E
ECHINACEA
| Other Common Name: | Purple coneflower |
| Botanical Names: | Echinacea angustifolia, Echinacea purpurea |
| Family: | Compositae |
| Plant Parts Used: | Root, aerial parts |
PRESCRIBING INFORMATION
| Actions | Immune modulating, immune enhancing, depurative, antiinflammatory, vulnerary, lymphatic, sialagogue | |
| Potential Indications | Based on appropriate evaluation of the patient, practitioners should consider prescribing Echinacea root in formulations in the context of: | |
| Contraindications | No conclusive evidence has been found that using Echinacea for long periods is detrimental or that it is contraindicated in disorders such as autoimmune disease, allergies, and asthma. The risk of allergic reaction to Echinacea itself is very small, especially if preparations of the root are used, given that these are free of pollens. | |
| Warnings and Precautions | Caution is advised for transplant patients taking immunosuppressive drugs; short-term therapy only is suggested. Misinformation exists that Echinacea is potentially hepatotoxic because of the presence of pyrrolizidine alkaloids (PAs). However, the PAs found in Echinacea possess chemical structures that are known to be nontoxic. | |
| Interactions | See the “Warnings and Precautions” section in this monograph. | |
| Use in Pregnancy and Lactation | A prospective, controlled study published in 2000 concluded that gestational use of Echinacea (generally for 5 to 7 days) during organogenesis was not associated with an increased risk of major malformations. No significant differences were found in pregnancy outcome between the study group, including 206 women who had used Echinacea during pregnancy (112 women in the first trimester) and their matched controls.1 | |
| Side Effects | Side effects are generally not expected for oral or topical administration. | |
| Dosage | Flowering tops, aerial parts, root, and whole plant of Echinacea are used medicinally. In traditional herbal medicine, the root was the preferred plant part that Native Americans and the Eclectic physicians used. Only doses for the use of the root of the preferred Echinacea species are provided here. | |
| Echinacea purpurea root: | ||
| Dose per day* | Dose per week* | |
| 3–6 ml of 1:2 liquid extract | 20–40 ml of 1:2 liquid extract | |
| 4.5–8.5 ml of 1:3 glycetract | 30–60 ml of 1:3 glycetract | |
| Echinacea angustifolia root: | ||
| Dose per day* | Dose per week* | |
| 3–6 ml of 1:2 liquid extract | 20–40 ml of 1:2 liquid extract | |
| Preparations containing a blend of Echinacea purpurea root and Echinacea angustifolia root: | ||
| Dose per day* | Dose per week* | |
| 3–6 ml of blended 1:2 liquid extracts | 20–40 ml of blended 1:2 liquid extracts | |
* This dose range is extrapolated from the British Herbal Compendium 1992 and the author’s education and experience.
Except when specifically referenced, the following book was referred to in the compilation of the pharmacologic and clinical informationMills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Edinburgh: Churchill Livingstone, 2000.
1 Gallo M, et al. Arch Intern Med. 2000;160(20):3141-3143.
2 Felter HW, Lloyd JU. King’s American dispensatory, ed 18. Portland: Eclectic Medical Publications, 1905. rev 3, reprinted 1983
3 Ellingwood F, Lloyd JU. American materia medica, therapeutics and pharmacognosy, ed 11. Portland: Eclectic Medical Publications, 1983.
4 Vogel VJ. American Indian medicine. Norman, Okla: University of Oklahoma Press, 1970.
5 Awang DVC. Altern Ther Women’s Health. 1999;July:57-59.
6 Rehman J, et al. Immun Lett. 1999;68(2-3):391-395.
7 Barrett B, Vohman M, Calabrese C. J Fam Prac. 1999;48(8):628-635.
8 MacIntosh A et al: Publication in press.
9 Lindenmuth GF, Lindenmuth EB. J Altern Complement Med. 2000;6(4):327-334.
10 Turner RB, Riker DK, Gangemi JD. Antimicrob Agents Chemother. 2000;44(6):1708-1709.
11 Scientific Committee of the European Scientific Cooperative on Phytotherapy [ESCOP]. ESCOP monographs: Echinaceae purpureae radix. Argyle House, Gandy Street, Exeter, Devon, EX4 3LS, United Kingdom: European Scientific Cooperative on Phytotherapy, ESCOP Secretariat, October 1999.
ELDER FLOWER
| Botanical Name: | Sambucus nigra |
| Family: | Caprifoliaceae |
| Plant Part Used: | Flower |
PRESCRIBING INFORMATION
| Actions | Diaphoretic, anticatarrhal | |
| Potential Indications | Based on appropriate evaluation of the patient, practitioners should consider prescribing elder flower in formulations in the context of: | |
| 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* |
| 2–6 ml of 1:2 liquid extract | 15–40 ml of 1:2 liquid extract | |
* This dose range is extrapolated from the British Herbal Pharmacopoeia 1983 and the author’s education and experience.
SUPPORTING INFORMATION
| Traditional Prescribing | Traditional Western herbal medicine uses include: • As a diaphoretic in any condition requiring fever management, including the common cold and influenza (particularly in the early stages); sinusitis, chronic nasal catarrh with deafness,1 pleurisy, bronchitis, sore throat, measles, fevers, scarlet fever2 |
| Eclectic physicians regarded warm infusions of Sambucus canadensis, a similar herb, as diaphoretic and warming and cold infusions as diuretic and depurative. Therefore Sambucus canadensis was also used to treat skin infections and liver disorders.3 | |
| Pharmacologic Research | • Aqueous extract of elder (part undefined) demonstrated an insulinreleasing and insulinlike activity in vivo (route unknown). The following isolated constituents did not stimulate insulin secretion:lectin, rutin, lupeol, and β-sitosterol.4 In an earlier trial, oral administration of aqueous extract of elder (part unknown) did not affect glucose homeostasis under either normal or induced diabetic conditions.5 • Aqueous extract of elder (part unknown) increased urine flow and urinary sodium excretion in vivo (route unknown).6 A diuretic effect was observed after intragastric administration of elder flower infusion and an extract high in potassium and flavonoids.7 • A methanolic extract of elder flower inhibited the biosynthesis of the following cytokines in vitro: interleukin-1α, interleukin-1β, and TNF-α.8 Mild antiinflammatory activity was demonstrated after intragastric administration of elder flower extract in an experimental model.9 • Intraperitoneal administration of an unsaponifiable fraction of elder flower moderately enhanced phagocytosis in vivo.10 |
| Clinical Studies | • An increase in diaphoresis in healthy volunteers has been reported,12 although theories suggested that the effect was caused by the large amount of hot fluid consumed.13 |
1 British Herbal Medicine Association’s Scientific Committee. British herbal pharmacopoeia. Bournemouth: BHMA, 1983.
2 Grieve M. A modern herbal. New York: Dover Publications, 1971.
3 Felter HW, Lloyd JU. King’s American dispensatory, ed 18. Portland: Eclectic Medical Publications, 1905. rev 3, reprinted 1983
4 Gray AM, Abdel-Wahab YH, Flatt PR. J Nutr. 2000;130(1):15-20.
5 Swanston-Flatt SK, et al. Diabetes Res. 1989;10(2):69-73.
6 Beaux D, Fleurentin J, Mortier F. Phytother Res. 1999;13(3):222-225.
7 Rebuelta M, et al. Plantes Med Phytother. 1983;17:173-181.
8 Yesilada E, et al. J Ethnopharmacol. 1997;58(1):59-73.
9 Mascolo N, et al. Phytother Res. 1987;1:28-31.
10 Delaveau P, Lallouette P, Tessier AM. Planta Med. 1980;40(1):49-54.
11 Schmersahl KJ. Naturwissenschaften. 1964;51:361.
12 Wiechowski W. Med Klin. 1927;23:590-592.
13 Bisset NG, editor. Herbal drugs and phytopharmaceuticals. Stuttgart: Medpharm Scientific Publishers, 1994.
14 Blumenthal M, et al, editors. The complete German Commission E monographs: therapeutic guide to herbal medicines. Austin: American Botanical Council, 1998.
ELECAMPANE
| Botanical Name: | Inula helenium |
| Family: | Compositae |
| Plant Part Used: | Root |
PRESCRIBING INFORMATION
| Actions | Expectorant, diaphoretic, antibacterial, spasmolytic, bronchospasmolytic | |
| Potential Indications | Based on appropriate evaluation of the patient, practitioners should consider prescribing elecampane in formulations in the context of: | |
| Contraindications | See the “Use in Pregnancy and Lactation” section in this monograph. | |
| Warnings and Precautions | Caution is advised in people with known sensitivity to elecampane or to other members of the Compositae family. | |
| Interactions | None known. | |
| Use in Pregnancy and Lactation | According to the British Herbal Compendium, elecampane is contraindicated in pregnancy and lactation.1 However, no substantial basis has been found for this concern. | |
| Side Effects | Occasional allergic reactions may occur because of sensitivity caused by the sesquiterpene lactones present in elecampane.2,3 | |
| Dosage | Dose per day* | Dose per week* |
| 3–6 ml of 1:2 liquid extract | 20–40 ml of 1:2 liquid extract | |
* This dose range is extrapolated from the British Herbal Compendium 1992 and the author’s education and experience.
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