LIVRO Pocket Guide to Herbal Medicine 2004 - Eletrônicos (2025)

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<p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Page intentionally left blank</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50 h</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Page intentionally left blank</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Pocket Guide</p><p>to Herbal Medicine</p><p>Karin Kraft, M.D.</p><p>Professor</p><p>Outpatient Clinic</p><p>University of Rostock</p><p>Germany</p><p>Christopher Hobbs, L.Ac., A.H.G.</p><p>Clinical Herbalist and Acupuncturist in Private Practice</p><p>Davis, California</p><p>USA</p><p>Foreword by Jonathan Treasure</p><p>Thieme</p><p>Stuttgart · New York</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Library of Congress Cataloging-in-</p><p>Publication Data is available from the</p><p>publisher</p><p>This book is an authorized and revised</p><p>translation of the German edition</p><p>published and copyrighted 2000 by</p><p>Georg Thieme Verlag, Stuttgart,</p><p>Germany. Title of the German edition:</p><p>Phytotherapie</p><p>Translator: Suzyon O’Neal Wandrey,</p><p>Berlin, Germany</p><p>© 2004 Georg Thieme Verlag,</p><p>Rüdigerstrasse 14, 70469 Stuttgart,</p><p>Germany</p><p>http://www.thieme.de</p><p>Thieme New York, 333 Seventh Avenue,</p><p>New York, NY 10001 USA</p><p>http://www.thieme.com</p><p>Cover design: Martina Berge, Erbach</p><p>Typesetting by Satzpunkt Ewert GmbH,</p><p>Bayreuth</p><p>Printed in Germany by Druckhaus Götz,</p><p>Ludwigsburg</p><p>ISBN 3-13-126991-X (GTV)</p><p>ISBN 1-58890-063-0 (TNY) 1 2 3 4 5</p><p>Important note:</p><p>Medicine is an ever-</p><p>changing science undergoing continual</p><p>development. Research and clinical experi-</p><p>ence are continually expanding our knowl-</p><p>edge, in particular our knowledge of proper</p><p>treatment and drug therapy. Insofar as this</p><p>book mentions any dosage or application,</p><p>readers may rest assured that the authors,</p><p>editors, and publishers have made every</p><p>effort to ensure that such references are in</p><p>accordance with</p><p>the state of knowledge at</p><p>the time of production of the book.</p><p>Nevertheless, this does not involve, imply,</p><p>or express any guarantee or responsibility</p><p>on the part of the publishers in respect to</p><p>any dosage instructions and forms of appli-</p><p>cations stated in the book.</p><p>Every user is re-</p><p>quested to examine carefully</p><p>the manu-</p><p>facturers’ leaflets accompanying each drug</p><p>and to check, if necessary in consultation</p><p>with a physician or specialist, whether the</p><p>dosage schedules mentioned therein or the</p><p>contraindications stated by the manufac-</p><p>turers differ from the statements made in</p><p>the present book. Such examination is</p><p>particularly important with drugs that</p><p>are either rarely used or have been</p><p>newly released on the market. Every dosage</p><p>schedule or every form of application used</p><p>is entirely at the user’s own risk and respon-</p><p>sibility. The authors and publishers request</p><p>every user to report to the publishers any</p><p>discrepancies or inaccuracies noticed.</p><p>Some of the product names, patents, and</p><p>registered designs referred to in this book</p><p>are in fact registered trademarks or propri-</p><p>etary names even though specific reference</p><p>to this fact is not always made in the text.</p><p>Therefore, the appearance of a name with-</p><p>out designation as proprietary is not to be</p><p>construed as a representation by the pub-</p><p>lisher that it is in the public domain.</p><p>This book, including all parts thereof, is</p><p>legally protected by copyright. Any use,</p><p>exploitation, or commercialization outside</p><p>the narrow limits set by copyright legisla-</p><p>tion, without the publisher’s consent, is ille-</p><p>gal and liable to prosecution. This applies in</p><p>particular to photostat reproduction, copy-</p><p>ing, mimeographing, preparation of micro-</p><p>films, and electronic data processing and</p><p>storage.</p><p>V</p><p>Fo</p><p>re</p><p>w</p><p>o</p><p>rd</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Traditionally, Western medical knowledge from Graeco-Roman times onward</p><p>has been transmitted by means of authoritative printed texts. Today, both patient</p><p>and physician may be more likely to use the Internet as a first reference source.</p><p>The sheer amount of medical information available on the World Wide Web and</p><p>the speed of its renewal and retrieval may outpace the Caxtonian mechanics of</p><p>printed textbook production, but has done little to erode the authority of the</p><p>printed word. Conversely, in fact, major medical reference texts are these days</p><p>being “ported” into the memory of hand-held electronic devices or on-line data-</p><p>bases. This development, welcomed by gadgetry enthusiasts, eliminates the hefty</p><p>size and weight of the printed tome, but decreases the legibility and convenience</p><p>of the printed page as well as undermining the narrative qualities of the tradition-</p><p>al medical textbook.</p><p>However, another, and only slightly less illustrious tradition has long co-existed</p><p>with that of the major medical opus. This is the “vade mecum,” literally “go with</p><p>me,” intended as a portable tome to be kept on hand for immediate reference. To</p><p>be successful, this format requires authors to possess a high degree of intimacy</p><p>and fluency with their subject matter, to be able to communicate its essentials</p><p>with precision and confidence, compacting prose and condensing content with-</p><p>out sacrificing narrative. The size of the resultant printed volume must be com-</p><p>pact enough to make it easily portable, which nowadays translates as “pocket</p><p>guide.”</p><p>The present pocket guide is a medical vade mecum devoted specifically to the field</p><p>of phytotherapy (herbal medicine), authored by the German physician and phy-</p><p>totherapist Karin Kraft. Prof. Kraft is a member of the Commission E (the official</p><p>expert committee which originally considered the safety and efficacy of phyto-</p><p>medicines in Germany), and is currently a member of the supervising editorial</p><p>board of ESCOP (European Scientific Cooperative on Phytotherapy). ESCOP</p><p>produces the scientific monographs that provide the official core data for herbal</p><p>medicines in the EU.</p><p>In Germany, phytotherapy enjoys a higher degree of integration into general</p><p>medical practice than in any other European country, with physicians regularly</p><p>writing millions of prescriptions for approved phytomedicines on a daily basis. In</p><p>the original German edition of this pocket guide, Prof. Kraft provides the busy-</p><p>general practitioner with a compact and practical reference guide that includes a</p><p>materia medica of herbs, a prescriber for many conditions, and extensive data on</p><p>dosage, forms of administration, safety data and technical standards for German</p><p>commercial herbal products. (Special mention should made of Prof. Kraft’s inclu-</p><p>sion of an often neglected area, that of topical applications of herbal medications</p><p>such as poultices and compresses, more popular in Europe than in the USA).</p><p>In North America, herbal medicine is a more marginal discipline, ultimately the</p><p>legacy of a period of political opposition between medical factions at the turn of</p><p>the 19th century which resulted in the effective outlawing of botanical medical</p><p>practice following the Flexner Report of 1910. Although the majority of “official”</p><p>medicines in the United States Pharmacopoeia were originally botanicals or bo-</p><p>tanically derived, there remains a sharp discontinuity between standard practice</p><p>medicine today and its botanical past. The once widespread schools of physio-</p><p>medical and eclectic botanical medicine were preserved partly through their mi-</p><p>gration to the United Kingdom, where an unbroken tradition today enables qual-</p><p>Foreword</p><p>V</p><p>I</p><p>Fo</p><p>re</p><p>w</p><p>o</p><p>rd</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>ified British medical herbalists</p><p>of an experienced health care profession-</p><p>al such as a naturopathic practitioner or herbalist. Many milder teas like gin-</p><p>ger, peppermint, and chamomile have some medicinal qualities, but are usu-</p><p>ally considered safe to use at home with care. The use and sale of many of these</p><p>herb teas fall under the food laws in North America; beverage teas, see p. 479).</p><p>– The concentrations of active principles in medicinal teas are determined by</p><p>the relative proportion of the herbs to extractant (water), the degree of cut-</p><p>ting or grinding of the herb, the recommended water temperature, and the</p><p>steeping time.</p><p>– Disadvantages: It is difficult to determine the exact dosage; combined com-</p><p>ponents may become separated. Cutting or powdering of herbs often dras-</p><p>tically reduces their shelf life by allowing oxygen to reach and degrade ac-</p><p>tive constituents.</p><p>– Suppliers of medicinal teas: Pharmacies, drug stores, health food stores, herb</p><p>shops, and supermarkets.</p><p>– Preparation: Leaves, flowers, and other plant materials are cut coarsely to</p><p>finely. Wood, bark, and root materials are cut finely or pulverized.</p><p>– Storage: Keep dry and store in metal tins or dark jars to prevent direct light</p><p>exposure. The expiration date should be indicated on the label.</p><p>➤ Types of tea preparations</p><p>– Loose tea: Available as single-herb preparations and as tea mixtures. Tea</p><p>mixtures do not usually contain more than seven different plant species.</p><p>Traditional Chinese tea formulas often contain 6 to 15 different herbs.</p><p>Those with as many as 20 to 30 herbs cannot reliably be used to achieve</p><p>selective or specific effects.</p><p>– Tea bags</p><p>• Definition: Small filter bags in which finely chopped herbal teas are en-</p><p>closed.</p><p>• Suitability: All herbs with constituents readily extractable with boiling</p><p>water.</p><p>• Advantages: The small particle size of the tea yields a high degree of ex-</p><p>traction of the constituents. Tea bags are easy to use and ensure uni-</p><p>formity of dose and composition.</p><p>• Disadvantages: Some of the volatile substances are lost during prepara-</p><p>tion and storage and certain constituents undergo oxidation upon expo-</p><p>sure to the air.</p><p>• The individual tea bags should be separately wrapped in airtight pack-</p><p>ets.</p><p>1.4 Herbal Formulations</p><p>16</p><p>Fu</p><p>n</p><p>d</p><p>am</p><p>en</p><p>ta</p><p>ls</p><p>o</p><p>f P</p><p>h</p><p>yt</p><p>o</p><p>th</p><p>er</p><p>ap</p><p>y</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>– Instant teas</p><p>• Definition: Tea preparation that readily dissolves in water. Powdered</p><p>teas contain around 8–10 % extractable plant constituents in addition to</p><p>fillers, carriers, flavor enhancers, and colorants (e. g., sugar, dextrin, gel-</p><p>atin, acacia). To prepare tea granules, liquid drug extracts are sprayed</p><p>onto a carrier and dried. Tea granules consist mainly of sugar, with plant</p><p>constituents comprising only 2–3 % of the final product. Many Chinese</p><p>medicinal tea blends are available in this form.</p><p>Note: Diabetics must be aware of the relatively high sugar content. Since</p><p>essential oils are lost during the comminution process, they are some-</p><p>times added at a later phase of the manufacturing process.</p><p>➤ Methods of tea preparations (see also p. 27 )</p><p>– Infusion: Preparation made by pouring boiling water onto the fresh or</p><p>dried herbs and allowing them to steep in order to extract their medicinal</p><p>principles. Suitable for the preparation of delicate or finely chopped herbs</p><p>(leaves, flowers, seeds, bark, and roots) with volatile and thermolabile con-</p><p>stituents (e. g., essential oils).</p><p>– Decoction: Prepared by boiling fresh or dried herbs in water for 10 to 60</p><p>minutes to extract their medicinal principles. Suitable for the preparation</p><p>of hard or very hard plant materials (woods, barks, roots) or herbs with</p><p>sparingly soluble constituents (e. g., silicic acid).</p><p>– Maceration (cold extract): Prepared by allowing a tea herb to steep in cold</p><p>water for several hours to extract its active principles. Suitable for the prep-</p><p>aration of mucilage-containing herbs such as flaxseeds or psyllium seeds</p><p>whose high concentrations of starches and pectins would cause them to ge-</p><p>latinize if prepared with boiling water. Also used to prevent the extraction</p><p>of undesirable constituents that dissolve in hot water.</p><p>1.4 Herbal Formulations</p><p>17</p><p>Fu</p><p>n</p><p>d</p><p>am</p><p>en</p><p>ta</p><p>ls</p><p>o</p><p>f P</p><p>h</p><p>yt</p><p>o</p><p>th</p><p>er</p><p>ap</p><p>y</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ Prescription and reimbursement of costs</p><p>– In some European countries, as well as China, properly-prescribed herbal</p><p>preparations are reimbursable by law.</p><p>– In North America, herbal preparations, even when prescribed by a licensed</p><p>practitioner, are not reimbursable by insurance companies or HMOs. This</p><p>is slowly changing, as more research-based evidence of the cost-effective-</p><p>ness of herbal remedies emerges.</p><p>➤ Reading and writing prescriptions</p><p>– The Latin terminology should be used in written prescriptions so that the</p><p>medicinal herb in question can be readily identified at the pharmacy, where</p><p>the drug containers are labeled with the Latin terms.</p><p>– The English and Latin terms for the most important plant parts are listed in</p><p>Table 1.</p><p>English and Latin names and abbreviations of plant parts</p><p>➤ Writing prescriptions for teas, tinctures and other special preparations:</p><p>The prescription must tell the pharmacist how much of which drugs to use,</p><p>which ratio of each drug to use, and so forth.</p><p>➤ Prescription format: The standard Latin abbreviations should be used in writ-</p><p>ten instructions for the pharmacist. The most important terms and abbrevia-</p><p>tions used in written prescriptions are summarized in Table 2.</p><p>Latin terms and abbreviations used in prescription writing</p><p>Continued</p><p>English Name Latin Name</p><p>Singular (Plural)</p><p>Abbreviation</p><p>Leaf folium (folia) fol.</p><p>Flower flos (flores) flor.</p><p>Fruit fructus (fructus) fruct.</p><p>Herb herba (herbae) herb.</p><p>Root radix (radices) rad.</p><p>Rhizome rhizoma (rhizomae) rhiz.</p><p>Bark cortex (cortices) cort.</p><p>Latin Abbreviation Derivation English Equivalent</p><p>Aa ana partes aequales (equal parts) of each</p><p>aqu. aqua water</p><p>add. adde add</p><p>aut simil. aut similia or similar</p><p>c. cum with</p><p>cc, conc. concisus cut</p><p>cont. contusus crushed</p><p>d. da give</p><p>Table 1</p><p>Table 2</p><p>1.5 Prescribing Herbal Medicines</p><p>18</p><p>Fu</p><p>n</p><p>d</p><p>am</p><p>en</p><p>ta</p><p>ls</p><p>o</p><p>f P</p><p>h</p><p>yt</p><p>o</p><p>th</p><p>er</p><p>ap</p><p>y</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Continued</p><p>Latin Abbreviation Derivation English Equivalent</p><p>d.s. detur signetur give and label as follows</p><p>Ft fiat make, prepare</p><p>Gtt gutta, guttae drops</p><p>Inf infunde make an infusion</p><p>m. misce mix</p><p>M ft spec. misce fiat species mix and make a tea</p><p>M ft ungt. misce fiat unguentum mix and make an ointment</p><p>M. D. S. misce, da, signe mix, give, label as</p><p>p.c. post cibum after meals</p><p>pulv. pulvus, pulveratus powder, pulverized</p><p>Rx recipe take</p><p>S. signa label, mark</p><p>spec. species tea</p><p>supp. suppositorium suppository</p><p>tal. dos. tales doses such doses</p><p>tct., tr. tinctura tincture</p><p>ungt. unguentum ointment</p><p>Table 2</p><p>1.5 Prescribing Herbal Medicines</p><p>19</p><p>Fu</p><p>n</p><p>d</p><p>am</p><p>en</p><p>ta</p><p>ls</p><p>o</p><p>f P</p><p>h</p><p>yt</p><p>o</p><p>th</p><p>er</p><p>ap</p><p>y</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ The proper dose in herbal medicine is always a matter to be considered in clin-</p><p>ical practice.</p><p>➤ Several factors should be taken into account when determining the proper</p><p>dose, as follows.</p><p>– The cultural context in which the herb is used</p><p>– Federal or state regulations</p><p>– The potential toxicity or strength of each herb</p><p>– The relative concentration or strength of the product</p><p>– The dose form, i. e., tincture, standardized extract, etc.</p><p>– The age, strength, and needs of the individual taking the preparation</p><p>– The duration of administration</p><p>➤ Cultures vary as to how much of an herb or herb preparation is taken at a dose,</p><p>and over how long a period.</p><p>– For instance, native Americans were used to drinking several cups of strong</p><p>teas made by boiling the herbs. Consumption leading to vomiting was com-</p><p>mon as a means of cleansing the system. This would not be acceptable in</p><p>most technologically developed nations today.</p><p>– In China, a common herb prescription contains from 5 to 10 herbs, and the</p><p>daily dose for each is in the range of 3–12 grams. Many herb tea prescrip-</p><p>tions given for therapeutic use contain about 60 – 200 grams of dried herbs.</p><p>These are to be boiled for up to an hour and 2–3 cups of the strong brew are</p><p>consumed over the course of a day.</p><p>➤ In Germany and other European countries, as well as North America, standard-</p><p>ized extracts are commonly prescribed in tablets and capsules, as well as teas</p><p>and hydroethanolic tinctures. Some standardized extracts are highly concen-</p><p>trated. For instance, Ginkgo biloba leaves are extracted to produce a 50 : 1 con-</p><p>centrate. One part of the finished extract represents the active flavonoids and</p><p>terpenes from 50 parts of the leaves.</p><p>➤ Teas and tinctures in Europe tend to be of lower concentration than in North</p><p>America, and the recommended daily dose also seems to be lower. In Germany</p><p>and Europe, mother tinctures made with an extract ratio of 1 : 10 are often</p><p>favored. This means that 10 parts of the finished tincture represent most of</p><p>the desirable and active constituents from only 1 part of the herb. This is called</p><p>a “mother tincture.” For instance an ounce of echinacea mother tincture made</p><p>at this concentration would represent 1/10 of an ounce of dried echinacea root</p><p>or leaves, or about 3 grams. If the recommended dose were 1–2 mL, 3 times/</p><p>day, the patient would receive the equivalent of about 100–200 mg of dried</p><p>herb, 3 times/day, or up to 600 mg/day. By comparison, a common daily dose</p><p>of Chinese herbs can be up to 200 grams of herbs boiled and consumed as a</p><p>tea. While it has been argued that hydroalcoholic tinctures are more absorb-</p><p>able by the body and so have a stronger impact than teas, the difference would</p><p>be slight compared with the great difference in doses between the two cul-</p><p>tures.</p><p>➤ In North America, as in Europe, standardized extracts are commonly sold and</p><p>prescribed by practitioners. Chinese herb tea and tablet prescriptions are also</p><p>widely used.</p><p>➤ Hydroalcoholic tinctures are usually manufactured at a concentration of any-</p><p>where from 3 : 1 to 10 : 1, and most are around 5 : 1. The recommended dose</p><p>listed on bottles of these tincture products tends to be 20 to 80 drops, several</p><p>times daily. More experienced western herbal practitioners tend to prescribe</p><p>1.6 Determination of Doses</p><p>20</p><p>Fu</p><p>n</p><p>d</p><p>am</p><p>en</p><p>ta</p><p>ls</p><p>o</p><p>f P</p><p>h</p><p>yt</p><p>o</p><p>th</p><p>er</p><p>ap</p><p>y</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>up to 5 mL of a hydroalcoholic tincture, 3 to 5 times/day, as an initial therapeu-</p><p>tic dose, and about 1–2 mL, 2 to 3 times/day as a maintenance dose.</p><p>➤ Based on all these differences, how is one to best determine the dose for each</p><p>individual for any given clinical encounter? This has to be determined on the</p><p>basis of a knowledge of the strength of the herb, the strength of the prepara-</p><p>tion, the quality and freshness of the herbs that went into the product, and of</p><p>course the size, weight, age, and needs of the patient.</p><p>➤ In Table 5 , usual German doses are given, along with the usual North American</p><p>dose. We recommend that you adjust the dose within this range of doses, again</p><p>based on the individual situation. Use common sense. Smaller people need a</p><p>smaller dose than a very large person. Young children need a smaller dose than</p><p>an adult. Very young children usually need only a few drops to obtain a thera-</p><p>peutic response. Weak or sensitive individuals need (or can tolerate) a smaller</p><p>dose than a robust, healthy person. Do not think of the dose as static and fixed</p><p>for all circumstances. Use your best judgement, taking account of the situation,</p><p>and always adjust the dose rather than dispensing an herb in the same dose for</p><p>every situation and person.</p><p>➤ In the plant summaries this book maintains the German dosages of the origi-</p><p>nal, however, please refer to the dosage table 337 f for American doses.</p><p>➤ Usually it is best to start a person on a new herb or formula at the minimum</p><p>dose to check for sensitivity and response before going on to a larger dose if no</p><p>response is noted. For long-term use the dose can often be half of the therapeu-</p><p>tic dose as a maintenance dose.</p><p>1.6 Determination of Doses</p><p>21</p><p>G</p><p>en</p><p>er</p><p>al</p><p>G</p><p>u</p><p>id</p><p>el</p><p>in</p><p>es</p><p>fo</p><p>r</p><p>U</p><p>se</p><p>o</p><p>f H</p><p>er</p><p>b</p><p>al</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>es</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Clinical Applications of Herbal Medicine</p><p>➤ Primary indications</p><p>– Gastrointestinal diseases</p><p>– Colds and flu</p><p>– Liver and gallbladder diseases</p><p>– Psychovegetative diseases</p><p>– Circulatory problems and decreased mental performance</p><p>– Sleep disorders</p><p>– Diseases of the kidney and efferent urinary passages</p><p>– Prostatic diseases</p><p>– Diseases of the female genital tract</p><p>– Varicose veins</p><p>– Convalescent care</p><p>– Prevention of degenerative diseases</p><p>– Supportive (adjuvant) treatment</p><p>➤ Indicated for adjuvant therapy only in</p><p>– Severe diseases</p><p>– Infectious diseases</p><p>– Emergency medicine</p><p>➤ Advantages of herbal medcines</p><p>– Although recent reports highlight a few problems with herb–drug interac-</p><p>tions such as St. John’s wort reducing plasma levels of antirejection and</p><p>antiretroviral drugs, the overall chance of most herbal preparations inter-</p><p>fering with the safety and efficacy of synthetic drugs is small, on the basis</p><p>of actual human reports. Many published comments about herb–drug</p><p>interactions in the literature and popular press involve theoretical inter-</p><p>actions only. More work needs to be performed in this new area of research.</p><p>– Herbal medicines have a wide therapeutic range (the gap between thera-</p><p>peutic and toxic doses is very large) and, thus, a superior risk-to-benefit</p><p>ratio. A number of recent published studies involving thousands of patients</p><p>show that patient reports of adverse effects are close to those reported for</p><p>placebo.</p><p>– Herbal medicines provide a high level of treatment safety.</p><p>– When given a choice, patients with the conditions listed above tend to ac-</p><p>cept them more readily than synthetic drugs, thereby increasing compli-</p><p>ance.</p><p>– Herbal medicines facilitate the transition from acute short-term to chronic</p><p>long-term treatment.</p><p>– Herbal medicines can replace some of the conventional synthetic drugs</p><p>used to treat patients with chronic diseases, such as chronic fatigue syn-</p><p>drome, and multiple morbidity syndromes. This is important because their</p><p>synthetic counterparts often have considerable side effects.</p><p>➤ Disadvantages of herbal medicines</p><p>– Herbal medicines are often not potent enough to treat severe illnesses by</p><p>themselves, except sometimes with a long-term course.</p><p>– Diseases may be drawn out unnecessarily when self-prescribed herbal</p><p>drugs are taken improperly.</p><p>– The improper long-term use of certain herbal preparations, such as the pyr-</p><p>rolizidine alkaloid-containing herb comfrey, can lead to severe side effects.</p><p>2.1 Potentials and Limitations</p><p>22</p><p>G</p><p>en</p><p>er</p><p>al</p><p>G</p><p>u</p><p>id</p><p>el</p><p>in</p><p>es</p><p>fo</p><p>r</p><p>U</p><p>se</p><p>o</p><p>f H</p><p>er</p><p>b</p><p>al</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>es</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Self-Care Management</p><p>➤ Owing to budget restrictions and the reduced number of drugs covered under</p><p>many health insurance plans, the role of herbal self-treatment is increasing.</p><p>➤ In self-care management, the responsibility for correct herb use and dosage</p><p>lies with the patient.</p><p>➤ As a result, side effects and interactions with other drugs are more likely to go</p><p>unnoticed by these patients.</p><p>➤ It is therefore imperative that all herbs and herbal remedies be accurately la-</p><p>beled with adequate instructions and warnings.</p><p>Ideally, the patient will con-</p><p>sult a qualified health care professional such as a physician trained in herbal</p><p>medicine, trained herbalist, or naturopathic physician before initiating self-</p><p>treatment with any herbal remedy. The advice of a physician should also be</p><p>sought when herbal preparations are used together with pharmaceutical</p><p>drugs, and obviously with severe ailments.</p><p>➤ In North America, according to recent studies, most patients do not inform</p><p>their physician about herbal use. This may be because most medical doctors</p><p>are uninformed about some of the current research regarding the safety and</p><p>efficacy of herbal preparations. This is not surprising, since they rarely receive</p><p>training or continuing education in this area. Perceived disapproval from a</p><p>physician may also play a role in this choice.</p><p>Role of the Physician</p><p>➤ The physician should be informed of the use of herbal remedies to avoid un-</p><p>necessary or excessive treatment and unwanted interactions with synthetic</p><p>drugs (physician-supervised self-care management).</p><p>➤ Since physicians should be able to advise patients about the limitations of self-</p><p>care management, doctors must have a solid knowledge of herbal medicine.</p><p>Patients often tend to be more responsive about informing physicians con-</p><p>cerning herbal use when they feel the physician is knowledgeable and, as far</p><p>as possible, unbiased.</p><p>Note: Not all herbal medicinal products are safe and gentle. The improper long-</p><p>term use of certain herbs can lead to serious side effects. Therefore, herbal rem-</p><p>edies should not be used for extended periods without the supervision of a</p><p>physician or other appropriately experienced health care provider.</p><p>2.1 Potentials and Limitations</p><p>23</p><p>G</p><p>en</p><p>er</p><p>al</p><p>G</p><p>u</p><p>id</p><p>el</p><p>in</p><p>es</p><p>fo</p><p>r</p><p>U</p><p>se</p><p>o</p><p>f H</p><p>er</p><p>b</p><p>al</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>es</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Preliminary Remarks</p><p>➤ Owing to their low rate of side effects, the use of herbal remedies is increasing</p><p>in certain patient groups, particularly in chronically ill children, pregnant and</p><p>nursing mothers, and senior citizens.</p><p>➤ Certain precautions may be observed when treating allergy sufferers and</p><p>intensive-care patients with herbal remedies.</p><p>Infants and Children</p><p>➤ Pharmacokinetics</p><p>– The pharmacokinetic and pharmacodynamic responses of infants and small</p><p>children to herbal remedies are different from those of adults. As a result,</p><p>the therapeutic range of an herbal drug will also differ in children and</p><p>adults.</p><p>– These differences are attributable to the underdevelopment of organ struc-</p><p>ture and function in children and differences in receptor structures.</p><p>– Drugs are retained longer in a child’s body owing to the lower rates of ex-</p><p>cretion and metabolism.</p><p>➤ Basic rules for treatment of pediatric patients</p><p>– The treatment of pediatric patients with herbal medicinal preparations</p><p>should be carried out under the supervision of a physician and/or other ap-</p><p>propriately experienced health care provider, if the persons who take care</p><p>of the child are not experienced in herbal medicine, or the disease is more</p><p>serious or longer lasting. A herbal remedy suitable for use in children should</p><p>be selected and administered at the lowest dose possible.</p><p>– Generally, the herbal preparation should be administered according to the</p><p>supplier’s recommendation.</p><p>– For preparations without dose recommendation a formula for calculation</p><p>of reduced dosages for children and infants based on body weight may be</p><p>used: children’s dose = (adult dose/110) × (1.5 × weight in kg).</p><p>➤ Practical dosage recommendations for administration of teas (or diluted</p><p>tinctures) to pediatric patients</p><p>– Infants: 5 drops or 1 to 2 droppersful of a tea, or 1 part of tincture (ca. 1 : 5)</p><p>diluted with 10 parts water, several times a day.</p><p>– Children 1 to 5 years: 1 to 2 teaspoons of a tea infusion 3 to 5 times a day (or</p><p>a liquid made by diluting 1 part of tincture with 10 parts of water).</p><p>– Children 6 to 10 years: 1⁄4 to 1⁄3 of the adult dose.</p><p>– Children 11 to ca. 16 years: 1⁄2 of the adult dose.</p><p>– Children over 16 years: Generally the adult dose, but used with greater cau-</p><p>tion.</p><p>– It is important to start with the smallest dose for the first day and work up</p><p>to a higher dose, if no adverse reactions are apparent.</p><p>➤ Administration: Teas, highly diluted alcoholic tinctures, and flavored liquid</p><p>glycerites are preferably used with pediatric patients because they contain low</p><p>doses of the active constituents.</p><p>Note: Instant teas containing saccharose promote the formation of dental</p><p>caries.</p><p>– Alcohol-free herbal preparations, such as flavored glycerites, are preferable</p><p>for pediatric medicine. Liquid herbal remedies often contain alcohol as a</p><p>preservative; the ethanol content must be indicated on the label.</p><p>2.2 Special Patient Groups</p><p>24</p><p>G</p><p>en</p><p>er</p><p>al</p><p>G</p><p>u</p><p>id</p><p>el</p><p>in</p><p>es</p><p>fo</p><p>r</p><p>U</p><p>se</p><p>o</p><p>f H</p><p>er</p><p>b</p><p>al</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>es</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Note: In Germany, many herbal remedies, even those that have been taken by</p><p>pediatric patients for years without adverse effects, are labeled with state-</p><p>ments such as “Owing to the lack of sufficient scientific data on the use of this</p><p>preparation in children, it should not be used in children under 12 years of</p><p>age”. Such statements are intended to indicate a residual risk. In this case, it is</p><p>important to obtain the advice of a physician in selecting the proper remedy.</p><p>On the other hand, remedies labeled with the statement “Children under 12</p><p>years of age should not take this preparation” are clearly contraindicated in</p><p>pediatric patients. In North America, many preparations are not labeled with</p><p>recommendations for pediatric use, which is why special children’s herbal</p><p>products are increasingly popular. These are mild and pleasant-tasting.</p><p>➤ Value of herbal medicine: The rate of spontaneous healing is much higher in</p><p>infants and children than in adults. This makes it more difficult to assess the</p><p>effectiveness of herbal medicines in pediatric patients.</p><p>Geriatric Patients</p><p>➤ Preliminary remarks: Around 27 % of all individuals over the age of 65 are</p><p>afflicted by one chronic disease, 20 % by two chronic illnesses, and 3 % by three</p><p>or more. In some cases, the symptoms of organ dysfunction precede the clinical</p><p>manifestation of a disease by several years. Many of these patients respond</p><p>well to herbal remedies.</p><p>➤ Pharmacokinetic changes of aging</p><p>– Impairment of blood pH regulation</p><p>– Decreased absorption of oxygen in the blood</p><p>– Decrease in the respiratory rate</p><p>– Decrease in renal and, to a lesser extent, hepatic function</p><p>➤ Basic rules for treatment of geriatric patients</p><p>– Because of their low rates of side effects and interactions with other drugs,</p><p>herbal preparations can be safely and effectively combined with obligatory</p><p>synthetic drugs, with a few exceptions such as St. John’s wort, which should</p><p>be monitored more closely.</p><p>– A lower dose may be needed due to the slower metabolism of geriatric pa-</p><p>tients.</p><p>➤ Value of herbal medicine: Because of the high rate of acceptance by geriatric</p><p>patients, herbal remedies can be a very helpful treatment alternative in this</p><p>patient group.</p><p>➤ Cost: In some cases, herbal preparations are less costly than pharmaceutical</p><p>drugs, despite the fact that insurance plans do not generally pay for them.</p><p>Pregnant and Nursing Mothers</p><p>➤ Pharmacokinetic considerations</p><p>– Drug therapy is always a problematic issue in pregnant and nursing moth-</p><p>ers because of the potential risk of damage to the fetus or infant.</p><p>– Furthermore, it is almost impossible to completely rule out the possibility</p><p>that a given drug may have harmful effects.</p><p>➤ Basic rules for treatment of pregnant and nursing mothers</p><p>– Herbal remedies have a long history of being used to treat pregnant and</p><p>nursing mothers.</p><p>– Warnings indicated on product labels should be interpreted carefully.</p><p>2.2 Special Patient</p><p>Groups</p><p>25</p><p>G</p><p>en</p><p>er</p><p>al</p><p>G</p><p>u</p><p>id</p><p>el</p><p>in</p><p>es</p><p>fo</p><p>r</p><p>U</p><p>se</p><p>o</p><p>f H</p><p>er</p><p>b</p><p>al</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>es</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>• Herbal remedies or preparations that specifically are labeled with the</p><p>statements‚ “Don’t use during pregnancy,” or “Don’t use during breast-</p><p>feeding” should not be used during those times unless under the guid-</p><p>ance of an experienced herbalist or physician with training in herbal</p><p>medicine.</p><p>• Other commercial herbal preparations or herb teas may not be specifi-</p><p>cally labeled “Don’t use during pregnancy or nursing,” but that does not</p><p>imply that they are necessarily safe to use during these times. Bulk herb</p><p>for teas are not often labeled, and some manufacturers may not be ex-</p><p>perienced or knowledgeable enough to label their products appropri-</p><p>ately.</p><p>• In some cases, herbs or herb products have been used safely for centu-</p><p>ries, and sometimes during pregnancy or nursing, but that does not</p><p>mean they are safe. Harmful effects are sometimes subtle and not no-</p><p>ticed, and may be apparent after continued use over time. In general</p><p>herbs and herb products are less likely to be problematic during preg-</p><p>nancy and nursing with occasional use, and it is best to avoid chronic use</p><p>of most herbs during these times.</p><p>• Virtually no herbs have high-quality research demonstrating lack of side</p><p>effects during pregnancy or nursing, rather the use is based on centuries</p><p>of apparently safe use. The other side to this argument is that just be-</p><p>cause an herb hasn’t been proven safe by modern scientific standards</p><p>doesn’t mean that it is probably harmful. Many foods in common use</p><p>have not been thoroughly tested to demonstrate safety with long-term</p><p>use.</p><p>– Herbal medicines that bear warnings such as “Contraindicated during preg-</p><p>nancy ” or “Contraindicated in nursing mothers” clearly should not be used</p><p>by pregnant or nursing mothers. For a complete list of known contraindica-</p><p>tions for herbs during pregnancy and nursing, refer to Botanical Safety</p><p>Handbook by McGuffin et al. (see References, p. 478).</p><p>Allergy Sufferers</p><p>➤ Certain medicinal plants contain allergens that may cause allergic reactions of</p><p>variable severity (even, in rare cases, anaphylactic shock) in individuals with a</p><p>corresponding predisposition. Medicinal plants are capable of triggering type</p><p>I (immediate) and type IV (delayed) allergic reactions.</p><p>➤ The allergenic potency of medicinal plants varies in accordance with the type</p><p>of the plant and the composition of its constituents.</p><p>➤ Cross-sensitivities are a frequent problem.</p><p>Note: Allergy to a given plant does not necessarily mean that the patient will be</p><p>hypersensitive to pharmaceutical preparations made from this plant.</p><p>➤ Type I allergies</p><p>– Pathophysiology: Antibodies of the IgE type start a chain reaction that trig-</p><p>gers the release of different mediators (e. g., histamine).</p><p>– Clinical features</p><p>• Allergic symptoms including allergic conjunctivitis, rhinitis, itching, ur-</p><p>ticaria, Quincke’s edema and allergic asthma as well as cramplike epi-</p><p>gastric complaints accompanied by diarrhea may develop with seconds</p><p>to minutes after exposure. In secondary reactions, they may develop</p><p>within 4 to 6 hours after exposure.</p><p>2.2 Special Patient Groups</p><p>26</p><p>G</p><p>en</p><p>er</p><p>al</p><p>G</p><p>u</p><p>id</p><p>el</p><p>in</p><p>es</p><p>fo</p><p>r</p><p>U</p><p>se</p><p>o</p><p>f H</p><p>er</p><p>b</p><p>al</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>es</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>• Anaphylactic shock usually does not occur unless the allergens are inject-</p><p>ed intravenously.</p><p>– Herbal drugs known to trigger type I allergies</p><p>• Essential oils derived from fennel, ginger, garlic, coriander, caraway</p><p>seed, lovage, balm, pepper, sage, mustard, and various citrus plants are</p><p>important triggers. Because of their ability to cause mucosal irritation,</p><p>they may also enhance other allergies. Inhalation of dust of iris root,</p><p>poke root, mustard, horseradish, castor oil, or linseed may cause rhinitis.</p><p>• Herbal remedies do not play a major role in pollen allergies.</p><p>➤ Type IV allergies</p><p>– Pathophysiology: Mediators of inflammation are released by sensitized T</p><p>lymphocytes.</p><p>– Clinical features: Contact eczema with itching, skin redness, swelling, and</p><p>scaling develops at the site of exposure within 48 to 72 hours.</p><p>– Herbal drugs known to trigger type IV allergies: Low-molecular-weight sec-</p><p>ondary plant chemicals such as coumarins (from parsley family members</p><p>like angelica, clovers like red clover, etc.) and terpenes (from many plant</p><p>families such as ginkgo), as well as flavones and sesquiterpene lactones</p><p>(from composite plants such as feverfew or arnica).</p><p>Intensive Care Patients</p><p>➤ Because of their rapid onset of action and superior dosability, synthetic drugs</p><p>are preferentially used in intensive care medicine. Nonetheless, certain herbal</p><p>drugs are suitable for adjuvant therapy, such as ginger tea or capsules to help</p><p>alleviate nausea.</p><p>➤ Early and effective treatment with herbal remedies with known immunomod-</p><p>ulating effects such as echinacea can reduce the required dose of antibiotics</p><p>and improve wound healing. Standard herbal treatments for various indica-</p><p>tions are described in Section Four (p. 290 ff.).</p><p>2.2 Special Patient Groups</p><p>27</p><p>G</p><p>en</p><p>er</p><p>al</p><p>G</p><p>u</p><p>id</p><p>el</p><p>in</p><p>es</p><p>fo</p><p>r</p><p>U</p><p>se</p><p>o</p><p>f H</p><p>er</p><p>b</p><p>al</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>es</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ Herbal treatment measures are selected in accordance with the type and se-</p><p>verity of the disease and the individual needs of the patient. Standard herbal</p><p>treatments for various indications are described in Section Four (p. 290 ff.). A</p><p>few basic rules for the use of herbal remedies are presented below.</p><p>Preparation of Teas</p><p>➤ Preparatory measures</p><p>– Tea mixtures: Shake the container holding the tea mixture prior to use to</p><p>ensure the uniform distribution of all components.</p><p>– Herbal teas containing essential oils: The herbs (fruit or seeds such as fennel)</p><p>should not be chopped or crushed until immediately prior to use.</p><p>Note: The caking of hygroscopic preparations such as water-soluble (instant)</p><p>teas makes it impossible to measure the preparation accurately. Therefore,</p><p>the spoon used to remove the tea granules or powder should be completely</p><p>dry and the container should be immediately recapped. In North America, in-</p><p>stant tea powders are mostly available only for Chinese herbs, and most ex-</p><p>tract powders are in capsule or tablet form for ease of use.</p><p>➤ Tea preparation</p><p>– Infusion: Pour boiling water onto the required amount of the herb, cover,</p><p>and allow to steep for 10 to 15 minutes, then strain. A dose of 1 teaspoon</p><p>herb per cup (150 mL) of water is generally recommended.</p><p>– Decoction: Pour cold water onto the required amount of the herb, bring to</p><p>a boil, then cover and allow to simmer for 10 to 15 minutes. Remove from</p><p>heat and allow to stand for a few moments, in some cases up to 10 minutes</p><p>if a slightly stronger preparation is desired, then strain. Several days of tea</p><p>can be stored safely in the refrigerator, then warmed at the time of con-</p><p>sumption. A dose of 1 teaspoon herb preparation per cup (150 mL) of water</p><p>is generally recommended.</p><p>– Maceration (cold extract): Pour cold water onto the comminuted herb. A</p><p>dose of 1 teaspoon herb per cup (150 mL) of water is generally recommend-</p><p>ed. The herb–water mixture is allowed to stand at room temperature for 5</p><p>to 8 hours, stirred occasionally, then strained. Because of the rapid spread</p><p>of bacteria and molds, teas prepared by maceration may be briefly boiled</p><p>before consumption, though the use of sanitary utensils and refrigeration</p><p>of the tea mixture for up to 3 days in the refrigerator makes this mostly un-</p><p>necessary. Make sure utensils are clean.</p><p>➤ Combined forms of preparation</p><p>– Recommended for the preparation of tea mixtures containing certain con-</p><p>stituents that should preferably be extracted</p><p>with cold water and others</p><p>that are best extracted with boiling water.</p><p>– A dose of 1 teaspoon tea mixture per cup of water is generally recommend-</p><p>ed. Half the required amount of water is poured onto the full dose of the tea</p><p>mixture, which is then left to steep for 5 to 8 hours and finally strained. The</p><p>other half of the water is later boiled and poured onto the herbs caught in</p><p>the tea strainer, then added to the cold extract.</p><p>➤ General tips</p><p>– Medicinal teas should be prepared in a non-metallic receptacle such as a</p><p>glass coffeepot or teapot. Teapots with a lid are preferable.</p><p>– The tea should be stirred occasionally while steeping, then pressed against</p><p>the tea strainer when finished.</p><p>2.3 Basics of Administering Herbal Preparations</p><p>28</p><p>G</p><p>en</p><p>er</p><p>al</p><p>G</p><p>u</p><p>id</p><p>el</p><p>in</p><p>es</p><p>fo</p><p>r</p><p>U</p><p>se</p><p>o</p><p>f H</p><p>er</p><p>b</p><p>al</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>es</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>– Teas for colds and flu should be sweetened with honey, whereas those for</p><p>gastrointestinal, liver, and biliary complaints are ideally taken unsweet-</p><p>ened. Use only as much sweetener for these herbs as is necessary to take</p><p>them regularly, because tasting the bitter enhances the therapeutic action.</p><p>Diabetics should use a sugar substitute.</p><p>– Special tea cups with a tight-fitting lid should be used to reduce the loss of</p><p>volatile constituents by evaporation.</p><p>➤ Dosage</p><p>– Adults: 1 teaspoon of herb per 150 mL (5 ounces) of water.</p><p>– Children up to 10 years of age: 1 teaspoon of herb per 250 mL (8 ounces) of</p><p>water.</p><p>– Children up to 1 year of age: 1⁄2 teaspoon of herb per 250 mL of water.</p><p>– Daily dose: 2 to 3 cups per day, sipped slowly.</p><p>Note: General dosage recommendations are provided in this section. The</p><p>specific instructions for use of a given product are found on the product label.</p><p>Certain tea preparations should not be administered to children. The patient</p><p>or guardian should always read the product label and, if uncertain, ask a phar-</p><p>macist or herbalist. Certain medicinal teas can produce side effects when</p><p>overdosed.</p><p>➤ Duration of use</p><p>– Medicinal teas should generally be taken for 4 weeks. Afterwards, the pa-</p><p>tient should discontinue the tea for 4 weeks or switch to another tea with</p><p>similar effects.</p><p>• Exceptions: St. John’s wort or hawthorn teas, which must be used for at</p><p>least 3 months. Many “tonic” teas recommended by a licensed tradition-</p><p>al Chinese medicine practitioner are taken for several months or more,</p><p>depending on the patient’s response, although the formula is often</p><p>changed regularly.</p><p>2.3 Basics of Administering Herbal Preparations</p><p>29</p><p>G</p><p>en</p><p>er</p><p>al</p><p>G</p><p>u</p><p>id</p><p>el</p><p>in</p><p>es</p><p>fo</p><p>r</p><p>U</p><p>se</p><p>o</p><p>f H</p><p>er</p><p>b</p><p>al</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>es</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Preparation of Wraps and Fomentations</p><p>➤ Herbal compresses, wraps, and fomentations are popular in Europe and other</p><p>countries where herbal preparations are used as part of a traditional healing</p><p>system. Applying herbs or herbal teas externally in this way is safe when a few</p><p>cautions are observed. Local anti-inflammatory effects and stimulation of cir-</p><p>culation and enhanced tissue repair can be expected because of constituents</p><p>such as the gingerols from ginger, which are absorbed transdermally.</p><p>➤ Definition: Wraps are made by winding multiple layers of cloth around an af-</p><p>fected body part. The prepared herbs are placed in the innermost cloth, which</p><p>serves as the carrier. When using fomentations, poultices, and compresses, the</p><p>cloth bearing the herbal preparation is placed in direct contact with the affect-</p><p>ed body part.</p><p>➤ Materials: Natural materials such as cotton, linen, flannel, or wool (e. g., used</p><p>sheets, kitchen towels, diapers, handkerchiefs, gauze compresses, and tow-</p><p>els as well as sheets made of terry cloth, flannel, or moleskin) should be used</p><p>(see Fig. 2). The use of synthetic materials or mixed fabrics is not recom-</p><p>mended.</p><p>– Innermost layer: Cotton or linen</p><p>– Middle layer: Cotton (e. g., terry cloth)</p><p>– Outer layer: Wool, moleskin or cotton (flat sheets, wool blankets, scarves)</p><p>– One or two hot water bottles</p><p>– Fixing material (e. g., adhesive tape, Velcro strips, or safety pins)</p><p>➤ Procedure</p><p>– Preparatory steps: Spread the wrapping materials on a table or countertop</p><p>and prepare the herbs (additive) as recommended on the product label</p><p>(Fig. 3). When the preparation is in place, the patient should be allowed to</p><p>rest without unnecessary distractions.</p><p>➤ Technique</p><p>– The temperature of the wrap is selected in accordance with the type of herb</p><p>used as the additive. It is also important to monitor each patient in accord-</p><p>ance with their age, general health condition, and body temperature.</p><p>– The sheet or packet with the herbal remedy is placed on the body or affected</p><p>body part and covered with a layer of fabric. The body or body part is then</p><p>wrapped in a second, outer layer. The patient should be covered with a</p><p>Fig. 2 Recommended wrap-</p><p>ping materials. Adapted with</p><p>permission from A. Sonn,</p><p>Wickel und Auflagen, Thieme,</p><p>Stuttgart, 1998.</p><p>2.4 Working Techniques</p><p>30</p><p>G</p><p>en</p><p>er</p><p>al</p><p>G</p><p>u</p><p>id</p><p>el</p><p>in</p><p>es</p><p>fo</p><p>r</p><p>U</p><p>se</p><p>o</p><p>f H</p><p>er</p><p>b</p><p>al</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>es</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Fig. 3 Preparation of wraps and fomentations. Adapted with permission from A. Sonn,</p><p>Wickel und Auflagen, Thieme, Stuttgart, 1998.</p><p>a b</p><p>c d</p><p>e</p><p>2.4 Working Techniques</p><p>31</p><p>G</p><p>en</p><p>er</p><p>al</p><p>G</p><p>u</p><p>id</p><p>el</p><p>in</p><p>es</p><p>fo</p><p>r</p><p>U</p><p>se</p><p>o</p><p>f H</p><p>er</p><p>b</p><p>al</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>es</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>warm blanket. Special attention should be paid to keeping the feet warm</p><p>(place a hot water bottle under the feet, if necessary).</p><p>– To prevent skin burns or irritation, a protective cloth should be placed be-</p><p>tween the skin and the hot water bottle.</p><p>– Duration of effect: The wrapping materials should be applied quickly but</p><p>calmly. The amount of time the wrap should be left on depends on the type</p><p>of wrap used (see Section Four, p. 291 ff.). The patient in the wraps should</p><p>be monitored carefully.</p><p>– Resting period: After the wraps or fomentations have been removed, the pa-</p><p>tient should be allowed to rest for 15 to 20 minutes.</p><p>Note: The herbs used as the additive can be discarded in the normal household</p><p>garbage container, or composted along with kitchen food scraps or yard trim-</p><p>mings. Used herbs should never be reused or consumed.</p><p>Footbaths</p><p>➤ Materials: Wash basin or vessel large enough for the feet to fit in comfortably,</p><p>warm water, and the herbs to be used as the additive.</p><p>➤ Procedure</p><p>– Preparation: Fill the basin or vessel with water heated to the appropriate</p><p>temperature, then add the selected herbal additive (e. g., a tea infusion, es-</p><p>sential oil, sea salt, or mustard flour). The ankle bone should be immersed</p><p>in the water.</p><p>Technique</p><p>– The patient should wear comfortable clothing and sit in a relaxed position.</p><p>If the patient is cold, a light blanket can be placed around the knees.</p><p>– Soaking time: The feet should be soaked for 5 to 20 minutes, depending on</p><p>which type of herb was used as the additive.</p><p>– Afterwards, the feet should be dried with a towel but not rinsed unless mus-</p><p>tard flour was used. Leaving mustard flour on the feet can cause skin necro-</p><p>sis. This can be prevented by rinsing the feet with lukewarm water after the</p><p>footbath.</p><p>– Resting period</p><p>• After the footbath, the patient should put on warm socks and rest for half</p><p>an hour. If preferred, the footbath can be taken at night before retiring.</p><p>• Invigorating footbaths should be taken around noon, and the patient</p><p>should remain mobile afterwards.</p><p>Inhalation</p><p>➤ General remarks: Inhalation is mainly used to treat diseases of the airways.</p><p>This is most easily achieved with steam inhalation.</p><p>➤ Materials:</p><p>Heat-proof vessel, towel, herbal additive.</p><p>➤ Procedure</p><p>– Preparation: Prepare a hot tea infusion or add essential oil to hot water and</p><p>pour into the vessel. Herbal tea infusions, essential oils, or salt-water solu-</p><p>tions can constitute the herbal additive.</p><p>Technique</p><p>– The patient’s head should be held at a comfortable distance above the</p><p>steam. The hair should be covered with a towel to ensure that the vapors</p><p>are trapped between the head and the vessel. The hot vapors should be in-</p><p>haled for 10 to 15 minutes.</p><p>2.4 Working Techniques</p><p>32</p><p>G</p><p>en</p><p>er</p><p>al</p><p>G</p><p>u</p><p>id</p><p>el</p><p>in</p><p>es</p><p>fo</p><p>r</p><p>U</p><p>se</p><p>o</p><p>f H</p><p>er</p><p>b</p><p>al</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>es</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Body washes</p><p>➤ General comments: The effects of body washes vary in accordance with the</p><p>washing technique, the selected water temperature and the reason for using</p><p>the herbal additive (e. g., to reduce fever, to stop itching, or to reduce sweat-</p><p>ing).</p><p>➤ Materials: Wash basin, towels (at least two), wash cloths, herbal additive (tea</p><p>infusion, essential oil, or bath salts).</p><p>➤ Procedure</p><p>– Preparation: Fill the basin with water heated to the desired temperature</p><p>and place the additive into it. If essential oils are used, it is important to add</p><p>a natural emulsifying agent such as milk, cream, or honey.</p><p>Technique</p><p>– Whole-body washes should always begin with the head and end with the</p><p>feet.</p><p>– To achieve a relaxing effect, the patient should be washed in circular mo-</p><p>tions proceeding in the direction of hair growth and moving away from the</p><p>center of the body.</p><p>– To achieve an invigorating effect, the circular motions should be directed</p><p>against the direction of hair growth and toward the center of the body. This</p><p>procedure stimulates receptors in the hair bulbs and increases central</p><p>lymph and blood volume, both generating a slight arousal reaction.</p><p>– The patient’s skin should not be allowed to cool off during or immediately</p><p>after the washing procedure.</p><p>Note: The additive should be an herb the patient likes to smell and to which</p><p>the patient is not allergic.</p><p>2.4 Working Techniques</p><p>33</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Adonis (</p><p>Adonis vernalis</p><p>L.)</p><p>➤</p><p>Synonyms:</p><p>False hellebore; Adonisröschen (Ger.)</p><p>➤</p><p>General comments:</p><p>The aerial plant parts of</p><p>Adonis vernalis</p><p>L. are used in</p><p>medicine.</p><p>➤</p><p>Pharmacology</p><p>–</p><p>Herb:</p><p>Adonis (Adonidis herba).</p><p>–</p><p>Important constituents:</p><p>Flavonoids and steroid cardiac glycosides.</p><p>–</p><p>Pharmacological properties:</p><p>Steroid glycosides have a positive inotropic</p><p>action.</p><p>➤</p><p>Indications</p><p>– Heart failure (NYHA classes I–II)</p><p>– Cardiac arrhythmia</p><p>– Nervous heart disorders</p><p>➤</p><p>Contraindications:</p><p>Pregnant or nursing mothers, children under 12 years of</p><p>age, and individuals hypersensitive to digitaloid drugs should not use adonis.</p><p>➤</p><p>Dosage and duration of use</p><p>–</p><p>Daily dose:</p><p>Mean 0.5 g, maximum 3 g.</p><p>➤</p><p>Adverse effects:</p><p>Vomiting, diarrhea, headache, loss of appetite, gynecomastia.</p><p>Signs of overdose range from mild cardiac arrhythmias to life-threatening ven-</p><p>tricular tachycardia, atrial tachycardia with AV block, stupor, confusion, hallu-</p><p>cinations, impaired vision, depression, and/or psychoses. Adonis poisoning is</p><p>rare since the oral absorption rate is low.</p><p>➤</p><p>Herb–drug interactions:</p><p>Comparable to those of other digitaloid pharmaceu-</p><p>tical drugs such as foxglove.</p><p>➤</p><p>Summary assessment:</p><p>Owing to its low and irreproducible absorption behav-</p><p>ior and the lack of adequate data on the drug, adonis is used only in combina-</p><p>tion with other digitaloid drugs.</p><p>✿</p><p>Literature</p><p>– Monographs: DAB 1998; Commission E</p><p>– Scientific publications: see p. 478</p><p>– Loew D: Phytotherapie bei Herzinsuffizienz. Z Phytother 18 (1997), 92–96.</p><p>Angelica (</p><p>Angelica archangelica</p><p>L.)</p><p>➤</p><p>Synonyms:</p><p>European angelica; Engelwurz (Ger.)</p><p>➤</p><p>General comments:</p><p>Angelica has an aromatic odor and a sweetish taste.</p><p>➤</p><p>Pharmacology</p><p>–</p><p>Herb:</p><p>Angelica root (Angelicae radix).</p><p>–</p><p>Important constituents:</p><p>Essential oils (</p><p>β</p><p>-phellandrene,</p><p>α</p><p>-pinene), furano-</p><p>coumarins (bergapten, xanthotoxin, imperatorin, isoimperatorin, ange-</p><p>licin, archangelicin), and caffeic acid derivatives (chlorogenic acid).</p><p>–</p><p>Pharmacological properties:</p><p>Angelica root extracts act as calcium antago-</p><p>nists in vitro.</p><p>➤</p><p>Indications</p><p>– Lack of appetite, anorexia</p><p>– Dyspeptic complaints</p><p>➤</p><p>Contraindications:</p><p>Pregnancy.</p><p>➤</p><p>Dosage and duration of use:</p><p>2 or 3 weeks, or longer under recommendation</p><p>by an experienced health-care provider.</p><p>Plant Summaries—A</p><p>34</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤</p><p>Adverse effects:</p><p>Sunbathing or intense exposure to UV light should be avoided</p><p>when using Angelica root, since the furanocouramins in the drug may induce</p><p>photodermatosis in susceptible individuals.</p><p>➤</p><p>Herb–drug interactions:</p><p>None known.</p><p>✿</p><p>Literature</p><p>– Monographs: Commission E</p><p>– Scientific publications: see p. 478</p><p>Aniseed (</p><p>Pimpinella anisum</p><p>L.)</p><p>➤</p><p>Synonyms:</p><p>Anise; Anis (Ger.)</p><p>➤</p><p>General comments:</p><p>The essential oil extracted from the mature and dried</p><p>fruit is used in medicine.</p><p>➤</p><p>Pharmacology</p><p>–</p><p>Herb:</p><p>Aniseed (Anisi fructus).</p><p>–</p><p>Important constituents:</p><p>Essential oil (2–6 %) consisting mainly of</p><p>trans</p><p>-</p><p>anethole (ca. 94 %) as well as apigenin-7-</p><p>O</p><p>-glucoside and luteolin-7-</p><p>O</p><p>-</p><p>glucoside.</p><p>–</p><p>Pharmacological properties:</p><p>Aniseed has expectorant, weakly spasmolytic</p><p>and antibacterial action. Aniseed oil has antibacterial and antiviral activity.</p><p>➤</p><p>Indications</p><p>– Fever, colds, and flu</p><p>– Cough, runny nose, bronchitis</p><p>– Inflammations of the mouth and throat</p><p>– Dyspeptic complaints</p><p>– Lack of appetite</p><p>– Acute pharyngitis</p><p>➤</p><p>Contraindications:</p><p>Hypersensitivity to aniseed or anethole; pregnancy.</p><p>➤</p><p>Dosage and duration of use</p><p>– Internal administration</p><p>•</p><p>Daily dose:</p><p>3 g dried seeds.</p><p>•</p><p>Tea:</p><p>One cup in the morning and/or evening (expectorant). For gastro-</p><p>intestinal complaints: 1 tablespoon daily (adults), 1 teaspoon in bottle</p><p>(infants).</p><p>–</p><p>When used as a liniment</p><p>, apply the oil every 30 to 60 minutes (acute) or 1 to</p><p>3 times a day (chronic).</p><p>➤</p><p>Adverse effects:</p><p>Occasional allergic reactions of the skin, respiratory tract and</p><p>gastrointestinal tract. Health hazards in conjunction with proper administra-</p><p>tion of the designated therapeutic doses of the drug are not known. In very rare</p><p>cases, sensitization can occur after repeated contact.</p><p>➤</p><p>Herb–drug interactions:</p><p>None known.</p><p>➤</p><p>Common misconceptions:</p><p>Claims of estrogenic action have never been proven.</p><p>➤</p><p>Summary assessment:</p><p>The information presented here is based on empirical</p><p>experience. No recent studies are available. The carminative action of aniseed</p><p>is weaker than that of fennel or caraway, but it is a better expectorant than</p><p>fennel</p><p>✿</p><p>Literature</p><p>– Monographs: ESCOP, Commission E</p><p>– Reichling J, Merkel B: Elicitor-Induced Formation of Coumarin Derivatives</p><p>of Pimpinella anisum. Planta Med 59 (1993), 187.</p><p>Plant Summaries—A</p><p>35</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Arnica (</p><p>Arnica montana</p><p>L.)</p><p>➤</p><p>General comments:</p><p>Medicinal arnica oil is extracted from fresh or dried arnica</p><p>flowers.</p><p>➤</p><p>Pharmacology</p><p>–</p><p>Herb:</p><p>Arnica flower (Arnicae flos).</p><p>– Important constituents</p><p>•</p><p>A. montana:</p><p>Sesquiterpene lactones of the pseudoguaianolide type</p><p>(mainly esters of helenalin and 11</p><p>α</p><p>,13-dihydrohelenalin), essential oil</p><p>(0.2–0.35 %), and flavonoids (0.4–0.6 %).</p><p>•</p><p>A. chamissonis ssp. foliosa:</p><p>Sesquiterpene lactones of the pseudoguaian-</p><p>olide type (0.2–1.5 %), helenalin derivatives, arnifolins, and chamis-</p><p>sonolides.</p><p>–</p><p>Pharmacological properties:</p><p>The sesquiterpenes (e. g. helenalin) have anti-</p><p>microbial action in vitro and antiphlogistic action in animals. Helenalin in-</p><p>hibits the activation of the transcription factor NF-</p><p>κ</p><p>B, which is a main me-</p><p>diator of the immune response. Topical arnica has antiphlogistic, analgesic,</p><p>and antiseptic action (due to the sesquiterpene lactones). The essential oil</p><p>and flavonoid compounds may contribute to these effects.</p><p>➤</p><p>Indications</p><p>– Thrombophlebitis</p><p>– Furunculosis and inflammations resulting from insect bites</p><p>– Inflammation of the skin</p><p>– Inflammation of the mouth and throat</p><p>– Rheumatic muscle and joint complaints</p><p>– Contusions</p><p>➤ Contraindications: Known allergy to arnica or other composite plants.</p><p>Warning: Arnica tincture should not be applied to open wounds or used</p><p>undiluted.</p><p>➤ Dosage and duration of use</p><p>– External use</p><p>• 1 : 10 tincture (DAB): One part arnica flower to 10 parts ethanol 70 %</p><p>(v/v) (dry-weight basis).</p><p>• Fomentations: Dilute arnica tincture at a ratio of 1 to 3–10 parts water.</p><p>• Mouth wash: Dilute tincture at a ratio of 1 : 10, since the tincture is un-</p><p>stable if diluted at a ratio of 1 : 100.</p><p>• Ointment: Mix (generally 10–20 %, but no more than 25 %) arnica tinc-</p><p>ture in a neutral ointment base. The ointment should contain no more</p><p>than 15 % arnica oil.</p><p>• Oil: One part drug extract to 5 parts slightly warmed, vegetable oil, such</p><p>as olive oil.</p><p>– Internal use: Not recommended. Concentrated tincture can cause irritation</p><p>of the gastrointestinal mucosa accompanied by nausea, vomiting, diarrhea</p><p>and bleeding, and in high enough doses can lead to respiratory stimulation,</p><p>paralysis of the heart, and death.</p><p>➤ Adverse effects: Health hazards in conjunction with external administration</p><p>of the designated therapeutic doses of arnica are minor. Frequent use of the</p><p>undiluted tincture can lead to sensitization (allergic skin rashes, itching, blis-</p><p>tering, ulcers/superficial gangrene). The external application of very high con-</p><p>centrations of the drug can cause primary toxic blister formation and necrosis.</p><p>Plant Summaries—A</p><p>36</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ Herb–drug interactions: None known.</p><p>Important: Arnica flower should not be used by persons allergic to the plant.</p><p>When selecting the remedy, the individual preferences of the patients should</p><p>be taken into consideration.</p><p>➤ Common misconceptions: Not all varieties of arnica trigger contact allergies.</p><p>Ointments made using the Spanish species of Arnica montana contain very low</p><p>concentrations of the allergy-causing substance helenalin.</p><p>➤ Summary assessment: Arnica is an effective remedy, especially for contusions</p><p>and strained muscles.</p><p>✿ Literature</p><p>– Monographs: DAB 1998, ESCOP, Commission E</p><p>– Scientific publications: see p. 478; Hörmann HP, Kortin HC: Allergic acute</p><p>contact dermatitis due to Arnica tincture self-medication. Phytomedicine 4</p><p>(1995), 315–317; Lyss G, Schmidt TJ, Merfort I, Pahl HL: Helenalin an anti-</p><p>inflammatory sesquiterpene lactone from Arnica selectively inhibits tran-</p><p>scription factor NF-κB. Biol Chem, 378 (1997), 951–961; Willuhn G, Leven</p><p>W: Qualität von Arnikazubereitungen. Deutsche Apotheker Ztg 135 (1995),</p><p>1939–1942.</p><p>Artichoke (Cynara scolymus L.)</p><p>➤ General comments: The dried whole or chopped basal leaves and the fresh or</p><p>dried herb of Cynara scolymus L. are used in medicine.</p><p>➤ Pharmacology</p><p>– Herb: Artichoke leaf (Cynarae folium).</p><p>– Important constituents: Caffeic acid derivatives, ca. 1 % (chlorogenic acid,</p><p>neochlorogenic acid, cryptochlorogenic acid, cynarin), flavonoids, 0.5 %</p><p>(cynaroside, scolymoside, cynarotrioside, luteolin), and sesquiterpene lac-</p><p>tones, 4 % (cynaropicrin, 47–83 %, dehydrocynaropicrin, grossheimin, and</p><p>cynaratriol).</p><p>– Pharmacological properties: Sesquiterpene lactones (bitter principles),</p><p>hydroxycinnamic acid and flavonoids have choleretic, hepatoprotective,</p><p>antidyspeptic, and antilipemic effects. The herb was shown to reduce cho-</p><p>lesterol levels in rats (luteolin inhibits cholesterol synthesis), as well as to</p><p>increase choleresis and reduce symptoms of dyspepsia, compared with</p><p>controls, in randomized double-blind studies with healthy human volun-</p><p>teers. In a small trial (n = 44), artichoke extract reduced total cholesterol in</p><p>volunteers with baseline values above 220 mg/dL, compared with controls.</p><p>➤ Indications</p><p>– Lack of appetite</p><p>– Meteorism</p><p>– Liver and gallbladder complaints</p><p>– Hyperlipoproteinemia (high-dose, standardized extracts)</p><p>➤ Contraindications: Allergy to composite plants; biliary tract obstruction; gall-</p><p>stones.</p><p>➤ Dosage and duration of use: The fresh leaves, fresh expressed plant juice, and</p><p>dry extracts are used in medicinal preparations.</p><p>– Daily dose: 6 g drug.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb.</p><p>Plant Summaries—A</p><p>37</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Clinical studies of the antidyspeptic effect of artichoke</p><p>have been performed. The antilipemic effect is still being investigated.</p><p>✿ Literature</p><p>– Monographs: BHP 96; Brazil 3; ESCOP. Commission E</p><p>– Scientific publications: see p. 478; Petrowicz O, Gebhardt R, Donner M,</p><p>Schwandt P, Kraft K: Effects of artichoke leaf extract on lipoprotein metab-</p><p>olism in vitro and in vivo. Atherosclerosis 129 (1997), 147; Fintelmann V:</p><p>Antidyspeptische und lipidsenkende Wirkung von Artischockenblätterex-</p><p>trakt. Z Phytother 17 (1996), Beilage ZFA; Gebhardt R: Antioxidative and</p><p>protective properties of extracts from leaves of the artichoke (Cynara scol-</p><p>ymus L.) against hydroperoxide-induced oxidative stress in cultured rat</p><p>hepatocytes. Toxicol Appl Pharmacol, 144 (1997), 279–286; Wasielewski</p><p>S: Artischockenblätterextrakt: Prävention der Arteriosklerose. Deutsche</p><p>Apotheker Ztg 137 (1997), 2065–2067.</p><p>Asian Ginseng (Panax ginseng C.H. Meyer)</p><p>➤ Pharmacology</p><p>– Herb: Asian ginseng root (Ginseng radix). The herb consists of the dried pri-</p><p>mary roots (tap roots), secondary roots, and hair roots of four- to seven-</p><p>year-old Panax ginseng C. H. M. plants and preparations of the same.</p><p>– Important constituents: Triterpene saponins (0.8–6 %) such as gingeno-</p><p>sides; panaxans; panaxynol, essential oil.</p><p>– Pharmacological properties: Asian ginseng induces an unspecific increase in</p><p>the endogenous defenses of animals to exogenous noxae and physical,</p><p>chemical and biological stressors, that is, it has an adaptogenic or antistress</p><p>effect. Stress models demonstrated that Asian ginseng increased the ani-</p><p>mals’ ability to cope with psychological and physical pressure. In addition,</p><p>ginseng increases, shortens the recovery phase, and enhances coordination</p><p>and memory in humans.</p><p>➤ Indications</p><p>– Exhaustion, convalescence</p><p>– Decreased mental and physical performance and concentration</p><p>– Fatigue and debility</p><p>➤ Contraindications: A contraindication in people with hypertension, especial-</p><p>ly with concomitant caffeine consumption is frequently given in North Amer-</p><p>ica; however, little clinical or research evidence exists to confirm this.</p><p>➤ Dosage and duration</p><p>of use:</p><p>– Tea: Boil 3 g of the finely cut dried roots for at least 30 or 45 minutes and</p><p>steep for another 15 minutes. Strain and drink or store in refrigerator for</p><p>use during the day. If only larger root pieces and whole roots are available,</p><p>the patient should crush or cut the roots into coarse pieces before use; pre-</p><p>crushed roots may also be available.</p><p>– Daily dose: Dry extract: 1–2 g. For a usual 5 : 1 extract, the dose would be</p><p>about 1 g, equivalent to 2 “0” caps or usually 2 tablets/day. Standardized</p><p>extract (5–10 % ginsenosides, typically 200 mg per unit); 1–2 capsules or</p><p>tablets twice daily. Tea: one cup, 3 to 4 times a day. Treatment should be</p><p>continued for 3 months followed by a break, after which treatment can be</p><p>re-initiated.</p><p>Plant Summaries—A</p><p>38</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ Adverse effects: Insomnia, hypertension, and edema have been reported as</p><p>symptoms of overdose.</p><p>➤ Herb–drug interactions: The concurrent use of beverages and substances</p><p>containing caffeine should be avoided.</p><p>➤ Summary assessment: Asian ginseng is an herbal drug with reliable effective-</p><p>ness in the specified indications. Clinical studies on the efficacy of Asian gin-</p><p>seng are available. Use of teas from whole roots chopped or ground at home</p><p>are acceptable; other use should be restricted to standardized preparations. As</p><p>recent studies show, some products are substandard, despite their labeling.</p><p>✿ Literature</p><p>– Monographs: DAB 1998; ESCOP, Commission E</p><p>– Scientific publications: see p. 478; Blasius H: Phytotherapie: Adaptogene</p><p>Wirkung von Ginseng. Deutsche Apotheker Ztg 135 (1995), 2136–2138;</p><p>Pfister-Hotz G: Phytotherapie in der Geriatrie. Z Phytother 18 (1997), 165–</p><p>162.</p><p>Plant Summaries—A</p><p>39</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Birch (Betula pendula Roth.)</p><p>➤ General comments: Two birch species are used in medicine, Betula pendula</p><p>and Betula pubescens. Various medicinal preparations are made from the</p><p>leaves of these two species.</p><p>➤ Pharmacology</p><p>– Drug: Birch leaf (Betulae folium).</p><p>– Important constituents: Flavonoids, triterpene saponins, essential oil, and</p><p>phenyl-carboxylic acids.</p><p>– Pharmacological properties: The chemical substances in birch leaf increase</p><p>the urinary volume and enhance the flow of urine in the urinary tract, re-</p><p>sulting in the increased elimination of water (aquaresis).</p><p>➤ Indications</p><p>– Rheumatic diseases (supportive treatment)</p><p>– Used as a diuretic to flush bacteria out of the lower urinary tract and to flush</p><p>out renal gravel.</p><p>➤ Contraindications: The drug is not recommended in patients with cardiac or</p><p>renal edema.</p><p>– Steep 1–2 tablespoons of the drug in 150 mL of hot water.</p><p>• Dosage: One cup, between meals, 3 to 4 times a day. An adequate intake</p><p>of fluids is essential.</p><p>➤ Adverse effects: Health hazards in conjunction with proper administration of</p><p>the designated therapeutic doses of the drug are not known.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Common misconceptions: Birch leaf does not irritate the renal parenchyma.</p><p>➤ Summary assessment: Birch leaf is an effective herbal aquaretic. It can be use-</p><p>fully combined with other aquaretics.</p><p>✿ Literature</p><p>– Monographs: ESCOP, Commission E</p><p>– Scientific publications: see p. 478</p><p>Bitter Orange (Citrus aurantium sinensis [L.] Osbeck)</p><p>➤ General comments: Both fresh and dried orange peel as well as the oil distilled</p><p>from the peel are used in medicine.</p><p>➤ Pharmacology</p><p>– Herb: Orange peel (Aurantii pericarpium). The herb consists of the fresh or</p><p>dried peel of Citrus aurantium (L.) O., without the spongy white layer</p><p>(albedo layer), and preparations of the same.</p><p>– Important constituents: Ca. 1.5 % essential oil ((+)-limonene, 90 %). Ex-</p><p>pressed orange oil also contains lipophilic flavonoids and furanocoumarins.</p><p>– Pharmacological properties: Orange peel increases gastric juice production</p><p>through reflex mechanisms.</p><p>➤ Indications</p><p>– Lack of appetite</p><p>– Dyspeptic complaints</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– Mean daily dose: 12 g.</p><p>– Daily dose: 10–15 g of the herb.</p><p>Plant Summaries—B</p><p>40</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb. The essential oil has a slight potential for sensitization after skin contact.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Orange peel has relatively weak effects, but can be use-</p><p>fully combined with other herbal preparations.</p><p>✿ Literature</p><p>– Monographs: Commission E, Mar 31</p><p>– Scientific publications: see p. 478; Hausen B: Allergiepflanzen, Pflanzen-</p><p>allergene. ecomed Verlagsgesellsch. mbH, Landsberg 1988; Ihrig M: Qua-</p><p>litätskontrolle von süßem Orangenschalenöl. PZ 140 (1995), 2350–2353;</p><p>Kern W, List PH, Hörhammer L (Ed): Hagers Handbuch der Pharma-</p><p>zeutischen Praxis. 4. Aufl., Bde. 1–8, Springer Verlag Berlin, Heidelberg,</p><p>New York 1992–1994.</p><p>Bittersweet (Solanum dulcamara L.)</p><p>➤ Synonyms: Bitter nightshade; Bittersüß (Ger.)</p><p>➤ General comments: The stems, which have especially high concentrations of</p><p>the active principles, are selected for medicinal use.</p><p>➤ Pharmacology</p><p>– Herb: Bittersweet stems (Dulcamarae stipites). The herb consists of the</p><p>dried stems of 2- to 3-year-old Solanum dulcamara L. plants, collected in the</p><p>spring before the start of leafing or in the late fall after the leaves have shed,</p><p>and preparations of the same.</p><p>– Important constituents: Steroid alkaloid glycosides (0.07–0.4 %) and steroid</p><p>saponins.</p><p>– Pharmacological properties: Saponins enhance the absorption of steroid al-</p><p>kaloid glycosides. They stimulate phagocytosis and have hemolytic, cyto-</p><p>toxic, antiviral, anticholinergic, and local anesthetic effects. The constituent</p><p>solasodine has a cortisone-like effect in individuals with rheumatic poly-</p><p>arthritis and Bekhterev’s arthritis, and it has a desensitizing effect.</p><p>➤ Indications</p><p>– Eczema, boils, acne</p><p>– Warts</p><p>– For supportive treatment of chronic eczema</p><p>➤ Contraindications: Pregnancy and breast feeding.</p><p>➤ Dosage and duration of use: No dose or duration of use specified for external use.</p><p>– Decoction: Add 1–2 g of the herb to 250 mL of water.</p><p>– External use only: Apply compresses soaked in bittersweet decoction sever-</p><p>al times a day.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb. Toxic effects are not to be expected when doses less than approximately</p><p>25 g per day are used.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: In recent years, bittersweet has become increasingly</p><p>popular for treatment of chronic eczema, but further study is necessary to val-</p><p>idate its efficacy in this indication.</p><p>✿ Literature</p><p>– Monographs: Commission E</p><p>Plant Summaries—B</p><p>41</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Black Cohosh (Actaea racemosa L. Nutt.)</p><p>➤ Synonym: Cimicifuga racemosa Nutt.</p><p>➤ General comments: The herb grows in the United States and Canada, where it</p><p>was used by the aboriginal population to treat snake bites and to facilitate</p><p>labor.</p><p>➤ Pharmacology</p><p>– Herb: Black cohosh (Cimicifugae rhizoma). The herb consists of the dried</p><p>rhizomes of Actaea racemosa L. and preparations of the same. Unstandard-</p><p>ized liquid and standardized powdered extracts in capsules and tablets are</p><p>widely available.</p><p>– Important constituents: Triterpene</p><p>glycosides (actein, cimifugoside), flavo-</p><p>noids (formononetin), and resins (cimifugin); also other phytoestrogens,</p><p>which are chemically unidentified.</p><p>– Pharmacological properties: The extract did not increase the weight of the</p><p>uterus in ovariectomized animals. The phytoestrogens in the rhizome of Ac-</p><p>taea racemosa bind to the estrogen receptors, and have selective estrogen</p><p>receptor modulator properties. In one double-blind placebo-controlled</p><p>clinical study, black cohosh extract was shown to improve the symptoms</p><p>of menopause, especially hot flushes.</p><p>➤ Indications</p><p>– Menopausal complaints</p><p>– Premenstrual syndrome (PMS)</p><p>– Menstrual cramps</p><p>➤ Contraindications</p><p>– Pregnancy and breast feeding</p><p>– Hormone-dependent tumors</p><p>➤ Dosage and duration of use</p><p>– Daily dose: 3 g herb.</p><p>– Tincture (1 : 10): 10 drops on a cube of sugar, 3 times a day. Allow to dissolve</p><p>slowly in the mouth.</p><p>– Standardized extract products (containing 200 mg extract), 1 tablet or cap-</p><p>sule twice daily.</p><p>– Black cohosh root should not be used for more than 6 months without the</p><p>supervision of a qualified health care practitioner.</p><p>➤ Adverse effects: Can occasionally upset the stomach.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Black cohosh is a well-tolerated herbal remedy that is</p><p>becoming increasingly popular, especially for treatment of menopausal com-</p><p>plaints.</p><p>✿ Literature</p><p>– Monographs: ESCOP, Commission E</p><p>– Scientific publications: see p. 478; Einer-Jensen N, Zhao J, Andersen KP,</p><p>Kristoffersen K: Cimicifuga and Melbrosia lack oestrogenic effects in mice</p><p>and rats. Maturitas 25 (1995), 149–153; Gruenwald J: Standardized Black</p><p>Cohosh (Cimicifuga) Extract Clinical Monograph. Quarterly Review of Nat-</p><p>ural Medicine 4 (1998), 117–125; Jarry H et al: Treatment of Menopausal</p><p>Symptoms with Extracts of Cimicifuga Racemosa, In vivo and in vitro Evi-</p><p>dence for Estrogenic Activity. Loew D et al. (Ed.): Phytopharmaka in For-</p><p>schung und klinischer Anwendung. Darmstadt, 1995, S 99–112; Liske E:</p><p>Plant Summaries—B</p><p>42</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Therapeutic Efficacy and Safety of Cimicifuga racemosa for Gynecologic</p><p>Disorders. Advances in Therapy 15, 1 (1998), 45–53.</p><p>Buckthorn (Rhamnus cathartica L.)</p><p>➤ Synonyms: Common buckthorn, European buckthorn; Kreuzdorn (Ger.)</p><p>➤ General comments: The buckthorn bush is widely distributed throughout</p><p>Europe. Its fruit is used as a laxative.</p><p>➤ Pharmacology</p><p>– Herb: Buckthorn fruit (Rhamni cathartici fructus). The herb consists of the</p><p>fresh or dried ripe drupes of Rhamnus cathartica L. and preparations of the</p><p>same.</p><p>– Important constituents: Anthracene derivatives (2–7 %) (anthranoids), tan-</p><p>nins (3–4 %), and flavonoids (1–2 %).</p><p>– Pharmacological properties: Anthranoid compounds are antiabsorptive and</p><p>hydragogue laxatives. Hence, the herb softens the stools and increases the</p><p>volume of the bowel contents.</p><p>➤ Indications: Constipation.</p><p>➤ Contraindications: Bowel obstruction, acute intestinal inflammations, ap-</p><p>pendicitis, abdominal pain of unknown origin. Pregnant or nursing mothers</p><p>should not use buckthorn fruit unless directed by a physician. Use is contra-</p><p>indicated in children under 12 years of age.</p><p>➤ Dosage and duration of use</p><p>– Tea: Steep 4 g (ca. 1 teaspoon) of the chopped herb in 1 cup of boiled water</p><p>for 10 to 15 minutes. Alternatively, place the herb in cold water, boil for 2</p><p>to 3 minutes, then strain immediately.</p><p>• Dosage: One cup in the morning and at night.</p><p>– Daily dose: 2–5 g.</p><p>– As a rule, the minimum dose required to soften the stools should be used,</p><p>and continuous use of the herb should be restricted to only a few days.</p><p>➤ Adverse effects: The laxative effect of the herb can lead to cramplike gastro-</p><p>intestinal complaints. Long-term use can result in the loss of electrolytes, par-</p><p>ticularly potassium ions, thereby leading to problems such as hyper-</p><p>aldosteronism and decreased bowel motility. Arrhythmias, nephropathies,</p><p>edemas, and accelerated bone degeneration are rare side effects. Consumption</p><p>of large quantities of buckthorn fruit can lead to diarrhea with vomiting and</p><p>kidney irritation.</p><p>➤ Herb–drug interactions: Owing to its laxative effect, buckthorn fruit can im-</p><p>pair the absorption of pharmaceutical drugs or herbal preparations containing</p><p>potentially toxic or life-sparing constituents such as cardiac glycosides (i. e.,</p><p>Digitalis spp.) if taken concomitantly.</p><p>Warning: Chronic use or abuse of the herb can increase the potency of car-</p><p>diac glycosides and diuretics owing to the resulting potassium deficiency.</p><p>➤ Summary assessment: Buckthorn fruit and other herbs containing anthra-</p><p>noids should not be used to treat chronic constipation.</p><p>✿ Literature</p><p>– Monographs: DAB 1998; Commission E</p><p>– Scientific publications: see p. 478; Anon: Abwehr von Arzneimittelrisiken,</p><p>Stufe II. Deutsche Apotheker Ztg 136 (1996), 2353–2354; Anon: Anwen-</p><p>dungseinschränkungen für Anthranoid-haltige Abführmittel angeordnet.</p><p>PUZ 25 (1996), 341–342.</p><p>Plant Summaries—B</p><p>43</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Butcher’s Broom (Ruscus aculeatus L.)</p><p>➤ General comments: Butcher’s broom is native to almost all parts of Europe,</p><p>West Asia and North Africa and has been used in medicine since ancient times.</p><p>➤ Pharmacology</p><p>– Herb: Butcher’s broom rhizome (Rusci aculeati rhizoma). The herb consists</p><p>of the dried rhizomes and roots of Ruscus aculeatus L. and preparations of</p><p>the same.</p><p>– Important constituents: Steroid saponins (4–6 %) (ruscin, ruscoside, aglycon</p><p>of neoruscogenin, ruscogenin) and benzofuranes.</p><p>– Pharmacological properties: Butcher’s broom is antiexudative, antiphlogis-</p><p>tic, and venotonic.</p><p>➤ Indications</p><p>– Hemorrhoids</p><p>– Varicose veins</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– External use: Daily dose: 7–11 mg total ruscogenins.</p><p>– Internal use: Daily dose: 100–200 mg total ruscogenins.</p><p>➤ Adverse effects: None known. Rare cases of diarrhea and lymphocellular col-</p><p>itis have been reported.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: The indications specified for butcher’s broom have not</p><p>been substantiated in controlled clinical studies, but are based on many years</p><p>of empirical experience.</p><p>➤ Literature</p><p>– Monographs: ESCOP, Commission E</p><p>– Scientific publications: see p. 478; Adamek B, Drozdzik M, Samochowiec L,</p><p>Wojcicki J: Clinical effect of buckwheat herb, Ruscus extract and troxerutin</p><p>on retinopathy and lipids in diabetic patients. Phytotherapy Res 10 (1996),</p><p>659–662; Dunaouau CH et al: Triterpenes and sterols from Ruscus acu-</p><p>leatus. Planta Med 62 (1997), 189–190.</p><p>Plant Summaries—B</p><p>44</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Calamus (Acorus calamus L.)</p><p>➤ Synonyms: Acorus, sweetflag; Kalmus (Ger.)</p><p>➤ General comments: Calamus is a very common plant, the rhizome of which is</p><p>used in medicine.</p><p>➤ Pharmacology</p><p>– Herb: Calamus rhizome (Calami rhizoma). The herb consists of the dried,</p><p>coarsely chopped (and usually peeled) rhizome of Acorus calamus (L.). Ca-</p><p>lamus oil is distilled from the same plant.</p><p>– Important constituents: Essential oil (1.7–9.3 %), α- and γ-asarone, β-</p><p>gurjunene, α-calacorene, and acorone (the content of cis-isoasarone and,</p><p>especially, β-asarone depends on the degree of ploidy of the plant).</p><p>– Pharmacological properties: Calamus inhibits platelet aggregation in vitro</p><p>and has vermicidal and insecticidal properties. In animal studies, the herb</p><p>demonstrated spasmolytic and sedative effects, reduced spontaneous</p><p>stomach activity, and lowered the ulcer index (reduced the production of</p><p>gastric juices and acids). Calamus also has stomachic</p><p>action due to the pres-</p><p>ence of bitter principles and the spasmolytic effect of its essential oil. Cala-</p><p>mus induces hyperemia when applied externally.</p><p>➤ Indications</p><p>– Internal use: Dyspeptic complaints.</p><p>– External use: To induce local hyperemia and treat exhaustion. Used as a bath</p><p>additive, it stimulates the circulation in the arms and legs.</p><p>➤ Contraindications: Should not be used by pregnant or nursing mothers or by</p><p>children under 6 years of age.</p><p>➤ Dosage and duration of use</p><p>– Tea: Steep 1–1.5 g (ca. 2 teaspoons) of the herb in ca. 150 mL of boiled water</p><p>for 3 to 5 minutes.</p><p>• Dosage: One cup with each meal.</p><p>– Bath additive: Use 250–500 g of the herb to prepare an infusion and add to</p><p>bath water.</p><p>➤ Adverse effects: There are no known health hazards or side effects in humans</p><p>in conjunction with proper administration of the designated therapeutic doses</p><p>of calamus of European origin (the essential oil of the European herb contains</p><p>15 % β-asarone) Alcoholic extracts of calamus will contain considerably more</p><p>β-asarone and should not be used for more than a few days.</p><p>Warning: Long-term use of the herb is not recommended since malignan-</p><p>cies were found to develop in rats.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Calamus has not been systematically evaluated, and</p><p>prolonged use of the herb is not recommended. In Germany, no official risk-to-</p><p>benefit assessment of calamus root has yet been published in any monograph.</p><p>The use of Indian calamus is not permitted owing to its high β-asarone content.</p><p>✿ Literature</p><p>– Monographs: None available.</p><p>– Scientific publications: see p. 478; Schneider K, Jurenitsch, J: Kalmus als</p><p>Arzneidroge: Nutzen oder Risiko. Pharmazie 47 (1992), 79–85; Steinegger</p><p>E, Hänsel R: Pharmakognosie. 5. Aufl., Springer Verlag, Heidelberg 1992.</p><p>Plant Summaries—C</p><p>45</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Camphor Tree (Cinnamomum camphora L. Sieb.)</p><p>➤ General comments: Medicinal camphor is the product of steam distillation of</p><p>wood chips obtained from the camphor tree.</p><p>➤ Pharmacology</p><p>– Herb: Camphor (Cinnamomi camphorae aetheroleum)</p><p>• The herb consists of either natural or synthetic camphor. Natural R(+)</p><p>camphor is obtained by steam distilling the wood of the camphor tree,</p><p>the product of which is then purified by sublimation.</p><p>• Camphor is applied locally in liquid (camphor spirit) or semisolid form</p><p>(liniment or ointment). The liquid form is used for inhalation therapy.</p><p>– Important constituents: D-(+)-camphor and (1R,4R)-1,7,7-trimethyl-bicyclo-</p><p>[2,2,1]-heptan-2-one. Synthetic camphor is designated DL-camphor.</p><p>– Pharmacological properties: Used externally, camphor induces hyperemia</p><p>and bronchosecretolysis.</p><p>➤ Indications</p><p>– Cardiac arrhythmias</p><p>– Coughs and bronchitis</p><p>– Low blood pressure</p><p>– Nervous heart disorders</p><p>– Rheumatic complaints</p><p>➤ Contraindications: Camphor should not be applied to the face, especially the</p><p>nose, of infants and small children. It is not recommended for internal use.</p><p>➤ Dosage and duration of use</p><p>– Semisolid forms (ointments, liniments) generally contain 10–20 % camphor</p><p>(maximum camphor content 25 %); preparations for infants and small chil-</p><p>dren should contain no more than 5 %.</p><p>– Camphor spirit containing 9.5–10.5 % camphor (DAB 10): Apply to skin sev-</p><p>eral times a day.</p><p>➤ Adverse effects: Skin irritation; poisoning due to excessive drug absorption</p><p>and/or inhalation (especially in children) can induce states of intoxication, de-</p><p>lirium, convulsions, and respiration regulation disorders. Oily camphor lini-</p><p>ments can induce contact eczema.</p><p>➤ Herb–drug interactions: None known.</p><p>✿ Literature</p><p>– Monographs: DAB 1998; Commission E</p><p>– Scientific publications: see p. 478; Bruchhausen F von, Ebel S, Frahm AW,</p><p>Hackenthal E (Eds): Hagers Handbuch der Pharmazeutischen Praxis.</p><p>5. Aufl., Bde 7–9 (Stoffe), Springer Verlag Berlin, Heidelberg, New York</p><p>1993; Roth L, Daunderer M, Kormann K: Giftpflanzen, Pflanzengifte. 4. Aufl.,</p><p>Ecomed Fachverlag Landsberg/Lech 1993.</p><p>Caraway (Carum carvi L.):</p><p>Caraway Oil (Carvi aetheroleum)</p><p>➤ General comments: Caraway is a well-known culinary herb, the fruits of</p><p>which are also used in medicine (e. g., as a carminative).</p><p>➤ Pharmacology</p><p>– Herb: Caraway oil (Carvi aetheroleum). The herb consists of the essential oil</p><p>distilled from the ripe seedlike fruit of Carum carvi L.</p><p>Plant Summaries—C</p><p>46</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>– Important constituents: D-(+)-carvone (45–65 %) and D-(+)-limonene (30–</p><p>40 %).</p><p>– Pharmacological properties: Carvone demonstrated antimicrobial action</p><p>against Bacillus subtilis, Pseudomonas aeruginosa, Candida albicans, and As-</p><p>pergillus niger. It was also reported to have a moderate effect on dermato-</p><p>phytes. Caraway oil has spasmolytic effects in animals.</p><p>➤ Indications: Dyspeptic complaints.</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– Dosage: 1 to 2 drops of caraway oil on sugar.</p><p>– Daily dose: 3 to 6 drops.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb. Long-term, high-dose administration of caraway oil (e. g., in caraway li-</p><p>queur) can cause kidney and liver damage.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Caraway oil has a marked carminative effect (see also</p><p>Caraway Seeds (Carvi fructus).</p><p>Caraway Fruit (Carvi fructus)</p><p>➤ Pharmacology</p><p>– Herb: Caraway fruit (Carvi fructus). The herb consists of the ripe, dried,</p><p>seedlike fruit of Carum carvi L.</p><p>– Important constituents: Essential oil (3–7 %), fatty oil (10–18 %) containing</p><p>petroselinic acid (40–50 %), oleic acid (29–30 %), and polysaccharides</p><p>(13 %).</p><p>– Pharmacological properties: See Caraway Oil.</p><p>➤ Indications: Dyspeptic complaints.</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– Tea: Steep 1 to 2 teaspoons (ca. 1.5 g) of the herb, crushed immediately prior</p><p>to use, in 150 mL of hot water for 10 to 15 minutes in a covered vessel.</p><p>• One dose equals 1–5 g herb.</p><p>– Daily dose: 1.5–6 g herb.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb. Long-term, high-dose administration of caraway oil (e. g., in caraway li-</p><p>queur) can cause kidney and liver damage.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Caraway is a stronger carminative than either anise or</p><p>fennel. Caraway seeds should be crushed immediately prior to use to prevent</p><p>unnecessary loss of the highly volatile essential oil.</p><p>✿ Literature</p><p>– Monographs: DAB 1998; ESCOP, Commission E</p><p>– Scientific publications: see p. 478.</p><p>Cayenne (Capsicum annuum L.)</p><p>➤ Synonyms: Red pepper, hot pepper; Paprika (Ger.)</p><p>➤ General comments: The cayenne plant is native to Central America. Its hot and</p><p>spicy fruit is best known as a spice, but is also used in medicine.</p><p>Plant Summaries—C</p><p>47</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ Pharmacology</p><p>– Herb: Cayenne fruit (Capsici fructus). The herb consists of the ripe, dried</p><p>fruit (without calyx) of Capsicum annuum L. or Capsicum fructescens L.</p><p>– Important constituents: Capsaicinoids (mainly capsaicin, 32–38 %), di-</p><p>hydrocapsaicin (18–52 %), carotinoids (0.3–0.8 %), and flavonoids.</p><p>– Pharmacological properties: Capsaicinoids are potent inducers of local hy-</p><p>peremia. Topical application of the herb initially induces erythema accom-</p><p>panied by sensations of pain and heat, followed by a phase of insensitivity</p><p>(reversible or irreversible deactivation of afferent fibers). The antinocicep-</p><p>to diagnose and treat conditions with phyto-</p><p>medicines, alongside their conventional medical colleagues. The British model is</p><p>distinct again from the German experience and emphasizes the importance of</p><p>understanding different cultural and national expressions of traditional herbal</p><p>medicine, education, and practice.</p><p>Sensitive to such cultural variations, Thieme wisely enlisted the aid of Christopher</p><p>Hobbs, a fourth-generation American herbalist, to help render the translation of</p><p>Prof. Kraft’s German text into the US cultural context. Hobbs, one of the most</p><p>highly regarded herbal practitioners in the US, addressed this challenging task by</p><p>reviewing every line of the text. Hobbs has replaced some herbs in the materia</p><p>medica, suggested more appropriate local equivalents for herbal products, and</p><p>annotated bi-cultural comments where relevant. He has also rewritten doses into</p><p>the typically higher US forms. Meanwhile, Hobbs has deftly preserved the nu-</p><p>ances of the German text; Prof. Kraft actively participated in, and agreed to, all the</p><p>changes. The result of this bi-cultural collaboration is an almost seamless repre-</p><p>sentation of the German original harmonized to the North American audience.</p><p>As more physicians in this country recognize the need to investigate the CAM</p><p>(complementary and alternative medicine) modalities that are being espoused by</p><p>many of their patients, a premium is inevitably placed upon reliable sources of</p><p>data and clinical information about CAM. Botanical medicines in particular have</p><p>sadly been the subject of excessive amounts of published secondary and tertiary</p><p>“information” devoid of clinical context, and largely irrelevant to the primary care</p><p>provider. By contrast, Karin Kraft and Christopher Hobbs present us with a suc-</p><p>cinct and authoritative survey of herbal medicine that is accessible to the physi-</p><p>cian and can readily be applied to everyday clinical practice. The “pocket guide”</p><p>represents a unique cross-cultural and trans-disciplinary blend of reliable, accu-</p><p>rate, and accessible information about phytotherapy; it is a mini-masterpiece of</p><p>integrative medicine.</p><p>March 2004 Jonathan Treasure</p><p>Medical Herbalist</p><p>Ashland, Oregon, USA</p><p>Foreword</p><p>V</p><p>II</p><p>P</p><p>re</p><p>fa</p><p>ce</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>The use of medicinal plants to treat everyday complaints and illnesses is becom-</p><p>ing ever more popular. This pocket guide is aimed not only at doctors and mem-</p><p>bers of the various healing professions interested in phytotherapy, but also in par-</p><p>ticular at interested lay people, for whom this book is intended as a practical guide</p><p>in the often confusing self-treatment market. This pocket guide is based on expe-</p><p>riences and prescriptions that have been used in Germany for many years or even</p><p>decades. If necessary, they have been supplemented by US-American remedies</p><p>and suggestions for use. Where possible, available scientific literature has also</p><p>been taken into account. The book includes the medicinal plants most widely used</p><p>in Germany, almost all of which are also used in the US, as well as their use in the</p><p>treatment of major syndromes. A general section in which production processes,</p><p>quality characteristics, and legal backgrounds are explained is followed by</p><p>portraits of the most important medicinal plants with references to more recent</p><p>scientific literature. Illnesses and possibilities of treating them with medicinal</p><p>plant preparations as well as a critical evaluation of the significance of this thera-</p><p>py make up the next section. A specialty of this checklist is the section “Care In-</p><p>volving Medicinal Plants.” Here special value was attached to practicability. A tab-</p><p>ular section divided up into medicinal plants with brief summaries of remedies</p><p>and references follows. Contact addresses and lists of manufacturers as well as a</p><p>comprehensive table of contents round off the guide.</p><p>Dr. Liane Platt-Rohloff and Ms Angelika-M. Findgott from Thieme International</p><p>have done a first-class job of coordinating the work of both authors and editing</p><p>the manuscripts. We, the authors, know that we echo their sentiments in wishing</p><p>that this pocket guide will be a practical aid to all those who are interested in using</p><p>medicinal plants and will contribute to the alleviation and curing of illnesses and</p><p>complaints.</p><p>Rostock in Spring 2004 Karin Kraft</p><p>Preface</p><p>V</p><p>II</p><p>I</p><p>Co</p><p>n</p><p>te</p><p>n</p><p>ts</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>1 Fundamentals of Phytotherapy</p><p>. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1</p><p>1.1 Characteristics and Status of Herbal Medicines . . . . . . . . . . . . . . . . . . . . . . 1</p><p>1.2 From the Plant to the Remedy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4</p><p>1.3 Constituents and Active Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7</p><p>1.4 Herbal Formulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11</p><p>1.5 Prescribing Herbal Medicines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17</p><p>1.6 Determination of Doses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19</p><p>2 General Guidelines for Use of Herbal Medicines</p><p>. . . . . . . . . . . . . . . . . . . . . 21</p><p>2.1 Potentials and Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21</p><p>2.2 Special Patient Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23</p><p>2.3 Basics of Administering Herbal Preparations . . . . . . . . . . . . . . . . . . . . . . . . . 27</p><p>2.4 Working Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29</p><p>3 Medical Plants from A to Z</p><p>. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33</p><p>Plant Summaries—A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33</p><p>Plant Summaries—B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39</p><p>Plant Summaries—C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44</p><p>Plant Summaries—D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54</p><p>Plant Summaries—E . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56</p><p>Plant Summaries—F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62</p><p>Plant Summaries—G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70</p><p>Plant Summaries—H . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74</p><p>Plant Summaries—I, J . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79</p><p>Plant Summaries—K . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82</p><p>Plant Summaries—L . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84</p><p>Plant Summaries—M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89</p><p>Plant Summaries—N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96</p><p>Plant Summaries—O . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99</p><p>Plant Summaries—P . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101</p><p>Plant Summaries—R . . . . . .</p><p>tor and antiphlogistic effects of the herb can persist for several hours to sev-</p><p>eral weeks.</p><p>➤ Indications</p><p>– Muscular tension</p><p>– Rheumatic diseases</p><p>➤ Contraindications: Skin diseases or inflammation, broken skin.</p><p>Important: Cayenne should not come into contact with the mucous mem-</p><p>branes.</p><p>➤ Dosage and duration of use</p><p>– Tincture (1 : 10): Apply a few drops to the affected area of the skin and rub</p><p>in thoroughly. Repeat several times daily.</p><p>– Semisolid preparations should contain no more than 50 mg of capsaicin in</p><p>100 g of a neutral base.</p><p>– Despite official warnings in the monograph of using Cayenne for more than</p><p>three consecutive days, to prevent the occurrence of side effects, in North</p><p>America the use of prescription pharmaceutical preparations for shingles</p><p>and rheumatism for extended periods has caused no problems.</p><p>➤ Adverse effects: Cayenne can cause blistering and ulcer formation above and</p><p>beyond the desired hyperemic effect.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Cayenne can be usefully combined with other anti-</p><p>inflammatory herbal preparations.</p><p>✿ Literature</p><p>– Monographs: DAB 1998; Commission E</p><p>– Scientific publications: see p. 478; Anon: Behandlung chronischer</p><p>Schmerzen: Capsaicin—Lichtblick für Schmerzpatienten. Deutsche Apo-</p><p>theker Ztg 137 (1997), 1027–1028; Anon: Phytotherapie: Pflanzliche</p><p>Antirheumatika—was bringen sie? Deutsche Apotheker Ztg 136 (1996),</p><p>4012–4015; Kreymeier J: Rheumatherapie mit Phytopharmaka. Deutsche</p><p>Apotheker Ztg 137 (1997), 611–613.</p><p>Chamomile (Matricaria recutita L. Rauschert)</p><p>➤ Synonyms: German chamomile; Kamille (Ger.)</p><p>➤ General comments: Chamomile is widely distributed throughout Europe and</p><p>is a favorite of people who like to pick their own herbs. When collecting cham-</p><p>omile, it is important to remember that the receptacle of true (German) cham-</p><p>omile is hollow and conical. The flower heads are used in medicine.</p><p>➤ Pharmacology</p><p>– Herb: Chamomile flower (Matricariae flos). The herb consists of the fresh or</p><p>dried flower heads of Matricaria recutita L., which is also called Chamomilla</p><p>recutita (L.) R., and preparations of the same.</p><p>Plant Summaries—C</p><p>48</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>– Important constituents: Essential oil (0.4–1.5 %) containing mainly α-bisab-</p><p>olol (5–70 %), bisabolol oxides A and B (5–60 %), β-trans-farnesene</p><p>(7–45 %), and chamazulene (1–35 %) derived from matricin, a nonvolatile</p><p>proazulene, by steam distillation. Flavonoids and mucilage are also present.</p><p>– Pharmacological properties: The essential oil has antiphlogistic and spasmo-</p><p>lytic effects and promotes wound healing. The compound α-bisabolol in-</p><p>hibits fungal and bacterial growth.</p><p>➤ Indications</p><p>– Colds and fever</p><p>– Inflammation of the skin</p><p>– Coughs and bronchitis</p><p>– Decreased resistance to infections</p><p>– Inflammations of the mouth and throat</p><p>– Mild nervousness or insomnia (not rated by the Commission E)</p><p>➤ Contraindications: Chamomile flower should not be used in compresses ap-</p><p>plied in the eye region to prevent pollen and other flower particles from get-</p><p>ting in the eyes.</p><p>➤ Dosage and duration of use</p><p>– Tea: Pour 1 cup of hot water onto 1 tablespoon (3 g) of the herb, cover, and</p><p>steep for 5 to 10 minutes (1 teaspoon = 1 g herb).</p><p>• Dosage: One cup, freshly prepared, between meals, 3 to 4 times a day.</p><p>– Bath additive: Steep 50 g of the herb in 1 liter of hot water, then add to bath</p><p>water.</p><p>– Steam bath: Pour hot water onto ca. 6 g of the herb.</p><p>– Mouthwash and gargle: Rinse the mouth or gargle with the fresh tea infu-</p><p>sion several times a day.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb. The herb has a slight potential for sensitization.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Chamomile is a well-known, well-tolerated, thor-</p><p>oughly investigated herb with a relatively wide therapeutic range. Only distil-</p><p>lates and alcohol preparations of the herb contain therapeutically effective</p><p>concentrations of the essential oil.</p><p>✿ Literature</p><p>– Monographs: DAB 1998; ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Ammon HPT, Sabieraj J, Kaul R: Kamille</p><p>– Mechanismus der antiphlogistischen Wirkung von Kamillenextrakten</p><p>und -inhaltsstoffen. Deutsche Apotheker Ztg 136 (1996), 1821–1834; Mil-</p><p>ler T, Wittstock U, Lindequist U, Teuscher E: Effects of some components of</p><p>the essential oil of chamomile, Chamomilla recutita, on Histamine release</p><p>from mast cells. Planta Med 62 (1997), 60–61.</p><p>Chaste Tree (Vitex agnus-castus L.)</p><p>➤ General comments: Chaste tree has been used as an herbal remedy since an-</p><p>cient times. Its natural habitat ranges from the Mediterranean region to Wes-</p><p>tern Asia.</p><p>➤ Pharmacology</p><p>– Herb: Chaste tree fruit (Agni casti fructus). The herb consists of the ripe,</p><p>dried fruit of Vitex agnus-castus L. and preparations of the same.</p><p>Plant Summaries—C</p><p>49</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>– Important constituents: Iridoids (agnuside, aucubin), flavonoids, and essen-</p><p>tial oil (0.8–1.6 %).</p><p>– Pharmacological properties: Chaste tree fruit has dopaminergic effects and</p><p>inhibits lactation. It suppresses the release of prolactin and reduces the</p><p>symptoms of premenstrual syndrome. In animals, the extract was found to</p><p>inhibit lactation, normalize stress-induced hyperprolactinemia, and exert</p><p>dopaminergic effects. Clinical studies demonstrated a positive effect on</p><p>symptoms associated with hyperprolactinemia such as mastalgia and other</p><p>symptoms of PMS.</p><p>➤ Indications</p><p>– Menopausal complaints</p><p>– Premenstrual syndrome (PMS)</p><p>➤ Contraindications: Pregnancy and breast feeding</p><p>➤ Dosage and duration of use</p><p>– Daily dose: 30–40 mg of the herb, usually in the form of 1–2 mL of an aque-</p><p>ous-alcohol extract, first thing in the morning.</p><p>➤ Adverse effects: Exanthema (skin eruptions) is an occasional side effect.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Chaste tree fruit is an effective remedy for premen-</p><p>strual syndrome, especially for relieving mastalgia, as has been demonstrated</p><p>in clinical studies.</p><p>✿ Literature</p><p>– Monographs: ESCOP, Commission E</p><p>– Scientific publications: see p. 478; Jarry H et al: In vitro prolactin but not LH</p><p>and FSH release is inhibited by compounds in extracts of Agnus castus, di-</p><p>rect evidence for a dopaminergic principle by the dopamine receptor assay.</p><p>Exp Clin Endocrinol 102 (1994), 448–454; Loew D, Gorkow C, Schrödter A</p><p>et al: Zur dosisabhängigen Verträglichkeit eines Agnus-castus-Spezial-</p><p>extraktes. Z Phytother 17 (1996), 237–243; Winterhoff H: Arzneipflanzen</p><p>mit endokriner Wirksamkeit. Z Phytother 14 (1993), 83–94.</p><p>Clove (Syzygium aromaticum L. Merr. et L.M. Perry)</p><p>➤ Pharmacology</p><p>– Herb: Clove (Caryophylli flos). The herb consists of the hand-picked and</p><p>dried flower buds of Syzygium aromaticum (L.) Merr. et L.M. Perry.</p><p>– Important constituents: Essential oil (15–21 %), consisting of 70–90 % eu-</p><p>genol plus eugenyl acetate, eugenol acetate (17 %), and β-caryophyllene</p><p>(5–12 %), as well as flavonoids and tannins (10 %).</p><p>– Pharmacological properties: Caryophylli flos is said to have bactericidal, fun-</p><p>gicidal, virustatic, antioxidant, hepatoprotective, local anesthetic, and spas-</p><p>molytic effects, but only a few of these effects have been proven experimen-</p><p>tally. The only confirmed data apply to the essential oil.</p><p>➤ Indications</p><p>– Inflammations of the mouth and throat</p><p>– Used in dental medicine as a topical pain reliever</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– As a mouthwash/gargle: Rinse the mouth or gargle several times a day with</p><p>an aqueous solution containing 1–5 % of the essential oil.</p><p>Plant Summaries—C</p><p>50</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>– For dental complaints: Apply the undiluted essential oil as a topical pain re-</p><p>liever.</p><p>➤ Adverse effects: Allergic reactions to eugenol can occur as a rare side effect.</p><p>The concentrated essential oil can irritate the mucous membranes.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Clove is an herb with demonstrated effectiveness. The</p><p>medicinal uses for the herb are a consequence of the therapeutic action of clove</p><p>oil. No clinical studies are available. Clove is safe enough for unrestricted over-</p><p>the-counter use.</p><p>✿ Literature</p><p>– Monographs: DAB 10; Commission E</p><p>– Scientific publications: see p. 478; Cai L, Wu CHD: Compounds from Syzy-</p><p>gium aromaticum possessing growth inhibitory activity against oral patho-</p><p>genes. J Nat Prod 59 (1996), 987–990: Debelmas AM, Rochat J: Plant Med</p><p>Phytother 1 (1967), 23; Tanaka T, Orii Y, Nonaka GI et al: Syziginins A and</p><p>B, two ellegitannins from Syzygium aromaticum. Phytochemistry 43</p><p>(1996), 1345–1348.</p><p>Coffee (Coffea arabica L.)</p><p>➤ Pharmacology</p><p>– Herb: Coffee bean (Coffeae semen). The herb consists of the dried, husked</p><p>beans of Coffea arabica (L.) and other Coffea species.</p><p>– Coffee charcoal (Coffeae carbo), the ground, blackish-brown to charcoal</p><p>roasted outer seed parts of the dried green seeds of Coffea arabica L. s.l., Cof-</p><p>fea liberica B. et H., Coffea canephore P. et F., and other coffee species.</p><p>– Important constituents: Purine alkaloids (caffeine, 0.6–2.2 %), theobromine,</p><p>theophylline, caffeic and ferulic acid esters of quinic acid (chlorogenic acid,</p><p>5–8 %), trigonelline, no–diterpene glycoside esters (atractyloside), and di-</p><p>terpenes (diterpene alcohol fatty acid esters kahweol and cafestol). Roasted</p><p>coffee beans contain many aroma substances due to the pyrolysis of carbo-</p><p>hydrates, proteins, fats, and aromatic acids.</p><p>– Pharmacological properties: The stimulatory effect of caffeine sets in within</p><p>a few minutes after administration. Most of the effects specified for coffee</p><p>are attributable to the action of caffeine.</p><p>• Effects of caffeine: Caffeine has positive inotropic effects and, when ad-</p><p>ministered in high doses, exerts a positive chronotropic effect on the</p><p>heart and stimulates the central nervous system. It relaxes the smooth</p><p>muscles of the blood vessels (except in the brain, where it causes vaso-</p><p>constriction) and bronchi. Caffeine has short-term diuretic effects, stim-</p><p>ulates the secretion of gastric juices, and increases the release of</p><p>catecholamines.</p><p>• Cardiovascular effects: Individuals who normally do not drink coffee ex-</p><p>hibit an average 10 mmHg increase in systolic blood pressure within</p><p>1 hour of administration of 250 mg of caffeine. Habitual coffee drinkers</p><p>are tolerant to this dose.</p><p>• An average dose of 5 to 6 cups of coffee per day (made by steeping the</p><p>herb in boiling water for 10 minutes) for 9 weeks significantly increases</p><p>the total cholesterol and LDL cholesterol levels in serum. The use of filter</p><p>paper can reduce this effect by 80 %.</p><p>Plant Summaries—C</p><p>51</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ Indications</p><p>– Migraine headaches</p><p>– Decreased performance</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use: Daily dose: 15 g of the herb.</p><p>➤ Adverse effects: Doses of up to 500 mg of caffeine (= 5 cups of coffee) per day</p><p>are toxicologically safe for healthy adults who are habitual coffee drinkers. Pa-</p><p>tients with cardiovascular lability, kidney diseases, hyperthyroidism, a predis-</p><p>position to convulsions, and certain psychiatric disorders (e. g., panic attacks)</p><p>should use the herb cautiously.</p><p>– Side effects (attributable to coffee’s chlorogenic acid content) include gas-</p><p>tric hyperacidity, gastric irritation, diarrhea, and reduced appetite. Vomit-</p><p>ing and abdominal cramps are signs of poisoning. Pregnant and nursing</p><p>mothers should avoid caffeine. The maximum safe daily dose should not</p><p>exceed 300 mg (equivalent to 3 cups of coffee).</p><p>– Caffeine can cause mental and physical dependence. Signs of withdrawal</p><p>include headaches and sleep disorders.</p><p>Important: The prolonged administration of more than 1.5 g of caffeine per</p><p>day is often observed to lead to unspecific symptoms such as restlessness,</p><p>irritability, insomnia, palpitation, dizziness, vomiting, diarrhea, lack of ap-</p><p>petite, and headaches. These effects can even occur with chronic use of as</p><p>little as 300–500 mg/day in sensitive individuals.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Ubiquitously used herbal preparation, OTC prepara-</p><p>tion, to increase mental performance. Clinically for headaches etc.</p><p>✿ Literature</p><p>– Monographs: Commission E (Coffee carbon)</p><p>– Scientific publications: see p. 478; Dieudonne S, Forero ME, Llano I: Lipid</p><p>analysis of Coffea arabica Linn. beans and their possible hypercholestero-</p><p>lemic effects. Int J Food Sci Nutr, 159 (1997), 135–139; Mensink RP,</p><p>Lebbink WJ, Lobbezoo IE, Weusten-Van der Wouw MP, Zock PL, Katan MB:</p><p>Diterpene composition of oils from Arabica and Robusta coffee beans and</p><p>their effects on serum lipids in man. J Intern Med, 237 (1995), 543–550;</p><p>Ratnayake WM, Pelletier G, Hollywood R, Malcolm S, Stavric B: Investiga-</p><p>tion of the effect of coffee lipids on serum chloestrol in hamsters. Food</p><p>Chem Toxicol, 33 (1995), 195–201; Anon: Kaffee erhöht den Cholesterin-</p><p>spiegel. Aga 19 (1991), 10682; Anon: Coffein-Entzugssyndrom bei Kaf-</p><p>feetrinkern. Deutsche Apotheker Ztg 133 (1993), 441; Bättig K: Kaffee in</p><p>wissenschaftlicher Sicht. Z Phytother 9 (1988), 95; Butz S: Nurses-Health-</p><p>Studie: Kaffee – kein Risikofaktor für koronare Herzkrankheit? Deutsche</p><p>Apotheker Ztg 136 (1996), 1680–1682; Garattini S: Caffeine, Coffee and</p><p>Health. Garattini S. Monographs of the Mario Negri Institute for Pharmaco-</p><p>logical Research, Milan. Raven Press, New York 1993; Lewin L: Gifte und</p><p>Vergiftungen. 6th ed (reprint), Haug Verlag, Heidelberg 1992; Silnermann</p><p>K et al: Entzugssymptome nach regelmäßigen Kaffeegenuß. New Engl J</p><p>Med 327 (1992), 1109.</p><p>Plant Summaries—C</p><p>52</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Condurango (Marsdenia condurango Reichb. F.)</p><p>➤ Synonyms: Marsdenia, eagle-vine bark; Kondurango (Ger.)</p><p>➤ General comments: The condurango tree grows in forests on the slopes of the</p><p>Andes mountains. Its bark is used as a bitter.</p><p>➤ Pharmacology</p><p>– Herb: Condurango bark (Condurango cortex). The herb consists of dried</p><p>bark from the trunk and branches of Marsdenia condurango R. fil.</p><p>– Important constituents: Pregnane glycosides, pregn-5-ene glycosides (in-</p><p>cluding condurangin, 2 %), and caffeic acid derivatives (0.7–2.1 %).</p><p>– Pharmacological properties: Like other bitters, condurangin increases the</p><p>flow of saliva and gastric juices through reflex mechanisms. There is a lack</p><p>of clinical data on the effects of the herb in humans.</p><p>➤ Indications</p><p>– Loss of appetite</p><p>– Dyspeptic complaints</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– Daily dose: 2–4 g of the herb.</p><p>– Add the herb to cold water and wait for 3 to 4 hours. Drink the cold extract.</p><p>– Dosage: One cup of the tea or one liqueur glassful of condurango wine 30</p><p>minutes before meals.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Condurango is a well-tolerated bitter herb that is be-</p><p>coming more popular in Europe today. It can usefully be combined with other</p><p>bitter herbs.</p><p>✿ Literature</p><p>– Monographs: Commission E</p><p>Coriander (Coriandrum sativum L.)</p><p>➤ General comments: The fruits</p><p>of the coriander plant are used as a kitchen herb</p><p>(bread, baked goods, etc.) and medicinal herb (e. g., for dyspeptic complaints).</p><p>➤ Pharmacology</p><p>– Herb: Coriander (Coriandri fructus). The herb consists of the ripe, dried</p><p>fruits of Coriandrum sativum L., var. vulgare A. and microcarpum.</p><p>– Important constituents: 0.4–1.7 % essential oil (D-(+)-linalool/coriandrol</p><p>(60–75 %) and 13–21 % fatty oil (oleic acid, linolenic acid).</p><p>– Pharmacological properties: The essential oil stimulates the secretion of</p><p>gastric juices and has carminative and mild spasmolytic effects.</p><p>➤ Indications</p><p>– Lack of appetite</p><p>– Dyspeptic complaints</p><p>➤ Contraindications: None known</p><p>➤ Dosage and duration of use</p><p>– Daily dose: 3 g of the crushed herb.</p><p>– Pour 150 mL of water onto 1 g of the fresh herb, crushed immediately prior</p><p>to use, then cover and steep for 10 minutes.</p><p>Plant Summaries—C</p><p>53</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>• Dosage: One cup, between meals, 3 times a day.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb. Coriander has a slight potential for sensitization.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Coriander is an old and familiar herbal remedy that</p><p>should be used in combination with other antidyspeptic preparations. Clinical</p><p>studies of the herb are not available.</p><p>✿ Literature</p><p>– Monographs: Commission E</p><p>Cowslip (Primula veris)</p><p>➤ See Primula</p><p>Plant Summaries—C</p><p>54</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Dandelion (Taraxacum officinale Weber)</p><p>➤ General comments: Dandelion is a widely distributed plant that has many</p><p>uses in folk medicine. The whole plant is used in medicine.</p><p>➤ Pharmacology</p><p>– Herb: Dandelion root and herb (Taraxaci radix cum herba). The herb con-</p><p>sists of whole-plant material from Taraxacum officinale G. H. Weber ex Wig-</p><p>ger s.l., collected at the time of flowering, and preparations of the same.</p><p>– Important constituents: Sesquiterpene lactones (tannins), triterpenes</p><p>(taraxasterol, γ-sitosterol, taraxerol, taraxol), flavonoids (luteolin-7-O-</p><p>glucoside), and inulin (2–40 %).</p><p>– Pharmacological properties: The tannins contained in dandelion root and</p><p>herb have cholagogic and secretagogic action. In animals, dandelion root</p><p>was found to have a saluretic effect attributable to its high concentrations</p><p>of minerals.</p><p>➤ Indications</p><p>– Lack of appetite</p><p>– Dyspeptic complaints</p><p>– Urinary tract infections</p><p>➤ Contraindications: Biliary tract obstruction, empyema of the gallbladder, and</p><p>intestinal obstruction. Patients with gallbladder problems should not use dan-</p><p>delion unless instructed by a qualified health care provider owing to the risk</p><p>of colic.</p><p>➤ Dosage and duration of use</p><p>– Tea: Add 3–4 g (1 tablespoon) of the finely chopped herb to 150 mL of</p><p>water, bring to a boil and steep for 15 minutes.</p><p>• Dosage: One cup of the tea in the morning and at night.</p><p>➤ Adverse effects: Because dandelion acts as a secretagogue, it can cause com-</p><p>plaints related to gastric hyperacidity. The herb has a weak potential for sen-</p><p>sitization.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Dandelion is a popular herbal medicament, but further</p><p>scientific research is required to characterize its effects.</p><p>✿ Literature</p><p>– Monographs: ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Budzianowski J: Coumarins, caffeoyltar-</p><p>taric acids and their artifactual esters from Taraxacum officinale: Planta</p><p>Med 63 (1997), 288.</p><p>Devil’s Claw (Harpagophytum procumbens Burch. D. C.)</p><p>➤ General comments: Devil’s claw grows in the Kalahari Desert region of south-</p><p>ern Africa. The plant has gained significance as an herbal medicament in recent</p><p>years.</p><p>➤ Pharmacology</p><p>– Herb: Devil’s claw (Harpagophyti radix). The herb consists of the secondary</p><p>storage roots of Harpagophytum procumbens (B.) D. C. and preparations of</p><p>the same.</p><p>– Important constituents: Iridoids (0.5–3 %) and iridoid glycosides such as</p><p>harpagoside (0.5–0.6 %), harpagide, and procumbide. Phenylethanol</p><p>Plant Summaries—D</p><p>55</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>derivatives such as acteoside, verbascoside, and isoacteoside are also</p><p>present.</p><p>– Pharmacological properties: Devil’s claw stimulates the secretion of gastric</p><p>juices and the production of bile (harpagoside). In animals, it has anti-</p><p>inflammatory, analgesic, and antiarthritic effects, and harpagoside was</p><p>found to inhibit the biosynthesis of certain prostaglandins that cause</p><p>inflammation.</p><p>➤ Indications</p><p>– Lack of appetite</p><p>– Dyspeptic complaints</p><p>– Supportive treatment of degenerative connective tissue diseases</p><p>➤ Contraindications: Gastric and duodenal ulcers.</p><p>➤ Dosage and duration of use</p><p>– Daily dose: 1.5 g herb for lack of appetite; otherwise 4.5 g herb.</p><p>– Tea: Steep 1 teaspoon (4.5 g) of the finely chopped herb in 300 mL of boiled</p><p>water for 8 hours. Divide into 3 portions to be taken throughout the day.</p><p>– Tincture for external use: Dilute 1 tablespoon with 250 mL of water and use</p><p>for gargling or compresses.</p><p>➤ Adverse effects: Allergic reactions can occur in isolated cases.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Preparations made of devil’s claw are suitable for</p><p>physician-supervised self-treatment. Devil’s claw is an effective herbal remedy</p><p>that is especially well suited for adjuvant treatment of rheumatic diseases.</p><p>Used in this capacity, it can reduce the frequency and dose of synthetic</p><p>antirheumatic drugs. Some recent controlled clinical trials suggest efficacy and</p><p>safety.</p><p>✿ Literature</p><p>– Monographs: BHP 83; BHP 96; ESCOP; HAB 1; Commission E, Mar 31</p><p>– Scientific publications: see p. 478; Chantre P, Cappelaere A, Leblan D, et al.</p><p>Efficacy and tolerance of Harpagophytum procumbens versus diacerhein in</p><p>treatment of osteoarthritis. Phytomedicine 7(3), (2000), 177–183; Baghdi-</p><p>kian L, et al. An analytical study, anti-inflammatory and analgesic effects of</p><p>Harpagophytum procumbens and Harpagophytum zeyheri. Planta Med 63</p><p>(1997), 171–176.</p><p>Dwarf Pine (Pinus mugo spp.)</p><p>➤ See Pine.</p><p>Plant Summaries—D</p><p>56</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Echinacea:</p><p>Paleflowered Echinacea (Echinacea pallida Nutt.)</p><p>➤ Synonyms: Pale coneflower; Blasse Kegelblume (Ger.)</p><p>➤ General comments: Paleflowered Echinacea is native to the United States. The</p><p>root is used in medicine.</p><p>➤ Pharmacology</p><p>– Herb: White Echinacea root (Echinaceae pallidae radix). The herb consists</p><p>of the fresh or dried roots of Echinacea pallida (N.) N., collected during the</p><p>fall, and preparations of the same.</p><p>– Important constituents: Polysaccharides (immunostimulatory effects,</p><p>rhamnoarabinogalactans), essential oil (0.2–2 %), caffeic acid derivatives</p><p>(echinacoside, 1 %), and alkylamides (0.1 %).</p><p>– Pharmacological properties: Immunostimulatory, antibacterial, virustatic.</p><p>Alcohol extracts of Paleflowered Echinacea root were found to stimulate</p><p>phagocytosis in animals, and the rate of in vitro phagocytosis in granulocytes</p><p>increased by 23 % after injection. In mice, the proliferation of splenic cells in-</p><p>creased greatly, and the production of cytokines and antibodies increased.</p><p>Clinical studies demonstrated that bacterial and viral infections of the upper</p><p>respiratory tract may improve more rapidly when treated with the herb.</p><p>➤ Indications: For supportive treatment of colds or flulike infections.</p><p>➤ Contraindications: Hypersensitivity to any of the compounds in</p><p>Paleflowered</p><p>Echinacea root in particular, or to composite plants in general. Parenteral admin-</p><p>istration of echinacea as used in Europe is contraindicated during pregnancy and</p><p>in general discouraged.</p><p>Warning: Paleflowered Echinacea root should be used under the advice of</p><p>a qualified health practitioner by individuals with progressive systemic dis-</p><p>eases such as tuberculosis, leukosis, connective tissue diseases, multiple</p><p>sclerosis, or other autoimmune diseases such as HIV infection.</p><p>➤ Dosage and duration of use: Continuous oral use of the tincture (1 : 5) or oral</p><p>preparations for more than 2 weeks is not recommended.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper internal or external administration of the designated thera-</p><p>peutic doses of the herb. Skin rashes and itching have been observed in isolated</p><p>cases. Facial swelling, difficulty in breathing, dizziness and reduction of blood</p><p>pressure are rare side effects.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Paleflowered Echinacea root is less commonly used</p><p>than the purple, the experimental and clinical investigation of the herb is not</p><p>yet complete.</p><p>✿ Literature</p><p>– Monographs: ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Beuscher N et al: Immunmodulierende</p><p>Eigenschaften von Wurzelextrakten verschiedener Echinacea-Arten. Z</p><p>Phytother 16 (1995), 157–166.</p><p>Purple Echinacea (Echinacea purpurea L. Moench).</p><p>➤ Synonyms: Purple coneflower; Purpurfarbene Kegelblume (Ger.)</p><p>➤ General comments: Purple Echinacea is native to the United States, where the</p><p>native Americans utilized its immunity-enhancing properties. The aerial parts</p><p>of the plant collected at the time of flowering are used in medicine.</p><p>Plant Summaries—E</p><p>57</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ Pharmacology</p><p>– Herb: Purple Echinacea (Echinaceae purpureae herba). The herb consists of</p><p>the fresh aerial parts of Echinacea purpurea (L.) Moench, collected at the</p><p>time of flowering.</p><p>– Important constituents: Polysaccharides (with immunostimulatory effects;</p><p>4-O-methylglucuronylarabinoxylans, alkyl amides, acid rhamnoarabino-</p><p>galactans), cichoric acid, and essential oil (0.08–0.32 %).</p><p>– Pharmacological properties: Purple Echinacea promotes wound healing.</p><p>Parenteral and oral doses increase the phagocytosic capacity of granulo-</p><p>cytes and macrophages; medium doses increase the production of T lym-</p><p>phocytes. Low doses of the expressed juice lead to induction of TNF-α, in-</p><p>terleukin-1 and interleukin-6. The herb has shown antiviral properties in</p><p>animal studies. Human studies show reduction and shortening of symp-</p><p>toms of viral syndromes, in particular the common cold, but other studies</p><p>show no effect. Still not proven conclusively with human studies.</p><p>➤ Indications</p><p>– Colds and fever</p><p>– Urinary tract infections</p><p>– Coughs and bronchitis</p><p>– Decreased resistance to infections</p><p>– Runny nose</p><p>– Wounds and burns (external use)</p><p>➤ Contraindications: Hypersensitivity to any of the compounds in Purple Echi-</p><p>nacea in particular or to composite plants in general.</p><p>Warning: Purple Echinacea should be used by individuals with progressive</p><p>systemic diseases such as tuberculosis, leukosis, connective tissue disease,</p><p>multiple sclerosis or other autoimmune diseases such as HIV infection un-</p><p>der the advice of a qualified health practitioner.</p><p>➤ Dosage and duration of use</p><p>– Take as recommended by the manufacturer.</p><p>– Daily dose: 6–9 mL of the expressed juice; should not be used continuously</p><p>for more than 2 weeks.</p><p>➤ Adverse effects: Skin rashes and itching have been observed in isolated cases.</p><p>Facial swelling, difficulty in breathing, dizziness, and reduction of blood pres-</p><p>sure are rare side effects. Parenteral administration of Purple Echinacea, as</p><p>used in Europe, is contraindicated during pregnancy and in general discouraged.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Purple Echinacea is a commonly used herb, the effec-</p><p>tiveness of which has been demonstrated in a growing number of studies. A</p><p>preventive effect with respect to flulike infections has not been proven.</p><p>✿ Literature</p><p>– Monographs: ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Melchert D, Linde K, Worku F et al:</p><p>Immunomodulation with Echinacea—a systematic review of controlled</p><p>clinical trials, Phytomedicine 1 (1994), 245–254; Mose J R: Med Welt 34</p><p>(1983), 51; Parnham MJ: Benfit-risk assessment of the squeezed sap of the</p><p>purple coneflower (Echinacea purpurea) for long-term oral immunostimu-</p><p>lation. Phytomedicine 3 (1996), 95–102.</p><p>Plant Summaries—E</p><p>58</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Eleutherococcus (Eleutherococcus senticosus Rupr. Maxim)</p><p>➤ Synonyms: Siberian ginseng</p><p>➤ General comments: Siberian ginseng is a shrub with effects largely similar to</p><p>those of ginseng, but is native to Siberia. The root is used in medicine.</p><p>➤ Pharmacology</p><p>– Herb: Siberian ginseng root (Eleutherococci radix). The herb consists of the</p><p>dried roots and/or rhizomes, and sometimes the dried prickly stems of Eleu-</p><p>therococcus senticosus R. e. M. and preparations of the same.</p><p>– Important constituents: Triterpene saponins (0.12 %), steroid glycoside</p><p>eleutheroside A, hydroxycoumarins (isofraxidin, eleutheroside B1), phe-</p><p>nylacrylic acid derivatives (eleutheroside B), lignans (sesamin, 0.23 %, eleu-</p><p>theroside D, and the 4,4,´-di-O-glucoside of syringaresinol, 0.1 %), and</p><p>polysaccharides.</p><p>– Pharmacological properties: The fluid extract of Eleutherococcus root has</p><p>immunostimulatory, immunomodulatory, and antiviral effects due to its</p><p>polysaccharide content. Eleutheroside B and other components were found</p><p>to increase the stress tolerance of animals in many stress models (immobi-</p><p>lization test, swim test, cold stress, etc.). The fluid extract increased the</p><p>number of lymphocytes, especially T lymphocytes, and killer cells in</p><p>healthy volunteers. Eleutheroside B has a testosterone-like effect.</p><p>➤ Indications</p><p>– Decreased resistance to infections</p><p>– Decreased performance</p><p>– Prevention or supportive treatment of jet lag or altitude sickness</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use:</p><p>– Daily dose: 2–3 g herb.</p><p>– Fluid extract (1 : 1): 3 to 5 drops in a glass of water several times a day.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the herb.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Data on the effects of Eleutherococcus in human volun-</p><p>teers are available for the specified indications. The herb probably has many</p><p>more potential uses.</p><p>✿ Literature</p><p>– Monographs: DAB 1998 ESCOP</p><p>– Scientific publications: see p. 478</p><p>English Ivy (Hedera helix L.)</p><p>➤ General comments: The young, tender leaves and shoots are used in medicine.</p><p>➤ Pharmacology</p><p>– Herb: Ivy leaf (Hederae helicis folium). The herb consists of the dried foliage</p><p>leaves of Hedera helix L. and preparations of the same.</p><p>– Important constituents: Ca. 5 % triterpene saponins (mainly hederacoside C,</p><p>which is broken down into (-hederin) and alkaloids (emetine).</p><p>– Pharmacological properties: Saponins have anti-inflammatory, antiviral,</p><p>antibacterial, antimycotic, and anthelmintic effects in animals. They also</p><p>have secretolytic/expectorant, antitussive, and spasmolytic action.</p><p>➤ Indications: Coughs and bronchitis</p><p>➤ Contraindications: None known.</p><p>Plant Summaries—E</p><p>59</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ Dosage and duration of use: Only commercial ivy preparations should be tak-</p><p>en according to the manufacturer's</p><p>instructions.</p><p>➤ Adverse effects: Health hazards in conjunction with proper administration of</p><p>the designated therapeutic doses of the drug are not known.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Use should be restricted to commercially manufact-</p><p>ured products. Recent clinical studies with positive effects in bronchitis are</p><p>available.</p><p>✿ Literature</p><p>– Monographs: ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Gladtke E: Zur Wirksamkeit eines</p><p>Efeublätterpräparates (Prospan). Intern Praxis 32 (1992), 187; Trute A,</p><p>Gross J, Mutschler E, Nahrstedt A: In vitro antispasmodic compounds of the</p><p>dry extract obtained from Hedera helix. Planta Med 63 (1997), 125–129;</p><p>Trute A, Nahrstedt A: Identification and quantitative analysis of phenolic</p><p>dry extracts of Hedera helix. Planta Med 63 (1997), 177–179.</p><p>English Lavender (Lavandula angustifolia Mill.)</p><p>➤ General comments: English lavender flowers are widely used in folk medi-</p><p>cine. The oil and the flowers are used in modern herbal medicine.</p><p>➤ Pharmacology</p><p>– Herb: English lavender flower (Lavandulae flos). The herb consists of the</p><p>dried flowers of Lavandula angustifolia M., collected just before full matu-</p><p>rity, and preparations of the same.</p><p>– Important constituents: Essential oil (1–3 %) consisting mainly of (−)-lina-</p><p>lool (20–50 %) and linalyl acetate (30–40 %).</p><p>– Pharmacological properties: In animal studies, lavender was found to have</p><p>a neurodepressant effect (reduces the sleep induction phase and prolongs</p><p>the duration of sleep) and to reduce motor activity. In humans, English lav-</p><p>ender taken by inhalation was shown to take action in the limbic cortex</p><p>(similarly to nitrazepam).</p><p>➤ Indications</p><p>– Lack of appetite</p><p>– Dyspeptic complaints</p><p>– Circulatory disorders</p><p>– Nervous complaints and insomnia</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use.</p><p>– Tea: Steep 1 to 2 teaspoons (1–2 g) lavender flower in 1 cup (150 mL) of hot</p><p>water for 10 minutes.</p><p>– Daily dose: 3–5 g of the herb, equivalent to 3 cups per day.</p><p>– Bath additive: Steep 100 g of lavender flower in 2 liters of hot water, or add</p><p>100 g of lavender flower to 2 liters of cold water and bring to a boil. Strain,</p><p>then add the concentrated infusion to the bath water.</p><p>– Infusion for external use: Add a handful of lavender flower to 1 liter of water</p><p>and boil for 10 minutes, then add another liter of water.</p><p>– Lavender oil: Take 1 to 4 drops on a suitable medium, e. g., a cube of sugar.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb. The essential oil has a weak potential for sensitization.</p><p>Plant Summaries—E</p><p>60</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: English lavender is a popular herb in empirical folk</p><p>medicine, but it has not been adequately evaluated in pharmacological or clin-</p><p>ical studies. English lavender combines well with other calming and sleep-</p><p>promoting herbal preparations.</p><p>✿ Literature</p><p>– Monographs: DAB 1998; Commission E</p><p>– Scientific publications: see p. 478; Buchbauer G, Jirovetz L, Jäger W et al:</p><p>Aromatherapy: Evidence for Sedative Effects of the Essential Oil of Lavender</p><p>after Inhalation. Z Naturforsch 46c (1991), 1067–1072; Hausen B;</p><p>Allgeriepflanzen, Pflanzenallergie. ecomed Verlagsgesellsch. mbH, Lands-</p><p>berg 1988.</p><p>English Plantain (Plantago lanceolata L.)</p><p>➤ Synonyms: Ribwort; Spitzwegerich (Ger.)</p><p>➤ General comments: English plantain has been used in many indications since</p><p>antiquity. It is distributed in cool to moderate zones throughout the world.</p><p>➤ Pharmacology</p><p>– Herb: English plantain leaftherb (Plantaginis lanceolatae folium/herba).</p><p>The herb consists of the fresh or dried aerial parts of Plantago lanceolata L.,</p><p>collected at the time of flowering, and preparations of the same.</p><p>– Important constituents: Iridoids (2–3 %), including aucubin, rhinanthin, and</p><p>catalpol, as well as mucilage (2–6 %), flavonoids, and tannins (6 %).</p><p>– Pharmacological properties: Fluid extracts and expressed juices from the</p><p>fresh leaves have bactericidal effects due to their content of aucubigenin</p><p>(hydrolyzed aucubin) and an antimicrobial saponin. English plantain prep-</p><p>arations have a short shelf-life, because aucubigenin is unstable. Aqueous</p><p>English plantain extracts promote wound healing and accelerate blood co-</p><p>agulation. Aucubin is assumed to protect the liver and soothe the mucous</p><p>membranes when inflamed. The tannins have astringent effects.</p><p>➤ Indications</p><p>– Colds and fever</p><p>– Skin inflammations</p><p>– Coughs and bronchitis</p><p>– Inflammations of the mouth and throat</p><p>– Runny nose</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– Tea: Pour boiling water onto 2–4 g of the chopped herb, or place the dose</p><p>in cold water and bring to a boil. Steep for 10 minutes, then strain. 2 tea-</p><p>spoons = ca. 3 g herb.</p><p>Important: The enzyme that hydrolyzes aucubin is inactivated upon heat-</p><p>ing.</p><p>• Dosage: One cup, several times a day.</p><p>– Daily dose: 3–6 g herb.</p><p>– For inflammations of the mouth and throat, gargle with the tea infusion</p><p>several times a day.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb.</p><p>Plant Summaries—E</p><p>61</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: The internal and external uses of plantain are general-</p><p>ly regarded as safe and effective. Plantain is also a popular remedy in pediatric</p><p>medicine (cough syrups).</p><p>✿ Literature</p><p>– Monographs: DAB 1998, ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Murai M et al: Phenylethanoids in the</p><p>herb of Planatago lanceolata and inhibitory effects on arachidonic acid-</p><p>induced mouse ear edema. Planta Med 61 (1995), 479–480.</p><p>Eucalyptus Leaf (Eucalypti folium)</p><p>➤ Pharmacology</p><p>– Herb: Eucalyptus leaf (Eucalypti folium). The herb consists of the dried ma-</p><p>ture leaves of older Eucalyptus globulus L. B. trees.</p><p>– Important constituents: 1–3 % essential oil (1,8-cineole, 45–75 %,</p><p>α-pinene, β-pinene, pinocarvone), and flavonoids (rutin, hyperoside, quer-</p><p>cetin).</p><p>– Pharmacological properties: Eucalyptus leaf has secretomotor, expectorant,</p><p>astringent, and weakly spasmolytic action. The drug has anti-inflammatory</p><p>and antiproliferative effects in animals.</p><p>➤ Indications: Coughs and bronchitis.</p><p>➤ Contraindications: See Eucalyptus Oil, internal use.</p><p>➤ Dosage and duration of use</p><p>– Tea: Pour 150 mL boiling water onto 1.5–2 g of the finely chopped drug;</p><p>cover and steep for 5 to 10 minutes.</p><p>– Daily dose: 4–6 g dried leaves. One dose equals 1.5 g dried leaves.</p><p>➤ Adverse effects: Nausea, vomiting, and diarrhea can occur as rare side effects.</p><p>No cases of overdose have been reported.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Eucalyptus leaf is weaker than eucalyptus oil and</p><p>should be combined with equal parts of other expectorants such as thyme and</p><p>anise seed.</p><p>✿ Literature</p><p>– Monographs: DAB 1998; Commission E</p><p>– Scientific publications: see p. 478; Fenaroli’s Handbook of Flavor Ingredi-</p><p>ents, Vol. 1, 2 nd Ed., CRC Press 1975; Osawa K et al: Macrocarpals H, I, and</p><p>J from the leaves of Eucalyptus globulus. J Nat Prod 59 (1996), 824–827.</p><p>Eucalyptus Oil (Eucalyptus globulus L. B.)</p><p>➤ General comments: Eucalyptus oil is obtained by steam distilling and purify-</p><p>ing the essential oil extracted from the fresh leaves or branch tips of Eucalyptus</p><p>globulus L. B.</p><p>➤ Pharmacology</p><p>– Important constituents: 80 % (of the rectified essential oil) consists of 1,8-</p><p>cineole; p-cymene and α-pinene are also present.</p><p>– Pharmacological properties: Some of the</p><p>properties listed below refer to iso-</p><p>lated cineole. Eucalyptus oils have antibacterial and fungicidal effects in</p><p>vitro. Eucalyptus oil inhibits prostaglandin synthesis and has weak hyper-</p><p>emic effects when applied topically. The drug also has expectorant,</p><p>Plant Summaries—E</p><p>62</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>secretomotor, antitussive, and surface-active surfactant-like effects and</p><p>improves lung compliance.</p><p>➤ Indications</p><p>– Coughs and bronchitis</p><p>– Rheumatic complaints</p><p>➤ Contraindications</p><p>– Internal use: Eucalyptus oil should not be used by children under 12 years</p><p>of age or during the first trimester of pregnancy. It also should not be used</p><p>by patients with inflammations of the gastrointestinal or biliary tract or se-</p><p>vere liver diseases.</p><p>– External use: Eucalyptus oil should not be applied to the face of infants and</p><p>small children since it can cause laryngospasm, bronchospasm, asthma-like</p><p>attacks and/or respiratory arrest.</p><p>➤ Dosage and duration of use</p><p>– Internal use: Daily dose: 0.3–0.6 g drug (0.2 g = 10 drops). Take 3 to 6 drops</p><p>in 150 mL warm water several times a day. Inhalation: Add 2 to 3 drops to</p><p>boiling water and inhale the vapors.</p><p>– External use: Oily and semisolid forms with 5–20 % essential oil content.</p><p>Aqueous ethanol preparations with 5–10 % essential oil content. Liniment:</p><p>Rub a few drops of 20 % eucalyptus liniment onto the affected area of the</p><p>skin.</p><p>➤ Adverse effects: Nausea, vomiting and diarrhea are rare side effects.</p><p>Warning: Overdose can result in life-threatening poisoning (only a few drops</p><p>can cause severe poisoning in children, and 4 to 5 mL can cause lethal poison-</p><p>ing in adults). Signs include a drop in blood pressure, circulatory disorders, col-</p><p>lapse, and respiratory paralysis.</p><p>➤ Herb–drug interactions: Eucalyptus oil accelerates the decomposition of</p><p>pharmaceutical drugs, thereby weakening or shortening their effectiveness.</p><p>➤ Summary assessment: Preliminary studies (see Literature) show that euca-</p><p>lyptus oil might be effective as an inhalant in steams to reduce inflammation</p><p>and congestion in sinus conditions related to the common cold, asthma, and</p><p>respiratory allergies.</p><p>✿ Literature</p><p>– Monographs: DAB 10; ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Juergens UR, Stober M, Vetter H: Inhi-</p><p>bition of cytokine production and arachidonic acid metabolism by eucalyp-</p><p>tol (1,8-cineole) in human blood monocytes in vitro. Eur J Med Res, 3(11)</p><p>(1998), 508–510; Riechelmann H, Brommer C, Hinni M, Martin C: Response</p><p>of human ciliated respiratory cells to a mixture of menthol, eucalyptus oil</p><p>and pine needle oil. Arzneimittelforschung 47(9) (1997), 1035–1039;</p><p>Gräfe AK: Besonderheiten der Arzneimitteltherapie im Säuglings- und</p><p>Kindesalter. PZ 140 (1995), 2659–2667.</p><p>European Elder (Sambucus nigra L.)</p><p>➤ General comments: Elder flowers and fruit (berries) are used in medicine.</p><p>➤ Pharmacology</p><p>– Herb</p><p>• Elder flower (Sambuci flos). The herb consists of the dried and sifted</p><p>flower heads of Sambucus nigra L. and preparations of the same.</p><p>Plant Summaries—F</p><p>63</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>• Elder berry (Sambuci fructus). The herbal preparations are syrups and</p><p>powdered extracts in capsules and tablets.</p><p>– Important constituents: Flavonoids (3 %), including rutin, isoquercitrin,</p><p>quercetin, and hyperoside, essential oil (0.03–0.14 %), and caffeic acid de-</p><p>rivatives (ca. 3 %).</p><p>– Pharmacological properties: Elder flower was found to increase bronchial</p><p>secretion in animals. The essential oil and flavonoids play a role in its su-</p><p>dorific (sweat-producing) action, but no scientific investigations are avail-</p><p>able on this subject. Elder fruit is used for easing the symptoms of colds and</p><p>flu. Some research in human cell cultures demonstrates antiviral and im-</p><p>munomodulating effects. Two small clinical trials showed shortening of re-</p><p>covery time in patients with influenza. Elder berry is not officially recom-</p><p>mended in a German monograph.</p><p>➤ Indications</p><p>– Fever and colds, mild cases of flu</p><p>– Coughs and bronchitis (supportive)</p><p>– Antiviral and immunomodulating effects as demonstrated in some small</p><p>clinical trials</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– Tea: Steep 2 teaspoons (3–4 g) of elder flower in 150 mL of boiled water for</p><p>5 minutes.</p><p>• Dosage: One to two cups of the tea, as hot as possible, several times a day</p><p>(especially in the second half of the day).</p><p>– Daily dose: 10–15 g drug.</p><p>– Fruit and syrups: Infuse 1 teaspoon in 1 cup of freshly boiled water for 30</p><p>minutes, and drink 1 cup 2 or 3 times daily. For syrups, 2 to 3 teaspoons</p><p>daily.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Elder flower is a widely used household remedy with</p><p>long traditional use in the specified indications. Use of elder berry is more com-</p><p>mon in North America.</p><p>✿ Literature</p><p>– Monographs: Commission E</p><p>– Scientific publications: see p. 478</p><p>European Golden Rod (Solidago virgaurea L.)</p><p>➤ Pharmacology</p><p>– Herb: European golden rod (Solidaginis virgaureae herba). The herb consists</p><p>of the aerial parts of Solidago virgaurea (L.).</p><p>– Important constituents: Triterpene saponins (0.2–0.3 %), essential oil (0.4–</p><p>0.5 %; less than 0.2 % in the stored drug), polysaccharides (6–8 %), 1.1–2 %</p><p>flavonoids (rutin, 0.8 %), phenol glycosides (0.2–1.0 %), and caffeic acid de-</p><p>rivatives (0.2–0.4 %).</p><p>– Pharmacological properties: European golden rod has diuretic and analgesic</p><p>action (due to the content of phenol glycosides). The essential oil and</p><p>Plant Summaries—F Plant Summaries—E</p><p>64</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>saponins have antimicrobial, weakly spasmolytic, antiexudative, and</p><p>aquaretic effects.</p><p>➤ Indications</p><p>– Used for irrigation therapy, to flush the kidneys of patients with urinary</p><p>tract infections and to eliminate renal or urinary calculi.</p><p>– For prevention of urinary calculi and renal gravel.</p><p>➤ Contraindications: Irrigation therapy is not recommended in patients with</p><p>cardiac or renal edema.</p><p>➤ Dosage and duration of use</p><p>– Tea: Steep 1 to 2 teaspoons (3–5 g) of the dried herb in ca. 150 mL of boiled</p><p>water for 15 minutes.</p><p>• Dosage: One cup, between meals, 2 to 4 times a day.</p><p>– Daily dose: 6–12 g chopped drug for infusions or other internally used</p><p>galenicals.</p><p>Important: An ample supply of fluids is essential.</p><p>➤ Adverse effects: No known health hazards.</p><p>➤ Herb–drug interactions: None known.</p><p>Warning: Patients with chronic renal disease should not use European golden</p><p>rod unless instructed by a physician or qualified health care provider.</p><p>➤ Summary assessment: The indications for European goldenrod are based on</p><p>the pharmacological properties of its constituents and therapeutic experience.</p><p>European goldenrod combines well with other aquaretic and urinary dis-</p><p>infectant drugs.</p><p>➤ Literature</p><p>– Monographs: DAB 1998; ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Bader G, Wray, V, Hiller, K: The main</p><p>saponins from the arial parts and the roots of Solidago virgaurea subsp.</p><p>virgaurea. Planta Med 61 (1995), 158–161; Hiller K, Bader G: Goldruten-</p><p>Kraut–Portrait einer Arzneipflanze. Z Phytother 17 (1996), 123–130.</p><p>Plant Summaries—E</p><p>65</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Fennel (Foeniculum vulgare Miller)</p><p>➤ General comments: The oil and</p><p>seedlike fruit of Foeniculum vulgare Miller are</p><p>used in medicine.</p><p>➤ Pharmacology</p><p>– Herb</p><p>• Fennel oil (Foeniculi aetheroleum) is the essential oil obtained by steam</p><p>distilling the dried ripe fruit of common fennel (Foeniculum vulgare) or</p><p>sweet fennel (Foeniculum dulce).</p><p>• Fennel seed/fruit (Foeniculi fructus) is the dried ripe fruit of Foeniculum</p><p>vulgare M. var. vulgare.</p><p>– Important constituents</p><p>• Common fennel: trans-Anethole (50–75 %), fenchone (12–33 %), and es-</p><p>tragole (2–5 %).</p><p>• Sweet fennel: trans-Anethole (80–90 %), fenchone (1–10 %), and es-</p><p>tragole (3–10 %).</p><p>• Both varieties contain flavonoids, rutin, and fatty oil (9–21 %).</p><p>➤ Pharmacological properties</p><p>– Anethole promotes smooth-muscle motility in the digestive tracts; higher</p><p>doses have antispasmodic effects. A dose-dependent reduction of the den-</p><p>sity of respiratory fluid (bronchosecretolysis) occurs. Fenchone has anti-</p><p>microbial and fungicidal effects in vitro.</p><p>– Fennel seed has a spasmolytic effect on the smooth muscles and accelerates</p><p>the vibration rate of the ciliary epithelium of the bronchial mucosa (secreto-</p><p>motor action). When used in vitro, fennel is antimicrobial, gastric motility-</p><p>enhancing, antiexudative, and presumably antiproliferative.</p><p>➤ Indications</p><p>– Dyspeptic complaints</p><p>– Coughs and bronchitis</p><p>– Catarrh of the upper respiratory tract in children (fennel honey or syrup)</p><p>➤ Contraindications: Fennel oil should not be used by pregnant mothers or</p><p>small children.</p><p>➤ Dosage and duration of use</p><p>– Fennel honey (contains 0.5 g fennel oil per kg) or fennel syrup:</p><p>• Daily dose: 10–20 g. The sugar content must be taken into account when</p><p>used by diabetic patients.</p><p>– Fennel oil</p><p>• Dosage: 2–5 drops, diluted in water or chamomile tea, after each meal.</p><p>• Daily dose: 0.1–0.6 mL. Should not be used for more than 2 weeks.</p><p>– Fennel seed tea: Steep 2–5 g of the herb, crushed or ground immediately</p><p>prior to use, in 150 mL of boiled water for 10 to 15 minutes.</p><p>• Dosage: One cup between meals, 2 to 4 times a day.</p><p>• Daily dose: 5–7 g crushed fruits.</p><p>– Fennel syrup: Fennel tincture: 0.8 mL (30 drops) to 2 mL, 3 times a day.</p><p>• Daily dose: 10–20 g. Should not be used for more than 2 weeks without</p><p>consulting an experienced practitioner.</p><p>➤ Adverse effects: No known health hazards. Allergic reactions can occur as a</p><p>very rare side effect. Cross-reactions with celery allergies are also possible.</p><p>➤ Herb–drug interactions: None known.</p><p>Plant Summaries—F</p><p>66</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ Summary assessment: Fennel is a herb used worldwide with empirically</p><p>demonstrated effects.</p><p>✿ Literature</p><p>– Monographs</p><p>• Fennel oil: DAB 1998; Commission E</p><p>• Fennel seed: ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Hiller K: Pharmazeutische Bewertung</p><p>ausgewählter Teedrogen. Deutsche Apotheker Ztg 135 (1995), 1425–1440;</p><p>Massoud H: Study on the essential oil in seeds of some fennel cultivars un-</p><p>der Egyptian environmental conditions. Planta Med 58 (1992), A681; Par-</p><p>zinger R: Fenchel. Deutsche Apotheker Ztg 136 (1996), 529–530; Albert-</p><p>Puleo M: J Ethnopharmacol 2 (1980), 337; Betts TJ: J Pharm Pharmacol 20</p><p>(1968), 61–64, 469–472; Czygan FC: Z Phytother 8 (1987), 82; El-Khrisy</p><p>EAM et al: Fitoterapia 51 (1980), 273; Forster HB et al: Planta Med 40</p><p>(1980), 309; Harborne JB, Williams CE: Phytochemistry 11 (1972), 1741–</p><p>1750; Harries N et al: J Clin Pharm 2 (1978), 171; Rothbacher H, Kraus A:</p><p>Pharmazie 25 (1970), 566; Trenkle K: PA 27 (1972), 319–324.</p><p>Flax (Linum usitatissimum L.)</p><p>➤ Synonyms: Flaxseed; Leinsamen (Ger.)</p><p>➤ General comments: There are many species of flax. Some are used to make</p><p>fabrics, whereas others are used to produce flaxseed oil, a valuable foodstuff</p><p>and medicinal product.</p><p>➤ Pharmacology</p><p>– Herb: Flaxseed (Lini semen). The herb consists of the ripe, dried seeds of</p><p>Linum usitatissimum and preparations of the same.</p><p>– Important constituents: 3–10 % mucilage (arabinoxylans, galactans, rham-</p><p>nogalacturonans), cyanogenetic glycosides (0.05–0.1 %), and 10–45 % fatty</p><p>oil (linolenic acid, 40–70 %; linoleic acid, 10–25 %; oleic acid, 13–30 %).</p><p>– Pharmacological properties: Linseed has laxative action due to its fiber and</p><p>mucilage components. Linseed lowers the cholesterol concentration in the</p><p>liver of animals. Prussic acid is not produced from the cyanogenetic acids.</p><p>➤ Indications</p><p>– Constipation</p><p>– Gastritis</p><p>– Enteritis</p><p>– Skin irritations</p><p>➤ Contraindications: Bowel obstruction, esophageal stenosis or narrowing of</p><p>the gastrointestinal tract and acute inflammatory diseases of the bowel, eso-</p><p>phagus, or cardia.</p><p>➤ Dosage and duration of use</p><p>– Internal use</p><p>• Constipation: One tablespoon of whole or crushed flaxseed, 2 to 3 times</p><p>a day, in two 6-ounce glasses of water (at least 150 mL).</p><p>• Gastritis, enteritis: Flaxseed gruel prepared using 2 to 3 tablespoons of</p><p>ground or chopped flaxseed.</p><p>– External use (poultices): For inflammatory skin diseases, prepare a gruel made</p><p>by mixing 125 g of flaxseed meal with 1 cup of water and wrap in a suitable</p><p>cloth. Apply a hot, wet poultice to the affected area of the skin twice daily.</p><p>Plant Summaries—F</p><p>67</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ Adverse effects: Bowel obstruction can occur when large quantities of flax-</p><p>seed are used to treat constipation without an adequate intake of fluids. The</p><p>cyanogenetic glycosides do not pose a health risk. Some commercial flaxseeds</p><p>have been identified in the past that contain levels of cadmium beyond recom-</p><p>mended government limits. This should be considered during chronic use of</p><p>flaxseed.</p><p>➤ Herb–drug interactions: Flaxseed can impair the absorption of pharmaceuti-</p><p>cal drugs or herbal preparations containing very potent constituents such as</p><p>cardiac glycosides (i. e. Digitalis spp.) if taken concomitantly.</p><p>➤ Summary assessment: Flaxseed is an herbal laxative that is also suitable for</p><p>treatment of chronic constipation. It has a very low rate of side effects and does</p><p>not interfere with the physiology of the bowels.</p><p>✿ Literature</p><p>– Monographs: ESCOP; Commission E</p><p>– Scientific publications: see p. 478.</p><p>Frangula (Rhamnus frangula L.)</p><p>➤ Synonyms: Alder buckthorn, black alder; Faulbaum (Ger.)</p><p>➤ Pharmacology</p><p>– Herb: Frangula bark (Frangulae cortex). The herb consists of the dried bark</p><p>of branches and twigs of Rhamnus frangula L. (Frangula alnus Miller)</p><p>Important: Since fresh Frangula bark can induce nausea, the drug must be</p><p>stored for one year before use.</p><p>– Important constituents: Anthraquinone derivatives (4–6 %), including an-</p><p>thranoids, glucofrangulin A and B, and frangulins A, B and C.</p><p>– Pharmacological properties: Anthraquinones promote the active secretion</p><p>of electrolytes and water into the intestinal lumen while simultaneously</p><p>inhibiting their absorption from the intestine. The liquefaction of the bowel</p><p>contents leads to an increase in intestinal filling pressure. Stimulation of</p><p>intestinal peristalsis also occurs.</p><p>➤ Indications: For short term treatment of occasional constipation.</p><p>➤ Contraindications: Bowel obstruction, acute inflammation of the bowels, ap-</p><p>pendicitis. Frangula bark should not be used by children under 10 years of age</p><p>or by pregnant or nursing mothers.</p><p>➤ Dosage and duration of use</p><p>– Tea: Steep 2 g of the finely chopped dried bark in 150 mL of boiled water for</p><p>15 minutes.</p><p>• Dosage: One cup in the morning and evening. Sweeten with honey and</p><p>add orange peel to taste if desired.</p><p>– An aqueous suspension containing 0.6 g of the powdered drug normally</p><p>produces a bowel movement within 6 to 24 hours.</p><p>– Daily dose of glucofrangulins: 20–30 mg, calculated based on the content of</p><p>glucofrangulin A.</p><p>– The smallest dose required to produce soft stools should be used.</p><p>– Duration of treatment: No more than 1 to 2</p><p>weeks.</p><p>➤ Adverse effects: Vomiting and cramplike gastrointestinal complaints.</p><p>Warning: Prolonged use leads to the loss of electrolytes, especially potassium</p><p>ions, which can result in hyperaldosteronism, inhibit intestinal motility and,</p><p>in rare cases, cause cardiac arrhythmia, nephropathy, muscle weakness,</p><p>edema, muscle weakness and accelerated bone degeneration.</p><p>Plant Summaries—F</p><p>68</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ Herb–drug interactions: Because of the loss of calcium, the drug can increase</p><p>the effects of cardiac glycosides if taken concurrently.</p><p>➤ Summary assessment: Frangula bark should be taken only for short periods</p><p>of time to alleviate constipation or to empty the bowels prior to X-ray exami-</p><p>nations. In North America, cascara sagrada (Rhamnus purshianus) is more com-</p><p>monly used in this way.</p><p>✿ Literature</p><p>– Monographs: DAB 10; ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Anon: Abwehr von Arzneimittelrisiken,</p><p>Stufe II. Deutsche Apotheker Ztg. 136 (1996), 3253–3254.</p><p>Fumitory (Fumaria officinalis L.)</p><p>➤ Synonyms: Earthsmoke; Erdrauch (Ger.)</p><p>➤ General comments: The dried herb and fresh aerial parts collected at the time</p><p>of flowering are used in medicine.</p><p>➤ Pharmacology</p><p>– Herb: Fumitory herb (Fumariae herba). The herb consists of the dried aerial</p><p>parts of Fumaria officinalis L. collected at the time of flowering.</p><p>– Important constituents: Isoquinoline alkaloids (1.25 %), including (−)-</p><p>scoulerin, protopine/fumarine, fumaricin, (+)-fumarilin, fumaretin, and</p><p>fumarofin. Flavonoids (rutin), fumaric acid, and hydroxycinnamic acid</p><p>derivatives (caffeoylmalic acid) are also present.</p><p>– Pharmacological properties: Mild spasmolytic action in the biliary tract and</p><p>gastrointestinal tract.</p><p>➤ Indications</p><p>– Liver and gallbladder complaints</p><p>– Cholelithiasis</p><p>– Cholecystitis</p><p>– Diseases of the liver</p><p>– Other diseases of the gallbladder/biliary tract</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– Tea: Steep 2–3 g of the dried herb in 150 mL of boiled water for 10</p><p>minutes.</p><p>• Dosage: One cup of the warm tea 30 minutes before meals.</p><p>– Tincture: 1 : 5. Dose: 2–4 ml, 3 times daily.</p><p>– Expressed juice: 2 to 3 teaspoons (2.4–3.5 g drug) a day, to be taken as a cold</p><p>infusion (maceration) or hot infusion.</p><p>– Freshly triturated plant material: 1 teaspoon, 3 times a day.</p><p>– Daily dose: 6 g dried herb.</p><p>➤ Adverse effects: No known health hazards.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Mild herbal preparation, mainly used in supportive</p><p>program for liver and gallbladder problems.</p><p>✿ Literature</p><p>– Monographs: BHP 96; DAB 1998; EB 6; HAB 1; Commission E, Mar 31; PF X</p><p>– Scientific publications: see p. 478; Duke JA: Die amphochloeretische</p><p>Wirkung der Fumaria officinalis. Z Allg Med 34 (1985), 1819; Hahn R,</p><p>Nahrstedt A: High Content of Hydroxycinnamic Acids Esterified with (+)-D-</p><p>Malic-Acid in the Upper Parts of Fumaria officinalis. Planta Med 59 (1993),</p><p>Plant Summaries—F</p><p>69</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>189; Roth L, Daunderer M, Kormann K: Giftpflanzen, Pflanzengifte. 4. Aufl.,</p><p>Ecomed Fachverlag Landsberg/Lech 1993; Willaman JJ, Hui-Li L: Lloydia 33</p><p>(1970), 1.</p><p>Plant Summaries—F</p><p>70</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Garlic (Allium sativum L.)</p><p>➤ General comments: Garlic is an ancient culinary and medicinal herb, the bulbs</p><p>of which are used in medicine.</p><p>➤ Pharmacology</p><p>– Herb: Garlic (Allii sativi bulbus). The herb consists of the fresh or dried bulbs</p><p>of Allium sativum L., which consist of a main bulb and several daughter</p><p>bulbs.</p><p>– Important constituents: Alliins (ca. 1 %), propenylalliin (ca. 0.2 %), methylal-</p><p>liin, and alliaceous oils (allicin and ajoene).</p><p>– Pharmacological properties: Garlic is antimicrobial, antilipemic, vasodilato-</p><p>ry, antioxidant, and fibrinolytic, and inhibits platelet aggregation. Clinical</p><p>studies demonstrated that the herb inhibits platelet aggregation, increases</p><p>the bleeding and coagulation times, lowers serum lipids in some individu-</p><p>als, and enhances fibrinolytic activity.</p><p>➤ Indications: The following indications are recommended in the monographs:</p><p>– Prevention of arteriosclerosis</p><p>– Hypertension</p><p>– There has been some convincing experience, but no rating by the Commis-</p><p>sion E, in the following indications:</p><p>• For minor infections</p><p>• For supporting therapy of gastric ulcers because of a strong anti-</p><p>Helicobacter activity</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– Daily dose: 4 g fresh garlic, that is, 1 to 2 fresh garlic bulbs per day or the</p><p>corresponding dose of a commercial preparation. Garlic must be crushed to</p><p>release allicin immediately before it is used in any way.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb. Consumption of large quantities of garlic can irritate the stomach.</p><p>➤ Herb–drug interactions: There is a slight possibility of interaction with blood-</p><p>thinning medications such as dicoumarol.</p><p>Warning: Avoid use of garlic for approximately 1 week before and after</p><p>major surgery.</p><p>➤ Summary assessment: Garlic is an ancient medicinal herb, the uses of which</p><p>have been investigated in a number of studies. The antihypertensive and lipid-</p><p>lowering effects are rather weak. There is still need for further research on the</p><p>herb.</p><p>✿ Literature</p><p>– Monographs: ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Ide N et al: Aged garlic extract and its</p><p>constituents inhibit Cu++ -induced oxidative modification of low density</p><p>lipoproteins. Planta Med 63 (1997), 263–264; Koch HP, Lawson LD: Garlic</p><p>– The Science and Therapeutic Application of Allium sativum L. and Related</p><p>Species, Williams & Wilkins, Baltimore, 1996; Orekov AN, Gruenwald J:</p><p>Effects of Garlic on Atherosclerosis. Nutrition 13 (1997), 656–663.</p><p>Ginger (Zingiber officinale Roscoe)</p><p>➤ General comments: The plant is indigenous to the Southeast Asian region. The</p><p>rhizome is used in medicine.</p><p>Plant Summaries—G</p><p>71</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ Pharmacology</p><p>– Herb: Ginger root (Zingiberis rhizoma). The herb consists of the peeled fresh</p><p>or dried rhizomes of Zingiber officinalis R. and preparations of the same.</p><p>– Important constituents: Essential oil (2.5–3.0 %) containing α-zingiberene,</p><p>ar-curcumene, β-bisabolene, neral, geranial, (E)-α-farnesene, and zin-</p><p>giberol. Gingerols, diarylheptanoids (gingerenones A and B), and starch</p><p>(50 %) are also present.</p><p>– Pharmacological properties: Ginger has antiemetic action, stimulates the</p><p>flow of saliva and gastric juices, and increases intestinal peristalsis. It also</p><p>has known antibacterial, antifungal, molluscacidal, nematocidal, and anti-</p><p>platelet effects.</p><p>➤ Indications</p><p>– Lack of appetite</p><p>– Travel sickness</p><p>– Dyspeptic complaints</p><p>– External use as a compress for contusion and arthritis pain</p><p>➤ Contraindications</p><p>– Morning sickness of pregnancy</p><p>➤ Dosage and duration of use</p><p>– Internal use: Daily dose: 2–4 g dried or fresh rhizome.</p><p>• Tea: Simmer 0.5–1 g of the dried or fresh, sliced or coarsely powdered</p><p>rhizome in a covered pot for 15 minutes, then pass through a tea strainer</p><p>(1 teaspoon = ca. 3 g drug).</p><p>• As an antiemetic: Take 2 g of the freshly powdered rhizome in fluids.</p><p>– One dose equals 0.3–1.5 g herb.</p><p>– External use: A compress of warm ginger tea for contusions and arthritis</p><p>pain (see p. 309).</p><p>➤ Adverse effects: There</p><p>are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb.</p><p>Warning: Owing to its cholagogic activity, patients with gallstones should not</p><p>use ginger before consulting a qualified health care provider.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Ginger is a well-investigated herb with demonstrated</p><p>effectiveness in the specified indications. The majority of clinical trials per-</p><p>formed showed a benefit for postoperative nausea, motion sickness, and</p><p>morning sickness, but a few studies showed no effect.</p><p>✿ Literature</p><p>– Monographs: DAB 1998; ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Kawai T et al: Anti-emetic principles of</p><p>Magnolia obovata bark and Zingiber officinale rhizome. Planta Med 60</p><p>(1994), 17; Kikuzaki H, Tsai SM, Nakatani N: Gingerdiol related compounds</p><p>from the rhizomes of Zingiber officinale. Phytochemistry 31 (1992), 1783–</p><p>1786.</p><p>Ginkgo (Ginkgo biloba L.)</p><p>➤ Synonyms: Japanese temple tree, maidenhair tree; Ginkgobaum (Ger.)</p><p>➤ Pharmacology</p><p>– Herb: Ginkgo leaf (Ginkgo bilobae folium). The herb consists of the dried</p><p>leaves of Ginkgo biloba L. and preparations of the same.</p><p>Plant Summaries—G</p><p>72</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>– Important constituents: Flavonoids (0.5–1.8 %), including quercetin bio-</p><p>sides, monosides, and triosides, isorhamnetins, and 3´-O-methyl myris-</p><p>ticins as well as biflavonoids (0.4–1.9 %), proanthocyanidins (8–12 %), di-</p><p>terpenes (0.06–0.23 %; ginkgolides A, B, C), and sesquiterpenes (bilobalide,</p><p>0.04–0.2 %).</p><p>– Pharmacological properties: Ginkgo has antioxidant and membrane-stabi-</p><p>lizing activity and improves the circulation. In addition, it increases cere-</p><p>bral tolerance to hypoxia, reduces the age-related reduction of muscarin-</p><p>ergic choline receptors and α2-adrenoceptors, and increases the hip-</p><p>pocampal absorption of choline. In animals, bilobalide and ginkgolides</p><p>were found to improve the flow capacity of the blood by lowering viscosity,</p><p>inactivating toxic oxygen radicals and improving the circulation in cerebral</p><p>and peripheral arteries. The herb inhibits the development and promotes</p><p>the elimination of cerebral edema, improves the utilization of ATP and glu-</p><p>cose, and stabilizes the cell membranes. Clinical, controlled double-blind</p><p>studies in humans have confirmed the results of animal experiments (gink-</p><p>go was found to improve the memory capacity and microcirculation and</p><p>reduce the viscosity of plasma).</p><p>➤ Indications</p><p>– Several small studies found a moderate benefit when using Ginko for ver-</p><p>tigo (dizziness) and tinnitus of vascular and involutional origin.</p><p>– Circulatory disorders (peripheral artery occlusion, especially intermittent</p><p>claudication, for which some controlled studies reported a benefit).</p><p>– Memory enhancement in younger people or people with no preexisting</p><p>memory impairment has been suggested, with both positive and negative</p><p>recent clinical trials, but this remains controversial.</p><p>– For symptomatic treatment of cerebro-organic impairment of mental per-</p><p>formance. (Controlled studies showed modest, but statistically significant</p><p>positive results for cerebral insufficiency. Several reports have indicated</p><p>modest benefit in controlled studies for Alzheimer’s and non-Alzheimer’s</p><p>dementia.)</p><p>➤ Contraindications: Hypersensitivity to ginkgo preparations.</p><p>➤ Dosage and duration of use</p><p>– For decreased mental performance: Oral daily dose: 120–240 mg of a spe-</p><p>cially formulated, standardized Ginkgo biloba extract (GBE; 24 % flavone</p><p>glycosides, 6 % terpenoids), divided into 2 to 3 portions, to be taken for a</p><p>period of at least 12 weeks. Thereafter, treatment should be continued after</p><p>a positive assessment result.</p><p>– For peripheral artery occlusion, vertigo, and tinnitus: 120–160 mg GBE per</p><p>day. Used for 6 to 8 weeks for treatment of vertigo and tinnitus; longer use</p><p>is only justified if some improvement can be registered. According to some</p><p>studies use for at least 3 months is necessary for full effect.</p><p>➤ Adverse effects: Mild gastrointestinal complaints, headaches, and allergic re-</p><p>actions are very rare side effects.</p><p>➤ Herb–drug interactions: May potentiate anticoagulant activity of aspirin,</p><p>warfarin, heparin, and other similar drugs.</p><p>Warning: Caution may be indicated during the perioperative period (see</p><p>Herb–drug interactions).</p><p>➤ Summary assessment: Ginkgo is an herb with a number of positive and well-</p><p>designed clinical trials, especially for improving symptoms of dementia in the</p><p>Plant Summaries—G</p><p>73</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>elderly. Also improvement of walking performance in intermittent claudica-</p><p>tion has been shown. Despite some positive trials, memory enhancement in</p><p>healthy persons remains controversial. Treatment should not be initiated be-</p><p>fore consulting a qualified health care provider.</p><p>✿ Literature</p><p>– Monographs, ESCOP; Commission E (the positive assessment in the mono-</p><p>graph applies only to a specially formulated, standardized GBE; see p. 72).</p><p>– Scientific publications: see p. 478; Caesar W: Alles über Ginkgo. Deutsche</p><p>Apotheker Ztg 134 (1994), 4363; Deutsches Institut für medizinische</p><p>Dokumentation und Information (Ed): ICD-10. Internationale und statis-</p><p>tische Klassifikation der Krankheiten und verwandter Gesundheitspro-</p><p>bleme. 10. Revision. Bd 1. Urban & Schwarzenberg, München Wien Balti-</p><p>more 1994; Dingermann T: Phytopharmaka im Alter: Crataegus, Ginkgo,</p><p>Hypericum und Kava-Kava. PZ 140 (1995), 2017–2024; Hopfenmüller W:</p><p>Nachweis der therapeutischen Wirksamkeit eines Ginkgo biloba-Spe-</p><p>zialextraktes. Metaanalyse von 11 klinischen Studien bei Patienten mit</p><p>Hirnleistungsstörungen im Alter. Arzneim Forsch/Drug Res 44 (1994),</p><p>1005–1013; Joyeux M et al: Comparative antilipoperoxidant, antinecrotic</p><p>and scavenging properties of terpenes and biflavones from Ginkgo and</p><p>some flavonoids. Planta Med 61 (1995), 126–129; Kanowski S et al: Proof</p><p>of efficacy of the ginkgo biloba special extract Egb 761 in outpatients suf-</p><p>fering from primary degenerative dementia of the Alzheimer type and multi-</p><p>infarct dementia. Pharmacopsychiatry 4 (1995), 149 –158; Pfister-Hotz G:</p><p>Phytotherapie in der Geriatrie. Z Phytother 18 (1997), 165–162.</p><p>Plant Summaries—G</p><p>74</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Hawthorn (Crataegus laevigata (Poiret) D. C.)</p><p>➤ General comments: Many species of hawthorn are distributed throughout the</p><p>moderate zones of the Northern Hemisphere. The use of its leaves and flowers</p><p>as a remedy for heart disorders dates back to the nineteenth century.</p><p>➤ Pharmacology</p><p>– Herb: Hawthorn leaf and flower (Crataegi folium cum flore). The herb con-</p><p>sists of the leaves and flowers of Crataegus laevigata DC. or, less frequently,</p><p>of other hawthorn species.</p><p>– Important constituents: Flavonoids (1.8 %) such as hyperoside (0.28 %), rutin</p><p>(0.17 %), and vitexin (0.2 %), and oligomeric procyanidins (2–3 %).</p><p>– Pharmacological properties: The procyanidins and flavonoids in hawthorn</p><p>determine its therapeutic action. These substances effect an increase in cor-</p><p>onary blood flow and dilate the blood vessels, thereby enhancing myocar-</p><p>dial circulation and perfusion. The herb has positive inotropic, chronotropic</p><p>and dromotropic effects, and improves the tolerance to hypoxia. The cardio-</p><p>tropic effects of Crataegus are attributed to an increase in the membrane</p><p>permeability to calcium ions and an increase in the intracellular cyclic AMP</p><p>concentration. Altogether, this makes the heart work more economically.</p><p>➤ Indications</p><p>– Supportive treatment for heart failure (NYHA</p><p>class I–II)</p><p>– As a strengthening tonic for prevention of heart irregularities and conges-</p><p>tive heart failure</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– Daily dose: 3.5–19.8 mg flavonoids, calculated as hyperoside (DAB 10), or</p><p>160–900 mg extract (4 : 1 to 7 : 1 with ethanol 45 % v/v or methanol 70 %</p><p>v/v), corresponding to 30–168.7 mg oligomeric procyanidins, calculated as</p><p>epicatechol. Hawthorn leaf/flower can be used for unlimited periods.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Clinical studies demonstrating the efficacy of haw-</p><p>thorn leaf/flower in NYHA class I–II heart failure are available.</p><p>✿ Literature</p><p>– Monographs: DAB 1998; ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Bahorun T, Gressier B, Trotin F et al:</p><p>Oxygen species scavenging activity of phenolic activities, fresh plant organs</p><p>and pharmaceutical preparations. Arzneim Forsch 46 (1996), 1086–1089;</p><p>Kaul R: Pflanzliche Procyanidine. Vorkommen, Klassifikation und pharma-</p><p>kologische Wirkungen. PUZ 25 (1996), 175–185; Tauchert M, Loew D:</p><p>Crataegi folium cum flore bei Herzinsuffizienz. In: Loew, D., Rietbrock, N.</p><p>(Ed): Phytopharmaka in Forschung und klinischer Anwendung. Steinkopf</p><p>Verlag, Darmstadt (1995), 137–144.</p><p>Plant Summaries—H</p><p>75</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Heartsease (Viola tricolor L.)</p><p>➤ Synonyms: Wild pansy; Wildes Stiefmütterchen (Ger.)</p><p>➤ General comments: Heartsease is distributed throughout all the temperate</p><p>regions of Eurasia. The herb has been used as a remedy for skin ailments since</p><p>the middle ages.</p><p>➤ Pharmacology</p><p>– Herb: Heartsease (Violae tricoloris herba). The herb consists of the dried</p><p>aerial parts of Viola tricolor L., collected at the time of flowering, and prep-</p><p>arations of the same. The subspecies vulgaris (K.) O and arvensis (M.) G. are</p><p>the main herb sources.</p><p>– Important constituents: Flavonoids, 0.2–0.4 % (rutin, 23 %), phenolcarbox-</p><p>ylic acids such as salicylic acid (0.06–0.3 %) and violutoside, mucilage</p><p>(10 %), and tannins (2–5 %).</p><p>– Pharmacological properties: Mucilage has soothing properties. In animal ex-</p><p>periments, eczema was found to improve after long-term oral administra-</p><p>tion of the herb.</p><p>➤ Indications: Skin inflammations.</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use: Steep 1 teaspoon of the finely chopped herb in</p><p>1 cup of hot water for 5 minutes. Soak gauze compresses in the infusion and</p><p>apply to the affected area of the skin.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Wild pansy is most commonly used to treat milk crust</p><p>and mild seborrheic skin conditions. Industrial wild pansy preparations are not</p><p>available.</p><p>✿ Literature</p><p>– Monographs: Commission E</p><p>– Scientific publications: see p. 478</p><p>Hops (Humulus lupulus L.)</p><p>➤ General comments: The hop plant has a very bitter taste and is an important</p><p>ingredient in beer brewing. The cones of the hop plant are used in medicine.</p><p>➤ Pharmacology</p><p>– Herb: Hops/hop cones (Lupuli flos). The herb consists of the whole, dried</p><p>female inflorescences of Humulus lupulus L. and preparations of the</p><p>same.</p><p>– Important constituents: 10 % acylphloroglucinols (α-bitter acids, humulone,</p><p>β-bitter acids, lupulone), 0.3–1.0 % essential oil (myrcene, 27–62 %), humu-</p><p>lene, 2-methylbut-3-en-2-ol), tannins, and flavonoids (isoxanthohumol).</p><p>– Pharmacological properties: Hops can have sedative effects; the drug pro-</p><p>motes the induction of sleep. The efficacy of the drug depends on the quality</p><p>of the individual extract. In animals, 2-methyl-3-buten-2-ol was found to</p><p>produce lasting, profound anesthetic sleep. The bitter acids in hops have</p><p>antibacterial/antimycotic action and stimulate the secretion of gastric</p><p>juices.</p><p>➤ Indications: Nervous tension and insomnia.</p><p>Plant Summaries—H</p><p>76</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– One dose equals 0.5 g herb.</p><p>– Single dose when used as a sleep aid is 1–2 g herb.</p><p>– Single dose when used for nervous tension is 2 to 3 cups of the tea during</p><p>the daytime and before retiring. Infuse 1–2 g of the dried strobiles in a cup</p><p>of boiled water for 20 minutes.</p><p>– Tincture: One dose equals 1–2 mL.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>drug.</p><p>Important: Contact with fresh hops can cause sensitization (hop-pickers’ dis-</p><p>ease).</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: The soporific (sleep-inducing) effect of hops is weaker</p><p>than that of valerian root extract. Hence, hops should preferably be taken in</p><p>combination with other soporific preparations.</p><p>✿ Literature</p><p>– Monographs: DAB 10; ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Orth-Wagner S, Ressin WJ, Friedrich I:</p><p>Phytosedativum gegen Schlafstörungen. Z Phytother 16 (1995), 147–156;</p><p>Stevens JF, Ivancic M, Hsu VL, Deinzer ML: Prenylflavonoids from Humulus</p><p>lupulus. Phytochemistry 44 (1997), 1575–1585.</p><p>Horehound (Marrubium vulgare L.)</p><p>➤ Synonyms: White horehound; Andorn (Ger.)</p><p>➤ Pharmacology</p><p>– Herb: Horehound herb (Marrubii herba). The herb consists of the fresh or</p><p>dried aerial parts of Marrubium vulgare L. and preparations of the same.</p><p>– Important constituents: Diterpene bitter principles (0.1–1.0 % marrubiin</p><p>and ca. 0.1 % premarrubiin), caffeic acid derivatives (chlorogenic acid, cryp-</p><p>tochlorogenic acid), flavonoids (luteolin-7-lactate, apigenin-7-lactate), and</p><p>essential oil (0.05–0.6 %), including camphene, p-cymene, and fenchen.</p><p>– Pharmacological properties: Marrubinic acid increases the flow of bile in an-</p><p>imals. It relaxes the sphincter of Oddi, demonstrating an antispasmodic ef-</p><p>fect, which might help explain its traditional use for easing coughs. The es-</p><p>sential oil constituents, diterpene bitters, tannins, and flavonoids (bitter</p><p>principles) enhance the secretion of gastric juices.</p><p>➤ Indications</p><p>– Lack of appetite</p><p>– Dyspeptic complaints</p><p>– Coughs and bronchitis</p><p>– Inflammations of the mouth and throat</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– 1 : 1 fluid extract containing ethanol 20 % (v/v) (BHP 83).</p><p>• Dosage: 2–44 mL, three times daily.</p><p>– Liquid extracts (ca. 1: 6), cough lozenges, and syrups are commonly found</p><p>and used. Dosage according to manufacturer’s recommendations.</p><p>Plant Summaries—H</p><p>77</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Marrubium is a seldom-used herb, partly because of its</p><p>very bitter taste, except in over-the-counter cough syrups and lozenges, which</p><p>contain sweetener. No systematic data on its efficacy are currently available.</p><p>✿ Literature</p><p>– Monographs: Commission E</p><p>– Scientific publications: see p. 478; Roth L, Daunderer M, Kormann K: Gift-</p><p>pflanzen, Pflanzengifte. 4. Aufl., Ecomed Fachverlag Landsberg/Lech 1993.</p><p>Horse Chestnut (Aesculus hippocastanum L.)</p><p>➤ General comments: The horse chestnut tree was originally native to South-</p><p>eastern Europe and the Near East, but has naturalized throughout Europe. The</p><p>seeds</p><p>. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110</p><p>Plant Summaries—S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114</p><p>Plant Summaries—T . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119</p><p>Plant Summaries—U . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123</p><p>Plant Summaries—V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125</p><p>Plant Summaries—W . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127</p><p>Plant Summaries—Y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131</p><p>4 Cardiovascular Diseases</p><p>. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132</p><p>4.1 Heart Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132</p><p>4.2 Coronary Artery Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134</p><p>4.3 Functional Heart Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136</p><p>4.4 Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138</p><p>4.5 Hypotension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140</p><p>4.6 Circulatory Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141</p><p>Gray Section: Fundamentals of Phytotherapy</p><p>Green Section: Plant Summaries</p><p>Blue Section: Herbal Treatment of Diseases</p><p>Contents</p><p>IX</p><p>Co</p><p>n</p><p>te</p><p>n</p><p>ts</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>4.7 Vertigo and Tinnitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142</p><p>4.8 Dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143</p><p>4.9 Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144</p><p>4.10 Chronic Venous Insufficiency (Varicose Veins) . . . . . . . . . . . . . . . . . . . . . . . 145</p><p>5 Respiratory Diseases</p><p>. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147</p><p>5.1 Diseases of the Nose and Nasal Sinuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147</p><p>5.2 Colds and Flu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150</p><p>5.3 Bronchitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154</p><p>5.4 Symptomatic Cough . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158</p><p>6 Diseases and Dysfunctions of the Digestive Organs</p><p>. . . . . . . . . . . . . . . . . . 161</p><p>6.1 Diseases of the Mouth and Throat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161</p><p>6.2 Anorexia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165</p><p>6.3 Reflux, Gastritis, Gastroduodenal Ulcers, Dyspepsia . . . . . . . . . . . . . . . . . . 169</p><p>6.4 Dyspeptic Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174</p><p>6.5 Chronic Hepatitis and Cirrhosis of the Liver . . . . . . . . . . . . . . . . . . . . . . . . . 180</p><p>6.6 Diseases of the Gallbladder and Biliary Tract . . . . . . . . . . . . . . . . . . . . . . . . 182</p><p>6.7 Diseases of the Rectum and Colon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186</p><p>6.8 Acute and Chronic Diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190</p><p>6.9 Irritable Bowel Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194</p><p>6.10 Constipation and Colonic Diverticulosis (Acquired) . . . . . . . . . . . . . . . . . . 196</p><p>7 Diseases of the Urogenital Tract</p><p>. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200</p><p>7.1 Urinary Tract Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200</p><p>7.2 Dysuria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202</p><p>7.3 Irritable Bladder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204</p><p>7.4 Urolithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205</p><p>7.5 Benign Prostatic Hyperplasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207</p><p>8 Diseases and Disorders of the Nervous System</p><p>. . . . . . . . . . . . . . . . . . . . . . 209</p><p>8.1 Sleep Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209</p><p>8.2 Nervous Anxiety, Tension, and Unease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211</p><p>8.3 Psychovegetative Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214</p><p>8.4 Depression and Mood Swings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216</p><p>8.5 Primary Headache Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218</p><p>9 Debility, Fatigue, Adaprive and Functional Disorders</p><p>. . . . . . . . . . . . . . . . 220</p><p>9.1 Non-age-related Debility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220</p><p>9.2 Adaptive and Functional Disorders of Aging . . . . . . . . . . . . . . . . . . . . . . . . . 222</p><p>10 Immunodeficiency Diseases</p><p>. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226</p><p>10.1 Conditions Related to Acquired Immunodeficiency . . . . . . . . . . . . . . . . . . 226</p><p>10.2 Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229</p><p>11 Rheumatic Diseases</p><p>. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231</p><p>11.1 Rheumatism and Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231</p><p>11.2 Gout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235</p><p>12 Gynecological Diseases</p><p>. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236</p><p>12.1 Disturbances of the Menstrual Cycle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236</p><p>12.2 Premenstrual Syndrome (PMS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237</p><p>12.3 Dysmenorrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239</p><p>12.4 Menopausal Complaints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240</p><p>Contents</p><p>X</p><p>Co</p><p>n</p><p>te</p><p>n</p><p>ts</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>13 Pediatric Diseases</p><p>. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241</p><p>13.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241</p><p>13.2 Acute Febrile Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242</p><p>13.3 Mouth and Throat Inflammations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247</p><p>13.4 Respiratory Tract Diseases . . . . . . . . .</p><p>are used in herbal medicine.</p><p>➤ Pharmacology</p><p>– Herb: Horse chestnut seed (Hippocastani semen). The herb consists of the</p><p>dried seeds of Aesculus hippocastanum L. and preparations of the same.</p><p>– Important constituents: Aescin is the most important constituent. Triter-</p><p>pene saponins (3–5 %) and flavonoids are also present.</p><p>– Pharmacological properties: Horse chestnut extract was found to be anti-</p><p>exudative and reduce capillary wall permeability, leading to an overall anti-</p><p>edematous effect. Clinical data on the venotonic effects are available. In</p><p>humans, the herb significantly reduces transcapillary filtration. Oral appli-</p><p>cation was found to significantly improve the symptoms of chronic venous</p><p>insufficiency in double-blind studies. It was found to significantly reduce</p><p>leg edemas, similarly to the results of compression treatments.</p><p>➤ Indications</p><p>– Complaints associated with chronic venous insufficiency</p><p>– Posttraumatic or postoperative soft-tissue swelling</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use: Daily dose should be equivalent to 100 mg of</p><p>aescin.</p><p>➤ Adverse effects: Inflammation of the mucous membranes in the gastrointes-</p><p>tinal tract can occur as a rare side effect after internal use.</p><p>➤ Herb–drug interactions: None known.</p><p>Important: Ointments containing aescin should not be rubbed vigorously onto</p><p>the skin, but applied gently. They might otherwise cause or worsen phlebitis.</p><p>Important: High-dose horse-chestnut formulations should not be used in the</p><p>last two trimesters of pregnancy or when nursing a baby unless absolutely nec-</p><p>essary.</p><p>➤ Summary assessment: Horse chestnut seed is an effective and clinically well-</p><p>researched herbal medicament. Individuals with chronic venous insufficiency</p><p>should not abstain from compression treatments.</p><p>✿ Literature</p><p>– Monographs: DAB 1998; ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Daub B: Chronische Veneninsuffizienz:</p><p>Roßkastanienextrakt oder Kompressionsstrumpf – gleiche Wirkung.</p><p>Deutsche Apotheker Ztg 136 (1996), 946.</p><p>Plant Summaries—H</p><p>78</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Horsetail (Equisetum arvense L.)</p><p>➤ General comments: Horsetail (field horsetail) is a widespread plant known for</p><p>its high silicic acid content.</p><p>➤ Pharmacology</p><p>– Herb: Horsetail herb (Equiseti herb). The herb consists of the dried, sterile</p><p>green stems of Equisetum arvense L., collected during the summer months.</p><p>– Important constituents: Flavonoids (0.6–0.9 %), caffeic acid esters (1 %), and</p><p>silicic acid (5–7.7 %).</p><p>– Pharmacological properties: Horsetail herb has aquaretic and spasmolytic</p><p>effects in animals. Its wound-healing properties are probably attributable</p><p>to its content of flavonoids and silicic acid.</p><p>➤ Indications</p><p>– Urinary tract infections</p><p>– Renal or urinary calculi</p><p>– Wounds and burns</p><p>➤ Contraindications: Horsetail should not be used for diuresis in patients with</p><p>cardiac or renal edema.</p><p>➤ Dosage and duration of use</p><p>– Internal use: Boil 2–3 g of the herb in 150–200 mL of water for 5 minutes,</p><p>then steep for 10 to 15 minutes.</p><p>• Dosage: One cup, between meals, several times a day.</p><p>• Daily dose: 6 g herb. An adequate intake of fluids is essential (i. e. about</p><p>two 6-ounce glasses of water).</p><p>– External use: For compresses, boil 10 g herb in 1 liter of water for 5 minutes,</p><p>then steep for 10 to 15 minutes.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: When used internally, horsetail should be combined</p><p>with other aquaretic preparations.</p><p>✿ Literature</p><p>– Monographs: DAB 1998; Commission E</p><p>– Scientific publications: see p. 478; Beckert C et al: Styrylpyrone biosyn-</p><p>thesis in Equisetum arvense L. Phytochemistry 44 (1997), 275–283.</p><p>Plant Summaries—H</p><p>79</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Iceland Moss (Cetraria islandica L. acharius)</p><p>➤ Synonyms: Cetrariae lichen, Fucus islandicus; Isländisches Moos (Ger.)</p><p>➤ General comments: Iceland moss is a lichen that is widespread in the alpine</p><p>and arctic regions of the Northern Hemisphere. The thallus, or plant body, is</p><p>used in medicine.</p><p>➤ Pharmacology</p><p>– Herb: Iceland moss (Lichen islandicus). The herb consists of the dried thallus</p><p>of Cetraria islandica (L.) A. s.l. and preparations of the same.</p><p>– Important constituents: Mucilage containing glucans (50 %), lichenin, and</p><p>isolichenin. Lichen acids (3–4.5 %) and other substances and compounds</p><p>with antibacterial effects are also present.</p><p>– The herb has soothing and coating effects due to its content of polysaccha-</p><p>rides. Lichenic acids stimulate the appetite and the secretion of saliva. The</p><p>extract also has weak antibiotic effects.</p><p>➤ Indications</p><p>– Lack of appetite</p><p>– Dyspeptic complaints</p><p>– Coughs and bronchitis</p><p>– Inflammations of the mouth and throat</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– Tea: Steep 1.5–2.5 g (1 to 2 teaspoons) of the finely chopped herb in boiled</p><p>water for 10 minutes. Sweeten if desired.</p><p>– Daily dose: 4–6 g herb. One dose equals 1.5 g herb, equivalent to 1 cup of</p><p>tea.</p><p>– To obtain preparations that are less bitter, pour hot water onto the herb and</p><p>discard the water immediately, then pour hot water onto the herb again</p><p>and steep.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Iceland moss is a popular remedy in folk medicine, but</p><p>only a few scientific studies on the herb have been conducted so far.</p><p>✿ Literature</p><p>– Monographs: DAB 1998; ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Pengsuparp T et al: Mechanistic eval-</p><p>uation of new plant-derived compounds that inhibit HIV-1 reverse tran-</p><p>scriptase. J Nat Prod 58 (1995), 1024–1031; Wunderer H: Zentral und</p><p>peripher wirksame Antitussiva: eine kritische Übersicht. PZ 142 (1997),</p><p>847–852.</p><p>Java Tea (Orthosiphon aristatus Miquel)</p><p>➤ Synonyms: Orthosiphon.</p><p>➤ General comments: Java tea is native to Southeast Asia. The inhabitants of the</p><p>region have used its leaves as a remedy for bladder and kidney disorders for</p><p>decades.</p><p>➤ Pharmacology</p><p>Plant Summaries—I, J</p><p>80</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>– Herb: Java tea leaf (Orthosiphonis folium). The herb consists of the foliage</p><p>leaves and stem tips of Orthosiphon aristatus or Orthosiphon spicatus (T.) B.</p><p>(syn. Orthosiphon stamineus B.), collected shortly before the time of flower-</p><p>ing, and preparations of the same.</p><p>– Important constituents: Essential oil (0.02–0.6 %) containing mainly β-</p><p>caryophyllene, α-humulene, and caryophyllene epoxide. Flavonoids (eupa-</p><p>torin), triterpene saponins (up to 4.5 %), and potassium salts are also</p><p>present.</p><p>– Pharmacological properties: The essential oil has antimicrobial and anti-</p><p>phlogistic effects. In animal and human studies, the herb was found to have</p><p>an aquaretic effect (due to the combined effects of saponins and flavo-</p><p>noids).</p><p>➤ Indications</p><p>– Urinary tract infections</p><p>– Renal or urinary calculi</p><p>➤ Contraindications: Irrigation therapy is not recommended if cardiac or renal</p><p>edema is present.</p><p>➤ Dosage and duration of use</p><p>– Tea: Steep 2 g of the herb in 150 mL of hot water for 15 minutes.</p><p>• Dosage: One cup, several times a day.</p><p>– Daily dose: 6–12 g of the herb.</p><p>Important: An adequate intake of fluids (at least 2 liters per day) is essen-</p><p>tial.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Java tea leaf combines well with other aquaretic and</p><p>urinary antiseptic herbal preparations.</p><p>➤ Literature</p><p>– Monographs: DAB 10; ESCOP; Commission E</p><p>– Scientific publications: see p. 478</p><p>Juniper (Juniperus communis L.)</p><p>➤ General comments: The juniper tree or bush is distributed throughout the</p><p>Northern Hemisphere. Its berrylike fruit (cones) have been used for aquaresis</p><p>and wound healing since ancient times.</p><p>➤ Pharmacology</p><p>– Herb: Juniper berry (Juniperi fructus). The herb consists of the ripe, fresh or</p><p>dried berrylike fruit of Juniperus communis L. and preparations of the same.</p><p>– Important constituents: Essential oil (0.8–2 %, depending on the site of herb</p><p>origin), monoterpene hydrocarbons (α-pinenes, terpinen-4-ol), diterpenes,</p><p>oligomeric proanthocyanidins of the catechin type, monosaccharides (in-</p><p>vert sugar, 20–30 %), and flavonoids.</p><p>– Pharmacological properties: Because of its essential oils (especially terpinen-</p><p>4-ol), juniper berry has an aquaretic effect. In animals, it was shown to have</p><p>mild antihypertensive and antiexudative effects.</p><p>➤ Indications</p><p>– Internal use</p><p>• Lack of appetite</p><p>Plant Summaries—I, J</p><p>81</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>• Dyspeptic complaints</p><p>• For aquaresis in unspecific inflammations of the lower urinary tract</p><p>Important: The cause of urinary tract infection must always be clarified</p><p>by a physician.</p><p>– External use: Essential oil as a bath additive for supportive treatment of</p><p>rheumatic diseases (see p. 286).</p><p>➤ Contraindications</p><p>– Internal use: Pregnancy, inflammatory kidney diseases.</p><p>– External use: Extensive skin injuries, acute skin diseases, severe febrile and</p><p>infectious diseases, heart failure and hypertension.</p><p>➤ Dosage and duration of use</p><p>– Infusion: Steep 1 teaspoon of crushed, dried juniper berries in 1 cup</p><p>(150 mL) of boiled water for 10 minutes.</p><p>• Dosage: One cup, 3 times a day.</p><p>– Tincture: Steep 20 g of the herb in 80 g of ethanol 70 % for 8 days.</p><p>• Dosage: 20 to 30 drops, 2 to 3 times a day.</p><p>– Daily dose: 2–10 g (maximum dose) of the herb, corresponding to 20–</p><p>100 mg of the essential oil.</p><p>– When used internally, the duration of treatment should be restricted to a</p><p>maximum of 6 weeks owing to the potential for tissue irritation by pinenes.</p><p>➤ Adverse effects: Overdose or long-term internal use can cause kidney irrita-</p><p>tion and/or damage.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Juniper is an effective herbal medicament in the spec-</p><p>ified indications. It combines well with other aquaretic and urinary antiseptic</p><p>preparations.</p><p>✿ Literature</p><p>– Monographs: DAB 1998; ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Schilcher H, Heil BM: Nierentoxizität von</p><p>Wacholderbeerzubereitungen. Z Phytother 15 (1994), 205–213; Schmidt</p><p>M: Wacholderzubereitungen. Muß die Monographie umgeschrieben wer-</p><p>den? Deutsche Apotheker Ztg 135 (1995), 1260–1264.</p><p>Plant Summaries—I, J</p><p>82</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Kava (Piper methysticum G. Forster)</p><p>➤ Synonyms: Kava-kava, intoxicating pepper.</p><p>➤ General comments: Kava is indigenous to the islands of the South Pacific. The</p><p>native Polynesians use the rhizome to make a mildly intoxicating beverage.</p><p>Kava rhizome extract has anxiolytic and sedative effects.</p><p>➤ Pharmacology</p><p>– Herb: Kava rhizome (Piperis methystici rhizoma). The herb consists of the</p><p>peeled, cut and dried rhizomes (usually with the root parts removed) of Pip-</p><p>er methysticum G. F. and preparations of the same.</p><p>– Important constituents: Kava lactones (kava pyrones, 5–12 %) consisting</p><p>mainly of (+)-kavain (1.8 %), (+)-methysticin (1.2 %), desmethoxyyangonin</p><p>(1 %), and yangonin (1 %).</p><p>– Pharmacological properties: Kava pyrones have sedative and central muscle</p><p>relaxant effects. Anticonvulsive, neuroprotective, narcosis-enhancing, cen-</p><p>tral muscle relaxant, spasmolytic, analgesic, and local anesthetic effects</p><p>were observed in animals. The herb has anxiolytic and soporific effects in</p><p>humans.</p><p>➤ Indications: Nervous tension, states of tension and anxiety.</p><p>➤ Contraindications: Pregnancy, breast feeding, and endogenous depression</p><p>(increased risk of suicide). The herb should not be taken for more than 3</p><p>months without the advice of a qualified health care practitioner.</p><p>➤ Dosage and duration of use</p><p>– Daily dose: 60–120 mg of herb preparations.</p><p>➤ Adverse effects: The prolonged use of high doses of kava can, in rare cases, lead</p><p>to gastrointestinal complaints, oculomotor equilibrium disorders, pupil dila-</p><p>tion, and insufficiency of accommodation. Slight morning fatigue can occur in</p><p>the initial phase of treatment. Disorders of complex movement with otherwise</p><p>unimpaired consciousness are initial signs of overdose, followed by fatigue</p><p>and a tendency to fall asleep. Kava increases the action of substances that affect</p><p>the central nervous system, e. g., alcohol, barbiturates, and other psychoactive</p><p>drugs. A few studies yielded some indication of hepatotoxicity in relation to</p><p>administration of kava. Though this information is limited to date and still</p><p>awaits scientific evaluation, it is recommended to consider the following when</p><p>using kava products.</p><p>Warning: Kava should not be taken on a daily basis for more than 4 weeks.</p><p>Warning: Use of kava should be discontinued if symptoms of jaundice</p><p>appear.</p><p>Warning: Patients with a history of liver problems or who suspect possible</p><p>liver problems or who are taking pharmaceutical drugs should use kava</p><p>only with the advice of a professional health care provider.</p><p>Warning: See p. 212 for cautions in the use of kava in disorders of the ner-</p><p>vous system.</p><p>➤ Herb–drug interactions: Kava should not be used by anyone who has liver</p><p>problems, is taking any drugs with known adverse effects on the liver, such as</p><p>NSAIDS, or is a regular consumer of alcohol.</p><p>➤ Summary assessment: Kava is an effective herb in the specified indications</p><p>(herbal tranquilizer). It has a low incidence of side effects and its effects have</p><p>been relatively well investigated.</p><p>Plant Summaries—K</p><p>83</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>✿ Literature</p><p>– Monographs: ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Gleitz J et al: Kavain inhibits non-stereo-</p><p>specifically veratridine-activated Na+ channels. Planta Med 62 (1996),</p><p>580–581; Hänsel R: Kava-Kava (Piper methysticum G. Forster) in der mo-</p><p>dernen Arzneimittelforschung. Portrait einer Arzneipflanze. Z Phytother 17</p><p>(1996), 180–195; Volz HP: Die anxiolytische Wirksamkeit von Kava-Spe-</p><p>zialextrakt WS 1490 unter Langzeittherapie – eine randomisierte Doppel-</p><p>blindstudie. Z Phytother Abstraktband, (1995), 9.</p><p>Plant Summaries—K</p><p>84</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Lemon Balm (Melissa officinalis L.)</p><p>➤ Synonyms: Balm; Melisse (Ger.).</p><p>➤ General comments: Balm is native in the eastern Mediterranean and Western</p><p>Asian regions. Lemon balm plants in Central Europe are either cultivated or</p><p>naturalized. The plant has been used as a medicinal herb since ancient times.</p><p>➤ Pharmacology</p><p>– Herb: Lemon balm leaf (Melissae folium). The herb consists of the fresh or</p><p>dried foliage leaves of Melissa officinalis L. and preparations of the same.</p><p>– Important constituents: Essential oil (0.02–0.8 %) containing geranial/α-</p><p>citral and neral/β-citral (40–75 % in total).</p><p>– Pharmacological properties: Lemon balm has antiviral</p><p>and antioxidant ef-</p><p>fects in vitro. Choleretic, calming, and carminative effects have been ob-</p><p>served in animals.</p><p>➤ Indications</p><p>– General nervousness and sleeplessness</p><p>– Herpes labialis (external application)</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– Tea: Steep 1.5–4.5 g of the herb in 1 cup of hot water for 10 minutes.</p><p>• Dosage: One cup, several times a day.</p><p>– Daily dose: 1.5–4.5 g of the herb.</p><p>➤ Adverse effects: None following proper administration of the designated</p><p>therapeutic doses.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Lemon balm is a popular herbal medicament that com-</p><p>bines well with other herbs with a similar therapeutic range. Clinical studies</p><p>on the herb (oral application as monodrug) are not available.</p><p>✿ Literature</p><p>– Monographs: DAB 1998; ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Hermann EC jr, Kucera LS: Antiviral sub-</p><p>stances in plants of the mint family (Labiatae): II. Nontanninic polyphenols</p><p>of Melissa officinalis. Proc Soc Exp Bio Med 124 (1995), 869; Mohrig A:</p><p>Melissenextrakt bei Herpes simplex – die Alternative zu Nucleosid-</p><p>Analoga. Deutsche Apotheker Ztg 136 (1996), 4575–4580; Orth-Wagner S,</p><p>Ressin WJ, Friedrich I: Phytosedativum gegen Schlafstörungen. Z Phytother</p><p>16 (1995), 147–156; Schultze W, König WA, Hilker A, Richter R: Melis-</p><p>senöle. Deutsche Apotheker Ztg 135 (1995), 557–577; Walz A: Melisse hilft</p><p>heilen. Deutsche Apotheker Ztg 136 (1996) 26.</p><p>Lesser Centaury (Centaurium erythraea)</p><p>➤ Synonyms: Broad-leaved centaury, common centaury; Tausendgüldenkraut</p><p>(Ger.)</p><p>➤ General comments: The dried aerial parts of Centaurium erythraea Rafn col-</p><p>lected at the time of flowering are used in medicine.</p><p>➤ Pharmacology</p><p>– Herb: Centaury herb (Centaurii herba).</p><p>– Important constituents: Iridoids and bitter principles, mainly swertiamarin</p><p>(75 %), gentiopicrin, and sweroside.</p><p>Plant Summaries—L</p><p>85</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>– Pharmacological properties: Reflex stimulation of saliva and gastric juice se-</p><p>cretion. The herb also has antiphlogistic and antipyretic action in animals.</p><p>➤ Indications</p><p>– Lack of appetite</p><p>– Dyspeptic complaints</p><p>➤ Contraindications: Ulcers of the stomach and small intestine.</p><p>➤ Dosage and duration of use</p><p>– Tea: Steep 2–3 g of the herb in 150 mL of boiled water for 15 minutes. Take</p><p>1⁄2 hour before meals.</p><p>– Daily dose: 6 g dried herb for tea.</p><p>– 1 : 5 tincture: 2–5 g per day.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>drug.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Owing to its bitter principles, centaury can effectively</p><p>stimulate the appetite and digestion.</p><p>✿ Literature</p><p>– Monographs: DAB 1998; ESCOP; Commission E</p><p>– Schimmer O, Mauthner H: Centaurium erythraea RAFN. Tausendgülden-</p><p>kraut. Z Phytother 15 (1994), 299–304; Schimmer O, Mauthner H: Poly-</p><p>methoxylated xanthones from the herb of Centaurium erythraea with</p><p>strong antimutagenic properties in Salmonella typhimurim. Planta Med 62</p><p>(1996), 561–564.</p><p>Licorice (Glycyrrhiza glabra L.)</p><p>➤ General comments: Licorice is a shrub native to the Mediterranean region that</p><p>grows to heights of 1 to 1.5 meters. The root is used in medicine.</p><p>➤ Pharmacology</p><p>– Herb</p><p>• Licorice root (Liquiritiae radix). The herb consists of the dried, unpeeled</p><p>roots and stolons of Glycyrrhiza glabra L. and preparations of the same.</p><p>• Licorice extract (Succus liquiritiae). The herb consists of the liquid de-</p><p>rived by boiling licorice root in hot water and thickening it by concen-</p><p>tration under vacuum (licorice juice).</p><p>– Important constituents: Triterpene saponins (3–15 %) such as glycyrrhizinic</p><p>acid, aglycone 18β-glycyrrhetinic acid, and their salts classified as glycyr-</p><p>rhizin. Flavonoids (liquiritigenin) and isoflavonoids are also present.</p><p>– Saponins have expectorant and secretolytic effects in animals; the flavo-</p><p>noid component has spasmolytic effects. 18β-Glycyrrhetinic acid inhibits</p><p>prostaglandin synthesis, lipoxygenase, and cortisol metabolism, thereby</p><p>exerting antiphlogistic and ulceroprotective effects. No clinical data on the</p><p>efficacy of licorice preparations in respiratory tract disease are available.</p><p>➤ Indications</p><p>– Gastritis</p><p>– Coughing and bronchitis</p><p>➤ Contraindications: Chronic liver disease, cholestatic liver diseases, cirrhosis</p><p>of the liver, severe renal failure, hypertension, hypokalemia, and pregnancy.</p><p>Plant Summaries—L</p><p>86</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ Dosage and duration of use</p><p>– Tea: Pour 150 mL of boiled water onto 2–4 g (1 teaspoon = ca. 3 g) of the</p><p>finely chopped or coarsely powdered herb, or place the herb in cold water</p><p>and bring to a boil. Steep for 10 to 15 minutes, then strain.</p><p>• Dosage: One cup, after meals, 2 to 3 times a day.</p><p>– Succus liquiritiae: 0.5–1 g herb for catarrhs of the upper respiratory tract;</p><p>1.5–3 g herb for peptic ulcers.</p><p>– Daily dose: 5–15 g herb (equivalent to 200–600 mg glycyrrhizin).</p><p>➤ Adverse effects: Hypokalemia, hypernatremia, edema, hypertension, heart dis-</p><p>orders and, in rare cases, myoglobinuria can occur after long-term, high-dose</p><p>(50 mg/day or more) administration owing to the mineralocorticomimetic (al-</p><p>dosterone-like) effect of the saponins in the herb. Therefore, continuous use of</p><p>licorice preparations should not exceed 6 weeks and the use of licorice fluid ex-</p><p>tract and commercial licorice products should be medically supervised.</p><p>Important: These side effects do not occur with deglycyrrhinized succus</p><p>preparations. These are commonly available as commercial preparations</p><p>(capsules and tablets) under the name DGL (deglycyrrhinized licorice).</p><p>➤ Herb–drug interactions: Thiazide and loop diuretics can increase the miner-</p><p>alocorticoid effects of licorice.</p><p>➤ Summary assessment: Licorice is suitable for self-treatment if it used short-</p><p>term and all safety warnings are heeded. Licorice should be used in combina-</p><p>tion with other expectorant or secretolytic herbs.</p><p>➤ Literature</p><p>– Monographs: DAB 1998; ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Khaksa G et al: Anti-inflammatory and</p><p>anti-nociceptive activity of disodium glycyrrhetinic acid hemiphthalate.</p><p>Planta Med 62 (1996), 326–328; Nose M et al: A comparision of the anti-</p><p>hepatotoxica activity between glycyrrhizin and glycerrhetinic acid. Planta</p><p>Med 60 (1994), 136.</p><p>Lily-of-the-valley (Convallaria majalis L.)</p><p>➤ General comments: The dried, cream-colored petals and flower heads are</p><p>used in medicine. The plant was originally native to Europe, but was later in-</p><p>troduced to North America and northern Asia.</p><p>➤ Pharmacology</p><p>– Herb: Lily-of-the-valley herb (Convallariae herba). The herb consists of the</p><p>aerial parts of Convallaria majalis L. or closely related species, collected du-</p><p>ring the time of flowering.</p><p>– Important constituents: Steroid cardiac glycosides (cardenolides, 0.1–</p><p>0.5 %). Depending on its site of origin, the herb may also contain convalla-</p><p>toxin (Western and Northwestern Europe) or convalloside (Northern and</p><p>Eastern Europe) or convallatoxin and convallatoxol (Central Europe).</p><p>– Pharmacological properties: The glycosides in Convallaria have effects sim-</p><p>ilar to those of digitoxin and strophanthin. The herb increases the contrac-</p><p>tile force and velocity of the myocardium while extending the relaxation</p><p>time. It also reduces the heart rate, slows stimulus conduction, and increas-</p><p>es the excitability of ventricular muscles (positive inotropic, negative</p><p>chronotropic, negative dromotropic, and positive bathmotropic effects).</p><p>Lily-of-the-valley was found to have diuretic, natriuretic, and vasoconstric-</p><p>tive effects in animals.</p><p>Plant Summaries—L</p><p>87</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ Indications</p><p>– Heart failure (NYHA classes I and II)</p><p>– Cardiac arrhythmias</p><p>– Nervous heart disorders</p><p>➤ Contraindications: Hypokalemia, hypercalcemia</p><p>➤ Dosage and duration of use: All specifications refer to standardized lily-of-</p><p>the-valley powder (DAB 8).</p><p>– Tincture (1 : 10): Single dose, 2.0 g; daily dose, 6.0 g.</p><p>– Fluid extract (1 : 1): Single dose, 0.2 g; daily dose, 0.6 g.</p><p>– Dry extract (4 : 1): Single dose, 0.05 g; daily dose, 0.15 g.</p><p>➤ Adverse effects</p><p>– Health hazards in conjunction with proper administration of the designat-</p><p>ed therapeutic doses of the herb are not known. Overdose can induce nau-</p><p>sea, vomiting, headaches, stupor and cardiac arrhythmias and can impair</p><p>color vision.</p><p>– The risk of lily-of-the-valley poisoning following oral administration of the</p><p>herb is relatively low because only small quantities of the glycosides are</p><p>absorbed.</p><p>➤ Herb–drug interactions: Lily-of-the-valley increases the effects and side ef-</p><p>fects of quinidine, calcium salts, saluretics, laxatives, and glucocorticoids when</p><p>used concomitantly.</p><p>Warning: Lily-of-the-valley should be used only under medical supervision</p><p>and according to the instructions of a qualified health care provider.</p><p>➤ Summary assessment: Lily-of-the-valley is a rarely used herbal remedy, but</p><p>can be recommended for the indications specified above.</p><p>✿ Literature</p><p>– Monographs: DAB 1998: Commission E</p><p>– Scientific publications: see p. 478; Krenn L, Schlifelner, L, Stimpfl, T. Kopp, B:</p><p>HPLC separation and quantitative determination of cardenolides in Herba</p><p>Convallariae. Planta Med 58 (1992), A682; Laufke R: Planta Med 6 (1958), 237;</p><p>Loew D: Phytotherapie bei Herzinsuffizienz. Z Phytother 18 (1997), 92–96.</p><p>Linden (Tilia spp.)</p><p>➤ Synonyms: Lime tree; Linde (Ger.).</p><p>➤ General comments: The linden tree is commonly used in the wood processing</p><p>industry. Linden flower has been used in medicine since the eighteenth century.</p><p>➤ Pharmacology</p><p>– Herb: Linden flower (Tiliae flos). The herb consists of the dried flowers of</p><p>Tilia cordata M. and/or Tilia platyphyllos S. and preparations of the same.</p><p>– Important constituents: Flavonoids (1 %) including astragalin, isoquercitrin,</p><p>kaempferol 3-O-rhamnoside, quercetin, and tiliroside. Mucilage (10 %) con-</p><p>taining arabinogalactans with a uronic acid component), essential oil</p><p>(0.01–0.2 %), and tannins (2 %) are also present.</p><p>– Pharmacological properties: Linden flower is reputed to have antitussive,</p><p>astringent, diaphoretic, diuretic, and general immunostimulant effects, but</p><p>there is a lack of scientific evidence to validate these uses. The tannins, gly-</p><p>cosides, and essential oil in linden flower have antimicrobial effects in hu-</p><p>mans. The inhalation of steam enriched with linden flower extract was</p><p>more effective in improving the symptoms of uncomplicated colds than the</p><p>inhalation of steam alone (control group).</p><p>Plant Summaries—L</p><p>88</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ Indications: Colds and associated cough.</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– Daily dose: 2–4 g of the herb.</p><p>– Tea: Steep 2 g of the herb in 1 cup of boiled water for 5 to 10 minutes</p><p>(1 teaspoon = ca. 1.8 g herb). The tea should be drunk while as hot as possi-</p><p>ble and is best taken during the afternoon.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the herb.</p><p>➤ Herb–drug interactions: None known</p><p>➤ Summary assessment: Linden flower is commonly used in folk medicine, but</p><p>hardly any scientific studies of its effects have been performed.</p><p>✿ Literature</p><p>– Monographs: DAB 10; Commission E</p><p>– Scientific publications: see p. 478</p><p>Lovage (Levisticum officinale Koch)</p><p>➤ General comments: Lovage is a widely used culinary herb. The rhizome is used</p><p>in medicine.</p><p>➤ Pharmacology</p><p>– Herb: Lovage root (Levistici radix). The herb consists of the dried rhizomes</p><p>and roots of Levisticum officinale K. and preparations of the same.</p><p>– Important constituents: Essential oil (0.35–1.7 %) containing alkylphthali-</p><p>des, (E)- and (Z)-ligustilide, 3-butylphthalide, and ligusticum lactone.</p><p>Hydroxycoumarins (umbelliferone) and furanocoumarins (bergapten,</p><p>apterin) are also present.</p><p>– Pharmacological properties: In animal studies, the essential oil was found to</p><p>have spasmolytic, anticholinergic, antibacterial, and sedative effects on the</p><p>smooth muscles. The herb has aquaretic action due to its content of turpen-</p><p>tine.</p><p>➤ Indications</p><p>– Urinary tract infections</p><p>– Renal or urinary calculi</p><p>➤ Contraindications: Irrigation therapy is not recommended for elimination of</p><p>cardiac or renal edema.</p><p>➤ Dosage and duration of use</p><p>– Tea: Steep 2 g of herb in 1 cup of boiled water.</p><p>• Dosage: One cup, between meals, several times a day.</p><p>– Daily dose: 4–8 g herb.</p><p>➤ Adverse effects: Lovage has a slight potential for sensitization. Because of its</p><p>irritant effects, individuals with nephritis, lower urinary tract inflammation or</p><p>decreased renal function should not use the essential oil. In fair-skinned indi-</p><p>viduals, lovage can cause increased sensitivity to ultraviolet light (phototoxic</p><p>effect of furanocoumarins).</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Lovage should be used in combination with other</p><p>herbal urological remedies.</p><p>✿ Literature</p><p>– Monographs: Commission E</p><p>Plant Summaries—L</p><p>89</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Mallow (Malva sylvestris L.)</p><p>➤ General comments: Mallow can be found in the subtropics and temperate re-</p><p>gions of both hemispheres today.</p><p>Mallow flower (Malvae flos)</p><p>➤ Pharmacology</p><p>– Herb: Mallow flower (Malvae flos). The herb consists of the dried flowers of</p><p>Malva sylvestris L. and/or M. sylvestris L. ssp. mauritiana (L.) A. e. G. and</p><p>preparations of the same.</p><p>– Important constituents: Mucilage (6–10 %) containing rhamnogalacturon-</p><p>ans and arabinogalactans; anthocyans (malvin), polysaccharides, and fla-</p><p>vonoids.</p><p>– Pharmacological properties: The herb has coating and soothing effects at-</p><p>tributable to its high mucilage content.</p><p>➤ Indications</p><p>– Coughs and bronchitis</p><p>– Inflammations of the mouth and throat</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– Tea: Place 1.5–2 g of the finely chopped herb in cold water, bring to a boil</p><p>and remove from heat, or pour boiling water onto the herb. Steep for 10</p><p>minutes, then strain.</p><p>• Dosage: One cup, 2 to 3 times a day.</p><p>– Daily dose: 5 g of the herb.</p><p>➤ Adverse effects: Health hazards in conjunction with proper administration of</p><p>the designated therapeutic doses of the herb are not known.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Mallow flower has demonstrated efficacy in the spec-</p><p>ified indications.</p><p>✿ Literature</p><p>– Monographs: Commission E</p><p>– Scientific publications: see p. 478; Classen B, Amelunxen F, Blaschek W:</p><p>Malva sylvestris – Mikroskopische Untersuchungen zur Entstehung von</p><p>Schleimbehältern. Deutsche Apotheker Ztg 134 (1994), 3597.</p><p>Mallow Leaf (Malvae folium)</p><p>➤ Pharmacology</p><p>– Herb: Mallow leaf (Malvae folium). The herb consists of the dried foliage</p><p>leaves of Malva sylvestris L. and/or Malva neglecta W. and preparations of</p><p>the same.</p><p>– Important constituents: Mucilage (6–8 %) containing mainly rhamnogalac-</p><p>turonans and arabinogalactans, flavonoids (hypolaetin-3-O-glucoside, gos-</p><p>sypetin-3-O-glucoside), and flavonoid sulfates such as gossypetin-8-O-β-D-</p><p>glucuronide-3-sulfate and hypolaetin-8-O-glucoside-3´-sulfate.</p><p>– Pharmacological properties: No data available.</p><p>➤ Indications</p><p>– Coughs and bronchitis</p><p>– Inflammations of the</p><p>mouth and throat</p><p>➤ Contraindications: None known.</p><p>Plant Summaries—M</p><p>90</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ Dosage and duration of use</p><p>– Tea: Steep 3–5 g of the herb (ca. 2 teaspoons) in 150 mL of boiled water for</p><p>10 to 15 minutes, or place the herb in cold water and steep for 2 to 3 hours</p><p>while stirring occasionally.</p><p>• Dosage: One cup, 1 to 2 times a day.</p><p>– Daily dose: 5 g of the herb.</p><p>➤ Adverse effects: None known.</p><p>➤ Herb–drug interactions: None known,</p><p>➤ Summary assessment: Mallow leaf is a herbal medicament with demonstrat-</p><p>ed effects at the recommended therapeutic doses.</p><p>✿ Literature</p><p>– Monographs: Commission E</p><p>– Scientific publications: see p. 478; Classen B, Amelunxen F, Blaschek W:</p><p>Malva sylvestris – Mikroskopische Untersuchungen zur Entstehung von</p><p>Schleimbehältern. Deutsche Apotheker Ztg 134 (1994), 3597.</p><p>Marigold (Calendula officinalis L.)</p><p>➤ Synonyms: Calendula; Ringelblume (Ger.)</p><p>➤ General comments: This plant is widely distributed throughout the Northern</p><p>Hemisphere and is a very popular remedy in folk medicine. Its flowers are used</p><p>in herbal medicine.</p><p>➤ Pharmacology</p><p>– Herb: Marigold flower (Calendulae flos). The herb consists of the ray flowers</p><p>of the completely mature flower heads of Calendula officinalis L.</p><p>– Important constituents: Triterpene saponins (2–10 %), triterpene alcohols</p><p>(4.8 %), flavonoids (0.3–0.8 %), hydroxycoumarins, carotinoids, essential oil</p><p>(0.2 %), and water-soluble polysaccharides (15 %).</p><p>– Pharmacological properties: Marigold flower is antimicrobial (essential oil,</p><p>flavones), fungicidal, virucidal (influenza and herpes simplex viruses), anti-</p><p>phlogistic, vulnerary, and immunostimulant (polysaccharides). Extensive</p><p>research data on the herb are available.</p><p>➤ Indications</p><p>– Inflammations of the mouth and throat</p><p>– Burns and wounds, including those that tend to heal poorly</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– Tea: Steep 1 to 2 teaspoons (2–3 g) of the herb in 150 mL of hot water for</p><p>approximately 10 minutes. Use the warm tea as a mouthwash or gargle sev-</p><p>eral times a day.</p><p>– Compresses: Soak a linen compress in Marigold infusion. Apply fresh com-</p><p>presses several times a day.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Marigold flower is a reliable wound-healing agent. It</p><p>is generally regarded as safe, even when used in children.</p><p>Plant Summaries—M</p><p>91</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>✿ Literature</p><p>– Monographs: DAB 1998; ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Mennet-von Eiff M, Meier B: Phytothera-</p><p>pie in der Dermatologie. Z Phytother 16 (1995), 201–210.</p><p>Marshmallow (Althaea officinalis L.)</p><p>Marshmallow Leaf (Althaea officinalis L.)</p><p>➤ Pharmacology</p><p>– Herb: Marshmallow leaf (Althaeae folium). The herb consists of the dried</p><p>foliage leaves of Althaea officinalis L.</p><p>– Important constituents: 6–10 % mucilage (colloidal polysaccharides and</p><p>arabinogalactans)</p><p>– Pharmacological properties: Since mucilage has a coating effect, it soothes</p><p>irritated mucous membranes. Anti-inflammatory and immunostimulatory</p><p>effects have been shown in animals and in vitro.</p><p>➤ Indications</p><p>– Dry, unproductive cough</p><p>– Irritations of the mouth and throat</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– Tea: Steep 1–2 g of the dried herb in hot water.</p><p>• Dosage: One cup, several times a day.</p><p>– Daily dose: 5 g herb.</p><p>➤ Adverse effects: None known.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: See Marshmallow Root.</p><p>➤ Literature</p><p>– Monographs: Commission E</p><p>– Scientific publications: see p. 478; Hahn-Deinstrop E: Eibischwurzel Iden-</p><p>tifizierung von Eibischwurzel-Extrakt und Gehaltsbestimmung in einem</p><p>Instant-Tee. Deutsche Apotheker Ztg 135 (1995), 1147–1149; Wunderer H:</p><p>Zentral und peripher wirksame Antitussiva: eine kritische Übersicht. PZ</p><p>142 (1997), 847–852.</p><p>Marshmallow Root (Althaea officinalis L.)</p><p>➤ Pharmacology</p><p>– Herb: Marshmallow root (Althaeae radix). The herb consists of the dried,</p><p>chopped, peeled, or unpeeled roots of Althaea officinalis L.</p><p>– Important constituents: 10–20 % mucilage (colloid-soluble polysaccha-</p><p>rides, rhamnogalacturonans, arabinogalactans) and 30–38 % starch.</p><p>– Pharmacological properties: See Marshmallow Leaf.</p><p>➤ Indications</p><p>– Inflammations of the mouth and throat and associated dry cough</p><p>– Mild gastritis</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use: The chopped roots are used to make aqueous</p><p>extracts and other galenicals for internal use.</p><p>– Tea: Add 6 g of the roots to 150 mL cold water and allow to steep for 90</p><p>minutes, stirring frequently.</p><p>Plant Summaries—M</p><p>92</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>• Dosage: One cup of the rewarmed tea, several times a day. The tea can</p><p>also be used as a mouthwash.</p><p>➤ Adverse effects: None known.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Marshmallow root is a well tolerated herb that is often</p><p>used in pediatric medicine.</p><p>✿ Literature</p><p>– Monographs: DAB 10; ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Hahn-Deinstrop E: Eibischwurzel: Iden-</p><p>tifizierung von Eibischwurzel-Extrakt und Gehaltsbestimmung in einem</p><p>Instant-Tee. Deutsche Apotheker Ztg 135 (1995), 1147–1149.</p><p>Meadowsweet (Filipendula ulmaria L. Maxim)</p><p>➤ Synonyms: Queen-of-the-meadow, bridewort; Mädesüß (Ger.)</p><p>➤ General comment: The dried flowers are used in medicine. The meadowsweet</p><p>is native to all parts of the Northern Hemisphere.</p><p>➤ Pharmacology</p><p>– Herb: Meadowsweet flower (Spiraeae flos). The herb consists of the dried</p><p>flowers of Filipendula ulmaria (L.) M. and preparations of the same.</p><p>– Important constituents: Essential oil (0.2 %) containing salicylaldehyde and</p><p>salicylic acid methyl ester, up to 5 % flavonoids (spiraeoside, quercetin-4´-</p><p>glucoside, 3–4 %), and tannins (ellagitannins).</p><p>– Pharmacological properties: Meadowsweet flower has antimicrobial, anti-</p><p>pyretic, and aquaretic effects. In animal experiments, the herb was found to</p><p>have a positive effect on the healing of peptic ulcers and to increase smooth-</p><p>muscle tone. These effects are attributable to its flavonoid components.</p><p>➤ Indications</p><p>– Colds and fever</p><p>– Coughs and bronchitis</p><p>➤ Contraindications: Because meadowsweet contains salicylates, individuals</p><p>with a known hypersensitivity to salicylates should not use it.</p><p>➤ Dosage and duration of use</p><p>– Tea: Steep 1 teaspoon (ca. 1.4 g herb) of the herb in boiled water for 10 minutes.</p><p>• Dosage: One cup, several times a day.</p><p>– Daily dose: 2.5–3.5 g (flowers).</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb. It can upset the stomach and cause nausea if overdosed.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Meadowsweet is a well-known household remedy for</p><p>colds and flu.</p><p>✿ Literature</p><p>– Monographs: Belg IV; EB 6; HAB 1; Helv V; Commission E</p><p>– Scientific publications: see p. 478; Barnaulov OD: Rastit Resur 14 (1987),</p><p>573; Haslam E et al: Ann Proc Phytochemistry Soc Eur 25 (1985), 252; Hör-</p><p>hammer L et al: Arch Pharm 61 (1956), 133; Valle MG et al: Planta Med 54</p><p>(1988), 181.</p><p>Plant Summaries—M</p><p>93</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Milk Thistle (Silybum marianum L. Gaertn.)</p><p>➤</p><p>Synonyms: Marian thistle; Mariendistel (Ger.)</p><p>➤ General comments: The milk thistle is a native European medicinal plant that</p><p>has been used since ancient times. It has striking deep green leaves with white</p><p>spots along the veins.</p><p>➤ Pharmacology</p><p>– Herb: Milk thistle fruit (Cardui mariae herba). The herb consists of the</p><p>pappus-free, ripe fruit of Silybum marianum (L.) G.</p><p>– Important constituents: Silymarin (flavonolignan mixture, 1.5–3 %), primary</p><p>components silybin A and B (combination of the two is called silibinin), iso-</p><p>silybin A, isosilybin B, silychristin, silydianin, flavonoids (apigenin, chryso-</p><p>eriol, eriodictyol, naringenin, quercetin, taxifolin), and fatty oil (20–30 %).</p><p>– Pharmacological properties: Silymarin and silibinin were found to have</p><p>hepatoprotective effects in studies on liver damage. Silymarin stimulates</p><p>RNA polymerase I in the nucleus of hepatocytes. This, in turn, increases the</p><p>rate of ribosomal protein synthesis and enhances the regenerative capacity</p><p>of the liver. Silymarin is an effective antidote for Amanita mushroom poi-</p><p>soning because it antagonizes the inhibition of RNA polymerase I by</p><p>α-amanitine. The herb also has weak cholagogic properties.</p><p>➤ Indications</p><p>– Dyspeptic complaints</p><p>– Liver and gallbladder complaints</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– Daily dose: 200–400 mg silymarin based on the silibinin content (usually</p><p>80 %) in a divided dose, around mealtimes.</p><p>➤ Adverse effects: None known.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Milk thistle is used to treat dyspeptic complaints. It</p><p>should be used in combination with other gallbladder remedies. The hepato-</p><p>protective effects should be confirmed in modern clinical trials.</p><p>✿ Literature</p><p>– Monographs: DAB 1998; Commission E</p><p>– Scientific publications: see p. 478; Lorenz D, Mennicke WH, Behrendt W:</p><p>Untersuchungen zur Elimination von Silymarin bei cholecystektomierten</p><p>Patienten. Planta Med 45 (1992), 216–233; Schulz HU, Schürer M, Krum-</p><p>biegel G et al: Untersuchungen zum Freisetzungsverhalten und zur Bio-</p><p>äquivalenz von Silymarin-Präparaten. Arzneim Forsch/Drug Res 45 (1995),</p><p>61–64; Tuchweber B et al: J Med 4 (1973), 327.</p><p>European Mistletoe (Viscum album L.)</p><p>➤ General comments: The medicinal use of mistletoe dates back to the pre-</p><p>Christian era. The plant grows mainly in Europe.</p><p>Mistletoe Herb (Visci herba)</p><p>➤ Pharmacology: Mistletoe herb consists of the leaves, fruit, and flowers on the</p><p>fresh or dried young branches of Viscum album L. and preparations of the same.</p><p>– Important constituents: Lectins (glycoproteins with an 11 % carbohydrate</p><p>fraction) and mistletoe lectin (ML) 1 (ML1, VAA-1, viscumin), ML2 and ML3</p><p>Plant Summaries—M</p><p>94</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>(VAA-2). These lectin fractions comprise a mixture of isolectins, 0.05–0.1 %</p><p>polypeptides (viscotoxins A2, A3, B and Ps-1), 4–5 % mucilage (galacturon-</p><p>ans, arabinogalactans), sugar alcohols (mannitol, quebrachitol, pinitol, vis-</p><p>cumitol), and flavonoids (glycoside derivatives of quercetin, quercetin me-</p><p>thyl ethers, isorhamnetin, sakuranetin, homoeriodictyol).</p><p>– Pharmacological properties: Mistletoe lectins have cytostatic, immunostim-</p><p>ulatory, and antihypertensive effects. The herb significantly improves the</p><p>symptoms of chronic joint disease by triggering cutivisceral reflexes and</p><p>improves the quality of life of cancer patients.</p><p>➤ Indications</p><p>– Rheumatism</p><p>– Adjuvant tumor therapy</p><p>– Hypertension</p><p>– For prevention of arteriosclerosis</p><p>➤ Contraindications:</p><p>– chronic-progressive infections such as tuberculosis, and conditions associ-</p><p>ated with high fever</p><p>– Administration of mistletoe by the parenteral route can lead to protein hy-</p><p>persensitivity.</p><p>➤ Dosage and duration of use</p><p>– Tea (for adjuvant treatment of hypertension or for prevention of arterio-</p><p>sclerosis): Pour 1 cup of cold water onto 2.5 g (1 teaspoon) of the finely</p><p>chopped herb, allow to stand at room temperature for 12 hours, then strain.</p><p>• Dosage: One to two cups per day.</p><p>– Fluid extract (1 : 1), prepared using diluted ethanol: 1–3 mL three times a</p><p>day.</p><p>– Daily dose: 10 g of the herb.</p><p>– Tincture (1 : 10): 20 drops to 1 mL three times a day.</p><p>➤ Adverse effects: Mistletoe is not toxic when administered via the oral route.</p><p>Parenteral administration of mistletoe extract can induce local skin reactions</p><p>(mainly wheals, sometimes necrosis), chills, fever, headaches, anginal com-</p><p>plaints, orthostatic circulatory disorders, and allergic reactions. Wheal forma-</p><p>tion and elevated body temperature are considered to be signs of the herb’s</p><p>immunostimulatory effects.</p><p>➤ Summary assessment: Studies on the efficacy of parenteral mistletoe prepa-</p><p>rations in cancer patients are currently in progress.</p><p>✿ Literature</p><p>– Monographs: DAB 1998; Commission E</p><p>– Scientific publications: see p. 478; Anon: Die Mistel. Deutsche Apotheker</p><p>Ztg 136 (1996), 4330–4332; Beuth J, Lenartz D, Uhlenbruck G: Lektionop-</p><p>timierter Mistelextrakt. Z Phytother 18 (1997), 85–91; Gabius HJ: Mythos</p><p>Mistel: Anspruch und Wirklichkeit. PZ 140 (1995), 1029–1030; Hamacher</p><p>H: Mistel (Viscum album L.) – Forschung und therapeutische Anwendung.</p><p>Z Phytother 18 (1997), 34–35; Saenz MT, Ahumada MC, Garcia MD:</p><p>Extracts from Viscum and Crataegus are cytotoxic against larynx cancer</p><p>cells. Z Naturforsch C52 (1–2) (1997), 42–44; Schmidt S: Unkonventionelle</p><p>Heilverfahren in der Tumortherapie. Z Phytother 17 (1996), 115–117;</p><p>Timoshenko AV et al: Influence of the galactoside-specific lectin from</p><p>Viscum album and its subunits on cell aggregation and selected intracellu-</p><p>lar parameters of rat thymocytes. Planta Med 61 (1995), 130–133.</p><p>Plant Summaries—M</p><p>95</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Mullein (Verbascum densiflorum Bertol.)</p><p>➤ Synonyms: Dense-flowered mullein; Königskerze (Ger.)</p><p>➤ General comments: Mullein flowers and leaves have been used in a variety of</p><p>traditional indications (e. g., as an expectorant) since ancient times. The flow-</p><p>ers are used in modern herbal medicine.</p><p>➤ Pharmacology</p><p>– Herb: Mullein flower (Verbasci flos). The herb consists of the flowers of Ver-</p><p>bascum densiflorum B. or Verbascum phlomoides L. and preparations of the</p><p>same.</p><p>– Important constituents: Triterpene saponins, iridoids (aucubin, 6β-xylo-</p><p>sylaucubin, catalpol), caffeic acid derivatives (verbascoside, acteoside),</p><p>0.5–4.0 % flavonoids (rutin, diosmin, quercetin-7-O-glucoside), and 3 %</p><p>mucilage (arabinogalactans, xyloglucans).</p><p>– Pharmacological properties: The expectorant and soothing properties of</p><p>mullein are due to the action of its mucilage and saponin constituents.</p><p>➤ Indications: Dry, unproductive cough and chronic bronchitis.</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– Tea: Steep 1.5–2 g (3 to 4 teaspoons) of the flowers in 150 mL of boiled</p><p>water for 10 to 15 minutes.</p><p>– Daily dose: 3–4 g of the herb.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Mullein is an old and familiar herbal remedy that</p><p>should be used in combination with other mucilage-containing herbs in prep-</p><p>arations such as cough syrups.</p><p>✿ Literature</p><p>– Monographs: Commission E</p><p>– Scientific publications: see p. 478; Grzybek J, Szewczyk A: Verbascum-</p><p>Arten – Königskerze oder Wollblume. Portrait einer Arzneipflanze. Z Phy-</p><p>tother 17 (1996), 389–398.</p><p>Plant Summaries—M</p><p>96</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Nasturium (Tropaeolum majus L.)</p><p>➤ Synonyms: Indian cress;</p><p>Kapuzinerkresse (Ger.)</p><p>➤ Pharmacology</p><p>– Herb: Nasturium herb (Tropaeoli herba). The herb consists of the aerial</p><p>parts (seeds or foliage leaves) of Tropaeolum majus or therapeutically effec-</p><p>tive preparations of the same.</p><p>– Important constituents: Glucosinolates (0.1 % in the fresh plant) including</p><p>glucotropaeolin and benzyl isothiocyanate (released when the cells are de-</p><p>stroyed), ascorbic acid (vitamin C, ca. 300 mg/100 g fresh plant), cucur-</p><p>bitacins (cucurbitacins B and E), and fatty oils (ca. 7.5 % in the seeds) includ-</p><p>ing erucic acid (ca. 50 %), 11-cis-eicosenoic acid (25 %), and oleic acid (12 %).</p><p>Oxalates, flavonoids (isoquercetin and quercetin glycosides), and caroti-</p><p>noids (flower pigments lutein and zeaxanthin) are also present.</p><p>– Pharmacological properties: Benzyl isothiocyanate has bacteriostatic, viru-</p><p>static, and antimycotic effects in vitro. Isothiocyanates mainly accumulate</p><p>in and are eliminated via the respiratory air and urine. Nasturium induces</p><p>local hyperemia when applied externally.</p><p>➤ Indications</p><p>– Urinary tract infections</p><p>– Coughs, acute or chronic bronchitis</p><p>– Diseases of the kidney and ureter</p><p>– Urethritis and urethral syndrome</p><p>– Cystitis</p><p>– Menstrual complaints.</p><p>➤ Contraindications: Nasturium should not be used by infants and small chil-</p><p>dren or patients with gastrointestinal ulcers or renal diseases.</p><p>➤ Dosage and duration of use</p><p>– Tea infusion: 30 g herb per liter of water.</p><p>• Dosage: One cup, 2 to 3 times a day.</p><p>– Expressed juice: Daily dose: 30 g.</p><p>➤ Adverse effects: Higher doses in fresh plant or essential oil preparations can</p><p>lead to gastrointestinal irritation. Prolonged intensive contact with the fresh</p><p>plant can cause skin irritation, as it has a slight potential for sensitization.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Accurate information on the safety and effectiveness</p><p>of nasturium is not yet available.</p><p>✿ Literature</p><p>– Monographs: Commission E</p><p>– Scientific publications: see p. 478; Fanutti C, Gidley MJ, Reid JS: Tropaeolum</p><p>majus and contact dermatitis. Br J Dermatol, 200 (1996) 221–228; Franz G:</p><p>Kapuzinerkresse (Tropaeolum majus L.) Portrait einer Arzneipflanze.</p><p>Z Phytother 17 (1996), 255–622; Pintao AM, Pais MS, Coley H, Kelland LR,</p><p>Judson IR: In vitro and in vivo antitumor activity of benzyl isothiocyanate:</p><p>a natural product from Tropaeolum majus. Planta Med, 61 (1995) 233–236,</p><p>Jun.</p><p>Plant Summaries—N</p><p>97</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Nettle: Stinging Nettle (Urtica dioica L.),</p><p>Small Nettle (Urtica urens)</p><p>➤ Synonyms: Common nettle; Brennesselkraut (Ger.)</p><p>➤ General comments: The fresh or dried aerial and subterranean parts of Urtica</p><p>spp., collected at the time of flowering, are used in medicine.</p><p>Nettle Leaft/Herb (Urticae folium/herba)</p><p>➤ Pharmacology</p><p>– Herb: Nettle leaft/herb (Urticae folium/herba). The herb consists of the fresh</p><p>or dried aerial parts of Urtica dioica L., Urtica urens L. and/or their hybrids</p><p>collected at the time of flowering, and preparations of the same.</p><p>– Important constituents: Histamine, serotonin, leukotriene, acetylcholine,</p><p>formic acid, 0.7–1.8 % flavonoids (rutin, 0.1–0.6 %, isoquercetin, 0.2 %), and</p><p>silicic acid (1–5 %).</p><p>– Pharmacological properties: Nettle leaft/herb is an aquaretic that also pro-</p><p>motes the excretion of uric acid. It can eliminate edemas when taken with</p><p>an ample volume of fluids. Local anesthetic and analgesic effects have been</p><p>observed in animals by external use of the tincture. The drug inhibits leuko-</p><p>triene and prostaglandin synthesis in vitro. Significant antirheumatic and</p><p>antiarthritic effects have been observed in studies with large numbers of</p><p>patients.</p><p>➤ Indications</p><p>– Rheumatic complaints</p><p>– Urinary tract infections</p><p>– Renal or urinary calculi</p><p>– External use for rheumatic pain (nettle spirit).</p><p>➤ Contraindications: The drug is not recommended in patients with cardiac or</p><p>renal edema.</p><p>➤ Dosage and duration of use</p><p>– Internal use: Daily dose: 4–6 g drug. An adequate intake of fluids (at least 2</p><p>liters per day) is essential for aquaresis.</p><p>– Tea: Place 1.5 g (2 teaspoons) of the finely chopped herb in cold water, bring</p><p>to a boil and steep for 10 minutes (1 teaspoon = ca. 0.8 g drug).</p><p>• Dosage: One cup, several times a day.</p><p>– External use: Tincture/spirit (1 : 10).</p><p>➤ Adverse effects: None known.</p><p>➤ Herb–drug interactions: None known</p><p>➤ Common misconceptions: In folk medicine, nettle herb is used for treatment</p><p>of diabetes mellitus, but the efficacy of the herb in this indication has never</p><p>been scientifically validated.</p><p>➤ Summary assessment: The anti-inflammatory effect of the drug has been</p><p>evaluated in an increasing number of uncontrolled clinical studies.</p><p>✿ Literature</p><p>– Monographs: BHP 96; DAB 1998; DAB 86; ESCOP; Commission E, Mar 31</p><p>– Scientific publications: see p. 478; Anon: Vet Hum Toxicol 24 (1982), 247;</p><p>Chaurasia N, Wichtl M: Planta Med 53 (1987), 432; Hughes RE et al: J Sci</p><p>Food Agric 31 (1980), 1279; Kern W, List PH, Hörhammer L (Ed): Hagers</p><p>Handbuch der Pharmazeutischen Praxis. 4. Aufl., Bde. 1–8, Springer Verlag</p><p>Berlin, Heidelberg, New York 1969; Lewin L: Gifte und Vergiftungen.</p><p>Plant Summaries—N</p><p>98</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>6. Aufl., Nachdruck, Haug Verlag, Heidelberg, New York 1992; Schiebel-</p><p>Schlosser G: Die Brennessel. PTA 8 (1994), 53; Schilcher H: Urtica-Arten –</p><p>Die Brennessel. Z Phytother 9 (1988), 160; Schomakers J, Bollbach FD,</p><p>Hagels H: Brennesselkraut – Phytochemische und anatomische Unter-</p><p>scheidung der Herba-Drogen von Urtica dioica und U. urens. Deutsche</p><p>Apotheker Ztg 35 (1995), 578–584.</p><p>Nettle Root (Urticae radix et rhizoma)</p><p>➤ General comments: See page 97.</p><p>➤ Pharmacology</p><p>– Herb: Nettle root and rhizome (Urticae radix et rhizoma). The drug consists</p><p>of the dried roots and rhizomes of Urtica dioica L. (common nettle), Urtica</p><p>urens L. (small nettle), hybrids of these species, and/or other wild species in</p><p>North America.</p><p>– Important constituents: Sterols (0.03–0.6 % β-sitosterol), 0.1 % lectins (Urti-</p><p>ca dioica agglutinin) and polysaccharides (glucans, glucogalacturonans,</p><p>acid arabinogalactans).</p><p>– Pharmacological properties: Immunomodulation (due to lectin content); in-</p><p>hibits the transformation of testosterone to estradiol in the prostate; in-</p><p>creases the flow of urine and decreases irritation and discomfort in stages I</p><p>to II of benign prostatic hyperplasia.</p><p>➤ Indications</p><p>– Prostate problems</p><p>– Irritable bladder</p><p>➤ Contraindications: The herb is not recommended in patients with cardiac or</p><p>renal edema.</p><p>➤ Dosage and duration of use</p><p>– Tea: Place 1.5 g (1 heaped teaspoon) coarsely powdered drug in a vessel</p><p>containing at least 200 mL of cold water, boil for 1 minute, then cover and</p><p>steep for 10 minutes.</p><p>– Dry extract: Manufactured with 8.3–12.5 parts herb to 1 part ethanol 60 %.</p><p>Dosage: 120 mg, two times a day in capsule or tablet form.</p><p>– Daily dose: 4–6 g herb.</p><p>➤ Adverse effects: Mild gastrointestinal symptoms can occur as an occasional</p><p>side effect.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Clinical studies on the efficacy of nettle root in benign</p><p>prostatic hyperplasia are highly suggestive of efficacy, but not conclusive.</p><p>✿ Literature</p><p>– Monographs: DAB 1998; ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Ganßer D, Spiteller G: Aromatase inhib-</p><p>itors from Urtica dioica. Planta Med 61 (1995), 138–140; Sonnenschein R:</p><p>Untersuchung der Wirksamkeit eines prostatotropen Phytotherapeu-</p><p>tikums (Urtica plus) bei benigner Prostatahyperplasie und Prostatitis – eine</p><p>prospektive multizentrische Studie. Urologe [B] 27 (1987), 232–237; Wag-</p><p>ner H et al: Studies on the binding of Urtica dioica agglutinin (UDA) and</p><p>other lectins in an in vitro epidermal growth factor receptor test. Phyto-</p><p>medicine 1 (1994), 287–290; Wagner H, Willer F, Samtleben R, Boos G:</p><p>Search for the antiprostatic principle of stinging nettle (Urtica dioica) roots.</p><p>Phytomedicine 1 (1994), 213–224.</p><p>Plant Summaries—N</p><p>99</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Oak (Quercus robur L.)</p><p>➤ General comments: The common or pedunculate oak (Quercus robur) is dis-</p><p>tinct from the sessile or durmast oak (Quercus petraea). There are no significant</p><p>differences in the concentrations of active substances in the bark of the two</p><p>species. The tree is common in Europe, Asia Minor, and the Caucasus. Bark from</p><p>a number of oak species is collected in North America, especially Quercus alba,</p><p>white oak.</p><p>➤ Pharmacology</p><p>– Herb: Oak bark (Quercus cortex), consists of the dried bark from young</p><p>branches and twigs of Quercus robur L. and/or Quercus petraea (M.) L. col-</p><p>lected in the spring and preparations of the same.</p><p>• Important constituents: Tannins (12–16 %), including catechins, oligo-</p><p>meric proanthocyanidins, and gallotannins.</p><p>• Pharmacological properties: The tannins have astringent, anti-inflam-</p><p>matory, antiviral, and anthelmintic effects.</p><p>➤ Indications:</p><p>– External use for: inflammatory skin complaints of various causes and</p><p>– Topical treatment of mild inflammations of the mouth and throat or genital</p><p>and anal region</p><p>– Internal use for unspecific acute diarrhea.</p><p>Warning: A physician should be consulted if diarrhea persists for more than</p><p>3 to 4 days.</p><p>➤ Contraindications: External use: extensive skin damage.</p><p>➤ Dosage and duration of use</p><p>– Internal use: Tea: Add 1 g finely chopped or coarsely powdered dried bark</p><p>to cold water, bring to a boil and steep (1 teaspoon = ca. 3 g drug).</p><p>– Daily dose: 3 g dried bark.</p><p>– External use</p><p>• Gargles and compresses: Bring 2 tablespoons of the finely cut dried bark</p><p>to a boil in 3 cups of water. For inflammations of the mouth and throat,</p><p>gargle with the solution several times a day.</p><p>• For hydrotherapy: Boil 5 g of the dried bark in 1 liter of water. Use the</p><p>infusion to prepare a full or partial bath. The patient should bathe for 20</p><p>minutes at 32–37 °C once a week initially, then 2 to 3 times a week</p><p>thereafter.</p><p>➤ Adverse effects: No known health hazards. When used internally, the secreto-</p><p>inhibitory effects of the drug can cause indigestion. Tannins can cause bowel</p><p>irritation in some individuals when the strong tea is taken on an empty stom-</p><p>ach.</p><p>➤ Herb–drug interactions: Oak bark interferes with the absorption of alkaloids</p><p>and other alkaline drugs.</p><p>➤ Summary assessment: Oak bark has an empirically proven efficacy for the</p><p>specified indications.</p><p>✿ Literature</p><p>– Monographs: Commission E</p><p>– Scientific publications: see p. 478; König M et al: Ellegitannins and complex</p><p>tannins from Quercus petraea bark. J Nat Prod 57 (1994), 1411–1415; Pal-</p><p>lenbach E, Scholz E, König M, Rimpler H: Proanthocyanidins from Quercus</p><p>petraea bark. Planta Med 59 (1993), 264.</p><p>Plant Summaries—O</p><p>10</p><p>0</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Oregon Grape (Mahonia aquifolium [Pursh.] Nutt.)</p><p>➤ Synonyms: Berberis aquifolia, holly-leaved barberry; Mahonie (Ger.)</p><p>➤ General comments: Oregon grape is a shrub native to the Pacific region of the</p><p>United States. In Europe, it is grown as an ornamental plant and can sometimes</p><p>be found growing wild.</p><p>➤ Pharmacology</p><p>– Herb: Oregon grape bark (Mahoniae cortex). The herb consists of the bark</p><p>of the branches and twigs as well as the branch tips of Mahonia aquifolium</p><p>(Pursh.) Nutt.</p><p>– Important constituents: Isoquinoline alkaloids (root bark 7–16 %, trunk bark</p><p>2–4.5 %), berberine, berbamine, oxyacanthine, and isocorydine.</p><p>– Pharmacological properties: Oregon grape bark contains bitters that are use-</p><p>ful for treating lack of appetite. The herb also may have antipsoriatic effects</p><p>when applied externally.</p><p>➤ Indications</p><p>– Dyspeptic complaints</p><p>– Eczema, boils, and acne</p><p>– Psoriasis</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– Decoction or powder: One dose equals: 1–2 g of the herb.</p><p>– Fluid extract: Maximum dose: 1–2 mL, 3 times a day.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Oregon grape bark can be tried in mild to moderate</p><p>psoriasis.</p><p>✿ Literature</p><p>– Monographs: HAB 1</p><p>– Scientific publications: see p. 478; Augustin M: Mahonia aquifolium bei</p><p>Psoriasis. Z Phytother 17 (1996), 44; Misik V et al: Lipoxygenase inhibition</p><p>and antioxidant properties of protoberberine and aporphine alkaloids iso-</p><p>lated from Mahonia aquifolium. Planta Med 61 (1995), 372–373.</p><p>Oxlip (Primula elatior)</p><p>➤ See Primula</p><p>Plant Summaries—O</p><p>10</p><p>1</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Parsley (Petroselinum crispum Mill. Nymph.)</p><p>➤ General comments: Parsley herb and root are widely used in cooking and</p><p>herbal medicine.</p><p>➤ Pharmacology</p><p>– Herb</p><p>• Parsley herb (Petroselini herba). The herb consists of the fresh or dried</p><p>aerial parts of Petroselinum crispum (M.) N. et A. W. H. and preparations</p><p>of the same.</p><p>• Parsley root (Petroselini radix). The herb consists of the dried subterra-</p><p>nean parts of Petroselinum crispum (M.) N. et A. W. H. and preparations</p><p>of the same.</p><p>– Important constituents</p><p>• Parsley herb: Essential oil (0.02–0.3 % in fresh parsley, ca. 1.2 % in dried</p><p>parsley) and up to 90 % apiol and myristicin, depending on the variety.</p><p>Other constituents include furanocoumarins, flavonoids (1.9–5.6 %),</p><p>and vitamins, especially vitamin C (up to 165 mg per 100 g fresh herb).</p><p>• Parsley root: 0.05–0.12 % essential oil (apiol, myristicin), furanocou-</p><p>marins, and 0.2–1.3 % flavonoids (apiin).</p><p>– Pharmacological properties: The efficacy of parsley in humans has not been</p><p>clearly demonstrated. Stimulation of the renal parenchyma due to the es-</p><p>sential oils is assumed to occur.</p><p>➤ Indications</p><p>– Urinary tract infections</p><p>– Renal or urinary calculi</p><p>➤ Contraindications: Known allergy to parsley or apiol; nephritis; pregnancy.</p><p>Irrigation therapy is contraindicated in cardiac or renal edema.</p><p>➤ Dosage and duration of use</p><p>– Tea: Infuse 2 g in a cup of boiled water for 20 minutes, 2–3 times a day.</p><p>– Daily dose: 6 g herb.</p><p>Important: An adequate intake of fluids (at least 2 liters per day) is essential</p><p>during irrigation therapy.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb. Contact allergy is a rare side effect.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Parsley herb and root should be combined with other</p><p>herbal preparations with aquaretic and urinary antiseptic effects.</p><p>✿ Literature</p><p>– Monographs: Commission E</p><p>Passion Flower (Passiflora incarnata L.)</p><p>➤ General comments: Several species of passion flowers, of which some are</p><p>known to be toxic, are native to North and South America, Mexico, and West</p><p>Indies. The plant supplies a tasty fruit. The herb is used in medicine.</p><p>➤ Pharmacology</p><p>– Herb: Passion flower herb (Passiflorae herba). The herb consists of the fresh</p><p>or dried aerial parts of Passiflora incarnata L. and preparations of the same.</p><p>– Important constituents: Up to 2.5 % flavonoids (mainly C-glycosylflavone),</p><p>and cyanogenetic glycosides (up to 1 % gynocardin).</p><p>Plant Summaries—P</p><p>10</p><p>2</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>– Pharmacological properties: Cyanogenetic</p><p>glycosides were found to reduce</p><p>the blood pressure and stimulate the respiratory center in animals. There is</p><p>still no unequivocal proof of the herb’s sedative or spasmolytic effects.</p><p>➤ Indications: States of nervous unrest.</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– Tea: Steep 1 teaspoon (2 g) of the herb in 150 mL of hot water for 10 min-</p><p>utes.</p><p>• Dosage: One cup, 2 to 3 times a day and 30 minutes before retiring.</p><p>– Daily dose: 4–8 g.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Hardly any scientific research on the herb has been</p><p>performed. Passion flower should be used in combination with other sleep-</p><p>promoting herbal preparations.</p><p>✿ Literature</p><p>– Monographs: DAB 1998; ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Anon: Phytotherapeutika: Nachge-</p><p>wiesene Wirkung, aber wirksame Stoffe meist nicht bekannt. Deutsche</p><p>Apotheker Ztg 137 (1997), 1221–1222.</p><p>Peppermint (Mentha piperita L.):</p><p>➤ General comments: Peppermint is widely distributed throughout Europe and</p><p>North America. The leaves and the oil extracted from them are used in medicine.</p><p>Peppermint Leaf (Menthae piperitae folium)</p><p>➤ General comments: See Peppermint Oil, p. 478.</p><p>➤ Pharmacology</p><p>– Herb: Peppermint leaf (Menthae piperitae folium). The herb consists of the</p><p>dried leaves of Mentha piperita L. and preparations of the same.</p><p>– Important constituents: Essential oil (0.5–4.0 %) consisting mainly of men-</p><p>thol (35–45 %), menthone (15–20 %), menthyl acetate (3–5 %), and 1,8-</p><p>cineole (6–8 %). Flavonoids are also present.</p><p>– Pharmacological properties: Antiviral, antimicrobial, aquaretic, choleretic,</p><p>and mildly sedative.</p><p>➤ Indications</p><p>– Dyspeptic complaints</p><p>– Liver and gallbladder complaints</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– Tea: Steep 1 tablespoon (3–6 g) of the herb in 150 mL of boiled water for</p><p>10 minutes. Sip slowly while hot.</p><p>• Dosage: One cup, between meals, 3 to 4 times a day.</p><p>➤ Adverse effects: Owing to its cholagogic action, the herb can induce acute ab-</p><p>dominal pain in patients with gallstones.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Peppermint leaf combines well with other herbal</p><p>preparations that induce spasmolysis and improve digestive function.</p><p>Plant Summaries—P</p><p>10</p><p>3</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>✿ Literature</p><p>– Monographs: ESCOP; HAB 34; Commission E</p><p>– Scientific publications see p. 478; Nöller HG: Elektronische Messungen an</p><p>der Nasenschleimhaut unter Mentholwirkung. In: Menthol and menthol-</p><p>containing external remedies. Thieme, Stuttgart 1967, S 146–153, 179.</p><p>Peppermint Oil (Menthae piperitae aetheroleum)</p><p>➤ Pharmacology</p><p>– Herb: Peppermint oil (Menthae piperitae aetheroleum). The herb consists</p><p>of the essential oil distilled from the fresh, flowering branch tips of Mentha</p><p>piperita L. and preparations of the same.</p><p>– Important constituents: Menthol (35–45 %), menthone (15–20 %), menthyl</p><p>acetate (3–5 %), neomenthol (2.5–3.5 %), isomenthone (2–3 %), mentho-</p><p>furan (2–7 %), and 1,8-cineole (6–8 %).</p><p>– Pharmacological properties: Peppermint oil has antimicrobial, insecticidal,</p><p>choleretic, and carminative effects. It induces smooth-muscle spasmolysis</p><p>and produces a cooling sensation when applied to the skin.</p><p>➤ Indications</p><p>– Dyspeptic complaints</p><p>– Colds and fever, runny nose</p><p>– Coughs and bronchitis</p><p>– Decreased resistance to infections</p><p>– Liver and gallbladder complaints</p><p>– Inflammations of the mouth and throat</p><p>➤ Contraindications</p><p>– Internal use: Individuals with biliary tract obstruction, inflammation of the</p><p>gallbladder or severe liver damage should not use peppermint oil. Owing to</p><p>its cholagogic action, the herb can induce acute abdominal pain in patients</p><p>with gallstones.</p><p>– External use: Peppermint oil preparations should not be applied to the face,</p><p>especially the nose or the eyes, of infants and small children due to the risk</p><p>of respiratory side effects such as respiratory arrest.</p><p>➤ Dosage and duration of use</p><p>– Daily dose: 6 to 12 drops. Daily dose for irritable colon: 0.6 mL; individual</p><p>dose in enteric coated preparations: 0.2 mL.</p><p>– Inhalation: Add 3 to 4 drops to hot water and inhale the vapors.</p><p>– External use: Apply several drops of peppermint liniment to the affected</p><p>area of the skin 2 to 4 times a day. Analgesic effects after application on the</p><p>temples in tension headache could be proven in clinical studies.</p><p>– Pediatric use: Apply 5 to 15 drops to the chest and back.</p><p>➤ Adverse effects: Peppermint oil can upset the stomach of sensitive individu-</p><p>als. Persons who tend to develop gastroesophageal reflux should avoid pep-</p><p>permint oil. Menthol-containing essential oils can increase the spasms of</p><p>bronchial asthma. Because of its menthol content, peppermint oil has a weak</p><p>potential for sensitization.</p><p>➤ Herb–drug interactions: None known.</p><p>Warning: See Contraindications.</p><p>➤ Summary assessment: Peppermint oil is an extremely popular herbal remedy</p><p>with a relatively wide therapeutic range.</p><p>Plant Summaries—P</p><p>10</p><p>4</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>✿ Literature</p><p>– Monographs: ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Gräfe AK: Besonderheiten der Arznei-</p><p>mitteltherapie im Säuglings- und Kindesalter. PZ 140 (1995), 2659–2667.</p><p>Pine (Pinus spp. L.):</p><p>Pine Needle Oil (Pini aetheroleum)</p><p>➤ Pharmacology</p><p>– Herb: Pine needle oil (Pini aetheroleum). The preparation consists of the es-</p><p>sential oil derived from the fresh needles and branch tips collected in the</p><p>springtime of Pinus sylvestris L., Pinus mugo spp. pumilio (H.) F., Pinus nigra</p><p>Arnold, or Pinus pinaster S. or preparations of the same.</p><p>– Important constituents</p><p>• P. sylvestris L.: α-pinenes (10–50 %), δ-3-carene (20 %), camphene (12 %),</p><p>β-pinene (10–25 %), limonene (10 %), myrcene, terpinolene, and bornyl</p><p>acetate</p><p>• P. mugo Turra: δ-3-carene (35 %), α- and β-pinenes (20 %), and β-phellan-</p><p>drene (15 %)</p><p>• P. nigra Arnold: α-pinene (48–65 %), β-pinene (32 %), and germacrene-</p><p>D (19 %)</p><p>• P. pallustris Mill.: α- and β-pinenes (95 %).</p><p>– Pharmacological properties: The essential oil has antimicrobial and expec-</p><p>torant effects and induces local hyperemia.</p><p>➤ Indications</p><p>– Coughs and acute bronchitis</p><p>– Decreased resistance to infections</p><p>– Inflammations of the mouth and throat</p><p>– Rheumatism and acute rheumatic fever</p><p>– Acute infections of the upper or lower respiratory tract</p><p>– Acute (obstructive) laryngitis, pharyngitis, or tracheitis</p><p>– Acute rhinopharyngitis or tonsillitis</p><p>– Arthropathies</p><p>– Neuralgia, neuritis, radiculopathy</p><p>➤ Contraindications: Bronchial asthma, whooping cough. Individuals with ex-</p><p>tensive wounds, acute skin diseases, febrile and infectious diseases, heart fail-</p><p>ure and/or hypertension should not use pine oils as a bath additive.</p><p>➤ Dosage and duration of use</p><p>– Inhalation: Add 2 g (9 to 10 drops) of pine oil to 2 cups of hot water and</p><p>inhale the vapors. Repeat several times a day.</p><p>– Bath additive: Add one drop of the oil per liter of water. Bathe for 10 to 20</p><p>minutes at a water temperature of 35–38°C.</p><p>– Externally: Apply a few drops of the oil to the affected areas of the skin and</p><p>rub in thoroughly.</p><p>– Ointment: Apply a 10–50 % ointment several times a day.</p><p>➤ Adverse effects: Can irritate the skin and mucous membranes or worsen bron-</p><p>chospasms.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Pine oil is a well-known herbal medicament with es-</p><p>tablished effectiveness.</p><p>Plant Summaries—P</p><p>10</p><p>5</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>✿ Literature</p><p>– Monographs: DAB 1998; Commission E, Mar 31</p><p>– Scientific publications: see p. 478; Glasl H et al: Gaschromatographische</p><p>Untersuchung von Arzneibuchdrogen 7. Mitt.: GC-Untersuchung von Pina-</p><p>ceen-Ölen des Handels und Versuche zu ihrer Standardisierung. Deutsche</p><p>Apotheker Ztg 120 (1980), 64–67; 455; Leung Ay: Encyclopedia of Common</p><p>Natural Ingredients Used in Food Drugs and Cosmetics. John Wiley & Sons</p><p>Inc. New York 1980.</p><p>Pine Sprouts (Pini turiones)</p><p>➤ Pharmacology</p><p>– Herb: Pine sprouts (Pini turiones). The herb consists of the fresh or dried</p><p>sprouts (3–5 cm in length) of Pinus sylvestris L., collected in the spring, and</p><p>preparations of the same.</p><p>– Important constituents: Essential oil (0.2–0.5 %) consisting mainly of bornyl</p><p>acetate, cadinene, δ-3-carene, limonene, phellandrene, and α-pinene. Resins,</p><p>bitter principles, pinicrin, and ascorbic acid (vitamin C) are also present.</p><p>– Pharmacological properties: The essential oil has bronchosecretolytic and</p><p>weakly antiseptic effects. It induces local hyperemia when applied to the</p><p>skin.</p><p>➤ Indications and contraindications: See Pine needle oil.</p><p>➤ Dosage and duration of use</p><p>– Bath additive: Add 100 g alcohol extract to a full tub of bath water.</p><p>– Semisolid forms: Apply the ointment (20–50 %) to the affected areas of the</p><p>skin several times a day.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the herb.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Pine sprouts is a well-known herb in Europe with</p><p>proven effectiveness in clinical experience.</p><p>✿ Literature</p><p>– Monographs: Commission E</p><p>– Scientific publications: See Pine needle oil.</p><p>Primula (Primula veris L.)</p><p>➤ Synonyms/related species: Cowslip (Primula veris), oxlip (Primula elatior L.</p><p>(Hill) ); Schlüsselblume (Ger.)</p><p>➤ General comments: Primula veris and Primula elatior, the species native to</p><p>Europe, are used in medicine. The parts used are the roots and flowers.</p><p>➤ Pharmacology</p><p>– Herb</p><p>• Primula flower (Primulae flos cum calycibus). The herb consists of the</p><p>dried, entire flowers (with calyx) of Primula veris L. and/or Primula ela-</p><p>tior (L.) H. and preparations of the same.</p><p>• Primula root (Primulae radix). The herb consists of the dried rhizomes</p><p>(with roots) of Primula veris L. and/or Primula elatior (L.) H. and prepa-</p><p>rations of the same.</p><p>– Important constituents</p><p>• Primula flower: Up to 2 % triterpene saponins (primula acid A), flavo-</p><p>noids (ca. 3 %), phenol glycosides (primverin and primulaverin).</p><p>Plant Summaries—P</p><p>10</p><p>6</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>• Primula root: 5–10 % triterpene saponins (primula acid A), phenol gly-</p><p>cosides (0.2–2.3 %), with the highest concentrations in the spring</p><p>(primulaverin).</p><p>– Pharmacological properties</p><p>• Primula flower: The flavonoids and saponins in primula flower have</p><p>bronchosecretolytic and expectorant action. In animal studies, the herb</p><p>was found to increase the volume of bronchial secretions. The herb also</p><p>contains saponins with antimycotic effects.</p><p>• Primula root: The herb contains saponins with bronchosecretolytic and</p><p>expectorant effects. The herb takes effect by stimulating the gastric mu-</p><p>cosa. This triggers the increased production of bronchial secretions due</p><p>to a CNS reflex possibly transmitted by the vagal nucleus.</p><p>➤ Indications: Acute and chronic coughs and bronchitis.</p><p>➤ Contraindications: Known allergy to primula.</p><p>➤ Dosage and duration of use</p><p>– Primula flower tea: Steep 1.3 g (1 teaspoon) of the herb in boiled water for</p><p>10 minutes.</p><p>• Dosage: One cup, several times a day, especially in the morning and be-</p><p>fore retiring at night.</p><p>• Daily dose: 3 g herb.</p><p>• May be sweetened with honey when used as a bronchial tea.</p><p>– Primula root tea: Add 0.2–0.5 g of the finely cut or pulverized herb</p><p>(1 teaspoon = ca. 3.5 g herb) to cold water and bring to a boil. Steep for 5</p><p>minutes, then strain. Sweeten with honey.</p><p>• Dosage: One cup every 2 to 3 hours.</p><p>• Daily dose: 1 g herb.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb. It can upset the stomach or cause nausea if overdosed.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Primula flower and, especially, primula root can be</p><p>recommended for treatment of persistent productive coughs.</p><p>✿ Literature</p><p>– Monographs: Commission E; ESCOP (Primulae radix)</p><p>– Scientific publications: see p. 478; Büechi S: Antivirale Saponine, pharma-</p><p>kologische und klinische Untersuchungen. Deutsche Apotheker Ztg 136</p><p>(1996), 89–98.</p><p>Psyllium (Plantago ovata L. [psyllium])</p><p>➤ General comments: Psyllium and Indian plantain (Plantago ovata Forssk.) are</p><p>related species.</p><p>➤ Pharmacology</p><p>– Herb: Psyllium (Psyllii semen). The herb consists of the dried mature seeds</p><p>of Plantago psyllium L., and other species, and preparations of the same. The</p><p>swelling index of the preparations used in medicine should be no less than</p><p>10.</p><p>– Important constituents: 10–12 % mucilage (arabinoxylans) in the seed coat</p><p>and iridoid glycosides (ca. 0.14 % aucubin).</p><p>– Pharmacological properties: Regulates the bowels owing to the swelling</p><p>capacity of its mucilages. The stool volume increases, the transit time</p><p>Plant Summaries—P</p><p>10</p><p>7</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>decreases (a desirable effect in constipation), and intestinal peristalsis is</p><p>stimulated. When used to treat diarrhea, the herb leads to fluid binding,</p><p>thereby normalizing the transit time.</p><p>➤ Indications</p><p>– For all psyllium species: Irritable colon, chronic constipation</p><p>– Additional indications for Indian psyllium</p><p>• Diarrhea of various origin</p><p>• Intestinal diseases in which stool softening is desired to facilitate defe-</p><p>cation</p><p>➤ Contraindications: Gastrointestinal tract stenosis, inflammation of the gas-</p><p>trointestinal tract (risk of irritation and spasm), imminent or existent bowel</p><p>obstruction, difficult to manage diabetes mellitus.</p><p>➤ Dosage and duration of use</p><p>– Daily dose: 12–40 g seeds. Allow whole or coarsely crushed seeds to swell</p><p>in water, then take with plenty of water (150 mL for each 5 g of the drug).</p><p>Psyllium is best taken on an empty stomach in the morning.</p><p>– Onset of effect after a single dose occurs within 12 to 24 hours. The maxi-</p><p>mum effect can be observed within 2 to 3 days. A physician should be con-</p><p>sulted in any case when diarrhea lasts for more than 3 to 4 days.</p><p>➤ Adverse effects: Hypersensitivity reactions (rhinitis, conjunctivitis, asthma,</p><p>urticaria) have been reported in isolated cases. Blockage of the esophagus or</p><p>intestine and choking attacks can occur if the patient, especially when elderly,</p><p>does not take an ample supply of water. Drinking two 8-ounce glasses of water</p><p>is recommended to prevent this effect.</p><p>➤ Herb–drug interactions: The herb can delay the absorption of other drugs if</p><p>used concomitantly. Psyllium polysaccharides can increase the effects of insu-</p><p>lin or oral antidiabetic drugs.</p><p>➤ Summary assessment: Psyllium is an herb with proven effects. It is well tol-</p><p>erated, even by children. Clinical studies on the efficacy of psyllium are avail-</p><p>able.</p><p>✿ Literature</p><p>– Monographs: DAB 10; ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Anon: Pharmaceutical Care: „Den Miß-</p><p>brauch von Laxanzien vermeiden helfen“. Deutsche Apotheker Ztg 135</p><p>(1995), 1867–1868.</p><p>Purple Butterbur (Petasites hybridus L. Gaertn., Mey. et Scherb.)</p><p>➤ General comments: Purple butterbur has the largest leaves of all the German</p><p>native plants. The rhizome is used in herbal medicine.</p><p>➤ Pharmacology</p><p>– Herb: Butterbur rhizome (Petasitidis rhizoma).</p><p>. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249</p><p>13.5 Gastrointestinal Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251</p><p>13.6 Urinary Tract Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255</p><p>13.7 Psychogenic Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256</p><p>13.8 Dermatological Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259</p><p>14 Dermatological Diseases</p><p>. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263</p><p>14.1 Psoriasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263</p><p>14.2 Eczema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265</p><p>14.3 Atopic Dermatitis (Neurodermatitis) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267</p><p>14.4 Acne and Seborrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269</p><p>14.5 Furuncles (Boils) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271</p><p>14.6 Hair Loss (Effluvium) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272</p><p>14.7 Itching (Pruritus) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273</p><p>14.8 Excessive Perspiration (Hyperhidrosis) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275</p><p>15 Open Wounds and Blunt Traumas</p><p>. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 276</p><p>15.1 Wounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 276</p><p>15.2 Blunt Traumas and latrogenic Wounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278</p><p>15.3 Leg Ulceration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280</p><p>16 Herbal Hydrotherapy (Balneotherapy)</p><p>. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282</p><p>16.1 Fundamentals of Hydrotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282</p><p>16.2 Colds and Flu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283</p><p>16.3 Circulatory Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284</p><p>16.4 Nervousness and Sleep Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285</p><p>16.5 Rheumatic Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286</p><p>16.6 Inflammatory Skin Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288</p><p>17 Standard Treatments for Cardiovascular Diseases</p><p>. . . . . . . . . . . . . . . . . . . 290</p><p>17.1 Arnica Wrap for Heart Ailments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290</p><p>17.2 Invigorating Rosemary Whole-Body Wash . . . . . . . . . . . . . . . . . . . . . . . . . . 291</p><p>18 Standard Treatments for Respiratory Diseases</p><p>. . . . . . . . . . . . . . . . . . . . . . 292</p><p>18.1 Flaxseed Poultice for Sinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292</p><p>18.2 Horseradish Poultice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293</p><p>18.3 Thyme Oil Compress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294</p><p>18.4 Thyme Chest Wrap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 296</p><p>18.5 Mustard Wrap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297</p><p>19 Standard Treatments for Gastrointestinal Disorders</p><p>. . . . . . . . . . . . . . . . . 299</p><p>19.1 Hot Stomach Wrap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299</p><p>19.2 Hot Chamomile Wrap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300</p><p>19.3 Fennel Oil Wrap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301</p><p>19.4 Hot Yarrow Wrap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302</p><p>Red Section: Practical Applications</p><p>Contents</p><p>X</p><p>I</p><p>Co</p><p>n</p><p>te</p><p>n</p><p>ts</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>20 Standard Treatments for Urinary Diseases</p><p>. . . . . . . . . . . . . . . . . . . . . . . . . . 303</p><p>20.1 Eucalyptus Oil Compress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303</p><p>20.2 Horseradish Poultice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 304</p><p>21 Standard Treatments for Nervous Disorders</p><p>. . . . . . . . . . . . . . . . . . . . . . . . 305</p><p>21.1 Mood-Enhancing Stomach Wrap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305</p><p>21.2 Lavender Oil Chest Compress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306</p><p>21.3 Lavender Oil Whole-Body Wash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307</p><p>22 Standard Treatments for Rheumatic and Systemic Diseases</p><p>. . . . . . . . . 308</p><p>22.1 Grass Flower Pillow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 308</p><p>22.2 Ginger Wrap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309</p><p>22.3 Arnica Joint Wrap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310</p><p>23 Standard Treatments for Pediatric Diseases</p><p>. . . . . . . . . . . . . . . . . . . . . . . . . 311</p><p>23.1 Arnica Pulse Wrap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311</p><p>23.2 Mustard Powder Footbath . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 312</p><p>23.3 Lemon Neck Wrap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313</p><p>23.4 Fever-Reducing Whole-Body Peppermint Wash . . . . . . . . . . . . . . . . . . . . . 314</p><p>24 Standard Treatments for Skin Diseases and Wounds</p><p>. . . . . . . . . . . . . . . . 315</p><p>24.1 Ringer–Calendula Mixture for Wet Dressings . . . . . . . . . . . . . . . . . . . . . . . . 315</p><p>24.2 Ringer–Calendula Dressing for Deep Wounds . . . . . . . . . . . . . . . . . . . . . . . 317</p><p>24.3 Rhatany Tincture for Wound Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318</p><p>24.4 Arnica Wrap for Soft-Tissue Swelling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319</p><p>24.5 Whole-Body Wash with Heartsease Infusion . . . . . . . . . . . . . . . . . . . . . . . . 320</p><p>24.6 White Cabbage Compress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321</p><p>24.7 Egg Yolk Hair Mask . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 322</p><p>24.8 Revitalizing Hair Mask . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323</p><p>25 Herbal Oils for Musculoskeletal Diseases</p><p>. . . . . . . . . . . . . . . . . . . . . . . . . . 324</p><p>26 Plant Glossaries</p><p>. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325</p><p>26.1 Latin–English Plant Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325</p><p>26.2 English–Latin Plant Glossary . . . . . . . . . . . . . . . . . . . . . . . . .</p><p>The herb consists of the</p><p>dried subterranean parts of Petasites hybridus L. P. G. M. et S. and prepara-</p><p>tions of the same.</p><p>– Important constituents: Petasins (petasin, neopetasin, isopetasin), sesqui-</p><p>terpenes, furanopetasin, 9-hydroxyfuranoeremophilane, and pyrrolizidine</p><p>alkaloids (0.0001–0.5 %).</p><p>– Pharmacological properties: Petasins inhibit leukotriene synthesis and have</p><p>spasmolytic, analgesic, and cytoprotective effects in animals. In humans,</p><p>they have analgesic effects in headaches caused by nervous tension and are</p><p>effective in treating psychasthenic neuroses.</p><p>Plant Summaries—P</p><p>10</p><p>8</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Warning: When pyrrolizidine alkaloid-containing herbs are adminis-</p><p>tered at high doses or chronically, they can induce hepatotoxic, muta-</p><p>genic, teratogenic, and carcinogenic effects.</p><p>➤ Indications</p><p>– Renal or urinary calculi</p><p>– Headaches</p><p>➤ Contraindications: Pregnancy and breast feeding.</p><p>➤ Dosage and duration of use: We do not recommend the use of purple butter-</p><p>bur teas. Only industrially manufactured butterbur extracts should be used. In</p><p>that case, they should be used according to the instructions supplied by the</p><p>manufacturers.</p><p>➤ Adverse effects: Purple butterbur tea and native extract contain pyrrolizidine</p><p>alkaloids with hepatotoxic and carcinogenic effects. Industrial manufacturers</p><p>are able to prepare extracts that are (virtually) pyrrolizidine alkaloid-free.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Interest in purple butterbur has grown in recent years</p><p>because of its efficacy in preventing headaches, especially migraine which</p><p>could be demonstrated in clinical trials. We advise against using the tea or</p><p>native extracts.</p><p>✿ Literature</p><p>– Monographs: Commission E</p><p>– Scientific publications: see p. 478</p><p>Pumpkin (Cucurbita pepo L.)</p><p>➤ General comments: Pumpkin is native to the Americas, where it is used to</p><p>make a variety of dishes. The seeds are a foodstuff, but are also used as an herb-</p><p>al remedy for prostate and irritable bladder complaints.</p><p>➤ Pharmacology</p><p>– Herb: Pumpkin seed (Cucurbitae peponis semen). The herb consists of the</p><p>ripe, dried seeds of Cucurbita pepo L. and other varieties cultivated from it.</p><p>– Important constituents: Steroids (1 %), especially 24-alkylsterols, δ-5-ster-</p><p>ols, and δ-7-sterols (ca. 0.5 %), clerosterol, isofucosterol, β-sitosterol, fatty</p><p>oils (35–53 %) including oleic and linoleic acids (35–68 %), and amino acids</p><p>(cucurbitin, 0.2–0.7 %).</p><p>– Pharmacological properties: The conformation of δ-7-sterols is very similar</p><p>to that of dihydrotestosterone. δ-7-sterols have antiphlogistic, antioxidant,</p><p>and diuretic effects. The experimental data are hardly sufficient to docu-</p><p>ment the clinical efficacy of the herb. There is empirical evidence of the ef-</p><p>ficacy of the herb in treating prostatic hyperplasia but clinical studies are</p><p>still not sufficient.</p><p>➤ Indications</p><p>– Prostate complaints associated with stage I–II prostatic adenoma</p><p>– Benign prostatic hyperplasia (BPH)</p><p>– Irritable bladder</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– Daily dose: 10 g of the coarsely ground seeds.</p><p>– Dosage: 1 to 2 heaped teaspoons in the morning and at night. The dose</p><p>should be chewed and swallowed with fluid or mixed with food.</p><p>Plant Summaries—P</p><p>10</p><p>9</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the herb.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Pumpkin seed is safe for unrestricted over-the-coun-</p><p>ter use. The use of commercial preparations is recommended.</p><p>✿ Literature</p><p>– Monographs: DAB 1998; Commission E</p><p>– Scientific publications: see p. 478; Koch E: Pharmakologie und Wirkmecha-</p><p>nismen von Extrakten aus Sabal fructus, Urticae radix und Cucurbitae</p><p>peponis semen bei der Behandlung der benignen Prostatahyperplasie.</p><p>Loew D (Ed): Phytopharm. in Forsch. und klin. Anwend. Darmstadt, 1995.</p><p>Plant Summaries—P</p><p>11</p><p>0</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Rauwolfia (Rauwolfia serpentina L. Benth.)</p><p>➤ General comments: Rauwolfia is native to Southeast Asia, where the root is</p><p>used to treat insect bites, snake bites and diarrhea and as a sedative.</p><p>➤ Pharmacology</p><p>– Herb: Rauwolfia root (Rauwolfiae radix). The herb consists of the dried roots</p><p>of Rauwolfia serpentina (L.) Benth. ex Kurz and preparations of the same.</p><p>– Important constituents: Indole alkaloids (1–2.5 %) including reserpine, ser-</p><p>pentinine, raubasine, and ajmaline.</p><p>– Pharmacological properties: Reserpine and other rauwolfia root alkaloids</p><p>induce sympathicolytic effects by depleting the stores of norepinephrine</p><p>and inhibiting its reabsorption at the nerve endings, thus inducing blood</p><p>pressure reduction. Ajmaline has membrane-stabilizing and antiarrhyth-</p><p>mic effects. A central sedative effect was observed in animals.</p><p>➤ Indications</p><p>– Hypertension</p><p>– Nervousness and insomnia</p><p>➤ Contraindications: Depression, ulcers, pheochromocytoma, pregnancy,</p><p>breast feeding.</p><p>➤ Dosage and duration of use: Daily dose of 600 mg herb, equivalent to a total</p><p>alkaloid content of 6 mg. Rauwolfia can be taken for several years.</p><p>➤ Adverse effects: Stuffy nose, depressive mood, tiredness, reduced potency.</p><p>Rauwolfia can impair the responsiveness to external stimuli, thus impairing</p><p>one’s ability to drive a motor vehicle or operate machinery.</p><p>➤ Herb–drug interactions</p><p>– The responsiveness to external stimuli slows down considerably when rau-</p><p>wolfia is used in combination with alcohol.</p><p>– Combination with neuroleptics and barbiturates leads to a mutual increase</p><p>in potency.</p><p>– Combining rauwolfia with digitalis glycosides results in severe bradycardia.</p><p>– Rauwolfia decreases the potency of levodopa while causing an undesirable</p><p>increase in extrapyramidal and motor symptoms.</p><p>– When combined with sympathicomimetics (contained in cold and flu re-</p><p>medies, for example), it can cause a large initial increase in blood pressure.</p><p>➤ Summary assessment: Rauwolfia is hardly ever used owing to its numerous</p><p>side effects. Reserpine, one of its alkaloids, is used in multidrug antihyperten-</p><p>sive medications.</p><p>✿ Literature</p><p>– Monographs: DAB 1998; Commission E</p><p>– Scientific publications: see p. 478; Lounasmaa M et al: On the structure of</p><p>the indole alkaloid ajmalicidine. Planta Med 60 (1994), 480.</p><p>Red Squill (Urginea maritima L. Bak.)</p><p>➤ General comments: Red squill is distributed through the entire Mediterrane-</p><p>an region and is sometimes cultivated in Germany. The cardiotonic effects of</p><p>the plant have been known since ancient times.</p><p>➤ Pharmacology</p><p>– Herb: Squill (Scillae bulbus). The herb consists of the dried, fleshy, central</p><p>bulb sections of the white onion species Urginea maritima (L.) B., collected</p><p>Plant Summaries—R</p><p>11</p><p>1</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>after the time of flowering and cut in to transverse or longitudinal strips,</p><p>and preparations of the same.</p><p>– Important constituents: Steroid cardiac glycosides (bufadienolide, 1–3 %),</p><p>glucoscillaren A, proscillaridin A, and scillaren A.</p><p>– Pharmacological properties: Squill has potent diuretic, positive inotropic</p><p>and negative chronotropic effects. It also lowers left ventricular end diasto-</p><p>lic pressure.</p><p>➤ Indications</p><p>– Heart failure (NYHA classes I and II)</p><p>– Cardiac arrhythmias</p><p>– Nervous heart disorders</p><p>➤ Contraindications: Individuals with AV block</p><p>classes II or III, hypercalcemia,</p><p>hypokalemia, hypertrophic cardiomyopathy, carotid sinus syndrome, ven-</p><p>tricular tachycardia, aneurysm of the thoracic aorta, or Wolff–Parkinson–</p><p>White (WPW) syndrome should not use squill or glycosides isolated from it.</p><p>➤ Dosage and duration of use</p><p>– One dose equals 60–200 mg herb.</p><p>– Daily dose: 180–200 mg herb.</p><p>– Standardized powder: 0.1–0.5 g.</p><p>– Extractum Scillae: 1.0 g.</p><p>– Fluid extract: 0.03–2.0 mL.</p><p>– Tincture: 0.3–2.0 mL.</p><p>Important: Because squill is so difficult to standardize, the isolated glyco-</p><p>sides (e. g., proscillaridin A) should preferentially be used.</p><p>➤ Adverse effects: Because steroid cardiac glycosides have a narrow therapeutic</p><p>range, therapeutic doses of these drugs can induce side effects in some indi-</p><p>viduals. These include increased muscle tone in the gastrointestinal region,</p><p>lack of appetite, nausea, diarrhea, headaches, and irregular pulse.</p><p>Warning: Symptoms of overdose</p><p>– Cardiac symptoms can range from cardiac arrhythmia to life-threatening</p><p>tachycardia and/or atrial tachycardia with AV block.</p><p>– CNS symptoms are stupor, impaired vision, depression, confusion, halluci-</p><p>nation, and psychoses.</p><p>– In lethal poisoning, the cause of death is cardiac arrest or asphyxia.</p><p>➤ Herb–drug interactions: The concomitant administration of arrhythmogenic</p><p>substances such as sympathomimetics, methylxanthines, phosphodiesterase</p><p>inhibitors, and quinidine increases the risk of cardiac arrhythmia.</p><p>➤ Summary assessment: Red squill is a cardiac glycoside-containing herb that</p><p>can effectively replace synthetic glycosides, especially in cases of mild kidney</p><p>dysfunction. It should be used only under medical supervision.</p><p>✿ Literature</p><p>– Monographs: DAB 1998; Commission E</p><p>– Scientific publications: see p. 478; Eichstädt H, Hansen G, Danne O et al: Die</p><p>positiv inotrope Wirkung eines Scilla-Extraktes nach Einmal-Applikation.</p><p>Z Phytother 12 (1991), 46; Majinda RRT et al: Bufadienolides and other con-</p><p>stituents of Urginea sanguinea. Planta Med 63 (1997), 188–190.</p><p>Plant Summaries—R</p><p>11</p><p>2</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Rhatany (Krameria lappacea Ruiz et Par.)</p><p>➤ Synonyms: Krameria, Peruvian rhatany; Rhatania (Ger.)</p><p>➤ General comments: Rhatany is a shrub that grows wild in the Central Andes,</p><p>especially in Peru. The dried root is used in medicine.</p><p>➤ Pharmacology</p><p>– Herb: Rhatany root (Rhataniae radix). The herb consists of the dried roots of</p><p>Krameria trianda R. et P. and preparations of the same.</p><p>– Important constituents: Tannins, 10–15 % (oligomeric proanthocyanidins),</p><p>tanner’s red compounds (phlobaphenes, polymers, insoluble products of</p><p>tannin oxidation), and neolignans (0.3 % rhatany phenols I–III).</p><p>– Pharmacological properties: Rhatany root has antimicrobial and fungitoxic</p><p>effects in vitro. It also has astringent effects due to its content of tannins and</p><p>lignans.</p><p>➤ Indications: Applied topically for gum inflammations and inflammations of</p><p>the mouth and throat.</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– Tea: Steep 1.5–2 g (1 teaspoon) of the coarsely powdered herb in 1 cup of</p><p>boiled water for 10 to 15 minutes. Rinse the mouth or gargle with the fresh-</p><p>ly prepared infusion 2 to 3 times a day. Use as long as the symptoms persist.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb. Allergic skin reactions have been observed as a rare side effect.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Rhatany root is well-tolerated when used externally.</p><p>✿ Literature</p><p>– Monographs: DAB 1998; Commission E</p><p>Rosemary (Rosmarinus officinalis L.)</p><p>➤ General comments: Rosemary has been used as a medicinal herb since ancient</p><p>times. Its leaves are used in herbal medicine.</p><p>➤ Pharmacology</p><p>– Herb: Rosemary leaf (Rosmarini folium). The leaves consist of the fresh or</p><p>dried foliage leaves of Rosmarinus officinalis L. collected during the time of</p><p>flowering, and preparations of the same.</p><p>– Important constituents: Essential oil (1.0–2.5 %) consisting mainly of 1,8-</p><p>cineole (20–50 %), α-pinene (15–25 %), and camphor (10–25 %). Diterpe-</p><p>nes (bitter-tasting substances), caffeic acid derivatives (rosmarinic acid),</p><p>flavonoids, and triterpenes are also present.</p><p>– Pharmacological properties: Rosemary leaf has weakly antimicrobial and</p><p>antiviral action, presumably due to its diterpene content. In animals, the</p><p>herb was found to have spasmolytic (biliary tract, small intestine), chole-</p><p>retic, and hepatoprotective effects. In humans, rosemary oil irritates the</p><p>skin and increases the circulation when applied topically.</p><p>➤ Indications</p><p>– Dyspeptic complaints</p><p>– Supportive treatment of rheumatic diseases</p><p>– Circulatory complaints</p><p>➤ Contraindications: Pregnancy.</p><p>Plant Summaries—R</p><p>11</p><p>3</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ Dosage and duration of use</p><p>– Tea: Steep 2 g (ca. 1 teaspoon) of the finely chopped herb in boiled water for</p><p>25 minutes and strain.</p><p>• Dosage: One cup, several times a day.</p><p>• Daily dose: 4–6 g herb.</p><p>– Internal use: Because they contain higher concentrations of the essential oil,</p><p>alcohol extracts are more effective for treating circulatory complaints than</p><p>the tea.</p><p>– External use</p><p>• Semisolid and liquid analgesic preparations containing 6–10 % essential</p><p>oil: Apply 2 to 3 times daily.</p><p>• Bath additive: Infuse 50 g of the herb in 1 liter of water. Add to bath water</p><p>or use to make a sitz bath.</p><p>➤ Adverse effects</p><p>– Contact allergies have been observed as an occasional side effect. Pregnant</p><p>women should avoid rosemary.</p><p>– Very large quantities of rosemary leaves are said to cause deep coma, con-</p><p>vulsions, vomiting, gastroenteritis, uterine bleeding, kidney irritation and,</p><p>are severe cases, pulmonary edema and death in humans. However, no</p><p>concrete cases of this have been reported.</p><p>➤ Herb–drug interactions: Can accelerate the metabolism of some pharmaceu-</p><p>tical medications when taken concomitantly.</p><p>➤ Summary assessment: Rosemary is a popular herbal medicament, but there</p><p>are hardly any clinical data to support its uses.</p><p>✿ Literature</p><p>– Monographs: DAB 1998; ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Czygan I; Czygan FC: Rosmarin – Ros-</p><p>marinus officinalis L. ZPZ 18 (1997), 182–186.</p><p>Plant Summaries—R</p><p>11</p><p>4</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Sage (Salvia officinalis L.)</p><p>➤ General comments: In folk medicine, sage is used to treat a variety of diseases.</p><p>The leaves of the plant are used in herbal medicine.</p><p>➤ Pharmacology</p><p>– Herb: Sage leaf (Salviae folium). The herb consists of the fresh or dried foli-</p><p>age leaves of Salvia officinalis L. and preparations of the same.</p><p>– Important constituents: Essential oil (1.5–3.5 %) consisting mainly of α- and</p><p>β-thujone (20–60 %), 1,8-cineole (6–16 %), and camphor (14–37 %). Caffeic</p><p>acid derivatives (3–6 %) consisting mainly of rosmarinic acid and chloro-</p><p>genic acid. Diterpenes (carnosolic acid, 0.2–0.4 %), flavonoids (apigenin- and</p><p>luteolin-7-O-glucosides), and triterpenes (ursolic acid, 5 %) are also present.</p><p>– Pharmacological properties: The thujone-rich essential oil and the diterpe-</p><p>noid substance carnosol have antimicrobial, antimycotic, and antiviral ef-</p><p>fects. Flavonoids are spasmolytic and choleretic. In animals, carnosolic acid</p><p>and carnosol act in the central nervous system. The tannins (rosmarinic</p><p>acid) have anti-inflammatory, astringent, and antihydrotic effects.</p><p>➤ Indications</p><p>– Lack of appetite</p><p>– Excessive perspiration</p><p>– Inflammations of the mouth and throat</p><p>➤ Contraindications: Pure sage oil</p><p>should be avoided during pregnancy. High-</p><p>dose or prolonged internal use of sage is not recommended.</p><p>➤ Dosage and duration of use</p><p>– Internal use: Steep 1–2 g of the herb in 150 mL of hot water for 15 minutes.</p><p>Sweeten with honey or sugar.</p><p>• Dosage: One cup, several times a day.</p><p>• For gastrointestinal complaints, drink 1 cup of the warm tea 30 minutes</p><p>before meals.</p><p>• For excessive perspiration, allow the tea to cool before drinking.</p><p>– External use: For mouthwash or gargle, steep 2.5 g of the herb in 100 mL of</p><p>hot water for 15 minutes. Use several times a day.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb.</p><p>➤ Herb–drug interactions: None known.</p><p>Warning: Heat sensations, tachycardia, vertigo, and epileptiform convulsions</p><p>can occur after prolonged use (of ethanolic sage extracts or sage oil) or over-</p><p>dose (>15 g sage leaf).</p><p>➤ Summary assessment: Sage is a well-known herbal medicament that is gen-</p><p>erally regarded as safe for short-term use.</p><p>✿ Literature</p><p>– Monographs: DAB 1998; ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Paris A, Strukelj B, Renko M et al: Inhibi-</p><p>tory effects of carnosolic acid on HIV-1 protease in cell free assays. J Nat</p><p>Prod 56 (1993), 1426–1430; Tada M et al: Antiviral diterpenes from Salvia</p><p>officinalis. Phytochemistry 35 (1994), 539.</p><p>Plant Summaries—S</p><p>11</p><p>5</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Saint John’s Wort (Hypericum perforatum L.)</p><p>➤ General comments: In earlier times, Saint John’s wort was used to treat a va-</p><p>riety of ailments. It has only recently become known as a remedy for psycho-</p><p>logical disorders. Dioscorides recommended the herb for easing pain of sciat-</p><p>ica.</p><p>➤ Pharmacological properties</p><p>– Herb: Saint John’s wort (Hyperici herba). The herb consists of the fresh plant</p><p>material or dried aerial parts of Hypericum perforatum L., collected during</p><p>the time of flowering, and preparations of the same.</p><p>– Important constituents: Anthracene derivatives, 0.1–0.15 % (hypericin,</p><p>pseudohypericin), flavonoids, 2–4 % (hyperoside, 0.7 %, quercetin, rutin),</p><p>acylphloroglucinols, 2–4 % (hyperforin), essential oil (0.1–1 %), oligomeric</p><p>procyanidins, and other catechinic tannins (6.5–15 %).</p><p>– Note: Plants with the highest hypericin content generally have the highest</p><p>content of all other constituents.</p><p>– Pharmacological properties</p><p>• Oral hypericum preparations have mild sedative, antidepressant, and</p><p>anxiolytic effects (probably due to synergistic effects of the constitu-</p><p>ents).</p><p>• Oily topical hypericum preparations have mainly antiphlogistic effects</p><p>due to their high content of flavonoids; they also exhibit antibacterial,</p><p>antiviral, and immunomodulatory action.</p><p>➤ Indications</p><p>– Internal use: Depressive mood, anxiety</p><p>– External use (oily preparations): Contusions, wounds, burns</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– Tincture: Extract 20 g of the herb in 100 g of 70 % ethanol and filter. Store</p><p>away from light. Take 3–4 mL three times a day. The mean daily dose</p><p>should be 0.2–1 mg total hypericin in any dosage form.</p><p>– For depressive mood: The herb preparations should be taken for a period of</p><p>at least 4 to 6 weeks to assess benefit. Solid and liquid hypericum prepara-</p><p>tions should be given at doses corresponding to 300 mg native extract</p><p>(standardized to 0.3 % hypericin, and/or 2–3 % hyperforin), 2 to 3 times a</p><p>day.</p><p>➤ Adverse effects</p><p>– Photosensitization (hypericism) has been observed in animals that con-</p><p>sume large quantities of the herb, but this is unlikely to occur in humans</p><p>following administration of the designated therapeutic doses. Nonetheless,</p><p>fair-skinned individuals should take due precaution when using Hyperi-</p><p>cum.</p><p>➤ Herb–drug interactions: Recently reduction of plasma concentrations of dig-</p><p>oxin and cyclosporin and some antiretroviral drugs has been described. Fur-</p><p>ther intense research is going on in this field.</p><p>➤ Summary assessment: Hypericum is an effective herb for treatment of mild</p><p>to moderate depression and in the other specified indications. The effective-</p><p>ness of the drug has been investigated quite thoroughly in a large number of</p><p>human studies. Some controlled studies show equivalent antidepressive ef-</p><p>fects to tricyclic and SSRI antidepressants with less than half the side effects.</p><p>Plant Summaries—S</p><p>11</p><p>6</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>✿ Literature</p><p>– Monographs: ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Saint John’s wort for depression: a meta-</p><p>analysis of well-defined clinical trials. Kim HL, Streltzer J, Goebert D. J Nerv</p><p>Ment Dis 187(9) (1999), 532–538; Hänsgen KD: Vesper, J.: Antidepressive</p><p>Wirksamkeit eines hochdosierten Hypericum-Extraktes. Münch Med</p><p>Wschr 138 (1996), 29–33; Rammert K: Phytopharmaka: Johanniskraut als</p><p>Antidepressivum. Deutsche Apotheker Ztg 136 (1996), 4131–4132;</p><p>Teuscher E, Lindequist U: Biogene Gifte – Biologie, Chemie, Pharmakologie.</p><p>2. Aufl., Fischer Verlag Stuttgart 1994.</p><p>Saw Palmetto (Serenoa repens Bartram Small)</p><p>➤ General comments: Saw palmetto grows wild in the southeastern region of</p><p>the United States. Its berries were first introduced to contemporary herbal</p><p>medicine towards the beginning of the twentieth century.</p><p>➤ Pharmacology</p><p>– Herb: Saw palmetto fruit (Sabal fructus, Serenoae repentis fructus). The</p><p>herb consists of the ripe, dried fruit of Serenoa repens (B.) S. (syn. Sabal ser-</p><p>rulata [M] N. et S.) and preparations of the same.</p><p>– Important constituents: Steroids (β-sitosterol and its glucosides), flavo-</p><p>noids, water-soluble polysaccharides, and a fatty oil consisting of 80 % lau-</p><p>ric, myristic, and oleic acids, two-thirds of which are present as free fatty</p><p>acids.</p><p>– Pharmacological properties: In animals, lipophilic saw palmetto fruit ex-</p><p>tracts inhibited testosterone production at the cytosol receptors, thus caus-</p><p>ing significant inhibition of prostatic growth. Owing to its β-sitosterol con-</p><p>tent, it increases the uterine weight of female mice after injection. Saw</p><p>palmetto extracts have antiandrogenic and antiestrogenic effects. Li-</p><p>pophilic extracts of the herb induce spasmolysis of the smooth muscles of</p><p>organs. The extract was found to have antiexudative and decongestive ef-</p><p>fects in animals and also promotes the degradation of prostaglandins and</p><p>leukotrienes. Saw palmetto improves the urinary flow rate and reduces the</p><p>residual urine volume in patients with grades I and II of prostatic hyperpla-</p><p>sia (Alken).</p><p>➤ Indications</p><p>– Urinary tract infections</p><p>– Benign prostatic hyperplasia grades I and II</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– Daily dose: 1–2 g herb or 320 mg lipophilic extract (standardized prepara-</p><p>tions made with supercritical carbon dioxide or hexane extraction tech-</p><p>niques). (Supercritical carbon dioxide extracts are made with carbon diox-</p><p>ide at a temperature and pressure at which it is in a state between liquid</p><p>and gas [the “supercritical state”], which preserves delicate fatty acids, and</p><p>leaves no residues in the finished product as with hexane-extracted fruits.)</p><p>Supercritical extracts are preferred in North America.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb. Stomach complaints have been observed as a rare side effect.</p><p>➤ Herb–drug interactions: None known.</p><p>Plant Summaries—S</p><p>11</p><p>7</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Warning: Malignant disease or retention of urine should be ruled out</p><p>before</p><p>taking saw palmetto.</p><p>➤ Summary assessment: Saw palmetto fruit extracts are effective in treating</p><p>problems associated with prostatic hyperplasia and irritable bladder, but do</p><p>not affect the size of the prostate.</p><p>➤ Literature</p><p>– Monographs: ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Bach D, Ebeling, L: Long-term drug treat-</p><p>ment of benign prostatic hyperplasia – Results of a prospective 3-year mul-</p><p>ticenter study using Sabal extract IDS 89. Phytomedicine 3 (1996), 105–</p><p>111; Engelmann U: Phytopharmaka und Synthetika bei der Behandlung der</p><p>benignen Prostatahypertrophie. Z Phytother 18 (1997), 13–19; Plosker GL,</p><p>Brogden RN: Serenoa repens (Permixon): A review of its pharmacological</p><p>and therapeutic efficacy in benign prostatic hyperplasia. Drugs & Aging 9</p><p>(1996), 379–395; Ravenna L et al: Effects of the lipidosterolic extract of Se-</p><p>renoa repens (Permixon) on human prostatic cell lines. Prostate 29 (1996),</p><p>219–230; Shimada H et al: Biological active acylglycerides from the berries</p><p>of saw-palmetto (Serenoa repens). J Nat Prod 60 (1997), 417–418.</p><p>Silverweed (Potentilla anserina L.)</p><p>➤ Synonyms: Goosewort, wild agrimony; Gänsefingerkraut (Ger.)</p><p>➤ Pharmacology</p><p>– Herb: Silverweed (Potentillae anserinae herba). The herb consists of the</p><p>fresh or dried leaves and flowers of Potentilla anserina L. collected shortly</p><p>before or during the time of flowering, and preparations of the same.</p><p>– Important constituents: 5–10 % tannins (ellagitannins).</p><p>– Pharmacological properties: Tannins have astringent action.</p><p>➤ Indications</p><p>– Unspecific diarrhea</p><p>– Inflammations of the mouth and throat</p><p>– Symptoms of dysmenorrhea (traditional use)</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– Tea: Steep 2 g of the finely chopped herb in 1 cup of boiled water for 10</p><p>minutes (1 teaspoon = ca. 0.7 g drug).</p><p>• Dosage: One cup of the freshly prepared tea between meals, 3 times a</p><p>day.</p><p>– Daily dose: 4–6 g herb.</p><p>– Topical use: Rinse the mouth with an infusion of the herb several times a</p><p>day. The infusion is made by steeping 4 g of the herb in 1⁄2 liter of hot water</p><p>for 15 minutes.</p><p>➤ Adverse effects: None known.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: This drug is safe for unrestricted over-the-counter use.</p><p>✿ Literature</p><p>– Monographs: Commission E</p><p>– Scientific publications: see p. 478; Kombal R, Glasl H: Flavan-3-ols and</p><p>flavonoids from Potentilla anserina. Planta Med 61 (1995), 484–485; Schim-</p><p>mer O, Lindenbaum M: Tannins with antimutagenic properties in the herb of</p><p>Alchemilla species and Potentilla anserina. Planta Med 61 (1995), 141–145.</p><p>Plant Summaries—S</p><p>11</p><p>8</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Sundew (Drosera rotundifolia L.)</p><p>➤ Synonyms: Round-leaved sundew; Sonnentau (Ger.)</p><p>➤ General comments: Sundew is distributed through the entire Northern Hemi-</p><p>sphere and is typically found on moist or marshy soils. Various sundew species</p><p>are used in medicine.</p><p>➤ Pharmacology</p><p>– Herb: Sundew herb (Droserae herba). The herb consists of the dried aerial</p><p>and subterranean parts of Drosera rotundifolia L.</p><p>– Important constituents: Flavonoids, anthocyans, and naphthalene deriva-</p><p>tives (naphthoquinones, 0.5 %, such as plumbagin).</p><p>– Pharmacological properties: The herb was found to exert antimicrobial, se-</p><p>cretolytic, bronchospasmolytic, and antitussive effects in animals. Plum-</p><p>bagin inhibits the synthesis of prostaglandins in vitro. An immunomodula-</p><p>tory effect has also been proposed.</p><p>➤ Indications: Coughs and bronchitis.</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– Tea: Steep 1–2 g of the herb in boiled water for 10 minutes.</p><p>• Dosage: One cup, 3 to 4 times a day.</p><p>• Mean daily dose: 3 g herb.</p><p>– Tincture (1 : 5): 1–3 mL, 2 or 3 times a day.</p><p>➤ Adverse effects: Plumbagin can induce allergic side effects.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Sundew tinctures and extracts are used in many in-</p><p>dustrial pharmaceutical preparations. The herb is seldom used for tea prepa-</p><p>ration. No controlled clinical studies on the herb are available.</p><p>➤ Literature</p><p>– Monographs: Commission E</p><p>– Scientific publications: see p. 478; Wunderer H: Zentral und peripher wirk-</p><p>same Antitussiva: eine kritische Übersicht. PZ 142 (1997), 847–852.</p><p>Plant Summaries—S</p><p>11</p><p>9</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Thuja (Thuja occidentalis L.)</p><p>➤ Synonyms: Arbor vitae, tree of life, Northern white cedar; Lebensbaum (Ger.)</p><p>➤ Pharmacology</p><p>– Herb: Thuja herb (Thujae herba). The herb consists of the branch tips and</p><p>young shoots of Thuja occidentalis (Thujae occidentalis stipites).</p><p>– Important constituents: Polysaccharides (immunostimulants), glycopro-</p><p>teins (immunostimulants), essential oil (1.4–4 %), (−)-thujone (α-thujone,</p><p>49–59 %), (+)-isothujone (β-thujone, 7–10 %), fenchone (10–15 %), flavo-</p><p>noids (quercetin, mearusitrin and the biflavonoids hinokiflavone, amento-</p><p>flavone, and bilobetin), proanthocyanidins, lignans, and tannins.</p><p>– Pharmacological properties: The antiviral effect of thujone has been demon-</p><p>strated in various trials. Topical application of the herb is therefore recom-</p><p>mended for viral warts. The polysaccharides in the herb promote T cell pro-</p><p>liferation (especially of CD4+ T-helper and inducer cells) and increase the</p><p>production of interleukin-2. The essential oil is spasmogenic and, when ad-</p><p>ministered in high doses, can induce clonic-tonic convulsions, damage to</p><p>the renal parenchyma, and cause severe metabolic disorders due to fatty</p><p>degeneration of the liver. Various Thuja species were among the most fre-</p><p>quently used medicinal agents, both externally and internally, for treating</p><p>infections, in native American medicine and in other cultures.</p><p>➤ Indications</p><p>– Colds and fever</p><p>– Decreased resistance to infections</p><p>– Psoriasis</p><p>– Warts</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– Extract: 1–2 mL, 3 times a day.</p><p>– Tincture (undiluted): No more than 0.5 g, to be painted onto the affected site.</p><p>➤ Adverse effects: Arbor vitae is toxic. Symptoms of poisoning, especially after</p><p>abuse of the herb as an abortifacient, include nausea, vomiting, painful di-</p><p>arrhea, and mucosal bleeding. Fatalities have been reported.</p><p>Warning</p><p>– Poisoning: All cases of poisoning reported since 1980 were attributable to</p><p>consumption of the leaves and young shoots of the fresh thuja plant. The</p><p>toxic effect of the herb is attributable to its high content of thujone. The tox-</p><p>ic threshold for safe oral administration of thujone is reported to be</p><p>1.25 mg/kg body weight. When herbal remedies are administered at the</p><p>designated therapeutic doses, the thujone concentration remains far below</p><p>the toxic threshold. A tea is the safest form of administration because thu-</p><p>jone is not easily soluble in water.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Use of thuja should be restricted to commercial prep-</p><p>arations and tea infusions.</p><p>➤ Literature</p><p>– Monographs: BHP 83; EB 6, Mar 31</p><p>– Scientific publications: see p. 478; Anon: Behandlung mit pflanzlichen</p><p>Immunmodulatoren. Symbiose 5 (1993), 9; Baba T, Nakano H, Tamai K,</p><p>Sawamura D, Hanada K, Hashimoto I, Arima Y: Inhibitory effect of beta-</p><p>Plant Summaries—T</p><p>12</p><p>0</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>thujaplicin on ultraviolet B-induced apoptosis in mouse keratinocytes. J</p><p>Invest Dermatol, 110 (1998) 24–8; Baumann J: Vergleichende pharmako-</p><p>gnostisch-phytochemische Untersuchungen an Drogen der Familie der</p><p>Cupressaceae. Diplomarbeit Göttingen 1987; Gohla SH: Dissertation Uni-</p><p>versität Hamburg 1988; Gross G: Papillomvirus-Infektionen der</p><p>Haut. Med</p><p>Welt 36 (1985), 437–440.</p><p>Thyme (Thymus vulgaris L.)</p><p>➤ General comments: Thyme has been revered as a remedy for pulmonary and</p><p>bronchial diseases since the Middle Ages. Its use as a culinary herb also dates</p><p>back to the Middle Ages.</p><p>➤ Pharmacology</p><p>– Herb: Thyme (Thymi herba). The herb consists of the stripped and dried fo-</p><p>liage leaves and flowers of Thymus vulgaris L and/or Thymus zygis L. and</p><p>preparations of the same.</p><p>– Important constituents: Essential oil (1.0–2.5 %) consisting mainly of thy-</p><p>mol (20–55 %), p-cymene (14–45 %), and carvacrol (1–10 %). Caffeic acid</p><p>derivatives (rosmarinic acid, 0.15–1.35 %) and flavonoids (luteolin, apigen-</p><p>in) are also present.</p><p>– Pharmacological properties: Thyme has primarily expectorant effects based</p><p>on the herb’s underlying bronchospasmolytic and secretomotor action. In</p><p>addition, thymol and carvacrol have antimicrobial, antimycotic, and anti-</p><p>viral effects. The herb has spasmolytic effects (due to its flavone fraction)</p><p>and expectorant effects in animals due to the action of terpenes on ciliary</p><p>activity. Thyme has excellent antioxidant effects. Controlled clinical studies</p><p>are not available.</p><p>➤ Indications</p><p>– Internal use for coughs and bronchitis.</p><p>– External use for supportive treatment of acute and chronic respiratory tract</p><p>diseases</p><p>– External use for dermatosis-related pruritus</p><p>➤ Contraindications: Long-term or high-dose administration of thymol and car-</p><p>vacrol, and thyme preparations such as alcoholic tinctures and distilled oils</p><p>that contain them, can be toxic.</p><p>Important: Use by patients with severe liver damage or impaired thyroid</p><p>function can aggravate these conditions. These individuals should there-</p><p>fore use thyme preparations with due caution.</p><p>➤ Dosage and duration of use</p><p>– Internal use</p><p>• Tea: Steep 1.5–2 g (1 to 1 1⁄2 teaspoons) of the herb in 1 cup of boiled</p><p>water for 10 minutes. Dosage: One cup, several times a day.</p><p>• Daily dose: 10 g herb with a 0.3 % phenol content, calculated as thymol.</p><p>– External use</p><p>• Compresses: Prepare using 5 % infusion.</p><p>• Baths: Steep 500 g of the herb in 4 liters of boiled water for 10 minutes,</p><p>then add to bath water.</p><p>➤ Adverse effects: Health hazards in conjunction with proper administration of</p><p>the designated therapeutic doses of the herb are not known. Thyme has a slight</p><p>potential for sensitization.</p><p>➤ Herb–drug interactions: None known.</p><p>Plant Summaries—T</p><p>12</p><p>1</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ Summary assessment: Thyme fluid extracts, tinctures, and teas are common-</p><p>ly added to preparations involving multiple herbal constituents. Thyme is an</p><p>herbal medicament with demonstrated effects.</p><p>➤ Literature</p><p>– Monographs: DAB 1998; ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Haraguchi H et al: Antiperoxidative com-</p><p>ponents in Thymus vulgaris. Planta Med 62 (1996), 217–221.</p><p>Tormentil (Potentilla erecta L. Raeuschel)</p><p>➤ General comments: Tormentil is a plant native to the entire European conti-</p><p>nent. It has long been revered for its astringent effects. The rhizome is used in</p><p>medicine.</p><p>➤ Pharmacology</p><p>– Herb: Tormentil rhizome (Tormentillae rhizoma). The herb consists of the</p><p>rootless dried rhizomes of Potentilla erecta (L.) R. (syn. Potentilla tormentilla</p><p>N.) and preparations of the same.</p><p>– Important constituents: Tannins (17–22 %), tannins of the catechin type</p><p>(15–20 %), gallotannins (ca. 3.5 %), flavonoids, and triterpenes (tormento-</p><p>side, tormentillic acid glucoside).</p><p>– Pharmacological properties: The tannins in tormentil have astringent, anti-</p><p>bacterial, and hemostyptic effects. Clinical studies are not yet available.</p><p>➤ Indications</p><p>– Diarrhea</p><p>– Inflammations of the mouth and throat</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– Tea: Steep 3–4 g herb in 150 mL of hot water. For diarrhea: One cup, be-</p><p>tween meals, 2 to 3 times a day.</p><p>– Daily dose: 4–6 g herb.</p><p>➤ Adverse effects: Tormentil can cause nausea or vomiting in sensitive individ-</p><p>uals, especially on an empty stomach.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Tormentil is a useful tannin-bearing herb that is suit-</p><p>able for unrestricted over-the-counter use.</p><p>✿ Literature</p><p>– Monographs: DAB 1998; Commission E</p><p>– Scientific publications: see p. 478; Geiger C et al: Ellagitannins from Al-</p><p>chemilla xanthochlora and Potentilla erecta. Planta Med 60 (1994), 384.</p><p>Turmeric (Curcuma longa, C. xanthorriza Valeton)</p><p>➤ General comments: Turmeric was originally native to India but has now be-</p><p>come naturalized in tropical regions of Southeast Asia. The rhizome is used as</p><p>both a culinary and medicinal herb. Curcuma longa and Curcuma xanthorriza</p><p>are used in herbal medicine.</p><p>➤ Pharmacology</p><p>– Herb: Turmeric rhizome (Curcumae rhizoma). The herb consists of the</p><p>fingerlike or cylindrical rhizomes of Curcuma longa L. (syn. Curcuma domes-</p><p>tica V.) or Curcuma xanthorriza Val., which are scalded and dried after</p><p>harvesting.</p><p>Plant Summaries—T</p><p>12</p><p>2</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>– Important constituents: Essential oil (3–4 %) containing ar-turmerone, α-</p><p>and β-turmerones, zingiberene, α- and γ-atlantones, curlone, and curcumol.</p><p>Curcuminoids (3–5 %) such as curcumin and desmethoxycurcumin are also</p><p>present. Curcuma longa contains di-p-coumaroylmethane, a chemical that</p><p>reduces the effects of the other curcuminoids.</p><p>– Pharmacological properties: Curcumin counteracts hepatotoxic effects and</p><p>has antilipemic, anti-inflammatory (in chronic inflammation), antioxidant,</p><p>antimicrobial, choleretic, and cholekinetic action. Curcumin is poorly ab-</p><p>sorbed from the gut.</p><p>➤ Indications</p><p>– Lack of appetite</p><p>– Dyspeptic complaints</p><p>➤ Contraindications: Individuals with biliary tract obstruction or gallstones</p><p>should not use turmeric, or should consult a physician if in doubt.</p><p>➤ Dosage and duration of use</p><p>– Tea: Pour 1 cup of boiled water onto 0.5–1 g (1 teaspoon) of the herb, then</p><p>cover and steep for 5 to 10 minutes. Drink between meals.</p><p>– Daily dose: 2 g of the herb.</p><p>➤ Adverse effects: Prolonged use or overdose can cause stomach disorders.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Curcuma xanthorriza is superior to Curcuma longa in</p><p>the treatment of dyspeptic complaints according to empirical reports.</p><p>✿ Literature</p><p>– Monographs: Commission E; ESCOP (Curcumae longae rhizoma)</p><p>– Scientific publications: see p. 478; Babu PS, Srinivasan K: Hypolipidemic ac-</p><p>tion of curcumin the active principle of turmeric (Curcuma longa) in strep-</p><p>tozotocin induced diabetic rats. Mol Cell Biochem, 30 (1997), 169–75; Bon-</p><p>te F, Noel-Hudson MS, Wepierre J, Meybeck A: Protective effect of</p><p>curcuminoids on epidermal skin cells under free oxygen radical stress.</p><p>Planta Med, 8 (1997), 265–6; Hanif R, Qiao L, Shiff SJ, Rigas B: Curcumin a</p><p>natural plant phenolic food additive inhibits cell proliferation and induces</p><p>cell cycle changes in colon adenocarcinoma cell lines by a prostaglandin-</p><p>independent pathway. J Lab Clin Med, 42 (1997), 576–84; Sikora E, Bielak-</p><p>Zmijewska A, Piwocka K, Skierski J, Radziszewska E: Inhibition of prolifer-</p><p>ation and apoptosis of human and rat T lymphocytes by curcumin, a curry</p><p>pigment. Biochem Pharmacol, 54 (1997), 899–907; Verma SP, Salamone E,</p><p>Goldin B: Curcumin and genistein plant natural products show synergistic</p><p>inhibitory effects on the growth of human breast cancer MCF-7 cells in-</p><p>duced by estrogenic pesticides. Biochem Biophys Res Commun, 233</p><p>(1997), 692–6.</p><p>Plant Summaries—T</p><p>12</p><p>3</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Uva-ursi (Arctostaphylos uva-ursi L. Sprengel)</p><p>➤ Synonyms: Bearberry, Bärentraube (Ger.)</p><p>➤</p><p>General comments: The dried leaves (bearberry leaf) and preparations made</p><p>from the fresh leaves are used in medicine. In Europe, bearberry is a protected</p><p>species and cannot be collected in the wild, but is not considered threatened</p><p>in North America.</p><p>➤ Pharmacology</p><p>– Herb: Bearberry leaf (Uvae ursi folium). The herb consists of the fresh or</p><p>dried young foliage leaves of Arctostaphylos uva-ursi (L.) Sprengel and prep-</p><p>arations of the same. The chopped or powdered drug and dry extracts are</p><p>used to prepare infusions, macerations, and other dosage forms intended</p><p>for internal use.</p><p>– Important constituents: Hydroquinone glycosides including arbutin, ar-</p><p>butoside, hydroquinone-O-β-D-glucoside (5–16 %) and methylarbutin, O-</p><p>galloylhydroquinone-O-β-D-glucoside (p-galloyloxyphenyl-O-β-D-gluco-</p><p>side), 2´-O-galloylarbutin, 6´-O-galloylarbutin, free hydroquinone (0.3 %)</p><p>and flavonoids consisting mainly of flavonol glycosides such as hyperoside</p><p>(0.8–1.5 %), quercetin, and isoquercetin. Phenolcarbonic acids (free gallic</p><p>acid: 180 mg/100 g), p-coumaric acid (18.0 mg/100 g), syringic acid</p><p>(16.8 mg/100 g), salicylic acid (12.0 mg/100 g), p-hydroxybenzoic acid</p><p>(9.6 mg/100 g), and 7–18 % tannins (gallotannins, proanthocyanidins) are</p><p>also present.</p><p>– Pharmacological properties: Phenol glycosides have antibacterial effects,</p><p>and tannins have astringent action. Hydroquinone conjugates of glucuronic</p><p>acid and sulfuric acid have bacteriostatic and urinary antiseptic effects.</p><p>➤ Indications</p><p>– Urinary tract infections</p><p>– Cystitis</p><p>➤ Contraindications: Pregnant or nursing mothers and children under 12 years</p><p>of age should not use uva-ursi. The duration of treatment should be restricted</p><p>to no more than one week at a time or five times a year.</p><p>➤ Dosage and duration of use</p><p>– Tea with bearberry content of up to 30 %: Steep 2 g of the finely chopped or</p><p>coarsely powdered drug in 150 mL of boiled water for 15 minutes. Teas</p><p>with a higher bearberry content must be prepared as macerations (macer-</p><p>ated in cold water for 6 to 12 hours). This prevents the extraction of excess</p><p>quantities of tannin to ensure better tolerability.</p><p>– Daily dose: 10 g finely chopped or powdered drug (equivalent to 400–</p><p>840 mg arbutin).</p><p>➤ Adverse effects: Preparations with high tannin contents can induce nausea</p><p>and vomiting. Prolonged use may result in liver damage.</p><p>➤ Herb–drug interactions: Drugs that produce acidic urine weaken the effects</p><p>of bearberry. A plant-rich diet enhances its effect by alkalinizing the urine.</p><p>➤ Summary assessment: Definitive clinical studies are not currently available.</p><p>✿ Literature</p><p>– Monographs: ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Matsuo K, Kobayashi M, Takuno Y,</p><p>Kuwajima H, Ito H, Yoshida T: Anti-tyrosinase activity constituents of Arc-</p><p>tostaphylos uva-ursi. Yakugaku Zasshi, 117 (1997), 1028–32; Ng TB et al:</p><p>Plant Summaries—U</p><p>12</p><p>4</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Examination of coumarins, flavonoids and polysaccharopeptides for anti-</p><p>bacterial activity. General Pharmacology 27 (1996), 1237–1240; Ritch-Krc</p><p>EM, Thomas S, Turner NJ, Towers GH: Carrier herbal medicine: traditional</p><p>and contemporary plant use. J Ethnopharmacol, 117 (1996), 85–94;</p><p>Stammwitz U: Pflanzliche Harnwegsdesinfizienzien – heute noch aktuell?</p><p>Z Phytother 19 (1998), 90–95.</p><p>Uzara (Xysmalobium undulatum L. R. Br.)</p><p>➤ General comments: The native inhabitants of South Africa have long used the</p><p>root of the uzara plant to treat digestive complaints. In Europe, it was first in-</p><p>troduced as an antidiarrheal herb in the early 1900s, and is also commonly</p><p>recommended for digestive cramps and irritable bowel syndromes today</p><p>because of its spasmolytic effect. To date, this herb has not found common</p><p>usage in North America.</p><p>➤ Pharmacology</p><p>– Herb: Uzara root (Uzarae radix). The herb consists of the dried, subterrane-</p><p>an parts of two- to three-year-old Xysmalobium undulatum (L.) R. B. plants</p><p>and preparations of the same.</p><p>– Important constituents: Steroid glycosides (cardenolides, their mixture is</p><p>also called uzarone or xysmalobin), uzarin (5.5 %), xysmalorin (1.5 %), and</p><p>pregnane derivatives.</p><p>– Pharmacological properties: Cardenolide glycosides (uzarin and xysma-</p><p>lorin) inhibit motility in the small intestine and urogenital tract. Because of</p><p>its glycoside content, higher doses of the herb have digitalis-like effects on</p><p>the heart. Clinical studies are not available.</p><p>➤ Indications: Acute, unspecific diarrhea.</p><p>➤ Contraindications: Use of cardiac glycosides, such as digoxin.</p><p>➤ Dosage and duration of use</p><p>– Daily dose: 45–90 mg total glycosides, calculated as uzarin.</p><p>– Use of uzara root should be limited to industrially produced tablets or tinc-</p><p>tures (to date only available in Europe), to be taken as instructed by the</p><p>manufacturer.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb. Poisoning is unlikely when the herb is taken by the oral route because the</p><p>glycosides in the herb are poorly absorbed and their cardiac action is very</p><p>weak.</p><p>➤ Herb–drug interactions: Digitalis preparations and other cardiac glycosides.</p><p>➤ Summary assessment: Uzara is an effective herbal antidiarrheal agent, even</p><p>in cases of diarrhea with vomiting. Because of its excellent tolerability, it can</p><p>be safely administered to infants and young children.</p><p>✿ Literature</p><p>– Monographs: Commission E</p><p>– Scientific publications: see p. 478; Schmidt M: Uzarawurzel. PTA 8 (1994),</p><p>498.</p><p>Plant Summaries—U</p><p>12</p><p>5</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Valerian (Valeriana officinalis L.)</p><p>➤ Synonyms: Garden heliotrope; Baldrian (Ger.)</p><p>➤ General comments: The subterranean root parts of Valeriana officinalis L.,</p><p>dried at temperatures below 40 °C, are used in medicine. The drug consists of</p><p>the rhizomes, roots, and stolons of the plant and preparations of the same.</p><p>➤ Pharmacology</p><p>– Drug: Valerian root (Valerianae radix).</p><p>– Important constituents: Iridoids (valepotriate, 0.5–2.0 %); essential oil, 0.2–</p><p>1.0 % (bornyl-isovalerianate, isovalerianic acid; sometimes also valerenal</p><p>and valeranone), and sesquiterpenes (valerenic acid, 0.1–0.9 %).</p><p>– Pharmacological properties: Valerian has central depressant, sedative, anxio-</p><p>lytic, spasmolytic, and muscle relaxant effects in animals and has a benzo-</p><p>diazepine-like effect on the GABA system. Valepotriates have a sedative effect</p><p>on the autonomic nervous system. The essential oil has sedative and spasmo-</p><p>lytic effects on the central nervous system. The efficacy of valerian prepara-</p><p>tions depends largely on the quality and freshness of the starting material, the</p><p>extraction process, and the freshness of the extract. In humans it reduces the</p><p>sleep induction time and has sedative action during the daytime.</p><p>Warning: Although Valerian tea and tincture do not contain any valepotri-</p><p>ates (because they are unstable), they do contain degradation products</p><p>with similar action. The long-term safety of these products has not been</p><p>determined.</p><p>➤ Indications</p><p>– Difficulty in falling asleep due to nervous tension</p><p>– Restlessness, anxiety, nervous agitation</p><p>– Lack of concentration, decreased mental performance</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use: Used internally and externally (hydrotherapy).</p><p>– Tea: Steep 1 teaspoonful (3–5 g) of the chopped roots and rhizomes in</p><p>150 mL of hot water for 10 to 15 minutes.</p><p>• Dosage: 2 to 3 cups a day, plus 1 cup before retiring.</p><p>• Daily dose: 15 g herb.</p><p>– 1 : 5 tincture: 15–20 drops several times a day.</p><p>– Extract: 2–3 g herb, one to several times a day.</p><p>➤ Adverse effects: No known health hazards. Gastrointestinal symptoms are</p><p>rare side effects and contact allergies are very</p><p>rare. Headaches, anxiety, insom-</p><p>nia, mydriasis and disturbance of heart action occasionally occur during pro-</p><p>longed use of high doses.</p><p>➤ Herb–drug interactions: None known</p><p>Warning: Valepotriate-free preparations are currently recommended for</p><p>pediatric use since the potential risk of mutagenic and/or genotoxic effects has</p><p>not yet been satisfactorily defined.</p><p>➤ Summary assessment: Valerian tea, tincture, and other valepotriate-free prepa-</p><p>rations promote the induction of sleep. Preparations containing valepotriates</p><p>are effective in the treatment of daytime mental and motor agitation and lack</p><p>of concentration; they have a calming effect when taken prior to stress situa-</p><p>tions. The ability to drive a motor vehicle or operate machinery is not impaired.</p><p>✿ Literature</p><p>– Monographs: DAB 1998; ESCOP; Commission E</p><p>Plant Summaries—V</p><p>12</p><p>6</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>– Scientific publications: see p. 478; Amon: Phytotherapeutika: Nachge-</p><p>wiesene Wirkung, aber wirksame Stoffe meist nicht bekannt. Deutsche</p><p>Apotheker Ztg 137 (1997), 1221–1222; Bodesheim U, Hölzl J: Isolation and</p><p>receptor binding properties of alkaloids and lignans from Valeriana offici-</p><p>nalis L. PA 52 (1997), 386–391; Hiller K-O, Zetler G: Neuropharmacological</p><p>Studies on Ethanol Extracts of Valeriana officinalis: Behavioural, Anticon-</p><p>vulsant Properties. Phytotherapy Res 10 (1996), 145–151; Hölzl J: Baldrian,</p><p>ein Mittel gegen Schlafstörungen. Deutsche Apotheker Ztg 136 (1996),</p><p>751–759; Jansen W: Doppelblindstudie mit Baldrisedon. Therapiewoche</p><p>27 (1977), 2779–2786.</p><p>Plant Summaries—V</p><p>12</p><p>7</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>White Deadnettle (Lamium album L.)</p><p>➤ General comments: White deadnettle is widely distributed throughout</p><p>Europe and Central Asia. It has been used as a remedy for inflammations since</p><p>ancient times.</p><p>➤ Pharmacology</p><p>– Herb: White deadnettle flower (Lamii albi flos). The herb consists of the</p><p>dried petals and stamens of Lamium album L. and preparations of the same.</p><p>– Important constituents: Iridoids, triterpene saponins, caffeic acid deriva-</p><p>tives (rosmarinic acid, chlorogenic acid), and mucilage.</p><p>– Pharmacological properties: The mucilage and saponins have expectorant ef-</p><p>fects; the tannins have astringent effects. Clinical studies are not available.</p><p>➤ Indications</p><p>– Skin inflammations</p><p>– Coughs and bronchitis</p><p>– Inflammations of the mouth and throat</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– Tea: Steep 1 g of the herb in 150 mL of hot water for 5 minutes. Sip slowly.</p><p>– Mean daily dose: 3 g.</p><p>– Sitz baths: Add 5 g of the herb to 1 liter of hot water; add more water as</p><p>needed.</p><p>– Compresses: Soak in infusion made by steeping 50 g of the finely chopped</p><p>herb in 500 mL of hot water.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the herb.</p><p>➤ Summary assessment: White deadnettle is a well-tolerated though weakly</p><p>affective herbal remedy that combines well with other herbal remedies with</p><p>soothing and expectorant effects.</p><p>✿ Literature</p><p>– Monographs: Commission E</p><p>– Scientific publications: see p. 478</p><p>White Mustard (Sinapis alba L.)</p><p>➤ General comments: White mustard is an ancient garden and medicinal plant.</p><p>Its seeds are used externally and internally. Black mustard (Brassica nigra L.)</p><p>has the same uses as white mustard.</p><p>➤ Pharmacology</p><p>– Herb: White mustard seed (Sinapis albae semen). The herb consists of the</p><p>ripe, dried seeds of Sinapis alba L. and preparations of the same.</p><p>– Important constituents: Glucosinolates such as sinalbin (2.5 %), which yields</p><p>hydroxybenzyl mustard oil when the seeds are ground and stirred to a paste</p><p>with warm water or chewed. Phenylpropane derivatives such as sinapine,</p><p>a choline ester of sinapic acid (1.5 %), are also present.</p><p>– Pharmacological properties: p-hydroxybenzyl mustard oil induces bacte-</p><p>riostatic, skin irritant, and hyperemic effects in the acral regions.</p><p>➤ Indications</p><p>– Coughs and bronchitis</p><p>– Rheumatic complaints</p><p>– Head colds</p><p>Plant Summaries—W</p><p>12</p><p>8</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ Contraindications: Gastric and intestinal ulcers, inflammatory nerve dis-</p><p>eases. Should not be used by children under 12 years of age.</p><p>➤ Dosage and duration of use</p><p>– External use</p><p>• Poultices: Mix 4 tablespoons of the powdered herb with water immedi-</p><p>ately prior to use (see p. 298 for standard treatment instructions). The</p><p>poultice is applied to the skin for 10 to 15 minutes in adults, and for 5 to</p><p>10 minutes in children. Patients with sensitive skin should reduce the</p><p>application time.</p><p>• Baths: Tie 150 g of mustard flour in a bag and add to bath water (35–</p><p>45 °C).</p><p>• Footbaths: Add 20–30 g of mustard flour per liter of water.</p><p>• Maximum duration of treatment: 2 weeks. Rinse with water after appli-</p><p>cation.</p><p>– Daily dose: 60–240 g herb.</p><p>➤ Adverse effects: Long-term topical use of mustard can damage the skin. The</p><p>herb has a slight potential for sensitization (and is a potential cause of food</p><p>allergies). Caution: supervision is always necessary because of the possibility</p><p>of falling asleep with the plaster in place, which can cause severe burns.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Mustard is a very effective inducer of hyperemia.</p><p>➤ Literature</p><p>– Monographs: Commission E</p><p>Witch Hazel (Hamamelis virginiana L.)</p><p>➤ General comments: The bark and leaves of the witch hazel bush are used in</p><p>medicine.</p><p>➤ Pharmacology</p><p>– Herb</p><p>• Witch hazel bark (Hamamelidis cortex) consists of the dried bark of the</p><p>branches and twigs of Hamamelis virginiana L. and preparations of the</p><p>same.</p><p>• Witch hazel leaf (Hamamelidis folium) consists of the dried foliage</p><p>leaves of Hamamelis virginiana L. and preparations of the same.</p><p>– Important constituents</p><p>• Bark: 12 % tannins (hamamelitannin, catechins, oligomeric procyani-</p><p>dins)</p><p>• Leaves: 5 % tannins (hamamelitannin, catechins, oligomeric procyani-</p><p>dins)</p><p>– Pharmacological properties: Tannins have astringent, anti-inflammatory,</p><p>venotonic, and local hemostyptic effects.</p><p>➤ Indications</p><p>– Hemorrhoids</p><p>– Skin inflammations</p><p>– Varicose veins</p><p>– Wounds and burns</p><p>➤ Contraindications: None known.</p><p>➤ Dosage and duration of use</p><p>– External use</p><p>Plant Summaries—W</p><p>12</p><p>9</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>• Rinses and compresses: Use a decoction containing 5–10 g of the herb</p><p>and 250 mL water.</p><p>• Gargle: Mix 2–3 g of the herb with 150 mL water and use several times</p><p>a day.</p><p>– Internal use: One suppository 3 times a day; each suppository should con-</p><p>tain 0.1–1 g herb.</p><p>➤ Adverse effects: Health hazards in conjunction with proper administration of</p><p>the designated therapeutic doses of the drug are not known. High tannin con-</p><p>tents in preparations of the drug can cause indigestion.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Witch hazel is a tried and tested herb that has been</p><p>subjected to intense scientific study in recent years. Only few clinical trials of</p><p>any significance have been performed.</p><p>✿ Literature</p><p>– Monographs: ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Erdelmeier CAJ et al: Antiviral and an-</p><p>tiphlogistic activites of Hamamelis virginiana bark. Planta Med 62 (1996),</p><p>241–245; Hartisch C et al: Dual inhibitory activities of tannins from</p><p>Hamamelis virginiana and related polyphenols on 5-lipoxygenase and</p><p>Lyso-PAF: Acetyl-CoA-Acetyltransferase. Planta</p><p>Med 63 (1997), 106–110;</p><p>Mennet-von Eiff M, Meier B: Phytotherapie in der Dermatologie. Z Phyto-</p><p>ther 16 (1995), 2001–2010.</p><p>Wormwood (Artemisia absinthium L.)</p><p>➤ Pharmacology</p><p>– Herb: Wormwood (Absinthii herba). The herb consists of the dried top parts</p><p>(shoot tips and foliage leaves) and/or the dried basal foliage leaves of Arte-</p><p>misia absinthium L., collected at the time of flowering.</p><p>– Important constituents: Essential oil (0.2–1.5 %) containing (+)-thujone, α-</p><p>bisabolol, and trans-sabinyl acetate or chrysanthenyl acetate (content of</p><p>each over 40 %). Sesquiterpene lactones, including absinthin, artabsin, and</p><p>matricin, are also present.</p><p>– Pharmacological properties: The essential oils and bitter substances in</p><p>wormwood have cholagogue and digestant effects. They also stimulate the</p><p>appetite and promote wound healing. Sesquiterpene lactones stimulate the</p><p>bitter receptors at the base of the tongue, thus triggering a reflex to increase</p><p>the secretion of gastric juices with higher acid concentrations. In patients</p><p>with liver diseases, 20 mg of wormwood extract administered through a</p><p>gastric tube increased the levels of α-amylase, lipase, bilirubin, and total</p><p>cholesterol in the duodenal fluid. The essential oil has antimicrobial effects</p><p>in vitro.</p><p>➤ Indications</p><p>– Lack of appetite</p><p>– Dyspeptic complaints</p><p>– Biliary dyskinesia</p><p>➤ Contraindications: Pregnancy, liver disease.</p><p>➤ Dosage and duration of use</p><p>– Tea: One cup, 30 minutes before meals, 3 times a day.</p><p>Plant Summaries—W</p><p>13</p><p>0</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>– Tincture: 10 to 30 drops in 150 mL of water, 3 times a day (not for long-term</p><p>use).</p><p>– Daily dose: 2–3 g herb.</p><p>➤ Adverse effects: The concentration of thujone may be high enough to cause</p><p>vomiting, stomach cramps, enterospasms, headaches, dizziness, and central</p><p>nervous disorders if high doses of the alcoholic extract are used internally. Tea</p><p>preparations contain much less thujone.</p><p>Warning: Prolonged use (more than 2 weeks) is not recommended; also</p><p>contraindicated for pregnancy, lactation, and liver disease.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Wormwood combines well with other bitter herbs.</p><p>➤ Literature</p><p>– Monographs: DAB 1998; ESCOP; Commission E</p><p>– Scientific publications: see p. 478; Roth L, Daunderer M, Kormann K: Gift-</p><p>pflanzen, Pflanzengifte. 4. Aufl., Ecomed Fachverlag, Landsberg/Lech.</p><p>Plant Summaries—W</p><p>13</p><p>1</p><p>M</p><p>ed</p><p>ic</p><p>in</p><p>al</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>fr</p><p>o</p><p>m</p><p>A</p><p>t</p><p>o</p><p>Z</p><p>2</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Yarrow (Achillea millefolium L.)</p><p>➤ General comments: Yarrow has long been revered for its wound-healing prop-</p><p>erties. It is now used to relieve gastrointestinal complaints. There are numerous</p><p>subspecies of yarrow such as Achillea asiatica which is used medicinally in Asia.</p><p>➤ Pharmacology</p><p>– Herb: Yarrow herb (Millefolii herba). The herb consists of the fresh or dried</p><p>aerial parts of Achillea millefolium L., collected at the time of flowering, and</p><p>preparations of the same.</p><p>– Important constituents: Essential oil (0.2–1.0 %) containing chamazulene</p><p>(6–40 % max.), camphor (20 %), β-pinene (23 %), and 1,8-cineole (up to</p><p>10 %). Sesquiterpene lactones (mainly guaianolides) and flavonoids (api-</p><p>genin-7-O-glucoside and rutin) are also present. Azulenes tend to occur in</p><p>the tetraploid subspecies growing in meadows, rather than hexaploid sub-</p><p>species growing in forests.</p><p>– Pharmacological properties: The bitter principles (guaianolides) have chol-</p><p>agogic effects, whereas the flavonoids are spasmolytic. The interaction of</p><p>different compounds (chamazulene and flavonoids) renders the herb anti-</p><p>edematous, anti-inflammatory, and antibacterial.</p><p>– Achillea asiatica: Has antiulcerogenic activity in rats, and anti-inflammatory</p><p>effects; contains high levels of chamazulene. Only a few varieties of A. mille-</p><p>folium contain chamazulenes. The German Pharmacopeia specifies that</p><p>yarrow flowers for tea should contain not less than 0.2 %, the Austrian and</p><p>French Pharmacopeias specify at least 0.3 % essential oil, with 0.02 %</p><p>proazulenes, calculated as chamazulene.</p><p>➤ Indications</p><p>– Internal use: Lack of appetite, dyspeptic complaints, liver and gallbladder</p><p>complaints.</p><p>– External use: For treatment of spasmodic pain in the minor pelvis.</p><p>➤ Contraindications: Allergy to yarrow or other composite plants.</p><p>➤ Dosage and duration of use</p><p>– Tea: Pour boiling water onto 2–5 g of the finely chopped herb, cover and</p><p>steep for 10 to 15 minutes.</p><p>• Dosage: One cup, between meals, 3 to 4 times a day.</p><p>– External use: Steep 100 g yarrow herb in 1 to 2 liters of water for 20 minutes,</p><p>then add to bathwater.</p><p>➤ Adverse effects: There are no known health hazards or side effects in conjunc-</p><p>tion with proper administration of the designated therapeutic doses of the</p><p>herb. The herb has a weak to moderate potential for sensitization.</p><p>➤ Herb–drug interactions: None known.</p><p>➤ Summary assessment: Yarrow is a well-known and well-tolerated herbal rem-</p><p>edy. Some species, including most varieties of A. millefolium, have little or no</p><p>chamazulenes, reducing their anti-inflammatory effects. Products from cultivat-</p><p>ed varieties in Europe, but not North America are required to contain not less</p><p>than 0.2 % proazulenes.</p><p>✿ Literature</p><p>– Monographs: DAB 1998; Commission E</p><p>– Scientific publications: see p. 478; Kastner U, Glasl S, Jurenitsch J: Achillea</p><p>millefolium – ein Gallentherapeutikum. Z Phytother 16 (1995), 34–36,</p><p>Müller-Jakic B et al: In vitro inhibition of cyclooxygenase and 5-lipoxygenase</p><p>by alkamides from Echinacea and Achillea species. Planta Med 60 (1994), 37.</p><p>Plant Summaries—Y</p><p>13</p><p>2</p><p>Ca</p><p>rd</p><p>io</p><p>va</p><p>sc</p><p>u</p><p>la</p><p>r</p><p>D</p><p>is</p><p>ea</p><p>se</p><p>s</p><p>3</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Clinical Considerations</p><p>➤</p><p>General comments</p><p>– In heart failure, the heart is unable to maintain adequate circulation owing</p><p>to a decrease in heart muscle function (cardiac output) resulting from car-</p><p>diac myocyte death. The main causes are hypertension (see p. 138) with in-</p><p>creased venous pressures or cardiac volumes, valvular defects, and</p><p>ischemia due to sclerotic coronary artery disease (see p. 134).</p><p>– The body attempts to compensate for the circulatory deficiency by stimu-</p><p>lating mechanisms such as the sympathetic nervous system and by narrow-</p><p>ing the blood vessels, resulting in a higher workload on the heart. Addition-</p><p>al compensatory mechanisms lead to a further decrease in cardiac</p><p>performance.</p><p>– Effective treatment measures should be initiated as early as possible to pre-</p><p>vent the progression of heart failure.</p><p>➤</p><p>Prognosis:</p><p>The overall prognosis for heart failure remains poor although the</p><p>conventional treatments (diuretics, ACE inhibitors, beta blockers, AT</p><p>1</p><p>-block-</p><p>ers, digitalis) are effective.</p><p>➤</p><p>Classification:</p><p>According to the system of the New York Heart Association</p><p>(NYHA), heart failure is divided into four clinical stages:</p><p>– NYHA I: Symptoms do not occur during normal physical exercise.</p><p>– NYHA II: Symptoms occur during more strenuous exercise.</p><p>– NYHA III: Symptoms occur during light exercise.</p><p>– NYHA IV: Symptoms occur even at rest.</p><p>➤</p><p>Clinical value of herbal medicine:</p><p>Hawthorn and digitaloid herbs are used in</p><p>NYHA I and II heart failure. The current knowledge does not support treatment</p><p>of NYHA III and IV heart failure by herbal remedies.</p><p>Recommended Herbal Remedies</p><p>Flavonoid-containing Herbs</p><p>➤</p><p>Hawthorn leaf and flower</p><p>(Crataegie folium cum flore; see p. 74).</p><p>–</p><p>Action</p><p>: Procyanidins enhance the influx of calcium into cardiac muscle</p><p>fibers while only moderately increasing the oxygen demand. These com-</p><p>pounds widen the coronary arteries and other cardiac vessels,</p><p>thereby ex-</p><p>tending the refractory time. This results in an antiarrhythmic effect.</p><p>– Advantages of hawthorn</p><p>•</p><p>Effective and well-tolerated in the early stages of heart failure, especially</p><p>in patients with age-related degenerative changes in the heart muscle.</p><p>•</p><p>With a high rate of acceptance by patients, hawthorn leaf and flower</p><p>have only few side effects.</p><p>•</p><p>Since flavonoids do not reduce the afterload, hawthorn can also be used</p><p>by patients with low blood pressure.</p><p>•</p><p>Hawthorn can be recommended for long-term use, and it combines well</p><p>with cardiac glycosides, but may have a synergistic effect. This potential</p><p>interaction should be watched. It may allow a reduction in medications</p><p>like digoxin while maintaining the same overall therapeutic effect.</p><p>–</p><p>Dosage and administration</p><p>: One oral dose, 2 to 3 times daily. Relatively large</p><p>doses over time are needed for sufficient effects. A daily dose of ca. 900 mg</p><p>hawthorn total extract is generally recommended. The herbal remedy takes</p><p>around 4 weeks to become fully effective.</p><p>4.1 Heart Failure</p><p>13</p><p>3</p><p>Ca</p><p>rd</p><p>io</p><p>va</p><p>sc</p><p>u</p><p>la</p><p>r</p><p>D</p><p>is</p><p>ea</p><p>se</p><p>s</p><p>3</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Note:</p><p>Tea infusion is not the best way to extract water-soluble com-</p><p>pounds from hawthorn. Hawthorn tea therefore has only weak effects</p><p>and can be recommended, at best, only for a health-promoting effect in</p><p>the very early stages of cardiac insufficiency, or as a long-term prevent-</p><p>ative measure.</p><p>Digitaloid Herbs</p><p>➤</p><p>Adonis</p><p>(Adonidis herba; see p. 33),</p><p>lily-of-the-valley</p><p>(Convallariae herba; see</p><p>p. 86), and</p><p>squill root</p><p>(Scillae bulbus; see p. 110).</p><p>–</p><p>Action</p><p>: The effects are comparable to those of the isolated substances dig-</p><p>oxin and digitoxin, but the herbal preparations have secondary effects such</p><p>as increased urinary excretion (squill) or frequency (lily-of-the-valley).</p><p>–</p><p>Advantages</p><p>: The herbal preparations have a somewhat wider therapeutic</p><p>range than the isolated substances, but their concentrations can extend into</p><p>the toxic range.</p><p>–</p><p>Disadvantages</p><p>: The absorption of the active compounds in the herbal prep-</p><p>arations is generally poor and variable. Hence, their bioavailabilities and</p><p>potencies are usually low.</p><p>–</p><p>Dosage and administration</p><p>: One oral dose, 2 to 3 times daily. Individualized</p><p>dose setting is required.</p><p>Warning:</p><p>All digitaloid preparations can be toxic (similar to the glycosides</p><p>digoxin and digitoxin), producing symptoms such as nausea, vomiting,</p><p>stomach complaints, diarrhea, and cardiac arrhythmias.</p><p>Combinations of Flavonoid and Digitaloid Herbs</p><p>–</p><p>Advantages</p><p>:</p><p>The tolerance is said to be better than that of preparations con-</p><p>taining digitaloid herbs alone.</p><p>–</p><p>Disadvantages</p><p>:</p><p>Their therapeutic range is smaller than that of pure haw-</p><p>thorn preparations, and their toxic effects are similar to those of digitaloid</p><p>drugs.</p><p>4.1 Heart Failure</p><p>13</p><p>4</p><p>Ca</p><p>rd</p><p>io</p><p>va</p><p>sc</p><p>u</p><p>la</p><p>r</p><p>D</p><p>is</p><p>ea</p><p>se</p><p>s</p><p>3</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Clinical Considerations</p><p>➤</p><p>General comments</p><p>– The prevalence of coronary artery disease (CAD) is increasing in industrial-</p><p>ized countries. This is certainly attributable to a general lack of physical</p><p>exercise, increased consumption of fatty foods, and cigarette smoking, but</p><p>is also due to the fact that people now live longer.</p><p>– Despite intensive research, some risk factors of CAD are still unknown or</p><p>untreatable.</p><p>➤</p><p>Herbal treatment measures</p><p>– In Germany, topical heart ointments containing aromatic herbs that in-</p><p>crease local blood flow of cutivisceral reflex regions are thought to be ben-</p><p>eficial in acute functional coronary artery spasms.</p><p>– Flavonoids in hawthorn extract reduce wall tension in normal and sclerotic</p><p>blood vessels. These chemicals are also presumed to stimulate beta-2 re-</p><p>ceptors and, thus, to widen coronary arteries and blood vessels in skeletal</p><p>muscle. The usefulness of hawthorn in CAD is therefore arguable, but has</p><p>not yet been confirmed in clinical studies.</p><p>➤</p><p>Clinical value of herbal medicine</p><p>– The recommendations in this section are solely based on empirical experi-</p><p>ence. Clinical study data or controlled studies on most of these indications</p><p>are not yet available.</p><p>– Once CAD has become manifest, herbal measures should be restricted to</p><p>adjunctive treatment only.</p><p>➤</p><p>Herbal measures to help counteract risk factors</p><p>– Antilipemic herbs: Garlic (see p. 70), artichoke (see p. 36).</p><p>– Antithrombotic herbs: Garlic (see p. 70).</p><p>– Antihypertensive herbs: Garlic (see p. 70).</p><p>➤</p><p>Clinical value of herbal medicine for risk factors of CAD</p><p>– The herbal treatments outlined here are purely prophylactic and adjunctive</p><p>measures that can be recommended as home remedies. Clinical studies are</p><p>available.</p><p>Recommended Herbal Remedies (Overview)</p><p>External Remedies</p><p>➤</p><p>Aromatic plant medicaments such as</p><p>camphor</p><p>(Cinnamomic camphorae ae-</p><p>theroleum),</p><p>rosemary leaf</p><p>(Rosmarini folium; see p. 112),</p><p>pine needles</p><p>(Pini</p><p>aetheroleum),</p><p>eucalyptus leaf</p><p>(Eucalypti folium; see p. 61), and</p><p>menthol</p><p>(Menthae aetheroleum).</p><p>–</p><p>Action</p><p>: Stimulate cutivisceral reflexes, blood flow and spasmolysis, thereby</p><p>reducing CAD-related pain.</p><p>–</p><p>Dosage and administration</p><p>: The preparations are applied to the left precor-</p><p>dial region of the chest and rubbed into the skin as often as needed.</p><p>Warning:</p><p>Ointments containing camphor can cause skin irritation and in-</p><p>flammation and should not be applied to damaged skin.</p><p>Internal Remedies</p><p>➤</p><p>Hawthorn</p><p>(see p. 74).</p><p>4.2 Coronary Artery Disease</p><p>13</p><p>5</p><p>Ca</p><p>rd</p><p>io</p><p>va</p><p>sc</p><p>u</p><p>la</p><p>r</p><p>D</p><p>is</p><p>ea</p><p>se</p><p>s</p><p>3</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Range of Applications</p><p>Acute Angina Pectoris</p><p>➤</p><p>Hawthorn leaf</p><p>and</p><p>flower</p><p>(see p. 74).</p><p>–</p><p>Dosage and administration</p><p>: Dose is diluted oil or other balm applied several</p><p>times daily or as needed for mild pain of angina. Apply twice daily to the left</p><p>precordial region, or as needed when chest pain occurs.</p><p>–</p><p>Clinical value</p><p>: Clinical studies have not been conducted. Large inter-</p><p>individual differences in the effects of these remedies can be observed.</p><p>Prevention and Treatment of Early-stage CAD</p><p>➤</p><p>Hawthorn leaf</p><p>and</p><p>flower</p><p>(see p. 74).</p><p>– Steep 2 teaspoons of the herb in 150 mL of boiling water for 20 minutes.</p><p>Sweeten lightly. This mild infusion should be used only for health-promot-</p><p>ing benefits.</p><p>–</p><p>Hawthorn tincture</p><p>(see p. 74): 2–4 mL several times a day.</p><p>–</p><p>Extract</p><p>standardized to flavonoids and/or proanthocyanins: 1 to 2 capsules</p><p>or tablets.</p><p>–</p><p>Dosage and administration</p><p>: One dose, 2 to 3 times daily.</p><p>–</p><p>Clinical value</p><p>: For low-potency treatment, hawthorn extracts that are not</p><p>standardized have a smaller therapeutic range than the corresponding</p><p>standardized commercial products.</p><p>Early-stage CAD with Mild Hypertension</p><p>➤</p><p>Tea</p><p>Rx</p><p>: Crataegi flos; Crataegi folium; Visci albi, aa ad 100.0.</p><p>–</p><p>Dosage and administration</p><p>: 1 to 2 teaspoons per cup, 2 times daily.</p><p>–</p><p>Clinical value</p><p>: For low-potency treatment. The extract is not standardized</p><p>and has a smaller therapeutic range than commercial products.</p><p>CAD with Gastrocardiac Symptom Complex (Roemheld’s Syndrome)</p><p>➤</p><p>Tincture</p><p>Rx</p><p>: Ol. Carvi 5.0; Tinct. Convallariae, Tinct. Crataegi, Tinct. Carmina-</p><p>tiva, Spirit. Aetheris Nitrosi, ad 10.0.</p><p>–</p><p>Dosage and administration</p><p>: 20 drops, 3 times a day.</p><p>–</p><p>Clinical value</p><p>:</p><p>This has proved to be a very useful remedy in elderly patients,</p><p>who often develop Roemheld’s syndrome.</p><p>Long-term Treatment of CAD</p><p>➤</p><p>Hawthorn preparations</p><p>(see p. 74), garlic (see p. 70).</p><p>4.2 Coronary Artery Disease</p><p>13</p><p>6</p><p>Ca</p><p>rd</p><p>io</p><p>va</p><p>sc</p><p>u</p><p>la</p><p>r</p><p>D</p><p>is</p><p>ea</p><p>se</p><p>s</p><p>3</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Clinical Considerations</p><p>➤</p><p>General comments</p><p>– The diagnosis of functional heart disorder is a diagnosis of exclusion. The</p><p>typical patient complains of heart palpitations.</p><p>– The most common symptoms are “loud” heartbeat, cardiac arrhythmias,</p><p>subjective feeling of unrest, diffuse left precordial, non-load-dependent</p><p>pressure sensation, sudden shortness of breath, nervousness, anxiety, rapid</p><p>fatigability, insomnia, lack of concentration, tendency to sweat heavily,</p><p>symptoms of heart “agitation.”</p><p>– The cardiac work-up usually does not reveal any abnormalities. If any</p><p>changes are found, they are usually harmless extrasystoles or functional</p><p>coronary spasms.</p><p>➤ Clinical value of herbal medicine: Herbal preparations can be helpful because</p><p>no specific synthetic drugs or chemical remedies for functional heart disorders</p><p>exist. Beta blockers are, in many cases, either contraindicated or not accepted</p><p>by the patients.</p><p>Recommended Herbal Remedies (Overview)</p><p>External Remedies: See Coronary Artery Disease, p. 134.</p><p>Internal Remedies (nonglycoside drugs)</p><p>➤ Hawthorn leaf and flower (Crataegi folium cum floribus; see p. 74), mother-</p><p>wort herb (Leonuri cardiacae herba).</p><p>– Action:</p><p>• Hawthorn, see p. 74 ff.</p><p>• Motherwort has mild negative chronotropic, antihypertensive, and</p><p>calming effects. Its use is recommended only as an additive to other car-</p><p>diac remedies or sedatives.</p><p>Internal Remedies (glycoside drugs)</p><p>➤ Adonis (Adonidis herba, see p. 33) and lily-of-the-valley (Convallariae herba,</p><p>see p. 86).</p><p>Note: Larger doses of any preparation containing cardiac glycosides are</p><p>toxic.</p><p>– For further information, see Heart Failure, section 4.1.</p><p>Range of Applications</p><p>Functional Heart Disorders</p><p>➤ Tincture Rx: Extract. Adonidis Fluid., Tinct. Convallariae, Tinct. Valerianae, aa</p><p>10.0.</p><p>– Dosage and administration: 30 drops, 3 times a day.</p><p>– Clinical value: Mild cardiac sedative, useful in nervous palpitations.</p><p>➤ Tea Rx: Leonuri cardiacae herba, Convallariae herba, Melissae folium, aa 100.0.</p><p>– Dosage and administration: Steep 2 teaspoons in 1 cup of boiling water. Take</p><p>1 cup, twice daily, for several weeks.</p><p>– Clinical value: Somewhat less potent than the first formulation.</p><p>4.3 Functional Heart Disorders</p><p>13</p><p>7</p><p>Ca</p><p>rd</p><p>io</p><p>va</p><p>sc</p><p>u</p><p>la</p><p>r</p><p>D</p><p>is</p><p>ea</p><p>se</p><p>s</p><p>3</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ Leonuri cardiacae herba (motherwort)</p><p>– Dosage and administration: Steep 2 teaspoons in 1 cup of boiling water, or</p><p>add 1–2 mL of the 1 : 5 tincture to a cup of water. Take 1 cup, 3 times daily.</p><p>– Clinical value: This prescription is very mild and can be recommended for</p><p>long-term use.</p><p>➤ Tea Rx: Crataegi flos, Crataegi folium, Visci albi, aa ad 100.0.</p><p>– Dosage and administration: Steep 1 to 2 teaspoons of the herbs in 1 cup of</p><p>boiled water, or add 1–2 mL Tinct. Crataegi tincture and 1 mL Tinct. Visci</p><p>to 1 cup of boiled water. Take 1 cup, 2 times a day.</p><p>– Clinical value: For mild antihypertensive action.</p><p>Functional Heart Disorders with Gastrocardiac Symptoms Complex</p><p>(Roemheld’s Syndrome): see p. 178.</p><p>Functional Heart Disorders with Severe Anxiety</p><p>➤ Tincture Rx: Tinct. Convallariae 5.0, Tinct. Crataegi 10.0, Tinct. Valerianae ad</p><p>30.0.</p><p>– Dosage and administration: 15 drops, 3 times a day.</p><p>– Clinical value: The valerian component provides an additional sedative</p><p>effect</p><p>4.3 Functional Heart Disorders</p><p>13</p><p>8</p><p>Ca</p><p>rd</p><p>io</p><p>va</p><p>sc</p><p>u</p><p>la</p><p>r</p><p>D</p><p>is</p><p>ea</p><p>se</p><p>s</p><p>3</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Clinical Considerations</p><p>➤ General considerations and classification</p><p>– Hypertension is defined by the World Health Organization (WHO) as systo-</p><p>lic blood pressure >139 mmHg and/or diastolic pressure >90 mmHg.</p><p>– Classification according to severity</p><p>• First degree: 140–159/90–99 mmHg</p><p>• Second degree: 160–179/100–109 mmHg</p><p>• Third degree: ≥180/≥110 mmHg</p><p>• Isolated systolic hypertension: ≥140/</p><p>. . . . . . . . . . . . . 330</p><p>27 Dosages</p><p>. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337</p><p>2</p><p>8 Addresses</p><p>. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 453</p><p>28.1 Professional Organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 453</p><p>28.2 Suppliers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 458</p><p>29 References and Resources</p><p>. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 477</p><p>29.1 Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 477</p><p>29.2 Interesting Web Sites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 478</p><p>Index</p><p>. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 479</p><p>Appendix: Glossaries, Dosages, Addresses, References, and Index</p><p>Contents</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Page intentionally left blank</p><p>1</p><p>Fu</p><p>n</p><p>d</p><p>am</p><p>en</p><p>ta</p><p>ls</p><p>o</p><p>f P</p><p>h</p><p>yt</p><p>o</p><p>th</p><p>er</p><p>ap</p><p>y</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Preliminary Remarks</p><p>➤</p><p>Herbal medicine is a scientifically recognized complementary and alternative</p><p>treatment method with proven efficacy.</p><p>➤</p><p>In North America, herbal remedies are considered dietary supplements by law</p><p>and are considered safe unless proven otherwise. Manufacturing standards are</p><p>not as stringent as required for pharmaceutical drugs. While only a few “struc-</p><p>ture and function” claims (such as “benefits digestion”) can be made by manu-</p><p>facturers, many work around that limitation by making extensive use of</p><p>“third-party” advertising in magazines and through company representatives.</p><p>➤</p><p>In Germany, herbal remedies are defined as medicinal products by German</p><p>Drug Law.</p><p>➤</p><p>German legislators regard herbs and herbal remedies as medicinal products</p><p>with specific pharmaceutical characteristics. Together with homeopathic and</p><p>anthroposophic medicines, herbal medicines are classified as drugs of a special</p><p>system of therapeutics.</p><p>➤</p><p>According to German law, every physician must be knowledgeable about herb-</p><p>al medicine. North American physicians are not required to have this training,</p><p>and few classes are offered in herbs or natural medicine in medical school.</p><p>➤</p><p>The public interest in alternative therapies for general health maintenance and</p><p>supportive treatment of chronic diseases has increased tremendously.</p><p>Distinctions Between the Different Types</p><p>of Therapeutic Preparations</p><p>➤</p><p>Herbal products:</p><p>One of the main distinguishing features of herbal prepara-</p><p>tions is their complex chemical composition.</p><p>➤</p><p>Chemical or synthetic drugs:</p><p>Chemically defined drugs in general contain</p><p>precisely definable quantities of usually one particular active ingredient and</p><p>also accompanying substances.</p><p>➤</p><p>Homeopathic remedies:</p><p>Homeopathic products are prepared according to</p><p>special formulation techniques and are prescribed according to the principles</p><p>introduced by Samuel Hahnemann in the early nineteenth century. His “Law</p><p>of Similars” states that the remedy prescribed, in a more or less highly diluted</p><p>form, to cure a given condition or disease should be a substance that induces</p><p>similar symptoms in healthy individuals when given in much higher amounts.</p><p>➤</p><p>Anthroposophic remedies:</p><p>Anthroposophic remedies are prepared according</p><p>to the ideas and teachings of Rudolf Steiner.</p><p>Definitions</p><p>➤</p><p>Herbal medicine:</p><p>A time-honored system of healing practiced in every culture</p><p>in the world. Science has modernized the system using analytical and pharma-</p><p>ceutical testing. The science-based practice of herbal medicine is now called</p><p>phytomedicine</p><p>or</p><p>phytotherapy</p><p>, which is a system of therapeutics in which dis-</p><p>eases and disorders are treated with medicinal plants and preparations made</p><p>from them using scientific principles.</p><p>➤</p><p>Medicinal herbs:</p><p>Medicinal products whose active ingredients consist exclu-</p><p>sively of medicinal plants and preparations made from them. Using modern</p><p>chemical and pharmaceutical methods, a number of popular herbal remedies</p><p>are nowadays “standardized” to provide consistent levels of proven identified</p><p>active compounds.</p><p>1.1 Characteristics and Status of Herbal Medicines</p><p>2</p><p>Fu</p><p>n</p><p>d</p><p>am</p><p>en</p><p>ta</p><p>ls</p><p>o</p><p>f P</p><p>h</p><p>yt</p><p>o</p><p>th</p><p>er</p><p>ap</p><p>y</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤</p><p>Phytochemistry:</p><p>The study of plant chemistry, including the identification,</p><p>isolation, analysis, and characterization of plant constituents, and determina-</p><p>tion of the chemical structures of plant constituents.</p><p>➤</p><p>Pharmaceutical biology:</p><p>The field of research concerned with the extraction</p><p>and development of biogenic drugs from plants and other living organisms as</p><p>well as the processing and application of these drugs.</p><p>➤</p><p>Phytopharmacology:</p><p>The study of the uptake, distribution, and effect of herb-</p><p>al preparations and of their elimination from the body.</p><p>➤</p><p>Active principles:</p><p>Substances or substance groups definable by chemical anal-</p><p>ysis that essentially contribute to the therapeutic action of a medicinal herbal</p><p>preparation.</p><p>➤</p><p>Active ingredients of medicinal herbal preparations:</p><p>Plant ingredients in</p><p>their natural states and preparations made from them.</p><p>➤</p><p>Minor constituents:</p><p>Substances that have an indirect or slight effect on the</p><p>therapeutic action of an herbal drug.</p><p>➤</p><p>Single-herb herbal preparation:</p><p>Herbal medicinal preparation from one</p><p>medicinal plant.</p><p>➤</p><p>Target constituents:</p><p>Herbal drug preparation constituents definable by</p><p>chemical analysis that are used as parameters of in-process quality control and</p><p>may contribute to a characteristic pharmaceutical property.</p><p>➤</p><p>Species, genus, family:</p><p>Taxonomic terms classifying a plant. A genus may in-</p><p>clude one or more species, and a family may include one or more genera.</p><p>Research on Herbal Remedies: State of the Art</p><p>➤</p><p>Remarkable advances in phytotherapeutic research have been made within</p><p>the past 15 years.</p><p>➤</p><p>The worldwide interest in herbal drug research is steadily increasing.</p><p>– Collaboration between universities, the dietary supplement and herbal in-</p><p>dustry, and the pharmaceutical industry is essential to promote the success</p><p>of this research. In North America, government funding of human studies</p><p>on the efficacy and safety of herbal preparations is just beginning.</p><p>– Comparable to research on chemically defined drugs, research on herbal</p><p>preparations is also carried out using molecular biological, pharmacologi-</p><p>cal, and clinical techniques of investigation.</p><p>– The findings of herbal research are published in recognized medical jour-</p><p>nals such as</p><p>JAMA</p><p>, the</p><p>British Medical Journal</p><p>, and</p><p>Arzneimittelforschung</p><p>.</p><p>– Researchers are developing high-quality standardized extracts with prov-</p><p>en efficacy.</p><p>– Both basic research and clinical studies have repeatedly shown that whole-</p><p>drug complexes are superior with respect to range of action and tolerability</p><p>to isolated chemical constituents.</p><p>German Drug Law Provisions</p><p>➤</p><p>Phytopharmaceutical standards:</p><p>In Germany, manufacturers of herbal prep-</p><p>arations are held to much higher standards than their counterparts in North</p><p>America. According to the German Drug Law (</p><p>Arzneimittelgesetz)</p><p>, herbal</p><p>“drugs” (preparations)</p><p>water onto 2.5 g (1 teaspoon) of the finely</p><p>chopped herb, allow to stand at room temperature for 12 hours, then</p><p>strain.</p><p>• Dosage: One to two cups per day. Tincture (1 : 1) 20 to 30 drops, several</p><p>times daily.</p><p>4.4 Hypertension</p><p>14</p><p>0</p><p>Ca</p><p>rd</p><p>io</p><p>va</p><p>sc</p><p>u</p><p>la</p><p>r</p><p>D</p><p>is</p><p>ea</p><p>se</p><p>s</p><p>3</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Clinical Considerations</p><p>➤ General comments</p><p>– Hypotension is defined as a chronic reduction in the systolic blood pressure</p><p>to</p><p>must meet the same standards as chemically defined</p><p>drugs with respect to pharmaceutical quality, efficacy, and safety, whereas in</p><p>the United States they are considered dietary supplements.</p><p>1.1 Characteristics and Status of Herbal Medicines</p><p>3</p><p>Fu</p><p>n</p><p>d</p><p>am</p><p>en</p><p>ta</p><p>ls</p><p>o</p><p>f P</p><p>h</p><p>yt</p><p>o</p><p>th</p><p>er</p><p>ap</p><p>y</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤</p><p>Marketing authorizations for herbal medical drugs:</p><p>In Germany, applica-</p><p>tions for marketing authorization must be submitted to the Federal Institute</p><p>for Drugs and Medicinal Products, accompanied by the following documents:</p><p>1. Results of physicochemical, biological and microbiological tests and a de-</p><p>scription of the testing methods (analytical testing, assessment of pharma-</p><p>ceutical quality)</p><p>2. Results of pharmacological and toxicological tests (assessment of drug</p><p>efficacy and safety)</p><p>3. Results of clinical studies (efficacy and safety)</p><p>– If the beneficial and adverse effects, and the side effects of a preparation are</p><p>already known, empirical evidence acquired by scientific methods can be</p><p>submitted instead of items 2 and 3.</p><p>– Until 1994, the Commission E, a diverse group of scientists, physicians,</p><p>pharmacists, physiatrists , biostatisticians, and representatives of the phar-</p><p>maceutical industry was charged with the task of preparing monographs</p><p>on the various medicinal plants. In this capacity, the Commission issued</p><p>summaries and assessments of the published data on the pharmacology,</p><p>toxicology, and clinical efficacy of 360 herbal medical preparations. These</p><p>monographs are available in English, published by the American Botanical</p><p>Council (see list of references, p. 479).</p><p>– This valuable and influential effort should not be overrated however. The</p><p>monographs are not referenced with the primary literature, and so cannot</p><p>be peer-reviewed or critically evaluated, especially since, recognizing the</p><p>explosion of recent scientific work, they have not been revised in nearly 10</p><p>years.</p><p>– The German Cooperative on Phytopharmaceuticals (Kooperation Phyto-</p><p>pharmaka) took over responsibility for revising the existing monographs in</p><p>Germany in 1994. The revised monographs included a comprehensive re-</p><p>view of the recent literature. Some of them are available in English.</p><p>– In 1994 also the ESCOP (European Scientific Cooperative on Phytotherapy)</p><p>was constituted in order to actualize the monographs on an European base</p><p>(see list of references, p. 479)</p><p>– This valuable and influential effort should not be overrated however. The</p><p>monographs are not referenced with the primary literature, and so cannot</p><p>be peer-reviewed or critically evaluated, especially since, recognizing the</p><p>explosion of recent scientific work, they have not been revised in nearly 10</p><p>years.</p><p>– According to the simplified reauthorization procedure for traditional med-</p><p>icines, traditional medicines must be labeled as follows: Traditionally used</p><p>(a) as a roborant (strengthening agent) in ...; (b) for improvement of general</p><p>feeling in ...; (c) to enhance organ function ...; (d) to prevent XYZ ...; or (e) as</p><p>a mildly effective medical drug in case of .… Specific diseases must not be</p><p>mentioned as indications for the traditional preparation.</p><p>1.1 Characteristics and Status of Herbal Medicines</p><p>4</p><p>Fu</p><p>n</p><p>d</p><p>am</p><p>en</p><p>ta</p><p>ls</p><p>o</p><p>f P</p><p>h</p><p>yt</p><p>o</p><p>th</p><p>er</p><p>ap</p><p>y</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Origins of Medicinal Plants for the Manufacture</p><p>of Herbal Products</p><p>➤</p><p>Wild harvested herbs</p><p>– Half of all medicinal plants on the market and two-thirds of all plant species</p><p>are harvested from the wild.</p><p>– For economic reasons, wild harvested herbs are preferably used in the cases</p><p>of certain slow-growing plants and of plants of which there is a naturally</p><p>abundant supply.</p><p>➤</p><p>Cultivated herbs</p><p>– Cultivated herbs are used when the natural supply is not sufficient to meet</p><p>demand or if a herb required for medicinal purposes is a protected plant</p><p>species, such as purple coneflower,</p><p>Echinacea purpurea,</p><p>and goldenseal,</p><p>Hydrastis canadensis</p><p>.</p><p>–</p><p>Advantages of controlled farming</p><p>•</p><p>Uniform seed material, optimal growing conditions and harvesting</p><p>times</p><p>•</p><p>Reduced risk of mistaken identity or adulteration</p><p>•</p><p>Reduction of impurities, microbial contamination, and residues from</p><p>pesticides and heavy metals (especially in plants imported from devel-</p><p>oping countries)</p><p>–</p><p>Organic farming:</p><p>Ensures the maintenance of natural growing conditions</p><p>and is environmentally friendly.</p><p>➤</p><p>Cultivation of special crops</p><p>– Mainly used to enrich and optimize the primary constituents of medicinal</p><p>plants. A way of standardizing active constituent levels.</p><p>– Reduces the number and quantity of undesirable substances in the plants.</p><p>– Enhances the resistance of the plants to atmospheric influences, diseases,</p><p>and pests.</p><p>Quality Assurance</p><p>➤</p><p>Homogeneous starting materials</p><p>– Homogeneity is achieved by optimization and wide-scale standardization</p><p>of growing conditions (e. g., in cultures), and asexual propagation</p><p>Note</p><p>:</p><p>The concentrations of constituents in a given plant (e. g., ginseng or</p><p>arnica) tend to vary according to location of origin, season of harvesting,</p><p>and age.</p><p>➤</p><p>Standardized preparation process</p><p>– Manufacturers use exact specifications for analyzing parent substances—</p><p>meaning the herbs and their parts used—and herbal extracts made from</p><p>them, using solvents such as ethanol. Specifications for assaying the con-</p><p>tent of target or primary constituents are just as exact and are designed to</p><p>ensure that the chemical composition of the herbal extracts remains con-</p><p>sistent from batch to batch.</p><p>– Standardization ensures that the quality of medicinal plants and extracts</p><p>made from them are reproducible and consistent.</p><p>– Minimum concentrations of active principles in raw (unprocessed) herbs</p><p>are specified in sources such as the German and European Pharmacopeias</p><p>and, lately, the US Pharmacopeia.</p><p>1.2 From the Plant to the Remedy</p><p>5</p><p>Fu</p><p>n</p><p>d</p><p>am</p><p>en</p><p>ta</p><p>ls</p><p>o</p><p>f P</p><p>h</p><p>yt</p><p>o</p><p>th</p><p>er</p><p>ap</p><p>y</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Note</p><p>:</p><p>Insofar as the manufacturers of phytomedicines use different methods</p><p>of processing, the final products may vary greatly with respect to the type and/</p><p>or concentration of their ingredients. This is especially true of liquid tinctures</p><p>of all kinds, including glycerites, and herb products that contain powdered</p><p>herbs.</p><p>➤</p><p>Chemical standardization:</p><p>Many manufacturers today sell products that con-</p><p>tain standardized extract powders in capsule and tablet form, and the levels of</p><p>identified active constituents vary much less in these products.</p><p>➤</p><p>Quality</p><p>is ensured through good harvesting, drying, processing, and storage</p><p>practices of both herbs and preparations (see also section on storage):</p><p>– Good harvesting practice takes into account the growth phase (time of year)</p><p>and best time of day to harvest a given plant.</p><p>– The drying process should be performed at a suitable temperature, without</p><p>overheating, and under appropriate lighting conditions.</p><p>– The plant material should be cut, cleaned, and stored without direct light</p><p>exposure at an appropriate temperature in accordance with the rules of</p><p>good professional practice. Herbal preparations such as liquids, capsules, or</p><p>tablets should be stored away from heat and direct sunlight, preferably in</p><p>glass containers that exclude oxygen.</p><p>➤</p><p>In-process controls:</p><p>The manufacturer should monitor each step of the pro-</p><p>cess of converting raw materials into finished medicinal products by applying</p><p>the appropriate analytical tests.</p><p>➤</p><p>Drug safety for herbal medicinal preparations</p><p>– In Germany,</p><p>herbal medicinal preparations are subject to essentially the</p><p>same standards for toxicity, teratogenicity, and mutagenicity/carcino-</p><p>genicity as chemically defined drugs. End user suppliers and storage spe-</p><p>cifications are described below.</p><p>– The processed plant material must be tested for a wide variety of different</p><p>pesticides. In North America, manufacturers of herbal products must follow</p><p>good manufacturing practices based on regulations for food products re-</p><p>garding cleanliness and safety. The Food and Drug Administration (FDA)</p><p>does not currently require manufacturers to test herbal medicines that are</p><p>generally recognized as safe (GRAS) and have been used in food products</p><p>before 1 January 1958 for toxicity in the same way as pharmaceutical drugs,</p><p>since manufacturers are allowed to make only minimal “structure–</p><p>function” claims for herbal preparations.</p><p>Note</p><p>:</p><p>Plants collected in the wild, as well as plants raised in conventional</p><p>(nonorganic) farms, may have high concentrations of pesticides and/or heavy</p><p>metals.</p><p>➤</p><p>End user suppliers:</p><p>Pharmacies, supermarkets, health food stores, web-based</p><p>suppliers, or by direct order from certain suppliers.</p><p>➤</p><p>Storage</p><p>– Store in a cool (not cold), dark place, out of the reach of children.</p><p>– Discard after the expiration date.</p><p>– Factors that can reduce the shelf life of herbal medicines:</p><p>•</p><p>Exposure to air (keep in airtight bottles)</p><p>•</p><p>Humidity</p><p>•</p><p>Heat</p><p>•</p><p>Light (leading to oxidation-related decomposition)</p><p>1.2 From the Plant to the Remedy</p><p>6</p><p>Fu</p><p>n</p><p>d</p><p>am</p><p>en</p><p>ta</p><p>ls</p><p>o</p><p>f P</p><p>h</p><p>yt</p><p>o</p><p>th</p><p>er</p><p>ap</p><p>y</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>• Fungal or bacterial contamination (leading to formation of poisonous</p><p>metabolites)</p><p>• Evaporation</p><p>Note: Plants infested with pests or mold must be destroyed.</p><p>– In order to identify plants that are spoiled or infested, the plant material</p><p>should be inspected for mold, altered or unpleasant odor, insects, and traces</p><p>of insects (cobwebs, etc.).</p><p>– The pharmacist should be able to furnish information on the shelf life of</p><p>herbal medicines (e. g., teas and other herbal remedies prepared in the</p><p>pharmacy).</p><p>– Herbal preparations should be stored in containers that are airtight, water-</p><p>proof, lightproof, and fragrance-free.</p><p>– Storage temperature: 10 – 20 °C (50 – 68 °F).</p><p>Comparison of Efficacy</p><p>➤ It is virtually impossible to compare the efficacy of herbal remedies prepared</p><p>by different manufacturers, even when they are derived from the same plant</p><p>species, because different companies use different drying, processing, and</p><p>manufacturing processes, and because plants from different populations vary</p><p>in constituent levels.</p><p>➤ The therapeutic efficacy of herbal remedies with comparable concentrations</p><p>of primary constituents but produced by different manufacturers may vary be-</p><p>cause of the differences in the content of minor constituents.</p><p>➤ In the future, individual pharmaceutical companies will be required to test the</p><p>efficacy and tolerability of plant extracts prepared by different manufacturing</p><p>processes.</p><p>1.2 From the Plant to the Remedy</p><p>7</p><p>Fu</p><p>n</p><p>d</p><p>am</p><p>en</p><p>ta</p><p>ls</p><p>o</p><p>f P</p><p>h</p><p>yt</p><p>o</p><p>th</p><p>er</p><p>ap</p><p>y</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>Primary and Secondary Metabolism</p><p>➤ A distinction is generally made between primary and secondary plant meta-</p><p>bolism. The products of primary metabolism maintain the plant’s vital func-</p><p>tions, whereas the products of secondary metabolism, as far as is currently</p><p>known, are not essential for the plant’s immediate survival.</p><p>➤ Products of primary metabolism: Carbohydrates, fats and proteins are basic</p><p>nutrients for humans and animals, but are rarely relevant as pharmacological-</p><p>ly active substances. Nonetheless, they may have a positive or negative effect</p><p>on the efficacy of the active principles in drugs.</p><p>➤ Products of secondary metabolism: Many secondary plant substances pro-</p><p>tect plants from feeding damage, act as storage or waste products, or ward off</p><p>pests and diseases. Some are pharmacologically active.</p><p>Examples of Products of Primary Metabolism</p><p>➤ Pectins</p><p>– Substance group: Carbohydrates.</p><p>– Example: Apple pectin.</p><p>– Structural properties: High-molecular weight compounds comprising</p><p>sugarlike molecules.</p><p>– Plant sources: Found in many kinds of fruit, especially when unripe.</p><p>– Pharmacological properties: Pectins cannot be digested by endogenous in-</p><p>testinal juices and have a high water-binding capacity.</p><p>– Indications: Diarrhea.</p><p>• Pectins lower the pH of the bowel because they encourage growth of</p><p>beneficial bacteria. This produces less favorable living conditions for the</p><p>pathological bacteria that cause diarrhea (see p. 190, “Diarrhea”).</p><p>➤ Essential omega-3 and omega-6 fatty acids</p><p>– Substance group: Fats.</p><p>– Examples: Alpha-linolenic acid and gamma-linolenic acid.</p><p>– Plant sources: Flaxseed, rape seed, evening primrose seed, etc.</p><p>– Structural properties: Fatty acids.</p><p>– Pharmacological properties: Used in the synthesis of tissue hormones of the</p><p>eicosanoid, prostaglandin, and thromboxane groups.</p><p>– Indications: Symptoms and ailments involving inflammation.</p><p>Products of Secondary Metabolism</p><p>➤ Alkaloids</p><p>– Examples: Atropine, caffeine, morphine, colchicine, nicotine, berberine.</p><p>– Plant sources: Mainly in nightshades such as belladonna, bittersweet, and</p><p>thornapple, but also in papaveraceous plants (opium poppy, greater</p><p>celandine), the borage family (coltsfoot, comfrey), and the spea family</p><p>(Crotalaria).</p><p>– Structural properties: Alkaloids contain nitrogen have complex structures,</p><p>and undergo alkaline reactions.</p><p>– Pharmacological properties: Most alkaloids have a potent effect on the cen-</p><p>tral nervous system, e. g., sympathomimetic or parasympatholytic effect.</p><p>– Indications</p><p>• Isolated alkaloids used in pure form (e. g., atropine) are highly potent</p><p>drugs that are available by prescription only.</p><p>1.3 Constituents and Active Principles</p><p>8</p><p>Fu</p><p>n</p><p>d</p><p>am</p><p>en</p><p>ta</p><p>ls</p><p>o</p><p>f P</p><p>h</p><p>yt</p><p>o</p><p>th</p><p>er</p><p>ap</p><p>y</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>• Chelidonine (celandine), berberine, caffeine, and theophylline are less</p><p>potent alkaloids.</p><p>• Pyrrolizidine alkaloids (present in members of the borage and aster fam-</p><p>ily): Their significant toxicological features are hepatotoxicity and mu-</p><p>tagenicity.</p><p>➤ Essential oils</p><p>– Examples of individual essential oil components: Menthol, thymol, α-pinene,</p><p>eugenol, chamazulene. Essential or volatile oils are highly complex mix-</p><p>tures of monoterpenes (containing 10 carbon atoms) and other types of</p><p>compounds.</p><p>– Plant sources: Found in a variety of plants, such as conifers, and members of</p><p>the mint and parsley families.</p><p>– Structural properties: Monoterpenes (e. g., menthol, thymol), sesquiter-</p><p>penes (e. g., constituents of chamomile such as bisabolol), sesquiterpene</p><p>lactones (parthenolide in feverfew), iridoid substances (gentopicrin in</p><p>gentian root), and phenylpropane (e. g., chemicals in ginger root, euge-</p><p>nol).</p><p>– Pharmacological properties: Essential oils are aromatic, highly volatile, fat-</p><p>soluble substances that stimulate chemoreceptors. They are readily ab-</p><p>sorbed in the gastrointestinal tract and by the skin (e. g., when used in bath</p><p>salts and liniments).</p><p>➤ Bitter substances</p><p>– Examples: Gentianin, gentiopicrin, cynaropicrin.</p><p>– Plant sources: Members of the Aster (artichoke, dandelion) and Gentian</p><p>(gentian, centaury) families.</p><p>– Structural properties: Mainly derivatives of terpenes and seco-iridoides.</p><p>– Pharmacological properties: Bitter substances stimulate the reflex produc-</p><p>tion of gastrointestinal secretions (especially saliva and gastric juices) via</p><p>lingual taste buds.</p><p>– Indications: For treatment of dyspeptic complaints; to stimulate appetite</p><p>and improve digestion and assimilation of nutrients.</p><p>➤ Carotinoids</p><p>– Examples: β-carotene, lycopene, lutein.</p><p>– Plant sources: Colored fruit, leafy vegetables.</p><p>– Structural properties: Tetraterpene derivatives.</p><p>– Pharmacological properties: Antioxidants and immunomodulators; vitamin</p><p>A precursors (β-carotene).</p><p>– Indications: Inflammation, immunodeficiency, photodermatosis.</p><p>➤ Flavonoids</p><p>– Examples: Rutin, silymarin, kaempferol, quercetin.</p><p>– Plant sources: Found in a wide variety of plants.</p><p>– Structural properties: Flavonoids have a molecular skeleton consisting of</p><p>acetic acid units and a phenylpropane group. Their pharmacological prop-</p><p>erties are determined by those of their substituents.</p><p>– Pharmacological properties: Flavonoids have a nonspecific protective effect</p><p>on the capillaries, act as radical scavengers, and stabilize the cell mem-</p><p>brane. They additionally have anticonvulsant and diuretic effects and in-</p><p>crease the tolerance of cells to oxygen deficiency.</p><p>– Indications: For treatment of varicose veins, inflammations, edema, dys-</p><p>peptic complaints and liver disorders; to stimulate bile secretion.</p><p>1.3 Constituents and Active Principles</p><p>9</p><p>Fu</p><p>n</p><p>d</p><p>am</p><p>en</p><p>ta</p><p>ls</p><p>o</p><p>f P</p><p>h</p><p>yt</p><p>o</p><p>th</p><p>er</p><p>ap</p><p>y</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ Tannins</p><p>– Examples: Proanthocyanides; phenolcarboxylic acids such as chlorogenic</p><p>acid, cynarin, and ursolic acid.</p><p>– Plant sources</p><p>• Relatively high concentrations can be found in many parts of woody</p><p>plants (e. g., oak bark) and in rose plants, blackberries, silverweed</p><p>(goosewort), stag-horn, blackthorn, and tormentil.</p><p>• Lower concentrations are present in many plant-based foods and bever-</p><p>ages (black and green tea, bilberries [blueberries]).</p><p>– Structural properties</p><p>• Phenolcarboxylic acids are derived from caffeic acid, salicylic acid, and</p><p>bile acid.</p><p>• Condensed proanthocyanides consist of catechinic acids.</p><p>– Pharmacological properties: Tannins irreversibly link protein chains and</p><p>have astringent action on the skin and mucous membranes. Hence, they</p><p>have anti-inflammatory, styptic, counterirritant, and weakly antibacterial</p><p>effects and prevent the excess secretion of mucus.</p><p>– Indications: External uses: for irritations of the skin and mucous mem-</p><p>branes. Internal uses: for acute unspecific diarrhea.</p><p>➤ Glycosides</p><p>– Examples: Cardiac glycosides, anthranoids, flavonol glycosides.</p><p>– Plant sources: Found in many members of the plant kingdom.</p><p>– Structural properties: Contain one or multiple sugar molecules as well as a</p><p>nonsugar component that determines their pharmacological activity.</p><p>– Pharmacological properties</p><p>• Positively inotropic (cardiac glycosides); laxative (anthranoids); im-</p><p>prove circulation (flavonol glycosides in ginkgo leaves).</p><p>• Higher doses can induce severe side effects and, in some cases, poison-</p><p>ing (cardiac glycosides, anthranoids).</p><p>– Indications: Cardiac failure, constipation; to improve the circulation.</p><p>➤ Phytosterins (phytosterols)</p><p>– Examples: β-Sitosterol.</p><p>– Plant sources: Pumpkin seed, nettle root, saw palmetto fruit.</p><p>– Structural properties: Very similar to those of cholesterol.</p><p>– Pharmacological properties: Phytosterols occupy cholesterol receptors and</p><p>thus lower cholesterol levels. They also stabilize cell walls and inhibit the</p><p>synthesis of mediators of inflammation.</p><p>– Indications: To counteract elevated concentrations of lipids (antilipemic);</p><p>for treatment of benign prostatic hyperplasia.</p><p>➤ Saponins</p><p>– Examples: α-Hederine (ivy), diosgenin (wild yam), glycyrrhizic acid (lico-</p><p>rice).</p><p>– Plant sources: Widely distributed in plants such as ivy (leaf), licorice (root-</p><p>stock), and horse chestnut.</p><p>– Structural properties</p><p>• Consist of a water-soluble sugar chain and a fat-soluble component</p><p>(aglycone or genin).</p><p>• Triterpene, steroid, and steroidal alkaline saponins are distinguished by</p><p>their aglycone component.</p><p>1.3 Constituents and Active Principles</p><p>10</p><p>Fu</p><p>n</p><p>d</p><p>am</p><p>en</p><p>ta</p><p>ls</p><p>o</p><p>f P</p><p>h</p><p>yt</p><p>o</p><p>th</p><p>er</p><p>ap</p><p>y</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>– Pharmacological properties: Saponins induce local tissue irritation and re-</p><p>flex expectoration, inhibit the growth of microorganisms, especially fungi,</p><p>and have partial anti-inflammatory and antiedematous effects.</p><p>– Indications: To emulsify watery and oily solutions and to promote the dis-</p><p>solution of substances that are not easily absorbed.</p><p>Note: Most saponins retain their hemolytic properties, even when highly di-</p><p>luted. Hence, they should not be used to treat injuries or inflammations of the</p><p>digestive organs.</p><p>➤ Mucilage</p><p>– Examples: Arabinolactans, glucans, lichenin.</p><p>– Plant sources: Marshmallow root, Iceland moss, ribwort, linden flower.</p><p>– Structural properties: Polysaccharides.</p><p>– Pharmacological properties: Mucilaginous substances swell when added to</p><p>water, forming viscous solutions or gels. Water-soluble mucilages are de-</p><p>mulcent and reduce inflammation. Insoluble mucilages swell in the gas-</p><p>trointestinal tract and regulate the bowels.</p><p>– Indications: To soothe irritated mucous membranes of the mouth, throat,</p><p>and gastrointestinal tract; to alleviate dry cough and to regulate the bowels.</p><p>➤ Mustard oils</p><p>– Examples: Sinalbin, glucobrassicin.</p><p>– Plant sources: Black radish, mustard, great nasturium.</p><p>– Structural properties: Steam-volatile, pungent compounds formed by orga-</p><p>nosulfuric acids.</p><p>– Pharmacological properties: Mustard oils have antibacterial effects and in-</p><p>duce hyperemia of the skin.</p><p>– Indications: Used externally to increase the blood flow.</p><p>1.3 Constituents and Active Principles</p><p>11</p><p>Fu</p><p>n</p><p>d</p><p>am</p><p>en</p><p>ta</p><p>ls</p><p>o</p><p>f P</p><p>h</p><p>yt</p><p>o</p><p>th</p><p>er</p><p>ap</p><p>y</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>General Formulations</p><p>➤ Objectives of processing</p><p>– To increase the concentrations of active principles.</p><p>– To eliminate undesirable constituents.</p><p>– The pharmacologically active principles of different species of a medicinal</p><p>plant genus can differ. The goal is to obtain high-quality extracts from a defined</p><p>plant species with the highest possible concentrations of the active principles.</p><p>➤ Starting materials</p><p>– In some cases the whole plant, but usually only the plant component with</p><p>the highest concentration of active principles (i. e., flowers or roots).</p><p>– The composition of extracts made from the same plant may vary according</p><p>to which part of the plant was used for its preparation (e. g., nettle leaf ex-</p><p>tract vs. nettle root extract ).</p><p>➤ Traditional dosage forms (result of processing of the herb)</p><p>– Tea (species)</p><p>– Decoction (decoctum)</p><p>– Infusion (infusum)</p><p>– Maceration (maceratio)</p><p>– Juice (succus)</p><p>– Syrup (sirupus)</p><p>– Tincture (tinctura)</p><p>– Extract (extractum)</p><p>➤ Modern pharmaceutical preparations (made with pharmaceutical excipients)</p><p>– Capsules</p><p>– Tablets</p><p>– Film-coated tablets</p><p>– Sugar-coated tablets</p><p>– Ointments</p><p>– Creams</p><p>Preparations from Fresh Plant Material</p><p>➤ Plant juice</p><p>– Definition: The liquid obtained by pressing and crushing freshly harvested</p><p>plant material (plant parts).</p><p>– Preparation: Prepared from freshly harvested plant parts. Expressed juice</p><p>primarily contains water-soluble plant constituents.</p><p>– Storage: Once opened, the bottle should be closed and stored in a refriger-</p><p>ator and the rest discarded after one week. The contents should be discard-</p><p>ed after the expiration date specified on the label.</p><p>– Medicinal action: Usually relatively weak, except in rare cases (expressed</p><p>Echinacea juice, for example).</p><p>➤ Distillates</p><p>– Definition: Formulations obtained by extracting active principles from fresh</p><p>or dried plant material by steam distillation.</p><p>– Preparation: Obtained by separating the steam-volatile constituents of</p><p>fresh or dried medicinal plants by vaporization.</p><p>– Storage: See p. 5.</p><p>– Medicinal action: Determined by the water-volatile constituents (e. g., mus-</p><p>tard oils, essential oils) contained in the distillate.</p><p>1.4 Herbal Formulations</p><p>12</p><p>Fu</p><p>n</p><p>d</p><p>am</p><p>en</p><p>ta</p><p>ls</p><p>o</p><p>f P</p><p>h</p><p>yt</p><p>o</p><p>th</p><p>er</p><p>ap</p><p>y</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>➤ Oily extracts</p><p>– Definition: The preparation obtained by dissolving the fat-soluble constitu-</p><p>ents of a medicinal plant in, for example, olive oil, almond oil, or peanut oil.</p><p>– Preparation: Prepared by immersing the freshly cut or dried plant parts in</p><p>a vegetable oil and allowing them to stand, usually at room temperature,</p><p>until the fat-soluble constituents have been extracted.</p><p>– Storage: These preparations are relatively unstable and should therefore be</p><p>prepared in small quantities (see p. 5 for storage instructions).</p><p>Extracts</p><p>➤ Definition</p><p>– Extracts are prepared by dissolving medicinal plants in a solvent to separate</p><p>their active principles from extraneous substances.</p><p>– The type of formulation (aqueous, alcoholic) depends on the type of solvent</p><p>used (water, alcohol).</p><p>– Extracts are characterized as either dry or liquid depending on the concen-</p><p>tration of residual solvent in the final product.</p><p>Note: The composition of and uses for preparations from the same plant may</p><p>differ between the various preparation techniques. Hence, any extract pro-</p><p>duced by a special preparation technique is a unique active substance.</p><p>➤ Process of manufacturing plant extracts: See Fig. 1.</p><p>➤ Aqueous extract</p><p>– Definition: An extract prepared using water as the extracting agent. These</p><p>extracts mainly contain water-soluble constituents and few lipid-soluble</p><p>components.</p><p>– Disadvantages: The individual constituents are relatively unstable, and</p><p>microorganisms can multiply rapidly.</p><p>➤ Alcohol extract</p><p>– Definition: An extract prepared using ethanol and water mixed at various</p><p>ratios and concentrations, called the menstruum.</p><p>– Preparation</p><p>• In Germany the standard procedure calls for the plant material to be cut</p><p>into pieces and then steeped in the menstruum (macerated) for several</p><p>hours; in the North American standard the fresh or dried and powdered</p><p>plant material is macerated in the menstruum for a week to 10 days and</p><p>the liquid is then pressed out with a hydraulic press (if available).</p><p>• The drug is repeatedly steeped in the menstruum, strained and concen-</p><p>trated (percolation) until completely extracted.</p><p>– Advantages</p><p>• Ethanol (grain alcohol) is an excellent extracting agent. At higher vol-</p><p>ume concentrations, it can also extract lipophilic drug constituents, such</p><p>as essential oils.</p><p>• Alcohol preserves the extracts for a longer times (up to 2 to 3 years).</p><p>• Alcohol assists rapid absorption of the active ingredients.</p><p>➤ Tincture</p><p>– Definition: A solution prepared by macerating or percolating a medicinal</p><p>herb in various concentrations of ethanol.</p><p>• According to the German Pharmacopeia (DAB 1996), dry extracts made</p><p>by using suitable concentrations of ethanol are also defined as tinctures.</p><p>1.4 Herbal Formulations</p><p>13</p><p>Fu</p><p>n</p><p>d</p><p>am</p><p>en</p><p>ta</p><p>ls</p><p>o</p><p>f P</p><p>h</p><p>yt</p><p>o</p><p>th</p><p>er</p><p>ap</p><p>y</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>H</p><p>er</p><p>b</p><p>Tr</p><p>an</p><p>sf</p><p>o</p><p>rm</p><p>in</p><p>g</p><p>F</p><p>re</p><p>sh</p><p>ly</p><p>H</p><p>ar</p><p>ve</p><p>st</p><p>ed</p><p>P</p><p>la</p><p>n</p><p>ts</p><p>in</p><p>to</p><p>E</p><p>xt</p><p>ra</p><p>ct</p><p>s</p><p>El</p><p>ua</p><p>te</p><p>D</p><p>ry</p><p>e</p><p>xt</p><p>ra</p><p>ct</p><p>,</p><p>na</p><p>ti</p><p>ve</p><p>N</p><p>at</p><p>iv</p><p>e</p><p>dr</p><p>y</p><p>ex</p><p>tr</p><p>ac</p><p>tC</p><p>ut</p><p>G</p><p>ro</p><p>un</p><p>d</p><p>+S</p><p>O</p><p>L:</p><p>fa</p><p>tt</p><p>y</p><p>oi</p><p>l</p><p>+S</p><p>O</p><p>L:</p><p>e</p><p>th</p><p>an</p><p>ol</p><p>+</p><p>w</p><p>at</p><p>er</p><p>Ev</p><p>ap</p><p>or</p><p>at</p><p>ed</p><p>+E</p><p>th</p><p>an</p><p>ol</p><p>D</p><p>rie</p><p>d</p><p>+E</p><p>th</p><p>an</p><p>ol</p><p>G</p><p>ro</p><p>un</p><p>d</p><p>an</p><p>d</p><p>si</p><p>ft</p><p>ed</p><p>Te</p><p>a</p><p>m</p><p>at</p><p>er</p><p>ia</p><p>l</p><p>H</p><p>er</p><p>b</p><p>po</p><p>w</p><p>de</p><p>r</p><p>Ex</p><p>pr</p><p>es</p><p>se</p><p>d</p><p>ju</p><p>ic</p><p>e</p><p>O</p><p>ily</p><p>m</p><p>ac</p><p>er</p><p>at</p><p>io</p><p>n</p><p>O</p><p>ily</p><p>m</p><p>ac</p><p>er</p><p>at</p><p>io</p><p>n</p><p>D</p><p>ry</p><p>e</p><p>xt</p><p>ra</p><p>ct</p><p>Fl</p><p>ui</p><p>d</p><p>ex</p><p>tr</p><p>ac</p><p>t/</p><p>ti</p><p>nc</p><p>tu</p><p>re</p><p>SO</p><p>L:</p><p>s</p><p>ol</p><p>ve</p><p>nt</p><p>G</p><p>re</p><p>en</p><p>li</p><p>ne</p><p>: h</p><p>er</p><p>b</p><p>pr</p><p>ep</p><p>ar</p><p>at</p><p>io</p><p>n</p><p>(n</p><p>at</p><p>iv</p><p>e)</p><p>G</p><p>ra</p><p>y</p><p>lin</p><p>e:</p><p>e</p><p>xt</p><p>ra</p><p>ct</p><p>p</p><p>re</p><p>pa</p><p>ra</p><p>ti</p><p>on</p><p>Fr</p><p>es</p><p>h</p><p>pl</p><p>an</p><p>ts</p><p>D</p><p>rie</p><p>d</p><p>C</p><p>ut</p><p>he</p><p>rb</p><p>Fig. 1 The process of manufacturing plant extracts.</p><p>1.4 Herbal Formulations</p><p>14</p><p>Fu</p><p>n</p><p>d</p><p>am</p><p>en</p><p>ta</p><p>ls</p><p>o</p><p>f P</p><p>h</p><p>yt</p><p>o</p><p>th</p><p>er</p><p>ap</p><p>y</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>– Preparation: Tinctures are prepared using 1 part drug and 5 parts extractant</p><p>or, with high-potency constituents like atropine from belladonna, 1 part</p><p>drug and 10 parts extractant.</p><p>– Labeling: Dried herb to extract ratio (HER) = 1 : 5 or 1 : 10 means that the</p><p>preparation was prepared using 1 part plant material and 5 or 10 parts of</p><p>the menstruum.</p><p>– Storage (see p. 5): Should not be stored for more than one year owing to the</p><p>potential instability of certain compounds in the extract. Some studies by</p><p>Bauer, a leading authority on echinacea, and co-workers show the stability</p><p>of echinacea tincture under normal conditions to be 2 to 3 years with about</p><p>30 % reduction in some important constituents per year. (Personal commu-</p><p>nication, Rudi Bauer, PhD, 1987.)</p><p>Note: Many tinctures should not be used undiluted.</p><p>➤ Fluid extract (fluid extract)</p><p>– Definition: An alcoholic preparation of a medicinal herb containing higher</p><p>concentrations of plant constituents than are found in conventional tinc-</p><p>tures. One part of fluid extract generally corresponds to one part of the par-</p><p>ent herb calculated on a dry-weight basis. This concentration has to be</p><p>achieved by evaporating off some of the alcohol.</p><p>– Preparation: As for tinctures.</p><p>➤ Dry extracts (powdered extracts)</p><p>– Definition: Solid preparations obtained by condensing and drying fluid ex-</p><p>tracts. A powdered extract contains generally 95 % solids and 5 % water resi-</p><p>due (moisture). A native extract or native dry extract contains only plant</p><p>extract material and is free of additives.</p><p>– Preparation</p><p>• Fluid extracts are separated from solvents by carefully heating the ex-</p><p>tract and allowing the solvent to evaporate, often in a vacuum chamber</p><p>by freeze-drying or spray-drying.</p><p>• The selected drying method has a decisive effect on product quality; for</p><p>example, excessive heat degrades some active constituents.</p><p>• Adjuvants and carriers such as highly dispersed silica, lactose, and me-</p><p>thylcellulose are sometimes added to prevent caking and to adjust the</p><p>final extract concentration. Extracts that are adjusted to 5 : 1 (meaning</p><p>that 1 part of the finished extract is equivalent to all the desirable and</p><p>active constituents of 5 parts of the dried herb) are typical.</p><p>• The package labeling provides information on the parent plant or plant</p><p>part, the extractant, and the dried herb/extract ratio (HER). An HER of</p><p>10 : 1 means that 10 parts of the plant material yielded 1 part extract. A</p><p>low HER (such as 1 : 2) indicates a high concentration of the active com-</p><p>pounds in the plant material.</p><p>➤ Special extracts</p><p>– Definition: Extracts that undergo special extraction and purification pro-</p><p>cesses to separate, concentrate, and free them from toxic and undesirable</p><p>substances.</p><p>– Preparation</p><p>• Special extracts are made from raw extracts.</p><p>• The raw extract undergoes special extraction and purification processes</p><p>to increase the concentration of desirable active principles.</p><p>1.4 Herbal Formulations</p><p>15</p><p>Fu</p><p>n</p><p>d</p><p>am</p><p>en</p><p>ta</p><p>ls</p><p>o</p><p>f P</p><p>h</p><p>yt</p><p>o</p><p>th</p><p>er</p><p>ap</p><p>y</p><p>1</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p><p>49</p><p>50</p><p>• Toxins and undesirable substances that do not contribute to the medi-</p><p>cinal action of the preparation are removed.</p><p>• This treatment reduces the risk factors associated with the native mate-</p><p>rial, and often provides a finished product that is many times more con-</p><p>centrated in one or more active constituents than is the parent herb,</p><p>such as the highly concentrated and standardized ginkgo extract typi-</p><p>cally sold in consumer products (50 : 1). Hence, the effects of the special</p><p>extract can no longer be compared with those of the raw materials.</p><p>Medicinal Teas</p><p>➤ Definition: Herb teas, such as orthosiphon or lobelia, with a strong medicinal</p><p>action. Best used under the guidance</p>