415 PHG

415 PHG

Evidence-based herbal

medicationsDr. Areej Al-Taweel

• Study of monographs of some of evidence-based herbal medications: - Garlic - Aloe - Myrrh - Saw Palmetto - St. John Wort - Echinacea - Ginkgo - Milk Thistle - Ginseng - Liquorice -Valerian - Ginger - Chamomile -Green tea - Grape seeds

Examples of clinically approved herbal formulations (integrated functions of herbs).

Herbal monographs normally include:

• Nomenclature • Part used• Constituents• Actions and pharmacology• Indications and usage - Approved by commission E - Unproven uses - Chinese Medicine - Indian Medicine

• Contraindications• Side effects• Dosage• Over dosage

Monographs on selected herbs are available from a number of sources, including: - The European Scientific Cooperative on Phytotherapy (ESCOP) - German Commission E - The World Health Organization (WHO) The WHO monographs, for example, describe the herb itself by a number of criteria including: -Name of herb and synonyms. -Part of used -Geographical distribution -Tests used to identify and characterize the herb (including macroscopic and microscopic examination and purity testing) -Active constituents -Dosage forms and dosing -Medicinal uses -Contraindications -Adverse reactions.

Garlic (Allium sativum)Fam. Alliaceae

Constituents:Garlic contains 1% alliin and its transformation Products and sulfur-containing essential oil

-Upon disrupting the cells by crushing or chewing, the enzyme alliinas comes into contact with the amino acid alliin, causing its rapid transformation into allylsulphenic acid, and subsequent conversion to allicin (thiosulfinates).

Allicin is the main precursor of various other transformation compounds such as allyl sulfides, ajoenes, and vinyldithiins, depending on the method of processing.

Pharmacology

Thiosulfinates (Allicin):• Antimicrobial, antifungal, antiprotozoal • Reduction of serum cholesterol and lipid levels • Antioxidant • Anticancer

In vitro and in vivo animal studies have also demonstrated garlic's ability to inhibit tumor formation and reduce blood pressure and exhibit antibacterial, antiviral.

In vivo studies in animals have concluded that garlic powder, fresh garlic, and garlic oil reduced hyperlipidemia and atherosclerosis.

Indications and usage

Commission E approved the use of garlic as: As a support to dietary measures at elevated levels of lipids in the blood as a preventive measure for age-dependent vascular changes.

Based on clinical studies, European Scientific Cooperative onPhytotherapy (ESCOP) recognizes the following indications for garlic: • Prophylaxis of atherosclerosis• Treatment of elevated blood lipid levels. • Improvement of blood flow in arterial vascular disease. • ESCOP also noted that garlic has been used traditionally for relief of cough, colds and rhinitis.

WHO Garlic used as an adjuvant to dietetic management in the treatment of hyperlipidaemia and to prevention of atherosclerotic vascular changes.

Contraindications Some sources suggest that substantial amounts of garlic should not be consumed prior to surgery, since it can prolong bleeding time.

Side Effects breath and body odor, heartburn, upset stomach, and allergic reactions. These side effects are more common with raw garlic.

Garlic effective for:

• High blood pressure. Some research shows that garlic can reduce blood pressure in people with high blood pressure by as much as 7% or 8%.

• Hardening of the arteries (atherosclerosis). As people age, their arteries tend to lose their ability to stretch and flex with age. Garlic seems to reduce this effect.

• Colon cancer, rectal cancer, and stomach cancer. Eating garlic seems to reduce the risk of developing these cancers. However, garlic supplements don’t seem to offer the same benefit.

•Fungal infections of the skin

Dosage of garlic •Garlic is considered safe by the FDA.• Malodorous breath can be diminished with enteric-coated tablets.• The usual dose is 300 mg, taken 2 to 3 times per day

Special precaution and warning

• Garlic consumption substantially increases the anticoagulant effects of warfarin. "Patients on warfarin therapy should be warned that garlic supplements may increase bleeding times. • Do not used together with other herbs that may interfere with blood clotting such as cat`s claw , Ginger , Ginkgo, Ginseng.• Do not use in large amounts in persons with bleeding disorders such as hemophilic patients, patients with bleeding ulcers or gastritis due to potential gastric irritation. • Use with caution in diabetic patients (garlic may lower blood glucose levels).• Do not use in large amounts in patients with thyroid dysfunction as garlic may interfere with iodine metabolism.• Do not ingest in large quantities during pregnancy and lactation (Garlic in large amounts may induce labor)

Myrrh (Commiphora myrrha)

Family: BurseraceaeMyrrh is a sap-like substance (oleo-gum resin ) and it has been knownto contain resin, essential oil, and gum This trees produce myrrh when their bark and sapwood are cut. At times throughout history, myrrh has been at least as valuable as gold because of its medicinal properties.

Active constituents:

-Volatile oil: elemene and furanosesquiterpenes of the elemene, eudesmen and germacren. The main ingredient is furanoeudesma-1,3-diene (approx. 50%).

-The resin in myrrh is made up of alpha-, beta-, and gamma- commiphoric acids, alpha- and beta-heerabomyrrhols.

- polysaccharide

-Tannins are also found in myrrh. “Several actions have been attributed to tannins including antidysenteric, antioxidant, antiviral, bactericide, cancer-preventative, hepatoprotective

Pharmacological Action of Myrrh

• Myrrh resin was used to dress wounds because of its astringent properties.

• In modern medicine, it is sometimes used as: - An antiseptic to prevent and treat gum disease swelling, inflamed gums, and chapped lips, and may be found in some mouthwashes and toothpastes. - Myrrh can help decrease swelling (inflammation) and kill bacteria.-Myrrh is used for indigestion, ulcers, colds, cough, lung congestion, arthritis pain, and syphilis.- It is also used as a stimulant and to increase menstrual flow. - It is also used topically for hemorrhoids.

Scientific research for Myrrh

• Myrrh was shown to produce analgesic effects on mice. Researchers showed that furanoeudesma-1,3-diene and another terpene in the myrrh affect opioid receptors in the mouse's brain which influence pain perception.

• Myrrh has been shown to lower cholesterol LDL levels, as well as to increase the HDL in various tests on humans done in the past few decades. One recent (2009) documented laboratory test showed this same effect on albino rats.

Side effects:Myrrh seems safe for most people. It can cause some side effects such as skin rash if applied directly to the skin, and diarrhea if taken by mouth.

Amounts greater than 2-4 grams can cause kidney irritation and heart rate changes.

Special precaution and warning • Avoid using Myrrh during:• Pregnant or breast feeding• Diabetic• Heart disease • Uterine bleeding•You are scheduled for surgery in the next two weeks.

Drug interactions:Antidiabetes drugsMyrrh might decrease blood sugar. Warfarin (Coumadin) Myrrh might decrease effectiveness of warfarin .

Dosage of myrrhThe appropriate dose of myrrh depends on several factors such as the user's age, health, and several other conditions.

Tincture:The tincture prepared with myrrh is useful to treat infections, fever, cold. This tincture is an exellant remedy for all problems of the respiratory tract. The tincture may be blended with other cough and cold remedies to treat the ailments. Dose of tincture of 1 or 2 ml daily. However it must be diluted well by adding water before consumption.

Capsules: It is advisable to take one capsule of 200 mg each

five time daily.

Garlic/mouth wash: Dilute the myrrh tincture by adding 1to 2 ml of it to half cup

of water and use this as a gargle or mouthwash to treat painful throats or mouth ulcers.

Oil: Take 10 drops of oil extracted from myrrh and dilute in 25 ml of water . Shake the mixture well and then apply externally on injuries and persistent sores or boils. Lotions prepared from the oil may also be used to stop hemorrhoids. In all such conditions the myrrh oil acts an effective remedy.

Mirazid®:

Mirazid is an egyptian drug made from myrrh, has been investigated as an oral treatment of parasitic ailments.