S

S




SAGE














Botanical Name: Salvia officinalis
Family: Labiatae
Plant Part Used: Aerial parts


PRESCRIBING INFORMATION


































Actions Spasmolytic, antioxidant, astringent, antihyperhidrotic, antimicrobial
Potential Indications
Based on appropriate evaluation of the patient, practitioners should consider prescribing sage in formulations in the context of:

• Inflammations and infections of the mouth and throat (4,5)

• Dyspepsia (4,5)

• Excessive sweating (4,5)

• Menopausal hot flashes* and night sweating, in combination with Medicago sativa (4)

• Reducing or stopping lactation (5)

• Febrile conditions (5)

• Nervous debility, nervous exhaustion (6)

• Topical treatment for inflammations of the mucous membranes of the nose (4)

• Topical treatment to stop the flow of milk (5)
Contraindications Pregnancy and lactation.1 (See also the “Use in Pregnancy and Lactation” section in this monograph.)
Warnings and Precautions The recommended dose must not be exceeded. Caution should be taken with long-term use.1 (These cautions are made because of the presence of the potentially toxic component thujone in the essential oil of sage leaf.)
Interactions None known.
Use in Pregnancy and Lactation Contraindicated in pregnancy and lactation. However, sage has been used traditionally to stop milk flow.
Side Effects None expected if taken within the recommended dose range.
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

* Sage has also been used in traditional herbal medicine for treating hot ashes. (6)


** 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:

• Inflammation of the mouth, tongue, or throat and topically for these conditions2
 
• Flatulent dyspepsia, debilitated digestion,2,3 bilious and kidney disorders4

• Excessive sweating,2,3 hot flashes of menopause 5

• Nervous exhaustion, debility of the nervous system, joint pain, tension headache4

• To improve the memory and stimulate the senses6

• To stop the flow of milk, both oral 2 and topical use3
Pharmacologic Research
The aerial parts of sage contain 1.5% to 2.5% essential oil, the composition of which varies depending on its origin. The essential oil contains monoterpenes, including approximately 30% thujone in some varieties. High doses of thujone may cause neurotoxicity. Other constituents of sage include flavonoids, rosmarinic acid, and phenolic diterpenes, including carnosol and carnosic acid.7,8 (Carnosic acid is also known as carnosolic acid or salvin.)

• Sage extract caused inhibition of lipid peroxidation in vitro.9 Isolated constituents of sage found to have in vitro antioxidant activity include the phenolic diterpenes carnosol, rosmanol, and carnosic acid.10

• Sage extract administered by injection demonstrated hypotensive and spasmolytic activity in experimental models.11

• Sage extract and sage oil inhibited acetylcholinesterase in a concentration-dependent manner in human brain tissue in vitro.12 Diterpenes isolated from sage were found to interact with the GABA-benzodiazepine receptor.13

• Aqueous extract of sage demonstrated moderate antibacterial activity in vitro.14

• Topical application of a chloroform extract of sage demonstrated dose-dependent antiinflammatory activity in the croton oil–induced ear edema model.15
Clinical Studies
• In a number of open studies, sage has reduced sweat production in patients with hyperhidrosis (excessive sweating). Daily dose ranged from the equivalent of 2.6 to 4.5 g of leaf.1

• A product containing sage and alfalfa (Medicago sativa) extracts produced improvement in the menopausal symptoms of hot flashes and night sweats in an open trial conducted for 3 months. The product appeared to produce a slight central antidopaminergic activity.16

• In Germany, the Commission E supports using sage to treat dyspeptic symptoms, excessive perspiration, and externally for inflammations of the mucous membranes of the nose and throat.17

• ESCOP recommends sage leaf for treating inflammations and infections of the mouth and throat, such as stomatitis, gingivitis, and pharyngitis, as well as hyperhidrosis.1


REFERENCES



1 Scientific Committee of the European Scientific Cooperative on Phytotherapy [ESCOP]. ESCOP monographs: Salviae folium. Argyle House, Gandy Street, Exeter, Devon, EX4 3LS, United Kingdom: European Scientific Cooperative on Phytotherapy, ESCOP Secretariat, March 1996.


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


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


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


5 Bartram T. Encyclopedia of herbal medicine, ed 1. Dorset, UK: Grace Publishers, 1995.


6 Culpeper N: Culpeper’s complete herbal, and English physician, Manchester, 1826, J. Gleave & Son, reprinted Bath, 1981, Harvey Sales.


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


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


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


10 Wang M, et al. J Nat Prod. 1999;62(3):454-456.


11 Todorov S, et al. Acta Physiol Pharmacol Bulg. 1984;10(2):13-20.


12 Perry N, et al. Int J Geriatr Psychiatry. 1996;11(12):1063-1069.


13 Rutherford DM, et al. Neurosci Lett. 1992;135(2):224-226.


14 Brantner A, Grein E. J Ethnopharmacol. 1994;44(1):35-40.


15 Brkic D et al: International Congress and 48th Annual Meeting of the Society for Medicinal Plant Research and the 6th International Congress on Ethnopharmacology of the International Society for Ethnopharmacology, Zurich, September 3-7, 2000, abstract P2A/1.


16 De Leo V, et al. Minerva Ginecol. 1998;50(5):207-211.


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





SARSAPARILLA

















Common Name: Sarsaparilla
Botanical Names: Smilax ornata, Smilax regelii,+Smilax febrifuga, +Smilax medica+Note: Other species have also been listed in traditional texts, although they were less favored (e. g., S. officinalis). Smilax aristolochiifolia is a botanical synonym of S. medica and therefore is also a medicinally interchangeable species for Smilax ornata.
Family: Smilacaceae
Plant Part Used: Root and rhizome

+ Medicinally interchangeable species.



PRESCRIBING INFORMATION








































Actions Antirheumatic, depurative, antiinflammatory
Potential Indications
Based on appropriate evaluation of the patient, practitioners should consider prescribing sarsaparilla in formulations in the context of:

• Psoriasis (4a,4,5)

• Chronic skin disorders (5)

• Rheumatoid arthritis (5)

• Providing general tonic effects (6)
Contraindications None known.
Warnings and Precautions The German Commission E advises that taking sarsaparilla preparations leads to gastric irritation and temporary kidney impairment (diuresis). The absorption of simultaneously administered substances (such as digitalis glycosides or bismuth) is increased. The elimination of other substances (e. g., hypnotics) is accelerated. This action can cause an uncontrolled condition of increased or decreased action of treatments taken simultaneously.1 However, these concerns are theoretical and not based on animal experiments or clinical case reports, and they would apply for any herb containing saponins. Such concerns would be alleviated by not taking sarsaparilla simultaneously with drug medication.
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
  Although these doses reflect recent modern use, nineteenth century clinicians used substantially higher doses, possibly because of the ntisyphilitic application. For example, the British Pharmacopoeia 1898 recommended 8 to 15 ml three times per day of a 1:1 extract.
  The clinical trial with psoriasis patients (see later discussion) used 15 g per day by decoction, but water does not effectively extract saponins. Hence lower doses of ethanol-water extracts may still be as effective. Nonetheless, a case may be made for increasing the sarsaparilla dose if the patient’s

* This dose range is extrapolated from the British Herbal Pharmacopoeia 1983.



SUPPORTING INFORMATION


























Traditional Prescribing
Traditional Western herbal medicine uses include:

• Chronic skin conditions, especially psoriasis2,3

• Rheumatoid arthritis, syphilis, dropsy2,3

• Adjuvant therapy for leprosy2
  Smilax regelii root has also been used traditionally in Guatemala for treating skin diseases, including abscess, boils, and acne, as well as urinary tract infections.4,5 Species of Smilax (“zarzaparrilla” [S. aristolochiaefolia and other species] and “cuculmeca” [Smilax spp.])6 have been used traditionally in Central America for blood and skin disorders, snakebite, and as a tonic to enhance vigor and treat weakness.7
  Sarsaparilla, which was introduced into North America from Spanish America, is listed in Spanish pharmacopoeias from 1739 to 1954, with the major actions being sudorific (inducing sweating, similar to a diaphoretic), antivenereal, and antirheumatic. Sarsaparilla was used extensively in the sixteenth and seventeenth centuries for treating syphilis.8
  Sarsaparilla from several species of Smilax (not to be confused with the American or wild sarsaparilla, Aralia nudicaulis) was official in the USP from 1820 to 1955 and the NF from 1955 to 1965 and was used as a tonic and flavoring agent. Native Americans used sarsaparilla to treat many diverse diseases.9
  Natives of the Amazon have used the root (Smilax officinalis) to reestablish virility in men and to treat symptoms of menopause.10 Such applications might well be anticipated, given the steroidal saponin content of the plant.
Pharmacologic Research
Species of sarsaparilla contain steroidal saponins for which sarsasa-ogenin and smilagenin have been identified as aglycones. 11

• Aqueous extract of Smilax regelii root inhibited the following dermatophytes in vitro: Epidermophyton floccosum, Microsporum canis, and Trichophyton mentagrophytes.4

• Oral pretreatment of rats with Smilax regelii extract inhibited carbon tetrachloride–induced hepatocellular metabolic changes. 12

• Sarsaparilla products have been popular among athletes and bodybuilders for testosterone supplementation. Despite this traditional use, sarsaparilla does not contain testosterone, and the steroidal saponins do not behave as anabolic steroids. A study reviewing all clinical trials published between 1966 and 1992 found no documented evidence to substantiate claims that diosgenin, smilagenin, and hecogenin increase growth hormone release in the body.13
Clinical Studies
• Oral administration of sarsaparilla improved psoriasis in over 50% of patients treated in open, uncontrolled trials.14–18 The daily dose provided for one of these trials was a sarsaparilla root decoction (15 g in 1 L).15 In many of these trials, a low-fat diet and ointments were also used, and long-term use of sarsaparilla (2 to 3 months) was required. Saponins from sarsaparilla produced greater improvement in psoriasis patients compared with controls. Sarsaparilla saponins were more beneficial for chronic plaque psoriasis. The average period of treatment was 4 months, with a range of 4 weeks to 7 months.19

• Smilax ornata extract (equivalent to 30 g root/day) taken for several months was superior to sulfones in treating leprosy.20 Favorable results were obtained in a later uncontrolled trial using a combination of sarsaparilla and sulfones for leprosy treatment.21

• Sarsaparilla root extract (2.4 g/day) produced a decrease in serum urea in both healthy volunteers and patients with nephritis. According to the authors, this finding may have been the result of increased urinary excretion. Symptoms of acute uremia (e. g., headaches, appetite loss) were relieved with the reduction in serum urea.22


REFERENCES



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


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


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


4 Caceres A, et al. J Ethnopharmacol. 1991;31(3):263-276.


5 Caceres A, et al. J Ethnopharmacol. 1987;20(3):223-237.


6 Hersch-Martinez P. Econ Bot. 1997;51(2):107-120.


7 Villalobos R. Rev Forest Centroam. 2000;32:39-42.


8 Fernandez Negri MA, Lopez Andujar G. Ars Pharm. 1990;31(3-4):223-231.


9 Vogel VJ. American Indian medicine. Norman, Okla: University of Oklahoma Press, 1970.


10 Evans Schultes R, Raffauf RF. The healing forest: medicinal and toxic plants of the Northwest Amazonia. Portland: Dioscorides Press, 1990.


11 Hostettmann K, Marston A. Chemistry & pharmacology of natural products: saponins. Cambridge: Cambridge University Press, 1995.


12 Rafatullah S, et al. Int J Pharmacogn. 1991;29(4):296-301.


13 Barron RL, Vanscoy GJ. Ann Pharmacother. 1993;27(5):607-615.


14 Deneke T. Dtsch Med Wochenschr. 1936;62:337-341.


15 Philippsohn A. Dermatol Wochenschr. 1931;93:1220-1223.


16 Ritter H. Dtsch Med Wochenschr. 1936;62:1629-1631.


17 Zaun H. Dtsch Med Wochenschr. 1938;64:1073.


18 Baird PCJr. N Engl J Med. 1939;220:794-801.


19 Thurman FM. N Engl J Med. 1942;227:128-133.


20 Rollier R, et al. Maroc Med. 1951;30:776-780.


21 Rollier R. Int J Leprosy. 1959;27:328-340.


22 Rittmann R, Schneider F. Klin Wochschr. 1930;9:401-408.





SAW PALMETTO














Botanical Names: Serenoa serrulata, Serenoa repens,#Sabal serrulata#
Family: Palmae
Plant Part Used: Fruit

# Alternative name.



PRESCRIBING INFORMATION








































Actions Antiinflammatory, male tonic, antiprostatic, spasmolytic, possibly antiandrogenic
Potential Indications
Based on appropriate evaluation of the patient, practitioners should consider prescribing saw palmetto in formulations in the context of:

• Mild to moderate BPH (4,5)

• Inflammation of the genitourinary tract, especially cystitis, atrophy of sexual tissues; as an aphrodisiac; sex hormone deficiency (5)

• Noninfectious prostatitis (7)
Contraindications None known.
Warnings and Precautions None required.
Interactions None known.
Use in Pregnancy and Lactation No adverse effects expected.
Side Effects Saw palmetto is well tolerated by most patients and causes relatively few side effects. Most side effects are minor gastrointestinal problems, such as nausea, which are usually resolved when the herb is taken with meals.
  One case of hemorrhage during surgery, which was associated with intake of saw palmetto extract, has been reported.1
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
  Capsules containing 160 mg of the liposterolic extract (LESP) are usually recommended at two capsules per day.** This extract is an 8:1 to 10:1 concentrate of the original dried berries (i. e., approximately 2.88 g/day of saw palmetto berries). Hence using LESP reflects a higher dosing strategy than that stated here.

* This dose range is extrapolated from the British Pharmaceutical Codex 1934, the British Herbal Pharmacopoeia 1983, and the German Commission E.


** This dose range is extrapolated from clinical trials and the German Commission E.



SUPPORTING INFORMATION


























Traditional Prescribing
Traditional Western herbal medicine uses include:

• Prostatic hypertrophy, inflammation of the genitourinary tract (especially cystitis), genitourinary tract discharge, atrophy of sexual tissues, sex hormone disorders; as an aphrodisiac2,3;enlarged ovaries, undeveloped mammary glands4

• Irritative cough, chronic bronchial coughs, whooping cough, laryngitis, acute catarrh, asthma3

• To improve digestion; as a tonic for the nervous system4
  Native Americans ate saw palmetto berries. Saw palmetto was official in the USP from 1906 to 1916 and the NF from 1926 to 1950 and was used as a diuretic, sedative, and anticatarrhal.5
Pharmacologic Research Saw palmetto berries contain free fatty acids, triglycerides, phytosterols (mainly β-sitosterol), fatty alcohols, flavonoids, and polysaccharides.
  LESP is a specially prepared extraction of dried saw palmetto berries using hexane, 90% ethanol, or supercritical carbon dioxide. The liposterolic extract contains 85% to 95% fatty acids (mostly as triglycerides) and 0.2% to 0.4% total sterols (with 0.1% to 0.3% β-sitosterol). Flavonoids are unlikely to be present, except in the extract prepared using 90% ethanol.
 
• Androgen deprivation can decrease the obstructive symptoms of BPH. In vitro studies confirm that the lipid component of LESP weakly inhibits 5α-reductase (an enzyme that converts testosterone to its more potent form: DHT), but saw palmetto probably does not possess clinically significant activity as a 5α-reductase inhibitor.

• In vitro research found that LESP inhibited testosterone and DHT binding in several tissue specimens, including vaginal skin and prepuce. Another study found that LESP did not inhibit binding of DHT to prostatic androgen receptor in an experimental model.

• LESP had a proliferative effect on androgen-responsive prostate cancer cells at low concentrations and a cytotoxic effect at higher concentrations. In cells unresponsive to androgen stimulation, LESP exerted a concentration-dependent, antiproliferative action. This antiandrogenic activity was confirmed for LESP in several animal models.

• LESP inhibited the effects of prolactin on hamster ovary cells, suggesting that the extract may inhibit prolactin-induced prostate growth.

• Dynamically caused urinary outlet obstruction is associated with increased smooth muscle tone. Saponifiable and ethanolic liposterolic extracts of saw palmetto produced a spasmolytic effect on isolated uterus, bladder, and aorta.

• BPH is associated with congestion and a noninfectious prostatitis, which is evidenced by white cell infiltration of the prostate. Agents with antiinflammatory and edema-protective activities may improve the clinical picture. LESP was found, in vitro, to be a dual inhibitor of cyclooxygenase and 5-lipoxygenase. The activity was found to reside in the acidic lipophilic fraction.

• A pronounced antiedematous effect was observed for oral doses of an alcohol extract of saw palmetto in carrageenan-induced edema of rat paw. LESP demonstrated antiedematous activity in a number of experimental models, with an antagonistic effect observed against histamine-induced edema but not in relation to serotonin- or bradykinin-induced weals. The participation of glucocorticoids in this antiinflammatory activity was excluded.

• In experimental models of BPH, high oral doses of LESP inhibited prostatic growth in castrated mice given testosterone. A moderate dose achieved a similar outcome in a rat model. A model of BPH that uses transplants of human prostrate tissue into hairless mice found high oral doses of LESP reversed the hormonal stimulation (by DHT and estradiol) of prostate growth.
Clinical Studies Except when specified, all of the clinical studies listed here used 320 mg/day of LESP, which is equivalent to an average daily dose of 2.88 g of saw palmetto berries. Saw palmetto liquid extracts will also provide such therapeutic benefits, provided similar dosage considerations are observed.
 
• A systematic review of randomized clinical trials found that LESP improved urologic symptoms and flow measures compared with placebo. LESP produced similar improvement in urinary symptoms and flow compared with finasteride and is associated with fewer adverse reactions.6 The trials outlined in this section were covered in this review.

• Several randomized, double-blind, placebo-controlled trials demonstrated that treatment with LESP for 28 to 90 days significantly reduced symptoms and nocturnal frequency and increased peak urinary flow rates and postvoid residual (PVR) in patients with BPH. One randomized, double-blind, placebo-controlled trial found that although LESP treatment improved BPH symptoms, equal improvement was observed in the placebo group.

• One hundred and seventy six (176) nonresponders to placebo were selected for a double-blind, placebo-controlled, multicenter study investigating BPH. LESP treatment significantly improved dysuria, significantly increased peak urinary flow rate, and decreased daytime and nocturnal urinary frequency compared with a placebo. This trial had a relatively short assessment period (30 days).

• A number of double-blind, comparative studies involving LESP have been completed. No significant differences were observed between LESP and finasteride (5 mg/day) for improving quality of life and IPSS, but finasteride did significantly increase peak flow rate over LESP in a large-scale, randomized trial. This trial was 26 weeks in duration, and finasteride can show increasing efficacy up to 1 year after initiation of therapy. Mean PVR and peak urinary flow outcomes were not significantly different between LESP and alfuzosin (7.5 mg/day), but the Boyarsky and obstructive scores were significantly better for alfuzosin in a 3-week trial. (Alfuzosin is a fast-acting drug.) LESP compared favorably with mepartricin (100,000 international units/day) for nocturnal frequency, dysuria, and PVR and with prazosin (4 mg/day for 12 weeks) for urinary frequency, mean urinary flow rate, and PVR.

• Results from several uncontrolled clinical trials demonstrated significant therapeutic effects for LESP in patients with BPH over the long term (3 years in one study), with good to excellent tolerability.

• Double-blind, controlled trials of combination therapy with LESP and other phytotherapeutic agents have been undertaken. Urinary flow, micturition time, residual urine, frequency of micturition, and a subjective assessment of the effect of treatment were all significantly improved over placebo for LESP and pumpkin seed extract (480 mg/day of extract) combination therapy. When LESP was combined with nettle root (equivalent to 2.4 g/day of root) and compared with placebo over 24 weeks, significant improvements were seen in IPSS and peak flow but not PVR. When the LESP-nettle root combination was compared with finasteride (5 mg/day) over 48 weeks, both treatments significantly improved urinary flow and IPSS, and no significant differences were observed between the two treatments. The herbal combination had better tolerability than finasteride. A subsequent analysis of a subgroup of patients from this trial indicated that efficacy was unrelated to prostate volume. 7 A randomized, placebo-controlled trial published in 2000 indicated that a blend of LESP, nettle root, pumpkin seed oil, and lemon flavonoid extract improved clinical parameters in symptomatic BPH slightly more than placebo. The blend was associated with significant epithelial contraction, especially in the transition zone, indicating a possible mechanism of action for the clinical effect.8 This blend also induced suppression of prostatic tissue DHT levels in a randomized clinical trial involving patients with BPH.9

• In Germany, the Commission E supports using saw palmetto to treat urination problems in BPH stages I and II.10

• Saw palmetto has been reinstated to the USP and is official in the USP24-NF19.


REFERENCES



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 Cheema P, El-Mefty O, Jazieh AR. J Intern Med. 2001;250(2):167.


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


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


4 Ellingwood F, Lloyd JU. American materia medica, therapeutics and pharmacognosy, ed 11. Portland: Eclectic Medical Publications, 1983.


5 Vogel VJ. American Indian medicine. Norman, Okla: University of Oklahoma Press, 1970.


6 Wilt TJ, et al. JAMA. 1998;280(18):1604-1609. Cochrane Database Syst Rev (2):CD001423, 2000.


7 Sokeland J. BJU Int. 2000;86(4):439-442.


8 Marks LS, et al. J Urol. 2000;163(5):1451-1456.


9 Marks LS, et al. Urology. 2001;57(5):999-1005.


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





SCHISANDRA

















Other Common Name: Schizandra
Botanical Names: Schisandra chinensis, Schizandra chinensis#
Family: Schisandraceae
Plant Part Used: Fruit

# Alternative name.



PRESCRIBING INFORMATION


































Actions Hepatoprotective, antioxidant, adaptogenic, nervine tonic, antitussive, oxytocic, mild antidepressant
Potential Indications
Based on appropriate evaluation of the patient, practitioners should consider prescribing Schisandra in formulations in the context of:

• Acute or chronic liver diseases, including hepatitis (3)

• Improving the detoxifying capacity of the liver (7)

• Improving physical performance, endurance, and resistance to the effects of stress (3)

• Improving mental performance (4)

• Chemical liver damage, poor liver function (7)

• Chronic cough, asthma (5)

• Spontaneous or night sweating, nocturnal emission, spermatorrhea, enuresis, frequent urination (5)
Contraindications In TCM, Schisandra is contraindicated in the early stages of cough or rash and in excess heat patterns.1 Schisandra is contraindicated in pregnancy, except at birth.
Warnings and Precautions None required.
Interactions None known.
Use in Pregnancy and Lactation Contraindicated in pregnancy, except to assist childbirth.
Side Effects Mild gastrointestinal symptoms (e. g., heartburn, indigestion, nausea) and headache have been reported. In one trial,4 out of the 107 patients treated with the equivalent of 1.5 g per day of dried fruit developed mild and transient nausea, headache, and stomachache.2,3
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 adapted from dried plant dosages administered by decoction in TCM.4 The author’s experience and the fact that ethanol-water is a more effective solvent than water for many phytochemicals are taken into account.

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