8 A Handbook of Medicinal Herbs ALEXANDRIAN SENNA (Senna alexandrina Mill.) + Synonyms — Cassia acutifolia Delile, C angustifolia Vahl, C lanceolata Forssk., C senna L Activities (Alexandrian Senna) — Antidysenteric (f; WHO); Antileukemic (1; CAN); Antispasmodic (f; PED); Bitter (f; PED); Carminative (f; WHO); Expectorant (f; WHO); Fungicide (1; JAD); Hepatoprotective (1; CAN); Laxative (1; BGB; PH2; PIP; SKY); Mutagenic (1; BGB); Peristaltic (1; PED; WHO) Indications (Alexandrian Senna) — Anemia (f; PH2); Cancer (f; JLH); Constipation (2; BGB; KOM; PH2; PIP; SKY; WHO); Cramp (f; PED); Dermatosis (f; WHO); Dysentery (1; WHO); Dyspepsia (f; WHO); Enterosis (f; PH2); Fever (f; PH2; WHO); Fungus (1; JAD); Gas (f; WHO); Gonorrhea (f; WHO); Hemorrhoid (f; BGB; PIP; WHO); Hepatosis (1; CAN; PH2); Infection (1; JAD); Jaundice (f; PH2); Leukemia (1; CAN); Mycosis (1; JAD); Ringworm (1; JAD); Splenosis (f; PH2); Typhoid (f; PH2); Wound (f; WHO) Dosages (Alexandrian Senna) — 0.5–2 g (0.5–1 tsp)/cup water (APA); 1–2 g fruit (WHO); 3–6 alexandrian or 4–12 tinnevelly pods steeped in 150 ml warm water 6–12 hours (CAN); 0.5–2 g dry leaflets (CAN); 1–2 g dry leaf (PED; WHO); g dry leaf:5 ml alcohol/5 ml water (PED); 0.5–2 ml liquid leaf extract (1:1 in 25% ethanol) (CAN); 20–30 mg hydroxyanthracene derivatives/day calculated as sennoside B (KOM); (25 mg) StX extracts 1–2 ×/day (APA); 10–60 mg sennosides (SKY) Contraindications, Interactions, and Side Effects (Alexandrian Senna) — Class 2b, 2c, 2d (AHP) Commission E and other sources report interaction of anthranoid laxatives (AEH) Anthranoid-containing laxatives can be habit-forming Some contain compounds suspected of being cytotoxic, genotoxic, mutagenic, and even tumorigenic Epidemiological studies in Germany reveal that abusers of anthranoid laxatives have three times higher rate of colon carcinoma One woman developed clubbing of her digits and hypertropic osteoarthropathy Handbook of Medicinal Herbs after taking at least three tablets daily for years for weight loss She also experienced several months of secondary amenorrhea Of senna leaf, Blumenthal et al lists abdominal pain of unknown origin, acute intestinal inflammation (e.g., Crohn’s disease and colitis ulcerosa), and appendicitis as contraindications Because of the anthraquinones, nonstandardized preparations should be avoided during pregnancy and lactation (CAN) “Anthraquinones may be secreted into breast milk” (CAN) Should not be used in lactation, pregnancy, or with children under 12 years old (KOM) Occasional cramp-like discomfort of the GI tract may require dosage reduction (KOM) Side effects with chronic abuse: disturbance of electrolyte balance, especially hypokalemia (may be exacerbated by simultaneous administration of corticoadrenal steroids, licorice root, or thiazide diuretics), leading to cardiopathy, muscular weakness especially with concurrent uses of cardiac glycosides, corticosteroids, or diuretics (KOM) Pigmentation of the intestinal mucosae (pseudomelanosis coli) is harmless and usually reverses on discontinuation of the drug Laxative like this should not be used more than 1–2 weeks without medical advice (KOM) CAN report anthraquinones are purgative and irritate GI tract Also contraindicated in hemorrhoids and nephropathy (CAN), intestinal obstruction, abdominal pain of unknown causes, any enterosis (appendicitis, colitis, Crohn’s disease, irritable bowel syndrome) hemorrhoids, nephropathy, menstruation (AHP) Do not use more than 8–10 days (AHP) Do not use this in case of abdominal pain or diarrhea Consult a health care provider prior to use in pregnancy or nursing Discontinue use if diarrhea or watery stools occur Not for long term use (AHP) “Some herbal laxative preparations, such as cascara and senna for example, can cause an increase in the potency of digoxin” (D’epiro, 1997) Pedersen (1998) cautions against taking the fresh leaf (we have done that in Peru with modest laxative results) “Senna causes gripping unless taken in combination with carminative herbs such as ginger, cloves, or various mint species.” Although GRAS, senna can be more habit-forming than cascara (PED) Lininger et al (1998) pronounce it “safe for children over the age of six” (half the adult dose) (SKY) I’d be more cautious Extracts (Alexandrian Senna) — Possibly representing a negative case for my synergy proposition, “The toxicity of total extracts is greater than that of the individual sennosides It has been proposed that the laxative and toxic components of senna could be separated” (CAN) Elsewhere, I have read that the sennosides are synergetic as far as their laxative action is concerned But then anomalously, CAN report that sennosides A and B are reported to be most potent with respect to laxative action, but the least toxic compared to other anthraquinone fractions LD50s of sennosides A & B are 4100 mg/kg ivn mus and of rhein-8-glycoside 400 mg/kg ivn mus All fractions had LD50 = >5000 mg/kg orl rat A 10 A Handbook of Medicinal Herbs ALFALFA (Medicago sativa L.) + Activities (Alfalfa) — Abortifacient (f; MAD); Alterative (f; PED); Antiatherosclerotic (1; APA); Antibacterial (1; CRC; WOI); Antiinflammatory (f; APA); Antipyretic (f; PED); Antiscorbutic (1; CRC); Antispasmodic (f; PED); Antithrombic (f; PED); Aperitif (f; CRC; SKY); Bitter (f; PED); Cardiotonic (f; CRC); Choleretic (1; PNC); Cyanogenic (f; CRC); Deobstruent (f; CRC); Depurative (f; CRC; PED); Digestive (1; PED); Diuretic (1; CRC; PED; PH2); Ecbolic (f; CRC); Emetic (f; CRC); Emmenagogue (1; CRC; FNF; UPW); Estrogenic (1; CRC; FAD; SKY); Fungicide (1; FAD); Hemolytic (f; APA); Hemostat (f; FAD); Hypocholesterolemic (f; CAN; PED); Hypoglycemic (f; PED); Lactagogue (1; CRC; FNF; UPW); Stimulant (f; CRC); Stomachic (f; CRC; PED); Tonic (f; CRC; PED) Indications (Alfalfa) — Alcoholism (f; FAD); Allergy (f; APA); Anorexia (f; CRC; FAD; SKY); Arthrosis (f; APA; CRC; FAD; MAD); Asthma (f; APA); Atherosclerosis (1; APA); Bacteria (1; CRC; FNF; WOI); Bleeding (f; FAD); Blood Clot (f; APA; PED); Boil (f; CRC); Cancer (f; FAD; JLH); Cholecystosis (f; APA); Cough (f; CRC); Cramp (f; PED); Debility (1; CAN); Diabetes (1; APA; CAN; FAD; MAD; PH2); Dyspepsia (f; APA); Dysuria (f; CRC; PED); Enterosis (f; CRC); ERT (1; FAD; FNF; SKY); Fever (f; CRC; PED); Fungus (1; FAD); Gall Bladder (1; PNC); Gastrosis (f; CRC); Gravel (f; CRC); Halitosis (1; FNF); High Cholesterol (1; APA; CAN; PED; PNC); Hyperglycemia (f; PED); Hypoprothrombinaemic Purpura (1; CAN); Indigestion (1; PED); Induration (f; MAD); Infection (1; FAD); Inflammation (f; APA); Mycosis (1; FAD); Myxedema (f; MAD); Nephrosis (f; APA; CRC); Ophthalmia (f; MAD); Otosis (f; DEM); Poor Milk Supply (1; FAD; FNF); Prostatosis (1; APA; FNF); Rheumatism (f; PED; MAD); Swelling (f; MAD); Thrombosis (f; PED); Thyroidosis (f; PHR; PH2); Water Retention (1; CRC; PED; PH2); Wound (f; MAD); Yeast (1; CAN) Handbook of Medicinal Herbs 11 Dosages (Alfalfa) — 1–2 tsp dry leaf/cup water ×/day (APA); 5–10 g/herb/day (CAN); 6–12 g/dry herb/day (PED); 5–10 ml tincture (1:1 in 25% alcohol) ×/day (CAN); 15–30 drops tincture ×/day (SF2); 3–4 (370 mg) capsules ×/day (NH); 1–2 (500 mg) capsules/day (SF); 8–9 (400–500 mg) capsules/day (SF2) Contraindications, Interactions, and Side Effects (Alfalfa) — Class (AHP) PHR is too kind with their usual template None known with proper dosage (which they don’t define) (PH2) Stachydrine and l-homostachydrine, in the seeds, may be emmenagogue and lactogenic One patient died from listerosis after ingesting contaminated alfalfa tablets (LRNP, March 1991) Seeds and/or sprouts may contain 13,000 ppm canavanine, which may be implicated in hypocomplementenemia, lupus, and pancytopenia Canavanine, a toxic amino acid, may cause systemic lupus erythematosus syndrome (CAN) Systemic lupus erythematosus (SLE)-like manifestations, skin reactions, gastrointestinal disturbances, raised serum urate levels are symptoms that have been associated with alfalfa use in humans Seeds should not be ingested during pregnancy or lactation (CAN) May cause stomach upset and diarrhea Believed by some herbalists to be helpful in delaying absorption of cholesterol and dissolving plaque deposits on arterial walls (TMA) Consumption of alfalfa tablets contaminated with Listeria monocytogenes was linked to a fatal case of listerosis One case of allergic reaction (from contamination with grass pollen) in alfalfa tablets has been reported (SF2) Flatulence, abdominal discomfort, loose stools, diarrhea, and loss of appetite may result from ingesting large amounts of alfalfa seeds (120 g/day) Extracts (Alfalfa) — Purines in seeds may raise mean serum urate levels (AEH) Porphyrins may photosensitize (PNC) Saponins decrease plasma cholesterol without changing HDL cholesterol, decrease intestinal absorption of cholesterol, increase excretion of neutral steroids and bile acids, and prevent atherosclerosis Saponins hemolytic, may interfere with vitamin E utilization Root saponins, selectively antiyeast and fungicide, also hypocholesterolemic, in monkeys (CAN) “Saponin contents act on the cardiovascular, nervous and digestive systems” (PHR) Alfalfa sprouts, not recommended, contain trace of COX-2 inhibitor apigenin (70 ppm ZMB) (COX) Forty g heattreated alfalfa seed, ×/day/8 weeks, helped normalize serum cholesterol concentrations in Type hyperlipoproteinanemia Alfalfa extracts, possibly due to the high manganese content, may reduce blood sugar, but only in patients with inability to use their stored manganese (CAN) ALISMA (Alisma plantago-aquatica L.) + Synonym — Alisma orientale (Sam.) Juz Activities (Alisma) — Antidote, opium (f; WO2); Antipyretic (f; DAA); Astringent (f; GMH; LMP); Diaphoretic (f; DAA; GMH); Diuretic (2; DAA; FAD; GMH; WO3); Hemostat (f; GMH); Hepatoprotective (1; PEP; WO3); Hypocholesterolemic (f; PEP; PH2); Hypoglycemic (f; PEP; PH2); Hypotensive (1; PH2; WO3); Irritant (1; FAD); Lactagogue (f; LMP); Lipotropic (f; PEP); Litholytic (f; WO2); Natriuretic (f; PEP); Rubefacient (1; FAD); Sterilant (f; DAA); Stomachic (f; LMP); Tonic (f; LMP); Vulnerary (f; WO2) Indications (Alisma) — Aphrodisiac (f; DAA); Ascites (f; DAA); Back (f; DEM); Beriberi (f; DAA); Bleeding (f; GMH); Bruise (f; FAD; GMH; WO2); Calculus (f; GMH); Cancer (f; WO2); Cancer, stomach (f; WO2); Cardiopathy (f; DEM); Catarrh (f; FAD); Childbirth (f; DEM); Cholecystosis (f; PHR); Chyluria (f; DAA); Constipation (f; DEM); Cramp (f; DEM); Cystosis (f; DAA); Debility (f; DEM); Diabetes (f; DAA; LMP); Diarrhea (f; FAD); Dropsy (f; DAA; LMP); Dysentery (f; GMH; WO2); Dysuria (1; DAA; FAD); Edema (1; DAA; FAD); Enterosis (f; DAA); Epilepsy (f; GMH); Fever (f; DAA; GMH); Flu (f; DEM); Frigidity (f; DAA); Gastrosis (f; DEM; WO2); Gonorrhea (f; DAA); Gout (f; WO2); Gravel (f; FAD; GMH); Heartburn (f; A 12 A Handbook of Medicinal Herbs DEM); Hematuria (f; DAA); Hepatosis (1; WO3); High Blood Pressure (1; PH2; WO3); High Cholesterol (f; PEP; PH2); Hydrophobia (f; WO2); Hyperglycemia (f; PEP; PH2); Induration (f; WO2); Infertility (f; DAA); Inflammation (f; WO2); Kidney Stone (f; DAA); Leprosy (f; DAA); Leukemia (f; WO2); Nephrosis (f; DAA); Obesity (f; PEP); Polyuria (f; DAA); Rhinosis (f; FAD); Snakebite (f; GMH); Sore (f; WO2); Stomachache (f; DEM); Stone (f; DAA; WO2); Swelling (f; DAA; FAD; GMH); Toothache (f; WO2); Tuberculosis (f; DEM); Urethrosis (f; PHR); UTI (f; PHR; WO3); VD (f; DAA; LMP); Venosis (f; DEM); Vertigo (f; WO3); Water Retention (2; DAA; FAD; GMH; WO3); Wound (f; FAD; WO2) Contraindications, Interactions, and Side Effects (Alisma) — Class 2d Prolonged use may cause GI irritation and gastroenterosis (AHP) Doses 20–40 times higher than clinical dose hepatotoxic and nephrotoxic in rats (AHP).“Hazards and/or side effects not known for proper therapeutic dosages” (PH2) (but PH2 designates no specific quantified dosage! JAD) Rhizome, most often used as a diuretic, should not be used when there is a clear, thin vaginal discharge May cause more than usual excretion of sodium and urea in healthy subjects (TMA) LD50 = >4 g/kg orl mouse (LMP) ALKANET, ALKANNA, DYER’S ALKANET (Alkanna tinctoria Tausch) X Synonyms — A lehmanii (Tineo) A DC., A tuberculata (Forssk.) Meikle, Anchusa bracteolata Viv., A tuberculata Forssk., Lithospermum lehmanii Tineo Activities (Alkanet) — Amebicide (1; FNF); Antibacterial (1; PHR); Antiseptic (1; PH2; PNC); Astringent (1; LAF; PNC); Candidicide (1; PHR; PH2); Carcinogenic (1; FNF; PHR; PH2); CNSDepressant (1; FNF); Curare (1; FNF); Emollient (f; EFS); Genotoxic (1; CAN; FNF); Hepatotoxic (1; CAN; PHR; PH2); Immunomodulator (1; LAF); Immunosuppressant (1; LAF); Neurotoxic (1; FNF); Paralytic (1; FNF); Vulnerary (f; BIS; PNC) Indications (Alkanet) — Abscess (f; LAF); Ameba (1; FNF); Bacteria (1; PH2); Burn (1; FNF); Cancer (1; FNF; JLH); Cancer, uterus (1; FNF; JLH); Candida (1; PHR; PH2); Decubitis (1; FNF); Dermatosis (f; PHR; PH2); Diarrhea (f; PHR; PH2); EBV (1; FNF); Indolent Ulcer (1; PH2; PNC); Induration (f; JLH); Inflammation (1; FNF); Leukemia (1; FNF); Snakebite (f; PNC); Sore (1; LAF); Staphylococcus (1; PH2); Ulcus cruris (2; PHR); Uterosis (f; JLH); Virus (1; FNF); Wound (1; PH2); Yeast (1; PHR; PH2) Dosages (Alkanet) — No more than 0.1 µg pyrrolizidine alkaloids with 1.2 necine framework and their N-oxides (PH2) Contraindications, Interactions, and Side Effects (Alkanet) — AHP Class 2a, 2b, 2c, 2d Longterm use discouraged Contains pyrrolizidine alkaloids (PAs) Effective July 1996, the AHP Board of Trustees recommends that all products with botanical ingredient(s) that contain toxic PAs, including Borago officinalis, display the following cautionary statement on the label: “For external use only Do not apply to broken or abraded skin Do not use when nursing” (AHP) PAs are genotoxic, carcinogenic, and hepatotoxic (CAN) Due to the PAs, alkanet use in pregnancy and lactation is to be avoided (JAD) Consolicine & Consolidine: CNS-Paralytic (3 × cynoglossine) (PHR) Dietary alkannin for 15 weeks at 1% of diet nontoxic in mice (LAF) Shikonin immunomodulatory at low doses, immunosuppressant at high doses .. .Handbook of Medicinal Herbs after taking at least three tablets daily for years for weight loss She also experienced several months of secondary amenorrhea Of senna leaf, Blumenthal... fractions LD50s of sennosides A & B are 4100 mg/kg ivn mus and of rhein-8-glycoside 400 mg/kg ivn mus All fractions had LD50 = >5000 mg/kg orl rat A 10 A Handbook of Medicinal Herbs ALFALFA (Medicago... Thyroidosis (f; PHR; PH2); Water Retention (1; CRC; PED; PH2); Wound (f; MAD); Yeast (1; CAN) Handbook of Medicinal Herbs 11 Dosages (Alfalfa) — 1–2 tsp dry leaf/cup water ×/day (APA); 5–10 g/herb/day