P. 1
Dermatology Notes

Dermatology Notes

|Views: 28|Likes:
lecture notes herbal medicine and dermatology
lecture notes herbal medicine and dermatology

More info:

Copyright:Traditional Copyright: All rights reserved


Read on Scribd mobile: iPhone, iPad and Android.
download as DOC, PDF, TXT or read online from Scribd
See more
See less





Herbal Therapeutics

Skin Conditions
Herbs for Skin Conditions
• Antiseptics; Baptisia tinctoria, Berberis spp, Calendula
officinalis, Echinacea angustifolia, Hydrastis canadensis, Tabebuia
impetiginosa, Thuja occidentalis, Thymus vulgaris
• Anti- inflammatories; Calendula officinalis, Chamomilla
recutita, lycyrrhi!a glabra
• Cholagogues/ bitters; Berberis spp, Chelidonum
majus,"umaria officinalis, Tara#acum officinale radi#
• Hormonal agents; $ioscorea villosa, Smila# ornata, %ite#
agnus castus
• Circulatory; Crataegus o#yacantha, %accinium myrtillus,
&ingiber officinalis
• Vulneraries ;'loe vera, 'rnica montana, E(uisetum arvense,
)lantago spp, Symphytum officinalis fol
• Astringents; 'chillea millefolium, Calendula officinalis,
Euphrasia officinalis, eranium maculatum, Hamamelis virginiana,
*uercus robur
• Demulcents/emollients; 'lthaea officinalis, 'vena sativa,
)lantago lanceolata, Symphytum officinalis, +lmus fulva
• Depuratives, otherwise known as “bloo cleansers! or
“alteratives!, are employed to effect a gradual change in chronic
disease states, especially skin, joint and the connective tissue
disorders, They are said to act by improving the processes of
deto#ification and elimination, hence they can be e#pected to act only
slo-ly, )rogress can be measured over months, rather than days or
-eeks, 'rctium lappa .burdock/, 0ahonia a(uifolium .1regon grape/,
Trifolium pratense .red clover/, alium aparine .cleavers/, 2ume#
crispus .yello- dock/, Scrophularia nodosa .fig-ort/, %iola tricolor
.heartsease/, Smila# species .sarsaparilla/, Solanum dulcamara
.bitters-eet/ and 3ris versicolor .blue flag/ )hytolacca decandra,
+rtica dioica, Ho-ever herbs -ith an activity on the immune system,
such as Echinacea species and )hytolacca and choleretic herbs
including Tara#acum officinale .dandelion/, Cynara scolymus .globe
artichoke/, "umaria officinalis .fumitory/ and Berberis vulgaris
.barberry/ are also regarded as possessing some depurative activity,
Assessment of "kin
eneral considerations regarding skin conditions
• body4s largest organ,
• a po-erful defence system for the body and repels many
e#ternal pathogens and environmental pollutants -hilst also offering
a path-ay for the intake of some remedies,
• means of elimination
• a -indo- on to the health of the body -ithin,
• people do seek herbal treatment for skin conditions, having a
dislike of the common use of steroidal creams, especially for children,
• general response to herbal treatment can be unpredictable,
• Perhaps this is why herbalists in a survey reported that skin
conditions were their least popular problem!
• )atients -ith skin complaints such as acne, ec!ema or
psoriasis may feel very much affected by their complaint,
• 3t may affect their lifestyle substantially, 5et the severity of their
condition can vary considerably,
• 3t is most important to accurately record the nature and e#tent
of the skin lesions on presentation,
• 6ook at the overall tone and elasticity of the skin as -ell as
• 3t is useful in most cases to look at the hands and nails, eyes,
tongue and sometimes the scalp,
• 3n the case history there may be underfunctioning in one or
more systems 7 those of particular interest are likely to be the
nervous system .embryologically skin and nerves derive from the
same tissue/ and the digestive system,
• 6ook for signs of accumulated to#icity and consider -hether
other organs of deto#ification .lung, kidney, bo-el etc/ are -orking
• some skin complaints such as pruritus .generalised itching/
may be related to the onset of much more serious disorders,
Herbal medicines can be applied in many -ays;
• 6otions, -ashes and douches
• creams and ointments
• 6iniments and rubs
• )astes and poultices
• "i#ed and essential oils
1ils and ointments can be heating, alcohol preparations can be
drying and irritant,
eneral approach to skin conditions8
.9/ Combat infection topically and internally
.:/ )romote local healing -ith effective circulation
.;/ 2educe inflammation using anti<inflammatories, astringents,
.=/ 2ecommend dietary and lifestyle changes to improve immune
function, elimination and tissue repair
.>/ 3mprove function in other organs?systems influencing skin .3T,
@S etc/
EA'03@E <
< elasticity and tone .smokerB/, colour etc
< spots, dryness? greasiness
< e#tent of lesions? ask< about patterns over time
also look at < hands?nails,tongue, scalp
accurate record
• categorise by site
• and by type of problem < infection?inflammation
• and by description of macule?papule?pustule
• To aid diagnosis of an unkno-n rash or lesion you should
establish the follo-ing features of the rash or lesion.s/ in (uestion8
9 Site,
: Erythematous .blanches on pressure/ or non<erythematous
; 'cute .C : -eeks/ or chronic .D : -eeks/
= Surface features;
@ormal?smooth i,e, same as surrounding skin
or Earty
> if the surface is normal then determine8 3f it is flat .macules and
patches/ or 2aised .papules, vesicles and pustules, pla(ues,
nodules and bullae/ and
F 3f non<erythematous < 3ts colour8 skin<coloured or pink, red, mauve;
purple, bro-n, -hite, yello-, cream or golden
2,'shton and B,6eppard .9GG:/ $ifferential $iagnosis in
$ermatology, :
ed, 2adcliffe 0edical )ress, 1#ford,
Consider the follo-ing factors in skin conditions
• @utritional deficiency? imbalance
• 3nfection 7 bacterial?viral?fungal
• )arasites
• 'llergy
• 'uto<immune factors
• Trauma 7 -ounds, burns
• To#icity
• Circulation 7 healing potential, hydration, lymphatics
• )sychogenic aspects 7 emotions
• Hormonal balance
$ifferential $iagnosis
• $ifferential diagnosis for itchingB
• "ibreglass,chickenpo#,habit,dry skin,allergy,contact dermatitis,
liver problem, gallbladder disease, scabies, insect bite, headlice,
ec!ema, diabetes, old age, psoriasis, healing -ound, sunburn, hay
fever .eyes/, heat rash, piles, tension, sleeplessness, leukaemia, non
Hodgkins lymphoma, renal failure, cancer, fungal infection, drugs,
pregnancy, menopause, polycythaemia
$ifferential $iagnosis
6ichen planus
• 'cute or chronic itchy rash, unkno-n aetiology,
• "le#or surfaces of -rist, ankles, may affect trunk and mucous
• itchy, small, shiny, flat topped lumps -ith fine -hile lines, occur
-here skin been scratched,
• +sually resolves -ithin fe- months
)ityriasis rosea
• 3tchy rash, unkno-n cause .viralB/
• itchy pink, maculopapular rash trunk, upper thighs , upper arms,
usually gone in F -eeks
Basal cell carcinoma
• 2odent ulcer, tend to occur around nose and inner canthus,
starting reddish, dome shaped, pearly nodules, progress to form
ulcer, -ith raised, rolled pearly edges,
S(uamous cell carcinoma
• Elderly and outdoor -orkers,
• aetiology; sun, leukoplakia, tar, parraffin, creosote, radiation,
chronic ulceration,
• +lcer -ith scab at centre, raised, rolled hard, commonly on
e#posed areas,
0alignant melanoma
• )igmented cancer
• sun
• deeply, variable pigmented lesions, sometimes ulcerated, often
on hands, feet, neck, face,
• 6ocal 6ymphadenopathy .spread rapidly/
• 0oles; suspicious if
– rapid gro-th
– itching
– bleeding
– ulcerated
– variable pigmentation
– satelite lesions,
$ermatitis herpetiformis
• luten enteropathy
• clusters, intensely itching vesicles usually on e#tensor aspects
of elbo-s, knees, bet-een scapula and on buttocks,
• Starts suddenly
Erythema multiforme
• +nkno-n aetiology
• associated -ith allergic reaction to certain drugs
.sulphonamides, aspirin, penicilin/ and herpes infection
• systemic disturbance .fever, sore throat, joint ache, headache,
• forearms, legs, mouth
• resemble archery targets
• better by > -eeks
)emphigus vulgaris
• 0iddle aged men and -omen, more fre(uent in He-s
• autoimmune
• prednisolone
'cne vulgaris
• Comedones, -hiteheads, blackheads on face, chest, back; acid
prone areas, as they contain high number of sebaceaous glands,
Acne vulgaris
• Typically a complaint of young people; skin oilier after puberty
as androgens increases production of sebum, 3ncrease causing
obstruction of the pilosebaceous follicle, creating environment for
bacteria, The bacteria contains lipases, breaking do-n sebum,
leading to increased production of free fatty acids, and
proinflammatory mediators,
• 'lso seen in older -omen -hen there are hormonal disorders
such as )C1$,
• 3ncrease before menses due to presence of progesterone .acts
as testosterone/
• aggrevated; heat, cosmetics, )0T, medications,
• 1nly occasionally greasy foods, and chocolate aggrevates,
• Consider the pattern of menstruation, and factors such as
stress, eating disorders
• Check for food intolerance and?or poor digestion -ith many
sugary foods,
• Check use of lotions and soaps,
Treatment aims to tone digestion, improve elimination through the
bo-el and lymphatic systems and support the immune system,
Conventional treatment
• 'ntibiotics, 1C) .high estrogen contain pill improve acne and
prevent )0T flare ups/ and for severe 'ccutane
Topical treatment
• )roper cleansing can improve situation after : -eeks,
• 'ntibacterial facial soap, -ashing t-ice a day, .chamomile,
#ea tree oil $melaleuca alternifolia%&
• constituents; terpinen<=<ol, alpha<terpineol, and alphapinene;
active against propionibacterium acnes, staphylococcus aureus, and
s epidermidis,
• ' trial -ith >I teatree oil significant effect, reducing number of
inflamed and non inflamed lession,
Herbal treatment
• %ite# agnus castus, Serenoa repens; inhibition fo
• elimination; rume# crispus, trifolium pratense, arctium lappa
• stress; adaptogens
• 6imit refined foods and sugar, and foods containing iodine and
transfatty acids .insulin efficacy in treating acne suggest defective
cutaneous tolerance or insuline insensititity,
• &inc essential for normal skin function; involved in production
of local hormone, immune function, tissue regeneration, 6o- !inc
levels increase ><alpha reduction of testosterone,
• )remenstrual acne; BF, deficiency causes increased uptake
and sensitivety to Testosterone,
A low-glycemic-load diet improves symptoms in acne vulgaris
patients: a randomized controlled trial.
2ecent epidemiological studies of non<Eesternised populations
suggest that dietary factors, including the glycaemic load, may be
involved in the pathogenesis of acne,
' randomised, controlled clinical trial assessed -hether a lo-
glycaemic<load diet improves acne lesion counts in young men .9>7
:> years old/, The lo-<glycaemic<load diet -as composed of :>I
energy from protein and =>I from lo-<glycaemic<inde#
carbohydrates, $iet for the control group focussed on carbohydrate<
dense foods -ithout reference to the glycaemic inde#,
)rotein intake increased in the lo- glycaemic< inde# group and
decreased slightly in the control group, indicating that some
carbohydrates -ere replaced -ith foods higher in protein,
'cne lesion counts and severity -ere assessed during monthly visits,
and insulin sensitivity -as measured at baseline and at 9: -eeks,
Significant improvement in acne and insulin sensitivity -as found for
the treatment,
6imitations to study; 'll participants -ere provided -ith a topical
cleanser, The cleanser may have contributed to the improvement in
acne, as acne improved in the control group -ithout any significant
changes to their diet,
Ho-ever, the difference in the number of total lesions bet-een the
diet and control groups from baseline to -eek 9: -as significant .p J
K,K;/, so any such effect -ould be small,
1ther dietary factors .e,g, !inc and vitamin ' intake/ might have
mediated or confounded the relation bet-een diet and acne
mith !"# $ann "%# &raue A et al. Am % Clin "utr '(()* +,-./: .()-
..0 low-glycaemic load diet control diet
'erberis a(uifolium
• 1regon rape has been traditionally taken internally for acne,
• 2ecent pharmacological investigations sho- anti<inflammatory,
antimicrobial and antiseborrhoeic activities,
• Based on these pharmacological findings, a pilot study on the
topical use of 0ahonia for the treatment of acne -as conducted
.6ampert and co-orkers/,
• @ine male and female patients aged from 9: to ;K years -ith
mild or moderate acne -ere included in the trial, )atients applied
either a cream containing 9KI 0ahonia 989K tincture or the
corresponding base .placebo/ t-ice a day for L -eeks,
• Both groups sho-ed a decrease in the number of inflamed
lesions, but there -as a tendency to diminished sebum levels in the
0ahonia group,
• There -ere insufficient numbers in this pilot study to sho- a
significant therapeutic effect .if any e#ists/,
• 1ne area of concern is the -eakness of the preparation used,
-hich contained only 9I of dried herb e(uivalent of 0ahonia,
3n a controlled trial of 9F9 patients
• 'cne , both male and female, a minimum of three months4
treatment -ith %ite# resulted in an improvement for MKI of patients, a
result -hich -as significantly better than placebo,
• The mechanism for the beneficial effect of %ite# on ache is not
kno-n, but may be due to a mild anti<androgen effect,
Sample 2# for acne
)hytolacca decandra 98> >
'rctium lappa 9;: 9K
Berberis a(uifolium 989 :>
2ume# crispus 98; :>
Echinacea angustifolia 98: ;> Sig 9K ml bid
Topical lotion for acne
• Tea tree essential oil >
• Echinacea 9;: ;K
• Symphytum 9;; ;K
• 'loe vera gel ;> +se as lotion bid
Calendula infusion can be made up and cooled to use as a -ash,
2educe dairy and animal fat in the diet,
3ncrease fluids and essential fatty acids,
'cne keloid
• This results in scar<like tissue is more likely to be found
amongst people of 'fro<Caribbean background,
• Treat in a similar -ay to 'cne above 7 'loe vera and
Symphytum officinalis, Hydrocotyle asiatica,
Topical lotion for scars
• Tea tree essential oil >
• Eheatgerm oil 9>
• Comfrey infused oil or hydrocotyle oil ;K
Sig, 'pply sparingly bid
Acne rosacea .latin like roses/, not related to acne
• 3ncreased reactivity of facial capillairies to heat, leading to
flushing, telangiectasia,
• 0ight lead to rhinophyma, nose distorted due to infiltration -ith
fibrous and hyperplastic sebaceous glands,
• 0ore common in -omen, appearing in ;Ks
• aggravated by stress and heat
• can spontanously disappear
• many factors suspected; alcoholism, menopausal flushing,
vasomotor neurosis, seborrheic dithsis, local infection, B<vitamin
deficiency, gastrointestinal disorders
• migraine more common in sufferers,
- facial area -ith flushing of the nose;
circulatory component to this disorder,
poor digestion and?or liver sluggishness < also stress
poor liver function and e#cess alcohol intake
consider -hether there are food intolerances,
1rthodo# treatment usually involves oral antibiotics,
• Herbal treatment -ith Echinacea angustifolia, Baptisia tinctoria,
• Speculation that there is correlation bet-een the bacteria
Helicobacter pylori, for this berberine containing herbs could be
helpful; such as Berberis spp,, Hydrastis canadensis
• Hypochlorhydria .psychological factors reduce gastric acidity;
Bitters to improve digestive tone such as entiana lutea, Erythraea
• 'void heating circulatory stimulants; Circulatory herbs such as
Crataegus o#yacantha, %accinium myrtillus and 'esculus
hippocastanum can be used,
• B vitamins
• $ietary improvements may be needed to improve gut function
such as increased fibre and decreased processed foods,
• $airy produce should be avoided and fluids increased to assist
elimination, 'void; coffee, alcohol, hot drinks, spicy foods, avoid
refined foods and sugar, transfatty acids,
)soriasis& psor $*greek for itching, iasis* conition%
• Skin can become so thin that bleeding readily occurs,
• +se of steroids to control the problem makes the skin yet
• )atients often report that they have had some clear periods,
sometimes -hen on holiday < both sunlight and sea -ater seem to
• 1rthodo# treatment involves use of methotre#ate -hich is
cytoto#ic but also blocks uptake of B vitamins,
• 'll ages affected
• the earlier the onset, the more severe the disease
• abnormality of the cell kinetics of keratinocytes, these cells
produce keratin, a protein found in hair, nails and skin,
• @ormal cell cycle; ;99 hours for keratinocytes, immature skin
cell move from lo-est layer to the outermost layer, -here it -ill die
and flake off,
• )soriasis; cycle ;F hours, so :L times the normal production of
epidermal cells, Skin unable to shed rapidly enough to avoid
accumulation so thick, red, dry pla(ues, highlighted by silvery, flake
surface made of dead skin,
• "H positive
• many; physical trauma, acute infection, stressfull event prior to
• )sychological aspects; ' large number .;GI/ of patients -ith
psoriasis report a specific stressful event occurring -ithin 9 month
prior to their initial episode, Such patients have a better prognosis,
• )hysical trauma .Noebner4s phenomenon/ stimulates
proliferative process, 'cute streptococcal infection; guttate psoriasis,
• High number of helper T<cells in pla(ues .the T<cells mistake
the bodies proteins as foreign antigen/, )hagocytes are mobilised as
a conse(uence leading to the damage,
• 3nvolved; Cytokines .produced by activated phagocytes/; 21<
alpha, tumor necrosis factor .elevated in serum, synovial fluid and
pla(ues of patients -ith psoriasis and psoriatic arthritis/, interleukin L,
Neyfunction cytokines; to attract other phagocytes to injured area,
• @eutrophils; stimulate release arachidonic acid from cell
membrane and broken do-n into leukotrienes and prostaglandins
.playing a role in inflammatory process/
• )soriasis vulgaris; begin small, often enlarge forming pla(ues,
Silvery; easily removed resulting in pin<head blood droplets, )atches
on same areas, both side of the body, scalp, elbo-s, knees, lo-er
back, enerally follo-ing flare<remission pattern
• guttate psoriasis; erythematous small papules and pla(ues on
trunk, can be on face, scalp, Children and young adults, shortly after
viral of bacterial infection .usually streptococcal/, Can dissappear
after fe- -eeks,
• Seborrheic psoriasis; red scaly patches in scalp, behind ears,
armpits, groin, centre of face,
• @ail psoriasis; pitting, long ridges, yello-<bro-n under nail,
Digestive system
• Endoto#ins .lipopolysaccharides from cell -alls of gram
negative bacteria/; normally bile acids, split endoto#ins into nonto#ic
• endoto#ins .cell -all components of ram<negative bacteria/,
streptococcal products, Candida albicans, yeast compounds, and 3gE
and 3g' immune comple#e, lead to increases in cyclic 0) levels
-ithin skin cells, thereby increasing the rate of proliferation
dramatically, Endoto#ins high in blood stream of patients,
• Clinical improvement been found by binding endoto#ins in gut
• $eficiency in bile acids; hepatics
• ' diet lo- in dietary fiber is associated -ith increased levels of
gut<derived to#ins,
• "iber components bind bo-el to#ins and promote their
e#cretion in the feces .beans, fruits, and vegetables/,
• soluble fiber .psyllium, oats/ is acted on by the gut flora leading
to production of short chain fatty acids such as butyric acid, These
bind bacterial endoto#ins -ithin the bo-el,
"mila+ sarsaparilla
• in a 9G=: study found to be effective in psoriasis, particularly
the more chronic, large pla(ue<forming variety,
• controlled study of G: patients, sarsaparilla greatly improved
the psoriasis in F:I of the patients and resulted in complete
clearance in another 9LI .i,e, LKI of the subjects e#perienced
significant benefits/,
• This benefit is apparently due to sarsaparilla components
binding to and promoting the e#cretion of bacterial endoto#ins,
• Clinical severity as -ell as therapeutic response have been
sho-n to correlate -ell -ith the level of circulating endoto#ins
• common name OsarsaparillaO comes from the Spanish Osar!aO,
meaning a bramble and OparillaO meaning a small vine,
• Sarsaparilla -as first introduced by the Spanish in 9>F; as a
cure for syphilis, and by the late 9Gth century in the +S' it had
become a major ingredient of many home remedies and had the
largest sales of all the herbal drugs from Spanish 'merica,
• ' number of Smila# species from various parts of the -orld are
used medicinally,
• 3n -estern herbal medicine the root and rhi!ome of Smila#
ornata, S, regelii, S, febrifuga or S, medica .synonym8 S,
aristolochiaefolia/ are used, Sarsaparilla is regarded as
antirheumatic, depurative and antipruritic .relieves itching/, and is
recommended for arthritic conditions and skin conditions, especially
psoriasis -ith irritation and heavy des(uamation,
• uatemala ;Smila# regelii root has also been used traditionally
in for the treatment of skin diseases including abscess, boils and
• Central 'merica ; S, aristolochiaefolia and other species have
been used traditionally in for blood and skin disorders,
• Constituents; steroidal saponins .9<;I/, including
sarsasapogenin and smilagenin as aglycones as -ell asfurostanol
saponins .eg sarsaparilloside/,
• +ncontrolled trials reported in the mid<9GKKs -ith sarsaparilla
e#tracts indicated favourable results in psoriasis and as an adjuvant
in the treatment of leprosy, 3n many of these trials a lo-<fat diet and
ointments -ere also used and long<term use of Sarsaparilla .:7;
months/ -as re(uired,
• 3n one small, controlled trial, saponins from Sarsaparilla
produced greater improvement in psoriasis patients compared to
controls, Sarsaparilla saponins -ere best at clearing the chronic,
large, pla(ue type of lesion,
• 3ncomplete digestion of protein leads to elevated levels of
polyamines .cadaverine, prutescine,,,/ < to#ic metabolites of the
amino acids arginine and ornithine,
• The polyamine inhibit c'0) formation .lo- levels in patients
skin/, responsible for cell maturation, .c0) is responsible for cell
proliferation < high level found in patients skin/, 6o-ered skin and
urinary levels of polyamines are associated -ith clinical improvement
in psoriasis
• )olyamines are vasoactive, and associated -ith increased
intestinal permeability/,
• inhibit the formation of polyamines ; vitamin ' and the alkaloids
of Hydrastis canadensis .goldenseal/ such as berberine inhibit
bacterial decarbo#ylase, the en!yme -hich converts the amino acids
into polyamines,
• prevent the e#cessive formation of polyamines by promoting
proper digestion of the proteins, stimulated HC6, digestive en!ymes,
etc by using bitters,
'erberis a(uifolium $,ahonia a(uifolium% root
• used traditionally for chronic skin diseases including ec!ema
and psoriasis,
• mild cholagogue and la#ative, and anticatarrhal,
• The Eclectic physicians regarded it as specific for scaly,
pustular and other skin diseases due to the disordered condition of
the blood, 3t -as of benefit internally for acne, dandruff, dyspepsia
and conditions -ith liver involvement,
• @ative 'mericans; general debility and as a bitter tonic for
appetite loss,
• Studies topically; 0ahonia effects cellular cutaneous immune
mechanism and reduces hyperproliferation of keratinocytes in
patients -ith psoriasis,
• Constituents; alkaloids o#yberberine, corytuberine,
columbamine -hich are potent lipo#ygenase inhibitors, 6ipo#ygenase
is the en!yme involved in the production of inflammatory leukotrienes
• Berberine inhibits the en!yme that converts the aminoacids to
polyamines in the gut,
• 'lkaloids; solvent in high alcohol
• Berbenine; antidandruff, antibacterial, antihistamine,immuno<
stimulatory, liver stimulant
• berberine; immuno<stimulatory activity, antiinflammatory,
antifungal, antiulcer, antibacterial, liver stimulant
-iver function
• psoriasis has been linked to the presence of several microbial
by<products in the blood, 3f the liver is over-helmed by e#cessive
levels of these to#ins from the bo-el, or if there is a decrease in the
liver4s deto#ification ability, the systemic to#in level -ill increase and
the psoriasis -ill get -orse,
• 'lcohol consumption is kno-n to significantly -orsen psoriasis,
'lcohol has this effect since it both increases the absorption of to#ins
from the gut .by damaging the gut mucosa/ and impairs liver function,
• Carduus marianus; silymarin .flavonolignand/ inhibits formation
of prostaglandins, and inhibits c'0) phosphodiesterase .en!yme
responsible for break do-n of c'0),
.mega-/ fatty acis
• serum free fatty acid levels are typically abnormal in these
• 0ost of the clinical research has utili!ed fish oils rich in
eicosapentaenoic acid .E)'/ and docosohe#anoic acid .$H'/,
• Several double<blind clinical studies have demonstrated that
supplementing the diet -ith 9K79: g of fish oils .providing 9,L g E)'
and 9,: g $H'/ results in significant improvement, This amount of
E)' and $H' -ould be e(uivalent to the amount of E)' in about
9>K g of salmon, mackerel, or herring,
• the competition of E)' for arachidonic acid binding sites, -hich
results in the inhibition of the production of inflammatory compounds,
• 3n the skin of individuals -ith psoriasis, the production of
inflammatory leukotrienes from arachidonic acid is many times
greater than normal, 6eukotrienes are potent inflammatory agents
and promoters of guanylate cyclase activity, 3n the involved
epidermis, the cellular contents of free arachidonic acid and 9:<HETE
.a product of lipo#ygenase metabolism of arachidonic acid/ are :>K
and L9K times greater, respectively, than in uninvolved epidermal
• These elevations appear to be due to the presence in the
pla(ues of a yet<to<be<defined inhibitor of cycloo#ygenase, -hich
normally metaboli!es arachidonic acid to less inflammatory
• Trauma also induces the release of free arachidonic acid and
may account for the common clinical observation of pla(ues at the
sites of repeated trauma,
• increase in 9:<HETE stimulates the ><lipo#ygenase path-ay,
promoting leukotriene formation, This path-ay is inhibited by E)'
and glutathione pero#idase, suggesting that a selenium deficiency
may be a contributory factor cycloo#ygenase inhibitors .e,g, aspirin
and most other non<steroidal anti<inflammatory agents/ may
e#acerbate psoriasis, -hile lipo#ygenase inhibitors .e,g,
beno#aprofen/ may cause improvement,
• limit the intake of animal products, particularly animal fats and
dairy products,
Diet, fasting, an foo allergy control
• The evaluation of ;9F psoriasis patients -ith ;FF controls, both
groups being in the age range 9F7F> years, found that psoriasis -as
positively associated -ith body mass inde# and inversely related to
intake of carrots, tomatoes, fresh fruits, and the inde# of beta<
carotene intake,
• 2esearch at a S-edish hospital studying the effects of fasting
and vegetarian regimens on chronic inflammatory disease found that
such diets helped psoriatic patients,
• The improvement -as probably due to decreased levels of gut<
derived to#ins and polyamines, )atients have also benefited from
gluten<free and elimination diets,
"upplements& vit A, vit 0, 1inc, "elenium
• $ecreased levels of vitamin ' and !inc are common in patients
-ith psoriasis,
• psoriatics typically have increased serum levels of both insulin
and glucose,
• lutathione pero#idase .)/ levels are lo- in psoriatic patients,
possibly due to such factors as alcohol abuse, malnutrition, and the
e#cessive skin loss of the hyperproliferative disease, The depressed
levels of ) normali!e -ith oral selenium and vitamin E therapy,
• 'nother study compared 99; patients -ith moderate to severe
psoriasis had lo- serum concentrations in -hole blood selenium, The
lo-est -hole blood selenium values -ere found in the subgroup of
male patients -ith -idespread disease of long duration -ho also
re(uired treatment -ith methotre#ate and retinoids,
Vitamin D
• the active form of vitamin $ .9,:><dihydro#ycholecalciferol/ has
a role in controlling cellular proliferation and differentiation,
• 1ne controlled study found that :7> -eeks of topical 9,:><
dihydro#ycholecalciferol resulted in definite to total improvement in all
five patients treated,
• 'nother study by the same researchers, this one uncontrolled,
found that four of seven patients had complete remission .after 97;
months/ -ith daily oral doses of 9,K Pg of 9alpha.1H/$ ; ,
• )atients -ith severe psoriasis have also been found to have
significantly lo- serum levels of 9,:><dihydro#ycholecalciferol -hich
normali!ed after treatment -ith oral 9alpha.1H/$ ;
Caruus marianus
• Hepatoprotective, anti<inflammatory,
• "lavonolignans;
– inhibit formation of prostaglandins in vitro, Confirmed by in vivo
studies, orally and topically,
– 3nhibits c'0) phosphodiesterase, en!yme responsible for
breakdo-n of c'0)
#rifolium pratense
• "lavonoids,
• 3n the BHC specific for psoriasis, ec!ema and rashes,
Arctium lappa
• 'uthors of the 9Gth C spoke highly of it; Qin obstinate skin
diseases, this -ill sometimes bring about a cure -hen all other
means fail4 @apheys 9LM>/,
• BHC; burdock has long been considered to have diuretic,
diaphoretic actions, to stimulate hepato<biliary function and useful
internally or e#ternally in the treatment of skin diseases,
• inulin activates the 'C) .alternative complement path-ay/;
possibly result in restoration of bactericidal activity and increased
levels of c'0)
• 6eukocytes; decreased cyclic '0) levels due to increased
cyclic '0)<phosphodiesterase activity and a decreased level of
prostaglandin precursors -hich lead to an increased histamine
release and decreased bactericidal activity,
• defect in serum bactericidal activity, a reaction dependent on
the integrity of the alternate complement path-ay .'C)/,
• used in -estern herbal medicine for skin eruptions, especially
ec!ema in the dry and des(uamatory phase and psoriasis,
• The concept of cleansing is the dominant feature in the -estern
use of Burdock root, traditionally applied for scrofulous skin
conditions, septic disorders, boils and any chronic inflammatory state,
'mong modern practitioners Burdock has the reputation of being one
of the most active depuratives, and possibly precipitating a transient
to#aemia in congested and to#ic conditions if given in sufficient
• Ho-ever, the Eclectic physician E0 Cook found it to act slo-ly
and mildly upon the organs of elimination .kidneys, skin, bo-els/,
having a gentle depurative action of use in cutaneous and scrofulous
conditions, particularly -here there is irritation, Burdock -as used by
@ative 'mericans as a general tonic and blood purifier .depurative/,
2ume# crispus
• %alued in the 9Lth<9Gth C in +S' for skin disorders,
• Tonic and la#ative properties, mild cholagogue, 'ntibacterial
activity -hich may reduce bacterial overgro-th in the gut,
• constituents; anthra(uinone glycosides .chrysarobin; -hich has
been used topically for psoriasis, the synthetic version $ithranol had
several clinical trials/
• BHC; specific for skin diseases, especially psoriasis
accompanied by constipation,
• specifically indicated in British Herbal )harmacopoeia 9GL; for
skin disease, especially psoriasis -ith constipation,
• The Eclectic physicians; depurative, particularly useful to treat
Rbad blood -ith skin disorders ,,, acting decidedly upon the glandular
system, removing chronic lymphatic enlargements, and especially ,,,
a tendency to indolent ulcerations and lo- inflammatory depositsR,
• @ative 'mericans used 2ume# spp, as a blood purifier
• 3n modern herbal practice 5ello- $ock is applicable to the
treatment of systemic to#ic states of any sort -here the main trouble
is seen to lie in the bile<bo-el a#is, eg skin disease, arthritis, to#ic
degenerative conditions combined -ith liver and bo-el dysfunction,
#opical use "ymphytum officinalis
• 'ntiinflammatory -hen applied topically
• traditional reputation as vulnerary
#opically& Capsicum frutescens $cayenne pepper%
• Capsaicin is the active component of cayenne pepper
. Capsicum frutescens/, Ehen topically applied, capsaicin is kno-n to
stimulate and then block small<diameter pain fibers by depleting them
of the neurotransmitter substance ),
• Substance ) is thought to be the principal chemomediator of
pain impulses from the periphery, 3n addition, substance ), -hich is
elevated in the skin of psoriatics, has been sho-n to activate
inflammatory mediators in psoriasis,
• Eith repeated application analgesia occurs, though it may take
up to M: hours for substance ) to be completely depleted, 3t must be
repeatedly applied to the area to achieve the desensiti!ation of the
sensory neurons,
• Several clinical studies have found that the topical application
of K,K:> or K,KM>I capsaicin is effective in improving psoriasis,
• 3n one double<blind study, == patients -ith symmetrically
distributed psoriasis lesions applied topical capsaicin to one side of
their body and a placebo to the other side, 'fter ;7F -eeks,
significantly greater reductions in scaling and redness -ere observed
on the capsaicin side, Burning, stinging, itching, and skin redness
-ere noted by nearly half of the patients initially, but this diminished
or vanished upon continued application,
• Capsaicin has been found to be effective for the relieve of
itching and improvement in psoriasis severity scores by a number of
systematic revie-s .Hautkappe 9GGL, &hang 9GG=/
• Study; patients applied capsaicin K,K:>I cream .nJ GL/ or
vehicle alone .n J GG/ four times a day for F -eeks, Efficacy -as
based on a physician4s global evaluation and a combined psoriasis
severity score including scaling, thickness, erythema, and pruritus,
Capsaicin<treated patients demonstrated significantly greater
improvement in global evaluation and in pruritus relief, as -ell as a
significantly greater reduction in combined psoriasis severity scores,
#opically Aloe vera
• .Syed et al 9GGF/double<blind, placebo<controlled study found
that topical application of an 'loe vera e#tract in a hydrophilic cream
-as highly effective in psoriasis vulgaris,
• Si#ty patients -ith slight to moderate chronic pla(ue<type
psoriasis, )'S3 .psoriasis area and severity inde#/ scores of bet-een
=,L and 9F,M .mean G,;/, and mean duration of the disease of L,>
years .range 97:9/ applied either the aloe or a placebo gel three
times a day,
• The treatment -as -ell tolerated by all the patients, -ith no
adverse drug<related symptoms and no drop<outs, By the end of the
study .=79: months of treatment/, the 'loe vera e#tract cream had
cured :>?;K patients .L;,;I/ compared -ith the placebo cure rate of
only :?;K .F,FI/, resulting in significant clearing of the psoriatic
pla(ues .;:L?;GF .L:,LI/ vs, placebo :L?;FF .M,MI/, and a
decreased )'S3 score to a mean of :,:,
• Biopsy analysis; reduction in levels of inflammatory infiltration,
vessel dilation, parakeratosis in the healed lesions of the aloe group,
2ervines, aaptogens
• -ithania somnifera ; has also glucocorticoid<like anti<
inflammatory activity -ith mild sedative properties,
• glycyrhi!a glabra .slo-ing do-n conversion of cortisol to the
inactive steroid cortisone, via inhibition of 99<beta<hydro#ysteroid
dehydrogenase .glycyrrhetinic acid/,
• ' common complaint, characteristically presenting -ith itching
and erythematous rashes in fle#ures and on other parts of the body
such as the face and neck,
• )atches may -eep and crust over, the skin can become scaly
and fissured,
• Secondary infections resulting from scratching are fre(uently
found, 3n atopic ec!ema children are mainly affected and hereditary
factors, food allergies and diet are implicated,
• Chronic, pruritic, inflammatory skin condition
• Skin is dry and hyperkeratotic
• 6esions include e#coriations, papules, ec!ema .patches of
erythema, e#udation, and scaling -ith small vesicles formed -ithin
the epidermis/, and lichenification .hyperpigmented pla(ues of
thickened skin -ith accentuated furro-s/
• cratching and rubbing lead to lichenification, most commonly in
the antecubital and popliteal fle#ures
• )ersonal or family history of atopy,
• prevalence of :,=7MI of the population,
• Current research indicates that atopic dermatitis is, at least
partially, an immediate hypersensitivity disease8
• serum 3gE is elevated in LKI of patients
• there is a positive family history in t-o<thirds of ec!ema patients
• many eventually develop allergic rhinitis and?or asthma
• most improve -ith an elimination diet,
• The major abnormalities .-ith possible mechanism/ are8
– a lo-ered threshold to itch stimuli .substance ) e#cessB/
– hypersensitivity to alpha<adrenergic agonists and cholinergic
agents -hich may be due to a partial beta<adrenergic blockade
.receptor site insensitivity/
– dry, hyperkeratotic skin, -hich has decreased -ater<holding
capacity .dry 7 !inc or thyroid deficiency; hyperkeratotic 7 vitamin '
– a marked tendency to lichenify in response to rubbing and
scratching .membrane fragilityB/
– a tendency of the skin to be heavily coloni!ed by bacteria,
especially coagulase<positive Staphylococcus aureus .immune
– 1ther aspects of possible significance are $ennie4s sign .an
accentuated double pleat belo- the margin of the lo-er eyelid/ and a
tendency to-ards vasoconstriction -hich can be provoked by
physical pressure .also called -hite dermatographism
– 3mmunological abnormalities;
• 6eukocytes; decreased cyclic '0) levels due to
increased cyclic '0)<phosphodiesterase activity and a
decreased level of prostaglandin precursors <D increased
histamine release and decreased bactericidal activity,
• defect in serum bactericidal activity, a reaction dependent
on the integrity of the alternate complement path-ay .'C)/,
• inulin activates the 'C); possibly result in restoration of
bactericidal activity and increased levels of c'0) .'rctium
lappa, Tara#acum officinale/,
• defects in immune function plus scratching and the
predominance of pathogenic Staphylococcus aureus in the
skin flora in GKI of patients -ith atopic dermatitis
<Dsusceptibility to Staphylococcus infections,
• cell<mediated immunity defects -hich lead to increased
susceptibility to cutaneous herpes simple#, vaccinia,
molluscum contagiosum, and verruca vulgaris infections,
• 2educed delayed<type hypersensitivity, cutaneous
anergy, and a decrease in vitro lymphocyte reactivity to
mitogens and antigens,
• These cell<mediated defects normali!e during clinical
remission and become abnormal again during recurrences of
the dermatitis,
4oo allergy
• breast feeding offers prophyla#is against atopic dermatitis .as
-ell as allergies in general/,
• 3f infants -ho are breast fed develop atopic dermatitis; transfer
of allergic antigens in the breast milk .mothers should avoid the
common food allergens .especially milk, eggs, and peanuts, and to a
lesser e#tent, fish, soy, -heat, citrus, and chocolate/,
• 3n older or formula<fed infants, milk, eggs, and peanuts appear
to be the most common food allergen, Ho-ever any food can be the
offending agent,
• elimination diet and challenge method, elimination of milk
products, eggs, peanuts, tomatoes, and artificial colors and
preservatives results in significant improvement in at least M>I of
• Sleaky gutT; increased gut permeability <D increased antigen
load on the immune system <Dover-helms the immune system,
increasing the likelihood of developing additional allergies,
• Elimination of allergenic foods appears to stop the development
of ne- allergies,
• if they can avoid offending foods for a period of up to 9 year 7 in
many cases they -ill SloseT or Soutgro-T their allergy,
• 6oss rate of food allergy in patients -ith atopic dermatitis after 9
year -as :FI for the five major allergens .egg, milk, -heat, soy, and
peanut/ and FFI for other food allergies,
0ssential fatty acis an prostaglanin metabolism
• )atients -ith atopic dermatitis appear to have altered essential
fatty acid .E"'/ and prostaglandin metabolism,
• "or e#ample, several analyses of fatty acids in plasma red
blood cells, and monocytes in patients -ith atopic dermatitis
demonstrated a tendency for linoleic acid levels to be increased -hile
longer<chain polyunsaturated fatty acids such as gamma<linolenic
acid, arachidonic acid, and the long<chain omega<; oils,
eicosapentaenoic acid .E)'/ and docosahe#anoic acid .$H'/, tend
to be relatively lo-,
• the ratio of omega<; to omega<F fatty acids -as significantly
lo-er in patients -ith atopic dermatitis,,
• $ietary enrichment -ith Sfish oilT supplements providing E)'
and $H' or simply eating more fatty fish .e,g, mackerel, herring, and
salmon/ results in significant incorporation of omega<; fatty acids into
the membrane phospholipid pools,
• fla#seed oil, -hich contains alpha<linolenic acid, the precursor
omega<; fatty acid, may provide some benefit to patients -ith atopic
dermatitis, since the degree of clinical improvement correlates -ith
the increase in the concentration of $H' in serum phospholipids, fish
oils tend to be more effective in raising $H' levels than fla#seed oil,
5nhibition of e+cess histamine release
• agents -hich stimulate c'0) production and?or inhibit c'0)
phosphodiesterase reduce the inflammatory process in atopic
dermatitis by reducing the shunting to histamine,
• ' number of flavonoids also inhibit c'0) phosphodiesterase,
-ith ma#imal activity from the flavonols (uercetin and hyperoside, the
flavones orientin and vite#in, and the flavanone naringen,
• "lavonoid e#tracts from %accinium myrtillus, 2osa damascena,
2uta graveolens, )runus spinosa and Crataegus pentagyna -ere the
most potent inhibitors, according to one study, These flavonoids are
also potent inhibitors of mast cell degranulation,
• "lavonoid<rich; green tea, or inkgo biloba .contains several
uni(ue terpene molecules kno-n collectively as ginkgolides that
antagoni!e platelet<activating factor .)'"/, a key chemical mediator
in atopic dermatitis, )'" plays a central role in many inflammatory
and allergic processes, including neutrophil activation, increasing
vascular permeability, smooth muscle contraction in<cluding
bronchoconstriction, and reduction in coronary blood flo-,
inkgolides compete -ith )'" for binding sites and inhibit the
various events induced by )'",
• studies have indicated that mi#tures of ginkgolides .B@ >:KF;/
as -ell as the inkgo biloba e#tract standardi!ed to contain :=I
ginkgo flavonglycosides and FI terpenoid are capable of
demonstrating clinically significant anti<allergy effects,
• 'pproach to treatment may be multifactorial, 'nti<allergenic
herbs such as +rtica dioica and Chamomilla recutita should be used,
$eto#ification -ith Tara#acum officinale, Berberis a(uifolium and
other bitter herbs,
• Support for the immune system -ith Echinacea angustifolia, 3n
addition provide support for the nervous system using herbs such as
)assiflora incarnata, Scutellaria laterifolia, etc,
Sample 2# for Ec!ema
• Chamomilla recutita :K
• %iola tricolor :K
• Echinacea angustifolia :K
• Tara#acum officinale :K
• +rtica dioica :K
$ietary advice; avoidance of potential allergens such as dairy
'voidance of salt and red meat,
3ntake of !inc and magnesium is important for metabolism of
essential fatty acids,
Supplementation -ith these minerals and E"'s,
Varicose ec3ema an ulcers
• +sually seen in the front of the lo-er legs
• Skin becomes thinner, shiny, hairless and itchy,
• Slight damage produces local lesions
• 3nflammation, if untreated, may lead to varicose ulcers -ith
tissue breakdo-n and necrosis,
• Can be very slo- in healing and re(uire regular replacement of
• +nderlying problem is one of poor circulation -hich results in a
lack of nutrients and o#ygen for tissue repair and local stasis,
• 3mprove venous circulation -ith capillary astringents such as
'esculus hippocastanum, %accinium myrtillus and peripheral
vasodilators such as Crataegus o#yacantha and inkgo biloba, 'lso
use anti<thrombotic herbs such as 'ngelica spp, 'chillea millefolium,
&ingiber officinale,
• The local area can be cleansed -ith Calendula infusion plus a
fe- drops of Tea Tree or 2osemary essential oil, 3f appropriate the
ulcer can be packed -ith a Symphytum officinalis or +lmus fulva
poultice -ith daily change of dressing,
• 1ther measures should be taken to improve circulation such as
raising leg, -iggling toes to encourage muscular compression of
veins, hot and cold compresses etc, $iet should concentrate on
vitamins and minerals to encourage -ound healing and circulation
especially vitamins ', C, E and !inc
6otu 7ola $Centella asiatica%
• otu kola has a long history of use, dating back to ancient
Chinese and 'yurvedic medicine, Traditionally, gotu kola has been
thought of as an agent that aids the liver, 'yurveda regards gotu kola
as an important rejuvenating herb for nerve and brain cells, capable
of increasing intelligence, longevity, and memory,
• otu kola is mentioned in the Shennong Herbal, compiled in
China roughly :,KKK years ago, and it has been -idely used
medicinally since 9MKK '$,
• 0auritius since 9L>:; used to treat leprosy,
• )hilippines; treat -ounds and gonorrhea,
• China; treat fever and respiratory infections,
• Sri 6anka, the Singhalese noted that elephants often consumed
the gotu kola plant, and given the longevity of elephants, proposed
that the plant may hold health benefits for humans, Thus, the
Sinhalese proverb8 Rt-o leaves a day keeps old age a-ay,R
• 3n 'yurvedic medicine, gotu kola is said to develop the cro-n
chakra, the energy center at the top of the head, and to balance the
right and left hemispheres of the brain, 3t has traditionally been used
by yogis as a food for meditation,
• 3ncorporated into the 3ndian )harmacopoeia in the 9Gth Century
and vie-ed as a rejuvenating herb,
• The "rench accepted it as a drug in the 9LLKs, 'siaticoside,
-as first isolated and purified in 9G=K, and systemic clinical studies
-ith gotu kola began in 9G=>,
• 'fter Eorld Ear 33, gotu kola -as included in an herb tea blend
called "o<Ti<Teng, -hich claimed to boost longevity because the
ancient Chinese herbalist, 6i Ching 5un, had used it regularly .and
lived for a reported :>F years/,
• Traditionally used in many countries, all referring to the
traditional uses is in skin disorders
• European scientists investigate the effects of the compounds
.phytochemicals/ in this herb on healing and the skin,
• 'ctive components, accounting for 9<LI of the constituents,
include asiatic acid, madecassic acid, asiaticoside, asiaticoside ',
and asiaticoside B .FG/,
• The leaves of Centella asiatica have also contain 9MKmg
calcium, ;Kmg phosphorous, ;,9mg iron, =9=mg potassium, F,>Lmg
beta<carotene, K,9>mg thiamine, K,9=mg riboflavin, 9,:mg niacin, and
=mg asorbic acid .FG/,
• 'ntio#idant effects8 'siaticoside derivatives, including asiatic
acid and asiaticoside, -ere sho-n to reduce hydrogen pero#ide<
induced cell death, decrease free radical concentrations, and inhibit
beta amyloid cell death in vitro, suggesting a possible role in the
treatment and prevention of 'l!heimerOs disease and beta amyloid
• 3n vivo; 'nti<gastric ulcer activity, inhibited gastric ulceration
induced by cold and resistant stress,
• 3n vivo; The titrated e#tract of Centella asiatica .TEC'/ has
been sho-n to have protective and therapeutic effects on gastric
mucosal damage in rats ,
• "resh juice; protective activity against gastric ulcers induced by
ethanol, aspirin, cold<restraint stress, and pyloric ligation , The higher
dose resulted in significantly increased mucin secretion and mucous
formation, -hile significantly decreasing cell shedding,
• 3n vivo; 'nti<inflammatory effects8 sho-n to decrease the
severity of radiation<induced dermatitis vs, control ,
• 3n vivo; 'nti<fertility effects8 'nimal study sho-s a consistent
reduction of fertility in female mice
• 3n vitro; Centella asiatica e#tract and asiaticoside are active
against herpes simple# virus,
• 3n vivo; Eound healing activity in many e#perimental models
.by injection, oral and topical administration/, The mechanism of
action includes the stimulation of maturation of the scar by the
production of type 3 collagen .hence collagen synthesis/ and a
resulting decrease in the inflammatory reaction,
• The constituents also stimulate glycosaminoglycan production
.glycosaminoglycans are the first component of the e#tracellular
matri# to be synthesised during the -ound healing process/, and act
specifically to shorten the immediate phase of healing,
• '(ueous e#tract, gel formulation, promoted healing in
e#perimental open -ounds,
• 1ral and topical administration of otu Nola e#tract produced
faster skin gro-th and a higher rate of -ound contraction compared
to controls,
• 3n vivo; Eound?burn healing effects8 3ncreased cellular
proliferation and collagen synthesis -as observed at -ound sites
after treatment -ith topical or oral e#tract of Centella asiatica in vivo,
'n animal study found that application of topical Centella asiatica
e#tract three times daily for := days to open -ounds resulted in
increased collagen content and tensile strength
• promotes healing -hen taken orally, suggesting that the healing
potential of otu Nola is not just confined to the skin but also
promotes healing in any tissue8 skin, bones or other organs,
• 3n vivo; 'ntineoplastic effects,
• 3n vivo; @europrotective effects, The researchers concluded
that this activity can be e#plored in epilepsy, stroke and other
degenerative conditions in -hich the role of glutamate is kno-n to
play vital role in the pathogenesis ,
• 3n vivo; an#iolytic properties of gotu kola
• 3n vivo; glucosides of Centella asiatica may prevent
dimethylnitrosamine<induced liver fibrosis in rats,
• 3n vitro; Histological studies using an e#tract of Centella asiatica
sho- promise in treating chronic hepatic disorders,
Clinical stuies&
• 'n#iolytic properties 8 Brad-ejn et al, performed a double<blind,
placebo controlled trial to study the effects of gotu kola on acoustic
startle response .'S2/, a validated instrument used to measure
levels of an#iety, 't ;K and FK minutes after intervention, subjects
-ho consumed 9:g dose of gotu kola e#perienced a significant
decrease in their 'S2, suggesting the possible ability of gotu kola to
decrease an#iety, mechanism of action remains unclear,
• Cardiovascular effects8 to stabili!e carotid pla(ues , gotu kola
regulated and modulated collagen production over the 9:<month
study period,
• Hepatic effects8 ' randomi!ed controlled trial sho-ed that a
combination product . Bacopa monneria, ingko biloba, catOs cla-,
gotu kola, rosemary/ may be an effective adjunct treatment for
patients -ith liver cirrhosis,
• %ascular effects 8 ' controlled study in :9 subjects -ith
postphlebitic limbs or lymphedema reports that daily causes a
significant decrease in both the lymphatic?plasma protein
concentration ratio and distal edema, reduce ankle edema, foot
s-elling, and capillary filtration rate, as -ell as to improve
microcirulatory parameters .including resting flu#, venoarteriolar
response, )1:, )C1:/ in subjects -ith reported venous insufficiency
of the lo-er e#tremities, reported to decrease venous distensibility
inde#, reduce venous congestion, and reduce supine venous
pressure after eight months in subjects -ith venous insufficiency,
deep vein thrombosis, or perimalleolar leg ulcers,
• oral administration of the triterpenes from otu Nola has been
successfully used to treat keloids and hypertrophic scars, 3n a study
of ::M patients, treatment -ith otu Nola actives for a period of : to
9L months had therapeutic value in both preventing and reducing
keloids .e#cessive scar formation on the skin/,
• Benefit has also been recorded in uncontrolled trials for the
treatment of gastric and duodenal ulcers .the triterpenes from otu
Nola, oral/ gastritis .asiaticoside,oral/ and bladder lesions caused by
infection .the triterpenes from otu Nola, injection/,
• )ositive results -ere obtained for oral use of the triterpenes
from otu Nola taken for ; to L -eeks in >K patients -ith leg ulcers,
• Topical application of otu Nola to the skin has been
successfully used in controlled and uncontrolled clinical trials to treat
a -ide variety of problems including8 varicose veins, chronic venous
insufficiency, psoriasis ,leg ulcers, soiled -ounds resistant to other
treatment, burns, and cellulitis,
• 0ultiple small European trials suggest that the total triterpenoid
fraction of Centella asiatica .TT"C'/ may have small to moderate
benefits on objective and subjective parameters associated -ith
chronic venous insufficiency,
• 'siaticoside derivatives, including asiatic acid and asiaticoside ,
-ere sho-n to reduce hydrogen pero#ide<induced cell death,
decrease free radical concentrations, and inhibit beta amyloid cell
death in vitro, suggesting a possible role for gotu kola in the treatment
and prevention of 'l!heimerOs disease and beta amyloid to#icity
• Studies have suggested beneficial effects of the total
triterpenoid fraction of Centella asiatica .TT"C'/ on subjective and
objective parameters of venous insufficiency of the lo-er e#tremities,
Based on these observations, it has been postulated that there could
be a role for gotu kola in the treatment of vascular disease associated
-ith diabetes,
• initial controlled trials have found oral gotu kola .TT"C', FKmg
t-ice daily/ to have statistically significant beneficial effects on
microcirculatory parameters in patients -ith diabetic microangiopathy,
This ensures the correct dose of the clinically<proven triterpenes,
6o-er doses of -eaker products are unlikely to be effective,
"eborrhoeaic ec3ema/ermatitis
' red, greasy, scaly rash 7 mildly irritating 7 usually on the face or
scalp around the nose, chin, forehead or hairline, 'lso can be found
on the chest, under breasts, in armpits and groin, Seasonal, -orse in
• 0ay be associated -ith a poor diet and %itamin B deficiencies,
• Treat in a similar -ay to ec!ema -ith the addition of a strong
vitamin B comple# supplement,
• Seborrheic dermatitis is a common papulos(uamous condition
-ith an appearance similar to ec!ema, Clinically it may be associated
-ith e#cessive oiliness .seborrhea/ and dandruff, The scale may be
yello-ish and either dry or greasy,
• "le#ural involvement is often complicated -ith Candida
infection, The condition occurs either in infancy .usually bet-een :
and 9: -eeks of age/ or in the middle<aged or elderly and has a
prognosis of lifelong recurrence,
• +nkno-n, but enetic predisposition, emotional stress, diet,
hormones, and infection -ith yeast<like organisms have all been
• no- recogni!ed as one of the most common manifestations of
'3$S, affecting as many as L;I, This recent observation has given
increased credence to the infection theory of seborrheic dermatitis,
• "ood allergy
• Seborrheic dermatitis usually begins as Scradle capT and,
although not primarily an allergic disease, has been associated -ith
food allergy .FMI develop some form of allergy by 9K years of age/,
• The underlying factor in infants appears to be a biotin
deficiency, ' syndrome clinically similar to seborrheic dermatitis has
been produced by feeding rats a diet high in ra- egg -hite .high in
avidin, a glycoprotein that binds biotin, making it unavailable for
absorption/, 6arge portion of the human biotin supply is provided by
intestinal bacteria, it has been postulated that the absence of normal
intestinal flora may be responsible for biotin deficiency in infants,
• ' number of articles have demonstrated successful treatment
of seborrheic dermatitis -ith biotin in both the nursing mother and the
• 3n adults, biotin alone is usually of no value, )ossibly long<chain
fatty acid synthesis is impaired in seborrheic lesions, B vitamins
.biotin, pyrido#ine, pantothenic acid, niacin, and thiamin and the
lipotropics/ are vital for fatty acid metabolism,
• 3n the sicca form of the disorder .involvement of the scalp 7
dandruff 7 bro-, nasolabial folds, and bearded area -ith varying
degrees of greasy adherent scales on an erythematous base/, all
patients cleared completely -ithin 9K days -ith local application of a
-ater<soluble ointment containing >K mg?g of pyrido#ine, 1ther types
of seborrheic dermatitis, particularly fle#ural and infected, did not
• checked for e#posure to pyrido#ine antimetabolites, E,g,
Hydra!ine dyes ."$UC yello- V>/ and drugs .3@H and hydrala!ine/,
dopamine, penicillamine, oral contraceptives, and e#cessive protein
4olic aci
• 1ral treatment -ith folic acid has been only moderately
• )arenteral injections of vitamin B9: , both synthetic and liver<
e#tracted, have been sho-n to be very effective in many cases,
)ossibly due to B9: 4s role as a cofactor .-ith choline/ in ><methyl<
tetrahydro folate methyltransferase, -hich regenerates
tetrahydrofolate, 3t has been hypothesi!ed that folate becomes
trapped as ><methyltetrahydrofolate by a lack of B 9: and?or choline,
• 1ther B vitamins have also been sho-n to be involved in
seborrheic dermatitis; e#perimentally induced ariboflavinosis
produces the sicca form of the disorder,
• alleviation of the biotin deficiency and control of the food
• "or adults, correcting the impaired long<chain fatty acid
synthesis by supplementing -ith large doses of vitamin B comple# is
the primary therapy,
• 'lteratives, bitters, and liver herbs,
• Topically use antifungals,
9rticaria $hives%
• +rticaria is locali!ed pruritic edema of the skin, 6imited to the
superficial portion of the dermis,
• 'bout >KI of patients develop angioedema 7 similar eruptions
to urticaria, but -ith larger -ell<demarcated edematous areas that
involve subcutaneous structures as -ell as the dermis,
• recurrent episodes of urticaria and?or angioedema of less than
F -eeks4 duration are considered acute, other -ise chronic,
• 9>7:KI of the general population has had hives at some time,
• young adults .post<adolescence through the third decade of life/
are the most often affected,
• release of inflammatory mediators from mast cells or basophilic
leukocytes as a result of 3gE7antigen comple#es interacting -ith
these cells, and or other mechanisms,
• The early vascular changes appear to be the result of mast cell<
dependent vasoactive mediators, particularly histamine and some
secondarily generated end<products of arachidonic acid metabolism,
The -heal and flare reactions occur -ithin minutes of initiation and
last ;K7FK minutes,
• The more prolonged, and delayed, reactions reflect leukocytic
infiltration in response to the release of mast cell granule<derived
chemotactic factors, These late<phase reactions develop over time
and are characteri!ed by erythema, edema, and induration beginning
-ithin : hours and lasting 9:7:= hours,
• )hysical;
• dermographic urticaria; pressure are applied, may be
associated -ith other diseases . parasitosis, insect bites,
neuropsychiatric disorders, hormonal changes, thyroid disorders,
pregnancy, menopause, diabetes, immunological alterations, other
urticarias, during or follo-ing drug therapy, Candida albicans,
• Cholinergic urticaria; passive overheating, physical e#ercise,
and emotional stress,,' variety of systemic symptoms ; Headache,
periorbital edema, lacrimation, and burning of the eyes are common
symptoms, 6ess fre(uent symptoms include nausea, vomiting,
abdominal cramps, diarrhea, di!!iness, hypotension, and asthmatic
• Cold urticaria Eidespread local e#posure and generali!ed
urticaria can be accompanied by8 flushing,headaches,chills,di!!iness,
tachycardia, abdominal pain, nausea, vomiting, muscle pain,
shortness of breath, -hee!ing, unconsciousness,,accompany a
variety of clinical conditions including8 viral infections, parasitic
infestations, syphilis, multiple insect bites, penicillin injections, dietary
changes, stress, The association of cold urticaria -ith infectious
mononucleosis, 1ther conditions asso<ciated -ith cold urticaria
include cryoglobulinemia and myeloma -here cold urticaria may
precede the diagnosis by several years,
• $rugs are the leading cause of urticaria reactions in adults,
• 3n children; foods, food additives, or infections,
• 3nfections; a major cause of urticaria in children, 'pparently in
adults immunological tolerance occurs to many microorganisms due
to repeated massive antigen e#posure, Chronic Trichomonas
infections have also been found to cause urticaria,
• Bacteria; acute streptococcal tonsillitis in children, and in
chronic dental infections in adults,
• %iruses Hepatitis B is the most fre(uent cause of viral<induced
urticaria, infectious mononucleosis and may develop several -eeks
before clinical manifestation,
• "ungal; Candida albicans is an important factor in at least :>I
of patients -ith chronic urticaria, 0ore patients responded to a
Syeast<freeT diet than to simple elimination of the organism, The
yeast<free diet employed e#cluded bread, buns, sausage, -ine, beer,
cider, grapes, sultanas, marmite, bovril, vinegar, tomato, ketchup,
pickles, and prepared foods containing food yeasts,
• )sychological aspects
• 3n one retrospective study involving :;F cases of chronic
urticaria, psychological factors, i,e, stress, -ere reported to be the
most fre(uent primary cause, Stress appears to play an important
role by decreasing intestinal secretory 3g' levels,
• +ltraviolet light therapy; some benefit to patients -ith chronic
urticaria, -ith cold, cholinergic, and dermographic urticaria display the
greatest therapeutic response, $aily sunbathing for 9>7:K minutes or
the use of a +%' solarium, especially in chronic physical urticaria, is
• Thyroid; 1ne study reported that thyroid hormone replacement
therapy dramatically improved chronic urticaria in patients -ho had
normal thyroid function but had evidence of thyroid autoimmunity
• %itamin B9: ;some value in the treatment of acute and chronic
• $iet
• Those foods most commonly associated -ith inducing urticaria
.i,e, milk, eggs, chicken, fruits, nuts, and additives/ should definitely
be avoided,
• "oods containing vasoactive amines should be eliminated
even if no direct allergy to them is noted, The primary foods to
eliminate are cured meat, alcoholic beverages, cheese, chocolate,
citrus fruits, and shellfish,
• The importance of eliminating food additives cannot be
overstated, 3f food additives do in fact increase the number of
perivascular mast cells in the skin, they may also do the same in the
small intestine, thereby greatly increasing the risk of developing a
SleakyT gut,
• 'lso of value is control of arachidonic acid<dependent
prostaglandins through the use of a lo- animal fat diet,
+rtica dioica folia
• Traditionally a blood purifier, styptic, stimulating tonic, diuretic
and Eclectics used the leaf and root for diarrhoea, dysentery,
discharges, chronic diseases of of the colon, and chronic skin
• ' syrup of leaf or root used to relieve bronchial and asthmatic
• @ettle infusion and specific tincture used topically for
nosebleed, burns, gargle and hairlotion,
• Beating of nettle leaves; arthritis, chronic rheumatism, loss of
muscular po-er,
• )oultice to relieve gout, sciatica, joint pain,
• 1rally; ec!ema, skin rashes, nettle rash,
• Seeds; consumption, goitre
• "lavonol glycosides, sterols, scopoletin .flo-ers/, chorophyll,
carotenoids, vitamins .C,B,N/ XN might be responsible for
haemostyptic actionsW, minerals, plant phenolic acids,
• Stining hairs; silicon, amines, including histamine, serotonin,
+rtica dioica .folia/
• 3n vitro; 'ntiinflammatory action; inhibiton of cyclo o#ygenase
and ><lipo#ygenase<derived reactions,
• 3n health volunteers; nettle leaf reduced release of cytokines in
a lipopolysaccharide stimulation .6)S/ and stimulated the secretion of
interleukin<F .-hich acts antagonistically to interleukin<9<beta in
decreasing prostaglandin E: synthesis and induces inhibitors of
proteinases .3,e, antiinflammatory/, the active constituents not
• Healthy volunteers; decreased release of T@"<alpha and 36<9<
Beta produced by activated monocytes?macrophages, these cytokins
perpetuate the inflammatory destructionof cartilage and bone, By
inhibiting these slo- do-n progression of these diseases,
randomi!ed, double<blind study of free!e<dried +rtica dioica in the
treatment of allergic rhinitis
• @inety<eight patients -ere randomi!ed to receive capsules
containing either ;KKmg of free!e<dried nettle or a similar amount of
colored lactose for seven days,
• "or one -eek, patients -ere instructed to take t-o capsules at
the onset of symptoms and to record their response to the medication
-ithin one hour, as dramatic improvement, moderate improvement,
no change or -orse, )atients also recorded the total number of doses
taken during the -eek, their overall evaluation of the severity of
symptoms and a global evaluation of the medication, T-enty patients
.F=,>I/ in the nettle group reported a dramatic or moderate
improvement more than >KI of the time compared to 9; .;=,:I/ of
patients in the placebo group, Eighteen .>LI/ nettle patients rated
the medication as moderately or highly effective compared to 9=
.;MI/ of placebo patients, Side effects -ere reported in five patients
in the placebo group and seven patients in the nettle group, The
majority of patients e#perienced mild gastric discomfort -hen the
medication -as taken on an empty stomach,
• @ettle is -idely used as a folk remedy to treat arthritic and
rheumatic conditions throughout Europe and in 'ustralia,
• )reclinical evidence suggests that certain constituents in the
nettle plant have anti<inflammatory and?or immunomodulatory activity,
• an open, e(uivalence trial comparing diclofenac >Kmg plus
ste-ed stinging nettles .$>KY+/ to diclofenac :KKmg .$:KK/ in the
treatment of an acute attack of chronic joint diseases .::/,
• The primary outcome measure -as improvement in elevated C<
reactive protein .C2)/, The median C2) concentration decreased to
FLI of baseline level in the diclofenac :KKmg group and to M9I in
the diclofenac >Kmg plus nettle group .pJK,;=/, $iclofenac >Kmg -ith
>Kg of ste-ed +rtica dioica produced an effect on C2) and clinical
symptoms of acute arthritis similar to diclofenac :KKmg,
• 'uthors concluded nettle enhanced activity of @S'3$,
• Case report; 1steoarthritis; counterirritation -ith fresh nettle
leaves produced remarkeble improvement and reduction in pain,
• 1pen pilot study; nettle leaf achieved reduction of @S'3$ of
>KI by using 9,; g of a F<L89 e#tract,
• erman study found that intake of nettle and dandelion juices
improved skin
• parameters in healthy -omen, Both active and control groups
used a moisturising cream, but only the active group took the herbal
juices, Skin hydration improved significantly after F -eeks in the
e#perimental group .pCK,K>/, Elasticity -as significantly improved
compared to controls, 'fter F -eeks of treatment, volunteers in the
active group rated their skin condition as significantly improved,
-hereas there -as little change for the control group
• rich source of Si, 0uch of this Si occurs in the stinging hairs
-hich are effectively fine silica glass needles, The Si in +rtica is more
rapidly e#tracted than E(uisetum, ' 989KK decoction of the dried
leaves simmered for ;K minutes yields about > mg of soluble Si for
every 9 g of +rtica used .)iekos, 2 and )asla-aska, S8 )lanta 0ed
;K, ;;9<F, 9GMF/, This is only about half as much Si as that obtained
from the same (uantity of E(uisetum decocted for ; hours, Therefore
+rtica leaf decoction is a more convenient -ay of obtaining
absorbable Si,
3n vitro and in vivo antiallergic effects of lycyrrhi!a glabra and its
components, )lanta 0ed, :KKM 0ar;M;.;/8:>M<F9, Epub :KKM "eb
Shin 5E et al
• 6icorice .lycyrrhi!a glabra 6,, 6eguminosae/ is fre(uently used
in traditional medicine to treat inflammatory and allergic diseases, 3n
this study, the main components .glycyrrhi!in, 9Lbeta<glycyrrhetinic
acid, isoli(uiritin, and li(uiritigenin/ -ere isolated from licorice, and
their anti<allergic effects, such as antiscratching behavior and 3gE
production<inhibitory activity, -ere evaluated both in vitro and in vivo,
• 6i(uiritigenin and 9Lbeta<glycyrrhetinic acid most potently
inhibited the degranulation of 2B6<:H; cells induced by 3gE -ith the
antigen .$@)<HS'/ and rat peritoneal mast cells induced by
compound =L?LK,
• 6i(uiritigenin and 9Lbeta<glycyrrhetinic acid potently inhibited
the passive cutaneous anaphylactic reaction as -ell as the scratching
behavior in mice induced by compound =L?LK, These components
inhibited the production of 3gE in ovalbumin<induced asthma mice but
li(uiritigenin had little effect,
• This suggests that the antiallergic effects of licorice are mainly
due to glycyrrhi!in, 9Lbeta<glycyrrhetinic acid, and li(uiritigenin, -hich
can relieve 3gE<induced allergic diseases such as dermatitis and
randomi!ed, controlled trial -ith ephedra sinica for allergic rhinitis
• Shaikh et al, conducted a randomi!ed, placebo controlled,
crossover trial -ith 99L patients -ith perennial allergic rhinitis .9F9/,
)atients -ere randomi!ed to receive placebo or a 9I ephedrine<
saline nasal -ash once every =L hours, 'fter a four<-eek interval,
patients -ere crossed over to the opposite treatment, 2esults
indicated that ephedrine<saline significantly improved symptom
scores and peak nasal inspiratory flo- rates .pBK,KK9/, Statistical
significance -as seen after the second -eek, and effects lasted for
greater than t-o -eeks, -ithout notable side effects seen in the
majority of patients,
Herbal treatment
• +rtica dioica
• Ephedra sinica
• lycyrrhi!a glabra
• Berberis a(uifolium
• liver; Carduus marianus,
• antiinflammatories; inkgo biloba
• echinaceae spps
$ecubitous ulcers
• @utritional support; %itamin ',C, !inc, calories, fluid, protein
• !inc deficiency associated -ith delayed -ound healing
• comfrey leaf and aloe gel; pack the fresh comfrey leaf in
blender, -ith the aloe gel, then pack into a sterile muslin cloth, apply
to ulcer for several hours each day,
• Calendula; the polysaccharides stimulate phagocytosis, -hile in
vivo research has sho-n that alcoholic and -ater e#tracts stimulate
epitheli!ation in surgigar -ounds, +sed e#ternally, some indicate
tincture better,
Turmeric .curcumin/8 ' -idely used curry ingredient, can contribute to
o#idative stress in
'sian patients -ith acute vitiligo,
• Schallreuter N+ 2okos H, 3ndian H $ermatol %enereol 6eprol
:KKF; M:8 >M<>G
"ifteen 'sian patients -ith acute vitiligo .a skin disorder -ith the loss
of native skin pigment daily -ere evaluated for their facial
repigmentation after the topical application of lo-<dose ultraviolet B<
activated pseudocatalase t-ice daily, .2estoration of skin colour can
be achieved after the reduction of epidermal hydrogen pero#ide
levels using a topical pseudocatalase cream,/
• 'fter F months, none of the patients sho-ed any significant
repigmentation, Eight of them -ere advised to avoid turmeric in their
diet and continue the application of the pseudocatalase, ' significant
improvement -as observed after : months, and at F months, si#
patients had nearly complete facial repigmentation,
• Ney "inding8 Curcumin .an active ingredient of turmeric/ may
contribute to the o#idative stress in acute vitiligo and thus prevent
Nim N, 5u H, Cha H, Seo S, Choi @, 5ou 5, ,
'ntibacterial activity of Curcuma longa 6, against methicillin<resistant
Staphylococcus aureus,
0ethicillin<resistant Staphylococcus aureus .02S'/ has been
emerging -orld-ide as one of the most important hospital and
community pathogens,
The present study investigated the antimicrobial activity of ethyl
acetate, methanol and -ater e#tracts of Curcuma longa 6, .C,
longa/ against 02S', The ethyl acetate e#tract of C, longa
demonstrated a higher antibacterial activity than the methanol
e#tract or -ater e#tract, Since the ethyl acetate e#tract -as more
active than the other e#tracts, the study e#amined -hether the
ethyl acetate e#tract could restore the antibacterial activity of beta<
lactams and alter the 02S' invasion of human mucosal fibroblasts
3n the checkerboard test, the ethyl acetate e#tract of C, longa
markedly lo-ered the 03Cs of ampicillin and o#acillin against
02S', 3n the bacterial invasion assay, 02S' intracellular invasion
-as significantly decreased in the presence of K,9:><: mg?m6 of C,
longa e#tract compared -ith the control group,
These results suggest that the ethyl acetate e#tract of C, longa may
have antibacterial activity and the potential to restore the
effectiveness of beta<lactams against 02S', and inhibit the 02S'
invasion of H0"s,
)hytotherapy 2esearch, :KK> Hul; 9G.M/8 >GG<FK=,
Boils? furunculosis
• 3ndicates a breakdo-n in immune function,
• Check for alternative causes
• $iabetes can predispose to infections due to high blood sugar
• To#icity in the body re(uires an assessment of the ability to
eliminate -astes effectively,
Sample topical poultice for boils
• E(ual parts of tinctures of Calendula officinalis, Commiphora
molmol and Echinacea angustifolia can be mi#ed to a thick paste -ith
+lmus fulva po-der and applied direct, changing every : hours,
• Treatment approach includes antibacterial and
immunostimulant herbs -ith alteratives and lymphatics, 6a#ative
herbs to improve bo-el clearance can also prove helpful,
• Sample 2# for boils
• Echinacea angustifolia ;K
• Baptisia tinctoria :K
• Calendula officinalis :K
• 'rctium lappa 9K
• 3ris versicolor 9>
• )hytolacca decandra > Sig 9K ml tid
3mpetigo? bacterial infection
• Contagious skin infection especially on face
• Emphasis should be on preventing further spread of infection,
• Neep children a-ay from school and emphasi!e hygiene,
• 1rthodo# antibiotic treatment may be needed in severe cases,
• Treatment for boils above should be used,
)lantar -arts can persist for many years,
• 1rthodo# treatment focusses on removal by free!ing or burning
agents .such as hydrogen pero#ide/,
• Consider -hy the problem may have originally developed and
-hether immune function and elimination have been? still are poor,
• Herbal approaches tend to fall into t-o camps 7 either gradual
removal -ith caustic or proteolytic herbs such as Euphorbias .the
inside of banana skin -ill also -ork/,
• or use of herbs -ith immunostimulant and cytoto#ic properties
such as Tea Tree or Thuja essential oil, Chelidonum majus late# may
offer both effects as it contains proteolytic en!ymes and is thought to
inhibit rapid cell turnover,
• 'pplication needs to be persistent in order to prevent regro-th,
• 3nternal use of herbs to boost immune function and elimination
can support the removal of -arts, helping to prevent their return, +se
'rctium lappa, Tara# officinalis radi# , Chelidonum majus, $ietary
advice should include improvement in fluid intake and fruit and fibre
for bo-el health, additional vitamins and minerals to boost the
immune system .especially vitamin C and !inc/,
Chelidonium majus
• traditional reputation as a liver herb,
• Topical applications of the fresh milky juice treatment for -arts,
• Scientific investigations are confirming such traditional uses
• large open study found that Chelidonium -as effective for
cramp<like pains associated -ith irritable bo-el syndrome and other
causes, Such spasmolytic and analgesic activities .alkaloids similar
to the ones found in other poppies, eg papaverine and codeine from
the opium poppy,
• Chinese medicine as a spasmolytic and antitussive treatment
for bronchitis and -hooping cough,
• ' cancer chemotherapy kno-n as +krain has been developed
from the alkaloids of Chelidonium, +krain has undergone e#tensive
testing in Eastern Europe
• constituents; the orange juice -hich is rich in alkaloids,
• Huice contains an en!yme capable of breaking do-n nucleic
acid .such as in viruses/, and may be responsible for the observed
activity against -arts,
• The dried herb contains up to 9,KI alkaloids including
chelidonine, sanguinarine, coptisine and chelerythrine, 1ther
components include chelidonic acid and other plant acids, and the
phenolic fraction contains hydro#ycinnamic acid derivatives and
• spasmolytic activity of Chelidonium preparations; studies found
it to be inconsistent, the medicinal action is greatly reduced on
prolonged storage,
• "resh plant gives really satisfactory results,
• Eeiss -rites8 S3 have been able to observe this for myself in
e#tensive e#periments -ith Chelidonium juice made from fresh
plants, $uring the first si# months it -as clearly effective,,, 'fter that
time, ho-ever, the juice had practically no effect, and soon none at
• )resumably this SChelidonium juiceT -as stabilised -ith a lo-
percentage of alcohol
• Berlin clinical trial ; dried Chelidonium e#tract -as given in
tablet form, 3n fact, the inconsistency and instability observed by
Eeiss can be e#plained and overcome,
• ' 2ussian study found a marked variation in the alkaloid
content of dried Chelidonium, depending on the drying conditions,
1nly Chelidonium dried at LKZC preserved the levels of alkaloids
found in the fresh plant,
• Ehen Chelidonium -as dried at temperatures bet-een :K and
>KZC, up to half of its alkaloid content -as lost, presumably due to
continued en!yme activity in the plant as it dried, This phenomenon
probably also e#plains the instability of the Chelidonium juice, since
lo-er levels of alcohol added to a fresh plant do not completely inhibit
en!yme activity, This residual activity in Chelidonium juice may have
resulted in a gradual reduction in alkaloid levels through their
en!yme<catalysed decomposition,
• The best solution to the problem posed by Eeiss is to use
Chelidonium preparations stabilised for a kno-n content of alkaloids,
as used in the Berlin study,
• Hepatoprotective and Choleretic 'ctivity; 1ral administration of
an alcohol e#tract of dried Chelidonium reduced carbon tetrachloride<
induced liver injury in rats, Significant reductions in elevated plasma
levels of liver en!ymes and bilirubin occurred in the treated group,
• E#tracts of dried Chelidonium -ere tested for choleretic activity
using the isolated perfused rat liver, The total e#tract of the herb
significantly induced choleresis .bile flo-/, Ho-ever, it did this -ithout
increasing the total output of bile acids .ie there -as an increased
flo- of more dilute bile/, 3n contrast, the phenolic and alkaloidal
fractions of the total e#tract, tested individually and in combination,
did not significantly increase bile flo-, although small increases -ere
observed, The authors concluded that the increased bile flo- is due
to an additive effect from all compounds in the total e#tract of
Chelidonium and not one or t-o specific active constituents or
• 'ntimicrobial 'ctivity 'n alkaloid fraction isolated from the dried
roots of Chelidonium contained chelerythrine and sanguinarine,
Chelerythrine and this fraction -ere found to be ineffective on ram<
negative bacteria in vitro, Ho-ever, significant antimicrobial effect
-as observed against ram<positive bacteria, such as
Staphylococcus aureus, t-o strains of Streptococcus and also
against the fungus Candida albicans,
• 'nother in vitro study investigated the effect of Chelidonium
e#tracts on several Candida species and other dermatophytes,"luid
e#tracts of Chelidonium prepared from dried plant material collected
in late Huly and in early September .Europe/ -ere compared, Both
e#tracts sho-ed greater than average antifungal activity against
organisms involved in skin infections such as 0icrosporum gypseum,
Trichophyton mentagrophytes, Epidermophyton floccosum and
Candida pseudotropicalis, The Huly e#tract -as effective against
Candida albicans, but the September e#tract sho-ed no activity,
• 'ntitumour 'ctivity; ' -ater<soluble, purified methanol e#tract
of dried Chelidonium demonstrated inhibition of transplanted tumours
in mice, -ith relatively mild cytoto#ic side effects, 3ntraperitoneal
administration of MKK mg?kg for M days resulted in >>I inhibition of
sarcoma 9LK and Ehrlich carcinoma, Crude chelidonine and
protopine both of -hich are insoluble in -ater, sho-ed insignificant
tumour inhibition,
• 'n alcohol e#tract of Chelidonium e#hibited cytoto#icity against
a carcinoma of the nasopharyn# in vitro, 1ne of the cytoto#ic
principles -as found to be the alkaloid coptisine,
• Chelidonium e#erted an antimutagenic effect in vitro against
several mutagens in the 'mes test,
• Chelidonine caused changes in the mitotic inde# of
transplanted ascitic cells, sho-ing marked antimitotic activity,
• 'nti<inflammatory 'ctivity; The Chelidonium alkaloids
chelerythrine and sanguinarine have demonstrated anti<inflammatory
activity in the carrageenan rat pa- oedema test,
• To#icology
• 6o- chronic to#icity -as demonstrated by oral administration of
an alkaloid fraction to female mice for a period of 9K days .9K
mg?kg?day for ; days follo-ed by > mg?kg?day for M days/, There -as
no marked effect on the gro-th of the animals and the major organs
did not sho- any significant structural changes,
• Chelidonium alkaloids demonstrate moderate acute to#icity
after intravenous or subcutaneous administration, The follo-ing 6$>K
values -ere observed in female mice8 chelerythrine chloride G>
mg?kg, sanguinarine chloride 9K:,K mg?kg, and alkaloid fraction L:
mg?kg,Clinical Studies
• Cholagogue Effect; ' clinical trial investigated the effect of a
suspension of Silybum marianum, Chelidonium and Curcuma on :L
patients, 3n comparison to a control li(uid, the herbal mi#ture
demonstrated a greater increase in bile flo- and pancreatic secretion,
• Spasmolytic Effect; 3n FK Berlin practices, FKL patients -ere
treated and observed in an open study over a ;<month period -ith a
high<dose standardised preparation of dried Chelidonium, -hich
acted as a plant<based spasmolytic,The main symptoms -ere cramp<
like pains in the gastrointestinal tract .=;I/ or gall ducts .=L,:I/,
Each Chelidonium tablet contained :,L> mg of total alkaloids
including K,MG mg of chelidonine, The dose -as initially > tablets?day
and this -as reduced to ; tablets?day in patients -ho responded to
treatment, The average duration of treatment necessary -as :: days
and the longest treatment time -as :,> months, ' good or very good
therapeutic effect on symptoms -ith a (uick response -as observed
in LM,=I of cases, 3n most cases symptom relief occurred -ithin ;K
minutes of taking the herbal medication .F:,;I/, 3n =F,9I of patients,
the average duration of efficacy of each tablet dose -as better than ;
hours, This study indicates the value of Chelidonium for the treatment
of cramp<like abdominal pains associated -ith irritable bo-el
syndrome and other causes,
Earts, )olyps
• 3n a small, open trial an infusion of dried Chelidonium -as
administered as an enema for colonic polyposis, 'dministration of ten
or more enemas resulted in complete disappearance of colonic
polyps in several cases,
• 3n a later study the fresh plant -as made into a paste and
administered t-o or three hours after an evacuant enema,3n most
cases, : or ; courses .consisting of 9K< :K enemas each/ -ere
deemed to be necessary, This regime -as inefficient for treating
malignant regenerated or degenerated polyps, 1ver a :<year period
treating 9=G patients -ith various forms of polyposis, LMI sho-ed
improvement -ith :MI making a complete recovery,
• 'n alcohol e#tract of Chelidonium -as used as a topical
application to treat nursing mothers for -arts, papillomas,
condylomas and nodules in an open trial, The e#tract -as applied to
the affected area appro#imately :KK times per day for : to ; -eeks or
until improvement -as observed, Complete resolution of the -arts
occurred after 9><:K days in 9;> individuals,
• Chelidonium -as given as a syrup or e#tract .e(uivalent to 9>g
of herb per day/ to patients -ith chronic bronchitis in an open study,
The effective rate -as around LKI, Chelidonium syrup or a decoction
of the fresh herb -as used to treat -hooping cough in an open study,
Treatment -as for a course of L to 9K days, 1f >KK cases so treated,
;>> -ere cured and 99F improved,
• 'nticancer 'ctivity @ote8 3n reading this section it should be
noted that +krain is a high<dose, -ater<soluble derivative of
Chelidonium alkaloids -hich is administered by injection, 2esults for
+krain are not relevant to the oral use of Chelidonium e#tracts,
+krain is believed to modulate the immune system, 3ntravenous
injection of +krain to nine men -ith proven lung cancer resulted in
restoration of cellular immunity, characterised by an increase in the
proportion of total T<cells and a significant decrease in the
percentage of T<suppressor cells, 1bjective tumour regression -as
seen in = of the G treated patients,
• Thirty<si# stage 333 rectal and ovarian cancer patients -ere
treated -ith intravenous injection of +krain,:> The effect of +krain on
immune parameters in these cancer patients -as compared -ith
control patients, +krain demonstrated cytostatic activity in malignant
cells at a concentration less than that re(uired for cytostatic activity in
normal cells, +krain also demonstrated favourable immunoregulatory
properties by regulating the
• T<lymphocyte subsets,:>dverse Effects
• ' case of haemolytic anaemia -as reported after oral ingestion
of Chelidonium e#tract, The patient -as treated -ith corticosteroids,
blood transfusions and haemodialysis and recovered after about 9:
• 'dverse effects noted in Chinese usage include dry mouth,
di!!iness, gastric discomfort, diarrhoea, abdominal distention, nausea
and mild leukopaenia in a minority of patients,9 Symptoms usually
disappeared in ; to > days -ithout discontinuation of the treatment,
• Choleretic, cholagogue, antispasmodic, mild la#ative, antiviral
.fresh juice topically/,
• 3ndications; all bladder disease, gall stones, 6iver disease,
• 3rritable bo-el syndrome, To assist in clearing to#ins from the
liver and
• the bo-el, Skin diseases such as psoriasis .the antimitotic
• of chelidonine may be relevant to the internal and topical use of
Chelidonium for psoriasis/,
• Topical application for -arts and polyps, especially the fresh
juice, 3n China, Chelidonium is kno-n as Bai(ucai and is used for the
treatment of gastritis, gastric ulcer, enteritis, jaundice, abdominal
pain, bronchitis and
• -hooping cough,
• @o harmful or to#ic effects from therapeutic doses have been
established, Ho-ever, e#cessive doses should be avoided .especially
alcohol<-ater e#tracts/ and the adverse effects described above
should be noted,:M
• +nder the terms of the British 0edicines 'ct 9GFL the sale of
Chelidonium is restricted to medical herbalists,
• 9 to : m6 of the 98: fluid e#tract per day, Short term use of
higher doses may be necessary, eg in the Berlin study doses up to
the e(uivalent of ; g per day -ere used, The dose used in China is ;
to G g per day, or even higher, Ho-ever, Chinese doses are
generally administered by decoction and this method may not
efficiently e#tract the Chelidonium alkaloids,
• 2eferences
Thuja occidentalis
• 3ts name is derived from the reek -ord RthuoR -hich means to
sacrifice, as the fragrant, camphoraceous -ood -as burnt -ith
Thuja occidentalis, constituents
• Essential oil .K,=<9I/, half of -hich consists of terpenic
ketones, for e#ample8 thujone .K,K>I of the dried herb/, isothujone,
thujane, camphor, fenchone, [<pinene, borneol,
• 0ucilage, no- kno-n as thuja polysaccharides .T)S/,
• *uercitrin and?or thujin .flavonoids -hich have viricidal, anti<
spasmodic, diuretic and vasopressor actions/,
• Thujaplicin, a fungicide and [<thujaplicin -hich has anti<tumour
• 'lectin, .also kno-n as sugar binding protein/ -hich in this
case, is a glycoprotein -ith arabinogalactans,
• )licatic acid, a mild allergen,
• Tannin, and a non<tannic astringent .thujin/,
• RStimulating depurativeR
• Stimulating to smooth muscles
• 3mmunostimulant by influencing the first phase of phagocytosis
.hence increases the activity of -hite blood cells/,
• 'nti<viral by causing the induction of C$= positive T cells by
• E#pectorant, diuretic, alterative, counter<irritant,
• 'nti<carcinomatous as indicated by its @ative 'merican
traditional use in uterine cancer,
• Emmenagogue
• astro<intestinal irritant
• Sedative effect is obtained from the use of seeds of T,
• The essential oil is neuroto#ic,and the herb is paralytic to cold
blooded animals,
'ntiviral activity
• against several viruses, the structure of -hich includes
enveloped and non<enveloped viruses -ith $@' and 2@' nucleic
'ntiviral activity too
• )apovaviridae; $@' not enveloped .naked/; -arts,
• acuminata
• )o#iviridae ; $@' enveloped ; Small po#.3n older herbals, thuja
-as indicated to counter the ill effects of small<po# vaccination,/
• )icornaviridae ; 2@' naked; 0ost common colds, 'cute
conjunctivitis, )oliomyelitis, 0yocarditis, )ancreatitis
• Bunyaviridae; 2@' enveloped; Haemorrhagic fevers .'s it -as
traditionally used to treat a haemorrhagic condition
.thrombocytopaenic purpura/, Thuja may have activity against the
Bunyaviridae class of viruses,/
• Eith activity on this range of virus structures, the antiviral action
of thuja may be able to be e#tended to other viral disorders,
• 3nternally; 3t is useful for all upper respiratory complaints
including infections, 3t is particularly useful for older patients, and is
indicated for bronchitis -ith cardiac failure,
• 'menorrhoea, .This action may be due to irritation of the 3T,
or the presence of an unkno-n oestrogenic substance,/
• Chinese herbalists treat metrorrhagia using T, orientalis,
• Cystitis and enuresis,
• 'rthritis .including osteo<, rheumatoid and psoriatic arthritis/
and psoriasis, as Thuja has good eliminative properties,
• +terine, breast and lung carcinomas,
• T, orientalis is used to treat neurasthenia,
• E#ternally
3ndications e#ternally
• nasal polyps, especially if the fresh plant tincture is used,
• 'rthritis, psoriasis, "resh thuja tops boiled in lard as a salve in
arthritic joints pain,
• Earts, 0ore success is found in treating small -arts, large
-arts may only reduce in si!e,
• There is some confusion about dosage, caused by the
presence of thujone in the plant, ho-ever its concentration in the
fresh or dried plant tincture is minimal, The concentration of thujone
in 'rtemisia absinthium, is higher .K,:>I of -hole plant/, than that in
Thuja but ', absinthium is only to#ic -hen used in the long term .over
• Herb .dry or by infusion/ 9 < : g per dose tds
• Seed .T, orientalis/ > g per dose tds
• "luid E#tract .dry plant/ 989 : m6 per day
• Tincture .dry plant/ 98> 9 m6 per dose tds
• Tincture .dry plant/ 989K : m6 per dose tds
• @ote8 the ma#imum dose used in my practice for long term use
is8 "resh )lant Tincture 98> K,K; m6 per kg per day,
• Combine Thuja -ith Baptisia and Echinacea for
immunomodulation, This combination can be used in acute infections
or for prophyla#is in lo-er doses for up to t-o months,
• 3t -as found to have a more beneficial effect in prophyla#is than
Echinacea on its o-n, This -as demonstrated by a single<blind, non<
placebo clinical
• trial -hich measured the number of colds contracted in a year
on t-o groups of 9>K children bet-een the ages of ; and 9=,
• The possible e#planation is that Thuja is stimulating first phase
of phagocytosis -hile Echinacea is active in the later phases of
• Eith Hamamelis -ater e#ternally in e#udative ec!ema,
• Eith rindelia, Senega and 6obelia in pulmonary complaints,
• pregnancy and lactation
• epilepsy .high doses/
• acute and chronic air-ay obstruction .in high doses, due to
stimulation of the smooth muscles/
• Thuja has a cumulative effect as thujone is lipophilic .hence
has an affinity for fat/, 3f high doses are used in the long term .more
than F months/, thujone -ill accumulate in the brain, liver and
• Thujone is also present in8 'rtemisia, Salvia, 6ippia and some
Tanacetum spp,
• $o not give milk to people -ith suspected, recent thujone
poisoning as it -ill increase intestinal absorption,
'ntiviral Component in Thuja 3dentified
• 2esearchers at the 3nstitute of )harmaceutical Biology in
0unich .erhauser, C et al/ have found that a MKI ethanolic e#tract
of Thuja occidentalis inhibits Herpes Simple# %irus .HS%/ in vitro,
+sing activity guided fractionation they found that the main active
component -as deo#ypodophylloto#in, a kno-n antiviral agent,
Commercial tinctures of Thuja -ere found to contain about K,;mg?m6
of this component, $eo#ypodophylloto#in at lo- concentrations may
also stimulate the immune system,
• Topical and oral doses of Thuja have traditionally been used for
the treatment of -arts, The observed antiviral activity is a plausible
e#planation for this traditional use, Since -arts are due to a naked
virus, this -ould imply that Thuja is active against both naked and
enveloped viruses .HS% is an enveloped virus/,
$eo#ypodophylloto#in is kno-n to be active against the -art virus,
This is therefore a more e#tensive antiviral activity than hypericin,
-hich although potent, is only active against enveloped viruses,
Herpes simple#
• 2ecurrent viral infection of the skin or mucous membranes
characteri!ed by the appearance of single or multiple clusters of
small vesicles on an erythematous
• base fre(uently occurring about the mouth .herpes
gingivostomatitis/, lips .herpes labialis/, genitals .herpes genitalis/,
and conjunctiva and cornea .herpes keratoconjunctivitis/
• 3ncubation period :79: days, averaging F7M
• Tingling and then painful vesicles -ith enlargement of local
lymph nodes,
• 1utbreak may follo- minor infections, trauma, stress
.emotional, dietary, and environmental/, and sun e#posure and
e#cess carbohydrate in the diet,
• 0ore than MK viruses compose the Herpes viradae, 1f these,
four are important in human disease8 herpes simple# .HS%/, varicella
!oster .%&%/, Epstein7Barr .EB%/, and cytomegalovirus .C0%/,
• Serological methods have distinguished t-o types of HS%,
-hich have been designated HS%<9 and HS%<:,
• Serological studies have sho-n that ;K79KKI of adults have
been infected -ith one or both HS% types, -ith the greatest incidence
among the lo-er socioeconomic groups, HS%<9 is primarily isolated
from e#tragenital sites, -hile genital infections are primarily by HS%<:
.9K7=KI are due to HS%<9/,
2ecurrence rate
• HS%<9 genital lesions have a recurrence rate of 9=I, -hile the
HS%<: recurrence rate is FKI,
• 0en seem more susceptible to recurrences, 'fter resolution of
the primary infection, HS% probably becomes a dormant inhabitant
-ithin sensory and?or autonomic ganglia,
• 2ecurrences develop at or near the sites of primary infection
and may be precipitated by many different stimuli8
– sunburn
– se#ual activity
– menses
– stress
– food allergy
– drugs
– certain foods,
• The risk of clinical herpes infection after se#ual contact -ith an
individual -ith active lesions is estimated to be M>I,
3mmunological aspects
• host defense mechanisms are paramount in protecting against
HS% infection,
• Chronic, persistent labial and genital infections are seen in
immunosuppressed individuals, The cell<mediated immune system is
the major factor in determining the outcome of herpes e#posure8
resistance, latent infection, or clinical disease,
• THE2')E+T3C C1@S3$E2'T31@S
• Enhancement of the host4s immunological status, There is
some evidence that a defect of specific cell<mediated immunity is
present even in apparently normal subjects -ith recurrent HS%
• &inc
• 1ral supplementation -ith !inc .>K mg?day/ has been sho-n to
be effective in clinical studies, 'lthough !inc is an effective inhibitor of
HS% replication in vitro, its effect in vivo is probably related to its role
in enhancing cell<mediated immunity, The topical application of K,K97
K,K:>I !inc sulphate solutions has also been sho-n to be effective
in both ameliorating symptoms and inhibiting recurrences of HS%
%itamin C
• Both oral consumption and topical application of vitamin C
increase the rate of healing of herpes ulcers,
• 3n a randomi!ed, double<blind study, an ascorbic acid<
containing pharmaceutical formulation .'sco#al/ applied -ith a
soaked cotton -ool pad three times daily for : minutes resulted in
patients reporting fe-er days -ith scabs and fe-er cases of
-orsening of symptoms, Cultures yielded herpes comple# viruses
significantly less fre(uently in the treatment group, 3n another study,
:K patients -ith herpes labialis -ere treated -ith a comple# of FKK
mg of -ater<soluble bioflavonoids and FKK mg of vitamin C given in
e(ual increments three times daily, T-enty episodes of herpes
labialis -ere treated -ith a comple# of 9,KKK mg of -ater<soluble
bioflavonoids and 9,KKK mg of vitamin C in e(ual increments five
times daily, Ten episodes -ere treated -ith a lactose preparation,
This approach -as maintained for ; days after the recognition of
symptoms, The -ater<soluble bioflavonoid7vitamin C comple# -as
sho-n to reduce vesiculation and to prevent the disruption of the
vesicular membrane, The therapy -as most beneficial -hen initiated
at the beginning of the disease, Those treated -ith the 9,KKK mg
regimen e#perienced =,= days for the blister to heal compared -ith
9K days for the placebo group,
6ysine and arginine
• ' lysine<rich?arginine<poor diet has become a popular treatment
for HS% infections,
• research sho-ing that lysine has antiviral activity in vitro due to
antagonism of arginine metabolism,HS% replication re(uires the
synthesis of arginine<rich proteins, and arginine itself is suggested to
be an operon coordinate inducer, ' preponderance of lysine over
arginine is believed to act as either an allosteric en!yme inhibitor or
an operon coordinate repressor,
• $ouble<blind studies on the effectiveness of lysine
supplementation -ith uncontrolled avoidance of arginine<rich foods
have sho-n inconsistent results, These results may be due to the
relatively lo- levels of lysine used .9:KK mg?day/ and the severity of
the cases in some of the studies .placebo and treated groups had
lesions for =KI of the time in one negative study/, 3n the most recent
study, lysine -as given at a larger dosage .9 g three times?day/ along
-ith dietary restriction of nuts, chocolate, and gelatin, 't F months,
lysine -as rated as effective or very effective in M=I of those
receiving lysine compared -ith only :LI for those receiving the
placebo, The mean number of outbreaks -as ;,9 in the lysine group
compared -ith =,: in the placebo group,
• "rom a theoretical perspective this approach should be
effective, since in vitro studies have sho-n that HS% replication is
dependent on ade(uate levels of arginine and lo- levels of lysine, 's
dibasic amino acids, they compete -ith each other for intestinal
transport, and rats fed a lysine<rich diet displayed a FKI decrease in
brain arginine levels, although there -as no change in serum levels,
Since HS% is believed to reside in the ganglia during latency, lysine
supplementation and arginine avoidance seem appropriate, Ho-ever,
this approach is not curative 7 it only inhibits recurrences, 3n some
patients, -ithdra-al from lysine is follo-ed byrelapse -ithin 97=
• $iet; $evelop a diet -hich avoids major food allergens and
arginine<rich foods -hile promoting lysine<rich foods , The foods -ith
the -orst arginine? lysine ratio are chocolate, peanuts, and almonds,
Topical preparations
• topical preparations in the treatment and prevention of herpes
outbreaks is a concentrated e#tract .MK89/ of 0elissa officinalis
.lemon balm/, 2ather than any single antiviral chemical, the melissa
contains several components that -ork together to prevent the virus
from infecting human cells,
• Ehen the melissa cream -as used in patients -ith the initial
herpes infection, results from comprehensive trials from three
erman hospitals and a dermatology clinic demonstrated that not a
single recurrence occurred, 3n other -ords, by using the cream not a
single patient -ith a first herpes outbreak developed another cold
• "urthermore, it -as noted in these studies that the melissa
cream produced a rapid interruption of the infection and promoted
healing of the herpes blisters much (uicker than normal, The control
group receiving other topical creams had a healing period of 9K days
-hile the group receiving the melissa cream -ere completely healed
-ithin > days,
• The melissa cream -as also studied in patients suffering from
recurrent cold sores, 2esearchers found that if subjects used the
melissa cream regularly, they -ould either stop having recurrences or
e#perience a tremendous reduction in the fre(uency of recurrences
.an average cold sore<free period of greater than ;,> months/,
• The melissa cream should be applied to the lips t-o to four
times a day during an active recurrence, 3t can be applied fairly thickly
.97: mm/, $etailed to#icology studies have demonstrated that it is
e#tremely safe and suitable for long<term use,
• 'nother popular topical treatment for preventing and treating
herpes outbreaks is to use preparations containing glycyrrhetinic
acid, This triterpenoid component of lycyrrhi!a glabra .licorice root/
inhibits both the gro-th and cytopathic effects of herpes simple#, as
-ell as vaccinia, @e-castle4s disease, and vesicular stomatitis
• Topical glycyrrhetinic acid has been sho-n in clinical studies to
be (uite helpful in reducing the healing time and pain associated -ith
cold sores and genital herpes,
Herpes and garlic
2a!avi S0, '!i!olahi B, 2ahimi H, ,
'n investigation on antiviral effect of garlic e#tract on herpes simple#
virus via cell culture,
• Background U 'im8 This study -as designed to investigate the
antiviral effect of arlic and the use of it as an herbal drug in the
treatment of HS%3 infections,
• 0ethods U 0aterials8 Hela cell culture -as used for several
assays in this e#perimental study, The re(uired virus -as collected
from infected patients, 'fter increasing the amount of virus, it -as
titrated by TC3$>1 assay via cell culture, "inally, the cytoto#ic doses
of arlic e#tracts -ere determined in cell culture and the antiviral
doses -ere assessed,
• 2esults8 The doses that caused >KI of cells death in cell
culture .CC>1/ respectively for a(ueous and alcoholic e#tract -ere8
:,G9mg?ml and ;,K>mg?ml, The doses that caused >KI reduction in
the virus cytopathic effect .3C>1/ -ere8 9,9; and K,GLmg?ml,
• Conclusion8 3t is obvious that both types of arlic e#tracts had a
significant antiviral effect on HS%9, 1n the other hand arlic had
cytoto#ic effect that appeared in the higher doses than antiviral
Hournal of $ental School, :KKF; :=.9/8 9=,
Hypericum perforatum
• study -hich e#amined the value of oral doses of St HohnOs -ort
for the treatment of herpes,
• Hypericin; antiviral action in vitro against several classes of
• an oral formulation of the St HohnOs -ort dry e#tract -as
compared -ith placebo in patients suffering from recurrent orofacial
herpes .trial 9; n J G=/ or genital herpes .trial :; n J 99K/ in t-o
separate double<blind, prospective randomised trials in parallel group
• 3n both trials, total observation time -as GK days and patients
received one tablet t,d,s, in symptom<free intervals and t-o tablets
t,d,s, during herpetic episodes,
• The total symptom score -as significantly lo-er in the St HohnOs
-ort group compared -ith placebo in both trials, The herb also led to
a superior reduction of the number of patients -ith herpetic episodes
in both trials compared -ith placebo, 3ndividual symptoms -ere
comparably improved by the active treatment,
• The authors commented that the positive outcome -as
une#pected, because laboratory studies on hypericin indicate that the
presence of light is necessary to activate the antiviral effect, .This is
despite the fact that many herbalists have been using St HohnOs -ort
e#tract in this -ay and enjoying good clinical success,/ They also
pointed out that their study does not establish a mechanism of action
for the herb, -hich could be antiviral, but might also be acting via
immunomodulatory effects, perhaps in turn mediated by the
antidepressant activity,
3s 1ral 6icorice 'ctive 'gainst EB%B
• The antiviral properties of glycyrrhi!in .6/ from licorice
.lycyrrhi!a glabra/ are -ell kno-n, "or e#ample, intravenous
administration of 6 has been beneficial in the treatment of chronic
viral hepatitis,
• 3n Hapan, a preparation of 6, cysteine and glycine kno-n as
S@0C is administered by injection for the treatment of acute
hepatitis, chronic hepatitis .including hepatitis C/ and subacute
hepatic failure due to viral hepatitis,
• 'fter oral administration of licorice, 6 is hydrolysed by
intestinal bacterial en!ymes into its aglycone glycyrrhetinic acid .'/,
-hich is then absorbed into the blood, ' may then undergo phase 33
hepatic conjugation to form glucuronates not unlike 6, as -ell as
other derivatives,
• 3n the past 6, but not ', has been sho-n to inhibit virus
gro-th and in some instances inactivate virus particles, 6 has been
found to be particularly active against herpes simple# virus, varicella<
!oster virus, human herpes<virus, and human immunodeficiency
• So the conclusion -as that oral doses of licorice -ould not
e#ert systemic antiviral effects due to the conversion of 6 to ',
• Ho-ever, ne- research has challenged the earlier finding that
' has no antiviral activity, at least in the conte#t of Epstein<Barr
virus .EB%/,
• ' team of scientists from Tai-an and 2ussia found that not only
is ' active against EB% in the test tube, it is around L times more
active than 6 at inhibiting viral gro-th in infected cells,
• 6 and ' -ere found to interfere -ith an early step in the
EB% replication cycle, possibly absorption and?or penetration into the
host cell, Since the target of most conventional antiviral drugs is the
virus<encoded en!yme $@' polymerase, involved in producing viral
copies, 6 and ' represent a ne- class of anti<EB% agents -ith a
different mode of action,
• Ehile these are only in vitro results, they do remove a key
conceptual barrier against the anti<EB% activity of oral doses of
licorice, 3f the activity of ' -as found to be clinically relevant, the
implications -ould go -ell beyond the use of licorice to treat
glandular fever, This is because chronic EB% has been implicated in
a range of autoimmune diseases, including rheumatoid arthritis and
multiple sclerosis,
• The activity of ' and its metabolites against other viruses
-ould also provide an interesting line of future research,
• Treat to reduce any stress and tension, to improve the immune
response and to improve elimination,
• 'n e#ternal lotion of Echinacea angustifolia and Commiphora
molmol can be used,
Sample 2# for herpes simple#
• 'vena sativa ;K
• Echinacea angustifolia ;K
• alium aparine :K
• 2ume# crispa 9>
• )hytolacca decandra > Sig > ml tid
3ncrease %itamin c substantially and ensure plenty of fluids,
Herpes !oster virus
• %aricella virus
• 1ver half of cases have lesions on the trunk, sometimes
occurring facially over the trigeminal nerve,
• 6o- immunity and?or great stress,
• Similar approach to that taken -ith herpes simple# can be
taken but -ith additional emphasis on nervous trophorestoratives
such as %erbena officinalis, Turnera diffusa and )ana# ginseng
"ungal infections
• $ermatophytes; uni(ue group of fungi that are able to infect
nonvisable keratini!ed cutaneous epithelium,
• "rom another person, animals, or soil,
• "ungi synthesi!e keratinases that digest keratin, allo-ing them
to live -ithin tissue,
• )henol rich plants have antifungal activity .oregano, thymus,
teatree, sandal-ood/
• studies -ith 9KKI Teatree sho-n as effective as 9I
clomitra!ole, and comparative trial -ith >I teatree, placebo
controlled, LKI of patients cleared after 9F -eeks fro onychomycosis
for the last F<;F months,
• arlic found to be superior to many other antifungals,
• 1ther; calendula, commiphora, tababuia, thuja
"ungal infections
"ungal infections
• "or 'thlete4s foot a fe- drops of Tea Tree essential oil applied
regularly -ill bring rapid relief,
• 'nother possibility for resistant cases of fungal infection of the
toenail is a mi#ture of e(ual parts of Thyme and Cinnamon essential
oils applied t-ice a day until improvement is seen then once daily,
• $ietary advice should focus on the avoidance of sugary foods
and foods high in carbohydrate,
• 'dvice in all cases of fungal infection should include the
importance of drying -ell after -ashing as moisture provide ideal
conditions for regro-th,
• E#tremely itchy infestation of a small burro-ing mite
• Highly contagious -here people share accommodation in close
• Eorst in -arm areas of skin such as bet-een the fingers and
inner -rists, and -ill soon spread to other areas,
• Close inspection may reveal the tiny tracks of the burro-s
• 0ay also be a -ider spread allergic reaction,
• 1rthodo# treatment involves a complete body application of
insecticide on repeated occasions and this may be the only ans-er in
some cases
• Traditional use of Tanacetum vulgaris infusion alone may be
ade(uate 7 alcohol is needed to kill mites,
• *uassia chips can be used to make an effective pesticide,
• 3mprovements in diet -ill be beneficial,
• Scrupulous hygiene is necessary to prevent spread and
recurrence, all bedclothes, linen, etc must be -ashed at high
Head lice
• Head lice are ubi(uitous in schools
• 2epeated infection is common,
• 6ife cycle of appro#imately one -eek,
• "emale laying eggs, or nits, at the base of hairs to-ards the
ears and back of the head -hich are difficult to remove,
• 'n itchy scalp is the most likely indicator of infestation,
• Topical treatment -ith essential oils such as Tea Tree, @eem,
2osemary or Eucalyptus diluted in a carrier oil and applied overnight
to the scalp can be very effective,
• 2egular daily use of a metal Qnit4 comb is essential to remove
remaining eggs,
• To prevent reinfestation add Tea Tree essential oil, L gtt, to a
-eekly shampoo and comb regularly,
C'SE H3ST125
Han :KKK8 .first visit/
: \ years old, female presenting -ith 'topic ec!ema on head and
face, fle#or surfaces of arms and legs, )arents concerned and
have taken some dietary steps to control it, but as yet no
improvements, E#acerbated by sun, daylight and chocolates,
Cleared up over summer OGL
0edical History< no childhood illness yet, had all immunisations, @o
asthma, hayfever, allergies, l episode of conjunctivitis Amas ZGG
$rug history< )heneigan, Histamine, Hydrocortisone 9I,
'ntibiotics B, $iprobase,
"amily history< 0other has psoriasis and ec!ema
$iet<< .typical day/
• Breakfast< toast and marmite? -eetabi#? egg, Chocolate milk
• 6unch< ham sand-ich? oven chips and nuggets, "ruit $inner<
0acaroni cheese? rice and stir fry? spaghetti bolognese and salad
• Snacks< olives, ice pole, biscuits,
• $rinks< -ater and juice
• 2S8 has some head colds =?9:
• 3T8 appetite good, bo-el movement l?day
• @S8 -aking at night to scratch
C'SE H3ST125
• Carry out a differential diagnosis and agree a -orking diagnosis
• 3dentify and classify causative factors
• 6ist up to F aims of herbal treatment
• 3dentify re(uired actions and a sample 2#
C'SE H3ST125
• : -eeks of dietary sheets given, advised that T# -ill take
• 0atricaria recutita 9Kml
• +rtica dioica 9Kml
• Sig, 9Kgtts B$S
• Cardius marianus capsules
• Sig, \ capsules B$ added to milk
• Stellaria cream FKg and E)1 > mls
• Sig8 T$S to affected area
2easons herbs -ere chosen
• 0aticaria recutica < %ery suitable for children, digestive
problems, mild bitter, carminative, 'nti<allergenic,
• +rtica dioica< 'nti< allergenic, cleansing, deto#ifying, diuretic,,
useful for childhood ec!ema,
• Cardius marianus < protects the liver, stimulates secretion of
• Stellaria media< for irritated skin, may soothe severe itchiness,
• E)1<E"'Os oil e#ternally, beneficial in treatment or ec!ema
"urther reading
• 'shton, 2, and 6eppard, B, .9GG:/ $ifferential diagnosis in
dermatology .Second ed,/ 1#ford8 2adcliffe 0edical )ress,
• @icholls, C, .9GGK/ Q)soriasis4, British Hournal of )hytotherapy
%ol 9 @o ;?= , pp 9G<:>

You're Reading a Free Preview

/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->