HeartPoint: Herbal Remedies: Tell me more

SPECIFIC HERBAL REMEDIES

In this section, specific herbs are presented in more detail. At the beginning are the most commonly used and best understood agents. As you will see, information is presented in tabular format, with a few comments in the introduction of more common agents. This is by no means an all-inclusive list. If you have comments regarding these or other agents, please feel free to contact us (see bottom of this page).

SOME AGENTS TO AVOID FOR PEOPLE WITH HEART DISEASE
Ephedra
Ginseng

POPULAR, PROBABLY SAFE, POSSIBLY EFFECTIVE
Ginko biloba
Garlic
Green Tea

LESS POPULAR, LESS UNDERSTOOD, MORE POTENTIAL TOXICITY
Butcher's Broom
Chestnut
Danshen
Digitalis
Gugulipid
Hawthorne
Lingusticum
Pseudoginseng (Panax)
Reserpine
Rosemary
Tetrandine
Veratrum/Hellebore

INTERNET RESOURCES (LINKS)

SOURCES

YOUR KNOWLEDGE AND OPINION

AGENTS TO AVOID

Ephedra (ma huang)

Contains the stimulants ephedrine and pseudoephedrine, the same agents used in decongestants. Regulated over-the-counter medicines (such as Sudafed and a host of others) do contain appropriate warnings that people with high blood pressure or heart disease should avoid such agents. These same people should avoid ephedra as well.

Ginseng

Ginseng, generally and widely used as an energy enhancer, is felt by most herbal authorities to be an agent to avoid for people with high blood pressure and cardiovascular diseases. My own experience with patients supports the idea that blood pressure increases, and that there is an increase in palpitations and arrhythmias.

POPULAR, PROBABLY SAFE, POSSIBLY EFFECTIVE

Ginko biloba

This is the most commonly prescribed herb worldwide, with 10 million prescriptions written by French and German physicians in 1989. Ginko appears to be useful in several conditions. It is probably safe to take . . . Realize that memory loss and cramps when walking may be indications of other serious conditions that may benefit greatly from appropriate diagnosis and other types of treatment.

Source (Herb):
Ginko biloba (maidenhair tree)

Active Ingredient:
Multiple

Used for:
Antioxidant
Memory enhancement

"Improved circulation". Specifically, it appears to improve walking distance in people with blocked arteries to the legs (it reduces "claudication"). It may take several weeks for this effect to improve.

Vertigo (dizziness).

Mood enhancement

Side Effects:
Gastrointestinal, headaches, skin rash

Dose:
Recommended dose in Europe is 40 mg three times daily

Comments:
Approved as a drug in Europe.

Garlic

Active Agent:
Allicin

Source (Herb):
Garlic

Used for:
Lowering cholesterol

Side Effects:
Garlic odor, heartburn, flatulence, other gastrointestinal effects. Allergies including skin rash.

Interactions:
May increase tendency to bleed. Use with caution with warfarin (coumadin).

Dose
Generally takes from 5-20 cloves for an average sized person (4 grams)
The active ingredient is allicin (4-12 milligrams/day). The ingredient in fresh garlin is allinin. Allinase converts allinin to allicin which may happen immediately in the mouth. Allinase is degraded by the acids in the stomach. All of this explanation is to point out that when taking a garlic pill (which contains the allinin and allinase), that it should be enteric coated so that the allinase is not degraded prior to working on the allinin to produce allicin.
This much allicin can generally be found in:

  - 400-1200 milligrams of powder
  - 2-5 milligrams fresh dried bulb
  - 2-5 grams of garlic oil
  - 2-4 milliliters of 1:5 tincture in 45% water three times daily

Comments:
May reduce cholesterol in the range of 5%, but not all studies have shown this. More, and more careful studies, would be helpful.
May lower blood pressure to a small degree. Has been shown in one study to preserve the elasticity of the aorta.

May have a role in decreasing clotting (reduces platelet thromboxane activity).

Green Tea

Active Agent:
Multiple, primarily flavenoids (antioxidants) and xanthines (caffeine-like substances)

Source (Herb):
Camellia sinensis

Used for:
Antioxidant
Stimulant
Cholesterol lowering agent (modest effects)

Side Effects:
Similar to caffiene:
- Insomnia
- Palpitations
- Anxiety

Interactions:
None known

Dosage:
Generally brewed
Prepared extracts are available.

LESS POPULAR, LESS UNDERSTOOD, MORE POTENTIAL TOXICITY

Butcher's Broom

Source (Herb):
Butcher's broom (Ruscus aculeatus)

Used for:
Venous disorders

Side Effects:
Nausea

Dose:
Available in Europe as capsule, tablet, ointment and suppository (for hemorrhoids)

Comments:
Appears to decrease vascular permeability induced by histamine
Decrease the tendency of the sympathetic nervous system to cause vasoconstriction -- venules dilate at lower temperatures.

Appears to work by calcium channel and alpha receptor blockade.

Chestnut

Active Agent:
Aescin

Source (Herb):
Chestnut (Horse Chestnut) (Aesculus hippocastanum)

Used for:
Venous disorders, varicose veins

Dose:
Initially 90-150 mg/daily, decreasing to 35-70 mg/daily if benefit seen

Interactions:
Multiple, particularly agents which are protein bound in the blood. This includes warfarin, commonly used in venous disorders as well.

Side effects:
Gastrointestinal symptoms
Severe allergic reactions (anaphylaxis)
Liver and kidney side effects (may be removed with dialysis)
Possibly associated with a lupus-like reaction

Comments:
Thought to work by inhibiting enzymes which "weaken vessel walls"
Increases venous tone, venousl flow and lymphatic flow
Antagonizes capillary hyperpermeability, decreasing edema formation
Has been shown in clinical trials to be helpful.
Apparently, no evidence that topical application (for example to varicose veins) is helpful.

Danshen

Source (Herb):
Danshen (Salvia, relative of western sage)

Used for:
Circulatory "stimulant"

Interactions:
Enhances effects of warfarin (coumadin)

Comments:
Dilates coronary arteries, but may cause either constriction or dilation of other vessels, and thus be associated with either high or low blood pressure.
May be an anti-oxidant.
Inhibits cyclic-AMP

Digitalis

Active Agent:
Digitalis (digoxin, digitoxin)

Source (Herb):
  Foxglove, Oleander, multiple other things

Used for:
Congestive Heart Failure, Supraventricular Tachycardias

Side Effects:
Nausea, visual difficulties (seeing yellow), slow heart rate

Interactions:
Multiple drugs and other herbs which are protein bound in the blood and tissues.

Comments:
Digitalis has been and continues to be used for heart failure and rapid heart rates (supraventricular tachycardias). Even when carefully dosed with accurate agents, it is considered a "narrow therapeutic window" drug. If it is felt there is some compelling reason for its use in herbal form, it should be done very carefully. Oleander should be avoided due to its high toxicities

Gugulipid

Source (Herb):
Gugulipid, a resin from the tree Commiphora mukul native to India

Used for:
Lowering cholesterol

Side Effects:
Headache, nausea, hiccups

Interactions:
May affect availability of propranolol, diltiazem, and other drugs decreasing their effectiveness.

Comments:
Has been shown to lower cholesterol and triglyceride levels (10% and 17% respectively)

Hawthorne

Active Agent:
multiple

Source (Herb):
Hawthorne, also known as Crataegus

Used for:
Angina, coronary artery disease

Side Effects:
Nausea, tiredness, perspiration, skin rash

Interactions:
Increases activity of digitalis

Dosage:
This should not be taken by cardiac patients without knowledgable dosing by qualified practitioner, and with the knowlede of conventional physician. It generally in the range of 80-300 mg of standardized extract in capsules or tablets or 4-5 milliliters of tincture three times daily. The berry is not approved in Germany.

Comments:
May enhance strength of cardiac contraction (through inhibition of cyclic AMP)
Vasodilator

Prolongs effective refractory period.

Possible anti-oxidant activity.

Appears to lower cholesterol to some (unquantified) degree, possibly by upregulating LDL receptors in the liver. Also exerts this effect by increasing bile acid formation from cholesterol.

Lingusticum

Active Agent:
Tetramethylpyrazine

Source (Herb):
Lingusticum wallichi

Used for:
High blood pressure, "circulatory stimulant", sedative

Side Effects:
Very little known

Interactions:
Very little known

Comments:
Appears to cause vasodilation by blockade of calcium channels and alpha receptors

Pseudoginseng (Panax)

Source (Herb):
Pseudoginseng (Panax notoginseng)

Used for:
Angina

Comments:
May act as a calcium channel blocker
Dilates coronary arteries. Constricts other arteries, and thus blood pressure may either increase or decrease.

Possible actions to decrease clotting and decrease smooth muscle proliferation.

Reserpine

Active Agent:
Reserpine

Source (Herb):
Snakeroot

Used for:
High blood pressure

Side Effects:
Depression is relatively common. Nasal congestion. Avoid with peptic ulcer disease. Diarrhea.

Comments:
Blocks uptake of adrenalin-type agents by nerve endings.

Rosemary

Source (Herb):
Rosemary

Used for:
Tonic and all-around stimulant
Enhance circulation, aid digestion, elevate mood, and boost energy
Arthritis and baldness (applied externally)

Side Effects:
Hyperglycemic and anti-insulin properties

Comments:
Antioxidant properties
Contains salicylates (the active ingredient in aspirin)

Tetrandine

Active Agent:
Tetrandine

Source (Herb):
Stephania tetrandra

Used for:
Hypertension

Side Effects:
Implicated in cases of kidney and liver failure

Comments:
Works in a manner similar to calcium channel blockers

Veratrum / Hellebore

Source (Herb):
Veratrum, also known as Hellebore

Used for:
High blood pressure

Side Effects:
Slow heart rate, hypotension (low blood pressure), nausea, vomiting

Comments:
Enhance sodium ion conductivity, activate Bezold-Jarish reflex causing slow heart rate and low (perhaps too low) blood pressure.

Other Internet Resources

National Institutes of Health National Center for Complementary and Alternative Medicine http://altmed.od.nih.gov/nccam/

University of Texas Center for Alternative Medicine Research http://www.sph.uth.tmc.edu:8052/utcam/

University of Washington Medicinal Herb Garden http://www.nnlm.nlm.nih.gov/pnr/uwmhg/

Columbia University Fact Sheets on Alternative Medicine: http://cpmcnet.columbia.edu/dept/rosenthal/factsheets.html

ASPET Herbal and Medicinal Plant Interest Group http://www.faseb.org/aspet/H&MIG3.htm#top

Herb Research Foundation http://www.herbs.org

The Phytochemical Database   http://www.orst.edu/dept/lpi/

American Botanical Council http://www.herbalgram.org/

Sources

I will be the first to admit I have little first hand experience with the herbal remedies (except my daily cup of coffee and green tea with dinner). I have compiled the table from recent reviews in conventional medical journals.

Winslow LC, Kroll DJ. Herbs as Medicines. Arch Intern Med 1998;158:2192-2199.

Mashour NH, Lin GI, Frishman WH. Herbal Medicine for the Treatment of Cardiovascular Disease. Arch Intern Med 158;158:2225-2234.

Herbal Medicine: What works, what's safe. Patient Care October 15, 1997.

Your Knowledge and Opinion

Please feel free to send comments or suggestions. Many of you will have valuable information to share.
�COPY;1997 HeartPoint    Updated December 1998.

| Commentary | Food You Will Love | HeartPoint Gallery | In The News | Health Tips | What's New
| Information Center | Home |

This site presents material for your information, education and entertainment. We can assume no liability for inaccuracies, errors, or omissions. Above all, material on this site should not take the place of the care you receive from a personal physician. It is simply designed to help in the understanding of the heart and heart disease, and not as a diagnostic or therapeutic aid. You should seek prompt medical care for any specific health issues. Please feel free to browse the site and download material for personal and non-commercial use. You may not however distribute, modify, transmit or reuse any of these materials for public or commercial use. You should assume that all contents of the site are copyrighted. �COPY;1997 HeartPoint

Source (Herb):	Ginko biloba (maidenhair tree)
Active Ingredient:	Multiple
Used for:	Antioxidant Memory enhancement "Improved circulation". Specifically, it appears to improve walking distance in people with blocked arteries to the legs (it reduces "claudication"). It may take several weeks for this effect to improve. Vertigo (dizziness). Mood enhancement
Side Effects:	Gastrointestinal, headaches, skin rash
Dose:	Recommended dose in Europe is 40 mg three times daily
Comments:	Approved as a drug in Europe.

Active Agent:	Allicin
Source (Herb):	Garlic
Used for:	Lowering cholesterol
Side Effects:	Garlic odor, heartburn, flatulence, other gastrointestinal effects. Allergies including skin rash.
Interactions:	May increase tendency to bleed. Use with caution with warfarin (coumadin).
Dose	Generally takes from 5-20 cloves for an average sized person (4 grams) The active ingredient is allicin (4-12 milligrams/day). The ingredient in fresh garlin is allinin. Allinase converts allinin to allicin which may happen immediately in the mouth. Allinase is degraded by the acids in the stomach. All of this explanation is to point out that when taking a garlic pill (which contains the allinin and allinase), that it should be enteric coated so that the allinase is not degraded prior to working on the allinin to produce allicin. This much allicin can generally be found in: - 400-1200 milligrams of powder - 2-5 milligrams fresh dried bulb - 2-5 grams of garlic oil - 2-4 milliliters of 1:5 tincture in 45% water three times daily
Comments:	May reduce cholesterol in the range of 5%, but not all studies have shown this. More, and more careful studies, would be helpful. May lower blood pressure to a small degree. Has been shown in one study to preserve the elasticity of the aorta. May have a role in decreasing clotting (reduces platelet thromboxane activity).

Active Agent:	Multiple, primarily flavenoids (antioxidants) and xanthines (caffeine-like substances)
Source (Herb):	Camellia sinensis
Used for:	Antioxidant Stimulant Cholesterol lowering agent (modest effects)
Side Effects:	Similar to caffiene: - Insomnia - Palpitations - Anxiety
Interactions:	None known
Dosage:	Generally brewed Prepared extracts are available.

Source (Herb):	Butcher's broom (Ruscus aculeatus)
Used for:	Venous disorders
Side Effects:	Nausea
Dose:	Available in Europe as capsule, tablet, ointment and suppository (for hemorrhoids)
Comments:	Appears to decrease vascular permeability induced by histamine Decrease the tendency of the sympathetic nervous system to cause vasoconstriction -- venules dilate at lower temperatures. Appears to work by calcium channel and alpha receptor blockade.

Active Agent:	Aescin
Source (Herb):	Chestnut (Horse Chestnut) (Aesculus hippocastanum)
Used for:	Venous disorders, varicose veins
Dose:	Initially 90-150 mg/daily, decreasing to 35-70 mg/daily if benefit seen
Interactions:	Multiple, particularly agents which are protein bound in the blood. This includes warfarin, commonly used in venous disorders as well.
Side effects:	Gastrointestinal symptoms Severe allergic reactions (anaphylaxis) Liver and kidney side effects (may be removed with dialysis) Possibly associated with a lupus-like reaction
Comments:	Thought to work by inhibiting enzymes which "weaken vessel walls" Increases venous tone, venousl flow and lymphatic flow Antagonizes capillary hyperpermeability, decreasing edema formation Has been shown in clinical trials to be helpful. Apparently, no evidence that topical application (for example to varicose veins) is helpful.

Source (Herb):	Danshen (Salvia, relative of western sage)
Used for:	Circulatory "stimulant"
Interactions:	Enhances effects of warfarin (coumadin)
Comments:	Dilates coronary arteries, but may cause either constriction or dilation of other vessels, and thus be associated with either high or low blood pressure. May be an anti-oxidant. Inhibits cyclic-AMP

Active Agent:	Digitalis (digoxin, digitoxin)
Source (Herb):	Foxglove, Oleander, multiple other things
Used for:	Congestive Heart Failure, Supraventricular Tachycardias
Side Effects:	Nausea, visual difficulties (seeing yellow), slow heart rate
Interactions:	Multiple drugs and other herbs which are protein bound in the blood and tissues.
Comments:	Digitalis has been and continues to be used for heart failure and rapid heart rates (supraventricular tachycardias). Even when carefully dosed with accurate agents, it is considered a "narrow therapeutic window" drug. If it is felt there is some compelling reason for its use in herbal form, it should be done very carefully. Oleander should be avoided due to its high toxicities

Source (Herb):	Gugulipid, a resin from the tree Commiphora mukul native to India
Used for:	Lowering cholesterol
Side Effects:	Headache, nausea, hiccups
Interactions:	May affect availability of propranolol, diltiazem, and other drugs decreasing their effectiveness.
Comments:	Has been shown to lower cholesterol and triglyceride levels (10% and 17% respectively)

Active Agent:	Tetramethylpyrazine
Source (Herb):	Lingusticum wallichi
Used for:	High blood pressure, "circulatory stimulant", sedative
Side Effects:	Very little known
Interactions:	Very little known
Comments:	Appears to cause vasodilation by blockade of calcium channels and alpha receptors

Active Agent:	Reserpine
Source (Herb):	Snakeroot
Used for:	High blood pressure
Side Effects:	Depression is relatively common. Nasal congestion. Avoid with peptic ulcer disease. Diarrhea.
Comments:	Blocks uptake of adrenalin-type agents by nerve endings.

Source (Herb):	Rosemary
Used for:	Tonic and all-around stimulant Enhance circulation, aid digestion, elevate mood, and boost energy Arthritis and baldness (applied externally)
Side Effects:	Hyperglycemic and anti-insulin properties
Comments:	Antioxidant properties Contains salicylates (the active ingredient in aspirin)

Active Agent:	Tetrandine
Source (Herb):	Stephania tetrandra
Used for:	Hypertension
Side Effects:	Implicated in cases of kidney and liver failure
Comments:	Works in a manner similar to calcium channel blockers

Source (Herb):	Veratrum, also known as Hellebore
Used for:	High blood pressure
Side Effects:	Slow heart rate, hypotension (low blood pressure), nausea, vomiting
Comments:	Enhance sodium ion conductivity, activate Bezold-Jarish reflex causing slow heart rate and low (perhaps too low) blood pressure.

National Institutes of Health National Center for Complementary and Alternative Medicine	http://altmed.od.nih.gov/nccam/
University of Texas Center for Alternative Medicine Research	http://www.sph.uth.tmc.edu:8052/utcam/
University of Washington Medicinal Herb Garden	http://www.nnlm.nlm.nih.gov/pnr/uwmhg/
Columbia University Fact Sheets on Alternative Medicine:	http://cpmcnet.columbia.edu/dept/rosenthal/factsheets.html
ASPET Herbal and Medicinal Plant Interest Group	http://www.faseb.org/aspet/H&MIG3.htm#top
Herb Research Foundation	http://www.herbs.org
The Phytochemical Database	http://www.orst.edu/dept/lpi/
American Botanical Council	http://www.herbalgram.org/