3: How to Use the Monographs

CHAPTER 3 How to Use the Monographs


These monographs are aimed at providing the herbal clinician with accessible and clinically relevant information on more than 100 well-known and widely used herbs. The information is presented as 125 herbal monographs that cover 137 liquid herbal extracts.


Each monograph is structured in the following way:


• Information that defines the herb by common names, botanical names, plant family, and plant part used

• Prescribing information that contains a summary of clinically relevant information, including actions, potential indications, contraindications, warnings and precautions, interactions, use in pregnancy and lactation, side effects, and dosage

• Supporting information that provides further detail to support the prescribing information and includes traditional prescribing, pharmacologic research, clinical studies, and references

The information in each monograph is covered under the following headings.



COMMON NAMES


Common names of the herb are used throughout the monographs and are presented in lower case. Exceptions are when the botanical name of the genus is used as a common name in which case it is capitalized, as in Echinacea, or when the common name contains a locality, as in Korean ginseng.



OTHER COMMON NAMES


This section lists other common names of the herb that are frequently used, particularly in the literature.



BOTANICAL NAMES


The botanical name consists of two Latin names: a generic name, which comes first, plus a specific epithet, both of which are italicized, as in Lycopus virginicus. The generic name, which is capitalized, defines the genus to which the plant belongs and may be abbreviated to its initial letter (e.g., L. virginicus). The members of a species may be grouped into subspecies or varieties, such as Arnica chamissonis subsp. foliosa or Viburnum opulus var. americanum.


Botanical names other than the current or preferred botanical name, which may be commonly encountered in the scientific or herbal literature, are also listed. These names are denoted by the superscript symbol # as an alternative name. Botanical nomenclature is being frequently updated, thus species and even genus names may change over time. Taxonomists and botanical authorities often disagree, and the status of a botanical name may change (an “old” name may become the “new” name). The botanical name listed first in this section of the monographs is not necessarily the most current botanical synonym but is usually the most widely used. The monographs do not contain a comprehensive listing of all botanical synonyms. Only the more recent or frequently encountered ones are included.


The American Herbal Products Association (AHPA) has reviewed the taxonomy of the most commonly used and important therapeutic herbs in use in the United States. The Association’s findings are reflected in the book Herbs of Commerce (2nd edition, October, 2000), a document that may supersede the previous Herbs of Commerce document that the U.S. Food and Drug Administration uses for the labeling requirements of the Dietary Supplement Health and Education Act 1994. The recommended changes by AHPA for the herbs featured in this book are:

































Common Name Old Botanical Name New Botanical Name
Black cohosh Cimicifuga racemosa Actaea racemosa
Couch grass Agropyron repens Elymus repens
Eyebright Euphrasia officinalis Euphrasia rostkoviana, Euphrasia stricta
Jamaica dogwood Piscidia erythrina Piscidia piscipula
Lavender Lavandula officinalis Lavandula angustifolia
Oregon grape Berberis aquifolium Mahonia aquifolium

Note: Anemone pulsatilla has been incorrectly assigned in this publication as Pulsatilla patens and Pulsatilla pratensis instead of Pulsatilla vulgaris.


A medicinally interchangeable species refers to another species, subspecies, or variety of an herb that has very similar therapeutic action or actions and may be clinically used in place of the preferred or official species. This species is denoted by the superscript plus symbol +.


Example: Lycopus virginicus, Lycopus europaeus+


Lycopus virginicus is the preferred species for the uses described for the herb bugleweed, but Lycopus europaeus (gypsywort) can also be used for the same clinical applications.


Occasionally, assigning the status of the species as medicinally interchangeable or as alternative is not easily resolved, and the alternative botanical name is listed with both symbols, for example, eyebright: Euphrasia officinalis, Euphrasia rostkoviana#/+.



FAMILY


The plant family is the higher grouping after the genus in the overall hierarchy of the plant kingdom. When investigating botany, an important aspect is to draw a distinction between nomenclature (naming) and taxonomy (classification in a hierarchical system). Taxonomy in particular is a constantly changing field in which plants are often reclassified into a different genus or family.


For simplicity, one authority was chosen as the primary reference: Mabberley DJ: The Plant Book, ed 2, Cambridge, 1997, Cambridge University Press. In this book, the author follows primarily the system of Cronquist (1981), which has been modified by Kubitzki (1990). Although this book is not the most recent source of taxonomic information, it is convenient for searching. (More recent classifications do not allow searching by genus.) Therefore changes in taxonomy that have occurred after the publication of Mabberley (1997) will not necessarily be represented here. Currently, the Scrophulariaceae and Malvaceae are undergoing revision, which is likely to affect several medicinal plants, especially Rehmannia glutinosa.
































Family Name Alternative Family Name
Palmae Arecaceae
Gramineae Poaceae
Cruciferae Brassicaceae
Leguminosae Fabaceae
Guttiferae Clusiaceae
Umbelliferae Apiaceae
Labiatae Lamiaceae
Compositae Asteraceae

Mabberley uses the family names recognized by the International Association of Botanical Nomenclature (St. Louis Code, 1999). However, alternative family names are also valid. Mabberley is outlined as follows:


This code indicates that both sets of family names are valid, with “Compositae” not out of date compared with “Asteraceae.” The issue of which family name to use comes down to the individual’s preference. The family names listed in the first column have been chosen for use in this text.



PLANT PARTS USED


The part or parts of the plant that are used therapeutically are defined.



PRESCRIBING INFORMATION



ACTIONS


This field contains a listing of the most relevant actions of the herb. Herbs have activity on the body either when taken orally or applied topically. This information comes mainly from traditional texts, but sources also include recent clinical use and established pharmacologic actions. A glossary at the end of the book provides definitions for these terms, and the appendix contains two action indexes that are categorized according to either the herb common name or the action.



POTENTIAL INDICATIONS


Recommended potential indications, considering the unique needs of the patient, are listed in an easy-to-read list. At the end of each indication, a number (or series of numbers) is displayed that denotes the level of evidence for that indication. This code is not a reference or citation in the usual sense. (Reference numbers are found throughout the rest of the monograph denoted by superscripted numbers.) The level of evidence code is presented as italic numerals in parentheses.


The aim of the code is to provide the reader with a powerful and concise summary of the supporting evidence for the recommended use of the herb by summarizing at a glance the traditional, pharmacologic, and clinical information contained throughout the rest of the monograph.






















Definition Notes
Level 1
Evidence obtained from a systematic review of all relevant randomized, controlled trials Includes systematic review (of randomized, controlled trials) and meta-analysis.
Level 2
Evidence obtained from at least one properly designed, randomized, controlled trial Trials must be controlled but not necessarily placebo controlled. Controls may include a controlled diet, compression stockings, or other physical treatments or conventional medication.
Level 3

• Evidence obtained from well-designed, controlled trials without randomization, or

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on 3: How to Use the Monographs

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