3/22/10


PaBent’s
details
 Case
history
–
lower
back
pain

Anna
Newton
BA
BSc
 Medical
Herbalist
MCPP
MNIMH
 •  •  •  •  •  Sex:
Male
 Date
of
birth:
1925
 Profession:
researcher
in
biochemistry

 Date
of
first
consultaBon:
Nov
2001
 PresenBng
symptom:
severe
lower
 back
pain
of
few
months
duraBon


1


2


Previous
medical
history

•  Severe
pain
in
lumbar
region,
worse
for
 walking
and

standing
 •  MedicaBon:


1.  muscle
relaxant
(Methocarbamol)
 2.  NSAID
(Ibuprofen)

 3.  calcium
channel
blocker
(Amlodipine)


InvesBgaBons
and
diagnosis

MIR
scan:


• R
lateral
and
posterior
 displacement
of
lumbar
 vertebrae
L3,L4,L5
 • degeneraBve
changes
 characterisBc
of
 osteoarthriBs
 • spinal
stenosis
 (scoliosis
may
have
been
 acquired
in
childhood)

3
 4


•  Weak
response
to
analgesic
medicaBon
 plus
side
effects
(skin
rash,
indigesBon)
 •  Low
mood,
symptoms
of
benign
prostaBc
 hypertrophy


Diet
and
lifestyle

•  Poor
diet
(meat
3
x
day,
veg)
 •  Large
alcohol
intake
(1/2
boYle
of
wine
 per
day)
 •  Walking
a
dog
for
5min,
4
x
day
(no
 other
exercise)
 •  Supplements:
vit
E,
mulBvitamins,
garlic
 tablets

5


IniBal
prescripBons

2001

Harpagophytum
 Dioscorea
 Salix
alba
FE
 UrBca
rad.
 Carduus
 Galium


2003

Hypericum
 Guaiacum
 Viburnum
prun.
 Apium
 Menyanthes


2006

Hypericum
 Apium
 Boswelia
 Curcuma
 Viburnum
op.
 Dioscorea


Outcome:
about
60‐80%
improvement
in
pain
frequency
and
 intensity,
no
need
for
ibuprofen
but
occasionally
taking
 muscle
relaxant
1
x
day
(Methocarbamol)

6


1


3/22/10


IniBal
prescripBons

2005
–
ointment


Base:
Arnica,
Symphytum,
Echinacea
(10g
of
each)
 Tinctures:

Salix
alba
FE
2ml,
Symphytum
root
5ml,
 



















Vib.op
2ml,
Capsicum
20gY
 Infused
oils:
Symphytum
3ml,
Hypericum
3ml
 EssenBal
oils:
cajaput,
lavender,
peppermint,
wintergreen
 
























(5‐10gY
of
each)


Final
prescripBon

2006
–
ongoing
 Saligesic
:
1
tablet
per
day
 (extract
of
Salix
purpurea,
each
tablet
 contains
extract
equivalent
to
8g
stem
bark;
 stand.
to
salicin
60mg)
 Outcome:
 ‐virtually
pain
free

 ‐walking
20
min
4
x
day

7
 8


Outcome:
the
ointment
helped
but
the
paBent
found
it
 difficult
to
apply


Comparison
of
Salix
purpurea

and
 Salix
alba
cons0tuents

ConsBtuent

Phenolic
glycozides,
 of
which
salicylates
 predominate
(e.g.
 salicin
=

2‐(hydroxymethyl)phenyl‐ b‐d‐glucopyranoside)


Comparison
of
Salix
purpurea

and
 Salix
alba
cons0tuents

B
Schmid,
I
KöYer,
L
Heide
‐
European
journal
of
clinical
 pharmacology,
2001
–
Springer.
PharmacokineBcs
of
salicin
amer
 oral
administraBon
of
standardised
willow
bark.
 “Salicylic
acid
was
the
major
metabolite
of
salicin
detected
in
 the
serum
(86%
of
total
salicylates),
besides
salicyluric
acid
 (10%)
and
genBsic
acid
(4%).
Peak
serum
levels
of
salicylic
acid
 were
on
average
1.2
mg/l....(which
is)
much
lower
serum
 salicylate
levels
than
observed
amer
analgesic
doses
of
syntheBc
 salicylates.
The
formaBon
of
salicylic
acid
alone
is
therefore
 unlikely
to
explain
analgesic
or
anB‐rheumaBc
effects
of
willow
 bark.”


Salix
purpurea


Salix
alba


6.1‐8.5%
(total
 salicin)


0.5‐1%
(total
 salicin)


9


10


References

B
Schmid,
I
KöYer,
L
Heide
‐
European
journal
of
clinical
 pharmacology,
2001
–
Springer.
PharmacokineBcs
of
salicin
amer
 oral
administraBon
of
standardised
willow
bark.
 BriBsh
Herbal
Compendium,
BHMA,
vol1
 S.Mills,
K.Bone,
The
essenBal
guide
to
herbal
safety,
Churchill
 Livingstone,
2005


11


2


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