Class Ranunculaceae

Common Trade Names

None known.

Common Forms

Available as fluidextract, powdered root, seed, or a solid extract.

Source

The active components are extracted from the dried rhizome and root of the perennial plant Helleborus niger.

Chemical components

The extract may contain hellebrin, an aglycone, and two highly toxic crystalline glycosides-bufadienole helleborin and helleborcin. These glycosides may indicate contamination with other related species. Other components include saponosides, ranunculoside derivatives, resin, fat, and starch. The commercial hellebore roots consist mainly of H. niger and are mostly hellebrin-free. Other related species, especially H. viridis, tend to have higher levels of glycosides and aglycones.

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The entire plant is considered poisonous. Extracts of black hellebore are claimed to promote menstrual flow and to have anthelmintic, narcotic, and purgative properties.

Protoanemonine is thought to cause abdominal pain, a burning sensation in the mouth and throat, dermatitis, eye irritation, and vomiting.

It combines with sulfhydryl groups, which results in subepidermal vesication. Topical application of the freshly bruised plant can cause serious irritation. Early in vitro studies using protoanemonine identified antifungal and cytotoxic properties .

Reported Uses

The plant has been used historically as a purgative and to treat amenorrhea, anxiety, heart failure, intestinal parasite infections, mental disorders, and skin ulcers. Other claims include its use as an anesthetic and a diuretic and to induce abortion.

In homeopathy, black hellebore tincture is said to be useful for eclampsia, encephalitis, epilepsy, meningitis, and psychoses. In Europe, black hellebore is used in homeopathy and as adjuvant therapy for cancer patients because of its claimed immunostimulatory properties. An in vitro study observed increased cytokine production in cells given an extract of black hellebore. There have been no controlled, double-blind, randomized human trials involving black hellebore preparations.

Dosage

For laxative use, 1 to 10 gtt of fluidextract P.O., 1 to 2 grains of solid extract P.O., or 10 to 20 grains of powder P.O.

Adverse Reactions

CV: arrhythmias, bradycardia, hypotension, irregular pulse (with contamination) .

EENT: burning sensation in the mouth, conjunctival and nasal irritation, increased salivation, sneezing.

GI: abdominal pain, diarrhea, vomiting.

Respiratory: respiratory failure (with contamination), shortness of breath.

Skin: dermatitis.

Interactions

None reported.

Contraindications and precautions

Avoid using black hellebore in pregnant or breast-feeding patients; effects are unknown.

Special considerations

Caution the patient that ingestion of the plant may result in abdominal pain, a burning sensation in the mouth and throat, diarrhea, increased salivation, and vomiting.

Advise the patient that black hellebore is considered toxic and, therefore, should not be consumed.

Advise the patient to consult a health care provider before using herbal preparations because a treatment that has been clinically researched and proved effective may be available.

Although no known chemical interactions have been reported in clinical studies, consideration must be given to the pharmacologic properties of the herbal product and the potential for exacerbation of the intended therapeutic effect of conventional drugs.

Points of Interest

H. niger blossoms white flowers in the winter, from which it received its name Christmas rose.

“Hellebore” is derived from the Greek elein (to injure) and bora (food), describing its toxic nature.

Commentary

Besides its use in homeopathy, black hellebore is used mainly as an ornamental garden plant. Although it is being used as a potential immunostimulant, controlled human trials to support this claim are lacking. Because of its recognized poisonous status and the lack of clinical data to support the medicinal use of black hellebore, products containing components of this plant should be avoided.

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Myrtaceae

Common Trade Names

Jambul Seed

Common Forms

Available as decoctions or a tea made from the seeds or dried leaves. Source

The drug is extracted from the fruits, seeds, and leaves of Syzygium cuminii, a 50′ to 80′ tree with edible berries that is native to India and Sri Lanka.

Chemical Components

The seeds of S. cuminii contain gallic acid, ellagic acid, corilagin, 3,6­hexahydroxydiphenoyl-glucose, 3-galloyl glucose, and quercetin.

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Jambul seeds have been claimed to have antihyperglycemic, antihypertensive, and anti-inflammatory effects. In some South American countries, tea made from the leaves is used by diabetics for its antihyperglycemic effects. One study found no effect of jambul seed tea on postprandial blood glucose levels when compared with water in normal rats and rats with streptozotocin-induced diabetes mellitus.

The anti-inflammatory effects of jambul seed extract have been evaluated. Jambul seed extract was found to significantly reduce paw edema, although less effectively than phenylbutazone . An extract of jambul seeds was found to have neuropsychopharmacologic effects in mice; the animals became quieter and less active, with less spontaneous mobility. Loss of motor coordination and tone, decreased body temperature, and antagonism of amphetamine toxicity were also noted .

Reported uses

Jambul seeds and extracts are thought to be useful in treating diarrhea and dysentery and in lowering blood glucose levels. Although the seeds have some anti-inflammatory and antipyretic properties, the extent of these properties has yet to be defined. Evidence for the therapeutic properties of jambul is anecdotal.

Teixeria and colleagues studied the effects of jambolan tea prepared from S. cumini in 30 nondiabetic patients after completing the original work in rats. In accordance with the results or the lack thereof found in rats, these investigators failed to find any hypoglycemic effect in humans after a glucose tolerance test and concluded that jambolan cannot be recommended as an antihyperglycemic agent.

Dosage

No consensus exists. In most cases, tea is prepared from the seeds or leaves of the tree.

Adverse Reactions

None reported.

Interactions

CNS depressants: May cause altered behavior. Avoid administration with jambul.

Contraindications And Precautions

No specific contraindications. Avoid using jambul in patients who are hypersensitive to this plant or related species and in pregnant or breast­feeding patients.

Special Considerations

Advise the patient to consult a health care provider before using herbal preparations because a treatment that has been clinically re searched and proved effective may be available.

Monitor the patient for changes in blood pressure or blood glucose levels.

Urge the patient to report changes in behavior or coordination.

Advise pregnant or breast-feeding patients to avoid using jambul.

Points of interest

In Porto Alegre, a southern city of Brazil, a related species, Syzygium jambos, has also been used for treating diabetes. S. jambos, like S. cumini, is usually consumed in the form of a tea.

Commentary

Although jambul has been claimed to be effective for several medical conditions (diabetes, diarrhea, dysentery), there is little clinical evidence of its efficacy. In fact, animal and human clinical trials have failed to identify any significant hypoglycemic properties. Some studies have found extracts of jambul seeds and leaves to have anti-inflammatory, antipyretic, and neuropsychopharmacologic effects in animals. Further study on the active constituents of the seeds and leaves is warranted to determine the true pharmacologic properties of this plant.

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Violaceae

Common Trade Names

None known.

Common Forms

Available as an extract.

Source

Active components are obtained from the flowers of Viola tricolor.

Chemical Components

The stems and leaves contain flavonoids, salicylate derivatives, terpenes and triterpenes, carbohydrate derivatives, sterines, a polysaccharide, and magnesium tartrate. Vitamin F and other fatty acids have also been detected . Other compounds include violanthin, rutin, violaquercitrin, resin, saponin, gums, and mucilage.

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Physiologic mechanisms of action are poorly described. Salicylates may be responsible for anti-inflammatory properties because of prostaglandin inhibition. Although not a major component of pansy, rutin has been shown to exert many pharmacologic effects, the most well known of which is its ability to affect capillary permeability. Herbs with high levels of rutin were thought to be useful for bleeding events. Other effects of rutin include inhibition of angiotensin II and prostaglandin E2.

Reported Uses

This agent is claimed to be useful in treating bronchitis, rheumatism, skin cancer, and whooping cough. One Hungarian study indicates its possible use in preventing heart spasms and as an anti-inflammatory .

Dosage

Dosage is 2 to 4 ml of tincture or tea P.O. t.i.d.

Adverse Reactions

GI: cathartic effects (seeds), diarrhea.

Interactions

Salicylates: Effects may be additive. Use cautiously.

Contraindications and Precautions

Avoid using pansy in pregnant or breast-feeding patients; effects are unKnown.

special Considerations

Monitor the patient for diarrhea.

Advise women to avoid using pansy during pregnancy or when breast- feeding.

Inform the patient that no clinical data support the use of this herb or any medical condition.

Commentary

Without clinical data supporting the use of pansy for medical purposes, it cannot be recommended.

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Myrtaceae

Common Trade Names

Jason Winter’s Tea Tree Oil, Swanson Ultra Tea Tree Oil, Thursday Plantation Tea Tree Oil

Common Forms

Available as creams, lotions, ointments, and soaps. It is also included in cosmetics, household products, and toiletries. Concentrations of melaleuca oil in these products range from less than 1% to 100%.

Source

Tea tree oil, or melaleuca oil, is an essential oil distilled from the leaves and branches of Melaleuca alternifolia, a member of the myrtle family that is native to coastal areas of Australia.

Chemical Components

The steam distillation of the leaves yields about 2% oil. The colorless to pale yellow oil is composed of terpene hydrocarbons (pinene, terpinene, cymene), cineol, and various minor sesquiterpenes and related alcohols. Composition of the extract is varied; the oxygenated terpene, terpinen-4-ol, can constitute up to 60% of the total oil. Some oils contain high concentrations of 1,8-cineol, which is the main component of eucalyptus oil. Most commercially available tea tree oils contain little or no cineol. More than 100 compounds (all plant terpenenes) have been identified in melaleuca oil.

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Terpinen-4-ol a main component of tea tree oil, has significant antibacterial and antifungal activity in vitro; susceptible organisms include Escherichia coli, Staphylococcus aureus, Proprionibacterium acnes, Pseudomonas aeruginosa, Streptococcus species, and Candida albicans. Controversy exists as to the precise mechanism of action for the melaleuca. One report suggests that tea tree oil disrupts cell membrane permeability, promoting leakage of intracellular ions and proteins. Earlier data have suggested that the antiseptic effect of tea tree oil was related to its ability to activate WBCs . Still other information suggests that organic matter and surfactants that accompany melaleuca oil were responsible for the antibacterial effect. Tea tree oil may be effective against MRSA carriers that have previously been treated with topical mupirocin . There is in vitro evidence as well that tea tree oil has antimicrobial activityagainst vancomycin-resistant enterococci. Polymyxin B may enhance melaleuca’s antibacterial effect against P. aeruginosa by enhancing permeability of the organism cell membrane to the tea tree oil components .

Cooling appears to be an effective modality for the therapy of burn wounds. An investigation in piglets was undertaken to determine the effect of melaleuca gel on artificially induced burn wounds . Melaleuca gel, applied immediately or in a delayed manner, reduced intradermal temperature (cooling) and promoted more rapid healing as compared with untreated controls. Cold water compresses appeared to fare as well as melaleuca.

Reported Uses

Tea tree oil has long been used primarily as a local antiseptic. Australian aborigines used it for athlete’s foot, burns, cuts, and insect bites, among other disorders. Some studies indicate that the oil is promising as a treatment for skin problems, including acne, chronic cystitis, eczema, furuncles, bacterial and fungal infections of the skin and oral mucosa, lice infestation, psoriasis, vaginal candidiasis, and wound infections .

Melaleuca oil has also been compared with tolnaftate and clot rimazole solution for various skin conditions with some effect. A cream comprising 2% butenafine and 5% melaleuca oil was studied in patients with onychomycosis . In this double-blind, randomized, placebo-controlled study, 60 patients with onychomycosis of at least 6 months’ duration were followed for 16 weeks after initiation of therapy. The results were rather dramatic, with 80% of the treatment group cured as compared with none in the placebo group. After several additional weeks of follow-up, no improvements in either group were demonstrated but no relapses were seen. Butenafine itself has activity against several typical fungal pathogens.

Melaleuca oil has also been studied against 5% benzoyl peroxide for the treatment of acne vulgaris . More research is needed to prove its use in this area.

Preliminary information suggests a role for melaleuca in the treatment of oral thrush infections.

Dosage

Tea tree oil is applied locally in concentrations ranging from 0.4% to 100%, depending on the type of product and the nature and location of the skin disorder.

Adverse Reactions

CNS: CNS depression (ataxia, drowsiness).

EENT: stomatitis.

GI: diarrhea, GI mucosal irritation, vomiting.

Skin: dermatitis (in sensitive people).

Interactions

None reported.

Contraindications and Precautions

Use tea tree oil cautiously in patients who are hypersensitive to the components of melaleuca oil or in those who are prone to contact dermatitis from plants. Some data point to the sesquiterpenoid fraction of the oil as the allergenic agent of melaleuca . Avoid using tea tree oil in pregnant or breast-feeding patients; effects are unknown.

Special Considerations

• Monitor for worsening of skin condition or infection.
• Inform the patient that melaleuca oil is ubiquitous in commercially available products and that concentration of the oil varies greatly.
• Because essential oils are more appealing to olfactory senses and exhibit more natural appeal than available topical drugs, melaleuca may be preferred for antiseptic use. Encourage the patient to consider conventional therapy until substantial testing is done with the oil.
• Caution the patient that the oil should not be ingested and should be kept out of the reach of young children. Even small amounts of oil taken internally may produce CNS depression. A 17 -month-old child who ingested less than 10 ml of tea tree oil experienced ataxia and drowsi ness but recovered fully .
• Advise women to avoid using tea tree oil during pregnancy or when breast-feeding.

Commentary

Interest in melaleuca oil has erupted with reports of favorable in vitro antimicrobial activity against multiple pathogens (gram-negative and gram-positive bacteria, MRSA, VRE, and some fungal pathogens), suggesting many potential therapeutic topical applications. Although antimicrobial activity has been well documented in vitro, human clinical trials evaluating melaleuca’s efficacy and safety profile are still preliminary. Topical application as an antifungal appears promising, but it seems prudent not to ingest the essential oil of the plant until more is known.

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Taxonomic Class

Lauraceae

Common Trade Names

Various manufacturers provide the entire leaf or crushed leaves as a condiment. No medicinal products are known.

Common Forms

Available as berries, essential oils, extracts, and leaves.

Source

Leaves and berries of Laurus nobilis, a small tree native to the Mediterranean, are commonly used to obtain bay. Another species of bay tree grows in California; its product is more bitter and used primarily for extracts.

Chemical Components

The volatile oil contains alpha-pinene, camphene, cineole, eugenol, geraniol, limonene, linalool, phenylhydrazine, piperidine, and sabinene. Other constituents include boldine, catechins, costunolide, isodomesticine, launobine, laurenobiolide, nandergine, neolitsine, proanthocyani dins, and reticuline.

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Eugenol acts as a sedative in rodents. Cineole has shown antibacterial activity against Vibrio parahaemolyticus. In mice, costunolide has had

a hepatic microsomal enzyme inductive effect on liver glutathione stransferase enzyme . Other studies with mice suggest chemotherapeutic effects . Aqueous extracts of L. nobilis seeds reportedly demonstrated anti ulcerative properties in experiments of ethanol-induced gastritic injury of rat models . Other rat studies suggest that methanolic extracts of bay may slow gastric emptying .

Reported Uses

Because of the plant’s strong aromatic qualities, herbalists claim that bay leaves are useful for common colds. Additional claims include the use of bay as an antirheumatic, a diuretic, and a stimulant. Bay is a common ingredient in natural toothpastes because of its purported antiseptic properties. Extracted oil has been used to treat muscle sprains and strains.

Dosage

The leaves are most commonly used to season foods and, if whole, are typically removed before consumption. Bay leaves should be thoroughly dried and crushed before ingestion. Bay extracts have been applied topically or used in baths and soaks.

Adverse Reactions

GI: GI impaction, perforation.

Respiratory: asthma.

Skin: contact dermatitis.

Interactions

Insulin: Increased hypoglycemic actions (bay leaf extract). Monitor concomitant use carefully.

Contraindications And Precautions

Avoid use in pregnant or breast-feeding patients.

Special Considerations

Caution the patient that the essential oil from bay leaves should not be consumed because of the risk of allergic reaction and asthma attack.

Alert Bay leaves are largely indigestible, have sharp serrated edges, and should not be consumed intact. The leaves can become lodged in the esophagus or intestines and often require surgical removal.

Urge the diabetic patient to closely monitor blood glucose levels.

Caution the patient not to ingest whole, intact bay leaves.

Advise the female patient to avoid using bay during pregnancy or breast-feeding.

Points of Interest

Bay increases insulin’s effects more than threefold and, therefore, nutritionists recommend it to diabetic patients.

Commentary

Bay leaf is a popular seasoning, but no therapeutic claim for treating diabetes or other diseases can be clinically verified.

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