Contents and use of subsequent chapters

The herbal monographs found in subsequent chapters do not constitute a comprehensive, encyclopedic listing of all of the more than three hundred herbs currently used in Western medicine. Readers who anticipate that approach will not have their expectations realized. The chapters that follow are instead devoted principally to phytomedici-

nals that are now considered to be the most useful for treating particular diseases or syndromes. Following brief general discussions of the pathophysiology of the various conditions, monographs of the useful herbs for treating those disorders are arranged in approximate order of their decreasing therapeutic utility. Occasionally, a particular sec- tion will contain brief discussions of herbs that are not particularly effective but are nevertheless included because of their popularity. Several minor carminatives in Chapter 3 are a case in point. A very few herbs considered totally ineffective or even dangerous to use are included for the same reason. Sarsaparilla and sassafras in Chapter 11 are examples.

Simply because an herb is listed does not mean that it should be used for the particular ailment. For example, phytomedicinals have no place in the self-treatment of self-diagnosed heart disease or cancer. Herbs of potential value in such conditions are discussed to bring them to the atten- tion of professionals who are qualified to use them properly. Hawthorn and taxol are examples. Each monograph must be read carefully to deter- mine the safety, utility, and proper use of the herb discussed there.

Unlike the botanical or alphabetical system utilized in most herbals, the classification of phytomedicines in this volume is based on their principal therapeutic use. Because some of them are useful for more than one condition, they may appear more than once. In most such cases, the minor reference is cross-referenced to the major monograph. For example, chamomile preparations are quite useful in the treatment of various kinds of skin conditions. However, such pharmaceutical preparations are not ordinarily available in the United States, so chamomile is briefly mentioned under treatments for dermatitis in Chapter 10 , and the reader is referred to Chapter 3. There the herb is discussed in detail, principally as a digestive aid, but also with respect to its other beneficial properties.

20 Tyler's herbs of choice: The therapeutic use of phytomedicinals The contents of the major monographs follow the same general pat-

tern with minor deviations. Ordinarily, the part of the plant used, the scientific name (Latin binomial followed by author citation), and the plant family are presented first, but synonyms, unless they are especially meaningful, are ignored. In a work devoted primarily to the therapeutics of useful herbs, enumeration of the multiplicity of common names was deemed unnecessary, as was much pharmacognostical information, such as habitat, production, preservation, and marketing. All of this is readily available elsewhere.

Chemical identification of the active principles (when known) is followed by a discussion of therapeutic use, mechanism of action, side effects, dosage and dosage forms, and usually some remarks about the value of the herb in the eyes of an authority such as the U.S. Food and Drug Administration (FDA) or Commission E of the former German Bundesgesundheitsamt (federal health agency), with additional comments by the authors. The FDA and its attitude toward phytomedicinals have been discussed sufficiently in Chapter 1 . The activities of Commission E are probably less well known to American readers, but because they are frequently quoted in the monographs, some explanation of that commission’s role in the evaluation of the safety and efficacy of phytomedicinals is required.

In 1978, the German equivalent of our FDA, formally known as the Bundesgesundheitsamt, undertook the task of evaluating the safety and efficacy of phytomedicinals. To do this, the agency established Commission

E, which was presented with the formidable task of examining appropri- ate data concerning about fourteen hundred different herbal drugs cor- responding to some six hundred to seven hundred different plant species. The data utilized by the commission included results obtained from clinical trials, collections of single cases, and scientifically documented medical experience. The latter category comprises both the scientific literature and collective conclusions of medical associations. 1

Results of the study were originally published in German as Commission E monographs in the Bundesanzeiger (Federal Gazette) and are now available as a single volume in the English translation. 2 More than three hundred such monographs, covering most of the economically important herbal remedies sold in Germany, appeared by 1993. 3 Approximately two- thirds of the monographs provide positive assessments of herbs found to

be safe and effective. The remaining monographs are negative, usually because the herb presents an unsatisfactory risk–benefit ratio. Each monograph generally provides summaries of such information as the identity, composition, use, contraindications, side effects, precautions, dosage, preparations, and effects for those herbs considered effective. For ineffective herbs, comments on the risks involved in consumption and an overall evaluation are substituted for much of the preceding information.

Chapter two: Contents and use of subsequent chapters

21 Of the first 285 monographs published, 66 percent mention risk aspects;

of these, fifty-eight monographs state that there is no plausible evidence of efficacy, and thus a negative risk–benefit ratio exists. Concerning contraindications, sixty-three monographs mention allergy to the active constitu- ent, twenty-four restrict use during pregnancy or lactation, fifteen state contraindication if the patient has gallstones, and seven monographs are contraindicative if the patient suffers from an inflammatory disease of the kidney. Common types of side effects are gastrointestinal disorders (mentioned in thirty-five monographs), allergic reactions (recorded in thirty),

and photosensitivity (identified in five). 4 See Blumenthal et al. for additional details. 2 The Commission E monographs contain the best evaluations of the utility of phytomedicinals currently available. Most experts in the field are in general agreement with the findings reported therein. Occasionally,

a different opinion has been expressed. If this is the case, in this volume the Commission E judgment is tempered somewhat by calling the herb “apparently modestly effective in this regard.” An example of a question- able statement in a Commission E report is the therapeutically noneffective dose of salicin (60–120 mg) recommended in the monograph on willow bark. Because of some scattered controversial findings of this nature, it is most unfortunate that neither the data used by the Commission in reach- ing its conclusions nor the minutes of its meetings are available to the public.

Nevertheless, to repeat for emphasis, the findings of the Commission

E on herb safety and efficacy constitute the most accurate body of scientific knowledge on that subject available in the world today. They are extensively referred to in this book.

Numerous references are included in the discussions of the various herbs in the following chapters. These will enable any of the principal subjects presented therein to be pursued in additional detail. Although it is regretted that some of the key references are written in the German language, this simply reflects the country in which many of the investiga- tions have been carried out. The discussion of the various properties of carminatives is an example where comparable information is not available in English. A considerable amount of information on herbal use appears for the first time in English in this book.

Some readers may consider it unusual that herbs commonly utilized in traditional Chinese and Indian (Ayurvedic) medicine are not repre- sented more frequently in the subsequent chapters. Many possible entries were considered, but with rare exceptions, such as ephedra, their utility remains unproven by Western scientific standards. The philosophic principles of Chinese and Ayurvedic medicine differ vastly from those on which Western medicine is based and lead, in some cases, to very different conclusions. For example, in this work, Chinese ginseng and American

22 Tyler's herbs of choice: The therapeutic use of phytomedicinals ginseng—different species of the same genus that contain similar active

principles—are considered together. As far as can be determined by Western studies, they have similar actions. Yet the Chinese believe they are very different in their properties: The American species is “cold” (yin) and the Oriental is “hot” (yang). In addition, many pharmacological and clinical studies carried out in China and India have lacked adequate “blinding” and controls in their experimental designs; their results are thus very difficult to interpret.

For these reasons, most of the data on which the herbal information in this book is based has been derived from studies in Europe and America. Because of their vast floras, China and India will eventually enrich herbal medicine with remedies of proven value; however, to date, their contribu- tions have been minimal.

Every effort has been made to be accurate and fair in the presentation of the truly useful herbal remedies. Occasionally, the potential use of a product has been mentioned, but on the whole, the scope of the information has been restricted to statements that are presently substantiated by facts. But in both science and medicine, today’s facts may not be the same as those of tomorrow. Therefore, as befits lifelong health professionals, the authors have attempted to present the information in neither a conserva- tive nor a liberal manner but, rather, in a conscientious one. We believe that most readers will appreciate this concept as they peruse the pages that follow.

References

1. Keller, K. 1991. Journal of Ethnopharmacology 32:225–229. 2. Blumenthal, M., W. R. Busse, A. Goldberg, T. Hall, C. W. Riggins, and R. S.

Rister, eds. 1998. The complete German Commission E monographs: Therapeutic guide to herbal medicines, trans. S. Klein and R. S. Rister. Austin, TX: American Botanical Council.

3. Schilcher, H. 1993. Zeitschrift für Phytotherapie 14:132–139. 4. Keller, K. 1992. Zeitschrift für Phytotherapie 13:116–120.

chapter three

Digestive system problems

Contents and use of subsequent chapters