LAVENDER

*Botanical Names:*	Lavandula officinalis, Lavandula angustifolia,^#^∧Lavandula angustifolia subsp. angustifolia,^#Lavandula vera^#
*Family:*	Labiatae
*Plant Part Used:*	Flower

# Alternative name.

∧ Adopted by the American Herbal Products Association as the new botanical name.¹

PRESCRIBING INFORMATION

Actions	Carminative, spasmolytic, antidepressant, anxiolytic
Potential Indications	Based on appropriate evaluation of the patient, practitioners should consider prescribing lavender in formulations in the context of: • Restlessness, insomnia (4) • Anxiety, to elevate mood (4a^) • Depression, headache (5)* • Functional abdominal complaints, such as nervous stomach irritations and meteorism (i.e., gaseous distension of the abdomen or intestine) (4) • Flatulent dyspepsia, colic, digestive dysfunction, rheumatism (5) • As a bath for functional circulatory disorders (4)
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. High (undefined) doses are said to cause abdominal pain and colic.^2,³
Dosage	*Dose per day^*	*Dose per week^*
	2.0-4.5 ml of 1:2 liquid extract	15-30 ml of 1:2 liquid extract

* Based on the assumption that oral dosage of lavender infusion or liquid extract would deliver a similar concentration of active constituents to the bloodstream as would topical use (or inhalation) of lavender essential oil.

** 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: • Flatulent dyspepsia, colic, digestive dysfunction, headache, depressive states ^2,⁴ • Internally as an infusion or extract to treat rheumatism ⁴ • As a stimulant for children ² • Topically (heated) for painful local affections ² • Regarded as a mild sedative and having slight cholagogue activity ⁵ • As a bath for vegetative dystonia ⁵ • As a gargle for hoarseness and loss of voice ³
Pharmacologic Research	Lavender flowers contain 1% to 3% essential oil (consisting mainly of linalyl acetate and linalool),⁶ phenolic compounds (probably derivatives of rosmarinic acid), and flavonoids.⁷ The percentage of essential oil present in a liquid extract depends on the percentage of ethanol used in the extraction with approximately 30% of the essential oil extracted by 45% ethanol. • Dried lavender straw as bedding material decreased the incidence and severity of travel sickness in pigs but not overall levels of stress.⁸ • An aqueous methanolic extract of lavender and its isolated phenolic components produced concentration-dependent inhibition of lipid peroxidation in vitro.⁹ • The spasmolytic activity of an aqueous methanolic extract of lavender was demonstrated for experimentally induced contractions of isolated circular and longitudinal smooth muscle.¹⁰ Lavender oil decreased tone in skeletal muscle tissue.¹¹ The mechanism of the spasmolytic action of lavender oil is postsynaptic and not atropinelike and is most likely to be mediated through cAMP. The activity of linalool reflected that of the whole oil.¹² • Lavender oil demonstrated sedative activity after inhalation in an experimental model. The activity correlated to the presence of linalool in the blood. Lavender oil, linalool, and linalyl acetate inhibited stimulation by caffeine.¹³ Oral administration of lavender oil (1.6%) produced sedative and anxiolytic activities in experimental models.^14,¹⁵ • Inhaling lavender oil reduced the content of cholesterol in aortic tissue and decreased atherogenesis in an experimental model. Serum cholesterol levels were unchanged.¹⁶ • An anticonvulsive activity for inhaled lavender oil was demonstrated in several experimental models using drug-induced convulsion.¹⁷ • Lavender oil has also demonstrated the following activities: • Antimicrobial activity in vitro for the vapor was observed, particularly in relation to filamentous fungi.^18,¹⁹ No antisporulating effect was observed when the oil was applied in solution, indicating that the vapor was specifically active.¹⁹ Antifungal activity has been demonstrated towards human pathogenic fungi, including Trichophyton rubrum after direct contact in vitro.²⁰ • Inhibition of immediate-type allergic reactions via inhibition of mast cell degranulation was observed following topical or intradermal administration in several experimental models.²¹ • Moderate immunostimulatory activity was exhibited in the modified carbon clearance test in vivo (usually by injection).²²
Clinical Studies	No clinical studies using lavender dried flower or lavender extracts have been found. • A study of percutaneous absorption of lavender oil following massage found that the main constituents of the oil were detected in the blood within 5 minutes after application. Following this rapid absorption, most of the lavender oil was excreted within 90 minutes.²³ • Inhaling lavender oil by volunteers decreased vigilance by approximately 20% from baseline values, indicating a sedative effect.²⁴ • An open, controlled trial investigating the effect of aromatherapy on patients with chronic hemodialysis found lavender aroma alleviated anxiety (by significantly reducing anxiety mean scores).²⁵ In a controlled study using volunteers and designed to link the effect of odors with the emotional process, inhaling lavender odor elicited mostly “happiness” as measured by evaluation and autonomic nervous system parameters.²⁶ Inhaling lavender oil for 3 minutes by volunteers produced increased frontal beta power (suggesting increased drowsiness), less depressed mood, relaxed feelings, and faster and more accurate mathematic computations compared with baseline values. The trial was randomized and controlled (compared with rosemary oil).²⁷ • A randomized, controlled trial compared the use of aromatherapy with lavender oil, massage, and periods of rest in an intensive care environment. No significant differences were observed in the physiological stress indicators or patients’ ability to cope following any of the three treatments. However, patients who received aromatherapy reported greater improvement in their mood. These patients also felt less anxious and were more positive immediately following therapy, although this effect was not sustained or cumulative.²⁸ • Lavender oil aromatherapy resulted in a near statistically significant reduction in diastolic blood pressure during recovery from exercise in a randomized, controlled trial involving 20 healthy men. (The control group received no aromatherapy.)²⁹ In an open trial, inhaling lavender oil had an antistress effect and reduced arousal in volunteers subjected to noise stress. The treatment had no effect on blood pressure or heart rate.³⁰ • Six drops of pure lavender oil in bath water, repeated for 10 days, produced lower mean discomfort scores in women with perineal discomfort subsequent to childbirth. However, no statistically significant difference was observed among the groups (pure lavender oil, synthetic lavender oil, and an inert substance) in this randomized, placebo-controlled trial.³¹ The authors suggested that further studies should explore varying the dose and mode of application.³² • A survey of hospital staff found an improvement in the work environment following the use of lavender oil burners for 3 months.³³ • Lavender oil inhalation lengthened sleep time in four geriatric patients with sleep disorders, three of whom had been taking benzodiazepines and neuroleptic drugs for some time. In this open trial, the drugs were discontinued, and lavender oil was then administered after a washout period.³⁴ • In a randomized, double-blind, placebo-controlled trial using lavender baths, a mild improvement in sleep quality was observed for patients with sleep disorders. (Low and high strength baths were compared.)³⁵ • In a randomized, crossover trial, a 10-minute hot footbath with or without lavender oil produced an increase in blood flow and parasympathetic nerve activity in volunteers. The footbath with the addition of lavender oil produced changes in autonomic activity characteristic of relaxation.³⁶ • In Germany the Commission E supports oral use of lavender to treat mood disturbances, such as restlessness or insomnia, and functional abdominal complaints (e.g., nervous stomach irritations, meteorism, nervous intestinal discomfort). The Commission E also supports using lavender for “functional circulatory disorders.”³⁷

REFERENCES

1 McGuffin M, editor. Herbs of commerce, ed 2, Bethesda, Md: American Herbal Products Association, 1998. [draft 3.3]

2 Felter HW, Lloyd JU. King’s American dispensatory, ed 18. Portland: Eclectic Medical Publications, 1905. rev 3, reprinted 1983

3 Grieve M. A modern herbal. New York: Dover Publications, 1971.

4 British Herbal Medicine Association’s Scientific Committee. British herbal pharmacopoeia. Bournemouth: BHMA, 1983.

5 Weiss RF. Herbal medicine, English ed. Beaconsfield, UK: Beaconsfield Publishers, 1988.

6 Wagner H, Bladt S. Plant drug analysis: a thin layer chromatography atlas, ed 2. Berlin: Springer-Verlag, 1996.

7 Bisset NG, editor. Herbal drugs and phytopharmaceuticals. Stuttgart: Medpharm Scientific Publishers, 1994.

8 Bradshaw RH, et al. J Altern Complement Med. 1998;4(3):271-275.

9 Hohmann J, et al. Planta Med. 1999;65(6):576-578.

10 Izzo AA, et al. Phytother Res. 1996;10(suppl 1):S107-S108.

11 Lis-Balchin M, Hart S. J Ethnopharmacol. 1997;58(3):183-187.

12 Lis-Balchin M, Hart S. Phytother Res. 1999;13(6):540-542.

13 Buchbauer G, et al. Z Naturforsch [C]. 1991;46(11-12):1067-1072.

14 Guillemain J, Rousseau A, Delaveau P. Ann Pharm Fr. 1989;47(6):337-343.

15 Delaveau P, et al. C R Seances Soc Biol Fil. 1989;183(4):342-348.

16 Nikolaevskii VV, et al. Patol Fiziol Eksp Ter. 1990;(5):52-53.

17 Yamada K, Mimaki Y, Sashida Y. Biol Pharm Bull. 1994;17(2):359-360.

18 Larrondo JV, Agut M, Calvo-Torras MA. Microbios. 1995;82(332):171-172.

19 Inouye S, et al. Mycoses. 1998;41(9-10):403-410.

20 Adam K, et al. J Agri Food Chem. 1998;46(5):1739-1745.

21 Kim HM, Cho SH. J Pharm Pharmacol. 1999;51(2):221-226.

22 Kedzia B, et al. Herba Polon. 1998;44(2):126-135.

23 Jager W, et al. J Soc Cosm Chem. 1992;43:49-54.

24 Buchbauer B, et al. Teranishi R, Buttery RG, Sugisawa H, editors. Bioactive volatile compounds from plants. ACS Symposium series. Washington, DC: American Chemical Society, 1993. Cited in

25 Itai T, et al. Psychiatry Clin Neurosci. 2000;54(4):393-397.

26 Vernet-Maury E, et al. J Auton Nerv Syst. 1999;75(2-3):176-183.

27 Diego MA, et al. Int J Neurosci. 1998;96(3-4):217-224.

28 Dunn C, Sleep J, Collett D. J Adv Nurs. 1995;21(1):34-40.

29 Romine IJ, Bush AM, Geist CR. Percept Mot Skills. 1999;88(3, pt 1):756-758.

30 Motomura N, Sakurai A, Yotsuya Y. Memoir Osaka Kyoiku Univ III Nat Sci Appl Sci. 1999;47(2):281-287.

31 Dale A, Cornwell S. J Adv Nurs. 1994;19(1):89-96.

32 Cornwell S, Dale A. Mod Midwife. 1995;5(3):31-33.

33 Tysoe P. Int J Nurs Pract. 2000;6(2):110-112.

34 Hardy M, Kirk-Smith MD, Stretch DD. Lancet. 1995;346(8976):701.

35 Emmerling M, et al. Z Phytother Abstractband. 1995:25.

36 Saeki Y. Complement Ther Med. 2000;8(1):2-7.

37 Blumenthal M, et al, editors. The complete German Commission E monographs: therapeutic guide to herbal medicines. Austin: American Botanical Council, 1998.

LEMON BALM

*Other Common Name:*	Melissa
*Botanical Name:*	Melissa officinalis
*Family:*	Labiatae
*Plant Part Used:*	Aerial parts

PRESCRIBING INFORMATION

Actions	Carminative, spasmolytic, mild sedative, diaphoretic, TSH antagonist, antiviral (topically)
Potential Indications	Based on appropriate evaluation of the patient, practitioners should consider prescribing lemon balm in formulations in the context of: • Sleep disturbances, in combination with valerian, hops, and motherwort (2) • Nervous sleeping disorders (4) • Infantile colic, in combination with chamomile, vervain, licorice, and fennel (3) • Indigestion, flatulence, colic (4,5) • Tenseness, irritability (4) • Depression, nervous breakdown (5) • Fevers (5) • The common cold, influenza (6) • Topical treatment for herpes simplex virus infection (2,4)
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^
	3-6 ml of 1:2 liquid extract	20-40 ml of 1:2 liquid extract