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 […]

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

Dosage Range GENERAL GUIDE • Dried herb: 3 g/day of either Echinacea angustifolia or Echinacea purpurea. • Liquid extract (1:2): 3-6 mL/day of either Echinacea angustifolia or Echinacea purpurea. This dose may be increased to 10-20 mL/day in acute conditions. Treatment is usually started at the first sign of URTI and continued for 7-14 days. SPECIFIC GUIDE • Echinacea angustifolia dried root: 1-3 g/day. • Echinacea purpurea dried root: 1.5-4.5 g/day. • Echinacea purpurea dried aerial parts: 2.5-6.0 g/day. • Echinacea purpurea expressed juice of fresh plant: 6-9 mL/day. • Echinacea pallida ethanolic extract of root: 2-4 mL/day. Although controversy still exists over which part of the plant and which particular plant has the strongest pharmacological activity, it appears that the cold-pressed juice of Echinacea purpurea is the most studied preparation for URTIs. Adverse Reactions Oral dose forms and topical preparations tend to be well tolerated, although allergic reactions are possible in rare cases (mainly to the aerial parts, in contact dermatitis). One study using Echinacea purpurea in children found that rash occurred in 7.1% of children using echinacea compared with 2.7% with Read more […]

Echinacea: Uses

Clinical Use Clinical trials using echinacea have used various preparations, such as topical applications, homeopathic preparations, injectable forms and oral dose forms, characteristics that should be noted when reviewing the data available. Overall, the majority of clinical studies performed in Europe have involved a commercial product known as Echinacin (Madaus, Germany), which contains the fresh-pressed leaf juice of Echinacea purpurea stabilised in ethanol. UPPER RESPIRATORY TRACT INFECTIONS Overall, clinical studies support the use of echinacea in URTIs, such as bacterial sinusitis, common cold, influenza-like viral infections and streptococcal throat. Evidence is strongest for use of echinacea in adults as an acute treatment; however, results in children have been disappointing. A 1999 review of 13 clinical trials consisting of 9 treatment studies and 4 prevention studies concluded that 8 of 9 treatment trials produced positive results whereas 3 of 4 prevention trials suggested modest effects. In other words, current evidence is stronger for supporting the use of echinacea as acute treatment in URTIs than as prophylactic treatment. In 2000, a Cochrane review was published that had assessed the evidence Read more […]

Echinacea: Background. Actions

Historical Note Echinacea was first used by Native American Sioux Indians centuries ago as a treatment for snakebite, colic, infection and external wounds, among other things. It was introduced into standard medical practice in the USA during the 1 800s as a popular anti-infective medication, which was prescribed by eclectic and traditional doctors until the 20th century. Remaining on the national list of official plant drugs in the USA until the 1940s, it was produced by pharmaceutical companies during this period. With the arrival of antibiotics, echinacea fell out of favour and was no longer considered a ‘real’ medicine for infection. Its use has re-emerged, probably because we are now in a better position to understand the limitations of antibiotic therapy and because there is growing public interest in self-care. The dozens of clinical trials conducted overseas have also played a role in its renaissance. Common Name Echinacea Other Names Echinacea angustifolia — American coneflower, black sampson, black susans, coneflower, echinaceawurzel, Indian head, kansas snakeroot, purple coneflower, purpursonnenhutkraut, racine d’echinacea, Rudbeckia angustifolia L, scurvy root, snakeroot Echinacea purpurea — Read more […]

Fenugreek: Interactions. Contraindications. Pregnancy Use. Practice Points. FAQ

Toxicity Safety studies indicate that fenugreek is extremely safe. When consumed as 20% of the diet, it did not produce toxic effects in animal tests. Adverse Reactions One clinical study found that a dose of 50 g taken twice daily produced mild gastrointestinal symptoms, such as diarrhea and flatulence, which subsided after 3-4 days. Allergic reactions have been reported, but are rare. Significant Interactions Where controlled studies are not available, interactions are speculative and based on evidence of pharmacological activity and case reports. HYPOGLYCAEMIC AGENTS Additive effects are theoretically possible in diabetes — monitor concomitant use and monitor serum glucose levels closely — potentially beneficial interaction. IRON Frequent use of fenugreek can inhibit iron absorption — separate doses by 2 hours. WARFARIN Although there is a theoretical concern that concomitant use could increase bleeding risk due to the herb’s coumarin content, this is unlikely. A placebo-controlled study found that fenugreek does not affect platelet aggregation, fibrinolytic activity or fibrinogen. Contraindications and Precautions Fenugreek is contraindicated in people with allergy to the herb, which has been Read more […]

Fenugreek: Uses. Dosage

Clinical Use DYSPEPSIA AND LOSS OF APPETITE Although controlled studies are unavailable, the increased activity of pancreatic and intestinal lipase seen in animal studies provides a theoretical basis for its use in dyspepsia. Commission E approved the internal use of fenugreek seed for loss of appetite. ELEVATED LIPID LEVELS Several clinical studies conducted in people with and without diabetes have identified significant lipid-lowering activity with different fenugreek preparations, such as defatted fenugreek, germinated seed and hydro-alcoholic extracts. As can be expected, the dose used and type of preparation tested has an influence over results. An open study using a daily dose of 18.0 g germinated fenugreek seed in healthy volunteers demonstrated significant reductions in total cholesterol and LDL-choles-terol levels. A placebo-controlled study found no effect after 3 months with a lower dose of 5 g seed daily, suggesting that higher intakes may be required for lipid-lowering activity to become significant. DIABETES Fenugreek is a popular natural treatment used to aid blood sugar regulation in diabetes. Overall, results from clinical studies have produced positive results however trials have used diverse Read more […]

Fenugreek: Background. Actions

Historical Note Fenugreek’s seeds and leaves are used not only as food but also as an ingredient in traditional medicine. It is indigenous to Western Asia and Southern Europe, but is now mainly cultivated in India, Pakistan, France, Argentina and North African countries. In ancient times it was used as an aphrodisiac by the Egyptians and, together with honey, for the treatment of rickets, diabetes, dyspepsia, rheumatism, anaemia and constipation. It has also been described in early Greek and Latin pharmacopoeias for hyperglycaemia and was used by Yemenite Jews for type 2 diabetes. In India and China it is still widely used as a therapeutic agent. In the United States, it has been used since the 19th century for postmenopausal vaginal dryness and dysmenorrhea. Common Name Fenugreek Other Names Trigonella seeds, bird’s foot, Greek hay, hu lu ba, methi, trigonella Botanical Name / Family Trigonella foenum graecum (family Leguminosae) Plant Parts Used Dried mature seed, although leaves are used less commonly. Chemical Components The main chemical constituents are fibre, tannicacid, fixed and volatile oils and a bitter extractive, steroidal saponins, flavonoids, polysaccharides, alkaloids, trigonelline, trigocoumarin, Read more […]

Garlic: Contraindications. Practice Points. FAQ

Contraindications and Precautions Patients with bleeding abnormalities should avoid therapeutic doses of garlic. Although usual dietary intakes are likely to be safe prior to major surgery, suspend the use of high-dose garlic supplements 1 week before, as garlic may increase bleeding risk. If being used as part of a topical application, a test patch is advised before more widespread application. Pregnancy Use Garlic is not recommended at doses greater than usual dietary intakes. Practice Points / Patient Counselling • Garlic is both a food and a therapeutic medicine capable of significant and varied pharmacological activity. • It has antioxidant, antimicrobial, antiplatelet, antithrombotic, antihypertensive, lipid-lowering, anti-atherosclerotic and vasoprotective activity. • It also enhances microcirculation and may have hypoglycaemic, anti-inflammatory and immunostimulant activity. • Garlic is used as a treatment for many common infections, to reduce the incidence of colds, improve peripheral circulation and manage hyperlipidaemia and hypertension. • Increased consumption of garlic has been associated with a decreased risk of stomach and colorectal cancer, according to a review of the Read more […]