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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