NMT150 BOT MED, Wk5, Radiculopathy Lecture material PDF

Botanicals and Radiculopathy Chris Pickrell, ND, Herbalist, TCM Practitioner Key Actions: Anti-inflammatory, analgesic, topical analgesic Use topical and local treatments like a cayenne salve or essential oils of eucalyptus, mint, and wintergreen for acute pain relief Key treatment principles: Promo...

Botanicals and Radiculopathy Chris Pickrell, ND, Herbalist, TCM Practitioner Key Actions: Anti-inflammatory, analgesic, topical analgesic Use topical and local treatments like a cayenne salve or essential oils of eucalyptus, mint, and wintergreen for acute pain relief Key treatment principles: Promoting blood flow is always the best treatment Consider the use of stronger analgesics as needed. Pro tip: Keep expectations of botanicals realistic in these cases: Appropriate physical activity, acupuncture, and hydrotherapy are more likely to provide better clinical outcomes. Capsicum annua (Cayenne) Botanicals in Lumbar Radiculopathy FEATURED HERBS IN THIS SECTION Capsicum annua (Cayenne) Cannabis indica (cannabis) Curcuma longa (Turmeric) Corydalis yanhusuo (click for link) Harpagophytum procumbens (Devil’s claw) Boswellia serrata (Frankincense) CASE PRESENTATION – Lumbar Radiculopathy A 63-year-old male presents with what he calls sciatica. He has focal pain in the lumbar region that radiates down the posterior leg and into the foot. He also describes numbness and tingling. The pain is worse on walking or sitting for prolonged periods. OUTCOME MEASURES Increase pain-free range of motion Increase time-to-onset of pain during activities Restore proper sensation to affected areas Botanicals in Lumbar Radiculopathy RELEVANT BOTANICAL ACTIONS TO CONSIDER PRIMARY SECONDARY or SUPPORTIVE OTHERS TO CONSIDER Anti-inflammatory Alterative Hepatic Diuretic Analgesic Adaptogen Corydalis yanhusuo Botanicals in Lumbar Radiculopathy FEATURED HERBS BY BOTANICAL ACTION Actions Anti-inflammatory Herbs Turmeric (Curcuma longa) Actea racemose (Black cohosh) Devil’s claw (Harpagophytum Polygonum cuspidatum procumbens) (Japaneses knotweed) Frankincense (Boswellia serrata) Polygonatum biflorum Cat’s claw (Uncaria tomentosa) (Solomon’s seal) St. John’s wort (Hypericum perforatum) Analgesic Adaptogen Corydalis (Corydalis yanhusuo) Valerian (Valeriana officinalis) Kava kava (Piper methysticum) Cannabis (Cannabis indica) Cayenne (Capsicum annua) Jamaican dogwood (Piscidia St. John’s wort (Hypericum piscipula), perforatum) Wild lettuce (Lactuca virosa) Ganoderma spp. (Reishi, Ling Codonopsis pilosula (Dan shen) zhi) Astragalus membranaceus Innonotus obliqus (Chaga) (Huang qi) Cordyceps sinensis (Cordyceps) Panax quinquefolia (NA ginseng) HERB SELECTION Formula Curcuma longa 70 Corydalis yanhusuo 30 100mL Dosage Tincture or powder: 1-2 teaspoons (5-10mL) every few hours as needed. Botanicals in Lumbar Radiculopathy Cautions, This formula should be well tolerated. Excessive consumption may Contraindications cause drowsiness. Consumption of Corydalis powder above 60 grams and Potential Side can cause severe hypotension. Effects Corydalis should not be used in post-partum bleeding, or any menstrual bleeding that is scanty. Relevant Herb-Drug Turmeric (Curcuma longa) will inhibit or induce certain pathways of Interactions cytochrome P450 metabolism Other Effective Contrasting hydrotherapy is beneficial in improving blood flow to the Therapies painful areas. Inclusion of healthy fats and oils, and ensuring appropriate amounts of protein are beneficial. Bone broths to promote macro and micro nutritional requirements Acupuncture may provide symptomatic relief (click for link) Topical and local treatments like a cayenne salve or essential oils of eucalyptus, mint, and wintergreen for acute pain relief Consider use of Cannabis for symptomatic pain management TCM INTEGRATION – Lumbar Radiculopathy Sciatic pain caused by an obstruction of the nerve or nerve roots will be diagnosed as a Bi (pain obstruction) syndrome, and in this case may include Heat. Sciatic pain is often viewed as an obstruction of the Gall Bladder meridian. In general, pain is treated by removing the obstruction to re-establish the smooth flow of Qi and Blood. Botanicals in Lumbar Radiculopathy SELECTED MONOGRAPHS Bupleureum chinensis (Chai hu) Primary Actions: Hepatic, alterative, anti-inflammatory, hepatoprotective Constituents: Triterpene saponins, sterols, volatile oils, polysaccharides Indications: Hepatic congestion, arthritis, chronic inflammation, acute infections with fever Cautions/Contraindications: Avoided in cold conditions or constitutions. Safety rating during pregnancy and lactation not established. Extra Information: Excellent hepatic alterative for long-standing inflammation from physical or emotional accumulation. Useful in hepatitis as both a hepatoprotective and an antiinflammatory. Part Used: Root Daily Therapeutic Dose Tincture: 6–12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 3–12 g Pairs Well With: Berberis vulgaris, Uncaria tomentosa, and Harpagophytum procumbens for inflammation, especially of joints. Paeonia alba for stagnant menses with heat presentation. Closest Substitute: Baptisia tinctoria Boswellia serrata (Frankincense) Primary Actions: Antimicrobial, anti-inflammatory, astringent Constituents: Resins, boswellic acid, volatile oils Indications: Inflammatory joint conditions, IBD, topical antimicrobial Cautions/Contraindications: Considered safe, though not generally taken internally in large amounts. Extra Information: To be effectively extracted, boswellia is dissolved in 90% alcohol, making even small ingested doses a risk for intoxication. Potent and profound fragance used commonly as a fortifying and attractive essential oil. Reasonably good evidence exists to support the use of boswellia as an anti-inflammatory, particularly in the treatment of RA. Part Used: Resin Daily Therapeutic Dose Tincture: 2–4 mL (1:5 in 90%) Daily Therapeutic Dose Infusion or Decoction: Best as powder or as encapsulated supplement. Suggested dose 300–3000 mg. Botanicals in Lumbar Radiculopathy Pairs Well With: Salvia officinalis as an antimicrobial for oropharyngeal and upper GI infections. Harpagophytum procumbens and Curcuma longa in formulas for inflammatory rheumatoid conditions. Closest Substitute: Commiphora myrrha 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) Pairs Well With: Zanthoxylum americanum as warming circulatory tonic. Closest Substitute: Zingiber officinalis Corydalis yanhusuo (Corydalis, Yan hu suo) Primary Actions: Analgesic, hepatic, warming carminative Constituents: alkaloids, volatile oils Indications: Any pain. Often used specifically for menstrual pain relief Cautions/Contraindications: Do not use in pregnancy. Will cause drowsiness in higher doses. Do not use for scanty menses, post-partum, or in patients with very weak vitality. Extra Information: Thought of as a specific for pain relief. One of the few strong hepatics and pain relievers that is warming. Corydalis is in the Papaver family; though it is not known to contain opioids, some of its pain-reducing properties may be caused by activity at opioid receptors. Part Used: Root Daily Therapeutic Dose Tincture: 3–12 mL (1:5 in 40%) Botanicals in Lumbar Radiculopathy Daily Therapeutic Dose Infusion or Decoction: 3–9g dried herb or powder Pairs Well With: Curcuma longa for menstrual cramp pain, or any pain due to stagnation/obstruction. Closest Substitute: None Curcuma longa (Turmeric) Primary Actions: Anti-inflammatory, mild antimicrobial, carminative, circulatory tonic Constituents: Phenolic antioxidants, curcumin, volatile oils, starches Indications: General inflammatory conditions, OA and RA, possibly cancer lesions (topical), stomach ulcers and dyspepsia Cautions/Contraindications: Broadly considered safe though acts as a mild inhibitor of phase I and inducer of phase II liver conjugation and should therefore be used with mild caution in patients taking medications with narrow therapeutic index. In large doses of greater than 15 g per day (sometimes recommended in practice), turmeric may augment the effects of antiplatelet and anticoagulant medications. Preg A, Lact C. Extra Information: Related to ginger, turmeric is warming and soothing to the stomach. May protect against NSAID-induced ulcers. Good-quality powder is likely the preferred method of delivery, and turmeric is best absorbed when taken with a meal containing fats or oils. Part Used: Root Daily Therapeutic Dose Tincture: 8–24 mL (1:5 in 30%) Daily Therapeutic Dose Infusion or Decoction: 8–20 g dried root or powder Pairs Well With: Dioscorea villosa for inflammation related to circulation Closest Substitute: Harpagophytum procumbens Glycyrrhiza glabra (Licorice) Primary Actions: Adaptogen, particularly to the adrenals; anti-inflammatory, demulcent, antiviral, hypertensive Constituents: Triterpene saponins (glycyrrhizin), glycyrrhetinic acid, chalcones Indications: Ongoing stress, hypotension, asthma, eczema, chronic or acute bronchitis, emphysema, URTI, post-viral cough, stomach ulcers (mostly DGL) Cautions/Contraindications: CI in hypertension. Preg A, Lact C. Botanicals in Lumbar Radiculopathy Extra Information: Licorice acts primarily as an aldosterone-like endocrine modulator. Thought of as specific to cases of deficiency presenting with dizziness and hypotension. Excellent in URTI as an antiviral and demulcent. Excellent for lingering post-viral cough. In TCM, one of two herbs that enter all 12 meridians. Glycyrrhiza uralensis mostly used in TCM, properties considered interchangeable. Part Used: Root Daily Therapeutic Dose Tincture: 3–9 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 2–9 g dried root Pairs Well With: Rosmarinus officinalis for coughs, especially viral coughs. Bupleurum sinensis in anti-inflammatory combos where clearance by the liver is suboptimal. Hypericum perforatum and Melissa officinalis (as infused oil) for the topical treatment of herpes infections. Closest Substitute: None Harpagophytum procumbens (Devil’s claw) Primary Actions: Anti-inflammatory, antirheumatic, mild anodyne, hepatic Constituents: Iridoid glycosides (harpagoside), phenolic acids, quinone Indications: RA, other inflammatory conditions, other arthritic conditions Cautions/Contraindications: Considered safe, though research inconclusive. Preg B, Lact C. Extra Information: Specific as an anti-inflammatory for rheumatic pain. Part Used: Root Daily Therapeutic Dose Tincture: 3–6 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 4–12 g dried root Pairs Well With: Curcuma longa as a rheumatic anti-inflammatory Closest Substitute: Curcuma longa Hypericum perforatum (St. John’s wort) Primary Actions: Uplifting nervine, antiviral, anti-inflammatory, vulnerary Constituents: Volatile oils, hyperforin, naphthodianthones (hypericin), flavonoids Indications: Mood dysregulation, neuralgia, anxiety, viral infections Cautions/Contraindications: Sensitization may occur at higher doses of the herb or its extract. Induces CYP3A4, thus potential drug interactions with numerous substances. Serotonin Botanicals in Lumbar Radiculopathy syndrome possible when taken in combo with SSRIs. Photosensitivity may occur in some indivduals. Preg B, Lact CC. Extra Information: Excellent as topical oil for herpes lesions. Considered by some a specific for irritability and anxiety from menopausal changes. Part Used: Aerial parts Daily Therapeutic Dose Tincture: 2–10 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 2–4 g Pairs Well With: Calendula officinalis and Stachys betonica for depressive states, especially Seasonal Affective Disorder. Glycyrrhiza glabra and Melissa officinalis as a topical for herpes lesions. Closest Substitute: None Polygonum cuspidatum (Japanese Knotweed) Primary Actions: Anti-inflammatory, hepatic, anti-microbial, laxative, astringent, anti-oxidant Constituents: anthraquinone glycosides, tannins, resveratrol Indications: Any joint pain. Inflammatory and auto-immune conditions: RA, psoriasis, lupus. Hepatitis, stagnant menses, fibroids, endometriosis. Any condition of difficult urination. Lyme. Cautions/Contraindications: Acts as a stimulating laxative. Do not use in pregnancy. May cause nausea or stomach pain. Extra Information: Also known as Reynoutria japonica, Fallopia japonica and Hu zhang. Bitter and cold in nature, Knotweed can be thought of as specific for any conditions characterized by pain, inflammation, and obstruction. Part Used: Root Daily Therapeutic Dose Tincture: 6–12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 9–15 g dried herb Pairs Well With: Polgonatum biflorum for joint pain. Closest Substitute: Rumex crispus