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 […]

Hawthorn: Dosage. Interactions. Practice Points

Dosage Range • Infusion of dried herb: 0.2-2 g three times daily. • Tincture of leaf (1:5): 3.5-17.5 mL/day. • Fluid extract (1:2): 3-6 mL/day. • Herpes simplex outbreak: 4 mL three times daily at the first sign of infection for a maximum of 2 days. Toxicity No target toxicity to 100-fold the human dose of the WS 1442 extract is defined. This is in contrast to inotropic drugs, such as digoxin, which generally have a low therapeutic index. Adverse Reactions Sweating, nausea, fatigue and a rash on the hands have been reported in one clinical trial using a commercial preparation containing 30 mg hawthorn extract standardised to 1 mg procyanidins. Headache, sweating, dizziness, palpitations, sleepiness, agitation, and gastrointestinal symptoms have also been reported. Significant Interactions Controlled studies are not available; therefore, interactions are based on evidence of activity and are largely theoretical and speculative. CARDIAC GLYCOSIDES Hawthorn may theoretically potentiate the effects of cardiac glycosides, as both in vitro and in vivo studies indicate that it has positive inotropic activity. Furthermore, the flavonoid components of hawthorn may also affect P-glycoprotein function Read more […]

Hawthorn: Uses

Clinical Use CONGESTIVE HEART FAILURE There is considerable experimental and clinical evidence supporting the use of hawthorn as an effective treatment for congestive cardiac failure in patients with slight, mild limitation of activity who are comfortable at rest or with mild exertion (i.e. NYHA class II). A meta-analysis of rigorous clinical trials of the use of hawthorn extract to treat patients with chronic heart failure (NYHA classes I-III) included eight trials involving 632 subjects. The results of the meta-ana lysis showed that treatment with standardised hawthorn extracts produced significant improvement in maximal workload, pressure-heart rate product, as well as symptoms such as dyspnoea and fatigue as compared with placebo. The hawthorn extract most commonly used in these trials was WS 1442, which is standardised to 18.8% oligomeric procyanidins. In some cases, hawthorn extract was used as an adjunct to standard therapy (such as diuretics) and the daily dose ranged from 160 mg to 1800 mg. A review of the results of 13 clinical trials published from 1981 to 1996, involving over 839 patients, suggests that a daily dose of 900 mg hawthorn extract improves exercise tolerance, anaerobic threshold and ejection Read more […]

Hawthorn: Background. Actions

Historical Note The name ‘hawthorn’ comes from ‘hedgethorn’, after its use as a living fence in much of Europe. Dioscorides and Paracelsus praised hawthorn for its heart-strengthening properties and it is also known in TCM. It has since been shown to have many different positive effects on the heart and is a popular prescription medicine in Germany for heart failure. Common Name Hawthorn Other Names Aubepine, bianco spino, crataegi (azarolus, flos, folium, folium cum flore [flowering top], fructus [berry], nigra, pentagyna, sinaica boiss), English hawthorn, Chinese hawthorn, fructus oxyacanthae, fructus spinae albae, hagedorn, hedgethorn, maybush, maythorn, meidorn, oneseed hawthorn, shanzha, weissdorn, whitehorn Botanical Name / Family Crataegus laevigata, Crataegus cuneata, Crataegus oxyacantha, Crataegus monogyna, Crataegus pinnatifida (family Rosaceae [Rose]) Plant Parts Used Extracts of the leaf and flower are most commonly used, although the fruit (berries) may also be used. Chemical Components Leaves and flowers contain about 1% flavonoids, such as rutin, quercitin, vitexin, hyperisise, 1-3% oligomeric procyanidins including catechin and epicatechin, triterpenes, sterols, polyphenols, coumarins, tannins. Read more […]

Lycopene: Adverse Reactions. Interactions. Pregnancy Use. Practice Points

Toxicity Animal studies have shown that 600 mg lycopene/kg/day is not toxic. Adverse Reactions Animal studies have demonstrated that 600 mg lycopene/kg/day does not produce adverse effects, and is well tolerated. This level is far in excess of usual dietary intake in humans. Significant Interactions DRUGS REDUCING FAT ABSORPTION (E.G. CHOLESTYRAMINE, ORLISTAT) Drugs that reduce fat absorption, such as cholestyramine, colestipol and orlistat, may also reduce the absorption of lycopene — separate doses by at least 2 hours. Contraindications and Precautions Hypersensitivity to lycopene or its food sources. Pregnancy Use Eating dietary amounts of foods rich in lycopene is likely to be safe. Practice Points / Patient Counselling • Lycopene is a fat-soluble, non-provitamin A carotenoid that imparts the red colour to tomatoes and is most bioavailable from processed food sources such as tomato paste. • Lycopene has antioxidant and cholesterol-lowering activity and may reduce the risk of developing cardiovascular disease, according to epidemiological evidence. • Epidemiological evidence generally suggests that higher intakes of tomato-based products reduce the risk of prostate cancer and possibly stomach Read more […]

Lycopene: Clinical Use. Dosage

The clinical effects of lycopene are studied in relation to dietary intake and oral supplementation. It should be noted that the assessment of dietary lycopene intake varies with the method used to collect dietary information and the food composition databases used to estimate nutritional content. CANCER PREVENTION Lycopene is often included as an ingredient in antioxidant combination supplements and is thought to contribute to risk reduction for cancer. Some studies have investigated the effects of lycopene on risk of disease, although many consider it as part of the carotenoid group and study its effects in this way. Total cancer risk A 2002 Japanese study involving 2444 people who were followed for 9 years found that high serum levels of lycopene, total carotenes and carotenoids were significantly and inversely associated with subsequent mortality from all causes and cancers of all sites after adjusting for gender, age and serum levels of total cholesterol, alpha-tocopherol and retinol. In particular, there is some evidence that lycopene levels are inversely proportional to cancers of the prostate, stomach and cervix. Prostate cancer A review of 1 5 epidemiological studies concluded that although results Read more […]

Lycopene: Actions

ANTIOXIDANT The many conjugated double bonds of lycopene make it a powerful antioxidant and its activity in vitro is nearly twice as great as beta-carotene. REDUCES LDL-CHOLESTEROL LEVELS AND LIPID OXIDATION A significant 14% reduction in plasma LDL-cholesterol concentrations has been shown for a dose of 60 mg/day lycopene taken over 3 months by healthy volunteers. While the mechanism of action is unclear, in vitro testing suggests HMG-CoA reductase inhibition and enhancement of LDL receptor activity in macrophages. Lycopene also prevents oxidation of lipids and LDL cholesterol, according to a clinical study. CHEMOPREVENTATIVE ACTIVITY Anticancer activity of lycopene has been demonstrated in cell and tissue culture studies and animal tumour models. Lycopene appears to inhibit human cancer cell growth by interfering with growth factor receptor signalling and cell cycle progression without producing toxicity or apoptosis. In vitro and in vivo evidence supports the theory that antiproliferative activity is achieved by upregulation of a gene, connexin 43, which restores direct intercellular gap junctional communication, usually deficient in many human tumours. This restoration of normal intercellular gap junctional Read more […]

Lycopene: Background

Background and Relevant Pharmacokinetics Lycopene is a fat-soluble, non-provitamin A carotenoid that imparts the red colour to tomatoes, guava, rosehip, watermelon and pink grapefruit. Animals and humans do not synthesise lycopene, so they must depend on dietary sources. Research shows that bioavailabihty of lycopene varies depending on factors such as food source, other foods in the diet, the presence of other carotenoids and dietary fat, cooking temperatures and processing. Processing, and heating in particular, has been found to significantly increase lycopene bioavailability, as it induces the isomerisation of lycopene from the trans- to cis-configuration. In other words, lycopene is best absorbed from tomato products such as pastes and sauces, rather than from unprocessed fresh tomatoes. Lycopene is widely distributed in the human body and is one of the major carotenoids found in human serum (between 21% and 43% of total carotenoids). High concentrations are found in the adrenal gland and testes, although significant amounts are also found in the liver, adipose tissue, prostate, kidney and ovaries. Lycopene has also been detected in high concentrations in ciliary body and retinal pigment epithelium. Chemical Read more […]