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˙˙˙˙
Internet Guide to Herbal Remedies
David J. Owen, MLS, Ph.D.
CONTENTS
Acknowledgements
Chapter 1: A Quick Tour of the World Wide Web
Chapter 2: Herbal Information on
the Internet
Chapter 3: A Little Background Botany
Chapter 4: General Health and CAM Web Sites
Chapter 5: Are Herbs Safe?
Chapter 6: Cancer
Chapter 7: Herbs for Specific Diseases and Conditions
Chapter 8: Herbs for Womens Health
Chapter 9: Information for Children and Parents
Chapter 10: Aging
Chapter 11: Searching MEDLINE and Other Databases
Chapter 12: Let the Buyer Beware: Fraud and Quackery
Chapter 13: Whats in the Bottle? - Regulations and Quality Issues
Chapter 14: Chat Rooms and Other Online Discussion Groups
Chapter 15: Herbs for Pets
ACKNOWLEDGEMENTS
This book would have taken longer to complete without an award from the University-wide Research Grants for Librarians program provided by the Librarians Association of the University of California (LAUC). This grant allowed me to spend some time away from the library during 2004-2005 to concentrate on the actual writing.
I wish to acknowledge the following people who, in many different ways, provided support and encouragement during the writing of this book: Mr. Stephen Rosenberg, Ben, Andy, Keith, Mitch, Tim, Chuck, Steve, David and Warren; my friend and colleague Min-Lin Fang; my dad and my sister Christine. Thanks also to M. Sandra Wood and the staff at Haworth Press.
Finally, this book is dedicated to the memory of my mother, Joan H.E. Lane, and to the memory of my mentor, Miss Margaret Maggie Collins.
Chapter 1
A Quick Tour of the World Wide Web
When I took office, only high energy physicists had ever heard of
what is called the World Wide Web....now even my cat has its own page.
Bill Clinton
This chapter will go over some of the things you need to know about the Internet and the World Wide Web, so you can get the most out of going online. Keep in mind that the Web is only part of the Internet, though its the most useful part for finding herbal information. Well cover chat rooms, electronic discussion groups, and newsgroups in a later chapter.
One of the most frustrating things about the Web is that it has become so BIG! There is so much there, both good and bad, and finding reliable information can be a challenge. Its often difficult for people to grasp just how big it really is, and in fact no one is really quite sure. Recently, Yahoo!Ž claimed that its search engine indexes over 19 billion documents ADDIN EN.CITE Markoff200510herbal Book.enlEndNote1023<style face="normal" font="Verdana" size="100%">Google and Yahoo Bicker Over the Size of Their Turf</style>1. It that figure doesnt mean much to you, dont worry, because however big it really is, its ENORMOUS, and it means that trying to find good information can be like looking for that needle in a haystack.
UNDERSTANDING WEB ADDRESSES
The World Wide Web (WWW), or simply the Web, is a huge world-wide network of computers that exchange information, such as text, pictures and sound. These computers talk to one other using the Internet. If you look at a map of the Internet it would look like a huge tangled spider's web, which is where the name for the World Wide Web comes from. Its important to know that each page on the Web has a location, and its location is indicated by a Web address. The address tells the computer exactly where this page can be found, just as your home address tells someone where you can be found. This Web address is called the Uniform Resource Locator (URL) (pronounced "you-are-ell").
Each Web-accessible document has a unique URL that can be used to pull it up on your Web browser. You may see the address of the document youre currently viewing in the Address box in Internet Explorer Address bar. When you move the mouse pointer over links on a page, youll see the address of the linked documents appear at the bottom of the browser window.
A Web site has one or more related Web pages, depending on how it's designed. These pages are linked together through a system of hyperlinks. A hyperlink is a link from a document that, when clicked, opens another page or file. You can tell when something is a hyperlink to another page: when you move your cursor over a text link or over a graphic link, it will change from an arrow to a hand. Each Web site has a homepage, which can be thought of as the starting point of the site. Homepages are like the table of contents in a book or magazine, usually providing an overview of what you'll find at the site.
Youll find it useful to know a little bit about how a URL acts as an Internet address. Lets take a look at the URL for a handout on St. Johns Wort, stored on a computer at the Food and Drug Administration (FDA):
http://www.fda.gov/health/stjohnswort.html
The first part of the URL, before the colon (:), identifies the type of document we are dealing with. Hypertext Transfer Protocol (HTTP) is simply a protocol (set of rules) used to retrieve a resource from the Internet: it tells us this is indeed a Web page that will be sent in the format all Web browsers can read. For Web addresses, a second protocol is sometimes widely used: most Web pages are sent across the network unencrypted. That is, if someone were snooping on you, they could see exactly what you were looking at, or see all the information you might be entering into an online order form. URLs that begin with https, however, are transmitted "encrypted," meaning that someone looking at an https file as it is transferred over the network would see nothing but gibberish. This is obviously a good thing for sensitive information such as usernames and passwords, credit card information, and so on. The www.fda.gov part is the name of the computer where the document is stored. You'll often see www in addresses though this is not really necessary. Obviously, fda stands for the Food and Drug Administration. A URL usually uses forward slashes (/) and dots to separate its parts. The .gov part is called the top-level domain name signifying that its a U.S. federal government computer. Other options are .com or .net for general commercial Web servers, .edu for servers at higher educational institutions, and .org for non-profit organizations' servers. Note that Web servers located in other countries end in a two letter code which identify that country: .uk for the United Kingdom, .fr for France, .de for Germany, .jp for Japan, and so on. The / tells us we're looking in a directory called health. The "stjohnswort.html refers to the specific page, though sometimes the .html part is often hidden from you. (Those pesky web masters, the people who are in charge of the website, are always moving pages around: so if a document has moved places on a Web site you can usually go to the homepage to track it down so in the above case you could go up through the directory to the homepage at HYPERLINK "http://www.fda.gov" www.fda.gov.)
You don't need to remember much of previous paragraph to function in today's information society. Just try to remember that a URL is a World Wide Web address and that most World Wide Web addresses begin with "http".
BROWSERS
A Web browser, or simply browser, is a piece of software that locates and displays Web pages. At the moment MicrosoftŽ's Internet Explorer (IE)Ž is the most commonly used browser, while Netscape NavigatorŽ, FoxfireŽ and AppleŽ's SafariŽ are used to a lesser extent. Internet Explorer comes preloaded on all computers using Microsoft Windows. You can download browser software for free from each company's Web site (see URLs at the end of this chapter). Note that there are slight differences between the Windows and Macintosh versions.
WEB SURFING WITH BOOKMARKS OR FAVORITES
One of the best ways to move around the Web is to let your browser remember the address so its easy to visit it again later. With Internet Explorer you save URLs as Favorites. When you are on a Web site, select the Favorites menu and click "Add to Favorites." A box will pop up, asking you to name the site. Click OK to add the site to your Favorites. To return to the site later, select the Favorites menu and click on the name of the site in the list. Netscape Navigator calls them Bookmarks. While you are on the site, select Bookmarks. Beside the Location box, click Add Bookmark. If you would like to edit or rename your bookmarks, choose Edit Bookmarks from the same location.
HOW TO NAVIGATE A WEB SITE
You dont need to be a computer whiz kid in order to move easily around a Web site but knowing a few important things will make it easier for you to find any information that may be buried in the sites pages. The first thing you need to know is that the Back button on your browser is the way to go back a page, and the Forward button is the way to move forward a page. Moving forward and backward is based strictly on pages you've already visited during your current online session. These two buttons are most useful for moving back and forth among two or three pages you're looking at a given moment. (Figure 1 shows the most useful Internet Explorer features for moving between Web sites.)
Figure 1
Using Your Browser to Move around the Web
_______________________________________________________
Back and Forward Buttons
INCLUDEPICTURE "http://www.laubach-on.ca/images/back&for.jpg" \* MERGEFORMATINET As you move between different sites your browser keeps track of where youve been. The toolbar buttons allow you to move backward and forward between pages. Stop Button
INCLUDEPICTURE "http://www.laubach-on.ca/images/stop.jpg" \* MERGEFORMATINET Clicking on this allows you to stop the loading of pages or documents. You may want to do this if it is taking too long, or if there is no response from the Web site.Home Button
INCLUDEPICTURE "http://www.laubach-on.ca/images/home.jpg" \* MERGEFORMATINET This takes you back to your home page. You can specify which home page to use by going to Internet Options.
Favorites
INCLUDEPICTURE "http://www.laubach-on.ca/images/favorites.jpg" \* MERGEFORMATINET This is where you add URLs for your favorites sites so you can easily go back to them without having to enter the URL
History
INCLUDEPICTURE "http://www.laubach-on.ca/images/history.jpg" \* MERGEFORMATINET This gives a history of sites youve visited. _______________________________________________________
Using hyperlinks to move around the Web is like flipping through the pages of a book, moving to an entirely different part of the book or opening another book altogether. Sometimes its not obvious which parts of a Web page are hyperlinks. They may be blue, underlined words, but they can also be an image on a page. The best way to tell if something on a Web page is a hyperlink is to slide your cursor over it. If it changes from an arrow to a little hand, then you know that its a hyperlink. If you click when the cursor is a hand, then you'll follow the hyperlink and a new page will appear in your browser.
Most Web sites try to make it easy for you to move from page to page on their site. The homepage usually has a navigation bar prominently displayed to help you find the most important pages, and is usually on the left hand side or top area of page. Once you spot a site's main navigation bar, you should be able to go almost anywhere on the site just by clicking on various links. This is a great way to get a quick overview of what a site has to offer and it's also a good way to go straight to your favorite parts of the site on return visits. Look also for a Site Map: this is map of a Web site's content that allows you to navigate through the site to find the information youre looking for.
If the site has one, read the FAQ (Frequently Asked Questions) first. This document often provides answers to questions commonly asked about the Web site. And if all else fails use the sites search engine, essentially a searchable index of the sites pages. Search engines are increasingly being added to individual Web sites to allow users to search the contents of a site.
The following URLs are to sites that allow you to download Internet Explorer, Netscape Navigator, Foxfire or Safari, with links to tutorials on getting the most out of each browser.
Microsoft (Download Explorer)
Netscape (Download Communicator)
Firefox
Safari
Safari is a web browser created by Apple computer made specifically for their computers running OS X.
How To Get the Most Out of Internet Explorer
How-to articles to get make the most out of using Internet Explorer. Learn the
basics for finding Web pages, using Favorites, and learn more about security and privacy settings.
Browsing the Web: The Basics
Introduction to using Netscape for beginners, made by the creators of Netscape Navigator.
ADDIN EN.REFLIST 1. Markoff J. Google and Yahoo Bicker Over the Size of Their Turf. The International Herald Tribune. August 16, 2005: 13.
Chapter 2
Herbal Information on the Internet
Getting information off the Internet is like taking a drink from a fire hydrant.
Mitchell Kapor
First, the good news: the quality of herbal information available online has improved considerably over the past few years and there are now many Web sites which provide good, reliable information on how to use herbal remedies. And now the bad news: youre unlikely to find any of the best Websites by simply typing search terms into an Internet search engine such as Google. Using an Internet search engine youll pull up thousands of Web sites, providing information of extremely variable quality, and if you look very closely at these sites youll notice that most of them are sponsored by herbal product manufacturers trying to convince you to buy their products - for which they often make extravagant and sometimes false claims! (I only use a search engine when I want to find a Web site that I already know exists.)
Its technically very easy and cheap to set up a Web site and this can be done by practically anyone with a computer, inexpensive software and access to the Internet. Unlike the information youll find in medical journals, however, there is little regulation or standardization of Web-based information and its quality is often determined solely by the organizations and individuals who publish it. This is of particular concern because misinformation or the incorrect use of medical information can be harmful. As the American publics interest in herbs grows, so does the number of Web sites containing a large amount of dubious claims and misinformation.
So, how do you go about sorting the good stuff from the bad? Though the chief aim of this book is to direct you to those Web sites that I and others consider to be some of the best ones around, youll find it helpful to learn a few things that will help you make your own mind up about the quality of a Web site and the information it provides. Look at Table 2: How to Recognize a Reliable Web Site.
Table 2
How to Recognize a Reliable Web Site
There is now general agreement on what you should be looking for to judge for yourself whether or not a Web site is one you can trust. (1) Source: Who provides the Web site? This should be the main way to determine a sites reliability and quality. Since federal government Web sites, and those affiliated with a college or university, are often the most trusted source of information, look for URL sites ending in .gov or .edu. Though a URL ending in .org identifies a not-for-profit organization (see Glossary), which people usually view as being unbiased, its important that you dont automatically accept an ".org" to indicate reliability since there are some ".org" Web sites sponsored by people who want to sell you something. (2) Content: Where did the information come from? Is there any clinical or scientific evidence (usually based on clinical trials: see Glossary) to support statements in support of a view or position. Medical facts and figures should have references, such as citations to articles in medical journals.(you could do a PubMed search to check: see Chapter 11). Personal testimonials such as "since I started taking your product I have never felt better and at age 90 have run my first marathon"
are not evidence. (3) Disclosure: the mission or purpose of the site should be clearly stated, it should be upfront about its purpose. Any reliable Web site should include a statement regarding the mission of the sponsoring organization. Also, when a Web site asks for user input or registration, the purpose and use of obtaining that information should be disclosed. Some health related Web sites are already collecting personal health information to "tailor" content, and as sites begin to integrate healthcare services and information, confidentiality and privacy safeguards will become increasingly important. (4) Links: high quality sites have links to other high-quality sites. The National Institutes of Health (NIH) is a high-quality site Marys Herbal Magic Garden and Goat Farm is not. (5) Design: though not essential to the quality of information a reputable site will put some thought into its design so that users can easily navigate and find information. (6) Interactivity: there should be a feedback mechanism so you can offer comments, corrections, and criticisms, and raise questions about the information provided. (7) Date: When was the Web site last updated? It is important that medical information be current, so Web sites should be reviewed and updated on a regular basis. And finally, (8) Referral; the Web site should encourage you to discuss the information with your health care provider. Be very suspicious of sites that do not!
You might also find it useful to look for the logo of the Health on the Net Foundation's Code of Conduct (HONCode):
EMBED MSPhotoEd.3
This was devised with the help of physicians and respected members of the Internet community in Europe and North America to help unify and standardize the quality of medical and health information available on the World Wide Web. Web sites that display the HONcode icon are more likely to be reliable.
Parents and guardians might also want to check that sites are appropriate for children. There are several sites that have been developed specifically for the information needs of young people (see Chapter 9). Some health promoting sites may also have a section especially for children, teenagers or parents.
The following Web sites and documents provide more detailed information and valuable discussions about using evaluation criteria for Web content:
Health on the Web: Finding Reliable Information
A patient-friendly guide from the American Academy of Family Physicians (AAFP).
Health On the Net Foundation (HON)
Includes health news and a search engine as well as a description of the widely used Health on the Net Code of Conduct (HONcode) for health and medical Web sites.
Medical Products and the Internet: A Guide to Finding Reliable Information
A clearly written document from the World Health Organization (WHO). Also includes valuable guidance on buying medical products online. The URL for this document is rather long, so you can find the document by going to the homepage then typing the words internet reliable into the search engine box.
QUICK: Quality Information Checklist
My favorite! Though designed to help children ages 5-7 evaluate the quality of health sites, its a useful and fun tool for all ages and explains this topic in clear easy-to-understand language.
Chapter 3
A Little Background Botany
The beginning of wisdom is to call things by their right name.
Chinese Proverb
What exactly is an herb? Do I say herb or erb? Why do herbs have both a common name and scientific name, and should I care? Are they different from botanicals? And why do people call them dietary supplements? If this isnt confusing enough, how am I supposed to pronounce words such as Hypericum perforatum? These and other terms are often used in the herbal literature, so youll benefit from a basic understanding of why theyre used and what they mean. This chapter will help you understand the words youll frequently come across and point out some useful Web sites that you should visit for further information.
WHAT IS AN HERB?
First, what exactly is an herb? For many people herb conjures up visions of soothing herbal teas such as Chamomile or the bright green flakes of basil in spaghetti sauce. If you do any cooking youll be familiar with common culinary herbs such as basil, mint, parsley, sage etc. But what about Garlic? Is this an herb? Once you start browsing lists of medicinal herbs youll come across many plants and plant parts that are rather different from the ones you use in the kitchen. Hawthorn, for example, is a tree, yet its thought of as a medicinal herb and is widely used in remedies to treat heart conditions. Then theres the bark from the Slippery Elm tree thats used to soothe sore throats. To a botanist or a gardener, an herb is a plant that has no woody tissue and dies down to the ground at the end of a growing season - hence the gardening term herbaceous border. However, today the word is used very loosely to refer to any plant part valued for its medicinal, savory, or aromatic qualities. As far as the pronunciation is concerned, both herb with an h and erb are correct but most Americans tend to drop the h.
NAMES
Both print and online herbal resources usually list herbs by either their scientific or common name. Understanding which is which, and why theyre used, will help you navigate to the correct entry for a particular herb on many Web sites. Take a look at Table 3.
Table 3
Names Used for St. Johns Wort
_______________________________________________________
Common names St. Johns Wort, Amber Touch and Heal, Tipton Weed,
Klamath Weed, Johns Rosin Rose
Johanniskraut (Germany)
Herb de millepertuis (France)
Hypericum perforatum .
Pharmacopeial name Hyperici herba
_______________________________________________________
This lists various names used for the herb popularly known as St. Johns Wort. As you can see, there are several common names which are often used in different regions or countries to refer to the same plant. To get around the problem of one plant having several different names, botanists give a plant one unique name, referred to as the scientific name (sometimes also referred to as the Latin or botanical name). Though a plant may have several different common names it will usually have only one scientific name. This is also sometimes referred to as the Latin name since it s usually derived from the ancient Latin language, and consists of two parts (referred to as binomial): the first part indicates the genus (with capital first letter), which is a group of closely related plants, and the second part is specific for this species (written entirely in lower case). It often helps to remember scientific names if you know what the words actually mean. For example, Echinacea is derived from the Greek "echinos," meaning hedgehog and refers to the spiny seed heads. The scientific name for St. John's Wort is Hypericum perforatum. Perforatum is Latin for "perforated, since the leaves show translucent dots when held up to the light, giving the impression that the leaf is perforated. The genus name Hypericum is thought to derive from two Greek words hyper and eikon for over an icon, a reference to the practice of placing sprigs of the plant above images to clear the air of evil spirits. "Wort" is simply Old English for "plant."
Note in Table 3 that there is also a third type of name you may come across: the pharmacopieal name. Not every part of a plant contains the active chemicals that make the herb effective. For example, St. Johns Wort is prepared from the plants yellow flowers while ginseng is prepared from the roots and Saw Palmetto from the berries. Sometimes different parts of the same plant even yield different products. (The glossary at the end of this book includes definitions for some of the common plant terms youll come across.) The pharmacopieal name is a convenient system for herbalists to identify an herbal preparation by referring both to a plants scientific name and the plant part or type of preparation that is useful. Thus, a preparation made from the root of Echinacea is referred to as Echinacea radix, while one using the parts of the plant growing above ground is known as Echinacea herba. Other common plant part names listed in herbal pharmacopeals are: Bulbus, for bulb; Cortex, for cortex or bark; Flos, for flower; Folium, for branch; Semen, for seed; and Spica, for flower spike.
When medicines are derived from herbs, theyre often called phytomedicines, botanicals, herbal products or herbal supplements. To make matters a little more complicated, in the U.S. herbal preparations are classified as "dietary supplements," along with vitamins and minerals. and information on herbs is often to be found listed under this term.
HOW DO I PRONOUNCE ECHINACEA?
Scientific names are usually derived from ancient Greek and Latin, but unfortunately there arent any ancient Greeks or Romans around to tell us how to speak it. However, a general rule is to pronounce it as you would any English word but try to pronounce every syllable. Table 4 provides a guide to how several of the more popular scientific names are pronounced.
The following Web sites provide basic botanical information that will be useful in understanding herbal information youll find on the Internet. Some of the Web sites have photographs or drawings of the plants. Aside from their use in identification, some of these images are just strikingly beautiful.
[INSERT FIGURE 3]
BOTANY Online The Internet Hypertextbook
This is an online textbook on botany written by two professors at the University of Hamburg in Germany (but dont worry, the important parts are in English!). There are brief chapters on the history of botany from ancient Egypt to present times and relevant sections such as how to identify plants, the parts of a plant and important features of flowering plants.
BOTANY: PLANT PARTS AND FUNCTIONS
This is part of a manual compiled by the College of Agriculture at the University of Arizona and is an excellent introduction to basic botany. Chapter 1 includes useful information on the functions of stems, leaves buds roots, flowers, fruits and seeds.
Daves Garden
<HYPERLINK "https://www.ckm.ucsf.edu/horde/util/go.php?url=http%3A%2F%2Fplantsdatabase.com%2F&Horde=6ee1d24a37db4167c853af3a7dafac70"http://davesgarden.com/>
Dave's Garden caters to the interests and needs of gardeners, farmers and horticulture professionals world-wide. The Plant Files section includes a useful guide to the pronunciation of the names of most herbs you'll come across. Garden Terms is a useful glossary of plant and gardening terms.
The PLANTS Database
This is a project of the United States Department of Agriculture (USDA) and is a great resource for finding images of herbs and other plants. Entries can be retrieved by both common and Scientific Names.
Chapter 4
General Health and CAM Web Sites
Useful information on herbs can be found on several of the most widely-used health and medicine Web sites, though its sometimes difficult to actually find information buried within a site and many simply provide links to the more specialized sites listed in later chapters of this book. However, they can be useful starting points for gathering information, so this chapter lists some of the most popular ones. Over the past few years a number of Web sites devoted entirely to alternative therapies have appeared and I would suggest you try these sites first.
You may have noticed that the title of this chapter includes the acronym CAM. This stands for Complementary and Alternative Medicine. Its a sort of umbrella term to refer to all those therapies or procedures people think of as being alternative medicine. When you start checking the Internet for herbal information youll notice that sometimes its included under the heading alternative medicine, sometimes complementary medicine and sometimes complementary medicine and alternative medicine (CAM). Youll also come across sites listed under the heading holistic or integrative medicine. I prefer the umbrella term complementary and alternative medicine, abbreviated as CAM, to refer to all those therapies or procedures commonly referred to as alternative medicine and will use it as such in this book.
[INSERT FIGURE 4]
Good meta-sites use subject experts (such as MDs) to review Web sites, and include only those that meet rules such as those discussed in Chapter 2. Look on the site itself for information about who selects the links. When you find a Web site that meets your needs, be sure to use your browser to bookmark it or add it to your "favorites."
If you want to do a bit of Internet surfing, the trick is to find a few good Web sites, such as the site for the National Center for Complementary and Alternative Medicine (NCCAM) (see Figure 4), then look on their pages for lists of "related resources," "links," or similar terminology. Many of the related resources will list other related resources, and so on.
The Alternative Medicine Homepage
The Alternative Medicine Homepage was created by Charles B. Wessel, at the Falk Library of the Health Sciences, University of Pittsburgh This is one of the best-known and most exhaustive lists of CAM sites on the Internet. Its a well annotated guide and jump station to Internet resources, mailing lists and newsgroups and bibliographic databases.
[INSERT FIGURE 5]
healthfinderŽ
healthfinderŽ is the federal governments gateway to reliable health information resources that have been carefully selected by the U.S. Department of Health and Human Services (DHHS). Every resource listed includes a brief description and contact information for the organization that produces it. Its useful, but not one of the best meta-sites for CAM. Find information by typing keywords into the search box .
Richard and Hinda Rosenthal Center for Complementary and Alternative Medicine
The Rosenthal center is part of the Columbia Presbyterian Medical Center in New York City. Created in 1993, it was one of the first centers at a major medical school established to deal specifically to research, education and training in complementary and alternative medicine. The CAM Research and Information Resources section contains some of the best descriptions of valuable information resources in the field of alternative and complementary medicine: go to the HYPERLINK "http://www.rosenthal.hs.columbia.edu/Patients.html" \t "" Patients and Consumers section.
MayoClinic.com
The Mayo Clinic's award-winning consumer Web site features easy-to-understand information on health and medical topics, all reviewed for accuracy by Mayo Clinic personnel. Content includes interactive resources and tools, information on specific diseases and disorders, management of particular chronic conditions, suggestions for healthy lifestyles, consumer drug information, specialists' answers to frequently asked questions about diseases and health decision-making guides. Click on the Drugs and Supplements tab to access comprehensive information herbs from Natural Standard, widely considered one of the most authoritative and reliable reference CAM sources providing impartial evidence-based information about herbs and supplements.
[INSERT FIGURE 6]
MedlinePlus
Developed by the National Library of Medicine (NLM), MEDLINEPlus is a goldmine of health information. It provides extensive health information in both English and Spanish and is updated daily. Site features an "A to Z" guide listing health topics alphabetically, including a section on Herbal Medicine. Click on the Espańol button to switch to Spanish-language materials.
Figure 6
MedlinePlus
National Center for Complementary and Alternative Medicine (NCCAM)
One of the most significant developments in U.S. medicine was the establishment at the National Institutes of Health (NIH) of the Office of Alternative Medicine in 1992, which was later renamed the National Center for Complementary and Alternative Medicine (NCCAM)). Established by Congress, and funded by the US government, NCCAMs mission is to promote research into the effectiveness of CAM practices, develop an understanding of how they work, and provide the American public with reliable information about their safety and effectiveness.
NCCAM supports and provides information for clinical trials involving herbal and other CAM therapies. A clinical trial is a research study to answer specific questions about new drugs, therapies or new ways of using known treatments and is used to determine whether new drugs or new treatments are both safe and effective. New drugs are tested on people only after laboratory and animal studies show promising results. There are clinical trials being conducted on CAM throughout the United States and the world.. To find out more about clinical trials, and to find trials that are recruiting participants, go to the Clinical Trials section. You can search this site by the type of therapy being studied or by disease or condition.
NOAH (New York Online Access to Health)
NOAHs mission is to provide accurate, timely, un-biased, and relevant consumer health information on a variety of health topics, in both English and Spanish.
Go to Health Topics/Procedures and Medicine/Complementary and Alternative Therapies, then Herbal Medicine.
The Office of Dietary Supplements (ODS)
< HYPERLINK http://odp.od.nih.gov/ods/about/law.html http://odp.od.nih.gov/ods/about/law.html>
In the U.S., herbal preparations are not currently classified as drugs but instead are bundled into the strange food category "dietary supplements." The Office of Dietary Supplements (ODS), within the National Institutes of Health (NIH), supports research into all dietary supplements as well as promoting the dissemination of research results. The ODS produces two very useful databases: the International Bibliographic Information on Dietary Supplements (IBIDS) and Computer Access to Research on Dietary Supplements (CARDS): IBIDS is discussed in Chapter 11.
[INSERT FIGURE 7]
Chapter 5
Are Herbs Harmful?
Let me begin this chapter by stating that the majority of herbs widely sold and distributed in the United States and Europe as capsules, tablets and teas are safe. When herbs are used correctly, they are as safe as conventional medications, and often have fewer side effects. That being said, however, you should be aware that there are some very hazardous herbs currently on the market and others which may be harmful if not used correctly.
First, remember that just because something is touted as being natural doesnt necessarily mean that its safe and wont harm you. Mushrooms may be natural, and in general you wont come to any harm from eating those you buy at your local grocery store, but some species such as the Death Cap (Amanita phalloides) can be deadly and people routinely die after mistakenly picking and eating the wrong kind. Some herbs contain powerful substances, which can have harmful effects on the body if used in too high a dose or over long periods of time. Even some widely used herbs may have harmful effects if not used correctly. For example, it is possible for anyone to have an allergic reaction to just about anything and some people develop allergic reactions to chamomile and other herbs. There is also some evidence that some commonly used herbs may cause undesirable effects during surgery, and the American Society of Anesthesiologists (ASA) recommends that all herbal medications should be discontinued 2-3 weeks before an operation (see entry in this chapter for ASA)..
Many patients, probably because they view all herbs are being harmless, often dont see any need to tell their doctor that theyre using herbs. Wrong! Health professionals are becoming increasing concerned about the risk of interactions between herbs and prescription drugs. Some herbal medicines may cancel the effect of a prescription drug, others may reduce it, or even exaggerate it. St. John's Wort for example, interacts with AIDS drugs, chemotherapy, and birth control pills, making them less effective ADDIN EN.CITE Izzo20049Con Herb Book-Converted.enlEndNote917<style face="normal" font="default" size="100%">Drug interactions with St. John's Wort (Hypericum perforatum): a review of the clinical evidence</style>1. Herb-drug interactions often cant be predicted, so it's best to play it safe: do some research and tell your doctor.
You should be particularly careful when shopping for herbal medicines, since there are few standards that regulate how theyre manufactured, and they receive little attention once they are on the market. Unlike conventional drugs they not tested and approved for safety or effectiveness by the Food and Drug Administartion (FDA) and can only be removed from the market after theyve been shown to be harmful. Furthermore, there are almost no standards that regulate how herbal products are manufactured, so sometimes you may never really know what youre really getting. You must be particularly careful using Chinese herbs since there are reports of preparations being contaminated with poisonous minerals such as lead and mercury, and even prescription drugs ADDIN EN.CITE Ernst200210Con Herb Book-Converted.enlEndNote1017<style face="normal" font="default" size="100%">Toxic heavy metals and undeclared drugs in Asian herbal medicines</style>2.(Chapter 13 discusses issues such as the regulation or herbal medicines and what to look for when buying herbal products).
I hope the preceding paragraphs have not sent you rushing to your medicine cabinet to throw all your herbal medicines in the garbage. As I stated at the beginning of this chapter, the vast majority of herbal products sold in the United States are safe, and in general seem to be less harmful than many conventional drugs. Just dont start taking them without doing a little research. Be especially careful if theres any chance they may interact with other medications youre taking. And, perhaps most important of all, discuss the information with your doctor.
Thankfully, reliable information on real or possible adverse effects associated with many herbs is now widely available. Most of the following sites also provide information on herb/drug interactions.
American Society of Anesthesiologists (ASA): Patient Education Website
< HYPERLINK "http://www.asahq.org/patientEducation.htm" http://www.asahq.org/patientEducation.htm>
There is some evidence that herbal remedies may cause complications during an operation. The ASA provides a patient education brochure HYPERLINK "http://www.asahq.org/patientEducation/herbPatient.pdf" What You Should Know About Herbal Use and Anesthesia that you can print out.
Familydoctor.org
This site is sponsored by the American Academy of Family Physicians (AAFP), one of the largest national medical organizations. All of the information on this site has been written and reviewed by physicians and patient education professionals at the AAFP. It provides easy-to-understand information for patients and the general public, including herbal and alternative remedies. Unfortunately it includes comprehensive information for only the most widely used herbs such as Echinacea:so, for example, youll find information about ginger in the section on treatments for nausea. Type the name of the herb in the search box to find information.
GNCLiveWell
General Nutrition Centers (GNC) is a major national chain specializing in herbs and supplements. The Web site provides access to Healthnotes, a resource providing up-to-date information on all CAM therapies. Healthnotes is written by licensed medical professionals and provides descriptions for over 350 herbal remedies, indexed by common and scientific (botanical) name, including Western, Chinese, and Ayurvedic herbs. Articles also provide dosage and safety information. Ignore all the ads and go straight to the Herbal Remedies index under Health Notes.
Consumer Advice on Food Safety, Nutrition and Cosmetics University of Maryland Medical Center: Interactions by Herb or Supplement
< HYPERLINK "http://www.umm.edu/altmed/ConsLookups/InteractionsByHerbSupp.html" http://www.umm.edu/altmed/ConsLookups/InteractionsByHerbSupp.html>
This site was created by the Center for Integrative Medicine (CFIM), an inter-departmental center within the University of Maryland School of Medicine. It contains easy-to-read articles about herbs, including how they are used and how to take them. Additional information includes precautions and possible interactions, and a listing of associated research. Useful information is provided about interactions between specific drugs and herbal supplements.
[INSERT FIGURE 8]
Ephedra Guide
The herbal supplement ephedra has been the subject of controversy for some time. In 2003 the U.S. Food and Drug Administration announced a ban on dietary supplements containing ephedra because of associated health risks such as heart attacks and stroke. This ephedra guide from the University of Maryland Medical Center provides useful information and advice.
MayoClinic.com: Natural Standard
The Drugs and Supplements section on the MayoClinic.com Web site provides access to fact sheets compiled by Natural Standard Ž, an international research collaboration that provides high-quality, information on complementary and alternative medical therapies. Natural Standard analyzes thousands of scientific studies to provide in-depth information about effectiveness, safety, interactions, and use during pregnancy and breastfeeding. The focus is on the therapeutic "bottom line" of treatment safety and effectiveness. The evidence indicating whether a therapy/herb might really work is graded from A (strong scientific evidence that it works) to F (it likely does not work).
Memorial Sloan-Kettering Cancer Center: Herbs and Botanicals
The Memorial Sloan-Kettering Cancer Center (MSKCC) is one of the world's oldest and largest private institutions at the forefront of scientific research into cancer treatments, as well as the development of innovative cancer therapies and new patient care programs. Though primarily aimed a the cancer patient, The Herbs and Botanicals section provides useful information on which herbs may pose a health risk if taken incorrectly, which ones are likely to contain contaminants, which might cause dangerous interactions or increase bleeding and which ones may cause photosensitivity and should not be used when undergoing radiation therapy.
Office of Dietary Supplements (ODS): Health Information
The Office of Dietary Supplements (ODS) was established to promote knowledge and understanding of dietary supplements by evaluating scientific information, stimulating and supporting research, disseminating research results, and to educate the public. Information includes HYPERLINK "http://dietary-supplements.info.nih.gov/Health_Information/Botanical_Supplements.aspx" Botanical Supplement Fact Sheets and a section on Consumer Safety.
Longwood Herbal Taskforce (LHTF)
Highly recommended! The LHTF is a collaboration between faculty, staff and students from HYPERLINK "http://www.childrenshospital.org/" Childrens Hospital, the HYPERLINK "http://www.mcphs.edu/" Massachusetts College of Pharmacy and Health Sciences and the HYPERLINK "http://www.dfci.harvard.edu/index.shtml" Dana Farber Cancer Institute. This site provides reviews of current literature on selected herbal supplements, including in-depth monographs, clinician information summary, and, for some herbs, a patient fact sheet you can print out.
University of Maryland Medical Center Complementary Medicine Program
The online medical library provides an excellent guide to the use of individual herbs, with a special section on herbal supplements and the brand-name and generic drugs that may interact with them.
ADDIN EN.REFLIST 1. Izzo AA. Drug interactions with St. John's Wort (Hypericum perforatum): a review of the clinical evidence. Int J Clin Pharmacol Ther. Mar 2004;42(3):139-148.
2. Ernst E. Toxic heavy metals and undeclared drugs in Asian herbal medicines. Trends Pharmacol Sci. Mar 2002;23(3):136-139.
Chapter 6
Cancer
We cannot change the direction of the wind,
but we can adjust our sails.
(Source unknown)
The Internet is frequently used by cancer patients wishing to find information about their cancer and its treatment. It's also not unusual to want to know more about complementary and alternative medicine (CAM), especially if conventional cancer treatments dont seem to be effective or are difficult to endure and have severe side effects. About one third of people with cancer have tried one or more CAM treatments, with dietary and herbal treatments being used by about 30% of cancer patients ADDIN EN.CITE Ernst199811Con Herb Book-Converted.enlEndNote1117<style face="normal" font="default" size="100%">The prevalence of complementary/alternative medicine in cancer: a systematic review</style>1. Many cancer patients don't expect CAM treatments to cure their cancer but use them to treat pain or control the side effects of chemotherapy. Ginger (Zingiber officinale), for example, is beneficial for reducing the nausea and vomiting associated with chemotherapy.
There is growing evidence that many plant compounds may be useful in the prevention of cancer and new approaches to cancer treatment now recognize the importance of diet and the protective effect of compounds found in herbs and other plants. Studies have shown that people in Southeast Asian countries have far lower risks of developing most cancers compared with those in North America, and it is thought that the consumption of certain vegetables and foods containing garlic, ginger, cayenne, turmeric, soy, plays a key role. Several studies support the use of Green Tea (Camellia sinensis) in the prevention and treatment of various forms of cancer. There is also a significant body of evidence showing the positive role of herbs in combination with conventional cancer treatments. In studies with mice, Ginkgo biloba extract enhanced the radiation effect on tumors without increasing damage to normal tissue. Grape Seed E
One of the most widely touted herbal cancer treatments is Essiac, also sold as flor-Essiace, an herbal tea mixture developed by a Canadian nurse that claims to relieve the pain associated with cancer and even to reduce the size of tumors. Another is the Hoxsey treatment, developed by Harry Hoxsey and based upon a complex mixture of herbs such as licorice, red clover, burdock root, stillingia root, barberry, cascara, pokeroot, prickly ash bark, and buckthorn bark. Just before he died, the actor Steve McQueen went to a clinic in Mexico for Hoxley herbal treatment (since the treatment is illegal in the United States.) However, there are only anecdotal reports indicating that either treatment is effective and no clinical studies to support their use.
Aromatherapy is a division of herbal medicine which uses fragrant oils from plants such as lavender to enhance moods and improve psychological health. These oils are usually used in conjunction with massage. Some reported benefits include an improvement in the psychological well-being of cancer patients by reducing both stress and depression.
The following Web sites have been created by leading cancer research and treatments institutions in the United States and should be the first place to go if youre looking for information on herbs and cancer.
Memorial Sloan-Kettering Cancer Center: Herbs and Botanicals
The Memorial Sloan-Kettering Cancer Center (MSKCC) is the world's oldest and largest private institution devoted to patient care, research and education in cancer. The Center's mission, the progressive control and cure of cancer, places it at the forefront of scientific research, as well as the development of innovative cancer therapies and new patient care programs. Though this site provides information primarily for oncologists and healthcare professionals, a consumer version of each monograph is available and can be printed. Theres also a useful FAQ section for specific information on herbs and other dietary supplements, with information on which herbs might increase photosensitivity and hence should not be used when undergoing radiation therapy.
Figure 9
Memorial Sloan-Kettering Cancer Center: Herbs and Botanicals
M.D. Anderson Cancer Center: Complementary/Integrative Medicine
Affiliated with the University of Texas, the M.D. Anderson Cancer Center is committed to providing current information on all possible cancer treatments to their patients and the public. This site provides evidence-based reviews of various complementary and integrative therapies, including herbs, and offers a glossary, a drug interaction section, and links to additional resources.
MayoClinic.com: Prostate Cancer
< HYPERLINK "http://www.mayoclinic.com/" http://www.mayoclinic.com/>
Prostate cancer is the most common type of cancer in men in the United States and the second leading cause of death. Several herbal products are marketed to relieve common prostate problems, including African plum tree (Prunus africana), African wild potato (Hypoxis rooperi), Pumpkin (Cucurbita pepo), Rye grass (Secale cereale), Stinging Nettle (Urtica dioica), Chaparral (Larrea tridentata) and PC-SPES, a mixture of eight herbs. What evidence is available suggests that if taken in small to moderate amounts these products appear to be safe, but up to now there have been no long-term trials to confirm their safety or to prove that they work. One herb widely used for prostate health is Saw Palmetto (Serenoa repens), which has been widely tested for its use in treating urinary symptoms in men with benign prostatic hyperplasia (BPH). Though it seems to be useful in alleviating BPH symptoms, it isn't yet known whether this herb has any role in treating or preventing prostate cancer.
MayoClinic.com is owned by the Mayo Foundation for Medical Education and Research, providing access to the experience and knowledge of the more than 2,000 physicians and scientists of the internationally renowned Mayo Clinic. Use the A to Z list of diseases and conditions to go to the section on prostate cancer.
Office of Cancer Complementary & Alternative Medicine (OCCAM)
Part of the National Cancer Institute (NCI), the Office of Cancer Complementary and Alternative Medicine (OCCAM) was established in 1998 to promote and support research in the various disciplines and modalities associated with the field of complementary and alternative medicine as they relate to the diagnosis, prevention and treatment of cancer. Areas of interest include a FAQ for cancer patients considering, or currently taking, CAM therapies and links to fact sheets for cancer patients.
[INSERT FIGURE 10]
OncoLink
OncoLink is maintained by the University of Pennsylvania Cancer Center and offers in-depth online cancer resources for practicing physicians, patients and their family members. OncoLink connects to the latest cancer news and research. The site is a little difficult to navigate, but provides useful advice on the use of herbs by cancer patients. To find the information type your keywords into the Quick Search box.
Dr. Susan Love: Herbal Remedies for Breast Cancer
Dr. Susan Love is one of the pioneers and founders of the breast cancer advocacy movement. Her mission has been to encourage women both to learn more about their own bodies and to become politically active to ensure that necessary federal funding will be allocated for research in methods of early detection of breast cancer. This unique Web site for women provides up to date information on breast cancer, including comprehensive information on potentially useful herbs.
ADDIN EN.REFLIST 1. Ernst E, Cassileth BR. The prevalence of complementary/alternative medicine in cancer: a systematic review. Cancer. Aug 15 1998;83(4):777-782.
Chapter 7
Diseases and Conditions
There are no non-healing herbs - only the lack of knowledge.
Avicenna
There are herbs and herbal therapies available for almost every disease and health conditions, and from a wide variety of healing systems. According to the World Health Organization (WHO), 80 percent of the worlds population use herbal remedies for some aspect of their health care. In many developing countries traditional medicine is still the main source of primary health care and medicinal herbs play a major role (traditional medicine refers to systems of healing that are not based on the Western scientific approach). China and the Indian subcontinent have developed what are probably the two most widely known systems, referred to respectively as Traditional Chinese Medicine (TCM) and Ayurvedic medicine. In both of these healing systems herbs have a significant role to play and are increasingly getting attention from Western medicine.
Herbs are currently being investigated to treat anxiety, arthritis, depression, high blood pressure, hormonal imbalances such as premenstrual tension, insomnia, migraines, nausea, poor blood circulation and skin problems such as eczema. In this section I list Web sites that provide information on herbs used for common health problems. Some of these herbs are widely known, and there is a respectable amount of information available on their use, while others are only now being investigated but show great promise.
AIDS/HIV AND SEXUALLY TRANSMITTED DISEASES (STDs)
Sexually transmitted diseases (STDs) (such as hepatitis B and genital herpes) and acquired immunodeficiency syndrome (AIDS) have gained importance due to rapid spread of the diseases, the high cost of treatment, and the increased risk of transmission of other STDs. Current therapies available for treatment of STDs and AIDS are quite expensive and are associated with the emergence of drug resistance. Many patients of STDs and AIDS are seeking therefore seeking help from alternative systems of medicines such Chinese and Ayurvedic healing systems.
Several plant extracts have now been shown to inhibit the replication of the HIV virus, including plants from Panama, Indonesia and ones found in Ayurvedic medicine. A Southern African plant, Sutherlandia frutescens, the so-called Cancer bush, is gaining international attention as a potential inexpensive immune booster in the treatment of HIV/AIDS. There is preliminary clinical evidence that it has a beneficial effect on the immune system..
Bulletin of Experimental Treatments for AIDS (BETA)
The BETA is published quarterly (in winter, spring, summer and fall) by the Treatment and Education Center of the San Francisco AIDS Foundation (SFAF). It covers new developments in AIDS treatment research with in-depth articles on current treatments for HIV-positive individuals and AIDS-related illnesses. At the homepage select browse by topic, then Alternative/Complementary Treatments.
ALZHEIMERS DESEASE/DEMENTIA
Alzheimer's disease (AD) is a progressive, degenerative brain disease that attacks the brain and results in problems such as memory loss, impaired thinking, agitation, and anxiety. It is the most common cause of dementia in the elderly and affects at least three to four million people in the United States. Over the years several herbs have reportedly been useful in improving memory in old age: Ginkgo, Hawthorn berries, Ginseng, Sage (Salvia officinalis) and Lemon Balm (Melissa officinalis) are the five most commonly mentioned. Several studies show the significant benefits of aromatherapy on reducing agitation in patients with advanced Alzheimer's, using lavender and lemon oil (see the Depression section for more information on Aromatherapy).
University of Maryland Medical Center: Herbs and Supplements for Alzheimers
A superb site with information on herbs and other supplements for Alzheimers, including comprehensive reviews of Ginkgo, American Ginseng, Cats Claw (Uncaria tomentosa) and Lemon Balm.
ANXIETY
Anxiety is difficult to describe. It affects how we feel, how we behave and has very real physical symptoms that can sometimes be mistaken for physical illness. Mild anxiety is vague and unsettling: severe anxiety can be extremely debilitating. Kava has been approved in Germany for anxiety as an over-the-counter medication since 1990 and in the U.S. is the ninth best-selling herb. Studies show a significant reduction of anxiety in patients taking kava extract.
University of Maryland Medical Center
Comprehensive information about the signs and symptoms of anxiety and links to fact sheets on Kava Kava, Lavender, Lemon Balm, Passion Flower, Skullcap and St. Johns Wort.
ARTHITIS
Osteoarthritis is a type of arthritis that is caused by the breakdown and eventual loss of cartilage in the joints. Several herbs show great promise in treating this condition: ginger is being studied for the treatment of osteoarthritis of the knee and capsaicin cream (containing an ingredient found in cayenne peppers) is a safe and effective treatment for relieving pain.
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints. Autoimmune diseases occur when the body is mistakenly attacked by its own immune system. Cat's claw is a common name for at least 20 plants with sharp, curved thorns native to Central and South American tropical rain forests. Two of them, Uncaria tomentosa (UT) and Uncaria guianensis (UG) have a history of use in the treatment of rheumatoid arthritis.
The Arthritis Foundation
The Arthritis Foundation has a section devoted entirely to supplements, including herbs such as Black Current Oil (Ribes nigrum), Cats Claw, Devils Claw (Harpagophytum procumbens) and Thunder God Vine (Tripterygium wilfordii).
CARDIOVASCULAR SYSTEM
Clinical and laboratory research findings indicate that Hawthorn (Crataegus orycantholdes) may be beneficial in treating heart conditions. European studies suggest it may be useful for strengthening heart contractions, lowering blood pressure and lowering pulse rate. The berries are widely employed for treating arrhythmia congestive heart failure. Garlic (Allium sativa) is reported to have beneficial effects on some of the risk factors associated with atherosclerosis: the process in which deposits of fatty substances, cholesterol, cellular waste products, calcium and other substances build up in the inner lining of an artery. There are claims that eating large amounts of garlic lowers your cholesterol levels, though it may have a much greater effect on your social life!
MayoClinic.gov: Garlic
Click on Drugs & Supplements at the homepage, then go to the alphabetical list under Supplement Information.
Dietar y S u p p l e m e n t E d u c a t i o n A l l i a n c e "!: H a w t h o r n
< h t t p : / / w w w . s u p p l e m e n t i n f o . o r g / a b o u t u s / d s e a . h t m >
T h e D i e t a r y S u p p l e m e n t E d u c a t i o n A l l i a n c e "! ( D S E A "!) i s a p a r t n e r s h i p c r e a t e d t o p r o m o t e t h e r e s p o n s i b l e u s e o f v i t a m i n s , m i n e r a l s , h e r b s a n d s p e c i a l t y s u p p l e m e n t s consisting of scientific, education and industry groups. At the homepage click on Browse Supplements, then Hawthorn.
THE COMMON COLD AND THE FLU
Herbs such as Echinacea, Eucalyptus, Garlic and Mint have been getting a lot of publicity as cold remedies. Echinacea is one of the most popular herbs in the United States and Europe. Several species of Echinacea grow in the U.S., the most common being the Eastern Purple Coneflower (Echinacea purpurea). The plant is part of the sunflower/daisy family, and its extracts have been used medicinally for centuries. It is widely used to prevent and treat the common cold, and is believed to boost immunity.
Common Cold Center (UK): Alternative Common Cold Medications
Affiliated with the University of Wales, the Centre is involved in clinical trials and basic research on new medications for the common cold. It provides much useful background information on the common cold, plus descriptions of conventional and alternative treatments.
Longwood Herbal Task Force: Patient Fact Sheet on Echinacea
An excellent review of the use of Echinacea to prevent or treat the common cold and influenza, and the scientific evidence for its effectiveness.
DIABETES
A number of plants with possible beneficial properties have been used in folk medicine
and traditional healing systems around the world. For example, metformin, derived from Goats Rue (Galega officinalis) is a widely used remedy in Ayurvedic medicine. There is some evidence suggesting that Ivy Gourd (Coccinia indica), ginseng species, Bauhinia forficate and Myrcia uniflora may be beneficial. Several of these herbs are used in Ayurvedic medicine.
National Diabetes Information Clearinghouse (NDIC)
The National Diabetes Information Clearinghouse is an information and referral service designed to increase knowledge about diabetes among patients and their families, health care professionals, and the public. At the homepage select Treatments, then HYPERLINK "http://diabetes.niddk.nih.gov/dm/pubs/alternativetherapies/index.htm" Complementary and Alternative Medical Therapies for Diabetes.
Diabetes.1.2.3
Diabetes.1.2.3 describes itself as the world leader in online diabetes care, with information put together by an international group of pediatric and adult endocrinologists, an obstetricians diabetes nurse specialists, dietitians, exercise physiologists, and counseling specialists. There is a great deal of useful material here for both for consumers and health professionals interested in type1 and type 2 diabetes. Under the Clinics section on the homepage click on Alternative Treatments. This is one of the best overview of CAM and diabetes that Ive come across, with brief information on Fenugreek, Bitter Melon, Gymnema sylvestre and other herbs. There is also a link to a useful overview of Ayurvedic medicine from the Agency for Healthcare Research and Quality (AHRQ).
Health and Age
As people get older, their risk of developing diabetes (and other complications) increases. The HealthandAge Web site is sponsored by the Novartis Foundation for Gerontology, an independent non-profit organization, promoing research into the aging process. For information on herbs which may be of value in the treatment of diabetes mellitus, go to the Alternative Medicine section, then browse Conditions by Name/ HYPERLINK "http://www.healthandage.com/html/res/com/ConsLookups/Uses/diabetesmellitus.html" Diabetes Mellitus.
HEADACHES AND MIGRAINE
Migraines are severe headaches, which can be linked to food sensitivity, pollutants, menstrual cycle, or stress. It is associated with changes in tensions within the arteries of the brain. Untreated symptoms may last for a few minutes or several days. Among the herbs known to have positive effects on migraines is Feverfew (Tanacetum parthenium).
National Headache Foundation ( N H F )
< h t t p : / / w w w . h e a d a c h e s . o r g / >
A t t h e h o m e p a g e s e l e c t H e a d a c h e S u f f e r e r , t h e n s e l e c t H e a d a c h e T o p i c s h e e t s f r o m E d u c a t i o n a l R e s o u r c e s f o r i n f o r m a t i o n o n F e v e r f e w a n d G i n g e r .
D i e t a r y S u p p l e m e n t E d u c a t i o n A l l i a n c e "!: F e v e r f e w
< h t t p : / / w w w . s u p p l e m e n t i n f o.org/aboutus/dsea.htm>
At the homepage select Browse Supplements, then select Feverfew.
DEPRESSION AND MEMORY IMPAIRMENT
Ginkgo is an extract from the leaves of the oldest species of tree on earth (more than 225 million years old). It is one of the most frequently used herbal products, especially in European countries. Its primarily used for alleviating memory problems but is also used to treat vertigo and tinnitus. The most widely known herb for the treatment of depression is St. Johns Wort (Hypericum perforatum), with the bulk of evidence from ongoing studies suggesting that the age-old remedy is a reliable mood elevator for people whose depression is mild to moderate. St. John's Wort is also taken to relieve anxiety, social phobia, seasonal affective disorder and mood changes linked to menopause and PMS.
Studies also report the benefits of aromatherapy for relieving stress and depression. Aromatherapy uses fragrant oils from plants to enhance moods and improve general well-being. Essential oils are inhaled, added to water or combined with massage.
InteliHealth: Aromatherapy
InteliHealth has a well written guide to aromatherapy and its uses. Go to the Complementary and Alternative Medicine section, then select Index Of Alternative Therapies And Modalities
NCCAM: St. John's Wort and the Treatment of Depression
The National Center for Complementary and Alternative Medicine (NCCAM) has developed this consumer fact sheet on the use of St. John's Wort to treat depression to help consumers make informed decisions.
University of Maryland: Depression
Comprehensive information about the signs and symptoms of depression, with links to fact sheets on St.Johns Wort, Asian Ginseng and Valerian.
IRRITABLE BOWEL SYNDROME (IBS)
Irritable bowel syndrome (IBS) is a disorder that interferes with the normal functions of the large intestine (colon). It is characterized by a group of symptoms such as cramp and abdominal pain, bloating, constipation, and diarrhea. Peppermint (Mentha piperita), one of the top ten best-selling herbal teas, is often used to treat symptoms associated with IBS.
Wholehealthmed.com: Supplement Recommendations for Irritable Bowel Syndrome
WholeHealthMD.com describes itself as a Complementary and Alternative Medicine (CAM) education Web site. Click on Healing Centers, then select Irritable Bowel Syndrome, and Nutritional Supplements for information on peppermint and Psyllium.
MENOPAUSE
(See Chapter 8: Womens Health Issues)
PROSTATE PROBLEMS (BENIGN PROSTATIC HYPERPLASIA (BPH))
Extract of the American saw palmetto or dwarf palm plant (Serenoa repens) and the African plum tree (Pygeum africanum) are widely used to treat benign prostatic hyperplasia (BPH). BPH is a non-cancerous enlargement of the prostate gland, usually resulting in problems with urination.
University of Maryland Medical Center: Benign Prostatic Hyperplasia (BPH)
This site contains comprehensive information about the signs and symptoms of BPH and links to fact sheets on relevant herbs such as Saw Palmetto, Flaxseed, and Stinging Nettle.
SEXUAL DYSFUNCTION/ERECTILE DYSFUNCTION
Erectile dysfunction (i.e., impotence) affects 50 percent of men aged 40-70 in the United States. The public is continually exposed to information on a variety of natural products claiming to restore erection and sexual vitality. What evidence is available suggests that most naturally occurring compound are not very effective. However, there is some evidence that Yohimbe (Pausinystalia johimbe), Ginseng, Maca (Lepidium meyenii), and Ginkgo biloba may be helpful.
Horny Goat Weed (Epimedium grandiflorum) is a traditional herbal medicine used in China (where it is known as Yin Yang Huo) and Japan. Although this herb has a history of traditional use for disorders of the kidneys, joints, liver, back and knees, its principle use is as an aphrodisiac. Legend has it that the name horny goat weed came from a herder who noticed his goats becoming more sexually active after eating the plant. Unfortunately there are no well-conducted clinical studies to see if it works in humans.
University of Maryland Medical Center: Sexual Dysfunction
This is a comprehensive recourse for information on all aspects of sexual dysfunctions, including male impotence, premature ejaculation in males, and problems with sexual desire (libido). Includes information on Dandelion (Taraxacum officinale), Gotu Kola (Centella asiatica), Passionflower (Passiflora incarnate), Saw Palmetto and other herbs.
SKIN CONDITIONS
Medicinal plants have been used to treat a variety of skin conditions, the best known being Aloe vera for burns and wounds. Tea Tree oil (Melaleuca alternifolia) has activity against certain bacteria and fungi, and is used to treat acne and fungal infections such as athletes foot. Other herbs include Vitex (Vitex agnus-castus) for treating premenstrual acne and Marigold (Calendula officionalis) preparation for the treatment of wounds, ulcers, burns, boils, rashes, chapped hands, herpes zoster, and varicose veins. Lemon Balm (Melissa officinalis) can be used to treat minor wounds and herpes lesions.
University of Maryland Medical Center: Skin, nails and hair disorders
Herbs to treat acne, burns, eczema, psoriasis and other skin conditions.
SLEEP AND INSOMNIA
Valerian (Valeriana officinalis) is widely used in Europe and the U.S. as a sedative and sleep aid. Studies suggest that extract of valerian root improves the quality of an individuals sleep, especially those who are poor or irregular sleepers.
ODS: Questions and Answers About Valerian for Insomnia and Other Sleep Disorders
This is a comprehensive overview of Valerian and its uses from the governments Office of Dietary Supplements (ODS).
SPORTS INJURIES/USE OF SUPPLEMENTS IN SPORTS
Hoping to improve their performance, 30 percent to 40 percent of young athletes take a dietary supplement. There are hundreds of products that promise to build strength, increase endurance, burn body fat and basically make us better athletes. Ephedrine, derived from Ephedra (Ephedra sinica) (also called Ma huang), has been extensively promoted to aid weight loss, enhance sports performance, and increase energy. It also increases blood pressure, heart rate, jitteriness and palpitations and may cause strokes or seizures. In 2003, Baltimore Orioles pitcher Steve Bechler, 23, who had been taking ephedrine to battle a weight problem, collapsed and died during spring training. In 2004 the FDA published a rule banning the sale of dietary supplements containing ephedrine.
Gatorade Sports Science Institute (GSSI)
< HYPERLINK "http://www.gssiweb.com" http://www.gssiweb.com>
GSSI is a valuable resource for sports nutrition professionals, with articles written by qualified health professionals. In the Dietary Supplements section youll find information about the dangers of ephedra and new so-called ephedra-free supplements containing herbs such as Bitter Orange (Citrus aurantium).
InteliHealth: Ephedra (Ephedra sinica), Ma-Huang
A great source of information on Ephedra, including news updates on FDA attempts to prevent its sale in the U.S. and easy-to-read information and warnings on its use.
SUBSTANCE ABUSE/ALCOHOLISM
There is increasing interest in Kudu (Pueraria lobata,), an herb widely used in Chinese medicine to treat alcoholism. Preclinical trials of an herbal formula with kudzu have shown that increased consumption of the herbal formula is associated with decreased consumption of alcohol. Extracts of St. Johns Wort (Hypericum perforatum) have been widely used in Europe for a long time to reduce symptoms of mild to moderate depression but recent studies indicate it may also help in reducing a persons alcohol intake.
GNC: Health Notes
Go to the Health Notes section for a review of Kudzu.
MedlinePlus: Herbal Medicine
Includes recent news on using kudzu to treat alcoholism.
TEETH AND GUMS
Herbal remedies, have long been used to treat both gum and tooth problems, though information is lacking on their actual effectiveness. Oil of Clove, from Eugenia aromatica is a well-known local anaesthetic for toothache. Some African tribes in Chad and the Sudan chew on sticks carved from the wood of Salvadora persica, or "toothbrush tree." Recent studies have discovered that Salvadora wood releases a bacteria-fighting liquid that helps prevent infection and tooth decay. It even contains fluoride.
GNC: Health Notes
Go to the Health Notes/Health Concerns section on Gingivitis for information on herbal toothpaste and herbal mouthwashes.
URINARY TRACT INFECTIONS (UTI)
It seems that a glass of cranberry juice a day keeps urinary tract infections away. Cranberries (Vaccinium marcocarpon) have been used for the prevention and treatment of urinary tract infections for decades and was a widely used treatment before the introduction of antibiotics. Most women develop this type of problem at least once in their lives, and some suffer from constant recurrences. Studies suggest the juice contains chemicals which inhibit the activity of Escherichia coli, the bacteria most often responsible for cystitis.
Longwood Herbal Fact Sheets: Cranberry
An excellent review of the use of Cranberry juice, with advice on its use during pregnancy, lactation and childhood.
University of Maryland Medical Center: Cranberry
A well-written and detailed guide to Cranberry and its medicinal uses with useful practical advice on its use in adults and children.
Chapter 8
Womens Health
A growing body of research now points to significant biological and physiological differences between the sexes/genders, with important implications for the health care of both men and women. Women are now recognized as having different health needs, different responses to diseases, and different responses to medicines. As a result of intensive lobbying from womens groups, research on women's health has mushroomed in the past two decades, producing a spate of books and other information resources specifically addressing the unique health concerns of women.
The herbal literature is especially rich in remedies for women, probably because in many societies women have often cared for the physical complaints of other women, serving as midwife and often as the communitys chief healer. Thus there are many useful herbal remedies for conditions specific to womens health, especially those associated with the menstrual cycle, pregnancy, childbirth and menopause.
Every woman will go through menopause. During this period of their life most experience symptoms that can include hot flushes, mood swings, anxiety, reduced libido and sleep disturbance. With increased awareness of the dangers of using hormone replacement therapy (HRT), more women are looking to CAM for symptomatic relief. Five popular herbs used during menopause are Black Cohosh (Cimicifuga racemosa) and Red Cover (Trifolium pratense) to reduce hot flashes, St.Johns Wort (Hypericum perforatum) to reduce depression and anxiety, Ginseng (Panax ginseng )to reduce fatigue and to increase libido, and Gingko biloba to counteract memory loss.
Dong Quai (pronounced Don Kway), also known as Chinese angelica (Angelica sinensis), is an aromatic herb that grows in China, Korea, and Japan. It is considered the ultimate, all-purpose woman's tonic herb, and has been used for almost every gynecological complaint from regulating the menstrual cycle to treating menopausal symptoms. Because of its popularity I have included a link for this herb.
The following Web sites provide information or links to resources for a variety of womens health issues.
Dong Quai (University of Maryland Medical Center)
< HYPERLINK "http://www.umm.edu/altmed/ConsHerbs/DongQuaich.html" http://www.umm.edu/altmed/ConsHerbs/DongQuaich.html>
A comprehensive source of information on the uses of Dong Quai, including its use in the treatment of menopause and Premenstrual Syndrome (PMS).
SusanLoveMD.org: The Website for Women
Dr. Susan Love is a noted breast surgeon, an adjunct associate professor of clinical surgery at the University of California at Los Angeles, director of the Santa Barbara Breast Cancer Institute. She is an author and patient advocate, well known for her down to earth style and ability to translate medical jargon into understandable concepts. Her Web site is focused on womens health concerns with an emphasis on breast cancer. As you might expect, there is much valuable information on herbs as they relate to women's health issues, such as hot flashes. Access the Complementary and Alternative Therapies section by clicking on the Take Charge button. Under Herbal Remedies youll find a list of herbs of possible use in alleviating the symptoms of menopause.
[INSERT FIGURE 13]
4.women.gov (The National Women's Health Information Center)
The National Women's Health Information Center (NWHIC) is sponsored by the U.S. Public Health Service and is a "combination Internet site/toll-free hotline dedicated to serving as a 'one-stop shopping' resource for women's health information. At the homepage, under Find Health Publications, select Browse Health Topics to go to an alphabetical list of topics, including Herbs.
March of Dimes
The March of Dimes is a national voluntary health agency whose mission is to improve the health of babies by preventing birth defects and infant mortality. Founded in 1938, the March of Dimes funds programs of research, community services, education and advocacy to save babies. This site has useful advice for pregnant woman thinking of taking herbal remedies for pregnancy-related discomforts: including information on herbs and herbal teas that should not be used during pregnancy. At the home page click on pregnancy & newborn, then During your Pregnancy and Herbs and Drugs.
Longwood Herbal Task Force: Herb and Supplement Patient Fact Sheets
<HYPERLINK "https://www.ckm.ucsf.edu/horde/util/go.php?url=http%3A%2F%2Fwww.mcp.edu%2Fherbal%2Fph.htm&Horde=6ee1d24a37db4167c853af3a7dafac70"http://www.mcp.edu/herbal/ph.htm>
The LHTF website is provided by faculty, staff and students from Children's Hospital, the Massachusetts College of Pharmacy and Health Sciences and the Dana Farber Cancer Institute. Though primarily aimed at clinicians the task force has produced a number of exceptional handouts aimed at consumers, each one having a short "IS IT SAFE FOR CHILDREN AND PREGNANT WOWEN" section summarizing what's known about an herb's safety in breastfeeding and pregnant women.
Urinary Tracts Infections (UTI)/Bladder Infections
Most women develop this problem at least once in their lives, and some suffer from constant recurrences. See the section on UTI and Cranberry juice in Chapter 7.
Chapter 9
Information for Children and Parents
"The test of the morality of a society is what it does for its children." Dietrich Bonhoeffer
Studies indicate that many parents give their children herbal remedies, such as Chamomile, Feverfew, Ginger, and Ginkgo. Unfortunately, there is a lack of good information available on how safe and effective they are. Some clinical trials, however, show promising results for the herbal treatment of specific pediatric disorders, such as extracts of the Kalmegh (Andrographis paniculata) of Ayurveda medicine for the prevention and treatment of upper respiratory tract infections (URTIs) and Valerian in the treatment of sleep problems in children with an intellectual deficit (ID) (mental retardation) ADDIN EN.CITE Francis200212Con Herb Book-Converted.enlEndNote1217<style face="normal" font="default" size="100%">Effect of valerian, Valeriana edulis, on sleep difficulties in children with intellectual deficits: randomised trial</style>1. Few parents or caregivers seem aware, however, of the potential risks involving adverse reactions or dangerous herb-drug interactions.
Children are not little adults, and in the past have been harmed because of the lack of knowledge of how drugs might affect them. They have developing central nervous and immune systems that may make them more sensitive to the adverse effects of herbs. Children differ from adults in their absorption, distribution, metabolism, and excretion of drugs, and infants and young children are likely to be physiologically more vulnerable to certain adverse effects. Some herbs such as Buckthorn (Rhamnus cathartica), Senna (Cassia senna), and Aloe are known cathartics (i.e., laxatives), while some herbal teas and preparations such as juniper oil contain powerful diuretic compounds that promote the formation of urine by the kidney. These actions may cause clinically significant dehydration and other medical problems in an infant or young child.
Parents considering giving their child herbal preparations should seek expert guidance first and make certain that any herbal preparations are bought from a reliable source, especially as a number of new herbal products specifically made for children are coming onto the market.
Longwood Herbal Task Force: Herb and Supplement Patient Fact Sheets
<HYPERLINK "https://www.ckm.ucsf.edu/horde/util/go.php?url=http%3A%2F%2Fwww.mcp.edu%2Fherbal%2Fph.htm&Horde=6ee1d24a37db4167c853af3a7dafac70"http://www.mcp.edu/herbal/ph.htm>
The LHTF website is provided by faculty, staff and students from Children's Hospital, the Massachusetts College of Pharmacy and Health Sciences and the Dana Farber Cancer Institute to learn more about and teach other clinicians about herbs and dietary supplements. Each patient handout has a short "IS IT SAFE FOR CHILDREN AND PREGNANT WOMEN" section summarizing what's known about an herb's safety in breastfeeding and pregnant women.
FTC: Promotions for Kids' Dietary Supplements Leave Sour Taste
The federal governments Federal Trade Commission (FTC) has responsibility for monitoring the advertising of dietary supplements, in print and broadcast advertisements, infomercials, catalogs, and similar direct marketing materials. The FTC's Consumer Education Office has developed an FTC Consumer Feature titled: "Promotions for Kids' Dietary Supplements Leave Sour Taste," which offer valuable "Pointers for Parents."
Kids Health
< HYPERLINK "http://www.kidshealth.org" http://www.kidshealth.org>
KidsHealth is a popular site on the Web providing doctor-approved health information about children from before birth through adolescence. Created by The Nemours Foundation's Center for Children's Health Media, it provides families with accurate, up-to-date, and jargon-free health information they can use. KidsHealth has separate areas for HYPERLINK "http://kidshealth.org/kid/" kids, HYPERLINK "http://kidshealth.org/teen/" teens, and HYPERLINK "http://kidshealth.org/parent/" parents - each with its own design, age-appropriate content, and tone. There are literally thousands of in-depth features, articles, animations, games, and resources - all original and all developed by experts in the health of children and teens. At the home page click on Doctors and Hospitals to get to the section on Alternative Medicine.
[INSERT FIGURE 14]
March of Dimes
Though not specifically about children, this site has useful advice for pregnant woman including information on herbs and herbal teas that should not be used during pregnancy. At the home page click on pregnancy & newborn, then During your Pregnancy and Herbs and Drugs.
ADDIN EN.REFLIST 1. Francis AJ, Dempster RJ. Effect of valerian, Valeriana edulis, on sleep difficulties in children with intellectual deficits: randomised trial. Phytomedicine. May 2002;9(4):273-279.
Chapter 10
Aging
"Why should a man die while sage grows in the garden?"
Chinese proverb
With the aging of the U.S. population, there has been considerable interest in the use of herbal medicines to counter some of the problems many of us will encounter as we grow older. The past few years has seen a significant increase in the number of studies conducted to understand how herbs might help slow the aging process. Some of these herbs you are already probably familiar with, such as St. Johns Wort to treat depression, Ginkgo to improve memory, and Ginseng to overcome fatigue and stimulate immune function. Others are just beginning to attract attention, like Pigweed (Amaranthus, various species) to strengthen bones and Astragalus (Astragalus membranaceus) to strengthen the immune system.
A word of caution: some companies are promoting their products to senior citizens by making "anti-aging" claims for which there is little or no supporting evidence on their safety or effectiveness. There are real concerns that some of these products may cause physical harm, especially as seniors often have a high prevalence of chronic health conditions and take multiple prescription drugs which increase the risk of possibly dangerous herb-drug interactions.
The following Web sites are designed specifically for seniors and their families. The Health and Age Web site is particularly useful for advice on which herbs you shouldnt take if youre being treated with particular medications.
Health and Age
Highly recommended! The HealthandAge Web site is sponsored by the Novartis Foundation for Gerontology, an independent non-profit organization. Its mission is to promote research into the aging process by funding selected studies and providing access to knowledge about healthy aging. At the homepage click on Alternative Medicine for extensive information on sections on herbs and other supplements. The Interactions by Herb or Supplement section lists herbs and supplements and the brand-name and generic drugs that may interact with them.
[INSERT FIGURE 15]
National Institute on Aging
The mission of the National Institute on Aging (NIA) is to "lead a national program of research on the biomedical, social, and behavioral aspects of the HYPERLINK "http://www.medterms.com/script/main/art.asp?articlekey=13403" aging process; the prevention of age-related diseases and disabilities; and the promotion of a better HYPERLINK "http://www.medterms.com/script/main/art.asp?articlekey=11815" quality of life for all older Americans." Go to the Publications section for documents on issues concerning the use of herbs and other supplements in seniors.
NIHSeniorHealth.gov
This site was developed by the National Institute on Aging (NIA) and the National Library of Medicine (NLM), both part of the National Institutes of Health (NIH). Its designed to make aging-related health information easily accessible for adults 60 and older and is also a useful tool for family members and friends who are seeking online health information for their older relatives. The Web site is organized by health topic. Each health topic includes genera background information, open-captioned videos, quizzes and frequently asked questions (FAQs). Though information on herbal remedies is limited this site has the added features to make the site more accessible to seniors. You can use buttons to change the text size, to change the contrast colors, or to turn speech on or off.
Chapter 11
Research Using MEDLINE (PubMed) and Other Databases
In 1984, Lorenzo Odone, a 5-year-old boy living in Virginia was diagnosed with an incurable degenerative disease called adrenoleukodystrophy (ALD). ALD is a rare, inherited metabolic disorder. Symptoms include dementia, loss of sight, hearing, speech, and ability to walk, usually resulting in death within a couple of years. Frustrated by the medical professions inability to help, his parents taught themselves biology and conducted an extensive search of the medical literature to develop a treatment for their son. Eventually they developed what came to be famously known as Lorenzo's Oil (Their story was immortalized in a film of the same name starring Nick Nolte and Susan Sarandon).
Back in 1984, before the days of free online access to the MEDLINE database, searching the medical literature was a difficulty task. The Odones had to spend months in libraries, searching through the biomedical literature. However, with the advent of the Internet, and the National Library of Medicine (NLM)s PubMed system this has now dramatically changed. PubMed now provides everyone with free online access to MEDLINE, the foremost medical database in the world. Using PubMed you can find citations and abstracts to articles in over 4,500 highly regarded medical journals. MEDLINE has been in use for more than 30 years - long before the Internet existed. Its content has saved lives, improved care and provided answers to important questions posed by researchers and health-care professionals. It is of great value to anyone looking for the latest medical research.
designed to help you zero in on the most important articles. More importantly,
MEDLINE is what is known as a bibliographic database, and is usually the first step in investigating a new research area. A bibliographic database is composed of citations, or individual records that contain the information necessary to identify the original publication. Generally, a citation consists of the article title, author, journal name, publication date, and pagination. Table 2 shows a typical MEDLINE citation.
MEDLINE is a huge database, containing information on over 15 million journal articles, so its sometimes a little tricky to find the information you want. To make searching easier, government-funded agencies such as the National Center for Complementary and Alternative Medicine (NCCM) and the Office of Dietary Supplements (ODS) have created free online databases that make it easier for members of the public to search for the latest journal articles. The two most useful ones are CAM on PubMed and the International Bibliographic Information on Dietary Supplements (IBIDS) database (pronounced E-bids).
You can also use the Internet to access more specialized databases, providing more detailed information on herbs, such as the names of the active chemical in herbal preparations and the uses of medicinal plants by traditional healing systems. The Rosenthal Center Directory of Databases provides information about and links to these sources.
MEDLINE (PubMed)
MEDLINE covers the journal literature of medicine, nursing, dentistry, veterinary medicine, the health care system, and the pre-clinical sciences such as anatomy and biochemistry. It currently contains references to around 15 million articles, from over 4,500 journals, now dating back to the 1950s. Around 33,000 new citations are added each month! However, not every journal is indexed from cover to cover and some are selectively indexed: if an article is not related to biomedicine it is not added to MEDLINE. Since June 1997 MEDLINE has been available free on the Internet through the PubMed site. PubMed is a World Wide Web (WWW) retrieval service developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM). Updated daily, PubMed provides a free search interface for the MEDLINE database.
All records in the MEDLINE database consist of two parts: a bibliographic citation and a list of indexing terms. (See Figure 2). The bibliographic citation contains everything you need to know to locate the original article; that is, title, author(s) and journal information. However, the citations themselves often do not contain enough information to allow you to easily find them in a database as large as MEDLINE. To add more information to a citation, professional indexers at the NLM add indexing terms to the Subject Field of the MEDLINE record from a standardized list of medical terms are called Medical Subject Headings (MeSH). PubMed has become a major resource for keeping up-to-date with current research in complementary and alternative medicine (CAM). Unfortunately, locating research on herbs can sometimes be tricky. One major problem is the confusion surrounding which names to use as search terms. For example, an article discussing Milk Thistle, may refer to its common name (Milk Thistle), or its scientific name (Silybum marianum), or simply to one of its bioactive chemical constituents (e.g. silymarin). For the most commonly used herbs though you can just type in the common name.
For an introduction to searching PubMed go to the PubMed homepage and click on Tutorial in the blue column. This site has extensive help on using the database. For a more detailed description of searching for herbal and other CAM information in PubMed look at the handout written by library staff at Bastyr University (URL listed in this chapter) or the paper by Saxton and Owen (1).
How do you get the complete journal article itself? The PubMed system provides something called LinkOut, which is a list PubMed journals that provide links to full text articles. Links are supplied by full text providers, and though some articles are free many journals usually require registration, a subscription fee, or some other type of fee to access the full text. If the text is not available online, LinkOut provides a list of libraries that subscribe to the journal. Your local public or medical library may also subscribe to the journal or give you advice on getting the article.
Bastyr Unversity: Complementary and Alternative Medicine (CAM)
Research Using MEDLINE
The library staff at Bastyr University, a leading naturopathic college, have written a superb online guide to searching MEDLINE for CAM research.
CAM on PubMed
CAM on PubMed is a joint venture of the National Center for Complementary and Alternative Medicine (NCCAM) and the National Library of Medicine (NLM). The database provides journal citations related to complementary and alternative medicine (CAM) and is intended for use by health professionals, CAM practitioners, researchers, educators, and consumers. It is essentially a subset of the MEDLINE database. Though the experienced searcher can probably get the same results using the parent PubMed database, this smaller database is obviously easier to deal with. Search it the same way as you would PubMed.
Combined Health Information Database (CHID)
CHID is a bibliographic database produced by health-related agencies of the Federal Government, including the Centers for Disease Control (CDC), the Office of Disease Prevention and Health Promotion, the Department of Veterans Affairs and National Center for Complementary and Alternative Medicine (NCCA). The database provides bibliographic citations for major health journals, books, reports, pamphlets, audiovisuals, hard to find information resources and health education/promotion programs. Go to Detailed Search, and under Select A Database for Searching, select Complementary and Alternative Medicine (AM).
Google ScholarŽ
< HYPERLINK "http://www.google.com/" http://www.google.com/>
(Select Scholar form the Google homepage.)
Google has launched a new service called HYPERLINK "http://scholar.google.com/" Google Scholar, that searches for scholarly materials such as peer-reviewed (see glossary) journal articles, theses, books and technical reports. Some information is available as full-text, though in some instances only abstracts are displayed with links to pay-for document delivery services. Google Scholar is still in development and has serious limitations. It does not compare with PubMed for finding the most up-to-date health information. Be careful it includes some Medline citations but not the most recent ones. You should use PubMed Medline for finding the most current peer-reviewed clinical information and medical research. However, its a useful research tool and in some ways complements PubMed.
International Bibliographic Information on Dietary Supplements (IBIDS) Database
The International Bibliographic Information on Dietary Supplements (IBIDS) database (pronounced E-bids) is produced by the Office of Dietary Supplements (ODS) and the US Department of Agriculture, and is designed to provide ready access to the international scientific literature on vitamins, minerals, hormonal products and botanicals. You can select from the IBIDS Consumer Database, the Full IBIDS Database, or Peer Reviewed Citations Only. Peer-reviewed journals have a board of experts or "peers" who evaluate articles submitted for publication. The IBIDS Consumer Database restricts searches to references that have been selected from journals that provide dietary supplement information geared specifically toward consumers, rather than scientists.
[INSERT FIGURE 16]
Rosenthal Center: Directory of Databases
The Richard and Hinda Rosenthal Center is part of Columbia Presbyterian Medical Center in New York, and is one of the first centers at a major medical school devoted specifically to research, education and training in complementary and alternative medicine. This Web page is a detailed list of databases available in the USA, Europe and Asia, designed to facilitate research by both professionals and the public. It includes information on HYPERLINK "http://www.rosenthal.hs.columbia.edu/Databases.html" \l "1#1" major biomedical bibliographic databases other than PubMed (e.g. EMBASE), major databases specific to complementary and alternative medicine (e.g. AMED), important pharmaceutical databases of relevant to herbal medicine (e.g., NAPRALERT) and traditional medicine databases (e.g. American Indian Ethnobotany Database and Dr. Duke's Phytochemical and Ethnobotanical Databases covering ethnobotanical uses for plants).
1: Saxton JD, Owen DJ. Developing Optimal Search Strategies for Finding Information on Herbs and Other Medicinal Plants in MEDLINE.
J Altern Complement Med. 2005 Aug;11(4):725-31.
Chapter 12
Let the Buyer Beware: Fraud and Quackery
Quack, quack, quack!
"Bust enhancing" or breast enlargement supplements are now widely marketed to young women. These products contain various combinations of herbs, the most popular being hops, saw palmetto, damiana (Turnera diffusa), dong quai, chaste-tree berry, blessed thistle), dandelion, wild yam (Dioscorea villosa), kava, fennel, black cohosh, and fenugreek. Ads regularly appear on television, on the Internet and in magazines, and claim to offer a non-surgical, "natural" way to increase breast size and firmness. Unfortunately, no clinical trials have been carried out to test whether these herbs work. Instead, they usually rely on personal testimonials. A 2002 20/20 television program found evidence that the people providing these testimonials are often paid actors, and the differences shown in "before and after" pictures are most likely the results of pushup bras.
Though fraud and quackery can occur throughout medicine, they tend to thrive in areas which do not have much scientific support or where the medical establishment is mistrusted. With more and more consumers using the Internet for finding health information the opportunities for fraud have significantly increased. Note that those who promote health fraud are being intentionally deceiving, and know that their product doesnt do what they say it does. In contrast, quackery involves people who really believe their system or therapy works. Unfortunately, exotic, unproven or exaggerated claims for herbs and other CAM therapies are widespread and sometimes even a physician has difficulty separating the serious science from the quackery.
As usual, I dont mean to scare you. Just keep you wits about you if you come across an unusual herbal remedy that interests you. Remember that if something sounds too good to be true, it usually is! Avoid anything that talks about anti-aging treatments, promises "quick and easy cures" or contains words such as "miraculous," "exclusive," magic or "secret."
The Federal Trade Commission (FTC) is responsible for monitoring the advertising of herbs and other supplements, in print and broadcast advertisements, infomercials, catalogs, and similar direct marketing materials. Such advertising must be truthful and not misleading. The FTC has taken action against supplement manufacturers, advertising agencies, distributors, retailers, catalog companies and others involved in the deceptive promotion of herbal products Its Health Claims on the Internet document has valuable advice on how to spot health fraud. Other Web sites listed here are for organizations set up to protect the consumer from fraud and quackery and provide valuable advice for anyone using the Internet for health information or buying health products.
If you regularly use the Internet for health information you might want to browse these sites to help identify any fraudulent claims you may come across.
Health Claims on the Internet: Buyer Beware (FTC)
The Federal Trade Commission (FTC) works to prevent fraudulent, deceptive and unfair business practices in the marketplace and to provide information to help consumers spot, stop and avoid them. This document has valuable information on how to spot fraudulent claims for herbs and other supplements on the Internet.
American Council on Science and Health (ACSH)
The American Council on Science and Health, Inc. (ACSH) is a nonprofit dedicated to the education of consumers on issues relating to food, nutrition, chemicals, pharmaceuticals, lifestyle, the environment and health.
Center for Science in the Public Interest (CSIPI)
The CSPI was founded in 1971 by scientists who had previously worked for Ralph Naders Center for the Study of Responsive Law. The Center is a nonprofit education and advocacy organization that focuses on improving the safety and nutritional quality of the food supply. Use the search engine box to locate articles from their Supplement Watch section.
ConsumerLab.com
ConsumerLab.com is a independent research laboratory that investigates the product quality of commercially available dietary supplements, including herbal products. ConsumerLab.com aims to test natural products to see if they meet scientific standards for potency, purity and consistency. You pay for the complete reports but summaries are free.
Consumer Reports
Consumer Reports is published by Consumers Union, a HYPERLINK "http://www.answers.com/main/ntquery;jsessionid=2e9lbs4gfgmso?method=4&dsid=2222&dekey=Non-profit+organization&gwp=8&curtab=2222_1&sbid=lc02a" \t "_top" non-profit organization known for publishing accurate reviews and comparisons of consumer products based on results from its in-house testing HYPERLINK "http://www.answers.com/main/ntquery;jsessionid=2e9lbs4gfgmso?method=4&dsid=2222&dekey=Laboratory&gwp=8&curtab=2222_1&sbid=lc02a" \t "_top" laboratory. Use the Site Map to go the Drugs and Supplements section. A subscription is required to view many of the reports.
Tips for the Savvy Supplement User: Making Informed Decisions
< HYPERLINK "http://www.fda.gov/fdac/features/2002/202_supp.html" http://www.fda.gov/fdac/features/2002/202_supp.html>
Tips from the FDA to to help consumers become savvy dietary supplement users. Includes useful information about what to look out for when buying herbal products.
Chapter 13
Whats in the Bottle? -
Regulations and Quality Issues
It is a funny thing about life: if you refuse to accept anything but the best
you very often get it.
W. Somerset Maugham
Herbal remedies are therapeutic products made from leaves, seeds, flowers and roots. As such they are often considered to be INCLUDEPICTURE "http://www3.interscience.wiley.com/giflibrary/12/ldquo.gif" \* MERGEFORMATINET naturally occurring INCLUDEPICTURE "http://www3.interscience.wiley.com/giflibrary/12/rdquo.gif" \* MERGEFORMATINET rather than INCLUDEPICTURE "http://www3.interscience.wiley.com/giflibrary/12/ldquo.gif" \* MERGEFORMATINET man-made INCLUDEPICTURE "http://www3.interscience.wiley.com/giflibrary/12/rdquo.gif" \* MERGEFORMATINET compounds like mainstream drugs, and hence are INCLUDEPICTURE "http://www3.interscience.wiley.com/giflibrary/12/ldquo.gif" \* MERGEFORMATINET safe. INCLUDEPICTURE "http://www3.interscience.wiley.com/giflibrary/12/rdquo.gif" \* MERGEFORMATINET They are also traditional, having been used by many societies for centuries. So why is the federal government trying to regulate their preparation and use? Virtually all facets of dietary supplement manufacturing, labeling and advertising are covered by regulations issued and enforced by the Food and Drug Administration (FDA) and by the Federal Trade Commission (FTC). Regulation of herbal remedies and alternative medicines in general has been slow, especially in the U.S. where herbs are not regulated as drugs. Because they are considered natural there is considerable public opposition to any form of regulation, so that herbs are virtually unregulated. There therefore are no legal standards for harvesting, processing or packaging of herbal products. Manufacturers of these products are not subjected to the same FDA scrutiny as pharmaceutical companies, so consumers are not afforded the same protections.
In 1994, Congress passed the Dietary Supplement Health and Education Act (DSHEA) that classified herbs as dietary supplements and limited the FDA's control. While drug manufacturers are required to prove that their products are safe before being marketed, herbal products manufactures do not have to. It is up to the FDA to prove that herbs on the market are unsafe. This is why youll see this disclaimer on the label: "This product has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.
Since the FDA does not regulate herbal supplements in the same way as drugs, there are also major issues concerning the quality, consistency and standardization of herbal preparations. How do you know whats in the bottle? Some herbal products do not always contain the ingredients listed on the labels: one study revealed that many products containing Feverfew had no detectable levels of the active component. Another study revealed that 60% of the 54 ginseng products tested contained far less than the known therapeutically effective levels of ginseng, with 20% containing none at all. The FDA is currently developing regulations for good manufacturing practices (GMPs), which will likely guarantee that whats in a dietary supplement is pure and the strength and potency of the supplements reflect whats stated on the label.
Identifying top-quality herb brands can be tricky but there are a few things you can look out for when buying them: these are summarized in Table 5.
Table 5
A Guide to Choosing Herbal Products _______________________________________________________
There should be an expiration date indicating that the manufacturer has procedures in place to test the shelf life of its products
Reputable manufacturers will include a telephone number or a Web site address on the label so you can ask questions about the product
Check if the bottle contains something to preserve freshness, such as silica and anti-oxidant packets, or comes with special air-tight seals and amber glass packaging to help protect the product from light
Look for the "USP Dietary Supplement Verified" seal on a label, indicating that the supplement has met certain manufacturing standards
Look for a certification mark from The Good Housekeeping Institute, a consumer products testing lab associated with Good Housekeeping magazine. A certification mark indicates they've found the product to be safe and effective.
______________________________________________________
The following Web sites provide sound advice on things to look out for when buying and using herbal products and what to look for on the label. They are also useful for educating your self about issues that affect the sale and availability of herbal supplements in the U.S.
ConsumerLab.com
Buying natural remedies can be an iffy proposition since they're subject to little federal regulation.ConsumerLab.com promotes itself as "a leading provider of consumer information and independent evaluations of products that affect health and nutrition." There is a testing fee paid by the manufacturer and results are proprietary to the manufacturer. However, if a product "Passes," it will appear in CL's Web site listing of the respective Product Review and is also eligible to carry the CL Seal of Approval. Funded by private investors rather than the supplements industry, it purchases products for testing from a selection of the top-selling brands. It tests for identity and potency, but not effectiveness: does the product contain what the label claims? Is it truly ginseng or ginkgo, or something else? But not "does it work?." Daily Newsbriefs provides tips and trends in the natural remedies world, and Technical Reports offer precise details on the chemical composition and performance of reviewed products.
Food and Drug Administration (FDA)
In the U.S., herbal preparations are not classified as drugs but as "dietary supplements," and are currently covered by the Dietary Supplement and Health Education Act (DSHEA) of 1994. From the FDA's homepage select Foods (to access the Center for Food Safety & Applied Nutrition), then from Program Areas choose Dietary Supplements to locate details on DSHEA and to view FDA information on reported adverse reactions and fraudulent claims.
Dietary Supplements (from the FDA)
Everything youll always wanted to know about the regulation of herbs and other dietary supplements but were afraid to ask.
NSF International: Consumers
NSF International is a not-for-profit, non-governmental organization, involved in standards development, product certification and education, for public health and safety. This is a useful Web site for learning about dietary supplement/herb issues, with sound advice on things to look out for when buying and using herbal products and what to look for on the label.
USP Verification Program
The United States Pharmacopeia (USP) is the official public standards-setting authority for all prescription and over-the-counter medicines, dietary supplements, and other healthcare products manufactured and sold in the United States. USP sets standards for the quality of these products and works with healthcare providers to help them reach the standards. The USP-Verified mark on a dietary supplement label helps you choose high-quality supplements. This Web site provides a list of which HYPERLINK "http://www.usp.org/USPVerified/dietarySupplements/companies.html" companies participating in the USP-Verified program and a list of HYPERLINK "http://www.usp.org/USPVerified/dietarySupplements/supplements.html" verified supplements, plus where they're available.
Chapter 14
Chat Rooms and Other
Online Discussion Groups
One of the great attractions of the Internet is that you can use it to communicate with people around the world and exchange information. Virtual communities and social networks are being created in cyberspace, through mailing lists, newsgroups, electronic discussion forums, Web-based discussion forums, and live chat rooms. The internet has opened a new social space for communication. An increasing number of health care consumers are now using the Internet for health-related research using newsgroups and chat-rooms. These are obviously more casual forms of information gathering than using the Web, so you need to be particularly careful about using any information that someone passes on to you. If you do find something that interests you, see what some of the more reliable Web sites have to say on the subject. If you join health-related discussion lists, Usenet groups or chat rooms, try to find ones monitored by a health care practitioner: this will offer protection against the possible sharing of wrong or irrelevant information.
ELECTRONIC DISCUSSION GROUPS
The two oldest forms of online discussion groups are electronic mailing lists and newsgroups. An electronic mailing list, sometimes called a listserv, is a subject-oriented on-line discussion group that uses e-mail as its primary means of communication. Messages posted to a listserv are automatically sent to everyone who has subscribed. Subscribers can actively take part in ongoing discussions, known as threads, asking questions, answering others' questions, or simply observinga practice known as lurking. Once you subscribe, new messages in the form of e-mail messages are automatically delivered to your electronic mailbox. You can simply read the contents of the messages, if you want to merely "lurk" in the background and not contribute to the mailing list, or you can ask a question, give your opinion, and participate in an ongoing discussion. Mailing lists can involve just a few people or tens of thousands. There are thousands of mailing lists covering almost any conceivable health topic.
CHAT ROOMS AND INSTANT MESSAGING
A chat room is exactly what it sounds like - a place on the Internet where people with similar interests can chat and socialize. Messages typed in by one user appear instantly to everybody who is in that chat room. Some chat rooms are moderated, where not all messages are broadcast because they might be off topic, use bad language or repeat undesirable messages or ones with obscene language. The majority of chat rooms, however, remain open where messages are posted automatically with no human intervention. People can often enter a chat room without any verification of who they are.
You probably already use email, so Im not going to cover it here. Instant Messaging (IM) is a sort of cross between e-mail and a telephone call. Its a fast, convenient and simple way to communicate with one or more people online in real-time. You create a contact list (or buddy list) and send and receive messages to any or all of them, as long as they are also online. You can customize your buddy lists and share files, photographs, videos, sounds and Internet links. Unlike email where there is a time lag, with instant messaging you can have a conversation without any delays.
WEBLOGS
More and more people are now keeping weblogs. A weblog, or "blog' for short, is a diary-style Web site in which the author (a "blogger") posts commentaries and links to other web pages he or she finds interesting. Weblogs are usually created by one person, so they're often very personal. Entries are usually brief and it might be updated every few hours or merely every few days. The universe of weblogs is usually called the HYPERLINK "http://www.everything2.com/index.pl?lastnode_id=1374653&node_id=1374650" \o "http://www.everything2.com/index.pl?lastnode id=1374653&node id=1374650" blogosphere. There are a number of blog-hosting websites and services, plus software packages that allow people to create their own weblog. Because of the very informal nature of weblogs I don't think you should use them for gathering information on herbal medicines. Some of the ones I've checked either don't have any herbal information you won't find on the reputable Web sites or have been primarily set up to help sell a product. If you want to see what blogs look like go to the Yahoo! directory and select Health and Medicine.
NETIQUETTE
Effective communication on the Internet is governed by what is known as netiquette (Internet etiquette) which refers to rules of behavior governing the use of Internet services, including e-mail, chat, communicating via discussion groups. Usually when we talk face to face with someone body language, including facial expressions, helps us communicate some things better than words can. Messages often pass between us without us even knowing that they're there. On the Internet body language is missing, so one very useful netiquette tool is the use of emoticons (smileys) to help express emotion or intent in Internet communication. Emoticons can be used in e-mail, instant messages, and chat messages, and are rather cartoonish in appearance. However they help get a feeling across when words might be misunderstood. Standard emoticons include:
Expression of humor :-)Frown, or expression of sadness :-(Wink, or expression of sarcasm ;-)
Yahoo! Directory/Weblogs
Yahoo! Groups
The Health and Wellness section lists over 5,000 newsgroups for Alternative Medicine. Check out the Herbal Medicine section but remember to be careful about using some of the information and advice you may find. Remember that many of these groups are used by herbal product manufacturers to promote their wares..
Yahoo! Chat
Fee-based chat rooms.
MSN Chat
Requires a subscription.
Free Email
There are many free e-mail systems on the Internet. These include
MSN HYPERLINK "http://www.hotmail.com" Hotmail
HYPERLINK "http://www.mail.yahoo.com/" Yahoo! Mail
Google Groups
Google Groups contains the world's most comprehensive archive of Usenet postings, dating back to 1981.Click on Groups Help to learn all about using newsgroups.
CataList: the Catalog of LISTSERVŽ lists
A searchable index of online discussion lists.
Netiquette Home Page
The core rules of netiquette excerpted from the book Netiquette by Virginia Shea.
Yahoo! Directory/Health and Medicine Weblogs
Click on Health and Medicine to see a list of available blogs. Check out the HYPERLINK "http://rds.yahoo.com/S=95984180:D1/CS=95984180/SS=96646899/SIG=113pkpuib/*http%3A/www.acsh.org/factsfears/" Health Facts and Fears blog from the American Council on Science and Health.
Chapter 15
Herbs for Pets
We call them dumb animals, and so they are, for they cannot tell us how they feel, but they do not suffer less because they have no words.
Anna Sewell, Black Beauty
Its not just humans who benefit from using of herbs. The recent revival of interest in "natural medicine" has moved to the world of cats and dogs. Spot and Fluffy are now getting the opportunity to try Echinacea and Ginkgo. CAM therapies in general are also becoming increasingly popular with organic food producers, partly as a result of growing desire among the general population for more environmentally friendly treatments. In folk veterinary practice there is a long tradition of using medicinal plants to treat animals, where theyre used with farm animals such as cows, sheep, poultry, horses and pigs. Several currently-used treatments for controlling parasites, such as mites, are based on compounds found in plants such as Chrysanthemum cinerariaefolium and Derris Roots (Derris elliptica). I was recently talking to a friend of mine whos a veterinary nurse and was surprised to find out how extensive CAM is used in the horseracing world. Though acupuncture and chiropractic techniques are the most widely used CAM therapies for racehorses, since they help relieve pain and stimulate tissue repair, herbs are also recommended for a variety of ailments.
If Fido starts to look as if he needs cheering up dont just start sprinkling St. Johns Wort over his food. Its important to remember that animals have very different physiologies than we do, so some compounds that humans can take safely can injure or even kill our pets. A well-known example is acetaminophen, the active ingredient in TylenolŽ, which humans can take with ease but which can kill cats! The use of garlic and other members of the Lily family such as onions, shallots, and chives in a cat's diet is also not advisable since ingestion of these plants in a raw, cooked, or dried form can damage red blood cells.
If theres one consistent theme in this book its if you find information about an herb and are thinking of trying it, talk it over with your health care provider." Your dog or cat obviously cant do this, but you can! Pet owners should only use herbal substances under the direction of a knowledgeable veterinarian, who is familiar with the use of herbal preparations by pets. Much of the current use of herbs with animals is unsupervised, and myths and misinformation abound. Some products on the market have little or no efficacy, dosage recommendations may be inappropriate, products may contain harmful contaminants, and some contain substituted herbs instead of the ones listed in the ingredients.
There are many Web sites offering information on the use of herbs in animals but there is little evidence that any of the treatments work. However, the following sites provide general guidance on their use.
equiworld.net
Equiworld provides a wide range of equestrian information, horse links, equine chat, horse sales, riding schools, and lots more information. From the horsecare section click on
Alternative Therapies herbs, then horse heatlh.
.
Veterinary Botanical Medicines Association (VBMA)
The Veterinary Botanical Medicine Association (VMBA) was founded to encourage international interaction between veterinarians, herbalists, pharmacologists and botanists to increase the safety and efficacy of herbal medicine use in animals. It encourages responsible herbal veterinary through research and education and increasing professional acceptance of herbal medicine for animals. The VBMA offers certification in botanical medicine and the Website includes a directory of certified veterinary herbalists. Other features include a list of useful books and journal, practitioner handouts on Herbs for Animals and Natural Flea Control, and a database of herbal studies in cats and dogs.
PetEducation.com
An excellent easy-to-use site from two Doctors of Veterinary Medicine (DVM), designed to educate the public about the health of dogs, cats and other pets. At the home page under Resourcs go to the section on Holistic & Alternative Veterinary Medicine, then Herbs, Natural Supplements, Minerals & Vitamins. This is a comprehensive collection of information on all the common herbs with useful information on its use in cats and dogs. For example: "Garlic at high doses can cause HYPERLINK "javascript:popupWin1('/dictionary_term.cfm?term=anemia&cls=0', 50, 50, 350, 300)" anemia in cats." There's also an impressive fact sheet on herbal adverse effects, Herbal Does not Mean Harmless that you should read first.
The Veterinary Institute of Integrative Medicine
The goal of The Veterinary Institute of Integrative Medicine is to help integrate holistic medicine into the veterinary field. It provides educational resources for veterinarians and pet owners, including the Veterinarian's Desk Reference of Natural Medicines (VDR) which can be viewed online. Pet owners will find the VDR a useful source of information.
Whole Pet Vet: A Guide to Holistically Treating Your Pets
Provides information about acupuncture, gold bead therapy, chiropractic, diet & nutrition and herbal medicine.
An Online Guide to Herbal Remedies DATE \@ "M/d/yyyy" 9/26/2006
Credibility
Is the site provided by a well-known and respected source?
Content
Where does the information come from? Does it provide evidence to support its claims? Personal testimonials are not evidence.
Disclosure
What is the mission or scope of the site?
Links
Are there links to other high-quality sites?
Design
Is it easy to find the information?
Interactivity
Is there a way to contact the author or Web site administrator?
Referral
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Ŕ ď ä UCSF Ó Ä d # An Online Guide to Herbal Remedies Title p 8 @ _PID_HLINKS ä A ( Ř G 5 Ť Q j a v a s c r i p t : p o p u p W i n 1 ( ' / d i c t i o n a r y _ t e r m . c f m ? t e r m = a n e m i a & c l s = 0 ' , 5 0 , 5 0 , 3 5 0 , 3 0 0 ) . } ¨ k h t t p : / / r d s . y a h o o . c o m / S = 9 5 9 8 4 1 8 0 : D 1 / C S = 9 5 9 8 4 1 8 0 / S S = 9 6 6 4 6 8 9 9 / S I G = 1 1 3 p k p u i b / * h t t p % 3 A / w w w . a c s h . o r g / f a c t s f e a r s / - a Ľ h t t p : / / w w w . m a i l . y a h o o . c o m / z 4 ˘ h t t p : / / w w w . h o t m a i l . c o m / % a H h t t p : / / w w w . e v e r y t h i n g 2 . c o m / i n d e x . p l ? l a s t n o d e _ i d = 1 3 7 4 6 5 3 & n o d e _ i d = 1 3 7 4 6 5 0 a " C h t t p : / / w w w . u s p . o r g / U S P V e r i f i e d / d i e t a r y S u p p l e m e n t s / s u p p l e m e n t s . h t m l G A h t t p : / / w w w . u s p . o r g / U S P V e r i f i e d / d i e t a r y S u p p l e m e n t s / c o m p a n i e s . h t m l > G 4 h t t p : / / w w w . f d a . g o v / f d a c / f e a t u r e s / 2 0 0 2 / 2 0 2 _ s u p p . h t m l C % h t t p : / / w w w . a n s w e r s . c o m / m a i n / n t q u e r y ; j s e s s i o n i d = 2 e 9 l b s 4 g f g m s o ? m e t h o d = 4 & d s i d = 2 2 2 2 & d e k e y = L a b o r a t o r y & g w p = 8 & c u r t a b = 2 2 2 2 _ 1 & s b i d = l c 0 2 a W 7 ~ h t t p : / / w w w . a n s w e r s . c o m / m a i n / n t q u e r y ; j s e s s i o n i d = 2 e 9 l b s 4 g f g m s o ? m e t h o d = 4 & d s i d = 2 2 2 2 & d e k e y = N o n - p r o f i t + o r g a n i z a t i o n & g w p = 8 & c u r t a b = 2 2 2 2 _ 1 & s b i d = l c 0 2 a [ { 4 h t t p : / / w w w . r o s e n t h a l . h s . c o l u m b i a . e d u / D a t a b a s e s . h t m l 1 # 1 ) $ x h t t p : / / s c h o l a r . g o o g l e . c o m / 3 ! u h t t p : / / w w w . g o o g l e . c o m / P X q = h t t p : / / w w w . m e d t e r m s . c o m / s c r i p t / m a i n / a r t . a s p ? a r t i c l e k e y = 1 1 8 1 5 S R n = h t t p : / / w w w . m e d t e r m s . c o m / s c r i p t / m a i n / a r t . a s p ? a r t i c l e k e y = 1 3 4 0 3 Z i h t t p : / / k i d s h e a l t h . o r g / p a r e n t / k ! f h t t p : / / k i d s h e a l t h . o r g / t e e n / u l c h t t p : / / k i d s h e a l t h . o r g / k i d / D ` h t t p : / / w w w . k i d s h e a l t h . o r g A R ] h t t p s : / / w w w . c k m . u c s f . e d u / h o r d e / u t i l / g o . p h p ? u r l = h t t p % 3 A % 2 F % 2 F w w w . m c p . e d u % 2 F h e r b a l % 2 F p h . h t m & H o r d e = 6 e e 1 d 2 4 a 3 7 d b 4 1 6 7 c 8 5 3 a f 3 a 7 d a f a c 7 0 A R W h t t p s : / / w w w . c k m . u c s f . e d u / h o r d e / u t i l / g o . p h p ? u r l = h t t p % 3 A % 2 F % 2 F w w w . m c p . e d u % 2 F h e r b a l % 2 F p h . h t m & H o r d e = 6 e e 1 d 2 4 a 3 7 d b 4 1 6 7 c 8 5 3 a f 3 a 7 d a f a c 7 0 z 1 T 4 h t t p : / / w w w . u m m . e d u / a l t m e d / C o n s H e r b s / D o n g Q u a i c h . h t m l n $ Q h t t p : / / w w w . g s s i w e b . c o m / p } N P h t t p : / / w w w . h e a l t h a n d a g e . c o m / h t m l / r e s / c o m / C o n s L o o k u p s / U s e s / d i a b e t e s m e l l i t u s . h t m l E K E h t t p : / / d i a b e t e s . n i d d k . n i h . g o v / d m / p u b s / a l t e r n a t i v e t h e r a p i e s / i n d e x . h t m 1 2 E h t t p : / / w w w . m a y o c l i n i c . c o m / " " < ( h t t p : / / w w w . d f c i . h a r v a r d . e d u / i n d e x . s h t m l U 9 h t t p : / / w w w . m c p h s . e d u / \ 6 " h t t p : / / w w w . c h i l d r e n s h o s p i t a l . o r g /
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Ŕ ď ä UCSF Ó Ä d # An Online Guide to Herbal Remedies Title p 8 @ _PID_HLINKS ä A ( Ř G 5 Ť Q j a v a s c r i p t : p o p u p W i n 1 ( ' / d i c t i o n a r y _ t e r m . c f m ? t e r m = a n e m i a & c l s = 0 ' , 5 0 , 5 0 , 3 5 0 , 3 0 0 ) . } ¨ k h t t p : / / r d s . y a h o o . c o m / S = 9 5 9 8 4 1 8 0 : D 1 / C S = 9 5 9 8 4 1 8 0 / S S = 9 6 6 4 6 8 9 9 / S I G = 1 1 3 p k p u i b / * h t t p % 3 A / w w w . a c s h . o r g / f a c t s f e a r s / - a Ľ h t t p : / / w w w . m a i l . y a h o o . c o m / z 4 ˘ h t t p : / / w w w . h o t m a i l . c o m / % a H h t t p : / / w w w . e v e r y t h i n g 2 . c o m / i n d e x . p l ? l a s t n o d e _ i d = 1 3 7 4 6 5 3 & n o d e _ i d = 1 3 7 4 6 5 0 a " C h t t p : / / w w w . u s p . o r g / U S P V e r i f i e d / d i e t a r y S u p p l e m e n t s / s u p p l e m e n t s . h t m l G A h t t p : / / w w w . u s p . o r g / U S P V e r i f i e d / d i e t a r y S u p p l e m e n t s / c o m p a n i e s . h t m l > G 4 h t t p : / / w w w . f d a . g o v / f d a c / f e a t u r e s / 2 0 0 2 / 2 0 2 _ s u p p . h t m l C % h t t p : / / w w w . a n s w e r s . c o m / m a i n / n t q u e r y ; j s e s s i o n i d = 2 e 9 l b s 4 g f g m s o ? m e t h o d = 4 & d s i d = 2 2 2 2 & d e k e y = L a b o r a t o r y & g w p = 8 & c u r t a b = 2 2 2 2 _ 1 & s b i d = l c 0 2 a W 7 ~ h t t p : / / w w w . a n s w e r s . c o m / m a i n / n t q u e r y ; j s e s s i o n i d = 2 e 9 l b s 4 g f g m s o ? m e t h o d = 4 & d s i d = 2 2 2 2 & d e k e y = N o n - p r o f i t + o r g a n i z a t i o n & g w p = 8 & c u r t a b = 2 2 2 2 _ 1 & s b i d = l c 0 2 a [ { 4 h t t p : / / w w w . r o s e n t h a l . h s . c o l u m b i a . e d u / D a t a b a s e s . h t m l 1 # 1 ) $ x h t t p : / / s c h o l a r . g o o g l e . c o m / 3 ! u h t t p : / / w w w . g o o g l e . c o m / P X q = h t t p : / / w w w . m e d t e r m s . c o m / s c r i p t / m a i n / a r t . a s p ? a r t i c l e k e y = 1 1 8 1 5 S R n = h t t p : / / w w w . m e d t e r m s . c o m / s c r i p t / m a i n / a r t . a s p ? a r t i c l e k e y = 1 3 4 0 3 Z i h t t p : / / k i d s h e a l t h . o r g / p a r e n t / k ! f h t t p : / / k i d s h e a l t h . o r g / t e e n / u l c h t t p : / / k i d s h e a l t h . o r g / k i d / D ` h t t p : / / w w w . k i d s h e a l t h . o r g A R ] h t t p s : / / w w w . c k m . u c s f . e d u / h o r d e / u t i l / g o . p h p ? u r l = h t t p % 3 A % 2 F % 2 F w w w . m c p . e d u % 2 F h e r b a l % 2 F p h . h t m & H o r d e = 6 e e 1 d 2 4 a 3 7 d b 4 1 6 7 c 8 5 3 a f 3 a 7 d a f a c 7 0 A R W h t t p s : / / w w w . c k m . u c s f . e d u / h o r d e / u t i l / g o . p h p ? u r l = h t t p % 3 A % 2 F % 2 F w w w . m c p . e d u % 2 F h e r b a l % 2 F p h . h t m & H o r d e = 6 e e 1 d 2 4 a 3 7 d b 4 1 6 7 c 8 5 3 a f 3 a 7 d a f a c 7 0 z 1 T 4 h t t p : / / w w w . u m m . e d u / a l t m e d / C o n s H e r b s / D o n g Q u a i c h . h t m l n $ Q h t t p : / / w w w . g s s i w e b . c o m / p } N P h t t p : / / w w w . h e a l t h a n d a g e . c o m / h t m l / r e s / c o m / C o n s L o o k u p s / U s e s / d i a b e t e s m e l l i t u s . h t m l E K E h t t p : / / d i a b e t e s . n i d d k . n i h . g o v / d m / p u b s / a l t e r n a t i v e t h e r a p i e s / i n d e x . h t m 1 2 E h t t p : / / w w w . m a y o c l i n i c . c o m / " " < ( h t t p : / / w w w . d f c i . h a r v a r d . e d u / i n d e x . s h t m l U 9 h t t p : / / w w w . m c p h s . e d u / \ 6 " h t t p : / / w w w . c h i l d r e n s h o s p i t a l . o r g /
3 V h t t p : / / d i e t a r y - s u p p l e m e n t s . i n f o . n i h . g o v / H e a l t h _ I n f o r m a t i o n / B o t a n i c a l _ S u p p l e m e n t s . a s p x G 0 B h t t p : / / w w w . u m m . e d u / a l t m e d / C o n s L o o k u p s / I n t e r a c t i o n s B y H e r b S u p p . h t m l W _ - 6 h t t p : / / w w w . a s a h q . o r g / p a t i e n t E d u c a t i o n / h e r b P a t i e n t . p d f @ * * h t t p : / / w w w . a s a h q . o r g / p a t i e n t E d u c a t i o n . h t m H V ! ) h t t p : / / o d p . o d . n i h . g o v / o d s / a b o u t / l a w . h t m l M [ y h t t p s : / / w w w . c k m . u c s f . e d u / h o r d e / u t i l / g o . p h p ? u r l = h t t p % 3 A % 2 F % 2 F p l a n t s d a t a b a s e . c o m % 2 F & H o r d e = 6 e e 1 d 2 4 a 3 7 d b 4 1 6 7 c 8 5 3 a f 3 a 7 d a f a c 7 0 u = h t t p : / / w w w . f d a . g o v / D o c u m e n t S u m m a r y I n f o r m a t i o n 8 ˙˙˙˙˙˙˙˙˙˙˙˙ Ä C o m p O b j ˙˙˙˙˙˙˙˙˙˙˙˙
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