Goldenseal: Practice Points – Patient Counselling. FAQ

Pregnancy Use Contraindicated in pregnancy and lactation. In addition to the preceding concerns about bilirubin, berberine has caused uterine contractions in pregnant and non-pregnant experimental models. A recent in vivo study using 65-fold the average human oral dose of goldenseal investigated effects on gestation and birth and found no increase in implantation loss or malformation. The authors conclude that the low bioavailability of goldenseal from the gastrointestinal tract was likely to explain the differences between in vitro and in vivo effects in pregnancy. Hydrastine (0.5 g) has also been found to induce labour in pregnant women. Until more pharmacokinetic studies are done, goldenseal is best avoided in pregnancy. Practice Points / Patient Counselling • Goldenseal has been used traditionally as an antidiarrheal agent and digestive stimulant. • It has been used topically as a wash for sore or infected eyes and as a mouth rinse. • Goldenseal is a bitter digestive stimulant that improves bile flow and improves liver function. • Most clinical evidence has been conducted using the chemical constituent berberine. This data has shown effectiveness against diarrhea, congestive heart failure, Read more […]

Goldenseal: Adverse Reactions. Interactions

Clinical note — Berberine absorption Berberine is poorly absorbed, with up to 5% bioavailability. In vitro data has clearly demonstrated that berberine is a potent antibacterial; however, in vivo data has established low bioavailability. Berberine has been shown to upregulate the expression and function of the drug transporter P-glycoprotein (Pgp). Pgp belongs to the super family of ATP-binding cassette transporters that are responsible for the removal of unwanted toxins and metabolites from the cell. It appears that Pgp in normal intestinal epithelia greatly reduces the absorption of berberine in the gut. In vivo and in vitro methods have been used to determine the role of Pgp in berberine absorption by using the known Pgp inhibitor cyclosporin A. Co-administration increased berberine absorption six-fold and clearly demonstrated the role of Pgp in absorption. Increased expression of Pgp can lead to cells displaying multi-drug resistance. As previously reported a certain flavonolignan in many Berberis spp. has the ability to inhibit the expression of multi-drug resistant efflux pumps allowing berberine and certain antibiotics to be more effective. Adverse Reactions Goldenseal is generally regarded as safe Read more […]

Goldenseal: Uses. Dosage

Clinical Use Goldenseal has not been significantly investigated under clinical trial conditions, so evidence is derived from traditional, in vitro and animal studies. Many of these have been conducted on the primary alkaloids. All results are for the isolated compound berberine, and although this compound appears to havevarious demonstrable therapeutic effects, extrapolation of these results to crude extracts of goldenseal is premature. It should also be noted that equivalent doses of the whole extract of goldenseal are exceptionally high. DIARRHOEA A double-blind, placebo-controlled, randomised trial examined the effect of berberine alone (100 mg four times daily) and in combination with tetracycline for acute watery diarrhea in 400 patients. Patients were divided into four groups and given tetracycline, tetracycline plus berberine, berberine or placebo; 185 patients tested positive for cholera and those in the tetracycline and tetracycline plus berberine groups achieved a significant reduction in diarrhea after 16 hours and up to 24 hours. The group given berberine alone showed a significant reduction in diarrhea volume (1 L) and a 77% reduction in cAMP in stools. Noticeably fewer patients in the tetracycline and Read more […]

Goldenseal: Background. Actions

Historical Note Goldenseal is indigenous to North America and was traditionally used by the Cherokees and then by early American pioneers. Preparations of the root and rhizome were used for gastritis, diarrhea, vaginitis, dropsy, menstrual abnormalities, eye and mouth inflammation, and general ulceration. In addition to this, the plant was used for dyeing fabric and weapons. Practitioners of the eclectic school created a high demand for goldenseal around 1847. This ensured the herb’s ongoing popularity in Western herbal medicine, but unfortunately led to it being named a threatened species in 1997. Today, most high-quality goldenseal is from cultivated sources. Common Name Goldenseal Other Names Eye root, jaundice root, orange root, yellow root Botanical Name / Family Hydrastis canadensis (family Ranunculaceae) Plant Parts Used Root and rhizome Chemical Components Isoquinoline alkaloids, including hydrastine (1.5-5%), berberine (0.5-6%) and canadine (tetrahydroberberine, 0.5-1.0%). Other related alkaloids include canadaline, hydrastidine, corypalmineand isohydrastidine. Clinical note — Isoquinoline alkaloids Isoquinoline alkaloids are derived from phenylalanine or tyrosine and are most frequently found Read more […]

Myrrh: Practice Points – Patient Counselling. FAQ

Myrrh has been used since ancient times in a variety of forms as an antiseptic, anti-inflammatory and analgesic medicine. • It has been used as a topical preparation to reduce inflammation and enhance wound healing — in vivo evidence suggests the anti-inflammatory activity of one of the main constituents is stronger than hydrocortisone and local anaesthetic activity is likely. • Preliminary evidence suggests that it may be a useful treatment in gingivitis and periodontal disease. • The preparation known as guggulipid, which comes from Commiphora species, may have lipid-lowering effects according to clinical studies; however, evidence is contradictory and further research is required to confirm this. • Myrrh is not to be used in pregnancy and may interact with a number of medications when used orally. Answers to Patients’ Frequently Asked Questions What will this herb do for me? Traditionally, the herb has been used as a mouthwash or topical paint to relieve symptoms of mouth ulcers, sore throats and gum disease. It has also been used as a topical application for inflamed skin conditions and wounds. Scientific research confirms antiseptic, anti-inflammatory and local anaesthetic effects Read more […]

Myrrh: Adverse Reactions. Significant Interactions. Pregnancy Use.

Toxicity A dose of 10 mg/kg/day was given to subjects in one study with no serious adverse effects. Adverse Reactions Restlessness, mild abdominal discomfort and gastrointestinal symptoms, such as diarrhea and nausea, have been reported, mainly with orally administered extracts. Allergic dermatitis has also been reported for topical usage. The standardised guggulsterone (guggulipid) preparations tend to be far better tolerated. Significant Interactions Interactions are theoretical and based on in vitro and in vivo data; therefore, clinical significance is unclear and remains to be confirmed. DIABETIC MEDICATION In vivo studies suggest myrrh may have hypoglycaemic effects and therefore would have additive effects with diabetic medications. Monitor for changes in serum glucose in patients taking these medications. LIPID-LOWERING MEDICATION Guggul may have cholesterol-lowering activity and therefore have additive effects with other lipid-lowering medications — observe patients taking this combination and monitor drug requirements. Beneficial interaction possible. ANTICOAGULANT AND ANTIPLATELET MEDICATION Guggul inhibited platelet aggregation in vitro and in a clinical study, therefore concurrent use may theoretically Read more […]

Myrrh: Other Uses. Dosage

TRADITIONAL INDICATIONS Myrrh has been used in TCM, Tibetan medicine, Ayurvedic medicine, Middle Eastern medicine and in Europe; therefore, it has numerous traditional indications. Myrrh has been used to treat infections, respiratory conditions, mouth ulcers, gingivitis, pharyngitis, respiratory catarrh, dysmenorrhoea, amenorrhoea, menopausal symptoms, wounds and haemorrhoids. It has also been used to treat arthritis and as an embalming agent. PARASITIC DISEASES Schistosomiasis Schistosomiasis is an important trematode infection affecting over 200 million people in the tropics and subtropics. After malaria, it is the next most important parasitic disease with chronic infection causing significant morbidity. Currently, the drug praziquantel is often recommended, but it does not affect the immature stage and may not abort an early infection. Additionally, a drug-resistant strain has developed. Due to these factors, there is great interest in discovering alternative treatments. One clinical study involving 204 patients with schistosomiasis produced impressive results with a 3 day oral dose regimen producing a cure rate of 92%. Re-treatment of non-responders increased the overall cure rate to 98%. A field study produced Read more […]

Myrrh: Clinical Use

TOPICAL TREATMENT OF ORAL OR PHARYNGEAL INFLAMMATION Often used as a component of gargles, mouthwashes or paints for these indications, there are few controlled clinical trials or in vitro studies on the effects of myrrh on cells derived from the human oral cavity. A 2003 in vitro study investigating the effects of myrrh oil on a number of key cells implicated in gingivitis found that low concentrations of myrrh oil reduced gingival fibroblast production of proinflammatory cytokines and, therefore, the participation of these cells in gingival inflammation associated with gingivitis and periodontitis. This is thought to be, at least in part, due to inhibition of PGE2. Commission E approved myrrh for these indications. EXTERNAL TREATMENT OF MINOR INFLAMMATORY CONDITIONS AND WOUNDS Myrrh is incorporated into salves and topical preparations for the treatment of bed sores, minor wounds and haemorrhoids. Although no clinical trials are available, the antimicrobial, anti-inflammatory, astringent and local anaesthetic activities of myrrh provide a theoretical basis for efficacy. HYPERLIPIDAEMIA, HYPERCHOLESTEROLAEMIA, HYPERTRIGLYCERIDAEMIA Szapary et al (2005) conducted a double-blind, placebo-controlled, randomised trial Read more […]

Myrrh: Background. Actions

Common Name Myrrh Other Names Abyssinian myrrh, bal, bol, common myrrh, heerabol, hirabol myrrh, gum myrrh tree, gummi myrrh, Somali myrrh, Yemen myrrh Botanical Name / Family Commiphora molmol (family Burseraceae) Plant Parts Used Gum resin, stem, leaves Historical Note The resin that seeps out of the bark of the Commiphora plant has been considered an important medicinal product in the Middle East, China and India since biblical times. Because of its antimicrobial activity, myrrh has historically been used, alone and in combination with other herbs, to treat infections and inflammations of the oral cavity, in purification rituals, to embalm bodies, dress infected wounds and as a treatment for leprosy. Chemical Components Myrrh contains three main components: gum resin 30-60%; alcohol-soluble resins 20-40%; volatile oils (2-10%). Guggul is the oleo-gum-resin exudate from Commiphora mukul, which is also used therapeutically and has been scientifically investigated. Resins are sticky, water-insoluble substances that are secreted where a plant is damaged by incision or natural causes. The viscous substance hardens shortly after secretion, but may be returned to a liquid state with heating. Resins tend Read more […]