Herbal and Alternative Medicine [PPC404] Lectures 4,5-edit PDF

Herbal and Alternative Medicine [PPC404] Dr. Marwa Saeed Galaa Goda | PhD Lecturer of Pharmacognosy, Faculty of Pharmacy, GU [email protected] Syllabus...

Herbal and Alternative Medicine [PPC404] Dr. Marwa Saeed Galaa Goda | PhD Lecturer of Pharmacognosy, Faculty of Pharmacy, GU [email protected] Syllabus Week Lecture 1st week: 28/9/2024 Advising & registration. 2nd week: 5/10/2024 Introduction: Complementary medicine (CAM) versus Conventional medicine. 3rd week: 12/10/2024 CAM: Domains of complementary and alternative medicine. 4th week: 19/10/2024 CAM: Cont. Domains of CAM & Regulation of CAM. 5th week: 26/10/2024 Phytomedicine: Herbal medicine for GIT disorders. 6th week: 2/11/2024 Phytomedicine: Cont. herbal medicine for GIT disorders. 7th week: 9/11/2024 Phytomedicine: Cont. herbal medicine for GIT disorders. Day 8th week: 16/11/2024 Midterm Exam 9th week: 23/11/2024 Phytomedicine: Herbal medicine for respiratory tract & cardiovascular disorders. 10th week: 30/11/2024 Phytomedicine:. Herbal medicine for endocrine and metabolic disorders. 11th week: 7/12/2024 Phytomedicine: Herbal medicine for musculoskeletal disorders. 12th week: 14/12/2024 Phytomedicine: Herbal medicine for urinary tract and reproductive system disorders. ASU lecture: Nutrition change the world/ Plant –based diet. 13th week: 21/12/2024 Student presentations I 14th week: 28/12/2024 Student presentations II 15th week: 4/1/2025 Final Exam  Learning Outcomes (LOs) K1. Define complementary and alternative medical practices and relate them to conventional medicine. K2. State the beliefs and techniques associated with the various complementary and Domain 1: alternative medical practices. Fundamental K3. Demonstrate the regulations concerning CAM practices. knowledge K4. Outline herbal approaches for certain pathological diseases. K5. Describe the active constituents, mechanisms of action, contraindications and side effects of herbal drugs. S1. Categorize herbal drugs and their use in the treatment of ailments in the different body Domain 2: systems. Professional and S2. Rationalize a certain prescription with detailed patient information regarding possible side ethical practice effects, precautions, and possible drug/herb or herb/herb interactions to promote the health of the patients C1. Develop team-working ability through group projects. Domain 4: C2. Demonstrate time-management and presentation skills. Personal practice C3. Use computer technology to get relevant information.  Phytotherapy or phytomedicine Herbal medicine for GIT disorders Herbal medicine for respiratory disorders Herbal medicine for endocrine and metabolic disorders Herbal medicine for urinary tract disorders Herbal medicine for musculoskeletal disorders Herbal medicine for reproductive system disorders Herbal medicine for cardiovascular system disorders - Herbal medicine for GIT disorders  Organs of the gastrointestinal tract (GIT) or the digestive system 7   GIT or gastro-intestinal disorders Oral cavity Stomach and intestinal Liver and biliary tract disorders disorders disorders Glossitis Gastritis & peptic ulcer Acute liver disorders Constipation Gingivitis Intestinal worms Chronic liver disorders Kinetosis Stomatitis Liver cirrhosis Hemorrhoids Irritable bowel Jaundice syndrome (IBS) Diarrhea Flatulence Dyspepsia 8  1. Oral cavity disorders 1. Stomatitis (oral mucositis)  Inflammation in the tissue lining the mouth or lips.  The most common types are cold sores and canker sores.  Cold sores (also known as Fever blisters) are painful fluid-filled sores that form on the outside of the mouth around the lips. Fever blisters are caused by the Herpes simplex virus (HSV) and spread through personal contact. HSV is not curable as medicines can reduce symptoms (usually heal in 1 or 2 weeks) but can't cure the infection. Other triggers include: feverish illnesses, like influenza (flu).  Canker sores are painful white or yellow sores that only form inside the mouth, usually on the insides of the cheeks or lips. They are triggered by emotional stress, dietary deficiencies, menstrual periods, hormonal changes, or acidic food. Even without treatment, canker sores usually go away within two weeks. 9  1. Oral cavity disorders 2. Gingivitis  Inflammation of the gum tissue.  Common symptoms include red, swollen, and bleeding gums.  Gingivitis is caused by bacteria.  Risk factors: poor oral care habits, smoking, diabetes, aging, vitamin C deficiency, dry mouth, hormonal change (pregnancy) or genetics. 3. Glossitis  Inflammation of the tongue (i.e. swollen or inflamed tongue).  It is caused by dry mouth, allergic reaction, or infection. 10  1. Oral cavity disorders Saliva is composed of water, mucus, proteins, mineral salts, and amylase at neutral pH, between 6.7 and 7.4. Saliva lubricates the mouth and throat, aids in swallowing and digestion, and shields teeth from cavity-causing bacteria. Therefore, decreased saliva secretion (as in cases of fever, mild diabetes, excessive perspiration, and belladonna intoxication) leads to stomatitis, gingivitis, and glossitis. Stomatics are medicines which treat infection and irritation in the oral cavity. 11 1. Oral cavity disorders Stomatic plants are a number of herbal medicines that may be useful against oral infections, irritations, and ulcers, e.g. Herbal medicine containing: - Essential oils: Plants having essential oils display antimicrobial activity. For examples: Anise fruit, German chamomile flower, Clove flower buds, Mentha herb, Thyme herb, Sage herb, Eucalyptus leaves, and Calendula/ Marigold flower (V.O. + mucilage). - Tannins: Plants having tannins show anti-inflammatory, antimicrobial, astringent (healing effect of oral ulcer), and demulcent properties. For examples: Rose petals (tannins+V.O.), Witch hazel bark and Oak bark. - Mucilage: Plants having high content of mucilage exhibit soothing/ demulcent effects. For examples: Linseed seed, Aloe gel of leaves and Marshmallow (Althea officinalis) root. 12 1. Oral cavity disorders Stomatic plants Menthol crystals Thymol crystals * Chamomile extract Menthol Menthol crystals Eugenol Thymol Chamomile extract * Eucalyptus oil Eugenol Clove oil * Calendula extract Methyl salicylate Eucalyptus oil Aloe sp. extract Sod. Hyaluronate * Eucalyptus, chamomile, and marigold have anti-inflammatory properties.  1. Oral cavity disorders Other stomatic plants used as mouth wash or gargle 1. Myrrh Oleo gum resin (17 % volatile oil, 40 % resin, and 61% gum). Volatile oil contains terpenes (sesquiterpenes), eugenol. It is used in treatment of mouth infections and sore throat due to its antiseptic and astringent properties. 2. Propolis Resinous dark material collected by honey bees from buds of certain plants (e.g. Populus). Propolis is used in construction of the bee hive and in preserving honey. Propolis has anti-inflammatory, antifungal, antiviral, antibacterial, and tissue regenerative properties. 14   GIT or gastro-intestinal disorders Oral cavity Stomach and intestinal Liver and biliary tract disorders disorders disorders Glossitis Gastritis & peptic ulcer Acute liver disorders Constipation Gingivitis Intestinal worms Chronic liver disorders Kinetosis Stomatitis Liver cirrhosis Hemorrhoids Irritable bowel Jaundice syndrome (IBS) Diarrhea Flatulence Dyspepsia 15 2. Stomach & intestinal disorders 2.1. Gastritis and peptic ulcer Gastritis means inflammation of the mucosa lining the stomach due to alcohol, spices, tobacco, bacteria (e.g. Helicobacter pylori), toxins and drugs such as NSAIDs like aspirin. Peptic ulcer means discrete mucosal damage or erosions (equal to or greater than 0.5 cm) of the stomach and or duodenum that is usually acidic and thus extremely painful. It affect about 10% of population. Symptoms: Some people may have no symptoms of an ulcer, but common symptoms include abdominal pain, nausea, vomiting, loss of appetite, weight loss, and in severe cases bleeding in the stomach or duodenum. 16 2. Stomach & intestinal disorders 2.1. Gastritis and peptic ulcer Treatment: Treatment of peptic ulcers is aimed to counteract aggressive factors or stimulate the mucosal defenses through - Eradication of H. pylori infection. - Reducing/neutralizing HCl using mild antacids, H2- receptor antagonsit (e.g. famotidine) or proton pump inhibitors (e.g. omeprazole) which has been proven to provide faster and more reliable healing than antacids. - Changes in life style: stop smoking, avoid coffee and alcohol, stop taking aspirin and take paracetamol instead. - Protective agents act as a physical barrier. 17 2. Stomach & intestinal disorders 2.1. Gastritis and peptic ulcer Herbal treatment of gastritis and peptic ulcer: - Antacids that neutralize gastric acid (HCl) e.g. sodium alginate (Gaviscon®; it is a cell wall component of marine brown algae), and Al. sucralfait (Gasrofait®; a semisynthetic form of sucrose of sugarcane). - Ulcer healing or Gastro-protective plants that may act through either elaboration of mucilage coating the mucosa and providing muco- protection from gastric acid & pepsin (Mucilaginous plants e.g. Marshmallow) OR enhancement of prostaglandin production and mucous cell proliferation e.g. Liquorice. - Bacteriostatic gum-resins that inhibit growth of H. pylori e.g. Olibanum 18  2. Stomach & intestinal disorders 2.1. Gastritis and peptic ulcer Liquorice Part used: Roots and rhizomes of Glycyrrhiza glabra. Liquorice was recommended by the Greeks to treat stomach ulcers and by Arab physicians to treat cough. It inhibits 15- hydroxyl prostaglandin dehydrogenase (the enzyme which metabolizes prostaglandin E2 to the inactive compound 15-Keto-prostaglandin) leading to increase of protective mucosa and cell proliferation of the gastric mucosa which leads to healing of ulcers. Carbenoxolone is a semisynthetic hydrogen succinate derivative of glycyrrhizinic acid (a constituent of liquorice) 19 2. Stomach & intestinal disorders 2.2. Constipation Constipation is a bowel dysfunction that makes bowel movements infrequent (Less than once in 2-3 days) or hard to pass a delayed transit of small stool volume (less than 50 g) a straining at the time of a bowel movement with expulsion of hard and dry stool accompanied by abdominal cramping and feeling of fullness. Etiology: 1) Poor dietary habits (low fiber content, low fluid intake) 2) Lack of physical activity 3) Over use of laxatives for many years 4) Pregnancy 20 2. Stomach & intestinal disorders 2.2. Constipation Herbal treatment Laxatives are medicines which are used in case of constipation to induce and facilitate defecation. Herbal laxatives are classified into 1. Stimulant or irritant laxatives: Most of them contain anthraquinones that act on mucosal cells &/or enteric nerves, thus affecting motility leading to laxative effect. They are the strongest laxatives that may cause muscle cramps as a main side effect and used in treatment of acute occasional constipation. E.g. senna, rhubarb, cascara and frangula. 21 2. Stomach & intestinal disorders 2.2. Constipation Herbal treatment 2. Bulk laxatives: They absorb water in intestine making the stool swell up into a soft, bulky mass, which is easier to pass. They are the safest laxative, so it is recommended for pregnant women. Similar actions are produced by psyllium seeds (psyllium husk) and bran. 3. Osmotic laxative: They act via osmotic effect that draws water into the bowel. They are the fastest laxatives. E.g. lactulose (a semisynthetic form of lactose) Sorbitol (Sorbit®), and glycerin suppository. 4. Lubricant laxative: E.g. Mineral oil (Olive oil) and glycerin 22 2. Stomach & intestinal disorders 2.3. Intestinal worms Examples of herbal anthelmintic Santonica flower: - Dried unexpanded flower heads of Artemisia cina, family: Compositae. - Sesquiterpene lactone bitters called santonin is very efficient against round worms (Ascaris). - Santonin affects vision causing "xanthopsia" (white objects look green, blue or yellow). It is generally used in combination with Digenic acid for its synergistic effect. - Santonin is fairly stable in air, however, it turns yellow on exposure to light whereby it gets converted into its isomeric form chromosantonin (photosantonin). The latter may be rated into santonin by simply crystallization from ethanol. “Photosantonin is inactive” that is why we use unexpanded santonica flower heads. 23 2. Stomach & intestinal disorders 2.3. Intestinal worms Examples of herbal anthelmintic Quassia wood: - Although its skeleton possesses 20 carbon atoms, quassin is not a diterpene but rather a triterpene, which derives from euphol by loss of 10 carbon atoms including C4. - Quassin bitter is anthelmintic against thread worms. Pomegranate bark: - Anthelmintic for tape worms (expels not kills). - Piperidine alkaloids (pelletierine, isopelletierine, methyl pelletierine, methyl isopelletierine and pseudo pelletierine). 24 2. Stomach & intestinal disorders 2.3. Intestinal worms Examples of herbal anthelmintic Male fern rhizome: - Oleoresin filixic acid is an anthelmintic against tape worms specifically a taenifuge. - Its use should be followed by saline purgative to eject killed worms and the remaining active ingredients. - Castor oil, which acts as anthelmintic, should not be used as its favors the absorption of filixic acid which is a poisonous when absorbed in large amount and resulted in blindness. 25 2. Stomach & intestinal disorders 2.4. Kinetosis [Motion sickness or travel sickness] Kinetosis is defined as Fatigue, nausea, dizziness, sometimes excessive salivation & vomiting when travelling. Motion sickness can manifest during air travel and in cars or trains, but it occurs most frequently during boat travel (seasickness). Etiology: When there is a discordance between the motion seen & the motion felt, the brain will come to the conclusion that one of them is hallucinating and further conclude that the hallucination is due to poison ingestion & responds by inducing vomiting, to clear the supposed toxin. 26 2. Stomach & intestinal disorders 2.4. Kinetosis [Motion sickness or travel sickness] Susceptibility or risk factors: Women are more likely than men to experience motion sickness, especially during pregnancy (morning sickness) or menstruation or in those taking hormone therapy. Patients with a history of migraines. Motion sickness may be caused by certain medications, including but not limited to macrolides, metronidazole, morphine, digoxin, and some selective serotonin reuptake inhibitors. Herbal treatment: The herbal drug used in mild cases of kinetosis is ginger. - Gingerol works on the gastrointestinal system to increase gastric motility. - Modulation of vasopressin release, (a posterior pituitary hormone, is involved in nausea and vomiting). - It is anti-emetic herbal remedy for Postoperative women with nausea and vomiting, Sea sickness, Morning sickness (pregnant women with severe nausea), and Chemotherapy-induced nausea 27   GIT or gastro-intestinal disorders Oral cavity Stomach and intestinal Liver and biliary tract disorders disorders disorders Glossitis Gastritis & peptic ulcer Acute liver disorders Constipation Gingivitis Intestinal worms Chronic liver disorders Kinetosis Stomatitis Liver cirrhosis Hemorrhoids Diarrhea Jaundice Irritable bowel syndrome (IBS)Flatulence Dyspepsia 29 2. Stomach & intestinal disorders 2.5. Hemorrhoids Hemorrhoids are swollen veins in the anus and lower rectum. Hemorrhoids are similar to varicose veins. Hemorrhoids can develop inside the rectum, called internal hemorrhoids. They also can develop under the skin around the anus, called external hemorrhoids. Etiology: Straining during bowel movements. Sitting for long periods of time, especially on the toilet. Having chronic diarrhea or constipation. Regularly lifting heavy items. Being pregnant. Eating a low-fiber diet. 30 2. Stomach & intestinal disorders 2.5. Hemorrhoids Treatment and prevention: Drink plenty of fluids, Consider fiber supplements, Don't strain, and Do exercise. Herbal treatment: Topical treatment with healing and astringent herbs as Witch hazel bark. Astringents shrink or tighten the swollen hemorrhoids. Tannins also relieve itching through protein precipitation. 31 2. Stomach & intestinal disorders 2.6. Diarrhea Symptoms of Diarrhea is Increased frequency (more than 3 times daily) Increased fluidity (liquid or semi liquid stool) Increased volume OR any combination of both. It lasts for 3-4 days (acute diarrhea) or may be for more than 4 weeks (chronic diarrhea). Etiology: 1) Often has an infectious cause e.g. Salmonella, Escherichia coli, or enterovirus (release toxins). 2) Food-induced diarrhea (dairy products, caffeine, chewing gum) 3) As an adverse effect of certain drugs 4) Irritable bowel syndrome or ulcerative colitis (chronic). 32 2. Stomach & intestinal disorders 2.6. Diarrhea Herbal treatment: - Tannin-containing herbs: blueberry, pomegranate rind, guava. - Antimicrobial natural products - Spasmolytic is helpful N.B In case of diarrhea accompanied with vomiting, herbal therapy is not applied Guava is the most frequently used anti-diarrhoeal plants due to 1. High fiber content: Fiber increases stool volume and improves stool consistency, aids in the digestive process and reduces the transit time of food through the intestines. 2. Antimicrobial properties: it can help fight infections that may be causing diarrhea. 3. Anti-diarrheal effect: Tannins work by forming a protective layer in the digestive tract, which helps reduce inflammation and hamper the absorption of toxins. 4. Source of electrolytes: Guava contains electrolytes such as potassium, magnesium and sodium (electrolyte balance). 33 2. Stomach & intestinal disorders 2.7. Irritable bowel syndrome Irritable bowel syndrome is Chronic functional GI disorder characterized by the presence of episodic abdominal pain or discomfort (flatulence, nausea, anorexia and anxiety) in association with altered bowel habits (diarrhea and/or constipation) and other GI symptoms such as bloating and distension. There are three major categories of IBS designated as IBS with predominate diarrhea (IBS‐D), IBS with predominate constipation (IBS‐C), and IBS with alternating constipation and diarrhea (IBS‐M). 34 2. Stomach & intestinal disorders 2.7. Irritable bowel syndrome 35 2. Stomach & intestinal disorders 2.7. Irritable bowel syndrome Herbal treatment: 1. IBS-C…………. Dietary fiber supplements (psyllium, bran). 2. IBS-D………… antidiarrheal agents 3. Antispasmodics (chamomile flowers) 4. Adaptogenic plants (stress relieving plants): Ashwagandha or Withania somnifera regulate cortisol level. 5. Hepato curative and choleretic herbs to improve liver function such as Silybum (St Mary’s thistle), Cynara (globe artichoke leaf). 6. Probiotics (Bifidobacterium sp.) Drug of choice: peppermint leaves. Peppermint oil had a relaxing effect on intestinal muscle, analgesic and anesthetic effects in the central and peripheral nervous systems. It helps relieve stomach cramps, and bloating. Mentha is used as enteric coated capsules why?? 36 2. Stomach & intestinal disorders 2.8. Flatulence Flatulence is the presence of excessive amount of gases in the stomach or in the intestine. Symptoms: Abdominal bloating, abdominal pain, and Belching Gases come from swallowed air or normal breakdown of indigested foods containing sugars, starches, and fibers Herbal treatment: 1. Carminatives: Anise, fennel, caraway and angelica. 2. Digestive enzymes (from animal pancreatic tissue): they compensate the excretory pancreatic insufficiency with associated indigestion. E.g. combination products containing lipase, amylase, and proteases (like papain extracted from unripe papaya fruit). 37 2. Stomach & intestinal disorders 2.9. Dyspepsia Functional dyspepsia (i.e. indigestion, or upset stomach, not associated with gastro-esophageal reflux or irritable bowel syndrome). Syndrome features: Nausea, epigastric pressure, bloating, flatulence or Cramps (abdominal pain). The cause of functional dyspepsia is unknown, but the possible causes may be: - Deficiency in gastric secretion - motility gastric disorders - deficient bile production - diet, alcohol, tobacco or aspirin-like drugs abuse - Helicobacter pylori infection - failure of fundic relaxation on meal ingestion But none of these has been found to be a definitive, unique cause of the disease 38 2. Stomach & intestinal disorders 2.9. Dyspepsia Herbal treatment: 1-Bitters or eupeptic: They promote gastric juice secretion, induces gastrin production and facilitate digestion. E.g. Gentian (pure bitter), bitter orange peel (aromatic bitters), and ginger (pungent bitter). 2-Cholagogues and choleretics: e.g. Artichoke, Turmeric, and Dandelion 3- Carminatives e.g. Caraway, Fennel and Anise 4- Antispasmodics 5- Others: e.g. Chili (capsicum or red pepper as capsaicin induces desensitization of nociceptive C fibers & attenuation of pain). 39 2. Stomach & intestinal disorders 2.9. Dyspepsia Herbal treatment: N.B. Bitters are administered in conc. Infusion (2-4%) form to be swallowed slowly Bitter drugs combined with an essential oil have the following effects: 1. A direct stimulus on taste and olfactory receptors 2. A direct stimulus on gastric secretion 3. Antibacterial effect 4. Stimulate bile secretion 5. Promote the expulsion of excessive intestinal gas (carminative) 6. Act as digestive stimulants when used in small doses between meals 40   GIT or gastro-intestinal disorders Oral cavity Stomach and intestinal Liver and biliary tract disorders disorders disorders Glossitis Gastritis & peptic ulcer Acute liver disorders Constipation Gingivitis Intestinal worms Chronic liver disorders Kinetosis Stomatitis Liver cirrhosis Hemorrhoids Irritable bowel Jaundice syndrome (IBS) Diarrhea Flatulence Dyspepsia 41  GIT or gastro-intestinal disorders 3. Liver Liver has ability to control infections, remove bacteria and toxins from the blood, process nutrients, hormones, and drugs, make proteins that regulate blood clotting & produce bile to help absorb fats and fat-soluble vitamins in the small intestine. 42  3. Liver disorders  Amebic liver abscess  Alcoholic liver Collection of pus in the liver disease brought on by an intestinal excessive drinking causes parasite. Acute alcoholic hepatitis  Hepatocellular  Viral infection carcinoma [hepatitis A, B, C] accounts for most liver cancers  Autoimmune hepatitis  Cirrhosis inflammation of the liver occurs Deterioration and poor liver when immune cells mistake the function occur as a result of liver's normal cells for harmful chronic liver disease invaders and attack them. 43 3. Liver disorders Symptoms Dark urine Fatigue Loss of appetite Pale stool Jaundice Nausea and vomitting Ascites Confusion Vomitting blood or blood in stool 44 3. Liver disorders The most common of liver disorders is the viral hepatitis : Acute viral hepatitis The most important causes are A,B,C viruses. Acute hepatitis can be treated using herbal medicine.  In the case of hepatitis A, treatment can lead to rapid recovery and protect against post hepatitis syndrome. For hepatitis B and C, herbal treatment will mainly help to prevent the disease becoming chronic. 45 3. Liver disorders Chronic viral hepatitis Chronic viral hepatitis or chronic persistent hepatitis usually results from infection with hepatitis B or C. Especially with hepatitis C, some features of the diseases may resemble auto- immune hepatitis Liver cirrhosis Liver cirrhosis: here death of liver cells usually results mainly due to alcohol abuse, Bilharzia or viral infection. Widespread death of liver cells accompanied by progressive fibrosis, distortion of liver architecture & impairment of liver functions. 46 3. Liver disorders Jaundice Yellow discoloration of skin & eyes caused by increased levels of bilirubin (product of heme catabolism) in the blood due to liver damage, bile duct obstruction or hemolytic anaemia. 47  3. Liver disorders  Essential aspects of treatment of liver disease as follows:  Diaphoretics: promote sweating, and are indicated in all acute infections accompanied by fever. E.g. Yarrow, tilia, elderflower, and peppermint. Antiviral agents: are indicated for acute or chronic viral hepatitis. E.g. St. John’s wort.  Immune – enhancing herbs: are indicated for acute and chronic viral infection.  Hepato-protective agents: are indicated for acute and chronic viral infection as well as liver cirrhosis to minimize liver damage.  Cholagogues & choleretics: Cholagogues stimulate gallbladder contraction to promote bile flow, whereas choleretics increase bile secretion by the liver. E.g. turmeric, artichoke and dandelion. They are indicated for gallbladder disorders and contraindicated in case of presence of gallstones. 48 3. Liver disorders 1. Echinacea (coneflower) It acts as an immuno-stimulant and antiviral herb. Echinacea polysaccharide improves overall immune responses and stimulates phagocytic activity and uptake of foreign particles. The effect developed rapidly (within a few days) Echinacea carry an unpleasant taste. The numbness/tingling of the lips/tongue is produced by the alkylamide. Echinacea- caffeine interaction: Echinacea might decrease the break down of caffeine, increase levels of caffeine and increase the risk of side effects from caffeine, such as nervousness, headache, and fast heartbeat. 49 3. Liver disorders 2. Turmeric (Curcuma rhizome) It acts as an immuno-stimulant, antiviral, anti-inflammatory and antioxidant herb. Curcumin displays an anti-inflammatory effect as it blocks the synthesis of prostaglandins by inhibiting Cyclooxygenase-1 and 2. Additionally, Curcumin exhibits antioxidant effect to which attributed the protection against liver damage. It has antiviral effect through inhibiting replication in a wide-range of viruses. It is a cholagogue, stimulating bile production in the liver and encouraging excretion of bile via the gallbladder, which improves the body's ability to digest fats. Curcumin is contraindicated for patients taking anti-coagulant or anti-platelet medications, or have a bleeding disorder, because curcumin inhibits platelet aggregation. Curcumin 50 3. Liver disorders 2. Turmeric (Curcuma) Curcumin is safe even at high doses (12 g/day) in humans but exhibit poor bioavailability due to poor absorption, rapid metabolism, and rapid systemic elimination. Despite the lower bioavailability, therapeutic efficacy of curcumin against various human diseases, including cancer, cardiovascular diseases, diabetes, and arthritis, has been documented. To solve this problem: Nanoparticle-based formulation of curcumin has high potential or formation of liposomal curcumin. Nonocurcumin has higher cellular uptake than curcumin 51 3. Liver disorders 3. Artichoke (Cynara) vitamins fats carbohydrates folic acid proteins minerals caffeoylquinic acid Bitter sesquiterpene derivatives carotenoids Cynaropicrin Sesquiterpene lactone bitters 52  3. Artichoke quercetin apigenin luteolin isorhamnetin rutin cynaroside Cynarin, Flavonoids caffeoylquinic acid derivative 53 3. Liver disorders 3. Artichoke The leaves of artichokes protect the liver from damage and help its regeneration due to the antioxidant effect. Artichokes are considered to have cholagogue and choleretic properties. They signal the liver to increase the production of bile and then stimulate the gallbladder to secrete this bile into the duodenum of the small intestine. This effect also helps in detoxification. Artichoke stimulates the flow of bile, so supplements shouldn't be used if there is a known or suspected blockage of the bile duct. Cynarin (1,5-dicaffeoylquinic acid) 54  3. Liver disorders 4. Milk thistle (Silybum or St Mary’s thistle) OH OCH3 O OCH3 O OH HO O OH O OH O CH2OH OH OCH3 HO O OH O CH2OH HO O O OH Silydianin   OH OH OH O OH O Silycristin Silybin A O CH2OH OH OCH3 O OCH3 HO O HO O O OH O  CH2OH  OH OH OH O OH O Isosilybin A Silybin B O OH Silymarin OH OCH3 HO HO O O O CH2OH OH OH OH OH O OH O Isosilybin B Taxifolin Major active constituents 55 3. Liver disorders 4. Milk thistle (Seeds & leaves) Silymarin is a flavonoid complex consisting of silybin, silydianin and silychrisin. Silymarin has antioxidant properties, so it protects liver cells from damage. It has a regenerating-promoting action. Silymarin has anti-inflammatory effects, which keep liver cells from swelling in response to injury. Silymarin has anti-fibrotic effect: fibrotic transformation plays a key role in the pathogenesis of hepatic cirrhosis and chronic inflammatory liver diseases. 56 3. Liver disorders 4. Milk thistle (Seeds & leaves) Silymarin plays a role in regulating vascular tone and suppressing platelet aggregation, thereby contributing to the regulation of blood pressure in individuals with hypertension. 57 3. Liver disorders 5. Dandelion Roots and leaves of dandelion contain Taraxacin, sesquiterpene lactone, provide bile-stimulating bitterness. It is contraindicated in case of gallbladder problems, or gallstones. Dandelion leaves are rich in potassium, so it is contraindicated for people with kidney diseases who are on potassium-restricted diets. Taraxacin 58 3. Liver disorders How to keep your liver healthy? 1 Well balanced healthy diet Rich in antioxidants Drinking enough fluid Adequate protein Low in fat; Avoid excessive consumption of salt and sugar 59 3. Liver disorders How to keep your liver healthy? 2 Try some light exercises few times a week 3 Cigarette and alcoholic drinks are forbidden 4 Get regular check-ups at the doctor's office 60 3. Liver disorders How to keep your liver healthy? 5 Avoid excessive medications 5 Use alternative and complementary therapies when Possible [under supervision] 61  Herbal and alternative medicine Herbal medicine for cardiovascular disorders. Herbal medicine for respiratory system disorders. Thank You gu.edu.eg