modern herbal tradition - ann walker

8/14/2019 Modern Herbal Tradition - Ann Walker

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Modern herbal tradition: what we can learn from

practitioners who publish

- examples of Vitex and Cimicifuga

Dr Ann WalkerSenior Lecturer in Human Nutrition

Hugh Sinclair Unit of Human Nutrition

The University of Reading, UK

Member of the College of Practitioners of Phytotherapy

Member of the National Institute of Medical Herbalists


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Vitex: historical perspective of use

Used by ancient Greeks and Romans to promotechastity. Monks used it to reduce libido. Other uses bythe ancients included the treatment of injuries,inflammation and epilepsy

Mrs Grieve reports nothing on hormonal effects: Theripe berries are pounded to a pulp and usedin the form of a tincture for the relief ofparalysis, pains in the limbs, weakness,etc.

Post WWII research in Germany established hormonal

regulating effects, including modulation of pituitaryfunction

Double-blind clinical trial evidence of normalisation ofhormonal imbalance in women

Late 20th Century use onwards by UK herbal

practitioners mainly for female hormonal imbalance


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Double-blind study

of Vitex treatment for cyclic mastalgia

Condition Number/

Duration

Significant

outcomeCyclicbreastpain

203months

Reducedsymptomscompared toplacebo

Kubista et al. 1983


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Double-blind studies of Vitex

treatment for PMS

Reference Number/

duration

Symptoms

significantly< placebo

Schellenberg2001

1703 months

Global PMSscore


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Active components of Vitex

berries

Iridoids

aucubin, agnuside

Flavonoids casticin, isovitexin

Other

volatile oil (mixture of mono- and

sequi-terpenes), triterpenoids,

castine (a bitter principle), viticin (an

alkaloid)


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Modern usage and perception of Vitex

Nowadays mainly used to treat adversesymptoms of the menstrual cycle andmenopause

Understood from scientific studies, to aidnormalisation of both raised and loweredplasma oestrogen - adaptogenic

Action: modulation of pituitary function -active component(s) of the herb mimicdopamine, binding to dopamine receptors,

which lowers plasma prolactin Lowering prolactin helps counter anxiety

and reduces risk of dysfunction of hormone-dependent tissues in both men and women


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How far is the modern perception

of the therapeutic profile of Vitex

reflected in publications of herbal

practitioners?


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Vitex: Traditional use References

Christie & Walker 1998) Eur J Herb Med 3, 29 Williamson 2003 Potters Herb Cyclopaedia McIntyre 1994 Complete Woman's Herbal Mills & Bone 2000 Principles & Practice

Phytotherapy Bone 2003 Guide to Blending Liquid Herbs Ody 1993 Complete Medicinal Herbal Bartram 1995 Encyclopedia of Herbal Medicine

Chevallier 1996 Encyclopedia of MedicinalPlants Weiss 1988 Herbal Medicine BHMA 2003 Guide Traditional Herbal Medicines

ESCOP 2003 Monographs


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Actions of Vitex

Galactogogue

(promotes

lactation)

Hypoprolactinaemic

agent

Hormone regulator

Dopaminergic

No. citationsMain Actions


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Therapeutic use of Vitex

Hyperprolactinaemia

Endometriosis

Polycystic ovary syndrome

(PCOS)

Menopausal problems,

including hot flushes

Amenorrhoea/ infertility/acne

Cyclical mastalgia

Insufficient lactation

Menstrual irregularities, PMS

No. citationsUses


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Calculation of dried herb equivalents

weight - g/day

PER DAY

Weight of dried herb by infusion or decoction

Weight of powdered dried herb in capsules A fifth of the volume of 1:5 tincture (g)

A third of the volume of 1:3 tincture (g) etc

Volume of 1:1 fluid extract expressed in g Five times the weight of 5:1 dried broad-

spectrum extract etc


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Daily dosage ranges Dried herb equiv* g/d for

adults ofVitex agnus-castus berries according to

authoritative sources

0 1 2 3 4 5M & B '0 0 Ge rm a n-M & B ' 0 0 E ngl i sh-

B o n e ' 0 3E SC O P ' 0 3

Cheva l l ie r '96B a rtra m '9 5H o f fma n ' 8 6

*, extract as tincture (1:5), liquid extract (1:2) or fluid extract (1:1)


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Cimicifuga racemosa(Black cohosh)


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Black cohosh: historical perspective of use

Ellingwood & Lloyd 1919

an efficient nerve sedative, although its most

pronounced action is on the unstriped muscles Through its influence upon the vasomotor centers

and upon the nerve ganglia, it has a beneficialinfluence upon the heart.

Indications: angina, heart irregularily, irritable coughs, chorea, muscle

aches and rheumatic fevers, rheumatic arthritis, neuralgia, sciatica,dysmenorrhoea, amenorrhoea, and orchitis.

In pregnancy: The agent is excellent in reliving irregularpains and uterine distress occurring during thecourse of pregnancy. It may be given in smalldoses, and it thus prepares the patient for

parturition and undoubtedly contributes largely to ashort, easy and uncomplicated labor.

Mrs Grieve 1932: Indications: cough, whooping-cough, rheumatism and St Vitus dance in

children.

Ellingwood & Lloyd 1919American Materia Medica, Therapeutics and Pharmacognosy


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Double-blind studies:

effect of 40 mg of dried black cohosh root/day for 3

months on adverse menopausal symptoms

Yes

(p = < 0.001

304Osmers et

al

2005

Yes, and

oestrogen

62Wuttke et al

2003

Symptoms

significantly

< placebo?

Total number

of women in

trial

Reference


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How far is the modern perception

of the therapeutic profile of Black

cohosh reflected in publications of

herbal practitioners?


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References for Black cohosh

Williamson 2003 Potters Herbal Cyclopaedia BHMA 2003 Guide to Traditional Herbal Medicines

BHP 1983 British Herbal Pharmacopoeia ESCOP 2003 Monographs Mills & Bone 2000 Principles & Pract Phytotherapy Bone 2003 Guide to Blending Liquid Herbs McIntyre 1994. Woman's Herbal

Ody 1993 Complete Medicinal Herbal Bartram 1995 Encyclopedia of Herbal Medicine Chevallier 1996 Encyclopedia of Medicinal Plants Weiss 1988 Herbal Medicine

Hoffman 1986 The Holistic Herbal


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Actions of Black cohosh

Hypotensive/ vaso-dilator

Diuretic

Antiinflammatory agent/ Anodyne/ antiarthritic

Hormone regulator/SERM*/ dopaminergic

Antispasmodic

Antitussive/ expectorant

Uterine tonic/ stimulant emmenagogue/

parturient

Antirheumatic

Sedative (cardiac)No. citationsMain Actions

*, selective oestrogen receptor modulator


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Therapeutic use of Black cohosh- 1

Respiratory tract disorders: Whooping cough/

asthma

Arthritis, including rheumatoid

Tinnitus

Menstrual disorders: dysmenorrhoea/

amenorrhoea/ menorrhagia/ ovarian pain/

PMS

Menopausal symptoms including hot flushesand depression

Rheumatism neuralgia/ intercostal myalgia/

cramps/ stiff neck/ post-exercise muscle

pain/ sciatica/ low back pain/ headaches

/migraine with hormonal element

ReferencesUses


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Therapeutic use of Black cohosh - 2

Hypertension

Infections/ fevers/ scarlet fever

Chorea

Conditions with raised luteinising hormone:infertility/ miscarriage/ ovarian cancer/

polycystic ovary syndrome/ breast pain

Child birth/ partus preparator/ uterine tonic

ReferencesUses


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Daily dosage ranges of dried-herb equivalent

(g/day) for adults of Black cohoshaccording to

authoritative sources

0 1 2 3 4 5 6 7M & B '0 0 Ge rm a n-B o n e ' 0 3 Ge rm a n-

E SC O P '0 3 G e rm a n-B H P '8 3

Cheva l l i e r ' 96M &B ' 0 0 E ngl i sh-B one ' 03 Engi sh-

*, extract as tincture (1:5), liquid extract (1:2) or fluid extract (1:1)


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Historical perspective on safety

19th century Eclectic and Physiomedical herbal

practitioners in 19th Century knew that overdose caused:.general relaxation, dimness ofvision, dizziness, tremors, slowing ofthe pulse, fall of arterial pressure,vomiting or gastric irritation: itsimulates expectoration andperspiration, causes intenseheadache and prostration.

According to ESCOP: Although side effects of

overdose of Black cohosh was well known by the 19thCentury American herbalists, older data suggest thatdaily doses of at least 5 g of unprocessed herb or 12 g offluid extract (equivalent to 12 g of dried herb) are neededto cause any symptoms. These dosages are far inexcess of those which would be used by herbal

practitioners in the UK.Drs Ellingwood and LloydAmerican Materia Medica, Therapeutics and Pharmacognosy(1919)


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Current Perspective on safety Williamson 2003 Potters Cyclopaedia

Mutagenicity, teratogenicity and other toxicity studieshave proved negative, and it is now considered to besafe in women for whom conventional hormone-replacement therapy is contraindicated.

ESCOP 2003 monograph ..caution that patients with existing oestrogen-

dependent tumours should not use the herb, remainsspeculative.

the weight of evidence indicates that Black cohoshdoes not influence the latency or development of

mammary tumours and it may even have an inhibitoryeffect. Contradictory results have been resulted fromin vitro experiments on cancer-cell lines, but clinicalexperience suggests no risk in the use of the herb.


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Pregnancy Category B2 No increase in frequency of

malformation or other harmful effect on the foetusfrom limited use in women. Animal studies are

lacking.

Contraindications

Patients with oestrogen-dependent

tumours, during pregnancy (except

to assist with birth). Do not use

during lactation without professional

advice.

Black cohosh is best avoided in

patients with oestrogen-dependenttumours, such as breast cancer, until

more information is available

regarding possible oestrogenic

activity.


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Conclusions

The writings of modern herbal practitionersare an important resource for posterity for thefollowing reasons:- Reflect a modern perspective on the therapeutic

profile of a herb built from a synthesis of:

Traditional use from ancient texts Traditional practitioner use for more than a

century Modern scientific findings

Give physiological actions, lacking in ancient texts Give dosages, which are lacking in ancient texts Give indications for diseases which are

understandable in terms of our modern concept ofmedicine

modern herbal tradition - ann walker

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