Eric Yarnell ND RH and Kathy Abascal BS JD Herbalist

Clinicians encounter patients with cardiac arrhythmiascommonly Many of these are minor and represent nodanger to patients but some of these problems may cause

sufficient palpitations and distress or hemodynamic effects towarrant treatment As always the cause or causes of any arrhyth-mia should be investigated and treated directly if possible Some-times the cause is not immediately or ever apparent howeverand therapy to control symptoms may be necessary Becauseantiarrhythmic drugs all have adverse effectsmdashsome of themquite serious including worsening of arrhythmias by flecainideand encainidemdashsafer botanical options are called for This articlereviews herbs that can modulate heart rhythms beneficially anddiscusses the clinical uses of these herbs Obviously other natu-ral therapies and lifestyle changes may be important for relievingarrhythmias but they are beyond the scope of this article

Clearly arrhythmias are a complex area Only practitionerswho are trained in this area should attempt to treat arrhythmiasunless a thorough workup by a cardiologist has failed to revealany known cause of the arrhythmia In such instances thearrhythmia is considered to be nonpathologic Generally theseare instances of mild sinus tachycardia or intermittent prematureventricular contractions Most competent clinicians with basiccardiovascular knowledge can treat patients with nonpathologicarrhythmias safely In all other instances only the most experi-enced and knowledgable clinicians should attempt therapyLaypeople should be told not attempt to treat their own arrhyth-mias but instead should be strongly encouraged to seek diagnos-tic and therapeutic support

The more serious an arrhythmia is the more careful one hasto be in deciding on botanical treatment Atrial flutter and atri-al fibrillation are associated with an increased risk of throm-boembolism They should only be treated with botanicalmedicine by highly experienced clinicians Those with littleexperience should refer patients with these conditions to cardi-ologists Any recurrent or chronic arrhythmia especially whenit is associated with other symptoms such as shortness of

breath or lightheadedness is indicative of underlying patholo-gy that needs to be thoroughly investigated by a licensedhealth care practitioner

Simple Sedatives for Treating Minor Arrhythmias

Arrhythmias that are not related to underlying heart or sys-temic pathology but that are sufficiently strong to cause palpita-t ion s andor anx ie ty can be qui te debi l i ta t ing In thesecircumstances the costs and hazards of drug therapy or pace-maker implantation make them treatments of last resort Numer-ous botanicals are available for precisely these circumstances toreduce or eliminate the problem safely and more cost effectivelyLeonurus cardiaca (motherwort) a humble mint of Eurasian ori-

gin stands preeminently among botanical remedies for non-pathologic arrhythmias The prickly flowering tops of the herbare used preferably fresh Its active and supportive constituentshave not been well-characterized although it has long been usedas a tea effectively suggesting that the most important com-pounds are watersoluble

The late preeminent figure of German phytotherapy RudolfFritz Weiss MD hailed motherwort as a remedy for ldquofunction-al heart complaints due to autonomic imbalancerdquo1 Eclectic prac-titioners have written about the sedative nature of this herbincluding Harvey Wickes Felter MD2 It is possible that mother-wort acts in part simply by calming the patient and reducinganxiety induced by fear of heart disease or the strangeness of thesensation of palpitations People who are under heavy stress andnot compensating for it well may also benefit when treated withmotherwort Motherwort is considered by many clinicians to bespecific for palpitations secondary to hyperthyroidism Palpita-tions that interfere with sleep or concomitant smooth-musclespasms in the gut or reproductive tract may also be counteractedby motherwort

A typical adult dose of motherwort is 1ndash2 teaspoons per cup ofwater infused for 15ndash20 minutes which is drunk in three cupsper day A glycerin extract (75 percent glycerin) has also provedto be useful at a dose of 3ndash5 mL three times per day or in lowerquantities when combined with other herbs in formulations Theherb is completely safe with no known contraindicationsValeriana officinalis (valerian) root Valeriana sitchensis (Pacific

valerian) root Scutellaria lateriflora (skullcap) herb Passifloraincarnata (passionflower) leaf Zizyphus jujuba (jujube) and Pipermethysticum (kava) root are some of the other choices for prob-lems such as this These herbs are less specific than motherwortalthough they can all help to normalize heart rhythm caused by

125

Botanicals for Regulating Heart Rhythms

NOTE All Latin and common names used are taken from McGuffin MKartesz JT Leung AY Tucker AO American Herbal Product Associa-tionrsquos Herbs of Commerce 2nd ed Silver Spring MD American HerbalProducts Association 2000

or secondary to anxiety uncompensated stress or by unknownbut nonpathologic causes All of these herbs have long historiesof safe use and have not produced adverse effects in clinical tri-als

The recent concern about the hepatotoxicity of kava is based onno more than a handful of cases most of which do not even sup-port the connection as a result of interfering factors such as con-comitant use of hepatotoxic drugs3 No reasonable practitionerwould ignore the beneficial effects of an herb (let alone ban it)based on such paltry weak evidence In our opinion politicalreasons must be driving the current hysteria surrounding the useof kava

One of the safest among these herbs although it has beenpoorly researched is skullcap A member of the Lamiaceae fami-ly like motherwort there are species in the genus that are nativeto both Eurasia and North America Based on clinical experienceskullcap is a very broadly applicable nervine that is helpful fortreating patients who have anxiety insomnia seizure disordersattention deficient hyperactivity disorder and similar problemsIn addition many practitioners have found the herb useful fortreating patients who have minor arrhythmias This herb is anexcellent candidate for clinical trials given its widespread use mdashand general appreciationmdashby practitioners It is imperative thatskullcap be used fresh or prepared from the fresh plant becausethe dried plant material loses much of its activity A typical doseof glycerite (75 percent glycerin) or tincture (30 percent ethanol)is 3ndash5 mL three times per day for adults

Queen-of-the-Night

Several botanicals are considered specifically for treatment ofpatients with arrhythmias in general One of the most promisingyet often forgotten herbs is Selenicereus grandiflorus (formerly Cac-tus grandiflora) known colloquially as night-blooming cereusThis climbing member of the Cactaceae family is unusual in thatit is native to the rainforests of Central America Meacutexico and theCaribbean instead of the desert This cactus produces an enor-mous incredibly fragrant white flower in a very narrow ldquowin-dowrdquo of time late at night once each year earning it anothercommon name queen-of-the-night

The Eclectic physicians (medical doctors who used primarilynatural remedies most active from 1850 to 1930) appear to haveused night-blooming cereus extensively It was considered to bea nervine with exceptional specificity for regulating the conduc-tive activity of the heart2 Although the herb was mainly consid-e red to be he lpful for tr ea ting tachya rrhy thmias somepractitioners also felt that it could counteract bradycardiac prob-lems This herb was also recommended for counteracting prob-lems associated with valvular regurgitation particularly aorticregurgitation and mitral valve prolapse However Felter wrotethat it was contraindicated in cases of stenotic valves Night-blooming cereus is useful for treating palpitations related tomenopause and anxiety The herb can also be beneficial forpatients with mild congestive heart failure although the plantdoes not contain cardioactive glycosides4 The nature of its action

126 ALTERNATIVE amp COMPLEMENTARY THERAPIESmdashJUNE 2003

Table 1 Summary of Major Antiarrhythmic Herbs

Latin name Common name Part used Typical adult dose Warnings

Leonurus cardiaca Motherwort Leaf and flower Infusion 1ndash2 tspcup of Occasional mild sedationwater infused for 15ndash20 minutes 1 cup tidFresh plant glycerin extract 3ndash5 mL tid

Scutellaria lateriflora Skullcap Leaf and flower Fresh plant glycerite Occasional mild sedationor tincture 3ndash5 mL tid

Cytisus scoparius Scotch broom Leaf and flower Fresh or dry plant tincture Avoid in pregnancy atrioven-05ndash1 mL tid tricular block hypertension many

drug interactions may cause bradycardia

Selenicereus grandiflorus Night-blooming Stem and flower Fresh plant tincture Do not overdoseor Hylocereus undatus cereus or 5ndash15 gtt tid

queen-of-the-nightRauvolfia serpentina Rauwolfia Root Dry plant tincture standardized Minor nasal stuffiness and

to 01ndash0125 reserpine loose stools common avoid in 3ndash5 gtt tid depressed patients do not over

dose many drug interactionsConvallaria majalis Lily-of-the-valley Root Fresh plant tincture May cause nausea hypokalemia

05ndash1 mL tid potentiates toxicityCrataegus laevigata Hawthorn Leaf flower and Infusion 2ndash3 tspcup steeped None

haws for 10ndash15 min 1 cup tidFresh or dry plant tincture or glycerite 3ndash10 mL tidExtracts standardized to 18 vitexin-4cent-rhamnoside or 10 procyanidins 100ndash250 mg tid

is gentlemdashit takes fairly consistent use over several months toobtain the full benefit Absolutely no research on this plant couldbe located

Use of a fresh plant tincture (50 percent ethanol) is recom-mended The usual dose ranges from the low end in the Eclectictradition of 10ndash30 drops diluted in 4 ounces of water then thepatient should take 1 teaspoon three times per day up to a morepharmacologic dose of 5ndash15 gtt three times per day Althoughqueen-of-the-night is generally considered to be an herb to usewith caution Felter did not mention any serious adverse effectsIt should probably be avoided in pregnancy and lactationbecause of lack of information

A similar vine-like jungle cactus is known as Hylocereus unda-tus These two cacti are sufficiently morphologically similar thatsome professionals in the field consider them to be frequent adul-terants of one another Dr Yarnellrsquos mentor Silena Heron NDof Sedona Arizona (founding chair of botanical medicine atBastyr University in Kenmore Washington) sent tinctures madefrom Selenicereus grandiflorus and Hylocereus undatus to the lateJohn Bastyr ND DC without saying which was which Heeventually reported back that the bottle that contained Hylocereustincture was generally more clinically effective

A Weed for All Seasons

A better-researched relatively strong and generally antiar-rhythmic herb is Cytisus scoparius (Scotch broom) formerlyknown as Sarothamnus scoparius This Fabaceae family memberoriginated in northern Europe but has since naturalized to manyparts of the world It is a pernicious weed in the Pacific North-west where it grows rapidly crowding out native plants Thismakes it a very sustainable source of medicine that should bemore widely utilized to help keep it in check ecologically speak-ing

The constituents of greatest interest in Scotch broom are quino-lizidine alkaloids particularly sparteine According to WeissScotch broom acts very similarly to quinine and quinidinealthough Scotch broom is much safer5 Weiss recommended it fortreating patients who have congestive heart failure to help regu-late heart rhythm and indirectly to improve venous return Hecited the plant as a specific treatment for atrial or ventricular fib-rillation and extrasystoles These indications are echoed in othermodern sources that also cite Scotch broom as specific for treatingsinus tachycardia and postmyocardial infarction arrhythmias6

Modern investigation has revealed that sparteine and relatedalkaloids antagonize potassium channels7 There is also evidenceof sodium-channel antagonism8 There is a definite positiveinotropic action from sparteine apparently a result of its con-comitant actions on sodium and potassium channels9mdashunlikemany standard class I antiarrhythmic drugs (quinidine mex-ilitene) which also inhibit calcium channels and are actually neg-ative inotropic

No published clinical trials were located on the efficacy ofScotch broom or sparteine The recommended dose of Scotchbroom herb tincture made from fresh or dry plant material(45ndash55 percent ethanol) for an average-sized adult is 05ndash1 mL

three times per day The standard pharmacologic dose of isolatedsparteine is 100ndash200 mg per day in divided doses Unfortunatelythe usual content of sparteine in crude Scotch broom could not beconfirmed Since 1977 the Food and Drug Administration hasmade injectable sparteine unavailable because of the unpre-dictability of its effects and its propensity to cause tetanic uterinecontractions10

Whole-plant extracts of Scotch broom at usual therapeuticdoses are essentially without adverse effects and even overdoseis rarely a problem6 The most likely adverse effects if any arebradycardia indigestion loose stools and hypertension Theherb is contraindicated in pregnancy (although Scotch broomdoes have some application during labor as an oxytocic) and atri-oventricular block (which it can exacerbate readily)11 Some prac-titioners also consider Scotch broom to be contraindicated fortreating hypertension because of the herbrsquos vasoconstrictiveproperties12

Much is known about the pharmacokinetics of sparteinebecause it is thoroughly and specifically oxidized by hepatic CYP2D6 Approximately 5 percent of people of European descent arepoor metabolizers of sparteine because of an inefficiency or lackof CYP 2D613 In these patients sparteine levels may build up totoxic levels

Arguably CYP 2D6 function should be assessed prior toadministration of this herb although the cost effectiveness of thisapproach is questionable Scotch broom or sparteine should notbe administered simultaneously with drugs that inhibit CYP 2D6function including cimetidine nor with many selective serotoninreuptake inhibitors including fluoxetine and paroxetine thiori-dazine haloperidol propoxyphene and ritonavir Even more

ALTERNATIVE amp COMPLEMENTARY THERAPIESmdashJUNE 2003 127

Selenicereus grandiflorus (night-blooming cereus or queen-of-the-night)copy2003 by Eric Yarnell ND RH

important is the fact that many antiarrhythmic drugs are CYP2D6 inhibitors including quinidine flecainide and amiodaroneCaution is warranted in combining Scotch broom with otherantiarrhythmics for this reason

It should also be noted that approximately 1 percent of popula-tions of European descent are hypermetabolizers of sparteine as aresult of excessive CYP 2D6 activity and these people would beunlikely to respond to Scotch broom therapy14

Other drugs should not be combined with Scotch broomBecause of the presence of simple amines in the plant it maycause problems if combined with monoamine oxidase inhibitorsIt should also not be given with epinephrine because of thepotential synergy of effects particularly with regard to vasocon-striction and uterine contraction

Indian Snakeroot

Another potent specific antiarrhythmic herb is Rauvolfia ser-pentina (rauwolfia) formerly known as Indian snakeroot whichcomes from India The root of this herb contains many interestingalkaloids Of particular interest in the case of arrhythmias isajmaline Ajmaline is said to have been isolated by Salimuzza-man Siddiquil and named after Hakim Ajmal Khan a strongadvocate for Unani-Tib (Arab traditional medicine)15

In animal studies isolated ajmaline has shown particular effi-cacy for preventing arrhythmias caused by cardiac ischemia16

Russian clinicians have found various rauwolfia preparationscontaining ajmaline to be effective for preventing supraventricu-lar arrhythmias17 Because other lines of research support the

concept that the combined alkaloids of the plant are more effec-tive than any alkaloid in isolation the whole plant or wholeplant extracts are recommended The usual dose of a tincturestandardized to 01ndash0125 percent reserpine (as a quality con-trol) is 3ndash5 gtt three times per day for an average-size adult18

Lily-of-the-Valley

The third relatively strong herb for intervention for treatingmore serious arrhythmias is Convallaria majalis (lily-of-the-val-ley) This herb has a long history of use for people with mild con-gestive heart failure and it contains cardioactive glycosides19

Unlike the much stronger and more dangerous plant Digitalisspp (foxglove) lily-of-the-valley glycosides do not accumulateand are vastly safer and produce milder effects Lily-of-the-valleyflavonoids are also considered to be important for the activity ofthe herb and this supports the use of the whole plant and not justthe cardiac glycosides in isolation20

Lily-of-the-valley has also long been recognized by cliniciansto have an antiarrhythmic effect Felter found it particularlyuseful for treating tachycardia and mitral insufficiency2 Hefound it less useful for addressing aortic valve problems Ani-mal studies support that l i ly of the valley has a posit iveinotropic effect and that it is a moderately strong vasoconstric-tor21 In a bizarre twist actual progesterone has been found inlily-of-the-valley presumably in quantities too minute to berelevant to medicine but suggesting that humans and plantsmay have more hormonal regulation systems in common thanwas once thought22

The usual dose of lily-of-the-valley fresh-plant tincture (25ndash30percent ethanol) is 05ndash1 mL three times per day for an average-sized adult Although lily of the valley is very safe it should notbe taken in excess and the patient should be told to maintain ah i g h i n t a k e o f f r u i t s a nd v eg e t a b le s t o gua rd ag a in s thypokalemia which potentiates the toxicity of other cardiac gly-cosides The herb should not be combined with potassium-wast-ing drugs such as loop diuretics and corticosteroids withoutcareful monitoring of potassium levels The onset of severe nau-sea vomiting or atrial fibrillation are all indications for discon-tinuation of the herb

Hawthorn The Tonifier

No discussion of plants for treating patients with arrhythmiaswould be complete without mentioning the ultimate cardiactonic Crataegus laevigata (hawthorn) This herb is so safe that ithas no known overdose level Its effects are very gentle oftentaking weeks or months to become fully noticeable For this rea-son it is advocated as a chronic treatment to prevent and treatessentially all types of arrhythmias

There is much less research on the antiarrhythmic activity ofhawthorn than on its many other actions However some animalresearch has shown directly that the hawthorn species Crataegusmeyeri is antiarrhythmic23 Surprisingly researchers who did onerat study actually found C laevigata standardized extract to beproarrhythmic in ischemic hearts24 It appeared that the calcium-

128 ALTERNATIVE amp COMPLEMENTARY THERAPIESmdashJUNE 2003

Crataegus laevigata (hawthorn) Photo by Holly Shull Vogel FrostFlower Farm

For a complete review of the intricacies of the clinical use and safety ofrauwolfia for treating hypertension an update of ref 18 will be publishedin Yarnell E Abascal K Hooper CG Clinical Botanical Medicine Larch-mont NY Mary Ann Liebert Inc 2003in press

channel antagonist activity of the herb was causing the problemThe extract was also administered by injection In similar studyusing the same methodology but using oral pretreatment withhawthorn researchers found that it did reduce the incidence ofpostischemic fibrillation in rats greatly25

Clinical trials of hawthorn in patients with congestive heartfailure (CHF) have often reported secondary outcomes involvingcardiac rhythm In one large open trial (n = 3664) hawthorn wasfound to be particularly useful in patients who had CHF withtachycardiac arrhythmias26 In another large open trial (n = 1011)the incidence of arrhythmias and ventricular estrasystoles wasnotable and appeared to coincide with improve myocardial per-fusion27 To confirm the antiarrhythmic nature of hawthornarrhythmia types and incidence should be assessed in future tri-als involving hawthorn as primary or secondary measures bothin patients with CHF and those with non-CHFndashrelated arrhyth-mias

Hawthorn can be taken in many forms The leaves flowersand haws (fruit or berries) are all utilized An infusion of 2ndash3 tea-spoons per cup steeped for 10ndash15 minutes can be drunk threetimes per day A tincture (25 percent ethanol) or glycerite (75 per-cent glycerin) is dosed at 3ndash10 mL three times per day foradults depending on severity of the disease and body size Theusual dose of extracts standardized to 18 percent vitexin-4cent-rhamnoside or to 10 percent procyanidins is 100ndash250 mg threetimes per day As noted above there are no known adverseeffects of this herb and no contraindications

Summary

Numerous herbs are useful for treating patients with a widerange of arrhythmias In all cases C laevigata is recommended forprevention and treatment as a gentle tonic For treating mildarrhythmias not related to demonstrable heart pathology simplesedatives such as L cardiaca and S lateriflora are recommendedFor more serious cases or when milder remedies are not suffi-cient S grandiflorus or H undatus C scoparius R serpentaria andC majalis offer more potent although also potentially more dan-gerous options However careful monitoring and proper dosingusually allow even these strong herbs to be utilized safely n

References1 Weiss RF Herbal Medicine Beaconsfield UK Beaconsfield Publishers19881862 Felter HW Eclectic Materia Medica Pharmacology and TherapeuticsSandy OR Eclectic Medical Publications 1922 [reprinted 1998]3 Denham A McIntyre M Whitehouse J Kavamdashthe unfolding storyReport of a work-in-progress J Altern Complement Med 20028237ndash263with special Appendix 1 Whitton P Whitehouse J Evans C Response toreported hepatotoxicity of high lactone extractions of Piper mythysticumForst (kava)]4 Hoffmann D The Complete Illustrated Herbal New York Barnes ampNoble 19961425 Weiss RF Herbal Medicine Beaconsfield UK Beaconsfield Publishers19881506 Thies PW Spartium and sparteine Its antiarrhythmic action [in Ger-man] Pharmazie unserer Zeit 19866172ndash176

7 Northover BJ Effect of pre-treating rat atria with potassium channelblocking drugs on the electrical and mechanical responses to phenyle-phrine Biochem Pharmacol 1994472163ndash1698 Puglsey MK Saint DA Hayes E et al The cardiac electrophysiologicaleffects of sparteine and its analogue BRB-I-28 in the rat Eur J Pharmacol1995294319ndash3279Honerjager P Loibl E Steidl I et al Negative inotropic effects of tetrodotox-in and seven class 1 antiarrhythmic drugs in relation to sodium channelblockade Naunyn Schmiedebergs Arch Pharmacol 1986332184ndash19510 United States Food and Drug Administration Online document atwwwfdagovohrmsdockets98fr100898btxt1 1 Bank on D a t a A u toma t ed o n D rug s On l i n e do cum en t a twwwbiam2org Accessed March 30 200312 Hoffmann D The Complete Illustrated Herbal New York Barnes ampNoble 19968513 Eichelbaum M Spannbrucker N Steincke B et al Defective N-oxida-tion of sparteine in man A new pharmacogenetic defect Eur J Clin Phar-macol 197916183ndash18714 Bathum L Johansson I Ingelman-Sundberg M Horder M Brosen KUltrarapid metabolism of sparteine Frequency of alleles with duplicatedCYP 2D6 genes in a Danish population as determined by restriction frag-ment length polymorphism and long polymerase chain reaction Pharma-cogenetics 19988119ndash12315 Islam Science Environment and Technology Online document atwwwislamsetcomscplantsajmalinehtml Accessed March 30 200316 Obayashi K Nagasawa K Mandel WJ et al Cardiovascular effects ofajmaline Am Heart J 197692487ndash49617 Kelrsquoman IM Paleev NR Prevention of supraventricular tachysystolewith anti-arrhythmia agents [in Russian] Kardiologiia 19771742ndash4518 Yarnell E Abascal A Treating hypertension botanically Altern Com-plement Ther 20017284ndash29019 Meixner HK Dobler S Oral heart therapy using convallaria glycosidesin ambulatory practice [in German] Z Allgemeinmed 197450(16)757ndash76820 Weiss RF Herbal Medicine Beaconsfield UK Beaconsfield Publish-ers 198814621 Lehmann HD Effect of plant glycosides on resistance and capacitancevessels [in German] Arzneim Forsch 198434423ndash42922 Kopp B Loffelhardt W Determination of progesterone in vegetativeorgans and cell organelles of Convallaria majalis L by radioimmunoassayZ Naturforsch [C] 19803541ndash4423 Garjani A Nazemiyeh H Maleki N Valizadeh H Effects of extractsfrom flowering tops of Crataegus meyeri A Pojark on ischaemic arrhyth-mias in anaesthetized rats Phytother Res 200014428ndash43124 Rothfuss MA Pascht U Kissling G Effect of long-term application ofCrataegus oxyacantha on ischemia and reperfusion induced arrhythmias inrats Arzneim Forsch 20015124ndash2825 al Makdessi S Sweidan H Dietz K Jacob R Protective effect ofCrataegus oxyacantha against reperfusion arrhythmias after global no-flow ischemia in the rat heart Basic Res Cardiol 19999471ndash7726 Schmidt U Albrecht M Podzuweit H et al High dosage therapy withCrataegus extract in patients suffering from heart failure NYHA class Iand II [in German] Z Phytother 19981922ndash3027 Tauchert M Gildor A Lipinski J High-dose Crataegus (hawthorn)extract WS 1442 for the treatment of NYHA class II heart failure patients[in German] Herz 199924465ndash474

Eric Yarnell ND RH is president of the Botanical Medicine Academya specialty board for using medicinal herbs Kathy Abascal BS JDHerbalist is executive director of the Botanical Medicine AcademyVashon Washington

To order reprints of this article write to or call Karen Ballen ALTERNA-TIVE amp COMPLEMENTARY THERAPIES Mary Ann Liebert Inc 2Madison Avenue Larchmont NY 10538-1961 (914) 834-3100

ALTERNATIVE amp COMPLEMENTARY THERAPIESmdashJUNE 2003 129

or secondary to anxiety uncompensated stress or by unknownbut nonpathologic causes All of these herbs have long historiesof safe use and have not produced adverse effects in clinical tri-als

The recent concern about the hepatotoxicity of kava is based onno more than a handful of cases most of which do not even sup-port the connection as a result of interfering factors such as con-comitant use of hepatotoxic drugs3 No reasonable practitionerwould ignore the beneficial effects of an herb (let alone ban it)based on such paltry weak evidence In our opinion politicalreasons must be driving the current hysteria surrounding the useof kava

One of the safest among these herbs although it has beenpoorly researched is skullcap A member of the Lamiaceae fami-ly like motherwort there are species in the genus that are nativeto both Eurasia and North America Based on clinical experienceskullcap is a very broadly applicable nervine that is helpful fortreating patients who have anxiety insomnia seizure disordersattention deficient hyperactivity disorder and similar problemsIn addition many practitioners have found the herb useful fortreating patients who have minor arrhythmias This herb is anexcellent candidate for clinical trials given its widespread use mdashand general appreciationmdashby practitioners It is imperative thatskullcap be used fresh or prepared from the fresh plant becausethe dried plant material loses much of its activity A typical doseof glycerite (75 percent glycerin) or tincture (30 percent ethanol)is 3ndash5 mL three times per day for adults

Queen-of-the-Night

Several botanicals are considered specifically for treatment ofpatients with arrhythmias in general One of the most promisingyet often forgotten herbs is Selenicereus grandiflorus (formerly Cac-tus grandiflora) known colloquially as night-blooming cereusThis climbing member of the Cactaceae family is unusual in thatit is native to the rainforests of Central America Meacutexico and theCaribbean instead of the desert This cactus produces an enor-mous incredibly fragrant white flower in a very narrow ldquowin-dowrdquo of time late at night once each year earning it anothercommon name queen-of-the-night

The Eclectic physicians (medical doctors who used primarilynatural remedies most active from 1850 to 1930) appear to haveused night-blooming cereus extensively It was considered to bea nervine with exceptional specificity for regulating the conduc-tive activity of the heart2 Although the herb was mainly consid-e red to be he lpful for tr ea ting tachya rrhy thmias somepractitioners also felt that it could counteract bradycardiac prob-lems This herb was also recommended for counteracting prob-lems associated with valvular regurgitation particularly aorticregurgitation and mitral valve prolapse However Felter wrotethat it was contraindicated in cases of stenotic valves Night-blooming cereus is useful for treating palpitations related tomenopause and anxiety The herb can also be beneficial forpatients with mild congestive heart failure although the plantdoes not contain cardioactive glycosides4 The nature of its action

126 ALTERNATIVE amp COMPLEMENTARY THERAPIESmdashJUNE 2003

Table 1 Summary of Major Antiarrhythmic Herbs

Latin name Common name Part used Typical adult dose Warnings

Leonurus cardiaca Motherwort Leaf and flower Infusion 1ndash2 tspcup of Occasional mild sedationwater infused for 15ndash20 minutes 1 cup tidFresh plant glycerin extract 3ndash5 mL tid

Scutellaria lateriflora Skullcap Leaf and flower Fresh plant glycerite Occasional mild sedationor tincture 3ndash5 mL tid

Cytisus scoparius Scotch broom Leaf and flower Fresh or dry plant tincture Avoid in pregnancy atrioven-05ndash1 mL tid tricular block hypertension many

drug interactions may cause bradycardia

Selenicereus grandiflorus Night-blooming Stem and flower Fresh plant tincture Do not overdoseor Hylocereus undatus cereus or 5ndash15 gtt tid

queen-of-the-nightRauvolfia serpentina Rauwolfia Root Dry plant tincture standardized Minor nasal stuffiness and

to 01ndash0125 reserpine loose stools common avoid in 3ndash5 gtt tid depressed patients do not over

dose many drug interactionsConvallaria majalis Lily-of-the-valley Root Fresh plant tincture May cause nausea hypokalemia

05ndash1 mL tid potentiates toxicityCrataegus laevigata Hawthorn Leaf flower and Infusion 2ndash3 tspcup steeped None

haws for 10ndash15 min 1 cup tidFresh or dry plant tincture or glycerite 3ndash10 mL tidExtracts standardized to 18 vitexin-4cent-rhamnoside or 10 procyanidins 100ndash250 mg tid

is gentlemdashit takes fairly consistent use over several months toobtain the full benefit Absolutely no research on this plant couldbe located

Use of a fresh plant tincture (50 percent ethanol) is recom-mended The usual dose ranges from the low end in the Eclectictradition of 10ndash30 drops diluted in 4 ounces of water then thepatient should take 1 teaspoon three times per day up to a morepharmacologic dose of 5ndash15 gtt three times per day Althoughqueen-of-the-night is generally considered to be an herb to usewith caution Felter did not mention any serious adverse effectsIt should probably be avoided in pregnancy and lactationbecause of lack of information

A similar vine-like jungle cactus is known as Hylocereus unda-tus These two cacti are sufficiently morphologically similar thatsome professionals in the field consider them to be frequent adul-terants of one another Dr Yarnellrsquos mentor Silena Heron NDof Sedona Arizona (founding chair of botanical medicine atBastyr University in Kenmore Washington) sent tinctures madefrom Selenicereus grandiflorus and Hylocereus undatus to the lateJohn Bastyr ND DC without saying which was which Heeventually reported back that the bottle that contained Hylocereustincture was generally more clinically effective

A Weed for All Seasons

A better-researched relatively strong and generally antiar-rhythmic herb is Cytisus scoparius (Scotch broom) formerlyknown as Sarothamnus scoparius This Fabaceae family memberoriginated in northern Europe but has since naturalized to manyparts of the world It is a pernicious weed in the Pacific North-west where it grows rapidly crowding out native plants Thismakes it a very sustainable source of medicine that should bemore widely utilized to help keep it in check ecologically speak-ing

The constituents of greatest interest in Scotch broom are quino-lizidine alkaloids particularly sparteine According to WeissScotch broom acts very similarly to quinine and quinidinealthough Scotch broom is much safer5 Weiss recommended it fortreating patients who have congestive heart failure to help regu-late heart rhythm and indirectly to improve venous return Hecited the plant as a specific treatment for atrial or ventricular fib-rillation and extrasystoles These indications are echoed in othermodern sources that also cite Scotch broom as specific for treatingsinus tachycardia and postmyocardial infarction arrhythmias6

Modern investigation has revealed that sparteine and relatedalkaloids antagonize potassium channels7 There is also evidenceof sodium-channel antagonism8 There is a definite positiveinotropic action from sparteine apparently a result of its con-comitant actions on sodium and potassium channels9mdashunlikemany standard class I antiarrhythmic drugs (quinidine mex-ilitene) which also inhibit calcium channels and are actually neg-ative inotropic

No published clinical trials were located on the efficacy ofScotch broom or sparteine The recommended dose of Scotchbroom herb tincture made from fresh or dry plant material(45ndash55 percent ethanol) for an average-sized adult is 05ndash1 mL

three times per day The standard pharmacologic dose of isolatedsparteine is 100ndash200 mg per day in divided doses Unfortunatelythe usual content of sparteine in crude Scotch broom could not beconfirmed Since 1977 the Food and Drug Administration hasmade injectable sparteine unavailable because of the unpre-dictability of its effects and its propensity to cause tetanic uterinecontractions10

Whole-plant extracts of Scotch broom at usual therapeuticdoses are essentially without adverse effects and even overdoseis rarely a problem6 The most likely adverse effects if any arebradycardia indigestion loose stools and hypertension Theherb is contraindicated in pregnancy (although Scotch broomdoes have some application during labor as an oxytocic) and atri-oventricular block (which it can exacerbate readily)11 Some prac-titioners also consider Scotch broom to be contraindicated fortreating hypertension because of the herbrsquos vasoconstrictiveproperties12

Much is known about the pharmacokinetics of sparteinebecause it is thoroughly and specifically oxidized by hepatic CYP2D6 Approximately 5 percent of people of European descent arepoor metabolizers of sparteine because of an inefficiency or lackof CYP 2D613 In these patients sparteine levels may build up totoxic levels

Arguably CYP 2D6 function should be assessed prior toadministration of this herb although the cost effectiveness of thisapproach is questionable Scotch broom or sparteine should notbe administered simultaneously with drugs that inhibit CYP 2D6function including cimetidine nor with many selective serotoninreuptake inhibitors including fluoxetine and paroxetine thiori-dazine haloperidol propoxyphene and ritonavir Even more

ALTERNATIVE amp COMPLEMENTARY THERAPIESmdashJUNE 2003 127

Selenicereus grandiflorus (night-blooming cereus or queen-of-the-night)copy2003 by Eric Yarnell ND RH

important is the fact that many antiarrhythmic drugs are CYP2D6 inhibitors including quinidine flecainide and amiodaroneCaution is warranted in combining Scotch broom with otherantiarrhythmics for this reason

It should also be noted that approximately 1 percent of popula-tions of European descent are hypermetabolizers of sparteine as aresult of excessive CYP 2D6 activity and these people would beunlikely to respond to Scotch broom therapy14

Other drugs should not be combined with Scotch broomBecause of the presence of simple amines in the plant it maycause problems if combined with monoamine oxidase inhibitorsIt should also not be given with epinephrine because of thepotential synergy of effects particularly with regard to vasocon-striction and uterine contraction

Indian Snakeroot

Another potent specific antiarrhythmic herb is Rauvolfia ser-pentina (rauwolfia) formerly known as Indian snakeroot whichcomes from India The root of this herb contains many interestingalkaloids Of particular interest in the case of arrhythmias isajmaline Ajmaline is said to have been isolated by Salimuzza-man Siddiquil and named after Hakim Ajmal Khan a strongadvocate for Unani-Tib (Arab traditional medicine)15

In animal studies isolated ajmaline has shown particular effi-cacy for preventing arrhythmias caused by cardiac ischemia16

Russian clinicians have found various rauwolfia preparationscontaining ajmaline to be effective for preventing supraventricu-lar arrhythmias17 Because other lines of research support the

concept that the combined alkaloids of the plant are more effec-tive than any alkaloid in isolation the whole plant or wholeplant extracts are recommended The usual dose of a tincturestandardized to 01ndash0125 percent reserpine (as a quality con-trol) is 3ndash5 gtt three times per day for an average-size adult18

Lily-of-the-Valley

The third relatively strong herb for intervention for treatingmore serious arrhythmias is Convallaria majalis (lily-of-the-val-ley) This herb has a long history of use for people with mild con-gestive heart failure and it contains cardioactive glycosides19

Unlike the much stronger and more dangerous plant Digitalisspp (foxglove) lily-of-the-valley glycosides do not accumulateand are vastly safer and produce milder effects Lily-of-the-valleyflavonoids are also considered to be important for the activity ofthe herb and this supports the use of the whole plant and not justthe cardiac glycosides in isolation20

Lily-of-the-valley has also long been recognized by cliniciansto have an antiarrhythmic effect Felter found it particularlyuseful for treating tachycardia and mitral insufficiency2 Hefound it less useful for addressing aortic valve problems Ani-mal studies support that l i ly of the valley has a posit iveinotropic effect and that it is a moderately strong vasoconstric-tor21 In a bizarre twist actual progesterone has been found inlily-of-the-valley presumably in quantities too minute to berelevant to medicine but suggesting that humans and plantsmay have more hormonal regulation systems in common thanwas once thought22

The usual dose of lily-of-the-valley fresh-plant tincture (25ndash30percent ethanol) is 05ndash1 mL three times per day for an average-sized adult Although lily of the valley is very safe it should notbe taken in excess and the patient should be told to maintain ah i g h i n t a k e o f f r u i t s a nd v eg e t a b le s t o gua rd ag a in s thypokalemia which potentiates the toxicity of other cardiac gly-cosides The herb should not be combined with potassium-wast-ing drugs such as loop diuretics and corticosteroids withoutcareful monitoring of potassium levels The onset of severe nau-sea vomiting or atrial fibrillation are all indications for discon-tinuation of the herb

Hawthorn The Tonifier

No discussion of plants for treating patients with arrhythmiaswould be complete without mentioning the ultimate cardiactonic Crataegus laevigata (hawthorn) This herb is so safe that ithas no known overdose level Its effects are very gentle oftentaking weeks or months to become fully noticeable For this rea-son it is advocated as a chronic treatment to prevent and treatessentially all types of arrhythmias

There is much less research on the antiarrhythmic activity ofhawthorn than on its many other actions However some animalresearch has shown directly that the hawthorn species Crataegusmeyeri is antiarrhythmic23 Surprisingly researchers who did onerat study actually found C laevigata standardized extract to beproarrhythmic in ischemic hearts24 It appeared that the calcium-

128 ALTERNATIVE amp COMPLEMENTARY THERAPIESmdashJUNE 2003

Crataegus laevigata (hawthorn) Photo by Holly Shull Vogel FrostFlower Farm

For a complete review of the intricacies of the clinical use and safety ofrauwolfia for treating hypertension an update of ref 18 will be publishedin Yarnell E Abascal K Hooper CG Clinical Botanical Medicine Larch-mont NY Mary Ann Liebert Inc 2003in press

channel antagonist activity of the herb was causing the problemThe extract was also administered by injection In similar studyusing the same methodology but using oral pretreatment withhawthorn researchers found that it did reduce the incidence ofpostischemic fibrillation in rats greatly25

Clinical trials of hawthorn in patients with congestive heartfailure (CHF) have often reported secondary outcomes involvingcardiac rhythm In one large open trial (n = 3664) hawthorn wasfound to be particularly useful in patients who had CHF withtachycardiac arrhythmias26 In another large open trial (n = 1011)the incidence of arrhythmias and ventricular estrasystoles wasnotable and appeared to coincide with improve myocardial per-fusion27 To confirm the antiarrhythmic nature of hawthornarrhythmia types and incidence should be assessed in future tri-als involving hawthorn as primary or secondary measures bothin patients with CHF and those with non-CHFndashrelated arrhyth-mias

Hawthorn can be taken in many forms The leaves flowersand haws (fruit or berries) are all utilized An infusion of 2ndash3 tea-spoons per cup steeped for 10ndash15 minutes can be drunk threetimes per day A tincture (25 percent ethanol) or glycerite (75 per-cent glycerin) is dosed at 3ndash10 mL three times per day foradults depending on severity of the disease and body size Theusual dose of extracts standardized to 18 percent vitexin-4cent-rhamnoside or to 10 percent procyanidins is 100ndash250 mg threetimes per day As noted above there are no known adverseeffects of this herb and no contraindications

Summary

Numerous herbs are useful for treating patients with a widerange of arrhythmias In all cases C laevigata is recommended forprevention and treatment as a gentle tonic For treating mildarrhythmias not related to demonstrable heart pathology simplesedatives such as L cardiaca and S lateriflora are recommendedFor more serious cases or when milder remedies are not suffi-cient S grandiflorus or H undatus C scoparius R serpentaria andC majalis offer more potent although also potentially more dan-gerous options However careful monitoring and proper dosingusually allow even these strong herbs to be utilized safely n

References1 Weiss RF Herbal Medicine Beaconsfield UK Beaconsfield Publishers19881862 Felter HW Eclectic Materia Medica Pharmacology and TherapeuticsSandy OR Eclectic Medical Publications 1922 [reprinted 1998]3 Denham A McIntyre M Whitehouse J Kavamdashthe unfolding storyReport of a work-in-progress J Altern Complement Med 20028237ndash263with special Appendix 1 Whitton P Whitehouse J Evans C Response toreported hepatotoxicity of high lactone extractions of Piper mythysticumForst (kava)]4 Hoffmann D The Complete Illustrated Herbal New York Barnes ampNoble 19961425 Weiss RF Herbal Medicine Beaconsfield UK Beaconsfield Publishers19881506 Thies PW Spartium and sparteine Its antiarrhythmic action [in Ger-man] Pharmazie unserer Zeit 19866172ndash176

7 Northover BJ Effect of pre-treating rat atria with potassium channelblocking drugs on the electrical and mechanical responses to phenyle-phrine Biochem Pharmacol 1994472163ndash1698 Puglsey MK Saint DA Hayes E et al The cardiac electrophysiologicaleffects of sparteine and its analogue BRB-I-28 in the rat Eur J Pharmacol1995294319ndash3279Honerjager P Loibl E Steidl I et al Negative inotropic effects of tetrodotox-in and seven class 1 antiarrhythmic drugs in relation to sodium channelblockade Naunyn Schmiedebergs Arch Pharmacol 1986332184ndash19510 United States Food and Drug Administration Online document atwwwfdagovohrmsdockets98fr100898btxt1 1 Bank on D a t a A u toma t ed o n D rug s On l i n e do cum en t a twwwbiam2org Accessed March 30 200312 Hoffmann D The Complete Illustrated Herbal New York Barnes ampNoble 19968513 Eichelbaum M Spannbrucker N Steincke B et al Defective N-oxida-tion of sparteine in man A new pharmacogenetic defect Eur J Clin Phar-macol 197916183ndash18714 Bathum L Johansson I Ingelman-Sundberg M Horder M Brosen KUltrarapid metabolism of sparteine Frequency of alleles with duplicatedCYP 2D6 genes in a Danish population as determined by restriction frag-ment length polymorphism and long polymerase chain reaction Pharma-cogenetics 19988119ndash12315 Islam Science Environment and Technology Online document atwwwislamsetcomscplantsajmalinehtml Accessed March 30 200316 Obayashi K Nagasawa K Mandel WJ et al Cardiovascular effects ofajmaline Am Heart J 197692487ndash49617 Kelrsquoman IM Paleev NR Prevention of supraventricular tachysystolewith anti-arrhythmia agents [in Russian] Kardiologiia 19771742ndash4518 Yarnell E Abascal A Treating hypertension botanically Altern Com-plement Ther 20017284ndash29019 Meixner HK Dobler S Oral heart therapy using convallaria glycosidesin ambulatory practice [in German] Z Allgemeinmed 197450(16)757ndash76820 Weiss RF Herbal Medicine Beaconsfield UK Beaconsfield Publish-ers 198814621 Lehmann HD Effect of plant glycosides on resistance and capacitancevessels [in German] Arzneim Forsch 198434423ndash42922 Kopp B Loffelhardt W Determination of progesterone in vegetativeorgans and cell organelles of Convallaria majalis L by radioimmunoassayZ Naturforsch [C] 19803541ndash4423 Garjani A Nazemiyeh H Maleki N Valizadeh H Effects of extractsfrom flowering tops of Crataegus meyeri A Pojark on ischaemic arrhyth-mias in anaesthetized rats Phytother Res 200014428ndash43124 Rothfuss MA Pascht U Kissling G Effect of long-term application ofCrataegus oxyacantha on ischemia and reperfusion induced arrhythmias inrats Arzneim Forsch 20015124ndash2825 al Makdessi S Sweidan H Dietz K Jacob R Protective effect ofCrataegus oxyacantha against reperfusion arrhythmias after global no-flow ischemia in the rat heart Basic Res Cardiol 19999471ndash7726 Schmidt U Albrecht M Podzuweit H et al High dosage therapy withCrataegus extract in patients suffering from heart failure NYHA class Iand II [in German] Z Phytother 19981922ndash3027 Tauchert M Gildor A Lipinski J High-dose Crataegus (hawthorn)extract WS 1442 for the treatment of NYHA class II heart failure patients[in German] Herz 199924465ndash474

Eric Yarnell ND RH is president of the Botanical Medicine Academya specialty board for using medicinal herbs Kathy Abascal BS JDHerbalist is executive director of the Botanical Medicine AcademyVashon Washington

To order reprints of this article write to or call Karen Ballen ALTERNA-TIVE amp COMPLEMENTARY THERAPIES Mary Ann Liebert Inc 2Madison Avenue Larchmont NY 10538-1961 (914) 834-3100

ALTERNATIVE amp COMPLEMENTARY THERAPIESmdashJUNE 2003 129

is gentlemdashit takes fairly consistent use over several months toobtain the full benefit Absolutely no research on this plant couldbe located

Use of a fresh plant tincture (50 percent ethanol) is recom-mended The usual dose ranges from the low end in the Eclectictradition of 10ndash30 drops diluted in 4 ounces of water then thepatient should take 1 teaspoon three times per day up to a morepharmacologic dose of 5ndash15 gtt three times per day Althoughqueen-of-the-night is generally considered to be an herb to usewith caution Felter did not mention any serious adverse effectsIt should probably be avoided in pregnancy and lactationbecause of lack of information

A similar vine-like jungle cactus is known as Hylocereus unda-tus These two cacti are sufficiently morphologically similar thatsome professionals in the field consider them to be frequent adul-terants of one another Dr Yarnellrsquos mentor Silena Heron NDof Sedona Arizona (founding chair of botanical medicine atBastyr University in Kenmore Washington) sent tinctures madefrom Selenicereus grandiflorus and Hylocereus undatus to the lateJohn Bastyr ND DC without saying which was which Heeventually reported back that the bottle that contained Hylocereustincture was generally more clinically effective

A Weed for All Seasons

A better-researched relatively strong and generally antiar-rhythmic herb is Cytisus scoparius (Scotch broom) formerlyknown as Sarothamnus scoparius This Fabaceae family memberoriginated in northern Europe but has since naturalized to manyparts of the world It is a pernicious weed in the Pacific North-west where it grows rapidly crowding out native plants Thismakes it a very sustainable source of medicine that should bemore widely utilized to help keep it in check ecologically speak-ing

The constituents of greatest interest in Scotch broom are quino-lizidine alkaloids particularly sparteine According to WeissScotch broom acts very similarly to quinine and quinidinealthough Scotch broom is much safer5 Weiss recommended it fortreating patients who have congestive heart failure to help regu-late heart rhythm and indirectly to improve venous return Hecited the plant as a specific treatment for atrial or ventricular fib-rillation and extrasystoles These indications are echoed in othermodern sources that also cite Scotch broom as specific for treatingsinus tachycardia and postmyocardial infarction arrhythmias6

Modern investigation has revealed that sparteine and relatedalkaloids antagonize potassium channels7 There is also evidenceof sodium-channel antagonism8 There is a definite positiveinotropic action from sparteine apparently a result of its con-comitant actions on sodium and potassium channels9mdashunlikemany standard class I antiarrhythmic drugs (quinidine mex-ilitene) which also inhibit calcium channels and are actually neg-ative inotropic

No published clinical trials were located on the efficacy ofScotch broom or sparteine The recommended dose of Scotchbroom herb tincture made from fresh or dry plant material(45ndash55 percent ethanol) for an average-sized adult is 05ndash1 mL

three times per day The standard pharmacologic dose of isolatedsparteine is 100ndash200 mg per day in divided doses Unfortunatelythe usual content of sparteine in crude Scotch broom could not beconfirmed Since 1977 the Food and Drug Administration hasmade injectable sparteine unavailable because of the unpre-dictability of its effects and its propensity to cause tetanic uterinecontractions10

Whole-plant extracts of Scotch broom at usual therapeuticdoses are essentially without adverse effects and even overdoseis rarely a problem6 The most likely adverse effects if any arebradycardia indigestion loose stools and hypertension Theherb is contraindicated in pregnancy (although Scotch broomdoes have some application during labor as an oxytocic) and atri-oventricular block (which it can exacerbate readily)11 Some prac-titioners also consider Scotch broom to be contraindicated fortreating hypertension because of the herbrsquos vasoconstrictiveproperties12

Much is known about the pharmacokinetics of sparteinebecause it is thoroughly and specifically oxidized by hepatic CYP2D6 Approximately 5 percent of people of European descent arepoor metabolizers of sparteine because of an inefficiency or lackof CYP 2D613 In these patients sparteine levels may build up totoxic levels

Arguably CYP 2D6 function should be assessed prior toadministration of this herb although the cost effectiveness of thisapproach is questionable Scotch broom or sparteine should notbe administered simultaneously with drugs that inhibit CYP 2D6function including cimetidine nor with many selective serotoninreuptake inhibitors including fluoxetine and paroxetine thiori-dazine haloperidol propoxyphene and ritonavir Even more

ALTERNATIVE amp COMPLEMENTARY THERAPIESmdashJUNE 2003 127

Selenicereus grandiflorus (night-blooming cereus or queen-of-the-night)copy2003 by Eric Yarnell ND RH

important is the fact that many antiarrhythmic drugs are CYP2D6 inhibitors including quinidine flecainide and amiodaroneCaution is warranted in combining Scotch broom with otherantiarrhythmics for this reason

It should also be noted that approximately 1 percent of popula-tions of European descent are hypermetabolizers of sparteine as aresult of excessive CYP 2D6 activity and these people would beunlikely to respond to Scotch broom therapy14

Other drugs should not be combined with Scotch broomBecause of the presence of simple amines in the plant it maycause problems if combined with monoamine oxidase inhibitorsIt should also not be given with epinephrine because of thepotential synergy of effects particularly with regard to vasocon-striction and uterine contraction

Indian Snakeroot

Another potent specific antiarrhythmic herb is Rauvolfia ser-pentina (rauwolfia) formerly known as Indian snakeroot whichcomes from India The root of this herb contains many interestingalkaloids Of particular interest in the case of arrhythmias isajmaline Ajmaline is said to have been isolated by Salimuzza-man Siddiquil and named after Hakim Ajmal Khan a strongadvocate for Unani-Tib (Arab traditional medicine)15

In animal studies isolated ajmaline has shown particular effi-cacy for preventing arrhythmias caused by cardiac ischemia16

Russian clinicians have found various rauwolfia preparationscontaining ajmaline to be effective for preventing supraventricu-lar arrhythmias17 Because other lines of research support the

concept that the combined alkaloids of the plant are more effec-tive than any alkaloid in isolation the whole plant or wholeplant extracts are recommended The usual dose of a tincturestandardized to 01ndash0125 percent reserpine (as a quality con-trol) is 3ndash5 gtt three times per day for an average-size adult18

Lily-of-the-Valley

The third relatively strong herb for intervention for treatingmore serious arrhythmias is Convallaria majalis (lily-of-the-val-ley) This herb has a long history of use for people with mild con-gestive heart failure and it contains cardioactive glycosides19

Unlike the much stronger and more dangerous plant Digitalisspp (foxglove) lily-of-the-valley glycosides do not accumulateand are vastly safer and produce milder effects Lily-of-the-valleyflavonoids are also considered to be important for the activity ofthe herb and this supports the use of the whole plant and not justthe cardiac glycosides in isolation20

Lily-of-the-valley has also long been recognized by cliniciansto have an antiarrhythmic effect Felter found it particularlyuseful for treating tachycardia and mitral insufficiency2 Hefound it less useful for addressing aortic valve problems Ani-mal studies support that l i ly of the valley has a posit iveinotropic effect and that it is a moderately strong vasoconstric-tor21 In a bizarre twist actual progesterone has been found inlily-of-the-valley presumably in quantities too minute to berelevant to medicine but suggesting that humans and plantsmay have more hormonal regulation systems in common thanwas once thought22

The usual dose of lily-of-the-valley fresh-plant tincture (25ndash30percent ethanol) is 05ndash1 mL three times per day for an average-sized adult Although lily of the valley is very safe it should notbe taken in excess and the patient should be told to maintain ah i g h i n t a k e o f f r u i t s a nd v eg e t a b le s t o gua rd ag a in s thypokalemia which potentiates the toxicity of other cardiac gly-cosides The herb should not be combined with potassium-wast-ing drugs such as loop diuretics and corticosteroids withoutcareful monitoring of potassium levels The onset of severe nau-sea vomiting or atrial fibrillation are all indications for discon-tinuation of the herb

Hawthorn The Tonifier

No discussion of plants for treating patients with arrhythmiaswould be complete without mentioning the ultimate cardiactonic Crataegus laevigata (hawthorn) This herb is so safe that ithas no known overdose level Its effects are very gentle oftentaking weeks or months to become fully noticeable For this rea-son it is advocated as a chronic treatment to prevent and treatessentially all types of arrhythmias

There is much less research on the antiarrhythmic activity ofhawthorn than on its many other actions However some animalresearch has shown directly that the hawthorn species Crataegusmeyeri is antiarrhythmic23 Surprisingly researchers who did onerat study actually found C laevigata standardized extract to beproarrhythmic in ischemic hearts24 It appeared that the calcium-

128 ALTERNATIVE amp COMPLEMENTARY THERAPIESmdashJUNE 2003

Crataegus laevigata (hawthorn) Photo by Holly Shull Vogel FrostFlower Farm

For a complete review of the intricacies of the clinical use and safety ofrauwolfia for treating hypertension an update of ref 18 will be publishedin Yarnell E Abascal K Hooper CG Clinical Botanical Medicine Larch-mont NY Mary Ann Liebert Inc 2003in press

channel antagonist activity of the herb was causing the problemThe extract was also administered by injection In similar studyusing the same methodology but using oral pretreatment withhawthorn researchers found that it did reduce the incidence ofpostischemic fibrillation in rats greatly25

Clinical trials of hawthorn in patients with congestive heartfailure (CHF) have often reported secondary outcomes involvingcardiac rhythm In one large open trial (n = 3664) hawthorn wasfound to be particularly useful in patients who had CHF withtachycardiac arrhythmias26 In another large open trial (n = 1011)the incidence of arrhythmias and ventricular estrasystoles wasnotable and appeared to coincide with improve myocardial per-fusion27 To confirm the antiarrhythmic nature of hawthornarrhythmia types and incidence should be assessed in future tri-als involving hawthorn as primary or secondary measures bothin patients with CHF and those with non-CHFndashrelated arrhyth-mias

Hawthorn can be taken in many forms The leaves flowersand haws (fruit or berries) are all utilized An infusion of 2ndash3 tea-spoons per cup steeped for 10ndash15 minutes can be drunk threetimes per day A tincture (25 percent ethanol) or glycerite (75 per-cent glycerin) is dosed at 3ndash10 mL three times per day foradults depending on severity of the disease and body size Theusual dose of extracts standardized to 18 percent vitexin-4cent-rhamnoside or to 10 percent procyanidins is 100ndash250 mg threetimes per day As noted above there are no known adverseeffects of this herb and no contraindications

Summary

Numerous herbs are useful for treating patients with a widerange of arrhythmias In all cases C laevigata is recommended forprevention and treatment as a gentle tonic For treating mildarrhythmias not related to demonstrable heart pathology simplesedatives such as L cardiaca and S lateriflora are recommendedFor more serious cases or when milder remedies are not suffi-cient S grandiflorus or H undatus C scoparius R serpentaria andC majalis offer more potent although also potentially more dan-gerous options However careful monitoring and proper dosingusually allow even these strong herbs to be utilized safely n

References1 Weiss RF Herbal Medicine Beaconsfield UK Beaconsfield Publishers19881862 Felter HW Eclectic Materia Medica Pharmacology and TherapeuticsSandy OR Eclectic Medical Publications 1922 [reprinted 1998]3 Denham A McIntyre M Whitehouse J Kavamdashthe unfolding storyReport of a work-in-progress J Altern Complement Med 20028237ndash263with special Appendix 1 Whitton P Whitehouse J Evans C Response toreported hepatotoxicity of high lactone extractions of Piper mythysticumForst (kava)]4 Hoffmann D The Complete Illustrated Herbal New York Barnes ampNoble 19961425 Weiss RF Herbal Medicine Beaconsfield UK Beaconsfield Publishers19881506 Thies PW Spartium and sparteine Its antiarrhythmic action [in Ger-man] Pharmazie unserer Zeit 19866172ndash176

7 Northover BJ Effect of pre-treating rat atria with potassium channelblocking drugs on the electrical and mechanical responses to phenyle-phrine Biochem Pharmacol 1994472163ndash1698 Puglsey MK Saint DA Hayes E et al The cardiac electrophysiologicaleffects of sparteine and its analogue BRB-I-28 in the rat Eur J Pharmacol1995294319ndash3279Honerjager P Loibl E Steidl I et al Negative inotropic effects of tetrodotox-in and seven class 1 antiarrhythmic drugs in relation to sodium channelblockade Naunyn Schmiedebergs Arch Pharmacol 1986332184ndash19510 United States Food and Drug Administration Online document atwwwfdagovohrmsdockets98fr100898btxt1 1 Bank on D a t a A u toma t ed o n D rug s On l i n e do cum en t a twwwbiam2org Accessed March 30 200312 Hoffmann D The Complete Illustrated Herbal New York Barnes ampNoble 19968513 Eichelbaum M Spannbrucker N Steincke B et al Defective N-oxida-tion of sparteine in man A new pharmacogenetic defect Eur J Clin Phar-macol 197916183ndash18714 Bathum L Johansson I Ingelman-Sundberg M Horder M Brosen KUltrarapid metabolism of sparteine Frequency of alleles with duplicatedCYP 2D6 genes in a Danish population as determined by restriction frag-ment length polymorphism and long polymerase chain reaction Pharma-cogenetics 19988119ndash12315 Islam Science Environment and Technology Online document atwwwislamsetcomscplantsajmalinehtml Accessed March 30 200316 Obayashi K Nagasawa K Mandel WJ et al Cardiovascular effects ofajmaline Am Heart J 197692487ndash49617 Kelrsquoman IM Paleev NR Prevention of supraventricular tachysystolewith anti-arrhythmia agents [in Russian] Kardiologiia 19771742ndash4518 Yarnell E Abascal A Treating hypertension botanically Altern Com-plement Ther 20017284ndash29019 Meixner HK Dobler S Oral heart therapy using convallaria glycosidesin ambulatory practice [in German] Z Allgemeinmed 197450(16)757ndash76820 Weiss RF Herbal Medicine Beaconsfield UK Beaconsfield Publish-ers 198814621 Lehmann HD Effect of plant glycosides on resistance and capacitancevessels [in German] Arzneim Forsch 198434423ndash42922 Kopp B Loffelhardt W Determination of progesterone in vegetativeorgans and cell organelles of Convallaria majalis L by radioimmunoassayZ Naturforsch [C] 19803541ndash4423 Garjani A Nazemiyeh H Maleki N Valizadeh H Effects of extractsfrom flowering tops of Crataegus meyeri A Pojark on ischaemic arrhyth-mias in anaesthetized rats Phytother Res 200014428ndash43124 Rothfuss MA Pascht U Kissling G Effect of long-term application ofCrataegus oxyacantha on ischemia and reperfusion induced arrhythmias inrats Arzneim Forsch 20015124ndash2825 al Makdessi S Sweidan H Dietz K Jacob R Protective effect ofCrataegus oxyacantha against reperfusion arrhythmias after global no-flow ischemia in the rat heart Basic Res Cardiol 19999471ndash7726 Schmidt U Albrecht M Podzuweit H et al High dosage therapy withCrataegus extract in patients suffering from heart failure NYHA class Iand II [in German] Z Phytother 19981922ndash3027 Tauchert M Gildor A Lipinski J High-dose Crataegus (hawthorn)extract WS 1442 for the treatment of NYHA class II heart failure patients[in German] Herz 199924465ndash474

Eric Yarnell ND RH is president of the Botanical Medicine Academya specialty board for using medicinal herbs Kathy Abascal BS JDHerbalist is executive director of the Botanical Medicine AcademyVashon Washington

To order reprints of this article write to or call Karen Ballen ALTERNA-TIVE amp COMPLEMENTARY THERAPIES Mary Ann Liebert Inc 2Madison Avenue Larchmont NY 10538-1961 (914) 834-3100

ALTERNATIVE amp COMPLEMENTARY THERAPIESmdashJUNE 2003 129

important is the fact that many antiarrhythmic drugs are CYP2D6 inhibitors including quinidine flecainide and amiodaroneCaution is warranted in combining Scotch broom with otherantiarrhythmics for this reason

It should also be noted that approximately 1 percent of popula-tions of European descent are hypermetabolizers of sparteine as aresult of excessive CYP 2D6 activity and these people would beunlikely to respond to Scotch broom therapy14

Other drugs should not be combined with Scotch broomBecause of the presence of simple amines in the plant it maycause problems if combined with monoamine oxidase inhibitorsIt should also not be given with epinephrine because of thepotential synergy of effects particularly with regard to vasocon-striction and uterine contraction

Indian Snakeroot

Another potent specific antiarrhythmic herb is Rauvolfia ser-pentina (rauwolfia) formerly known as Indian snakeroot whichcomes from India The root of this herb contains many interestingalkaloids Of particular interest in the case of arrhythmias isajmaline Ajmaline is said to have been isolated by Salimuzza-man Siddiquil and named after Hakim Ajmal Khan a strongadvocate for Unani-Tib (Arab traditional medicine)15

In animal studies isolated ajmaline has shown particular effi-cacy for preventing arrhythmias caused by cardiac ischemia16

Russian clinicians have found various rauwolfia preparationscontaining ajmaline to be effective for preventing supraventricu-lar arrhythmias17 Because other lines of research support the

concept that the combined alkaloids of the plant are more effec-tive than any alkaloid in isolation the whole plant or wholeplant extracts are recommended The usual dose of a tincturestandardized to 01ndash0125 percent reserpine (as a quality con-trol) is 3ndash5 gtt three times per day for an average-size adult18

Lily-of-the-Valley

The third relatively strong herb for intervention for treatingmore serious arrhythmias is Convallaria majalis (lily-of-the-val-ley) This herb has a long history of use for people with mild con-gestive heart failure and it contains cardioactive glycosides19

Unlike the much stronger and more dangerous plant Digitalisspp (foxglove) lily-of-the-valley glycosides do not accumulateand are vastly safer and produce milder effects Lily-of-the-valleyflavonoids are also considered to be important for the activity ofthe herb and this supports the use of the whole plant and not justthe cardiac glycosides in isolation20

Lily-of-the-valley has also long been recognized by cliniciansto have an antiarrhythmic effect Felter found it particularlyuseful for treating tachycardia and mitral insufficiency2 Hefound it less useful for addressing aortic valve problems Ani-mal studies support that l i ly of the valley has a posit iveinotropic effect and that it is a moderately strong vasoconstric-tor21 In a bizarre twist actual progesterone has been found inlily-of-the-valley presumably in quantities too minute to berelevant to medicine but suggesting that humans and plantsmay have more hormonal regulation systems in common thanwas once thought22

The usual dose of lily-of-the-valley fresh-plant tincture (25ndash30percent ethanol) is 05ndash1 mL three times per day for an average-sized adult Although lily of the valley is very safe it should notbe taken in excess and the patient should be told to maintain ah i g h i n t a k e o f f r u i t s a nd v eg e t a b le s t o gua rd ag a in s thypokalemia which potentiates the toxicity of other cardiac gly-cosides The herb should not be combined with potassium-wast-ing drugs such as loop diuretics and corticosteroids withoutcareful monitoring of potassium levels The onset of severe nau-sea vomiting or atrial fibrillation are all indications for discon-tinuation of the herb

Hawthorn The Tonifier

No discussion of plants for treating patients with arrhythmiaswould be complete without mentioning the ultimate cardiactonic Crataegus laevigata (hawthorn) This herb is so safe that ithas no known overdose level Its effects are very gentle oftentaking weeks or months to become fully noticeable For this rea-son it is advocated as a chronic treatment to prevent and treatessentially all types of arrhythmias

There is much less research on the antiarrhythmic activity ofhawthorn than on its many other actions However some animalresearch has shown directly that the hawthorn species Crataegusmeyeri is antiarrhythmic23 Surprisingly researchers who did onerat study actually found C laevigata standardized extract to beproarrhythmic in ischemic hearts24 It appeared that the calcium-

128 ALTERNATIVE amp COMPLEMENTARY THERAPIESmdashJUNE 2003

Crataegus laevigata (hawthorn) Photo by Holly Shull Vogel FrostFlower Farm

For a complete review of the intricacies of the clinical use and safety ofrauwolfia for treating hypertension an update of ref 18 will be publishedin Yarnell E Abascal K Hooper CG Clinical Botanical Medicine Larch-mont NY Mary Ann Liebert Inc 2003in press

channel antagonist activity of the herb was causing the problemThe extract was also administered by injection In similar studyusing the same methodology but using oral pretreatment withhawthorn researchers found that it did reduce the incidence ofpostischemic fibrillation in rats greatly25

Clinical trials of hawthorn in patients with congestive heartfailure (CHF) have often reported secondary outcomes involvingcardiac rhythm In one large open trial (n = 3664) hawthorn wasfound to be particularly useful in patients who had CHF withtachycardiac arrhythmias26 In another large open trial (n = 1011)the incidence of arrhythmias and ventricular estrasystoles wasnotable and appeared to coincide with improve myocardial per-fusion27 To confirm the antiarrhythmic nature of hawthornarrhythmia types and incidence should be assessed in future tri-als involving hawthorn as primary or secondary measures bothin patients with CHF and those with non-CHFndashrelated arrhyth-mias

Hawthorn can be taken in many forms The leaves flowersand haws (fruit or berries) are all utilized An infusion of 2ndash3 tea-spoons per cup steeped for 10ndash15 minutes can be drunk threetimes per day A tincture (25 percent ethanol) or glycerite (75 per-cent glycerin) is dosed at 3ndash10 mL three times per day foradults depending on severity of the disease and body size Theusual dose of extracts standardized to 18 percent vitexin-4cent-rhamnoside or to 10 percent procyanidins is 100ndash250 mg threetimes per day As noted above there are no known adverseeffects of this herb and no contraindications

Summary

Numerous herbs are useful for treating patients with a widerange of arrhythmias In all cases C laevigata is recommended forprevention and treatment as a gentle tonic For treating mildarrhythmias not related to demonstrable heart pathology simplesedatives such as L cardiaca and S lateriflora are recommendedFor more serious cases or when milder remedies are not suffi-cient S grandiflorus or H undatus C scoparius R serpentaria andC majalis offer more potent although also potentially more dan-gerous options However careful monitoring and proper dosingusually allow even these strong herbs to be utilized safely n

References1 Weiss RF Herbal Medicine Beaconsfield UK Beaconsfield Publishers19881862 Felter HW Eclectic Materia Medica Pharmacology and TherapeuticsSandy OR Eclectic Medical Publications 1922 [reprinted 1998]3 Denham A McIntyre M Whitehouse J Kavamdashthe unfolding storyReport of a work-in-progress J Altern Complement Med 20028237ndash263with special Appendix 1 Whitton P Whitehouse J Evans C Response toreported hepatotoxicity of high lactone extractions of Piper mythysticumForst (kava)]4 Hoffmann D The Complete Illustrated Herbal New York Barnes ampNoble 19961425 Weiss RF Herbal Medicine Beaconsfield UK Beaconsfield Publishers19881506 Thies PW Spartium and sparteine Its antiarrhythmic action [in Ger-man] Pharmazie unserer Zeit 19866172ndash176

7 Northover BJ Effect of pre-treating rat atria with potassium channelblocking drugs on the electrical and mechanical responses to phenyle-phrine Biochem Pharmacol 1994472163ndash1698 Puglsey MK Saint DA Hayes E et al The cardiac electrophysiologicaleffects of sparteine and its analogue BRB-I-28 in the rat Eur J Pharmacol1995294319ndash3279Honerjager P Loibl E Steidl I et al Negative inotropic effects of tetrodotox-in and seven class 1 antiarrhythmic drugs in relation to sodium channelblockade Naunyn Schmiedebergs Arch Pharmacol 1986332184ndash19510 United States Food and Drug Administration Online document atwwwfdagovohrmsdockets98fr100898btxt1 1 Bank on D a t a A u toma t ed o n D rug s On l i n e do cum en t a twwwbiam2org Accessed March 30 200312 Hoffmann D The Complete Illustrated Herbal New York Barnes ampNoble 19968513 Eichelbaum M Spannbrucker N Steincke B et al Defective N-oxida-tion of sparteine in man A new pharmacogenetic defect Eur J Clin Phar-macol 197916183ndash18714 Bathum L Johansson I Ingelman-Sundberg M Horder M Brosen KUltrarapid metabolism of sparteine Frequency of alleles with duplicatedCYP 2D6 genes in a Danish population as determined by restriction frag-ment length polymorphism and long polymerase chain reaction Pharma-cogenetics 19988119ndash12315 Islam Science Environment and Technology Online document atwwwislamsetcomscplantsajmalinehtml Accessed March 30 200316 Obayashi K Nagasawa K Mandel WJ et al Cardiovascular effects ofajmaline Am Heart J 197692487ndash49617 Kelrsquoman IM Paleev NR Prevention of supraventricular tachysystolewith anti-arrhythmia agents [in Russian] Kardiologiia 19771742ndash4518 Yarnell E Abascal A Treating hypertension botanically Altern Com-plement Ther 20017284ndash29019 Meixner HK Dobler S Oral heart therapy using convallaria glycosidesin ambulatory practice [in German] Z Allgemeinmed 197450(16)757ndash76820 Weiss RF Herbal Medicine Beaconsfield UK Beaconsfield Publish-ers 198814621 Lehmann HD Effect of plant glycosides on resistance and capacitancevessels [in German] Arzneim Forsch 198434423ndash42922 Kopp B Loffelhardt W Determination of progesterone in vegetativeorgans and cell organelles of Convallaria majalis L by radioimmunoassayZ Naturforsch [C] 19803541ndash4423 Garjani A Nazemiyeh H Maleki N Valizadeh H Effects of extractsfrom flowering tops of Crataegus meyeri A Pojark on ischaemic arrhyth-mias in anaesthetized rats Phytother Res 200014428ndash43124 Rothfuss MA Pascht U Kissling G Effect of long-term application ofCrataegus oxyacantha on ischemia and reperfusion induced arrhythmias inrats Arzneim Forsch 20015124ndash2825 al Makdessi S Sweidan H Dietz K Jacob R Protective effect ofCrataegus oxyacantha against reperfusion arrhythmias after global no-flow ischemia in the rat heart Basic Res Cardiol 19999471ndash7726 Schmidt U Albrecht M Podzuweit H et al High dosage therapy withCrataegus extract in patients suffering from heart failure NYHA class Iand II [in German] Z Phytother 19981922ndash3027 Tauchert M Gildor A Lipinski J High-dose Crataegus (hawthorn)extract WS 1442 for the treatment of NYHA class II heart failure patients[in German] Herz 199924465ndash474

Eric Yarnell ND RH is president of the Botanical Medicine Academya specialty board for using medicinal herbs Kathy Abascal BS JDHerbalist is executive director of the Botanical Medicine AcademyVashon Washington

To order reprints of this article write to or call Karen Ballen ALTERNA-TIVE amp COMPLEMENTARY THERAPIES Mary Ann Liebert Inc 2Madison Avenue Larchmont NY 10538-1961 (914) 834-3100

ALTERNATIVE amp COMPLEMENTARY THERAPIESmdashJUNE 2003 129

channel antagonist activity of the herb was causing the problemThe extract was also administered by injection In similar studyusing the same methodology but using oral pretreatment withhawthorn researchers found that it did reduce the incidence ofpostischemic fibrillation in rats greatly25

Clinical trials of hawthorn in patients with congestive heartfailure (CHF) have often reported secondary outcomes involvingcardiac rhythm In one large open trial (n = 3664) hawthorn wasfound to be particularly useful in patients who had CHF withtachycardiac arrhythmias26 In another large open trial (n = 1011)the incidence of arrhythmias and ventricular estrasystoles wasnotable and appeared to coincide with improve myocardial per-fusion27 To confirm the antiarrhythmic nature of hawthornarrhythmia types and incidence should be assessed in future tri-als involving hawthorn as primary or secondary measures bothin patients with CHF and those with non-CHFndashrelated arrhyth-mias

Hawthorn can be taken in many forms The leaves flowersand haws (fruit or berries) are all utilized An infusion of 2ndash3 tea-spoons per cup steeped for 10ndash15 minutes can be drunk threetimes per day A tincture (25 percent ethanol) or glycerite (75 per-cent glycerin) is dosed at 3ndash10 mL three times per day foradults depending on severity of the disease and body size Theusual dose of extracts standardized to 18 percent vitexin-4cent-rhamnoside or to 10 percent procyanidins is 100ndash250 mg threetimes per day As noted above there are no known adverseeffects of this herb and no contraindications

Summary

Numerous herbs are useful for treating patients with a widerange of arrhythmias In all cases C laevigata is recommended forprevention and treatment as a gentle tonic For treating mildarrhythmias not related to demonstrable heart pathology simplesedatives such as L cardiaca and S lateriflora are recommendedFor more serious cases or when milder remedies are not suffi-cient S grandiflorus or H undatus C scoparius R serpentaria andC majalis offer more potent although also potentially more dan-gerous options However careful monitoring and proper dosingusually allow even these strong herbs to be utilized safely n

References1 Weiss RF Herbal Medicine Beaconsfield UK Beaconsfield Publishers19881862 Felter HW Eclectic Materia Medica Pharmacology and TherapeuticsSandy OR Eclectic Medical Publications 1922 [reprinted 1998]3 Denham A McIntyre M Whitehouse J Kavamdashthe unfolding storyReport of a work-in-progress J Altern Complement Med 20028237ndash263with special Appendix 1 Whitton P Whitehouse J Evans C Response toreported hepatotoxicity of high lactone extractions of Piper mythysticumForst (kava)]4 Hoffmann D The Complete Illustrated Herbal New York Barnes ampNoble 19961425 Weiss RF Herbal Medicine Beaconsfield UK Beaconsfield Publishers19881506 Thies PW Spartium and sparteine Its antiarrhythmic action [in Ger-man] Pharmazie unserer Zeit 19866172ndash176

7 Northover BJ Effect of pre-treating rat atria with potassium channelblocking drugs on the electrical and mechanical responses to phenyle-phrine Biochem Pharmacol 1994472163ndash1698 Puglsey MK Saint DA Hayes E et al The cardiac electrophysiologicaleffects of sparteine and its analogue BRB-I-28 in the rat Eur J Pharmacol1995294319ndash3279Honerjager P Loibl E Steidl I et al Negative inotropic effects of tetrodotox-in and seven class 1 antiarrhythmic drugs in relation to sodium channelblockade Naunyn Schmiedebergs Arch Pharmacol 1986332184ndash19510 United States Food and Drug Administration Online document atwwwfdagovohrmsdockets98fr100898btxt1 1 Bank on D a t a A u toma t ed o n D rug s On l i n e do cum en t a twwwbiam2org Accessed March 30 200312 Hoffmann D The Complete Illustrated Herbal New York Barnes ampNoble 19968513 Eichelbaum M Spannbrucker N Steincke B et al Defective N-oxida-tion of sparteine in man A new pharmacogenetic defect Eur J Clin Phar-macol 197916183ndash18714 Bathum L Johansson I Ingelman-Sundberg M Horder M Brosen KUltrarapid metabolism of sparteine Frequency of alleles with duplicatedCYP 2D6 genes in a Danish population as determined by restriction frag-ment length polymorphism and long polymerase chain reaction Pharma-cogenetics 19988119ndash12315 Islam Science Environment and Technology Online document atwwwislamsetcomscplantsajmalinehtml Accessed March 30 200316 Obayashi K Nagasawa K Mandel WJ et al Cardiovascular effects ofajmaline Am Heart J 197692487ndash49617 Kelrsquoman IM Paleev NR Prevention of supraventricular tachysystolewith anti-arrhythmia agents [in Russian] Kardiologiia 19771742ndash4518 Yarnell E Abascal A Treating hypertension botanically Altern Com-plement Ther 20017284ndash29019 Meixner HK Dobler S Oral heart therapy using convallaria glycosidesin ambulatory practice [in German] Z Allgemeinmed 197450(16)757ndash76820 Weiss RF Herbal Medicine Beaconsfield UK Beaconsfield Publish-ers 198814621 Lehmann HD Effect of plant glycosides on resistance and capacitancevessels [in German] Arzneim Forsch 198434423ndash42922 Kopp B Loffelhardt W Determination of progesterone in vegetativeorgans and cell organelles of Convallaria majalis L by radioimmunoassayZ Naturforsch [C] 19803541ndash4423 Garjani A Nazemiyeh H Maleki N Valizadeh H Effects of extractsfrom flowering tops of Crataegus meyeri A Pojark on ischaemic arrhyth-mias in anaesthetized rats Phytother Res 200014428ndash43124 Rothfuss MA Pascht U Kissling G Effect of long-term application ofCrataegus oxyacantha on ischemia and reperfusion induced arrhythmias inrats Arzneim Forsch 20015124ndash2825 al Makdessi S Sweidan H Dietz K Jacob R Protective effect ofCrataegus oxyacantha against reperfusion arrhythmias after global no-flow ischemia in the rat heart Basic Res Cardiol 19999471ndash7726 Schmidt U Albrecht M Podzuweit H et al High dosage therapy withCrataegus extract in patients suffering from heart failure NYHA class Iand II [in German] Z Phytother 19981922ndash3027 Tauchert M Gildor A Lipinski J High-dose Crataegus (hawthorn)extract WS 1442 for the treatment of NYHA class II heart failure patients[in German] Herz 199924465ndash474

Eric Yarnell ND RH is president of the Botanical Medicine Academya specialty board for using medicinal herbs Kathy Abascal BS JDHerbalist is executive director of the Botanical Medicine AcademyVashon Washington

To order reprints of this article write to or call Karen Ballen ALTERNA-TIVE amp COMPLEMENTARY THERAPIES Mary Ann Liebert Inc 2Madison Avenue Larchmont NY 10538-1961 (914) 834-3100

ALTERNATIVE amp COMPLEMENTARY THERAPIESmdashJUNE 2003 129