?? ?????? ?? ???? ?? ???? ???? ??? ??? ?? ???? ? ?? ???? ?? ???? ?????? ???? ???? ?? ???? ????? ???? ?? ???? ????? ?? ???? ???? ???? ?? ???? ?? ? ?? ???? ???? ?????? ?? ???? ?? ?? ???

1
????? ???? ?????? ???? ?? ?????? ?????? ???? ??
?? ????????? ??? ?????? ??????? ???? ?????
?????? ? ??? ???? ???? ???? ?? ????
2

• ????? ???? ?? ??? ???? ????? ? ?????? ?? ????? ??
  ??30 ??? ????? ???? ??? ???? ????? ????? ??? .
  ???? ???? ??? ????? ?? ???? ????? ????? ??
  ????? ???? ???? ???? ??? ?? ???? ?? ?????? ??
  ???? ???? ???? ?? ???? ??????? ?????? ??????
  ?? ????? ????? ? ?????? ????? ??? ??? ?? ????
  ?????? ????? ???? ???? ?????? ??? ?????????
  ? ????? ???? ?? ????? ?????

3

• ?? ?????? ?? ???? ?? ???? ???? ??? ??? ?? ???? ?
  ?? ???? ?? ???? ?????? ???? ???? ?? ???? ?????
  ???? ?? ???? ????? ?? ???? ???? ???? ?? ????
  ?? ? ?? ???? ???? ?????? ?? ???? ?? ?? ???
  ????? ?? ???? ??? ?? ??? ?????? ?????? ?? ??????
  ?? ??????? ? ??? ?? ??????? ?? ??? ????? ?????
  ?? ??? ????? ?? ????? ????? ????? ? ??? ???
  ?? ?? ????? ?????? ?? ???????? ? ?? ??? ???
  ??????? ????? ?? ??? ???? ?? ???????? ??? ? ??
  ??? ?? ??????? ??? ???? .

4

• ???????? ?????? ?? ????? ?????? ?? ?? ???? ???
  ?????? ???? ????? ?? ?? ?? ??? ?? ????? ?????
  ????????? ???????? ? ?? ??? ???? ?? ?????
  ????? ??? ? ?????? ???????? ? ????? ? ?????
  ??????? ???? ???? ????? ???
• ???? ??? ???? ???? ? ?????? ?????? ???? ?? ??
  ????? ?????? ?? ?? ???? ??? ?? ????? ???? ??
  ???? ??? ????? ???? ?????? ?????? ????? ??? ?????
  ?? ???? ???? ???? ??? ??? ?? ??? ???????? ????
  ??? Las caux ?? ?????? ?? ???? ???? ????? ?????
  ??????? ??? ??? ?? 25000 - 13000 ??? ???
  ????? ???? ???? ????? .

5

• ?????? ??? ?? ??????? ????? ?? ??? ?? ??? ??
  ??? ?? ?? ?????? ??? ?? ???? ????? ????? ??? ???
  ? ????? ?? ????? ?? 5300 ??? ??? ??? ???? ??? ?
  ???? ????? ?? ????? ?? ????? ???? ??? ???? ???
  ?? ???? ???? ???? ??? .

6

• ?? ??? ???? ????? ???? ??? ?? ??????? ?????
  ?????? ????? ?? ?? ????? ????? ?????? ?????? ???
  ?? ????? . ????? ????? ??? ???? ???? ????
  ?????? ?? ??? ??? ?? ?? ?????? ??????? ???? ??
  ???? ??? ?? ????????? ? ??????"? ?????? ??? ??
  ???? ?????? ? ?? ???? ???? ???? ????
  ???????????? ???. ?

7

• ??????????? ?????? ?? ????? ????? ??? ?? ??????
  ?????? ????? ???? ??? ????? ?????? ????? ???????
  ?? ??? ???????? ? ?????? ?? 90? ???? ?????
  ??? ?? ?? ???? ?? Aframomum melegueta ?? ?????
  ????? ?? ???? ?????? ??? ?????? ?????? ?? ??
  ?????? ?? ??? ???? ? ????? ?????? ? ????????
  ????? ?? ?? ??????? ??? ??????.

8

• ?????? ??????? ?? ???? ?????? ?? ??????
  ??????? ??? ?? ???? ?? ??????? ???? ???? ????
  ???? ????? ?????? ??? ?? ????????????? ????
  ?????????? ?? ??? ???? ?? ??????? ????? ???
  ??????? ???? ????? ??? ??? ???? ?? ?? ?????????
  ??? ??? ??????.

9

• ??????? ????? ????? ??? ?? ?? ????? ???? ??? ??
  ???? ?? ?? ??? ???????? ??? ????? ????? ???? ??
  ? ??????????? ??? ?????. ??? ??? ???? ???????
  ????? ????? ???? ?? ????? ? ?? ?????? ???? ???? ?
  ?? ??? ????? . ???? ?? ??????? ?????? ?????
  ????? ????? ?? ??????? ?? ????? ???? ?????
  ?????? ????? ? ??????? ???? ?????? .

10

• ???? ???? ????? Koala ( ????? ???? ??? ? ????
  ) ??????? ?? ???????? ?????????? ????? ???
  ???????? ??? ???? ???? ???? ??????? ??? ??
  ????.? ?? ????? ?? ?? ????? ???? ?? ??? ???
  ?????? ???? ????? ?? ????? ?? ??? ??????.

11

• ?? ??? ????? ????? ?? ??? ?????? ???? ???? ????
  ?????? ??????? ?? ????? ???? ??? ???? ??? ? ????
  ?? ?? ?????? ?????? ???? ??? .

12

• ?????? ??? ?????? ?????? ?????? ?? ?????
  ????? ?? ?? ??? ?? 5000 ??? ??? ???? ??? ?? ??
  ??????? ????? ????? ?? ?????? ????? ???????
  ????? ??? ?? ????? ???? ? ????? ?? ????? ??? ????
  ??? . ?????? ???? 1000 ??? ??? ?? ????? ????
  ??? ??????? ? ???? ???? ???????? ?????? ?? ???
  ???? ?????? ???? ???? ???? ??? ?? ??????? ?????
  ???? ???? ?????? ??? ????? ???????? ?? ??? ????
  ??? ???? ???? ???? ???

13

• ????????? ?????? ??? ?? ??? ????? ????? ????
  ???? ??? ?? ???? ????? ? ??? ?? ???? ????? ??
  ????? ?????????? ??? ??? ???? ? ?????? ?????????
  ?????? ? ?????? ?? ????? ????? ??? .

14

• ???? ????? ??? ???? ??? ?? ????? ????????? ???
  ???? ?? ???? ?? ??? ? ????? 800 ????? ??? ???
  ?????? ? ???? ????? ????? ??? ???. ?? ???? ???
  ????? ??? ???? ???? ?????? ?????? ???? ????
  ???????? ??????? ? ???????? ??? ?? ??? ?????
  ???. ?????? ??? ?????? ?? ? ??? ???? ??? ?? ????
  ??? ????? ???? ??? .

15

• ???? ???????? ??????? ? ????? ?????? ????
  ?????? ?????? ?????? ????? ????? . ????? ?? ?????
  ? ??? ????? ???? ?????? ?????? ??? ?????? ??????
  ?????? ???? ????? ?????? ???? ??? ? ?? ???
  ???? ?? ????? ??????? ??????? ( ???? ????????
  ??????? ??? ???? ???? ? ????? )? ?? ????? ????
  ??? ???? ? ???? ?????? ????? ????? ? ????
  ?????? ???? ???? ?? ????? ?????? ????? ???????
  ?? ??? ????? ???? ????? .

16

• ??? ?? ????? ?? ????? ???? ??????
• ???? ?????? ?????? ?? ????? ???????? ??????"
  ?????? ????? ??? ????? ??? ?????? ??? ??????
  ???? ?? ???? ???? ?? ????? ?? ????? ??? ?????
  ???? ????? ??? ????? ????? ?? ????? ?? ????
  ????? ????? ? ???? ??????? ?????? ?? ??? ??
  ???????? (Ayurvedic )

17

• ?????? ?? ??????? ??????? ?? ?? ?????? ??????
  ????????? ????? ????? ?????? ???? ??????
  ??????? ????? ????? ??? ????? ?????? ?????????
  ??????? ? ?????. ?????? ?????? ????? ??? ???
  ??? ?? 80? ????? ???? ?? ??? ???? ?? ???????
  ????? ???? ???? ?????? ? ????? ??????? ????????
  ???????.
• ?? ???? ? ?? ?? ???? ?? ???????? ?????? ? ?????
  ????? ???? ??? ?????? .

18

• ?????? ?? ?????? ????? ?? ???? ?????? ?? ????
  ??? ?????? ?? ????? ?? ? ???? ??????? ???? ????
  ?????? ??? ???? ???? ???? ???? ???? ?? ????
  ???? ?? ???? ?? ?????? ??????? ??? ???? ?????
  ???? ?? ????? ?? ? ??? . ?????? ?? ???? ????????
  ??? ????? ????? ?? ????? 12000 ??? ???? ??
  ??????? ????? ??? . ?????? ?? ??????" ???? ??
  10? ?? ?? ????? ????? . ?? ?????? ?????? ????
  ????( ????? ??????????? )? ?????? ??????? ???
  ????? ????? ???? ?????? ? ????? ??? ??????.

19

• ??????? ????? ??? ?????? ???? ?????? ???????
  ???? ? ???? ??? ????? ?? ?????? ???? ????? ???
  ? ?? ??? ????? ??? .
• ??????? ?? ????? ????? ????? ????? ????
  ??????? ????? ????? ???? ???? ???? ?? ?? ????
  ???? ???? ?????? ???? ????? ???. 120 ????? ????
  ?? ?? ?????? ????? ??? ??? ???? ????? ?? ??
  ?????? ???? ?????? . 80? ???? ????? ?? ??????
  ???? ??? ???? ?????? ?????? ? ???? ???? ???????
  ??? ?? ?? ???? ??????? ??? ???. ????? ???????
  ???? ??? ????? ?? ???? - ????? 35000 ??? ????
  ????? ??? ?????? ????? ?????????? ?? ??? ?????
  ???? ???? ???

20

• ?? ????? ? ???? ???? ?? ???????? ??????? ? ?????
  ?? ???????? ?? ?????? ?????? ?????? ????? ? ??
  ??? ?????? ??????? ???? ???? ? ????" ??? ?????
  ???? ?? ??? ????? ? ?? ????? ???? ???? ??? ?????
  ???????? ?? ?????? ?? ?????? ???? ??????? ????
  ???? ?? ?? ?????? ???? ???? ? ???? ?????? ???
  ???????? ???? ???? ?? ???? ????? ???? ??????
  ???? ????? .

21

• ?? ???????? ?? ??? ???? ???? ?? ????? ????
  ??????? ??????? ??? ?????? ? ?? ???? ????? ??
  ???? ???? ?? ?????? ?? ???? ?? ???? ?? ????? ???
  ??????? ???? ?? ??? ???? ? ?? ?? ??? ??? ??????
  ???? ??????? .
• ??? ????? ?????????? ??? ??????? ?? ??
  ????????? ???? vitro) ( in ? ???
  ?????? ????? ??? ?? ???? ????? ?????? - ?????
  ??? ?? ????? ???? ??????? ?? ?? ????? ??????? .

22

• ???? ?????? ? ???????? ??????? ???? ?????
  ???????? ?? ?? ???? ????? ???? ???? ????
  ??????? ?????? ???? ???? ?? ???? ????????
• (Dra coceohallum Kotshyi Boiss)
  ?????? ????? ????? ??? ????? ?????? ? ?????? ??
  ???? ???? ? ????? ?????? .

23

• ???? ???? ??????? ?? ???? ?? ? ???? ???? ???
  ????? ???? ???. ??? ????? ????? ?????????? ??
  ???? ??? ? ???? ????? ??? ???? ??? ?????? ????
  ????????? ?????? ????? ????? . ?? ?? ????? ????
  ??? ?????? ????? ????? ???? ???? .????? ????
  ???? ???? ????? ?????? ?? ???? ??? ?????? ?? ????
  ?????.

24

• ???? ??? ??????? Trigonella foenum graecum
  ???? ???? ?????? ??? ?? ????? ??? ??? ???????
  ????? ?? ?? ?????? ??? ???????? ??? ?????
  ?????????? ???? ??? ??????? ???? ????? ???
  ??????? ?????? ??? ???? ????? ???? ???? ?? ?????
  ??? ???? ???? ???? ?????? ?? ?????? ???????
  ??????? ?? ???? ????? .

25

• ?? ??? ???? ???? ??? ?? ??? ??????? ???????
  ????? ?? ?? ???? ??? ????? ??????? ???? ??????
  ???? ???? ?? ???? ??? ????? ?? ???? ???? ?????
  ????? ? ???? ????? ?? ????? ???? ???? ? ?? ???
  ??? ???? ? ??????? ??? ???? ?????? ? ???? ????
  ????? ????? ????? ?? ??????? ???? ? ???????
  ????? ??? ?????? ?? ????? ??? ??? ????? ?????
  ? ???? ???? ?? ???? ?? ????? ?????? ???? . ?????
  ????? ??? ??? ????? ????? ???? 7 ??? ????
  ??????? ?? ?? ????? ????? ????? ?????? ??? .

26

• ???? ????? ?????? ???? ??? ???? ???? ?????? ?
  ????? ????? ?????? ????? ?? ?? ???? ??????? ?
  ??? ???? ? ????? ??? ? ??? ???? ???? ? ??? ????
  ? ??? ?????? ???? ????? (?????? )? ?????? ??? ???
  ??? ? ???? ???? ???? ????? ??? ? ???? ???? ??
  ????? ????? ???? ???. ????? ???? ??? ?????
  ?????????? ?????? ??????? ? ?? ???????? ??? ???
  ???? ? ??????? ?? ?? ?????? ???? ???? ????? ?????
  ? ????? ???? ????? ?? ???? ? ??? ???? ????? ????
  ??? .

27

• ??? ? ???? ?????? ???????? ????? ??? ??? ??? ??
  ?????? ???? 10-15? ?? ??????? ???? ?????? ????
  ?? ???? ?????? ???? ?????? .

28

• ???? ??????? ???? ???????????? ?????? ?????
  ???? ???? ???? ??? ????? ??????? ? ????????
  ? ?????? ?? ??? ? ?? ?? ??????? ?????? . ??
  ????? ???? ????? ?? ?? ????? ??? ??????
  ??????? ???? ??? ?? ???? ???? ????? ??? ?? ???
  ? ?? ?????? ? ?? ?? ??? ??????.

29

• ?? ??? ???? ????? ????? ?????? ? ?????? ????
  ??? ???? ???? ?????? ????? ???????? ??? ???
  ???? ????? ???? ???. ?? ?? ????? ???? ???? ????
  ????? ??? ???? ??? ???? ???? ?? ???? ??????
  ????? ?? ??? ??? ?????? ?? ???? ?????????
  ????? ??? ??? ?????? . ?? ??????? ? ?????
  ?????? ?? ?? ???? ??? .

30

• ????" ????? ??? ???? ??? ???? ??? ?? ??? ? ?? ??
  ????? ?? ?? ??? ???? ?? ????? ????

31

• ???? ????? ?? ????? ??? ???? ?? ???? ??? ?????
  ???? ??? ???? ?? ?????? ????? ??? ??? . ?? ????
  ??? ????? ?????? ???? ??? ???? ???? ????? ??
  ??? ???? ???? ????? ? ?????? ???? ???? . ?????
  24 ???? ??????? ???? ???? ???? ?? ?? ???? ????
  ????? ? ???? ???? ????? ?? ???? ??? 5 ???? ???
  ???? ???? ???? ?? ??? 14 ??? ????? ?????

32

• ??? ?????" ?????? ?? ?????? ???? ??? ??? ????
  ????? ? ????? ???? ???? ????? ?? ??? ?????????
  ????? ?????? ????? ? ??? ???????? ???? ??? ???
  ????? ??? ?? ????? ?????? ???? ?? ????. ????????
  ?? ??? ??? ???? ?????" ????? ????? ????(??
  ?????? ?? ????????? ? ??????? ????????) ????
  ?????. ???? ???? ??? ?? ????? ????????? ?????????
  ??? ???? ?????.

33
Herbal Medicine Today

• Botanical Medicine

34
Differences and Similarities of Drugs and
Medicinal Plants

• Today there are at least 120 distinct chemical
  substances derived from plants that are
  considered important drug and are currently in
  use in one or more countries in the world
• Some of these drugs are simply a chemical or
  chemicals extracted from plant materials and put
  into a capsule, tablet or liquid.

35
Herb may cut breast cancer risk Source
International Journal of Cancer April 2007

• Women taking supplements of black cohosh may cut
  their risk of breast cancer by more than 50 per
  cent

36
Ingredients in Green Tea may prevent arthritis
Source Experimental Biology April 29 2007

• (EGCG) extracted from green tea may inhibit the
  production of inflammatory molecules associated
  with and joint damage in people with rheumatoid
  arthritis, scientists have reported.
• The results add to an ever-growing body of
  science linking consumption to a wide range of
  health benefits, including lower risk of certain
  cancers, weight loss, heart health, and
  protection against Alzheimer's.

37
Green and Black Tea

• Tea contains many active compounds that may alter
  BP, including flavonoids, which are polyphenolic
  compounds with vasodilatory and antioxidant
  effects, theanine, theobromine, quercetin,
  epigallocatechin-3-0-gallate (EGCG),
  gamma-glutamylmethylamide (GMA), thearubigins and
  theaflavins.
• Additional studies in humans will be required to
  accurately assess these BP effects.
• Houston, MC, "The Role of Vascular Biology,
  Nutrition and Nutraceuticals in the Prevention
  and Treatment of Hypertension", The Journal of
  the American Nutraceutical Association,
  Supplement No. 1 April 2002 ISSN-1521-4524 p 30

38
Green Tea Evidence-increased consumption
correlates to decreased risk of several cancers
and possibly heart disease in studies on
Japanese extracts may lower cholesterol but
evidence is weak Cautions-caffeine! Although the
amount is less than in a cup of coffee contains
vitamin K so be careful with warfarin Products-?
Green tea or black? Capsules or
tea? Questions-how much? Does black tea have the
same effect? How much benefit?
39
Herbs for Longevity

• Ginseng (may slow aging process by improving
  bodys ability to use and absorb oxygen)
• Ginkgo Biloba (enhances age-related memory
  impairment)
• Green Tea (benefits immune system, protection
  from cancer and strokes, lowers blood pressure)

Sources Huguet, F., et al. Decreased cerebral
5-HT1A receptors during aging reversal by
ginkgo biloba extract. Journal Of Pharmacy and
Pharmacology. 46 316-318, 1994. Serafina, M.,
et al. In vivo antioxidant effect of green and
black tea in man. European Journal of Clinical
Nutrition. 50 28-32, 1996.
40
(No Transcript)
41
Milk Thistle

• Botany
• Silybum marianum
• Asteraceae family (daisy, thistles,)
• History
• long used to treat liver problems
• Chemistry
• fruits/seeds contain flavonolignans
• silymarincrude mixture of flavonolignans
  actually is mixture of several e.g. silybinin
• Seeds generally used

42
Milk ThistleSilybum marianum
43
(No Transcript)
44
Milk Thistle

• Pharmacology
• silymarin has strong antioxidant properties
• has ability to block toxin entry through
  membranes
• stimulates liver regeneration undergoes
  enterohepatic circulation
• increases glutathione
• stimulates ribosomal RNA polymerase
• has anti-carcinogenic activities in vitro and in
  animals
• Uses
• liver cirrhosis
• hepatitis A,B,C
• liver toxin poisoning (e.g. amanita mushroom)

45
Viral Hepatitis (A or B) in several studies
patients normalized hepatic function tests
faster in the milk thistle group compared to
placebo shorter hospital stay Hepatitis C known
efficacy Tanamley et al. (Dig Liver Dis. 2004
Nov36(11)752-9) were able to show improvement
compared to a multivitamin control at 1 yr
(n141). Toxin and Drug Inducted Hepatitis both
animal and some small patient studies show
protective effect of milk thistle or
silymarin Alcohol Related Liver Disease some
improvement in liver function tests compared to
placebo in limited studies cirrhosis Pares et
al. J. Hepatol 28615-621, 1998 no effect on
survival or clinical course of alcoholics n200
2yr study cirrhosis (Ferenci et al. J. Hepatol
9105-113, 1989 showed 58 4yr survival in
treated vs 39 placebo (p0.036) 4 yr
study Lucena et al. (Int J Clin Pharmacol
2002402-8) showed increase in glutathione and
decreased liver peroxidation in patients with
alcoholic cirrhosis but no change in routine
liver tests in treated compared to placebo.
N60 Alcoholic cirrhotic diabetics. Velussi et
al. 199726871-879. N60. Open label.
Improved. A meta-analysis (Am J Med
2002113506-15) concluded no strong benefit but
more studies needed animal studies indicate
considerable promise for beneficial activities
46
Milk Thistle

• Cautions
• Nothing special
• Interactions
• None of significance reported as yet. Recently
  shown to not affect indinavir pharmacokinetics
• Products
• flavonolignans are not water soluble
• extract used
• extracts containing at least 70 silymarin are
  best
• A lipid complex of silibin has high
  bioavailability

47
Echinacea(Echinacea purpurea)

• Member of daisy family
• Active ingredient(s)
• Polysaccharides, alkylamides, flavinoids, caffeic
  acid
• Physiologic effect(s)
• Activates T lymphocytes, stimulates IFN, TNF-?,
  ILs
• Most common use
• Prevention/reduction of cold and flu symptoms

48
Echinacea purpurea

• Cochrane review 16 RCT
• 3396 patients
• Suggests some preparations are superior to
  placebo in acute infection
• Rec 3 6 grams / day
• Melchart D, Cochrane Database Systematic Review
  2000

49
Garlic(Allium sativum)

• Active ingredient(s)
• Allicin
• Ajoene
• Physiologic effect(s)
• Inhibits platelet aggregation
• Inhibits cholesterol metabolism
• Most common use
• Reduces cholesterol (decreases triglycerides,
  LDLs, increases HDLs)

50
Garlic

• Anticoagulation increase with warfarin
• Ajoene irreversible platelet inhibition
• Case report of spontaneous spinal epidural
  hematoma and associated platelet dysfunction
• Rose KD, Crossant PD, Parliament CF, Levin MP.
  Spontaneous Spinal Epidural Hematoma with
  Associated Platelet Dysfunction From Excessive
  Garlic Ingestion A Case Report.
  Neurosurgery.199026(5)880-882.

51
Garlic

• garlic increases fibrinolytic activity
  diminishes human platelet aggregation
• Garlic / 400 mg twice daily / 12 weeks reduced
  spontaneous platelet aggregation 59 vs placebo
  in 80 patients
• Combining with aspirin may increase risk of
  hemorrhage.
• Bordia AK, Joshi Hk, Sanadhya YD, Bhu N. 1977..
  Atheroscler, 28155-9
• Kiesewetter H, Jung F, Jung EM, Mrowietz C,
  Koscielny J, Wenzel E. 1993. Eur. J. Clin.
  Pharmacol. 454333-336.
• Harenberg J, Giese C, Zimmermann R. 1988.
  Atheroscler, 74247-249, 1988

52
Ginger(Zingiber officinal)

• Active ingredient(s)
• Sesquiterpenes, aromatic ketones
• Physiologic effect(s)
• Inhibits arachidonic acid metabolism
• Most common uses
• Antiemetic, diuretic, digestion aid

53
Gingko(Gingko biloba)

• Active ingredient(s)
• Flavone glycosides
• Flavonoids
• Terpene lactones
• Physiologic effect(s)
• Antioxidant, prevent platelet aggregation,
  antagonize PAF, increases cerebral perfusion
• Most common use(s)
• cerebral vascular insufficiency, peripheral
  vascular disease (eg Raynauds
  disease),Alzheimer disease

54
Ginkgo

• 40 mg twice daily of a 501 ginkgo extract
  induced spontaneous bleeding following 3-year
  aspirin use by a 70-year-old man.
• Subdural hematoma was reported after chronic
  ginkgo use in humansCombining with aspirin may
  increase risk of hemorrhage
• 32 healthy young males ginkgo extract 2 wks
  120, 240 or 480 mg daily
• hemostasis, coagulation and fibrinolysis were not
  significantly altered

55
HDI in Humans Ginkgo

• Relatively potent platelet inhibitor
• Ginkgolide B may inhibit platelet activating
  factor causing increase of inhibition of
  aggregation
• Increased bleed risk
• Monitor for signs of bleed, immediate d/c if
  occurrence
• consider PT/INR monitor at onset of TX until
  stable with continued monitoring
• Rosenblatt M, Mindel J. Spontaneous Hyphema
  Associated With Ingestion Of Ginkgo Biloba
  Extract(Letter). N Engl J Med.19973361108.
• Matthews MK. Association of Ginkgo biloba with
  intracerebral hemorrhage. Neurology
  1998501933-1934.

56
Sedatives
BZD Barbituates EtOH Non-BZD
Valerian Goldenseal Chamomile Melatonin
57
Herbs and Surgery

• On average, herbs used by 17.6 to 22 of
  pre-surgical patients
• Among those who used herbs, most commonly used
• Ginkgo 32.4
• Garlic 26.5
• Ginseng 26.5
• Ang-Lee MK, Moss J, Yuan C-S. Herbal medicines
  and perioperative care. JAMA 2001286208.

58
Herbs and Surgery

• Advise discontinuation of
• anti-thrombotic natural supplements
• 7 10 days prior to surgery or invasive
  procedures

59
5. Position of botanicals at the interface of
nutrition and therapeutics

• Valeriana officinalis
• As functional food
• promote sleeping
• As phytomedicine
• neurosedative

60
Valerian Surgery

• Increased sedation
• Interference with anesthetics
• Withdrawal potential post surgical
• Begin dose taper weeks in advance of surgery
• If unable to taper, continue use through surgery
  and treat potential withdrawal with BZD
• University of Chicago Hospitals, July 11, 2001,
  JAMA

61
GinsengBotany

• Source -- American Ginseng, Panax quinquifolius,
  Asian or Chinese Ginseng, P. ginseng, and
  Siberian Ginseng, Eleutherococcus senticosus.
• Active Part -- Root

62
Ginseng(Panax ginseng)

• Active ingredient(s)
• Tritepenoid saponin glycosides
• Physiologic effect(s)
• May have effect on pituitary similar to
  corticosteroids, improves HbA1c
• Hypertensive at low dose hypotensive at high
  dose
• Most common use
• Couteracts physical/mental fatigue
• Improvement of bodys ability to fight stress and
  disease

63
Ginseng Chemical Constituents

• Ginsenosides (panaxosides) -- American and
  Chinese
• Eleutherosides -- Siberian
• Vitamins (A, B, C, D) in varying concentrations
• Essential oils
• Resins

64
Ginseng Proposed Uses

• Although different uses exist for the various
  forms of Ginseng, the numerous uses for any may
  include diabetes mellitus and stress and for
  their adaptogenic, immuno-stimulant, anti-cancer,
  and cognitive (American and Chinese) actions.

65
Ginseng Pharmacology

• May act as agonists at mineralocorticoid,
  glucocorticoid, progestin, and œstrogen
  (Siberian) receptors.
• Decrease both fasting and post-prandial blood
  glucose levels
• Has been shown to increase T lymphocyte cell
  counts.
• American ginseng has been shown to have numerous
  opposing effects

66
Ginseng Dosing Recommendations

• Wide ranges of doses have been used for ginseng.
• Ranges from 200 mg to 2 G daily.

67
Ginseng (Siberian)Adverse Effects

• Diarrhœa
• Difficulting in concentrating
• Dizziness
• Euphoria
• Hypertension
• Increased Agitation
• Nervousness
• Skin Eruptions
• Vaginal bleeding and other œstrogenic effects

68
Ginseng Contraindications

• Pregnancy
• Known Hypersensitivity

69
Ginseng Clinical Considerations

• Most literature, including herbal literature,
  recommend use for no more than three (3) weeks
• Patients should be monitored for any changes in
  stress response for electrolyte abnormalities

70
Ginseng antibiotics

• ginseng extract (100 mg twice daily) increased
  pulmonary bacterial clearance during acute
  attacks of chronic bronchitis when used with
  amoxicillin and clavulanic acid more than when
  the antimicrobials were used alone

Scaglione F, Weiser K, Allessandria M. 2001.
Effects of the Standardised Ginseng Extract G115
in Patients with Chronic Bronchitis A
Nonblinded, Randomised, Comparative Pilot Study.
Clin. Drug Invest, 21(1)41-45.
71
5. Physiological interactions between botanicals
and drugs

• St Johns Wort
• Antidepressive plant
• Molecular interactions with diverse drugs
  (ciclosporine, theophylline, digoxine,
  anticonceptionals, anti-AIDS drugs)

Hypericum perforatum (Hypericaceae)
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SJW Menopause

• 301 women
• Black cohosh (80 120 mg/day) and SJW (1200 mg /
  day)
• Reduction in MRS 50
• Placebo 19.6 at 16 weeks
• Uebelhack, Obstet Gyn 2006
• Level Evidence A

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ChamomileMatricaria recutita

• Dose use the flowering top
• Infusion 1 cup (2 tsp herb) 1-3 x day
• Tincture 1-4 ml 3 x day
• Homeopathic tablets use 6x as needed for colicky
  or teething babies, irritable children
• Caution - rarely, people are allergic to
  chamomile.

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Chasteberry Vitex agnus castus

• Acts on the hypothalamic-pituitary-ovarian (HPO)
  axis, which is easily disrupted in womenlt20 years
  old
• Increases LH, favors progesterone
• Inhibits prolactin
• Herbal actionscarminative, dopaminergic,
  galactagogue, HPO regulator, ovulaation
  stimulant, progesterogenic, uterine tonic

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Vitex, cont

• Qualities cooling or warming potential, dry,
  neutral, tonic
• Toxicology none known
• Indications PMS, infertility, menopausal sx
  including mood changes, migraines, menorrhagia,
  polymenorrhoea, menstrual cramping, insomnia, hot
  flashes, to restore balance after hormonal
  contraceptives.

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Vitex, cont

• Known in writings of Hippocrates (450 BC),
  Dioscorides (500 AD), Pliney, the Eclectics, and
  others.
• Dose is slow working, take for 3-6 months
• Tincture - 1 ml 3 times daily
• Infusion - 1 tsp/cup 3 times daily
• Capsules - 1 daily

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Menstrual Problems

• Hormonal imbalance, often caused by poor diet,
  congestion in liver, adversely affecting hormonal
  relationships
• Treatment
• Whole food diet, rich in fruits vegetables
• Herbs burdock
• Mayan Uterine Massage - a technique taught by
  Rosita Arvigo, of the ancient art of abdominal
  massage.

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Infertility

• Vitex - normalizes hormones
• Mayan/Mexican Uterine Massage

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Menopause

• Hot flashes - Vitex,
• Insomnia, anxiety, depression, tension - St.
  Johns wort, oats, valerian, kava
• Genitourinary symptoms -
• Hypertension atherosclerosis - hawthorn,
  motherwort, garlic,

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HawthornCrataegus oxyacantha

• Actions cardiotonic, diuretic, astringent,
  hypotensive
• Indications
• most heart conditions, including hypertension,
• to prevent development of cardiac disease,
• as part of post MI program
• all persons over age 50, postmenopausal women

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5. Position of botanicals at the interface of
nutrition and therapeutics

• Crataegus oxyacantha
• As functional food
• calming for the heart
• As phytomedicine
• for cardiac erethism in the adult
• (healthy heart)

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HawthornCrataegus oxyacantha

• Scientific research in Europe
• isolated constituents have insignificant effects
• whole plant effects are significant
• Based on a study by the German Federal Ministry
  of Health, hawthorn is recognized as a major
  heart remedy in Europe
• effects improves coronary circulation, dilating
  coronary arteries, reducing angina enhances
  nutrition and activity of heart muscles

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HawthornCrataegus oxyacantha

• No toxicity known
• Dose
• Tincture - 1-2 ml 3 x day
• Infusion - use 2 tsp dried herb, drink 3 x day
• Capsules - 2 caps 1-3 x day

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NettleBotany

• Source -- Urtica dioica L., a perennial of the
  nettle family (Urticaceæ), native world-wide.
  The plant grows 2-3 feet high with heart-shaped,
  serrated leaves. Plants are gender specific,
  with flowers in long,branched clusters appearing
  June-September. The plant is hirsute, with each
  hair serving as a small, hollow, needle-like form
  of protection.
• Active Parts -- Leaves, Stems, Roots

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NettleChemical Constituents

• Stems (non-therapeutic) --
• Histamine, serotonin, choline, formic acid
• Roots --
• Phenylpropanes and lignans
• Roots and Flowers --
• Scopoletin, steryl derivatives, lignan
  glycosides, flavonol glycosides
• Whole Plant --
• B, C, and K vitamins, sitosterol and other
  steroid related compounds

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NettleProposed Uses

• Diuresis -- hypertension, heart failure, and
  urinary, bladder, and kidney dysfunction
• Benign Prostatic Hypertrophy
• Other Uses -- Rheumatoid arthritis,
  antispasmodic, expectorant, asthma, cough,
  tuberculosis, locally for alopecia, epistaxis,
  uterine bleeding, diabetes, gout, cancer, eczema,
  wound healing.

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NettlePharmacology

• Nettle apparently does possess some diuretic
  activity, although the mechanism is not known.
• Shown to stimulate uterine contractions in
  rabbits.
• Possesses immunostimulant (lectin protein) and
  anti-inflammatory actions (scopoletin)
• Inhibits BPH in mice.