Herbal Pharmacology: Case Based Studies with … · Herbal Pharmacology: Case Based Studies with...
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Herbal Pharmacology: Case Based Studies with Guido Masé, RH (AHG)
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Guido Masé RH(AHG)
*A case-based approach
Part I
*Tissue-level activity
Gastrointestinal tractUrinary tractVascular endotheliumLymphatic channels
“Acupharmacology”Reflex action mediated by autonomics
Hepatic effectsDirect action on the liverBroad-ranging implications
Epigenetic effectsGene expression
GI tract – astringency, demulcency, antispasmodic effects, glycemic index modulation
Renal tissue and urinary epithelium –
anti-inflammatory effects (major excretory route)
Vascular endothelium – anti-inflammatory, protective effects
Lymphatic channels – stimulating macrophage activity
Simon Mills – Out of the Earth and Principles and Practices of Phytotherapy
Direct activity – anti-inflammatory, anti-fibrotic, modulation of lipid synthesis
Broader implications – systemic inflammation, xenobiotic metabolism, blood glucose balance
Methylation, acetylation, effects on gene expression(much more to come in Part 2)
Male, 65 years old
Active, generally fit, with decent diet – but complains of frequent recurrent heartburn, especially after rich food
Stress and travel are also triggers
Can go for many days without issue – but will relapse into a persistent cycle of reflux
Warm, moist constitution – thick tongue with even coat, good skin tone, pink to red face color. Full but slow pulse.
Medication: omeprazole QD
No other complaints or diagnoses
Potentially applicable chemical classes:
Polysaccharide mucilages
Tannins
Flavonoids
Bitter principles?
Constitutional notes:
Adaptogens?
Nervines?
Avoid over-moistening?
Potentially applicable chemical classes:
Polysaccharide mucilages
Ulmus fulva inner bark
Yarnell Eric and Abascal Kathy. Herbs for Gastroesophageal reflux disease. Alternative and Complementary Therapies. December 2010, 16(6): 344-346.
Potentially applicable chemical classes:
Polysaccharide mucilages
Glycyrrhiza glabra root
Raveendra KR et al. An Extract of Glycyrrhiza glabra Alleviates Symptoms of Functional Dyspepsia: A Randomized, Double-Blind, Placebo-Controlled Study. Evid Based Complement Alternat Med. 2012;2012:216970.
Potentially applicable chemical classes:
Tannins
Ellagic acid – Prunus persica
Rajagopalan, Tuticorin Govindac et al. Use of ellagic acid in the manufacture of a medicament for the treatment of duodenal or gastric ulcer. European Patent Application EP0839531 (1998)
Potentially applicable chemical classes:
Flavonoids
Apigenin – Apium graveolens
Haslam, E. Natural polyphenols as drugs and medicines: potential modes of action. In Cathérine Chèze ed. Polyphenols, wine and health. 2001
Potentially applicable chemical classes:
Flavonoids
Procyanidin – Crataegus spp
Haslam, E. Natural polyphenols as drugs and medicines: potential modes of action. In Cathérine Chèze ed. Polyphenols, wine and health. 2001
Potentially applicable chemical classes:
Bitter principles
Bitter lactone – Taraxinic acid
Rankin, Guthrie. "A Post-Graduate Lecture on Indigestion: Delivered at the London School of Clinical Medicine." British medical journal 1.2621 (1911): 665.
Male, 65 years old
Recommendations:
Juiced Apium with unsweetened almond milk
Glycyrrhiza powder – 1/2tsp. After each meal
Taraxacum tincture – 2ml TID before meals
Tea of Crataegus lf/fl and Prunus twigs, 1L QD
… 2 weeks …
Much less reflux – very pleased
Improved digestion
-> wean omeprazole, Glycyrrhiza
Maintenance plan:
Apium, Crataegus, Taraxacum
Female, 46 years old
Walks for exercise, fairly mainstream diet (includes refined carbohydrates, processed meat sources)
Somewhat overweight, occasional belly complaints
Complains of recurrent mild-to-moderate urinary pain, developing over the last 5-10 years. 3-4x/wk
Diagnoses: interstitial cystitis, osteoarthritis (mild).
Cool constitution, some signs of poor circulation and congestion (thick tongue coat)
Medication: ibuprofen 400mg QD
Potentially applicable chemical classes:
Flavonoids
Polysaccharide mucilages
Salicylates (phenolic acids)
Resins?
Constitutional notes:
Diet needs adjustment
Alternative for ibuprofen?
Potentially applicable chemical classes:
Flavonoids
Quercetin – Solidago spp
Katske F et al. Treatment of interstitial cystitis with a quercetin supplement. Tech Urol. 2001 Mar;7(1):44-6.
Potentially applicable chemical classes:
Polysaccharide mucilages
Althaea officinalis
T Hudson. Treating Interstitial Cystitis: A Natural Medicine Approach. Alternative & Complementary Therapies, 2001
Potentially applicable chemical classes:
Salicylates (phenolic acids, glycosides)
Methyl salicylate- Filipendula ulmaria
R DiPasquale. Effective Use of Herbal Medicine in Urinary Tract Infections. Journal of Dietary Supplements, 2008
Female, 46 years old
Recommendations:
Tea of Solidago, Althea, Filipendula. 1L BID (only beverage)
Switching a portion of carbohydrates from refined grains to root vegetables daily: carrot, parsnip, sweet potatoes
… 1 week …
Cystitis symptoms occurred only once, quickly passed
Diet changes manageable
-> Switch out 2 portions of grains
-> Reduce ibuprofen: 200mg QD
… 4 weeks …
1-2 mild episodes of cystitis
Actually improved GI health too
Male, 8 years old
Acute presentation of spasmodic, dry cough with some blood
Worst part: kept awake at night
Preceded by an upper respiratory tract infection with fever
Generally hot / dry presentation, rapid pulse, no temperature now but still somewhat flushed
Appetite still reduced
Nasal congestion no longer present
Potentially applicable chemical classes:
Polysaccharide mucilages
Cyanogenic glycosides
Good hydration
Constitutional notes:
Avoid tannins despite blood
Avoid hot / spicy plants
Potentially applicable chemical classes:
Polysaccharide mucilages (+saponins!)
Glycyrrhiza glabra root
G Jianfang. Clinical Analysis on Laryngeal Cough in Children Treated by Glycyrrhiza and Balloonflower Decoction with Additional Integrants. Journal of Practical Traditional Chinese Medicine, 2010
Potentially applicable chemical classes:
Cyanogenic glycosides
Prunasin - Prunus serotina
Yarnell Eric and Abascal Kathy. Spasmolytic botanicals: relaxing smooth muscle with herbs. Alternative and Complementary Therapies. June 2011, 17(3): 169-174.
Male, 8 years old
Recommendations:
Cold infusion of fresh Prunus serotina young, green bark mixed with eq. pts. b/v raw honey. 2TBS Q2hrs
Licorice tincture, 40% alc. b/v. 15gtt PRN for cough (at bedside)
… 24 hours …
Mostly improved, still waking w/ cough
No more blood
-> Keep Prunus syrup by bedside too
… 72 hours …
Cough is productive, no more spasm
-> w/d Prunus syrup
Female, 28 years old
History: post-partum DVT following prolonged bedrest, twice misdiagnosed and discharged. From L femoral vein to IVC (!). Redness, swelling, pain, limited ROM
Admitted, filter installed, treated w/ heparin -> lovenox (3 weeks in hospital) and discharged on warfarin
Otherwise no remarkable Hx. 3 children.
Excellent diet, somewhat overweight
Warm, moist constitution. “Solid”.
Some developing varicose veins.
Medications: warfarin
Potentially applicable chemical classes
Venotonic saponins (Aesculus esp.)
Coumarins
Flavonoids
Phenolic acids (salicylates) might be nice, but caution is warranted here due to warfarin (same w/ curcuminoids)
Constitutional notes:
Excess moisture could use correcting
Internal “fire” will suffer with forced
lack of movement (leg damage)
Potentially applicable chemical classes:
Flavonoids
Anthocyanin – Vaccinium angustifolium
Kalt, W. et al. Health functionality of blueberries. HortTechnology (Jul-Sep 1997)Ngo N, Brantley SJ, Carrizosa DR, et al. The warfarin-cranberry juice interaction revisited: A systematic in vitro-in vivo evaluation. J Exp Pharmacol. 2010;2:83-91.
Potentially applicable chemical classes:
Coumarins
Coumarin – Galium aparine
JR Casley-Smith et al. The mode of action of coumarin and related compounds in the treatment of edema. Lymphoedema. 1977Link, KP. The discovery of dicoumarol and its sequels. Circulation,19 (1959) 97-107.
Female, 28 years old
Recommendations:
Tincture of Aesculus 1ml + Galium 4ml, 5ml TID
Tea: Tilia, Scutellaria lateriflora, Ocimum sanctum 1L QD
Banana / blueberry smoothie BID
… 48 hours …
Reduced swelling, redness, and pain. Very happy. Had to advocate strongly for herbal Rx w/MD
Still nighttime pain
-> Add Corydalis, 1-2ml before bed
… 6 months …
Continues w/ tincture only.
Better, though L leg still compromised
Female, 58 years old
Received diagnosis of non-alcoholic steatohepatitis following nausea, mild jaundice, and blood tests w/ high LV enzymes
Lovastatin – 3+ years – w/d by MD
Symptoms improved, but LV enzymes still high
Slightly overweight, moist constitution. Borderline high blood sugar and high blood lipids, tendency to constipation.
Yellow coating on wide tongue
Rapid pulse, mildly elevated BP
Diet is decent, homegrown mostly
No alcohol consumption
Medication: occasional aspirin
Potentially applicable chemical classes:
Lignans / flavonolignans
Flavonoids
Polysaccharides
Anthraquinones
Curcuminoids (double-phenolic acid)
Constitutional notes:
Could use more exercise
Blood glucose support
Potentially applicable chemical classes:
Flavonolignans
Silymarin – Silybum marianum
Jacobs BP. Milk thistle for the treatment of liver disease: a systematic review and meta-analysis. Am J Med. 2002 Oct 15;113(6):506-15.
Potentially applicable chemical classes:
Flavonoids
Procyanidin – Crataegus spp
Walker AF et al. Promising hypotensive effect of hawthorn extract: a randomized double-blind pilot study of mild, essential hypertension. Phytother Res. 2002 Feb;16(1):48-54.Peters W et al. Nanomechanics and sodium permeability of endothelial surface layer modulated by hawthorn extract WS 1442. PLoS One. 2012;7(1):e29972.
Potentially applicable chemical classes:
Polysaccharides
Beta-glucan - Avena sativa
Othman RA, Moghadasian MH, Jones PJ. Cholesterol-lowering effects of oat β-glucan. NutrRev. 2011 Jun;69(6):299-309
Potentially applicable chemical classes:
Anthraquinones
Emodin – Rumex crispus
CH Zhou et al. Effect and mechanism of emodin on intestinal movement. Chinese Pharmacological Bulletin, 2003
Potentially applicable chemical classes:
Curcuminoids (condensed phenolic acids)
Curcumin – Curcuma longa
H Shapiro, R Bruck. Therapeutic potential of curcumin in non-alcoholic steatohepatitis. Nutrition research reviews, 2005
Female, 58 years old
Recommendations:
Morning oatmeal with: 2TBS ground Silybum seed, 1tsp Cinnamomum pwd, 1tsp Trigonella pwd, 2TBS Crataegus jam
Tincture: Cynara 1ml, Rumex 1ml, Curcuma 3ml TID before meals
Capsule: Silybum extract, 80% flavonolignans, 140mg BID
… 6 weeks …
Liver enzyme levels return to baseline
Regular bowel habits now
Yellow coat gone from tongue
Blood lipid levels same even w/o med
BP normal so far, except if angry
Male, 53 years old
Diabetes mellitus Type 2. 10+ yrs diagnosed, relatively poor blood glucose control (A1C = 8.8%).
Works on his feet all day. Developed pressure sore, foot swells and throbs by the end of the day. Red and hot on exam with eraser-head sized ulceration, no necrosis.
Wants to heal wound, wants to reduce pain!
Constitutionally balanced
Carb and sweet overindulgence
Low fruit / veg intake
Medications: metformin 500mg TID
Ibuprofen 400mg QD for pain as needed
Antibiotic ointment
Potentially applicable chemical classes:
Antibiotic alkaloids (hydrastine, berberine e.g.)
Allantoin (Symphytum – tissue regenerant)
Phenolic acids / aldehydes
Flavonoids
Coumarins
Constitutional notes:
Needs ongoing foot elevation – breaks!
Improve diet – challenge w/ bitters
Potentially applicable chemical classes:
Phenolic aldehyde (modified phenolic acid)
Cinnamaldehyde – Cinnamomum
R Akilen et al. Effect of cinnamon on glycaemic control? A meta-analysis of randomisedcontrol trials. Proceedings of the Nutrition Society 2011 70 : E120C Plaisier et al. Effects of cinnamaldehyde on the glucose transport activity of GLUT1. Biochimie, 2011
Potentially applicable chemical classes:
Flavonoids
Anthocyanin – Vaccinium angustifolium
Kalt, W. et al. Health functionality of blueberries. HortTechnology (Jul-Sep 1997)S Wang et al. How natural dietary antioxidants in fruits, vegetables and legumes promote vascular health. Food Research International, 2011
Potentially applicable chemical classes:
Flavonoids
Quercetin – Solidago spp
Omar EA et al. Herbal medicines and nutraceuticals for diabetic vascular complications: mechanisms of action and bioactive phytochemicals. Curr Pharm Des. 2010;16(34):3776-807.
Potentially applicable chemical classes:
Coumarins
Coumarin – Galium aparine
JR Casley-Smith et al. The mode of action of coumarin and related compounds in the treatment of edema. Lymphoedema. 1977
Male, 53 years old
Recommendations:
Tea of Ocimum s., Solidago, Cinnamomum, Galium 1L QD
Blueberry / Banana / Cinnamomum smoothie BID
Tincture of Gentiana, Gymnema 15gtt PRN for sweet cravings
Capsule of quercetin 500mg, bromelain 250mg TID (pain)
Topical: paste of Hydrastis and Symphytum
Topical: oil of Hypericum
… 1 week …
Pain/swelling improved, wound healing
Pain returns if w/d capsule
… 12 weeks …
A1C 7.9%
Guido Masé RH(AHG)
Clinical pharmacognosy