Complementary Alternative Cardiovascular Medicine

Chapter 3 / Botanical Medicine and CVD 31
excitability (positive bathmotrope) (16). Although the suitability of digitalis
for CHF has been questioned with more recent advances in pharmacological
interventions, a recent Cochrane review found that the literature
indicates that digitalis has a useful role in the treatment of patients with
CHF who are in normal sinus rhythm (17).
Even though many physicians are familiar with digitalis, most are not
aware that other countries have used and continue to use several cardiac
glycoside-rich plants to treat mild CHF. The inner scales of the bulb from
white squill (Urginea maritima), a common plant of coastal Mediterranean
regions that, depending on its origin, as well as time and manner of
harvest and drying, contains 0.15–2.0% cardioactive glycosides. The
primary glycosides are scillaren A and proscillaridin. The product is typically
standardized to 0.2% proscillariden, with a standard dose being
0.1–0.5 g/d (18). The German Commission E monograph (revised 1989)
approved the use of squill for milder cases of heart insufficiency and also
for diminished kidney capacity. The monograph lists nausea, vomiting,
stomach disorders, diarrhea, and irregular pulse as side effects (19).
Lily of the valley (Convallaria majalis) remains popular among herbalists
throughout the world as a treatment for minor CHF. The aerial parts
of the plant are gathered and dried during flowering. The herb contains
more than 30 different cardioactive glycosides, namely convallatoxin
and convallatoxol. Lily of the valley has primarily the same activity as
digitalis (positive inotrope, negative chronotrope, negative dromotrope,
and positive bathmotrope). The German Commission E monograph (revised
1990) approved the use of the herb for mild cardiac insufficiency,
heart insufficiency resulting from old age, and chronic cor pulmonale.
The dose listed in the monograph is 0.6 g/d standardized lily-of-thevalley
herb (19).
Note: Cardiac glycosides have a low therapeutic index and care must
be taken when prescribing. Given the variability of glycoside levels in the
herbs, only standardized products are recommended. It should go without
saying that any cardiac glycoside-containing botanical be administered only
by qualified health care professionals who are well versed in the management
of patients with cardiac illnesses.
DANDELION (TARAXACUM OFFICINALE)
Class 3 as a Diuretic for Hypertension
Folk healers throughout most of the world regard dandelion leaf and
root as effective diuretics. Herbalists often add dandelion leaf to hypertension
formulas to reduce intravascular volume. However, other than
some older animal data (20), there is basically no research available for