1 2 3 4 5 6 7 Page intentionally left blank 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 h 43 44 45 46 47 48 49 50 1 2 3 4 5 6 7 Page intentionally left blank 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 Pocket Guide 1 to Herbal Medicine 2 3 4 5 6 7 Karin Kraft, M.D. 8 9 Professor 10 Outpatient Clinic 11 University of Rostock 12 Germany 13 14 Christopher Hobbs, L.Ac., A.H.G. 15 16 Clinical Herbalist and Acupuncturist in Private Practice 17 Davis, California 18 USA 19 20 21 22 23 24 Foreword by Jonathan Treasure 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 Thieme 50 Stuttgart · New York Library of Congress Cataloging-in- Important note: Medicine is an ever- Publication Data is available from the changing science undergoing continual publisher development. Research and clinical experi- 1 ence are continually expanding our knowl- 2 edge, in particular our knowledge of proper 3 treatment and drug therapy. Insofar as this book mentions any dosage or application, 4 readers may rest assured that the authors, 5 editors, and publishers have made every 6 effort to ensure that such references are in 7 accordance with the state of knowledge at 8 the time of production of the book. 9 Nevertheless, this does not involve, imply, or express any guarantee or responsibility 10 on the part of the publishers in respect to 11 any dosage instructions and forms of appli- 12 cations stated in the book. Every user is re- 13 quested to examine carefully the manu- 14 facturers’ leaflets accompanying each drug 15 This book is an authorized and revised and to check, if necessary in consultation translation of the German edition with a physician or specialist, whether the 16 published and copyrighted 2000 by dosage schedules mentioned therein or the 17 Georg Thieme Verlag, Stuttgart, contraindications stated by the manufac- 18 Germany. Title of the German edition: turers differ from the statements made in 19 Phytotherapie the present book. Such examination is 20 particularly important with drugs that 21 are either rarely used or have been newly released on the market. Every dosage 22 schedule or every form of application used 23 is entirely at the user’s own risk and respon- 24 sibility. The authors and publishers request 25 Translator: Suzyon O’Neal Wandrey, every user to report to the publishers any 26 Berlin, Germany discrepancies or inaccuracies noticed. 27 28 29 30 31 32 33 34 Some of the product names, patents, and registered designs referred to in this book 35 are in fact registered trademarks or propri- 36 etary names even though specific reference 37 © 2004 Georg Thieme Verlag, to this fact is not always made in the text. 38 Rüdigerstrasse 14, 70469 Stuttgart, Therefore, the appearance of a name with- 39 Germany out designation as proprietary is not to be 40 http://www.thieme.de construed as a representation by the pub- Thieme New York, 333 Seventh Avenue, lisher that it is in the public domain. 41 New York, NY 10001 USA 42 http://www.thieme.com This book, including all parts thereof, is 43 legally protected by copyright. Any use, 44 Cover design: Martina Berge, Erbach exploitation, or commercialization outside 45 Typesetting by Satzpunkt Ewert GmbH, the narrow limits set by copyright legisla- 46 Bayreuth tion, without the publisher’s consent, is ille- Printed in Germany by Druckhaus Götz, gal and liable to prosecution. This applies in 47 Ludwigsburg particular to photostat reproduction, copy- 48 ing, mimeographing, preparation of micro- 49 ISBN 3-13-126991-X (GTV) films, and electronic data processing and 50 ISBN 1-58890-063-0 (TNY) 1 2 3 4 5 storage. Foreword V 1 Traditionally, Western medical knowledge from Graeco-Roman times onward d 2 has been transmitted by means of authoritative printed texts. Today, both patient or 3 and physician may be more likely to use the Internet as a first reference source. w 4 The sheer amount of medical information available on the World Wide Web and e r 5 the speed of its renewal and retrieval may outpace the Caxtonian mechanics of o 6 printed textbook production, but has done little to erode the authority of the F 7 printed word. Conversely, in fact, major medical reference texts are these days 8 being “ported” into the memory of hand-held electronic devices or on-line data- 9 bases. This development, welcomed by gadgetry enthusiasts, eliminates the hefty 10 size and weight of the printed tome, but decreases the legibility and convenience 11 of the printed page as well as undermining the narrative qualities of the tradition- 12 al medical textbook. 13 However, another, and only slightly less illustrious tradition has long co-existed 14 with that of the major medical opus. This is the “vade mecum,” literally “go with 15 me,” intended as a portable tome to be kept on hand for immediate reference. To 16 be successful, this format requires authors to possess a high degree of intimacy 17 and fluency with their subject matter, to be able to communicate its essentials 18 with precision and confidence, compacting prose and condensing content with- 19 out sacrificing narrative. The size of the resultant printed volume must be com- 20 pact enough to make it easily portable, which nowadays translates as “pocket 21 guide.” 22 23 The present pocket guide is a medical vade mecum devoted specifically to the field 24 of phytotherapy (herbal medicine), authored by the German physician and phy- 25 totherapist Karin Kraft. Prof. Kraft is a member of the Commission E (the official 26 expert committee which originally considered the safety and efficacy of phyto- 27 medicines in Germany), and is currently a member of the supervising editorial 28 board of ESCOP (European Scientific Cooperative on Phytotherapy). ESCOP 29 produces the scientific monographs that provide the official core data for herbal 30 medicines in the EU. 31 32 In Germany, phytotherapy enjoys a higher degree of integration into general 33 medical practice than in any other European country, with physicians regularly writing millions of prescriptions for approved phytomedicines on a daily basis. In 34 the original German edition of this pocket guide, Prof. Kraft provides the busy- 35 general practitioner with a compact and practical reference guide that includes a 36 materia medica of herbs, a prescriber for many conditions, and extensive data on 37 dosage, forms of administration, safety data and technical standards for German 38 commercial herbal products. (Special mention should made of Prof. Kraft’s inclu- 39 sion of an often neglected area, that of topical applications of herbal medications 40 such as poultices and compresses, more popular in Europe than in the USA). 41 42 In North America, herbal medicine is a more marginal discipline, ultimately the 43 legacy of a period of political opposition between medical factions at the turn of 44 the 19th century which resulted in the effective outlawing of botanical medical 45 practice following the Flexner Report of 1910. Although the majority of “official” 46 medicines in the United States Pharmacopoeia were originally botanicals or bo- 47 tanically derived, there remains a sharp discontinuity between standard practice 48 medicine today and its botanical past. The once widespread schools of physio- 49 medical and eclectic botanical medicine were preserved partly through their mi- 50 gration to the United Kingdom, where an unbroken tradition today enables qual- VI Foreword d ified British medical herbalists to diagnose and treat conditions with phyto- 1 or medicines, alongside their conventional medical colleagues. The British model is 2 w distinct again from the German experience and emphasizes the importance of 3 e understanding different cultural and national expressions of traditional herbal 4 r o medicine, education, and practice. 5 F 6 Sensitive to such cultural variations, Thieme wisely enlisted the aid of Christopher 7 Hobbs, a fourth-generation American herbalist, to help render the translation of 8 Prof. Kraft’s German text into the US cultural context. Hobbs, one of the most 9 highly regarded herbal practitioners in the US, addressed this challenging task by 10 reviewing every line of the text. Hobbs has replaced some herbs in the materia 11 medica, suggested more appropriate local equivalents for herbal products, and 12 annotated bi-cultural comments where relevant. He has also rewritten doses into 13 the typically higher US forms. Meanwhile, Hobbs has deftly preserved the nu- 14 ances of the German text; Prof. Kraft actively participated in, and agreed to, all the 15 changes. The result of this bi-cultural collaboration is an almost seamless repre- 16 sentation of the German original harmonized to the North American audience. 17 18 As more physicians in this country recognize the need to investigate the CAM 19 (complementary and alternative medicine) modalities that are being espoused by 20 many of their patients, a premium is inevitably placed upon reliable sources of 21 data and clinical information about CAM. Botanical medicines in particular have 22 sadly been the subject of excessive amounts of published secondary and tertiary “information” devoid of clinical context, and largely irrelevant to the primary care 23 provider. By contrast, Karin Kraft and Christopher Hobbs present us with a suc- 24 cinct and authoritative survey of herbal medicine that is accessible to the physi- 25 cian and can readily be applied to everyday clinical practice. The “pocket guide” 26 represents a unique cross-cultural and trans-disciplinary blend of reliable, accu- 27 rate, and accessible information about phytotherapy; it is a mini-masterpiece of 28 integrative medicine. 29 30 March 2004 Jonathan Treasure 31 Medical Herbalist 32 Ashland, Oregon, USA 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 Preface VII 1 The use of medicinal plants to treat everyday complaints and illnesses is becom- e 2 ing ever more popular. This pocket guide is aimed not only at doctors and mem- ac 3 bers of the various healing professions interested in phytotherapy, but also in par- ef 4 ticular at interested lay people, for whom this book is intended as a practical guide Pr 5 in the often confusing self-treatment market. This pocket guide is based on expe- 6 riences and prescriptions that have been used in Germany for many years or even 7 decades. If necessary, they have been supplemented by US-American remedies 8 and suggestions for use. Where possible, available scientific literature has also 9 been taken into account. The book includes the medicinal plants most widely used 10 in Germany, almost all of which are also used in the US, as well as their use in the 11 treatment of major syndromes. A general section in which production processes, 12 quality characteristics, and legal backgrounds are explained is followed by portraits of the most important medicinal plants with references to more recent 13 scientific literature. Illnesses and possibilities of treating them with medicinal 14 plant preparations as well as a critical evaluation of the significance of this thera- 15 py make up the next section. A specialty of this checklist is the section “Care In- 16 volving Medicinal Plants.” Here special value was attached to practicability. A tab- 17 ular section divided up into medicinal plants with brief summaries of remedies 18 and references follows. Contact addresses and lists of manufacturers as well as a 19 comprehensive table of contents round off the guide. 20 21 Dr. Liane Platt-Rohloff and Ms Angelika-M. Findgott from Thieme International 22 have done a first-class job of coordinating the work of both authors and editing 23 the manuscripts. We, the authors, know that we echo their sentiments in wishing 24 that this pocket guide will be a practical aid to all those who are interested in using 25 medicinal plants and will contribute to the alleviation and curing of illnesses and 26 complaints. 27 28 29 Rostock in Spring 2004 Karin Kraft 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 VIII Contents ts Gray Section: Fundamentals of Phytotherapy 1 n 2 te 1 Fundamentals of Phytotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 3 n 1.1 Characteristics and Status of Herbal Medicines . . . . . . . . . . . . . . . . . . . . . . 1 4 o C 1.2 From the Plant to the Remedy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 5 1.3 Constituents and Active Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 6 1.4 Herbal Formulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 7 1.5 Prescribing Herbal Medicines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 8 1.6 Determination of Doses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 9 10 2 General Guidelines for Use of Herbal Medicines. . . . . . . . . . . . . . . . . . . . . 21 11 2.1 Potentials and Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 12 2.2 Special Patient Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 13 2.3 Basics of Administering Herbal Preparations . . . . . . . . . . . . . . . . . . . . . . . . . 27 14 2.4 Working Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 15 16 Green Section: Plant Summaries 17 18 3 Medical Plants from A to Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 19 Plant Summaries—A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 20 Plant Summaries—B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 21 Plant Summaries—C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 22 Plant Summaries—D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 23 Plant Summaries—E . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 24 Plant Summaries—F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 25 Plant Summaries—G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 26 Plant Summaries—H . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 27 Plant Summaries—I, J . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 28 Plant Summaries—K . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 29 Plant Summaries—L . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 30 Plant Summaries—M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Plant Summaries—N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 31 Plant Summaries—O . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 32 Plant Summaries—P . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101 33 Plant Summaries—R . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110 34 Plant Summaries—S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .114 35 Plant Summaries—T . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .119 36 Plant Summaries—U . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123 37 Plant Summaries—V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .125 38 Plant Summaries—W . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .127 39 Plant Summaries—Y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .131 40 41 Blue Section: Herbal Treatment of Diseases 42 43 4 Cardiovascular Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .132 44 4.1 Heart Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .132 45 4.2 Coronary Artery Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .134 46 4.3 Functional Heart Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .136 47 4.4 Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .138 48 4.5 Hypotension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140 49 4.6 Circulatory Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .141 50