Volker Schulz Rudolf Hansel Varro E.

Tyler

Rational
Phytotherapy
A Physicians' Guide to Herbal Medicine

Fourth edition, fully revised and expanded

With 90 figures and 50 tables

Springer
1 Medicinal Plants, Phytomedicines,
and Phytotherapy 1
1.1 Common Roots of Pharmacotherapy 1
1.2 Making Medicines Safer by Isolating
and Modifying Plant Constituents 2
1.3 Pharmaceutical Preparation of Phytomedicines . . 4
1.3.1 What are Extracts? 5
1.3-2 Standardization of Extracts 5
1.3.2.1 Quality of the Herbal material 6
1.3.2.2 Production Methods 6
1.3.2.3 Adjustment of Quality 7
1.3.2.4 Analytical Quality Control 8
1.4 Phytomedicines 9
1.4.1 Liquid Dosage Forms 9
1.4.1.1 Tinctures, Glycerites, and Related Products 9
1.4.1.2 Syrups 10
1.4.1.3 Medicinal Oils 10
1.4.1.4 Medicinal Spirits 11
1.4.1.5 Plant Juices 11
1.4.2 Solid Dosage Forms 11
1.4.2.1 Granules 12
1.4.2.2 Uncoated Tablets 12
1.4.2.3 Coated Tablets 12
1.4.2.4 Capsules 12
1.4.2.5 Lozenges 13
1.4.3 Packaging , 13
1.4.4 Herbal Combination Products , 14
1.5 Phytotherapy 16
1.5.1 Pharriiacologic Characteristics 16
1.5.1.1 Therapeutic Range 16
1.5.1.2 Onset of Action 16
,1.5.2 ..-Pharmacologic and Clinical Research 17
1.5.3 Indications for the Use of Phytomedicines 19
1.5.4 What Physicians Require from Phytomedicines . . 20
1.55 Hopes and Expectations of the Patients 22
1.5.6 Benefits and Risks of Phytomedicines
Compared with Other Therapies 23

XI
1.6 Medicinal Teas Today 25
1.6.1 Origin of the Word Tea.
Medicinal and Nonmedicinal Teas 25
1.6.2 Medicinal Teas and Their Actions 27
1.6.3 Various Forms of Medicinal Teas 30
1.6.3.1 Mixtures of Cut and Dried Herbs 31
1.6.3.2 Tea-bag Teas 31
1.6.3.3 Soluble Teas 31
1.6.4 Standard Approval for Tea Mixtures 31
1.6.5 Teas Compounded as prescribed by a Physician . . 32
1.6.6 Guidelines for Tea Preparation 34
1.6.7 Teas for Infants and children 35
1.6.8 Adverse Effects and Risks . 36

2 Central Nervous System 41

2.1 Ginkgo in the Treatment
of Cognitive Deficiency 42
2.1.1 Introduction 42
2.1.2 Botanical Description 43
2.1.3 Crude Drug and Extract 44
2.1.4 Key Constituents, Analysis, Pharmacokinetics . . . 44
2.1.5 Pharmacology and Toxicology 45
2.1.6 Clinical Efficacy in Patients
with Cognitive Deficiency 46
2.1.7 Indications, Dosages, Risks,
and Contraindications 52
2.1.8 Therapeutic Significance 53
2.1.9 Drug Products 54
2.2 ST. John's Wort as an Antidepressant 57
2.2.1 Introduction 57
2.2.2 Botanical Description 57
2.23" ~ Crude Drug and Extract 58
2.2.4 Key Constituents, Analysis, Pharmacokinetics . . . 59
2.2.5 Pharmacology 6l
2.2.5.1 Biochemical Models 6l
2.2.5.2 Behavioral Models in Animals 63
2.2.6 Toxicology, Photosensitization 64
2.2.7 Clinical Efficacy in Depressed Patients 64
2.2.8 Indications,-'Dosages, Risks,
and Contraindications 70
2.2.9 , Therapeutic Significance 72
2.2.10 * / Drug Products 73
2.3 Kava as an Anxiolytic 78
2.3.1 Introduction 78
2.3.2 Botanical Description 78
2.3.3 Crude Drug and Extract 78

XII Table of Contents

2.3.4 Key Constituents, Analysis, Pharmacokinetics ... 79
2.3.5 Pharmacology and Toxicology 80
2.3.6 Clinical Efficacy 81
2.3.7 Side Effects and Risks 84
2.3.8 Indications and Dosages 85
2.3.9 Therapeutic Significance 85
2.3.10 Drug Products 85
2.4 Restlessness and Sleep Disturbances 87
2.4.1 Valerian 87
2.4.1.1 Medicinal Plant 87
2.4.1.2 Crude Drug a n d Extract 87
2.4.1.3 Key Constituents, Analysis, Pharmacokinetics ... 88
2.4.1.4 Pharmacology and Toxicology 89
2.4.1.5 Pharmacologic Effects in Humans
and Clinical Efficacy in Patients 91
2.4.1.6 Indications, Dosages, Risks, and Contraindications 96
2.4.1.7 Therapeutic Significance 97
2.4.2 Hops, Lemon Balm, Passion Flower, and Lavender 97
2.4.2.1 Hop Strobiles and Hop Glands 98
2.4.2.2 Balm Leaves 99
2.4.2.3 Passion Flower 99
2.4.2.4 Lavender 100
2.4.3 Sedative Teas 102
2.4.4 Drug Products 103

3 Cardiovascular System 107

3.1 Heart Failure and Coronary Insufficiency 107
3.1.1 Hawthorn 108
3.1.1.1 Introduction 108
3.1.1.2 Medicinal Plant 109
3.1.1.3 Crude Drug and Extract 109
3.1.1.4 Key Constituents, Analysis, Pharmacokinetics . . . 109
3.1.1.5 Pharmacology 110
3.1.1.6 Toxicology 113
3.1.1.7 Clinical Efficacy 114
3.1.1.8 Indications. Dosages, Risks,
and Contraindications 117
3.1.1.9 Therapeutic Significance 118
3.1.1.10 Drug Products 118
3.1.2 Herbs Containing Digitaloids 119
3,.1.2.1 False Hellabore 120
4.\22 Lily-of-the-Valley 120
3.1.2.3 Squill Powder 121
3.1.2.4 Oleander Leaves 121
3-1.2.5 Drug Products 122
3.1.3 Other Cardioactive Plant Drugs . . . . . . 122

Table of Contents XIII

3.2 Hypotension and Hypertension 124
3.2.1 Phytotherapy of Hypotension 124
3.2.1.1 Caffeine-Containing Herbs and Beverages 125
3.2.1.2 Essential Oils 126
3.2.2 Phytotherapy of Hypertension 126
3.3 Atherosclerosis and Arterial Occlusive Disease . . 128
3.3.1 Garlic 128
3.3.1.1 Historical Background 128
3.3.1.2 Botanical Description 129
3.3.1.3 Crude Drug 130
3.3.1.4 Key Constituents, Analysis, Pharmacokinetics . . . 131
3-3.1-5 Experimental Pharmacology 133
3.3.1.5.1 Effects on Atherogenesis
and Lipid Metabolism 135
3-3.1.5.2 Effects on Vascular Resistance, Fibrinolysis,
and Platelet Aggregation 135
3.3-1-5.3 Cardioprotective and Antioxidative Effects 137
3.3-1-5.4 Other Actions 137
3.3^1-6 Toxicology 138
3-3-1-7 Clinical Studies 138
3.3.1.7.1 Reduction of Elevated Blood Lipids 140
3.3.1.7.2 Blood Pressure Reduction 141
3.3.1.7.3 Inhibiting the Progression of Atherosclerosis
in Humans 142
3.3-1.7.4 Other Clinical Studies 144
3.3.1.8 Side Effects and Garlic Odor 144
3.3.1.9 Indications, Dosages, Risks,
and Contraindications 146
3.3.1.10 Therapeutic Significance 147
3-3-1.11 Drug Products 148
3.3.2 Gingko Special Extract for Peripheral
Arterial Occlusive Disease 152
3r3-3 Other Herbs with Antiatherosclerotic
Properties 155
3-3-3.1 Red Yeast Rice 156
3.4 Chronic Venous Insufficiency 158
3.4.1 Horse Chestnut Seed Extract 158
3.4.1.1 Introduction 158
3.4.1.2 Crude Drug-and Extract 159
3.4.1.3 Chemistry and Pharmacokinetics of Aescin 160
3:4.1.4 Pharmacology 160
3.4.1.5/' Toxicology 161
3.4.176 Actions and Efficacy in Subjects and Patients . . . 161
3.4.1.6.1 Studies in Healthy Subjects 161
3.4.1.6.2 Therapeutic Studies in Patients 161
3.4.1.7 Indications, Dosages, Risks,
and Contraindications 165

XIV Table of Contents

3.4.1.8 Therapeutic Significance 165
3.4.2 Topical Venous Remedies 166
3.4.3 Drug Products 167

4 Respiratory System 169

4.1 Cold Syndrome (Flulike Infection) 169
4.1.1 Risk Factors 169
4.1.2 Viruses and Host Defenses 170
4.2 General Phytotherapeutic Measures 171
4.2.1 Teas for Cold Relief 171
4.2.1.1 Elder Flowers 171
4.2.1.2 Linden Flowers 172
4.2.1.3 Meadowsweet Flowers 173
4.2.1.4 Willow Bark and Salicylates 174
4.2.1.5 Tea Formulas 174
4.2.2 Essential Oils 176
4.2.2.1 Nasal Ointments and Nosedrops 176
4.2.2.2 Inhalation Therapy 177
4.2.2.3 Lozenges, Troches and Gargles 178
4.3 Herbal Cough Remedies 180
4.3.1 Mucilaginous Herbs 180
4.3.2 Essential Oils in Cough Remedies 181
4.3-3 Ephedra 182
4.4 Herbal Expectorants 184
4.4.1 Mechanisms of Action 184
4.4.1.1 Reduction of Mucus Viscosity by Water 184
4.4.1.2 Neural Mechanism Based
on the Gastropulmonary Reflex 185
4.4.1.3 Liquefaction of Secretions by Direct Action
on the Bronchial Glands 185
4.4.2 Saponin-Containing Herbs 186
4.4.3 Essential Oils as Expectorants 189
4.4.3.1 Dosage Forms 190
4.4.3.2 Cineole (Eucalyptol) 192
4.4.3.3 Myrtol 192
4.4.3.4 Anise Oil and Anethole 193
4.4.4 Licorice Root 194
4.4.5 Suggested Formulations 195
4.5 Phytotherapy of Sinusitis 197
-4.6 Drug Products 198

Table of Contents XV
5 Digestive System 203
5.1 Anorexia and Dyspepsia 203
5.1.1 Introduction 203
5.1.2 Bitter Herbs (Bitters) 204
5.1.2.1 "Wormwood (Absinth) 206
5.1.2.2 Other Bitter Herbs 207
5.1.3 Biliary Remedies (Cholagogues) 209
5.1.3.1 Artichoke Leaves 210
5.1.3.2 Other Cholagogues 213
5.1.4 Digestive Enzymes 214
5.1.5 Suggested Formulations 215
5.1.6 Drug Products 217
5.2 Bloating and Flatulence 218
5.2.1 Definition and Actions of Carminatives 219
5.2.2 Typical Carminative Herbs 219
5.2.3 Suggested Formulations 220
5.3 Gastritis and Ulcer Disease 222
5.3.1 Chamomile 223
5.3.2 Licorice Root 223
5.3.3 Drug Products 224
5.4 Irritable Bowel Syndrome 225
5.4.1 Symptoms, Epidemiology, and Approaches
to Treatment 225
5.4.2 Peppermint 226
5.4.2.1 Crude Drug and Constituents t : 226
5.4.2.2 Peppermint Oil 226
5.4.2.3 Pharmacokinetics 227
5.4.2.4 Pharmacology 228
5.4.2.5 Therapeutic Efficacy 228
5.4.2.6 Risks and Side Effects 239
5.4.2.7 Indications, Dosages, and Contraindications . . . . 230
5.5 Acute Diarrhea 232
5.5.1 Tannin-Containing Herbs 232
5.5.1.1 Green and Black Tea 233
5.5.1.2 Other Tannin-Containing Herbs 234
5.5.1.3 Tannic Acid and Albumin Tannate 235
5.5.2 Pectins . ;:-. 236
5.5.3 Live Dried Yeast 236
5.5.3-1 Pharmacology and Toxicology 237
5.5.3.2 Therapeutic Efficacy 237
5.5.3-3 Indications, Dosages, Risks,
and Contraindications 238
5.5.4 Other Herbal Antidiarrheals 238
5.5.5 Suggested Formulations 240

XVI Table of Contents

5.6 Constipation 241
5.6.1 Symptoms, Causes, General Measures 241
5.6.2 Bulk-Forming Agents 242
5.6.2.1 Mechanism of Action 242
5.6.2.2 Linseed 244
5.6.2.3 Wheat Bran 246
5.6.2.4 Psyllium Seed and Husk 247
5.6.2.5 Agar and Karaya Gum 248
5.6.3 Osmotic Agents 248
5.6.4 Anthranoid-Containing Herbs 249
5.6.4.1 Rhubarb Root 251
5.6.4.2 Buckthorn Bark 252
5.6.4.3 Senna Pods and Leaves 253
5.6.4.4 Aloe 253
5.6.5 Castor Oil 254
5.6.6 Suggested Formulations 255
5.7 Liver Diseases 257
5.7.1 Milk Thistle Fruits, Silymarin 258
5.7.1.1 Medicinal Plant and Crude Drug 258
5.7.1.2 Components and Active Constituents 259
5.7.1.3 Pharmacokinetics 259
5.7.1.4 Pharmacology and Toxicology 259
5.7.1.5 Therapeutic Efficacy in Chronic Liver Diseases . . 260
5.7.1.6 Use in Mushroom Poisoning 261
5.7.1.7 Indications, Dosages, Risks,
and Contraindications 262
5.7.2 Soybean Phospholipids 262
5.7.3 Drug Products 263

6 Urinary Tract 265

6.1 Inflammatory Diseases of the Urinary Tract . . . . 265
6.1.1 Uva Ursi Leaves 266
6.1.2 Petasite Rhizome 268
6.2 Benign Prostatic Hyperplasia 268
6.2.1 Saw Palmetto Berries 270
6.2.2 Nettle Root 274
6.2.3 Pumpkin Seeds 275
6.2.4 Grass Pollens 276
6.2.5 Phytosterols from Hypoxis rooperi 277
6.2.6 Pygeum 278
/
'6.3 Therapeutic Significance 278
6.4 Drug Products Other than Teas 279
6.5 Bladder and Kidney Teas 280

Table of Contents XVII

7. Gynecologic Indications for Herbal Remedies . . . 285
7.1 Chasteberry 286
7.2 Black Cohosh 289
7.3 Phytoestrogens 291
7.4 Other Herbs 293
7.5 Therapeutic Significance 295
7.6 Drug Products 295

8 Skin,Trauma, Rheumatism, and Pain 299

8.1 Dosage Forms and Preparations 299
8.2 Inflammations and Injuries of the Skin 301
8.2.1 Chamomile Flowers 301
8.2.1.1 Crude Drug, Constituents, and Preparations . . . . 302
8.2.1.2 Pharmacology and Toxicology 304
8.2.1.3 Therapeutic Efficacy 305
8.2.1.4 Indications, Dosages, Side Effects, and Risks . . . . 305
8.2.2 Witch Hazel and Other
Tannin-Containing Herbs 306
8.2.3 Evening Primrose Oil 308
8.2.4 Other Dermatologic Herbs 310
8.3 Post-traumatic and Postoperative Conditions . . . 313
8.3.1 Bromelain 313
8.3.2 Comfrey 314
8.3.3 Arnica 314
8.4 Rheumatic Conditions and Degenerative
Joint Diseases 316
8.4.1 " Devil's Claw 316
8.4.2 Willow Bark, Ash, Aspen 318
8.4.3 Nettle Tops 319
8.4.4 Boswellia serrata 319
8.5 Treatment of Pain 320
8.5.1 Peppermint Oil and Tension Headache 320
8.5.2 Capsicum (Paprika) for Local Pain Relief 322
8.6, Formulations 325
8.7 / Drug Products 326

XVIII Table of Contents

9 Agents that Increase Resistance to Diseases . . . . 3 3 1
9.1 Adaptogens 331
9.1.1 Ginseng 332
9.1.1.1 Plant, Crude Drug, and Constituents 332
9.1.1.2 Pharmacology and Toxicology 333
9.1.1.3 Clinical Studies in Humans 334
9.1-1.4 Indications, Dosages, Risks,
and Contraindications 334
9.1.2 Eleutherococcus Root 335
9.1-3 Other Adaptogenic Drugs 336
9.1.3.1 Cordyceps 336
9.1.3.2 Ashwagandha 337
9.1.3.3 Gotu Kola 337
9.1.3.4 Astragalus 338
9.1.3.5 Cat's Claw 338
9-1.3.6 Botanical Antioxidants (Grape Seed,
Green Tea, Pine Bark) 339
9-1-3.6.1 Pharmacology and Toxicology 339
9-1-3.6.2 Clinical and Epidemiological Studies 340
9-1-3.6.3 Indications and Dosage 341
9.2 Immune Stimulants 341
9.2.1 Coneflower (Echinacea) 342
9.2.1.1 Plant, Crude Drug, and Constituents 342
9.2.1.2 Pharmacology and Toxicology 343
9-2.1.3 Studies on Therapeutic Efficacy 344
9-2.1.4 Indications, Dosages, and Risks 346
9.2.2 European Mistletoe 347
9.2.2.1 Plant, Constituents, and Actions 347
9.2.2.2 Clinical Efficacy Studies 349
9.2.2.3 Indications, Dosages, and Risks 350
9.2.3 Medicinal Yeasts 350
'9.2.4 Goldenseal 351
9.3 Therapeutic Significance 352

10 Appendix
The 100 Most Commonly Prescribed
Herbal Medications in Germany 357

Subject Index 369

Table of Contents XIX