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Volume
8
No
1 2003
Modern Phytotherapist
FOR PROFESSIONAL USE ONLY. NOT FOR PUBLIC DISTRIBUTION
© MEDIHERB 2003
Effective Herbal Treatment
of Allergies
BY TRACEY COOK
Most herbalists will not treat severe acute allergic reactions, as
in these life-threatening cases urgent medical intervention is
essential. They do however see a large proportion of people with
hypersensitivity reactions and intolerances where herbal
treatment can be most beneficial. A detailed and comprehensive
case history is essential, and where foods are suspected, a food
diary or elimination diet can be useful.
The term allergy is often used to describe immediate
hypersensitivity reactions and atopic diseases where there is IgE
antibody involvement. Most manifestations are produced by
mast cell degranulation as outlined below.1
Allergic individuals have been sensitized to a specific
allergen/antigen. Their mast cells and basophils are “armed”
with receptor sites for IgE-antibodies specific to the allergen.
Exposure to the allergen results in an interaction between the
allergen and receptor-bound IgE triggering mediator release.
The mediators released from mast cells and basophils are
responsible for the subsequent allergic reaction. These
mediators can be divided into three broad categories of action,
the kind that:2
Contents
•
increase vascular permeability and contract smooth muscle
(e.g. histamine and PAF (platelet activating factor));
Clinical Anecdotes:
Use of Anthelmintic Herbs 20
•
are chemotactic for or activate other inflammatory cells
(e.g. leukotriene B4);
Prostate Problems and
Solutions
22
•
modulate the release of other mediators including PAF.
Clinical Monitor
29
Effective Herbal Treatment
of Allergies
Editorial: Understanding and
Practising Effective
Phytotherapy – More than
Herbal Monographs
2
Herbal Treatment for
Intestinal Parasites
continued page 3 ➔
This Modern Phytotherapist is for educational purposes only. MediHerb and Standard Process do not recommend or suggest that any herb discussed
is for use in the diagnosis, cure, mitigation or treatment of any disease or disease-related condition. MediHerb and Standard Process are not responsible
for any recommendations or suggestions health care practitioners make for any medical uses. Health care practitioners should refer to the Contraindications
& Cautions Book for MediHerb botanicals before recommending any products to patients.
1 Modern Phytotherapist
1
13
Editorial
Editorial
Understanding and Practising Effective Phytotherapy
is About More than Herbal Monographs
BY KERRY BONE
Phytotherapy
(PPP) by Simon Mills and myself was
published in 1999 it was hailed as the first
textbook of modern herbal practice. Since then several
other herbal texts have been released for the
professional reader. However, most of these
publications contain only herbal monographs and seem
to be based on the assumption that knowing about the
properties of herbs is all that is necessary to be an
effective herbal clinician. Furthermore, many of these
materia medica textbooks are not written by practising
herbalists and, rather than acting as working manuals
or references for the herbal clinician, are quite negative
about the worth and safety of many herbal treatments
(under the guise of an evidence-based evaluation).
W
HEN Principles and Practice of
Very few, if any, modern texts reflect the current core
activity of most Western herbal practitioners: namely
arriving at an individual prescription after an extensive
consultation and then dispensing this prescription as a
compounded liquid formulation. Herbalists in
Australia, New Zealand, the UK and the USA have
functioned in this way for more than 100 years, yet this
mode of practice is regarded by many as on the fringe
of medicine. This contrasts strongly with traditional
Chinese medicine where the textbooks do reflect
current practice and draw strongly from the traditional
knowledge base. No one in China belittles the
traditional basis of their herbal practice, unlike the case
for many Western herbal texts.
For some time now I have felt that a text which reflects
the Western herbalist’s art of formulating liquids for the
individual patient was needed. This need, coupled with
the common feedback on PPP that it contained too few
herbal monographs, led to the development of a new
book entitled The Clinical Guide to Blending Liquid
Herbs: Herbal Formulations for the Individual Patient
which will be published later this year by ChurchillLivingstone. In one sense this text is an appendage to
and update of PPP and this is particularly reflected in
the way the monographs are written.
I have drawn upon my 18 years of herbal practice to
write the clinical guide. It contains three main sections,
the first section deals with all the practical issues
involved with prescribing and dispensing liquid herbal
products. The second section outlines, with many
worked examples, the rationale and thought processes
behind using individual prescribing with liquid herbs
for the treatment of a variety of health issues. In the
third section, the reader will find comprehensive up-todate monographs on more than 100 herbs. In
particular, these monographs are written from the
perspective of a prescribing herbal clinician and contain
indications from both traditional sources and scientific
investigations. (One feature of the monographs is that
the level of evidence behind each indication is clearly
stated.)
Effective herbal therapy is more than just knowing
about the properties of herbs. Any clinician who wishes
to understand and apply in a modern scientific context
the fascinating, flexible and (in my experience) clinically
effective methodology of the traditional Western
herbalist should explore the art of individual
phytotherapeutic prescribing.
Editors: Kerry Bone and Amanda Williams
Managing Editor: Michelle Morgan
Publisher: MediHerb Pty Ltd A.C.N. 006 454 717
P.O. Box 713, Warwick, Queensland, 4370, Australia.
Telephone: +61 7 4661 0700 Facsimile: +61 7 4661 0788
email: [email protected]
web site: www.mediherb.com
Contents copyright © MediHerb Pty Ltd 2003
2 Modern Phytotherapist
MH/293
For professional use only. Not for Public Distribution.
Clinical
Effective Herbal Treatment of Allergies
…continued from page 1
The T helper cells that drive immediate hypersensitivity
responses are usually of the TH2-type. TH2 helper cells
induce the inflammatory interleukins IL-4, IL-5, IL-6
and IL-10. Interferon-gamma production is associated
with TH1 responses which include contact dermatitis.2
Classification of urticaria with angioedema:2
•
- Atopic diathesis
- Specific antigen sensitivity (e.g. pollens, foods,
drugs, fungi, moulds)
- Physical (e.g. dermographism, cold, light,
vibratory, exercise-related)
Types of Allergic Reaction
Anaphylaxis
Systemic anaphylaxis occurs within minutes after
administration of a specific antigen by injection. In rare
cases, anaphylaxis can occur after ingestion of antigen
in highly sensitized individuals. Varying degrees of
severity of reaction will occur with respiratory distress,
pruritis, urticaria and sometimes angioedema. Vascular
collapse and shock can occur in severe cases. There may
also be abdominal pain, nausea, vomiting and
diarrhoea.
IgE-dependent
•
Complement-mediated
- Hereditary angioedema (type 1, type 2)
- Acquired angioedema (type 1, type 2)
- Necrotising vasculitis
- Serum sickness
- Reactions to blood products
•
Nonimmunologic
Antigens capable of causing an anaphylactic reaction in
humans include:2
- Direct mast cell-releasing agents (e.g. opiates,
antibiotics, radiocontrast media)
•
- Agents which presumably alter arachidonic acid
metabolism (e.g. aspirin, NSAIDs (nonsteroidal
anti-inflammatory agents), azo dyes, benzoates)
drugs such as antibiotics (e.g. penicillins),
local anaesthetics (e.g. procaine), vitamins
(e.g. thiamine) and diagnostic agents
(e.g. sulfobromophthalein),
•
pollen extracts (e.g. ragweed, grass, trees),
•
nonpollen extracts (e.g. dust mite, cat dander),
•
foods (e.g. eggs, seafood, nuts, grains, beans),
•
occupational proteins (e.g. rubber products) and
chemicals (e.g. ethylene oxide),
•
Hymenoptera venom (e.g. hornets, wasps, bees,
fire ants),
•
antiserum (e.g. antilymphocyte gamma globulin),
•
hormones and enzymes (e.g. insulin, penicillinase,
trypsin).
Angioedema and Urticaria
Angioedema may appear as localised oedema (nonpitting) or it may occur with urticaria. Urticaria
presents as well circumscribed wheals with
erythematous borders but the centres are blanched.
These wheals may coalesce to form giant wheals and
they are intensely pruritic. They can appear on the body
but most commonly the extremities, external genitalia
and face particularly the eyes and lips. Not all urticaria
is caused by immune reactions.
For professional use only. Not for Public Distribution.
•
Idiopathic
Allergic Rhinitis
Symptoms include sneezing; profuse, clear, running
mucus; obstruction of nasal passages; conjunctive, nasal
and pharyngeal itching and lacrimation. It most
commonly occurs seasonally as in hay fever but it can
also occur perennially.
Allergic rhinitis is most common in atopic patients who
have a personal history or family history of eczema,
asthma and urticaria.
Most medical texts state that food sensitivity reactions
are rare and the antigen is far more likely to be an
airborne pollen or mould. In the case of perennial
allergic rhinitis the culprit is more likely to be animal
dander, chemicals or dust. Many patients with allergic
rhinitis will react when there is no obvious allergen
present.
Nasal polyps can be a feature of allergic rhinitis,
particularly in the perennial type. They often coincide
with the mucosal oedema and/or infection and this
exacerbates the nasal congestion. Polyps are mucosal
protrusions containing chiefly oedema fluid with
variable degrees of eosinophilic infiltration.
Modern Phytotherapist 3
Clinical
Eczema/Dermatitis2
Allergic contact dermatitis occurs when the skin comes
into contact with an allergen that the skin is sensitive to.
Common symptoms include redness, itching, swelling,
blistering and weeping, and this usually occurs within
48 hours of contact. The allergen can be a substance
used for years, but more commonly it is in reaction to
contact with plants.
Atopic eczema is an itchy skin rash characterised by
scaly, red, itchy lesions which may weep. It usually
occurs in skin flexures (especially behind the knees and
inside the elbows) but can occur on other areas of the
body as well. It is more common in infants and during
childhood but may continue into adulthood. Patients
may have an increased blood eosinophil count. Its
aetiology is unknown, however people with atopic
eczema and their families have a greater incidence of
asthma and hayfever, raising the possibility of a genetic
basis to the condition.
Nummular eczematous dermatitis (discoid) is a
stubborn rash which forms circular lesions on the skin.
As the lesions progress, they may clear in the centre –
resembling a ring worm. It tends to be a chronic
condition, sometimes being less active than others. It is
easily misdiagnosed and I have seen patients who have
been treated for ring worm, impetigo and herpes
instead of nummular eczema.
Asteatotic eczema (winter itch) occurs commonly on
the lower legs of elderly individuals during dry times of
the year. It appears as fine cracks resembling the cracks
(crazing) seen in china or porcelain.
Hand eczema may occur with other skin problems such
as atopic eczema or psoriasis or may occur alone.
Excessive exposure to irritants may initiate the disorder
and aggravate it as well. Often the dermatitis begins
under rings where water and irritants are trapped.
affected by the other organs including the nervous
system. This is not to say that medical treatment of the
symptoms is not at times valid. There are times when it
is essential, especially in severe cases where the majority
of the skin is affected. In such cases, the integrity of the
skin is so at risk as to leave the individual susceptible to
systemic and local infection. For this reason, the
“healing crisis” is best avoided. With this in mind herbs
with antiallergic activity are vital in the treatment of
allergic conditions.
As the skin is an organ of elimination, it is useful to
assess the other eliminatory channels i.e.: bowels, lungs
and kidneys. Increasing the efficiency of these organs
will help to reduce the stress placed on the skin by an
overloaded toxic system. This will also reduce the risk of
exacerbation of symptoms and reduce reactivity.
The Role of Food Sensitivities and
Gut Function
There are many studies indicating that food
hypersensitivity plays a role in cutaneous skin lesions. It
is common that sensitivity to food and increased
intestinal permeability go hand in hand and must be
addressed. Many patients who have intolerances to
certain foods also have a history of some
gastrointestinal tract insult such as Salmonella
poisoning, giardiasis or multiple antibiotic therapy –
this can lead to a malabsorption syndrome and chronic
inflammation of the gut.
There are also studies indicating that the immune
factors of expectant mothers are passed on to infants.
One such study indicates that infants have nearly twice
the risk of developing eczema if their mothers had
asthma or eczema during their pregnancy.3 It may
therefore be worthwhile for expecting mothers to take
care with their diet if they have food sensitivities so as
to reduce the infant's risk of developing sensitivities too.
Medical treatment is topical corticosteroids for severe,
widespread reactions, if more than 30% of the body is
involved or if there is involvement of the hands, face or
genitals. Such treatment includes the glucocorticoid
dexamethasone. Antibiotic therapy (often
prophylactically) and antipruritics are also prescribed.
Dermatitis herpetiformis (a variant of coeliac disease)
will usually respond to the removal of gluten from the
diet, however, there have been case reports where the
gluten content of the diet had been removed but the
dermatitis only cleared when dairy products were also
removed from the diet. In one study this also controlled
the patient’s dyspepsia.4
Holistic Treatment of Allergic
Conditions
Seventy-five percent of patients with dermatitis
herpetiformis in one study were found to have
significantly increased prevalence (p<0.001) of serum
IgG antibodies reactive with wheat gliadin, bovine milk
or ovalbumin compared to controls. IgA anti-milk
antibodies were detected in patients irrespective of
whether they were on a gluten-free diet.5
Most inflammatory skin diseases, including eczema and
dermatitis, are multifactorial and if treated holistically,
usually respond well. The skin must never be seen in
isolation but as a tissue intimately connected to and
4 Modern Phytotherapist
For professional use only. Not for Public Distribution.
Clinical
Assessing Gut Function
Nervous System Involvement
Treatment with herbs will be needed if there is:
Most patients with skin problems will report that stress
exacerbates the condition. The effects of the hormones
released from the adrenal and pituitary glands can have
deleterious effects on the body if the stress state is
prolonged. This can result in a lowered resistance
generally and can stimulate the inflammatory process.
Noradrenalin stores can be depleted in depression and
stress. Nervine herbs such as Scutellaria lateriflora,
Avena sativa, Hypericum perforatum and adaptogens
such as Withania somnifera and Eleutherococcus
senticosus would be of benefit.
•
Reduced gastric acid secretion, use bitters –
barberry (Berberis vulgaris), gentian (Gentiana
lutea), golden seal (Hydrastis canadensis).
•
Feeling of food sitting there, especially after eating
proteins – use bitters (as above).
•
Excessive burping, bloating, flatulence – use bitters
(as above).
•
Heartburn, reflux – use demulcents, golden seal,
marshmallow root (Althaea officinalis) glycetract,
meadowsweet (Filipendula ulmaria), slippery elm
(Ulmus rubra).
•
Sluggish bowels/constipation – use bitters + bulk
laxatives e.g. butternut (Juglans cinerea), cascara
(Rhamnus purshiana), dandelion root (Taraxacum
officinale), golden seal, flaxseed (Linum
usitatissimum), psyllium (Plantago psyllium), yellow
dock (Rumex crispus).
•
Explosive bowels/loose diarrhoea – use
meadowsweet, chamomile (Matricaria recutita),
slippery elm.
•
Abdominal cramping, pain – use chamomile,
cramp bark (Viburnum opulus), licorice
(Glycyrrhiza glabra).
•
Irritable bowel syndrome – use Boswellia (Boswellia
serrata), chamomile, cramp bark, Mexican valerian
(Valeriana edulis), wild yam (Dioscorea villosa).
The above herbs and nervine tonics such as skullcap
(Scutellaria laterifolia), St John’s wort (Hypericum
perforatum), and valerian (Valeriana officinalis), are
prescribed as necessary according to the individual's
needs.
An interesting study looked at noradrenalin levels in
eczema sufferers. Physical stress-induced secretion of
adrenal and pituitary hormones in patients with atopic
eczema was compared with normal controls. Patients
with atopic eczema and an age-matched control group
performed exhausting incremental graded bicycle
exercise to evaluate the release of cortisol,
adrenocorticotropin (ACTH), beta-endorphin,
adrenalin and noradrenalin induced by physical stress.
Patients with severe eczema displayed a significantly
lower increase in noradrenalin levels when compared
with the less affected patient group.6
Salicylate Sensitivity
When patients complain of an exacerbation of
symptoms in summer I always suspect salicylates due to
the abundance of wonderful salicylate-rich foods at that
time of the year e.g. strawberries, tomatoes, peaches and
apricots.
Symptoms associated with salicylate sensitivity include a
history of:
•
sinus problems, sinus congestion, multiple sinus
infections, sinus headaches,
•
gut problems, heartburn, abdominal cramping
pain, diarrhoea, burning anus,
Common sensitivities: Wheat and/or gluten, dairy, yeast
(very common). But also: Additives, flavourings,
colourings (especially in children), salicylates.
•
skin symptoms – hives, pimple-like rash (especially
on the face, neck and arms), itchy skin with no
rash,
Patients can be hypersensitive to any substance and in
rare cases there will be those who seem to react to
almost everything. In this case the treatment of the gut
generally with anti-inflammatory gut herbs, berberinecontaining herbs and bitters, in conjunction with
treatment of nervous system and hepatic detoxification
processes is extremely effective.
•
joint pains – generalised polyarthralgia or may be
limited to one or two joints,
•
asthma.
Food Sensitivities
For professional use only. Not for Public Distribution.
The patient may present with all of these symptoms or
a combination of any of the above or indeed just one
symptom.
Modern Phytotherapist 5
Clinical
It is easy to exacerbate the symptoms with the use of
herbal medicines and therefore I will generally put the
patient on a low salicylate diet for two weeks and
prescribe L-glutamine (for gut function, repair and
absorption). After this time I will often start a herbal
formula using herbs which are known to be low in
salicylates – such as Rehmannia (antiallergic herb),
dandelion root (to assist the liver), celery seed (Apium
graveolens) for inflammation, and this is usually well
tolerated. If patients react to the herbal formula it will
usually occur after a few days, as the salicylate sensitivity
is cumulative which is why it is difficult to diagnose.
(For a discussion of salicylates in herbs refer to Modern
Phytotherapist 1995; 1(3): 1-7.)
Lower Gastrointestinal Herbs – for sluggish bowels.
Also bulk laxatives.
Butternut (Juglans cinerea)
Dandelion (Taraxacum officinale)
Flaxseed (Linum usitatissimum)
Licorice (Glycyrrhiza glabra)
Psyllium husks (Plantago psyllium)
Slippery elm powder (Ulmus rubra)
Yellow dock (Rumex crispus)
Anti-inflammatory Herbs
Boswellia (Boswellia serrata)
Bupleurum (Bupleurum falcatum)
Gluten Sensitivity
Licorice (Glycyrrhiza glabra)
The classical symptoms of gluten sensitive patients are
diarrhoea, abdominal cramping, bloating and
debilitating fatigue. However, there are many people
that are gluten sensitive but have no symptoms (or they
may merely have fatigue) and the gluten sensitivity is
diagnosed only after they are found to have recurring
anaemia. I have known a couple of patients to complain
only of pruritis ani. Dermatitis herpetiformis is also
associated with gluten sensitivity.
Rehmannia (Rehmannia glutinosa)
Most symptoms disappear rapidly with the withdrawal
of gluten from the diet. Repair of gastrointestinal tissue
is essential to ensure the absorption of nutrients and
particularly minerals. For patients with a long history of
suspected gluten intolerance bone densitometry may be
indicated, as lack of calcium absorption (and indeed
other minerals making up the bone matrix) can often
cause osteoporosis. I have had some patients whose first
indication of a problem was anaemia, but they had no
gut symptoms.
Adaptogens
Nervine Tonics
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Skullcap (Scutellaria lateriflora)
St John’s wort (Hypericum perforatum)
Valerian (Valeriana officinalis)
Wood betony (Stachys betonica)
Bupleurum (Bupleurum falcatum)
Eleuthero (Eleutherococcus senticosus)
Gotu kola (Centella asiatica)
Licorice (Glycyrrhiza glabra)
Rehmannia (Rehmannia glutinosa)
Metabolic Alteratives/Depuratives/Blood Purifiers –
these herbs increase elimination of toxic waste.
Burdock (Arctium lappa)
Herbs to Consider for Allergic
Conditions or Intolerances
Dandelion root (Taraxacum officinale)
The following table outlines herbs with specific
and/or appropriate actions to address the factors
discussed above.
Fringe tree (Chionanthus virginicus)
Figwort (Scrophularia nodosa)
Oregon grape (Berberis aquifolium)
Red clover (Trifolium pratense)
Upper Gastrointestinal Herbs
(bitters and specific herbs)
Herbs which increase Detoxification through
Urinary Tract – this eases the burden of elimination
from the skin.
Barberry (Berberis vulgaris)
Burdock (Arctium lappa)
Fumitory (Fumaria officinalis)
Cleavers (Galium aparine)
Gentian (Gentiana lutea)
Dandelion leaves (Taraxacum officinale)
Golden seal (Hydrastis canadensis)
Figwort (Scrophularia nodosa)
Indian barberry (Berberis aristata)
Heartsease (Viola tricolor)
Meadowsweet (Filipendula ulmaria)
Red clover (Trifolium pratense)
6 Modern Phytotherapist
For professional use only. Not for Public Distribution.
Clinical
Antiallergic Herbs
Albizia (Albizia lebbek)
Baical skullcap (Scutellaria baicalensis)
Licorice (Glycyrrhiza glabra)
Rehmannia (Rehmannia glutinosa)
Antioxidant Herbs – to reduce the oxidative damage
from the inflammation.
Cat's claw (Uncaria tomentosa)
Chaparral (Larrea tridentata)
Crataeva (Crataeva nurvala)
Ginger (Zingiber officinale)
Ginkgo (Ginkgo biloba)
CASE 1: SEVERE
HYPERSENSITIVITY TO WHEAT
Patient: 52-year-old woman. Teacher in a very stressful
job. Presented with allergic shiners. Eczema on legs and
waking every night with a streaming nose and irritated
eyes. Bowels: Increased flatulence and bloating over the
last 12 months. Diet: Typical Western diet.
Treatment
Dietary changes: increase fruit and vegetables, increase
water intake and avoid dairy and wheat.
Herbal Formula 1
Milk thistle (Silybum marianum)
1:2
40 mL
Green tea (Camellia sinensis)
Albizia (Albizia lebbek)
1:2
20 mL
Propolis
Licorice (Glycyrrhiza glabra)
1:1
40 mL
Reishi (Ganoderma lucidum)
Dandelion root (Taraxacum officinale)
1:2
20 mL
Mexican valerian (Valeriana edulis)
1:2
20 mL
Skullcap (Scutellaria lateriflora)
Meadowsweet (Filipendula ulmaria)
1:2
40 mL
Milk thistle (Silybum marianum)
Eyebright (Euphrasia officinalis)
1:2
20 mL
Turmeric (Curcuma longa)
Flavouring mix
Grape seed (Vitis vinifera)
Rosemary (Rosmarinus officinalis)
Schisandra (Schisandra chinensis)
Topical Application of Herbs in Skin Damage –
these herbs can be tremendous for reducing
inflammation locally, increasing patient comfort and
reducing pruritis.
10 mL
210 mL
Dose: 5 mL t.i.d.
Aloe leaf/gel (Aloe barbadensis)
The formula contained:
Calendula (Calendula officinalis)
•
Milk thistle for its antioxidant activity and ability to
support the liver with detoxification.
Chickweed (Stellaria media)
•
Albizia for its antiallergic activity.
Comfrey (Symphytum officinale) – Caution: not on
broken skin.
•
Licorice to support the adrenal glands due to the
long-term stress experienced, and for its antiinflammatory activity.
•
Dandelion root because it is high in vitamin A,
great for skin conditions and assists liver
detoxification.
•
Mexican valerian is one of the few herbs which
patients can feel the effect of within about half an
hour. I use it extensively in cases of stress and
although it is commonly used as a sedative for
insomnia, I use it at lower doses during the day and
find it is brilliant for stress without causing the
patient to fall asleep.
•
Meadowsweet for its healing and protective effects
on the gut wall as the patient had experienced
increased flatulence over the last 12 months.
Chamomile (Matricaria recutita) extract or essential oil
Lavender (Lavandula officinalis) essential oil
St John’s wort (Hypericum perforatum) macerated oil
Other Antioxidants: Foods
Garlic (Allium sativum)
Linoleic acid – enhances the function of the fat soluble
antioxidants
Olive oil (Olea europaea)
Plums – very high
Red wine
Sesame seeds (Sesamum indicum)
Tempeh
Wheat grass
For professional use only. Not for Public Distribution.
Modern Phytotherapist 7
Clinical
•
Herbal Formula 3
Eyebright for its calming effects on irritated
mucous membranes.
Echinacea purpurea root and
E. angustifolia root blend
1:2
40 mL
Licorice (Glycyrrhiza glabra)
1:1
40 mL
Milk thistle (Silybum marianum)
1:2
40 mL
Cleavers (Galium aparine)
1:2
20 mL
Korean ginseng (Panax ginseng)
1:2
20 mL
Third Consultation (4 weeks later)
Indian barberry (Berberis aristata)
1:1
20 mL
Eyes absolutely back to normal. Felt very well, more
energy, more relaxed. Rash on legs still improving.
Rehmannia (Rehmannia glutinosa)
1:2
40 mL
Second Consultation (2 weeks later)
Eyes looked much better, not oedematous now. Nose
had stopped streaming. The rash on both legs
improving slowly.
Herbal formula as above was repeated.
Herbal Formula 2
220 mL
Dose: 5 mL b.i.d.
Milk thistle (Silybum marianum)
1:1
40 mL
Albizia (Albizia lebbek)
1:2
20 mL
Licorice (Glycyrrhiza glabra)
1:1
40 mL
Greater celandine (Chelidonium majus)
1:2
20 mL
Black walnut hulls (Juglans nigra)
1:2
20 mL
Cleavers (Galium aparine)
1:2
20 mL
Rehmannia (Rehmannia glutinosa)
1:2
40 mL
Flavouring mix
10 mL
210 mL
Dose: 5 mL b.i.d.
Greater celandine, black walnut and cleavers were all
used for their ability to increase the expulsion of waste
products through the various eliminatory organs. I tend
to use these herbs only when the eliminative organs
have had some support from the previous herbs, so an
exacerbation of symptoms is often avoided altogether.
Fourth Consultation (7 weeks later)
In the intervening time period the patient had called in
for more herbal formula. In this consultation the
patient reported severe urticaria, spreading right up to
her thighs. The most amazing oedema I’ve ever seen,
legs looked like elephantiasis. The patient had eaten
wheat 24 hours earlier (one slice of bread). I didn’t
think it was the wheat as it was such a severe reaction.
Additionally: evening primrose oil (Oenothera biennis)
1 g capsule b.i.d. and vitamin B complex.
Echinacea was added to strengthen the immune system.
Korean ginseng has warming properties and is an
adaptogen. The patient was a very cold woman who was
lacking energy and I felt this adaptogenic herb would be
beneficial.
Subsequent Consultation
A day later the patient saw her medical doctor. A biopsy
was performed on the leg tissue. The pathology results
from the biopsy showed severe allergic reaction,
possibly due to a spider bite.
In due course, the allergic reaction in the legs subsided
and the urticaria disappeared.
Approximately one month later the patient forgot to
avoid wheat and ate one triangle of a sandwich with
wheat-containing bread. The above reaction occurred
again to the same severity.
Two months later the allergic reaction occurred again
and the suspect this time was a licorice confectionery
containing wheat. She continued on the above herbal
formula.
Eczema slowly cleared completely and the patient felt
well and has now remained well for two years. She was
gradually able to reintroduce wheat into her diet 2 to 3
times per week without a reaction but an increase above
this would cause her to react.
CASE 2: ALLERGIC RHINITIS
Patient male, aged 51 with headaches, CAT scan showed
six out of seven sinuses totally blocked. This patient also
8 Modern Phytotherapist
For professional use only. Not for Public Distribution.
Clinical
complained of stress. He had copious amounts of
tenacious mucus and postnasal drip, snored at night
and woke totally exhausted every morning. He had
previous septoplasty for deviated septum with a poor
result. Current medications: budesonide nasal spray, an
analgesic containing paracetamol (acetaminophen),
codeine and doxylamine for headaches.
Headaches less frequent and less intense. Much
easier to manage and less medication needed. Mucus
significantly reduced to just a little in the morning.
Slight energy improvement. Patient was not taking the
analgesic tablets and found that sleep was not as good.
Treatment
Herbal Formula 2
Dietary changes: increase orange-coloured vegetables
(contains beta-carotene is great for the skin) and avoid
dairy.
Echinacea purpurea root and
E. angustifolia root blend
1:2
40 mL
Golden seal (Hydrastis canadensis)
1:2
20 mL
Eyebright (Euphrasia officinalis)
1:2
30 mL
Schisandra (Schisandra chinensis)
1:2
40 mL
Fenugreek
(Trigonella foenum-graecum)
1:2
40 mL
Ashwaganda (Withania somnifera)
1:2
40 mL
Herbal Formula 1
Echinacea purpurea root and
E. angustifolia root blend
1:2
40 mL
Golden seal (Hydrastis canadensis)
1:3
20 mL
Fenugreek
(Trigonella foenum-graecum)
1:2
40 mL
Second Consultation (2 weeks later)
210 mL
Eleuthero
(Eleutherococcus senticosus)
1:2
40 mL
Dose: 5 mL b.i.d.
Schisandra (Schisandra chinensis)
1:2
40 mL
Ginger (Zingiber officinale)
1:2
20 mL
Tablets containing 500 mg Mexican valerian
(Valeriana edulis): 2–3 nocte (nightly).
200 mL
Dose: 5 mL t.i.d.
The formula contained:
•
Echinacea for cases of blocked sinuses even when
there is only evidence of allergy and no infection
because the sinuses are so prone to chronic low
grade infection due to the thick copious mucus
produced by the allergic patient. It is advisable to
use root only preparations of Echinacea in cases of
potential allergy to pollen from the aerial part.
•
Golden seal as a mucous membrane tonic and as an
antibacterial.
•
Fenugreek for its demulcent activity on mucous
membranes.
•
Eleuthero as an adaptogenic to increase vitality
generally.
•
Schisandra as it increases both phase I and II liver
detoxification.
•
Ginger as a herb providing anti-inflammatory
activity.
For professional use only. Not for Public Distribution.
Eyebright was added for its effects on strengthening
mucous membranes and ashwaganda as a long-term
adaptogenic.
Third Consultation (4 weeks later)
Improvement again, feeling much better, mucus gone
and headaches occurring only occasionally.
CASE 3: ECZEMA & ASTHMA
Twin boys aged 4 years.
History: Asthma since age 2. Eczema since birth.
Breastfed for 4 months, very allergic to pet hair.
The boys had received multiple antibiotic treatment. On
examination: Erythema in skin folds, cracked, dry and
flaky; trunk – rough like sandpaper.
Current medical treatment: A corticosteroid cream
every night.
Treatment
Dietary changes: avoid preservatives, colourings, dairy,
changed to a heavy rye bread; increase orange-coloured
vegetables.
Modern Phytotherapist 9
Clinical
Herbal Formula 1
Herbal Formula 2
Licorice (Glycyrrhiza glabra)
1:1
15 mL
Rehmannia (Rehmannia glutinosa)
1:2
40 mL
Figwort (Scrophularia nodosa)
1:2
15 mL
Figwort (Scrophularia nodosa)
1:2
40 mL
Skullcap (Scutellaria lateriflora)
1:2
20 mL
Burdock (Arctium lappa)
1:2
20 mL
Grindelia (Grindelia camporum)
1:2
20 mL
Echinacea purpurea root and
E. angustifolia root blend
1:2
40 mL
Burdock (Arctium lappa)
1:2
20 mL
Grindelia (Grindelia camporum)
1:2
40 mL
Albizia (Albizia lebbek)
1:2
15 mL
Skullcap (Scutellaria lateriflora)
1:2
40 mL
105 mL
Dose: 2 mL b.i.d.
The best way to get children to take the dose is to mix it
into thick apricot nectar. Red grape juice, jam or honey
can also be used. If all else fails, the dose can be
administered by drawing into a plastic syringe and
squirting down the throat!
Other supplements taken daily: evening primrose oil
(Oenothera biennis) 1 teaspoon (5 mL, equivalent to
1 x 500 mg capsule) and a magnesium supplement.
The formula contained:
•
Licorice for its anti-inflammatory, antiallergic and
adrenal tonic action.
•
Figwort as a gentle eliminative herb specifically for
the skin.
•
Skullcap as a nervine tonic. (Eczema in children is
often exacerbated by stress or anxiety. Highly
excitable children are also susceptible to eczema
flare-ups.)
•
Grindelia as a gentle respiratory spasmolytic.
•
Burdock as an alterative herb to increase the
elimination of toxins.
•
Albizia for its antiallergic activity.
Second Consultation (6 weeks later)
Skin much improved, the inflammation totally gone,
but skin still dry in places. No asthma.
220 mL
Dose: 2 mL b.i.d.
Evening primrose oil dose was doubled (1 teaspoon
twice per day, 2 x 500 mg capsules).
Rehmannia was added for its antiallergic effects and as
an adrenal tonic herb and Echinacea to boost the
immune system to reduce the risk of infection thereby
reducing the risk of asthma.
Third Consultation (6 weeks later)
Their mother was very pleased with progress –
occasional flare-ups but not using the corticosteroid
cream now, using rose hip oil instead.
CASE 4: ALLERGIC RHINITIS
This 23-year-old patient complained of allergy
problems. She seemed to react to dust mites, cats, dogs
and perfume. Her reactions were characterised by
sneezing, itchy eyes, nasal congestion and blotchy red
skin. She often woke with headaches and generally had
plentiful tenacious mucus and postnasal drip. She also
complained of bloating and bad history of bronchial
asthma. She had a fairly good diet and had eliminated a
lot of mucus-causing foods.
Treatment
Herbal Formula 1
Pau d’arco (Tabebuia avellanedae)
1:2
40 mL
Eyebright (Euphrasia officinalis)
1:2
40 mL
Albizia (Albizia lebbek)
1:2
40 mL
Skullcap (Scutellaria lateriflora)
1:2
40 mL
Golden seal (Hydrastis canadensis)
1:3
40 mL
200 mL
Dose: 5 mL t.i.d.
Additionally: vitamin C with bioflavonoids.
10 Modern Phytotherapist
For professional use only. Not for Public Distribution.
Clinical
The formula contained:
•
Pau d’arco to boost the immune system and reduce
Candida levels.
•
Eyebright as a mucous membrane tonic to
strengthen the irritated and reactive mucous
membranes.
skin was exceptionally dry, she had severe eczema on
most of her body which was intensely pruritic. Her
hands were shedding pieces of skin and she could not
stop scratching. She was a smoker (10 cigarettes per
day) and had been on an elimination diet.
•
Albizia for its antiallergic activity.
Current medications: Promethazine to sleep, evening
primrose oil at night, fish oil and lecithin.
•
Skullcap as a nervine tonic.
Treatment
•
Golden seal as a mucous membrane tonic.
Dietary changes: increase orange-coloured vegetables
and water intake.
Second Consultation (2 weeks later)
She had been consistent with treatment and diet and
had experienced three flare-ups associated with
dusting/housekeeping.
Herbal Formula 2
Golden seal (Hydrastis canadensis)
1:3
40 mL
Albizia (Albizia lebbek)
1:2
30 mL
Elder flower (Sambucus nigra)
1:2
30 mL
Herbal Formula 1
Rehmannia (Rehmannia glutinosa)
1:2
80 mL
Licorice (Glycyrrhiza glabra)
1:1
40 mL
Ashwaganda (Withania somnifera)
1:2
60 mL
Dandelion root (Taraxacum officinale)
1:2
20 mL
Mexican valerian (Valeriana edulis)
1:2
20 mL
220 mL
Echinacea purpurea root and
E. angustifolia root blend
1:2
40 mL
Dose: 5 mL t.i.d.
Licorice (Glycyrrhiza glabra)
1:1
40 mL
The formula contained:
Valerian (Valeriana officinalis)
1:2
20 mL
•
Rehmannia for its antiallergic effect and because it
is particularly good for allergic skin conditions.
•
Licorice mostly as an adrenal tonic but also for its
antiallergy activity.
•
Ashwaganda an adaptogenic and tonic herb.
•
Dandelion root for liver support.
•
Mexican valerian as a nervine relaxant.
200 mL
Dose: 5 mL b.i.d.
The formula contained:
•
Elder flowers to dry up the sinuses.
•
Echinacea to boost the immune system.
•
Licorice as a demulcent.
Third Consultation (4 weeks later)
Second Consultation (2 weeks later)
The patient was generally better – less mucus, less
sneezing and less itchy eyes. She took a course of
antibiotics for bronchitis (she had an infection).
No flare-up of eczema.
Herbal formula repeated and Acidophilus added to
regime.
Rehmannia (Rehmannia glutinosa)
1:2
80 mL
Licorice (Glycyrrhiza glabra)
1:1
40 mL
Fourth Consultation (6 weeks later)
Mexican valerian (Valeriana edulis)
1:2
30 mL
The patient was pleased with the reduction of allergy
symptoms and has not suffered from influenza despite
those around her contracting it.
Ashwaganda (Withania somnifera)
1:2
50 mL
CASE 5: CHRONIC ECZEMA
This patient is a 44-year-old woman who had a history
of eczema for 15 to 16 years. When I first saw her, her
For professional use only. Not for Public Distribution.
Herbal Formula 2
200 mL
Dose: 5 mL b.i.d.
Tablets containing valerian (Valeriana officinalis),
passion flower (Passiflora incarnata) and spiny jujube
(Zizyphus spinosa): 1 tablet t.i.d.
Modern Phytotherapist 11
Clinical
Third Consultation (2 weeks later)
Eczema had improved, not as much redness,
significantly less pruritis. She was trying to give up
smoking.
Started with an initial 10 mL dose and followed hourly
with 5 mL, for 4 hours. The above herbs were
prescribed for their antiallergic action.
Rehmannia (Rehmannia glutinosa)
1:2
80 mL
Licorice (Glycyrrhiza glabra)
1:1
40 mL
Mexican valerian (Valeriana edulis)
1:2
15 mL
Patient went home and came back around 2 hours later
– face was visibly improved, eyes not as swollen and the
chest not as tight. In this situation the patient would
normally have had to take antihistamines but did not
need to in this case. She continued taking the herbal
formula the following day at 5 mL t.i.d., and reduced
the dose thereafter over 2 days.
St John’s wort (Hypericum perforatum)
1:2
50 mL
REFERENCES
Herbal Formula 3
1
Edwards CRW et al (eds). Davidson’s Principles and Practice of Medicine,
17th Edn. Churchill Livingstone, Edinburgh, 1995.
Dose: 5 mL b.i.d.
2
Harrison TR, Isselbacher JK. Harrison's Principles of Internal Medicine,
14th Edn. McGraw-Hill, New York, 1994.
St John’s wort was added to relieve symptoms of
depression (she displayed some evidence of anxiety and
depression over the course of consultations).
3
Kurzius-Spencer M, Halonen M, Holberg CJ et al. American Thoracic
Society’s 98th International Conference, Georgia, May 20, 2002,
Poster J50.
4
Werbach M. Nutritional Influences on Illness. Third Line Press, 1996.
5
Barnes RM, Lewis-Jones MS. J Clin Lab Immunol 1989; 30(2): 87-91
6
Rupprecht M, Salzer B, Raum B et al. Exp Clin Endocrinol Diabetes 1997;
105(1): 39-45
185 mL
Fourth Consultation (4 weeks later)
Skin considerably better. Occasional flare-ups but mild
in comparison. Much less itchy and very pleased with
her progress.
This patient remained on herbal treatment. She did have
a flare-up of eczema after running out of the herbal
formula, which was controlled after her going back on
the herbs.
I saw this patient recently for another health issue, and
was pleased to note that her skin remains clear.
CASE 6: ACUTE ALLERGIC
REACTION
In this case of acute allergic reaction, herbal treatment
provided remarkable results.
A 32-year-old female presented as highly allergic to cat
dander. She had been exposed approximately 1/2 hour
before, by the time I saw her, her eyes were so
oedematous they were slitting. Her face was swollen,
puffy, red and blotchy and she was audibly wheezing
and finding it difficult to breathe.
Treatment
Herbal Formula
Rehmannia (Rehmannia glutinosa)
1:2
40 mL
Albizia (Albizia lebbek)
1:2
60 mL
Licorice (Glycyrrhiza glabra)
1:1
60 mL
160 mL
Ms Tracey Cook
ND, MNHAA, MATMS
Tracey Cook was a registered nurse for a number of
years before undertaking a career change to
naturopathy. She has over 12 years' experience in
Naturopathy and has a busy practice in a
multidisciplinary natural health clinic in Adelaide.
Tracey has lectured extensively in colleges and a
number of hospitals in Adelaide and also on radio.
She treats many patients with allergies and
sensitivities and began naturopathy due to her
experience with 20 years of severe atopic eczema
which completely disappeared after naturopathic
treatment.
Dose: 5 mL hourly (as follows).
12 Modern Phytotherapist
For professional use only. Not for Public Distribution.
Clinical
Herbal Treatment for Intestinal Parasites
BY KERRY BONE AND MICHELLE MORGAN
Spring is traditionally a time for cleaning. This was well
recognised by European herbalists who used a number
of herbs as “spring tonics” or “spring cleansers”. Many of
these spring tonics provided much needed vitamins
after a lengthy period of consuming stored foods. But
they also included the depurative herbs (which cleanse
the blood by yet unknown mechanisms) and herbs for
promoting digestion, including the bitter herbs
wormwood and gentian. Wormwood, as the name
implies, was also traditionally used to treat
gastrointestinal worm infestation. We may conclude
that this aspect was also part of the use of spring tonics.
Whether this is the case or not, it is true to say that the
plant world has long provided options to assist in the
control of intestinal parasites. A few of the more
popular of these herbs are reviewed below, together
with a significant and highly active anthelmintic herb
from traditional Chinese medicine (TCM). But the
main thrust of this review is to suggest that synergistic
activity via a combination of these key herbs (with
other herbal treatments as well to support digestion and
immunity for example) will yield the best results.
Stemona
Stemona radix, the tuberous root of Stemona sessilifolia,
Stemona tuberosa or Stemona japonica, is used in TCM
mainly for the treatment of acute and chronic cough.
Externally it is used for the treatment of fungal
infections, lice infestation and as an enema for pinworm
infestation.1,2,3 In addition to its primary use for the
treatment of cough, in Vietnam Stemona japonica root
is prescribed for Ascaris infestation and is used
externally to treat scabies (mite infestation).4 Plant
extracts from the Stemonaceae have also been used in
Japanese traditional medicine in the treatment of
respiratory diseases and as anthelmintics.5
Key Constituents
A series of complex alkaloids have been isolated from
the root of these Stemona species.6 The unusual and
complex alkaloids exist only in Stemona plants and in a
few related species and include tuberostemonine and
stemonine.7
Anthelmintic Activity
The experimental anthelmintic activity of crude extract
For professional use only. Not for Public Distribution.
of Stemona may be due to the action of its alkaloids.
Tuberostemonine, an alkaloid isolated from Stemona
sessilifolia, S. tuberosa and S. japonica root,6 paralysed
the motility of Angiostrongylus cantonensis in vitro and
showed contractive effects on the motility of Dipylidium
caninum and Fasciola hepatica.8 Tuberostemonine was
inactive in vitro as an anthelmintic against a species of
tapeworm.9
One hundred and forty cases of ancylostomiasis (hook
worm infestation) were treated with the herb. After 3
months, follow-up examination of 110 cases revealed a
negative rate of 94.5%. Another group of 48 cases was
effectively treated with the herb decoction; 116 worms,
all from the duodenum, were expelled. However, the
same method did not show any anthelmintic effects in
later trials.2 Alcoholic extracts may have greater efficacy
than decoction.
A suppository prepared from Stemona root tuber was
used to treat 40 children with oxyuriasis (infestation
with a type of nematode); 16 of them were cured.
Twenty-seven out of 63 cases were cured by the herb
powder.2
Dosage:
•
Suppository (12.5 g each), one suppository was
inserted into the rectum at 8 pm, another at 10 pm
every night for one week, then every other night
for another week.
•
Powder: 1.5 g, 3 times daily for 3 days.
Wormwood
Artemisia absinthium is well known to herbalists with
particular application to treating nematode infestation,
especially infestation with Enterobius or Ascaris.10,11
Wormwood has been used as an anthelmintic since
ancient times and is currently utilised in many
countries throughout the world for this purpose.
Wormwood tincture is employed in the West Indies as a
worm preventative.12 Wormwood has also been used for
the de-worming of horses, cows and sheep.13,14
Key Constituents
Constituents of the aerial parts of wormwood include
bitter substances (sesquiterpene lactones, mainly
absinthin) and an essential oil containing mainly
Modern Phytotherapist 13
Clinical
terpenes. The essential oil contains the potentially toxic
monoterpene thujone and for this reason the
recommended therapeutic doses of wormwood should
not be exceeded.15
Anthelmintic Activity
In vitro wormwood aqueous extract demonstrated
anthelmintic activity towards the nematode
Trichostrongylus colubriformis,16 and wormwood oil was
active in the Toxocara assay (defined below).17 Thujone
is also implicated in the anthelmintic activity of
wormwood. Experiments carried out in Edinburgh in
1955 indicated the efficacy of thujone in eliminating
Ascaris lumbricoides.18
Other Related Activity
Wormwood aqueous extract and alcohol extract
strongly inhibited the in vitro growth of the parasitic
protozoa Naegleria fowleri. The sesquiterpene lact one
fraction isolated from the alcohol extract was also
active.19
Wormwood powder (1.5 g/day) provided effective
treatment for acute intestinal amoebiasis in an
uncontrolled trial of 20 patients. Symptoms were
relieved and 70% of cases were cleared of the protozoa
Entamoeba histolytica according to stool analysis.20
Wormwood is also used to treat other gastrointestinal
conditions such as appetite loss, disturbed digestion,
flatulence11 and disordered bile flow.21 Clinical trials
have demonstrated the ability of wormwood to increase
the flow of gastric enzymes, pancreatic enzymes and
bile.22,23
Black Walnut Hulls
A globular fruit is produced from the black walnut tree
which contains a corrugated nut in its yellowish-green
hull (also called husk or fruit wall). Upon ripening the
hull softens and turns dark brown to black due to
chemical oxidation. A decoction of the hull of Juglans
nigra fruit has been used traditionally to expel worms.11
Key Constituents
The unripe, green hulls of Juglans nigra contain 1,4naphthoquinones including juglone and plumbagin.24
The juglone content in green hulls varies with different
cultivars and different months of growth.25
Anthelmintic Activity
In vitro studies indicate that plumbagin inhibited the
motility of and hatching of Haemonchus contortus first
14 Modern Phytotherapist
stage larvae. Plumbagin was larvicidal towards Ascaris
suum at the highest test concentration (100 mM).
Partial inhibition of embryonic development of A. suum
occurred with plumbagin.26 The authors suggested that
because of the relatively high doses required for the
maximal effect on inhibiting the development of larval
stages, plumbagin may not find practical application.
The combination with other anthelmintic herbs would
however, boost the activity of plumbagin.
Clove Bud Essential Oil
The dried, unopened flower bud of Syzygium
aromaticum (Eugenia caryophyllus) has been used in
Ayurveda and Western herbal medicine as a carminative
and aromatic.11,27 It has recently been popularised as a
worm treatment. Therapeutic indications for clove bud
include nausea, flatulence, dyspepsia and to assist the
action of other herbal remedies.11,27,28
In traditional Thai medicine the essential oil is used as a
carminative and to treat stomach ache, in addition to
the well-known topical application of toothache.29 In
Indonesian traditional medicine clove oil is taken with
beer to protect against abdominal pain! Clove bud is
also used in this traditional system to alleviate
flatulence.30
Key Constituents
Key constituents of clove bud include an essential oil
(15–20%, consisting mainly of eugenol, eugenol acetate,
beta-caryophyllene), flavonoids, tannins and phenolic
acids.31 Eugenol is a major constituent of clove bud
essential oil (80–85%).32
Anthelmintic Activity
Clove powder demonstrated potent anthelmintic
activity in vitro towards Pheretima spp. (earthworms).
At the time of the study, earthworms were used as a
model to investigate anthelmintic activity. Suspension
of clove powder was more than 5 times more potent
than a water extract of cloves, and clove powder was 4.5
times more potent than powdered fresh garlic.
Suspension of clove powder was 7.3 times more active
than the anthelmintic drug piperazine, whereas the
water extract of clove was of similar potency.33
Piperazine is an anthelmintic drug which has been used
to treat pinworm and roundworm infections in humans
for decades.
Both water extract and methanol extract of clove bud
were strongly active in a nematocidal assay.34 The assay
used the second-stage larva of the roundworm Toxocara
canis, which at the time of the study was highly resistant
For professional use only. Not for Public Distribution.
Clinical
to anthelmintic drugs. The relative movability (RM)
value compares the extent of movement of the test
population which has been exposed to the anthelmintic
agent with the movability of the control sample. Strong
activity was defined as a RM value of 0 (at which all
larvae are dead). A value of 100 indicates no activity (no
disabling effect on the larvae), and increasingly lower
RM values approaching 0 indicate stronger activity of
the extracts against the larvae.
A value of 0 was obtained for clove methanolic extract
tested at both concentrations (1 mg/mL, 10 mg/mL)
and at both time frames (6 h, 24 h) and for water
extract (10 mg/mL) at 24 hours. Piperazine produced a
RM value of 32 for 1 mg/mL after 24 hours of
incubation in the same assay and other anthelmintic
drugs such as phenothiazine produced a RM value of 0
under the same conditions. Eugenol produced a
RM value of 0 at 1 mg/mL at 24 h, and a value of 50 at
the lower concentration of 0.1 mg/mL after the same
time period.34 In another study using the same assay a
RM value of 0 was obtained for clove bud oil at
1 mg/mL for both time frames (6 h, 24 h), and for
eugenol at the same concentration at 24 h.17
Clove oil killed Anisakis spp. larva in vitro.35 Eugenol
also demonstrated potent anthelmintic activity towards
Substance
Caenorhabditis elegans in vitro36 and Rhabditis
macrocerca and Ascaris suum in vitro and in vivo in mice
(route unknown).37
Potential for Synergistic
Anthelmintic Activity
The phenomenon known as bursting of worm larvae
occurs when the outer covering of the larva is torn,
resulting in protrusion of its intestine. Nematocidal
assays can discover active principles that cause the
killing and/or bursting of worm larvae. A constituent
that has no nematocidal activity may produce bursting
when combined with a nematocidal agent.
Eugenol caused bursting of worm larvae in the Toxocara
assay described above. The activity of eugenol on its
own was relatively weak (11%) but it caused marked
bursting of worms (90–91%) when combined with
tannins (hydrolysable tannin and condensed tannins
respectively).34 Tannins are not larvicidal by themselves,
but they cause bursting when combined with a
larvicidal compound, as has been demonstrated in the
same assay previously.38 This is visually represented in
the following table.
Nematocidal Activity §
Bursting Activity §
clove bud methanol extract
√ (strong)
x
eugenol
√ (strong)
√ (weak, 11%)
tannins*
x
x
√ (strong)
√ (strong, 90–91%)†
eugenol + tannins*
Table 1. The presence of an inactive substance increases the bursting activity of weakly active substances.34,38
Note: All substances tested at 1 mg/mL and 24 h incubation, except the tannins when tested alone (0.2–10 mg/mL). For the
constituent-tannin combination eugenol = 1 mg/mL, tannins = 0.1 mg/mL.
§
Strong nematocidal activity is defined as RM = 0 at 1 mg/mL, 24 h; strong bursting activity: 50–100%.
*
Two sets of tannins tested: a hydrolysable tannin (tannic acid) and condensed tannins
(mixture from Areca catechu (betel nut)).
†
Range expresses hydrolysable tannin and condensed tannin mixture respectively.
In order to cause bursting, coexistence of both the
anthelmintic compound and the bursting factor is
necessary. The bursting activity of tannins (when
combined with the suitable larvicidal substance)
increased with increasing degree of condensation for
condensed tannins and with increasing proportion of
phenolic groups for hydrolysable tannins.38 The types
For professional use only. Not for Public Distribution.
of tannins found in green tea extract were not tested
but could be expected to be active based on the
significant activity seen for complex hydrolysable
tannins. Grape seed extract could also be expected to be
active but this activity would only be due to the tannins
with a higher degree of condensation (tetramers or
more) found in these extracts.
Modern Phytotherapist 15
Clinical
Eugenol in combination with tannins can cause, even at
lower concentration than its minimum lethal
concentration (MLC), the bursting of worms if a large
amount of (another) nematocidal constituent is
Eugenol
present. (MLC was defined as the lowest concentration
producing a RM value of 0 after 24 hours incubation,
determined for eugenol as 0.33 mg/mL.)34 This is
highlighted in the following table.
Methyleugenol
+ Tannins
Bursting Activity
–
weak, 11%
–
weak, 13%
0.1 mg/mL
strong, 90–91%
1 mg/mL
0.1 mg/mL
inactive, 0–4%
0.9 mg/mL
0.1 mg/mL
strong, 55–92%
1 mg/mL
1 mg/mL
1 mg/mL
0.1 mg/mL
Note: Experimental conditions as per Table 1 (previous page).
Conclusions from these and further studies using the
Toxocara assay indicate:
•
a balance between the hydrophilicity (watersoluble) and hydrophobicity (fat-soluble) of the
constituents is important for the larvicidal
activity;39
•
the bursting activity may be caused not only by
tannins but also by other nonvolatile34 and volatile
constituents;17
•
that a different bursting feature was observed for
the tannin-nematocide mixture compared to the
bursting caused by essential oil alone17 suggesting a
different mechanism of action;
•
the synergistic action of tannins and an
anthelmintic not only damages the worms
irreversibly, but also, in some instances markedly
reduced the required amount of the anthelmintic.38
Methanol extract of turmeric rhizome (Curcuma longa)
demonstrated anthelmintic activity in the Toxocara
assay described above. RM values of 0 were obtained at
24 h for concentrations of 0.1–10 mg/mL.34,40 The
curcuminoids curcumin, demethoxycurcumin and
bisdemethoxycurcumin were ineffective when tested
individually. When they were mixed in equal
proportions (1:1:1), a strong nematocidal activity was
demonstrated.40
This research suggests the value of combining various
herbal agents for a synergistic anthelmintic activity. It
also implies that combination of anthelmintic herbs
with tannin-containing herbs such as green tea and
particularly herbs containing condensed tannins such as
grape seed extract will enhance their activity. As seen in
16 Modern Phytotherapist
the turmeric research the activity of an individual herb
depends on several of its constituents working in
synergy.
Recent Anthelmintic Research
In vitro tests conducted at a government laboratory in
Brisbane in 2002 using a number of herbal extracts and
essential oils have indicated that clove bud and Stemona
have definite positive anthelmintic activity towards a
sheep intestinal nematode prevalent in this locality.41
The testing included egg hatch assay, larval development
assay and infective larvae assay. At the tested dosage,
clove bud gave a convincing kill of the larvae
population, rather than just immobilisation. A field trial
testing a number of herbs and essential oils for the
treatment of worm infestation in sheep is pending.
Suggested Combinations for
Increased Activity
The following treatments would combine well and
provide synergistic anthelmintic activity with the
wormwood, black walnut hulls, Stemona and clove bud
essential oil mentioned above. These treatments should
be taken together (i.e. at the same time). The list
includes:
•
holy basil (Ocimum sanctum) essential oil, since the
leaf has been used in traditional Ayurvedic
medicine as an anthelmintic and the essential oil
has demonstrated potent anthelmintic activity in
vitro towards Caenorhabditis elegans.36 In the worm
bursting assay outlined above34 methyleugenol
demonstrated nematocidal activity but was devoid
of worm bursting activity. The presence of even a
For professional use only. Not for Public Distribution.
Summary of Anthelmintic Activity: Toxocara Assays
Substance
RM values
Burst
10 mg/mL
10 mg/mL
1 mg/mL
1 mg/mL
0.1 mg/mL
6h
24 h
6h
24 h
6h
0
0
67
0
0.1 mg/mL 1 mg/mL
24 h
Anthelmintic Study 1: Spices, Constituents, Standard Drugs1
clove methanol extract
0
clove water extract
0
0
garlic methanol extract
44
0
turmeric water extract
34
0
turmeric methanol extract
33
0
eugenol †
0
50
11%
methyleugenol †
0
56
13%
piperazine
32
phenothiazine
0
0
Anthelmintic Study 2: Essential Oils, Constituents2
clove bud oil
wormwood oil
0
0
67
0
24%
eugenol §
0
100
5%
methyleugenol §
0
97
9%
Anthelmintic Study 3: Turmeric & Turmeric Constituents3
turmeric methanol extract
84
0
curcumin
100
100
demethoxycurcumin
100
100
bisdemethoxycurcumin
100
100
curcumin +
demethoxycurcumin +
bisdemethoxycurcumin
9
0
Nematocidal activity determined using the second-stage larvae of Toxocara canis.
Note: A smaller RM (relative movability) value indicates a stronger nematocidal activity, and when all larvae die, this value is 0.
Moderate activity is defined as RM < 50, a value of 100 indicates the test substance is inactive. The lower the concentration
and the shorter the time of incubation the stronger the activity. The table is adapted from the indicated studies and does not
include all results.
†
Extracted from the dried fruit of allspice (Pimento dioica).
§
Purchased or obtained by fractional distillation from appropriate essential oils.
References
1
Kiuchi F, Nakamura N, Miyashita N et al. Shoyakugaku Zasshi 1989; 43(4): 279-287.
2
Nakamura N, Kiuchi F, Tsuda Y et al. Shoyakugaku Zasshi 1990; 44(3): 183-195.
3
Kiuchi F, Goto Y, Sugimoto N et al. Chem Pharm Bull 1993; 41(9): 1640-1643.
For professional use only. Not for Public Distribution.
Clinical
small amount of eugenol (5–10%) in the
methyleugenol-tannin mixture caused the bursting
of the worms, particularly when the tannin was of
the condensed type.34 Both eugenol and
methyleugenol occur in holy basil essential oil; the
amount of each varies depending upon the
chemotype.42
•
•
•
•
•
tannin-containing herbs especially preparations
containing green tea (Camellia sinensis) and grape
seed (Vitis vinifera) extract. These herbs should be
taken concomitantly with the anthelmintic herbs.
turmeric (Curcuma longa), because the rhizome has
been used as an anthelmintic in Thai traditional
medicine43 and has demonstrated in vitro
anthelmintic activity (outlined above).34,40
immune enhancing herbs such as Echinacea, and
also preparations containing Andrographis
paniculata and holy basil essential oil, to enhance
the body’s natural immune function and assist in
the immune response to worm infestation.
(Eosinophilia (increased number of eosinophils in
the blood) and elevated serum IgE (gamma-E
globulin) levels are features of many helminthic
infections.)
garlic (Allium sativum) which has been used as an
anthelmintic in Western herbal medicine,10 for
example, as a decoction or freshly mashed and
administered to children on an empty stomach.44
Garlic extract containing alliin/allicin was effective
against Rhabditis spp. and the eggs of Ascaris suum
in vitro.45
laxative herbs to promote elimination of the
worm infestation (or worm debris) via the bowel
including preparations containing cascara
(Rhamnus purshiana) and yellow dock
(Rumex crispus).
•
bitter herbs to promote the gastric acid barrier to
resist reinfestation. Gentian (Gentiana lutea) liquid
extract is recommended.
•
digestive enzyme preparations, such as the latex of
Ficus spp. which contains ficin has been used
traditionally in neotropical areas such as the
Amazon as an anthelmintic.46 However,
concomitant intake of digestive enzymes with
tannins may result in the inactivation of the
enzymes.
For professional use only. Not for Public Distribution.
Example Treatments
Herbal Liquid Formula
Echinacea purpurea root and
E. angustifolia root blend
1:2
30 mL
Wormwood (Artemisia absinthium)
1:5
15 mL
Black walnut hulls (Juglans nigra)
1:10 20 mL
Cranesbill root (Geranium maculatum)
1:2
20 mL
Thyme (Thymus vulgaris)
1:2
25 mL
110 mL
Dose: 5 mL with water 4 to 6 times a day for 10 days.
After a 10-day break, repeat treatment for 10 days. The
second treatment is to kill any larvae which may have
hatched after treatment, since herbal anthelmintics are
not very effective at killing eggs.
Note: These are adult doses. Use appropriate
calculations based on body weight for children’s
doses.
Tablet or Combined Protocols
Note that the doses for products given below represent
adult doses. Use appropriate calculations based on body
weight for children’s doses.
Core Treatment
Herbal tablets containing Andrographis, Echinacea
angustifolia root and holy basil leaf plus essential oil.
Dose: 4 tablets per day as a continuous treatment for
immune support.
AND
Herbal tablets containing Stemona spp., wormwood,
black walnut hulls, and clove oil.
Dose: 4 to 6 tablets per day for 10 days. After a
10-day break, repeat treatment for 10 days.
Additional Treatments (as required)
•
Garlic tablets (3 per day on the same days as the
wormwood tablets) for stubborn parasites.
•
A herbal formulation to promote digestion
containing chamomile (Matricaria recutita),
dandelion (Taraxacum officinale), Echinacea
angustifolia root, milk thistle (Silybum marianum)
and gentian (4 mL with water before meals) if a low
gastric acid barrier and poor digestion are thought
to contribute to reinfestation.
Modern Phytotherapist 17
Clinical
•
Herbal tablets containing rosemary (Rosmarinus
officinalis), green tea, turmeric and grape seed
(2 tablets per day on the same days as the
wormwood tablets but at different times) to provide
synergistic worm-killing activity.
24
Binder RG, Benson ME, Flath RA. Phytochem 1989; 28(10): 2799-2801.
25
Lee KC, Campbell RW. HortScience 1969; 4(4): 297-298.
26
Fetterer RH, Fleming MW. Comp Biochem Physiol C 1991; 100(3):
539-342.
27
Chopra RN, Chopra IC, Handa KL et al. Chopra’s Indigenous Drugs of
India, 2nd Edn, 1958, reprinted Academic Publishers, Calcutta, 1982,
pp 172-173.
28
Pharmaceutical Society of Great Britain. British Pharmaceutical Codex
1934. The Pharmaceutical Press, London, 1941, pp 288-289.
29
Farnsworth NR, Bunyapraphatsara N (eds). Thai Medicinal Plants.
Medicinal Plant Information Center, Bangkok, 1992, pp 233-236.
30
Dharma AP. Indonesian Medicinal Plants. Balai Pustaka, Jakarta, 1987,
pp 52-54.
31
See the following article for clinical anecdotes on the
treatment of worm infestation.
Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals: A Handbook for
Practice on a Scientific Basis. Medpharm Scientific Publishers, Stuttgart,
1994, pp 130-131.
32
Battaglia S. The Complete Guide to Aromatherapy. Virginia, Queensland,
The Perfect Potion, 1995, pp 235-236.
REFERENCES
33
Krishnakumari MK, Majumder SK. J Sci Indust Res 1960; 19C: 202-204.
34
Kiuchi F, Nakamura N, Miyashita N et al. Shoyakugaku Zasshi 1989; 43(4):
279-287.
Oishi K, Mori K, Nishiura Y. Nippon Suisan Gakkaishi 1974; 40(12): 12411250.
•
Laxative herbs, such as herbal tablets containing
cascara, dandelion root, yellow dock, dill (Anethum
graveolens) seed and chamomile (2–6 tablets before
bed twice a week during treatment with the
wormwood tablets) to assist the expulsion of
worms. The dose should be sufficient to create a
very loose stool.
1
Pharmacopoeia Commission of the People’s Republic of China.
Pharmacopoeia of the People’s Republic of China, English Edn, Volume I.
Chemical Industry Press, Beijing, 1997, p 173.
35
2
Chang HM, But PP. Pharmacology and Applications of Chinese Materia
Medica. Volume I. World Scientific, Singapore, 1987, pp 484-488.
36
Asha MK, Prashanth D, Murali B et al. Fitoterapia 2001; 72(6): 669-670.
37
Valette G, Cavier R, Debelmas J. Ann Pharm Franc 1953; 11: 649-653.
38
Kiuchi F, Tsuda Y, Kondo K et al. Chem Pharm Bull 1988; 36(5):
1796-1802.
39
Kiuchi F, Miyashita N, Tsuda Y et al. Chem Pharm Bull 1987; 35(7): 28802886.
3
Bensky D, Gamble A. Chinese Herbal Medicine Materia Medica. Eastland
Press, Seattle, 1986, pp 297-298.
4
World Health Organization. Medicinal Plants in Viet Nam. WHO Regional
Office for the Western Pacific, Manilla, 1990, pp 354-355.
5
Pilli RA, Ferreira de Oliveira MC. Nat Prod Rep 2000; 17(1): 117-127.
6
Tang W, Eisenbrand G. Chinese Drugs of Plant Origin. Springer-Verlag,
Berlin, 1992, pp 957-961.
40
Kiuchi F, Goto Y, Sugimoto N et al. Chem Pharm Bull 1993; 41(9):
1640-1643.
7
Qin GW, Xu RS. Med Res Rev 1998; 18(6): 375-382.
41
8
Terada M, Sano M, Ishii AI et al. Nippon Yakurigaku Zasshi 1982; 79(2):
93-103.
Information on file. MediHerb Research Laboratory, University of
Queensland, St. Lucia, Queensland 4072, Australia.
42
9
Wiesner KF (ed). Alkaloids, MTP International Review of Science, Organic
Chemistry, Series 1, Volume 9. Butterworths, London, 1975, p 144.
Lawrence BM. Essential Oils 1988-1991. Allured Publishing Corporation,
Carol Stream, 1993, pp 200-201.
43
10
British Herbal Medicine Association’s Scientific Committee. British Herbal
Pharmacopoeia. BHMA, Bournemouth, 1983.
Farnsworth NR, Bunyapraphatsara N (eds). Thai Medicinal Plants.
Medicinal Plant Information Center, Bangkok, 1992, pp 130-138.
44
Guarrera PM. J Ethnopharmacol 1999; 68(1-3): 183-192.
11
Felter HW, Lloyd JU. King’s American Dispensatory. 18th Edn, 3rd revision,
Volume 1. First published 1905, reprinted Eclectic Medical Publications,
Portland, 1983.
45
Chybowski J. Herbal Pol 1997; 43(4): 383-387.
46
Hansson A, Veliz G, Naquira C et al. J Ethnopharmacol 1986; 17(2):
105-138.
12
Quinlan MB, Quinlan RJ, Nolan JM. J Ethnopharmacol 2002; 80(1):
75-83.
13
Waller PJ, Bernes G, Thamsborg SM et al. Acta Vet Scan 2001; 42: 31-44.
14
Uncini Manganelli RE, Camangi F, Tomei PE. J Ethnopharmacol 2001;
78(2-3): 171-191.
15
Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. Medpharm
Scientific Publishers, Stuttgart, 1994, pp 45-48.
16
Bara S, Zaragoza C, Valderrabano J. SEMh Congreso 1999: Sociedad
Espanola de Malherbología, Longrono, Spain, November 23-25, 1999,
pp 233-240.
Glossary
Angiostrongylus cantonensis
Species of parasitic nematode. Human infection, caused by
consumption of raw slugs and land snails, results in
eosinophilic meningitis.
Anisakis
17
Nakamura N, Kiuchi F, Tsuda Y et al. Shoyakugaku Zasshi 1990; 44(3):
183-195.
Genus of roundworm. Human infection results from the
consumption of fish harbouring roundworm larvae.
18
Albert-Puleo M. Econ Bot 1978; 32: 65-74.
Anthelmintic/antihelmintic/nematocidal
19
Mendiola J, Bosa M, Perez N et al. Trans R Soc Trop Med Hyg 1991; 85(1):
78-79.
Causing the death and/or elimination of worms.
20
Tahir M, Siddiqui MM, Khan AB. Hamdard Med 1997; 40(3): 24-27.
Ascaris spp.
21
Blumenthal M et al (eds). The Complete German Commission E
Monographs: Therapeutic Guide to Herbal Medicines. American Botanical
Council, Austin, 1998, pp 232-233.
22
Glatzel H, Hackenberg K. Planta Med 1967; 3: 223-232.
23
Baumann IC, Glatzel H, Muth HW. Z Allgemeinmed 1975; 51(17):
784-791.
Ascaris lumbricoides is the largest nematode found in the
human intestine. Ascaris suum is a species of parasitic
nematode usually found in domestic pigs and a few other
animals. Human infection can also occur from handling pig
manure.
18 Modern Phytotherapist
For professional use only. Not for Public Distribution.
Clinical
Caenorhabditis elegans
Species of nematode that is widely used in biological,
biochemical, and genetic studies.
Dipylidium caninum
Species of tapeworm of which the dog and cat are definitive
hosts, and humans are an occasional host.
Entamoeba histolytica
Species of parasitic protozoa causing amoebiasis and amoebic
dysentery.
Enterobius
Genus of intestinal nematode including the pinworm or
threadworm Enterobius vermicularis.
Fasciola hepatica
Species of helminth commonly called the sheep liver fluke.
Occasionally seen in humans, it is most common in sheep and
cattle.
Haemonchus spp.
Haemonchus is a genus of parasitic nematode which infests
herbivores e.g. sheep, which ingest it with the grasses they eat.
Infestation of man is accidental.
Helminths
Parasitic worms, and includes the Acanthocephala, Nematoda
and Platyhelminths (which includes tapeworms (Cestoda)).
Larva
Mr Kerry Bone
BSc (Hons), Dip Phyto, FNIMH, FNHAA, MCPP
Kerry Bone was an experienced research and
industrial chemist before studying herbal medicine
full-time in the UK where he graduated and joined
the National Institute of Medical Herbalists. Kerry
is the founder of, and Director of Research and
Development at MediHerb and from 1990–1997
was appointed to the Traditional Medicines
Evaluation Committee of the Therapeutic Goods
Administration. He is a prolific writer and
presenter in Australia, New Zealand and the USA.
He has written and co-authored several authoritive
herbal medicine textbooks. Kerry is also a
practising herbalist with 18 years’ experience.
Immature, grublike stage, following the egg in the life cycle of
insects, worms, and other metamorphosing animals.
Nematode
Any worm of the phylum Nematoda (smooth-skinned,
unsegmented worms with a long cylindrical body shape
tapered at the ends).
Naegleria fowleri
Species of parasitic protozoa. Infection with this pathogen
produces primary amoebic meningoencephalitis.
Rhabditis
Genus of nematode, a few species of which are parasitic in
humans.
Toxocara canis
Species of parasitic nematode found in the intestine of dogs.
Infection in humans has consequences to tissues beyond the
intestines.
Trichostrongylus colubriformis
Nematode which is parasitic in the digestive tract of
herbivorous animals and occurs only as incidental infections in
humans.
For professional use only. Not for Public Distribution.
Ms Michelle Morgan
BSc, Dip App Sci (Herbalism)
Michelle Morgan has a Bachelor of Science degree
majoring in Chemistry from the University of
Queensland (1987) and worked in the scientific
field as a laboratory technician for many years. She
has expertise in Quality Assurance, working for
over 3 years as a Quality Assurance Chemist in
building products manufacture. Michelle has
worked for 8 years at MediHerb as Technical Writer
where she is responsible for information gathering,
technical writing and organising technical
publications. Michelle has also completed studies
in herbal medicine.
Modern Phytotherapist 19
Clinical
Use of Anthelmintic Herbs
Clinical Anecdotes by Dr Ella M McElwee
Case 1
Therapy
Female aged 69. General health: good. Digestive
problems, tightness in abdomen, moderate lightheadedness, sleep disturbances. Symptoms were not
previously experienced until about three months ago.
No prescription medications used at present. No
digestive stool analysis done. On a wheat- and dairyfree diet.
Therapy
Completed the following purification programme:
•
A whole food and botanical supplement mixed
with water to make a shake with a balance of
macro- and micronutrients from plant sources in a
highly bioavailable form
Dose: 2 rounded tbsps in 2 cups of water with
2 tsps of unheated flaxseed oil
•
Vitamin complexes, minerals, and phytonutrients
enlisting the detoxifying properties of over 20
different whole foods and botanicals in a
vegetarian nutritional supplement
Dose: 7 capsules t.i.d. on an empty stomach
for 7 days
•
Dietary fibre containing phytonutrients from 5
different whole foods and botanicals that function
synergistically
Dose: 3 capsules t.i.d. on an empty stomach
for 16 days
Goal to restore proteolytic activity and eliminate
parasites. The comprehensive protocol of superior
quality Echinacea purpurea root and E. angustifolia root
blend, black walnut hulls, pau d’arco, wormwood and
ginger was given as the following formula:
Herbal Formula
Echinacea purpurea root and
E. angustifolia root blend
1:2
Black walnut hulls (Juglans nigra)
1:10 50 mL
Pau d’arco (Tabebuia avellanedae)
1:2
50 mL
Wormwood (Artemisia absinthium)
1:5
30 mL
Ginger (Zingiber officinale)
1:2
10 mL
60 mL
200 mL
Dose: 5 mL t.i.d. for two weeks. Rest one week. Repeat
for two more weeks.
All the above problems were eliminated after six weeks
of herbal treatment.
Case 2
Female aged 65. General health: fair. Itching of skin,
grinding of teeth at night. Symptoms present for over
90 days. Using prescription medications for heart etc.
Involved in automobile accident two years ago. In
hospital for three months with multiple fractures,
including skull. In rehabilitation hospital for six
months.
20 Modern Phytotherapist
During the above programme the following were
avoided: wheat, dairy, refined sugars, caffeine, alcohol,
carbonated beverages, eggs, chicken, red meat, peanuts,
and shellfish. Diet included organic fresh fruits and
vegetables; brown, Thai, wild or Basmati rice; rice-based
foods, for example rice cakes, crackers, bread made with
rice flour, pasta, pancake mix, etc; non-medicinal herbal
or green teas; bottled organic fruit juices; unheated cold
pressed flaxseed oil. However, itching of skin continued,
along with grinding of teeth at night, so I prescribed the
comprehensive protocol for parasites: each tablet
containing a blend of Stemona spp. (1000 mg),
wormwood (100 mg), black walnut hulls (100 mg) and
clove oil (20 mg).
Dose: 4 tablets per day for 14 days, 10 day break and
repeat for 14 days.
The patient’s skin cleared and the grinding of
teeth stopped.
For professional use only. Not for Public Distribution.
Clinical
Clinical Anecdote
by Dr Bruce Bond
IDDM
My daughter, Marissa, is 15.5 years old and has been
dealing with IDDM for 2.5 years. Actually, up until
recently her sugar has been fairly constant but I suspect
hormonal issues are taking effect during certain times
of the month. She is a remarkable girl in that her diet is
phenomenal. She told me a while ago that she will take
care of her body and her diet mirrors this. She eats no
refined foods other than what her mother makes for her
(which has very low glycaemic index and is organic).
Our diet at home is all organic and free-range. We
actually had a doctor tell us to let her eat whatever she
wants and just adjust the insulin accordingly. To them
it’s all about the number, nothing about the long-term
effects of spiking blood levels. She was given the
following tablets to see if an antiparasitic protocol
would improve her condition.
•
Tablets containing a blend of Stemona spp.
(1000 mg), wormwood (100 mg), black walnut
hulls (100 mg) and clove oil (20 mg).
Dose: 2 tablets b.i.d. (Referred to below as
worming tablets.)
•
Capsules containing fig, papain, bromelain,
amylase, lipase and cellulose.
Dose: 2 capsules t.i.d. Part of her regular diabetic
regimen also included a Gymnema tablet (4 g,
standardised for gymnemic acid content).
Dose: 1 tablet t.i.d.
We saw a change in the sugar reading with the
introduction of the antiparasitic tablets, within a few
days Marissa’s blood sugar levels had stabilised. While
on these tablets her blood glucose remained around 90135 mg/dL. She had been experiencing wide swings
prior to beginning these tablets. The glucose readings
would range anywhere from 50 to 250 and occasionally
as high as 300. Once off the protocol for the 10-day rest
period, her blood glucose would gradually become less
stable. When beginning the antiparasitic tablets again,
she would quickly even out and would not have the
dramatic swings in blood glucose readings.
For professional use only. Not for Public Distribution.
Dr Ella M McElwee
ND, HMD, PhD
Dr Ella McElwee has been utilising the concept of
homoeopathy and naturopathy in her clinic since the
early 1970s. Dr McElwee is the owner and President of
Health By Choice, a health food store and nutritional
counselling centre situated in the Morrison’s Cove area
of western Pennsylvania which draws clients from all
over the United States, Canada, and beyond. Dr
McElwee uses the Carey Reams theory of ionisation
(which determines the state of homoeostasis
biochemically within the body) combined with other
disciplines such as iridology to suggest a nutritional
program that is unique to the client’s body’s chemistry.
She supports over fifty organizations, journals and
research groups in the integrative healthcare field, is a
Board Member of the American College of Integrative
Medical Practitioners and lectures regularly.
Dr Bruce Bond
DC, NOAC
Dr Bruce Bond has been in full-time private practice
since 1988. He graduated in 1985 from the National
College of Chiropractic, Illinois, USA. Before starting
his own practice he had worked as an associate doctor
for 2.5 years. His practice today is 95% private pay,
providing chiropractic manipulation, whole food
supplementation, and herbal therapy to his patients. He
also lectures around the country teaching the Meridian
Response Technique, nutrition, herbal therapy and
practice management to practitioners approximately
every other weekend throughout the year.
Modern Phytotherapist 21
Clinical
Prostate Problems and Solutions
BY ROB SANTICH
Increasing numbers of men are consulting natural
therapists for solutions to a variety of prostate
dysfunctions and diseases. The aim of this article is to
review these diseases and dysfunctions and examine the
herbal treatments available to practitioners.
The prostate is a gland about the size of a walnut which
encircles the urethra at the exit from the bladder. Its
function is to produce, along with the seminal vesicles, a
fluid in which ejaculated sperm are suspended. The
secretions from the prostate contain a large number of
different chemical substances, including nutrients and
buffers that protect the sperm against the acidic vaginal
secretions and prostaglandins.1
Benign Prostatic Hyperplasia
(BPH)
BPH is the result of non-malignant neoplasms of
epithelial glandular tissue, which causes hypertrophy of
the prostate gland. Fibroadenomatous nodes develop
mostly in the periurethral prostate tissue, but may
develop in the walls or middle lobe as well. The
resulting enlargement of the fibromusculature of the
prostate gland causes difficulty in urination and sexual
function.2
Symptoms and Signs
The symptoms due to BPH can be divided into voiding
symptoms which include decreased force of stream,
hesitancy, intermittency, straining to void, incomplete
emptying and urinary retention and storage symptoms
which include urgency, frequency, nocturia, dysuria and
urge incontinence. These symptoms are collectively
referred to as lower urinary tract symptoms. Current
thinking is that not all of these are due to BPH,
especially in older men, and may be the result of
detrusor urinae muscle changes.3
Pathogenesis
The exact pathogenesis of BPH is as yet unknown,
however investigators have proposed several hypotheses
to explain the development of prostate enlargement.
These can be divided into hormone-dependent
hyperplasia, the mechanical component, and alphaadrenergic tone (or the dynamic component).
Androgen Hypothesis (Mechanical Component)
Because androgen is required for prostate development,
it has been proposed increased prostatic concentrations
of androgen or increased androgen activity causes BPH.
It is widely accepted that the growth, function and
maintenance of the prostate gland are androgen
dependent. In the prostate, testosterone is converted to
5-alpha-dihydrotestosterone (DHT) by the enzyme 5alpha-reductase. DHT is the active intracellular
androgen and it elicits its biological activity by binding
to the nuclear androgen receptor (AR) protein. This
complex (DHT-AR) can bind to a specific DNA
sequence, thereby initiating or inhibiting the expression
of genes involved in growth regulatory pathways or the
production of secretory products such as prostate
specific antigen (PSA).6 Studies have shown, however,
that androgens do not stimulate prostatic epithelial cell
growth directly, whereas growth factors such as
epithelial growth factor (EGF) and transforming growth
factor alpha (TGF-alpha) do.7
These results perhaps support earlier work that
concluded that androgens, although not directly
involved, act to switch on proliferative processes, with a
certain level of androgens required to initiate the
proliferation.8
It is also interesting to note that it has been
demonstrated that the levels of DHT were similar in
both normal and BPH tissue.9
Prevalence
Oestrogen Hypothesis
The prevalence of BPH increases with age, with 50% of
men in their 50s and 90% of men over 80 having
histological evidence of BPH.4 Contrasting this, for the
clinical diagnosis of BPH, population-based studies
have shown the prevalence of BPH increases from 24%
of men in their 50s to over 50% of men in their 70s.5
Oestrogens originate from testosterone and the adrenal
androgen androstenedione through conversion by the
aromatase enzyme system. Early evidence from
experimental models, where the administration of
oestrogens and androgens induced BPH, suggested that
oestrogens might be involved in BPH.10
22 Modern Phytotherapist
For professional use only. Not for Public Distribution.
Clinical
Testis
Testosterone
PROSTATE
Testosterone
5-Reductase
DHT
Androgen
Receptor
The possible mechanism was described some years
previous by a leading prostate researcher who proposed
that oestrogen, mediated by sex hormone binding
globulin (SHBG), participates with androgen in setting
the pace of prostate growth and function. It is stated in
the review that SHBG increases with age and can act
like an additional androgen receptor in the prostate cell.
The author suggests that when oestrogen binds to
SHBG in the cell membrane, insulin-like growth factor
1 (IGF-1) is synthesised causing proliferation of
prostatic epithelial cells. Accompanying this, androgens
activate binding sites for growth factors, which cause
further proliferation. To summarise, using the words of
the researcher, oestrogen not only directs stromal
proliferation and secretion, but also through IGF-1
conditions the response of the epithelium to androgen.13
Dynamic Component
The term prostatism is given to the dynamic
component of symptoms relating to urethral
obstruction. Sympathetic nerve fibres (alphaadrenergic) innervate the smooth muscle of the prostate
capsule and bladder neck. Alpha-adrenergic tone
contributes to the total urethral resistance and some of
the symptoms of BPH are said to be related to the
corresponding state of contraction of the smooth
muscle of the prostate capsule and bladder neck.3
Growth Regulation, Secretion
Medical Management
Action of dihydrotestosterone (DHT) on prostatic tissue.
Adapted from Harrison’s Principles of Internal Medicine, 14th Edn. CD-ROM.
Mc Graw Hill, New York, 1998.
In recent years some light has been shed on the
question of age-related oestrogen/androgen balance and
BPH. One study concluded that the prostatic
accumulation of DHT, oestradiol and oestrone is in part
intimately correlated with ageing, leading (with
increasing age) to a dramatic increase of the
oestrogen/androgen ratio particularly in the stroma of
the prostate.11
Further to this, it has been demonstrated that prostate
size correlates with oestradiol levels and with the ratio
of oestradiol to free testosterone. The researchers stated
that the endocrine environment tended to be oestrogendominant with age, in particular after middle age, and
that patients with large prostates have more oestrogendominant environments. They concluded that this
relatively oestrogen-dominant status induces stromal
proliferation by some mechanism and leads to the
development of BPH.12
For professional use only. Not for Public Distribution.
For mild to moderate BPH alpha-adrenergic blockers
such as terazosin are used to improve voiding. Less
commonly prescribed are 5-alpha-reductase inhibitors
such as finasteride, which over time reduce prostate size
and therefore improve voiding.3
Prostate Cancer
Prostate cancer (PC) is the most common cancer (other
than skin cancer) in males and caused 2449 deaths in
Australia in 1997.14 The incidence of PC in Australia is
120 cases per 100 000 men15 with a mortality rate of 25
per 100 000.16 These figures imply that the majority of
affected men will die with PC and not from it.
The aetiological factors associated with PC are yet to be
firmly established. However, studies have highlighted
some trends.
•
There seems to be a clear difference in the
prevalence and mortality between various ethnic
groups. African-Americans have the highest rate,
Caucasian Americans an intermediate rate, while
Asian men have the lowest.17
Modern Phytotherapist 23
Clinical
•
The data on diet and PC has revealed a strong
correlation between per capita fat intake and PC
incidence and mortality.6
•
The single most important risk factor for
developing PC appears to be age, the chances
increase dramatically after age 50.17
•
Researchers have looked to the role of androgens in
promoting growth of the prostate gland. As a result,
pathways involved in androgen metabolism have
been implicated in PC such as 5-alpha-reductase
and the CYP3A4 gene. The CYP3A4 enzyme is
associated with the oxidative deactivation of
testosterone. A genetic variant of this gene has been
identified. Such a mutation may disrupt the
expression and activity of the gene. Therefore,
individuals with the mutation may have less
potential for oxidising testosterone, leaving greater
bioavailability of the hormone to be metabolised to
DHT. Studies have demonstrated an increase in
prostate tumour stage in men who carry this
mutation versus non-carriers.18
•
At least eight prospective studies have demonstrated
a correlation between PC risk and serum levels of
hormones. There appears to be a strong trend of
increasing PC risk and increasing levels of
testosterone and an inverse trend with increasing
levels of SHBG.19
Xeno-oestrogens, Phyto-oestrogens and
Prostate Cancer
For the past 40 years or so, evidence has been steadily
accumulating that suggests environmental chemicals
such as pesticides and industrial chemicals are having a
hormone-like effect in humans, fish and wildlife and
could possibly be a causative factor in human cancers. It
is believed that the endocrine and reproductive effects
of these chemicals are due to their ability to:
impotent and had low sperm counts.20
Recent meta-analyses of studies concerning the
incidence of prostate cancer amongst farm workers,
found there was a positive association between PC and
farming and concluded that this was most probably due
to the exposure to hormonally active agricultural
chemicals.21
The dietary intake of soy products has been associated
with a decreased risk of PC. It has been proposed that
the isoflavones present in soy beans are responsible for
this effect. Many mechanisms of action have been
identified for the isoflavone prevention of cancer. These
include: oestrogenic/antioestrogenic activity,
antiproliferation, induction of cell-cycle arrest and
apoptosis, prevention of oxidation, induction of
detoxification enzymes, regulation of the host immune
system and changes in cellular signalling. It is probable
that a combination of these effects is responsible for the
cancer prevention activity of isoflavones.22
A number of studies performed on experimental
models implanted with PC cells, using either soy or
genistein (an isoflavone present in soy), have
demonstrated that tumour growth was significantly
retarded and that invasive tumours were fewer.23
Epidemiological studies that include populations with a
wide range of PC rates and a wide variety of soy
consumption patterns generally show that men who eat
more soy are less likely to develop PC. For example,
consumption of soy products was more protective than
any other dietary factor in a study that examined
nutritional and socio-economic factors related to PC
mortality in 42 countries.24
•
mimic the effect of endogenous hormones,
•
antagonise the effect of endogenous hormones,
In 1997, the Medical Journal of Australia published a
case study that reported significant apoptosis in a
prostatic specimen from a man with adenocarcinoma
who had taken isoflavones (160 mg per day) derived
from red clover one week before surgery. The author
described this effect as typical of a response to high
dose oestrogen therapy and is suggestive of tumour
regression. There were no adverse side effects.25
•
disrupt the synthesis and metabolism of
endogenous hormones,
Human Papillomavirus (HPV) and PC
•
disrupt the synthesis and metabolism of hormone
receptors.
In 1949, the insecticide DDT was found to negatively
affect sperm count in crop dusters. Some time later
workers at a plant producing the insecticide kepone
were found to have lost their libido, many were
24 Modern Phytotherapist
Several papers have appeared in the literature suggesting
that HPV may cause genetic mutations in prostatic cells
leading to PC.26,27,28 Bob Flaws, a respected practitioner
of traditional Chinese medicine (TCM), writing in his
book Cervical Dysplasia and Prostatic Cancer, HPV, a
Hidden Link?, believes from his clinical perspective that
this connection is significant.
For professional use only. Not for Public Distribution.
Clinical
Diagnosis and Medical Treatment
Two investigations are used in screening patients for
PC. Digital rectal examination is used for diagnosis and
monitoring and measurement of blood prostate specific
antigen (PSA) helps track the course of the disease and
evaluate the response to treatment.3
Left untreated the 5-year survival is 91–100% for
localised disease, 85–95% for regional disease and only
26–31% for those patients with distant metastases.
Treatment options for prostate cancer depend on the
stage and histological grade of the cancer, the age of the
patient and co-morbidities. Treatment options include
observation, surgery, radiotherapy, hormonal therapy
and chemotherapy.3
Herbal Treatment for BPH
Treatment Goals
The mainstay of herbal treatment is the use of prostate
specific herbs (saw palmetto, nettle root and willow
herb). Secondary to these herbs, other useful strategies
can be employed if indicated, such as improving
bladder tone and function with Crataeva (usually
indicated in the older patient) and the alleviation of
prostatism with the use of antispasmodics such as
valerian and cramp bark.
Prostate Specifics
Saw Palmetto (Serenoa repens)
The use of saw palmetto berries for symptoms of BPH
dates back hundreds of years and it was highly regarded
by Eclectic physicians. It is widely accepted that the
berries possess anti-inflammatory, spasmolytic and
possibly antiandrogenic properties. Eclectic physicians
used the berries in a range of disorders from
inflammation of the respiratory tract to inflammation
of the genitourinary tract, especially cystitis and
prostatic hypertrophy as well as atrophy of sexual
tissues. It has considerable tonic activity as well and is
used as a sexual tonic.29
compared with placebo and that LESP produced similar
improvement in urinary symptoms and flow compared
to the drug finasteride and is associated with fewer
adverse treatment events.31 The majority of studies in
this review used 320 mg per day of LESP.
Nettle Root (Urtica spp.)
Stinging nettle root has a long tradition of use in
Germany for the treatment of inflammations of the
urinary tract, for the prevention of urinary lithiasis and
for the treatment of BPH.32
The use of nettle root extract is well supported from a
clinical perspective. There have been quite a number of
studies using nettle root extract on males with BPH
symptoms, the following is a representative sample.
Clinical observations of men after long-term treatment
with an alcoholic extract of nettle root reported an
improvement in bladder outlet obstruction symptoms
and a decrease in post-voiding residual urine.32 Another
study of BPH patients treated with an alcoholic fluid
extract of nettle root reported a 66% decrease in
residual urine, whilst another reported a decrease in
nocturia frequency in patients over the age of 60 after 6
months’ treatment at 5 mL per day of a 1:5 tincture.33
Willow Herb (Epilobium parviflorum)
The evidence for the use of willow herb for BPH, at
least from a scientific stance is lacking. In vitro studies
conducted on the plant are not convincing as to its
pharmacological activity, however my own positive
clinical experience is enough for me to continue
prescribing this herb.
There is an impressive body of pharmacological and
clinical evidence that supports saw palmetto use for
BPH, but to date its precise pharmacological activity
remains elusive, although research is suggestive of a
mild inhibition of 5-alpha-reductase, antiandrogenic
activity and an inhibition of androgen binding.30 Much
of the clinical work has used a liposterolic extract
(LESP) dosage form and not a fluid extract.
A recent review of clinical trials concluded that LESP
improves urological symptoms and flow measures
For professional use only. Not for Public Distribution.
WILLOW HERB
Modern Phytotherapist 25
Clinical
Crataeva (Crataeva nurvala)
Crataeva is one of the most important Ayurvedic herbs
with influence in the urinary tract. The herb possesses
bladder tonic and anti-inflammatory activity.34 It is now
widely accepted that not all BPH symptoms are due to
enlargement of the prostate, particularly in older men,
where an atonic bladder can contribute significantly to
symptoms.
Clinical data supports such a use. Thirty patients with
hypotonic bladder due to BPH were given a decoction
of Crataeva. There was a marked improvement in
frequency, incontinence, pain and retention of urine.
Urine flow improved as well as an increase in bladder
tone after therapy.34
Herbal Treatment of Prostate
Cancer
There are probably as many herbal treatments for
cancer as there are individual cancers. Unfortunately
there is no standard herbal protocol in relation to PC, as
treatment depends on individual causative factors.
However the following herbs may prove useful.
Essiac
Although not specific for PC alone, the use of Essiac
formula may have some benefit. The Essiac formula
(also known as sheep sorrel formula) consists of 4
herbs: burdock root, rhubarb root, sheep sorrel and
slippery elm. A recent study funded by the US National
Institutes of Health found widespread use and perceived
benefits amongst cancer patients taking Essiac (as a tea).
Just over 40% (40.6%) of the 1577 (of which 15.1%
were PC patients) current and former cancer patients
attributed a halt in their cancer progression to its use,
whilst 22% perceived the tea to be responsible for
partial or total remission of their cancer symptoms.
Nearly 90% reported positive effects such as a reduction
in pain, less nausea and fatigue and a return of appetite.
From these results the University of Texas
recommended controlled clinical trials be undertaken.35
Soy
Due to the compelling evidence in relation to soy and
isoflavones, an increase in soy consumption or soy
supplementation is warranted.
consider are saw palmetto and nettle root with support
from Crataeva and willow herb.
Antivirals
If HPV is implicated Thuja could prove useful. (HPV is
a naked virus and so St John’s wort (Hypericum
perforatum) will be ineffective.)
Others
Although clinical evidence is lacking, several herbs or
their components have displayed promising activity
against PC cell lines in vitro. Epigallocatechin-3-gallate
(EGCG), the major polyphenolic constituent in green
tea, has demonstrated apoptosis-inducing effects in
both androgen-sensitive and androgen-insensitive
human prostate carcinoma cells.36 Curcumin from
turmeric (Curcuma longa) was also found to possess
this same activity by down-regulating apoptosis
suppressor proteins.37
CASE STUDY 1: BPH
Retired male 58 years of age, diagnosed with moderate
BPH, 5 years previous. Had been prescribed prazosin
(an alpha-adrenergic blocker) when initially diagnosed,
but due to the unpleasant side effects, such as
headaches, and the feeling of weakness and lack of
energy, he decided to discontinue treatment. Since then
he had not sought further medical treatment. In the last
couple of years his symptoms had gradually worsened
to the point where he was now experiencing overflow
incontinence to such an extent that he had taken to
wearing a sarong to spare the embarrassment of the wet
stains on his trousers. It also kept him at home most of
the time.
Herbal Treatment
Nettle root (Urtica dioica)
1:2
30 mL
Willow herb (Epilobium parviflorum)
1:2
30 mL
Crataeva (Crataeva nurvala)
1:2
40 mL
100 mL
Dose: 10 mL t.i.d.
A capsule containing Serenoa serrulata liposterolic
extract: 1 capsule t.i.d.
Herbal Antiandrogens
Treatment Rationale
A similar protocol to that used in BPH may beneficial
in the initial stage of PC where the growth of the
prostate gland is under androgen control. The herbs to
A high priority was placed on the improvement of
bladder tone, which was the main reason such a large
dose of the herbal liquid was recommended. The second
26 Modern Phytotherapist
For professional use only. Not for Public Distribution.
Clinical
priority was the prescription of all the prostate specific
remedies in an endeavour to elicit maximum herbal
antiprostatic activity.
Course of Treatment
After 8 weeks of treatment, signs of a slight
improvement had begun to emerge in relation to
nocturia, urgency and overflow incontinence. At this
point there was no need to alter either the prescription
or the dose. From this point forward we communicated
by phone. The above treatment was continuous for 18
months, during which time improvement was steady,
although the dose of the liquid was reduced to 5 mL
t.i.d. after 6 months. After 18 months’ treatment the
patient no longer experienced overflow incontinence
and there was an all-round improvement in other
symptoms as well. The patient’s nocturia pattern was
down to twice a night.
CASE STUDY 2: PROSTATE
CANCER
SCHISANDRA
Male 61 years of age, single and working as an
upholsterer. Diagnosed with PC recently through
elevated PSA levels (9.3 ng/mL) and biopsy. Has a
history of urinary tract symptoms and hypertension
which is being managed with ramipril (2.5 mg once per
day). Ceased cigarette smoking in 1983. Living alone he
has found it difficult to prepare meals and will often
consume take-away foods. He consumed 1–2 x 750 mL
bottles of beer daily. He had already agreed to the
radiotherapy recommended by his medical specialist,
which was due to begin in 2 months. His main reason
for coming to see me was to establish whether herbal
medicines could support him through radiotherapy and
if this was successful whether herbal therapies could
keep the cancer at bay. After lengthy discussion the
following protocol was initiated.
Herbal Treatment
Astragalus (Astragalus membranaceus)
1:2
30 mL
Turmeric (Curcuma longa)
1:1
35 mL
Schisandra (Schisandra chinensis)
1:2
35 mL
his O blood group and given a dietary supplement
consisting of fruit and vegetable powders as a means of
increasing antioxidants such as lycopene. He also agreed
to cease drinking beer.
Treatment Rationale
Astragalus was chosen for its adaptogenic and tonic
activity; turmeric for its anti-inflammatory, anticancer,
antioxidant and cholagogue properties; Schisandra for
its adaptogenic and hepatoprotective properties. The
sheep sorrel formula tea was chosen for its traditional
use in various types of cancer.
Course of Treatment
The patient passed through the radiotherapy with
relative ease and was largely free of any side effects.
Following radiotherapy his PSA levels had dropped to
3.9 ng/mL. At this point he ceased taking the liquid
herbal formula but continued with the sheep sorrel
formula tea and was prescribed a soy supplement to be
taken three times a day. His dietary compliance was
reasonable and has continued with zero beer
consumption.
100 mL
Dose: 8 mL b.i.d.
A tea made from a dried herb combination containing
sheep sorrel, rhubarb root, burdock root and slippery
elm: 60 mL b.i.d.
The patient was also recommended a diet in line with
For professional use only. Not for Public Distribution.
In the 12 months following radiotherapy, his PSA levels
have not risen above 5 ng/mL. Currently the patient is
taking a tablet combination of turmeric, rosemary,
green tea and grape seed (3 tablets per day), and a
supplement of soy, standardised to contain 50 mg of
isoflavones (3 tablets per day). There has been no
significant change to his PSA levels.
Modern Phytotherapist 27
Clinical
REFERENCES
1
Vander AJ, Sherman JH, Luciano D.S. Human Physiology. 5th Edn.
McGraw-Hill Publishing, New York, 1990, pp 605-607.
2
Walsh PC. Benign prostatic hyperplasia. In: Harrison JH, Gittes RF,
Perlmutter AD et al (eds). Campbell’s Urology. WB Saunders, Philedelphia,
1979, pp 949-966.
3
Moran JA, Street PR, Rogerson JW. Aust J Hosp Pharm 2001; 31: 115-119.
4
McConnell JD. Epidemiology, etiology, pathophysiology and diagnosis of
benign prostatic hyperplasia. In: Walsh PC, Retik AB, Vaughan ED, Wein
AJ (eds). Campbell’s Urology. 7th Edn. WB Saunders, Philadelphia, 1998,
pp 1429-1452.
5
Garraway WM, Collins GN, Lee RJ. Lancet 1991; 338: 469-471
6
Marcelli M, Shao TC, Cunningham GR. J Anti-Aging Med 2000; 3(2):
191-200.
7
Jones HE, Eaton CL, Barrow D et al. Prostate 1997; 30(4): 219-231.
8
Bruchovsky N, Rennie PS, Vanson A. Biochem Biophys Acta 1975; 394(2):
248-266.
9
Walsh PC, Hutchins GM, Ewing LL. J Clin Invest 1983; 72: 1772-1777.
10
Coffey DS, Walsh PC. Urol Clin Nth Am 1990; 17: 461-475.
11
Kreig M, Nass R, Tunn S. J Clin Endocrinol Metab 1993; 77(2): 375-381.
12
Shibata Y, Ito K, Suzuki K et al. Prostate 2000; 42(1): 45-55.
13
Farnsworth WE. Prostate 1996; 28(1): 17-23.
14
Australian Institute of Health and Welfare and Australian Institute of
Cancer Registries. Cancer in Australia 1997: Incidence and Mortality Data
for 1997 and Selected Data for 1998 and 1999. Cancer Series No. 15. AIHW,
Canberra, November 2000.
15
Frydenberg M. Med J Aust 1998; 168: 477-478.
16
Hirst GHL, Ward JE, Del Mar CB. Med J Aust 1996; 164: 285-288.
17
Landis S, Murray T, Bolden S et al. CA Cancer J Clin 1999; 49: 8-31.
18
Zeigler-Johnson C. Clin J Oncol Nurs 2000; 5(4): 153-154.
19
Eaton NE, Reeves GK, Appleby PN et al. Br J Cancer 1999; 80: 939-934.
20
Sonnenschein C, Soto AM. J Steriod Biochem Mol Biol 1998; 65(1-6):
143-150.
21
Keller-Byrne JE, Khuder SA, Schaub EA. Am J Ind Med 1997; 31(5):
580-586.
22
Birt DF, Hendrich S, Wang W. Pharmacol Ther 2001; 90(2-3): 157-177.
23
Messina MJ. Am J Clin Nutr 1999; 70(suppl): 439S-450S.
24
Hebert JR, Hurley TG, Olendzki BC et al. J Natl Cancer Inst 1998; 90:
1637-1647.
25
Stephens FO. Med J Aust 1997; 167(3): 138-140.
26
McNicol PJ, Dodd JG. J Clin Microbiol 1990; 28(3): 409-412.
27
Serth J, Panitz F, Paeslack U et al. Cancer Res 1999; 59(4): 823-825.
28
Suzuki H, Komiya A, Aida S et al. Prostate 1996; 28(5): 318-324.
29
Ellingwood F, Lloyd JU. American Materia Medica, Therapeutics and
Pharmacognosy. 11th Edn. Eclectic Medical Publication, Portland, 1983.
30
Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal
Medicine. Churchill Livingstone, Edinburgh, 2000, pp 523-533.
31
Wilt T, Ishani A, Mac Donald R. Cochrane Database Syst Rev 2002;
(3):CD001423.
32
Bruneton J. Pharmacognosy, Phytochemistry, Medicinal Plants. Lavoisier
Publishing, Paris, 1995, p 604.
33
Scientific Committee of ESCOP (European Scientific Cooperative on
Phytotherapy). ESCOP Monographs: Urticae radix. European Scientific
Cooperative on Phytotherapy, ESCOP Secretariat, UK, March 1996.
34
Bone K. Clinical Applications of Ayurvedic and Chinese Herbs.
Phytotherapy Press, Warwick, 1996.
35
Richardson MA, Sanders T, Tamayo C et al. HerbalGram 2000; 50: 40-46
36
Gupta S, Hussain T, Mukhtar H. Arch Biochem Biophys 2003; 410(1):
177-185.
37
Dorai T, Gehani N, Katz A. Prostate Cancer Prostatic Dis 2000; 3(2):
84-93.
28 Modern Phytotherapist
Mr Rob Santich
DMH, MNHAA
Rob has been a practising herbalist for 18 years and
runs a herbal practice in Newport, Sydney. He is
the head of the Botanical Medicine Faculty at the
Australasian College of Natural Therapies in
Sydney and is a member of the expert advisory
panel to the Complementary Medicines Evaluation
Committee. He served as an examiner on the board
of the National Herbalists Association of Australia
for 5 years. Rob is a member of MediHerb’s
practitioner support team by advising on the
Clinical Support Line. His special interests are
medicinal Australian native plants and essential oils
and he is working with an Aboriginal land council
on research and development in this field.
Rob also has an interest in the use of herbs by
native Americans.
For professional use only. Not for Public Distribution.
Clinical
Clinical Monitor
BY KERRY BONE
Common Quality Pitfalls for
Tribulus are Highlighted
The herb Tribulus terrestris has become popular as a
herb which boosts libido and male sexual performance.
It is also used by phytotherapists to promote male and
female fertility, for menopausal symptoms and to boost
physical performance and fitness.1 Tribulus is a
common weed found in many parts of the world and
has been used for therapy in several traditional systems
such as Ayurveda and Chinese medicine. But the
modern uses cited above stem largely from Bulgarian
research using a standardised Tribulus leaf preparation
which is rich in furostanol saponins, especially the
marker phytochemical protodioscin.
Now two studies have highlighted that most Tribulus
products on the market are quite different from the
Bulgarian extract.2,3 The first study, conducted in the
US, found that the level of protodioscin varied
substantially with the plant part (leaf, stem or fruit) and
origin (Bulgaria, India or China) of the Tribulus.2 Only
leaf from Bulgaria was high in protodioscin. Analysis of
products selected from the US market found
deficiencies of protodioscin in the majority.
The second study from Australia produced similar
results.3 An Eastern European variety of Tribulus (from
Slovakia) contained high levels of protodioscin in the
leaf but none in the fruit. Leaf from Australia and India
did not contain protodioscin.
Comment
The principle of phytoequivalence dictates that if the
benefits demonstrated in a clinical trial are claimed for
a herbal product, then that product must closely match
the one used in the clinical trial. The Bulgarian clinical
trials which have shown that Tribulus boosts libido and
fertility and alleviates menopausal symptoms all used
Tribulus leaf rich in protodioscin collected from
Bulgaria. Therefore only similar products might
reasonably be expected to have the same effects. If a
Tribulus product is made from the root or fruit of the
plant, or is sourced from anywhere else other than
Eastern Europe, it will probably contain low levels of
protodioscin and so will be quite different to the
Bulgarian standardised extract. This is despite what
For professional use only. Not for Public Distribution.
might be claimed on the label for such products because
often inferior methods of analysis have been used to
measure the furostanol saponins, such as gravimetric or
colorimetric techniques. The quality of Tribulus
products is best assessed by high performance liquid
chromatography as used in the two studies cited above.
Coincidentally, a recent publication found that a
Tribulus extract rich in protodioscin possessed
aphrodisiac activity in male rats which was probably
due to an androgenic effect.4
REFERENCES
1
Morgan M, Bone K. Tribulus terrestris. Professional Review Aug 2001;
No. 76, pp 1-4.
2
Ganzera M, Bedir E, Khan IA. Determination of steroidal saponins in
Tribulus terrestris by reversed-phase high-performance liquid
chromatography and evaporative light scattering detection. J Pharm Sci
2001; 90(11): 1752-1758.
3
Lehmann RP, Penman KG, Halloran KG. Comparison of photometric
HPLC-ELSD analytical methods for Tribulus terrestris. Revista de
Fitoterapia 2002; 2(S1): 217 (Abstract B006).
4
Gauthaman K, Adaikan PG, Prasad RNV. Aphrodisiac properties of
Tribulus terrestris extract (protodioscin) in normal and castrated rats. Life
Sci 2002; 71: 1385-1396.
Claw Therapy for Arthritis and
Muscular Pain
Devil’s claw (Harpagophytum procumbens) is well
recognised as a herbal treatment for arthritic pain and
there are several clinical trials which support its use for
osteoarthritis and low back pain.1 A recent clinical trial
involving 63 patients found that the herb is also useful
for muscular pain in patients with slight to moderate
muscular tension or slight muscular pain of the back,
shoulder and neck.2 Patients received the equivalent of
about 3 g per day of devil’s claw over 4 weeks or a
closely-matched placebo.
Devil’s claw is also generating interest for veterinary
applications. The treatment of degeneration of the
proximal intertarsal, distal interdistal and tarsometatarsal joints and of muscular disorders was
investigated in ten race horses in comparison with a
control group of ten horses treated with
phenylbutazone over 60 days.3 The horses were given 0.5
mg/kg of an approximately 3:1 extract of devil’s claw.
Six horses receiving the devil’s claw showed a marked
improvement of symptoms, even compared to the
Modern Phytotherapist 29
Clinical
control group receiving the drug.
What is surprising is that another “claw” herb normally
used to boost immune function, namely cat’s claw, is
also under investigation for the treatment of
rheumatoid arthritis (RA). Forty patients undergoing
conventional drug therapy for active RA were enrolled
in a randomised 52-week, two phase study.4 During the
first phase (24 weeks) patients were treated with cat’s
claw extract or placebo under double-blind conditions.
In the second phase (28 weeks) all patients received the
herbal extract. Results for the first phase demonstrated a
reduction of the number of painful joints for the cat’s
claw group compared to placebo (by 53.2% vs. 24.1%;
p=0.044). Patients previously on placebo who then
received cat’s claw in the second phase of the study also
experienced a highly significant reduction in the
number of painful and swollen joints. Only minor side
effects were observed such as pruritis and dyspepsia and
there was a similar distribution of adverse events in the
active and placebo groups.
Comment
The finding that devil’s claw is beneficial for the relief of
muscular pain is a significant development and suggests
that devil’s claw may have value in the treatment of
fibromyalgia. The dose of devil’s claw given to the race
horses (0.5 mg/kg of extract) was considerably lower
than the dose used in the human trial (greater than
10 mg/kg of extract). However, it is conceivable that
horses may be more sensitive to the herb.
Rheumatoid arthritis is a complex and chronic disease,
so it would be simplistic to suggest that cat’s claw on its
own is an effective treatment for this condition.
Nonetheless, the favourable clinical trial is a positive
development in our understanding of phytotherapy for
RA. The extract used in the trial was from the
pentacyclic oxindole alkaloid chemotype of cat’s claw
(tetracyclic oxindole alkaloids were absent). This
chemotype is also preferred for the immune system
applications of cat’s claw.
REFERENCES
1
Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal
Medicine. Churchill Livingstone, Edinburgh, 2000, pp 345-349.
2
Gobel H, Heinze A, Ingwersen M et al. [Effects of Harpagophytum
procumbens LI 174 (devil’s claw) on sensory, motor and vascular muscle
reagibility in the treatment of unspecific back pain]. Schmerz 2001; 15(1):
10-18.
3
Montesano D, Ferrara L. Devil’s claw root: pharmacological study in
horses. Revista de Fitoterapia 2002; 2(S1): 105 (Abstract A045).
4
Mur E, Hartig F, Eibl G et al. Randomized double blind trial of an extract
from the pentacyclic alkaloid-chemotype of Uncaria tomentosa for the
treatment of rheumatoid arthritis. J Rheumatol 2002; 29: 678-681.
30 Modern Phytotherapist
New Clinical Uses for
Milk Thistle?
A group of Italian scientists investigated the ironbinding capacity of silybin, a component of the
complex of flavanolignans known as silymarin found in
milk thistle (Silybum marianum).1 Their motivation in
doing so was to find an orally-active, non-toxic
alternative to the iron-binding synthetic drug
desferrioxamine, which causes side effects such as bone
deformities, sensory abnormalities and cerebral toxicity.
Desferrioxamine, which must be administered by
injection, is currently the treatment of choice for the
iron overload which can follow transfusion therapy for
Cooley’s anaemia (-thalassaemia major). The scientists
found that silybin strongly binds the ferric ion (Fe(III)),
even at acidic pH. The complex of this molecule with
iron demonstrated remarkable stability.
Insulin-resistance and the associated conditions of
metabolic syndrome X and type I diabetes are becoming
increasingly prevalent in modern communities. In this
context a clinical trial published in 1997 should be
revisited. The aim of the study was to determine if longterm treatment with the silymarin complex from milk
thistle was effective in reducing lipid peroxidation and
insulin resistance in diabetic patients with cirrhosis.2 A
12-month open, controlled study was conducted in two
well-matched groups of insulin-treated diabetics with
alcoholic cirrhosis. One group (n=30) received 600 mg
silymarin per day plus standard therapy, while the
control group (n=30) received standard therapy alone.
The efficacy parameters, measured regularly during the
study, included fasting blood glucose levels, mean daily
blood glucose levels, daily glucosuria levels, glycosylated
haemoglobin (HbA1c) and malondialdehyde levels.
There was a significant decrease (p<0.01) in fasting
blood glucose levels, mean daily blood glucose levels,
daily glucosuria and HbA1c levels already after 4
months of treatment in the silymarin group. In
addition, there was a significant decrease (p<0.01) in
fasting insulin levels and mean exogenous insulin
requirements in the treated group, while the untreated
group showed a significant increase (p<0.05) in fasting
insulin levels and a stabilised insulin need. These
findings are consistent with the significant decrease
(p<0.01) in basal and glucagon-stimulated C-peptide
levels (an indicator of endogenous insulin production)
in the treated group and the significant increase in both
parameters in the control group. Another interesting
finding was the significant decrease (p<0.01) in
malondialdehyde levels observed in the treated group.
For professional use only. Not for Public Distribution.
Clinical
These results show that treatment with silymarin may
reduce the lipoperoxidation of cell membranes and
insulin resistance, significantly decreasing endogenous
insulin overproduction and the need for exogenous
insulin administration.
Comment
For some time I have been treating patients with the
iron-storage disease haemochromatosis with relatively
high doses of milk thistle extract (3 to 4 tablets per day
containing 200 mg of extract standardised to 168 mg of
silymarin). My motive in doing so was to protect the
liver against the oxidative damage caused by iron
accumulation in that organ. However, the above study
suggests that there could be significant additional
benefits from milk thistle in this disease. If milk thistle
tablets are taken with meals they will inhibit iron
absorption, but also the capacity of silybin to strongly
bind iron suggests that milk thistle therapy could also
facilitate the removal of iron from tissues. The next
question to be answered is how strongly silybin might
also bind heavy metals such as lead, cadmium and
mercury.
The capacity of milk thistle to reduce insulin resistance
could be a huge development in the therapy for this
major health issue. However, this finding needs to be
confirmed in patients with type II diabetes who do not
also have alcoholic cirrhosis.
Incidentally, a recent rat study found that silymarin had
significant oestrogenic activity.3 Will this versatile herb
also find a role in the management of menopausal
symptoms?
REFERENCES
1
Borsari M, Gabbi C, Ghelfi F et al. Silybin, a new iron-chelating agent. J
Inorg Biochem 2001; 85: 123-129
2
Velussi M, Cernigoi AM, De Monte A et al. Long-term (12 months)
treatment with an anti-oxidant drug (silymarin) is effective on
hyperinsulinemia, exogenous insulin need and malondialdehyde levels in
cirrhotic diabetic patients. J Hepatol 1997; 26(4): 871-879
3
Kummer V, Maskova J, Canderle J et al. Estrogenic effects of silymarin in
ovariectomized rats. Vet Med - Czech 2001; 46(1): 17-23
Saw Palmetto for Male Pattern
Baldness?
Laboratory experiments have shown that the
liposterolic extract of saw palmetto (LESP) is a weak
inhibitor of 5--reductase (5AR). While the relevance
of this weak activity to the oral use of LESP for benign
prostatic hyperplasia is debatable,1 a group of scientists
decided to test the effect of oral intake of LESP on male
pattern baldness in a pilot study involving men between
For professional use only. Not for Public Distribution.
SAW PALMETTO
the ages of 23 and 64 under double-blind conditions.2
The product tested also contained -sitosterol and
nutrients and the dose of LESP used was 400 mg per day
(equivalent to about 4 g of berry). The blinded
investigative staff rated 60% of the volunteers receiving
active treatment as improved, compared to only 11% for
the placebo group. Self-assessment by volunteers showed
a similar but less striking trend. The authors suggested
that this positive pilot trial justifies the expansion to
larger trials.
Comment
While the results of oral LESP for male pattern baldness
might be significant, they are also likely to be modest. It
is conceivable that topical application of LESP to the
scalp could add to the observed effect since it delivers a
high concentration of dose to the affected area. Soft gel
capsules could be cut and massaged into the scalp at
night.
While on the subject of herbs to improve appearance, an
interesting German study found that intake of nettle
and dandelion juices improved skin parameters in
healthy women.3 Both active and control groups used a
moisturising cream, but only the active group took the
herbal juices. Skin hydration improved significantly after
6 weeks in the experimental group (p<0.05). Elasticity
was significantly improved compared to controls. After 6
weeks of treatment, volunteers in the active group rated
their skin condition as significantly improved, whereas
there was little change for the control group.
Modern Phytotherapist 31
Clinical
REFERENCES
1
Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal
Medicine. Churchill Livingstone, Edinburgh, 2000, pp 523-533.
2
Prager N, Bickett R, French N et al. A randomized, double-blind, placebocontrolled trial to determine the effectiveness of botanically derived
inhibitors of 5--reductase in the treatment of androgenetic alopecia. J
Altern Complement Med 2002; 8(2): 143-152
3
Schmid D, Lang A, Allgauer T et al. Evaluation of effects of skin
parameters through oral treatment with stinging nettle and dandelion
extracts – an open, controlled, prospective pilot-study. Akt Dermatol 2001;
27: 25-29
Clinical Trial with Echinacea
Polysaccharides
In an open, prospective study with matched historical
controls, a polysaccharide fraction isolated from
Echinacea purpurea cell cultures was tested to see if it
could counter the undesired side effects of cancer
chemotherapy.1 Fifteen patients with advanced gastric
cancer undergoing palliative chemotherapy with a range
of cytotoxic drugs also received daily intravenous
injections of 2 mg of a polysaccharide fraction from
Echinacea. While the polysaccharide treatment did
appear to increase white cell counts, there were no
clinically relevant effects on phagocytic activity or
lymphocyte subpopulations. The authors suggested that
this form of treatment should be investigated in further
studies.
Comment
While on the subject of Echinacea myths, the
proponents of restricting the clinical application of
Echinacea to short-term use will probably make much
of a recent adverse reaction report concerning a 51year-old woman who developed mild leucopenia
(reduced white cell count) after taking Echinacea and
vitamin supplements over several months.3 Her white
cell count returned to normal on two occasions after
ceasing the Echinacea. However, this publication
contains the typical deficiency of many adverse case
reports for herbs, namely the failure to identify exactly
what the patient was taking. No information was
provided as to the Echinacea species or plant part used
by the patient, nor was there any analysis of the product
to determine whether it had been contaminated with
other substances or actually contained Echinacea. This
is an idiosyncratic adverse reaction of uncertain
aetiology and does not provide any proof that the longterm use of Echinacea is deleterious in a wider
population.
REFERENCES
1
Melchart D, Clemm C, Weber B et al. Polysaccharides isolated from
Echinacea purpurea herba cell cultures to counteract undesired effects of
chemotherapy – a pilot study. Phytother Res 2002; 16: 138-142
2
Dietz B, Heilmann J, Bauer R. Absorption of dodeca-2E,4E,8Z,10E/Ztetraenoic acid isobutylamides after oral application of Echinacea
purpurea tincture. Planta Med 2001; 67(9): 863-864
3
Kemp DE, Franco FN. Possible leukopenia associated with long-term use
of Echinacea. JABFP 2002; 15(5): 417-419
For several years now it has been proposed by some
writers that the activity of oral preparations of
Echinacea can be attributed to polysaccharides. In fact,
in advertising literature Echinacea has been compared
to other sources of polysaccharides such as larch
extracts and been found wanting (in terms of in vitro
models designed to detect polysaccharide-related
immune activities).
While the above research has demonstrated the
potential of a novel and new treatment, it also reveals a
fundamental flaw behind attempts to explain the
activity of Echinacea in terms of polysaccharides. In the
trial, the polysaccharides were administered by injection
because their oral bioavailability is uncertain. If the trial
scientists had believed that the polysaccharides were
orally active, then they would have administered them
this way.
Recently Bauer and coworkers found that the lipophilic
(and therefore ethanol-soluble) alkamides could be
detected in the bloodstream after oral doses of
Echinacea, thus establishing their bioavailability.2
Anyone wishing to explain the activity of traditional
preparations of Echinacea should be looking in this
direction.
32 Modern Phytotherapist
ECHINACEA
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