Herbal Medicine 6

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sally89
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22418
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Herbal Medicine 6
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2010-06-07 03:49:20
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Herbal Medicine
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Session 6
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  1. Some traditional herbal analgesics include
    – Corydalis spp (Corydalis)
    – Eschscholtzia californica (Californian poppy)
    – Salix alba (Willow bark)
    – Stephania tetandra (Stephania)
    – Piscidia erythrina (Jamaican Dog Wood)
    – Anemone pulsatilla (Pasque flower)
    – Piper methysticum (Kava)
    Topical Analgesics
    – Peppermint
    – Cayenne
    – Arnica
    • Indications for herbal analgesics
    • • Pain associated with inflammation e.g.
    • – Arthritis
    • – Tendonitis
    • – Myalgia
  2. • Pain associated with visceral spasm e.g.
    – Gall bladder
    – Urinary tract
    – Intestinal colic
    – Spasmodic dysmenorrhoea
    • • Pain associated with vascular spasm eg:
    • – Migraine
    • – Angina
    • – Intermittent claudication
    • • Neuralgic pain (in limited cases)
    • – Shingles
  3. • Herbal analgesics should be restricted to experienced and well trained
    practitioners
    • Areas which should be approached with caution:
    – Concurrent prescription of powerful analgesics
    – Pain in children
    – Neurological disease
    – Depression & psychosis
    – Liver & kidney disease
    – History of allergy & anaphylactic reactions
    • • Application
    • – Herbal analgesics may be taken as required or before
    • food. There is likely to be a longer delay compared to
    • synthetic analgesics and thus leading to a temptation to
    • overdose.
    • • Long term therapy with analgesics is not advised.
  4. • In conventional pharmacological terms,
    Sedatives
    • reduce nervous activity
    Hypnotics
    • promote sleep
    Tranquilizers
    • reduce anxiety
    • • Many herbal remedies have varying degrees of sedative and
    • tranquillizing activity, some supported by clinical studies.
    • • However, it is probably misleading to apply the strict
    • pharmacological definitions to them as their effects are much
    • broader, with strong sedation rare.
    • Herbal Sedatives, Hypnotics & Anxiolytics
    • • Indications
    • – Modern tension and anxiety syndromes (short term or
    • intermittent use)
    • – Insomnia – difficulty getting to sleep first thing at night.
    • – Weaning off conventional sedative prescriptions
    • – Restlessness during convalescence
  5. • Contraindications
    – Generally milder than prescribed sedatives and should not be seen as
    immediate substitutes in more serious indications.
    – It would be unwise and possibly dangerous to stop strong medication
    without careful planning.
    – Insomnia marked by increasing restlessness during the early morning
    – Depression
  6. Application
    • • May be taken as required, at bedtime or before food.
    • • May also be used in some cases of inflammatory disease
    • • Prescription time should be limited
    • – Although unlikely to lead to addiction, compared with
    • modern sedatives, the body may become dependant and
    • effects diminished.
  7. Antispasmodics and Relaxants
    • Used to reduce the symptoms of tension in the body.
    • Today they are offered to the modern stressed patient as a
    welcome antidote to the culture of tranquillizers and
    sedatives.
    • Working from the ‘neck down’, they reduce physical effects of
    tension without befuddling the brain or impugning sanity.
    • • Some traditional herbal
    • antispasmodics and
    • relaxants are
    • – Vibernum opulus.
    • – Dioscorea villosa,
    • – Leonuris cardiaca,
    • – Matricaria recutita,
    • – Passiflora incarnata,
    • – Piper methysticum,
    • – Scutellaria lateriflora,
    • – Tilia spp,
    • – Valeriana off.
  8. • Indications
    – Anxiety, irritability and restlessness, including in children
    – Sleeplessness due to anxiety and irritability
    – Nervous dyspepsia
    – Irritable bowel and intestinal colic
    – Tension headache
    – Spasmodic dysmenorrhoea
    • • Many conditions of tension are linked with fatigue, debility
    • and depression
    • • A group of remedies have emerged to meet the needs of a
    • modern stressed society
    • • This category of remedies to restore energies and build up
    • strength is referred to as nervine tonics (nervous
    • trophorestoratives)
  9. – Avena sativa,
    – Hypericum perforatum,
    – Scutellaria laterifolia,
    – Turnera aphrodisiaca,
    – Verbena off
    – Withania somnifera.
    • • Indications
    • – Nervous exhaustion
    • – Neuralgia, herpes infections
    • – Depressive states
    • – Insomnia (waking in the small hours after getting to sleep easily)
    • – Convalescence
    • – Neurasthenia
  10. • Contraindications
    – True trophorestoratives are almost nutritive in their effects, with few
    risks of adverse effects except in those patients with extremely
    debilitated constitutions.
    • Application
    – May be taken as required or before food.
    – Long term therapy with trophorestoratives is generally the norm
    • Anxiety
    • – Neurotic disorder characterised by apprehension, uncertainty
    • and XS fear
    • – Intense panic associated with physical changes
    • – There can be a genetic tendency
  11. – Factors include arousal of ANS flight or fight in response to
    fearfulness and or emotions psychologically individual to the
    person
    – May be subconscious and harder to uncover
    – Hidden emotion not recognised by patient
    – Social fear of loosing control of situation and actions.
    – Anxiety attacks instead of expressing anger.
  12. • CNS symptoms
    • – fight or flight
    • • Tachycardia
    • • Palpitations
    • • Cold sweats
    • • Fine tremors
    • • Dizziness
    • • Overall motor weakness
    • • Butterfly's in stomach
    • • Nausea and sometimes diarrhoea
    • • Respiratory changes
    • – hyperventilation
  13. • Patient may observe feeling
    of being unconnected with
    people and objects around
    them combined with sense
    of unreality, which together
    prolong anxiety attack
    • Often fear of loosing
    consciousness and or
    dying
    • Chronic Anxiety
    • • Like acute anxiety, less
    • severe and debilitating.
    • • Symptoms can be of longer
    • duration - lasting days or
    • months.
    • • General sense of tension,
    • apprehension or dread.
    • • Tendency to startle easily. An
    • uneasiness in normal
    • situations of life and work.
    • • A vague persistent fear of the
    • future.
  14. Conventional Treatment
    • Pharmacological measures
    – Benzodiazepines
    • Valium
    – Tricyclic antidepressants
    • Amytriptyline
    – Monoamine oxidase MAO) inhibitors
  15. • Psychotherapy
    • • Hypnotherapy
    • • Relaxation Techniques
    • • Meditation
  16. Herbal Treatment
     Kava
     St. John’s Wort
     Valerian
     Lemon balm
     Wood Betony
     Hyssop
     Lime flowers
     Oats
     Passionflower
     Hops
     Damiana
    • The authors concluded that their
    • results support Kava as a
    • treatment alternative to tricyclic
    • antidepressants and
    • benzodiazepines in anxiety, with
    • proven long term efficacy and
    • none of the tolerance problems
    • associated with these drugs.
  17. Insomnia
     In any year 30% of the population will experience insomnia with 4 to 6
    million people a year receiving prescriptions for sedative hypnotics
     Ageing itself tends to decrease the total amount of sleep needed and the
    sleep is usually more restless
    • Onset insomnia
    •  Difficulty falling off to sleep
    •  Maintenance insomnia
    •  Repeated awakenings, with difficulty returning to sleep
    •  Offset insomnia
    •  Early morning awakening
    •  Non-restorative sleep
    •  A sense of not getting enough sleep
  18. Sedative
     relax and reduce nerve conduction and can be used during the day
    without causing drowsiness
     Relaxants
     help to relax tense muscles and can be used during the day also
    • Hypnotics
    •  induce sleep => used at night
    •  Circulatory Stimulants
    •  aid the rapid absorption and distribution of the active compounds
    •  eg. Cayenne specific here
  19. Insomnia associated with:anxiety and stress=
    Valerian, Hops
    Passionflower
    • Insomnia associated with:depression=
    • St. John’s Wort
    • Lavender
  20. Insomnia associated with-pain general

    Californian Poppy, Corydalis
    Jamaican Dog Wood
    • Insomnia associated with-
    • associated with inflamation
    • (analgesic effect)=

    • Willow Bark
    • Californian Poppy
  21. Insomnia associated with-
    associated with smooth muscle cramping=

    Cramp Bark, Wild Yam, Raspberry leaf
    Corydalis, Ginger
    • Insomnia associated with-
    • Menopausal hot flushes and/or night sweats=

    Zizyphus
  22. Insomnia associated with inability to relax=
    Hops, Lavender, Passion flower
    • Hypericum perforatum
    • Mode of Action
    •  Still an element of uncertainty
    • about its exact mode of action
    •  Originally thought to be a MAOI
    •  Later research suggests it is
    • more likely to be an SSRI
    •  May also inhibit the reuptake of
    • nor-adrenaline
  23. Hypericum side effects
     G.I.T. symptoms
     most common side effect reported in clinical trials
     Paraesthesia
     Photosensitivity
     very rare in humans and unlikely to occure at normal
    therapeutic doses, however it is recommended to advise
    patients to avoid excess sun while taking high doses
    •  Combining Hypericum with antidepressant
    • medication?
    •  Unclear from the herbalists point of view
    •  However, widely believed and stated by the medical
    • profession that they should not be combined
    •  Theoretically serotonin syndrome could occur if combined
    • with SSRIs or MAOIs
  24. Serotonin Syndrome is a potentially fatal complication to
    treatment with serotonin reuptake inhibitors
     Most commonly associated with the concurrent use of two or
    more drugs that enhance serotonin neurotransmission
     Symptoms include
     Early symptoms - muscle cramps, stiffness or tics, waking feeling
    hung-over
     Severe symptoms - confusion, agitation and restlessness, shivering,
    ataxia, fever, diaphoresis, hypertension, and tachycardia.
    • Other herbs to consider
    • Kava
    •  Siberian Ginseng
    •  Panax Ginseng
    •  Scullcap
    •  Passiflora
    •  Oats
    •  Ginko Biloba
    • Lavender
    •  Vervain
    •  Damiana
    •  Schisandra
  25. “Adrenal Exhaustion”
     Low adrenal function results from different stressors e.g.,
     Mental Stress
     Physical Stress
     Viral Illness
    • This dysfunction impacts the normal communication between
    • the hypothalamus, pituitary gland, and the adrenal glands.
    •  Symptoms include:
    •  Tiredness
    •  Dizziness
    •  Headache
    •  Anxiety
    •  Depression
  26. Herbs which are specific for treating adrenal exhaustion:
     Rehmannia glutinosa
     Codonopsis pilosula
     Bupleurum falcatum
     Rhodiola rosea
     Panax ginseng
     Glycyrrhiza glabra
     The perceived causes, such as compromised immunity, poor liver
    function, malabsorption issues must also be addressed.
    • Rehmannia glutinosa
    • Rehmannia inhibits the
    • catabolism of cortisol
    • and reduces the
    • suppressive effects of
    • corticosteroid drugs
  27. Rehmannia inhibited the metabolism of cortisol by
    hepatocytes in vitro
     Simultaneous administration of endogenous
    adrenocortical hormones resulted in cortisol levels
    remaining close to normal
     The authors believed the mechanism to be a competitive
    effect at the hepatocellular receptor which affected the
    uptake of corticosteroid hormone, thereby slowing the
    catabolism of cortisol
    • Rehmannia treatment also prevented or reversed
    • morphological changes in the pituitary and adrenal cortex,
    • appearing to antagonize the suppressive effect of
    • glucocorticoids on the hypothalamic-pituitary-adrenal axis
  28. Codonopsis pilosula (Dang shen)
    Codonopsis strengthens the Qi, nourishes fluids, and tonifies
    the lungs
     It invigorates the spleen, invigorates vital energy, and is good
    for the blood
     Major uses include digestive problems such as lack of
    appetite, diarrhoea and vomiting
    • It also treats symptoms, which arise due to loss of body fluids including
    • anaemia
    •  Because it brings energy inwards it counteracts the tendency for tissues
    • to move outwards and downwards
    •  Hence its effectiveness in the treatment of organ prolapse and discharges
  29. Medicinal Uses
     Fatigue
     Adrenal exhaustion
     Long term stress
     To improve mental and physical performance
     Anaemia
     Hyperglycaemia
  30. Bupleurum falcatum
    •  Diaphoretic, regulates gastrointestinal function and restores
    • liver function
    •  It is used to treat common cold, alternating chills and fever,
    • liver enlargement, prolapse of the uterus and rectum, and
    • irregular menstruation
    •  Bupleurum is a major herb for the liver
  31. The anti-inflammatory activity of the saikosaponins
    (triterpenoid saponins) appears to be related, to their ability to
    both induce secretion of endogenous corticosterone and
    potentiate its anti-inflammatory activity
     Combined oral administration of Bupleurum extract and
    corticosterone acetate increased anti-inflammatory activity
    compared to corticosterone alone
    • It is suggested that the site of action of saikosaponins is the
    • hypothalamic-pituitary system
    •  It is also suggested that saikosaponins may be used to
    • reduce the dose of glucocorticoid drugs and to prevent
    • glucocorticoid-induced adrenal suppression
  32. The ability of saikosaponins to raise blood glucose levels was
    demonstrated in several pharmacological studies following
    both oral and injected doses
     This is probably a direct consequence of their ability to
    increase levels of endogenous glucocorticoids
     Since saikosaponins also increase liver glycogen stores,
    Bupleurum may prove to be useful in the treatment of
    reactive hypoglycaemia
    • Rhodiola rosea
    • Actions
    •  Adaptogen
    •  tonic
    •  antitumour
    •  hepatoprotective
    •  hepatotrophorestorative
  33. Therapeutic Indications
     Fatigue, mental and/or
    physical exhaustion
     To improve mental
    performance, concentration
    and memory, especially when
    under stress
     To enhance physical
    performance and endurance
    •  Adverse Reactions
    •  Very few side effects have been reported.
    •  A small clinical study found an increase in symptoms in a subgroup of
    • depressed patients with hysteric and phobic symptoms.
    •  Contraindications & Cautions
    •  Caution is advised in depressed patients with hysteric and phobic
    • symptoms, such as might occur with bipolar disorder.
    •  As with all strong adaptogenic and tonic herbs, concurrent use with
    • stimulants such as caffeine is best avoided.
  34. Panax ginseng
    Korean ginseng helps
    support the normal function
    of the hypothalamicpituitary-
    adrenal axis, the
    hormonal stress system of
    the body.
     Caution should be
    exercised as over
    stimulation may occur in
    susceptible patients at high
    doses
    • Glycyrrhiza glabra
    • Licorice root is known to
    • stimulate the adrenal
    • glands and to block the
    • breakdown of active cortisol
    • in the body.
    •  Contraindicated
    •  Patients with elevated
    • blood pressure
    •  Long term use

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