A Clinical Materia Medica - Verlag Systemische Medizin

COMBINING WESTERN HERBS ANDCHINESE MEDICINEJeremy RossA Clinical Materia Medica– 120 Herbs in Western Use –Foreword by Dr. Andreas HöllIllustrations by Inken ToepfferVerlag für Ganzheitliche Medizin Dr. Erich Wühr GmbH,Bad Kötzting / Bayer. Wald, GermanyCopyright © 2012Verlag Systemische Medizin AG

Bibliographic information published by the Deutsche NationalbibliothekThe Deutsche Nationalbibliothek lists this publication in the Deutsche Nationalbibliografie; detailed bibliographic dataare available in the Internet at http://dnb.d-nb.de.ISBN 978-3-927344-92-1© 2010 Jeremy Ross, Greenfields Press. www.jeremyross.com andVerlag für Ganzheitliche Medizin Dr. Erich Wühr GmbH, D-93444 Bad Kötzting/Bayer. Wald© Illustrations2010 Jeremy Ross, Greenfields Press. www.jeremyross.com andVerlag für Ganzheitliche Medizin Dr. Erich Wühr GmbH, D-93444 Bad Kötzting/Bayer. Wald andInken Toepffer, D-93059 RegensburgType-setting: modern ART, Vilshofener Str. 12, D-93055 RegensburgProduction: TYPOS, CZ -30537 Plzeň/PilsenAll rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronicor mechanical, including photocopying, recording, or by any information or retrieval system, without the prior writtenpermission of the copyright holder, except where permitted by law.CautionAll persons involved in the preparation and publication of this book have, as far as it is possible, taken care to ensure thatthe information given in this text is accurate and up-to-date. However, medical knowledge is constantly changing, andreaders are strongly advised to consult all the available data to confirm that the information given in this text complieswith the latest legislation and standards of practice, especially with regard to drug usage. Internet medical researchresources such as PubMed can be used to help update some of the information in the text.The author and the publisher welcome notifications from readers on the need to change information in this book and canbe contacted via the address of the publisher. Relevant alterations to the text will be included in the next edition of thisbook, and in the meantime will be cited in the author’s website (www.jeremyross.com) and the publisher’s website(www.vgm-portal.de) under the heading of Text updates.Before using any of the herbs listed in this book, practitioners should study the data on dose and contraindications givenin the relevant chapters on those herbs. In addition, practitioners are strongly advised to read the chapters on Principlesof herb combination, Practical herb combination, Dose, and Safety in Combining Western Herbs and Chinese Medicine:Principles, Practice, and Materia Medica by Jeremy Ross. Where the author is aware of differing opinions, for example, ondosage and contraindications, references for these different opinions have been given. Practitioners should consult thesereferences and weigh the available evidence themselves to come to their own conclusions before using this information totreat a patient.The information given for treatment in this book is meant as a guide only. It is the responsibility of the practitioner todecide whether a herb or herb combination is appropriate for a specific patient at a particular time. It should also bepointed out that herbal therapy is not proposed as an alternative to conventional medical diagnosis and treatment whenthis is necessary for the patient.Copyright © 2012Verlag Systemische Medizin AG

Table of ContentsForeword _______________________________XISources _______________________________ XIIIAnemone pulsatilla _______________________ 16Angelica archangelica _____________________ 18IntroductionXVApium graveolens ________________________22Arctium lappa ___________________________24Why I wrote this book ___________________ XVWhere to find things in this book __________ XVHow to use the herb chapters ____________ XVIPrinciples and practice of herb combination XVIIIDose and dispensing ____________________ XIXSafety _________________________________ XXMateria MedicaAchillea millefolium ______________________ 2Acorus calamus ___________________________ 4Aesculus hippocastanum ___________________ 6Agrimonia eupatoria _______________________ 8Agropyron repens ________________________ 10Aloe vera _______________________________ 12Althea officinalis _________________________ 14Arctostaphylos uva-ursi ___________________26Arnica montana _________________________28Artemisia absinthium _____________________30Asclepias tuberosa ________________________34Astragalus membranaceus ________________36Avena sativa ____________________________38Ballota nigra ____________________________40Berberis vulgaris _________________________42Calendula officinalis ______________________46Capsella bursa-pastoris ____________________48Capsicum species ________________________50Chamaelirium luteum ____________________54Chamomilla recutita ______________________56Chelidonium majus _______________________58Cimicifuga racemosa _____________________60Copyright © 2012Verlag Systemische Medizin AG

Cinchona species _________________________64Cinnamomum cassia _____________________66Citrus aurantium _________________________68Commiphora molmol _____________________ 70Convallaria majalis _______________________72Crataegus species ________________________ 74Curcuma longa __________________________ 78Echinacea species ________________________80Elettaria cardamomum ____________________84Ephedra sinica ___________________________86Equisetum arvense _______________________90Eucalyptus globulus ______________________ 92Euphorbia hirta __________________________94Euphrasia officinalis ______________________96Filipendula ulmaria _______________________98Foeniculum vulgare _____________________100Fucus vesiculosus _______________________ 102Galium aparine _________________________104Gentiana lutea __________________________106Glechoma hederacea _____________________ 108Glycyrrhiza glabra _______________________ 110Grindelia species ________________________ 114Hamamelis virginiana ___________________ 116Harpagophytum ________________________ 118Hedera helix ____________________________120Humulus lupulus ________________________122Hydrangea arborescens __________________124Hydrastis canadensis ____________________126Hypericum perforatum __________________128Hyssopus officinalis _____________________ 132Iris versicolor ___________________________134Isatis indigotica _________________________136Juglans species __________________________138Juniperus communis _____________________ 140Lavandula angustifolia ___________________ 144Leonurus cardiaca _______________________ 146Lobelia inflata __________________________150Lycium chinensis ________________________154Marrubium vulgare ______________________156Melissa officinalis _______________________158Mentha piperita _________________________ 160Mentha pulegium _______________________ 162Myrica cerifera _________________________ 164Nepeta cataria __________________________ 168Ophiopogon japonicus ___________________ 170Panax ginseng __________________________ 172Passiflora incarnata ______________________ 176Petroselinum crispum ___________________ 178Phytolacca Americana ___________________ 180Pimpinella anisum ______________________ 182Piscidia erythrina _______________________ 184Plantago major __________________________ 186Polygala senega _________________________ 188Polygonum bistorta ______________________190Copyright © 2012Verlag Systemische Medizin AG

Populus tremuloides _____________________ 192Potentilla erecta _________________________194Prunus serotina _________________________ 198Quercus robur __________________________200Rhamnus purshiana _____________________202Rheum palmatum _______________________204Rosmarinus officinalis ___________________208Rubus idaeus ___________________________ 210Rumex crispus __________________________ 212Ruta graveolens _________________________ 214Salvia officinalis _________________________ 216Sambucus nigra _________________________220Sanguinaria canadensis __________________222Thymus vulgaris ________________________260Tilia species ____________________________262Trigonella foenum- ______________________264Turnera diffusa _________________________266Urtica dioica ___________________________268Valeriana officinalis _____________________ 270Verbena officinalis _______________________ 274Viburnum prunifolium ___________________ 276Viola tricolor ___________________________ 278Vitex agnus-castus ______________________280Zanthoxylum species ____________________282Zea mays ______________________________284Zingiber officinale _______________________286Sanguisorba officinalis ___________________226Sarothamnus scoparius __________________228Schisandra chinensis ____________________230Scrofularia nodosa ______________________232Scutellaria species _______________________234Serenoa serrulata ________________________238Silybum marianum ______________________240Smilax species __________________________242Solidago virgaurea _______________________244Stellaria media __________________________246Syzygium aromaticum ___________________248Tanecetum parthenium __________________250Taraxacum officinale ____________________ 252Thuja occidentalis _______________________256Comparison of herb action groups… six Blood tonic herbs ___________________20… six bitter herbs ________________________ 32… seven circulatory stimulants _____________ 52… five cardioregulatory herbs ______________ 76… seven antimicrobial herbs and antibiotics __ 82… five antiasthmatic herbs _________________88… seven antidepressant herbs _____________130… four diuretic herbs ____________________ 141… five uteroregulatory herbs ______________ 148… four anticatarrhal herbs ________________ 166… ten sweet tonics_______________________ 175… seven astringent herbs _________________196Copyright © 2012Verlag Systemische Medizin AG

… laxative and purgative herbs ____________206… four aromatic herbs ___________________ 218Herb Properties ______________________365Herb Names ___________________________369… six herbs with isoquinoline alkaloids _____224… four nervine herbs ____________________236… alterative herbs _______________________254… five bitter calming herbs _______________272Cross ReferencesEnglish – botanical name _____________ 375Botanical name– family ______________ 379AppendicesReferences ____________________________ 291Glossary _____________________________333Chinese Organs and Syndromes:Terminology __________________________ 337Herbs for Chinese Syndromes __________339Family – botanical name ______________383Pharmaceutical name – English ________385Botanical name – Mandarin __________389Mandarin – botanical name ___________ 393Western Indications – Herb (pairs) ______397Herb (pairs) – Western Indications ______ 417Copyright © 2012Verlag Systemische Medizin AG

IntroductionWhy I wrote this bookTHE TOPICSince I started combining Western herbs and Chinese medicinetwenty years ago, there has been a great increase ininterest in this topic in many countries.A BASIC TEXTMy first book on this topic was Combining Western Herbsand Chinese Medicine: Principles, Practice, and MateriaMedica. This 970-page book was written to provide the basictheory and practical techniques, and to give detail on 50herbs and 150 herb combinations.TEXTS ON SPECIFIC TOPICSWhile teaching many courses on ‘Combining’ after thebook was written, students and practitioners have requestedbooks on specific aspects of this topic. As a consequence,a series of books on Combining Western herbs and Chinesemedicine is now planned.A CLINICAL MATERIA MEDICAFrom discussion, the most urgent need of the majority ofcourse participants was for more herbs, and for a flash cardstylepresentation of the key data for each herb.This book, A Clinical Materia Medica – 120 Herbs in WesternUse, was written in answer to their requests.KEY DATA TABLESEach herb in this book has a specially designed key data table,equivalent to a flash card, clearly showing the Chineseactions, Western actions, Western uses, and examples ofherb pairs for that herb.COMBINING THREE TRADITIONSWhat has become increasingly clear during my work withthis topic over the years is that the range of use of a herbcan be greatly expanded by combining information fromthe three traditions: Chinese medicine, Western herbal tradition,and modern pharmacological and clinical research.For some herbs, this opens up a remarkable panorama ofpotential future uses. Crataegus is an excellent example ofthis.EVIDENCE FOR STATEMENTS MADEIn books on Western herbal medicine written over the lastfifty years, authors often simply made statements or claimsabout herbs without giving supporting references fromeith er traditional texts or modern research. As a result, thereader did not know whether a statement made by the authorwas anything other than their unsubstantiated opinion.In more recent books, such as the ESCOP monographs, theBritish Herbal Compendia, or the works of Mills and Bone,references are given for statements made. In modern bookson Western herbs, citing references is essential if the workis to be regarded as a serious medical rather than a populartext.TRADITIONAL AND RESEARCH DATAEach herb in this book has one section on Traditional useand another section on Constituents and pharmacology.In these sections, a selection of material from traditionaltexts and from modern research studies is presented withreferences. Approximately 1,200 references are cited in thisbook.LIST OF HERBS FOR CHINESE SYNDROMESMany practitioners have requested a list of herbs for Chinesesyndromes, with signs and symptoms, pulse and tonguegiven for each syndrome.Such a list with all the main Chinese syndromes plus 125common combinations of syndromes is given as an appendixin this book.WESTERN INDICATIONSThis book meets also the needs of those who want to look upthe main Western indications for each single herb and double.See appendices “Western Indications and herb pairs”.Where to find things in this bookCOMPANION TEXTSThis book was designed to be a companion text to CombiningWestern Herbs and Chinese Medicine: Principles, Practice,and Materia Medica (PPMM).It provides a quick reference clinical materia medica for 120herbs, whilst PPMM provides the theoretical basis, practicalinstructions, great detail of 50 herbs, and discussion of150 herb combinations.THIS BOOKApart from the 120 herb chapters, this book contains thefollowing information:Copyright © 2012Verlag Systemische Medizin AGIntroductionXV

PRINCIPLES OF COMBINATION, DOSE, SAFETYThere is a brief summary of these topics toward the end ofthis Introduction. These topics are discussed in much greaterdetail in PPMM.SOURCESA number of basic texts are referred to so frequently in thisbook, that an abbreviation is used when citing them, oftenthe names of the authors or editors. These abbreviations areexplained in the beginning of the book in the Sources chapter.REFERENCESApproximately 1,200 references are cited in this book. Sincethe aim was to keep each herb chapter to two pages, the referencesare listed in the References appendix.GLOSSARYA Glossary at the back of this book explains some of theterms used in the text.The Actions glossary in PPMM will further help with thedefinition of Western herbal action categories and the discussionof their nearest Chinese equivalents.CHINESE ORGANS AND SYNDROMES: TERMINOLOGYThis section at the back of this book describes non-standardChinese syndromes that I encounter in my practice.HERBS FOR CHINESE SYNDROMESOne appendix contains all the main Chinese syndromes andabout 125 common syndrome combinations with details ofsigns and symptoms, pulse and tongue, and suitable herbs.HERB PROPERTIES, HERB NAMES, AND CROSS-REFERENCE LISTSThese useful tables provide a cross reference for botanical,English, pharmaceutical, and Mandarin names, and givegroupings of the herbs into families.PRINCIPLES, PRACTICE, AND MATERIA MEDICAThe reader is referred to PPMM for background material,and specifically to the following chapters: Although there are fewer herb chapters in PPMM, theseherb chapters provide greater detail on:- herb pairs- herb combinations- comparison of herb combinations- discussion of research data- toxicology- dose discussion- comparison of Western and Chinese useHow to use the herb chaptersEach of the 120 herb chapters in this book is organizedin the following way:Names and botanical detailNames, part used, familyBotanical descriptionBotanical illustrationUse of different types and plant parts (where applicable)Key herb dataTemperature, tastes, organsActions, uses, and herb pairs tableTraditional useTraditional use in ChinaTraditional use in the WestComparison with a similar herbComparison with another single herbComparison within a herb groupConstituents and pharmacologyTypes of constituentsActions supported by researchActions linked to a constituentDose and dispensingDried herbLiquid extractTinctureInitial doseDurationXVIIntroductionCopyright © 2012Verlag Systemische Medizin AG

CautionsGeneral contraindicationsChinese contraindicationsPregnancy and lactationSide effectsOverdoseDrug interactionsNames and botanical detailNAMES, PART USED, FAMILYThe English, botanical, and pharmaceutical names of theherb are given, together with the parts used, and familyname.The Mandarin name and Chinese characters are givenwhere applicable.BOTANICAL DESCRIPTION AND BOTANICALILLUSTRATIONThese are given to help create a mental picture and give afeel for the herb and to aid in identification.USE OF DIFFERENT TYPES AND PLANT PARTSFor some of the herbs, specific data on the use of differentspecies, subspecies, varieties, or plant parts is given in a separatesection. This section, which may also include a briefdescription on differences of tradition in different countries,is found directly underneath the main table.Key herb dataTEMPERATURE, TASTES, ORGANSTemperature Some herbs are classified with a range ofpotential temperatures, e.g., Achillea is classified as warmcool.For discussion of the concept of variable-temperatureherbs, please see the Temperature chapter in PPMM.Taste properties The aromatic property is included withthe taste properties in this book. For a detailed discussion ofthe taste properties, please see the Taste chapter in PPMM.Organs entered This is equivalent to the concept of meridiansentered in other texts. Please see the appendix Chineseorgans and syndromes: terminology in this book for explanationof organ concepts, such as Intestines or Uterus.ACTIONS, USES, AND HERB PAIRS TABLEOrganization by Chinese actions This table uses the mainChinese actions for the herb as the coordinating theme tolink Chinese actions, Western actions, and Western uses.For each of the main Chinese actions, an example of a herbpair is given to treat a specific disorder.Flash card or basis for detailed study This table showsthe key data on the specific herb, and it summarizes anenormous amount of information.The table can be used like a flash card that assists with learningthe essentials of a herb. Alternatively, each Chinese actionin the table can be used as a starting point for detailedstudy.Traditional useTRADITIONAL USE IN CHINAWhenever a herb is also commonly used in China, this sectiongives available herb data, including properties, actions,and uses.TRADITIONAL USE IN THE WESTMaterial from masters of the past, such as Dioscorides,Lonicerus, Tabernaemontanus, Gerard, and Culpeper, is includedwhere space allows. The material is often condensedor paraphrased, with antique terminology converted tomodern English. Readers are strongly encouraged to studythese texts, which represent the rich heritage of our Westernmateria medica.Comparison with a similar herbCOMPARISON WITH ANOTHER SINGLE HERBSometimes the herb of the chapter is compared with a similarherb, for example, Angelica archangelica is comparedwith Angelica sinensis. The similarities and differences ofthe herbs are discussed in terms of properties, actions, anduses, so that the practitioner can get a clearer idea of whento use each herb in practice.COMPARISON WITHIN A HERB GROUPSometimes the herb of the chapter is compared with otherherbs in an action group. For example, the end of the Angelicachapter has a Comparison of six Blood tonic herbs,which compares Angelica sinensis with molasses, Lycium,Gentiana, Rosmarinus, and Salvia.Constituents and pharmacologyTYPES OF CONSTITUENTSThe main types of constituents are listed, organized bychemical type, e.g., essential oils, flavonoids, alkaloids, tannins.The list mainly focuses on the constituents that givethe herb its characteristic actions.ACTIONS SUPPORTED BY RESEARCHThis section lists the actions that are supported by one ormore research studies, including in vitro, in vivo, humanpharmacological, or clinical studies.ACTIONS LINKED TO A CONSTITUENTThis section shows which constituents are responsible forwhich actions, when there is data available. This section issometimes organized by constituent and sometimes by action,as appropriate.Dose and dispensingDRIED HERB, LIQUID EXTRACT, TINCTUREDosage is usually given as three individual doses per day. Ifthe daily amount was given as a single dose in the sourcetext, this was usually converted to an amount for three individualdoses.In this book, the most frequently used source text for doselevels was the British Herbal Pharmacopoeia of 1983, seeDose and dispensing at the end of this chapter.INITIAL DOSE, DURATIONThese sections indicate whether there is a restriction on the initialdose or on the length of time that the herb can be taken.Copyright © 2012Verlag Systemische Medizin AGIntroductionXVII

CautionsIt is absolutely essential that practitioners read this sectionbefore using any herb in this book.GENERAL CONTRAINDICATIONSThis section lists known contraindications or cautions fromWestern tradition or modern research.Where space permits, contraindications based on adversereaction reports are differentiated from theoretical concernsbased on the presence of a potentially toxic constituent.This differentiation is discussed in detail in PPMM.CHINESE CONTRAINDICATIONSThis section lists traditional contraindications from textson Chinese medicine. It may also list contraindications thatare not given in these texts, but that have occurred clinicallydue the nature of the herb’s actions. For example, Rosmarinusmay aggravate Heart Spirit Disturbance in susceptiblepersons due to its stimulant action.PREGNANCY AND LACTATIONThis section gives data on safety concerns during pregnancyand lactation. Please see The Essential Guide to Herbal Safetyby Mills and Bone for more detail.SIDE EFFECTS, OVERDOSEThese sections include data on adverse reactions within andabove the therapeutic dose range, respectively.DRUG INTERACTIONSThis section gives data on adverse herb-drug reactions,when available.Principles and practice of herbcombinationThis book is a clinical materia medica, in which there is nospace for a detailed discussion of the principles and practiceof herb combinations. Only a very brief outline is given hereand the reader is referred to PPMM.ChecklistTo create a balanced, effective, and safe herb combination inChinese medicine, it is important to consider the followingprinciples. These principles apply whether the herbs usedare Chinese or Western. ACCURATE DIFFERENTIAL DIAGNOSISThe foundation for creating an effectiveherb combination is accurate diagnosis.In herbal treatment, accurate diagnosis is important. Withoutit, the consequences to the patient may be unpleasantor even dangerous. The practitioner needs to determinethe Chinese syndromes underlying the patient’s signs andsymptoms in order to choose appropriate herbs to treatthese syndromes. This can be summarized by the phrase:Wrong diagnosis means wrong herbs!PRIORITIZATION OF CHINESE SYNDROMESThe next step consists of prioritizing the patient’s Chinesesyndromes into those of primary and those of secondaryimportance.How to decide The decision as to which syndromes areprimary and which are secondary is made partly accordingto which disorders are most important to the patient, andpartly according to medical principles, such as the optimumsequence for treating ‘root’ and ‘branch’ in the given case.Importance of prioritization Primary syndromes requiremore herbs in the combination than do secondarysyndromes. If the practitioner gets the syndromes right, butthe prioritization of the syndromes wrong, the patient mayget worse not better. See An example with mistakes in thePractical herb combination chapter in PPMM.BALANCING TEMPERATUREIn the traditions of Western and Chinese herbal medicine,both patient and herbs were classified in terms of temperature(hot, warm, neutral, cool, or cold). Herbs were thenmatched to patients on the basis of this classification.For example, a cool pathology would generally be treatedwith a herb combination that was warm in its overall temperaturebalance. To treat a cool pathology with a hot combinationwould be seen as a potentially damaging overcorrection.Incorrect temperature balance is one of the most commonmistakes in herb combination.BALANCING TASTE PROPERTIESTaste balance is a relatively sophisticated level of herb combination,but the practitioners should at least be aware ofthe contraindications for the different taste properties.Each taste property has its specific range of uses and itsspecific disadvantages. Tastes can be combined so that onetaste can enhance the beneficial effects of another or moderateits potential adverse effects.Tables showing taste contraindications and how to balancethe tastes are included in the Taste chapter in PPMM.BALANCING HERB ACTIONSIt is important to balance the actions of the individual herbsin a herb combination.For example, a purgative like Rheum is commonly givenwith a carminative like Foeniculum to reduce the potentialpurgative side effect of intestinal colic.As another example, an alterative like Taraxacum is oftencombined with a detoxicant and anti-inflammatory likeGlycyrrhiza to reduce the potential alterative side effect ofaggravating skin and arthritic conditions.A table showing how to balance herb actions is included inthe Actions chapter of PPMM.XVIIIIntroductionCopyright © 2012Verlag Systemische Medizin AG

CHECKING FOR POTENTIAL CONTRAINDICATIONSIt is essential that the practitioner check for each herb in theproposed combination whether it can cause side effects in aspecific patient.Some obvious examples of questions are: stimulant herbs should be avoided? loose stools, so that cooling, bitter, downward drainingherbs should be avoided? herbs are contraindicated? tionsto any of the herbs? or a specific herb, so that only low doses should be used? so that treatment with alterative herbs may cause an aggravationof symptoms? herbs may interact?Four different approaches to herbcombinationThree of these approaches involve using a preexisting combination,and the fourth involves creating a new combinationby using the basic principles of herb combination.USING A PREEXISTING COMBINATIONThere are three main possibilities: tionsNote for beginners Creating a new combination by combiningelements of different preexisting combinations is anadvanced technique. If the technique is used by those whoare inexperienced in herbal medicine, it can easily resultin an assortment of ill-matched fragments rather than in acarefully balanced and harmonious combination.It is recommended that beginners first become thoroughlyfamiliar with the properties of the individual herbs and withthe principles of herb combination. They can then developtheir skills by using preexisting combinations, with simplemodifications where appropriate, and by learning to createsimple new combinations from first principles.CREATING A NEW COMBINATIONWhen creating a new combination that matches the specificChinese syndromes and life situation of the patient, it isnecessary to work through the stages in the checklist above.See examples in PPMM.Dose and dispensingDose levelsTHERAPEUTIC DOSE RANGEEach herb has a therapeutic dose range, within which a suitabledose for most adults will be found.Minimum therapeutic dose This is the smallest dose thatwill have a therapeutic result. Below this is the subtherapeuticdose, which is too small to have a therapeutic effect.Maximum dose In the case of herbs with potential adverseeffects, this is the largest dose that is safe to administer. Thetoxic dose is the dose, at and above which adverse reactionsdue to toxic effects are likely to occur. In the case of herbslike Althaea, for which there are no reports of adverse effectseven at overdose levels, the maximum dose can be definedas the largest dose that is generally necessary to obtaina therapeutic effect.DIFFERENCES OF OPINIONThe statement on dose above sounds clear and definite. Theproblem is that there are often differences of opinion as towhat constitutes the minimum and maximum therapeuticdose for a specific herb.Common sense dosing The author of this book recommendsusing the least dose required to get the desired therapeuticeffect. He takes the middle road between what may be calledthe higher dose approach and the lower dose approach. Thistopic is discussed in detail in PPMM, where alternativedoses are often given for each herb and where the appropriateuse in different situations is described.BHP AS A BASISFor dried herbs and for herb tinctures, this book generallyadopts the dose levels of the British Herbal Pharmacopoeiaof 1983.Recent research on dose In cases where subsequent researchhas indicated that lower doses should be used forsafety reasons or that higher doses are more clinically effective,these are the doses that are included in the currenttext. For example, the BHP recommended 3-6 ml of a 1:5tincture of Crataegus per day, whilst The Essential Guide toHerbal Safety by Mills and Bone recommended 3.5-17.5 mlper day. The latter amount is recommended in the currenttext, and is an example of the higher dose approach.A GENERAL GUIDEVery approximately, the dose for the average herb is 1-2 g ofdried herb or 2.5-5 ml of 1:5 tincture, three times per day,for an adult.However, some herbs are more potent, and their doses maybe much less. For example, the maximum permitted dose inthe UK of Lobelia inflata is 0.2 g of dried herb or 1 ml of 1:5tincture, three times per day.Dose and ageInfants, children, and the elderly are given smaller dosesthan people of other age groups, as shown in the table. Theseare individual doses to be taken three per day.Copyright © 2012Verlag Systemische Medizin AGIntroductionXIX

Ageinfants6-12 monthsinfants1-2 yearschildren2-5 yearschildren5-10 yearsteens10-18 yearsIndividual doseof 1:5 tincturein mlIndividual doseof 1:5 tincturein drops*0.05-0.5 ml 1-10 drops0.1-1 ml 2-20 drops1-2.5 ml 20-50 drops2-3.75 ml 40-75 drops2-5 ml 40-100 dropsadults 2.5-5 ml 50-100 dropselderly 2-3.75 ml 40-75 drops* The figures are based on the assumption of 20 drops per mlDose formHerbs can be taken orally as powdered dried herbs to betaken with water, infusions, decoctions, tinctures, liquidextracts, or concentrates. Each dose form has its advantagesand disadvantages, summarized in the table below. For a detaileddiscussion, see the Dose chapter in PPMM.AdvantagesInfusions and decoctions cheapness and accessibility link to the natural world tituents decoctions suitable for water-solubleconstituents, such as polysaccharidesand tannins treatment of patterns of Cold treatment of patterns of Dryness diaphoretic treatments Tinctures and liquid extracts taste Disadvantagesble constituents, such asresinssoluble constituents, suchas polysaccharides andtanninstreatmentsAdvantages suitable for ethanol-solubleconstituents, such as essential oils,alkaloids, resins, and saponins treatment of patterns of Cold andDamp, Deficiency, and StagnationPowders Pills and capsules SafetyPlease do not use any of the herbs in this book without firststudying their properties, actions, use, dose, and contraindications.ChecklistPractitioners can use the following checklist to minimizeadverse reactions due to herb use.For detailed discussion of safety, see: Safety, Safety and the organ systems,and Safety in clinical practice in PPMM by Mills and BoneMonitoringDisadvantagestreatmentsof herbs in a combinationconstituentspossible to match them tothe specific needs of the tuentsHERBS NEEDING MONITORINGFor some of the herbs in this book, it is suggested that thepatient be monitored for side effects during the course oftreatment.These herbs include: Capsicum, Cinchona, Convallaria,Ephedra, Lobelia, and Sarothamnus.Monitoring may also be appropriate for some of the alterativeherbs, specifically Arctium seeds and Taraxacum root,which have the potential for aggravating skin rashes andarthritis, especially in patients with high levels of accumulatedtoxins.MONITORING BY PRACTITIONER AND PATIENTPractitioner The practitioner should check for signs andsymptoms of any potential side effects that are to be expectedwith the specific herbs and the specific patient. Monitoringis essential for herbs with the possibility of severeadverse reactions.XXIntroductionCopyright © 2012Verlag Systemische Medizin AG

Patient The patient can be asked to keep a record of thefollowing: tions:noting such details as severity and the time anddate the symptoms occurred medication, herbs, or food supplements responsible for the symptomsRechallenge If it is appropriate and if the patient agrees,the herbs can be taken again, at a lower dose and/or in adifferent form if preferred, to determine if the symptomsrecur. The patient should be asked to keep in contact withthe practitioner during this process and to stop the herbsimmediately if the adverse effect recurs.Rechallenge may not be appropriate for herbs with potentiallysevere adverse effects, even if the dose is greatly reduced.General1. take a full medical history2. make an accurate differential diagnosis3. prioritize Chinese syndromes4. decide if further specialist diagnosis is required5. decide if herbal treatment is appropriate6. allow informed patient choiceHerb combining7. balance temperature8. balance taste properties9. balance herb actions10. check for potential contraindications11. choose appropriate dose level, dose form, timing ofdose, and duration of prescription for the patientAfter prescribing12. monitor for adverse reactions, if appropriate13. manage adverse reactions, if appropriate14. report adverse reactions, if anyCopyright © 2012Verlag Systemische Medizin AGIntroductionXXI

AchilleaEnglish yarrowBotanical name Achillea millefolium L., s. l.Pharmaceutical name Achilleae millefolii herba cumflore (= Millefolii herba cum flore)Part herb and flowersMandarin yáng shī căo (), the aerial parts of A.millefolium, is not a main herb in Chinese medicineFamily Asteraceae (Compositae)An aromatic stoloniferous perennial with erect, usually unbranchedstems, 0.2-1 m tall. Leaves are feathery, lanceolate,and 2-3-pinnate. Flowers are small and white or occasionallypink, borne in dense flat-topped clusters. Native to theNorthern hemisphere, where it grows in grassy habitats, roadverges, and lawns. Achillea prefers well-drained soil.TemperatureTastesOrganswarm-coolacrid, bitter, aromaticLU, SP, HT, UTPlease see the chapter on this herb in Principles, Practiceand Materia Medica for herb combinations and for furtherinformation 1 .Actions, uses, and herb pairsChinese actions(Western actions)I. clear Wind Heat(diaphoretic, antipyretic, alterative)Western usesacute respiratory disorders with feverishnessdominant to chillsPair examples(disorders)Achillea + Mentha piperita(common cold + sore throat)II.clear Wind Cold(diaphoretic, antipyretic, alterative)acute respiratory disorders with chillsdominant to feverishnessAchillea + Zingiber (fresh)(influenza + cold sensation)III.clear Lung Phlegm Heat(diaphoretic, antipyretic, alterative)acute respiratory disorders with fever,cough, bronchial phlegmAchillea + Asclepias(pleurisy + fever)IV.clear Lung Phlegm Cold Damp(anticatarrhal, alterative)acute respiratory disorders with nasal orbronchial phlegm and cold sensationsAchillea + Angelica archangelica(influenza + sinusitis)V. clear Retained Pathogen, tonify Defensive Qi(diaphoretic, alterative, tonic)recurring respiratory infections, with lowgradefever and fatigueAchillea + Echinacea(recurring respiratory infections)VI.tonify Spleen Qi and Blood(bitter digestive tonic)digestive weakness with exhaustion (andanemia), postfebrile convalescenceAchillea + Artemisia absinthium(postfebrile exhaustion)VII.tonify Spleen Qi and Heart Qi(digestive and cardiac tonic)(postfebrile) exhaustion with digestive andcardiac weaknessAchillea + Cinchona(some cases of chronic fatigue)VIII.reduce leakages, reduce bleeding(astringent, anticatarrhal, hemostatic)nosebleeds, hemoptysis, diarrhea, leukorrhea,menorrhagia, woundsAchillea + Urtica(menorrhagia)2 AchilleaUSE OF DIFFERENT TYPES AND PLANT PARTSA. millefolium is a complex of barely distinguishable species or subspecies,which have evolved by polyploidy (changes in chromosome number) 2 . Differencesin chromosome number between the A. millefolium subspeciesare often accompanied by important chemical differences, which in theirturn, may lead to differences in temperature, actions, and uses 1 .Copyright © 2012Verlag Systemische Medizin AG

Traditional use in the WestDIOSCORIDES (1 ST CENTURY AD) 3 and heal the wound, clear it from heat and inflammation,and congeal the blood herb with wool and put in the vagina LYLE (1897) 4It stimulates the appetite and tones the digestive organs. Itis important as a tonic to the general system. In cold infusions,it acts as a tonic in convalescence from fevers, fromnervous prostration, and in pulmonary tuberculosis andnight sweats.CHRISTOPHER (1976) 5 equalizes the circulation, and purifies the blood of morbidwaste material cludingtyphoid fever), eruptive diseases (including mea- derdischarges urine, enuresis BHP (1983) 6This text gave the specific indication of thrombotic conditionswith hypertension, including cerebral and coronarythromboses.Comparison with a similar herbACHILLEA AND HYSSOPUSACHILLEA AND TILIASee Tilia.See Hyssopus.Constituents and pharmacologyTYPES OF CONSTITUENTS 2 (0.2-1%) composition of essential oil variesgreatly with chromosome number, for example:- hexaploid plants have no chamazulene, but mainlyoxygenated monoterpenes, especially linalool (26%) andcamphor (18%), with some borneol and 1,8-cineole- tetraploid plants contain mainly sesquiterpenes, especiallychamazulene (about 25%) and β-caryophyllene(11-22%) achillicin (= 8-acetoxyartabsin)is the main prochamazuleneincluding apigenin, luteolin and their gluco- sides mainly achilleine (= betonicine = L-4-hydroxy-stachydrine)as well as stachydrine, betaine, andcholine tannins (3-4%), polyacetylenes, triterpenes, sterols(including beta-sitosterol), coumarins, phenolic acids(including salicylic and caffeic acids)ACTIONS SUPPORTED BY RESEARCHThe following actions have been reported for Achillea plantmaterial or for its isolated constituents:antibacterial 7 , anti-inflammatory 8 , antiulcer 9 , spasmolytic 8 ,choleretic 8 , hepatoprotective 10 , antihypertensive and antilipidemic(A. wilhelmsii) 11 , hemostatic 12 , antitumor 13ACTIONS LINKED TO A CONSTITUENT essential oil (including linalool) 7 flavonoids, dicaffeoylquinic acids 8 flavonoids 8 dicaffeoylquinic acids 8 12 achimillic acids (sesquiterpenoids) 13Dose and dispensingDRIED HERB 2-4 g of dried herb, as powder or as infusion, three timesper day (BHP) 6 .TINCTURE 2-4 ml of 1:5 tincture in 45% alcohol, three to four timesper day (BHP).INITIAL DOSE Can start at the standard dose (JR).DURATION Achillea infusions are generally for acute conditions and for short-termuse only (JR).CautionsGENERAL CONTRAINDICATIONS Sensitivity to Asteraceae (M&BSafety) 14 .CHINESE CONTRAINDICATIONS Not widely used in Chinesemedicine.PREGNANCY AND LACTATION No adverse effects in humans reported,but see M&B Safety for animal research. No restrictions on breastfeedinglisted by BSH 15 .SIDE EFFECTS See General contraindications.OVERDOSE No adverse effects reported (M&B Safety).DRUG INTERACTIONS No adverse effects reported (M&B Safety).Copyright © 2012Verlag Systemische Medizin AGAchillea 3