H A N D B O O K O F Medicinal Herbs SECOND EDITION 1284_frame_FM Page 2 Thursday, May 23, 2002 10:53 AM H A N D B O O K O F Medicinal Herbs SECOND EDITION James A. Duke with Mary Jo Bogenschutz-Godwin Judi duCellier Peggy-Ann K. Duke CRC PR ESS Boca Raton London New York Washington, D.C. Peggy-Ann K. Duke has the copyright to all black and white line and color illustrations. The author would like to express thanks to Nature’s Herbs for the color slides presented in the book. Library of Congress Cataloging-in-Publication Data Duke, James A., 1929- Handbook of medicinal herbs / James A. Duke, with Mary Jo Bogenschutz-Godwin, Judi duCellier, Peggy-Ann K. Duke.-- 2nd ed. p. cm. Previously published: CRC handbook of medicinal herbs. Includes bibliographical references and index. ISBN 0-8493-1284-1 (alk. paper) 1. Medicinal plants. 2. Herbs. 3. Herbals. 4. Traditional medicine. 5. Material medica, Vegetable. I. Duke, James A., 1929- CRC handbook of medicinal herbs. II. Title. [DNLM: 1. Medicine, Herbal. 2. Plants, Medicinal.] QK99.A1 D83 2002 615′.321--dc21 2002017548 This book contains information obtained from authentic and highly regarded sources. Reprinted material is quoted with permission, and sources are indicated. A wide variety of references are listed. Reasonable efforts have been made to publish reliable data and information, but the author and the publisher cannot assume responsibility for the validity of all materials or for the consequences of their use. Neither this book nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage or retrieval system, without prior permission in writing from the publisher. The consent of CRC Press LLC does not extend to copying for general distribution, for promotion, for creating new works, or for resale. Specific permission must be obtained in writing from CRC Press LLC for such copying. Direct all inquiries to CRC Press LLC, 2000 N.W. Corporate Blvd., Boca Raton, Florida 33431. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation, without intent to infringe. Visit the CRC Press Web site at www.crcpress.com © 2002 by CRC Press LLC No claim to original U.S. Government works International Standard Book Number 0-8493-1284-1 Library of Congress Card Number 2002017548 Printed in the United States of America 1 2 3 4 5 6 7 8 9 0 Printed on acid-free paper Introduction By the time this second edition is published, the first edition of the Handbook of Medicinal Herbs will have been out more than 15 years. The second edition is designed to present most of the old information plus new information on the more important of those original 365 herbs. I submitted the first edition under the original unpublished title, Herbs of Dubious Salubrity. I intentionally left out many of the completely safe culinary herbs, spices, and food plants that are clearly medicinal. I also intentionally omitted some strictly dangerous herbs, such as foxglove, that were too unhealthy for use in unskilled hands. I did include several obscure hallucinogenic plants of dubious salubrity. I did, or should have, dropped some of these because they have little medicinal importance. Some poorly documented species, such as Mimosa hostilis and Phoradendron leucarpum, for example, were retained with fragmentary entries, so as to at least mention species from the first edition that might better have been dropped. Now I think I have the most important herbs well covered here. In edition two, which I will refer to frequently as my Herbal Desk Reference (HDR), I have tried to concisely corral the data on some 1000 herbs in as little space as possible, striving to make a reliable, referenced resource to parallel the PDR for Herbal Medicines. I use the three-letter abbreviation, HDR, to indicate the second edition of my Handbook of Medicinal Herbs, because I compare and contrast it to other important sources, which are also represented by three-letter abbreviations. (See the reference abbreviation appendix.) With this edition, I have tried to cover most of the widely mentioned medicinal plants, whether they are extremely salubrious or extremely toxic. Without counting them, I estimate we include more than 1000 of the most important herbs, including the more important herbs from the young Native American and the European traditions (including most of those approved by Commission E (KOM), and almost all of those included in the PDR for Herbal Medicine (PHR for the first edition, and PH2 for the second edition). Unlike Commission E and the Herbal PDR, which seem to stress European and American traditions, I include proportionately more herbs from the older African, Ayurvedic, and Chinese traditions as well, not wanting to slight any major medicinal plant from any major tradition. Let me explain the new format for the second edition. First, a common name appears, usually but not always in English, followed by a recently accepted scientific name, with the authority for the scientific name. Then follows a safety score, X, +, ++, or +++. An X means I don’t recommend taking it at all, or realize that it is so dangerous that it should not be taken without expert guidance. But for litigious reasons, I give some potent medicinal herbs the X (amateurs beware!). A single plus (+) indicates that I do not consider that the herb is, overall, as safe as coffee. I score two pluses (++) for those herbs I think of, overall, as being as safe as coffee. I score three pluses (+++) for those herbs I believe to be safer than coffee. In the first edition, I related the plus sign to a cup of coffee, figuring that 1, 2, or 3 cups per day of an herbal tea from the herb would be as safe as 1, 2, or 3 cups per day of coffee. I often drink more than 3 cups of coffee a day, especially while I worked on this project! Clearly, this is an oversimplification. Too often, some parts of a plant are more helpful or more toxic than other parts of the same species, and different ethnic groups or cultures may use parts differently. The safety scoring is a continuation of the same scoring system I used in the first edition. Some scores have been upgraded a bit, some have been downgraded. Often, there are some comments on synonymy and other nomenclature difficulties that arose in completing this opus. I inject these following the nomenclature line. Here you may find some proven and/or suspected synonyms, or notes of related species that may be included in this species concept, especially by nontaxonomically trained authors. I have often used, as final arbiter of scientific names and sometimes common names, the nomenclature database at the USDA (www.ars- grin.gov; curator, Dr. John. H. Wiersema: Mavor. So, if you are looking for an herb that has been suggested by a pediatrician, scroll down to WAM. Ditto for PIP, Hans Schilcher’s Phytotherapy in Paediatrics. This is an evolving system that changes as new science validates the folklore, often resulting in an upgrading of the indication or activity. Occasionally, bad news about the plant will result in my lowering its safety rating, from +++ to ++, or ++ to +, or + to X. This does not constitute my recommendation of an herb. It merely indicates how I think the herb compares with others, based on the literature surveyed. As a botanist, I cannot legally, and do not, prescribe. But I find mechanical searches of the Handbook of Medicinal Herbs to be an extremely fast way to find the better herbs for a given indication. We have used the same abbreviations that are used in my database at the USDA (http://www.ars- grin.gov/duke). I much prefer the abbreviations used there because they do not get you into as much trouble when you e-mail a query to the taxpaying public. For example, the preferred abbre- viation of microgram, at least with some publishers (including CRC), but not me, is µg. Too often, if I put that abbreviation (or use an italicized u) in an e-mail, the u or µ disappears and the reader receives g instead of ug or µg, giving an often dangerously high reading, a million times too high. Ditto for ul or µl (microliter) as opposed to ml (milliliter). And with uM and mM, micromole and millimole, respectively. In a sense, my scored second edition is a loner’s approach to a Commission E, but I am the sole member of the fictitious commission, Commission U.S. for us, here in the good old USA. Note that unlike the ratings in, for example, APA, my ratings assess the efficacy of each activity and indication. I’ll keep revising the scoring for an online version as new information, positive or negative, comes in on the safety or efficacy of the herb, or chemicals it contains. So, like the allopaths, health announcers, and reporters, I reserve the right to change my mind as I oscillate from side to side of the pendulum on my long, tedious, treacherous, and tumultuous trip, veering like a coiled caduceus, deviously toward the truth. Users will find it easy to search and find which herbs score highest for efficacy and safety. The three-letter abbreviations will lead them to some, but by no means all, of the sources I consulted including the one(s) or some of them that led me to the numerical scores for efficacy. The scores are my own. Only rarely did all the cited and consulted sources agree; but one of the indicated sources provided the evidence that led me to arrive at the assigned score. By no means should these scores be attributed to anyone except me. THE APA RATINGS A warning: my highest ratings are my best ratings. With the American Pharmaceutical Association (APA) and the American Herbal Products Association (AHP), the converse is true: the higher the number, the lower the rating. APA’s best, (1), is verified by large clinical, randomized, placebo- controlled, double-blind, human trials. That too would have gotten approval, we assume, in Commis- sion E. That would get a (2) in my HDR, if the study were of an extract of the plant, but a (3) for example if the study were of the natural whole herb, such as garlic or onion. The APA (1) and the HDR (3) scores are rare indeed. Their number (1) means “Years of use and extensive, high-quality studies indicate that this substance is very effective and safe when used in recommended amounts for the indication(s) noted in the ‘Will It Work For You?’ section.” Unfortunately, they often mention unapproved, unstudied folklore in this section, even clearly noting that it was unapproved. With APA, (2) is a large, clinical human trial, but not necessarily double blind and placebo controlled. That would also get a (2) in my HDR, if the study were of an extract of the plant, but a (3) if the study were of the whole herb, rather than the extract. And the third one is hard for me to believe, but here is the quote, “large, placebo-controlled animal experiment.” That would get a (1) in my HDR. The APA (4) is for in vitro studies, which I suppose includes studies, e.g., of isolated phytochemicals. Those score (1) in HDR. The APA (5) is for decades or centuries of well-known folk use, but no supporting studies. That would get an (f) for folkloric in the HDR. APA (6) is a large collection of case histories, which would also get an (f) in HDR. At the bottom of the APA ladder is the personal anecdote, which of course, also gets an (f), even though it has not yet evolved into folklore. THE AHPA CLASSIFICATION A few specific comments regarding the American Herbal Products Association (AHP). Although I like the way they handled some perplexing little details, such as idiosyncratic allergies, trivial quantities of toxic substances, etc., I’m a little alarmed by their ‘Class 1’ definition. Why alarmed? Because I feel that all drugs, whether they be synthetic, phytochemical, nutritional, or herbal, “can be safely consumed when used appropriately.” Class 1: Can be safely consumed if used appropriately. Class 2: Herbs with the following use restrictions apply; unless otherwise directed by an expert qualified in the use of the substance: (2a) External use only (2b) Not for use in pregnancy (2c) Not for use while nursing (2d) Other restrictions as noted Class 3: Herbs with significant data suggesting labeling: “To be used only under the super- vision of an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage, contraindications, potential adverse effects and drug interactions, and other information pertinent to the safe use of the substance. Class 4: Herbs with data insufficient for classification. Why don’t I like that ‘Class 1’ definition? My interpretation of ‘Class 1’ definition is that all herbs are ‘Class 1’ and can be safely used if used appropriately (appropriate is safe). Similarly, I think we could say appropriately for many, if not most, herbs what AHPA says of labeling information that should be required for aloe, “Do not use this product if you have abdominal pain or diarrhea. Consult a health care provider prior to use if you are pregnant or nursing. Discontinue use in the event of diarrhea or watery stools. Do not exceed recommended dose. Not for long term use.” (AHP, 1997) A subset of American phytomedicine advocates argue that we should emulate the German Commission E’s Standard of Excellence. Which one? Two versions came out in 1998, purporting to be authentic English presentations of the Commission E conclusions. There were some differ- ences; e.g., Blumenthal’s very careful book (identified as KOM in this book) states that hyssop is unapproved by Commission E, while Gruenwald, in the second edition of the PDR for Herbal Medicine, says hyssop is approved for colds, fevers, and gallbladder and liver complaints. In the title line, where I evaluate safety, I scored hyssop with three pluses (+++), meaning that I think it is safer than coffee as an herbal medicine. As to efficacy, I had decided to let Commission E endorsement rank 2 in my Activities and Indications columns. This example of divergence between the published “Commission E” interpretations of hyssop (and there are more than ten English interpretations of Commission E now) is just one of many that I encountered as I traversed most of these interpretations. It really raises a serious question again that I raised for myself back in the early 1980s as I was working on my Medicinal Plants of China. Clearly, I was capable of working only with the English translations of Chinese books on medicinal plants, embellished by three trips to China. I assumed that by the time I had compiled most of the information from five different books, there would be little new information as I traversed the sixth. But diminishing returns had not yet set in. There are a few major discrepancies in recent translations of romance language, scientific German, as with Commission E. How many more can we expect in translations of ancient Chinese, Hindu, and Sanscrit writings that are thousands of years old? Small wonder we often encounter differences of opinion. One can only be thankful that these books have survived because they document millennia of empirical wisdom. The best of the herbal medicines have survived and the worst have been marginalized. That took thousands of years. You can almost say the same of pharmaceuticals: some have survived, while some of the worst have been marginalized or withdrawn. But none of the pharmaceuticals have survived more than 200 years with us. But the ~140 herbs mentioned in the Bible have been with us 2000 years. A recent study showed that humans have been active in the Biblical area for at least 1,700,000 years. So, the genes of some humans have experienced many of the phytochemicals from Biblical plants for nearly 2 million years. More new synthetics hit the market each year, to your peril, but few new herbs surface in a given year. Mankind does not want bad medicine. Man empirically selects the good and rejects the bad. I feel strongly that many of the herbs treated in this book are as good as the competing synthetic pharmaceuticals, and almost always cost less, in dollars and in side effects. Until the better of these herbs have been clinically compared with the pharmaceuticals, neither your physician nor mine, nor you nor I, knows for sure which is best. Meanwhile, pharmaceuticals will kill more than 100,000 Americans a year, as per JAMA, a propharmaceutical journal, while herbs will kill fewer than 100, as per the conservative Washington Post in an antiherb article (Gugliotta, March 19, 2000). On May 1, 2002, the Journal of the American Medical Association (JAMA) suggested that adverse drug reactions may be the leading cause of death in the United States. FORMAT SYNONYM: In some cases I list one or more taxonomic synonyms often following the USDA Nomenclature database, curated by John Wiersema http://www.ars-grin.gov/npgs/tax/taxgenform.html. ACTIVITIES: Most of the published biological activities that crossed my desk are listed alphabetically, with each activity followed by the “f” or numerical score for efficacy, followed by the citation for the source. INDICATIONS: Most published indications that crossed my desk are listed alphabetically, with each indication followed by the “f” or numerical score for efficacy, followed by the citation for the source. It was with some trepidation that I converted more specific terms such as arthritis to arthrosis, and bronchitis to bronchosis, but I think that was a more economical (space-wise) way of presenting the data. Classically, the suffix “itis” means inflammation, and “osis” means ailment of. Thus, arthritis is inflammation of the joint, and arthrosis is broader, meaning an ailment in the joint. Where some author just said “for joint problems,” that became “arthrosis,” but where they were more specific and said inflammation of the joint, it means the more specific “arthritis.” Toward the end we aggregated both under “arthrosis.” Many people will dislike that I converted all the more specific -itis entries to -osis, rather than somewhat redundantly include both. DOSAGE: I have attempted in this edition to give the range of published dosage ranges I have encountered. With good editorial prodding, I have gone back to my sources to see if they specified which plant part. In some cases my sources were not specific as to plant part. And sometimes one source specified one part, another source identified another part. A few dosages were taken right off the bottles of herbs. If there are dangerous published dosages given under dangerous herbs, I have indicated with an “X” that it should not be taken except with a skilled practitioner on hand. None of the dosages originate with me (except for an occasional “food farmacy” comment, indicating that the herb is eaten as food); they are from the literature, as indicated by the usual set of abbreviations. Several do, however, represent dosages said to have been approved by Commission E, especially those cited with the abbreviations KOM, PHR, and PH2. I suppose by appearing in