Dong quai: Interactions. Pregnancy Use. Practice Points. FAQ

Adverse Reactions Furanocoumarins, such as bergapten and psoralen, which are in dong quai have been widely studied for their phototoxicity; however, only Angelica gigas (Korean angelica) has been demonstrated to cause photodermatitis. Safrole, found in the volatile oil, is a potential carcinogen; however, no specific cases of carcinogenesis have been reported. High doses of dong quai volatile oil have been reported to cause nephrosis in rats but there are no reports in humans. Significant Interactions WARFARIN Case reports suggest the elevations in prothrombin and INR may occur when dong quai is used with warfarin — use caution if used concurrently with warfarin. Contraindications and Precautions Because dong quai may have oestrogenic effects, women with hormone-sensitive tumours, endometriosis and uterine fibroids should avoid using dong quai. Traditional contraindications include diarrhea due to weak digestion, haemor-rhagic disease, heavy periods, first trimester of pregnancy, and acute infection such as colds or flu. Pregnancy Use Dong quai may stimulate uterine contractions and is therefore contraindicated in pregnancy. Practice Points / Patient Counselling • Dong quai is a popular Chinese Read more […]

Dong quai: Uses. Dosage

Clinical Use GYNAECOLOGICAL USE Orally, dong quai has been traditionally used in combination with other herbs for gynaecological ailments including menstrual cramps, irregularity, retarded flow, weakness during the menstrual period, and symptoms of menopause. Very little clinical research has been conducted to determine its effectiveness as sole treatment in these indications. In a 12-week randomised, placebo-controlled trial in 55 postmenopausal women, a combination of dong quai and chamomile was found to significantly reduce hot flushes and improve sleep disturbances and fatigue. Another double-blind, randomised, placebo-controlled clinical trial of 71 women using dong quai as a single agent (4.5 g/day) found no differences between groups in the number of vasomotor flushes, endometrial thickness, or vaginal cells over a 24-week period. It is suggested that dong quai may have some efficacy for premenstrual syndrome when used in traditional Chinese multi-herbal formulas, and an uncontrolled trial has suggested the possible benefit of uterine irrigation with dong quai extract for infertility due to tubal occlusion. Other Uses In TCM, dong quai is used to strengthen the heart, lung and liver meridians and harmonise Read more […]

Dong quai: Background. Actions

Historical Note Dong quai is an aromatic herb commonly used in TCM. Its reputation is second to that of ginseng and is regarded as a ‘female’ remedy, or women’s ginseng. Used in combination with other herbs, dong quai is used to treat numerous menstrual disorders and menopausal symptoms, as well as abdominal pain, migraine headache, rheumatism and anaemia. Dong quai (Angelica sinensis) is closely related to the European Angelica archangelica, a common garden herb and the flavouring in Benedictine and Chartreuse liqueurs. Common Name Dong quai Other Names Chinese angelica, dang gui, women’s ginseng, tang kuei Botanical Name / Family Angelica sinensis (synonym: Angelica polymorpha sinensis) (family Apiaceae [Umbelliferae] — carrot family) Plant Part Used Root Chemical Components Dong quai contains essential oil (0.4-0.7%) consisting of 45% ligustilide, n-butylphthalide, cadinene, carvacrol, safrole and isosafrol. The root also contains sucrose (40%) and various lactonesand vitamins, together with phytosterols, ferulic acid and coumarins, including osthole, psoralen and bergapten. Ferulic acid and ligustilide are considered to be the main active components and it has been suggested that assessment of total Read more […]

Siberian ginseng: Patient Counselling. FAQ

Contraindications and Precautions Some authors suggest that high-dose Siberian ginseng should be avoided by those with cardiovascular disease or hypertension (BP >80/90 mmHg). Others merely suggest a caution, as reports are largely unsubstantiated. As such, it is recommended that people with hypertension should be monitored if using high doses. A study in elderly people with hypertension over 8 weeks did not affect blood pressure control. Due to possible effects on glycaemic control, care should betaken in people with diabetes until safety is established. Suspend use 1 week before major surgery. Traditional contraindications include hormonal changes, excess energy states, fever, acute infection, concurrent use of other stimulants and prolonged use. Pregnancy Use Insufficient reliable information is available, but the herb is not traditionally used in pregnancy. Practice Points / Patient Counselling • Siberian ginseng appears to alter the levels of different neurotransmitters and hormones involved in the stress response, chiefly at the HPA axis. • It is widely used to treat individuals with nervous exhaustion or anxiety due to chronic exposure to stress, or what are now termed ‘allostatic load situations’. Read more […]

Siberian ginseng: Reactions. Interactions.

Adverse Reactions Clinical trials of 6 months’ duration have shown no side-effects from treatment. High doses may cause slight drowsiness, irritability, anxiety, mastalgia, palpitations or tachycardia although these side effects may be more relevant to Panax ginseng. Clinical note — Case reports of Siberian ginseng need careful consideration Some adverse reactions attributed to Siberian ginseng have subsequently been found to be due to poor product quality, herbal substitution and/or interference with test results. For example, initial reports linking maternal ginseng use to neonatal androgenisation are now suspected to be due to substitution with another herb, Periploca sepium (silkvine), as American herb companies importing Siberian ginseng from China have been known to be supplied with two or three species of Periploca. Additionally, rat studies have failed to detect significant androgenic action for Siberian ginseng. Another example is the purported interaction between digoxin and Siberian ginseng, which was based on a single case report of a 74-year-old man found to have elevated digoxin levels for many years. It was subsequently purported that the herbal product may have been adulterated with digitalis. Read more […]

Siberian ginseng: Uses. Dosage

Clinical Use STRESS Siberian ginseng is widely used to treat individuals with nervous exhaustion or anxiety due to chronic exposure to stress, or what is now termed ‘allostatic load situations’. The biochemical effects on stress responses observed in experimental and human studies provide a theoretical basis for this indication. One placebo-controlled study conducted over 6 weeks investigated the effects of an ethanolic extract of Siberian ginseng (8 mL/day, equivalent to 4 g/day dried root). In the study, active treatment resulted in increased cortisol levels, which may be consistent with animal research suggesting a threshold of stress below which Siberian ginseng increases the stress response and above which it decreases the stress response. FATIGUE Siberian ginseng is used to improve physical and mental responses during convalescence or fatigue states. Its ability to increase levels of noradrenaline, serotonin, adrenaline and cortisol provide a theoretical basis for its use in situations of fatigue. However, controlled studies are limited. A randomised, double-blind, placebo-controlled trial of 300 mg/day (Eleutherococcus senticosus dry extract) for 8 weeks assessed health-related QOL scores in 20 elderly Read more […]

Siberian ginseng: Actions

Main Actions ADAPTOGENIC (MODULATES STRESS RESPONSE) Siberian ginseng appears to alter the levels of different neurotransmitters and hormones involved in the stress response, chiefly at the HPA axis. It degrades the enzyme (catechol-O-methyl transferase), and increases levels of noradrenaline and serotonin in the brain and adrenaline in the adrenal glands, according to animal studies. Eleutherosides have also been reported to bind to receptor sites for progestin, oestrogen, mineralocorticoids and glucocorticoids in vitro and therefore may theoretically exert numerous pharmacological actions important for the body’s stress response. Owing to such actions, herbalists and naturopaths describe the herb’s overall action as ‘adaptogenic’, whereby the body is better able to adapt to change and homeostasis is more efficiently restored. More recently, the term ‘allostasis’ is being adopted in the medical arena to describe ‘the ability to achieve stability through change’. Although the mechanism of action responsible is still unclear, several theories have been proposed to explain the effect of Siberian ginseng on allostatic systems, largely based on the pharmacological actions observed in test-tube and animal studies. Siberian Read more […]

Siberian ginseng: Background

Historical Note Siberian ginseng has been used for over 2000 years, according to Chinese medical records, where it is referred to as Ci Wu Jia. It was used to prevent colds and flu and to increase vitality and energy. In modern times, it has been used by Russian cosmonauts for improving alertness and energy, and to aid in adaptation to the stresses of life in space. It has also been used as an ergogenic aid by Soviet athletes before international competitions and was used after the Chernobyl accident to counteract the effects of radiation. Other Names Ci Wu Jia, devil’s bush, devil’s shrub, eleuthero, eleutherococcus, eleuthero root, gokahi, ogap’l, russisk rod, taigawurzel, touch-me-not, Wu Jia Pi Botanical Name / Family Eleutherococcus senticosus (synonym: Acanthopanax senticosus) (family Araliaceae) Plant Part Used Root Chemical Components Glycosides (eleutherosides A-M, includes saponins, coumarins, lignans, phenylpropanoids, oleanolic acids, triterpenes, betulinic acid and vitamins); steroid glycoside(eleutherosideA); lignan (eleutheroside D, sesamine); glycans (eleutherans A-G); triterpenoid saponins; saponin (protoprimulagenin A); hydroxycoumarin (isofraxidin); phenolics; polysaccharides; lignans; coumarins; Read more […]

Meadowsweet: Practice Points – Patient Counselling. FAQ

• Meadowsweet is traditionally used as a herbal antacid, analgesic and antipyretic, antidiarrheal and treatment for urinary tract infections. • Commission E approves its use as supportive therapy for the common cold. • It contains several different salicylates that are thought to be responsible for much of its clinical activity. • Although it contains salicylates, the herb does not appear to cause significant gastrointestinal irritation and may in fact have anti-ulcer activity. • People who are salicylate sensitive should not take this herbal medicine. • In practice, it is often combined with herbs such as chamomile and marshmallow in the treatment of gastrointestinal complaints. Answers to Patients’ Frequently Asked Questions What will this herb do for me? Traditionally, the herb has been used to treat gastrointestinal complaints such as dyspepsia and diarrhea, urinary tract infections and joint aches and pains. It is also used as supportive therapy for the common cold. When will it start to work? Symptomatic relief should be experienced within the first few doses. Are there any safety issues? People who are salicylate sensitive should not take meadowsweet. Read more […]

Meadowsweet: Interactions. Contraindications. Pregnancy Use

Adverse Reactions Although salicylates are present, they appear to cause less gastrointestinal irritation than acetylsalicylic acid. In fact, a meadowsweet preparation protected against acetylsalicylic acid-induced stomach ulcers in vivo. Significant Interactions Controlled studies are not available, therefore interactions are based on evidence of activity and are largely theoretical and speculative. WARFARIN As increased bleeding may occur, observe patients taking warfarin concurrently. The herb has been shown to exert anticoagulant activity in vitro and in vivo, but the clinical significance of these results is unknown. ASPIRIN AND SIMPLE ANALGESICS Theoretically, meadowsweet may enhance anti-inflammatory and antiplatelet effects Observe patients taking this combination — beneficial interaction possible. Contraindications and Precautions Meadowsweet should not betaken by people with salicylate sensitivity. Suspend use of concentrated extracts 1 week before major surgery. Pregnancy Use Not recommended.