Overview

The name "ginseng" is used to refer to both American (Panax quinquefolius) and Asian or Korean ginseng (Panax ginseng), which belong to the genus Panax and have a somewhat similar chemical makeup. Both Asian and American ginseng contain ginsenosides, which are the substances thought to give ginseng its medicinal properties. But they contain different types in different amounts.

Siberian ginseng, or Eleuthero (Eleutherococcus senticosus), is an entirely different plant with different effects. It is distantly related to ginseng, but it does not contain the same active ingredients.

Like Asian ginseng, American ginseng is a light tan, gnarled root that often looks like a human body with stringy shoots for arms and legs. Native Americans used the root as a stimulant and to treat headaches, fever, indigestion, and infertility. Ginseng remains one of the most popular herbs in the United States.

Ginseng is sometimes called an "adaptogen," meaning it is an herb that helps the body deal with various kinds of stress, although there is no scientific evidence to prove the benefit of adaptogens.

Most ginseng studies have used Panax ginseng (Asian ginseng). There is some evidence that Panax ginseng may:

• Help boost the immune system
• Reduce the risk of cancer
• Improve mental performance and well being

Laboratory studies in animals have found that American ginseng is effective in boosting the immune system, and as an antioxidant. Other studies show that American ginseng might have therapeutic potential for inflammatory diseases. Research on American ginseng has focused on a number of conditions, including the following.

Diabetes

Several human studies show that American ginseng lowered blood sugar levels in people with type 2 diabetes. The effect was seen both on fasting blood sugar and on postprandial (after eating) glucose levels. One study found that people with type 2 diabetes who took American ginseng before or together with a high sugar drink experienced less of an increase in blood glucose levels. Other studies suggest that North American ginseng prevents diabetes-related complications including retinal and cardiac functional changes by reducing stress. More research is needed.

One study in mice found that the American ginseng berry was more effective at lowering blood sugar levels than the root.

Cancer

American ginseng has been shown to inhibit tumor growth. In one laboratory study on colorectal cancer cells, researchers found that American ginseng possessed powerful anti-cancer properties.

Colds and flu

In two studies, people who took a specific product called Cold FX for 4 months got fewer colds than people who took a placebo. And those who got colds found their symptoms did not last as long compared to those who took a placebo.

Attention deficit hyperactivity disorder (ADHD)

One preliminary study suggests that American ginseng, in combination with ginkgo (Ginkgo biloba), may help treat ADHD. More research is needed.

Immune system enhancement

Some scientists believe American ginseng enhances the immune system. In theory, this improvement in immune function could help the body fight off infection and disease. Several clinical studies have shown that American ginseng does boost the performance of cells that play a role in immunity.

Cognition

Preliminary studies suggest that American ginseng may improve cognition. More research is needed.

Plant Description

The American ginseng plant has leaves that grow in a circle around a straight stem. Yellowish-green, umbrella-shaped flowers grow in the center and produce red berries. Wrinkles around the neck of the root tell how old the plant is. This is important because American ginseng is not ready for use until it has grown for about 6 years. American ginseng is endangered in the wild. So it tends to be expensive. It is now being grown on farms to protect wild American ginseng from over-harvesting.

What's It Made Of?

American ginseng products are made from ginseng root and the long, thin offshoots called root hairs. The main chemical ingredients of American ginseng are ginsenosides and polysaccharide glycans (quinquefolans A, B, and C).

American ginseng seems to be more relaxing than Asian ginseng, which may have stimulating effects.

Available Forms

American ginseng (dried) is available in water, water and alcohol, alcohol liquid extracts, and in powders, capsules, and tablets. American ginseng is available with other herbs in several combination formulas.

Be sure to read the label carefully so that you are purchasing the type of ginseng that you want. If you are looking for Asian ginseng, make sure you buy Korean, red, or Panax ginseng. If you are looking for American ginseng, you should buy Panax quinquefolius.

Eleuthero (Eleutherococcus senticosus), which is sometimes called Siberian ginseng, may also be found in health food stores or pharmacies. It does not have the same active ingredients as Asian or American ginseng.

How to Take It

Pediatric

American ginseng is not recommended for use in children except under a doctor's supervision.

Adult

Available forms include:

• Standardized extract
• Fresh root
• Dried root
• Tincture (1:5)
• Fluid extract (1:1)

Precautions

The use of herbs is a time honored approach to strengthening the body and treating disease. Herbs, however, contain components that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider that is qualified in the field of botanical medicine. Always tell your doctor about any herbs you may be taking.

Side effects are rare, but may include:

• High blood pressure
• Insomnia
• Restlessness
• Anxiety
• Euphoria
• Diarrhea
• Vomiting
• Headache
• Nosebleed
• Breast pain
• Vaginal bleeding

To avoid hypoglycemia (low blood sugar), even in people without diabetes, take American ginseng with food.

People with hypertension (high blood pressure) should not take American ginseng products without the close supervision of their doctors. At the same time, people with low blood pressure, as well as those with an acute illness, should use caution when taking American ginseng.

People with schizophrenia or bipolar disorder should not take ginseng, because it may increase the risk of mania.

Pregnant or breastfeeding women should not take American ginseng.

Women who have a history of breast cancer, or other hormone-sensitive conditions, should not take ginseng.

Stop taking American ginseng at least 7 days prior to surgery. American ginseng can lower blood glucose levels and could create problems for patients fasting before surgery. In addition, American ginseng may act as a blood thinner, increasing the risk of bleeding during or after the procedure.

Possible Interactions

If you are being treated with any of the following medications, you should not use ginseng without talking to your doctor:

Medications for diabetes. American ginseng may lower blood sugar levels, so it could interfere with the effectiveness of prescription drugs for diabetes. Talk to your doctor before taking American ginseng if you are taking medicines for diabetes, including insulin and oral hypoglycemic agents, such as metformin (Glucophage).

Blood-thinning medications (anticoagulants). One small study suggested that American ginseng might decrease the effectiveness of warfarin (Coumadin), a blood-thinning medication. If you take any blood-thinning medications, talk to your doctor before taking ginseng.

MAOIs (monoamine oxidase inhibitors). Ginseng may increase the risk of side effects when taken with MAOIs, a type of antidepressant. There have been reports of interaction between ginseng and phenelzine (Nardil) causing headaches, tremors, and mania. MAOIs include:

• Isocarboxazid (Marplan)
• Phenelzine (Nardil)
• Tranylcypromine (Parnate)

Antipsychotic medications. American ginseng may increase the effects of medications used to treat psychiatric disorders such as schizophrenia and bipolar disorder. So they should not be taken together.

Stimulants. Ginseng may increase the stimulant effect and side effects of some medications taken for attention deficit hyperactivity disorder (ADHD), including amphetamine and dextroamphetamine (Adderall) and methylphenidate (Concerta, Ritalin).

Morphine. Asian ginseng may block the painkilling effects of morphine.

Supporting Research

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Andrade AS, Hendrix C, Parsons TL, et al. Pharmacokinetic and metabolic effects of American ginseng (Panax quinquefolius) in healthy volunteers receiving the HIV protease inhibitor indinavir. BMC Complement Altern Med. 2008 Aug 19;8:50.

Ang-Lee MK, Moss J, Yuan C-S. Herbal medicines and perioperative care. JAMA. 2001;286(2):208-216.

Banz WJ, Iqbal MJ, Bollaert M, et al. Ginseng modifies the diabetic phenotype and genes associated with diabetes in the male ZDF rat. Phytomedicine. 2007 Oct;14(10):681-9.

Barton DL, Soori GS, Bauer BA, et al. Pilot study of Panax quinquefolius (American ginseng) to improve cancer-related fatigue: a randomized, double-blind, dose-finding evaluation: NCCTG trial N03CA. Support Care Cancer. 2010;18(2):179-87.

Biondo PD, Robbins SJ, Walsh JD, McCargar LJ, Harber VJ, Field CJ. A randomized controlled crossover trial of the effect of ginseng consumption on the immune response to moderate exercise in healthy sedentary men. Appl Physiol Nutr Metab. 2008 Oct;33(5):966-75.

Carai MAM, Agabio R, Bombardelli E, et al. Potential use of medicinal plants in the treatment of alcoholism. Fitoterapia. 2000;71:S38-S42.

Dey L, Xie JT, Wang A, et al. Anti-hyperglycemic effects of ginseng: comparison between root and berry. Phytomedicine. 2003;10(6-7):600-5.

Dougherty U, Mustafi R, Wang Y, et al. American ginseng suppresses Western diet-promoted tumorigenesis in model of inflammation-associated colon cancer: role of EGFR. BMC Complement Altern Med. 2011;11:111.

Fu Y, Ji LL. Chronic ginseng consumption attenuates age-associated oxidative stress in rats. J Nutr. 2003;133(11):3603-9.

Harkey MR, Henderson GL, Gershwin ME, et al. Variability in commercial ginseng products: an analysis of 25 preparations. Am J Clin Nutr. 2001;73:1101-1106.

Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm. 2000;57(13):1221-1227.

Hsu CC, Ho MC, Lin LC, et al. American ginseng supplementation attenuates creatine kinase level induced by submaximal exercise in human beings. World J Gastroenterol. 2005;11(34):5327-31.

Ichikawa T, Li J, Nagarkatti P, et al. American ginseng preferentially suppresses STAT/iNOS signaling in activated macrophages. j Ethnopharmocal. 2009;125(1):145-50.

Izzo AA, Ernst E. Interactions between herbal medicines and prescribed drugs: a systematic review. Drugs. 2001;61(15):2163-2175.

Karmazyn M, Moey M, Gan XT. Therapeutic potential of ginseng in the management of cardiovascular disorders. Drugs. 2011;71(15):1989-2008.

King ML, Adler SR, Murphy LL. Extraction-dependent effects of American ginseng (Panax quinquefolium) on human breast cancer cell proliferation and estrogen receptor activation. Integr Cancer Ther. 2006;5(3):236-43.

LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide. Hudson, OH: LexiComp; 2000:442-444.

Lee NH, Son CG. Systematic review of randomized controlled trials evaluating the efficacy and safety of ginseng. Review]. J Acupunct Meridian Stud. 2011;4(2):85-97.

Li XL, Wang CZ, Sun S, et al. American ginseng berry enhances chemopreventive effect of 5-FU on human colorectal cancer cells. Oncol Rep. 2009;22(4):943-52.

Luo X, Wang CZ, Chen J, et al. Characterization of gene expression regulated by American ginseng and ginsenoside Rg3 in human colorectal cancer cells. Int J Oncol. 2008;32(5):975-83.

Lyon MR, Cline JC, Totosy de Zepetnek J, et al. Effect of the herbal extract combination Panax quinquefolium and Ginkgo biloba on attention-deficit hyperactivity disorder: a pilot study. J Psychiatry Neurosci. 2001;26(3):221-228.

McElhaney JE, Goel V, Toane B, et al. Efficacy of COLD-fX in the prevention of respiratory symptoms in community-dwelling adults: a randomized, double-blinded, placebo controlled trial. J Altern Complement Med. 2006;12(2):153-7.

Mantle D, Lennard TWJ, Pickering AT. Therapeutic applications of medicinal plants in the treatment of breast cancer: a review of their pharmacology, efficacy and tolerability. Adverse Drug React Toxicol Rev. 2000;19(3):2223-240.

Mantle D, Pickering AT, Perry AK. Medicinal plant extracts for the treatment of dementia: a review of their pharmacology, efficacy, and tolerability. CNS Drugs. 2000;13:201-213.

Mucalo I, Jovanovski E, Rahelic D, Bozikov V, Romic Z, Vuksan V. Effect of American ginseng (panax quinquefolius L.) on arterial stiffness in subjects with diabetes and concomitant hypertension. J Ethnopharmacol. 2013;150(1):148-53.

Mucalo I, Rahelic D, Jovanovski E, Bozikov V, Romic Z, Vuksan V. Effect of American ginseng (panax quinquefolius L.) on glycemic control in type 2 diabetes. Coll Antropol. 2012;36(4):1435-40.

Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Saunders; 2013.

Ossoukhova A, Owen L, Savage K, et al. Improved working memory performance following administration of a single dose of American ginseng (Panax quinquefolius L.) to healthy middle-age adults. Hum Psychopharmacol. 2015;30(2):108-22.

Predy GN, Goel V, Lovlin R, et al. Efficacy of an extract of North American ginseng containing poly-furanosyl-pyranosyl-saccharides for preventing upper respiratory tract infections: a randomized controlled trial. CMAJ. 2005;173(9):1043-8.

Scholey A, Ossoukhova A, Owen L, et al. Effects of American ginseng (Panax quinquefolius) on neurocognitive function: an acute, randomised, double-blind, placebo-controlled, crossover study. Psychopharmacology (Berl). 2010;212(3):345-56.

Seida JK, Durec T, Kuhle S. North American (Panax quinquefolius) and Asian Ginseng (Panax ginseng) Preparations for Prevention of the Common Cold in Healthy Adults: A Systematic Review. Evid Based Complement Alternat Med. 2009. [Epub ahead of print]

Sen S, Chen S, Feng B, Wu Y, Lui E, Chakrabarti S. Preventative effects of North American ginseng (Panax quinquefolium) on diabetic nephropathy. Phytomedicine. 2012;19(6):494-505.

Sen S, Chen S, Feng B, Wu Y, Lui E, Chakrabarti S. Preventative effects of North American ginseng (Panax quinquefolium) on diabetic retinopathy and cardiomyopathy. Phytother Res. 2013;27(2):290-8.

Sui DY, Yu XF, Qu SC, et al. [Protective effect of Panax quinquefolium 20s-proto-panaxdiolsaponins on acute myocardial infarction in dogs]. Zhongguo Zhong Yao Za Zhi. 2001;26(6):416-9.

Sung J, Han KH, Zo JH, et al. Effects of red ginseng upon vascular endothelial function in patients with essential hypertension. Am J Chin Med. 2000;28(2):205-216.

Vaes LP, Chyka PA. Interactions of warfarin with garlic, ginger, ginkgo, or ginseng: nature of the evidence. Ann Pharmacother. 2000;34(12):1478-1482.

Vladimir V, Sievenpiper JL, Koo VY, et al. American ginseng (Panax quinquifolius L) reduces postprandial glycemia in nondiabetic subjects and subjects with type 2 diabetes mellitus. Arch Intern Med. 2000;160(7):1009-1013.

Vohra S, Johnston BC, Laycock KL, et al. Safety and tolerability of North American ginseng extract in the treatment of pediatric upper respiratory tract infection: a phase II randomized, controlled trial of 2 dosing schedules. Pediatrics. 2008 Aug;122(2):e402-10.

Vuksan V, Sievenpiper JL, Koo VYY, et al. American ginseng (Panax quinquefolius L) reduces postprandial glycemia in nondiaetic subjects and subjects with type 2 diabetes mellitus. Arch Intern Med. 2000;160:1009-1013.

Vuksan V, Sievenpiper JL, Xu Z, et al. Konjac-mannan and American ginseng: emerging alternative therapies for type 2 diabetes mellitus. J Am Coll Nutr. 2001;20(5):370S-380S.

Vuksan V, Stavro MP, Sievenpiper JL, et al. Similar postprandial glycemic reactions with escalation of dose and administration time of American ginseng in type 2 diabetes. Diabetes Care. 2000;23:1221-1226.

Wang M, Guilbert LJ, Li J, et al. A proprietary extract from North American ginseng (Panax quinquefolium) enhances IL-2 and IFN-gamma productions in murine spleen cells induced by Con-A. Int Immunopharmacol. 2004;4(2):311-5.

Wargovich MJ. Colon cancer chemoprevention with ginseng and other botanicals. J Korean Med Sci. 2001;16 Suppl:S81-S86.

Wu CF, Liu YL, Song M, et al. Protective effects of pseudoginsenoside-F11 on methamphetamine-induced neurotoxicity in mice. Pharmacol Biochem Behav. 2003;76(1):103-9.

Wu Z, Luo JZ, Luo L. American ginseng modulates pancreatic beta cell activities. Chin Med. 2007 Oct 25;2:11.

Xie JT, Wang CT, Li XL, Ni M, Fishbein A, Yuan CS. American ginseng and Scutellaria baicalensis using an ob/ob mice model. Fitoterapia. 2009;80(5):306-11.

Yeh GY, Eisenberg DM, Kaptchuk TJ, et al. Systematic review of herbs and dietary supplements for glycemic control in diabetes. Diabetes Care. 2003;26(4):1277-94.

Yuan CS, Wei G, Dey L, et al. Brief communication: American ginseng reduces warfarin's effect in healthy patients: a randomized, controlled Trial. Ann Intern Med. 2004;141(1):23-27.

Overview

Arnica (Arnica montana) has been used for medicinal purposes since the 1500s and is still popular today. Applied to the skin as a cream, ointment, liniment, salve, or tincture, arnica has been used to soothe muscle aches, reduce inflammation, and heal wounds. It is commonly used for injuries, such as sprains and bruises. As an herb, arnica is usually used topically (on the skin) because it can cause serious side effects when taken by mouth. Oral homeopathic remedies do contain arnica, but they use a diluted form that is not considered dangerous. If you have any question about whether you have the herbal or homeopathic form of arnica, talk to your doctor.

Plant Description

Arnica is a perennial that grows to a height of 1 to 2 feet with yellow-orange flowers similar to daisies. Stems are round and hairy, ending in 1 to 3 flower stalks, with flowers 2 to 3 inches across. Leaves are bright green. The upper leaves are toothed and slightly hairy, while lower leaves have rounded tips. It is native to the mountains of Europe and Siberia, and is cultivated in North America.

Parts Used

Fresh or dried flower heads are used in medicinal preparations.

Medicinal Uses and Indications

• Arnica is used topically for a wide range of conditions, including bruises, sprains, muscle aches, wound healing, superficial phlebitis, joint pain, inflammation from insect bites, and swelling from broken bones. More recent studies suggest it may also be helpful in the treatment of burns.
• Homeopathic preparations are also used to treat sore muscles, bruises, and other conditions caused by overexertion or injury. Homeopathic doses are extremely diluted. They have no detectable amount of the plant in them and are generally considered safe for internal use when taken according to the directions on the label.

Available Forms

Arnica is available in topical creams and ointments. It is most commonly found as a tincture, which can also be used as the base for compresses and poultices. Arnica oil may also be used in topical preparations.

A number of homeopathic remedies are available in pill, topical, or injectable forms.

How to Take It

You should not take arnica by mouth without direct medical supervision, except in an extremely diluted form as a homeopathic remedy, because side effects may be severe (see "Precautions").

Use homeopathic products according to directions on the label or the advice of your homeopathic practitioner. Health care providers may give homeopathic preparations by injection.

When using arnica topically, never apply it to an open wound without a doctor's supervision.

Pediatric

You may also use homeopathic preparations to treat bruising, swelling, and trauma to soft tissues. Follow the dosage instructions on the product label or consult a licensed homeopath. Use only in homeopathic formulations. DO NOT use the herb itself.

Adult

Commercial preparations of creams, ointments, and lotions are available through some specialty stores and natural health providers. Homeopathic preparations are widely available at health food stores and many pharmacies.

Precautions

Arnica is generally safe when used on the skin. However, using it for a long time may irritate the skin, causing eczema, peeling, blisters, or other skin conditions. Arnica should not be used on broken skin, such as leg ulcers. In one study, researchers found that arnica used topically increased leg pain 24 hours after participants performed calf exercises. Also, people who are hypersensitive or allergic to the herb should avoid it.

Arnica is rarely used as an internal herbal remedy because it can cause dizziness, tremors, and heart irregularities. It may also irritate mucous membranes and cause vomiting. Large doses can even be fatal. DO NOT take arnica by mouth except under close supervision of your doctor. You can generally take homeopathic remedies, which use extremely small amounts of arnica, safely.

If you are pregnant or breastfeeding, avoid taking arnica, and ask your doctor before using it on your skin. Talk to your doctor before taking any medication, including herbs.

Possible Interactions

When used topically or in a homeopathic remedy, there are no known interactions with arnica and conventional medications.

Supporting Research

Adkison JD. The effect of topical arnica on muscle pain. Ann Pharmacother. 2010;44(10):1579-84.

Auerbach. Wilderness Medicine. 6th ed. Philadelphia, PA: Elsevier Mosby; 2011.

Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000.

Bolognia. Dermatology. 3rd ed. St. Louis, MO: Elsevier Saunders; 2012.

Brinkhaus B, Wilkens JM, Ludtke R, Hunger J, Witt CM, Willich SN. Homeopathic arnica therapy in patients receiving knee surgery: Results of three randomised double-blind trials. Complement Ther Med. 2006 Dec;14(4):237-46.

Huber R. Bross F, Schempp C, Grundermann C. Arnica and stinging nettle for treating burns - a self-experiment. Complement Ther Med. 2011;19(5):276-80.

Kotlus BS, Heringer DM, Dryden RM. Evaluation of Homeopathic Arnica montana for Ecchymosis After Upper Blepharoplasty: A Placebo-Controlled, Randomized, Double-Blind Study. Ophthal Plast Reconstr Surg. 2010 Jul 29. [Epub ahead of print]

Seeley BM, Denton AB, Ahn MS, Maas CS. Effect of homeopathic Arnica montana on bruising in face-lifts: results of a randomized, double-blind, placebo-controlled clinical trial. Arch Facial Plast Surg. 2006 Jan-Feb;8(1):54-9.

Sutovska M, Capek P, Kocmalova M, et al. Characterization and pharmacodynamic properties of Arnica montana complex. Int J Biol Macromol. 2014;69:214-21.

Overview

Ginseng has been used in Chinese medicine for thousands of years. The name "ginseng" refers to both American (Panax quinquefolius) and Asian or Korean ginseng (Panax ginseng), which are made up of similar chemicals. Siberian ginseng, or Eleuthero (Eleutherococcus senticosus), is a completely different plant and does not have the same active ingredients. Both Asian and American ginseng contain substances called ginsenosides, which researchers think are the active ingredients.

Like American ginseng, Asian ginseng is a gnarled root that looks like a human body with stringy shoots for arms and legs. Long ago, herbalists thought that because of the way ginseng looks it could treat many problems, from fatigue and stress to asthma and cancer. In traditional Chinese medicine (TCM), ginseng is often combined with other herbs.

Today, ginseng is sometimes called an "adaptogen," which is a substance that is supposed to help the body better cope with mental or physical stress. Scientists have not found any evidence that adaptogens exist. But ginseng has been studied for several conditions, and it is one of the most popular herbs in the United States.

Many studies of Asian or Korean ginseng have used combinations of herbs. So it is not always possible to say whether ginseng by itself produced the results. Research on Asian ginseng has included the following conditions:

Cold and flu

It has been said that Asian ginseng boosts the immune system, which might help the body fight off infection and disease. The best evidence is that it may help reduce your risk of getting a cold or flu. Studies have found that ginseng seems to increase the number of immune cells in the blood and improve the immune system's response to a flu vaccine. In one study, 227 people got either ginseng or placebo for 12 weeks, and got a flu vaccine after 4 weeks. The number of colds and flu were two-thirds lower in the group that took ginseng.

Two studies found that ginseng lowered the chance of getting a cold. In one double-blind, placebo-controlled study of 323 people, those who took 400 mg of ginseng daily for 4 months had fewer colds. When they did get a cold, it was less severe and shorter than the colds of people who took placebo.

Heart health

Asian ginseng seems to be an antioxidant. Antioxidants help rid the body of free radicals, which are substances that can damage DNA and contribute to heart disease, diabetes, and other conditions. Preliminary studies suggest Asian ginseng may improve the symptoms of heart disease in people. It also may decrease LDL (bad) cholesterol levels and raise HDL (good) cholesterol.

Asian ginseng's effect on blood pressure is more complicated. Some studies suggest it lowers blood pressure while others found that it causes blood pressure to rise. This has led researchers to question if ginseng increases blood pressure at usual doses, but lowers it when doses are higher. Until researchers know for sure, you should not take ginseng if you have high blood pressure unless your doctor tells you it is OK.

Type 2 diabetes

Although American ginseng has been studied more for diabetes, both types of Panax ginsengs may lower blood sugar levels in people with type 2 diabetes. However, in a few studies it looked like Asian or Korean ginseng raised blood sugar levels. Some people think that the ginsenosides in American ginseng might lower blood sugar while different ginsenosides in Asian ginseng could raise blood sugar levels. Until researchers know more, you should not take ginseng if you have diabetes without your doctor's supervision and monitoring.

Mental performance

People who take ginseng often say they feel more alert. Several studies report that Asian ginseng may slightly improve thinking or learning. Early research shows that Asian ginseng may improve performance on such things as mental arithmetic, concentration, memory, and other measures. Some studies have also found a positive effect with the combination of Asian ginseng and Ginkgo biloba.

Most of the studies have found that ginseng does improve mental performance. But they have measured different kinds of mental function. That makes it hard to know exactly what the effects of ginseng are. For example, one study found that people who took ginseng increased their ability for abstract thought. But it did not create any changes in their reaction time or concentration levels.

Physical endurance

There have been a number of studies using Asian ginseng for athletic performance in people and laboratory animals. Results have been mixed, with some studies showing better strength and endurance, others showing improved agility or reaction time, and others showing no effect at all. Even so, athletes often take Asian ginseng to boost both endurance and strength. Asian ginseng was also found to reduce fatigue in a study of 332 people.

Stress and well-being

Asian ginseng is sometimes credited with helping the body deal with physical or mental stress. While these properties can be difficult to study, there is some evidence that ginseng (both Asian and American) can improve quality of life, although quality of life can be hard to measure, too.

A study of 501 men and women living in Mexico City found better quality of life measures (energy, sleep, sex life, personal satisfaction, and well-being) in those taking Asian ginseng. Another well-designed study found that people who took a nutritional supplement with ginseng said they had better quality of life than those taking the same supplement without ginseng.

Fertility/erectile dysfunction

Asian ginseng is widely believed to boost sexual performance. But there are not many studies to back this up. In animal studies, Asian ginseng has increased sperm production, sexual activity, and sexual performance. A study of 46 men has also shown an increase in sperm count as well as motility. Another study in 60 men found that Asian ginseng increased sex drive and decreased erection problems. Also, in one study of 45 men, those who took 900 mg of Korean ginseng 3 times per day for 8 weeks had less trouble getting an erection than those who took placebo.

Cancer

Several studies suggest that Asian ginseng may reduce the risk of some types of cancers. In one observational study, researchers followed 4,634 people for 5 years. They found that those who took ginseng had lower risks of lung, liver, pancreatic, ovarian, and stomach cancers. But the study could not be sure that other things, including healthy eating habits, were responsible for the lower risk of cancer. The study also found that taking ginseng only 3 times a year led to a big reduction in cancer risk.

Several studies suggest that Asian ginseng slows down or stops the growth of tumors, although researchers are not yet sure how it might work in humans. More research is needed.

Menopausal symptoms

There have been only a few studies of ginseng for menopausal symptoms. Two well-designed studies evaluating red Korean (Asian) ginseng suggest it may relieve some of the symptoms of menopause, improving sense of well-being and mood, particularly feelings of depression. People took ginseng along with a vitamin and mineral supplement. Other studies show no effect.

Plant description

The ginseng plant has leaves that grow in a circle around a straight stem. Yellowish-green, umbrella-shaped flowers grow in the center and produce red berries. Ginseng has a taproot that looks a little like the human body, with 2 "arms" and 2 "legs." Wrinkles around the neck of the root tell how old the plant is. Ginseng is not ready to be used as medicine until it has grown for about 6 years.

Asian or Chinese and Korean ginseng are the same plants, but grown in different areas. American ginseng is a relative of the same species, native to North America.

What is it Made of?

Asian ginseng supplements are made from the ginseng root, and the long, thin offshoots, called root hairs. Both Asian or Korean and American ginseng have ginsenosides, saponins that are ginseng's active ingredients. Asian ginseng also contains glycans (panaxans), polysaccharide fraction DPG-3-2, peptides, maltol, B vitamins, flavonoids, and volatile oil.

Available Forms

White ginseng (dried, peeled) or red ginseng (unpeeled root, steamed before drying) is available in water, water-and-alcohol, or alcohol liquid extracts, and in powders or capsules. Asian ginseng root is also available for making decoctions (boiling the root in water).

Read the label carefully to make sure you get the type of ginseng you want. If you are looking for Asian ginseng, make sure you buy Korean, red, or Panax ginseng. If you are looking for American ginseng, you should buy Panax quinquefolius. Eleuthero (Eleutherococcus senticosus), which is sometimes called Siberian ginseng, does not have the same active ingredients as Asian or American ginseng.

How to Take it

Pediatric

Do not give ginseng to a child.

Adult

Asian ginseng comes in different forms and is often used in combination with other herbs or nutrients. Talk with an experienced health care practitioner to find the right dose for you.

Healthy people who want to boost physical or mental performance, prevent illness, or better resist stress should take Asian ginseng in cycles. For example, take every day for 2 to 3 weeks, then stop for 3 weeks, then start back.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. However, herbs can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care under the supervision of a health care provider, qualified in the field of botanical medicine.

Asian ginseng should not be taken continuously; take periodic breaks and consult a trained herbal prescriber if you are considering long-term use.

Asian ginseng may cause nervousness or sleeplessness, especially if taken at high doses or combined with caffeine. Other side effects are rare, but may include:

• High blood pressure
• Insomnia
• Restlessness
• Anxiety
• Euphoria
• Diarrhea
• Vomiting
• Headache
• Nose bleed
• Breast pain
• Vaginal bleeding

To avoid hypoglycemia or low blood sugar, even in people without diabetes, take Asian ginseng with food.

People with high blood pressure should not take Asian ginseng products without their doctor's supervision. People who are ill or have low blood pressure should take caution when using Asian ginseng.

People with bipolar disorder should not take ginseng because it may increase the risk of mania.

People with an autoimmune disease, such as rheumatoid arthritis, lupus, or Crohn disease, should ask their doctors before taking Asian ginseng. Theoretically, Asian ginseng may boost an already overactive immune system.

Pregnant or breastfeeding women should not take Asian ginseng. Asian ginseng may cause vaginal bleeding.

Women who have a history of breast cancer should not take ginseng.

Stop taking Asian ginseng at least 7 days prior to surgery. Asian ginseng may act as a blood thinner, increasing the risk of bleeding during or after a procedure.

Possible Interactions

If you are currently taking any of the following medications, you should not use Asian ginseng without first talking to your health care provider:

ACE inhibitors (blood pressure medications): Asian ginseng may interact with angiotensin-converting enzyme (ACE) inhibitors used to lower high blood pressure. These medications include:

• Captopril (Capoten)
• Benazepril (Lotensin)
• Enalapril (Vasotec)
• Lisinopril (Prinivil, Zestril)
• Fosinopril (Monopril)
• Ramipril (Altace)
• Perindopril (Aceon)
• Quinapril (Accupril)
• Moexipril (Univasc)
• Trandolapril (Mavik)

Calcium channel blockers (heart and blood pressure medications): Asian ginseng may make certain heart medications, including calcium channel blockers, work differently than intended. These medications include:

• Amlodipine (Norvasc)
• Diltiazem (Cardizem)
• Nifedipine (Procardia)

Blood-thinners (anticoagulants and antiplatelets): Asian ginseng may increase the risk of bleeding, especially if you already take blood thinners, such as aspirin, warfarin (Coumadin), or clopidogrel (Plavix).

Caffeine: Ginseng may make the effect of caffeine stronger, possibly causing nervousness, sweating, insomnia, or irregular heartbeat.

Diabetes medications, including insulin: Ginseng may lower blood sugar levels, increasing the risk of hypoglycemia or low blood sugar.

Drugs that suppress the immune system: Asian ginseng may boost the immune system and may interact with drugs taken to treat an autoimmune disease or drugs taken after organ transplant.

Stimulants: Ginseng may increase the stimulant effect and side effects of some medications taken for attention deficit hyperactivity disorder (ADHD), including amphetamine and dextroamphetamine (Adderall) and methylphenidate (Concerta, Ritalin).

MAOIs (monoamine oxidase inhibitors): Ginseng may increase the risk of mania when taken with MAOIs, a kind of antidepressant. There have been reports of interaction between ginseng and phenelzine (Nardil) causing headaches, tremors, and mania. MAOIs include:

• Isocarboxazid (Marplan)
• Phenelzine (Nardil)
• Tranylcypromine (Parnate)

Morphine: Asian ginseng may block the painkilling effects of morphine.

Furosemide (Lasix): Some researchers think Asian ginseng may interfere with Lasix, a diuretic (water pill) that helps the body get rid of excess fluid.

Other medications: Asian ginseng may interact with medications that are broken down by the liver. To be safe, if you take any medications, ask your doctor before taking Asian ginseng.

Supporting Research

Adams LL, Gatchel RJ. Complementary and alternative medicine: applications and implications for cognitive functioning in elderly populations. Alt Ther. 2000;7(2):52-61.

Ang-Lee MK, Moss J, Yuan C-S. Herbal medicines and perioperative care. JAMA. 2001;286(2):208-16.

Biondo PD, Robbins SJ, Walsh JD, McCargar LJ, Harber VJ, Field CJ. A randomized controlled crossover trial of the effect of ginseng consumption on the immune response to moderate exercise in healthy sedentary men. Appl Physiol Nutr Metab. 2008 Oct;33(5):966-75.

Bucci LR. Selected herbals and human exercise performance. Am J Clin Nutr. 2000;72(2 Suppl):624S-36S.

Cardinal BJ, Engels HJ. Ginseng does not enhance psychological well-being in healthy, young adults: Results of a double-blind, placebo-controlled, randomized clinical trial. J Am Diet Assoc. 2001;101:655-60.

Caso MA, Vargas RR, Salas VA, Begoña IC. Double-blind study of a multivitamin complex supplemented with ginseng extract. Drugs Exp Clin Res. 1996;22(6):323-9.

Chen CF, Chiou WF, Zhang JT. Comparison of the pharmacological effects of Panax ginseng and Panax quinquefolium. Acta Pharmacol Sin. 2008 Sep;29(9):1103-8.

Coleman CI, Hebert JH, Reddy P. The effects of Panax ginseng on quality of life. J Clin Pharm Ther. 2003;28(1):5-15.

Ernst E. The risk-benefit profile of commonly used herbal therapies: ginkgo, St. John's wort, ginseng, echinacea, saw palmetto, and kava. Ann Intern Med. 2002;136(1):42-53.

Fugh-Berman A. Herb-drug interactions. Lancet. 2000;355:134-8.

Gao JL, Lv GY, He BC, et al. Ginseng saponin metabolite 20(S)-protopanaxadiol inhibits tumor growth by targeting multiple cancer signaling pathways. Oncol Rep. 2013;30(1):292-8.

Geng J, Dong J, Ni H, Lee MS, Wu T, Jiang K, Wang G, Zhou AL, Malouf R. Ginseng for cognition. Cochrane Database Syst Rev. 2010 Dec 8;12:CD007769.

Gyllenhaal C, Merritt SL, Peterson SD, et al. Efficacy and safety of herbal stimulants and sedatives in sleep disorders. Sleep Med Rev. 2000;4(2):229-251.

Harkey MR, Henderson GL, Gershwin ME, et al. Variability in commercial ginseng products: an analysis of 25 preparations. Am J Clin Nutr. 2001;73:1101-6.

Hartley DE, Elsabagh S, File SE. Gincosan (a combination of Ginkgo biloba and Panax ginseng): the effects on mood and cognition of 6 and 12 weeks' treatment in post-menopausal women. Nutr Neurosci. 2004;7(5-6):325-33.

Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm. 2000;57(13):1221-7.

Heo JH, Lee ST, Chu K, Oh MJ, Park HJ, Shim JY, Kim M. An open-label trial of Korean red ginseng as an adjuvant treatment for cognitive impairment in patients with Alzheimer's disease. Eur J Neurol. 2008 Aug;15(8):865-8.

Hong B, Ji YH, Hong JH, et al. A double-blind crossover study evaluating the efficacy of korean red ginseng in patients with erectile dysfunction: a preliminary report. J Urol. 2002;168(5):2070-3.

Izzo AA, Ernst E. Interactions between herbal medicines and prescribed drugs: a systematic review. Drugs. 2001;61(15):2163-75.

Jang DJ, Lee MS, Shin BC, Lee YC, Ernst E. Red ginseng for treating erectile dysfunction: a systematic review. Br J Clin Pharmacol. 2008 Oct;66(4):444-50.

Jiang X, Williams KM, Liauw WS, et al. Effect of St John's wort and ginseng on the pharmacokinetics and pharmacodynamics of warfarin in healthy subjects. Br J Clin Pharmacol. 2004;57(5):592-9.

Kabalak AA, Soyal OB, Urfalioglu A, et al. Menometrorrhagia and tachyarrhythmia after using oral and topical ginseng. J Womens Health. (Larchmt ) 2004;13(7):830-3.

Kennedy DO, Scholey AB, Wesnes KA. Modulation of cognition and mood following administration of single doses of Ginkgo biloba, ginseng, and a ginkgo/ginseng combination to heathy young adults. Physiol Behav. 2002;75:739-51.

Kim JH, Park CY, Lee SJ. Effects of Sun Ginseng on subjective quality of life in cancer patients: a double-blind, placebo-controlled pilot trial. J Clin Pharm Ther. 2006;31:331-4.

Lieberman HR. The effects of ginseng, ephedrine, and caffeine on cognitive performance, mood and energy. Nutr Rev. 2001;59(4):91-102.

Liu J, Burdette JE, Xu H, et al. Evaluation of estrogenic activity of plant extracts for the potential treatment of menopausal symptoms. J Agric Food Chem. 2001;49(5):2472-9.

Mantle D, Lennard TWJ, Pickering AT. Therapeutic applications of medicinal plants in the treatment of breast cancer: a review of their pharmacology, efficacy and tolerability. Adverse Drug React Toxicol Rev. 2000;19(3):2223-40.

Mantle D, Pickering AT, Perry AK. Medicinal plant extracts for the treatment of dementia: a review of their pharmacology, efficacy, and tolerability. CNS Drugs. 2000;13:201-13.

McElhaney JE, Gravenstein S, Cole SK, et al. A placebo-controlled trial of a proprietary extract of North American ginseng (CVT-E002) to prevent acute respiratory illness in institutionalized older adults. J Am GeriatrSoc. 2004;52:13-19.

McElhaney JE, Goel V, Toane B, et al. Efficacy of COLD-fX in the prevention of respiratory symptoms in community-dwelling adults: a randomized, double-blinded, placebo controlled trial. J Altern Complement Med. 2006;12:153-7.

Mucalo I, Jovanovski E, Rahelic D, Bozikov V, Rmoic Z, Vuksan V. Effect of American ginseng (Panax quinquefolius L.) on arterial stiffness in subjects with type-2 diabetes and concomitant hypertension. J Ethnopharmacol. 2013;150(1):148-53.

Oh KJ, Chae MJ, Lee HS, Hong HD, Park K. Effects of Korean red ginseng on sexual arousal in menopausal women: placebo-controlled, double-blind crossover clinical study. J Sex Med. 2010 Apr;7(4 Pt 1):1469-77.

Park SE, Park C, Kim SH, Hossain MA, Kim MY, Chung HY, et al. Korean red ginseng extract induces apoptosis and decreases telomerase activity in human leukemia cells. J Ethnopharmacol. 2009 Jan 21;121(2):304-12.

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Scholey A, Ossoukhova A, Owen L, Ibarra A, Pipingas A, He K, Roller M, Stough C. Effects of American ginseng (Panax quinquefolius) on neurocognitive function: an acute, randomised, double-blind, placebo-controlled, crossover study. Psychopharmacology (Berl). 2010 Oct;212(3):345-56.

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Overview

Astragalus (Astragalus membranaceus) has been used in Traditional Chinese Medicine (TCM) for thousands of years. It was often combined with other herbs to strengthen the body against disease. Astragaus is called an adaptogen, meaning it helps protect the body against various stresses, including physical, mental, or emotional stress.

Astragalus may help protect the body from diseases such as cancer and diabetes. It contains antioxidants, which protect cells against damage. Astragalus is used to protect and support the immune system, preventing colds and upper respiratory infections, lowering blood pressure, treating diabetes, and protecting the liver.

Astragalus has antibacterial and anti-inflammatory properties. People sometimes use it on the skin for wound care. In addition, studies have shown that astragalus has antiviral properties and stimulates the immune system, suggesting that it may help prevent colds.

In the United States, researchers have looked at astragalus as a possible treatment for people whose immune systems have been weakened by chemotherapy or radiation. In these studies, astragalus supplements seem to help people recover faster and live longer. Research on using astragalus for people with AIDS has produced mixed results.

Recent research in China suggests that, because astragalus is an antioxidant, it may help people with severe forms of heart disease, relieving symptoms, lowering cholesterol levels, and improving heart function. At low-to-moderate doses, astragalus has few side effects. However, it does interact with a number of other herbs and prescription medications. Astragalus may also be a mild diuretic, meaning it helps rid the body of excess fluid.

Plant Description

Astragalus is a perennial plant, about 16 to 36 inches tall, that is native to the northern and eastern parts of China, as well as Mongolia and Korea. It has hairy stems with leaves made up of 12 to 18 pairs of leaflets. The root is the medicinal part of the plant, and is usually harvested from 4-year-old plants.

Parts Used

The dried root is used medicinally.

Medicinal Uses and Indications

Astragalus has been used for the following:

• Adaptogen. Protects the body from stress and disease.
• Anemia. One early study suggested astragalus may improve blood counts in people with aplastic anemia. The study was poorly designed, so more research is needed.
• Colds and influenza. In TCM, astragalus is used as part of an herbal combination to prevent or treat colds, although TCM theory holds that, in some cases, it may make colds worse. Evidence in animal and laboratory tests suggests it may act against viruses like the ones that cause colds.
• Diabetes. Astragalus appears to lower blood sugar. More studies are needed to determine whether it can help treat diabetes.
• Fatigue or lack of appetite from chemotherapy. Some studies suggest astragalus may help reduce side effects from chemotherapy. The studies have not been well designed, however. More research is needed.
• Heart disease. Several studies suggest that astragalus may act as an antioxidant and help treat heart disease. Other studies suggest astragalus may help lower cholesterol levels.
• Hepatitis. A few studies have used a combination of herbs containing astragalus to treat hepatitis. Results have been mixed.
• Kidney disease. Preliminary research suggests astragalus may help protect the kidneys and may help treat kidney disease. More studies are needed.
• Seasonal allergies. One study found that astragalus may help reduce symptoms in people who have allergic rhinitis or hayfever.
• Cancer. Preliminary studies suggest astragalus may have anti-tumor effects, specifically against melanoma and leukemia.

Available Forms

Astragalus root may be available in a variety of forms:

• Tincture (liquid alcohol extract)
• Capsules and tablets, standardized and non-standardized
• Injectable forms for use in hospital or clinical settings in Asian countries
• Topically for the skin

How to Take It

Pediatric

There is not a lot of scientific evidence about giving astragalus to children, so ask your doctor first. According to TCM, you should not give astragalus to a child with fever because the herb may make the fever last longer or grow stronger. Dosage should be determined by your doctor.

Adult

Dosage depends on condition being treated, age, and weight. Work with your physician to determine the safest and most effective dosage for you. Higher doses may suppress the immune system. For best results, use a standardized astragalus supplement. Dosages depend on a number of factors, such as whether astragalus is being used primarily as an adaptogen or for other reasons. People should work with a knowledgeable provider to determine the appropriate dosing schedule for their needs.

Precautions

At recommended doses, astragalus has no serious side effects and can generally be used safely. It does interact with other herbs and medications (see Possible Interactions section).

Evidence about whether astragalus is safe for women who are breastfeeding or nursing is lacking. Talk to your doctor before taking any medication, including herbs.

People with autoimmune disease should speak with their doctor first before taking Astagalus because it may stimulate the immune system.

Many practitioners recommend against using any single "adaptogenic" herbs over long periods of time. Instead, they might suggest rotating among several "adaptogens" every couple of months.

Possible Interactions

If you take any of the following medications, you should not use astragalus without first asking your doctor:

Drugs that suppress the immune system: Astragalus may interfere with these drugs. If you have an autoimmune disease, such as rheumatoid arthritis or lupus, or take cyclophosphamide, a medication used to reduce the chances of rejection in transplant recipients, or corticosteroids, do not take astragalus.

Lithium: Astragalus can make it harder for the body to get rid of lithium, so dangerously high levels of the drug could build up.

Supporting Research

Chen KT, Su CH, Hsin LH, et al. Reducing fatigue of athletes following oral administration of huangqi jianzhong tang. Acta Pharmacol Sin. 2002;23(8):757-761.

Cheng Y, Tang K, Wu S, et al. Astragalus polysaccharides lowers plasma cholesterol through mechanisms distinct from statins. PLoS One. 2011;6(11):e27437.

Duan P, Wang ZM. [Clinical study on effect of Astragalus in efficacy enhancing and toxicity reducing of chemotherapy in patients of malignant tumor]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2002;22(7):515-517.

Hao Y, Qiu QY, Wu J. Effect of Astragalus polysaccharides in promoting neutrophil-vascular endothelial cell adhesion and expression of related adhesive molecules. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2004;24(5):427-430.

Hei ZQ, Zhang JJ, Lin SQ, et al. [Effects of Astragalus membranaceus injection on nitric oxide and endothelin concentration of intestinal mucosa after hemorrhage shock-reperfusion in rats]. Zhongguo Zhong Yao Za Zhi. 2004;29(5):444-447.

Huang XY, Zhang SZ, Wang WX. Enhanced antitumor efficacy with combined administration of astagalus and pterostilbene for melanoma. Asian Pac J Cancer Prev. 2014;15(3):1163-9.

Jia XH, Yin BH, Li JC. [Effect of astragalus injection on U937 leukemia cells proliferation and apoptosis and relevant molecular mechanisms]. Zhongguo Dang Dai Er Ke Za Zhi. 2013;15(12):1128-33.

Kim SH, Lee SE, Oh H, et al. The radioprotective effects of bu-zhong-yi-qi-tang: a prescription of traditional Chinesemedicine astragalus. J Chin Med. 2002;30(1):127-137.

Li M, Wang W, Xue J, Gu Y, Lin S. Meta-analysis of the clinical value of Astragalus membranaceus in diabetic nephropathy. J Ethnopharmacol. 2011;133(2):412-9.

Mao SP, Cheng KL, Zhou YF. [Modulatory effect of Astragalus membranaceus on Th1/Th2 cytokine in patients with herpes simplex keratitis]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2004;24(2):121-123.

Matkovic Z, Zivkovic V, Korica M, et al. Efficacy and safety of Astragalus membranaceus in the treatment of patients with seasonal allergic rhinitis. Phytother Res. 2010;24:175-81.

Shao BM, Xu W, Dai H, et al. A study on the immune receptors for polysaccharides from the roots of Astragalus membranaceus, a Chinese medicinal herb. Biochem Biophys Res Commun. 2004;320(4):1103-1111.

Shi FS, Yang ZG, Di GP. [Effect of Astragalus saponin on vascular endothelial cell and its function in burn patients]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2001;21(10):750-751.

Wang D, Zhuang Y, Tian Y, Thomas GN, Ying M, Tomlinson B. Study of the effects of total flavonoids of Astragalus on atherosclerosis formation and potential mechanisms. Oxid Med Cell Longrev. 2012;2012:282383.

Yang QY, Lu S, Sun HR. Clinical effect of Astragalus granule of different dosages on quality of life in patients with chronic heart failure. Chin J Integr Med. 2011;17(2):146-9.

Zhang HW, Lin ZX, Xu C, Leung C, Chan LS. Astragalus (a traditional Chines medicine) for treating chronic kidney disease. Cochrane Database Syst Rev. 2014;10:CD008369.

Overview

Medicinal use of barberry dates back more than 2,500 years. It has been used in Indian folk medicine to treat diarrhea, reduce fever, improve appetite, relieve upset stomach, and promote vigor, as well as a sense of well being. Today, it is widely used for medicinal purposes in Iran, including for biliary disorders (such as gallbladder disease) and heartburn.

Barberry and goldenseal (Hydrastis canadensis) are often used for similar medicinal purposes because both herbs contain the chemical berberine. Berberine has been shown to inhibit the growth of bacteria in test tubes, and may help the immune system function better. The aqueous extract of barberry has beneficial effects on both the cardiovascular and neural system. As such, it may be useful in the treatment of hypertension, tachycardia (rapid heartbeat), and some neuronal disorders, such as epilepsy and convulsions. Recent studies suggest that barberry also has antioxidant properties, and may help prevent certain types of cancer.

Infection and skin disorders

Barberry is used to ease inflammation and infection of the urinary (bladder and urinary tract infections), gastrointestinal, and respiratory tracts (sore throat, nasal congestion, sinusitis, bronchitis), as well as candida (yeast) infections of the skin or vagina. Barberry extract may also improve symptoms of certain skin conditions including psoriasis and acne. More research is needed to confirm these findings.

Diarrhea

Barberry may be an effective treatment for diarrhea (including traveler's diarrhea and diarrhea caused by food poisoning). A few studies have suggested that barberry improves symptoms faster than antibiotics, perhaps because it has astringent properties, but that antibiotics may be more effective at killing bacteria in the intestines. Because of the serious consequences associated with bacterial diarrhea, if barberry is used to ease symptoms, it is best to take the herb along with standard antibiotic therapy. However, taking barberry with antibiotics may reduce the effectiveness of antibiotics. Talk to your doctor before combining the two.

Plant Description

Barberry is a shrub with gray, thorny branches that can grow to about 9 feet tall. Bright yellow flowers bloom between the months of April and June and become dark, drooping bunches of red berries in the fall. The root, bark, and berries are used for medicinal purposes.

What is It Made Of?

The stem, root bark, and fruit of barberry contain alkaloids, the most prominent of which is berberine. Laboratory studies in test tubes and animals suggest that berberine has antimicrobial (killing bacteria and parasites), anti-inflammatory, hypotensive (causing a lowering of blood pressure), sedative, and anticonvulsant effects. Berberine may also stimulate the immune system. It also acts on the smooth muscles that line the intestines. This last effect may help improve digestion and reduce gastrointestinal pain.

Available Forms

Barberry is available in capsules, fluid extracts, tinctures, and as a topical ointment. Dried roots of barberry can also be used in tea. Barberry extracts are standardized to contain 8 to 12% alkaloids (berberine).

How to Take It

Pediatric

There is not enough evidence to establish a dose for children. Certain dosages of barberry may be unsafe for children so onlly use barberry in children under the supervision of a qualified health care provider.

Adult

Dosages should be determined by your provider. Barberry should not be taken for long periods of time (more than a week) without the supervision of your doctor.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects, and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider.

People using normal and appropriate doses of barberry do not generally report side effects. Cases of nosebleeds and vomiting have been reported with extremely high doses of this herb.

In infants, berberine (a constituent of barberry) may interfere with liver function and might worsen jaundice.

Pregnant women should not take barberry because it may cause uterine contractions and trigger miscarriage.

Possible Interactions

It is not known for certain what drugs, herbs, or supplements may interact with barberry. However, it is possible that barberry may interact with the following:

Antibiotics: Taking barberry with antibiotics may decrease the effectiveness of the antibiotics. Talk to your doctor about taking barberry in conjunction with antibiotic therapy.

Anticoagulants (blood thinners): Barberry may alter the effectiveness of blood-thinning medication. DO NOT take barberry if you take anticoagulants.

Antihistamines: Barberry may increase the effects of antihistamines.

Blood pressure medication: Barberry may increase the effects of these drugs. DO NOT take barberry if you take blood pressure medication.

Celecoxib (Celebrex): Barberry may interact with Celebrex. Talk to your doctor before combining the two.

Diuretics (water pills): Barberry may increase the effects of these drugs. Talk to your doctor before combing the two.

Medications for diabetes: Barberry may lower blood sugar, making the effects of these drugs stronger. DO NOT take barberry if you take medications for diabetes.

Other drugs metabolized by the liver: Because barberry works on the liver, it may alter the way many medications, which are metabolized by the liver, work in your body. Speak with your physician about potential interactions.

Supporting Research

Abd El-Wahab AE, Ghareeb DA, Sarhan EE, Abu-Serie MM, El Demellawy MA. In vitro biological assessment of Berberis vulgaris and its active constituent, berberine: antioxidants, anti-acetylcholinesterase, anti-diabetic and anticancer effects. BMC Complement Altern Med. 2013;13:218.

Arayne MS, Sultana N, Bahadur SS. The berberis story: Berberis vulgaris in therapeutics. Pak J Pharm Sci. 2007;20(1):83-92.

Berberine. Altern Med Rev. 2000;Apr;5(2):175-177.

Bergner P. Goldenseal and the common cold; goldenseal substitutes. Medical Herbalism: A Journal for the Clinical Practitioner. 1996-1997;8(4).

Fatehi M, Saleh TM, Fatehi-Hassanabad Z, Farrokhfal K, Jafarzadeh M, Davodi S. A pharmacological study on Berberis vulgaris fruit extract. J Ethnopharmacol. 2005;102(1):46-52.

Foster S, Tyler V. Tyler's Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies. Binghamton, NY: Haworth Herbal Press; 1999:43-45.

Fouladi RF. Aqueous extract of dried fruit of Berberis vulgaris L. in acne vulgaris, a clinical trial. J Diet Suppl. 2012;9(4):253-61.

Gruenwald J, Brendler T, Jaenicke C, et al, eds. PDR for Herbal Medicines. 2nd ed. Montvale, NJ: Medical Economics Company Inc; 2000:61-62.

Imanshahidi M, Hosseinzadeh H. Pharmacological and therapeutic effects of Berberis vulgaris and its active constituent, berberine. Phytother Res. 2008;22(8):999-1012.

Ivanovska N, Philipov S. Study on the antiinflammatory action of Berberis vulgaris root extract, alkaloid fractions, and pure alkaloids. Int J Immunopharmacol. 1996;18:552-561.

Kaneda Y, Torii M, Tanaka T, et al. In vitro effects of berberine sulphate on the growth and structure of Entamoeba histolytica, Giardia lamblia and Trichomonas vaginalis. Ann Trop Med Parasitol. 1991 Aug;85(4):417-425.

Pierpaoli E, Arcamone AG, Buzzetti F, Lombardi P, Salvatore C, Provinciali M. Antitumor effect of novel berberine derivatives in breast cancer cells. Biofactors. 2013;39(6):672-9.

Rabbani GH, Butler T, Knight J, et al. Randomized controlled trial of berberine sulfate therapy for diarrhea due to enterotoxigenic Escherichia coli and Vibrio cholerae. J Infect Dis. 1987 May;155(5):979-984.

Shamsa F, Ahamadiani A, Khosrokhavar R. Antihisminic and anticholinergic activity of barberry fruit (Berberis vulgaris) in the guinea-pig ileum. J Ethnopharmacol. 1999;64:161-166.

Sun D, Courtney HS, Beachey EH. Berberine sulfate blocks adherence of Streptococcus pyogenes to epithelial cells, fibronectin, and hexadecane. Antimicrob Agents Chemother. 1988;32:1370-1374.

Tomosaka H. Antioxidant and cytoprotective compounds from Berberis vulgaris (barberry). Phytother Res. 2008;22(7):979-81.

Yesilada E, Kupeli E. Berberis crataegina DC. root exhibits potent anti-inflammatory, analgesic and febrifuge effects in mice and rats. J Ethnopharmacol. 2002 Feb;79(2):237-48.

Zhang CM, Gao L, Zheng YJ, Yang HT. Berbamine protects the heart from ischemia/reperfusion injury by maintaining cytosolic Ca(2+) homeostasis and preventing calpain activation. Circ J. 2012;76(8):1993-2002.

Zilaee M, Kermany T, Tavalaee S, Salehi M, Ghayour-Mobarhan M, Ferns GA. Barberry treatment reduces serum anti-heat shock protein 27 and 60 antibody titres and high-sensitivity c-reactive protein in patients with metabolic syndrome: a double-blind, randomized placebo-controlled trial. Phytother Res. 2014;28(8):1211-5.

Overview

Bilberry has been used for centuries, both medicinally and as a food in jams and pies. It is related to the blueberry and is native to Northern Europe. Bilberry fruit contains chemicals known as anthocyanosides, plant pigments that have excellent antioxidant properties. They scavenge damaging particles in the body known as free radicals, helping prevent or reverse damage to cells. Antioxidants have been shown to help prevent a number of long-term illnesses, such as heart disease, cancer, and an eye disorder called macular degeneration. Bilberry also contains vitamin C, which is another antioxidant.

Not many studies have examined bilberry specifically. Even fewer studies have been done in humans. Recommendations about bilberry come from research on similar antioxidants, or from test tube and animal studies.

Chronic venous insufficiency

In Europe, health care professionals use bilberry extracts to treat this condition, which occurs when valves in veins in the legs that carry blood to the heart are damaged. Studies have reported improvements in symptoms, but most were poorly designed.

Diabetes

Traditionally, bilberry leaves have been used to control blood sugar levels in people with diabetes. Research shows that all berries help reduce the body's glucose response after eating a high sugar meal. Studies suggest bilberry may be effective for managing blood sugar levels, particularly when combined with oatmeal. More research is needed. At this time, bilberry is not recommended to help manage diabetes.

Atherosclerosis

Studies show that anthocyanosides may strengthen blood vessels, improve circulation, and prevent the oxidation of LDL ("bad") cholesterol, a major risk factor for atherosclerosis (plaque that blocks blood vessels, leading to heart attack and stroke). More research is needed.

Diarrhea and wounds

Bilberry has been used in European medicine for nearly one thousand years, primarily to treat diarrhea. The fruit contains tannins, substances that act as both an anti-inflammatory and an astringent (constricting and tightening tissues). Bilberry is believed to help people with diarrhea by reducing intestinal inflammation. No studies, however, have examined bilberry's use for diarrhea.

Vision

Anthocyanosides found in bilberry fruits may also be useful for people with vision problems. During World War II, British fighter pilots reported improved nighttime vision after eating bilberry jam. Studies have shown mixed results, however. Bilberry has been suggested as a treatment for retinopathy (damage to the retina) because anthocyanosides appear to help protect the retina. Bilberry has also exhibited protective effects against macular degeneration, glaucoma, and cataracts. However, studies are lacking.

Other Disorders

Preliminary studies suggest the anthocyanosides may help lower the risk of chronic diseases, including cancer and Alzheimer disease.

Plant Description

Bilberry is a perennial shrub that grows to about 16 inches in height. It has sharp-edged, green branches and black wrinkled berries, which are ripe for picking in late summer. Bilberry is a relative of blueberry, cranberry, and huckleberry, and its fruit looks and tastes much like the American blueberry.

What is It Made Of?

The key compounds in bilberry fruit are called anthocyanosides. These compounds help build strong blood vessels and improve circulation to all areas of the body. They also prevent blood platelets from clumping together (helping to reduce the risk of blood clots), and they have antioxidant properties (preventing or reducing damage to cells from free radicals). Anthocyanidins boost the production of rhodopsin, a pigment that improves night vision and helps the eye adapt to light changes.

Bilberry fruit is also rich in tannins, a substance that acts as an astringent. The tannins have anti-inflammatory properties and may help control diarrhea.

Available Forms

You may eat bilberries fresh or dried, and you can make bilberry tea using fresh or dried berries. Bilberry extract should be standardized to contain 25% anthocyanidin. The extract contains the highest percentage of anthocyanosides, making it the strongest form of bilberry.

How to Take It

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs under the supervision of a health care provider.

Pediatric

Bilberry may be used in children 2 years of age and older for the treatment of diarrhea, but only under the supervision of your doctor.

Adult

Speak with your doctor regarding dosing.

Precautions

Bilberry fruit and extract are considered generally safe, with no known side effects. However, bilberry leaf and extract should not be taken in large quantities over an extended period of time because the tannins they contain may cause severe weight loss, muscle spasms, and even death. Taking bilberry may change the way other remedies, medicines, and even vitamins work, and using these products together may cause harmful effects. Pregnant and breastfeeding women should not use bilberry extracts unless the supervision of a knowledgeable herbal prescriber.

Possible Interactions

Anticoagulants (blood-thinning medication): In theory, because the anthocyanosides in bilberry may stop blood from clotting, there may be an increased risk of bleeding if you take bilberry with blood-thinning medication, including aspirin. The whole fruit may be safer in these instances. Ask your doctor before taking bilberry if you take blood-thinning medication.

Medication for diabetes: Because bilberry appears to lower blood sugar, it could make the effects of diabetes medication stronger. Also, taking bilberry with other herbs that also lower blood sugar may result in hypoglycemia (low blood sugar). Herbs that also lower blood sugar include ginger, ginseng, fenugreek, and garlic. DO NOT take bilberry if you take medications for diabetes.

Supporting Research

Bailey C, Day C. Traditional plants medicine as treatments for diabetes. Diabetes Care. 1989;12:553-564.

Bao L, Yao XS, Tsi D, Yau CC, CHia CS, Nagai H, Kurihara H. Protective effects of bilberry (Vaccinium myrtillus L.) extract on KBr03-induced kidney damage in mice. J Agric Food Chem. 2008;56(2):420-5.

Bell DR, Gochenaur K. Direct vasoactive and vasoprotective properties of anthocyanin-rich extracts. J Appl Physiol. 2006 Apr;100(4):1164-70.

Blumenthal M, Busse WR, Goldberg A, et al. The Complete German Commission E Monographs. Boston, MA: Integrative Medicine Communications; 1998.

Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000:18-19.

Bomser J, Madhavi DL, Singletary K, et al. In vitro anti-cancer activity of fruit extracts from Vaccinium species. Planta Med. 1996;62:212-216.

Burdulis D, Ivanauskas L, Jakstas V, Janulis V. Analysis by anthocyanin content in bilberry (Vaccinium myrtillus L.) fruit crude drugs by high-performance liquid chromatography method. Medicina. 2007;43(7):568-74.

Cignarella A, Nastasi M, Cavalli E, et al. Novel lipid-lowering properties of Vaccinium myrtillus L. leaves, a traditional antidiabetic treatment, in several models of rat dyslipidaemia: a comparison with ciprofibrate. Thromb Res. 1996;84(5):311-322.

Granfeldt YE, Bjorck IM. A bilberry drink with fermented oatmeal decreases postprandial insulin demand in young healthy adults. Nutr J. 2011;10:57.

Gruenwald J, Brendler T, Jaenicke C, et al, eds. PDR for Herbal Medicines. 2nd ed. Montvale, NJ: Medical Economics Company Inc; 2000.

Head KA. Natural therapies for ocular disorders, part two: cataracts and glaucoma. Altern Med Rev. 2001;6(2):141-166.

Kolehmainen M, Mykkanen O, Kirjavainen PV, et al. Bilberries reduce low-grade inflammation in individuals with features of metabolic syndrome. Mol Nutr Food Res. 2012;56(10):1501-10.

Kramer JH. Anthocyanosides of Vaccinium myrtillus (bilberry) for night vision -- a systematic review of placebo-controlled trials. Surv Ophthalmol. 2004 Nov-Dec;49(6):618.

Laplaud PM, Lelubre A, Chapman MJ. Antioxidant action of Vaccinium myrtillus extract on human low density lipoproteins in vitro: initial observations. Fundam Clin Pharmacol. 1997;11(1):35-40.

Logan AC, Wong C. Chronic fatigue syndrome: oxidative stress and dietary modifications. Altern Med Rev. 2001;6(5):450-459.

Magistretti NJ, Conti M, Cristini A. Antiulcer activity of an anthocyanidin from Vaccinium myrtillus. Arzneim-Forsch. 1988;38:686-690.

Maatta-Riihinen KR, Kahkonen MP, Torronen AR, et al. Catechins and procyanidins in berries of vaccinium species and their antioxidant activity. J Agric Food Chem. 2005 Nov 2;53(22):8485-91.

Muth ER, Laurent JM, Jasper P. The effect of bilberry nutritional supplementation on night visual acuity and contrast sensitivity. Altern Med Rev. 2000;5(2):164-173.

Norred CL, Finlayson CA. Hemorrhage after the preoperative use of complementary and alternative medicines. AANA J. 2000;68(3):217-220.

Puupponen-Pimia R, Nohynek L, Ammann S, Oksman-Caldentey KM, Buchert J. Enzyme-assisted processing increases antimicrobial and antioxidant activity of bilberry. J Agric Food Chem. 2008;56(3):681-8.

Rakel: Integrative Medicine. 3rd ed. St. Louis, MO: Elsevier Saunders. 2012.

Schulz V, Hansel R, Tyler VF. Rational Phytotherapy. Berlin, Germany: Springer-Verlag; 1998:193.

Sehitoglu MH, Farooqi AA, Qureshi MZ, Butt G, Aras A. Anthocyanins: targeting of signaling networks in cancer cells. Asian Pac J Cancer Prev. 2014;15(5):2379-81.

Torronen R, Sarkkinen E, Tapola N, Hautaniemi E, Kilpi K, Niskanen L. Berries modify the postprandial plasma glucose response to sucrose in healthy subjects. Br J Nutr. 2010;103(8):1094-7.

Vepsalainen S, Koivisto H, Pekkarinen E, et al. Anthocyanin-enriched bilberry and blackcurrant extracts modulate amyloid precursor protein processing and alleviate behavioral abnormalities in the APP/PS1 mouse model of Alzheimer's disease. J Nutr Biochem. 2013; 24(1):360-70.

Overview

More than two centuries ago, Native Americans discovered that the root of the black cohosh plant (Actaea racemosa, formerly known as Cimicifuga racemosa) helped relieve menstrual cramps and menopausal symptoms, such as hot flashes, irritability, mood swings, and sleep disturbances. Today, people use black cohosh for these same reasons. In fact, the herb has been widely used in Europe for more than 40 years and is approved in Germany for premenstrual discomfort, painful menstruation, and menopausal symptoms.

Menopausal Symptoms

Studies confirm that black cohosh is effective for relieving menopausal symptoms, although some have found no improvement. Early German studies found black cohosh improved physical and psychological menopausal symptoms, including anxiety, hot flashes, night sweats, and vaginal dryness.

In a study of 120 women with the menopausal symptoms, black cohosh was more effective in relieving hot flashes and night sweats than the antidepressant fluxetine (Prozac).

Given the results of most clinical studies, many experts conclude that black cohosh may be a safe and effective alternative for women who cannot or will not take hormonal replacement therapy (HRT) for menopause. A 2010 review by researchers found that black cohosh provided a 26% reduction in hot flashes and night sweats (also known as vasomotor symptoms). More recently, studies have linked black cohosh to reduced sleep disturbance among menopausal women.

However, experts do not agree on the effectiveness and safety of using black cohosh to relieve symptoms of menopause. The American College of Obstetricians and Gynecologists (ACOG) reports that many of the early studies were poorly designed and did not evaluate the safety and effectiveness of black cohosh beyond 6 months of use. A 2009 study reported that black cohosh did not relieve hot flashes any more than placebo did. Still, the ACOG recognizes the value of black cohosh for menopausal symptoms.

Until further studies are conducted, some doctors recommend only short-term (less than 6 months) use of this herb for the relief of hot flashes.

Premenstrual Syndrome

Some studies suggest black cohosh can help ease premenstrual syndrome (PMS) and menstrual pain.

Hot Flashes Related to Breast Cancer Treatments

Breast cancer medications such as tamoxifen (Nolvadex) can cause hot flashes. While many breast cancer patients may take black cohosh to reduce the number and intensity of hot flashes, two well-designed studies concluded that the herb is no more effective than placebo. In addition, Yale researchers report that herbal medicines such as black cohosh may interfere with common breast cancer treatments, such as radiation and chemotherapy drugs.

There has been some concern that black cohosh may contain plant-based estrogens, or phytoestrogens, which can stimulate the growth of breast tumors. However, a case-control clinical study of 949 breast cancer cases and 1,524 controls found that black cohosh use had significant protective effects against breast cancer development. More research is needed. Patients with a history of breast cancer, risk factors for breast cancer, or who are actively engaged in breast cancer treatment, should talk to their doctor before taking black cohosh.

Arthritis

Preliminary studies suggest that black cohosh may help reduce inflammation associated osteoarthritis and rheumatoid arthritis. In a review of scientific studies, researchers concluded that a combination of black cohosh, willow bark (Salix spp.), sarsaparilla (Smilax spp.), guaiacum (Guaiacum officinale) resin, and poplar bark (Populus tremuloides) may help relieve symptoms of osteoarthritis. However, there is not enough human research to support the use of black cohosh alone for arthritis.

Osteoporosis

Laboratory studies have found that plant-based estrogens (called phytoestrogens) in black cohosh may inhibit bone loss, such as seen with osteoporosis. More research is needed.

Plant Description

Black cohosh is a tall, flowering plant found in rich, shady woods in eastern areas of North America. A member of the buttercup family, black cohosh is also known as black snakeroot, bugbane, bugwort, and squawroot. Its rhizomes and roots (both underground parts of the plant) are used for medicinal purposes.

What Is It Made Of?

Black cohosh contains glycosides (sugar compounds), isoferulic acids (substances with anti-inflammatory effects) and, possibly phytoestrogens (plant-based estrogens), among several other active substances.

Available Forms

Black cohosh is available in capsules, tablets, liquid tincture, and extracts that can be mixed in water, and dried root for a tea. A standardized preparation of black cohosh is recommended for use in menopause.

Black cohosh should not be confused with blue cohosh, a nicotine-like herb that has similar effects but has not been thoroughly tested for its safety and effectiveness.

How to Take It

Pediatric

There are no known scientific reports on the pediatric use of black cohosh, and it is not currently recommended for children.

Adult

The recommended dose of black cohosh ranges from 20 to 80 mg per day. The tablets should be standardized to contain 1 mg of 27-deoxyactein.

For black cohosh tincture, that equals 2 to 4 ml, 1 to 3 times per day in water or tea. Two capsules or tablets typically provide the recommended daily dose.

Although used traditionally, teas may not be as effective in relieving menopausal symptoms as the standardized extract of black cohosh. To make a black cohosh drink, put 20 g of dried root in 34 oz of water. Bring to a boil and then simmer 20 to 30 minutes until the liquid is reduced by a third. Strain, cover, and store in the refrigerator or a cool, dry place. The liquid keeps for up to 48 hours. Drink one cup 3 times daily.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. However, herbs contain active substances that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs only under the supervision of a health care provider.

Some people who take high doses of black cohosh report side effects, including abdominal pain, shortness of breath, diarrhea, dizziness, headaches, joint pains, nausea, slow heart rate, tremors, visual dimness, vomiting, and weight gain. You should not use black cohosh if you have a hormone-sensitive condition, such as breast cancer, endometriosis, ovarian cancer, uterine cancer, or fibroid tumors.

It is not clear whether black cohosh stimulates the growth of breast cancer cells or inhibits their growth. Research has been limited and has produced mixed results. Women with a history of breast cancer, and those at a high risk for developing breast cancer (for example, a strong family history like a mother or sister with breast cancer), should not take black cohosh without talking to a provider.

A few cases of liver toxicity have been reported, but a direct association with the ingestion of black cohosh has not been demonstrated. However, you should not use black cohosh if you have liver damage or drink alcohol in excessive quantities. Pregnant and breastfeeding women should avoid black cohosh as the herb may stimulate contractions and lead to premature labor. However, some homeopathic practitioners recommend the use of black cohosh to induce labor in pregnant women who are at or past term. Even then, pregnant women should never use black cohosh unless under the strict supervision of a knowledgeable physician.

Possible Interactions

There are no known scientific reports of interactions between black cohosh and conventional medications. There is some concern about taking black cohosh along with medications that are toxic to the liver. Since so many medications affect the liver, it is possible that combining black cohosh with prescription medications could potentially be harmful to the liver. It is also possible that taking black cohosh could alter the effects of drugs that are metabolized by the liver. Speak with your physician and see the Precautions section.

Taking black cohosh can interact with other medicines, vitamins, and certain foods. Talk to your health care provider about possible interactions. Yale researchers also report that herbal medicines such as black cohosh may interfere with common breast cancer treatments, such as radiation and chemotherapy drugs.

Supporting Research

Amsterdam JD, Yao Y, Mao JJ, Soeller I, Rockwell K, Shults J. Randomized, double-blind, placebo-controlled trial of Cimicifuga racemosa (black cohosh) in women with anxiety disorder due to menopause. J Clin Psychopharmacol. 2009;29(5):474-83.

Bebenek M, Kemmler W, von Stengel S, Engelke K, Kalender WA. Effect of exercise and Cimicifuga racemose (CR BNO 1055) on bone mineral density, 10-year coronary heart disease risk, and menopausal complaints: the randomized controlled Training and Cimicifuga racemosa Erlangen (TRACE) study. Menopause. 2010;17(4):791-800.

Borrelli F, Ernst E. Black cohosh (Cimicifuga racemosa) for menopausal symptoms: a systematic review of its efficacy. Pharmacology Res. 2008;58(1):8-14.

Chung DJ, Kim HY, Park KH, et al. Black cohosh and St. John's wort (GYNO-Plus) for climacteric symptoms. Yonsei Med J. 2007;48(2):289-94.

Einbond L, Shimizu M, Xiao D, Nuntanakorn et al. Growth inhibitory activity of extracts and purified components of black cohosh on human breast cancer cells. Breast Cancer Research and Treatment. 2004;83(3):221-31.

Ernst E, Chrubasik S. Phyto -- anti-inflammatories. A systematic review of randomized, placebo-controlled, double-blind trials. Rheum Dis Clin North Am. 2000;26(1):13-27.

Frei-Kleiner S, Schaffner W, Rahlfs VW, Bodmer Ch, Birkhauser M. Cimicifuga racemosa dried ethanolic extract in menopausal disorders: a double-blind placebo-controlled clinical trial. Maturitas. 2005;51(4):397-404.

Fritz H, Seely D, McGowan J, et al. Black cohosh and breast cancer: a systematic review. Integr Cancer Ther. 2014;13(1):12-29.

Geller SE, Shulman LP, van Breemen RB, Banuvar S, Zhou Y, Epstein G, Hedayat S, Nikolic D, Krause EC, Piersen CE, Bolton JL, Pauli GF, Farnsworth NR. Safety and efficacy of black cohosh and red clover for the management of vasomotor symptoms: a randomized controlled trial.Menopause. 2009;16(6):1156-66.

Ismail R, Taylor-Swanson L, Thomas A, et al. Effects of herbal preparations on symptom clusters during the menopausal transition. Climacteric. 2015;18(1):11-28.

Jacobson JS, Troxel AB, Evans J, et al. Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer. J Clin Oncol. 2001;19(10):2739-45.

Jiang K, Jin Y, Huang L, et al. Black cohosh improves objective sleep in postmenopausal women with sleep disturbance. Climacteric. 2015;18(4):559-67.

Leach MJ, Moore V. Black Cohosh (Cimicifuga supp.) for menopausal symptoms. Cochrane Database Syst Rev. 2012;9:CD007244.

McKenna DJ, Jones K, Humphrey S, Hughes K. Black cohosh: efficacy, safety, and use in clinical and preclinical applications. [Review]. Altern Ther Health Med. 2001;7(3):93-100.

Mahady GB, Low D, Barrett ML, Chavez ML, gardiner P, Ko R, Marles RJ, Pellicore LS, Giancaspro GI, Sarma DN. United Sates Pharmacopeia review of the black cohosh case reports of hepatotoxicity. Menopause. 2008;15(4 pt 1):628-38.

Mahady GB. Black cohosh (Actaea/Cimicifuga racemosa): review of the clinical data for safety and efficacy in menopausal symptoms. Treat Endocrinol. 2005;4(3):177-84.

Newton KM, Reed SR, LaCroix AZ, Grothaus LC, Ehrlich K, Guiltinan J. Treatment of Vasomotor Symptoms of Menopause with Black Cohosh, Multibotanicals, Soy, Hormone Therapy, or Placebo. Annals of Internal Medicine. 2006 December;145(12):869-79.

Niederhuber: Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Saunders; 2013.

Oktem M, Eroglu D, Karahan HB, Taskintuna N, Kuscu E, Zeyneloglu HB. Black cohosh and fluoxetine in the treatment of postmenopausal symptoms: a prospective, randomized trial. Adv Ther. 2007;24(2):448-61.

Palacio C, Masri G, Mooradian AD. Black cohosh for the management of menopausal symptoms: a systematic review of clinical trials. Drugs Aging. 2009;26(1):23-36.

Qiu SX, Dan C, Ding LS, et al. A triterpene glycoside from black cohosh that inhibits osteoclastogenesis by modulating RANKL and TNFalpha signaling pathways. Chem Biol. 2007;14(7):860-9.

Rakel. Rakel Integrative Medicine. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012.

Reed SD, Newton KM, Lacroix AZ, Grothaus LC, Grieco VS, Ehrlich K. Vaginal, endometrial, and reproductive hormone findings: randomized, placebo-controlled trial of black cohosh, multibotanical herbs, and dietary soy for vasomotor symptoms: the Herbal Alternatives for Menopause (HALT) Study. Menopause. 2007;Publish Ahead of Print [Epub ahead of print].

Rockwell S, Liu Y, Higgins S. Alteration of the effects of cancer therapy agents on breast cancer cells by the herbal medicine black cohosh. Breast Cancer Research and Treatment. 2005;90(3):233-9.

Rostock M, Fischer J, Mumm A, Stammwitz U, Saller R, Bartsch HH. Black cohosh (Cimicifuga racemosa) in tamoxifen-treated breast cancer patients with climacteric complaints - a prospective observational study. Gynecol Endocrinol. 2011;27(10):844-8.

Ruediger O, Friede M, Liske E, Schnitker J, Freudenstein J, Zepelin H. Efficacy and safety of isopropanolic black cohosh extract for climacteric symptoms. Obstetrics & Gynecololgy. 2005;105:1074-83.

Sammartino A, Tommaselli GA, Gargano V, et al. Short-term effects of a combination of isoflavones, lignans and Cimicifuga racemosa on climacteric-related symptoms in postmenopausal women: a double-blind, randomized, placebo-controlled trial. Gynecol Endocrinol. 2006;22(11):646-50.

Schonberg MA, Wee CC. Menopausal symptom management and prevention counseling after the Women's Health Initiative among women seen in an internal medicine practice. J Womens Health (Larchmt). 2005;14(6):507-14.

Shams T, Setia MS, Hemmings R, McCusker J, Sewitch M, Ciam A. Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis. Altern Ther Health Med. 2010;16(1):36-44.

Teschke R. Herb induced liver injury presumably caused by black cohosh: a survey of initially purported cases and herbal quality specifications. Ann Hepatol. 2011;10(3):245-59.

Tsukamoto S, Aburatani M, Ohta T. Isolation of CYP3A4 Inhibitors from the Black Cohosh (Cimicifuga racemosa). Evid Based Complement Alternat Med. 2005;2(2):223-6.

Viereck V, Grundker C, Friess SC, et al. Isopropanolic extract of black cohosh stimulates osteoprotegerin production by human osteoblasts. J Bone Miner Res. 2005;20(11):2036-43.

Walji R, Boon H, Guns E, Oneschuk D, Younus J. Black cohosh (Cimicifuga racemosa [L.] Nutt.): safety and efficacy for cancer patients. Support Care Cancer. 2007;15(8):913-21.

Overview

Burdock has been used for centuries to treat a variety of ailments. Traditionally, it has been used as a:

• "Blood purifier" to clear the bloodstream of toxins
• Diuretic to help eliminate excess water by increasing urine output
• Topical remedy for skin problems such as eczema, acne, and psoriasis

Medicinal uses of burdock have also been reported, in treating chronic diseases, such as cancers, diabetes, and AIDS.

Extracts of burdock root are found in a variety of herbal preparations, as well as homeopathic remedies. In Traditional Chinese Medicine (TCM), burdock is often used with other herbs for sore throat and colds.

In Japan and some parts of Europe, burdock is eaten as a vegetable. Burdock contains inulin, a natural dietary fiber, and is also used to improve digestion. As a root vegetable, it possesses considerably stronger antioxidant activity than common vegetables and fruits. In fact, recent studies confirm that burdock has prebiotic properties that could improve health.

Despite the fact that burdock has been used for centuries to treat a variety of conditions, few scientific studies have examined its effects. Preliminary studies suggest topical application of burdock leaves may help treat burns.

Plant Description

Burdock is native to Europe and Northern Asia, and is now widespread throughout the United States, where it grows as a weed. In Japan and parts of Europe, it is cultivated as a vegetable.

A member of the daisy family, burdock is a stout, common weed with burrs that stick to clothing or animal fur. The plant grows to a height of about 3 to 4 feet. It has purple flowers that bloom between the months of June and October. Burdock has wavy, heart-shaped leaves that are green on top and whitish on the bottom. The deep roots, which are used medicinally, are brownish-green, or nearly black on the outside.

What is It Made Of?

Burdock consists primarily of carbohydrates, volatile oils, plant sterols, tannins, and fatty oils. Researchers are not sure which active ingredients in burdock root are responsible for its healing properties. But the herb may have anti-inflammatory, antioxidant, and antibacterial effects. Recent studies show that burdock contains phenolic acids, quercetin, and luteolin, which are all powerful antioxidants.

Available Forms

Burdock products consist of fresh or dried roots. Burdock supplements can be purchased in different forms, such as:

• Dried root powder
• Decoctions (liquid made by boiling down the herb in water)
• Tinctures (a solution of the herb in alcohol, or water and alcohol)
• Fluid extracts

How to Take It

Pediatric

There are no known scientific reports on the pediatric use of burdock, so you should only give burdock to children under the supervision of a doctor.

Adult

Speak with your doctor regarding dosing. Topical preparations of burdock are also used for skin problems (such as eczema) and wounds.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. However, herbs can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of health care provider.

Pregnant or nursing women should avoid burdock as it may cause damage to the fetus.

If you are sensitive to daisies, chrysanthemums, or ragweed, you may experience an allergic reaction to burdock, including dermatitis.

People who are dehydrated should not take burdock because the herb's diuretic effects could make dehydration worse.

It is best to avoid taking large amounts of burdock as a supplement because there are so few studies on the herb's safety. Burdock is considered safe when eaten as a food.

Because the roots of burdock closely resemble those of belladonna or deadly nightshade (Atropa belladonna), there is a risk that burdock preparations may be contaminated with these potentially dangerous herbs. Be sure to buy products from established companies.

DO NOT gather burdock in the wild.

Possible Interactions

There are no known scientific reports of interactions between burdock and conventional medications. However, you should talk to your doctor before taking burdock if you take:

• Diuretics (water pills): Burdock could make the effects of these drugs stronger, causing you to become dehydrated.
• Medications for diabetes: Burdock might lower blood sugar, resulting in hypoglycemia (low blood sugar).
• Blood-thinning medications: Burdock might slow blood clotting, and when taken with blood-thinning medications, may increase the risk of bruising and bleeding.

Supporting Research

Bissett NG, ed. Herbal Drugs and Phytopharmaceuticals. Boca Raton: CRC Press; 1994:99-101.

Blumenthal M, Busse WR, Goldberg A, et al, eds. The Complete German Commission E Monographs. Therapeutic Guide to Herbal Medicines. Boston, MA: Integrative Medicine Communications; 1998:318.

Bradley P, ed. British Herbal Compendium. Dorset, England: British Herbal Medicine Association. 1996:47-49.

Chan YS, Cheng LN, Wu JH, et al. A review of the pharmacological effects of Arctium lappa (burdock). Inflammopharmacology. 2011;19(5):245-254.

De Smet PAGM, Keller K, Hänsel R, et al, eds. Adverse Effects of Herbal Drugs. Berlin, Germany: Springer-Verlag; 1997:231-237.

Ferracane R, Graziani G, Gallo M, Fogliano V, Ritieni A. Metabolic profile of the bioactive compounds of burdock seeds, roots and leaves. J Pharm Biomed Anal. 2010;51(2):399-404.

Grases F, Melero G, Costa-Bauza A, et al. Urolithiasis and phytotherapy. Int Urol Nephrol. 1994;26:507-511.

Hutchens A. Indian Herbalogy of North America. Boston, MA: Shambhala Publications; 1991:62-65.

Kolacz NM, Jaroch MT, Bear ML, Hess RF. The effect of Burns & Wounds (B&W)/burdock leaf therapy on burn-injured Amish patients: a pilot study measuring pain levels, infection rates, and healing times. J Holist Nurs. 2014;32(4):327-40.

Li D, Kim JM, Jin Z, Zhou J. Prebiotic effectiveness of inulin extracted from edible burdock. Anaerobe. 2008;14(1):29-34.

Lin CC, Lu JM, Yang JJ, et al. Anti-inflammatory and radical scavenge effects of Arctium lappa. Am J Chin Med. 1996;24:127-137.

Lin SC, Lin CH, Lin CC, et al. Hepatoprotective effects of Arctium lappa Linne on liver injuries induced by chronic ethanol consumption and potentiated by carbon tetrachloride. J Biomed Sci. 2002 Sep-Oct;9(5):401-409.

Liu J, Cai YZ, Wong RN, et al. Comparative analysis of caffeoylquinic acids and lignans in roots and seeds among various burdock (Arctium lappa) genotypes with high antioxidant activity. J Agric Food Chem. 2012;60(16):4067-4075.

Newall C, Anderson L, Phillipson J. Herbal Medicines: A Guide for Health-care Professionals. London, England: Pharmaceutical Press; 1996:52-53.

Predes FS, Ruiz AL, Carvalho JE, Foglio MA, Dolder H. Antioxidative and in vitro antiproliferative activity of Arctium lappa root extracts. BMC Complement Altern Med. 2011;11:25.

Reiman MT, Neely AN, Boyce ST, et al. Amish burn ointment and burdock leaf dressings: assessments of antimicrobial and cytotoxic activites. J Burn Care Res. 2014;35(4):e217-23.

Swanston-Flatt SK, Day C, Flatt PR, et al. Glycaemic effects of traditional European plant treatments for diabetes. Studies in normal and streptozotocin diabetic mice. Diabetes Res. 1989;413:69-73.

Thring TS, Hili P, Naughton DP. Anti-collagenase, anti-elastase and anti-oxidant activities of extracts from 21 plants. BMC Complement Altern Med. 2009;9:27.

Tyler V. The Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies. 4th ed. New York, NY: Haworth Herbal Press; 1999:71-72.

Overview

The flower petals of the calendula plant (Calendula officinalis), or pot marigold, have been used for medicinal purposes since at least the 12th century. Calendula is native to Mediterranean countries but is now grown as an ornamental plant throughout the world. However, it is not the same as the annual marigold plant that is often grown in gardens.

Calendula has high amounts of flavonoids, plant-based antioxidants that protect cells from being damaged by unstable molecules called free radicals. Calendula appears to fight inflammation, viruses, and bacteria.

Traditionally, calendula has been used to treat stomach upset and ulcers, as well as relieve menstrual cramps, but there is no scientific evidence that calendula works for these problems. Today, calendula is often used topically, meaning it is applied to the skin.

Calendula has been shown to help wounds heal faster, possibly by increasing blood flow and oxygen to the affected area, which helps the body grow new tissue. It is also used to improve skin hydration and firmness. The dried petals of the calendula plant are used in tinctures, ointments, and washes to treat burns, bruises, and cuts, as well as the minor infections they cause. Calendula also has been shown to help prevent dermatitis or skin inflammation in people with breast cancer during radiation therapy.

Plant Description

Calendula is an annual plant that thrives in almost any soil but can typically be found in Europe, Western Asia, and the United States. It belongs to the same family as daisies, chrysanthemums, and ragweed. Its branching stems grow to a height of 30 to 60 cm, and it blooms from early spring until frost. The orange-yellow petals of the flowers are used for medicine.

Parts Used

The dried petals of the calendula plant are used for medicinal purposes.

Medicinal Uses and Indications

Today, calendula is not usually taken by mouth. The exception is when it is used in extremely small amounts in homeopathic preparations. Calendula is usually applied topically, to the skin.

Burns, cuts, and bruises

Calendula tinctures, ointments, and washes are often applied to the skin to help burns, bruises, and cuts heal faster, and to fight the minor infections they cause. Calendula cream is also used to treat hemorrhoids. Animal studies show that calendula helps wounds heal faster, maybe by increasing blood flow to the wounded area and by helping the body make new tissue. There are no scientific studies looking at whether calendula works in humans, but using it on your skin is considered safe.

Professional homeopaths often recommend using ointments with calendula to heal first-degree burns and sunburns.

Dermatitis

Early evidence suggests that calendula may help prevent dermatitis, skin inflammation, in people with breast cancer who are undergoing radiation therapy, however, other studies show no effect. Calendula is also a safe and effective remedy for diaper rash.

Ear infection (otitis media)

Ear drops containing calendula are sometimes used to treat ear infections in children. A few scientific studies have found no side effects. More research is needed to determine whether calendula helps treat ear infections.

Available Forms

Fresh or dried calendula petals are available in tinctures, liquid extracts, infusions, ointments, and creams.

Calendula products should always be protected from light and moisture, and should not be used after 3 years of storage.

How to Take It

Pediatric

Use only topical and homeopathic preparations for children.

For homeopathic dosages, consult a licensed homeopath.

Adult

Speak to your doctor regarding dosing instructions.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider.

Calendula is generally considered safe to use on your skin. DO NOT apply it to an open wound without a doctor's supervision. People who are allergic to plants in the daisy or aster family, including chrysanthemums and ragweed, may also have an allergic reaction to calendula (usually a skin rash).

Pregnant and breastfeeding women should not use calendula. In theory, calendula could interfere with conception, and possibly cause miscarriage, so couples trying to get pregnant should not use calendula.

Possible Interactions

There are no known scientific reports of interactions between calendula and conventional or herbal medications. In theory, taking calendula orally may interact with the following medications, so talk to your doctor before combining these drugs with calendula:

• Sedatives
• Medications to treat high blood pressure
• Medications to treat diabetes

Supporting Research

Akhtar N, Zaman SU, Khan BA, Amir MN, Ebrahimzadeh MA. Calendula extract: effects on mechanical parameters of human skin. Acta Pol Pharm. 2011;68(5):693-701.

Alnuqaydan AM, Lenehan CE, Hughes RR, Sanderson BJ. Extracts from Calendula officinalis offer in vitro protection agains H2O2 induced oxidative stress cell killing of human skin cells. Phytother Res. 2015;29(1):120-4.

Barajas-Farias LM et al. A dual and opposite effect of Calendula officinalis flower extract: chemoprotector and promoter in rat hepatocarcinogenesis model. PLanta Med. 2006;72(3):217-21.

Basch E, Bent S, Foppa I, et al. Marigold (Calendula officinalis):An evidence-based systematic review by the Natural Standard Research Collaboration. J Herb Pharmacother. 2006;6(3-4):135-59.

Duran V, Matic M, Jovanovc M, et al. Results of the clinical examination of an ointment with marigold (Calendula officinalis) extract in the treatment of venous leg ulcers. Int J Tissue React. 2005;27(3):101-6.

Fronza M, Heinzmann B, Hamburger M, Laufer S, Merfort I. Determination of the wound healing effect of Calendula extracts using the scratch assay with 3T3 fibroblasts. J Ethnopharmacol. 2009 Dec 10;126(3):463-7.

Hematology/Oncology Clinics of North America. Dietary supplement use in cancer care: Help or harm. Hematology/Oncology Clinics of North America. 2008;22(4).

Jimenez-Medina E, Garcia-Lora A, Paco L, Algarra I, Collado A, Garrido F. A new extract of the plant Calendula officinalis produces a dual in vitro effect: cytotoxic anti-tumor activity and lymphocyte activation. BMC Cancer. 2006;6:119.

Kassab S, Cummings M, Berkovitz S, van Haselen R, Fisher P. Homeopathic medicines for adverse effects of cancer treatments. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD004845. Review.

McQuestion M. Evidence-based skin care management in radiation therapy: clinical update. Semin Oncol Nurs. 2011;27(2):e1-17.

Panahi Y, Sharif MR, Sharif A, et al. A randomized comparative trial on the therapeutic efficacy of topical aloe vera and Calendula officinalis on diaper dermatitis in children. Scientific World Journal. 2012;2012:810234.

Pommier P, Gomez F, Sunyach MP, D'Hombres A, Carrie C, Montbarbon X. Phase III randomized trial of Calendula officinalis compared with trolamine for the prevention of acute dermatitis during irradiation for breast cancer. J Clin Oncol. 2004 Apr 15;22(8):1447-53.

Saini P, Al-Shibani N, Sun J, et al. Effects of Calendula officinalis on human gingival fibroblasts. Homeopathy. 2012;101(2):92-8.

Sarrell EM, Cohen HA, Kahan E. Naturopathic treatment for ear pain in children. Pediatrics. 2003 May;111(5 Pt 1):e574-9.

Sarrell EM, Mandelberg A, Cohen HA. Efficacy of naturopathic extracts in the management of ear pain associated with acute otitis media. Arch Pediatr Adolesc Med. 2001;155(7):796-799.

Sharp L, Finnila K, Hohansson H, Abrahamsson M, Hatschek T, Bergenmar M. No differences between Calendula cream and aqueous cream in the prevention of acute radiation skin reactions--results from a randomised blinded trial. Eur J Oncol Nurs. 2013; 17(4):429-35.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995:254-255;334.

Overview

Named after its hook-like horns, cat's claw (Uncaria tomentosa) is a woody vine native to the Amazon rainforest and other places in South and Central America. The bark and root have been used by South Americans for centuries to treat health problems including arthritis, stomach ulcers, inflammation, dysentery, and fevers. It was also used as a form of birth control.

Test tube studies indicate that cat's claw may stimulate the immune system, help relax the smooth muscles (such as the intestines), dilate blood vessels (helping lower blood pressure), and act as a diuretic (helping the body eliminate excess water).

Cat's claw also has antioxidant properties, helping the body eliminate particles known as free radicals that damage cells. Scientists believe free radicals to contribute to health problems, including heart disease and cancer. Antioxidants can help neutralize free radicals and may reduce, or even help prevent, some of the damage they cause.

Some early studies suggest cat's claw may kill tumor and cancer cells in test tubes.

Osteoarthritis

Not many scientific studies have looked at the safety and effectiveness of cat's claw, but it has been used traditionally to treat osteoarthritis (OA). One study found that it may help relieve pain from knee OA without significant side effects.

Rheumatoid arthritis

Cat's claw has been suggested as a treatment for rheumatoid arthritis (RA) because it may help reduce inflammation. One small study of people who were already taking sulfasalazine or hydroxychloroquine to treat RA found that those who also took cat's claw had fewer painful, swollen joints than those who took a placebo (dummy pill). But although cat's claw may help reduce inflammation, there is no evidence to show that it stops joint damage from getting worse. For that reason, RA should be treated with conventional medications, which can stop joint damage.

Further research

Cat's claw is being studied for a number of other possible uses, including HIV, Crohn disease, multiple sclerosis, systemic lupus erythematosus (SLE or lupus), endometriosis, kidney problems, bladder cancer, and Alzheimer disease. More research is needed before scientists can say whether it is effective.

Plant Description

Cat's claw is a thorny vine that can climb as high as 100 feet. It grows mostly in the Amazon rainforest, as well as tropical areas in South and Central America. Much of the cat's claw sold in the United States was grown in Peru.

Cat's claw got its name from the curved, claw-like thorns that grow on its stem. The root and bark of cat's claw are the parts used for medicine.

What is It Made Of?

Cat's claw contains many types of plant chemicals that help reduce inflammation, such as tannins and sterols, and fight viruses, such as quinovic acid glycosides.

Cat's claw preparations are made from the root and bark of the cat's claw vine. How effective the root and bark are may depend on what time of year the plant was harvested.

Available Forms

The bark of the cat's claw vine can be crushed and used to make tea. Standardized root and bark extracts (containing 3% alkaloids and 15% phenols) are also available in either liquid or capsule forms.

How to Take It

Pediatric

No one has studied cat's claw in children, so no one knows whether it is safe. DO NOT give a child cat's claw except under your doctor's supervision.

Adult

Speak to your health care provider regarding dosing instructions.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects, and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider.

Cat's claw appears to have few side effects, however, there have not been enough scientific studies on cat's claw to determine its safety. Some people have reported dizziness, nausea, and diarrhea when taking cat's claw. The diarrhea or loose stools tend to be mild and go away with continued use of the herb.

Pregnant or nursing women should not take cat's claw because it may cause miscarriage.

People with autoimmune diseases, skin grafts, tuberculosis, or those receiving organ transplants should not use cat's claw unless specifically directed by their physician because of its possible effects on the immune system.

People with leukemia or low blood pressure should not take cat's claw.

People with kidney or liver disease should not use cat's claw without first asking their doctor.

Possible Interactions

If you are currently taking any of the following medications, you should not use cat's claw without first talking to your health care provider.

Medications that suppress the immune system: In theory, because cat's claw may stimulate the immune system, it should not be used with medications that suppress the immune system. Those include cyclosporine or other medications prescribed following an organ transplant, or to treat an autoimmune disease.

Blood-thinning medications: Cat's claw may increase the risk of bleeding, especially if you also take blood thinners such as aspirin, warfarin (Coumadin), or clopidogrel (Plavix).

Diuretics (water pills): Cat's claw may act as a diuretic, helping the body eliminate excess fluid. If you also take diuretics, which do the same thing, you could be at risk of developing an electrolyte imbalance.

Blood pressure medication: Cat's claw may lower blood pressure. If you take medication for high blood pressure, taking cat's claw may cause your blood pressure to be too low.

Other medications: Cat's claw may interfere with some medications that are processed by the liver. If you take any medications, check with your doctor before taking cat's claw.

Supporting Research

Aquino R, De Feo V, De Simone F, et al. New compounds and anti-inflammatory activity of Uncaria tomentosa. J Nat Prod. 1991;54:453-459.

de Fatima Fernandes Vattimo M, da Silva NO. Uncaria tomentosa and acute ischemic kidney injury in rats. Rev Esc Enferm USP. 2011;45(1):194-8.

Gonzales GF, Valerio LG. Medicinal plants from Peru: a review of plants as potential agents against cancer. Anticancer Agents Med Chem. 2006;6(5):429-44.

Hardin SR. Cat's claw: an Amazonian vine decreases inflammation in osteoarthritis. Complement Ther Clin Pract. 2007 Feb;13(1):25-8.

Kaiser S, Dietrich F, de Resende PE, et al. Cat's claw oxindole alkaloid isomerization induced by cell incubation and cytotoxic activity against T24 and RT4 human bladder cancer cell lines. Planta Med. 2013;79(15):1413-20.

Keplinger K, Laus G, Wurm M, et al. Uncaria tomentosa (Willd.) Dethnomedicinal use and new pharmacological, toxicological and botanical results. J Ethnopharmacol. 1999;64:23-34.

Miller MJ, Mehta K, Kunte S, Raut V, Gala J, et al. Early relief of osteoarthritis symptoms with a natural mineral supplement and a herbomineral combination: a randomized controlled trial [ISRCTN38432711]. J Inflamm (Lond). 2005 Oct 21;2:11.

Mur E, Hartig F, Eibl G, et al. Randomized double blind trial of an extract from the pentacyclic alkaloid-chemotype of uncaria tomentosa for the treatment of rheumatoid arthritis. J Rheumatol. 2002 Apr;29(4):678-81.

Nogueira N, Coelho TM, Aguiar GC, et al. Experimental endometriosis reduction in rats treated with Uncaria tomentosa (cat's claw) extract. Eur J Obstet Gynecol Reprod Biol. 2011;154(2):205-8.

Pilarski R, Zielinski H, Ciesiolka D, et al. Antioxidant activity of ethanolic and aqueous extracts of Uncaria tomentosa (Willd.) DC. J Ethnopharmacol. 2006 Mar 8;104(1-2):18-23.

Piscoya J, Rodriguez Z, Bustamante SA, et al. Efficacy and safety of freeze-dried cat's claw in osteoarthritis of the knee: mechanisms of action of the species Uncaria guianensis. Inflamm Res. 2001;50(9):442-448.

Quilez AM, Saenz MT, Garcia MD. Uncaria tomentosa (Willd. ex. Roem. & Schult.) DC. and Eucalyptus globulus Labill. interactions when administered with diazepam. Phytother Res. 2012;26(3):458-61.

Rizzi R, Re F, Bianchi A, et al. Mutagenic and antimutagenic activities of Uncaria tomentosa and its extracts. J Ethnopharmacol. 1993;38(1):63-77.

Rosenbaum CC, O'Mathúna DP, Chavez M, Shields K. Antioxidants and antiinflammatory dietary supplements for osteoarthritis and rheumatoid arthritis. Altern Ther Health Med. 2010 Mar-Apr;16(2):32-40. Review.

Sandoval M, Charbonnet RM, Okuhama NN, et al. Cat's claw inhibits TNFalpha production and scavenges free radicals: role in cytoprotection. Free Radic Biol Med. 2000;29(1):71-78.

Setty AR, Sigal LH. Herbal medications commonly used in the practice of rheumatology: mechanisms of action, efficacy, and side effects. Semin Arthritis Rheum. 2005 Jun;34(6):773-84. Review.

Sheng Y, et al. Induction of apoptosis and inhibition of proliferation in human tumor cells treated with extracts of Uncaria tomentosa. Anticancer Res. 1998;18:3,363-3,368.

Sheng Y, Pero RW, Wagner H. Treatment of chemotherapy-induced leukopenia in a rat model with aqueous extract from Uncaria tomentosa. Phytomedicine. 2000;7(2):137-143.

Spelman K, Burns J, Nichols D, et al. Modulation of cytokine expression by traditional medicines: a review of herbal immunomodulators. Altern Med Rev. 2006 Jun;11(2):128-50. Review.

Steinberg PN. Cat's claw: medicinal properties of this Amazon vine. Nutrition Science News. 1995.

Overview

Native Americans have used cayenne (Capsicum annuum, frutescens, or red pepper) as both food and medicine for at least 9,000 years. The hot and spicy taste of cayenne pepper is mostly due to a substance known as capsaicin, which helps reduce pain.

Cayenne pepper is an important spice, particularly in Cajun and Creole cooking, and in the cuisines of Southeast Asia, China, Southern Italy, and Mexico. Cayenne has also been used in traditional Indian Ayurvedic, Chinese, Japanese, and Korean medicines as an oral remedy for stomach problems, poor appetite, and circulatory problems. It has also been applied to the skin for arthritis and muscle pain.

Today, ointments and creams with capsaicin are used in the United States and Europe to relieve pain from arthritis and shingles (Herpes zoster). Capsaicin is also a key ingredient in many pepper sprays.

Pain relief

Capsaicin has powerful pain-relieving properties when applied to the skin. It reduces the amount of substance P, a chemical that carries pain messages to the brain, in your body. When there is less substance P, the pain messages no longer reach the brain, and you feel relief. Capsaicin is often recommended for the following conditions:

• Osteoarthritis and rheumatoid arthritis, as well as joint or muscle pain from fibromyalgia or other causes.
• Nerve pain from shingles and other painful skin conditions (postherpetic neuralgia) that happens even after the skin blisters have gone away. Research is mixed. Check with your doctor to see if trying capsaicin ointment is right for you.
• Pain after surgery, such as a mastectomy or an amputation.
• Pain from nerve damage in the feet or legs from diabetes, called diabetic peripheral neuropathy. However, capsaicin doesn't seem to work for peripheral neuropathy from HIV.
• Low back pain. Several studies suggest capsaicin cream can reduce lower back pain.

Psoriasis

Capsaicin cream can reduce itching and inflammation from psoriasis, a long-lasting skin disease that generally appears as patches of raised, red skin covered by a flaky white buildup.

Weight loss

A few studies suggest that cayenne supplements may help suppress appetite and help people feel full. But not all studies agree, and many have looked at cayenne or capsaicin combined with other ingredients, making it impossible to tell whether capsaicin itself was responsible for any weight loss. More studies are needed.

Other uses

• In extremely diluted homeopathic formulations, capsaicin may help treat ear infections (otitis media).
• Preliminary studies suggest that capsaicin may help treat heartburn. More research is needed.
• Capsaicin is being investigated for treating circulatory problems (for example, heart disease from atherosclerosis or plaque blocking the arteries to the heart) and reducing the risk of an irregular heart rhythm.
• Preliminary studies suggest capsaicin has anti-tumor properties and may play a role in the treatment of certain cancers including colon, prostate, and gastrointestinal cancers.

Plant description

Cayenne is a shrub that originated in Central and South America and now grows in subtropical and tropical climates. Its hollow fruit grows into long pods that turn red, orange, or yellow when they ripen. The fruit is eaten raw or cooked, or it is dried and powdered into a spice that has been used for centuries in meals and medicines.

What is It Made of?

Capsaicin is the most active ingredient in cayenne. Other important ingredients include vitamins A and C, and flavonoids and carotenoids, pigments that give red, yellow, and orange plants their color and have antioxidant properties.

Available forms

As a spice, cayenne may be eaten raw or cooked. Dried cayenne pepper is available in powdered form, and you can add it to food, or stir it into juice, tea, or milk. It is also available in capsule form or in creams for external use. Creams should contain at least 0.075% capsaicin.

How to take it

DO NOT apply capsaicin cream to cracked skin or open wounds.

Pediatric

DO NOT give cayenne to children under 2. However, with caution, capsaicin ointment may be used on the skin for older children. DO NOT use topical cayenne ointments for more than 2 days in a row for a child.

Adult

Speak to your health care provider regarding dosing instructions.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. But herbs can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs under the supervision of a health care provider.

Cayenne does not dissolve easily in water, so it is hard to wash off. Use vinegar to get it off the skin. Capsaicin cream may cause an itching, burning sensation on the skin. These symptoms tend to go away quickly. Test capsaicin cream on a small area of your skin before extended use. If it causes irritation, or if your symptoms do not get better after 2 to 4 weeks, stop using it.

DO NOT use capsaicin with a heating pad, and DO NOT apply capsaicin cream immediately before or after a hot shower. After using capsaicin, wash your hands well and avoid touching your eyes. If you are using cayenne around children, make sure they wash their hands thoroughly after handling cayenne and DO NOT touch their eyes or nose.

Capsaicin capsules may cause stomach irritation. People with ulcers or heartburn should talk to their provider before using capsaicin. Eating too much capsaicin could cause stomach pain.

People who are allergic to latex, bananas, kiwi, chestnuts, and avocado may also have an allergy to cayenne.

Eating cayenne in food is considered safe during pregnancy. But pregnant women should not take cayenne as a supplement. Cayenne does pass into breast milk, so nursing mothers should avoid cayenne as a supplement.

Capsaicin may make some of the dangerous side effects of cocaine worse.

DO NOT use capsaicin on open wounds or broken skin.

Possible interactions

If you are currently being treated with any of the following medications, you should not use cayenne supplements without first talking to your doctor.

ACE inhibitors: Using capsaicin cream may raise the risk of developing a cough, which is one of the side effects of ACE inhibitors. These medications are used to treat high blood pressure (hypertension). People who take ACE inhibitors should talk to their doctor before taking cayenne. ACE inhibitors include:

• Captopril (Capoten)
• Elaropril (Vasotec)
• Fosinopril (Monopril)
• Lisinopril (Zestril)

Stomach acid reducers: Capsaicin can increase stomach acid, making these drugs less effective. These drugs include:

• Cimetidine (Tagamet)
• Esomeprazole (Nexium)
• Famotidine (Pepcid)
• Omeprazole (Prilosec)
• Ranitidine (Zantac)
• Over-the-counter drugs such as Maalox, Rolaids, Tums
• Nonprescription versions of Tagamet, Pepcid, Zantac, and Prilosec

Aspirin: Capsaicin may make aspirin less effective as a pain reliever. It may also increase the risk of bleeding associated with aspirin.

Blood-thinning medications and herbs: Capsaicin may increase the risk of bleeding associated with certain blood-thinning medications such as warfarin (Coumadin), clopidogrel (Plavix), and herbs such as ginkgo, ginger, ginseng, and garlic.

Medications for diabetes: Capsaicin lowers blood sugar levels, raising the risk of low blood sugar (hypoglycemia). If you have diabetes, ask your doctor before using capsaicin.

Theophylline: Regular use of cayenne may cause your body to absorb too much theophylline, which is a medication used to treat asthma. This could be dangerous.

Supporting research

Ahuja KD, Robertson IK, Geraghty DP, Ball MJ. Effects of chilli consumption on postprandial glucose, insulin, and energy metabolism. Am J Clin Nutr. 2006;84(1):63-69.

Ahuja KD, Ball MJ. Effects of daily ingestion of chilli on serum lipoprotein oxidation in adult men and women. Br J Nutr. 2006;96(2):239-242.

Ahuja KD, Robertson IK, Geraghty DP, Ball MJ. The effect of 4-week chilli supplementation on metabolic and arterial function in humans. Eur J Clin Nutr. 2007;61(3):326-333.

Allison DB, Fontaine KR, Heshka S, Mentore JL, Heymsfield SB. Alternative treatments for weight loss: a critical review. Crit Rev Food Sci Nutr. 2001;41(1):1-28; discussion 39-40.

Attal N. Chronic neuropathic pain: mechanisms and treatment [Review]. Clin J Pain. 2000;16(3 Suppl):S118-S130.

Bouraoui A, Toumi A, Mustapha HB, et al. Effects of capsicum fruit on theophylline absorption and bioavailability in rabbits. Drug-Nutrient Interact. 1988;5:345-350.

Chrubasik S, Weiser T, Beime B. Effectiveness and safety of topical capsaicin cream in the treatment of chronic soft tissue pain. Phytother Res. 2010 Dec;24(12):1877-1885.

D'Alonzo AJ, Grover GJ, Darbenzio RB, et al. In vitro effects of capsaicin: antiarrhythmic and antiischemic activity. Eur J Pharmacol. 1995;272(2-3):269-278.

Deal CL, Schnitzer TJ, Lipstein E, et al. Treatment of arthritis with topical capsaicin: a double-blind trial. Clin Ther. 1991;13(3):383-395.

Ellison N, Loprinzi CL, Kugler J, et al. Phase III placebo-controlled trial of capsaicin cream in the management of surgical neuropathic pain in cancer patients. J Clin Oncol. 1997;15(8):2974-2980.

Friese KH. Acute otitis media in children: a comparison of conventional and homeopathic treatment. Biomedical Therapy. 1997;15(4):462-466.

Fusco BM, Marabini S, Maggi CA, Fiore G, Geppetti P. Preventative effect of repeated nasal applications of capsaicin in cluster headache. Pain. 1994;59(3):321-325.

Gagnier JJ, van Tulder M, Berman B, Bombardier C. Herbal medicine for low back pain. Cochrane Database Syst Rev. [Review]. 2006 Apr 19;(2):CD004504.

Hakas JF Jr. Topical capsaicin induces cough in patient receiving ACE inhibitor. Ann Allergy. 1990;65:322.

Hautkappe M, Roizen MF, Toledano A, Roth S, Jeffries JA, Ostermeier AM. Review of the effectiveness of capsaicin for painful cutaneous disorders and neural dysfunction. [Review]. Clin J Pain. 1998;14(2):97-106.

Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. [Review]. Am J Health Syst Pharm. 2000;57(13):1221-1227.

Jensen PG, Larson JR. Management of painful diabetic neuropathy [Review]. Drugs Aging. 2001;18(10):737-749.

Jin J, Lin G, Huang H, et al. Capsaicin mediates cell cycle arrest and apoptosis in human colon cancer cells via stabilizing and activating p53. Int J Biol Sci. 2014;10(3):285-95.

Kang JH, Goto T, Han IS, Kawada T, Kim YM, Yu R. Dietary capsaicin reduces obesity-induced insulin resistance and hepatic steatosis in obese mice fed a high-fat diet. Obesity (Silver Spring). 2010 Apr;18(4):780-787.

Kenney JK, Jamjian C, Wheeler MM. Prevention and management of pain associated with Herpes zoster. Journal of Pharmaceutical Care in Pain and Symptom Control. 1999;7(3):7-26.

Laslett LL, Jones G. Capsaicin for osteoarthritis pain. Prog Drug Res. 2014;68:277-91.

Leung FW. Capsaicin as an anti-obesity drug. Prog Drug Res. 2014;68:171-9.

Mozsik G. Capsaicin as new orally applicable gastroprotective and therapeutic drug alone or in combination with nosteroidal anti-inflammatory drugs in healthy human subjects and in patients. Prog Drug Res. 2014;68:209-58.

Nicholas JJ. Physical modalities in rheumatological rehabilitation. Archives of Physical and Medical Rehabilitation. 1994;75(9):994-1001.

Paice JA, Ferrens CE, Lashley FR, Shott S, Vizgirda V, Pitrak D. Topical capsaicin in the management of HIV-associated peripheral neuropathy. J Pain Symtom Manage. 2000;19(1):45-52.

Petersen KL, Fields HL, Brennum J, Sandroni P, Rowbotham MC. Capsaicin evoked pain and allodynia in post-herpetic neuralgia. Pain. 2000;88:125-133.

Rains C, Bryson HM. Topical Capsaicin. A review of its pharmacological properties and therapeutic potential in post-herpetic neuralgia, diabetic neuropathy and osteoarthritis. Drugs and Aging. 1998;7(4):317-328.

Reinbach HC, Smeets A, Martinussen T, Møller P, Westerterp-Plantenga MS. Effects of capsaicin, green tea and CH-19 sweet pepper on appetite and energy intake in humans in negative and positive energy balance. Clin Nutr. 2009 Jun;28(3):260-265.

Robbins W. Clinical applications of capsaicinoids [Review]. Clin J Pain. 2000;16(2 Suppl):S86-S89.

Sharma SK, Vij AS, Sharma M. Mechanisms and clinical uses of capsaicin. Eur J Pharmacol. 2013;720(1-3):55-62.

Stam C, Bonnet MS, van Haselen RA. The efficacy and safety of a homeopathic gel in the treatment of acute low back pain: a multi-centre, randomised, double-blind comparative clinical trial. Br Homeopath J. 2001;90(1):21-28.

Stander S, Luger T, Metze D. Treatment of prurigo nodularis with topical capsaicin. J Am Acad Dermatol. 2001;44(3):471-478.

Stankus SJ, Dlugopolski M, Packer D. Management of herpes zoster (shingles) and postherpetic neuralgia. [Review]. Am Fam Physician. 2000;61(8):2437-44, 2447-2448.

Volmink J, Lancaster T, Gray S, Silagy C. Treatments for postherpetic neuralgia--a systematic review of randomized controlled trials. Fam Pract. 1996;13(1):84-91.

Yeoh KG, Kang JY, Yap I, et al. Chili protects against aspirin-induced gastroduodenal mucosal injury in humans. Dig Dis Sci. 1995;40:580-583.

Yoshioka M, St-Pierre S, Suzuki M, Tremblay A. Effects of red pepper added to high-fat and high-carbohydrate meals on energy metabolism and substrate utilization in Japanese women. Br J Nutr. 1998;80(6):503-510.

Zhang WY, Li Wan Po A. The effectiveness of topically applied capsaicin. Eur J Clin Pharmacol. 1994;46:517-522.

Overview

Celery seed has been used as medicine for thousands of years in the Eastern world. During ancient times, Indian Ayurvedic medicine used celery seed to treat colds, flu, water retention, poor digestion, different types of arthritis, and certain diseases of the liver and spleen.

Today, celery seed is used mostly as a diuretic, meaning it helps your body eliminate water by increasing urine output. Celery seed is also used for:

• Treating arthritis and gout
• Helping reduce muscle spasms
• Calming the nerves
• Reducing inflammation
• Lowering blood pressure

There are no human scientific studies that show whether celery seed helps treat these conditions or any others. Studies do show that celery seed acts as a mosquito repellent.

A few animal studies suggest that celery seed extracts may help lower blood pressure and cholesterol, as well as protect the liver from damaging substances such as high doses of the pain reliever acetaminophen (Tylenol). But again, researchers do not know whether those effects apply to humans.

Researchers have found that people who eat a diet rich in lutein, found in celery, spinach, broccoli, lettuce, tomatoes, oranges, carrots, and greens, were less likely to develop colorectal cancer. However, celery was just one part of their diet. So it could be celery, another food, or some combination of foods that lowered their risk of cancer.

Plant description

The celery plant is slender and stands about 2 to 3 feet tall. It has 3 to 5 segmented leaves and flowers with small white petals. Celery seeds, which are found in the flowers, are very small, tan to dark brown, and have a strong, pleasant smell.

What is it Made of?

Celery seeds contain several substances, including:

• Volatile oils
• Flavonoids, which are antioxidants that give plants their colors and may protect cells from damage
• Coumarins, chemicals that help thin the blood
• Linoleic acid, an omega-6 fatty acid

Available forms

Celery seeds are available as:

• Fresh or dried seeds
• Tablets
• Capsules filled with celery seed oil
• Celery seed extract

How to take it

Pediatric

Scientists have not studied celery seeds in children, so it is not recommended for use in children under 18.

Adult

The dose depends on what you are taking it for and which form you are taking, such as celery seed oil capsules or tablets, extract, or whole celery seeds. Ask your doctor to help you determine the right dose.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. However, herbs can have side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs under the supervision of a health care provider.

Pregnant women should not use celery seed because it may lead to uterine bleeding and muscle contractions in the uterus, which could cause miscarriage.

People with active kidney inflammation should not take celery seed.

People with low blood pressure should use caution when considering taking celery seed as a supplement.

Some people who are allergic to birch pollen may also be allergic to celery seed.

Some of the chemicals in celery stems and seeds can cause the skin to become very sensitive to the sun's UV rays. Use sunscreen or sunblock lotions.

DO NOT take celery seeds from a gardening packet. These seeds have usually been treated with chemicals.

Possible interactions

Few studies have investigated celery seed, so researchers do not really know whether it interacts with other herbs and medications. However, people who take the following medicines should ask their doctors before taking celery seed.

Lithium: Celery seed may alter how this medication is excreted in the body.

Thyroid medications: Celery seed may interact with thyroid medications.

Diuretics (water pills): Celery seed acts as a diuretic. So it could make the effects of other diuretics stronger and raise the risk of dehydration.

Blood-thinning medications (anticoagulants and antiplatelets): Celery seed contains chemicals that may thin the blood. This could make the effects of blood thinners stronger and raise the risk of bleeding. Blood thinners include aspirin, warfarin (Coumadin), and clopidogrel (Plavix).

Other medications: Celery seed may interact with lithium, thyroid medications, and sedatives.

Supporting Research

Ahmed B, Alam T, Varshney M, Khan SA. Hepatoprotective activity of two plants belonging to the Apiaceae and the Euphorbiaceae family. J Ethnopharmacol. 2002 Mar;79(3):313-6.

Al-Howiriny T, Alsheikh A, Alqasoumi S, Al-Yahya M, ElTahir K, Rafatullah S. Gastric antiulcer, antisecretory and cytoprotective properties of celery (Apium graveolens) in rats. Pharm Biol. 2010 Jul;48(7):786-93.

Atta AH, Alkofahi A. Anti-nociceptive and anti-inflammatory effects of some Jordanian medicinal plant extracts. J Ethnopharmacol. 1998;60:117-124.

Banerjee S, Sharma R, Kale RK, Rao AR. Influence of certain essential oils on carcinogen-metabolizing enzymes and acid-soluble sulfhydryls in mouse liver. Nutr Cancer. 1994;21:263-269. Abstract.

Boffa MJ, Gilmour E, Ead RD. Case report. Celery soup causing severe phototoxicity during PUVA therapy [letter]. Br J Dermatol. 1996;135(2):334.

Cheung MC, Lin LY, Yu TH, Peng RY. Hypolipidemic and antioxidant activity of mountian celery seed essential oils. J Agric Food Chem. 2008;56(11):3997-4003.

Choochote W. et al., Potential of crude seed extract of celery, Apium graveolens L., against the mosquito Aedes aegypti (L.) (Diptera: Culicidae). J Vector Ecol. 2004;29(2):340-6.

Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm. 2000;57(13):1221-1227.

Ko FN, Huang TF, Teng CM. Vasodilatory action mechanisms of apigenin isolated from Apium graveolens in rat thoracic aorta. Biochim Biophys Acta. November 14; 1991;1115:69-74.

Miller L. Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med. 1988;158(20):2200-2211.

Moghadam MH, Imenshahidi M, Mohajeri SA. Antihypertensive effect of celery seed on rat blood pressure in chronic administration. J Med Food. 2013;16(6):558-63.

Singh A, Handa SS. Hepatoprotective activity of Apium graveolens and Hygrophila auriculata against paracetamol and thioacetamide intoxication in rats. J Ethnopharmacol. 1995;49:119-126.

Slattery ML, Benson J, Curtin K, Ma K-N, Schaeffer D, Potter JD. Carotenoids and colon cancer. Am J Clin Nutr. 2000;71:575-582.

Sultana S, Ahmed S, Jahangir T, Sharma S. Inhibitory effect of celery seeds extract on chemically induced hepatocarcinogenesis: modulation of cell proliferation, metabolism and altered hepatic foci development. Cancer Lett. 2005;221(1):11-20.

Teng CM, Lee LG, Ko SN, et al. Inhibition of platelet aggregation by apigenin from Apium graveolens. Asia Pac J Pharmacol. 1985;3:85.

Tsi D, Das NP, Tan BK. Effects of aqueous celery (Apium graveolens) extract on lipid parameters of rats fed a high fat diet. Planta Med. 1995;61:18-21.

Tuetun B, et al., Mosquito repellency of the seeds of celery (Apium graveolens L.). Ann Trop Med Parasitol. 2004;98(4):407-17.

Zheng GQ, Kenney PM, Zhang J, Lam LK. Chemoprevention of benzo[a]pyrene-induced forestomach cancer in mice by natural phthalides from celery seed oil. Nutr Cancer. 1993;19:77-86.

Zhou Y, Taylor B, Smith TJ, Liu ZP, Clench M, Davies NW, Rainsford KD. A novel compound from celery seed with a bactericidal effect against Helicobacter pylori. J Pharm Pharmacol. 2009 Aug;61(8):1067-77.

Overview

Comfrey (Symphytum officinale) is sometimes used on the skin to treat wounds and reduce inflammation from sprains and broken bones. Comfrey roots and leaves contain allantoin, a substance that helps new skin cells grow, along with other substances that reduce inflammation and keep skin healthy. Comfrey ointments have been used to heal bruises as well as pulled muscles and ligaments, fractures, sprains, strains, and osteoarthritis.

In the past, comfrey was also used to treat stomach problems. However, it has toxic substances called pyrrolizidine alkaloids that damage the liver and can lead to death. Comfrey is no longer sold in the U.S., except in creams or ointments. The United Kingdom, Australia, Canada, and Germany also have banned the sale of oral products containing comfrey.

The dangerous substances in comfrey are also absorbed through the skin, so harmful amounts may build up in the body. Be careful if you use an ointment containing comfrey (see How to Take It section), and never use comfrey on broken skin.

Plant Description

Comfrey is a perennial shrub that is native to Europe and some parts of Asia. Fond of moist soils, comfrey has a thick, hairy stem, and grows 2 to 5 feet tall. Its flowers are dull purple, blue or whitish, and densely arranged in clusters. The leaves are oblong, and often look different depending on where they are on the stem. Lower leaves are broad at the base and tapered at the ends while upper leaves are broad throughout and narrow only at the ends. The root has a black outside and fleshy whitish inside filled with juice.

Comfrey preparations are made from the leaves or other parts of the plant grown above the ground. New leaves tend to have more of the poisonous pyrrolizidine alkaloids than older leaves. Some preparations were also made from the roots, but roots contain up to 16 times the amount of pyrrolizidine alkaloids.

What is it Made Of?

Comfrey contains substances that help skin regrow, including allantoin, rosmarinic acid, and tannins. It also has poisonous chemicals called pyrrolizidine alkaloids.

Available Forms

Oral comfrey products have been banned in the U.S. and many European countries, but you can still find creams and ointments for the skin.

Comfrey ointments (containing 5 to 20% comfrey), creams, poultices, and liniments are made from the fresh or dried herb, leaf, or root of comfrey species. Use only products made from leaves of common comfrey.

Be sure to buy comfrey products from companies with good reputations. Follow dosage recommendations below.

How to Take It

Pediatric

Never give a child comfrey by mouth. DO NOT put creams or ointments with comfrey on a child's skin.

Adult

• Never take comfrey by mouth. Severe liver poisoning and even death may occur.

When using herb and leaf ointments, creams, and other preparations for the skin, follow these safety recommendations:

• Never apply comfrey to broken skin.
• Use only small amounts of creams with comfrey for no longer than 10 days at a time.
• DO NOT use any comfrey product for more than 4 to 6 total weeks in one calendar year.

Precautions

Comfrey has toxic substances that can cause severe liver damage and even death. You should never take comfrey by mouth.

The toxic substances in comfrey can be absorbed by the skin. Even creams and ointments should be used for only a short time, and only under a doctor's supervision.

DO NOT use comfrey on open wounds or broken skin.

DO NOT use comfrey if you have liver disease, alcoholism, or cancer.

Children, the elderly, and pregnant or breastfeeding women should not use comfrey products, even ones for the skin.

Possible Interactions

Since comfrey may increase the risk of liver damage, it should not be used with other medications that may also affect the liver, such as acetaminophen (Tylenol). If you take any medications, whether prescription or over the counter, ask your doctor before using comfrey.

You should not use some herbs that have also been known to cause liver problems, such as kava, skullcap, and valerian, while using comfrey ointments or creams.

Supporting Research

Barna M, Kucera A, Hladíkova M, Kucera M. Randomized double-blind study: wound-healing effects of a Symphytum herb extract cream (Symphytum×uplandicum Nyman) in children. Arzneimittelforschung. 2012 Jun;62(6):285-9. doi: 10.1055/s-0032-1308981.

Bleakley CM, McDonough SM, MacAuley DC. Some conservative strategies are effective when added to controlled mobilisation with external support after acute ankle sprain: a systematic review. Aust J Physiother. 2008;54(1):7-20.

D'Anchise R, Bulitta M, Giannetti B. Comfrey extract ointment in comparison to diclofenac gel in the treatment of acute unilateral ankle sprains. Arzneimittelforschung. 2007;57(11):712-6.

Frost R, MacPherson H, O'Meara S. A critical scoping review of external uses of comfrey (Symphytum spp.). Complement Ther Med. 2013;21(6):724-45.

Frost R, O'Meara S, MacPherson H. The external use of comfrey: a practioner survey. Complement Ther Clin Pract. 2014;20(4):347-55.

Grube B, Grunwald J, Krug L, Staiger C. Efficacy of comfrey root (Symphyti offic. radix) extract ointment in the treatment of patients with painful osteoarthritis of the knee: results of a double-blind randomised, bicenter, placebo-controlled trial. Phytomedicine. 2007;14(1):2-10.

Koll R, Klingenburg S. Therapeutic characteristance and tolerance of topical comfrey preparations. Results of an observational study of patients. Fortschr Med Orig. 2002;120(1):1-9.

Miller LG. Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med. 1998;158(20):2200-2211.

Miskelly FG, Goodyer LI. Hepatic and pulmonary complications of herbal medicines. Postgrad Med J. 1992;68:935-936.

Pabst H, Schaefer A, Staiger C, Junker-Samek M, Predel HG. Combination of Comfrey Root Extract Plus Methyl Nicotinate in Patients with Conditions of Acute Upper or Low Back Pain: A Multicentre Randomised Controlled Trial. Phytother Res. 2012 Aug 8. doi:10.1002/ptr.4790.

Ridker PM, Ohkuma S, McDermott WV, Trey C, Huxtable RJ. Hepatic venocclusive disease associated with the consumption of pyrrolizidine-containing dietary supplements. Gastroenterology. 1985;(88):1050-1054.

Smith DB, Jacobson BH. Effect of a blend of comfrey root extract (Symphytum officinale L.) and tannic acid creams in the treatment of osteoarthritis of the knee: randomized, placebo-controlled, double-blind, multiclinical trials. J Chiropr Med. 2011 Sep;10(3):147-56. doi: 10.1016/j.jcm.2011.01.003.

Staiger C. Comfrey: a clinical overview. Phytother Res. 2012 Oct;26(10):1441-8. doi: 10.1002/ptr.4612.

Staiger C. Comfrey root: from tradition to modern clinical trials. Wien Med Wochenschr. 2013;163(3-4):58-64.

Stickel F, Seitz HK. The efficacy and safety of comfrey. Public Health Nutr. 2000;3(4A):501-508.

Weston CFM, Cooper BT, Davies JD, et al. Veno-occlusive disease of the liver secondary to ingestion of comfrey. Br Med J. 1987;295:183.

Yeong ML, Swinburn B, Kennedy M, Nicholson G. Hepatic veno-occlusive disease associated with comfrey ingestion. J Gastroenterol Hepatol. 1990;5(2):211-214.

Overview

Cranberry (Vaccinium macrocarpon) has been used as both food and medicine for centuries. It is native to North America and was used by Native Americans to treat bladder and kidney diseases. Early settlers from England learned to use the berry both raw and cooked for many conditions, including appetite loss, stomach problems, blood disorders, and scurvy caused by not getting enough vitamin C.

Cranberry is best known for preventing urinary tract infections (UTIs), commonly caused by bacteria known as Escherichia coli (E. coli). At first doctors thought cranberry worked by making urine acidic enough to kill the bacteria. Now, studies show that cranberry may prevent bacteria from attaching to the walls of the urinary tract. Good scientific studies support using cranberry either in capsules or as juice, for preventing, though not treating, UTIs.

Plant Description

Found primarily in North America and grown in bogs, cranberry is an evergreen shrub related to blueberry, buckberry, huckleberry, and bilberry. The cranberry bush has upright branches with leaves that are speckled underneath by tiny dots. Pink flowers blossom and red-black fruits appear during June and July.

Cranberry fruit is high in antioxidants, partly from substances called proanthocyanidins, which give cranberries their vibrant color. Antioxidants neutralize particles in the body known as free radicals, which damage DNA and are thought to contribute to heart disease, diabetes, cancer, and other conditions.

Cranberries are also an excellent source of vitamin C, another important antioxidant. Scientists are researching to see if the antioxidants in cranberries will help protect against heart disease and cancer.

Parts Used

The ripe fruit of the cranberry is the part used as food and medicine.

Medicinal Uses and Indications

Urinary tract infections

Several studies indicate that cranberry helps prevent UTIs of the bladder and urethra (the tube that drains urine from the bladder), especially for women who have frequent UTIs. In one study of older women, cranberry juice reduced the amount of bacteria in the bladder compared to placebo. Another study showed that younger women with a history of frequent UTIs who took cranberry capsules had fewer UTIs compared to those who took placebo.

However, studies suggest that cranberry does not work once you have a UTI. That is because it helps keep bacteria from attaching to the urinary tract. But it is less effective once the bacteria have already attached. That is why cranberry is better at preventing UTIs than treating them. UTIs should be treated with conventional antibiotics.

Ulcers

Two studies showed that cranberry may also prevent the bacteria Helicobacter pylori (H. pylori) from attaching to stomach walls. H. pylori can cause stomach ulcers. So cranberries may play a role in preventing stomach ulcers. More research is needed to be sure cranberry helps.

Other uses

Scientists are still studying cranberry for the following conditions. More research is needed.

Cancer: Some test tube and animal studies suggest cranberry may help stop cancer cells from growing.

High cholesterol: One preliminary study found that drinking cranberry juice raised HDL (good) cholesterol levels.

Viruses: Cranberry seems to fight some viruses in test tubes. Studies in people are needed.

Bacterial illnesses: Cranberry has been shown to inhibit common forms of bacteria, such as Escherichia coli (E. coli) and Listeria monocytogenes.

Available Forms

You can get cranberries fresh or frozen, and in juice and concentrate forms. Dried berries are also available as tablets or capsules. Pure cranberry juice is very sour, so most juices contain a mixture of cranberries, vitamin C, and sweeteners, which may make the juice less healthy. Look for a brand of cranberry juice that has the lowest amount of added sugar or is sugar-free.

How to Take it

Pediatric

Cranberry juice is considered safe for children to drink. However, there is not enough evidence to say what would be a safe dose for children who tend to get UTIs. A child with a UTI should be seen by a doctor.

DO NOT give children cranberry supplements.

Adult

• Juice: Studies have used 3 or more fluid oz. of pure juice per day, or about 10 oz. of cranberry juice cocktail, for preventing UTIs. Ask your doctor about the right dose for you.
• Fresh or frozen cranberries: 1.5 oz.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a health care provider.

Cranberry juice as a beverage (in normal amounts) is generally considered safe to drink with no serious side effects, even for pregnant women. Cranberry supplements are considered safe for most people, although pregnant and breastfeeding women should ask their doctor before taking any supplement, including cranberry.

Cranberry has relatively high levels of oxalate, chemicals that may raise the risk of kidney stones in some people. If you have kidney stones, talk to your doctor before taking cranberry supplements or drinking a lot of cranberry juice.

DO NOT use cranberry if you already have a UTI. You should see a doctor for prescription antibiotics.

Most cranberry juice has added sugar. People who have diabetes should look for brands that are artificially sweetened or should be careful how much sweetened juice they drink.

People who are allergic to aspirin may also be allergic to cranberry.

Possible Interactions

Warfarin (Coumadin): Cranberry may raise the risk of bleeding, especially if you already take medications to thin the blood such as warfarin. It increases the amount of time that warfarin stays in your body. The evidence is mixed and not completely clear, so it is best to ask your doctor before you take cranberry or drink a lot of juice.

Aspirin: Like aspirin, cranberries contain salicylic acid. If you take aspirin regularly, as a blood-thinner, for example, or if you are allergic to aspirin, you should not take cranberry supplements or drink a lot of juice.

Other medications: Cranberry may interact with medications that are broken down by the liver. To be safe, if you take any medications, ask your doctor before taking cranberry.

Supporting Research

Ahuja S, Kaack B, Roberts J. Loss of fimbrial adhesion with the addition of Vaccinium macrocarpon to the growth medium of P-fimbriated Escherichia coli. J Urol. 1998;159:559-562.

Aston JL, Lodolce AE, Shapiro NL. Interaction between warfarin and cranberry juice. Pharmacotherapy. 2006 Sep;26(9):1314-9.

Avorn J, Monane M, Gurwitz JH, Glynn RJ, Choodnovskiy I, Lipsitz LA. Reduction of bacteriuria and pyuria after ingestion of cranberry juice. JAMA. 1994;271:751-754.

Bailey DT, Dalton C, Joseph Daugherty F, et al. Can a concentrated cranberry extract prevent recurrent urinary tract infections in women? A pilot study. Phytomedicine. 2007 Feb 10; [Epub ahead of print].

Bomser J, Madhavi DL, Singletary K, et al. In vitro anticancer activity of fruit extracts from Vaccinium species. Planta Med. 1996;62(3):212-216.

Burger O, Ofek I, Tabak M, et al. A high molecular mass constituent of cranberry juice inhibits helicobacter pylori adhesion to human gastric mucus. FEMS Immunol Med Microbiol. 2000 Dec;29(4):295-301.

Caton PW, Pothecary MR, Lees DM, Khan NQ, Wood EG, Shoji T, Kanda T, Rull G, Corder R. Regulation of vascular endothelial function by procyanidin-rich foods and beverages. J Agric Food Chem. 2010 Apr 14;58(7):4008-13.

Côté J, Caillet S, Doyon G, Sylvain JF, Lacroix M. Analyzing cranberry bioactive compounds. Crit Rev Food Sci Nutr. 2010 Oct;50(9):872-88.

Dugoua JJ, Seely D, Perri D, Mills E, Koren G. Safety and efficacy of cranberry (vaccinium macrocarpon) during pregnancy and lactation. Can J Clin Pharmacol. 2008;15(1):e80-6.

Duthie SJ, Jenkinson AM, Crozier A, et al. The effects of cranberry juice consumption on antioxidant status and biomarkers relating to heart disease and cancer in healthy human volunteers. Eur J Nutr. 2006 Mar;45(2):113-22. Epub 2005 Jul 20.

Hamilton K, Bennett NC, Purdie G, Herst PM. Standardized cranberry capsules for radiation cystitis in prostate cancer patients in New Zealand: a randomized double blinded, placebo controlled pilot study. Support Care Cancer. 2015;23(1):95-102.

Howell AB, Vorsa N, Der Marderosian A, et al. Inhibition of the adherence of P-fimbriated Escherichia coli to uroepithelial-cell surfaces by proanthocyanidin extracts from cranberries. N Engl J Med. 1998;339(15):1085-1086.

Jepson RG, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2008;1:CD001321.

Kontiokari T, Sundqvist K, Nuutinen M, et al. Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women. BMJ. 2002;322:1571-1573.

Lacombe A, McGivney C, Tadepalli S, Sun X, Wu VC. The effect of American cranberry (Vaccinium macrocarpon) constituents on the growth inhibition, membrane integrity, and injury of Escherichia coli O157:H7 and Listeria monocytogenes in comparison to Lactobacillus rhamnosus. Food Macrobiol. 2013;34(2):352-9.

Ledda A, Bottari A, Luzzi R, et al. Cranberry supplementation in the prevention of non-severe lower urinary tract infections: a pilot study. Eur Rev Med Pharmacol Sci. 2015;19(1):77-80.

McKay DL, Blumberg JB. Cranberries (Vaccinium macrocarpon) and cardiovascular disease risk factors. Nutr Rev. 2007;65(11):490-502.

Paeng CH, Sprague M, Jackevicius CA. Interaction between warfarin and cranberry juice. Clin Ther. 2007;29(8):1730-5.

Pedersen CB, Kyle J, Jenkinson AM, et al. Effects of blueberry and cranberry juice consumption on the plasma antioxidant capacity of healthy female volunteers. Eur J Clin Nutr. 2000;54(5):405-408.

Prasain JK. Effect of cranberry juice concentrate on chemically-induced urinary bladder cancers. Oncol Rep. 2008;19(6)1565-70.

Rossi R, Porta S, Canovi B. Overview on cranberry and urinary tract infections in females. J Clin Gastroenterol. 2010 Sep;44 Suppl 1:S61-2. Review.

Ruel G, Pomerleau S, Couture P, Lemieux S, Lamarche B, Couillard C. Low-calorie cranberry juice supplementation reduces plasma oxidized LDL and cell adhesion molecule concentrations in men. Brit J Nutr. 2008;99(2):352-9.

Schlager TA. Effect of cranberry juice on bacteriuria in children with neurogenic bladder. J Pediatr. 1999;135:698-702.

Shmuely H, Yahav J, Samra Z, et al. Effect of cranberry juice on eradication of Helicobacter pylori in patients treated with antibiotics and a proton pump inhibitor. Mol Nutr Food Res. 2007 Jun;51(6):746-51.

Terris MK, Issa MM, Tacker JR. Dietary supplementation with cranberry tablets may increase the risk of nephrolithiasis. Urol. 2001;57:26-29.

Vasileiou I, Katsargyris A, Theocharis S, Giaginis C. Current clinical status on the preventive effects of cranberry consumption against urinary tract infections. Nutr Res. 2013; 33(8):595-607.

Weiss EI, Lev-Dor R, Kashamn Y, et al. Inhibiting interspecies coaggregation of plaque bacteria with a cranberry juice constituent. J Am Dent Assoc. 1998;129(12):1719-1723.

Zhang L, Ma J, Pan K, et al. Efficacy of cranberry juice on Helicobacter pylori infection: a double-blind, randomized placebo-controlled trial. Helicobacter. 2005 Apr;10(2):139-45.

Overview

While many people think of the dandelion (Taraxacum officinale) as a pesky weed, it is chock full of vitamins A, B, C, and D, as well as minerals, such as iron, potassium, and zinc. Dandelion leaves are used to add flavor to salads, sandwiches, and teas. The roots are used in some coffee substitutes, and the flowers are used to make wines.

In the past, dandelion roots and leaves were used to treat liver problems. Native Americans also boiled dandelion in water and took it to treat kidney disease, swelling, skin problems, heartburn, and upset stomach. In traditional Chinese medicine (TCM), dandelion has been used to treat stomach problems, appendicitis, and breast problems, such as inflammation or lack of milk flow. In Europe, dandelion was used in remedies for fever, boils, eye problems, diabetes, and diarrhea.

So far, there have not been any quality scientific studies on dandelion. Today, the roots are mainly used to stimulate the appetite, and for liver and gallbladder problems. Dandelion leaves are used as a diuretic to help the body get rid of too much fluid.

Plant Description

Hundreds of species of dandelion grow in the temperate regions of Europe, Asia, and North America. Dandelion is a hardy perennial that can grow to a height of nearly 12 inches. The plants have deeply-notched, toothy, spatula-like leaves that are shiny and hairless. Dandelion stems are capped by bright yellow flowers. The grooved leaves funnel rain to the root.

Dandelion flowers open with the sun in the morning and close in the evening or during gloomy weather. The dark brown roots are fleshy and brittle and are filled with a white milky substance that is bitter and slightly smelly.

Parts Used

Dandelion leaves act as a diuretic, increasing the amount of urine your body makes. The leaves are used to stimulate the appetite and help digestion. Dandelion flower has antioxidant properties. Dandelion may also help improve the immune system.

Herbalists use dandelion root to detoxify the liver and gallbladder, and dandelion leaves to help kidney function.

Medicinal Uses and Indications

Most scientific studies of dandelion have been in animals, not people. Traditionally, dandelion has been used as a diuretic, to increase the amount of urine and eliminate fluid in your body. It has been used for many conditions where a diuretic might help, such as liver problems and high blood pressure. However, there is no good research on using dandelion as a diuretic in people.

Fresh or dried dandelion herb is also used as a mild appetite stimulant, and to improve upset stomach. The root of the dandelion plant may act as a mild laxative and has been used to improve digestion. Preliminary research suggests that dandelion may help improve liver and gallbladder function. But this study was not well designed.

Preliminary animal studies suggest that dandelion may help normalize blood sugar levels and lower total cholesterol and triglycerides while raising HDL (good) cholesterol in diabetic mice. But not all the animal studies have found a positive effect on blood sugar. Researchers need to see if dandelion will work in people.

A few animal studies also suggest that dandelion might help fight inflammation.

Available Forms

You can find dandelion herbs and roots fresh or dried in a variety of forms, including tinctures, liquid extract, teas, tablets, and capsules. Dandelion can be found alone or combined with other dietary supplements.

How to Take it

Pediatric

Ask your doctor before giving dandelion supplements to a child so the doctor can determine the dose.

Adult

Ask your doctor to help determine the right dose for you.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. However, herbs can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs under the supervision of a health care provider.

Dandelion is generally considered safe. Some people may have an allergic reaction from touching dandelion. Others may get mouth sores.

If you are allergic to ragweed, chrysanthemums, marigold, chamomile, yarrow, daisies, or iodine, you should avoid dandelion.

In some people, dandelion can cause increased stomach acid and heartburn. It may also irritate the skin.

People with kidney problems, gallbladder problems, or gallstones should consult their doctors before eating dandelion.

Possible Interactions

Dandelion leaf may act as a diuretic, which can make drugs leave your body faster. It also interacts with a number of medications that are broken down by the liver. If you are taking prescription medications, ask your doctor before taking dandelion leaf. Medications that may interact with dandelion include:

Antacids: Dandelion may increase the amount of stomach acid, so antacids may not work as well.

Blood-thinning medications (anticoagulants and antiplatelets): It is possible that dandelion may increase the risk of bleeding, especially if you already take blood thinners such as aspirin, warfarin (Coumadin), or clopidogrel (Plavix).

Diuretics (water pills): Dandelion may act as a diuretic, causing your body to produce more urine to get rid of excess fluid. If you also take prescription diuretics, or other herbs that act as diuretics, you could be at risk of electrolyte imbalances.

Lithium: Lithium is used to treat bipolar disorder. Animal studies suggest that dandelion may worsen the side effects of lithium.

Ciproflaxin (Cipro): One species of dandelion, Taraxacum mongolicum, also called Chinese dandelion, may lower the amount of the antibiotic ciproflaxin that your body absorbs. Researchers do not know whether the common dandelion would do the same thing.

Medications for diabetes: Theoretically, dandelion may lower blood sugar levels. If you take medications for diabetes, taking dandelion may increase the risk of low blood sugar.

Medications broken down by the liver: Dandelion can interact with a number of medications. To be safe, ask your doctor before taking dandelion if you take any medication.

Supporting Research

Cho SY,Park JY, Park EM, et al. Alternation of hepatic antioxidant enzyme activities and lipid profile in streptozotocin-induced diabetic rats by supplementation of dandelion water extract. Clin Chim Acta. 2002;317(1-2):109-117.

Clare BA, Conroy RS, Spelman K. The diuretic effect in human subjects of an extract of Taraxacum officinale folium over a single day. J Altern Complement Med. 2009 Aug;15(8):929-34.

Davies MG, Kersey PJ. Contact allergy to yarrow and dandelion. Contact Dermatitis. 1986;14 (ISS 4):256-7.

Hu C, Kitts DD. Antioxidant, prooxidant, and cytotoxic activities of solvent-fractionated dandelion (Taraxacum officinale) flower extracts in vitro. J Agric Food Chem. 2003;51(1):301-10.

Hudec J, et al. Antioxidant capacity changes and phenolic profile of Echinacea purpea, nettle (Urtica dioica L.), and dandelion (Taraxacum officinale) after application of polyamine and phenolic biosynthesis regulators. J Agric Food Chem. 2007;55(14):5689-96.

Jeon HJ, Kang HJ, Jung HJ, Kang YS, Lim CJ, Kim YM, Park EH. Anti-inflammatory activity of Taraxacum officinale. J Ethnopharmacol. 2008 Jan 4;115(1):82-8.

Kim HM, Shin HY, Lim KH, el al., Taraxacum officinale inhibits tumor necrosis factor-alpha production from rat astrocytes. Immunopharmacol Immunotoxicol. 2000;22(3):519-30.

Kisiel W, Barszcz B. Further sesquiterpenoids and phenolics from Taraxacum officinale. Fitoterapia. 2000;71(3):269-73.

LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide. Hudson, OH: LexiComp; 2000:420-421.

Mascolo N, et al. Biological screening of Italian medicinal plants for anti-inflammatory activity. Phytotherapy Res. 1987:28-29.

Miller L. Herbal Medicinals: Selected Clinical Considerations Focusing on Known or Potential Drug-Herb Interactions. Arch Intern Med. 1998;158:2200-2211.

Petlevski R, Hadzija M, Slijepcevic M, Juretic D. Effect of 'antidiabetis' herbal preparation on serum glucose and fructosamine in NOD mice. J Ethnopharmacol. 2001;75(2-3):181-184.

Qian L, Zhou Y, Teng Z, Du CL, Tian C. Preparation and antibacterial activity of oligosaccharides derived from dandelion. Int J Biol Macromol. 2014;64:392-4.

Schutz K, Carle R, Schieber A. Taraxacum--a review on its phytochemical and pharmacological profile. J Ethnopharmacol. 2006;107(3):313-23.

Sigstedt SC, Hooten CJ, Callewaert MC, Jenkins AR, et al. Evaluation of aqueous extracts of Taraxacum officinale on growth and invasion of breast and prostate cancer cells. Int J Oncol. 2008 May;32(5):1085-90.

Swanston-Flatt SK, Day C, Flatt PR, Gould BJ, Bailey CJ. Glycaemic effects of traditional European plant treatments for diabetes. Studies in normal and streptozotocin diabetic mice. Diabetes Res. 1989;10(2):69-73.

Sweeney B, Vora M, Ulbricht C, Basch E. Evidence-based systematic review of dandelion (Taraxacum officinale) by Natural Standard Research Collaboration. J Herb Pharmacother. 2005;5(1):79-93.

Trojanova I, Rada V, Kokoska L, Vlkova E. The bifidogenic effect of Taraxacum officinale root. Fitoterapia. 2004;75(7-8):760-3.

Zhi X, Honda K, Ozaki K, Misugi T, Sumi T, Ishiko O. Dandelion T-1 extract up-regulates reproductive hormone receptor expression in mice. Int J Mol Med. 2007;20(3):287-92.

Overview

Native to southern Africa, devil's claw (Harpagophytum procumbens) gets its name from the tiny hooks that cover its fruit. Historically, devil's claw has been used to treat pain, liver and kidney problems, fever, and malaria. It has also been used in ointments to heal sores, boils, and other skin problems.

Devil's claw was introduced to Europe in the early 1900s, where the dried roots have been used to restore appetite, relieve heartburn, and reduce pain and inflammation.

Today, devil's claw is used widely in Germany and France to fight inflammation or relieve arthritis pain, headache, and low back pain. Animal and test tube studies suggest that devil's claw can help fight inflammation.

Plant Description

Devil's claw does not have an odor, but it contains substances that make it taste bitter. It is a leafy perennial with branching roots and shoots. It has secondary roots, called tubers, that grow out of the main roots. The roots and tubers are used as medicine.

Medicinal Uses and Indications

Osteoarthritis

Several studies show that taking devil's claw for 8 to 12 weeks can reduce pain and improve physical functioning in people with osteoarthritis. One 4-month study of 122 people with knee and hip osteoarthritis compared devil's claw and a leading European medication for pain relief. The people who took devil's claw had as much pain relief as the people who took the medication. Those who took devil's claw had fewer side effects and needed fewer pain relievers throughout the study.

An analysis of 14 studies using devil's claw to treat arthritis found that higher quality studies showed devil's claw may relieve joint pain. And a review of 12 studies using devil's claw for treating arthritis or low back pain found that devil's claw was at least moderately effective for arthritis of the spine, hip, and knee.

Back and neck pain

Preliminary evidence suggests that devil's claw may help relieve neck and low back pain. In a small study of 63 people with mild-to-moderate back, neck, or shoulder pain, taking a standardized extract of devil's claw for 4 weeks provided moderate relief from muscle pain. In a larger study of 197 men and women with chronic low back pain, those who took devil's claw every day for a month said they had less pain and needed fewer painkillers than those who took placebo.

A 54-week study compared 38 people who took devil's claw with 35 people who took the pain reliever rofecoxib (Vioxx). For these people, devil's claw worked as well as Vioxx to relieve pain. The Food and Drug Administration (FDA) took Vioxx off the market because it increases the risk of heart problems.

Other uses

Many professional herbalists suggest that devil's claw can help treat upset stomach, loss of appetite, headaches, allergies, and fever. Topical preparations of devil's claw are also applied to the skin to heal sores, ulcers, boils, and skin lesions. However, there are not any definitive scientific studies that show using devil's claw to treat these conditions is effective.

What is it Made of?

Devil's claw contains iridoid glycosides, components believed to have strong anti-inflammatory effects. It has a high concentration of one type of iridoid, called harpagoside, and some laboratory tests suggest it may relieve pain and inflammation.

Available Forms

Dried or fresh root of devil's claw can be found in capsules, tablets, liquid extracts, and topical ointments. Teas (infusions) can also be made from dried devil's claw root.

How to Take it

Pediatric

Devil's claw is not recommended for children, since studies have not been done to see if it is safe.

Adult

Ask your doctor to help you find the right dose.

Precautions

The use of herbs is a time-honored approach for strengthening the body and treating disease. However, herbs can have side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs under the supervision of a health care provider qualified in the field of botanical medicine.

If taken at the recommended dose for a short time, health practitioners consider devil's claw non-toxic and safe, with few side effects. High doses can cause mild stomach problems in some people. Researchers do not know if it would be safe to take devil's claw for a long time.

People with stomach ulcers, duodenal ulcers, or gallstones should not take devil's claw. Studies show taking devil's claw may vause gastrointestinal side effects.

Pregnant and breastfeeding women should not take devil's claw since studies in these populations are lacking.

People with heart disease, high blood pressure, or low blood pressure should ask their doctors before taking devil's claw.

Possible Interactions

Blood-thinning medications (anticoagulants and antiplatelets): In theory, devil's claw may increase the risk of bleeding, especially if you already take blood thinners such as aspirin, warfarin (Coumadin), or clopidogrel (Plavix).

Medications for diabetes: Devil's claw may lower blood sugar. If you take medications to treat diabetes, taking devil's claw may raise the risk of developing low blood sugar.

Antacids: Devil's claw may increase the amount of stomach acid, making antacids less effective.

Other medications: Devil's claw may interact with other medications that are broken down by the liver. If you take any medications, ask your doctor before taking devil's claw.

Supporting Research

Abdelouahab N, Heard C. Effect of the major glycosides of Harpagophytum procumbens (Devil's Claw) on epidermal cyclooxygenase-2 (COX-2) in vitro. J Nat Prod. 2008 May;71(5):746-9.

Baghdikian B, Lanhers M, Fleurentin J, et al. An analytical study, anti-inflammatory and analgesic effects of Harpagophytum procumbens and Harpagophytum zeyheri. Planta Med. 1997;63:171-176.

Brendler T, Gruenwald J, Ulbricht C, Basch E; Natural Standard Research Collaboration. Devil's Claw (Harpagophytum procumbens DC): an evidence-based systematic review by the Natural Standard Research Collaboration. J Herb Pharmacother. 2006;6(1):89-126.

Brien S, Lewith GT, McGregor G. Devil's Claw (Harpagophytum procumbens) as a Treatment for Osteoarthritis: A Review of Efficacy and Safety. J Altern Complement Med. 2006;12(10):981-93.

Cameron M, Gagnier JJ, Little CV, Parsons TJ, Blümle A, Chrubasik S. Evidence of effectiveness of herbal medicinal products in the treatment of arthritis. Part I: Osteoarthritis. Phytother Res. 2009 Nov;23(11):1497-515. Review.

Chantre P, Cappelaere A, Leblan D, Guedon D, Vandermander J, Fournie B. Efficacy and tolerance of Harpagophytum procumbens versus diacerhein in treatment of osteoarthritis. Phytomedicine. 2000;7(3):177-83.

Chrubasik S, Junck H, Breitschwerdt H, Conradt C, Zappe H. Effectiveness of Harpagophytum extract WS 1531 in the treatment of exacerbation of low back pain: a randomized, placebo-controlled, double-blind study. Eur J Anaesthesiol. 1999;16(2):118-129.

Chrubasik S, Sporer F, Dillmann-Marschner R, Friedmann A, Wink M. Physiochemical properties of harpagoside and its in vitro release from Harpagophytum procumbens extract tablets. Phytomedicine. 2000;6(6):469-473.

Chrubasik S, Pollak S, Black A. Effectiveness of devil's claw for osteoarthritis. Rheumatology (Oxford). 2002;41(11):1332-3.

Chrubasik S. [Devil's claw extract as an example of the effectiveness of herbal analgesics]. Orthopade. 2004;33(7):804-8.

Conrozier T, Mathieu P, Bonjean M, Marc JF, Renevier JL, Balblanc JC. A complex of three natural anti-inflammatory agents provides relief of osteoarthritis pain. Altern Ther Health Med. 2014;20 Suppl 1:32-7.

Denner SS. A review of the efficacy and safety of devil's claw for pain associated with degenerative musculoskeletal diseases, rheumatoid, and osteoarthritis. Holist Nurs Pract. 2007;21(4):203-7.

Ernst E, Chrubasik S. Phyto anti-inflammatories. A systematic review of randomized, placebo-controlled, double-blind trials. Rheum Dis Clin North Am. 2000;26(1):13-27.

Gagnier JJ, van Tulder MW, Berman B, Bombardier C. Herbal medicine for low back pain: a Cochrane review. Spine. 2007;32(1):82-92.

Gobel H, Heinze A, Ingwersen M, Niederberger U, Gerber D. Effects of Harpagophytum procumbens LI 174 (devil's claw) on sensory, motor und vascular muscle reagibility in the treatment of unspecific back pain. [German] Schmerz. 2001;15(1):10-18.

Grant L, McBean DE, Fyfe L, Warnock AM. A review of the biological and potential therapeutic actions of Harpagophytum procumbens. Phytother Res. 2007;21(3):199-209.

Gregory P, Sperry M, Friedman Wilson A. Dietary supplements for osteoarthritis. Am Fam Phys. 2008;77(2):177-84.

Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm. 2000;57(13):1221-7.

Hostanska K, Melzer J, Rostock M, Suter A, Saller R. Alteration of anti-inflammatory activity of Harpagophytum procumbens (devil's claw) extract after external metabolic activation with S9 mix. J Pharm Pharmacol. 2014;66(11):1606-14.

Izzo AA, Di Carlo G, Borrelli F, Ernst E. Cardiovascular pharmacotherapy and herbal medicines: the risk of drug interaction. Int J Cardiol. 2005;98(1):1-14.

Lanhers MC, Fleurentin J, Mortier F, Vinche A, Younos C. Anti-inflammatory and analgesic effects of an aqueous extract of Harpagophytum procumbens. Planta Med. 1992;58:117-123.

Laudahn D, Walper A. Efficacy and tolerance of Harpagophytum extract LI 174 in patients with chronic non-radicular back pain. Phytother Res. 2001;15(7):621-4.

Leblan D, Chantre P, Fournie B. Harpagophytum procumbens in the treatment of knee and hip osteoarthritis. Four-month results of a prospective, multicenter, double-blind trial versus diacerhein. Joint Bone Spine. 2000;67(5):462-467.

Na HK, Mossanda KS, Lee JY, Surh YJ. Inhibition of phorbol ester-induced COX-2 expression by some edible African plants. Biofactors. 2004;21(1-4):149-53.

Soulimani R, Younos C, Mortier F, et al. The role of stomach digestion on the pharmacological activity of plant extracts, using as an example extracts of Harpagophytum procumbens. Can J Physiol Pharmacol. 1994;72(12):1532-1536.

Wegener T, Lupke NP. Treatment of patients with arthrosis of hip or knee with an aqueous extract of devil's claw (Harpagophytum procumbens DC.). Phytother Res. 2003;17(10):1165-72.

Wegener T. [Degenerative diseases of the musculoskeletal system--overview of current clinical studies of Devil's Claw (Harpagophyti radix)]. Wien Med Wochenschr. 2002;152(15-16):389-92.

Whitehouse L, Znamirowski M, Paul CJ. Devil's Claw (Harpagophytum procumbens): no evidence for anti-inflammatory activity in the treatment of arthritic disease. Can Med Assoc J. 1983;129:249-251.

Overview

Dong quai (Angelica sinensis) root has been used for more than one thousand years as a spice, tonic, and medicine in China, Korea, and Japan. It is still used often in Traditional Chinese Medicine (TCM), where it is usually combined with other herbs. TCM practioners often prescribe dong quai to treat women's reproductive problems, such as dysmenorrhea or painful menstruation, and to improve blood flow.

Dong quai is sometimes called the "female ginseng." Although there are few scientific studies on dong quai, it is sometimes suggested to relieve cramps, irregular menstrual cycles, infrequent periods, premenstrual syndrome (PMS), and menopausal symptoms.

Plant Description

Dong quai grows at high altitudes in the cold, damp, mountains of China, Korea, and Japan. This fragrant, perennial plant -- a member of the celery family -- has smooth purplish stems and umbrella-shaped clusters of white flowers and winged fruits in July and August. The yellow-brown thick-branched roots are used as medicine. It takes 3 years for the plant to reach maturity. The root is harvested and made into tablets, powders, and other medicinal forms.

Medicinal Uses and Indications

Few studies have investigated dong quai for use in humans. Some lab tests suggest that dong quai contains compounds that may help reduce pain, open blood vessels, and stimulate and relax the muscles of the uterus. More studies are needed to see whether dong quai works and is safe.

Treatment

Dong quai is sometimes suggested for the following conditions:

Menopausal symptoms

Some women say dong quai relieves symptoms such as hot flashes. Researchers are not sure whether dong quai acts like estrogen or blocks estrogen in the body. Studies are conflicting, and one study found that dong quai did not help to relieve menopausal symptoms.

Other

Dong quai has also been suggested for these conditions, although there is no good scientific evidence:

• Amenorrhea (absence of menstruation)
• Heart disease. One study suggested that a combination of dong quai, Asian ginseng (Panax ginseng), and astragalus (Astragalus membranaceus) decreased symptoms of chest pain in a small group of people with heart disease.
• High blood pressure
• Premature ejaculation, as one ingredient in a cream applied to the skin

Dosage and Administration

You can find dong quai in a variety of forms, including tablets and powders. In China and Japan, it is given as an injection in a hospital or health center. You should not use injections at home.

Dong quai should be stored in a cool, dry place.

Pediatric

You should not give dong quai to a child.

Adult

Researchers do not know what a safe dose is, so there is no recommended dose.

Dried herb (raw root): may be boiled or soaked in wine before consuming.

Powdered herb (available in capsules): In one study for menopausal symptoms, people took 500 to 600 mg tablets or capsules up to 6 times daily.

Tincture (1:5 w/v, 70% alcohol): 40 to 80 drops (equivalent to 2 to 4 mL, there are 5 mL in a tsp.), 3 times daily is one possible dosing schedule, however, individual doses will vary and it is unusual for Dong quai to be prescribed alone. It is usually part of a formula containing synergistic herbs.

Precautions

You should not drink the essential oil of dong quai because it has a small amount of cancer-causing substances.

People who have chronic diarrhea or abdominal bloating should not use dong quai.

People who are at risk of hormone-related cancers, including breast, ovarian, and uterine cancers, should not take dong quai because researchers are not sure if it acts like estrogen in the body.

Side Effects

Dong quai, particularly at high doses, may make you more sensitive to sunlight and cause skin inflammation and rashes. Stay out of the sun or use sunscreen while taking dong quai.

Pregnancy and Breastfeeding

DO NOT use dong quai during pregnancy. It may cause the uterus to contract and raise the risk of miscarriage. Nursing mothers should not take dong quai because no one knows if it is safe when you are breastfeeding.

Pediatric Use

DO NOT give dong quai to a child because no one knows whether it is safe for children.

Interactions and Depletions

Dong quai may interact with some medications and herbs, includin the following:

Blood thinners (anticoagulants and antiplatelets: Dong quai may raise the risk of bleeding, especially if you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin. The same is true of using dong quai with many herbs and supplements. Talk to your doctor before taking dong quai. These are some of the herbs and supplements that may act like blood thinners:

• Feverfew (Tanacetum parthenium)
• Fish oil and other omega-3 fatty acids
• Garlic (Allium sativum)
• Ginger (Zingiber officinale)
• Ginkgo (Ginkgo biloba)
• Ginseng (Panax ginseng)
• Licorice (Glycyrrhiza glabra)
• Chinese skullcap (Scutellaria baicalensis)
• Turmeric (Curcuma longa)

Hormone medications: There is not much research on using dong quai with hormone medications, such as estrogens, progesterones, birth control pills, tamoxifen, or raloxifene (Evista). But, because dong quai may act like estrogen in the body, you should not take it with hormone medications except under your doctor's supervision.

St. John's wort: Both Dong quai and St. John's wort can make you more sensitive to sunlight. Talk to your doctor before taking them together.

Supporting Research

Al-Bareeq RJ, Ray AA, Nott L, Pautler SE, Razvi H. Dong Quai (angelica sinensis) in the treatment of hot flashes for men on androgen deprivation therapy: results of a randomized double-blind placebo controlled trial. Can Urol Assoc J. 2010 Feb;4(1):49-53.

Carroll DG. Nonhormonal therapies for hot flashes in menopause. Am Fam Physician. 2006;73(3):457-64.

Cho CH, Mei QB, Shang P, et al. Study of the gastrointestinal protective effects of polysaccharides from Angelica sinensis in rats. Planta Med. 2000;66(4):348-351.

Choi HK, Jung GW, Moon KH, et al. Clinical study of SS-Cream in patients with lifelong premature ejaculation. Urology. 2000;55:257-61.

Circosta C, Pasquale RD, Palumbo DR, Samperi S, Occhiuto F. Estrogenic activity of standardized extract of Angelica sinensis. Phytother Res. 2006;20(8):665-9.

Fugh-Berman A. Herb-drug interactions. Lancet. 2000; 355(9198):134-138.

Hardy ML. Herbs of special interest to women. J Am Pharm Assoc. 2000;40(2):234-242.

Kan WL, Cho CH, Rudd JA, Lin G. Study of the anti-proliferative effects and synergy of phthalides from Angelica sinensis on colon cancer cells. J Ethnopharmacol. 2008 Oct 30;120(1):36-43.

Kelley KW, Carroll DG. Evaluating the evidence for over-the-counter alternatives for relief of hot flashes in menopausal women. J Am Pharm Assoc (2003). 2010 Sep-Oct;50(5):e106-15. doi: 10.1331/JAPhA.2010.09243. Review.

Kupfersztain C, Rotem C, Fagot R, Kaplan B. The immediate effect of natural plant extract, Angelica sinensis and Matricaria chamomilla (Climex) for the treatment of hot flushes during menopause. A preliminary report. Clin Exp Obstet Gynecol. 2003;30(4):203-6.

LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide. Hudson, OH: LexiComp; 2000:425-426.

Smolinske A. Dietary supplement-drug interactions. J Am Med Womens Assoc. 1999;54(4):191-196.

Williamson JS, Wyandt CM. An herbal update. Drug Topics. 1998;142(6):66-75.

Wojcikowski K, Wohlmuth H, Johnson DW, Rolfe M, Gobe G. An in vitro investigation of herbs traditionally used for kidney and urinary system disorders: Potential therapeutic and toxic effects. Nephrology (Carlton). 2008 Sep 22. [Epub ahead of print]

Wong VK, Yu L, Cho CH. Protective effect of polysaccharides from Angelica sinensis on ulcerative colitis in rats. Inflammopharmacology. 2008 Aug;16(4):162-7.

Yang T, Jia M, Meng J, Wu H, Mei Q. Immunomodulatory activity of polysaccharide isolated from Angelica sinensis. Int J Biol Macromol. 2006;39(4-5):179-184.

Yim TK, Wu WK, Pak WF, Mak DH, Liang SM, Ko KM. Myocardial protection against ischaemia-reperfusion injury by a Polygonum multiflorum extract supplemented 'Dang-Gui decoction for enriching blood', a compound formulation, ex vivo. Phytother Res. 2000;14(3):195-199.

Overview

Echinacea is one of the most popular herbs in America today. Echinacea is a Native American medicinal plant named for the prickly scales in its large conical seed head, which resembles the spines of an angry hedgehog (echinos is Greek for hedgehog).

Archaeologists have found evidence that Native Americans may have used echinacea for more than 400 years to treat infections and wounds, and as a general "cure-all." Throughout history people have used echinacea to treat scarlet fever, syphilis, malaria, blood poisoning, and diphtheria. Although this herb was popular during the 18th and 19th centuries, its use began to decline in the United States after the introduction of antibiotics. Echinacea preparations became increasingly popular in Germany throughout the 20th century. In fact, most of the scientific research on echinacea has been conducted in Germany.

Today, people use echinacea to shorten the duration of the common cold and flu, and reduce symptoms, such as sore throat (pharyngitis), cough, and fever. Many herbalists also recommend echinacea to help boost the immune system and help the body fight infections.

General Uses

Several laboratory and animal studies suggest that echinacea contains active substances that boost immune function, relieve pain, reduce inflammation, and have hormonal, antiviral, and antioxidant effects. For this reason, professional herbalists may recommend echinacea to treat urinary tract infections, vaginal yeast (candida) infections, ear infections (also known as otitis media), athlete's foot, sinusitis, hay fever (also called allergic rhinitis), as well as slow-healing wounds. Preliminary studies in the lab suggest echinacea may help inhibit colon tumors when combined with cichoric acid. One study even suggests that echinacea extract exerted an antiviral action on the development of recurrent cold sores triggered by the herpes simplex virus (HSVI) when taken prior to infection.

Common Cold

Whether or not echinacea helps prevent or treat the common cold remains controversial. Some studies have shown that the herb can make you feel better faster. Others suggest that echinacea has no impact on a cold at all. Several clinical trials have shown that people who take echinacea as soon as they feel sick reduce the severity of their cold and have fewer symptoms than those who do not take the herb. One study of 95 people with early symptoms of cold and flu (such as runny nose, scratchy throat, and fever) found that those who drank several cups of echinacea tea every day for 5 days felt better sooner than those who drank tea without echinacea.

A review of 14 clinical trials found that echinacea reduced the odds of developing a cold by 58% and the duration of a cold by 1 to 4 days. However, some experts dispute these findings claiming there were several weaknesses in the analyses. Echinacea preparations tested in clinical trials differ greatly. It is important to choose a high-quality echinacea supplement, and to use echinacea as early as possible in the course of a cold, with multiple doses per day for the first few days. Talk to your health care provider for recommendations.

Plant Description

Echinacea is a perennial herb native to the midwestern region of North America. It has tall stems, bears single pink or purple flowers, and has a central cone that is usually purple or brown in color. The large cone is actually a seed head with sharp spines that resemble a stiff comb.

What Is It Made Of?

Echinacea contains several chemicals that play a role in its therapeutic effects. These include polysaccharides, glycoproteins, alkamides, volatile oils, and flavonoids.

The chemicals contained in the root differ considerably from those in the upper part of the plant. For example, the roots have high concentrations of volatile oils (odorous compounds) while the above-ground parts of the plant tend to contain more polysaccharides (substances known to trigger the activity of the immune system). The combination of these active substances is responsible for echinacea's beneficial effects, though research suggests that the above ground portion of Echinacea purpurea is the most effective.

In Germany (where herbs are regulated by the government), the above-ground parts of Echinacea purpurea are approved to treat colds, upper respiratory tract infections, urinary tract infections, and slow-healing wounds. The root of the Echinacea pallida plant is also approved for the treatment of flu-like infections.

Available Forms

Three species of echinacea are commonly used for medicinal purposes: Echinacea angustifolia, Echinacea pallida, and Echinacea purpurea. Many echinacea preparations contain one, two, or even all three of these species. Different products use different parts of the echinacea plant, which is why the effectiveness of echinacea may differ from one product to another.

Echinacea (including one, two, or all three species) is available in extracts, tinctures, tablets, capsules, and ointments. It is also available in combination with other immune-boosting herbs, vitamins, and minerals.

A study performed by ConsumerLab.com (an independent company that tests the purity of health, wellness, and nutrition products) found that of 11 brands of echinacea purchased for testing, only 4 contained what was stated on their labels. About 10% had no echinacea at all; half were mislabeled as to the species of echinacea in the product; and more than half of the standardized preparations did not contain the labeled amount of active ingredients.

Buy products made by reputable, established companies that distribute their products through trustworthy and knowledgeable establishments. When possible, select products with guaranteed potency or standardized extracts.

How to Take It

Pediatric

You should work with your child's pediatrician or an herbal practitioner trained in children to determine pediatric dosing.

Use alcohol-free preparations for children.

Adult

For general immune system stimulation, during colds, flu, upper respiratory tract infections, or bladder infections, take echinacea 3 times a day until you feel better, but not for more than 10 days.

DO NOT take echinacea on an empty stomach. Instead, take it with food or a large glass of water.

Apply creams or ointments for slow-healing wounds as needed.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. However, herbs contain active substances that may trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs only under the supervision of a health care provider knowledgeable in the field of botanical medicine.

People with tuberculosis, leukemia, diabetes, connective tissue disorders, multiple sclerosis, HIV or AIDS, any autoimmune diseases, or, possibly, liver disorders should not take echinacea. There is some concern that echinacea may reduce the effectiveness of medications that suppress the immune system. For this reason, people receiving organ transplants who must take immunosuppressant medications should avoid this herb.

In rare cases, echinacea may cause allergic reactions, ranging from a mild rash to anaphylaxis (a life-threatening reaction accompanied by throat tightening, shortness of breath, and, possibly fainting). People with asthma and allergies may be at an increased risk for developing these adverse reactions. People with allergies to plants in the daisy family (compositae) should not take Echinacea without the supervision of a provider.

Minor side effects can include stomach upset, nausea, dizziness, and dry eyes.

There has been one report of an individual developing erythema nodosum (a painful skin condition) after taking echinacea to treat the flu.

When taken by mouth, echinacea may cause temporary numbing and tingling on the tongue.

Despite concerns that echinacea may be unsafe for pregnant or breastfeeding women, evidence suggests that the use of echinacea during pregnancy does not increase the risk of birth defects or other pregnancy related health problems. More research is needed. In the meantime, avoid using Echinacea during pregnancy or breastfeeding until more conclusive studies are conducted.

Talk to your doctor if you have questions.

Possible Interactions

If you are taking any prescription medications, including medications used during surgery, such as anesthesia medications, you should talk to your doctor before taking echinacea. Some of the well-known interactions include the following:

• Econazole. Echinacea may be useful in combination with econazole, an antifungal agent used to treat yeast infections (such as athlete's foot). When echinacea is used together with econazole, recurrence rates of these infections may be reduced.
• Immunosuppressants. Immunosuppressants refers to a group of medications that are used for two main purposes, treating cancer and suppressing the immune system following organ transplant so that the new organ is not rejected. Because echinacea can enhance immune function, people should not use the herb with immunosuppressive medications, especially when taken for organ transplant.
• Caffeine. Echinacea may increase the amount of time it takes for the body to break down caffeine, and therefore, increas the amount of time caffeine stays in the body.

Supporting Research

Askeroglu U, Alleyne B, Guyuron B. Pharmaceutical and herbal products that may contribute to dry eyes. Plast Reconstr. Surg. 2013;131(1):159-67.

Auerbach: Auerbach Wilderness Medicine. 5th ed. Philadelphia, PA: Elsevier Mosby; 2007.

Barrett B, Brown R, Rakel D, Mundt M, Bone K, Barlow S, Ewers T. Echinacea for treating the common cold: a randomized trial. Ann Intern Med. 2010;153(12):769-77.

Borchers AT, Keen CL, Stern JS, Gershwin ME. Inflammation and Native American medicine: the role of botanicals. [Review]. Am J Clin Nutr. 2000 Aug;72(2):339-47.

ConsumerLab.com. Product review: echinacea. Accessed on April 1, 2002.

Di Pierro F, Rapacioli G, Ferrara T, Togni S. Use of a standardized extract from Echinacea angustifolia (Polinacea) for the prevention of respiratory tract infections. Altern Med Rev. 2012;17(1):36-41.

Ernst E. The risk-benefit profile of commonly used herbal therapies: Ginkgo, St. John's Wort, Ginseng, Echinacea, Saw Palmetto, and Kava. [Review]. Ann Intern Med. 2002;136(1):42-53.

Frank LG. The efficacy of Echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double blind, placebo-controlled study. J Comp Alt Med. 2000;6(4):327-34.

Gallo M, Sarkar M, Au W, et al. Pregnancy outcome following gestational exposure to echinacea. Arch Intern Med. 2000;160:3141-3.

Ghemi A, Soleimanjahi H, Gill P, Arefian E, Soudi S, Hassan Z. Echinacea purpurea polysaccharide reduces the latency rate in herpes simplex virus type-1 infections. Intervirology. 2009;52(1):29-34.

Goel V, Lovlin R, Barton R, et al. Efficacy of a standardized echinacea preparation (Echinilin) for the treatment of the common cold: a randomized, double-blind, placebo-controlled trial. J Clin Pharm Ther. 2004;29(1):75-83.

Haller J, Hohmann J, Freund TF. The effect of Echinacea preparations in three laboratory tests of anxiety: comparison with chlordiazepoxide. Phytother Res. 2010;24(11):1605-1.

Islam J, Carter R. Use of Echinacea in upper respiratory tract infection. South Med J. 2005;98(3):311-8.

Karsch-Volk M, Barrett B, Kiefer D, Bauer R, Ardjomand-Woelkart K, Linde K. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev. 2014;2:CD000530.

Linde K, Barrett B, Wolkart K, Bauer R, Melchart D. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev. 2006;1:CD000530.

Lindenmuth GF, Lindenmuth EB. The efficacy of echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double-blind placebo-controlled study. J Altern Complement Med. 2000;6(4):327-34.

Mahady GB. Echinacea: recommendations for its use in prophylaxis and treatment of upper respiratory tract infections. Nutr Clin Care. 2001;4(4):199-208.

Melchart D, Linde K, Fischer P, Kaesmayr J. Echinacea for preventing and treating the common cold. [Review]. Cochrane Database Syst Rev. 2000;2:CD000530.

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Naser B, Lund B, Henneicke-von Zepelin HH, Kohler G, Lehmacher W, Scaglione F. A randomized, double-blind, placebo-controlled, clinical dose-response trial of an extract of Baptisia, Echinacea and Thuja for the treatment of patients with common cold. Phytomedicine. 2005;12(10):715-22.

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Introduction

Elderberry, or elder, has been used for centuries to treat wounds, when applied to the skin. It is also taken by mouth to treat respiratory illnesses such as cold and flu. Some evidence suggests that chemicals in elder flower and berries may help reduce swelling in mucous membranes, including the sinuses, and help relieve nasal congestion. Elder may have anti-inflammatory, antiviral, anti-influenza, and anticancer properties.

Elderberry also contains flavonoids, which have antioxidant properties and may help prevent damage to the body's cells. In fact, elderberry outranks blueberries, cranberries, goji berries, and blackberries in terms of total flavonol content. However, few studies have been done in humans, so researchers don't know how effective elder may be.

There are several species of elder, but Sambucus nigra, or European elder (also called black elder), is most often used for medicinal purposes. Avoid dwarf elder (Sambucus ebulus), which can be toxic. Use a trusted preparation of elder because raw or unripe fruit, as well as the leaves, seeds, and bark, contain a chemical related to cyanide, which is poisonous.

Alternative Names

Elder; Elder flower

Plant Description

European elder is a large shrub or small tree that grows up to 30 feet tall in wet or dry soil in a sunny location. Elder is native to Europe, Africa, and parts of Asia, but it has become widespread in the United States. Deciduous leaves grow in opposite pairs and have 5 to 7 leaflets. Flowers are white and flat topped with 5 primary rays. Berries are green, turning red, then black when ripe.

Parts Used

The berries and flowers are used as medicine. Berries must be cooked before they are taken. Raw berries contain a chemical similar to cyanide.

Medicinal Uses and Indications

Colds and Flu

Elderberry may help treat cold and flu symptoms by reducing congestion and possibly making you sweat more. One study suggested that using a standardized elderberry extract, Sambucol, could shorten the duration of flu by about 3 days. Sambucol contains other herbs plus vitamin C, so no one knows whether elderberry by itself would have the same effect.

Another preliminary study found that a lozenge with elderberry extract (ViraBLOC) helped reduce flu symptoms when taken within 24 hours of symptoms starting. In the lab, one study suggested that elderberry could kill the H1N1 virus ("swine flu") in test tubes, but researchers do not know whether it would be effective against H1N1 in people.

Bacterial Sinusitis (Sinus Infection)

One study examined the use of a proprietary product, Sinupret, to treat bacterial sinusitis along with an antibiotic (doxycycline or vibramycin) and a decongestant. People who took the combination did better compared to those who did not take Sinupret. However, Sinupret contains other herbs along with elderberry, so no one knows whether taking elderberry alone would work as well.

Elderberry is available as a liquid, syrup, and tincture, as well as in capsule and lozenge forms. Dried elder flower is usually standardized to at least 0.8% flavonoids. Sambucol is standardized to 38% elderberry extract for adults and 19% for children. Sinupret contains 18 mg of elder flower.

How to Take It

Pediatric

DO NOT give elderberry or any product containing elder to a child without first talking to your pediatrician.

Adult

• Sinupret: 2 tablets taken 3 times a day for bacterial sinusitis
• Sambucol: 4 tbsp. a day for 3 days for colds and flu
• Tea: Steep 3 to 5 g dried elder flower in 1 cup boiling water for 10 to 15 minutes. Strain and drink 3 times per day.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs only under the supervision of a health care provider.

DO NOT use unripe or uncooked elderberries. They may be poisonous.

Elderberry appears to have few side effects when used properly for short periods of time (up to 5 days).

Pregnant and breastfeeding women should not take elderberry.

If you have an autoimmune disease, such as rheumatoid arthritis or lupus, ask your doctor before taking elderberry, as it may stimulate the immune system.

Possible Interactions

If you are being treated with any of the following medications, you should talk to your health care provider before taking elderberry:

Diuretics (water pills). Diuretics help the body get rid of excess fluid and increase the amount of urine your body makes. Elderberry may also act as a diuretic, so taking it along with a diuretic could make that drug stronger and raise your risk of dehydration. Diuretics include:

• Hydrochlorothiazide
• Bumetanide (Burinex)
• Furosemide (Lasix)
• Amiloride (Midamor)
• Metolazone (Zaroxolyn)

Diabetes medications. Elderberry may lower blood sugar levels. If you are also taking drugs for diabetes, taking elderberry may increase your risk of developing hypoglycemia, or low blood sugar.

Chemotherapy. Elderberry may interact with some chemotherapy drugs. If you are undergoing chemotherapy, ask your oncologist before taking any herb or supplement.

Laxatives. Elderberry may act like a laxative and should not be taken at the same time as other laxatives.

Theophylline (TheoDur). Elderberry may reduce levels of theophylline, a drug taken for asthma and other respiratory conditions. That could make the drug not work as well.

Drugs that suppress the immune system. Because elderberry may stimulate the immune system, it could interfere with medications taken to suppress the immune system. These medications include corticosteroids (prednisone) and medications used to treat autoimmune diseases. People with organ transplants should also avoid elderberry.

Supporting Research

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Roschek B, Fink RC, McMichael MD, et al. Elderberry flavonoids bind to and prevent H1N1 infection in vitro. Phytochemistry. 2009;70:1255-61.

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Swaminathan K, Dyason JC, Maggioni A, von Itzstein M, Downard KM. Binding of a natural anthocyanin inhibitor to influenza neuraminidase by mass spectrometry. Anal Bioanal Chem. 2013;405(20):6563-72.

Ulbricht C, Basch E, Cheung L, et al. An evidence-based systematic review of elderberry and elderflower(Sambucus nigra) by the Natural Standard Research Collaboration. J Diet Suppl. 2014;11(1):80-120.

Uncini Manganelli RE, Zaccaro L, Tomei PE. Antiviral activity in vitro of Urtica dioica L., Parietaria diffusa M. et K. and Sambucus nigra L. J Ethnopharmacol. 2005 Apr 26;98(3):323-7.

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