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Modern herbal tradition: what we can learn from
practitioners who publish
- examples of Vitex and Cimicifuga
Dr Ann WalkerSenior Lecturer in Human Nutrition
Hugh Sinclair Unit of Human Nutrition
The University of Reading, UK
Member of the College of Practitioners of Phytotherapy
Member of the National Institute of Medical Herbalists
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Vitex: historical perspective of use
Used by ancient Greeks and Romans to promotechastity. Monks used it to reduce libido. Other uses bythe ancients included the treatment of injuries,inflammation and epilepsy
Mrs Grieve reports nothing on hormonal effects: Theripe berries are pounded to a pulp and usedin the form of a tincture for the relief ofparalysis, pains in the limbs, weakness,etc.
Post WWII research in Germany established hormonal
regulating effects, including modulation of pituitaryfunction
Double-blind clinical trial evidence of normalisation ofhormonal imbalance in women
Late 20th Century use onwards by UK herbal
practitioners mainly for female hormonal imbalance
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Double-blind study
of Vitex treatment for cyclic mastalgia
Condition Number/
Duration
Significant
outcomeCyclicbreastpain
203months
Reducedsymptomscompared toplacebo
Kubista et al. 1983
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Double-blind studies of Vitex
treatment for PMS
Reference Number/
duration
Symptoms
significantly< placebo
Schellenberg2001
1703 months
Global PMSscore
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Active components of Vitex
berries
Iridoids
aucubin, agnuside
Flavonoids casticin, isovitexin
Other
volatile oil (mixture of mono- and
sequi-terpenes), triterpenoids,
castine (a bitter principle), viticin (an
alkaloid)
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Modern usage and perception of Vitex
Nowadays mainly used to treat adversesymptoms of the menstrual cycle andmenopause
Understood from scientific studies, to aidnormalisation of both raised and loweredplasma oestrogen - adaptogenic
Action: modulation of pituitary function -active component(s) of the herb mimicdopamine, binding to dopamine receptors,
which lowers plasma prolactin Lowering prolactin helps counter anxiety
and reduces risk of dysfunction of hormone-dependent tissues in both men and women
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How far is the modern perception
of the therapeutic profile of Vitex
reflected in publications of herbal
practitioners?
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Vitex: Traditional use References
Christie & Walker 1998) Eur J Herb Med 3, 29 Williamson 2003 Potters Herb Cyclopaedia McIntyre 1994 Complete Woman's Herbal Mills & Bone 2000 Principles & Practice
Phytotherapy Bone 2003 Guide to Blending Liquid Herbs Ody 1993 Complete Medicinal Herbal Bartram 1995 Encyclopedia of Herbal Medicine
Chevallier 1996 Encyclopedia of MedicinalPlants Weiss 1988 Herbal Medicine BHMA 2003 Guide Traditional Herbal Medicines
ESCOP 2003 Monographs
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Actions of Vitex
Galactogogue
(promotes
lactation)
Hypoprolactinaemic
agent
Hormone regulator
Dopaminergic
No. citationsMain Actions
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Therapeutic use of Vitex
Hyperprolactinaemia
Endometriosis
Polycystic ovary syndrome
(PCOS)
Menopausal problems,
including hot flushes
Amenorrhoea/ infertility/acne
Cyclical mastalgia
Insufficient lactation
Menstrual irregularities, PMS
No. citationsUses
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Calculation of dried herb equivalents
weight - g/day
PER DAY
Weight of dried herb by infusion or decoction
Weight of powdered dried herb in capsules A fifth of the volume of 1:5 tincture (g)
A third of the volume of 1:3 tincture (g) etc
Volume of 1:1 fluid extract expressed in g Five times the weight of 5:1 dried broad-
spectrum extract etc
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Daily dosage ranges Dried herb equiv* g/d for
adults ofVitex agnus-castus berries according to
authoritative sources
0 1 2 3 4 5M & B '0 0 Ge rm a n-M & B ' 0 0 E ngl i sh-
B o n e ' 0 3E SC O P ' 0 3
Cheva l l ie r '96B a rtra m '9 5H o f fma n ' 8 6
*, extract as tincture (1:5), liquid extract (1:2) or fluid extract (1:1)
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Cimicifuga racemosa(Black cohosh)
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Black cohosh: historical perspective of use
Ellingwood & Lloyd 1919
an efficient nerve sedative, although its most
pronounced action is on the unstriped muscles Through its influence upon the vasomotor centers
and upon the nerve ganglia, it has a beneficialinfluence upon the heart.
Indications: angina, heart irregularily, irritable coughs, chorea, muscle
aches and rheumatic fevers, rheumatic arthritis, neuralgia, sciatica,dysmenorrhoea, amenorrhoea, and orchitis.
In pregnancy: The agent is excellent in reliving irregularpains and uterine distress occurring during thecourse of pregnancy. It may be given in smalldoses, and it thus prepares the patient for
parturition and undoubtedly contributes largely to ashort, easy and uncomplicated labor.
Mrs Grieve 1932: Indications: cough, whooping-cough, rheumatism and St Vitus dance in
children.
Ellingwood & Lloyd 1919American Materia Medica, Therapeutics and Pharmacognosy
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Double-blind studies:
effect of 40 mg of dried black cohosh root/day for 3
months on adverse menopausal symptoms
Yes
(p = < 0.001
304Osmers et
al
2005
Yes, and
oestrogen
62Wuttke et al
2003
Symptoms
significantly
< placebo?
Total number
of women in
trial
Reference
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How far is the modern perception
of the therapeutic profile of Black
cohosh reflected in publications of
herbal practitioners?
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References for Black cohosh
Williamson 2003 Potters Herbal Cyclopaedia BHMA 2003 Guide to Traditional Herbal Medicines
BHP 1983 British Herbal Pharmacopoeia ESCOP 2003 Monographs Mills & Bone 2000 Principles & Pract Phytotherapy Bone 2003 Guide to Blending Liquid Herbs McIntyre 1994. Woman's Herbal
Ody 1993 Complete Medicinal Herbal Bartram 1995 Encyclopedia of Herbal Medicine Chevallier 1996 Encyclopedia of Medicinal Plants Weiss 1988 Herbal Medicine
Hoffman 1986 The Holistic Herbal
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Actions of Black cohosh
Hypotensive/ vaso-dilator
Diuretic
Antiinflammatory agent/ Anodyne/ antiarthritic
Hormone regulator/SERM*/ dopaminergic
Antispasmodic
Antitussive/ expectorant
Uterine tonic/ stimulant emmenagogue/
parturient
Antirheumatic
Sedative (cardiac)No. citationsMain Actions
*, selective oestrogen receptor modulator
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Therapeutic use of Black cohosh- 1
Respiratory tract disorders: Whooping cough/
asthma
Arthritis, including rheumatoid
Tinnitus
Menstrual disorders: dysmenorrhoea/
amenorrhoea/ menorrhagia/ ovarian pain/
PMS
Menopausal symptoms including hot flushesand depression
Rheumatism neuralgia/ intercostal myalgia/
cramps/ stiff neck/ post-exercise muscle
pain/ sciatica/ low back pain/ headaches
/migraine with hormonal element
ReferencesUses
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Therapeutic use of Black cohosh - 2
Hypertension
Infections/ fevers/ scarlet fever
Chorea
Conditions with raised luteinising hormone:infertility/ miscarriage/ ovarian cancer/
polycystic ovary syndrome/ breast pain
Child birth/ partus preparator/ uterine tonic
ReferencesUses
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Daily dosage ranges of dried-herb equivalent
(g/day) for adults of Black cohoshaccording to
authoritative sources
0 1 2 3 4 5 6 7M & B '0 0 Ge rm a n-B o n e ' 0 3 Ge rm a n-
E SC O P '0 3 G e rm a n-B H P '8 3
Cheva l l i e r ' 96M &B ' 0 0 E ngl i sh-B one ' 03 Engi sh-
*, extract as tincture (1:5), liquid extract (1:2) or fluid extract (1:1)
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Historical perspective on safety
19th century Eclectic and Physiomedical herbal
practitioners in 19th Century knew that overdose caused:.general relaxation, dimness ofvision, dizziness, tremors, slowing ofthe pulse, fall of arterial pressure,vomiting or gastric irritation: itsimulates expectoration andperspiration, causes intenseheadache and prostration.
According to ESCOP: Although side effects of
overdose of Black cohosh was well known by the 19thCentury American herbalists, older data suggest thatdaily doses of at least 5 g of unprocessed herb or 12 g offluid extract (equivalent to 12 g of dried herb) are neededto cause any symptoms. These dosages are far inexcess of those which would be used by herbal
practitioners in the UK.Drs Ellingwood and LloydAmerican Materia Medica, Therapeutics and Pharmacognosy(1919)
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Current Perspective on safety Williamson 2003 Potters Cyclopaedia
Mutagenicity, teratogenicity and other toxicity studieshave proved negative, and it is now considered to besafe in women for whom conventional hormone-replacement therapy is contraindicated.
ESCOP 2003 monograph ..caution that patients with existing oestrogen-
dependent tumours should not use the herb, remainsspeculative.
the weight of evidence indicates that Black cohoshdoes not influence the latency or development of
mammary tumours and it may even have an inhibitoryeffect. Contradictory results have been resulted fromin vitro experiments on cancer-cell lines, but clinicalexperience suggests no risk in the use of the herb.
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Pregnancy Category B2 No increase in frequency of
malformation or other harmful effect on the foetusfrom limited use in women. Animal studies are
lacking.
Contraindications
Patients with oestrogen-dependent
tumours, during pregnancy (except
to assist with birth). Do not use
during lactation without professional
advice.
Black cohosh is best avoided in
patients with oestrogen-dependenttumours, such as breast cancer, until
more information is available
regarding possible oestrogenic
activity.
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Conclusions
The writings of modern herbal practitionersare an important resource for posterity for thefollowing reasons:- Reflect a modern perspective on the therapeutic
profile of a herb built from a synthesis of:
Traditional use from ancient texts Traditional practitioner use for more than a
century Modern scientific findings
Give physiological actions, lacking in ancient texts Give dosages, which are lacking in ancient texts Give indications for diseases which are
understandable in terms of our modern concept ofmedicine