cancer has been of benefit in reducing side effects and aiding in bone marrow recovery.30
N.B.: Note that Reishi Mushroom Extract and Astragalus are also known to reduce side effects from radiation
treatment (see details in related sections of this document)
Dosage and Standardized Grade
1. Immune Stimulation (Chronic Fatigue Syndrome, weakened immune status):100-500 mg per day in divided doses
(std to 4-8 percent ginsenoside content) – Panax Ginseng is considered to be the best choice for this purpose.1, 2
For Siberian Ginseng – consider 100-200 mg per day in divided doses (20:1 extract)1
2. Weight Loss or Ergogenic Athletic Aid: 200 mg per day in divided doses (Panax Ginseng std to 4-8 percent
ginsenoside content)32
3. General Anti-Stress Support: 100-200 mg per day (Panax Ginseng std to 4-8 percent ginsenoside content)33
4. Postmenopausal Support for Women: 100-500 mg per day in divided doses. (std to 4-8 percent ginsenoside
content – Panax Ginseng)1
5. Male Infertility and Erectile Dysfunction: 100-500 mg per day in divided doses (std to 4-8 percent ginsenosides
content – Panax Ginseng)1
6. Type II Diabetes and Syndrome X: 200 mg per day (100 mg, twice daily with meals) (std to 4-8 percent ginsenoside
content
–
Panax
Ginseng)1
N.B. Must consult the attending physician prior to Ginseng use in these cases
7. Adjunct to Chemotherapy or Radiation Treatment: Siberian Ginseng 300-400 mg per day in divided doses (20:1
extract)21
N.B. Long-term Ginseng supplementation usually involves a cycling effect with a two to three week non-use period,
every 30 to 60 days1, 2
Adverse Side Effects and Toxicity
1. Panax Ginseng: The most common side effects include insomnia,diarrhea, skin eruptions, vaginal bleeding and
breast tenderness. “Ginseng Abuse Syndrome” may exist in which over stimulation from Ginseng may cause
hypertension, restlessness, nervousness, euphoria, insomnia, diarrhea and skin eruptions – from overuse. This
description has been criticized due to the fact that most studied subjects also ingested high levels of caffeine.1
2. Siberian Ginseng: The most common side effects include insomnia, irritability, melancholy, anxiety Patients with
rheumatic heart disease have reported pericardial pain, headaches, palpitations, and elevations in blood pressure.2
3. American Ginseng: The most common side effects include insomnia and irritability21
Contraindications and Precautionary Measures for all Forms of Ginseng
Ginseng should not be given in the following cases:
Hypertension
Acute illness and fever
Insomnia – (not to be taken at night by these individuals)
Asthma
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Emphysema
Cardiac disorders
Patients suffering from mania, schizophrenia
Insulin dependent diabetes mellitus
Fibrocystic Breast Desease1,2,33
Caution must be exercised when administering Ginseng supplements:
to type II diabetics
as an adjunct to chemotherapy or radiation therapy1, 2, 33
at the same time as caffeine-containing beverages due to potential over stimulation effects.21, 38
Drug-Nutrient Interactions
Ginseng is contraindicated in patients on the following medications:
1. Drugs affecting brain neurotransmitters, especially monoamine oxidase inhibitors (MAO-inhibitors): Ginseng can
potentiate the drug effect leading to headache, euphoria, Central Nervous System stimulation and tremors, mania
symptoms.34
2. Phenobarbital 5
3. Warfarin – Ginseng has been shown to antagonize the clotting effects of warfarin, altering the prothrombin time or
INR.35, 36
4. Ticlopidine – a platelet-inhibiting drug. Similar effects on clotting due to Ginseng intake may counter effect of this
drug, used by patients with intermittent claudication or to prevent stroke.21
5. Digoxin or Digitalis – Ginseng has been shown to elevate serum levels of digoxin, potentiating the drugs effect on
the heart.35, 37 This occurred in one case and no clear relationship exists, but caution should be exercised.37
N.B.: Several studies performed in various countries have repeatedly shown that a high percentage of commercially
available Ginseng supplement products do not meet the label claim for the amount of Ginseng, ginsenosides or active
constituents they claim to possess. Furthermore, several cases of athletes consuming adulterated Ginseng products
(i.e. ephedrine, pseudoephedrine) have occurred in which athletes have incurred doping charges against them and
disqualification.39, 40, 41, 42, 43
As such, it is recommended that Ginseng products used for the intended purposes mentioned here, have available to
health practitioners and consumers, “certificate of analysis” on each new batch of product formulated, to ensure
potency and purity of the product.39-43
High quality Ginseng raw materials are expensive and thus may encourage some manufacturers to use inferior grades
or to adulterate their products with cheaper ingredients (e.g., ephedra, caffeine) to simulate the anti-fatigue,
performance-enhancing effects of Ginseng.
Use with caution with patients on anti-asthmatic and antihypertensive drugs, as Ginseng may potentiate the effects of
these drugs. As such, appropriate patient monitoring under these conditions is recommended.11,19
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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.
19. Boon H, Smith M. The Botanical Pharmacy. Quarry Health Books 2000:180-99
20. Murray M. The healing Power of Herbs. Prima Publishing 1995:265-79, 314-20
21. Chang H, But P. Pharmacology and Applications of Chinese Materia Medica. World Scientific, Philadelphia PA 1986:p773
22. Teegarden R. Chinese Tonic Herbs. Japan Publishing Inc NY 1985:p197
23. Bensky D, Gamble A. Chinese Herbal Medicine Materia Medica. Eastland Press, Seattle WA 1986:p556
24. Fulder SJ. Ginseng and the hypothalmic-pituitary control of stress. American Journal of Chinese Medicine 1981;0:112-8
25. Hiai S, Yokoyama H Oura H. Features of ginseng saponins-induced corticosterone secretion. Endocrinologia Japonica 1979;26:737-40
26. Hiai S, Yokoyama H, Oura H, Kawashima Y. Evaluation of corticosterone secretion-inducing effects of ginsenosides and their
prosapogenins and sopogenins. Chemical and Pharmaceutical Bulletin 1983;31:168-74
27. Fulder S. The drug the builds Russians. New Science 1980;21:576-9
28. Avakian EV et al. Effect of panax ginseng on energy substrates during exercise. Fed Proc 1980;39:287
29. Avakian EV et al. Effect of panax ginseng extract on erergy metabolism during exercise in rats. Planta Medica 1984;50:p151
30. McNaughton L et al. A comparison of Chinese and Russian ginseng as ergogenic aids to improve various factets of physical fitness. Int
Clin Nutr Rev 1989;9:32-7
31. See DM, Broumand N, Sahl L, Tilles JG. 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
32. Liu J, Wang S, Liu H et al. Stimulatory effect of saponins from Panax ginseng on immune function of lymphocytes in the elderly.
Mechanisms of Ageing and Development 1995;83(1):43-53
33. Bohn B, Nebe CT, Birr C. Flow-cytometric studies with Eleutherococcus senticosus extract as an immunomodulatory agent.
Arzneimittelforschung 1987;37(10):1193-6
34. Jie YH, Cammisuli S, Baggiolini M. Immunomodulatory effects of Panax ginseng C.A. Meyer in the mouse. Agents and Actions
1984;15:386-91
35. Yun TK, Yun YS, Han IW. Anti-carcinogenic effect of long-term oral administration of newborn mice exposed to various chemical
carcinogens. Cancer Detection and Prevention 1983;6:515-25
36. Yeung HW, Cheung K, Leung KN et al. Immunopharmacology of Chinese medicine. I. Ginseng-induced immuno suppression in virus
infected mice. American Journal of Chinese Medicine 1982;10:44-54
37. Kang M, Yoshimatsu H, Oohara A et al. Ginsenoside Rg1 modulates ingestive behavior and thermal response induced by interleukin-1
beta in rats. Physiology and Behaviour 1995;57(2):393-6
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Meschino Health Comprehensive Guide to Herbs
38. Scaglione F, Cattaneo G, Alessandria M, Cogo R. Efficacy and safety of the standardized Ginseng extract G115 for potentiating
vaccination against the influencza syndrome and protection against the common cold. [Published erratum appears in Drugs Exp Clin Res
1996;22(6):p338]. Drugs Under Experimental and Clinical Research 1996;22(2):65-72
39. Healthnotes Online. Healthnotes Inc. 2000; www.healthnotes.com: Ginseng
40. Punnonen R, Lukola A. Oestrogen-like effects of ginseng. British Mecial Journal 1980;281:p1110
41. Palmer BV, Montgomer ACV, Monteiro JC. Ginseng and mastalgia. [Letter] British Medical Journal 1978;1:p1284
42. Salvati G, Genovesi G, Marcellini L et al. Effects of Panax Ginseng: C.A. Meyer, Saponins on male fertility. Panminerva Med
1996;38(4):249-54
43. Chen, X, Lee TJ. Ginsenosides-induced nitric oxide-mediated relaxation of the rabbit corpus cavernosum. British Journal of
Pharmacology 1995;115(1):15-8
44. Sotaniemi EA, Haapakoski E, Rautio A. Ginseng therapy in non-insulin-dependent diabetic patients. Diabetes Care 1995;18(10):1373-5
45. Vukson V et al. American ginseng reduces postprandial glycemia in nondiabetic subjects and subjects with type 2 diabetes mellitus. Arch
Int Med 2000;160:1009-1013
46. Farnsworth NR, Kinghorn AD, Soejarto D, Waller DP. Siberian ginseng (Eleuthrococcus sentricosus): Current status as an adaptogen. In:
Wagner H, hikino H, Farnsworth NR, eds. Economic and Meidicinal Plant Research. Academic Press Orlando FL: 1985:155-215
47. Ben-Hur et al. Effect of Panax ginseng and Eleutherococcus S. on survival of cultural mammalian cells after ionizing radiation. Am J Chin
Med 1981;9:48-56
48. Kupin VI et al. Stimulation of the immunological reacitivty of cancer patients by eleutherococcus extract. Vopr Onkol 1986;32:21-6 [in
Russia]
49. Salvati G et al. Effects of Panax ginseng C.A. Meryer saponins on male fertility. Panminerva Med 1996;38:249-54
50. Colgan M. Optimum Sports Nutrition. Advanced Research Press 1993:p310
51. Brown DJ. Herbal Prescriptions for Better health. Prima Publishing Rocklin CA 1996;129-38
52. Miller LG. Herbal Medicinals: Selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med
1998;158(20):2200-11
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Meschino Health Comprehensive Guide to Herbs
Goldenseal (Hydrastis Canadensis)
General Features
Goldenseal is a perennial member of the buttercup family, whose rhizome is the part used for medicinal purposes.1 It
is most frequently used for its anti-microbial properties to help fight infections and infestations. 2
Principle Active Constituents
Alkaloids, including isoquinoline alkaloids such as berberine, which are thought to have anti-microbial properties.2
Clinical Application and Mechanism of Action
1. Antimicrobial
In vitro studies have shown berberine to be effective against a large number of bacteria including members of
Bacillus sp, Streptococcus sp, Staphylococcus sp, Klebsiella spp, Proteus spp, Corynebacterium diptheria,
Enterobacter aerogenes, Salmonella typhi, Vibrio cholerae, Shigella boydii, Pseudomonas aeruginosa,
Mycobacterium tuberculosis, Escherichia coli and Xanthomonas citri. It is also active against a wide range of fungi,
and using chick embryos, berberine at a dose of 0.5 mg per egg offered protection from Chlamydia trachomatis.
This action was comparable to that afforded by a dose of 1 mg of sulphadiazine per egg.2
Berberine sulfate has been shown to prevent the adherence of streptococci to host cells, which may explain its
antibiotic properties.2
Berberine has also been shown to activate macrophages, which engulf and destroy bacteria.3
Berberine has been shown to have an antipyretic effect (lowers fever) in rats4 and has been used historically for
this purpose by certain populations.
Thus, berberine may offer complementary support in the treatment of infections of the mucous membranes (oral
cavity, throat, sinus, bronchi, genitourinary tract and gastro-intestinal tract.5
Goldenseal is often used to treat the common cold, either alone or in combination with Echinacea.6
Author’s Note: Due to insufficient evidence, Goldenseal should not be assumed to be a substitute for antibiotic
therapy.
2. Liver Disorders
Berberine has been shown to stimulate the secretion of bile and bilirubin. Studies with patients suffering from
chronic cholecystitis (inflammation of the gallbladder) demonstrated improvement in clinical symptoms, a decrease
in bilirubin levels, and an increase in the bile volume of the gallbladder. The oral doses of 5 to 20 mg of berberine,
three times per day before meals, produced these results within 24-48 hours.5
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Meschino Health Comprehensive Guide to Herbs
Dosage and Standardized Grade
As no established protocols exist for the treatment of mucous membrane infections, the following guide may serve to
provide the body with additional anti-microbial support:
250-500 mg (three times daily) of a powdered extract capsule (caplet), standardized to 4:1 or 8-12 percent alkaloid
content.5
Adverse Side Effects, Toxicity and Contraindications
Berberine has been shown to be very non-toxic in rat studies.5 It should be used with caution n cases of
hypertension.7
Possible adverse effects include the fact that in high doses Goldenseal has been noted to cause: oral and pharyngeal
irritation, nausea, vomiting, diarrhea, paresthesia, dizziness, nose bleeds, skin irritation, convulsions, hypotension, and
death from respiratory or cardiac paralysis. However, the lack of adverse reactions reported from the widespread use
of Goldenseal in many countries suggests that these potential reactions may be exaggerated.2 Death from berberine
poisoning has occurred but, generally speaking, it is unlikely to produce any serious adverse reactions at a dose at or
below 1,500 mg per day. 9
However, patients with congestive heart failure, cardiac arrythmia (irregular heart beat) or high blood pressure should
not take Goldenseal without proper monitoring by their physician as Goldenseal has been shown to prolong the
duration of ventricular action potentials and increase vasodilation. It also has anti-arrhythmia effects on the heart and
increases the cardiac synthesis of ATP through its inotropic properties. 8 As well, jaundiced individuals should not use
Goldenseal. 10
Drug-Nutrient Interactions
1. Paclitaxel: The efficacy of this chemotherapy drug is diminished by the ingestion of Goldenseal and therefore,
should not be taken concurrently with this medication. 11
2. Tetracycline and Doxycycline: Berberine has been shown to reduce the absorption of tetracycline and possibly
other antibiotics in one study, and appears to diminish the antibiotic effect of tetracycline against cholera. Thus, it
may not be wise to use Goldenseal concurrently with antibiotic therapy. 12
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Meschino Health Comprehensive Guide to Herbs
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. Leung AY, Encyclopedia of Common Natural Ingredients Used in Food, Drugs, and Cosmetics, John Wiley & Sons: New York, 52-
52, 1980, 189-190.
2. Boon H and Smith M, Health Care Professional Training Program in Complementary Medicine, Institute of Applied Complementary
Medicine Inc, 1997, 204-207.
3. Kumazawa T, et.al., Activation of Peritoneal Macrophages by Berberine Alkoloids in Terms of Induction of Cytostatic Activity, Int J
Immunopharmacol 6, 1984, 587-592.
4. Sabir M, et.al., Further Studies on Pharmacology of Berberine, Indian J Physiol Pharmacol 22, 1978, 9-23.
5. Murray M, The Healing Power of Herbs (2nd edition), Prima Publishing, 1995, 162-172.
6. Kumazawa Y, et.al., Activation of Peritoneal Macrophages by Berberine Alkaloids in Terms of Induction of Cytostatic Activity, Int J
Immunopharmacol 6, 1984, 587-592.
7. Mills S, The Essential Book of Herbal Medicine (2nd edition), London: Penguin Publishing, 1991, 677.
8. Lau CW, Yao XQ, Chen ZY et al. Cardiovascular actions of berberine. Cardiovasc Drug Rev. 2001; 19 (3): 234-44.
9. Principles and Practice of Phytotherapy. Mills S and Bone K. Churchill Livingstone Publishers. 2000: 294-295.
10. Chan E. Displacement of bilirubin from albumin by berberine. Biol Neonate. 1993; 63 (4):201-208.
11. Lin HL et al. Berberine modulates expression of Mdr1 gene product and the response of digestive tract cancer cells to paclitaxel. Br
J Cancer. 1999; 81 (3): 416-22.
12. Healthnotes, Inc. 2001. www.healthnotes.com: Goldenseal
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Gotu Kola (Centella asiatica)
General Features
Gotu Kola grows in tropical, swampy areas in various countries in the Middle East, the south of Africa, Eastern Europe,
and Central Asia. The roots and leaves are used medicinally. 15,16 There is good supporting evidence that Gotu
Kola, like Horsechestnut and Grape Seed Extract, is an effective intervention for chronic venous insufficiency when
taken orally. It has also shown a positive effect in preventing keloid scar formation if taken prior to surgery, and it may
be helpful in the treatment of enlarged scars. Applied topically, Gotu Kola has been shown to be effective in the
treatment of burns and wounds, 1,17 although some experimental evidence suggests that it may be carcinogenic to skin
cells when applied in this topical form. 18
Principle Active Constituents
The primary active constituents are saponins (triterpenoids), which include asiaticoside, madecassoside, and
madasiatic acid. These saponins, unique to Gotu Kola, have been shown to prevent excess scar formation by
inhibiting the over-production of collagen at the wound site. The same constituents are also associated with promoting
wound healing and they have been shown to increase the cement substance (ground substance or
glycosaminoglycans) between cells and collagen fibers, forming a more effective seal in cases of chronic venous
insufficiency and possibly other blood vessel leakage conditions. 15,16
Clinical Application and Mechanism of Action
1. Chronic Venous Insufficiency and Varicose Veins
There is significant evidence for the use of Gotu Kola in the treatment of varicose veins and venous insufficiency.
17 At least four well designed clinical trials (a mix of placebo controlled, double blind and one open trial) have
provided convincing evidence that Gotu Kola Extract (standardized grade) is able to improve vein function, reduce
leg swelling and heaviness, and improve pain and discomfort, in a large percentage of these cases compared to
the placebo groups. Moreover, two of the studies demonstrated a dose-dependent relationship, in that a higher
dosage resulted in greater improvement than the lower dosage. 19, 20,21,22 A 1992 review of Gotu Kola studies
(published in Minerva Cardioangiol), concluded that when taken orally, using a standardized grade extract, it
provides a dose-related improvement in venous insufficiency symptoms, reducing foot swelling, ankle edema, and
fluid leakage from veins. 23
Studies suggest that Gotu Kola Extract may improve structure and function of connective tissue in the body, helping
to strengthen veins and possibly reducing symptoms of other connective tissue disorders, such as scleroderma and
dermatitis. 24
2. Increases Formation of Glycosaminoglycans. 1
By increasing the synthesis of glycosaminoglycans, Gotu Kola Extract may further strengthen the walls of veins an