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WHITE HOREHOUND














Botanical Name: Marrubium vulgare
Family: Labiatae
Plant Part Used: Aerial parts


PRESCRIBING INFORMATION


































Actions Expectorant, spasmolytic, bitter tonic
Potential Indications
Based on appropriate evaluation of the patient, practitioners should consider prescribing white horehound in formulations in the context of:

• Acute or chronic bronchitis, nonproductive cough, the common cold, asthma (5)

• Dyspepsia (4,5)

• Loss of appetite, bloating, flatulence (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*
  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, the British Herbal Compendium 1992, and the author’s education and experience.



SUPPORTING INFORMATION














Traditional Prescribing
Traditional Western herbal medicine uses include:

• Acute or chronic bronchitis, whooping cough, respiratory conditions with nonproductive cough, the common cold, asthma1,2

• As a warm infusion for diaphoresis, jaundice, hoarseness, amenorrhea, excitability, and asthma2

• Dyspepsia, intestinal worms2
Pharmacologic Research
The aerial parts of white horehound contain bitter principles, including the diterpene marrubiin.3

• Experimental studies indicate that white horehound has an expectorant action (route unknown), which was attributed to marrubiin and the volatile oil.4

• Extract of leaves, stems, and roots demonstrated antispasmodic activity in several isolated smooth muscle preparations by inhibiting the action of some neurotransmitters.5

• Marrubiin, by injection, exhibited potent analgesic effects in two experimental models. The findings suggest marrubiin and the whole plant extract do not interact with opioid systems.6
Clinical Studies
No clinical studies using white horehound have been found.

• In Germany, the Commission E supports using white horehound to treat loss of appetite and dyspepsia, including bloating and flatulence.7


REFERENCES



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


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


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


4 British Herbal Medicine Association. British herbal compendium. Bournemouth: BHMA, 1992.


5 Schlemper V, et al. Phytomed. 1996;3(2):211-216.


6 de Jesus RA, et al. Phytomed. 2000;7(2):111-115.


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





WHITE PEONY

















Other Common Name: Paeonia
Botanical Name: Paeonia lactiflora
Family: Paeoniaceae
Plant Part Used: Root


PRESCRIBING INFORMATION


































Actions Spasmolytic, mild skeletal muscle relaxant, anticonvulsant, antiinflammatory, cognition-enhancing
Potential Indications
Based on appropriate evaluation of the patient, practitioners should consider prescribing white peony in formulations in the context of:

• Polycystic ovary syndrome, infertility, dysmenorrhea,* in combination with licorice (4)

• Skeletal muscle cramps and spasm, in combination with licorice (3)

• Fibroids, in combination with Paeonia suffruticosa, Poria cocos, Cinnamomum cassia, and Prunus persica (4)

• Angina, in combination with Stevia rebaudiana and ginsenosides (4)

• Epilepsy, in combination with licorice and fossilized mammalian tooth (4)

• Rheumatoid arthritis (4a)

• Menstrual dysfunction (5)

• Assisting memory and learning (7)
Contraindications None known.
Warnings and Precautions Because of the anticoagulant findings in experimental models, caution should be exercised in patients taking warfarin and other anticoagulant 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**
  4.5-8.5 ml of 1:2 liquid extract 30-60 ml of 1:2 liquid extract

* White peony has also been used in TCM for treating dysmenorrhea. (5)


** This dose range is adapted from dried plant dosages administered by decoction in TCM.1 The author’s experience and the fact that ethanol-water is a more effective solvent than water for many phytochemicals are taken into account.



SUPPORTING INFORMATION














Traditional Prescribing
Uses and properties from TCM include:

• To invigorate and cool the blood, dispel congealed blood, and clear heat and liver fire2

• Dysmenorrhea, amenorrhea, gynecological problems from hot blood; abdominal pain or immobile masses, chest pain2

• Swellings, trauma, abscess, boils; swollen painful eyes1,2

• Nosebleed, hematemesis1
Pharmacologic Research
White peony root contains the unusual constituent paeoniflorin, which is a glucoside with a cagelike monoterpene structure.3

• The results of in vitro studies suggest that paeoniflorin inhibits testosterone synthesis in ovaries but does not affect estradiol synthesis. Binding to glucocorticoid receptors was moderate, but binding was absent for progesterone receptors.4,5 White peony reduces testosterone production from ovaries but not from adrenal glands.6,7 Oral administration of a white peony and licorice combination resulted in a lower incidence of experimental uterine adenomyosis compared with controls.8 In an ovariectomized model, this combination increased DHEA and brought about an increase in serum estrogen concentration.9

• White peony has exhibited smooth muscle relaxant activity in isolated tissue (ileum and uterus) from several animal species.10 Paeoniflorin and related compounds inhibited twitch responses of skeletal muscle in response to direct and indirect stimulation.10 This effect was potentiated by GL from licorice and was confirmed in vivo.10

• Intragastric administration of white peony decoction exhibited antiin-flammatory activity in the adjuvant-induced arthritis model.11

• Oral administration of white peony decoction or paeoniflorin attenuated the performance deficit produced by scopolamine,12 and paeoniflorin reduced learning impairment13 in experimental models.

• Aqueous extract of white peony inhibited the convulsant activity of the drug pentylenetetrazol in isolated neuronal tissue. The most active constituents were albiflorin and the gallotannin fraction.14 White peony showed a clear inhibitory effect on the bursting activity of neurons induced by pentylenetetrazol in vitro.15

• An aqueous methanol extract of white peony demonstrated anti-cholinergic activity in vivo. Paeoniflorin was one of the active constituents in vivo but had no effect on isolated tissue,16 probably because the active form is a metabolite of paeoniflorin.

• White peony and licorice decoction demonstrated antidiarrheal activity in cisplatin-induced diarrhea.17

• White peony, which was found to inhibit nine types of common pathogenic bacteria, also enhanced the phagocytic activity of macrophages and increased T lymphocytes.18

• White peony inhibited platelet aggregation, increased fibrinolytic activity, and prolonged prothrombin time in vitro.19 Anticoagulant activity was demonstrated in vivo for paeoniflorin.20

• An antiatherogenic activity was demonstrated after oral administration of white peony in an experimental model of hypercholesterolemia.21

• Oral administration of Shimotsu-to, an herbal formula containing equal amounts of white peony, Rehmannia root, Angelica acutiloba root, and Cnidium officinale rhizome prevented the development of brain infarction and rarefaction induced by chronic brain ischemia in an animal model.22
Clinical Studies
The white peony and licorice combination (TJ-68, Shakuyaku-kanzo-to [Japanese];Shaoyao Gancao Tang [Chinese]) referred to here is approved for use in clinical practice in Japan and has been used to treat pain accompanying acute muscle spasms, including dysmenorrhea. TJ-68 is a granular extract,7.5 g of which contains a dried concentrate made from 6 g of dried white peony root and 6 g of dried licorice root.

• Eight infertile, hyperandrogenic, and oligomenorrheic women were investigated for the lowering of serum testosterone levels and inducing regular ovulation by treatment with TJ-68 (5 to 10 g/day for 2 to 8 weeks).23 After the treatment period, serum testosterone levels had normalized in seven patients, and six patients were ovulating regularly. Two of these six patients subsequently became pregnant.

• The effect of white peony and licorice combination (TJ-68,7.5 g/day for 24 weeks) in patients with polycystic ovary syndrome (PCOS) was studied over a 24-week period. Serum testosterone and free testosterone levels were significantly decreased after 4 weeks. However, testosterone levels after 12 weeks were lower only in the patients who became pregnant. After 24 weeks, the LH/FSH ratio was significantly lower in the treated group.24 In an earlier uncontrolled trial, the effect of treatment with the same herbal combination varied according to the type of PCOS treated. Overall plasma testosterone was decreased in 90% of women treated and 25% became pregnant. Plasma testosterone tended to remain higher in PCOS of the general cystic type than in the peripheral cystic type, and the pregnancy rate in individuals with the general cystic type was lower.25

• In an uncontrolled study,110 premenopausal patients with fibroids were treated with a traditional Chinese formula containing white peony, Paeonia suffruticosa, Poria cocos, Cinnamomum cassia, and Prunus persica. Clinical symptoms were improved in 90% of cases, and the fibroids shrunk in approximately 60% of cases.26

• TJ-68 has shown benefit in clinical trials for treating muscle spasm. In a multicenter, double-blind, placebo-controlled trial, treatment with the combination (7.5 g/day for 2 weeks) resulted in significantly greater improvement in muscle spasm (mainly of the calf muscle) than placebo treatment for patients with liver cirrhosis.27

• White peony combined with licorice and fossilized mammalian tooth provided benefit for almost one half of 43 cases of epilepsy.28

• The total glucosides of white peony (TGP) have been used clinically for treating rheumatoid arthritis.29 This use of TGP capsules was approved in China in 1995.30

• Tablets containing mainly white peony, Stevia rebaudiana, and ginseno-sides were used to treat patients with angina, with a 93% success rate in symptoms and improvement in ECG in 53%. Microcirculation was also significantly improved.31 (Ginsenosides are present in Panax ginseng.)

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