Scientific name: Harpagophytum procumbens
Also known as grapple plant, wood spider, Windhoek’s root
Devil’s Claw, Harpagophyum procumbens
Co urte s y o f He nri P i d o ux
Devil’s claw is native to southern Africa. It was brought from there to Europe by colonists who saw the medicinal potential of the herb. The secondary roots, also known as the storage tubers, are the only part of the plant that appears to have any medicinal value.4 4 4 They are cut into pieces or pulverized and then dried. Devil’s claw is cultivated in places in North America, but does not grow wild on this continent.
Devil’s claw was introduced to Europe and North America in the 1950s and 1960s. Like many herbs, it went through a period when it was regarded as a wonder drug—able to treat headache, loss of appetite, fever, blood disorders, and even cancer.4 4 5 With time, as the research began trickling in, the focus has narrowed so that now devil’s claw is primarily used for arthritis pain and swelling, and for back pain. In 1998, Commission E was not convinced of the efficacy of devil’s claw, and did not recommend it for any purpose in their last monographs. In 2003, an article in Phytomedicine echoed Commission E’s concerns about the quality of studies that showed devil’s claw’s analgesic and anti-inflammatory properties.4 4 6 Since that time, however, new studies have been released, and some of them (none a large, definitive study, however) have suggested that the traditional use of devil’s claw for back pain and arthritis is not entirely without foundation.
What is it g ood for?
Back pain. Because devil’s claw is native to some fairly remote areas of Africa and is relatively new to the West, we don’t have as much information about its traditional uses as we do with other herbs. Though it is used widely throughout Europe for mild joint pain,4 4 7 Commission E does not recommend devil’s claw for this use because of this lack of knowledge. Experiments on rats show that devil’s claw has both pain-relieving and anti-inflammatory properties.4 4 8 Two human trials examined its effects on back pain. They found strong evidence that doses standardized to 50 mg or 100 mg harpagoside were better than placebo for short term improvements in pain.4 4 9 A study testing devil’s claw for mild muscle pain and stiffness of the back, shoulder, and neck found similar positive results: less stiffness and better blood supply to the muscles.4 50
Arthritis. One experiment on rats shows that devil’s claw might be helpful for both the pain and inflammation associated with arthritis.4 51 Another shows no use at all.4 52 In an open clinical study in Germany, physicians prescribing devil’s claw to their patients for arthritis of the hip or knee found a 45.5% improvement for pain on palpation, 35% improvement for limitation of mobility. and 25.4% improvement for joint crepitus (creaking or grinding in the joints).4 53 But again Commission E does not recommend devil’s claw for arthritis.
How do you use it?
Traditionally, devil’s claw is taken orally as a decoction or infusion. One teaspoon of the finely chopped or powdered root is added to 1–¼ cup boiling water, and then steeped for eight hours.4 54 The potency of devil’s claw, however, varies quite a bit from plant to plant. Clinical evidence shows that a daily dose of approximately 50 mg of harpagoside is necessary for the anti-inflammatory effect.4 55 Unless you obtain your roots from a supplier who tests the active ingredients in each tuber it ships, the only sure way to get this dose is through standardized commercial preparations (capsules).
Dosag e : How much do you use ?
Based on tradition, a probable effective dosage is a tea made from 4.5 g daily.4 56 The tea can be taken up to three times a day.4 57 If you prefer to take a standardized commercial preparation, you’ll want to take around 50 mg of harpagoside per day.4 58 Experiments using 25 mg show markedly less effect.4 59 Short term studies have shown that people can tolerate 100 mg.4 60 One well-tested standardized preparation is Doloteffin®, which is produced by Ardeypharm, a German company.
What should you be aware of be fore using it?
If you are taking devil’s claw regularly, consult a doctor if you want to use it longer than two to
three weeks. Studies have not been conducted to demonstrate its safety beyond three to four months.4 61
Possible side effects include stomach upset, low blood pressure, and increased heart rate.4 62 Don’t take devil’s claw if you have ulcers.4 63
Don’t take it if you have biliary stones.4 64 Don’t take it if you are pregnant or nursing.4 65
Don’t take it if you are taking antithrombotic drugs because it may increase the effects.4 66 If you plan to have surgery, tell your surgeon you have been taking devil’s claw and discontinue use. Be cautious when using it in conjunction with other herbs known or suspected of increasing the risk of bleeding. (See Chapter 5 for a list.)
If you are diabetic or have blood sugar problems, consult with your doctor before taking devil’s claw. Animal experiments suggest that it may affect blood sugar.4 67 Be cautious when using it in conjunction with herbs known or suspected to affect blood sugar levels. (See Chapter 5 for a list.)
If you have heart problems, consult with your doctor before taking devil’s claw because experiments on animals show that it does seem to have some effect on the heart.4 68 Don’t use it in conjunction with other herbs that have an effect on heart function. (See Chapter 5 for a list.)
E
CHINACEAScientific name: Echinacea spp.
Also known as purple coneflower, black Sampson, black Susan, cock-up-hat, combflower, snakeroot, hedgehog, Indian head, Kansas snake root, red sunflower, scurvy root, solhat, sun hat
Echinacea purpurea
Echinacea is part of the daisy family. It is native to the American Midwest and Deep South.
Because of its popularity, it is now cultivated throughout the world. Though the flower had a part in the medical chest of early American settlers, the root is most commonly used in modern herbal medicine. Nine species of Echinacea grow in North America, but Echinacea purpurea is the most commonly used medicinally.4 69
An American plant, echinacea was used by native Americans and early settlers alike. For colds and flu, they would make a tea or simply take a small piece of the root (1 or 2 g) and slowly chew it.
For insect bites, snake bites, and wounds, they would use echinacea as a poultice. The herb was a crucial part of American medicine until antibiotics became widespread. At that point it was taken off the National Formulary, dismissed as folk superstition, and its use declined.4 70 Ironically, the illnesses it had been most commonly used for—colds and flu—are not affected by antibiotics.
Interest in echinacea picked up again in the 1970s as part of the herbal renaissance. Today it is one of the most used herbs in Europe and North America. In the United States, no other herb sells better.4 71 In parts of Europe it can be medically prescribed.
Commission E recommends only E. pallida root and E. purpurea herb, citing a lack of evidence
for other species and parts of the plant.4 72 The species purpurea is the most commonly cultivated, but some herbalists believe angustifolia is more potent.4 73 One way to tell if the echinacea you have is potent is to hold it in your mouth for a little while. Echinacea is a sialogogue: If it makes your tongue tingle or stimulates salivation, its active ingredients are still intact.4 74
What is it g ood for?
Common cold, upper respiratory infections, other infections. Echinacea is most commonly used to help speed healing from colds and flu. The Cheyenne used it for colds and sore throats, the Kiowa for coughs and sore throats, the Choctaw for coughs, and the Comanche for sore throats.4 75 The Modern Herbal recommends it for resistance to infection. The Eclectic School recommended it for fevers. The traditional attestation in North America is strong, so much so that echinacea can now be found all over the world.
Test-tube studies show that it kills viruses, including influenza.4 76 They also show macrophage activation and activation of polymorphonuclear leukocytes and natural killer cells.4 77 A study in mice showed immune stimulation and a quicker recovery from radiation exposure.4 78 Another uncontrolled study of upper respiratory infection in dogs showed positive results.4 79
In humans, a study that looked at activation of the immune system showed that tinctures of echinacea stimulated the immune system within 24 hours of when they were taken.4 80 A study of a proprietary echinacea extraction (Echinilin®) showed that it enhanced the non-specific immune response and elicited free-radical scavenging properties.4 81 Other studies, however, have found no such activation.4 82
What about human clinical studies? Do they show that echinacea works? The jury is still out.
Some studies have showed no difference between echinacea and placebo either in the likelihood of getting an induced cold or in decreasing the severity of symptoms.4 83 Others, however, have found a decreased severity in those who take echinacea at the first sign of a cold.4 84 A study of children with upper respiratory tract infections showed that those who took echinacea had a 28% less chance of developing a second upper respiratory infection within four weeks.4 85 But another study of children found no difference in the duration or severity of upper respiratory tract infection in those taking echinacea versus placebo.4 86 Still others see little enough improvement that the results may not be statistically significant.4 87 The evidence that it improves quality of life in people with upper respiratory tract infections is also inconclusive.4 88
These equivocal findings, however, may say more about the studies themselves than echinacea.
The problems with echinacea studies have been fourfold: First, studies show a complete lack of standardization. From study to study, we see different species (Echinacea purpurea, E. pallida, and E. angustifolia), different parts of the plant (leaves, flowers, roots), different modes of administering the herbs (juice, tablets, dried herb in capsule, teas, and tinctures), different quantities of the active ingredient, different doses.4 89 Second, some studies simply used over-the-counter echinacea without any check of the contents of the formulation. Recent studies have found that some brands of echinacea supplements contain herbs from species not on the label, and some actually contain little or no actual echinacea.4 90 Third, echinacea can lose its potency quickly,
especially if not handled well. Most studies did nothing to control for the potency of the echinacea they were using. Fourth, there is more than one kind of cold/flu. We now suspect that echinacea works least well with rhinovirus, the most common kind of cold.4 91
Fortunately, we now have enough echinacea studies that we’re able to get meta-analyses. A small Swiss meta-study looked at echinacea and induced colds and found that across three studies, the likelihood of experiencing a clinical cold was 55% higher with placebo than with echinacea.4 92 A much larger meta-study sorted through the studies, discarded the problematic ones, and found that in the remaining studies, echinacea decreased the chance of getting a cold by 58% and shortened the duration of a cold by 1.4 days.4 93
Poorly healing wounds and chronic ulcerations. This use was a common one among settlers on the Great Plains.4 94 The Lakota also used echinacea on wounds and sores. The Cheyenne used it for sore gums. The Dakota, Winnebago, Ponca, Pawnee, and Omaha all used it on burns.4 95 Commission E also recommends purpurea for this purpose.4 96 Echinacea contains caffeic acid derivatives and glycoside which help the wound healing process.4 97 It also has some antibiotic properties.4 98 One study looked at vocal fold wounds in pigs and found that an extract of echinacea helped heal induced injuries.4 99 But the clinical trials are still not there to support this use.
How do you use it?
Commercial preparations. Numerous forms of echinacea are available for purchase. It can be found in tablets, capsules, tonics, and as a part of numerous cold remedies. Preparations vary widely.
The way it’s processed has some effect on its potency.500 Purchase your echinacea from a reputable source. According to one study, price is one mark of quality.501 If echinacea preparations are too cheap, be suspicious. Echinaforce® is one brand that has been tested and found effective.502
Decoction. If you choose to use the root itself, store it whole,503 and don’t use it after it’s lost its smell.504 One way to tell if the echinacea you have is potent is to hold it in your mouth for a little while. Echinacea is a sialogogue: If it stimulates salivation, it has its active ingredients still intact.505 Make a decoction of 2 teaspoons of the chopped root material, per cup of water.506 Bring it to a boil and then simmer for 10–15 minutes. You can take the decoction a cup at a time, three times daily, or you can take it in small doses (2 teaspoons to 2 tablespoons) every 1 or 2 hours during the acute stage of colds and flu. If you want to use it on wounds, you can use the decoction or diluted tincture as a wash. Be aware, however, that echinacea infusions and decoctions tend to lose their potency quickly. Even if you store them in the refrigerator, they change significantly in a few days time.
Infusion. One analysis of research to date suggests that the aerial parts of the plant are more effective than the roots in treating colds.507 Aerial parts of the plant will need less cooking than roots. Use a standard infusion method to make a tea.
Extracts. The juice pressed from the plant is available commercially.
Tincture. 1:5, 45–50%. If you want to hold a homemade echinacea preparation for a while, an alcohol tincture is a better bet than a preparation made with water.508 If you make a tincture using at least 50% ethanol (e.g. 100 proof vodka), the tincture should hold for more than a year.509
Studies show that tinctures effectively carry the active ingredients into the body, with maximum concentration of the main alkamides hitting the bloodstream in less than 30 minutes.510
Oils, salves and creams. These can be used to treat wounds. Commercial preparations are available. We have, however, no clear consensus in either the research literature or marketplace about what echinacea cream is good for.
Dosag e : How much do you use ?
The probable effective dosage is:
Root extract capsules: 250 mg 3 times per day511
Tincture: 30–60 drops, 3 times per day512 (roughly ¼ to 2/3 of a teaspoon)
Expressed juice: 1¼–1¾ teaspoons per day, divided into two or three doses, for five to seven days513
Don’t take echinacea for more than three weeks. After three weeks of use, discontinue for at least a week to avoid a decrease in effectiveness.514 Or you can rotate in three-week cycles with astragalus.515
What should you be aware of be fore using it?
A wound wash can do more harm than good if you don’t use pure ingredients and careful, sterile procedures. If you have any question about the sterility of your decoction, don’t use it on an open wound.
Adverse effects reported generally have been uncommon and minor, including abdominal upset, nausea, and dizziness.516 High doses increase the chances of dizziness or nausea
Don’t use echinacea internally if you have a progressive systemic disease, such as tuberculosis, leucosis, collagenosis, or multiple sclerosis.517
If you have any immune system problems, check with your doctor before taking echinacea.
Avoid, or at least be very cautious about, using echinacea if you are allergic to members of the Asteraceae family, for example ragweed, sunflowers, asters, or daisies.
Don’t take it if you are taking immunosuppressant, or hepatotoxic drugs such as amiodarone, methotrexate, and ketoconazole.518
Some researchers suggest that you not take it at the same time as acetaminophen (such as Tylenol™) because the combination increases the chance of liver damage. This opinion, however, is not universally agreed upon.519
Don’t take it in conjunction with any other herb or drug known to affect liver function. (See Chapter 5 for a list.)520
E
LDERScientific name: Sambucus nigra (European Elder), Sambucus canadensis (American elder), and Sambucus ebulus (European Dwarf Elder).
Also known as elderberry, elder flower, black elderberry, European elder, European alder, ellanwood, ellhorn, red elder, boor tree
European Elder, Sambucus nigra
Co urte s y o f Re na te Ed e r
Sambucus is the genus of the elder tree. Various species of elder grow as small trees or large bushes throughout the world. The species used medicinally are the European elder, the American elder, and the European Dwarf elder. This article is about the European elder in particular. The fruit, typically referred to as “berries,” are rich in vitamins A and C and have nutritional as well as medicinal value when taken internally. For topical uses, the flowers are the main part used medicinally, though historically the leaf and bark were used as well.
What is it g ood for?
Colds and flu, especially feverish and mucous conditions. The tradition of using elder for colds, flu, and fever spans at least two continents (Europe and North America). Elder has a long history of
medicinal use especially among Native Americans. The Cherokee, Iroquois, Yuki, Pima, and Pomo all used it to sweat out a fever.521 The Quileute, Cahuilla, Kawaiisu, and Costanoan used it as a cold and flu remedy.522 According to traditional herbalism, elder flower tea is a diaphoretic, meaning that it increases perspiration. It also increases bronchial secretions and reduces phlegm.523 The tradition, however, is stronger than the research. In test-tube studies elder shows antiviral activity, albeit fighting viruses that typically infect cats.524 In a single clinical trial, a placebo-controlled, double-blind study of sixty adults in Norway showed that elderberry syrup relieved flu-like symptoms four days earlier than placebo, with less use of other cold medication.525 Clinical trials of a proprietary elderberry extract (Sambucol®) showed that it stimulates the immune system.526
Swellings, bruises, and sprains. Topically, elder infusions or decoctions have been used as an anti-inflammatory for bruises, sprains, and other swellings. Again this use has substantial attestation in native American tradition. The Delaware, Houma, Iroquois, Rappahannock, and Choctaw all used elder on swellings.527 The Cherokee and Hanaksiala used it for rheumatism or arthritis,528 and the Mendocino on bruises.529 From animal testing, we know that Sambucus ebulus inhibits inflammation in mice.530 Human research is sparser, but one study shows that it’s very useful for inflammation of the gums.531
How do you use it?
Internal use: For internal use (for colds, flu, etc.), the safest way to use elderberry is in commercial formulas. Using the wrong part of the tree in the wrong way can make you very sick.
Find a reputable commercial product and follow label directions. One extract that has been tested extensively and found to be effective is Sambucol®.532
Infusion: A compress for skin irritations can be made from an infusion of flowers. Use 2 teaspoonfuls of the flowers. Simmer them gently in a half cup of water for five minutes and then strain.533 Use this infusion externally only unless you first get guidance from a trained herbalist.
Dosag e : How much do you use ?
The safest way to use elderberry is in commercial formulas. Find a reputable one and follow label directions.
What should you be aware of be fore using it?
What should you be aware of be fore using it?