Phytotherapy and Herbal Medicine

• Phytotherapy, also known as herbal medicine, uses plant-derived substances to treat and prevent illnesses.
• Herbs and botanicals include plant leaves, flowers, or roots.

Herbal Supplement Facts

• Herbs have been used for thousands of years.
• Herbal supplements are available without a prescription and may include function claims.
• Function claims describe a nutrient's or dietary ingredient's role in affecting the normal structure or function of the human body.
• There is no data suggesting herbs are more beneficial than conventional drugs.
• "Natural" products are not always safe and can have drug-like effects.
• Herbal supplements do not require the same strict FDA testing as over-the-counter (OTC) and prescription medicines.
• For many botanical products, the active ingredients and mode of action have been identified, while others are still being researched.
• Botanical medicine can be investigated through double-blind, placebo-controlled clinical trials, similar to prescription drugs.

Botanical Formulations

• Bulk herbs, beverages, extracts, and pills are different forms of botanical formulations.
• Under current regulations, topical applications of botanicals and/or nutrients in creams or essential oils are not classified as dietary supplements.

Regulation of Herbals

• Herbals and botanicals are sold as dietary supplements, with different regulations than pharmaceutical drugs.
• The FDA does not test herbs for safety or efficacy.
• The Dietary Supplement Health and Education Act of 1994 (DSHEA) clarifies marketing regulations for botanicals, reclassifying them as dietary supplements distinct from food or drugs.
• Claims about prevention or cure of specific conditions are prohibited; for example, manufacturers cannot claim a dietary supplement "prevents heart disease".
• All products must display the disclaimer: "This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease", therefore it is consumer's responsibility to educate themselves.
• In Europe, especially Germany, botanicals are considered drugs and are prescribed by physicians and dispensed by pharmacists.

Problems Reported Since DSHEA Passage

• Misrepresentation of product contents
• Varying recommended dosages
• Inadequate information on sourcing and processing
• Poor quality standards for safety and ingredient activity
• Governments and industries are developing high-quality manufacturing guidelines (Good Manufacturing Practices or GMP) for all dietary supplements, including botanical products.

Classification of Herbs

• The American Herbal Products Association has developed a helpful safety rating classification.
• Class 1 herbs can be safely consumed when used appropriately.
• Class 2 herbs have use restrictions, unless otherwise directed by an expert.
• Class 2a herbs are for external use only.
• Class 2b herbs are not to be used during pregnancy.
• Class 2c herbs are not to be used while nursing.
• Class 2d herbs have other specific use restrictions.
• Class 3 herbs require labeling with the statement: "To be used only under the supervision of an expert qualified in the appropriate use of this substance."
• Class 4 herbs have insufficient data available for classification.

Commonly Used Herbs

• Echinacea
• Garlic
• Ginger
• Ginkgo
• Ginseng
• Hawthorn
• Milk Thistle
• Saw Palmetto
• St. John's Wort
• Valerian

Echinacea (حشيشة القنفذ الأرجوانية)

• Source: Purple flower.
• Indication: Prevents or moderates cold and flu symptoms and chronic upper respiratory tract infections.
• Action: Has immune-stimulating activity due to high and low molecular weight flavonoids and caffeic acid derivatives.
• Cautions: Should be avoided by those taking immunosuppressive drugs and should not be used frequently
• Class 1 botanical.
• Echinacea stimulates the immune system and is a low-risk, effective alternative to cold medicines.
• Studies proving this used echinacea concentrate, not echinacea sold in stores.
• Store-bought echinacea may lack potency, and supplements may contain additional substances.
• Contains a complex mix of antimicrobial active substances with human immune system properties
• Controls the activity of a range of enzymes and cell receptors, protecting the plant from infections and UV radiation damage, and has antioxidant properties
• Contains alkyl-amides which have an effect on the immune system.

Garlic (الثوم)

• Source: Garlic plant (Allium genus, closely related to onion).
• Indication: Treats hyperlipidemia, hypertension, and bacterial, fungal, and viral infections.
• Action: Chewing or crushing garlic activates sulfur-containing compounds.
• Modest reduction in blood pressure and cholesterol levels
• Inhibition of blood clot formation and smooth muscle relaxation
• Cautions: More than five cloves may cause heartburn, mild allergic reactions, and GI symptoms.
• There can be interaction when using aspirin or other anticoagulant drugs
• Alliin is a sulfoxide and a natural constituent of fresh garlic
• Alliinase converts alliin into allicin when fresh garlic is crushed
• antioxidant and hydroxyl radical-scavenging properties contained within alliin.
• Allicin is responsible for the aroma of fresh garlic.
• Alliin affects immune responses in blood.
• Alliin was the first natural product found to have both carbon- and sulfur-centered stereochemistry.
• Short-term heating reduces the anti-inflammatory effects of fresh raw garlic extracts.

Ginger (الزنجبيل)

• Source: Ginger plant, Zingiberaceae family.
• Part Used: Tuberous rhizome (rootstock), cleaned, freed from the outer layer of cork, and dried in the sun.
• Contains aromatic essential oils and non-volatile pungent substances (gingerols and shogaol).
• Class 1 botanical.
• Cautions: Increases bleeding risk when combined with blood-thinning agents. May interfere with blood pressure and blood sugar regulating medication
• Benefits: Relieves gastrointestinal (GI) irritation, stimulates saliva and bile production, and suppresses gastric contractions, helping prevent colon cancer and constipation.
• Nausea: Chewing raw ginger or drinking ginger tea is a common home remedy for nausea during cancer treatment.
• Takes ginger for motion sickness seems to reduce feelings of nausea, but it does not appear to prevent vomiting.
• Pain reduction: reduces muscle pain, and symptoms of dysmenorrhea
• Inflammation: been found to be "modestly efficacious and reasonably safe" for treating inflammation associated with osteoarthritis.
• Cardiovascular health.

Ginkgo (الجنة)

• Source: Ginkgo tree - Ginkgo biloba L.
• Part Used: Dried leaves.
• Ginkgo leaves contain flavonoids, diterpenlactone (ginkgolides), and bilobalide (ginkgolic).
• Indication: treats age-related mental decline and Alzheimer's.
• Action: Antioxidant activity against free radical damage and increased blood flow improving circulation.
• Cautions: Should not be combined with blood thinning medications or supplementations, interferes with diabetes medication.
• Should not be used during pregnancy and breast-feeding ginkgo should not be used without consulting the doctor

Ginseng (الجنسنج)

• Source: Slow-growing plant that takes at least 6 years to grow.
• Indication: Helps the body cope with stress, improves energy levels and circulation, and treats fatigue.
• Action: Affects blood pressure and has mild action on the central nervous system.
• Caution: Concurrent intake with caffeine may cause overstimulation and GI distress.
• Affects blood sugar/pressure, interferes with blood coagulation and affects the heart rate.
• Class 2d botanical.

Hawthorn (الزعرور البري)

• Source: Hawthorn tree (leaves, berries, and blossoms).
• Indication: Improves blood flow in circulatory disorders, heart failure, and heartbeat.
• Action: dilates coronary vessels to lower blood pressure, metabolic processes and increases nerve conductivity and heart muscle contractility.
• Cautions: Should consult healthcare provider, there are side effects are rare, although no adverse reactions with medication, caution when combining with cardio active drugs, blood pressure lowering medication or supplementation.
• Class 1 botanical.

Milk Thistle (حرشف بري عكوب أو شوك اللبن)

• Source: Tall plant with prickly leaves and milky sap.
• Indication: Treats mild to moderate liver disease and lower fat deposit in the liver.
• Action: Protects hepatocytes from toxins and increases liver cell regeneration from protein synthesis.
• Cautions: Has a mild laxative effect in the first few days and may reduce the activity of drug-metabolizing enzymes in the intestine and liver.
• Class 1 botanical.

Turmeric (curcuma domestica)

• Botanical name: Curcuma longa L.
• Part used: Dried rhizomes.
• Ingredients: The rhizomes of Curcuma contain spicy curcuminoids (Dicinnamoyl methane derivate), curcumin (yellow pigments), and essential oils.
• Indication: treats liver disorder and inflammatory conditions.
• Action: Anti-inflammatory, free radical scavenger, and cyclooxygenase inhibitor
• Cautions: Should not be taken with bile obstruction or inflammation of a bile, gall stones or gall bladder and liver disease patient.
• There are still no studies on the safety during pregnancy and breastfeeding as well as for use in children and adolescents under 18 years old.

Willow Bark (الصفصاف)

• Name: Willow - Salix L.
• Part used: Dried bark of young branches in the second or third year.
• Ingredients: Contains salicylic acid derivatives (salicylates), caffeic acid derivatives and flavonoids.
• Indication: treats chronic forms of muscle pain, rheumatoid fever and headache.
• Action: Works due to phenolic glycoside (Salicin) content.
• Cautions: Do not take with hypersensitivity to salicylates (e.g. aspirin) and anti-inflammatory drugs; People with asthma, gastrointestinal ulcers or renal or liver function problems should only use it after consulting a doctor.
• Has not been recommended for patients during pregnancy or breastfeeding as salicylates penetrate the placenta and enter the breast milk & not to be used for children and adolescents under 18 years old should first consult a doctor.

Saw Palmetto (عشب المنشار)

• Source: Saw palmetto palm tree.
• Indication: Reduces the incidence of benign prostatic hyperplasia.
• Action: This extract inhibit 5-a-reductase (the enzyme which catalyzes the conversion of testosterone to dihydrotestosterone)
• Cautions: Contains phytoestrogens that mimic effects of the animal hormone estrogen and can interfere with estrogen therapy, progesterone therapy, and oral contraceptives.
• Class 1 botanical.

St. John's Wort (عشبة القديس يوحنا)

• Source: Small yellow flowers.
• Indication: Treats Mild to moderate depression.
• Ingredients: hyperforin and hypericin and pseudo hypericin.
• Action: inhibits the reuptake of neurotransmitters (serotonin and norepinephrine).
• Cautions: Not to be used for Oral contraceptives or LDL cholesterol patients.
• Class 2d botanical.
• St. John's Wort has been proven to alleviates symptoms including lack of activity, tiredness, fatigue, and disturbed sleep.
• Has been associated with negative side effects, like gastrointestinal irritations, allergic reactions, and restlessness.
• St. John's Wort has not been tested for its long term safety.
• Interaction with oral contraceptives effects the pharmacokinetics of norethindrone and ethinyl estradiol, ovarian activity and breakthrough bleeding.
• Women on OCs should be cautioned that St. John's Wort might interfere with contraceptive effectiveness.
• Can reduce Rosuvastatin efficacy.

Valerian (الناردين)

• Source: White and red flowers.
• Indication: Sleep aid, treats anxiety, and insomnia.
• Action: Binds to receptor sites & depress central nervous system activity.
• Cautions: No side effects if used at the recommendations level.
• Class 1 botanical.

Recommended Discontinuation Times of Dietary Supplements Before Surgery

• Important to discuss dietary supplement use with health care professionals before surgery.
• Echinacea Insufficient data
• Garlic >7 days
• Gingko >36 hours
• Ginseng >7 days
• Kava >24 hours
• St. John's wort >5 days
• Valerian Insufficient data

FDA Warning on Herbs

• Certain herbs are considered toxic and should be avoided including the following:
• Chapparal: Causes irreversible liver damage
• Comfrey: Causes liver toxicity, carcinogenic effects, and damage to the fetus if used during pregnancy
• Ephedra: Results in hypertension, myocardial infarction (MI), seizure, stroke, psychosis, leads to 155 deaths and over 16,000 side effects
• Germander: Results in liver damage and death
• Kava: Liver damage, especially risky for those with liver problems
• Lobelia: Causes breathing problems, rapid heartbeat, low blood pressure, coma, or death
• Willow bark: Causes Reye's syndrome in children and allergic reactions in adults
• Wormwood: Causes seizures, numbness of limbs, delirium, and kidney failure
• Yohimbe: Causes hypotension (low blood pressure), heart conduction disorders, kidney disorders, nervous system disorders, and death.