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Chapter 2 Herbs releasing Exterior syndromes解 表药 Introduction The Concepts: Exterior herbs Exterior Syndromes Wind/cold Syndromes Wind/heat Syndromes Aversion to cold/wind、fever/ nose congestion、 sneeze喷嚏、sweating/no-sweating、running nose、 cough、throat itch/sore、tough white coating、 pulse floating fast Upper respiratory infection(cold、flu)、 At first stage of Acute infectious Exterior syndromes Exterior herbal pharmacology Induce sweating Most herbs induce sweating Specially Pungent warm herbs Stimuli sweat glands:Mahuang麻黄fragrant oil挥发油、 ephedrines麻黄碱 Dilate blood vessels of skin ,regulate circulation:Shengjiang生姜、guizi桂枝. 扩张血管 Reduce fever (1)induce sweating; (2)inhibit bacteria/virus, decrease fever factors; (3)anti-inflammatory; (4)inhibit PGE(prostaglandin E) synthesized; (5)decrease cAMP in brain. Pungent cold herbs-stronger reduce fever Other functions Analgesic action, Anti-anaphylaxis, Anti-inflammation Regulating immune function Ephedra (Mahuang) 麻黄 Introduction Fuction & indications Induce sweat/expel cold、 stop wheezing induce urination reduce edema Exterior wind/cold, stuffed in chest cough/wheez Exterior edema Main components L-ephedrines 麻黄碱 、 D-pseudo-ephedrine 伪麻黄碱 Main effects 1、Main pharmacology functions (1)Induce sweating component: Ephedrines, L-ephedrines functions:a. reduce sweat gland’s ability to re-absorb sodium(Na increase the crystal osmotic pressure) b. stimulate CNS & receptor (а) (2)Releasing asthma 平喘 a. Stimulate adrenergic nerve to release adrenaline b. Lead to rise intracellular cAMP levels , make subsequent bronchial smooth muscle relaxation c. Prevent to release powerful inflammation mediators (3)、Inducing diuresis 利尿 a. Dilate potassium(K) channel of renal tubule and improve blood circulation b. Prevent renal tubule from reabsorbing sodium (4)anti-inflammatory & anti-allergenic reaction 2. Other pharmacology functions (l)Exciting CNS (2)Stimulating heart & increasing BP(α,β) Indications: a. Bronchial asthma b. Stuffy nose c. Low blood pressure d. Urticaria Ephedra(Mahuang)-side effects Lead to bleeding of eyes Nervous & Cardiac: nervousness, anxiety, palpitation headache, nausea, hypertension, seizures, strokes, myocardial infarction, hyperthermia, and death. Lead to restlessness, insomnia Interaction Avoid with medication that are for lowing blood pressure Avoid with medication that are for promoting sweats Gui zhi (cinnamon) introduction Induce sweat expel pathogenic factors from muscle、 Function & Warm meridian indications Wind/cold flu,cold stomached, Cold amenorrhea arthritis, phlegm, edema,palpitation components Cinnamic aldehyde Cinnamic acid Phenylpropyl acetate ethyl p-methoxycinnamate Guizhi main pharmacology 1、main effects a. Dilsting blood vessels to promote sweating cinnamic aldehyde can help blood flow to skin, especially with ephedra b. Reducing fever & stopping pain This action is related to promoting sweating. It can increase the ability of enduring pain ( pain threshold) c. anti-inflammation & anti-allergy d. anti-bacteria (staphylococcus aureus pnumococcus) and anti-virus(influenza virus) e. Good for cardiac circulation 2. Other effects Anti-convulsion Sedation Anti-sezure Inducing diuresis Caihu (Bupleurum) 柴胡 introduction Functions & indications components Harmonize ext/enterior harmonize liver Qi uprise Yang alternate chill/fever Hypochondriac pain Irregular period Prolapse of uterus, Saiko-side a, b, c &d A-spinastral Volatile oil, fatty acid Caihu main pharmacologic effects 1、effects (1)Abate fever Saiko-side & volatile oil have the fever abating effects---can treat Mumps (2)Tranquilize, has analgesic effect, & stop cough. The saiko-side has this effect but less potent than codeine (3) Promote immune function. It can strengthen the action of kuffer’s cell & NK cell. (4)protect liver, cholagogue (benefiting the gallbladder) and low cholesterol. The saiko-side has this effect. Caihu root prepared with vinegar is more effective in lowering cholesterol( especially for triglyceride), saiko-side can protect mitocandria. A-spinastral for gallbladder (5)treat digestive ulcer. The saiko-side can prevent the mucosa of the stomach from being impaired by acid & alcohol (6)relax the spasm of intestinal muscles Side effects Excessive intake would lead to sleepiness, poor appetite, and abdominal distension. Injection may lead to allergic reaction. Interaction with drugs May increase the risk of bleeding when taken with drug that increase the risk of bleed… aspirin, anticoagulants(blood thinners) such as warfarin or heparin, anti-platelet : clopidogrel(plavix)and non-steroidal, anti-inflammatory drugs: ibuprofen naproxen May stimulate the adrenals & decrease the effects of antihypertensives (drugs for high BP), patients taking blood pressure medications including beta-blocker or ACE inhibitors should use cautiously May increase the drowsiness caused by some drugs: benzodiazepine such as lorazepam diazepam, barbiturates such asphenobarbital, narcotics such as codeine, some antidepressants and alcohol Gegen(Kudzu) Functions & indications Releases muscles, clears heat in subcutaneous region and muscles Vents measles Alleviates diarrhea Nourishes fluids, alleviates thirst components Wind/heat headache、 Migraines, Deaf. Diabetes, measles, diarrhea Daidzin, daidzein puerarin 大豆苷、大豆苷元 葛根素 1、Effects (1)reducing fever 解热 1)daidzin dilate vessels, promote circulation reduce fever。 2)inhibit CNS β-receptors and reducing cAMP, then low fever。 (2)Reduce blood sugar/ low cholesterol Daizin can reduce blood sugar (3)Effects on circulatory system a. puerarin can reduce blood pressure b. promote the circulation of brain c. dilate the coronary vessels. It can relax the spasm of coronary vessels. Good for coronary heart diseases d. promote heart functions. (4) Anti-myocardial ischemia puerarin is β-blocking agent (5)Anti-arrhythmia Gegen can affect heart cell membrane permeability of K+、Na+、Ca2+ then reduce heart muscles excitability Or block β receptor (6) Relax the smooth muscles of intestines 葛根素 Side effects and warning Currently there are no side effects report of Gegen treatment when take orally. Introvenous puerarin has caused intrvascular hemolysis(distruction of red blood cells). Intraperitoneal administraion of puerarin or crude extracts of pueraria lobata caused hypothermia(low body temperature) Drug interaction Anti-diabetics Anticoagulant & antiplatelet drugs