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ALBIZIA














Botanical Names: Albizia lebbeck, Albizzia lebbeck#, A. lebbek#
Family: Leguminosae
Plant Part Used: Stem bark

# Alternative name.



PRESCRIBING INFORMATION


































Actions Antiallergic, hypocholesterolemic, antimicrobial
Potential Indications
Based on appropriate evaluation of the patient, practitioners should consider prescribing Albizia in formulations in the context of:

• Allergic rhinitis (5,7)

• Allergic respiratory disorders especially asthma (4,5)

• Eczema (5)

• Possible benefit in hypercholesterolemia (7)
Contraindications None known.
Warnings and Precautions None required.
Interactions None known.
Use in Pregnancy and Lactation No adverse effects expected.
Side Effects None expected if taken within the recommended dose range.
Dosage Dose per day* Dose per week*
  3.5–8.5 ml of 1:2 liquid extract 25–60 ml of 1:2 liquid extract

* This dose range is extrapolated from traditional Ayurvedic medicine1 and the author’s education and experience.



SUPPORTING INFORMATION














Traditional Prescribing
Traditional Ayurvedic uses include:

• Bronchitis, asthma, allergic disorders, leprosy, eczema, pruritus, paralysis, gum inflammation, worm infestation1–4

• As an antiinflammatory agent5
Pharmacologic Research
• Studies found Albizia to have antiallergic and antianaphylactic activity.5–7 Early processes of sensitization were inhibited, levels of allergy-inducing antibodies were depressed, as was T-lymphocyte and B-lymphocyte activity. A stabilizing effect on mast cells compared with disodium cromoglycate and prednisolone was exhibited.3,6

• A protective effect on the adrenal glands was demonstrated for oral administration of Albizia extract or decoction. An increase in adrenal activity was also observed.3,8,9

• Oral doses of Albizia significantly decreased serum cholesterol in vivo.3,6

• Albizia demonstrated antiulcer activity in vivo but not in nonsteroidal antiinflammatory drug (NSAID) models of ulcer induction (indomethacin and acetylsalicylic acid).10

• Albizia has demonstrated antimicrobial activity11 and anthelmintic activity12 in vitro.
Clinical Studies In an uncontrolled study involving 20 patients with asthma, the response to Albizia was excellent for asthma of recent onset (less than 2 years) but less predictable in more chronic cases. Improvement in clinical and biochemical parameters such as plasma cortisol, catecholamine, histaminase, and blood histamine were observed. The significant increase in plasma cortisol levels after treatment suggests that Albizia might provide benefit through supporting the adrenal cortex. Albizia was administered as a decoction (25 ml four times/day) for 3 weeks.13


REFERENCES



1 Kapoor LD. CRC handbook of ayurvedic medicinal plants. Boca Raton, Fla: CRC Press, 1990.


2 Kirtikar KR, Basu BD. Indian medicinal plants, vol 2 . SN Basu, Allahabad, India, 1933.


3 Tripathi RM, Sen PC, Das PK. J Ethnopharmacol. 1979;1(4):385-386.


4 Thakur RS, Puri HS, Husain A. Major medicinal plants of India. Lucknow, India: Central Institute of Medicinal and Aromatic Plants, 1989.


5 Tripathi RM, Das PK. Indian J Pharmacol. 1977;9:189-194.


6 Tripathi RM, Sen PC, Das PK. J Ethnopharmacol. 1979;1:397-406.


7 Johri RK, et al. Indian J Physiol Pharmacol. 1985;29(1):43-46.


8 Tripathi SN, Shukla P. Indian J Exp Biol. 1979;17:915-917.


9 Tripathi P, et al. Indian J Physiol Pharmacol. 1983;27(2):176-178.


10 Chatterjee SS, Jaggy H: 4th International Congress on Phytotherapy, Munich, September 10-13, 1992; Abstract SL75.


11 Ganguli NB, Bhatt RM. Indian J Exp Biol. 1993;31:125-129.


12 Kaleysa Raj R. Indian J Physiol Pharmacol. 1975;19:47-49.


13 Tripathi SN, et al. Quart J Surg Sci. 1978;14:169-176.





ALOE VERA

















Other Common Name: Aloe
Botanical Name: Aloe spp.
Family: Asphodelaceae
Plant Part Used: Juice from the leaf


PRESCRIBING INFORMATION





























Actions Immune enhancing, antiviral, vulnerary, antiinflammatory, antitumor
Potential Indications
Based on appropriate evaluation of the patient, practitioners should consider prescribing Aloe juice concentrate in formulations in the context of:

• Non-insulin–dependent diabetes mellitus, hypertriglyceridemia (3)

• Adjuvant therapy for the treatment of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) (4)

• Improving the response of the immune system (7)

• Topical treatment for genital herpes (2)

• Topical treatment for psoriasis and seborrheic dermatitis (3)

• Topical treatment for chronic leg ulcers (4)

• Topical treatment for burns (4)

• Topical treatment for mouth ulcers (4a, 6)

• Topical treatment for wounds and abscesses (6)
Contraindications Individuals with known hypersensitivity should avoid using Aloe juice products.1,2
Warnings and Precautions None required.
Interactions None known.
Use in Pregnancy and Lactation No adverse effects expected.
Side Effects Aloe products have caused hypersensitivity reactions such as dermatitis when used topically and orally.1,2
Dosage 25 ml of Aloe juice concentrate (4.5:1) is taken one to four times per day. Aloe juice concentrate can be taken in orange or pineapple juice.* Aloe juice concentrate is best given on its own and not mixed with herbal extracts.

* This dose range is extrapolated from pharmacologic and clinical trial data.3


Leaf concentrates providing quantified levels of acemannan are recommended and should ideally contain not less than 11.25 mg/ml of acemannan. Additionally, the safety assessments in this monograph apply only for Aloe liquids that contain low levels of anthraquinones (usually by a removal process).



SUPPORTING INFORMATION














Traditional Prescribing
Uses from traditional Ayurvedic and Thai medicine include:

• Peptic ulcers4

• Topically for burns, wounds, abscesses, mouth ulcers,4 and inflamed areas5
Pharmacologic Research
• Important constituents in Aloe leaves, apart from the anthraquinone glycosides, are the polysaccharides, in particular, acetylated galactomannan. This long-chain polysaccharide was given the name acemannan.6

• Short-term exposure of peritoneal macrophages to acemannan upregulated their respiratory burst, phagocytosis, and killing of Candida albicans.7

• Several studies have shown acemannan to have a beneficial effect in treating and preventing tumors.8,9 Injection of Aloe powder (undefined) stimulated cell-mediated responses in an experimental tumor model.10

• Oral administration or injection of acemannan was beneficial for treating feline immunodeficiency virus infection in vivo.11 Experimental studies suggest that acemannan has some benefits in the management of HIV.12–14

• Acemannan was shown to increase splenic and peripheral blood cellularity and levels of hematopoietic progenitors in the spleen and bone marrow in experimental studies.15

• Oral administration of Aloe gel was active as an antiinflammatory agent in several models of inflammation. The activity was said to depend on the presence of anthraquinones.16

• In laboratory studies, wounds were treated either by topical application or by oral administration of Aloe gel, with both treatments producing beneficial results.17–19 Aloe cream demonstrated benefit in first- and second-degree burns,20 which may be a result of inhibition of thromboxane B2 and prostaglandin F2α formation, thereby preserving dermal circulation and decreasing burn wound tissue.21

• Gastrointestinal treatment with Aloe juice (170 ml/day) resulted in improved gastric and intestinal function.22
Clinical Studies
The Aloe leaf yields two products that have medicinal, pharmaceutical, and cosmetic uses: Aloe resin and Aloe gel (often made into a juice).

Aloe resin is a solid residue obtained from the latex or sap that exudes from the cut leaf. The resin contains anthraquinone components and is well known for its laxative activity. Aloe gel is a mucilaginous material obtained mainly from the central part of the leaf, known particularly for healing wounds. Both the resin and the gel have been used traditionally.

Recently, the Aloe gel in the form of extracts or juices has demonstrated new medical applications. In many of the clinical studies listed here, the Aloe extract is not defined, but assumptions are that the extract does not contain large amounts of anthraquinones.

• Several clinical studies using acemannan in treating HIV and AIDS have been conducted.23,24 In an uncontrolled clinical study, 29 patients with AIDS received Aloe vera whole leaf juice (containing 1200 mg/day of acemannan), essential fatty acids, and nutrients. Karnofsky scores improved in all of these patients over 180 days.25

• Seventy two patients with recently diagnosed non-insulin–dependent diabetes received either Aloe juice or placebo over 6 weeks in an open trial. From day 14, the blood sugar levels of patients treated with Aloe were significantly reduced compared with the control group and continued to fall steadily over the treatment period. Blood triglyceride levels were significantly reduced from day 28. Cholesterol levels were unaffected.26 In a single-blind, placebo-controlled trial, Aloe juice in combination with glibenclamide significantly reduced levels of fasting blood glucose within 2 weeks and triglycerides within 4 weeks compared with glibenclamide alone. Even after 6 weeks of treatment however, blood sugar levels had not fallen to normal values.27 In both trials, 1 tablespoon of 80% Aloe juice prepared from gel was taken twice per day.

• Oral administration of an Aloe extract for 6 months demonstrated benefit in patients with chronic asthma. One third of the 33 patients were regarded as effectively treated based on patients’ impressions and physicians’ observations. Aloe was not beneficial for patients who had previously been administered a steroid drug. The daily dose prescribed was 10 ml of a 20% solution of Aloe extract in saline. The extract was not defined except that it was stored in the dark at 4 C (39° F) for 7 days.28

• In a double-blind trial, topical application of Aloe extract (0.5%) in a hydrophilic cream was significantly more beneficial than was the placebo in treating psoriasis.29 Topical application of an Aloe emulsion (containing 30% Aloe extract) was an efficacious treatment for patients with seborrheic dermatitis in a double-blind, placebo-controlled trial.30

• Aloe gel was beneficial in treating partial-thickness burns in a controlled trial compared with gauze containing white petroleum jelly.31 In an open trial, Aloe was beneficial for treating chronic leg ulcers. Patients received an Aloe drink (60 ml/day of 98% stabilized gel) and applied aloe gel topically.32

• Aloe extract (0.5%) in a hydrophilic cream was more efficacious than was placebo in a randomized, double-blind trial involving 60 men with genital herpes. The group treated with Aloe had shorter mean time to healing compared with the placebo group and contained a higher number of healed patients.33

• Patients with a history of recurrent aphthous stomatitis (mouth ulcers or canker sores) were treated with an acemannan hydrogel. Patients using the acemannan hydrogel showed a significant reduction in the healing time of mouth ulcers compared with an active over-the-counter preparation.34


REFERENCES



1 Morrow DM, Rapaport MJ, Strick RA. Arch Dermatol. 1980;116(9):1064-1065.


2 Hogan DJ. CMAJ. 1988;138(4):336-338.


3 Plaskett LG. The health and medical use of Aloe vera. Tacoma, Wash: Life Sciences Press, 1996.


4 Farnsworth NR, Bunyapraphatsara N, editors. Thai medicinal plants. Bangkok: Medicinal Plant Information Center, 1992.


5 Chopra RN, et al. Chopra’s indigenous drugs of India, ed 2. Calcutta: Academic Publishers, 1958. reprinted 1982


6 Pelley RP. Aloe polysaccharides and their measurement. In: Inside Aloe. Irving, Tex: International Aloe Science Council; 1997.


7 Stuart RW, et al. Int J Immunopharmacol. 1997;9(2):75-82.


8 Peng SY, et al. Mol Biother. 1991;3(2):79-87.


9 King GK, et al. J Am Anim Hosp Assoc. 1995;31(5):439-447.


10 Corsi MM, et al. Int J Tissue React. 1998;20(4):115-118.


11 Yates KM, et al. Vet Immunol Immunopathol. 1992;35(1-2):177-189.


12 McDaniel HR, Rosenberg LJ, McAnalley BH. Int Conf AIDS. 1993;9(1):498.


13 Yates KM, et al. Int Conf AIDS. 1993;9(1):196.


14 Kemp MC, et al. Int Conf AIDS. 1990;6(2):315.


15 Egger SF, et al. Cancer Immunol Immunother. 1996;43(4):195-205.


16 Davis RH, et al. J Am Podiatr Med Assoc. 1989;79(6):263-276.


17 Chithra P, Sajithlal GB, Chandrakasan G. Mol Cell Biochem. 1998;181(1-2):71-76.


18 Chithra P, Sajithlal GB, Chandrakasan G. J Ethnopharmacol. 1998;59(3):195-201.


19 Chithra P, Sajithlal GB, Chandrakasan G. J Ethnopharmacol. 1998;59(3):179.


20 Bunyapraphatsara N, et al. Phytomed. 1996;2(3):247-251.


21 Heggers JP, et al. J Surg Res. 1980;28(2):110-117.


22 Bland J. Prev Med. 1985;March/April:1.


23 Montaner JS, et al. J Acquir Immune Defic Syndr Hum Retrovirol. 1996;12(2):153-157.


24 Scrip–World Pharmaceutical News. 1996;(1530):23.


25 Pulse TL, Uhlig E. J Advancement Med. 1990;3(4):209-230.


26 Yongchaiyudha S, et al. Phytomed. 1996;3(3):241-243.


27 Bunyapraphatsara N, et al. Phytomed. 1996;3(3):245-248.


28 Shida T, Nishimura H. Proc Symp Wakanyaku. 1980;13:47-51. Shida T, et al. Planta Med. 1985;51(3):273-275.


29 Syed TA, et al. Trop Med Int Health. 1996;1(4):505.


30 Vardy DA, et al. J Dermatol Treat. 1999;10:7-11.


31 Visuthikosol V, et al. J Med Assoc Thai. 1995;78(8):403-409.


32 Atherton P. Nurs Stand. 1998;12(41):49-52. 54


33 Syed TA, et al. J Dermatol Treat. 1997;8(2):99-102.


34 Plemons JM, et al. Wounds. 1994;6(2):40-45.





ANDROGRAPHIS














Botanical Name: Andrographis paniculata
Family: Acanthaceae
Plant Part Used: Aerial parts


PRESCRIBING INFORMATION











Actions Bitter tonic, choleretic, immune enhancing, hepatoprotective, antipyretic, antiinflammatory, antiplatelet, antioxidant, anthelmintic
Potential Indications
Based on appropriate evaluation of the patient, practitioners should consider prescribing Andrographis in formulations in the context of:

• Bacterial and viral respiratory tract infections (including the common cold) and reducing associated fever (2, 5)

• Preventing the common cold and pharyngotonsillitis (2)

• Preventing urinary tract infections* following shock wave lithotripsy (3)

• Enteric infections (4, 5)

• Infective hepatitis (4)

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