8 Diseases and Disorders of the Nervous System – Around 20–30% of the population is affected by sleep disorders, and the frequency of these disorders increases with age. – Alternation between different depths of sleep is essential for restful sleep. Mental performance and general well-being are also greatly dependent on restful sleep. – A progressive sleep deficit (insomnia) due to deficient quality and/or quantity of sleep is classified as a manifest disease when the difficulties in falling asleep or staying asleep and general poor quality of sleep persist for more than one month, recur at a rate of at least three times a week, and have a negative effect on the patient’s daytime well-being. – Primary insomnia is a separate entity characterized by disturbances in the rhythmic change between sleep and wakefulness. Melatonin and various neurotransmitters play a role in the complex control mechanisms underlying these changes. The production of melatonin, the substance that synchronizes the sleeping–waking rhythm, slackens with age. – Secondary insomnia may occur due to organic causes (e. g., restless legs syndrome) or psychiatric diseases as well as due to the consumption of alcohol, drugs, or medications. – So-called sleep hygiene measures and behavioral therapy play an important role in the treatment of sleep disorders. Pharmaceutical agents should not be used unless these measures have failed. – Herbal sleep aids should be taken orally. They are mainly used for treatment of nervous sleep disorders. – Certain herbal baths also promote sleep. See Herbal Hydrotherapy, p. 285. – Action • Valerian root: The most important constituents in valerian root are the essential oil, valepotriates, and amino acids, which were shown to have overall central sedative and muscle relaxant effects in animals. No study data are available on their absorption, distribution and excretion in humans. Recent clinical studies in insomnia patients demonstrated that valerian root was able to normalize the sleep profile while improving the quality of sleep as well as the patient’s daytime well-being. However, it took several days for the herbal remedy to take effect. • Hop cones: Oxidation products of the bitter principles humulone and lupulone as well as flavonoids are assumed to be responsible for the sleep-promoting effect of the herb. Hop cones are generally used in combination with other herbal remedies. In one clinical study, a mixture of hop cones and valerian root was shown to improve the sleep pattern, decrease the sleep induction time, and improve the patients’ ability to sleep through the night. • Passion flower herb: The constituents responsible for the rather mild sedative effects of the herb still have not been identified. Passion flower is almost always used in combination with other herbal remedies. • Balm leaf: Balm leaf oil has calming and central sedative effects as well as spasmolytic, carminative, and antibacterial actions. This herb is particularly useful in patients who find it difficult to fall asleep owing to nervous heart and gastrointestinal problems. • Lavender flower: Lavender flower oil has a weak calming effect and mitigates nervous gastrointestinal complaints. • Chamomile: Chamomile flower is mildly calming and promotes sleep as a tea before bedtime. Chamomile tea is generally considered one of the safest teas for children and mothers, and during pregnancy. – Contraindications: Because of the lack of study data, valerian should not be used during pregnancy and lactation or in children under 12 years of age. Patients with impaired liver function, epilepsy, or brain damage should not use preparations containing alcohol. – Dosage and administration • Sedative tea Rx 1: Valerianae radix 40 g, Lupuli strobulus 20 g, Melissae folium 15 g, Menthae piperitae folium 15 g, Aurantii pericarpium 10 g. Pour 1 cup of water onto 1 teaspoon of the herbs, then cover and steep for 5 to 10 minutes. Take 2 to 3 cups during the day and 1 cup before retiring. • Sedative tea Rx2: Valerianae radix, Lupuli strobulus, Melissae folium, Lavandulae flos, aa ad 100 g. Pour 1 cup of boiling water onto 1 teaspoon of the herbs, then cover and steep for 5 to 10 minutes. Take 2 to 3 cups during the day, and 1 cup before retiring. – Side effects and drug interactions: Not known. – Clinical value: These herbal treatments are a very good alternative to synthetic tranquilizers that are potentially habit-forming. – The frequency of nervous disorders and stress intolerance increases with age. These problems often affect people in poor social conditions, menopausal women, and aging smokers. – “Burnout” is caused by intense mental strain. The initial symptoms include listlessness, tiredness, and lack of motivation. These can later progress to dizziness, heart pains, gastrointestinal problems, sleep disorders, tensed back muscles, and low resistance to infections. – Stress intolerance and nervous disorders should be treated using a holistic strategy that includes exercise, relaxation, reduction of dietary fats and meats, and herbal treatment measures. – Standardized kava root extract (Piper methysticum) is an increasingly popular remedy for anxiety and tension. – Lemon balm oil is another safe and effective alternative treatment. – Unlike their synthetic counterparts, herbal tranquilizers are not habit-forming and they do not affect the patient’s mental alertness or reaction time when taken short-term. – Action, dosage, and administration • Kava – Kava extract contains anxiolytic substances called kavapyrones. Dopaminergic, glutamatergic, and serotoninergic mechanisms and inhibition of monoamine oxidases A and B may play a role in their therapeutic action. Only low-level binding of kava pyrones with the GABAA-benzodiazepine receptor complex can be observed. – The herbal remedy induces relaxation without significant sedation. It also improves the anxiety, hot flushes, sleep disorders, and vertigo associated with menopausal syndrome. – Evidence suggests that kava also has a neuroleptic component. – Kava extracts are taken orally. Fundamentally, no rebound effects should occur when a patients is switched from benzodiazepines to kava. Moreover, one report shows that no rebound effects were observed after 24-week treatment with kava root extract was discontinued, and improvement of clinical symptoms was observed after only one week of treatment. Owing to the lack of sufficient clinical study data, kava cannot be recommended for treatment of panic attacks, phobias, compulsive disorders, or generalized anxiety disorders. – Valerian and passion flower extracts – Counteract daytime nervous unrest and related concentration difficulties. – The most important constituents in valerian root are the essential oil, valepotriates, and amino acids, which were shown to have overall central sedative effects and muscle relaxant effects in animals.
8.1 Sleep Disorders
Clinical Considerations
General comments
General and herbal treatment measures
Clinical value of herbal medicine: In light of the known side effects and danger of habit formation of benzodiazepine tranquilizers and other synthetic and chemical tranquilizers, herbal sedatives containing valerian, hops, passion flower, and lemon balm are becoming increasingly important in the treatment of mild to moderate sleep disorders.
Recommended Herbal Remedies and Range of Applications
Valerian root (Valerianae radix, see p. 125); hop cones (Lupuli strobulus, see p. 75); balm leaf (Melissae folium, see p. 84); passion flower herb (Passiflorae herba, see p. 101); lavender flower oil (Lavandulae flosoleum. see p. 59)
This tea is known for its pleasant taste.
8.2 Nervous Anxiety, Tension, and Unease
Clinical Considerations
General comments
General and herbal treatment measures
Clinical value of herbal medicine: The growing number of clinical studies demonstrating beneficial effects and vast amounts of empirical data indicate that herbal remedies play an increasingly important role in these indications.
Recommended Herbal Remedies (Overview)
Kava rhizome (Piperis methystici rhizoma, see p. 82); balm leaf (Melissae folium, see p. 84); valerian root (Valerianae radix, see p. 125); passion flower herb (Passiflorae herba, see p. 101); lavender flower (Lavandulae flos, see p. 59); St. John’s wort (Hyperici herba, see p. 115).
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