTES
This combination can be taken as 5 m1 of 1:5 tincture in quarter of a cup of warm water. three times per day. This combination can be taken for long periods with the appropriate cautions. breaks. and modifications. 6. Headache + facial neuralgia
Liver Hyperactive Yang + Stagnant Qi and Blood in the channels Herb
Ratio
Temperature
Taste
Rosmarinus
1 1 1 1
warm
Lavandula Piscidia Lobelia
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of warm water, three times per day, with Capsicum given in a separate bottle so that the requisite number of drops of Capsicum can be added to each dose of the main medicine. This combination can be taken for long periods with the appropriate cautions, breaks, and modifications.
neutral
0.5-1
Valeriana
PRACTICAL NOTES
warm sl. warm
1 1 1 1
Glycyrrhiza Zingiber
0.5 0.5 0.5
sl. warm
aromatic. bitter, acrid aromatic, bitter, 51. acrid
cool
bitter, sweet
cold warm-cool
bitter acrid
neutral-cool
sweet
hot
acrid, arom
GENERAL
This combination is for headache as a result of Liver Hyperactive Yang with Stagnant Qi and Blood in the channels of the face and head. There may also be some Liver
.....
............ --
Rosmarinus Wmd, Wmd Cold invasion, and Deficient Qi and Blood in
I'
l---
~
the channels. The overall temperature is warm to treat neutral or cool conditions. For cold conditions, Capsicum could be added. The dominant taste properties are aromatic and acrid to control Liver Yang and to warm and move Qi and Blood in the channels. The bitter constituents of Rosmarinus and Lavandula can help to move Liver Stagnant Qi, and the bitter constituents of Piscidia and Valeriana can contribute a calm-
643
2. The aromatic and acrid herbs Rosmarinus, Zanthoxylum, Zingiber, and Capsicum combine to warm, move, and tonify the Qi of the Spleen, Stomach, and Intestines. The bitter constituents of Gentiana and Rosmaririus combine to stimulate digestion, and the sweet constituents of Panax and Glycyrrhiza can tonify the Spleen.
3. Food intolerances + cold sensations
4. Digestive disorders + depression
ing effect.
Liver Stagnant Qi + Cold
Liver invades Spleen
USE
.H~'r\r;eiY~~ih"'< .Rati~':~tL·
;~~rtl =';'~'------'---'--"-
• facial neuralgia with sensations of cold • headache with facial neuralgia • headache or migraine with nervous tension • headache with irritability and depression PRACTICAL NOTES
This combination can be taken as 5-10 rnl of 1:5 tincture in quarter of a cup of warm water, three times per day. It can be taken for up to a week or in the acute stage of a recurring condition. It is not to be taken continuously for long periods unless Piscidia and Valeriana are reduced to 0.5 in ratio, with respect to the other herbs. This modified combination can be taken for 2 weeks to 1 month with the appropriate cautions, breaks, and modifications.
COMPARISON OF THE SIX ROSMARINUS COMBINATIONS 1. Postnatal depression + exhaustion
2. Digestive weakness + cold sensations
Deficient Qi and Blood + Heart Stagnant Qi
Spleen Deficient Qi + Spleen Deficient Yang
Rosmarinus Artemisia abs. Gentiana Citrus (ripe peel) Glycyrrtliza Zingiber Capsicum
1 1 1 0.5 1 0.5 5-20 drops
Rosmarinus Verbena Artemisia abs. Mentha pip. Glycyrrhiza Zingiber Capsicum
_ _..i
1 1 1 0.5 0.5 0.5 5-20 drops
3. Combination No.3 can strengthen the metabolism of the liver, especially its capacity to detoxify. It can thus be used to treat disorders associated with weak and sluggish liver function with accumulation of toxins. Such disorders include: • overindulgence of rich foods, alcohol, and drugs • sequelae of liver disease • side effects of prolonged multimedication Both combination No.2 and combination No.3 contain Rosmarinus, Gentiana, Glycyrrhiza, Zingiber, and Capsicum. However, combination No.2 is characterized by Zanthoxylum to warm and move the Qi of the Spleen and Intestines, and Panax to tonify the Spleen. Combination No.3 is characterized by the presence of Artemisia and Citrus. which assist Rosmarinus to tonify and move Liver Qi. Combination No.3 can be compared to Artemisia: food intolerances + heat sen-
sations. Rosmarinus Salvia off. Leonurus Astragalus Angelica sin. Glycyrrtliza Zingiber Cinnamomum (bark)
1 1 1 1 0.5 0.5 0.5 0.5
Rosmarinus 1 Gentiana 1 Panax gin. 1 Glycyrrtliza 0.5 Zanthoxylum (berries) 0.5 Zingiber 0.5 Capsicum 5-20 drops
4. Both combination No.3 and combination No.4 contain Rosmarinus, Artemisia, Glycyrrhiza, Zingiber, and Capsicum. However, combination No.3 is characterized by Gentiana and Citrus to assist digestion, whilst combination· No.4 is characterized by Verbena and Mentha which can be combined to assist treatment of depression. Verbena is specific for depression associated with liver or gallbladder disorders, and for depression and exhaustion after fever.
1. Salvia and Leonurus combine to strengthen and normalize the Uterus. Rosmarinus. Zingtber, and Cinnamomum combine to warm and move the Qi of the Liver, Heart, and Uterus, and to treat depression. Astragalus, Angelica, and Glycyrrhiza combine to tonify the Qi and Blood.
5. Irritable bowel syndrome + cold sensations
Intestines Qi Disturbance + Cold
6. Headache + facial neuralgia
Liver Hyperactive Yang + Stagnant Qi and Blood in the channels
Combining Western Herbs and Chinese Medicine
644
Essential oil
Rosmarinus officinalis contains
essential oils, of which the main components are: Rosmarinus Lavandula Hamamelis Myrica Lobelia Glycyrrhiza Zingiber
1 1 1 1 0.5-1 0.5 0.5
Rosmarinus Lavandula Valeriana Piscidia Lobelia Glycyrrhiza Zingiber
1 1 1 1 0.5 0.5 0.5
5. Combination No. 5 can be compared to Lavandula: irritable bowel syndrome + cold sensations. In combination No.5, Rosmarinus, Lavandula, Myrica, and Zingiber combine to warm, move, relax, and calm Intestinal Qi. Rosmarinus combines with Lavandula and Lobelia to treat smooth muscle spasms and to treat the effect of nervous tension on intestinal function. Hamamelis and Myrica are astringents for diarrhea, and they can also normalize and heal inflamed or damaged mucous membranes. Zingiber combines with Glycyrrhiza to relieve intestinal spasms, and Glycyrrhiza is a soothing, demulcent anti-inflammatory for the mucous membranes. 6. Combination No. 6 has Rosmarinus, Lavandula, Glycyrrhiza, and Zingiber in common with combination 5. However, in combination No.- 5, Lobelia, Hamamelis, and Hydrastis regulate the Intestines, whilst in combination No. 6, Salvia, Valeriana, and Piscidia control Liver Hyperactive Yang to treat headache and also reduce nervous tension.
OTHER ROSMARINUS COMBINATIONS The following additional combinations further illustrate the range of uses of Rosmarinus:
• Angelica: depression + obesity • Capsicum: depression + bronchitis • Juniperus: mental dullness • Lavandula: anxiety + depression • Salvia: headache + anemia • Turnera: depression + sexual debility
Research
1.0-2.5%':;~~7~
• 1,8-cineole (20-50%) • a-pinene (15-25%) • camphor (10-25%) • a-terpineol (12-24%) • camphene (5-10%) • borneol (1-6%) • bornyl acetate (1-5%)
"""
Also present are limonene, ~-pinene, ~-caryophyllene, and myrcene.
Variability of composition The composition of the essential oil varies according to the place of origin and the stage of development. For example, the aromatherapist, Mailhebiau,lo listed three varieties of Rosmarinus officinalis with respect to biochemical specificity (b.s.) of the essential oil component. His datacan be summarized in the table: Variety
Specific uses
R. officinalis
heart tonic, antispasmodic
Southem France
mucolytic and expectorant for respiratory ailments, for example, asthma. bronchitis,
Morocco, Tunisia
b.s. camphor R. officinalis b.s. 1,8-cineole
sinusitis R. officinalis b.s. bornyl acetate, verbenone
hepatic. choleretic, cholagogue, antilipidemic
Corsica
The 'R. officinalis b.s. camphor' of Mailhebiau may be equivalent to the 'Spanish type' of Bruneton, II and Mialhebiau's 'R. officinalis b.s. 1,8-cineole' may be equivalent to Bruneton's 'Moroccan and Tunisian type.' Bruneton gives numbers to differentiate these two types of R. officinalis, which can be summarized in the table: R. OFFlCINALlS 'Spanish type'
R. OFACINALIS 'Moroccan type'
Monoterpenoid (%) a-pinene (monoterpene)
18--26%
9-14%
l,8-cineole (monoterpenic oxide~
16-25%
38-55%
camphor (ketone)
13-18.5%
5-15% -
CONSTITUENTS • essential oil • diterpenoids • triterpenoids • flavonoids • phenolic acids
!"""'\
9
I
Diterpenoids Rosmarinus contains phenolic diterpene bitters such as carnosol (picrosalvin), which may be up to 4.6%; carnos(ol)ic acid; rosmanol; isorosmanol; epirosman01; rosmaridiphen01; and rosmadial. 12 Triterpenoids
Rosmarinus contains triterpene acids, such
--
r
I
1-
r
L Rosmarinus as ursolic acid,l3 and triterpene alcohols, such as amyrin and betulin. 14
0.-
and ~
Flavonoids Rosmarinus contains flavonoids such as luteolin, genkwanin (7-0-methylapigenin), diosmetin, and the corresponding glycosides. \5 Phenolic adds Rosmarinus also contains the caffeic acid derivative rosmarinic acid (2-3%).16
Effect on estrogen metabolism Mice fed for 3 weeks with 2%
CLINICAL RESEARCH
Rosmarinus extract in their diet showed enhancement of liver microsomal oxidation and glucoronidation of estradiol and estrone. Also, administration of 2% Ro~marinus extract in the diet for 3 weeks resulted in a decrease in the uterotropic action of estradiol and estrone in ovariectomized mice;1
• antimicrobial • anti-inflammatory • antispasmodic • anticonvulsant • hepatic and hepatoprotective • cholagogic and choloretic • hyperglycemic • central nervous system stimulant • antioxidant • antitumor Antimicrobial Carnosic acid from Rosmarinus showed an inhibitory e~ect on HIV-l protease in cell-free assays.17 Rosmarinus ethanol extract inhibited herpes simplex virus type 2,18 and isoborneol was reported to be a potent inhibitor of the herpes simplex virus type 1. 19 Rosemary oil has shown antibacterial and antifungal activity against a . " 9 '0 2\ '2 '3 range 0 f organIsms un der a range 0 f test cond"lt1ons.'-' .-.-
-
....
Hepatic and hepatoprotective Inclusion of Rosmarinus extract in the diet of rats, at a level as low as 0.25%, enhanced activity of the liver enzymes GSH-transferase and NAD(P) H-quinone reductase. 37 Rosmarinus extract significantly reduced the hepatotoxicity of tert-butyll-hydroperoxide to rat hepatocytes,38.39 and an ethanol extract of Rosmarinus had hepatoprotective effect in rats, which the authors attributed to phenolic constituents with high antioxidant activity.40
PHARMACOLOGICAL AND
The following effects have been reported:
.!
645
Anti-inflammatory Rosmarinic acid has been shown to have anti-inflammatory effects, as evident by the inhibition of complement-dependent mechanisms. 24, 25. 26 Rosmarinus 27 tincture has demonstrated antiulcer activity in rats. Finally, a-pinene has shown anti-inflammatory effects, but needs the integrity of the adrenal glands to do this. ~8 Topical application of rosmarinic acid showed inhibition of gingivitis in rhesus monkeys.29 In addition, topical application of rosemary extract or its constituents carnosol or ursolic acid reduced chemically induced skin inflammation in mice. 30 Antispasmodic Rosmarinus oil has shown antispasmodic effects in both rats and guinea pigs. 31 .32.33. 34 Cineole and bornyl acetate have also shown antispasmodic effects in both these animals. 32 However, camphor increased the size of the twitch response in rat skeletal muscle. 35 Anticonvulsant Intraperitoneal administration of freshly prepared aqueous Rosmarinus extract (10%) delayed the onset of picrotoxin-induced convulsions in mice. 36
Cholagogic and choloretic Injection of Rosmarinus tincture significantly increased bile flow in rats, and the young shoot extract increased bile flow by 114%, as opposed to the whole plant extract, which produced a 47% incrementY Rosmarinus tincture resulted in a rapid increase in bile secretion in guinea pigs. 43 Hyperglycemic Rosmarinus oil was shown to have hyperglycemic and insulin release inhibitory effects in rabbits. 44 Central nervous system stimulant Inhalation of Rosmarinus oil was reported to produce a four-fold increase in locomotor activity in mice;s A clinical study on the basic emotions induced by inhalation of volatile substances reported camphor as being associated with 'happiness: 'surprise: or 'sadness: depending on the past history of the subject.46 The central nervous system stimulant effect of Rosmarinus may be due in part to camphor, which has been reported to have a stimulating effect on the central nervous system, a possible cardiotonic effect, and the ability to produce a sensation of warmth and restlessness;7 Antioxidant Rosmarinus extract showed free radical scavenging activity in rats.48 The flavonoid hesperedin extracted from Rosmarinus showed antioxidant activity.49 The diterpenoids carnosic acid, carnaso!, rosmanol, and epirosmano!, extracted from the leaves of Rosmarinus; showed inhibition of superoxide anion production in the xanthine/xanthine oxidase system. Also, carnosic acid protected red blood cells against oxidative hemolysis. so Antitumor Rosmarinus extract or its antioxidant constituents camosic acid or camosol were shown to decrease activation and increase detoxification of the human carcinogen benzo[alpyrene in human bronchial epithelial cells.sl Topical
Combining Western Herbs and Chinese Medicine
646
application of Rosmarinus extract or its constituents carnosol or ursolic acid were shown to inhibit skin tumorigenesis in mice. 28 Pretreatment of mice with Rosmarinus oil, followed by an injection of cyclophosphamide significantly reduced the induced mitodepression in the bone cells. 40 Rats fed a diet that included 1% of Rosmarinus extract for 21 weeks showed a reduction in the development of chemically induced mammary gland carcinoma. 52 Rosmarinus oil has been reported to show cytotoxic effects on leukemia cells.53 RESEARCH VERIFICATION OF TRADITIONAL ACTIONS From the research on Rosmarinus or its isolated constituents summarized above, there is support for the following traditional actions: central nervous system stimulant, antispasmodic, hepatic, choloretic and cholagogic, and antimicrobial. Additional effects demonstrated by research Antimicrobial, anti-inflammatory, anesthetic, hyperglycemic, antioxidant, and antitumor effects have been reported. TOXICOLOGY
I' I
Cautions These cautions apply to Rosmarinus infusion and tinc-"~.~~c~-. ture. The use of Rosmarinus oil is outside the scope o(thk~~-g.:
book.··~l:;:'",{~:· ..-... ~~~~:"~
Western contraindications Some patients have disorders for which Rosmarinus is appropriate, such as exhaustion and depression. However, at the same time, they have other disorders for which Rosmarinus is not appropriate, such as mental restlessness and insomnia. For patients with mild restlessness and insomnia, for whom the prescription of Rosmarinus is appropriate to treat exhaustion and depression, I recommend that the patients do not take a combination containing Rosmarinus after midday. I avold the use of Rosmarinus in cases of severe restlessness or insomnia with sensations of heat. Chinese contraindications None are given in the Chinese7:':~~~':: Herbal Medicine Dictionary, but I would not prescribe Rosmarinus in cases with patterns of Excess Heat or Disturbance of Heart Spirit with Heart Deficiency Heat Pregnancy and lactation No adverse reactions are known in humans, and possible anti-implantation effects may have been observed at high doses in rats; see the discussion in
.""
Toxicology.56
No acute toxicity was reported in either rats or mice given a single intraperitoneal dose of 2g/kg of an alcoholic extract of Rosmarinus,54 and rosemary is not a tumor initiator in mouse skin.55 The results of one study, in which rats received rosemary extract during different stages of pregnancy may suggest that rosemary extract may have an antiimplantation effect, without causing significant changes in postimplantation loss or in the number of abnormalities in the term fetuses. 56 However, the reported possible antiimplantation effect was achieved using doses equivalent to about 5 to 10 times the recommended therapeutic level for humans.
Side effects Rosmarinus may cause mild nocturnal rest':' lessness in patients with a tendency to'restless insomnia. ~~.y ,;:.
Overdose
....
~~ ~r·~
No adverse reports.
Interactions No adverse clinical reports. A decrease in the uterotropic action of estradiol and estrone has been reported in mice, but at doses equivalent to over 20 g of Rosmarinus per day for a human. (see Research).
Regulatory status Please read the Regulatory status section in the chapter
Dose Dried herbs The BHP listed 2-4 g of dried herb, three times per day. Tincture The BHP listed 2-4 ml of liquid extract 1:1 in 45% alcohol, three times per day. The dose for 1:5 tincture in 70% alcohol has been listed as 3-8.5 ml per day.12 Initial dose Duration
Can start at the standard dose. Can be used long-term.
on Safety. Rosmarinus (rosemary) is on the UK General Sale List, and it is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Rosmarinus is not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
Traditional sources The nature of the entry in the Chinese Herbal Medicine
!'F":.'.'
Rosmarinus
647
Dictionary suggests that R. officinalis is not much used in China. In addition. this herb seems to have been less used in America than in Europe.
,".1
Spleen and Stomach
PROPERTIES Temperature According to Dioscorides, rosemary is warming in nature. Lonicerus57 said that it is hot and dry to the third degree. Tabernaemontanus,a wrote that rosemary is warm and dry, and removes external and internal dampness. Both Gerard and Culpeper listed Rosmarinus as hot and dry in the second degree. Culpeper stated that the warming action of Rosmarinus helps all cold diseases of the head, stomach, liver, and belly. The Chinese Herbal Medicine Dictionary classifies mi die xiang (R. officinalis) as warm in temperature. I classify Rosmarinus, as it is used in the West, as warm. Taste
Taste in the mouth Tabernaemontanus said that rosemary has a bitter and pungent taste, and is astringent. According to the monograph on Rosmarinus in Wichtl,"9 its odor is spicy, harsh, and almost camphor-like, and its taste is spicy and harsh, bitter and aromatic, and somewhat pungent. I found that samples of fresh, dried, and 1:5 tincture in 45% alcohol all tasted aromatic, bitter and acrid.
Intestines
congestion of the spleen, cold stomach
Source."
..
Tabernaemontanus
poor appetite
Lonicerus
indigestion and retention of food
Culpeper
flatulence
Culpeper
The Chinese Herbal Medicine Dictionary does not list meridians entered by mi die xiang (R. officinalis). ACTIONS Evidence from the traditional sources for the following actions of Rosmarinus are discussed below: • tonic • nervine • circulatory stimulant • stimulant and antidepressant • tranquilizer • carminative and antispasmodic • hepatic and cholagogue • expectorant • diuretic • antimicrobial • topical for rheumatism
Taste properties The Wichtl monograph linked the carminative action of Rosmarinus to the essential oil component and the cholagogic action to the bitter substances. The Chinese Herbal }.tIedicine Dictionary classified R. officinalis as acrid in taste. This book classifies R. officinalis, as used in the West, as aromatic, bitter, and acrid (see discussion in Limitations section).
ORGANS In terms of Chinese medicine, Rosmarinus, as used in the West, can be associated mainly with disorders of the following organs: ,-
.. ---"'
Organ
Examples of use
Source
Heart
clears melancholy from the heart
Culpeper
strengthens the heart. restores loss of speech
Tabernaemontanus
opens obstructions of the liver. jaundice
CUlpeper
congestion of the liver, jaundice
Tabernaemontanus
Liver
Tonic Dioscorides said that Rosmarinus can help with fatigue, Lonicerus said that it strengthens the health, and the BHP listed it for general debility.
Hair tonic According to Grieve, Rosmarinus is used in hair lotions to stimulate the hair follicles and prevent premature baldness,.and a body temperature Rosmarinus infusion with borax is used to trea-rliandruff. I include the pair Rosmarinus and Salvia officinalis in combinations to treat hair loss in women on the basis that these aromatic and bitter herbs stimulate digestion. By tonifying the Spleen and Stomach Qi, the herbs secondarily assist in the tonification of Blood. Also, Rosmarinus and Salvia can combine to calm worry and thus increase the efficiency of the Spleen to make Blood. In terms of Chinese medicine, tonifying Blood can help to strengthen the hair. Nervine The Grete Herbal, translated from French into English in about 1525, suggested Rosmarinus for weakness of the brain. 60 In Hamlet, written about 1601, Shakespeare had Ophelia say "There's rosemary, that's for remembrance:' Culpeper listed Rosmarinus for cold diseases of the head and brain, with giddiness, lethargy, drowsiness, 'dullness of the
648
Combining Western Herbs and Chinese Medicine I ~1
mind and senses like a stupidness: and recommended it to quicken the senses and for weak memory and loss of speech. Tabernaemontanus listed Rosmarinus to strengthen the brain and to treat somnolence. In terms of Chinese medicine, many of these aspects can be linked to Deficiency of Heart Qi and Heart Spirit. Circulatory stimulant Both Culpeper and Tabernaemontanus recommended Rosmarinus for the heart, and the BHP listed Rosmarinus for cardiovascular ~eakness. The Commission E monograph6! stated that Rosmarinus has positively inotropic effects and increases coronary blood supply, but it does not list references. According to Mills,6! camphor, which is a major component of the Rosmarinus essential oil, can act as a circulatory stimulant, affecting both coronary and peripheral circulation. Weiss stated that the circulatory tonic action of Rosmarinus is due to its camphor content so that it can be used for chronic circulatory weaknesses, including hypotension. According to Mabey,63 Rosmarinus can improve the circulation and strengthen fragile blood vessels due to the flavonoid diosmetin. Stimulant and antidepressant Culpeper listed Rosmarinus for drowsiness and lethargy and to drive melancholy vapors from the heart. Tabernaemontanus recommended rosemary for somnolence, and the BHP listed the specific indication of Rosmarinus as depressive states with general debility and cardiovascular weakness. Mailhebiau recommended R. officinalis b.s. 1.8 cineole for depression in people who are 'psychologically inhibited' and listed R. officinalis b.s. bornyl acetate, verbenone for postnatal depression. Tranquilizer In terms of Chinese medicine, the calming effect of Rosmarinus can be said to have three main aspects: • calms Disturbance of Heart Spirit • calms Spleen worry • calms Liver Hyperactive Yang
Calms Disturbance of Heart Spirit The tradition of use for Rosmarinus is as a stimulant and antidepressant, rather than a sedative. In Chinese terms, Rosmarinus is not usually given in the West for Disturbance of Heart Spirit but more for Stagnation of Heart Qi. However, it is listed as a sedative by the BHP. Grieve listed rosemary wine as calming for palpitations due to a weak heart, and Kloss6-1 listed rosemary for insanity. Nevertheless, as Weiss pointed out, its stimulatory effect may prevent sleep if Rosmarinus preparations are taken too late in the evening. These apparently contradictory indications may result in part from the properties of camphor as discussed by
Ellingwood, for example. Camphor may calm or stimulate __~~==~= the mind, depending on the dose and the condition of the ~=~-;;
,
patient. Ellingwood mentioned it for treatment of restlessness, nervous excitement, hysteria, and febrile mania, and ~ .:.:,:c:=c also for depression associated with exhaustion, melancholy.,,~;._ and hypochondria. A study reported in 1999 on the emotions induced by inhalation of volatile substances reported camphor as being associated with 'happiness: 'surprise: or 'sadness: depending on the past history of the subject.46
=
Calms Spleen worry Although I have not seen Rosmarinus listed for worry in Western traditional sources, I consider Rosmarinus helpful for calming worry in nervous patients of the Spleen or Earth type. According to Chinese medical theory, excessive worry can impair Spleen function and thus reduce formation of Blood. This in turn can aggravate loss . •..... or greying of the hair. I therefore use Rosmarinus combined with Salvia officinalis for hair loss associated with worry and_; =,o;:::.£~ Deficient Blood. In my opinion Rosmarinus can be used for worry, obsessive thoughts, and too much thinking divorced from action, when these symptoms are associated with Spleen patterns of Cold and Deficiency. I do not use Rasmarinus when these disorders are linked to Heat and Excess.
Calms Liver Hyperactive Yang Rosmarinus is important in that it can calm Liver Hyperactive Yang to treat migraine and headache without having a deadening effect on metabolism or mood. Its ability to reduce the upward movement of Liver Hyperactive Yang is balanced by its capacity to warm and move Stagnant Liver and Heart Qi. According to Grieve. Rosmarinus is a good remedy for headache caused by feeble circulation, which might be seen in terms of Chinese medicine as headache associated with Deficient Qi and Blood. Carminative and antispasmodic Lonicerus recommended Rosmarinus for poor appetite, and Culpeper listed it for cold diseases of the stomach and intestines, with indigestion, retention of meat, and flatulence. Rosemary is used in European cooking for rich and fatty meat dishes, such as roast lamb. Wichtl noted its use in stimulating the appetite and gastric secretion, and for indigestion and flatulence. The BHP listed it for 'flatulent dyspepsia associated with psychogenic tension: Hepatic and cholagogue Both Culpeper and Tabernaemontanus recommended Rosmarinus for obstruction or congestion of the liver and for jaundice. The ESCOP monograph on Rosmarinus noted its use to improve hepatic and biliary function. 16 Expectorant Tabernaemontanus recommended Rosmarinus wine to open the trachea, alleviate wheezing, and help
-
Rosmarinus _ xpectoration. The essential oil fraction of Bruneton's 'Spanish type' of R. officinalis contains 16-25% cineole, but he 'Moroccan type' contains up to 55% of this expectorant -.:hemical. It is not surprising that Mailhebiau wrote that the oil of R. officinalis b.s. cineole is the specific remedy for res.. piratoryailments. - Diuretic Lonicerus said that Rosmarinus can promote uri-- nation, and the BHP listed it as a diuretic. According to Bruneton, one of the traditional uses of this herb in France is to enhance urinary function, and Mailhebiau stated that R. .. officinalis b.s. borny! acetate, verbenone can act as a diuretic _ in cases of urine retention. The possible diuretic action may be linked to the high a.-pinene content.
.
Antimicrobial The anonymous Bankes' Herbal, written about 1525, recommended a tooth powder made from burnt rosemary wood to keep the teeth free from all evils.64 Lonicerus listed rosemary powder to clean the teeth, the BHP listed Rosmarinus as an antimicrobial, and Rosmarinus products are used as preservatives and antioxidants in the food industry, for example, for meat and fat. Topical Culpeper said that rosemary ointment was good for cold numb joints, sinews, and limbs. Wichtl noted its traditional use externally in Germany for rheumatism in the muscles and joints, and the BHP listed it as a rubefacient and mild analgesic for the topical treatment of myalgia, sciatica, and intercostal neuralgia. The topical antirheumatic effect may be partly due to the camphor content.
649
References 1. Culpeper ~. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks, Glenwood, Illinois (1990)
2. Dioscorides P. Kreutterbuch (1610). Reprinted by Verlag Konrad Kolbl, Miinchen, Germany (1960) 3. Grieve M. A Modern Herbal, vols. 1 and 2. Dover Publications, New York, New York (1971) 4. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983) 5. Felter HW, lloyd JU. King's American Dispensatory, vols. 1 and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1983) 6. Ellingwood F. American Materia Medica, Therapeutics and Pharmacognosy, 11th edn. (1919). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1994) 7. Christopher JR. School of Natural Healing. BiWorld, Provo, Utah (1976) 8. Lyle TJ. Physio-Medical Therapeutics, Materia Medica and Pharmacy. Originally published Ohio (1897). Reprinted by the National Association of Medical Herbalists of Great Britain, London, United. Kingdom (1932) 9. Panizzi L, Flamini G, Cioni PL et al. J Ethnopharmacol 39:167-170 (1993) 10. Mailhebiau P. Portraits in Oils. The C.W. Daniel Company, Saffron Walden, United Kingdom (1995) 11. Bruneton J. Pharmacognosy: Phytochemistry Medicinal Plants, 2nd edn. Lavoisier, Paris, France (1999) 12. Stahl-Biskup E. Rosmarinus. In: Hansel R, Keller K, Rimpler H et al. (eds) Hagers Handbuch der Pharmazeutischen Praxis 5th ed. Springer-Verlag, Berlin-Heidelberg, Germany, pp 490-503 (1994) 13. BrieskornCH. DtschApoth Ztg 105:1524 (1965) 14. Brieskorn CH, Decken M, Degel U et al. Arch. Pharm 299: 663 (1966)
COMPARISON OF WESTERN AND CHINESE USE OF ROSMARINUS
•
. ---.
.....
---
Rosmarinus, with its high essential oil content and its balance between antidepressant and antispasmodic actions, is one of the most important herbs in the Western materia medica to treat physical conditions that are linked to depression and emotional stress. Rosmarinus has a very wide range of uses in the West. It can be used in combinations to treat heart disease, postoperative recovery, chronic fatigue syndrome, depression, postnatal disorders, digestive disorders, recovery from drugs or prolonged multimedication, and it is specific for headache and migraine. Rosmarinus is not given importance in Chinese herbal medicine, and most of the valuable uses of this herb are unknown. The entry in the Chinese Herbal Medicine Dictionary merely states that Rosmarinus is an aromatic herb that can strengthen the Stomach and stimulate digestion, calm the Spirit, and treat headache.
15. Brieskorn, Micbelk HI, Biechele W. Dtsch. Lebensm. Rundsch 69:245 (1973) 16. European Scientific Cooperative on Phytotherapy: Monographs on the Medicinal Uses of Plant Drugs (monograph on Rosmarini folium cum). European Scientific Cooperative on Phytotherapy, Exeter, United Kingdom (1997) 17. Paris A, Strukelj B, Renko Met al. I Nat Prod 56(8):1426-1430 (1993) 18. Romero E, Tateo F, Debiaggi M. Mitt Gebiete Lebensm Hyg 80: 113-119 (1989) 19. Armaka M, Papanikolaou E, Sivropoulou A et al. Antiviral Res 43(2):79-92 (1999) 20. Mangena T, Muyima NY. Lett Appl Microbiol28(4):291-296 (1999) 21. Hethelyi E, Koczka I, Tetenyi P. Herba Hungarica 28:99-115 (1989) 22. Montes M, Wilkomirsky T, Valenzuela L et al. An Real Acad Farm 57:425-438 (1991) 23. Benjilali B, Tantaoui-El-Araki A et al. Plantes Med Phytother 20:155167 (1986) 24. Rampart M, Beetens JR, Bult H et al. Biochem Pharmacol 35:13971400 (1986) 25. Farnham MJ, Kesselring K. Drugs of the Future 10:756-757 (1985) 26. Gracza L,Koch H,I.offlerE.Arch Pharm318:1090-1095 (1985)
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Combining Western Herbs and Chinese Medicine
650
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27. Dias PC. Foglio MA, Possenti A et al. I EthnopharmacoI69(1):57-62 (2000)
49. Okamura N. Haraguchi H. Hashimoto K et al. 1463-1466 (1994)
28. Martin S. Padilla E, Owe MA et al. Planta }'led 59(6):533-536 (1993)
50. Haraguchi H. Saito T. Okamura N et al. Planta Med 61(4):333-336 (1995)
29. Van Dyke TE. Braswell L. Offenbacher S. Agents Actions 19:376-377 (1986)
.'.
30. Huang MT, Ho cr. Wang ZY et al. Cancer Res 54(3):701-708 (1994)
51. Offord EA. Mace K. Ruffieux C et al. Carcinogenesis 16(9):2057-2062 (1995)
31. Aqel MB. I EthnopharmacoI33(1-2):57-62 (1991)
52. Singletary K. Faseb Journal 5.5.A927 (1991) [cited in European
32. HofS.Ammon HPT.Planta Med 55:106-107 (1989)
Scientific Cooperative on Phytotherapy: Monographs 00 the medicinal uses of plant drugs (monograph on Rosmarini folium). ~
33. Forster HB. Niklas H. Lutz S. Planta Med 40:309-319 (1980)
Scientific Cooperative on Phytotherapy. Exeter. United Kingdom
34. Aqel MB. Int I Pharmacog 30:281-288 (1992)
(1997)]
35. Lis-Balchin M.HartS.1 Ethnopharmacol58(3):183-187 (1997)
53. llarionova M. Todorov D. Burov P.Aoticancer Res 12:1915 (1992)
36. Abdul-Ghani As. El-Iati SG. Sacaan AI et al. Int I Crude Drugs Res 25:39-43 (1987)
54. Mongold
37. Singletary K. Gutierrez E. Faseb Journal 7.4.A866 (1993) [cited in
55. Ho CoT. Ferraro T. Chen Q et al.ln: Ho C-T.Osawa T. HuangM-T et al (eds). Food Phytochemicals for Cancer Prevention II.ACS Symposium
European Scientific Cooperative on Phytotherapy: Monographs on the medicinal uses of plant drugs (monograph on Rosmarini folium). European Scientific Cooperative on Phytotherapy. Exeter. United Kingdom (1997)] 38. Joyeux M. Rolland A. Fleurentin I. Planta Med 56: 171-173 (1990) 39. Joyeux M. Mortier F. Fleurentin J. Phytotherapy Res 9:228-230 (1995) 40. Fahim FA. EsmatAY. Fadel HM et al.lnt I Food Sci Nutr 50(6):413-427 (1999) 41. Zhu BT. Loder DP. Cai MX et al. Carcinogenesis 19(10):1821-1827 (1998) 42. Hoefler C. Fleureotin J. Mortier F. J Ethnopharmacol 19:133-143 (1987) 43. Mongold (1991)
JJ. Camillieri S. Susplugas S. Plantes Med Phytother 25:6-11
44. al-Hader AA, Hasan ZA. Aqel MB. J Ethnopharmacol 43(3):217-221 (1994) 45. Kovar KA. Gropper B. Friess D. Planta Med 53:315-318 (1987)
n. Camillieri S, Susplugas S. Planes Med Phytother 25:6-11
(1991)
Series 547. Washington DC: American Chemical Society. pp 2-19 (1994) 56. Lemonica IP. Damasceno DC. di-Stasi LC. Braz
J
Med Bioi Res
29(2):223-227 (1996) 57. Lonicerus A. Kreuterbuch (1697). Reprinted by Verlag Konrad Kolbl. Miinchen (1962) 58. Tabernaemontanus IT. Krauterbuch (1731). Reprinted by Verlag Konrad Kolbl. MOOchen (1993) 59. Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm, Stuttgart Germany (1994). from 2nd German edn Wichtl M (ed), (1989) 60. Rohde ES. The Old English Herbals. Dover. New York, New York (197l) 61. Blumenthal M (ed). The Complete German Commission E Monographs: Therapeutic Guide to herbal Medicines. American Botnical Council, Austin, Texas (1998)
46. Vernet-Maury E, Alaoui-Ismaili O. Dittmar A et al. J Auton Nerv Syst 75(2-3):176-183 (1999)
62. Mills S. The Essential Book of Herbal Medicine. Arkana/Penguin.
47. Bensky D. Gamble A. Chinese Herbal Medicine Materia Medica. Eastland Press. Seattle. Washington (1986)
63. Mabey R (ed). The Complete New Herbal. Elm Tree Books. London.
48. Concepcion Navarro M. Pilar Montilla M, Martin A et al. Planta Med 59(4):312-314 (1993)
64. Kloss I. Back to Eden. 5th edn. (1939). Reprinted by Lifeline Books.
London, United Kingdom (1991) United Kingdom (1988)
Santa Barbara. California (1975)
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Ruta Botanical name Ruta graveolens L. Family Rutaceae Pharmaceutical name Rutae herba Part dried aerial parts English rue German Raute French rue Mandarin chou cao (". Jf.) is the aerial part of R. graveolens Use in the West Ruta graveolens is an evergreen perennial shrub with characteristic blue-green leaves, a strong odor, and a bitter and acrid taste. It is native to Southern Europe l and is naturalized in the Eastern United States.2 Ruta is a member of the Rutaceae family, which also includes the Citrus species and Zanthoxylum (prickly ash). According to Grieve,; the generic name Ruta derives from the Greek reuo, to set free, and Ruta was used in ancient Greece since the time of Hippocrates (400 BC) for disorders such as nervous indigestion and as an antidote to poison. In the 1" century AD, the Roman army doctor Dioscorides~ listed Ruta for coughs, stomachaches, flatulence, worms, edema, amenorrhea, headache, and pains of the eyes or ears. This tradition of use has continued to the present day, and all the uses of Ruta that were described by Dioscorides were also listed by John Christopher in 1976.3
.
ingly, all these uses were also listed by John Christopher.) Ruta does not appear to have been a main herb in Chinese medicine. No meridians entered are given in the Chinese Herbal Medicine Dictionary, and this herb is not listed by Yeung7 or by Chang and But.S
What is special about Ruta In terms of Chinese medicine, Ruta graveolens can be said to be warm-cool in temperature, bitter .and aromatic in taste, and to have its primary effects on the Kidney, Liver, Heart, and Uterus. It has secondary effects on the Spleen, and Intestines.
The key to understanding Ruta is that it can act as a tonic to the nervous system and to the digestive system, and that it has a calming effect that can help in the treatment of • fear, nightmares. insomnia, and enuresis • nervous headache, muscle spasms. and convulsions • nervous indigestion. flatulence. and intestinal colic • menstrual disorders associated with nervous tension RUTA AND THE KIDNEY SYSTEM In this book. it is proposed that there is an association of Ruta with the Kidney system. specifically that Ruta can have the following actions:
Use in China The Chinese Herbal Medicine Dictionarl has an entry for chou cao, the aerial parts of Ruta graveolens L. This herb is listed for edema, amenorrhea, fever, joint pains, convulsions, skin disorders, and venomous bites. (Interest-
• to.nify Deficiency of Kidney Qi
651
Combining Western Herbs and Chinese Medicine
652
• move Stagnation of Kidney Qi • calm Kidney fear and thus reduce the effects of Kidney fear on other organ systems In my opinion, excessive Kidney fear can result in Deficiency or Stagnation of Kidney Qi. Kidney fear can also have an indirect affect on other organs. This topic is discussed under the following headings: • Kidney itself • Kidney and Bladder • Kidney and Heart • Kidney and Intestines • Kidney and Liver • Kidney and Uterus • Ruta and sexuality Kidney itself Fear of failure or fear of loss of control can result in exhaustion from overwork. Ruta can be used for exhaustion with this etiology, and 1 use it for some patients with chronic fatigue syndrome. Kidney and Bladder Fear can affect urination, and Ruta has a tradition of use for enuresis and dysuria. Kidney and Heart Excessive Kidney fear, whether expressed, suppressed, or even unconscious, can disturb Heart Spirit, and Ruta has been used for insomnia, nightmares, nervousness, palpitations, and hysteria. Kidney and Intestines Excessive fear can disturb the regularity and rhythm of the Intestines, and Ruta has been used in the West for over 2000 years for nervous indigestion and flatulence. Kidney and Liver
Liver Hyperactive Yang Kidney Qi is one of the factors that can stabilize Liver Yang. If Kidney Qi is Deficient, then Liver Hyperactive Yang and Liver Wind may increase. Deficient Kidney Qi may be associated with Kidney fear, and this may lead to further disturbance of Liver Yang and Wind. According to the Five Elements hypothesis, fear can be the mother of anger, just as Water can be the mother ofWood. Ruta can be used to treat conditions involving combinations of the following syndromes: • Kidney Deficient Qi • Kidney fear • Liver Hyperactive Yang • Liver Wind Such conditions can include nervous headache, nervous spasms, convulsions, and epilepsy. Ruta has a traditio·n of use in the West for all of these conditions.
Liver Stagnant Qi Kidney fear can stagnate the movement of Qi in the Kidney and Bladder channels, and aggravate and combine with Stagnation of Liver Qi. Ruta has a long tradition of use for obstructions of the liver, pains in the chest and sides, and sciatica.
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Kidney and Uterus
Stagnation of Kidney and Liver Qi In terms of Chinese medicine, the functioning of the female reproductive system can be said to be especially linked to the Kidney and Liver. If there is Stagnation of Kidney and Liver Qi, this may lead to obstruction of the flow of Qi and Blood in the Uterus system. This can result in dysmenorrhea, amenorrhea, and infertility.
Kidney fear and Liver Hyperactive Yang If there is disturbance of the Qi of the Uterus associated with Kidney fear and Liver Hyperactive Yang, this may result in disturbance of the menstrual cycle combined with psychological or neurological disorders. I use Ruta, often combined with Artemisia and Cimicifuga, for such combined conditions as premenstrual syndrome with nervous headache, or amenorrhea in teenagers with psychological disorders and/or petit mal epilepsy. 1 also use Ruta for infertility in patients with fearfulness and nervous tension, but not while the patients are attempting to conceive since there is a possibility that Ruta may have a postcoital anti-implantation effect or may increase the chance of abortion; see Research. Ruta and sexuality Ruta has a tradition of use in the West to disperse accumulation and stagnation of sexual energy in men and to increase libido and fertility in women by warming and stimulating the 'uterus'; see the discussion in Traditional sources. Also, fear is a most basic emotion, and sudden fright and shock, or the tension of chronic fear, can affect both sex and reproduction by causing Stagnation of Qi and Blood in the sexual system. This may not only result in infertility, amenorrhea, dysmenorrhea, and pain in the testes, but also in a lack of libido in men and women. CHINESE ACTIONS In terms of Chinese medicine, Ruta, as used in the West, can be said to have the following actions: I. II. III. IV.
calm Liver Yang calm Heart Spirit tonify and move Kidney Qi, calm Kidney fear regulate Spleen Qi, transform Phlegm and Damp
V. regulate the Uterus Chinese actions 1, II, III, and V have been discussed under Ruta and the Kidney system above.
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Ruta Regulate Spleen Qi. transform Phlegm and Damp Tabernaemontanus classified Ruta as a warming, drying, penetrating, dissolving herb that can clear damp, phlegm. and cold. It has a tradition of use in the West for weight gain, stomach aches due to cold, loss of appetite, digestive weakness, flatulence, and intestinal colic. In terms of Chinese medicine, this can be represented by the following actions: • warm and tonify the Spleen and Stomach • stimulate the Spleen to transform Damp and Phlegm • move and relax Intestinal Qi
WESTERN ACTIONS The Western actions of Ruta are shown here in terms of its five main Chinese actions: Chinese actions
Western actions
I. tonify Kidney Qi and calm Kidney fear
nervine tonic tranquilizer
II. calm Liver Yang and Kidney fear
tranquilizer anticonvulsant
III. calm Heart Spirit and Kidney fear
tranquilizer
IV. regulate Spleen Qi, transform Phlegm and Damp
bitter digestive tonic carminative
V. regulate the Uterus
emmenagogue tranquilizer
WESTERN USES The Western uses of Ruta can be related to its five Chinese actions:
653 DIRECTION OF ENERGY Ruta can help to control pathological upward movements of energy including Liver HyperaCtive Yang, Liver Wind, and Heart Spirit Disturbance.
TYPICAL CASE EXAMPLE Signs and symptoms The patient is tired and nervous. She has a tendency to nervous headache, especially before menstruation, and a tendency to delayed menstruation or amenorrhea. She has occasional nervous palpitations and frightening dreams. She tends to overwork and become exhausted, partly because she is afraid of losing control of her life if she reduces the pressure that she puts on herself and partly because her will is stronger than her reserves of energy. Her pulse is empty, thin and choppy, especially at the Kidney position, and wiry, especially at the Kidney, Liver and Heart positions. Her tongue is pale and thin with toothmarks. Diagnosis She has Liver Hyperactive Yang, associated with the headache; Disturbance of Heart Spirit, associated with the palpitations; and Kidney fear, associated with the frightening dreams and fear of loss of control. The nervous tension has been a constant drain on her energy, resulting in Deficiency of Qi (empty pulse and pale, flabby tongue) and Deficiency ot Blood (thin choppy pulse and pale, thin tongue). A combination of Stagnation and Deficiency of Qi, . associated with fear and nervous tension, have combined to produce Deficiency and Stagnation in the Uterus with amenorrhea and premenstrual problems. Choice of Ruta This herb is chosen bec~use in addition to calming the Kidney, Heart, and Liver, it can also stimulate and regulate the Uterus.
Limitations of Ruta TEMPERATURE Ruta is classified in this book as a warm-cool variabletemperature herb. It can be used as a cooling herb to treat warm conditions, such as fever or inflammation. However, it is mainly used as either one of the following:
".As noted before, Ruta is not used while the patient is attempting to conceive.
• a neutral tranquilizer and emmenagogue to treat nervous headache. palpitations, and premenstrual tension • a warming carminative and emmenagogue to treat loss of appetite and colic, or amenorrhea and infertility. associated with Cold, Damp, and Phlegm
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Combining Western Herbs and Chinese Medicine
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TASTE Ruta is classified in this book as bitter and aromatic in its taste property. In some situations, Ruta can show an acrid property in the sense of warming the Interior. Bitter Ruta can be used as a bitter digestive tonic, and its bitter constituents may contribute to its nervine tonic and tranquilizing actions. However, Ruta does not appear to have a primary action as a cooling, bitter anti-inflammatory. Aromatic Ruta has a tradition of use as an aromatic carminative, and its aromatic constituents may contribute to its tranquilizing and anticonvulsant actions. However, whilst Ruta had a past tradition of use as an antitussive and anticatarrhal, this aspect of the aromatic property is not in main current use. ACTIONS Antipyretic Although there is evidence of antipyretic action both from traditional sources and from modern research, I do not consider this to be a primary action for Ruta. However, especially when combined with Artemisia, it can be used for cases of chronic fatigue syndrome or fibromyalgia with recurring low-grade fever or recurring feverishness. This pair would be particularly appropriate for patients with chronic fatigue syndrome or fibromyalgia who have menstrual problems in addition to their fever. Carminative Ruta can be used for nervous indigestion and colic and has a tradition of Western use as a warming, drying herb that, in Chinese medicine terms, can assist the Spleen in transforming Phlegm and Damp. In my opinion, Ruta has a weaker carminative action than Acorus or Rosmarinus. However, for patients who require a herb that can clear Phlegm Disturbing the Mind, calm Disturbance of Heart Spirit, and calm Kidney fear, Ruta would be specifically suitable. However, these three actions would each need to be reinforced by combining Ruta with other herbs.
with other anticonvulsant herbs, such as Cimicifuga.
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Emmenagogue I do not consider Ruta t~ be a strong allpurpose emmenagogue. Rather, it is a herb that can be appropriate for treating specific patterns in gynecology. For example, it can be used for: • premenstrual syndrome with nervous tension associated with Liver Hyperactive Yang • amenorrhea or infertility associated with nervous tension from Liver irritability, Heart anxiety, or Kidney fear • amenorrhea or infertility associated with obstruction of the Uterus by Damp and Phlegm Ruta becomes an important herb for patients with Stagnant Qi and Blood in the Uterus associated with the stagnating effect of Kidney fear. This Stagnation could result in amenorrhea, infertility, dysmenorrhea, or irregular menstru- . ation.
Ruta paired with other herbs Discussion of the limitations of each of the main actions of Ruta can be useful to clarify just what it can and cannot do. However, suitable combination with other herbs can extend its range of use beyond its limitations. Ruta is an excellent example of a herb that needs the strength of other herbs to realize its important specific actions. The basic unit of herb combination is the herb pair. Twelve pairings of Ruta are briefly explained below. CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair. Ruta + Leonurus
Palpitations + fearfulness Tranquilizer and anticonvulsant Ruta is not a sedative or even a strong tranquilizer. Its calming effects are related to specific situations, such as palpitations or nightmares with both Kidney fear and Heart anxiety, nervous headache, premenstrual headache, and amenorrhea with nervous tension. Although Ruta is specifically suitable in these situations, I consider it only as a mild tranquilizer that needs to be used in combination with other calming herbs. Ruta has a long tradition of use in the West as an anticonvulsant for epilepsy and other convulsions. Whilst I have used Ruta, combined with Artemisia absinthium, for petit mal, I consider that it requires to be used in combination
Both herbs can be used for nervous palpitations and for nervous amenorrhea, but Leonurus is more cardioactive than Ruta. This pair can be used for nervous exhaustion associated with overwork linked to excessive Kidney will and Deficient Heart Qi, and for nervous exhaustion with fearful dreams and palpitations. Ruta + Anemone
Exhaustion from overwork Cold Anemone is a stronger sedative and analgesic than Ruta, but both. herbs are specific for feelings of pressurized
.
-,.
Ruta nervous tension and desperation linked to overwork from fear and overambition, associated with excessive Kidney will. Physical symptoms could include amenorrhea, dysmenorrhea, headache or nervous spasms, and tremors.
655 pausal syndromes with nervous tension from Liver Hyperactive Yang or Disturbance of Heart Spirit. Ruta + Lavandula
Insomnia + fearfulness Ruta + Hypericum
Enuresis Both herbs can regulate the Kidney and calm Kidney fear, and both herbs have a tradition of use for treating bedwetting. Hypericum extends the use of the pair to nervous anxiety with depression, and Ruta enables the pair to treat menstrual or menopausal neurosis.
This pair can calm the Heart to treat insomnia and calm the Liver to treat headache. However, this pair has less of an emmenagogue effect than the previous pair, Ruta and Salvia officinalis. Ruta combines with Lavandula to treat nervous indigestion with colic, especially in cold patterns, since both herbs are slightly warming. Ruta + Artemisia absinthium
Infertility + nervous tension
Ruta + Schisandra
Nightmares By firming Kidney Qi, Schisandra can stabilize the Kidney, and the combination of Schisandra and Ruta can limit the effects of Kidney fear on the Bladder and the Heart. This pair can be used for bedwetting, nightmares, insomnia, or palpitations due to Kidney fear. Ruta and Schisandra can reduce the loss of Kidney energy by regulating Kidney fear . and also Kidney will.
This is one of the great herb pairs. These herbs can be used for nervous headache associated with Liver Hyperactive Yang as well as cramps, convulsions, amenorrhea, infertility, or dysmenorrhea associated with nervous tension. Hildegard von Bingen used Ruta and wormwood for male sexual problems. Ruta is used more to regulate the Kidney, and Artemisia is used more to regulate the Liver. Artemisia absinthium is the bitterer herb with a stronger digestive tonic effect.
Ruta + Serenoa Ruta + Juniperus
Dribbling urination Serenoa is a sweet and sour Kidney and Spleen tonic that complements the bitter and aromatic properties of Ruta. Serenoa can tonify Kidney Qi, Yang, and Yin to reduce instability due to Kidney Deficiency resulting in Kidney fear. Both Ruta and Serenoa can have a regulating effect on the Kidney and Bladder, and both have a tradition of use for dribbling urination. Aromatic Ruta balances the potentially Damp-producing Serenoa.
Mental dullness Both herbs are warming and drying and can stimulate the Spleen to transform Damp and Phlegm. Also, both herbs can act as tonics for Kidney Qi. The combination of these effects can help to treat mental cloudiness and mental dullness associated with Phlegm-Damp in the head, and mental tiredness linked to Kidney Deficiency. Both herbs can also have carminative and antispasmodic actions, and can be used to treat flatulence and intestinal colic.
Ruta + Cimicifuga Ruta + Thuja
Amenorrhea + petit mal I
_"
This pair can treat congested conditions of the Uterus such as amenorrhea or dysmenorrhea, and spasms and convulsions associated with Liver Wind and Liver Hyperactive Yang. Cimicifuga can be used to treat spasms of the bronchial muscles, and Ruta has a tradition of use for respiratory problems.
Infertility + obesity Both herbs can act as stimulant anticatarrhal ernmenagogues for amenorrhea or infertility with obesity as a result of Stagnation of Qi, Damp, and Phlegm in the Uterus. Ruta and Thuja can also be combined to treat bronchitis since both herbs can act as acrid aromatic herbs to reduce Phlegm, and both herbs can be used to treat enuresis.
Ruta + Salvia officinalis Premenstr~al syndrome
.
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+ nervous tension
This pair has both calming and emmenagogue action. It is specific for headache with nervous tension, especially before menstruation. Salvia is specific for hot flashes and heavy sweating, and Ruta can be used for nervous palpitations. Therefore, the pair can be used for menstrual or meno-
Ruta + Thymus
Shingles + nervous tension These herbs can combine to treat enuresis, nightmares, nervous indigestion and colic, and menstrual irregularities. In addition, both herbs have a tradition of use to treat shingles.
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656
Ruta combinations Six. Ruta combinations are discussed below:
or cool patterns with the appropriate modifications. The fMi;:-::::~~ main taste properties are balanced in this combination to achieve its multiple aims. USE
Combination
Chinese syndromes
1. chronic fatigue syndrome + palpitations 2. exhaustion + fear
Kidney fear + Heart Spirit Disturbance Kidney Deficient Qi + Kidney fear
3. nightmares
Heart Spirit Disturbance + Kidney fear
4. headache + premenstrual syndrome + depression
Liver Hyperactive Yang + Liver Stagnant Qi
5. amenorrhea + nervous tension
Uterus Stagnant Qi and Blood + Heart Spirit Disturbance
6. infertility + obesity
Uterus Stagnant Qi and Blood + Damp and Phlegm
CAUTION
Before using any of the combinations below, it is important to be familiar with the cautions listed for each herb in the combination. Please see the discussion in this chapter in the Research and Toxicity sections on postcoital antifertility and abortifacient effects.
:\
• chronic fatigue syndrome or fibromyalgia with nervous palpitations, maybe nervous he.adache, menstrual irregularities, or menopausal disorders PRACTICAL NOTES
This combination is conveniendy taken as 5 ml of 1:5 tincture in quarter of a glass of water, three times per day. It is for chronic conditions and can be taken for 1 month or more with the appropriate cautions, breaks, and modifications. It can be taken as a decoction or iI?-fusion, but Ruta, Achillea, and Salvia are not usually simmered since their essential oils would be lost. Anemone, Crataegus, Glycyr.rhiza, Leonurus, and fresh Zingiber can be decocted for 15 minutes, the heat turned off, and the other three herbs added and allowed to steep for 15 minutes in a covered vessel. Providing appropriate cautions are taken with the herbs in this combination, it can be taken for a long period with appropriate breaks and modifications. 2. Exhaustion + fear
Kidney Deficient Qi + Kidney fear :-'.".).' .
1. Chronic fatigue syndrome + palpitations
Herb
Kidney fear + Heart Spirit Disturbance
Ruta Anemone Hypericum Serenoa Schisandra Ophiopogon Glycyrrhiza Zingiber
Herb Ruta Anemone Salvia off. Achillea leonurus Crataegus Glycyrrhiza Zingiber
Ratio
Temperature
Taste
1 1 1 1 1 1
warm-cool cold warm-cool
bitter, aromatic bitter aromatic, acrid acrid, bitter sl. bitter, sour sweet, sour sweet acrid, aromatic
0.5 0.5
warm-cool neutral sl. warm neutral-cool hot
GENERAL
This combination is used to: • calm Kidney fear and tonify Kidney Qi • tonify and stabilize Heart Qi to calm Disturbance of the Heart Spirit It has the secondary functions of calming Liver Hyperactive Yang and moving Stagnation of Qi and Blood in both the muscles at the surface to treat muscle aches and the Uterus to normalize menstruation. The overall temperature is more or less neutral, and it can be used for warm, neutral,
1 1 1 1
warm-cool cold neutral neutral
1 1 0.5 0.5
warm cool neutral-cool hot
Tast~::~.'~~·zff bitter, aromatic-' .
,...
bitter sour, sl. sweet . sweet, sl. sour sour sweet, sl. bitter sweet acrid, aromatic
GENERAL
This combination is used to tonify and firm Kidney Qi, and to calm the Disturbance of Heart Spirit and Kidney fear. The overall temperature is more or less neutral, and the sour taste is used to firm Kidney Qi, thereby stabilizing the Kidney and Heart and reducing Kidney fear. USE
• burnout from overwork from ambition or fear ofloss of control, and nervous tension due to fear, maybe urinary frequency or lower back weakness PRACTICAL NOTES
This combination is conveniently taken as 5 rnl of 1:5
--
Ruta
657
tincture in quarter of a glass of water. three times per day. It is
5. Amenorrhea + nervous tension
for chronic conditions and can be taken for 1 month or more with the appropriate cautions. breaks. and modifications.
Uterus Stagnant Qi and Blood + Heart Spirit Disturbance Herb
3. Nightmares
Heart Spirit Disturbance + Kidney fear Herb Ruta Anemone Valeriana Lavandula Thymus Schisandra Glycyrrhiza
Ratio
Temperature
Taste
1 1 1 1 1 1
warm-cool cold cool sl. warm warm-cool warm neutral-cool
bitter, aromatic bitter bitter. sweet aromatic, bitter, 51. acrid aromatic sour sweet
0.5
GENERAL
USE
• nightmares in children or adults PRACTICAL NOTES
This combination is conveniently taken as 5 ml of 1:5 tincture in quarter of a glass of water, three times per day. It is for chronic conditions and can be taken for 1 month or more with the appropriate cautions, breaks. and modifications. 4. Headache + premenstrual syndrome + depression
Liver Hyperactive Yang + Liver Stagnant Qi
Salvia off. Rosmarinus Lavandula Artemisia abs. Ruta Zingiber Mentha pip. Glycyrrhiza
Ratio
Temperature
Taste
1 1 1 1 1 1
warm-cool warm 51. warm warm-cool warm-cool hot warm-cool neutral-cool
aromatic. acrid aromatic. bitter. acrid aromatic, bitter, 51. acrid bitter, aromatic bitter, aromatic acrid, aromatic aromatic, acrid sweet
0.5 0.5
GENERAL
This combination is the same as Salvia: headache + premenstrual syndrome + depression and is discussed under that heading.
Temperature
1 1
warm-cool warm-cool warm-cool neutral warm hot neutral-cool
1 1 1
0.5 0.5
,Taste bitter, aromatic bitter, aromatic aromatic, acrid sour, sl. bitter aromatic acrid, aromatic sweet
GENERAL
This combination is the same as Artemisia: amenorrhea
+ nervous tension and is discussed under ,that heading. 6. Infertility + obesity
This combination is for Disturbance of Heart Spirit, especially when this is due to Kidney fear arising from Deficient Kidney Qi or Kidney Qi not being Firm. The combination is a more or less neutral combination in which aromatic. bitter, sour. and sweet constituents combine to calm and stabilize the Heart and Kidney.
Herb
Artemisia abs. Ruta Salvia off. Leonurus Mentha pul. Zingiber Glycyrrhiza
Ratio
Uterus Stagnant Qi and Blood + Damp and Phlegm Herb Ruta
Ratio
1
Artemisia abs. 1 Hydrastis 1 Thuja 1 Phytolacca 1 Zanthoxylum (berries) 1 Zingiber 0.5 Capsicum 5-20 drops
Temperature Taste warm-cool warm-cool cool warm-cool cool hot hot hot
bitter. aromatic bitter, aromatic bitter acrid, aromatic, bitter acrid acrid. aromatic, bitter acrid. aromatic acrid
GENERAL
This combination is for Stagnation of Qi and Blood in the Uterus accompanied by Damp and Phlegm. It is a warm combination for cool or cold conditions. The cool herb Hydrastis has been included to balance the warm herbs since many people with Deficient Cold Spleen patterns also have some Stomach Heat. The dominant taste properties are aromatic and acrid to assist the Spleen in transforming Damp and Phlegm. and to move Damp and Phlegm obstructions in the channels and vessels. USE
• amenorrhea or infertility with obesity. maybe sinus and bronchial phlegm PRACTICAL NOTES
The herbs other than Capsicum are conveniently taken as 5 ml of a 1:5 tincture in quarter of a glass of warm water, three times per day. Drops of 1:5 Capsicum tincture can be added from a separate bottle. The combination is for chronic conditions and can be taken for 1 month or more with the appropriate cautions. breaks. and modifications.
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Combining Western Herbs and Chinese Medicine
658
Caution The combination contains warming, drying, anti-..~;;~""i
catarrhal herbs, some of which have a diuretic effect. Therefore, unless it is modified, it is not appropriate for patterns of Heat or Deficient Yin. Patients can be monitored for dry mouth or uncomfortable heat sensations, and the combination can be stopped, reduced in dose, or modified if these occur. In addition, the combination of Artemisia, Hydrastis,
.':-'--~~
Ruta Anemone Valeriana Lavandula Thymus SChisandra Glycyrrhiza
1 1 1 1 1 1 0.5
Ruta, and Thuja should not be taken if there is a likelihood of conception.
RUTA COMBINATIONS
1. Chronic fatigue syndromes + palpitations
2. Exhaustion + fear
Kidney fear + Heart Spirit Disturbance
Kidney Deficient Qi + Kidneyfear ,',
1 1 1 1 1 1 0.5 0.5
Herb
Ratio
Ruta Anemone Hypericum Serenoa Schisandra Ophiopogon Glycyrrhiza
1 1 1 1 1 1 0.5 0.5
Zingiber
1 1 1 1 1 1 0.5 0.5
3. As in combinations No. 1 and No.2, Ruta and Anemone are paired for Disturbance of Heart Spirit with Kidney fear in combination No.3. Ruta and Thymus are paired for nightmares. Valeriana and Lavandula are specific fo'r insomnia and can calm the Heart, and as in combination No.2, Schisandra and Glycyrrhiza are included to firm and stabilize the Qi of both Heart and Kidney.
COMPARISON OF THE SIX
Ruta Anemone Salvia off. Achillea Leonurus Crataegus Glycyrrhiza Zingiber
Salvia off. Rosmarinus Lavandula Artemisia abs. Ruta Zingiber Mentha pip. Glycyrrhiza
1. Ruta and Anemone combine to calm Heart anxiety
and Kidney fear. Leonurus and Crataegus can act as a pair to tonify and stabilize the Heart to treat palpitations and exhaustion. Achillea, Salvia, and Zingiber combine to regulate the surface and treat muscle aches and recurring lowgrade fever. 2. Ruta and Anemone are included in both combinations No.1 and No.2 to calm Kidney fear and a feeling of desperation associated with seif-imposed unrealistic goals and a fear of failure or loss of control. In combination No.2, the sour herbs Hypericum, Serenoa, and Schisandra are included to firm Kidney Qi. These three herbs are assisted by Glycyrrhiza and Ophiopogon, which possess the sweet property, allowing them to tonify Kidney Qi and Yin. 3. Nightmares
4. Headache + premenstrual syndrome + depression
Heart Spirit Disturbance + Kidney fear
Liver Hyperactive Yang + Liver Stagnant Qi
4. Ruta and Artemisia are a specific pair that can be used for premenstrual headache with nervous tension. Salvia and Lavandula are paired for nervous tension headache associated with Liver Stagnant Qi and Liver Hyperactive Yang. The aromatic and acrid components in Salvia and Zingiber may help to diffuse some of the nervous and muscular tension by directing the Qi outward to the body surface. Artemisia, Ruta, and Salvia can harmonize menstrual irregularities. 5. Amenorrhea + nervous tension
6. Infertility + obesity
Uterus Stagnant Qi and Blood + Heart Spirit Disturbance
Qi and Blood +
Herb Artemisia abs. Ruta Salvia off. Leonurus Mentha pul. Zingiber Glycyrrhiza
Uterus Stagnant Damp and Phlegm
Ratio
Herb
1 1 1 1 1 0.5 0.5
Ruta Artemisia abs. Hydrastis Thuja Phytolacca Zanthoxylum (berries) Zingiber 5-20 Capsicum
1 1 1 1 1 1 0.5 drops
5. Like combination No.4, combination No.5 contains Artemisia, Ruta, and Salvia to regulate the Uterus. However, instead of Lavandula and Rosmarinus for headache, it contains Leonurus and Mentha pulegium to move Stagnant Qi and Blood in the Uterus. Leonurus and Mentha pulegium also combine with Artemisia, Ruta, and Salvia to calm nervous tension, whether linked to Liver Hyperactive Yang or to Disturbance of Heart Spirit. Ruta and Mentha pulegium can also treat amenorrhea and infertility associated with Stagnation of Qi due to Kidney fear.
,
Ruta
L
,. ,
6. Hydrastis and Phytolacca are cooling anticatarrhals, and Ruta, Thuja, and Zanthoxylum have a tradition of use as warming, drying herbs that, in Chinese medicine terms, help the Spleen to transform Phlegm and Damp. Also, Artemisia, Ruta, and Thuja all have a tradition of Western use as diuretics. Thuja, Zanthoxylum, and Zingiber are circulatory stimulants that can combine to clear Damp and Phlegm from the channels. Artemisia, Hydrastis, Ruta, and Thuja can have a stimulant effect on the Uterus to treat amenorrhea or infertility.
OTHER RUTA COMBINATIONS Other combinations that contain Ruta include the following:
• Achillea: amenorrhea + exhaustion • Anemone: dysmenorrhea + fear • Cimicifuga: amenorrhea + convulsions • Cimicifuga: menopausal disorders + exhaustion • Leonurus: menstrual disorders + anxiety
Research
659 • psoralen • bergapten (5-methoxypsoralen =5-MOP) • xanthotoxin (8-methoxypsoralen =8-MOP)1l The coumarins chalepensin and umbelliferone were isolated from R. chalepensis. 12 Alkaloids Ruta contains various alkaloids, including arborinine and fagarine. 9 Eleven alkaloids have been isolated from R. chalepensis, including graveoline and graveolinine,l! and six quinoline or quinolone type alkaloids were isolated from R. montana. 13 Flavonoids According to the BHP, Ruta contains rutin and quercetin. A recent study reported that an ethanolic extract of dried aerial parts of R. graveolens contained the following glycosides: 14 • 3'-sinapoyl-6-feruloylsucrose • methylcnidioside • methylpicraquassioside • 3',6-disinapoylsucrose • cnidioside A • rutin • picraquassioside A.
CONSTITUENTS Ruta graveolens herb contains the following constituents:
The greater acridity in the mouth of fresh Ruta compared to dried Ruta preparations suggests that important chemicai changes may occur on drying. It would be most helpful if future research on the constituents or pharmacology of this plant were to differentiate between fresh and dried material, and also investigate the differences between them.
...
Essential oil Ruta contains about 0.1 % essential oil, I of which, according to Mabey,9 up to 90% is methylnonyl ketone, with smaller quantities of limonene and cineole. However, these texts did not specify whether their descriptions referred to fresh or dried material. Tisserand and Balacs lO reported that oil from the fresh herb of R. graveolens contained: • 2-undecanone (methylnonyl ketone) 31-49% • 2-nonanone 18-25% Coumarins coumarins:
CLINICAL RESEARCH The following effects have been reported for Western species of Ruta:
• essential oil • coumarins • alkaloids • flavonoids
....
PHARMACOLOGICAL AND
Ruta contains the following linear furano-
• antimicrobial • anti-inflammatory • antipyretic • analgesic • antispasmodic • antihypertensive • tranquilizer • antifertility • antitumor • dermatological agent Antimicrobial An aqueous extract of R. chalepensis showed antifungal activity against Microsporum canis (a common cause of ringworm in cats and dogs, which is often transmitted to children).15 Anti-inflammatory An ethanol extract of R. chalepensis was reported to have anti-inflammatory activity in rats, as shown by inhibition of carrageenan-induced paw edema. 16 Bergapten was reported to have anti-inflammatory activity at 10 mglkg.17
660
Combining Western Herbs and Chinese Medicine
Antipyretic R. chalepensis showed antipyretic activity in mice by the reduction of yeast-induced hyperthermia.16 Analgesic An ethanolic extract of R. graveolens was reported to have analgesic effect in studies with mice, as demonstrated by both the acetic acid-induced and hot plate-induced thermal stimulation tests. 18 Bergapten was reported to have analgesic activity at 10 mglkg. 17 Antispasmodic R. graveolens was reported to relax preconstricted rat tail artery strips.19 Antihypertensive R. graveolens was reported to have a hypotensive effect in normotensive rats. 19
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TOXICOLOGY An important distinction made between the use of:
A careful distinction must be
• fresh or dried material • therapeutic doses of Ruta as an infusion, decoction, or tincture • Ruta essential oil • isolated components of Ruta It is not always clear from the literature whether fresh or dried material has been used, or whether reference is being made to infusions, decoctions, or tinctures as opposed to the
essential oil. Tranquilizer Studies on spontaneous motor activity in mice and conditioned avoidance responding in rats, using ethanolic extracts of the aerial parts of R. chalepensis, showed a dose-dependent depression of the central nervous system. 16 Antifertility Anti-implantation effects were reported for R. graveolens with inhibition of pregnancy in 50-60% of rats. 20 Chloroform extracts of R. graveolens showed significant antifertility activity in rats when administered intragastrically on days 1-10 postcoitum. Fractionation of the extracts led to the isolation of chalepensin as the active component. 21 R. graveolens showed postcoital antifertility activity in rats, but not in hamsters. 22 Antitumor R. graveolens showed significant cytotoxic effect, using cells ofYoshida ascites sarcoma. 23 . Dermatological agent According to Bruneton, the photosensitizing properties of 5-MOP and 8-MOP can be applied in the PUVA (psoralen plus UV) management of psoriasis and vitiligo. The patient takes the furanocoumarin orally and is then exposed to UV radiation. According to one report, patients treated with 8-MOP healed faster than those with 5_MOP.24 However, nausea or vomiting, pruritis, and erythema were the most common short-term risks, especiallywith 8_MOP. 25 RESEARCH VERIFICATION OF TRADITIONAL ACTIONS
Isolated constituents
2-Undecanone Also known as methylnonyl ketone, this chemical has been classified as nontoxic, nonirritant, nonsensitizing, and nonphototoxic,26
Furanocoumarins
The three main furanocoumarins in Ruta oil are psoralen, bergapten, and xanthotoxin. These have been described as phototoxic27 and potentially photocarcinogenic. 28 It would appear from the statements of Tisserand and Balacs and of the IFRA (International Fragrance Association), given below, that the level of furanocoumarins in Ruta oil does not contraindicate its use by humans. Essential oil Tisserand and Balacs concluded that there seems no reason to restrict the oral use of Ruta oil, except that it should be used with caution during pregnancy and in patients with epilepsy or fever. Precautions should also be taken to avoid phototoxicity. It should be noted that statements made by Tisserand and Balacs relate to oil from the fresh herb. 10
Phototoxicity The IFRA recommended that, if Ruta oil is to be applied to areas of the skin exposed to sunshine, the oil be limited to a maximum of 0.78% in the final cosmetic product except for soaps and other products that are washed off the skin. 29 Tisserand and Balacs recommended that, if Ruta oil is applied to the skin at over its maximum use level, the skin should not be exposed to sunlight or sunbed rays for 12 hours.
Skin irritant effects Although there are anecdotal reports of
From the research summarized above on Ruta species or their isolated constituents, there is evidence for the following traditional actions: antipyretic, antispasmodic, tranquilizer, and sexual regulator (antifertility).
Ruta oil being an irritant to both the skin and mucous membrane,30 the tests of Tisserand and Balacs found it to be a
Additional effects demonstrated by research These include: antimicrobial, anti-inflammatory, analgesic, antihypertensive, antitumor, and dermatological agent.
facient effects of Ruta oil, but the dosage levels used were very high, equivalent to ingestion by a 60 kg human of about 180 ml (about 3 ml/kg),31 and between 720 ml and 3 liters of Ruta
nonirritant to mucous membrane.
Abortifacient effects Animal studies have reported aborti-
r Ruta - oil. 32 According to Tisserand and Balacs. there are anecdotal reports that Ruta oil can cause abortion in humans. and the authors recommended that Ruta oil should be used with - caution during pregnancy until further data becomes available.
;-:"".
Toxicity The acute oral LD so of Ruta oil has been reported as 2.5-5 g1kg. 26 This is the equivalent of 150-300 g of rue oil for a 60 kg human.
661 Tmcture The BHP listed 0.5-1 ml of 1:1 liquid extract in 25% alcohol, three times per day. I do not generally prescribe Ruta as a single herb, but (in 1:5 tincture in 25% alcohol) in combination with four to six other herbs. This would be equivalent to about 0.5-1 ml of Ruta tincture, three times per day. Initial dose Can start at the standard dose, providing there is no history of phototoxic reaction to the psoralens.
"'- Infusions, decoctions, and tinctures Felter and Lloyd33 r- wrote in 1898 that the symptoms of overdose of Ruta graveolens can include vomiting, stomach pain and headache, sensation of fullness in the head, hot flashes, and a frequent desire to pass urine that smells strongly of Ruta. According to the Commission E monograph,34 severe liver and kidney damage has been reported for Ruta, as well as deaths of pregnant women who have used Ruta to produce abortions. However, the Commission E monograph failed to specify the dose at which these adverse reactions occurred, whether these adverse reactions involved essential oil of rue or infusion of Ruta, or whether the extracts derived from fresh or dried material. No research references were given.
Duration Can be used long-term, within the therapeutic dose and with appropriate breaks in treatment, providing there are no side effects.
Perinatal toxicology There has been a report of adverse
Chinese contraindications The Chinese Herbal Medicine Dictionary contraindicates the use of R. graveolens (chou dio) during pregnancy.
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perinatal changes in mice 3s using infusions of the dried leaves of R. cha,\apensis 1. However, the relevance of these findings to humans is debatable since the daily doses of R. chalapensis administered to the mice ranged from 0.16 to 1.6 glkg, which would be the equivalent of from 9.6 g to 96 g per day for a 60 kg human. This is between about 3 to 30 times the maximum therapeutic daily dose of R. graveolens recommended by the BHP.
Phototoxic reactions Up to 1999, only a few phototoxic reactions to R. graveolens (garden rue) have been reported from handling this plant.36• 37 The IFRA recommended that, for application to areas of skin exposed to sunshine, products should contain less than 0.78% of Ruta oil. This implies that the internal use of therapeutic doses of Ruta by infusions, decoctions, or tinctures would seem unlikely to have phototoxic risk. However, a small number of individuals may conceivably be hypersensitive even to therapeutic levels of dried Ruta.
Dose Dried herbs The BHP listed 0.5-1 g of dried herb, by infusion, three times per day.
Infusion or decoction
According to Christopher, Ruta should never be boiled, or the medically active essential oil will be lost.
Cautions These cautions apply to the infusion and tincture. No contraindications are listed for the liquid extract by the BHP. The use of the oil is outside~e scope of this book. Western contraindications I would not generally use Ruta for patients with a history of phototoxic reactions to the psoralens.
Pregnancy and lactation Ruta is contraindicated by some authors during pregnancy or lactation.s.9 Side effects The most common side effect may be nausea. According to the German Commission E monograph, tiredness, melancholy, sleep disorders, dizziness, and spasms can occur at therapeutic doses. Also, this text stated that the juice of the fresh leaves may result in swelling of the tongue, gastrointestinal irritation, clammy skin, low pulse, sleepiness, or abortion. However, no references were given. Overdose Vomiting, stomach pain, and headache have been reported. See also Toxicology, above. Interactions None have been reported. SCREENING Before prescribing Ruta, it should be determined whether the patient: • has ever had adverse reactions to Ruta • has ever had adverse phototoxic reactions to a furanocoumarin such as psoralen, for example following a PUVA treatment (psoralen application followed by exposure to UV radiation) for a dermatological disorder such as psoriasis
Combining Western Herbs and Chinese Medicine
662
• is pregnant or is likely to conceive during the time the Ruta combination is being taken
izer or emmenagogue and also as a cooling anti-inflammatory or antipyretic.
--
...
_-'-".~.
Taste
TREATMENT PRECAUTIONS The following precautions can be taken during treatment: • using Ruta within the recommended dose range • giving regular breaks during the herbal treatments • alternating the use of Ruta in a combination with another herb • never using Ruta as a single herb but always combining it with herbs likely to moderate any possible adverse effects, such as Glycyrrhiza and Zingiber
MONITORING During the course of a herbal treatment that includes Ruta, the patient should be monitored for potential side effects of this herb. The most common side effects may include nausea and gastrointestinal discomfort, and the rarer side effects are listed in the Cautions section. If the side effects persist, the use of this herb should be discontinued.
Regulatory status
Taste in the mouth The BHP described the taste in the mouth as pungent. I found that a 1:5 tincture in 25% alcohol had a slightly sweet and slightly acrid fragrance, and tasted bitter, sour, slightly acrid, slightly aromatic, and slightly sweet. A sample of the dried herb had no smell, but tasted bitter, sour, slightly aromatic, slightly acrid, and slightly sweet, with a slightly mucilaginous sensation. A sample of the fresh leaves, picked in August in Seattle, had a strong and characteristic aromatic scent. It was strongly acrid with a slightly burning sensation on the tongue, bitter, and slightly aromatic. After I had completed this tasting, which required that I take well over the therapeutic dose for Ruta, I experienced mild nausea. It would seem from this tasting, that the chemical composition of a Ruta sample may change greatly with drying or vary with the type of extraction process. For example, the strong acridity in the fresh leaves seems to be much reduced in the dried leaves or tincture. Taste property Tierra classified the taste property as bitter and acrid. Ruta is classified in this book as bitter and secondarily aromatic. However, it may, under certain circumstances, have an acrid property to warm the Interior, and the sour taste suggests an astringent property.
Please read the Regulatory status section in the chapter on Safety. Ruta (rue) is on the UK General Sale List, and is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Ruta is not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
Traditional sources PROPERTIES Temperature According to Dioscorides,4 Ruta is warming. Hildegard von Bingen38 said that it grows more from the strong full liveliness of the earth than from heat, having a temperate heat, which means that Ruta is a little more hot than cold. Lonicerus,39 Gerard,40 and Tabernaemontanus41
ORGANS In terms of Chinese medicine, R. graveolens, as used in the West, is associated mainly with disorders of the following organs: Organ
Examples of use
Source'
Kidney, Bladder
penetrates damp and promotes urination
Lonicerus
bedwetting
Tabemaemontanus
Liver
headache congestion of the liver
Dioscorides Tabernaemontanus
Heart
heart pains palpitations
Tabernaemontanus Mabey'
Spleen, Stomach, Intestines
vomiting and unable to digest food
Tabernaemontanus
nervous indigestion and colic
all described it as hot and dry in the third degree. However, it is not always clear whether these authors are referring to fresh or dried material. Tierra 4z classified Ruta as warm. In this book, Ruta is classified as warm-cool since it can act as a neutral tranquil-
. Mabey
Lung
coughs, pneumonia antitussive
Dioscorides BHP
Uterus
induces menstruation atonic amenorrhea
Dioscorides BHP
Ruta
I
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ACTIONS
Antidiarrheal Dioscorides said that Ruta can reduce bowel
Evidence from the traditional sources for the following actions of Ruta are discussed below:
movements, and Tabernaemontanus listed Ruta for diarrhea. intestinal pain from phlegm, and urgency of bowel movements as a result of damp phlegm or cold.
• antipyretic • carminative • tranquilizer and anticonvulsant • emmenagogue • sexual regulator • expectorant • diuretic • agent for eye disorders • vermifuge • antidote Antipyretic Dioscorides listed Ruta for the shivering occurring at the beginning of fever and said that it can 'bring out smallpox.' Tabernaemontanus wrote that it could be used for fever and chills, chronic low-grade fever, German measles, and malaria. He said that it should be taken before the fever has started. It is interesting that modern research has reported antipyretic effects for R. chalepensis in mice (see Research). Carminative
Anticatarrhal Gerard said that Ruta cuts and digests gross and tough humors. Tabernaemontanus described Ruta as a warm, drying, penetrating, and dissolving herb that can clear damp, phlegm, and cold. Lonicerus wrote that eating wild rue can help a person lose weight, and Culpeper43 said that Ruta could help to 'extenuate fat corpulent bodies.'
Gastrointestinal anti-inflammatory Lonicerus said that Ruta simmered in vinegar is good for belching and acid regurgitation, and that chewing and eating green Ruta leaves could help to get rid of the bad smell of garlic and onions. It is possible that this indicates that there are not only warming chemicals in Ruta, but also chemicals with a cooling or antiinflammatory effect.
Antispasmodic and carminative Dioscorides listed Ruta simmered with dill for stomach aches and suggested Ruta for gas or bloating of the bowel. Culpeper recommended it for pains in the stomach, spleen, or belly. Tabernaemontanus said that Ruta could be used to:
.
663
• treat stomach aches due to cold with no desire to eat • strengthen a stomach that has been weakened by heavy vomiting • treat children who have been vomiting and are unable to digest food • treat congestion of the spleen The Commission E monograph documented the use of Ruta for loss of appetite and for dyspepsia.
Tranquilizer and anticonvulsant As discussed in the section What is special about Ruta, this herb may have its calming, strengthening, and clearing effects on the mind through a combination of one or more of the following actions: • tonifies Kidney Qi • calms Kidney fear • calms Heart Spirit • calms Liver Yang • stimulates Spleen to transform Damp and Phlegm These actions are summarized under the headings of Heart and Kidney, Liver and Kidney, and Spleen below, and evidence from traditional Western use is arranged under those headings.
Heart· and Kidney Tabernaemontanus suggested Ruta for aches and pains of the heart. In 1751, John Hill wrote that it is good in all nervous diseases, especially in hysteric cases. 44 Christopher recommended Ruta for nervous nightmares, and Mabey listed it for heart palpitations. The Commission E monograph noted traditional German use of Ruta for circulatory disorders, arteriosclerosis, palpitations, nervousness, and hysteria.
Liver and Kidney Dioscorides listed Ruta for headache, and Tabernaemoritanus said that it could be used for headache due to cold, could open congestion of the liver, and could treat liver pains and liver disorders. Christopher recommended Ruta for nervous headache and for dizziness. Mabey listed it for nervous headache and headache due to eyestrain, and the Commission E monograph noted its traditional German use for headache, neuralgia, and toothache. In 1625, $e Neapolitan doctor Piperno recommended Ruta as a specific herb for vertigo and epilepsy,3 and Tabernaemontanus also listed it for the treatment of epilepsy. In 1781, William Cullen noted the use of Ruta for hysteric complaints and epilepsy,45 and Felter and lloyd wrote that it can be used for some nervous complaints, hysteria, and epilepsy. Kloss listed Ruta for nervousness, hysteria, spasms, and convulsions, and especially for colic and convulsions in children. Christopher said that it can be excellent in all hysterical and spasmodic affections, and can be used for nervousness, hysterical spasms, convulsions, epilepsy, and insanity. Dioscorides recommended placing Ruta simmered in honey between the vagina and the anus of women who have fainted 'due to an ascending uterus.' This is analogous to the use of Ren 1 (hul yin) in acupuncture to restore consciousness.
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664
Combining Western Herbs and Chinese Medicine -,:~_.·~~~~s-·
~
Spleen Lonicerus said that Ruta penetrates dampness. and Tabernaemontanus wrote that it can be used for diseases of cold, damp. and phlegm. In Chinese medicine terms. Ruta can be said to stimulate the Spleen to transform Damp and Phlegm. This can help to clear Phlegm from the Heart and mind. Kloss-lO listed Ruta for confused mind. dizziness. and insanity. Emmenagogue Dioscorides said that Ruta induces menstruation, and Lonicerus recommended it for pain and cramping of the uterus. Tabernaemontanus wrote that Ruta increases menstruation, expels the afterbirth and a stillbirth. cleans the uterus in postnatal women. and relieves postlabor contractions. Kloss said that Ruta is a uterine stimulant and tonic that relieves congestion of the uterus. and is excellent in suppressed menstruation. His instructions were to pour a pint .. of boiling water over a tablespoon of Ruta, steep it for 30 minutes. strain it. and drink a cupful of the warm infusion every 2 hours. Christopher recommended it as an emmenagogue for uterine atony and for the treatment of amenorrhea. delayed menstruation. dysmenorrhea, and menorrhagia. The Commission E monograph documented its traditional German use as a uterine stimulant for menstrual disorders, and the BHP listed Ruta for atonic amenorrhea. Sexual regulator
Tradition of opposite effects in men and women Dioscorides said that Ruta dries up the natural semen. According to Hildegard von Bingen, Ruta can clear the harmful mucus resulting from retention of sperm in men (see the chapter on Artemisia). Lonicerus recommended Ruta to get rid of evil passions and to reduce desire, and Culpeper wrote that it 'abates venery (sexual desire): Tabernaemontanus said that Ruta can be used for spermatorrhea, and that it subdues and dries out the natural semen because of its warming and drying action. Also, it reduces abnormally high libido so that it 'is a wholesome and healthy remedy for clergymen and those who have vowed to keep chastity: However, he said that for women it has the opposite effect and can increase the libido by drying out cold dampness from the uterus. 'so that nuns should avoid rue: Treatment of both cold and hot conditions Gerard wrote that Ruta can treat 'inflammation and swelling of the stones (testicles) proceeding from long abstinence from venery: This statement, like that of Hildegard von Bingen. emphasized the old Western idea that sexual abstinence in men can result in accumulation of damp. phlegm. or heat. Gerard's statement indicated that Ruta was not only used to treat cold and damp conditions, but it could also be used for conditions of heat (inflammation). This use is mentioned by
__ ..!..d.'L_~::·
-,"d.
Dioscorides. who recommended application of rue and laUrel" ::." __ :-::~ to the genitals to treat heat-type genital swelling. Expectorant Both Dioscorides and Tabernaemontanus listed Ruta for shortness or heaviness of breath. coughs. pneumonia. and chest pain. Tabernaemontanus said that Ruta opens the Lungs if they are congested with cold and viscous phlegm and that it can be used for wheezing or for those who expectorate pus. Culpeper also recommended Ruta for inflammations of the lungs. Diuretic Dioscorides said that Ruta increases urination and helps with the dropsy. Lonicerus said that wild rue could be used for severe damp, because it penetrates damp and increases urination. Tabernaemontanus included Ruta in combinations for bedwetting, dribbling urination. bladder pain and kidney stones. Culpeper wrote that Ruta could be used for pains in the kidneys or bladder due to the stoppage of urine. Agent for eye disorders Dioscorides said that salted and marinated rue helps to clear the eyes. and that a poultice of rue and barley soothes eye pain. Tabernaemontanus wrote that Ruta could treat dimness of the eyes and eye diseases due to dampness or cold. Gerard recommended the application of rue. honey. and fennel juice for dim eyes. Culpeper also listed this mixture but added the gall of a cock. Mabey recommended Ruta for eyestrain. and the Commission E monograph noted its traditional German use for weakness of the eyes. Vermifuge Dioscorides and Lonicerus recommended Ruta for worms. Studies on the traditional uses of herbs in central Italy reported that R. graveolens is one of the most commonly used antihelminthics. 47 Antidote Ruta was used by the ancient Greeks as an antidote for poisons. and Dioscorides listed it for poisoning and snake bites. Tabernaemontanus recommended Ruta as an antidote for poisonous herbs and included it in combinations for poisonous bites and stings. Gerard suggested the juice of Ruta for toadstool poisoning.
COMPARISON OF WESTERN AND CHINESE USE OF RUTA R. graveolens appears to have a wider tradition of use in the West than in China. The following traditional Western uses for Ruta are also listed in the Chinese Herbal Medicine
Dictionary: fever. edema, pains in the joints, infantile convulsions. amenorrhea, bruises from trauma, skin eruptions, and antidote to poisons
-
$'.'
Ruta
665
r However, the following traditional Western uses for Ruta are not listed in the Chinese Herbal Medicine Dictionary:
L
• coughs, chronic bronchitis • loss of appetite, nervous indigestion, flatulence, intestinal colic • nervousness, palpitations, nightmares, hysteria, hysterical spasms, nervous headache, dizziness • earache, eye inflammations, weakness of vision • dysmenorrhea
22, Gandhi M, Lal R, Sankaranarayanan A et al. J Ethnopharmacol 34( 1): 49-59 (1991) 23, Trovato A, Monforte MT. Rossitto A et al. Boll Chim Farm 135(4):263266 (1996) 24. Berg M, Ros ANI. Photodermatol Photoimmunol Photomed 10(5): 217-220 (1994) 25. McNeely W, Goa KI.. Drugs 56(4):667-690 (1998) 26, Opdyke DLJ. Food and Cosmetics Toxicology 13 (1975) [cited in Tisserand R, Balacs T. Essential Oil Safety: A guide for Health Care Professionals, Churchill Livingstone, Edinburgh, United Kingdom (1995)] 27. Zaynoun ST et al. Contact Dermatitis 3:225-239 (1997)
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1,;'
References L British Herbal Pharmacopoeia. British Herbal Medicine Association.
West Yorks, United Kingdom (1983) 2, Crellin JK, Philpott J. A Reference Guide to Medicinal Plants, Duke University Press, Durham, North Carolina (1990) 3. Grieve M. A Modem Herbal. vols. 1 and 2. Dover Publications, New York, New York (1971) 4. Dioscorides P, Kreutterbuch (1610). Reprinted by Verlag Konrad Kelbl. Miinchen, Germany (1960) 5. Christopher JR. School of Natural Healing. BiWorld, Provo, Utah (1976) 6. Jiangsu New Medicine lnstitute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science and Technology Press, Shanghai, China (1975) , -'
7. Yeung H-C. Handbook of Chinese Herbs and Formulas. vol. L lnstitute of Chinese Medicine, Los Angeles, California (1985) 8, Chang H-M, But PP-H (eds). Pharmacology and Applications of Chinese Materia Medica. vols, 1 and 2. World Scientific Publishing, Singapore (1986) 9, Mabey R (ed). The Complete New Herbal. Elm Tree Books, London, United Kingdom (1988) 10. Ttsserand R, Balacs T. Essential Oil Safety: A Guide for Health Care Professionals. Churchill Livingstone, Edinburgh, United Kingdom (1995) 11. Bruneton J. Pharmacognosy: Phytochemistry Medicinal Plants, 2nd edn. Lavoisier, Paris. France (1999) 12. El Sayed K, AI-Said MS, El-Feraly FS et al. J Nat Prod 63(7):995-997 (2000) 13. Touati D,Atta-ur-Rahman. U1ubelen A. Phytochemistry 53(2):277-279 (2000) 14. Chen CC, HuangYL, Huang FI et al, J Nat Prod 64(7):990-992 (2001) 15. Ali-Shtayeh MS,Abu Ghdeib SI. Mycoses 42(11-12):665-672 (1999) 16. al-Said MS, Tariq M, al-Yahya MA et al. J EthnopharmacoI28(3):305312 (1990) 17. Chen YF. Tsai HY, Wu TS. PlantaMed 61(1):2-8 (1995) 18. AttaAH.AlkofahiA.J EthnopharmacoI60(2):117-124 (1998) 19. Chiu KW,FungAY.Gen PharmacoI29(5):859-862 (1997)
28. Young AR et al. J Photochemistry Photobiology 7:231-250 (1990) 29, International Fragrance Association. Code of Practice. Latest Amendments, June 1992. International Fragrance Association, Geneva. Switzerland (1992) 30. Arctander S. Perfume and Flavor Materials of Natural Origin. Elizabeth, New Jersey (1960) [cited in Tisserand R, Balacs T. Essential Oil Safety: A guide for Health Care Professionals. Churchill Livingstone, Edinburgh. United Kingdom (1995)] 31. Anon. Federal Register 39(185):34215 (1974) [cited in Tisserand R, Balacs T. Essential Oil Safety: A guide for Health Care Professionals, Churchill Livingstone, Edinburgh, United Kingdom (1995)] 32. Patior A et al. CR Soc Bioi 127:1324-1325 (1938) 33. Felter HW. Lloyd Jv. King's American Dispensatory, vols. 1 and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1983) 34. Blumenthal M (ed). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council, Austin, Te.us (1998) 35. Zeichen de Sa R, Rey A, Arganaraz E et al. J EthnopharmacoI69(2):9398 (2000) 36. Heskel NS. Amon RB, Storrs FJ et al. Contact Dermatitis 9(4):278-280 (1983) 37. Schempp CM. Schopf E, Simon JC. Hautartz 50(6):432-4 (1999) 38. Von Bingen H. Hildegard von Bingen's Physica. Healing Arts, Rochester, Vermont (1998) 39. Lonicerus A. Kreuterbuch (1679). Reprinted by Verlag Konrad Kelbl, Miinchen, Germany (1962) 40. Gerard J. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publications, New York, New York (1975) 41. Tabernaemontanus n. Krauterbuch (1731). Reprinted by Verlag Konrad Kelbl. Miinchen, Germany (1993) 42. Tierra M. Planetary Herbology. Lotus Press, Twin Lakes, WISconsin (1988) 43. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks. Glenwood, Illinois (1990) 44. Hill I. A History of the Materia Medica. Longman, London. United Kingdom (1751) 45. Cullen W. Lectures on the Materia Medica. Whitestone, Dublin, Ireland (1781)
20. Prakash AO, Saxena V, Shukla S.Acta Eur Fertil16(6):441-448 (1985)
46. Kloss J. Back to Eden, 5th edn (1939). Reprinted by Lifeline Books, Santa Barbara, California (1975)
21. KongYC, LauCP, Wat KH etal. Planta Med 55(2):176-178 (1989)
47. Guarrera PM.J Ethnopharmacol68(1-3):183-192 (1999)
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Salvia Botanical name Salvia officinalis L. Family Lamiaceae (Labiatae) Pharmaceutical name Salviae officinalis folium Part dried leaves English sage German Salbei French sauge officinale Mandarin: Salvia officinalis L. is not used; dan shen (ft~) is the root of S. miltiorrhiza Bge.
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Use in the West Salvia officinalis is an aromatic shrub native to the Mediterranean region, especially the Adriatic, and is now cultivated in many countries. I According to Grieve/ the generic name Salvia is derived from the Latin salvere to save, reflecting this plant's eady reputation as a panacea. Dioscorides 3 wrote that sage could cause the hair to become black again, increase urination, induce menstruation, increase fertility, treat genital itching, stop bleeding from wounds, cleanse foul ulcers, and help against the poisonous bites of snakes. Culpeper4 endorsed these uses and also listed sage for hoarse voice, cough, abdominal pain, rheumatism, headache, cramps, and palsy. In addition, he emphasized the neurological and psychological effects of sage, and used it to warm and quicken the senses, help the memory, and treat lethargy and those who are dull and heavy'of spirit. John Christopher,s whether he knew it or not, continued the tradition of Dioscorides' uses for sage that had been passed down to Culpeper and recommended sage for fever, night sweats, tonsillitis. ulcers of the mouth and throat, excessive
salivation, indigestion, flatulence, nervousness, and hysteria. I use Salvia officinalis for a very wide range of conditions and can understand why, according to Grieve, the Chinese at one time so valued sage that they exchanged it with the Dutch for three times its weight of the choicest China tea.
Subspecies of S. officinalis In the past, S. officinalis was divided into three subspecies: • S. officinalis subsp. minor (Gmelin) Gams • S. officinalis subsp. major (Garsault) Gams • S. officinalis subsp.lavandulifolia (Vahl) Gams In Germany, subspecies minor and major are recognized as official, but subspecies lavandulifolia is not. I These three subspecies are now regarded as separate species:6 • S. officinalis subsp. minor (Gmelin) Gams = S.officinale s.s. • S. officinalis subsp. major (Garsault) Gams = S. tomentosa Miller • S.officinalis subsp.lavandulifolia (Vahl) Gams = S.lavandulifolia vahl
Other species used Various species of Salvia have been used in herbal therapy in Europe, including S. sclarea (clary sage) and S. triloba (Greek sage). Also, S.libanotica (East Mediterranean sage) is used in the Middle East to treat disorders such as colds and abdominal pain. 7 Various species of Salvia are used in different parts of the United States. For example, the root of S.lyrata L. (lyre-leaved sage) has been used by the Native Americans as a salve for
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sores and as an infusion of the whole plant for colds and nervous debility.8 Confusion can arise in the warmer parts of the United States, where Artemisia species are often referred to as 'sage: for example, Artemisia ludoviciana Nutt. (Western mugwort) is sometimes called white sage.8 The name white sage can also refer to Salvia apiana.9 Use in China The species used as dan shen in Chinese medicine is usually S. miltiorrhiza Bge., but other species may be used, such as S. przewalskii Maxim or S. trijuga Diels. IO The root is used, rather than the leaves. Two of the main uses of dan shen are to treat chest, epigastric, or abdominal pain due to Stagnant Blood, and to treat restlessness, palpitations, and insomnia associated with Deficient Yin of the Heart and Kidney. I I
What is special about Salvia In terms of Chinese medicine, Salvia officinalis can be said to be warm-cool in temperature and aromatic and acrid in taste property. It has its primary effects on the body surface, Lung, Heart, Liver, and Uterus. It can also have secondary effects on the Spleen, Intestines, and Kidney.
The key to understanding Salvia is that it can: • be a variable-temperature herb that can treat hot or cold patterns • regulate sweating and reduce muscle spasms at the body surface • calm restless nervous tension • treat headache ofvarious etiologies • treat gynecological and obstetric disorders CHINESE ACTIONS In terms of Chinese medicine, Salvia officinalis leaves, as used in the West, can be said to have five main groups of actions: I. clear Wind Heat and clear Heat Toxin II. clear Wind Cold, regulate the surface, and tonify Defensive Qi III. clear Heart Deficiency Heat, tonify Heart and Kidney Yin, and calm Heart Spirit IV. calm Liver Hyperactive Yang, move Liver Qi, and tonify the Blood V. regulate the Uterus Clear Wmd Heat Salvia clears Wind Heat and Heat Toxin in the specific case of inflammations and infections of the throat to treat tonsillitis, laryngitis, and hoarseness of voice.
Clear WlDd Cold Salvia can help to clear Stagnation of ~",=",_=-=~, in the surface channels when this is associated with one o?:' ,;;;;;:;>
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more of the following patterns: • Wind Cold • Liver Stagnant Qi • Deficient Defensive Qi • Deficient Blood Salvia can thus help to treat muscle aches associated with exposure to cold, nervous tension with muscle tension, systemic weakness, and low resistance to infection. Clear Heart Deficiency Heat Neither S. officinalis nor S. miltiorrhiza (dan shen) are primarily Yin tonics. However. they can act as secondaryYm tonics of the Heart and Kidney, which is closely related to their abilities to clear Heart Deficiency Heat and tonify the Blood. Calm Liver Hyperactive Yang, move. Liver Qi, and tonify
the Blood Salvia can be used to treat headache of various etiologies, involving one or more of the following syndromes: • Liver Hyperactive Yang • Liver Stagnant Qi • Wind Cold • Deficient Blood Salvia can be used to treat headache and muscle aches '::":--0'. associated with nervouS tension involving both Liver H~:::¥;~; active Yang and Liver Stagnant Qi. However, for headache " . ' C . . ,-
and muscle aches associated with depression and Liver Stagnant Qi, the more stimulant and antiq.epressant herb Rosmarinus would be substituted for Salvia.
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Regulate the Uterus The actions of S. officinalis that involve the Uterus can be utilized as follows:
• amenorrhea and • irregular menstruation • premenstrual headaches
tonify the Blood, move Liver Qi, regulate the Uterus calm Liver Hyperactive Yang,
• postnatal disorders
regulate the Uterus tonify the Blood, move the Blood, regulate bleeding,
• menopausal disorders
regulate the Uterus clear Heart Heat, regulate sweating, calm the Spirit, regulate the Uterus
WESTERN ACTIONS The main Western actions of Salvia are shown here in terms of its five main groups of Chinese actions:
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Salvia Chinese actions· I. clear Wind Heat and clear Heat TOlC.in
diaphoretic antimicrcbial alterative
II. clear Wind Cold, regulate the surface, and tonity Defensive Qi
diaphoretic
III. clear Heart Deficiency Heat, tonity Heart and Kidney Yin, and calm Heart Spirit
tranquilizer nervine tonic antihyperhidrotic
IV. calm Liver Hyperactive Yang, move Liver Qi, and tonity the Blood
tranquilizer antispasmodic
V. regulate the Uterus
emmenagogue tranquilizer
WESTERN USES The Western uses of Salvia can be related to its five main groups of Chinese actions: Chinese actions
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Western uses
I. clear Wind Heat and clear Heat TOlC.in
acute tonsillitis, laryngitis, hoarse voice
II. clear Wind Cold, regulate the surface, and tonity Defensive Qi
influenza or exposure to cold wind followed by headache and muscle aches, fibromyalgia
III. clear Heart Deficiency Heat, tonity Heart and Kidney Yin, and calm Heart Spirit
afternoon sweats in chronic fatigue syndrome, night sweats, menopausal hot flashes. restlessness and nervous tension
IV. calm Liver Hyperactive Yang, move Liver Qi, and tonity the Blood
V. regulate the Uterus
headache and muscle spasms from cold or nervous tension. headache with anemia amenorrhea, irregular menstruation. premenstrual headache, postnatal disorders. menopausal disorders
Myalgia In my opinion, Salvia is specific for patients with recurring muscle aches or pains who have a combination of the following Chinese syndromes and complaints. Firstly, they have both Deficient Defensive Qi and Deficient Blood so that they tend to have anemia and· debility, and are easily chilled by exposure to cold and winds, resulting in recurring myalgia. Secondly, they tend to have both Liver Hyperactive Yang and Liver Stagnant Qi so that they have recurring headache, muscle aches, irritability, and depression. Thirdly, a combination of Liver Hyperactive Yang and Liver Stagnant
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Qi may result in headache, depression, and irritability premenstrually, whilst Deficient Blood may result in exhaustion, depression, and headache postmenstrually. Sweating Salvia can regulate sweating, and it can increase sweating during a fever to clear Wind Heat and cool the body. Alternatively, it can reduce afternoon sweating, night sweats, or sweating with menopausal flashes, associated with: • Heart Deficiency Heat • Deficient Heart and Kidney Y'm • Deficient Blood • Deficient Defensive Qi DIRECTION OF ENERGY The aromatic and acrid constituents of Salvia can be said to have.a warming and moving effect, spreading the Qi in an outward direction. Exterior rather than Interior effect Salvia seems to have its main spreading effect on Qi at the surface of the body to relieve muscle aches from Stagnation of Qi associated with Cold invasion or Liver Stagnation. This is in contrast to Rosmarinus and Lavandula, which have their main spreading effect in the Interior, for example, to treat depression associated with Stagnation of Qi of the Liver or Heart. However, Salvia can both increase and reduce the movement through the body surface, according to the situation. This is in contrast to fresh Zingiber, for example, which tends to increase outward movement through the surface. Control of upward movement Salvia, Rosmarinus, and Lavandula are three members of the family Labiatae that can be used to control the upward movement of Liver Yang or Heart Spirit to treat headache and nervous tension. Combination of spreading with stimulant or tranquilizer action Salvia can act as either a mild tranquilizer or a mild central nervous stimulant, depending on the situation. TYPICAL CASE EXAMPLE Signs and symptoms The patient has recurring hyperhidrosis during the day when she is exhausted and stressed, and at night she experiences restlessness, anxiety, and insomnia. She has recurring headache and muscle aches in the neck and shoulders, especially when she is tired and stressed and exposed to cold wind. She has irregular and painful menstruation made worse by cold. Her pulse is thin and choppy, especially in the Heart position, and slightly rapid. Her tongue is pale and thin with a red tip.
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Diagnosis She has Deficient Blood, Heart Deficient Y"m, and Heart Deficiency Heat producing the restlessness, insomnia, and hyperhidrosis. She has Deficient Defensive Qi, Liver Hyperactive Yang, and Wind Cold invasion producing the headache. Choice of Salvia Salvia can tonify Defensive Qi and Blood to prevent entry of Wind Cold, and it can tonify Heart Y"m and clear Heart Deficiency Heat to treat the hyperhidrosis, restlessness, and insomnia. Salvia can also clear Wind Cold invasion and calm Liver Hyperactive Yang to treat headache and muscle aches in the neck and shoulders, and warm and move Qi and Blood in the Uterus to treat irregular menstruation and dysmenorrhea.
Limitations ofSalvia
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ACTIONS Tonic Salvia can act as a tonic in that it can astringe the surface and regulate or restrict the loss of defensive Qi. However, it does not have the sweet tonic effect on the Nutritive Qi possessed by sweet herbs such as Cinnamomum twig, fresh Zingiber, or Ziziphus. Similarly, Salvia can act as a nervine tonic by mildly tonifying Heart Blood and Yin, and by reducing the Disturbance of Heart Spirit that prevents replenishment of Blood and Y'm. It does not directly supply nutrients to nourish Qi, Y'm, and Blood like the sweet nutritive nervine tonics Avena or Angelica sinensis. However, S. officinalis is specific for excessive sweating from a combination of Deficient Defensive Qi, Deficient Blood, and Deficient Heart Yin, as seen in menopause or many cases of chronic fatigue. It is also specific for fibromyalgia syndromes with recurring aches in the muscles due to a combination of Deficient Defensive Qi, Deficient Blood,
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and Liver Stagnant Qi. TEMPERATURE Salvia can be regarded as a variable-temperature herb that can have warming or cooling effects.
Warming effects: • clear Wind Cold invasion • clear Cold in the Stomach or Intestines
Cooling effects: • clear Wind Heat and Heat toxin with acute tonsillitis • clear Heart Deficiency with chronic h~t flashes and night sweats Which temperature effect is evoked will depend on the patient's needs and the herbs with which it is combined. However, Salvia has only a mild warming effect so that it must be combined with hot herbs, such as Zingiber, to treat cold conditions. Also, it is specific for headache due to Liver Hyperactive Yang with Wind Cold. For Hyperactive Yang with Wind Heat or Liver Heat, colder herbs, such as Tanacetum, would be required. TASTE The primary taste properties of Salvia are aromatic and acrid, associated with monoterpenoids, such as thujone, camphor, and cineole. Salvia is acrid more in terms of warming the surface of the body, and it is not so strong in warming the Interior. Salvia seems to have less of a bitter digestive tonic and regulator effect than Rosmarinus, although both plants have diterpenoid bitters, such as carnoso!.
Tranquilizer and antidepressant
Tonifies and calms Heart Spirit Salvia is specific for calming restlessness, mild anxiety, mild insomnia, night sweats, and hot flashes coming from a combination of Heart Deficient Blood, Heart and Kidney Deficient Yin, and Heart Deficiency Heat. It is not a strong sedative herb for severe anxiety or insomnia. Whilst Salvia can help to normalize emotions and treat mild anxiety-depression, it is not as strong a stimulant or antidepressant as Panax ginseng, Rosmarinus, or Turnera.
Calms Liver Hyperactive Yang Salvia is best for Liver Hyperactive Yang headache when these occur with Wind Cold invasion, Liver Stagnant Qi, or Deficient Blood. Headache with signs of Heat are better treated with other herbs, such as Piscidia or Chrysanthemum. Salvia is specific for headache. It is not the herb of choice for treating other Liver Hyperactive Yang symptoms such as dizziness or irritability. Antimicrobial and antipyretic Although Kloss and Christopher listed Salvia for fever in general, its specific target area is the throat. It is specific for clearing Heat Toxin in acute tonsillitis or Deficiency Heat in subacute laryngitis. Emmenagogue Salvia is an important herb for premenstrual headache and for menopausal hot flashes and sweating. In my opinion, it is of secondary importance for other gynecological problems. Astringent and antihemorrhagic Salvia has been listed by some texts as an astringent, for example by Christopher, the
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Salvia ~- BHP, and Tierra. However, Tabernaemontanus described
this herb as slightly astringent, and it has not had a tradition of use as a primary astringent or antihemorrhagic (see discussion in Traditional sources).
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and anxiety. Mentha is the stronger tranquilizer, and Salvia helps to relax the muscle tension. This pair can also be used for menstrual irregularities. Salvia + Ruta
Premenstrual syndrome + headache
Salvia paired with other herbs Discussion of the limitations of each of the main actions of Salvia can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Salvia beyond its limitations. The basic unit of herb combination is the herb pair. Twelve pairings of Salvia are briefly explained below.
These herbs can combine to treat nervous tension headache during the premenstrual period. Both herbs can help to regulate the female reproductive system, and both can control Liver Hyperactive Yang. This pair can also have a tonic effect since Salvia can help to tonify Blood and Ruta can help to tonify Kidney Qi. Strengthening the Blood and Kidney Qi can help to stabilize Liver Yang and reduce headache. Salvia + Leonurus
CAUTION 1-
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair. Salvia + Baptisia
Acute tonsillitis Both herbs are specific for acute tonsillitis. Baptisia is the colder herb and the stronger antimicrobial, and here it is complemented by the astringent action of Salvia.
Menopausal disorders + palpitations This pair is specific for menopausal disorders with palpitations and debility. Both herbs can calm Heart Spirit and tonify Heart Qi and Blood. Leonurus has a stronger tonic, regulatory, and calming action on the Heart, and Salvia is more cooling and specific for excessive sweating. Since both herbs have emmenagogue action, this pair can also be used for amenorrhea with nervous tension and debility. Salvia + Anemone
Menopausal disorders + hotflashes Salvia + Achillea
Sweatingfrom debility
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Both herbs can be used to clear Wind invasion and to tonify Defensive Qi and regulate its flow through the surface of the body. Part of this regulatory action may be due to the astringent action of the tannins in both these plants. These herbs can be paired to treat sweating as a result of debility, and the tonic action of the bitter constituents of Achillea may assist in this. Salvia + Zingiber
Myalgia from cold The acrid and aromatic constituents of these two herbs combine to clear Wind Cold from the surface of the body, thereby treating headache and muscle aches. Zingiber is the hotter and more diffusive herb, which is balanced by the astringent action of Salvia. It may act as a mild tonic to the Defensive Qi, complementing the tonifying action of the . sweet constituents of fresh Zingiber on the Nutritive Qi. Salvia + Mentha pulegiwn
Headache + nervous tension This pair can be used for headache and muscle aches from Wind Cold invasion combined with nervous tension
These herbs are specific for menopausal problems involving hot flashes and nervous overexcitement. Anemone is the colder herb and the stronger sedative, and it is complemented by the regulatory effect of Salvia on sweating. Salvia + Lavandula
Headache + insomnia These two Labiates may be paired to treat headache combined with insomnia since they can: • calm Disturbance of Heart Spirit to treat insomnia • calm Liver Hyperactive Yang to treat headache resulting from nervous tension Salvia can also clear Heart Deficiency Heat and tonify Heart and Kidney yoill to reduce restlessness and sweating. Salvia + Rosmarinus
Headache + depression This Labiate pair has a more stimulant and less calming effect than Salvia + Lavandula, and can be used to treat headache from Liver Hyperactive Yang and Liver Stagnant Qi. Rosmarinus is also more warming than Lavandula so that Rosmarinus can be used to treat headache and depression associated with Liver Stagnation and Cold.
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to be familiar with the cautions listed for each herb"i7i"i';~.~~~;; bination.
Salvia + Ophiopogon
Sweating + heat sensations This pair is specific for sweating associated with Heart Deficient Yin and Heart Deficiency Heat, as seen in some menopausal and some chronic fatigue syndrome patterns. The sweet constituents of Ophiopogon can tonify Heart Yin and its bitter constituents may clear Heart Deficiency Heat. The acrid and aromatic constituents of Salvia can regulate the body surface and help to normalize sweating. Both herbs have a mildly calming effect. Salvia + Cinchona
Myalgia + cardiac weakness
1. Acute tonsillitis
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Wind Heat + Heat Toxin Herb
Ratio
Temperature
Salvia off. Baptisia Commiphora Phytolacca
1 1 1 1
warm-cool cold warm cool
aromatic, acrid bitter bitter. acrid acrid
GENERAL
These herbs can combine for muscle aches or cramps, and they can be especially useful in cases of fibromyalgia in which there is also heart and digestive weakness and exhaustion. Cinchona can tonify and stabilize Heart Qi, and Salvia can help to tonify Blood. The bitter constituents of Cinchona and the aromatic constituents of Salvia can strengthen qigestion and assist in the recovery. Salvia + Angelica sinensis
This combination is used to clear Heat Toxin. and Wmd "''''''''',-' Heat in acute conditions. It is cool in temperature, but Salvia' and Commiphora can have a balancing warming effect. _ .. _- . Therefore, this combination could be used for mixed_colld:i:: :L;Li:l;i~-,. tions of Heat and Cold, such as tonsillitis in patients wiili;',::·1;;-::-'G.c::" Stomach Heat but Deficient Spleen Qi. The dominant taste properties in this combination are bitter and acrid. USE
Amenorrhea + anemia
• acute tonsillitis Both herbs can tonify and move Blood to prevent Wind Cold invasion that might result in muscle aches or headache. These herbs can also combine to treat menstrual disorders resulting from Deficient Blood, such as amenorrhea, or resulting in Deficient Blood, such as menorrhagia.
Salvia combinations Six Salvia combinations are discussed below: Combination
Chinese syndromes
1. acute tonsillitis
Wind Heat + Heat Toxin
2. menopausal hot flashes
Heart Heat + Heart Deficient Yin
3. excessive sweating +
Deficient Defensive Qi + Deficient Blood + Heart Deficient Yin
exhaustion
4. headache + myalgia
Liver Hyperactive Yang + Wind Cold
5. headache + anemia
Liver Hyperactive Yang + Liver Deficient Blood
6. headache + premenstrual syndrome + depression
Liver Hyperactive Yang + Liver Stagnant Qi
CAUTION
Before using any of the combinations below, it is important
PRACTICAL NOTES
This combination is conveniently taken as 5 mlof -1:5 ' tincture in quarter of a glass of water. The p~ti.~.Il~~~<;>~~-fi2;.~~J::~' gargle thoroughly with the liquid. three times, and then .,c,._. swallow it. This can be done three to five times per day. This -.. combination should not be taken at full dose for more than 3 days. If the tonsillitis has not substantially reduced, a different combination or a different mode of treatment may be appropriate. The combination may be taken for a further 5 days at half dose to clear Heat Toxins, or it may be modifie~ by the addition of milder anti-inflammatory herbs such as Althaea. Ophiopogon. or Viola.
Caution
In the case of severe tonsillitis. patients should
consult their allopathic physician. 2. Menopausal hot flashes
Heart Heat + Heart Deficient Yin Herb Salvia off. Salvia mil. Leonurus Anemone Ophiopogon Glycyrrhiza Valeriana
Ratio 1 1 1 1 1
0.5 0.5
warm-cool cool neutral cold cool neutral-cool cool
aromatic, acrid bitter sour. sl. bitter bitter sweet, sl. bitter sweet bitter, sweet
Salvia 4. Headache + myalgia
GENERAL
This combination is used to clear Heart Heat, tonify Heart Yin and Blood, and regulate the nerus. The temperature is cool-cold for warm or hot conditions. The sweet property is tonifying and stabilizing to the Heart, the bitter taste is cooling, and the aromatic property is calming. USE
• menopausal hot flashes, sweating, anxiety, and menstrual irregularities PRACTICAL NOTES
This combination is conveniently taken as 5 rnl of 1:5 tincture in quarter of a glass of water, three times per day. This combination can be taken with the appropriate cautions, breaks, and modifications for several months. 3. Excessive sweating + exhaustion
Deficient Defensive Qi + Deficient Blood + Heart Deficient Yin Herb
Ratio
Temperature
Taste
Salvia off. Achillea Crataegus Cinchona Ophiopogon Angelica sin. Glycyrrhiza
1 1 1 1 1 1 0.5
warm-cool warm-cool 51. warm cool cool warm neutral-cool
aromatic, acrid acrid. bitter sour, sweet bitter sweet,s!. bitter sweet, aromatic, bitter sweet
GENERAL
This combination is for Deficient Defensive Qi with Deficient Qi, Deficient Blood, and Deficient Ym. There may be some Wind invasion or Retained Pathogen. The overall temperature is approximately neutral so that this combination can be used for either cool or warm conditions, or for Deficiency conditions with a mixture of Heat and Cold. The sweet and bitter constituents have a tonic action, and the acrid constituents can clear Exterior Wind or Retained Pathogen to assist in the recovery. USE
• excessive sweating with exhaustion as seen in some cases of chronic fatigue syndrome or fibromyalgia • excessive sweating in menopause with exhaustion PRACTICAL NOTES
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This combination is conveniently taken as 5 rnl of 1:5 tincture in quarter of a glass of water, three times per day. This combination can be taken, with appropriate cautions, breaks, and modifications, for 1-2 months.
Liver Hyperactive Yang + Wind Cold Herb
Daily dose
Temperature
T~ste
Salvia off. Achillea Mentha pul. Zingiber (fresh) Glycyrrhiza
4g 4g 4g 3 slices 1.5g
warm-cool warm-cool warm hot neutrai-cool
aromatic, acrid acrid, bitter aromatic aromatic, acrid sweet
GENERAL
This combination is for headache and muscle aches from a combination ofWmd Cold invasion and Liver Hyperactive Yang. The temperature is warm for cool or cold conditions. The dominant taste is acrid to warm the surface and to clear Wind Cold, but the sweet constituents of fresh ginger and licorice can help to tonify Nutritive Qi. The aromatic property can calm the mind and relax the muscles. USE
• influenza, headache, and muscle aches with sensations of cold and/or nervous tension PRACTICAL NOTES
Glycyrrhiza and fresh Zingiber are simmered gently in 7 cups of water for about 15 minutes, then the heat is turne~ off. Achillea and Salvia are then added and steeped for about 7 minutes with a well-fitting lid on the pan. Then Mentha is added and steeped for a further 5 minutes. Two cups of the filtered decoction-infusion can be taken as warm as possible, three times per day. The patient should rest and keep warm. This combination is for acute situations, but it can be used whenever the situation recurs.
Caution For some patients, usually those with Deficient Blood and Deficient Ym, Achillea and Salvia together can be rather drying. For such patients, three pieces of Ziziphus fruit (thre.e red dates) can be simmered for 15 minutes with the Glycyrrhiza and fresh Zingiber. 5. Headache + anemia
Liver Hyperactive Yang + Liver Deficient Blood Herb Salvia off. Rosmarinus Artemisia abs. Angelica sin. Lycium (fruit) Valeriana Zingiber
Ratio
Temperature
Taste
1 1 1 0.5-1 0.5-1 0.5-1
warm-cool warm warm-cool warm neutral cool hot
aromatic, acrid aromatic, bitter, acrid
0.5
bitter, aromatic sweet, aromatic, bitter sweet bitter, sweet acrid, aromatic
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674 GENERAL
PRACTICAL NOTES
This combination is used to calm Liver Hyperactive Yang and tonify Blood. The patients may not have diagnoses of anemia in terms of Western medicine. but they may have defmite signs and symptoms of Deficient Blood: The overall temperature is warm. to treat cool conditions. The sweet taste is important in tonifying the Blood. and the aromatic and acrid properties combine to improve Blood movement If there are muscle aches in addition to headache. as seen in some cases of fibromyalgia. herbs such as Zanthoxylum and Cinchona may need to be added. observing appropriate cautions with Cinchona.
This combination can be taken as 2.5-7.5 rnl of 1:5 tincture in quarter of a cup of warm water. three tirries per day. .. _ During the period of the premenstrual symptoms and in :.~~::: 5 days before it. the individual dose can be 5-7.5 ml. At other ..;~.~'~;v times during the cycle. the dose can be reduced to 2.5-5 mI.. It may be necessary to take the combination for several months. However. once there has been considerable improvement in the premenstrual symptoms. it may be possible to take a reduced dose of 2.5-5 m1 just during the premenstrual period; under these conditions. the combination should not be taken during the rest of the cycle.
.....:-
"~'=--:~
..
the
~
.
:~
- :~:.;;.::::-"'-~;;..-.
USE
• postmenstrual syndrome or other situations with headache. anemia. and exhaustion
COMPARISON OF THE SIX SALVIA COMBINATIONS
PRACTICAL NOTES
This combination is conveniently taken as 5 ml of 1:5 tincture in quarter of a glass of water. three times per day. This combinati~m can be taken. with appropriate cautions. breaks. and modifications. for 1-3 months. If the patient's stress levels are high. extra Valeriana can be given temporarily. 6. Headache + premenstrual syndrome + depression
Liver Hyperactive Yang + Liver Stagnant Qi Herb:__ .. := - - Ratio ,Temperature
Taste
Salvia off. Rosmarinus Lavandula Artemisia abs. Ruta Zingiber Mentha pip. Glycyrrhiza
aromatic, acrid aromatic, bitter. acrid aromatic, bitter, 51. acrid bitter, aromatic bitter, aromatic acrid, aromatic aromatic, acrid sweet
1 1 1 1 1 1 0.5 0.5
warm-cool warm 51. warm warm-cool warm-cool hot warm-cool neutral-cool
GENERAL
This combination is used to calm Liver Hyperactive Yang and move Liver Stagnant Qi. The temperature is warm. but there are four herbs with variable temperature in this combination. Therefore. it can be used for mLxed conditions of moderate Heat and Cold. The aromatic constituents can calm nervous tension. the aromatic and bitter constituents can combine to tonify and regulate the Liver, and the acrid taste assists the aromatic constituents in moving Liver StagnantQi. USE
• premenstrual syndrome with headache. muscle aches. depression. and maybe abdominal distension
1. Acute tonsillitis
2. Menopausal hot flashes
Wind Heat + Heat Toxin
Heart Heat + Heart Deficient Yin
Herb
. - . Ratio -,
Salvia off. Baptisia Commiphora Phytolacca
1 1 1 1
Sa!via off. Salvia mil. Leonurus Anemone Ophiopogon Glycyrrhiza Valeriana
1 1 1 1 1 0.5 0.5
1. The four herbs in combination No. 1 are antimicrobials specific for tonsillitis. Salvia and Commiphora are both warming and provide a balance to Baptisia. which is a cold herb that otherwise might aggravate Deficient Spleen patterns. Phytolacca helps to clear Phlegm. Damp. and Heat Toxins from the throat and from the lymph system.
2. Both Salvias in combination No. 2 can clear Heart Deficiency Heat and help to tonify Deficient Heart Yin and Blood. They can also act as emmenagogues to regulate menstruation. S. officinalis is specific for menopausal sweating and combines with Leonurus and Anemone to treat menopausal disorders. Anemone and Valeriana can clear Heart Heat, and Ophiopogon and Glycyrrhiza combine to tonify the Yin. 3. Excessive sweating + exhaustion
4. Headache + myalgia
Deficient Defensive Qi + Deficient Blood + Heart Deficient Yin
Liver Hyperactive Yang + Wind Cold
~-·-f
rI Salvia i· l
1·-'. --
Herb'--~';:;;::';'7;::-Ratio-"''''~",'~' Salvia off. Achillea Crataegus Cinchona Ophiopogon Angelica sin. GIycyrrhiza
1 1 1 1 1 1 0.5
'-Herb"--:-;-:::~,~.;:Dail~d~i~ •
•.
Salvia off. Achillea Mentha pul. Zingiber (fresh) Glycyrrhiza
.
.-.
Co
•• _
--._
675
combination No. 5 contains Angelica and Lycium to treat
;.,.-:..;:;
4g 4g 4g 3 slices 1.5g
Deficient Blood, whilst combination No. 6 contains Ruta to treat premenstrual syndrome and headache, and Mentha and a higher ratio of Zingiber to move Liver Stagnant Qi.
OTHER SALVIA COMBINATIONS Other combinations that contain Salvia officinalis include the following:
3. Combination No.2 can treat excessive sweating associated with Heat and nervous tension, and therefore contains the cooling and calming herbs Anemone and Valeriana. In combination No.3. Salvia and Achillea are paired to treat excessive sweating due to Deficient Defensive Qi. Crataegus, Cinchona. and Angelica are included to treat excessive sweating due to Deficient Heart Qi and Blood.
4. Combinations No. 2 and No. 3 are used to reduce
L
• Artemisia: amenorrhea + nervous tension • Cimicifuga: menopausal disorders + rheumatism • Cinchona: recurringfever + night sweats • Convallaria: cardiac arrhythmia + restlessness • Leonurus: palpitations + anemia • Rosmarinus: postnatal depression + exhaustion • Ruta: chronic fatigue syndrome + palpitations • Tanacetum: headache + conjunctivitis
excessive sweating, whilst combination No.4 is used to promote sweating in order to clear Wmd Cold from the surface channels. The first four herbs in combination No.4 can combine to warm and move the Qi at the surface, promote sweating. and clear Wind Cold. The aromatic constituents of Salvia and Mentha can calm nervous tension and treat headache and muscle tension, the sweet components of Zingiber and Glycyrrhiza combine to tonify Nutritive Qi, and Salvia and Achillea can assist in the tonification of Defensive Qi.
Research CONSTITUENTS: WESTERN SPECIES The leaves of S. officinalis have been reported to contain the following constituents: • monoterpenoids
5. Headache + anemia
Liver Hyperactive Yang + Liver Deficient Blood
"--,
-~
6. Headache + premenstrual syndrome + depression
Liver Hyperactive Yang + Liver Stagnant Qi
Herb
Ratio
Herb
Ratio .;,"y:.:,
Salvia off. Rosmarinus Artemisia abs. Angelica sin. Lycium (fruit) Valeriana Zingiber
1 1 1 0.5-1 0.5-1 0.5-1 0.5
Salvia off. Rosmarinus Lavandula Artemisia abs. Ruta Zingiber Mentha pip. Glycyrrhiza
1 1 1 1 1 1 0.5 0.5
5. Combination No.4 is for headache associated with Wind Cold, whiLst combination No.5 is for headache from Deficient Blood. In combination No.4, Salvia is combined with Achillea and Zingiber to promote sweating and clear Wind Cold. In combination No.5, Salvia is combined with Rosmarinus, Artemisia, and Angelica to tonify the Blood.
..
6. Both combinations No. 5 and No.6 include Salvia, Rosmarinus. and Artemisia to treat headache. However,
• diterpenoids • triterpenes ·.tannins • flavonoids Monoterpenoids Salvia officinalis contains 1-2.5% essential oil, the composition of which can be variable. The bicyclic monoterpenoid ketones, the thujones, may represent up to 60% of the oil.
Species variation The standard for official sage oil from S. officinalis is compared below to that of S.lavandulifolia: 12 S. OFACINALIS
S. LAVANDUll FOLIA
Constituent % by herb a-thujone
18-43%
<
5%
~thujone
3-8.5%
<
5%
camphor
4.5-24.5%
11-36%
cineole
5.5-13%
11-25%
humulene
0-12%
a-pinene
1-6.5%
Iinalool
4-11% 0.5-9%
676
Combining Western Herbs and Chinese Medicine
"."";.:~ .~~~~.~~~
3,2W~~~:_
S. triloba contains mainly cineole (60%) and about 7% thujones. S. sc1area contains linyl acetate (45-70%), linalool (lO-20%), and the diterpene sc1areol. 12
salviol, protocatechuic aldehyde, protocatechuic acid. b-(. dihydroxyphenyl) lactic acid and vitamin E. 1o "----.-.:':-
Seasonal variation in monoterpenoids Major seasonal changes were reported in the composition of the oil of S. libanotica (East Mediterranean sage). The table compares the changes in the levels of selected monoterpenes between winter {January} and spring (April}:l3
PHARMACOLOGICAL AND CLINICAL
WINTER
SPRING
12.3%
7.7%
1.9%
1.3%
4.8%
3.1%
Constituent % by season camphor (1.-
and
~-
thujone
camphene
Seasonal changes in the levels of monterpenes and sesquiterpenes were also reported for the oil of S. officinalis. 14 Diterpenoids S. officinalis contains bitter diterpenoids such as carnosol (also known as picrosalvin), rosmanol, and carnosic acid.! Triterpenes S. officinalis contains many triterpenes, for example, ursane and oleanolic acid and its derivatives. '2 Tannins S. officinalis contains 3-7% tannins, including rosmarinic acid.!S
RESEARCH: WESTERN SPECIES The following effects have been reported for S. officinalis and other Salvia species used in the West: • antimicrobial • antipyretic and analgesic • anti-inflammatory • antispasmodic • antihypertensive • antihyperhidrotic • central nervous system effects • antitumor Antimicrobial
Herb Sage leaves were reported to contain diterpenes with activity against the vesicular stomatitis virus. Ii. IS Oil Sage oil has demonstrated antibacterial and antifungal effects when tested on Gram-positive and Gram-negative bacteria, fIlamentous fungi, and yeasts, including Candida albicans. 19• 2o The oil of the aerial parts of S. tormentosa has been reported to be remarkably effective in inhibiting the growth of Gram-positive and Gram-negative bacteria. except for Pseudomonas aeruginosa. 2\ ,
Flavonoids The leaves of S. officinalis contain 1-3% flavonoids, for example, 5-methoxysalvigenin.!6
CONSTITUENTS:
S. MILTIORRHIZA
The roots of S. miltiorrhiza (dan shen) have been reported to contain the following constituents:\2 • diterpenoid quinones • phenolics • other Diterpenoid quinones These substances are based on an abietane skeleton, and include:
• orthoquinones tanshinones and derivatives, cryptotanshinone, miltirone, and miltionones • paraquinones isotanshinones, and danshenxinkun A-C Phenolics These include lithospermate B (a rosmarinic acid dimer), rosmarinic acid, salvianolic acid, and a benzofuranoid derivative. Other The following constituents have also been reported:
~
....;.
,,;:~
....
Isolated constituents • a topical application of 5% rosmarinic acid lowered both gingival and plaque indices in monkeys22 • the diterpene l-oxoferruginol from the roots of S. viridis showed antimicrobial activity against B. subtilis and S. aureus23 • diterpenoids from the roots of S. multicaulis showed antimicrobial activity against Mycobacterium tuberculosis 24 Antipyretic and analgesic Aqueous extracts of Salvia africana-Iutea were investigated for analgesic and antipyretic activities in mice and rats. S. africana-lutea significantly inhibited acetic acid-induced writhing, delayed the time of reaction of mice to thermal stimulation produced by the hot plate test, and reduced the fever induced by a lipopolysaccharide. However, paracetamol had no effect on hot plateinduced nociception and on pyrexia produced by the lipopolysaccharide. These data suggested potential analgesic 2s and antipyretic activity for S. africana-Iutea. Anti-inflammatory Rosmarinic acid has shown antiinflammatory activity,26by inhibition of the complement-
"
....
I' i
Salvia
I,
,
\.-
!
'.~
dependent stimulation of prostacyclin biosynthesis. 27 The diterpene aethiopinone from the roots of S. aethiopsis showed antipyretic, anti-inflammatory, and analgesic activity in animal experiments. 28 S. officinalis leaves were investigated for their topical anti-inflammatory properties. The n-hexane and the chloroform extracts dose-dependently inhibited the Croton oilinduced ear edema in mice, with the chloroform extract being the more active. By contrast, the methanol extracts showed very little activity, and the essential oil was inactive. Ursolic acid was found to be the main component involved in the anti-inflammatory activity of the chloroform extract. The anti-inflammatory effect of ursolic acid OD 50 = 0.14 Ilmole/cm2) was two-fold more potent than that of indomethacin (10 50 = 0.26 Ilmole/cm!),which was used as a reference nonsteroidal anti-inflammatory drug (NSAID). The content of ursolic acid in sage and sage-based remedies for the topical treatment of inflammatory diseases was proposed as a parameter for quality control purposes. 29 Antispasmodic According to Bruneton, small doses of sage oil inhibit electrically induced contractions in isolated guinea pig ilea, and sage tincture can reduce spasms induced by acetylcholine or serotonin. One study noted that the differences in chemical profile of the different Salvia species could have an effect on their biological activity. Extracts from S. officinalis and S. triloba tended to inhibit, to varying degrees, smooth muscle contractions induced by acetylcholine, histamine, or serotonin, whilst extracts from S. verbenaca usually potentiated the contractions. 30 A recent study reported that a secoisopimarane diterpenoid isolated from the leaves of S. cannabinara had antispasmodic activity on histamine-, acetylcholine-, and barium chloride-induced contractions in isolated guinea pig ileum. 31
...
Antihypertensive Applied intravenously and duodenally, S. officinalis tincture produced moderate but prolonged lowering of blood pressure in cats, and a decoction of S. triloba had a similar effect on spontaneously hypertensive rats. 30 Antihyperhidrotic A preparation of fresh sage leaves reduced excessive sweating in humans,32.33 and excessive sweating induced by pilocarpine was inhibited as well. 32 An' extract based on the leaves of S. officinalis and Medicago sativa (alfalfa) was reported to be effective in the treatment ofho! flashes and night sweats in menopausal women, without side effects.3-l Central nervous system effects Extracts from S. triloba were reported to prolong hexobarbital-induced sleep in animal studies.30 Extracts of S. leriifolia leaves, at a dose of 500 mg/kg, were reported to be as effective as 5 mg/kg of
677
diazepam in reducing the withdrawal syndrome in morphine-dependent mice as estimated by a reduction in the number of jumping episodes. 35 In a study on the reputed ability of plants to enhance memory, extracts of three Salvia species showed the ability to displace nicotine from nicotinic receptors and scopalamine from muscarinic receptors in homogenates of human cerebral cortical cell membranes. 36 Salvia lavandulifolia (Spanish sage) essential oil and individual monoterpenoid constituents have been shown to inhibit the enzyme acetylcholinesterase both in vitro and in vivo. The authors suggested that this activity is relevant to the treatment of Alzheimer's disease since anticholinesterase drugs are currently the only drugs available to treat Alzheimer's disease. Other activities of Salvia relevant to Alzheimer's disease include antioxidant, anti-inflammatory, and estrogenic effects. Antioxidant activity (inhibition of bovine brain liposome peroxidation) was demonstrated for the ethanol extract of the dried herb at a dose of 5 mg/mI, for the monoterpenoids (O.IM) a- and ~-pinene, and for 1,8-cineole. Thujone and geraniol had lower antioxidant effects, while camphor had no antioxidant effects. 37 Antitumor The oil of S. libanotica showed potent inlubition of tumor promotion in mouse skin, and the authors suggested that it could be an effective chemoprotective agent against skin cancer. 38
PHARMACOLOGICAL AND CLINICAL RESEARCH:
S. MILTIORRHIZA
The following effects have been reported: • antimicrobial • antiallergic • cardioactive • antihypertensive and vasodilatory • antilipemic and antiatherotic • antithrombotic • cerebral and central nervous system effects • hepatic and hepatoprotective • renal effects • antioxidant • antitumor Antimicrobial Decoctions of S. miltiorrhiza were reported to have antibacterial action,39 and cryptotanshinone and dihydrotanshinone I from S. miltiorrhiza showed antibacterial activity against a broad range of Gram-positive bacteria. 40 Antiallergic Cryptotanshinone and dihydrotanshinone I from S. miltiorrhiza showed antiallergic activity in vitro. 41
678
Combining Western Herbs and Chinese Medicine
Cardioactive
Studies using S. miltiorrhiza extracts According to early Chinese investigations, Salvia extracts: • accelerated the recovery of myocardial ischemic areas in dogs42 • showed relief of anginal pain and improvement of ECG patterns in patients with coronary disease 43.-I-I • showed improvement in blood flow velocity and blood viscosity45.-l6 In more recent studies, using patients with coronary heart disease, it was found that Salvia miltiorrhiza tended to normalize the serum lipid peroxide and superoxide dismutase levels, decreasing the former and increasing the latter. 47.48 It was suggested by the authors that S. miltiorrhiza may treat coronary heart disease by regulating phospholipid metabolism.
Studies using tanshinones It has been reported that, using isolated rat heart, tanshinones I and VI and cryptotanshinone can reduce the complications of myocardial ischemia. 12 Early clinical studies in China reported that tanslUnone II-A, solubilized by sulfonation, relieved the pain of angina pectoris. to
Studies using dihydroxyphenyl lactic acid
Early studies in China reported that b-3,4-dihydroxyphenyl lactic acid could:10 • improve ECG abnormalities in rabbits or rats with acute myocardial ischemia induced by pituitrin • improve cardiac function and reduce infarct area in dogs Antihypertensive and vasodilatory Early Chinese research reported vasodilatory action when S. miltiorrhiza extracts were administered into toad systemic blood vessels, rabbit auricular blood vessels, or dog femoral arteries. lo S. miltiorrhiza or tanshinone preparations have been reported to have antihypertensive effects in animals,49.50 and in humans. 51 .52 Antilipemic and antiatherotic S. miltiorrhiza preparations were reported to inhibit the formation of experimentally induced atheromatous plaques in rabbits. 53 S. miltiorrhiza decoction was reported to reduce serum and liver triglycerides in atherosclerotic rabbits and reduce serum cholesterol in some humans. However, an antilipemic effect or protection against aortic lesions was not found following oral administration of the decoction to rats with experimentally induced atherosclerosis. 54 •55 Antithrombotic S. miltiorrhiza decoction was reported to reduce human platelet aggregation induced by epinephrine. This was thought to be due to fibrinolytic activity by the de-
coction, producing fibrin/fibrinogen degradation products ....~~ "'=c,= which then inhibited platelet aggregation. 56 In vitro rat stud:·''''';~';f.' '7,
ies reported that S. miltiorrhiza root could significandy reduce the thrombus size.S7 Cerebral and central nervous system effects It has been claimed that S. miltiorrhiza root can assist in the recovery from ischemic stroke resulting from cerebral atherosclerosis. 58 Studies on transient forebrain ischemia in gerbils suggested that monoamine neurotransmitters were involved in the ischemic neuron damage. S. miltiorrhiza extracts had a protective role during cerebral ischemia by reducing the dysfunctions of monoamine neurotransmitters. 59 Studies with rats showed that S. miltiorrhiza preparations protected cultured hippocampal neurons from anoxic damage. 60 S. miltiorrhiza was reported to reduce spontaneous activity in mice and to potentiate the hypnotic action of . chlorohydrate and cyclobarbital.61 . 62 Salvianolic acid A had an ameliorating effect on learning and memory impairment':-:::':::-:.::::,' caused by cerebral ischemia in mice. This may be related to its antioxidant activity.63 Hepatic and hepatoprotective Clinical studies with S. miltiorrhiza root injection showed beneficial effects in chronic persistent or chronic active hepatitis. 64 Extracts from S. miltiorrhiza reduced experimentally induced hepatic fibrosis in rats.65 Intravenous administration of preparations of S. miltiorrhiza in dogs with hepatic cirrhosis resulted in a decrease in portal venous pressure and in hepatic venous pressure. After 10-12 weeks administration of preparations of S. miltiorrhiza to patients with hepatic cirrhosis, portal vein and splenic vein diameters were decreased, and liver function, 66 anorexia, and abdominal distension were improved. An aqueous extract of S. miltiorrhiza was administered to bile duct-ligated rats at a dose of 0.2 g twice per day for 4 weeks, resulting in reduced fibrosis and reduced portal hypertension compared to the controls. 67 In another study, a hot water extract of S. miltiorrhiza roots was administered orally to bile duct ligated rats at a dose of 100 mg/kg for 28 68 days with a reduction in fibrosis and lipid peroxidation. Renal effects Extracts from S. miltiorrhiza were reported to reduce glycerol-induced renal damage in rats,69 and S. miltiorrhiza was reported to treat chronic renal iiJ.sufficiency. -;0 Experiments with normal and uremic animals reported that S. miltiorrhiza extracts could increase the glomerular filtra~ tion rate, increase excretion of ure.a and creatinine, and decrease uremia. These effects appeared to be due to lithospermate B. 12 Antioxidant S. miltiorrhiza showed antioxidant effects in cultured rat hepatocytes. It inhibited the cytotoxicity of afla. toxin B1 by decreasing reactive oxygen species formation,
-
I
Salvia inhibiting lipid peroxidation, and preventing intracellular glutathione depletion. 71
produced no side effects or adverse changes in the blood or in tests of liver and kidney function.
Antitumor S. miltiorrhiza was shown to inhibit cell growth and induce apoptosis in human hepatoma HepG(2)
Salvia essential oil According to the German Commission E monograph, S. officinalis is an 'approved herb: and an internal daily dose of the essential oil is given as 0.1-0.3 g. When Salvia oil was administered to animals by intraperitoneal injections, convulsions appeared above 0.5 g1kg, and became lethal above 3.2 g1kg. 73 The oral LD;o of sage essential oil was reported as 2.6 g1kg inrats. 74 This would be equivalent to a 60 kg human ingesting 156 g of oil.
cells.72
RESEARCH VERIFICATION OF TRADITIONAL ACTIONS From the research summarized above on herb extracts or on isolated constituents, there is evidence for the following traditional actions:
• Western Salvia species
• S. miltiorrhiza
antimicrobial, antipyretic, anti-inflammatory, topical anti-inflammatory, antispasmodic, antihyperhidrotic, tranquilizer, and memory stimulant antianginal, 'blood mover' (cardioactive, antithrombotic, and antilipidemic), and tranquilizer (antihypertensive and hypnotic)
Additional effects demonstrated by research The following additional effects have been demonstrated using herb extracts or isolated constituents, as discussed above:
• Western Salvia species . • S. miltiorrhiza
antimicrobial, analgesic, antihypertensive, and antitumor antimicrobial, antiallergic, neuroprotective, memory enhancement, hypnotic, hepatoprotective, antioxidant, and antitumor
TOXICOLOGY An important distinction
A careful distinction needs to
be made between the use of: II
~ __
679
Thujone When taken orally, in an acute toxicity test, the LD,o of a- and ~-thujone in rats was reported as 192 mg/kg.~2 In subchronic activity tests in rats on 10 mglkg per day of aand ~-thujone, 5% showed convulsions. 7; This is equivalent to 600 mg of thujone for a 60 kg human. According to the Wicht! monograph, adverse effects of thujone may include dizziness, hot flashes, tachycardia, and convulsions.
Thujone and pregnancy 1 have not found any data on the effects of thujone in pregnancy in a search of both the literature and the Internet-based PubMed resource. Mutagenic activity Salvia tincture showed no mutagenic activity in the Ames test. 76 Salvia oil showed no mutagenic or DNA-damaging activity in the Ames or Bacillus subtilis recassay.77 In perspective If 1prescribe 3 individual doses of 5 ml of a 1:5 tincture in which S. officinalis is combined with four other herbs, this is 15 ml of the combination per day. This contains 3 ml of 1:5 Salvia tincture, which is theoretically equivalent to 600 mg of dried herb. If it is assumed that thujones make up 1% of the dried herb, then the daily dose of the combination theoretically contains 6 mg of thujones. The dose of thujones that resulted in convulsions in 50/0 of
rats was equivalent to 600 mg for a 60 kg human. This is 100fold greater than my maximum therapeutic dose.
• therapeutic doses of Salvia as an infusion or tincture • Salvia essential oil • isolated components of Salvia, such as thujone
:iii
----. . .
Salvia infusion or tincture According to Bruneton, infusions or tinctures of S. officinalis seem to have little toxicity. The LD 50 for S. miltiorrhiza by peritoneal injection has been reported as 36.7 glkg.IO This extraordinary figure is equivalent to injecting a 60 kg human with over 2 kg of extract. According to Bensky and Gamble, intravenous injections into anesthetized animals of 40 to 80 times the clinical dose of S. miltiorrhiza produced no toxic reactions. Intravenous injection of 20 to 30 times the clinical dose for 14 days also
Dose Dried herb The BHp 78 listed 1-4 g of dried herb, by infusion, three times per day. Tmeture The BHP listed 1-4 ml of liquid extract in 45% alcohol, three times per day. Initial dose
Can start at the standard dose.
Duration Can be used for a long period as long as it is used within the therapeutic dose, providing there are no signs of thujone side effects.
Combining Western Herbs and Chinese Medicine
680
~,
~,.
·,-:'"l" •.-.
· __ '~!;~:'~~·o.
Cautions These cautions apply to the infusion and the tincture. The use of the oil is outside the scope of this book. Western contraindications
None reported. 79
Chinese contraindications None reported for S. officinalis. According to Bensky and Gamble, S. miltiorrhiza should be used cautiously in cases 'without Congealed Blood: Pregnancy and lactation Contraindicated by some authorsBO during pregnancy or lactation because of the presence of thujone, although no adverse effects have been reported with the use of infusion or tincture. Side effects Overdose
None reported.
. =:
fied Salvia between second and third degree with respect to·:~> heat and dryness, and Culpeper86 recommended it for pains in the head coming from cold and rheumatic humours. Salvia officinalis is classified in this book as a warm-cool herb that can be used to treat hot or cold conditions, as discussed in the Limitations section. Taste
Taste in the mouth The BHP stated that S. officinalis leaves an aromatic and bitter taste in the mouth, whilst this herb was described in Wicht! as spicy, bitter, and astringent in taste. I recorded the following data for different samples of S. officinalis: • 1:5 tincture
80
No adverse reports. 80
Interactions None reported for S. officinalis. It has been reported that extra::ts of S. miltiorrhiza roots can increase the absorption rate and decrease the clearance of warfarin, explaining the clinically observed incidents of increased warfarin adverse effects when taken concomitantly with S. miltiorrhiza.81 This would suggest that S. miltiorrhiza should be avoided or used with caution for patients taking warfarin until further information is available.
Regulatory status Please read the Regulatory status section in the chapter on Safety. S.officinalis (sage oil) is on the UK General Sale List and is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. S. officinalis is not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
• dried leaves
• fresh leaves
an aromatic odor; and an acrid, aromatic, and slightly bitter taste a less aromatic odor than the tincture; and a taste that was aromatic, but more strongly acrid and less bitter than the tincture an aromatic odor; a strongly acrid and strongly aromatic taste, and a taste intermediate in bitterness between the tincture and the dried sample
I compared the bitterness of 1:5 tinctures of the following herbs from the same supplier, on a scale of 0-3, with the following results:
• S. officinalis • Lavandula • Rosmarinus
0.5-1 1-1.5 2
Taste properties The taste properties listed in this book for S. officinalis are aromatic and acrid. The acrid refers primarily to the property of clearing Exterior Wind from the surface since this herb seems to have a weaker effect than Rosmarinus in warming the Interior. The aromatic property can be associated with its carminative, antispasmodic, tranquilizer, and antidepressant actions. ORGANS
Traditional sources PROPERTIES Temperature Hidegard von Bingen82 described Salvia as hot and dry in nature, growing more from the heat of the sun than the moisture of the earth, and as being useful in the treatment of excess phlegm. She recommended it for urinary incontinence due to coldness of the stomach. According to both Lonicerus83 and Tabernaemontanus84, Salvia is hot in the first degree and dry in the second degree. Gerard 85 classi-
In terms of Chinese medicine, S. officinalis, as used in the West, can be associated mainly with disorders of the organ systems shown in the table below. Data for these organ systems is also given for S. miltiorrhiza, although in Chinese tradition, S. miltiorrhiza is listed as entering the meridians of Heart, Pericardium, and Liver. II ACTIONS Evidence from the Western traditional sources for the following actions of S. officinalis are discussed below:
k; :
Salvia
strengthens the nerves and helps with weaknesses due to congestion of the brain or nerves. He said that Salvia wine could strengthen and warm the cold and .weak head and brain and could be used for all injuries to the head and brain, especially stroke, vertigo, trembling and palsy of the limbs, cramps, and somnolence. Culpeper said that Salvia could warm cold sinews troubled with the palsy and cramps. Chinese studies have reported that S. miltiorrhiza can assist in the recovery of cerebrovascular accident (see Research). Mabey9° recommended Salvia to strengthen a debilitated nervous system.
• blood and hair tonic • nervine tonic • tranquilizer • carminative and antispasmodic • hepatic • emmenagogue • expectorant • diuretic • antimicrobial • astringent and antihemorrhagic • topical
\ I~
Blood and hair tonic Culpeper said that Salvia strengthens the liver and breeds blood, and quoted Dioscorides as saying that it causes the hair to become black again. This is similar to the Chinese use of the Blood tonic Polygonum multiflorum for prematurely graying hair. Kloss89 said that Salvia will make hair grow when the roots are not destroyed and remove dandruff. Christopher listed Salvia as a general tonic and as a hair tonic. I often pair the aromatic bitters S. officinalis with Rosmarinus for hair loss in women. In my opinion, this pair can strengthen the Spleen and Liver to promote production of Blood. These herbs can also reduce hair loss from worry since in Chinese medicine, worry (and obsessive thoughts, excessive thinking, or excessive study) can reduce the Spleen function, resulting in reduction of Blood formation by the Spleen. Nervine tonic This action can have both physical and psychological aspects.
Physical aspects According to Tabernaemontanus, Salvia
SALVIA OFFlCINALlS (LEAF) ~
,
.Source
Psychological aspects Culpeper emphasized the stimulant and tonic effect of Salvia to quicken the senses and to treat heaviness and dullness of spirit, lethargy, ana poor memory. According to Grieve, Salvia was used in France to treat the physical and mental effects of grief. Both Kloss and Christ0pher noted a regulatory effect of Salvia on sexuality and recommended it both to tonify sexual debility and to calm excessive sexual desire. Tranquilizer This action can be considered in terms of two Chinese actions: • calms Heart Spirit • calms Liver Yang and Wind
Calms Heart Spirit Christopher listed Salvia for nervous overexitement and hysteria, Kloss said that it is 'very soothing and quieting to the nerves: and Tierra recommended it as a muscle relaxant for nervous tension. I use S. officinalis for restlessness, insomnia, anxiety, hot flashes and night sweats in menopause associated with Deficient Heart and Kidney Yin and Heart Deficiency Heat. Mailhebiau91 recom-
SALVIA MILTIORRHIZA (ROOn
Example of use
Source
Culpeper
insomnia and palpitations
Yeung88
Christopher
chest pain from Stagnant Blood
Benskyl1
warms the liver
Lonicerus Culpeper
pain in the ribs from Liver Stagnant Qi
Benskfl
good for the liver • Uterus
promotes menstruation, expels the dead child
Lonicerus
irregular menstruation, amenorrhea, dysmenorrhea
Chang & But
• Spleen, Stomach, and Intestines
epigastric distension, belching, flatulence
Bruneton
Benskfl
flatulent dyspepsia
BHP
pain in the epigastrium or abdomen from Stagnant Qi and Blood
Organ
Example of use
• Lung and surface
hoarse voice and cough
Culpeper
nasal catarrh, laryngitis, tonsillitis, pneumonia
Christopher87
dullness and heaviness of spirit overexcitement. hysteria. night sweats
.~ ----r;._'
• Heart 'i.,;i
• Liver <~_"i
01
681
:;;.
.. ,
.
682
Combining Western Herbs and Chinese Medicine
mended the oil of S. officinalis in aromatherapy to treat anxiety. mental excitation. and hyperemotional states. In my opinion. S. officinalis can be either calming or a stimulant to the nervous system. depending on the needs of the patient. These variable effects may be linked to the active constituents. For example. camphor can either stimulate the circulatory system and the central nervous system and produce feelings of exhilaration. or under different circumstances. it may produce drowsiness.92
Calms Liver Hyperactive Yang Culpeper recommended Salvia for headache due to cold. and Grieve recommended it for nervous headache. As already mentioned, Tabemaemontanus listed sage for vertigo, trembling. and palsy of the limbs that can be associated with Liver Wind in terms of Chinese medicine. Antihypertensive effects of both S. triloba and S. miltiorrhiza have been reported (see Research). Carminative and antispasmodic According to Tabemaemontanus, Salvia can strengthen and warm the stomach. remove dampness in the stomach, and increase the appetite. Felter and Uoyd wrote that it could treat flatulence with gastric debility. Christopher recommended it for indigestion and flatulence. and the BHP listed it as a carminative for flatulent dyspepsia. This herb has been used in Germany for inflammation of the intestinal mucosa in diarrhea. Hepatic Lonicerus said that Salvia warms the liver. and Culpeper recommended it for this organ. Both Kloss and Christopher recommended it for liver disorders. Emmenagogue Statements in the early texts illustrate the regulatory effect of Salvia on the female reproductive system. Culpeper quoted Pliny as saying that Salvia promotes menstruation but prevents the flow from coming down too fast. Gerard stated that Salvia could be used to prevent miscarriage by retaining the child, yet Culpeper listed Salvia as helpful in expelling the dead child. Tabemaemontanus wrote that cooked sage could induce menstruation when it is late and help with labor. This regulatory effect may be partially the result of a balance between the stimulatory action of thujone on the uterus and the astringent action of the tannins. Both Christopher and the BHP listed Salvia for reducing excessive milk flow. Mabey listed it for amenorrhea. dysmenorrhea. and menopausal hot flushes. Mailhebiau wrote that the oil of S. officinalis can be used in aromatherapy for amenorrhea, dysmenorrhea. (menopausal) hot flashes, and leukorrhea. Dioscorides suggested Salvia decoction in a warm bath to relieve genital itching. Expectorant Tabernaemontanus quoted Pliny as recommending Salvia for pleurisy and coughs. Culpeper recommended it for hoarse voice and cough, and Christopher listed it for nasal catarrh, laryngitis, and pneumonia. Mailhebiau
described the use of S. officinalis oil in aromatherapy~asan_::: ,_-"'":' expectorant in respiratory disorders. The expectorant action;· _. .of Salvia may be linked to its relatively high cineole content (see Research). Diuretic Both Dioscorides93 and Tabernaemontanus said that Salvia increases urination. and Lonicerus wrote that it helps with urinary retention. Both Kloss and Christopher recommended Salvia for kidney disorders. Tierra wrote that it can be very effective in the treatment of cystitis. a-Pinene occurs as 1-6.5% of the essential oil of S. officinalis and may be responsible for diuretic effects. Antimicrobial Culpeper wrote that Salvia 'cleanses foul ulcers: and both Christopher and the BHP listed it as an antiseptic. Astringent and antihemorrhagic Salvia has been listed as an astringent by Christopher, the BHP, and Tierra. However. although S. officinalis does contain tannins. it is not generally considered as a primary astringent or antihemorrhagic. and these applications are limited to specific situations. For example: • laryngitis • excessive sweating • excessive milk production • bleeding wounds
Laryngitis The BHP listed Salvia as a gargle or mouthwash for inflammations of the mouth and throat. However. its effectiveness for these disorders may derive mainly from its antimicrobial and anti-inflammatory actions, rather than from an astringent effect.
Excessive sweating The BHP also listed Salvia for hyperhidrosis, but its effectiveness in reducing excessive sweating may be due to its ability to clear Heat and tonifyY"m, Blood. or Defensive Qi. rather than to a direct astringent effect.
Excessive milk production The BHP listed Salvia for galactorrhea. but this may be due to a hormonal regulatory effect rather than to direct astringent action.
Bleeding wounds
Culpeper recommended Salvia to 'stay the bleeding of wounds' and this indication was repeated by Christopher. I cannot comment on its effectiveness, since I have not used Salvia for this purpose. I fmd Commiphora so effective in stopping external bleeding that I rarely use other herbs. Topical The BHP listed Salvia as a gargle or mouth wash for pharyngitis, stomatitis. gingivitis. or glossitis. The BHP also listed Salvia in combination with Potentilla or Gileadensis (poplar buds) as a gargle for throat conditions.
Salvia COMPARISON OF WESTERN AND CHINESE USE OF SALVIA SPECIES The data in the table below on S. miltiorrhiza is from Yeung and from Bensky and Gamble. From the table it can be seen that S. officinalis may have a greater effect at the surface of the body, for example in regulating sweating, treating muscle aches as a result of Wind Cold, and clearing Wind Heat from the throat. S. officinalis is more for calming Liver Hyperactive Yang, whilst both Salvias can calm Heart Spirit. However, S. officinalis is more for menopausal hot flashes and sweating, whilst S. miltiorrhiza is more for insomnia. S. officinalis is more for moving Qi, especially at the surface. S. miltiorrhiza, in contrast, is more for moving Blood, especially in the chest and abdomen. S. officinalis is specific for women's problems involving headache, hot flashes, sweating, or menstrual irregularities due to Qi Stagnation associated with nervous tension. S. miltiorrhiza is specific for menstrual irregularities or pain associated with Stagnant Blood. Summary of differences In summary, we can say that the leaves of S. officinalis are more related to the movement of
SALVIA OFACINAUS (LEAF) -, ..,. .-""
'
.c.;<
Qi, especially at the surface, whilst the roots of S. miltiorrhiza are more related to the moveme~t of Blood. The differences in actions and uses between the two species may relate to chemical differences: .
• S. officinalis leaves • S. miltiorrhiza roots
larger amounts of both monoterpenes and flavonoids the presence of tanshinones and other diterpenoid quinones
References 1. Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn.
Medpharrn, Stuttgart, Germany (1994), from 2nd German edn. Wichtl M (ed) (1989) 2. Grieve M. A Modern Herbal, vols. 1 and 2. Dover Publications, New York, New York (1971) 3. Dioscorides P. Kreutterbuch (1610). Reprinted by Verlag Konrad Kolbl, Miinchen, Germany (1960) 4. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks, Glenwood, Illinois (1990) 5. Christopher JR. School of Natural Healing. BiWorld, Provo, Utah (1976)
SALVIA MllTIORRHIZA (ROOT)
~.
Chinese actions. .,"
683
~',.,
",- i.~·J(;r~~C:1~:·,~)_:~ .. ,....
Clears Heat clears Heat Toxin and Wind Heat, for example, acute tonsillitis not so much used for high fever except with tonsillitis
clears Excess Heat (in Nutritive level) with high fever, subcutaneous bleeding, hemoptysis, epistaxis
clears Deficiency Heat, for example, hot flashes
clears Deficiency Heat; not listed for hot flashes, but rather for restlessness, irritability, and insomnia
Regulates the surface tonifies and regulates Defensive Qi, for example, for excessive sweating with debility clears Wind Cold, for example, muscular aches
Calms iI
calms Liver Hyperactive Yang, for example, headache calms Disturbance of Heart Spirit, for example, restlessness and nervousness, but not so much for insomnia
calms Disturbance of Heart Spirit, for example, insomnia and palpitations
Moves QI and Blood moves Liver Qi at the surface, for example, muscle aches, but not so much for hypochondriac pain
...
moves Liver Qi with Stagnant Blood, for example, hypochondriac pain, but not for aches at the surface moves Stagnant Blood, for example, chest pain
Regulates uterus premenstrual headache amenorrhea and dysmenorrhea with nervous tension, rather than Stagnant Blood
amenorrhea and dysmenorrhea with Stagnant Blood, rather than with nervous tension
retained placenta
retained placenta
684
Combining Western Herbs and Chinese Medicine
c~·:201i4~~ __-:__ ~~_~..:.:;,:,,·-~<;;.i.i!iiiiiiifrr~-;~
-'~:i!i:::
6. Unger R, Ruckenbauer Th, Jurenitsch Jet al. Sci Pharm 59:321 (1991)
35. Hosseinzadeh H, Larry P. Phytothcr Res 14(5):384-387 (2000) ?=-:::.::~~:
7. Gali-~uhtasib H, Hilan C. Khater C. J Ethnopharmacol71(3):513-520 (2000)
36. Wake G, Court J, Pickering A. J EthnopharmacoI69(2):105-114 (2000)
8. Foster S. Duke J. Medicinal Plants. Houghton Mifflin, Boston, Massachusetts (1990) 9. Moore M. Medicinal Plants of the Pacific West. Red Crane Books. Santa Fe. New Mexico (1993) 10. Chang H-M, But PP-H (eds). Pharmacology and Applications of Chinese Materia Medica, vols. 1 and 2. World Scientific Publishing. Singapore (1986)
-- ~
-.~:~~;:r~~-7
....
37. Perry NS, Houghton PJ, Sampson J et al. J PharmPharmacol 53(10): 1347-1356 (2001) 38. Gali-Muhtasib HU,Affara NI. Phytomedicine 7(2):129-136 (2000) 39. Zhejiang People's Academy of Health. Internal Information. (cited in Chang H-M. But PP-H (eds). Pharmacology and Applications of Chinese Materia Medica, vols. 1 and 2. World Scientific Publishing, Singapore (1986) J 40. Lee DS, Lee SH, Noh JG et al. Biosci Biotechnol Biochem 63(12):22362239 (1999)
11. Bensky D. Gamble A. Chinese Herbal Medicine Materia Medica. Eastland Press, Seattle, Washington (1986)
41. Ryu SY, Oak MH, Kim KM. Planta Med 65(7):654-655 (1999)
12. Bruneton J. Pharmacognosy: Phytochemistry Medicinal Plants. 2nd edn. Lavoisier. Paris, France (1999)
42. Zhongshan Teaching Hospital, Shanghai First Medical College. Pharmaceutical Industry (6):4 (1976)
13. Farhat GN. Affara NI. Gali-Muhtasib HU. Toxicon 39(10):1601-1605 (2001)
43. Shanghai Coordinating Research Group on Heart-Relaxant Tablet of Radix Salviae miltiorrhiza. Cardiovascular Diseases (1):5 (1974)
14. Santos-Gomes PC, Fernandes-Ferreira M. J Agric Food Chem 49(6): 2908-2916 (2001)
44. Shanghai Coordinating Research Group on Compound Salvia miltiorrhiza. Cardiovascular Diseases (1):1 (1974)
15. Djarmati Z et al. Phytochemistry 31:1307 (1992) 16. Brieskorn CH. Kapadia Z. Planta Med 35:376-378 (1979)
..._ ...•.•-'-.;.;.,;;... 45. Yang XY et al. Xinyiyaoxue Zazhi (Journal of Traditional. Chinese Medicine) (4):51 (1979)
17. Tada M, Takakuwa T, Nagai Met al. Agric Bioi Chern 54:3061-3063 (1990)
46. Physiology Section, Shanghai First Medical College etal. Chinese Journal of Internal Medicine (4):203 (1977)
18. Chiba K. Takakuwa T, Tada M et al. Biosci Biotech Biochem 56:17691772 (1992)
47. Xing ZQ, Zeng XC, Yi CT. Chung Ku() Chung Hsi I Chieh Ho TsaChih
19. Jalsenjak V, Peljnjak S, Kustrak D. Pharmazie 42:419-420 (1987)
48. Wei XD, Li 1., Bai J. Chung Kuo Chung His I Chieh Ho Tsa Cbib 17(6):
20. Janssen AM. Leiden: Rijksuniversiteit te Leiden pp 91-108 (1989) [cited in European Scientific Cooperative on Phytotherapy: Monographs on the medicinal uses of plant drugs. European Scientific Cooperative on Phytotherapy. Exeter. United Kingdom (1997) J
49. Zhang SF et al. Jiangsu Zhongyi (Jiangsu Journal of Traditional Chinese Medicine) (3):22 (1965)
21. Haznedaroglu MZ, Karabay NU, Zeybek U. Fitoterapia 72(7):829-831 (2001)
51. Shanghai Coordinating Clinical Research Group on Compound~ , ...~~.,.. miltiorrhiza 201. Chinese Traditional and Herbal Drugs Cornmunica~
22. Van Dyke TE, Braswell L, Offenbacher S. Agents Actions 19:376-377 (1986) 23. Ulubelen A. Oksuz S, Kolak U et al. Planta Med 66(5):458-462 (2000) 24. Ulubelen A. Topcu G. Johansson CB. J Nat Prod 60(12):1275-1280 (1997)
16(5):287-288 (1996) 336-338 (1997)
SO. Chen WZ et al.Acta Pharmaceutica Sinica 14(5):277 (1979)
,.
tions (1):37 (1978) 52. Emergency Room, Shuguang Teaching Hospital of Shanghai College of Traditional Chinese Medicine. Medical Research Communications (Information Unit of the Chinese Academy of Medical Sciences) (10): 26 (1974)
(Shan:d~hg··
25. Amabeoku GJ, Eagles P, Scott G et al. J Ethnopharmacol 75(2-3):117124 (2001)
53. Pathology Section. Yiyao Xuebao (Journal of Medicine)
26. Verweij-van Vught AMJJ, Appelmelk BJ. Groeneveld ABJ et al. Agents Actions 22:288-294 (1987)
54. Biochemisty-Coronary Vessels Research Unit, Human Physiology Department. Yiyao Xuebao (Journal of Medicine) (Shandong Medical
27. Rampart M, Beetens JR. Bult H et al. Biochem Pharmacol 35:13971400 (1986)
55. Liu DG. Selected Information of Scientific Research (Military Medical
28. Hernandez-Perez M, Rabanal RM. de la Torre MC et al. Planta Med 61(6):505-509 (1995) 29. Baricevic D. Sosa S. Della Loggia R et al. J Ethnopharmacol 75(23):125-132 (2001) 30. Todorov S, Philianos S, Petkov V. Acta Physiol Pharmacol Bulg 10(2): 13-20 (1984) 31. Romussi G. Ciarallo G. Bisio A et al. Planta Med 67(2):153-155 (2001) 32. Mayr JK.Arch Dermatol Syph 162:146-149 (1930)
Medical College) (1):62 (1975)
College) (2):17 (1974) College of the Chinese PLA) (6):69 (1974) 56. Coronary Disease Research Unit, Second Teaching Hospital et al. Zheyi Tongxun (Communications ofZhejiang Medical College) (5):11 (1975) 57. Biochemistry Department of the Basic Sciences Research Unit. Xiyuan Hospital of the Chinese Academy of Traditional Chinese Medicine et al. Xinyiyaoxue Zazhi (Journal of Traditional Chinese Medicine) (8):64 (1978)
33. Council of Europe. Plant Preparations Used as Ingredients of Cosmetic Products. 1st ed. Strasbourg, France (1989)
58. Emergency and Internal Medicine Departments, Shuguang Teaching Hospital of Shanghai College of Traditional Chinese Medicine. Medical Exchanges (Chinese Medical Association, Shanghai Branch) (1):16
34. De Leo V. Lanzetta D, Cazzavacca R. Minerva Ginecol 50(5):207-211 (1988)
59. Cheng J, Kuang P. Wu Wet al. J Trad Chin Med 19(2):135-140 (1999)
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Salvia 60. Liu J, Kuang P, Wu W etal. J Trad Chin Med 18(1):49-54 (1998) 61. Internal Medicine Department, 469th Airforce Hospital of the Chinese PLA. Liaoning Yiyao (Liaoning Medical Journal) 0 ):25 (1975) 62. Zhang HY et al. Acta Pharmaceutica Sinica 14(5):288 (1975) 63. Du G,Zhang I. Chin Med J 110(1):65-68 (1997) 64. Traditional Chinese Medicine Department, General Hospital of Beijing PLA Units et al. Xinyiyaoxue Zazhi (Journal of Traditional Chinese Medicine) (10):30 (1977) 65. Wasser S, Ho JM,Ang HK etal.J HepatoI29(5):76O-771 (1998) 66. Li X. Yao X, Li T. Chung Hua Nei Ko Tsa Chili 36(7):450-453 ( 1997)
r r r
1
67. Huang IT, Lee TY, Lin HC et al. Can J Physiol Pharmacol 79(7):566572 (2001) 68. Nan JX, Park EJ, Kang HC et al. J Pharm Pharmacol 53(2):197-204 (200l) 69. Jin H, Wang A, Wang Y. Chung Kuo Chung Yao Tsa Chili 22(4):236238,255-256(1997) 70. Zhang JR et al. Shanghai Zhongyiyao Zazhi (Shanghai Journal of Traditional Chinese Medicine) 0):17 (1978) 71. Liu J, Yang CF, Lee BLetal. Free Radic Res 31(6):559-568 (1999) 72. Liu J,Shen HM,Ong CN. Cancer Lett 153(1-2):85-93 (2000)
685 pean Scientific Cooperative on Phytotherapy, Exeter, United Kingdom (1997) 80. Blumenthal M (ed). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council, Austin, Te..xas (1998) 81. Chan K, Lo AC, Yeung JH et a1.
J Pharm Pharmacol 47(5):402-406
(1995) 82. Von Bingen H. Hildegard von Bingen's Physica. Healing Arts, Rochester,Vermont (1998) 83. Lonicerus A. Kreuterbuch (1679). Reprinted by Verlag Konrad Kolbl, Munchen, Germany (1962)
84. Tabernaemontanus n. Krauterbuch (1731). Reprinted by Verlag Konrad Keilbl, Miinchen, Germany (1993) 85. Gerard J. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publications, New York, New York (975) 86. Culpeper N. Culpeper's Complete Herbal and 'English Physician Enlarged. Meyerbooks, Glenwood, Illinois (1990) 87. Christopher JR. School of Natural Healing. BiWorld, Provo, Utah (1976) 88. Yeung H-C. Handbook of Chinese Herbs and Formulas, voL 1. institute of Chinese Medicine, Los Angeles, California (1985)
73. Millet Y, Tognetti P, Lavaire-Pierlovisi M. Rev EEG };europhysiol 9: 1218 (1979) 74. Von Skramlik E. Pharmazie 14:435-445 (1959) 75. Pinto-Scognarnigtio W. Boll Chim Farm 106:292-300 (1967) 76. Schirnmer O. Kriiger A, Paulini H et al. Pharmazie 49:448-51 (994) 77. Zani F, Massimo G, Benvenuti S et al. Planta ~ied 57:237-241 (991) 78. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983) 79. European Scientific Cooperative on Phytotherapy: Monographs on the Medicinal Uses of Plant Drugs (monograph on Salviae folium). Euro-
89. Kloss J. Back to Eden, 5th edn. (1939). Reprinted by Lifeline Books, Santa Barbara, California (1975) 90. Mabey R (ed). The Complete New Herbal. Elm Tree Books, London, United Kingdom (1988) 91. Mailhebiau P. Portraits in Oils. The C.W. Daniel Company, Saffron Walden. United Kingdom (1995) 92. Mills S. The Essential Book of Herbal Medicine. Arkana/Penguin Books, London, United Kingdom (1991) 93. Dioscorides P. Kreutterbuch (1610). Reprinted by Verlag Konrad Kolbl, Miinchen, Germany (1960)
\.
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I.
Sambucus Sambucus nigra 1.
Use in North America The Native Americans used infu-
Family Caprifoliaceae Pharmaceutical name Sambuci flos Part dried flowers English elder German Schwarzer Holunder French sureau noir Mandarin S. nigra 1. is not used; jie gil mil (~*;f;..) is the woody stem of S. williamsii Hance
sions of the inner bark of S. canadensis as an emetic, laxa-
Botanical name
Use in the West
Use in Europe
Sambucus nigra is a shrub indigenous to Europe, Western and Central Asia, and, West Africa that has had common use in Europe at least since the time of Dioscorides. However, the emphasis in British herbal practice on the use of the flowers is recent and may have occurred within the last 30 years. Grieve,' writing in 1931, described the uses of the bark, leaves, flowers, and berries, and older texts also described the use of the roots, green stems, young shoots,
tive, and diuretic, and made poultices of the inner bark for the pain and swelling ofboils.' Ellingwood listed the American elder, S. canadensis, and Felter and lloyd descnbed the uses of the flowers, berries, and inner bark of this plant. They wrote that the flowers of S. canadensis are diaphoretic in warm infusion and diuretic in cold infusion, and that the specific indication of this herb is for skin disorders. The European elder, S. nigra, was known to American herbalists of the late 19th century, ~ and the uses of the flowers, bark, and fruit were briefly described by Lyle.s However, S. nigra was not mentioned by Fox6 or Ellingwood,' and appeared only in a footnote in Felter and Lloyd. s The flowers of S. nigra and S. canadensis were not extensively used by the North America herbalists of the last 150 years, and neither Kloss9 nor Christopher 1o have entries for either species. Use in China S. nigra is not used in China, but jie gil mil, the
seeds, and even a fungus growing on the elder. Current British use of S. nigra seems to be mainly of the dried flowers as a diaphoretic for colds and influenza, and as an anticatarrhal and anti-inflammatory for rhinitis and sinusitis. However, according to Grieve, the flowers were also used in the past for bronchitis, pleurisy, scarlet fever, measles,
woody stem of S. williamsii, is used to clear Wmd and Damp, and to treat rheumatism, lumbar pain, and edema. I I
and other eruptive diseases, and as a lotion for skin disor-
In terms of Chinese medicine, Sambucus, as used in the
ders. In France the flowers are traditionally used as a diuretic and as an adjunct in weight loss programs. 2
West, can be said to be a cool, acrid, and slightly bitter herb
What is special about Sambucus
that has its main effects on the Lung.
687
Combining Western Herbs and Chinese Medicine
688
The key to understanding Sambucus is that it is a diaphoretic and anticatarrhal agent with specific action on the nose and sinuses. CHINESE ACTIONS In terms of Chinese medicine, Sambucus, as used in the West, can be said to have two main actions:
TYPICAL CASE EXAMPLE
..•. ,~
'-.--_.
••
~4
Signs and symptoms The patient has acute influenza with fever and nasal obstruction and a history of recurring rhinitis and sinusitis. During the acute influenza stage, the pulse is superficial, tight, and slightly slippery. At other times, it tends to be slippery, especially in the Lung position. The tongue is more or less normal, but tends to have a greasy coat.
1. clear Wmd Heat n. clear Lung Phlegm Clear Wmd Heat Elder flowers are specific for Wind Heat patterns. However, in suitable combination, for example, with Zingiber, they can also be used to clear Wind Cold and Damp. Clear Lung Phlegm Sambucus can clear Lung Phlegm from the nose and sinuses, whether the Phlegm is associated with Heat or with Cold and Damp, depending on the herbs with which it is combined.
Diagnosis The patient has acute Wind Heat invasion associated with the influenza and tends to accumulation of Phlegm in the Lung, especially in the sinuses. Choice of Sambucus This herb is specific for acute Wind Heat invasion with Phlegm in the nasal area and for recurring rhinitis and sinusitis with accumulation of Phlegm.
LlinrtationsofSarnbucus
WESTERN ACTIONS
TEMPERATURE
The main Western actions of Sambucus are shown here in terms of its two main Chinese actions:
In this book, Sambucus is classified as cool, associated with its antipyretic and anti-inflammatory actions. However, colder herbs such as Asclepias would be required if the fever
Chinese actions
__ •
.. Western actions
I. clear Wind Heat
II. clear Lung Phlegm
<
diaphoretic anticatarrhal anti·inflammatory antiallergic anticatarrhal anti·inflammatory
WESTERN USES The main Western uses of Sambucus can be related to its two main Chinese actions:
were other than mild.
TASTE Sambucus is classified as acrid and slightly bittedn this' book, associated with its diaphoretic and anti-inflammatory actions, respectively. However, in my opinion, its acrid property to clear Exterior Wind is not as strong as Achillea, for example, and the Heat-clearing aspect of its bitter property is also relatively mild.
ACTIONS
'Chineseactions .... ,. , I. clear Wind Heat
colds, influenza, rhinitis, allergic rhinitis
II. clear Lung Phlegm
acute or chronic sinusitis, sinusitis with catarrhal deafness
Diaphoretic and antipyretic In my opinion, the diaphoretic and antipyretic actions of Sambucus are of secondary importance compared to its effect on the nasal area. Anti-inflammatory and antiallergic agent Sambucus is a herb of choice for inflammatory or allergic disorders of the nose and sinuses, but not for inflammatory or allergic disor-
DIRECTION OF ENERGY
ders of other systems.
In terms of Chinese medicine, the diaphoretic action resulting from hot infusions of Sambucus can assist an outward movement of the Qi towards and through the surface to clear Wind invasion. However, there is also an old tradition of use that describes the diuretic (downward) effect of cool infusions of this herb.
Anticatarrhal Sambucus is specific for catarrhal conditions of the mucous membranes of nose, sinuses, and Eustachian tubes, but not for catarrhal conditions of other systems. Alterative and dermatological agent There is a tradition of use for the flowers of both European elder and American
•
Sambucus
r
elder both internally and topically for skin disorders. However, I do not have experience in this area.
689
ness. Both are cool anticatarrhal and anti-inflammatory herbs that can clear Wmd Heat and Lung Phlegm. Sambucus + Echinacea
Sambucus paired with other herbs Discussion of the limitations of each of the main actions of Sambucus can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Sambucus beyond its limitations. The basic unit of herb combination is the herb pair. Six pairings of Sambucus are briefly explained below.
,
CAUTION
L
Before using any of the herb pairs below, it is important to be familiar with the cautions listedfor each herb in the pair. Sambucus + Zingiber
Influenza, sinus congestion, and chills
Sinusitis + infection Whilst Sambucus is a herb that is mainly limited in its application to the nasal area, Echinacea can have a wide range of use. It is an antimicrobial, anticatarrhal, anti-inflammatory, and antiallergic agent that can be used for congestion, infection, and inflammation of the nose and sinuses. Sambucus + Hydrastis
Sinusitis + gastritis Hydrastis can have strong antimicrobial, anti-inflammatory, and anticatarrhal action on the mucous membranes of the nose and sinuses. In Chinese terms, it can be used in cases of sinusitis associated not only with Heat in the Lung, but also Heat in the Stomach. Hydrastis and Sambucus can be paired for sinusitis with yellow, purulent, or bloody discharge, bad breath, and maybe gastritis and thirst.
Although Sambucus is a cool herb specifically for Wmd Heat invasion, in combination with Zingiber, it can be used for acute patterns of Wind Cold and Damp and for chronic patterns of Lung Phlegm Cold and Damp. Sambucus + Ephedra Allergic rhinitis Although Ephedra is classified as warm and Sambucus as cool, both herbs are specific for allergic rhinitis and can be used for this disorder, whether it is associated with patterns of Heat or Cold, in combination with appropriate herbs. Sambucus + Achillea
Influenza + sinus congestion i
. ..J!J
•
.._.JM
Achillea is the primary diaphoretic and antipyretic for influenza and fever. Sambucus supports these actions of Achillea and has its primary effect as an anticatarrhal and anti-inflammatory for the nose. This pair is most effective when the patient drinks copious amounts of hot infusion, wraps up warmly and retires to bed. Since the dominant herb, Achillea, is of variable temperature, this pair can be used for patterns of Wind Heat or Wind Cold, in appropriate combination with other herbs.
Sambucus combinations Four Sambucus combinations are discussed below: .Combination 1. influenza + sore throat
Wind Heat
2. influenza + sinusitis
Wind Cold Damp
3. acute allergic rhinitis
Wind Heat
4. chronic sinusitis
Lung Phlegm Heat
CAUTION
Before using any ofthe combinations below, it is important to be familiar with the cautions listed for each herb in the combination. 1. Influenza + sore throat
Wind Heat Herb' . Achillea
Sambucus + Euphrasia
Mentha pip.
Sinusitis
Sambucus
Both herbs are specific for the nasal area and can be used for acute or chronic rhinitis or sinusitis, or catarrhal deaf-
Tast~:;·::·;~~~~~~:·,:
Daily dose
Temperature
6g 3g 3g
warm-cool
acrid, bitter
warm-cool cool
acrid, aromatic acrid, sl. bitter
This combination is the same as Achillea: influenza + sore throat and is discussed under that heading.
690
Combining Western Herbs and Chinese Medicine
2. Influenza + sinusitis
Wind Cold Damp Sambucus Herb Achillea Angelica arc. Sambucus Euphrasia Zingiber
Daily dose
Temperature
3g 3g 3g. 3g
warm-cool warm cool neutral-cool hot
3 slices
Taste· acrid, bitter aromatic, bitter, acrid acrid, sl. bitter acrid, sour. bitter acrid, aromatic
This combination is the same as Achillea: influenza + sinusitis and is discussed under that heading. 3. Acute allergic rhinitis
Wind Heat
Euphrasia Ephedra Urtica Echinacea Sambucus Glycyrrhiza
1 1 1 1 1
neutral-cool warm warm-cool cool cool neutral-cool
0.5
acrid, sour, bitter acrid, sl. bitter acrid acrid, bitter, sl. sweet acrid, sl. bitter sweet
This combination is the same as Euphrasia: acute allergic rhinitis and is discussed under that heading.
Lung Phlegm Heat
Euphrasia Echinacea
Temperature
1 1 1 1 1 1 1
Sambucus Hyssopus Hydrastis Glechoma Phytolacca
neutral-cool cool cool warm-cool cool
acrid, sour, bitter acrid, bitter, sl. sweet acrid, sl. bitter acrid, aromatic bitter
neutral cool
sour, bitter acrid
This combination is the same as Euphrasia: chronic sinusitis and is discussed under that heading.
COMPARISON OF THE FOUR SAMBUCUS COMBINATIONS 1. Influenza + sore throat
2. Influenza + sinusitis
Wind Heat
Wind Cold Damp
.
Herb Achillea Mentha
.":;,t:J.:,""
:"'t'·· ,;';~'~':' "'\.:' '. \.,.. :,', .
'-DailyDose .
,'"
",
6g 3g
'.
~;
,
Achillea Angelica arc.
3g 3g
3 slices
3. Acute allergic rhinitis
4. Chronic sinusitis
Wind Heat
Lung Phlegm Heat Ratio
Herb EUJ::hrasia Echinacea
Echinacea Sambucus
1 1 1 1 1
Glycyrrhiza
0.5
Glechoma
Ephedra Urtica
Taste -
3g
2. Combination No.2 differs from combination No.1 by being specifically directed to the sinuses and head. The previous combination is especially for Wind Heat, whilst the warming and drying herbs Angelica and Zingiber make this combination more appropriate for sinusitis with Wmd, Cold, Damp, and Phlegm. Achillea, Euphrasia, and Sambucus help to clear Phlegm from the head and sinuses.
Euphrasia
Ratio
3g
1. This infusion is an excellent general diaphoretic. antipyretic, and anticatarrhal combination. Achillea is the primary herb and the strongest diaphoretic and antipyretic of the three. Sambucus emphasizes the anticatarrhal action of Achillea and directs its action toward the sinuses. Mentha has an anti-inflammatory action on the throat and a carminative action on the digestive system. In addition, both Achillea and Mentha can assist the liver function in order to speed recovery.
Herb
4. Chronic sinusitis
Herb
Sambucus Euphrasia Zingiber
3g
Sambucus Hyssopus Hydrastis Phytolacca
1 1 1 1 1 1 1
3. All the herbs in this acute allergic rhinitis combination can be used for acute allergic conditions involving rhinitis and/or conjunctivitis. Ephedra is included despite its warm temperature since it can be the most powerful of the antiallergenic herbs. Euphrasia and Sambucus are specific for rhinitis, and the anti-inflammatory and anticatarrhal actions of these herbs are supported by Echinacea and Urtica. Echinacea may contribute antiviral and antibacterial effects as well. 4. This chronic sinusitis combination contains Euphrasia and Echinacea like the previous combination, but does not contain Ephedra, Sambucus, and Urtica for Exterior Wmd.lnstead, this combination contains Sambucus, Hyssopus, Phytolacca, Glechoma, and Hydrastis, which can combine to treat chronic nasopharyngeal catarrh. Hyssopus and Glech-
'0;.:•.;:
Sambucus
t
oma also have expectorant action. Thus, this combination can be used for upper respiratory catarrh accompanied by some lower respiratory congestion. The previous combination is for problems of the nose and eyes, whilst this combination is for disorders of the nose and bronchi.
OTHER SAMBUCUS COMBINATIONS The following additional combination further illustrates the range of uses of Sambucus:
• Euphrasia: catarrhal deafness
691
Sambucus herb extracts The flowers of S. nigra have many potentially active constituents, and little is known of the mechanism of the actions of this herb. The following effects have been reported for preparations of different Sambucus species: • antiviral • diaphoretic • anti-inflammatory and analgesic • antidiabetic • antiosteoporotic
Antiviral A S. racemosa branch tip extract was reported as active against respiratory syncytial virus. 18
Research CONSTITUENTS The following constituents have been reported: • flavonoids • phenolic acids • other Flavonoids
Diaphoretic An increase in the response of sweat glands to heat stimuli has been reported for preparations of S. nigra,19,10 but some authors have questioned whether this effect was simply due to the intake oflarge amounts of hot fluid. 14
Anti-inflammatory and analgesic A moderate anti-inflammatory effect has been reported for S. nigra in animals,2\ and both anti-inflammatory and analgesic actions have been reported in rats using extracts of S. edulis rhizome. 22
These may be up to 3% \2 and are mainly: 13
Antidiabetic An aqueous extract of S. nigra was found to • flavonol glycosides, especially rutin (about 1.5%), and also isoquercitrin and astragalin • free aglycones such as quercetin ana kaempferol
have insulin-releasing and insulin-like activity in rodent tissue in vitro. 23
Antiosteoporotic An antiosteoporotic effect has been rePhenolic acids Chlorogenic acid (3-caffeoylquinic acid) may be up to 3% and p-coumaric and caffeic acids are also present. 14 Other Sambucus also contains: • essential oil (0.05-0.2%) of thick consistency because of the large amount of free fatty acids such as palmitic acid ls • triterpenes, about 1% of a- and ~-amyrin occurring mainly as fatty acid esters l6 l6 • triterpene acids, about 0.85%, mainly ursolic acid tannins l7 l7
• mucilage • minerals (8-9%), especially potassium I; • sterols (about 0.1 %), mainly sitosterol, stigmasterol, and campestero1'6
ported for rodents, in vitro and in vivo, using extracts of the stems of S. sieboldiana.24 Chlorogenic add Chlorogenic acid is a condensation product of caffeic acid and quinic acid. Such caffeic acid esters of quinic acid are also known as caffeoylquinic acids, and some of them have been called pseudotannins. Whilst the following effects have been reported for chlorogenic acid as an isolated chemical, it is not yet known whether these effects would also be produced by therapeutic doses of infusions or tinctures of S. nigra flowers: • antiatheroma • antioxidant • antitumor • cardioprotective and anti-ischemic
Antiatheroma Prevention of atherosclerosis formation by PHARMACOLOGICAL AND
chloragenic acid was reported from in vitro studies with human vascular endothelial cell cultures. 25
CLINICAL RESEARCH
"
This is discussed under three headings: • Sambucus herb extracts • chlorogenic acid • rutin
Antioxidant Chlorogenic acid was reported to be partially responsible for the antioxidative effects of water-soluble extracts of Cynara (globe artichoke) against hydroperoxideinduced oxidative stress in cultured rat hepatocytes. 26 In vitro and in vivo rat studies demonstrated that chlorogenic
Combining Western Herbs and Chinese Medicine
692
acid can protect against paraquat-induced oxidative stress. 27 Investigation of the antioxidant activity, such as scavenging of superoxide anion radicals, of chlorogenic acid isomers
Antiatheroma According to an animal study, rutin,can~,.·'"~~~'.~-
showed that the different isomers investigated had almost the same antioxidant activity.28
oxygen radical scavenger,40 a 6 week, randomized. placebocontrolled trial reported that supplementation of humans with 500 mg of rutin did not produce significant change in
Antitumor CWorogenic acid was-found to: • reduce glandular stomach carcinogenesis induced by N-methyl-N-nitrosourea in rats29 • reduce the development of azoxymethane-induced colon carcinogenesis in rats30 • induce cytotoxicity in human oral tumor celllines31 • reduce carcinogenesis induced in the rat tongue by 4-nitroquinoline-l- oxide3Z,33
.,=.~.
reduce cholesterol-induced atheroma.41
Antioxidant Although rutin has been reported to be an
plasma antioxidant status. 42
AntiosteopoTotic Rutin and/or its metabolites were reported to inhibit ovariectomy-induced trabecular bone loss in rats, both by slowing down bone resorption and by increasing osteoblastic activity.43
Antitumor Rutin showed moderate reduction ofandrogenindependent human prostate tumor cell proliferation.4-l
• prevent the genotoxicity of monocWoramine in gastric mucosa34
Cardioproteetive and anti-ischemic One study reported that the cardiovascular protective effects of chlorogenic acid may involve the direct protection of human low density lipoprotein or alpha-tocopherol from oxidation. 35 Rutin Rutin, also known as quercetin-3-rutoside, is a flavonoid glycoside, with quercetin as the aglycone, combined with rhamnose and glucose sugar units. As with cWorogenic acid, whilst the following effects have been reported for rutin as an isolated chemical, it is not yet known whether these effects would also be produced by therapeutic doses of infusions or tinctures of S. nigra flowers: • vascular protective • antiatheroma • antioxidant • antiosteoporotic
RESEARCH VERIFICATION OF TRADITIONAL ACTIONS The diaphoretic and anti-inflammatory traditIonal ac-
':'"-,.
tions have been supported by research. Additional effects demonstrated by research
The follow':'
ing effects have been reported as discussed above: • extracts of parts of Sambucus species: antiviral, analgesic, antidiabetic, and antiosteoporotic • cWorogenic acid: antiatheroma, antioxidant, cardio- "." ...
protective, and antitumor
.....
• rutin: vascular protective, antiatheroma, antioxidant, and antitumor These additional reported effects would suggest that Sambucus flowers are an underused resource that would be worthwhile researching further.
• antitumor
Vascular protective Rutin was thought to improve capillary function by reducing abnormal leakage and was given to relieve capillary impairment and venous insufficiency of the legs, and to treat hemorrhoids. 36 When it was discovered that natural rutin is poorly absorbed by the body, more easilyabsorbable synthetic rutosides were developed. These have been reported to improve capillary permeabilitf7 and to be effective at treating venous insufficiency38 and venous hypertension. 39 However, rutin is now known to be broken down by intestinal bacteria to the aglycone quercetin and then to the antioxidative phenol 3,4-dihydroxyphenylacetic acid. 40 It is therefore possible that rutin's breakdown products may be responsible for the effects seen with orally administered rutin.
'-'.-
.~-~;,;~~~~.~:,;..~~;;;~:~:.
TOXICOLOGY Dried herb
No contraindications, side-effects, overdose
effects, toxic effects. or herb-drug interactions are listed by the BHC,45 the German Commission E monograph,46 or the Botanical Safety Handbook47 for the flowers of S. nigra. Isolated chlorogenic acid I have not found data on the toxicology of chlorogenic acid. To the contrary, there are several reports of antioxidant and antitumor effects by this chemical, as discussed above. Isolated rutin
A 6-week randomized, single-blind, place-
bo-controlled clinical trial using 500 mg of rutin supplement did not induce any adverse changes in blood chemistry or indices ofliver function. 42
~:.'.
Sambucus
693
Traditional sources
Dose Dried herb The BHC listed 3-5 g of the dried flowers (preferably taken in a hot infusion), three times per day. Tincture The BHC listed 10-25 ml of 1:5 tincture (25% ethanol), three times per day. I have never prescribed such a large dose of a tincture of Sambucus as a single herb. On those occasions when I prescribe Sambucus as tincture rather than as hot infusion, I generally use Sambucus in a combination of about five herbs. so that each individual 5 ml dose of the combination tincture will contain about 1 ml of Sambucus tincture. If 10 ml of the combination tincture is taken, this gives 2 ml of Sambucus tincture per individual dose. Initial dose
I start at my standard dose but cannot com-
ment on the higher doses listed by the BHC. Duration I am not aware of restrictions on the duration of prescription.
Cautions
berries, and seeds. Lonicerus 49 mentioned the use of the roots, green bark, leaves, berries, and flowers. Tabernaemontanus SO mentioned these and the use of a fungus that grows on the elder, Hirneola auricula (jew's ear). Gerard;l and Culpepef'i2 mentioned the use of the flowers, but gave them relatively little emphasis.
PROPERTIES Temperature Lonicerus and Tabernaemontanus described elder as warm and dry, but whether this classification applies to the flowers is not clear. Gerard quoted Galen as classifying the various parts of the elder, including the flowers, as drying and warming. The main text referred to in the Chinese Herbal Medicine Dictionary listed jie gil inil, the woody stem of S. williamsii, as neutral, but one subsidiary text cited classified it as cold. The flowers of S. nigra are described in this book as cool because of their use as antipyretics and anti-inflammatories in Western tradition.
Western contraindications None are known.
Taste
Chinese contraindications None are known for the flowers
Taste in the mouth The BHpS3 described the taste of the
ofS. nigra.
flowers of S. nigra as mucilaginous and slightly bitter, whilst
Pregnancy and lactation No adverse effects are known for the flowers of S. nigra. The woody stem of S. williamsii (jie gii mil) is contraindicated in the Chinese Herbal Medicine
they are listed in the Wichtl monograph as mucilaginous and sweet. I found the odor of a sample of the dried flowers to be slightly sweet and of a 1:5 tincture of the dried flowers in 25% alcohol to be strongly sweet. The taste of the dried sample was acrid, slightly bitter, and mucilaginous. The taste of
Dictionary during pregnancy. Ability to drive and use machines Side effects
None are known.
Overdose
No adverse reports.
No adverse reports.
Interactions No adverse reports.
.U
Dioscorides-lS described the use of the roots, twigs, leaves,
Regulatory status Please read the Regulatory status section in the chapter on Safety. Sambucus (elder) is on the UK General Sale List and is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Sambucus is not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
the tincture was sweet and somewhat mucilaginous, slightly acrid, slightly bitter, and slightly sour.
Taste properties The flowers of S. nigra are classified in this book as acrid and slightly bitter. The Chinese Herbal Medicine Dictionary listed jie gii mil, the woody stem of S. williamsii, as sweet and bitter.
ORGANS In terms of Chinese medicine, the flowers of S. nigra, as used in the West, can be associated with the Lung, and there is a tradition of use for skin disorders and edema: .r-
Organ<;;Lung
~_'::~·.;l·.';
Sourse,;f;;j influenza, sinusitis
BHP
bronchial disorders
Grieve
Combining Western Herbs and Chinese Medicine
694
Source·
Organ Skin
sunburn measles. chicken pox chapped hands
Culpeper Lyle Grieve
Kidney
edema
Bruneton
The Chinese Herbal Medicine Dictionary did not ·list the meridians entered by jie gu mil, the woody stem of S. williamsii. ACTIONS The following traditional actions are discussed: • diaphoretic and antipyretic • anti-inflammatory and anticatarrhal • alterative and dermatological agent • diuretic • other Diaphoretic and antipyretic The use of elder flowers for fever may be of relatively recent origin since it was not discussed by Dioscorides, Lonicerus, Tabernaemontanus, Gerard, or Culpeper. In 1897, Lyle wrote that the flowers of S. nigra have a mild, diffusive, relaxing, and diaphoretic action. These words were later repeated by Priest and Priest, 54 who also wrote that Sambucus is indicated for children subject to frequent febrile reactions. He recommended a combination of Sambucus with Achillea and Anemone for fever with hot dry skin, and a combination of Sambucus with Salvia officinalis for weakening night sweats. According to Grieve, elder flowers were used as a diaphoretic for colds and influenza, and were also used for scarlet fever and measles. Most modern texts mention the use of hot elder flower infusion for feverish colds or influenza.2.14.53.55 Anti-inflammatory and anticatarrhal According to Gerard, elder flowers were used in fomentations to treat inflammation and to ease pain, for example, one old text mentioned a fomentation for the pain of hemorrhoids. Felter and Lloyd recorded the use of elder flowers for catarrhal nasal obstructions of infants, and Grieve listed it for bronchitis and pleurisy. The BHP indicated Sambucus for sinusitis and for chronic nasal catarrh with deafness. Alterative and dermatological agent Dioscorides wrote that elder berries simmered in wine could be used for heattype swellings of the eyes, boils, and gout. Grieve noted that elderberry preparations had been used in the past as an alterative for rheumatism and syphilis. Lyle wrote that the flowers of S. nigra are an excellent addition to alterative combinations, and his words were later
repeated by Priest and Priest, who recommended elder flowers for eczema and dermatitis. Felter and Lloyd also mentioned the alterative action and listed the use of the flowers of S. canadensis for skin disorders and rheumatism. Culpeper recommended elder flower water for freckles and sunburn, and for red and bloodshot eyes. According to Grieve, a century ago, elder flower water was in common use by women to clear the complexion, and elder flower lotion was also used to treat skin disorders, boils, and tumors. Grieve as well as Felter and Lloyd recorded the use of an ointment of the flowers for wounds, burns, and scalds. Diuretic One of the main uses of the various parts of elder by Dioscorides, Lonicerus, Tabernaemontanus, Gerard, and Culpeper was as a diuretic for edema. According to Grieve, the bark of S. nigra has been used as a diuretic for cardiac and renal edema. Both the BHC and Bruneton listed a tradition of use of elder flowers as a diuretic. Other
Laxative According to Grieve, the bark of S. nigra can have a strong purgative action and has been used for this purpose since the time of Hippocrates. Lyle, Grieve, Priest and Priest, Wichtl, and Bruneton mentioned a gentle laxative action for the flowers of S. nigra.
Digestive tonic Both Gerard and Tabernaemontanus mentioned the use of a vinegar extract of elder flowers to stimulate the appetite, and Tabernaemontanus said that this can dissolve the viscous phlegm in the body. COMPARISON OF WESTERN AND CHINESE USE OF SAMBUCUS SPECIES The data in the table on jie gu mil (next page, top) are from the Chinese Herbal Medicine Dictionary. Whilst there is slight overlap of use, in that both traditions have at some time used their respective herbs for measles, skin rashes, rheumatism, and edema, the traditions are very different. The flowers of the Western species are primarily used for influenza and/or nasal catarrh, and this use is not mentioned for jie gu mil. Also, jie gil mil has been used in China for painful Stagnant Blood patterns such as trauma, lumbar pain, and bone fractures; in the West, this use is minimal.
References 1. Grieve M. A Modern Herbal. vols. 1 and 2. Dover Publications. New
York. New York (1971) 2. Bruneton
J. Pharmacognosy: Phytochemistry Medicinal Plants, 2nd
edn. Lavoisier. Paris. France (1999)
Sambucus
695
WESTERN USES
CHINESE USES
S. nigra or S.
S. williamsii woody stem Oie gu mil)
canadensis flowers
20. Schmersahl KJ. Naturwissenschaften 51:361 (1964) 21. Mascolo N, Autore G, C~passo F et al. Phytother Res 1:28-31 (1987)
Actions diaphoretic, antipyretic
fever in colds or influenza. (past use for eruptive diseases)
anti-inflammatory, antiallergenic, anticatarrhal
acute or chronic rhinitis or sinusitis, maybe with catarrhal deafness
analgesic
22. Ahmadiani A, Fereidoni M, Semnanian S et al. J EthnopharmacoI61(3):229-235 (1998)
measles
23. Gray AM, Abdel-Wahab YH, Flatt PRo J Nutr 130(1):15-20 (2000) 24. Li H, Li J, Prasain JK et al. Bioi Pharm Bull 21(6):594-598 (1998) lumbar pain, pain and swelling from injuries, bone fractures
alterative, dermatological agent
skin disorders. rheumatism (secondary use)
rashes, itching, rheumatism (Wind Damp)
diuretic
edema (secondary use)
edema
25. Chang C, Chen J, Wong H. Zhonghua Yu Fang Yi Xue Za Zhi 35(2):79-82 (2001) 26. Gebhardt R. Toxicol Appl Pharmacoll44(2): 279-286 (1997) 27. Tsuchiya T, Suzuki 0, Igarashi K. Biosci Biotechnol Biochem 60(5):765-768 (l996) 28. Nakatani N, Kayano S, Kikuzaki H et al. J Agric Food Chern 48(11):5512-5516 (2000)
3. Foster S, Duke J. Medicinal Plants. Houghton Mifflin, Boston, Massachusetts (1990)
29. Shimizu M, Yoshimi N, Yamada Y et al. J Toxicol Sci 24(5):433-439 (1999)
4. Crellin JK, Philpott J. A Reference Guide to Medicinal Plants. Duke University Press, Durham, North Carolina (1990)
30. Mori H, Kawabata K, Matsunaga K et al. Biofactors 12(1-4):101-105 (2000)
5. Lyle TJ. Physio-Medical Therapeutics. Materia Medica and Pharmacy. Originally published Ohio (1897). Reprinted by National Association of Medical Herbalists of Great Britain, London, United Kingdom (1932)
31. JiangY.Kusama K,Satoh Ketal. Phytomedicine 7(6):483-491 (2000)
6. Fox W. The Working Man's Model Family Botanic Guide to Health,7th edn. William Fox, Sheffield, United Kingdom (l878) 7. Ellingwood F. American Materia Medica, Therapeutics and Pharmacognosy,l1th edn. (1919). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1994) 8. Felter HW, lloyd JU. King's American Dispensatory, vols. 1 and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1983) 9. Kloss J. Back to Eden, 5th edn. (1939). Reprinted by Lifeline Books, Santa Barbara, California (1975) 10. Christopher JR. School of Natural Healing. BiWorld, Provo, Utah (1976) 11. Jiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science and Technology Press, Shanghai, China (1975) 12. Davidek J. Nature 189:487-488 (1961) 13. Radu A, Tamas M, Otlacan A. Farmacia (Bucharest) 24:9-15 (1976) through Chern Abstr 85:74954 (1976) 14. Bisset NG (ed). Herbal Drugs and Phytopharrnaceuticals. English edn. Medpharm, Stuttgart. Germany (1994), from 2nd German edn. Wichtl M (ed) (1989) 15. Toulemonde B, Richard HMJ. J Agric Food Chern 31:365-370 (1983) 16. Willuhn G,RichterW. Planta Medica 31:328-343 (1977) 17. Steinegger E and Hansel R [TI3) (1988). [cited in Bradley PR (ed). British Herbal Compendium. vol. 1. British Herbal Medicine Association, Bournemouth, United Kingdom (1992)] 18. McCutcheon AR, Roberts TE, Gibbons E et al J Ethnopharmacol 49 (2):101-110 (1995) 19. Wiechowski W. Med Klin 23:590 (1927)
32. Tanaka T. Kojima T.Kawamori T et al. Carcinogenesis 14(7):1321-1325 (1993) 33. Kasai H, Fukada S, Yamaizurni Z et al. Food Chern ToxicoI38(5):467471 (2000)
34. SJlibata H, Sakamoto Y. Oka M et al. Biosci Biotechnol Biochem 63(7): 1295-1297 (1999) 35. Zhangz'Chang Q,ZhuM et al. J Nutr Biochem 12(3):144-152 (2001) 36. Reynolds EFJ (ed). Martindale: The Extra Pharmacopoeia, 31st edn. Royal Pharmaceutical Society, London, United Kingdom (1996) 37. Wismer R. Praxis 52:1412 (1963) 38. Fitzgerald D. Practitioner 198:406 ( 1967) 39. BalcaroG,RuloA,CandianiC.Vasa 18(2):146-151 (1989) 40. Mills S. Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone, Edinburgh, United Kingdom (2000) 41. Leung Rl. Rutin. In: Leung AY (ed) Encyclopedia of Common Natural Ingredients Used in Food, Drugs and Cosmetics. John Wiley. New York, New York (1980) 42. Boyle SP. Dobson VI., Duthie SJ et al. Eur J Clin Nutr 54(10):774-782 (2000)
43. Horcajada-Molteni MN, Crespy V, Coxam V et al. J Bone Miner Res 15(11):2251-2258 (2000) 44. Knowles LM. Zigrossi DA. Tauber RA et al. Nloltr Cancer 38(1):116-122 (2000)
45. Bradley PR (ed). British Herbal Compendium, vol. 1. British Herbal Medicine Association. Bournemouth, United Kingdom (1992) 46. Blumenthal M (ed). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin. Texas (1998) 47. McGuffin M, Hobbs C, Upton R et al. American Herbal Products Association's Botanical Safety Handbook. CRC Press, Boca Raton, Florida (1997)
696
Combining Western Herbs and Chinese Medicine
.c::~_:~~~ 7":.:~-S:.~~:'
.
48. Dioscorides P. Kreutterbuch (1610). Reprinted by Verlag Konrad Kolbl, MUnchen.Germany (1960) 49. Lonicerus A. Kreuterbuch (1679). Reprinted by Verlag Konrad Kolbl. MUnchen, Germany (1962) 50. Tabernaemontanus JT. Krauterbuch (1731). Reprinted by Verlag Konrad Kolbl. MUnchen, Germany (1993) 51. Gerard J. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publications, New York, New York (1975)
'i:.;>ffi.~"'';;;7
52. Culpeper N. Culpeper's Complete Herbal and English Physician-::=d'~~"'-~_ Enlarged. Meyerbooks, Glenwood, Illinois (1990) - -53. British Herbal Pharmacopoeia. British Herbal Metlicine Association. West Yorks. United Kingdom (1983) 54. Priest AW, Priest LR. Herbal Medication. L.N. Fowler. Romford Essex. United Kingdom (1982)
55.
Tierra M. Planetary Herbology. Lotus Press. Twin Lakes, Wisconsin (1988)
""'-·-1
Sarothamnus Botanical name
, \~
Sarothamnus scoparius (1.)
Wimmer ex Koch Family
Fabaceae (previously included in Papilionaceae)
Pharmaceutical name Cytisi scoparii flos, Spartii scoparii herba, Scoparii herba, Genistae scopariae herba Part dried leaves, flowers, or aerial parts with flowers English
Scotch broom
German
Besenginster
French
combination listed by TabernaemontanusS to strengthen the heart. In 1853, Stenhouse extracted and identified the alkaloid sparteine from Sarothamnus, and Felter and Lloyd 6 reported in i898 that both Sarothamnus and sparteine were used to regulate heart action and to produce diuresis. They recorded the use of sparteine in the treatment of cardiac weakness, cardiac arrhythmia, palpitations, cardiac asthma, and cardiac edema. Sarothamnus is now mainly used in Britain for cardiac weakness with hypotension and palpitations, cardiac edema, and tachycardia. 7
genet abalai
Mandarin:
S. scoparius 1. is not used
Part used The part of Sarotharnnus used in herbal mediUse in the West Sarothamnus scoparius is a bushy shrub
cine has been rather variable. Culpep~r used the distilled
up to 2 m in height with handsome golden yellow flowers. It
water of the flowers, the juice or decoction of the young
is indigenous to temperate regions of Europe and Northern
branches or seed, or the powder of the leaves and seed. The
Asia, growing especially on sandy pastures and heaths, and it is naturalized in North America. I
BHp cited the dried tops gathered when the shrub was flow-
Sarothamnus has been used medicinally since antiquity. Dioscorides2 used water extracts ofbroom twigs to treat tonsillitis and hip pain. In his herbal of 1606, Dodoens recom-
the herb and the flowers, and a mixture that consists mainly
7
ering, the German Commission E8 has monographs on both of twig fragments with some leaves and flowers is described in Wichtl.9
mended decoctions of broom tops for dropsy (edema) and
Broomrape (Orobanche) This parasite growing on
for 'stoppages of the liver: 1 Culpeper used Sarothamnus as a diuretic for edema and to treat urinary stones, gout, and
I
I
Sarothamnus was used by Gerard 10 and Culpeper in similar
pains in the joints. In addition to these uses, Lonicerus4 also recommended it for menstrual problems.
ways as Scotch broom itself. It would be interesting to ascer-
Authors from the 17th century emphasized the use of
Scotch broom, and to determine whether it takes these metabolites from its host plant.
tain if broomrape contains similar active constituents to
Sarothamnus for urinary disorders. Prior to the 19th century, the only reference to the cardioregulatory effects of Saro-
Use in China Sarotharnnus does not have an entry in the
thamnus that I have found was the inclusion of this herb in a
•
Chinese Herbal Medicine Dictionary.11
697
698
Combining Western Herbs and Chinese Medicine
What is special about Sarothamnus In terms of Chinese medicine, Sarothamnus scoparius, as used in the West, can be said to be neutral and bitter, and to have its main effect on the Heart, and to a lesser extent on the Kidney-Bladder system.
The key to understanding Sarothamnus is that it is a herb with a limited range of actions, and that its use in the West is now mainly restricted to treatment of • cardiac weakness with hypotension • cardiac edema • cardiac arrhythmia
.---
WESTERN USES
.....
The Western uses of Sarothamnus can be related to its three main Chinese actions: Chinese actions
··Western uses .... ~ ..·.·-O ..':-·~C.
I. tonify Heart Qi
cardiac weakness with hypotension
II. tonify Heart and Kidney Qi, and drain Damp
cardiac weakness with edema
III. stabilize Heart Qi
cardiac arrhythmia. especially with cardiac weakness
DIRECTION OF ENERGY Sarothamnus can have two main effects on the flow of energy:
CHINESE ACTIONS In terms of Chinese medicine, Sarothamnus, as used in the West, can be said to have three main actions: I. tonify Heart Qi II. tonify Heart and Kidney Qi, and drain Damp III. stabilize Heart Qi
• may increase blood pressure by strengthening heart action, resulting in increased upward movement of Qi • can help to drain fluid downward
TYPICAL CASE EXAMPLE
Sarothamnus has been used in the West to treat menorrhagia/ which in Chinese medicine terminology can be included in the action of 'regulate the Uterus: However, this is not currently a main use of this herb.
Signs and symptoms The patient has exhaustion, hypotension, recurring tachycardia and palpitations, and some ankle edema. The pulse is irregular and empty, especially at the Heart and Kidney positions. The tongue is slightly pale and flabby, with slight trembling.
WESTERN ACTIONS
Diagnosis The patient has Heart Deficient Qi and to a lesser extent Kidney Deficient Qi, associated with the exhaus· tion, hyPotension, and edema; and Heart Qi Irregularity, associated with the tachycardia and palpitations.
The main Western actions of Sarothamnus are shown here in terms of its three main Chinese actions: Chinese actions
_--~
Western actions
I. tonify Heart Qi
cardiotonic antihypotensive
II. tonify Heart and Kidney Qi, and drain Damp
cardiotonic cardiac diuretic diuretic
111. stabilize Heart Qi
cardioregulator
Cardiotonic The cardiotonic action of Sarothamnus, its ability to strengthen Heart Qi, may underlie its antihypotensive, cardiac diuretic, and cardioregulatory actions. Cardiac diuretic This herb is specific for cardiac weakness with edema, linked primarily to Deficient Heart Qi and secondarily to Deficient Kidney Qi. Cardioregu1ator Sarothamnus, like Convallaria, is specific to treat Irregularity of Heart Qi in order to normalize heart function, especially heart rhythm.
Choice ofSarothamnus This herb can be selected to tonify Deficient Qi of the Heart and Kidney, and to normalize the Irregularity of Heart Qi. However, the screening, precautions, and monitoring procedures as discussed in the Cautions section should be followed.
Limitations ofSarothamnus TEMPERATURE Sarothamnus is listed in this book as neutral so that it can be used for warm, neutral, cool, or cold patterns when it is combined with the appropriate herbs to adjust the temper· ature balance of the combination.
TASTE The main taste property of Sarothamnus is bitter, which is mainly associated with its bitter cardiotonic action. Saro-
-">"'\
Sarothamnus
699
i
, mamnus is not generally used as a bitter digestive tonic, oartly because it is inappropriate in cases of hypertension or bile blood pressure, and partly because some people may - m1d that larger doses of this herb cause nausea. '"" .CTIONS Cardiotonic Sarothamnus is a cardiotonic with specific nd limited use. Since it is specific for cardiac weakness with "_xhaustion and hypotension, it is inappropriate for cases with high or labile blood pressure. _ •,. . k-
i
Cardiac diuretic Sarothamnus is specific for edema linked to cardiac weakness. Even in the absence of heart involvement, it has a tradition of use as a diuretic, urinary alterative, and antilithic, which extends from ancient times to the present day. However, it is now usually used as a secondary herb to treat urinary disorders, for example, to support a primary herb, such as Arctostaphylos.
Before using any of the pairs below, it is important to be familiar with the cautions listed for each herb in the combination. This is especially so for Convallaria and Cinchona, which are included in Schedule Part III ofthe Supply ofHerbal Remedies Order 1977 of the United Kingdom, with limitations on their maximum doses. Sarothamnus + Leonurus
Cardiac arrhythmia + emotional lability Both herbs can be used for cardiac weakness associated with Heart Deficient Qi. The two herbs can complement each other since Sarothamnus is more for arrhythmia from physical causes, associated with the pattern of Heart Qi Irregularity, whilst Leonurus is more for palpitations linked to anxiety, associated with the pattern of Heart Spirit Disturbance. Leonurus tends to moderate any tendency of Sarothamnus to cause hypertension.
'-. Cardioregulator Sarothamnus can balance heart function. It can strengthen heart function when it is weak. or slow, or it ~ _ can slow the heart rate to normal when it is abnormally rapid. It has been suggested that it has a tendency to aggravate hypertension, but I have not seen research evidence to show that this occurs at therapeutic doses. Nevertheless, it might be advisable to avoid this herb for patients with cardiac weakness accompanied by either high or labile blood '=' pressure. Herbs, such as Crataegus or Leonurus, would be more appropriate to treat such patients since these herbs can normalize or lower the blood pressure, respectively.
Sarothamnus paired with other herbs I
~
Discussion of the limitations of each of the main actions of Sarothamnus can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Sarothamnus . beyond its limitations. The basic unit of herb combination is the herb pair. Six pairings of Sarothamnus with other herbs are briefly discussed below. CAUTION
.. J
Patients with suspected heart disorders require conventional diagnosis. Sarothamnus can be used with other herbs as an adjunct to conventional Western treatment if appropriate. However, herbal therapy is not meant as a substitute for conventional diagnosis and treatment. Also, practitioners should be aware ofpotential herb-drug interactions.
Sarothamnus + Crataegus
Cardiac weakness + cardiac arrhythmia Both herbs can be used for cardiac weakness and cardiac arrhythmia. However, Sarothamnus tends to raise blood pressure, and Crataegus tends to normalize it and can therefore act as a moderator for Sarothamnus. Crataegus adds antianginal, antiatheromatic, and mild tranquilizing actions to those of Sarothamnus. Sarothamnus + Panax ginseng
Cardiac weakness + hypotension Both herbs can be used for cardiac weakness with exhaustion and hypotension. Therefore, this pair is contraindicated for patients with either hypertension or labile blood pressure. Sarothamnus + Convallaria
Cardiac weakness + cardiac edema Sarothamnus and Convallaria can both treat cardiac weakness with exhaustion and edema. The effects of the cardioactive alkaloids of Sarothamnus can complement the effects of the cardioactive glycosides of Convallaria. Sarothamnus can be more effective at treating hypotension, and Convallaria can be more effective at treating chest pain resulting from heart disease; as a result, the two herbs form a complementary pair. Both herbs are more for physical conditions involving Heart Qi Irregularity, such as arrhythmia, rather than for emotional conditions involving Heart Spirit Disturbance, such as anxiety or insomnia. For Heart Spirit Disturbance, Leonurus would be more appropriate.
Combining Western Herbs and Chinese Medicine
700
Caution Convallaria is included in Schedule Part III of the Supply of Herbal Remedies Order 1977 of the United Kingdom with limitations on its maximum dose. If Sarothamnus and Convallaria are to be used together in a combination, it is advisable to use initially just one of these herbs in the combination. Then providing there are no adverse effects, the other herb can also be added to the combination. The screening, precautions, and monitoring measures for both herbs should be adopted. This is especially the case regarding patients who are taking digoxin or similar conventional cardioactive glycoside medicines, if indeed these patients are to receive herbal treatment. Sarothamnus + Cinchona
CAUTION
,-
-.~.:~~:;~.
Patients with suspected heart disorders require conven~-··""'·-·tional diagnosis. Sarothamnus can be used with other herbs as an adjunct to conventional Western treatment if their use ~ appropriate. However, herbal therapy is not meant as a substitute for conventional diagnosis and treatment. Also, practitioners should be aware ofpotential herb-drug interactions. Before using any ofthe combinations below, it is important to be familiar with the cautions listed for each herb in the combination. This is especially so for Convallaria and Cinchona which are included in Schedule Part III ofthe Supply ofHerbal Remedies Order 1977 of the United Kingdom with limitations on their maximum doses.
Cardiac weakness + digestive weakness Both herbs can be used for cardiac weakness with arrhythmia and exhaustion. Cinchona can also act as a bitter digestive tonic to treat digestive weakness, loss of appetite, and recovery from fever or other illnesses.
Caution Cinchona is included in Schedule Part III of the Supply of Herbal Remedies Order 1977 of the United Kingdom with limitations on its maximum dose. If Sarotharnnus and Cinchona are to be used together in a combination, it is advisable to use initially just one of these herbs in the combination. Then, providing there are no adverse effects, the other herb can also be added to the combination. The screening, precautions, and monitoring measures for both herbs should be adopted. This is especially the case regarding patients who are taking digoxin or similar conventional cardioactive glycoside medicines, if indeed these patients are to receive herbal treatment. Sarothamnus + Taraxacum
1. Cardiac weakness + cardiac edema
Heart Deficient Qi + Kidney Deficient Qi + Damp
Convallaria Crataegus sarothamnus Taraxacum Parietaria Juniperus Zingiber
neutral sl. warm neutral cool-eold neutral sl. warm hot
1 1 1 1 1 1 1
bitter, sl. sweet sour, sweet bitter bitter bitter aromatic, sl. acrid, sl. sour .acrid, aromatic
This combination is the same as Convallaria: cardiac weakness + cardiac edema and is discussed under that head:'--"" mg.
2. Cardiac arrhythmia + hypotension
Heart Qi Irregularity + Kidney Deficient Qi
Cardiac edema Taraxacum can be used for edema of various etiologies, and Sarothamnus is specific for cardiac edema. In terms of Chinese medicine, Sarothamnus and Taraxacum can be combined to tonify Heart and Kidney Qi and to drain Damp.
Sarothamnus combinations Two Sarothamnus combinations are discussed below:
Herb Crataegus Convallaria Sarothamnus Leonurus Panax gin. Schisandra Glycyrrhiza Zingiber
Ratio
Temperature
1 1 1 1 1 1 0.5 0.5
51. warm neutral neutral neutral 51. warm warm neutral-cool hot
sour. sweet bitter. 51. sweet bitter sour, sl. bitter sweet, sl. bitter sour sweet acrid. aromatic
This combination is the same as Crataegus: cardiac arrhythmia + hypotension and is discussed under that headmg.
1. cardiac weakness + cardiac edema
Heart Deficient Qi + Kidney Deficient Qi + Damp
2. cardiac arrhythmia + hypotension
Heart Qi Irregularity + Kidney Deficient Qi
COMPARISON OF THE TWO SAROTHAMNUS COMBINATIONS
Sarothamnus 1. Cardiac weakness + cardiac edema
2. Cardiac arrhythmia + hypotension
Heart Deficient Qi + Kidney Deficient Qi + Damp
Heart Qi Irregularity + Kidney Deficient Qi
-
,,-.,, Ratio Convallaria Crataegus Sarothamnus Taraxacum Parietaria Juniperus Zingiber
1 1 1 1 1 1 1
'i. -
Herb
.o,i "'::': -:~ ..
-;:o';.:~atio
Crataegus Convallaria Sarothamnus Leonurus Panax gin. Schisandra Glycyrrhiza Zingiber
1 1 1 1 1 1 0.5 0.5
1. In combination No.1, Crataegus, Convallaria, and Sarothamnus are combined to tonify Heart Qi and treat exhaustion, and to stabilize Heart Qi Irregularity and treat arrhythmia. Convallaria and Sarothamnus are specific for cardiac edema and are combined with the general diuretic combination of Taraxacum, Parietaria, Juniperus, and Zin-
giber. 2. Both combinations No. 1 and No.2 can treat cardiac weakness, and contain Crataegus, Convallaria, and Sarothamnus. However, the emphasis of combination No.2 is not on edema but on arrhythmia and hypotension. Crataegus, Convallaria, and Sarothamnus are therefore combined with Leonurus and Schisandra to stabilize Heart Qi and treat arrhythmia. Panax ginseng and Sarothamnus are combined to treat hypotension.
Research CONSTITUENTS • alkaloids • amines • flavonoids • tannins • other Alkaloids Sarothamnus contains 0.8-1.5 % quinolizidine alkaloids, especially (-)-sparteine, with some lupanine, 4hydroxylupanine, 13-hydroxylupanine, and ammodendrine, and traces of 20 other alkaloids that are found mainly in the stem. 12 Amines These, especially tyramine, dopamine, and etha13 mine, are concentrated mainly in the flowers (up to 2%). Flavonoids These occur in all the parts (0.2-0.6%) and include scoparoside, genitoside, spiraeoside, and isoquer-
701
citrin. 14 Isoflavones, such as sarothamnoside, are also present. IS Tannins The tannins mentioned by the ·BHP and by Mabei 6 are not listed by Wichtl or Bruneton, but Grieve I mentioned that there are considerable amounts of tannin in the bark, which in former times was used for tanning leather. The BHP, Mabey, and Grieve did not include references regarding the statements on tannin content. Other Coumarins, caffeic acid derivatives, and traces of essential oil have been reported:' Lectins have been reported in extracts of the seeds. 18
PHARMACOLOGICAL AND CLINICAL RESEARCH The following effects have been reported for extracts of Sarothamnus or for its isolated constituents: • antiarrhythmic • antihypotensive • oxytocic Antiarrythmic Sparteine, the main alkaloid in Sarothamnus, has been shown to be a potassium channel antagonist. 19 Sparteine was reported to have antiarrhythmic action against electrically- and ischemically-induced arrhythrilias in rats. This effect of sparteine was thought to be due to its potassium- and sodium-channel blocking properties. 20 It has been postulated that sparteine can reduce overstimulation of the nerve conduction mechanism in the myocardium, thereby reducing fibrillation and extrasystoles (also called premature beats). Sarothamnus has been used for arrhythmia subsequent to a heart attack, ventricular extrasystoles, and sinus tachycardia.21 According to Weiss,22 the action of sparteine resembles that of quinine and quinidine, but is gentler and safer. Weiss stated that the alkaloids sarothamnin and genestein also inhibited conduction and that the flavonoids also had a beneficial effect on myocardial function; however, Weiss failed to cite references. Antihypotensive
Sparteine It was reported in Wichtl that sparteine does not have a positive inotropic effect, but rather it extends diastole, and that a normalizing effect has been observed in cases of hypotension. However, no references were given. In a study on anesthetized dogs, in which 3 mglkg of sparteine was administered by intravenous injection, the authors concluded that sparteine showed no pronounced inotropic effect in the heart, but increased arterial blood pressure by direct vas-
•
Combining Western Herbs and Chinese Medicine
702
cular constriction. 2J However, 3 mglkg represents 180 mg of sparteine for a 60 kg human. This is about 30 times the amount of approximately 6 mg of sparteine contained in 3 ml of 1:5 Sarothamnus tincture (see Toxicology below).
Tyramine The German Commission E monograph on Sarotharnnus flower stated that the amine tyramine can act indirectly as a sympathomimetic and can have a vasoconstrictive and hypertensive effect. Whether there is enough tyramine in therapeutic doses of Sarothamnus to make this effect appreciable is not yet documented. Oxytocic Bruneton stated that sparteine is oxytocic, causing a moderate increase in uterine tone and in the strength of uterine contractions, and that sparteine was used in obstetrics as an oxytocin-like medication during labor. According to Weiss, Sarothamnus resembles quinine in stimulating uterine contractions. He wrote that the oxytocic effect of Sarothamnus had been demonstrated by Klein, but gave no references. Sparteine is now little used as an oxytocic because of the uterine spasms experienced by women with defective sparteine metabolism. 24 One study reported that about 5% of male and female subjects studied were unable to metabolize sparteine by N-oxidation. 25 The inability to oxidize sparteine seems to be a genetic trait. 26 •27 RESEARCH VERIFICATION OF TRADITIONAL ACTIONS The use of Sarothamnus for heart disorders by the Eclectics in the late 19th century evolved in tandem with the early pharmacological research on sparteine and other active constituents. 28 The use of Sarothamnus for cardiac arrhythmia has been reported. There is also evidence for antiarrhythmic, hypertensive, and oxytocic effects for sparteine as an isolated chemical. TOXICOLOGY Important distinction A careful distinction needs to be made between the use of: • therapeutic doses of Sarothamnus as an infusion, decoction, or tincture • isolated components of Sarothamnus, such as sparteine Sarothamnus preparations There is little toxicological data for the whole herb. I have not seen reports of adverse reactions to therapeutic doses of Sarothamnus as an infusion, decoction, or tincture. Since Sarothamnus may contain less than 1% sparteine, the reported adverse effects resulting from high doses of
sparteine as an isolated chemical are unlikely to appIfto1bi" whole herb. Also, administration of sparteine by injection ?';,;-'";.",,, into the bloodstream may bypass chemical changes of ,/::~~ sparteine in the digestive system or the liver. Therefore; re~:: 'C""c',~,=:" C
~orts of adverse effects of sparteine administered by injec:~.~-::',. tlOn may not be wholly applicable to oral administration of " the herb. Sparteine According to Grieve, large doses of sparteine may result in vomiting and purging, and may weaken the heart and lower blood pressure.
AV block A study in 1975 reported that research had indicated that sparteine sulfate did not cause atrioventricular (AV) block as a side effect in animals and healthy humans. ..~", The authors reported that in their clinical study with::~rtf patients with predamaged heart conduction systems, intra- . . ~. ,:;;::venous injection of 200 mg of sparteine sulphate coul<J2:.;tI~~ aggravateAV block in a minority of patients.29'Howeve~:~':~7'0':!:, quantity of sparteine is equivalent to over 33 times the amount of sparteine that is in my recommended daily dose ..", - . of 3 ml of 1:5 Sarothamnus tincture. Asswning that dried Sarothamnus contains about 1% sparteine, 3 ml of 1:5 tincture contains about 6 mg of sparteine. This is assuming that the tincturing process extracts all the sparteine from the dried material, which may not be the case. Also, the sparteine,','":,. in the study was administered by intravenous injectiori;},~:~~~, rather than orally. '. .. ti>;~~ ";'-,
;--;: : ~:-:-:-::~._~~-::~:---:j~~::::
Genetic polymorphism The metabolic oxidation of sparteine'O~oo· ... shows genetic polymorphism, and this property has been used in screening tests to identify individuals at risk for adverse drug reactions. The population can be divided into two phenotypes based on their metabolic handling of cer- . tain probe drugs. These two types have been termed 'rapi~ metabolizers' and 'slow metabolizers: 27 Slow sparteine metabolizers are more likely to experience adverse effects such as, ... ':'. uterine contractions during the use of sparteine as an oxytocic25 or AV block during the use of sparteine for the treatment of coronary disease. 3D
>
Dose Dried herbs The BHP listed 1-2 g of dried tops as a decoction, three times per day. Tincture The BHP listed 0.5-2 ml of 1:5 tincture (in 45% alcohol), three times per day. I generally use Sarothamnus: • as a 1:5 tincture rather than as infusions or decoctions of the dried herb
'::
~,
...
.. '.
~
Sarothamnus • in combination with other herbs rather than as a single herb • at doses of 1:5 Sarothamnus tincture equivalent to 1 ml three times per day, which is 3 ml per day in total Initial dose Start at half the minimum dose for 3 days, then increase the dose to the standard dosage, providing the patient does not report any adverse effects, such as nausea, or an increase in blood pressure. Duration This herb can be used for 1-3 months, providing that the screening, precautions, and monitoring procedures listed below are observed.
Cautions Sarothamnus is on the UK General Sale List. and is not on Schedule Part III ofthe Supply of Herbal Remedies Order 1977 of the UK, with maximum dose limitations. Although in my opinion this can be a very useful herb. there is an argument for restricting its over-the-counter sales for therapeutic purposes. Considerations of safety might suggest restriction of its use to health practitioners qualified and licensed in herbal therapy. The Botanical Safety Handbook31 has an entry for Sarothamnus under Cytisus scopariuS, listing this herb as Class 3. that is 'to be used only under the supervision of an expert qualified in the appropriate use of this substance.' Western contraindications The BHP contraindicated this herb in cases of hypertension. Chinese contraindications
None reported.
Pregnancy and lactation The BHP listed the use of this herb as inadvisable during pregnancy. and its use in pregnancy is contraindicated in Wichtl. I have not seen any research evidence of adverse effects during pregnancy or lactation for Sarotharnnus decoctions or infusions. However. as noted in Research, sparteine as.an isolated chemical has been reported to initiate uterine spasms especially in women with defective sparteine metabolism. Side effects
No adverse reports.
3
Overdose The German Commission E monograph reported that no overdose effects were known. However, Felter and Lloyd reported that Sarothamnus could be emetic and cathartic in large doses. See also Toxicology.
-;.~
Interactions No adverse interactions are known for therapeutic doses of Sarothamnus as an infusion. decoction, or tincture.
703
Concurrent ingestion of MAO inlubitors and tyramine can lead to hypertension. Although I have not seen anyevidence that Sarothamnus preparations can have adverse interactions with MAO inhibitors. it may be wise to avoid this herb for patients who are taking these drugs. SCREENING Before prescribing Sarothamnus, it should be determined whether the patient: • has ever had adverse reactions to Sarotharnnus or sparteine • is taking any medications that include MAO inhibitors • has ever had hypertension or labile blood pressure • is pregnant The use of Sarothamnus should be avoided in these situations. TREATMENT PRECAUTIONS The following precautions can be taken during treatment: • use Sarotharnnus within the recommended dose range and start initially at a lower dosage • use Sarotharnnus initially for only short periods or give regular breaks in the herbal treatment • alternate the use of SarotharnnuS; in a combination with another herb • do not use Sarothamnus as a single herb, but rather combine it with herbs likely to moderate any possible adverse effects, such as Leomri.-us or Crataegus MONITORING During the course of a herbal treatment including Sarothamnus. the patient should be monitored for: • hypertension • heart rhythm irregularities • nausea
If any of these occur, administration of Sarothamnus should be stopped.
Regulatory status Please read the Regulatory status section in the chapter on Safety. Sarotharnnus (broom) is on the UK General Sale List, and it is not included in Part 4 of Schedule 4 of the Thera-
Combining Western Herbs and Chinese Medicine
704
-~--~~~.--
.
not currently listed by the FDA (USA) as a prohibited sub-
8tg~~~;~·.:·"~~_:~·.:rC~;~i;~'~f_~~t~~~lti$Jllj~~
stance, as subject to an import alert, or as a substance with a
Heart
strengthens the heart hypotension, tachycardia, cardiac edema
Tabemaemontanus BHP
Kidney-Bladder
edema urinary stones
Gerard Lonicerus
peutic Goods Act Regulations of Australia. Sarothamnus is
warning on its use.
Traditional sources
Sarothamnus does not have an entry in the Chinese
NOMENCLATURE
Herbal Medicine Dictionary.
1':':,'
Gerard wrote that the Spartium mentioned by Dioscorides is judged by most writers to be 'Spanish Broome: which is not Sarothamnus (also known as Scotch broom).
ACTIONS Felter and Lloyd stated that Sarothamnus is a diuretic in
Lonicerus also distinguished Sarothamnus (which he
small doses, but that it can be emetic and cathartic in large
called Genista, Ginst, Genist, and Ginster) from Spartium
doses. According to Tierra,32 broom can be used for acute
(which he called Pfrimmen and which appears to be Spanish
constipation. Evidence from the traditional sources for the following
broom). Tabernaemontanus also distinguished Sarothamnus (which he called Genista, Genesta, Genst, and Genster) from Spartium (which he called Spanish Pfrimmen). Unfortunately, Tabernaemontanus' main German name for Sarothamnus (Scotch broom)' is Pfrimmen, nicely confusing it with the pfrimmen (Spanish broom) of Lonicerus.
PROPERTIES Sarothamnus does not have an entry in the Chinese
Herbal Medicine Dictionary. Temperature
Lonicerus and Tabernaemontanus said that
Sarothamnus (Genista) was warm and dry in the second degree. Gerard said that the flowers, twigs, and seeds of 'Broome' (Genista or Genesta) are hot and dry in the second degree. In this book, Sarotharnnus is classified as neutral Taste
actions of Sarothamnus are discussed below: • cardiotonic • diuretic • emmenagogue • other Cardiotonic Tabernaemontanus recommended this herb for strengthening the heart. In their section on sparteine sulfate, Felter and Lloyd reported on the use of both Sar0thaIIl:~ nus (scoparius) and sparteine to regulate heart action·TIi~,.,.~;::; stated that sparteine appears to have a norm~g. ~.f!~?P,;;.2,;;~. the heart. It can strengthen heart function when it is weak or slow, and it can slow the heart rate to normal when it is abnormally rapid. They stated that sparteine can act quickly, in about 30 minutes, reaching its maximum effect in about 5 hours and sometimes lasting almost 1 week.
Cardiac weakness with hypotension According to
Mabey,
Taste in the mouth The BHP stated that this herb contains
Sarothamnus can increase constriction of the peripheral blood vessels and thus increase blood pressure. TheBH.P ..
bitter principles, and its taste is listed as very bitter in Wichtl.
recommended this herb for hypotension and contraindicat-
I found that a sample of 1:5 tincture of broom tops in 25%
ed its use in cases of hypertension.
alcohol was predominantly bitter in taste. The tincture also had a sweet fragrance and tasted slightly sweet and slightly sour.
Taste properties Sarothamnus is listed as bitter in this book. associated with its cardiotonic action.
Cardiac arrhythmias Weiss recommended Sarothamnus for arrhythmias and extrasystoles, and for postinfectious myocarditis with arrhythmia. He stated, however, that it is not adequate for 'absolute arrhythmia' or paroxysmal tachycardia. The BHP recommended this herb for tachycardia and palpitations.
ORGANS
Diuretic
In terms of Chinese medicine, Sarothamnus, as used in
General diuretic Dodoens, Gerard, and Culpeper recom-
the West, can be associated mainly with disorders of the following systems:
mended Sarothamnus for dropsy. Lonicerus said that the pounded flowers mixed with rose honey could cleanse the
..
Sarothamnus
705
kidneys, increase urination, and expel stones from the kidney and bladder. Culpeper wrote that Sarothamnus 'draws phlegmatic and watery humours from the joints, whereby it helps gout, sciatica, and pains of the hips and joints; it also ... cleanses the kidneys and bladder of the stone, provokes urine abundantly, and hinders the growing again of the
Tabernaemontanus and Gerard said that Sarothamnus could cleanse and open the liver and spleen. Culpeper recommended it for swelling of the spleen, jaundice i swollen knees, gout, and surfeit from overeating.
stone in the body: Tabernaemontanus reported that Sarothamnus could be used for edema due to phlegm since it 'leaches out slimy and watery dampness through the urine: He wrote that when the seeds or flowers of this herb are used, no viscous material would stay in the kidneys or bladder and grow into a stone. Ellingwood33 as well as Felter and Lloyd also listed Sarotham-
References
nus for dropsy. Kloss3~ recommended Sarothamnus for kidney and bladder disorders, especially bladder stones, and recommended a combination of Sarothamnus, Arctostaphylos, Galium, and Taraxacum to cleanse the kidneys and bladder and increase the flow of urine. Grieve recorded the use of the following Sarotharnnus combination for bladder and kidney affections, including chronic dropsy (edema): Sarotharnnus Taraxacum root Juniperus
10z 0.5 oz 0.5 oz
Sarothamnus and Taraxacum are placed in one pint of water, and the mi.'dure is boiled down to half a pint. The bruised Juniperus berries are added towards the end. The heat is turned off, the decoction is strained when it is cold, and a small amount of Capsicum is added. The dose is one wineglass, three to four times per day.
Cardiac diuretic Felter and Lloyd listed sparteine sulfate for cardiac edema, and the BHP listed Sarothamnus tops for cardiac edema. Emmenagogue Lonicerus recommended Sarothamnus for women's diseases to promote menstruation and to cleanse the uterus.
1. Grieve M. A Modern Herbal. vols. 1 and 2. Dover Publications, New York. New York (1971) 2. Dioscorides P. Kreutterbuch (1610). Reprinted by Verlag Konrad Kelbl. MOOchen, Germany (1960) 3. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks, Glenwood Illinois (1990) , 4. Lonicerus A. Kreuterbuch (1679). Reprinted by Verlag Konrad Kelbl, Moochen. Germany (1962) 5. Tabernaemontanus JT. Krauterbuch (1731). Reprinted by Verlag Konrad Kelbl. MOOchen. Germany (1993) 6. Felter HW. lloyd Ju. King's American Dispensatory. voh. 1 and 2. 18th edn. (1898). Reprinted by Eclectic Medical Publications. Sandy. Oregon (1983) 7. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983) 8. Blumenthal M (ed). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin. Texas (1998) 9. Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm. Stuttgart, Germany (1994) from 2nd German edn. Wichd M (ed) (1989) 10. Gerard J. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publications. New York. New York (1975) 11. Jiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian). Science and Technology Press. Shanghai. China (1975) 12. Wmk M et al, Plant Cell Rep 3:230 (1984) 13. Bruneton J. Pharmacognosy: Phytochemistry Medicinal Plants, 2nd edn. Lavoisier, Paris, France (1999) 14. Brum-Bosquet M. Delaveau P. Plantes Med. Phytotherap 15:201 (1981) 15. Brum-Bosquet M et al. Planta Med 43:367 (1981); Tetrahedron Lett 22:1233 (1981)
Uterine stimulant and oxytocic Weiss and Bruneton recorded the use of Sarothamnus as an oxytocic during labor, although this use has declined. This herb was contraindicated during pregnancy by both the BHP and Wichtl.
16. Mabey R (ed). The Complete New Herbal. Elm Tree Books, London. United Kingdom (1988)
Antihemorrhagic According to Weiss, the use of sparteine for uterine hemorrhages was introduced into gynecology by Klein in 1938. The BHP recommended Sarotharnnus as an antihemorrhagic for profuse menstruation.
19. Northover BJ. Biochemical Pharmacology 47(12):2163-2169 (1994) 20. Pugsley MK. Saint DA. Hayes E et al. Eur J PharmacoI294(1):319-327 (1955)
Other Tabernaemontanus said that this herb is good for
22. Weiss RF. Herbal Medicine, English edn. Beaconsfield Publishers. Beaconsfield, United Kingdom (1988)
gout because it strongly promotes bowel movement and thus gets rid of the viscid phlegm that causes the gout. Both
23. Schmidt HD, Padeken D. Beck L.Arzneimittelforschung 36(10):14811484 (1986)
17. Kurihara T. Kikuchi M. Yakugaku Zasshi 100:1054 (1980); Chemical Abstracts 93:235183 (1980) 18. Young NM, Watson DC. Williams RE. Biochem J 222( 1):41-48 (1984)
21. Thies PW. Pharmazie in Unserer Zeit 6:172-176 (1986)
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_-_ ..
Combining Western Herbs and Chinese Medicine
706
24. Mills S. Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone, Edinburgh, United Kingdom (2000)
25. Eichelbaum M. Spannbrucker N. Steincke B et al. Eur j Clinical PharmacoI16:183-187 (1979) 26. Vinks A. Inaba T, Otton SV et al. Clinical Pharmacol Therapeutics 31(1):23-29 (1982) 27. Eichelbaum M. Kroemer HK. Mikus G. Toxicol Lett 64-65:115-122 (1992) 28. Felter HW. lloyd jU. King's American Dispensatory. vols.1 and 2. 18th edn. (1898). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1983)
29. Nordeck E,Avenhaus H. Z Kardiol64(5):411-418 (1975)
-~."':':::::: ..
30. Wagner F. jahnchen E, Trenk D et al. Klin Wochenschr 65(24):11641168 (1987) 31. ~kGuffin M. Hobbs C. Upton Ret al. American Herbal Products Association's Botanical Safety Handbook. CRC PreSS, Boca Raton. Florida (I997) 32. Tierra M. Planetary Herbology. Lotus Press, Twin Lakes. Wisconsin (1988) 33. Ellingwood F. American Materia Medica. Therapeutics and Pharmacognosy.11th edn. (1919). Reprinted by Eclectic Medical Publications. Sandy. Oregon (1994) 34. Kloss j. Back to Eden. 5th edn. (1939). Reprinted by Lifeline Books. Santa Barbara. California (1975)
Smilax Botanical name Smilax species Family Smilaceae (included in Liliaceae) Pharmaceutical name Sarsaparillae radix. cum rhizomate Part dried root and rhizomes English sarsaparilla German Sarsaparille French salsepareille Mandarin til fU ling (±.iR.~) is the rhizomes of S. glabra Roxb.
, j
Use in the West The Smilax species used in the West are large perennial climbers with thorny stems, native to Central and South America. According to Grieve, the name Sarsaparilla comes from the Spanish sarza-parilla meaning bramble-vine. Jamaica sarsaparilla was introduced to Europe in the mid-16th century as a remedy for syphilis, although it l later became used for other diseases, such as rheumatism.
Species used in the West
What is special about Smilax In terms of Chinese medicine, Smilax, as used in the West. can be said to be a cool, slightly bitter herb that has its main effects on the channels of the skin, muscles, and joints. It may also have an effect on the Liver, Kidney, and Bladder.
The key to understanding Smilax is that it is an alterative herb that is specific for psoriasis, rheumatism, and arthritis. CHINESE ACTIONS In terms of Chinese medicine. Smilax, as used in the West, can be said to have two main groups of actions:
1. clear Heat Toxin clear Damp Heat clear Heat in the Blood
According to the BHC, various
species of Smilax are now used:
II.
2
drain Damp regulate the Middle Burner
• S. aristolochiaefolia Miller Vera Cruz, Mexico, or gray sarsaparilla • S. febrifuga Kunth • S. ornata Hooker • S. regelii Killip et Morten
tonify the Spleen Clear Heat Toxin, Damp Heat, and Heat in the Blood
Ecuador or Guayaquil sarsaparilla
The
actions are listed in descending order of importance. Smilax
Jamaica, Costa Rica, or red sarsaparilla
is a secondary herb for clearing Heat in the Blood. It is used
Honduras or brown sarsaparilla
the Heat in the Blood is combined with Heat Toxin, as seen
only to support other primary herbs, and usually it is used if in some cases of acute aggravation of psoriasis.
Use in China The rhizome of S. glabra Roxb. is used as til fli lin~ to clear Damp Heat and Heat Toxins, and to treat rheumatoid arthritis. hot skin lesions, such as boils or ulcers, urinary infections, and more recently syphilis.
Drain Damp, regulate the Middle Burner, and tonify the Spleen This group of actions, associated with clearing Damp. is generally of lesser importance than the primary
707
Combining Western Herbs and Chinese Medicine
708
group of actions. associated with clearing Heat. However. in both Western and Chinese traditions, Smilax has been used
dominant illness. The pulse is usually slightly rapid arid-::--:-:.. --"~- slightly wiry. and the tongue is purplish with red spots.
to treat pathologies involving Damp. although usually when
During the acute skin aggravations. the pulse becomes rapid.
the Damp is associated with Heat.
flooding, and wiry. and the tongue becomes scarlet. Diagnosis The patient has chronic Heat Toxin with some
WESTERN ACTIONS
Stagnation of Qi and Blood. In addition. Heat in the Blood is
The main Western actions of Smilax are shown here in terms of its two main Chinese action groups:
present during the acute phases. Choice of Smilax
Smilax is specific for chronic Heat Toxin
with some Stagnation of Qi and Blood, manifesting here as Chinese actions
Western actions
I. clear Heat TOXin, Damp Heat, Heat in the Blood
alterative dermatological agent antiarthritic antirheumatic
II. drain Damp, regulate the Middle Burner, tonify the Spleen
diuretic alterative dermatological agent antiarthritic antirheumatic
chronic psoriasis and arthritis. It can also be used for acute Heat in the Blood, but only in combination with other, colderherbs.
Limitations ofSmilax TEMPERATURE In this book. Smilax is classified as cool and can be used for warm. neutral. or cool conditions. It would not normally be used for cold patterns. To treat hot patterns, it would need
WESTERN USES
to be combined with other herbs. such as Rheum or
The Western uses of Smilax can be related to its two
Taraxacum.
main Chinese action groups: Chinese actions -
- Western uses
TASTE Smilax is classified as a slightly bitter herb in this book.
I. clear Heat Toxin, Damp Heat. Heat in the Blood
psoriasis, acne, boils, eczema, psoriatic arthropathy, arthritis, rheumatoid arthritis, gout
II. drain Damp, regulate the Middle Burner, tonify the Spleen
psoriasis. eczema. arthritis, rheumatoid arthritis. gout
DIRECTION OF ENERGY
associated with its anti-inflammatory action. It may also have mild sweet tonic action. Smilax is a good example of a herb that is not easy to classify in terms of taste property with any clarity.
ACTIONS Alterative Smilax is an alterative with a range of use that is limited to skin disorders, especially psoriasis. and to rheu-
Smilax can clear primarily Heat Toxin and Damp Heat, and secondarily Heat in the Blood and Damp from the chan-
matism and arthritis. For example. for the following conditions I would use other alterative herbs:
nels of the skin. muscles. and joints. It may mildly move Qi and Blood and drain Damp downwards, but it does not have a strong directional effect on the movement of Qi, whether upwards, downwards, inwards, or outwards.
• Iris • Arctium or Mahonia • Arctium or Galium • Phytolacca or Viola
constipation. skin disorders teenage acne lymphadenitis adjunct to cancer therapy
TYPICAL CASE EXAMPLE Signs and symptoms
The patient has chronic psoriasis
Smilax paired with other herbs
with purplish lesions under white scales. Occasionally, there are severe acute aggravations of the psoriasis with bright red, hot, itchy skin. There is a history of rheumatoid arthritis, which still occasionally occurs, but now the psoriasis is the
Discussion of the limitations of each of the main actions of Smilax can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs
rI
I
Smilax - can extend the range of use of Smilax beyond its limitations. The basic unit of herb combination is the herb pair. Six pairings of Smilax are briefly explained below.
CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair.
709 Smilax + Thuja
Psoriasis Thuja is a warm herb that can act as a 'circulatory stimulant, though not as strongly as Zanthoxylum. It is an anticatarrhal and alterative that can clear both Heat Toxin and Phlegm from the organs and the channels. The two herbs can be paired for psoriasis, rheumatism, or arthritis linked to Heat Toxins, Damp, or Phlegm.
Smilax + Scrophularia
Acute psoriasis These herbs make an excellent pair for acute psoriasis since Smilax is primarily for Heat Toxin and secondarily for Heat in the Blood, and Scrophularia is primarily for Heat in the Blood and secondarily for Heat Toxin. This pair can also be used for acute aggravation of acne, boils, or eczema associated with Heat Toxin and Heat in the Blood.
Smilax combinations Three Smilax combinations are discussed below: Combination
Chinese syndromes
1. acute psoriasis
Heat in the Blood
2. arthritis + psoriasis
Damp Heat + Heat Toxin
3. chronic psoriasis
Stagnant Qi and Blood + Phlegm
+ Heat Toxin
Smilax + Harpagophytum
Rheumatoid arthritis Smilax is more for Heat Toxin and Harpagophytum is more for Damp Heat, so that these herbs can be used for arthritis, rheumatism, or gout associated with patterns of Heat Toxin and Damp Heat. Smilax + Arctium
Boils ~
Both herbs can clear Heat Toxin and are specific for acne and boils. Arctium reinforces the diuretic alterative action of Smilax and has a mild laxative action of its own. Smilax + Salvia miltiorrhiza
.,
Chronic psoriasis
-J
Salvia miltiorrhiza is specific for chronic disorders involving Stagnant Blood. Smilax and Salvia can be combined for stubborn chronic psoriasis or boils associated with Stagnant Blood and Heat Toxin. Salvia can also be used for patterns involving some Deficiency Heat or Heat in the Blood, with restlessness, skin rashes, and sensations of heat.
.
CAUTION
Before using any ofthe combinations below, it is important to be familiar with the cautions listed for each herb in the combination. Please read Cautions on the use of alterative herbs in the chapter on Safety. 1. Acute psoriasis
Heat in the Blood + Heat Toxin Herb Smilax Scrophularia Arctium (seeds) Mahonia Taraxacum Rheum Glycyrrhiza
Ratio
TemperatUre
1 1 1 1 1 1
cool cool cool cool cook:old cook:old neutral-cool
0.5
..Taste sl. bitter sl. bitter acrid, sl. bitter bitter bitter bitter, sour sweet
GENERAL
Smilax + Zanthoxylum
This combination is for Heat in the Blood with Heat Toxin and maybe some Damp Heat. The overall temperature is cool-cold to treat hot or warm conditions. The dominant taste is bitter to drain Heat.
Chronic arthritis
USE
Zanthoxylum is a warm herb that can move stagnant Blood and Qi, and clear obstruction associated with Cold, Damp, or Phlegm. Zanthoxylum and Smilax can be combined for chronic psoriasis with stubborn bluish lesions or for arthritis or rheumatism with sensations of cold, heaviness, numbness, or pain in the limbs.
• acute psoriasis, eczema, acne rosacea, or boils, with red, hot, itchy, painful skin lesions PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of water, three times per day. It is most effec-
Combining Western Herbs and Chinese Medicine
710
:
tive as a decoction, but it is rather bitter. Plenty of water should be drunk daily whilst taking this combination to assist in the flushing of toxins from the system. This combination is used for acute conditions and can be taken for 1 to 2 weeks. Once the severe redness, itching, and sensations of heat have subsided, this combination can be replaced by a combination that is less cold and draining, to be taken during the subacute or remission phase. 2. Arthritis + psoriasis
Damp Heat + Heat Toxin Herb
Ratio
Temperature
Taste
Smilax Scrophularia Harpagophytum Filipendula Mahonia Arctium (root) Taraxacum Glycyrrhiza
1 1 1 1 1 1 1
cool cool cool cool cool cool cool-cold neutral-cool
sl. bitter 51. bitter bitter sour. bitter bitter 51. acrid. 51. bitter bitter sweet
0.5
-. -;
...
o.R~tio _o~Te~pe~tu;e:i~:ja~:~!!:;~!if?l~:o~~.'~ "". -
-Herb::
"--.o'~'~-~-";d
Thuja Zanthoxylum (bark) Salvia mil. Zingiber
1 1 1 0.5
warm-cool hot cool hot
~~
.
acrid. aromatic, bitter acrid. aromatic, bitter bitter acrid. aromatic
GENERAL
As with the two previous combinations, this combination can clear Heat Toxin, especially when it is associated with Stagnant Qi and Blood, and obstruction of the channels of the skin, muscles, or joints by Phlegm, Damp Heat, Damp, or Cold. The overall temperature is neutral-cool, and this combination can be used for warm, neutral, cool, or mixed patterns with both Heat and Cold. The dominant taste is bitter to clear Damp and Damp Heat, but the acrid taste is also present to assist the Spleen to transform Damp and Phlegm, and to clear obstruction of Phlegm, Damp, or Cold from the channels. USE
• chronic arthritis, rheumatoid arthritis, gout, or psoriasis
GENERAL
This combination is for Damp Heat with Heat Toxin, the overall temperature is cool to treat hot or warm conditions, and the dominant taste is bitter to drain Damp Heat. USE
• chronic arthritis, rheumatoid arthritis, or gout, with psoriasis or eczema • psoriatic arthropathy PRACTICAL NOTES
PRACTICAL NOTES
This combination can be taken as 5 rnl of 1:5 tincture in quarter of a cup of water, three times per day. It is used for chronic conditions, and can be taken for several months with appropriate breaks and modifications. Duringa~e~s.::."."~ sion phase, this combination can be replaced by a more tonic combination.
COMPARISON OF THREE
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of water, three times per day. Plenty of water should be drunk daily whilst taking this combination to assist in the flushing of toxins from the system. The combination is used for chronic conditions, and can be taken for several months, with appropriate breaks and modifications. During a remission phase, this combination can be replaced by a more tonic and less draining combination.
SMILAX COMBINATIONS All three Smilax combinations can treat Heat Toxin, but each combination is distinguished by the herbs that are included to treat the additional pathological factors. -~
1. Acute psoriasis
Heat in the Blood + Heat Toxin
3. Chronic psoriasis
The additional factor in ombination No.1 is Heat in the Blood, and Scrophularia and Rheum are specific for treating this. They are supported in this by the other herbs in the
Stagnant Qi and Blood + Phlegm
combination. "0
Herb
Ratio
Temperature
Taste
Smilax Mahonia Phytolacca
1 1 1
cool cool cool
51. bitter bitter acrid
. i .. ~' ',':- ;..:: , r- '.",'".
2. Arthritis + psoriasis
Damp Heat + Heat Toxin The additional factor in combination No.2 is Damp Heat,
iiIi
Smilax specifically Damp Heat associated with joint inflammation. Harpagophytum and Filipendula are specific for treating this. They are assisted by Arctium and Tara.xacum. Many patients with rheumatoid arthritis take nonsteroidal anti-inflammatories (NSAIDs) tor extended periods. Filipendula and Glycyrrhiza are included in this combination to counter the tendency of these drugs to damage the gastric lining. In addition, these two herbs contribute to the antiinflammatory and antiarthritic effect of the combination.
sides, named smiglasides, have been isolated from the rhizome of S. glabra. '2 Other These include about 50% star~h, 2.5% resin,S about 1.25% potassium, other minerals, and sarsapic acid. 4
PHARMACOLOGICAL AND CLINICAL RESEARCH The folloWing effects have been reported:
3. Chronic psoriasis
Stagnant Qi and Blood + Phlegm The additional factors in combination No.3 are Phlegm and Stagnant Qi and Blood. Zanthoxylum and Salvia miltiorrhiza are included to move Stagnant Qi and Blood, in which they are assisted by Zingiber and Thuja. The main herbs for clearing Phlegm in this combination are Phytolacca and Thuja, assisted by Zanthoxylum and Zingiber.
Research CONSTITUENTS The following constituents have been reported:
•
• steroidal saponins • phytosterols • flavonoid glycosides • phenylpropanoid glycosides • other
•
vI:iJ
~
...
711
.......
Steroidal saponins The species of Smila.x used in the West contain 1-3% steroidal saponins, based on the aglycones sarsapogenin and smilagenin. 4 These aglycones differ only in their configuration at C-25, and correspond to the reduced forms of yamogenin and diosgenin, respectively.s S. aristolochiaefolia contains the glucosides parillin, desglucoparillin, and desgluco-desrhamnoparillin. 6 It also contains sarsaparilloside, which has two independent glycosyl groups and can be hydrolyzed to parillin. It is possible that parillin and related saponins are formed from sarsaparilloside when the herb dries.'
• antibacterial • vermicidal • anti-intlammatory • diuretiL • dermatological agent • hepatoprotective • hypoglycemic • hypocholesterolemic • antihemorrhagic andior antivenom • antimutagenic Antibacterial A Chinese clinical study reported that decoctions of S. glabra were effective in the treatment of leptospirosis.'-' S. lundelii has been reported to show antibacterial activity to several enterobacteria that are pathogenic in man. 14
Antisyphilitic A Chinese study reported that decoctions of S. glabra, in combination with other herbs, were effective in the treatment of syphilis. I) However, without prior studies on the individual component herbs, studies on herb combinations are of limited value, and I have not seen research evidence for antisyphilitic effects for Smilax as a single herb. Vermicidal A decoction of S. glabra was reported to have vermicidal action in vitro. IS Anti-inflammatory S. sarsaparilla significantly inhibited carrageenan-induced inflammation in rats. 16
Phytosterols ~ and E-sitosterol, sitosterol glucoside, stigmasterol,S and pollinasterol have been reported. 9
Diuretic It has been reported that Smilax has a diuretic action and increases the elimination of chlorides and uric 'd I' Another study reported that S. macrophylla Vers., aCl. administered orally in doses of 1 or 2 glkg in normal rats or in rats made hyperuricemic and hyperuricosuric by fructose, did not modify diuresis but increased the excretion of uric acid and allantoin. ls
Flavonoid glycosides The flavanone smitilbin 'o and three flavanol glycosides have been isolated from the rhizome of S. glabra: isoengelitin, isoastilbin, and astilbinon. 11
Dermatological agent There was an early clinical report that Smilax extract was effective in the treatment of psoriasis, but this was not a double-blind study,!9
Phenylpropanoid glycosides
Five phenylpropanoid glyco-
Hepatoprotective Smilax can have hepatoprotective effect
712
Combining Western Herbs and Chinese Medicine
c,~~,~:
.::'~::":-;;:;~=~~~;~' -.- - ..
according to one rat study,2°and the flavanone smitilbin isolated from the rhizome of S. glabra has been reported to protect against immunological-induced hepatocyte damage in mice in vitro. \0 Hypoglycemic A methanol extract of S. glabra rhizomes at the equivalent of 100 mg!kg reduced the blood glucose of normal mice and of two types of diabetic mice 4 hours after intraperitoneal administration. The authors concluded that the hypoglycemic effect of S. glabra raised insulin sensitivity.21 Hypocholesterolemic Both Smilax and Trigonella (fenugreek) contain seroidal saponins based on the aglycone smilagenin. Although I have not seen data for Smilax species, the saponins and sapogenins from Trigonella were reponed to have hypocholesterolemic activity in diabetic dogs. 22
RESEARCH VERIFICATION OF TRADITIONAL ACTIONS There is support for the alterative action in the sense that antimicrobial, anti-inflammatory, and dermatological effects have been reported, but there is no data as of yet to support an antiarthritic action. However, there has been a report of a diuretic action and another report that Smilax can increase the excretion of uric acid. Hepatoprotective effects have been reported, supporting the use of this herb for liver disorders in both China and the West, and an antidote effect has been noted to snake venom, supporting the tradition of use of this herb against poisons. Additional effects demonstrated by research These include vermicidal, hypoglycemic, hypocholesterolemic, and antimutagenic effects. TOXICOLOGY BHC This text stated that there were no known contraindications for this herb. Botanical Safety Handbook This text listed Smilax as Class 1, indicating that it is a herb that can be safely consumed when used appropriately.25 German Commission E According to the German Commission E monograph on Smilax, this herb may lead to gas-
..
t:.-~:~~.-
author of this monograph did not give references to suPport'-:::--'~':_-' this statement.26 In fact, the American editors of the English translation of the Commission E monographs point out that they could fmd nothing in the scientific literature to substantiate this assertion. They note that many commonly consumed vegetables contain saponins and that sarsaparilla root is a common ingredient in soft drinks such as root beer and many teas. They therefore disagree with the Commission that potential gastric irritation is likely following ingestion of therapeutic doses of this herb. The value of the Commission E reports has been questioned by one author, due to its failure to include verifiable primary sources. 27
Antihemorrhagic Extracts of S. cuculmeca were reported to inhibit hemorrhage in mice induced by the venom of the snake Bothrops asper. 23 Antimutagenic Decoctions of S. china L. have been reported to inhibit the mutagenicity of benzo[a] pyrene using the Salmonella!microsomal system. 24
~-.~;
tric irritation and temporary kidney impa~ment,but~th~c:',?-c,,~~~t. •
Dose. Dried herb
The BHp28 listed 1-4 g of dried herb, three
times per day. Tincture The BHC listed 2-4 ml of 1:1 liquid extract in 50% alcohol, three times per day. I generally use about 1 m1 of 1:5 Smilax tincture in 25% alcohol, three times per day, in combination with other herbs and not as a single herb. Initial dose
Can start at the standard dose.
Duration Can be used for 1 month or more.
Cautions Western contraindications Not known to aggravate specific disorders, but see Side effects. Chinese contraindications Depending on the text, S. glabra (til ill ling) is to be used with caution 13 or is contraindicated3 in cases of Deficient Yin of the Liver and Kidney. Pregnancy and lactation No adverse reports. Side effects According to the German Commission E monograph on Smilax, this herb may lead to gastric irritation and temporary kidney impairment, but no references were given and this statement has been disputed, see Toxi-
cology. Overdose See Side effects. Interactions According to the Commission E monograph on Smilax, this herb may increase absorption of digitalis glycosides or bismuth, and accelerate elimination of other sub-
......
r
i
Smilax stances, such as hypnotics. However, according to the Botanical Safety Handbook, these proposed interactions have not been substantiated by other references.
713
Muscle channels
gout, rheumatoid arthritis
Christopher"9 BHP
skin channels
skin eruptions, psoriasis
Christopher BHP
Regulatory status Please read the Regulatory status section in the chapter on Safety. Smilax (sarsaparilla root) is on the UK General Sale List (Statutory Instrument Order 1977 No. 2129 to the Medicines Act 1968). Smilax is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Smilax is not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
The main text cited in the Chinese Herbal Medicine Dictionary listed S. glabra (m fU ling) as entering the Liver and Stomach, but another cited text listed it as entering the Liver and Spleen.
ACTIONS • alterative • dermatological agent • anti-inflammatory • antirheumatic and antiarthritic • diuretic
Traditional sources PROPERTIES The main text cited in the Chinese Herbal Medicine Dictionary listed S. glabra (til fU ling) as neutral,
Temperature
but another cited text listed it as cool. The Smilax species in common use in the West are listed as cool in this book since Smilax can be used for psoriasis with irritation, which is associated in Chinese medicine terms with the presence of Heat Toxins.
"
Taste
Taste in the mouth The BHP described the dried rhizomes of Smilax as having a bitter taste. I found that:
...
_.
• a 1:5 tincture of S. ornata in 25% alcohol tasted slightly bitter, slightly sweet, and slightly sour • a sample of dried rhizome of S. ornata tasted initially slightly sweet and then slightly bitter on further chewing
Taste properties The main text cited in the Chinese Herbal Medicine Dictionary listed S. glabra, (til fU ling) as sweet and bland, but another cited text listed it as bitter. The Smilax species in common use in the West are listed as slightly bitter in this book, associated with their antiinflammatory action. The relation of the slight sweet taste of Smilax to its actions is not clear.
ORGANS In terms of Chinese medicine, Smilax, as used in the West, can be associated mainly with disorders of the following systems:
• other Alterative Although Christopher listed many actions for Smilax, including alterative, deobstruant, diuretic, tonic, stimulant, relaxant, diaphoretic, carminative, and demulcent, the main effect used in current Western practice is its alterative or 'blood cleansing' action. Whilst the original alterative use of this herb in the West was the treatment of syphilis, the two main current applications of the alterative action are for skin disorders and rheumatoid arthritis. Dermatological agent Lyle30 noted the use of Smilax as an alterative for skin diseases, Felter and Lloyd31 listed it for herpes, and Christopher recommended it for skin eruptions, psoriasis, chronic abscesses, old ulcers, and ringworm. The BHP gave its specific indication as psoriasis with irritation and heavy desquamation, and the BHC listed it for psoriasis and eczema. Anti-inflammatory Christopher recommended Smilax for internal inflammations, and the BHC listed it as an antiinflammatory. Moore32 has recommended S. californica for benign prostatic hypertrophy and for immune hyperactivity with allergies and chronic inflammations. Antirheumatic and antiarthritic Felter and Lloyd noted the use of Smilax for rheumatism, and Christopher recommended it for rheumatism, gout, and arthritis. The BHP and the BHC both listed Smilax for rheumatism and rheumatoid arthritis. Diuretic Felter and Lloyd noted the use of Smilax for 'passive general dropsy: and the BHC listed it as a diuretic. Michael Moore used S. californica in combination with other herbs for nocturnal urination.
Combining Western Herbs and Chinese Medicine
714
· , , _ ·__
-:,,".,,~~1t:7~
Other Christopher recommended Smilax as a tonic for physical debility and sexual impotence, and Felter and Lloyd listed it as a hepatic for chronic liver disorders. Christopher also recommended Smilax as an antidote for poison, and Maber3 noted its use in the specific case of mercury poisoning.
5. Evans WC. Trease and Evans' Pharmacognosy, 14th edn. WB .~~~~.~~~~ London, United Kingdom (1996) -:~::.~:;,-;..::::.-6. Tschesche R. Kotteler R, Wulff G. Liebigs Ann Chern 699:212-222 (1966) 7. Tschesche R, Ludke G, WulffG. Chern Ber 102:1253-1269 (1969) 8. HagersHandbuch.BandVIB425-431 [Tl1] (1979) 9. Devys M, Alcaide A. Pinte F et al. C R Acad Sc Paris serie D 269:20332034 (1969)
COMPARISON OF WESTERN AND
10. Chen T. Li J, Cao J et al. Planta Med 65(1):56-59 (1999)
CHINESE USE OF SMILAX SPECIES
11. Chen G, Shen 1.. Jiang P. Zhongguo Zhong Yao Za Zhi 21(6):355-357. 383 (1996)
Entries in the table marked with an asterisk* are less common uses of the herb. Western uses (Western Smilax species)
Chinese uses
dermatological agent
psoriasis, eczema, boils, ulcers
boils, sores, psoriasis
antiarthritic
arthritis, rheumatism, gout
arthritis
diuretic
edema*
urinary infections
antisyphilitic
used previously for syphilis
current use for syphilis
hepatic
chronic hepatic disorders*
jaundice
antidote
poisoning, mercury poisoning*
mercury poisoning*
Actions
(S. glabra)13.34
12. Chen T,Li JX,XuQ. Phytochemistry 53(8):1051-1055 (2000) 13. Bensky D, Gamble A. Chinese Herbal Medicine Materia Medica. Eastland Press, Seattle, Washington (1986) 14. Caceres A, Cano 0, Samayoa Bet al. J EthnopharmacoI30(1):55-73 (1990) 15. Rhee JK. WOO K), Baek BK etal.Am J Chin Med 9(4):277-284 (1981) 16. AgeelAM. Mossa JS.al-YahyaMA et al.Drugs Exp Clin Res 15(8):369372 (1989) 17. Hobbs C. Herbal-Gram (American Botanical Council) (17):1.10-15 (1988) 18. Giachetti D, Taddei I, Taddei E. Pharmacol Res Commun $uppl 5:59-62 (1988) 19. Thurmon FM. New Eng J Med 227:128-133 (1942) .
The main current uses of Smilax species in the West are to treat psoriasis or rheumatism and arthritis. Although Chinese texts, such as the Chinese Herbal Medicine Dictionary, place more emphasis on the treatment of boils than psoriasis, my training in Nanjing in the treatment of skin disorders with Chinese herbal medicine emphasized the use of S. glabra (til fU ling) for psoriasis. It was included in combinations for cases of psoriasis involving Heat Toxin, Damp Heat, or Heat in the Blood. S. glabra is also used in China for urinary infections, jaundice and syphilis. These uses, however, are less common in the West, although Smilax was originally introduced into Europe from Jamaica as a cure for syphilis.
20. Rafatullah $, Mossa JS, Al-Yahya MA et a1. Drugs Exptl Clin Res 15:369-372 (1989) 21. Fukunaga T. Miura T, Furuta K et al. Bioi Pharm Bull 20(1):44-46 (1997) 22. $auvaire Y. Ribes G, Baccou JC et al. Lipids 26(3):191-197 (1991)'7.:';' 23. Castro 0, Gutierrez JM, Barrios M et al. Rev BioI Trap 47(3):6Os:.616 .. ' ,.. •. -r ., - -,-.,(1999) -,.~:,~~,:,~~,;~
"';~~s
24. Lee H, Lin lY. Mutat Res 204(2):229-234 (1988) 25. McGuffin M. Hobbs C. Upton R et al. American Herbal Products Association's Botanical Safety Handbook. CRC Press, Boca Raton, Florida (1997) 26. Blumenthal M (ed). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, Texas (1998) 27. Treasure J. European Journal of Herbal Medicine. 5(1):38-43 (2000) 28. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983) 29. Christopher JR. School of Natural Healing. BiWorld. Provo. Utah (1976)
References 1. Grieve M. A Modern Herbal, vols. 1 and 2. Dover Publications, New York, New York (1971)
2. Bradley PR (ed). British Herbal Compendium, vol. 1. British Herbal Medicine Association, Bournemouth. United Kingdom (1992) 3. Jiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science and Technology Press, Shanghai. China (1975) 4. Harnischfeger G, Stolze H. Smilax species-Sarasparille. In: Bewahrte Pflanzendrogen in Wissenschaft und Medizin. Bad Homburg! Melsungen: Notamed Verglag pp 216-225 (1983)
30. Lyle TJ. Physio-Medical Therapeutics. Materia Medica and Pharmacy. Originally published Ohio (1897). Reprinted by the National Association of Medical Herbalists of Great Britain, United Kingdom (1932)
2:
31. Felter HW, lloyd Ju. King's American Dispensatory, vols. 1 and isib edn. (1898). Reprinted by Eclectic Medical Publications. ~d~.'''-' Oregon (1983) . 32. Moore M. Medicinal Plants of the Pacific West. Red Crane B004 ;';':." Santa Fe, New Mexico (1993) ." '.~;\~J(\;':
33. Mabey R (ed). The Complete New Herbal. Elm Tree Books, ~~;',,:(~{.;United Kingdom (1988) :'''', '..
mstifuk'" .';~.';'
34. Yeung H-C. Handbok of Chinese Herbs and Formulas vol I. of Chinese Medicine. Los Angeles, California (1985) .;;'·';t+4:~{,·;:t,·~
t
'
r
L
Tanacetum Botanicalname Tanacetum parthenium (L.) Schulz-Bip. Family Asteraceae (Compositae) Pharmaceutical name Taneceti parthenii herba Part dried aerial parts English feverfew German Mutterkraut French grande camomille Mandarin T. parthenium (L.) Schulz-Bip. is not used:
transferred to the United States. This use is not so prevalent in Germany, and feverfew is not included in Wichtl l1 or the German Commission E monographs. 12
Nomenclature • throughout this chapter the term 'Tanacetum' refers specifically to T. parthenium, and not to other Tanacetum species, such as T. vulgare
see below Use in the West Feverfew is a tall perennial originally na- . 1 tive to Asia minor and now found in Europe. According to Grieve,2 the name feverfew may be a corruption of the word "febrifuge;' from the Latin febris, meaning a fever. The use of this herb may go back at least to the time of Dioscorides,3 although problems with nomenclature make it uncertain that the Parthenion of Dioscorides is identical to the T. parthenium of today.
Use in the last century Until recently, this herb has not been
• previous botanical names for Tanacetum parthenium include: Chrysanthemum parthenium, Matricaria parthenium, and Pyrethrum parthenium Problems of nomenclature are discussed further in
Traditional sources. Use in China Tanacetum is not listed in the Chinese Herbal Medicine Dietionary.13 JU huil, the flowers of Chrysanthemum morifolium Ramat., may be the nearest equivalent herb commonly employed in China, in terms of actions and uses.
used much in the last century in either Britain or the United States. It is not listed in American texts such as Lyle,4 Ellingwood,s KlOSS,6 or Christopher,' and its use is only briefly discussed in Felter and Lloyd,S mainly as a tonic. It is not 9 described in British texts such as Priest and Priest or the BHP,lo and it is described in Grieve as a general tonic and for
used in the West for headache and migraine, can be said to
menstrual disorders or melancholy.
be a cool, bitter herb that has its main effects on the Liver.
Recent use
The key to understanding feverfew is that it is an anti-inflammatory herb that is specificfor headache and migraine.
What is special about Tanacetuln In terms of Chinese medicine, Tanacetum, as currently
The modern use of this herb for migraine and headache started in England in the 1970s, and has now
715
Combining Western Herbs and Chinese Medicine
716
..
~~:- ::,::::=:::.:~
cifically for headache and migraine that are associated in Chinese terms with:
CHINESE ACTIONS In terms of Chinese medicine, Tanacetum, as it is currently used in the West to treat headache and migraine, can be said to have two main actions:
• Liver Hyperactive Yang with Wmd Heat: for example, headache with conjunctivitis (often combined with Chrysanthemum) • Liver Hyperactive Yang with Liver Heat: for example, headache with hypertension (often combined with
I. calm Liver Hyperactive Yang II. clear Wind Heat or Liver Heat
Calm Liver Hyperactive Yang The main action of Tanacetum appears to be to calm Liver Hyperactive Yang, but only when this syndrome is associated with headache or migraine. Clear Wmd Heat or Liver Heat Tanacetum can be said to clear Wind Heat or Liver Heat, specifically when these syndromes are associated with a headache or migraine resulting from Liver Hyperactive Yang. However, this herb can be used for headache associated with other syndromes, such as Wind Cold, Liver Stagnant Qi, or Heart Spirit Disturbance, when it is used in appropriate combination with other herbs.
Valeriana or Piscidia) However, Tanacetum can be included in combinations with other herbs for a wider range of headache, for example: • with Lavandula or Passiflora for headache with insomnia • with Salvia for headache with myalgia • with Rosmarinus for headache with depression • with Artemisia or Mentha pulegium for headache with premenstrual syndrome DIRECTION OF ENERGY
WESTERN ACTIONS The main Western actions of Tanacetum are shown here in terms of its two main Chinese actions:
This herb can reduce the pathological upward movement of Liver Yang in the particular case of headache and migraine, but it is not a heavy sedative herb to 'sink the Spirit:
I. calm Liver Hyperactive Yang
anti-inflammatory
II. clear Wind Heat or Liver Heat
anti-inflammatory
Anti-inflammatory The term 'anti-inflammatory' is used here as an approximation to indicate the general anti-inflammatory effect and specific antiarthritic and antimigraine effects. However, the antimigraine effect is not fully understood and may be linked to antihypertensive or tranquilizing effects that are as yet unstudied. Antihypertensive and sedative actions have been reported for the similar herb C. morifolium. 14 WESTERN USES
TYPICAL CASE EXAMPLE Signs and symptoms The patient has a migraine about twice a month and a headache at least twice a week, being most severe just before her menstrual period_ She also has frequent irritability and impatience, redness of the eyes, and occasional dizziness. The pulse is wiry, and the tongue is slightly purple with a few red dots. Diagnosis
The patient has Liver Hyperactive Yang with
some Liver Heat and some Liver Stagnant Qi. Choice of Tanacetum This herb is specific for chronic migraine and headache associated with Liver Hyperactive Yang and some Liver Heat.
The current Western uses of feverfew can be related to its two main Chinese actions. Older traditions of use for Tanacetum are discussed in Traditiona/sources:
Limitations ofTanacetum
Western:....uses •.. :: ...
TEMPERATURE
I. calm Liver Hyperactive Yang
headache, migraine
II. clear Wind Heat or Liver Heat
headache, migraine
In this book, feverfew is classified as cool, but it can be used for hot, warm, neutral, or cool conditions if it is combined with appropriate herbs. It would not normally be sufficient for treating hot conditions unless it was combined
,
Headache and migraine The main current use of Tanacetum in the West is for headache and migraine. I use it spe-
with cold herbs.
--
-.-"'1
oj
~
iii
Tanacetum
717 Tanacetum + Salvia officinalis
TASTE
Headache + myalgia
Tanacetum is classified as a bitter herb in this book, in the sense of calming Liver Hyperactive Yang and clearing Liver Heat and Wind Heat. It is not primarily a bitter digestive tonic.
Both herbs can treat headache associated with Liver Hyperactive Yang, but Salvia can also treat headache associated with Wind Cold, Wmd Heat, Deficient Ym, or menstrual disturbance. Tanacetum + Rosmarinus
ACTIONS Anti-inflammatory in the treatment of migraine Tanacetum is currently used in the West as an anti-inflammatory to treat migraine and headache, rather than for any other anti-inflammatory manifestation.
Tanacetum paired with other herbs Discussion of the limitations of each of the main actions of Tanacetum can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Tanacetum beyond its limitations. The basic unit of herb combination is the herb pair. Six pairings of Tanacetum are briefly explained below.
CAUTION
Headache + depression Both herbs can treat migraine or headache associated with Liver Hyperactive Yang, but Rosmarinus is a warm, circulatory stimulant herb, which can move Stagnant Qi of Liver or Heart to treat headache associated with depression. Tanacetum + Artemisia absinthium
Premenstrual headache + nervous tension Artemisia can calm Liver Hyperactive Yang and move Liver Stagnant Qi to regulate menstruation and· treat premenstrual headache. Besides calming Liver Hyperactive Yang to treat headache, Tanacetum has an old tradition of use of regulating menstruation.
Tanacetum combinations Two Tanacetum combinations are discussed below:
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair.
- .-' ;~'-.'~ t:.~ ,,<:-,~._~.:}:~: ;:\:-.~. -.: - <.:: '<"':;' ',.It: ~ ;"~''':, •.~•. Chlnese··syndromes···.'·· ,. ," ','~'.:"f;•. '. -,
Both these herbs can be used for headache with red, itchy eyes associated with Liver Heat and Wmd Heat. Tanacetum is specific for headache and migraine, and C. morifolium is specific for eye disorders. Tanacetum + Valeriana
•
Liver Hyperactive Yang + liver Heat
+ conjunctivitis
liver Hyperactive Yang + Wind Heat
eriana is used more as a sedative.
..
2. headache
CAUTION
Before using any ofthe combinations below, it is important to be familiar with the cautions listed for each herb in the combination.
Headache + hypertension These herbs can be combined for headache with hypertension associated with Liver Heat and Liver Hyperactive Yang. Tanacetum is specifically used for headache, and Val-
...
.
1. hypertension + headache
Tanacetum + Chrysanthemum morlfolium
Headache + conjunctivitis
-
Tanacetum + Lavandula
Headache + insomnia Both herbs can calm Liver Hyperactive Yang, but Lavandula can also calm Heart Spirit to treat headache with restlessness, an:ciety, and insomnia.
1. Hypertension + headache
Liver Hyperactive Yang + Liver Heat Herb
Ratio
Temperature
Taste
cool
bitter, sweet
cold
bitter
warm-cool
aromatic, acrid
cool
bitter
cool
bitter
Taraxacum
1 1 1 1 1 1
Rheum
0.5
cool-cold cool-cold
bitter bitter, sour
Valeriana Piscidia Salvia off. Tanacetum Berberis
Combining Western Herbs and Chinese Medicine
718
This combination is the same as Valeriana: hypertension
+ headache and is discussed under that heading. 2. Headache + conjunctivitis
Liver Hyperactive Yang + Wind Heat Herb Tanacetum Chrysanthemum mor. Salvia off. Viola trio Ophiopogon Glycyrrhiza Zingiber (fresh)
Ratio
Temperature
Taste
1 1 1 1 0.5 0.5 0.5
cool cool warm-cool cool cool neutral-cool hot
bitter sweet, sl. bitter aromatic, acrid sour, sweet. bitter sweet. sl. bitter sweet acrid, aromatic
2. Headache + conjunctivitis
Liver Hyperactive Yang + Wind Heat The previous combination is colder, more bitter, and more draining, and is therefore used to treat acute patterns of Excess and Heat associated with hypertension and restlessness. In contrast, this combination for headache and conjunctivitis is sweeter, more tonifying, and more acrid, thus allowing it to clear the Exterior. The inclusion of C. morifolium makes this combination specific for eye irritations associated with Wmd Heat, Liver Heat, and Deficient LiverYm.
Research
GENERAL
This combination is for Liver Hyperactive Yang with Wind Heat, some Liver Heat, and some Deficient Yin of the Liver and Kidney. The overall temperature of the combination is cool to treat warm conditions. The bitter taste is to drain Heat, the acrid taste is to clear Exterior Wind, and the sweet taste is to tonify the Yin. USE
• acute or chronic headache with eye inflammation and redness PRACTICAL NOTES
For chronic conditions, this combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of water, three times per day. For acute conditions, it can be taken as 3 cups of an infusion-decoction per day, with Ophiopogon, Glycyrrhiza, and fresh Zingiber decocted for about 30 minutes. The other herbs are then added and the heat is turned off. The mixture is allowed to steep for 15 minutes, then strained, and the liquid is drunk warm.
COMPARISON OF THE TWO TANACETUM COMBINATIONS
1. Hypertension + headache
Liver Hyperactive Yang + Liver Heat This combination should be taken only for a short period for acute patterns of Excess and Heat. Valeriana, Piscidia, Salvia, and Tanacetum can calm Liver Hyperactive Yang and help to clear Liver Heat. Berberis, Taraxacum, and Rheum drain Liver Heat.
CONSTITUENTS The following constituents have been reported: • sesquiterpene lactones • essential oil • other Sesquiterpene lactones These include compounds with an a-methylene-y-Iactone ring, especially the germacranolide parthenolide (0.1-0.9%),15 which is considered to be the main active constituent of Tanacetum. Other germacranotides are present, such as artemorin, and the eudesmanolide santamarin, has been found in North American and Mexican samples.\
Importance of a-methylene-y-Iactone group
Parthenolide and some of the other sesquiterpene lactones in Tanacetum have an a-methylene-y-lactone group (a-methylene-butyrolactone ring). This group may be responsible for a large part of the pharmacological activity of feverfew, probably because it can neutralize thiol (sulfhydryl) groups on enzymatic or structural proteins. 16
Variability ofparthenolide content According to Bruneton, there can be great variation in parthenolide content: • it is at its maximum when the plant is blooming; at that time, the leaves can contain four times more parthenolide than before flowering • it is found in greatest concentration in the flowering tops (1.38%), while it is almost absent from the roots • it is present in some varieties of feverfew in Europe and North America, but is absent from Mexican material • its concentration is highest in the fresh plant and can fall by nearly 50% in 9 months if the crushed drug is stored with no precautions
Tanacetum An analysis in 1991 of commercially available preparations made from dried material showed that parthenolide was absent from about a third of the preparations and varied from 0.01-1 % in the other two thirds. Essential oil
The major constituents are camphor and
chrysanthemyl acetate.' Other
These include flavonoidsl~ and polyacetylene com-
pounds. 18
RESEARCH ON TANACETl."~l The following effects have been reported: • antimicrobial • anti-inflammatory • antimigraine • antiarthritic • antispasmodic • vasoprotective • antilipidemic • antitumor Antimicrobial
thenium to inhibit phagocytosis and degranulation may contribute to its anti-inflammatory activity,::5 and Tanacetum extracts or parthenolide have been reported to inhibit the production or release of mediators of inflammation such as prostaglandin26 and histamine. 27 In addition, the lipophilic flavonoid, tanetin, can inhibit the production of proinflammatory eicosanoids. 18.19 Antimigraine
Mechanism
PHARMACOLOGICAL AND CLINICAL
l,-_
719
Both Tanacetum extracts and isolated con-
stituents have shown antirnicrobi~ activity.
Herb extracts Tanacetum extracts were reported to inhibit the growth of some species of Gram-positive bacteria and some species of fungi. 19
Essential oil Both bactericidal and fungicidal activity has been demonstrated using essential oil from the flowers of T. parthenium. 20
Eudesmanolides
Antibacterial activity has been reported 2 using eudesmolides isolated from T. parthenium. \
The pathogenesis of migraine is not fully understood. One proposed mechanism is that the cascade of events resulting in a migraine episode is triggered by abnormal platelet activity with increased release of serotonin.50 Tanacetum extracts have been reported to inhibit the secretion of serotonin by blood platelets,>\ and this appears to be due at least in part to parthenolide and other sesquiterpene lactones. 32 The a-methylene-y-Iactone group on parthenolide and other Tanacetum sesquiterpene lactones may neutralize thiol (sulphydryl) groups on enzymes that are needed in platelet secretion.53.34
Clinical trials
An early clinical trial reported that Tanacetum was not only effective at reducing the frequency and severity of headache and migraine, but in some cases, it could also reduce the symptoms of arthritis and improve digestion, sleep, and general well-being. 35 However, a later trial with improved methodology, using doses corresponding to 170 mg of dried herb with an equivalent of 0.5 mg parthenolide, found no significant difference between Tanacetum and a placebo. 36 Nonetheless, a recent review of clinical trials on the efficacy of Tanacetum for migraine reported that of the six trials that met the methodology criteria of the reviewers, the majority indicated that Tanacetum is likely to be effective in the treatment of migraine.57 Antiarthritic
Parthenolide An in vitro study reported that parthenolide
Mechanism Tanacetum may inhibit the release of inflam-
can inhibit the growth of Gram-positive bacteria, yeasts, and filamentous fungi.21
matory secretions from white blood cells in inflamed joints. Specifically, it inhibits granular secretions by polymorphonuclear leukocytes in vitro, possibly by blocking cellular sulfhydryl groups.38
Anti-inflammatory The mechanism of the anti-inflammatory, antirnigraine, and antiarthritic effects of T. parthenium is not fully understood. Whilst parthenolide and other sesquiterpene lactones with an a-methylene-y-Iactone group can have anti-inflammatory activity,13 and may thereby be the main active constituents, other chemicals, such as flavonoids, may also contribute to these effects. Oral administration of T. parthenium extract at doses of 10,20, and 40 mg/kg had dose-dependent anti-inflammatory effect in both rats and mice, and intraperitoneal administration of parthenolide at doses of 1 or 2 mg/kg also had an anti-inflammatory effect. 24 The reported ability of T. par-
Clinical trials Whilst there have been reports that Tanacetum can reduce the symptoms of arthritis in some cases/; a more recent clinical trial showed no significant difference between Tanacetum and a placebo. 39 Antispasmodic One study compared extracts prepared from fresh and dried Tanacetum and found marked differences in their action on rodent smooth muscle material in vitro. Extracts of the fresh leaves inhibited contractile responses of the smooth muscle. and this was associated with the presence of parthenolide and other sesquiterpene
Combining Western Herbs and Chinese Medicine
720
lactones containing a-methylene-y-lactone groups in the fresh material. In contrast, extracts of the dried material did not inhibit contractile responses of the smooth muscle. They did, however, elicit sustained contractions; these results are attributed to the absence of sesquiterpene lactones containing a-methylene-y-lactone groups in the dried material. 40 Another study reported that Tanacetum extract inhibited bronchoconstriction in guinea pigs. ~l Vasoprotective A Tanacetum extract protected the endothelium of aorta strips from induced injury, suggesting a vasoprotective effect.~2 Antilipidemic This effect has been demonstrated in mice for compounds containing an a-methylene-y-lactone group.H Antitumor Low concentrations of parthenolide inhibited in vitro growth of tumor cell lines in a cytostatic manner.4-1 Parthenolide enhanced the paclitaxel sensitivity of breast cancer cells, suggesting that it may be used to increase the sensitivity of cancers with constitutively active NF-kappa B· toward chemotherapeutic drugs. ~5
PHARMACOLOGICAL AND CLINICAL RESEARCH ON C. MORIFOLIUM The following effects have been reported: • antimicrobial • antipyretic • anti-inflammatory • cardiotonic • antihypertensive • anti-HIV Antimicrobial In vitro studies reported that decoctions of ju hua 46 or essential oil extracted from the fresh aerial parts47 had antimicrobial action against some bacteria. Antipyretic Oral administration of the fluid extract of ju hua has been reported to have antipyretic effect in induced fever in rabbits,48 but another report claimed that significant antipyretic effect was only achieved with toxic doses of ju hua. 49 Anti-inflammatory In a study with mice, helianol, the main component of the triterpene alcohol fraction of C. morifoliurn, was reported to have a marked inhibitory effect on induced inflammation.50 Cardiotonic In animal studies, ju hua preparations have been reported to dilate the coronary vessels, increase the force of cardiac contraction, increase the coronary flow, and slow the heart rate. 51
In clinical studies with ju huii decoction on angina:.., ~:==:,;:.. patients, it was claimed that there was an improvement in -symptoms such as chest discomfort, palpitations, dizziness. and headache. 52 Antihypertensive Chrysanthemin, a constituent of ju hua. was reported to have antihypertensive action in animal studies. 14 In one clinical study, chrysanthemin was reported to have a significant antihypertensive effect in hypertensive angina patients,52 but another clinical report on angina patients showed no significant antihypertensive effect. 53 Anti-HIV The flavonoid acacetin-7-0-f3-D-galactopyranoside from C. morifolium has been reported to exhibit anti-HIVactivity.54
COMPARISON OF T. PARTHENIUM AND
C. MORIFOLIUM
I have not found sufficient information on C. morifolium to make an adequate comparison of the constituents of these two herbs. Both herbs have been reported to have antimicrobial and anti-inflammatory activity. It would be interesting to determine if T. parthenium has antihypertensive activity, as reported for C. morifolium, in view of the older traditional use of feverfew for dizziness and vertigo in addition to its modern use for headache and migraine.
RESEARCH VERIFICATION OF TRADITIONAL ACTIONS The recent traditional anti-inflammatory and antimigraine applications of T. parthenium are supported by research, but the older antipyretic, anticatarrhal, antidepressant, emmenagogue, tonic, and carminative applications are not. These older applications have not been subject to specific research studies. However, one clinical survey on the effectiveness of T. parthenium for migraine reported that some long-term users of T. parthenium experienced better digestion and an increased sense of well-being. Additional effects demonstrated by research Antimicrobial, antiarthritic. antispasmodic, vasoprotective, antilipidemic, and antitumor effects have been reported.
TOXICOLOGY Severe adverse effects It has been reported that Tanacetum extract can have anti-inflammatory effects without altering the normal behavior of animals,24 and that rodents, fed over
Tanacetum 100 times the human daily dose of Tanacetum for 5 weeks, had no adverse effects.35 In addition, no major adverse effects 55 56 were reported following two clinical trials of feverfew. .
short-term infusion for an acute condition, and with four to
Mild adverse effects In one clinical survey, some mild side effects were reported in 17.9% of the patients.)5 The most common of these side effects was soreness of the tongue or mouth ulcers (6.4%). Other effects included indigestion or abdominal pain, urinary problems, headache, diarrhea, and swollen lips or mouth. The oral side effects may be due to the fact that the patients were chewing the fresh herb. However, in two subsequent clinical trials, the incidence of adverse effects was greater in the placebo groups than in the verum groups.55. 56
Dried herb At one end of the range of opinion on dose are Mills and Bone who recommended 150 mg of dried herb, containing at least 0.6 mg of parthenolide, one to two times per day. At the other end of the range is Tierra, who recommended 3-9 g, presumably per day.
Allergic contact dermatitis This has been reported in some cases after contact with Tanacetum, and is thought to be due to the sesquiterpene lactones. 57 Mutagenicity Parthenolide was reported to be nonmutagenic in an assay using bacteria. 58 In a clinical study, the use of Tanacetum over 11 months did not result in chromosomal aberrations compared to the control groUp.59
Dose USE OF FRESH OR DRIED MATERIAL
......
. I
~
•
The amount of parthenolide can decrease the longer the dried material is stored, and some dried material has been reported to contain little or no parthenolide or other sesquiterpene lactones containing a-methylene-y-Iactone groups. It is these sesquiterpene lactones that are thought to be the main constituents responsible for migraine relief. Also, fresh and dried material have been reported to have opposite effects on smooth muscle. 40 It would therefore be most useful to determine the differences in migraine relief between fresh and dried material, and to relate this to the quantity of active sesquiterpene lactones present. For the present, if dried material is used, its quality should be as high as possible, and it should be stored for only a minimum time before use.
INFUSION OR TINCTURE
'"
721
I generally use dried Tanacetum in larger doses as an infusion for acute headache; and in smaller doses as a tincture of the dried herb for chronic conditions. I do not generally use Tanacetum by itself. Rather, I use it in combination with other herbs, that is, with one to four other herbs in a
seven other herbs in a long-term tincture for a chronic condition.
Infusion for acute headache I generally prescribe about 1 g of dried Tanacetum steeped in boiling water for 10-15 minutes, three times per day, usually in combination with other herbs such as Lavandula or Salvia. This prescription is for 3 days only. For chronic conditions, I do not generally use Tanacetum as the dried herb, but rather in tincture form at the doses listed below. Tincture Mills and Bone recommended 0.7-2 ml of 1:1 fresh plant tincture per day, or 1-2 ml of 1:5 dried plant tincture per day. I generally use 0.7-1 ml of 1:5 dried Tanacetum tincture three times per day, in a combination with four to six other herbs.
Initial dose Can start at the standard dose. Duration It may be necessary to take Tanacetum for at least 4 months for consistent improvement.
Cautions Western contraindications Tanacetum is contraindicated in cases of reported hypersensitivity to feverfew, parthenolide, or members of the Asteraceae (Compositiae) family. Chinese contraindications None reported for T. partheni-
urn. Pregnancy and lactation The BHC contraindicated Tanacetum in pregnancy. According to Mills and Bone, however, no adverse effects are known for this herb at its recommended dose levels during pregnancy and lactation, but they suggested that doses be kept to a minimum during pregnancy. Side effects Allergic contact dermatitis, mouth ulcers or tongue soreness, digestive disturbance, or abdominal pain have been reported in some cases. Overdose No severe adverse effects have been reported. Interactions No adverse reports.
Combining Western Herbs and Chinese Medicine
722
Regulatory status
PROPERTIES
Please read the Regulatory status section in the chapter on Safety. Tanacetum (feverfew) is on the UK General Sale List, and is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Tanacetum is not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
Traditional sources Nomenclature The nomenclature for feverfew can be confusing and is summarized in the table below: .
:........'~:~ .• _~·-,~7
.' :..-:-: _. ~',:"",~.:':::,,;,
language
••
.•-:;:.-_'~ .•~. ::.
_=.
~7;'~;
-- ... ~
_~,.,,~-,
'._
Temperature The old European texts differ as to whether 'feverfew' is cold or hot in nature. However, it is not certain that all sources were referring to the same herb, or if that herb was T. parthenium. Dioscorides used Parthenion for heat-type S'ovellings and abscesses and for heat-type swellings of the uterus. Lonicems used Mutterkraut for heat-type problems of the uterus and for fever. Tabernaemontanus listed Mettram for fever but also recommended it for cold disorders of stomach or uterus. Gerard wrote that feverfew is hot in the third degree, and Culpeper listed it for headache from a cold cause. T. parthenium, as currently used in the West, is listed in this book as cool, associated with its anti-inflammatory properties. In Chinese medicine, a related herb with similar use is ju hua, Chrysanthemum morifolium, which is classified as cool. 60
Name'
Taste modern Latin (current)
Tanacetum parthenium
modern Latin (previous)
Chrysanthemum parthenium Matricaria parthenium Pyrethrum parthenium
old Latin (or Latinized Greek)
Parthenion, Solis oculus (Dioscorides) Matricaria ( Lonicerus) Artemisia ( Tabernaemontanus)
Taste in the mouth The Parthenion of Dioscorides, the Mutterkraut of Lonicerus, and the feverfew of Grieves are all described as bitter. I found a 1:5 tincture ofT. parthenium in 25% alcohol to be moderately bitter, and a sample of dried material to be definitely bitter.
Taste properties
modern English
feverfew
Tanacetum as used in the West is classified as bitter in this book, in association with its anti-inflammatory Heat-
old English
feverfew, featherfew (Culpeper) feverfew, fedderfew (Gerard)
clearing action.
modern German
Mutterkraut
old German
Metern, Mutterkraut (Lonicerus) Mettram (Tabernaemontanus)
For a study in the nomenclature of this plant which illustrates the difficulties of certain identification in the face of a great variety of shifting names, German-speaking readers are referred to page 29 of Tabernaemontanus.
ORGANS In terms of Chinese medicine, Tanacetum, as currently used in the West, can be associated mainly with disorders of the Liver organ system: Organ
Examples of use
Source'
Liver
headache migraine
Culpeper
Is Parthenion the same herb as feverfew? Dioscorides wrote that Parthenion could be used for disorders of the uterus and for melancholy due to black bile, and these two uses were also listed by Gerard and Culpeper for feverfew. However, although the illustration for feverfew (Matricaria) in Gerard makes it likely that he was using T. parthenium, it is not certain that the Parthenion of Dioscorides was either the feverfew of Gerard or the T. parthenium of today. It may be that Gerard and Culpeper were transcribing the uses listed by Dioscorides for Parthenion onto a different herb.
SHe
T. parthenium is not listed in the Chinese Herbal Medicine Dictionary, but C. morifolium, ju hua, is listed as entering the Lung and Liver. 61
ACTIONS The main modern use of T. parthenium is as an antiinflammatory for the treatment and prophylaxis of headache and migraine. However, other actions and uses have been emphasized in the past, although it is not certain that all the
-
r !
Tanacetum herbs described as feverfew by the different authors are identical to T. parthenium. • anti-inflammatory • antipyretic • anticatarrhal and antidepressant • carminative • tonic • emmenagogue Anti-inflammatory action and the treatment of migraine Gerard wrote that because feverfew purges melancholy and phlegm, it is very good for those who are giddy in the head or those who have vertigo with a swimming and turning sensation in the head. According to Culpeper, feverfew is effective for all pains of the head due to cold and can be used for vertigo (a swimming sensation in the head). According to Bruneton, feverfew has been used in France to prevent headache. In addition, this herb is listed for the treatment of migraine in the BHC, the ESCOP monograph on this herb, and in Mills and Bone. Antipyretic Lonicerus and Tabernaemontanus listed their respective herbs for fever, and Gerard and Culpeper recommended feverfew for the ague (malaria). Felter and Lloyd noted the use of a warm infusion of feverfew in recent colds and in some febrile diseases.
i
_
-
Anticatarrhal and antidepressant According to Dioscorides, Parthenion can drive out phlegm-dampness and black bile through the stools so that it can be used for wheezing and for melancholy due to black bile. Lonicerus wrote that Mutterkraut can drive out evil phlegm and gall, and Tabernaemontanus stated that Mettram can dispel phlegm and evil damp. Gerard wrote that feverfew can purge phlegm and melancholy so that it can help those whose lungs are stuffed with phlegm or those who are melancholy, sad, pensive, and without speech. Culpeper recommended feverfew for those who are troubled with melancholy and heaviness or sadness of the spirits. Grieve recommended feverfew for coughs, wheezing, and difficult breathing, but her emphasis on the use of this herb for psychological disorders was somewhat different. She recommended it for nervousness and lowness of spirits, or for distressing sensitivity to pain in a highly nervous sub-
723
intestinal tract, increasing the appetite, and improving digestion: They also recommended this herb for atonic dyspepsia and for nervous debility. Grieve listed feverfew as a bitter and as a general tonic. Emmenagogue Dioscorides recommended Parthenion to soften a hard uterus and treat heat-type uterine swellings. Lonicerus listed Mutterkraut to clear evil damp from the uterus, promote menstruation, and assist conception. Tabernaemontanus noted the use of Mettram to treat uterine spasms, infertility, or decreased libido due to cold, and to treat postnatal uterine contractions. Gerard said that feverfew can expel the afterbirth or the dead child, and Culpeper recommended feverfew to promote menstruation and to treat postnatal problems. Grieve as well as Felter and Lloyd listed feverfew as an emmenagogue. COMPARISON OF
AND C. MORIFOLIUM T. parthenium and the variety of C. morifolium known as huang ju hua or yellow chrysanthemum can both be used for: • Liver Hyperactive Yang headache • Liver Heat headache and eye irritation .,Wind Heat headache and fever The variety of C. morifolium known as bcii ju hua (white chrysanthemum) or gan ju hua, ( sweet chrysanthemum), is considered to be more of a tonic than huang ju hua (yellow chrysanthemum), and can be used to treat blurred vision or dizziness associated with Deficiency of Liver and Kidneys.6O This compares with the use of feverfew by the Eclectics as a tonic and nervine. The difference between the modern use of T. partheniurn and C. morifolium is that T. parthenium is used more for headache and migraine of any etiology, in combination with appropriate herbs, whilst ju hua is especially used to clear Wind Heat and Liver Heat patterns. In the past, herbs described as feverfew have been used to treat bronchial phlegm, melancholy, and gynecological and obstetric disorders, but these uses are not generally given for C. morifolium.
ject. Carminative Lonicerus listed Mutterkraut, and Tabernaemontanus listed Mettram, for intestinal pain due to cold, Culpeper listed feverfew for abdominal wind and colic, and Grieve listed feverfew as a carminative. Tonic Felter and Lloyd wrote that feverfew taken as a cold infusion could be a valuable tonic, 'influencing the whole
T. PARTHENIUM
References J. Pharmacognosy: Phytochemistry Medicinal Plants, 2nd edn. Lavoisier, Paris, France (1999)
1. Bruneton
2. Grieve M. A Modern Herbal, vols. 1 and 2. Dover Publications, New York. New York (1971) 3. Dioscorides P. Kreunerbuch (1610). Reprinted byVer1ag Konrad Kolbl. Miinchen. Germany (1960)
Combining Western Herbs and Chinese Medicine
724
4. Lyle TJ. Physio-Medical Therapeutics. Materia Medica and Pharmacy. Originally published Ohio (1897). Reprinted by the National Association of Medical Herbalists of Great Britain. United Kingdom (1932) 5. Ellingwood F. American Materia Medica. Therapeutics and Pharmacognosy. 11th edn. (1919). Reprinted by Eclectic Medical Publications. Sandy. Oregon (1994) 6. Kloss J. Back to Eden. 5th edn. (1939). Reprinted by Lifeline Books. Santa Barbara. California (1975) 7. Christopher JR. School of Natural Healing. BiWorld. Provo. Utah (1976) 8. Felter HW.lloyd Ju. King's American Dispensatory, vols. 1 and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications. Sandy. Oregon (1983) 9. Priest AW, Priest LR. Herbal Medication. L.N. Fowler, Romford Essex. United Kingdom (1982) 10. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983) 11. Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm, Stuttgart. Germany (1994). from 2nd German edn. Wichtl M (ed) (1989)
34. Heptinstall S. Groenewegen WA. Spangenberg P et al"Lfbarm:.:.. ~_':.::= PharmacoI39:459-465 (1987) ·",:,,".r,·, 35. Johnson ES. Feverfew (Overcoming Common Problems). Sheldon Press, London, United Kingdom, pp 42-55 (1984) , 36. De Weerdt
CJ, Bootsma
HPR, Hendriks H. Phytomed 3(3):225-230
(1996) 37. Ernst E, Pittler M. Public Health Nutr 3(4A):509-514 (2000) 38. Losche W, Michel E. Heptinstall S et al. Planta Med 54(5):381-384 (1988) 39. Patrick M. Heptinstall S. Doherty M. Ann Rheum Dis 48(7):547-549 (1989) 40. Barsby RW, Salan U. Knight DW et al. Planta Med 59(1 ):20-25 (1993) 41. Keery RJ. Lumley P. Br J Pharmacol89:834P (1986) 42. Voyno-Yasenetskaya TA. Loesche W. Groenewegen WA et al. J Pharm PharmacoI40(7):501-502 (1988) 43. HallIH, Lee KH. Starnes CO et al. J Pharm Sci 67(9):1235-1239 (1978) 44. Ross JJ. Amason JT. Birnboim HC. Planta Med 65(2):126-129 (1999) 45. Patel NM. Nozaki S, Shortle NH et al. Oncogene 19(36):4159-4169 (2000)
12. Blumenthal M (ed). The Complete German Commission E Mono-
46. Traditional Chinese Medicine and Materia Medica Research Unit of
graphs: Therapeutic Guide to Herbal Medicines. American Botanical
the Internal Medicine Department. First Teaching Hospital of Chong-
Council. Austin, Texas (1998)
qing Medical College. Acta Microbiologica Sinica 8( 1):52 (1960)
13. Jiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary
47. Medical Laboratory and Pharmacy. Medical Techniques (Norman
(Zhong yao da ci dian) Science and Technology Press. Shanghai, China (1975)
Bethune Hospital for International Peace of the Chinese PLA) (1-
14. Chang H-M, But PP-H (eds). Pharmacology and Applications of Chinese Materia Medica, vols. 1 and 2. World Scientific Publishing. Singapore (1986) 15. Soucek M. Herout V, Sorm F. Collect. Czech. Chem. Commun. 26: 803810 (1961) 16. Abad MJ. Bermejo P. Villar A. Phytother Res 9(2):79-92 (1995) 17. Williams CA. Hoult JR. Harborne JB et al. 38(1 ):267-270 (1995) 18. Bohlmann F.Zdero C. Phytochem 21(10):2543-2549 (1982) 19. Kalodera Z, Pepeljnjak S. Petrak T. Pharmazie 51(12):995-996 (1996) 20. Kalodera Z, Pepeljnjak S. Blazevic N et al. Pharmazie 52(1l):885-886 (1997) 21. Stephanovic M, Ristic N. Vukmiorovic M. Sci Nat 23:23-40 (1988) 22. Blakeman JP. Atkinson P. Physiol Plant PathoI15(2): 183-192 (1979) 23. Hall IH. Lee KH. Starnes CO et al. J Pharm Sci 68:537-542 (1979)
2):1l3 (1974) 48. Yuan F. Acta Academiae Medicinae Anhui (2):62 (1977) 49. Nakamura. Tohoku Jikken Igaku (8):409 (1925); Qiu CB. New Compilation of Chinese Materia Medica. Shanghai Medical Publishing House. p 274 (1956) 50. Akihisa T. Yasukawa K, Oinuma H et al. Phytochemistry 43(6):125~ 1260 (1996).·~.· ...... 51. .Physiology Section. Zhejiang Medical College et al. Communications of Zhejiang Medical College (Zhejiang Medical College) (2-3):70 (1975) 52. Coronary Disease Unit, First Teaching Hospital of Zhejiang Medical College. Medical Research Information (Zhejiimg Medical College) (1 ):32 (1975) 53. Zhejiang Coordinating Research Group for Clinical Trial of Dendranthema morifolium Tablet for Coronary Disease. Acta Academiae Medicinae Zhejiang 7(4):9 (1978)
24, Jain NK. Kulkarni SK. J Ethnopharmacol68(1-3):251-259 (1999)
54. Wang HK.Xia Y. Yang ZY et al.AdvExp Med Bioi 439:191-225 (1998)
25. Williamson LM. Harvey DM. Sheppard KJ et al. Inflammation 12(1):1l-16 (1988)
55. Johnson ES, Kadam NP. Hylands DM et al. Brit Med J 291:569-573
26. Groenewegen WA, Knight DW, Heptinstall S. Prog Med Chern 29:217238 (1992)
56. Murphy JJ. Heptinstall S. Mitchell JRA. Lancet ii: 189-192 (1988)
27. Hayes NA. Foreman Je. J Pharm PharmacoI39(6):466-470 (1987)
(1985)
57. Lamrninpaa A, Estlander T. lolanki R et al. Contact Derm 34(5):330335 (1996)
28. Williams CA, Hoult JR. Harborne JB et al. Phytochem 38(1):267-270 (1995)
58. Maries RJ, Pazos-Sanou 1, Compadre CM et al. Sesquiterpene Laetones
29. Williams CA. Harborne JB, Geiger H et al. Phytochemistry 51(3):417423 (1999)
istry, vol. 29, Phytochemistry of Medicinal Plants. Plenum Press, New
Revisited. In: Amason IT et al (eds) Recent Advances in PhytochemYork. pp 333-,356 (1995)
30. Hanington E,Jones RJ.Amess JAetal. Lancet 2(8249):720-723 (1981)
59. Anderston D, Jeckinson PC. Dewdney RS et al. Hum Toxicol 7(2):145-
31. Groenewegen WA. Knigiht DW, Heptinstall S. J Pharm Pharmacol 38:709-712 (1986)
60. Bensky D, Gamble A. Chinese Herbal Medicine Materia Medica.
32. Heptinstall S. Awang DV, Dawson BA et al. J Pharm Pharmacol 44(5):391-395 (1992)
61. Yeung H-C. Handbok of Chinese Herbs and Formulas vol. 1. Institute
33. Knight DW. Nat Prod Rep 12(3):271-276 (1995)
.. -----
152 (1988) Eastland Press, Seattle. Washington (1986) of Chinese Medicine, Los Angeles, California (1985)
'-~
"
Taraxacum Botanical name Taraxacum officinale Weber Family Asteraceae (Compositae) Pharmaceutical name Taraxaci radi.~ cum rhizomate Part dried root and rhizome English dandelion German Lowenzahn French dent-de-lion, pissenlit Mandarin T. officinale Weber is not commonly used pu gong ying (~~ is the entire plant of T. mongolicum
*)
Use in North America T. officinale may have been brought to North America in the 17th century with the early settlers, but it was not a favorite herb of the Eclectic practitioners. Although it was clearly described by Lyle, it has only a brief mention by Ellingwood; and the rather self-contradictory description in Felter and UoydS suggests a lack of familiarity with this herb. Dandelion is not mentioned in Christophe~ and until recently has been more used in Europe than in North America.
Species variation T. officinale has many varieties and microUse in the West
,~
.
species/ and is now regarded as a complex of mainly apomictic plants.s
Use in Europe T. officinale is a herbaceous plant native throughout the Northern hemisphere that has been used for centuries in Europe for both its nutritional and its therapeutic properties. The young leaves of dandelion have been used in spring salads I and in dandelion beer;l the flowers have been made into dandelion wine;3 and the dried roots have been made into dandelion coffee. 4 The dandelion beer described by Grieve,3 containing dandelion, nettle, yellow dock, and ginger, has both tonic and cleansing properties. The Arabian physicians of the 10th century may have been the first to record a specifically medical use for dandelion/ although there is not always clear differentiation in the older texts between T. officinale and other dandelion-like plants in the genera Taraxacum and Hieracium. According to Grieve, the name dandelion is a corruption of the French dent de lion, associated with the Latin dens lionis, from the imagined resemblance of the jagged serrations of the leaves to the teeth of a lion.
Use in China The species mainly used in China is T. mongolicum Hand.-Mazz, although, according to Chang and Butt,9 many other Taraxacum species are also used as pu gong ying. This herb is used as a cold bitter agent to clear Heat, Damp Heat, and Heat Toxin, especially to treat hepatitis, cholecystitis, mastitis, and boils.
What is special about Taraxacum In terms of Chinese medicine, T. officinale, as used in the West, can be said to be a cool-cold, bitter herb that has its main effects on three groups of organ systems: • Liver and Gallbladder • Stomach and Intestines • Kidney and Bladder
725
726
_.
Combining Western Herbs and Chinese Medicine
The key to understanding Taraxacum is that it is a herb with four interrelated groups ofactions: • tonifies and moves the Qi of the Liver and Gallbladder and ofthe Stomach and Intestines • clears Heat from the Liver and Gallbladder and from the Stomach and Intestines • assists the Kidney and Bladder to drain Damp • clears Damp Heat and Heat Toxin from the body (alterative function) CHINESE ACTIONS In terms of Chinese medicine, Taraxacum, as used in the West, can be said to have six main actions: I. tonify and move the Qi ofthe Liver and Gallbladder and of the Stomach and Intestines II. dear Damp Heat from the Liver and Gallbladder III. dear Heat from the Liver and Gallbladder IV. dear Heat from the Stomach and Intestines V. dear Damp Heat and Heat Toxin from the body (alterative function) VI. assist the Kidney and Bladder to drain Damp Clear Heat from the Liver and Gallbladder In Chinese medicine, T. mongolicum, pu gong ying, can be used for Liver Heat patterns, such as red, swollen, painful eyes. The 1597 edition of Gerard, quoted by Crellin and Philpott,8 mentions the use of dandelion for hot burning of the liver and for eye inflammations. Although recent tradition in the West does not emphasize the use of T. officinale for what would be termed Liver Heat patterns in Chinese medicine, I use this herb in combinations for some Liver Heat patterns involving such manifestations as hypertension, anger, restlessness, sensations of heat, and red, inflamed eyes. In such cases, I often use it combined with Berberis and Rheum. Clear Heat from the Stomach and Intestines In Chinese medicine, T. mongolicum has been used in combinations for Excess Heat in the Stomach and Intestines. Research in China has reported that this herb can be effective in the treatment of gastritis and gastric ulcers, as discussed in the Research section. T. officinale has had a similar tradition of use in the West, see Traditional sources. I use this herb in combinations for some patterns of Stomach Excess Heat, often combined with Hydrastis and Rheum.
Chinese actions I. tonify and move Qi of the Liver. Gallbladder. Stomach. and Intestines
bitter digestive tonic hepatic choloretic
II. clear Damp Heat from the Liver and Gallbladder
hepatobiliary anti· inflammatory
III. clear Heat from the Liver and Gallbladder
anti·inflammatory adjunct to antihyper· tensive therapy
IV. clear Heat from the Stomach and Intestines
gastrointestinal antiinflammatory mild lal(ative
V. clear Damp Heat and Heat TOl(in from the body
VI. assist the Kidney and Bladder to drain Damp
alterative dermatological agent antirheu'matic adjunct to cancer therapy
'...... :
diuretic
In the West, Tara..xacum is mainly used as a digestive and hepatobiliary tonic, digestive and hepatobiliary anti-inflammatory, alterative, and diuretic. However, in my opinion, this herb can also assist the gastrointestinal anti-inflammatory and antihypertensive action of other herbs.
-.
Alterative Taraxacum can be used as an alterative toveat"",,,,,',_ skin disorders, arthritis, or the side effects of cancer therap~-:;':$;~+:.-especially in cases in which toxins have accumulated~:~{~~·~~$i.; body from one or more of the following origins: ., ,.~;..;,:;...~,·,t'rr~~' • sluggish gastrointestinal function with constipation • sluggish hepatobiliary function • gastrointestinal inflammation • hepatobiliary inflammation • sluggish urinary function WESTERN USES The main Western uses of Taraxacum are shown here in terms of its six main Chinese actions: Chinese actions I. tonify and move Qi of the Liver. Gallbladder, Stomach, and Intestines
poor appetite, atonic digestionl sluggish liver function, difficulty digesting fats. constipation .
II. clear Damp Heat from the Liver and Gallbladder
hepatitis, cholecystitis, cholelithiasis
WESTERN ACTIONS
III. clear Heat from the Liver and Gallbladder
eye inflammations. hypertension
The main Western actions of Taraxacum are shown here in terms of its six main Chinese actions:
IV. clear Heat from the Stomach and Intestines
gastritis, peptic ulcer
Taraxacum ACTIONS
Chinese aCtions·· . V. clear Damp Heat and Heat Toxin in the body
VI. assist Kidney and Bladder to drain Damp
727
boils. acne rosacea, eczema, arthritis, rheumatism, adjunct to cancer therapy edema, oliguria
DIRECTION OF ENERGY In terms of Chinese medicine, Taraxacum can contribute to an outward spreading movement of Liver Qi, and its diuretic and mild la.''{ative actions can give a downward
Bitter digestive tonic Although there is a Western tradition of use of Taraxacum as a bitter digestive tonic, I do not use it as a primary herb for this purpose. Hepatic and cholagogue Taraxacum is a cool-cold, bitter, anti-inflammatory, and alterative herb that can also have hepatic and choloretic activity. However, if a hot or warm, acrid or aromatic herb is required to stimulate liver and gallbladder function, other herbs would be more suitable.
TYPICAL CASE EXAMPLE
Hepatobiliary anti-inflammatory Taraxacum is specific for inflammatory conditions of the liver and gallbladder in which there is some degree of sluggish liver function. If the hepatobiliary disorder is accompanied by spasms or infection, then Chelidonium or Berberis, respectively, would be more appropriate.
Signs and symptoms The patient has right hypochondriac discomfort, difficulty digesting fatty foods, poor appetite, constipation, recurring reddish skin rashes and boils, irritability, and occasional dysuria. The pulse i~ slightly wiry and slippery, and the tongue is slightly red with a slightly
Antihypertensive Taraxacum has not been shown to have direct antihypertensive action, but it can assist in the treatment of hypertension, restlessness, and irritability by clearing Liver Heat. For this purpose, it is best combined with other herbs, such as Rheum or Berberis.
greasy yellowish coat.
Gastrointestinal anti-inflammatory Whilst I do not regard Taraxacum as a primary herb to treat gastritis or peptic ulcer, I use it when these conditions are associated with Stomach Excess Heat combined with either Intestines Heat, Liver Heat, or both of these syndromes.
movement to stools and urine.
Diagnosis The patient has Stagnation of Qi in the Liver, Gallbladder, Stomach, Intestines, and Bladder. There is also some Liver-Gallbladder Heat and Damp Heat, as well as Heat Toxin.
J
Choice of T. officinale This herb is specific for conditions involving Stagnant Qi of one or more of the following organ systems: Liver, Gallbladder, Stomach, Intestines, and Bladder, especially when these are combined with Damp Heat and Heat Toxins. .
Limitations ofTaraxacum TEMPERATURE In this book, T. officinale is classified as cool-cold and is more appropriate for hot or warm conditions, although it can be used for neutral, cool, or even cold conditions if it is suitably combined with other herbs.
TASTE T. officinale is classified as bitter, but it does not taste as bitter in the mouth and is not as strong a bitter digestive tonic as, for example, Cinchona, Artemisia absinthium, or Gentiana.
Laxative Taraxacum is only a mild laxative, specifically for mild constipation associated with atonic digestion, sluggish hepatobiliary function, and associated skin eruptions. Diuretic Taraxacum has a long tradition as a diuretic and as a herb that can help to clear obstructions, ~ven gravel, or ulceration from the urinary passages. However, I use it primarily as a diuretic for edema in combination with other herbs, such as Juniperus or Petroselinum. Other herbs are likely to be more effective for the following types of urinary disorders:
• infection • inflammation • obstruction
Arctostaphylos or Hydrastis Althaea or Zea· Hydrangea, Parietaria
Alterative Taraxacum can be used as an alterative to treat skin disorders, arthritis, or the side effects of cancer therapy, especially in cases in which toxins have accumulated in the body from sluggish function and/or inflammation in the' hepatobiliary or gastrointestinal systems. However, in specific situations the following herb pairs might be preferred: • Scrophularia + Rheum
acute eczema with Heat in the Blood
Combining Western Herbs and Chinese Medicine
728 • Mahonia + Hydrastis
chronic eczema with Damp Heat • Smilax + Salvia miltiorrhiza
psoriasis with Heat Toxin and Stagnant Blood • Arctium + Phytolacca
acne with Heat Toxin and Phlegm
Taraxacum paired with other herbs Discussion of the limitations of each of the main actions ofT. officinale can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of T. officinale beyond its limitations. The basic unit of herb combination is the herb pair. Twelve pairings of T. officinale are briefly explained below.
ter anti-inflammatory action of Taraxacum. Althaea has-a--::';~ tradition of use as a mild diuretic and urinary anti-inflammatory, so that the two herbs can also be combined for edema or oliguria with some urinary inflammation. .• "'f
.•
"'-:"..;'_~":"!'
Taraxacum + Glycyrrhiza
Detoxification regimes There can be a tendency for high doses of alterative herbs such as Taraxacum, Arctium, and Rumex to release toxins into the bloodstream faster than they can be detoxified and eliminated. The result may be a temporary aggravation of the skin disorder or arthritic condition under treatment. This can be minimized or avoided by a variety of measures, see the Cautions section, including the combination of Taraxacum with a detoxifying anti-inflammatory herb such as Glycyrrhiza. These herbs can also be paired to treat Stomach Heat patterns. Taraxacum + Rheum
CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair. Taraxacum + Chelidonium
Cholecystitis + pain Both herbs can move stagnation of Qi in the Liver and Gallbladder. Taraxacum can clear Liver Heat, and Chelidonium can relieve spasms and pain in the bile ducts.
Constipation These herbs can clear Heat from the Stomach and Intestines to treat gastrointestinal inflammation and constipation. They can also clear Heat from the Liver to assist in the treatment of hypertension and help to cleat Heat Toxins to treat boils and acne. Both herbs have a laxative action, but that of Rheum is considerably stronger than that of Taraxacum. Taraxacum + Mahonia
Chronic eczema Taraxacum + Berberis
Hypertension + anger Both herbs can move Stagnation of Liver Qi and clear Liver Heat, and thus indirectly reduce symptoms associated with this pattern, such as headache, red eyes, and irritability. Both herbs can also clear Damp Heat from the Liver and Gallbladder to treat cholecystitis and hepatitis, as well as Damp Heat-associated eczema or arthritis. Taraxacum + Hydrastis
Peptic ulcer Both herbs can help to clear Stomach Excess Heat, treating gastritis, peptic ulcer, or constipation. Hydrastis can also help to heal damaged mucus membranes and reduce gastrointestinal bleeding. Taraxacum + Althaea
Gastritis Althaea is a mucilaginous demulcent anti-inflammatory for the gastrointestinal system that can complement the bit-
Mahonia is specific for chronic skin disorders due to Damp Heat and can combine with Taraxacum for this purpose. Both herbs can also be used for Damp Heat cholecystitis. Taraxacum + Rumex
Chronic eczema + constipation Rumex is a mild la.'(ative, cholagogue, and alterative that can be combined with Taraxacum to treat disorders of the liver and gallbladder, especially when these are combined with skin disorders, constipation, or both. Rumex can also be used to treat psoriasis. Taraxacum + Arctium
. Adjunct to cancer therapy Arctium is an alterative and mild diuretic, which can be used for cystitis, rheumatism, arthritis, gout, eczema, psoriasis, and other conditions associated with accumulation of Heat Toxin. It can be used to treat disorders of the lymph system and can be combined with Taraxacum to treat the side effects of cancer therapy.
"_,.J
..
r Taraxacum
729
Taraxacum + Arctostaphylos
Dysuria + infection Berberis
Arctostaphylos can act as a strong urinary antiseptic and can be combined with Taraxacum for dysuria, urinary ob-
Taraxacum Chelidonium Artemisia abs. Glycyrrhiza
struction, and edema with urinary infection.
Zingiber
Taraxacum + Convallaria
Cardiac edema Convallaria is specific for cardiac weakness with edema, and Taraxacum can act both as a diuretic and as a supplier of potassium to replace the potassium leached out by conven10:'1_ _
tional diuretic drugs.
1 1 1 1
cool
0.5 0.5
neutral-cool hot
cool-cold cool warm-cool
:
i
/..-.
I
bitter, 51. acrid aromatic, bitter sweet acrid, aromatic
This combination is the same as Berberis: cholecystitis and is discussed under that heading.
2. Gastritis + constipation
Stomach Heat + Liver Heat
Taraxacum +Juniperus t~.
bitter bitter
Herb
Edema + digestive weakness Taraxacum is a cooling diuretic, and Juniperus is a warming diuretic. The two' herbs can be combined to treat edema that is either neutral or mixed in temperature. Juniperus is an acrid, aromatic herb, which can tonify both the Spleen
:,;CRatio
Rheum Taraxacum Hydrastis
!e.mperatur~.
cool-cold cool-cold cool
1 1 1 1 1
Ophiopogon Glycyrrhiza
cool neutra!-cool
Taste
"'
.
bitter, sour bitter bitter sweet, sl. bitter sweet
and Kidney to transform and drain Damp.
'::-
This combination is the same as Rheum: Gastritis + constipation and is discussed under that heading.
Taraxacum combinations 3. Hypertension + heat sensations Six Taraxacum combinations are discussed below: Combination
1. cholecystitis
Chinese syndromes
Heart Heat + Liver Heat _-
~
··._s
..
Liver-Gallbladder Damp Heat
2. gastritis + constipation
Stomach Heat + Liver Heat
3. hypertension + heat
Heart Heat + Liver Heat
sensations
20-50 drops
Zingiber Lobelia Berberis
1 1 1 1 1
Taraxacum
4. acute psoriasis
Blood Heat + Heat Toxin
5. edema
Kidney Deficient Qi
6. cardiac weakness +
Heart Deficient Qi + Kidney Deficient Qi + Damp
cardiac edema
Capsicum
+ Damp
Rheum
hot hot warm-cool
acrid acrid, aromatic
cool
acrid bitter
coo!-cold
bitter
cool-cold
bitter, sour
This combination is the same as Capsicum: hypertension
+ sensations ofheat and is discussed under that heading. 4. Acute psoriasis
CAUTION
Before using any ofthe combinations below, it is important to be familiar with the cautions listed for each herb in the combination. Also, see Cautions on the use of alterative herbs in the chapter on Safety. 1. Cholecystitis
Liver-Gallbladder Damp Heat
Blood Heat + Heat Toxin Herb>.:.~'/',.· Ratio' . Temperature .
Taste ,".,
cool
sl. bitter
cool
Aretium (seeds)
1 1 1
sl. bitter acrid, sl. bitter
Mahonia Taraxacum
1 1
cool coo!-cold
Rheum Glycyrrhiza
1
cool-cold neutra!-cool
Smilax Scrophularia
0.5
cool
bitter bitter bitter, sour sweet
Combining Western Herbs and Chinese Medicine
730
This combination is the same as Smilax: acute psoriasis and is discussed under that heading.
5. Edema
Kidney Deficient Qi + Damp Herb
Ratio
Juniperus Parietaria Taraxacum Urtica Panax gin. Cinnamomum (twigs) Zingiber
1 1 1 1 1
Temperature Taste
0.5
sl. warm neutral cool-cold warm-cool sl. warm warm
aromatic, sl. acrid, sl. sour bitter bitter acrid sweet, sl. bitter acrid, sweet, aromatic
0.5
hot
acrid, aromatic
This combination is the same as Juniperus: edema and is discussed under that heading.
6. Cardiac weakness + cardiac edema
Heart Deficient Qi + Kidney Deficient Qi + Damp Herb
Ratio
Convallaria Crataegus Sarothamnus Taraxacum Parietaria Juniperus Zingiber
1 1 1 1 1 1 1
neutral sl. warm neutral cool-cold neutral sl. warm hot
bitter, sl. sweet sour, sweet bitter bitter bitter aromatic, sl. acrid, sl. sour acrid, aromatic
ing.
COMPARISON OF THE SIX TARAXACUM COMBINATIONS
1. Cholecystitis
2. Gastritis + constipation
Liver-Gallbladder Damp Heat
Stomach Heat + Liver Heat
. -,,'~'
Berberis Taraxacum Chelidonium Artemisia abs. Glycyrrhiza Zingiber
Ratio 1 1 1 1 0.5 0.5
1. In this combination, the first four herbs can tonify and move Liver Qi, and clear Liver-Gallbladder Damp Heat. The cooling, downward-draining effect of the first three bitter herbs is moderated by the warming, moving effect of the aromatic and acrid constituents of Artemisia and Zingiber. The sweet anti-inflammatory and detoxicant Glycyrrhiza helps to prevent any potential aggravation of symptoms from toxins that Taraxacum and Berberis help to release iD.to the system from the liver and tissues.
2. In combination No.2, the three bitter herbs, Rheum, Taraxacum, and Hydrastis clear Heat from the Stomach, Intestines, and Liver to relieve gastric inflammation. In addition, they all have varying degrees oflaxative action to relieve constipation. The two sweet herbs Ophiopogon and Glycyrrhiza also have anti-inflammatory action on the Stomach and Intestines, and they are sweet tonics, which can tonify the Yin and moisten the Intestines to relieve constipation associated.with Deficiency Heat and Dryness. 3. Hypertension + heat sensations
4. Acute psoriasis
Heart Heat + Liver Heat
Blood Heat + Heat Toxin
Temperature Taste
This combination is the same as Convallaria: cardiac weakness + cardiac edema and is discussed under that head-
Herb
..
Herb Rheum Taraxacum Hydrastis Ophiopogon Glycyrrhiza
Ratio 1 1 1 1 1
Herb
Ratio
Herb
Ratio.,-·
Capsicum Zingiber Lobelia Berberis Taraxacum Rheum
20-50 drops
Smilax Scrophularia Arctium (seeds) Mahonia Taraxacum Rheum Glycyrrhiza
1 1 1 1 1 1 0.5
1 1 1 1 1
3. Although Capsicum is a hot herb, it is used in this combination to disperse Heat by stimulating the circulation to redistribute Heat around the body, including to the body surface. Zingiber directs the dispersive action of Capsicum to the surface, and Lobelia emphasizes the relaxing aspect of this circulatory balancing process. Berberis, Taraxacum, and Rheum are cold bitter herbs that drain Heat downward and out of the body, and help clear accumulated Heat Toxins. These actions can help to clear Heart and Liver Heat, assisting the treatment of hypertension, agitation, anxiety, overexcitement, or ax:ger associated with these Chinese syndromes. 4. Smilax, Arctium, and Mahonia are specific for psoriasis. Scrophularia is specific for Heat in the Blood in acute skin disorders. Rheum and Taraxacum can help to clear Heat Toxin as well as Heat in the Blood due to Excess Heat in the Liver, Stomach, or Intestines. Glycyrrhiza can detoxify substances released into the bloodstream by the alterative action of the other herbs.
..".
"""I
r
Taraxacum 5. Edema
6. Cardiac weakness + cardiac edema
Kidney Deficient Qi + Damp
Heart Deficient Qi + Kidney Deficient Qi + Damp
. Ratio
Herb
;:<;, i'~
Juniperus Parietaria Taraxacum Urtica Panax gin. Cinnamomum (twigs) Zingiber
Herb
Convallaria Crataegus Sarothamnus Taraxacum Parietaria Juniperus Zingiber
1 1 1 1 1
0.5
Ratio 1 1 1 1 1 1 1
0.5
5. Juniperus, Parietaria, and Taraxacum are primary diuretics, and Urtica can assist the diuretic effect. Panax and Cinnamomum, assisted by Zingiber, can tonify and warm the Kidney and Bladder to promote urination. 6. Combinations No.5 and No.6 contain Juniperus, Parietaria, Taraxacum, and Zingiber. Whilst the previous combination contains Panax and Cinnamomum twigs to warm and tonify the Kidney and Bladder, and Urtica as an additional diuretic, this combination contains Convallaria, Sarothamnus, and Crataegus to tonify Heart Qi. Convallaria and Sarothamnus are specific for cardiac edema.
731
bitter-tasting sesquiterpene lactones of both the eudesmanolide and germacranolide types: IO • eudesmanolide type: tetrahydroridentin B and tara.xacolide ~- D-glucoside • germacranolide type: taraxicinic acid ~-D-glucoside and 11,13-dihydrotaraxinic acid ~-D-glucoside Other T. officinale also contains: • taraxacoside: p-hydroxyphenylacetic acid ester of y-butyrolactone glucoside ll • triterpenes: pentacyclic alcohols, including taraxasterol (a-lactucerol) and\jHaraxasterol (isolactucerol), and phytosterols, including ~-sitosterol and stigmasterol lo • phenolic acids: caffeic acid and p-hydroxyphenylacetic acid l2 • hydroxycinnamic acids: chicoric acid, cWorogenic acid, and monocaffeyltartaric acid 13 • flavonoids: apigenin and luteolin 7-glucosides7 • carbohydrates: fructose, about 18% in springH • inulin, about 2% in spring and up to 40% in autumn, H and mucilage, about 1% • minerals, especially potassium (1.8-2.6%) and calcium 15 • vitamins A, B, C, and D l2 PHARMACOLOGICAL AND CLINICAL RESEARCH
OTHER TARAXACUM COMBINATIONS Taraxacum also has an important role in the following combinations:
• Artemisia: food intolerances + heat sensations • Berberis: acute eczema • Echinacea: boils + infec!ion • Harpagophytum: arthritis + heat sensations • Phytolacca: chronic acne • Smilax: arthritis + psoriasis • Thuja: cancer therapy adjunct
Research CONSTITUENTS The following constituents have been reported for T. L::.
officinale: • sesquiterpene lactones • other Sesquiterpene lactones The bitter substance taraxacin mentioned in the older literature has now been identified as
L
The following effects have been observed: • anti-inflammatory • immunoregulatory • choloretic • antidiabetic • diuretic • antitumor Anti-inflammatory Pretreatment with an ethanol extract of T. officinale root at an oral dose of 100 mg extract/kg reduced carageenan-induced paw edema in rats by 25%.16 In another study, intraperineal administration of 100 mg/kg of T. officinale extract partially inhibited carageenan-induced rat paw edema.17 Immunoregulatory T. officinale was reported to restore the suppressed immune functions in scald mice. ls Choloretic Animal studies have shown the following choloretic effects: • intravenous administration of a decoction of fresh T. officinale root (equivalent to 5 g of dried plant) doubled bile secretion in dogs l9
Combining Western Herbs and Chinese Medicine
732
• cannula administration of a 5% T. officinale extract (2m1) produced a choloretic effect in rats 20 • administration of an alcoholic extract of the whole plant produced a 40% increase in bile secretion in rats 21 Antidiabetic T. officinale root has been reported as hypoglycemic,22 but I have not found research data on this topic. Diuretic Administration of 50 mglkg of T. officinale root extract to mice did not produce consistent patterns of diuresis, although some extracts showed significant natriuretic and kaliuretic effects related to the potassium content of the roots. 17.23 Antitumor An extract of T. officinale was reported to inhibit tumor necrosis factor-alpha production in rat astrocytes. 24
PHARMACOLOGICAL AND CLINICAL RESEARCH:
T. MONGOLICUM AND OTHER
SPECIES
A more recent study found a multifactorial drug iriter-:~:';~~';:';" action between aqueous extracts of T. mongolicum ~d"-th~-··:7::
....-.
fluoroquinolone antibiotic ciprofloxacin in rats. Whilst the overall bioavailability of ciprofloxacin remained more or less unchanged, T. mongolicum lowered the plasma concentration of ciprafloxacin, whilst increasing apparent drug distribution volume and terminal elimination half-life. 32
Early clinical studies T. mongolicum preparations were reported to be effective in the treatment of upper respiratory tract infections, including acute tonsillitis and acute pharyngitis. 33 Anti-inflammatory One clinical report indicated that 15 m1 of a 1:5 alcoholic tincture ofT. mongolicurn, taken thrice daily, was effective in the treatment of acute mastitis of four days duration, and less effective in cases of over five days duration. 34 Local application of the paste of the crushed fresh herb or of ointment of the powdered rhizomes was reported to be effective in cases of submaxillaritis, cellulitis of the neck and back, and nodules resulting from intramuscular injections.35
The following effects ha~e been observed: • antimicrobial • anti-inflammatory • antiallergic • immunoregulatory • gastrointestinal anti-inflammatory, antiulcer • stomachic and laxative • hepatoprotective • antitumor Antimicrobial
Antiviral In tissue culture experiments, T. mongolicum decoction delayed the pathological changes induced by ECHO ll and herpes virus, but did not inhibit other viruses tested, such as influenza Jingke 68-1 strain or adenovirus type 3.25.26 A more recent study reported that preparations ofT. mongolicum showed antiviral action against type-l herpes simplex viruS. 27
Antibacterial It was reported that extracts of T. mongolicum inhibited a range of bacteria, including Staphylococcus aureus and Streptococcus hemolyticus,28 but did not reliably inhibit Shigella species. 29
Interactions with antibiotic drugs One early study in China reported that the dose of antibiotics given to patients with a variety of bacterial diseases can be reduced after a T. mongolicum injection. 30 Another early study reported that T. mongolicum decoction can act in synergy with the diaminopyridine antibiotic, trimethoprim. 31
Antiallergic Desacetylmatricarin, isolated from T. platycarpum, was reported to have antiallergic action. It inhibited ()-hexosaminidase release, from RBL-2H3 cells.36 Immunoregulatory T. mongolicum decoction was reported to increase the human peripheral lymphoblast transformation rate in vitro. 37 Gastrointestinal anti-inflammatory~ antiulcer In one clinical report, 15 g of T. mongolicum, decocted twice and given orally in three doses after eating, was reported to be effective in the treatment of patients with chronic gastritis. 38 In another clinical report, 1.5 g of the powdered root of T. mongolicum, given thrice daily after meals, was reported to be effective in the treatment of gastric and duodenal ulcers. 39 Stomachic and laxative Reports from China have described stomachic and laxative activity in the clinic for pu gong ying. 38.40 Hepatoprotective Injections of T. mongolicum preparations were reported to reduce the fatty degeneration of liver cells following carbon tetrachloride-induced liver damage in rats. The same author reported a clinical study indicating that T. mongolicum preparations accelerated recovery in cases of acute icteric hepatitis and nonicteric hepatitis. 4l Antitumor A recent study using the triterpenoids taraxasterol and taraxerol from the roots of T. japonicum showed marked antitumor activity in tests using induced mouse skin tumors and mouse spontaneous mammary tumors. 42
i
r Taraxacum
733
, k
Dose
T. OFFICINALE, T. MONGOLICUM, AND OTHER SPECIES Pharmacological and clinical research on extracts or isolated constituents of T. officinale (T. off.) and on T. mongolicum and other species (T. mon.), is summarized and compared in the table below:
T.
..
off.
T. mono -I
antiallergic
-I
v v
immmunoregulatory anti-inflammatory +-
- - - - - - - - - - - - - - _• • • -
in 45% alcohol, three times per day. The BHC listed 5-10 ml of 1:5 tincture in 25% alcohol, three times per day; or 4-8 ml of expressed juice from the fresh root, three times per day. When I use Taraxacum tincture in combination with the tinctures of about five other herbs, the amount of Taraxa-
- _ ••_ - - - - - - - _ . _ - - - _ . _ - _ . _ _ ._-
cum tincture in each 5-10 rnl individual dose of the mixture is about 1-2 ml.
-I
stomachic and laxative choloretic
v
antidiabetic - .".'-
.-.'
.._-
•...
_._ .. -------.-. __ ....
Can start at standard dose (see Cautions below.)
Initial dose
hepatoprotective
antitumor
The BHP listed 2-8 ml of 1:1 liquid extract in
30% alcohol, three times per day; or 5-10 ml of 1:5 tincture
v v v
antiulcer
Dried material The BHpls listed 2-8 g of the dried root, three times per day. The BHC'6 listed 3-5 g of the dried root, three times per day. Tincture
! '-
antimicrobial
The discussion below refers to the roots of T. officinale, not the leaves.
v .. __ .._
~_
Duration ..... --.
No restriction known.
__ .__ .--------_..__ .--
Cautions
RESEARCH VERIFICATION OF TRADITIONAL ACTIONS The following traditional actions have been supported
practice and in the appendix Healing crises.
by research: • research on T. officinale: choloretic, diuretic, and alterative (antitumor) • research on T. mongolicum and other species: hepatic, stomachic, laxative, gastrointestinal anti-inflammatory, and alterative (antitumor) _JI
Precautions for the use of alterative herbs and alterative combinations are discussed in the chapter Safety in clinical
Additional effects demonstrated by research The following additional effects have been reported as discussed above:
Western contraindications One text contraindicates T. officinale for occlusion of the bile ducts, gallbladder empyema, and obstructive ileus. 14 Chinese contraindications No contraindications are listed for pu gong ying, T. mongolicum, in the Chinese Herbal
Medicine Dictionary.47 Pregnancy and lactation
No adverse reports.
• T. officinale: immunoregulatory and antidiabetic • T. mongolicum and other species: antimicrobial, antiallergic, and immunoregulatory
Side effects
Occasional reports of contact allergy follow-
ing contact with latex, which may be due to the sesquiterpene lactone, taraxinic acid glucoside. 48
TOXICOLOGY
Overdose
The LD so of a fluid extract of the root of T. officinale (1 ml equivalent to 1 g dry drug) by intraperitoneal adminis-
Interactions
tration to mice was 36.6 glkg, which is equivalent to over 2 kg for a 60 kg human.43 An ethanol extract of T. officinale
Pharmacological and clinical research: T. mongolicum above.
showed low toxicity in mice and rats at doses up to the equivalent of 10 glkg of dried drug by oral administration, and 4 glkg by intraperitoneal administration. 17 An aqueous extract of T. mongolicum applied subcutaneously for 5 days had no effect on the fertility of female mice.
44
No adverse reports. No adverse interaction effects known, but
interactions with two antibiotics have been reported, see
Regulatory status Please read the Regulatory status section in the chapter on Safety.
Combining Western Herbs and Chinese Medicine
734
Taraxacum (dandelion) is on the UK General Sale List, and is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Taraxacum is not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
Spleen, Stomach
spleen obstructions atonic dyspepsia
Culpeper Grieve
Intestines
gastroenteritis constipation
Lyle Felter and Lloyd
The main text cited in the Chinese Herbal Medicine Dictionary listed T. mongolicum as entering the Liver and Stomach, but two subsidiary texts cited list it as entering the Kidney or the Spleen and Stomach, respectively.
Traditional sources PROPERTIES Temperature According to both Gerard~9 and Tabernaemontanus,SO dandelion is both cold and dry in nature. The main text cited in the Chinese Herbal Medicine Dictionary listed T. mongolicum, pu gong ying, as cold, but two subsidiary texts cited classify it as neutral and neutral to slJ.ghtly cool. T. officinale, as used in the West, is classified in this book as cool-cold, due to its traditions of use as a cooling alterative and anti-inflammatory, and as a bitter digestive tonic. Taste
Taste in the mouth The BHP described the taste of dandelion root as sweetish, and I found a 1:5 tincture of T. officinale in 25% alcohol as slightly sweet and slightly bitter. The bitter taste was slightly more pronounced in a sample of pu gong ying, although this also tasted slightly sweet.
Taste properties The main text cited in the Chinese Herbal Medicine Dictionary listed T. mongolicum as bitter and sweet, but two subsidiary texts cited classify it as slightly bitter or sweet, respectively. T. officinale, as used in the West, is classified in this book as bitter in terms of Chinese medicine, associated with its Western traditions of use both as an alterative and as a bitter digestive tonic. ORGANS In terms of Chinese medicine, the root of 1. officinale, as used in the West, can be associated mainly with disorders of the following organ systems: Organ Liver, Gallbladder
Kidney, Bladder
.Examples of use
Sources
liver and gallbladder obstructions cholecystitis, cholelithiasis, jaundice
Culpeper
edema oliguria
Tabernaemontanus
BHP
BHP
ACTIONS The following traditional actions are discussed: • choloretic and hepatic • bitter digestive tonic • gastrointestinal anti-inflammatory • laxative • diuretic • alterative and dermatological agent • other Choloretic and hepatic According to Crellin and Philpott, the 1597 edition of Gerard's Herbal listed dandelion for 'hot burning of the liver: 'stopping of the gall: yellow jaundice, and inflammation of the eyes: This compares with the Chinese use of T. mongolicum for red, swollen, painful eyes with Liver Heat patterns. Culpeper noted the use of dandelion for obstructions of the liver and gallbladder, and Tabernaemontanus wrote that dandelion can be used for pains of the liver of the hot type. Grieve recommended dandelion for hepatic complaints of persons who have lived for long periods in warm climates, and gave a decoction for gallstones containing dandelion root, parsley root, balm herb, ginger, and licorice. The BHP listed Taraxacum root for cholecystitis, cholelithiasis, and jaundice, especially in combination with Veronicastrum (Leptandra), Berberis, and Chelone. The monograph on dandelion in Wichtl noted the use of this herb for liver and gallbladder disorders with digestive complaints, especially the incomplete digestion of fat. According to Mills and Bone,s, Taraxacum can act as an hepatoprotective agent and can be included in the treatment of patients with a history of liver damage, as in cirrhosis or exposure to toxins, or in the treatment of posthepatitis syndrome.
Womens disorders Mills and Bone wrote that 'the liver is the site of the breakdown of female hormones and a sluggish liver may contribute to hormone imbalance: They, therefore, recommended hepatics such as Taraxacum to assist in the treatment of premenstrual tension. They also recommended
Taraxacum ~
fl;;
hepatics such as Taraxacum in some cases of morning sickness. Bitter digestive tonic Gerard wrote that dandelion can strengthen the weak stomach. Lyle said that it can assist digestion and assimilation, and can be used as a gastric tonic for dyspepsia. Wichtl noted its use as an appetite-stimulating bitter, and the BHP listed it for atonic dyspepsia and anorexia. Tabernaemontanus recommended dandelion for anemia (the green sickness), as did KlOSS,5Z who also listed this herb for diabetes. Gastrointestinal anti-inflammatory Tabernaemontanus recommended dandelion for heat-type colic of the stomach and liver. According to Lyle, dandelion can be used for'irritation of the gastric and intestinal membrane, especially when there is torpor of the liver.' Ellingwood53 noted its use for catarrhal gastritis, Kloss recommended it for inflammation of the bowels, and Grieve advocated its use when the stomach is irritated. Laxative Both Gerard and Tabernaemontanus listed dandelion for dysentery, whilst Lyle, Felter and Lloyd, Grieve, and the BHP viewed it as a mild laxative. Mills and Bone recommended only gentle 1a.'Qtives such as Taraxacum to treat constipation in cases of irritable bowel syndrome. Diuretic Tabernaemontanus listed dandelion for edema, Gerard said that it could be used for paiilful urination, and Culpeper wrote that it could open the urinary passages and cleanse ulcers from them. Grieve recommended it for edema and for urinary stone and gravel, and the BHP listed it for oliguria.
..
-
Alterative and dermatological agent Gerard described dandelion as cooling, drying, opening, and cleansing. According to Ellingwood, it has specific use as an alterative for blood disorders, rheumatism, and chronic skin eruptions. Grieve recommended it for eczema and all eruptions on the surface of the body. The BHP listed it for rheumatism, and Mills and Bone noted the European tradition of use for arthritis. Wichtl noted its traditional use in Germany as a 'blood purifier' for arthritic and rheumatic complaints, and for skin disorders.
Adjunct to cancer therapy In 1635, Reid noted the use of dandelion in the management of cancer.~ Mills and Bone noted its use in alterative combinations currently used in Europe as adjuncts to cancer therapy.
.
..
Other
Antihypertensive According to Mills and Bone, the diuretic activity and high levels of potassium in dandelion leaves can be useful in the treatment of elevated systolic pressure in the elderly.
735
Antipyretic Lonicerus55 listed dandelion for hot fever. Tabernaemontanus wrote that it is good for all types of fever, especially malarial fever, but also chronic '~oul fevers.' Culpeper said that dandelion helps to clear the heat of malarial fever (ague fits), and Lyle strongly recommended it for typhoid fever. According to Mills and Bone, cooling bitters such as Taraxacum can assist the reduction of febrile temperatures by 'stimulating the otherwise dormant digestive system, thus helping to counter fermentation or infection arising from the gut.' The bitter tonic action of such remedies can assist postfebrile recovery.
COMPARISON OF WESTERN AND CHINESE USE OF TARAXACUM SPECIES' The data in the table on pu gong ying (next page, top) comes from the Chinese Herbal Medicine Dictionary. Whilst there is considerable overlap of use, as can be seen from the table, there is a clear difference in emphasis between Western and Chinese use. For example, both cultures use a Tara."{acum species to treat hepatobiliary inflammatory disorders such as cholecystitis and, to a lesser extent, gastrointestinal inflammatory disorders such as gastritis. However, the emphasis in the West is not only on the alterative action of T. officinale, but also on its tonic and regulatory actions on the liver, and to a lesser extent on the digestive system. In Chinese medicine, the emphasis is on clearing Heat, Damp Heat, or Heat Toxins from the Liver and Gallbladder, and from the Stomach and Intestines. -In addition, both cultures use a Taraxacum species to treat skin disorders. However, there is greater emphasis in Chinese tradition on lumps, breast lumps and abscesses, mastitis, and insufficient lactation due to Heat.
References 1. Culpeper No Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks, Glenwood,l1linois (1990) 2. Bulmer SH. Saaed and Herbal Healing Beers. An Imprint of Bre\"ers Publications, Boulder, Colorado (1998) 3. Grieve M. A Modern Herbal. vols. 1 and 2. Dover Publications, N~ York, Ne\vYork (1971) 4. Lyle TJ. Physio-Medical Therapeutics, Materia Medica and Pharmacy. Originally published Ohio (l897). Reprinted by the Xational Association of Medical Herbalists of Great Britain (1932) 5. Felter HW and Lloyd JU. King's American Dispensatory, vols. 1 and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1983) 6. Christopher JR. School of Natural Healing. BiWorid. Provo, Utah (1976)
..:.....,.',:.
736
Combining Western Herbs and Chinese Medicine
~::~:~,:'.~·":_';~:.~·7':::.~:"'~~~":':~;~~;~~-:::t~0 '.~:~~_;:.~~;·~:--':2~:~~~~%fe:~e~;:u~e~¢"t~~g~ffi.ii iW::t~'~i} Actions
Western uses' of T. officinale
• bitter hepatic tonic, choloretic
sluggish liver, atonic dypepsia or constipation, recovery from liver damage, premenstrual tension, morning sickness
• hepatobiliary anti-inflammatory
cholecystitis, hepatitis
hypochondriac pain. hepatitis, gallbladder infections
• bitter digestive tonic
loss of appetite, digestive weakness, atonic dyspepsia, anemia
tonifies Spleen, harmonizes Stomach
• gastrointestinal anti-inflammatory
gastritis, gastroenteritis
indigestion. hiccups. stomach pain, stomach ulcers
• laxative
mild laxative dysentery (older use)
constipation. slows diarrhea
• diuretic
edema, oliguria
edema. urinary tract infection
• alterative, antirheumatic, dermatological agent, antitumor agent
chronic skin eruptions, rheumatism, arthritis. adjunct to cancer therapy
acute mammary duct infections. lymph gland infections, scrofula, tonsillitis, boils, subcutaneous Phlegm nodules
.. .
• galactogogue
(pu gong Ylng)
insufficient lactation due to Heat
7. Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm. Stuttgart, Germany (1994), From 2nd German edn. Wicht! M (ed), (1989)
25. Virus Section, Institute of Materia Medica of the Academy of Traditional Chinese Medicine. Xinyiyaoxue Zazhi (Journal of Traditional Chinese Medicine) (1) :26 (1973)
8. Crellin JK, Philpott J. A Reference Guide to Medicinal Plants. Duke University Press, Durham, North Carolina (1990)
26. Guangzhou Institute of Medicine and Health. New Medical Communications (Guangzhou Health Bureau) (1):14 (1974)
9. Chang H-M, But PP-H (eds). Pharmacology and Applications of Chinese Materia Medica. vols. 1 and 2. World Scientific Publishing, Singapore, China (1986)
27. ZhengM.ZhongXiYi Jie He ZaZhi 10(1):39-41,6 (1990) 28. Lingling District (Hunan) Sanitation and Anti-Epidemic Station. Hunan Yiyao Zazhi (Hunan Medical Journal) (5):49 (1974)
10. Hansel R, Kartarahardja M, Huang JT et al. Phytochemistry 19:857861 (1980)
29. Jinzhong District (Shanxi) Sanitation and Anti-Epidemic Station. Studies on Epidemic Prevention (2):133 (1976)
11. Rauwald HW and Huang IT. Phytochemistry 24: 1557-1559 (1985)
30. Shanghai No. 10 Pharmaceutical Factory et al. Pharmaceuticallndus-
12. Benigni R, Capra C and Cattorini PE. vol. 2 1593-1599 ITl] (1964). [cited in Bradley PR (ed). British Herbal Compendium, vol 1. British Herbal Medicine Association, Bournemouth, United Kingdom (1992) J
3\. Sun SQ. Chinese Traditional And Herbal Drugs Communications
13. Williams CA. Goldstone F, Greenham J. Phytochemistry 42(1): 121-127 (1996)
32. Zhu M, Wong PY, Li RC. J Pharm Sci 88(6):632-634 (1999)
14. Czygan Fe. Z Phytotherapie 11:99-102 (1990)
try (6):27 (1971) (6):11 (1979)
33. Editorial Group. South Zhejiang Herbal. New edition. Wenzhou Health Bureau, Zhejiang, China. p 396 (1975)
15. Vogel HH and Schaette R. Erfahrungsheilkunde 26:347-355 (1977)
34. Wang CY. Liaoning Medical Journal (7):21 (1960)
16. Mascolo N.Autore G. Capasso F et al. Phytother Res 1:28-31 (1987) 17. Tita B, Bello U, Faccendini P et al. Pharmacological Research 27(suppl. 1),23-24 (1993)
35. Nursing Group of the Cardiovascular Ward, Internal Medicine Department of the First Teaching Hospital of the Second Military Medical College. Academic Information (Second r-.1ilitary Medical
18. Luo ZH. Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi 9( 1):56-58, 80 (1993)
36. Cheong H, Choi EJ, Yoo GS et al. Planta Med 64(6):577-578 (1998)
College) (1):70 (1978)
19. Chabrol E, Charonnat R, Maximin M et al. C R Soc Bioi 108: 1100-11 02 (1931)
37. Medical Laboratory, Second Teaching Hospital. Medical Research
20. Biissemaker J. Naunyn-Schmied Arch Exper Pathol Pharm 181:512513 (1936)
38. Yuan F.Acta Acaderniae Medicinae Anhui (1):75 (1976)
21. Bohm K. ArzneimForschlDrug Res 9:376-378 (1959)
(ShenyangMedicalCollege) (4):41 (1975)
39. Jiangsu College of New Medicine. Encyclopedia of Chinese Materia Medica. Shanghai People's Publishing House, p 2459 (1977)
22. Foster S, Duke J. Medicinal Plants. Houghton Mifflin, Boston, Massachusetts (1990)
40. Editorial Group of Clinical Applications of Chinese Traditional Drugs.
23. Hook I, McGee A, Henman M.lnt J Pharmacog 31:29-34 (1993)
4\. Shi HG. Journal of Traditional Chinese Medicine (12):55 (1979)
24. Kim HM, Shin HY, Lim KH et al. Immunopharmacollmmunotoxiciol 22(3):519-530 (2000)
42. Takasaki M, Konoshima T, Tokuda H et al. BioI Pharm Bu1122(6):606-
New Chinese Medicine (2):40 (1972)
610 (1999)
Taraxacum
I·.
43. Rikz-Kotilla E. Racz G. Solomon A. Planta ~Ied 26:112-217 (1974) 44. Matsui AS. Rogers J. WOO YK et al. Med Pharmacol Exp Int J Exp Med 6:414-425 (1967)
737
50. Tabernaemontanus JT. Krauterbuch (1731). Reprinted by Verlag Konrad Kolbl. Miinchen. Germany (1993) 51. Mills S. Bone K. Principles and Practice of Phytotherapy: Modern
Association.
Herbal Medicine. Churchill Livingstone. Edinburgh. United Kingdom (2000)
46. Bradley PR (ed). British Herbal Compendium. vol. I. British Herbal
52. Kloss J. Back to Eden, 5th edn. (1939). Lifeline Books, Santa Barbara. California (1975)
45. British Herbal Pharmacopoeia. British Herbal
~ledicine
West Yorks, United Kingdom (1983)
Medicine Association. Bournemouth. United Kingdom (1992) 47. Jiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary
53. Ellingwood F. American Materia Medica, Therapeutics and Pharma-
(Zhong yao da ci dian) Science and Technology Press, Shanghai. China
cognosy,l1th edn. (1919). Reprinted by Eclectic Medical Publications, Sandy. Oregon (1994)
(1975) 48. Hausen BM. Derrnatosen 30:51-53 (1982) 49. Gerard J. The Herbal or General History oi Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publications. New York. New York (1975)
54. Read A. The Chirurgicall Lecutres of Tumors and Ulcers. Constable and Bush, London. United Kingdom (1635) 55. Lonicerus A. Kreuterbuch (1679). Reprinted by Verlag Konrad Kolbl, Miinchen, Germany (1962)
Thuja Botanical name Thuja occidentalis L. Family Cupressaceae Pharmaceutical name Thujae folium Part dried younger twigs English arbor-vitae, tree of life, American cedar German Lebensbaum French d:dre blanc du Canada, arbre de vie Mandarin T. occidentalis L. is not used; ce hili ye (1111;fa 1t) is the leafy twigs of Biota (Thuja) orientalis L. Use in the West Thuja occidentalis is an evergreen coniferous tree, usually less than 10 m in height, native to Canada and especially the Northern United States. According to Foster and Duke, l the Native Americans used the leaves for colds, coughs, headache, rheumatism; arthritis, and gout, and the inner bark of the tree for pulmonary tuberculosis. Felter and Lloyd! wrote that Thuja was not widely employed by the Eclectic profession in America until the 1880s, when Howe publicized its use for a greatly extended range of indications and it became a major herb of the Eclectic physicians. Felter and Lloyd recorded the following uses ofThuja:
Lyle3 noted the use of Thuja as a circulatory stimulant and antihemorrhagic, and as an alterative and topical application for rheumatism, eczema, warts, and syphilis.
Use in Europe Grieve~ called this tree yellow cedar and recorded that it was imported to France from Canada, and introduced to Britain in 1566. Both TabernaemontanusS and Gerard6 had only very brief entries on Thuja since its medical uses were not then well known in Europe. The Eclectic tradition of use may have been transferred from North America to Britain in the late 19th century. Grieve recorded the use of Thuja for coughs, intermittent fever, rheumatism, edema, and amenorrhea. The Eclectic tradition is also continued in the BHP,' which listed Thuja for bronchial catarrh, enuresis, cystitis, psoriasis, warts, rheumatism, and amenorrhea. Nomenclature The various English names of T. occidentalis can be confusing: thuja, arbor-vitae, tree of life, white cedar, Northern white cedar, false white cedar, yellow cedar, and American cedar. Also, it is sometimes called Cedrus lycea, even though, according to Evans,s the genus Cedrus is in the family Pinaceae, whereas the genus Thuja is in the family Cupressaceae.
• antiseptic and stimulant anticatarrhal for nasal catarrh, bronchial catarrh and leukorrhea
• alterative for enlarged lymph glands, chronic skin
Use in China The Chinese Herbal Medicine Dictionarl has an entry for ce bili ye, the leaves and new soft twigs of Biota orientalis (L.) Endl. This herb, which has also been called Thuja orientalis 1., has had a long tradition of use in China. Its actions include:
disorders, and carcinoma-tous ulcerations
• anti-inflammatory and astringent for laryngitis, tonsillitis, enuresis, cystitis, urinary dribbling, and prostatitis
• stimulant and anticatarrhal emmenagogue for
• clears Wind Damp • cools the Blood
amenorrhea
739
Combining Western Herbs and Chinese Medicine
740 • clears Heat Toxin • stops bleeding
Biota orientalis has been used to treat cough, rheumatism, epistaxis, hematuria, diarrhea with bleeding, metrorrhagia, mumps, skin infections, and burns.
What is special about Thuja In terms of Chinese mediCine, Thuja occidentalis, as used in the West, can be said to be a variable-temperature herb that can have cooling or warming temperature effects. It is acrid, aromatic, and bitter in its taste properties, and has its main effects on the Lung, Heart, Bladder, and Uterus.
The key to understanding Thuja is that it is a circulatory stimulant and counterirritant herb that can help to clear pathogens and accumulated toxins from the tissues. It can thus treat chronic or recurring infections and inflammatory conditions, regardless of whether these are associated with sensations ofheat or cold. It can also have anticatarrhal, astringent, antihemorrhagic, and emmenagogue actions. THUJA AS A VARIABLE-TEMPERATURE HERB What is described as inflammation and infection in Western terms, can be described as local or systemic Stagnation of Qi and Blood in Chinese medicine. This stagnation can result in accumulation of Damp, Phlegm, Retained Pathogen, or Toxins. This accumulation can be associated with patterns of either Heat or Cold. Thuja can stimulate the movement of Qi and Blood in the tissues both locally and systemically. This can help to clear accumulations of Damp, Phlegm, Retained Pathogen, and Toxins. In the terminology of Western herbal therapy, Thuja can act as a circulatory stimulant and counterirritant, increasing circulation and elimination in the tissues. This can result in the clearance of wastes and toxins and in the reduction of inflammation and infection. Thuja can therefore be used for inflammation and/or infection associated with patterns of Stagnation and accumulation, whether these patterns are associated with Heat, such as cystitis from Bladder Damp Heat, or with Cold, such as bronchitis from Lung Phlegm Cold. Whether Thuja has a warming or a cooling effect depends on the state of the patient and on the herbs with which Thuja is combined.
CHINESE ACTIONS In terms of Chinese medicine, Thuja, as used in the West, can be sai~ to have four main action groups:
I. regulate the Lung II. regulate the Bladder m. regulate the Uterus IV. clear Pathogens Each of these action groups is based on the ability of Thuja to move Qi and Blood, and thus clear accumulations of Phlegm, Damp, Retained Pathogen, or Toxins arising from Stagnation. Regulate the Lung This action group includes the following individual actions: • clear Retained Pathogen • clear Lung Phlegm Damp • move Lung Qi • move Heart Qi Regulate the Bladder This action group includes the following individual actions: • clear Retained Pathogen • clear Bladder Damp Heat • clear Bladder Phlegm Damp • move Bladder Qi Regulate the Uterus This action group includes the following individual actions: • move Uterus Qi and Blood • clear Lower Burner Damp Heat • clear Lower Burner Phlegm Damp • reduce bleeding Clear Pathogens This action group includes the following individual actions: • move Qi and Blood in the channels • clear Retained Pathogen • clear Damp Heat • clear Heat Toxin • clear Phlegm Damp
WESTERN ACTIONS The main Western actions of Thuja are shown here in terms of its four main Chinese action groups: Chinese actions I. regulate the Lung
antimicrobial alterative anti-inflammatory anticatarrhal stimulant expectorant counterirritant circulatory stimulant cardiotonic
Thuja
741
WESTERN USES II. regulate the Bladder
antimicrobial anti-inflammatory anticatarrhal tonic astringent diuretic
III. regulate the Uterus
tonic astringent anticatarrhal stimulant emmenagogue
IV. clear Pathogens
circulatory stimulant counterirritant antimicrobial alterative anti-inflammatory anticatarrhal antirheumatic dermatological agent antitumor agent
Some of the Western actions listed in this table are discussed below. Anticatarrhal Thuja can help to reduce excessive secretion and accumulation of mucus in the respiratory, urinary, and reproductive systems. In terms of Chinese medicine, Thuja can be said to move the Qi and to clear accumulations of Phlegm and Damp in a variety of systems and situations: • Lungs • Bladder • male and female reproductive systems • channels in the muscles and joints • channels in the skin • lumps growing in the tissues from condensation of Phlegm In addition to the Stagnation of Qi and accumulation of Phlegm and Damp, there may also be accumulation of Retained Pathogen and/or Toxins, and symptoms of either Heat or Cold. In Western terms, the accumulation of mucus may be associated by circulatory stagnation in the tissues, accumulation of toxins, inflammation, and infection. Alterative Thuja can be said to be an alterative in the sense of stimulating circulation in and between the cells of the tissues and their local blood and lymph capillary networks. This can result in more efficient removal of wastes and toxins, enhancing the natural healing mechanisms and reducing local inflammation and infection. Antirheumatic and dermatological agent Thuja can be especially useful in cases in which there is Stagnation of Qi in the channels of the joints, muscles, or skin, with accumulation of Phlegm Damp and/or Heat Toxin. Some stubborn cases of arthritis, gout, rheumatism. or psoriasis are examples of this pattern.
The Western uses of Thuja can be related to its four main Chinese action groups: GJ:linese actions
Western uses
I. regulate the Lung
recurring respiratory infections, laryngitis, tonsillitis, sinusitis, catarrhal hearing loss, phlegm in the throat, chronic bronchitis with difficult expectoration, bronchitis with cardiac weakness
II. regulate the Bladder
recurring urinary infections, cystitis, urethritis with discharge, enuresis, polyuria, dysuria, prostatitis with urinary dribbling
III. regulate the Uterus
leukorrhea or menorrhagia from weakness, amenorrhea, infertility
IV. clear Pathogen
warts, recurring viral infections, mononucleosis, lymphadenitis, adjunct to cancer therapy, skin disorders, arthritis, rheumatism, gout
Some of the Western uses listed in this table are discussed below. Recurring infections The circulatory stimulant, alterative, anticatarrhal, and antimicrobial actions of Thuja may all be involved in the use of this herb to treat acute, subacute, recurring, or chronic inflammatory conditions and/or infections. Thuja can be used for recurring infections of the respiratory or urinary systems. or for simultaneous infections of both systems. It can be useful in some cases of chronic fatigue syndrome with recurring respiratory infections, a chronic tendency to systemic catarrh, and cardiac weakness. Bronchitis with cardiac weakness Thuja can be used for bronchitis with phlegmy cough or difficult expectoration combined with cardiac weakness and cold extremities. In terms of Chinese medicine, Thuja can be said to move Stagnant Qi of the Lung and Heart, and clear Lung Phlegm. Catarrhal hearing loss Thuja is one of the few anticatarrhal herbs, others include Euphrasia, Hydrastis, and Zanthoxylum, with a tradition of use for hearing loss due to blockage of the Eustachian tubes by phlegm. The patient may also have a history of sinus and bronchial catarrh and overweight. Lymphadenitis 1 use Thuja as a lymphatic alterative for lymphadenitis, for example, in mononucleosis or chronic fatigue syndrome.l also use Thuja as an adjunct to conventional cancer therapy, especially when there is lymph system involvement.
Combining Western Herbs and Chinese Medicine
742
Prostate disorders I use Thuja in combinations for prostate disorders, especially those that include the following: • prostatitis with urinary tract infection linked to Stagnation of Qi with Damp Heat in the Lower Burner • benign prostatic enlargement linked to Stagnation of Qi with accumulation of Phlegm Damp in the Lower Burner • as an adjunct to conventional cancer therapy for prostate cancer linked to Stagnation of Qi with Heat Toxin Amenorrhea Thuja can be used specifically for cases of amenorrhea, infertility, or leukorrhea linked to Stagnation of Qi with accumulation of Phlegm Damp in the Uterus. This may occur especially in patients who have chronic catarrhal conditions, such as sinusitis and bronchitis, and who are overweight DIRECTION Of ENERGY Thuja does not so much move the energy in a specific direction. Rather, it can stimulate the movement of Qi and Blood and clear obstruction in the channels and in the organs, regardless of whether the obstruction is linked to Phlegm and Damp, Retained Pathogen, Heat, or Cold. TYPICAL CASE EXAMPLE Signs and symptoms The patient is lethargic with recurring respiratory infections that easily progress to lingering nasopharyngeal catarrh and catarrhal reduction of hearing. The patient also has chronic mild arthritis and psoriasis. The pulse is slippery and slightly wiry, and the tongue is pale, flabby, and slightly purple, with some red spots, and has a greasy yellowish coat. Diagnosis The patient has Retained Pathogen, Lung Phlegm, and Stagnation of Qi and Phlegm in the channels of the joints and skin. There may also be some Damp Heat, Heat Toxin, or Phlegm in the channels of the joints and skin. Choice of Thuja This herb is specific for: • recurring infections and respiratory catarrh associated with Retained Pathogen and accumulation of Phlegm • joint and skin disorders associated with Stagnation of Qi and Blood in the channels and obstruction by Damp Heat, Heat Toxin, or Phlegm
Limitations ofThuja TEMPERATURE In this book, Thuja is classified as a variable-temperature
herb that can be cool, neutral, or warm. It can treat hot Con.o:·o~;:.:".~. ditions, such as cystitis with Damp Heat, or cold conditions, such as arthritis with Phlegm Cold. However. fo! best results, it should be combined with cooler or warmer herbs, as appropriate. TASTE Acrid Thuja can have a mildly warming effect associated with its circulatory stimulant and cardiotonic actions, but it does not strongly warm the Interior like Capsicum or disperse Exterior W md like Achillea. The acrid property of Thuja is more like that of Lobelia in that it can move Stagnation of Qi and clear Phlegm obstruction without necessarily having either a warming or a cooling effect. Aromatic However, Thuja differs from Lobelia in that it also has the aromatic property, which Lobelia lacks. Thuja can be said to be aromatic in that it can clear Phlegm, whetherin the organs or in the channels. However, whilst Thuja can disperse Damp and Phlegm in the channels and ducts, it does not have a tradition of use for Phlegm Damp digestive problems, such as nausea, vomiting, loss of appetite, or abdominal distension. Bitter The bitter taste of Thuja may be associated with the use of this herb to clear Damp Heat and Heat Toxin. However, this use is restricted to urogenital, joint, and skin disorders. It does not extend to the treatment of Damp Heat in other systems, such as the hepatobiliary system. ACTIONS Anticatarrhal In terms of Chinese medicine, T. occidentalis, as used in the West, is specific for accumulation of Phlegm Damp associated with Qi Stagnation. Thuja is especially useful for catarrhal states of the respiratory, urinary, and reproductive systems, and for Phlegm Damp obstruction of the channels of the skin, muscles, and joints. For catarrhal states of the digestive or hepatobiliary systems, other herbs would be more appropriate, such as Hydrastis. Expectorant Thuja can be used as an expectorant for bronchial or nasopharyngeal catarrh. Although Thuja can have warming or cooling effects, depending on the state of the patient, for Cold conditions it would need to be combined with hotter herbs, such as Capsicum, and for Hot conditions it would need to be combined with cooler herbs, such as Hydrastis. Thuja can be used for bronchial phlegm accompanied by cardiac weakness, but in this case, it is best combined with herbs that have a primarily cardiotonic action, such as Crataegus.
Thuja Circulatory stimulant Although Thuja has been described as a circulatory stimulant and cardiotonic, I would not use it as a primary herb for either poor peripheral circulation or cardiac weakness. Rather, in my opinion, its primary importance lies in its ability to increase the capillary and lymph circulation to the tissues, and also assist in the clearance of pathogens and toxins. Urinary regulator The antimicrobial, anti-inflammatory, alterative, anticatarrhal, astringent, and diuretic actions may all contribute to the use of Thuja in the treatment of urinary problems such as recurring urinary infections, cystitis, urethritis with discharge, or enuresis. However, I would not regard it as a primary diuretic. like Taraxacum, or as a main herb for urinary stones, like Parietaria.
Prostate disorders I regard Thuja as an effective herb for
743
icine terms, were based on Stagnation of Qi with accumulation of Phlegm and Damp, or Retained Pathogen and Heat Toxin. In my opinion, Thuja is so appropriate for skin disorders that would be classified in Chinese medicine as associated with Wind Heat, Blood Heat, Deficient Blood, or Blood Stagnation. Antitumor agent Thuja has had a strong tradition of use in retarding the growth of both benign and malignant tumors. However, there is as yet no research evidence to support this tradition. Thuja should not be used unless there has been thorough investigation of the tumor by conventional medicine, with conventional cancer therapy if it is appropriate. However, Thuja can be used as an adjunct to cancer therapy, and in combinations, it can be used to reduce'the side effects of radio- or chemotherapy.
prostate disorders, but I generally increase its specificity by combining it with other herbs:
• prostatitis + urinary infection • prostatitis + sexual debility • prostatitis + incontinence • benign prostatic enlargement • prostate cancer
Thuja + Arctostaphylos Thuja + Turnera Thuja + Equisetum Thuja + Hydrangea Thuja + Viola odorata
The latter is used as an adjunct to conventional therapy. Emmenagogue Thuja is not generally used for premenstrual, postnatal, or menopausal disorders. I consider it to be specific for the treatment of amenorrhea and infertility. This use is based on two main effects: • it can act as a stimulant to the uterine muscle • it can clear catarrhal obstruction of the ducts of the reproductive system
Thuja paired with other herbs Discussion of the limitations of each of the main actions of Thuja can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Thuja beyond its limitations. The basic unit of herb combination is the herb pair. Twelve pairings of Thuja are briefly explained below. CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair. Thuja + Thymus
Bronchitis with difficult expectoration
~-
...;:::..-
,:;..::-:-
Astringent and antihemorrhagic Thuja has been used mainly as an astringent for excessive discharge from the mucous membranes. Its antimicrobial, alterative, anticatarrhal, and astringent actions may all combine to make it a useful herb in the treatment of catarrhal conditions such as urethritis with discharge, prostatitis with discharge, or leukorrhea. Thuja has not had major use in the West to control diarrhea or bleeding, and I would not use it as a primary antihemorrhagic herb, for example, in the treatment of menorrhagia. Alterative Thuja has had a wide range of use as an alterative, including in the treatment of warts, recurring infections, arthritis, skin disorders, lymph disorders, and as an aid to reduce the side effects of cancer therapy. However, I would not use Thuja as a primary herb for skin disorders or joint inflammation unless these conditions, in Chinese med-
Both herbs can have antimicrobial, stimulant expectorant, urinary astringent, and uterine stimulant actions. Therefore, they can be paired for: • recurring respiratory infections • cough with difficult expectoration • enuresis • amenorrhea Thuja + Glechoma
Nasopharyngeal catarrh Both herbs have anticatarrhal and expectorant action so that they can be paired for nasopharyngeal catarrh combined with bronchitis or with catarrhal hearing loss. They also have an effect on the urinary system so that they can be used for cystitis.
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Combining Western Herbs and Chinese Medicine
744
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Thuja + Phytolacca
Amenorrhea + obesity Both herbs have alterative anticatarrhal action to treat nasopharyngeal catarrh or obstruction of the channels or ducts by Phlegm. as in rheumatism. psoriasis. prostatitis, or amenorrhea. Both herbs are specific for cleansing the lymph system and they can both be used as an adjunct to cancer therapy. Thuja + Myrica
Sinusitis Thuja and Myrica can act as astringent anticatarrhals to clear phlegm in the nose and sinuses. Thuja can also treat bronchial catarrh. This pair has circulatory stimulant and anticatarrhal actions to warm and stimulate the circulation of Qi and Blood in the channels. and to clear Phlegm obstruction. thereby treating rheumatism. prostatitis. and amenor~hea. Thuja + Hydrastis
therapy. Viola has demulcent action. which can help to mod..--.-{~ erate the more acrid and stimulant effect of Thuja on the .. stomach. It can also help to tonify Lung and Stomach Yin. Thuja + Arctium
Gout Like the previous pair. Thuja and Arctium are alteratives that can be used for cystitis. skin disorders. rheumatism. gout. arthritis, lymphadenitis. or the sequela of radio- or chemotherapy. Arctium differs from Viola in that it is more for Wmd Heat and Heat Toxin. whilst Viola is more for Heat Toxin with Deficiency Heat linked to Deficient Yin. Thuja + Smilax
Arthritis + psoriasis These herbs can be combined for stubborn cases of psoriasis, arthritis. or psoriatic arthropathy, which can be described in terms of Chinese medicine as associated With Stagnation of Qi and Blood with accumulation of Phlegm and Damp and/or Retained Pathogen and Heat Toxin.
Catarrhal hearing loss Both herbs can be used for upper respiratory catarrh and catarrhal deafness. and both can have stimulant and anticatarrhal effects on the uterus to treat amenorrhea associated with obstruction by Phlegm. Both herbs can have antimicrobial action and can be used to treat recurring viral or bacterial infections which. in Chinese medicine terms. can be associated with Retained Pathogen.
Thuja + Calendula
Fungal infections of the fingers or toes and nails Both herbs have antifungal action and both have a vulnerary action. which can assist in the local recovery of the tissues. Thuja + Echinacea
Recurring infections Thuja + Arctostaphylos
Prostatitis with infection These herbs can be paired to treat infection and inflammation of the urogenital system associated in Chinese medicine terminology with Damp Heat, as in cystitis. prostatitis. or vaginitis. Thuja + Zanthoxylum
Echinacea and Thuja both have antiviral and antibacterial action which. in terms of Chinese medicine, can be equated with clearing Retained Pathogen. Also, both herbs contain immunoregulatory polysaccharides, which in Chinese medical terms can be said to strengthen Defensive Qi. This pair can be used to treat recurring respiratory or urinary infections. It can also be used to clear phlegm in the respiratory system.
Arthritis + poor peripheral circulation Both herbs can be used to treat rheumatism. gout. or arthritis. but Zanthoxylum makes this pair specific for patterns of Cold. The ability of this pair to clear Cold. Damp, and Phlegm obstruction can be used to treat catarrhal hearing loss. prostatitis, or amenorrhea. Thuja + Viola odorata
Adjunct to cancer therapy Both herbs can clear Damp Heat and Heat Toxins from the system, so that they can be used as alteratives for cystitis, skin disorders, arthritis, or the sequela of radio- or chemo-
_i'!"!'"
Topical uses ofThuja Thuja has been used topically in the past for chapped and rough hands. skin disorders, wounds, ulcers, bedsores, gangrene. hemorrhoids. anal fissure~, and a variety of other disorders. However. its main current topical use is for warts and fungal skin disorders of the hands. feet, and nails.
Warts Thuja tincture can be painted on the warts three or ritore times per day. Thuja tincture can be used singly or combined in equal proportions with Chelidonium.
Thuja -~
~-
Fungal infections Thuja tincture can be painted on the infected area three or more times per day. Thuja tincture can be used singly or combined in equal proportions with Calendula or Commiphora. Thuja can be given internally as well as topically to support its topical action.
Six Thuja combinations for internal use are discussed below. In addition, four alterative combinations, which include Thuja, are briefly compared: .. Chinese syndromes
1. chronic bronchitis +
Lung Phlegm Cold Heart Deficient Qi
cardiac weakness
sexual debility
3. prostatitis + infection
Lower Burner Damp Heat
4. enuresis
Heart Spirit Disturbance + Kidney Fear
5. amenorrhea + catarrhal
Uterus Stagnant Qi and Blood + Phlegm Cold Damp
conditions
Stagnant Qi Heat Toxin
6. cancer therapy adjunct
USE
• chronic bronchitis with cardiac weakness, maybe cold extremities and exhaustion
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of warm water, three times per day. Capsicum can be given in a separate bottle so that the requisite number of drops of Capsicum can be added to each dose of the main medicine. The combination is for chronic bronchitis and can be taken, with appropriate breaks and modifications, for 1-2 months.
+
Bladder Phlegm Cold + Kidney Deficient Qi
2. prostatic enlargement +
ic taste properties can warm and open the Lung to clear Phlegm Cold, and the sweet and sour tastes can tonify the Heart.
PRACTICAL NOTES
Thuja combinations
Combination ..
745
+ Damp Heat +
2. Prostatic enlargement + sexual debility
Bladder Phlegm Cold + Kidney Deficient Qi Herb Thuja Zanthoxylum (bark) Phytolacca Hydrangea Serenoa Turnera Panax gin. Zingiber
CAUTION
Before using any of the combinations below, it is important to be familiar with the cautions listed for each herb in the com-
Ratio
Tempe@ture. Taste .. ~ .... _, "
1 1 1 1 1 1 1 1
warm-cool
acrid, aromatic, bitter
hot
acrid, aromatic, bitter
cool
acrid
neutral
bitter, sour
neutral
sweet, sl. sour
warm
bitter, aromatic, acrid
51. warm
sweet, sl. bitter
hot
acrid, aromatic
GENERAL
Ratio
Temperature
Taste
1 1
warm-cool
acrid, aromatic, bitter
Thymus
warm-cool
aromatic
This combination is for Bladder Phlegm Cold with Deficient Kidney Qi. There may also be some degree of Kidney Deficient Yang. The overall temperature is warm to treat cool or cold conditions. The acrid and aromatic taste properties can warm and move the circulation of Qi and Blood in the Lower Burner to clear obstruction associated with Cold, Phlegm, and Damp. The sweet herbs can tonify Kidney Qi, and the aromatic bitter Turnera can stimulate Kidney Yang.
Lobelia
1
warm-cool
Prunus
1
neutral
acrid bitter, aromatic
USE
Crataegus
1
sl. warm
sour, sweet
Sanguinaria
0.5 0.5 5-20 drops
warm
bitter, acrid
bination. 1. Chronic bronchitis + cardiac weakness
Lung Phlegm Cold + Heart Deficient Qi Herb Thuja
Glycyrrhiza Capsicum
neutral-cool
sweet
hot
acrid
• prostate enlargement with difficult or dribbling urination, sexual debility, and exhaustion PRACTICAL NOTES
GENERAL
This combination is for Lung Phlegm Cold with some Heart Deficient Qi and Yang. The overall temperature is warm to treat cool or cold conditions. The acrid and aromat-
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of warm water, three times per day. It is used for chronic conditions and can be taken, with appropriate breaks and modifications, for 1-2 months.
Combining Western Herbs and Chinese Medicine
746
._--..,.....~..,.,.....-,---
3. Prostatitis + infection
5. Amenorrhea + catarrhal conditions
Lower Burner Damp Heat
Uterus Stagnant Qi and Blood + Phlegm Cold DamP"':-:-C:--:::;;,-: -,..:'
Herb
Ratio
Herb
Temperature Taste
Thuja Arctostaphylos
1 1
warm-cool
Juniperus Hydrastis
1
Hydrangea Equisetum
1 1
sl. warm cool neutral
cool
1
aromatic, sl. acrid, sl. sour
cool
Ratio Temperature, Taste
!:
~
bitter bitter, sour sl. bitter, sl. sweet
1 Thuja 1 Thymus 1 Hydrastis 1 Myrica Zanthoxylum (bark) 1 0.5 Zingiber 5-20 drops Capsicum
warm-cool warm-cool cool warm hot hot hot
/<:••
..:;"''lo,,,
acrid, aromatic, bitter . aromatic
bitter sour, bitter, acrid acrid, aromatic, bitter acrid, aromatic acrid
GENERAL
GENERAL
This combination is for Lower Burner Damp Heat. The overall temperature is cool to treat warm conditions. For patients with hot conditions. Juniperus can be replaced by Baptisia. Juniperus is a warm herb. but it is included since it can be used as a specific for urinary or prostate infections. The antimicrobial action is linked to the bitter components of Arctostaphylos md Hydrastis, and to the aromatic components ofThuja and Juniperus.
This combination is for obstruction of the circulation of Qi and Blood in the Uterus by Phlegm. Damp. and Cold. The overall temperature is warm to treat cool or cold conditions. The acrid and aromatic taste properties combine to warm and move Qi and Blood. and to clear Phlegm, Damp, and Cold. Although Hydrastis is a cool bitter herb, it is included in the combination since it is specific for normalizing se~re-c:. tions by the mucous membranes of the reproductive system and it has a regulatory effect on the tone and rhythm of contractions of the uterine muscle.
USE
• prostatitis with bacterial infection, maybe with urinary infection
• amenorrhea or infertility with lethargy, sensations of cold and heaviness in the lower body; nasopharyngeal or bronchial phlegm; or obesity PRACTICAL NOTES ~
.... -"-",
.~....
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of warm water, three times per day. Capsicum can be given in a separate bottle so that the requisite number of drops of Capsicum can be added to each dose of the main medicine. The combination is for chronic conditions and can be taken, with appropriate breaks and modifications, for 1-2 months.
Caution This combination is contraindicated if there is a chance of conception.
4. Enuresis
Heart Spirit Disturbance + Kidney fear 6. Cancer therapy adjunct Herb
Ratio
Temperature
Taste
Thymus Thuja
1 1
aromatic
Equisetum Hypericum Schisandra
1 1 1 1
warm-cool warm-cool cool neutral
Glycyrrhiza
0.5
Anemone
Stagnant Qi + Damp Heat + Heat Toxin
acrid, aromatic, bitter
cold
sl. bitter, sl. sweet sour, sl. sweet bitter
warm
sour
neutral-cool
sweet
This combination is the same as Thymus: enuresis and is discussed under that heading.
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--
USE
PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of water, three times per day. This combination is used for acute conditions and can be taken for 1-2 weeks. Once the infection and inflammation has subsided, this combination can be modified by replacing Hydrastis and Juniperus with Zea and Serenoa. to give a more demulcent and tonic combination for the subacute or remission phase.
- ;..~.
.•~~.~~;~
---~
~:.'._.
acrid, aromatic, bitter bitter, sour
;~",-,::~'.,-:,'
..
~';".2:.:;;~--:r.~~::-::'::_-~.:'-'
Herb Thuja Viola odo. Phytolacca Hydrastis Taraxacum Arctium (root) Glycyrrhiza Zingiber
J4
Ratio
Temperature
Ta~'t~
1 1 1: 1 1 1 0,5 0.5
warm-cool cool cool cool cool-cold cool neutral-cool
acrid, aromatic, bitter . sour, sweet, bitter
hot
acrid bitter bitter sl. acrid, 51. bitter sweet acrid, aromatic
-
Thuja •
GENERAL
Herb
This combination is for Stagnation of Qi and Blood with accumulation of Damp Heat and Heat Toxin. The overall temperature is cool to treat warm conditions. The bitter taste is associated here with clearing Damp Heat and Heat Toxins, but the capacity to retard the growth of tumors may be linked to herbs with a variety of taste properties including acrid, aromatic, sour, sweet, and bitter tastes. USE
• as an adjunct to cancer therapy • to reduce the side effects of radio- or chemotherapy PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of warm water, three times per day. It can be used after radio- or chemotherapy, with appropriate breaks and modifications, for 1-2 months. When the side effects of the radio- or chemotherapy are reduced, this combination can be replaced by a more tonic combination.
Caution This combination is appropriate if there are
-.
symptoms of Heat, such as sensations of heat and restless discomfort. If symptoms of Deficiency and Cold predominate or appear during the administration of this combination, then the combination is inappropriate and should not be used. This combination includes alterative herbs so that there may be temporarily increased frequency of urination, mild diarrhea, red skin rashes, or mild sensations of heat and restlessness as the toxins are cleared from the system. However, should these signs and symptoms persist, the dose of the herbs can be reduced, and if they become severe, the herbs should be stopped.
COMPARISON OF THE SIX THUJA COMBINATIONS 1. Chronic bronchitis + cardiac weakness
2. Prostatic enlargement + sexual debility
Lung Phlegm Cold + Heart Deficient Qi
Bladder Phlegm Cold + Kidney Deficient Qi
Herb Thuja Thymus Lobelia Prunus Crataegus
747
1 1 1 1 1
.Herb
Ratio
Th~a
1 1 1 1 1
Zanthoxylum (bark) Phytolacca Hydrangea Serenoa
Sanguinaria Glycyrrhiza Capsicum
0.5 0.5 5-20 drops
"'-'"'. '-', ..•• ~._ ....<-.,. ' " .
~-,
".' '·"~·:·Ratio
Turnera Panax gin. Zingiber
1 1 1
1. Thuja and Thymus can both act as warming, stimulant expectorants, and Thymus, Lobelia, Prunus, and Glycyrrhiza can act as antispasmodic antitussives for bronchitis with hacking cough. Crataegus, Capsicum, Sanguinaria, and Thuja can strengthen the Heart to treat cardiac weakness with exhaustion and cold extremities. 2. Combination No.1 contains the expectorants Thymus, Lobelia, and Prunus, and the cardiotonics Crataegus, Capsicum, and Sanguinaria. These herbs have been replaced in combination No.2 by Hydrangea and Serenoa, which are specific for prostate disorders. Also, in this combination, Thuja, Zanthoxylum, and Phytolacca combine to clear obstructions associated with Phlegm Cold from the prostate and urinary system. Panax, Turnera, and Serenoa combine to tonify Kidney Qi. 3. Prostatitis + infection
4. Enuresis
Lower Burner Damp Heat
Heart Spirit Disturbance + Kidneyfear
Herb
,-;' _...~atio···
Thuja Arctostaphylos Juniperus Hydrastis Hydrangea Equisetum
1 1 1 1 1 1
Thymus Thuja Equisetum Hypericum Anemone Schisandra Glycyrrhiza
1 1 1 1 1 1
0.5
3. Combination No.2 is for prostate enlargement without infection but with Kidney Deficiency. Combination No.3 is for prostate inflammation and infection with signs of Heat and without appreciable Deficiency. Thuja, Arctostaphylos, Juniperus, and Hydrastis are antimicrobial anti-inflammatories, and Hydrangea and Equisetum are specific for prostatitis.
4. In combination No.1, Thuja and Thymus are combined as expectorants for bronchial catarrh. In combination No.4, Thymus and Thuja, assisted by Equisetum, Hypericum, and Schisandra, are combined as urinary regulators and astringents for enuresis. In this combination, Thymus, Hypericum, Anemone, and Schisandra can calm and firm the Heart and Kidney to reduce nocturnal fear and an.:o.ety, and Schisandra and Glycyrrhiza together can tonify and firm Kidney Qi.
5. Amenorrhea + catarrhal conditions
6. Cancer therapy adjunct
Uterus Stagnant Qi and Blood + Phlegm Cold Damp
Stagnant Qi + Damp Heat + Heat Toxin
Herb
-~.:'.'-';"'.""
Combining Western Herbs and Chinese Medicine
748
.- Ratio ...•
1 Thuja Thymus 1 Hydrastis 1 Myrica 1 Zanthoxylum (bark) 1 Zingiber 0.5 Capsicum 5-20 drops
Herb
• Angelica: sinusitis + obesity • Capsicum: depression + bronchitis • Cinnamomum: amenorrhea + cold sensations • Ruta: infertility + obesity • Zanthoxylum: prostatitis + cold sensations
.•... Ratio
Thuja Viola odo. Phytolacca Hydrastis Taraxacum Arctium (root) Glycyrrhiza Zingiber
1 1 1 1 1 1 0.5 0.5
5. In combination No.5, Thuja and Thymus are paired to stimulate uterine contraction and to clear catarrhal obstruction from the reproductive system. Thuja and Thymus are assisted by Hydrastis, a cooling uterine stimulant and anticatarrhal, and by Myrica and Zanthoxylum, which can have warming circulatory stimulant and anticatarrhal actions. Zingiber and Capsicum help to clear the Stagnation of Qi associated with Cold. 6. Thuja and Phytolacca are paired in combination No.2 for prostatic enlargement and in combination No.6 for cancer therapy. In both combinations, the pair can help to move Stagnation of Qi and the associated accumulation of Phlegm Damp. However, in combination No.2, Thuja and Phytolacca are combined with herbs for the prostate and reproductive system, whilst in combination No.6, Thuja and Phytolacca are combined with alteratives. Thuja, Viola, Phytolacca, Hydrastis, Taraxacum, and Arctium are alterative herbs that can help to clear Retained Pathogen, Damp Heat, and Heat Toxin to reduce the side effects of radio- or chemotherapy. Thuja, Viola, and Phytolacca have a reputation for retarding the growth of tumors. Glycyrrhiza can assist in the detoxification process and can act as an anti-inflammatory and as a tonic. Zingiber moderates the effect of the cooling herbs and helps to stimulate circulation and digestion.
Research CONSTITUENTS The following constituents have been reported: • essential oil • flavonoid glycosides • mucopolysaccharides • tannin Essential oil T. occidentalis The main constituents of the essential oil of· T. occidentalis 'o are shown in the table below and are compared with data for the essential oil from Salvia officinalis leaves: 11
Constituent Q-thujone
31-65%
18-43% 3-8.5%
~thujone
8-15%
fenchone
7-15%
camphor
2-3%
4.5-24.5% 5.5-13%
cineole
The amounts of the thujones are similar. However, Salvia has cineole and more camphor, whilst Thuja has fench0lle and somewhat more thujones.
Biota orientalis The essential oil fraction of Biota orientalis (ce hili ye), the nearest equivalent herb to T. occidentalis that is used in Chinese medicine, is reported to contain thujone, thujene, fenchone, pinene, and caryophylleneY
THUJA ALTERATIVE COMBINATIONS The alterative Thuja combination No.6 (Thuja: cancer therapy adjunct) has already been discussed: The following four additional alterative combinations, shown in the table below, include Thuja and are discussed in detail in the chapters on each of the leading herbs. OTHER THUJA COMBINATIONS Other combinations that contain Thuja include the following:
Flavonoid glycosides T. occidentalis is reported to contain unspecified flavonoid glycosides, and B. orientalis is report12 ed to contain aromadendrin, quercetin, and myricetin. Mucopolysaccharides A high molecular weight polysaccharide fraction from T. occidentalis has been reported to ha,:e therapeutic effects (see Polysaccharides below). ..:' Tannins
Both T. occidentalis l3 and B. orientalis 14 have been
reported to contain tannins.
'--
Thuja
Thymus: recurring respiratory infection
Calendula: lymphadenitis
Zanthoxylum: arthritis + cold extremities
Smiltt chronic psoriasis
Retained Pathogen + Deficient Defensive Qi
Retained Pathogen + Heat Toxin
Stagnant Qi and Blood + Cold in the channels
Stagnation of Qi and Blood + Phlegm
zanthoxylum (bark) Populus Harpagophytum Angelica arc. Angelica sin. Zingiber Capsicum
Smilax Mahonia Phytolacca Thuja Zanthoxylum (bark) Salvia mil. Zingiber
Thymus Thuja Echinacea Hydrastis Glechoma Glycyrrhiza Zingiber
Calendula Thuja Arctium (root) Phytolacca Baptisia Glycyrrhiza Zingiber
1 1 1 1 1 0.5 0.5
1 1 1 1 1 0.5 0.5
PHARMACOLOGICAL AND CLINICAL RESEARCH ON
T. OCCIDENTALIS
There is very little research data on the pharmacological and clinical effects of preparations of T. occidentalis the herb. There is evidence to support the following effects for isolated constituents of T. occidentalis:
• thujone • fenchone • mucopolysaccharides
.,
- •......J
acaricidal antitussive immunoregulatory
Thujone Adverse effects for thujone are discussed in this chapter under Toxicology, but thujone may also have beneficial effects. Recent research on Artemisia absinthum suggested that the acaricidal property of this herb, that is its capacity to destroy mites, could be partly due to its thujone content.15 Also, Mills '6 wrote that thujone, like other terpenes, is antiseptic and carminative, and in moderate doses, thujone has restorative and calming effect. However, no references were given. Fenchone A study on rabbits showed that the administration of fenchone increased the volume of the respiratory tract fluid. The response was dose-dependent with a maximum at 9 mglkg:i Whilst this response might be associated with an anti- . tussive effect for the whole herb, the dose of 9 mg/kg is equivalent to 540 mg/kg for a 60 kg human, which is far higher than the herbal therapeutic dose. Assuming that Thuja contains about 1% of oil and the oil contains about 10% of fenchone, 1 g of the herb would contain about 10 mg of oil and about 1 mg of fenchone. Assuming the daily dose of the herb to be 3-6 g per day, this would contain 3-6 mg of fenchone, as opposed to the 540 mg of fenchone used in the
..
i·,
749
study.
1 1 1 1 1 0.5 5-20 drops
1 1 1 1 1 1 0.5
Polysaccharides Thuja polysaccharide g fraction (TPSg) has been shown to have immunoregulatory effects. TPSg enhanced cytokine production in human lymphocyte and macrophage cultures, and inhibited the expression of HIVI-specific antigens and of HIV-l-specific reverse transcriptase. 18 TPSg also had a protective effect against radiation damage in mice 19 and enhanced the recovery of hemopoietic progenitor cells in sublethally irradiated mice. 2O An extract of T. occidentalis also had immunostimulant effect on the first phase of phagocytosis of erythrocytes by the reticulohistiocytic system of isolated perfused rat liver. 21
PHARMACOLOGICAL AND CLINICAL RESEARCH ON
B. ORIENTALIS (CE BAI YE)
The following effects have been reported: • antimicrobial • antiulcer • expectorant • antitussive • antiasthmatic • antispasmodic • tranquilizing • anticoagulant Antimicrobial B. orientalis decoctions have been reported to have antibacterial22 and antiviraF3 actions. Administration to humans of an 18% ethanol extract; in doses of 50 ml thrice daily, was reported to be effective in the treatment of bacillary dysentery.24 Antiulcer B. orientalis decoction reduced the duration of bleeding in patients with peptic ulceration. 25 Expectorant An ethanol extract of B. orientalis, and also isopimaric acid isolated from it, had an expectorant effect in mice,26 and a petroleum ether extract of the herb appeared
750
Combining Western Herbs and Chinese Medicine
to have a direct expectorant effect on the bronchial mucosa. 27 Clinical studies with B. orientalis preparations were effective in treating bronchitis!! and pulmonary tuberculosis. 29 In the latter case, cough, expectoration, hemoptysis, and lassitude were improved. Antitussive B. orientalis extracts have shown antitussive effects in mice. 30 One study reported that a decoction of 30 g of fresh leaves of B. orientalis to a final volume of 100 ml, with 20 ml of honey, at a dose of 15-25 ml thrice daily for children under 2 years of age, reduced whooping cough in the majority of cases. 3l Antiasthmatic ~-caryophyllene demonstrated both antiasthmatic and antitussive effects in humans. 3! Interestingly, ~-caryophyllene itself was found to lack antiasthmatic activity, but its degradation product in gastric acid was found to be active. 33 In addition, decoctions of B. orientalis relaxed the isolated bronchial smooth muscle of mice and guinea pigs.3-I Antispasmodic B. orientalis decoction showed a significant relaxant effect on the isolated intestines of guinea pigs. 35 Tranquilizing In the same study, B. orientalis decoction reduced spontaneous activity in mice and prolonged pentobarbital-induced sleep.
but not for T. occidentalis. In addition, T. occidentalis'containS· .. _..,...-..... immunoregulatory polysaccharides, and I have not yet seen a similar report for B. orientalis. The only direct evidence for a therapeutic effect of T. occidentalis is for an immunoregulatory action. The presence of thujone and fenchone may be responsible for acaricidal and antitussive effects, respectively, for both Thuja and Biota, and the presence of caryophyllene may be responsible for the reported antiasthmatic action of B. orientalis. A variety of effects have been reported for B. orientalis from research done in China in the 1970s, but have not yet been reported for T. occidentalis: antimicrobial, antiulcer, expectorant, antitussive, antispasmodic, tranquilizing, and anticoagulant.
TOXICOLOGY An important distinction A careful distinction needs to be made between the use of: • therapeutic doses of Thuja as an infusion, or tincture • Thuja essential oil • isolated components of Thuja, such as thujone Infusion, decoction, or tincture
T. occidentalis I have not found toxicological information on this herb.
Anticoagulant B. orientalis decoction shortened bleeding time in mice and capillary coagulation time in rabbits. 36
RESEARCH VERIFICATION OF TRADITIONAL ACTIONS From the research summarized above, there is evidence for the following traditional actions from research on T. occidentalis or its isolated constituents: tonic (immunoregulatory) and antitussive. Additional effects demonstrated by research The following additional effect has been demonstrated by research: acaricidal.
COMPARISON OF THUJA AND BIOTA There is, as yet, insufficient research data for a thorough comparison of the constituents and pharmacology of Thuja occidentalis and Biota orientalis. Both herbs contain thujone and fenchone as the main essential oil components, and both herbs contain flavonoid glycosides and tannins, but there may be pharmacologically important differences in the makeup of the essential oil, flavonoid glycoside, and tannin fractions. For example, caryophyllene is listed for B. orientalis,
B. orientalis No fatalities were reported within 72 hours in . mice fed a decoction of Biota orientalis (T. orientalis) at 60
g/kg, and the LD 50 by peritoneal injection in mice was reported as 15.2 glkg. These are huge amounts, equivalent to 3.6 kg orally and 912 g (0.912 kg) peritoneally, respectively, for a 60 kg human.3-I It was reported that the only side effects of intragastric administration in rats at doses of 24-48 g/kg for 6 weeks were reduced activity and poor appetite. There were no significant effects on the growth, liver function, blood picture, or pathology. Again, these are very large amounts, equivalent 35 to 1.44-2.88 kg for a 60 kg human. Thuja essential oil The acute oral LD 50 of Thuja essential oil has been reported as 0.83 g/kg. 37 This is a very large amount, equivalent to about 50 g for a 60 kg human. According to Tisserand and Balacs, toxic signs from the ingestion of Thuja oil include: flatulence, gastroenteritis, hypotension, and convulsions. It was reported that Thuja oil caused epileptiform convulsions in a 50-year old woman who took 40 drops of the oil per day for 5 days.3! Assuming that 1 drop is 0.05 mI, then 40 drops is 2 ml, which is approximately 2 g of oil. Assuming that Thuja contains about 1% oil and that the digestive
..--
Thuja process can fully extract the oil from the herb, this is approximately equivalent to the ingestion of 200 g of Thuja herb f--'
per day. Thujone The acute oral LD;o of a- and (3-thujone in rats was reported as 192 mg/kg. 39 In subchronic activity tests in rats on 10 mg/kg per day of a- and (3-thujone, 5% showed convulsions.40 This is equivalent to 600 mg of thujone for a 60 kg human. According to Wichtl, adverse effects of thujone may include dizziness, hot flashes, tachycardia, and convulsions.
Thujone and pregnancy I have not found any data on the effects of thujone in pregnancy in a search of both the literature and the Internet-based PubMed resource.
751
Western contraindications None reported. Chinese contraindications No contraindications were listed for B. orientalis in Bensky and Gamble (Chinese therapeutic dose was listed as 6-15 g), but the Chinese Herbal Medicine Dictionary noted that this herb may result in upset stomach at high doses. Pregnancy and lactation The BHP contraindicated thuja in pregnancy. This may be due to the presence of thujone. Side effects The possibility of gastrointestinal irritation was reported by Felter and Lloyd. Overdose
See Side effects.
Interactions
No adverse reports.
Fenchone The terpenoid ketone fenchone has been report41 ed as nontoxic, nonirritant, and nonsensitizing. In perspective If I prescribe three individual doses of 5 ml of a 1:5 tincture in which Thuja is combined with four other herbs, in equal proportions, then 15 ml of the combination is consumed per day. This contains 3 ml of 1:5 Thuja tincture, which is theoretically equivalent to 600 mg of dried herb. If it is assumed that thujones make up 1% of the dried herb, then the daily dose of combination tincture theoretically contains 6 mg of thujones. The dose of thujones that resulted in convulsions in 5% of rats was equivalent to 600 mg for a 60 kg human. This is 100-fold greater than my maximum therapeutic dose.
Dose Dried herb ' .....-.IIi
The BHP listed 1-2 g of dried herb, three times
per day. Tincture The BHP listed 1-2 ml of 1:10 tincture in 60% alcohol, three times per day. However, in a combination of between five to eight herbs, I generally include about 0.5-1 ml of Thuja in each individual dose. Initial dose
Can start at the standard dose, providing the
cautions are observed. Duration In the therapeutic doses listed above, this herb can be used up to 1-2 months, providing the cautions are observed.
Cautions The cautions below apply to the use of infusion, decoction, or tincture of Thuja herb. Use of the essential oil is outside the scope of this book.
Regulatory status Please read the Regulatory status section in the chapter on Safety. Thuja is not on the UK General Sale List and it is not included in Schedule Part III of the UK Supply of Herbal Remedies Order 1977. It is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. T. occidentalis is not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
Traditional sources PROPERTIES Temperature According to Hidegard von Bingen, 4~ the cedar (cedrus) is hot and slightly dry, but she may have been referring not to Thuja in the family Cupressaceae, but to Cedrus species in the family Pinaceae. Gerard made the distinction between the cedar tree (Cedrus) and the tree of life (Thuja), although he classified both plants as hot and dry. Tabernaemontanus classified Thuja as warm and dry, but was unfamiliar with the uses of this herb. The main entry in the Chinese Herbal Medicine Dictionary classified the leafy twigs of ce bai ye (Biota orientalis) as cold, and one text cited classified it as cool. According to Bensky and Gamble, since ce bai ye is slightly cold in nature, it can be used for bleeding in Heat patterns. However, it may also be used with warming herbs for bleeding in Cold patterns. In this book, T. occidentalis, as used in the West, is classified as warm-cool in terms of Chinese medicine since it can be used to treat both warm conditions,
752
Combining Western Herbs and Chinese Medicine
such as cystitis due to Damp Heat, or cool conditions, such as arthritis due to Phlegm Cold. Taste
Taste in the mouth The BHP described the odor and taste of Thuja as strongly camphoraceous. I found a 1:10 tincture of Thuja in 60% alcohol to have an aromatic, resinous, and woody fragrance and an aromatic, acrid, and bitter taste. Taste properties The main entry of the Chinese Herbal Medicine Dictionary classified the leafy twigs of ce bili ye (Biota orientalis) as bitter and astringent, and one text cited also listed this herb as acrid. In this book, T. occidentalis, as used in the West, is classified as acrid, aromatic, and bitter in terms of Chinese medicine. The acrid taste is associated with the action of helping to move Qi and Blood, the aromatic property is associated with clearance of Phlegm and Damp, and the bitter taste, in this case, is associated with clearing Damp Heat. ORGANS In terms of Chinese medicine, Thuja occidentalis, as used in the West, can be associated mainly with disorders of the following organs: Source Lung
hemoptysis. nasal polyps bronchitis
Felter and Lloyd BHP
Heart
stimulates heart muscles. bronchitis with cardiac weakness
BHP
Bladder
urethritis enuresis, cystitis
Felter and Lloyd BHP
Uterus
amenorrhea, leukorrhea amenorrhea
Felter and Lloyd BHP
• alterative • topical use • nervine Anticatarrhal Lyle described Thuja as a stimulating alter:,~~::~:;'"':-;:¢:-, ative for the mucous membranes. Felter and Lloyd liSted":·~~t:., Thuja for catarrhal disorders of the respiratory, urinary,and "--;","E:':t-: reproductive systems.
-
Expectorant and antitussive According to Ellingwood,u Thuja can be used for nasal catarrh, postnasal catarrh, chronic bronchitis, and bronchitis with offensive discharge. Felter and Lloyd also recommended Thuja for coughs, hemoptysis, nasal polyps, and other growths in the nose or nasopharynx. The BHP listed this herb as an expectorant for bronchial catarrh.
':; .. '~
stimulant'-,;,:~~J~:
hot infusion. Grieve wrote that both fenchone and thujoh~;;i~1~4,: stimulate the heart muscle. The BHP listed Thuja as a stimu~";~ii':";~ lant of heart muscle and gave bronchitis with cardiac w~~,:',:-7#: " ness as a specific indication. ,:', ,·,.~,;T .~;
-\Y; ~'/.\·~L'f~~1,t~~:
Urinary regulator One of the main uses of ThuJ'a by,:th~,·,,;~,·,.,~,~,~:,Z:,',~,:,c,;r .' . ,"1:.,~'\.vr:,,~·,· Eclectic physicians was for urinary disorders. Felter and Ll~ '~:~~~:~:C; as well as Ellingwood recommended Thuja for: .. , ,..t>~.;:y~ • enuresis in children • incontinence on coughing or with slight musculat;\' exertion "".;.~( • nocturnal urinary frequency • senile urinary dribbling • polyuria with sexual debility • prostatic enlargement with urinary dribbling • urethritis with urethral discharge • cystitis with frequent urination and burning sensati0ll..;:.~,;;,~~:~t~~",
,L:,r;;:,,',
,.",:-:? ;'-f-:~;;:':~~';:;:-'-: '. "l'''t'~''~-VT: :'~.'
These indications reflect three main types of actions:;~:t"':~:,:;/ • tonic astringent • antimicrobial, anti-inflammatory, and alterative
Heart. Liver, and Large Intestine meridians, but other texts cited also include the Lung, Kidney, Bladder, Spleen, Stomach, and Small Intestine.
• anticatarrhal
• anticatarrhal • expectorant and antitussive • circulatory stimulant • urinary regulator • emmenagogue • astringent and antihemorrhagic
~
Circulatory stimulant Lyle described Thuja as a herb, which could influence the circulation when taken as a'
The main entry in the Chinese Herbal Medicine Dictionary listed ce biii ye (Biota orientalis) as entering the
ACTIONS
.'.
~·_-:~·~i.~·2~j~L~. .--.".;: ,
,
The anticatarrhal action can be associated with either ..... the tonic astringent or the antimicrobial anti-inflammatory' . actions. The tonic astringent action is especially useful Jor . patterns of Deficiency with obstruction of the urogeni!al;:~:,L;:. '''''I''..,···~.":·",.t«..,
system by Phlegm and Cold, and the anti-inflammatoIY.::"Y~;t2;: action is especially useful for patterns of Heat with obstruc->'~;~;') tion of the urogenital system by Damp Heat and Phlegm. ,";~2.t~1;i '-.~. '.~,:~' '~,;l;~i;'-:'
Emmenagogue Lyle used Thuja for amenorrhea linked to"';:J:~I,~ congestion. Both Ellingwood as well as Felter and Lloyd used::;:":.:" Thuja for amenorrhea with pelvic atony, catarrhal diseases of/8~;·:: . .. : ,,~,
Thuja the female system (including leukorrhea), and an enlarged and overrelaxed uterus with severe menorrhagia. The BHP listed Thuja as a uterine stimulant for amenorrhea. In July 2000. a Review of Practice report summarized replies to a questionnaire sent to UK herbal practitioners by the National Institute of Medical Herbalists on the use of Thuja. Out of the 49 practitioners who replied to the questionnaire, 22 used Thuja in the treatment of cancer, 14 for fibroids, and 4 for endometriosis. Astringent and antihemorrhagic Felter and Lloyd used Thuja as an astringent for hemorrhoids, anal fissures, and rectal prolapse, and as an anticatarrhal astringent for urethral discharge and leukorrhea. Ellingwood noted the use of this herb for chronic diarrhea with ulceration of the bowels in addition to its use as a urinary astringent.
Antihemorrhagic Lyle wrote that Thuja can control capillary hemorrhage. Ellingwood as well as Felter and Lloyd included the use of Thuja for hemoptysis. menorrhagia, and bleeding associated with malignant growths. However, these authors did not appear to give the antihemorrhagic action the same importance as the urinary astringent effect. Alterative The alterative action of Thuja is of great importance and is discussed under the following 4eadings: • antimicrobial • antiviral • counter to the adverse effects of inoculations • recurring respiratory infections • lymphatic • antirheumatic • dermatological agent • antitumor • warts
Antimicrobial The Native Americans used this herb for colds, and Felter and Lloyd noted its use for remittent and intermittent fever. Thuja can be described as an antimicrobial alterative that also has immunostimulant and immunoregulatory effects (see Research). These actions can be described in terms of Chinese medicine as clearing Retained Pathogen and tonifying the Defensive Qi. Antiviral Mills and Bone wrote that T. occidentalis is active against enveloped viruses as well as naked viruses such as the wart virus and enteroviruses; they did not cite references to support this claim. They also listed T. occidentalis as an antiviral herb that can be used for viral hepatitis and to counteract the recurring viral infections experienced by many patients with chronic fatigue syndrome.
753
Counter to the adverse effects ofinoculations The BHP noted the use of Thuja to counteract the ill effects of the smallpox vaccination. and Tierra recommended 10 drops of Thuja four times per day for four days to counteract the adverse effects of vaccinations and inoculations in general. Recurring respiratory infections I use Thuja in combination with Thymus to treat recurring acute respiratory and urinary infections followed by lingering upper respiratory phlegm in children and adults. This pair of herbs can be used to: • strengthen the immune system • clear lingering pathogens or their toxic products • clear phlegm and normalize respiratory secretions
Lymphatic Felter and Ll~yd wrote that '"f!1uja is an antiseptic and stimulant herb and noted its use for lymph gland enlargement. I use this herb as an adjunct to the treatment of cancer of the lymph glands. Antirheumatic Thuja has had a tradition of use by the Native Americans for rheumatism. arthritis, and gout. Lyle recommended a hot fomentation of the leaves for rheumatism. and both Ellingwood and Felter and Lloyd noted its. use for rheumatism or gout. Both Grieve and the BHP listed it for rheumatism. Dermatological agent Lyle listed Thuja as an alterative herb for eczema. Felter and Lloyd noted its value in chronic skin disorders,"and the BHP listed it for psoriasis and exudative eczema. Felter and Lloyd noted the use of Thuja for fungal infections of the skin, and Mills and Bone wrote that Thuja can be used for fungal infections of the skin and nails. Antitumor Ellingwood wrote that Thuja acts directly to retard the development of abnormal growths. Felter and Lloyd listed it for nasal polyps and growths in the nasopharynx, and for reducing hemorrhage associated with malignant growths. According to Mills and Bone. this herb has been used to treat benign growths including benign breast disorders, such as fibroadenoma or breast cysts, and uterine fibroids. The authors also noted its use as an adjunct to cancer therapy. The BHP noted its use for uterine carcinomas. Warts Both Lyle as well as Felter and Lloyd recorded the use of Thuja for warts. The BHP listed Thuja, administered both internally and topically. as a specific herb for warts. particularly those of the genital and anal regions. Topical use Thuja has been used topically both as a vulneraryand a counterirritant, and these actions may complement the astringent, antihemorrhagic, antimicrobial. antiinflammatory, circulatory stimulant, and alterative actions of this herb in treating conditions of the body surface.
Combining Western Herbs and Chinese Medicine
754
Vulnerary Ellingwood wrote that Thuja can be used for senile gangrene since it causes gangrenous surfaces to dry without hemorrhaging or issuing other discharge, and influences granulation. He listed Thuja for bed sores and other open ulcers dependent on local or general nerve exhaustion.
Counterirritant The BHP listed Thuja as a counterirritant, and this action may underlie the topical use of T. occidentalis in the West for chronic skin disorders and warts, and the use of B. orientalis in China for burns and boils, for promoting hair growth.
COMPARISON OF WESTERN AND CHINESE USE OF THUJA AND BIOTA The dried young leafy twigs are the plant part used for both T. occidentalis and B. orientalis (ce hili ye). The comparison of these two herbs is organized under the following headings: • anticatarrhal • expectorant and antitussive • circulatory stimulant • urinary regulator • emmenagogue • astringent and antihemorrhagic • alterative and antirheumatic • antitumor • vulnerary Anticatarrhal In the Western tradition of use for T. occidentalis, the anticatarrhal action has been regarded as important. In Chinese medicine terms, Thuja occidentalis has been used for Phlegm accumulation and obstruction in the respiratory, urinary, and reproductive systems. This tradition is not listed in the Chinese Herbal Medicine Dictionary for ce hili yeo Expectorant and antitussive Both herbs have a tradition of use for chronic cough and bronchial catarrh. However, the use of B. orientalis in China is specifically for Lung Heat patterns with accumulation of Phlegm. difficult expectoration, and bloody sputum. 12 This use is understandable in light of the fact that ce biii ye is classified as cool or cold in Chinese theory.9
-
.... ":_-_:~:-::'-~-_.:..--
Circulatory stimulant T. occidentalis has a tradition of use':: ... -~::.. in the West as a mild circulatory stimulant and mild cardiotonic. It may stimulate local circulation between the cells of the tissues and the lymph and blood capillary ·networks. Although one of the subsidiary texts cited by the Chinese Herbal Medicine Dictionary listed ce hili ye as promoting circulation and dispersing Blood Stagnation, this does not appear to be a major use in China. Also, the listing of ce bili ye as entering the Heart meridian may refer more to clearing Heart Heat than to tonifying or moving Heart Qi. Urinary regulator
Nervine Ellingwood wrote that Thuja is of especial service 'in those cases in which the mind is seriously depressed by the physical condition: as it 'stimulates the nervous forces' and improves the entire nervous system. He recommended Thuja for cases of 'nervous irritation and sexual neuresthenia.' The BHP listed Thuja as a nerve stimulant.
...__ :._::;_~~.::.i~~i •.;"..
Although subsidiary texts cited by the
Chinese Herbal Medicine Dictionary listed ce bai ye as entering the Kidney andlor Bladder channels, and one text listed it as promoting urination, this herb it is not much used for urinary problems in China. However, in the West, this has been one of the most important uses for T. occidentalis. Emmenagogue T. occidentalis has a tradition of use in the West as a uterine stimulant for amenorrhea and as an anticatarrhal for amenorrhea or leukorrhea. There does not appear to be a comparable use for ce bai ye in China. Astringent and antihemorrhagic According to Bensky and Gamble, the main use of ce bai ye is to treat a wide range of bleeding disorders, especially when they are associated with Heat in the Blood, although it may also be used for bleeding in Cold patterns when it is combined with warming herbs. For example, ce bai ye has a tradition of use for, ..... hemoptysis, hematuria, and abnormal uterine bleeding. T. occidentalis has been used as an antihemorrhagic in the West. However, this use has been of minor importance compared to its use as a urinary astringent and anticatarrhal. Alterative and antirheumatic Since its early use by the Native Americans, T. occidentalis has been employed as an alterative herb for rheumatism, arthritis, and gout. This has not been the primary use of ce bai ye in China, although some texts cited in the Chinese Herbal Medicine Dictionary have noted its action to promote circulation of the Blood, clean the Blood, and clear Wind Cold Bi, Wind Damp Bi, and Damp Bi (Bi = Obstruction syndrome = arthritis).lt is also listed for skin infection, boils, and the swelling of mumps due to Heat Toxin. Antitumor
I have not seen this Western tradition of use
for T. occidentalis listed for ce biii yeo Vulnerary Both T. occidentalis and ce bai ye have a tradition of use as vulneraries. T. occidentalis has been used for gangrene and ulcers to help granulation and wound healing, and ce bai ye has been used for burns and to promote tissue regeneration ('grow flesh').
,,.,
Thuja
References 1. Foster S, Duke J. Medicinal Plants. Houghton Mifflin, Boston, Massachusetts (1990) 2. Felter HW, lloyd JU. King's American Dispensatory, vols. 1 and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications, Sandy. Oregon (1983) 3. Lyle TJ. Physio-Medical Therapeutics, Materia Medica and Pharmacy. Originally published Ohio (1897). Reprinted by the National Association of Medical Herbalists of Great Britain, London, United Kingdom (1932) 4. Grieve M. A Modern Herbal, vols. 1 and 2. Dover Publications, New York, New York (1971) 5. Tabernaemontanus JT. Krauterbuch (1731). Reprinted by Verlag Konrad Kolbl, Miinchen, Germany (1993) 6. Gerard J. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publications, New York, New York (1975) 7. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983) 8. Evans WC. Trease and Evans' Pharmacognosy, 14th edn. WB Saunders, London, United Kingdom (1996) 9. Jiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science and Technology Press, Shanghai, China (1975) 10. Tisserand R, Balacs T. Essential Oil Safety: A Guide for Health Care Professionals. Churchill Livingstone. Edinburgh, United Kingdom (1995) . 11. Bruneton J. Pharmacognosy: Phytochemistry Medicinal Plants, 2nd edn. Lavoisier. Paris, France (1999)
,........
.'::
12. Bensky D. Gamble A. Chinese Herbal Medicine Materia Medica. Eastland Press, Seattle, Washington (1986) 13. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983)
'-
14. Chang H-M. But PP-H (eds). Pharmacology and Applications of Chinese Materia Medica, vols. 1 and 2. World Scientific Publishing. Singapore (1986) 15. Chiasson H. Belanger A, Bostanian N et al. J Econ EntomoI94(1):167171 (2001) 16. Mills S. The Essential Book of Herbal Medicine. Arkana/Penguin
755 23. Virus Section, Institute of Chinese Materia Medica of the Academy of Traditional Chinese Medicine. Xinyiyaoxue Zazhi (Journal of Traditional Chinese Medicine) (1 ):26 (1973) 24. 171st Hospital of the Chinese PLA. New Medical Information (Jiangxi School of Pharmacy) (6):11 (1971) 25. Ni DR. Chinese }Internal Med 8(3):49 (1960) 26. Medicinal Chemistry Group of Chronic Bronchitis Research Unit, Fourth Military Medical College of the Chinese PLA. Scientific and Technical Information (Fourth Military Medical College) (6): 1 (1975) 27. Pharmacology Group of Chronic Bronchitis Research Unit, Fourth Military medical College of the Chinese PLA. Scientific and Technical Information (Fourth Military Medical College) (3):21 (1976) 28. Clinical Bronchitis Research Unit, Fourth Military Medical College of the Chinese PLA. Scientific and Technical Information (Fourth Military Medical College) (2):41 (1976) 29. Tuberculosis Department, 309th Hospital of the Chinese PLA. People's Military Medicine (7):57 (1976) 30. Pharmacology Group of Chronic Bronchitis Research Unit, Fourth Military Medical College of the Chinese PLA. Scientific and Technical Information (Fourth Military Medical College) (5): 10 (1973) 31. Pediatrics Department, Guilin Workers' Hospital. Chinese Journal of Pediatrics (2):146 (1960) 32. Zhejiang Institute of Traditional Chinese Medicine. Compiled Information on Science and Technology. Zhejiang Institute of Traditional Chinese Medicine. p 27 (1979) 33. Bian RL. Private consultation. (1980) [cited in Chang H-M. But PP-H (eds). Pharmacology and Applications of Chinese Materia Medica. vols. 1 and 2. World Scientific Publishing, Singapore (1986) ) 34. Chronic Bronchitis Research Section, Institute of Materia Medica of Zhejiang People's Academy of Health. Scientific Research Compilation. Zhejiang People's Academy of Health. p 130 (1972) '35. Chronic Bronchitis Research Section, Institute of Materia Medica of Zhejiang People's Academy of Health. Scientific Research Compilation. Zhejiang People's Academy of Health. p 175 (1973) 36. Pharmacology Section, Shandong Institute of Traditional Chinese medicine. Studies on Traditional Chinese Medicine (Shandong Institute of Traditional Chinese Medicine) (3):48 (1965) 37. Opdyke DLJ. Food Cosmetics Toxicology 12 (1973) [cited in Tisserand R, Balacs T. Essential Oil Safety: A Guide for Health Care Professionals. Churchill Livingstone, Edinburgh, United Kingdom (1995) 1
Books, London, United Kingdom (1991) 17. Boyd EM, Sheppard EP. PharmacoI6:65-80 (1971) 18. Offergeld R, Reinecker C, Gumz E et al. Leukemia 6(Suppl 3):189S1915 (1992) 19. Gan 01. Drize NI. Gola S et al. Biull Eksp Bioi Med 112(12):635-637 (1991) 20. Hassan HT,Drize NJ et al.lmmunol Lett 50(1-2):119-122 (1996) 21. Vomel T.Arzneimittelforschung 35(9):1437-1439 (1985) 22. Jiangsu Coordinating Research Group on Biota orientalis. Clinical Trial of Biota orientalis in the Treatment of Chronic Bronchitis. (1973) [cited in Chang H-M, But PP-H (eds). Pharmacology and Applications of Chinese Materia Medica. vols. 1 and 2. World Scientific Publishing, Singapore (1986))
38. Millet Y. Clinical TOxicology 18(12):1485-1498 (1981) 39. Van Dyke TE,. Braswell 1. Offenbacher S. Agents Actions 19:376-377 (1986) 40. Pinto-Scognarniglio W. Boll Chim Farm 106:292-300 (1967) 41. Opdyke DLJ. Food Cosmetics Toxicology 14 (1973) [cited in Tisserand R, Balacs T. Essential Oil Safety: A guide for Health Care Professionals. Churchill Livingstone, Edinburgh. United Kingdom (1995) ) 42. Von Bingen H. Hildegard von Bingen's Physica. Healing Arts, Rochester, Vermont (1998) 43. Ellingwood F. American Materia Medica. Therapeutics and Pharmacognosy, 11th edn. (919). Reprinted by Eclectic Medical Publications. Sandy, Oregon (1994)
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Thymus Botanical name Thymus vulgaris L., Thymus zygis L. Family Lamiaceae (Labiatae) Pharmaceutical name Thymi herba et flos Part dried leaves and flowers English common thyme, garden thyme German Gemeiner Thymian, Garten-Thymian French thym vulgaire Mandarin she xiang cao (~~1f.) is the aerial part of T. vulgaris ill
Use in the West Thymus vulgaris is a small evergreen shrub native to central and southern Europe, and is now cultivated in Europe, the Middle East, India, Africa, and North America. l The European Pharmacopoeia 2 defined the drug as the 'whole leaves and flowers separated from the previously dried stems of Thymus vulgaris L. or Thymus zygis L. or a mixture of both species: In the 1st century AD, Dioscorides3 wrote that thyme could help to expel phlegm and damp through the stools and could be used for bronchial phlegm and wheezing. He also listed its internal use to increase urination, induce menstruation, expel worms, and dissolve congealed blood in the body; and its topical use to heal ulcers and cure warts. Culpeper~ recommended thyme for strengthening the lungs and purging the body of phlegm. He listed it for cough, shortness of breath, stomach disorders, flatulence, sciatica, and gout, and to induce menstruation and assist in labor. In addition to these uses, Gerards recorded the use of thyme for chronic headache and for persons that are fearful, melancholic, and troubled in mind. Tabernaemontanus6 wrote that thyme could be used to treat depressed and melancholic people.
These early traditions of use have been continued in the West to the present day. Christophee listed T. vulgaris for bronchitis, whooping cough, asthma, stomach weakness, diarrhea, flatulence, intestinal colic, spasms, dysmenorrhea, headache, hysteria, and nightmares. He also listed it for rheumatism and gout, as a gargle for throat irritations, and as a topical application for indolent ulcers. The early use of thyme for psychological disorders has been developed in aromatherapy, and the oil of T. vulgaris has been used for nervous depression, mental fatigue, claustrophobia, and fears and other emotional disorders in children.s
Thymus serpyllum and T. pulegioides Thymus serpyllum L. is described as a separate herb in some texts and is known as Serpylli herba, wild thyme, Wilder Thymian, or Herbe de serpolet. There are various subspecies, and T. serpyllum is not always differentiated from T. pulegioides L. 9 Grieve 10 wrote that T. serpyllum has the same properties as T. vulgaris but to an inferior degree, and its indications are described in Wicht! as similar to T. vulgaris but again to an inferior degree. Nomenclature In older texts, such as those by Dioscorides or Hildegard von Bingen, it is not always certain which species of Thymus is being discussed. In this chapter, the word Thymus refers to T. vulgaris and T. zygis, unless otherwise stated. Use in China The Chinese Herbal Medicine Dictionaryll has an entry for she xiang cao, the aerial parts of T. vulgaris. However, the main entry is taken from a modern text, no
757
Combining Western Herbs and Chinese Medicine
758
data on properties or meridians are given, and there is more information on pharmacology than on traditional data. It would therefore appear that this herb has not been of wide use or importance in traditional Chinese medicine.
• calm Disturbance of Heart Spirit, especially when this is associated with Kidney f e a r - · " ' ....~• stimulate the movement of Heart Spirit when this is reduced by tiredness or depression
WESTERN ACTIONS
What is special about Thymus 1n terms of Chinese medicine, Thymus vulgaris, as used in the West, can be said to be a variable-temperature herb and is classified in this book as warm-cool. It can be said to be aromatic in its taste property and to have its primary effect on the Lung. It can also have secondary effects on the Kidney, Bladder, Heart, Spleen, Intestines, and Uterus.
The key to understanding Thymus is that it can help to: • clear lingering respiratory ~nd urinary infections • strengthen digestion and clear catarrh • promote expectoration and calm bronchial spasms • calm fear and treat depression • regulate menstruation CHINESE ACTIONS In terms of Chinese medicine, Thymus, as used in the West, can be said to have five main actions: I. II. III. IV.
v.
clear Retained Pathogen transform Phlegm and relieve cough and wheezing regulate Bladder Qi and clear Bladder Damp Heat regulate Heart Spirit and calm Kidney fear regulate the Uterus
Clear Retained Pathogen Thymus can help to clear the Retained Pathogen associated with recurring respiratory and/or urinary infections. In my opinion, Thymus can be especially helpful when these infections are associated with physical debility, chronic depression, and disturbance of the mind, emotions, and behavior. By helping to clear Retained Pathogen, tonify Defensive Qi, and regulate the emotions, Thymus can help to renew the physical and psychological health in both children and adults.
The main Western actions of Thymus are shown here in terms of its five main Chinese actions: Chinese actions
Western actions
I. clear Retained Pathogen
antimicrobial alterative immunoregulatory
II. transform Phlegm and relieve cough and wheezing
carminative anticatarrhal expectorant antispasmodic antitussive
III. regulate Bladder Qi and clear Bladder Damp Heat
tranquilizer astringent antimicrobial
IV. regUlate Heart Spirit and calm Kidney fear
tranquilizer antidepressant
V. regulate the Uterus
emmenagogue anticatarrhal antimicrobial
ImmunoreguIatory and alterative actions Thyme may be especially appropriate for those who have had -repeated -_"........w.~ antibiotic therapy, for example, for respiratory or urinary infections, with the result that the immune system and the digestive system have been weakened. This, in turn, can result in an accumulation of pathogens that are not cleared from the body. The antimicrobial and alterative actions of Thymus can help to clear pathogenic microorganisms from the system. By strengthening the immune, respiratory, and digestive systems, Thymus may help to prevent further infection. Anticatarrhal and carminative actions Thymus has a tradition of use in the West as a warming, drying herb to thin and dissolve thick phlegm, and to purge the body of phlegm and damp. In Chinese medicine terminology, Thymus could be said to:
Regulate Heart Spirit and calm Kidney fear Thymus has a tradition of use in the West to treat fear and nervousness on the one hand, and mental exhaustion, depression, and melancholy on the other. In terms of Chinese medicine, this can be described as the capacity to regulate and normalize the balance of movement of the Heart Spirit. Depending on the state of the patient, Thymus can:
• help the Spleen to transform Phlegm and Damp • help the Lung to disperse Phlegm accumulation In Western herbal terminology, Thymus can also be said to help to clear catarrhal obstruction of the respiratory, urinary, or reproductive systems, and to clear associated accumulated pathogens.
.."
Thymus
759
Limitations ofThymus
WESTERN USES The main Western uses of Thymus are shown here in terms of its five main Chinese actions: 0·
Chinese actions
('CO""
Westem uses
I. clear Retained Pathogen
recurring respiratory and/or urinary infections
II. transform Phlegm and relieve cough and wheezing
digestive weakness. bronchial phlegm, cough, whooping cough
III. regulate Bladder Qi and clear Bladder Damp Heat
enuresis, recurring urinary infections
IV. regulate Heart Spirit and
nightmares. children's nervous disorders
calm Kidney fear
V. regulate the Uterus
dysmenorrhea, amenorrhea
DIRECTION OF ENERGY Thymus does not have a marked directional effect on the movement of energy. It is an aromatic herb that is a member of the family Labiatae, like Lavandula, Rosmarinus, and Salvia. However, unlike these herbs, it does not have an appreciable effect in controlling pathological upward movement of Qi and Yang. Also, it lacks the regulatory effect on energy movement at the surface of the body possessed by Salvia.
TYPICAL CASE EXAMPLE Signs and symptoms The patient has frequent recurring respiratory infections, which can progress to lingering bronchial phlegm and cough. She is generally tired and cold, and has poor appetite, occasional dysmenorrhea, occasional urinary infections, and white vaginal discharges, which occasionally become yellowish. Diagnosis The patient has Deficient Defensive Qi, Retained Pathogen, and Lung Phlegm. She has Damp in the Bladder, which occasionally transforms into Damp Heat, and her dysmenorrhea may be associated with Cold, Damp, and Phlegm. Choice of Thymus Thymus can help to tonify Defensive Qi, thereby assisting the body in clearing Retained Pathogen and reducing the frequency of the recurring respiratory and urinary infections. Thymus is an aromatic herb, which can clear Lung Phlegm and assist the Spleen in transforming Phlegm and Damp, reducing the amount of Damp and Phlegm obstructing the reproductive or urinary systems. By its antimicrobial action, Thymus can help to reduce Damp Heat and treat yellow leukorrhea.
TEMPERATURE Thymus is a variable-temperature herb and is classified in this book as warm-cool. It can be used as a warming herb for cool patterns of bronchitis, digestive weakness, or dysmenorrhea. It can be used as a cooling herb for warm patterns of respiratory or urinary infection. However, its warming and cooling actions are not very strong, and are best enhanced by warming herbs, such as Zingiber or Myrica, or cooling herbs, such as Hydrastis or Arctostaphyl~s.
TASTE The primary taste property of Thymus is aromatic, associated with its actions of helping the Spleen to transform Phlegm, helping the Lung to disperse Phlegm, and relaxing and moving theQi of the Intestines.
ACTIONS
In my opinion, Thymus can be a useful herb for a variety ofpurposes. However, it is a herb that works best in combination with others. Antimicrobial and alterative Thymus can have antimicrobial action. It is especially useful if used internally for respiratory and urinary infections, and as a gargle for infections of the throat. However, Thymus is usually combined with other herbs, for example, • with Echinacea for respiratory infections • with Arctostaphylos for urinary infections • with Baptisia for infections of the throat For infections of other systems, different herbs may be more effective. For example, Hydrastis may be more effective for infections of the digestive system.
Alterative Thymus is an alterative in the sense of being an antimicrobial, clearing exogenous and endogenous pathogens, and in the sense of being an anticatarrhal, clearing Phlegm from the system. It is not an alterative in the sense of increasing bowel movement, increasing urination, or increasing hepatic function, like Taraxacum. Tonic Several tonic effects of Thymus may combine to assist in the recovery from recurring infections and from the weakening effects of the antibiotics given for these infections. These tonic effects are listed below with their nearest Chinese equivalent:
• strengthens immune system tonifies Defensive Qi
.. 760 • strengthens respiratory system • strengthens digestive system • acts as nervine tonic
Combining Western Herbs and Chinese Medicine tonifies the dispersing function of the Lung warms and moves Spleen Qi to aid in transforming Phlegm and Damp moves and calms Heart Spirit
However, individually, these tonifying effects may not be strong, and Thymus is best combined with other herbs to emphasize these effects. Anticatarrhal Thymus has a long tradition of use in the West of clearing Phlegm. However, its use as an anticatarrhal is primarily that of normalizing mucus secretion in the respiratory system. In my opinion, Thymus can be used as a secondaryanticatarrhal for phlegm obstruction in the urinary or reproductive systems, especially in cases in which a herb with both antimicrobial and anticatarrhal actions is "required. However, I do not consider it to be as powerful an anticatarrhal as Echinacea, Hydrastis, or Thuja, and I would not use it as an anticatarrhal for phlegm obstruction in the digestive or hepatobiliary systems. Expectorant, antitussive, and antiasthmatic Thymus has a tradition of use as an expectorant, especially when bronchial catarrh results from recurring respiratory infections. However, in the following situations, the listed herbs would be preferable:
• cooling expectorant • moistening expectorant • warming expectorant • drying expectorant
Euphorbia Glycyrrhiza Sanguinaria Angelica archangelica
Antitussive Thymus has a long tradition of specific use for whooping cough (pertussis), although I would use it in combination with Prunus and Marrubium.
Tranquilizer and antidepressant Thymus can act as:'a-:~::"-""+~:7 mild tranquilizer, especially when used for nightmares or enuresis, and as a mild antidepressant. However, these effects are not strong, and Thymus is best used in combination with other herbs. Emmenagogue In my opinion, Thymus vulgaris is of secondary importance for gynecological disorders, but it can be a useful secondary herb to clear Damp, Phlegm, and Damp Heat from the Uterus to treat dysmenorrhea, amenorrhea, or leukorrhea.
Thymus paired with other herbs Discussion of the limitations of each of the main actions of Thymus can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Thymus beyond its limitations. The basic unit of herb combination is the herb pair. Twelve pairings of Thymus are briefly explained below. CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair. Thymus + Hyssopus
Influenza + bronchitis Both herbs can be used for common colds or influ'eIlza developing into bronchitis. They can have expectorant, carminative, and calming actions. The two herbs complement each other since Hyssopus is somewhat more for acute situations, especially with fever, and Thymus is somewhat more for recurring infections with debility.
Antiasthmatic I do not regard Thymus as a primary herb for asthma. I use it as a secondary herb in some cases of asthma associated with bronchial catarrh. Carminative and antispasmodic Thymus can be used as an antispasmodic for intestinal colic, but in my experience, it is not as effective for colic as Rosmarinus or Lavandula. Its use as a carminative is more to help transform and move Damp and Phlegm by stimulating the Spleen. Astringent Thymus does contain tannins, and it has a tradition of use to treat diarrhea and enuresis. However, part of its antidiarrheal effect may be linked to its antimicrobial and carminative actions, and its use in the treatment of enuresis may be partly linked to its calming effect in children. In any case, Thymus is not a primary herb for diarrhea, although it is a primary herb for enuresis.
Thymus + Echinacea
Recurring infections Both herbs can be used to clear Lung Phlegm, clear Retained Pathogen, and tonify Defensive Qi to treat recurring respiratory or urinary infections. In addition, Echinacea can clear Exterior Wind, and Thymus can help the Spleen to transform Phlegm. The aromatic constituents of Thymus complement the acrid, bitter, and sweet constituents of Echinacea. Thymus + Thuja
Chronic bronchial phlegm This pair can have a wide range of uses. They can both be used as:
Thymus • expectorants and anticatarrhals for chronic bronchitis • antimicrobials and anticatarrhals for recurring respiratory or urinary infections • urinary astringents for enuresis • emmenagogues and anticatarrhals for amenorrhea Thymus + Glechoma
Chronic bronchial and nasopharyngeal catarrh This pair has anticatarrhal and expectorant actions and can treat the accumulation of phlegm in the nose, throat, or chest. Thymus + Hydrastis
Chronic infections and inflammations
'.:B:t
This pair can be used to treat catarrhal states of the respiratory, urinary, or reproductive systems, especially when there are recurring microbial infections with yellow discharge. Both herbs are antimicrobial, but Thymus can have a warming carminative action to moderate the cooling effect of Hydrastis, thus reducing any potentially adverse effects on the beneficial gut flora by the latter herb. Thymus + Marrubium
Chronic bronchitis + exhaustion Both herbs can have expectorant and antispasmodic actions to treat bronchitis, cough, or whooping cough. The aromatic carminative actions of Thymus complement the bitter digestive tonic action of Marrubium so that these herbs can be paired to treat debility.
761
act via the monoterpene phenols thymol and carvacrol, and Arctostaphylos to act via the hydroquinone glucoside arbutin. Thymus + Hypericum
Enuresis Both herbs may have astringent and calming actions, which contribute to the treatment of enuresis. Both herbs may calm the disturbing effect of Kidney fear on Heart Spirit. Thymus + Lavandula
Nightmares Thymus and Lavandula can have both.a calming and an antidepressant action, with Lavandula being the stronger tranquilizer and hypnotic. Thymus is more specific for Kidney fear and nightmares. Thymus + Mentha pulegium
Amenorrhea These two herbs can be paired for amenorrhea or delayed menstruation due to Cold and Damp, nervous tension, or shock. Both herbs can act either as uterine antispasmodics or as uterine stimulants. Thymus is more for clearing Damp and Phlegm from the Uterus, and Mentha pulegium is a stronger tranquilizer for nervous tension aggravating the uterine spasms.
Thymus combinations
Thymus + Prunus
Spasmodic cough Both herbs can have antitussive and antispasmodic action to treat spasmodic coughs. Prunus is the stronger antitussive, antispasmodic, and sedative, and Thymus is more anticatarrhal and antimicrobial. Thymus + Lobelia
Bronchial catarrh + asthma Lobelia is the primary antispasmodic and antiasthmatic, and Thymus is the secondary. These herbs can be combined to treat asthma, spasmodic cough, or dysmenorrhea. The antispasmodic actions of the two herbs are reported to have different mechanisms: Lobelia acting via alkaloids, and Thymus acting via flavonoids. Thymus + Arctostaphylos
Recurring urinary infections Both herbs can have an antimicrobial effect on the urinary system. but via different mechanisms. Thymus is reported to
Si.."C Thymus combinations are discussed in detail below: .Combination ..
.. '. . ..Chinese s~dr()'!1e~;...
1. recurring respiratory infection
Retained Pathogen + Deficient Defensive Qi
2. bronchitis + sinusitis
Lung Phlegm
3. spasmodic cough
Lung Rebellious Qi
4. enuresis
Heart Spirit Disturbance + Kidney fear
5. nightmares
Heart Spirit Disturbance + Kidney fear
6. dysmenorrhea
Uterus Stagnant Qi and Blood
CAUTION
Before using any ofthe combinations below, it is important to be familiar with the cautions listed for each herb in the combination.
762
Combining Western Herbs and Chinese Medicine
1. Recurring respiratory infection
Retained Pathogen + Deficient Defensive Qi .Herb
. Ratio
Thymus Thuja Echinacea Hydrastis Glechoma Glycyrrhiza Zingiber
Temperature
Taste
1 1 1 1 1
warm-cool
aromatic
warm-cool
acrid, bitter, aromatic
0.5 0.5
cool
acrid, bitter, sl. sweet
cool
bitter
neutral
sour, bitter
neutral-cool
sweet
hot
acrid, aromatic
for mixed patterns of Heat and Cold. There may be Lung Deficient Qi. Thymus and Zingiber are warming herbs, more for Lung Phlegm Cold, and Euphrasia and Euphorbia are more for Lung Phlegm Heat. In this combination, the acrid and aromatic constituents are mainly warming, and the bitter constituents are mainly cooling. USE
• acute, subacute, or chronic bronchial and nasopharyngeal phlegm, or phlegmy cough PRACTICAL NOTES
GENERAL
This combination is for clearing Retained Pathogen, clearing Lung Phlegm, and tonifying Deficient Defensive Qi. It is a slightly warm combination for neutral or cool conditions. It can be modified to treat warm conditions by removing Zingiber. The primary taste property is aromatic, derived largely from the monoterpenoid constituents, with additional antimicrobial, alterative, anticatarrhal, and carminative effects.
During the acute phase, this combination can be taken as a warm infusion. For convenience, during the subacute or remission phases, it can be taken as 5 ml of 1:5 tincture in quarter of a cup of warm water, three times per day. It may need to be taken, with appropriate breaks and modifications, ..for several months. 3. Spasmodic cough
..
~
Lung Rebellious Qi
USE
• recurring respiratory infection progressing to lingering bronchitis, maybe chronic debility and digestive weakness associated with prolonged antibiotic therapy • recurring respiratory and urinary infections • recurring nasopharyngeal and bronchial phlegm
Herb
Ratio
Temperature
Taste __. y
Thymus
1 1 0.5-1 0.5-1
warm-cool
aromatic
neutral warm-cool
bitter, aromatic
neutral-cool
sweet
Prunus Lobelia Glycyrrhiza
•.•.• : •••.
acrid
PRACTICAL NOTES GENERAL
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of warm water, three times per day. It is for the subacute or remission phase, and may need to be taken, with appropriate breaks and modifications, for several months. 2. Bronchitis + sinusitis
This combination is for Lung Rebellious Qi with Lung Stagnant Qi and often with Heart Spirit Disturbance. The combination is more or less neutral in temperature, but it can be used for warm, neutral, or cool patterns. With appropriate modification, the combination can be used for hot or cold patterns. Acrid, aromatic, sweet, and bitter taste properties contribute to the antitussive and antispasmodic actions.
Lung Phlegm USE
Thymus
warm-cool
aromatic
warm-cool neutral
acrid, aromatic bitter
neutraI-cool
acrid, sour, bitter
cool
bitter, acrid
Phytolacca
1 1 1 1 1 1
cool
acrid
Zingiber
0.5
hot
acrid, aromatic
Hyssopus Marrubium Euphrasia Euphorbia
GENERAL
This combination for Lung Phlegm is more or less neutral and can be used for neutral, warm, or cool conditions, or
• irritant coughs, nervous coughs • spasmodic coughs, whooping cough, croup PRACTICAL NOTES
This combination can be taken as 2.5-5 ml of 1:5 tincture in quarter of a glass of water, three times per day. Reduced doses should be given to infants or children; see the chapter on Dose. The combination can be taken, with appropriate cautions, breaks, and modifications, for one to several weeks. The dose can be increased or reduced according to fluctuations in the severity of the symptoms.
Thymus
763
Caution Severe conditions may require immediate conven-
6. Dysmenorrhea
'ional medical attention, and this combination can be used
Uterus Stagnant Qi and Blood
IS
an adjunct to conventional medical treatment. Herb
i.Enuresis ",;;,..i
..... ;,...
-
Heart Spirit Disturbance + Kidney fear Herb Thymus Thuja Equisetum Hypericum Anemone Schisandra Glycyrrhiza
Ratio
Temperature
Taste
1 1 1 1 1 1
warm-cool warm-cool cool neutral cold warm neutral-cool
aromatic acrid. aromatic, bitter 51. sweet, 51. bitter sour, 51. sweet bitter sour sweet
0.5
Daily dose
Thymus 3g 3g Mentha pul. Viburnum 3g Lobelia 0.6g* Zingiber (fresh) - 3 slices
Temperature
Taste
warm-cool warm neutral warm-cool hot
aromatic aromatic 51. bitter, 51. sour acrid acrid, aromatic
'UK daily maximum dose for dried Lobelia is 0.6 g; see the Dose section in the Lobelia chapter.
GENERAL
This combination is for uterine spasms and pain as a result of Stagnation of Qi and Blood of the Uterus associated with:
GENERAL
This combination can calm Heart Spirit Disturbance associated with Kidney fear arising from Deficient Kidney Qi or Kidney Qi not being firm. It is a more or less neutral combination, which can be used for warm, neutral, or cool patterns. Bitter Anemone and aromatic Thymus can calm the Heart and Kidney, and sour Schisandra and Hypericum
• obstruction of the channels by Cold, Damp, and Phlegm • nervous tension or shock
It is a warm combination in which the dominant tastes are acrid and aromatic with warming and moving effects. USE
• dysmenorrhea with sensations of cold or with shock or nervous tension
can firm Kidney Qi. USE
• enuresis in children, especially with fearfulness or nightmares
Decoction/infusion This prescription is most effective as a
PRACTICAL NOTES
This combination can be taken as 2.5-5 ml of 1:5 tincture in quarter of a glass of water, three times per day. Reduced doses should be given to younger children; see the chapter on Dose. The combination can be taken, with appropriate cautions, breaks, and modifications, for 1-2 months.
1 t:.-
PRACTICAL NOTES
5. Nightmares
Heart Spirit Disturbance + Kidney fear
decoction/infusion. To make the daily dose, Lobelia, Viburnum, and fresh Zingiber are decocted by simmering them gently for about 15 minutes in about 750 ml of water, in a covered pan. The heat is turned off, Thymus and Mentha pulegium are added, the lid is replaced, and the mi.-
Reheating The liquid should neither be simmered nor Herb
Ratio
Temperature
Taste
Ruta Anemone Valeriana Lavandula Thymus Schisandra Glycyrrhiza
1 1 1 1 1 1
warm-cool cold cool 51. warm warm-cool warm neutral-cool
bitter, aromatic bitter bitter, sweet aromatic, bitter, 51. acrid aromatic sour sweet
0.5
This combination is the same as Ruta: nightmares and is discussed under that heading.
boiled, or the essential oils will be lost. A portion can be reheated by adding a suitable amount of boiling water to it.
Duration of the prescription Three single doses can be taken per day, for a maximum of three days. If this combination is appropriate, it is usually rapidly effective. If it is not rapidly effective, a different combination may be appropriate.
Caution This combination should not be used in pregnancy, and appropriate precautions should be used with Lobelia.
Combining Western Herbs and Chinese Medicine
764
-
THYMUS COMBINATIONS
Lobelia Glycyrrhiza
1. Recurring respiratory infection
2. Bronchitis + sinusitis
Retained Pathogen + Deficient Defensive Qi
Lung Phlegm
7'~1ib:":'
Thymus Thuja Echinacea Hydrastis Glechoma Glycyrrhiza Zingiber
.:- " .. ~
'.
1 1 1 1 1 0.5 0.5
:~~._\"
Herb
Thymus Hyssopus Marrubium Euphrasia Euphorbia Phytolacca Zingiber
Ratio 1 1 1 1 1 1 0.5
1. Thymus and Thuja combine as warming. aromatic herbs with antimicrobial, anticatarrhal, and alterative actions to treat recurring respiratory infections and bronchial catarrh. Echinacea and Hydrastis can act as cooling, bitter herbs with antimicrobial, anticatarrhal, and alterative actions to clear lingering pathogens from the body. Thymus and Thuja combine with Zingiber to give circulatory stimulant and carminative actions that help to treat debility and assist in the recovery process. Also the warming carminative effect of these herbs helps to moderate any adverse effect of Echinacea or Hydrastis on the digestion and absorption. Glechoma is specific for chronic nasopharyngeal and bronchial catarrh.
2. Combination No.2 lacks Thuja, Echinacea, and Hy-
drastis, and is therefore less effective for Retained Pathogen than combination No.1. However. combination No.2 is specific for chronic nasopharyngeal and bronchial catarrh with phlegmy cough. Thymus and Hyssopus can treat acute bronchitis with influenza and they are both calming herbs. Euphorbia is more for bronchial phlegm, and it is combined with Euphrasia. which is more for nasopharyngeal catarrh. These herbs are cooling and anti-inflammatory for Lung Phlegm Heat. Marrubium is useful as a herb with a bitter expectorant principle, marrubiin, and can act as a bitter digestive tonic to treat bronchitis with Deficient Lung and Spleen Qi. Phytolacca can treat both bronchial and nasal phlegm. 3. Spasmodic cough
4. Enuresis
Lung Rebellious Qi
Heart Spirit Disturbance + Kidneyfear
Thymus Prunus
1 1
0.5-1 0.5-1
Equisetum Hypericum Anemone Schisandra Glycyrrhiza
1 1 1 1
0.5
3. This combination is specific for whooping cough or .4·-:' ',':-"'
Ratio
":'.·.-:~&",,·T
~~~::~J~~,:~--?~~
COMPARISON OF THE SIX
Thymus Thuja
1 1
for spasmodic coughs in general. It resembles Lobelia: acute asthma in that both combinations contain Lobelia, Prunus, and Glycyrrhiza. The difference is that Thymus: spasmodic cough contains Thymus whilst Lobelia: acute asthma contains Ephedra. Both Thymus and Ephedra can be used for asthma but Ephedra is a much stronger antiasthmatic, specific for allergic asthma. Thymus is a secondary antiasthmatic, specific for asthma with bronchial catarrh. 4. Thymus, Thuja, Equisetum, Hypericum. and Schisandra are specific for enuresis. All five herbs may have astrin--gent actions of different kinds, and Thymus, Hypericum, Anemone, and Schisandra can calm and firm the Heart and Kidney to reduce nocturnal fear and anxiety. 5. Nightmares
6. Dysmenorrhea
Heart Spirit Disturbance + Kidney fear
Uterus Stagnant Qi and Blood
Herb "-~ :':,: ":~. R~tl;6;"-·~:-,tf~~ ._-
Ruta
Anemone Valeriana Lavandula Thymus Schisandra Glycyrrhiza
1 1 1 1 1 1
Thymus Mentha pul. Viburnum Lobelia Zingiber (fresh)
3g 3g 3g 0.6g 3 slices
0.5
5. This combination is similar to combination No.4, but instead of Thuja, Equisetum. and Hypericum to treat enuresis, this combination contains the calming herbs Lavandula and Valeriana for insomnia. Thymus and Lavandula are aromatic herbs from the botanical family Lamiaceae, which can have calming or antidepressant action. depending on the state of the patient. Thymus is more for calming Kidney fear, and Lavandula is more for calming Heart Spirit Disturbance or Liver Hyperactive Yang. Ruta and Schisandra can combine to tonify and stabilize Kidney Qi to help to reduce the disturbing effect of Kidney fear on Heart Spirit.
6. This combination combines Thymus with the warming and calming herb Mentha pulegium. Both herbs can warm and move Stagnant Qi and Blood in the Uterus. However, Mentha pulegium is more for dysmenorrhea or amen-
Thymus orrhea from shock or nervous tension whilst Thymus is more for either dysmenorrhea or amenorrhea associated with Damp or Phlegm or for dysmenorrhea associated with Damp Heat. Viburnum. Lobelia. and Zingiber have an antispasmodic effect on the Uterus. This combination is a general-purpose combination for use as a decoction or infusion. It can be compared to the larger and more specific combination Anemone: dysmenorrhea + fear. Both combinations contain Mentha. Viburnum. Lobelia. and Zingiber. but the Anemone combination is made specific for dysmenorrhea with fearfulness and cold by the inclusion ofAnemone. Ruta. and Capsicum.
765
Flavonoids T. vulgaris contains flavonoids. including thymonin, cirsilineol. and 8-methoxy-cirsilineo1. 14 According to Bruneton. T. vulgaris contains apigenin, luteolin, and 6hydroxyluteolin glycosides. . Polysaccharides The leaves of T. vulgaris have been reported to contain an acidic polysaccharide termed TV-3IIIA-IIa. 1s Other T. vulgaris has been reported to contain: • biphenyl compounds such as rosmarinic acid l6 • saponins 17 • tannins (in T. serpyllum, the tannin content can be as high as 7%) I
OTHER THYMUS COMBINATIONS The following additional combinations further illustrate the range of uses for Thymus:
• Achillea: recurringfever + respiratory infection • Commiphora: chronic bronchitis + cold sensations • Juniperus: cystitis + recurring respiratory infection • Thuja: amenorrhea + catarrhal conditions
Research CONSTITUENTS The following constituents have been reported: • essential oil • flavonoids • polysaccharides • other Essential oil T. vulgaris contains 1-2.5% essential oils. mainly the isomeric monoterpenes thymol (30-70%) and carvacrol (3-15%). Also present are thymol methyl ether (1.4-2.5%). p-cymene, y-terpinene. and limonene. 12
Variation in the essential oil composition The composition I
I.
I ....
I I
k
of the essential oil varies depending on the place of origin and the stage of development. Also. there are many chemotypes (biochemical specificities) of this plant, some with widely different essential oil composition. For example, T. vulgaris subsp. aestivus (Reut. ex WillIe.) contains cineol (22%), geranyl acetate (20%). and geraniol (17%).13 The aromatherapist Mailhebiau noted that there are at least six different chemotypes of T. vulgaris and described two main chemotypes: T. vulgaris b.s. thymol, and T. vulgaris b.s.linalool. The uses of these two chemotypes are discussed in Traditional sources. The composition of the essential oil fraction of herb samples labeled as T. serpyllum can also be highly variable.9
PHARMACOLOGICAL AND CLINICAL RESEARCH The following effects have been reported: • antimicrobial • anti-inflammatory and antiallergic • antispasmodic • expectorant • hypolipidemic • antioxidant • antimutagenic Antimicrobial Oil ofThymus has shown both antibacterial and antifungal action in vitro.18 .
Antibacterial Oil of Thymus has shown antibacterial activity against Salmonella typhimurium 19 and against Staphylococcus spp. and Sarcina Spp.20 Thymol has shown antibacterial activity against various oral oacteria,21 and its mechanism may involve the perforation of the bacterial membrane, resulting in rapid loss of the cell contents. 22 Thymol and carvacrol showed broad-spectrum activity against bacteria associated with upper respiratory infections.23 The two main phenols found in Thymus were shown to have a synergistic effect with respect to their antibacterial activity.23.24
Antifungal Oil of T. vulgaris has shown antifungal activity against a range of pathogenic fungi,25.26.27.28 and thymol and carvacrol have also been reported to have antifungal activity.29 The ESCOP monograph on T. vulgaris reported antifungal activity against Candida albicans. 30 Anti-inflammatory and antiallergic Oil of T. vulgaris was reported to inhtbit prostaglandin biosynthesis in vitro 31 and to inhibit immediate allergic reaction by inhibition of ~-hex osaminidase release from rat basophilic leukemia cells. 32
766
Combining Western Herbs and Chinese Medicine
Rosmarinic acid was reported to have an anti-inflammatory effect both in vitro and in vivo in rats, which was considered to be due to inhibition of the classical complement pathway.33 The leaves of T. vulgaris have been reported to contain an acidic polysaccharide termed TV-3-lIIA-Ila with anticomplementary activity.15 Antispasmodic T. vulgaris extract showed an antispasmodic effect on various isolated smooth muscles and potentiated the relaxing effect of bradykinin.J.l Oil of T. vulgaris demonstrated an antispasmodic effect on tracheal and on ileal muscles. 35
Relative importance of monoterpenes and j1avonoids In vitro experiments with guinea pig trachea indicated that bronchospasmolysis was due to the flavonoids thymonin, cirsilineol, and 8-methoxy-cirsilineol. 36 • 37 The antispasmodic action may be a result of inhibition of calcium ion flow by the flavonoids. 37 The antispasmodic activity of the flavonoids on isolated ileum and trachea was found to be more potent than that of the phenols thymol and carvacro1.38 Whilst thymol and carvacrol in high enough doses do have an antispasmodic effect,39 the concentration of these phenols in the Thymus extracts used in some studies may have been too low to be responsible for the reported antispasmodic effects..w Expectorant A 5-day, double-blind, randomized study with 60 patients with productive cough showed that syrup of Thymus and bromhexine had equal beneficial effects. 41
,
.....
Antimutagenic The flavonoid luteolin, isolated from Thymus, showed antimutagenic activity against a dietary carcinogen formed during cooking. 49 Thymus extract was reported to have antimutagenic effects in Escherichia coli.;.o
RESEARCH VERIFICATION OF TRADITIONAL ACTIONS From the research summarized above on Thymus extracts or its isolated constituent, there is support for the following traditional actions: antimicrobial, anticatarrhal, expectorant, and antispasmodic. Additional effects demonstrated by research Antiinflammatory, antiallergic, hypolipidemic, antioxidant, and antimutagenic effects have been demonstrated. ~:
TOXICOLOGY An important distinction
increase both the secretion (of mucus) and the transport brought about by the movement of the bronchial cilia. 12• 39 According to the monograph on T. vulgaris in Wichtl, this increase is partly due to a reflex action from the stomach, and partly due to a direct action on the bronchial mucosa, since some of the essential oil is excreted by the lungs. l However, T. vulgaris infusion was reported to have an inhibiting effect on the normal transport rate of isolated esophageal epithelial cilia.42
be made between the use of:
Antioxidant A methanol extract of Thymus was reported to demonstrate hydroxyl radical scavenging effect in vitro. 44 Rosmarinic acid showed antioxidant activity in vitro, including inhibition of lipid peroxidation and decreased production of the superoxide anion radical. 45 A preparation of T. vulgaris was reported to have antioxidant capacity, which was considered to be largely due to its rosmarinic acid content,46
_--~'
The flavonoid eriodictyol and a biphenyl compound is<>:', ... _ .. _~.. lated from Thymus were reported to have antioxidant activity in vitro by inhibiting lipid peroxidation and superoxide anion production. The biphenyl compound was reported to be a powerful antioxidant and to protect red blood cells against oxidative hemolysis.47 Thymol, carvacrol, and p-cymene-2,3-diol isolated from Thymus oil showed antioxidant ability in vitro. The strongest of the three was p-cymene-2,3-diol, which had a stronger antioxidant activity than a-tocophero1. 48
Secretion and transport ofmucus Thymus preparations may
Hypolipidemic Dietary administration of Thymus oil decreased the saturated fatty acid to polyunsaturated fatty acid ratio in mice. 43
--.. _..
-_._~--_._"
A careful distinction needs to
• therapeutic doses of Thymus as an infusion, decoction, or tincture • Thymus essential oil • isolated components of Thymus Thymus extracts
General Both the ESCOP monograph and the German Commission E monograph 51 on this herb reported that no contraindications, side effects, or herb-drug interactions are 52 known for T. vulgaris. The Botanical Safety Handbook listed T. vulgaris as a Class 1 herb, that is, it can be safely consumed when used appropriately.
Acute toxicity A concentrated Thymus extract at oral doses of 0.5-3 g1kg (approximating to 4.3-26 g1kg dried Thymus) reduced locomotor activity and slightly reduced respiration in mice. 53 Even the lower dose, 4.3 g1kg, represents an ingestion of 258 g for a 60 kg human, which is over 20 times the maximum therapeutic dose of 12 g per day listed by the BHP. 54
r I '
767
Thymus
L. Chronic toxicity Oral administration of a concentrated 95% ethanol extract, equivalent to 0.9 glkg per day of dried
Thymus, were administered to mice for 3 months, and an increase in liver and testes weight were observed. Spermatotoxic activity was not demonstrated. 53 For a 60 kg human, this would be approximately equivalent to 4.5 times the maximum therapeutic dose recommended by the BHP, and 18 times the lower therapeutic dose.
-
Essential oil The LD 50 of Thymus oil in rats has been reportedas 2.84 glkg.55 This would be equivalent to over 170 g of oil for a 60 kg human, which is a lot of oil. A different report listed the acute oral LD 50 as 4.7 glkg.56
Mutagenicity Thymus oil showed no mutagenic or DNA-
Overdose
No adverse reports.
Interactions
No adverse reports.
Regulatory status Please read the Regulatory status section in the chapter on Safety. T. vulgaris is on the UK General Sale List and is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. T. vulgaris is not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
damaging activity in either the Ames or the Bacillus subtilis rec-assay.57 Phenolic terpenes The acute oral LD 50 of thymol in mice has been reported as 1.8 glkg.58 The acute oral LD so of carvacrol has been reported as 0.1-0.81 glkg. For a 60 kg human, these figures would represent the ingestion of 10 kg of dried Thymus in the case of thymol, and of 3 kg in the case of carvacrol.
Mutagenicity Thymol has been reported as nonmutagenic in the Ames assay.59
Dose Dried herbs
Traditional sources PROPERTIES Temperature Hildegard von Bingen60 wrote that Thymus is hot and dry, and both Gerard and Tabernaemontanus classified thyme as hot and dry in the third degree. The Chinese Herbal Medicine Dictionary did not list a temperature value for this herb. Thymus vulgaris, as used in the West, is classified in this book as a variable-temperature herb. It can be used as a cool herb for warm conditions, such as urinary inflammation and infection, or as a warm herb for digestive weakness.
The BHP listed 1-4 g of dried herb, three
times per day.
Taste
Tincture
Taste in the mouth According to the Wichtl monographs on these herbs, the taste of T. vulgaris is aromatic and somewhat pungent, and the taste ofT. serpyllum is intensely spicy and aromatic and somewhat bitter. I found the taste of T. vulgaris, as the fresh plant, dried herb, or tincture, to be predominantly aromatic, slightly acrid, and slightly bitter. These samples of Thymus lacked the strong bitterness and acridity of, for example, Rosmarinus.
The BHP listed 2-6 ml of 1:5 tincture in 45%
alcohol, three times per day. Initial dose Duration
Can start at the standard dose. Can be used long-term.
L
Cautions
Taste properties The Chinese Herbal Medicine Dictionary These cautions apply to the use of the infusion and the tincture of Thymus within the therapeutic dose range. The use of the oil is outside the scope of this book. Western contraindications None reported. Chinese contraindications None reported. Pregnancy and lactation No adverse reports. Side effects
None reported.
did not list taste values for this herb. In this book, the taste property of T. vulgaris, as used in the West, is classified as predominantly aromatic. Mills61 has st~ted that 1. vulgaris contains bitter constituents which can stimulate digestive activity. However, I did not find T. vulgaris to have a particularly bitter taste and have not found reference to bitter constituents in the literature for T. vulgaris. According to Wichtl, T. serpyllum contains bitter substances of unknown constitution.
768
Combining Western Herbs and Chinese Medicine
ORGANS In terms of Chinese medicine, Thymus, as used in the West, can be associated mainly with disorders of the followingorgans: Organ
Examples of use
Source
Lung
cough, shortness of breath bronchitis, pertussis, asthma
Gerard BHP
Spleen, Stomach, Intestines
• comforts the stomach, flatulence, pains and hardness of the spleen • dyspepsia, chronic gastritis, diarrhea in children
Culpeper
Bladder
diuretic enuresis in children
Gerard BHP
Heart
fearfulness, melancholy nightmares, hysteria nervous depression, fears in children
Gerard Christopher Mailhebiau
Uterus
induces menstruation, facilitates labor amenorrhea, dysmenorrhea
Culpeper Christopher
BHP
The Chinese Herbal Medicine Dictionary did not list meridians for this herb. ACTIONS Evidence from the traditional sources for the following actions of Thymus are discussed below: • antimicrobial • alterative and anticatarrhal • expectorant and antitussive • carminative and antispasmodic • tonic and irnmunoregulatory • tranquilizer and antidepressant • emmenagogue • diuretic • hepatic • topical Antimicrobial Christopher listed Thymus as an antiseptic, and the BHP listed it as a bactericidal herb. It is listed in 2 Mabet as a gargle for sore throats and infected gums. Mailhebiau said that the oil of T. vulgaris b.s. thymol could be used for deep-seated chronic infections that alter an individual's predisposition to disease, thus, affecting the person's psychic and physical identity. In terms of Chinese medicine, Retained Pathogen can predispose the body to recurrent disease and prevent complete recovery. Clearing Retained Pathogen can help to restore Defensive Qi. Alterative and anticatarrhal According to Dioscorides, Thymus drunk with a little salt and vinegar expels white
slimy dampness through the stools. Hildegard von Bingen'7:::-:~-=-' wrote that Thymus removes the putrid matter of food by its '" '-' heat and diminishes bad humors. Gerard said that it purges by the stool tough and clammy phlegm, sharp and choleric humors, and all corruption of blood. TabernaemontanuS stated that Thymus helps to dissolve and thin out thick viscous phlegm in the body, and recommended a drink of Thymus mixed with honey vinegar for gout, 'because, as Aetius writes, it gets rid of bile and other evil dampness: According to Mailhebiau, the oil of T. vulgaris b.s.linalool 'is a good renal drainer for children worn out by a long course of antibiotic therapy.' Expectorant and antitussive Dioscorides wrote that Thymus helps to expel viscous phlegm from the chest. Culpeper said that this herb is one of the best lung tonics, purges the body of phlegm, and can treat pertussis and shortness of breath. Felter and Lloyd recommended Thymus .. for convulsive and catarrhal coughs. The BHP listed T. vulgaris as an expectorant, antitussive, and antispasmodic for bronchitis, whooping cough, and asthma. The Commission E monograph noted the traditional use of this herb in Germany for catarrh of the upper respiratory tract. Weiss63 said that, since Thymus oil is eliminated largely by the lungs, it is concentrated at exactly the site where it is required. He said it does not matter whether the cough is acute or chronic, whenever there are spasmodic elements in a cough, Thymus will be of benefit. He recommended it for .' .... spasmodic lung afflictions including whooping cough in children and asthma, bronchitis, or emphysema in adults. He said that 'thyme is to the trachea and bronchi what peppermint is to the stomach and intestines.' Carminative and antispasmodic Culpeper said that Thymus comforts the stomach and expels wind. Christopher recommended this herb for intestinal colic and flatulence. The BHP listed T. vulgaris as an antispasmodic and carminative and recommended it for dyspepsia, chronic gastritis, and diarrhea in children. Bruneton noted that T. vulgaris has a tradition of use in France for gastrointestinal disturbances, such as impaired digestion, epigastric distension, belching, and flatulence. According to Mailhebiau, the oil of T. vulgaris b.s. linalool can regulate the appetite, reducing it in cases of bulimia and increasing it in cases of anorexia. Tonic and immunoregulatory The American literature • emphasized a tonic action. Felter and Lloyd6-l wrote that T. vulgaris can be a stimulating tonic to those recovering from exhausting diseases. Kloss 65 listed thyme as a tonic and nervine, and Christopher recommended it for children exhausted by whooping cough.
"7: \
17\i
Thymus Mailhebiau wrote that the oil of T. vulgaris b.s. thymol can have immunostimulant properties. He also recommended the oil of T. vulgaris b.s. linalool as an immunostimulant in cases of repeated bronchitis and angina to help to avoid the removal of the adenoids and tonsils in children.
\' l___
.~
Tranquilizer and antidepressant According to Aetius, quoted by Tabernaemontanus, Thymus taken in powdered form with honey vinegar is good for depressed and melancholic people. Gerard recommended T. vulgaris (garden thyme) to expel phlegm and melancholy; and for the fearful and troubled mind. Both Gerard and Culpeper said that T. sei'pyllum (wild thyme) could help lethargy on the one hand and frenzy and madness on the other. This apparent contradiction can be explained in terms of Chinese medicine as T. serpyllum being able to clear Heart Phlegm. According to Gerard, T. serpyllum infusion can be used for headache 9r other nervous affections. Felter and Lloyd wrote that T. vulgaris could be used for the nervous and spasmodic diseases of children and that it could be used for hysteria and headache. Kloss recommended T. vulgaris for nightmares and headache. Mailhebiau suggested the use of the oil of T. vulgaris b.s.linalool: • as a nerve tonic and a mental stimulant for nervous depression, mental fatigue, and claustrophobia • for children with emotional problems from conflict or lack of understanding in the family • to moderate instinctive reactions, violence, and fears
L
Emmenagogue According to Dioscorides, Thymus can help to induce menstruation and to expel the afterbirth. Culpeper stated that T. vulgaris can induce menstruation, give a safe and speedy delivery during labor, and bring away the afterbirth. Tabernaemontanus wrote that T. vulgaris can warm and strengthen the uterus in cold disorders of this organ. Felter and Lloyd recommended Thymus for dysmenorrhea, and Christopher listed it for amenorrhea and dysmenorrhea. The BHP listed T. serpyllum for dysmenorrhea. Diuretic Tabernaemontanus wrote that thyme increases urination, and Gerard listed both T. vulgaris and T. serpyllum as diuretics. In addition, he said that T. serpyllum could be used to break. bladder stones and ease the stranguary. The BHP listed T. vulgaris for enuresis in children and T. serpyllum as a diuretic. However, the urinary disorders for which I most commonly use Thymus are enuresis and recurring urinary infections. Hepatic Culpeper and Gerard recommended T. serpyllum for inflammation of the liver. According to Mills, Thymus has been used in France for liver disorders.
769
Topical The BHP recommended T. vulgaris as a gargle for laryngitis and tonsillitis, and the topical use of T. serpyllum for wounds or mastitis (as the herb), and for sciatica and rheumatism (as the oil). Mabey recommended T. vulgaris as an ointment for herpes zoster.
COMPARISON OF WESTERN AND CHINESE USE OF THYMUS SPECIES T. vulgaris has a long tradition of use in the West for a wide variety of disorders. In contrast, its use in China, as she xiang dio, appears to have been minimal, and most of the valuable uses of T. vulgaris are unknown. The main text cited in the Chinese Herbal Medicine Dictionary gave very little information, and merely stated that she xiang cao can treat cough, whooping cough, acute bronchitis, and inflammation of the throat. A subsidiary text cited listed it as an aromatic herb for calming the Spirit.
References 1. Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm. Stuttgart, Germany (1994) from 2nd German edn Wicht! M.(ed) (1989) 2. European Pharmacopoeia. 3rd edn. European Department for the Quality of Medicines within the Council of Europe, Strasbourg. pp 1638-1639 (1996) 3. Dioscorides P. Kreutterbuch (1610). Reprinted by Verlag Konrad Kolbl, Miinchen. Germany (1960) 4. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks. Glenwood,1llinois (1990) 5. Gerard J. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publications, New York, New York (1975) 6. Tabernaemontanus IT. Krauterbuch (1731). Reprinted by Verlag Konrad Kolbl, Miinchen, Germany (1993) 7. Christopher JR. School of Natural Healing. BiWorld, Provo, Utah (1976) 8. Mailhebiau P. Portraits in Oils. The C.W. Daniel Company. Saffron Walden. United Kingdom (1995) 9. Bruneton J. Pharmacognosy: Phytochemistry Medicinal Plants. 2nd edn. Lavoisier, Paris. France (1999) 10. Grieve M. A Modern Herbal, vols. 1 and 2. Dover. Publications. New York. New York (1971) 11. Jiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science and Technology Press, Shanghai, China (1975) 12. Kommentar DAB 10 (cited in Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm, Stuttgart, Germany (1994). from 2nd German edn. Wicht! M (ed) (1989)] 13. Amparo Bhizquez A. Carmen Zafra-Polo M. Pharmazie 45:802 (1990)
770
Combining Western Herbs and Chinese Medicine
14. Van den Broucke CO, Dommissee RA, Esmans EL et al. Phytochem 21:2581-2583 (l982) 15. Chun H, Shin DH, Hong BS et al. Bioi Pharm Bull 24(8):941-946 (2001)
40. Mills S, Bone K. Principles and Practice of Phytotherapy: Modern :.~_.:.= Herbal Medicine. Churchill Livingstone, Edinburgh, United Kingdom . (2000) 41. Knols G, Stal PC, Van Ree JW. Huisart Wetens 37(9):392-394 (1994)
16. Lamaison JL, Petitjean-Freytet C, Carnat A. Ann Pharm Franc 46(2):103-108 (1990)
42. Muller-Linunroth W, Frohlich HH. Fortschr Med 98(3):95-101 (l9sO)
17. Garcia Marquina JM, Gallardo Villa M. Farmacognosia 9:261-276 (1949)
44. Chung SK, Osawa T, Kawakishi S. Biosci Biotech Biochem 61(1):118123 (1997)
18. Panizzi L, Flamini G, Cioni PL et al. J EthnopharmacoI39(3):167-170 (1993)
45. Huang YS, Zhang JT.Yao Hsueh Hsueh Pao 27(2):96-100 (1992)
19. Juven BJ, Kanner J, Schved F et al. J Appl Bacteriol 76(6):626-631 (1994)
47. Haraguchi H, Saito T, Ishikawa H et al. Planta Med 62(3):217-221
20. Vampa G, Albasini A, Provvisionato A et al. Plantes Med Phytother 22(3):195-202 (1988)
48. Schwarz K,Ernst H, TernesW. J Sci Food Agric 70(2):217-223 (l996)
21. Shapiro S, Meier A, Guggenheim B. Oral Microbiol1mmunol 9(4) :202208 (1994) 22. Shapiro S, Guggenheim B. Oral Microbiolimmunol 10(4):241-246 (1995) 23. Didry N, Dubreuil L, Pinkas M. Pharmazie 48(4):301-304 (l993) 24. Didry N, Dubreuil 1, Pinkas M. Phimn Acta Helv 69(1):25-28 (1994) 25. El-Kady lA, EI-Maraghy SSM, Mostafa ME. Qatar Uni Sci J 13{l):6369 (1993)
43. Deans SG, Noble RC, Penzes L etal.Age 16:71-74 (l993)
46. ZhengW; Wang SY. J Agric Food Chern 49(ll):5165-5170 (2001) (1996)
49. Samejima K, Kanazawa K, Ashida H et al. J Agric Food Chem 43(2):410-414 (l995) 50. Vukovic-Gacic B, Simic D. Basic Life Sci 61:269-277(l993) 51. Blumenthal M (ed). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines (monograph on T. vulgaris). American Botanical Council, Austin, Texas (l998) 52. McGuffin M, Hobbs C, Upton R et al. American Herbal Products Association's Botanical Safety Handbook. CRC Press, Boca Raton, Florida (l997)
26. Tantaoui-Elaraki A, Beraoud LJ. Environ Pathol Toxicol Oncol 13(l):67-72 (1994)
53. Qureshi S, Shah AH, Al-Yahya MA et al. Fitotherapia 62(4):319-323
27. Zambonelli A, D'Aulerio AZ, Bianchi A et al. J Phytopathol 144(910):491-494 (1996)
54. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983)
28. Paster N, Menasherov M, Ravid U et al. J Food Protect 58(1):81-85 (1995)
55. Von SkramIik E. Pharmazie 14:435-445 (l959)
29. Viollon C, Chaumont JP. Mycopathologia 128(3):151-153 (l994) 30. European Scientific Cooperative on Phytotherapy: Monographs on the Medicinal Uses of Plant Drugs. European Scientific Cooperative on Phytotherapy, Exeter, United Kingdom (1997)
(l991)
56. Opdyke DLJ. Food Cosmetics Toxicology 12 (1975) [cited in Tissmmd R, Balacs T. Essential Oil Safety: A guide for Health Care Professionals. Churchill Livingstone, Edinburgh, United Kingdom (1995»).. ..: 57. Zeni F. Massimo G, Benvenuti S et al. Planta Med 57(3):237-241 (1991)
31. Wagner H, Wierer M, Bauer R. Planta Med 52:184-187 (l986)
58. Spector WS (ed). Handbook of Toxicology, vol. 1. Acute Toxicities. WB Saunders, Philadelphia, Pennsylvania (1956)
32. Tanaka Y,Konishi Y, TakagakiY et al.J Food Hygien Soc Jap 38(1):7-11 (l997)
59. Zeni F, Massimo G, Benvenuti S et al. Planta Med 57(3):237-241 (1991)
33. Englberger W, Hadding U, Etschenberg E et al. Int J Immunopharm 10:729-737 (1988) 34. Jensen KB, Dyrud OK. Acta Pharmacol ToxicoI19:345-355 (1962)
60. Von Bingen H. Hildegard von Bingen's Physica. Healing Arts' Rochester, Vermont (1998) 61. Mills S. The Essential Book of Herbal Medicine. ArkanalPenguin Books, London, United Kingdom (1991)
35. Reiter M, Brandt W.Arzneim Forsch 35(lA):408-414 (l985)
62. Mabey R (ed). The Complete New Herbal. Elm Tree Books, London,
36. Van den Broucke CO, Lemli J, Lamy J. Plantes Med Phytother 16:310317 (l983)
63. Weiss RF. Herbal Medicine, English edn. Beaconsfield Publishers,
37. Van den Broucke CO, Lemli JA. Pharm WeekbI5(Sci):9-14 (1983) 38. Van den Broucke CO. New Pharmacologically Important Flavonoids of Thymus vulgaris. In: Margaris N, Koedam A, Vokou 0 (eds) Aromatic Plants: Basic and Applied Aspects, Martinus Nijhoff, The Hague, Netherlands,pp 271-276 (1982) 39. Van Den Broucke CO, Lemli JA. Planta Med41:129-135 (l981)
United Kingdom (1988) Beaconsfield, United Kingdom (l988) 64. Felter HW, lloyd Jv. King's American Dispensatory. vols. 1 and 2, 18th edn (1898). Reprinted by Eclectic Medical Publications, Sandy, Oregon (l983) 65. Kloss J. Back to Eden, 5th edn (1939). Reprinted by Lifeline Books, Santa Barbara, California (l975)
~
..
; ~---
~
"-
.
........
Turnera Botanical name Turnera diffusa Willd. var. aphrodisiaca Urb. Family Turneraceae Pharmaceutical name Turnerae folium, Damianae folium Part dried leaves and stems English damiana German Damiana French damiana Mandarin Turnera species are not used
...
Other species used According to GrieveS, in Brazil, T. opifera leaf infusions were used for their tonic and astringent properties and T. ulmifolia was used for its tonic and expectorant effects. Use in China
Turnera diffusa is not listed in the Chinese Herbal Medicine Dictionarl or in Chang and But.7 According to Perry,8 the roots of T. subulata and T. trioniflora, both natives of America, are used in the Malay peninsula as a poultice for boils.
Use in the West Turnera is a small shrub native to Mexico, South America, and Texas that has had only recent use in Europe and North America. Lyle l wrote that the Mexicans drunk it freely to enable them to endure hardships and long journeys, and to protect them from disease, and Ellingwood2 reported that Turnera had a local reputation in Mexico as a sexual tonic long before its introduction to North America. According to Crellin and Philpott,3 it was promoted as an aphrodisiac in the United States in the 1870s, but its effectiveness in the treatment of impotence was already being questioned by 1884. In the herbal tradition of the United States and Britain over the last century, Turnera has been used as a general tonic for debility, as a stimulant to the central nervous system to treat nervous exhaustion and depression, and as a tonic to the reproductive system to treat sexual weakness.
What is special about Turnera In terms of Chinese medicine, Turnera, as used in the West, can be said to be a warm, bitter, aromatic, and acrid herb that has its main effects on the Kidney, Spleen, and Large Intestine.
The key to understanding Turnera is that it is a tonic herb that can strengthen primarily Kidney Qi and Yang, and secondarily the Qi and Yang ofthe Spleen and Large Intestine. CHINESE ACTIONS In terms of Chinese medicine, Turnera, as used in the West, can be said to have two main actions:
Classification The botanical family Turneraceae belongs to th~
order Violales and contains seven genera and 120 species of trees, shrubs, and herbs. The genus Turnera has 61 species, of which T. diffusa is the best known. f
1. tonify the Yang and Qi of the Kidney II. tonify the Yang and Qi of the Spleen and Large Intestine
771
Combining Western Herbs and Chinese Medicine
772
.".'-:?':';"'::-:::
Kidney In my opinion, Turnera can tonify various aspects of Kidney Yang and Qi: • mental tiredness associated with exhaustion of the nervous system • emotional lethargy and depression • exhaustion associated with adrenal insufficiency • low sex drive, impotence, and frigidity • edema, oliguria, dysuria, and prostatitis Spleen and Large Intestine In my opinion, Turnera can tonify two main aspects of the Yang and Qi of these systems: • atonic digestion, especially when linked to exhaustion • atonic constipation in the elderly
The primary current uses of Turnera in the We,st include"~'-=:cx general debility, nervous exhaustion. and sexual debility. Its ':,:::== secondary uses are to assist in the treatment of atonic digestion, atonic constipation, and atonic conditions of the urinary system.
DIRECTION OF .ENERGY As a Yang tonic, Turnera tends to raise the Qi and Yang, and as an antidepressant herb, it tends to move the Qi. The combination of these effects can result in an upward ,and slightly outward effect on the direction of energy.
TYPICAL CASE EXAMPLE I consider this herb a tonic more for the energetic (Yang) aspect of Qi than for the structive (Yin) aspect. Although it does contain compounds that may be regarded as sweet in property, such as starch (nutritive sweet tonic) and a small amount of sterols (adaptogenic sweet tonic), In my opinion, its main effects are due to the aromatic constituents, the essential oils, and perhaps the resins. The latter constituents give Tumera an upward and outward directional impetus to the movement of Qi.
WESTERN ACTIONS The main Western actions of Turnera diffusa are shown here in terms of its two main Chinese actions: Chinese actions I. tonify the Qi and Yang of the Kidney
II. tonify the Yang of the Spleen and Large Intestine
Western actions" general tonic antidepressant sexual tonic emmenagogue diuretic digestive tonic antidiabetic carminative mild tonic laxative
WESTERN USES The main Western uses of Turnera can be related to its two main Chinese actions:
Signs and symptoms The patient is physically debilitated, mentally exhausted, and depressed, and shows little sexual interest. He has a low appetite, slow digestion, mild constipa-...,..tion, dysuria, and an enlarged prostate. The pulses are slow,-:.:::',:,deep, and empty, especially at the third positions, where they are also somewhat slippery and weakly flooding. The tongue is large, flaccid, pale, and moist. Diagnosis The patient has Deficient Yang and Qi of the Kidney, Spleen, and Large Intestine. There is some accumulation of Damp in the Lower Burner, perhaps due to Stag.. nation of Qi arising from Deficiency. ·-. ...··-l' 'T,--
Choice of Turnera This herb can tonify Kidney Yang and Qi, and also tonify the Yang and Qi of the Spleen and Large ~: .. ;:"" Intestine. It may also be able to help in the drainage of Damp from the body.
Limitations ofTurnera TEMPERATURE In this book Turnera is classified as warm and can be used to treat a cool condition. For cold conditions, Turnera should be combined with more warming herbs, such as Capsicum and Zingiber.
TASTE Chinese actions I. tonify the Qi and Yang of the Kidney
II. tonify the Yang of the Spleen and Large Intestine
Western uses ' ' general debility, lethargy, nervous exhaustion, depression, sexual inadequacy, prostatitis atonic digestion, diabetes, nervous dyspepsia, atonic constipation
Turnera is classified as a bitter, aromatic, and acrid herb in this book. It has a bitter taste in the mout~, but if a bitter tonic for the Liver and Spleen were required, herbs such as Artemisia or Gentiana would be preferable. It is aromatic in . the sense that it has stimulant and antidepressant actions. However, if a strong carminative antispasmodic herb were required to treat intestinal colic, for example, a different herb
\
Turnera would be required, such as Rosmarinus. It is acrid in the sense of warming the Interior, but is mainly used for Cold conditions of Kidney and Spleen, rather than for Cold conditions of Lung, Liver, or Heart.
773
CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair. Tumera + Serenoa
ACTIONS General tonic I consider Turnera a tonic for the Yang aspect of Qi, rather than its Yin aspect. In my opinion, Turnera is not appropriate by itself to treat mixed conditions with Deficiency of both Yin and Yang. However, it can be effective in such cases if it is combined with the sweet Kidney Yin and Qi tonic Serenoa. Antidepressant Due to its aromatic constituents, Turnera may have some effect on depression associated with Stagnation of Qi. However, I would mainly use this herb for depression associated with Deficiency of Kidney Yang and Qi. Sexual tonic Large doses of Turnera over a period of several months may be required for significant improvement in cases of sexual debility, and this risks aggravating conditions of Liver Hyperactive Yang or Heart Spirit Disturbance with underlying Deficient Yin. If Turnera is to be used in such cases, it may need to be combined with other herbs that also tonify Y'ID, such as Serenoa, or calm Liver Hyperactive Yang and Heart Spirit, such as Lavandula or Passiflora. Urogenital tonic Whilst I would not rely on Turnera as a primary diuretic, urinary anti-inflammatory, or prostate anti-inflammatory, I consider it to be a useful secondary herb to treat oliguria, dysuria, or prostatitis when these disorders are associated with Deficiency of the Yang and Qi of the Kidney and Spleen. Carminative and laxative I do not consider Turnera to be a herb of choice for poor appetite, slow digestion, abdominal distension, or atonic constipation. However, when these disorders are associated with Deficiency of the Yang and Qi of the Kidney and Spleen, then Turnera can be a useful secondaryherb.
Turnera paired with other herbs Discussion of the limitations of each of the main actions of Turnera can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Turnera beyond its limitations. The basic unit of herb combination is the herb pair. Six pairings of Turnera are briefly explained below.
Exhaustion + prostatitis Both these herbs can tonify Kidney Qi. Turnera can tonify especially the energetic or Yang aspect of Qi, whilst Serenoa can tonify especially the structive or Y'ID aspect of Qi. Together the two herbs make a balanced pair that can be used to treat Kidney Deficiency with exhaustion, depression, or prostatitis. Tumera + Avena
Exhaustion + depression Like Serenoa, Avena can tonify Kidney Qi and Y'ID, but in addition it can help to calm Heart Spirit Disturbance. Turnera by itself can possibly aggravate Heart Spirit Disturbance. Its combination with Avena enables Turnera to be used in cases of nervous exhaustion and depression accompanied by some Heart instability. Tumera + Panax ginseng
Exhaustiol1 + depression Turnera is primarily an aromatic tonic and antidepressant, and Panax is primarily a sweet adaptogenic tonic. Both herbs have bitter constituents that may act as Heart tonics. This pair is specific for exhaustion and depression due to Deficient Kidney Yang and Qi, but both herbs have the potential to aggravate disturbed upward movement of Qi. They should therefore be avoided in cases of Heart or Liver disturbance with Yin Deficiency. Tumera + Cinnamomum bark
Exhaustion + sensations ofcold Both herbs can tonify Kidney Yang, but Turnera is primarily an aromatic antidepressant, whilst Cirmamomum is primarily an acrid warming herb. Together they can tonify, warm, and move Qi and Yang to treat exhaustion and depression with atonic digestion and sensations of cold in the body. Tumera + Rosmarinus
Exhaustion + digestive weakness Turnera can tonify Kidney and Spleen Yang, and Rosmarinus can tonify Spleen Yang and move Stagnant Qi of the Spleen, Liver, and Heart. The two herbs can be combined in cases of Kidney Deficient Yang combined with:
Combining Western Herbs and Chinese Medicine
774
• Spleen Deficient Yang with slow digestion and exhaustion • Liver Stagnant Qi with depression and lack of sexual drive • Heart Stagnant Qi with depression and lack of interest in relationships Turnera + Juniperus
Both Turnera and Juniperus can tonify Kidney and Spleen Qi and Yang. Juniperus is specific for edema, whilst Turnera is specific for exhaustion with depression or sexual debility. The two herbs can be combined for exhaustion with mental dullness and loss of appetite, or edema.
Turnera combinations Six Turnera combinations are discussed below: Combination
Chinese syndromes
1. sexual debility + cold sensations
Kidney Deficient Yang
2. cardiac weakness + depression
Heart Deficient Yang + Kidney Deficient Yang .
depression + cold extremities
Kidney Deficient Yang + Heart Deficient Qi
4. exhaustion + sexual debility
Kidney Deficient Yang + Kidney Deficient Yin
5. depression + sexual debility
Kidney Deficient Qi + Liver Stagnant Qi
6. prostatic enlargement +
sexual debility
Bladder Phlegm Cold + Kidney Deficient Qi
CAUTION
Before using any of the combinations below, it is important to be familiar with the cautions listed for each herb in the combination. 1. Sexual debility + cold sensations
Turnera Serenoa Schisandra Panax gin. Cinnamomum (bark) Zingiber GIycyrrhiza
• sexual debility and lack of sexual drive or interest, exhaustion, and depression PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of hot water, three times per day. The dose may initially need to be increased to 7.5 mI, or even 10 mI, three times per day, in order to be effective.
Caution This combination can be taken for a long peri().d.!._ . _ . but it is essential to have the correct diagnosis. Since the c6m~ bination contains Yang tonics such as Turnera, Panax ginseng, and Cinnamomum bark, it may be inappropriate for patients with Deficient Ym, Heart Spirit Disturbance, or Liver Hyperactive Yang. Even if the patient does not initially have these syndromes, they must be monitored for signs of heat, restlessness, insomnia, cardiac irregularity, or hypertension. If these signs become appreciable, the combination must be stopped and then modified or replaced by a different combination; . 2. Cardiac weakness + depression
Heart Deficient Yang + Kidney Deficient Yang Ratio Temperature Taste
Herb
Crataegus 1 1 Convallaria Panax gin. 1 1 Turnera Cinnamomum (bark) 1 0.5 Glycyrrhiza 5-20 drops Capsicum
sl. warm neutral sl.warm warm hot neutral-cool hot
••.•
~ •••
·ii·.l.
sour, sweet bitter, 51. sweet sweet, 51. bitter bitter, aromatic, acrid acrid, sweet, aromatic sweet acrid
This combination is the same as Crataegus; cardiac weakness + depression and is discussed under that heading.
Kidney Deficient Yang Herb
This combination is for Kidney Deficient Yang with Kidney Deficient Qi. The overall temperature is warm to treat cool or cold conditions. Sweet, sour, bitter, acrid, and aromatic constituents may each contribute different tonic effects to the overall tonic action on the Kidney. USE
Exhaustion + edema
3.
GENERAL
Ratio Temperature Taste 1 1 1 1 1 1 0.5
warm neutral warm sl. warm hot hot neutral-cool
bitter, aromatic, acrid sweet, sl. sour sour sweet, sl. bitter acrid, sweet, aromatic acrid, aromatic sweet
3. Depression + cold extremities
Kidney Deficient Yang + Heart Deficient Qi Herb Turnera Serenoa
Ratio
Temperature
Taste
1 1
warm neutral
bitter, aromatic. acrid sweet, sl. sour
Turnerti ,. Ratio' Temperature Taste" ....
Herb
775
outward to the surface. The sweet components tonify Ym and some of the bitter components can clear Deficiency
Panax gin. 1 __ Rosmarinus 1 Angelica arc. 1 Zanthoxylum (bark) 1 Capsicum 5-20 drops
sl. warm warm warm hot hot
sweet. sl. bitter aromatic. bitter. acrid bitter. acrid. aromatic acrid. aromatic. bitter acrid
GENERAL
Heat. Yang is tonified by some of the sweet components working together with the acrid and aromatic constituents. Some of the bitter components may have a tonic effect as well. USE
This combination is for Heart Deficient Yang with Kidney Deficient Yang and Heart Stagnant Qi. The overall tempera-
• exhaustion and sexual debility with a mixture of signs of heat and cold, and a mixture of restlessness and lethargy
ture is warm to treat cool or cold conditions. The sweet com! .'
ponents tonify the Kidney, some of the bitter components tomfy the Heart, and the aromatic and acrid components warm and move Heart and Kidney Qi and Yang. USE
• depression with exhaustion, maybe cold body and
PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of water, three times per day. This is a balanced combination that can be taken for a long period, providing the cautions on the use of Panax ginseng are observed.
extremities, and lower back pain or frequent urination
5. Depression + sexual debility
PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of hot water, three times per day. Capsicum r· ....
---
can be given in a separate bottle, which allows the patient to vary the number of drops as required, reducing the number of drops if there are any signs of digestive upset related to the Capsicum.
Caution This combination can be taken for a long period, providing that appropriate cautions and monitoring proceh,..-
Kidney Deficient Qi + Liver Stagnant Qi Herb Turnera Serenoa Panax gin. Rosmarinus Artemisia vul. Mentha pip. Zingiber
Ratio
Temperature
Taste
1 1 1 1 1
warm neutral sl. warm warm warm-cool warm-cool hot
bitter. aromatic, acrid sweet. sl. sour sweet. sl. bitter aromatic, bitter. acrid aromatic, 51. bitter acrid. aromatic acrid. aromatic
0.5 0.5
dures are observed as for combination ~o. 1 above. GENERAL
4. Exhaustion + sexual debility
This combination is for Kidney Deficient Qi and Yang
Kidney Deficient Yang + Kidney Deficient Yin Herb
Ratio
Temperature
Taste
1 1 1 1 1
warm neutral sl. warm cool neutral neutral-cool hot
bitter. aromatic. acrid sweet. 51. sour sweet. sl. bitter sweet. sl. bitter sweet sweet acrid. aromatic
with Liver Stagnant Qi. The overall temperature is warm, to treat cool conditions. This combination could be used to treat cold conditions if Capsicum is added. The sweet components strengthen the Kidney, and the aromatic, acrid, and
Turnera Serenoa Panax gin. Ophiopogon Avena Glycyrrhiza Zingiber
0.5 0.5
GENERAL
bitter constituents can warm, move, and tonify the Liver. USE
• depression and sexual debility, maybe with lethargy, impaired digestion, abdominal distension, or menstrual disorders PRACTICAL NOTES
This combination is for Kidney Deficient Yang with
This combination can be taken as 5 ml of 1:5 tincture in
Kidney Deficient Ym. The overall temperature is more or less
quarter of a cup of hot water, three times per day. This is a balanced combination that can be taken over a long period,
neutral, although the combination contains some warm herbs that tonify Yang and some cool herbs that tonify Ym. Zingiber is included to disperse Interior Deficiency Heat
providing the cautions on the use of Panax ginseng are observed.
:;;;:::--
Combining Western Herbs and Chinese Medicine
776
6. Prostatic enlargement + sexual debility
Bladder Phlegm Cold + Kidney Deficient Qi ··Ratio .. Tempe.r:ature
Herb
warm-cool
Thuja 1 Zanthoxylum (bark) 1 Phytolacca Hydrangea Serenoa Tumera Panax gin. Zingiber
1 1 1 1 1 1
Kidney DefiCient Yang + Kidney Deficient Yin
cool
acrid
Turnera
1
Turnera
neutral neutral
bitter, sour
serenoa
1
sweet, sl. sour bitter, aromatic, acrid
Panax gin. Rosmarinus
1 1
Serenoa Panax gin.
sweet, sl. bitter
Angelica arc. 1 Zanthoxylum (bark) 1 Capsicum 5-20 drops
sl. warm hot
acrid, aromatic
TURNERA COMBINATIONS
1. Sexual debility + cold sensations
2. Cardiac weakness + depression
Kidney Deficient Yang
Heart Deficient Yang + Kidney Deficient Yang 'A~;b":"'~~~c'~~~\;" .
Crataegus
Zingiber
1 1 1 1 1 1
Glycyrrhiza
0.5
Capsicum
~...
... , ..._.. ..
_._-~:.-~~
.
-_.--,-.
Herb·
COMPARISON OF THE SIX
Schisandra Panax gin. Cinnamomum (bark)
Kidney Deficient Yang + Heart Deficient Qi
acrid, aromatic, bitter acrid, aromatic, bitter
This combination is the same as Thuja: prostatic enlargement + sexual debility and is discussed under that heading.
Turnera Serenoa
4. Exhaustion + sexual debility
hot
warm
_-----
3. Depression + cold extremities
Ophiopogon Avena Glycyrrhiza Zingiber
1 1 1 1 1
0.5 0.5
3. Turnera, Serenoa, and Panax are inciuded in this combination and in combination No. 1 to treat sexual debility, exhaustion, and depression. However, the presence of . Rosmarinus, Angelica archangelica, Zanthoxylum bark, and Capsicum enables combination No. 3 to move Heart Stagnant Qi and treat poor peripheral circulation. 4. Similarly, Turnera, Serenoa, and Panax are included in combination No.4 to tonify Kidney Qi and Yang to treat exhaustion and sexual debility. However, this combination is made distinct by the inclusion of herbs that, in combination, can tonify Kidney Ym: Ophiopogon, Avena, and Glycyrrhiza.
. ~R~ti6'~"i;~1 ~.;~...
Convallaria Panax gin. Turnera Cinnamomum (bark)
1 1 1 1 1
Glycyrrhiza
0.5
,';
5-20 drops
1. Even though this combination is for Deficient Yang,
herbs that tonify Qi and Yin, Serenoa and Glycyrrhiza, have been included to form a structural basis for the increase in Yang. The sour herb Schisandra has been added to firm Kidney Qi, again to assist in integrating the increased Yang into the system, rather than have it rapidly disperse or cause a disturbance. Turnera and Panax, within the context of the other herbs, Can help to treat depression and sexual weakness. 2. Whilst Turnera, Serenoa, and Panax enable the previous combination to be used for sexual problems, the pairing of Crataegus and Convallaria make this combination specific for heart disorders. Panax, Turnera, Cinnamomum, and Capsicum combine to tonify Heart and Kidney Yang to treat exhaustion and depression.
5. Depression + sexual debility
6. Prostatic enlargement + sexual debility . - -"" .-..:""-
Kidney Deficient Qi + Liver Stagnant Qi
Bladder Phlegm Cold + Kidney Deficient Qi
Herb Turnera Serenoa Panax gin. Rosmarinus Artemesia vul. Mentha pip. Zingiber
~.
Ratio 1 1 1 1 1
0.5 0.5
~f,·-r;~-\.,···
Herb Thuja Zanthoxylum (bark) Phytolacca Hydrangea Serenoa Turnera Panax gin. Zingiber
1 1 1 1 1 1 1 1
5. Once again, Turnera, Serenoa, and Panax are included to treat sexual debility, exhaustion, and depression associated with Kidney Deficiency. What makes combination No.5 distinct is the inclusion of Rosmarinus, Artemisia, Mentha, and Zingiber to treat depression and sexual disinterest due to Liver Stagnant Qi. 6. In combination No.6, Turnera, Serenoa, and Panax tonify Kidney Qi, and Serenoa, Hydrangea, and Phytolacca treat prostate disorders. Thuja and Zanthoxylum together can warm and move Qi, and clear Phlegm and Damp in the
.... I"~
Turnera __Lower Burner to treat obstruction of the channels of the prostate.
_OTHER TURNERA COMBINATIONS Turnera also has an important role in the following combinations:
• Angelica: depression + obesity • Cinnamomum: amenorrhea + cold sensations • Juniperus: mental dullness
Research CONSTITUENTS The following constituents have been reported: • essential oil • arbutin • other Essential oil This fraction constitutes about 0.5%, and 9 contains more than 20 components, including:
Sesquiterpenes ;:..l
Monoterpenoids
....
'-
777 • sexual tonic • anti-inflammatory and antiulcer • antihyperglycemic
Sexual tonic A recent study reported that when rats were treated with 0.25-1 mlIkg of fluid extract of T. diffusa there was no effect on the behavior of sexually potent rats. However, the copulatory performance of sexually sluggish rats was ~proved without affecting locomotor activity.14 Extrapolating from these results, a comparable effect in humans would necessitate the administration of 15-60 ml of fluid extract per day in a 60 kg human. Anti-inflammatory and antiulcer Extracts of T. ulrnifolia inhibited carageenin-induced edema in rodents, and inhibited gastric lesions induced by indomethacin and ethanol. Interestingly, the extracts increased the wall mucus as well. ls Antihyperglycemic Intragastric administration of T. diffusa had antihyperglycemic effects in temporarily hyperglycemic rabbits. Turnera significantly decreased the hyperglycemic peak and/or the area under the glucose tolerance curve. 16
• o-cadinene • a-copaene • calamenene
10% 3% 3%
RESEARCH VERIFICATION OF
• thymol • a-pinene • ~-pinene
4% 2% 1%
The following traditional actions have been supported by research:
Tisserand and Balacs 10 listed 1,8-cineole (25%) and terpinen-4-ol (25%), but 1,8-cineole was not reported in other studies. 11,9 Arbutin This is a phenolic glycoside which is hydrolyzed by the intestinal flora to produce the aglycone hydroquinone. Arbutin has been reported as up to 0.7% in Turnera,12 as compared to 6-12% in Arctostaphylos (see chapter on Arctostaphylos for discussion of arbutin). Other These include:
• resins • gums • starch • tannins
14% 13.5% 6% 3.5%
In addition, the cyanogenic glycoside, tetraphyllin B (0.26%)13 and small amounts of ~-sitosterol have been re· ported. II
PHARMACOLOGICAL AND CLINICAL RESEARCH The following effects have been reported:
TRADITIONAL ACTIONS
• sexual tonic • antidiabetic • anti-inflammatory (although not specifically urogenital anti-inflammatory) Additional effects demonstrated by research Turnera extracts have been reported to have antiulcer effects.
TOXICOLOGY I have not found data on the toxicology of this herb. According to Tisserand and Balacs, the essential oil of the leaves of T. diffusa is unlikely to present any hazard in aromatherapy. They also wrote that cadinene is nontoxic, nonirritating, and nonsensitizing. In addition, the Botanical Safety Handbook17 classified T. diffusa as'Class 1: a herb that can be safely consumed when used appropriately. The German Commission E monograph 'S stated that, while no risks are known from the use of this herb, 'since the effectiveness ... is not documented, a therapeutic administration cannot be recommended: However, there is now research data to support the effectiveness of this herb (see
Research).
Combining Western Herbs and Chinese Medicine
778
Dose Dried herb The BHP '9 listed 2-4 g of the dried herb, three times per day. Tmcture The BHC20 listed 3-6 ml of 1:1 liquid extract in 60% alcohol, three times per day. 1 generally prescribe about 1 ml of 1:5 Turnera tincture in 60% alcohol, three times per day. However, I do not generally prescribe Turnera as a single herb but as part of a combination of 5-8 herbs. Initial dose D'.lfation
Can start at the standard dose. Can be taken for a long period.
Cautions
Turnera (damiana) is on the UK General Sale List, and is _._-: not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Turnera is not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
Traditional sources The recorded use of this herb seems to have begun with the early Eclectics and to have been transferred from them to Britain and Europe. PROPERTIES Temperature In this book, Turnera is classified as warm, associated with its tonic and stimulant properties. Taste
Western contraindications According to the BHC, no contraindications are known for this herb, but it might be prudent to adopt caution with its use in cases of irritable bowel syndrome associateq with hyperactivity and nervous tension. Chinese contraindications T. diffusa is not listed in the Chinese Herbal Medicine Dictionary. However, since I regard this herb as a Yang tonic, I would avoid its use in the following patterns unless it was suitably combined with other herbs:
Taste in the mouth According to the BHP both the odor and taste of Turnera are aromatic, but I found a 1:5 tincture in 60% alcohol to be not only aromatic, but also acrid and strongly bitter.
Taste properties Turnera is classified in this book as aromatic and acrid, associated with its stimulant and antidepressant action on the Kidney, Spleen, and Large Intestine. The bitter property may have both a cardiotonic and digestive tonic action. ORGANS
• Deficient Tm • Liver Hyperactive Yang • Heart Spirit Disturbance
In terms of Chinese medicine, Turnera, as used in the West, can be associated mainly with disorders of the followingorgans:
Pregnancy and lactatio~ No adverse reports. Side effects
None reported.
Overdose Most texts have not listed overdose effects for this herb. One text stated that too much Turnera can cause insomnia and headache, but did not cite references; this conclusion may be based on extrapolations from Chinese medicine theory.21 However, if Turnera is classified as a Yang tonic, it would be prudent to avoid overdose, especially in cases of mixed Deficiency ofYin and Yang. Interactions
Organ
. Examples of use
Kidney
sexual debility renal and cystic catarrh
Lyle Ellingwood
Spleen
impaired digestion nervous dyspepsia
Lyle
Large Intestine
constipation
BHP
BHP
Turnera is not listed in the Chinese Herbal Medicine
Dictionary.
None reported. ACTIONS The following traditional actions have been discussed:
Regulatory status Please read the Regulatory status section in the chapter on Safety.
• general tonic • antidepressant • sexual tonic • emmenagogue
r
Turnera - • urogenital anti-inflammatory • diuretic • carminative and mild la..xative • antidiabetic • expectorant _"--:;eneral tonic According to Lyle, the Mexicans used Turnera as a general tonic to increase endurance and to prei~., vent disease. He wrote that Turnera strengthens digestion : - _and the nervous system, and can be used to treat impaired digestion, general debility, and nervous prostration. Priest and Priese 2 followed Lyle in classifying Turnera as a'stimu_ lating tonic nervine and spinal trophorestorative' with especial influence on the reproductive system. The use of Turnera for debility, depression, and lethargy ~ is noted in Mabey. According to Mills, Turnera 'may be recommended for any debilitated condition of the central nervous system (from depression to neuralgias and problems such as herpes-it has a particular use in containing g~nital herpes).' 23 Mills and Bone listed the use of Turnera for nervousness with hormonal symptoms. 24
lO::
Antidepressant British texts, such as the BHP, the BHC, Mabey, and Mills and Bone, listed Turnera for depression. The BHP also listed it for anxiety neurosis with a predominantly sexual factor. Sexual tonic Lyle noted the use of this herb for sexual debility and impotence, and Ellingwood reported its use for sexual neurasthenia, impotence, and frigidity. Priest and Priest noted the use of Turnera for frigidity, impotence, senile decline, abnormal menstruation at puberty, and anxiety neurosis. The BHP listed Turnera for 'coital inadequacy: and Tierra25 recommended this herb for frigidity in women and impotence in men. Emmenagogue Ellingwood noted the use of Turnera for delayed or suppressed menstruation in young girls, irregularity at the beginning of menstruation, dysmenorrhea, headache at menstruation, and skin disorders related to insufficient menstruation. Urogenital anti-inflammatory Lyle noted the use of this herb for enuresis, cystic catarrh, arid prostate problems. Ellingwood wrote that Turnera could soothe irritation of the mucous membranes of the urinary passages to treat renal and cystic catarrh. This tradition of use has been continued by Tierra.
779
ed Turnera for atonic constipation and as a stomachic for nervous dyspepsia. Antidiabetic Lyle noted the use of this herb for diabetes, and it is interesting that a research study has 'recently reported an antidiabetic effect. Expectorant Ellingwood wrote that Turnera can soothe irritation of the mucous membranes and treat respiratory disorders, especially those with profuse secretion. Grieve reported the use of T. ulmifolia as an expectorant by the natives of Brazil, and Tierra recommended Turnera for treating irritable coughs.
References 1. Lyle TJ. Physio-Medical Therapeutics, Materia Medica and Pharmacy.
Originally published Ohio (1897). Reprinted by the National Association of Medical Herbalists of Great Britain, London, United Kingdom (1932) 2. Ellingwood F. American Materia Medica, Therapeutics and Pharmacognosy, 11th edn. (1919). Reprinted by Eclectic Medical Publications, Sandy. Oregon (1994) 3. Crellin JK. Philpott J. A Reference Guide to Medicinal Plants. Duke University Press. Durham. North Carolina (1990) 4. Evans we. Trease and Evans' Pharmacognosy, 14th edn. WB Saunders, London. United Kingdom (1996) 5. Grieve M. A Modern Herbal, volland 2. Dover Publications, New York, New York (1971) 6. Jiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science and Technology Press, Shanghai. China (1975) 7. Chang H-M, But PP·H (eds). Pharmacology and Applications of Chinese Materia Medica, vols. 1 and 2. World'Scientific Publishing, Singapore (1986) 8. Perry L'vt. Medicinal Plants of East and Southeast Asia. The MIT Press, Cambridge, United Kingdom (1980) 9. AuterhoffH and Momberger H.Arch Pharmaz 305:455-462 (1972) 10. Tisserand R, Balacs T. Essential Oil Safety A Guide for Health Care Professionals. Churchill Livingstone, Edinburgh, United Kingdom (1995) 11. Dominguez XA and Hinojosa M. Planta Medica 30:68-71 (1976) 12. Auterhoff Hand Haufel HP. Arch Pharmaz 301:537-544 (1968) 13. Spencer KC and Seigler DS. Planta Medica 43:175-178 (1981) 14. Arletti R, Benelli A. Cavazzuti E et al. Psychopharmacology (Berl) 143(1):15-19 (1999) 15. Antonio MA, Souza Brito AR. J EthnopharmacoI6H3):215-228 (1998)
Diuretic Both Grieve and Tierra have listed Turnera as a diuretic.
16. Alarcon-Aguilara Fl. Roman-Ramos R, Perez-Gutierrez S et al. EthnopharmacoI61(2):101-110 (1998)
Carminative and mild laxative Lyle and Ellingwood noted the use of Turnera for constipation, and the BHP list-
17. McGuffin M. Hobbs C, Upton R et al. American Herbal Products Association's Botanical Safety Handbook. CRC Press. Boca Raton. Florida (1997)
J
Combining Western Herbs and Chinese Medicine
780
18. Blumenthal M (ed). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council,Austin, Texas (1998) 19. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom ( 1983) 20. Bradley PR (ed). British Herbal Compendium, vol. 1. British Herbal Medicine Association, Bournemouth, United Kingdom (1992) 21. Mabey R (ed). The Complete New Herbal. Elm Tree Books, London, United Kingdom (1988)
22. Priest AW, Priest LR. Herbal Medication. LN. Fowler, Romford Essex; .~._.:United Kingdom (1982) .23. Mills S. The Essential Book of Herbal Medicine. Arkana/Penguin, London, United Kingdom (1991) 24. Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone, Edinburgh, United Kingdom (2000) 25. Tierra M. Planetary Herbology. Lotus Press, Twin Lakes, WISCOnsin (1988)
,..
10"' .....
~--
-
Valeriana
ft·
...
Botanical name Valeriana officinalis L. s.l. Family Valerianaceae Pharmaceutical name Valerianae radix Part dried underground parts English valerian German Baldrian . French valeriane Mandarin xie cao (#l J!-) .is the root of V. officinalis L. s.l. Use in the West Valeriana officinalis is a large perennial herb native to Europe and parts of Asia, and naturalized in Northeastern America. 1 In Europe it is common in: damp woods, ditches, and by the sides of streams;2 and according to Grieve,3 it grows best in rich, heavy, moist loam. Grieve wrote that the name' Valeriana' was not used until the 9th or 1ath century, and may then have been used to refer to the same herb that Dioscorides4 described as 'phu: Gerards and Tabernaemontanus6 described a number of species of Valeriana. However, none were specifically listed as V. officinalis, and it is by no means certain that the early European writers were in fact describing this specific plant. The Western use of v. officinalis can be said to have had three phases, each emphasizing different aspects of this herb:
though the herbs they described may not have been V. officinalis. Lonicerus, Tabernaemontanus, Culpeper, and Gerard noted the use of valerian for painful disorders such as headache or back pain, and Gerard listed its use for convulsions. However, they did not mention the use of valerian as a calming herb to treat insomnia or illnesses due to nervous tension. Indeed, as pointed out by Crellin and Philpott,9 specific references to the use of Valeriana for the treatment of nervous disorders were not consistent until the 19th century.
The Eclectic tradition The Eclectics described the use of a herb they called V. officinalis that had been introduced to America from Europe. Their primary use of this plant was as a calming, relaxing, antispasmodic, and anticonvulsive for nervousness in children, nervous headache, insomnia, hysteria, colic, cramps, and epilepsy. However, they also described it as a stimulating, tonifying nervine and mentioned a secondary use as a cerebral stimulant for mental depr~ssion.
Modern European use In Europe, both recent traditional use and data from research emphasize the calming and antispasmodic effects of Valeriana, and most texts do not mention the stimulant action or the treatment of depression. Indeed, I would avoid the use ofValeriaria in cases of depression unless it was combined with other herbs.
• early European use • use by the Eclectics • modem European use
Early European use
Seemingly conflicting actions V. officinalis has been variously described as either cooling and calming or as warming and stimulating.
Dioscorides, Lonicerus/ Tabernaemontanus, Culpeper,s and Gerard described valerian as a warming herb to promote urination or menstruation, al-
781
782
Combining Western Herbs and Chinese Medicine
American tradition According to Ellingwood,'o Valeriana is best for cases of nervous debility with pale face, cool skin, and general weakness. He wrote that Valeriana is not the remedy 'in conditions where the nervousness is induced by hyperactivity.' This tradition of use is continued by Michael Tierra, I I who stated that Valeriana is best for individuals who have a cold, nervous condition. He wrote that it can have the opposite effect (that is, it can induce a state of agitation) 'on individuals who have a heated condition, since it is heating as well as sedative.' Reports of individuals who find Valeriana stimulating rather than calming seem more prevalent in the United States than in Britain.
What is special aboutValericinaIn terms of Chinese medicine, V. officinalis, as used in the West, can be said to be a cool, bitter, and sweet herb that has its main effects on the Heart, Liver, Stomach, and Intestines.
The key to understanding Valeriana is that it is a calming, antispasmodic herb that can relieve the physical, emotional and mental effects of nervous tension. In Chinese terms, it can calm both Heart and Liver, and it can clear Heat associated with restless disturbance of these organ systems.
Modern European tradition Modern European texts, referring to the use of V. officinalis from plants grown in Europe,
CHINESE ACTIONS
do not caution against the use of this herb for conditions that would be described in Chinese terms as patterns of Heat or Excess. I use Valeriana grown in Europe (rather than Valeriana grown in North America), and I use it for patterns of Heat, including those of Excess. I do not use this herb for conditions of Deficiency and Cold unless it is combined with warming and stimulant herbs. The seeming conflict between European and North American traditions of use for Valeriana may be partly explained in terms of genetic variability within the species.
In terms of Chinese medicine, Valeriana, as used in the West, can be said to have four main actions:
Subspecies variation The term 'Valeriana officinalis' is a collective term that refers to a very variable group of subspecies and varieties. Valeriana exhibits polyploidy, with variation in chromosome number between the different Valeriana subspecies. The basic type is diploid,1 but tetraploids and octoploids also exist. Phytochemical differences have been reported between the different chromosomal types. 12. 13 It may be that these differences in constituents are sufficient to account for the perceived differences in clinical effects between V. officinalis grown in the United States and V. officinalis grown in Europe.. Use in China The Chinese Herbal Medicine Dictionaryl4 has an entry for xie cao, the root and root bark of V. officinalis L. Although it is not a commonly used herb, it appears that xie cao does have a tradition of use in China. However, since the entry has three times as much data on constituents, pharmacology, and clinical research than on traditional Chinese data, it may be that there is a strong Western influence on the data given on actions and uses. In addition to the use of V. officinalis as xie cao, other species of Valeriana are used, under different Chinese names, in the different provinces of China. For example, V. jatamansii Jones is used as zhI zhil xiang.
I. calm Heart Spirit DiSturbance and clear Heart Heat II. calm Liver Hyperactive Yang and Liver Wind, and clear Liver Heat III. clear Stomach Heat IV. calm Intestines Disturbance of Qi Perceptions of the main actions of Valeriana may differ between American and European practitioners, with respect to the treatment of: • Excess or Deficiency • Heat or Cold This subject is discussed further in the Limitations section later in this chapter. WESTERN ACTIONS The main Western actions ofValeriana are shown here in terms of its four main Chinese actions: Chinese actions
Western actions
I. calm Heart Spirit Disturbance and clear Heart Heat
tranquilizer hypnotic antihypertensive
II. calm Liver Hyperactive Yang and Liver Wind, and clear Liver Heat
tranquilizer antispasmodic anticonvulsive
III. clear Stomach Heat
tranquilizer antispasmodic anti-inflammatory antiulcer
IV. calm Intestines Disturbance of Qi
tranquilizer antispasmodic
Valeriana "..::.:..:
"'"
WESTERN USES The Western uses of Valeriana can be related to its four main Chinese actions: Chinese actions I. calm Heart Spirit Disturbance and clear Heart Heat
~
.... fiIIW:
tines. In addition, by regulating the Liver, it can clear Liver Heat and relieve restlessness and irritability.
Limitations ofValeriana
Western uses restlessness with sensations of heat. menopausal hot flashes. insomnia, overexcitement, hyperactivity, anxiety, panic attacks
II. calm Liver Hyperactive Yang and Liver Wind. and clear Liver Heat
nervous tension, headache. migraine. dizziness, hypertension, muscle cramps and spasms, convulsions. epilepsy
III. clear Stomach Heat
nervous tension with gastritis or peptic ulcer
IV. calm Intestines Disturbance of Qi
nervous tension with intestinal colic or irritable bowel syndrome ulcer
'-
DIRECTION OF ENERGY Valeriana can reduce disturbed upward movement of Qi from Disturbance of Heart Spirit, Liver Hyperactive Yang, Liver Wmd, or Heat associated with the Heart or Liver. Also, its general relaxing action can indire~tly relieve Stagnation of Qi and Blood caused by muscle contractions due to nervous tension. The ability of Valeriana to control disturbed upward movement of Heart or Liver energy may be partly linked to a heavy sweet property that can both sink and stabilize the Qi.
TYPICAL CASE EXAMPLE Signs and symptoms The patient has recurring headache, stiffness and muscle spasms in the neck associated with nervous tension, and recurring intestinal pain that is worse with stress. The patient is also tense and irritable with elevated blood pressure and occasional dizziness. The pulse is wiry and slightly rapid, and the tongue is reddish purple with red spots at the edges.
783
TEMPERATURE In this book, the Valeriana officinalis grown in Europe is classified as cool and can be used for neutral to hot conditions. It can be used for Excess or Deficiency Heat of the Heart or Liver when they are associated with Heart Spirit Disturbance or Liver Hyperactive Yang, respectively. In other words, it can be used for conditions with sensations of heat and restlessness when these derive from nervous tension. In cases when the Heat derives from a cause other than nervous stress, for example, respiratory infection and inflammation, another herb may be more suitable. Some American practitioners, for example, Tierra, regard V. officinalis as warm and use it with caution for patients with heat patterns. However, the herb used by these practitioners is generally grown in the United States.
TASTE In this book, the bitter taste of Valeriana is associated mainly with its capacity to calm the Heart or Liver and clear Heat, but it is not considered to have a bitter digestive tonic action. The sweet property of Valeriana may be associated with a heaviness of nature that assists in the sinking and stabilization of disturbed and rising energy of Heart or Liver, but it is not regarded in this book as having a sweet tonic effect.
ACTIONS
Diagnosis The p:ltient has Liver Hyperactive Yang with some Liver Heat. The irregularity and constraint on the Liver Qi is obstructing the Gallbladder channel in the neck region and invading the Intestines.
Antispasmodic and analgesic I consider at least a part of the antispasmodic and analgesic actions of Valeriana to be indirect and a result of its calming effect on nervous tension. This is in contrast to Lobelia, which I consider as primarily an antispasmodic and secondarily a calming herb. Therefore, I would use V. officinalis more for spasms and pain linked to nervous tension, but I would use Lobelia for spasms or pain that was not necessarily associated with psychological stress.
Choice of Valeriana This herb is specific for calming Liver Yang and relieving its manifestations of dizziness and headache. By calming Liver Yang, it can also relieve the effect of irregularity and constraint of the Liver Qi on the skeletal muscle of the neck and on the smooth muscle of the lntes-
Tranquilizer and hypnotic In both the American and the modern European traditions of use, V. officinalis is mainly employed for the physical and emotional manifestations of nervous tension. The Eclectic tradition links V. officinalis grown in the United States especially to nervous tension
Combining Western Herbs and Chinese Medicine
784
conditions associated with weakness and sensations of cold. I use V. officinalis grown in Europe for conditions ranging from Excess to Deficiency and from Heat to Cold. However, I use it especially for conditions of ExceSS, Heat, or Excess and Heat together when they are associated with nervous tension.
I do not use it for the following patterns unless it is combined with warming, stimulant, or moving herbs: • patterns of Cold and Deficiency • depression, unless accompanied by restlessness and! or signs of Heat • Liver Hyperactive Yang linked to Stagnation of Liver Qi rather than to Heart Spirit Disturbance Antihypertensive Valeriana can be appropriate for hypertension linked to Heart Spirit Disturbance or Liver Hyperactive Yang, with or without simultaneous patterns of Heat in these organs. However, it is not known to have the ability to clear Phlegm from the blood vessels and prevent atherosclerosis, and herbs such as Crataegus or Commiphora would be more appropriate for this purpose. Anticonvulsive Valeriana has a long tradition of use for spasms, tremors, convulsions, and fits, and can be appropriate for these if they are linked primarily to Liver Hyperactive Yang and Liver Wind. However, if these conditions are linked primarily to Deficient Blood, Valeriana would be inadequate as a single herb and would need to be combined with Blood tonics. Antiulcer Valeriana can be very effective for peptic ulcer, providing this disorder is linked to nervous tension. I use it especially for gastritis or ulcers linked to Stomach Heat.
-
u
..
,~
.::,.~~;r~-
~g.;.:~-::i:t~r---
----- -~-'y~-:~~i~ --
Valeriana is primarily calming and secondarily antispU.:_~ modic and analgesic. Piscidia is a sedative and analg~ic that -,,=,-= is specific for trigeminal neuralgia. Valeriana + Anemone
Menopausal hotflashes Valeriana and Anemone can treat menopausal hot flashes associated with restless anxiety and the pattern of Heart Heat. Anemone is specific for Heat associated with imbalance of Heart and Kidney, whilst Valeriana is more appropriate for Heat associated with imbalance of Heart and Liver. Valeriana + Humulus
Colitis + nervous tension Both herbs can have calming and antispasmodic actionS. In addition, Humulus can have strong antimicrobial and bitter digestive tonic effects. Valeriana + Lavandula
Insomnia 1- headache The calming effects of sweet heavy Valeriana and~~= matic Lavandula combine to calm Heart Spirit Disturbance and treat insomnia and anxiety. They can also ~.E~~ Hyperactive Yang and treat headache. ~',:.';--:"'.i:i'::-, Valeriana + Rosmarinus
Anxiety + depression Both Rosmarinus and Valeriana can calm Liver Hyperactive Yang and treat headache and migraine. Valeriana can calm Heart Spirit and treat anxiety. The warming and stimu-
or ;.'
Valeriana paired with other herbs Discussion of the limitations of each of the main actions of Valeriana can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Valeriana beyond its limitations. The basic unit of herb combination is the herb pair. Twelve pairings ofValeriana are briefly explained below.
CAUTION
lating actions of Rosmarinus can moderate any tendeIlcr, Valeriana to stagnate the movement of Qi, allowing this pair
to treat headache when they are combined with d~presSio~. due to Heart or Liver Stagnant Qi. Valeriana + Zingiber
Nervous tension + sensations ofcold Zingiber moderates the tendency of Valeriana to cool, slow, or stagnate the movement of Qi. Therefore, this pair can be used for conditions of anxiety or insomnia associated with Deficiency or Cold, providing these patterns are not too extreme.
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair. Valeriana + Piscidia
Trigeminal neuralgia
Valeriana + Glycyrrhiza
Insomnia + agitation The sweet tonic Glycyrrhiza can be combined with
Valeriana
785
Valeriana in cases where agitation, restlessness, and/or in-
Valeriana combinations
somnia are associated with Qi Deficiency. Also, the sweet and heavy property of Glycyrrhiza emphasizes the sweet and
Six Valeriana combinations are discussed b~low:
heavy quality of Valeriana to sink and stabilize the Spirit so that it is more grounded in the physical body. Valeriana + Lobelia i _..,,'.
~
Asthma + nervous tension Valeriana is specific for nervous tension and Lobelia is specific for muscle spasms, so that the two herbs can form an excellent complement to each other in treating muscle spasms associated with stress, for example, in asthma, chest pain due to heart disease, intestinal colic, or dysmenorrhea. Valeriana + Viburnum
Combination
Chinese syndromes
1. insomnia
Heart Spirit Disturbance
2. palpitations
+ anxiety
Heart Spirit Disturbance + Heart Qi Irregularity
3. hypertension + headache
liver Hyperactive Yang + liver Heat
4. headache + facial neuralgia
liver Hyperactive Yang + Stagnant Qi and Blood in the channels
5. peptic ulcer
Stomach Heat
6. colitis
+ nervous tension
Dysmenorrhea Valeriana is a general-purpose tranquilizing antispasmodic and Viburnum is an antispasmodic that is specific for uterine pain. The two herbs can be combined for dysmenorrhea associated with nervous tension.
Intestines Heat + Heart Spirit Disturbance
CAUTION
Before using any ofthe combinations below, it is important to be familiar with the cautions listedfor each herb in the combination.
Valeriana + Rheum
Hypertension + sensations ofheat In terms of Chinese medicine, Rheum can be used to clear Heat from the body, including Liver Heat. Research in China has reported antihypertensive effects for this herb. Rheum· can be combined with Valeriana to treat hypertension associated ...ith Heat of the Heart, Liver, or Stomach.
1. Insomnia
Heart Spirit Disturbance
Lavandula Valeriana Anemone Glycyrrhiza
Valeriana + Berberis
Headache + irritability Although Berberis by itself does not calm Liver Hyperactive Yang, it can help to move Liver Stagnant Qi and clear Liver Heat arising from Stagnation. It can, therefore, be combined with Valeriana to treat headache or migraine with accompanying irritability, which are associated with Liver Hyperactive Yang, Liver Stagnant Qi, and Liver Heat. Valeriana + Hydrastis
Gastritis + nervous tension Hydrastis can be used to clear Stomach Heat and also to heal damaged gastric mucosa. Valeriana can be used to clear Stomach Heat when this is associated with excessive psychological stress, so that the two herbs can be combined to treat gastrointestinal inflammations or ulceration linked to nervous tension.
1 1 1
0.5
sl. warm cool cold neutral-<:ool
aromatic, bitter, sl. acrid bitter, sweet bitter sweet
This combination is the same as Lavandula: insomnia and is discussed under that heading. 2. Palpitations + anxiety
Heart Spirit Disturbance + Heart Qi Irregularity Herb" Lavandula Valeriana Anemone Leonurus. Crataegus Convallaria Glycyrrhiza
"Ratio 1 1 1 1 1 1
0.5
Temperature"" Taste sl.warm cool cold neutral sl. warm neutral neutral-cool
"-
aromatic, bitter, sl. acrid bitter, sweet bitter sour, sl. bitter sour, sweet bitter, sl. sweet sweet
This combination is the same as Lavandula: palpitations
+ anxiety and is discussed that heading. "
---------------------------
-
Combining Western Herbs and Chinese Medicine
786 3. Hypertension + headache
Liver Hyperactive Yang + Liver Heat Calendula
Herb Valeriana Piscidia Salvia off. Tanacetum Berberis Taraxacum Rheum
Ratio
Temperature
Taste
1 1 1 1 1 1
cool
bitter, sweet
Filipendula Hydrastis Valeriana
cold warm-cool
bitter aromatic, acrid
Ophiopogon Glycyrrh iza
cool cool cool-cold cool-cold
bitter bitter
0.5
bitter bitter. sour
1 1 1 1 1
0.5
cool
bitter
cool
sour, bitter bitter
cool cool cool neutral-cool
6. Colitis + nervous tension
This combination is for Liver Hyperactive Yang with Liver Heat. The overall temperature is cool to cold to treat warm to hot conditions. The dominant taste is bitter to calm Liver Hyperactive Yang and to clear Heat.
Intestines Heat + Heart Spirit Disturbance Herb -
Ratio ': -. Temperature
Valeriana Humulus
1 -1
Lobelia Hydrastis Sanguisorba Hamamelis
1 1 1 1
PRACTICAL NOTES
Glycyrrhiza
0.5
This combination can be taken as 5 rnl of 1:5 tincture in quarter of a cup of cqld water, three times per day. It can be taken for about 2 weeks, until the hypertension, headache, irritability, and signs of heat are reduced, and then it can be replaced with a less cold and less draining combination.
GENERAL
• hypertension with headache, restlessness, red face and sensations of heat; maybe irritability or anger
Caution This combination is appropriate for patterns of Excess and Heat, and should not be taken in cases of Deficiency and Cold, especially if there is diarrhea.
Liver Hyperactive Yang + Stagnant Qi and Blood in the channels
Rosmarinus Lavandula Valeriana Piscidia Lobelia
-- Ratio 1 1 1 1
Glycyrrhiza Zingiber
0.5 0.5 0.5
Temperature
Taste
warm 51. warm cool cold warm-cool neutral-cool
aromatic, bitter, acrid aromatic, bitter, 51. acrid bitter, sweet
hot
cool cold warm-cool cool cool neutral-cool neutral-cool
bitter. sweet bitter acrid bitter sour. bitter sour. sl. bitter sweet
This combination is for Intestines Qi Disturbance with Intestines Heat. There may also be Liver Hyperactive Yang and Heart Spirit Disturbance underlying the Disturbance oL Intestines Qi. The overall temperature is cool to "treat ~ilt to hot conditions. The dominant taste is bitter to calm and to clear Heat. The sour taste is astringent, and the sweet taste is demulcent. USE
4. Headache + facial neuralgia
Herb
sweet. sl. bitter sweet
This combination is the same as Calendula: peptic ulcer and is discussed under that heading.
GENERAL
USE
bitter. sweet
bitter acrid sweet acrid. aromatic
• colitis with diarrhea and pain and maybe mucus and blood, aggravated by nervous tension PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of cold water, three times per day. It can be taken for about 2 weeks. until the symptoms are reduced, and then it can be replaced with a less cold and more tonic combination. If the diarrhea or bleeding do not reduce sufficiently, a double ratio of Potentilla can temporarily be added to this combination.
This combination is the same as Rosmarinus: headache + facial neuralgia and is discussed under that heading. 5. Peptic ulcer
Stomach Heat
Caution
This combination is appropriate for patterns of diarrhea and bleeding associated with Heat and should not be taken in cases of Deficiency and Cold. Patients with severe or prolonged diarrhea, or blood in the stools, should receive conventional medical investigation.
-
Valeriana COMPARISON OF THE SIX VALERIANA COMBINATIONS
L~
l.lnsomnia
2. Palpitations + anxiety
Heart Spirit Disturbance
Heart Spirit Disturbance + Heart Qi Irregularity
Herb
Ratio
Herb
Ratio
Lavandula Valeriana Anemone Glycyrrhiza
1 1 1
Lavandula Valeriana Anemone Leonurus Crataegus Convallaria GIycyrrti iza
1 1 1 1 1 1
0.5
787
bine to calm Liver Hyperactive Yang and move Liver Stagnant Qi. Valeriana and Piscidia are stronger calming herbs with a more sedative effect, which can control LiverYang and treat facial neuralgia and nervous tension. They are assisted in this by the antispasmodic action of Lobelia. Glycyrrhiza emphasizes the sweet, heavy, stabilizing effect ofValeriana on Liver Yang and Heart Spirit. Zingiber assists the aromatic herbs to warm and move Liver Stagnant Qi, and moderates the cooling, sedative action of Piscidia. 6. Colitis + nervous tension
5. Peptic ulcer Stomach Heat
0.5
1. In this effective symptomatic combination for insomnia, Anemone and Valeriana are the stronger calming herbs. Lavandula contr.ibutes a tranquilizing effect, but balances this with mildly tonifying and moving actions. Sweet heavy Glycyrrhiza emphasizes the sweet heaviness ofValeriana, but
Intestines Heat + Heart Spirit Disturbance Ratio
Herb
Calendula Rlipendula Hydrastis Valeriana Ophiopogon Glycyrrhiza
1 1 1 1 1
0.5
this grounding effect is moderated by the moving and lightening action of the Lavandula essential oils. 2. Combination No.2 includes all four herbs from combination No.1, but adds Crataegus, Convallaria, and Leonurus to regulate and strengthen Heart Qi. Combination No. 1 is more for short-term or occasional use, whilst combination No.2 can be used long-term to strengthen and regulate the Heart. 3. Hypertension + headache
4. Headache + facial neuralgia
Liver Hyperactive Yang + Liver Heat
Liver Hyperactive Yang + Stagnant Qi and Blood in the channels
Herb
Ratio
Herb
Valeriana Piscidia Salvia off. Tanacetum Berberis Taraxacum Rheum
1 1 1 1 1 1
Rosmarinus Lavandula Valeriana Piscidia Lobelia Glycyrmiza Zingiber
0.5
. Ratio 1 1 1 1
0.5 0.5 0.5
3. Combination No.3 is to be taken short-term for acute
Herb
Valeriana Humulus Lobelia Hydrastis Sanguisorba Hamamelis Glycyrrhiza
Ratio 1 1 1 1 1 1
0.5
5. All the herbs in combination No.5 can help to clear Stomach Heat, and Ophiopogon can tonify Stomach Yin and moisten dryness. Calendula, Filipendula, and Hydrastis can have astringent, antihemorrhagic, and vulnerary action. Valeriana, Ophiopogon, and Glycyrrhiza together can calm the stresses of anxiety, worry, or anger that may underlie gastric irritation. 6. Valeriana, Humulus, and Lobelia can calm nervous tension and relieve the spasms of intestinal muscle, allowing normalization of peristalsis. Humulus, Hydrastis, and Sanguisorba have antimicrobial action, and Hamamelis and Glycyrrhiza have anti-inflammatory action. Sanguisorba and Hamamelis can act as cooling astringents to reduce diarrhea and bleeding associated with the Heat. OTHER VALERIANA COMBINATIONS Other combinations that contain Valeriana include the following:
• Lavandula: irritable bowel syndrome + heat sensations • Piscidia: insomnia + muscle spasms • Ruta: nightmares • Salvia: menopausal hot flashes
patterns of Excess and Heat. Valeriana, Piscidia, Salvia, and Tanacetum can calm Liver Hyperactive Yang and help to clear Liver Heat. Berberis, Taraxacum, and Rheum clear Liver Heat. 4. The aromatic herbs Rosmarinus and Lavandula com-
Research CONSTITUENTS The composition ofY. officinalis varies considerably with
Combining Western Herbs and Chinese Medicine
788
..
"~.'.,.,'.'
'''_0
the subspecies used, the time of harvesting, and conditions and duration of storage. The following constituents have been reported: • iridoids • essential oil • nonvolatile sesquiterpenes • other Iridoids Roots and stolons ofY. officinalis, which are carefully dried at a temperature below 40°C, contain 0.5-2% valepotriates (an acronym for valeriana epoxy triesters), which are bicyclic iridoid monoterpenes. Valtrate and isovaltrate predominate, with smaller amounts of didrovaltrate, acevaltrate, and others. IS
Decomposition ofvalepotriates The valepotriates are unstable and decompose rapidly on exposure to heat (greater than 40°C) or acidity (pH ofless than 3).2 Valtrate and isovaltrate decompose mainly to baldrinal and homobaldrinal, but the decomposition products of didrovaltrate do not include these metabolites. 16 The valepotriates do not remain in appreciable amounts in infusions and tinctur~s, and only their decomposition products are present. l Isolated'valepotriates have been taken in prepared medicines, but are decomposed in the stomach into baldrinals and other derivatives. Essential oil V. officinalis has 0.3-0.7% essential oils,17 which contain: 13 • mainly monoterpenes, especially bornyl acetate • lesser amounts of volatile sesquiterpenes, including valerenal and valeranone Nonvolatile sesquiterpenes Y. officinalis, contains 0.080.3% valerenic and acetoxyvalerenic acids,18 but other Valeriana species do not contain these chemicals. Other Y. officinalis contains lignans l9 and traces of alkaloids. 20 Species variation Several species within the genus Valeriana have been found to have calming effects, but there can be considerable variation in both type and amount of the main active constituents: 2 • V. edulis Nutt., ssp. procera EG. Meyer, a valerian from Central America, contains 4-7% valepotriates • V. walichii DC. (Y. jatamansi Jones), Indian valerian, is used in Ayurvedic medicine as a sedative and contains 3-6% valepotriates and up to 9% essential oil • V. fauriei Briq., Japanese valerian, contains very little sesquiterpenes, but still has sedative effects
PHARMACOLOGICAL AND
or
~
-
-_ .. __ ..;:.
....
'.~.~'--""'_'_.'
.
CLINICAL RESEARCH The main effect of Valeriana can be said to be calming, whether this is described as tranquilizing, anxiolytic, or sedative. The following effects have been reported: • tranquilizer • hypnotic • antispasmodic • anticonvulsant The data from pharmacological and clinical research on Valeriana is complex and sometimes contradictory. The identity of the substances responsible for the calming effect and the mechanism of this effect are still not clear. This may be partly due to variation in constituents associated with variation chromosome number between the dif. ferent subspecies and varieties ofY. officinalis. It may be that a varietY of different chemicals can contnoute to the calmiDg-'---" effect of Y. officinalis, and that the predominating chemical or chemical group varies with the subspecies used. Tranquilizer Intraperitoneal injection of Valeriana essen- . tial oils valerenal, or valeranone was reported to have central nervous system depressive effect in mice. 21 Studies with mice also showed central depressant effects for Valeriana root 24 tincture,22 valerenic acid,23 and homobaldrinal. ,.-c'-'~'::'" .. Valeriana in doses of 12 mglkg, but not 6 mglkg,had ~':S·:;:::· xiolytic effects in acute diazepam withdrawal in dependenC;;;;':;;;. rats,2S and valepotriates were reported to have sedative effects in humans. 26 Hypnotic Most of the clinical trials on Valeriana preparations and constituents have been on their effect on sleep, and 27 28 this subject has been reviewed in recent publications. . A 4-week randomized, double-blind study was conducted with insomnia patients taking an evening dose of 600 mg of valerian tincture. Sleep quality and the feeling of being rested after sleep both improved in the Valeriana groUp.29 Another double-blind study using the equivalent of 1.3 g of root taken an hour before bed by insomnia patients reduced the average time taken to fall asleep and improved sleep quality without increased morning drowsiness. 5O . An EEG, double-blind, placebo-controlled, crossover study on healthy subjects showed that Valeriana tended to 31 normalize the sleep profile and reduce wakefulness. Another study with healthy volunteers found that both flunitrazepam and Valeriana syrup resulted in subjective improvement of sleep quality. Whilst the flunitrazepam group showed impairment of performance on the morning following medication, the Valeriana group reported only a very slight impairment of vigilance. 32
-
-
Valeriana Antispasmodic Intraperitoneal injection of Valeriana volatile oils, valerenal, or valeranone showed muscle relaxant ._ effect in mice. 21 Oral administration of Valeriana extract at 100 or 250 mg/kg reduced muscle tone in cats. JJ
for the GABA-A receptor in rat brain, and it was suggested that interaction with GABA-A receptors may underlie the calming effect ofValeriana. However, the identity of the interacting Valeriana constituent is not known. 3;
Anticonvulsant Intraperitoneal administration of an ethanol extract of Valeriana or pure valerenic acid showed anticonvulsant activity against picrotoxin in mice..H
Melatonin receptor An ethanolic extract of Valeriana displaced radiolabeled melatonin from receptor sites in the human cerebellum. On the other hand, valerenic acid and an aqueous extracts of valerian did not displace the radiolabeled melatonin. 38
Constituents responsible for the tranquilizing effect Valeriana contains three main groups of constituents that contribute to its calming effect: • valepotriates and their decomposition products • volatile oil components • nonvolatile sesquiterpenes
Valepotriates and their decomposition products The constituents mainly responsible for the tranquilizing action of Valeriana were once thought to be the valepotriates. However, since these are scarce or absent in tinctures and infusions made from the dried material, it is now thought that the baldrinals and other decomposition products of the valepotriates are the main active constituents.24
Essential oil components About one third of the calming
L--
action of Valeriana may be contributed by the essential oil components. J5 Calming activity was once linked to bornyl acetate, and the volatile sesquiterpene valeranone has also been reported to have sedative, hypotensive, and anticonvulsant effects. 2
Nonvolatile sesquiterpenes Valerenic acid has been reported to have tranquilizing effects, but since this compound is unique to V. officinalis,18 other constituents must be responsible for the reported calming effect in other Valeriana species. Combined .tranquilizing effects The calming effect of Valeriana is now believed to be due to a combination ofbaldrinals and other degradation products of the valepotriates, as well as other constituents, such as the essential oil and nonvolatile sesquiterpenes. 36
\~--.:.
789
Mechanism of the tranquilizing effect There have been recent studies on various central nervous system receptors that may be responsible for mediating the calming effect of Valeriana, but the nature of the Valeriana active constituents and the mediating mechanisms remain unclear. The following mechanisms have been suggested: • interaction with GABA-A receptors • interaction with melatonin receptors • interaction with 5-HT IA receptors
GABA (gamma-aminobutyric acid) receptor complex Both alcoholic and aqueous extracts of Valeriana showed affinity
5-HTI.4 receptor 5-HT (5-hydroxytryptamine), otherwise known as serotonin, can act as a neurotransmitter involved in changes in mood, and as a precursor of melatonin involved in regulating the sleep cycle. The lignan (+ )-l-hydroxypinoresinol, isolated from Valeriana, showed a high affmity for the 5-HT lA receptor. 18
RESEARCH VERIFICATION OF TRADITIONAL ACTIONS The tranquilizer, hypnotic, antispasmodic, and anticonvulsant actions have all been confirmed for preparations of Valeriana officinalis and for various of its constituents, but the antihypertensive, antiulcer, and stimulant nervine actions have not Additional effects demonstrated by research No other main effects have so far been reported for V. officinalis.
TOXICOLOGY Valeriana An ethanolic extract of Valeriana root has low toxicity. For example, the LD 50 in mice by intraperitoneal injection is 3.3 g/kg. This extract was also administered intraperitoneally to rats for 45 days at up to 600 mglkg without significant changes in their weight, blood, or urine. 39 Valepotriates Valtrate, didrovaltrate, and acevaltrate did not have acute toxicity following oral administration in mice up to 4.6 g/kg.-lO (This is the equivalent of 276 g for a 60 kg human). Oral administration of valepotriates for 30 days did not have adverse effects on pregnant mice or their offspring.41
Cytotoxicity of valepotriates Although some valepotriates have shown cytotoxicity in vitro,42 it has been reported that valepotriates are not cytotoxic when given orally since they break down in the stomach to' safe decomposition productS.43 Valeranone The volatile sesquiterpene valeranone in the essential oils fraction of Valeriana has an oral LD 50 of over 3 g/kg in both rats and mice.+!
Combining Western Herbs and Chinese Medicine
790
.
Valerenic acid The nonvolatile sesquiterpene valerenic acid also has low toxicity, requiring 400 mglkg to cause convulsions and death in mice. 22 Interactions Adverse interactions have not been demonstrated. In fact, an animal study reported that valepotriates did not increase the depressant effect of alcoho1. 45 A human study reported that when a herbal product containing Valeriana was taken with alcohol, the effects were not greater than those of alcohol on its own. 46
Dose
-
;;~~-,~~~~~
Ability to drive and use machines According to Mills and ~~. Bone, no adverse results are expected. However, I advise . r.·-:"'~_7'· patients not to take high therapeutic doses of Valeriana preparations at the same time as hypnotic or sedative medications if they are going to drive or operate machinery. Side effects Some individuals may experience drowsiness with high doses of Valeriana, in which case the dose can be reduced or another herb prescribed. There have been reports from American practitioners that Valeriana officinalis (grown in the United States) can have stimulant effects in a few individuals, in which case, the use of this herb should be stopped, and another herb substituted.
Dried herb The BHC47 listed 1-3 g of dried herb, three times per day. For acute, severe stress or insomnia, if this dose proves to be inadequate, I may increase it to 5-7.5 g, three times per day, for up to 3 days, providing that th~s dose does not cause undue drowsiness in the daytime.
Overdose In one case, a dose of about 20 g caused symptoms of fatigue, abdominal cramps, chest tightness, light~ headedness, and hand tremors, which disappeared within 24 hours.oI8 __ ._.'-.c.:._:"-~: ("'-" ..
Tincture The BHC listed 3-5 ml of 1:5 tincture in 70% alcohol, three times per day. For acute, severe stress or insomnia, if this dose proves to be inadequate, I may increase it to 7.5 ml, three times per day, for up to 3 days, providing that this dose does not cause undue drowsiness in the daytime.
~
Initial dose
Can start at the standard dose.
Duration Can be used for one month or more, providing cautions are observed.
Cautions If patients are exhausted but are forcing themselves to function, and perhaps not admitting or realizing the degree of their tiredness, they may initially feel heavy and drowsy on taking Valeriana. This is usually temporary, while their system takes the rest that is necessary for recovery. Western contraindications I would not prescribe high doses of Valeriana grown in Europe unless it was combined with warming, stimulant, or moving herbs in cases of weakness with sensations of cold, or in cases of depression in the absence of restlessness and anxiety. Chinese contraindications
The main text quoted in the
Chinese Herbal Medicine Dictionary lists weak body and Deficient Yin as contraindications for xie cao, but a subsidiary cited text lists neurasthenia and restless spirit as an indication. Pregnancy and lactation
No adverse reports.
Interactions No herb-drug interactions have been demonstrated, see Toxicology above. However, I would advise patients to avoid large doses of central nervous system depressants and alcohol whilst taking high doses ofValeriana. ."c(.~ ••..
..-
Regulatory st~tus Please read the Regulatory status section in
the'~~a~f~1~~~~:
on Safety.:/~1:;~J:~~. Valeriana is on the UK General Sale List, and is not in.. cluded in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Valeriana is not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
Traditional sources PROPERTIES Temperature Dioscorides listed phu as warming, Hildegard von Bingen49 classified denemarcha as hot and moist, Tabernaemontanus described baldrian is warming and drying, and Lonicerus wrote that baldrian is hot in the third degree and dry in the beginning of the second degree. According to Gerard, the valerians are slightly hot, and Culpeper described garden valerian as warming. However, it is not certain that the herbs described by these authors (printed in italics above) are identical to our present-day V. officinalis. The main entry of the Chinese Herbal Medicine Dictionary classifies xie cao as warm. However, in this book,
,.,..
Valeriana the dried underground parts of V. officinalis, as used in Europe, are classified as cool in terms of Chinese medicine since this herb is recommended not only to calm Heart Spirit Disturbance and Liver Hyperactive Yang, but also to clear Heart, Liver, or Stomach Heat. Taste
/.
,..
791
The mam entry m the Chinese Herbal Medicine Dictionary listed V. officinalis (xie cao) as entering the Heart and Liver. ACTIONS • antispasmodic and analgesic
Taste in the mouth The BHp50 described the odor of Valeriana as aromatic and pungent, and the taste as bitter and camphoraceous. I tested a 1:5 tincture of Valeriana in 25% alcohol, from a British supplier, and a sample of dried root from an American supplier. I found the odor of both the dried root and the tincture to be aromatic and pungent. However, I found definite differences in taste between the two samples. I found the British tincture to be acrid, bitter, slightly sour, slightly sweet, and slightly mucilaginous. I found the taste of the dried American root to be bitter, but more acrid and aromatic' and less sour and sweet, than the British tincture. I also found that the American material had a more warming sensation in the mouth. These differences in taste in the mouth may reflect a difference in constituents that results in differences in temperature effect and actions. Taste properties The main text cited in the Chinese Herbal Medicine Dictionary classified xie dio as acrid and bitter. However, a subsidiary cited text listed it as acrid and slightly sweet. In this book, the dried underground parts of V. officinalis, as used in Europe, are classified as bitter and sweet in terms of Chinese medicine. This is because this herb is recommended not only as a calming bitter herb that can clear Heat, but also as a somewhat sweet and heavy herb to sink
• anticonvulsant • tranquilizer and hypnotic • antihypertensive • antiulcer • stimulant nervine and antidepressant • other Antispasmodic and analgesic
Hildegard von Bingen rec-
ommended denemarcha for the pain of gicht, which probably means the pain of gout, rheumatism, or arthritis. Lonicerus listed the root of baldrian for groin pain, backache, ~d headache, and Tabernaemontanus wrote that it could be used for sciatica or kidney pain. Gerard noted the use of valerian for cramp, and Culpeper said that valerian could be used for pains in the chest or sides. Kloss and Christopher listed Valeriana for colic or cramps, and Christopher listed Valeriana for nervous coughs and whooping cough. The BHP described it as an antispasmodic and mild anodyne that could be used for cramps, rheumatic pains, intestinal colic, and dysmenorrhea. The wording on the package insert from the German Standard License includes nervous, cramp-like pains in the gastrointestinal region.· Anticonvulsant
According to Grieve, valerian was first
popularized specifically for epilepsy in 1592 by Fabius
and ground the Heart Spirit.
Calumna after he had used it to cure himself of the disease. Gerard listed valerian for convulsions, as did Lyle, and Felter
ORGANS
and lloyd;) noted its use for chorea or epilepsy. Both Kloss
In terms of Chinese medicine, V. officinalis, as used in the West, can be associated mainly with disorders of the fol. lowing organs: Organ
Examples of use
Source
Heart
nervous menopausal disorders insomnia
Ellingwood
Liver
nervous headache migraine
Ellingwood BHP
Stomach
stomach ulcers
Kloss,51 Christopher2
Intestines
intestinal colic
Christopher, BHP
BHP
and Christopher recommended it for convulsions in infants. Christopher also listed it for vertigo, delirium tremens, and epilepsy. Valeriana was one of the main ingredients of the famous Antispasmodic tincture used by the Physiomedicalists, the Eclectics, and later American herbalists such as Christopher for fits and convulsions (see the chapter on Lobelia). Tranquilizer and hypnotic Lyle listed Valeriana for irritability of the nervous system, restlessness or nervousness in children, insomnia, and hysteria. Ellingwood wrote that Valeriana could be used for nervous headache, nervous menopausal disorders, and imaginary pain. Both Kloss and Christopher recommended Valeriana for palpitations of
792
Combining Western Herbs and Chinese Medicine
the heart. Priest and Priest54 noted the use of Valeriana for nervous excitability, nervous palpitations, and nervous insomnia, and the BHP listed Valeriana for nervous excitability and migraine.
tion with other herbs, for pleurisy, cough, wheezing, and tightness of the chest, and to help expectorate phlegm.
Antihypertensive Christopher noted the inclusion of valerian in Dr. Shook's high blood pressure compound, and uses it in a combination for dizziness. The BHP listed V. officinalis for hypertension.
CHINESE USE OF VALERIANA
Antiulcer Both Kloss and Christopher recommended valerian for stomach ulcers. Stimulant nervine and antidepressant Eclectic texts, such as those of Lyle,S5 Ellingwood, or Felter and Lloyd mainly listed Valeriana as a calming herb for the effects of nervous tension. However, they also listed a secondary action as a stimulant nervine for conditions involving nervous debility, and resulting in depression, nervous depression, or hypochondria. In contrast to the work of the Eclectics, this stimulant or antidepressant action is not emphasized by modern Europ~antradition or by modern research.
COMPARISON OF WESTERN AND
The data in the table on Chinese uses comes from the
Chinese Herbal Medicine Dictionary. Data marked with an asterisk* comes from the main text cited, and data not so marked comes from subsidiary texts cited. It should be noted that the entry '-' in the table does not necessarily mean that Valeriana has never been used for this indication, but that, if it has been employed, the use is relatively uncommon. It can be seen from the table below that the use of valerian in China and the West differs greatly. The main similarities of use are for muscle spasms and pain, and for the older Eclectic indication of nervous debility. The main difference~ of use can be summarized as:
Other Dioscorides, Lonicerus, Tabernaemontanus, Culpeper, and Gerard emphasized the use of valerian to promote urination or menstruation. According to both Kloss and Christopher, valerian can be used to promote menstruation and for gravel in the bladder. Lonicerus recommended baldrian root simmered with fennel and licorice to soothe a cough and to treat heavy breathing. Tabernaemontanus listed baldrian, in combina-
Actions
Western uses
antispasmodic and analgesic
cramps, intestinal colic, dysmenorrhea, spasmodic coughs
anticonvulsant
convulsions, epilepsy, delirium tremens
• valerian is far more widely used in the West • the main Western uses for conditions involving nervous tension or insomnia seem to be rare in China; only one subsidiary text cited in the Chinese Herbal Medicine Dictionary listed valerian's use for such a condition: palpitations • the anticonvulsant and antihypertensive actions utilized. in the West are not listed in the Chinese Herbal Medicine:
D i c t i o n a r y >.
• whilst the use for gastric ulcers is not common in China, the Chinese Herbal Medicine Dictionary listed 'weak stomach' as an indication Chinese uses .' • the Chinese use of valerian for menstrual . . .. .... irregularities is not current in the West, low back pain, * injuries although there was an old tradition of from trauma, * sciatica, Western use to promote menstruation gastrointestinal spasms -
References
tranquilizer and
nervous tension, nervous
palpitations
hypnotic
palpitations, nervous headache, imaginary pain, overexcitement, restlessness, insomnia
antihypertensive
hypertension, dizziness (from hypertension)
2. Bruneton). Pharmacognosy: Phytochemistry Medicinal Plants, 2nd edn. Lavoisier, Paris, France (1999)
antiulcer
gastric ulcers
3. Grieve M. A Modern Herbal, vols. 1 and 2. Dover
nervine
nervous debility, nervous depression (older, Eclectic usage)
1. Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm, Stuttgart, Germany (1994), from 2nd German edn. Wicht! M (ed) (1989)
Publications, New York, New York (1971) poor memory, altitude sickness, neurasthenia
digestive tonic
weak stomach*
emmenagogue
irregular menstruation,* amenorrhea. difficult menses
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(1975) 15. Wagner H, Bladt S. Plant Drug Analysis: a Thin Layer Chromatography Atlas, 2nd edn. Springer-Verlag, Berlin, Germany, pp 342-344 (1996) 16. Von Der Hude W. Scheutwinkel-Reich.'vl, Braun R. Mutat Res 169(12):23-27 (1986) 17. Bos Ret al. Phytochemistry 25:133 (1986) 18. HanselR,Schulz J. DtschApoth Ztg 122:215 (1982) 19. Bodesheim U, HoW J. Pharmazie 52(5):386-391 (1997) 20. Hagers Handbuch. Band VI C, 375-383 [Tll] (1979) [cited in Bradley PR (ed). British Herbal Compendium, vol 1. British Herbal Medicine Association, Bournemouth, United Kingdom (1992) 1 21. Hendriks H. Bos R.A1lersma DP et al. Planta Med 42:62-68 (1981) 22. Torrent MT. Iglesias J, Adzet T. Circular Farmaceutica 30:107-112 (1972)
HW Jr. J Pharm Sci 50:240-244 .
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23. Hendriks H. Bos R, Woerdenbag HJ et al. Planta Med 51:28-31 (1985)
50. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983)
24. Wagner H. Jurcic K. Schaette R. Planta Med 38:358-365 (1980)
51. Kloss J. Back to Eden, 5th edn. (1939). Reprinted by Lifeline Books,
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r
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United Kingdom (1982)
(2000) 55. Lyle TJ. Physio-Medical Therapeutics, Materia Medica and Pharmacy. 29. Vorbach EU. Gortelmeyer R, Bruning J. Psychopharmakotherapie 3:109-115 (1996) 30. Leathwood PD. Chauffard F. Planta Med 51:144-148 (1985)
Originally published Ohio (1897). Reprinted by the National Association of Medical Herbalists of Great Britain. London. United Kingdom (1932)
Viburnum Botanical name Viburnum prunifolium L. FaniUy Caprifoliaceae Pharmaceutical name Viburni prunifolii cortex Part dried bark of stem or root English black haw German Schneeballbaum French viorne Mandarin V. prunifolium L. is not used: but see below Use in Europe Gerard 1 gives an uncharacteristically vague description of a Viburnum, which he called Lantana, or the wayfaring tree, and Tabernaemontanus~gave an unusually brief discussion of this same plant, which may be V. lantana. However, as Crellin and Philpott' pointed out, relatively little was written in the West on the medical uses of the Viburnum species until the mid-19th century in North America. Use in North America V. prunifolium is a shrub or tree indigenous to North America, growing to a height of 3-7 meters, especially in dry woods and thickets and on rocky hillsides in fertile soil. According to Felter and Lloyd,4 for a long time it was customary for slave owners in America to compel their female slaves to drink an infusion of black haw daily whilst pregnant to prevent their attempts to abort by taking cotton root bark. It was promoted by Dr. Phares of Atlanta in 1860 for threatened miscarriage. It was also included in the US Pharmacopoeia of 1882. 3
interchangeably. However, according to Grieve,' although the two herbs have similar properties, V. opulus is considerably weaker than V. prunifolium. Nomenclature In this book, the term Viburnum refers to either V. prunifolium or V. opulus unless otherwise specified. Use in China V. prunifolium and V. opulus are not used in Chinese medicine. No Viburnum species are listed by Chang and But,6 Yeung/ or Bensky and Gamble. s However, the Chinese Herbal Medicine Dictionary listed the use of many Viburnum species,9 for example, • diaobaiye (,'f1avt") • jia mt (:;t i!Ii) • xln ye ji
Diao bdi ye This refers to the leaves, flowers, or root of V. cylindricum Buch., V. coriaceum Bl., or V. crassifolium Rehd. It is used for dry coughs, dysentery, arthritis, and rashes.
Jid mi This refers to the stems and leaves of V. dilatatum Thunb. It is used for food stasis and roundworms. Xln ye jid mi gen This refers to the root of V. cordifolium Wall. Et DC. It is used for arthritis and injuries. The entries for diilO bai ye and xln ye jici mt gen were take!l from provincial texts, and the texts did not list the meridians entered. The only Viburnum entry taken from an old traditional text is jici mi. In summary, the Viburnum species used in China are of minor importance in Chinese medicine.
Other Western VIburnum species According to Felter and Lloyd, V. opulus (cramp bark) resembles V. prunifolium (black haw) in its effects so that the two species may be used
795
Combining Western Herbs and Chinese Medicine
796
What is special aboutViburnum
-~-_t:--
In terms of Chinese medicine, Viburnum, as used in the West, can be said to be a neutral herb, which is slightly sour and slightly bitter, and has its main effect on the Uterus.
The key to understanding Viburnum is that it is primarily a uterine antispasmodic and secondarily a uterine antihemorrhagic and a tranquilizer; the herb is specific for dysmenorrhea and threatened miscarriage.
II. calm Heart Spirit and Liver Wind
dysmenorrhea with nervous tension; nervous cooditions, vomiting, or hyper. tension during pregnancy; convulsions
III. reduce bleeding
abnormal uterine bleeding during menstruation, preg· nancy. postnatal, or menopause
CHINESE ACTIONS
DIRECTION OF ENERGY
In terms of Chinese medicine, Viburnum, as used in the West, can be said to have the following actions:
In terms of Chinese medicine, Viburnum can normalize the flow of Qi and Blood in the muscles when this flow is reduced by muscle spasms, and it can reduce leakage of blood from the uterus. It does not, however, have marked directional effects on the flow of energy.
I. move Stagnant Qi and Blood II. calm Heart Spirit and Liver Wind Ill. reduce bleeding ,
~_
"
Move Stagnant Qi and Blood By relaxing the muscles in spasm, Viburnum can restore the normal movement of Qi and Blood. However, Viburnum is not a circulatory stimulant. Calm Heart Spirit and Liver Wmd Viburnum can calm the Disturbance of Heart Spirit or Liver W md. However, it is used for these syndromes mainly when they occur together with menstrual disorders that might be described as Disturbance of Uterus Qi.
WESTERN ACTIONS The main Western actions of Viburnum are shown here in terms of its three main Chinese actions:
TYPICAL CASE EXAMPLE Signs and symptoms The patient has a history of dysmenorrhea and habitual miscarriage. The dysmenorrhea comes with a sensation of tiredness and a dragging-down sensation in the lower abdomen. She has nervous tension and occasional muscle cramps in the legs. Her pulse is somewhat thin and empty, and slightly wiry especially in the third positi()n. Her tongue is somewhat thin and flabby, pale and slightly purple, with a slight tremor. Diagnosis The patient has a general condition of Deficient and Stagnant Qi and Blood, and specifically Deficient and Stagnant Qi and Blood of the Uterus. She may have some Heart Spirit Disturbance and Liver Wind associated with Deficiency.
Chinese actions
Choice of Viburnum antispasmodic emmenagogue antiasthmatic
II. calm Heart Spirit and Liver Wind
tranquilizer antihypertensive anticonvulsant
Ill. reduce bleeding
astringent antihemorrhagic
• dysmenorrhea or threatened miscarriage associated with Deficiency • dysmenorrhea or threatened miscarriage associated with Heart Spirit Disturbance and Liver Win? • muscle cramps in the legs
The main Western uses of Viburnum are shown here in terms of its three main Chinese actions: Chineseactioris:' I. move Stagnant Qi and Blood
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Western uses
This herb is chosen because it can
treat:
WESTERN USES
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Western actions
I. move Stagnant Qi and Blood
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dysmenorrhea, threatened miscarriage, postnatal pain. asthma, cramps
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Limitations ofViburnum TEMPERATURE In this book, Viburnum is classified as neutral and can be used for warm, neutral, cool, or mixed conditions. It can also be used for hot or cold conditions, providing it is suitably combined with other herbs.
Viburnum
I.
Viburnum + Zingiber
TASTE The antispasmodic action of Viburnum may be linked to its bitter constituents, and its antihemorrhagic action may be linked to its sour taste. Otherwise, Viburnum does not show marked bitter or sour effects.
Dysmenorrhea + cold sensations Both herbs can have a specific antispasmodic effect on the Uterus, and Zingiber is a warming circulatory stimulant that can help to clear Cold in the Uterus channels. Viburnum + Vmea
ACTIONS
Menorrhagia + dysmenorrhea
Antispasmodic Viburnum is sometimes used for asthma or for muscle cramps in the limbs. It does not have a powerful general antispasmodic action like Lobelia, although it may be used as a supporting herb, with Lobelia as the primary herb. The antispasmodic use of Viburnum is mainly limited to menstrual pain, threatened miscarriage, and postnatal pain. Tranquilizer Viburnum is sometimes used for palpitations, chorea, petit mal, and other convulsive disorders. However, it is mainly used to treat these disorders when they occur with menstrual irregularities. Astringent and antihemorrhagic Viburnum is sometimes used for diarrhea, but it is mainly used as an astringent and antihemorrhagic to treat abnormal uterine bleeding or leukorrhea.
Viburnum paired with other herbs
k
797
Discussion of the limitations of each of the main actions of Viburnum can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Viburnum beyond its limitations. The basic unit of herb combination is the herb pair. Six pairings ofViburnum are briefly explained below.
Viburnum has primary uterine antispasmodic and secondary uterine antihemorrhagic actions, and Vmca has primary uterine antihemorrhagic action. Viburnum and Vinca can be combined for dysmenorrhea with excessive menstrual bleeding, threatened miscarriage, postnatal hemorrhage and pain, and menopausal menorrhagia. They can also be combined for enuresis. Viburnum + Chamaelirium
Threatened miscarriage' Both herbs can have tonic, antispasmodic, and mild astringent action. They are, therefore, specific for normalizing uterine tone and the rhythm of uterine contractions in the treatment of acute threatened miscarriage or for the prevention of habitual miscarriage. They can also be combined as secondary herbs for leukorrhea. Viburnum + Hydrastis
Postnatal pain and bleeding Both herbs are specific for dysmenorrhea and postnatal pain, and can be used together, usually with the addition of Lobelia, to facilitate childbirth. Hydrastis is the primary antihemorrhagic for menorrhagia or postnatal bleeding, and in this pair, it is supported by Viburnum as the secondary antihemorrhagic herb. Viburnum + Mitchella
Preparation for childbirth CAUTION
Before using any of the herb pairs below, it is impottant to be familiar with the cautions listedfor each herb in the pair. Viburnum + Lobelia
Asthma Lobelia can be used as the primary herb, as a powerful general antispasmodic, and Viburnum can be paired with it as the secondary herb with a less powerful, but supporting, antispasmodic effect. This pair is specific for uterine spasms and pain, but it can also be used for asthma and for muscle cramps in the limbs.
Both herbs can be used during pregnancy to strengthen the female reproductive system. Viburnum is primarily a uterine antispasmodic that can normalize the tone of the uterine muscle, with a secondary astringent action. Mitchella is primarily an anticatarrhal astringent that. can normalize the function and tone of the uterine mucous membranes, with a secondary antispasmodic action.
Viburnum combinations Four Viburnum combinations are discussed below:
Combining Western Herbs and Chinese Medicine
798
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antisp~smodic effect, and sour constituents are responsible for the antihemorrhagic action.
Combination 1. dysmenorrhea
Uterus Stagnant Qi and Blood
2. postnatal pain + bleeding
Uterus Stagnant Qi and Blood
3. threatened miscarriage
Uterus Qi Disturbance
4. habitual miscarriage
Uterus Deficient Qi and Blood
USE
CAUTION
Before using any ofthe combinations below, it is important to be familiar with the cautions listed for each herb in the combination.
• persisting pain and bleeding following childbirth PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of water, three times per day. This combination is designed for short-term use, and as soon as the pain and bleeding have subsided, this combination can be replaced by a more tonic combination, such as Capsella: menorrhagia
+ exhaustion. Caution
Severe or pefSlstmg bleeding after childbirth should be investigated by a conventional medicine specialist before herbal therapy is employed, unless it is used as first aid whilst awaiting conventional investigation.
1. Dysmenorrhea
Uterus Stagnant Qi and Blood
Thymus
3g
warm-cool
aromatic
Mentha pul.
3g
warm
aromatic
Viburnum
3g
neutral
sl. bitter, sl. sour
warm-cool
acrid
hot
acrid, aromatic
Lobelia 0.6g* Zingiber (fresh) .3 slices
'The UK daily maximum dose for dried Lobelia is 0.6 in the Lobelia chapter.
g; see the Dose section
This combination is the same as Thymus: dysmenorrhea and is discussed under that heading.
3. Threatened miscarriage
.Uterus Qi Disturbance .Ratio Viburnum Chamaelirium Vinca Mitchella Zingiber Lobelia
1 1 1 1 0.5 0.25
neutral neutral neutral neutral hot warm-cool
sl. bitter, sl. sour bitter, sour sour sl. sour acrid, aromatic acrid
2. Postnatal pain + bleeding
GENERAL
Uterus Stagnant Qi and Blood
This combination is for acute threatened miscarriage associated with Uterus Qi Disturbance. If there are additional syndromes such as Deficiency, Cold, Heat, or Heart Spirit Disturbance, this combination would need to be modified. The overall temperature is warm, but the temperature of the combination can be altered, if required, by suitable modification. For example, the Zingiber can be removed if a neutral combination is required. Bitter, acrid, and aromatic constituents may be involved in the uterine antispasmodic effect, and sour constituents may be responsible for the anti-
Herb Viburnum Vinca Hydrastis Lobelia Zingiber
Ratio
Temperature
1 1
neutral
sl. bitter, sl. sour
neutral
1
cool warm-cool
sour bitter
0.5 0.5
hot
acrid acrid, aromatic
GENERAL
This combination is for postnatal pain associated with Stagnation and/or Irregularity of the circulation of Qi and Blood in the channels of the Uterus. There may be bleeding associated with Deficiency and Cold, Heat, or Stagnation of Blood. The overall temperature of the combination is more or less neutral, so that it can be used, with suitable modification, for hot, warm, neutral, cool, cold, or mixed patterns. Bitter, acrid, and aromatic constituents are involved in the uterine
hemorrhagic action. USE
• acute threatened miscarriage with contractions and bleeding PRACTICAL NOTES
This combination can be taken as 1-2 ml of 1:5 tincture in quarter of a cup of water, every hour until the pain and/or
..\ ..., Viburnum bleeding subsides. A maximum of 10 doses of 1-2 ml per day can be taken. It is important that the patient stays in bed and avoids stress.
Caution
799
PRACTICAL NOTES
For patients with habitual miscarriage, three different combinations can be used during pregnancy, as appropriate:
If there are signs of threatened miscarriage, the
patient should contact her physician and/or midwife imme-
1. Rubus and Mitchella tea: preparation for childbirth
diately. Herbal therapy can be used, if it is appropriate, as an
A daily dose of 5 g of Rubus with 5 g of Mitchella can be steeped for 20 minutes as an infusion in about 500 ml of boiling water, flltered, and drunk warm in three individual
r..,.
adjunct to conventional treatment. This combination contains Lobelia, although it is in such
{-~--
low doses as to make nausea unlikely as a side effect. The combination can be started on the lower dose of 1 ml to check for signs of nausea. Several precautions need to be followed: • if nausea is absent and if the symptoms persist, the dosage can be increased • if nausea is experienced, the herbs should be stopped .immediately, or if the patient has a known sensitivity
doses during the day. This combination can be taken throughout the pregnancy by healthy women to strengthen and normalize uterine function, and to facilitate a healthy childbirth. In the case of those with habitual miscarriage, Rubus and Mitchella tea can be taken during pregnancy up to about 2 weeks before the time that the previous miscarriage took place. At that point, Rubus and Mitchella tea is replaced by
Viburnum: habitual miscarriage tea.
to Lobelia, the amount ofLobelia in the combination can be reduced or this herb can be omitted entirely • if the practitioner is inexperienced with the use of Lobelia or with the treatment of pregnancy disorders, Lobelia should be omitted from this combination
4. Habitual miscarriage
Uterus Deficient Qi and Blood l-
Herb
Taste
Daily Dose
Temperature
5g 5g 5g 5g
neutral
sl. bitter, sl. sour
neutral
bitter, sour
neutral
sl. sour
neutral
bitter, sour
i
Viburnum Chamaelirium Mitchella Rubus
2. Viburnum: habitual miscarriage tea The daily dose of this combination listed above can be steeped for 20 minutes as an infusion in about 750 ml of boiling water, filtered, and drunk warm in three individual doses per day. This combination can be taken from about 2 weeks before the time that the previous miscarriage took place to 1-2 weeks after this time. If no indications of miscarriage take place by this time, then the Viburnum: habitual miscarriage tea can be replaced by the Rubus and Mitchella tea described above, and this can be taken until delivery. 3. Viburnum: threatened miscarriage tincture
If signs of miscarriage do occur, such as contractions or GENERAL
This combination is for patients who have a history of one or more previous miscarriages associated with the pat-
, b-
tern of Uterus Deficient Qi and Blood. The patient is often chronically pale and exhausted with an empty, thin, or choppy pulse, especially at the third position. If there is general Deficiency of Qi and Blood, in addition to uterine weakness, tonic herbs, such as Urtica, can be added. The temperature of this combination is neutral, but warming herbs can be added if they are required. The bitter
bleeding, then: • if these are mild, the Viburnum: habitual miscarriage tea can be continued until 2 weeks after the signs have ceased .' if they are more severe, then the Viburnum: habitual
miscarriage tea can be replaced by the Viburnum: threatened miscarriage tincture, as described above Caution
and sour constituents together have a tonic and astringent
If there is a history of habitual miscarriage, the patient should notify her physician and/or midwife. If there are signs of threatened miscarriage, the patient should con-
effect on the Uterus.
tact her physician and/or midwife immediately, and should
USE
• prevention of habitual miscarriage
stay in bed and keep as quiet as possible. Herbal therapy can be used, if it is appropriate, as an adjunct to conventional treatment.
: - __ .,;1.
Combining Western Herbs and Chinese Medicine
800
stronger antihemorrhagic Vinca has been replaced by'ih~ milder astringent Rubus. This combination aims to strengthen and normalize uterine function and prevent habitual miscarriage, in contrast to the previous combination, which treats acute threatened abortion.
COMPARISON OF THE FOUR VIBURNUM COMBINATIONS 1. Dysmenorrhea
2. Postnatal pain + bleeding
Uterus Stagnant Qi and Blood
Uterus Stagnant Qi and Blood
OTHER VIBURNUM COMBINATIONS Other combinations that contain Viburnum include the
Herb Thymus Mentha pul. Viburnum Lobelia Zingiber
Daily dose
Herb
3g 3g 3g
Viburnum Vinca Hydrastis Lobelia Zingiber
0.6 g
3 slices
Ratio 1 1 1
following:
• Anemone: dysmenorrhea + fear • Zanthoxylum: muscle cramps + cold extremities
O.S O.S
1. Combination No.1 combines Thymus with the warming and caiming herb Mentha pulegium. Both herbs can warm and move Stagnant Qi and Blood in the Uterus. However, Mentha is more for dysmenorrhea or amenorrhea from shock or nervous tension, whilst Thymus is more for dysmenorrhea or amenorrhea associated with Damp or Phlegm, or dysmenorrhea associated with Damp Heat. Viburnum, Lobelia, and Zingiber have an antispasmodic effect on the Uterus.
2. The warming and calming aromatic herbs Thymus and Mentha, present in the previous combination, have been replaced in combination No.2 with the sour uterine antihemorrhagic Vinca and the bitter uterine antihemorrhagic Hydrastis. Hydrastis strengthens the uterine antispasmodic action of.Viburnum, Lobelia, and Zingiber.
CONSTITUENTS From Felter and Lloyd in 1898 to Grieve in 1931 and the BHP in 1983,10 both V. prunifolium (black haw) and V. opu- . Ius (cramp bark) were said to contain resins, the bitter gIyCO~'~::"~~-;- side viburnin, valeric acid, and tannin. The 1989 edition of Evans ll listed 0.2% salicin,essential oil, isovaleric acid, resin, and tannin as constituents of the root bark of V. prunifolium, but did not mention viburnin. More recently, the following constituents have been reported as present in V. prunifolium: 12 • coumarins: scopoletin, scopotin, aesculetin. ..':,>,.:.:,.. • phenolic acids: chlorogenic acid, i~ochlorogenicacid. . salicylic acid, ursolic acid, and oleanolic acid :., • tannins: about 2% • flavones: amentoflavone • triterpenes: n- and ~-amyrin • sitosterol
3. Threatened miscarriage
4. Habitual miscarriage
PHARMACOLOGICAL AND
Uterus Qi Disturbance
Uterus Deficient Qi and Blood
CLINICAL RESEARCH
Herb
Ratio
Viburnum 1 Chamaelirium 1 Vinca 1 Mitchella 1 Zingiber O.S Lobelia 0.2S
Herb
Daily dose
Viburnum Chamaelirium Mitchella Rubus
sg Sg Sg Sg
3. Combination No.3 is for acute threatened miscarriage. Viburnum, Chamaelirium, Zingiber, and Lobelia are antispasmodics that reduce uterine contractions, and Vinca and Mitchella are uterine antihemorrhagics that treat mild bleeding. 4. Combination No.4 lacks the antispasmodics Zingiber and Lobelia present in the previous combination, and the
The following effects have been reported for Viburnum preparations or for its isolated constituents: • antispasmodic • analgesic • anti-inflammatory • hepatoprotective • immunoregulatory • antiviral I have not found clinical studies on'Viburnum, and only a few animal studies using Viburnum extracts. Most of the effects reported below use isolated constituents ofViburnum species, and it is not yet clear whether the level of these constituents is sufficiently high in the plants to confer these same effects on Viburnum herb extracts.
\_
I
Viburnum Antispasmodic Viburnum has been reported to have uterine relaxant properties. One study reported that there are four substances in the methanolic extract, which the authors proposed had a direct effect, rather than a sympathomimetic effect, on the uterine muscle. 13 Leaf extracts from V. toronis were reported to have uterine relaxant effect using isolated organs. 14 The isolated constituents scopoletin and aesculetin have been reported to have an antispasmodic effect. IS Analgesic Leaf extracts from V. toronis were reported to have an analgesic effect in animal experiments. 14 The isolated chemical amentoflavone was reported to possess strong analgesic activity in the acetic acid-induced writhing test in animal studies. 16 Anti-inflammatory In the same study, amentoflavone showed anti-inflammatory activity in the rat carrageenan paw edema model (ED50=42 mglkg) compared to prednisolone (35 mglkg) and indomethacin (10 mglkg). Amentoflavone has also been reported to inhibit gastric ulcers in animal studies. l ; On topical application, the coumarin scopoletin inhibited induced edema of the rat ear at doses of 1-10 micrograms per ear. 18 It has been reported that the triterpenoids oleanolic acid and ursolic acid have demonstrated anti-inflammatory effects in animal research. 19
f
lr,
I,
Hepatoprote<:t:m: The same review reported that oleanolic acid and ursolic acid have demonstrated hepatoprotective effects in chemically induced liver injury in animal studies, and that oleanolic acid has been marketed in China as an oral drug for human liver disorders. 19 Immunoregulatory Water-soluble polysaccharides from the squeezed berries ofv. opulus have been found to have an immunostimulating activity in that they enhance phagocytosis, especially the phagocytic index of and the secretion of lysosomal enzymes from peritoneal macrophages. 2o Antiviral Amentaflavone was reported to have significant activity against influenza A and B viruses, and moderate activity against herpes viruses HSV-1 and HSV_2. 21 RESEARCH VERIFICATION OF TRADITIONAL ACTIONS The following traditional actions of Viburnum have been supported by research: antispasmodic and analgesic. Additional effects demonstrated by research The following additional effects have been reported for isolated constituents ofViburnum species, as discussed above, but not as yet for the herb itself: anti-inflammatory, hepatoprotective, immunoregulatory, and antiviral.
801
TOXICOLOGY I have not found information on the toxicity ofV. prunifolium or V. opulus.
Dose Dried herb The BHP listed 2.5-5 g and 2-4 g of the dried herb, three times per day, for v. prunifolium and V. opulus, respectively. Tincture The BHP listed 5-10 ml of 1:5 tincture (70% ethanol), three times per day, for V. prunifolium, and 5-10 ml of 1:5 tincture (45% ethanol), three times per day, for v. opuIus. When I use either V. prunifolium or v. opulus tincture in a combination with the tinctures of about five other herbs, the amount of Viburnum tincture in each 5-10 ml of the mixture is about 1- 2 ml. Initial dose Duration
Can start at the standard dose. No restrictions are known.
Cautions Western contraindications No adverse reports. Chinese contraindications V. prunifolium and V. opulus are not listed in the Chinese Herbal Medicine Dictionary. Pregnancy and lactation No adverse reports. Side effects According to Gladstar,22 there have been no reported cases of toxicity or side effects with V. prunifolium. Overdose According to Felter and Lloyd, large doses may sometimes produce nausea and vomiting. Interactions
No adverse reports.
Regulatory status Please read the Regulatory status section in the chapter on Safety. Both V. prunifolium (black haw) and v. opulus (cramp bark) are on the UK General Sale List, and are not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Viburnum is not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
Combining Western Herbs and Chinese Medicine
802
Traditional sources
• antispasmodic and analgesic • astringent and antihemorrhagic
___ ..
.' -
-- .. .........
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~-
• tranquilizer
PROPERTIES Temperature The tree that Gerard called Viburnum or Lantana was described as being cold and dry, but he was rather uncertain as to the identity of the plant. Tabernaemontanus described Lantana as cooling and drying. Viburnum prunifolium and V. opulus are not listed in the Chinese Herbal Medicine Dictionary. They are, however, classified in this book as neutral since I have not found either herb to be specifically warming or cooling in nature and since I use either herb for disorders that are warm, neutral, cool, or mixed in temperature. Taste
Taste in the mouth The BHP described both V. opulus and V. prunifolium as astringent and bitter. I found 1:5 tinctures in 25% .alcohol of both V. opulus and V. prunifolium to be slightly bitter and slightly sour.
Taste properties V. opulus and V. prunifolium are classified in this book as slightly bitter and slightly sour. The bitter taste may be associated with its tonic, antispasmodic, and calming actions; and the sour taste may be associated with its astringent and antihemorrhagic actions. ORGANS In terms of Chinese medicine, Viburnum, as used in the West, can be associated mainly with disorders of the Uterus system and to a lesser extent with disorders of the Heart or Lung systems: Organ
Examples of use
Source
Uterus
threatened miscarriage menorrhagia
Ellingwood 23 Felter and Lloyd
Heart
palpitations hysteria
Felter and Lloyd Christopher'
Lung
asthma
BHP
The Chinese Herbal Medicine Dictionary did not list V. opulus and V. prunifolium, but it did list the use of many Viburnum species, including diilO bai ye ( leaves, flowers, or root ofV. cylindricum), jia mi (stems and leaves ofV. dilatatum), and xln ye jia mi gen (the root ofV. cordifolium). The Chinese Herbal Medicine Dictionary did not list meridians entered for diilO bai ye or jia mi. Xln ye jia mi gen is listed as entering the Liver.
ACTIONS The following traditional actions are discussed:
The antispasmodic action of Viburnum is the primary action of this herb. and the astringent. antihemorrhagic. and tranquilizer actions are secondary actions. Whilst these three actions can have general application. for example in treating leg cramps, diarrhea, and palpitations, respectively. the specific use of these actions of Viburnum is for gynecological and obstetric problems. Antispasmodic and analgesic Depending on the initial condition of the uterine muscle, Viburnum can· act as a uterine tonic or as a uterine antispasmodic to treat: • dysmenorrhea • threatened miscarriage • postnatal pain
Dysmenorrhea
According to Felter and Lloyd. Viburnum can be used as a uterine tonic 'in weakened conditions of the body with feeble performance of the uterine functions: for example. dysmenorrhea with deficient menses. In terms of Chinese medicine. this can be described as dysmenorrhea of the Deficiency type with a combination of Uterus Deficient Qi and Blood as well as Uterus Stagnant Qi and Blood. Felter and Lloyd also wrote that 'in amenorrhea in pale, bloodless subjects, the menses are restored by it (Viburnum): and they also recommended Viburnum for spasmodic dysmenorrhea•.. especially with excessive flow, which could be described in terms of Chinese medicine as dysmenorrhea of the Excess type.
Threatened miscarriage Ellingwood gave a good practical description of the uses ofVibumum for the treatment of acute threatened miscarriage and for the prevention of habitual miscarriage. In the case of acute threatened miscarriage. he recommended doses of 1 dram (about 3.7 rnI) of Viburnum fluid extract every hour until the pain subsides or the flow ceases. The patient must be kept in a recumbent position and perfectly quiet. To prevent habitual miscarriage, he recommended giving Viburnum in occasional doses for one or more weeks before the time at which a previous miscarriage occurred. 'As the time approaches, the patient is kept quiet and free from excitement, and Viburnum is given 3-4 times daily. The interval is shortened to 1-2 hours with the first suspicious indications at the usual time: If no symptoms appear, Viburnum can be reduced to daily doses only for a week or two longer, but the patient should be advised to increase the doses immediately should signs of threatened miscarriage appear.
_
_...,;.~,-
Viburnum Postnatal pain Ellingwood recommended Viburnum in small doses as a 'partus praeparator' to prevent the problems of pregnancy and to facilitate a speedy and uncomplicated normal labor. He also used it to treat postnatal pains.
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f"'
L
Astringent and antihemorrhagic Ellingwood recommended Viburnum for sudden menstrual bleeding in young women associated with severe acute fever or prolonged lowgrade fever. Felter and Lloyd listed Viburnum for menorrhagia due to malaria. Both Ellingwood and Felter and Lloyd recommended Viburnum for postnatal hemorrhage, and Felter and Lloyd listed it for uterine hemorrhage associated with menopause, for chronic uterine inflammation, and for leukorrhea. Tranquilizer According to Ellingwood, Viburnum may directly influence the heart and can lower arterial pressure. He wrote that Viburnum, can be used for morning sickness and is specific for nervous conditions during pregnancy. Felter and Lloyd listed Viburnum for palpitations and wrote that it can be used for nervous disorders such as 'chorea, hysteria, hystero-epilepsy, petit mal, and paralysis agitans: but only when these troubles are associated with menstrual disorders. These conditions could be described, in terms of Chinese medicine, as Disturbance of Uterus Qi with Heart Spirit Disturbance and/or Liver Wmd. Summary Christopher listed V. opulus (cramp bark) for dysmenorrhea, menorrhagia, threatened abortion, all nervous disorders during pregnancy, and vomiting in pregnancy. He also recommended this herb for asthma, cramps, neuralgia, lockjaw, convulsions, and fits. The BHP listed V. prunifolium for asthma, dysmenorrhea, and threatened miscarriage, especially if the latter is accompanied by a rise in arterial tension. In addition, the BHP listed V. opulus as a partus praeparator and for menopausal menorrhagia. Both Christopher and the BHP listed V. opulus for enuresis. and Felter and Lloyd listed this herb for spasmodic contractions of the bladder.
COMPARISON OF WESTERN AND CHINESE USE OF VIBURNUM SPECIES Whilst V. prunifolium and V. opulus have had wide use in the West, especially to relieve uterine spasms, the species of Viburnum used in China appear to be of minor importance in Chinese medicine. In addition, there is remarkably little overlap between the uses of the Western and Chinese species of Viburnum. The Chinese Herbal Medicine Dictionary did not list diao bcii ye (from V. cylindricum), jia mt (from V. dilatatum), or xin ye jia mi gen (from V. cordifolium) for
803
dysmenorrhea, threatened miscarriage, or for asthma. Also, the secondary Western uses ofViburnum for uterine hemorrhage, and nervous palpitations, hysteria, or hypertension seem unknown for the Chinese species. The following uses are listed in the Chinese Herbal
Medicine Dictionary: • diao btii ye dry coughs, dysentery, arthritis, rashes food stagnation, roundworms • jid mi • xln ye jid mi gen arthritis, pain from external injuries None of these uses are emphasized in the West.
References 1. Gerard I. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publications. New York. New York (1975) 2. Tabernaemontanus IT. Krauterbuch (1731). Reprinted by Verlag Konrad Kolbl. Miinchen, Germany (1993) 3. Crellin JK, Philpott J. A Reference Guide to Medicinal Plants. Duke University Press, Durham. North Carolina (1990) 4. Felter HW. lloyd Ju. King's American Dispensatory. vols. 1 and 2. 18th edn. (1898). Reprinted by Eclectic Medical Publications. Sandy. Oregon (1983) 5. Grieve M. A Modern Herbal. vols. 1 and 2. Dover Publications, New York. New York (1971) 6. Chang H-M. But PP-H (eds). Pharmacology and Applications of Chinese Materia Medica. vols. 1 and 2. World Scientific Publishing. Singapore (1986) 7. Yeung H-C. Handbook of Chinese Herbs and Formulas. vol. 1. Institute of Chinese Medicine. Los Angeles, California (1985) 8. Bensky D. Gamble A. Chinese Herbal Medicine Materia Medica. Eastland Press. Seattle. Washington (1986) 9. Jiangsu New Medicine Institute et al. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science and Technology Press. Shanghai. China (1975) 10. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks. United Kingdom (1983) 11. Evans WC. Trease and Evans' Pharmacognosy. 14th edn. WB Saunders. London, United Kingdom (1996) 12. Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm. Stuttgart. Germany (1994), from 21'!d German edn. Wichtl M (ed),(1989)
13. Jarboe CH, Schmidt CM. Nicholson KA et al. Nature (London) 212:837 (1967) 14. Calle J. Toscano M. Pinzon R et al. J Ethnopharmacol 66(1):71-73 (1999) 15. Horhammer L, Wagner H, Reinhardt H et al. Z Naturforsch 22b:768 (1967) 16. Kim HK. Son KH. Chang HW et al. Arch Pharm Res 21(4):406-410 (1998)
Combining Western Herbs and Chinese Medicine
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17. Goel RK. Gambhir SS. Das Gupta G. Indian
J Med Res
88:192-196
22. Gladstar R. Herbal Healing for Women. Fireside. New York,""New York'~~.. .~
(1988) 18. Farah MH.Samueisson G. Planta Med 58(1):14-18 (1992)
23. Ellingwood F. American Materia Medica, Therapeutics and Pharma-
19. Liu J. J EthnopharmacoI49(2):57-68 (1995)
cognosy, 11th edn. (1919). Reprinted by Eclectic Medical Publications,
20. Ovodova RG, Golovchenko VV. Popov SV et al. Bioorg Khirn 26(1):61-
Sandy, Oregon (1994)
67 (2000) 21. Lin YM.Flavin MT.Schure R et al. PlantaMed 65(2):120-125 (1999)
:~-~.
(1993)
24. Christopher JR. School of Natural Healing. BiWorid. Provo, Utah (1976)
,-
... -.-.". .;.,,~
... ........ ~
. ...
-.
, ..
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Zanthoxylum Botanical name
Z. clava-herculis L. Family Rutaceae Pharmaceutical name
•
This herb is used in China mainly for digestive disorders with sensations of cold. Zanthoxyli cortex
Part dried bark English prickly ash German Eschenblattriges Gelbholz French bois piquant Mandarin Z. americanum Mill. and Z. clava-herculis L. are not used; hua jiao (1t.#.t) (chuan jiao) is the pericarp of Z. bungeanum Maxim. Use in the West Both Zanthoxylum americanum Mill. (Northern prickly ash) and Z. clava-herculis L. (Southern prickly ash) are used in herbal therapy. They are used mainly for circulatory or digestive disorders, either as the dried bark or as the dried mature fruit. Northern prickly ash grows in the North Eastern parts of the United States, and Southern prickly ash is found in the Southern states. Both species range in size from a shrub to a small tree. Zanthoxylum was one of the most important indigenous remedies used by the early Eclectics in the United States, but it was not known in Europe before the knowledge of its use was imported from America. It is not mentioned in Dioscorides, I Lonicerus.,z Tabernaemontanus,3 Culpeper,4 or Gerard.s Use in China
• Z. schinifolium Sieb. et Zucco (Z. mantschuricum Benn.)
Zanthoxylum americanum Mill. or
Comparison of bark and berries The pericarp of the fruit is often used in China/ but combinations of root, leaf, and seed have also been used. This is comparable to the tradition of use of combining bark and fruit in the West.8 Both the bark and berries are used in the West, and differences between the bark and berries are discussed in the Traditional sources section, under Taste and Actions. In this book, the bark of the Western species of Zanthoxylum is regarded as more acrid in property than the berries, and more effective for circulatory disorders. The berries are regarded as more aromatic than the bark, and more appropriate for flatulence or intestinal spasms, and for catarrhal conditions associated with accumulation of Spleen Damp and Phlegm.
What is special·about Zanthoxylum In terms of Chinese medicine, Zanthoxylum, as used in the West, can be said to be hot, acrid, aromatic, and bitter. It has its main effects on the Heart, Spleen, Stomach, and Intestines.
The Chinese Herbal Medicine Dictionarl
The key to understanding Zanthoxylum is that it can act as a circulatory stimulant, anticatarrhal, antirheumatic, and carminative to treat peripheral circulatory disorders and a variety ofconditions that may be associated with them.
entry for hua jiao can refer to either: • Z. bungeanum Maxim. (Z. bungei Planch. et Linden = Z. fraxinoides Hems!.)
805
806
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Combining Western Herbs and Chinese Medicine
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CHINESE ACTIONS
could increase production of saliva and gastric, intestinal;_~o"':.. pancreatic, and biliary secretions. Zanthoxylum was also .
In terms of Chinese medicine, Zanthoxylum, as used in the West, can be said to have three main actions:
seen as a warming antispasmodic for the intestines.
I. warm and move Qi and Blood to clear Cold II. clear Phlegm Cold III. .warm and move Qi of Stomach and Intestines Warm and move Qi and Blood to clear Cold In terms of Chinese medicine, Zanthoxylum can be said to warm and move Qi and Blood in the channels supplying the body surface, the extremities, and the Interior. Clear Phlegm Cold In terms of Chinese medicine, Zanthoxylum can be said to treat: • Phlegm Cold obstructing the channels in the muscles, joints, and body surface as observed in rheumatism, arthritis, and some chronic skin disorders • Phlegm Cold in the Stomach, Intestines, Gallbladder, or Bladder with excessive mucus secretion associated with Deficiency of the Qi and Yang of those organs Warm and move Qi of Stomach and Intestines Zanthoxylum can stimulate gastrointestinal function, and it can relax muscle spasms in the intestines.
Summary Each of the three main actions of Zanthoxylum is linked to its general warming and stimulatory effect: • stimulation oflocal and peripheral blood circulation • stimulation of atonic mucous membranes to normalize excessive mucus secretion • stimulation of secretion of saliva, digestive juices, and bile
WESTERN USES The Western uses of Zanthoxylum can be related to its three main Chinese actions: Chinese actions I. warm and move Qi and Blood to clear Cold
poor peripheral circulation. maybe with influenza. cardiac weakness, chronic fatigue syndrome, or chronic skin disorders
II. clear Phlegm Cold
rheumatism, obesity with edema
III. warm and move Qi of Stomach and Intestines
digestive weakness, flatulence, abdominal pain
WESTERN ACTIONS The main Western actions of Zanthoxylum are shown here in terms of its three main Chinese actions: Chinese actions
Western actions
I. warm and move Qi and Blood to clear Cold
circulatory stimulant mild warming diaphoretic
II. clear Phlegm Cold
warming anticatarrhal antirheumatic
III. warm and move Qi of Stomach and Intestines
carminative antispasmodic
Circulatory stimulant Zanthoxylum is a circulatory stimulant that is specific for treating poor peripheral circulation associated, in Chinese terminology, with Stagnation of Qi and Blood and obstruction of the channels by Cold and Phlegm. Anticatarrhal In the Eclectic tradition, Zanthoxylum was considered specific for excessive mucus secretion associated with poor circulation and weakness of the mucous membranes. Carminative and antispasmodic The Eclectic practitioners regarded Zanthoxylum as a warming carminative that
DIRECTION OF ENERGY Zanthoxylum can move Qi and Blood and clear obstruction by Cold and Phlegm in the Interior. It can also act as a diffusive circulatory stimulant and mild diaphoretic to direct the movement of Qi and Blood outward to the Exterior and to the extremities.
TYPICAL CASE EXAMPLE Signs and symptoms The patient is pale and lethargic; has sensations of cold in the hands and feet with occasional numbness or tingling; feels cold at the body surface; has recurring aches in the muscles aggravated by cold; has poor appetite; and sensations of cold in the epigastrium and abdomen that are aggravated by cold food and drinks. The pulse is slow and empty, especially in the Heart and Spleen positions; and the tongue is pale, flabby, and slightly purple. Diagnosis The patient has chronic Stagnation of Qi and Blood with accumulation of Cold in the channels, as well as a tendency to Wind Cold invasion of the body surface associated with weak surface circulation of Qi and Blood. There is also Deficient Qi of the Heart and Spleen, with Cold in the Stomach and Intestines.
-~,_.~
Zanthoxylum Choice of Zanthoxylum This herb is specific for chronic poor peripheral circulation associated with Stagnation and Deficiency of Qi and Blood. It is also specific for poor peripheral circulation accompanied by Wind Cold invasion of the body surface or invasion of Cold into the Stomach and Intestines.
LlinrtationsofZanthoxylum TEMPERATURE In this book, Zanthoxylum is classified as hot in temperature (see Traditional sources), but it is not as hot as Capsicum, for example. For extreme Cold patterns, Capsicum is more appropriate.
TASTE In this book, Zanthoxylum is classified as acrid, aromat,
._~
ic, and bitter. Acrid Zanthoxylum has been used as a diaphoretic, to warm the surface of the body and expel Wind Cold, but it is mainly used to warm the Interior and to increase the efficiency of circulation to the extremities. I consider the acrid circulatory stimulant action to be the primary function of Zanthoxylum. Aromatic _ Zanthoxylum, especially the berries, can be used to treat intestinal colic and flatulence when these are associated with Cold. It would not be appropriate for intestinal colic associated with Damp Heat. I consider the aromatic carminative action to be a secondary function of this herb.
cases of general debility, such as postfebrile recovery. However, I regard the tonic action as of secondary importance to the circulatory stimulant, anticatarrhal, and antirheumatic actions. Carminative and antispasmodic I do not usually use Zanthoxylum as a primary carminative and antispasmodic herb unless the digestive disorder is accompanied by poor peripheral circulation with sensations of cold in the extremities as well as in the epigastrium and abdomen. Hepatic and cholagogue I consider Zanthoxylum of secondary importance as a hepatic and cholagogue; it is used for Stagnation of Qi in the Liver or Gallbladder associated with Cold, Damp, and Phlegm. Anticatarrhal Zanthoxylum is specific for catarrhal states associated with patterns of Cold and Deficiency. Hydrastis would be more appropriate for catarrhal states associated with inflammation due to Damp Heat. In my opinion, Zanthoxylum is specific for rheumatism associated with Phlegm Cold obstruction of the channels and it can also be used for gastritis or prostatitis associated with Phlegm Cold. I do not use Zanthoxylum for Lung Phlegm Cold patterns since I do not consider that it is an important herb for the respiratory system. Alterative The cleansing action of Zanthoxylum on the blood, lymph, and tissue fluids may be a result of its circulatory stimulant, diaphoretic, anticatarrhal, and tonic actions, and of the proposed antiseptic action of the fruit. I do not use Zanthoxylum as a primary alterative but rather as a secondary herb to help to treat chronic lymph, skin, or joint disorders when these are associated with Deficiency, Stagnation, and Cold.
Bitter I consider the bitter taste to be of tertiary importance for Zanthoxylum, related to its tonic action on the digestive and hepatobiliary systems. However, the bitter constituents may contribute to the circulatory stimulant action.
Dermatological agent Zanthoxylum can be used for dermatological disorders from Stagnation of Qi and Blood associated with Cold, Damp, and Phlegm. It is not appropriate for skin disorders associated with Wind invasion, Deficient Blood, Damp Heat, or Heat in the Blood.
ACTIONS
Antirheumatic Zanthoxylum is not appropriate for arthritis or rheumatism associated with Wind Heat, Damp Heat, or Heat Toxin, but it can be used for these disorders when they are linked to Stagnation of Qi and Blood with Cold or Phlegm Cold. Zanthoxylum can also be used for mixed conditions of Heat and Cold if it is combined with cooling herbs in a suitable balance.
Circulatory stimulant Zanthoxylum is specific for poor peripheral circulation. It is not as effective a central circulatory stimulant as Capsicum, nor is it as effective a diffusive circulatory stimulant as Zingiber.
=
807
Diaphoretic Zanthoxylum is only a mild diaphoretic and is usually used for this purpose in combination with stronger diaphoretics, such as Capsicum or Zingiber. Tonic Zanthoxylum has a tradition of use as a tonic and stimulant to the digestive system so that it may be used in
Diuretic Although Zanthoxylum is not a major herb for the urinary system, it can be used for prostate or urination problems associated with Stagnation of Qi with Cold, Damp, and Phlegm.
Combining Western Herbs and Chinese Medicine
808
Zanthoxylum paired with other herbs Discussion of the limitations of each of the main actions of Zanthoxylum can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Zanthoxylum beyond its limitations. The basic unit of herb combination is the herb pair. Twelve pairings of Zanthoxylum are briefly explained below. CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair.
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peripheral circulation systems, and relieve pain. is cooling and Zanthoxylum is warming, this pair can be '.~~-~~:.;;~ used to treat neutral or mixed conditions. Zanthoxylum + Crataegus
Cardiac weakness + poor peripheral circulation Both Crataegus and Salvia miltiorrhiza, used in the previous pair, can move Stagnant Heart Blood and relieve pain. However, whilst Salvia can calm Disturbance of the Heart Spirit and treat restlessness and insomnia with sensations of Heat, Crataegus is more for Heart Deficient Qi with exhaustion. Crataegus combined with Zanthoxylum can be used to strengthen both the central and peripheral circulation, and can treat exhaustion with cardiac weakness and poor peripheral circulation for example, in chronic fatigue syn. drome.
Zanthoxylum + Cinchona
Recurringfever + myalgia Cinchona can clear Retained Pathogen and thus reduce recurring fever, and Zanthoxylum can move Stagnation of Qi and Blood in the Muscle channels to treat muscle ache and weakness. The two herbs can act as opposites in that Cinchona can clear Heat and Zanthoxylum can clear Cold in this mixed condition. The two herbs can also complement each other since Cinchona can strengthen the heart and Zanthoxylum can stimulate the peripheral circulation. Zanthoxylum + Populus
Muscle cramps Both herbs can be used to treat muscle cramps, postfebrile weakness, and chronic fatigue or fibromyalgia. Zanthoxylum is a warming antirheumatic, circulatory stimulant, and carminative, and Populus can act both as a cooling antirheumatic and as a neutral bitter digestive tonic. Zanthoxylum + Achillea
Postsurgical recovery After surgery and anesthetics, the central and peripheral circulation may be depressed, and warming circulatory stimulants can assist in the recovery. Zanthoxylum can be paired with Achillea to stimulate the circulatory and digestive systems, and to speed wound healing. This pair can also be used in the treatment of chronic fatigue syndrome and fibromyalgia. Zanthoxylum + Salvia miltiorrhiza
Angina pectoris + poor peripheral circulation Salvia and Zanthoxylum together can help to move Stagnation of Qi and Blood in both the coronary and
Zanthoxylum + Capsicum
Cold body + poor peripheral circulation Capsicum is a stronger central circulatory stimulant and a stronger diaphoretic than Zanthoxylum, but the two herbs are complementary: Capsicum can stimulate the coronary circulation, and Zanthoxylum can stimulate the peripheral circulation. Zanthoxylum + Zingiber
Influenza + poor peripheral circulation Although Zanthoxylum is not a primary diaphoretic,· both herbs are diffusive stimulants that together can clear Wind Cold to treat acute influenza as well as move Stagnation of Qi and Blood in the channels to treat chronic accumulation of Cold in the extremities. Zanthoxylum + Myrica
Poor peripheral circulation If Capsicum is more for cold in the interior and Zingiber is more for cold at the surface, Zanthoxylum is more for cold in the limbs and extremities. Both Zanthoxylum and Myrica are warming anticatarrhal herbs that can treat catarrhal disorders associated with Phlegm and Damp in the channels, such as catarrhal deafness, prostatitis, or amenorrhea. Zanthoxylum + Angelica archangelica
Arthritis + chronic bronchitis Both herbs are circulatory stimulant, anticatarrhal, and antirheumatic, and can be used for rheumatism or arthritis aggravated by Wind, Cold, and Damp. Zanthoxylum is the stronger circulatory stimulant, while Angelica is more drying since its anticatarrhal action is complemented by its
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Zanthoxylum diuretic effect. Angelica is also an expectorant that can treat Lung Phlegm. Therefore, this combination can be used for patients with a combination of circulatory, rheumatic, and bronchial disorders.
809
4. arthritis + cold extremities
Stagnant Qi and Blood + Cold in the channels
5. prostatitis + cold sensations
Stagnant Qi and Blood + Bladder Phlegm Cold
6. intestinal colic + cold extremities
Stagnant Qi and Blood Intestines Cold
Zanthoxylum + Juniperus
Arthritis Juniperus is a diuretic rather than a circulatory stimulant. However, Juniperus and Zanthoxylum can be combined to treat backache. rheumatism, and arthritis associated with Deficiency, Cold, and Damp. Juniperus has a reputation as a mild diuretic and can assist Zanthoxylum in the treatment of edema and other urinary disorders linked with Deficiency. Cold, and Damp. Zanthoxylum + Phytolacca
+
CAUTION
Before using any of the combinations below, it is important to be familiar with the cautions listedfor each herb in the combination. 1. Angina pectoris + cold sensations
Rheumatism + obesity
Heart Stagnant Blood + Heart Deftdent Yang
Phytolacca is an antirheumatic. anticatarrhal, and alterative herb, which can be combined with Zanthoxylum to treat rheumatism or arthritis associated with Stagnation of Qi and the accumulation of Damp and Phlegm. The patient may be overweight and very phlegmy with catarrhal deafness, sinusitis, bronchitis, chronic skin eruptions, aches, and a sensation of heaviness in the muscles and limbs. Zanthoxylum + Thuja
Herb Convallaria Crataegus Salvia mil. Zanthoxylum
Ratio
Temperature
Taste
1 1 1 1
neutral
bitter, 51. sweet
Both herbs are circulatory stimulant and anticatarrhal. and can be combined to treat Stagnation of Qi in the lower body associated with obstruction by Cold, Phlegm. and Damp. for example, prostatitis, amenorrhea, or cold, heavy aching sensations in the legs.
sour, sweet
cool
bitter
hot
acrid, aromatic, bitter
(bark) Panax gin.
0.5
sl. warm
sweet, sl. bitter
Lobelia
0.5
warm-cool
acrid
hot
acrid
Capsicum' 5-20 drops
Prostatitis
sl. warm
This combination is the same as Convallaria: angina pectoris + cold sensations and is discussed under that heading. The cautions for Convallaria should be observed. 2. Muscle cramps + cold extremities
Stagnant Qi and Blood + Deficient Blood
Zanthoxylum combinations
Herb
Six Zanthoxylum combinations are discussed below. All six of the conditions in this table involve Stagnation of Qi and Blood with Cold. Each of the six conditions is then made unique by having one or more additional Chinese syndromes. .
.
Combination,...,., . 1. angina pectoris + cold sensations
Chinese syndromes . Heart Stagnant Blood + Heart Deficient Yang
2. muscle cramps + cold extremities
Stagnant Qi and Blood Deficient Blood
3. chronic fatigue syndrome + cold extremities
Stagnant Qi and Blood + Deficient Qi and Blood
Zanthoxylum
Ratio
.. , Temperature Taste
1
hot
acrid, aromatic, bitter
Cinchona
1
cool
bitter
Populus
1
neutral-cool
bitter, sour
Angelica sin.
1
warm
sweet, aromatic, bitter
Viburnum
1
neutral
sl. sour, sl. bitter
Lobelia
0.5-1
warm-cool
,!crid
Zingiber
0.5-1
hot
Capsicum
5-20 drops hot
(bark)
acrid, aromatic acrid
GENERAL
+
This combination is for Stagnant Qi and Blood in the muscles associated with Deficient Blood and Cold. The overall temperature is warm. Although Cinchona and Populus are
Combining Western Herbs and Chinese Medicine
810
cool, they are specific for muscle cramps and are balanced by the other herbs in the combination, which are warming. The dominant taste properties are bitter and acrid; these are supported by the sweet and aromatic tastes. USE
• muscle cramps with poor peripheral circulation and sensations of cold PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of warm water. three times per day, with Capsicum given in a separate bottle so that the requisite number of drops of Capsicum can be added to each dose of the main medicine. It can be used for acute or chronic muscle cramps, and can be taken, with appropriate cautions. for 1 to 2 weeks. Once the cramps are reduced in frequency and severity, the combination can be changed to a more tonic combination.
GENERAL
This combination is for accumulation of Wind, Cold. and Damp in the channels of the joints, ten~ons, and muscles. It is associated with Stagnation of Qi and Blood and. with Deficient Blood. There may also be accumulation of some Damp Heat. Heat Toxin, or PWegm. The overall temperature is warm, although the two cool bitter herbs enable the combination to be used for mixed conditions of Cold with some Heat. The acrid and aromatic properties warm and move the Qi and Blood, and help to clear Wind, Cold, Damp, and Phlegm from the channels. The bitter, aromatic. and sweet properties combine to strengthen the capacity of the Spleen to make Blood, which in turn can help to prevent the entry of Cold into the channels. USE
• rheumatism or arthritis with poor peripheral circulation, and maybe catarrhal conditions, for example, sinusitis or bronchitis
3. Chronic fatigue syndrome + cold extremities
PRACTICAL NOTES
Stagnant Qi and Blood + Deficient Qi and Blood
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of warm water, three times per day, with Capsicum given in a separate bottle so that the requisite number of drops of Capsicum can be added to each dose of the main medicine. It can be used for acute or chronic conditions, and can be taken for 1 month, with appropriate cau-
Herb:.
Ratio
T~mperature
Taste
1 1
warm
acrid, sour, bitter
hot
acrid, aromatic,
Crataegus
1
sl. warm
sour, sweet
Angelica sin.
0.5-1
warm
sweet, aromatic, bitter
Panax qui.
0.5-1
neutral
sweet, sl. bitter
Glycyrrhiza
0.5
neutral-cool
sweet
Zingiber
0.5
hot
acrid, aromatic
Capsicum
5-20 drops
hot
acrid
Myrica Zanthoxylum (bark)
bitter
This combination is the same as Myrica: chronic fatigue syndrome + cold extremitietand is discussed under that heading.
tions, breaks. and modifications. When the symptoms are reduced or when remissions become more frequent, this combination can be used during the acute phase, and a more tonic combination is used during the remission phase.
Caution This combination is warming and can be rather drying. It is. therefore, important to monitor the patient for adverse signs of dryness or heat.
5. Prostatitis + cold sensations 4. Arthritis + cold extremities -
Stagnant Qi and Blood + Bladder Phlegm Cold
Stagnant Qi and Blood + Cold in the channels Herb Herb Zanthoxylum
Ratio 1
Temperature Taste hot
(bark) Populus Harpagophytum
1 1
neutral-cool cool
Zanthoxylum
acrid, aromatic,
(berries)
bitter
Myrica
bitter, sour
Thuja
bitter
Phytolacca
Angelica arc.
1
bitter, acrid, aromatic
Angelica sin.
1
warm warm
Equisetum
sweet, aromatic, bitter
Hydrangea
0.5
hot
acrid, aromatic
Zingiber
5-20 drops
hot
acrid
Capsicum
Zingiber Capsicum
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Ratio
Temperature
Taste
1
hot
acrid. aromatic.
1 1 1 1 1
warm
acrid, sour, bitter
warm-cool
acrid, aromatic, bitter
cool
acrid
bitter
cool
sl. bitter, sl. sweet
neutral
bitter, sour
0.5
hot
acrid, aromatic
5-20 drops
hot
acrid
Zanthoxylum
This combination is for Stagnation of Qi and Blood with accumulation of Phlegm Cold in the Bladder and reproductive system. The overall temperature is warm although there are cooling anti-inflammatory herbs in the combination. The acrid and aromatic tastes help to warm and move the Qi and Blood in the lower body, and they help to clear Cold, Damp, and Phlegm.
Capsicum given in a separate bottle so that the requisite number of drops of Capsicum can be added to each dose of the main medicine. It can be used for acute or chronic conditions, and can be taken for 1 month, with appropriate cautions, breaks, and modifications. When the symptoms are reduced or when remissions become more frequent, this combination can be used during the acute phase, and a more tonic combination can be used during the remission phase.
USE
Caution This combination is very warming and is not gen-
GENERAL
• nonmalignant prostatitis or prostate enlargement with urinary frequency or difficulty, and sensations of cold in the abdomen PRACTICAL NOTES
"'*
811
erally appropriate for patients with patterns of Heat. The patient should be monitored for increasing symptoms of heat when taking this combination.
COMPARISON OF THE SIX
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of warm water, three times per day, with Capsicum given in a separate bottle so that the requisite number of drops of Capsicum can be added to each dose of the main medicine. It is for chronic conditions and can be taken for 1 to 2 months, with appropriate cautions, breaks, and modifications.
ZANTHOXYLUM COMBINATIONS 1. Angina pectoris + cold sensations
2. Muscle cramps + cold extremities
Heart Stagnant Blood + Heart Deficient Yang
Stagnant Qi and Blood + Deficient Blood
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Herb,: ;.":, Ratio;
6. Intestinal colic + cold extremities
Stagnant Qi and Blood + Intestines Cold
1 Zanthoxylum (berries) 1 Myrica 1 Achillea 1 Crataegus 1 Commiphora 0.5 Glycyrrhiza 0.5 Zingiber 5-20 drops Capsicum
hot warm warm
acrid, aromatic, bitter acrid, sour, bitter acrid, bitter sour, sweet bitter, acrid sweet acrid, aromatic acrid
GENERAL
This combination is for Stagnant Heart Qi and Blood accompanied by Cold in Intestines and Stomach. The overall temperature is warm, and the dominant taste is acrid to warm and move Stagnation of Qi and Blood in the Heart, Intesines, and Stomach; the secondary taste is bitter to strengthen digestion. USE
• pain with sensations of cold in the epigastrium and abdomen, poor peripheral circulation PRACTICAL NOTES
This combination can be taken as 5 ml of 1:5 tincture in quarter of a cup of warm water, three times per day, with
Convallaria Crataegus Salvia mil. Zanthoxylum (bark) Panaxgin. lobelia Capsicum
1 1 1 1
zanthoxylum (bark) Cinchona Populus Angelica sin. Viburnum
1 1 1 1 1
0.5 0.5
lobelia Zlngiber Capsicum
0.5-1 0.5-1 5-20 drops
5-20 drops
1. In combination No.1, Convallaria, Crataegus, and Salvia are combined to move Stagnant Heart Blood and to relieve chest pain due to heart disease. Lobelia is included as an antispasmodic, combined with Capsicum to warm and strengthen the Heart Qi and Yang, which will assist the spreading of Stagnant Heart Qi and Blood in the coronary vessels. Zanthoxylum moves Qi and Blood in the peripheral vessels. 2. In combination No.2, Cinchona, and Populus combine with Zanthoxylum to treat muscle cramps, replacing Convallaria, Crataegus, and Salvia, which made the previous combination specific for angina. In combination No.2, Viburnum and Lobelia act as general antispasmodics, and Zanthoxylum, Angelica, Zingtber, and Capsicum combine to move Stagnant Qi and Blood and to clear Cold. Cinchona and Populus, both of which are bitter, and Angelica sinensis, which is sweet, combine to tonify the Blood.
&
Combining Western Herbs and Chinese Medicine
812
antirheumatic herbs Harpagophytum and Populus, pr~~t7:::-:
3. Chronic fatigue syndrome + cold extremities
4. Arthritis + cold extremities
Stagnant Qi and Blood + Deficient Qi and Blood
Stagnant Qi and Blood + Cold in the channels
.Herb.
.. Ratio
Myrica Zanthoxylum (bark) Crataegus Angelica sin. Panax qui. Glycyrrhiza Zingiber Capsicum
1 1 1 0.5-1 0.5-1
0.5 0.5
Herb _. zanthoxylum (bark) Populus Harpagophytum Angelica arc. Angelica sin. Zingiber Capsicum
Ratio. 1 1 1 1 1
0.5 5-20 drops
5-20 drops
3. Combination No.2 contains only one sweet tonic, Angelica sinensis, since the emphasis is more on relieving muscle spasms. Combination No; 3 contains four sweet tonics, Crataegus, Angelica, Panax. and Glycyrrhiza, to strengthen Heart Blood and Qi. Myrica, Zanthoxylum, Zingiber, and Capsicum combine to warm the Interior, the body surface, and the extremities. 4. All the herbs in combination No.4 can be used to treat arthritic and rheumatic disorders. Zanthoxylum, Angelica archangelica, Zingiber, and Capsicum make this combination appropriate for cases involving Wind, Cold, Damp, and Phlegm with poor peripheral circulation and sensations of cold. Harpagophytum and Populus can act as general-purpose antiarthritics for inflammation, pain, and immobility, but they are also specific for patterns involving Wmd Cold Damp and Damp Heat. They enable this combination to be used for mixed patterns of Cold and Heat. 5. Prostatitis + cold sensations
6. Intestinal colic + cold extremities
Stagnant Qi and Blood + Bladder Phlegm Cold
Stagnant Qi and Blood + Intestines Cold
Zanthoxylum (berries) Myrica Thuja Phytolacca Equisetum Hydrangea Zingiber Capsicum
1 1 1 1 1 1
0.5 5-20 drops
Herb ..
Ratio·
Zanthoxylum (berries) Myrica Achillea Crataegus Commiphora Glycyrrhiza Zingiber Capsicum
1 1 1 1 1
0.5 0.5 5-20 drops
5. In combination No.5, Zanthoxylum, Zingiber, and Capsicum combine to move Qi and Blood and to clear Phlegm Cold, similar to combination No.4. However, the
f::',?
in combination No.4, are absent here. In this combination, Thuja and Phytolacca are paired to clear Damp and Phlegm from the urinary and reproductive systems, assisted bY:-:.::'.2:~L Zanthoxylum berries, which may be more effective in clearing Spleen Damp than the bark. Equiseturn and Hydrangea are paired for prostatic and urinary inflammation. 6. Both combinations No.5 and No.6 contain Zanthoxylum berries, Myrica, Zingiber, and Capsicum. In combination No.6, the emphasis is on improving the central and peripheral circulation, so Achillea, Crataegus, and Cornmiphora have been added, and the herbs to treat urinary problems are absent. Zanthoxylum berries, Myrica, and Commiphora are acrid and bitter herbs, which combine to warm, stimulate, and tonify the Stomach. OTHER ZANTHOXYLUM COMBINATIONS Zanthoxylum bark Other combinations that contain Zanthoxylum bark include the following:
• Achillea: Atherosclerosis + hypertension + cold extremities .• Hamamelis: varicose veins • Smilax: chronic psoriasis • Thuja: amenorrhea + catarrhal cOJ.ditions ,
.~-._"
.
-..
Zanthoxylum berries Other combinations that contain .....:.;.;.;::. Zanthoxylum berries include the following: .'-
• Angelica: depression + obesity • Angelica: sinusitis + obesity • Euphrasia: catarrhal deafness • Ruta: infertility + obesity
Research CONSTITUENTS The following constituents have been reported: • alkaloids .lignans • coumarins • essential oil • other Alkaloids The main alkaloid in the stem bark of Z. clava~ herculis is chelerythrine, with nitidine and temberatine also being present.9 The root bark contains the alkaloids mag10 noflorine, lauriflorine, candicine, and tembetarine.
r I
I
Zanthoxylum Lignans Z. clava-herculis has been reported to contain 0.3% of the lignan asarinin. " Seven lignans were isolated from the leaves of Z. naranjillo. 12 Coumarins These chemicals are present in Z. arnericanum but appear to be absent from Z. clava-herculis. 1o Twenty two coumarins were reported in the root bark of Z. schinifolium. '3 Essential oil The root bark of Z. clava-herculis contains essential oil as a minor constituent. The fruit of Z. bungeanum have been reported to have 0.7-9% essential oil, containing geraniol, limonene, and cumie alcohol. H Other The bark of Z. clava-herculis also contains the cinnamarnide herclavin (c. 0.4%), the polyenearnide neoherculin (c. 0.025%), \I tannins, and resins. IS
PHARMACOLOGICAL AND CLINICAL RESEARCH The following effects have been reported for Zanthoxylum species:
i"i L.
i
L
• antimicrobial • antiparasitic • anti-inflammatory • antispasmodic and analgesic • antiplatelet aggregation • antilactation • antitumor
Anti-inflammatory Chelerythrine has demonstrated antiinflammatory activity in rats. 16 Antispasmodic and analgesic Intramuscular injection of an extract of Z. bungeanum was reported to be effective in relieving abdominal pain in cases of ulcers, gallbladder disease, and intestinal spasms. 14 Tetrahydroberberine, isolated from the fruit of Z. integrifoliolum, was reported to have a weak vasorelaxing effect on norepinephrine-induced contraction of rat aorta. 19 Antiplatelet aggregation A series of studies from Taiwan has investigated the antiplatelet activity of Zanthoxylum constituents. Chelerythrine chloride from Z. simulans showed inhibitory effect on rabbit platelet aggregation and release reaction, perhaps due to inhibition of thromboxane formation and phosphoinositides breakdown. 20 Three indolopyridoquinazoline alkaloids from the fruit of Z. integrifoliolum 21 and terpenyl-coumarins and furoquinolines from Z. schinifolium 13 exhibited antiplatelet aggregation in vitro. Antllactation It has been reported that extracts of the fruit of Z. bungeanum have reduced or stopped milk flow in mothers who are 1 or 2 days postnatal. 14 Antitumor It was reported that the essential oil from Zanthoxylum increased levels of carcinogen-metabolizing enzymes in mice. 22
Antimicrobial
RESEARCH VERIFICATION OF
Antibacterial Chelerythrine was reported to have antibacterial effect against Gram-positive bacteria, for example, Staphylococcus aureus and two strains of Streptococcus. 16
TRADITIONAL ACTIONS
Antifungal Extracts of Zanthoxylum were reported to 17 inhibit the aflatoxin production of Aspergillus parasiticus.
It has been claimed that extracts of Z.leprieurii and Z. xanthoxyloides inhibited the in vitro growth of Candida albicans and other fungi to varying degrees,ts and chelerythrine 16 has shown an inhibitory effect against Candida albicans. Antiprotozoal The lignan (- )-methylpluviatolide was reported as highly active in vivo against the bloodstream forms of two strains of Trypanosoma cruzi, but it was noneffective against the tissue forms of the parasite. '2
Antiparasitic Extracts of the fruit of Z. bungeanum have been reported to have an effect against both schistosomiasis and pinworm, and geraniol, a constituent of the essential oil of Z. bungeanum. has been reported to kill roundworms in guinea pigs. H
813
From the research summarized above, the only traditional actions that are supported by research are the antispasmodic and carminative actions. Additional effects demonstrated by research The following additional effects have been reported: antibacterial, antifungal, antiprotozoal, anti-inflammatory, antiplatelet, antilactation, and antitumor.
TOXICOLOGY I have not found any accounts of adverse effects from taking a tincture, infusion, or decoction of the bark or fruit of Z. americanum or Z. clava-herculis. Nor have I found toxicological information on these herbs. The fruit of the Zanthoxylum species used in China are contraindicated for Deficient Yin patterns with Heat signs, and caution is suggested with the use of this herb in preg-
814
Combining Western Herbs and Chinese Medicine i
"1
nancy. Isolated constituents from Z. simulans, Z. integrifolialum, and Z. schinifolium have been reported to have inhibitory effect on platelet aggregation, but I have not found any report of antiplatelet activity for Z. americanum or Z. clava-herculis.
Dose Dried herb per day.n
The BHP listed 1-3 g of dried bark, three times
Tincture The BHP listed 2-5 ml of 1:5 tincture in 45% alcohol, three times per day. However, in a combination of between five to eight herbs, I generally include about 1 ml of Zanthoxylum in each individual dose.
Initial dose Can start at the standard dose, providing cautions are observed. Duration Can be used up to 1 to 2 months, providing cautions are observed.
Cautions
Traditional sources BARK AND BERRIES In the West, both bark and berries-are used. There is difference of opinion as to whether there is a significant difference in the actions of the bark and the berries, and difference of opinion as to the specific indications of each. According to Felter and Lloyd, the berries are more carminative and antispasmodic, and are preferred to the bark for flatulence and intestinal colic. They wrote that the bark is specific for lack of secretion in any part of the intestinal tract. Christopher24 considered the berries to be more effective in general due to their essential oil content. According to the BHP, the berries are similar to the bark in their actions and indications, but are more active in circula-: tory disorders. In this book, Zanthoxylum bark is considered to be more effective as a warming circulatory stimulant, due to its more -- -- -. -_. -acrid taste in the mouth, and the berries are considered to have a stronger carminative and antispasmodic action, due to their more aromatic taste. The bark has therefore been included in combinations such as Zanthoxylum: arthritis + cold extremities, whilst the berries have been included in such combinations as Zanthoxylum: intestinal colic + cold extremities.
Western contraindications None reported. Chinese contraindications Contraindicated for patterns of Deficient Yin with Heat. 14 I use it with caution in all Heat patterns. Pregnancy and lactation To be used with caution during pregnancy.14 Side effects
None reported.
Overdose No adverse reports. Interactions No adverse reports.
Regulatory status Please read the Regulatory status section in the chapter on Safety. Zanthoxylum (prickly ash) is on the UK General Sale List (Statutory Instrument Order 1977 No: 2129 to the Medicines Act 1968). It is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. Zanthoxylum is not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
PROPERTIES Temperature Lyle 25 wrote that the bark of Z. americ;uiUiii"~<"":"-~" warms the stomach and can be used for coldness of the skin and extremities. In Chinese medicine, the fruit of the Zanthoxylum species (hua jiao) are classified as hot in temperature."14 I have classified the bark and berries of the Zanthoxylum species used in the West as hot since this book does not include a temperature category between hot and warni. If it did, then Zanthoxylum would be a suitable exemplar of this category. In my opinion, Zanthoxylum is not as hot as Capsicum, Zingiber, or good quality Cinnamomum bark, which are graded as hot, but it is more warming than Angelica archangelica or Myrica, which are classified as warm. Taste Taste in the mouth The BHP recorded both the bark and the berries of Zanthoxylum as pungent and bitter. Comparing 1:5 tinctures of Zanthoxylum bark and berries, both in 25% alcohol, I found that:
• both tasted acrid, but the bark was more acrid than the berries, leaving a tingling sensation and a somewhat clove-like taste on the tongue
.
Zanthoxylum • both smelled and tasted aromatic, but the berries smelt and tasted considerably more aromatic than the bark • both tasted bitter, especially the bark • the berry tincture tasted salty and sweet, but the bark did not When I chewed a sample of the dried cut bark I found it less bitter but more strongly acrid than the bark tincture, with a stronger tingling sensation on the tongue. It also increased salivation.
;:;:.'
Taste properties Both the bark and the berries of the Western species of Zanthoxylum are classified as acrid, aromatic, and bitter in this book. I consider acrid to be the dominant property, associated with the warming, circulatory stimulant action of this herb; aromatic to be a secondary property, associated with the carminative and anticatarrhal actions; and bitter to be a tertiary property, associated with a tonic effect o~.the digestive and hepatobiliary systems. The fruit of the Zanthoxylum species used as hua jiao in Chinese medicine are classified as acridY~ ORGANS
\~
-,
~ ..
In terms of Chinese medicine, Zanthoxylum, as used in the West, can be associated mainly with disorders of the following organs: Organ
Examples ()f use
Heart
tonifies the heart, overcomes blood stasis peripheral circulatory and rheumatic conditions
Ellingwood 26
Spleen, Stomach
warms the stomach increases digestive secretions
Lyle Felter and Lloyd
Intestines
flatulence
Felter and Lloyd
Liver, Gallbladder
increases biliary secretion, liver problems
Felter and Lloyd Christopher
BHP
Range of opinion in Chinese texts There is considerable variation of opinion in Chinese texts on the channels entered by Zanthoxylum (hua jiao). Taken together, the four texts discussed in the Chinese Herbal Medicine Dictionary listed the channels as the Spleen, Lung, Liver, Heart, Pericardium, Kidney, and the right Kidney (ming men). A discussion of this concept of the right Kidney follows in the subsection on the diuretic action below. ACTIONS Changing traditions of use More recent British texts, such as the BHP and BHC, emphasized the circulatory stimulant
815
action rather than the carminative action of Zanthoxylum. However, older American texts, such as Ellingwood as well as Felter and Lloyd, gave greater emphasis to the carminative action than to the circulatory stimulant action of this herb. The use of the fruit of Zanthoxylum species fur abdominal pain is common to both the Eclectic and Chinese traditions. Evidence from Western traditional sources for the following actions of Zanthoxylum are discussed below: • circulatory stimulant • diaphoretic • tonic • carminative and antispasmodic • hepatic and cholagogue • anticatarrhal and alterative • dermatological agent • antirheumatic • diuretic Circulatory stimulant For7 recommended Zanthoxylum for cold hands and feet, and Lyle stated that it assists capillary and arterial circulation. Felter and Lloyd listed it for sluggish circulation and wrote that it increases cardiac action and slightly accelerates the pulse. According to Ellingwood, it directly tonifies the heart, mildly stimulates the capillary circulation of the entire body, and overcomes blood stasis and congestion. Christopher listed Zanthoxylum as a cardiac stimulant for sluggish circulation and cold extremities. Priest and Priesf8 described Zanthoxylum as a positive diffusive stimulant that assists arterial and capillary circulation and restores vascular tone. The BHP and the BHC19 listed Zanthoxylum as a circulatory stimulant for intermittent claudication and Raynaud's syndrome. Diaphoretic Zanthoxylum is listed by some texts, such as Christopher and the BHP, as a diaphoretic, but this has not been a primary traditional use of this herb in the West. It can be included in combinations for influenza with sensations of cold, but it is used especially for influenza where there is a background of chronic poor peripheral circulation. Tonic According to Ellingwood, Zanthoxylum is a stimulant to the nerve centers and through these centers increases the activity of the different organs. He recommended it as a digestive tonic and included it in a combination for recuperation after debilitating fever. Felter and Lloyd wrote that Zanthoxylum can increase the flow of saliva and of gastric, intestinal, and biliary secretions. They recommended it for dryness of the mouth and as a gastrointestinal tonic. Carminative and antispasmodic According to Felter and Lloyd, the berries of Zanthoxylum are more carminative and antispasmodic than the bark. They recommended the berries
816
Combining Western Herbs and Chinese Medicine
for flatulence. intestinal pain. and as an aid in restoring the bowels to normal after severe attacks of dysentery. Christopher listed Zanthoxylum for flatulence. colic, and diarrhea. Felter and Lloyd also listed Zanthoxylum for dysmenorrhea. According to the Chinese Herbal Medicine Dictionary. hua jiao (Zanthoxylum species) can treat postnatal abdominalpain.
ciency Cold in the Lower Burner since this herb can enter the right Kidney (ming men) to tonify the Ministerial Fire and thus secure the Essence. This herb can also treat urinary frequency due to declining Yang. with weak limbs and chronic diarrhea.
Hepatic and cholagogue Felter and Lloyd reported that Zanthoxylum can increase biliary secretion. and Christopher wrote that it can treat liver problems.
USE OF ZANTHOXYLUM SPECIES
Anticatarrhal and alterative Felter and Lloyd listed Zanthoxylum for gastric or biliary catarrh and wrote that it is specific for catarrhal states arising from weakness of the mucous membranes. Christopher listed this herb as a deobstruant and recommended it for removing obstructions in every part of the body. Felter and Lloyd wrote that Zanthoxylum berries can have antiseptic action and listed it as an alterative for syphilis. Christopher stated that Zanthoxylum has antiseptic and alterative action. and listed it for syphilis. Fox noted its use for gonorrhea. Dermatological agent According to Felter and Lloyd. Zanthoxylum assists in bringing rashes to the surface in eruptive diseases since it can move blood stasis and overcome capillary engorgement. Ellingwood wrote that it was used as an alterative to treat scrofula and some cases of chronic skin disorder from 'disordered blood.' I use Zanthoxylum in combinations for chronic skin disorders with purple lesions that are resistant to treatment, such as psoriasis of the Stagnant Blood type. Antirheumatic Ellingwood wrote that Zanthoxylum can be used as an antirheumatic due to its stimulating diaphoretic and tonic effects. In fact. the antirheumatic action of this herb may be linked to a combination of its circulatory stimulant. diaphoretic. tonic, anticatarrhal, and alterative actions. Felter and Lloyd listed Zanthoxylum for rheumatism in debilitated patients, neuralgic pains in anemic and weak people, lumbago, myalgia, and muscular rheumatism. The BHP stated that Zanthoxylum is specific for weak peripheral circulation with rheumatic disorders. I use it for rheumatism or arthritis associated with Stagnation of Qi and Blood with obstruction of the channels by Cold, Damp. and Phlegm. Diuretic According to Felter and Lloyd, Zanthoxylum can activate the kidneys and increase urination, and Christopher listed it as a diuretic for dropsy.
Concept of the right Kidney (ming men) According to one source cited by the Chinese Herbal Medicine Dictionary. hua jiao (Zanthoxylum) can treat spermatorrhea from Defi-
COMPARISON OF WESTERN AND CHINESE
Circulatory stimulant In terms of Chinese medicine. the circulatory stimulant action can be said to be associated with both moving Stagnant Qi and Blood as well as clearing obstruction from Cold. Damp, and Phlegm. The species of Zanthoxylum used in the West have a tradition of use for: • peripheral circulatory disorders, including Raynaud's disease and intermittent claudication • the following disorders when accompanied by poor peripheral circulation: influenza, cardiac weakriess: .... chronic fatigue syndrome. muscle cramps or aches. rheumatism or arthritis. chronic skin disorders. obesity with edema There does not seem to be a comparable tradition of use in China. Antirheumatic In terms of Chinese medicine. the antirheumatic and antiarthritic action can be said to be associated with the herbs ability to move Stagnant Qi and Blood. and clear Cold, Damp. and Phlegm from the channels. The Zanthoxylum species used in the West have been used for acute or chronic rheumatism (including arthritis) associated with both exposure to wind. cold, or damp, and with chronic circulatory weakness. Whilst some texts of Chinese medicine published in the West did not list Zanthoxylum for bi syndromes/' 14 some of the texts reported in the Chinese Herbal Medicine Dictionary listed hua jiao for Wind Cold Damp bi. Dermatological agent Zanthoxylum, as used in the West. can be said to move Stagnant Qi and Blood. and to clear Cold. Damp. and Phlegm from the channels. It is also used to assist in bringing rashes to the surface in eruptive disorders and to treat chronic skin disorders. Hua jiao has been used 6 as an external wash for itching in eczema14 and for scabies. Carminative and antispasmodic The main use of the Zanthoxylum species in China is to warm, move, and regulate the Qi of the Spleen, Stomach, and Intestines. to treat epigastric and abdominal disorders, and to alleviate pain due to Cold. Whilst the old Eclectic use of the Western species of Zanthoxylum was almost identical to the Chinese
817
Zanthoxylum use. the main recent use of the Western species in Britain has been for circulatory disorders. Antiparasitic The Chinese use of Zanthoxylum species for treating roundworm or pinworm infestations does not seem to have a counterpart in the West.
12. Bastos JK, Albuquerque S, Silva ML Planta Med 65(6) :541-544 ( 1999) 13. Tsai
rr.. Lin WY, Teng CM et al. Planta Med 66(7):618-623 (2000)
14. Bensky D, Gamble A. Chinese Herbal Medicine Materia Medica. Eastland Press, Seattle (1986) 15. Leung AY [nO) (1980) [cited in: Bradley PR (ed). British Herbal Compendium, vol 1. British Herbal Medicine Association, Boumemouth, United Kingdom (1992)) 16. Lenfeld (1981)
References 1. Dioscorides P. Kreutterbuch (1610). Reprinted by Verlag Konrad Kolbl, Miinchen, Germany (1960) 2. Lonicerus A. Kreuterbuch (1679). Repr'J1ud by \"erlag Konrad Kolbl, Miinchen, Germany (1962) 3. Tabernaemontanus JT. Krauterbuch (1731). Reprinted by Verlag Konrad Kolbl. Miinchen. Germany (1993) 4. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks. Glenwood,lllinois (1990) 5. Gerard J. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publications. New York, New York (1975) 6. Jiangsu New Medicine Institute. Chinese Herbal .Medicine Dictionary (Zhong yao da ci dian) Science and Technology Press, Shanghai, China (1975) 7. Yeung H-C. Handbook of Chinese Herbs and Combinations, vol. 1. Institute of Chinese Medicine, Los Angeles, California (1985) 8. Felter HW, Lloyd JU. King's American Dispensatory, vols. 1 and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1983) 9. Fish F,Waterman PG. J Pharm Pharmac Suppl25:115-116 (1973) 10. Fish F, Gray AI, Waterman PG et al. Lloydia 38:268-270 (1975) 11. Crombie L J Chern Soc 995-998 (1955)
~.
J. KroutH
M, Marsalek E et al. Planta Med 43(2):161-165
17. Hitokoto H, Morozumi S, Wauke T et al. Mycopathologia 66(3):161167 (1979) 18. Ngane AN, Biyiti 1, Zollo PH et al. J Ethnopharmacol 70(3):335-342 (2000) 19. Chen IS, Chen n, ChangYL et al. J Nat Prod 62(6):833-837 (1999) 20. Ko FN, Chen IS, Wu SJ. Biochim Biophys Acta 1052(3):360-365 (1990) 21. Sheen WS, Tsai lL, Teng CM et al. Planta Med 62(2):175-176 (1996) 22. Banerjee S, Sharma R, KaleRK et al. Nun Cancer 21(3):263-269 (1994) 23. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983) 24. Christopher JR. School of Natural Healing. )3iWorld, Provo, Utah (1976)
n.
25. Lyle Physio-Medical Therapeutics. Materia Medica and Pharmacy. Originally published Ohio (1897). Reprinted by the National Association of Medical Herbalists of Great Britain, United Kingdom (1932) 26. Ellingwood F. American Materia Medica, Therapeutics and Pharmacognosy, 11th edn (1919). Eclectic Medical Publications, Sandy, Oregon (1994) 27. Fox W. The Working Man's Modd Family Botanic Guide to Health, 7th edn. William Fox, Sheffield, United Kingdom (1878) 28. Priest AW, Priest LR. Herbal Medication. L.N. Fowler, Rornford Essex, United Kingdom (1982) 29. Bradley PR (ed). British Herbal Compendium, vol 1. British Herbal Medicine Association, Boumemouth, United Kingdom (1992)
~,'
1-,
Zingiber
-
10--'
Botanical name Zingiber officinale Roscoe Family Zingiberaceae Pharmaceutical name Zingiberis rhizoma Part dried or fresh rhizome: see below English ginger German Ingwer French gingembre Mandarin shengjiang (.1.4) is the fresh rhizome of Z. officinale; gan jiang i-) is the dried rhizome of Z. officinale
(+
Use in the West Zingiber may have originated in India, but it is now cultivated in many countries with a subtropical to tropical climate and grows well where the rainfall is at least 2 m per year. Since the plant is sterile, it is grown by propagation of the rhizomes. I Zingiber has been used as a spice and a medicine since ancient times, not only in India and China, but also by the Greeks and Romans. In the 1st century AD, Dioscorides 2 described Zingiber as a warm herb that helps the digestion, soothes the stomach and abdomen, and can be used in herbal combinations as an antidote for poisons. Zingiber was known in England by the 11th century, but as Gerard3 wrote 'ginger is most impatient of the coldness of our Northern regions: and he found that when he planted it in his garden 'in winter it perished both blade and root: The Spaniards introduced Zingiber to the West Indies (and also to America), and in 1547, they exported about 200 tons of Zingiber to Europe. 4 Jamaican Zingiber is still considered to be the best variety, but with world production of Zingiber now estimated at about 100,000 tons per year, the supply of Jamaican Zingiber is limited. 5
Lyle6 described Zingiber as one of the most useful agents in the materia medica, and Tierra7 called it one of the most versatile of herbs. Zingiber has many uses in herbal therapy, and since it is often used to enhance or moderate the actions of other herbs, or to reduce potentially toxic effects, it may well be the most used herb in the Western, Ayurvedic, and Chinese herbal systems. Use in China In Chinese medicine, both fresh Zingiber (sheng jiang) and dried Zingiber (gan jiang) can be used to treat chronic phlegmy cough due to Lung Phlegm Cold or vomiting due to Stomach Cold. However, fresh Zingiber is considered to be more appropriate for disorders involving invasion of the surface of the body by Exterior Wind Cold, especially when there is Deficiency at the surface. Dried Zingiber is considered to be more specific for disorders involving Interior Cold associated with Lung or Stomach patterns, or with the Collapse ofYang.8 Comparison of fresh and dried Zingiber Differences in the components of fresh and dried Zingiber are discussed in Research: constituents. Differences in the actions and uses of fresh and dried Zingiber are discussed in Traditional sources.
What is special about Zingiber In terms of Chinese medicine, Zingiber, as used in the West, can be said to be a hot, acrid, and aromatic herb that has its main effects on the Lung, Spleen, Stomach, Intestines, Uterus, and the Muscle channels.
819
Combining Western Herbs and Chinese Medicine
820
The key to understanding Zingiber is that it can have many herbal actions, including: • enhance, moderate, or detoxify other herbs • warm, stimulate, andyet relax organ systems • disperse Stagnation, Cold, Damp, and Phlegm • disperse Stagnation and Heat
.- -:- :;:i7:~~::'~ ..
WESTERN USES The Western uses of Zingiber can be rdated to its ten main Chinese actions: -- ..__...._- _.__.-. ---_._._----+---._.. ,
-,~
,"
Chinese actions· I. modify the actions of other herbs
moderation of other herbs and combinations
CHINESE ACTIONS
II. clear Wind Heat
acute respiratory disorders with fever
In terms of Chinese medicine, Zingiber, as used in the West, can be said to have the following main actions:
III. clear Wind Cold
colds, influenza
IV. clear Lung Phlegm Cold
acute or chronic phlegmy cough
V. tonify and move Heart Qi
poor peripheral circulation
I. II. III. IV. V. VI. VII. VIII. IX. X.
modify the actions of other herbs clear Wind Heat clear Wind Cold clear Lung Phlegm Cold tonify and move Heart Qi clear Stomach Cold calm Rebellious Stomach Qi regulate Intestines Qi move Uterus.Qi and Blood calm Liver Hyperactive Yang and Heart Spirit Disturbance
VI. clear Stomach Cold
atonic digestion
VII. calm Rebellious Stomach Qi
nausea, vomiting
VIII. regUlate Intestines Qi
flatulence, intestinal colic, diarrhea, constipation
IX. move Uterus Qi and Blood X. calm Liver Hyperactive Yang and Heart Spirit Disturbance
dysmenorrhea, amenorrhea headache, insomnia, restless anxiety, irritability with depression
DIRECTION OF ENERGY WESTERN ACTIONS The main Western actions of Zingiber are shown here in terms of its ten main Chinese actions: Chinese actions
Western actions '"
I. modify the actions of other herbs
enhancer moderator antitoxin
II. clear Wind Heat
diaphoretic antipyretic
III. clear Wind Cold
diaphoretic circulatory stimulant
IV. clear Lung Phlegm Cold
V. tonify and move Heart Qi
expectorant anticatarrhal antitussive circulatory stimulant
VI. clear Stomach Cold
carminative digestive stimulant
VII. calm Rebellious Stomach Qi
antiemetic
VIII. regulate Intestines Qi
carminative antispasmodic antidiarrheal laxative
IX. move Uterus Qi and Blood X. calm Liver Hyperactive Yang and Heart Spirit Disturbance
circulatory stimulant emmenagogue tranquilizer diaphoretic
Fresh Zingiber Fresh Zingiber in hot infusion or decoction can assist the outward dispersal through the surface of:' • Wind Cold in the Exterior • Interior Cold or Heat associated with Stagnant Qi in the Interior Dried Zingiber Dried Zingiber in hot infusion or decoction can have a similar, if lesser effect, and can also warm and move Qi and Yang in the Interior.
TYPICAL CASE EXAMPLE Signs and symptoms The patient has a tendency to recurring influenza, especially when exhausted, that ends in lingering cough with bronchial phlegm. She has chronic sensations of cold in the surface of the body and in the upper and lower abdomen, with poor digestion, flatulence and abdominal pain. She has a tendency to have delayed menstruation and dysmenorrhea. The pulse is tight but empty in the superficial depth, and slippery and slightly wiry in the middle depth, especially in the Lung and Stomach positions. The tongue is pale, slightly purple, flabby, and with a slight greasy white coat. Diagnosis
The patient has Deficient Qi in the body surface
..,...
l·"i
Zingiber
! .
with recurring invasions of Wind Cold, which then progress to Lung Phlegm Cold. She also has Deficiency, Stagnation, and Cold in the Stomach, Intestines, and Uterus. Choice of Zingiber This herb is specific for: • Wind Cold invasion with Deficiency of surface Qi • Lung Phlegm Cold • Deficiency, Stagnation, and Cold in the Stomach and Intestines • Deficiency, Stagnation, and Cold in the Uterus
Limitations of Zingiber TEMPERATURE In this book, Zingiber is classified as hot, but for very cold conditions it can be replaced by or combined with the hotter herb Capsicum. Fresh Zingiber has a dispersive and diffusive action, and although it is specific for clearing Exterior or Interior Cold it can. in certain circumstances and in a hot infusion, also be used for clearing Interior Heat associated with Deficiency and/or Stagnation.
TASTE Zingiber is essentially an acrid herb to warm the Exterior (especially fresh Zingiber) or the Interior (especially dried Zingiber). It also has aromatic property in that it can help to disperse and to transform Phlegm, and to regulate smooth muscle tone and peristalsis. Fresh Zingiber can also be said to have a sweet tonic action on the surface Qi, but it is not generally used as a sweet tonic for the Qi of the Interior. ACTIONS Agent for other herbs Zingiber can act as an antitoxin, enhancer, or moderator for certain other herbs; see Tradi-
tional sources. Diaphoretic Fresh Zingiber ina hot infusion or decoction can act as a diffusive diaphoretic to clear Wind Cold and, in certain circumstances, to clear Wind Heat. However, its diaphoretic action is not combined with an alterative or bitter tonic action, as in the case of.Achillea, or with an astringent action, as in the case of Salvia. Expectorant Zingiber is an expectorant that is specific for patterns ofLung Phlegm Cold with white sputum and is not usually appropriate for cough associated with Lung Phlegm Heat and Dryness.
821
Circulatory stimulant and antirheumatic Unlike Capsicum, Zingiber does not have such a strong effect on coronary and internal circulation. Fresh Zingiber. especially, is more effective as a diffusive circulatory stimulant to warm the surface. Unlike Zanthoxylum, Zingiber does not have such a strong effect on peripheral circulation or on rheumatoid or arthritic conditions, but it is a useful complement to the action of Zanthoxylum. Digestive stimulant The combination of the acrid, aromatic, sweet, and bitter tastes make Zingiber a useful stimulant and tonic for the digestive system, especially in cases of Deficiency and Stagnation combined with Cold. It may not be suitable for Stomach patterns involving Heat. Antiemetic Zingiber can be an effective antiemetic, but, again, it is more for cold, cool, or neutral patterns, and may not be appropriate for warm or hot conditions. Carminative Zingiber is one of the most used carminative herbs for flatulence, borborygmus, and abdominal pain. However, it is used specifically for patterns associated with Cold. Anti-inflammatory In Chinese medicine, fresh Zingiber (sheng jiang) is combined with Ziziphus (da zao) to reduce potential gastrointestinal irritation from other herbs. Recent research has supported its role as a gastrointestinal antiinflammatory, providing it is used within therapeutic doses. Above this level, it may aggravate gastrointestinal irritation, see Pharmacological and clinical research. Antipyretic Fresh Zingiber can be used to treat febrile conditions, especially when the fev:er are accompanied by chills, as in Wind invasion. Hot infusions or decoctions of fresh Zingiber may also be used to disperse out to the surface Interior Heat that is associated with Deficiency Heat or Stagnation, relieving some cases of headache, insomnia, anxiety, or frustration and depression. However, this needs to be
done with caution since inappropriate use has the risk of aggravating the condition. Tranquilizer In some cases of Liver Hyperactive Yang with Liver Stagnant Qi, associated with nervous tension. muscle tension, headache, irritability, and depression, fresh Zingiber can help to move Liver Stagnation and disperse the build up of Liver Hyperactive Yang. It can have this effect in either Cold or Hot Liver patterns, but in patterns of Liver Heat, it should be used with caution. Emmenagogue Zingiber is not generally considered to be a herb that regulates the hormone balance. Rather, it is a herb that can warm and stimulate the circulation of Qi and Blood
-----------------_-..Combining Western Herbs and Chinese Medicine
822
-.
in the Uterus, relax the uterine muscles, and treat problems associated with Cold, Stagnation, and, to a lesser extent, Deficiency.
Zingiber paired with other herbs Discussion of the limitations of each of the main actions of Zingiber can be useful to clarify just what this herb can and cannot do. However, suitable combination with other herbs can extend the range of use of Zingiber beyond its limitations. The basic unit of herb combination is the herb pair. Twelve pairings of Zingiber are briefly explained below. CAUTION
Before using any of the herb pairs below, it is important to be familiar with the cautions listed for each herb in the pair. Zingiber + Asclepias
Influenza + fever Asclepias is a cold herb with antipyretic effect. Zingiber not only moderates the potential of this herb to lower body metabolism, but also helps to clear heat from the body surface by increased diaphoresis. This pair can be used for acute respiratory conditions with fever, such as influenza, bronchitis, pleurisy, or pneumonia. Zingiber + Achillea
Influenza + cold sensations Achillea is the primary herb for influenza with a unique range of complementary actions, including diaphoretic, antipyretic, anti-inflammatory, astringent, alterative, bitter tonic, and circulatory regulator. Zingiber is acting here as a warming diaphoretic to make this pair specific for influenza due to Wind Cold. Zingiber + Capsicum
Zingiber + Zanthoxylum
_.~._.---.~:;,.o:..~
Poor peripheral circulation Zanthoxylum is the primary herb for Stagnation of Qi and Blood in the extremities, joints, and muscles at the body surface. Zingiber complements the circulatory stimulant and antirheumatic effects of Zanthoxylum, and also assists the primary herb in clearing Phlegm from the channels. Zingtber + Mentha pulegium
Dysmenorrhea + cold sensations This pair is specific for menstrual pain or amenorrhea with sensations of cold, associated in terms of Chinese medicine with Stagnation of Qi and Cold in the Uterus. However, since M. pulegium can also be used for nervous tension from anxiety or fear, this pair can also be used for dysmenorrhea or delayed menstruation from that cause. Zingiber + Lobelia
Bronchitis + asthma Both herbs can have expectorant action: Zingiber is more for Lung Phlegm Cold, and Lobelia is more for Lung Stagnant Qi and asthma. Both herbs can also be used as antispasmodics to treat intestinal colic or dysmenorrhea. In addition, the antiemetic action of Zingiber can moderate the tendency of Lobelia to cause nausea. Zingiber + Salvia officinalis
Headache + muscle tension Fresh Zingiber and Salvia leaves in hot infusion can relieve headache, neck pain and stiffness, arid muscle spasms by moving the Stagnation of Qi in the muscles and body surface. and by discharging Wind Cold or Wind Heat by increased diaphoresis. Whilst both herbs can be used to clear Hot or Cold conditions, Zingiber is more for clearing Cold and Salvia is more for clearing Heat. Since both herbs can tonify the surface Qi, this pair can be incorporated into combinations to treat muscle aches in Deficiency conditions such as those found in some types of fibromyalgia.
Hypothermia These herbs are often paired to treat cold hypothermia associated with Deficient Yang of the Heart and Spleen with accumulation of Interior Cold. Capsicum can also reinforce the diaphoretic effect of Zingiber, especially when Wind Cold is combined with Interior Cold. In Christopher's Lower Bowel Tonic, the two herbs are paired partly to reduce the likelihood of intestinal spasms from the laxative herbs and also to stimulate the circulation and innervation of the colon wall.
Zingiber + Lavandula
Headache + nervous tension Lavandula is specific for calming Liver Hyperactive Yang to treat headache and for clearing Heart Spirit Disturbance to treat insomnia or anxiety. In cases in which there is accUmulation of internal tension with sensations of pressure, restlessness, and heat, Zingiber can sometimes be effective by moving the Interior Stagnation and dispersing the Heat out through the surface.
••
Zingiber
823
Zingiber + Rosmarinus
Zingibercornbinations
Headache + depression Lavandula is more calming, but Rosmarinus is more warming, stimulating, and antidepressant. Rosmarinus and Zingiber are an excellent pair to warm, stimulate, and move Liver Qi, to treat depression, digestive disorders, intolerance to certain foods, and the sequela of prolonged multiple medication or drug abuse. This pair can also be used to treat intestinal distension and abdominal pain. Rosmarinus and Zingiber together are to be avoided in Heat patterns and should not be taken after about 3 p.m. in cases of restless insomnia since they are stimulants. Zingiber + Hydrastis
Cholecystitis Zingiber is often used to moderate the cooling effect of bitter herbs such as Berberis or Hydrastis, so that these USt;ful anti-inflammatory herbs can be used not only for hot or warm conditions, but also for neutral or cool patterns or for mixed conditions of Heat and Cold. Zingiber and Hydrastis can be combined to treat disorders of the gastrointestinal and hepatobiliary systems, including indigestion, diarrhea, constipation, and cholecystitis. Zingtoer + Glycyrrhiza '-
Bronchitis This is perhaps the most used pair of herbs in both Chinese and Western herbal therapy, present in hundreds of herb combinations to treat disorders of every system of the body. Not only can these two herbs enhance, moderate, and detoxify other herbs in the combination, they also moderate each other. The cooling, demulcent, and antiulcer effects of Glycyrrhiza tend to counteract any tendency of Zingiber to overheat the body or to irritate the gastric lining. The warming, carminative and anticatarrhal effects of Zingiber tend to counteract any tendency of sweet, moist licorice to aggravate the production of phlegm. Zingiber + Rheum
Constipation Zingiber can moderate the tendency of Rheum to produce intestinal spasms and can moderate the cooling effect of this herb on the Spleen. Zingiber can be combined with Rheum not only to treat constipation, but also to treat diarrhea and dysentery. Rheum can act as an alterative and astringent in low doses. Zingiber can treat intestinal spasms or tenesmus associated with severe diarrhea, and it can counteract the severe Deficiency and Cold that can develop in some cases.
Eight Zingiber combinations are discussed below: Combination
Chinese syndromes
1. influenza + fever
Wind Heat + Lung Heat
2. influenza + sinusitis
Wind Cold Damp
3. chronic bronchitis +
Lung Phlegm Cold + Spleen Deficient Yang
cold sensations
4. arthritis + cold extremities
Stagnant Qi and Blood Cold in the channels
5. nausea + vomiting
Stomach Rebellious Qi
6. intestinal colic + cold sensations
Intestines Stagnant Qi Cold
7. dysmenorrhea
Stagnant Qi and Blood of the Uterus
8. headache + anxiety
Liver Hyperactive Yang + Heart Spirit Disturbance
+
+
CAUTION
Before using any ofthe combinations below, it is important to be familiar with the cautions listed for each herb in the combination. 1. Influenza + fever
Wind Heat + Lung Heat Herb Asclepias Achillea Lobelia Zingiber (fresh)
DailY dose
Temperature
Taste">
6g 6g O.6g* 3 slices
cold warm-cool warm-cool hot
bitter acrid. bitter acrid acrid, aromatic
·UK daily maximum dose for dried Lobelia is 0.6 g: see Dose section in Lobelia chapter
This combination is the same as Asclepias: influenza + fever and is discussed under that heading. 2. Influenza + sinusitis
Wind Cold Damp Herb Achillea Angelica arc. Sambucus Euphrasia Zingiber (fresh)
Daiiy dose
Temperature" Taste
3g 3g 3g 3g 3 slices
warm-cool warm cool neutral-cool hot
acrid, bitter bitter. acrid. aromatic acrid, sl. bitter acrid, sour. bitter acrid. aromatic
This combination is the same as Achillea: influenza + sinusitis and is discussed under that heading.
--------------------Combining Western Herbs and Chinese Medicine
824
It is interesting that the commentary on the Qing dynasty materia medica of Wang Ren Hui noted the use of fresh Zingiber for headache and nasal obstruction due to Cold.9
USE
• prevention and treatment of nausea and vomiting, especially when associated with sensations 'of cold; can be used for motion sickness, postoperative nausea, vomiting in pregnancy, and nausea from overeating
3. Chronic bronchitis + cold sensations PRACTICAL NOTES
Lung Phlegm Cold + Spleen Deficient Yang Ratio' . Temperature
Herb
Commiphora 1 1 Thymus Angelica arc. 1 Prunus 1 Lobelia 1 Glycyrrhiza 0.5 Zingiber 0.5 Capsicum 5-20 drops
Taste
warm
:~
i ~'('"
.
bitter, acrid aromatic bitter, acrid, aromatic bitter, aromatic acrid sweet acrid, aromatic acrid
warm~ool
warm neutral war~ool
neutrak:ool hot hot
This combination is the same as Commiphora: chronic bronchitis + cold sensations and is discussed under that heading.
Prevention This combination can be taken as 5 rnl of 1:5 tincture in quarter of a glass of warm water 30 minutes before traveling. Treatment This combination can be taken as 2.5-5 ml of
-
1:5 tincture in quarter of a glass of warm water, three times per day. For morning sickness, it is important to have the tincture in water ready in a glass by the bed to take immediately on rising.
Caution This combination is specifically for Cold patterns. If the pattern were that of Stomach Heat, it would be better to omit Zingiber from the prescription. 6. Intestinal colic + cold sensations
4. Arthritis + cold extremities
Intestines Stagnant Qi + Cold
Stagnant Qi and Blood + Cold in the channels __
~~.'~~-'': ~·,,~:":-;·_·~~'7·,-:~··~',~ '~:l: ;-»:~ "'. -::,_~~.rv. =.~ ,,_~ >---;;;
Herb:-,o . --' " .
rr'~';
-:- ~'\:. ..?~~-,...-~·-~:'~~·7~:<~:
":':"'_+~ ,,,: Ratio·,'.Temperature " - , . ,-
Zanthoxylum (bark) Populus Harpagophytum Angelica arc. Angelica sin. Zingiber Capsicum 5-20
•.
;.' _.'.
1 1 1 1 1
0.5 drops
:.. _••-'....
•
_.
r>··
.-Taste.-.::", " _". " ',: ":. ": "C,'" ,.:..:- ,,{ - , '- '".
hot neutrak:ool cool warm warm hot hot
·:-;5~·~ "~1;'~
.-~
acrid, aromatic, bitter bitter, sour bitter bitter, acrid, aromatic sweet, aromatic, bitter acrid, aromatic acrid
Herb:' Foeniculum Zingiber Cinnamomum (bark) Lobelia Glycyrrhiza
1
0.5 0.5 0.5 0.5
51. warm hot hot
aromatic, sl. acrid acrid, aromatic acrid, sweet, aromatic
warm~ool
acrid sweet
neutral~ool
GENERAL
5. Nausea + vomiting
This combination is for Intestines Stagn~t Qi with Cold and is a warm preparation to treat cold or cool conditions. The aromatic, acrid, and sweet constituents contribute to the antispasmodic action, and the acrid constituents also warm the Intestines to remove the Cold.
Stomach Rebellious Qi
USE
This combination is the same as Zanthoxylum: arthritis + cold extremities and is discussed under that heading.
i'
_
.Herb ""'!"7!,.~,,,.Ratio, ....~~;..,Jemperature.•.;J~~~ Zingiber Ballota Matricaria
1 1 1
hot neutral cool
....,."
acrid, aromatic bitter, sour 51. bitter, 51. aromatic
GENERAL
This combination is for Stomach Rebellious Qi with some Cold in the Stomach and Intestines. The overall temperature is warm, and the combination is best for cold or cool conditions. Aromatic, bitter, and sour constituents may contribute to the antiemetic action, and the acrid property warms the Stomach to remove the Cold.
• intestinal colic associated with indigestion, flatulence, and abdominal sensations of cold PRACTICAL NOTES
This combination can be taken as 5 rnl of 1:5 tincture in quarter of a cup of warm water, three times per day. As soon as the colic decreases, the dose of the combination can be reduced. The combination can be stopped when the patient is free from pain.
Caution This combination is specifically for Cold patterns, and if the pattern were that ofIntestines Heat, this combination would be inappropriate.
Zingiber 7. Dysmenorrhea
Stagnant Qi and Blood of the Uterus Herb Thymus Mentha pul. Viburnum Lobelia Zingiber (fresh)
Daily dose
Temperature
3g 3g 3g 0.6 g* 3 slices
warm
.Taste aromatic aromatic 51. bitter, 51. sour acrid acrid. aromatic
.UK daily maximum dose for dried Lobelia is 0.6 g: see Dose section in
lobelia chapter
This combination is the same as Thymus: dysmenorrhea
825
2. Zingiber augments the ability of Achillea and Angelica archangelica to clear Wmd Cold and Damp from the surface of the body, especially from the sinuses, to relieve influenza accompanied by sinusitis and sensations of cold. Although Sambucus and Euphrasia are cooling herbs, they are included in this combination because they are used specifically to clear Phlegm and Damp from the sinuses. 3. Chronic bronchitis + cold sensations
4. Arthritis + cold extremities
Lung Phlegm Cold + Spleen Deficient Yang
Stagnant Qi and Blood + Cold in the channels
and is discussed under that heading. Herb
8. Headache + anxiety
Liver Hyperactive Yang + Heart Spirit Disturbance
Lavandula Salvia off. Mentha pul. Anemone Valeriana Glycyrrhiza Zingiber
1 1 1 1 1 0.5 0.5
sl. warm warffi
aromatic, bitter, 51. acrid aromatic. acrid. bitter
warm cold cool neutral
aromatic bitter bitter. sweet sweet acrid. aromatic
This combination is the same as Lavandula: headache +
anxiety and is discussed under that heading.
COMPARISON OF THE EIGHT ZINGIBER COMBINATIONS
1. Influenza + fever
2. Influenza + sinusitis
Wind Heat + Lung Heat
Wind Cold Damp
Herb . Asclepias Achillea
Daily dose 6g 6g
Lobelia 0.6 g Zingiber (fresh) 3 slices
Herb Achillea Angelica arc. Sambucus Euphrasia Zingiber (fresh)
; Daily dose 3g 3g 3g 3g 3 slices
1. This combination is for acute febrile conditions with both Wind Heat and Lung Heat in the Interior. Although
Zingiber is a hot herb, it is used here in combination with Achillea to cool the body by diaphoresis. Zingiber's circulatory stimulant action can also moderate the sedative effect of the cold herb Asclepias, and its antiemetic action can moderate the tendency of Lobelia to cause nausea.
Commiphora Thymus Angelica arc. Prunus Lobelia Glycyrrhiza Zingiber Capsicum
Ratio -
"Herb-
Ratio
1 1 1 1 1 0.5 0.5
Zanthoxylum (bark) Populus Harpagophytum Angelica arc. Angelica sin. Zingiber Capsicum
1 1 1
~20
1 1 0.5 ~20
drops
drops
3. Combination No.3 combines Commiphora with the antispasmodic antitussives Thymus, Lobelia, and Prunus. Thymus, Lobelia, Angelica, and Zingiber can also have an expectorant effect; and Commiphora, Angelica, Zingiber, and Capsicum can also have carminative and a circulatory stimulant effect. 4. In combinations No.3 and No.4, one of the functions of both Angelica and Zingiber is to help the Spleen transform Damp and Phlegm. In combination No.3, these herbs helped to clear Cold, Damp, and Phlegm from the Lung, whilst in combination No.4, Angelica and Zingiber help to clear Cold, Damp, and Phlegm from the channels of the joints. In addition, Angelica archangelica combines with A. sinensis to warm and move Qi and Blood in the charmels, and also to tonify Qi and Blood. Capsicum strengthens the warming circulatory stimulant and antiarthritic effects of Zingiber.
5. Nausea + vomiting
6. Intestinal colic + cold sensations
Stomach Rebellious Qi
Intestines Stagnant Qi + Cold
Zingiber Ballota Matricaria
1 1 1
Foeniculum Zingiber Cinnamomum (bark) . Lobelia Glycyrrhiza
1 0.5 1 0.5 0.5
Combining Western Herbs"and Chinese Medicine
826
5. All three herbs in combination No.5 are specific for nausea and vomiting. Zingiber is effective at treating vomiting associated with Stagnation and disturbance of Stomach Qi associated with Cold, Damp, and Phlegm. Matricaria is effective at treating vomiting associated with Heat in the Stomach and Intestines. Ballota can be used in both Hot and Cold patterns. 6. The emphasis of combination No. 5 is on controlling emesis. Combination No.6 is used to relax spasms of the smooth muscle of the intestines to relieve pain and to allow normal peristalsis to clear gas and remove distension. Foeniculum, Zingiber, and Cinnamomum are warming, aromatic carminatives that make this combination specific for
abdominal pain and distension associated with Cold in the Intestines. Lobelia and Glyeyrrhiza can be used as antispasmodics for patterns of either Heat or Cold. 7. Dysmenorrhea
8. Headache + anxiety
Stagnant Qi and Blood ofthe Uterus
Liver Hyperactive Yang + Heart Spirit Disturbance
~m~¥'-"~~';'~f;:"".~f;llI~f?~~~J:'?)
;;Herb;;'""';;Y~";'-' ~"';"''''--:~'-~:._,.''''---
Daily"dose '-::;
'~.:"'-'.:"'.-:
Thymus
3g
Mentha put.
3g
•....'.':~, - : .~~I
Viburnum 3g Lobelia 0.6 g Zingiber (fresh) 3 slices
~;~
'..'
··~·.7~,'·:
Zingiber, like Glycyrrhiza, is a multipurpose herb that is present in many combinations: the following examples give an idea of the wide range of uses of this herb:
• Achillea: amenorrhea + exhaustion • Achillea: Atherosclerosis + hypertension + cold extremities • Achillea: recurringfever + exhaustion • Arctostaphylos: urinary infection + heat sensations • Capsicum: hypertension + heat sensations • Cinnamomum: chronic diarrhea + cold sensations • Gentiana: poor appetite + anorexia • Juniperus: phlegmy cough • Lavandula: anxiety + depression • Salvia: headache + anemia • Smilax: chronic psoriasis • Thuja: prostatic enlargement + sexual debility • Viburnum: threatened miscarriage
Research
..;; ..r:::~;·_~~"";::--.1J': " -,
Herb"". _: :-':~~'"'~::;- Ratio Lavandula Salvia off.
Mentha put. Valeriana Anemone Glycyrrhiza Zingiber
OTHER ZINGIBER COMBINATIONS
1 1 1 1 1
0.5 0.5
7. Foeniculum makes combination No.6 specific for intestinal spasms, while Viburnum makes combination No.7 specific for spasms of the uterine muscle. The aromatic herbs Thymus and Mentha can warm and move Stagnant Qi and Blood in the Uterus, and can also treat dysmenorrhea or amenorrhea associated with shock or nervous tension. Zingiber and Mentha combine to treat dysmenorrhea or amenorrhea associated with Cold in the Uterus. Lobelia acts as a general-purpose antispasmodic. 8. In combination No.7, Mentha is combined with Thymus to treat uterine spasms with nervous tension, whereas in combination No.8, Mentha and Anemone combine to treat headache associated with nervous tension from Heart Spirit Disturbance and Kidney fear. Lavandula, Salvia, and Valeriana are combined for headache associated with both Liver Hyperactive Yang and Heart Spirit Disturbance. Glycyrrhiza helps to stabilize the Heart and Kidney, and Zingiber and Salvia combine to disperse Qi Stagnation in the Muscle channels resulting from nervous tension.
CONSTITUENTS The following constituents have been reported: • essential oil • pungent principles • other EsSential oil Zingiber contains about 1-3% essential oils, which varies considerably in composition according to the geographical source of the material. Sesquiterpenes may constitute over 50% of the essential oils, with a lesser amount of monoterpenoids. The main components (as a percent of the total essential oil) are usually: 10 20-30% • zingiberene 6-19% • ar-curcumene 7-12% • f3-sesquiphellandrene 5-12% • f3-bisabolene However, the oil of Vietnamese Zingiber contains about 67% monoterpenoids and 33% sesquiterpenes,lI and Australian Zingiber contains mainly monoterpenoids, such as camphor, f3-phellandrene, geranial and linalool, with a small proportion of sesquiterpenes. 12 Pungent principles Zingiber contains 4-7.5% of an oleoresin, which itself contains pungent principles, together with nonpungent principles such as fats and waxes. The main nonvolatile pungent components, making up about 30% of the oleoresin, are the following phenolic compounds: 13
r I
Zingiber • gingerols, mainly 6-gingerol • shogaols, which are more pungent than the gingerols but present in lesser amounts Pungent constituents present in lesser amounts include paradols, gingediols, gingediacetates,10 gingerdiones,12 and .
gmgerenones. Other
u
Ginger also contains the following constituents: II
• starch • proteins • fats
40-60% 10% 10%
Differences between fresh and dried Zingiber The therapeutic differences attributed in Chinese medicine to fresh and dried Zingiber may be related to their chemical differ-
827 • anticholesterol • antiplatelet • antioxidant • antitumor • antimutagenic
Antiviral Several sesquiterpenes from Indonesian Zingiber, Z. officinale, especially ~-sesquiphellandrene, were reported to have antirhinoviral activity.17 Antibacterial Zingiber extract mildly inhibited the growth of various bacteria, including Escherichia coli, Salmonella typhimurium, and Staphylococcus aureus. 18 Antifungal Extracts of Zingiber showed antifungal activity . against Fusarium udum~19-
ences:
Essential oil Zingiberene and ~-sesquiphel1andrene decompose on drying and storage,l; and are therefore pre~ sent in greater quantities in fresh Zingiber rather than dried \-z;,
Zingiber.
Pungent principles Shogaols are mainly absent from fresh Zingiber and are anhydrogingerols formed during the dry16 ing process from the decomposition of gingerols. PHARMACOLOGICAL AND i L.
r L::
Antiparasitic An in vitro study reported that Zingiber extract, especially the constituents 6-gingerol and 6-shogaol, was effective against Anisakis.20 Diaphoretic, antipyretic, and thermogenic Whilst diaphoresis can be associated with either the antipyretic or the thermogenic action, the cooling antipyretic effect and the warming thermogenic effect are apparent opposites. Which of these effects predominates may depend on the initial body temperature of the patient and on the specific factors of the situation.
CLINICAL RESEARCH The following effects have been reported: • antiviral • antibacterial • antifungal • antiparasitic • diaphoretic, antipyretic, and thermogenic • immunoregulator • antiallergic • anti-inflammatory • antirheumatic • antiulcer • digestive stimulant • choloretic and cholagogic • hepatoprotective and antitoxin • bioavailability enhancer • hypoglycemic • antispasmodic • antitussive • antiemetic • antidiarrheal • cardiotonic • blood pressure regulator • tranquilizer
Diaphoretic A diaphoretic is a substance that can promote sweating, which can help to cool the body in a fever. Whilst the diaphoretic effect of Zingiber is well known, I have not seen research studies on this topic.
Antipyretic Some antipyretic substances act at least partly by diaphoresis, while others do not induce sweating but lower body temperature by other mechanisms. Orally administered Zingiber extract was reported to reduce yeastinduced fever in rats to a similar degree as aspirin but had no effect on normal rats. 21
Thermogenic The diaphoretic action of Zingiber may be partly related to its demonstrated thermogenic effect. Extracts of both fresh and dried Zingiber and both gingerols and shogaols demonstrated thermogenic effects in the perfused rat hind limb.22 The thermogenic effect may arise by more than one mechanism, for example, by serotonin inhibition or by catecholamine secretion. Both Zingiber extract and purified 6shogaol were reported to inhibit serotonin-induced hypothermia. 2J Zingerone was reported to increase secretion of catecholamine from the rat adrenal medulla,24 and this may also playa part in an overall thermogenic effect.
'i
828
Combining Western Herbs and Chinese Medicine
Immunoregulator Zingiber extracts were reported to stimulate both cell-mediated immunity and humoral immunity, and the authors suggested this might form a basis for the practice (in India) of prescribing Zingiber to mothers after childbirth and to invalids with a relatively poor immune status. 25 Antiallergic 8-gingerol and 6-shogaol inhibited experimentally induced histamine release from rat peritoneal mast cells, and 6-gingerol and 6-shogaol have shown antiallergic activity in vivo. 26 Anti-inflammatory An ethanolic Zingiber extract reduced carrageenan-induced paw swelling in rats but did not show an analgesic effect,21 Effects on eicosanoid metabolism inflammatory response by:
Zingiber may reduce the
• reduction of prostaglandin synthesis by inhibition of cyclooxygenase by gingerols,27 8-shogaol, and 8-paradoF8 • reduction ofleu1
reduced the proteolytic activity of pepsin and increa.Se
...
...
...
-to
.--
Choloretic and cholagogic Zingiber was reported to increase bile secretion in rats, and 6-gingerol and 10-gingerol were seen as mainly responsible for this effect. 41 Hepatoprotective and antitoxin In vitro studies with cultured rat hepatoeytes demonstrated antihepatotoxic activity of gingerols and shogaols against carbon tetrachloride- and galactosamine-induced cytotoxicity.42·· . Bioavailability enhancer Zingiber is present in a great:,;:;.;>,,:;.;_ number of Western, Ayurvedic, and Chinese herbal combinations, and is sometimes described as a 'messenger' or
r;:-.
Antitussive 6-shogaol was reported to have an intense antitussive effect. 44 Antiemetic Clinical trials The majority of recent clinical trials have reported that Zingiber can significantly reduce nausea and vomiting in a variety of situations, for example,
• 940 mg of dried Zingiber was found to be more effective than 100 mg of dymenhydrinate (Dramamine) in
"
Zingiber
i-.
reducing motion sickness induced in blindfolded subjects in a tilted rotating chair (placebo-controlled, single-blind trial)4S • 1 g of Zingiber was found to reduce vertigo induced by heat stimulation of the vestibular system in healthy volunteers (placebo-controlled) double-blind, crossover trial )016 • 1 g of Zingiber reduced the vomiting and cold sweating of seasickness in 80 naval cadets on a sailing vessel in heavy seas (placebo-controlled, double-blind, randomized trial)47 • 1.25 g average daily dose of Zingiber was more effective than metoclopramide in reducing vomiting in children suffering from hyperketonemia (double-blind, comparative trial)48 .0.5 g Zingiber reduced postoperative nausea in women who had had major gynecological surgery (placebocontrolled, double-blind, randomized trial}49 • four 250 mg capsules of Zingiber per day for four days significantly reduced nausea and vomiting in patients with hyperemesis gravidarum (placebo-controlled, double-blind, randomized, crossover trial)50 However, some clinical studies have reported that Zingiber did not significantly reduce nausea or vomiting in motion sickness,51.52.53 postoperative nausea, or vomiting
829
duced a three-phase pattem:44 a rapid fall in blood pressure, followed by a marked rise, and then a delayed fall. 59 It should be remembered that shogaols are generally absent from fresh Zingiber. It would be interesting to determine if decoctions of fresh Zingiber lower blood pressure in association with the diaphoretic action of the herb. Clinical trials are needed to determine the effects of therapeutic doses of fresh and dried Zingiber on blood pressure in normal, hypertensive, and hypotensive humans. Tranquilizer Administration of 6-gingerol or 6-shogaol has been reported to reduce spontaneous motor activity and prolong hexobarbitol-induced sleep time. 44 Anticholesterol Zingiber decreased serum and hepatic cholesterol in cholesterol-fed rats in one study,60 but not in another study with hypercholesterolemic rats. 61 Zingiber reduced total cholesterol and serum LDL-cholesterol in hyperlipidemic rabbits, and increased the fecal excretion of cholesterol.62 Antiplatelet Studies on the effect of Zingiber and its components on platelet aggregation have not shown consistent results. It appears that Zingiber and its individual constituents may have multiple effects on platelet aggregation, so that different overall effects are produced in different situations.
t
L\.-
following gynecological surgery. 54 The mechanism by which Zingiber has its antiemetic effect is still not resolved. One concept is that Zingiber components, such as 6-gingerol and 8-gin43 gerol, may block serotonin receptors in the digestive tract. Another proposal is that Zingiber has its antimotion sickness effect via central and peripheral anticholinergic and antihistamine effects.55
Antiemetic mechanism
Antidiarrheal Acetone extract of Zingiber at 75 mglkg was reported to reduce serotonin-induced diarrhea in mice. 6-shogaol and 8- and 10-gingerol were found to have an anticathartic action, with 6-shogaol having the greater effect. 23 Cardiotonic Zingibe~ and 8-gingeroP; have been reported to have positive inotropic effects in isolated guinea pig left atria.
=
Blood pressure regulator In an early study in China, normal subjects were given 1 g of fresh Zingiber to chew, without swallowing. As a result, the systolic and diastolic pressures were increased by 11.2 and 14 mg Hg, respectively.58 In rats, low doses of both 6-gingerol and 6-shogaol reduced blood pressure. However, at high doses, they pro-
• 6-shogaol inhibited arachidonic-induced platelet aggregation in rabbits, which the authors suggested might be due to the previously demonstrated in vitro inhibitory action of 6-shogaol on cyclooxygenase and 5-lipoxygenase63 • gingerol inhibited the aggregation and release reaction of rabbit platelets induced by some factors but not by others; gingerol inhibited the secondary aggregation of human platelets but had no influence on primary aggregation; the authors concluded that the antiplatelet activity of gingerol is due mainly to the inhibition of thromboxane synthesis64 • in a placebo-controlled study in which patients with coronary artery disease were given 4 g of powdered Zingiber daily for 3 months, there was no effect on ADPand epinephrine-induced platelet aggregation; however, a single dose of 109 of powdered Zingiber administered to such patients produced a significant reduction in ADP- and epinepllrine-induced platelet aggregation65 • a placebo-controlled, randomized, crossover, ex vivo human study reported that Zingiber did not result in a decrease in thromboxane synthesis; 66 however, the study had certain design problems that may have affected the results l5
830
Combining Western Herbs and Chinese Medicine
• a patented, standardized Zingiber extract was reported to have no significant effect on coagulation parameters or on Warfarin-induced changes in blood coagulation67 Antioxidant As an antioxidant, Zingiber was reported to be as effective as ascorbic acid in one rat study,68 and both 6gingerdiol and its glucoside extracted from fresh Zingiber were found to have antioxidant activity in a linoleic acid model system.69 Antitumor Antitumor and antiproliferative effects have been reported for the Zingiber constituents 6-gingerol and 6-paradol,70 and Zingiber extracts showed cancer prevention potential using an Epstein-Barr virus (EBV) early antigen model. 71 Zerumbone from Z. zerumbetwas also identified as a potential antitumor agent using the EBV mode1. 72 An ethanol Zingiber extract showed inhibition of tumor promotion in the SENCAR mouse skin tumorigenesis model. 73 Antimutagenic Zingiber has been found to be antimutagenic in studies using various mutagens in a Salmonella mode1. 74 ,7s.76 A patented Zingiber extract, administered to pregnant rats during the period of organogenesis, was reported to cause neither maternal nor developmental toxicity at daily doses of up to 191kg bodyweight.77 RESEARCH VERIFICATION OF TRADITIONAL ACTIONS The following traditional actions have been supported by research: antitoxin, enhancer of other herbs, antipyretic, circulatory stimulant (see Thermogenic and Cardiotonic above), antirheumatic, digestive stimulant, carminative (see Antispasmodic above), antiemetic, antidiarrheal, and tranquilizer. Additional effects demonstrated by research The following effects have been reported as discussed above: antiviral, antibacterial, antifungal, antiparasitic, immunoregulator, antiallergic, anti-inflammatory, antiulcer, choloretic, hepatoprotective, hypoglycemic, anticholesterol, antiplatelet, antioxidant, antitumor, and antimutagenic. From this list, it would appear that, although Zingiber has had a wide range of uses in the past, it has even more potential uses for the future.
administration, and as displaying no skin sensitization o;'~': ,~phototoxicity. They classify the zingiberene component of the oil as of no apparent toxicity.
Ethanolic extract An 80% ethanolic extract given by gaVage to mice was well tolerated at doses of 2.5 glkg. Doses of 3 g!kg resulted in 20% mortality within 72 hours of administration. 21 Chronic toxicity An animal study reported that 100 mglkg of Zingiber extract per day for 3 months did not result in significant changes in visceral condition or white blood cell levels, and that there was no spermatotoxic effect. In fact, there were significant increases in sperm motility and sperm content.80 Mutagenicity According to the ESCOP monograph on Zingiber, neither Zingiber nor its isolated constituents have been systematically investigated in mammalian cell cultures.81 In tests on nonmammalian cells, Zingiber, zingerone, gingerol, and shogaol have been reported as mutagenic, nonmutagenic, or antimutagenic, depending on the test model used. In an E. coli model, Zingiber juice was reported to suppress mutagenesis by 6-gingerol and to suppress spontaneous mutations. 82 In a Salmonella model, it was found that zingerone suppressed the mutagenicity of gingerol and sho,: gaol. S3 ., Interactions It has been reported that Zingiber matih~-~t··= crease the bioavailability of certain drugsll4 and may enhan~_. absorption of sulphaguanidine.s5 Pharmacological studies on the effect of Zingiber and its components on platelet aggregation have not showed consistent results, as has been discussed in the Pharmacological and clinical research section. According to Mills and Bone, Zingiber has not been reported to result in bleeding problems in humans, but the authors propose that daily doses of Zingiber in excess of 4 g should be used with caution in patients with increased risk of hemorrhage or in patients taking blood-thinning drugs such as aspirin or warfarin.
Dose Dried herb
TOXICOLOGY Acute toxicity -
Antiemetic The BHC listed a single dose of powered root as 1-2 g.
Oil The acute oral LD so in rats and the acute dermal LD so in rabbits exceeded 5 glkg of Zingiber oil.78 Tisserand and Balacs79 classify Zingiber oil as nontoxic by oral and dermal
Other use For other Western herbal uses, the BHC listed 0.25-1 g of powered Zingiber, three times per day. For Chinese herbal uses, Bensky and Gamble listed 3-12 g (1-4 qian) of
Zingiber dried Zingiber. Assuming this represents a total of six doses (three per day for 2 days), this is approximately 0.5-2 g for an individual dose, compared to the BHC figure of 0.25-1 g for an individual dose. Fresh herb \~
Mills and Bone listed 0.5-1 g of fresh Zingiber
three times per day. For infusions or decoctions for acute conditions, such as Achillea: influenza + sinusitis or Asclep-
ias: influenza + fever, I use one slice of Zingiber per individ!,...,
ual dose, that is, three slices per day. A thin slice of fresh Zingiber (transverse section) from a small to medium diameter rhizome weighs about 1 g. For Chinese herbal therapies, Bensley and Gamble listed 3-9 g (1-3 qian) for fresh Zingiber. Assuming this represents a total of six doses (three per day for 2 days), this is approximately 0.5-1.5 g for an individual dose. Tincture
Antiemetic To treat acute nausea or vomiting, I might use Zingiber combined with a single other herb such as Matricaria in equal proportions. A 2.5-5 ml single dose of the mixed tincture would then contain 1.25-2.5 ml of Zingiber tincture. r:"'. i
r-':,
Other use Mills and Bone listed 1.7-5 ml of 1:5 Zingiber tincture per day, which represents 0.56-1.66 ml for each individual dose. The BHC listed a considerably higher dose of 1.5-3 ml of 1:5 tincture in 90% alcohol, three times per day. I generally use Zingiber as part of a combination of 5-8 herbs, with Zingiber in either equal proportion to the other herbs or half that dosage. This means that in a 5 ml dose of the mixed tincture, there is usually less than 0.5-1 ml of Zingiber tincture.
the cautions are observed. I
Duration
protect against gastric ulceration, and it is only in doses of 6 g or over that deleterious effects were noted; see Pharmacological and clinical research above. I would not use Zingiber to treat vomiting or other gastric upset linked to Stomach Heat, but would not contraindicate it for gastric disorders linked to other Chinese Stomach syndromes, such as Deficient Qi, Stagnant Qi, or Cold. As with any herb, if the condition is consistently aggravated by the prescription, then the use of the herb should be stopped.
Bleeding disorders As reported in Pharmacological and clinical research above, doses of 4 g of Zingiber daily did not affect platelet aggregation. It was only at 109 doses that a significant reduction in platelet aggregation was observed. However, the maAimum recommended therapeutic dose as listed in Dose above does not exceed 3 g per day. Although I have not seen reports of adverse effects of Zingiber on bleeding disorders, it might be prudent to monitor platelet aggregation in patients with bleeding disorders on doses of 3 g Zingiber per day.
Gallstones According to the German Commission E monograph,86 Zingiber should only be used in cases of gallstones after consultation with a doctor. The Commission E text gave no references or explanation for its cautionary statement. Chinese contraindications
Fresh Zingiber Sheng jiang is contraindicated in Lung Heat patterns although it has been combined with the cold substance dried bamboo sap (zhu 11) for Phlegm Heat. Sheng jiang is also contraindicated in cases of vomiting with Stomach Heat.
Dried Zingiber Gan jiang is contraindicated in Deficient
Initial dose Can start at the lower standard dose, providing I"
831
Can be used for 1 month or more, providing the
cautions are observed.
Cautions Western contraindications
According to the ESCOP
monograph on Zingiber, there are no contraindications or special precautions for the use of this herb. However, the precautions found in some other texts are given below.
Peptic ulcer Mills and Bone suggested caution in the use of Zingiber in cases of peptic ulceration or other gastric diseases. However, Zingiber has been used in research studies to
Yin with Heat signs or bleeding from Blood Heat. Pregnancy and lactation According to Mills and Bone, no adverse effects are to be expected. According to Bensley and Gamble, dried Zingiber should be used with caution in pregnancy. However, this may refer to using Zingiber for treating Heat patterns rather than the other Chinese syndromes for which Zingiber may indeed be benefici~, such as Rebellious Stomach Qi with Deficiency or Cold. According to the German Commission E monograph, Zingiber should not be used during morning sickness. However, the editor of the English translation of the Commission E monographs pointed out that a review of the research literature could not justify this caution. In fact, the data given in Pharmacological and clinical research above indicates that Zingiber may be of value in reducing vomiting during pregnancy.
Combining Western Herbs and Chinese Medicine
832
Side effects One study has reported heartburn as a side effect in some patients.S1 Overdose
No adverse reports.
Interactions It has been suggested that Zingiber should be used with caution in patients with increased risk of hemorrhage or in patients taking blood-thinning drugs, see Toxicology (Interactions) above.
Regulatory status
ORGANS In terms of Chinese medicine, Zingiber, as used in the West, can be associated mainly with disorders of the followingorgans:
...
,
acute colds bronchitis
BlingwOO~9
Spleen, Stomach
anorexia. atonic dyspepsia, vomiting in pregnancy
SHC
Intestines
flatulent colic diarrhea'
Christopher90
Heart
cold extremities
Felter and L1oyd 91
Uterus
dysmenorrhea
Blingwood
Muscle channels
rheumatism, gout
Christopher
skin channels
boils
Christopher
Lung
Please read the Regulatory status section in the chapter on Safety. Zingiber (ginger) is on the UK General Sale List and it is not included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia. However, products containing 2 g and above of dry Zingiber equivalent per dose' . must have warnings regarding concomitant use with anticoagulants, and must advise those with bleeding problems to seek medical advice. 15 Zingiber is not currently listed by the FDA (USA) as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use.
Traditional sources PROPERTIES Temperature According to Dioscorides, Zingiber is warming in nature. Lonicerus87 wrote that it is hot in the third degree and moist in the first degree. It is heating, but because it is so moist, the heating effect is not prolonged. According to Gerard, fresh Zingiber is hot and moist, and dried Zingiber is hot and dry in the third degree. Both fresh Zingiber (sheng jiang) and dried Zingiber (gan jiang) have been classified as hot in Chinese medicine.8 In this book, both fresh and dried Zingiber are classified as hot. Taste
Taste in the mouth According to the BHP,88 dried Zingiber has an agreeable and aromatic odor and a strongly pungent taste. I found both fresh and dried Zingiber to be strongly acrid, and also aromatic, bitter, and sweet in taste. Taste properties Both fresh Zingiber (sheng jiang) and dried Zingiber (gan jiang) are classified as acrid in Chinese medicine. In this book, both fresh and dried Zingiber are classified as acrid, associated with their warming properties, and aromatic, associated with their carminative and antispasmodic properties.
'.',
SHC
BHP
In Chinese medicine, fresh Zingiber (shengjiang) is said 92 to enter the Lung and Stomach channels, and Yeung also listed the Spleen channel. Dried Zingiber (gan jiang) is said to enter the Spleen, Stomach, and Lung channels. Yeung additionally listed the Heart channel, and Bensky and Gamble additionally listed the Kidney channel! According to the Newly Edited Materia Medica, dried Zingiber'dries Spleen Damp and tonifies the Spleen, opens the Heart and aids the Yang and tonifies Heart Qi, opens the' . five zang and six fu, opens the four extremities, and opens the joints and spreads to all the luo mai: ACTIONS • antitoxin • enhancer of other herbs • moderator of other herbs • diaphoretic • circulatory stimulant • antirheumatic • expectorant • digestive stimulant • carminative and antispasmodic • antiemetic • antidiarrheal • emmenagogue • other Antitoxin Dioscorides recommended Zingiber as an antidote to poisons, and this antitoxin action has been supported by recent research. In my opinion, one of the reasons that Zingiber is included in so many herbal combinations is its
.....
L,
r'l Zingiber ability to reduce the potentially toxic effects of some other herbs or to assist in the detoxification of waste substances released in the body by the action of alterative herbs. Enhancer of other herbs According to Christopher, Zingiber can be said to be a carrier of other herbs, for example, to the intestines or the reproductive organs. According to Mills and Bone, it can reinforce the therapeutic activity of other herbs. Moderator of other herbs
Zingiber can be used to:
• moderate the emetic effect ofherbs9 \ such as Lobelia • moderate the cooling effects of herbs such as Berberis, Hydrastis, and Taraxacum • moderate the intestinal spasms produced by herbs91 such as Rhamnus and Rheum
r
',--
Diaphoretic Loniceros said that Zingiber can assist sweating and thus rid the body of evil damp. Lyle listed it as one of the best herbs for feverishness, and Ellingwood noted its use as a stimulant diaphoretic for acute colds, Felter and Lloyd wrote that Zingtber is especially good for fever with borborygmus and intestinal pain. According to Christopher, when taken hot, it can be used as a diaphoretic for colds and influenza. The BHP and the BHC both listed Zingiber as a diaphoretic, and Tierra recommended a few slices of the fresh rhizome to counteract the early stages of a simple cold or flu. Circulatory stimulant Felter and Lloyd recommended Zingiber for cool extremities or cold body surface in children's diseases. According to both Christopher and Priest and Priest,93 Zingiber is a mild and diffusive circulatory stimulant. Julian Scott94 recommended it for cold and weak conditions in children and the elderly.
833
Carminative and antispasmodic According to Dioscorides, Zingiber soothes the stomach and abdomen, and Lonicerus wrote that it can be used to soothe stomach and intestinal pains due to bloating. Felter and Lloyd recommended it for cramps and pains of the stomach and bowels, and the BHP listed it as a carminative and antispasmodic for flatulent intestinal colic. Antiemetic Felter and Lloyd, Lyle, Kloss, Christopher, the BHC, and Wichtl all noted the use of Zingiber for nausea, and the BHC listed its use for the prevention of travel sickness and for vomiting in pregnancy. Antidiarrheal Felter and Lloyd noted the use of Zingiber, in combination with astringents, for diarrhea and dysentery, Grieve listed it for diarrhea from 'relaxed bowel: and Christopher also recommended Zingiber for diarrhea. Emmenagogue Lyle wrote that Zingiber assists the menstrual flow, Ellingwood recommended it for dysmenorrhea, and Felter and Lloyd listed it for menstrual disorders. Grieve prescribed hot infusion of ZingIber for amenorrhea due to cold, Christopher recommended it for problems of the reproductive organs, especially for dysmenorrhea, and Tierra listed it as promoting menstruation. According to Rosemary Gladstar,97 Zingtber is specific for problems associated with congestion in the reproductive system since it directs blood to the pelvic area and helps to relax the smooth muscles. Other
Dermatological agent Christopher recommended a'maturation poultice' for boils, composed of one part Zingiber to one part flour.
Tranquilizer According to Ellingwood, Zingiber can act as
Antirheumatic KlOSS recommended Zingiber for gout, and Christopher listed it for both gout and rheumatism. The BHC listed Zingiber for rheumatic complaints, and Tierra wrote that grated Zingiber can be applied topically as a poultice or hot fomentation to relieve aches, sprains, and spasms.
'a sedative to an irritated and overwrought system when there is extreme exhaustion: and recent research has reported that Zingiber can reduce spontaneous motor activity and prolong hexobarbitol-induced sleep time.
Expectorant Lyle recorded the use of Zingiber in bronchitis, pneumonia. and pleurisy, and Christopher listed it for chronic bronchitis and for hemorrhage of the lungs. Traditional use in Germany as an expectorant is noted in Wichtl.96
venery: and recent research has reported that it can increase sperm quantity and motility.
Digestive stimulant According to Dioscorides, Zingiber helps the digestion, and Lonicerus wrote that it is good for a cold stomach. According to Felter and Lloyd, Zingiber increases the flow of saliva and the flow of gastric juice. According to both Christopher and the BHC, it can be used for atonic dyspepsia.
DRIED ZINGIBER
95
Aphrodisiac Gerard wrote that fresh Zingiber can 'provoke
COMPARISON OF FRESH AND
The distinction between the actions and uses of fresh and dried Zingiber is of more importance in Chinese herbal therapy than in Western herbal therapy, and indeed for some indications, for example, for nausea and vomiting, fresh and dried Zingiber can be used interchangeably. However, in my
--------------------_.---------------834
Combining Western Herbs and Chinese Medicine
opinion, there are certain important differences in action and use between fresh and dried Zingiber, and that these have a biochemical basis; see Constituents. Fresh Zingiber In Chinese medicine, the following functions_are specifically associated with fresh Zingiber (sheng jiang):8 • clears Exterior Wind Cold from the body surface and the Lung • adjusts the Nutritive and Defensive Qi; in my opinion, the moist, sweet nature of fresh Zingiber can not only adjust but also help to tonify the Qi at the body surface In my opinion, the diffusive circulatory and diaphoretic actions of hot infusions or decoctions of fresh Zingiber can be used in some cases of Deficient Ym with accumulation of Deficiency Heat in the Interior. The hot Zingiber preparation helps to bring the Heat out to the surface and to disperse it through the skin. This can help to reduce the feelings of inner Heat, pressure, restlessness, and emotional discomfort, and can help to treat certain cases of insomnia, anxiety, and headache.
• warms the Middle and clears Interior (Deficiency) Cold in cases of poor appetite, abdominal pain, and coldlirnbs • rescues devastated Yang and clears Interior Cold in cases of very weak pulse and cold limbs
As for the latter use, it is interesting that Ellingwood recommended Zingiber as a stimulant for emergency situations.
COMPARISON OF WESTERN AND CHINESE USE OF ZINGIBER The data in the table on sheng jiang (fresh Zingiber) and gan jiang (dried Zingiber) comes from Bensley and Gamble and from Yeung. It should be noted that the entry'-' in the table does not mean that Zingiber has never been used for this indication, but that it is a relatively uncommon usage. It can be seen from the table that there is great similarity in the use of Zingiber in China and the West. The main differences of use can be summarized as: • fresh Zingiber seems to have greater use as a circulatory stimulant in the West, and dried Zingiber seems to have greater use for prostration in China
Dried Zingiber In Chinese medicine the following functions are specifically associated with dried Zingiber (gan jiang):8 -
".~ -
-,,""_'&,J: "
-,.-:'.' ••
.,.ljf""~~.'-,:~;-....;;.:.~f.:t:;._:ioi~.. :'*:.-~-lt,·;:-,'
...' _.i-.; .,(,_,.
Actions
Western uses
Chinese uses .
enhancer of other herbs
'carrier' of other herbs, especially to the intestines or reproductive organs
not known
moderator of other herbs
moderates cooling, emetic, or spasmogenic effects of other herbs
(fresh) reduces irritation of the gastrointestinal tract by other herbs
antitoxin
detoxification of other herbs
(fresh) detoxification of other herbs
diaphoretic, antipyretic
common cold, influenza
(fresh) common cold, influenza with Wind Cold (especially with Deficiency at the body surface) 9 (fresh) headache and nasal congestion from Cold
circulatory stimulant
cold surface and extremities, sudden prostration (old use)
(dried) Collapse of Yang
antirheumatic
rheumatism and gout
expectorant, antitussive
bronchial phlegm
(fresh or dried) cough, bronchial phlegm with Wind Cold and/or Lung Phlegm Cold
digestive stimulant
atonic dyspepsia
(dried) poor appetite, cold abdomen from Deficiency Cold in the Spleen and Stomach
carminative, antispasmodic
flatulence, abdominal distension, intestinal colic
(fresh or dried) epigastric pain with Cold
antiemetic
nausea and vomiting, travel sickness, vomiting in pregnancy
(fresh or dried) nausea and vomiting, especially with Cold
antidiarrheal
diarrhea or dysentery, cholera, tenesmus
dysentery or diarrhea, especially with Cold
antihemorrhagic
emmenagogue
.,
(dried or quick·fried) hemorrhage from Deficiency Cold, especially uterine bleeding amenorrhea, dysmenorrhea
~:l
Zingiber
1.-
c
• fresh and dried Zingiber appear to have greater use for rheumatism and arthritis in the West, although fresh Zingiber is present and is often combined with Ziziphus (da zio) in some Chinese combinations, such as chuan bi tang and modifications of gui zhi tang, for arthritis with Wind, Cold, and Damp combined with Deficiency at the surface • Zingiber appears to be more commonly use for flatulence and intestinal pain in the West, and more commonly for epigastric pain in China • Zingiber seems to be more specifically used for travel sickness and for vomiting in pregnancy in the West, although it is used for nausea and vomiting in both the West and China • Zingiber is more frequently used (dried or quick-fried) for hemorrhages, especially uterine hemorrhages, in China than in the West • ZingIber is more commonly used in the West than in China to regulate menstruation, to treat amenorrhea and dysmenorrhea, and to act as a carrier of other herbs to the reproductive area
References I:
I,
r I
L
835 Herbal Medicine. Churchill Livingstone, Edinburgh, United Kingdom (2000)
16. Govindarajan VS. Part 1 CRC Crit Rev Food Sci Nutr 17(1):1-96 (1982); Part 2 ibid 17(3):189-258 (1982) 17. Denyer CV, lackson P. Loakes DM et al. I Nat Prod 57(5):658-662 (1994) 18. Gugnani HC. Ezenwanze EC. I Commun Dis 17(3):233-236 (1985) 19. Singh R,Rai B.Microbios 102(403):165-173 (2000) 20. Gato C, Kasuya S, Koga K et al. Parasitol Res 76(8):653-656 (1990) 21. Mascolo N. lain R. lain SC et al. I EthnopharmacoI27(1-2):129-140 (1989) 22. Eldershaw TP, Colquhoun EQ, Dora KA et al. Int lObes Relat Metab Disord 16( 10):755-763 (1992) 23. Huang Q. Matsuda H. Sakai K et al. Yakugaku Zasshi 110(12):936-942 (1990) 24. Kawada T. Sakabe S. Watanabe T et al. Proc Soc Exp Bioi Med 188(2):229-233 (1988) 25. Puri A. Sahai R. Singh KL et al. I Ethnopharmacol 71(1-2):89-92 (2000)
26. Yamahara I. Matsuda H. Yamaguchi S et al. Nat Med 49(1):76-83 (1995) 27. Kiuchi F, Shibuya M. Sankawa U. Chern Pharm Bull 30(2):754-757 (1982) 28. Tjendraputra E, Tran VH. Liu-Brennan D et al. Bioorg Chern 29(3):156-163 (2001) 29. Iwakami S. Shibuya M. Tseng CF et al. Chern Pharm Bull 34(9):396Q.. 3963 (1986)
1. Evans WC. Trease and Evans' Pharmacognosy, 14th edn. WB Saunders. London, United Kingdom (1996)
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3. Gerard I. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas lohnson. Dover Publications, New York, New York (1975) 4. Grieve M. A Modern Herbal. vols. 1 and 2. Dover Publications, New York. New York (1971) 5. Bradley PR (ed). British Herbal Compendium, vol. 1. British Herbal Medicine Association. Bournemouth, United Kingdom (1992) 6. Lyle Tj. Physic-Medical Therapeutics, Materia Medica and Pharmacy. Originally published in Ohio (1897). Reprinted by the National Association of Medical Herbalists of Great Britain, United Kingdom (1932) 7. Tierra M. Planetary Herbology. Lotus Press. Twin Lakes, Wisconsin (1988) 8. Bensky D. Gamble A. Chinese Herbal Medicine Materia Medica. Eastland Press. Seattle, Washington (1986) 9. Zhang Gao-ming (ed). The Newly Edited Essential Materia Medica (Xin bian ben cao bei yao) Shi Yi Press, Tainan, Taiwan (1982) 10. Lawrence BM. Perfumer & Flavorist 9:1-40 (1984) 11. van Beek TA et al. Phytochemistry 26:3005 (1987) 12. Harvey DI. I Chromatogr 212:75 (1981) 13. Connell DW. Flavour Industry 1:677-693 (1970) 14. Endo K. Kanno E, Oshima Y. Phytochemistry 29:797-799 (1990) 15. Mills S, Bone K. Principles and Practice of Phytotherapy: Modern
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Saeed SA. Br I Pharmacol
32. Yamahara I. Huang QR. Li YH et al. Chern Pharm Bull 38(2):430-431 (1990) 33. Agrawal AK. Rao Cv. Sairam K et al. Indian I Exp Bio138( 10):994-998 (2000) 34. Yoshikawa M. Yamaguchi S. Kunimi K et al. Chern Pharm Bull 42(6):1226-1230 (1994) 35. Oyama S. lapan Centra Revuo Medicina 88:221(2) (1944) 36. Platel K. Srinivasan K. Intj Food Sci Nutr 47(1 ):55-59 (1996) 37. Platel K.Srinivasan K.Nahrung44(l):42-46 (2000) 38. Blumberger W. Glatzel H. Nutr Dieta 6: 181-192 (1964) 39. Sharma SS. Gupta YK. I EthnopharmacoI62(l):49-55 (1998) 40. Yamahara I. Huang QR. Li YH et aI. Chern Pharm Bull 38(2):430-431 (1990) 41. Yamahara I. Moo K. Chisaka T et at I Ethnopharmacol13(2):217-225 (1985) 42. Hikino H. Kiso Y. Kato Net aI.1 EthncpharmacoI14(l):31-39 (1985) 43. Yamahara I, Huang QR, Iwamoto),.l et al. Phytother Res 3(2):70-71 (1989) 44. Suekawa M. Ishige A, Yuasa K et al. I Pharmacobiodyn 7(11):836-848 (1984) 45. Mowrey DB. Clayson DE. Lancet 1(8273):655-657 (1982) 46. Grontved A. Hentzer E. ORL I Otorhinolaryngol Relat Spec 48(5):282286 (1986)
------------------
,
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Combining Western Herbs and Chinese Medicine
836
-----···1 .
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:.;~~~~
47. Grontved A. Brask T. Kambskard J et al. Acta Oto!aryngoll05(1-2):4549 (1988)
73. Katiyar SK. Agarwal R. Mukhtar H. Cancer Res 56(5):1023~1030·::-:~ .. , - . ( 1 9 9 6 ) ; - - ' : -.
48. Careddu P. Treatment of Periodic Acetonemic Vomiting: Comparison of Drugs. Unpublished Pharmaton report (1986). [cited in European Scientific Cooperative on Phytotherapy: Monographs on the medicinal uses of plant drugs. European Scientific Cooperative on Phytotherapy. Exeter, United Kingdom (1997»)
74. Kada T.Morita K. Inoue T.Mutat Res 53:351-353 (1978)
49. Bone ME, Wilkinson OJ, Young JR et al.Anaesthesia 45:669-671 (1990) 50. Fischer-Rasmussen W. Kjaer SK, Dahl C et a1. Eur} Obstet Gynecol Reprod Bioi 38(1):19-24 (1990) 51. Stewart n, Wood M}, Wood CD et al. Pharmacology 42(2):111-120 (1991) 52. Wood DC. Manno JE, Wood MJ et a1. Clin Res Pract Drug Regul Affairs 6(2):129-136 (1988)
I
75. Morita K. Hara M, Kada T. Agric Bioi Chern 42: 1235-1238 (1978) 76. SakaiY,Nagase H,OseY et al.Mutat Res 206:327-334 (1988) 77. Weidner MS, Sigwart K. Reprod ToxicoI15(1):75-80 (2001) 78. Wood CD, Manno JE, Wood M} et a1. Clin Res Pract Drug Reg Aff 6:129-136 (1988) 79. Tisserand R. Balacs T. Essential Oil Safety: A Guide for Health Care Professionals. Churchill Livingstone, Edinburgh, United Kingdom (1995) 80. Qureshi S, Shah AH. Tariq M, et a1. Am J Chin Med 17(1-2):57-63 (1989)
53. Stewart Wood MJ, Wood CD et al. Aviat Space Environ Med 62(5):465 (1991)
81. European Scientific Cooperative on Phytotherapy: Monographs on the Medicinal Uses of Plant Drugs (monograph on Zingiberis rhizoma). European Scientific Cooperative on Phytotherapy, Exeter, United
54. Arfeen Z, Owen H, Plummer }L et al. Anaesth Intensive Care 23(4):449-452 (1995)
82. Nakamura H, Yamamoto T. Mutat Res 103:119-126 (1982)
55. Qian OS, Liu ZS. Chung-Kuo Chung Hsi I Chieh Ho Tsa Chih 12(2):95-98.70 (1992)
83. Nagabhushan M, Amonkar AJ, Bhide Sv. Cancer Lett .36:221-233. (1987)
56. Shoji N, Iwasa A, Takemoto T et a1. J Pharm Sci 71(10):1174-1175 (1982)
84. Atal ck, Zutshi U, Rao PG. J EthnopharmacoI4(2):229-232 (1981)
n,
57. Kobayashi M. Ishida Y. Shoji N et al. J Pharmacol Exp Ther 246(2):667673 (1988) 58. Zhu Y. Journal of Traditional Chinese Medicine (6):47 (1960) 59. Suekawa M, Aburada M. Hosoya E. J Pharmacobiodyn 9(10):842-852 (1986) 60. Giri J, Sakthidevi TK, Meerarani S. Ind J Nutr Diet 21(12):433-436 (1984) 61. Sambaiah K,Srinivasan K. Nahrung35(1):47-51 (1991) 62. Sharma I, Gusain 0, DixitVP. Phytother Res 10(6):517-518 (1996) 63. Suekawa M, Yuasa K, Isono M et a1. Nippon Yakurigaku Zasshi 88(4):263-269 (1986) 64. Guh JH, Ko FN, Jong TT et al. J Pharm Pharmacol 47(4):329-332 (1995) 65. Bordia A. Verma SI<, Srivastava KC. Prostaglandins Leukot Essent Fatty Acids 56(5):379-384 (1997) 66. Janssen PL, Meyboom S, van Staveren WA et al. Eur J Clin Nutr 50(11):772-774 (1996) 67. Weidner MS, Sigwart K. J EthnopharmacoI73(3):513-520 (2000)
Kingdom (1997)
85. Sakai K. Oshima N, Katsuna T, et al. Yakugaku Zasshi 106(10): 947-950 (1986) 86. Blumenthal M (ed). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council, Austin. Texas (1998) 87. Lonicerus A. Kreuterbuch (1679). Reprinted by Verlag Konrad K61bl, MOOchen, Germany (1962) 88. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983) 89. Ellingwood F. American Materia Medica, Therapeutics :~d' -,_..Pharmacognosy, 11th edn. (1919). Reprinted by Eclectic Medical Publications. Sandy, Oregon (1994) 90. Christopher JR. School of Natural Healing. BiWorld, Provo, Utah (1976) . 91. Felter HW, Lloyd JU. King's American Dispensatory, rols. 1 and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1983) 92. Yeung H-C. Handbook of Chinese Herbs and Combinations. vol. 1. Institute of Chinese Medicine, Los Angeles. California (1985) 93. Priest AW, Priest LR. Herbal Medication. L.N. Fowler, Romford Essex. United Kingdom (1982)
68. Ahmed RS, Seth V, Banerjee BD. Indian J Exp Bioi 38(6):604-606 (2000)
94. Scolt j. Natural Medicine for Children. Unwin Paperbacks, London.
69. Sekiwa Y, Kubota K, Kobayashi A. J Agric Food Chern 48(2):373-377 (2000)
95. Kloss J. Back to Eden, 5th edn. (1939). Reprinted by Lifeline Books,
70. Surh Y. Mutat Res 428(1-2):305-327 (1999)
96. Bisset NG (ed). Herbal Drugs aad Phytopharmaceutica1s. English edn. Medpharm. Stuttgart, Germany (1994), from 2nd German edn. Wicht!
71. Vimala S, Norhanom AW. Yadav M. Br J Cancer 80(1-2):110-116 (1999) 72. Murakami A. Takahashi M. Jiwajinda S et al. Biosci Biotechnol Biochem 63(10):1811-1812 (1999)
...
United Kingdom (1990) Santa Barbara, California (1975)
M (ed) (1989) 97. Gladstar R. Herbal Healing for Women. Fireside, New York. New York (1993)
-
Additional herbs \-
""
contains data on the herbs that do not have a materia medica chapter of their own but are included in one or more of the herb combinations given in
T
HE TABLE BELOW
this book. Caution Due to space limitations, minimal information is given on the uses and contraindications of the herbs in the table below. It is the responsibility of the practitioner to gain a fuller understanding of these herbs before using them in the clinic.
Bladder as the meridians entered for Ephedra, but Lung and Heart is listed in the current text since this herb has such a marked effect on the Heart system, and its effect on the Bladder is not considered of primary importance. DOSE All dose figures in the table refer to an individual dose, to be given three times per day. These doses refer to oral administration of powders, infusions, decoctions, tinctures, or liquid extracts of the herb. They do not refer to:
Notes on the table
• pure essential oils • isolated constituents • preparations of the herb 'boosted' by the addition of isolated constituents or other chemicals • administration by injection
HERB NAMES Only the botanical name, together with the part used, is given for each herb. The tables in the Appendix provide the pharmaceutical, English, German, and French names for each of these herbs, and their Mandarin names and Chinese
Source of dose information
References For each herb in the table, a superscript refer-
characters, where available.
ence number indicates the source of the information on dosages, for example, I refers to Bensky and Gamble, 2 refers to Mills and Bone, 3 refers to the BHP, and" refers to my own experience.
PROPERTIES For the Western herbs shown in the table below, values for the temperature, tastes, and organs entered based upon the actions and uses of these herbs have been providep.
Number of doses per day The BHP is the main source used for dose information in the table below, and both the BHP and the table give data in terms of an individual dose, to be given three times per day. Some other texts, for example Mills and Bone, give dosage figures in terms of one dose per day. Figures taken from such texts have been divided by
These values reflect my own opinion. For the Chinese herbs shown in the table, the values given in Bensky and Gamble l are mainly, but not always, followed. For example, Bensky and Gamble listed the Lung and
837
I
--~\
838
Combining Western Herbs and Chinese Medicine
three, to give the individual (thrice-daily) dose figures shown in the table. The exceptions to the thrice-daily representation are Rhamnus purshiana (bark) and Vitex agnuscastus (fruit), which are generally given in one dose per day. The dosage figures given in Bensky and Gamble are taken to be equivalent to six individual doses (three doses per day for two days). Where dosages are given in grams, they have therefore been divided by six to give the individual dose figures shown in the table. Where dosages are given in qian, they have been divided by two to give the individual dose figures in grams, since there are 3 grams in one qian.
ing on their unique combination of syndromes and on their- -:-::::-:. individual response to herbal therapy. It will also depend on how the herb is combined with other herbs.
CAUTIONS AND CONTRAINDICATIONS
Australia Of the herbs in the table, only Mentha pulegium is included in Part 4 of Schedule 4 of the Therapeutic Goods Act Regulations of Australia and is marked in the table below with the superscript TGA •.
Contraindications and dose range If no cautions or contraindications are listed for a herb in the table, it indicates that none were found when the herb was used within the therapeutic dose range give,,! in the table. There may be adverse effects if these herbs are used at higher dosage levels. Contraindications and species Information on cautions and contraindications, whether from Western texts, Chinese texts, or from my own experience, is only given for the particular species and plant part listed. For example, contrain- . dications are listed for the aerial parts of Scrophularia nodosa. Contraindications for the root of Scrophularia ningpoensis (xuan shen) are not given in the table since this is a different species and a different plant part. Allergic reactions A few individuals may have allergic responses to herbs from a particular plant family, for example, the Asteraceae or the Umbelliferae. These relatively rare allergic responses have not been listed as contraindications in this table. If a patient has a history of allergic responses to a particular plant family, herbs in this family can be avoided (see the Family names-botanical names table in the Appendix). Source of contraindications For each herb, a superscript reference indicates the source of the information on the con~ traindications listed.
USE Caution Any potentially serious illness must receive a conventional specialist's diagnosis and also conventional treatment, where appropriate. For example, angina pectoris, hematuria, and threatened miscarriage are conditions included in the Use column of the table, but herbal therapy, if appropriate, would only be used as an adjunct to conventional therapy after a conventional diagnosis. Effectiveness The effectiveness of a herb for the conditions listed in the table will vary from patient to patient, depend-
REGULATORY STATUS OF THE ADDITIONAL HERBS Please read the section on Regulatory status in the chapter on Safety for a detailed discussion of this topic. The first column in the table below gives information for each herb listed on regulatory status, at the time of writing, for Australia, the UK, and the USA.
UK Herbs that are on the UK General Sale List are marked in the table below with the superscript GSL. Of.the herbs found in the table, only Chelidonium and Ephedra are on Schedule Part III of the Supply of Herbal Remedies Order 1977 of the UK and are marked with the superscript SPllI. USA Of the herbs in the table, only Ephedra is listed by the FDA of the USA as a prohibited substance, as subject to an import alert, or as a substance with a warning on its use (see the discussion in Regulatory status in the chapter on Safety); the herb is marked in the table below with the superscript Fn\• Caution The regulatory status of herbs is constantly changing, and it is the responsibility of the practitioners in a particular country or state to be familiar with their local regulations. ADDITIONAL ABBREVIATIONS
BP This abbreviation was used for a few of the tinctures listed in the British Herbal Pharmacopoeia (BHP). BP refers to British Pharmacopoeia, Her Majesty's Stationary Office, London. BPC This abbreviation was used for a few of the tinctures listed in the British Herbal Pharmacopoeia. BPC refers to British Pharmaceutical Codex, The Pharmaceutical Press, London. The publication was prepared by the Pharmaceutical Society of Great Britain. Note: The publication has ceased, and the last (tenth) edition was issued in 1973. FOOTNOTES Footnotes to the table are marked with a superscript lower case letter and give additional information on the herb so marked.
'."!':
Additional Herbs Herb:: _::,:::-:c:~_ . c:Prope-rfJes;::"" (part used)
"
,--
organs
Dose'"(3 -per day); -"-'~:::::~.~~:~;c -::,::.:'::-::: :-:-~::.-:
... Cautions and contraindications
839 us~- "',: _.-.:~~.;:;;g;:~~~~?~~~;{~-::;. ;.~~;;~:~~~::~~:: ''''::':':~''-:':'-''
varicose veins (internally and topicalbO, aid to prevention of deep vein thrombosis subsequent to surgery
SP
dried material 0.3-0.6 g; tincture (1:5) 1.6-5 ml 2 T contraindicated for application to broken or ulcerated skin; also. see the discussion in Mills and Bone 2
Agrlmonia eupatoriaGSl (aerial parts)
neutral sour. sl. bitter
dried material 2-4 g; tincture (1:5 in 45% alcohol) 1-4 ml 3
gastritis, enteritis, malabsorption disorders, colitis. diarrhea in children, cystitis, urinary incontinence (orally); leukorrhea (douche)
Agropyron rerens GSL (rhizome)
neutral sour, sl. sweet
dried material 4-8 g; tincture (1:5 in 40% alcohol) 5-15 ml 3
urinary tract inflammation, urinary stones, prostatitis. benign prostatic hypertrophy
Astragalus species (root)
sl.warm sweet
dried material 3-10 g; liquid extract (1:2) 1.3-2.6 ml;2 tincture (1:5 in 25% alcohol) 1-2 ml 4 T contraindicated for Exterior Excess Heat patterns and for Deficient Yin patterns with Heat signs;! inadvisable in acute infections2
spontaneous sweating, organ prolapse, diarrhea, or edema. when these are associated with debility; impaired immunity, viral infections, cancer therapy adjunct
Avena sativa GSL (endosperm)
neutral sweet
SP,HT,KI
liquid extract (1:1 in 25% alcohol) 0.6-2 ml 3 T inadvisable for Spleen Deficiency with Stagnation and Damp4
menopausal disorders with hot flashes, emotional lability, and depression; mental. emotional. and physical exhaustion with nervous tension. emotional lability, depression, and weight loss
Ballota nigra (aerial parts)
neutral bitter, sour
dried material 2-4 g; tincture (1:10 in 45% alcohol) 1·2 ml 3
nervous indigestion. nausea or vomiting, especially during pregnancy
Baptlsla tinctoria GSl (root)
cold bitter
dried material 0.5-1 g; tincture BPC i'9341 2-5 mil T contraindicated for Spleen Deficiency with Cold; use inadvisable for more than seven days'
strong short-term antimicrobial for acute infections and fever. tonsillitis and throat infections,lymphadenitis, or boils (orally); leukorrhea (douche)
Caulophyllum thalictroidesGSl (root)
neutral bitter
dried material 0.3-1 g; liquid extract (l:1 in 70% alcohol) 05-1 mt? tincture (l:5 in 70% alcohol) 1-2 mi' T contraindicated by some during pregnancy, but used by others in small amounts for threatened miscarriageS
amenorrhea, dysmenorrhea. induction of labor
Chamaellrlum luteumGSl (root and rhizomes)
neutral bitter, sour
dried material 1-2 g; tincture (1:5 in 45% alcohol) 2·5 ml 3 T to be used with caution during pregnancy and only by practitioners experienced in herbal Jherapt
amenorrhea, infertility, dysmenorrhea. vomiting during pregnancy, threatened miscarriage, uterine prolapse, leukorrhea
Chelidonium sp majus ", (aerial parts)
cool bitter, sl. acrid
Chrysanthemum morifolium (flos)
cool sweet, sl. bitter
Citrus ,al aurantium (ripe peel)
warm acrid, aromatic,bitter
Aesculus hippocastanumGSl (seed)
cool bitter. sour
LU,IN, BL, UT
BL
r1;
~\
-
SP,LU
't"
r-
~
I:' l
L, "
'i-"
L
ST
LU
,L.
UT
I· !
~-
li
UT
I
I, " .~
dried material 2 g;8 tincture (1:10 in 45% alcohol) 2-4 ml 3
cholecystitis or cholelithiasis with spasms and pain in the right subcostal area. and intestinal spasms and pain; depression, headache. or gastrointestinal disorders from sluggish action of the liver
dried material 0.75-1.5 g;' tincture (l:5 in 25% alcohol) 1-2 mi' T to be used with caution for patients with Deficient Qi, poor appetite, or diarrhea I
fever, headache; red, painful dry eyes; weak or blurred vision, dizziness
dried material 1.3-2 g;6 tincture (1:5 in 25% alcohol) 0.5-1 ml 4
loss of appetite, digestive weakness, flatulence. chronic bronchitis
LR.GB,IN
LU,LR
SP,ST,IN,LU
---------_. -------
840
Combining Western Herbs and Chinese Medicine
Curcuma longa lbl (rhizome)
cool bitter, acrid, aromatic LR,GB,HT
dried material 1.3-2.6 g; liquid extract (1:1 in 25% alcohol) 1.64.6 ml;2 tincture (1:5 in 25% alcohol) 1-2 mt' .., contraindicated for obstruction of the bile duct (but no evidence to support this claim was given)7
hyperlipidemia and angina pectoris, gallbladder··· disorders, indigestion from sluggish liver function, amenorrhea, dysmenorrhea
Elettarla cardamomumGSl (ripe seeds)
warm aromatic. acrid ST,IN
dried material 1-2 g; tinctureBP(1973) 2-4 ml3
anorexia, nausea, abdominal distension, flatulence, intestinal spasms
Ephedra sinica'oA.sPlI1 (young stems)
warm acrid, sl. bitter LU,HT
dried material 0.6 g; tincture (1:4 in 45% alcohol) 0.5-2.5 ml8 .., Ephedra is on the Schedule Part III list of the UK (maximum dose limitations are given above), and is contraindicated for severe hypertension, glaucoma, hyperthyroidism, coronary thrombosis, enlargement of prostate, and while taking MAQ-inhibitors8 Ephedra is to be avoided in cases of headache, cardiac arrhythmia, hyperactivity, severe restlessness, insomnia, anxiety, and mental disturbance; and to be avoided or used with caution during pregnancy and lactation'
acute asthma, allergic rhinitis, urticaria
Equlsetum arvenseGSl (sterile stems)
cool 51. bitter, sl. sweet BL
dried material 1-4 g;3 tincture (1:5 in 25% alcohol) 2-6 mj9 .., no contraindications are known according to the German Commission E;7 the SHC contraindicated Equisetum for cardiac or renal dysfunction, but gave no evidence to support this statement9
edema, enuresis, inflammation or mild infection of urinary system, hematuria, prostatitis, benign prostatic enlargement
Eupatorium perfoliatumGSl (aerial parts)
warm bitter, acrid, aromatic LU
dried material 1-2 g; tincture (1:5 in 45% alcohol) 1-4 mfl
short-term use as warm Infusion for acute .,. ~ .,. influenza or bronchitis with fever, especially.~..:.:t_;,,;;.,:~, . myalgia ('deep aching sensation')
Euphorbia hirta GSl (entire plant)
cool bitter, acrid LU
dried material 120-300 mg; tinctureBl'C(1923) (1:5 in 60% alcohol) 0.6-2 ml 3
bronchitis with heat sensations, nasopharyngeal or bronchial catarrh, asthma, laryngeal spasms. edema, diarrhea (bacterial or amoebic)
Foeniculum vulgareGSl (fruit)
51. warm aromatic. 51. acrid ST,IN, KI, LR
dried material 0.3-0.6 g;3 tincture (1:5 in 25% alcohol) 1-4 mt'
anorexia, epigastric discomfort or pain, nausea, belching, abdominal distension, flatulence. intestinal colic (especially in children), chronic cough, insufficient lactation
Gallum neutral aparine GSl sour, 51. bitter (root and rhizome) LU,BL
dried material 2-4 g; tincture (1:5 in 25% alcohol) 4-10 ml9
psoriasis, lymphadenitis, enlarged lymph nodes, edema, urinary obstruction, cystitis
Geranium maculatumGSl (rhizome)
neutral sour ST,IN,UT
dried material 1-2 g; tincture (1:5 in 45% alcohol) 2-4 ml3
diarrhea, hemorrhoids, melena, duodenal ulceration, hematemesis, abnormal uterine bleeding
Glechoma hederacea GSl (aerial parts)
neutral sour, bitter LU
dried material 2-4 g; tincture (1:5 in 25% alcohol) 5-10 ml 9
chronic catarrh of the nose, throat, or bronchi
Humulus lupulusGSl (strobiles)
cold bitter HT, LR, IN
dried material 0.5-1 g; tincture (1:5 in 60% alcohol) 1-2 mj9
restlessness, hyperactivity, insomnia, anxiety, colitis, loss of appetite
....
...
Additional Herbs
{.-
L c.
_~iydrangea
,":
F _.
arborescensGSL (underground parts)
neutral biner,sour
dried material 2-4 g; tincture (1:5 in 45% alcohol) 2-10 ml3
urinary tract inflammation, urinary stones, prostatitis, prostatic enlargement
BL
Hypericum Gst perforatum (aerial parts)
neutral sour, sl. sweet HT,K1,LR
dried material 2-4 g; tincture (1:10 in 45% alcohol) 2-4 ml3 ... not advisable in cases of known photosensitivity (see the discussion in Mills and Bone)2
depression with menopausal hot flashes and anxiety; depression with irritability, emotional hypersensitivity, and lack of confidence; enuresis, nightmares, insomnia
Hyssopus officinalisGSL (aerial parts)
warm-eool acrid, aromatic LU,HT
dried material 2-4 g; tincture (1:5 in 45% alcohol) 2-4 ml3
common cold or influenza with fever, acute or chronic bronchial catarrh, cough, sore throat
Iris versicolof st (rhizome)
cool bitter
dried material 0.6-2 g; tincture (1:5 in 45% alcohol) 3-10 ml9
constipation or skin disorders with hepatobiliary weakness
Lyclum chinense (fruit)
neutral sweet
dried material 1-2.5 g;l tincture (1:5 in 25% alcohol) 1-2 ml" ... contraindicated for Excess Heat or for Deficient Spleen with Dampl
anemia with exhaustion, blurred Vision, dizziness, headache
Marrubium vulgareGSL (aerial parts)
neutral bitter LU,SP
dried material 1-2 g; tincture (1:5 in 25% alcohol) 3-6 ml 9
acute or chronic bronchial phlegm with spasmodic, nonproductive cough and digestive weakness; whooping cough
Matricaria recutitaGSL (flower heads)
cool sl. bitter, sl. aromatic
dried material 2-8 g;3 tincture (1:5 in 45% alcohol) 3-10 ml9
nausea and vomiting, especially travel sickness and vomiting during pregnancy; teething and restlessness in infants; gastrointestinal disorders with nervous irritability or insomnia in children; irritable bowel syndrome with nervous tension
dried material 2-4 g;3 tincture (1:5 in 45% alcohol) 2-3 ml 9
nausea and vomiting, epigastric discomfort and belching, abdominal distension, flatulence and intestinal colic (all with sluggish liver function); common cold with sore throat
dried material 1-4 g;3 liquid extract (1:1 in 45% alcohol) 1-4ml;3 tincture (1:5 in 25% alcohol) 0.5-1 ml" ... contraindicated during pregnancy3
dysmenorrhea or menstrual irregularity with shock or fear, fearfulness, sensation of vibrating or shaking from fear or emotion, sensation of not being solidly in the body, intestinal colic from nervous tension
LR.GS,IN
LR.K1
ST.IN,HT
,.
..
Mentha piperitaGSL (aerial parts)
warm-eool acrid, aromatic
Mentha pulegi umGSL.1GA (aerial parts)
warm aromatic
Mitchella repensGSL (entire plant)
neutral sl.sour
LU,ST,IN,LR
\~
~
-
841
HT,IN,UT
r~
Molasses, blackstrap
Nepeta catariaGSL (aerial parts)
UT
neutral
sweet, sl. biner SP
cool aromatic, acrid, sl. biner
LU,IN,HT
dried material 2-4 g;3 liquid extract (1:1 in 25% alcohol) 2-4 ml;3 tincture (1:5 in 25% alcohol) 1-4 ml"
taken throughout pregnancy or prior to parturition to facilitate childbirth, assists in the prevention of miscarriage, leukorrhea
5 ml (dissolved in half a cup of warm water)" ... not advisable in cases of obesity"
iron-deficiency anemia, insomnia and nervous conditions related to B vitamin and mineral deficiency
dried material 2-4 g; tincture (1:5 in 25% alcohol) 3-6 ml3
especially in children: insomnia, flatulent colic, headache, or fever with restlessness, agitation, or nervous tension
842
Ophiopogon japonicus (tuber)
Combining Western Herbs and Chinese Medicine
cool sweet, 51. bitter HT,LU,ST
dried material 1-2.5 g;l tincture (1:5 in 25% alcohol) 1-2 ml' T contraindicated in patients with Cold Deficient diarrhea or Congested Auids 1
chronic dry sinuses, dry mouth, dry cough with sticky sputum and difficult expectoration, gastritis with thirst and constipation, night sweats and sensations of heat, low-grade fever, restlessness, insomnia exhaustion, poor concentration, depression, lack of motivation, lack of sexual drive, hypotension or palpitation from cardiac weakness, shortness of breath
Panax ginseng GSl (root)
sl.warm sweet, 51. bitter KI, HT, SP, LU
dried material 1-2 g;3 tincture (1:5 in 60% alcohol) 0.5-1.5 ml' T contraindicated for patterns of Heat, Liver Hyperactive Yang, Heart Spirit Disturbance, including: irritability, headache, dizziness, hypertension, cardiac arrhythmia, hyperactivity, restlessness, insomnia, anxiety, and mental disturbance; to be used with caution in patterns of Qi constraint with sensation of obstruction in the chest'
Panax quinquefolium (root)
neutral sweet, 51. bitter LU,ST,KI
dried material 0.4-1.5 g;l tincture (1:5 in 60% alcohol) 1-2 ml' T Chinese tradition contraindicates P. quinquefolium for Cold Damp Stomach patterns,1 but excessive use of this herb has been reported to result in Qi Stag· nation and Heat symptoms;10 to be used with caution for patterns of Heat, Liver Hyperactive Yang, or Heart Spirit Disturbance'
mental and physical exhaustion in people with restlessness and insomnia for whom P. ginseng would be inappropriate; postfebrile debility without heat signs
Parietaria diffusaGSL (aerial parts)
neutral bitter KI,BL
dried material 1-5 g; tincture (1:5 in 45% alcohol) 2-10 ml 3
edema, oliguria, urinary tract inflammation. urinary stones
Passiflora incarnataGSl (aerial parts)
neutral sl.bitter HT,LR
dried material 0.25-1 g; tincture (1:8 in 45% alcohol) 0.5-2 ml 3
hyperactivity in children, restlessness, insomnia, palpitations, anxiety, headache
Petroselinum crispumGSl (root)
sl.warm aromatic, 51. acrid KI, BL, IN, UT
dried material 2-4 g; liquid extract (1:1 in 25% alcohol) 2-4 ml 3 T contraindicated for pregnancy and kidney inflammation (no references were given to support this claim)7
edema, dysuria, cystitis, rheumatism, dysmenorrhea. flatulence with intestinal colic
Plantago lanceolataGSl (leaves)
cool sour, 51. bitter LU,IN
dried material 1-2 g;6 tincture (1:5 in 25% alcohol) 1-2 ml'
cystitis with hematuria, hemorrhoids with bleeding and irritation;C) upper respiratory catarrh 1d)
Polygonum bistortaGSL (root and rhizome)
cool sour, sl. bitter LU, IN
dried material 1-2 g; tincture (1:5 in 25% alcohol) 1-3 ml 3
respiratory, intestinal, or urinary inflammation with catarrh or bleeding; diarrhea or colitis with mucus in the stools; anal fissure (ointment)
Populus tremuloidesGSl (bark)
neutral-cool bitter, sour SP, ST,IN, LR, BL
dried material 1-4 g;3 tincture (1:5 in 25% alcohol) 0.5-1.5 ml' T contraindicated for patients with sensitivity to salicylate (no references were given to support this claim)7
recurring fever, intermittent fever, chronic lowgrade fever, postfebrile debility, poor appetite, digestive weakness, myalgia, arthritis
Prunus serotina GSl (bark)
neutral bitter, aromatic LU,HT
dried material 0.5-2 g;3 liquid extract (1:1 in 25% alcohol) 1-2 ml;3 tincture (1:5 in 25% alcohol) 1-1.5 ml'
chronic dry, irritant, or nervous cough; whooping cough, nervous digestive disorders
Additional Herbs
843
Herb":,,"2.~::-.~c:-:--PrOperji~S;~.7-:,~:pose (part 'used) ':"organs-
Pseudostellaria heterophylla (root)
pulsatilla chinensis (root)
Quercus roburGSL (inner bark)
Rhamnus purshianaGSl (bark)
Rubus
f';'.
idaeusGSL (leaves)
:.'
(3 ·~·dayl;:-;:frt§~$;:-~~';.:~:i:'~C-;:.?(::~2.·;~7?J[@S:~]~~Z~:~-ii~~~.~i~-;-t1;71:j CaUtions and contraindications .<: '.... ..: _,. _..:. . -'.---.. .. ."
neutral sweet, sl. bitter SP,LU,HT
dried material 1-2.5 g;l tincture (1:5 in 25% alcohol) 1-2 mi'
postfebrile debility, especially with thirst; exhaustion, in cases in which heat signs, hypertension, or insomnia preclude the use of Panax species; cardiac weakness with debility
cold bitter
dried material 1.5-2.5 g;l tincture (1:5 in 25% alcohol) 1-2 mi' T contraindicated in chronic dysentery with injured Spleen or Stomach Qi;l use P. chinensis as an antiprotozoal, shortterm, for the initial phase of herbal treatment of patients with protracted giardial diarrhea, but add Zingiber and/or Cinnamomum bark to protect the Spleen and Stomach'
bacterial or protozoal dysentery
dried material 1-2 g; liquid extract (1:1 in 25% alcohol) 1-2 ml;3 tincture (1:5 in 25% alcohol) 0.5-1.5 mi' T no contraindications for the internal use of Quercus, but contraindicated for external use to treat skin damage over a large area (no references are given to support this claim);7 short-tenn use only unless given at lower doses'
acute diarrhea (orally, in frequent small doses); hemorrhoids,leukorrhea (douche); tonsillitis (gargle)
dried material one dose of 0.25-1 g at bedtime;9 liquid extractBP (1973) one dose of 2-5m' at bedtime3 T contraindicated for abdominal pain of unknown origin; intestinal Obstruction, stenosis, or atony; colon inflammations such as Crohn's disease or ulcerative colitis; appendicitis; severe dehyqration states with water or electrolyte depletion;u short-term use only unless given at lower doses'
acute constipation (higher doses), normalization of bowel function (lower doses)
dried material 4-8 g;3 liquid extract (1:1 in 25% alcohol) 4-8 inl;3 tincture (1:5 in 25% alcohol) 1-2 mi'
taken throughout pregnancy or prior to parturition to facilitate childbirth, assists in the prevention of miscarriage, leukorrhea, assists in the normalization of bowel function
dried'material 2-4 g; tincture (1:5 in 45% alcohol) 1-2 mtJ T patients with a history of kidney stones should use this herb cautiOUSly, presumably because of its oxalate content (no primary references were given to support this claim)s
chronic skin disease with constipation or sluggish liver function, anemia
dried material 0.06-0.5 g; tincture (1:5 in 60% alcohol) 0.3-2 ml3 T caution is advisable since Sanguinaria may cause nausea 5
chronic bronchial phlegm, asthma, or sore throat, all with poor peripheral circulation; sluggish liver function
dried material 2-6 g; tincture (1:5 in 45% alcohol) 2-8 ml3 T contraindicated in Cold Deficient patients1
diarrhea or ulcerative colitis, especially with bleeding and/or sensations of heat; menorrhagia or leukorrhea, especially with sensations of heat
dried material 0.25-1.5 g (0.25-0.5 g for chronic cough; 1-1.5 g as a tonic);l tincture (1:5 in 25% alcohol) 1-2 mi' T contraindicated in Excess Heat patterns or in early stages of cough or rashes 1
exhaustion with: poor concentration, palpitations, anxiety, insomnia, nightmares, depression, cough, asthma, allergic skin disorders, sweating, urinary frequency or enuresis, or diarrhea
IN,ST,LR
neutral sour, bitter
IN
cool bitter
IN,ST,LR
neutral bitter, sour
UT,IN
t-._
,-
Rumex crispusGSL (underground parts)
Sanguinaria canadensisGSL (rhizome)
Sangulsorba officinalisGSl (aerial parts)
Schlsandra chinensis (fruit)
cool bitter, sl. sour
LR,IN
warm bitter, acrid
lU,HT.LR
cool sour, bitter
IN.UT
warm sour
HT.K1,LU,LR
&
Combining Western Herbs and Chinese Medicine
844
dried material 2-8 g (infusion); tincture (l:lO in 45% alcohol) 2-4 mr ., BHP contraindicated the aerial parts of S. officinalis for ventricular tachycardia {no references were given to support this claim)3
eczema, psoriasis, tendency to ulceration, enlarged lymph glands
dried material 0.5-1 g;3 tincture (1:5 in 45% alcohol) 1-2 ml4
urinary tract inflammation, prostatitis, benign prostatic hypertrophy, emaciation, exhaustion
dried material1-S g; tincture (1:S in 4S% alcohol) 2-10 ml; ointment l:S in ointment base'
mainly used topically as ointment or poultice for skin inflammation, irritation, or ulcers; as poultice for boils or abscess; as bolus for vaginal inflammation internal use for bronchitis
dried material 0.5-1 g; tincture (1:10 in 45% alcohol) 2-4 ml3 ., patients with a history of kidney stones should use this herb cautiously. presumably because of its oxalate content (no primary references were given for this claim)5
asthma, bronchitis, whooping cough, assists in the treatment of convulsions
exhaustion and emaciation. poor appetite, gastritis, insufficient lactation (orally); boils, myalgia, gout (poultice)
Sp,IN,lU
dried material 2 g;6 tincture (1:5 in 25% alcohol) 1-2 mt' ., contraindicated for patients with Deficient Yin and Heat signsl
Urtica dioica GSL (aerial parts)
warm-eool acrid
dried material 2-4 g; tincture (1:5 in 45% alcohol) 2-6 mr
arthritis, allergic eczema, allergic rhinitis, bronchitis, watery stools with mucus, cystitis, prostatitis, menorrhagia
Vinca f.) majorGSl (aerial parts)
neutral sour
Bl,UT
dried material 2-4 g; liquid extract (1:1 in 25% alcohol) 2-4 ml;3 tincture (1:5 in 25% alcohol) 1-2 ml4 ., contraindicated for constipation3 and for hypotension12
abnormal uterine bleeding, assists in the treatment of threatened miscarriage, leukorrhea, enuresis
Viola odorata GSl (leaves and flowers)
cool sour, sweet, bitter
dried material 2-4 g; liquid extract (1:1 in 25% alcohol) 2-4 ml;3 tincture (1:5 in 25% alcohol) 1-2 ml 4
chronic nasopharyngeal or bronchial catarrh, adjunct to cancer therapy
Viola tricolorGSl (aerial parts)
cool sour, sweet, bitter
dried material 2-4 g; liquid extract (1:1 in 25% alcohol) 2-4 ml;3 tincture (1:5 in 25% alcohol) 1-2 ml4
dry cough or whooping cough; respiratory, gastric, or urinary inflammation; arthritis, skin disorders
certain types of: amenorrhea, infertility, premenstrual syndrome, abnormal uterine bleeding, fibroids, endometriosis, insufficient lactation, acne
Scrophularia nodosaGSl (aerial parts)
Serenoa serrulataGSl (fruit) Stellaria media GSl (aerial parts)
Symplocarpus foetidusGSl (root and rhizome)
Trigonella foenum-graecum GSl (seeds)
cool sl.bitter
lU
neutral sweet, sl. sour
KI,Bl,SP cool sl. sour, sl. bitter
lU,IN
warm acrid
lU,lR
sl.warm bitter, sl. sweet. sl.acrid
lU, IN, Bl, UT
-r'
o
~i'~
-\\1--
lU,Bl
lU,Bl Vitex agnus-castus (fruit)
neutral bitter, sl. acrid
lR,UT
tincture (1:5) one daily dose of 1-5 ml taken before breakfast? ., preferably not to be taken concurrently with the contraceptive pill, progesterone, or hormone replacement therapf
Zea maysGSl
neutral sweet
dried material 4-8 g; tincture (1:5 in 25% alcohol) 5-15 ml 3
urinary tract inflammation, urinary stones, edema, enuresis, prostatitis
dried material 1.6-5 g;13 tincture (1:5 in 25% alcohol) 1-2 m~ ., contraindicated for patterns of Excess Damp;l inadvisable for obese patients with Spleen Deficiency and Stagnation with Damp4
chronic eczema or recurring urticaria with debility, recurring respiratory infections with debility and dry cough, emotional lability from exhaustion
(stigmas and styles) Ziziphus jujuba (fruit)
Bl
neutral sweet
SP,ST
';'
1
Additional Herbs
845
Footnotes
(a) As used in the West. Citrus aurantium consists of the peel of ripe bitter orange from which the spongy white parenchyma is largely removed. This differs from chen Pi in that the latter is the peel of the ripe tangerine. usually C. reticulata. (b) In the West, Curcuma longa commonly consists of the ovate primary rhizomes (bulb turmeric), the cylindrical secondary rhizomes (fingers), or a mixture of both. Chinese meOlCine distinguishes
References 1. Bensky D, Gamble A. Chinese Herbal ~ledicine Materia Medica.
Eastland Press. Seattle, Washington (1986) 2. Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone, Edinburgh, United Kingdom (2000)
3. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983) 4. Ross J. Personal experience and opinion 5. McGuffin M, Hobbs C, Upton R et al. American Herbal Products Association's Botanical Safety Handbook. CRC Press, Boca Raton, Florida (1997) 6. Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm, Stuttgart, Germany (1994), from 2nd German edn. Wichtl M (ed) (1989)
between yU jin (turmeric tuber) and jiang huang (turmeric rhizome). It is not clear if primary rhizomes are identical to yu jin and secondary rhizomes to jiang huang. (c) Data given by the BHpJ for Plantago major. (d) Data given by Wichtl 12 for Plantago lanceolata. (e) The Vinca species mainly used in the UK is V. major. but in France and Germany, V. minor is the main species used.
7. Blumenthal M (ed). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council, Austin, Texas (1998) 8. Hyde F. Herbal Practitioner's Guide to the Medicines Act 1968. New Herbal Practitioner 4(3) (1978) 9. Bradley PR (ed). British Herbal Compendium, vol. 1. British Herbal Medicine Association, Bournemouth, United Kingdom (1992) 10. Tierra M. Planetary Herbology. Lotus Press, Twin Lakes, WISconsin (1988) 11. European Scientific Cooperative on Phytotherapy: Monographs on the Medicinal Uses of Plant Drugs. European Scientific Cooperative on Phytotherapy, Exeter, United Kingdom (1997) 12. List PH, Horhammer L. Hagers Handbuch der Pharmazeutischen Praxis. 7 vols. Springer-Verlag, New York, New York (1973-1979) 13. Yeung H-C. Handbook of Chinese Herbs and Formulas, vol.1.lnstitute of Chinese Medicine, Los Angeles, California (1985)
[
.
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, ~.
Glossary general glossary, herb actions are defined in the Actions glossary chapter, and definitions of nonstandard Chinese syndromes are given in the Terminology section at the beginning of this book. An underline indicates that the term is defined elsewhere in this glossary. In some cases, the abbreviation for the term follows its heading in bold print.
I I
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cific name, which is written in lower case. The species name is often followed by the name of the botanist(s), or their accepted abbreviations (such as L. for Linnaeus), who first described the species. In a few cases, the name of the botanist may be followed by a further abbreviation. For example, the botanical name for yarrow is Achillea millefolium L. s.l. The abbreviation 's.1: stands for the Latin words sensu lato. When more than one species in the same genus is discussed, the generic name may be abbreviated to the first letter in upper case. For example, when species in the Artemisia genus are discussed, wOrnlwood may be abbreviated as A. absinthium and mugwort as A. vulgaris.
N ADDITION TO THIS
Adverse reaction Some authors use the terms 'adverse reaction' and 'side effect' synonymously to indicate a negative reaction to a herb or conventional drug. However, other authors use the term adverse reaction to indicate a negative reaction that is severe enough to merit filling in an adverse reaction report. In contrast, they use the term side effect to indicate a negative reaction ranging from mild to moderate, for example, temporary nausea or diarrhea.
Botanical name This is the name of a herb, in Latin, according to binomial nomenclature, that is, the generic name followed by the species name, for example, Achillea millefolium. The botanical name is the most precise and internationally recognized name for a plant.
Asthenic A term used by Physiomedical and Eclectic practitioners to indicate a state of weakness (as opposed to sthenic). Asthenia corresponds to the pattern of Deficiency in Chinese medicine.
BP A few of the specifications for tinctures or liquid extracts listed in the British Herbal Pharmacopoeia (BHP) are followed by the letters BP. This abbreviation refers to the British Pharmacopoeia (Her Majesty's Stationary Office, London, UK).
Atonic A term used by Physiomedical and some later herbal practitioners to indicate a lack of tone in skeletal muscles and tendons, in skin and connective tissues, or in the smooth muscles of organs and ducts. The term is sometimes used with the implication of hypofunction of an organ or tissue.
BPC A few of the specifications for tinctures or liquid extracts listed in the British Herbal Pharmacopoeia (BHP) are followed by the letters BPC. This abbreviation refers to the British Pharmaceutical Codex (The Pharmaceutical Press, London, UK). This publication was prepared by the Pharmaceutical Society of Great Britain. Note: The publi-
Binomial nomenclature In botany, the first part of the plant name is the generic name, which starts with an uppercase letter, and the second part of the plant name is the spe-
847
Combining Western Herbs and Chinese Medicine
848
.~._.,l..
cation has ceased, and the last (tenth) edition was issued in 1973. Catarrh This refers to excessive production of mucus by the mucous membranes. According to the Eclectics, this catarrh may then obstruct the ducts of the body leading to dysfunction of the respiratory, digestive, hepatobiliary, urinary, or reproductive system. The anticatarrhal action is discussed in the Actions glossary chapter. Caution The term is used in this book for any symptom or situation in a patient's condition that indicates that a specific herb or type of herb should be used with caution because of the possibility of an adverse reaction, whether mild or severe. Contraindication Any symptom or situation in a patient's condition that indicates that a specific herb or type of herb should not be used because of the possibility of a severe adverse reaction. For example, pregnancy is a contraindication for certain herbs, especially those with stimulant emmenagogue action. Cultivated variety Often shortened to cultivar, this is a variety that is not usually found in natural populations of the species but is produced by agricultural or horticultural techniques. For example, the two main cultivars of Mentha piperita (peppermint) are: • M. piperita var. vulgaris Sole black mint • M. piperita var. officinalis Sole white mint A cautionary note Cultivars may be different in constituents and pharmacology from plants in the natural population of the species, and may have different effects on humans, both negative and positive. Dose range The range within which a suitable dose for most adults will be found.
ness, and the terms 'tiredness' and 'fatigue' are used synonymously. The term 'debility' refers to muscular weakness, which is not necessarily involved in exhaustion. Family An important rank in the taxonomic hierarchy, which some consider to be the highest natural grouping. The Latin names of families usually end in 'aceae: as in Asclepiadaceae (the milkweed family) and Berberidaceae (the barberry family). A family consists of a number of related genera, for example, the Lamaiceae (mint family) contains genera such as Salvia (the sages) and Thymus (the thymes). Genus
The taxonomic rank below family and above
species. A genus consists of a number of related species. For example, the genus Artemisia contains species such as A. absinthium (wormwood), A. abrotanum (southernwood), and A. vulgaris (mugwort). Healing crisis
Both healing crises and side effects can
involve the aggravation of existing symptoms or the production of additional symptoms. However, side effects are associated with processes that are harmful to the body and may continue as long as the medication is taken. In contrast, the unpleasant symptoms produced during healing crises are temporary, lasting a few hours or a few days. They are a part of the self-healing process of the body so that the healing crises result in long-term benefit (see the next·_·'~·"
Appendix). Hypersensitivity This term is sometimes used in a general sense to indicate abnormal sensitivity reactions of various kinds. In its more specific meaning, it is restricted to allergic reactions-abnormal responses of the body to the presence of a specific antigens. Examples are the rare cases of contact allergy to certain members of the Asteraceae plant family, such as Tanaceturn (see the Tanacetum chapter).
Eclectic movement This movement in herbal medicine had considerable overlap with the Physiomedical movement, and both derived in part from the work of Thomson (see the History chapter). However, the Eclectic practitioners were mainly medical doctors specializing in botanic medicine who often incorporated into their herbal practice the new biochemical knowledge of the time.
Idiosyncratic reactions These can be defined as unusual or unexpected sensitivities or responses shown by an individual to a specific drug or food. Some texts separate hypersensitivity reactions, associated with an allergic response, from idiosyncratic reactions, associated with genetically determined enzyme deficiencies. Idiosyncratic reactions may sometimes be serious.
ED sa This is an abbreviation for the median effective dosethe dose of a substance that is required to produce a specified effect in 50 percent of individuals tested. Exhaustion
In this book, this term refers to extreme tired-
__
._-¥
In vitro The Latin words in vitro, which literally mean 'in glass', refer to an experiment performed outside a living organism, for example, in extracted tissue samples or in a cell cultures. Compare in vivo.
_w,
Glossary In vivo The Latin words in vivo, which literally mean 'in life', refer to an experiment performed within a living organism. Compare in vitro.
'stimulation' and 'relaxation' in the human body. It originated in North America from the work of Samuel Thomson (see the History chapter).
LDso The dose of a toxic compound that causes death in 50 percent of the group of experimental animals to which it is administered. The LD;o is often shown in units of g or mg of the toxic compound per kg of body weight.
Polyploidy This term can refer to a variation in chromosome number. It can also refer to chromosome numbers higher than those found in the diploid form. Haploid plants have a single set of chromosomes (n). diploids have two sets of chromosomes (2n), triploids have three sets (3n), tetraploids have four sets (4n), and so on. For example, the different subspecies of Achillea and Valeriana exhibit polyploidy (see the chapters on these herbs). This may be associated with differences in the constituents and pharmacology between the subspecies.
Maximum dose In the case of herbs with potentially negative effects at high doses, this is the largest dose that can safely be administered. If the ma.ximum dose is considerably less than the toxic dose, the medication can be used with greater safety. If the maximum dose is close to, or even overlaps with. the toxic dose, then the medication is less safe. and greater precautions need to be taken in its use. F
L
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849
Minimum therapeutic dose have a therapeutic effect.
The smallest dose that will
NYHA classification The New York Heart Association has classified cardiac disease into four classes. For example. Class III refers to patients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest, but less than ordinary activity causes fatigue. palpitations, dyspnea, or anginal pain. Pharmaceutical name This is the name of a herb that is often used in pharmacy and consists of the generic name followed by the plant part used, in Latinized form. For example. Hamamelidis cortex refers to the bark of Hamamelis virginiana (witch hazel). If more than one species of the genus is used, then the pharmaceutical name may also include the species name between the generic name and the part name. For example. Menthae piperitae folium refers to the leaves of Mentha piperita (peppermint). Phototoxicity Ingestion of certain chemicals, or their application to the skin, may cause abnormal sensitivity of the skin to light (especially UV light) resulting in dermatitis. Some plants in the family Apiaceae (Umbelliferae), such as Heracleum mantegazzianum (giant hogweed), have been associated with phototoxic reactions. However. Angelica archangelica is a member of the Apiaceae family that has not been associated with phototoxicity when the infusions, decoctions and tinctures are used in their therapeutic doses (see the Angelica chapter). This movement in herbal Physiomedical movement medicine was characterized by a belief in a vital force and in the restoration of health by balancing the processes of
Sensu lato (8.1.) The Latin words sensu lata mean 'in a broad sense: that is, with a wide or general interpretation, as opposed to sensu stricto, 'in a narrow sense: For example, the name Achillea millefolium has been applied to a complex of barely distinguishable species and subspecies. The name Achillea millefolium sensu lato refers to Achillea millefolium sensu stricto or to any other member of the species complex. In contrast, Achillea millefolium sensu stricto refers only to Achillea millefolium 1. subspecies millefolium. Side effects These are negative reactions that may be relatively common in occurrence and may be predictable from the type of disorder or constitution of the patient. For example, Rosmarinus is a stimulant antidepressant herb that may have the side effect of mild restlessness and insomnia, especially if patients who already have this tendency take this herb late in the evening. Species The basic unit of taxonomy. There is no exact definition, but when the reproduction is sexual, one criterion is that members of the same species can breed and produce fertile offspring. In many species, there is a reproductive barrier in that interspecies hybrids are sterile. However, for some plant species, hybrids may be fertile within the same genus, and sometimes even across genera. The abbreviation for species is ,sp. (singular) or spp. (plural). Species names are discussed under binomial nomenclature. Sthenic
A term used by Physiomedical and some later
herbal practitioners to indicate a pathological increase in vital activity either in general or of some specific organ system. Sthenia corresponds to Excess in Chinese medicine.
... 850
Combining Western Herbs and Chinese Medicine
Subspecies (subsp. or ssp.) The rank below a species in the taxonomic hierarchy. There is no exact definition. It refers to a form of a species that is morphologically and ecologically distinct from other forms of that species. There may also be chemical differences and, in some cases, chromosomal differences between related subspecies (see ~ ploidy). Subtherapeutic dose This is a dose that is too small to have a therapeutic effect.
Toxic dose The dose at and above which adverse reactions due to toxic effects are likely to occur. Variety (var.) A rank below ~ in the taxonomic hierarchy. Each variety within a species may be morphologically, but not necessarily geographically, distinct. For example, several varieties of the species Glycyrrhiza glabra are used in Western phytotherapy, including Glycyrrhiza glabra var. typica Regel et Herd. (Spanish licorice). It should be noted that what one author terms a variety, another author may term a subspecies.
.- I
Healing crises Side effect or healing crisis?
.
I
In cases where an apparently negative effect is due to the herbs themselves. it is important to distinguish between a side effect and a healing crisis. Both side effects and healing crises can involve the aggravation of existing symptoms or the production of additional symptoms. However, side effects are associated with processes that are harmful to the body and may continue as long as the medication is taken. In contrast, the unpleasant symptoms produced during healing crises are temporary, lasting a few hours or a few days. They are a part of the selfhealing process of the body so that the healing crises result in long-term benefit.
The healing crisis is seen as an integral part of the healing process, without which recovery may in some cases be incomplete.
Safety It is most important to: • distinguish between genuine healing crises and side effects resulting from incorrect treatment • manage healing crises to minimize distressing symptoms whilst maximizing long-term benefits • avoid healing crises in patients for whom these are inappropriate
Clearance oftoxins
DISTINGUISHING GENUINE
I
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HEALING CRISES
An important aim of holistic medicine is to assist the natural processes that enable the body to heal itself. One of these is the clearance from the body of accumulated toxins that can cause acute and chronic illnesses. In some cases, during this cleansing process, toxins may be released from the tissues at a rate greater than that at which they can be detoxified or eliminated from the body. The toxins may then circulate in the blood and produce unpleasant symptoms, such as nausea, fever, or skin rashes. During a holistic treatment of such toxic conditions, the patient may, at some point, get worse before they get better.
It is essential to distinguish between genuine healing crises, which can be a necessary part of the healing process, and side effects caused by practitioner egor. Characteristic symptoms of healing crises One way of distinguishing genuine healing crises from side effects is that the symptoms associated with healing crises are temporary and are manifestations of the clearance of toxins from the body. Healing crises may involve the following characteristic and temporary symptoms:
851
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852
Combining Western Herbs and Chinese Medicine
• feverishness or even fever as toxins 'burn off' • restlessness, disturbed sleep • skin rashes • inflammation of the joints • coughing up of mucus from the bronchi • profuse discharge of mucus from the nose • profuse discharge of mucus in the stools • nausea or even vomiting • diarrhea • increased urination • increased vaginal discharge • increased menstrual flow However, even these symptoms can sometimes result from practitioner error, as shown in the second example below. EXAMPLE 1: genuine healing crisis
A man has a history of recurring respiratory infections followed by sinusitis. For each episode, the patient is prescribed antibiotics. In holistic medicine, this is seen as attempting to suppress the symptoms without treating the cause, which would be considered to be a catarrhal condition associated with residual pathogens and accumulated toxins. In terms of Chinese medicine, this can be described as Retained Pathogen with accumulation of Lung Phlegm. If this patient were given herbs to assist the body in clearing the accumulated toxins, there might be a temporary profuse nasal discharge of mucus as part of the cleansing process. However, once the discharge is finished, the patient would then feel better in himself and the recurrence of the respiratory infections would be reduced. EXAMPLE 2: side effects from practitioner error
A woman has chronic arthritis of the shoulders and elbows with occasional severe episodes. Since the aggravations appear to be associated with either exposure to cold and damp or exhaustion, the practitioner includes warming Kidney Yang tonics such as Cinnamomum bark and red Panax ginseng in the prescription. However, in this case, the practitioner misses the fact that the patient has an underlying Deficient Yin constitution, which occasionally results in symptoms of Deficiency Heat when the patient is exhausted. The combination with Cin~ namomum and Panax results in feverishness, sensations of heat in the joints, and increased joint pain. These symptoms occur every time the patient takes the combination. The patient's condition does not improve, and she does not feel better in herself. This is not a healing crisis; this is a practitioner error as a result of inappropriate treatment.
- ._- . ··~":~3~=X~
MANAGING HEALING CRISES In the past, drastic methods were often used to rid the body of toxins. Emetics were given to cleanse the upper digestive system by profuse vomiting and cathartics were given to cleanse the intestines by violent defecation. Nowadays, with the predominance of weak patients with chronic disorders, practitioners tend to avoid healing crises or to minimize them. The following guidelines can be used to better manage healing crises: • inform the patient of the possibility of experiencing a healing crisis, the type of symptoms to expect, and what to do to minimize and manage the healing crisis if it occurs • the weaker the patient, the greater the caution required of the practitioner • when using alterative herbs, such as Arctium or Taraxacum, start at low doses before gradually increasing the dose • when using alterative herbs, the severity of the healing crisis can be minimized by including in the combination demulcent and anti-inflammatory herbs, such as Althaea and Viola, and detoxifying and hepatoprotective herbs, such as Glycyrrhiza and Zingiber • the patient should drink plenty of water during the . detoxifying and eliminative process • the patient should adopt a bland diet and avoid rich foods, alcohol, coffee, and tea during the cleansing treatment • if the symptoms of the healing crisis become too severe, the dose of the herbs should be reduced or the herbs should be stopped • if the symptoms of the healing crisis persist for longer than 3 days, the dose of the herbs should be reduced or the herbs should be stopped PATIENTS FOR WHOM HEALING CRISES MAY BE INAPPROPRIATE For the following groups of patients, herbs that may produce a healing crisis should be avoided or used with great caution: • very weak patients • patients with preexisting liver damage • patients who are taking hepatotoxic conventional medications • patients who are emotional or mentally unstable • patients who cannot intelligently follow instructions
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Herb properties r
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Botanical name
Temperature
Achillea millefolium
.warrn:cool .
Taste -:;...
.;--- -...~~.;;" ..~.
Organs ,'.:·i~··
. acrid,bitter
Aesculus hippocastanum
cool
Agrimonia eupatoria
neutral
Agropyron repens
neutral
sour, sl. sweet
BL
Althaea officinalis
cool
sweet, sl. bitter
LU, ST,IN, BL
Anemone pulsatilla
cold
bitter
HT, KI
Angelica archangelica
warm
bitter, acrid, aromatic ..
LU, Sp' ST, IN, HT
Angelica sinensis
warm
sweet, aromatic, bitter
HT, LR, Sp' UT
Arctium lappa (root)
cool
sl:acrid,sl: bitter
LU, IN: KI:BL';':
Arctium lappa (seeds)
cool
acrid, sl. bitter
LU, IN, KI, BL
Arctostaphylos uva-ursi
cool
.bitter, sour
KI, BL
Artemisia abrotanum
warm-cool
aromatic, sl. bitter
LR, Sp' UT
Artemisia absinthium
warm-cool
bitter, aromatic
LR, Sp' UT
Artemisia vulgaris
warm-cool
aromatic, sl. bitter
LR, Sp' UT
Asclepias tuberosa
cold
Astragalus species
sl. warm
bitter, sour
SP
;' .,:. ~J~i,~;~i.··bitter
LU,IN, BL,Ur·
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Av~~~~~~i~'(~~d~i·p;r~):.~:c. Ballota nigra
.
.bitter .~.'
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LU .. ,
sweet
Sp' LU
bitter, sour
ST
'.
neutral neutral
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854
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Botanical name
Temperature
Taste
organs
Baptisia tinctoria
cold
bitter
LU
Berberis vulgaris
cool
bitter
LR, GB, SP, ST, LU, IN, BL, UT
Calendula officinalis
cool
bitter
ST,IN
Capsella bursa-pastoris
neutral
sour
UT , ST, IN, BL
Capsicum species
hot
acrid
HT, Sp' ST, IN, LU
Caulophyllum thalictroides
neutral
bitter
UT
Centaurium erythraea
neutral-cool
bitter
Sp' ST, SI, LR, GB
Chamaelirium luteum
neutral
bitter, sour
_-i
:.:::c ......:.:·:.,:.. -
Chelid()n~urn 'rriaj':!s . ~ - .
cool
Chrysanthemum morifolium
cool
cimi6ifu~ii~~~rri6sa~':
;:.,.
Gin~~ffi~~~~~~~~iCl~~~~i~l.~.~" ".,
hot
Cinnamomum cassia (twigs)
warm
,~,
.,'::,..
",~
':
warm
Commiphora molmol
warm
~;
. acrid, sl. bitter, sl. sweet
,,_.'.. ,',"'" ...'.- ..... ·~l.' __ :.•• ,'....
KI, LR, UT
---~-_"--I"'W"
.~ ,,·~~,,:·.:;t';.·.;~:~"1 ~
... '
HT, SP
bitter .... :,,'; acr.id,5weet, aromatic
::_
...
,:.,.,"-':.;:'.~",;..~.":;"'~_'~'.',
. -:~'.:.
-
".'
'. ~
acrid, sweet, aromatic
~'
Citiusa~rarit!Urn(ripepee!);_ '.' ..
LU, LR
sweet, sl. bitter
---'.
cool
_..
LR,GB,IN:-
. ,..- bit1;er, st'""acrid
cool
Cinchona species
___ '. ' ......- . ....._
UT
.
.
,y ••'.
'~:acrid, aromatic, bitter
...'.'.·;,v' ,-_ ;."':';;.
~,
HI, LU, BL
,'.
bitter, acrid
HT, ST, IN, LU, UT
-' , bitter, '51. sweet 51. warm
sour, sweet
HT
cool
acrid, bitter
LR, GB, HT
cool
acrid, bitter, sl. sweet
LU, BL
aromatic, acrid
ST,IN
warm
acrid, 51. bitter
LU, HT
cool
51. bitter, 51. sweet
BL
Eupatorium perfoliatum
warm
bitter, acrid, aromatic
LU
Euph()rb~~,hirta
cool
bitter, acrid
LU
Euphrasia officinalis
neutral-cool
acrid, sour, bitter
LU
RIipE!ridulcf ulmaria
cool,'
sour, bitter
ST,IN! BL.
Foeniculum vulgare
sl. warm
aromatic, 51. acrid
ST, IN, KI, LR
Crataegus species Curcuma longa (rhizome) '.
Echinacea species
Ephedra sinica
••. , j ;
·-'··f· ..... -
Equisetum arvense • '1.-'.-_:"-' ';' ,,~,'
oj
•
",~ ~--
or..,:;.. ~..~. . .~ n::-:-', ~:;;: ' '.
- .,.
SOUr,51. bitter Gentiana lutea
neutral-cool
bitter
Sp' ST, SI, LR, GB
.. _~.;,;:.'"1
,:;·~'. ~:}L~it~~l~
Herb properties
855
Botanical name
Temperature
Taste
Organs
Geranium maculatum
neutral
sour
ST, IN, UT
Glechoma hederacea
neutral
sour, bitter
LU
Glycyrrhiza_ glabra ,
neutral~ool
sweet
SI, IN, LU, KI, HT
Hamamelis virginiana
neutral~ool
sour, sl. bitter
Sp' IN
Harpagophytum procumbens
cool
bitter
Sp' ST
Humulus lupulus
cold
bitter
HI, LR, IN
Hydrangea arborescens
neutral
bitter, sour
BL
Hydrastis canadensis
cool
bitter
LR, GB,.ST, IN,!!.!, BL, Sp' UT ~
.'~~~f~~i~~~~~rrrh0
neutral
"
'.'~'
warm~ool
Hyssopus officinalis
acrid, aromatic
sl. warm
aromatic, 51. sour, 51. acrid
'sl.~rm
':~)~f;f~":~~~§ti~1bitt~~ \1: ~acOd'
Leonurus cardiaca
neutral
sour, 51. bitter
L~~l~~I~~-~~:~-"~,"
warm-cool
Lycium chinense
neutral
'M~h~~'f~0~~bif6Ii~in;',-'~,' .
cool
"~~d~la'~~gJstifoliaJ;; ..... , _ : . ' .'./.. ~.,,-~.,:•.
,
"'.
""-'_.f
•
'.
';;
~~,IN'
HT, UT , LU, IN, HT, UT
sweet
LR, KI
'~~~;:T": bitter "';'::-":':';.•':;- ··:i.;/A 0,,,;~:,::J::':;L.R}GB~·IN ",'. -_:"'",_ -
-~ -~~
.'
neutral
bitter
LU,SP
Matricaria recutita
cool
sl. bitter, 51. aromatic
ST, IN, HT
Mentha piperita
warm~ool
acrid, aromatic
LU, ST, IN, LR
. -; .~:..:: '.':::':~i.:' Y"_','; :'..
' , : '.. ~., "';""
'.
.~,
._:;~~:
neutral
Molasses (black)
neutral
Myrica cerifera
warm
'~',
.,...H:'...-••·....~ .... :...,.~ •.r-r ...·.:...,.~ ..
,.
, "cool
Nepeta cataria'Ophiopogon japonicus ....
"~
::",-:':".
~:,_:,
1·~'~
-'-,·,,~
~·
~"'<-
",_,"';
'Parteta'rii
...-. ',.- _
Passiflora incarnata
sl. warm neutral
sweet, sl. bitter
SP
acrid, sour, bitter
ST, IN, LR, GB, HT, LU
aromatic,acnd, sweet, sl. bitter
~-_.
-c'
,'-'-"-'.
UT
' " T-" "
...
Panax quinquefolium
•
.
.. HT, IN, UT
-
sl. sour ,
cool
-
.Panax ••ginseng\;, .• .. _," •••-1-
,--~}>[i{;~rOmatic
warm
I '
Mitchella repens
sl.' bitter
'"LU, IN, HT HT, LU, ST
y-,
sweet, sf bitter
KI, HT, Sp' LU
sweet, sl. bitter
LU, ST, KI
sl. bitter
HT, LR
:' neutral neutral
.::;" , ...,'.:",,',
KI, BL, Sp' IN, LU, LR
Marrubium vulgare
,Menthapulegium ',. -"
. .
LU, HT
""?;~~~birt;~C"':;';! -::-:::'~·,;.s;:;'"~7';-""'-'-~'-'~' - , -'(R;:'GB}'iN" ;,." Juniperus communis
-.
--------------------------_
_.
....--_.---_.
Combining Western Herbs and Chinese Medicine
856
•
.:~c~~:'~. :.
~.~5~L!M~: ~-; ~
.. ::- ~7.-__·:~~_~ .
Temperature
Botanical name
...
Organs
Taste
Petroselinum crispum (root) _
sl. warm
aromatic, 51. acrid
KI, Bl IN, UT __ ".
Phytolacca americana
cool
acrid
lU
Piscidia erythrina' - -
'"cold
f
lU, IN
cool
sour, sl. bitter
LU, IN·
Populus tremuloides
neutral-cool
bitter, sour
Sp' ST, IN, lR, Bl
Potentilla erecta
neutral-cool
sour, bitter
IN
neutral
bitter, aromatic
lU,HT
bitter
IN,.ST, lR
sour, bitter ...
IN
bi~orta
Prunus serotina •
..•
,'~._~
;;~-.,
.• " -",'.-""-.- ;->-.
>.:~.~.,':,~~. ~.:/};:-:~:1=
: HT,lR
sour, sl. bitter
Potygonum
~,~
..... "-'--' _-._...:..... , _ _ J,;.'
cool
Plantago lanceolata (leaves)
..-, ..'- ",'·-·--",,'T""---'
Pseudosteilarla:fleterophylla'; -:.:~-:;"" neutral ":. '" . ". . . ~.'
,"
Pulsatilla chinensis
cold
Quercus robu~,~~'
·"<:'-.-neutral
Rhamnus purshiana
cool
bitter
IN, ST, lR
Rosmarinus officinalis
warm
aromatic, bitter, acrid
HT, lR, Sp' ST, IN
bitter, sour. • . 'o¥
':."
Rumex crispus
cool
bitter, sl. sour
lR, IN
Ruta. graveolen~.,~ _'
warm-cool
bitter, aromatic .
KI, lR, HT, UT, 5P, IN:;;;,~,
Salvia miltiorrhiza
cool
bitter
HT, lR, UT
warm-cool
aromatic, acrid
lU, HT, lR, UT
cool
acrid, sl. bitter
lU
'. -• . . ".' ;:::~~.'-'-:- .. _•.."~.~'.:::.: ..~~"¥
-
Salvia
officinalis,'~
)
Sambucus nigra -- .."" -·':"-~-:""\~~.7~~···
~"''''_:O-'~'''.-::"t~
-....f : ... '··-".
Sanguinaria canaClenSis< . ' , ? " , ' . warm .
,-.~~.~~,,'::.l:;;-_'.'.-;'.'
,.,
, . .. bitter, acrid
-
-"
"-
.. -:-"--''':
lU, HT, lR
Sanguisorba officinalis
cool
sour, bitter
1I, UT
'Sarotharriri~~(~'cd~rius
neutral
bitter
HT, KI, Bl'
Schisandra chinensis
warm
sour
HT, KI, lU, lR
cool
sl. bitter
lU
neutral
sweet, sl. sour
KI, Bl, SP
_.
•
-_"'~
..,,:,. _~.' L:,' _.
.>
Serenoa serrulata
;-:':J.~.:-~:'.r:-.:.
,. Stellaria media
cool
51. bitter
cool
51. sour, sl. bitter
lU, IN
acrid Tanacetum parthenium
cool
bitter
lR
, i
• ",--' '. - - •
bitter
•.
.,.....,...:.~ ;~:~~
'_:"';-;,:-.~;'"_:~-
~.-:.:... .:.:::
\\
Herb properties
857
"
Botanical name
Temperature
Taraxacum officinale
cool-cold
Thuja occidentalis
warm-cool
acrid, aromatic, bitter
LU, HT, Bl, UT
Thymus vulgaris
warm-cool
aromatic.
LU, KI, Bl, HT, Sp' IN, UT
Trigonella foenum-graecum
sl. warm
bitter, sl. sweet, sl. acrid
Sp' IN, lU
Turnera diffusa
warm
bitter, aromatic, acrid
KI, Sp' IN
Urtica dioica
warm-cool
acrid
LU, IN, Bl, UT
Valeriana officinalis
cool
bitter, sweet
HI, lR, SI, IN
Viburnum prunifolium
neutral
sl. bitter, sl. sour
UT
cool
sour, sweet, bitter
Taste
organs
. bitter
KI, Bl, LR, GB, ST, IN
:, .• J
, .c<. ,',_,",:,
'~'."
.:Ji<.'
~
...... " ••
.Vlnca"minor .. ,., . ~'.::'
II..
,;-~~
Viola odorata
-
.~.
cool neutral
Vitex agnus castus ~:' :~;~':'"";'l'
;-.:r:., -,•.,
ot-.. ··.~:·I_.·
"'.:-_~:"::'
".. ~':'
,. ,
. ~.
Zanthoxylum sPecies (bark) .;
L
•
--.c· ... · · '
' • .<• • • ., ~-,
'
•
hot
·-·""7'_~.'!'-t;-~o:-c·:!~~~~-,","·
lU,Bl .':'"
sour, sweet; bitter bitter, sl. acrid
5c,.,,~:,::LU;"-~{"::";;"'-"''''-:f'
.- ...."
lR, UT
·;\7~ti~~?;;·t··;t:·;n~~~~:]I?~~icil~b~~L>:~:,::i;~~~:~:~W:.~]P~)_~~~~~}:,.,
Zanthoxylum species (berries)
hot
Zea'mays
neutral
Zingiber officinale (dried)
hot
Zingib~r'officil1ale' (fresh) .
hot
Ziziphus jujube
neutral
acrid, aromatic, bitter
HT, Sp' ST, IN
acrid, aromatic
lU, 5p, 5I, IN, HI, UT
sweet
5p, 5T
.:. Note: The properties and organ systems given for some of the Chinese herbs in this list are different from those listed in Bensky and Gamble. The explanations of these differences are given under the heading Organs in the Traditional sources section of each materia medica chapter.
--~
~
'~"I
,' (
Herb names
EtA -:.i,~Tn
.'.-~i~.
'~:'-:':'.._"""""~
860
Combining Western Herbs and Chinese Medicine
_..... - - ":'.-:':~'--~::::-::-;"::":":':":-'":.~::---... -:.....---::-:-:::.-.-::~:::=;.~-;.~ ...
-Botanical
Pharmaceutical,'
"~':;,:. ",EilgiiSh: --;:~:_-:-': :~":G~rina'n':-"~:"':~S;::f:~?::r~-1~~~~~;f:~::~~
(part used)
......".......
-!
Asclepias tuberosa (underground parts)
Asclepiadis tuberosae radix
pleurisy root. butterfly weed
Knollige Seidenpflanze
asclepiade tubereuse
Astragalus species (root)
Astragali radix
astragalus
Astragalus
astragale
Avena sativa (endosperm)
Avenae endospermii
oats
Hafer
avoine
Ballota nigra (aerial parts)
Ballotae herba
black horehound
Schwarznessel
ballote noire
Baptisia tinctoria (root)
Baptisiae radix
wild indigo
wilder Indigo
indigotier sauvage
Berberis vulgaris (root and/or stem bark)
Berberidis cortex
barberry
Berberitze
epine-vinette
Calendula officinalis (ligulate florets or composite flowers)
Calendulae f10s
marigold
Ringelblume
souci
~~
..:~
---,'. .,"~._-"
Capsella bursa-pastoris (aerial parts)
Capsellae herba or Bursae pastoris herba
shepherd's purse
Hirtentaschel
bourse-a-pasteur
Capsicum species (ripe fruit)
Capsici fructus
cayenne, chillies
Cayennepfeffer, Chilipfeffer
piment de Cayenne
Caulophyllum thalictroides (root)
Caulophylli thalictroidis radix
blue cohosh
Blauer HahnenfuB
cohosh bleu
Centaurium erythraea (flowering aerial parts)
Centaurii herba
centaury
Tausendguldenkraut
petite centauree
Chamaelirium luteum (root and rhizomes)
Chamaelirii lutel radix cum rhizomate
false unicorn
Falsches Einkorn
Mlonias
Chelidonium majus (aerial parts)
Chelidonii herba
greater celandine
Schollkraut
chelidoine
Chrysanthemum morifolium (flowers)
Chrysanthemi morifolii f10s
chrysanthemum
Gartner-Chrysantheme
chrysantheme des f1euristes
Cimicifuga racemosa (root and rhizomes)
Cimicifugae radix cum rhizomate
black cohosh
Cimicifuga
actee
Cinchona species (bark)
Cinchonae cortex
Jesuit's bark, Peruvian bark
Chinarinde
quinquina
Cinnamomum cassia (bark)
Cinnamomi cassiae cortex
cinnamon
Chinesischer Zimt
canelie de Chine
Cinnamomum cassia (twigs)
Cinnamomi cassiae ramulus
cinnamon
Chinesischer Zimt
canelle de Chine
Citrus aurantium (ripe peel)
Aurantii pericarpium
bitter orange
Pomeranze
orange amer
Commiphora molmot (oleogum resin from the bark of Commiphora species)
Myrrha
myrrh
Myrrhe
myrrhe
Convallaria majalis (leaves)
Convallariae herba
lily of the valley
Maiglockchen
muguet
Crataegus species (fruit, leaves, or flowers)
Crataegi fructus, Crataegi folium, or Crataegi f10s
hawthorn
WeiBdorn
aubepine
Curcuma longa (rhizomes)
Curcumae longae rhizoma
turmeric
Gelbwurz. Curcuma
curcuma
--,-H,~,
., -
;.7"'"\
---";'
','
.,' ','7.',t. - '.' .• t. ~
..
. -'., . • - h~:.-r'~Q.~';"",:~~:~,,·,:.,-
a grappes
Herb names
.
861
Botanical (part used)
Pharmaceutical
Echinacea species (root; sometimes with stem or herb)
Echinaceae radix
echinacea (coneflower)
Purpursonnenhut
echinacee
Elettaria cardamomum (ripe seeds)
Cardamomi fructus
cardamom
Kardamom
cardamome
Ephedra sinica (young stems)
Ephedrae herba
ephedra
Ephedra
ephedra
Equisetum arvense (sterile stems)
Equiseti herba
horsetail
Schachtelhalm
prele des champs
Eupatorium perfoliatum (aerial parts)
Eupatorii perfoliati herba
boneset
Wasserdost
herbe parfaite
Eupatorium purpureum (root)
Eupatorii purpurei radix
gravel root
Purpurdost
herbe
Euphorbia hirta (entire plant)
Euphorbiae herba cum radice
pill-bearing spurge
Wolfsmilch
euphorbe indienne
Euphrasia officinalis (aerial parts)
Euphrasiae herba
eyebright
Augentrost
euphraise
Filipendula ulmaria (aerial parts or flowers)
Spiraeae herba or Spiraeae f10s
meadowsweet
I\UidesQB
reine-
Foeniculum vulgare (fruit)
Foeniculi fructus
fennel
Fenchel
fenouil
Galium aparine (aerial parts)
Galii herba
cleavers
Klettenlabkraut
gratteron
Gentiana lutea (root)
Gentiaflae radix
(yellow) gentian
Enzian
gentianejaune
Geranium maculatum (rhizomes)
Geranii rhizoma
American cranesbill
Gefleckter Storchschnabel
geranium americain
Glechoma hederacea (aerial parts)
Glechomae herba
ground ivy
Gundermann
Iierre terrestre
Glycyrrhiza glabra (unpeeled roots and stolons)
Liquiritiae radix (Glycyrrhizae radix)
licorice (liquorice)
SQBholz
reglisse
Hamamelis virginiana (bark or leaves)
Hamamelidis cortex or Hamamelidis folium
witch hazel
Hamamelis
hamamelis
Harpagophytum procumbens (transverse slices of the secondary tubers)
Harpagophyti radix
devil's claw
sQdafrikanische Teufelskralle
harpagophytum
Humulus lupulus (strobiles)
Lupuli strobulus
hops
Hopfen
houblon
Hydrangea arborescens (underground parts)
Hydrangeae radix
wild hydrangea
Gemeine Hortensie
hortensia sauvage
Hydrastis canadensis (rhizomes)
Hydrastidis rhizoma
golden seal
Kanadische Gelbwurzel
hydraste du Canada
Hypericum perforatum (aerial parts)
Hyperici herba
St. John's wort
Johanniskraut
millepertuis
Hyssopus officinalis (aerial parts)
Hyssopi herba
hyssop
Ysop
hysope
Iris versicolor (rhizomes)
Iridis versicolores rhizoma
blue flag
Blaue Schwertlilie
giaieul bleu
Juniperus communis (ripe fruit)
Juniperi fructus
juniper
wacholder
genevrier
a la gravelle
-----------------------------
-----.....
----.-- - - - -
-
;.:.~-
862
Combining Western Herbs and Chinese Medicine
..
Botanical (part used)
Pharmaceutical
Lavandula angustifolia (flowers)
Lavandulae f10s
lavender
Lavendel
lavande
Leonurus cardiaca (aerial parts with flowers)
Leonuri cardiacae herba cum f10re
motherwort
Herzgespann
agripaume
Lobelia inflata (aerial parts)
Lobeliae herba
lobelia
Lobelie
10Mlie
Lycium chinense (fruit)
Lycii fructus
Chinese wolfberry
Bocksdorn
Iyciet
Mahonia aquifolium = Berberis aquifolium (root and rhizomes)
Mahoniae radix cum rhizomate
Oregon grape
Mahonie
mahonia
Marrubium vulgare (aerial parts)
Marrubii herba
white horehound
Andorn
marrube blanc
Matricaria recutita (flower heads)
Matricariae f10s
German chamomile
Feldkamille
camomille allemande
Mentha piperita (aerial parts)
Menthae piperitae herba
peppermint
Pfefferminze
menthe poivree
Mentha pulegium (aerial parts)
Menthae pulegii herba
pennyroyal
Poleiminze
menthe pouliot
Mitchella repens (entire plant)
Mitchellae repentis herba et radix
squaw vine
Rebhuhnbeere
Iiane
Molasses
Melasse
melasse
I
~ __
.f
.,..
Molasses (blackstrap) (syrup)
a squaw
a suit
Myrica cerifera (root bark)
Myricae cortex radicis
Bayberry
wachsmyrte
arbre
Nepeta cataria (aerial parts)
Nepetae catariae herba
catnip
Katzenminze
cataire
Ophiopogon japonicus (tuber)
Ophiopogonis Japonici tuber
Ophiopogon
Schlangenbart
muguet du Japon
Panax ginseng (root)
Ginseng radix
Ginseng
Ginseng
ginseng
Panax quinquefolium (root)
Panacis quinquefolii radix
American ginseng
Amerikanischer Ginseng
ginseng d' Amerique
Parietaria diffusa (aerial parts)
Parietariae herba
pellitory-of-the-wall
Glaskraut (Parietaria erecta = Aufrechtes Glaskraut)
parietaire
Passiflora incarnata (aerial parts)
Passiflorae herba
passionflower
Passionsblume
passiflore
Petroselinum crispum (root)
Petroselini radix
parsley
Petersilie
persil
Phytolacca americana (root parts)
Phytolaccae radix
poke root
Amerikanische Kermesbeere
phytolaque
Piscidia erythrina (root bark) ,
Piscidiae radicis cortex
Jamaica dogwood
Gemeiner Fischfanger
cornouiller de Jamalque
Plantago lanceolata (leaves)
Plantaginis lanceolatae folium
long-leaved plantain
Spitzwegerich
plantain lanceole
Polygonum bistorta (root and rhizomes)
Polygoni bistortae radix cum rhizomate
bistort root
Schlangenknoterich
bistorte
Populus tremuloides (bark)
Populi cortex
quaking aspen
Pappel
tremble
,--
Herb names
863 .. - . . _._. ..
-_. __.•'-_..._-'-< .•.. -.
~
~,._---,.
,.
Botanical (part used)
Pharmaceutical
English
Potentilla erecta (rhizomes; separated from the roots)
Tormentillae rhizoma
common tormentil
Tormentill
tormentille
Prunus serotina (bark)
Pruni serotinae cortex
black cherry
Kirsche
prunier de Virginie
Pseudostellaria heterophylla (root)
Pseudostellariae radix
pseudostellaria
Pseudostellaria
pseudostellaria
Pulsatilla chinensis = Anemone chinensis (root)
Pulsatillae chinensis radix
Chinese anemone
Chinesische Kiichenschelle
anemone chinoise
Quercus robur (inner bark)
Quercus cortex
oak
Eiche
chene commun
Rhamnus purshiana (bark)
Rhamni purshiani cortex
cascara
Amerikanischer Faulbaum
cascara sagrada
Rheum palmatum (underground parts)
Rhei radix
rhubarb
Rhabarber
rhubarbe de Chine
Rosmarinus officinalis (leaves)
Rosmarini folium
rosemary
Rosmarin
romarin
Rubus idaeus (leaves)
Rubi idaei folium
raspberry
Himbeere
framboisier
Rumex crispus (underground parts)
Rumicis crispi rhizoma
yellow dock
Krauser Ampfer
patience sauvage
Ruta graveolens (aerial parts)
Rutae herba
rue
Raute
rue
L__
Salvia miltiorrhiza (root)
Salviae miltiorrhizae radix
salvia root
Rotwurzsalbei
sauge rouge
Salvia officinalis (leaves)
Salviae officinalis folium
sage
Salbei
sauge officinale
Ie
Sambucus nigra (flowers)
Sambuci flos
elder
Schwarzer Holunder
sureau noir
Sanguinaria canadensis (rhizome)
Sanguinariae rhizoma
blood root
Kanadische Blutwurz
sanguinaire
Sanguisorba officinalis (aerial parts)
Sanguisorbae herba
greater burnet
GroSer Wiesenknopf
sanguisorbe
Sarothamnus scoparius (leaves, flowers. or aerial parts with flowers)
Cytisi scoparii flos, Spartii scoparii herba, Scoparii herba, Genistae scopariae herba
Scotch broom
Besenginster
genet
Schisandra chinensis (fruit)
Schisandrae fructus
schisandra
Schisandra
schisandra
Scrophularia nodosa (aerial parts)
Scrophulariae herba
common figwort
Knotige Braunwurz
srofulaire noueuse
Serenoa serrulata (fruit)
Sabal fructus
saw palmetto
Sabal
sabal
Smilax species (root and rhizomes)
Sarsaparillae radix cum rhizomate
sarsaparilla
Sarsaparille
salsepareille
Stellaria media (aerial parts)
Stellariae herba
chickweed
Vogelmiere
mouron blanc
Symplocarpus foetidus (root and rhizomes)
Symplocarpi radix et rhizomate
skunk cabbage
Stinkkohl
chou sconse
Tanacetum parthenium (aerial parts)
Tanaceti parthenii herba
feverfew
Mutterkraut
grande camomille
~
:~':
~
fl"'" i:~
f:.~
1"
L
-~
i
l:-
b:=-
-
. German
French
a balai
____ •
864
.-.-~_:t;f'~
Combining Western Herbs and Chinese Medicine
'-i~~~~'_:
~'4
-,."-.
Botanical (part used) Taraxacum officinale (root and rhizomes)
Taraxaci radix cum rhizomate
dandelion
Lowenzahn
dent-de-lion, pissenlit
Thuja o.ccidentalis (younger twigs)
Thujae folium
arbor-vitae, tree of life, American cedar
Lebensbaum
cedre blanc du Canada, arbre de vie
Thymus vUlgaris (leaves and flowers)
Thymi herba et flos
common thyme, garden thyme
Gemeiner Thymian, Garten-Thymian
thym vulgaire
Trigonella foenum-graecum (seeds)
Foenugraeci semen
fenugreek
Bockshornklee
fenugrec
Turnera diffusa (leaves and stems)
Turnerae folium, Damianae folium
damiana
Damiana
damiana
Urtica dioica (aerial parts)
Urticae herba
stinging nettle
Brennessel
grande ortie
Valeriana officinalis (underground parts)
Valerianae radix
valerian
Baldrian
valeriane
Verbena officinalis (aerial parts)
Verbenae herba
vervain
Eisenkraut
verveine officinale
Viburnum prunifolium (stem or root bark)
Viburni prunifolii cortex
black haw
Schneeballbaum
viome
Vinca minor (leaves)
Vincae minoris folium
lesser periwinkle
Immergriin
petite pervenche
Viola odorata (leaves and flowers)
Violae odoratae folium cum flore
sweet violet
violette odorante Wohlriechendes Veilchen, Marzveilchen
Viola tricolor (aerial parts)
Violae tricoloris herba
heartsease
Ackerstiefmiitterchen
pensee sauvage
Vitex agnus-castus (fruit)
Agni casti fructus
chaste tree
Keuschlamm, Monchspfeffer
gattilier
Zanthoxylum species (bark)
Zanthoxyli cortex
prickly ash
Eschenblattriges Gelbholz
bois piquant
Zanthoxylum species (berries)
Zanthoxyli fructus
prickly ash
Eschenblattriges Gelbholz
bois piquant
Zea mays (stigmas and styles)
Maidis stigma
corn
Mais
mais
Zingiber officinaIe (rhizomes)
Zingiberis rhizoma
ginger
Ingwer
gingembre
Ziziphus jujube (fruit)
Ziziphi jujubae fructus
Chinese date
Jujube, Brustbeere
jujubier
~
.
l'lr' I
L.
Family-botanical
I~
NAMES CROSS REFERENCE A··· .. ··· .... ·· .. ·· ........ ·....
c··........·..·........·····....
Asteraceae (Compositae) ASTER OR SUNFLOWER FAMILY
Achillea Arctium Artemisia species Calendula Chrysanthemum species Echinacea Eupatorium Matricaria Tanacetum Taraxacum
Apiaceae (Umbelliferae) PARSLEY FAMILY
Angelica species Foeniculum Petroselinum Apocynaceae DOGBANE FAMILY
Vinca Araceae (Aroideae) ARUM FAMILY
B
Panax species Arecaceae (Palmae) PALM FAMILY
Serenoa
Humulus Caprifoliaceae HONEYSUCKLE FAMILY
Sambucus Viburnum Caryophyllaceae PINK FAMILY
Pseudostellaria Stellaria Cupressaceae
Berberidaceae
GINSENG FAMILY
HEMP FAMILY
.
Symplocarpus Araliaceae
Cannabaceae
CYPRESS OR CEDAR FAMILY
BARBERRY FAMILY
Berberis Caulophyllum Mahonia
Juniperus Thuja
E
..
Brassicaceae (Cruciferae) MUSTARD FAMILY
Capsella Isatis
Ephedraceae MORMON TEA FAMILY
Ephedra .
Asclepiadaceae
Burseraceae
Equisetaceae
MILKWEED FAMILY
NOT KNOWN
HORSETAIL FAMILY
Asclepias
Commiphora
Equisetum
865
.. Combining Western Herbs and Chinese Medicine
866 Ericaceae
Hypericaceae
HEATH FAMILY
ST. JOHNSWORT FAMILY
p
Hypericum
Arctostaphylos
~
-.....
.
~--_
.....
.. .
_,.;._~_
-
~
~-.-:
..__-w,-r""e':'" .
Papaveraceae poppy FAMILY
Euphorbiaceae
I
.
Sanguinaria Chelidonium
SPURGE FAMILY
Euphorbia
Iridaceae PASSION-FLOWER FAMILY
Iris
F································
.
Passifloraceae
IRIS FAMILY
Passiflora
L
Fabaceae (Leguminosae)
.
NOT KNOWN
Lamiaceae (Labiatae)
Astragalus Baptisia Glycyrrhiza Piscidia Sarothamnus Trigonella
Harpagophytum
MINT FAMILY
Ballota Glechoma Hyssopus
Phytolaccaceae POKEWEED FAMILY
Phytolacca
Lavandul~
Leonurus Marrubium Mentha species Nepeta cataria Rosmarinus Salvia species Thymus
Fagaceae BEECH OR OAK FAMILY
Quercus
G········ .......... ··· .. ·..·.... Gentianaceae
Lauraceae
GENTIAN FAMILY
LAUREL FAMILY
Centaurium Gentiana
Plantaginaceae PLANTAIN FAMILY
Plantago Polygonaceae BUCKWHEAT FAMILY
Polygonum Rheum Rumex
Cinnamomum Liliaceae
Geraniaceae
R
Chamaelirium Convallaria Ophiopogon Smilax
Geranium Grarnineae GRASS FAMILY
Ranunculaceae BUTTERCUP FAMILY
Lobeliaceae (incl. in Campanulaceae)
Agropyron Avena Zea
LOBELIA FAMILY
Anemone species Cimicifuga Hydrastis Pulsatilla species
UNCL. IN HAREBELL FAMILY)
Rhamnaceae
Lobelia
..
Hamamelidaceae WITCH HAZEL FAMILY
Hamamelis
BUCKTHORN FAMILY
M
..
MAGNOLIA FAMILY
Schisandra Malvaceae
BUCKEYE FAMILY
MALLOW FAMILY
Aesculus
Rhamnus Ziziphus
Magnoliaceae
Hippocastanaceae
Althaea
Hydrangeaceae (Saxifragaceae)
Myricaceae
HYDRANGEA FAMILY
BAYBERRY OR WAX-MYRTLE FAMILY
Hydrangea
.
LILY FAMILY
GERANIUM FAMILY
H
...
Pedaliaceae
PEA FAMILY
Myrica
Rosaceae ROSE FAMILY
Agrimonia Crataegus Filipendula Potentilla Prunus Rubus Sanguisorba
Family-botanical Names Cross Reference -
Rubiaceae
Smilaceae (incl. in Liliaceae)
MADDER FAMILY
CATBRIER OR GREENBRIER FAMILY
Cinchona Galium Mitchella
(I~CL.
867
v····
VALERIAN FAMILY
Valeriana
Solanaceae Rutaceae
,.--...
i I....
5
Verbenaceae
~IGHTSHADE FAMILY
Capsicum Lycium
Citrus Ruta Zanthoxylum
T
.
Populus
VERBENA FAMILY
Verbena Vitex
.
Violaceae VIOLET FAMILY
Turneraceae
Viola
TURNERA FAMILY
Turnera
Salicaceae WILLOW FAMILY
u
..
z
.
Zingt'beraceae
t.,__
Scrophulariaceae
Urticaceae
FIGWORT OR SNAPDRAGON FAMILY
NETTLE FAMILY
Euphrasia Scrophularia
!.
.... -
·· ·
Valerianaceae
IN LILY FAMILY)
Smilax
CITRUS OR RUE FAMILY
··
Parietaria Urtica
GINGER FAMILY
Curcuma longa Elletaria Zingiber
--
~;,
Botanical-family NAMES CROSS REFERENCE ,-
~-
A
...............................
Artemisia abrotanum
C
. ..............................
Asteraceae (Compositae) ~
Calendula officinalis
Achillea millefolium Asteraceae (Compositae)
. Arte7J1isia absinthium
Asteraceae (Compositae)
Asteraceae (Compositae)
Capsella bursa-pastoris
Aesculus hippocastanum Hippocastanaceae
Artemisia vulgaris
Brassicaceae (Cruciferae)
Asteraceae (Compositae)
Agrimonia eupatoria ".
Rosaceae
Gramineae
Asclepiadaceae
Caulophyllum thalictroides Berberidaceae
Astragalus species Fabaceae (Leguminosae)
Althaea officinalis Malvaceae
Solanaceae
Asclepias tuberosa
Agropyron repens
Gramineae
Chamaelirium luteum Liliaceae
Ranunculaceae
Angelica archangelica
B
...............................
Apiaceae (Umbelliferae)
Arctium lappa Asteraceae (Compositae)
Arctostaphylos uva-ursi Ericaceae
Chelidonium majus Papaveraceae
Apiaceae (Umbelliferae)
Angelica sinensis
Centaurium erythraea Gentianaceae
Avena sativa
Anemone pulsatilla
Capsicum species
Ballota nigra Lamiaceae (Labiatae)
Baptisia tinctoria
Chrysanthemum morifolium Asteraceae (Compositae)
Cimicifuga racemosa
Fabaceae (Leguminosae)
Berberis vulgaris
Ranunculaceae
Cinchona species
Berberidaceae
869
Rubiaceae
Combining Western Herbs and Chinese Medicine
870
Cinnamomum cassia Lauraceae
Gentianaceae
Citrus aurantium
Geranium maculatum
Rosaceae
Curcuma longa
Solanaceae
Lamiaceae (Labiatae)
M
.
Glycyrrhiza glabra Fabaceae(Leguminosae)
Liliaceae
Crataegus species
Lycium chinense
Glechoma hederacea
Burseraceae
Convallaria majalis
Lobeliaceae (included in Campanulaceae)
Geraniaceae
Rutaceae
Commiphora molmol
Lobelia injlata
Gentiana lutea
Mahonia aquifolium Berberidaceae
H·······························
Marrubium vulgare Lamiaceae (Labiatae)
Hamamelis virginiana Hamamelidaceae
Zingiberaceae
Matricaria recutita Asteraceae (Compositae)
Harpagophytum procumbens
E································ Echinacea species
Pedaliaceae
Cannabaceae
Mentha pulegium Lamiaceae (Labiatae)
Hydrangea ar,borescens
Zingiberaceae
Ephedra sinica
Lamiaceae (Labiatae)
Humulus lupulus
Asteraceae (Compositae)
Elettaria cardamomum
Mentha piperita
Hydrangeaceae(Saxilragaceae)
Mitchella repens
Hydrastis canadensis
Rubiaceae
Ranunculaceae
Ephedraceae
Myrica cerifera Equisetum arvense
Hypericum perforatum
Eupatorium perfoliatum
Myricaceae
Hypericaceae
Equisetaceae
N
Hyssopus officinalis
.
Lamiaceae (Labiatae)
Asteraceae (Compositae)
Nepeta cataria Eupatorium purpureum
I
Lamiaceae (Labiatae)
.
Asteraceae (Compositae)
Euphorbia hirta
o
Iris versicolor
.
Iridaceae
Euphorbiaceae
Ophiopogon japonicus Euphrasia officinalis
Isatis tinctoria
F································
J
Filipendula ulmaria
Juniperus communis
.
Rubiaceae
Araliaceae
.
Lavandula angustifolia
Galium aparine
.
Panax quinquefolium
L
Apiaceae (Umbelliferae) G·······························
p Panax ginseng
Cupressaceae
Rosaceae
Foeniculum vulgare
Liliaceae
Brassicaceae (Cruciferae)
Scrophulariaceae
Lamiaceae (Labiatae)
Leonurus cardiaca Lamiaceae (Labiatae)
Araliaceae
Parietaria diffusa Urticaceae
Passiflora incarnata Passifloraceae
Botanical-family Names Cross Reference
! Petroselinum crispum
Ruta graveolens
Phytolaccaceae
Piscidia erythrina Fabaceae (Leguminosae) ~-,.;;..
Plantago lanceolata L"-.
Plantaginaceae
'f"~
Polygonum bistorta
'YO
Salvia miltiorrhiza
Salvia officinalis Lamiaceae (Labiatae)
Sambucus nigra
Sanguinaria canadensis
Rosaceae
Prunus serotina Rosaceae
,,",oM
Pseudostellaria heterophylla Caryophyllaceae
...
Pulsatilla chinensis Ranunculaceae
r:-' l><
Q
...............................
Quercus robur Fagaceae
R
...............................
Rhamnus purshiana Rhamnaceae
Rheum palmatum Polygonaceae
Rosmarinus officinalis Lamiaceae (Labiatae)
Rubus idaeus Rosaceae
Rumex crispus Polygonaceae
Lamiaceae (Labiatae)
Trigonella foenum-graecum Fabaceae (Leguminosae)
Turnera diffusa
Lamiaceae (Labiatae)
Populus tremuloides
Potentilla erecta
~
...............................
Polygonaceae
~-:it.
~
5
Caprifoliaceae
Salicaceae
Thymus vulgaris
Rutaceae
Apiaceae (Umbelliferae)
Phytolacca americana
871
Papaveraceae
Sanguisorba officinalis
Turneraceae
U ............................... Urtica dioica Urticaceae
V
Valeriana officinalis
Rosaceae
Sarothamnus scoparius
...............................
Valerianaceae
Verbena officinalis
Fabaceae (Leguminosae)
Verbenaceae
Schisandra chinensis
Viburnum prunifolium
Magnoliaceae
Caprifoliaceae
Scrophularia nodosa
Vinca minor
Scrophulariaceae
Serenoa serrulata
Apocynaceae
Viola odorata
Arecaceae (Palmae)
Smilax species
Violaceae
Viola tricolor
Smilaceae (included in Liliaceae)
Stellaria media
Violaceae
Vitex agnus castus
Caryophyllaceae
Symplocarpus foetidus Araceae (Aroideae)
T ................................ Tanacetum parthenium Asteraceae (Compositae)
Tara.xacum officinale Asteraceae (Compositae)
Thuja occidentalis Cupressaceae
Verbenaceae
Z
...............................
Zanthoxylum species Rutaceae
Zea mays Gramineae
Zingiber officinale Zingiberaceae
Ziziphus jujube Rhamnaceae
r i
~
.....•
~
!
English-botanical HERB NAMES CROSS REFERENCE
.
'-
A·······························
c· ......··..........·..........·
bistort root... Polygonum bistorta, 842
~.
angelica (garden) ... Angelica archangelica, 205-218
cardamom...
bitter orange...
Elettaria cardamomum, 840
Citrus aurantium, 839
cascara...
agrimony... Agrimonia eupatoria, 839
American cranesbill... Geranium maculatum, 840
American ginseng... Panax quinquefolium, 842
black cherry...
Rhamnus purshiana, 843
Prunus serotina. 842
catnip... black cohosh ...
Nepeta cataria, 841
Cimicifuga racemosa, 339-354
cayenne... black haw...
Capsicum species, 319-337
Viburnum prunifolium, 795-804
centaury... black horehound...
arbor-vitae...
f·
I
\-
Thuja occidentalis, 739-755
Centaurium erythraea, 455-471
Ballota nigra, 839
chaste tree... blood root...
astragalus... Astragalus species, 839
B······
·· ..····.. ·
barberry... Berberis vulgaris, 273-298
bayberry... Myrica cerifera, 573-58?
bearberry... Arctostaphylos uva-ursi, 233-242
Vitex agnus-castus, 844
Sanguinaria canadensis, 843
Chinese anemone... blue cohosh ... Caulophyllum thalictroides, 839
blue flag ...
Pulsatilla chinensis (=Anemone chinensis), 843
Chinese angelica...
Iris versicolor, 841
boneset...
Angelica sinensis, 205
Chinese date...
Eupatorium perfoliatum, 840
burdock...
Ziziphus jujube, 844
Chinese wolfberry...
Arctium lappa, 221-232
Lycium chinense, 841
Cross references list only the main reference for a herb: detailed references are given in the Index under the botanical name
873
Combining Western Herbs and Chinese Medicine
874 chrysanthemum...
hydrangea, wild...
fenugreek ..:
Chrysanthemum morifolium, 839
cinnamon...
feverfew ...
Cinnamomum cassia, 371-385
cleavers...
hyssop...
Tanacetum parthenium, 715-724
figwort, common ... Scrophularia nodosa, 844
Galium aparine, 840
coneflower (echinacea) ... Echinacea species, 425-438
German chamomile...
couch grass...
..
ginger...
Piscidia erythrina, 599-605
Jesuits bark (Peruvian bark)... Cinchona species, 355-370
juniper...
Panax ginseng, 842
Juniperus communis, 513-526
golden seal...
dandelion ...
Hydrastis canadensis, 274-298
Taraxacum officinale, 725-737
gravel root...
devils claw... Harpagophytum procumbens, 503-512
Eupatorium purpureum, 525
greater burnet.., Sanguisorba officinalis, 843
dock, yellow...
greater celandine...
Rumex crispus, 843
Chelidonium majus, 839
·
.
Zingiber officinale, 819-836
Turnera diffusa, 771-780
E· .. ·.. ·
J Jamaica dogwood...
ginseng...
damiana ...
..
Matricaria recutita, 841
Agropyron repens, 839
o
I
Baptisia tinctoria. 839
Gentiana lutea, 455-471
Zea mays, 844
Hyssopus officinalis, 841
indigo, wild...
G······ .. ·.. ·· .. ·.... ·..·.... ·.. gentian (yellow) ...
corn ...
Hydrangea arborescens, 841
Trigonella foenum-graecum, 844
..
ground ivy... Glechoma hederacea, 840
L
..
lavender... Lavandula angustifolia, 527-538
licorice (liquorice) ... Glycyrrhiza glabra, 473-491
lily of the valley... Convallaria majalis, 399-409
lobelia... Lobelia inflata, 553-572
echinacea (coneflower) ... Echinacea species, 425-438
elder... Sambucus nigra, 687-696
ephedra... Ephedra sinica, 840
eyebright... Euphrasia species, 439
F··· .. ·.. ··· .. ··· .... ·.... ·.. ·.. · false unicorn ... Chamaelirium luteum, 839
fennel ...
H
..
hawthorn... Crataegus species, 411-424
heartsease... Viola tricolor, 844
hops... Humulus lupulus, 840
horehound, white... Marrubium vulgare, 841
horse-chestnut... Aesculus hippocastanum, 839
horsetqif...
Foeniculum vulgare, 840
Equisetum arvense, 840
M
..
marigold... Calendula officinalis, 299-308
marshmallow... Althaea officinalis, 183-191
meadowsweet... Filipendula ulmaria, 447-454
motherwort... Leonurus cardiaca, 539-552
mugwort... Artemisia vulgaris, 243
myrrh... Commiphora molmol, 387-398
Cross references list only the main reference for a herb: detailed references are given in the Index under the botanical name
':"-.'
English-Botanical Herb Names Cross Reference
o
.
prickly ash...
southernwood...
Zanthoxylur.n species, 805-817
oak...
pseudostellaria...
Quercus robur. 843
875
Artemisia abrotanur.n, 243
squaw vine...
Pseudostellaria heterophylla, 843
~tchella repens,
841
oats... Avena sativa, 839
Q
St. John's wort... Hypericur.n perforatur.n, 841
..
ophiopogon... Ophiopogon japonicus, 842
stinging nettle...
quaking aspen...
Urtica dioica, 844
Populus tremuloides, 842
Oregon grape... ~ahoniaaquuoliur.n
R
..
sweet violet...
(=Berberis aquifolium), 708
Viola odorata, 844
raspberry...
p
Rubus idaeus, 843
.
T
..
rhubarb... parsley...
Rheur.n palmatur.n, 619-634
Petroselinum crispum, 842 i~
r-_, ..... _
Thymus vulgaris, 757-770
rosemary...
pasque flower...
Rosmarinus officinalis, 635-660
Anemone pulsatilla, 193-204
tormentil, common... Potentilla erecta, 607-618
rue...
passionflower...
Ruta graveolens, 651-665
Passiflora incarnata, 842
thyme, common...
5
turmeric... Curcur.nalonga, 840
..
pellitory-of-the-wall... Parietaria diffusa, 842
v·
· ·
··..
Salvia officinalis, 667-685
pennyroyal... ~entha pulegium,
sage...
841
peppermint... Mentha piperita, 841
periwinkle, greater...
valerian... salvia root...
Valeriana officinalis, 781-793
Salvia miltiorrhiza, 668
vervain... sarsaparilla...
Verbena officinalis, 530
Smilax species, 707-715
Vinca major, 844
saw palmetto...
'-
Peruvian bark (Jesuit's bark)...
Serenoa serrulata, 844
w
..
Cinchona species, 355
pill-bearing spurge... Euphorbia hirta, 840
plantain, long-leaved... Plantago lanceolata, 842
pleurisy root. .. Asclepias tuberosa, 263-271
poke root... Phytolacca americana, 587-597
schisandra...
witch hazel... Hamamelis virginiana, 493-501
Schisandra chinensis, 843
Scotch broom...
wormwood... Artemisia absinthiur.n, 253-254
Sarothamnus scoparius, 697-706
shepherd's purse... Capsella bursa-pastoris, 309-318
skunk cabbage... Symplocarpus foetidus, 844
y
.
yarrow... Achillea millefolium, 165-181
Cross references list only the main reference for a herb: detailed references are given in the Index under the botanical name
Pharmaceutical-English HERB NAMES CROSS REFERENCE A······ .... ··············· .. ···· .. ···· ..
Asclepiadis tuberosae radix... pleurisy root, 263-271
.--"":.
Absinthii herba... wormwood, leaves and flowering tops, 253-254
Agni casti fructus ... chaste tree, fruit, 844
Astragali radix... astragalus, root, 839
Aurantii pericarpium... bitter orange, ripe peel, 839
Agrimoniae herba... agrimony, aerial parts, 839
Avenae endospermii... oats, endosperm, 839
Althaeae radix... marshmallow root, 183-191 B····························· .. ·· .. ····
Anemonae herba (PuIsatiIIae herba)... pasque flower, aerial parts, 193-204
Ballotae herba... black horehound, aerial parts, 839
Angelicae archangelicae radix cum rhizomate... angelica (garden), root and rhizomes, 205-218
Baptisiae radix... wild indigo root, 839
Angelicae sinensis radi.."C... Chinese angelica, root, 205
Arctii radix (Bardanae radix =Lappae radix)...
Bardanae radix (Arctii radix = Lappae radix) ... burdock, root, 221-232
burdock, root, 221-232
Arctii semen (Bardanae semen =Lappae semen)...
Bardanae semen (Arctii semen = Lappae semen)... burdock, seeds,223
burdock, seeds, 223
Artemisiae abrotani herba...
Berberidis cortex... barberry, root and/or stem bark, 273-298
southernwood, leaves and flowering tops, 243
Artemisiae vulgaris herba...
Bursae pastoris herba (Capsellae herba)...
mugwort, leaves and flowering tops, 243
shepherd's purse, aerial parts, 309-318
Cross references list only the main reference for a herb: detailed references are given in the Index under the botanical name
877
Combining Western Herbs and Chinese Medicine
878
.
c·······································
E··..·..···.. ·· .. ·· ..······· .. ·.. ·······
Calendulae fios ...
Echinaceae radix... coneflower, root (sometimes with stem or herb), 425-438
marigold,ligulate florets or composite flowers, 299-308
Capsellae herba (Bursae pastoris herba)...
Ephedrae herba... ephedra, young stems, 840
shepherd's purse, aerial parts, 309-318
Capsici fructus ...
Equiseti herba... horsetail, sterile stems, 840
cayenne, ripe fruit, 319-337
Eupatorii perfoliati herba... Cardamomi fructus ...
boneset, aerial parts, 840
cardamom, seeds, 840
Eupatorii purpurei radix... Caulophylli thalictroidis radix... blue cohosh, root, 839
gravel root, root, 525
Euphorbiae herba cum radice... pill-bearing spurge, entire plant, 840
Centaurii herba... centaury, flowering aerial parts, 455-471
Euphrasiae herba... eyebright, aerial parts, 439
Chamaelirii lutei radix cum rhizomate... false unicorn, root and rhizomes, 839
Chelidonii herba... greater celandine, aerial parts, 839
F
.
Foeniculi fructus ... fennel, fruit, 840
Chrysanthemi morifolii fios... chrysanthemum, flowers, 839
Foenugraeci semen... fenugreek, seeds, 844
Cimicifugae radix cum rhizomate... black cohosh, root and rhizomes, 339-354
Cinchonae cortex...
G
..
Jesuit's bark, bark, 355
Galii herba... Cinnamomi cassiae cortex... cinnamon, bark, 371-385
Cinnamomi cassiae ramulus... cinnamon, twigs, 373
Convallariae herba... lily of the valley, leaves, 399-409
Crataegi fructus, Crataegi folium, or Crataegi fios... hawthorn, fruit, leaves, or flowers, 411-424
Curcumae longae rhizoma... turmeric, rhizomes, 840
Cytisi scoparii (Genistae scopariae = Scoparii = Spartii scoparii) herba, fios, herba cum fios ... Scotch broom,leaves, flowers, or aerial parts with flowers, 697-706
cleavers, aerial parts, 840
Genistae scopariae (Cytisi scoparii =Scoparii = Spartii scoparii) herba, fios, herba cum fios ... Scotch broom, leaves, flowers, or aerial parts with flowers, 697-706
Gentianae radix... gentian (yellow), root, 455-471
Geranii rhizoma... American cranesbill, rhizomes, 840
Ginseng radix... ginseng, root, 842
Glechomae herba... ground ivy, aerial parts, 840
Glycyrrhizae radix (Liquiritiae radix) ...
D········ .. ····························· Damianae (Turnerae) folium ... damiana,leaves and stems, 771-780
licorice (liquorice), unpeeled roots and stolons, 473-491
Graminis rhizoma ... couch grass, rhizomes, 839
Cross references list only the main reference for a herb: detailed references are given in the Index under the botanical name
·"C~-C''''''''''''··
.:
-..
879
Pharmaceutical-English Herb Names Cross Reference rl
.
Lyeii fructus ... Chinese wolfberry, fruit, 481
Hamamelidis cortex or Hamamelidis folium ... witch hazel, bark or leaves, 493-501
Harpagophyti radix...
M
.
Mahoniae radix cum rhizomate...
devil's claw, transverse slices of the secondary tubers, 503-512
Oregon grape, root and rhizomes, 708
Maidis stigma... ~
Hippocastani semen...
corn, stigmas and styles, 844
horse-chestnut, seeds, 839
I'" _
Marrubii herba... Hydrangeae radix...
white horehound, aerial parts, 841
hydrangea (wild), underground parts, 841
Matricariae jIos... Hydrastidis rhizoma ...
German chamomile, flower heads, 841 .
golden seal, rhizomes, 274-298
Menthae piperitae herba... - Hyperici herba...
peppermint, aerial parts, 841
St. John's wort, aerial parts, 841
Menthae pulegii herba...
~._ Hyssop; herba...
pennyroyal, aerial parts, 841
hyssop, aerial parts, 841
Millefolii herba cum jIore... yarrow, aerial parts + flowers, 165-181
.........................................
Mitchellae repentis herba cum radix...
Iridis versicolores rhizoma...
squaw vine, entire plant, 841
blue flag, rhizomes, 841
1§
Myricae cortex radicis...
J
..
bayberry, root bark, 233-242
Myrrha...
Juniperi fructus ...
myrrh, oleogum resin from the bark of Commiphora species, 387-398
juniper, ripe fruits, 513-526
L
.
Lappae radix (Arctii radix = Bardanae radi.:,,) ... burdock, root, 221-232
Ltlppae semen (Arctii semen = Bardanae semen)... burdock, seeds, 223
Lavandulae jIos...
N Nepetae catariae herba... catnip, aerial parts, 841
o
motherwort, aerial parts with flowers, 539-552
Liqlliritiae radix (Glycyrrhizae radi.,,) ... licorice (liquorice), unpeeled roots and stolons, 473-491
Lobeliae herba... lobelia, aerial parts, 553-572
Lupuli strobulus... hops, strobiles, 840
.
Ophiopogonis Japonici tuber...
lavender, flowers, 527-538
Leonuri cardiacae herba cum jIore...
..
ophiopogon, tuber, 842
p
.
Panacis quinquefolii radix... American ginseng, root, 842
Parietariae herba... pellitory-of-the-wa!l, aerial parts; 842
Passiflorae herba... passionflower. aerial parts. 842
Cross references list only the main reference for a herb: detailed references are given in the Index under the botanical name
---------------------_._-_._-_ _--..
:td!ii:a
--
\
Combining Western Herbs and Chinese Medicine
880
Salviae miltiorrhizae radix...
Petroselini radix...
salvia root, root, 668
parsley, root, 842
Salviae officinalis folium ...
Phytolaccae radix...
sage, leaves, 667-685
poke root, 587-597
Sambuci jios...
Piscidiae radicis cortex... Jamaica dogwood, root bark, 599-605
elder, flowers, 687-696
Sanguinariae rhizoma...
Plantaginis lanceolatae folium ...
blood root, rhizome, 843
long-leaved plantain, leaves, 842
Polygoni bistortae radix cum rhizomate...
Sanguisorbae herba... greater burnet, aerial parts, 843
bistort, root and rhizomes, 842
Sarsaparillae radi.", cum rhizomate...
Populi cortex...
sarsaparilla, root and rhizomes, 707-715
quaking aspen, bark, 842
Schisandrae fructus ...
Pruni serotinae cortex...
schisandra, fruit, 843
black cherry, inner bark, 842
Scoparii (Cytisi scoparii =Genistae scopariae = Spartii scoparii) herba, jios, herba cum jios...
Pseudostellariae radix... pseudostellaria, root, 843
Scotch broom, leaves, flowers, or aerial parts with flowers, 697-706
Pulsatillae herba (Anemonae herba)... pasque flower, aerial parts, 193-204
_'''1'::':,
Scrophulariae herba... common figwort, aerial parts, 844
Pulsatillae chinensis radix...
Spartii scoparii (Cytisi scoparii = Genistae scopariae = Scoparii) herba, jios, herba cum jios...
Chinese anemone, root, 843
Q
..
Scotch broom, leaves, flowers, or aerial parts with flowers, 697-706
Quercus cortex...
Spiraeae herba or Spiraeae jios...
oak, inner bark, 843
meadowsweet, aerial parts or flowers, 447-454
R
..
Symplocarpi radix cum rhizomate... skunk cabbage, root and rhizomes, 844
Rhamni purshiani cortex... cascara, bark, 843
T
.
Rhei radix... rhubarb, underground parts, 619-634
feverfew, aerial parts, 715-724
Rosmarini folium ...
Taraxaci radix cum rhizomate...
rosemary, leaves, 635-660
dandelion, root and rhizomes, 725-737
Rubi idaei folium ...
Thujae folium ...
raspberry, leaves, 843
arbor-vitae, younger twigs, 739-755
Rumicis crispi rhizoma... yellow dock, underground parts, 843
rue, aerial parts, 651-665
Tormentillae rhizoma...
.
Sabal fructus ... saw palmetto, fruit, 844
Thymi herba et jios... thyme (common), leaves and flowers, 757-770
Rutae herba...
s
Tanaceti parthenii herba...
tormentil (common), rhizomes (separated from the roots), 607-618
Turnerae (Damianae) folium ... damiana, leaves and stems, 771-780
Cross references list only the mail! reference for a herb: detailed references are given in the Index under the botanical name
-- ."- I \
Pharmaceutical-English Herb Names Cross Reference
i·'
u
..
Verbenae herba...
z
881
.
vervain, aerial parts, 530
Urticae herba... stinging nettle, aerial parts, 844
Uvae ursi folium ... bearberry, leaves, 233-242
-
Viburni prunifolii cortex... black haw, stem or root bark, 795-804
Vincae majoris folium ... greater periwinkle, leaves, 844
v ..·..·..·············..········..··· ..·
Violae odoratae folium cum flore ...
Valerianae radix..,
Violae tricoloris herba...
valerian, underground parts, 781-793
sweet violet, leaves and flowers, 844
heartsease, aerial parts, 844
Zanthoxyli cortex... prickly ash, bark, 805-817
Zanthoxyli fructus ... prickly ash, berries, 805-817
Zingiberis rhizoma... ginger, rhizomes, 819-836
Ziziphi jujubae fructus ... Chinese date, fruit, 844
Cross references list only the main reference for a herb: detailed references are given in the Index under the botanical name
-".--:.
Botanical-Mandarin HERB NAMES CROSS REFERENCE CHINESE CHARACTERS are generally only given for herbs with their own individual chapter in the materia medica (and not for herbs in the Additional herbs chapter); for Western species if the herb has an entry in the Chinese Herbal Medicine Dictionary; and for Chinese species if they are in the same genus as a species used in the West and have comparable use.
A······ ........·· ........ ·.. ····
B
.
Achillea millefolium...
Berberis vulgaris...
Cinnamomum cassia (twigs) ... gul zhi (#.~), 371
,
r.;
yangshi do
(5f- f
C
Althaea rosea... shU kui gen (Jj **&,), 183
Angelica dahurica ... bai zhi (81:),217
Angelica pubescens... duhu6 (~i~), 217
Angelica sinensis... dang gui ('t jf). 217 Arctium lappa (root) ... niu banggen
(4-**L't), 221-232
Arctium lappa (seeds) ... niu bangzi
xiiio bo (+~), 273-298
Jt.), 165-181
(4- *-f), 223
Artemisia vulgaris... • , • (..x'7F~::.t-) ., '3 ,.""t
al ye
Asclepias curassavica... Han sheng gm zi hua U!1:A1-f~t.),263
Astragalus species... huang qi ("*,:f), 839
Citrus aurantium... zhi sm (~;;%), 839
..
Commiphora molmol... Calendula officinalis...
rnoyao U9..~), 387-398
jin zhan ju (~jJij), 299-308
Capsella bursa-pastoris... jlcai Of~), 309-318
Canvallaria keiskei.... linglan (1t:t), 399
Crataegus species...
Capsicum species...
shan zha
Ill. jiao (~:th), 319-337
Chelidonium majus... bai qu cai (a~~), 839 Chrysanthemum morifolium...
(Jd!). 411-424
Curcuma langa... jianghuang
(t-"*). 840
E
.
ju hua (~ ~t.), 839
Cimicifuga species... sheng rna (1:..$.), 339
Elettaria cardamomum...
Cinchona species..,
Ephedra sinica...
jinjile (~$.$}]), 355
Cinnamomum cassia (bark) ... rougu'i (~#.), 371-385
Cinnamomum cassia (branches) ... gul pi (#.&:,), 371
bai dou kou (a ji ~). 840 rna huang (~,*), 840
Equisetum arvense... wen jing (r"H(.j). 840
Euphorbia hirta... da fei yang do
(*- jjt ~ Jt.), 840
Cross references list only the main reference for a herb: detailed references are given in the Index under the botanical name
883
------_. __
.•...........
Combining Western Herbs and Chinese Medicine
884
Sanguisorba officinalis... dl yU (it.#.!), 843
Myrica species...
Euphrasia maximowiczii.. ..
yangmei (;fJ]~), 573
mangxiao mi do (~+*:!?), 439
Euphrasia regelii....
N
Schisandra chinensis... wUweizi (li.,*+), 843
.
xiao mi cao (, j, *:!?), 439
Nepeta cataria... jia jing jie ('!R $j 1F-), 841
Smilax species...
F································ Foeniculum vulgare...
o
Stella ria media... fan Iii (~~), 844
xiao hui xiang
(+ i27 :t), 840
tufUling (±-M.~), 707-715
.
Ophiopogon japonicus... maimendong ($--r,~), 842
G·······························
p
Galium aparine...
pugongying (~/t>*), 725
Panax ginseng...
Thuja (= Biota) orientalis...
fen shen (A.~), 842
qinjiao(*!t),466
Gentiana scabra... 16ng dan do (j£1Jy.:!? ), 466-467
ce bai ye (11l1~~), 739
Panax quinquefolium...
Thymus vulgaris...
xi yang shen (t!§ 5f- ~ ), 842 mei shang lil (~jllj ~), 587-597
Polygonum bistorta...
Pseudostellaria heterophylla...
Humulus lupulus...
Pulsatilla chinensis...
Hypericum perforatum...
bill t6u weng (a ~ ~), 843
gu1myelianqi11O ("t*it~), 841
R
.
.
xin ye jia mi gen
dahuang
dil song SID (*±t.e}~), 513
(,-:; ~ ~i!tAft), 795 Viburnum cylindricum.. .. diao bai ye (r'j1 avt"), 795
Viburnum dilatatum.... jia mi (*.i1!t), 795
Rheum palmatum...
Juniperus rigida.. ..
Viburnum cordifolium.. ..
tai zi shen (;k+~), 843
pijilihua (o"'~:ft.), 840
J
xiecao (~:!?), 781-793
jin jin bang (~1H+·), 607
jl hua ye (;fl:Ut.'t), 493
r ~), 844
Valeriana officinalis...
Potentilla reptans....
Hamamelis chinensis.. ..
hU III ba (tJj
v·······························
quanshen (... ~), 842
H·······························
she xiang cao (Ir:t::!?), 757-770
Trigonella foenum-graecum ...
Phytolacca americana...
Glycyrrhiza uralensis... gan do (it:!?), 473
.
Taraxacum mongolicum...
.
ba xian cao (A -f.L :!?), 840
Gentiana macrophylla...
T
-l!WJ'.l
(.*-*), 619-634
Viola tricolor... san se ji n (-=-~:i), 844
Rosmarinus officinalis... mi die xiang (.i!lii!:t:), 635-650
z
Leonurus heterophyllus... yl mli do (~~:!?), 539-540
Rumex crispus...
Zanthoxylum bungeanum... hua jiao ({t. fu), 805
Lobelia chinensis.... ban bian lian (i'-iiLj{), 553
Ruta graveolens...
Lycium chinense...
5
L
.
gouqi zi (*~~+), 841
M
.
Matricaria recutita ... mliju (~~), 841
nhler dahuang( 4-lf.*-*) , 843 chbucao (~:!?), 651-665
.
Zea mays... yil shU shU (.£. jj ~ ). 844 Zingiber officinale (dried) ... gan jiang
(-t 1-). 819-836
Zingiber officinale (fresh) ....
Salvia miltiorrhiza... dan shen
.
668
Sambucus williamsii... jie glimil (~1f;lq, 687
shengjiang
(1.1-), 819-836
Ziziphus jujube... da zao
(.*-J!t.). 844
Cross references list only the m'Jin reference for a herb: detailed references are given in the Index under the botanical name
t~:;:
__
Mandarin- Botanical
1..:.-.-
HERB NAMES CROSS REFERENCE CHINESE CHARACTERS are generally only given for herbs with their own individual chapter in the materia medica (and not for herbs in the Additional herbs chapter); for Western species if the herb has an entry in the Chinese Herbal Medicine Dictionary; and for Chinese species if they are in the same genus as a species used in the West and have comparable use.
A······················· .. ·.. ··:
o
ai ye (:)t $f-)
da fei ydng cao (*-;it;fJ] ~) ...
'"
Artemisia vulgaris, 243
da huang (kw) ... dazao (*--*-) ...
Galium aparine, 840
*J ...
Salvia miltiorrhiza, 668
diingguf (i;jf) '"
Chelidonium majus, 839
bai tau weng (6~~) ...
Angelica sinensis, 217
Lycium chinense, 841
guan ye /ian qiao (1' 1i Ii~)
Angelica dahurica, 217
Hypericum perforatum, 841
gUlpi (~~) ... 371
Sanguisorba officinalis, 843
(~:tt) ... Cinnarnomum cassia (twigs), 371
gUI zhf
Viburnum cylindricum, 795
(.f ilL j{) ...
du hu6
W~ ~~)
H
...
..
Angelica pubescens, 217
Lobelia chinensis, 553
. .
Thuja (= Biota) orientalis, 739
chou cao (~~) ... Ruta graveolens, 651-665
'"
Cinnamomurn cassia (branches),
diao bai ye( ;p 6';-) ...
baizhi (6 X) ...
'"
Zingiber officinale (dried), 819-836
di yu (!l!? ff,J) ...
Pulsatilla chinensis, 843
cebaiye (fllU8~)
giin jiiing (T -l)
gou qi zi (;#] le.-r) ...
diin shen (1t~) ...
Elettaria cardamomum, 840
c
Glycyrrhiza uralensis, 473
Ziziphus jujube, 844
bdi dou kou (6'§"~) ...
.
giin cao (it:!?) ...
Rheum palrnatum, 619-634
bii xiiin cao (A1Jd,t.) ...
ban bian lian
G
Euphorbia hirta, 840
B·· ......·.. ·.... ·..·.......... ·
bdi qii cai (6 fi.f.
..
dil song shi (~±.t~~) ... Juniperus rigida, 513
F· ...... ·.. ·· ..·.. ·· .. ·· .. ·..·..· fan lu (~~) ...
hu lu bii
...
hua jiao (-it. ta) '" Zanthoxylum bungeanum, 805
huangqi
Stellaria media, 844
(~Jl 1'~)
Trigonella foenum-graecum, 844
(**) '"
Astragalus species, 839
Cross references list only the main reference for a herb: detailed references are given in the Index under the botanical name
885
Combining Western Herbs and Chinese Medicine
886 J
-.,...".
.
j1 cai
(*"*) ...
jia jfngjie (~AA 1f.)
Commiphora molmol, 387-398
Matricaria recutita. 841
... N
, ( ....."':It) ~ ilJi ... Viburnum dilatatum, 795
niu bcmggen (4-1f~)
Jla ml
...
jfnji le (~$j~) ... Cinchona specie~, 355
ju huii (ifj :ft.) ...
Q
Schisandra chinensis, 843
x·.. ·..·....····......··· ..··· .. xi yang shen (~$f- *") ... Panax quinquefolium, 842
Taraxacum mongolicum, 725
xiao bil (+~) ... Berberis vulgaris, 273-298
..
xiaohuixiang (+rii~) ...
qinjiiio (*-it) ...
..
Foeniculum vulgare, 840
Gentiana macrophylla, 466
xiao mi cao
quan shen (~*") ...
(~th) ...
R
linglan (#-:t) ... Convallaria keiskei, 399
lian sheng gUI zi huii (it1.U.-f1t.) ... Asclepias curassavica, 263
M
..
... ...
*
Jt.) ... Euphrasia maximowiczii, 439 (~Wi
.. Viola tricolor, 844
Ophiopogon japonicus, 842
(:c +
y
Cinnamomum cassia (bark), 371385
s
iii) ...
Phytolacca americana, 587-597
*' 1tf!I*) ...
Viburnum cordifolium, 795
sansejin (-=-~:i) ...
Ephedra sinica, 840
mili men dong ($--r,~)
xin ye jia migen (,~
(A.~) ...
TOU gUI (~#,) ...
Gentiana scabra, 466-467
$) .. ,
Valeriana officinalis, 781-793
Panax ginseng, 842
long dan cao (Jt}l!!Jt.) ...
*
xiecao (~Jt.) .:.
..
Ten shen
(+
Euphrasia regelii, 439
Polygonum bistorta, 842
Capsicum species, 319-33.7
...
Equisetum arvense, 840
wu wei zi (li. ~-f) ...
Humulus lupulus, 840
pugongying ({;i~*) ...
mei shiing lu
wen jfng (M AA)
.
jfn zhanju (~.s.ifj) ... Calendula officinalis, 299-308
mang xiao mi cao
.
...
Rumex crispus, 843
pijiu huii ('it $f,!j :ft.) ...
Chrysanthemum morifolium, 839
Smilax species, 707-715
w
(4-1f -f) ...
niu eT da huang ( 4- Jf.*-"*)
Potentilla reptans, 607
ma huang (M- "*)
tu jU ling (.±.-R:q:.) ...
...
p
jfnjin bcmg (~~#-) ...
lil jiiio
Pseudostellaria heterophylla, 843
Arctium lappa (seeds), 223
Sambucus williamsii, 687
L
tilizi shen (~-r~) ...
Arctium lappa (root), 221-232
niu bangzi
jie gu mil (.fi1f;j\..) ...
.
..
Curcuma longa, 840
...
T
muju (-HJ:~) ...
Nepeta cataria, 841
jiiinghuang (-l-"*)
(Ii ~*) AJthaearosea, 183
shU kui gen
mil yao U~P-i) ...
(:ilUt. "t) ...
Hamamelis chinensis, 493
.. ,
Cimicifuga species, 339
Rosmarinus officinalis, 635-650
Capsella bursa-pastoris, 309-318
Jl huii ye
sheng ma (1.M-) ...
mi die xiiing (i!t..i!~) ...
..
yang shi cao ($f- f $)
.
Achillea millefolium, 165-181
yang mei (#1 ;fit) ... Myrica species, 573
Yl mu cao (~-HJ:$) ... Leonurus heterophyllus, 539-540
shan zha
(J.!~)
... Crataegus species, 411-424
yushushU (..L1J~) .. · Zea mays, 844
shexiangciio (.~Jt.) ... Thymus vulgaris, 757-770
shengjiang (1.4-) ... Zingiber officinale (fresh), 819-836
z
.
zhi shi (iP- ~) ... Citrus aurantium, 839
Cross references list only the main reference for a herb: detailed references are given in the Index under the botanical name
:
i....
Combinations-Chinese syndromes ~-
CROSS REFERENCE This Cross reference mainly lists Chinese syndrome pairs: see the Index to find page references to individual Chinese syndromes.
A·········· .. ··· ....····· .. ··· ..
Anemone: dysmenorrhea + fear... Kidney Stagnant Qi + Kidney fear, 197
Achillea: amenorrhea + exhaustion... Deficient Blood and Qi, 172
Angelica: depression + obesity... Heart Stagnant Qi + Spleen Damp, 209
Achillea: atherosclerosis + hypertension + cold extremities... Hear~ Phlegm Cold
+ Heart Stagnant Qi, 172
r,
Achillea: influenza + sinusitis...
j
Wind Cold Damp, 171
'---
Achillea: influenza + sore throat... Wind Heat, 170
Achillea: recurringfever + exhaustion... Retained Pathogen + Liver Deficient Qi, 171
Angelica: sinusitis + obesity... Lung Phlegm Damp + Spleen Damp, 209
Arctium: chronic eczema.., Damp Heat + Deficient Blood, 226 Arctium: recurring urticaria (acute phase)... Wind Heat + Retained Pathogen, 222 Arctium: recurring urticaria (remission phase) ... Retained Pathogen + Deficient Blood, 225
Achillea: recurringfever + respiratory infection... Retained Pathogen + Deficient Defensive Qi, 172
Arctostaphylos: cystitis + hematuria... Bladder Damp Heat + Bleeding from Heat, 236
Althaea: colitis... Intestines Heat, 186
Arctostaphylos: urinary infection + heat sensations... Bladder Damp Heat, 236
Althaea: cystitis... Bladder Heat + Kidney Deficient Ym,187
Arctostaphylos: vaginitis... Lower Burner Damp Heat, 237
Althaea: dry cough ... ,'::::-
Lung Deficiency Heat + Lung Deficient Yin, 186
Artemisia: amenorrhea + nervous tension ... Uterus Stagnant Qi and Blood + Heart Spirit Disturbance, 249
Althaea: gastritis... Stomach Deficiency Heat + Stomach Deficient Ym, 186
887
Combining Western Herbs and Chinese Medicine
888
Artemisia: food intolerances + heat sensations... Liver Stagnant Qi + Liver Damp Heat, 248
Asclepias: acute respiratory disorders + fever... Lung Phlegm Heat + Wind Heat, 266
Asclepias: bronchitis + heat sensations... Lung Phlegm Heat + Liver Heat, 267
Asclepias: influenza + fever... Wind Heat + Lung Heat, 266
Cinchona: cardiac arrhythmia + recurringfever... Heart Qi Irregularity + Retained Pathogen, 362
Cinchona: cardiac weakness + digestive weakness... Heart Deficient Qi + Spleen Deficient Qi, 362
Cinchona: digestive weakness + postfebrile exhaustion... Spleen Deficient Qi, 361
Cinchona: recurring fever + cardiac weakness... Retained Pathogen + Heart Deficient Qi, 361
B·· .. ·· ....······ ..··.... ·.. ··..
Cinchona: recurring fever + myalgia...
Berbel is: acute eczema...
Cinchona: recurringfever + night sweats...
Liver-Gallbladder Damp Heat, 281
Berberis: cholecystitis... Liver-Gallbladder Damp Heat, 281
c· ..·......·....·..·....·· ..·..···
Retained Pathogen + Wind Heat. 360 Retained Pathogen + Heart Deficient Tm. 361
Cinnamomum: amenorrhea + cold sensations... Uterus Stagnant Qi and Blood + Cold. 376 Cinnamomum: arthritis + cold extremities + exhaustion... Deficient Qi and Blood + Cold in the channels, 376
Calendula: lymphadenitis... Retained Pathogen + Heat Toxin, 302
Calendula: peptic ulcer... Stomach Heat. 302
Calendula: peptic ulcer + bleeding... Stomach Heat + Bleeding from Heat, 302
Capsella: menorrhagia + anemia... Spleen not holding Blood + Deficient Blood, 312
Capsella: menorrhagia + exhaustion... Spleen not holding Blood + Kidney Deficient Qi. 312 Capsella: menorrhagia + heat sensations... Bleeding from Heat, 312
Capsella: severe menorrhagia... various syndromes, 311
Capsicum: depression + bronchitis... Heart Stagnant Qi + Lung Stagnant Qi. 326
Cinnamomum: chronic diarrhea + cold sensations... Kidney Deficient Yang + Cold, 376
Commiphora: chronic bronchitis + cold sensations... Lung Phlegm Cold + Spleen Deficient Yang, 392
Convallaria: angina pectoris + cold sensations... Heart Stagnant Blood + Heart Deficient Yang, 403
Convallaria: cardiac arrhythmia + restlessness... Heart Qi Irregularity + Heart Deficient Yin, 403
Convallaria: cardiac weakness + cardiac edema ... Heart Deficient Qi + Kidney Deficient Qi + Damp, 402
Crataegus: angina pectoris... Heart Stagnant Blood, 415
Crataegus: atherosclerosis + hypertension... Heart Phlegm Heat + Heart Stagnant Qi. 416
Crataegus: bipolar disorders... Heart Spirit Disturbance + Heart Deficient Yin and Yang, 417
Capsicum: hypertension + heat sensations... Heart Heat + Liver Heat, 325
Crataegus: cardiac arrhythmia + exhaustion... Heart Qi Irregularity + Heart Deficient Blood. 416
Cimicifuga: amenorrhea + convulsions... Uterus Stagnant Qi and Blood + Liver Wind. 344
Crataegus: cardiac arrhythmia + hypotension... Heart Qi Irregularity + Kidney Deficient Qi. 417
Cimicifuga: menopausal disorders + exhaustion... Kidney Deficient Yin + Liver Deficient Yin. 345
Crataegus: cardiac weakness + depression ... Heart Deficient Yang + Kidney Deficient Yang. 418
Cimicifuga: menopausal disorders + rheumatism... Heart Deficient Yin + Damp Heat. 345
Cimicifuga: premenstrual syndrome + headache... Liver Hyperactive Yang + Uterus Stagnant Qi and Blood. 344
E
.
Echinacea: boils + infection... Heat Toxin, 431
r'
~
Combinations-Chinese Syndrome Cross Reference Euphrasia: acute allergic rhinitis...
L
889
.
Wind Heat, 442 i
.
~
Euphrasia: catarrhal deafness... Lung PWegm Cold, 442
Lavandula: anxiety + depression ... Heart Spirit Disturbance + Liver Stagnant Qi, 533 Lavandula: asthma + anxiety...
Euphrasia: sinusitis + heat sensations... Lung PWegm Heat, 442
Heart Spirit Disturbance + Lung Stagnant Qi. 532
Lavandula: headache + anxiety... Liver Hyperactive Yang + Heart Spirit Disturbance, 532
G·······························
Lavandula: insomnia... Gentiana: digestive weakness + anemia... I,
Spleen Deficient Qi + Deficient Blood, 460
Gentiana: digestive weakness + gastrointestinal inflammation... Spleen Deficient Qi + Intestines Heat, 461
Gentiana: nausea + digestive weakness... Spleen Deficient Qi + Stomach Rebellious Qi, 460 Gentiana: poor appetite +anorexia... Spleen Deficient Qi + Deficient Blood and Qi, 460
Heart Spirit Disturbance. 531
Lavandula: irritable bowel syndrome + heat sensations... Intestines Qi Disturbance + Intestines Heat, 532
Lavandu1a: palpitations + anxiety... Heart Spirit Disturbance + Heart Qi Irregularity. 531
Leonurus: amenorrhea... Uterus Stagnant Qi and Blood + Uterus Deficient Qi and Blood, 545
Leonurus: anxiety... Heart Spirit Disturbance. 544
H·······························
Leonurus: cardiac weakness + digestive weakness... Heart Deficient Qi + Spleen Deficient Qi. 544
Hamamelis: diarrhea + bleeding... Spleen Qi Sinking + Spleen not holding Blood, 496
Hamamelis: varicose veins...
Leonurus: menstrual disorders + anxiety... Uterus Stagnant Qi and Blood + Heart Spirit Disturbance. 545
Spleen Qi Sinking, 496
Harpagophytum: arthritis + exhaustion... Damp Heat in the channels + Deficient Ym. 506
Leonurus: palpitations + anemia... Heart Spirit Disturbance + Deficient Blood, 544
Harpagophytum: arthritis + heat sensations...
Leonurus: postnatal pain + anxiety... Uterus Stagnant Qi and Blood + Heart Spirit Disturbance, 545
Damp Heat in the channels, 506
J
.
Lobelia: acute asthma... Lung Stagnant Qi, 560
Juniperus: cystitis + recurring respiratory infection... Retained Pathogen + Bladder Damp Heat. 517 1.-...
Juniperus: digestive weakness + flatulence... Spleen Deficient Qi + Damp + PWegm. 518
Juniperus: edema... Kidney Deficient Qi + Damp. 518
M
..
Myrica: chronic diarrhea + digestive weakness... Spleen Deficient Qi + Spleen Qi Sinking, 579 Myrica: chronic fatigue + cold extremities... Stagnant Qi and Blood + Deficient Qi and Blood, 578
Juniperus: intestinal colic + anxiety... Intestines Stagnant Qi + Intestines Qi Disturbance. 519
Myrica: colitis + mucus in the stools...
Juniperus: mental dullness... Spleen Deficient Qi + Kidney Deficient Qi. 519
Myrica: depression + digestive disorders... Liver Stagnant Qi + Cold + Damp and Phlegm, 578
Juniperus: phlegmy cough... Lung PWegm Damp + Spleen Deficient Qi. 518
Myrica: menorrhagia + cold sensations...
Intestines PWegm Damp + Spleen Deficient Qi, 579
Spleen not holding Blood + Cold, 579
Combining Western Herbs and Chinese Medicine
890
p
.
5
Phytolacca: chronic acne... lIeatToxin+Phle~,591
Piscidia: dysmenorrhea + nervous tension...
..
Salvia: acute tonsillitis... Wind Heat + lIeat Toxin, 672 Salvia: excessive sweating + exhaustion...
Uterus Stagnant Qi and Blood + lIeart Spirit Disturbance, 602
Piscidia: insomnia + muscle spasms...
Deficient Defensive Qi + Deficient Blood + lIeart Deficient Yin, 673
Salvia: headache + anemia...
lIeart Spirit Disturbance + Stagnant Qi and Blood, 601
Potentilla: acute diarrhea + heat sensations... Intestines Damp lIeat, 611
Potentilla: acute severe diarrhea ...
Liver lIyperactive Yang + Liver Deficient Blood, 673
Salvia: headache + myalgia... Liver Hyperactive Yang + Wind Cold, 673 Salvia: headache + premenstrual syndrome + depression ...
various syndromes, 610
Potentilla: protozoal diarrhea ...
Liver lIyperactive Yang + Liver Stagnant Qi, 674
Salvia: menopausal hot flashes ...
Intestines Damp lIeat + lIeat Toxin, 611
R
.
lIeart Heat + lIeart Deficient Ym, 672
Smilax: acute psoriasis... lIeat in the Blood + lIeat Toxin, 709
Rheum: acute constipation... Intestines Stagnant Qi, 623
Smilax: arthritis + psoriasis... Damp lIeat + lIeat Toxin, 71 0
Rheum: chronic constipation... Intestines Stagnant Qi + Intestines Deficient Qi, 624
Smilax: chronic psoriasis... Stagnant Qi and Blood + Phle~, 711
Rheum: gastritis + constipation... Stomach lIeat + Liver lIeat, 625
Rosmarinus: digestive disorders + depression ... Liver invades Spleen, 642
Rosmarinus: digestive weakness + cold sensations... Spleen Deficient Qi + Spleen Deficient Yang, 641
Rosmarinus: food intolerances + cold sensations... Liver Stagnant Qi + Cold, 641
Rosmarinus: headache + facial neuralgia... Liver lIyperactive Yang + Stagnant Qi and Blood in the channels, 642
Rosmarinus: irritable bowel syndrome + cold sensations... Intestines Qi Disturbance + Cold, 642
Rosmarinus: postnatal depression + exhaustion... Deficient Qi and Blood + Heart Stagnant Qi, 641
T
.
Tanacetum: headache + conjunctivitis... Liver lIyperactive Yang + Wind lIeat, 718
Thuja: amenorrhea + catarrhal conditions... Uterus Stagnant Qi and Blood + Phlegm Cold Damp, 746 Thuja: cancer therapy adjunct... Stagnant Qi + Damp lIeat + lIeat Toxin, 747 Thuja: chronic bronchitis + cardiac weakness... Lung Phlegm Cold + lIeart Deficient Qi, 745
Thuja: prostatic enlargement + sexual debility... Bladder Phlegm Cold + Kidney Deficient Qi, 745
Thuja: prostatitis + infection... Lower Burner Damp lIeat, 746
Ruta: chronic fatigue syndrome + palpitations... Kidney fear + lIeart Spirit Disturbance, 656
Thymus: bronchitis + sinusitis...
Ruta: exhaustion + fear...
Thymus: dysmenorrhea ...
Kidney Deficient Qi + Kidney fear, 656
Ruta: infertility + obesity... Uterus Stagnant Qi and Blood + Damp and Phlegm, 657
Ruta: nightmares... lIeart Spirit Disturbance + Kidney fear, 657
Lung Phlegm, 762
Uterus Stagnant Qi and Blood, 763
Thymus: enuresis... lIeart Spirit Disturbance + Kidney fear, 763
Thymus: recurring respiratory infection... Retained Pathogen + Deficient Defensive Qi, 762
r Combinations-Chinese Syndrome Cross Reference Thymus: spasmodic cough ...
Viburnum: postnatal pain + bleeding...
Lung Rebellious Qi, 762
Uterus Stagnant Qi and Blood, 798
Turnera: depression + cold extremities...
Viburnum: threatened miscarriage...
Kidney Deficient Yang + Heart Deficient Qi, 774
Turnera: depression + sexual debility... Kidney Deficient Qi + Liver Stagnant Qi, 775
Turnera: exhaustion + sexual debility... Kidney Deficient Yang + Kidney Deficient Ym, 775
-
-
Turnera: sexual debility + cold sensations... Kidney Deficient Yang, 774
\. l.
.
Zanthoxylum: arthritis + cold extremities... Stagnant Qi and Blood + Cold in the channels, 810
Zanthoxylum: intestinal colic + cold extremities... Stagnant Qi and Blood + Intestines Cold, 811. Zanthoxylum: muscle cramps + cold extremities... Stagnant Qi and Blood + Deficient Blood, 810
Valeriana: colitis + nervous tension ...
Zanthoxylum: prostatitis + cold sensations...
Intestines Heat + Heart Spirit Disturbance, 786
Valeriana: hypertension + headache... Viburnum: habitual miscarriage... Uterus Deficient Qi and Blood, 799
i
z
v··.. ········......······.... ···
Liver Hyperactive Yang + Liver Heat, 786 !.....
Uterus Qi Disturbance, 798
Stagnant Qi and Blood + Bladder Phlegm Cold, 810
Zingiber: intestinal colic + cold sensations... Intestines Stagnant Qi + Cold, 824 Zingiber: nausea + vomiting... Stomach Rebellious Qi, 824
891
-----------------_
....
_-_.. __ ._--_.----
--------....
--
r
Disorders-combinations CROSS REFERENCE
A······ ...... ·.... ·· .... ·..·....
anxiety... Leonurus: anxiety, 544
acne, chronic... Phytolacca: chronic acne, 591
allergic rhinitis, acute...
anxiety + depression ... Lavandula: anxiety + depression, 533
arthritis + psoriasis...
Euphrasia: acute allergic rhinitis, 442
amenorrhea ...
Smilax: arthritis + psoriasis, 710
arthritis + cold extremities... Zanthoxylum: arthritis + cold extremities, 810
Leonurus: amenorrhea, 545
amenorrhea + catarrhal conditions.., Thuja: amenorrhea + catarrhal conditions, 746
amenorrhea + cold sensations... Cinnamomum: amenorrhea + cold sensations, 376
arthritis + cold extremities + exhaustion... Cinnamomum: arthritis + cold extremities + exhaustion, 376
arthritis + exhaustion... Harpagophytum: arthritis + exhaustion, 506
I
\>-,
amenorrhea + convulsions... Cimicifuga: amenorrhea + convulsions, 344
amenorrhea + exhaustion... Achillea: amenorrhea + exhaustion, 172
arthritis + heat sensations... Harpagophytum: arthritis + heat sensations, 506
asthma + anxiety... Lavandula: asthma + anxiety, 532
amenorrhea + nervous tension ... Artemisia: amenorrhea + nervous tension, 249
asthma, acute...
angina pectoris...
atherosclerosis + hypertension...
Lobelia: acute asthma, 560
Crataegus: angina pectoris, 415
Crataegus: atherosclerosis + hypertension, 416
angina pectoris + cold sensations...
atherosclerosis + hypertension + cold extremities... Achillea: atherosclerosis + hypertension, 173
Convallaria: angina pectoris + cold sensations, 403
Disorders are listed here only if they occur as part of the name of a herb-combination: for detailed references to disorders, see the Index
893
Combining Western Herbs and Chinese Medicine
894
--.....,)
B·······························
colitis... Althaea: colitis, 187
bipolar disorders... Crataegus: bipolar disorders. 417
boils + infection... Echinacea: boils + infection. 431
bronchitis + heat sensations... Asclepias: bronchitis + heat sensations, 267
bronchitis + sinusitis... Thymus: bronchitis + sinusitis, 762
bronchitis, chronic + cardiac weakness... Thuja: chronic bronchitis + cardiac weakness, 745
colitis + mucus in the stools... Myrica: colitis + mucus in the stools, 579 colitis + nervous tension ... Valeriana: colitis + nervous tension, 786 constipation, acute... Rheum: acute constipation, 623
constipation, chronic... Rheum: chronic constipation, 624
cough, dry... Althaea: dry cough, 186
bronchitis, chronic + cold sensations... Comrniphora: chronic bronchitis + cold sensations, 392
cough, phlegmy... Juniperus: pWegmy cough, 518
c······························· cancer therapy adjunct. .. Thuja: cancer therapy' adjunct, 747
cardiac arrhythmia + exhaustion... Crataegus: cardiac arrhythmia + exhaustion, 416
cough, spasmodic... Thymus: spasmodic cough, 762
cystitis... Althaea: cystitis, 187
cystitis + hematuria.., Arctostaphylos: cystitis + hematuria, 236
cardiac arrhythmia + hypotension... Crataegus: cardiac arrhythmia + hypotension, 417
cystitis + recurring respiratory infection... Juniperus: cystitis + recurring respiratory infection, 517 .
cardiac arrhythmia + recurringfever... Cinchona: cardiac arrhythmia + recurring fever, 362
D·······························
cardiac arrhythmia + restlessness...
depression + bronchitis...
Convallaria: cardiac arrhythmia + restlessness, 403
Capsicum: depression + bronchitis, 326
cardiac weakness + cardiac edema... Convallaria: cardiac weakness + cardiac edema, 402
depression + cold extremities...
cardiac weakness + depression ...
depression + digestive disorders ... Myrica: depression + digestive disorders, 578
Crataegus: cardiac weakness + depression, 418
Turnera: depression
+ cold extremities, 774
cardiac weakness + digestive weakness... Leonurus: cardiac weakness + digestive weakness, 544
depression + obesity...
catarrhal deafness...
depression + sexual debility... Turnera: depression + sexual debility, 775
Euphrasia: catarrhal deafness, 442
cholecystitis... Berberis: cholecystitis, 281
Angelica: depression + obesity, 209
diarrhea, acute + heat sensations... Potentilla: acute diarrhea + heat sensations, 611
chronic fatigue syndrome + cold extremities... Myrica: chronic fatigue syndrome + cold extremities, 578
diarrhea, acute, severe...
chronic fatigue syndrome + palpitations... Ruta: chronic fatigue syndrome + palpitations, 656
diarrhea, chronic + cold sensations...
Potentilla: acute severe diarrhea, 610 Cinnamomum: chronic diarrhea + cold sensations, 376
Disorders are listed here only if they occur as part of the name of a herb combination: for detailed references to disorders, see the Index
Disorders-Combinations Cross Reference diarrhea, chronic + digestive weakness...
895
F··· .. ·.... ··· .......... ······..·
Myrica: chronic diarrhea + digestive weakness, 579
diarrhea, protozoal...
fever, recurring + cardiac weakness... .Cinchona: recurring fever + cardiac weakness, 361
Potentilla: protozoal diarrhea, 611
diarrhea + bleeding...
fever, recurring + exhaustion... Achillea: recurring fever + exhaustion, 171
Hamamelis: diarrhea + bleeding, 496
digestive disorders + depression ...
fever, recurring + myalgia... Cinchona: recurring fever
Rosmarinus: digestive disorders + depression, 637
+ myalgia, 360
fever, recurring + night sweats... digestive weakness + anemia ...
r
Cinchona: recurring fever + night sweats, 361
Gentiana: digestive weakness + anemia, 460
digestive weakness + cold sensations... Rosmarinus: digestive weakness + cold sensations, 641
digestive weakness + flatulence ... Juniperus: digestive weakness + flatulence, 518
digestive weakness + gastrointestinal inflammation... Gentiana: digestive weakness + gastrointestinal inflammation, 461
digestive weakness + postfebrile exhaustion... Cinchona: digestive weakness + postfebrile exhaustion, 361
dysmenorrhea...
fever. recurring + respiratory infection.... Achillea: recurring fever + respiratory infection, 172 food intolerances + cold sensations... Rosmarinus: food intolerances + cold sensations, 641 food intolerances + heat sensations... Artemisia: food intolerances + heat sensations, 248
G· .... ·.... ·.. ·.... ·.. ··· .. ··· .. gastritis... Althaea: gastritis, 187
gastritis + constipation... Rheum: gastritis + constipation, 625
Thymus: dysmenorrhea, 763
dysmenorrhea + fear... Anemone: dysmenorrhea + fear, 197 Ii.
dysmenorrhea + nervous tension ... Piscidia: dysmenorrhea + nervous tension, 602
H
.
headache + anemia... .Salvia: headache + anemia, 673 headache + anxiety... Lavandula: headache + anxiety, 532
E········ .. ·......··.... ··· .... ·· headache + conjunctivitis... eczema, acute...
L
Berberis: acute eczema, 281
eczema, chronic... Arctium: chronic eczema, 223
edema ... Juniperus: edema, 517
enuresis... Thymus: enuresis, 763
exhaustion + fear... Ruta: exhaustion + fear, 656
exhaustion + sexual debility... Turnera: exhaustion + sexual debility, 775
Tanacetum: headache + conjunctivitis, 718
headache + facial neuralgia... Rosmarinus: headache + facial neuralgia, 642
headache + myalgia... Salvia: headache
+ myalgia, 673
headache + premenstrual syndrome + depression ... Salvia: headache + premenstrual syndrome + depression, 674
hypertension + headache... Valeriana: hypertension + headache, 786
hypertension + heat sensations... Capsicum: hypertension + heat sensations, 325
Disorders are listed here only if they occur as part of the name of a herb combination: for
detailed references to disorders, see the Index
",-...- .. 1t~
··.:~~,~t;
Combining Western Herbs and Chinese Medicine
896
.~
I
.
infertility + obesity... Ruta: infertility + obesity, 657 influenza + fever... Asclepias: influenza + fever, 266 influenza + sinusitis... Achillea: influenza + sinusitis, 171 influenza + sore throat... Achillea: influenza + sore throat, 170 insomnia ... Lavandula:insonrrnia,531 insomnia + muscle spasms... Piscidia: insonrrnia + nrruscle spasnrrs, 601 intestinal colic + anxiety... Juniperus: intestinal colic + anxiety, 519 intestinal colic + cold extremities... Zanthoxylum: intestinal colic + cold extr~nrrities, 811 intestinal colic + cold sensations... Zingiber: intestinal colic + cold sensations, 824 irritable bowel syndrome + cold sensations... Rosnrrarinus: irritable bowel syndronrre + cold sensations, 642 irritable bowel syndrome + heat sensations... Lavandula: irritable bowel syndronrre + heat sensations, 532
L
..
--~
menorrhagia + heat sensations... Capsella: nrrenorrhagia + heat sensations, 312 menorrhagia, severe... Capsella: severe nrrenorrhagia, 311 menstrual disorders + anxiety... Leonurus: nrrenstrual disorders + anxiety, 545 mental dullness... Juniperus: nrrental dullness, 519 miscarriage. habitual... Viburnunrr: habitual nrriscarriage, 799 miscarriage, threatened... Viburnunrr: threatened miscarriage, 798 muscle cramps + cold extremities... Zanthoxylum: nrruscle cramps + cold extrenrrities, 810
N
..
nausea + digestive weakness... Gentiana: nausea + digestive weakness, 460 nausea + vomiting... Zingiber: nausea + vonrriting, 824 nightmares... Ruta: nightnrrares, 657
p
..
.
lymphadenitis... Calendula: lynrrphadenitis, 302
M
__ ---....0--..
menorrhagia + exhaustion... Capsella: nrrenorrhagia + exhaustion, 312
palpitations + anemia... Leonurus: palpitations + anenrria, 544 palpitations + anxiety... Lavandula: palpitations + anxiety, 531
menopausal disorders + exhaustion... Cinrricifuga: nrrenopausal disorders + exhaustion, 345
peptic ulcer... Calendula: peptic ulcer, 302
menopausal disorders + rheumatism ... Cinrricifuga: nrrenopausal disorders + rheunrratisnrr,345
peptic ulcer + bleeding... Calendula: peptic ulcer + bleeding, 302
menopausal hot flashes ... Salvia: nrrenopausal hot flashes, 672
poor appetite + anorexia... Gentiana: poor appetite + anorexia, 460
menorrhagia + anemia... Capsella: menorrhagia + anenrria, 312
postnatal depression + exhaustion... Rosnrrarinus: postnatal depression + exhaustion, 641
menorrhagia + cold sensations... Myrica: nrrenorrhagia + cold sensations, 579
postnatal pain + anxiety... Leonurus: postnatal pain + anxiety, 545
Disorders are listed here only if they occur as part of the name of a herb combination: for detailed references to disorders, see the Index
--e-'
~
...
'
i _.
Disorders-Combinations Cross Reference sinusitis + heat sensations...
postnatal pain + bleeding... Viburnum: postnatal pain + bleeding, 798
Euphrasia: sinusitis + heat sensations, 442
sinusitis + obesity...
premenstrual syndrome + headache... Cimicifuga: premenstrual syndrome + headache, 344
-
prostatic enlargement + sexual debility... Thuja: prostatic enlargement + sexual debility, 745
prostatitis + cold sensations... Zanthoxylum: prostatitis + cold sensations, 810
Angelica: sinusitis + obesity, 209
sweating, excessive + exhaustion... Salvia: excessive sweating + exhaustion, 673
T
Thuja: prostatitis + infection, 746
Salvia: acute tonsillitis, 672
u
psoriasis, acute... Smila.x: acute psoriasis, 709
Arctostaphylos: urinary infection + heat sensations, 236
Smilax: chronic psoriasis, 711
urticaria, reCUTTing (acute phase)...
..
Arctium: recurring urticaria (acute phase), 224
respiratory disorders, acute + fever...
urticaria, recurring (remission phase)...
Asclepias: acute respiratory disorders + fever, 266
respiratory infection, recurring... Thymus: recurring respiratory infection. 762
.:. Cold extremities and cold sensations
Arctium: recurring urticaria (remission phase), 225
v·......·....·..........·..·.... vaginitis...
.
Arctostaphylos: vaginitis, 237
sexual debility + cold sensations... Turnera: sexual debility + cold sensations, 774
t..
..
urinary infection + heat sensations...
psoriasis, chronic...
5
.
tonsillitis, acute...
prostatitis + infection...
R
897
varicose veins... Hamamelis: varicose veins, 496
In this book, the term 'cold extremities' refers to disorders of peripheral cir-
culation involving cold hands and feet, as, for example, in the combination Zanthoxylum: arthritis + cold extremities. The term 'cold sensations' is less specific and may refer to sensations of cold in the extremities, in the chest or abdomen, or in the muscles of the back and neck. For example, the combination Rosmarinus: irritable bowel syndrome + cold sensations
~--
is specifically for sensations of cold in the abdomen.
Disorders are listed here only if they occur as part of the name of a herb combination: for detailed references to disord~rs, see the Index
~'..i
to.,:
~,
Index • general topics • primary disorder • secondary disorder
Index organization ~-
The Index has been specially designed for ease of access to four main types of data:
r-'
• herbs • herb actions • disorders • Chinese syndromes
HERBS The references for each herb listed in the index are divided, where applicable, into two main types: • general topics • herb pairs For example, see Berberis. Important note Herbs are only referred to by their botanical name in the Index. Readers who wish to refer to herbs by their English, Pharmaceutical, or Mandarin names will find these in the cross references in the Appendix.
The 'primary disorder' and 'secondary disorder' categories lists herb pairs or herb combinations that treat a pair of disorders. Using insomnia as an example, the 'primary disorder' category refers to disorder pairs in which insomnia is the primary disorder, such as insomnia + agitation. The 'secondary disorder' category refers to disorder pairs in which insomnia is the secondary disorder, such as depression
+ insomnia. CHINESE SYNDROMES The references for each Chinese syndrome listed in the index are similarly divided, where applicable, into three categories: • general topics • primary syndrome • secondary syndrome The 'primary syndrome' and 'secondary syndrome' categories list herb combinations that treat a pair of Chinese syndromes. Using Liver Hyperactive Yang as an example, the 'primary syndrome' category refers to syndrome pairs in which Liver Hyperactive Yang is the primary disorder, such as Liver Hyperactive Yang + Deficient Blood. The 'secondary syndrome' category refers to syndrome pairs in which Liver Hyperactive Yang is the secondary syndrome, such as Kidney
HERB ACTIONS The references for each action listed in the index are divided, where applicable, into the subtypes of that action. For example, see tonic.
DISORDERS The references for each disorder listed in the index are divided, where applicable, into:
fear + Liver Hyperactive Yang.
899
Index
900 INDEX ABBREVIATIONS: d
= definition
acne. teenage Arctium. 708 Mahonia.708 action category names. 57-58
= table
actions defined, 57 d balancing for effectiveness, 61-66t
A abdominal distension + depression Lavandula. pair, 530 abortifacient Artemisia, 253, 258 abscess Echinacea, topical application, 437 Glycyrrhiza, topical application, 489 Lobelia, 570 Phytolacca,596 abscess, chronic Smilax, 713 absinthe,254 acaricidal Lavandula, 535 Achillea millefolium, 165-181 Native American use, 179 + Angelica archangelica, 169,207 + Artemisia species, 170.246 + Asclepias, 170,265 + Berberis, 278 + Capsella. 170 + Capsicum, 324 + Cinchona, 359 + Commiphora, 390 + Crataegus, 170,414 + Echinacea, 170,429
+ Eupatorium perfoliatum, 169
+ Marrubium, 170 + Mentha piperita, 169 + Pseudostellaria, 170 + Salvia officinalis, 169,671 + Sambucus, 689
basic concepts. 59-60 contraindication situations. 60-61 extending the range of, 87 adaptogen, 67 d Addison's disease Glycyrrhiza,486 administration, 97d adrenergic Cinnamomum, 380 adrenocortical insufficiency Glycyrrhiza, 475, 490 Aesculus hippocastanum about,839 + Hamamelis, 495 agitation insomnia + agitation Valeriana, pair, 784 Agrimonia eupatoria about, 839
+ Artemisia, 246
+ Centaurium,459 + Gentiana, 459 + Hamamelis, 495 Agropyron repens, 839 allergic reaction. See antiallergic alterative defined,67d Biota vs. Thuja, 754 cautionslcontraindications, 154 supportive and moderating actions, 61t tinctures used as, 109 for toxin clearance, 67 alterative, herb as
+ Zanthoxylum, 170. 808
Achillea, 169, 178 Berberis, 275, 277, 294
+ Zingiber, 822 Achillea wilhelmsii, 175 acne Arctium, pair, 224 Calendula, 306 Phytolacca, pair, 590 acne, chronic Arctium, pair, 227
Calendula, 300, 306 Cimicifuga,351 Cinchona, 357 Convallaria, 408 Echinacea, 427, 428,437
Phytolacca. combination, 591 acne. primary disorder acne + Heat Toxin + Phlegm Arctium, pair, 728 acne + infection Echinacea, combination. 431
Filipendula,449 Hydrastis, 277, 294 Myrica, 584 Phytolacca, 589, 596 Rheum, 632 Sambucus, 688,694 Smilax. 708, 713
The Index lists herbs by botanical name only: see the Cross references for alternative names
Index Ruta,654 Ruta, combination, 657 Salvia, pair, 675
Taraxacur.n, 726, 727,735 Thuja, 741, 743, 753 Thymus, 758, 759, 768 Zanthoxylum, 807,816 Althaea officinalis, 183-191 Althaea rosea compared, 191 Filipendula compared, 448 for urinary disorders, 727 Althaea officinalis, pairs
+ Arctostaphylos, 235
+ Centaurium, 459 + Gentiana, 459 + Glycyrrhiza, 185,477 + Hydrastis, 280 + Marrubium, 185 + Ophiopogon, 185 + Polygonum, 185
+ Potentilla, 185
....
-
+ Taraxacum, 727,728
+ Viola tricolor, 185 Althaea rosea about, 183 Althaea officinalis compared, 191 amenorrhea Achillea, 178 Cimicifuga, 352 Cimicifuga, pair, 344 Leonurus, combination, 545 Leonurus, pair,543 Salvia, 668 Thuja,742 Thymus. pair, 761 amenorrhea, primary disorder amenorrhea + anemia Artemisia, pair, 247 Salvia, pair, 672 amenorrhea + catarrhal conditions Hydrastis, pair, 285 Myrica, pair, 581 Thuja, combination, 746 amenorrhea + cold sensation Cinnamomum, combination, 376 Thuja, pair, 748 amenorrhea + convulsions Cimicifuga, combination, 344-345 Ruta, pair, 659 amenorrhea + debility Achillea, pair, 170 amenorrhea + exhaustion Achillea, combination, 172 Ruta, pair, 659 amenorrhea + nervous tension Artemisia, combination, 249 Artemisia, pair, 247
901
amenorrhea + obesity Phytolacca, pair, 590 Thuja, pair, 744 amenorrhea + petit mal epilepsy Cimicifuga, pair, 343 Ruta, pair, 655 analeptic, 67 -68d analgesic anesthetic VS., 68 supportive and moderating actions, 61 t analgesic, herb as Anemone, 195,202 Angelica, 212 Artemisia, 251 Capsicum, 328-329 Cimicifuga,343,347,351 Commiphora, 394, 396 Filipendula, 449, 453 Hamamelis,498 Harpagophytum, 504, 508, 511 Juniperus, 521 Lobelia,558, 564,569 Piscidia, 599, 600, 604 Rheum, 627 Rosmarinus, 649 Ruta,660 Salvia, 676 Sambucus extract, 691 Valeriana, 783,791 Viburnum, 801,802 Zanthoxylum, 813 analgesic, local (topical) Capsicum, 321, 322, 335 analgesic anodynes, 68d analgesic anti-inflammatory, 68d analgesic demulcent Rheum,633 anemia. See also antianemic Artemisia, pair, 247 Centaurium,468 Gentiana, 468 anemia, primary disorder anemia + exhaustion Centaurium, pair, 458 Gentiana, pair, 458 anemia + weight loss Centaurium, pair, 458 Gentiana, pair, 458 anemia, secondary disorder amenorrhea + anemia Artemisia, pair, 247 Salvia, pair, 672
The Index lists herbs by botanical name only: see the Cross references for alternative names
fda
902
..... :;:.:-.=.~~.-=~: .. ~~~..-.
Index
arthritis + anemia Filipendula, pair, 449 digestive weakness + anemia Centaurium, combination, 460 Gentiana, combination, 460 exhaustion + anemia Rosmarinus, pair, 639 headache + anemia Artemisia, combination, 248 Salvia, combination, 673-674 menorrhagia + anemia Capsella, combination, 312 Myrica, pair, 581 palpitations + anemia Salvia, pair, 675 Anemone pulsatilla, 193-204 cautions!contraindications, 148 Pulsatilla chinensis compared, 201-202,203 Anemone pulsatilla, pairs + Convallaria, 195-196 + Crataegus, 195 + Glycyrrhiza, 196 + Hypericum, 196 + Lavandula, 196,530 + Leonurus, 196 + Lobelia, 196 + Mentha pulegium, 196 +Passiflora,196 + Piscidia, 601 + Ruta, 196, 654 + Salvia officinalis, 671 + Valeriana, 196, 784 + Zingiber, 196 anesthetic analgesic vs., 68 Lavandula, 535 Angelica archangelica, 205-218 cautions!contraindications, 140 as expectorant, 760 Angelica archangelica, pairs + Achillea, 169, 207 + Juniperus, 516 + Lobelia, 558 + Myrica, 576 + Phytolacca, 208,589 + Rosmarinus, 208 + Thuja, 208 + Zanthoxylum, 208, 808 + Zingiber, 208 Angelica dahurica about, 205 cautions!contraindications, 140 Angelica pubescens, 214t, 217
.. . . _... _.~-~'
-~~:.:;:, ~
.
Angelica sinensis about,205 acrid properties, 217 herb-drug interaction example, 133 organs and channels, 218 reproductive system carcinoma and, 147 warfarin with, 143 Angelica s"inensis, pairs + Artemisia, 247 + Centaurium, 458 + Cinnamomum (twigs), 375 + Gentiana, 458 + Rosmarinus, 639 + Salvia, 672 Angelica species comparison, 214t, 217 ~;'
anger anger + restlessness Berberis, pair, 278 hypertension + anger "Taraxacum, pair, 728 angina pectoris. See also antianginal Cinnamomum, combination, 377 Cinnamomum, pair, 375 Commiphora, pair, 390 Convallaria, pair, 402 Crataegus, combination, 415-416 Crataegus, pair, 414 Leonurus, pair, 543 Lobelia, combination, 560 Lobelia, pair, 558 angina pectoris, primary disorder angina pectoris + circulation, poor peripheral Zanthoxylum, pair, 808 angina pectoris + cold sensation Capsicum, combination, 326 Convallaria, combination, 403 Lobelia, pair, 562 Zanthoxylum, combination, 809 angina pectoris, secondary disorder cardiac weakness + angina Capsicum, pair, 323 anogenital problems Hamamelis, 498 anorexia Rosmarinus, 637 appetite lacking + anorexia Artemisia, combination, 248 Centaurium, combination, 460 Gentiana, combination, 460 Glycyrrhiza, pair, 481 antacid, 68d. See also antiulcer antiabortive. See also miscarriage defined, 68d Artemisia, 258
The Index lists herbs by botanical name only: see the Cross references for alternative names
Index antiallergic Artemisia, 252 Capsella, 314 Cinnamomum,380 Echinacea,428 Rheum, 627 Salvia, 677 Sambucus, 688 Taraxacum, 732 Thymus, 765 Zingiber, 828 antiamnesiac Berberis, 288 antiandrogen Myrica, 581 antianemic. See also anemia Angelica, 213 antianginal. See also angina pectoris defined,68d Capsicum, 322, 334 Cinnamomum, 374, 383-384 Commiphora,393 Convallaria, 400, 401, 408 Crataegus, 412, 414, 420, 422 Leonurus, 542, 550 Lobelia, 569 antiarrhythmic defined, 68d Angelica, 212-213 Cinchona, 358, 364,369 Crataegus,420 tIarpagophytum,509 Sarothamnus,701 antiarthritic. See also arthritis defined,68-69d supportive and moderating actions, 62t Cinnamomum, 374, 382, 383 Filipendula, 453 tIarpagophytum, 509 Smilax, 713 Tanacetum, 719 antiasthmatic. See also asthma defined,69d Angelica, 212, 216 Artemisia, 252 Cimicifuga,351 Lobelia, 557 Thuja,750 Thymus, 760 antiatherogenic Angelica, 213 antiatheromatic. See also antilipidemic defined, 69d Crataegus, 412, 414, 420, 422
Glycyrrhiza, 483 Sambucus, 691, 692 antiatherotic Salvia, 678 antibacterial. See also antimicrobial Achillea, 175 Anemone, 202 Anemone pulsatilla, 200 Berberis, 286-287 Cimicifuga, 347 Cinnamomum,379 Phytolacca, 593 Pulsatilla chinensis, 200 Rheum, 627 Smilax,711 Taraxacum, 732 Thymus,765 Zanthoxylum, 813 Zingiber,827 antibiotic. See antimicrobial antibiotic drug interaction, 732 antibronchitic. See also bronchitis Angelica, 212 anticarcinoma. See also antimutagenic; antitumor Pulsatilla chinensis, 200 anticatarrhal. See also catarrh; phlegm defined, 69d Biota vs. Thuja, 754 ~pportive and moderating actions, 62t diaphoretic + anticatarrhal Achillea, 167 anticatarrhal, herb as Achillea, 167, 169, 177-178, 179 Anemone, 203 Angelica, 216 Arctostaphylos, 234 Asclepias, 265, 270 Berberis, 277, 293 Commiphora, 389, 396, 397 Echinacea, 428, 437 Euphrasia, 440, 445 tIydrastis, 275, 277,293,294 Juniperus, 514, 525 Myrica, 576, 584 Phytolacca, 589, 596 Ruta, 663 Sambucus, 688, 694 Tanacetum,723 Thuja, 741, 742, 752 Thymus, 758, 760, 768 Zanthoxylum,806,807,816 anticholesterol Cinnamomum, 379 Rheum, 628 Zingiber, 829
The Index lists herbs by botanical name only: see the Cross references for alternative names
903
904
..._._ .. :..=-;.:;;~;i..':.;.:.:.
Index
anticlotting. See also blood clotting regulator Cinnamomum, 380 anticoagulant. See also blood clotting regulator adverse reactions, avoiding, 143 Angelica, 213 Artemisia, 252 Capsicum, 329-330 Filipendula, 451 Leonurus, 547 Thuja, 750 anticonvulsant. See also convulsions defined,69-70d Artemisia, 246, 257 Cimicifuga, 343, 347, 351 Cinnamomum, 380 Convallaria,408 Lavandula, 529,535, 537 Lobelia, 569 Rosmarinus,645 Ruta, 654, 663 Valeriana, 784, 789, 791 antidepressant. See also stimulants defined, 80-81 supportive and moderating actions, 62t antidepressant, herb as Capsicum, 322, 333 Centaurium,468 Crataegus, 414 Gentiana, 468 Lavandula,528,529,537 Leonurus, 549 Lobelia, 563 Rosmarinus, 639, 648 Salvia, 670 Tanacetum, 723 Thymus, 760, 769 Turnera, 773, 779 Valeriana, 792 antidiabetic Achillea, 179 Arctium,228 Arctostaphylos, 239, 242 Artemisia, 251 Berberis, 288 Hydrastis, 289, 292 Taraxacum, 732 Tumera,779 antidiarrheal. See also diarrhea Berberis, 278, 287-288,293 Cimicifuga,347 Cinnamomum, 374, 382, 383 Hydrastis, 278, 293-294 Potentilla, 613 Flheum, 622,628, 632
Ruta,663 Zingiber, 829, 833 antidiarrheal, specific to absorptive Berberis, 287 anti-inflammatory Berberis,287 antimicrobial Berberis, 287 antisecretory Berberis, 287 antispasmodic Berberis, 287 antidote. See also antitoxin Artemisia, 257 Glycyrrhiza, 489 Ruta,664 antiemetic defined, 70d Centaurium, 468, 469 Cinnamomum, 374, 382, 383 Gentiana lutea, 469 Gentiana macrophylla, 468, 469 Gentiana scabra, 469 Hydrastis, 295 Lobelia, 556, 570 Zingiber, 821,828-829,833 antifertility. See also infertility Artemisia, 252, 253 Ruta,660 antifungal. See also antimicrobial; fungal infection Achillea, 175 Anemone pulsatilla, 200 Asclepias, 268 Berberis, 287 Calendula, 304 Cinnamomum,379 Echinacea, 433 Glycyrrhiza,482 Phytolacca, 593, 597 Pulsatilla chinensis, 200 Flheum,627 Thymus, 765 Zanthoxylum, 813 Zingiber,827 antigalactagogue, 70d antihelminthic. See also vermifuges defined,70d Artemisia, 251 antihemorrhagic. See also astringent Achillea, 178, 179 Berberis, 278, 294 Biota vs. Thuja, 754 Calendula, 306
The Index lists herbs by botankal name only: see the Cross references for alternative names
-
...
I '
Index
-f ~
I
t.""
c, L
c: I
L
Capsella, 310, 314, 316, 317 Capsicum, 330, 335 Hydrastis, 275, 278, 294 Myrica, 576, 584 Potentilla, 613 Rheum, 628, 632 Salvia, 670, 682 Smilax, 712 Thuja, 743, 753 Viburnum,797,803 antihemorrhagic, specific to diarrhealdysentery Achillea, 178 hemoptysis Achillea, 178 internal bleeding Capsicum, 335 ulcers Achillea, 178 uterus Sarothamnus,705 antihepatitis. See also antiviral Glycyrrhiza, 482 anti-HIV. See also antiviral Calendula, 304 Capsella, 314 Chrysanthemum, 720 Glycyrrhiza, 482, 483 Potentilla,613 antihyaluronidase, 434 antihyperglycemic Cimicifuga, 347 Commiphora, 393 Turnera, 777 antihyperhidrotic. See also sweating Salvia, 677, 682 antihyperlipidemic. See antilipidemic antihypertensive. See also blood pressure defined,70d supportive and moderating actions, 62t antihypertensive, herb as Achillea, 167,169,175,178,179 Angelica, 213 Berberis, 288 Capsicum, 322, 334 Chrysanthemum, 720 Crataegus, 414, 420, 422 Leonurus, 542, 547,550 Lobelia, 558, 569 Rheum, 622, 628 Ruta, 660 Salvia, 677,678 Taraxacum,727,735 Valeriana, 784, 792
905
antihypotensive Capsicum, 322 Sarothamnus,701 anti-inflammatory defined, 70-71d supportive and moderating actions, 63t anti-inflammatory, herb as Achillea, 175 Althaea, 188 Angelica, 212 Arctium, 228 Arctostaphylos, 234, 238 Artemisia, 251,252 Berberis, 287 Calendula, 300, 304 Capsella, 310,314,316,317 Centaurium, 456-457, 463, 464 Chrysanthemum, 720 Cimicifuga, 347, 351 Commiphora, 393, 397 Crataegus,"420 Echinacea, 428,433-434, 437 Euphrasia, 440, 443-444, 445 Filipendula, 448,451,495 Gentiana,456-457,463,464 Glycyrrhiza,482 Hamamelis,495,498,500 HarpagophytuIn,504,508,511 Hydrangea,495 . Hydrastis,276,289 Juniperus, 521,524 Lavandula, 535 Lobelia, 564 Phyto~cca,495,593
Piscidia, 605 Rheum, 627 Rosmarinus, 645 Ruta, 659, 663 Salvia, 676 Sambucus, 688, 694 Sambucus extract, 691 Smilax, 711,713 Tanacenun,716,719,723 Taraxacum, 731, 732 Thymus, 765 Turnera,777 Viburnum, 801 Zanthoxylum, 813 Zingiber, 821, 828 anti-inflammatory, gastrointestinal Arctium, 231 Berberis, 293 Calendula, 304, 306 Centaurium,468,469
The Index lists herbs by botanical name only: see the Cross references for alternative names
Index
906
antilithic defined,71d Arctostaphylos, 241 antimalarial Artemisia, 251. 252, 256
Filipendula.453 Gentiana. 468. 469 Glycyrrhiza,488 Hydrastis, 293 Rheum, 622. 632 Ruta,663 Taraxacum, 727, 732,735 anti-inflammatory, respiratory Arctium,231 Rheum, 633 anti-inflammatory, specific to anogenital problems Hamamelis, 498 hepatobiliary Taraxacum, 727
Berberis, 287 Cinchona, 358, 364, 368
internal Glycyrrhiza,482 migraine Tanacetum,717 skin disorder Hamamelis, 498 topical Glycyrrhiza,482 anti-inflammatory, urinary Arctostaphylos, 239. 241 Filipendula,453 Glycyrrhiza,488 Juniperus, 515 Rheum, 633 Taraxacum, pair, 727 anti-inflammatory, urogenital Berberis, pair, 278 Turnera,779 anti-inflammatory analgesic, 68d anti-inflammatory demulcent Althaea, 184 Althaea, pair, 185 Glycyrrhiza,476 anti-ischemic. See also vasoconstrictor; vasodilator Sambucus, 692 antilactation. See also lactation Zanthoxylum, 813 antilipemic Artemisia, 252 Salvia, 678 antilipidemic. See also antiatheromatic defined,71d Achillea, 167, 175 Calendula, 304 Commiphora. 393. 396 Crataegus,420 Glycyrrhiza, 483 Tanacetum, 720
antirne1anin Arctostaphylos, 239 Myrica, 581 antimicrobial. See also antibacterial; antifungal; antiprotozoal; antiviral defined,71d warming, 321 antimicrobial + circulatory stimulant Cinchona, 368 antimicrobial, herb as Anemone, 202 Angelica, 212 Arctium,228 Arctostaphylos, 234, 238 . Artemisia, 251, 252 Berberis, 294 Calendula, 303-304, 306 Capsella. 314, 316 Capsicum, 321, 322, 329, 334 Centaurium, 463, 464 Chrysanthemum, 720 Cinchona, 357, 358, 364, 368 Cinnamornum, 379, 382, 383 Comrniphora, 393, 396, 397 Echinacea, 427, 428, 433, 437 Euphrasia.443 Filipendula, combination, 451 Gentiana, 463, 464 Glycyrrhiza, 482 Hamamelis, 498 Hydrastis, 276, 286, 294 Juniperus, 521, 524 Lavandula.535 Myrica, 581 Potentilla,613 Rheum, 627 Rosmarinus, 645, 649 Ruta,659 Salvia, 670, 676, 677.682 Tanacetum,719 Taraxacum. 732 Thuja, 749, 753 Thymus. 758,759.765,768 Zanthoxylum, 813 antimicrobial, urinary Arctostaphylos, 239, 241 Juniperus. 515
The Index lists herbs by botanical name only: see the Cross references for alternative names
Index
L ,
I~
i
k~
,. !
antimigraine. See also migraine; headache defined,71d Tanacetum, 719. 723 antimucosecretory Commiphora,394 antimutagenic. See also cancer therapy adjunct Anemone pulsatilla, 200 Angelica, 213 Arctium, 228 Calendula, 304 Cinnamomum.380 Commiphora, 394 Glycyrrhiza,484 Hamamelis, 498 Phytolacca, 594 Potentilla, 613 Pulsatilla chinensis, 200 Smilax, 712 Thymus,765 Zingiber, 830 antimutagenic, specific to breast cancer Glycyrrhiza,484 endometrial cancer Glycyrrhiza, 484 antineoplastic. See antitumor antiosteoporotic. See also bone protective effects Sambucus,691,692 antioxidant defined, 71-72d, 78d Arctium, 228 CapseIla, 314 Centaurium,464 Cinnamomum, 380 Crataegus, 420 Echinacea,434 Gentiana, 464 Glycyrrhiza, 484 Hamamelis, 498 Lavandula,535 Myrica, 581 Potentilla, 613 Rheum,628 Rosmarinus,645 Salvia,678 Sambucus, 691, 692 Thymus, 765 Zingiber, 830 antiparasitic defined, 72d Cinnamomum,379 Hydrastis, 289 Lavandula, 538 Phytolacca, 597
907
Zanthoxylum, 813, 817 Zingiber,827 antiperiodics. See antipyretic antiplatelet. See also antithrombotic Arctium, 228 Rheum,628 Zanthoxylum, 813 Zingiber, 829 antiprotozoal. See also antimicrobial Berberis, 287 Calendula, 304 Glycyrrhiza,482 Pulsatilla chinensis, 200 Rheum, 627 Zanthoxylum, 813 antipyretic defined, 72d, 76d diaphoretic + antipyretic Achillea, 167 normalizing action on temperature Lobelia, 569 antipyretic, herb as Achillea,168,177,179 Anemone pulsatilla, 200 Artemisia, 246, 251, 252, 256 Asclepias, 265, 270 Berberis,275, 277, 287, 294 Capsicum, 334 Centaurium, 463, 467,469 Chrysanthemum, 720 Cimicifuga, 347,351 Cinchona, 356, 357,358,364,368-369 Cinnamomum,379 Commiphora, 393 Echinacea,428,437 Filipendula, 448 Gentiana, 463, 467,469 Gentiana macrophyIla, 469 Gentiana scabra, 469 Hydrast~,277,294
Leonurus,551 Lobelia, 557, 569 Piscidia, 605 PotentiIla, 617 Rheum, 633 Ruta,654. 660, 663 Salvia, 670, 676 Sambucus, 688, 694 Tanacetum, 723 Taraxacum, 735 Zingiber, 821,827 antirheumatic. See also rheumat~m Angelica, 216 Biota vs. Thuja, 754
The Index lists herbs by botanical name only: see the Cross references for alternative names
Index
908
:~.
Capsicum, 322, 334-335 Centaurium, 469 Cimicifuga, 342, 351 Gentiana macrophylla, 469 Gentiana scabra, 469 Juniperus. 525 Lavandula. 538 Rheum,632 Smilax, 713 Thuja. 741. 753 Zanthoxylum, 807.816 Zingiber. 821, 828, 833 antiseptic. See antimicrobial anti_smoking effect Lobelia, 563 antispasmodic. See also muscle cramps; muscle spasms defined,72-73d supportive and moderating actions. 63t ovarian pain. 352 antispasmodic. herb as Achillea. 175 Anemone, 195,200.202 Angelica. 207.212 Artemisia, 251 252 Asclepias, 265, 270 Berberis, 287 Capsicum. 334 Centaurium, 464 Cimicifuga, 343. 347, 351 Cinchona, 364, 369 Cinnamomum,374,382 Commiphora.394 Euphrasia,444 Gentiana,464 Glycyrrhiza, 476, 483, 488, 489 Juniperus. 515 Lavandula.528.529,535 Leonurus, 547. 550 Lobelia, 558, 569 Piscidia, 600, 605 Rosmarinus, 639, 645, 648 Ruta. 660. 663 Salvia, 677, 682 Tanacetum, 719 Thuja,750 Thymus, 760, 765, 768 Valeriana, 783, 789, 791 Viburnum.797,801, 802 Zanthoxylum,806,807,813,815,816 Zingiber, 828, 833 antispasmodic, bronchial Anemone, 202 Asclepias. 270 Lobelia, 569 p
antispasmodic, intestinal Juniperus, 525 antispasmodic, uterine Cimicifuga.352 Lobelia, 570 Vlburnum. 802. 803 antispasmodic emmenagogue. See also emmenagogue defined. 77d Artemisia, 258 Leonurus. 542. 550 antispermatogenic Achillea. 175 antithrombotic. See also thrombosis defined,72-73d Achillea, 167, 178 Commiphora, 393 Salvia,678 antitoxin. See also antidote Angelica. 216 Calendula, 306 Capsella, 314 Glycyrrhiza, 483 Lobelia, 570 Zingiber, 828, 832 antitoxin, antivenom Lobelia, 564 antitumor. See also cancer therapy adjunct defined,73d Biota vs. Thuja, 754 antitumor, herb as Achillea, 175 Angelica, 213 Arctium, 228 Calendula, 304 Capsella, 314 Capsicum, 330 Centaurium,464 Crataegus, 420 Echinacea, 434 Euphrasia,444 Filipendula, 451 Gentiana,464 Glycyrrhiza, 484 Myrica,582 Potentilla, 613 Rosmarinus, 645 Ruta,660 Salvia, 677,678 Sambucus, 692 Tanacetum, 720 Taraxacum, 732 Thuja, 743, 753 Zanthoxylum, 813 Zingiber, 830
The Index lists herbs by botanical name only: see the Cross references for alternative names
. ...
---
Index antitumor, specific to breast cancer Cimicifuga.349 Glycyrrhiza,484 Tanacetum,720 colon cancer Berberis. 288 endometrial cancer Glycyrrhiza, 484 esophageal cancer Berberis, 288 gastric adenocarcinoma Angelica, 213 antitussive defined,73d anticatarrhals vs., 69 Biota vs. Thuja, 754 supportive and moderating actions, 63t antitussive, herb as Althaea, 184, 188, 190 Arctostaphylos, 239 Cimicifuga,351 Cinnamomum, 382, 383 Glycyrrhiza, 476, 483
~
.
.. I
Juniperus, 525 Lobelia, 558, 569 Phytolacca,593 Piscidia,605 Thuja, 750, 752 Thymus, 760, 768 Zingiber, 828 antiulcer. See also antacid, ulcer defined,73d Cinnamomum,379 Commiphora,393 Filipendula,451 Glycyrrhiza,483 Potentilla, 613 Rheum, 622, 627 Tara."'l:acum.732 Thuja,749 Turnera,777 Valeriana, 784. 792 Zingiber, 828 antivenom. See also antitoxin Lobelia, 564 antiviral. See also antihepatitis; anti-HIV; antimicrobial Calendula, 303 Cimicifuga, 347 Echinacea, 433 Glycyrrhiza,482 Phytolacca.593 Rheum, 627 Sambucus extract, 691
Taraxacum, 732 Thuja,753 Viburnum, 801 Zingiber,827 anxiety Lavandula, pair, 530 Leonurus, 541 Leonurus, combination, 544 Leonurus, pair, 543 anxiety, primary disorder anxiety + depression Anemone, pair, 196 Lavandula, combination. 533 Valeriana, pair, 784 anxiety + fearfulness Anemone, pair, 196 anxiety, secondary disorder asthma + anxiety Lavandula, 528 Lavandula, combination, 532 Lobelia, pair, 562 colic, intestinal + anxiety Juniperus, combination. 519 Lobelia, combination. 561 depression + anxiety,528 headache + anxiety Anemone, combination, 197 Lavandula, combination, 532 Zingiber, combination, 825 menstrual disorders + anxiety Lavandula, pair, 534 Leonurus, 541 Leonurus, combination, 545 Leonurus, pair, 543 Ruta, pair, 659 palpitations + anxiety Convallaria, combination, 403 Lavandula, combination, 531 Valeriana, combination, 785 postnatal pain + anxiety Leonurus, combination, 545-546 anxiolytic. See tranquilizer aperient. See laxatives aphrodisiac. See also sexual tonic; stimulant, sexual defined,73d Zingiber, 833 appetite changes Capsicum, 329 appetite lacking bitter herbs in treating, 32,74 Juniperus, 521, 525 Rosmarinus,637 appetite lacking, primary disorder appetite lacking + anorexia Artemisia, combination, 248
The Index lists herbs by botanical name only: see the Cross references for alternative names
909
Index
910 Centaurium, combination, 460 Gentiana, combination, 460 Glycyrrhiza, pair, 481 appetite lacking + digestive weakness Centaurium, pair, 458 Gentiana, pair, 458 arbutin metabolism Arctostaphylos, 239 Arctium lappa, 221-232 as alterative, 708 + Baptisia, 224 + Ephedra, 223 + Filipendula,449 + Harpagophytum, 223 + Iris, 224 + Mahonia,223 + Phytolacca, 224, 590, 728 + Rheum, 224, 623 + Scrophularia,224 + Smilax, 224, 709 + Taraxacum, 224, 728 + Thuja, 744 + Urtica,223 + Viola, 224 Arctium lappa seeds Chinese use of,231 + Ephedra, 223 Arctostaphylos uva-ursi, 233-242 + Althaea, 235 + Echinacea, 235, 427,429 + Hydrastis, 235, 280 + Juniperus, 235, 516 + Rumex, 235 + Taraxacum, 727, 729 + Thuja, 235, 743, 744 + Thymus, 761 aristolochic acid (AA), 144 Aristotle, 11 aromatherapy, infusions in, 105 aromatic digestives. See carminative aromatic herb, 49d Ar-Rhazi,12-13 arrhythmia, cardiac. See also antiarrhythmic adverse reactions, avoiding, 143 Convallaria, pair, 402 Glycyrrhiza,475 Sarothamnus, 704 arrhythmia, cardiac, primary disorder arrhythmia + emotional lability Sarothamnus, pair, 699 arrhythmia + exhaustion Crataegus, combination, 416 arrhythmia + fever, recurring Cinchona, combination, 362
arrhythmia + hypotension Convallaria, combination, 403 Cnitaegus, combination, 417 Glycyrrhiza, combination, 478 Sarothamnus,704 Sarothamnus, combination, 700 arrhythmia + restlessness Convallaria, combination, 403 Salvia, pair, 675 arrhythmia + weakness Cinchona, pair, 359 arrhythmia, cardiac, secondary disorder cardiac weakness + arrhythmia Sarothamnus, pair, 699 Artemisia abrotanum about,243 aserrunenagogue, 169 Artemisia absinthium absinthe, 254 essential oil, 253-254 history of use, 243 Artemisia absinthium, pairs + Berberis, 279 + Centaurium,459 + Gentiana, 459 + Ruta,655 + Tanacetum, 716, 717 Artemisia apiacea, 259 Artemisia argyi, 259 Artemisia capillaris, 259 Artemisia species, 243-261 + Achillea, 170, 246 + Agrimonia, 246 + Angelica sinensis, 247 + Berberis, 247 + Cimicifuga, 247 + Cinchona, 246 + Gentiana, 247 + Lavandula, 247 + Ophiopogon, 247 + Rosmarinus, 247, 640 + Ruta,247 + Salvia officinalis, 247 Artemisia species comparison, 259 Artemisia vulgaris, 243, 251 arthritis. See also antiarthritic cold as cause of Cinnamomum, pair, 375 Filipendula, pair, 449 Zanthoxylum, pair, 809 arthritis, chronic Smilax, pair, 709 arthritis, chronic + cystitis Harpagophytum, pair, 505
The Index lists herbs by botanical name only: see the Cross references for alternative names
Index
\. arthritis, chronic + heat sensation Arctium, pair, 223 arthritis, primary disorder arthritis + anemia Filipendula, pair, 449 arthritis + bronchitis, chronic Zanthoxylum, pair, 808 arthritis + circulation, poor peripheral Achillea, pair, 170 Thuja, pair, 744 arthritis + cold extremities Harpagophytum, combination, 507 Harpagophytum, pair, 505 Thuja, combination, 749t Zanthoxylum, combination, 810 Zingiber, combination, 824 arthritis + cold extremities + exhaustion Cinnamomum, combination, 376-377 arthritis + cold sensation Angelica, combination, 209 Angelica, pair, 208 Phytolacca, pair, 590 arthritis + exhaustion Filipendula, combination, 450 Harpagophytum, combination, 506 arthritis + feverishness Harpagophytum, pair, 505 arthritis + gastritis Harpagophytum, pair, 505 arthritis + heat sensation Arctium, combination, 226 Berberis, combination, 282 Berberis, pair, 279 Glycyrrhiza, combination, 479 Harpagophytum, combination, 506 arthritis + irritability Harpagophytum, pair, 505 arthritis + psoriasis Arctium, pair, 227 Harpagophytum, combination, 506 Smilax, combination, 710 Thuja, pair, 744 arthritis, secondary disorder cystitis + arthritis Arctostaphylos, pair, 235 arthritis, rheumatoid Cimicifuga, pair, 344 Glycyrrhiza, pair, 477 rheumatoid arthritis + psoriasis Harpagophytum, pair, 505 Asclepias curassavica, 263 Asclepias species comparison, 270 Asclepias tuberosa, 263-271 normalizing effect of, 555
Asclepias tuberosa, pairs + Achillea, 170,265 + Berberis, 278 + Capsicum, 265 + Echinacea, 265,427, 429 + Lobelia, 265, 558 + Prunus, 265 + Zingiber, 265,822 asthenic, 847 d asthma. See also antiasthmatic Echinacea,435 Lobelia, pair, 558 Viburnum, pair, 797 asthma, acute Glycyrrhiza, pair, 481 Lobelia, combination, 560 Lobelia emetic for, 570 asthma, allergic Glycyrrhiza, pair, 477 asthma, cardiac cardiac weakness + cardiac asthma Convallaria, 408 asthma, primary disorder asthma, aggravated by cold Cinnamomum, pair, 374 asthma + anxiety Lavandula, 528 Lavandula, combination. 532 Lobelia, pair. 562 asthma + bronchitis Capsicum, pair, 323 asthma + nervous tension Anemone, pair. 196 Valeriana, pair, 785 asthma, secondary disorder bronchitis + asthma Zingiber, pair, 822 Astragalus species about,839 cautionslcontraindications, 142 + Capsella, 311 + Echinacea,430 astringency, 35-38 astringent. See also antihemorrhagic, hemostatic defined, 73-74d Biota vs. Thuja, 754 supportive and moderating actions, 63t astringent, herb as Achillea, 169, 175, 178. 179 Arctostaphylos, 234 Berberis, 293-294 Calendula, 300 Capsel1a, 310, 316, 317 Commiphora, 394, 396-397
The Index lists herbs by botanical name only: see the Cross references for alternmive names
911
Index
912 Crataegus.422 Equisetum, 495 Euphrasia, 440, 445, 495 Filipendula, 448 Hamamelis. 500 Hydrastis. 294 Myrica, 575-576. 584 Potentilla. 608. 613, 616 S~via,495,670,682
Thuja, 743, 753 Thymus, 760 Viburnum, 797, 803 astringent. anticatarrhal Hydrastis, 294 astringent, antihemorrhagic Hydrastis, 294 astringent, internal Hamamelis, 494 Potentilla, 609, 616 astringent, local Potentilla, 608 astringent, specific to diarrhealdysentery Achillea, 178 Hydrastis, 294 fem~e reproductive system Hamamelis, 500 gastrointestin~ system Filipendula,453 Hamamelis, 494-495 hemoptysis Achillea, 178 KidneyQi Juniperus, 524 ulcers Achillea, 178 urinary Arctostaphylos, 241 wound healing Achillea,178 astringent, topical Potentilla, 608, 616 atheroma. See antiatheromatic atherosclerosis Crataegus, pair, 414 atherosclerosis, primary disorder atherosclerosis + hypertension Commiphora, combination, 391 Crataegus, combination, 416 atherosclerosis + hypertension + cold extremities Achillea, combination, 173 atherosclerosis + thrombosis Commiphora, pair, 390 atonic, 847d
atonic mucus membranes, tonic for, 440 atony, digestive constipation + digestive atony Rheum, pair, 622 Australia, regulations and legislation in, 135 autoimmune disorders Echinacea, 434, 435 Avena sativa about,839 + Crataegus,415 + Lavandula, 530 + Turnera,773 Avicenna,13
...
B b~ancing actions table, 61-66t
Ballota nigra, 839 Baptisia tinctoria about, 839 cautions!contraindications, 141 Baptisia tinctoria, pairs + Arctium, 224 + C~endula, 301 + Capsicum, 325 + Commiphora, 390, 391 + Echinacea, 427,429 +Phytolacca,590 + S~via,671 + Thymus, 759 basic concepts, 59-60 Berberis aquifolium. See Mahonia aquifolium Berberis vulgaris, 273-298 Coptis compared, 296 Filipendula compared, 449 Hydrastis compared, 288, 295-296 Phellodendrom compared, 296 Berberis vulgaris, pairs + Achillea, 278 + Artemisia absinthium, 279 + Artemisia species, 247 + Asclepias, 278 + Capsicum, 279 + Cinchona, 278, 359 + Harpagophytum, 279,505 + Hydrastis, 278 + Iris, 279 + Potentilla, 609 + Rheum, 279, 623 + Rosmarinus, 279, 639 + Taraxacum, 278, 728 + Valeriana, 785 + Zingiber, 279 BHP (British Herbal Pharmacopoeia), 8, 16
The Index lists herbs by botanical name only: see the Cross references for alternative names
-~
..
Index bile secretion, stimulating. See cholagogue bioavailability enhancer Zingiber, 828 Biota orientalis Chinese use of, 739 Thuja compared, 750, 754 toxicology, 750 bipolar disorders Crataegus, combination, 417 Crataegus, pair, 415 Glycyrrhiza, 475 Glycyrrhiza, pair, 477,480 Lavandula, 528 Leonurus, 541 Leonurus, pair, 543 bitter digestive. See tonic, bitter digestive
f'¥ ,-
bitters, 74d, 112 Bladder Damp Heat Arctostaphylos, combination, 236 Echinacea, combination, 431 Hydrastis, combination, 284 Bladder Damp Heat + Bleeding from Heat Arctostaphylos, combination, 236 Retained Pathogen + Bladder Damp Heat Juniperus, combination, 517 Bladder Heat Bladder Heat + Kidney Deficient Y"m Althaea, combination, 187 Arctostaphylos, combination, 236-237 Bladder Phlegm Cold Bladder Phlegm Cold + Kidney Deficient Qi Thuja, combination, 745 Turnera, combination, 776 Stagnant Qi and Blood + Bladder Phlegm Cold Zanthoxylum, combination, 810-811 bleeding. See also wounds; antihemorrhagic internal Capsicum, 335 during pregnancy Capsella, pair, 311 postnatal Viburnum, combination, 798 Viburnum, pair, 797 to reduce Myrica, 574 uterine, abnormal Hydrastis. pair, 280 Bleeding from Heat Capsella,312 Hydrastis, combination, 284 Bladder Damp Heat + Bleeding from Heat Arctostaphylos, combination, 236 Stomach Heat + Bleeding from Heat Calendula, combination, 302
Blood, tonify Salvia, 668 blood cleanser. See alterative blood clot prevention. See antithrombotic blood clotting regulator. See also anticlotting; anticoagulant Berberis, 288 Hydrastis, 289 blood coagulation. See anticoagulant; antihemorrhagic Blood Heat + Heat Toxin Taraxacum, combination, 729 blood pressure, labile Crataegus, pair, 415 blood pressure regulator. See also antihypertensive Zingiber, 829 blood purifiers. See alterative body resistance, enhancing. See also immunostimulatory Echinacea, 437 body temperature cold + poor peripheral circulation Zanthoxylum, pair, 808 low Myrica, pair, 576 body temperature fluctuating debility + body temperature fluctuating Cinchona, pair, 359 boils. See also skin disorder Arctium, pair, 224 Lobelia, 570 Phytolacca, 596 Sambucus, 694 Smilax, pair, 709 Zingtber,833 boils, primary disorder boils + infection Arctium, pair, 224, 227 Echinacea, combination, 431 Echinacea, pair, 427,429 Rheum, pair, 626 bone protective effects. See also antiosteoporotic Cimicifuga, 348 bowel function normalization Rheum, 620-621, 622 Rheum, pair, 623 BP (British Pharmacopoeia), 847d BPC (British Pharmaceutical Codex), 847d breast cancer Cimicifuga, 349 Glycyrrhiza, 484 Tanacetum, 720 bronchitis. See also antibronchitic Hydrastis, pair, 279 Zingiber, pair, 823 bronchitis, acute bronchitis, acute + fever Berberis, pair, 278
The Index lists herbs by botanical name only: see the Cross references for alternative names
913
Index
914 bronchitis, acute+ infection Asclepias, pair, 265 bronchitis. acute + painful cough Asclepias, pair, 265 bronchitis, acute + sinus congestion Asclepias, pair, 265 cough, painful + acute bronchitis Asclepias, pair, 265 bronchitis, chronic Hydrastis, pair, 280 arthritis + bronchitis, chronic Zanthoxylum, pair, 808 bronchitis, chronic + cardiac weakness Capsicum, combination, 327 Lobelia, pair, 562 Thuja, combination, 745 bronchitis, chronic + cold sensation Angelica, pair, 208 Commiphora, combination, 392 'Zingiber, combination, 824 bronchitis, chronic + laryngitis Commiphora, pair, 391 bronchitis, chronic + digestive weakness Commiphora, pair, 391 bronchitis, primary disorder bronchitis + asthma Zingiber, pair, 822 bronchitis + cardiac weakness Thuja, 741 bronchitis + expectoration, difficult Thuja, pair, 743 bronchitis + heat sensation Asclepias, combination, 267 Berberis, combination, 281 Lobelia, pair, 562 bronchitis + sinusitis Phytolacca, pair, 593 Thymus, combination, 762 bronchitis. secondary disorder asthma + bronchitis Capsicum, pair, 323 depression + bronchitis Capsicum, combination. 326 Thuja, pair, 748 influenza + bronchitis Thymus, pair, 760 sinusitis + bronchitis Euphrasia, pair, 441 Phytolacca, pair, 589 bronchodilatory Lobelia, 563 broomrape (orobanche).697 bruises Calendula, topical application, 306
Hamamelis, topical application, 494 Lobelia, topical application. 570 Potentilla, pair, topical application, 608 Buplerum.637 burns/scalds. See also sunburn Calendula, topical application. 300, 306 Potentilla. pair, topical application, 608 Sambucus, 694
c calcium ion channel antagonist Lobelia, 563 calcium regulator Rheum,628 Calendula officinalis, 299-308 Potentilla compared, 608 + Baptisia, 301 + Commiphora, 301, 390, 391 + Euphrasia,441 + Geranium, 301 + Hamamelis. 301,494,495 ,+ Hydrastis. 301 + Syrnphytum, 301 + Thuja, 744 calm and tonify Heart Spirit Salvia. 670 calm Heart Spirit Disturbance Anemone, 194 Lavandula, 537 Rosmarinus. 648 Ruta,663 Salvia, 681 Viburnum, 796 calm Hyperactive Yang Cirnicifuga, 341 calming emmenagogue. See also emmenagogue Artemisia. 258 calming herb. See also tranquilizer generally, 112 Glycyrrhiza,475 calm Kidney fear Anemone, 194 Ruta, 652 Heart Spirit + Kidney fear Thymus, 758 Kidney fear + Liver Hyperactive Yang Ruta,652 calm Liver Heat Tanacetum, 716 calm Liver Hyperactive Yang Lavandula,537 Rosmarinus, 648
The Index lists herbs by botanical name only: see the Cross references for alternative names
i::n-'
Index
"I'"
p'
k.
Salvia, 668, 670, 682 Tanacetum,716 calm Liver Hyperactive Yang + Liver \-'iind Cimicifuga,340 calm Liver Yang Ruta, 652. 663 calm Spleen worry Rosmarinus, 648 calm Wmd Heat Tanacetum.716 camphor, 169 cancer. See also antimutagenic; antitumor breast Cimicifuga,349 Glycyrrhiza,484 Tanacetum,720 colon Berberis, 288 endometrial Glycyrrhiza, 484 esophageal Berberis, 288 prostate Thuja, pair, 743 reproductive system, 146-147 urinary system, 144 cancer therapy adjunct. See also antimutagenic; antitumor Arctium, 230 Arctium, combination, 226 Echinacea, 428, 437 Echinacea, pair, 429 Glycyrrhiza, combination, 479 Phytolacca, 708 Phytolacca, combination, 591 Phytolacca, pair, 590 Smilax, pair, 708 Tara.'tacum,735 Taraxacum. pair, 728 Thuja, combination, 747-748 Thuja, pair, 744 Viola odorata, 708 Capsella bursa-pastoris, 309-318 + Achillea, 170 + Astragalus, 311 + Cinnamomum (bark), 311 + Hydrastis, 311 + Myrica, 581 + Polygonum, 311 + Potentilla,311 + Vinca,311 Capsicum species, 319-337 cautionslcontraindications, 141 dosing example, single herb tincture, 114 herb-drug interaction example, 133 on Lobelia, normalizing effect, 555
Capsicum species, pairs + Achillea, 324 + Asclepias, 265 + Baptisia, 325 + Berberis, 279 + Cinchona, 359 + Cinnamomum (twigs),375 + Comrniphora, 324, 325, 390, 391 + Crataegus,323,415 + Hydrastis, 323 + Lobelia, 323, 325, 559 + Myrica, 323, 576 + Panax ginseng, 323 + Rheum, 324, 622 + Rosmarinus, 323, 640 + Sanguinaria, 323 + Valeriana, 326 + Zanthoxylum, 324, 808 + Zingiber, 323, 822 carbuncles Lobelia, 564, 570 cardiac disease. 849d. See also heart disease cardiac diuretic Convallaria, 401.408 Sarotharnnus, 698. 699,705 cardiac edema Taraxacum, pair, 729 cardiac weakness + cardiac edema Convallaria. combination, 402 Sarothamnus. combination. 700 Sarothamnus, pair, 699 Taraxacum. combination, 730 cardiac weakness in elderly Crataegus, 422 following severe or chronic illness Convallaria, pair. 401 with hypertension Crataegus.422 subsequent to infection Convallaria,408 Crataegus.422 in youth Crataegus, 422 cardiac weakness. primary disorder cardiac weakness + angina Capsicum, pair, 323 cardiac weakness + cardiac arrhythmia Sarothamnus. pair, 699 cardiac weakness + cardiac asthma Convallaria.408 cardiac weakness + cardiac edema Convallaria. combination. 402 Sarothamnus, combination, 700
The Index lists herbs by botanical name only: see the Cross references for alternative names
915
Index
916 Sarothamnus, pair, 699 Taraxacum, combination, 730 cardiac weakness + circulation, poor peripheral Zanthoxylum. pair. 808 cardiac weakness + cold sensation Cinchona, pair, 359 cardiac weakness + debility Cinchona, pair, 359 cardiac weakness + depression Capsicum, combination, 326 Capsicum, pair, 323 Convallaria, 408 Convallaria, combination, 402 Crataegus, 422 Crataegus, combination, 418 Rosmarinus, pair, 640 Tumera, combination, 774 cardiac weakness + digestive weakness Cinchona, combination, 362 Leonurus, combination, 544 Sarothamnus, pair, 700 cardiac weakness + exhaustion Convallaria.408 Convallaria. pair, 401 cardiac weakness + hypertension Crataegus, 422 cardiac weakness + hypotension Convallaria, pair, 401 Sarothamnus, 704 Sarothamnus, pair, 699 cardiac weakness, secondary disorder bronchitis + cardiac weakness Thuja, 741 bronchitis, chronic + cardiac weakness Capsicum, combination, 327 Lobelia, pair, 562 Thuja, combination, 745 digestive weakness + cardiac weakness Centaurium, pair, 458 Gentiana, pair, 458 fever, recurring + cardiac weakness Cinchona, combination, 361 Glycyrrhiza, pair, 480 myalgia + cardiac weakness Salvia, pair, 672 cardioactive Salvia, 678 cardioprotective Crataegus, 420 Leonurus, 547 Sambucus, 692 cardioregulator defined, 74d, 80d and emmenagogue actions link, 550
cardioregulator, herb as Berberis, 288 Capsicum, 329, 334 Cinchona, 356 Convallaria,400,401,408 Crataegus, 412, 414, 420, 422 Glycyrrhiza, 475, 483 Harpagophytum,509 Hydrastis, 289 Leonurus,S42,547.549 Sarotharnnus, 698, 699 cardiotonic. See also tonic defined.74d Angelica, 215 Asclepias, 268 Calendula, 307 Capsicum, 334, 335 Centaurium, pair, 458 Chrysanthemum, 720 Cinchona, 358, 369 Cinnamomum, 374, 383 Commiphora, 396 Convallaria, 400, 401, 407
-
-
Crataegus,412,41~,420,422
Gentiana, 458 Leonurus, 540, 542, 549 Lobelia, 569 Pulsatilla chinensis, 200 Rosmarinus, 638 Sarothamnus,698,699,704 Zingtber, 829 cardiovascular system. See also antianginal; antiarrhythmic; anticholesterol; antihypertensive; cardioregulator; cardiotonic adverse reactions, avoiding, 143-144 Capsella, 314 Lobelia,569 cardiovascular weakness + myalgia Cinchona, combination, 359 carminative. See also flatulence defined,74-75d supportive and moderating actions, 64t carminative, herb as Angelica, 207, 216 Artemisia, 257 Asclepias, 270 Calendula, 307 Capsicum,334,335 Cinnarnornurn.374,382,383 Commiphora. 389, 396, 397 Juniperus, 514,515, 525 Lavandula, 529,537 Rosmarinus, 639,648 Ruta,654 Salvia,682
....
l,- •
The Index lists herbs by botanical name only: see the Cross references for alternative names
Index
... ..... '
",-.'.""
Tanacetum, 723 Thymus, 758, 760, 768 Turnera, 773, 779 Zanthoxylum, 806, 807, 815, 816 Zingiber, 821,833 catarrh, 848d. See also anticatarrhal; phlegm catarrh, bronchial bronchial catarrh + asthma Thymus, pair, 761 digestive weakness + bronchial catarrh Juniperus, pair, 516 catarrh, bronchial, chronic Thymus, pair, 761 catarrh, nasopharyngeal Euphrasia, pair, 441 Myrica, topical application, 577,584 Phytolacca, pair, 589 Thuja, pair, 743 catarrh, nasopharyngeal, chronic Myrica, pair, 577 Thymus, pair, 761 catarrh, primary disorder catarrh + infection, chronic Echinacea,427 catarrh, secondary disorder amenorrhea + catarrh Hydrastis, pair, 285 Myrica, pair, 581 Thuja, combination, 746 catarrhal deafness Euphrasia, combination, 442-443 Euphrasia, pair, 441 Hydrastis, pair, 285 Thuja.741 Thuja, pair. 744 cathartic, 141. See also laxatives Caulophyllum thalictroides about, 839 + Cimicifuga, 343 caution, 848d Centaurium erythraea, 455-471 cautions/contraindications,141 Gentiana vs., 463 Centaurium erythraea, pairs + Agrimonia, 459 + Althaea, 459 + Angelica sinensis, 458 + Artemisia absinthium, 459 + Cinchona, 458 + Crataegus,458 + Gentiana,458 + Hydrastis, 459 + molasses, 458 + Panax ginseng, 458
917 + Rosmarinus, 459
+ Taraxacum, 459 central nervous system Anemone cautions, 148 Angelica, 213 Hydrastis, 289 Salvia, 677, 678 central nervous system depressant Centaurium, 464, 465 Gentiana, 464, 465 Chamaelirium luteum about, 839 cautions/contraindications, 146 + Viburnum, 797 Chelidonium majus about, 839 + Taraxacum, 728 chilblains Capsicum, 389 Capsicum, topical application, 324 childbirth. See also oxytocics; postnatal disorders; pregnancy labor. delayed/difficult Hydrastis, pair, 280 Lobelia, 570 partus praeparator, 79d preparation for Rubus, combination. 799 Viburnum, pair, 797 chills + influenza + sinus congestion Sambucus, pair, 689 cholagogue defined,75d supportive and moderating actions, 65t cholagogue, herb as Artemisia, 251,252,257 Berberis, 275, 277 Calendula, 307 Centaurium, 464, 468, 469 Cinchona, 369 Gentiana, 464, 468, 469 Gentiana macrophylla, 469 Gentiana scabra, 469 Hydrastis, 276, 277 Lavandula, 529, 537 Myrica, 581 Rheum, 632 Rosmarinus, 639, 645, 648 Taraxacum, 727 Zanthoxylum, 807, 816 Zingiber, 828 cholecystitis Artemisia, pair, 247 Berberis, combination, 281 Taraxacum, combination, 729
The Index lists herbs by botanical name only: see the Cross references for alternative names
Index
918 Taraxacum. pair, 728 Zingiber, pair. 823 cholecystitis + pain Taraxacum, combination, 729 choloretic defined,75d Achillea. 175 Berberis, 288 Calendula, 304 Centaurium, 464 Gentiana,464 Glycyrrhiza.483 Harpagophytum, 505, 511 Juniperus. 521 Rheum, 622, 627 Rosmarinus, 645 Taraxacum, 731, 734 Zingiber. 828 Christopher, John, 16-17, 103 chronic fatigue syndrome Cinchona, 356 Crataegus, pair, 415 Glycyrrhiza, pair, 477 Leonurus, 541 Leonurus, pair, 543 Myrica, 575 Rosmarinus,636 chronic fatigue syndrome, primary disorder chronic fatigue syndrome + cold extremities Myrica. combination, 578 Zanthoxylum, combination, 810 chronic fatigue syndrome + palpitations Glycyrrhiza, pair, 475, 481 Ruta, combination, 656 Ruta, pair. 475 Salvia, pair, 675 Chrysanthemum morifolium about,839 Tanacetum compared, 720, 723 + Tanacetum, 717 Chrysanthemum parthenium. See Tanacetum parthenium Cimicifuga racemosa, 339-354 herb-drug interaction example, 123 reproductive system carcinoma and, 147 Cimicifuga racemosa, pairs + Artemisia, 247 + Caulophyllum. 343 + Harpagophytum, 344 + Hypericum, 343 + Lobelia, 343 + Ruta, 343, 655 + Salvia officinalis, 343 + Thuja, 344 + Valeriana, 343 + Zanthoxylum, 344
Cimicifuga species comparison, 352,..353 Cinchona species, 355-370 about, 355 cautions!contraindications, 143 comparison of Cinchona species, 369 herb-drug interaction example, 133 Cinchona species, pairs + Achillea, 359 + Artemisia, 246 + Berberis, 278, 359
+ Capsicum. 359 + Centaurium, 458 + Convallaria, 401 + Crataegus, 359, 415
+ Gentiana, 359, 458 + Leonurus, 359, 543
+ Ophiopogon, 359
+ Panax ginseng, 359 + Pseudostellaria,359 + Salvia officinalis, 359, 672 + Sarothamnus, 700 + Zanthoxylum, 359,808 cinchonism, 365 Cinnamomum cassia, 371-385 cautions!contraindications, 141 Cinnamomum cassia (bark) about, 371 temperature properties, 373 Cinnamomum cassia (bark), pairs
+ Capsella, 311
+ Foeniculum,375 + Glycyrrhiza, 375 + Panax ginseng, 375 + Potentilla, 609 + Schisandra, 376
+ Serenoa, 375 + Turnera, 375, 773 Cinnamomum cassia (twigs) about, 371 temperature properties, 373 Cinnamomum cassia (twigs), pairs
+ Angelica sinensis, 375 + Capsicum, 375 + Ephedra,374 + Salvia miltiorrhiza, 375 + Zanthoxylum, 375 + Zingiber,374-375 Cinnamomum laureirii, 371-372 Cinnamomum species comparison, 383-384 Cinnamomum verum,371 circulation, poor peripheral Cinnamomum, pair, 375 Commiphora, pair. 390
The Index lists herbs by botanical name only: see the Cross references for alternative names
---
--
Index
•
i L
Zanthoxylum, pair, 808 Zingiber, pair, 822 circulation, poor peripheral, primary disorder circulation, poor peripheral + depression Rosmarinus, pair, 640 circulation, poor peripheral, secondary disorder angina pectoris + circulation, poor peripheral Zanthoxylum, pair, 808 arthritis + circulation, poor peripheral Achillea, pair, 170 Thuja, pair, 744 cardiac weakness + circulation, poor peripheral Zanthoxylum, pair, 808 exhaustion + peripheral circulatior:, poor Crataegus, pair, 415 influenza + circulation, poor peripheral Zanthoxylum, pair, 808 rheumatism + circulation, poor peripheral Achillea, pair, 170 circulatory stimulant. See stimulant, circulatory cirrhosis of the liver Berberis, 288 Citrus aurantium about,839 + Juniperus, 516 classification systems, 6-11, 15, 19,29-30,58-59 clear Damp Heat Smilax, 707 clear Deficiency Heat Cimicifuga, 340 Cinchona, 357 clear Epidemic Toxin Cinchona, 357 clear Heart Deficiency Heat Salvia,668 clear Heart Heat Rheum, 620 clear Heat and Toxin Achillea, 179 clear Heat from Liver and Gallbladder Taraxacum, 726 clear Heat from Stomach and Intestines Taraxacum, 726 clear Heat in the Blood Smilax, 707 clear Heat Toxin Glycyrrhiza,489 Smilax,707 Heat Toxin + Wmd Heat Arctium, 222 Heat Toxin + Retained Pathogen Arctium,223 clear Liver Heat Rheum,620
919
clear Lung Phlegm Sambucus, 688 clear Lung Phlegm Cold Myrica,574 clear Phlegm Cold Zanthoxylum, 806 clear Retained Pathogen Artemisia, 244 Echinacea, 426-427 Phytolacca, 588 Thymus,758 clear Stomach Heat Rheum, 620 clear 'Wind + Damp Heat in Muscle channels Cimicifuga, 340 clear Wmd Cold Salvia, 668 clear Wmd Cold Damp Angelica, 206 clear Wmd Heat Echinacea, 426-427 Salvia, 668 Sambucus, 688 clear Wmd Heat + Retained Pathogen Arctium, 222 clinical practice, safety in, 151-157 Cold treatment for patterns of, 105, 109 Cold + Deficient Spleen, cautions, 140-141 Cold, secondary syndrome Intestines Qi Disturbance + Cold Rosmarinus, combination, 642 Intestines Stagnant Qi + Cold Zingiber, combination, 824 Kidney Deficient Yang + Cold Cinnamomum, combination, 376 Liver Stagnant Qi + Cold Centaurium, combination, 461 Gentiana, combination, 461 Rosmarinus, combination, 641 Liver Stagnant Qi + Cold + Damp and Phlegm Myrica, combination, 578 Spleen not holding Blood + Cold Myrica, combination, 579-580 Uterus Stagnant Qi and Blood + Cold Cinnamomum, combination, 376 cold herb, 22-23 Cold in the channels Deficient Qi and Blood + Cold in the channels Cinnamomum, combination, 376-377 Stagnant Qi and Blood + Cold in the channels Angelica, combination, 209 Harpagophytum, combination, 507 Thuja, combination, 749t
The Index lists herbs by botanical name only: see the Cross references for alternative names
Index
920 Zanthoxylum, combination, 810 Zingiber, combination, 824 cold sensation defined,891d amenorrhea + cold sensation Cinnamomum, combination, 376 Thuja, pair, 748 angina pectoris + cold sensation Capsicum, combination, 326 Convallaria, combination, 403 Lobelia, pair, 562 Zanthoxylum, combination, 809 arthritis + cold sensation Angelica, combination, 209 Angelica, pair, 208 Phytolacca, pair, 590 bronchitis, chronic + cold sensation Angelica, pair, 208 Zingiber, combination, 824 cardiac weakness + cold sensation Cinchona, pair, 359 colic, intestinal + cold sensation Cinnamomum, combination, 376 Glycyrrhiza, pair, 481 Rosmarinus, pair, 640 Zingiber, combination, 824 diarrhea + cold sensation Potentilla, pair, 609 diarrhea, chronic + cold sensation Cinnamomum, combination, 376 digestive weakness + cold sensation Capsicum, combination, 327 Centaurium, pair, 459 Gentiana, pair, 459 Rosmarinus, combination, 641 dysmenorrhea + cold sensation Anemone,pair,196 Viburnum, pair, 797 Zingiber, pair, 822 exhaustion + cold sensation Turnera, pair, 773 food intolerance + cold sensation Centaurium, combination, 461 Gentiana, combination, 461 Rosmarinus, combination, 641 influenza + cold sensation Zingiber, pair, 822 irritable bowel syndrome + cold sensation Lavandula, pair, 534 Lobelia, pair. 562 Myrica, pair, 581 Rosmarinus, combination, 642 menorrhagia + cold sensation Capsella, pair, 311 Myrica, combination, 579-580
nervous tension + cold sensation Valeriana, pair, 784 neuralgia + cold sensation Piscidia, pair, 600, 601 prostatitis + cold sensation Myrica, pair, 581 Thuja, pair, 748 Zanthoxylum, combination, 810-811 sexual debility + cold sensation Cinnarnomum, combination, 377 Turnera, combination, 774 colic, intestinal in children Lavandula, pair, 530 Juniperus, pair, 517 Lobelia, pair, 559 Rosmarinus, 637 colic, intestinal, primary disorder colic, intestinal + anxiety Juniperus, combination, 519 Lobelia, combination, 561 colic, intestinal + cold extremities Zanthoxylum, combination, 811 colic, intestinal + cold sensation Cinnarnomum, combination, 376 Glycyrrhiza, pair, 481 Rosmarinus, pair, 640 Zinglber, combination, 824 colic, intestinal + flatulence Cinnarnomum, pair, 375 colic, intestinal, secondary disorder constipation + intestinal colic Rheum, pair, 622 flatulence + intestinal colic Rosmarinus, pair, 640 colitis Althaea, combination, 186, 187 Althaea, pair, 185 Glycyrrhiza, combination, 478 Glycyrrhiza, pair, 477 Hydrastis, combination, 284 Hydrastis. pair, 280 colitis, mucous Myrica, pair, 577 colitis, primary disorder colitis + mucus in the stools Hamamelis, combination, 496 Myrica, combination, 579 colitis + nervous tension Glycyrrhiza, pair, 481 Valeriana, combination, 786 Valeriana, pair, 784 colitis, secondary disorder gastritis + colitis Hydrastis, pair, 280
The Index lists herbs by botanical name only: see the Cross references for alternative names
- /•..
,
/'fII'>-:-j
f~
I
Index ,. ,
I"
.~
,,.
ti
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colon cancer Berberis, 288 combinations. See also interaction of dose forms, 116 new, creating, 92-96 practical approach to, 89-96 of tastes, 52-55 using preexisting by combining elements, 91-92 by modification, 90-91 without alteration, 89-90 combinations balancing checklist for, 89 contraindication checking, 88-89,152 example, 93, 95 foursomes as basis of, 88 interaction assessment stage, 86-87 example, 93, 94 new, creating, 92-96 pair as basis of, 87-88 principles of, 83 provisional combination screening, 84,139,152 example, 92, 94 syndrome to herb matching stage, 83-84 example, 92, 93 taste balancing stage, 84-85 example, 92-93, 94 temperature balancing stage, 84-85 example, 92, 94 trios as basis of, 88 Commiphora molmol, 387-398 Potentilla compared, 608 + Achillea, 390 + Baptisia, 390, 391 + Calendula, 301, 390, 391 + Capsicum, 324, 325, 390, 391 + Crataegus, 390 + Hamamelis, 390, 391 + Hamamelis, topical application, 494 + Hydrastis, 390, 391 + Marrubium. 391 + Myrica, 390, 391, 577 + Salvia miltiorrhiza, 390 + Salvia officinalis, 391
+ Thymus, 391 + Zanthoxylum, 390 Commiphora myrrha, 387 complementarity, in interaction assessment, 86 conjunctivitis Calendula, 301 Potentilla, pair, topical application, 608 Sambucus, combination, 690 conjunctivitis, acutelchronic Calendula, topical application, 301
921
conjunctivitis, primary disorder conjunctivitis + sinusitis Euphrasia, pair. 441 conjunctivitis, secondary disorder headache + conjunctivitis Salvia, pair, 675 Tanacetum. combination, 718 Tanaceturn, pair, 717 consciousness, loss of, 67-68 constipation Glycyrrhiza, pair. 477 Iris versicolor, 708 Lobelia, pair, 559 Rheum, pair. 622 Smilax, pair. 708 Taraxacum, pair, 728 Zingiber, pair, 823 constipation, acute Rheum, combination, 623-624 constipation, atonic Capsicum, pair, 324 digestive weakness + atonic constipation Capsicum, pair. 323 constipation, chronic Berberis, pair. 279, 283 Hydrastis, pair, 285 Lobelia. pair, 562 Rheum, combination, 624 constipation, primary disorder constipation + colic Rheum, pair, 622 constipation + digestive atony Rheum, pair, 622 constipation. secondary disorder eczema, chronic + constipation Taraxacum, pair. 728 eczema + constipation Berberis, pair, 279 gastritis + constipation Glycyrrhiza, pair, 481 Rheum, combination, 625 Rheum, pair, 623 Taraxacum, combination, 729 skin disorder + constipation Arctium. pair, 224 Phytolacca, pair, 590 contraindication, 848d contraindication checking, 88-89. See also safety example. 93, 95 Convallaria keiskei; 399 Convallaria majalis. 399-409 cautionslcontraindications, 143 herb-drug interaction example. 133
The Index lists herbs by botanical name only: see the Cross references for alternative names
Index
922 Convallaria majalis, pairs + Anemone, 195-196 + Cinchona, 40 1 + Crataegus,402,414 + Leonurus,402 + Panax ginseng, 401 + Sarothamnus, 40 1, 699 + Taraxacum, 402,729 Convallaria species comparison, 408-409 convulsions. See also anticonvulsant amenorrhea + convulsions Cimicifuga, combination, 344-345 Ruta, pair, 659 Cook, W. H., 5 cool-cold herb, 25 cool herb, 22-23 Coptis Berberis compared, 296 Hydrastis compared, 296 Phellodendron compared, 286, 296 corticosteroid side effects Glycyrrhiza,475 cortisone treatment moderation Glycyrrhiza, 484 cough. See also antitussive; expectorant Euphrasia, pair, topical application, 441 Glycyrrhiza, 489 cough + respiratory infection, recurring Juniperus, pair, 516 cough, chronic Althaea, pair, 185 cough, dry Althaea, combination, 186, 187 Glycyrrhiza, combination, 478 Glycyrrhiza, pair, 477 cough, dry, painful Asclepias, pair, 265 cough, irritant Glycyrrhiza, pair, 477 Lobelia, pair, 558 cough, nervous Lobelia, pair, 558 cough, painful cough, painful + acute bronchitis Asclepias, pair, 265 cdugh, painful, dry Asclepias, pair, 265 cough, pWegmy . Angelica, pair, 211 Juniperus, combination, 518 Juniperus, pair, 516 cough, spasmodic Lobelia, combination, 560
Thymus, combination, 762 Thymus, pair, 761 counterirritant defined,75d Capsicum, 321, 322, 328-329, 335 Commiphora,397 Lobelia, 556, 558, 569 Thuja,754 counterirritant, topical Capsicum, 322, 328-329, 335 Thuja,754 Crataegus species, 411-424 comparison of Crataegus species, 423 vs. digoxin, risk:benefit, 124 herb-drug interaction example, 123 Leonurus vs., 540 Crataegus species, pairs + Achillea, 170,414 + Anemone, 195 + Avena, 415 + Capsicum, 323,415 + Centaurium, 458 + Cinchona, 359,415 + Commiphora, 390 + Convallaria, 402, 414 + Gentiana, 458 + Hypericum, 415 + Leonurus, 415, 543 + Lobelia, 558 + Passiflora,415 + Rosmarinus,640 + Salvia officinalis,415 + Sarothamnus, 415, 699 + Tilia, 414 + Zanthoxylum, 415, 808 Culpeper, Nicholas, 7, 8, 14-15, 20
II!!'" ..
l.
cultivar, 848d cultiv~edvoonety,848d
Curcuma longa, 840 cystitis. See also urinary regulator Althaea, combination, 187 Althaea, pair, 185 Arctostaphylos, combination, 236
-"".
CapselIa, pair, 311 Filipendula, pair, 449 cystitis, primary disorder cystitis + arthritis Arctostaphylos, pair, 235 cystitis + arthritis, chronic Harpagophytum, pair, 505 cystitis + gastrointestinal inflammation Arctostaphylos, pair, 235 cystitis + hematuria Arctostaphylos, combination, 236
The Index lists herbs by botanical name only: see the Cross references for alternative names
1>\·,1
r ,I
I
Index
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j
Hydrastis, pair, 285 cystitis + respiratory infection Arctostaphylos, pair, 235 cystitis + respiratory infection, recurring Arctostaphylos, combination, 236-237 Juniperus, combination, 517 cystitis, secondary disorder arthritis, chronic + cystitis Harpagophytum, pair, 505 cytotoxic Berberis, 288
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Damp drain bitter property and, 31 Arctium, 222 Smilax, 707 ethanol tinctures for, 109 Damp, primary syndrome Damp + Phlegm cautions!contraindications, 149 Juniperus, 525 Ruta,663 Damp + Stagnation + Deficient Spleen, 141 Damp, secondary syndrome Deficient Spleen + Damp + Stagnation, 141 Kidney Deficient Qi + Damp Juniperus, combination, 518 Taraxacum, combination, 730 Spleen Deficient Qi + Damp + Phlegm Angelica, combination, 209 Juniperus, combination, 518 Uterus Stagnant Qi and Blood + Damp + Phlegm Ruta, combination, 657 Damp Heat, clear Srnilax,707 Damp Heat, primary syndrome Damp Heat + Deficient Blood Arctium, combination, 226 Damp Heat + Deficient Yin Filipendula, combination, 450 Damp Heat + Heat Toxin Harpagophytum, combination, 506 Smilax, combination, 710 Damp Heat, secondary syndrome eczema, chronic + Damp Heat Mahonia, pair, 728 Heart Deficient Ym + Damp Heat Cirnicifuga, combination, 345 Stagnant Qi + Damp Heat + Heat Toxin Arctium, combination, 226 Glycyrrhiza, combination 479
923
Phytolacca, combination, 591 Thuja, combination, 747-748 Damp Heat in Lower Burner Arctostaphylos, combination, 237 Damp Heat in the channels Arctium, combination, 226 Glycyrrhiza, combination, 479 Harpagophyturn,504 Harpagophytum, combination, 506 Damp Heat in the channels + Deficient Yin Harpagophyturn, combination, 506 Damp Heat in the channels + Liver Damp Heat Berberis, combination, 282 deafness, catarrhal Euphrasia, combination, 442-443 Euphrasia, pair, 441 Hydrastis, pair. 285 Thuja, 741 Thuja, pair, 744 debility, postfebrile Artemisia, pair, 246 Crataegus, pair, 415 Leonurus, pair, 543 debility, primary disorder debility + body temperature fluctuating Cinchona, pair, 359 debility + digestive weakness Achillea, pair, 170 Cinchona, pair, 359 debility + low-grade febrile episodes Achillea, pair, 170 debility, secondary disorder amenorrhea + debility Achillea, pair. 170 cardiac weakness + debility Cinchona, pair, 359 menorrhagia + debility Achillea, pair, 170 debility, sexual sexual debility + cold sensation Cinnamomum, combination, 377 Turnera, combination, 774 exhaustion + sexual debility Glycyrrhiza, pair, 475, 481 Ruta, pair, 475 Turnera, combination, 775 prostatic enlargement + sexual debility. Thuja, combination. 745 Tumera, combination, 776 prostatitis + sexual deb$ty Thuja, pair, 743 decoctions about, 102-106 Althaea as, 185-186
The Index lists herbs by botanical name only: see the Cross references for alternative names
Index
924 Defensive Qi, tonify indirectly Cinchona, 357 Defensive Qi, tonify and regulate Echinacea, 426-427 deficiency, 847 d Deficiency + Stagnation of Heart Qi Rosmarinus, 636 Deficiency Heat, clear Cimicifuga, ~40 Cinchona, 357 Deficient Blood Damp Heat + Deficient Blood Arctium, combination, 226 Deficient Defensive Qi + Deficient Blood + Heart Deficient Yin Salvia, combination, 673 Heart Spirit Disturbance + Deficient Blood Leonurus, combination, 544 Liver Hyperactive Yang + Deficient Blood Rosmarinus, 637 Retained Pathogen + Deficient Blood Arctium, combination, 225-226 Glycyrrhiza, combination, 479 Spleen Deficient Qi + Deficient Blood Centaurium, combination, 460 Gentiana, combination, 460 Spleen not holding Blood + Deficient Blood Capsella, combination, 312 Deficient Blood and Qi Achillea, combination, 172 Spleen Deficient Qi + Deficient Blood and Qi Artemisia, combination, 248 Centaurium, combination, 460 Gentiana, combination, 460 Deficient Defensive Qi, primary syndrome Deficient Defensive Qi + Deficient Blood + Heart Deficient Y"m Salvia, combination, 673 Deficient Defensive Qi, secondary syndrome Retained Pathogen + Deficient Defensive Qi Achillea, combination, 172 Echinacea, combination, 430 Thuja, combination, 749t Thymus, combination, 762 Deficient Kidney Yang, cautions, 140 Deficient Kidney Yin+Heat, cautions, 140 Deficient patterns, treatment of, 109 Deficient Qi and Blood Deficient Qi and Blood + Cold in the channels Cinnamomum, combination, 376-377 Deficient Q.i and Blood + Heart Stagnant Qi Rosmarinus, combination, 641 Stagnant Qi and Blood + Deficient Qi and Blood Myrica, combination, 578 Zanthoxylum. combination, 810
Deficient Spleen, cautions, 140-141 Deficient Y"m Damp Heat + Deficient Y"m Filipendula, combination, 450 Damp Heat in the channels + Deficient Y"m Harpagophytum, combination, 506 definitions of terms used, 847-850. See also terminology conventions dementia Euphrasia, 440, 445 demulcent. See also emollient defined,75d,188d direct effect, 188 Dryness patterns treatment, 105 indirect effect, 188 reflex effect, 188 supportive and moderating actions, 64t demulcent, gastrointestinal Althaea, 190 demulcent, respiratory Althaea, 190 demulcent, topical Althaea, 190 demulcent, urinary Althaea,190 demulcent analgesic Rheum, 633 demulcent anti-inflammatory Althaea, pair, 185 Glycyrrhiza,476 demulcent expectorant Glycyrrhiza, 488 deobstruant defined,75-76d Myrica, 584 depression. See also antidepressant
,.
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.!
--t e
Rosmarinus, 636 Rosmarinus, pair, 639 depression, chronic Angelica, pair, 208 depression, postnatal + exhaustion Rosmarinus, combination, 641 Salvia, pair, 675 depression, primary disorder depression + anxiety, 528 depression + bronchitis Capsicum, combination, 326 Thuja, pair, 748 depression + cold extremities Capsicum, pair, 323 Turnera, combination, 774-775 depression + digestive disorders Myrica, combination, 578
The Index lists herbs by botanical name only: see the Cross references for alternative names
---
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925
Index depression + headache + premenstrual syndrome Artemisia, combination, 248 Ruta, combination, 657 Salvia, combination, 674
··,i:;"';
depression + indigestion Berberis. pair, 279 Myrica, pair, 576 depression + insomnia, 528 depression + obesity Angelica, combination, 209-210 depression + sexual debility Tumera, combination, 775 depression, secondary disorder abdominal distension + depression Lavandula, pair, 530 anxiety + depression Anemone, pair, 196 Lavandula, combination, 533 Valeriana, pair, 784 cardiac.weakness + depression Capsicum, combination, 326 Capsicum, pair, 323 Convallaria, 408 Convallaria, combination, 402 Crataegus. 422 Crataegus. combination, 418 Rosmarinus, pair, 640 Tumera,.combination,774 circulation, poor + depression Rosmarinus, pair, 640 digestive disorders + depression Rosmar.nus, combination, 642 dysmenorrhea + depression Artemisia, pair, 247 exhaustion + depression Berberis. pair, 279 Capsicum, pair, 323 Cinchona, pair, 359 Cinnamomum, pair, 375 Crataegus, pair, 415 Glycyrrhiza, pair, 477 Rosmarinus, pair, 639 Tumera, pair, 773 headache + depression Piscidia, pair, 601 Salvia, pair, 671 Tanaceturn,pair,717 Zingiber, pair, 823 headache + premenstrual syndrome + depression Artemisia, combination, 248 Lavandula, pair, 534 Ruta, combination, 657 Salvia, combination, 674
impotence + depression Rosmarinus, pair, 640 menopausal disorders + depression Anemone, pair, 196 nervous exhaustion + depression Lavandula, pair, 530 depurant. See alterative dermatological agent. See also skin disorder poison ivy/oak Lobelia, 570 sebaceous cyst Calendula, 306 tinea manuum and capitis Lobelia, 564 detoxicant. See also toxins, eliminating Achillea, 178 Arctium, pair, 224 Glycyrrhiza, 476, 488 Rosmarinus,637 Taraxacum, pair, 728 for drug abuse, 637 diaphoretic defined, 76d supportive and moderating actions, 64t tinctures used as, 109 diaphoretic, herb as Achillea,166-167,168,177,179 Angelica, 207, 215 Arctium, 223, 231 Asclepias, 265, 270 Capsicum, 322, 334-335 Cimicifuga, 351 Cinnamomum, 374,382,383 Echinacea, 428 Filipendula, 448, 453 Myrica, 575, 583 Sambucus,688,691,694 Zanthoxylum, 807, 815 Zingiber, 821, 827, 833 diarrhea. See also antidiarrheal Achillea, 178 Althaea, pair, 185 Hamamelis, pair, 495 Myrica, pair, 577 Rheum, 621 diarrhea, acute Potentilla, pair, 609 diarrhea, acute + heat sensation Berberis, pair, 283 Potentilla, combination, 611 Rheum, combination, 624 Rheum, pair, 622 diarrhea, acute severe Myrica, pair, 581 Potentilla, combination, 610
The Index lists herbs by botanical name only: see the Cross references for alternative names
Index
926 diarrhea, chronic diarrhea, chronic + cold sensation Cinnamomum, combination, 376 diarrhea, chronic + digestive weakness Myrica, combination, 579 diarrhea, primary disorder diarrhea + bleeding Capsella, pair, 311 Hamamelis, combination, 496 Potentilla, combination, 612 Potentilla, pair, 609 diarrhea + cold sensation Potentilla, pair, 609 diarrhea + mucus in the stools Commiphora, pair, 390 diarrhea, protozoal Potentilla, combination, 611 Potentilla, pair, 609 diarrheal antihemorrhagic Achillea, 178 diarrheal astringent Achillea, 178 diazepam vs. Valeriana, risk:benefit, 124-125 Dietary Supplements Health and Education Act 1994, USA (nsHEA),135 Dieter, Jakob, 14 digestive, aromatic. See carminative digestive disorders, generally Rosmarinus, 637 digestive disorders + depression Rosmarinus, combination, 642 depression + digestive disorders Myrica, combination, 578 digestive weakness bitter herbs in treating, 32 Juniperus, 525 digestive weakness, primary disorder digestive weakness + anemia Centaurium, combination, 460 Gentiana, combination, 460 digestive weakness + atonic constipation Capsicum, pair, 323 digestive weakness + bronchial catarrah Juniperus, pair, 516 digestive weakness + cardiac weakness Centaurium, pair, 458 Gentiana, pair, 458 digestive weakness + cold sensation Capsicum, combination, 327 Centaurium, pair, 459 . Gentiana, pair, 459 Rosmarinus, combination, 641 digestive weakness + flatulence Angelica, combination, 209
Angelica, pair, 208 Juniperus, combination, 518 digestive weakness + gastrointestinal inflammation Althaea, combination, 188 Centaurium, combination, 461 Gentiana, combination, 461 Hydrastis, pair, 285 digestive weakness + hepatic weakness Centaurium, pair, 459 Gentiana, pair, 459 digestive weakness + postfebrile exhaustion Cinchona, combination, 361-362 digestive weakness, secondary disorder appetite lacking + digestive weakness Centaurium, pair, 458 Gentiana, pair, 458 bronchitis, chronic + digestive weakness Commiphora, pair, 391 cardiac weakness + digestive weakness Cinchona, combination, 362 Leonurus, combination, 544 Sarothamnus, pair, 700 debility + digestive weakness Achillea, pair, 170 Cinchona, pair, 359 diarrhea, chronic + digestive weakness Myrica, combination, 579 edema + digestive weakness Taraxacum, pair, 729 exhaustion + digestive weakness Centaurium, pair, 458 Gentiana, pair, 458 Turnera, pair, 773 hypochondriac pain + digestive weakness Berberis, pair, 279 nausea + digestive weakness Centaurium, combination, 460-461 Gentiana, combination, 460-461 digoxin,124,133-134 Dioscorides, 3, 9,11-12,14 distention, abdominal + depression Lavandula, pair, 530 diuretic defined,76d supportive and moderating actions, 64t diuretic, cardiac Convallaria, 401, 408 Sarothamnus, 698, 699, 705 diuretic, herb as Achillea, 179 Althaea, 190 Angelica, 216 Arctium, 223, 228, 230-231 Arctostaphylos, 239, 241 Artemisia, 258-259
The Index lists herbs by botanical name only: see the Cross references for alternative names
....
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Index
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Asclepias, 270 Cinnamomum, 374, 383, 384 Crataegus, 420, 422 Filipendula, 449, 453 Juniperus, 515, 521, 524 Lavandula,538 Leonurus, 547, 551 Lobelia, 570 Phytolacca,594 RheUnl,633 Rosmarinus, 649 Ruta,664 Salvia, 682 Sarothamnus, 704 Smilax, 711, 713 TaraxacUnl, 727, 732, 735 Thymus, 769 Turnera,779 Zanthoxylur.n,807,816 diuretic, urinary system Achillea, 179 dose defined, 97 d, 848d, 849d adverse reaction prevention guidelines, 153 cautions/contraindications,101 equivalence comparisons, 111-112 idiosyncratic reactions, 102 minimum therapeutic, 108, 122 , principles of combination, 83 subtherapeutic, 98d, 850d toxic, 849d, 850d weights and measures explained, 116-118 dose, factors affecting the required, 99-102 age of the patient, 100, 101 dispensing form, 100 ethanol as solvent, 106, 109, 154 herb dose range group, 100 illness phase, 100 number of herbs, in pairs or combinations, 1DO, 104-105 sample quality, 100 taste preferences of the patient, 102,105-106,109, 112 tolerance variability, 100-102 dose form defined, 97 d advantages and disadvantages compared, 110-111 t combination, 116 concentrates, 110-111 equivalence comparisons, 111-112 examples, 113-116 infusions/decoctions, 102-106, 110-l1lt matching to patients, 153 pills/capsules, 110, lIlt powdered dried herbs, 109-110, lIlt tinctureslliquid extracts, 106-109
927
dose philosophy, 97-98, 108 dose preparation infusions/decoctions, 101-104 solvents used in, 106-107, 109 tinctures, 106 dose prescribing/recommendations guidelines, 99 for children, 114 decreasing effectiveness and, 113 duration of prescription, 112-113, 153 flexible vs. precise method, 97-98, 108-109 illness phase transitions, 115-116 long-term, 113, 115, 153 short-term, 113 timing, 112,114-115, 153 dose range, 848d dose recommendations, 108 drain Damp CinnamomUnl,381 Smilax, 707 bitter property in, 31 dreams, fearful. See also nightmares insomnia + fearful dreams Piscidia, pair, 601 drug abuse. See also detoxicant Rosrnarinus,637 dryness laryngitis + dryness Althaea, pair, 185 Dryness patterns CinnamomUnl,381 infusions/decoctions for, 105 DSHEA (Dietary Supplements Health and Education Act 1994, USA), 135 dysentery. See also diarrhea Achillea, 178 dysmenorrhea Anemone, combination, 197-198 Anemone, pair, 196 Cimicifuga, pair, 343 Hydrastis, combination, 284 Hydrastis, pair, 280 Leonurus, pair, 543 Lobelia, 570 Lobelia, combination, 560 Piscidia, combination, 601 Thymus, combination, 763 Valeriana, pair, 785 Viburnum, 802 Viburnum, combination, 798 Zingiber, combination, 825 dysmenorrhea, primary disorder dysmenorrhea + cold sensation Anemone, pair, 196
The Index lists herbs by botanical name only: see the Cross references for alternative nam~s
Index
928 Lobelia, pair, 559 Viburnum, pair, 797 Zingiber, pair, 822 dysmenorrhea + depression Artemisia, pair, 247 dysmenorrhea + fear Anemone, pair, 197-198 Lobelia, pair, 562 Ruta, pair, 659 Viburnum, pair, 800 dysmenorrhea + nervous tension Lobelia, pair, 559 Piscidia, combination, 602 dysmenorrhea, secondary disorder menorrhagia + dysmenorrhea Viburnum, pair, 797 dysuria + infection. See also urinary system Taraxacum, pair, 729
E ear infection Potentilla, pair, topical application, 608 eating disorder. See anorexia Echinacea angustifolia, 425, 433 Echinacea pallida, 425, 433 Echinacea purpurea, 425, 432 Echinacea species, 425-438 +Achillea,170,429 + Arctostaphylos, 235, 427,429 + Asclepias, 265, 427,429 + Astragalus, 430 + Baptisia, 427,429 + Ephedra, 429 + Euphrasia,429,441 + Hydrastis,279,427,429 + Panax quinquefolium, 429 + Phytolacca, 589 + Sambucus, 689 + Thuja, 427,429, 744 + Thymus, 429, 760 + Zingiber,430 Eclectic movement, 7-10, 15-16, 99, 848d. See also herbal medicine, history of eczema. See also skin disorder Calendula, 306 Calendula, pair, 301 Glycyrrhiza. pair, 480 Hamamelis, 498 Lobelia, 570 Rheum, 628 Sambucus, 694 Smilax, 713 Taraxacum, 735
Zanthoxylum, 816 eczema + constipation Berberis, pair, 279 eczema, acute Arctium, pair, 224 Berberis, combination, 281-282 Rheum, pair, 623, 626 eczema, acute + Heat in the Blood Scrophularia, pair, 727 eczema, chronic Arctium, combination, 226 Arctium, pair, 223, 226 Mahonia, pair, 728 Phytolacca, 596 eczema. chronic + constipation Taraxacum, pair. 728. eczema, chronic + Damp Heat Mahonia, pair, 728 eczema, exudative Thuja,753 eczema,subacute Lobelia, 564 edema. See also diuretic Juniperus, combination, 517 Juniperus, pair, 516 Taraxacum, combination, 730 edema + digestive weakness Taraxacum,pair,729 exhaustion + edema Rheum, pair, 623 Turnera, pair, 774 edema, cardiac Convallaria, pair, 402 Taraxacum, pair, 729 cardiac weakness + cardiac edema ConvaIlaria, combination, 402 Sarothamnus, combination, 700 Sarothamnus, pair, 699 Taraxacum, combination, 730 ED (median effective dose),848d eicosanoid metabolism, 828 Elettaria cardamomun, 840 Ellingwood's action categories, lOt emetic cautionslcontraindications, 141 defined,76d Lobelia, 556, 564, 570 emmenagogue. See also stimulant emmenagogue defined,76-77d Biota vs. Thuja, 754 cardioregulators link to, 550 supportive and moderating actions, 65t emmenagogue, herb as Achillea, 169, 178, 179
The Index lists herbs by botanical name only: see the Cross references for alternative names
-..,.
Index .,
.)
i .-..
--
Anemone, 203 Angelica, 212, 216 Artemisia, 169,246,252,257-258 Berberis, 278, 294 Calendula, 307 Cimicifuga, 343,351-352 Cinchona, 369 Cinnamomur.n, 374, 383,384 Commiphora, 396, 397 Hydrastis, 276, 278, 294 Juniperus, 525 Lavandula, 538 Leonurus, 542, 550 Rheum,633 Ruta,664 Salvia, 670, 682 Sarothamnus, 705 Tanacetum,723 Thuja, 743, 752 Thymus, 760, 769 Turnera, 779 Zingiber, 821, 833 emmenagogue, antispasmodic defined, 77 d Artemisia, 258 Leonurus,542,550 emmenagogue, calming Artemisia, 258 emmenagogue, normalizing, 77 d emmenagogue, specific to amenorrhea Achillea, 178 infertility Achillea, 178 leukorrhea Achillea, 178 menorrhagia Achillea, 178 emmenagogue, stimulant defined,77d Artemisia, 258 Leonurus, 542, 550 emmenagogue, tonic defined, 77d Artemisia, 258 Leonurus,550 emmenagogue, tranquilizing Leonurus, 542 emollient. See also demulcent defined, 77d, 188d Althaea, 188 emotional lability. See also antidepressant, nervine, tranquilizer Anemone, pair, 195 Leonurus,541
929
cardiac arrhythmia + emotional lability Sarothamnus,pair,699 emphasis in interaction assessment, 86-87 endometrial cancer Glycyrrhiza, 484 energetic lability Leonurus, 541 energy movement, related to taste, 51 enhancer of antibiotics, 732. See also moderator of inoculatory drugs enhancer of herbs. See also moderator of other herbs Capsicur.n,333 Lobelia, 563 Zingiber, 828, 833 enuresis. See also urinary regulator Ruta, pair, 655 Thuja, combination, 746 Thymus, combination, 763 Thymus, pair, 761 Ephedra sinica about, 840 adverse reaction report example, 131 cautions/contraindications,140,142,143 Ephedra sinica, pairs + Arctiur.n seeds, 223 + Cinnamomur.n (twigs),374 + Echinacea, 429 + Glycyrrhiza,477 + Lobelia, 558 + Sambucus, 689 Epidemic Toxin, clear Cinchona, 357 epilepsy, petit mal amenorrhea + petit mal epilepsy Cimicifuga, pair, 343 Ruta, pair, 655 Equisetum arvense about, 840 astringent effect, 495 + Thuja, 743 equivalence comparisons dose form, 111-112 weights and measures for dosages, 116-118 ESCOP (European Scientific Cooperative on Phytotherapy), 126-127 esophageal cancer Berberis, 288 Eupatoriur.n perfoliatum about,840 + Achillea, 169 Eupatoriur.n purpureur.n, 525 Euphorbia hirta about, 840 as expectorant, 760 + Euphrasia,441
The Index lists herbs by botanical name only: see the Cross references for alternative names
Index
930 Euphrasia maximowiczii, 439 Euphrasia officinalis, 439 Euphrasia regelii, 439 Euphrasia rostkoviana, 439 Euphrasia species, 439-446 astringent effect. 495 + Calendula,441 + Echinacea, 429. 441 + Euphorbia. 441 + Glechoma.441
+ Hamamelis. 495 + Hydrastis,279.441 + Phytolacca.589 + Sambucus. 441, 689 + Zanthoxylum. 441 Euphrasia species comparison, 446 European Scientific Cooperative on Phytotherapy (Escop),126-127 exhaustion defined,848d Cinnamomum, pair. 375 overwork causing Ruta, pair, 654 exhaustion, postfebrile Centaurium, 468 Centaurium. pair. 458 Gentiana, 468 Gentiana, pair. 458 digestive weakness + postfebrile exhaustion Cinchona. combination, 361-362 exhaustion, primary disorder exhaustion + anemia Rosmarinus. pair, 639 exhaustion + cold sensation Turnera. pair. 773 exhaustion + depression Berberis. pair. 279 Capsicum. pair. 323 Cinchona. pair. 359 Cinnamomum. pair. 375 Crataegus, pair. 415 Glyeyrrhiza. pair, 477 Rosmarinus, pair. 639 Turnera. pair, 773 exhaustion + depression. postnatal Salvia. pair. 675 exhaustion + digestive weakness Centaurium. pair. 458 Gentiana. pair, 458 Turnera. pair, 773 exhaustion + edema Rheum. pair. 623 Turnera. pair, 774
exhaustion + fear Anemone. combination. 197 Glycyrrhiza. pair. 475. 481 Ruta. combination, 656 Ruta.pair,475 exhaustion + heart disease Leonurus. pair, 542 exhaustion + hypotension ·Crataegus. pair. 415 exhaustion + poor peripheral circulation Crataegus, pair, 415 exhaustion + prostatitis Turnera, pair. 773 exhaustion + sexual debility Glycyrrhiza. pair, 475. 481 Ruta. pair. 475 Turnera. combination. 775 exhaustion + weight loss Cinnamomum. pair, 375 exhaustion, s~condary disorder amenorrhea + exhaustion Achillea. combination, 172 Ruta. pair. 659 anemia + exhaustion Centaurium. pair. 458 Gentiana, pair. 458 arrhythmia. cardiac + exhaustion Crataegus, combination, 416 arthritis + exhaustion Filipendula. combination. 450 Harpagophytum, combination, 506 arthritis + cold extremities + exhaustion Cinnamomum, combination. 376-377 cardiac weakness + exhaustion Convallaria. 408 Convallaria. pair. 401 depression. postnatal + exhaustion Rosmarinus. combination. 641 excessive sweating + exhaustion Salvia, combination. 673 fever. recurring + exhaustion Achillea. combination. 171-172 Artemisia. combination, 248 Berberis, combination. 281 Centaurium, combination, 460 Gentiana, combination, 460 Glycyrrhiza. pair. 480 headache + exhaustion Rosmarinus, pair. 639 menopausal disorders + exhaustion Cimicifuga. combination, 345 Ruta. pair. 659 menorrhagia + exhaustion Capsella. combination. 312 Capsella. pair, 311
The Index lists herbs by botanical name only: see the Cross references for alternative names
, - . .1
"
i
Index nervous tension + exhaustion Anemone, pair, 196 pneumonia + exhaustion Asclepias, pair, 265 Exhaustion of Kidney Qi, 148 expectorant defined,77d anticatarrhals vs., 69 Biota vs. Thuja, 754 supportive and moderating actions, 65t expectorant, herb as Angelica, 207,216
....
Artemisia, 259 Asclepias, 265, 270 Capsicum, 335 Cinnamomum, 382, 383 Commiphora, 389, 396, 397 Glycyrrhiza, 476, 483 Lobelia, 557 Phytolacca, 593 Rosmarinus, 648 Ruta,664 Salvia, 682 Thuja, 742, 749, 752 Thymus, 760,765, 768 Thymus, pair, 760 Turnera,779 Zingiber, 821, 833 expectorant, cooling Euphorbia, 760 expectorant, demulcent Glycyrrhiza, 488 expectorant, drying Angelica, 760 expectorant, moistening Glycyrrhiza, 760 expectorant, stimulant Lobelia, 568
expectorant demulcent Glycyrrhiza,488 expectoration, difficult bronchitis + expectoration, difficult Thuja, pair, 743 expectoration of blood Achillea, 178 extracts, liquid (fluid). See tinctures/liquid extracts extremities, cold defined, 891 d Capsicum, topical application, 324 __ .M
Myrica, pair, 576
extremities, cold, secondary disorder arthritis + cold extremities Harpagophytum, combination, 507 Harpagophytum. pair, 505 Zanthoxylum, combination, 810 Zingiber, combination, 824 arthritis + cold extremities + exhaustion Cinnamomum, combination, 376-377 atherosclerosis + hypertension + cold extremities Achillea, combination, 173 chronic fatigue syndrome + cold extremities Myrica, combination, 578 Zanthoxylum, combination, 810 colic, intestinal + cold extremities Zanthoxylum, combination, 811 depression + cold extremities Capsicum, pair, 323 Turnera, combination, 774-775 muscle cramps + cold extremities, 800 Lobelia, pair, 562 Viburnum, pair, 800 Zanthoxylum, combination, 810 rheumatism + cold extremities Capsicum, pair, 324 eye disorders Centaurium, 469 Euphrasia, pair, topical application, 441 Euphrasia, topical application, 440 Gentiana macrophylla,469 Gentiana scabra, 469 Ruta,664 eye disorders, sore/inflamed Calendula, topical application, 306 Centaurium, 469 Gentiana, 469 Potentilla, topical application, 610 eye disorders, swollen Sambucus, 694
F
expectorant, warming Sanguinaria, 760
~.
931
family, 848d fatigue. See chronic fatigue syndrome, exhaustion fatty ltlIl1ps in the flesh Phytolacca, 588 FDA (Food and Drug Adminstration, USA), 135-136 fear anxiety + fearfulness Anemone, pair, 196 dysmenorrhea + fear, 800 Lobelia, pair, 562 Ruta, pair, 659 exhaustion + fear Anemone, combination. 197
The Index lists herbs by botanical name only: see the Cross references for alternative names
Index
932 Glycyrrhiza, pair, 475, 481 Ruta, combination, 656 Ruta, pair, 475 insomnia + fearful dreams Piscidia, pair, 601 insomnia + fearfulness Ruta, pair, 655 palpitations + fearfulness Ruta, pair, 654 febrifuges. See antipyretic feet, cold. See also extremities, cold Capsicum, topical application, 324 Felter, H. W., 16 fewr. See also antipyretic; diaphoretic Lobelia. 569 fever, disorder following a debility Artemisia, pair, 246 Crataegus, pair, 415 Leonurus, pair, 543 exhaustion Centaurium, 468 Centaurium, pair, 458 Gentiana, 468 Gentiana. pair, 458 fever, intermittent Capsicum, 334 fever,low-grade Artemisia, 245 Artemisia, pair. 247 Capsicum, 334 debility + low-grade febrile episodes Achillea, pair, 170 fever, primary disorder fever + respiratory disorders, acute Asclepias, combination, 266-267 Echinacea, combination, 430 Lobelia. combination, 560 fever + respiratory infection Echinacea, pair, 427 fever + respiratory infection, acute Echinacea, pair, 429 fever, prostrating Capsicum, 334 fever, putrescent stage Capsicum, 334 fever, recovery from Cinchona, pair, 359 Echinacea. pair, 429 fever, recurring Artemisia, 246 Berberis, pair, 278 Echinacea, pair. 429 fever, recurring + cardiac weakness
Cinchona, combination, 361 Glyeyrrhiza, pair, 480 fever, recurring + exhaustion Achillea, combination, 171-172 Artemisia, combination, 248 Berberis, combination, 281 Centaurium, combination, 460 Gentiana, combination, 460 Glyeyrrhiza, pair, 480 fever, recurring + hepatic function reduced Cinchona, pair, 359 fever, recurring + myalgia Cinchona, combination, 360 Cinchona, pair. 359 Zanthoxylum, pair, 808 fever, recurring + night sweats Cinchona, combination, 361 Cinchona, pair, 359 Salvia, pair, 675 fever, recurring + respiratory infection Achillea, combination, 172 Echinacea, combination, 430 fever, secondary disorder influenza + fever Achillea, combination, 170 Asclepias, combination, 266 Asclepias, pair, 265 Zingiber, combination, 823 Zingiber, pair, 822 respiratory disorders, acute + fever Glyeyrrhiza, pair, 480 respiratory infection acute + fever Lobelia, 569 fever, Shao Yang stage Cinchona, 357 feverishness arthritis + feverishness Harpagophytum, pair, 505 fibromyalgia Cinchona, 356 Crataegus, pair, 415 Myrica, 584 Filipendula salicylates, 451 Filipendula ulmaria, 447-454 Althea compared, 448 anti-inflammatory effects, 495 Berberis compared, 449 Hydrastis compared, 448 Ophiopogon compared, 448 Taraxacum compared, 449 Filipendula ulmaria, pairs + Arctium, 449 + Glyeyrrhiza, 449 + Harpagophytum, 449,505 + Hydrastis, 280
The Index lists herbs by botanical name only: see the Cross references for alternative names
.-.-
•••
---~_.
p
__ ...
-_ . . . . ., ..~~;.;.-; • •
I
~
, -~\ I
-..:../
'.
Index + Ophiopogon. 449 + Populus. 449 + Viola. 449
i \
Five Element theory,S and taste, 30, 39 flatulence. See also carminative Rosmarinus.637 flatulence + colic, intestinal Rosmarinus, pair. 640 digestive weakness + flatulence Angelica, combination, 209 Angelica, pair, 208 Juniperus, combination, 518 Foeniculum vulgare about. 840 + Cinnamomum (bark), 375 + Rheum, 622 Food and Drug Adminstration, USA (FDA), 135-136 food intolerance Artemisia, 245 Artemisia, pair, 247 Berberis, pair. 279 Rosmarinus, 637 food intolerance, primary disorder food intolerance + cold sensation Centaurium, combination. 461 Gentiana, combination, 461 Rosmarinus, combination. 641 food intolerance + heat sensation Artemisia. combination, 248 Berberis, combination, 282 food intolerance, secondary disorder hepatic weakness + food intolerance Rosmarinus, pair, 640 Four Element theory,S Four Humors of the body, 5-6 foursomes, combination examples, 88 Four Temperaments, 5-6 fungal infection. See also antifungal Calendula, pair, 301 Commiphora, pair, 390 Commiphora, pair, topical application, 391 Thuja.753 Thuja, pair, topical application, 744, 745
G galactagogue, 77d galactophygics. See antigalactagogue Galen of Pergamon, 3, 6-8, 9.12 Galium aparine about, 840 as alterative, 708 + Phytolacca, 590
933
gallstones. See antilithic gastric secretory Artemisia, 251 Capsicum. 329 gastritis Althaea, combination. 186. 187 Althaea. pair. 185 Capsicum, 329 Glycyrrhiza.490 Hydrastis, pair, 280. 285 Rheum, 621 Taraxacum, pair, 728 gastritis, acute Rheum. pair. 623 gastritis, primary disorder gastritis + bleeding Calendula, pair. 301 gastritis + colitis Hydrastis, pair, 280 gastritis + constipation Glycyrrhiza, pair, 481 Rheum. combination, 625 Rheum, pair, 623 Taraxacum. combination, 729 gastritis + nervous tension Valeriana, pair, 785 gastritis + thirst Filipendula, pair, 449 Glycyrrhiza. pair, 477 gastritis, secondary disorder arthritis + gastritis Harpagophytum, pair, 505 sinusitis + gastritis Sambucus, combination. 689 gastrointestinal inflammation Arctium. 231 Berberis, 293 Calendula, 304, 306 Centaurium, 468, 469 Centaurium. pair. 459 Filipendula.453 Gentiana, 468, 469 Gentiana, pair, 459 Glycyrrhiza.488 Hydrastis, 293 Rheum. 622, 632 Taraxacum, 727,732. 735 gastrointestinal inflammation, primary disorder gastrointestinal inflammation + infection Centaurium, pair, 459 Gentiana. pair, 459 gastrointestinal inflammation, secondary disorder cystitis + gastrointestinal inflammation Arctostaphylos, pair, 235
The Index lists herbs by botanical name only: see the Cross references for alternative names
Index
934 digestive weakness + gastrointestinal inflammation Althaea, combination, 188 Centaurium, combination, 461 Gentiana, combination, 461 Hydrastis, pair, 285 gastrointestinal system adverse reactions, avoiding, 140-141 antiabsorption Cinnamomum, 379 astringent Filipendula, 453 Hamamelis, 494-495 disorders, generally Lobelia, pair, 559 motility Cinnamomum, 379 transit time changes Capsicum, 329 General Sale List, UK, 135 Gentiana lutea, 455-471 cautions!contraindications, 141 Centaurium vs., 463 Gentiana lutea, pairs + Agrimonia, 459 + Althaea, 459 + Angelica sinensis, 458 + Artemisia absinthium, 459 + Artemisia species, 247 + Centaurium, 458 + Cinchona, 359, 458 + Crataegus, 458 + Hydrastis,459 + molasses, 458 + Panax ginseng, 458 + Rosmarinus, 459 + Tara..'<:acum, 459 Gentiana macrophylla, 466, 469 Gentiana scabra, 466-467,469 Gentiana species comparison, 466-467 genus, 848d Geranium maculatum about,840 + Calendula, 301
+ Hydrastis, 280 + Potentilla, 609 Gerard,John,14 German practices, decoctions, 103 gingivitis. See also gum infection Commiphora, pair, 391 Commiphora, topical application, 389, 397 Echinacea, topical application, 437 Myrica, pair, 577 Salvia, topical application, 682
Glechoma hederacea about,840 + Euphrasia, 441 + Phytolacca, 589 + Thuja, 743 + Thymus, 761 glossary. See also terminology conventions of actions, 67-81 general,847-850 glossitis Salvia, topical application, 682 glucocorticoid metabolism Glycyrrhiza,484 Glycyrrhiza glabra, 473-491 cautions!contraindications, 143, 146 as expectorant, 760 herb-drug interaction example, 133 reproductive system carcinoma and, 147 Glycyrrhiza glabra, pairs + Althaea, 185,477 + Anemone, 196 + Cinnamomum (bark), 375
+ Ephedra, 477 + Filipendula,449 + Harpagophytum,477
+ Lobelia, 477 + Ophiopogon,477 + Panax ginseng, 477 + Prunus, 477 + Pseudostellaria, 477 + Rheum, 477, 623 + Serenoa, 477 + Taraxacum, 728 + Valeriana, 478, 784 + Zingiber, 477,823 Glycyrrhiza species comparison, 489-490 Glycyrrhiza uralensis, 473 gout Filipendula, pair, 449 Sambucus, 694 Thuja, pair, 744 GRAS (Generally Regarded As Safe), 135 gum disorders Potentilla, pair, topical application, 608 gum infection. See also gingivitis Calendula, topical application. 301 Myrica, 584 Myrica, topical application, 577
H halitosis Commiphora, pair, 390 Hamamelis chinensis, 493
The Index lists herbs by botanical name only: see the Cross references for alternative names
Index
-
r" ill
Hamamelis species comparison, 500 Hamamelis virginiana, 493-501 Potentilla compared, 608 Hamamelis virginiana, pairs + Aesculus, 495 + Agrimonia, 495 + Calendula, 301, 494, 495 + Commiphora, 390, 391, 494 + Euphrasia,495 + Hydrastis, 495 + Myrica, 495 + Plantago lanceolata, 495 + Plantago major, 495 + Potentilla, 609 + Ranunculus fica ria, 495 Harpagophytum procurobens, 503-512 Harpagophytum zeyheri compared, 510 + Aretiuro, 223 + Berberis, 279, 505 + Cimicifuga,344 + Filipendula, 449, 505 + Glycyrrhiza, 477 + Populus, 505 + Smilax, 50S, 709 + Viola, 505 + Zanthoxylum, 505 Harpagophyturo zeyheri Harpagophytum procumbens compared, 510 headache. See also migraine Artemisia, 257 Rosmarinus,637 Tanacetum.716 headache, premenstrual Cimicifuga, pair, 343 Salvia, 668 headache, premenstrual+ nervous tension Tanacetum, pair, 717 headache. primary disorder headache + anemia Artemisia, combination, 248 Salvia, combination, 673-674 headache + an.xiety Anemone, combination, 197 Lavandula, combination, 532 Zingiber, combination, 825 headache + conjunctivitis Salvia, pair, 675 Tanacetum, combination, 718 Tanacetum, pair, 717 headache + depression Piscidia, pair, 601 Salvia, pair, 671 Tanacetum, pair, 717 Zingiber, pair, 823
935 headache + exhaustion Rosmarinus, pair, 639 headache + facial neuralgia Lavandula, pair, 534 headache + hypertension Tanacetum, combination, 717 headache + insomnia Salvia, pair, 671 Tanacetum, pair, 716, 717 headache + irritability, 601 Valeriana, pair, 785 headache + Liver Stagnant Qi Piscidia, pair, 600 headache + muscle tension Zingiber, pair, 822 headache + muscle tremors Cirnicifuga, pair, 343 headache + myalgia Rosmarinus, pair, 640 Salvia, combination, 673 Tanacetum, pair, 716, 717 headache + nervous tension Artemisia, pair, 247 Lavandula,pair,530 Rosmarinus, pair, 640 Salvia, pair. 671 Zingiber, pair, 822 headache + neuralgia, facial Piscidia, combination, 602 Rosmarinus, combination, 642-643 Valeriana, combination, 786 headache + premenstrual syndrome Tanacetum, pair, 716 headache + premenstrual syndrome + depression Artemisia, combination, 248 Lavandula, pair, 534 Ruta, combination, 657 Salvia, combination, 674 headache, secondary disorder hypertension + headache Berberis, pair, 283 Rheum. pair, 626 Tanacetum, combination, 718 Tanacetum, pair, 717 Valeriana. combination, 786 influenza + headache Achillea, pair, 169 insomnia + headache Valeriana, pair, 784 premenstrual syndrome + headache Cirnicifuga, combination, 344 Lavandula, pair, 534 Salvia, pair, 671
The Index lists herbs by botanical name only: see the Cross references for alternative names
936
. '-~~~;~-~~r~-'~:'
Index
healing crisis, 848d, 851-852 hearing loss!deafness. See deafness Heart, tonify Glycyrrhiza,489 Heart Deficiency Heat, clear Salvia, 668 Heart Deficient Blood Heart Qi Irregularity + Heart Deficient Blood Crataegus, combination, 416 Heart Deficient Qi Heart Deficient Qi + Kidney Deficient Qi + Damp Convallaria, combination, 402 Sarothamnus, combination, 700 Taraxacum, combination, 730 Heart Deficient Qi + Spleen Deficient Qi Leonurus, combination, 544 Cinchona, combination, 362 Kidney Deficient Yang + Heart Deficient Qi Turnera, combination, 774-775 Lung Phlegm Cold + Heart Deficient Qi Capsicum, combination, 327 Thuja, combination, 745 Heart Deficient Yang Heart Deficient Yang + Kidney Deficient Yang Capsicum, combination, 326 Convallaria, combination, 402 Crataegus, combination. 418 . Turnera, combination, 774 Heart Stagnant Blood + Heart Deficient Yang Capsicum, combination, 326 Convallaria, combination, 403 Zanthoxylum, combination, 809 Heart Deficient rm Heart Deficient rm + Damp Heat Cirnicifuga, combination, 345 Heart Heat + Heart Deficient Yin Anemone, combination. 197 Salvia. combination. 672-673 Heart Qi Irregularity + Heart Deficient r m Convallaria, combination. 403 Retained Pathogen + Heart Deficient r m Cinchona, combination, 361 Heart Deficient rm and Yang Heart Spirit Disturbance + Heart Deficient Yin and Yang Crataegus, combination, 417 heart disease defmed,849d Leonurus, 541 Rosmarinus, 636 exhaustion + heart disease Leonurus, pair, 542 rtHeat cautions/contraindications, 140 Heart Heat + Heart Deficient Yin
.--
Anemone, combination, 197 Salvia, combination, 672-673
~:::~"t--::.-L~_:
Heart Heat + Liver Heat Capsicum, combination, 325-326 Rheum, combination, 625 Taraxacum, combination, 729 Heart Heat, clear Rheum, 620 Heart Phlegm Cold Heart Phlegm Cold + Heart Stagnant Qi Achillea, combination, 172 Cornmiphora, combination, 391
")
i ~
Heart Phlegm Heat Heart Phlegm Heat + Heart Stagnant Qi Crataegus, combination, 416 Heart Qi, stabilize Convallaria, 400 Heart Qi and Kidney Qi, tonify Convallaria, 400 Heart Qi and Yang, 312 Heart Qi Irregularity, described, xviii Heart Qi Irregularity, primary syndrome Heart Qi Irregularity + Heart Deficient Blood Crataegus, combination, 416 Heart Qi Irregularity + Heart Deficientrm Convallaria, combination, 403 Heart Qi Irregularity + Kidney Deficient Qi Convallaria, combination, 403 Crataegus, combination, 417 Glycyrrhiza, combination, 478 Sarothamnus, combination, 700 Heart Qi Irregularity + Retained Pathogen Cinchona, combination, 362 Heart Qi Irregularity Heart Spirit Disturbance vs., xviii Heart Qi Irregularity, secondary syndrome Heart Spirit Disturbance + Heart Qi Irregularity Convallaria, combination, 403 Lavandula, combination, 531 Valeriana, combination, 785 Heart Spirit Disturbance cautions/contraindications, 140, 148 Heart Qi Irregularity vs., xviii Heart Spirit Disturbance, herb for Anemone, combination. 197 Glycyrrhiza, combination, 478-479 Lavandula, combination, 531 Leonurus, combination. 544 Salvia, 670 Valeriana, combination. 785 Heart Spirit Disturbance, calm Anemone, 194 Lavandula, 537 Rosmarinus, 648 Ruta.663
The Index lists herbs by botanical name only: see the Cross references for alternative names
-
..
,...
Index
r:
I""
i
r
I
L.-.
Salvia, 681 Viburnum, 796 Heart Spirit Disturbance, primary syndrome Heart Spirit Disturbance + Deficient Blood Leonurus, combination, 544 Heart Spirit Disturbance + Heart Deficient ¥ m and Yang Crataegus, combination, 417 Heart Spirit Disturbance + Heart Qi Irregularity Convallaria, combination, 403 Lavandula, combination, 531 Valeriana, combination, 785 Heart Spirit Disturbance + Kidney fear Ruta, combination, 657 Thuja, combination, 746 Thymus, combination, 763 Heart Spirit Disturbance + Liver Stagnant Qi Lavandula, combination, 533 Heart Spirit Disturbance + Lung Stagnant Qi Anemone, combination, 197 Lavandula, combination. 532 Heart Spirit Disturbance + Stagnant Qi and Blo~d Piscidia, combination, 601 Heart Spirit Disturbance, secondary syndrome Heart Qi Irregularity vs. + Heart Spirit Disturbance, xviii Intestines Heat + Heart Spirit Disturbance Valeriana, combination, 786 Kidney fear + Heart Spirit Disturbance Ruta,combination,656 Liver Hyperactive Yang + Heart Spirit Disturbance Anemone, combination, 197 Lavandula, combination, 532 Zingiber, combination, 825 Uterus Stagnant Qi and Blood + Heart Spirit Disturbance Artemisia, combination. 249 Leonurus, combination, 545-546 Piscidia, combination. 602 Ruta, combination, 657 Heart Stagnant Blood Cinnamomum, combination, 377 Crataegus, combination, 415-416 Lobelia, combination, 560 Heart Stagnant Blood + Heart Deficient Yang Capsicum, combination. 326 Convallaria, combination, 403 Zanthoxylum, combination, 809 Heart Stagnant Qi cautions/contraindications, 140, 148 described, xviii Stagnant Blood of the Heart vs., xviii warm and move Angelica, 206 Heart Stagnant Qi, primary syndrome Heart Stagnant Qi + Lung Stagnant Qi Capsicum, combination, 326
Heart Stagnant Qi + Spleen Damp Angelica, combination. 209-210 Heart Stagnant Qi, secondary syndrome Deficient Qi and Blood + Heart Stagnant Qi Rosmarinus, combination, 641 Heart PWegm Cold + Heart Stagnant Qi Achillea, combination, 172 Commiphora, combination, 391 Heart PWegm Heat + Heart Stagnant Qi Crataegus. combination, 416 Heart Stagnant Qi + Blood Commiphora,397 Heat bitter property in clearing of, 31 clearing using a hot herb, 320-321 Heat + Deficient Kidney ¥ m, cautions, 140 Heat from Liver and Gallbladder, clear Taraxacum, 726 Heat from Stomach and Intestines, clear Taraxacum, 726 Heat in the Blood Heat in the Blood + acute eczema, 727 Scrophularia, pair, 727 Heat in the Blood + Heat Toxin Arctium, combination, 226 Rheum, combination, 625 Smilax, combination, 709 Heat in the Blood, clear Smilax, 707 Heat in the Heart Cinchona, 357 heat sensation arthritis + heat sensation Arctium, combination, 226 Berberis, combination. 282 Berberis, pair, 279 Glycyrrhiza, combination, 479 Harpagophytum, combination, 506 arthritis, chronic + heat sensation Arctium, pair, 223 bronchitis + heat sensation Asclepias, combination, 267 Berberis, combination, 281 Lobelia, pair, 562 diarrhea, acute + heat sensation Berberis, pair, 283 Potentilla, combination, 611 Rheum, combination, 624 food intolerance + heat sensation Artemisia, combination, 248 Berberis, combination, 282 hypertension + heat sensation Berberis, pair, 283 Capsicum, combination, 325-326
The Index lists herbs by botanical name only: see the Cross references for alternative names
.~. - _._--_._~ . ;.=-~.-""~-:::...~
Index
938 Lobelia, pair, 562 Rheum, 621 Rheum, combination, 625 Taraxacum, combination, 729 Valeriana, pair, 785 irritable bowel syndrome + heat sensation Lavandula, combination, 532-533 menorrhagia + heat sensation Capsella, combination, 312 Hydrastis, combination, 284 sinusitis + heat sensation Euphrasia, combination, 442 sweating + heat sensation Salvia, pair, 672 urinary infection + heat sensation Arctostaphylos, combination, 236 Echinacea, combination, 431 Hydrastis, combination, 284 Heat Toxin CiInicifuga, 353 Echinacea, combination, 431 Heat Toxin, clear Glycyrrhiza,489 Smilax,707 Heat Toxin + Retained Pathogen Arctium, 223 Heat Toxin + Wind Heat Arctium, 222 Heat Toxin, primary syndrome Heat Toxin + Phlegm Phytolacca, combination, 591 Heat Toxin + Stagnant Qi + Damp Heat Arctium, combination, 226 Heat Toxin, secondary syndrome acne + Heat Toxin + Phlegm Arctium, pair, 728 Damp Heat + Heat Toxin Harpagophytum, combination, 506 Smilax, combination, 710 Heat in the Blood + Heat Toxin Arctium, combination, 226 Rheum, combination, 625 Smilax, combination, 709 Intestines Damp Heat + Heat Toxin Potentilla, combination, 611 psoriasis + Heat Toxin + Stagnant Blood Smilax, pair, 728 Retained Pathogen + Heat Toxin Calendula, combination, 302-303 Phytolacca, combination, 591 Thuja, combination, 749t Wind Heat + Heat Toxin Phytolacca, combination, 591 Salvia, combination, 672
.-- ---
hematuria. See also urinary system Achillea, 179 cystitis + hematuria Arctostaphylos, combination, 236 Hydrastis, pair, 285 urinary infection + hematuria Arctostaphylos, pair, 235 hemoptysis Achillea, 178 hemorrhoids Hamamelis, 498 hemorrhoids, bleeding Commiphora, pair, 390 Hamamelis, topical application, 494 Potentilla, topical application, 610, 615 Quercus robur, 389 hemorrhoids, bleeding + irritation Hamamelis, pair, 495 hemorrhoids, internal Potentilla, topical application, 615 hemostatic. See also astringent Achillea, 169,175 hepatic defined, 78d supportive and moderating actions, 65t hepatic, herb as Angelica, 216 Artemisia, 246, 257 Berberis, 275, 277, 288 Calendula, 307 Centaurium, 468, 469 Cinchona, 369 Gentiana, 468, 469 Gentiana macrophylla, 469 Gentiana scabra, 469 Harpagophytum, 50S, 511 Hydrastis, 276, 277 Juniperus, 525 Lavandula, 529,537 Potentilla, 617 Rheum,632 Rosmarinus, 639, 645, 648 Salvia, 678, 682 Taraxacum, 727,734 Thymus, 769 Zanthoxylum, 807, 816 hepatic function reduced fever, recurring + hepatic function reduced Cinchona, pair, 359 hepatic weakness Capsicum, pair, 323 hepatic weakness + food intolerances Rosmarinus, pair, 640
The Index lists herbs by botanical name only: see the Cross references for alternative names
.. -
Index digestive weakness + hepatic weakness Centaurium, pair, 459 Gentiana, pair, 459 hepatobiliary disorders adverse reactions, avoiding, 141-143 Berberis, 293 Centaurium, pair, 459 Gentiana, pair, 459 Hydrastis, 293
....,~,
...
L
hepatoprotective defined, 78d Angelica, 213 Arctium, 228 Artemisia, 251,252 Centaurium,464 Cinchona, 364 Euphrasia,444 Gentiana,464 Glyeyrrhiza,483 Juniperus, 521 Myrica, 581 Rheum, 627 Rosmarinus, 645 Salvia, 678 Smilax, 711 Taraxacum, 732 Viburnum, 801 Zingiber, 828 hepatotoxicity, 141-142, 153-154 herb-drug interactions, 132-134, 145-148 herbal medicine, history of. See also Eclectic movement; Physiomedical movement 20th century, 16-17 background, 3-4 classification systems, 4, 6-11 complementary opposing forces concept, 4-5 elements theory in, 5-6 in England, 13-15, 16-17 Graeco-Roman,4-9,l1-12
L
Islamic, 12-13 materia medica, 11-17 monastic religious, contribution of, 7, 13 in North America, 14-16 in the Renaissance, 13-14 vital force concept, 4, 20 herpes Leonurus, 551 Lobelia, 564 Rheum, 628 Smilax, 713 Thymus, topical application, 769 Hippocrates, 3, 4, 5,8 HIY. See anti-HIV; immunoregulatory, HIV
homeostasis hyper- and hypo-function in, 5 variable temperature and, 24 hormonal regulator Cimicifuga, 340, 343, 351-352 hot herb, 20-21 Humulus lupulus about,840 cautionsl contraindications, 148 + Valeriana, 784 Hydrangea arborescens about,841 anti-inflammatory effects, 495 for urinary disorders, 727 + Taraxacum, 727 + Thuja, 743 Hydrastis canadensis, 274-298 Berberis compared, 288, 295-296 cautionslcontraindications, 143 Coptis compared, 296 Filipendula compared, 448 Phellodendron compared, 296 Potentilla compared, 608 for pruritus, 389 for urinary disorders, 727 Hydrastis canadensis, pairs + Althaea, 280 + Arctostaphylos, 235, 280 + Berberis, 278 + Calendula, 301 + Capsella, 311 + Capsicum, 323 + Centaurium, 459 + Commiphora, 390, 391 + Echinacea,279,427,429 + Euphrasia, 279, 441 + Filipendula, 280 + Gentiana,459 + Geranium, 280 + Hamamelis,495 + Leonurus, 543 + Lobelia, 280, 559 + Mahonia,728 + Myrica, 280, 577 + Polygonum,280 + Rheum, 623 + Sambucus, 689 + Taraxacum, 727, 728 + Thuja,280, 744 + Thymus, 761 + Valeriana, 785 + Viburnum, 280, 797 + Vinca, 280 + Zingiber,823
The Index lists herbs by botanical name only: see the Cross references for alternative names
939
Index
940 hydroquinone, 239-240 Hyperactive Yang, aggravate!calm Cimicifuga, 341 hyper-function, 5, 19 . hyperglycemic Centaurium, 464 Gentiana,464 Rosmarinus, 645 Hypericum perforatum about,841 herb-drug interactions, 133 + Anemone, 196 + Cimicifuga, 343 + Crataegus, 415 + Leonurus, 543 + Ruta,655 + Thymus, 761 hyperkalemia from hypoaldosteronism Glycyrrhiza, 486 hypersensitivity, 551, 848d. See also antiallergic hypertension. See also antihypertensive adverse reactions, avoiding, 143 Achillea, pair, 170 Crataegus, pair, 414 hypertension, primary disorder hypertension + anger Taraxacum, pair, 728 hypertension + headache Berberis, pair, 283 Rheum, pair, 626 Tanacetum,combination, 717, 718 Valeriana, combination, 786 hypertension + heat sensation Berberis, pair, 283 Capsicum, combination, 325-326 Lobelia, pair, 562 Rheum, 621 Rheum, combination, 625 Taraxacum, combination, 729 Valeriana, pair, 785 hypertension + hyperlipidemia Commiphora, pair, 390 hypertension, secondary disorder atherosclerosis + hypertension Commiphora, combination, 391 Crataegus, combination, 416 atherosclerosis + hypertension + cold extremities Achillea, combination, 173 cardiac weakness + hypertension Craraegus, 422 headache + hypertension Tanacetum, pair, 717 hypnotic. See also insomnia; tranquilizer defined, 78d, 80d
.~
Piscidia, 600, 604 Valeriana, 783-784, 788, 791 hypoaldosteronism Glycyrrhiza,486 hypocholesterolemic Smilax, 712 hypochondriac pain + digestive weakness Berberis, pair, 279 hypofunction in homeostasis,S temperature and, 19 hypoglycemic Althaea, 188 Juniperus, 521 Smilax, 712 Zingiber, 828 hypolipidemic Thymus, 765 hypotension cardiac arrhythmia + hypotension Convallaria, combination, 403 Crataegus, combination, 417 Glycyrrhiza, combination, 478 Sarothamnus, 704 Sarothamnus, combination, 700 cardiac weakness + hypotension Convallaria, pair, 401 Sarothamnus, 704 Sarothamnus, pair, 699 exhaustion + hypotension Crataegus, pair, 415 hypotensive. See also antihypertensive Centaurium, 465 Cimicifuga, 347 Gentiana,465 Harpagophyturn,509 Lobelia, 563 hypothermia Cimicifuga, 347 Zingiber, pair, 822 Hyssopus officinalis about,841 + Thymus, 760
Ibn Sina, 13 immunoregulatory Althaea, 188 Angelica, 213 Berberis, 288 Calendula, 304 Echinacea, 434, 435 Filipendula,451
The Index /ists herbs by botanical name only: see the Cross references for alternative names
Index
I /iiiI.
Glycyrrhiza,483 Hydrastis, 289 Phytolacca,593 Taraxacur.n,731,732 Thymus, 758, 768 Viburnum, 801 Zingiber, 828 immunoregulatory, HIV Calendula, 304 Glycyrrhiza, 483 immunostimulatory. See also body resistance, enhancing Centaurium,463 Gentiana,463 impetigo. See also skin disorders Rheum, 628 impotence Cinnamomur.n, pair, 375 impotence + depression Rosmarinus, pair, 640 incontinence prostatitis + incontinence Thuja, pair, 743 indications (ofaherb),57d indigestion. See also antacid depression + indigestion Berberis, pair, 279 Myrica, pair, 576 infection, chronic infection, chronic + catarrh Echinacea,427 Thymus, pair, 761 infection, recurring Thuja, 741 Thuja, pair, topical application, 744 Thymus, pair, 760 infection, severe acute Echinacea,427 infection prevention Echinacea,427,434 Echinacea, pair, 430 Thymus, 758 infertility. See also antifertility Achillea, 178 Cimicifuga,352 uterine stimulant/relaxant for, 352 infertility, primary disorder infertility + nervous tension Ruta,654 Ruta, pair, 655 infertility + obesity Phytolacca, pair, 593 Ruta, combination, 657 Ruta, pair, 655 Thuja, pair, 748
941
inflammation, chronic Thymus, pair, 761 influenza Capsicum, pair, 324 Cinnamomum, pair, 374-375 Myrica, pair, 576 Sambucus, pair, 689 influenza, primary disorder influenza + bronchitis Thymus, pair, 760 influenza + circulation, poor peripheral Zanthoxylum, pair, 808 influenza + cold sensation Zingiber, pair, 822 influenza + fever Achillea, pair, 170 Asclepias, combination, 266 Asclepias, pair, 265 Zingiber, combination, 823 Zingiber, pair, 822 influenza + headache Achillea, pair, 169 influenza + laryngitis Achillea, pair,169 influenza + myalgia Achillea, pair, 169 influenza + sinus congestion Achillea, pair, 169 Echinacea, pair, 430 Myrica, pair, 576 Sambucus, combination, 689 influenza + sinus congestion + chills Sambucus, pair, 689 influenza + sinusitis Achillea, combination, 171 Angelica, combination, 208 Angelica, pair, 207 Sambucus, combination, 690 Zingiber, combination, 823 influenza + sore throat Achillea, combination, 170-171 Achillea, pair, 169 Sambucus, combination, 689 influenza, recurring Achillea, pair, 170 Berberis, pair, 278 Cinchona, pair, 359 infusions, 102-106 inoculations. countering adverse effects Thuja,753 insect bites/stings Calendula, topical application, 300 Potentilla, pair, topical application, 608 poisonous
The Index lists herbs by botanical name only: see the Cross references for alternative names
Index
942 Echinacea, topical application, 437 Ruta,664 insomnia. See also hypnotic Anemone, combination, 197 Anemone, pair, 196 Glycyrrhiza,475 Glycyrrhiza, pair, 478-479 Lavandula, combination, 531 Valeriana,788 Valeriana, combination, 785 insomnia in children Lavandula, pair, 530 insomnia, primary disorder insomnia + agitation Valeriana, pair, 78-1 insomnia + Deficiency Piscidia, pair, 600 insomnia + fearful dreams Piscidia, pair, 601 insomnia + fearfulness Ruta, pair, 655 insomnia + headache Valeriana, pair, 784 insomnia + muscle spasms Lavandula, pair, 534 Lobelia, pair, 562 Piscidia, combination, 601 insomnia + nervous tension Lavandula, pair, 530 insomnia + neuralgia Piscidia, pair, 601 nervous exhaustion + insomnia Lavandula, pair, 530 insomnia, secondary disorder depression + insomnia. 528 headache + insomnia Salvia, pair, 671 Tanacetum, pair, 716, 717 interaction. See also combinations herb-drug, 131-134.143 negative, 87, 132d positive, 131-132 interaction assessment, 86-87 intestinal astringent Hamamelis, 494-495 Potentilla, 609, 616 intestinal spasms Juniperus, 525 intestines, terminology convention, xviii Intestines Cold Stagnant Qi and Blood + Intestines Cold Commiphora, combination, 392 Zanthoxylum, combination, 811
Intestines Damp Heat Potentilla, combination, 611 Rheum, combination, 624 Intestines Damp Heat + Heat Toxin Potentilla, combination, 611 Intestines Deficient Qi Intestines Stagnant Qi + Intestines Deficient Qi Rheum, combination, 624 Intestines Heat Althaea, combination, 186-187 Glycyrrhiza, combination, 478 Hydrastis, combination, 284 Intestines Heat + Heart Spirit Disturbance Valeriana, combination, 786 Intestines Qi Disturbance + Intestines Heat Lavandula, combination, 532-533 Spleen Deficient Qi + Intestines Heat Centaurium, combination, 461 Gentiana, combination, 461 Intestines Phlegm Damp Intestines Phlegm Damp + Spleen Deficient Qi Hamamelis, combination, 496 Myrica, combination, 579 Intestines Qi Disturbance described, xviii Intestines Qi Disturbance + Cold Rosmarinus, combination, 642 Intestines Qi Disturbance + Intestines Heat Lavandula, combination, 532-533 Intestines Stagnant Qi + Intestines Qi Disturbance Juniperus, combination, 519 Lobelia, combination, 561 Intestines Stagnant Qi Intestines Stagnant Qi + Cold Zingiber. combination, 824 Intestines Stagnant Qi + Intestines Deficient Qi Rheum, combination, 624 Intestines Stagnant Qi + Intestines Qi Disturbance Juniperus, combination, 519 Lobelia, combination, 561 Rheum, combination, 623-624 Iris versicolor about,841 as alterative, 708 + Arctium, 224 + Berberis, 279 + Phytolacca, 590 irritability arthritis + irritability Harpagophytum. pair, 505 headache + irritability, 601 Valeriana, pair, 785 irritable bowel syndrome Lavandula,528
The Index /!sts herbs by botanical name only: see the Cross references for alternative names
Index Lavandula, pair, 530 irritable bowel syndrome + cold sensation Lavandula, pair, 534 Lobelia, pair. 562 Myrica, pair, 581 Rosmarinus, combination, 642 irritable bowel syndrome + heat sensation Lavandula, combination, 532-533 Islamic medicine. history of. 12-13
J Johnson. Thomas. 14 joints. cold, numb Rosmarinus, topical application, 649 Juniperus communis. 513-526 cautions/contraindications, 144,146 + Angelica archangelica, 516 + Arctostaphylos, 235, 516 + Citrus,516 + Mentha pulegium. 517 + Parietaria,516 + Petroselinum root, 516
+ Ruta,655
+ Schisandra. 516 + Taraxacum, 516. 729 + Thuja, 516 + Thymus, 516 + Turnera, 516, 774 + Viola tricolor, 516 + Zanthoxylum, 809 Juniperus rigida, 513
K ,. l
Kidney and Liver Qi and Yin, tonify Cimicifuga, 341 Kidney Deficient Qi, primary syndrome Kidney Deficient Qi + Damp Juniperus, combination, 518 Taraxacum, combination, 730 Kidney Deficient Qi + Kidney fear Anemone, combination, 197 Ruta, combination, 656 Kidney Deficient Qi + Liver Stagnant Qi Turnera, combination, 775, 776 Kidney Deficient Qi, secondary syndrome Bladder Phlegm Cold + Kidney Deficient Qi Thuja, combination, 745 Heart Deficient Qi + Kidney Deficient Qi + Damp Convallaria, combination, 402 Sarothamnus, combination, 700 Tara:<:acum. combination, 730
943 Heart Qi Irregularity + Kidney Deficient Qi Convallaria, combination, 403 Crataegus, combination, 417 Glycyrrhiza, combination, 478 Sarothamnus, combination, 700 Spleen Deficient Qi + Kidney Deficient Qi Juniperus, combination, 519 Spleen not holding Blood + Kidney Deficient Qi Capsella, combination, 312 Kidney Deficient Yang Cinnamomum, combination, 377 Turnera, combination, 774 Kidney Deficient Yang, primary syndrome Kidney Deficient Yang + Cold Cinnamomum, combination, 376 Kidney Deficient Yang + Heart Deficient Qi Turnera, combination, 774-775 Kidney Deficient Yang + Kidney Deficient Yin Turnera, combination, 775 Kidney Deficient Yang, secondary syndrome Heart Deficient Yang + Kidney Deficient Yang Capsicum, combination, 326 Convallaria, combination, 402 Crataegus, combination, 418 Turnera, combination, 774 Kidney Deficient Y'm Kidney Deficient Y'm + Liver Deficient Yin Cimicifuga. combination, 345 Bladder Heat + Kidney Deficient Yin Althaea. combination. 187 Arctostaphylos. combination. 236-237 Kidney Deficient Yang + Kidney Deficient Y'm Turnera, combination, 775 Kidney fear Anemone, 194 Ruta, 652. 663 Kidney fear. primary syndrome Kidney fear + Heart Spirit Disturbance Ruta, combination, 656 Kidney fear + Liver Hyperactive Yang Ruta.652 Kidney fear. secondary syndrome Heart Spirit Disturbance + Kidney fear Ruta, combination, 657 Thuja. combination, 746 Thymus, combination, 763 Kidney Deficient Qi + Kidney fear Anemone. combination. 197 Ruta, combination, 656 Kidney Stagnant Qi + Kidney fear Anemone. combination, 197-198 Kidney Fear invades the Heart. xviii KidneyQi astringent effect on Juniperus, 524
The Index lists herbs by botanical name only: see the Cross references for alternative names
Index
944 tonify Ruta, 663 Kidney Qi and Yang, 322
Lavandula spica. 527 Lavandula stoechas, 527 Lavender species, chemical differences, 533-534
Kidney Stagnant Qi, xviii Kidney Stagnant Qi + Kidney fear Anemone, combination, 197-198 Kidney Yang and Qi, tonify Turnera,772
laxative defined, 78d abuse of, 630 adverse effects, potential, 630
L lactation adverse reactions, avoiding in infants, 146 antilaetation Zanthoxylum, 813 excessive Salvia, 682 Larrea tridentata, 142 laryngitis Euphrasia, pair, topical application, 441 Salvia, 682 Thymus, topical application, 769 laryngitis, acute Comrniphora, pair, 390 laryngitis, chronic Commiphora, pair, 390 Comrniphora, pair, topical application, 391 laryngitis, primary disorder laryngitis + dryness Althaea, pair, 185 laryngitis, secondary disorder bronchitis, chronic + laryngitis Commiphora, pair, 391 influenza + laryngitis Achillea, pair,169 lavandins,527 Lavandula angustifolia, 527-538 energy direction of,637 + Anemone, 196,530 + Artemisia, 247 + Avena, 530 + Leonurus, 530, 543 + Mentha piperita, 530 + Nepeta, 530 + Ophiopogon, 530 + Passiflora, 530 + Piscidia, 601 + Rosmarinus, 530, 640 + Ruta,655 + Salvia officinalis, 530, 671 + Tanacetu'm, 530, 716, 717 + Thymus, 761 + Valeriana, 530, 784 + Verbena, 530 + Zingiber, 822
.'.",
laxative, herb as Althaea, 184 Arctium, 223, 231 Berberis, 287, 293 Hydrastis, 293-294 Lobelia,564,570 Rheum,621,628,630, 632 Sambucus, 694 Taraxacum,727,732,735 Turnera, 773 laxative, mild herb Glycyrrhiza, 476,488 Turnera,n9 LD,849d Leonurus cardiaca. 539-552 Crataegus vs., 540 Leonurus heterophyllus compared, 551 Sarotharnnus vs., 540 Leonurus cardiaca, pairs + Anemone, 196 + Cinchona, 359, 543 + Convallaria, 402 + Crataegus, 415, 543 + Hydrastis, 543 + Hypericum, 543 + Lavandula, 530, 543 + Panax ginseng, 542 + Passiflora, 543 + Ruta, 543, 654 + Salvia rniltiorrhiza, 543 + Salvia officinalis, 543, 671 + Sarothamnus, 699 + Thuja, 543 + Viburnum, 543 Leonurus heterophyllus about,539 Leonurus cardiaca compared, 551 Sarothamnus vs., 539-540 leukorrhea Achillea, 178 Echinacea, pair, 429 Myrica, pair, 5n Myrica, topical application, 577, 584 Potentilla, topical application, 610,615 vaginitis + leukorrhea Arctostaphylos, pair, 235 Linnaeus, Carl, 14, 15 L
The Index lists herbs by botanical name only: see the Cross references for alternative names
I
Index
rdIi·
;.
l1--
\,. .. -
lipid regulation Capsicum, 330 Liver and Gallbladder Qi, warm, tonify and move Myrica,574 Liver Damp Heat Damp Heat in the channels + Liver Damp Heat Berberis, combination, 282 Liver Stagnant Qi + Liver Damp Heat Artemisia, combination, 248 Berberis, combination, 282 Liver Deficient Blood Liver Hyperactive Yang + Liver Deficient Blood Artemisia, combination, 248 Salvia, combination, 673-674 Liver Deficient Qi Liver Deficient Qi + Liver Stagnant Qi, cautions, 140, 142-143 Retained Pathogen + Liver Deficient Qi Achillea, combination, 171-172 Artemisia, combination, 248 Berbe~, combination, 281 Centaurium, combination, 460 Gentiana, combination, 460 Liver Deficient Y'm Kidney Deficient Yin + Liver Deficient Y'm Cimicifuga, combination, 345 liver disease, dosage cautions, 101 Liver-Gallbladder Damp Heat Berberis, combination, 281-282 Taraxacum. combination, 729 Liver Heat Heart Heat + Liver Heat Capsicum, combination, 325-326 Rheum, combination, 625 Tara;{acurn, combination, 729 Liver Hyperactive Yang + Liver Heat Tanacetum, combination, 717, 718 Valeriana, combination, 786 Lung Phlegm Heat + Liver Heat Asclepias, combination, 267 Berberis, combination, 281 Stomach Heat + Liver Heat Rheum, combination, 625 Tara.'
945 Liver Hyperactive Yang + Heart Spirit Disturbance Anemone, combination, 197 Lavandula, combination, 532 Zingiber, combination, 825 Liver Hyperactive Yang + Liver Deficient Blood Artemisia, combination, 248 Salvia, combination, 673-674 Liver Hyperactive Yang + Liver Heat Tanacetum,combination, 717, 718 Valeriana, combination, 786 Liver Hyperactive Yang + Liver Stagnant Qi Artemisia, combination, 248 Rosmarinus, 637 Ruta, combination, 657 Salvia, combination, 674 Liver Hyperactive Yang + Liver Stagnant Qi + Interior Cold Rosmarinus, 637 Liver Hyperactive Yang + Liver Wind Cimicifuga, 340 Liver Hyperactive Yang + Spleen Deficient Qi Rosmarinus, 637 Liver Hyperactive Yang + Stagnant Qi and Blood in channels Piscidia, combination, 602 Rosmarinus, combination, 642-643 Valeriana, combination, 786 Liver Hyperactive Yang + Uterus Stagnant Qi and Blood Cimicifuga, combination, 344 Liver Hyperactive Yang + Wind Cold Salvia, combination, 673 Liver Hyperactive Yang + Wind Heat Tanacetum, combination, 718 Liver Hyperactive Yang, secondary syndrome Kidney fear + Liver Hyperactive Yang Ruta,652 Liver invades Spleen Rosmarinus, combination, 642 Liver Stagnant Qi Ruta,652 Liver Stagnant Qi, primary syndrome Liver Stagnant Qi + Cold Centaurium, combination, 461 Gentiana, combination, 461 Rosmarinus, combination, 641 Liver Stagnant Qi + Cold + Damp and Phlegm Myrica, combination, 578 Liver Stagnant Qi + Liver Damp Heat Artemisia, combination, 248 Berberis, combination, 282 Liver Stagnant Qi, secondary syndrome . Heart Spirit Disturbance + Liver Stagnant Qi Lavandula, combination, 533 Kidney Deficient Qi + Liver Stagnant Qi Turnera, combination, 775
The Index lists herbs by botanical name only: see the Cross references for alternative names
Index
946 Liver Deficient Qi + Liver Stagnant Qi cautions!contraindications, 140, 142-143 Liver Hyperactive Yang + Liver Stagnant Qi Artemisia, combination, 248 Flosmarinus, 637 Fluta, combination, 657 Salvia, combination, 674 Liver Hyperactive Yang + Liver Stagnant Qi + Interior Cold Rosmarinus, 637 LiverWmd Viburnum, 796 Uterus Stagnant Qi and Blood + Liver Wmd Cimicifuga, combination, 344-345 Liver Yang, calm Fluta, 652, 663 Lloyd, J. U., 16,99 Lobelia chinensis about, 553 comparison of Lobelia species, 571 Lobelia inflata, 553-572 cautions/contraindications, 141, 146 Lobelia inflata, pairs + Anemone, 196 + Angelica, 558 + Asclepias, 265, 558 + Capsicum, 323, 325, 559 + Cimicifuga, 343 + Crataegus, 558 + Ephedra, 558 + Glycyrrhiza,477 + Hydrastis, 280,559 + Mentha pulegium, 559 + Piscidia, 601 + Prunus, 558 + Rheum, 559, 623 + Thuja,558 + Thymus, 761 + Valeriana, 559, 785 + Viburnum, 797 + Zingiber, 559, 822 Lobelia species comparison, 571 Lower Burner Damp Heat Arctostaphylos, combination, 237 Thuja, combination, 746 Lung Deficiency Heat Lung Deficiency Heat + Lung Deficient Yin Althaea, combination, 186 Glycyrrhiza, combination, 478 Lung Deficient Qi, cautions, 140 Lung Deficient rm Lung Deficiency Heat + Lung Deficient Yin Althaea, combination, 186 Glycyrrhiza, combination, 478 Lung Dryness, cautions, 140
Lung Heat Wind Heat + Lung Heat Asclepias, combination, 266 Zingiber, combination, 823 Lung Phlegm cautions!contraindications, 140 Thymus,.combination, 762 Lung Phlegm, clear, 32, 688 Lung Phlegm + Damp, cautions, 140 Lung Phlegm Cold Euphrasia, combination, 442-443 Lung Phlegm Cold + Heart Deficient Qi Capsicum, combination, 327 Thuja, combination, 745 Lung Phlegm Cold + Spleen Deficient Yang Angelica, pair, 208 Commiphora, combination, 392 Zingiber, combination, 824 Lung Phlegm Cold, dear Myrica,574 Lung Phlegm Damp Lung Phlegm Damp + Spleen Damp Angelica, combination, 209 Myrica, combination, 578 Lung Phlegm Damp + Spleen Deficient Qi Juniperus, combination, 518 Lung Phlegm Heat Euphrasia, combination, 442 Hydrastis, combination, 283-284 Phytolacca, combination, 591 Sambucus, combination, 690 Lung Phlegm Heat + Liver Heat Asclepias, combination, 267 Berberis, combination, 281 Lung Phlegm Heat + Wind Heat Asclepias, combination, 266-267 Echinacea, combination, 430 Lobelia, combination, 560 Lung Flebellious Qi Lobelia, combination, 560 Thymus, combination, 762 Lung Stagnant Qi described, xviii Lobelia, combination, 560 Heart Spirit Disturbance + Lung Stagnant Qi Anemone, combination, 197 Lavandula, combination, 532 Heart Stagnant Qi + Lung Stagnant Qi Capsicum, combination, 326 Lycium chinense, 841 Lyle, T.J., 15-16 lymphadenitis Arctium, 708 Arctium, pair, 227
The Index t'sts herbs by botanical ntlme only: see the Cross references for alternative names
Index
.....
.,.. -
Calendula, combination, 302-303 Calendula, pair, 301 Galium, 708 Phytolacca. combination, 591 Phytolacca, pair, 590 Smilax, pair, 708 Thuja, 741 Thuja, combination, 749t lymphatic Calendula, 306 Thuja, 753
M
~.
!
Mahonia aquifolium as alterative, 708 Native American use, 273 + Arctium, 223 + Hydrastis, 728 + TaraxacUm, 728 malabsorption syndromes Artemisia, pair, 246 Centaurium, pair, 459 Gentiana, pair, 459 Marrubium vulgare about, 841 + Achillea, 170 + Althaea, 185 + Commiphora, 391 + Thymus, 761 mastitis Thymus, topical application, 769 materia medica, history of, 11-17 Matricaria parthenium. See Tanacetum parthenium Matricaria reeutita, 841 Medicines Act 1968, UK, 135 Medicines (Supply of Herbal Remedies) Order 1977, UK, 135 Medicines (General Sale List), UK, 135 memory enhancement Lobelia, 563 menopausal disorders Cimicifuga,348-349 Crataegus. pair, 415 Leonurus, 541 Leonurus, pair, 543 Salvia, 668 menopausal disorders, primary disorder menopausal disorders + depression Anemone, pair, 196 menopausal disorders + exhaustion Cimicifuga, combination, 345 Ruta, pair, 659 menopausal disorders + hot flashes Salvia, pair, 671
947
menopausal disorders + palpitations Salvia, pair, 671 menopausal disorders + rheumatism Cimicifuga, combination, 345 Salvia, pair, 675 menopausal hot flashes Anemone, combination, 197 Cimicifuga, 340 Cimicifuga, pair, 343 Salvia, combination, 672-673 Salvia, pair, 671 Valeriana, pair, 784 menopausal neurosis Anemone, pair, 196 menopausal night sweats Salvia,669 menorrhagia Achillea, 178 Myrica, pair, 577 menorrhagia, primary disorder menorrhagia + anemia Capsella, combination, 312 Myrica, pair, 581 menorrhagia + cold sensation Capsella, pair, 311 Myrica, combination, 579-580 menorrhagia + debility Achillea, pair, 170 menorrhagia + dysmenorrhea Viburnum, pair, 797 menorrhagia + exhaustion Capsella, combination, 312 Capsella, pair, 311 menorrhagia + heat sensation Capsella, pair, 312 Hydrastis, combination, 284 menorrhagia, severe Capsella, combination, 311-312 menstrual disorders menstrual disorders + anxiety Lavandula, pair, 534 Leonurus, 541 Leonurus, combination, 545 Leonurus, pair, 543 Ruta, pair, 659 menstruation. See also emmenagogue adverse reactions, avoiding, 144 irregular Salvia, 668 mental stimulant Juniperus, 525 Juniperus, combination, 519 Juniperus, pair, 516 Ruta, pair, 655
The Index lists herbs by botanical name only: see the Cross references for alternative names
Index
948 Mentha piperita about. 841 + Achillea, 169 + Lavandula, 530 Mentha pulegium about,841 + Anemone, 196 + Juniperus, 517 + Lobelia, 559 + Salvia, 671 + Tanacetum, 716 + Thymus, 761 + Zingiber. 822 metabolism arbutin Arctostaphylos, 239 eicosanoid Zingiber, 828 glucocorticoid Glycyrrhiza,484 mineralocorticoid Glycyrrhiza,485-486 rate changes Capsicum, 329 Middle Burner regulation Smilax, 707 migraine. See also antirnigraine; headache Anemone, pair, 196 Lavandula, 528 Lavandula, pair, 530 Rosmarinus, 637 Tanacetum,716 mineralocorticoid metabolism Glycyrrhiza, 485-486 miscarriage. See also antiabortive causes of Juniperus and, 146 habitual Viburnum, combination, 799 partus praeparator, 79d reducing risk of, 68 threatened Lobelia, 570 Viburnum, 802 Viburnum, combination, 798-799 Viburnum, pair, 797 uterine antispasmodic for, 570 Mitchella repens about,841 + Rubus,799 + Viburnum, 797 moderation technique in side effect reduction, 101, 153. 156 moderator of herbs. See also enhancer of other herbs about, 87
Glycyrrhiza,476,489 Glycyrrhiza, pair, 477 Zingiber, 833 moderator of inocu1atory drugs, 753. See also enhancer of
..
antibiotic drugs molasses blackstrap, 841 + Centaurium, 458 + Gentiana, 458 monastic religious. 13 morning sickness. See also pregnancy Hydrastis, 295 Zingiber for relieving. 146 mouth disorders Myrica, topical application, 577 Potentilla, pair, topical application, 608 Potentilla, topical application, 610 mouth infections .Hydrastis, pair, 280 mouth ulcers Commiphora, pair, topical application, 391 Commiphora, topical application, 389, 397 Potentilla, topical application, 610,615 move and tonify Spleen and Liver Qi Artemisia, 244 move Heart Blood Convallaria, 400 move Liver Qi Salvia, 668 move Liver Qi + calm Yang and Heart Artemisia, 244 move Stagnant Qi and Blood Viburnum, 796 move Stagnation of Qi in Muscle channels Cimicifuga, 340 move the Blood, 620 mucus, expectoration of bloody Achillea, 178 mucus colitis Hamamelis, pair, 495 mucus in the stools colitis + mucus in the stools Hamamelis, combination, 496 Myrica, combination, 579 diarrhea + mucus in the stools Commiphora, pair, 390 mucus membranes, atonic, tonic for, 440 mucus secretion/accumulation. See also anticatarrhal; catarrh; expectorant expectorant vs. anticatarrhal, 69 Phytolacca, 588 multiple sclerosis Cinchona, 369
The Index li::ts herbs by botanical name only: see the Cross references for alternative names
';f.,
Index muscle contractions stimulation of Berberis, 287 in uterus, regulator of Cimicifuga, 340 muscle cramps. See also antispasmodic Zanthoxylum, pair, 808 muscle cramps + cold extremities Viburnum, pair, 800 Zanthoxylum, combination, 810 muscle pain. See myalgia muscle spasms. See also antispasmodic Glycyrrhiza, 489 insomnia + muscle spasms Lavandula, pair, 534 Piscidia, combination, 601 muscle tension headache + muscle tension Zingiber, pair, 822 muscle tonic Hamamelis, 500 muscle tremors headache + muscle tremors Cirnicifuga, pair, 343
•
myalgia Cimicifuga, 343 Hamamelis, topical application, 494 Lavandula, topical application, 538 Potentilla, pair, topical application, 608 Salvia, 669 cold as cause of Salvia, pair, 671 myalgia + cardiac weakness Salvia, pair, 672 myalgia, secondary disorder cardiovascular weakness + myalgia Cinchona, pair, 359 fever, recurring + myalgia Cinchona, combination, 360 Cinchona, pair, 359 Zanthoxylum, pair, 808 headache + myalgia Rosmarinus, pair, 640 Salvia, combination, 673 Tanacetum, pair, 716, 717 influenza + myalgia Achillea, pair, 169 Myrica cerifera, 573-585 + Angelica archangelica, 576 + Capsella, 581 + Capsicum, 323, 576 + Commiphora, 390, 391, 577 + Hamamelis,495 + Hydrastis, 280, 577
949 + Phytolacca, 577, 590 + Polygonum, 577 + Potentilla, 577, 581 + Rosmarinus, 581
+ Sanguinaria, 576 + Thuja, 576, 581, 744 + Urtica, 577 + Zanthoxylum, 576, 581, 808 + Zingiber, 576 Myrica gale, 573 Myrica pensylvanica, 573 Myrica rubra, 573 Myrica species comparison, 584
N nails, fungal infection Commiphora, pair, topical application, 391 name, botanical, 847d narcotic analgesics, 68d nasal polyps Myrica, topical application, 584 Nationallnstitute of Medical Herbalists, UK (NIMH), 16, 127 nausea morning sickness Zingiber for relieving, 146 nausea + digestive we~ess Centaurium, combination, 460-461 Gentiana, combination, 460-461 nausea + vomiting Zingiber, combination, 824 Nepeta cataria about,841 + Lavandula, 530 nephroprotective Arctostaphylos, 239 nephrotoxicity,l44 nervine. See also tranquilizer defined, 78-79d, 80d Anemone, 203 Arctium, 231 Capsicum, 333 Cimicifuga, 343, 351, 352 Cinchona, 369 Convallaria, 40 1, 408 Hydrastis, 292 Lavandula, 529, 537 Rosmarinus,647 Salvia,681 Thuja,754 Thymus, 760 nervine, stimulant Valeriana, 792
The Index lists herbs by botanical name only: see the Cross references for alternative names
950
Index _I
nervous exhaustion nervous exhaustion + depression Lavandula, pair, 530 nervous exhaustion + insomnia Lavandula, pair, 530 nervous exhaustion + nervous tension Lavandula, pair, 530 nervous exhaustion + palpitations Lavandula, pair, 530 nervous system and behavior, 147-149 nervous tension Capsicum, combination, 326 nervous tension, primary disorder nervous tension + cold sensation Valeriana, pair, 784 nervous tension + exhaustion Anemone, pair, 196 nervous tension, secondary disorder amenorrhea + nervous tension Artemisia, combination, 249 Artemisia, pair, 247 Ruta, 654 Ruta,combination, 657 'Salvia, pair, 675 asthma + nervous tension Anemone, pair, 196 Valeriana, pair, 785 colitis + nervous tension Glycyrrhiza, pair, 481 Valeriana, combination, 786 Valeriana, pair, 784 dysmenorrhea + nervous tension Lobelia, pair, 559 Piscidia, combination, 602 gastritis + nervous tension Valeriana, pair, 785 headache + nervous tension Artemisia, pair, 247 Lavandula, pair, 530 Rosmarinus, pair, 640 Salvia, pair, 671 Zingiber, pair, 822 infertility + nervous tension Ruta,654 Ruta, pair, 655 insomnia + nervous tension Lavandula, pair, 530 nervous exhaustion + nervous tension Lavandula, pair, 530 premenstrual syndrome + nervous tension· Ruta,654 Ruta, pair, 655 shingles + nervous tension Ruta, pair, 655
neuralgia Capsicum, topical application, 324 Lobelia, pair, topical application, 559 Lobelia, topical application, 570 neuralgia, facial headache + facial neuralgia Lavandula, pair, 534 Piscidia, combination, 602 Rosmarinus, combination, 642-643 Valeriana, combination, 786 neuralgia, intercostal Lavandula, topical application, 538 neuralgia, primary disorder neuralgia + cold sensation Piscidia, pair, 600, 601 neuralgia, secondary disorder insomnia + neuralgia Piscidia, pair, 601 neuralgia, trigeminal Valeriana, pair, 784 neuron regenerating Euphrasia, 444 neutral-cool herb, 25 neutral herb, 22 nightmares. See also dreams, fearful Lavandula, pair, 534 Ruta, combination, 657 Ruta, pair, 655 Thymus, combination, 763 Thymus, pair, 761 night sweats. See also sweating fever, recurring + night sweats Cinchona, combination, 361 Cinchona, pair, 359 Salvia, pair, 675 menopausal Salvia, 669 NIMH (National Institute of Medical Herbalists, UK), 16, 127 nomenclature, binomial, 847d norepinephrine release Lobelia, 563 normalizing emmenagogue, 77 d NSAID side effects, 475 nutritive, 79d. See also tonic, nutritive NYHA classification, 849d
o obesity Phytolacca, 588 obesity, secondary disorder amenorrhea + obesity Phytolacca, pair, 590 Thuja, pair, 744
The Index lists habs by botanical name ollly: see the Cross references for alternative names
Index depression + obesity Angelica, combination, 209-210 infertility + obesity Phytolacca, pair, 593 Ruta, combination, 657 Ruta, pair, 655 Thuja, pair, 748 rheumatism + obesity Zanthoxylum, pair, 809 sinusitis, chronic + obesity Angelica, combination, 209 Angelica, pair, 208 sinusitis + obesity Myrica, combination, 578 Phytolacca, pair, 593 Thuja, pair, 748 Ophiopogon japonicus about, 842 cautions/contraindications, 140,141 Filipendula compared, 448 Ophiopogon japonicus, pairs + Althaea, 185 + Artemisia, 247 + Cinchona, 359 + Filipendula, 449 + Glycyrrhiza,477 + Lavandula,530 + Salvia, 672 organ syndromes, Chinese, 139-140 orobanche (broomrape), 697 OTC (over-the-counter sales), 126, 135-136 oxytocic. See also childbirth defined,79d Sarothamnus, 702, 705
p pain relief. See analgesic pairs, combination examples, 87-88 palpitations Anemone, pair. 195-196 Crataegus, pair, 415 Glycyrrhiza,475 Leonurus, 550 LeonurUs, pair, 543 palpitations, primary disorder palpitations + anemia Leonurus, combination. 544 Salvia, pair. 675 palpitations + anxiety Convallaria, combination, 403 Lavandula, combination. 531 Valeriana, combination, 785
951
palpitations + fearfulness Ruta, pair, 654 palpitations, secondary disorder chronic fatigue syndrome + palpitations Glycyrrhiza, pair, 475, 481 Ruta, combination, 656 Ruta, pair, 475 Salvia, pair, 675 menopausal disorders + palpitations Salvia, pair, 671 nervous exhaustion + palpitations Lavandula, pair, 530 Panax ginseng about, 842 cautions/contraindicat:ons, 142, 143 herb-drug interactions, 133-134 reproductive system carcinoma and, 147 warfarin with, 143 Panax ginseng, pairs + Capsicum, 323 + Centaurium, 458 + Cinchona, 359 + Cinnamomum (bark), 375 + Convallaria, 40 1 + Gentiana,458 + Glycyrrhiza, 477 + Leonurus, 542 + Rosmarinus, 639 + Sarothamnus, 699 + Turnera, 773 Panax quinquefolium about, 842 reproductive system carcinoma and, 147 + Echinacea, 429 Parietaria diffusa about, 842 for urinary disorders, 727 + Juniperus, 516 + Taraxacum, 727 partus praeparator, 79d Passiflora incarnata about,842 + Anemone, 196 + Crataegus,415 + Lavandula, 530 + Leonurus, 543 patient, the informed choice- risk:benefit ratia, 152 monitoring by, 154 side effects acceptability to, 155-156 peptic ulcer. See also ulcers Calendula, combination, 302 Filipendula, combination, 450 Filipendula, pair, 449
The Index liSTS herbs by botanical name only: see the Cross references for alternative names
Index
952 Glycyrrhiza, 490 Glycyrrhiza, combination, 478 Hydrastis, combination, 284 Rheum, 621 Tara.~acum, pair, 728 Valeriana, combination, 786 peptic ulcer + bleeding Calendula, combination, 302 Petroselinum crispum, 144, 842 Petroselinum root + Juniperus, 516 pharmaceutical name, 849d pharyngitis Commiphora, topical application, 397 Salvia, topical application, 682 pharyngitis, chronic Commiphora, pair, topical application, 391 Phellodendron Berberiscompared,296 Coptis compared, 286, 296 Hydrastis compared, 296 phenelzine, 134 Phlegm. See also anticatarrhal; catarrh acne + Heat Toxin + Phlegm Arctium, pair, 728 Damp + Phlegm cautions, 149 Juniperus, 525 Ruta,663 Heat Toxin + Phlegm Phytolacca, combination, 591 Spleen Deficient Qi + Damp + Phlegm Angelica, combination, 209 Juniperus, combination, 518 Stagnant Qi and Blood + Phlegm Smilax, combination, 711 Stagnation of Qi and Blood + Phlegm Phytolacca, combination, 591 Thuja, combination, 749t phlegm, bronchial acute/chronic Lobelia, pair, 558 Thymus, pair, 760 Capsicum, pair, 323 Phlegm Cold, clear Zanthoxylum, 806 Phlegm Cold Damp Uterus Stagnant Qi and Blood + Phlegm Cold Damp Thuja, combination, 746 Phlegm in the channels Phytolacca, 588 phototoxicity,849d Physiomedical movement, 4-5, 7, 9,15-16, 849d. See also herbal medicine, history of
Phytolacca americana, 587-597 as alterative, 708 anti-inflammatory effects, 495 Phytolacca americana, pairs + Angelica archangelica, 208, 589 + Arctium, 224, 590, 728 + Baptisia, 590 + Echinacea, 589 + Euphrasia, 589 + Galium, 590 + Glechoma, 589 + lris,590 + Myrica, 577,590 + Smila.~, 590 + Thuja, 590, 744 + Zanthoxylum, 590, 809 Phytolacca species comparison, 597 Piscidia erythrina, 599-605 cautions/contraindlcations, 148 + Anemone, 601 + Lavandula, 601 + Lobelia, 601 + Rosmarinus, 601,639 + Valeriana, 601,784 + Zingiber, 601 Plantago lanceolata about,842 + Hamamelis, 495 Plantago major + Hamamelis,495 pleurisy Achillea, pair, 170 Pliny the Elder, 12 pneumonia + exhaustion Asclepias, pair, 265 Polygonum bistorta about,842 + Althaea, 185 + Capsella, 311 + Hydrastis, 280 + Myrica, 577 polyploidy,849d polyps, nasal Myrica, topical application, 584 Populustremuloides about,842 + Filipendula, 449 + Harpagophytum, 505 + Zanthoxylum, 808 postfebrile debility Artemisia, pair, 246 Crataegus, pair, 415 Leonurus, pair, 543 postfebrile exhaustion Centaurium, 458, 468
The Index li~ts herbs by botanical name only: see the Cross references for alternative names
-, "'I
','tl
-f'i"" 0..:•."
-""""'1 L.'
Index
:-.': ...l ,
Gentiana,468 Gentiana, pair, 458 digestive weakness + postfebrile exhaustion Cinchona, combination, 361-362 postfebrile recovery Cinchona, pair, 359 Echinacea, pair, 429 postnatal disorders. See also childbirth; pregnancy Leonurus, 541 Leonurus, pair, 543 Rosmarinus, 637 Salvia,668 depression + exhaustion Rosmarinus, combination, 641 Salvia. pair, 675 mastitis Thymus, topical application, 769 postnatal pain Viburnum, 803 postnatal pain + anxiety Leonurus, combination, 545-546 postnatal pain + bleeding, 285 Lobelia, pair, 562 Viburnum, combination, 798 Viburnum, pair, 797 Potentilla anserina, 607, 613-614, 617 Potentilla canadensis, 607,617 Potentilla erecta, 607-618 Calendula compared, 608 Commiphora compared, 608 Hamamelis compared, 608 ~ herb-drug interaction example, 134 Hydrastis compared, 608 Potentilla ereda, pairs + Althaea, 185 + Berberis, 609 + Capsella, 311 + Cinnamomum, 609 + Geranium, 609 + Hamamelis, 609 + Myrica, 577, 581 + Pulsatilla chinensis, 609 + Rheum,609,622 Potentillareptans,607,617 Potentilla species comparison, 617 practitioners accreditationllicensing, 126 clinical safety, 151-157 qualifications and training, 122-123, 126 pregnancy. See also childbirth; morning sickness; postnatal disorders adverse reactions, avoiding during, 145-146 bleeding during Capsella, pair, 311
953
premenstrual headache Salvia,668 premenstrual syndrome Artemisia, pair, 247 premenstrual syndrome + headache Cimicifuga, combination, 344 Lavandula, pair, 534 Salvia, pair, 671 Tanacetum, pair, 716 premenstrual syndrome + headache + depression Artemisia, combination, 248 Lavandula, pair, 534 Ruta,combination,657 Salvia, combination, 674 premenstrual syndrome + nervous tension Ruta,654 Ruta, pair, 655 preservation ofherbs/tinctures, 109 prolapse Potentilla, pair, topicai application, 608 Potentilla, topical application, 610,615 prostate cancer Thuja, pair, 743 prostatic enlargement, benign Thuja, pair, 743 prostatic enlargement + sexual debility Phytolacca, pair, 593 Thuja, combination, 745 Turnera, combination, 776 prostatitis Myrica, pair, 576 Zanthoxylum, pair, 809 prostatitis + cold sensation Myrica, pair, 581 Thuja, pair, 748 Zanthoxylum, combination, 810-811 prostatitis + incontinence Thuja, pair, 743 prostatitis + infection Arctostaphylos, combination, 237 Hydrastis, pair, 285 Thuja, combination, 746 Thuja, pair, 744 prostatitis + sexual debility Thuja, pair, 743 prostatitis + urinary infection Thuja, pair, 743 Prunus serotina about,842
+ Asclepias, 265
+ Glycyrrhiza. 477 + Lobelia, 558 + Thymus, 761
The Index lists herbs by botanical name only: see the Cross references for alternative names
Index
954 pruritus Hamamelis, pair, 495 Hydrastis, 389 Potentilla, pair, topical application, 608 Pseudostellaria heterophylla about,843 + Achillea, 170 + Cinchona, 359 + Glycyrrhiza, 477 psoriasis. See also skin disorder Phytolacca, 596 Phytolacca, pair, 590 Ruta, 660 Smilax, 713 Smilax, pair, 709 Thuja, 741, 753 psoriasis, acute Arctium, combination, 226 Arctium, pair, 224 Rheum, combination, 625 Rheum, pair, 623 Smilax, combination, 709 Smilax, pair, 709 Taraxacum, combination, 729 psoriasis, chronic Arctium, pair, 224 Phytolacca, combination, 591 Smilax, combination, 711 Smilax, pair, 709 Thuja, combination, 749t psoriasis, primary disorder psoriasis + Heat Toxin + Stagnant Blood Smilax, pair, 728 psoriasis, secondary disorder arthritis + psoriasis Arctium, pair, 227 Harpagophytum, combination, 506 Smilax, combination, 710 Thuja, pair, 744 pulmonary protective Rheum,627 Pulsatilla chinensis about, 843 Anemone pulsatilla compared, 200-201, 203 cautions!contraindications, 141 + Potentilla, 609 purgative, 65t. See also la.'{ative; Rheum Pyrethrum parthenium. See Tanacetum parthenium pyrrolizidine alkaloids, 142
Q Qi bitter property in moving downward, 31 functions of, 67
Qi and Blood, warm and move Myrica,574 Zanthoxylum, 806 Qi and Ym of Kidney and liver, tonify Cirnicifuga, 340 Qi of Stomach and Intestines, warm and move Zanthoxylum, 806 Quercus robur, 389, 843 quinine!quinidine, 365-366
R Ranunculus ficaria + Hamamelis, 495 rash. St?e skin disorder reaction, adverse. See also safety; side effect defined, 847 d ascertaining, 154-155 availability and safety debate, 122 cardiovascular system, 143-144 clinical vs. theoretical, 132 data interpretation, 127-129 gastrointestinal system, 140-141 hepatobiliary system, 141-143 management of, 154-157 monitoring for, 154 nervous system and behavior, 147-149 prevention, 152-153 report examples, 129-131 reporting procedures,126-127 reproductive system, 144-i47 respiratory system, 140 risk:benefit ratio, 123-125, 152 severe, 156-157 urinary system, 144 reaction, allergic. See antiallergic reaction, idiosyncratic, 848d regulate and move Kidney Qi Ruta, 652 regulate and tonify Defensive Qi Echinacea, 426-427 regulate Heart Spirit + calm Kidney fear Thymus,758 regulate Spleen Qi Ruta, 653 regulation of herb use, 134-137 relaxant. See antispasmodic Remifemin,348-349 renal protective Rheum,627 renal system Salvia, 678 reproductive system adverse reactions, avoiding, 144-147
The Index iists herbs by botanical name only: see tht? Cross references for alternative names
-~ ..
I
Index anti-inflammatory Arctostaphylos, 241 antimicrobial Arctostaphylos, 241
-.... ....
astringent Hamamelis, 500 carcinoma in Cimicifuga racemosa, 146-147 hormones Glycyrrhiza, 484 tonic astringent Arctostaphylos, 241 respiratory disorders, acute + fever Asclepias, combination, 266-267 Echinacea, combination, 430 Glycyrrhiza, pair, 480 Lobelia, combination, 560 respiratory infection Echinacea,433 Thymus, pair, 759 respiratory infection, acute respiratory infection acute + fever Echinacea, pair, 429 Lobelia, 569 respiratory infection, primary disorder respiratory infection + fever Echinacea, pair, 427 respiratory infection, recurring Echinacea, pair, 429 Juniperus, pair, 516 Phytolacca, pair, 589 Thuja, 753 Thuja, combination, 749t Thymus, combination, 762 respiratory infection, recurring + cough Juniperus, pair, 516 cough + respiratory infection, recurring Juniperus, pair, 516 cystitis + respiratory infection, recurring Arctostaphylos, combination, 236-237 Juniperus, combination, 517 respiratory infection, secondary disorder cystitis + respiratory infection Arctostaphylos, pair, 235 fever, recurring + respiratory infection· Achillea, combination, 172 Echinacea, combination, 430 respiratory system adverse reactions, avoiding, 140 normalizing effects ofLobelia, 556 respiratory system stimulant Lobelia, 568 restlessness anger + restlessness Berberis, pair, 278
955
arrhythmia, cardiac + restlessness Convallaria, combination, 403 Salvia, pair, 675 cardiac arrhythmia + restlessness Convallaria, combination, 403 restorative. See analeptic resuscitant,67-68,70, 570 Retained Pathogen, dear Artemisia, 244 Berberis, 286 Cinchona, 357 Echinacea, 426-427 Phytolacca, 588 Thymus, 758 Retained Pathogen, primary syndrome Retained Pathogen + Bladder Damp Heat Juniperus, combination, 517 Retained Pathogen + Deficient Blood Aretium, combination, 225-226 Glycyrrhiza, combination, 479 Retained Pathogen + Deficient Defensive Qi Achillea, combination, 172 Echinacea, combination, 430 Thuja, combination, 749t Thymus, combination, 762 Retained Pathogen + Heart Deficient Qi Cinchona, combination, 361 Retained Pathogen + Heart Deficient Yin Cinchona, combination, 361 Retained Pathogen + Heat Toxin Calendula, combination, 302-303 Phytolacca, combination, 591 Thuja, combination, 749t Retained Pathogen + Liver Deficient Qi Achillea, combination, 171-172 Artemisia, combination, 248 Berberis, combination, 281 Centaurium, combination, 460 Gentiana, combination, 460 Retained Pathogen + Wind Heat Arctium, 222 Cinchona, combination, 360 Retained Pathogen, secondary syndrome Heat Toxin + Retained Pathogen Arctium,223 Heart Qi Irregularity + Retained Pathogen Cinchona, combination, 362 Wmd Heat + Retained Pathogen Arctium, combination, 224-225 Rhamnus purshiana about, 843 + Rheum, 622 Rhazes, 12-13
The Index lists herbs by botanical name only: see the Cross references for alternative names
Index
956 rheumatism. See also antirheumatic Capsicum, topical application, 324 Lobelia. topical application, 570 Rosmarinus, topical application, 649 Thymus, topical application, 769 rheumatism, primary disorder rheumatism + circulation, poor peripheral Achillea, pair, 170 rheumatism + cold extremities Capsicum, pair, 324 rheumatism + obesity Zanthoxylum, pair, 809 rheumatism, secondary disorder menopausal disorders + rheumatism Cimicifuga, combination, 345 Salvia, pair, 675 Rheum officinale. See Rheum palmatum Rheum palmatum, 619-634 herb-drug interaction example, 134 lactation and, 146 Rheum palmatum, pairs + Arctium, 224, 623 + Berberis; 279, 623 + Capsicum, 324, 622 + Foeniculum, 622 + Glycyrrhiza, 477,623 + Hydrastis, 623 + Lobelia, 559, 623 + Potentilla, 609, 622 + Rhamnus purshiana, 622 + Scrophularia, 623, 727 + Taraxacum, 623,728 + Valeriana, 785 + Zingiber, 622, 823 rhinitis acute Euphrasia. pair, 441 acute allergic Echinacea, combination, 430 Euphrasia, combination, 442 Glycyrrhiza, pair, 480 Sambucus, combination, 690 allergic Echinacea, pair, 429 Sambucus, pair, 689 ringworm Smilax, 713 Rosmarinus officinalis, 635-650 Achillea compared, 169 Angelica compared, 206 Lavandula compared. 529 Rosmarinus officinalis, pairs + Angelica. 208 + Angelica sinensis, 639
+ Artemisis, 640 + Berberis, 279,639 + Capsicum, 323, 640 + Centaurium, 459 + Crataegus, 640 + Gentiana,459 + Lavandula, 530, 640 + Myrica, 581 + Panax ginseng, 639 + Piscidia, 601,639 + Salvia officinalis, 640, 671
...
+ Tanacetum, 716, 717 + Turnera. 640,773 + Valeriana. 784 + Zanthoxylum (berries), 640
...
+ Zingiber, 640, 823 rubefacient, 79d. See also counterirritant Rubus idaeus about. 843 + Mitchella,799 Rumex crispus about, 843 cautions/contraindications, 143 + Arctostaphylos, 235 + Taraxacum, 728 Ruta graveolens, 651-665 + Anemone, 196. 654 + Artemisia, 247 + Artemisia absinthium, 655 + Cimicifuga, 343, 655 + Glycyrrhiza, 475 + Hypericum, 655 + Juniperus, 655 + Lavandula, 655 + Leonurus, 543, 654 + Salvia officinalis, 655, 671 + Schisandra, 655 + Serenoa, 655 + Thuja, 655, 748 + Thymus, 655
5 safety. See also contraindication checking; reaction. adverse Chinese organ syndromes, screening for, 139-140 in clinical practice, 151-157 dosage cautions liver disease, 101 in pregnancy, 146 increasing, 125-127.134-136 provisional combination screening for, 84, 139 quality control in manufacturing for, 125-126, 134 regulatory authority and. 123, 126-129, 134-136 standards for, 125
The Index lists herbs by botanical name only: see the Cross references for alternative names
-"
Index safety vs. risk availability of herbs in, 121-123, 126-129 conventional medicine compared, 124-1.25. 132-134 food and drink comparisons in. 123 multiple active constituents and, 122 practitioners qualifications and training in, 122-123, 126 saliva, stimulating. See sialogogue Salvia miltiorrhiza Chinese use of, 668 herb-drug interaction example, 134 Salvia officinalis compared, 683, 683t warfarin with, 143 Salvia rniltiorrhiza, pairs + Cinnamomum (twigs), 375 + Commiphora, 390 + Leonurus, 543 + Smilax, 709, 728 + Zanthoxylum, 808 Salvia officinalis, 667-685 astringent effect, 495 energy direction of, 637 Salvia miltiorrhiza compared. 683, 683t Salvia 0 fficinalis, pairs + Achillea, 169,671 + Anemone, 671 + Angelica sinensis, 672 + Artemisia, 247 + Baptisia, 671 + Cimicifuga, 343 +Cinchona,359,672 + Commiphora, 391 + Lavandula, 530.671 + Leonurus, 543, 671 + Mentha pulegium, 671 + Ophiopogon, 672 + Rosmarinus, 640, 671 + Ruta. 655, 671 + Tanacetum, 716, 717 + Zingiber, 671. 822 Sambucus canadensis, 687,694, 695t Sambucus nigra, 687-696 + Achillea, 689 + Echinacea,689 + Ephedra, 689 + Euphrasia. 441, 689 + Hydrastis, 689 + Zingiber, 689 Sambucus species comparison, 694, 695t Sambucus, williamsii, 687, 694, 695t Sanguinaria canadensis about, 843 as expectorant, 760 cautions!contraindications, 141 + Capsicum, 323 + Myrica, 576
957
Sanguisorba officinalis, 843 Sarothamnus scoparius, 697-706 cautions!contraindications, 143 herb-drug interaction example. 134 Leonurus VS., 540 Sarothamnus scoparius, pairs + Cinchona, 700 + Convallaria, 401, 699 + Crataegus,415,699 + Leonurus, 699 + Panax ginseng, 699 + Taraxacum, 700 scalds. See burns!scalds Schedule Part III of the Medicines Order 1977, UK, 135 Schisandra chinensis about,843 + Cinnamomum (bark), 376 + Juniperus, 516 + Ruta,655 sciatica Thymus, topical application, 769 Scrophularia nodosa about. 844 + Arctium, 224 + Rheum. 623, 727 + Smilu, 709 Scudder, John, 99 sedative. See also tranquilizer cautions!contraindications, 148 defined,80d Anemone, 194,203 Anemone pulsatilla, 200 Angelica, 212 Asclepias, 265, 270 Cinnamomum, 380 Lavandula, 535 Lobelia, 563 self-care components, 106 sensitivity to light, 849d sensu lato (s.l.), 849d Serenoa serrulata about, 844 + Cinnamomum (bark), 375 + Glycyrrhiza, 477 + Ruta,655 + Turnera, 773 sexual debility, primary disorder sexual debility + cold sensation Cinnamomum, combination, 377 Turnera, combination, 774 sexual debility, secondary disorder exhaustion + sexual debility Glycyrrhiza, pair, 475, 481 Ruta, pair, 475 Tumera, combination, 775
The Index lists herbs by botanical name only: see the Cross references for alternative names
--~<"':'I
958
Index
prostatic enlargement + sexual debility Phytolacca, pair, 593 Thuja, combination, 745 Turnera, combination, 776 prostatitis + sexual debility Thuja, pair, 743 sexual regulator Artemisia, 258 Ruta, 652, 664 sexual stimulant Cimicifuga,352 sexual tonic Arctium. 231 Capsicum, 333 Cimicifuga,352 Echinacea,437 Turnera, 773. 777, 779 Shao Yang stage fever Cinchona, 357 shingles + nervous tension. See also herpes Ruta, pair, 655 sialogogues, 79d side effect. See also reaction, adverse defined, 847d, 849d acceptability to the patient, 155-156 cumulative, in long-term prescriptions, 113 dosage cautions, 101 healing crisis vs., 851 idiosyncratic reactions, 102 interaction assessment for, 86-87 side effect reduction moderation technique, 101, 153, 156 monitoring in, 154 partial substitution technique. 101-102, 156 using breaks in, 113. 153 Sinking of Qi, alleviate Cimicifuga, 341 Sinking ofYang Qi Cimicifuga,353 sinus congestion Sambucus, pair. 689 bronchitis, acute + sinus congestion Asclepias, pair, 265 influenza + sinus congestion Achillea, pair, 169 Echinacea, pair, 430 Myrica, pair. 576 Sambucus. combination, 689 sinus infection Euphrasia. pair, 441 sinusitis Hydrastis. 279 Phytolacca, pair, 589
Sambucus, pair, 689 Thuja, pair, 744 sinusitis, chronic Angelica, pair, 211 Echinacea, combination, 430 Echinacea. pair, 429 Hydrastis, combination, 283-284 Phytolacca, combination, 591 Sambucus, combination, 690 sinusitis, chronic + obesity Angelica. combination, 209 Angelica, pair, 208 sinusitis, primary disorder sinusitis + bronchitis Euphrasia, pair, 441 Phytolacca, pair, 589 sinusitis + gastritis Sambucus, pair, 689 sinusitis + heat sensation Euphrasia, combination, 442 sinusitis + infection Sambucus, pair, 689
+ obesity Myrica, combination, 578 Phytolacca, pair, 593 Thuja, pair, 748 sinusitis + purulent discharge Echinacea, pair, 429
sinusit~s
sinusitis, secondary disorder bronchitis + sinusitis Phytolacca, pair, 593 Thymus, combination, 762 conjunctivitis + sinusitis Euphrasia. pair. 441 influenza + sinusitis Achillea, combination. 171 Angelica, combination. 208 Angelica. pair, 207 Sambucus, combination, 690 Zingiber, combination, 823 skin disorder. See also dermatological agent; specific disorders. e.g., boils Berberis, 294 Hydrastis. 294 Iris versicolor. 708 hypersensitivity Leonurus,551 skin disorder + constipation Arctium. pair. 224 Phytolacca, pair, 590 skin inflammation. See also sunburn Hamamelis, 498 Hamamelis, pair, 495
The Index lists herbs by botanical name only: see the Cross references for alternlltive names
-
Index Rheum, 628 Sambucus, 694 skin rash Calendula, 306 Glycyrrhiza, topical application, 489 encouraging to the surface Lobelia, 570 Zanthoxylum, 816
.-
itchy/red Calendula, topical application, 300 Potentilla, pair. topical application, 608 Rheum, 621 poison ivy/oak Lobelia, 570 skin ulcers Calendula, 306 Rheum, 628 Smila:,<,713 sleep disturbances. See hypnotic; insomnia; nightmares
I
~
slightly warm herb, 21-22 Smilax species, 707-715 comparison of Smilax species, 714t -+ Arctium, 224, 709 + Harpagophytum, 505, 709 + Phytolacca, 590 + Salvia miltiorrhiza, 709, 723 + Scrophularia,709 + Thuja, 709, 744 + Zanthoxylum, 709 smoking cessation Lobelia, 563 smooth muscle regulator Berberis, 287 Hydrastis, 289 Lobelia, 556 sore throat. See also throat disorders; tonsillitis Capsicum, pair, topical application, 324 Euphrasia, pair, topical application, 441 Myrica, topical application, 584 Potentilla, 615 Potentilla. topical application, 615 sore throat, chronic Capsicum, pair, 324 sore throat, secondary disorder influenza + sore throat Achillea, combination, 170-171 Achillea, pair, 169 Sambucus, combination, 689 sore throat, ulcerated Echinacea,437 spasmolytic. See antispasmodic species (sp.lspp.), 849d Spleen, tonify . Glycyrrhiza,439 Smilax, 707
959
Spleen and Large Intestine, tonify Turnera,772 Spleen and Liver Qi, move and tonify Artemisia, 244 Spleen and Stomach Qi, warm, tonify and move Myrica. 574 Spleen Damp Heart Stagnant Qi + Spleen Damp Angelica, combination. 209-210 Lung Phlegm Damp + Spleen Damp Angelica, combination, 209 Myrica, combination, 578 Spleen Deficient Qi Cinchona, combination, 361-362 Spleen Deficient Qi, primary syndrome Spleen Deficient Qi + Damp + Phlegm Angelica, combination, 209 Juniperus, combination, 518 Spleen Deficient Qi + Deficient Blood Centaurium, combination, 460 Gentiana, combination, 460 Spleen Deficient Qi + Deficient Blood and Qi Artemisia, combination, 248 Centaurium, combination, 460 Gentiana, combination, 460 Spleen Deficient Qi + Intestines Heat Centaurium, combination, 461 Gentiana, combination, 461 Spleen Deficient Qi + Kidney Deficient Qi Juniperus, combination, 519 Spleen Deficient Qi + Spleen Deficient Yang Rosmarinus, combination, 641 Spleen Deficient Qi + Spleen Qi Sinking Myrica, combination, 579 Spleen Deficient Qi + Spleen Stagnant Yang Capsicum, combination, 327 Spleen Deficient Qi + Stomach Rebellious Qi Centaurium, combination, 460-461 Gentiana, combination, 460-461 Spleen Deficient Qi, secondary syndrome Heart Deficient Qi + Spleen Deficient Qi, 544 Cinchona, combination, 362 Intestines Phlegm Damp + Spleen Deficient Qi Hamamelis, combination, 496 Liver Hyperactive Yang + Spleen Deficient Qi Rosmarinus,637 Lung Phlegm Damp + Spleen Deficient Qi Juniperus, combination, 518 Spleen Deficient Yang Lung Phlegm Cold + Spleen Deficient Yang Angelica, combination, 208 Commiphora, combination, 392 Zingiber, combination, 824
The Index lists herbs by botanical name only: see the Cross references for alternative names
Index
960 Spleen Deficient Qi + Spleen Deficient Yang Rosmarinus. combination, 641 Spleen not holding Blood Spleen not holding Blood + Cold Myrica, combination, 579-580 Spleen not holding Blood + Deficient Blood Capsella, combination, 312 Spleen not holding Blood + Kidney Deficient Qi Capsella, combination, 312 Spleen Qi Sinking + Spleen not holding Blood Hamamelis, combination. 496 Potentilla, combination, 612 Spleen Qi, regulate Ruta,653 Spleen Qi and Yang, 322 Spleen Qi Sinking . Hamamelis, combination, 496 Spleen Deficient Qi + Spleen Qi Sinking Myrica, combination. 579 Spleen Qi Sinking + Spleen not holding Blood Hamamelis, combination, 496 Potentilla, combination, 612 Spleen Stagnant Yang Spleen Deficient Qi + Spleen Stagnant Yang Capsicum, combination, 327 Spleen worry, calm Rosmarinus, 648 sprains Calendula, topical application, 306 Capsicum. topical application. 324 stabilize Heart Qi ConvaIlaria,400 Stagnant Blood psoriasis + Heat Toxin + Stagnant Blood Smilax. pair, 728 Stagnant Blood of the Heart vs. Heart Stagnant Qi, xviii Stagnant patterns, treatment of, 109 StagnantQi Stagnant Qi + Damp Heat + Heat Toxin Arctium, combination, 226 Glycyrrhiza, combination, 479 Phytolacca, combination. 591 Thuja, combination, 747-748 Stagnant Qi and Blood Stagnant Qi and Blood + Bladder Phlegm Cold Zanthoxylum, combination, 810-811 Stagnant Qi and Blood + Cold in the channels Angelica, combination, 209 Harpagophytum, combination, 507 Thuja, combination, 749t Zanthoxylum, combination, 810 Zingiber. combination, 824 Stagnant Qi and Blood + Deficient Blood Zanthoxylum, combination. 810
Stagnant Qi and Blood + Deficient Qi and Blood Myrica, combination. 578 Zanthoxylum, combination, 810 Stagnant Qi and Blood + Intestines Cold Commiphora, combination, 392 Zanthoxylum, combination, 811 Stagnant Qi and Blood + Phlegm Smilax. combination. 711 Heart Spirit Disturbance + Stagnant Qi and Blood Piscidia, combination, 601 Stagnant Qi and Blood in channels Liver Hyperactive Yang + Stagnant Qi and Blood in channels Piscidia, combination, 602 Rosmarinus, combination. 642-643 Valeriana, combination, 786 Stagnant Qi and Blood of the Uterus Ruta,654 Zingiber. combination, 825 Stagnation Deficient Spleen + Damp + Stagnation,141 Stagnation of Heart Qi Deficiency + Stagnation of Heart Qi Rosmarinus,636 Stagnation of Qi and Blood . Stagnation of Qi and Blood + Phlegm Phytolacca, combination, 591 Thuja, combination, 749t standardUation,125d Stellaria media, 844 sthenic, 849d stimulant. See also analeptic; antidepressant cautionslcontraindications, 147-148 defined, 67 d, 79-80d Heart Qi and Yang. 322 Kidney Qi and Yang, 322 Spleen Qi and Yang, 322 timing of the dose, 112 tonics vs., 79 warming, 333 stimulant, herb as Capsicum, 322, 333, 335 Rosmarinus, 648 stimulant, bronchial Capsicum, 335 stimulant. central nervous system Lobelia, 563 Rosmarinus,645 stimulant, circulatory defined,75d supportive and moderating actions, 64t Achillea, 167, 169, 178.179 Angelica. 207, 216 antihypertensive, 167 Biota vs. Thuja, 754
The Index lis:s herbs by botanical name only: see the Cross references for alternative names
,-
I Index Capsicum, 320, 334, 335 Commiphora, 389, 396, 397 Myrica, 575, 583 Rosmarinus, 638, 648 Thuja, 743, 752 Zanthoxylum, 806, 807,815,816 Zingiber, 821, 833 stimulant, circulatory + antimicrobial Cinchona, 368 diaphoretic + circulatory stimulant Achillea. 167 stimulant, digestive Capsicum, 334 Zingiber, 821, 828, 833 stimulant, respiratory Lobelia, 563, 568 stimulant, sexual See also aphrodisiac; sexual tonic Cimicifuga, 352 stimulant emmenagogue. See also emmenagogue defined, 77d Artemisia, 258 Leonurus, 542, 550 stimulant expectorant. See also expectorant Lobelia, 568 stimulant nervine. See also nervine Valeriana,792 Stomach Deficiency Heat Stomach Deficiency Heat + Stomach Deficient Y"m Althaea, combination, 186 Stomach Deficient Y"m Stomach Deficiency Heat + Stomach Deficient Y"m Althaea, combination, 186 Stomach Heat cautions/contraindications, 140, 1~1 Calendula, combination, 302 Cimicifuga, 353 Filipendula. combination, 450 Glycyrrhiza, combination, 478 Hydrastis, combination, 284 Valeriana, combination, 786 Stomach He~t, clear Rheum, 620 Stomach Heat, primary syndrome Stomach Heat + Bleeding from Heat Calendula, combination, 302 Stomach Heat + Liver Heat Rheum, combination, 625 Stomach Heat + Liver Heat Taraxacum, combination, 729 stomachic Tara.''<:acum, 732 Stomach Rebellious Qi cautionslcontraindications, 140 Zingiber, combination, 824
961
Spleen Deficient Qi + Stomach Rebellious Qi Centaurium, combination, 460-461 Gentiana, combination, 460-461 stomatitis Echinacea, topical application, 437 Salvia, topical application, 682 ulcerative Lavandula, topical application, 538 stones, dissolving/discharging. See antilithic stools bitter property in purging of, 31 stools, loose Deficient Spleen + loose stools, cautions, 140 stools, mucus in the colitis + mucus in the stools Hamamelis, combination, 496 Myrica, combination, 579 diarrhea + mucus in the stools Commiphora, pair, 390 strength, matching to actions, 60 stress, managing, 67 styptics, 80d subspecies (subsp./ssp.), 850d subtherapeutic dose, 98d sudorific. See diaphoretic sunburn Calendula, 389 Calendula, topical application, 300 Hamamelis, 498 Potentilla, pair, topical application, 608 support,61d surgery, postsurgical recovery Rosmarinus, 636 Zanthoxylum, pair, 808 sweating. See also diaphoretic; night sweats from debility Salvia, pair, 671 regulating Salvia, 669 sweating + heat sensation Salvia, pair, 672 sweating, excessive Salvia,682 sweating, excessive + exhaustion Salvia, combination 673 sweet tonic, 66t, 79 Symphytum + Calendula, 301 Symplocarpus foetidus, 844 syndrome to herb matching, 19-10, 83-84
T Tabernaemontanus, 14 tachycardia in thyroid patients, 550
The Index lists herbs by botanical name only: see the Cross references for alternative names
Index
962 Tanacetum puthenium, 715-724 Chrysanthemum morifolium compared, 720, 723 + Artemisia, 716 + Artemisia absinthium, 717 + Chrysanthemum, 717 + Lavandula, 530, 716, 717 + Mentha pulegium, 716 + Rosnuuinus,716,717 + Salvia officinalis, 716, 717 + Valeriana, 717 tannin-containing herb, 141-142. See also Potentilla Taraxacum mongolicum about, 725 cautions!contraindications, 141, 143 Chinese use of,725 Taraxacum officinale compared, 735 Taraxacum officinale, 725-737 .cautionslcontraindications, 141 Filipendula compared, 449 Taraxacum mongolicum compared, 735 Taraxacum officinale, pairs + Althaea, 728 + Arctium, 224, 728 + Arctostaphylos, 729 + Berberis, 278, 728 + Centaurium, 459 + Chelidonium, 728 + Convallaria, 402, 729 + Gentiana, 459 + Glycyrrhiza,728 + Hydrastis, 728 + Juniperus, 516, 729 + Mahonia,728 + Rheum, 623, 728 + Rumex,728 + Sarothamnus, 700 taste balancing in pair or combination, 85-86, 92-93, 94 biochemistry and, 30-31 Chinese herbal tradition of, 30 classification systems of, 8, 29-30 combining for effectiveness, 52-55
comparison of taste in the mouth and taste as a property, 29 energy movement direction related to, 51 masking and effectiveness,102 matching to actions, 60-61 patient preferences in dosing, 102, 105-106 property of, 29-30 Western herbal tradition of, 30 taste properties, acrid Chinese herbal tradition, 41-46 properties compared, 51-SSt taste sensation, 41-46, 51-55t
taste properties, acrid, for the herb Achillea, 168 Angelica, 207, 215, 217 Cimicifuga, 342, 350 Cinnamomum, 373 Commiphora, 389 Echinacea, 436 Juniperus, 515 Myrica, 575 Rosmarinus, 638 Thuja,742 Zanthoxylum, 807 taste properties, acrid, slightly Juniperus, 524 Lavandula, 537 taste properties, aromatic Chinese herbal tradition, 46-51 properties compared, 51-SSt taste and smell sensations, 46-51, 51-SSt, 106-107, 112 taste properties, aromatic, for the herb Angelica, 207,215,217 Cinnamomum, 373 Juniperus, 515, 524 Lavandula, 529, 536 Ruta,654 Thuja,742 Zanthoxylum, 807 taste properties, bitter Chinese herbal tradition, 31-35 properties compared, 51-SSt taste properties, bitter, for the herb Achillea, 168 Angelica,207,215,217 Asclepias, 264 Cimicifuga, 342, 350 Commiphora, 389 Convallaria, 40 1 Echinacea, 436 Harpagophytum, 511 Lavandula, 536 Leonurus, 542 Myrica, 575 Rosmarinus, 638 Ruta,654 Thuja,742 Zanthoxylum, 807 taste properties, sour Chinese herbal tradition, 35-38 properties compared, 51-SSt taste sensation, 35-38, 51-SSt taste properties, sour, for the herb Crataegus, 413, 414 Juniperus. 515 Leonurus,542 Myrica,575
The Index list,: herbs by botanical name only: see the Cross references for alternative names
Index
I t... '--
~--
taste properties, sour, slightly Juniperus, 524 taste properties, sweet Chinese herbal tradition, 38-41 properties compared, 51-SSt taste sensation, 38-41, 51-SSt taste properties, sweet, for the herb Angelica, 215, 217 Cimicifuga, 342, 351 Cinnamomum,373 Convallaria, 401 Crataegus, 413, 414 Echinacea, 436 Glycyrrhiza, 487 temperature defined in herbal medicine, 19d of acrid herbs, 46, 51-52 of aromatic herbs, SO, 51-52 of astringent herbs, 38, 51-52 of bitter herbs, 35, 51-52 matching to actions, 60 of sour and bitter herbs, 38 of sour herbs, 38, 51-52 of sweet herbs, 41, 51-52 temperature balance in combination, assessment for, 84-85 . in pair or combination, assessment for, 92, 94 principle of, 4, 20 temperature classification systems overview, 6-8, 25-26 cold herbs, 22-23 cool-cold herbs, 25 cool herbs, 22-23 hot herbs, 20-21 neutral-cool herbs, 25 neutral herbs, 22 slightly warm herbs, 21-22 syndrome to herb matching system, 19-20 variable-temperature herbs, 23-25 warm-cool herbs, 25 warm herbs, 21 terminology conventions, xvii-xviii, 19. See also glossary Teucrium chamaedrys,adverse reaction report example, 130-131 Theophrastus of Eresos, 11
thirst gastritis + thirst Filipendula, pair, 449 Glycyrrhiza, pair, 477 Thomson, Samuel, 15 throat disorders. S~e also laryngitis; sore throat; tonsillitis Commiphora, topical application, 389 Myrica, topical application, 577 Potentilla, pair, topical application, 608 Potentilla, topical application, 610
963
throat disorders, infection Thymus, pair, 759 throat disorders, ulcers Echinacea,437 Myrica, 584 Potentilla, topical application, 610,615 thrombosis. See also antithrombotic atherosclerosis + thrombosis Commiphora, pair, 390 Thuja occidentalis, 739-755
+ Angelica archangelica, 208 + Arctium, 744 + Arctostaphylos, 235,743,744 + Calendula, 744 + Cimicifuga, 344
+ Echinacea, 427,429,744 + Equisetum, 743 + Glechoma,743 + Hydrangea, 743
+ Hydrastis, 280, 744 + Juniperus, 516
+ Leonurus, 543 + Lobelia, 558
+ Myrica, 576, 581, 744 + Phytolacca, 590, 744 + Ruta,655
+ Smilax, 709, 744 + Thymus, 743, 760 + Tumera, 743
+ Viola odorata, 743, 744 + Zanthoxylum, 744,809 Thuja orientalis. See Biota orientalis thujone in Artemesia, 254 Thymus pulegiodes, 757, 769 Thymus serpyllum, 757,769 Thymus species comparison, 769 Thymus vulgarislThymus zygis, 757-770 + Arctostaphylos, 761 + Baptisia,759 + Commiphora, 391 + Echinacea, 429, 760 + Glechoma,761 + Hydrastis, 761 + Hypericum, 761 + Hyssopus,760 + Juniperus, 516 + Lavandula, 761 + Lobelia, 761 + Marrubium, 761
+ Mentha pulegiurn, 761 + Prunus, i61 + Ruta,655 + Thuja, H3, 760
The Index lists herbs by botanical name only: see the Cross references for alternative names
Index
964 Tilia + Crataegus, 414 tinctureslliquid extracts advantages/disadvantages, lIlt alcoholic/ethanol as solvents, 106, 109, 154,253 dosing examples, 113-114 lower dose approach, 99 tinnitus Cimicifuga, pair, 344 tiredness. See chronic fatigue syndrome; exhaustion tongue inflammation Salvia, topical application, 682 tongue, taste and the, 29 tonic. See also adaptogen; cardiotonic; stimulants defined, 67d,80d stimulants vs., 79 Heart Qi and Yang, 322 Kidney Qi and Yang, 322 Spleen Qi and Yang, 322 tonic, adrenocorticotropic Glycyrrhiza, 488 tonic, astringent Myrica, 575-576 tonic, bitter Berberis, 277 Cinchona, 356 Hydrastis, 277 tonic, bitter digestive defined,74d cautions/contraindications, 141 supportive and moderating actions, 64t Alchillea, 178, 179 Alngelica, 207, 216 Mtemisia, 257 Berberis, 292 Centaurium,456-457,463,468 Cinchona, 364, 369 Commiphora,389 Gentiana, 456-457, 463, 468 Harpagophytum, 504, 509, 511 Hydrastis, 289, 292 Rheum, 622, 632 Rosmarinus,639 Tanacetum,723 Taraxacum, 727, 735 diaphoretic + bitter digestive tonic Alchillea, 167 tonic, blood Mtemisia, 257 Salvia, 681 tonic, cardiovascular Berberis, 292 Hydrastis, 293 tonic, central neuronal degeneration Euphrasia,440
tonic, convalescent Alchillea,167 Alrtemisia, 257 tonic, digestive defined,74d Alchillea, 167, 169 Alrtemisia, 246, 251 Capsicum, 334, 335 Centaurium, 456-457, 469 Centaurium, pair, 458 Cinchona, 358 Cinnamomum, 374, 382, 383 Commiphora, 393, 396 Gentiana, 458, 469 Myrica, 583 Sambucus, 694 Thymus, 760 Zanthoxylum, 807,815 tonic, for visual weakness Euphrasia, 440, 445 tonic, general Alchillea, 167, 179 Alrctium, 223, 231 Alrtemisia, 246, 256-257 Capsicum, 320, 333 Centaurium, 456-457,467,469 Centaurium, pair, 458 Cinnamomum, 382, 383 Commiphora,396 Gentiana, 456-457,458,467, 469 Leonurus, 549 Tumera, 773, 779 tonic, hair Rosmarinus,647 Salvia, 680, 681 tonic, heart Centaurium, 468 Gentiana,468 tonic, immune system Alchillea, 167 Echinacea 427, 428, 437 Thymus, 759, 768 tonic, muscle Hamamelis, 500 tonic, nutritive Allthaea, 190 Mctium, 231 Glycyrrhiza, 476, 488 tonic, respiratory system Thymus, 760 tonic, sexual. See also aphrodisiac; sexual stimulant Mctium,231 Capsicum, 333 Cimicifuga,352
The Index lists herbs by botanical name only: see the Cross references for alternative names
n Index
,
,...
If
_
Echinacea,437 Turnera,773,777,779 tonic, skin Arctium,230 tonic, sweet, 66t, 79 tonic, urogenital Tumera,773 tonic, uterine Calendula, 304 Capsella, 314 tonic, warming, 333 tonic, Yang Cimicifuga, 342 tonic astringent Hamamelis, 494-495 reproductive disorders Arctostaphylos, 241 urinary disorders Arctostaphylos, 241 tonic emmenagogue. See also emmenagogue defined, 77 d Artemisia, 258 Leonurus,550 tonify and calm Heart Spirit Salvia,670 tonity and move Spleen and Liver Qi Artemisia, 244 tonify and regulate Defensive Qi Echinacea,426-427 tonity Blood Salvia, 668 tonify Defensive Qi, indirectly Cinchona, 357 tonify Deficiency and calm Irregularity of Uterus Qi Cimicifuga,340 tonify Heart Glycyrrhiza,489 tonify Heart Qi and Kidney Qi Convallaria, 400 tonity Kidney and Liver Qi and 'lm Cimicifuga, 341 tonity Kidney Yang and Qi Tumera,772 tonity Spleen Glycyrrhiza, 489 Smilax, 707 tonify Spleen and Large Intestine Tumera,772 tonify YIn and Qi of Kidney and Liver Cimicifuga, 3-10 tonsillitis. See also throat disorders Commiphora, pair, 390 Echinacea, pair, -t!7 Thymus, topical application, 769
tonsillitis, acute Phytolacca, combination. 591 Phytolacca. pair, 590 Salvia, combination. 672 Salvia, pair, 671 toothache Calendula. topical application, 306 Lavandula. topical application, 538 toxins, eliminating, 67, 76d. 851. See also detoxicant tranquilizer. See also hypnotic defined, 80-81 d supportive and moderating actions, 66t timing of the dose, 112 tranquilizer, herb as Anemone, 194, 195 Artemisia. 246, 257 Calendula, 307 Capsicum, 333 Centaurium.468 Cimicifuga, 343, 351 Crataegus, 414, 420, 422 Gentiana,468 Glyeyrrhiza,476 Lavandula, 528, 529, 537 Leonurus,542,547.550 Lobelia, 558, 569 Piscidia, 600. 604 Rosmarinus, 639, 648 Ruta, 654, 660, 663 Salvia, 670, 681 Thuja,750 Thymus, 760, 769 Valeriana, 783-784, 788-789,791 Viburnum, 797, 803 Zingiber, 821. 829, 833 tranquilizing analgesic, 68d tranquilizing emmenagogue Leonurus,542 transform Phlegm and Damp Ruta,653 trigeminal neuralgia Valeriana, pair, 784 Trigonella foenum-graecum, 844 trios, combination examples, 88 trophorestoratives. See nervine Turnera diffusa, 771-780 + Avena, 773 + Cinnamomum (bark), 375, 773 + Glycyrrhiza,475 + Juniperus. 516, 774 + Panax ginseng, 773 + Rosmarinus, 640, 773 + Serenoa, 773 + Thuja, 743
The Index lists herbs by botanical name only: see the Cross references for alternative names
965
c
Index
966
u ulcer. See also antiulcer antihemorrhagics for, 178 Achillea, 178 Glycyrrhiza, topical application, 489 ulcer, duodenal Hydrastis, pair, 280 ulcer, mouth/throat Commiphora, pair, 391 Commiphora, topical application, 389, 397 Myrica, 584 Potentilla, topical application, 610, 615 ulcer, nonhea1ing Commiphora, topical application, 397 ulcer, peptic Calendula, combination, 302 Filipendula, combination, 450 Filipendula, pair, 449 Glycyrrhiza, 490 Glycyrrhiza, combination, 478 Hydrastis, combination, 284 Rheum, 621 Taraxacum, pair, 728 Valeriana, combination, 786 peptic ulcer + bleeding Calendula, combination, 302 ulcer, skin Calendula, 306 Rheum, 628 Smilax, 713 ulcer, slow-healing Myrica. topical application, 575, 576, 577, 584 ulcer, stomatitis Lavandula, topical application, 538 United Kingdom, regulations and legislation in, 135 United States, regulations and legislation in, 135-136 upward movement of Qi, regulate Cimicifuga, 341 urinary anti-inflammatory Arctostaphylos, 239, 241 Filipendula,453 Glycyrrhiza,488 Juniperus, SiS Rheum,633 Taraxacum, pair. 727 urinary antimicrobial Arctostaphylos. 239. 241 Juniperus, 515 urinary frequency Cinnamomum, pair. 376 urinary infection Arctostaphylos, pair. 235 Echinacea. pair. 427
Hydrastis, pair, 280 Taraxacum, pair, 727 Thymus, pair, 759 urinary infection, primary disorder urinary infection + heat sensation Arctostaphylos, combination, 236 Echinacea, combination, 431 Hydrastis, combination, 284 urinary infection + hematuria Arctostaphylos, pair, 235 urinary infection, recurring urinary infection, recurring + inflammation Juniperus, pair, 516 Thymus, pair, 761 urinary infection, secondary disorder prostatitis + urinary infection Thuja, pair, 743 urinary regulator. See also cystitis; enuresis Biota vs. Thuja, 754 Thuja, 743, 752 urinary stones. See also antilithic Achillea, 179 urinary system. See also hematuria Capsella, 310, 316, 317 Juniperus, 514 adverse reactions, avoiding, 144 carcinoma in, 144 obstruction Taraxacum, pair, 727 tonic astringent Arctostaphylos, 241 urination, decreasing Achillea, 179 urination, dribbling Ruta, pair, 655 urination, increasing. See also diuretic Achillea, 179 urogenital inflammation Berberis, pair, 278 Turnera, 779 urogenital tonic Turnera, 773 Urtica dioica about, 844 + Arctium, 223 + Myrica, 577 urticaria, acute Arctium, pair, 223 urticaria, recurring Arctium. combination, 224-225 Glycyrrhiza, combination. 479 Hydrastis, pair, 285 uterine bleeding, abnormal Hydrastis, pair. 280
The Index lists herbs by botanical name only: see the Cross references for alternative names
-F
Index uterine muscle tone regulator Hydrastis, 294 uterine regulator Artemisia, 244 Cimicifuga, 340 Salvia,668 for obstetric conditions Cimicifuga, 352 uterine stimulant/relaxant Leonurus, 547 Sarothamnus, 70S uterine stimulant/relaxant, specific to amenorrhea Cimicifuga, 352 1-:"""
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infertility Cimicifuga, 352 uterotonic Calendula, 304 Capsella, 314 uterus, terminology convention, xviii Uterus Deficient Qi and Blood Viburnum, combination, 799 Uterus Stagnant Qi and Blood + Uterus Deficent Qi and Blood Leonurus, combination, 545 Uterus Qi Disturbance Viburnum, combination, 798-799 Uterus Stagnant Qi, xviii Uterus Stagnant Qi and Blood Hydrastis, combination, 284 Lobelia, combination, 560 Thymus, ..:ombination, 763 Viburnum, combination, 798 Uterus Stagnant Qi and Blood, primary syndrome Uterus Stagnant Qi and Blood + Cold Cinnamomum, combination, 376 Uterus Stagnant Qi and Blood + Damp and Phlegm Ruta, combination, 657 Uterus Stagnant Qi and Blood + Heart Spirit Disturbance Artemisia, combination, 249 Leonurus, combination, 545-546 Piscidia, combination, 602 Ruta, combination, 657 Uterus Stagnant Qi and Blood + Liver Wind Cimicifuga, combination, 344-345 Uterus Stagnant Qi and Blood + Phlegm ColC Damp Thuia, combination, 746 Uterus S~agnant Qi and Blood + Uterus Def_-::ent Qi and Blood Leonurus, wmbination, 545 Uterus Stagnant Qi and Blood, secondary syndrome Liver Hyperactive Yang + Uterus Stagnant Qi and Blood Cimicifuga, combination, 344
967
v vaginitis Althaea, combination, 188 Arctostaphylos, combination, 237 Hydrastis, pair, 285 vaginitis + leukorrhea Arctostaphylos, pair, 235 Valeriana officinalis, 781-793 cautionslcontraindications, 148 vs. diazepam, risk:benefit, 124-125 dosing example, single herb tincture, 114 Valeriana officinalis, pairs + Anemone, 196,784 + Berberis, 785 + Capsicum, 326 + Cimicifuga, 343 + Glycyrrhiza, 478, 784 + Humulus, 784 + Hydrastis, 785 + Lavandula, 530, 784 + Lobelia, 559, 785 + Piscidia, 601,784 + Rheum, 785 + Rosmarinus, 784 + Tanacetum, 717 + Viburnum, 785 + Zingiber, 784 variable-temperature herb, 23-25 varicose veins Calendula, 300, 306 Calendula, pair, 301 Hamamelis, 494 Hamamelis, combination, 496 Hamamelis, pair, 495 Potentilla, 610 Potentilla, pair, topical application, 608 variety (var.), 850d vascular protective Sambucus (rutin), 692 vasoconstrictor. See also anti-ischemic Hamamelis, 498, 500 vasodilator Salvia, 678 vasodilator, peripheral Cimicifuga, 347 vasoprotective Tanacetum,720 Verbena officinalis + Lavandula, 530 vermicidal Smilax, 711 vermifuge Artemisia, 246, 258 Ruta, 664
The Index lists herbs by botanical name only: see the Cross references for alternative names
Index
968 vesicant. See counterirritant Viburnum cordifoIium, 795, 803 Viburnum cylindricum, 795 Viburnum dilatatum, 795 Viburnum opulus, 795, 803 Viburnum prunifoIium, 795-804 + Anemone, 800 + Chamaelirium, 797 + Hydrastis, 280, 797 + Leonurus, 543 + Lobelia, 797 + Mitchella, 797 + Valeriana, 785 + Vinca,797 + Zanthoxylum, 800 + Zingiber, 797 'Viburnum species comparison, 795, 803 ,("mea major, 844 + Capsella, 311 + Hydrastis, 280 + Viburnum, 797 'Vinca minor, 845 VIola odorata about, 844 as alterative, 708 + Arctium, 224 + Filipendula,449 + Harpagophytum, 505 + Thuja, 743, 744 'Viola tricolor about, 844 + Althaea, 185 + Juniperus, 516 wItex agnus-castus, 145,844 witiligo Ruta, 660
vitro, 848d vivo, 849d 7lDmiting. See also antiemetic
:m rm
nausea + vomiting Zingiber, combination, 824 wnmiting, emetic for cautionslcontraindications, 141 Lobelia, 556, 564, 570 wnn Bingen, Hildegard, 7,13,107 wulnerary defined,81d Biota vs. Thuja, 754 wlllnerary, herb as Althaea, 184 Calendula, 304, 306 Commiphora, 394, 396-397 Echinacea, 428, 437 Potentilla,613 Thuja, topical application, 754
w ~arin,134,143
warm and astringe the Intestines Myrica,574 warm and move Heart Stagnant Qi Angelica, 206 warm and move Qi and Blood (to dear Cold) Myrica, 574 Zanthoxylum, 806 warm and move Qi of Stomach and Intestines Zanthoxylum, 806 warm-coolherb,25 warm herb, 21 warm, tonify and move Liver and Gallbladder Qi Myrica, 574 warm, tonify and move Spleen and Stomach Qi Myrica, 574 warts
Thuja,753 Thuja, topical application, 744 water, therapeutic value of, 105 weakness. See also cardiac weakness; debility weakness, cardiovascular + myalgia Cinchona, combination, 359 cardiac arrhythmia + weakness Cinchona, pair, 359 weakness, hepatic Capsicum, pair, 323 digestive weakness + hepatic weakness Centaurium, pair, 459 Gentiana, pair, 459 hepatic weakness+ food intolerances Rosmarinus, pair, 640 weight loss anemia + weight loss Centaurium, pair, 458 Gentiana, pair, 458 exhaustion + weight loss Cinnamomum, pair, 375 weights and measures for dosages, 116-118 Wmd and Damp Heat in Muscle channels, dear Cimicifuga, 340 Wind Cold Liver Hyperactive Yang + Wind Cold Salvia, combination, 673 Wmd Cold,dear Salvia,668 Wind Cold Damp Achillea, pair, 171 Angelica, pair, 208 Sambucus, combination, 690 Zingiber, combination, 823 Wind Cold Damp, clear Angelica, 206
The Index lists herbs by botanical name only: see the Cross references for alternative names
969
Index ¥ind Heat Achillea, combination, 170-171 Cimicifuga, 353 Echinacea, combination, 430 Euphrasia, combination, +12 Sambucus, combination. 689, 690 ,..;. Wind Heat, clear Echinacea,426-427 Salvia, 668 Sambucus, 688 Tanacetum,716 ~ Wind Heat, primary syndrome Wind Heat + Heat Toxin Phytolacca, combination. 591 Salvia, combination, 672 Wind Heat + Lung Heat Asclepias, combination, 266 Zingiber, combination, 823 Wind Heat + Retained Pathogen Arctium,222 Arctium, combination, 224-225 '-- Wind Heat, secondary syndrome Heat Toxin + Wmd Heat Arctium, 222 Liver Hyperactive Yang + Wmd Heat Tanacetum, combination, 718 Lung Phlegm Heat + Wmd Heat Asclepias, combination, 266-267 Echinacea, combination, 430 Lobelia, combination, 560 \\.Retained Pathogen + \V'md Heat Cinchona, combination, 360 wounds. See also counterirritant; vulnerary Achillea, 178 Calendula, pair, 301 Calendula, topical application, 300, 306 Capsicum, topical application, 324 Commiphora, topical application, 389, 397 Echinacea, topical application, 434 Glycyrrhiza, topical application, 489 Potentilla, pair. topical application, 608 Potentilla, topical application, 610 ,~
...
Salvia, 682 Thymus, topical application, 769 wounds, granulation promotion for Euphrasia,444 wounds, septic Echinacea, topical application, 437
Yang tonic Cimicifuga, 342 Yin and Qi of Kidney and Liver, tonify Cimicifuga, 340 Yin and Yang effects of Lobelia, 554 Y"m in Yang and Yang in Y"m Capsicum, 555 Lobelia, 555 Y"m-Yang balance and Lobelia, 554-555
z Zanthoxylum americanum. See Zanthoxylum species Zanthoxylum bark combinations, 812 Zanthoxylum berries combinations including. 812 + Rosmarinus, 640 Zanthoxylum bungeanum, 805, 816-817 Zanthoxylum clava-herculis. See Zanthoxylum species Zanthoxylum species, 805-817 + Achillea, 170, 808 + Angelica, 208 + Angelica archangelica, 808 + Capsicum, 324, 808 + Cimicifuga, 344 +Cinchona,359,808
+ Cinnamomum (twigs), 375 + Commiphora,390 + Crataegus,415, 808 + Euphrasia,441
+ Harpagophytum, 505 + Juniperus, 809 + Myrica, 576, 581,808 + Phytolacca, 590, 809 + Populus, 808
+ Salvia miltiorrhiza, 808 + Smilax, 709
+ Thuja, 744, 748, 809 + Zingiber, 808, 822 Zanthoxylum species comparison, 816-817 Zeamays about,844
+ Taraxacum, 727 Zingiber officinale, 819-836 cautions/contraindications, 141, 143, 146 herb-drug interactions, 134 Zingiber officinale, pairs
+ Achillea. 822 + Anemone, 196
y Yang adverse effects Cimicifuga, 3.;: Yang Deficiency of Kidney and Heart, 149
+ Angelica, 208 + Asclepias, 265, 822 + Berberis, 279
The Index lists herbs by botanical name only: see the Cross references for alternative names
Index
970 + Capsicum. 3i3. 822
+ Piscidia. 601
+ Cinnamomum (twigs). 374-375 + Echinacea,430 + Glycyrrhiza, 477.823 + Hydrastis, 823
+ Rheum, 622, 823 + Rosmarinus, 640. 823 + Salvia officinalis. 822. 671 + Sambucus. 689
+ Lavandula. 822
+ Valeriana, 784
+ Lobelia, 559. 822 + Mentha pulegium, 822 + Myrica, 576
+Viburnum, 797 + Zanthoxylum, 808, 822 Ziziphus jujube, 140, 141, 844
-
-
-
-
The Index lists herbs by botanical name only: see the Cross references for alternative names
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COMBINING WESTERN HERBS AND CHINESE MEDICINE
Important note This book is about using Western herbs according to the principles of Chinese medicine, West-
Combining Western Herbs and Chinese Medicine combines 2,000 years of Western herbal tradition with traditional Chinese medicine and modern pharmacology research. This unique integration offers a new level of understanding that can resolve many of the
ern herbal tradition, and modern pharmacology. It is not specifically about combining Western and Chinese herbs, although Chinese herbs appear in some of the combinations in this book.
difficulties and controversies of the past. It can give a broader
This book is only suitable for readers
and deeper understanding of the individual herbs, enabling more
with a basic understanding of Chinese
sophisticated herb combinations that are both safer and more effective.
medicine -
specifically a knowledge
of the Chinese organ syndromes.
Containing over 800 tables, the text is specially organized and designed for clear, easy access to a vast amount of useful data. ~
A foundation text and reference for both students and practitioners, with discussion of: 50 Western herbs unparalleled detail reveals the unique character ofeach herb 380 herb pairs
the basic units for building herb combinations 150 herb combinations a wealth ofpractical detail with essential comparison tables 1,500 references pharmacological and clinical research is cited and fully discussed ~
Special emphasis on the following topics: PrInciples of herb combining How to make safe and effective combinations
Practical herb use Full details ofherb dose, dispensing, and administration 5afety
"With his deep knowledge of Chinese medicine, Western herbal medicine, and Western sciences, Jeremy Ross is uniquely qualified to undertake the important and difficult task ofinterpreting the nature and functions of Western herbs according to the principles of Chinese medicine." -
GIOVANNI MACIOCIA
<'There have been many interesting books on herbal medicine written in the last few years, but the present book is exceptional in containing so much new and clinically useful material . .. this book stands out in a class of its own." -
JULIAN SCOTT
Three special chapters on safety issues. Each of the 50 herb chapters discusses cautions and contraindications Data accesa /'
ISBN 0-9728193-0-4
Extensive cross references, plus a unique 70-page index for easy access to data on individual herbs, herb pairs, herb combinations, herb actions, Chinese syndromes, and disorders GREENFIELDS PRESS •
SEATTLE
1!1JJ.11
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