-
• Some traditional herbal analgesics include
– Corydalis spp (Corydalis)
– Eschscholtzia californica (Californian poppy)
– Salix alba (Willow bark)
– Stephania tetandra (Stephania)
– Piscidia erythrina (Jamaican Dog Wood)
– Anemone pulsatilla (Pasque flower)
– Piper methysticum (Kava)
• Topical Analgesics
– Peppermint
– Cayenne
– Arnica
- Indications for herbal analgesics
- • Pain associated with inflammation e.g.
- – Arthritis
- – Tendonitis
- – Myalgia
-
• Pain associated with visceral spasm e.g.
– Gall bladder
– Urinary tract
– Intestinal colic
– Spasmodic dysmenorrhoea
- • Pain associated with vascular spasm eg:
- – Migraine
- – Angina
- – Intermittent claudication
- • Neuralgic pain (in limited cases)
- – Shingles
-
• Herbal analgesics should be restricted to experienced and well trained
practitioners
• Areas which should be approached with caution:
– Concurrent prescription of powerful analgesics
– Pain in children
– Neurological disease
– Depression & psychosis
– Liver & kidney disease
– History of allergy & anaphylactic reactions
- • Application
- – Herbal analgesics may be taken as required or before
- food. There is likely to be a longer delay compared to
- synthetic analgesics and thus leading to a temptation to
- overdose.
- • Long term therapy with analgesics is not advised.
-
• In conventional pharmacological terms,
– Sedatives
• reduce nervous activity
– Hypnotics
• promote sleep
– Tranquilizers
• reduce anxiety
- • Many herbal remedies have varying degrees of sedative and
- tranquillizing activity, some supported by clinical studies.
- • However, it is probably misleading to apply the strict
- pharmacological definitions to them as their effects are much
- broader, with strong sedation rare.
-
- Herbal Sedatives, Hypnotics & Anxiolytics
- • Indications
- – Modern tension and anxiety syndromes (short term or
- intermittent use)
- – Insomnia – difficulty getting to sleep first thing at night.
- – Weaning off conventional sedative prescriptions
- – Restlessness during convalescence
-
• Contraindications
– Generally milder than prescribed sedatives and should not be seen as
immediate substitutes in more serious indications.
– It would be unwise and possibly dangerous to stop strong medication
without careful planning.
– Insomnia marked by increasing restlessness during the early morning
– Depression
-
Application
- • May be taken as required, at bedtime or before food.
- • May also be used in some cases of inflammatory disease
- • Prescription time should be limited
- – Although unlikely to lead to addiction, compared with
- modern sedatives, the body may become dependant and
- effects diminished.
-
Antispasmodics and Relaxants
• Used to reduce the symptoms of tension in the body.
• Today they are offered to the modern stressed patient as a
welcome antidote to the culture of tranquillizers and
sedatives.
• Working from the ‘neck down’, they reduce physical effects of
tension without befuddling the brain or impugning sanity.
- • Some traditional herbal
- antispasmodics and
- relaxants are
- – Vibernum opulus.
- – Dioscorea villosa,
- – Leonuris cardiaca,
- – Matricaria recutita,
- – Passiflora incarnata,
- – Piper methysticum,
- – Scutellaria lateriflora,
- – Tilia spp,
- – Valeriana off.
-
• Indications
– Anxiety, irritability and restlessness, including in children
– Sleeplessness due to anxiety and irritability
– Nervous dyspepsia
– Irritable bowel and intestinal colic
– Tension headache
– Spasmodic dysmenorrhoea
- • Many conditions of tension are linked with fatigue, debility
- and depression
- • A group of remedies have emerged to meet the needs of a
- modern stressed society
- • This category of remedies to restore energies and build up
- strength is referred to as nervine tonics (nervous
- trophorestoratives)
-
– Avena sativa,
– Hypericum perforatum,
– Scutellaria laterifolia,
– Turnera aphrodisiaca,
– Verbena off
– Withania somnifera.
- • Indications
- – Nervous exhaustion
- – Neuralgia, herpes infections
- – Depressive states
- – Insomnia (waking in the small hours after getting to sleep easily)
- – Convalescence
- – Neurasthenia
-
• Contraindications
– True trophorestoratives are almost nutritive in their effects, with few
risks of adverse effects except in those patients with extremely
debilitated constitutions.
• Application
– May be taken as required or before food.
– Long term therapy with trophorestoratives is generally the norm
- Anxiety
- – Neurotic disorder characterised by apprehension, uncertainty
- and XS fear
- – Intense panic associated with physical changes
- – There can be a genetic tendency
-
– Factors include arousal of ANS flight or fight in response to
fearfulness and or emotions psychologically individual to the
person
– May be subconscious and harder to uncover
– Hidden emotion not recognised by patient
– Social fear of loosing control of situation and actions.
– Anxiety attacks instead of expressing anger.
-
• CNS symptoms
- – fight or flight
- • Tachycardia
- • Palpitations
- • Cold sweats
- • Fine tremors
- • Dizziness
- • Overall motor weakness
- • Butterfly's in stomach
- • Nausea and sometimes diarrhoea
- • Respiratory changes
- – hyperventilation
-
• Patient may observe feeling
of being unconnected with
people and objects around
them combined with sense
of unreality, which together
prolong anxiety attack
• Often fear of loosing
consciousness and or
dying
- Chronic Anxiety
- • Like acute anxiety, less
- severe and debilitating.
- • Symptoms can be of longer
- duration - lasting days or
- months.
- • General sense of tension,
- apprehension or dread.
- • Tendency to startle easily. An
- uneasiness in normal
- situations of life and work.
- • A vague persistent fear of the
- future.
-
Conventional Treatment
• Pharmacological measures
– Benzodiazepines
• Valium
– Tricyclic antidepressants
• Amytriptyline
– Monoamine oxidase MAO) inhibitors
-
• Psychotherapy
- • Hypnotherapy
- • Relaxation Techniques
- • Meditation
-
Herbal Treatment
Kava
St. John’s Wort
Valerian
Lemon balm
Wood Betony
Hyssop
Lime flowers
Oats
Passionflower
Hops
Damiana
- The authors concluded that their
- results support Kava as a
- treatment alternative to tricyclic
- antidepressants and
- benzodiazepines in anxiety, with
- proven long term efficacy and
- none of the tolerance problems
- associated with these drugs.
-
Insomnia
In any year 30% of the population will experience insomnia with 4 to 6
million people a year receiving prescriptions for sedative hypnotics
Ageing itself tends to decrease the total amount of sleep needed and the
sleep is usually more restless
- Onset insomnia
- Difficulty falling off to sleep
- Maintenance insomnia
- Repeated awakenings, with difficulty returning to sleep
- Offset insomnia
- Early morning awakening
- Non-restorative sleep
- A sense of not getting enough sleep
-
Sedative
relax and reduce nerve conduction and can be used during the day
without causing drowsiness
Relaxants
help to relax tense muscles and can be used during the day also
- Hypnotics
- induce sleep => used at night
- Circulatory Stimulants
- aid the rapid absorption and distribution of the active compounds
- eg. Cayenne specific here
-
Insomnia associated with:anxiety and stress=
Valerian, Hops
Passionflower
- Insomnia associated with:depression=
- St. John’s Wort
- Lavender
-
Insomnia associated with-pain general
Californian Poppy, Corydalis
Jamaican Dog Wood
- Insomnia associated with-
- associated with inflamation
- (analgesic effect)=
- Willow Bark
- Californian Poppy
-
Insomnia associated with-
associated with smooth muscle cramping=
Cramp Bark, Wild Yam, Raspberry leaf
Corydalis, Ginger
- Insomnia associated with-
- Menopausal hot flushes and/or night sweats=
Zizyphus
-
Insomnia associated with inability to relax=
Hops, Lavender, Passion flower
- Hypericum perforatumMode of Action
- Still an element of uncertainty
- about its exact mode of action
- Originally thought to be a MAOI
- Later research suggests it is
- more likely to be an SSRI
- May also inhibit the reuptake of
- nor-adrenaline
-
Hypericum side effects
G.I.T. symptoms
most common side effect reported in clinical trials
Paraesthesia
Photosensitivity
very rare in humans and unlikely to occure at normal
therapeutic doses, however it is recommended to advise
patients to avoid excess sun while taking high doses
- Combining Hypericum with antidepressant
- medication?
- Unclear from the herbalists point of view
- However, widely believed and stated by the medical
- profession that they should not be combined
- Theoretically serotonin syndrome could occur if combined
- with SSRIs or MAOIs
-
Serotonin Syndrome is a potentially fatal complication to
treatment with serotonin reuptake inhibitors
Most commonly associated with the concurrent use of two or
more drugs that enhance serotonin neurotransmission
Symptoms include
Early symptoms - muscle cramps, stiffness or tics, waking feeling
hung-over
Severe symptoms - confusion, agitation and restlessness, shivering,
ataxia, fever, diaphoresis, hypertension, and tachycardia.
- Other herbs to considerKava
- Siberian Ginseng
- Panax Ginseng
- Scullcap
- Passiflora
- Oats
- Ginko Biloba
- Lavender
- Vervain
- Damiana
- Schisandra
-
“Adrenal Exhaustion”
Low adrenal function results from different stressors e.g.,
Mental Stress
Physical Stress
Viral Illness
- This dysfunction impacts the normal communication between
- the hypothalamus, pituitary gland, and the adrenal glands.
- Symptoms include:
- Tiredness
- Dizziness
- Headache
- Anxiety
- Depression
-
Herbs which are specific for treating adrenal exhaustion:
Rehmannia glutinosa
Codonopsis pilosula
Bupleurum falcatum
Rhodiola rosea
Panax ginseng
Glycyrrhiza glabra
The perceived causes, such as compromised immunity, poor liver
function, malabsorption issues must also be addressed.
- Rehmannia glutinosaRehmannia inhibits the
- catabolism of cortisol
- and reduces the
- suppressive effects of
- corticosteroid drugs
-
Rehmannia inhibited the metabolism of cortisol by
hepatocytes in vitro
Simultaneous administration of endogenous
adrenocortical hormones resulted in cortisol levels
remaining close to normal
The authors believed the mechanism to be a competitive
effect at the hepatocellular receptor which affected the
uptake of corticosteroid hormone, thereby slowing the
catabolism of cortisol
- Rehmannia treatment also prevented or reversed
- morphological changes in the pituitary and adrenal cortex,
- appearing to antagonize the suppressive effect of
- glucocorticoids on the hypothalamic-pituitary-adrenal axis
-
Codonopsis pilosula (Dang shen)
Codonopsis strengthens the Qi, nourishes fluids, and tonifies
the lungs
It invigorates the spleen, invigorates vital energy, and is good
for the blood
Major uses include digestive problems such as lack of
appetite, diarrhoea and vomiting
- It also treats symptoms, which arise due to loss of body fluids including
- anaemia
- Because it brings energy inwards it counteracts the tendency for tissues
- to move outwards and downwards
- Hence its effectiveness in the treatment of organ prolapse and discharges
-
Medicinal Uses
Fatigue
Adrenal exhaustion
Long term stress
To improve mental and physical performance
Anaemia
Hyperglycaemia
-
Bupleurum falcatum
- Diaphoretic, regulates gastrointestinal function and restores
- liver function
- It is used to treat common cold, alternating chills and fever,
- liver enlargement, prolapse of the uterus and rectum, and
- irregular menstruation
- Bupleurum is a major herb for the liver
-
The anti-inflammatory activity of the saikosaponins
(triterpenoid saponins) appears to be related, to their ability to
both induce secretion of endogenous corticosterone and
potentiate its anti-inflammatory activity
Combined oral administration of Bupleurum extract and
corticosterone acetate increased anti-inflammatory activity
compared to corticosterone alone
- It is suggested that the site of action of saikosaponins is the
- hypothalamic-pituitary system
- It is also suggested that saikosaponins may be used to
- reduce the dose of glucocorticoid drugs and to prevent
- glucocorticoid-induced adrenal suppression
-
The ability of saikosaponins to raise blood glucose levels was
demonstrated in several pharmacological studies following
both oral and injected doses
This is probably a direct consequence of their ability to
increase levels of endogenous glucocorticoids
Since saikosaponins also increase liver glycogen stores,
Bupleurum may prove to be useful in the treatment of
reactive hypoglycaemia
- Rhodiola rosea
- Actions
- Adaptogen
- tonic
- antitumour
- hepatoprotective
- hepatotrophorestorative
-
Therapeutic Indications
Fatigue, mental and/or
physical exhaustion
To improve mental
performance, concentration
and memory, especially when
under stress
To enhance physical
performance and endurance
- Adverse Reactions
- Very few side effects have been reported.
- A small clinical study found an increase in symptoms in a subgroup of
- depressed patients with hysteric and phobic symptoms.
- Contraindications & Cautions
- Caution is advised in depressed patients with hysteric and phobic
- symptoms, such as might occur with bipolar disorder.
- As with all strong adaptogenic and tonic herbs, concurrent use with
- stimulants such as caffeine is best avoided.
-
Panax ginseng
Korean ginseng helps
support the normal function
of the hypothalamicpituitary-
adrenal axis, the
hormonal stress system of
the body.
Caution should be
exercised as over
stimulation may occur in
susceptible patients at high
doses
- Glycyrrhiza glabra
- Licorice root is known to
- stimulate the adrenal
- glands and to block the
- breakdown of active cortisol
- in the body.
- Contraindicated
- Patients with elevated
- blood pressure
- Long term use
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