Based on the chapters about herbs of the very good medical book of Simon C., et al., Oxford Handbook of General Practice, Oxford Medical Publications, 2nd edition, 2005. www.oup.com

A. HERBAL MEDICINE

Herbal medicine is a worldwide method of complementary medicine. However there are many stereotypes about its indications and its safety. Unfortunately there are fewer studies about herbal medicine, in addition to contemporary drugs. Herbs are considered safe; however as all drugs herbs have specific indications, contraindications, interactions with other drugs and side effects such as allergy, nausea and gastrointestinal disturbance. Herbalists are the specialty that can guide patients how to use sufficiently and more safely herb medication. A well informed GP can also give herbs. However, it is unacceptable for people to buy herbs on the supermarket without counseling an expert.

Further information on internet is: http://www.herbmed.org and also http://www.nimh.org.uk and http://www.herbnet.com
Echinacea is a famous herb for prevention and treatment of common cold. Its theoretical contraindications are autoimmune diseases and HIV (+). It also may decrease the effects of immunosuppressant drugs. Patients mustn’t take it more than 8 weeks, because it can cause immunosuppression. Also there isn’t any indication to use it in order to prevent flu. Its side effects are dizziness, nausea, dermatitis, pruritus, hepatotoxicity and rare allergy. Many companies combine Echinacea with zinc and vitamin C that are also effective against common cold. There is also Echinacea remedy as a nose spray for congested nose (but sometimes it stings).

Propolis (a substance that bees use) is also used for common cold and sore throat as syrup or a spray for oropharynx. Honey and lemon juice are also useful in sore throat. Many advise for sore throat the gargling (of oropharynx) with betadine.

St Johns’ Wort is another herb that is used for mild depression. In case the patient has to undertake a surgery, then it is better to discontinue the herb 2 weeks prior the surgery because there is a theoretical risk to interact with anesthetics. Generally, all antidepressants, including this herb, must not be discontinued abruptly, but always gradually. Furthermore patients better consult a psychiatrist instead of taking self medication. St Johns’ Wort induces hepatic enzymes of P450 cytochrome and can cause drug interactions and decrease the effect of warfarin (for anticoagulation), anticonvulsants, cyclosporine (immunosuppressive), digoxin (for heart disease), theophylline (for asthma) and COC (the Pill for women).

Avoid using St Johns’ Wort concurrently with antidepressants and triptans (for migraine such as sumatriptan), as it can increase their serotonergic effect and cause sweating, flashing, shivering, muscle contractions etc. Its side effects are anticholinergic such as dry mouth, gastrointestinal symptoms. The above symptoms are caused also by antidepressants such as SSRIs or TCAs. Other side effects of St Johns’ Wort are fatigue, dizziness, headache, rash and an increase of skin sensitivity to sun.

Valerian is a very famous herb for stress and insomnia. It is also useful for irritable bowel syndrome (IBS). By the way, exercise (such as jogging) also helps insomnia, stress and IBS. Its side effects are few and it is usually well tolerated. Many companies combine it with other relaxants such as vitamin B1, 2, 3, passion flower, hops and magnesium. Magnesium is used some times as muscle relaxant however it should better used only for magnesium deficiency (and also eclampsia in pregnant or for severe asthma) because it has the side effect that extreme amounts cause cardiac and respiratory arrest. However its serious deficiency (e.g. on an alcoholic or a homeless) can cause serious tachyarrhythmia such as VF and Torsades and has to be considered on ALS.

Other herbs with antistress and relaxing effect are the herb teas such as chamomile, mountain tea and sage. Also mint is a herb can help the irritable bowel syndrome with its mild antispasmodic role. Green tea isn’t relaxant (teas are stimulant, except mountain tea) but it is said that helps losing weight, without clear evidence if it indeed helps. However is a very good antioxidative. Another good antioxidative is red wine and also black chocolate.

Gingo Biloda is another famous herb used for good memory. It helps improving cerebral blood flow and intermittent claudication (arterial insufficiency of legs). It may help and tinnitus (ear buzzing). Its main side effect is spontaneous bleeding. Gingo Biloda can increase the anticoagulative effect of warfarin and antiplatelet drugs, so avoid using it together with these drugs.

Feverfew is a herb that probably is effective on migraine prophylaxis. It can interact with anticoagulants and its main side effect is menstrual bleeding.

Chinese herbs may be effective for irritable bowel syndrome and childhood eczema, however many of them have serious side effects such as blood dyscrasias, hepatotoxicity and cancer. It is better to be used under an expert’s (herbalist) guidance.

Saw palmento is a herb that is used for benign prostate hypertrophy and decrease the symptoms if used more than 1 – 2 months. Its side effects are dizziness, mild gastrointestinal effects and rarely pruritus, hypertension and headache. However it is important an urologist to exclude prostate cancer before start taking this herb.

Cranberry juice is now used widely for urinary tract infections (UTIs) however its efficacy is controversial. Patients with UTI have to be advised to urinate frequently, increase fluid intake, double void (i.e. urinate again after 5 – 10 min) and void after intercourse and take prophylactic antibiotics for recurrent UTIs (however beware nephrotoxicity of some antibiotics). Agnus castrus fruit extract helps the premenstrual syndrome (PMS) on women.

Spirulina is a substance taken from seaweeds. It is very rich in aminoacids and also contains vitamins and minerals. It is recommended for astronauts!

About stress, there are antistress herbs such as valerian (you can take it on pills) and the herb teas (you can drink them as hot teas) chamomile, mountain tea (however as a tea is a bit stimulative), passion flower, sage and linden.

B. VOLATILE OILS - AROMATHERAPY

There are many aromatic plant oils that are inhaled by putting 3 – 4 drops to a special or by application and massage to the skin or used in a hot bath. The side effects are few with main the allergy to specific oil. However there isn’t any good evidence for effectiveness. However the small make people feel better. The oils that are used are very concentrated.

The most famous oil is levanter that is said to help insomnia, stress, burns and blisters. Other oils useful for stress are rose wood, rosemary, valerian, ilang – ilang and geranium. The last is also antidepressive.

Tea tree oil is said to help head lice, wound infection and athlete’s foot (fungi).

Eucalyptus oil is famous for common cold and clears the blocked (congested) nose (e.g. VicksR ). There are ready sprays for congested nose with eucalyptus. The classic gel Vicks can be used by stirring 1 -2 tablespoons in a cup containing boiled water and inhaling the vapors (but the patient has to be careful for eye irritation i.e. to wear glasses). Also Vicks can be used for chest infections such as pneumonia by application of the gel on the chest skin (usually at night). It has to be mentioned that, in addition with eucalyptus, patients mustn’t use nasal anticongestants more than 5 – 7 days to avoid the risk of inducing pharmaceutical rhinitis from the drug its self. Very helpful for rhinitis is washing the nose with saline flush or sterile sea water (there are special medications on drug stores) but without undue pressure as flushing the nose.

Thyme oil is antiseptic and used for common cold. Rosemary was mentioned previously for relaxation. However it is most used as antiseptic and soothing and is said to help especially sinus infections. Sinus infections may become chronic and often resistant to antibiotics.

Peppermint oil is said to be useful for headache and indigestion.

Valerian is famous as an antistress herb. But as oil helps as well anxiety and insomnia.

Further information about aromatherapy on the web: http://www.aromatherapycouncil.co.uk

NOTE

There are several antioxidants that may help in preventing cancer, aging and many diseases. Very good antioxidants are the substances resveratrol (a kind of plant hormone), flavonoids, polyphenols and procyanidins. A great proportion of these antioxidants are contained in red wine (however be careful not to drink too much wine, because it is harmful, the max daily dose is 3 small ‘wine’ glasses – I recommend 1 small glass). The above antioxidants are contained also in green coffee, black chocolate, green tea, coffee, olive oil (has also vitamin E), honey, grains, blackberries, blueberries, cranberries (these also help patients with urinary tract infections), cherries, palms, cabbage, broccoli, etc. Also many antioxidants are found in beetroots, garlic, cauliflower, melted tomato, and onion. Excellent antioxidants are grapes and pomegranate (the last is said to help people with hematological problems).

The consumption of all the above nutrition is strongly recommended, however a healthy diet should be followed by a daily exercise (such as jogging, cycling or quick walking), weight loss (diet & exercise +_ drugs +_ surgery if morbid obesity), smoking cessation (nicotine or drugs such as buproprion), BP & high cholesterol control (diet and exercise help, avoid salt, sweets, fried foods and fats), and glucose control if diabetic (diabetes mellitus is a great factor for obstructing the vessels, leading to heart attack stroke, renal failure, blindness and gangrene).

REFERENCE

Herbal Medicine, p. 148 – 149, Oxford Handbook of General Practice, C. Simon, H. Everitt, T. Kendrick, 2nd edition, Oxford University Press, 2005.