Class Ranunculaceae

Common Trade Names

None known.

Common Forms

Available as fluidextract, powdered root, seed, or a solid extract.

Source

The active components are extracted from the dried rhizome and root of the perennial plant Helleborus niger.

Chemical components

The extract may contain hellebrin, an aglycone, and two highly toxic crystalline glycosides-bufadienole helleborin and helleborcin. These glycosides may indicate contamination with other related species. Other components include saponosides, ranunculoside derivatives, resin, fat, and starch. The commercial hellebore roots consist mainly of H. niger and are mostly hellebrin-free. Other related species, especially H. viridis, tend to have higher levels of glycosides and aglycones.

Actions

The entire plant is considered poisonous. Extracts of black hellebore are claimed to promote menstrual flow and to have anthelmintic, narcotic, and purgative properties.

Protoanemonine is thought to cause abdominal pain, a burning sensation in the mouth and throat, dermatitis, eye irritation, and vomiting.

It combines with sulfhydryl groups, which results in subepidermal vesication. Topical application of the freshly bruised plant can cause serious irritation. Early in vitro studies using protoanemonine identified antifungal and cytotoxic properties .

Reported Uses

The plant has been used historically as a purgative and to treat amenorrhea, anxiety, heart failure, intestinal parasite infections, mental disorders, and skin ulcers. Other claims include its use as an anesthetic and a diuretic and to induce abortion.

In homeopathy, black hellebore tincture is said to be useful for eclampsia, encephalitis, epilepsy, meningitis, and psychoses. In Europe, black hellebore is used in homeopathy and as adjuvant therapy for cancer patients because of its claimed immunostimulatory properties. An in vitro study observed increased cytokine production in cells given an extract of black hellebore. There have been no controlled, double-blind, randomized human trials involving black hellebore preparations.

Dosage

For laxative use, 1 to 10 gtt of fluidextract P.O., 1 to 2 grains of solid extract P.O., or 10 to 20 grains of powder P.O.

Adverse Reactions

CV: arrhythmias, bradycardia, hypotension, irregular pulse (with contamination) .

EENT: burning sensation in the mouth, conjunctival and nasal irritation, increased salivation, sneezing.

GI: abdominal pain, diarrhea, vomiting.

Respiratory: respiratory failure (with contamination), shortness of breath.

Skin: dermatitis.

Interactions

None reported.

Contraindications and precautions

Avoid using black hellebore in pregnant or breast-feeding patients; effects are unknown.

Special considerations

Caution the patient that ingestion of the plant may result in abdominal pain, a burning sensation in the mouth and throat, diarrhea, increased salivation, and vomiting.

Advise the patient that black hellebore is considered toxic and, therefore, should not be consumed.

Advise the patient to consult a health care provider before using herbal preparations because a treatment that has been clinically researched and proved effective may be available.

Although no known chemical interactions have been reported in clinical studies, consideration must be given to the pharmacologic properties of the herbal product and the potential for exacerbation of the intended therapeutic effect of conventional drugs.

Points of Interest

H. niger blossoms white flowers in the winter, from which it received its name Christmas rose.

“Hellebore” is derived from the Greek elein (to injure) and bora (food), describing its toxic nature.

Commentary

Besides its use in homeopathy, black hellebore is used mainly as an ornamental garden plant. Although it is being used as a potential immunostimulant, controlled human trials to support this claim are lacking. Because of its recognized poisonous status and the lack of clinical data to support the medicinal use of black hellebore, products containing components of this plant should be avoided.

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Myrtaceae

Common Trade Names

Jambul Seed

Common Forms

Available as decoctions or a tea made from the seeds or dried leaves. Source

The drug is extracted from the fruits, seeds, and leaves of Syzygium cuminii, a 50′ to 80′ tree with edible berries that is native to India and Sri Lanka.

Chemical Components

The seeds of S. cuminii contain gallic acid, ellagic acid, corilagin, 3,6­hexahydroxydiphenoyl-glucose, 3-galloyl glucose, and quercetin.

Actions

Jambul seeds have been claimed to have antihyperglycemic, antihypertensive, and anti-inflammatory effects. In some South American countries, tea made from the leaves is used by diabetics for its antihyperglycemic effects. One study found no effect of jambul seed tea on postprandial blood glucose levels when compared with water in normal rats and rats with streptozotocin-induced diabetes mellitus.

The anti-inflammatory effects of jambul seed extract have been evaluated. Jambul seed extract was found to significantly reduce paw edema, although less effectively than phenylbutazone . An extract of jambul seeds was found to have neuropsychopharmacologic effects in mice; the animals became quieter and less active, with less spontaneous mobility. Loss of motor coordination and tone, decreased body temperature, and antagonism of amphetamine toxicity were also noted .

Reported uses

Jambul seeds and extracts are thought to be useful in treating diarrhea and dysentery and in lowering blood glucose levels. Although the seeds have some anti-inflammatory and antipyretic properties, the extent of these properties has yet to be defined. Evidence for the therapeutic properties of jambul is anecdotal.

Teixeria and colleagues studied the effects of jambolan tea prepared from S. cumini in 30 nondiabetic patients after completing the original work in rats. In accordance with the results or the lack thereof found in rats, these investigators failed to find any hypoglycemic effect in humans after a glucose tolerance test and concluded that jambolan cannot be recommended as an antihyperglycemic agent.

Dosage

No consensus exists. In most cases, tea is prepared from the seeds or leaves of the tree.

Adverse Reactions

None reported.

Interactions

CNS depressants: May cause altered behavior. Avoid administration with jambul.

Contraindications And Precautions

No specific contraindications. Avoid using jambul in patients who are hypersensitive to this plant or related species and in pregnant or breast­feeding patients.

Special Considerations

Advise the patient to consult a health care provider before using herbal preparations because a treatment that has been clinically re searched and proved effective may be available.

Monitor the patient for changes in blood pressure or blood glucose levels.

Urge the patient to report changes in behavior or coordination.

Advise pregnant or breast-feeding patients to avoid using jambul.

Points of interest

In Porto Alegre, a southern city of Brazil, a related species, Syzygium jambos, has also been used for treating diabetes. S. jambos, like S. cumini, is usually consumed in the form of a tea.

Commentary

Although jambul has been claimed to be effective for several medical conditions (diabetes, diarrhea, dysentery), there is little clinical evidence of its efficacy. In fact, animal and human clinical trials have failed to identify any significant hypoglycemic properties. Some studies have found extracts of jambul seeds and leaves to have anti-inflammatory, antipyretic, and neuropsychopharmacologic effects in animals. Further study on the active constituents of the seeds and leaves is warranted to determine the true pharmacologic properties of this plant.

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Violaceae

Common Trade Names

None known.

Common Forms

Available as an extract.

Source

Active components are obtained from the flowers of Viola tricolor.

Chemical Components

The stems and leaves contain flavonoids, salicylate derivatives, terpenes and triterpenes, carbohydrate derivatives, sterines, a polysaccharide, and magnesium tartrate. Vitamin F and other fatty acids have also been detected . Other compounds include violanthin, rutin, violaquercitrin, resin, saponin, gums, and mucilage.

Actions

Physiologic mechanisms of action are poorly described. Salicylates may be responsible for anti-inflammatory properties because of prostaglandin inhibition. Although not a major component of pansy, rutin has been shown to exert many pharmacologic effects, the most well known of which is its ability to affect capillary permeability. Herbs with high levels of rutin were thought to be useful for bleeding events. Other effects of rutin include inhibition of angiotensin II and prostaglandin E2.

Reported Uses

This agent is claimed to be useful in treating bronchitis, rheumatism, skin cancer, and whooping cough. One Hungarian study indicates its possible use in preventing heart spasms and as an anti-inflammatory .

Dosage

Dosage is 2 to 4 ml of tincture or tea P.O. t.i.d.

Adverse Reactions

GI: cathartic effects (seeds), diarrhea.

Interactions

Salicylates: Effects may be additive. Use cautiously.

Contraindications and Precautions

Avoid using pansy in pregnant or breast-feeding patients; effects are unKnown.

special Considerations

Monitor the patient for diarrhea.

Advise women to avoid using pansy during pregnancy or when breast- feeding.

Inform the patient that no clinical data support the use of this herb or any medical condition.

Commentary

Without clinical data supporting the use of pansy for medical purposes, it cannot be recommended.

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Myrtaceae

Common Trade Names

Jason Winter’s Tea Tree Oil, Swanson Ultra Tea Tree Oil, Thursday Plantation Tea Tree Oil

Common Forms

Available as creams, lotions, ointments, and soaps. It is also included in cosmetics, household products, and toiletries. Concentrations of melaleuca oil in these products range from less than 1% to 100%.

Source

Tea tree oil, or melaleuca oil, is an essential oil distilled from the leaves and branches of Melaleuca alternifolia, a member of the myrtle family that is native to coastal areas of Australia.

Chemical Components

The steam distillation of the leaves yields about 2% oil. The colorless to pale yellow oil is composed of terpene hydrocarbons (pinene, terpinene, cymene), cineol, and various minor sesquiterpenes and related alcohols. Composition of the extract is varied; the oxygenated terpene, terpinen-4-ol, can constitute up to 60% of the total oil. Some oils contain high concentrations of 1,8-cineol, which is the main component of eucalyptus oil. Most commercially available tea tree oils contain little or no cineol. More than 100 compounds (all plant terpenenes) have been identified in melaleuca oil.

Actions

Terpinen-4-ol a main component of tea tree oil, has significant antibacterial and antifungal activity in vitro; susceptible organisms include Escherichia coli, Staphylococcus aureus, Proprionibacterium acnes, Pseudomonas aeruginosa, Streptococcus species, and Candida albicans. Controversy exists as to the precise mechanism of action for the melaleuca. One report suggests that tea tree oil disrupts cell membrane permeability, promoting leakage of intracellular ions and proteins. Earlier data have suggested that the antiseptic effect of tea tree oil was related to its ability to activate WBCs . Still other information suggests that organic matter and surfactants that accompany melaleuca oil were responsible for the antibacterial effect. Tea tree oil may be effective against MRSA carriers that have previously been treated with topical mupirocin . There is in vitro evidence as well that tea tree oil has antimicrobial activityagainst vancomycin-resistant enterococci. Polymyxin B may enhance melaleuca’s antibacterial effect against P. aeruginosa by enhancing permeability of the organism cell membrane to the tea tree oil components .

Cooling appears to be an effective modality for the therapy of burn wounds. An investigation in piglets was undertaken to determine the effect of melaleuca gel on artificially induced burn wounds . Melaleuca gel, applied immediately or in a delayed manner, reduced intradermal temperature (cooling) and promoted more rapid healing as compared with untreated controls. Cold water compresses appeared to fare as well as melaleuca.

Reported Uses

Tea tree oil has long been used primarily as a local antiseptic. Australian aborigines used it for athlete’s foot, burns, cuts, and insect bites, among other disorders. Some studies indicate that the oil is promising as a treatment for skin problems, including acne, chronic cystitis, eczema, furuncles, bacterial and fungal infections of the skin and oral mucosa, lice infestation, psoriasis, vaginal candidiasis, and wound infections .

Melaleuca oil has also been compared with tolnaftate and clot rimazole solution for various skin conditions with some effect. A cream comprising 2% butenafine and 5% melaleuca oil was studied in patients with onychomycosis . In this double-blind, randomized, placebo-controlled study, 60 patients with onychomycosis of at least 6 months’ duration were followed for 16 weeks after initiation of therapy. The results were rather dramatic, with 80% of the treatment group cured as compared with none in the placebo group. After several additional weeks of follow-up, no improvements in either group were demonstrated but no relapses were seen. Butenafine itself has activity against several typical fungal pathogens.

Melaleuca oil has also been studied against 5% benzoyl peroxide for the treatment of acne vulgaris . More research is needed to prove its use in this area.

Preliminary information suggests a role for melaleuca in the treatment of oral thrush infections.

Dosage

Tea tree oil is applied locally in concentrations ranging from 0.4% to 100%, depending on the type of product and the nature and location of the skin disorder.

Adverse Reactions

CNS: CNS depression (ataxia, drowsiness).

EENT: stomatitis.

GI: diarrhea, GI mucosal irritation, vomiting.

Skin: dermatitis (in sensitive people).

Interactions

None reported.

Contraindications and Precautions

Use tea tree oil cautiously in patients who are hypersensitive to the components of melaleuca oil or in those who are prone to contact dermatitis from plants. Some data point to the sesquiterpenoid fraction of the oil as the allergenic agent of melaleuca . Avoid using tea tree oil in pregnant or breast-feeding patients; effects are unknown.

Special Considerations

• Monitor for worsening of skin condition or infection.
• Inform the patient that melaleuca oil is ubiquitous in commercially available products and that concentration of the oil varies greatly.
• Because essential oils are more appealing to olfactory senses and exhibit more natural appeal than available topical drugs, melaleuca may be preferred for antiseptic use. Encourage the patient to consider conventional therapy until substantial testing is done with the oil.
• Caution the patient that the oil should not be ingested and should be kept out of the reach of young children. Even small amounts of oil taken internally may produce CNS depression. A 17 -month-old child who ingested less than 10 ml of tea tree oil experienced ataxia and drowsi ness but recovered fully .
• Advise women to avoid using tea tree oil during pregnancy or when breast-feeding.

Commentary

Interest in melaleuca oil has erupted with reports of favorable in vitro antimicrobial activity against multiple pathogens (gram-negative and gram-positive bacteria, MRSA, VRE, and some fungal pathogens), suggesting many potential therapeutic topical applications. Although antimicrobial activity has been well documented in vitro, human clinical trials evaluating melaleuca’s efficacy and safety profile are still preliminary. Topical application as an antifungal appears promising, but it seems prudent not to ingest the essential oil of the plant until more is known.

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Taxonomic Class

Lauraceae

Common Trade Names

Various manufacturers provide the entire leaf or crushed leaves as a condiment. No medicinal products are known.

Common Forms

Available as berries, essential oils, extracts, and leaves.

Source

Leaves and berries of Laurus nobilis, a small tree native to the Mediterranean, are commonly used to obtain bay. Another species of bay tree grows in California; its product is more bitter and used primarily for extracts.

Chemical Components

The volatile oil contains alpha-pinene, camphene, cineole, eugenol, geraniol, limonene, linalool, phenylhydrazine, piperidine, and sabinene. Other constituents include boldine, catechins, costunolide, isodomesticine, launobine, laurenobiolide, nandergine, neolitsine, proanthocyani dins, and reticuline.

Actions

Eugenol acts as a sedative in rodents. Cineole has shown antibacterial activity against Vibrio parahaemolyticus. In mice, costunolide has had

a hepatic microsomal enzyme inductive effect on liver glutathione stransferase enzyme . Other studies with mice suggest chemotherapeutic effects . Aqueous extracts of L. nobilis seeds reportedly demonstrated anti ulcerative properties in experiments of ethanol-induced gastritic injury of rat models . Other rat studies suggest that methanolic extracts of bay may slow gastric emptying .

Reported Uses

Because of the plant’s strong aromatic qualities, herbalists claim that bay leaves are useful for common colds. Additional claims include the use of bay as an antirheumatic, a diuretic, and a stimulant. Bay is a common ingredient in natural toothpastes because of its purported antiseptic properties. Extracted oil has been used to treat muscle sprains and strains.

Dosage

The leaves are most commonly used to season foods and, if whole, are typically removed before consumption. Bay leaves should be thoroughly dried and crushed before ingestion. Bay extracts have been applied topically or used in baths and soaks.

Adverse Reactions

GI: GI impaction, perforation.

Respiratory: asthma.

Skin: contact dermatitis.

Interactions

Insulin: Increased hypoglycemic actions (bay leaf extract). Monitor concomitant use carefully.

Contraindications And Precautions

Avoid use in pregnant or breast-feeding patients.

Special Considerations

Caution the patient that the essential oil from bay leaves should not be consumed because of the risk of allergic reaction and asthma attack.

Alert Bay leaves are largely indigestible, have sharp serrated edges, and should not be consumed intact. The leaves can become lodged in the esophagus or intestines and often require surgical removal.

Urge the diabetic patient to closely monitor blood glucose levels.

Caution the patient not to ingest whole, intact bay leaves.

Advise the female patient to avoid using bay during pregnancy or breast-feeding.

Points of Interest

Bay increases insulin’s effects more than threefold and, therefore, nutritionists recommend it to diabetic patients.

Commentary

Bay leaf is a popular seasoning, but no therapeutic claim for treating diabetes or other diseases can be clinically verified.

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Taxonomic Class

Lamiaceae

Common Trade Names

Hyssop Herb, Hyssop Low Alcohol and Alcohol Free, Hyssop Organic, ViBlend (Echinacea/Hyssop for Kids) Liquid

Common Forms

Available as fluidextracts, oils, and tinctures. Fresh or dried flowering tops are used to prepare compresses or tea. Narcissus oil is used in fragrances. Narcissus pseudonarcissus lectin (also called narcissus pseudonarcissus agglutinin) is used in biochemistry.

Source

The plant belongs to Hyssopus officinalis of the Lamiaceae family.

Chemical components

Hyssop contains terpenoids (including marrubiin, oleanolic, and ursolic acids), a volatile oil (camphor, pinocamphone, thujone, isopinocampholle, with alpha- and beta-pinene, camphene, alpha­terpinene, linalool, bornylacetate, and others), flavonoids (including diosmin and hesperidiin), hyssopin (a glucoside), tannins, and resin.

Actions

Hyssop is reported to have anti-inflammatory, antiflatulent, antiseptic, antispasmodic, diaphoretic, expectorant, hepatic, sedative, and stimulant activities. It has been claimed to promote menstrual flow and to serve as a muscle relaxant. Crude extracts have been shown to inhibit HIV replication in vitro . A previously unidentified polysaccharide (MAR-10) isolated from aqueous extracts of H. officinalis has been shown to inhibit HIV-1 replication in vitro with no significant direct toxicity on lymphocyte functions or T-cell counts .

Reported Uses

Hyssop tea has been used for absence seizures, anxiety, asthma, bronchitis, colds, coughs, flatulence, hysteria, and indigestion. Hyssop preparations, especially the volatile oils, have been used externally for burns, cold sores, genital herpes sores, skin irritations, and wounds. Hyssop has been used with white horehound and colt’s foot for bronchitis and coughs; with boneset, elder flower, and peppermint for colds; and with sage as a gargle for sore throats.

Dosage

Tea: Infuse 1 to 2 tsp of dried hyssop in 1 cup of boiling water for 10 to 15 minutes. Drink t.i.d. for cough; gargle t.i.d. for sore throat.Tincture: 1 to 4 ml P.O. t.i.d.

Adverse Reactions

CNS: seizures (hyssop’s essential oil is known to possess strong convulsant chemicals).

GI: diarrhea, indigestion.

Interactions

None reported.

Contraindications And Precautions

Hyssop is contraindicated in pregnant patients and in patients with seizure disorders until effects are known. Use low-strength preparations in elderly patients and in children aged 2 to 12. Avoid use in children under age 2.

Special Considerations

Do not confuse hyssop with giant hyssop, hedge hyssop, prairie hyssop, or wild hyssop.

Instruct the patient to keep hyssop out of the reach of children and pets.

Urge women to report planned or suspected pregnancy.

Advise patients with seizure disorders to reconsider using hyssop because it may adversely affect seizure control.

Advise the patient to use hyssop under medical supervision if he is taking it longer than 3 consecutive days.

Points of Interest

The volatile oil is an ingredient in many French liqueurs, specifically Chartreuse and Benedictine. Essential oil is also used in perfume.

Commercial hyssop is not identical to the hyssop mentioned in the Bible; the latter is more commonly identified as Marjoram species or the caper plant, Capparis spinosa.

Commentary

Little clinical trial information exists for this herb. Hyssop might be generally recognized as safe, but medical supervision is suggested when using it longer than 3 consecutive days. There is no documented evidence that hyssop is effective in its external use in treating burns, wounds, and other infections. Even though hyssop extracts have been shown to inhibit HIV in vitro, there is no evidence for the usefulness of hyssop in treating patients with AIDS.

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Taxonomic Class

Fabaceae

Common Trade Names

None known.

Common Forms

Available as cigarettes, extracts, root, and teas

Source

The crude drug is prepared from the twigs and flowers of Cytisus scoparius (Sarothamnus scoparius). Broom has been naturalized from Europe to the United States and Canada. This plant should not be confused with Spanish broom (Spartium junceum), used in trace amounts in foods and cosmetics.

Chemical Components

Broom tops (flowers) contain the alkaloid sparteine. The concentration of this alkaloid ranges from 0.01% to 0.22% in floral parts and up to 1.5% in twigs. Broom also contains the flavone glycosides genitoside, isoquercetin, lupanine, oxysparteine, scoparoside, and spiraeoside. Caffeic acid derivatives, essential oils (containing phenyl ethyl alcohol, phenols, and acids), isoflavones (sarothamnoside), kaempferol, and quercetin derivatives have also been reported. Broom seeds contain phytohemagglutinins, or lectins.

Actions

The metabolism of sparteine has been repeatedly documented in humans. Studies with rodents show that sparteine inhibits sodium and potassium transport across the cell membrane. This action in cardiac cells mimics the actions of type IA antiarrhythmics, such as quinidine and procainamide. Sparteine produces a negative chronotropic effect and, possibly, a negative inotropic effect .

Sparteine undergoes oxidative metabolism by way of the cytochrome P-450 system in the liver. Cardiac drugs that share the same CYP2D6 pathway have demonstrated the ability to inhibit sparteine metabolism . All drugs known to share this metabolic pathway have the potential to interfere with the metabolism of sparteine. Sparteine is also a known oxytocic.

Another component of broom, scoparoside, possesses diuretic properties.

Reported Uses

Medical folklore and homeopathy have endowed broom with antiarrhythmic, cathartic, diuretic, and emetic properties at high doses. Smoking broom cigarettes is reported to produce euphoria and relaxation. Some researchers argue that these effects are unlikely to occur because of the small quantity of alkaloids taken into the body through smoking of the plant.

lectins isolated from broom seeds have been used as pharmacologic markers . They have also been used to classify red cell polyagglutinability. Sparteine, like debrisoquin, is used to characterize metabolizers of the oxidative metabolic pathway CYP2D6 in the liver .

Dosage

No consensus exists.

Adverse Reactions

CNS: headache, mind-altering sensations (from smoking plant parts).

CV: arrhythmias, worsening of heart failure.

Respiratory: fungal pneumonia (increased risk when contaminated broom tops are smoked as cigarettes).

Other: spontaneous abortion (from effects of sparteine), uterine contractions.

Interactions

Antihypertensives: May alter effectiveness of some antihypertensives. Avoid administration with broom.

Beta blockers, other cardiac drugs, tricyclic antidepressants, and other drugs that undergo metabolism by way of CYP2DG: May enhance the effects of these drugs; increases risk of serious arrhythmias, such as ventricular fibrillation, ventricular tachycardia, bradycardia, and heart block. Avoid administration with broom.

Cardiac pacemakers: May interfere with proper function of pacemaker.

Avoid use of broom in patients with pacemakers.

Contraindications And Precautions

Broom is contraindicated in pregnant patients because it is known to cause spontaneous abortion. It is also contraindicated in patients with hypertension or significantly impaired cardiac function because of the potential for arrhythmias and the agent’s ability to increase the tone of the vascular system.

Special Considerations

Alert Poisoning from overdose is possible. At toxic concentrations, broom may cause a clinical picture similar to that of nicotine poisoning: diarrhea, mental status changes, nausea, shock, tachycardia, and vertigo.

Caution the patient to avoid ingesting or smoking broom preparations because of potentially dangerous effects on the vascular system.

Inform the patient that broom is a dangerous herb and lacks approval for any therapeutic use.

Advise the patient not to confuse this plant with Spanish broom (S .junceum).

Caution women to avoid using broom during pregnancy.

Points of Interest

Before the use of hops, broom was used to enhance the taste and intoxicating power of beer .

The FDA considers this plant unsafe for human consumption. The German Commission E, which oversees drug use in Germany, considers broom effective for certain cardiac disorders.

Commentary

Although broom contains interesting and potentially useful therapeutic

agents, the risks appear to outweigh any purported benefits. Besides, safer and more effective drugs are available for all the potential therapeutic applications for broom. Additional data are needed to determine more completely the risks and benefits of the pharmacologic alkaloids contained in this plant.

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Polygonaceae

Common Trade Names

Dahuang Liujingao, Extractum Rhei Liquidum

Common Forms

Available as tablets and water- and alcohol-based extracts, syrups, and tinctures.

Source

Active components are derived from the dried root bark of Rheum palmatum, a large, perennial herb that is native to the mountains of Tibet and northwest China.

Chemical Components

Chinese rhubarb contains anthraquinones, stilbenes, and tannins. The anthraquinones occur as glycosides and have been identified as aloe emodin, chrysophanol, emodin, and rhein. Other substances include phenolics (such as catechin, gallic acid, and glucogallin) and sennosides A,B,and C.

Actions

The herb’s dramatic purgative or laxative effect is attributable to rhein and sennosides. Sennosides act on the large intestine to increase motility after being degraded by microorganisms in the colon. Increased laxative activity appears to correlate with sennoside content. Anthraquinones exhibit laxative and antimicrobial effects.

Rhubarb extract has been studied in chronic renal failure in the rat . One study found rhubarb to decrease the severity of proteinuria, decrease BUN levels, and attenuate the severity of glomerulosclerosis.

Rhein and emodin inhibit mitochondrial energy production. This may explain the inhibitory effect of rhubarb extracts on renal growth. Hypermetabolism is implicated in initiation of remnant kidney scarring.

In patients with upper GI bleeding, rhubarb has been found to increase blood vessel constriction and promote hemostasis; the mechanism of this action is unknown .

Reported Uses

Chinese rhubarb has been used medicinally for centuries as an antidiarheal and a laxative and to treat conjunctivitis, GI bleeding, indigestion, jaundice, menstrual disorders, and traumatic injuries. It has also been used topically to treat burns, scabs, and sores and as an astringent or styptic to stop bleeding.

The combination of an ACE inhibitor, captopril, and Chinese rhubarb was found to be superior to either agent alone in slowing the progression of renal failure . Similar results were obtained with rhubarb and other adjuvant drugs. Chinese researchers concluded that such treatments may be used as transitional measures in chronic renal disease before more radical therapies are instituted .

In patients with GI bleeding, rhubarb was found to help control bleeding, decrease blood loss, reduce the need for clotting agents, resolve fever, increase peristalsis of the colon without affecting the stomach or duodenum, and help eliminate extravasated bleeding.

Rhubarb stalk fiber was studied in hypercholesterolemic men and was shown to lower serum total cholesterol and LDL levels .

Dosage

Traditional uses suggest the following doses:

• For constipation, ‘Ic to I tsp P.O. daily of tincture or I to 2 tsp P.O. daily of decoction.
• For diarrhea, I tsp P.O. daily of tincture or decoction.
• For upper GI bleeding, 3-g tablets or powder P.O. b.i.d. to q.i.d.
• Use lower-strength preparations for older children and patients over age 65.

Adverse Reactions

• GU: urine discoloration (bright yellow or red).
• Skin: contact dermatitis (from handling the leaves).

Interactions

None reported.

Contraindications And Precautions

Chinese rhubarb is contraindicated in pregnant or breast-feeding patients, in children under age 2, and in patients with intestinal problems, such as ulcers and colitis. Use of the herb for longer than 2 weeks is contraindicated because it can induce a tolerance in the colon.

Special Considerations

• Most of the literature comes from the Orient, making interpretation of published studies difficult.
• Inform the patient that Chinese rhubarb is not the same as rhubarb found in the United States.
• Advise the laboratory that the patient’s urine will be bright yellow or red.
• Urge the patient to take Chinese rhubarb for only a short time to avoid such problems as melanosis coli and laxative dependence. .AURT Leaves contain poisonous oxalic acid. Consumption causes abdominal pain, burning in the mouth and throat, diarrhea, nausea, vomiting, and, possibly, seizures and death with ingestion of large amounts.
• Caution the patient against preparing Chinese rhubarb formulations at home to avoid the risk of oxalic acid poisoning. Urge him to keep this plant out of the reach of children and pets.
• Inform the patient that this herb may color the urine bright yellow or red.
• Advise women to stop taking the herb if pregnancy is planned or suspected or if breast-feeding is planned.

Points of Interest

Chinese rhubarb is officially listed in the Chinese Pharmacopia and was mentioned in the Chinese herbal Pen-King (ca. 2700 B.C.). Rhubarb root is one of the oldest and most common Chinese herbal medicines available. It has also been used in the manufacture of liqueurs and aperitifs.

Rhubarb species grown in Europe and North America and used for food and medicinal purposes are less potent than Chinese rhubarb.

Commentary

Active medicinal components of Chinese rhubarb suggest its theoretic application as an agent for GI dysmotility. With safety and efficacy data lacking, the herb cannot be recommended for this use.

The use of Chinese rhubarb in renal failure and GI bleeding appears intriguing, but data are from the foreign literature and difficult to interpret. Future studies should probably focus on these aspects of Chinese rhubarb for potential therapeutic application.

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Urticaceae

Common Trade Names

Nettles Capsules, Nettles Liquid Extract

Common Forms

Available as capsules (Iso mg, 300 mg) and dried leaf and root extract or tincture.

Source

The active chemical components are found in the leaves, stems, and roots of Urtica dioica, a perennial herb of the nettle family. It is one of three species that are native to Europe and is naturalized throughout the United States and parts of Canada.

Chemical Components

Nettle roots and flowers contain scopoletin, steryl derivatives, lignan glucosides, and flavonol glycosides. The roots contain phenylpropanes and lignans. The plant has B-group vitamins as well as vitamins C and K and steroid-related compounds such as sitosterol. The stinging, hair­like projections on the stems contain amines, such as histamine, serotonin, and choline, and formic acid. The lectin found in the roots is specific to this plant and may help to standardize preparations. Actions

Nettle acts primarily as a diuretic by increasing urine volume and decreasing systolic blood pressure. It has been observed to stimulate uterine contractions in rabbits, but the mechanism is unknown.

Other compounds identified have known pharmacologic activity. The U dioica agglutinin, a lectin protein, has immunostimulating activity. Scopoletin has anti-inflammatory activity. A 20% methanolic extract of stinging nettle roots inhibited benign prostatic hyperplasia (BPH) in mice . The plant extract was effective in reducing urine flow, nocturia, and residual urine in human patients. Another study of stinging nettle extract reported it to have an antiproliferative effect on human prostatic cancer cells .

Reported Uses

Nettle has been used to treat rheumatism and is claimed to be helpful as an antispasmodic and an expectorant. The leaves have been smoked to treat asthma. Nettle tea has been used to treat cough and tuberculosis. the juice has been applied to the scalp to stimulate hair growth. The plant’s styptic or astringent action has been useful for treating nosebleeds and uterine bleeding. Other claims include treatment of cancer, diabetes, eczema, and gout and wound healing.

Nettle’s diuretic properties have prompted its use in heart failure, hypertension, and urinary, bladder, and renal disorders. It was studied with other herbs as a bladder irrigant for treating prostatic adenoma in humans and was found to reduce postoperative blood loss, bacteriuria, and inflammation. The German Commission E recognizes this irrigant for treating urinary tract inflammation and for preventing and treating kidney gravel. Nettle is widely used in Germany for the early treatment of BPH and has been shown to be effective for treating allergic rhinitis . However, there is stronger evidence for the use of saw palmetto, beta-sitosterols, and pygeum in the treatment of BPH than for nettle.

Dosage

For allergic rhinitis, 150 to 300 mg in capsule form P.O. t.i.d., as needed.

Root: 4 to 6 g P.O. daily.

Tea: 1 or 2 tsp of dried herb mixed in 1 cup of boiling water; up to 2 cups P.O. daily.

Tincture: IS to 1 tsp P.O. up to b.i.d.

Adverse Reactions

Skin: contact urticaria (leaves).

CV: edema (internal use).

GI: abdominal distress, diarrhea, indigestion (internal use).

GU: oliguria (internal use).

Interactions

Diuretics: May potentiate effects. Avoid administration with nettle.

Contraindications and Precautions

Nettle is contraindicated in pregnant or breast-feeding women because of its diuretic and uterine stimulation properties. It is also contraindicated in children under age 2. Use cautiously and in reduced doses in older children and adults over age 65.

Special Considerations

Advise the patient to eat foods high in potassium, such as bananas and fresh vegetables, and to replenish electrolytes lost through diuresis.

Caution the patient against self-medicating with nettle for BPH or to relieve fluid accumulation associated with heart failure without approval and supervision of a health care provider.

Alert If rubbed against the skin, nettles can cause intense burning for 12 hours or longer. Instruct the patient to wash thoroughly with soap and water, use antihistamines and steroid creams, and wear heavy gloves if the plant is to be handled.

Points of Interest

The FDA considers this herb to be of undefined safety.

Nettle plants were used in weaving in the Bronze Age; archeologists have found burial shrouds made of nettle fabric.

Nettle juice was an ingredient in hair-growth preparations in the 19th century.

Native American women believed that nettle tea eased delivery and stopped uterine bleeding after childbirth.

Commentary

Despite its traditional use for several conditions, the only proven pharmacologic action of nettle is as a diuretic. It is considered relatively safe in the amounts recommended, and adverse effects from the oral form are rare. The herb has been studied in the treatment of allergic rhinitis, BPH, and osteoarthritis and as a component in postoperative bladder irrigation, but more studies are needed to determine its role for these uses.

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