NMT150 Wk12 BOT Hypertension Lecture material (1) PDF

The use of Botanicals in Hypertension Chris Pickrell, ND, Herbalist, TCM Practitioner Key Actions: Hypotensive, Cardiotonic Key treatment Diet and Lifestyle factors, specifically physical activity, are virtually non- principles: negotiable in the effecti...

The use of Botanicals in Hypertension Chris Pickrell, ND, Herbalist, TCM Practitioner Key Actions: Hypotensive, Cardiotonic Key treatment Diet and Lifestyle factors, specifically physical activity, are virtually non- principles: negotiable in the effective treatment of hypertension Pro tip: Remove all caffeine for at least three weeks. Cratageus oxycanthus (Hawthorn) FEATURED HERBS IN THIS SECTION Lily of the Valley (Convallaria majalis) Motherwort (Leonurus cardiaca) Hawthorn (Cratageus oxycanthus) Skullcap (Scutellaria lateriflora) Hibiscus (Hibiscus sabdariffa) Snake root (Rauwolfia serpentina) Linden (Tillia cordata) Nettle leaf (Urtica dioica) Ginkgo (Ginkgo biloba) Valerian (Valeriana officinalis)  Botanicals in Hypertension CASE PRESENTATION – Hypertension A 50-year-old male presents blood pressure of 150/90, which he monitors at home and reports as normal for him. He is not medicated and would like to avoid medication, if possible. Associations: He consumes a standard North American diet, has low activity levels, and mentions ongoing moderate to high stress levels. The patient has been moderately overweight for many years, but is not obese. OUTCOME MEASURES Objectively decrease blood pressure RELEVANT BOTANICAL ACTIONS TO CONSIDER PRIMARY SECONDARY or OTHERS TO CONSIDER SUPPORTIVE Cardiotonic Vascular tonic Nervine Circulatory tonic  Botanicals in Hypertension Lily of the Valley (Convallaria majalis) FEATURED HERBS BY BOTANICAL ACTION Actions Herbs General Lily of the valley (Convallaria Valerian (Valeriana officinalis) Hypotensive majalis) Hibiscus (Hibiscus sabdariffa) Hawthorn (Crataegus oxyacantha) Skullcap (Scutellaria lateriflora) Linden (Tilia cordata) Motherwort (Leonurus cardiaca) Mistletoe (Viscum album) Passionflower (Passiflora incarnata) Garlic (Allium sativum) Snake root (Rauwolfia serpentina) Cardiotonic Lily of the valley (Convallaria majalis) Garlic (Allium sativum) Hawthorn (Crataegus oxyacantha) Vascular Hawthorn (Crataegus oxyacantha) Linden (Tilia cordata)  Botanicals in Hypertension tonic Garlic (Allium sativum) Gingko (Gingko biloba) Hibiscus (Hibiscus sabdariffa) Motherwort (Leonurus cardiaca) Circulatory Prickly ash (Zanthoxylum tonic americanum) Cayenne (Capsicum frutescens) Gingko (Gingko biloba) Nervine Linden (Tilia cordata) Motherwort (Leonurus cardiaca) Passionflower (Passiflora Valerian (Valeriana officinalis) incarnata) (Sedative) Skullcap (Scutellaria lateriflora) Lobelia (Lobelia inflata) HERB SELECTION (Cratageus) Hawthorn 40 (Convallaria) Lily of the Valley 20 Formula (Tilia) Linden 20 (Leonurus) Motherwort 20 100mL Dosage Tincture: Begin with one teaspoon, once a day and work up to 2 teaspoons (10mL) twice a day between meals. Duration Six weeks, possibly ongoing as needed. Expectations BP will likely decrease within 5-7 days and may continue to decrease for up to 10 days before stabilizing at what will likely be the maximum change for a given dose. Dose can be increased for further results. Cessation of formula, in the absence of other lifestyle changes or interventions, will result in a gradual return to previous levels, with a rebound hypertension unlikely. Cautions, Convallaria contains cardiac glycosides and does have the potential for Contraindications adverse effects if taken in large doses. The dosage indicated here can  Botanicals in Hypertension and Potential Side be considered safe, but a patient should be informed of the risks and Effects monitored. Signs of cardiac glycoside toxicity include: blurred vision, appearance of halos around objects, changes in heart rhythm, and allergic presentations such as hives. More common side effects, possible even at safe doses, are digestive symptoms, such as stomach pain and diarrhea. General caution: Any time a blood pressure altering medication is used, BP should be monitored and the patient advised what to do if it drops too low. A home BP cuff is the best way to measure BP consistently. Relevant Herb- This combo, or any of the hypotensive herbs in general will augment the Drug Interactions effects of other blood pressure medications. Often, this is desirable, and allows a patient to decrease or cease current medications, or to avoid escalating up the progression of anti-hypertensive medications. Other Effective Hibiscus is an effective hypotensive and vascular tonic. It may be added Therapies to the tincture above, but is best used as a strong infusion taken daily. Dietary and lifestyle modifications will always be primary in treating all cardiovascular conditions: regular exercise; do not smoke; consume plenty of vegetables, fruits, and fiber; avoid battered and fried foods; consume healthy oils and fats; minimize refined sugars, preservatives, and alcohol; try not to experience too much stress; and get adequate sleep. Remove caffeine for at least three weeks. In many cases, this is independently sufficient to significantly improve blood pressure. Omega 3s, specifically fish oil has been shown to have a beneficial effect on regulating BP, Cardiovascular disease, and all-cause mortality.  Botanicals in Hypertension TCM INTEGRATION – Hypertension Hypertension is predominantly a condition of Heat rising. The causes of Heat can be Excess or Deficient, but hypertension is more common and more serious in Excess conditions. If Phlegm is present, such as in CVD, the prognosis is worse and the condition more difficult to treat.  Botanicals in Hypertension SELECTED MONOGRAPHS Allium sativum (Garlic) Primary Actions: Vascular tonic, antimicrobial, hypotensive, stink-producer. Constituents: Organosulfur compounds (allicin), flavonoids, volatile oils Indications: Digestive infections, skin infections, URTI, CVD, hypertension. Cautions/Contraindications: Considered safe, widely used as food. In large doses of fresh bulb, skin irritation and photosensitization may occur. May interact with anticoagulant medications. Extra Information: Effective, though can be difficult to administer due to lingering pungency emitted from the skin and breath. Most effective if taken as raw bulb (or clove), but roasted bulb still useful, especially in treating vascular conditions. Makes an excellent (and delicious) infused oil (usually in olive oil) for ear infections in kids. Part Used: Bulb Daily Therapeutic Dose Tincture: 6–15 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 2–4 bulbs fresh or roasted Pairs Well With: Crataegus oxyacantha and Convallaria majalis for hypertension and CVD treatment. Finely chopped Lentinula edodes fried in butter. Closest Substitute: Allium cepa Capsicum frutescens (Cayenne) Primary Actions: Stimulant, circulatory tonic, rubefacient, sialagogue, libido tonic Constituents: Capsaicinoids (capsaicin), steroidal saponins Indications: Circulatory deficiencies, arthritic conditions, pain relief, depression Cautions/Contraindications: Non-toxic, but large doses will cause sweating and possible syncope. Safety rating during pregnancy and lactation not established. Extra Information: Acts as pain relief via local topical substance-P depletion. Excellent in salves for arthritis. Avoid contact with mucus membranes; internal use effective, but must be used in low doses. Part Used: Dried or powdered fruit Daily Therapeutic Dose Tincture: 1–5 mL (1:5 in 25%) Daily Therapeutic Dose Infusion or Decoction: 1–2 g powder (potency of starting material can vary considerably)  Botanicals in Hypertension Pairs Well With: Zanthoxylum americanum as warming circulatory tonic. Closest Substitute: Zingiber officinalis Convallaria majalis (Lily of the valley) Primary Actions: Cardiotonic, hypotensive Constituents: Cardiac glycosides (convallarin, convallamarin, convallatoxin) Indications: Hypertension, CHF, any cardiovascular conditions Cautions/Contraindications: All parts of this plant contain cardiac glycosides and should be considered toxic, though toxicity reports are rare, and the specific cardiac glycosides of Convallaria are non-cumulative. Avoid in pregnancy. Extra Information: Perhaps one of the most reliable and abundant hypotensives in North America. Although of indispensable use in the cardiovascular system, this is a strong medicine, and should be used with moderate caution. Positive inotropic, negative chronotropic, improves coronary contractility and circulation. Part Used: Leaf Daily Therapeutic Dose Tincture: 3–12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 2–4 g dried leaf Pairs Well With: Crataegus oxyacantha and Leonurus cardiaca for hypertension. Closest Substitute: Crataegus oxyacantha Crataegus oxyacantha (Hawthorn) Primary Actions: Cardiotonic, hypotensive, vascular tonic, nutritive Constituents: Flavonoids Indications: Hypertension, CHF, any cardiovascular conditions Cautions/Contraindications: Considered safe and nutritious, berries may be consumed as food. Extra Information: Positive inotropic, improves coronary contractility and circulation. Ripe berries are delicious and make a tasty therapeutic jam. Part Used: Berry, leaf Daily Therapeutic Dose Tincture: 8-12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 5–15 g dried fruit Pairs Well With: Convallaria majalis for hypertension and CHF. Closest Substitute: Hibiscus sabdariffa  Botanicals in Hypertension Gingko biloba (Gingko) Primary Actions: Circulatory tonic, vasodilator, anti-inflammatory, anticoagulant (as an antiplatelet activator factor [PAF]) nootropic, mild astringent. Constituents: Flavonoid glycosides, terpene lactones (gingkolides) Indications: Poor perfusion of tissues, especially cerebral; inflammation, clot formation, cognitive decline, erectile dysfunction, BPH. Cautions/Contraindications: Though not toxic, may cause stomach discomfort or cramping. Extra Information: At 200 million years old, Gingko trees are the most ancient species of tree on the planet and the only remaining member of their genus. They are also thought to be the hardiest tree species and are among the most resilient trees in urban environments. Gingko trees have a distinct male and female. The females produce a characteristically unpleasant smelling, but edible fruit. Part Used: Leaf and fruit Daily Therapeutic Dose Tincture: 3–9 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 4–10 g dried leaf Pairs Well With: Actaea racemosa and Hydrastis canadensis for vertigo. Capsicum frutescens in formulas for improved circulation. Centella asiatica for enhancing cognitive performance. Closest Substitute: Centella asiatica Hibiscus sabdariffa (Hibiscus) Primary Actions: Hypotensive, antioxidant, mild nervine, astringent, cooling, mild diuretic, mild alterative, mild emmenagogue. Constituents: Flavonoids, vitamin C, anthocyanidins, tannins Indications: Hypertension, inflammation and heat patterns Cautions/Contraindications: Long history of use as pleasure tea, broadly considered safe. Safety rating during pregnancy and lactation not established. Extra Information: Excellent infusion and often used to improve palatability of a formula. As a mild uterine tonic it may be indicated for recurrent miscarriages, but it should be cautioned in cool patterns or constitutions. Hibiscus rosa-sinensis is used similarly, and the two species are generally thought to be interchangeable. Part Used: Flower Daily Therapeutic Dose Tincture: 6–15 mL (1:5 in 25%) Daily Therapeutic Dose Infusion or Decoction: 6–12 g dried flower  Botanicals in Hypertension Pairs Well With: Chrysanthemum morifolium for excessive heat patterns. Crataegus oxyacantha berry for hypertension and cardiovascular conditions. Closest Substitute: Schisandra sinensis Leonurus cardiaca (Motherwort) Primary Actions: Nervine, hypotensive, cardiotonic, mild emmenagogue. Constituents: Iridoids, flavonoids, alkaloids Indications: Anxiety, insomnia, delayed menses Cautions/Contraindications: Considered safe. Extra Information: Used especially in cases of anxiety with concomitant cardiovascular conditions, or irregular menses from nervous tension. Part Used: Aerial parts Daily Therapeutic Dose Tincture: 3–12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 4–6 g dried leaf Pairs Well With: Crataegus oxyacantha and Ginkgo biloba in cardiovascular presentations. Scutellaria lateriflora and Agrimonia repens for anxious tension. Closest Substitute: Scutellaria lateriflora Lobelia inflata (Lobelia) Primary Actions: Antispasmodic, CNS acting relaxing nervine, emetic, diffusive pulmonary tonic. Constituents: Piperidine alkaloids (lobeline). Indications: Smoking cessation support, asthma, anxiety, panic attacks, persistent cough. Cautions/Contraindications: Non-toxic, but may cause emesis in doses larger than 1 tablespoon. Safety rating during pregnancy and lactation not established. Extra Information: Usually used as 10% or less of a formula, often paired with mint for dispersal through the CNS, excellent in anxiety formulas. Used acutely for panic attacks. Part Used: Aerial parts, seeds, seed powder. Daily Therapeutic Dose Tincture: 1–2 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 1-3 g Pairs Well With: Artemisia absinthium and Passiflora incarnata as an acute treatment for panic attacks and general cravings. Coleus forskohlii in treating asthma. Closest Substitute: Nicotiana tabacum  Botanicals in Hypertension Passiflora incarnata (Passionflower) Primary Actions: Sedative, nervine, hypotensive, antispasmodic, anti-inflammatory Constituents: Alkaloids, flavonoids Indications: Insomnia, general anxiety and restlessness, hypertension, neuralgia Cautions/Contraindications: Considered safe. May potentiate other anxiolytics. Extra Information: Slightly spicy in flavour similar to Lobelia inflata or Nicotiana tabacum, but overall cooling. Effective nervine-sedative, used especially in conditions presenting with nervous anxiety. Part Used: Leaf Daily Therapeutic Dose Tincture: 3–12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 1–4 g dried herb Pairs Well With: Agrimonia eupatoria and Avena sativa for nervous tension preventing sleep. Closest Substitute: Scutellaria lateriflora Rauwolfia serpentina (Snake root) Primary Actions: Hypotensive, CNS depressant, sedative Constituents: Indole alkaloids (reserpine, serpentine, yohimbine) Indications: Hypertension, anxiety Cautions/Contraindications: Cautioned in patients concurrently taking other hypotensive medications, especially beta-blockers and calcium channel blockers. Although uncommon, prudence suggests patients should be monitored for mood changes. Similarly, many practitioners suggest Rauwolfia is CI in patients with a history of depression. Rauwolfia is CI in pregnancy and lactation. Extra Information: There are many herbs commonly called snakeroot, and it is specifically the Indian snakeroot being referred to here. Primarily an Ayurvedic herb, Rauwolfia was traditionally used to treat “lunacy and insanity” or what is now thought to be schizophrenia and other forms of psychosis. Still used as an effective hypotensive, it is currently regaining popularity as a new generation of practitioners discover it is safe and effective in therapeutic dose. Part Used: Root Daily Therapeutic Dose Tincture: 0.5–2 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: Not well established Pairs Well With: Crataegus oxyacantha in hypotensive formulas. Closest Substitute: Convallaria majalis  Botanicals in Hypertension Scutellaria lateriflora (Skullcap) Primary Actions: Nervine, hypotensive, mild antispasmodic Constituents: Flavonoids, iridoids, volatile oils Indications: Anxiety, particularly worrisome anxiety. Digestive, nervous, or menstrual symptoms associated with worry. Cautions/Contraindications: Considered safe. Extra Information: Excellent nervine with minimal soporific properties, often thought of as tonic and mild adaptogen. Note: Not interchangeable with Scutellaria baicalensis. Part Used: Leaf, aerial parts Daily Therapeutic Dose Tincture: 6–12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 3–6 g dried herb Pairs Well With: Avena sativa and Borago officinalis as restorative nervines from anxious exhaustion. Closest Substitute: Leonurus cardiaca Tilia cordata (Linden) Primary Actions: Cardiotonic, circulatory tonic, nervine, hypotensive Constituents: Volatile oils, flavonoids, mucilage, tannins Indications: Nervous tension, cardiovascular conditions associated with stress or anxiety, hypertension, respiratory congestion, URTIs. Cautions/Contraindications: Considered safe. May interfere with iron absorption, so best taken away from meals or iron supplementation in some cases. Extra Information: Reliable hypotensive and cardiotonic with anxiolytic properties, best in combo with other primaries. Other Tilia species such as T. europaea, T. platyphyllos, and T. americana are at present considered interchangeable. Part Used: Flower Daily Therapeutic Dose Tincture: 8–15 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 2–6 g dried blossom Pairs Well With: Crataegus oxyacantha as non-cardiac glycoside cardiotonic and hypotensive. Scutellaria lateriflora, Passiflora incarnata as nervine and hypotensive. Closest Substitute: Leonurus cardiaca Urtica dioica (Nettle leaf)  Botanicals in Hypertension Primary Actions: Nutritive, alterative, diuretic Constituents: Indoles, flavonoids, formic acid Indications: Skin conditions, weakened kidneys, nutritive in pregnancy, seasonal allergies Cautions/Contraindications: Considered safe. Preg B, Lact C. Extra Information: Will create significant urtication when harvested fresh (primarily due to the presence of formic acid), though drying and cooking inactivates the sting. Useful in all conditions related to the kidneys, and an excellent general alterative. Nettle is nutritious as a food, and makes excellent cordage if lost in the woods. Considered interchangeable with Urtica urens. Part Used: Leaf Daily Therapeutic Dose Tincture: 6–12 mL (1:5 in 30%) Daily Therapeutic Dose Infusion or Decoction: 8–15 g dried herb Pairs Well With: Galium aparine and Berberis vulgaris for post-infection convalescence or summer colds. Trifolium pratense for childhood eczema. Closest Substitute: Taraxacum officinalis leaf, Trifolium pratense. Valeriana officinalis (Valerian) Primary Actions: Sedative, nervine, hypotensive, anodyne, antispasmodic, emmenagogue, decongestant, mild carminative. Constituents: Iridoids, valpotriates, baldrinals, essential oils, valerianic acid Indications: Deficient pattern anxiety and insomnia, sinus congestion, pain conditions. Cautions/Contraindications: Considered safe. May potentiate other anxiolytics, particularly benzodiazepines. Extra Information: Has an especially strong smell reminiscent of dirty socks. Effective sedative, may induce grogginess the next morning if used in high dose. Best prepared using a strong infusion (30+ min). Some individuals experience a “paradoxical reaction” in which valerian makes them feel restless and stimulated; this is seen especially in people with TCM heat/empty heat patterns. Valerian is generally considered a warm, dry herb. Notably useful in attenuating the symptoms of benzodiazepine withdrawal. Mexican valerian (Valeriana edulis) is considered interchangeable. Of note, valerian is considered safe in pregnancy, and it may be thought of as the treatment of choice in insomnia or anxiety during pregnancy. Part Used: Root Daily Therapeutic Dose Tincture: 8–18 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 6–9 g dried root  Botanicals in Hypertension Pairs Well With: Syzygium aromaticum for a warm, drying bedtime decongestant in cold- pattern URTIs. Any of the other sedatives for anxiety, insomnia, or pain relief. Closest Substitute: None Viscum album (Mistletoe) Primary Actions: Hypotensive, cardiotonic, vascular tonic, antineoplastic Constituents: Lectins, polypeptides, polysaccharides Indications: Hypertension, angina pectoris, CHF Cautions/Contraindications: Cytotoxic ribosomal inhibitor (phoratoxin), must be used with caution, if at all. However, eclectic traditional use suggests infusion of the leaves was used in large doses without side effect. All parts of the mistletoe plant are considered toxic and not to be ingested. CI in pregnancy and lactation. Extra Information: Semi-parasitic plant. Injectable mistletoe extract has been used in trials in the treatment of various cancers, as the drug Iscador or Helixor. Traditionally an herb used for kissing at Christmas, mistletoe is, humorously, in the Santalaceae family. Part Used: Whole plant Daily Therapeutic Dose Tincture: 3–6 mL (1:5 in 45%) Daily Therapeutic Dose Infusion or Decoction: 10 g dried herb Pairs Well With: Convallaria majalis for CHF or refractory hypertension Closest Substitute: Rauwolfia serpentina