Herbal Medicine Materia Medica 2 · Herbal Medicine Materia Medica 2 WHMF212 ... • In TCM contraindicated in cough with weakness ... (Bone & Mills, 2013; Fisher, 2009))

Herbal Medicine Materia Medica 2

WHMF212

Session 2:

Hepato-biliary System Part I

© Endeavour College of Natural Health endeavour.edu.au

Session 2

Hepato-biliary System Part I

• Materia Medica (from Traditional literature &

research):

• Bupleurum falcatum

• Berberis vulgaris

• Chelidonium majus

• Curcuma longa

• Cynara scolymus

© Endeavour College of Natural Health endeavour.edu.au 2

Gall Bladder


Gallbladder:

•Fundus

•Body

•Neck

(Tortora & Dickinson, 2014)

Gall Bladder

Herbal medicines can be useful for the treatment or

management of:

• Cholecystitis (biliary infection/inflammation).

• Minor/early or established biliary cholelithiasis

(biliary stones).

• Conjugated hyperbilirubinaemia.

• Chronic and moderate hepatobiliary disease.

Traditional prescribing includes:

• Bilious conditions, intolerance to alcohol, fats &

headaches.

• Systemic ‘toxicity’.

• Chronic constipation due to sluggish digestion.(Bone & Mills, 2013)


Gall Bladder

Herbal Actions include:

• Choleretics: enhance hepatocyte bile production

• Bitters: have choleretic properties.

• Cholagogues : stimulate the release of bile from the

gallbladder (some have choleretic action also).

• Dosage: best 30 minutes before meals in liquid

formulation.

Caution for use in:

• Biliary carcinoma.

• Blocked bile duct.

• Acute and severe hepatobiliary disease.(Bone & Mills, 2013)


Bupleurum falcatum

Plant family: Apiaceae

Parts used: Root

Active Constituents:

Triterpenoid saponins

(saikosaponins),

polysaccharides.

Actions:

Hepatoprotective, anti-

inflammatory, immune

modulating, nephroprotective,

antitussive, diaphoretic. (Bone & Mills, 2013)


Bupleurum falcatum

(Ifnaer, 2013)

Bupleurum falcatum

Historical & Traditional

Prescribing:

• Alternating chills and fever, liver

enlargement, prolapse of uterus

and rectum.

• Epigastric pain, nausea,

indigestion.

• TCM: Bitter and cold acting as a

diaphoretic to regulate and

restore gastrointestinal and liver

function. (Bone & Mills, 2013)


Bupleurum falcatum

(Fornax, 2005)

Bupleurum falcatum

Cautions / Contraindications / Warnings:

• In TCM contraindicated in cough with weakness

(deficient Yin)

• May cause nausea or vomiting (use low dose)

• May sedate some clients.

Herb/Drug Interactions:

• None known.

Pregnancy and Lactation Data:

• No adverse effects expected.(Bone & Mills, 2013)


Bupleurum falcatum

Preparation Adult mL/g Dosage directions & considerations

Oral Side effects: Large doses may act as

a sedative, increase bowel

movements and cause flatulence,

nausea and reflux

Liquid extract 1:2 25-60mL/week

Dried root 0.5-3gm/dose Take up to three times per day


(Bone & Mills, 2013)

Taste: Bitter, cold (Thomsen and Gennat, 2009)

Berberis vulgaris

Plant family: Berberidaceae

Parts used: Root, stem bark or both.


• Alkaloids (berberine), tannins.

Actions:

• Antimicrobial, antibacterial,

antiprotozoal, antipyretic, anti-

inflammatory, alterative

• Cholagogue, anti-haemorrhagic,

anti-diarrhoeal, laxative tonic to

spleen causing splenic

contractions. (Bone & Mills, 2013; Fisher, 2009)

)© Endeavour College of Natural Health endeavour.edu.au 10

Berberis vulgaris

(Porse, 2001)

Berberis vulgaris

Historical & Traditional

Prescribing:

• To cleanse the body of choler,

reduce body heat & conditions

linked to this: itch, ringworm,

scabies, jaundice, bile.

• Renal calculi, soreness and

burning of the urinary tract. Blood

purification (tea), tonic.

• Topically for mouth ulcers, lip

sores, chronic ophthalmia, scalds.

(Bone & Mills, 2013; Fisher, 2009)


Berberis vulgaris

(Kurz, 2013)

Berberis vulgaris

Warnings and Precautions:

• None required.


• Berberine may reinforce the effects of other drugs

that displace the protein binding of bilirubin.


• Berberine containing plants are not recommended

for use during pregnancy or for jaundiced neonates. (Bone & Mills, 2013; Fisher, 2009)


Berberis vulgarisPreparation Adult mL/g Dosage directions & considerations

Oral Side effects: high doses of

berberine may cause dizziness,

nosebleeds, dyspnoea, eye

irritation, gastrointestinal

irritation, nausea, diarrhoea,

nephritis, urinary tract disorders

Fluid Extract 1:2 (45%) 20-40mL/week

Decoction 0.5-1gm/dose Take up to three times per day


(Bone, 2003)

Taste: Bitter, cold and dry (Thomsen and Gennat, 2009)

Chelidonium majusPlant family: Papaveraceae

Parts used: Aerial parts


• Alkaloids (Chelidonine), flavonoids,

phenolic acids.

Actions:

• Cholagogue, choleretic, mild

laxative, anti-inflammatory,

spasmolytic, diuretic.

• Topically: antiviral, vulnerary. (Bone & Mills, 2013; Fisher, 2009)


Chelidonium majus

(Manske, 2006)

Chelidonium majus

Historical & Traditional Prescribing:

• Used since the Middle ages for skin

inflammation & infections, warts, indolent

ulcers, fungal growths.

• GIT conditions due to poor liver function,

gallbladder inflammation, gallstones,

cholecystitis.

• Blood cleanser, diaphoretic (hot infusion).

• Abdomen application for griping & post-

partum pain. (Bone, 2003; Fisher, 2009)


Chelidonium majus

(Male, 2006)

Chelidonium majus

Cautions / Contraindications / Warnings:

• Long term use is not recommended due to the

alkaloid content of the herb.

• Pre-existing serious liver disease or damage.


• None known


• Avoid in pregnancy and lactation

• Category C – risk of causing harmful effects to the

foetus or neonate without causing malformations.(Bone & Mills, 2013)


Chelidonium majus


Oral Long term use not

recommended (alkaloids)

Fluid Extract 1:2 (45%) 7-15ml /week

Infusion of dried herb 2-4gm/dose Take up to three times per day


(Bone, 2003; Fisher, 2009)

Taste: bitter, pungent, dry 3rd degree, hot 3rd degree (Thomsen & Gennat, 2009)

Curcuma longaPlant family: Zingiberaceae

Parts used: Rhizome

Active Constituents: Volatile oil,

curcuminoids, minerals, vitamins,

polysaccharides.

Actions:

• Anti-inflammatory, antiplatelet

aggregation, antioxidant, antimicrobial,

depurative.

• Hepatoprotective, neuroprotective,

choleretic, hypolipidemic, carminative.

(Blumenthal et al., 2000; Bone & Mills, 2013)


Curcuma longa

(Monfils, 2008)

Curcuma longa

Historical & Traditional Prescribing

• Western: jaundice, mild aromatic digestive stimulant.

• Ayurvedic: liver disorders, poor digestion, diarrhoea,

vomiting of pregnancy. Fevers, catarrhal cough, bites.

Externally: eczema, arthritis, ulcers, skin infections

• TCM : amenorrhea, dysmenorrhea. Chest pain,

abdominal distension & pain. Jaundice with dark urine.

Traumatic injury (Bone & Mills, 2013)


Curcuma longa

(Eugster, 2014)

Curcuma longa

Cautions / Contraindications / Warnings

• Biliary tract obstruction & gallstones.

• Cautioned use in female pre-conception, clients with

hair loss.

• Topical administration may cause photosensitivity.


• Additive effect: antiplatelet, anticoagulant (doses

higher >15g/day).


• Category A - No adverse effects are expected. (Bone & Mills, 2013)


Curcuma longa

Preparation Adult mL/g Dosage directions &

considerations

Oral

Liquid Extract 1:1

(45%)

35-90mL /week

Dry herb 1-2 g / day

Powdered extract 1.5-3 g / day


(Bone, 2003)

Taste: Pungent and warm (Thomsen & Gennat, 2009)

Cynara scolymus

Plant family: Asteraceae

Parts used: Leaf


• Phenolic acids, cynarin, volatile oil,

inulin, phytosterols, sugars, flavonoids.

Actions:

• Hepatoprotective, hepatic

trophorestorative, choleretic,

cholagogue, hypolipidemic, diuretic,

antiemetic, depurative. (Bone & Mills, 2013; Fisher, 2009)


Cynara scolymus

(Manske, 2009)

Cynara scolymusHistorical & Traditional Prescribing:

• Jaundice, hypercholesterolemia,

anorexia, liver tonic, anti-toxic.

• Clearing the complexion,

depurative for itchy skin.

• Rheumatism, arthritis, gout,

dropsies.

• Urinary stones, oliguria, uraemia.

• For body odour and snake bites. (Bone & Mills, 2013; Fisher, 2009)


Cynara scolymus

(Simak, 2008)

Cynara scolymus

Cautions / Contraindications:

• Allergy to members of the Asteraceae family.

• Gallbladder obstruction. Under professional

supervision in cholelithiasis.


• No adverse effects expected.

• Cynara contains a milk curdling enzyme, so

theoretically contra-indicated in lactation.

(Bone & Mills, 2013; Fisher, 2009)


Cynara scolymus


Oral Side effects: Mild and transient

infrequent side effects including

flatulence, hunger and

weakness.

Fluid extract 1:2

(35%)

15-35mL/ week

Infusion of dried leaf 2gm /dose Take three times per day


(Bone, 2003; Fisher, 2009)

Taste: cold and moist (Thomsen & Gennat, 2009)

Recommended Readings

Braun, L., & Cohen, M. (2015). Herbs & natural supplements. An evidence-based guide (4th ed.). Chatswood, NSW, Australia: Churchill Livingston.

• Globe artichoke monograph p. 466-471,

• Turmeric monograph p 1009-1021.

Fisher, C. (2009). Materia medica of Western herbs. Nelson, New Zealand: C. Fisher.

• Berberis vulgaris, p. 59-61,

• Chelidonium majus, p. 180-181,

• Cynara scolymus, p. 37-38.


ReferencesBlumenthal, M. (2000). Herbal medicine: Expanded commission E monographs. Newton,

Massachusetts, USA: Integrative Medicine Communications.

Bone, K., & Mills, S. (2013). Principles and practice of phytotherapy (2nd ed.). St Louis, Missouri: Churchill Livingstone.

Bone, K. (2003). A clinical guide to blending liquid herbs: Herbal formulations for the individual patient. St Louis, Missouri, USA: Churchill Livingston.

Eugster, S.A. (2014). Curcuma longa [Image]. Retrieved fromhttp://upload.wikimedia.org/wikipedia/commons/thumb/5/5b/Curcuma_longa_roots.jpg/640px-Curcuma_longa_roots.jpg

Fisher, C. (2009). Materia medica of Western herbs. Nelson, New Zealand: C. Fisher.

Fornax (2005). Bupleurum falcatum [Image]. Retrieved fromhttp://upload.wikimedia.org/wikipedia/commons/thumb/e/ee/Bupleurum_falcatum1_eF.jpg/640px-Bupleurum_falcatum1_eF.jpg

Ifnaer, S. (2013). Bupleurum falcatum [Image]. Retrieved fromhttp://upload.wikimedia.org/wikipedia/commons/thumb/b/b3/Bupleurum_falcatum_sl3.jpg/640px-Bupleurum_falcatum_sl3.jpg

Kurz, M. (2013). Berberis vulgaris [Image]. Retrieved fromhttp://upload.wikimedia.org/wikipedia/commons/2/27/Berberis-vulgaris-E-GEO-233b.jpg

Male, D. (2006). Chelidonium majus 001 [Image]. Retrieved from http://upload.wikimedia.org/wikipedia/commons/thumb/5/5d/Chelidonium_majus.001_-_Serra_de_Enci%C3%B1a_de_Lastra.JPG/800px-Chelidonium_majus.001_-_Serra_de_Enci%C3%B1a_de_Lastra.JPG

Manske, M. (2006). Chelidonium majus resize [Image]. Retrieved from http://upload.wikimedia.org/wikipedia/commons/thumb/d/d6/Chelidonium_majus_resize.jpg/640px-Chelidonium_majus_resize.jpg


http://upload.wikimedia.org/wikipedia/commons/thumb/5/5b/Curcuma_longa_roots.jpg/640px-Curcuma_longa_roots.jpg

http://upload.wikimedia.org/wikipedia/commons/thumb/e/ee/Bupleurum_falcatum1_eF.jpg/640px-Bupleurum_falcatum1_eF.jpg

http://upload.wikimedia.org/wikipedia/commons/thumb/b/b3/Bupleurum_falcatum_sl3.jpg/640px-Bupleurum_falcatum_sl3.jpg

http://upload.wikimedia.org/wikipedia/commons/2/27/Berberis-vulgaris-E-GEO-233b.jpg

http://upload.wikimedia.org/wikipedia/commons/thumb/5/5d/Chelidonium_majus.001_-_Serra_de_Enci%C3%B1a_de_Lastra.JPG/800px-Chelidonium_majus.001_-_Serra_de_Enci%C3%B1a_de_Lastra.JPG

http://upload.wikimedia.org/wikipedia/commons/thumb/d/d6/Chelidonium_majus_resize.jpg/640px-Chelidonium_majus_resize.jpg

ReferencesManske, M. (2009). Cynara scolymus [Image]. Retrieved from

http://upload.wikimedia.org/wikipedia/commons/thumb/c/c6/P1000578_Galactites_tomentosa_%28Compositae%29_Flowers.JPG/800px-P1000578_Galactites_tomentosa_%28Compositae%29_Flowers.JPG

Monfils, L. (2008). Curcuma longa [Image]. Retrieved from http://upload.wikimedia.org/wikipedia/commons/thumb/4/47/Curcuma_longa.jpg/640px-Curcuma_longa.jpg

Porse, S. (2001). Berberis vulgaris flowers [Image]. Retrieved fromhttp://upload.wikimedia.org/wikipedia/commons/f/f5/Berberis-vulgaris-flowers.jpg

Simak, E. (2008). Artichoke (Cynara scolymus) [Image]. Retrieved from http://upload.wikimedia.org/wikipedia/commons/thumb/0/09/Artichoke_%28Cynara_scolymus%29_-_detail_-_geograph.org.uk_-_935427.jpg/450px-Artichoke_%28Cynara_scolymus%29_-_detail_-_geograph.org.uk_-_935427.jpg

Thomsen, M., & Gennat, H. (2009). Phytotherapy desk reference. Global. www.globalnaturalmedicine.com Natural Medicine Pty Ltd.

Tortora, GJ & Derrickson, B 2014. Principles of Anatomy and Physiology,

14th edn, Wiley.


http://upload.wikimedia.org/wikipedia/commons/thumb/c/c6/P1000578_Galactites_tomentosa_(Compositae)_Flowers.JPG/800px-P1000578_Galactites_tomentosa_(Compositae)_Flowers.JPG

http://upload.wikimedia.org/wikipedia/commons/thumb/4/47/Curcuma_longa.jpg/640px-Curcuma_longa.jpg

http://upload.wikimedia.org/wikipedia/commons/f/f5/Berberis-vulgaris-flowers.jpg

http://upload.wikimedia.org/wikipedia/commons/thumb/0/09/Artichoke_(Cynara_scolymus)_-_detail_-_geograph.org.uk_-_935427.jpg/450px-Artichoke_(Cynara_scolymus)_-_detail_-_geograph.org.uk_-_935427.jpg

http://www.globalnaturalmedicine.com/

Tutorial

Session 2

Tutorial – Case Study

Frederick: 69 yo male, BP 120/74, HR 88. Height 172cm,

weight 97kg.

Frederick presents with shooting & radiating pain to his

abdomen and right shoulder blade following fatty or rich

foods.

He has experienced recurrent bouts of biliary pain for the

last 6 months.

His stools are currently pale brown to whitish in colour and

he has frequent and loose bowel motions.

He has a long history of undigested food in stool and

constipation.

His symptoms are worse for fatty or rich food.


Tutorial


On questioning, he rates the severity of his pain as 7/10

(0=none, 10=severe)

The pain lasts for 30 minutes to a couple of hours (if a

very large meal).

He has brought in X-rays and abdominal ultrasound

results that reveal gallbladder inflammation but currently

no gallstones.

Tutorial

• Based on this information create short term and long

term treatment goals to assist Frederick.

• Treatment goals should identify the symptom/system

that you are working on, the herbal action required,

and what the herb is doing in the body to effect

change.

• Create a list of herbs that fit the actions identified

within each goal.


Tutorial• From this list, choose the herbs that best suit the

case and generate a herbal prescription, including a

100mL liquid extract formula.

• Consider other forms of herbal interventions, eg

teas, creams, separate herbal liquid extract that

would be suited to the case.

• Provide clear dosage instructions to the client on

how to take the prescription/s.

• This should include quantity of dose, frequency of

dose, timing of dose and any other relevant

information.

• Groups discuss their findings with the class


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Herbal Medicine Materia Medica 2 · Herbal Medicine Materia Medica 2 WHMF212 ... • In TCM contraindicated in cough with weakness ... (Bone & Mills, 2013; Fisher, 2009))

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