American Botanical Council : Hawthorne Berry

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American Botanical Council : Hawthorne Berry

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Hawthorn berry

 

Latin Name: Crataegus monogyna

Pharmacopeial Name: Crataegi fructus

Other Names: English hawthorn, whitethorn herb, hawthorn tops, haw,

mayhaw

 

Overview

Description

Chemistry and Pharmacology

Uses

Contraindications

Side Effects

Use During Pregnancy and Lactation

Interactions with Other Drugs

Dosage and Administration

References

Additional Resources

 

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Overview

 

There are approximately 280 known species of hawthorns in the genus

Crataegus. The species referred to in this monograph is a spiny

shrub

native to the northern wooded temperate zones of Europe, from

England to

Latvia and from the Pyrenees Mountains (southern France) to northern

Italy (Leung and Foster, 1996). It has become naturalized in parts

of

North America as a garden escape (Budavari, 1996; Leung and Foster,

1996). The material of commerce for the phytomedicine industry is

obtained from the United Kingdom and other European countries (BHP,

1996), including Albania, Bulgaria, Romania, the former Yugoslavia,

and

Poland (Wichtl and Bisset, 1994).

 

Hawthorn has a long history of use, confirmed safety, and clinical

evidence to support its cardiovascular benefits, especially

cardiotonic

activity. There is significant evidence to support its use in

clinical

cardiology and by the general public. The fruits (berries) of

various

species, long used in traditional European herbal medicine, are

edible

(Hedrick, 1972). Hawthorn is one of the oldest known medicinal

plants

used in European medicine; its cordial actions on the heart were

first

reported by first century Greek herbalist Dioscorides and later by

Swiss

physician Paracelsus (1493–1541) (Weihmayr and Ernst, 1996). Other

sources state that its clinical use for heart disease and

cardiovascular

disorders did not begin in Europe until the nineteenth century

(Anschutz, 1900; Hobbs and Foster, 1990).

 

In phytomedicine, hawthorn refers to the fruit, leaf, and/or flower

of

the genus Crataegus (usually C. laevigata, syn. C. oxyacantha) and

C.

monogyna. Commission E in 1984 published one monograph on hawthorn

(often commonly referred to as crataegus, based on the Latin name of

the

genus) that included all of its aerial parts and was based on

historical

experience, many pharmacological studies on various preparations on

the

three different plant parts, about 20 open clinical studies, and

many

patient case reports (Schilcher, 1997). The original indications

were

for functional Stages I to II of the New York Heart Association

(NYHA)

assessment of the four stages of heart disease. Other indications

included sensation of pressure in the chest, cardiac degeneration

not

yet requiring digitalis, and slight forms of bradycardic arrhythmias

(Steinhoff, 1997).

 

In 1994, however, the original monograph was replaced by four: an

approved monograph for hawthorn leaf with flower and three

unapproved

monographs for hawthorn fruit (berry), leaf, and flower,

respectively.

There was good reason for this change. When the first monograph had

been

produced, none of the scientific data on hawthorn included studies

carried out according to good clinical practices (GCP). Both

experimental and clinical studies that have been conducted since

around

1991 have confirmed activity of hawthorn leaf with flower

preparations.

A subsequent review of clinical literature revealed the availability

of

pharmacodynamics (the effects of a substance on the physiological

processes) of a 45% ethanol extract, or 70% methanol extract of

flowering leaf tops with defined content of flavonoids and

proanthocyanidins. The other three hawthorn components were re-

evaluated

and " the flowers, leaves, and fruits as single compounds received a

negative assessment because there no longer seemed to be sufficient

scientific evidence to justify their inclusion " (Steinhoff, 1993–

1994).

This also brought the monographs in line with the tenth edition of

the

French pharmacopeia, which specifies " dried flowering tops " of C.

monogyna. The approval of the one hawthorn preparation based on the

extract of leaf with flower is an example of the trend later adopted

by

the Commission to rely on new scientific data for evaluations and to

re-assess and approve specific, well-defined extract preparations

that

are often proprietary commercial products. A recent monograph on

hawthorn berry (fruit) acknowledges the lack of research on the

cardioactivity of the berry (Upton et al., 1999a).

 

The literature review also resulted in a more precise indication for

the

approved monograph: " decreasing cardiac output according to

functional

Stage II of the NYHA. " According to NYHA, Stage II is defined as

" Patients with cardiac disease but without resulting limitations of

physical activity. They are comfortable at rest. Ordinary physical

activity results in fatigue, palpitation, dyspnea, or anginal pain "

(NYHA, 1994). The use of hawthorn appears to be extremely safe;

Commission E noted no contraindications or adverse side effects, nor

have more recent reviews (e.g., Upton et al., 1999a, 1999b).

 

Hawthorn has been extensively studied in Germany. A review on

hawthorn

preparations used in cardiology found that hawthorn can be employed

for

indications for which digitalis is not yet indicated (Blesken,

1992). In

a later review of its therapeutic effectiveness, the authors found

that

recent research supported its usefulness in congestive heart failure

(CHF) (Weihmayr and Ernst, 1996). Rigorous clinical trials showed

benefit concerning objective signs and subjective symptoms of Stage

II

NYHA congestive heart failure. No adverse drug reactions had been

reported. The authors concluded that hawthorn is an effective and

safe

therapeutic alternative for CHF.

 

One placebo-controlled, randomized, double-blind study on 30

patients

for eight weeks was performed with hawthorn leaf with flower extract

WS

1442 (Crataegutt® forte; W. Schwabe, Germany) at a dose of 160 mg

per

day (Leuchtgens, 1993). The hawthorn group showed a statistically

significant advantage over placebo in all parameters: Alteration in

the

pressure-x-rate product under standardized stationary bicycle

endurance

test, a score of subjective improvement of complaints elicited by a

questionnaire, exercise tolerance, and changes in heart and arterial

blood pressure (systolic and diastolic blood pressure was mildly

reduced

in both groups). No adverse reactions occurred.

 

Studies with early-stage CHF patients, using daily doses of leaf

with

flower extract ranging from 160 to 900 mg, showed improved heart

function and exercise tolerance, and a lessening in shortness of

breath

and postexercise fatigue (Reuter, 1994; Zapfe et al., 1993). Schulz

and

co-authors cite 14 clinical studies published from 1981 to 1994 on

the

therapeutic efficacy of hawthorn preparations on a total of 808

patients

(Schulz et al., 1998). A recent monograph on hawthorn leaf with

flower

extract cites 10 clinical studies on standardized preparations (3

open

studies, 7 controlled) (Upton et al., 1999b). Reuter discussed 15

clinical trials on 872 patients given single preparations of

Crataegus

extracts (160–900 mg) standardized to 5% oligomeric

proanthocyanidins

(OPC), 19% OPC, and 2.2% flavonoids. Tolerability was generally very

good, with higher dosages resulting in occasional mild side effects.

Significant improvements in stress tolerance and anaerobic threshold

occurred with daily doses of 300–900 mg over a four-week period, and

to

a greater extent after eight weeks. Subjective complaints, however,

improved with much lower doses of 160–180 mg (Reuter, 1994).

 

An eight-week multicenter, placebo-controlled, double-blind trial

using

WS 1442 in 136 patients with Stage II NYHA cardiac insufficiency

focused

on changes in the blood pressure and heart rate output measured at

the

beginning and end of treatment (Weikl et al., 1996). A clear

improvement

in the performance of the heart in the treatment group was seen,

while

the placebo group progressively worsened. The therapeutic difference

between the groups was statistically significant. Patient assessment

of

improvement in the main symptoms (reduced performance, shortness of

breath, ankle edema, etc.) confirmed the superiority of hawthorn,

with

better quality of life and mental well-being reported. Tolerability

was

very good, with overall results confirming the extract to be an

effective and low-risk phytotherapeutic form of treatment for

patients

with Stage II NYHA cardiac insufficiency.

 

Another study provided evidence that hawthorn extract can improve

heart

function in patients with chronic heart disease (Schmidt et al.,

1994).

This eight-week, multicenter, double-blind, placebo-controlled study

tested the effects of 600 mg/day of Faros® 300, (LI 132, an extract

manufactured by Lichtwer Pharma, Berlin). Seventy-eight patients

with

Stage II heart disease taking hawthorn had significant gains in

their

stamina and endurance (as measured by a stationary bicycle), had

lower

blood pressure and lower heart rates while exercising, and pumped

more

blood at lower pressure. Also, patients taking hawthorn had fewer

overall symptoms, felt less fatigue, and experienced less shortness

of

breath.

 

Hawthorn extract (LI 132) at a dose of 900 mg daily was shown to

compare

favorably with the cardiac drug Captopril (37.5 mg daily) in the

treatment of 132 Stage II cardiac insufficiency patients (Tauchert

et

al., 1994). Captopril is used to reduce resistance to blood flow in

peripheral arteries. Hawthorn performed equally well, with the added

benefit of working on the heart. Exercise tolerance significantly

increased in both test groups, and the incidence and severity of

symptoms decreased by 50%. There was no placebo control.

 

Another report evaluated the efficacy of high doses of hawthorn leaf

with flower extract (900 mg daily of Faros® 300) in 1,476 patients

with

Stage I and Stage II cardiac insufficiency, with therapy lasting

four

and eight weeks (Loew et al., 1996). Treatment-related changes were

evaluated for the typical symptoms of heart failure. The symptom

score

decreased by a mean of 66% at the conclusion of therapy, with the

Stage

I NYHA patients largely symptom-free. A subgroup of patients with

symptoms including borderline hypertension showed decreases in

systolic

and diastolic pressure. This group also showed a drop in heart rate

from

89 to 79 beats per minute, and arrhythmias were significantly

reduced

independently of heart failure.

 

Although the Commission E no longer recognizes this use, hawthorn

berry

preparations have been shown to combat angina, a condition resulting

from insufficient blood flow to the heart muscle. In one study

demonstrating the usefulness of a combined extract of hawthorn

berry,

leaf, and flower in the treatment of patients with stable angina

pectoris (Hanack and Br ckel, 1983), 60 angina patients were given

either 180 mg of hawthorn berry-leaf-flower extract (Crataegutt®

novo,

W. Schwabe, Germany) or placebo for three weeks. The ECG measures

improved in the hawthorn patients, and blood flow and oxygen

delivery to

the heart muscle rose. Hawthorn patients also exercised for longer

periods of time without an angina attack.

 

A double-blind crossover study tested the effects of Crataegutt®

novo

hawthorn berry-leaf-flower extract in 36 patients, averaging 74

years in

age, with Stage I or Stage II cardiac insufficiency (O'Connolly et

al.,

1986; O'Connolly et al., 1987). The study found that patients

treated

with this preparation had a decreased heart rate and improved

cardiac

output under resting and exercise conditions, which was not

evidenced in

the control group. Treated patients also had significant improvement

in

psychological assessment ratings and sleep behavior.

 

In Germany, hawthorn leaf with flower is official in the German

Pharmacopeia (DAB, 1997), approved in the Commission E monographs,

and

the tea infusion dosage form is official in the German Standard

License

monographs (Braun et al., 1997). The alcoholic fluidextract dosage

form

is official in the German Pharmacopeia, tenth edition, third

supplement

(DAB 10, 1993). Hawthorn is used as a component in over 100 drug

preparations, especially cardiotonics, coronary remedies, and

antihypertensives, in various dosage forms, including the

hydro-alcoholic native dry extract in dragÈes (coated tablets),

fluidextract (drops) (Wichtl and Bisset, 1994), and aqueous infusion

(Braun et al., 1997; Meyer-Buchtela, 1999).

 

German pharmacopeial grade hawthorn leaf with flower consists of the

whole or cut, dried flower-bearing tips, up to about 7 cm long, of

C.

monogyna Jaquin emend. Lindman or C. laevigata (Poiret) de Candolle

(syn: C. oxyacantha L.p.p. et auct.), and rarely some other European

species such as C. pentagyna Waldstein et Kitaibel ex Willdenow, C.

nigra Waldstein et Kitaibel, and/or C. azarolus L. It must contain

not

less than 0.7% flavonoids calculated as hyperoside. Botanical

identity

must be confirmed by a thin-layer chromatography (TLC) test,

macroscopic

and microscopic examinations, and organoleptic evaluations (DAB,

1997).

Under proper storage conditions, the raw material shelf life is

three

years (Braun et al., 1997). It is interesting to note that the only

form

of hawthorn that is official in the 1998 European Pharmacopoeia is

the

dried false-fruit, which is an unapproved herb in the Commission E

monographs. It must contain not less than 1.0% procyanidins,

calculated

as cyanidin chloride, based on the dried material (Ph.Eur.3, 1998).

 

 

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Description

 

Hawthorn berry consists of the dried fruit of Crataegus monogyna

Jaquin

emend. Lindman or C. laevigata (Poiret) de Candolle or others in a

valid

pharmacopeia citing Crataegus [Fam. Rosaceae] and preparations

thereof.

A recent monograph provides detailed information on the botany and

chemistry of hawthorn berry (Upton et al., 1999a).

 

 

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Chemistry and Pharmacology

 

There are no scientific data on which to base the pharmacology and

toxicology of the herb. Spectrographic analysis of the chemical

constituents of the herb distinguishes only quantitative differences

between preparations from the fruit and preparations combining leaf

and

flower. One may assume pharmacodynamics similar to those shown for

the

preparation containing both leaf and flower.

 

Proanthocyanidins in the berry " possess a higher degree of

polymerization, a characteristic that reportedly increases

antioxidant

activity " (Upton et al., 1999a).

 

 

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Uses

 

It has been claimed that preparations of hawthorn berry have been

applied to the treatment of coronary circulation, coronary

complications

and weak heart, heart and circulatory disturbances, hypotension, and

arteriosclerosis.

 

Note: This monograph was published as a negative/unapproved

monograph.

The Commission E stated that since the effectiveness of hawthorn

berry

(used by itself) for its claimed applications has not been

documented,

therapeutic use cannot be recommended.

 

According to the Commission, the berry as a water extract, water-

alcohol

extract, wine infusion, and fresh juice has been utilized

traditionally

to strengthen and invigorate heart and circulatory function. These

statements are based exclusively on historical record and long

experience.

 

[Ed. Note: There are no clinical studies available on hawthorn berry

alone. Three clinical studies have been performed on a preparation

combining extracts of hawthorn berry with leaf with flower extract

(Crataegutt novo, W. Schwabe, Germany) (Hanak and Bruckel, 1983;

O'Connolly et al., 1986; O'Connolly et al., 1987; Iwamoto et al.,

1981).

Positive results of these studies are presumably due, at least to

some

significant degree, to the flavonoid content of the leaf with flower

portion of the extract.]

 

 

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Contraindications

 

No risks or contraindications are known.

 

 

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Dosage and Administration

 

See the approved monograph on hawthorn leaf with flower.

 

 

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References

 

Anschutz, E.P. 1900. New, Old and Forgotten Remedies. Philadelphia,

PA:

Boericke and Tafel.

 

Blesken, R. 1992. [Crataegus in cardiology] [in German]. Fortschr

Med

110(15):290–292.

 

Braun, R. et al. 1997. Standardzulassungen f r Fertigarzneimittel—

Text

and Kommentar. Stuttgart: Deutscher Apotheker Verlag.

 

British Herbal Pharmacopoeia (BHP). 1996. Exeter, U.K.: British

Herbal

Medicine Association. 98–101.

 

Budavari, S. (ed.). 1996. The Merck Index: An Encyclopedia of

Chemicals,

Drugs, and Biologicals, 12th ed. Whitehouse Station, N.J.: Merck &

Co,

Inc. 435.

 

Deutsches Arzneibuch, 10th ed., 3rd suppl. (DAB 10). 1993.

Stuttgart:

Deutscher Apotheker Verlag.

 

Deutsches Arzneibuch (DAB 1997). 1997. Stuttgart: Deutscher

Apotheker

Verlag.

 

Europ‰isches Arzneibuch, 3rd ed., 1st suppl. (Ph.Eur.3). 1998.

Stuttgart: Deutscher Apotheker Verlag. 667–668.

 

Hanack, T. and M.H. Br ckel. 1983. The treatment of mild stable

forms of

angina pectoris using Crategutt novo. Therapiewoche 33:4331–4333.

 

Hedrick, U.P. (ed.). 1972. Sturtevant's Edible Plants of the World.

New

York: Dover Publications [reprint of 1919 original].

 

Hobbs, C. and S. Foster. 1990. Hawthorn—a literature review.

HerbalGram

22:19–33.

 

Iwamoto, M., I.Takashi, S.Tasuo. 1981. [Clinical actions of

Crataegutt

on angina pectoris of ischemic or hypertesive origin] [in German].

Planta Med 42:1–16.

 

Leuchtgens, H. 1993. [Crataegus special extract WS 1442 in NYHA II

heart

failure. A placebo controlled randomized double-blind study] [in

German]. Fortschr Med 111(20–21):352–354.

 

Leung, A.Y. and S. Foster. 1996. Encyclopedia of Common Natural

Ingredients Used in Food, Drugs, and Cosmetics, 2nd ed. New York:

John

Wiley & Sons, Inc. 295–297.

 

Loew, D., M. Albrecht, H. Podzuweit. 1996. Efficacy and tolerability

of

a Hawthorn preparation in patients with heart failure Stage I and II

according to NYHA—a surveillance study. Munich: 2nd International

Congress on Phytomedicine.

 

Meyer-Buchtela, E. 1999. Tee-Rezepturen—Ein Handbuch f r Apotheker

und

ƒrzte. Stuttgart: Deutscher Apotheker Verlag.

 

New York Heart Association (NYHA). 1994. Revisions to Classification

of

Functional Capacity and Objective Assessment of Patients with

Diseases

of the Heart.

 

O'Connolly, M., G. Bernhˆft, G. Bartsch. 1987. [Treatment of

stenocardia

(Angina pectoris) pain in advanced age patients with multi-

morbidity]

[in German]. Therapiewoche 37:3587–3600.

 

O'Connolly, M., W. Jansen, G. Bernhˆft, G. Bartsch. 1986. Behandlung

der

nachlassenden Herzleistung. [Treatment of decreasing cardiac

performance. Therapy using standardized crataegus extract in

advanced

age] Fortschr Med 104(42):805–808.

 

Ph.Eur.3. See Europ‰isches Arzneibuch.

 

Reuter, H. 1994. Crataegus (Hawthorn): A Botanical Cardiac Agent. Z

Phytother 15:73–81.

 

Schilcher, H. 1997. Personal communication to M. Blumenthal. Dec.

30.

 

Schmidt, U., U. Kuhn, M. Ploch, W.D. Hubner. 1994. Efficacy of the

hawthorn (crataegus) preparation LI 132 in 78 patients with chronic

congestive heart failure defined as NYHA functional class II.

Phytomedicine 1:17–24.

 

Schulz, V., R. H‰nsel, V.E. Tyler. 1998. Rational Phytotherapy: A

Physicians' Guide to Herbal Medicine. New York: Springer.

 

Steinhoff, B. 1993–1994. New developments regarding phytomedicines

in

Germany. Brit J Phytother 3(4):190–193.

 

———. 1997. Herbal medicines increasingly preferred. Pharmazeutische

Zeitung 142(49):4412–4417.

 

Tauchert, M., M. Ploch, W.D. Hubner. 1994. Effectiveness of hawthorn

extract LI 132 compared with the ACE inhibitor Captopril:

Multicenter

double-blind study with 132 NYHA Stage II. Muench Med Wochenschr 136

suppl:S27–S33.

 

Upton, R. (ed.) et al. 1999a. Hawthorn Berry. Santa Cruz, CA:

American

Herbal Pharmacopoeia.

 

Upton, R. (ed.) et al. 1999b. Hawthorn Leaf with Flower. Santa Cruz,

CA:

American Herbal Pharmacopoeia.

 

Weihmayr, T. and E. Ernst. 1996. [Therapeutic effectiveness of

Crataegus] [in German]. Fortschr Med 114(1–2):27–29.

 

Weikl, A. et al. 1996. Crataegus special extract WS 1442. Assessment

of

objective effectiveness in patients with heart failure. Fortschr Med

114(24)291–296.

 

Wichtl, M. and N.G. Bisset (eds.). 1994. Herbal Drugs and

Phytopharmaceuticals. Stuttgart: Medpharm Scientific Publishers.

161–166.

 

Zapfe, G., K.D. Assmus, H.S. Noh. 1993. Placebo-controlled

multicenter

study with Crataegus special extract WS 1442: Clinical results in

the

treatment of NYHA II cardiac insufficiency. Presented at the 5th

Congress on Phytotherapy: Bonn, Germany; June 11.

 

 

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Additional Resources

 

Ammon, H.P. and M. Handel. 1981. [Crataegus, toxicology and

pharmacology, Part I: Toxicity] [in German]. Planta Med 43(2):105–

120.

 

———. 1981. [Crataegus, toxicology and pharmacology, Part II:

Pharmacodynamics] [in German]. Planta Med 43(3):209–239.

 

———. 1981. [Crataegus, toxicology and pharmacology, Part III:

Pharmacodynamics and pharmacokinetics] [in German]. Planta Med

43(4):313–322.

 

Ammon, H.P.T. and R. Kaul. 1994. [Crataegus: Activity on heart and

circulation of Crataegus extracts, flavonoids and procyanidins. Part

1:

History and hormones] [in German]. Dtsch Apoth Zeitg 134(26):2433–

2436.

 

———. 1994. [Crataegus: Activity on heart and circulation of

Crataegus

extracts, flavonoids and procyanidins. Part 2: Actions on the heart]

[in

German]. Dtsch Apoth Zeitg 134(27):2521–2527.

 

———. 1994. [Crataegus: Activity on heart and circulation of

Crataegus

extracts, flavonoids and procyanidins. Part 3: Actions on

circulation]

[in German]. Dtsch Apoth Zeitg 134(28):2631–2636.

 

Beretz, A., M. Haag-Berrurier, R. Anton. 1978. Choice of

pharmacological

methods for the study of hawthorn activities. Plantes Med PhytothÈr

12(4):305–314.

 

Brown, D., S. Austin, R. Reichert. 1997. Early-stage congestive

heart

failure. Seattle: Natural Products Research Consultants.

 

Gabhard, B. et al. (eds.). 1983. Wandlungen in der Therapie der

Herzinsuffizienz. Wiesbaden: Friedr. Vieweg & Soyn.

 

Guendjev, Z. 1977. Experimental myocardial infarction of the rat and

stimulation of the revascularization by the flavonoid drug

crataemon.

Arnzeimforsch 27(8):1576–1579.

 

McGuffin, M., C. Hobbs, R. Upton, A. Goldberg. 1997. American Herbal

Product Association's Botanical Safety Handbook. Boca Raton: CRC

Press.

 

Newall, C.A., L.A. Anderson, J.D. Phillipson. 1996. Herbal

Medicines: A

Guide for Health-Care Professionals. London: The Pharmaceutical

Press.

 

Occhiuto, F., C. Circosta, R. Costa, F. Briguglio, A. Tommasini.

1986.

Study comparing the cardiovascular activity of young shoots, leaves

and

flowers of C. laevigata L. II: Effects of extracts and pure isolated

active principles on the isolated rabbit heart. Plantes Med

PhytothÈr

20:52–63.

 

Rakotoarison, D.A. et al. 1997. Antioxidant activities of

polyphenolic

extracts from flowers, in vitro callus and cell suspension cultures

of

Crataegus monogyna. Pharmazie 52(1):60–64.

 

Roddewig, C. and H. Hensel. 1977. [Reaction of local myocardial

blood

flow in non-anesthetized dogs and anesthetized cats to the oral and

parenteral administration of a Crateagus fraction] [in German].

Arnzeimforsch 27(7):1407–1410.

 

Stepka, W. and A.D. Winters. 1973. A survey of the genus Crataegus

for

hypotensive activity [symposium paper]. Proceedings American Society

of

Pharmacognosy: Jekyll Island, Georgia; Jul 15–20. Lloydia 36(4):430–

443.

 

 

Sticher, O. and B. Meier. Hawthorn (Crataegus): Biological Activity

and

New Strategies for Quality Control. In: Lawson, L.D. and R. Bauer

(eds.)

1998. Phytomedicines of Europe: Chemistry and Biological Activity.

Washington, DC: American Chemical Society.

 

Tyler, V.E. 1994. Herbs of Choice: The Therapeutic Use of

Phytomedicinals. New York: Haworth Press.

 

Weng, W.L. et al. 1984. Therapeutic effect of Crataegus pinnatifida

on

46 cases of angina pectoris—a double blind study. J Trad Chin Med

4(4):293–294.

 

 

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Note

 

This material was adapted from The Complete German Commission E

Monographs—Therapeutic Guide to Herbal Medicines. M. Blumenthal,

W.R.

Busse, A. Goldberg, J. Gruenwald, T. Hall, C.W. Riggins, R.S. Rister

(eds.) S. Klein and R.S. Rister (trans.). 1998. Austin: American

Botanical Council; Boston: Integrative Medicine Communications.

 

1) The Overview section is new information.

 

2) Description, Chemistry and Pharmacology, Uses, Contraindications,

Side Effects, Interactions with Other Drugs, and Dosage sections

have

been drawn from the original work. Additional information has been

added

in some or all of these sections, as noted with references.

 

3) The dosage for equivalent preparations (tea infusion,

fluidextract,

and tincture) have been provided based on the following example:

 

Unless otherwise prescribed: 2 g per day of [powdered, crushed, cut

or

whole] [plant part]

 

Infusion: 2 g in 150 ml of water

 

Fluidextract 1:1 (g/ml): 2 ml

 

Tincture 1:5 (g/ml): 10 ml

 

4) The References and Additional Resources sections are new

sections.

Additional Resources are not cited in the monograph but are included

for

research purposes.

 

This monograph, published by the Commission E in 1994, was modified

based on new scientific research. It contains more extensive

pharmacological and therapeutic information taken directly from the

Commission E.

 

 

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Excerpt from Herbal Medicine: Expanded Commission E Monographs

Copyright 2000 American Botanical Council

Published by Integrative Medicine Communications

Available from the American Botanical Council.

 

This material is not intended as a guide to self medication by

consumers. The lay reader is advised to discuss the information

contained herein with a doctor, pharmacist, nurse or other

authorized

health care practitioner. Neither the editors nor the publisher

accepts

any responsibility for the accuracy of the information itself or the

consequences from the use or misuse of the information contained

herein.

 

 

 

 

 

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American Botanical Council, unless otherwise noted.

 

 

 

 

American Botanical Council, 6200 Manor Rd, Austin, TX 78723

Phone: (512) 926-4900 | Fax: (512) 926-2345 | Email: ab-

@herbalgram.org

 

 

JoAnn Guest

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www.geocities.com/mrsjoguest/Diets