Family: Asteraceae

Parts used:  Fresh or dried leaves and flowers.

Indications and actions:  Tanacetum has traditionally been used in migraine prevention.  Its mode of action is unclear but it is thought that parthenolide contained in the plant may have an anti-prostaglandin and spasmolytic effect, thereby helping to modulate the tone of blood vessels by promoting normal relaxation and contraction of the vessel walls.  Another postulated mechanism of action is parthenolide’s inhibitory effect on secretions, including serotonin (5-HT) from platelets.  Serotonin (5-HT) has been implicated in migraine.

Tanacetum is a longstanding remedy for rheumatic conditions and adequate clinical trials are needed to confirm its effectiveness in reduction of inflammation and pain in rheumatoid arthritis.  One double-blind, placebo controlled trial (Pattrick et al. 1989) involving 40 women demonstrated increased grip strength in the feverfew group but no reduction in other parameters tested.  This may have been due to insufficient quantities of the herb, too small a sample size and too short a duration of the trial (6 weeks).  The sesquiterpene lactones have been observed to have a dual action on white blood cells, having both a cytotoxic effect and an inhibitory effect on their pro-inflammatory secretions.  These actions may exert an anti-inflammatory effect in addition to that due to inhibition of prostaglandin synthesis (Heptinstall 1988).

Other actions:  as its name implies, T. parthenium reduces fever.  It is reputed to be bactericidal and it is an emmenagogue, increasing menstrual flow and has been used to speed up difficult births.  Its analgesic properties render it useful for period pains.

Key constituents: sesquiterpene lactones (including parthenolide and santamarine), volatile oil, sesquiterpenes (including camphor, farnesene and germacrene), tannins, monoterpenes.

Cautions:  Avoid in pregnancy.  It is a uterine stimulant and may cause premature contractions.  As it has anti-platelet activity, if taken with warfarin there may be an increased risk of bleeding.  Fresh leaves may cause mouth ulceration and gastrointestinal disturbance.  Sudden cessation of the herb may result in rebound headaches.

Tilia europaea (Linden, lime blossom).

Family:  Tiliaciae

Parts used: Flowers, bracts

Indications:

Used long-term Tilia is a specific for hypertension, as both prophylaxis and treatment, particularly when the high blood pressure is linked to nervous tension.  It has diuretic and antispasmodic actions, which are likely to contribute to its hypotensive effects. It has a relaxing effect on the nervous system as well as being a cardiotonic. 

Its sedative actions make it beneficial for anxiety and insomnia. It can also relieve migraines associated with nervous tension. 

As a diaphoretic, it is useful for colds and flu and for alleviation of catarrhal irritation of the mouth and throat.  It also helps to relieve headaches associated with sinusitis. 

When used topically it may alleviate itching in skin rashes.

Constituents:

Essential oils including farnesol, geraniol and eugenol

Flavonoids: quercetin glycosides(rutin, hyperoside, quercitrin, isoquercitrin), kaempferol glycosides (including astragalin).

Caffeic and chlorogenic acids, mucilage, tannins,

Benzodiazepine-like compounds.

Ulmus rubra (slippery elm).

Family: Ulmaceae

Part used: inner bark

This is soothing, anti-inflammatory and demulcent due to its high mucilage (polyscaccharides) content.  A preparation is made from the inner bark of this deciduous tree and taken internally to heal inflamed, sensitive, gastrointestinal mucosa.  It is used for gastritis, colitis, peptic ulcers, enteritis and diarrhoea.  It contains tannins, which give it mild astringent properties and add to its healing actions.  It is also used topically for vaginitis and as a poultice for boils, burns, carbuncles, haemorrhoids etc.  The bark is taken at 5 -20 g, one part in 8-10 parts water. It is powdered, decocted and drank whilst hot, usually half a cup three times daily.  It can also be taken as a cooked porridge, suitable for babies and convalescing patients.

Family:  Labiatae

Parts used:  Leaves (folia) and root (radix), seed.

The plants should be collected when they are young and tender. The leaves and root have quite different therapeutic uses and will be dealt with separately.

Folia

Urtica dioica folia have traditionally been used for skin eruptions, including allergy related eczema, bites and stings (including nettle stings!) and those of a psychogenic origin.  Its anti-allergy properties make it beneficial for allergic rhinitis (such as hay fever) and asthma also. 

As it inhibits tumour necrosis factor alpha, arachidonic acid, 5-lipoxygenase and other pro-inflammatory cytokines in vitro, it may reduce the inflammation anywhere in the body.  For example, it is believed to be of therapeutic value in arthritides by reducing the inflammatory response in these diseases.   Deliberate stinging of the skin around around a joint is reputed to relieve arthritic pain.

It is a strengthening tonic as it contains numerous vitamins and minerals and is a detoxifying remedy.  These qualities not only aid in elimination of toxins from the skin, liver and kidneys (it is a potassium sparing diuretic) but provide the body with the strength to heal. 

It has a styptic effect topically and when taken internally it may also reduce heavy menstrual bleeding.

 Key constituents are chlorophyll, histamine, serotonin and flavonoids.

Radix

Benign prostatic hyperplasia:

Lignans found in the root have been shown to inhibit the binding activity of human sex hormone binding globulin (SHBG).  The majority of sex hormones circulate in the bloodstream bound to SHBG (a protein produced by the liver).  They are inactive when bound, preventing excess free circulating sex hormones being available to the tissues.  SHBG increases with age and oestrogens, particularly oestrones synthesized in fatty tissues by aromatase (enzyme), are less likely to bind to SHBG than androgens (male sex hormones).  This results in excess free oestrogens, which stimulate an increase in prostate cells.  This increases prostate cell binding sites for dihydrotestosterone (DHT), a more potent form of the male hormone testosterone.  DHT then stimulates further prostate cell proliferation.    High levels of oestrone also increase levels of SHBG, stimulating more oestrone and therefore more prostate hypertrophy (increased size of the gland). Urtica dioica radix lignans also inhibit aromatase activity, so reducing the amount of oestrone produced in fatty tissues.

Clinical studies have demonstrated an improvement in urological symptoms in men with BPH, such as improved urinary flow and decreased prostate size.  Urtica dioica radix is usually given in combination with serenoa repens (saw palmetto) and Prunus Africana (pygeum bark), both of which inhibit 5-alpha reductase, the enzyme responsible for converting testosterone to DHT.  Reduction in DHT has been shown to reduce prostate size.

(Mills and Bone 2001: 491, 524;  Kelly and Vankrieken 1997).

Vaccinium myrtillus (bilberry).

Family:  Ericaceae

Part used:  Ripe fruit

Vaccinium is high in antioxidants such as anthocyanocydes, flavonols eg quercetin, and oiligomeric procyanidins.  Its antioxidant properties strengthen blood vessel connective tissue and prevent capillary fragility – a particular risk in the kidney in hypertension.  Additionally, it has been shown to inhibit proteases so prevents collagen degradation in larger blood vessels.

Indications

·         This herb is useful for peripheral vascular disorders as it inhibits atherogenesis (the formation of atheromatous plaques in the inner lining of the arteries) and improves vascular tone. 

·         Used to enhance poor microcirculation, it will protect small blood vessels, protects fragile blood vessels in the elderly and helps treat telangiectasia (spider veins ie dilated blood vessels on the skin surface).  Its protective effect on blood vessels makes it a useful herb to add to oral prescriptions for varicose veins and haemorrhoids.

·         It inhibits platelet aggregation so reduces the risk of formation of blood clots.

·         The strength of the antioxidant component makes this herb a popular remedy for the eyes, potentially improving night vision and helping to protect against macular degeneration and diabetic retinopathy.  These effects on the eyes have not been proved and should not be a substitute for orthodox medical care however.

·         Due to its anti-inflammatory flavonoid component and astringent tannins it is also traditionally used to treat mild inflammation of the mouth and throat so will help to protect the oesophagus from inflammation due to acid and enzyme attack in cases of reflux disease as well as helping to heal gastric mucosa in cases of peptic ulceration. 

·         It has been traditionally used to treat diarrhoea, for which the astringent tannins are the active components. 

·         It reduces the production of chemicals, such as histamine and bradykinin, responsible for allergic reactions.

Cautions: May have an additive effect with anticoagulants.  Long-term use may cause stomach irritation.

Valeriana officinalis (valerian).

Family: Valerianaceae

Parts used: rhizome/root              

Valerian relieves stress and anxiety and aids restful sleep at night.  The valepotriates – bicyclic monoterpenes, are active constituents, although their decomposition products, the baldrinals, and other components such as sesquiterpenes eg valerenic acid, interact to give it depressive, sedative, anxiolytic, and muscle relaxing and anti-ulcerogenic actions.  Baldrinals are mainly responsible for its sedative action.  They are GABA-ergic.  GABA and glutamine in valerian may have a direct sedative effect.  The sesquiterpene valerenic acid is responsible for its spasmolytic effect in intestinal colic, mainly due to effects on the CNS.  The valepotriates may act as prodrugs through biotransformation into homobaldrinal by bacterial flora. Valerian lowers blood pressure if stress and anxiety are aetiological factors.

Family:  Caprifoliaceae

Parts used: bark

This herb relieves any muscle tension and will therefore relax the smooth muscles in the bowel, airways, and uterus and also relaxes striated or skeletal muscle.

Indications

·         Gastrointestinal problems: It is known to relieve spasms in irritable bowel syndrome and also relieves constipation by making the stools easier to pass.  Relaxing the muscles will also increase blood flow to the area.  It is also a relaxing nervine so will help relieve associated stress.  Its astringent properties may help relieve diarrhoea.

·         Dysmenorrhoea:  Period pains in which there are excessive uterine spasms may be relieved by Viburnum opulus.

·         Menorrhagia: The herb’s astringent action can help to allay heavy menstrual blood loss.

·         Threatened miscarriage:  The combined antispasmodic and astringent action of Viburnum opulus may help prevent miscarriage.

·         Asthma:  It may reduce breathing difficulties arising from airway spasm by relaxing the bronchial muscles.

·         Arthritic conditions:  In cases where arthritis has caused muscle tension and contraction Viburnum may bring relief from pain by relaxing the muscles and increasing blood flow to the area.

·         Night cramps:  Relaxation of muscles and improved blood supply may bring relief from painful spasms

The herb contains hydroquinones, coumarins, resin and tannins but it is not clear which are the main active constituents.  It has an astringent action, which will benefit her menorrhagia.

Cautions:  No side-effects or contraindications have been reported.

Vitex agnus castus (monk’s pepper, chasteberry).

Family: Verbenaceae

Parts used:  Dried fruit

Vitex was used by monks in medieval Europe to decrease libido.

Control of the menstrual cycle is finely tuned by hormones secreted from the pituitary, ovaries and hypothalamus.  These hormones balance each other and when one is secreted in excess or is in short supply the other hormones are thrown out of synchronisation.  Vitex agnus castus works on the hypothalamus-pituitary ovarian axis to regulate the menstrual cycle and ovulation.  Results of clinical trials have suggested that it is also safe and effective for mild to moderate premenstrual syndrome.

Up to 75% of women of reproductive age have experienced one or more symptoms of premenstrual syndrome.  Symptoms range from confusion, fatigue, impaired performance and memory, sore and swollen breasts, bloating, fluid retention, appetite changes, mood swings, tearfulness, diarrhoea, backache etc.  These symptoms must be differentiated from the more severe premenstrual dysphoric disorder (PMDD) in which a person can become severely depressed or aggressive (Prilepskaya et al. 2006). Additionally, conditions such as acne, genital herpes and mouth ulcers, which may worsen before a ‘period’, have shown improvement with Vitex.

Many of Vitex’s effects on the menstrual cycle may be due to its effects on prolactin, a hormone secreted by the anterior pituitary:  Latent hyperprolactinaemia, an abnormal sensitivity to, or mildly elevated levels of, prolactin, is believed to be the cause of many PMS symptoms.  Vitex contains the diterpene rotafundin, which suppresses prolactin secretion via a dopaminergic action (Heinrich et al. 2004).  This then results in enhanced corpus luteum function with a consequent increased secretion of progesterone (Mills and Bone 2000). 

·         Mastalgia: The decrease in prolactin may explain Vitex’s effect in alleviating premenstrual breast discomfort. 

·         Mood: Vitex’s dopaminergic action may help to improve mood and cognitive function in those with PMS. Dopamine is believed to play a role in mood.  Deficient dopamine secretion may be responsible for some PMS symptoms such as anxiety, depression and decreased cognition.  Prolactin inhibits dopamine production and dopamine inhibits prolactin (ie these hormones are normally finely balanced with one another). 

·         Increases luteinising hormone production: By normalising the luteal phase of the menstrual cycle Vitex may stimulate the corpus luteum (and therefore progesterone) production and improve fertility in women with luteal defects. It also has an effect in alleviating other conditions related to luteal defects, such as polymenorrhoea (frequent periods), oligomenorrhoea (infrequent or light periods), amenorrhoea (absent periods) and menorrhagia (heavy flow).

·         Amenorrhoea is sometimes due to latent hyperprolactinaemia, sometimes as a result of stress, anorexia or excessive exercise (Trickey 1998).  Prolactin is released in response to physical and psychological stress.  Vitex may reinstate menstruation by reducing prolactin levels and improving mood by its dopaminergic actions

·         Dysmenorrhoea:  Vitex may alleviate painful periods when given with antispasmodics.  If dysmenorrhoea is primary or spasmodic (onset with menstruation), Vitex may aggravate the symptoms if given alone due to its effect on progesterone.  This effect is likely to be temporary, however, due to the beneficially anti-inflammatory actions of Vitex.  Congestive or secondary dysmenorrhoea can be helped by the anti-inflammatory effects of Vitex (Mills and Bone 2000). 

·         Anti-inflammatory and immune modulating actions: Prolactin is believed to be involved in promoting the immune response.  Autoimmune diseases such as systemic lupus erythematosus, multiple sclerosis and rheumatoid arthritis are more prevalent in women than in men and prolactin levels are higher in women than in men.  Prolactin levels are raised in autoimmune diseases and bromocriptine, a prolactin suppresser, has shown positive effects in relieving symptoms of certain autoimmune diseases; for example, autoimmune uveitis (Lee 2002).  Vitex has been used traditionally for inflammatory conditions and it may be via its hypoprolactinaemic actions that it exerts its effects.

Key constituents:

Flavonoids: casticin, kaempferol, orientin, quercetagetin and isovitexin), iridoid glycosides: agnuside and aucubin), and essential oils: limonene, cineol, pinene, and sabunene (Roemheld-Hamm 2005).

Cautions:  Not to be used at the same time as the contraceptive pill or other female hormone preparations such as hormone replacement therapy.  Vitex should not be given to children or before the menarche.  Although considered safe during breastfeeding it is not advisable to use it during pregnancy.

There have been some reports of diarrhoea, dizziness and dry mouth.

Synonyms include winter cherry (English), ashwagandha (Ayurvedic), asgandh (Unani) and amukkurra (Siddha).

Family:  Solanaceae

Parts used:  roots but occasionally the fruit, seeds, leaves or decocted bark. 

Withania somnifera (WS) has been an important herb in Indian Ayurvedic and other traditional medicine systems for thousands of years (Khare 2004).  It is taken as a dietary supplement around the world and, sometimes known as Indian ginseng because of its adaptogenic properties, has become a popular herb in western herbal medicine (Chevallier 1996).

It is a bisexual, medium, erect shrub.  It is a branching perennial with hairy, ligneous stems with simple, ovate, alternating leaves.  Flowers are yellowish-white, sessile, with the calyx expanded around a small, globular red fruit.  The plant has an odour that has been likened to horse’s urine (Scartezzini and Speroni 2000).

WS contains withanolides, naturally-occurring steroids, including major active principles Withaferin A and withanolide D. The roots also contain alkaloids, including nicotine, somnine, somniferine and somniferininine, and tropane alkaloids.  Steroidal lactones include withanine, withanininine, anaferinine, anhygrine and visamine. Other active constituents are sitoindosides VII and VIII (saponins) and sitoindosides IX and X.  It is rich in iron and contains small amounts of L-DOPA (Nagashayana et al. 2000). 

Actions and uses as indicated by clinical and in vitro research

·         Alzheimer’s disease: Contains nicotine (Qadry 2002; Khare 2004; Scartezzini and Speroni 2000) and inhibited acetylcholinesterase activity in vitro (Vinutha et al. 2007).

·         In vitro studies suggest a potential nootropic effect of WS (Tohda et al. 2000; Zhao et al. 2002). 

·         Antineoplastic: Antiproliferative effects on human osteosarcoma, breast carcinoma, colon, CNS, lung, bladder and prostate cancer cell lines. Withaferin A is selectively cytotoxic to malignant cells. Withaferin A and Withanolide D have an anti-angiogenic action of WS may be of value in inhibiting neovascularisation in age-related macular degeneration and cancer (Kaur et al. 2004; Bargagana-Mohan et al. 2006; Jayaprakasam et al. 2003).

·         Anti-inflammatory:  Free radical scavenging effect on human fibroblasts (Russo et al. 2001).  Withanolides inhibited COX-2 enzymes in vitro, suggesting an anti-inflammatory activity for WS without the risk of stomach ulcer formation (COX-1 inhibition causes gastric ulcers) (Jayaprakasam and Nair 2003).

·         Antimicrobial activity:  Kills S. aureus, Salmonella typhimurium and has antifungal activities (Awadh Ali et al. 2001; Abou-Douh 2002). 

·         Insomnia by the action of somniferin (Manjunath and Telles 2005).

·         Osteoarthritis: Effective with Zingiber officinale, Boswellia serrata and Curcuma longa in relieving pain and stiffness (Chopra et al. 2004).

·         Parkinson’s disease:  Improvement in symptoms was demonstrated in a clinical trial. Contains L-DOPA (Nagashayana et al. 2000).

·         Hypoglycaemic and hypocholesterolaemic effects indicated by clinical trials in diabetic patients (Andallu & Radhika 2000). 

·         Immunomodulatory activity: reduces oral thrush and viral load in HIV (Usha et al. 2003).

·         Growth-promoting effects: Increases haemoglobin, red blood cell count and plasma protein (Venkataraghavan et al. 1980).

·         Anti-ageing effects: Increased hair melanin, improved nail calcium content, improved seated stature, decreased serum cholesterol and improved sexual performance (Kuppurajan et al. 1980).

·         Adaptogenic properties: Improves mood, alertness, awareness and physical capabilities (Roy et al. 1992).

Summary of uses supported by in vitro and clinical research: Infections, fertility and libido enhancement, joint health, depression and ‘brain fog’, osteoarthritis and rheumatoid arthritis, lumbago, burns, hypertension, epilepsy, diabetes, asthma, eye diseases, anxiety, stress, fatigue, amnesia, dementia, Parkinson’s, insomnia, inflammatory conditions, neurological disorders, enhancement of learning and memory, eye diseases, hypertension, oedema, stress and musculoskeletal problems and as a general tonic and restorative. 

Summary actions: Nootropic, antineoplastic, anti-inflammatory, antioxidant, anti-angiogenic, hypocholesterolaemic, antibacterial, antifungal, immunomodulatory, haematinic, adaptogenic, diuretic, sedative and antidiabetic actions.  It could potentially be used by the modern western herbalist for arthritic conditions, general debility and exhaustion eg myalgic encephalomyelitis, infectious diseases, anaemia and as an adjunct to orthodox medicine for diabetes, cancer and HIV.

The quality of clinical research on Withania somnifera has been generally poor.  Although the studies cited above suggest a positive therapeutic value of WS used alone or in synergy with other herbs, a dearth of large, high quality, controlled clinical trials of sufficient duration means there is insufficient scientific evidence for its efficacy in humans.  Due to ethical considerations, time constrictions and financial restrictions with regard to human clinical trials it is easier to conduct in vivo animal and in vitro studies (Andrade et al. 2000: 146) in an attempt to confirm traditional use of WS against a variety of pathologies.  As such studies cannot be reliably extrapolated to humans it may be appropriate for more efforts to be made in relation to the conduction of clinical trials to support its therapeutic value.  Meanwhile, there is a solid basis of historical, anecdotal and ethnobotanical evidence, gleaned over thousands of years, to lend support for its value in modern and traditional use today.

Zingiber officinale (ginger).

Family:  Zingiberaceae

Part used:  Rhizome

Actions:

·         Ginger is a circulatory stimulant so it enhances the actions of other herbs. 

·         It is diaphoretic,

·         antimicrobial,

·         expectorant,

·         antiplatelet, anticoagulant,

·         antiemetic,

·         anti-inflammatory, It inhibits cyclooxygenase and lipoxygenase, thus inhibiting the formation of prostaglandins and the concomitant release of pain inducing pro-inflammatory cytokines and leukotrienes

·         Antioxidant.  It spares SOD (superoxide dismutase) – an important anti-oxidant, catalase – an enzyme essential for breaking down potentially harmful hydrogen peroxide in cells, gluathione peroxidise – also acts on hydrogen peroxide and helps maintain integrity of cell membranes;

·          thermogenic (warming), stimulates peripheral circulation;

·         cardiotonic (strengthens the heart),

·          hypotensive (fresh).

Indications

Pain and inflammation: 

Ginger is traditionally used for reduction of muscular pain and inflammation as in fibrositis, muscle sprains and rheumatoid arthritis.  It contains gingerols and diarylheptanoids, which inhibit the synthesis of enzymes cyclooxygenase and lipoxygenase from arachidonic acid and therefore formation of pro-inflammatory prostaglandins and leukotrienes respectively.   Prostaglandin inhibition also results in pain reduction and leukotriene inhibition may reduce histamine production.  A rubefacient, it will increase blood supply to the damaged areas and speed up the healing and detoxification process.

For dysmenorrhoea it is useful in the form of hot compresses and baths as well as taken internally, if the pain is due to ischaemic cramp (lack of uterine blood supply).

It is also good in the form of hot compresses for abdominal cramps, headaches and joint stiffness and there is also significant pain relief when taken internally.

Gastrointestinal tract:  Its anti-emetic properties render ginger useful for morning sickness and travel sickness.  It is also reputed to alleviate nausea from chemotherapy.  It is carminative so helps to alleviate flatulence and colic.  It may also be used to treat diarrhoea. The antiseptic, anti-emetic and anti-diarrhoeal actions of ginger may reduce the severity of food poisoning.

Respiratory tract:  Ginger can be used for throat infections and to relieve congestion in sinusitis.  It reduces fever in colds and flu and suppresses a dry, irritating cough in laryngitis. 

Key constituents: Pungent principals: gingerol and shogaols, gingerol being the main one; essential oils, especially the sesquiterpenes zingiberine, zingiberol, sesquiphellandrene, beta-bisabolene and curcumene; diarylyheptanoids

Cautions: Avoid large doses.  Around10g. of fresh plant with anticoagulants; may incrase bioavailability of drugs Only 3-10 ml weekly of tincture is enough.

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