2. Reavley NM. The New Encyclopedia of Vitamins, Minerals, Supplements, and Herbs. Evans and
Company Inc. 1998.
3. The Healing Power of Herbs (2nd edition). Murray M. Prima Publishing 1995.
4. Boon H and Smith M. Health Care Professional Training Program in Complementary Medicine.
Institute of Applied Complementary Medicine Inc. 1997.
1. Hobbs C. Taraxacum officinale: a monograph and literature review. In: Eclectic dispensatory. Portland: OR. Eclectic Medical
Publications 1989.
2. Faber K. The dandelion taraxacum officinale. Pharmazie 1958;13:423-36.
3. Susnik F. Present state of knowledge of the medicinal plant taraxacum officinale weber. Med Razgledi 1982;21:323-8.
4. Bohm K. Choleretic action of some medicinal plants. Arzneimittel-Forsch 1959;9:276-378.
5. Murray M. The healing power of herbs. 2nd edition. Prima Publishing 1995:86-91.
6. Bradley P. British herbal compendium. Bournemouth. BHMA 1992:239.
7. Houghton P. Bearberry, dandelion, and celery. The Pharmaceutical Journal 1995;225:272-3.
8. Hirono I, et.al. Safety examination of some edible plants, part 2. Journal of Environmental Pathology Toxicology and Oncology
1977;1:72-4.
9. Healthnotes, Inc.2001. www.healthnotes.com: Dandelion.
10. Natural Products Encyclopedia. www.consumerslab.com: Dandelion
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Devil’s Claw
General Features
Devil’s Claw is a native plant of southern Africa. It’s unusual name stems from the herb’s fruits, which seem to be
covered with numerous small hooks. The secondary storage roots, or tubers of the plant are used for medicinal
purposes.1
Decoctions of dried roots have been taken as a tea by indigenous peoples for a variety of digestive and rheumatic
conditions.2
It was introduced to Europe by Mehnert and became so popular that in 1976, it was estimated that 30,000 arthritis
patients in the United Kingdom alone were using it.3
Principle Active Constituents
a. Iridoid glycosides: harpogide, harpogoside, and procumbide
b. Phenolic acids: chlorogenic acid, cinnamic acid
c. Flavonoids
N.B. Harpogoside appears to be the constituent of greatest scientific research interest for arthritis and related
musculoskeletal problems.4
Clinical Application and Mechanism of Action
Arthritis and Joint Inflammatory Conditions
Devil’s Claw has been reputed to have anti-inflammatory and anti-rheumatic properties.2,5,6,7 It is commonly used in the
management of many inflammatory joint diseases including osteoarthritis, rheumatoid arthritis and gout.5,6,7
Experimental evidence demonstrates that the aqueous extracts of Devil’s Claw possesses anti-inflammatory activity
8,9and may be equivalent to that of phyenylbutazone according to one experimental study.10 However, its mode of
action has not been determined, as it does not appear to directly block the synthesis of pro-inflammatory
prostaglandins.11,12,19
A standardized grade of Devil’s Claw improved arthritic symptoms, with marked improvement in pain (89%), range of
motion (84%), and time needed to reduce stiffness (86%), in a trial involving 43 patients.13 A double-blind study also
revealed Devil’s Claw’s value in reducing low back pain.14 Other trials have not shown a benefit from the use of Devil’s
Claw supplementation in arthritic cases.15,16
Dosage and Standardized Grade
Arthritis and Joint Inflammation: 200 - 500 mg, three times daily as a single agent (standardized grade containing 3-
5% harpagoside content (iridoid glycoside).4,12,13,19
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Adverse Side Effects, Toxicity and Contraindications
Devil’s Claw is considered a safe herb to use at recommended doses. Infrequent reports of slight digestive upset have
been reported in various studies in a small number of patients. On a theoretical level, Devil’s Claw is considered a
classic bitter, which increases gastric acid secretions to aid in digestion. As such, patients with active ulcers should
avoid its use, although no formal evidence indicates that Devil’s Claw has exacerbated peptic ulcers in available
human studies.4
Drug-Nutrient Interactions
Bleeding Disorders - Devil’s Claw has been shown to potentiate the anti-coagulant effects of warfarin and possibly the
platelet inhibitor drug known as Ticlopidine, used to prevent stroke and to treat intermittent claudication and other
conditions. In one patient Devil’s Claw was associated with purpura (bleeding under the skin) when taken concurrently
with warfarin.17,18 Thus, Devil’s Claw should not be taken concurrently with anticoagulant drugs such as, warfarin,
coumadin, and aspirin.17
Pregnancy and Lactation
During pregnancy and lactation, the only supplements that are considered safe include standard prenatal
vitamin and mineral supplements. All other supplements or dose alterations may pose a threat to the
developing fetus and there is generally insufficient evidence at this time to determine an absolute level of
safety for most dietary supplements other than a prenatal supplement. Any supplementation practices
beyond a prenatal supplement should involve the cooperation of the attending physician (e.g., magnesium
and the treatment of preeclampsia.)
References: Pregnancy and Lactation
1. Encyclopedia of Nutritional Supplements. Murray M. Prima Publishing 1998.
2. Reavley NM. The New Encyclopedia of Vitamins, Minerals, Supplements, and Herbs. Evans and
Company Inc. 1998.
3. The Healing Power of Herbs (2nd edition). Murray M. Prima Publishing 1995.
4. Boon H and Smith M. Health Care Professional Training Program in Complementary Medicine.
Institute of Applied Complementary Medicine Inc. 1997.
1. Tyler VE. The honest herbal. 3rd ed. Binghamton, NY. Pharmaceutical Products Press 1993:111-2.
2. Weiss R. Herbal medicine. Beaconsfield. Beaconsfield Press 1988:362.
3. Grahame R, Robinson B. Devil’s Claw (Harpagophytum Procumbens): pharmacological and clinical studies. Ann Rheum Dis
1981;40:632.
4. Boon H, Smith M. The botanical pharmacy. Quarry Health Books 2000:92-6.
5. Bradley P. British herbal compendium. Bournemouth. BHMA 1992:239.
6. Chevallier A. The encyclopedia of medicinal plants. London. Reader’s Digest 1996:336.
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Meschino Health Comprehensive Guide to Herbs
7. Hoffman D. Holistic herbal. Rockport, MA. Element Books 1996:256.
8. Soulimani R, Younos C, Mortier F, Derrieu D. The role of stomachal digestion on the pharmacological activity of plant extracts, using
as an example of harpagophytum procumbens. Canadian Journal of Physiology and Pharmacology 1994;72(12):1532-6.
9. Lanhers M, Fleurentin J, Mortier F, et.al. Anti-inflammatory and analgesic effects of an aqueous extract of harpagophytum
procumbens. Planta Medica 1992;58:117-23.
10. Newall C, Anderson L, David Phillipson J. Herbal medicines: a guide for health care professionals. London. The Pharmaceutical
Press 1996:296.
11. Whitehouse L, Znamirowska M, Paul C. Devil’s Claw (Harpagophytum Procumbens): no evidence for anti-inflammatory activity in
the treatment of arthritic disease. Canadian Medical Association Journal 1983;129:249-51.
12. Moussard C, Alber D, Toubin M, Thevenon N, Henry J. A drug used in traditional medicine, Harpagophytum Procumbens: no
evidence for NSAID-like effect on whole blood eicosanoid production in humans. Prostaglandins Leukotrienes and Essential Fatty
Acids 1992;46:283-6.
13. Pinget M, Lecomte A. The effects of Harpagophytum Capsules (Arkocaps) in degenerative Rheumatology. Medecine Actuelle
1985;12:65-7.
14. Chrubasik S, et.al. Effectiveness of Harpogophytum Procumbens in treatment of acute low back pain. Phytomed 1996;3:1-10.
15. Whitehouse LW, et.al. Devil’s Claw (Harpagophytum Procumbens): no evidence for anti-inflammatory activity in the treatment of
arthritic disease. Can Med Assoc J 1983;129:249-51.
16. Grahame R, et.al. Devil’s Claw (Harpagophytum Procumbens): pharmacological and clinical studies. Ann Rheum Dis 1981;40:632.
17. Healthnotes Online. Healthnotes, Inc. 2000.
18. Shaw D, et al. Traditional remedies and food supplement: a 5-year toxicological study. Drug Safety
19. 1997:17(1991-1995):342-56.
20. Dietary Supplement Information Bureau. www.content.intramedicine.com: Devil’s claw.
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Echinacea (Purple Coneflower)
General Features
Echinacea is a wildflower that is native to North America, although the majority used in herbal supplements comes
from cultivated plants. It is a perennial herb, whose medical ingredients are found in the whole plant, including the
root and aerial portions. It is primarily used as a short-term supplement to arrest the onset of a cold or flu (upper
respiratory tract infection) in the early stages, or as means to shorten the duration of these self-limiting
conditions.1,6,7
Principle Active Constituents
a) Echinacoside - a compound composed of caffeic acid, a caffeic acid derivative
(similar
to
catechol),
glucose and rhamnose, all attached to a central glucose molecule. Other caffeic acid derivatives important to
the pharmacology of Echinacea include cichoric acid, chlorogenic acid and cynarin. A significant degree of
Echinacea’s immune modulating properties are attributable to the presence of echinacoside.
b) Polysaccharides – a number of immunostimulatory polysaccharides have been isolated including inulin
(Echinacea root contains ~ 20% inulin), which has been shown to stimulate the alternate complement
pathway, enhancing the movement of white blood cells into areas of infection. Arabinogalactan has been
shown to increase interferon, tumor necrosis factor and interleukin-1.
c) Various Flavonoids 1,6,7,8
Clinical Application and Mechanism of Action
1. Immunostimulation
a) Inulin stimulates alternative complement pathway of the immune system, which has been shown to enhance the
action of white blood cells to fight infection and other pathogens.
b) Echinacea enhances T cells production of interferon and other immune potentiators. The result is enhanced T
cell replication, macrophage activity, antibody binding, and increased numbers of circulating neutrophils.
c) The non specific T cell activation by Echinacea also increases activity of natural killer cells.
d) Echinacea enhances macrophage phagocytosis and stimulates macrophages to produce a number of immune-
potentiating compounds (i.e. tumor necrosis factor, interferon, and interleukin-1).
e) Echinacea Inhibits hyaluronidase enzyme, which is normally secreted by microorganisms in an attempt to
breakdown tissue barriers between cells ( known as the cement substance, ground substance or proteoglycans),
enabling the microorganism to more easily spread and invade new cells.2,3,4,5,6,7
2. Therapeutic Application
Treatment of Upper Respiratory Tract Infections (URI)- a review of 16 clinical trials, involving a total of 3396
patients, provided evidence that Echinacea can abort a cold or flu (upper respiratory tract infection) in the early
stages and/or shorten the duration and severity of upper respiratory tract infections in a significant number of
cases. 9 In one study involving 80 individuals, it was shown that Echinacea shortened the duration of cold
symptoms from 6 days on average, compared to 9 days in the placebo group. 10 However, there is insufficient
evidence to suggest that Echinacea can prevent colds and related URI, if taken prophylactically over a long period
of time (e.g., throughout the winter). Studies examining this possible benefit have mostly reported negative results
in that Echinacea has not demonstrated an ability to reduce the number of URI, colds or flus in clinical trials where
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Meschino Health Comprehensive Guide to Herbs
it has been tested as a preventive agent in this regard. 11 Thus, at this time Echinacea is not recommended as a
supplement to be taken for long periods, but is rather used most effectively as a short-term intervention to rally the
immune system during the early (prodromal) stages of an upper respiratory tract infection.1,6,7
Best Variety: Some experts suggest that Echinacea Purpurea is the best variety because it provides the greatest
range of active compounds and has the greatest level of clinical research support. 1
Dosage and Standardized Grade
Upper Respiratory Tract Infection - as an agent to help arrest the onset, or to help shorten the duration and minimize
the severity of the common cold or flu, taking 300 mg of Echinacea every two hours for the first day of illness, then 300
mg three times per day for the duration of symptoms is a common practice. If taken as a capsule or caplet the
standardized extract should contain 3.5 percent or greater echinacoside content and not less than 2.4% soluble beta-
1,2 d-5 fructofuranosides, per 300 mg tablet or capsule. 6
Author’s Note: Anecdotal evidence suggests that many people take much higher doses of Echinacea at the beginning
of cold symptoms and during the cold cycle. It is not uncommon to encounter individuals using doses as high as 900
mg of Echinacea every two hours at the outset of a cold, and maintaining this level of intake until the symptoms begin
to subside. Fortunately, Echinacea appears to be generally safe, even when taken in very high doses, as indicated
below.
Adverse Side Effects, Toxicity and Contraindications
Echinacea is regarded as being generally safe, even when taken at high doses. It has not been found to cause any
toxic effects and reported side effects of high dose supplementation are infrequent and usually limited to minor
gastrointestinal symptoms, and increased urination. 12,13 Some minor allergic symptoms have also been reported. In
Australia, one survey found that 20% of allergy-prone individuals were allergic to Echinacea upon testing. On rare
occasions severe allergic reactions have occurred with Echinacea supplementation, some of them life threatening.
6,7,14
Other concerns are based upon the long-term administration of Echinacea and the possibility of over-stimulating the
immune system in at risk individuals. As such, Echinacea should not be used by people with autoimmune disorders
(Lupus, Rheumatoid Arthritis, etc.) and patients with multiple sclerosis, as there is evidence to show that it may trigger
or aggravate such conditions. 15 A reported case also implicated the use of Echinacea in triggering recurrent episodes
of erythema nodosum, an inflammatory condition that involves tender nodules under the skin. 16
As prolonged use of Echinacea may over-stimulate immune function and trigger underlying or hidden pathologies, the
daily use of Echinacea for long periods as may occur in patients with impaired immune function (i.e., chronic fatigue),
should not exceed eight weeks. The customary cycle of use in these cases is as follows: After one week of abstaining
from Echinacea supplementation patients can begin another eight week cycle of supplementation, followed by one
week off and so on.1
Thus, a primary concern of long-term use of Echinacea is rooted in the risk of sustained immune system
enhancement, which may trigger some auto destructive consequences (i.e., attacking healthy body tissues,
reawakening of dormant herpes viruses and/or, triggering autoimmune reactions).1
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Drug-Nutrient Interactions
a. Immunosuppressive Drugs – Echinacea counters the effects of these drugs and should not be used
concurrently.17,18
b. Corticosteroid Medications – Echinacea may counter the effects of these drugs in patients with autoimmune
conditions and should not be taken concurrently.19
Pregnancy and Lactation
During pregnancy and lactation, the only supplements that are considered safe include standard prenatal
vitamin and mineral supplements. All other supplements or dose alterations may pose a threat to the
developing fetus and there is generally insufficient evidence at this time to determine an absolute level of
safety for most dietary supplements other than a prenatal supplement. Any supplementation practices
beyond a prenatal supplement should involve the cooperation of the attending physician (e.g., magnesium
and the treatment of preeclampsia.)
References: Pregnancy and Lactation
1. Encyclopedia of Nutritional Supplements. Murray M. Prima Publishing 1998.
2. Reavley NM. The New Encyclopedia of Vitamins, Minerals, Supplements, and Herbs. Evans and
Company Inc. 1998.
3. The Healing Power of Herbs (2nd edition). Murray M. Prima Publishing 1995.
4. Boon H and Smith M. Health Care Professional Training Program in Complementary Medicine.
Institute of Applied Complementary Medicine Inc. 1997.
1. Murray MT. The Healing Power of Herbs. 2nd ed. Prima Publishing, 1995
2. Luetigg B, et.al. Macrophage activation by the polysaccharide arabinogalactan isolated from plant cell cultures of echinacea
purpurea. J Nati Cancer Inst 1989;81:669-75.
3. Tubaro A, et.al. Anti-inflammatory activity of a polysaccharide fraction of echinacea angustifolia root. J Pharm Pharmacol
1987;39:567-9.
4. Roesier, J, et.al. Application of purified polysaccharides from cell cultures of the plant echinacea purpurea to mice medicates
protection against systematic infections with listeria monocytogenes and candida albicans. Int J Immunopharmacol 1991;13:27-37.
5. Brauning B, et.al. Echinacea purpurea radix for strengthening the immune response in flu-like infections. Z Phytother 1992;13:7-13.
6. Healthnotes, Inc.2001.www.healthnotes.com: Echinacea.
7. Dietary Supplement Information Bureau. www.content.intramedicine.com: Echinacea
8. Duke JA. Handbook of phytochemical constituents of GRAS herbs and other economic plants. Boca Raton, FL: CRC Press, 1992.
9. Melchart D, Linde K,Fisher P, et al. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev. 2000;
(2): CDOOO530
10. Schulten B, Bulitta M, Ballering-Bruhl B, et al. Efficacy of Echinacea purpurea in patients with a common cold. A placebo-controlled,
randomized, double-blind trial. Arzneimittelforschung. 2001; 51 (7): 563-8.
11. Barrett B, Vohmann M, Calabrese C. Echinacea for upper respiratory infection. J Fam Pract. 1999; 48 (8): 628-35.
12. Schultz V Hansel R, Tyler VE. Rational Phytotherapy: A Physicians’ Guide to Herbal Medicine. 3rd ed. Berlin, Germany: Springer-
Verlag; 1998: 276
13. Parnham MJ. Benefit-risk assessment of the squeezed sap of the purple coneflower (Echinacea pupurea) for long-term oral
immunostimulation. Phytomedicine. 1996; 3: 95-102.
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14. Mullins RJ, Heddle R. Adverse reactions associated with Echinacea: the Australian experience. Ann Allergy Asthma Immunol. 2002;
88: 42-51
15. Natural Products Encyclopedia. www.consumerslab.com: Echinacea.
16. Soon SL, Crawford RI. Recurrent erythema nodosum associated with Echinacea herbal therapy. J Am Acad Dermatol. 2001; 44:298-
99.
17. Vomel VT. Effect of a nonspecific immunostimulant on the phagocytosis of erythrocytes and the Ink by the reticulohistocyte-sytem in
the isolated, perfused liver of rats of various ages. Arzneim Forsch/Drug Res. 1984; 34: 691-95
18. See DM, et al. In vitro effects of Echinacea and ginseng on natural killer and antibody-dependent cell cytotoxicity in healthy subjects
and chronic fatigue syndrome or acquired immunodeficiency syndrome patients. Immunopharmacology. 1997; 35 (3): 229-35.
19. Bauer R. Echinacea Drugs—effects and active ingredients. Z Arztl Fortbild. (Jena). 1996; 90 (2): 111-15.
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Meschino Health Comprehensive Guide to Herbs
Ephedra
General Features
Various Ephedra species of plants are found throughout the world and grow in desert or arid regions. Ephedra sinica,
also known as Ma Huang, is probably the best-known Ephedra species, but there are many others. They are erect,
branching shrubs whose stems and branches contain alkaloids, of which 40-90 percent is the stimulant known as
ephedrine and the remaining alkaloids being primarily pseudoephedrine and norpseudoephedrine.1,2,3
Western medicine’s interest in Ephedra began in 1923, with the discovery that ephedrine possessed a number of
pharmacological effects. Ephedrine was synthesized for pharmaceutical purposes in 1927 and since then both
ephedrine and pseudoephedrine have been used extensively in over-the-counter cold and allergy medications.4 In
1973, more than 20 million prescriptions contained either ephedrine or pseudoephedrine.1
Principle Active Constituents
1. Ephedrine
Ephedrine has similar pharmacological action as epinephrine, but is less potent. Ephedrine is also absorbed