Pelargonium sidoides

This geranium native to southern Africa, and is often known as Umckaloabo. A common preparation is Umcka, which was first used and marketed in Europe and is now sold in the U.S. under the Nature's Way brand.
Its most common application is the treatment of upper respiratory infection, from the common cold to bronchitis and pneumonia. Because it is generally well-tolerated and has a good amount of specific research behind it, many often recommend it for children.
Phytomedicine has just released a supplement to its regular issues that reviews some of the most recent research on this remarkable plant. Here is a quick roundup:

EPs® 7630, an extract from Pelargonium sidoides roots inhibits adherence of Helicobacter pylori to gastric epithelial cells


Fascinating metabolic pools of Pelargonium sidoides and Pelargonium reniforme, traditional and phytomedicinal sources of the herbal medicine Umckaloabo®

In vitro evaluation of antibacterial and immunomodulatory activities of Pelargonium reniforme, Pelargonium sidoides and the related herbal drug preparation EPs® 7630

Inhibition of lipopolysaccharid-induced sickness behavior by a dry extract from the roots of Pelargonium sidoides (EPs® 7630) in mice

Mass spectroscopic characterisation of oligomeric proanthocyanidins derived from an extract of Pelargonium sidoides roots (EPs® 7630) and pharmacological screening in CNS models

Treatment of rats with the Pelargonium sidoides extract EPs® 7630 has no effect on blood coagulation parameters or on the pharmacokinetics of warfarin

Extract of Pelargonium sidoides (EPs® 7630) improves phagocytosis, oxidative burst, and intracellular killing of human peripheral blood phagocytes in vitro

Extract of Pelargonium sidoides (EPs® 7630) inhibits the interactions of group A-streptococci and host epithelia in vitro

Treatment effect and safety of EPs® 7630-solution in acute bronchitis in childhood: Report of a multicentre observational study

EPs® 7630-solution - an effective therapeutic option in acute and exacerbating bronchitis

Pelargonium sidoides preparation (EPs® 7630) in the treatment of acute bronchitis in adults and children

Liquid herbal drug preparation from the root of Pelargonium sidoides is effective against acute bronchitis: Results of a double-blind study with 124 patients

Some issues: the patented liquid preparation, for one. This is a "1X homeopathic dilution of an alcohol extract of Pelargonium". I tend to prefer whole-plant administrations that are traditionally prepared. Also, the large amount of in-vitro and animal studies. Nevertheless, there is some good data on this plant and more is becoming available. As modern medicine continues its shift away from the overuse of antibiotics in respiratory infection, this herb seems to be a helpful adjunct to the tried-and-true diaphoretics and immunomodulators herbalists have been using. I will try to grow it this summer, and see if I can overwinter it in my heated greenhouse...

Cannabis decreases neuropathy

Dr. Abrams (and others), who has a history of working on treatments to improve the quality of live for HIV patients, has co-authored a small but statistically significant trial on the effects of smoked cannabis on the neuropathy associated with HIV. The nerve pain in question is characterized by hypersensitivity to even the smallest stimuli, like the brushing of clothing on the skin, and has some similarities to the intense burning and pain associated with shingles, the herpes zoster infection.
Here is a quick summary of some of this placebo-controlled study's findings:

• Over the course of the study, smoked cannabis reduced daily pain by 34%, versus 17% with placebo.
• 52% of the cannabis group reported at least a 30% reduction in pain, compared with 24% in the placebo group.
• The first cannabis cigarette reduced chronic pain by 72%.
• No serious adverse events were reported.

And, bottom line: "Smoked cannabis was well tolerated and effectively relieved chronic neuropathic pain from HIV-associated sensory neuropathy. The findings are comparable to oral drugs used for chronic neuropathic pain". This is a significant result: not only is chronic neuropathy very difficult to deal with, both as a patient and as a clinician, but conventional drugs like neurontin (not to mention the narcotics) leave a lot to be desired.
This trial provides yet another safe and effective clinical use for this much-maligned botanical medicine.

Antibiotic resistance update

Some of the responses from medical doctors involved in a brand-new prospective study published in the Lancet today are downright alarming:

• "...get on and do something about it before the antibiotic era finally grinds to its apocalyptic halt..."
• "...antibiotic prescribing affects the patient, their environment, and all the people that come into contact with that patient or with their environment..."
• "Physicians should take into account the striking ecological side-effects of antibiotics when prescribing such drugs to their patients..."

Two macrolide antibiotics, Zithromax and Biaxin, were administered to patients and the naturally-occurring strep bacteria in their throats were examined at the end of treatment. Within a week at most, the treatment group showed over 50% more resistant bacteria than did the placebo group. These effects, the study concludes, were evident for up to 180 days after the treatment (at which point the study stopped following the patients).
And as the comments above rightly point out, antibiotic resistance isn't limited to the patient receiving treatment - bacteria are experts at spreading their successful adaptations.
Herbalists have been pointing out the dangers of antibiotic overuse for years now, and the medical community has been coming around (note the recommendation against antibiotics in childhood ear infections, and against overprescription in bronchitis). Antibiotics are fantastic lifesavers when used in dire situations. But with the dangers of their indiscriminate use now clearly proven, what can we turn to?

Talk to your local herbalist.

Wormwood in Crohn's

Wormwood, that famous Artemisia known as a primary ingredient in absinthe, has long been used as a tonic for the digestive tract. New research points to its use in managing Crohn's disease, an inflammatory condition that generally manifests in the lower bowel. Steroids, which are sometimes used to treat this inflammation, can only be used for short periods of time (due to their myriad powerful side-effects), and patients usually suffer relapses after the steroids are tapered off. By adding wormwood to the treatment regimen:
"...there was a steady improvement in CD [Crohn's disease] symptoms in 18 patients (90%) who received wormwood in spite of tapering of steroids as shown by CDA-Index, IBDQ, HAMD, and VAS. After 8 weeks of treatment with wormwood there was almost complete remission of symptoms in 13 (65%) patients in this group as compared to none in the placebo group. This remission persisted till the end of the observation period that was week 20, and the addition of steroids was not necessary".

Wormwood is a powerful herb, and remarkably bitter. The dose is usually lower than average - about 30 drops of a 1:5 tincture, taken 2-3 times daily before food is what I usually recommend. If it were me, I would also combine it with a warming, carminative herb (like fennel seed) and a bit of a soothing demulcent/astringent (like meadowsweet, or even licorice) in a custom herbal formula.

Apigenin and breast cancer

The flavone apigenin, common in many members of the Umbelliferae (Apiaceae), has been shown in a recent study to have marked and positive impact on human breast cancer. These findings, coupled with previous research on apigenin's good oral bioavailability from crude plant preparations, builds on previous evidence for the beneficial role of such humble foods as common Parsley in supporting sometimes difficult conditions like cancer.
One note: the dose of Parsley should be relatively high - up to 2g of "blanched" Parsley per kg of body weight on a daily basis. This comes out to about 140g for an averabe 150lb human, which is quite a bit. But combined with soups, veggie stir-fries, and steamed greens, such a dose can be easily achieved. And it reduces the need for added salt, while providing lots of dietary potassium.

Herbal alternatives for cholesterol roundup

Herbalgram provides us with a decent HerbClip summary of some of the different herbal and dietary options for managing dislipidemias. Some interesting points:

• dietary fiber is crucial (reducing the absorption of exogenous cholesterol)
• phytosterols seems to have two mechanisms of action: competing with exogenous cholesterol for micelle formation; and working in the liver on lipid metabolism itself (esp. guggulsterone)
• omega-3 essential fatty acids (of course)
• garlic - powerful stuff, but its mechanism of action is still unclear
• red yeast rice. I haven't used this popular supplement in my practice yet, mostly because I'm unfamiliar with its effects overall, and its dosage ranges. Doing a little research, it seems at least part of this supplement's effect comes from the formation of statin-like substances during the fermentation of the rice. Some reports outline potential muscular and liver complications from taking red yeast rice. Hmmm... stay tuned.
  

Comfrey and arthritis

Comfrey (Symphytum officinalis) usually ranks high on my list of topical applications to stimulate regeneration of skin and tissue after an injury. Its preparations (root or leaf) are soothing, and their allantoin content helps new skin cells proliferate. Historically, Comfrey preaparations have been used for a whole variety of other purposes, many of which relate to its usefulness as a regenerator of mucous membranes when taken internally. Of course, blessed pyrrolizidine alkaloids, we just can't use Comfrey internally anymore (in fact, we should probably ban it) - that is, if we enjoy letting the government tell us what to do. But I digress.
Though still a historical use, recent investigations have uncovered a pronounced therapeutic effect for Comfrey in folks with arthritis pain (osteoarthritis - degradation and subsequent inflammation in the joints). Some details:

• a strong oil-based root salve, Kytta-salbe, made in Germany and produced by Merck
• over 200 people with long-standing (over 6 years) osteoarthritis of the knee
• 3 week double-blind, placebo-controlled trial
• over 50% reduction in severity of symptoms
• increased mobility

Pretty good! Perhaps more curative than just analgesic?

Cold medicine kills infants

"Clinicians should use caution when prescribing cough and cold medications to children under 2" Why is the CDC (and not the FDA?!?) issuing this warning? The results of a long-term investigation show that over-the-counter medications used to treat common coughs and colds were responsible in the deaths of multiple infants in 2005 - and these are just the documented cases. Medicines involved: acetaminophen (Tylenol), detromethorphan (Robotussin), pseudoephedrine (Sudafed and just about every other OTC decongestant) and carbinoxamine (Pediatex, Palcid).
I'd venture to say that, in one fell swoop, this class of cold-related suppressive cocktails generated more adverse event reports than any herb has over the course of its documented use. It's good that we get a warning. And a good dozen references on Google News. It's hard to hide from the media frenzy! But I can understand all they hype: you couple these deaths with the use of pseudoephedrine in methamphetamine production, and it's almost as newsworthy as a poorly designed study on how Echinacea doesn't help children's colds. I think we should ban Echinacea from pharmacy shelves! Pass the Tylenol Cold & Flu, please!

Black Cohosh and breast cancer

The root of this woodland plant is back in the forefront in a new study from the University of Pennsylvania that tracks its use, among other herbals, in perimenopausal women who also had breast cancer (over 900) along with controls (over 1500). Not only do we continue to see improvement in menopausal symptoms, but Black Cohosh specifically seems to protect against breast cancer.
There has long been a debate as to whether "phytoestrogens" (mostly steroidal-like molecules present in plants) are harmful or helpful in cases of breast cancer. The argument that plants like Black Cohosh are harmful runs something like this: if estrogen-dependent breast cancers are exposed to estrogen-like substances from the plant world, proliferation will ensue as these substances are mild agonists at the estrogen receptor - after all, they help alleviate estrogen-deficiency symptoms, right? In contrast, many herbalists argue that phytoestrogens are amphoteric, and their weak action at the estrogen receptor actually leads to less proliferation by blocking the receptor from the much more powerful human estrogen. Since cancer cells are overproducing this receptor, Black Cohosh actually has a net benefit by "plugging up" those cancer-stimulating sites.
Hopefully this study will help in the ongoing discussion on the role of phytoestrogens.

Integrative Herbalism Roundup

How have consumers and patients been using herbal medicine? How does it mix with modern therapies? How well informed is everyone about the different choices patients are making?
Here's a brief summary of the research perspectives on some of these important questions.

Herbal medicine: women's views, knowledge and interaction with doctors: a qualitative study.: BMC Complement Altern Med. 2006;6:40 Authors: Vickers KA, Jolly KB, Greenfield SM
CONCLUSION: The women had little knowledge about herb-drug interactions and rarely disclosed use of herbal medicines to their doctor. Doctors' communication and openness regarding herbal medicines needs to improve and there should be increased access to accurate information on herbal medicines in the public and health care domain.

Alternative medicine and herbal use among university students.: Alternative medicine and herbal use among university students. J Am Coll Health. 2006 Nov-Dec;55(3):163-8 Authors: Johnson SK, Blanchard A
Overall, 58 % of the participants had used at least one type of CAM, and 79 % of the students had used at least one herbal substance in the past 12 months. A hierarchical regression determined that increased age, female gender, flu-like symptoms, musculoskeletal symptoms, pseudoneurological symptoms, and modern health worries were significantly related to students' CAM use.

Ethnicity and use of alternative products in psychiatric patients.: Psychosomatics. 2006 Sep-Oct;47(5):408-13 Authors: Ng B, Camacho A, Simmons A, Matthews SC
The use of herbal and natural products for medical purposes is common in all human civilizations, and use in Western societies has grown considerably in recent years. However, differences in usage patterns between different ethnic groups are yet to be delineated. The current study examined the frequency and type of complementary/alternative medications used by a sample of 453 rural psychiatric outpatients of two different ethnic groups. The products were classified as "natural" (herbal products requiring some preparation before consumption) and "processed" (products in "ready-to-use" form). There were significant ethnic differences in usage patterns of the various preparations: Hispanics, relative to Caucasians, were twice as likely to use natural products, whereas Caucasians were more likely than Hispanics to use processed products. The symptoms addressed were predominantly psychiatric, with natural products, and nonpsychiatric, with processed products. These results may increase awareness among healthcare providers regarding the usage frequency of such complementary/alternative medications products and the different usage patterns across ethnic groups.

Herbal medicine and anesthesia.: Curr Opin Anaesthesiol. 2001 Dec;14(6):667-9 Authors: Dorman T
Unfortunately little is understood about many of the interactions that can occur and as many as 50% of the patients do not inform their health care providers about these complementary and alternative therapies. The interactions that are most important in the perioperative period include sympathomimetic, sedative, and coagulopathic effects.

Evidence for the use of nutritional supplements and herbal medicines in common eye diseases.: Am J Ophthalmol. 2006 Jan; 141(1): 157-66 West AL, Oren GA, Moroi SE
CONCLUSION: Because of the widespread use of nutritional supplements and herbal medicines, ophthalmologists should be aware of their use so that they can inform patients properly when the supplements and herbal medicine are being used for eye disease.

Epidemiology of insomnia: Prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors.: Sleep Med. 2006 Feb 1; Authors: Morin CM, Leblanc M, Daley M, Gregoire JP, Mérette C
CONCLUSIONS: These findings confirm the high prevalence of insomnia in the general population. While few insomnia sufferers seek professional consultations, many individuals initiate self-help treatments, particularly when daytime impairments such as fatigue become more noticeable. Improved knowledge of the determinants of help-seeking behaviors could guide the development of effective public health prevention and intervention programs to promote healthy sleep.

The Sh-h-h-h Project: nonpharmacological interventions.: Holist Nurs Pract. 2005 Nov-Dec;19(6):263-6 Authors: Robinson SB, Weitzel T, Henderson L
Promoting rest and sleep is integral to the profession of nursing. The Sh-h-h-h Project, a nonpharmacological program designed to enhance rest and sleep, was implemented on a hospital medical unit. Nursing assistants provided patients with various modalities to improve sleep, including back rubs, warm drinks, blankets warmed in a blanket warmer, aromatherapy, relaxation music, and earplugs. Additional interventions were taken to reduce noise. The outcomes of the Sh-h-h-h Project are reported here, with patients indicating improved sleep quality and quantity.


The role of complementary and alternative therapies in cardiac rehabilitation: a systematic evaluation.: Eur J Cardiovasc Prev Rehabil. 2006 Feb;13(1):3-9 Authors: Arthur HM, Patterson C, Stone JA
CONCLUSIONS: Some complementary and alternative medicine therapies hold promise for patients in cardiac rehabilitation. Further research is essential, however, in all areas of complementary and alternative medicine to confirm its usefulness as an adjunct to cardiac rehabilitation.

Differences Between Herbal and Nonherbal Users in Dental Practice.: J Dent Hyg. 2006;80(1):10 Authors: Tam KK, Gadbury-Amyot CC, Cobb CM, Williams KB
RESULTS: Eighty participants (54%) reported using some form of herbs. They were characterized as mostly female (71%), who were less likely to disclose herbal usage to practitioners (p< .05), believed in herbal effectiveness (p< .05), and reported a more positive perceived level of health status compared to nonusers (p= .02). Although herb users reported a willingness to disclose use of herbs to health practitioners, only three patients had any written documentation of their herb use in their medical/dental health chart (p= .0001). Fifty-five herb users were also taking prescription drugs (69%) that could potentially lead to herb-drug interactions. CONCLUSION: The findings provide supportive evidence that dental hygiene practitioners need to be aware of their patients' use of herbs. Knowing potential risks, side effects, and possible drug interactions is necessary for patient management and each patient's oral health.

My conclusions: Some key patterns seem to be emerging from the analyses done around herbal and "alternative" medicine use and how it interfaces with the modern medical establishment. As the studies above indicate, many different specialties have "uncovered" evidence of herbal use by their patients: dentists, opthalmologists, cardiologists, anesthesiologists as well as general practitioners and nurses. Well over 50% of patients seem to be using some form of "alternative" medicine (which begs the question - is it really "alternative"?). More women than men are reporting its use. Certain ethnicities seem to also be more likely to report its use. Overall, doctors are strongly encouraged to learn more about these therapies (call your local herbalist would be my first suggestion!). And finally, these therapies seem to be offering some real help, often with many fewer side effects.

One final paper, presented by a group of nurses from Brazil, shows some amazing insights that I believe apply equally to health care here in the United States. It delves into some thorny issues relating to the use of herbs in nursing practice, and its conclusions show a great deal of empathy, intelligence, and heart. I recommend it as inspiring reading - even though the spectre of legal repercussions looms large.

The use of medicinal plants as a therapeutical resource: from the influences of the professional formation to the ethical and legal implications of its applicability as an extension of nursing care practice.: Rev Lat Am Enfermagem. 2006 May-Jun; 14(3): 316-23 Alvim NA, Ferreira Mde A, Cabral IE, de Almeida Filho AJ

Chocolate flavonoids and cholesterol

Chocolate (Theobroma cacao) has had a long history of scientific inquiry highlighting its extensive cariovascular benefits, from reducing blood lipids and bad cholesterol while raising good cholesterol (1, 2) to improving endothelial integritiy in blood vessels (1), even reducing inflammation and improving cardiovascular tone and platelet function in smokers (1). To say nothing about the effect of theophylline (a major alkaloid present in dark chocolate) and its effects on asthma and airway inflammation, where it can be a lifesaving remedy; or its effects on mood and well-being.
A new study has reinforced the idea that chocolate's flavonoid content has a beneficial effect on serum lipids and bad cholesterol, helping reduce LDL by over 7% (that's 17 points for someone at 250 total cholesterol - read the review at the American Botanical Council). This continues to be great news for a chocolate-lover like myself. However, some important points bear mention:

• Dark chocolate is the only way to go. All studies find that flavonoid concentration in dark chocolate is much higher.
• Cocoa butter is not great in huge quantities, so I generally use cocoa powder (Green and Black's organic criollo is my favorite by far). The daily dose is between 2 and 4 tablespoons.
• Large amounts of sugar are also not too helpful. Again, a reason to use cocoa powder instead of sweetened bars.

So, a quick recipe for a great chocolate drink:
1 to 1 and 1/2 TBS dark cocoa powder
1 TBS milk, or almond, rice, or soy milk
1 tsp honey
a pinch of cayenne

mix cocoa and milk until a nice paste is formed. Add hot water (to about 12 oz), stir in some honey, and a pinch of cayenne to taste. Excellent!

Black Cohosh in the news

A new study came out a few days ago that finds 160mg of powdered Black Cohosh (Cimicifuga / Actaea racemosa) root daily is ineffective for hot flash symptoms in peri- or post-menopausal women aged 45-55. And, or course, the media frenzy ensues: a quick Google News search reveals almost 400 reports with various defaming titles all claiming to show "proof" that this herb has no effect (my favorite: "Black Cohosh a Flash in the Pan for Menopause Symptoms". Who comes up with these amazing witticisms?)
A closer look at the study itself reveals a few interesting facts:

• The material used: powdered herb (root, I most certainly hope, although even this is unclear). This is in contrast to the multiple studies (see below) that demonstrated Black Cohosh's effectiveness for the vasomotor symptoms associated with perimenopause: most of the previous research focused on hydroalcoholic extracts of the root, not powdered root.
• The dose: 160mg (solo) to 200mg (in combination) daily, barely 1/5 of a gram. If an herbalist told me they were using this dose to help control hot flashes in one of their clients, I'd tell them to go back and study their phytopharmacology. Bottom line: this is a ridiculously small dose compared not only to previous modern research, but also to the tried-and-true experience of Eclectic physicians (see King's dispensatory) who recommend 1/2 to 2 drams (about 2 to 8 fluid ounces) of a 1:1 fluid extract, equivalent to about 2-8 grams (2,000mg to 8,000mg) of raw plant material! Who's doing the research for this new study? Where did they come up with the 160mg daily dose?
• Although the study author kindly comments that "the trials did not simulate the whole person approach used by naturopathic physicians", this study doesn't even make an attempt to classify the types of women in the treatment group (other than by age and whether they were peri- or post-menopausal). Many other studies are more comprehensive in their analyses, and find that women with "excess estrogen" patterns earlier in life (defined by menstrual history and/or estrogen-dependent breast cancer) benefit much more from this botanical. Its weak estrogen receptor antagonism and its ability to block LH have been hypothesized as possible mechanisms of action (see studies below).
  

So in sum, another poorly-designed clinical trial receievs undue media hype. I will most certainly continue to grow and use Black Cohosh in my practice (and not only for hot flashes, which isn't even its most beneficial application). A couple of studies (one from Europe, the other from the Mayo clinic) are included below for further reading.

Hungary
Mayo

Animal models have some serious flaws

Medical research, whether focused on pharmaceutical or herbal medicines, often makes use of animal models in the initial phases of study. For many herbal remedies, animal studies are the only data (other than, of course, thousands of years of traditional and experiential knowledge) available to the scientific community, and often these data are used to dismiss phytomedicines as ineffective. In an article in the British Journal of Medicine, researchers identify potential shortcomings of the animal model in drug trials. It comes down to two main conclusions: first, animal studies are often methodologically flawed (not sure why this is, perhaps people pay less attention if only little mice are involved). Second, the animal model has serious predictive deficits and very often has no relevance to actual human therapeutics.
We can speculate endlessly as to why this may be. An interesting thought comes from the European Journal of Cancer: perhaps mice that are genetically engineered to produce "research cancers" exhibit tumors that are substantially different in morphology and behavior from those that develop slowly and naturally in humans (or in pet dogs, as was the focus of this study). These differences may account for the discrepancy between the artificial models and actual human beings. But regardless of the "why", the bottom line remains a challenge to the established phase I, II, III drug trial model. It should also be food for thought for herbalists who are relying on animal models for therapeutic data. And perhaps, if this challenge remains relevant, the entire medical community can start to think about different research strategies that don't involve torturing and killing animals...

The cholesterol conundrum

Pfizer has halted clinical trials of its new cholesterol medication, which was designed to increase HDL ("good") cholesterol levels in human blood. The hope: to get everyone on the planet to take a statin/torcetrapib combination and get everyone's cholesterol numbers into a "happy" testing range. Turns out the torcetrapib actually increases one's chances of dying. So Pfizer pulled the plug (at least they had the decency to do that, unlike Merck's Vioxx fiasco).
I have two main problems with the line of research pharmaceutical companies are pursuing regarding cholesterol. First off, why not consider a combination of herbal therapies, perhaps featuring Fenugreek (Trigonella faenum-graecum) along with other botanicals, which have not only been proven to lower LDL cholesterol, raise HDL, but also manage blood sugar, improve and soothe digestive function, and actually enhance life? Lack of patentability would be my first guess.
Secondly, the whole approach of attempting to alter serum levels of cholesterol and their lipoprotein packages seems like "teaching to the test" rather than trying to improve final outcomes. Sure, high cholesterol levels seem to be present when there is dangerous heart disease. But I haven't yet found conclusive evidence that there is a causal relationship between the two, and I am beginning to suspect that underlying cardiovascular inflammation is at the root of both conditions. It would seem that devising new drugs that are specific only for improving your cholesterol numbers on a blood test misses the point and can, apperently, be quite dangerous. My humble suggestion: if you and/or your doctor are concerned about high cholesterol levels, consider herbal therapy alongside nutritional intervention. There's a great track record out there, with no increased mortality risk.

Antibiotics overprescribed in bronchitis

The inflammation of the respiratory and lung passages known as bronchitis is most often (at least 70% of the time) caused by a lingering viral infection. Antibiotics are useless for this condition, and may in fact cause harm, even though they are administered in over 80% of the cases of bronchitis that present clinically. These are the conclusions of Drs. Wenzel and Fowler, as reported in a clinical vignette published in the New England Journal of Medicine.
While bacterial bronchitis is certainly a possibility, and bacterial pneumonia (which can sometimes be a complication of untreated respiratory infections) certainly warrants aggressive treatment, it is ridiculous to jump right in with antibiotic treatment in most cases. So what is left? Watch and wait, according to modern medicine. And while I applaud the recent cautions concerning antibiotic use (aviod for ear infections; aviod for respiratory infections), and recognize the healthy fear antibiotic resistance has engendered in the medical community (finally! it only took 50 years), I cannot condone a "watch and wait" attitude, and that is not the strategy in my practice.
This is a perfect example of how a complementary therapy like herbalism, when integrated intelligently into the holistic picture of patient care, can contribute significantly to improved outcomes. Our strategies: boost immunity, encourage the natural eliminative function of the lungs and respiratory system, and guard against opportunistic infection. All of these goals are extremely amenable to herbal intervention, and the results are there (both empirically and as part of clinical trials) to prove it. Why can't all primary care providers take the road many are following, and suggest the advice of a competent herbalist for chronic or lingering bronchitis, rather than simply sending their patients away (or even worse, giving them a harmful treatment out of ignorance)?

So I agree: antibiotics are harmful in most cases of bronchitis. Leave your doctor's office, and go straight to your local herbalist to learn how to take care of yourself using plants that, very possibly, are growing in your garden or back yard.

Ginkgo and Alzheimer's

The leaves of Ginkgo biloba have an extensive reasearch history behind them, although their therapeutic use is fairly recent. Though many claims have been made about this ancient tree (mostly relating to memory, energy, mental function), there are some clear indications and effects that almost everyone agrees on: first, ginkgo increases circulation; second, it has a marked antioxidant and cell-protective effect; third, it influences biochemical mechanisms in the blood resulting in an net reduction of clotting power.
Recently, based primarily on the first two facts listed above, researchers have been focusing on ginkgo's use in treating Alzheimer's-related dementia. A trial released in 2004 showed promising results and began to elucidate some of the mechanisms in the brain (relating to neurotransmitter activity and the reduction of protein tangles) that contributed to its positive effect. Now, a new trial in the European Journal of Neurology (those Europeans, always messing around with herbs...) confirms the previous results and lends more credence to ginkgo as a good treament for slowing the progress of Alzheimer's disease. It also reinforces the idea that ginkgo has the effect of increasing ACh (acetylcholine, an important neurotransmitter in the brain and body) sensitivity, and is much better tolerated than the prescription drugs that are currently used.

What is "Yang"?

When speaking in terms of herbal "energetics", there are many classifications that can be used. These are helpful in defining herbal actions because they addresss the plant remedy from a holistic point of view, giving a broader "feel" of the herb's medicinal virtues. Sometimes (though not always), these classifications bear a striking connection to physical / biochemical characteristics - for instance, "yin" herbs tend to be more cooling, soothing, demulcent and rich in mucilage; "blood (xue) tonic" herbs may have a good supply of iron, or serve to increase erythropoiesis. Recently, an interesting study out of Hong Kong highlighted a potential biochemical connection to the energetic idea of "yang", always associated with warmth, increased vitality, and energy.
A systematic review of some "yang" botanicals showed that they invariably increase mitochondrial ATP-generating capacity. Deep inside our cells, the mitochondria create a proton gradient between two membranes by moving electrons through the electron-transport-cycle. This gradient is used to drive a transmembrane protein, ATP-synthase, which attaches a phosphate group to spent ADP, renewing its energy-generating ability. The protons can also move back down the gradient through "leak" channels, akin to a short-circuit, instead of through the ATP synthase protein. This has the net effect of generating warmth, and serves as a basic temperature-regulating mechanism for the body. So, it seems, "yang" herbs do in fact increase energy, vitality and warmth. But, as chinese medicine rightly points out, they might be contraindicated in severely depleted conditions (can't stoke the furnace without enough fuel) or in highly overheated, overstimulated conditions (obviously).

File this under the "science finally catches up" category.

Saffron Crocus and Depression

Crocus sativus, best known for its stigma and pollen (source of saffron, perhaps the most expensive spice in the world), has traditionally been linked to various medicinal effects, depending on the part used: from mood enhancement of the saffron itself, to the treatment of gout with the alkaloid colchinine found in its underground bulb. A very recent (6/06) study from Iran evaluated the use of the petals of this wonderful fall-blooming flower to determine its use in a small sample (n=40) of individuals who me the diagnostic criteria for mild to moderate depression. The results: "At 6 weeks, petal of C. sativus produced a significantly better outcome on Hamilton Depression Rating Scale than placebo (d.f.=1, F=16.87, p<0.001). There were no significant differences in the two groups in terms of observed side effects. The results of this study indicate the efficacy of petal of C. sativus in the treatment of mild-to-moderate depression".
The authors recommend additional research, and larger-scale trials. I fully agree!
What is most interesting to me about this study is the fact that the petals of the crocus were used, rather than the more commonly studied (and way more expensive) stigmas. The researchers used capsules filled with the powdered petals, but pending some additional pharmacological research, I would tentatively say that the traditional hydroalcoholic tincture might be equally, and perhaps more, effective. Nevertheless, this presents a sustainable, affordable, effective, beautiful, and easy-to-grow option for mild to moderate depression.
Full abstract from Phytomedicine.

Cannabinoids mellow out a spastic colon

Our bodies are riddled with receptors for the class of molecules, known as cannabinoids, that are found in large concentrations in marijuana. While it may be that our own endogenous anandamide-like substances are the reason for the presence of these receptors, it seems that in the plant world marijuana is the only source of cannabinoids we have available. Co-evolution, anyone?
Regardless, a preliminary investigation by Michael Camilleri, M.D. (Mayo Clinic), who has spent the last decade researching drugs, neurotransmitters, receptors and pharmacological pathways involved in irritable bowel syndrome and other spasmodic conditions of the lower bowel, shows promise for using cannabinoid receptors in the gut to help modulate these distressing conditions. Doctor Camilleri's plan: feed folks with sensitive digestive systems over a pint of chocolate milkshake after giving them a pill of Marinol, a synthetic THC (tetra-hydro-cannabinol). Without getting into what a pint of chocolate milkshake would do to me (or anyone really) if taken on an empty stomach, and whether that represents cruel and unusual punishment for someone with colitis or irritable bowel, it seems that the synthetic cannabinoid is one of the most effective remedies the good doctor has ever seen for the cramping and pain people experience after pounding said milkshake. The next step: back to the lab, to find a synthetic cannabinoid that "does not have psychoactive properties".
If you ask me, that seems like a time-consuming, expensive proposition. Over and over, folks who have used cannabinoids as medicine (for glaucoma, wasting syndrome, chemo-induced nausea, and bowel trouble) complain that the pharmaceuticals are not as effective as a crude, inhalable folk-preparation of the marijuana plant (a.k.a. "the joint"). One puff may not be psychoactive, but it still seems to be quite medicinal if you trust the reports of those who have tried. But the feds might not appreciate that (nor the pharmaceutical companies, for that matter). And we all know the best way to fund research is to come up with a good, actionable, patentable pharmaceutical, not some devil-weed - regardless how cheap, accessible, or useful it may be.

Kava-Kava doesn't seem to be liver-toxic at all.

Kava (Piper methysticum) has long been used in Polynesia as a relaxing beverage, made from the fresh roots in communal settings with the intention of promoting conviviality, community, and peace. While there are some anectdotal reports on long-term abuse leading to "kava skin" (patchy, scaly eruptions that disappear after kava is withdrawn), this plant was always considered safe until 2002, when Germany and other European countries banned its use after liver failure in a patient who had a history of liver disease grossly abused a strong Kava extract and died from liver failure (maybe we should ban whiskey too).
Anyway, in a study that just came out in Phytomedicine, we see interesting new information that, in animal models, doses of kava given daily don't seem to have any toxicity at all, even when administered for long periods of time. This seems to corroborate traditional info. Hopefully it will have an impact in Europe where the use of kava, a potent anxiolytic and relaxant, is still shunned after the 2002 decision.