Handbook of Medicinal Herbs 213 Erysipelas (f; GMH; MAD); Escherichia (f; HH2); Fever (f; CRC; DAA; MAD; PIP); Flu (f; CRC; DAA; LMP; MAD; PHR); Fistula (f; HAD); Gastrosis (f; CRC; FEL); Headache (f; CRC; FEL); Hematemesis (f; HAD); Hemoptysis (f; CRC; DAA; LMP); Hoarseness (2; APA; KOM; MAD; PIP); Immunodepression (1; CAN); Induration (f; CRC; JLH); Infection (1; CRC); Inflammation (2; CAN; FAD; KOM; PH2); Laryngosis (1; CAN; FEL); Low Blood Pressure (1; APA); Mucososis (2; CRC; FAD; KOM; PH2); Neurosis (f; CRC); Nicotinism (f; PH2); Ophthalmia (f; CRC); Pertussis (f; CAN; FEL); Pharyngosis (2; KOM; PH2; PIP); Phthisis (f; CRC; DAA); Plethora (f; CRC); Pleurosis (f; MAD); Pulmonosis (f; CRC; FAD); Respirosis (2; KOM; 2; PIP); Rheumatism (f; CRC; PH2); Rhinosis (f; CRC; FEL); Scrofula (f; CRC; FEL; GMH); Sinusosis (f; CRC); Sore Throat (f; PHR; PIP); Stomatosis (2; APA; PHR; PH2; PIP); Swelling (1; CAN; CRC; HH2; MAD); Tonsillosis (f; PHR; PIP); Tracheosis (f; MAD); Tuberculosis (f; CRC; DAA; DEM; MAD); Tumor (f; CRC); Wart (f; MAD); Water Retention (f; CRC; PIP) Dosages (Coltsfoot) — tsp powdered leaf/cup water (APA; WIC); 0.3–0.6 g solid leaf extract (PNC); 2–4 ml liquid leaf extract (PNC); 4.5–6 g leaf, 0.6–2.0 ml liquid extract (1:1 in 25% ethanol) ×/day (CAN); 0.6–2.0 g herb as tea ×/day (CAN); 2–8 ml tincture (1:5 in 45% alcohol) ×/day (CAN); 2–8 ml syrup (1:4 liquid extract in syrup) ×/day (CAN); g root as diaphoretic (MAD); 1.5–2.5 g leaf or flower/cup tea, to g day (PH2); 0.6–2 ml liquid flower extract (PNC) Contraindications, Interactions, and Side Effects (Coltsfoot) — Class 2b, 2d (flower); longterm use discouraged 2b, 2c, 2d (leaf); not exceed recommended dose; not for long-term use (AHP) Commission E reports flower, herb, root not permitted for therapeutic use Contains hepatotoxic pyrrolizidine alkaloids (PAs) in all plant parts Leaf is permitted for oral use Contraindications in pregnancy and lactation CAN cautions that the PAs are genotoxic, carcinogenic, and hepatotoxic Because of the PAs, coltsfoot use in pregnancy and lactation is to be avoided (CAN) Dosage maximum 10 g PA/day (herbal tea) or maximum g PA/day (extracts, expressed sap) for maximum 4–6 weeks/year (AEH) Commission E advises not to take more than to weeks of the year at 4.5 to g/day This is the only herb (1.5–6 g leaf/day) except related Petasites with toxic PAs still tolerated by Commission E Still, CAN cautions that coltsfoot is phototoxic in guinea pig skin In guinea pig sensitization experiments, it showed weak allergenic capacity, possibly due to the sesquiterpene lactones present in the plant PAs are toxic to humans, with liver damage with cirrhosis and ascites, or seneciosis, or veno-occlusive disease (VOD) reported in almost all cases of severe or fatal intoxications, from intakes of 0.5 mg/kg to 3.3 mg/kg (AEH1) 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) Canadians not allow in food (Blackburn, 1993) Bisset says there is no danger of acute poisoning when used as prescribed (Bisset, 1994) Hepatotoxicity of coltsfoot may be due to senkirkine (~150 ppm), highlighting the dangers of chronic exposure to even low doses of PAs Rats fed more than 4% coltsfoot in their diet develop hepatic tumors Newborn rats are more susceptible than weanlings to hepatotoxicity of senkirkine despite lacking the hepatic microsomal enzymes required to produce the toxic pyrrholic metabolites Fatal hepatic venoocclusive disease was documented in a newborn infant whose mother chronically consumed herb teas during pregnancy (coltsfoot and senecio specified) The mother exhibited no signs of hepatic damage again suggesting increased sensitivity of the fetal liver to PA toxicity Animal studies document placental transfer and secretion into breast milk of unsaturated PAs (CAN) Excessive doses may interfere with blood pressure and heart therapy (CAN) C 214 Handbook of Medicinal Herbs COLUMBINE (Aquilegia vulgaris L.) + C Activities (Columbine) — Astringent (f; CRC); Cholagogue (f; MAD; PHR); Collyrium (f; MAD); Cyanogenic (f; PH2); Diaphoretic (f; CRC; WO2); Diuretic (f; CRC; WO2); Emmenagogue (f; CRC); Litholytic (f; MAD); Narcotic (f; CRC); Oxytocic (f; WO2); Poison (1; HH2); Resolvent (f; CRC); Tranquilizer (f; HH2; PHR; PH2) Indications (Columbine) — Agitation (f; PHR; PH2); Cancer, breast (f; CRC; JLH); Cancer, stomach (f; CRC; JLH); Cancer, uterus (f; CRC; JLH); Cholecystosis (f; PHR); Debility (f; MAD); Dermatosis (f; HH2; MAD; WO2); Dropsy (f; MAD); Dysmenorrhea (f; CRC; HH2; MAD; PH2); Eczema (f; CRC); Enterosis (f; PHR); Erysipelas (f; MAD); Fever (f; CRC; WO2); Fistula (f; CRC; HH2); Fracture (f; MAD); Gastrosis (f; PHR); Globus Hystericus (f; PH2); Halitosis (f; MAD); Headache (f; MAD); Hepatosis (f; CRC; MAD); Hysteria (f; CRC; PH2); Insomnia (f; CRC; MAD); Jaundice (f; CRC; HH2; MAD; PHR; PH2); Measles (f; MAD); Menopause (f; PH2); Nervousness (f; HH2; MAD; PHR; PH2); Ophthalmia (f; CRC; HH2); Pertussis (f; MAD); Pharyngosis (f; WO2); Photosensitivity (f; MAD); Psoriasis (f; MAD); Rash (f; MAD); Respirosis (f; MAD); Scurvy (1; PHR; PH2); Sore (f; CRC); Sore Throat (f; CRC; WO2); Splenosis (f; MAD); Stomatosis (f; CRC; HH2; WO2); Stone (f; CRC; MAD); Syncope (f; MAD); Tremor (f; CRC); Uterosis (f; CRC); Water Retention (f; CRC; WO2); Wound (f; MAD) Dosages (Columbine) — Only homeopathic doses given (PH2) Contraindications, Interactions, and Side Effects (Columbine) — Not covered (AHP) None known (PHR) “Hazards and/or side effects not known for proper therapeutic dosages” (PH2) Poisoning due to HCN not observed (PHR) Human fatalities reported (LEL) COMFREY (Symphytum spp.) + Most contributors cited S officinale but few studies are vouchered and the species are difficult to determine Activities (Comfrey) — Alterative (f; CRC); Analgesic (1; CAN); Antiaging (f; CRC); Antihemorrhagic (f; CAN); Antiinflammatory (2; APA; KOM; PH2; WAM); Antileukocyte (1; PH2); Antimitotic (1; PHR; PIP); Antimutagenic (1; PNC); Antipsoriatic (1; PNC); Antitumor (1; FAD); Astringent (1; APA; FAD; FEL; PNC); Callus-Promoter (1; PHR); Carcinogenic (1; APA; CRC); Demulcent (1; CAN; FEL; PH2; WAM); Emollient (1; CRC; WAM); Expectorant (f; CRC; MAD); Hemostat (f; CRC); Hepatotoxic (1; APA); Hypotensive (1; PH2); Tonic (f; FAD); Uterotonic (1; CAN); Vulnerary (1; APA; CAN; WAM) Indications (Comfrey) — Adenopathy (f; CRC); Amenorrhea (f; CRC); Anemia (f; FEL); Angina (f; PHR); Arthrosis (1; CRC; PNC; PH2); Asthma (f; CRC); Backache (f; CRC); Bleeding (1; APA; CAN; CRC; MAD); Bronchosis (1; APA; CRC; FAD); Bruise (2; APA; FAD; KOM; PH2; SHT); Bug Bite (1; APA); Cancer (1; CRC; FAD; FNF; PNC); Cancer, bone (f; CRC); Cancer, lung (1; CRC; FNF); Candida (f; CRC); Catarrh (f; MAD); Chafing (1; APA); Cholecystosis (f; CRC); Colitis (1; APA; CAN); Congestion (f; APA); Constipation (f; DEM); Contusion (f; PIP); Cough (f; CRC; FAD); Debility (f; FEL); Decubitis (1; APA; JAD); Dermatosis (1; APA; FAD); Diabetes (f; MAD); Diarrhea (f; FAD; MAD; PH2); Duodenal Ulcer (2; CAN); Dysentery (f; CRC; DEM; FAD); Dysmenorrhea (f; CRC; MAD); Dyspepsia (f; APA); Eczema (1; PNC); Enterosis (1; CRC; PHR; PH2); Epicondylosis (1; PH2); Fracture (1; APA; CAN; WAM); Gallstone (f; CRC); Gastrosis (1; CRC; PHR; PH2); Gastric Ulcer (f; CAN); Gingivosis (1; APA; PHR; PH2); Gonorrhea (f; DEM; MAD); Gout (f; CRC); Heartburn (f; DEM); Hematemesis (f; CAN; FAD); Hematochezia (f; CRC); Hemoptysis (f; MAD); Hemorrhoid (f; MAD); Hepatosis (f; CRC); Hernia (f; CRC); High Blood Pressure (1; PH2); Hoarseness (f; CRC); Hysteria (f; Handbook of Medicinal Herbs 215 FAD); Indolent Ulcer (2; JAD); Inflammation (2; APA; CAN; KOM; PH2; WAM); Itch (f; APA); Leukorrhea (f; CRC; MAD); Mastosis (1; FAD; FEL); Metrorrhagia (f; FEL); Myosis (1; WAM); Nephrosis (f; CRC; MAD); Ophthalmia (f; CRC); Osteosis (f; PH2); Pain (1; CAN); Pertussis (f; CRC); Pharyngosis (1; PHR; PH2); Phthisis (f; MAD); Pleurosis (f; PHR; PH2); Psoriasis (1; APA; PNC); Pulmonosis (f; CRC); Rash (1; APA); Respirosis (f; MAD); Rheumatism (1; CRC; PH2; PNC); Scrofula (f; CRC; FEL); Sore Throat (f; CRC; PH2); Sprain (2; CRC; KOM; PH2; SHT); Stomatosis (f; CRC); Strain (1; APA; SHT); Sunburn (f; APA); Swelling (f; MAD); Tendovaginosis (1; PH2); Tonsilosis (f; CRC); Tuberculosis (f; MAD); Tumor (1; FAD); Ulcer (f; CRC; MAD); Ulcus cruris (1; FNF; MAD);Vaginosis (f; CRC; PH2); Varicosis (f; PED); VD (f; DEM); Wound (1; APA; CAN; MAD); Yeast (f; CRC) Dosages (Comfrey) — Do not use (APA); not use root (JAD); 2–4 g root as tea ×/day (CAN); tsp (= ~7.4 g) root in hot tea (MAD); 2–4 ml liquid root extract (PNC); 2–4 ml liquid extract (1:1 in 25% ethanol) ×/day (CAN); 2–8 ml liquid leaf extract (1:1 in 25% alcohol) ×/day (CAN); 2–8 g leaf in tea ×/day (CAN); 0.25–0.5 cup fresh leaf (PED); 6–12 g dry leaf (PED); g dry leaf:45 ml alcohol/45 ml water (PED); 1–3 cups tea/day (5–10 g herb) remembering PAs (PH2) Contraindications, Interactions, and Side Effects (Comfrey) — Class 2a, 2b, 2c, 2d Longterm use discouraged (AHP) Commission E reports the herb, leaf, and root permitted for external use only Skin should be intact and pregnant users should first consult physician External dosage of pyrrolizidine alkaloids (PAs) maximum 100 g/day for a maximum 4–6 weeks/year (AEH) Comfrey root may cause liver damage if taken internally (WAM) Contains PAs Internal use may cause severe hepatic damage PAs are toxic to humans, with liver damage with cirrhosis and ascites, or seneciosis, or veno-occlusive disease (VOD) reported in almost all cases of severe or fatal intoxications, from intakes of 0.5 mg/kg to 3.3 mg/kg (AEH1) Chronic comfrey use implicated in at least one instance of hepatic VOD (PNC) 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) CAN cautions the PAs are genotoxic, carcinogenic, and hepatotoxic Because of the PAs, its use in pregnancy and lactation is to be avoided Animal studies document placental transfer and secretion into breast milk of unsaturated PAs (CAN) May speed up metabolism of other drugs (stimulates metabolism of aminopyrine-N-demethylase, a drug metabolizing enzyme) (CAN) Internal use for more than 4–6 weeks is discouraged (SHT) Canadians not allow in food (Blackburn, 1993) “No human being or animal should eat, drink, or take comfrey in any form” (Br Med J 6163: 596; 1979) According to studies reported in the Lawrence Review of Natural Products, rats fed comfrey roots or leaves for 600 days developed hepatocellular adenomas, with signs of liver toxicity developing within 180 days Urinary bladder tumors developed also, even in those on the lowest levels of comfrey The incidence of liver tumors was higher with dietary roots than with dietary comfrey leaves Alkaloids of Russian comfrey caused chronic liver damage and pancreatic islet cell tumors after years administration in animal models (LRNP, October 1990) Extracts (Comfrey) — Extracts antiinflammatory in vitro and in vivo, perhaps due to rosmarinic acid (PNC) Allantoin a well known dermatological agent (PNC) Aqueous extract stimulates release of prostaglandin-like material from rat gastric mucosa (PNC) Two nonhepatotoxic PAs, platyphylline and sarracine, have been used for GI hypermotility and peptic ulceration Yes, aqueous extracts increase survival time of mice with spontaneous tumors, and decrease tumor growth, and have antimutagenic activity (PNC) Is comfrey more likely to cause, cure, or prevent cancer? This is what we really should be studying C 216 Handbook of Medicinal Herbs COMMON BUCKTHORN (Rhamnus cathartica L.) + C Activities (Common Buckthorn) — Antitumor (1; FNF; HOX; PNC); Collyrium (f; DEM); Depurative (f; HHB; MAD; PHR; PH2); Diuretic (f; EFS; HHB; MAD; PHR; PH2); Emetic (f; EFS); Laxative (2; DEM; EFS; KOM; PNC); Peristaltic (f; PHR) Indications (Common Buckthorn) — Anemia (f; MAD); Appendicitis (f; MAD); Asthma (f; MAD); Cachexia (f; MAD); Cancer (1; FNF; HOX; JLH; PNC); Chlorosis (f; MAD); Colic (f; MAD); Constipation (2; EFS; KOM; PHR; PH2; PNC); Diarrhea (f; MAD); Dropsy (f; MAD); Exanthema (f; MAD); Gout (f; MAD); Hemorrhoid (2; KOM; PHR; PH2); Herpes (f; MAD); Itch (f; DEM); Nausea (f; MAD); Obesity (f; MAD); Ophthalmia (f; DEM); Proctosis (f; PH2); Rheumatism (f; MAD); Sore (f; MAD); Stomatosis (f; MAD); Tumor (1; FNF; HOX; PNC); Uremia (f; MAD); Water Retention (f; EFS; HHB; HH2; MAD; PHR; PH2) Dosages (Common Buckthorn) — 0.6–5 g fruit (HHB); 0–20 berries (MAD); 15–30 g juice; children 0.5–1 tsp syrup (MAD); g dry fruit/cup tea, 2–5 g drug/day corresponding to 20–30 mg hydroxyanthracene (calculated as glucofrangulin A) (PH2); 2–4 ml buckthorn berry syrup (PNC) Contraindications, Interactions, and Side Effects (Common Buckthorn) — Class 2b (AHP) Commission E reports for fruit, contraindications, adverse effects, and interactions of anthranoid laxatives (AEH) Contraindicated in obstruction of the bowel or intestines, acute inflammation of the bowels as in appendicitis, colitis, and Crohn’s disease Do not use if under 12 years of age, or pregnant (KOM; PH2) See anthranoids in introductory section Berry extract induce tumor necrosis in mice (PNC) Handbook of Medicinal Herbs 217 COMMON DAFFODIL (Narcissus pseudonarcissus L.) X C Activities (Common Daffodil) — Antimitotic (1; HHB); Antispasmodic (f; FEL; GMH); Aphrodisiac (f; GMH); Astringent (f; EFS); Cardiotoxic (1; EFS); Depurative (f; EFS); Emetic (f; EFS; HHB); Emmenagogue (f; EFS); Mydriatic (f; FEL); Narcotic (f; EFS; GMH); Paralytic (f; EFS); Poison (1; EFS; GMH; PH2) Indications (Common Daffodil) — Alopecia (f; GMH); Asthma (f; PH2); Bronchosis (f; GMH; HHB; PH2); Cancer (f; JLH); Cancer, uterus (1; FNF; JLH); Catarrh (f; FEL; GMH; PH2); Chorea (f; FEL); Cold (f; PH2); Cramp (f; FEL; GMH); Diarrhea (f; FEL; HHB); Dysentery (f; FEL; GMH); Epilepsy (f; FEL; GMH); Fever (f; FEL); Hysteria (f; FEL; GMH); Induration (f; JLH); Malaria (f; FEL); Mucososis (f; PH2); Pertussis (f; HHB; PH2); Rheumatism (f; FEL); Rhinosis (f; HHB); Sore (f; HHB); Swelling (f; JLH); Tumor (1; HHB); Uterosis (f; JLH); Worm (f; FEL) Dosages (Common Daffodil) — 1/4 to 10 drops tincture (bulb macerated in 98% ethanol) (FEL); 10–60 grains powdered flower or bulb (FEL) Contraindications, Interactions, and Side Effects (Common Daffodil) — Not covered (AHP) “Hazards and/or side effects not known for proper therapeutic dosages” (PH2) (but PH2 designates no specific quantified dosage! JAD) Potentially allergenic Intoxication (confused with onion bulbs) can cause CNS disorders, diarrhea, GI irritation, salivation, and vomiting (FEL; PH2) COMMON GROMWELL (Lithospermum officinale L.) X Activities (Common Gromwell) — Antiestrogenic (1; WOI); Antigonadotropic (1; WOI); Antithyroid (f; WOI); Contraceptive (1; WOI); Depurative (f; WOI); Diuretic (f; CEB; EFS); Litholytic (f; EFS; WOI); Sedative (f; WOI) ... not use if under 12 years of age, or pregnant (KOM; PH2) See anthranoids in introductory section Berry extract induce tumor necrosis in mice (PNC) Handbook of Medicinal Herbs 217 COMMON DAFFODIL... CRC); Hernia (f; CRC); High Blood Pressure (1; PH2); Hoarseness (f; CRC); Hysteria (f; Handbook of Medicinal Herbs 215 FAD); Indolent Ulcer (2; JAD); Inflammation (2; APA; CAN; KOM; PH2; WAM); Itch... likely to cause, cure, or prevent cancer? This is what we really should be studying C 216 Handbook of Medicinal Herbs COMMON BUCKTHORN (Rhamnus cathartica L.) + C Activities (Common Buckthorn) — Antitumor