Adverse effects: Underline = life-threatening
B
Primary Chemical Components and Possible Actions—cont’d Chemical Class Individual Component Possible ActionMagnofl orine; Anagyrine;
Baptifoline; Ubiquitous
Uterine stimulant Thalictroidine; Lupanine;
Sparteine
Saponin Caulosaponin; Cauloside Uterine stimulant (Satchithanandam, 2008)
Phosphoric acid Phytosterol
Client Considerations Assess
• Assess cardiac status (blood pressure; pulse, including character, rate, and rhythm). Assess for the use of all medications (see Interactions).
• Assess diabetic clients for hypoglycemia; check glucose levels.
• Assess for toxicity; look for signs similar to those of nicotine poisoning (tachycar-dia, diaphoresis, abdominal pain, vomiting, muscle weakness, fasciculations).
Administer
• Ensure that commercial preparations are taken in the correct dosage.
Teach Client/Family
• Inform the client that pregnancy category is 6 and breastfeeding category is 5A.
• Caution the client to keep blue cohosh products out of the reach of children because the seeds are poisonous to them.
• Advise the client not to use nicotine products while using blue cohosh. The effects of nicotine will be increased.
Blue Flag
(blew fl ag)
Scientifi c name: Iris versicolor
Other common names: Dagger fl ower, dragon fl ower, fl ag lily, fl eur-de-lis, fl ower-de-luce, liver lily, poison fl ag, snake lily, water fl ag, wild iris Origin: Blue fl ag is a perennial found in the wetlands of the United States.
Uses
Blue fl ag is used primarily for its antimicrobial effects. It is also used for its laxative side effect and its emetic and diuretic properties. Blue fl ag is used topically to treat sores, bites, and bruises.
Actions
Most of the information available on the actions of blue fl ag is based on anecdotal evidence rather than primary research. The anecdotal evidence focuses on the
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100 Blue Flag
= Pregnancy = Pediatric = Alert = Popular Herb use of this herb as a laxative and an antiinfl ammatory. The tannins may be respon-sible for these actions. Irilon and irisolone may cause a laxative effect. Because of the toxicity of this herb, the unsupervised internal use of blue fl ag is not recommended.
Product Availability
Extract: 0.5-1 fl uid drams (2.5-5 ml); powdered root: 20 grains (1300 mg); solid extract: 10-15 grains (650-975 mg); tincture: 1-3 fl uid drams (5-15 ml) Plant Parts Used: Rhizome with roots
Dosages Laxative
• Adult PO powdered root: 10-20 grains one-time dose
• Adult PO tincture: 1⁄2-3 fl uid drams one-time dose Other
• Adult topical powdered root: make poultice, apply prn
Contraindications
Pregnancy category is 2; breastfeeding category is 2A.
Blue fl ag should not be given to children. It is contraindicated in all but small doses.
Side Effects/Adverse Reactions CNS: Headache
EENT: Mucous membrane irritation, soreness GI: Nausea, vomiting, anorexia, hepatotoxicity SYST: Death by poisoning
Interactions Drug
Anticoagulants, antiplatelets, salicylates: Blue fl ag may increase risk for bleeding.
Antihypertensives, ganglionic or peripheral adrenergics: Blue fl ag may increase the effect of these products.
Barbiturates, beta-blockers, sedative/hypnotics: Blue fl ag’s effect may be decreased.
Cardiac glycosides (digoxin): Use with blue fl ag may lead to increased side effects (Jellin et al, 2008).
Diuretics: Use with blue fl ag may lead to hypokalemia (Jellin et al, 2008).
Herb
Aloe, buckthorn, cascara, castor, horsetail, licorice, podophyllium, senna, yellow dock: Use with blue fl ag may lead to hypokalemia.
Lab Test
Blood glucose, INR, PT: Blue fl ag may increase blood glucose, INR, PT levels.
Potassium: Blue fl ag may decrease potassium levels.
Bogbean 101
Adverse effects: Underline = life-threatening
B
Primary Chemical Components and Possible ActionsChemical Class Individual Component Possible Action Volatile oil Furfural
Triterpene Irigermanal
Glycoside Irilon; Irisolone Laxative
Xanthone Irigenin; Tectoridine Flavonoid
Starch
Tannin Wound healing;
antiinfl ammatory Gum
Client Considerations Assess
• Assess for severe nausea and vomiting.
• Assess for irritation or soreness of the mucous membranes.
• Assess for toxicity.
Administer
• Instruct the client to take blue fl ag PO to treat constipation. Dosages for other uses are not documented.
Teach Client/Family
• Inform the client that pregnancy category is 2 and breastfeeding category is 2A.
• Caution the client not to give blue fl ag to children.
• Advise the client not to use blue fl ag internally except under the direction of a competent herbalist and not to use it topically near mucous membranes.
Bogbean
(bahg’been)
Scientifi c name: Menyanthes trifoliata
Other common names: Buckbean, marsh trefoil, water shamrock Origin: Bogbean is found in the wetlands of the United States and Europe.
Uses
Bogbean is used as an antiinfl ammatory, and to treat anorexia and gastrointestinal distress.
Actions
Very limited primary research exists on bogbean. One study researched its analgesic effect, postulating that bogbean decreases prostaglandin synthesis (Huang et al, 1995). Two chemical components of bogbean, caffeic acid and ferulic acid, have been identifi ed as bile stimulants. Antiinfective properties have also been identifi ed
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102 Bogbean
= Pregnancy = Pediatric = Alert = Popular Herb (Bishop et al, 1951). In addition, anecdotal information suggests that bogbean stimulates the appetite and gastric juices. Immunomodulating polysaccharide frac-tions were identifi ed in bogbean (Kudik-Jaworska, 2004).
Product Availability Dried leaf, fl uid extract, tincture Plant Part Used: Leaves Dosages
• Adult PO dried leaf: 1.5-3 g (Blumenthal, 1998) prepared as tea, used as often as tid
• Adult PO fl uid extract: 1-2 ml (1:1 dilution) tid with 8 oz water
Contraindications Class 2d herb.
Because uterine stimulation can occur, bogbean should not be used during preg-nancy. Until more research is available, this herb should not be used during breastfeeding. Bogbean should not be given to children.
Side Effects/Adverse Reactions GI: Nausea, vomiting, anorexia
SYST: Bleeding, hemolysis (if taken with anticoagulants, NSAIDs, antiplatelets)
Interactions Drug
Antacids, H2 antagonists, proton pump inhibitors: Bogbean decreases the effect of these products.
Anticoagulants, antiplatelets, aspirin, NSAIDs: Use of bogbean with anticoagulants, antiplatelets, aspirin, and NSAIDs may increase the risk of bleeding;
do not use concurrently.
Laxatives, stimulants: Bogbean may increase the effect of these products.
Herb
Angelica, anise, arnica, boldo, capsicum, celery, chamomile, clove, danshen, fenugreek, feverfew, garlic, ginger, ginkgo, horse chestnut, horseradish, licorice, meadowsweet, prickly ash, onion, papain, passionfl ower, poplar, red clover, turmeric, wild carrot, willow: Use with bogbean may increase risk for bleeding (Jellin et al, 2008).
Lab Test
Hemoglobin: Bogbean may decrease hemoglobin levels.
Primary Chemical Components and Possible Actions Chemical Class Individual Component Possible Action Acid Caffeic acid; Ferulic acid
Chlorogenic acid;
Salicylic acid; Vanillic acid; Folic acid;
Palmitic acid
Bile stimulant
Boldo 103
Adverse effects: Underline = life-threatening
B
Chemical Class Individual Component Possible Action Alkaloid Gentianin; Gentianidine;
Choline
Flavonoid Quercetin Antiinfl ammatory
Rutin
Hyperin; Kaempferol;
Trifolioside
Antioxidant;
immunomodulating (Kudik-Jaworska, 2004) Coumarin
Scopoletin Iridoid Carotene Ceryl alcohol
Primary Chemical Components and Possible Actions—cont’d
Client Considerations Assess
• Assess for bleeding. Determine whether the client is also taking aspirin, NSAIDs, anticoagulants, or antiplatelets, all of which will increase the risk of bleeding.
• Assess for pain and infl ammation. Determine whether the client is taking bogbean to treat these conditions.
Administer
• Instruct the client to store bogbean in a cool, dry place, away from heat and moisture.
Teach Client/Family
• Because uterine stimulation can occur, caution the client not to use bogbean dur-ing pregnancy. Until more research is available, caution the client not to use bog-bean during breastfeeding.
• Do not give bogbean to children.
• Advise the client to avoid using bogbean with other medications that can cause bleeding: aspirin, anticoagulants, antiplatelets, NSAIDs.
Boldo
(bole’doe)
Scientifi c names: Boldea boldus, Peumus boldus
Other common names: Boldea, boldine, boldo-do-Chile, boldus Origin: Boldo is an evergreen found in Chile, Peru, and Morocco.
Uses
Boldo is used as a laxative, liver tonic, and sedative. It is also used to treat spastic conditions of the gastrointestinal tract, fl atulence, gout, dysmenorrhea, colds, and weakness.
104 Boldo
= Pregnancy = Pediatric = Alert = Popular Herb Investigational Uses
Research is ongoing into the use of boldo as a treatment for gallstones.
Actions
Although boldo has been used to treat various conditions in many parts of the world, its actions are not well researched. Boldo is thought to possess diuretic, anthelmin-tic, and hepatoprotective actions. The tannins are responsible for wound healing and antiinfl ammatory actions. However, very little primary research is available to con-fi rm these actions.
Diuretic Action
Boldo has been shown to possess diuretic effects. In a study of dogs given boldo, urine excretion increased by 50% (Speisky et al, 1994).
Anthelmintic Action
One of the chemical components of boldo, the volatile oil, ascaridole, exhibits anthelmintic activity.
Other Actions
Boldo may exert antioxidant, hepatoprotective, and antiinfl ammatory activity. How-ever, little research currently exists to confi rm these possible actions. Boldo has shown uterine stimulant effects and teratogenic effects in rats (Almedia, 2000). Only one study (Lanhers et al, 1991) could be found to confi rm these effects. This study used an in vitro technique in mice. Boldine, the main alkaloid, appears to possess a hepatoprotective action but does not possess antiinfl ammatory action.
Product Availability Extract, tea, tincture Plant Part Used: Leaves Dosages
Do not exceed recommended dosage.
• Adult PO: 0.2-3 g dried leaves daily
• Adult PO: 60-200 mg of dried leaf tid or as a tea tid (Jellin et al, 2008)
• Adult tincture: 1.5-6 ml/day (1:5); 1.8-6 ml/day (1:10)(Mills, Bone, 2005)
• Adult liquid extract: 0.7-2 ml/day (1:2) (Mills, Bone, 2005)
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Contraindications
Pregnancy category is 7; breastfeeding category is 5A.
Boldo should not be given to children. Persons with neurologic or respiratory disease, renal disease, obstruction of the bile duct, or severe hepatic disease should avoid the use of boldo. Persons with gallstones should use this herb cautiously.
Side Effects/Adverse Reactions Very high doses
CNS: Paralysis, exaggerated refl exes, convulsions, coma, death RESP: Respiratory depression
Interactions Drug
Anticoagulants, antiplatelets: Boldo given with anticoagulants, antiplate-lets can lead to increased risk of bleeding (Jellin et al, 2008).
CNS depressants: Boldo may increase the effect of these products.
Boneset 105
Adverse effects: Underline = life-threatening
B
Primary Chemical Components and Possible ActionsChemical Class Individual Component Possible Action Isoquinolone
alkaloid
Boldine; Isoboldine;
Reticuline
Antispasmodic; diuretic;
antiinfl ammatory;
antipyretic; antioxidant Flavonoid
Volatile oil Ascaridole; thymol;
transverbenol
Anthelmintic Coumarin
Resin
Tannin Wound healing;
antiinfl ammatory
Client Considerations Assess
• Assess for central nervous system reactions and respiratory depression. If either is present, discontinue use of this herb.
Administer
• Instruct the client to store boldo in a cool, dry place, away from heat and moisture.
Teach Client/Family
• Inform the client that pregnancy category is 7 and breastfeeding category is 5A.
• Caution the client not to use boldo in children. Keep boldo products out of the reach of children because this herb is toxic in high doses.
• Advise the client to avoid the use of boldo if central nervous system disorder, respiratory disorder, or severe hepatic disease is present.
Boneset
(bown’seht)
Scientifi c name: Eupatorium perfoliatum
Other common names: Agueweed, crosswort, eupatorium, feverwort, Indian sage, Joe-pye-weed, sweating plant, thoroughwort, vegetable antimony
Origin: Boneset is a perennial found in the wetlands of the United States and Canada.
Uses
Boneset is used to treat fever, bronchitis, and infl uenza. It is also used as a sedative, a laxative, and an expectorant.
Investigational Uses
Beginning research has shown antiinfl ammatory, immunostimulant, and wound-healing properties of boneset. Also, it has the possibility of a weak antibacterial
!
106 Boneset
= Pregnancy = Pediatric = Alert = Popular Herb action against gram-positive organisms, action against some parasitic infections, and a cytotoxic response.
Actions
The fl avonoids may be responsible for wound healing and antiinfl ammatory proper-ties. Pyrrolizidine alkaloids are hepatotoxic when used over a long period of time or in high doses. Several other chemical components of boneset have been identifi ed, but the action is unknown.
Immunostimulant Action
One study demonstrated that the chemical components of boneset increase both granulocytes and mac ro phages (Wagner et al, 1985). Another study showed an in-crease in phagocytosis when boneset was combined with Echinacea angustifolia, Baptisia tinctoria, and Arnica montana. This increase in phagocytosis was much more pronounced when boneset was used in combination with the three other spe-cies than when it was used alone (Wagner et al, 1991).
Other Actions
Boneset has been shown to possess emetic, antiinfl ammatory, and antimalarial properties (Hall, 1974; Lira-Salazar, 2006). A study focused on the possible effects of boneset on the common cold and showed no changes in the cold as a result of the use of this herb (Gassinger et al, 1981). Habtemariam et al (2000) discovered a weak antibacterial effect (gram-positive organisms [Staphylococcus aureus, Bacillus megaterium]) and a potent cytotoxic effect when compared with chlorambucil.
Product Availability Extract, tea
Plant Parts Used: Dried leaves, fl owers, whole herb Dosages
• Adult PO extract: 10-40 drops mixed in a small amount of liquid, tid
• Adult PO tea: 2-6 tsp dried leaves (crushed) or fl owers in 8 oz water, boiled then steeped for 15 min, tid
Contraindications Class 4 herb.
Because uterine stimulation can occur, boneset should not be used during pregnancy.
Until more research is available, this herb should not be used during breastfeeding.
Persons with hepatic disorders, an allergy to ragweed (Jellin et al, 2008), or a hyper-sensitivity to boneset should not use this herb. Avoid long-term use; toxicity can occur.
Side Effects/Adverse Reactions
GI: Nausea, vomiting, anorexia, diarrhea, hepatotoxicity SYST: Hypersensitivity
Interactions Herb
Asteracae family (daisy, chrysthanemum): Boneset can produce allergic reactions with these herbs.
Borage 107
Adverse effects: Underline = life-threatening
B
Primary Chemical Components and Possible ActionsChemical Class Individual Component Possible Action
Alcohol Tremetol Antidiabetic
Volatile oil Triterpenes
Flavonoid Kaempferol; Quercetin;
Astragalin; Rutin
Wound healing;
antiinfl ammatory
Glycoside Eupatorin
Resin insulin sterols
Pyrrolizidine alkaloids Hepatotoxic
Client Considerations Assess
• Assess for hepatotoxicity (jaundice, increased hepatic function test levels, clay-colored stools, right upper-quadrant pain). If these symptoms occur, use of this herb should be discontinued.
• Assess for gastrointestinal symptoms, nausea, vomiting, diarrhea; if these symp-toms occur, use of herb should be discontinued.
• Assess for hypersensitivity reactions; if present, discontinue use of this herb.
Administer
• Instruct the client to take boneset PO as a tea or extract.
• Instruct the client to store boneset in a cool, dry place, away from heat and moisture.
• Inform the client that boneset may be given to children in small doses.
Teach Client/Family
• Because uterine stimulation can occur, caution the client not to use boneset during pregnancy. Until more research is available, advise the client not to use this herb during breastfeeding.
Borage
(baw’rij)
Scientifi c name: Borage offi cinalis
Other common names: Beebread, common borage, common bugloss, cool tankard, ox’s tongue, starfl ower
Origin: Borage is an annual found in North America and Europe.
Uses
Borage is used to treat arthritis, hypertension, the common cold, and bronchitis.
It has been used primarily as a galactagogue but should not be used during breast-feeding until research confi rms or denies the presence of pyrrolizidine alkaloids.
Borage is also used for menopause, depression, adrenal replenishment, and as a tonic.
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108 Borage
= Pregnancy = Pediatric = Alert = Popular Herb Investigational Uses
Borage may decrease body fat accumulation.
Actions
Antiinfl ammatory Action
Several studies have demonstrated the benefi cial effects of borage oil for treating rheumatoid conditions. Diets high in arachidonic acid have been shown to increase the formation of pros ta glan din and leukotriene with proinfl ammatory action (Zurier et al, 1996). Two studies have shown that doses of 1.1 to 1.4 g gamma-linolenic acid in borage seed oil reduces joint infl ammation signifi cantly (Leventhal et al, 1993; Pullman-Mooar et al, 1990). A study using a combination of evening primrose oil and borage oil showed positive results in rheumatologic conditions (Belch et al, 2000). However, not all studies have shown positive results.
Antihypertensive Action
One study has shown that the high levels of gamma-linolenic acid in borage oil are responsible for its ability to decrease hypertension. The decrease in blood pressure occurred in response to two factors: (1) a reduction in the affi nity to angiotensin II receptors in cells that produce aldosterone and (2) a reduction in the aldosterone/
renin ratio (Engler et al, 1998).
Other Actions
A borage oil study has shown a decrease in body fat accumulation in rats. Rats were fed a low-fat diet containing borage oil. The result was a decrease in body fat mass (Takahashi et al, 2000). Rosmarinic acid may be responsible for the antioxidant action in borage (Bandoniene, 2002). Borage extract revealed in the lab the pres-ence of several radial scavenging components.
Product Availability
Capsules: 240, 500, 1300 mg; seed oil Plant Parts Used: Leaves, seeds, stems Dosages
Joint Infl ammation
• Adult PO seed oil: 1.1-1.4 g gamma-linolenic acid daily (Leventhal et al, 1993;
Pullman-Mooar et al, 1990)
Contraindications Class 2a/2b/2c herb.
Until more research is available, borage should not be used during pregnancy and breastfeeding because of the possible presence of pyrrolizidine alkaloids. It should not be given to children.
Side Effects/Adverse Reactions GI: Hepatotoxicity
Interactions Drug
Anticoagulants, antiplatelets, salicylates: Borage may increase the risk for bleeding.
Anticonvulsants: Bogbean may decrease the effect of this product.
Borage 109
Adverse effects: Underline = life-threatening