Study Guide for Exam 2
Study Guide for Exam 2 HORT 3440
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Exam 2 Study Guide 1.) Describe the experiment (clinical trial) that was conducted to compare the relative effectiveness of ginger and Dramamine in controlling motion sickness. What is the basic design of a clinical trial? What is a placebo? What is its role in a clinical trial? What is a washout period? Did the clinical trial of Echinacea at the University of Virginia conclude that Echinacea was a safe and effective preventative for the common cold? 36 people were given either a placebo, ginger, or Dramamine. Then they were put on a spinning chair for as long as they could, with the maximum being 6 minutes. The three different treatments (ginger, Dramamine, placebo) were used to compare their effectiveness in helping motion sickness (created by the spinning chair). The 36 were each put on the chair for as long as they could. Clinical trials generally have a control treatment (the placebo), the new (experimental) treatment(s), and the old/traditional treatment(s). Every subject is given one of those treatments randomly, they are put into the experiment and observed. At the end, all of the data is collected and the results are compared, based on whatever was being tested. Placebo – an inactive substance given as a control treatment; it’s indistinguishable from the other treatments. Placebos are used as a measurement of comparison to see how the other treatments did compared to no treatment at all. A washout period is when no treatment is given to a subject before a clinical trial; all treatment the person was receiving is stopped and then those drugs get “washed out” of their systems. The University of Virginia Echinacea clinical trial didn’t conclude that. They concluded that it was ineffective, but there were a lot of major flaws in the study, so who knows. 2.) During the 18th and 19th centuries there was considerable competition between physicians practicing “Regular” medicine in the United States and herbal practitioners. Briefly define each of the following people or concepts, and explain whether they represented the “Regular” medicine or alternative (e.g., herbal) medicine of the time: Heroic Medicine – (regular) based on Theory of the Four Humors/Humoral theory, where there are 4 fluids (humors) that determine a person’s health and character; illness was a result of imbalances of the fluids, as well as a result of overstimulation of the blood and nervous system. Samuel Thompson – (irregular/alternative); all disease is caused by cold; emphasized use of emetics, purgatives, stimulants, and steam baths. Dr. Wooster Beach – (irregular/alternative; Eclectic); had a traditional medical degree; sought to combine medical science with herbal tradition; founder of Eclectic medicine. Shaker Herb Farms – (irregular/alternative; Herbal); thriving wholesale herb business that emphasized quality control; known for consistent product; sold only to pharmacists and physicians. Manufacturers of patent medicines – (regular); usually contained about 2550% alcohol; contained powerful drugs such as senna, opium, antimony, and ipecac; advertised as “blood purifiers” Lydia Pinkham – (regular); herbal recipe to be used for “female complaints;” encouraged women to take control of their health and offered tips for healthy living; contained black cohash The chemists that developed synthetic organic compounds (like aspirin) – pharmaceuticals developed entirely in laboratories; known as more reliable, safer, and more effective than herbal remedies; actual medicine, as opposed to “barbaric” patent medicines. 3.) What were the primary treatment techniques used by practitioners of heroic medicine during George Washington’s era? According to Samuel Thompson, what was the primary cause of disease? Did Dr. Wooster Beach share this belief? What segment of society did Lydia Pinkham target with her herbal products? Bleeding, dosing with mercury (or antimony or other heavy metal poisons), blistering, and emetics Thompson said all disease is caused by cold Dr. Beach was the founder of Eclectic medicine; he had a traditional medical degree (heroic medicine). Beach believed in combining new scientific knowledge with the best of herbal tradition Lydia Pinkham’s product was for women, but she marketed to both men and women. Women – take charge of their own health. Men – keep their women from going crazy 4.) Did the second century physician Galen place more emphasis on pragmatic evidence and observation, or on theoretical interpretations of disease? How did his belief in the four “bodily humors” justify the treatment techniques of subsequent practitioners of heroic medicine? Galen had a highly theoretical system of illness based on Humoral theory. Humoral theory is based on the idea that there are 4 humors (fluids) in the body and illness is a result of an imbalance of those fluids. The four treatments were a means to restore balance and cure the illness. 5. In the first decade of the 20th Century, which group of practitioners was more numerous in the United States, “Regular” physicians or Eclectic herbalists? Explain why the Flexner Report resulted in the closing of so many medical colleges in the early 20th century. Did the Flexner Report strengthen or weaken the American Medical Association? How did Flexner’s principles for medical education depart from the beliefs of “irregular” practitioners like the Eclectics? Which piece of federal legislation put restrictions on patent medicines? Which piece of legislation was the first to require that drugs be proven safe before they are put on the market? In the early 1900s there were many alternative practitioners (10,000 homeopaths; 8,000 Eclectics), but there were more “Regular” physicians (80,000). Flexner Report contained details about the low standards, poor equipment, and nonexistent clinical facilities; most Irregular schools were criticized. American people were shocked by this. “…there has been an enormous overproduction of uneducated and illtrained medical practitioners.” Flexner Report strengthened the AMA to the point that the AMA was in control; to this day, no American medical school can operate without AMA’s approval. Flexner emphasized pharmacology and laboratory sciences (anatomy, pathology, bacteriology) are central to the curriculum; botany was no longer necessary, because medicine “need only concern itself with the pharmaceutical side.” Eclectics were all about all about alternative and herbal medicine, so botany was required. Many Eclectic schools didn’t have laboratories. The Food and Drug Act of 1906 abolished patent medicine (as well as meatpacking frauds). The Food, Drug and Cosmetic Act of 1938 required that drugs must be proven safe. 6.) European countries and the United States have taken different approaches to regulating the manufacture and sale of herbal medicines. What is the role of the German Commission E? What are the basic regulations concerning the sale of herbal medicines in the United States as defined by the Dietary Supplement Health and Education Act of 1994? Explain what you consider to be the strengths and weaknesses of the German vs. United States approaches to regulating herbal medicines. If you were a manufacturer of herbal medicines in the United States today, why might you pay for the services of Consumerlab.com or the U.S. Pharmacopeia? Are herbal manufacturers in the USA required to provide a system for consumers to report “adverse events” to the FDA? German Commission E is a panel of medical experts that oversee the use of herbal medicine in Germany. It’s the equivalent of our FDA and it decides the standard of “reasonable certainty.” The Dietary Supplement Health and Education Act of 1994 (DSHEA) defines herbs as dietary supplements (not drugs); these dietary supplements aren’t required to be approved by the FDA (unlike drugs) and the products are taken off the market only after they’ve proven unsafe (the FDA has to prove this). Medicinal benefits can’t be referenced, but general structure and function claims are okay; this also means that the manufacturer doesn’t have to prove efficacy. German approach to herbal medicine is better because it treats herbal remedies/supplements like drugs, testing them and monitoring their production. This ensures that herbal medicines are safe for consumers. The products are guaranteed to be safe and pure. The German Commission E created labels that indicate efficacy, side effects, precautions, medicinal interactions, and doses. This makes it easier and safer for people to use herbal medicine and it led to much more widespread and effective use of medicinal plants in Europe. In the US, there’s little to no regulation and basically no important medical information on labels. Herbal medicines are considered dietary supplements, so you never know what you’re really getting. This makes the use of herbal medicine more difficult and dangerous, because people aren’t told of the risks and side effects of these medicines. Consumerlab.com and Pharmacopeia provide independent testing programs that reviews herbal medicine for consumers, certifying/verifying their quality. Federal legislation passed in 2006 requires manufacturers to report adverse events to the FDA. 7.) Field cultivation, hydroponics, artificial shade, cultivation in a woodland setting, and greenhouse production of herbs and medicinal plants each have particular advantages and disadvantages from the commercial standpoint. Describe each method and give an example of a situation where it would be appropriate to use it. Review the “enterprise budgets” or production budgets for field and shade production of Goldenseal that we discussed in class and be familiar with the general categories of expenses. Field cultivation Most economical. Certified organic production brings premium price. Preparation of seedbed, planting, weed & pest control, and harvesting are highly autotomized (depending on crop & scale). Best for mass production (ex. Jamaican allspice, ginger, and turmeric production. Hydroponics Growing plants in nutrient solutions without soil. Allows intensive production in small space. Allows control over nutrients and eliminates soil borne weeds & diseases, minimizing herbicide and pesticide use. Requires less fertilizer and water than field production. Extended growing season Artificial shade For plants that can’t tolerate full sun. Shade cloth and wooden lath allow control over light exposure. Exposes plants to ambient temperature and airflow. Cheaper than greenhouses. Cultivation in woodland setting (woodland culture). Growing plants under a forest canopy. Useful for southeastern plants that like to grow in the forest understory, like ginseng, goldenseal, and black cohosh. Varies in intensity and expense, Greenhouse Conditions can be optimized for growth year round. Useful for herbs that are tender, in great demand, and where appearance is a factor. Good for growing herbs for wholesale or as transplants. Categories of expense: Planting stock Soil prep (fertilizer, lime, soil amendments, sprays) Labor (site prep, planting, harvesting, washing, drying etc.) Machine costs (repaid, rental, gas, etc) Utilities (electric, water, etc.) Advertising/promotion Certifications (like organic certified) Analytical testing Packaging Shipping/transportation Goldenseal in artificial shade had much greater expenses due to shade construction, and soil prep however because they sold the herb fresh (undried) they made a much greater net profit than the manufacturer who used forest grown goldenseal and dried it. 8.) Define or explain each of these terms: Anthraquinones – secondary compounds found in aloe and senna; laxatives Bulkforming laxatives: aren’t digested, but they absorb liquid in the intestines and swell to form soft, bulky masses; bowel is stimulated by the presence of the bulky mass. Mucilage soothes the lining of the gut (demulcent). Bulky mass in intestines stimulates smooth muscles, softens stools, and is unaffected by bacteria. Stimulant laxatives: increase the waves of contraction in the intestinal muscles because of the secondary plant products they contain; harsher than bulkforming laxatives and should only be used occasionally. sennosides – secondary compound in senna; anthraquinone; cause water to flow into the colon instead of out and stimulate more forceful contractions of the colon. demulcent – A substance, often rich in mucilage, that can soothe and protect inflamed or irritated internal tissues laxative – loosens stool and increases bowel movement emetic – induce vomiting Frances Kelsey – Doctor who worked for the FDA. She prevented many more American Thalidomide babies by investigating the drug before allowing it to be approved for mass acceptance/use. Purgative – laxative Tonic – a substance with a nourishing or restorative effect on the body; a “revitalizer;” valued for their ability to promote longevity, convalescence, and a general sense of wellbeing. Adaptogen – helps the body respond to physical or emotional stress; a performance enhancer. Natural substance that helps body adjust to stress; has a normalizing effect on bodily functions menthol – principle component of peppermint essential oil; can cause infants and children to choke; alliin/allinase/allicin – Alliinase is an enzyme present in garlic and onions; it and alliin is released when cells are ruptured. Alliinase converts alliin to allicin; alliinase catalyzes chemical reactions that produce volatile chemicals responsible for the plant's’ odor and flavor. Elixir of Sulfanilamide – had antifreeze in it; caused a mass poisoning in the US in 1937 (100+ killed). Public outcry lead to the 1938 Food, Drug, and Cosmetic Act (requires drugs to be proven safe) Absinthe – alcoholic drink made from fennel, wormwood, and anise; it supposedly has a hallucinogenic effect. Contains compound called thujone that’s toxic in high doses; you’d kill yourself with alcohol poison before thujone would affect you. organoleptic analysis –Analysis of taste and smell properties helps the USDA determine if a product transfers taste or smell to its packaging. Also used to detect disease and contamination. Organoleptic refers to properties of a substance related to sense (taste, smell, etc.) chemotype – chemical races of a specific plant that are not necessarily morphologically distinguishable. Eclectic physicians – combined herbal medicine with current scientific knowledge when treating patients. Eclectic school of medicine was founded by Dr. Wooster Beach. Good Manufacturing Practices (GMPs) – rules established by the FDA about handling, processing, labeling, and storing products. Includes quality control standards, record keeping, qualifications for technical staff, handling customer complaints . thalidomide – caused deformities in 1000s of infants around the world. Was prescribed for anything, including anxiety, insomnia, and gastritis; advertised as safe for pregnant women… patent medicines – proprietary medicine, available without prescriptions, but sometimes prescribed by physicians; contained 2550% alcohol and often contained powerful drugs like opium, senna, antimony, and ipecac. peptic ulcer – perforation in the lining of the upper gastrointestinal tract (stomach and small intestine); used to be blamed on excess stomach acid (due to diet, stress, etc.); it’s now known to be caused by bacterial infections found in most ulcers. Aloe juice and licorice help. berberine – bright yellow alkaloid found used for its antiinflammatory and antimicrobial effects; can depress heart function and may stimulate the uterus. Found in goldenseal hydrodistillation – process of collecting essential oil; plant material is mixed into a solution, water is heated and then cooled off, and oil is collected. carminative – relieves flatulence essential oils – extracted from plant material; extremely concentrated, can be absorbed through the skin or sniffed; very potent and potentially lethal if taken internally (not for oral use) glycyrrhizic acid – active component found in licorice; induces production of mucous in the gut to protect lining from ulcers; may help reduce inflammation; also known as glycyrrhizin, a saponin glycoside that’s 50 x sweeter than sugar horticulture – branch of agriculture that deals with “garden crops,” like nuts, fruit, vegetables, ornamental plants, and medicinal plants. Includes trees; can be commercial, largescale production. accession – a documented element in a collection (known provenance) astringent – tightens mucous membranes and skin, reducing secretions and bleeding from abrasions; causes the contraction or constriction of tissues Doctrine of Signatures – plants that resemble a body part can be used to treat aliments associated with that body part Tulsi – Holy Basil. Mint family; has antioxidant, antibacterial, antifungal, and antiinflammatory properties; used as a cureall (panacea) 9.) Aloe leaves contain a powerful laxative and a healing gel. Where are each of these substances located within the aloe leaf? Name five ways that aloe gel promotes healing. Gel – interior of the leaves Laxative – under epidermis of leaves Aloe gel… ▪ Gel’s polysaccharides keep wounds moist by absorbing water like a sponge ▪ Recruits white blood cells to repair and defend tissues ▪ Promotes formation of new capillaries ▪ Inhibits the formation of free radicals ▪ Can inhibit formation of painful prostaglandin molecules 10.) The German physician Dr. Samuel Hahnemann developed the system of homeopathy as an alternative to heroic medicine. Describe the basic beliefs and practices of homeopathy. Define the “Law of Similars”, the “Law of Infinitesimals”, and “succussion”. Why are adverse side effects usually less of a concern with homeopathic medicines than with pharmaceutical medicines? Homeopathy is the use of small doses of a remedy that mimics the symptoms of an illness. It is meant to stimulate the body's own healing response. Treatment involves getting very small doses of substances called “remedies” that would produce similar symptoms of illness in a healthy person if given in larger doses (like cures like) Law of similars “like cures like;” introducing a small amount of a similar illness boosts immune response to the actual illness. Law of infinitesimals the smaller the dose (the more diluted the remedy) the more effective it is. Succussion the systematic dilution of a substance with vigorous shaking at each step of dilution (successions) Also called a serial dilution. Side effects are less severe than pharmaceuticals because the “remedy” of the illness is so diluted that the immune system can usually deal with it. Makes the remedy more effective by “extracting the vital essence” 11.) Name at least one herb from our Herb Cabinet list that is useful for treating each of the following conditions: stomach ulcers; motion sickness; diarrhea; minor burns; constipation; high cholesterol; colds and flu; anxiety; insomnia; physical stress. Stomach Ulcers – licorice; aloe Motion sickness – ginger. (sometimes valerian, catnip, peppermint, licorice root, chamomile, and black horehound) Diarrhea – Psyllium Minor burns – Aloe Constipation – aloe, psyllium, and senna High cholesterol – Prickly Pear/Nopal, garlic Colds and flus – goldenseal, Echinacea, astragalus, garlic Anxiety – Valerian, St. John’swort, kava, passionflower Insomnia – valerian, kava, hops, chamomile Physical stress – Valerian, kava, gotu kola 12.) What are the basic steps in the commercial harvest of peppermint and the extraction of peppermint oil? When wholesalers test the composition of peppermint oils from different sources, what types of differences are they trying to detect? When the mint is ready to be harvested, it is gathered from the field. Then it gets chopped up and taken to the distillery where the oil is extracted with steam. Wholesalers test the concentrations of various essential oils in the peppermint. 13.) Researchers at Purdue University evaluated and selected basil chemotypes in an effort to develop new cultivars with what two characteristics? What role did the “common garden” or “horticultural trial” at the Purdue experimental farm play in their research? What is the difference between “evaluation” and “selection”? Sought to increase total essential oil content and increase content of cinnamonscented oils. A common garden or “horticultural trial” was used to germinate the seeds Evaluation is the initial screening of the plants while selection is choosing the genetic lines with the target traits to continue growth and continued evaluations 14.) Describe the differences between the following types of herbal preparations: infusions, decoctions, tinctures, capsules, poultices and compresses, creams and ointments, and infused oils. Which of these preparations should be used immediately and which ones can be stored for longer periods of time? If you want to prepare a tincture but don’t want to use alcohol, what are two other solvents that you can substitute? Infusions – basically herbal teas without the bags; used with things that yield their chemicals easily, like leaves and flowers Decoctions – basically herbal teas without bags; used with stout materials to extract chemicals, like roots and twigs. Tinctures – chemicals are extracted in alcohol (it’s more soluble than water); stronger than infusions or decoctions Capsules – contain dried and ground up herbs; good for herbs that taste/smell bad. Poultices and Compresses – For external use only. Poultices are wads of chopped up plant material applied directly to the skin. Compresses are clean cloths that have been dipped in herbals solutions; can be used to hold a poultice in place. Creams and Ointments – External use only. Ointments contain oils or fats heated with herbs; they lay on the skin. Creams are oils with fats or water in an emulsion; they blend into the skin. Infused Oils – Oils like olive oil or vegetable oil that had herbs sit in them and then removed; the oils retain the chemicals from the herbs. Infusions should be used the same day they’re made; decoctions within 2 days. Tinctures last up to 2 years. You can use vinegar and glycerin to make tinctures 15.) We discussed several herbs that are useful in treating anxiety and sleeping difficulties. Which of these requires caution because of its interaction with alcohol? Which one is related symbolically to the crucifixion of Christ? Which one reduces the effectiveness of birth control pills? Which one has roots that smell like dirty socks? Kava interacts with alcohol. Passionflowers are symbolic of the crucifixition St John’swort reduces the effectiveness of contraceptives Valerian’s root smell really bad 16.) • What plants were introduced from the New World to the Old World during the “Columbian Exchange”? Corn, tomatoes, potatoes, peanuts, pumpkins, squash, sweet potatoes, peppers, tobacco, pineapples cacao, beans, and vanilla. • What is the difference between “naturalistic” and “personalistic” illnesses in Mayan medicine; what are some examples of each type of illness? Naturalistic – symptom based, treatment based on apparent symptoms with medicinal plants; “visible reality;” fevers, rheumatic pains, women’s conditions, respiratory, dermatological, gastrointestinal, edemas, and breaks or sprains Personalistic – illnesses that require intervention by healers with ceremonial healing rituals or special prayers. Evil eye, Godgiven illnesses, soul or spirit problems, and susto fright. • What alcoholic drink is prepared from the leaves of Agave americana (Century Plant)? Tequila, mescal, and Pluque 17.) • What step did the UGArden staff take to make their teas more popular when they discovered there wasn’t much demand for individual herbs? They made teas that were combinations of herbs and not just individual ones. • What are the objectives of Noelle Fuller’s thesis research? To characterize yield, and the content and composition of essential oil in holy basil varieties. • What laboratory techniques does Noelle use to separate the essential oils from her study plants and to analyze the composition of the oils? Hydrodistillation; Gas Chromatograph – Mass Spectrometer For reference — Herb Cabinet plants that we have covered in class so far: In addition to the type of material emphasized in the preceding review questions, you should be familiar with the following information for each species on the Herb Cabinet list: (a) the part of the plant used medicinally, (2) the main therapeutic uses, and (3) whether the species is native to North America (plants that are “naturalized” or growing as weeds are not considered native to that region). Aloe – Leaves used. Africa. Burns, scrapes, constipation, and ulcers Garlic – Bulbs used. Asia. Colds and flus. Lowers blood pressure and cholesterol, antiseptic Gotu Kola – Entire plant used Asia. Improving memory, reducing stress, wound healing, cellulite, and skin rejuvenation. Ashwagandha – Asia. Leaves, roots, and berries. Adaptogen, used to counter longterm stress; traditionally used to strengthen male libido and sexual function Astragalus – Asia. Roots. Colds and flus, chronic fatigue, AIDS, and cancer (supportive) Ginger – Asia. Rhizome. Nausea, motion sickness, indigestion Kava – Asia. Root. Anxiety, stress, insomnia Passionflower – North America (US). Aerial shoots. Nonaddictive tranquilizer for nervous unrest. Reduces anxiety and induces sleep Skullcap – North America. Dried aerial parts. Sedative, tranquilizer, and “nerve tonic” Ginkgo – Asia. Leaves. Improves circulation, memory, and cognitive function. Licorice – Europe and Asia. Root. Ulcers, upperrespiratory tract congestion. Siberian Ginseng – Asia. Root. Fatigue, stress, increasing stamina, tonic, and memory. Chamomile – Asia. Flower. Nausea, indigestion, and insomnia; relieves gas, calms intestinal spasms, and fights inflammation. Ginseng – Asia and North America. Root. Fatigue, tonic, and athletic performance. Peppermint – Europe. Leaves. Nausea, indigestion, flatulence, and GI spasms Senna – Africa. Leaves and fruit pods. Constipation (stimulant laxative) Echinacea – North America (US). Root and above ground parts used. Treats colds and flus; immune system stimulant Goldenseal – North America (US). Rhizome and roots. Colds and flus, astringent, and antibacterial Psyllium – Europe. Seeds and seed husks. Constipation, hemorrhoids, and diarrhea St. John’swort – Europe and Asia. Successfully introduced in North America. Leaves and flowering tops. Depression and anxiety. Valerian – Europe and Asia. Roots. Mild tranquilizer. Restlessness, stress, and insomnia Hops – Europe and Asia. Bracts of female flowers. Sedative and sleepaid. Saw Palmetto – North America (US). Fruit. Extract treats benign enlargement of prostate gland; blocks production of dihydrotestosterone Hawthorn – North temperate regions. Flowers, leaves, and fruit. Treats angina, high blood pressure. Improves heart function. Increases heart muscle’s energy supply and pumping power. Milk Thistle – Europe; naturalized in US. Seeds. Prompts manufacture of new, healthy liver cells; extracts and neutralizes toxins from Death Cap mushroom. Liver problems; hepatitis and cirrhosis) Kudzu – Asia. Root. Treatment for alcoholism Schisandra – Asia. Berries and leaves. Adaptogen (used to fight stress); used as an overall tonic to enhance physical and mental performance. Bearberry – Temperate regions in Northern Hemisphere. Leaves. Treats mild urinary tract infections; antiseptic and astringent Cranberry – North America. Fruit. Prevents and treats urinary tract infections. NOTES Sept. 16 th The Herb Cabinet Motion sickness video ○ Most common theory has to do with mismatched sensory signals. ○ When traveling in the car, your body is getting 2 different messages: Your eyes are seeing the inside of the car, which isn’t moving, while your ears tell your brain that you’re accelerating ○ The vestibular system in your inner ear gives you your sense of balance and motion ▪ Inside there are 3 semicircular tubules that can sense rotation and movement, with one for each dimension of space ▪ There are also 2 hairlined sacs filled with fluid When you move, the fluid shifts and tickles the hairs, telling your brain if you’re moving horizontally or vertically (or both) ○ With all of this combined, your body can sense which direction you’re moving in, how much you’ve accelerated, and even at what angle ○ In the car, your vestibular system correctly senses your movement, but your eyes don’t see it, especially if you’re not looking outside ○ The opposite can happen too ▪ When you’re in a theater and the camera makes a broad sweeping motion, your eyes think you’re moving, while your ears know that you’re not ○ Scientists aren’t sure why these conflicting messages make us feel bad, but they think there’s an evolutionary explanation. ▪ Fast moving vehicles and movies have only been around for that last couple of centuries, which is nothing in evolutionary time. ▪ For most of our history, there wasn’t much that could cause this sensory mix up, except for poisons This doesn’t explain why women are more affected than men or why passengers get more nauseous than drivers ○ Another theory suggests the cause may have more to do with how unfamiliar situations make it harder to maintain our natural body posture ○ Common remedies: ▪ Looking at the horizon ▪ Chewing gum ▪ Pills But none of these are totally reliable and they can’t really help intense motion sickness. Ginger ○ Ginger fam ○ Zingiber officinale ○ Herbaceous perennial ○ Native to Asia; grown throughout the tropics ○ Rhizome used ○ Nausea, motion sickness, indigestion ○ Cautions: anticoagulant drugs – thins blood Placebo ○ An inactive substance given as a control treatment. ○ Should be indistinguishable from the treatments Dramamine acts on the CNS (Central Nervous System) to block the vomiting response, with drowsiness as a side effect ○ Ginger appears to work directly on the gastrointestinal tract, activating normal stomach rhythm and motion ○ Other herbs that are sometimes recommended for motion sickness include Valerian, Catnip, Peppermint, Black horehound, licorice root, and chamomile Peppermint ○ Mint fam ○ Mentha x piperita ○ Herbaceous perennial, native to Europe ○ Leaves are used ○ Nausea, indigestion, flatulence, GI spasms ○ Cautions: don’t ingest essential oil; menthol can cause infants and children to choke ○ Peppermint essential oil ▪ Principal components include menthol and menthone ▪ Very important as a commercial flavoring; cultivated on a large scale ▪ Pure essential oils are very potent; they can be lethal if taken internally; peppermint tea is a better option ▪ Peppermint releases the LES, so avoid if suffering from acid reflux Chamomile ○ Sunflower fam ○ Matricaria recutita ○ Aromatic annual native to Western Asia ○ Flower is used ○ Nausea, indigestion, insomnia ○ Cautions: pollen allergies and contact dermatitis ○ Popular herb that relieves gas, calms intestinal spasms, and fights inflammation; soothes the GI tract ○ Tea is a mild sedative and sleep aid ▪ Insomnia is a condition that is often better treated with herbs than with drugs; Fewer side effects ○ Used topically for blisters and acne; woundhealing, antiseptic, and anti inflammatory properties; moisten tea bag and hold against skin Notes from Sept. 19 The Herb Cabinet Continued Psyllium ○ Plantain fam ○ Plantago spp. ○ Annual native to Mediterranean region ○ Seeds and seed husks are used ○ Constipation, hemorrhoids, diarrhea ○ Cautions: relatively safe bulk laxative ○ Used as a bulk laxative; seed husks absorb water and swell in size, producing a jellylike mucilage ○ Bulky mass in intestines stimulates smooth muscles, softens stool, and is unaffected by bacteria ○ Also absorbs excess water in intestines ○ Mucilage soothes lining of the gut (demulcent) Purgatives and Cathartics ○ Purging has been a popular practice at various times in human history ○ Egyptians mixed castor oil and beer ○ London apothecaries encourages purging every fortnight in their shops ○ Today, laxative abuse is one of the symptoms of anorexia nervosa Laxatives ○ Bulkforming Laxatives ▪ Ex: Psyllium ▪ Not digested but absorb liquid in the intestines and swell to form a soft, bulky mass. ▪ The bowel is the stimulated normally by the presence of the bulky mass ○ Stimulant Laxatives ▪ Ex: Senna ▪ Increase the waves of contraction in the intestinal muscles (peristalsis) because of the secondary plant products they contain (anthraquinones) ▪ These are harsher than bulkforming laxatives and should only be used occasionally ○ Demulcent ▪ A substance, often rich in mucilage, that can soothe and protect inflamed or irritated internal tissues Senna ○ Pea fam ○ Cassia senna ○ Perennial shrub native to tropical Africa ○ Fruit pods and leaves are used ▪ Leaves are stronger ○ Constipation (stimulant laxative) ○ Cautions: can cause cramps and diarrhea; do not give to children ○ The secondary compounds in senna are anthraquinones called “sennosides” ▪ They’re activated by the natural bacteria found in the colon The bacteria liberate the active compounds from attached sugars Another example of a glycoside ▪ Sennosides cause water to flow into the colon instead of out, and they stimulate more forceful contractions of the colon Aloe ○ Lily fam ○ Aloe vera ○ A. barbadensis ○ Perennial with succulent leaves native to Africa ○ Leaves are used for gel and juice ○ Burns, scrapes, constipation, and ulcers ○ Cautions: do not use if intestines obstructed or inflamed (colitis) ○ Anthraquinone compounds are obtained from dried yellow latex in leaves, stored just below the epidermis of the leaves ○ Extremely potent laxative effect ○ A juice is made commercially from the gel that’s in the interior of the leaves ▪ This is taken internally for peptic ulcers and irritable bowel syndrome ▪ Has a cleansing, soothing, and healing effect ○ Aloe gel promotes healing ▪ Gel’s polysaccharides keep wounds moist by absorbing water like a sponge ▪ Recruits white blood cells to repair and defend tissues ▪ Promotes formation of new capillaries ▪ Inhibits the formation of free radicals ▪ Can inhibit formation of painful prostaglandin molecules Peptic Ulcers ○ About 10% of Americans suffer from ulcers at some point in life ○ Ulcers are perforations in the lining of the upper GI tract (stomach or small intestine) ○ Previously the problem was blamed on excess stomach acid due to stress, diet, etc. ○ Now known that bacterial infections are present in most ulcers (Heliobacter pylori) and antibiotics are often prescribed ○ Ibuprofen and Aspirin also promote ulcers Licorice ○ Pea fam ○ Glycyrrhiza glabra ○ Woodystemmed perennial up to 2 meters, nature to Europe and Asia ○ Root is used ○ Treats ulcers, upperrespiratory tract congestion ○ Cautions: high blood pressure, heart disease, pregnancy ○ Licorice and Ulcers ▪ Licorice protects the walls of the guy by increasing the production of protective mucous Appears to also reduce inflammation ▪ Glycyrrhizic acid (glycyrrhizin) is an important component 50 times sweeter than table sugar A saponin glycoside ▪ Serious side effects of licorice include fluid retention, hypertension, muscle weakness, and uterine contractions ▪ Can use deglycyrrhizated licorice, but the is the herb effective without this ingredient? Probably not. Colds and Flus ○ Adults get an average of 4 colds per year ○ No cure: colds and flus are viral respiratory infections; antibiotics are useless against them (although they can help if secondary bacterial infections are present) ○ Doctors prescribe antibiotics to 60% of patients that suffer from colds and flus ○ Herbal medicines can be used to strengthen the immune system to reduce the frequency and duration of colds and flus Echinacea ○ Sunflower fam ○ E. purpurea ○ E. angustifolia ○ Herbaceous perennials native to the US ○ Root and above ground parts are used ○ Used to treat colds and flus ○ Immune system stimulant ○ Cautions: allergic reactions ○ Believed to increase the production of antiviral substances, such as interferon, and to enhance the ability of the immune cells to engulf microbes ○ Target ailments include colds, flus, chronic infections (respiratory, urinary), and allergies (asthma) ○ WHO supports its use, as do many experimental studies. ○ Should not be used continuously for more than a few weeks ○ If you put Echinacea extract in a test tube with bacteria, nothing happens ▪ Echinacea works by stimulating the immune system It’s an “immunomodulatory” University of Virginia’s Echinacea Trail ○ More than 400 students were treated with Echinacea then challenged with rhinovirus (the virus that causes 3050% of common colds) ○ Students were isolated in a hotel room for 5 days for observation ○ Researchers tracked cold symptoms (sneezing, coughing, nasal secretions, serum antibodies) ○ Found no significant difference between Echinacea and placebo ▪ Echinacea defenders say the dose was too low, the volunteers were all young, and only one virus was tested Goldenseal ○ Buttercup fam ○ Hydrastis canadensis ○ Herbaceous perennial native to the Eastern US ○ Rhizome and roots are used ○ Colds and flus, astringent, antibacterial ○ Cautions: heart disease and pregnancy ○ Berberine is a bright yellow alkaloid used for its antiinflammatory and antimicrobial effects ○ Astringent – causes the contraction or constriction of tissues ○ Goldenseal dries up secretions of mucous membranes ○ Berberine can depress heart function and may stimulate the uterus ○ Goldenseal does not mask morphine Astragalus (Milk Vetch) ○ Pea fam ○ Astragalus membranceus ○ Herbaceous perennial native to Asia (NE China) ○ Root is used ○ Colds and flus, chronic fatigue, AIDS, and cancer (supportive) ○ Cautions: pregnancy and tissue rejection ○ Astragalus is the Tradition Chinese Medicine of Echinacea ○ Used in TCM for its immuneenhancing properties ○ Appears to stimulate the branch of the immune system that is involved in tissue rejection, so it should be avoided during pregnancy or following organ transplants or skin grafts ○ Some studies suggest patients undergoing chemotherapy or radiation therapy recover faster and live longer if Astragalus is given concurrently Garlic ○ Lily fam ○ Allium sativum ○ Herbaceous perennial, probably of Asia, but now is a viable cultigen ○ Bulbs are used ○ Colds and flus, lowers blood pressure and cholesterol, antiseptic ○ Cautions: heartburn and anticoagulants ○ The Garlic Biochemical “Cascade” ▪ Alliin is an odorless sulfurcontaining amino acid derivative found in intact cells ▪ When cells are ruptured the enzyme alliinase is released; it converts alliin to allicin ▪ Allicin is the active component and it releases the strong odor of garlic ▪ The more finely you chop, the more alliin reacts with the alliinase and the more potent the garlic ▪ Cooking mellows garlic because it deactivates alliinase; that’s why roasted garlic has a much more delicate flavor Notes for Sept. 21 Hippocrates ○ 460 – 377 BCE ○ The Greek “Father of Medicine” ○ He considered illness to be a natural rather than supernatural phenomenon; medicine should not involve ritual ceremonies or magic ○ By today’s standards, Hippocrates had a remarkably holistic approach ▪ “It’s more important to know what sort of person has a disease than what sort of disease a person has” ▪ If we could give every individual the right amount of nourishment and exercise, not too little or not too much, we would’ve found the safest way to health” ▪ “Cure sometimes, treat often, comfort always” ▪ “Natural forces within us are the true healers of disease” Theory of the Four Humors ○ ○ Four principal fluids (humors) exist within the body ○ The balance of those fluids determines a person’s character and health ○ Imbalance resulted in illness; the task of the physician was to restore balance HUMOR ORGA TEMPERMEN CHARACTERISTICS N T Blood Heart Sanguine Courageous, hopeful, playful, carefree Yellow Bile Liver Choleric Ambitious, leaderlike, restless, easily angered Black Bile Spleen Melancholic Despondent, quiet, analytical, serious Phlegm brain Phlegmatic Calm, thoughtful, patient, peaceful Galen ○ 131201 CE (AD) ○ Developed a highly theoretical system of illness based on the Humoral Theory ○ Galen’s system gave physicians a theoretical framework to work within, while often ignoring pragmatic results ○ Galen led to the divergence between professional physicians and traditional healers; the former looked down on the latter ○ His system prevailed in Europe for more than 1500 years “Heroic” Medicine ○ Hippocrates: “Desperate cases need the most desperate remedies” ○ Europe was swept by terrible plagues from the Middle Ages onwards ○ Mercury was somewhat effective against syphilis; eventually it was being prescribed for everything, indiscriminately ○ Illness was thought to result from overstimulation of the blood and the nervous system ○ Treatment consisted of draining off the excess “humors” by a variety of means Heroic Treatment Options ○ Bleeding – venesection (cutting open a vein) and cupping ○ Dosing with mercury (or antimony or other heavy metal poisons) in the form of Calomel (Hg 2L )2 this was a powerful purgative (and a severe poison) ○ Blistering – applying hot (temperaturewise and causticwise) plasters to the skin to promote blisters, which were then drained ○ Emetics – induced vomiting Dr. Samuel Hahnemann & Homeopathy ○ German physician who was appalled by Heroic medicine ○ Too some cinchona bark (quinine) and developed symptoms similar to malaria ▪ Concluded that “like cures like” The Law of Similars Cinchona ○ Coffee fam ○ Cinchona spp. ○ Large forest tree native to the Andes (Peru, Colombia, & Ecuador) ○ Bark is used and is the source of the alkaloid quinine ○ Interferes with the metabolism of the malaria parasite Plasmodium Homeopathic Beliefs and Practices ○ Every person has an energy called a vital force or selfhealing response which can become disrupted ○ Homeopathy stimulates the body’s own healing response ○ Treatment involves getting very small doses of substances called “remedies” that would produce similar symptoms of illness in a healthy person if given in larger doses (like cures like) (Law of Similars) Homeopathic Paradox ○ Law of Infinitesimals: the more dilute an agent, the greater the healing power ○ Systematically diluting a substance with vigorous shaking at each step of dilution (“succussions”) makes the remedy more effective by extracting the vital essence ○ Most remedies come from plant, animal, or mineral sources ○ Clinical trials are inconclusive (Placebo effect?) Samuel Thomson ○ 17691843 ○ American appalled by Heroic medicine ○ Came from humble beginnings ○ “all disease is caused by cold” ○ Emphasized emetics, purgatives, stimulants, and steam baths ○ Principal herbs were Lobelia (emetic, relaxant, panacea) and cayenne pepper (stimulant); both increase body temperature and dilate blood vessels ○ Included about 65 herbs; drew heavily from Native American uses of medicinal plants ○ Thomson was empirical; regulars emphasized theory ○ He was a strong and determined advocate, opposed by the medical establishment ○ Had many followers, but never popular with wealthy, educated classes Dr. Wooster Beach and the “Eclectics” ○ 17941868 ○ Came from relatively privileged background but was appalled by Heroic medicine ○ Apprenticed with an herbalist in NJ ○ Earned a traditional medical degree; wanted to change the system “from within” ○ Sought to combine new scientific knowledge with best of herbal tradition. (Eclectic medicine) ○ Several Eclectic medical schools were established during the mid and late19 th century, primarily in Midwestern states th 19 Century Shakers in America ○ Shaker Herb Farms ○ Thriving wholesale herb business by mid1800s ○ Gathered, grew, and processed more than 400 species of medicinal plants ○ Sold directly to physicians and pharmacists (exclusively) ○ Emphasis on quality control; known for consistent product ○ Relied on European introductions, as well as native species Patent Medicines (Quack Quack) ○ Usually about 2550% alcohol ○ Often contained powerful drugs such as opium, senna, antimony, and ipecac (emtic) ○ Advertised as “blood purifiers” ○ “One dose for a man, two for a horse” Ipecac ○ Coffee fam ○ Psychotira ipecacuanha ○ Tropical shrub native to Brazil ○ Dried roots are the source of the alkaloids emetine and cephaeline ○ Expectorant at low doses (used to treat bronchitis), strong emetic at higher doses Lydia Pinkham’s Vegetable Compound ○ An herbal recipe for “female complaints” that became a profitable patent medicine business ○ Encouraged women to take control of their own health and offered tips for healthy living ○ Secret recipe included Black Cohash (which does help) ○ Lydia Pinkham’s innovative marketing strategy appealed to both women and men Gradual Ascendancy of Organic, or “Bench” Chemistry ○ While many patent medicines remained barbaric, modern scientific medicine was th gaining steam during the 19 Century ○ Development of the microscope, germ theory of disease, diagnostic xrays ○ Pharmaceutical businesses were growing; “made in the laboratory” came to mean “more reliable, safer, and more effective” than herbal remedies ○ Mainstream medicine was at odds with herbal medicine at the end of the 19 th Century Notes from Sept. 23 At the turn of the 19 century (late 1800s – early 1900s) … ○ Heroic medicine had been replaced by more scientific medicine that emphasized the use of pharmaceutical drugs ○ Herbal medicines still had a strong following, led by practitioners belonging to the Eclectic School ○ Homeopathic medicine was practiced, and patent medicines were popular ○ There was very little government regulation of medicine and health care Early 1900s: The American Medical Association Gains Momentum ○ American herbalists were holding their own at the turn of the century: 80,000 regulars,” 10,000 homeopaths, 8,000 eclectics, plus a few thousand other alternative practitioners ○ AMA was dominant, but not in complete control of the healthcare landscape ○ In 1905, the Journal of the AMA announced it would start accepting advertisements from pharmaceutical companies; revenues jumped A Disarming Offer ○ In the early 1900s there were too many doctors, and (from the AMA’s perspective) too much competition from Irregulars ○ “Irregulars” were welcomed to join regular medical societies as long as they gave up formal allegiance to competing schools and sects ○ Many accepted the offer, weakening the Irregular societies The Strategic Importance of Medical Schools ○ Too many badlytrained doctors were graduating from too many lowgrade schools ○ 1902: The AMA formed a Council on Medical Education to address the problem ○ 1907: Counsel representatives begin visiting 160plus schools throughout the country, Regular and Irregular, and assigning them a number rating based on entry requirements, lab and teaching facilities, faculty research, etc. ○ Obstacles: No power of enforcement, couldn’t claim to be impartial, project was expensive Carnegie Endowment and the Flexner Report ○ Carnegie Foundation for the Advancement of Teaching agreed to fund survey and provide surveyor ○ Abraham Flexner was an experienced educator, but not a physician ○ Conducted a 15month survey of 168 North American medical schools ○ Flexner moved fast: “You don’t need to eat a whole sheep to know it’s tainted” Two “ThumbsDown” for American Medical Training ○ The Flexner Report, published in 1910, burst like a bombshell on the American public ○ Provided lurid details about low standards, poor equipment, nonexistent clinical facilities ○ “For 25 years there has been an enormous overproduction of uneducated and illtrained medical practitioners” ○ Almost all Irregular schools, including Eclectics and others that stressed medicinal plants, were strongly criticized Flexner’s Principles for Modern Scientific Medical Training ○ Laboratory sciences are central to the curriculum (anatomy, pathology, bacteriology) ○ Emphasis on pharmacology ○ Botany no longer necessary; modern medicine “…need only concern itself with the pharmaceutical side” ○ Focus was placed on disease rather than health, on cure rather than prevention Impact of the Report: AMA firmly in control ○ 29 schools closed during the 4 years following the report ○ By 1920 there was only one Eclectic school left; it closed in 1938 ○ Total number of medical schools and their enrollment was cut in half by 1920 ○ Today no US medical school can operate without AMA approval Food and Drug Legislation in the 20 century ○ Food and Drug Act of 1906: abolished patent medicine and meatpacking frauds in response to public outcry ▪ Prohibited adulterated or misbranded drugs; DID NOT address safety and efficacy FDA Given More Authority in Response to Two Drug Tragedies ○ Issue: Elixir of Sulfanilamide in 1930s ▪ Federal response: 1938 Food, Drug, and Cosmetic Act; required that drugs must be proven safe ○ Issue: Thalidomide deformities in the 1960s ▪ Federal response: 1962 KefauverHarris Amendments; drugs must be proven safe and effective ▪ Frances Oldham Kelsey Pharmacists Show Herbs the Door, Health Food Stores Put out Welcome Mat ○ Acceptable evidence for efficacy and safety of herbal medicines as drugs didn’t exist ○ Herbs migrated to health food stores and coops where they were sold as teas, supplements, etc. ○ Labels limited to common names of plants, no claims of effectiveness A Watershed Event for Herb Manufacturers and Consumers: 1994 Dietary Supplement Health and Education Act (DSHEA) ○ Defines herbs as “dietary supplements,” not drugs ○ Prior approval by FDA not required (unlike with drugs) ○ Products are taken off market only after they have been proven toxic. (burden of proof is on the FDA) ○ General structure and function claims are okay, specific reference to medical benefits not allowed (manufacturer doesn’t have to prove efficacy) ○ Since the FDA doesn’t analyze the contents of supplements, the herbs you purchase might… ▪ Not contain the correct species ▪ Contain higher or lower amounts of the active ingredient than indicated on label ▪ Be contaminated with pesticides, other species, or pharmaceuticals FDA finally published Good Manufacturing Practices (GMPs) in 2007 ○ 1994 DSHEA authorized FDA to produce GMPs for dietary supplements ○ Establishes rules for: handling, processing, labeling, and storing products ○ Includes quality control standards, record keeping, qualifications for technical staff, handling customer complaints, etc. ○ Examples of GMP activities necessary for dietary supplement industry compliance include: ▪ Employing qualified staff ▪ Having physical plants designed or built to protect against adulteration ▪ The use of appropriate equipment and utensils ▪ The use of master manufacturing and batch production records ▪ Employing quality control procedures ▪ Holding and distributing dietary supplements and manufacturing materials in ways that ensure that quality is not negatively affected ▪ Recording each product’s GMPrelated complaints and retaining these records for 12 years ○ Adverse Event Reporting ▪ Federal legislation passed in 2006 requires supplement manufacturers to report adverse events to the FDA ▪ In 2008, 604 adverse events had been reported, including at least 5 deaths (anything from “isn’t working” to serious illness… and death apparently) ▪ 482,154 adverse event reports for prescription drugs in 2007 Independent Testing Programs to Verify the Quality of Herbal Products ○ Consumerlab.com – product reviews for consumers and voluntary certification program for manufacturers ○ U.S. Pharmacopeia – verification programs for manufacturers who choose to participate ○ Seeing the USP Verified Mark on a dietary supplement label indicates that the product: ▪ Contains the ingredients listen on the label, in the declare potency and amounts ▪ Does not contain harmful levels of specified contaminants ▪ Will break down and release into the body within a specified amount of time ▪ Has been made according to the current FDA Good Manufacturing Practices using sanitary and wellcontrolled procedures German Commission E ○ German government accepted standard of “reasonable certainty” ○ German equivalent of our FDA established a panel of experts to oversee use of herbal medicines in Germany ○ Panel produced monograms on efficacy, side effects, precautions, medical interactions, and dose ○ Led to much more widespread and more effective use of medicinal plants in Europe than in US (things like Valerian) Notes from Sept. 26 th Valerian ○ Valerian fam ○ Valeriana officinalis ○ Herbaceous perennial native to Europe and western Asia ○ Roots are used; they have a bad smell (rumored to have been used by the?
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