ตำรับยาสมุนไพร (ส่วนที่ 1) — สมุนไพรเพื่อการแพทย์

MATERIA MEDICA An understanding of the herbal materia medica is the basis of herbal medicine. As pointed out in chapter 1, the list of herbs that could potentially be included here is many thousands long! However, the materia medica that follows reflects my experience and training, and so emphasizes the European and North American herbs most often encountered in Western herbal medicine. The fact that most of the herbs used in ayurveda or traditional Chinese medicine are not included is in no way a rejection of their value, but simply a reflection of my focus on Western herbalism. MATERIA MEDICA OUTLINE Each materia medica entry follows the same general format, explained here. Latin binomial Common name Taxonomic family Other Names or Related Species: Many herbs have numerous regional names. Alternative common names commonly used in North American herbalism are included under this heading. If there are nomenclature issues, such as recent binomial changes, they are also noted here. Other species commonly used medicinally are listed as Related Species. Part Used: This entry lists the part or parts of the herb used medicinally. Constituents: The lists provided here represent a compilation of relevant phytochemical research on the particular remedy. This is not a comprehensive constituent listing, as each plant contains many hundreds of thousands of distinct chemicals, both organic and inorganic. Thus, I have listed only the most relevant chemicals, and did not include the ubiquitous primary constituents found in all plants. The information provided here reflects current pharmacological thinking about which chemicals are the pri-mary contributors to the plant's actions. It is important to remember, however, that fashions and insights come in and out of favor in science as much as in any other area of human endeavor. For more details on a constituent or group of constituents, please refer to the chapters on phytochemistry in part 1 of this book. A wealth of scientific information about the whole range of different plant components is available. However, this does not necessarily tell us much about the value and benefits of the herb when used in healing. The activity of the whole plant is always more than the sum of its parts, just as a human being is more than the sum of his or her biochemistry. Knowing the chemistry of sesquiterpenes is not the same as knowing chamomile. Actions: This section provides an overview of the physiological actions demonstrated by the herb, which are explored in depth in chapter 25 (Herbal Actions). Knowing an herb's actions is the key to using it holistically and effectively. The approach followed here is based on the practice of medical herbalism developed during the 19th and 20th centuries in North America and the United Kingdom. Indications: Here I provide a brief overview of the clinical indications for the herb. As there is so much variability among both people and plants (the gift of diversity!), the indications provided in herbals are rarely all encompassing. Thus, the indications listed reflect my particular training and experience. In addition, I have included quotations from some invaluable but difficult-to-find texts from the 19th-century Eclectic and Physiomedicalist traditions. These sources of therapeutic information are based upon years of clinical experience. Much of the technical language and writing style reflects the time periods in which these physicians were practicing, so it probably sounds strange to modern ears. I have not changed their words or grammar, although I could not resist occasional comments. Their Victorian terminology and spelling have been left untouched.

MATERIA MEDICA Texts cited include: Priest and Priest: from Priest and Priest, Herbal Medications. London: L. N. Fowler and Co. Ltd.,

Ellingwood: from Elling-wood, Finley. American Materia Medica, Therapeutics and Pharmacognosy. 1898. Reprint, Sandy, OR: Eclectic Medical Publications,

Felter: from Felter, Harvey W. The Eclectic Materia Medica, Pharmacology and Therapeutics. 1922. Reprint, Sandy, OR: Eclectic Medical Publications,

King's: from Felter, Harvey W. and Lloyd, John Uri. King's American Dispensatory vols. 1 and 2, 1892. Reprint, Sandy, OR: Eclectic Medical Publications,

Safety Considerations: If there are any concerns about the safe use of the herb, the issues are discussed under this heading, including side effects, contraindications, and drug interactions. Preparations and Dosage: This section lists dosage ranges for various herbal preparations, taken from a number of sources. I have provided details of concentration (weight/volume ratios, expressed as "w/v") and alcohol percentages for tinctures and liquid extracts. For example, a tincture containing 1 part herb to 5 parts solvent in a menstruum composed of 45% alcohol is denoted as "1:5 in 45%." More information on these calculations may be found in chapter 11. References: Whenever possible, at the end of the entry I have provided a reference to a more technical monograph that covers pharmacology, clinical trials, and regulatory status for that herb. Key to Dosage Sources Unless otherwise indicated in the text, the sources listed here are the pharmacopoeias from which I took the official medicine-making standards cited in Preparations and Dosage. They are abbreviated in the text according to the following; key: BPC: British Pharmacopoeia Code):, 4th ed. (1898) BHP: British Herbal Pharmacopoeia (1990) BHC: British Herbal Compendium 11992) Comm. E: German Commission E Monographs (1998) USP: United States Pharmacopoeia, 9th ed. (1916) Achillea millefolium L. Yarrow Asteraceae Parts Used: Aerial parts Constituents: 0.3% to 1.4% volatile oil (a- and |3-pinene, borneol, bornyl acetate, camphor, a-caryophyllene, 1,8 cineole); sesquiterpene lactones (achillicin, achillin, achillifolin, millifin, millifolide); 3% to 4% tannins; flavonoids (apigenin, luteolin, isorhamnetin, rutin); alkaloids (betonicine, stachydrine, achiceine, moschatine, trigonelline, and others); phenolic acids (caffeic, salicylic); coumarins1 Actions: Diaphoretic, hypotensive, astringent, antiinflammatory, antispasmodic, diuretic, antimicrobial, bitter, hepatic Indications: Achillea is an important diaphoretic herb and is a standard remedy for helping the body deal with fever. It stimulates digestion and tones blood vessels. As a urinary tract antiseptic, it is indicated in infections such as cystitis, for which it is most effective if used fresh. Achillea is considered a specific in thrombotic conditions associated with hypertension, and is thought to lower blood pressure through dilation of peripheral vessels. Researchers believe that its anti-inflammatory and antispasmodic actions are related to its content of flavonoids.2 Used externally, Achillea aids in wound healing. Antimicrobial activity against a range of bacteria has been reported for water and ether extracts of the plant.3 Priest and Priest described Achillea as a . . . mild, slow and stimulating diaphoretic: indicated for the first stage of acute febrile reactions. For atonic and relaxed tissues where there is free discharge or passive hemorrhage of bright red blood. Cold preparations stimulate the appetite and tone the digestive organs. Priest and Priest gave: the following specific indications: acute stage of colds, influenza, and respiratory catarrhs; chronic diarrhea and dysentery; epistaxis, intestinal hemorrhage, and bleeding hemorrhoids; uterine hemorrhage, profuse protracted menstruation, and leukorrhea. Safety Considerations: Hypersensitivity to yarrow and other plants in the Asteraceae family has been reported. Some authorities caution against using Achillea during pregnancy.4 No restrictions during lactation are suggested. Preparations and Dosage: Tincture dosage is 2 to 4 ml (1:5 in 25%) three times a day. To make an infusion, pour 1 cup of boiling water over 1 to 2 teaspoons of dried herb and infuse for to minutes. This should be drunk hot three times a day. When ihe patient is feverish, it should be drunk hourly.

Dosage recommended by the BHC is 2 to 4 g of dried herb, 2 to 4 ml of tincture, 1 to 2 ml fluid extract (1:1 in 25%), or 3 to 5 ml pressed juice from fresh herb three times a day. Commission E recommends 4.5 g dried herb, 3 teaspoons pressed juice, or 3 g fresh flowers daily. Yarrow, in Herbal Medicine, Expanded Commission E Monographs Aesculus hippocastanum L. Horse Chestnut Hippocastanaceae Other Names: Do not confuse this plant with its North American relative Aesculus glabra, commonly known as buckeye. Parts Used: Seeds, pericarp Constituents: 3% to 6% triterpene saponin glycosides, a complex mixture known as aescin (escin); 0.2% to 0.3% flavonoids; coumarin derivatives (esculetin and esculin); condensed tannins; sterols (including stigmasterol, <xspinasterol, and |3-sitosterol); fatty acids (such as linolenic, palmitic, and stearic acids)5 Actions: Astringent, anti-inflammatory, venous tonic Indications: Aesculus has unique actions on the vessels of the circulatory system. The herb appears to increase the elasticity and tone of the veins while decreasing vein permeability. It may be used internally in the treatment of phlebitis, vein inflammation, varicosities, and hemorrhoids. Externally, it may be used as a lotion for the same conditions, as well as for leg ulcers. Aescin has antiexudative actions and a tightening effect on the vasculature. Aesculus extract may reduce the activity of lysosomal enzymes, which is increased in chronic pathological conditions of the veins and inhibits the breakdown of mucopolysaccharides in the capillary walls. A reduction in the activity of these enzymes has the effect of decreasing vascular permeability, leading to improvement in symptoms of chronic venous insufficiency (including sensations of tiredness, heaviness, pruritus, pain, and swelling in the legs).6 A study of patients with venous insufficiency showed that 1,200 mg of Aesculus extract (standardized to mg aescin per capsule) lowered capillary filtration by 22% in 3 hours.7 A review of clinical studies reported that horse chestnut was superior to placebo in improving symptoms of chronic venous insufficiency. The pooled results showed that horse chestnut reduced edema, pain, fatigue, tenseness, and in some cases, pruritus in the legs.8 Safety Considerations: The seed contains coumarin derivatives that may theoretically interact with anticoagulant medications. Preparations and Dosage: Tincture dosage is 1 to 4 ml three times a day (1:5 in 40%). To make an infusion, pour 1 cup of boiling water over 1 to 2 teaspoons of dried fruit and leave to infuse for to minutes. This should be drunk three times a day or used as a lotion. Commercial extracts are usually standardized to 16% triterpene glycosides, calculated as aescin. Recommended doses are the equivalent of mg aescin two or three times a day (300 to mg of a 16% extract). Commission E recommends a total daily dose of mg aescin, corresponding to to 312.5 mg extract in delayed-release form. Horsechestnut seed, in Principles and Practice of Phytotherapy Agathosma betulina (Berg.) Bartl. and Wendl. Buchu Rutaceae Other Names: Until recently, the binomial was Barosma betulina. Part Used: Leaf Constituents: Volatile oils, 1.0% to 3.5% (limonene, menthone, pulegone); flavonoids (rutin, diosmetin, diosmin, hesperidin, quercetin, and derivatives); miscellaneous: vitamins of the B group, tannins, mucilage9 Actions: Diuretic, urinary antiseptic Indications: Buchu is useful in infections of the genitourinary system, such as cystitis, urethritis, and prostatitis. Its healing and soothing properties indicate its use in combination with other relevant remedies for many conditions affecting this system. It is especially useful when dysuria is part of the symptom picture. However, the volatile oil content may make it too irritating for people with a history of kidney disease. Safety Considerations: Remedies high in antimicrobial oils may be contraindicated in people with kidney disease. The volatile oil of buchu contains diosmin and pulegone, which can cause irritation. However, there have been no reports of adverse effects. Preparations and Dosage: Tincture dosage is 1 to 2 ml three times a day (1:5 in 60%). To make an infusion, pour 1 cup of boiling water over 1 to 2 teaspoonfuls of dried herb and infuse for minutes. This should be drunk three times a day. The BHC recommends 1 to 2 g in infusion of dried herb, 2 to 4 ml tincture (1:5 in 60%), or 0.5 to 1.5 ml fluid extract (1:1 in 90%) three times daily. Buchu, in Principles and Practice of Phytotherapy

MATERIA MEDICA AS. 525 Agrimonia eupatoria L. Agrimony Rosaceae Parts Used: Aerial parts Constituents: Tannins (3% to 21%); coumarins; flavonoids (glycosides of luteolin, apigenin, and quercetiij); polysaccharides; glycosidal bitters10 Actions: Astringent, tonic, bitter, diuretic, vulnerary, antispasmodic, diaphoretic, carminative, hepatic, cholagogue Indications: The combination of astringency and bitter tonic properties in agrimony makes this herb a valuable remedy. This is especially true when astringent activity is needed in the digestive system, as agrimony also contributes a tonic action through bitter stimulation of digestive and liver secretions. Agrimony may be used to treat indigestion, and is a specific for childhood diarrhea. It is the herb of choice in early-stage appendicitis, and its properties give it a role in the treaunent of mucous colitis. It may also be helpful for urinary incontinence and cystitis. Agrimony has a long tradition of use as a spring tonic. As a gargle, it helps relieve sore throats and laryngitis. Used in ointment form, it aids in the healing of wounds and bruises. In one study, agrimony infusion was used successfully to treat cutaneous porphyria in a group of patients.11 Results demonstrated improvements in skin eruptions as well as decreases in serum iron concentrations and urinary porphyrins. Activity against Staphylococcus aureus and a-hemolytic streptococci has been reported.12 In another study, a preparation containing agrimony was used to treat patients suffering from chronic gastroduodenitis.13 Mter days of therapy, 75% of the patients were free of pain, 95% from dyspeptic symptoms, and 76% from palpitation pains. Gastroscopy indicated that previous erosions and hemorrhagic mucous changes had healed. No side effects or signs of toxicity were observed. Priest and Priest described agrimony as a . . . gently stimulating tonic with a gastro-intestinal emphasis that is suitable for both infants and the elderly. It influences mucous membranes, promotes assimilation and restores debilitated conditions. They provided the following specific indications: general alimentary weakness, hepatic weakness, enuresis, diarrhea, leukorrhea, rheumatism, and arthritis. Safety Considerations: No side effects or drug interactions have been reported. Preparations and Dosage: Tincture dosage is 1 to 4 ml three times a day (1:5 in 45%). For an infusion, pour 1 cup of boiling water over 1 to 2 teaspoons of the dried herb and infuse for to minutes. This should be drunk three times a day. Commission E states that the average daily dosage is 3 g of herb or equivalent preparation. Ellingwood recommended 1 dram of pulverized leaves as decoction or 0.25 to 1 dram of tincture. Dosage given in the United States Dispensatory (23rd ed.) is 1 dram (4 g) or more. Agrimony, in Herbal Medicines: A Guide for Health-Care Professionals Alchemilla vulgaris L. Lady's Mantle Rosaceae Parts Used: Leaf, flowering shoots Constituents: Tannins, consisting mainly of glycosides of ellagic acid; salicylic acid (trace amounts)14 Actions: Astringent, diuretic, anti-inflammatory, emmenagogue, vulnerary Indications: This and other species of Alchemilla have been widely used in folk medicine throughout Europe. Lady's mantle helps reduce pains associated with menstrual periods and ameliorates excessive bleeding. It also has a role to play in easing symptoms of menopause. As an emmenagogue, it can stimulate proper menstrual flow. However, in the often apparently paradoxical way of herbal remedies, the herb is also a useful uterine astringent, helpful in both metrorrhagia and metrorrhagia. Its astringency makes it beneficial in the treatment of diarrhea, as a mouthwash for sores and ulcers, and as a gargle for laryngitis. Safety Considerations: No side effects or drug interactions have been reported. Preparations and Dosage: Tincture dosage is 2 to 4 ml three times a day (1:5 in 25%). To make an infusion, pour 1 cup of boiling water over 2 teaspoons of dried herb and infuse for to minutes. This should be drunk three times a day. For use in diarrhea, or as a mouthwash or lotion, make a stronger infusion by boiling the herb for a few minutes to extract all the tannin. Dosage recommended in the BHP is 2 to 4 g dried herb or 2 to 4 ml fluid extract (1:1 in 25%). Lady's Mantle, The Complete Gentian Commission E Monographs

Allium sativum L. Garlic Liliaceae Part Used: Bulb Constituents: Organosulfur compounds (alliin, converted to allicin in the presence of the enzyme allinase); miscellaneous: enzymes including allinase, B vitamins, minerals, flavonoids15 Actions: Antimicrobial, diaphoretic, hypocholesteremic, cholagogue, hypotensive, antispasmodic Indications: Used daily, garlic aids and supports the body in ways that no other herb can match. It is an effective antimicrobial, acting on bacteria, viruses, and parasites of the alimentary tract. The volatile oil is largely excreted via the lungs, making garlic useful in infections of the respiratory system, such as chronic bronchitis, respiratory catarrh, recurrent colds, and influenza. It may also be helpful in the treatment of whooping cough and as part of a broader approach to bronchial asthma. In general, garlic may be used as preventive medicine against most infectious conditions, digestive as well as respiratory. In the digestive tract, garlic is thought to support the development of the natural bacterial flora while killing pathogenic organisms. Garlic has a range of effects upon cardiovascular health. It reduces serum cholesterol and triglyceride levels while raising levels of high-density lipoproteins (HDL). It can also act as an effective inhibitor of plateletactivating factor (PAF). Garlic's antioxidant properties help prevent the peroxidation of fats, yet another contributing factor in the development of atherosclerosis. Taken together, these properties provide a potential way to prevent atherosclerosis, thrombosis, hypertension, heart attack, and stroke. According to epidemiological evidence, garlic may have cancer-preventive properties, especially against cancers of the gastrointestinal tract. It has been used externally for the treatment of the fungal infection ringworm and as a suppository against pinworm (Enterobius vermicularis). Immune potentiation and hypoglycemic actions in humans have also been reported. Safety Considerations: At high doses, garlic may irritate the intestinal mucosa, causing nausea, diarrhea, vomiting, and burning of the mouth. However, in humans, daily administration of high doses of garlic essential oil (approximately mg, equivalent to g/day fresh garlic) over a period of 3 months did not cause any adverse effects.16 Contact dermatitis from occupational exposure has been reported. Therapeutic doses (not dietary) of garlic may potentiate the activity of anticoagulant medications and the antithrombotic actions of anti-inflammatory medications, such as aspirin. Caution is advised both before and after surgical procedures.17,18 Preparations and Dosage: A clove should be eaten daily for prophylaxis. During acute infections, 1 clove three times a day is indicated. Alternatively, use garlic oil capsules at a dosage of 1 capsule a day as a prophylactic or 1 capsule three times a day for infection. Recommended dosage of standardized garlic powder (6 mg allicin yield) is to mg/day. Enteric-coated garlic supplements can help control after-odor on breath and skin. Commission E suggests a daily dosage of 4 g fresh garlic or equivalent preparations. Koch HP, Lawson D, eds. Garlic: The Science and Therapeutic Application of Allium sativum L. and Related Species. Baltimore: Williams and Wilkins Publishing Co., 1996. Althaea officinalis L. Marshmallow Malvaceae Parts Used: Root, leaf Constituents: Root: Mucilage (18% to 35%, consisting of a number of polysaccharides); miscellaneous: about 35% pectin, 1% to 2% asparagine, tannins Leaf: Mucilage (including a low-molecular-weight Dglucan); flavonoids (such as kaempferol, quercetin, and diosmetin glucosides); scopoletin (a coumarin); polyphenols acids (including syringic, caffeic, salicylic, vanillic, p-coumaric)19 Actions: Demulcent, emollient, diuretic, anti-inflammatory, expectorant Indications: Because of the abundance of mucilage it contains, marshmallow is an excellent demulcent that is indicated whenever such an action is needed. Marshmallow root has been used primarily in the digestive system, and leaf in the urinary system and lungs. All inflammatory disorders of the gastrointestinal tract will benefit from the application of marshmallow root, including inflammations of the mouth, gastritis, peptic ulceration, and colitis. Leaf helps in cystitis, urethritis, and urinary gravel, as well as bronchitis, respiratory catarrh, and irritating coughs. Externally, the herb is often used as an ingredient in drawing ointments for abscesses and boils and as an emollient for varicose veins and ulcers. The mucilage has demonstrated hypoglycemic activity in nondiabetic mice.20 Antimicrobial activity against Pseudomonas aerugiMATERIA MEDICA nosa, Proteus vulgaris, and Staphylococcus aureus has been documented.21 Priest and Priest considered marshmallow a . . . soothing demulcent indicated for inflamed and irritated states of mucous membranes. Particularly suitable for the elderly with chronic inflammatory conditions affecting the gastrointestinal system or genitourinary tract. They gave the following specific indicadons: acute respiratory disease, gastroenteritis, pepdc ulcer, cysdtis, urethritis, inflammation of the mouth and throat, inflamed hemorrhoids and wounds, burns and scalds, bedsores, abscesses, boils, and skin ulcers. Safety Considerations: Marshmallow may delay absorption of other drugs taken at the same time. Preparations and Dosage: Tincture dosage is 1 to 4 ml three times a day (1:5 in 25%). A cold infusion of marshmallow root may be made by infusing overnight 2 to 4 g of root in 1 cup of cold water. Dosage recommended by the BHC is 2 to 5 g as dried herb or cold infusion or 5 to ml tincture. The BPC (1949) suggests a dosage of 2 to ml of syrup. Commission E recommends a daily dosage of 6 g root or 5 g leaf. Marshmallow leaf and Marshmallow root, in Herbal Medicine, Expanded Commission E Monographs Anethum graveolens L. Dill Apiaceae Part Used: Seed Constituents: Volatile oil (mainly carvone, with dihydrocarvone, limonene, a- and (3-phellandrene, eugenol, anethole, myristicin, carveole, x-pinene); flavonoids (kaempferol); coumarins (such as scopoletin, esculetin, bergapten, umbelliferone); xanthone derivatives, such as dillanoside; miscellaneous: triterpenes, phenolic acids, protein, fixed oil22 Actions: Carminative, aromatic, antispasmodic, antiinflammatory, galactagogue Indications: Dill is an excellent remedy for flatulence and associated colic. This is the herb of choice for children's colic. It also stimulates milk flow in nursing mothers. Chewing the seeds helps clear bad breath. Safety Considerations: Contact with juice from the fresh plant may cause photodermatitis. Preparations and Dosage: Tincture dosage is 2 to 4 ml three times a day (1:5 in 25%). To make an infusion, pour 1 cup of boiling water over 1 to 2 teaspoons of gently crushed seeds and infuse in a covered container for to minutes. For the treatment of flatulence, take a cup of this infusion before meals. According to Commission E, average daily dosage is 3 g of seed or equivalent preparations, or 0.1 to 0.3 ml essential oil. Dosage from the United States Dispensatory (23rd ed., 1948) is grains to 1 dram (1 to 4 g) seed. The BPC recommends to ml of dill water (hydrosol) or

2 g dried herb or 1 to 2 ml fluid extract. Dosage listed in the BHC is 2 to 6 g of dried herb, 2 to 4 ml tincture (1:5 in 25%), or 2 to 6 ml fluid extract (1:1 in 25%). Dill seed, in The Complete German Commission E Monographs Angelica archangelica L. Angelica Apiaceae Other Name: European angelica Parts Used: Root and leaf (medicinal); stem and seed (confectioneiy) Constituents: Volatile oils (0.3% to 1.0%, highest in seeds): a- and |3-phellandrene, a-pinene, a-thujene, limonene, (3-caryophyllene, linalool, borneol, acetaldehyde; macrocyclic lactones; phthalates (hexamethylphthalate); furanocoumarin glycosides (angelicin, umbelliferone, psoralen, bergapten, imperatoren); miscellaneous: sugars, plant acids, flavonoids, and sterols23 Actions: Astringent, tonic, diuretic, vulnerary, cholagogue, anti-inflammatory Indications: Angelica is a useful expectorant for coughs, bronchitis, and pleurisy, especially when accompanied by fever, colds, or influenza. Angelica leaf may be used as a compress to treat inflammations of the chest. The content of carminative essential oil explains its use easing intestinal colic and flatulence. As a digestive agent, angelica stimulates appetite and may be helpful in anorexia nervosa. It has also been shown to help ease rheumatic inflammations. In cystitis, it: acts as a urinary antiseptic. The furanocoumarin constituent bergapten has been used in the PUVA treatment of psoriasis. (PUVA is an acronym describing oral administration of psoralen and subsequent exposure to long-wavelength ultraviolet light.) Angelica is a common flavoring for liqueurs, such as Chartreuse and Benedictine, and is an ingredient of gin and vermouth. The leaves may be used as a garnish or in salads, and the candied stalks in cakes and pudding. Safety Considerations: Because of its furanocoumarin

constituents, angelica may provoke photosensitivity reactions. During treatment with angelica, patients should avoid prolonged sunbathing and exposure to strong UV radiation. In addition, some authorities state that because of the coumarin constituents, high doses of angelica may interfere with anticoagulant therapy. Preparations and Dosage: Tincture dosage is 2 to 5 ml three times a day (1:5 in 45%). To make a decoction, place 1 teaspoon of cut root in 1 cup of water, bring to a boil, and simmer for 2 minutes. Remove from heat and let stand for minutes. Decoction dosage is 1 cup three times a day. The BHP recommends 2.5 g dried herb, 2 to 5 ml tincture (1:5 in 45%), or 2 to 5 ml liquid extract (1:1 in 25%) three times daily. Commission E recommends a daily dose of 4.5 g dried herb, 1.5 ml tincture (1:5), or 1.5 to 3.0 ml fluid extract (1:1). The total daily essential oil dosage is in the range of to drops. Angelica root, in Herbal Medicine, Expatided Commission E Monographs Apium graveolens L. Celery Seed Apiaceae Part Used: Dried ripe seed Constituents: Volatile oil (2% to 3%): limonene (60%), selenine (10% to 15%), cx-eudesmol and (3-eudesmol, santalol; phthalides (3-w-butylphthalide, ligustilide, sedanolide, and sedanenolide); furanocoumarins (apigravin, bergapten, celerin, isoimperatorin, isopimpinellin, umbelliferone, 8-hydroxy-5-methoxypsoralen); flavonoids (apiin, apigenin, isoquercitrin, and others)24 Actions: Antirheumatic, anti-inflammatory, diuretic, carminative, antispasmodic, nervine Indications: Celery seed finds its main use in the treatment of rheumatism, arthritis, and gout. It is especially useful in rheumatoid arthritis associated with mental depression. Its value in rheumatic conditions is related primarily to its diuretic action. Celery seed is also used as a urinary antiseptic, largely because of its content of apiol, a volatile oil constituent. In mice, phthalide constituents showed sedative and antispasmodic activities.25 Celery seed oil has been reported to be active against Bacillus subtilis, Vibrio cholerae, Staphylococcus aureus, S. albus, Shigella dysenteriae, Corynebacterium diphtheriae, Salmonella typhi, Streptococcus faecalis, S. pyogenes, Pacillus pumilus, and Pseudomcmas solanacearum.16 No activity against Escherichia coli, Sarcina lutea, or Pseudomonas aeruginosa was observed. Safety Considerations: While no problems have been documented for celery seed, photosensitivity reactions resulting from external contact with celery stems have been reported.2' This has been attributed to their content of furanocoumarins, which are known photosensitizing agents.28 Preparations and Dosage: Tincture dosage is 1 to 4 ml three times a day (1:5 in 60%). To make an infusion, pour 1 cup of boiling water over 1 to 2 teaspoons of freshly crushed seeds; infuse in a covered container for to 15 minutes. This should be drunk three times a day. Dosage from the BHC is 0.5 to 3 g dried seed (or infusion), 2 to 8 ml tincture (1:5 in 90%), or 0.5 to 2 ml fluid extract (1:1 in 90%) three times a day. Apii fructus, in Herbal Drugs and PhytopharmMeuticals Arctium lappa L. Burdock Asteraceae Parts Used: Root, rhizome, leaf Constituents: Lignans (arctigenin, arctiin, and matairesinol); polyacetylenes; carbohydrates: inulin (45% to 50%), mucilage, pectin, sugars; miscellaneous: organic acids, fatty acids, and phenolic acids29 Actions: Alterative, diuretic, bitter Indications: Burdock is a valuable remedy for the treatment of skin conditions that result in dry and scaly patches. It may be most effective for psoriasis if used over a long period of time. It has value when used as part of a wider treatment program for rheumatic complaints, especially when associated with psoriasis. Part of burdock's action is related to bitter stimulation of digestive juice secretion, especially bile secretion. Thus, it helps with digestion and appetite, and has been used in anorexia nervosa and similar conditions. It has also been used to support kidney function and to treat cystitis. In general, burdock will move the body to a state of integration and health, improving indicators of systemic imbalance, such as skin problems and dandruff. Externally, burdock may be applied as a compress or poultice to speed healing of wounds and ulcers. Eczema and psoriasis may also be treated this way, but it is important to remember that such skin problems can be healed only from within, with the help of internal remedies. Animal studies using roots and leaves of burdock plants that had not yet flowered demonstrated diuretic,

MATERIA MEDICA hypoglycemic, and antifurunculous properties.30 The antimicrobial activity documented for burdock has been attributed to its polyacetylene constituents, although only traces of these compounds are found in dried commercial herb.31 Other studies have suggested that burdock may afford protection against mutagenicity.32,33 Burdock has also shown antitumor activity.34 In an animal study, the addition of dietary fiber (5%) from burdock roots to the diet of rats provided protection against toxicity from various artificial food colorings.35 Priest and Priest considered burdock a . . . general alterative: influences skin, kidneys, mucous and serous membranes, to remove accumulated waste products. It is specific for eruptions on the head, face and neck, and for acute irritable and inflammatory conditions. They gave the following specific indications: eczema, psoriasis, dermatitis; boils, carbuncles, sties, sores, rheumatism, gout, and sciatica. Safety Considerations: Potentially, burdock may cause allergic reactions in people sensitive to plants in the Asteraceae family. Preparations and Dosage: Tincture dosage is 2 to 4 ml three times a day (1:5 in 40%). To make a decoction, put 1 teaspoon of root into 1 cup of water, bring to a boil, and simmer for to minutes. This should be drunk three times a day. The BHC recommends 2 to 6 g of dried root by decoction, 8 to ml tincture (1:5 in 25%), or 2 to 6 ml fluid extract (1:1 in 25%) three times a day. Burdock root, in The Complete German Commission E Monographs Arctostaphylos uva-ursi (L.) K. Sprang. Bearberry Ericaceae Other Names: Uva-ursi, kinnikinnick Part Used: Leaf Constituents: Hydroquinones (arbutin, methylarbutin); iridoids (monotropein); flavonoids (quercitrin, isoquercitrin, myricacitrin, and others); miscellaneous: tannins; volatile oil; ursolic, malic and gallic acids36 Actions: Diuretic, astringent, antimicrobial, demulcent Indications: Bearberry has a specific antiseptic and astringent effect on the membranes of the urinary system. It generally soothes, tones, and strengthens these tissues. It is specifically used for conditions in which there is gravel or ulceration in the kidney or bladder. It may be applied in the treatment of acute urinary tract infections, such as pyelitis and cystitis, or used as part of a holistic approach to chronic kidney problems. It has proved effective for some cases of bed-wetting. As a douche, it may be helpful in the treatment of vaginal ulceration and infection. Ellingwood provided the following specific indications for bearberry: Its direct influence is upon relaxed conditions of the bladder walls, to which it imparts tone and induces normal contraction. It restrains excessive mucous discharges. He recommended the herb for ulceration of the bladder, cystitis, pyelitis, pyelonephritis, and gonorrhea. Safety Considerations: Urinary acidifiers inhibit the conversion of arbutin to active hydroquinone, rendering bearberry less effective. Preparations and Dosage: Tincture dosage is 2 to 4 ml three times a day (1:5 in 25%). To make an infusion, pour 1 cup of boiling water over 1 to 2 teaspoons of dried leaves; infuse in a covered container for to minutes. This should be drunk three times a day. Commission E recommends to g (equivalent to to mg of arbutin) in ml water as infusion or cold macerate. Dosage from BHC is 1.5 to 2.5 gdried leaf infusion or cold aqueous extract, 2 to 4 ml tincture (1:5 in 25%), or 1.5 to 2.5 ml fluid extract (1:1 in 25%). Bearberry, in Principles and Practice of Phytotherapy Arnica montana L. Arnica Asteraceae Part Used: Flower head Constituents: Sesquiterpene lactones (arnifolin, arnicolides, helenalin); flavonoids (such as eupafolin, patuletin, and spinacetin); volatile oil, containing thymol and various ethers of thymol; miscellaneous: phenolic acids, coumarins, resins, bitters (arnicin), tannins, carotenes37 Actions: Anti-inflammatory, vulnerary Indications: This herb should not be taken internally, as it is potentially toxic. However, arnica provides us with one of the best external remedies for local healing, and may be considered a specific when it comes to the treatment of bruises and sprains. The homeopathic preparation is entirely safe to take internally, especially when used according to homeopathic directions. The herb itself, used externally, will help relieve pain and inflammation of phlebitis, rheumatism, and similar conditions. In fact, it

may be used on the skin in all cases of pain or inflammation, as long as the skin is not broken. Arnica has been shown to be an immunostimulant, as both the sesquiterpene lactone helenalin and the polysaccharide fraction stimulate phagocytosis. Sesquiterpene lactones are known to have anti-inflammatory activity, and their biological effects appear to be mediated through immunological processes. The fact that helenalin is an anti-inflammatory sesquiterpene lactone might help account for the value of arnica for pain and inflammation. Safety Considerations: Due to the toxicity of the sesquiterpene lactones it contains, oral use of arnica must be avoided altogether. Topical applications of arnica may cause an allergy in the form of painful, itchy, inflammatory changes to the skin in some people. Preparations and Dosage: For topical use, a simple folk tincture will suffice. Pour V2 liter (1 pint) of 70% alcohol over g (2 ounces) of freshly picked flowers in a clear glass container. Seal and let stand for at least a week in the sun or a warm place. Filter and store in a sealed container; keep out of direct sunlight. Use as needed. Arnica flowers, in Principles and Practice of Phytotherapy Artemisia absinthium L. Wormwood Asteraceae Parts Used: Leaf, flowering top Constituents: Volatile oil, including a- and (3-thujone (35%); sesquiterpene lactones (absinthin, artemetin, matricin, isoabsinthin, artemolin); acetylenes; flavonoids; phenolic acids; lignans (diayangambin and epiyangambin)38 Actions: Bitter, carminative, antimicrobial, anthelmintic, antidepressant Indications: Traditionally, wormwood has been used in a wide range of conditions, from indigestion to depression, many of which have been validated by scientific analysis. The herb is primarily used as a bitter to stimulate and invigorate the whole digestive process. It is helpful in indigestion, especially when due to a deficient quantity or quality of gastric juices. As the name implies, wormwood is a powerful remedy against worm infestations, especially roundworm and pinworm. The herb may also be used to help the body deal with fever and infections. It has a long history of use as an antidepressant. Safety Considerations: Adverse effects are likely only with overdose, and are due primarily to the effects of thujone, which is toxic. Taken in high doses, wormwood preparations may cause intoxication with vomiting, severe diarrhea, retention of urine, stupor, and convulsions. Aqueous extracts contain relatively little thujone. Wormwood is contraindicated for patients with stomach hyperacidity and intestinal ulcers. Avoid during pregnancy. Concerns about the safety of wormwood are related largely to the presence of the monoterpene constituent thujone in the essential oil (see chapter 6 for more information). Concerns about the toxicity of wormwood essential oil are well founded; however, the amount of essential oil in the dried herb is low, minimizing danger. Thujone is also a component of certain other essential oils, including white cedar oil (from the leaves of Thuja occidentalism and tansy oil (from the leaves and tops of Tanacetum vulgare). It is also found in tire leaves of the culinary sage (Salvia officinalis) and of rosemary (Rosmarinus officinalis). For purposes of comparison, the thujone content of selected plants is listed here. Salvia officinalis (sage leaf): 1,453 to 12,636 ppm Artemisia absinthium (wormwood leaf): 3,500 ppm Rosmarinus officinalis (rosemary plant): to ppm Antifertility studies were conducted in rats using dry extract of wormwood (probably containing some essential oil). Oral administration of this extract at a dosage of 200 mg/kg for 7 days caused a significant anti-implantation effect.39 Daily oral administration of thujone to rats at 10 mg/kg produced convulsions on day of the study (after intake of a total of mg of thujone) in 5% of the rats. The oral LDS0 of mixed a- and (3-thujones has been determined to be mg/kg in rats, mg/kg in mice, and mg/kg in guinea pigs; however, a-thujone is more toxic than (3-thujone.40 Overdose of wormwood in humans may cause major CNS disturbances, including convulsions and paralysis leading to unconsciousness and death. Very high doses of wormwood tincture have been reported to induce abortion. Dilute aqueous extracts of dried wormwood contain only trace amounts of essential oil. Thujone-free wormwood extracts can be prepared with extraction procedures using either water, 30% ethanol, or supercritical carbon dioxide extraction technology. Preparations and Dosage: Tincture dosage is 1 to 4 ml three times a day (1:1 in 25%). To make an infusion, pour 1 cup of boiling water over 1 to 2 teaspoons of the dried herb; infuse for to minutes. This should be drunk three times a day. To avoid the extremely bitter taste when using wormwood as an anthelmintic, powdered wormwood may be taken in pill form to eliminate worms. Commission E lists a daily dosage of 2 to 3 g of herb as a water infusion. BPC recommends 3 to ml of tineMATERIA MEDICA ture daily. Dosage from the BHP is I to 2 g of dried herb or 1 to 2 ml of fluid extract (1:1 in 25%) three times a day. Artemisiae herba, in Herbal Drugs and Phytopharmaceuticals Artemisia vulgaris L. Mugwort Asteraceae Parts Used: Leaf, root Constituents: Volatile oil (linalool, 1,8-cineole, (3-thujone, borneol, a- and (3-pinene); sesquiterpene lactones (vulgarin); flavonoids; coumarin derivatives; triterpenes41 Actions: Bitter tonic, stimulant, nervine tonic, emmenagogue Indications: As a bitter, mugwort may be used whenever digestive stimulation is indicated. However, the herb supports digestion not only through bitter stimulation, but also through carminative actions conferred by the volatile oils it contains. In addition, it has a mild nervine action, which also appears to be related to volatile oil content, that may help ease depression and tension. Thus, it is essential that the volatile oil is not lost in preparation. Mugwort may also be used as an emmenagogue to promote normal menstrual flow. Safety Considerations: Mugwort is potentially allergenic to people sensitive to plants in the Asteraceae family. Preparations and Dosage: Tincture dosage is 1 to 4 ml three times a day (1:5 in 25%). To make an infusion, pour 1 cup of boiling water over 1 to 2 teaspoons of dried herb and infuse for to minutes in a covered container. This should be drunk three times a day. Dosage from the BHP is 0.5 to 2 g of dried herb or

Mugwort, in The Complete German Commission E Monographs Asclepias tuberosa L. Pleurisy Root Asclepiadaceae Part Used: Rhizome Constituents: Cardenolides (including asclepiadin); flavonoids (rutin, kaempferol, quercetin, and isorhamnetin); miscellaneous: friedalin, a- and (3-amyrin, lupeol, viburnitol, choline sugars42 Actions: Diaphoretic, expectorant, antispasmodic, carminative, anti-inflammatory Indications: Pleurisy root is effective against respiratory infections, reducing inflammation and promoting expec-toration. It can be used in the treatment of bronchitis, influenza, and other respiratory conditions. The fact that it also has diaphoretic and antispasmodic powers explains why it is so highly valued for treating pleurisy and pneumonia. In the laboratory, low doses of extracts of Asclepias species stimulated uterine contractions and exhibited estrogenic effects.43 Priest and Priest gave the following specific indications: catarrhal complaints from cold and damp, hard dry cough, bronchitis, pleurisy, peritonitis, pneumonia, influenza, intercostal rheumatism, and other intercostal diseases. According to King's: It was one of the most common medicines employed by the Eclectic fathers. The drug has fallen into unmerited neglect, and could profitably be employed at the present day for purposes for which much more powerful, and sometimes dangerous, drugs are used. It has an extensive range of usefulness, being possessed of diaphoretic, diuretic, laxative, tonic, carminative, expectorant, and probably anti-spasmodic properties. Pleurisy root is one of the best diaphoretics of the Eclectic materia medica. It is not stimulating, and may be used to promote diaphoresis, no matter how high the degree of fever. Pleurisy root has a deservedly good reputation in respiratory diseases. It acts upon the mucous membrane of the pulmonary tract, augmenting the secretions and favoring easy expectoration. ... As its popular name indicates, pleurisy root is of much value in treating pleurisy. Not only is its action on serous membranes marked, but it is very effectual in intercostal neuralgia and rheumatism, as well as in pericardial pains. In pneumonia, as well as in bronchitis, it is best adapted to the acute stage, where the lesion seems to be extensive, taking in a large area of lung parenchyma and mucous tissues. In the convalescing stage of pneumonia, and other respiratory lesions, when suppression of the expectoration and dyspnoea threaten, small doses at frequent intervals will correct the trouble. It, as well as Euphrasia and Matricaria, is among our best drugs for snuffles, or acute nasal catarrh of infants. It is an excellent remedy for ordinary colds. It is, in fact one of our best drugs for catarrhal conditions, whether of the pulmonary or gastrointestinal tract, especially when produced by recent colds. Stomach troubles, particularly those of children, are often markedly benefited by small doses. Safety Considerations: Asclepias increases the risk of cardiac glycoside toxicity if taken with drugs or herbs that contain such constituents.

532 «- TREATMENT APPROACHES BY BODY SYSTEM Preparations and Dosage: Tincture dosage is 1 to 2 ml three times a day (1:5 in 45%). To make an infusion, pour 1 cup of boiling water over V2 to 1 teaspoon of the herb and infuse for to minutes. This should be drunk three times a day. Pleurisy root, in Herbal Medicines: A Guide for Health-Care Professionals Astragalus membranaceus (Fisch.) Bunge Astragalus Fabaceae Part Used: Root Constituents: Triterpenoid saponin glycosides (astragalosides I-VTI); flavonoid glycosides and aglycones; highmolecular-weight polysaccharides44 Action: Immunomodulator Indications:.Astragalus has been used since ancient times in traditional Chinese medicine. When research illuminated its effects upon the immune system, it was adopted as an important remedy in the West. Studies indicate that the polysaccharides in astragalus intensify phagocytosis in reticuloendothelial systems, stimulate pituitary-adrenal cortical activity, and restore depleted red blood cell formation in bone marrow. Astragalus is also one of the herbs known to stimulate the body's natural production of interferon.45 Astragalus has been used in combination with drug therapies to reduce their toxicity and ameliorate side effects. The herb has been employed to treat chronic leukopenia (low white blood cell count) related to treatment with steroids, anticancer drugs, and other therapies.46 In an in vitro study, researchers were able to use a lower dose of interleukin 2 (IL 2), a common cancer treatment, by combining the drug with astragalus. High doses of IL 2 are associated with significant side effects.47 The addition of astragalus potentiated IL 2 activity tenfold, thus potentially facilitating a lower dose of IL 2 for the same therapeutic outcome. In a laboratory study, astragalus prevented liver damage induced by the common anticancer drug stilbenemide.48 Astragalus appears to strengthen both nonspecific and specific immunity. The conclusion drawn by most Western herbalists is that astragalus is an ideal remedy for anyone who might be immunocompromised. It strengthens many functions of the immune system, helps protect the liver from damage, and may have valuable anticancer effects. Safety Considerations: Astragalus potentiates the effects of interleukin 2 and acyclovir, but may be incompatible with immunosuppressive drugs (e.g., cyclosporine, azathioprine, and methotrexate).49 Preparations and Dosage: Tincture dosage is 4 to 8 ml three times a day (1:5 in 40%). To make a decoction, put 2 to 4 teaspoons of root into 1 cup of water, bring to a boil, and simmer for to minutes. This should be drunk three times a day. In traditional Chinese medicine, pieces of root are boiled in soups and removed prior to serving. Astragalus, in Principles and Practice of Phytotherapy Avena sativa L. Oats Poaceae Other name: Oatstraw Parts Used: Seed, whole plant Constituents: Proteins (prolamines known as avenins); C-glycosyl flavones; avenacosides (spirostanol glycosides); fixed oil; vitamin E; starch50 Actions: Nervine tonic, antidepressant, nutritive, demulcent, vulnerary Indications: Oats is one of the best remedies for "feeding" the nervous system, especially when the patient is under stress. It is considered a specific in cases of nervous debility and exhaustion associated with depression. Oats may be used in combination with most of the other nervines, both relaxant and stimulant, to strengthen the whole nervous system. It is also used to treat general debility. Safety Considerations: No side effects or drug interactions have been reported. Preparations and Dosage: Tincture dosage is 3 to 5 ml three times a day (1:5 in 25%). To make an oatstraw infusion, pour 1 cup of boiling water over 1 to 3 teaspoons of dried straw and leave to infuse to minutes. This should be drunk three times a day. A soothing bath for use in treating neuralgia and irritated skin conditions can be made by boiling 1 pound of shredded oatstraw in 2 quarts of water for one-half hour. Strain the liquid and add to the bath. Alternately, put cooked rolled oats into a muslin bag and soak it in the bathwater. Dosage recommended by the BHP is 1 to 5 ml tincture (1:5 in 45%) or 0.6 to 2 ml fluid extract (1:1 in 25%) three times daily. Commission E suggests using g dried herb for one full bath. Avenae herba, in Herbal Drugs and Phytopharmaceuticals

MATERIA MEDICA Ballota nigra L. Black Horehound Lamiaceae Constituents: Diterpenes (marrubiin, ballonigrin, ballotinone)3) Actions: Antiemetic, nervine, astringent, emmenagogue, expectorant Indications: Black horehound—not to be confused with white horehound (Marrubium vulgare)—is an excellent remedy for calming nausea and vomiting when the cause lies within the nervous system, rather than in the stomach. It may be safely used for motion sickness, for example, in which nausea is triggered through the inner ear and the central nervous system. This herb is also of value in treating nausea and vomiting caused by pregnancy or nervousness. Black horehound has a reputation as a normalizer of menstrual function and as a mild expectorant. Safety Considerations: No side effects or drug interactions have been reported. Preparations and Dosage: Tincture dosage is 1 to 2 ml three times a day (1:5 in 25%). To make an infusion, pour 1 cup of boiling water over 1 to 2 teaspoons of dried herb and infuse for to minutes. This should be drunk three times a day, or as needed. Horehound, Black, in Herbal Medicines: A Guide for Health-Care Professionals Baptisia tinctoria (L.) Venten. Wild Indigo Fabaceae Part Used: Root Constituents: Isoflavones (genistein, biochanin A); flavonoids; alkaloids (such as cytisine); coumarins; polysaccharides32 Actions: Antimicrobial, anticatarrhal Indications: Wild indigo is especially valuable for the treatment of infections and catarrh of the ear, nose, and throat. It may be used for laryngitis, tonsillitis, pharyngitis, and catarrhal infections of the nose and sinuses. Taken both internally and as a mouthwash, it heals mouth ulcers and gingivitis and helps control pyorrhea. Systemically, it may be useful in the treatment of enlarged and inflamed lymph glands (lymphadenitis) and to reduce fevers. A douche of wild indigo decoction will improve leukorrhea. Ellingwood had much to say about this neglected remedy: The agent has been widely used for many years by our practitioners in the treatment of typhoid conditions, and has established its position as an important remedy. In scarlet fever, with its specific indications, it is a useful remedy. Large doses are not necessary, but it should be employed early and the use persisted in. In the treatment of low fevers this agent is said to exercise marked sedative power over the fever. It is advised in all diseases of the glandular system, and in hepatic derangements especially, with symptoms of the character. In the various forms of stomatitis, putrid sore throat and scarlatina; in inflammation of the bowels, where there is a tendency to typhoid conditions, especially ulcerative inflammation of any of the internal organs; in dyspepsia, with great irritability and offensive decomposition of food; in scrofula and in cutaneous infections, the agent should be long continued. In the long protracted and sluggish forms of fevers, with great depression of the vital forces; in ulceration of the nipples or mammary glands, or cf the cervix uteri, it is spoken highly of. Safety Considerations: No side effects or drug interactions have been reported. Preparations and Dosage: Tincture dosage is 1 ml three times a day (1:5 in 60%). To make a decoction, put 7z to 1 teaspoon of dried root in 1 cup of water, bring to a boil, and simmer for to minutes. This should be drunk three times a day. Berberis vulgaris L. Barberry Berberidaceae Part Used: Bark of root or stem Constituents: Isoquinoline alkaloids (berberine, berbamine); miscellaneous: chelidonic acid, resin, tannins53 Actions: Cholagogue, hepatic, antiemetic, bitter, laxative Indications: Barberry is a traditional remedy for correcting liver function and promoting the flow of bile. It is indicated when gallstones or gallbladder inflammation is present and when jaundice occurs due to a congested state of the liver. As a bitter tonic with mild laxative effects, it helps strengthen and cleanse the system in weak or debilitated people. Barberry has the interesting ability to reduce the size of an enlarged spleen. It has antimalarial actions and is effective against infections caused by the protozoan Leishmania spp. Priest and Priest described barberry as follows:

. . . stimulating tonic hepatic: influences the mucosa generally, removing mucoid accumulations and controlling excess secretion. Improves appetite, digestion and assimilation. Indicated for "gouty" constitutions. They provided the following specific indications: biliary catarrh with constipation and jaundice, gastritis, biliousness, debility during convalescence, ulcerative stomatitis, and eczema of the hands. Safety Considerations: Avoid during pregnancy. Preparations and Dosage: Tincture dosage is 1 to 2 ml three times a day (1:5 in 60%). To make a decoction, put 1 teaspoon of herb into 1 cup of cold water and bring to a boil. Simmer for to minutes. This should be drunk three times a day. The BPC suggests a dosage of 1 to 3.5 ml fluid extract three times a day. Recommended dosage from the BHP is 1 to 2 g of dried herb, 2 to 4 ml tincture (1:10 in 60%), or 2 to 3 ml fluid extract (1:1 in 25%) three times a day. Barberry, in The Complete German Commission E Monographs Betula alba L. Birch Betulaceae Parts Used: Young leaf, twig Constituents: Flavonoids (mainly hyperoside, with luteolin and quercetin glycosides)54 Actions: Diuretic, anti-inflammatory, antiseptic, tonic Indications: Birch leaf is an effective remedy for cystitis and other infections of the urinary system and helps eliminate excess water from the body. Perhaps because of this cleansing, diuretic activity, the plant has been used to treat gout, rheumatism, and mild arthritic pain. Birch bark helps ease muscle pain if applied externally, with the fresh, wet, internal side of the bark placed against the skin. Safety Considerations: No side effects or drug interactions have been reported. Preparations and Dosage: Tincture dosage is 1 to 2 ml three times a day (1:5 in 25%). To make an infusion, pour 1 cup of boiling water over 1 to 2 teaspoons of dried leaf and infuse for minutes. This should be drunk three times a day. Commission E suggests a dosage of 2 to 3 g dried herb several times a day. Betulae folium, in Herbal Drugs and Pbytopharmaceuticals Brassica nigra (L.) W.D.J. Koch Black Mustard Brassicaceae Other Names and Related Species: Formerly Sinapsis nigra. White mustard (Brassica alba Rabenh., non L., syn. Sinapsis alba L.) may be used interchangeably. Part Used: Seed Constituents: Glucosinolates (black mustard contains sinigrin, white mustard sinalbin); miscellaneous: sinapine, sinapic acid, fixed oil, protein, mucilage55 Actions: Rubefacient, irritant, stimulant, diuretic, emetic Indications: This well-known spice finds its main use in medicine as a stimulating external application. The rubefacient action causes mild irritation to the skin, which stimulates the circulation in that area and relieves muscular and skeletal pain. This also gives it a role in the treatment of chilblains. Because of its stimulating, diaphoretic action, mustard can be applied in the same ways that cayenne and ginger are. For feverishness, colds, and influenza, mustard seed may be taken as a tea or ground and sprinkled into a bath. An infusion or poultice of mustard is useful in the treatment of bronchitis. Safety Considerations: No side effects or drug interactions have been reported. May cause skin irritation when applied externally, especially in fair-skinned people. Preparations and Dosage: Mustard is most commonly used as a poultice, which can be made by mixing g (4 oz) of freshly ground mustard seeds with enough warm water (at about 45°C or 110°F) to form a thick paste. Spread this mixture onto a piece of cloth the size of the body area to be covered. To prevent the paste from sticking to the skin, first lay a piece of dampened gauze on the skin. Apply the cloth spread with mustard and remove after 1 minute. The skin may be reddened by this treatment, but may be soothed by the application of olive oil afterward. To make an infusion, pour 1 cup of boiling water over 1 teaspoon of mustard flour (powder) and infuse for 5 minutes. This may be drunk three times a day. For a footbath, make an infusion using 1 tablespoon of bruised seeds to 1 liter (2 pints) of boiling water. Calendula officinalis L. Calendula Asteraceae Other Names: Marigold, pot marigold Parts Used: Petals, flower head

MATERIA MEDICA JZ- 535 Constituents: Triterpenes (calenchilosides A-D); flavonoids (including narcissin, rutin); volatile oil; chlorogenic acid56 Actions: Anti-inflammatory, antispasmodic, lymphatic, astringent, vulnerary, emmenagogue, cholagogue, antifungal Indications: Calendula may be used safely whenever there is inflammation on the skin, whether due to infection or physical damage. It may be applied for any external bleeding or wound, bruising, or strains. The herb is also of benefit for slow-healing wounds and skin ulcers, and ideal for first-aid treatment of minor burns and scalds. Calendula may be applied locally as a lotion, poultice, or compress, depending on which is most appropriate. Calendula has long been used throughout Europe for wound healing and treatment of both skin and gastric ulcers. Its healing power appears to be based at least in part on its terpene content. When taken internally, calendula has anti-inflammatory actions in the digestive system, and thus may be used in the treatment of gastric and duodenal ulcers. As a cholagogue, it helps relieve gallbladder problems and many of the vague digestive complaints known as "indigestion." Calendula demonstrates marked antifungal activity and may be used both internally and externally to combat fungal infections. As an emmenagogue, it has a reputation for helping with delayed menstruation and easing painful periods. In general, it is considered a normalizer of the menstrual process. In the laboratory, calendula has demonstrated antiinflammatory, antibacterial, and antiviral activities.57 A combination of allantoin and calendula extract applied to surgically induced skin wounds in rats was reported to stimulate physiological regeneration and granulation. Allantoin alone exerted a much weaker action.58 Safety Considerations: Calendula is a possible allergen for those with known sensitivity to members of the Asteraceae family. Calendula was shown to be nontoxic when administered chronically to mice in the form of aqueous extract.59 No symptoms of toxicity were observed after administration of a calendula flower extract at a dosage of 0.15 g/kg to hamsters older than months and rats older than 21 months.60 Preparations and Dosage: Tincture dosage is 1 to 4 ml three times a day (1:5 in 60%). To make an infusion, pour 1 cup of boiling water over 1 to 2 teaspoons of flowers and infuse for to minutes. This should be drunk three times a day. Calendula may be applied externally as a lotion or ointment for cuts, bruises, diaper rash, sore nipples, burns, and scalds. Dosage recommended in the BHP is 1 to 4 g dried herb, 0.3 to 1.2 ml tincture, or 0.5 to 1 ml liquid extract three times daily. Commission E suggests 1 to 2 g dried herb per cup of water (150 ml) or 2 to 4 ml tincture daily. Calendula flower, in Herbal Medicine, Expanded Commission E Monographs Capsella bursa-pastoris (L.) Medikus Shepherd's Purse Brassicaceae Parts Used: Aerial parts Constituents: Flavonoids (luteolin-7-rutinoside, quercetin3-rutinoside); plant acids (fumaric and bursic acids)61 Actions: Astringent, diuretic, anti-inflammatory Indications: Shepherd's purse may be used whenever a gentle diuretic is indicated—for instance, to alleviate water retention due to kidney problems. As an astringent, the herb proves effective in the treatment of diarrhea, wounds, nosebleeds, and other conditions. It traditionally was used to stimulate the menstrual process, but is also of value in reducing excess menstrual flow. Ellingwood recommended shepherd's purse for hematuria, passive hemorrhage, chronic menorrhagia, intestinal hemorrhage, gastric hemorrhage, atonic dyspepsia, diarrhea, and dysentery, and externally for bruised or strained muscles, bleeding piles, and rheumatic joints. Safety Considerations: Because of its oxalic acid content, patients with kidney stones should avoid shepherd's purse. Preparations and Dosage: Tincture dosage is 1 to 2 ml three times a day (1:5 in 25%). To make an infusion, pour 1 cup of boiling water over 1 to 2 teaspoons of dried herb and infuse for to minutes. For menstrual conditions, a cup should be drunk every 2 to 3 hours just before and during the period. Otherwise, it should be drunk three times a day. Dosage listed in the BHP is 1 to 4 g dried herb or 1 to 4 ml liquid extract (1:1 in 25%) three times a day. Commission E recommends to g of herb or equivalent preparations daily. Shepherd's Purse, in Herbal Medicine, Expanded Commission E Monographs

536 TREATMENT APPROACHES BY BODY SYSTEM Capsicum annuum L. Cayenne Solanaceae Part Used: Fruit Constituents: Capsaicinoids (up to 1.5%): capsaicin, dihydrocapsaicin, others; carotenoids (capsanthin, capsorubin, carotene); steroidal saponins, known as capsicidins, in seed and root62 Actions: Stimulant, carminative, anticatarrhal, sialagogue, rubefacient, antimicrobial Indications: Cayenne is the most useful of the systemic stimulants. It stimulates blood flow, strengthening the heart, arteries, capillaries, and nerves. A general tonic, it is especially useful for toning both the circulator}' and digestive systems. Cayenne may be helpful in cases of flatulent dyspepsia and colic. It may also be used in conditions marked by insufficient peripheral circulation leading to cold hands and feet and, possibly, chilblains. It is also valuable for debility and for warding off colds. Externally, cayenne is applied as a rubefacient for problems such as lumbago and rheumatic pains. As an ointment, it can help with unbroken chilblains, as long as it is used in moderation. As a gargle for laryngitis, it combines well with myrrh. This combination also makes a good antiseptic wash. Research has shown that capsaicin blocks the transmission of pain and itching by nerve fibers in the skin. Capsaicin applied in the form of a topical cream helps relieve pain by depleting local supplies of a neurotransmitter called substance P, which transmits pain and itching signals from the nerves in the skin to the spinal cord. A link exists between many painful disorders and unusually high levels of substance P in nerve fibers. Unlike other local anesthetics, cayenne does not block impulses to all of the nerve fibers, only type C fibers, which are stricdy related to pain. Thus, it does not interfere with perception of touch, temperature, and pressure. In numerous clinical studies, a topical cream containing 0.025% or 0.075% capsaicin has proved helpful in treating painful and itchy skin disorders, including psoriasis, shingles, diabetic neuropathy, and postmastectomy pain.63,64 Capsaicin cream may also be effective in relieving the severe, stabbing pain associated with trigeminal neuralgia, a disorder that affects the largest nerve in the face. Improvement was generally apparent after several days of applying the cream three times daily. Capsaicin cream also shows promise in reducing the pain of arthritis.65 King's described cayenne thus: Capsicum is a pure, energetic, permanent stimulant, producing in large doses vomiting, purging, pains in the stomach and bowels, heat and inflammation of the stomach, giddiness, a species of intoxication and an enfeebled condition of the nervous power. The infusion is much used in colds, catarrh, hoarseness, etc. In atonic dyspepsia and catarrhal gastritis it stimulates the nerves of the stomach, promotes the secretion of the digestive juices, and assists peristaltic motion . . . Capsicum meets the debility of young and old, but is particularly useful in the elderly, when the body-heat is low, vitality depressed and reaction sluggish. Tired, painful muscles, stiffened joints and relaxation of any part are common conditions in the elderly that are, in a measure, rectified by Capsicum. Flatulence in dyspeptic states may be dispelled by capsicum. Externally, the infusion and tincture have been found valuable as a stimulating gargle in the ulcerated throat of scarlatina. If used early in tonsillitis, with relaxation, it may abort the trouble, but if it does not, its use should be discontinued until the active inflammation has subsided. Hoarseness, from atony of the vocal cords, is relieved by it, and it is a remedy for relaxed uvula. It enters into various tinctures and liniments. The concentrated tincture of capsicum has been highly recommended in the treatment of chilblains and toothache. In the former, a piece of sponge of flannel must be saturated with it, and rubbed well over the seat of the chilblain, until a strong tingling and electrical feeling is produced. This application should be continued daily, until the disease is removed; relief will be experienced on the very first application and frequently there will be a total removal of the disease after the second or third application. This, however, will depend upon the severity of the case. Safety Considerations: No side effects or drug interactions have been reported. Preparations and Dosage: Tincture dosage is 0.25 to 1 ml three times a day (1:5 in 25%). To make an infusion, pour 1 cup of boiling water over V2 to 1 teaspoon of cayenne and infuse for minutes. Mix a tablespoon of this infusion with hot water and drink when needed. Dosage recommended in the BPC is 0.06 g of dried herb or 0.3 to 0.9 ml tincture three times daily. The BHP recommends to mg of dried herb or 0.3 to 1 ml of tincture three times daily. Cayenne pepper, in Herbal Medicine, Expanded Commission E Monographs

MATERIA MEDICA Carum carvi L. Caraway Apiaceae Part Used: Seed Constituents: Volatile oil, consisting of carvone (40% to 60%) and limonene, with other constituents; flavonoids (mainly quercetin derivatives); miscellaneous: polysaccharide, protein, fixed oil, calcium oxalate66 Actions: Carminative, antispasmodic, expectorant, emmenagogue, galactagogue, astringent, antimicrobial Indications: Caraway is used as a calming herb to ease flatulent dyspepsia and intestinal colic, especially in children. It also helps stimulate appetite. Its astringency makes it useful in the treatment of diarrhea and, when applied as a gargle, in laryngitis. It may be employed for bronchitis and bronchial asthma, and its antispasmodic actions help relieve menstrual pains. Caraway has been used to increase milk flow in nursing mothers. Safety Considerations: No side effects or drug interactions have been reported. Preparations and Dosage: Tincture: dosage is 1 to 4 ml three times a day (1:5 in 40%). To make an infusion, pour 1 cup of boiling water over 1 teaspoon of freshly crushed seeds and infuse in a covered container for to minutes. This should be drunk three times a day. Carvi fructus, in Herbal Drugs and Phytopharmaceuticals Centaurium erythraea Rafn. Centaury Gentianaceae Parts Used: Dried aerial parts Constituents: Secoiridoids: gentiopicroside (gentiopicrin), swertiamarin; alkaloids (gentianine, gentianidine, gentioflavine); xanthone derivatives; phenolic acids; triterpenes ((^-sitosterol, campesterol, brassicasterol, stigmasterol, a- and (3-amyrin, erythrodiol)67 Actions: Bitter, hepatic Indications: Centaury may be used whenever a digestive and gastric stimulant is needed. It is indicated primarily for appetite loss (anorexia) associated with liver weakness. Centaury is helpful in dyspepsia and any other condition involving sluggish digestion. Safety Considerations: No side effects or drug interactions have been reported. Preparations and Dosage: Tincture: dosage is 1 to 2 ml three times a day (1:5 in 25%). To make an infusion, pour 1 cup of boiling water over 1 teaspoon of dried herb and infuse for 5 to minute;:. Drink 1 cup one half hour before meals. Commission E recommends an average daily dosage of 6 g dried herb or equivalent preparations, or 1 to 2 ml extract daily. Centaurii herba, in Herbal Drugs and Phytopharmaceuticals Cephaelis ipecacuanha (Brot.) A. Rich. Ipecacuanha Rubiaceae Other Name: Ipecac Parts Used: Root, rhizome Constituents: Isoquinoline alkaloids (2% to 3%): mainly emetine, cephaeline, psychotrine; tannins: ipecacuanhin and ipecacuanhic acid68 Actions: Expectorant, emetic, sialagogue, antiprotozoal Indications: Ipecac is used mainly as an expectorant for conditions such as bronchitis and whooping cough. At higher doses, it is a powerful emetic, and as such is used to treat poisoning. Care must be taken when using this herb. After administration of an effective emetic dose, the patient should drink large amounts of water. In the same way that ipecac promotes expectoration through stimulation and subsequent elimination of mucus, it fosters the production of saliva. It has been found effective against amoebic dysentery. Safety Considerations: Because it is an emetic, ipecac will prevent the absorption of drugs. Preparations and Dosage: Ipecac is a very powerful herb, so only a small amount should be used. Use 0.01 to

over a pea-sized amount of herb and infuse for 5 minutes. This may be drunk three times a day. Ipecacuanhae radix, in Herbal Drugs and Phytopharmaceuticals Cetraria islandica Iceland Moss Parmeliaceae Part Used: Whole plant (a lichen) Constituents: Lichen acids (fumarprotocetraric, protocetraric, cetraric, usnic); polysaccharides (about 50%): mainly lichenin and isolichenin; miscellaneous: furan derivatives, fatty acid, lactones, terpenes69 Actions: Demulcent, anti-inflammatory, antiemetic, expectorant

Indications: As a soothing demulcent with a high mucilage content, Iceland moss is valuable in gastritis, vomiting, and dyspepsia. It is also often used in respiratory catarrh and bronchitis to soothe mucous membranes. Its nourishing qualities give it a role in the treatment of cachexia, a state of malnourishment and debility. King's described Iceland moss as . . . demulcent, tonic and nutritious. Excessive doses may induce nausea and looseness of the bowels, while ordinary doses improve the appetite, digestion and general nutrition. Constipation is not produced by it, and the circulation is unaffected. Its nutritive qualities are undoubtedly due to its starch. The bitterness of cetrarin may be detected in the nursing mother's milk. Used as a demulcent in chronic catarrhs, chronic dysentery and diarrhea, and as a tonic in dyspepsia, convalescence and exhausting diseases. Boiled with milk, it forms an excellent nutritive and tonic in phthisis and general debility. It relieves the cough of chronic bronchitis. Safety Considerations: Because of its high mucilage content, Iceland moss may impair absorption of drugs. Preparations and Dosage: Tincture dosage is 1 to 2 ml three times a day (1:5 in 25%). To make a decoction, put 1 teaspoon of shredded moss in 1 cup of cold water. Boil for 3 minutes and let stand for minutes. A cup should be drunk morning and evening. Commission E recommends 4 to 6 g of herb or equivalent preparations daily. Iceland moss, in Herbal Medicine, Expanded Commission E Monographs Chelone glabra L. Balmony Scrophulariaceae Parts Used: Dried aerial parts Constituents: Very little research has been conducted on this plant. Only resins and bitters have been reported. Actions: Cholagogue, hepatic, bitter, antiemetic, stimulant, laxative Indications: Balmony is an excellent agent for liver problems and acts as a tonic for the whole digestive system. The herb stimulates the secretion of digestive juices, and in this way produces its laxative actions. Balmony is used to treat gallstones, inflammation of the gallbladder, and jaundice. It is considered a specific for gallstones that lead to congestive jaundice. The herb stimulates appetite; eases colic, dyspepsia, and biliousness; and is beneficial in debility. Externally, it has been used to treat inflamed breasts, painful ulcers, and piles. Priest and Priest said that balmony is a . . . mild relaxing hepatic influencing the mucous membranes, stimulating appetite and toning the stomach. It is suitable for children and the elderly. Indicated for gastrointestinal disturbances after prolonged illness. They gave the following specific indications: atonic conditions, malaise and debility, dyspepsia, malabsorption, roundworms and threadworms, colitis from hepatic dysfunction, and chronic jaundice. Safety Considerations: No side effects or drug interactions have been reported. Preparations and Dosage: Tincture dosage is 1 to 2 ml three times a day (1:10 in 40%). To make an infusion, pour 1 cup of boiling water over 2 teaspoons of dried herb and infuse for to minutes. This should be drunk three times a day. Chionanthus virginicus L. Fringetree Oleaceae Part Used: Bark Constituents: Phyllyrin (a lignin glycoside); chionanthin70 Actions: Hepatic, cholagogue, alterative, diuretic, tonic, antiemetic, laxative Indications: This valuable herb may be safely used for many liver problems, especially when jaundice is part of the picture. It is a specific for the treatment of gallbladder inflammation and a valuable component of treatment for gallstones. Fringetree aids the liver in general, and as such is often used as a tonic as part of a wider treatment to support the whole body. Because it stimulates the release of bile, it also acts as a gentle and effective laxative. Ellingwood considered fringetree specific for . . . the liver. It is a remedy for hepatic engorgement; jaundice more or less pronounced; pain over the region of the gall-bladder; pain in the epigastrium; pain radiating from the navel over the abdomen; soreness in the region of the liver, extending to the umbilicus; enlargement of the of the liver, determined by percussion; nausea; occasional vomiting; constipation with dry feces, temperature slightly above normal; skin usually yellow. In addition, he recommended it for acute congestion of the liver, catarrh of the common bile duct, acute jaundice, jaundice of childhood, bilious headaches, malarial

MATERIA MEDICA conditions, diabetes mellitus, sugar in the urine, and typhoid fever. Safety Considerations: No side effects or drug interactions have been reported. Preparations and Dosage: Tincture dosage is 1 to 2 ml three times a day (1:5 in 40%). To make an infusion, pour 1 cup of boiling water over 1 to 2 teaspoons of herb and infuse for to minutes. This should be drunk three times a day. Chondrus crispus (L.) Stackh. Irish Moss Gigartinacea Part Used: Dried thallus (Note: This is a seaweed, not a moss.) Constituents: Polysaccharides; the extract, also known as carrageenan, consists of sulfated, straight-chain galactans. (There are a variety of grades of carrageenan of different molecular weights, including a food grade with a molecular weight of about 100,000 to 500,000.)" Actions: Expectorant, demulcent, anti-inflammatory Indications: With modern attention on dramatically effective "miracle drugs," it is refreshing to remember the nourishing and strengthening food medicines, such as Irish moss. The safety of this seaweed allows it to make some unique contributions to health care. Its main traditional use was for respiratory illness, where it often served as the core of prescriptions used to treat irritating coughs, bronchitis, and many other lung problems. Irish moss may be freely used in digestive conditions for which a demulcent is indicated, such as gastritis and ulceration of the stomach and duodenum. Its soothing activity makes it helpful for inflammations of the urinary system, and it was once used extensively in the same way cornsilk is used today. It has also been used as a food as part of maintenance diets for people with diabetes. However, in the past, its primary role was in speeding recuperation from debilitating illness, which once received a greater focus of attention than it does today. Herbs such as Irish moss and other tonic, nutritive remedies have much to offer in facilitating proper recovery of health after major disease. King's suggested the use of Irish moss as ... a demulcent in chronic affections of the air passages, chronic diarrhea and dysentery, scrofula, rickets, enlarged mesenteric glands, irritation of the bladder and kidneys, etc. As a culinary article, it may be employed in the preparation of jellies, white soup, blanc mange, etc. Safety Considerations: Irish moss may impair absorption of drags. Preparations and Dosage: To use fresh, wash the seaweed well, add 1 cup to 3 cups of milk or water, and flavor to taste. Simmer slowly until most of the seaweed has dissolved. Remove any undissolved fragments and pour it into a mold to set. The dried seaweed is best made into a decoction. Steep 1 oz of dried Irish moss in cold water for minutes, boil for to minutes in 3 pints of water (or milk), and strain. It may be combined with licorice, lemon, ginger, or cinnamon and sweetened to taste. Cimicifuga racemosa (L.) Nutt. Black Cohosh Ranunculaceae Parts Used: Dried root and rhizome (not fresh) Constituents: Triterpene glycosides (actein, cimicifugoside, cimifugine, racemoside, cimiracemosides); isoferulic acid; salicylic acid; miscellaneous: volatile oil, tannins72 Actions: Emmenagogue, antispasmodic, anti-inflammatory, antirheumatic, alterative, nervine, hypotensive Indications: Black cohosh is a valuable relaxant and normalizer of the female reproductive system. It may be used to good effect to treat painful or delayed menstruation, and relieves cramping pain in the womb and cramping associated with ovulation. Modern interest in this herb has focused on its gynecological uses. While it is of undoubted value in this area, its contribution to the treatment of arthritic disorders should not be overlooked. It is very effective against rheumatic pain, including that of rheumatoid arthritis, osteoarthritis, and muscle problems, and is helpful for neurological pain, including sciatica and neuralgia. As a relaxing nervine, it may be used in many situations where such an agent is needed. It has also been found beneficial for tinniltis. Black cohosh helps to ease the physical and mental changes associated with perimenopause and menopause, as well as hormonal deficits resulting from ovariectomy or hysterectomy in younger women. Clinical studies support the primary application of black cohosh for the treatment of menopausal symptoms such as hot flashes, headache, vertigo, heart palpitations, ringing in the ears, and a range of associated psychological symptoms, including irritability, sleep disturbances, and depressive moods. Black cohosh extract has also been used successfully in women younger than years for treatment of hormonal deficits resulting from ovariectomy or hysterectomy. At least 8 weeks of treatment are required to alleviate symptoms. A

review of clinical studies showed that trials have ranged in length from 8 weeks to as long as 6 months.73 Because of the wealth of accrued experience presented in King's American Dispensatory, I have included a passage from its extensive monograph on black cohosh: This is a very active, powerful, and useful remedy, and appears to fulfil a great number of indications. It possesses an undoubted influence over the nervous system. In small doses the appetite and digestion are improved, and larger amounts augment the secretions of the gastrointestinal tract. The heart-beat is slowed and given increased power by it, while arterial tension is elevated. Upon the reproductive organs it exerts a specific influence, promoting the menstrual discharge, and by its power of increasing contractility of the unstriped fibres of the uterus, it acts as an efficient parturient. . . . Few of our remedies have acquired as great a reputation in the treatment of rheumatism and neuralgia. Indeed, few cases of rheumatism, or conditions depending upon a rheumatic basis, will present, which will not be influenced for the better by Cimicifuga. Muscular pain of a rheumatoid character, when not amounting to a true rheumatic attack, and other rheumatoid pains when acute and not of spinal origin such as gastralgia, enteralgia, tenesmic vesical pains, pleurodynia, pain in the mediastina orbits or ears, are relieved by Cimicifuga. By its special affinity for the female reproductive organs, it is an efficient agent for the restoration of suppressed menses. In dysmenorrhoea it is surpassed by no other drug, being of greatest utility in irritative and congestive conditions of the uterus and appendages, characterized by tensive, dragging pains, resembling the pains of rheumatism. If the patient be despondent and chilly, combine Cimicifuga with Pulsatilla, especially in anemic subjects. . . . Cimicifuga has proved a better agent in obstetrical practice than ergot. It produces natural intermittent uterine contractions, whereas ergot produces constant contractions, thereby endangering the life of the child, or rupture of the uterus. Where the pains are inefficient, feeble, or irregular, Cimicifuga will stimulate to normal action. It is an excellent "partus praeparator" if given for several weeks before confinement. It is a diagnostic agent to differentiate between spurious and true labor pains, the latter being increased, while the former are dissipated under tts use. It is the best and safest agent known for the relief of after-pains, and is effectual in allaying the general excitement of the nervous system after labor. . . . Preparations of Cimicifuga, to be of any medicinal value, must be prepared from recently dried roots. Safety Considerations: When used at the recommended dosage, no adverse effects are to be expected. The herb should not be used during pregnancy, except to assist birth. Preparations and Dosage: Tincture dosage is 2 to 4 ml three times a day (1:5 in 60%). To make a decoction, pour 1 cup of water over V2 to 1 teaspoon of dried root, bring to a boil, and simmer for to minutes. This should be drunk three times a day. Dosage listed in the BPC is 1.8 to 3.6 ml tincture (1:10 in 60%) or 0.3 to 1.8 ml fluid extract (1:1 in 90%). Commission E suggests a daily dosage of 40% to 60% ethanol extract corresponding to mg of drug. The USP recommends 1 g dried herb or 1 ml liquid extract. Black Cohosh, in Principles and Practice of Phytotherapy Cola acuminata Schumann Cola Sterculiaceae Other Names: Cola vera; kola Part Used: Seed kernel (the kernel freed from the testa) Constituents: Caffeine, with traces of theobromine; tannins and other phenolics; miscellaneous: phlobaphene (an anthocyanin pigment known as kola red), betaine74 Actions: Central nervous system stimulant, antidepressant, astringent, diuretic Indications: Cola has a marked stimulating effect on human consciousness. It can be used whenever there is a need for direct stimulation, which is less often than some may believe! If the health and function of the nervous system is improved, it will usually not need such stimulation. In the short term, however, cola may be used in nervous debility, states of atony, and weakness. Cola can be viewed as specific in cases of depression associated with weakness and debility, and may act as a specific in nervous diarrhea. It will help in general depression and, in some people, may even give rise to euphoric states. It may also be beneficial for some types of migraine. Because of its stimulant properties, it can be a valuable part of treatment for anorexia. Safety Considerations: Because it contains caffeine, cola may cause all of the reactions and potential drug interactions associated with this constituent. In addition, it may cause cumulative caffeine effects when used in combination with coffee, black or green tea, guarana, or mate. Preparations and Dosage: Tincture dosage is 1 to 2 ml three times a day (1:5 in 40%). To make a decoction, put 1 to 2 teaspoons of powdered cola nuts in a cup of water,

MATERIA MEDICA JZ- 541 bring to a boil, and simmer gently for to minutes. This should be drunk when needed. Dosage recommended in the BHC is 1 to 3 g powdered cotyledons, ] to 4 ml dncture (1:5 in 60%), or 0.6 to 1.2 ml fluid extract (1:1 in 60%) three times a day. Commission E lists a daily dosage of 2 to 6 g dried herb, to g tincture, or 2.5 to 7.5 g fluid extract. Cola nut, in Herbal Medicine, Expanded Commission E Monographs Collinsonia canadensis L. Stoneroot Lamiaceae Parts Used: Root, rhizome Constituents: Essential oil; tannins; saponins; alkaloids; resins; organic acid75 Actions: Antilithic, diuredc, diaphoretic Indications: As its name suggests, stoneroot finds its main use in the treatment and prevention of stone and gravel in the urinary system and gallbladder. It may be used as a prophylactic, but is also an excellent remedy when the body needs assistance in passing stones or gravel. It is a strong diuretic. In his extensive monograph, Ellingwood gave the following indications for stoneroot: Hemorrhoids, catarrhal gastritis, pain in the rectum, heart tonic, rheumatic inflammation, laryngitis, pharyngitis, clergyman's sore throat, dysentery, ulcers, fistula, inflammation of the middle ear, acute cystitis, vaginismus. Safety Considerations: No side effects or drug interactions have been reported. Preparations and Dosage: Tincture dosage is 1 to 2 ml three times a day (1:5 in 40%). To make a decoction, put 1 to 2 teaspoons of dried root in 1 cup of water, bring to a boil, and simmer for to minutes. This should be drunk three times a day. The BHP recommends 1 to 4 g dried herb, 2 to 8 ml tincture (1:5 in 40%), or 1 to 4 ml liquid extract (1:1 in 25%) three times a day. Stone Root, in Herbal Medicines: A Guide for Health-Care Professionals Commiphora molmol (Nees) Engl. Myrrh Burseraceae Part Used: Gum resin Constituents: Volatile oil (1.5% to 17%); gum (up to 60%); resins (up to 40%, average 20%); sterols76 Actions: Antimicrobial, astringent, carminative, anticatarrhal, expectorant, vulnerary Indications: Myrrh is an effective antimicrobial agent that has been shown to work in two complementary ways. Its primary action is to stimulate the production of white blood corpuscles, which have antipathogenic actions. Secondarily, it has a direct antimicrobial effect. Myrrh may be used in a wide range of conditions appropriate for treatment with an antimicrobial agent. It finds specific use in the treatment of infections of the mouth, such as mouth ulcers, gingivitis, and pyorrhea, as well as catarrhal problems, such as pharyngitis and sinusitis. Myrrh is often employed as part of an approach to the treatment of the common cold, and may be of benefit for laryngitis and respiratory complaints. Systemically, it is useful in the treatment of boils and similar conditions, glandular fever, and brucellosis. Applied externally, it is healing and antiseptic for wounds and abrasions. Anti-inflammatory arid antipyretic actions have been documented in mice.77 Hypoglycemic activity in both normal and diabetic rats has been reported.78 The proposed mode of action involved a decrease in gluconeogenesis and an increase in peripheral utilization of glucose in diabetic rats. Safety Considerations: Use of undiluted tincture of myrrh in the mouth may give rise to a transient burning sensation and irritation of the palate. Theoretically, myrrh may interfere with existing antidiabetic therapy, as hypoglycemic properties have been documented. Preparations and Dosage: The resin dissolves much more easily in alcohol than in water, so tincture is preferred and is easily obtainable. Dosage is 1 to 4 ml three times a day (1:1 in 90%). As the resin is difficult to dissolve in water, it should be powdered well for an infusion. Pour 1 cup of boiling water over 1 to 2 teaspoons of myrrh powder and infuse for to minutes. This should be drunk three times a day. For external use, Commission E recommends dabbing the skin two to three times daily with undiluted tincture. As a rinse or gargle, add 5 to drops of tincture to a glass of water. Dental powders should contain 10% powdered resin. Shepherd's Purse, in Herbal Medicine, Expanded Commission E Monographs

Crataegus laevigata (Poir.) DC. Hawthorn Rosaceae Parts Used: Traditionally, berry; modern products often use flower and leaf Constituents: Flavonoids (leaf and flower, up to 1.78%): vitexin, quercetin, hyperoside, rutin; oligomeric procyanidins (leaf and flower, 1.0% to 2.4%); triterpene acids (leaf and flower, up to 0.6%): ursolic, oleanolic, crataegolic acids; phenolic acids (caffeic, chlorogenic, and related phenolcarboxylic acids)79 Actions: Cardiotonic, diuretic, astringent, hypotensive Indications: A tonic in the true sense, Crataegus can be considered a specific remedy for most cardiovascular disease. A whole plant preparation should be used, as the individual effects of isolated constituents proved insignificant when tested in the laboratory. The whole plant, on the other hand, has unique and valuable properties. After a four-year study commissioned by the German Federal Ministry of Health, Crataegus gained recognition as a heart remedy in Europe. Please see chapter for a more detailed discussion of these research results and the possible mechanisms of action of this important herb. Hawthorn's primary attribute appears to be an ability to improve coronary circulation. It dilates the coronary arteries, relieving cardiac hypoxemia. Consequently, it reduces the likelihood of angina attacks and relieves symptoms of angina when they occur. The herb thus directly affects the cells of the cardiac muscle, enhancing both activity and nutrition. Crataegus is also positively inotropic; that is, it increases the contractility of cardiac muscle. However, it is quite different in activity from the cardiac glycoside-containing remedies. They impact the contractile fibers, while Crataegus assists with the availability and utilization of energy, facilitating a gentle but sustained reversal of degenerative, age-related changes. Used in conjunction with other cardiac herbs, Crataegus helps keep the heart in healthy condition, minimizing the risk of the development of coronary disease. It is indicated for cardiovascular degenerative disease, coronary artery disease, and associated conditions, including angina pectoris, mild congestive heart failure, essential hypertension, and recovery after myocardial infarction. It is especially beneficial for loss of function due to old age that has not yet resulted in overt pathology. It causes no toxicity, accumulation, or habituation, and is safe for long-term use in the elderly. Safety Considerations: Hawthorn enhances the activity of cardioactive drugs, such as Digitalis spp., Convallaria majalis, strophanthin, and the cardiac glycosides digitoxin and digoxin. However, because of its coronary vasodilating and antiarrhythmic effects, it also potentially reduces the toxicity of these cardiac glycosides by reducing the dosage needed to achieve the desired effect. Hawthorn procyanidins have reportedly potentiated coronary artery dilation caused by theophylline, caffeine, papaverine, sodium nitrate, adenosine, and epinephrine. However, the European Scientific Cooperative on Phytotherapy (ESCOP) monograph does not list any interactions, so some authorities apparently do not consider these interactions significant. Preparations and Dosage: Tincture dosage is 2.5 ml three times daily, then 2.5 ml morning and evening as a maintenance dose (1:5 in 40%). For the treatment of acute or severe conditions, use up to 5 ml three times a day. In the elderly, treatment should be continued over many months. To make an infusion, infuse 2 teaspoons of dried herb in 1 cup of boiling water; this should be drunk three times a day. Dosage suggested in the BHP is 0.3 to 1 g dried herb, 1 to 2 ml tincture (1:5 in 45%), or 1 to 2 ml liquid extract (1:1 in 25%) three times a day. Commission E recommends to mg water-ethanol extract (corresponding to to 168.7 mg procyanidins, calculated as epicatechin, and 3.5 to 19.8 mg flavonoids, calculated as hyperoside). Hawthorn, in Principles and Practice of Phytotherapy Daucus carota L. Wild Carrot Apiaceae Parts Used: Dried aerial parts, seed Constituents: Flavonoids; daucine (an alkaloid); volatile oil; petroselinic acid; tannins80 Actions: Diuretic, antilithic, carminative, antispasmodic, antirheumatic Indications: The volatile oil present in wild carrot is an active urinary antiseptic, which helps explain its application in such conditions as cystitis and prostatitis. It has been considered a specific for the treatment of kidney stones. For the treatment of gout and rheumatism, it is used as a diuretic in combination with other remedies. The seeds may be used as a settling carminative agent for the relief of flatulence and colic.

MATERIA MEDICA Safety Considerations: Juice of the fresh plant may cause photosensitivity. Preparations and Dosage: Tincture dosage is 1 to 2 ml three times a day (1:5 in 25%). To make an infusion of aerial parts, pour 1 cup of boiling water over 1 teaspoon of dried herb and infuse for to minutes. This should be drunk three times a day. To prepare an infusion of seeds, use 'A to 1 teaspoon per cup of water. This should be drunk three times a day. Wild Carrot, in Herbal Medicines: A Guide for Health-Care Professionals Dioscorea villosa L. Wild Yam Dioscoreaceae Parts Used: Dried underground parts Constituents: Steroidal saponins, based on diosgenin: dioscin, dioscorin, and others81 Actions: Antispasmodic, anti-inflammatory, antirheumatic, hepatic, cholagogue, diaphoretic Indications: This valuable herb was at one time the sole source of the chemicals used as raw material for the manufacture of contraceptive hormones. However, this should not be taken to mean that the herb is a source of so-called namral progesterone. The human body is incapable of converting the sapogenins to sex hormones. In herbal medicine, wild yam is a remedy that can be used to relieve intestinal colic, soothe diverticulitis, ease dysmenorrhea, and relieve ovarian and uterine pains. It is of great use in the treatment of rheumatoid arthritis, especially the acute phase, in which there is intense inflammation. Priest and Priest described wild yam and its indications in the following way: . . . autonomic nerve relaxant, especially for gastrointestinal conditions, vegetative neuroses and hyperaesthesiae. Rheumatic syndromes arising from hepatic and intestinal dysfunction. They offered the following specific indications: bilious colic, flatulence, gastrointestinal irritation, neuralgic conditions, dysmenorrhea, uterine pains, nervousness, restlessness, and pains of pregnancy. Ellingwood considered it specific for . . . sudden spasmodic griping pain in the stomach and bowels. It is specific in bilious colic, in the pain of the passing of gallstones, in mild cases, and is valuable in spasmodic colic of any kind. In addition, Ellingwood recommended it for neuralgic dysmenorrhea, ovarian neuralgia, and cramplike pains. King's provides the following monograph: It is a specific in bilious colic, having proved almost invariably successful in doses of '/2 pint of the decoction, repeated every half hour or hour. No other medicine is required, as it gives prompt and permanent relief in the most severe cases. In fact it is not only of value in bilious colic, but in all forms of colic and other painful abdominal neuroses and all forms of gastro-intestinal irritation. If it does not relieve in one hour, the medicine should be discontinued. It has allayed the pain incident to the passage of biliary calculi when given with full doses of gelsemium. It will likewise allay nausea, also spasms of the bowels and combined with equal parts of Conms sericea in decoction, is eminently beneficial in the nausea and vomiting of pregnancy. This root appears to exert an action especially upon enfeebled and irritable mucous tissues that become painful from spasmodic contractions of their muscular fibers; hence its value in bilious colic, in painful dysenteric tenesmus, in dysmenorrhoea (the result of spasmodic irritation of the mucous membrane), of the cervix uteri and in spasmodic irritations of the gastric mucous membrane attended with pain, nausea and vomiting. It is reputed useful in indigestion with hepatic derangement, in chronic hepatic congestion and in the chronic gastritis of drunkards. It is also useful in after-pains. Safety Considerations: No side effects or drug interactions have been reported. Preparations and Dosage: Tincnire dosage is 2 to 4 ml three times a day (1:5 in 40%). To make a decoction, put 1 to 2 teaspoons of herb in 1 cup of water, bring to a boil, and simmer gently for to minutes. This should be drunk three times a day. The BHP recommends 2 to 4 g dried herb, 2 to ml tincture (1:5 in 45%), or 2 to 4 ml fluid extract (1:1 in 45%) three times daily. Drosera rotundifolia L. Sundew Droseraceae Parts Used: Whole plant Constituents: Naphthoquinones, including plumbagin; flavonoids (kaempferol, mvricetin, quercetin, hyperoside); miscellaneous: carotenoids, plant acids, resin, tannins, ascorbic acid82 Actions: Antispasmodic, antitussive, expectorant

Indications: Sundew may be used to great benefit in bronchitis and whooping cough. The presence of plumbagin helps to explain its actions here, as the constituent has been shown to be active against Streptococcus, Staphylococcus, and Pneumococcus bacteria. Sundew is also effective against infections in other parts of the respiratory tract, and its relaxing effect upon involuntary muscles makes it useful in relieving asthma. In addition to pulmonary conditions, sundew has a long history of use for treating stomach ulcers. Drosera prevents acetylcholine- or histamine-induced bronchospasm and has antitussive properties. These antispasmodic actions have been attributed to its naphthoquinone constituents. Antimicrobial properties have been documented for the naphthoquinones. In vivo, plumbagin demonstrated a broad spectrum of activity against various gram-positive and gram-negative bacteria, influenza viruses, pathogenic fungi, and parasitic protozoans. Successful treatment of Microsporum infections in guinea pigs by local applications of 0.25% to 0.5% solutions of plumbagin (in 40% alcohol) or 1% emulsions has been reported. However, plumbagin was ineffective against Lamblia muris and tuberculosis infection when administered orally to mice for 5 days.83 Safety Considerations: No side effects or toxicity has been documented. Plumbagin has a LD50 of mg/kg body weight (i.p.) in mice. Preparations and Dosage: Tincture dosage is 1 to 2 ml three times a day (1:5 in 60%). To make an infusion, pour 1 cup of boiling water over 1 teaspoon of dried herb and infuse for to minutes. This should be drunk three times a day. Commission E recommends a dosage of 3 g herb daily. Droserae longifoliae herba, in Herbal Drugs and Phytopharmaceuticals Echinacea spp. Echinacea Asteraceae Other Name: Purple coneflower. The main Echinacea species available in commerce are E. purpurea, E. angustifolia, and E. pallida. Part Used: Root Constituents: Caffeic acid esters (0.6% to 2.1%) including echinacoside (in E. angustifolia but not E. purpurea) and cichoric acid (E. purpurea only); alkylamides, mostly unsaturated isobutyl amides (including dodeca-2,4,8,10tetraenoic acid); polysaccharides (including echinacin B); polyacetylenes; essential oil84 Actions: Antimicrobial, immunomodulator, antiinflammatory, anticatarrhal, vulnerary, alterative Indications: Echinacea is one of the primary remedies for helping the body rid itself of microbial infections. It is often effective against both bacterial and viral attacks. It may be used for conditions such as boils, septicemia, and similar infections, and, in conjunction with other herbs, it may be used for any infection anywhere in the body. For example, in combination with yarrow or bearberry, it is effective against cystitis. Echinacea is especially useful for infections of the upper respiratory tract, including laryngitis, tonsillitis, the common cold, and other catarrhal conditions of the nose and sinus. In general, it may be used widely and safely. Tincture or decoction of echinacea may be used as a mouthwash for gingivitis or pyorrhea. The herb may be applied externally as a lotion to treat septic sores and cuts. Much research has focused upon this plant, providing important insights into its activity and potential uses. Constituents from the roots have demonstrated mild activity against Streptococcus and Staphylococcus aureus. The caffeic acid derivative echinacoside was the most active; about 6 mg were reported to be equivalent to 1 unit of penicillin.85 Treatment with tincture reduced both the rate of growth and the rate of reproduction of Trichomonas vaginalis, and was deemed effective in halting recurrence of Candida albicans infection.86 In other studies, echinacea appeared to prevent infection and repair tissue damaged by infection, partially by inhibiting the activity of the enzyme hyaluronidase.87 The hyaluronidase system is a primary defense mechanism in which connective "ground substance," composed largely of hyaluronic acid, acts as a barrier against pathogenic organisms. Some pathogens activate an enzyme, hyaluronidase, which destroys the integrity of the ground substance. The barrier then becomes leaky, allowing pathogens to invade, attach themselves to exposed cells, penetrate the membranes, and kill the cells. The result is an inflammatory infection. Echinacea inhibits the action of hyaluronidase by bonding with it in some way, causing a temporary increase in the integrity of the barrier and impairing the ability of pathogens to stimulate the destruction of the ground substance. A range of constituents mediates this process, especially a complex polysaccharide called echinacin B. This anti-hyaluronidase action also supports the regeneration of connective tissue destroyed during infection and the elimination of pathogenic organisms that create infection. Purified polysaccharides from echinacea strongly acMATERIA MEDICA tivate the body's macrophage-mediated defense system. Macrophages initiate the destruction of pathogens and cancer cells. Echinacea activates macrophages on its own, independent of any effect on T cells. A tumorinhibiting principle—an oncolytic lipid-soluble hydrocarbon from the essential oil—has also been identified. The echinacoside glycosides appear to be the primary "antibiotics" in echinacea, but they probably function synergistically with many other active substances present in the plant. The polysaccharides possess the best immunestimulating properties and are also antiviral. Other constituents have been shown to possess good antitumor, bacteriostatic, and anesthetic properties.88 Clinical data support the use of echinacea in a variety of situations.89 It is indicated primarily for the prevention and treatment of acute infections, particularly colds, influenza, and other acute upper respiratory tract infections, in which it reduces both the duration and severity of symptoms. This all points to a conclusion that echinacea's actions are related on some level to immune system function, as it helps the body deal with infections and stimulates immune response. The herb activates the macrophages that destroy cancer cells and pathogens and increases phagocytosis by raising levels of white blood cells, such as neutrophils, monocytes, eosinophils, and Blymphocytes. It also affects propericlin levels, suggesting activation of the complement system.90 Safety Considerations: Echinacea may cause allergic reactions in people sensitive to plants in the Asteraceae family. Theoretically, it may interfere with immunosuppressant therapy. Preparations and Dosage: Echinacea is often inappropriately used as "daily immune support." It is more appropriately used to treat active infection or at the first sign of an acute infection. Tincture dosage is 1 to 4 ml three times a day (1:5 in 40%). To make a decoction, put 1 to 2 teaspoons of root in 1 cup of water and bring slowly to a boil. Let simmer for to minutes. This should be drunk three times a day. The BHC recommends 1 g dried root, 2 to 5 ml tincture (1:5 in 45%), or 0.5 to 1 ml of fluid extract (1:1 in 45%) of Echinacea angustifolia three times daily. Commission E suggests E. pallida tincture (1:5 in 50%, from dry extract) corresponding to mg herb or 6 to 9 ml expressed juice of E. purpurea daily. Echinacea, in Principles and Practice of Phytotherapy Eleutherococcus senticosus (Rupr. and Maxim.) Maxim. Siberian Ginseng Araliaceae Other Names: Acanthopanax senticosus; eleuthero Part Used: Root Constituents: Eleutherosides A-E; glycosides of a range of aglycones, including sterols, lignans, and phenolics; polysaccharides91 Action: Adaptogen Indications: Siberian ginseng is one of the primary adaptogens in use today. As discussed in more detail in chapter 25, an adaptogen is a substance that acts to enhance the body's nonspecific resistance to various internal and external stressors. Because of this nonspecific action, Siberian ginseng can be recommended as a general tonic with a very wide range of clinical indications. Siberian ginseng improves the body's resistance to environmental stressors and enhances physical and mental performance. It stimulates many aspects of the immune response, is antihepatotoxic, and increases resistance to oxygen deprivation of the heart.92 The herb is especially useful for conditions influenced by the stress response, including angina, hypertension, hypotension, various types of neuroses, chronic bronchitis, and cancer. It is beneficial against the effects of prolonged stress or overwork such as exhaustion, irritability, insomnia, and mild depression. Siberian ginseng may also be employed to support recovery from acute or chronic diseases, trauma, surgery, and other stressful events, and can help counter the debilitating effects of treatments such as chemotherapy and radiation. It may be taken on a long-term basis to minimize the incidence of acute infections and to generally improve well-being. Safety Considerations: Siberian ginseng may interfere with cardiac medications (including hypo- and hypertensive drugs) and hypoglycemic agents. It may also enhance some drug effects. In a clinical study, the herb appeared to increase the efficacy of the antibiotics monomycin and kanamycin, used to treat Shigella dysentery and Proteus enterocolitis.93 Preparations and Dosage: Based upon clinical studies, standard tincture dosage is to drops three times a day. An equivalent dosage for a solid extract concentrated at a ratio of 20:1 would be to mg. The recommended regimen is usually for a 6-week course of treatment followed by a 2-week break.

Dosage recommended in the BHC is 2 to 3 g dried root and rhizome or equivalent preparations three times daily. Commission E suggests 2 to 3 g of root daily. Siberian Ginseng, in Principles and Practice of Phytotherapy Elymus repens (L.) Beauvois Couch Grass Poaceae Other Name: Formerly Agropyron repens Part Used: Rhizome Constituents: Carbohydrates (10%); triticin, inositol, mannitol, and mucilage; volatile oil (0.05%), mainly agropyrene; flavonoids (tricin)94 Actions: Diuretic, demulcent, antimicrobial Indications: Couch grass may be used in urinary tract infections such as cystitis, urethritis, and prostatitis. Its demulcent properties soothe irritation and inflammation. The herb is of value in the treatment of benign prostatic hypertrophy (BPH, or enlarged prostate), and may also be used for kidney stones and gravel. As a tonic diuretic, couch grass has been used in combination with other herbs for rheumatism. Research has demonstrated broad antibiotic activity for the terpene constituent agropyrene and its oxidation product. Safety Considerations: There is a theoretical risk of potassium depletion when couch grass is used in combination with potassium-depleting diuretics. Preparations and Dosage: Tincture dosage is 2 to 4 ml three times a day (1:5 in 40%). To make a decoction, put 2 teaspoons of cut rhizome in 1 cup of water, bring to a boil, and simmer for minutes. This should be drunk three times a day. Dosage recommendations from the BHP are 4 to 8 g dried herb, 5 to ml tincture (1:5 in 40%), or 4 to 8 ml fluid extract (1:1 in 25%) three times a day. The BPC lists a fluid extract dosage of 3.5 ml to ml three times a day. Commission E recommends 6 to 9 g dried herb daily. Couch Grass, in The Complete Ger?nan Commission E Monographs Ephedra sinica Stapf Ephedra Ephedraceae Other Name: Ma huang Part Used: Stem Constituents: Alkaloids (L-ephedrine, with D-ephedrine, pseudoephedrine, norephedrine, N-methylephedrine, benzylmethylamine); flavonoid glycosides; glycans; proanthocyanidins95 Actions: Vasodilator, hypertensive, circulatory stimulant, antiallergic Indications: Ephedra has been used in China for at least 5,000 years to treat a range of health problems. This ancient medicinal plant was also mentioned in the Hindu Vedas. With the discovery of the alkaloids in ephedra, this time-honored, traditional herbal wisdom was verified, providing modern medicine with important healing tools. Ephedra contains a range of therapeutically active alkaloids, which sometimes amount to up to 2% of the dried herb. Various Asian Ephedra species provide the source material for the widely used alkaloids ephedrine and pseudoephedrine, mainly E. sinica and E. equisetina from China and E. gerardiana from India. The alkaloids present in ephedra have apparently opposite effects on the body. The whole plant, as used in traditional herbal medicine, has an overall beneficial, balancing action. A brief review of the pharmacology of these alkaloids may prove illuminating. Ephedrine was the first ephedra alkaloid to find wide use in Western medicine, being hailed as a "cure for asthma" because of its ability to relax airways in the lungs. Unfortunately, as is often the way with miracle cures, it soon became clear that this isolated ephedra constituent had unacceptable side effects that dramatically limited its use. The adverse effects were related to the way in which ephedrine stimulates the autonomic nervous system, which has the effect of elevating blood pressure, among others. Studies on the whole plant, however, demonstrated only a slight blood pressure elevation. This led researchers to the discovery that pseudoephedrine, another ephedra alkaloid, slightly reduces heart rate and lowers blood pressure, thus avoiding the side effects of ephedrine.96 Pseudoephedrine is also an effective bronchodilator, equivalent in strength to ephedrine. However, it has the advantage of causing less stimulation of the nervous system, and thus less vasoconstriction, tachycardia, and other cardiovascular symptoms. Clinical studies have shown that pseudoephedrine has insignificant side effects. The efficacy and safety of pseudoephedrine are recognized by the Food and Drug Administration, which approved it as an over-the-counter nasal decongestant. All of these findings confirm the traditional applications of Ephedra sinica as an effective treatment for nasal congestion and sinus pressure, whether due to the common cold, allergies, or sinusitis. The herb is used with great success in the treatment of asthma, bronchial asthma, bronchitis, and associated conditions, because of

MATERIA MEDICA its power to relieve spasms in the bronchial tubes. It eases allergic reactions, giving it a role in the treatment of hay fever and other allergies. It may also be employed to treat low blood pressure and circulatory insufficiency. Safety Considerations: Combined with cardiac glycosides or halothane, ephedra can produce cardiac arrhythmias. Guanethidine enhances the sympathomimetic effect of ephedra. Combining ephedra with monoamine oxidase inhibitors can significantly increase the sympathomimetic action of the alkaloid ephedrine in the herb, possibly causing fatal hypertension. Used in combination with secale alkaloid derivatives (e.g., ergotamine) or oxytocin can produce hypertension.97,98 Ephedra is contraindicated for people with certain health problems. It should not be used in the presence of cardiovascular conditions, thyroid disease, or diabetes, or by men experiencing difficulty urinating due to prostate enlargement. Preparations and Dosage: Tincture dosage is 1 to 4 ml three times a day (1:4 in 45%). To make a decoction, put 1 to 2 teaspoons of the dried herb in 1 cup of water, bring to a boil, and simmer for to minutes. This should be drunk three times a day. Commission E recommends a single daily dose corresponding to to mg total alkaloid. Ephedra, in Herbal Medicine, Expanded Commission E Monographs Equisetum arvense L. Horsetail Equisetaceae Part Used: Dried stem Constituents: Alkaloids (including nicotine, palustrine, and palustrinine); flavonoids (such as isoquercitrin and equicetrin); sterols (including cholesterol, isofucosterol, campesterol); silicic acid; miscellaneous: a saponin (equisitonin), dimethylsulphone, thiaminase, aconitic acid99 Actions: Astringent, diuretic, vulnerary Indications: Horsetail is an excellent astringent for the genitourinary system, reducing hemorrhage. While it acts as a mild diuretic, its toning and astringent actions make it invaluable in the treatment of incontinence and bedwetting in children. It is considered a specific for cases of inflammation or benign enlargement of the prostate gland. Applied externally, it is a vulnerary that helps heal skin wounds. In some cases, it has been found to ease the pain of rheumatism and stimulate the healing of chilblains. Safety Considerations: No side effects or drug interactions have been reported. Preparations and Dosage: Tincture dosage is 2 to 4 ml three times a day (1:5 in 25%). To make an infusion, pour 1 cup of boiling water over 2 teaspoons of dried plant and infuse for to minutes. This should be drunk three times a day. Horsetail may be used to make a bath to help with rheumatic pain and chilblains. Steep g (31/2 ounces) of herb in hot water for 1 hour and add to the bath. The BHC recommends 1 to 4 g dried herb, 2 to 6 ml tincture (1:5 in 25%), or 1 to 4 ml fluid extract three times a day. Commission E suggests 6 g of herb or equivalent preparations daily. Horsetail, in Herbal Medicine, Expanded Commission E Monographs Eschscholzia californica Cham. California Poppy Papaveraceae Parts Used: Dried aerial parts Constituents: Alkaloids: flavone glycosides100 Actions: Nervine, hypnotic, antispasmodic, anodyne Indications: California poppy has been used as a sedative and hypnotic for children, especially in cases of overexcitement and sleeplessness. It can be used wherever an antispasmodic remedy is indicated—for example, for colic pain. It may also be useful to treat gallbladder colic. Safety Considerations: California poppy has additive effects when used with other sedatives. Preparations and Dosage: Tincture (1:5 in 25%) dosage is 1 to 4 ml at night for sleeplessness in children. For antispasmodic indications, use 0.5 to 2 ml three times daily. To make an infusion, pour 1 cup of boiling water over 1 to 2 teaspoons of dried herb and infuse for minutes. A cup drunk at night will promote restful sleep. Eucalyptus globulus Labill. Eucalyptus Myrtaceae Other Name: Blue gum Parts Used: Leaf, essential oil distilled from leaf Constituents: Volatile oil (0.5% to 3.5%): 1,8-cineole (= eucalyptol, 70% to 85%); a-pinene, p-pinene, dlimonene, a-phellandrene; polyphenols acids (caffeic, ferulic, gallic, protocatechuic, and others); flavonoids (including eucalyptin, hypeirosides, rutin)101

Actions: Antimicrobial, antispasmodic, expectorant, stimulant, febrifuge Indications: Eucalyptus leaf is used topically as an antimicrobial and internally as a decongestant and expectorant. The essential oil is used in aromatherapy. King's American Dispensatory described the way this plant was used by the Eclectic physicians. Here are some relevant excerpts: Eucalyptus globulus has for a long time been known as a remedy for intermittent fever among the natives of the countries of its origin. Aside from its alleged utility in intermittents, this agent has had other virtues attributed to it, as follows: The leaves and their preparations have been successfully used as a tonic and gently stimulating stomachic, in atonic dyspepsia, and in catarrh of the stomach and typhoid fever; also advised in mucous catarrhal affections generally; in pseudo-membranous laryngitis, in asthma, with profuse secretion, and in chronic bronchitis, with or without emphysema, and in whooping-cough; it has likewise proved efficient in chronic catarrh of the bladder, where the urine is high-colored, contains an abnormal amount of mucus, or, perhaps, some purulent matter, and micturation is attended with much pain. More recently it has been recommended as a diuretic in the treatment of dropsy. Both the leaves and the oil are excitants and deodorizers, and, as such, have been successfully employed as local applications in bronchial affections with fetid expectoration, in ozena, in fetid or profuse mucous discharges, in vaginal leucorrhoea, offensive lochial discharges, gonorrhoeal discharges, indolent, fetid wounds or ulcers, cancerous ulcerations, in septicemia, and in gangrene. The leaves may, in some cases, be applied alone, directly to the part, in form of cataplasm; or they may be combined with odier articles to form a poultice. The oil may be applied of full strength, or diluted with some other agent. In throat and pulmonary maladies, a tincture diluted, or a medicated water, may be inhaled in the form of spray; if the oil be employed, it may be dropped on some cotton placed in a small tube, from which the vapor may be inhaled. As a deodorizer, the tincture or the oil may be sprinkled or sprayed upon die offensive body, or the atmosphere of an apartment may be frequendy sprayed with the same. Externally applied, the oil gives relief in some forms of neuralgic and rheumatic pains. The leaves of Eucalyptus, made up into cigars or cigarettes, and smoked, have been advised to afford relief in bronchial catarrh, asthma, and other affections of the respiratory organs. . . . Eucalyptus honey, gathered by bees from Eucalyptus flowers, is quite active, and has been rec-ommended for parasitic and putrescent conditions, gonorrhoea, fevers, and catarrhal diseases. A plant preparation containing a mixture of various herbal tinctures, including eucalyptus, has been used successfully to treat chronic suppurative otitis. The efficacy of the preparation was attributed to the antibacterial and anti-inflammatory actions of the herbs.102 Safety Considerations: No side effects or drug interactions have been reported. Preparations and Dosage: Tincture dosage is 1 ml three times a day (1:5 in 25%). Make an infusion with 1 to 2 teaspoons of the leaves to 1 cup of boiling water. Infuse in a covered container for to minutes. This should be drunk three times a day. Commission E recommends a daily dose of 4 to 6 g leaf or 3 to 9 g tincture. Eucalyptus leaf and oil, in Herbal Medicine, Expanded Commission E Monographs Euonymus atropurpureus Jacq. Wahoo Celastraceae Other Name: Spindle tree Part Used: Root Constituents: Cardenolides based on digitoxigenin; alkaloids, such as asparagine and atropurpurine; sterols (euonysterol, atropurpurol, homoeuonysterol)103 Actions: Cholagogue, hepatic, laxative, diuretic, circulatory stimulant Indications: Wahoo is one of the primary liver herbs. It alleviates congestion in the liver, facilitating the free flow of bile and thus supporting the digestive process. It may be used to treat jaundice and gallbladder problems, such as inflammation and pain or congestion due to stones. It will relieve constipation due to liver or gallbladder problems. Because of its normalizing action upon the liver, it may be beneficial for a range of skin problems in which the liver may play a role. Ellingwood considered wahoo specific for . . . indigestion with biliousness, constipation, chronic intermittents with cachexia, pulmonary phthisis with night sweats and great weakness; dropsical affections following acute disease; in convalescence from severe intermittent fever; enlargement of the liver; chronic bronchitis. In addition, he recommended it for malarial cachexia, as a nutritive tonic, as a hepatic stimulant, and for chronic pulmonary complaints.

MATERIA MEDICA Safety Considerations: Wahoo is contraindicated for people taking cardiac glycosides or other cardioactive agents. Preparations and Dosage: Tincture dosage is 1 to 2 ml three times a day (1:5 in 40%). To make a decoction, pour 1 cup of water over l/i to 1 teaspoon of herb, bring to a boil, and simmer for to minutes. This should be drunk three times a day. The BHC lists a dosage of 0.3 to 1 g dried bark, 5 to ml expressed juice, 0.6 to 2.6 ml tincture (1:5 in 45%), or 0.3 to 1 ml fluid extract (1:1 in 45%) three times a day. Euonymus Bark, in British Herbal Compendium., vol. 1 Eupatorium perfoliatum L. Boneset Asteraceae Parts Used: Dried aerial parts Constituents: Sesquiterpene lactones (eupafolin, euperfolitin, eufoliatin, eufoliatorin, euperfolide, eucannabinolide, and helenalin); immunostimulatory polysaccharides; flavonoids (quercetin, kaempferol, hyperoside, astragalin, rutin, eupatorin, and others); miscellaneous: diterpenes (dendroidinic acid, hebenolide); sterols; volatile oil104 Actions: Diaphoretic, bitter, laxative, tonic, antispasmodic, carminative, astringent Indications: Boneset is one of the best remedies for the relief of symptoms that accompany influenza. It will speedily relieve aches and pains and help the body deal with any fever present. Boneset may also be used to help clear the upper respiratory tract of mucus congestion. Its mild aperient activity eases constipation. Overall, it is a safe choice for any fever and for use as a general cleansing agent. It may also provide symptomatic relief as part of treatment for muscular rheumatism. High dilutions of various sesquiterpene lactones isolated from E. perfoliatum demonstrated immunostimulant activity.105 In addition, polysaccharide fractions from E. perfoliatum. showed immumostimulant actions in granulocyte, macrophage, and carbon clearance tests.106 King's American Dispensatory included an extensive monograph on boneset, an excerpt of which is included here: As a tonic, it is useful in remittent, intermittent, and typhoid fevers, dyspepsia, and general debility. In intermittent fever, a strong infusion, as hot as can be comfortably swallowed, is administered for the purpose of vomiting freely. This is also attended with proluse diaphoresis, and sooner or later by an evacuation of the bowels. During the intermission, the cold infusion or extract is given every hour as a tonic and antiperiodic. The chill and succeeding fever is slight, the skin dry, and not, as a rule, followed by perspiration; there are pains in the bones, praecordial oppression, and great thirst. If, however, the case is one in which the fever lasts all day, a slight sweating may follow at night. A nother indication in ague is vomiting, especially of much bile. Eupatorium given as above, or sometimes in small doses, may relieve headache of intermittent character when the intermissions are irregular. In epidemic influenza the warm infusion is valuable as an emetic and diaphoretic, likewise in febrile diseases, catarrh, colds, with hoarseness and pleuritic pains, and wherever such effects are indicated. In influenza it relieves the pain in the limbs and back. Its popular name "boneset" is derived from its well-known property of relieving the deep seated pains in the limbs which accompany this disorder, and colds and rheumatism. Often this pain is periosteal, and if neuralgic in character, or due to a febrile condition, Eupatorium will relieve it. But it is not a remedy for periosteal pain due to inflammation or to organic changes in the periosteum. On the other hand, when given until the patient sweats, and then continued in 5-drop doses of specific eupatorium it has relieved the severe nocturnal muscular and "bone pains" of syphilis. It is a remedy for the cough of the aged, that cough in which there is an abundance of secretion, but lack of power to expectorate. The cough of measles, common colds, of asthma, and hoarseness are also relieved by it. Unless given in excess it acts as a good tonic to the gastric functions, increasing the appetite and power of digestion. Safety Considerations: Boneset may cause allergic reactions in people sensitive to plants in the Asteraceae family. Preparations and Dosage: Tincture dosage is 2 to 4 ml three times a day (1:5 in 45%). To make an infusion, pour 1 cup of boiling water over 1 to 2 teaspoons of dried herb and infuse for to minutes. This should be drunk as hot as possible. For fevers or flu, it should be drunk every half hour; otherwise, drink three times a day. Boneset, in Herbal Medicines: A Guide for Health-Care Professionals Eupatorium purpureum L. Gravel Root Asteraceae Other Name: Also commonly known as Joe pye. Do not confuse with boneset (Eupatorium perfoliatum.). Parts Used: Rhizome, root Constituents: Volatile oil, of unknown composition; flavonoids (including euparin); resin107

Actions: Diuretic, antilithic, antirheumatic Indications: Gravel root is used primarily to treat kidney stones or gravel. It may also be of benefit in urinary tract infections, such as cystitis or urethritis, and can also play a useful role in a systemic treatment of rheumatism and gout. Ellingwood considered it to have the following indications: Irritation of the bladder in women from displacement and chronic inflammation of the uterus; and suppression of urine, partial or complete, during or after pregnancy. He recommended it for dropsy, strangury, gravel, hematuria, diseases of the kidney and bladder due to an excess of uric acid, chronic endometriosis, leukorrhea, chronic uterine disease, threatened abortion, ovarian and uterine atony, dysmenorrhea, dysuria, constant desire to urinate, intermittent fever, and severe bone pains. Safety Considerations: Gravel root may cause allergic reaction in people sensitive to plants in the Asteraceae family. Preparations and Dosage: Tincture dosage is 2 ml three times a day (1:5 in 40%). To make a decoction, put 1 teaspoon of herb in 1 cup of water, bring to a boil, and simmer for minutes. This should be drunk three times a day. Gravel Root, in Herbal Medicines: A Guide for Health-Care Professionals Euphrasia officinalis L. Eyebright Scrophulariaceae Parts Used: Dried aerial parts Constituents: Iridoid glycosides, including aucubin (0.5%); tannins (about 12%, both condensed and hydrolyzable gallic acid types); phenolic acids (including caffeic and ferulic); volatile oil (about 0.2%); flavonoids108 Actions: Anticatarrhal, astringent, anti-inflammatory Indications: Eyebright is an excellent remedy for mucous membrane problems. Its combination of antiinflammatory and astringent properties makes it relevant for many conditions. Used internally, eyebright is a powerful anticatarrhal, and thus may be used to treat nasal catarrh, sinusitis, and other congestive states. However, the herb is best known for its use in eye conditions, including acute or chronic inflammations, stinging and weeping eyes, and oversensitivity to light. It may be applied as a compress in conjunction with internal use for conjunctivitis and blepharitis. Priest and Priest described it as a ... mild stimulating astringent. Vaso-constrictor to vessels of nasal and conjunctival membranes. Specific for congestive conditions of the eyes with profuse lachrymation. They gave these specific indications: catarrhal blepharitis, rhinitis, sinusitis, conjunctivitis, hay fever, acute coryza, irritable sneezing, and lachrymation. Safety Considerations: No side effects or drug interactions have been reported. Preparations and Dosage: Tincture dosage is 1 to 4 ml three times a day (1:5 in 45%). To make an infusion, pour 1 cup of boiling water over 1 teaspoon of dried herb and infuse for 5 to minutes. This should be drunk three times a day. For a compress, place 1 teaspoon of 1 dried herb in l/i liter (1 pint) of water. Boil for minutes and let cool slightly. Moisten a cloth in the lukewarm liquid, wring out slightly, and place over the eyes. Leave the compress in place for minutes. Repeat several times a day. Eyebright, in Principles and Practice of Phytotherapy Filipendula ulmaria (L.) Maxim. Meadowsweet Rosaceae Parts Used: Aerial parts Constituents: Volatile oil; salicylaldehyde (up to 70%), ethylsalicylate, methylsalicylate, phenolic glycosides (spiraein, monotropin, gaultherin); flavonoids (flavonols, flavones, flavanones, and chalcone derivatives); polyphenolics and other tannins, mainly hydrolyzable (1% in alcohol extract, 12.5% in aqueous extract); miscellaneous: phenylcarboxylic acids, coumarin, vitamin C109 Actions: Antirheumatic, anti-inflammatory, carminative, antacid, antiemetic, astringent Indications: Meadowsweet is one of the best digestive remedies available. As such, it will be indicated in many conditions, if they are approached holistically. The herb protects and soothes the mucous membranes of the digestive tract, reducing excess acidity and easing nausea. It is used in the treatment of heartburn, hyperacidity, gastritis, and peptic ulceration. Its gentle astringency is especially helpful in children's diarrhea. The presence of aspirin-like chemicals (salicylates) explains meadowsweet's ability to reduce fever and relieve the pain of rheumatism in muscles and joints. Safety Considerations: Meadowsweet should be avoided by people with salicylate sensitivity.

MATERIA MEDICA Preparations and Dosage: Tincture dosage is 2 to 4 ml three times a day (1:5 in 45%). To make an infusion, pour 1 cup of boiling water over 1 to 2 teaspoons of dried herb and infuse in a covered container for to minutes. This should be drunk three times a day or as needed. The BHC recommends 2 to 6 g dried herb, 2 to 4 ml tincture (1:5 in 45%), or 2 to 6 ml fluid extract (1:1 in 25%) three times daily. Commission E suggests 2.5 to 3.5 g flower or 4 to 5 g herb or equivalent preparations daily. Meadowsweet, in Principles and Practice of Phytotherapy Foeniculum vulgare Mill. Fennel Apiaceae Part Used: Seed Constituents: Volatile oil (8%): anethole (60% to 80%), fenchone (10% to 30%); flavonoids (mainly rutin, quercetin, and kaempferol glycosides); coumarins (bergapten, imperatorin, xanthotoxin, and marmesin); miscellaneous: sterols, fixed oils, sugars110 Actions: Carminative, aromatic, antispasmodic, anti-inflammatory, galactagogue, hepatic Indications: Fennel is an excellent stomach and intestinal remedy that relieves flatulence and colic while stimulating digestion and appetite. It is similar to aniseed in its calming effect in bronchitis and other coughs, and is a good choice for flavoring cough remedies. Fennel may increase milk flow in nursing mothers. Used externally, the essential oil eases muscular and rheumatic pains. Fennel infusion may be used as a compress to treat conjunctivitis and blepharitis (inflammation of the eyelids). Safety Considerations: No side effects or drug interactions have been reported. Preparations and Dosage: Tincture dosage is 1 to 2 ml three times a day (1:5 in 40%). For an infusion, pour 1 cup of boiling water over 1 to 2 teaspoons of slightly crushed seeds and infuse in a covered container for minutes. This should be drunk three times a day. To ease flatulence, take a cup V2 hour before meals. Recommended dosage from the BHP is 0.3 to 0.6 g herb or 0.8 to 2 ml liquid extract (1:1 in 70%) three times daily. The USP suggests 1 g herb, ml fennel water (hydrosol), or 0.2 ml essential oil. The BPC suggests a three times daily dose of 2 5 to ml fennel water or 0.3 ml oil three times daily. Daily dosage recommended by Commission E is 5 to 7 g herb, to g syrup or honey, 5 to 7.5 ml compound fennel tincture, or equivalent preparations. Fennel fruit, in Principles and Practice of Phytotherapy Fucus vesiculosus L. Kelp Fucaceae Other Name: Bladderwrack Part Used: Whole plant (a seaweed) Constituents: Phenolic compounds (phloroglucinol, fucols); mucopolysaccharides (algin); sulphuryl-, sulphonyl-, and phosphonyl-glycosyl ester diglycerides; polar lipids; trace metals (particularly iodine)111 Actions: Antihypothyroid, antirheumatic Indications: Bladderwrack has proved useful in the treatment of underactive thyroid and goiter. By regulating thyroid function, the seaweed helps bring about improvement in all related symptoms. For cases in which obesity is associated with thyroid trouble, this herb may aid in weight loss. It has a reputation for helping to relieve symptoms of rheumatism and rheumatoid arthritis, when both taken internally and applied externally to inflamed joints. Safety Considerations: Kelp's iodine content may cause hyper- or hypothyroidism, and it may interfere with existing treatment for abnormal thyroid function.112 In general, brown seaweeds are known to concentrate various heavy metals and other toxic elements. Elevated urinary arsenic concentrations have been traced to ingestion of kelp tablets. Prolonged ingestion of kelp may reduce gastrointestinal iron absorption (due to the binding properties of fucoidan), resulting in a slow reduction in hemoglobin, packed cell volume, and serum iron concentrations. Prolonged ingestion may also affect absorption of sodium and potassium ions (alginic acid) and cause diarrhea.113 Preparations and Dosage: Kelp may be taken in tablet form as a dietary supplement or as an infusion. For an infusion, pour 1 cup of boiling water over 2 to 3 teaspoons of dried herb and steep for minutes. This should be drunk three times a day. The BHC recommends 0.8 to 2 g dried thallus, 2 to 6 ml tincture (1:5 in 25%), or 0.5 to 2 ml fluid extract (1:1 in 25%) three times daily. Fucus, in Herbal Drugs and Phytopharmaceuticals Fumaria officinalis DC. Fumitory Fumariaceae Parts Used: Aerial parts Constituents: Isoquinoline alkaloids114

Actions: Diuretic, laxative, alterative, hepatic Indications: Fumitory has a long history of use for the treatment of skin problems, such as eczema and acne. Its action is probably related to general cleansing mediated via the kidneys and liver. Fumitory may also be used as an eyewash to soothe conjunctivitis. Safety Considerations: No side effects or drug interactions have been reported. Preparations and Dosage: Tincture dosage is 1 to 2 ml three times a day (1:5 in 25%). For an infusion, pour 1 cup of boiling water over 1 to 2 teaspoons of dried herb and infuse for to minutes. This may be drunk freely, but for skin problems, it should be drunk at least three times a day. The BHC lists a dosage of 2 to 4 g dried herb or 2 to 4 ml fluid extract (1:1 in 25%) three times a day. Commission E recommends a daily dosage of 6 g dried herb. Fumariae herba, in Herbal Drugs and Phytopharmaceuticals Galega officinalis L. Goat's Rue Fabaceae Parts Used: Dried aerial parts Constituents: Amines (galegine, 4-hydroxygalegine, peganine); flavonoids; saponins115 Actions: Hypoglycemic, galactagogue, diuretic, diaphoretic Indications: Goat's rue is one of many herbal remedies with the ability to reduce blood sugar levels. It is thus potentially indicated in diabetes mellitus. It cannot replace insulin therapy, however, and should be used only under professional supervision. Goat's rue is also an effective galactagogue. It stimulates both the production and flow of breast milk, and has been shown to increase milk output by up to 50% in some cases. It may also stimulate the development of the mammary glands. Safety Considerations: Goat's rue may potentiate the action of hypoglycemic drugs. Preparations and Dosage: Tincture dosage is 1 to 2 ml three times a day (1:10 in 45%). For an infusion, pour 1 cup of boiling water over 1 teaspoon of dried herb and infuse for to minutes. This should be drunk twice a day. Galegae herba, in Herbal Drugs and Phytopharmaceuticals Galium aparine L. Cleavers Rubiaceae Parts Used: Aerial parts Constituents: Plant acids (caffeic, ^-coumaric, gallic, ^-hydroxybenzoic, salicylic, citric); coumarins; iridoids (asperuloside, rubichloric acid); tannins116 Actions: Diuretic, alterative, anti-inflammatory, tonic, astringent Indications: Cleavers is a very valuable plant, being perhaps the best tonic available for the lymphatic system. As a lymphatic tonic with alterative and diuretic actions, it may be used safely for a wide range of problems involving the lymphatic system. These include swollen glands (lymphadenitis) anywhere in the body, especially tonsillitis and adenoid trouble. Cleavers is helpful in skin conditions, especially the dry types, such as psoriasis. It makes a useful contribution to the treatment of cystitis and other urinary tract conditions associated with pain, and may be combined with urinary demulcents for this. There is a long tradition of using cleavers to treat ulcers and tumors. Cleavers also makes an excellent vegetable. Priest and Priest described cleavers as a . . . soothing, relaxing and diffusive diuretic: increases aqueous excretion, corrects inability to pass normal catabolic wastes and relieves irritation. Preferred diuretic for exanthemas. They gave these specific indications: dropsy, renal obstructions, bladder stone, gravel, calculi, scalding micturation, dysuria, irritable bladder, cystitis, enuresis in children, eczema, and psoriasis. Safety Considerations: No side effects or drug interactions have been reported. Preparation and Dosage: Tincture dosage is 4 to 8 ml three times a day (1:5 in 25%). To make an infusion, pour 1 cup of boiling water over 2 to 3 teaspoons of dried herb and infuse for to minutes. This should be drunk three times a day. A pleasant and effective way of using fresh cleavers is to juice or simply puree in a blender. The resulting deep green liquid must be used right away or it will ferment. However, it may be frozen immediately for future use. An ice cube-sized piece makes an ideal dose. Dosage listed in the BHC is 2 to 4 g dried herb, 5 to ml expressed juice, 4 to ml tincture (1:5 in 25%), or 2 to 4 ml fluid extract (1:1 in 25%) three times a day. Clivers, in Herbal Medicines: A Guide for Health-Care Professionals

MATERIA MEDICA -G. 553 Gentiana lutea L. Gentian Gentianaceae Parts Used: Dried rhizome and root Constituents: Iridoids: marogentin, gentiopicroside (= gentiopicrin), swertiamarin; xanthones (gentisein, gentisin, isogentisin); alkaloids: mainly gentianine (0.6% to

traces of volatile oil117 Actions: Bitter, sialagogue, hepatic, cholagogue, antimicrobial, anthelmintic, emmenagogue: Indications: Gentian is an excellent bitter that, like all bitters, stimulates the appetite and digestion via general stimulation of digestive juices. Thus, it promotes the production of saliva, gastric juices, and bile. Because of this stimulation, it has a generally fortifying effect. It also accelerates the emptying of the stomach. It is indicated for most cases involving lack of appetite and digestive sluggishness, as well as dyspepsia and flatulence. Priest and Priest considered it an . . . intense, bitter, stimulating tonic: influences digestive organs, mucous membranes and the portal circulation. Indicated for atonic and sub-acid states: slowly promotes peristalsis and facilitates assimilation.. They offered the following specific indications: languid conditions and general debility, anorexia, alimentary insufficiency; portal congestion, biliousness, and jaundice. Safety Considerations: In predisposed persons, gentian may cause headaches. Gentian is contraindicated during pregnancy and for those with gastric or duodenal ulcers. Preparations and Dosage: Tincture dosage is 1 to 2 ml three times a day (1:5 in 40%), to minutes before meals, or any time acute stomach pains are associated with a feeling of fullness. To make a decoction, put xh teaspoon of shredded root in 1 cup of water and boil for 5 minutes. This should be drunk warm about to 30 minutes before meals, or according to the guidelines given for tincture. Commission E recommends a daily dosage of 2 to 4 g root, 1 to 3 ml tincture, or 2 to 4 ml fluid extract. The USP (23th ed., 1943) suggests 1 to 2 g as decoction three times daily; the BHP recommends 0.6 to 2 g by infusion or decoction or 1 to 4 ml tincture (1:5 in 45%) three times daily. Gentian root, in Herbal Medicine, Expanded Commission E Monographs Geranium maculatum L. Cranesbill Geraniaceae Part Used: Rhizome Constituents: Tannins, including gallic acid (levels are highest just before flowering)118 Actions: Astringent, antihemorrhagic, anti-inflammatory, vulnerary Indications: American c.ranesbill is an effective astringent used for diarrhea, dysentery, and hemorrhoids. When duodenal or gastric ulceration is associated with bleeding, this remedy may be used in combination with other relevant herbs. Cranesbill wj.ll help when blood is lost in the feces, although careful diagnosis is vital. It is also indicated for the treatment of monorrhagia (excessive blood loss during menstruation) or metrorrhagia (uterine hemorrhage). As a douche, it may be used to treat leukorrhea. Safety Considerations: No side effects or drug interactions have been reported. Preparations and Dosage: Tincture dosage is 2 to 4 ml three times a day (1:5 in 40%). For a decoction, put 1 to 2 teaspoons of rhizome in 1 cup of cold water, bring to a boil, and simmer for to minutes. This should be drunk three times a day. The BHP recommends 1 to 2 g by decoction, 2 to 4 ml tincture (1:5 in 45%), or 1 to 2 ml liquid extract (1:1 in 45%) three times a day. Ginkgo biloba L. Ginkgo Ginkgoaceae Parts Used: Leaf; seed kernel is used extensively in traditional Chinese medicine Constituents: Diterpene lactones (ginkgolides A, B, C, and J); sesquiterpene lactone (bilobalide); flavonol glycosides (mainly flavone glycosides, including ginkgetin, quercetin, and kaempferol derivatives)119 Actions: Anti-inflammatoiy, vasodilator, relaxant, digestive bitter, uterine stimulant Indications: The modern use of ginkgo is not derived from traditional Chinese medicine, although ginkgo fruit has a long history of use in that system. Extracts of Ginkgo biloba leaf were introduced into Western medical practice in 1965 in Germany. Most pharmacologic studies on ginkgo leaf for the treatment of peripheral vascular disease and cerebral insufficiency have utilized the proprietary extract EGb and, more recently, LI 1370, not the crude leaf or simple extracts.120

Ginkgo's primary actions are to increase blood supply, antagonize platelet activating factor (PAF), and protect and enhance brain function (an action known as cerebroprotection). Its ability to improve circulation and thus blood supply appears to be due to both its vasodilating properties and its ability to reduce total blood viscosity. Various mechanisms may underlie the vasodilating activity—for example, effects on prostaglandin metabolism that increase the synthesis of the vasodilator prostacyclin. Ginkgo's antioxidant, radical-scavenging properties may also play a role. Its ability to lower pathologically elevated total blood viscosity seems to be due to its PAF antagonism, which results in a reduction in erythrocyte aggregation. The ginkgolides and bilobalide appear to be responsible for the herb's cerebroprotective properties.121 A mong other factors, researchers have studied ginkgo's ability to increase tolerance to hypoxia, protect against ischemia, improve energy metabolism, and reduce edema in order to demonstrate the protective actions of ginkgo extracts on experimentally damaged brain. Other ginkgo actions are based on its radicalscavenging effects and PAF antagonism. The constituents of ginkgo extract with PAF-antagonistic activity are the ginkgolides. In particular, ginkgolide B has been found to be a very active PAF antagonist. As discussed elsewhere, PAF binding to PAF receptors on target cells leads to the release of mediators and to various physiologic reactions, such as vasodilation and platelet aggregation. These actions are responsible for asthma, inflammation, and anaphylaxis. PAF antagonists block the PAF receptors of target cells. This inhibition of platelet aggregation appears to be one of the most relevant actions associated with ginkgo use. Ginkgo's main clinical indication is for the treatment of cerebral insufficiency, a common problem in the elderly.122 A mong the symptoms typical of cerebral insufficiency are difficulties with concentration and memory, absentmindedness, confusion, lack of energy, tiredness, decreased physical performance, depressed mood, and anxiety. Headache, vertigo, and tinnitus are other common complaints. These symptoms are associated with impaired cerebral circulation, and are sometimes thought to be early indications of dementia, either the degenerative or the multiple infarct type. However, in some cases, no explanation for the symptoms can be found. Many experimental and clinical studies support the efficacy of ginkgo extract in the treatment of peripheral blood flow disorders. Vertigo, hearing disorders, and tinnitus have many and varied causes, but are often associated with insufficient perfusion of the brain or inner ear. Vertigo is regarded as one of the pathologic conditions that respond best to ginkgo extract. Ginkgo can also contribute, as part of a broader treatment, to the control of peripheral arterial occlusive disease (intermittent claudication). Safety Considerations: Ginkgo may have an additive effect when used with other antiplatelet agents. One patient taking mg of a 50:1 concentrated extract twice daily in combination with long-term aspirin therapy experienced bleeding from the iris.123 However, it is important to note that ginkgo has demonstrated a very low incidence of side effects and a relative lack of reported drug interactions, evidenced by the fact that many elderly patients taking ginkgo are taking multiple other medications simultaneously. Ginkgo may potentiate the effects of papaverine used to treat male impotence.124 Raw ginkgo fruits are reportedly toxic. Ginkgo extracts, however, are derived from the leaves. Preparations and Dosage: Dosage of standardized extract is to mg/day in divided doses, 50:1 standardized leaf extract containing 22% to 27% ginkgo flavone glycosides and 5% to 7% terpene lactones (ginkgolides A, B, C, and bilobalides). For optimal results, 4 to 8 weeks of daily use are required. Commission E recommends to mg dry extract in two or three doses to treat disturbances of performance related to organic brain syndromes. For other cardiovascular indications, it recommends to mg in two or three doses. Ginkgo, in Principles and Practice of Phytotherapy Glycyrrhiza glabra L. Licorice Fabaceae Part Used: Dried root Constituents: Oleanane triterpenes (glycyrrhizin, glycyrrhetinic acid, and phytosterols); flavanones; isoflavonoids; chalcones; polysaccharides (mainly glucans); volatile oil (containing fenchone, linalool, furfuryl alcohol, benzaldehyde); miscellaneous: starch, sugars, amino acid125 Actions: Expectorant, demulcent, anti-inflammatory, antihepatotoxic, antispasmodic, mild laxative Indications: Licorice is a traditional herbal remedy with an ancient history and worldwide usage. Modern research has demonstrated that the herb has effects upon the endocrine system and the liver, among other organs. The triterpenes of Glycyrrhiza are metabolized in the body to

MATERIA MEDICA molecules with a structure similar to that of the adrenal cortex hormones. This may be the basis of the herb's antiinflammatory action. As an antihepatotoxic, licorice can be effective in the treatment of chronic hepatitis and cirrhosis, for which it is widely used in Japan. Much of the liver-oriented research has focused upon the triterpene glycyrrhizin. Studies show that this constituent inhibits hepatocyte injury caused by carbon tetrachloride, benzene hexachloride, and polychlorinated biphenyl (PCB).126 It inhibits the growth of several DNA and RNA viruses and irreversibly inactivates herpes simplex virus particles.127 Licorice has a wide range of applications for bronchial problems, including catarrh, bronchitis, and coughs in general. The herb is used in orthodox medicine as a treatment for peptic ulcers, and is similarly used in herbal medicine for gastritis and ulcers. It may also be effective in relieving abdominal colic. King's described it thus: Liquorice root is emollient, demulcent and nutritive. It acts upon mucous surfaces, lessening irritation and is consequently useful in coughs, catarrhs, irritation of the urinary organs and pain of the intestines in diarrhoea. It is commonly administered in decoction, sometimes alone, at other times with the addition of other agents and which is the preferable mode of using it. As a general rule, the acrid principle should be removed previous to forming a decoction. When boiled for some time the water becomes impregnated with its acrid resin; hence, in preparing a decoction for the purpose of sweetening diet drinks or covering the taste of nauseous drugs, it should not be boiled over 5 minutes. The efficiency of the root in old bronchial affections may be due to this acrid resin. The powdered root is also employed to give the proper solidity to pills and to prevent their adhesion; the extract for imparting the proper viscidity to them. The extract, in the form of lozenge, held in the mouth until it has dissolved, is a very popular and efficient remedy in coughs and pectoral affections. The bitterness of quinine, quassia, aloes and the acrid taste of senega, guaiacum are masked by Liquorice. Safety Considerations: Side effects are minimal if daily intake is less than mg of glycyrrhizin. Chronic use may cause hypokalemia, headache, spastic numbness, hypertension, weak limbs, dizziness, and edema. Glycyrrhizin and glycyrrhetinic acid have antidiuretic, mineralocorticoid-type actions, but these constituents are removed from most commercial extracts. The resulting extracts are denoted as "deglycyrrhizinated." Prolonged use in conjunction with thiazide and loop diuretics and cardiac glycosides is contraindicated, and licorice should not be administered in combination with spironolactone or amiloride.128 This herb is not recommended for patients taking cardiac glycosides, hypotensive agents, corticoids, diuretic drugs, or monoamine oxidase inhibitors. Preparations and Dosage: Tincture dosage is 1 to 3 ml three times a day (1:5 in 40%). To make a decoction, put V2 to 1 teaspoon of root in 1 cup of water, bring to a boil, and simmer for to minutes. This should be drunk three times a day. Commission E recommends an average daily dosage of 5 to g root, equivalent to to mg of glycyrrhizin. Dosage according to the BHP is 1 to 5 g (by infusion or decoction) or 2 to 5 ml liquid extract three times a day. Licorice, in Principles and Practice of Phytotherapy Grindelia squarrosa (Pursh) Dunal Gumweed Asteraceae Related Species: Grindelia camporum Parts Used: Dried aerial parts Constituents: Diterpenes (grindelic acid and others); flavonoids (including acacetin, kumatakenin, quercetin); 1 resins Actions: Antispasmodic, expectorant, hypotensive Indications: Gumweed acts to relax smooth muscles and heart muscles. This helps to explain its use in the treatment of asthmatic and bronchial conditions, especially when these are associated with rapid heartbeat and nervous response. The herb may be used for asthma, bronchitis, whooping cough, and upper respiratory catarrh. Because of its relaxing effect on the heart and pulse rate, it may reduce blood pressure. Externally, it can be applied in a lotion to treat poison ivy dermatitis. King's discussed in detail the indications for two species: The grindelias leave in the mouth a bitter, acrid sensation, which persists for some time and is accompanied or followed by an increased flow of saliva. On account of their irritant effects upon the kidneys, they act as diuretics. The brain and cord are first stimulated by them, followed by motor impairment of the lower extremities and a desire to sleep. The number of respirations are reduced by them. Grindelia robusta has been found especially efficient in asthma giving prompt relief. Occasionally, however, as is, indeed, the case with all the therapeutical agents, it has

failed but the circumstances attending these failures have not yet been determined. It has likewise been found efficient in bronchial affections, in pertussis, and in some renal maladies. Prof. Scudder was partial to this remedy as a local application in chronic diseases of the skin with feeble circulation, particularly old chronic and indolent ulcers. Grindelia squarrosa has been highly eulogized as an efficient remedy in intermittent fever and in other malarial affections, also to remove the splenic enlargement which frequendy follows those disorders. Why two plants so closely allied as the G. robusta and the G. squarrosa, and possessing nearly identical constituents, should give such discordant therapeutical results, is certainly enigmatical. The fact is, that many physicians have a great proneness to run after new remedies, especially when introduced under some pretentious name, and to place a marvelous credulity in the statements of interested parties, who are incapable of determining accurate conclusions as to the value of a remedy. [Author's note: This is as relevant today as it was years ago!] As a local application, the fluid extract is stated to be of value in the painful eczematous inflammation and vesicular eruption resulting from contact with the poison vine or the poison oak. Safety Considerations: Gumweed may theoretically cause allergic reactions in people sensitive to plants in the Asteraceae family. Preparations and Dosage: Tincture dosage is 1 to 2 ml three times a day (1:5 in 60%). For an infusion, pour 1 cup of boiling water over 1 teaspoon of dried herb and infuse for to minutes. This should be drunk three times a day. The BHC recommends 0.3 to 1 g resin or 1 to 4 ml tincture (1:5 in 90%) up to three times daily. According to Commission E, total daily dosage is 4 to 6 g of drug or equivalent preparations or 1.5 to 3 ml tincture (1:10 or 1:5, 60% to 80%). Gumweed herb, in The Complete German Commission E Monographs Guaiacum officinale L. Guaiacum Zygophyllaceae Other Name: Guaiac Part Used: Heartwood Constituents: Lignans (furoguaiacidin, guaiacin, furoguaiacin, furoguaiaoxidin); resins (15% to 20%), including guaiaretic, hydroguaiaretic, guaiacic, and a- and (3-guaiaconic acids; miscellaneous: vanillin, terpenoids (including guaiagutin, guaiasaponin)130 Actions: Antirheumatic, anti-inflammatory, laxative, diaphoretic, diuretic Indications: Guaiacum is a specific for rheumatic complaints. It is especially useful in cases involving much inflammation and pain, and is thus valuable for chronic rheumatism and rheumatoid arthritis. It helps in the treatment of gout and may be used to prevent recurrence of this disease. Safety Considerations: Due to the high content of resins in this valuable herb, care must be taken with patients with gastritis or peptic ulceration, who may be more likely to experience stomach upset. Preparations and Dosage: Tincture dosage is 1 to 2 ml three times a day (1:5 in 90%). Commission E recommends 4.5 g of herb or equivalent preparations daily. Guaiac wood, in The Complete German Commission E Monographs Hamamelis virginiana L. Witch Hazel Hamamelidaceae Parts Used: Twig, leaf Constituents: Tannins (hamamelitannins); flavonoids (quercetin, kaempferol, astragalin, myricitrin); volatile oil; saponins; resin131 Actions: Astringent, anti-inflammatory Indications: This herb can be found in most households in the form of distilled witch hazel. It is one of the easiestto-use astringents for external use. As with all astringents, witch hazel may be applied in all cases of bleeding, internal and external. It is especially valuable for easing symptoms of hemorrhoids, and has a well-deserved reputation for the treatment of bruises, inflamed swellings, and varicose veins. Witch hazel helps control diarrhea and is useful in dysentery. Ellingwood considered it specific for . . . soreness of muscles, muscular aching, a bruised sensation, soreness from violent muscular exertion, soreness from bruises and strains, soreness and muscular aching from cold and exposure, relaxed mucous membranes, dark blue membranes from venous stasis, veins dilated, relaxed, enlarged, and full varicoses. In addition, he recommended it for sore throat, tonsillitis, diphtheria, acute catarrh, diarrhea, hemorrhoids, prolapse of the bowel, leukorrhea, and sore breasts. Safety Considerations: No side effects or drug interactions have been reported.

MATERIA MEDICA Preparations and Dosage: Tincture dosage is 1 to 2 ml three times a day (1:5 in 40%). For an infusion, pour 1 cup of boiling water over 1 teaspoon of dried herb and infuse for to minutes. This should be drunk three times a day. Witch hazel can be made into an excellent ointment and many other topical formulations. Witchhazel, in Principles and Practice of Phytotherapy Harpagophytum procumbens IDC. ex Meisn. Devil's Claw Pedaliaceae Part Used: Rhizome Constituents: Iridoid glycosides (harpagide, harpagoside, procumbide); flavonoids (kaempferol and luteolin glycosides); phenolic acids (chlorogenic and cinnamic acid); a quinone (harpagoquinone); miscellaneous: triterpenes, oleanolic and ursolic acid derivatives, esters, sugars132 Actions: Anti-inflammatory, antirheumatic, anodyne, hepatic Indications: This valuable plant has proved effective in some cases of arthritis. This appears to be due to the presence of a glycoside called harpagoside, which reduces inflammation in the joints. Unfortunately, devil's claw is not always effective, but it is well worth considering for arthritis associated with inflammation and pain. The plant also helps with liver and gallbladder complaints. Safety Considerations: No drug interactions have been reported. Pharmacological research suggests a potential protective action against arrhythmia, which has led to the speculation that it may interact with antiarrhythmic agents.133 Preparations and Dosage: Tincture dosage is 1 to 2 ml three times a day (1:5 in 40%). For a decoction, put V2 to 1 teaspoon of rhizome into 1 cup of water, bring to a boil, and simmer for to minutes. This should be drunk three times a day. The regimen should be continued for at least 1 month. Commission E recommends 1.5 g daily for loss of appetite, otherwise 4.5 g daily. Devil's claw, in Principles and Practice of Phytotherapy Humulus lupulus L. Hops Cannabaceae Part Used: Inflorescence (strobile) Constituents: Volatile oil (humulene, |3-caryophyllene, myrcene, farnesene); flavonoids (mainly glycosides of kaempferol and quercetin); oleoresin (3% to 12%): humulone, lupulene; estrogenic substances of undetermined structure; miscellaneous: tannins, lipids, xanthohumol (a chalcone)134 Actions: Sedative, hypnotic, antimicrobial, antispasmodic, astringent Indications: Hops has a marked relaxing effect upon the central nervous system, and is used extensively for the treatment of insomnia. It eases tension and anxiety, and is appropriate for cases in wliich tension leads to resdessness, headache, and indigestion. As it is also astringent, it may be valuable for conditions such as mucous colitis. However, patients experiencing significant depression should avoid hops, as it may accentuate this mood state. Externally, its antiseptic action is applied to treat skin ulcers. Clinical studies generally refer to hops given in combination with one or more additional herbs. Hops in combination with valerian has been reported to improve sleep disturbances.135 A combination of hops, chicory, and peppermint was shown to relieve pain in patients with chronic cholecystitis (calculous and non-calculous).136 Ellingwood considered hops specific for "marked cases of nerve irritation and wakefulness where anxiety and worry are the cause." He recommended it for hysteria, insomnia, acute local inflammations, facial neuralgia, delirium tremens, and excessive sexual excitement. Safety Considerations: Do not use hops in patients with marked depression, as the sedative effect may accentuate symptoms. The sedative action may also potentiate the effects of alcohol or of existing sedative therapy. Preparations and Dosage: Tincture dosage is 1 to 4 ml three times a day (1:5 in 40%). For an infusion, pour 1 cup of boiling water over 1 teaspoon of dried herb and infuse in a covered container for to minutes. A cup should be drunk at night to induce sleep. This dose may be strengthened if needed. The BHC suggests 0.5 to 1 g dried strobiles, 1 to 2 ml tincture (1:5 in 60%), or 0.5 to 1 ml fluid extract (1:1 in 45%) three times daily and before going to bed. According to Commission E, dosage is 0.5 g dried herb as a single dose. Hops, in Herbal Medicine, Expanded Commission E Monographs Hydrangea arborescens L. Hydrangea Hydrangeaceae Parts Used: Dried root and rhizome Constituents: Flavonoids (kaempferol and quercetin); coumarin (hydrangin); saponin; volatile oil137

Actions: Diuretic, antilithic Indications: Hydrangea's primary use is for the treatment of inflamed or enlarged prostate. It may also be effective against urinary stones and gravel associated with infections, such as cystitis. Ellingwood gave the following specific symptomatology for this underutilized remedy: . . . frequent urination with heat, burning, accompanied with quick, sharp, acute pains in the urethra; partial suppression of urine with general irritation and aching or pain in the back, pain from the passage of renal sand, are direct indications for this agent. I am convinced after a lifetime of experience that it is more universally a sedative to pain and distress in kidneys and urinary bladder than any other one remedy. Ellingwood also recommended hydrangea for acute nephritis, urinary gravel, backache due to urinary tract problems, and urinary irritation. Safety Considerations: No side effects or drug interactions have been reported. Preparations and Dosage: Tincture dosage is 2 to 4 ml three times a day (1:5 in 40%). To make a decoction, put 2 teaspoons of root in 1 cup of water, bring to a boil, and simmer for to minutes. This should be drunk three times a day. Hydrangea, in Herbal Medicines: A Guide for Health-Care Professionals Hydrastis canadensis L. Goldenseal Ranunculaceae Parts Used: Root, rhizome Constituents: Isoquinoline alkaloids (2.5% to 6.0%): hydrastine (1.5% to 4.0%), berberine (0.5% to6.0%); fatty acids; resin; phenylpropanoids (meconin, chlorogenic acid); phytosterins; a small amount of volatile oil138 Actions: Bitter, hepatic, alterative, anticatarrhal, antimicrobial, anti-inflammatory, laxative, emmenagogue, oxytocic Indications: Goldenseal is one of our most useful remedies, and owes much of its value to its tonic effects on mucous membranes. This probably accounts for its effectiveness in digestive problems, from peptic ulcers to colitis. The alkaloids it contains stimulate bile production and secretion, and this bitter stimulant activity makes it useful for loss of appetite. Goldenseal is effective in catarrhal conditions, espe-cially sinus disorders. The herb's pharmacological activity, including its antimicrobial properties, is usually attributed to the isoquinoline alkaloid constituents, primarily hydrastine and berberine. Berberine has immunostimulant, antispasmodic, sedative, hypotensive, uterotonic, cholerectic, and carminative actions. It also has marked antimicrobial activity, and while not in the same league as pharmaceutical antibiotics, it has a broad spectrum of antibiotic activity. Activity has been demonstrated against a number of bacteria, protozoans, and fungi in vitro.139 Traditionally, Hydrastis canadensis was used during labor to help contractions, but for this very reason, it should not be taken during pregnancy. Applied externally, it can help with eczema, ringworm, itching, earache, and conjunctivitis. Ellingwood recommended it for numerous conditions: . . . functional disorders of the stomach, catarrhal gastritis, atonic dyspepsia, chronic constipation, hepatic congestion, chronic alcoholism, hepatic congestion, general debility, protracted fevers, cerebral engorgements, prostrating night sweats, menorrhagia or metrorrhagia due to uterine subinvolution, postpartum haemorrhage, tumors, catarrhal conditions, aphthous ulcers, indolent ulcers, nasal catarrh, diphtheria, tonsillitis, inflammation of the eyes, leucorrhoea, anal fissure, eczema, gall stones, cholecystitis, congestive jaundice, goitre, non-malignant mammary tumors. Safety Considerations: Goldenseal is contraindicated for individuals with elevated blood pressure. Prolonged use of goldenseal may decrease vitamin B absorption. Like all berberine-containing plants and strong bitters, Hydrastis is not recommended for use during pregnancy. Uterine stimulant properties have been reported for berberine, canadine, hydrastine, and hydrastinine.140 Goldenseal should not be taken during lactation. Preparations and Dosage: Tincture dosage is 1 ml three times a day (1:5 in 60%). To make an infusion, pour 1 cup of boiling water over V2 to 1 teaspoon of powdered root and infuse for to minutes. This should be drunk three times a day. Decoct unpowdered root in the usual way, by simmering. Dosage from the BPC is 2 to 4 ml tincture or 0.3 to

in the BHC is 0.5 to 1 g dried rhizome and root, 4 to 10 ml tincture (1:10 in 60%), or 0.3 to 1 ml fluid extract (1:1 in 60%) three times daily. Berberis bark and Hydrastis root, in Principles and Practice of Phytotherapy

MATERIA MEDICA Hypericum perforatum L. St. John's Wort Clusiaceae Parts Used: Aerial parts Constituents: Volatile oil (caryophyllene, methyl-2-octane, w-nonane, w-octanal, w-decanal, a- and (3-pinene); naphthodianthones (hypericin, pseudohypericin); phloroglucinols (hyperforin); catechins; proanthocyanidins; flavonoids (hyperoside, rutin)141 Actions: Anti-inflammatory, astringent, vulnerary, nervine, antimicrobial Indications: Taken internally, St. John's wort has sedative and pain-relieving effects, giving it a place in the treatment of neuralgia, anxiety, tension, and similar problems. It is considered especially appropriate for use when menopausal changes trigger irritability and anxiety. St. John's wort is increasingly recommended to treat depression, an indication that is supported by numerous clinical trials in both Europe and the United States.142 However, in my opinion these claims are overblown. St. John's wort is helpful for neuralgic pain and will ease fibrositis, sciatica, and rheumatic pain. Externally, it is a valuable healing and anti-inflammatory remedy. Applied in lotion form, it speeds the healing of wounds and bruises, varicose veins, and mild burns. An infused oil is especially useful for the healing of sunburn. The mechanism of action for the purported antidepressant activity of Hypericum perforatum is not understood. One study tested the herb in several biochemical models relevant to the mechanism of action of antidepressant drugs—for example, monoamine oxidase (MAO) inhibition. It was found to have weak MAO-A and MAOB inhibition activity in vitro, but the study authors concluded that MAO inhibition does not explain the herb's antidepressant activity.143 While hypericin is considered an MAO inhibitor, newer studies indicate that the constituent hyperforin is also active. Thus, based on currently available information, the whole extract must be considered the "active ingredient," as the single constituents responsible for this activity remain unknown. Consequendy, dosage should be based on the quantity of total extract, not on hypericin content. Priest and Priest described St. John's wort as a . . . sedative nervine for muscular twitching and choreiform movements—especially indicated for nerve injuries to the extremities and teeth/gums. Promotes elimination of catabolic waste products. They provided the following specific indications: painful injuries to sacral spine and coccyx, traumatic shock, hemorrhoids with pain and bleeding, facial neuralgia after dental extractions and toothache, neurasthenia, chorea, and depression. Safety Considerations: No adverse reactions have been confirmed at dose levels up to 1 mg of total hypericin.144 Photosensitization at high doses has been reported during experimental antiviral treatment with synthetic hypericin (35 mg intravenously) in HIV-positive patients.145 While a few instances of photosensitization have been documented, this appears to be very rare. A recent study utilizing human keratinocyte cell cultures demonstrated that usual therapeutic doses of Hypericum extracts are about 30 to times below the phototoxic level.146 There have been reports of elevated serotonin levels in patients taking selective serotonin reuptake inhibitors (e.g., sertraline) in combination with St. John's wort.147 Evidence suggests that St. John's wort affects the hepatic cytochrome P450 system, increasing the activity of its most abundant isozyme, CYP3A4. Thus, theoretically, the herb could reduce the activity of simultaneously administered drugs that are known substrates for this isozyme, including nonsedating antihistamines, oral contraceptives, certain antiretroviral agents, antiepileptic medications, calcium channel-blockers, cyclosporine, some chemotherapeutic drugs, macrolide antibiotics, and selected antifungals. Preparations and Dosage: Tincture dosage is 2 to 4 ml three times a day (1:5 in 40%). To make an infusion, pour 1 cup of boiling water over 1 to 2 teaspoons of dried herb and infuse for to minutes. This should be drunk three times a day. See chapter or for instructions on making St. John's wort-infused oil for external application. Based on clinical studies, dosage of standardized extract is mg three times a day of extract standardized to 3% to 5% hyperforin. Dosage recommended in the BHP is 2 to 4 g dried herb, 2 to 4 ml tincture (1:10 in 45%), or 2 to 4 ml (1:1 in 25%) three times a day. Commission E suggest 2 to 4 g of herb or 0.2 to 1 mg total hypericin in other forms of application. St John's wort, in Principles and Practice of Phytotherapy Hyssopus officinalis L. Hyssop Lamiaceae Parts Used: Dried aerial parts Constituents: Diterpenes (marrubiin); triterpenoid saponins (oleanolic and ursolic acids); volatile oil (camphor, pinocaphone, thujone, and many others); flavonoids

(including diosmin and hesperidin); miscellaneous: hyssopin (a glucoside), tannins (5% to 8%), resin148 Actions: Antispasmodic, expectorant, diaphoretic, nervine, anti-inflammatory, carminative Indications: Hyssop has an interesting range of uses, largely attributed to the antispasmodic action of its volatile oil. The herb is used for coughs, bronchitis, and chronic catarrh. Its diaphoretic properties explain its use for the common cold. As a nervine, it may be taken for anxiety states and petit mal seizures. King's Dispensatory considered hyssop a .. . stimulant, aromatic, carminative and tonic. Principally used in quinsy and other sore throats, as a gargle, combined with sage and alum, in infusion sweetened with honey. Also recommended in asthma, coughs, and other affections of the chest, as an expectorant. The leaves applied to bruises, speedily relieve the pain, and disperse every spot or mark from the affected parts. Safety Considerations: No side effects or drug interactions have been reported. Preparations and Dosage: Tincture dosage is 1 to 4 ml three times a day (1:5 in 45%). For an infusion, pour 1 cup of boiling water over 1 to 2 teaspoons of dried herb and infuse in a covered container for to minutes. This should be drunk three times a day. Hyssop, in The Complete German Commission E Monographs Inula helenium L. Elecampane Asteraceae Part Used: Rhizome Constituents: Sesquiterpene lactones, including alantolactone (= helenalin), isoalantolactone; polysaccharides, mainly inulin (up to 44%); miscellaneous: sterols, resin149 Actions: Expectorant, antitussive, diaphoretic, hepatic, antimicrobial Indications: Elecampane is a specific for irritating bronchial coughs, especially in children. It may be used whenever copious catarrh is present—for example, in bronchitis or emphysema. It can be helpful in asthma and bronchial asthma, and has been applied for the treatment of tuberculosis. This remedy provides a good illustration of the complex and integrated ways in which herbs work. The mucilage has a relaxing effect, while the essential oils bring about stimulation, so the herb both soothes irritation and promotes expectoration. These actions are combined with an overall antibacterial effect. Its bitter principle stimulates digestion and appetite. Priest and Priest considered elecampane a . . . gently stimulating tonic expectorant for chronic catarrhal conditions: warming, strengthening and cleansing to pulmonary mucous membranes. Indicated for chronic pectoral states with excessive catarrhal expectoration and/or a tubercular diathesis. They suggested it for the following specific indications: bronchial and gastric catarrh, chronic bronchitis, tuberculosis, pneumoconiosis, silicosis, pertussis, emphysematous conditions, and chronic cough in the elderly. Safety Considerations: Elecampane may cause allergic reactions in people sensitive to plants in the Asteraceae family. Preparations and Dosage: Tincture dosage is 1 to 2 ml three times a day (1:5 in 40%). To make an infusion, pour 1 cup of cold water over 1 teaspoon of shredded root. Let stand for 8 to hours. Heat and take very hot three times a day. Helenii rhizoma, in Herbal Drugs and Phytopharmaceuticals Iris versicolor L. Blue Flag Iridaceae Part Used: Rhizome Constituents: Volatile oil, containing furfural; iridin (also known as irisin, a glycoside); acids (including salicylic and isophthalic); miscellaneous: a monocyclic C3I triterpenoid, gum, resin, sterols150 Actions: Cholagogue, hepatic, alterative, laxative, diuretic, anti-inflammatory Indications: Blue flag is used in the treatment of skin diseases, and apparently works in this area through effects on the liver, the main detoxifying organ of the body. It is valuable as part of a wider treatment for eczema and psoriasis. Priest and Priest described blue flag as a . . . positive alterative for chronic, torpid conditions: influences glandular system, lymphatics, liver and gall ducts, and intestinal glands. Specific for hepatic congestion due to venous or lymphatic stasis. They recommended it for chronic hepatitis, rheumatic conditions, toxic sciatica, scrophulous skin conditions, eczema, psoriasis, herpes, enlarged thyroid gland, and uterine fibroids.

MATERIA MEDICA Safety Considerations: No side effects or drug interactions have been reported. Preparations and Dosage: Tincture dosage is 1 ml three times a day (1:5 in 40%). To make a decoction, put 1 teaspoon of dried herb into 1 cup of water, bring to a boil, and simmer for to minutes. This should be drunk three times a day. According to the BHC, dosage is 0.6 to 2 g dried rhizome (or by decoction), 3 to ml tincture (1:5 in 45%), or 0.6 to 2 ml fluid extract (1:1 in 45%) three times daily. Blue Flag, in Herbal Medicines: A Guide for Health-Care Professionals Juniperus communis L. Juniper Cupressaceae Part Used: Dried fruit (berry) Constituents: Volatile oil (0.2% to 3.42%): myrcene, sabinene, a- and |3-pinene, 4-cineole, camphene, limonene; condensed tannins; diterpenes; flavonoids (amentoflavone, quercetin, isoquercitrin, apigenin); miscellaneous: sugars, resin, vitamin C151 Actions: Diuretic, antimicrobial, carminative, antirheumatic Indications: The actions documented for juniper are primarily associated with its volatile oil components. Juniper berries make an excellent antiseptic for urinary tract conditions such as cystitis. Their essential oil is quite stimulating to the kidney nephrons, however, so people with kidney disease should avoid this herb. Juniper's bitter action aids digestion and eases flatulent colic. The herb is taken internally for rheumatism and arthritis, and, used externally, helps relieve pain in the joints or muscles. In the laboratory, a juniper extract demonstrated potent inhibition of herpes simplex virus type I in human cell culture.152 Safety Considerations: With prolonged use or overdose, juniper may cause renal damage, evidenced by renal pain with an increased urge to urinate, pain during urination, and hematuria and albuminuria (the presence of blood and protein, respectively, in the urine). People with kidney disease should not take juniper berries. They should also be avoided in pregnancy. Preparations and Dosage: Tincture dosage is 0.5 to 1 ml three times a day (1:5 in 40%). To make an infusion, pour 1 cup of boiling water over 1 teaspoon of lightly crushed berries and infuse in a covered container for minutes. This should be drunk three times a day. Commission E recommends a total daily dosage of 2 g to a maximum of g of dried juniper fruit, corresponding to to mg of essential oil. Juniper berry, in Herbal Medicine, Expanded Commission E Monographs Lactuca virosa L. Wild Lettuce Asteraceae Part Used: Dried leaf Constituents: Lactucin (a sesquiterpene lactone); flavonoids (mainly based on quercetin); coumarins (cichoriin and aesculin); N-methyl-|3-phenethylamine153 Actions: Nervine, anodyne, hypnotic, antispasmodic Indications: The latex of wild lettuce was at one time sold as "lettuce opium," or "lactucarium," as it was called in the official pharmacopoeias of the day. Wild lettuce is a valuable remedy for insomnia and restlessness. As an antispasmodic, it can be applied as part of a holistic treatment for whooping cough and dry irritated coughs in general. It relieves colic pains in the intestines and uterus, and so may be used in dysmenorrhea. It also eases muscular pains related to rheumatism. The herb has been used as an anaphrodisiac. Safety Considerations: Wild lettuce may cause allergic reactions in people sensitive to plants in the Asteraceae family. Preparations and Dosage: Tincture dosage is 1 to 2 ml three times a day (1:5 in 40%). To make an infusion, pour 1 cup of boiling water over 1 to 2 teaspoons of herb and infuse for to minutes. This should be drunk three times a day. Dosage recommended in the BHC is 0.5 to 4 g dried herb or 0.5 to 4 ml fluid extract (1:1 in 25%) three times daily. The USP gives a dosage of 2 ml lactucarium tincture three times a day. Wild Lettuce, in Herbal Medicines: A Guide for Health-Care Professionals Lavandula angustifolia Miller Lavender Lamiaceae Part Used: Flower Constituents: Volatile oil (linalyl acetate, linalol, lavandulyl acetate, borneol, limonene, caryophyllene); coumarins (umbelliferone, herniarin, coumarin); miscellaneous: triterpenes (e.g., ursolic acid), flavonoids (e.g., luteolin)154

Actions: Carminative, antispasmodic, relaxing nervine, antidepressant, rubefacient, emmenagogue, hypotensive Indications: This beautiful herb has many uses, culinary, cosmetic, and medicinal. It can help relieve headaches, particularly when they are stress-related. Lavender may be quite effective in clearing depression, especially if used in conjunction with other remedies, and can also be used to promote natural sleep. As a gentle, strengthening nervous system tonic, it may be used to treat states of nervous debility and exhaustion. The essential oil may be applied externally as a stimulating liniment to help ease aches and pains of rheumatism. The general safety and efficacy of the essential of lavender make it widely applicable in topical formulations. Safety Considerations: No side effects or drug interactions have been reported. Preparations and Dosage: To make an infusion to take internally, pour 1 cup of boiling water over 1 teaspoon of dried herb and infuse in a covered container for minutes. This can be drunk three times a day. Lavender essential oil should not be taken internally, but can be inhaled, rubbed on the skin, or added to baths. Commission E recommends 1 to 2 teaspoons of herb per cup of water or 1 to 4 drops (approximately to mg) of lavender essential oil. Lavender flower, in Herbal Medicine, Expanded Com?nission E Monographs Leonurus cardiaca L. Motherwort Lamiaceae Parts Used: Aerial parts Constituents: Iridoids (leonuride and others); labdane diterpenes (including leocardin); flavonoids (apigenin, kaempferol, and quercetin glucosides); caffeic acid; alkaloids (0.35%): tachydrine, betonicine, turicin, leonurine; tannins (2% to 8%); volatile oil (0.05%)lss Actions: Nervine, emmenagogue, antispasmodic, hepatic, cardiotonic, hypotensive Indications: The binomial of this plant illustrates the range of uses to which it has been put. "Motherwort" indicates its relevance for menstrual and uterine conditions, while "cardiaca" suggests that it is beneficial in cardiovascular and circulatory system treatments. The herb is valuable for stimulating delayed or suppressed menstruation, especially when anxiety or tension is involved, and may be used to ease false labor pains. It is a useful relaxing tonic for menopausal changes. Motherwort is also an excellent heart tonic, strengthening without straining. It is considered a specific for tachycardia (heart palpitations), especially when brought on by anxiety or other such causes. It may be used in all heart conditions associated with anxiety and tension. Motherwort has demonstrated cardioactivity in vitro. An alcoholic extract was found to have a direct inhibitory effect on myocardial cells: It exerted an antagonistic action against calcium chloride and stimulated both a- and (3-adrenoceptors.156 According to Priest and Priest, motherwort is . . . diffuse, stimulating and relaxing, an antispasmodic nervine: indicated for reflex conditions affecting cardiac function, and as a simple cardiac tonic. It also influences pre-menstrual nerve tension and muscular rigidity. They provided the following specific indications: anemic nervousness and insomnia, palpitations, cardiac weakness after infections, neurosis, hyperthyroid cardiac reactions, premenstrual syndrome, congestive amenorrhea, and dysmenorrhea. Safety Considerations: Excessive use of motherwort may interfere with other cardiovascular treatments. Preparations and Dosage: Tincture dosage is 1 to 4 ml three times a day (1:5 in 40%). For an infusion, pour 1 cup of boiling water over 1 to 2 teaspoons of dried herb and infuse for to minutes. This should be drunk three times a day. According to the BHC, dosage is 2 to 4 g dried herb, 4 to ml tincture (1:5 in 45%), or 2 to 4 ml fluid extract (1:1 in 25%) three times daily. Commission E recommends 4.5 g herb or equivalent preparations. Motherwort herb, in The Complete German Commission E Monographs Leptandra virginica (L.) Nutt. Black Root Scrophulariaceae Other Name: Veronicastrum virginicum (L.) Farw. Parts Used: Rhizome, root Constituents: Volatile oil (cinnamic acid, methoxycinnamic acid, dimethoxycinnamic acid); saponins; mannitol; dextrose; tannins157 Actions: Cholagogue, hepatic, laxative, diaphoretic, antispasmodic Indications: Black root is used to relieve liver congestion and to treat inflamed gallbladder (cholecystitis). Black root is also appropriate for use in jaundice caused by liver

คำศัพท์สำคัญในบทนี้ Key Terms

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dosage

ปริมาณยาที่กำหนดให้ใช้ในแต่ละครั้ง

tincture

สารสกัดสมุนไพรที่แช่ในแอลกอฮอล์เข้มข้น

extract

สารออกฤทธิ์ที่แยกออกมาจากพืชสมุนไพร

treatment

วิธีการรักษาหรือบรรเทาอาการเจ็บป่วย

infusion

น้ำยาสมุนไพรที่ได้จากการชงใบหรือดอกในน้ำร้อน

chronic

อาการที่เป็นต่อเนื่องยาวนาน ไม่หายง่าย

flavonoid

สารสีในพืชที่ต้านอนุมูลอิสระและลดการอักเสบ

diuretic

สมุนไพรที่เพิ่มการผลิตปัสสาวะเพื่อขับของเสีย

infection

การที่เชื้อโรคเข้าสู่ร่างกายและทำให้เกิดโรค

skin

อวัยวะชั้นนอกสุดที่ปกป้องร่างกายจากสิ่งแวดล้อม (ผิวหนัง)

decoction

น้ำยาสมุนไพรที่ได้จากการต้มรากหรือเปลือกไม้

volatile oil

น้ำมันระเหยง่ายจากพืชที่ให้กลิ่นหอมและมีฤทธิ์ทางยา

inflammation

ปฏิกิริยาร่างกายต่อการบาดเจ็บ ทำให้บวม แดง ร้อน ปวด

anti-inflammatory

สมุนไพรที่ลดอาการบวม แดง ปวด จากการอักเสบ

antispasmodic

สมุนไพรที่คลายการเกร็งตัวของกล้ามเนื้อและลดอาการปวดเกร็ง

astringent

สมุนไพรที่ทำให้เนื้อเยื่อหดตัวเพื่อหยุดเลือดหรือลดการอักเสบ

glycoside

สารประกอบน้ำตาลในพืชที่ปล่อยสารออกฤทธิ์เมื่อย่อยสลาย

herbal medicine

การใช้พืชสมุนไพรในการรักษาและป้องกันโรค

antimicrobial

สมุนไพรที่ฆ่าหรือยับยั้งเชื้อแบคทีเรีย ไวรัส เชื้อรา

liver

อวัยวะขนาดใหญ่ที่กรองสารพิษและผลิตน้ำดี (ตับ)

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