Monograph of Actaea (Cimicifuga) racemosa

Actaea racemosa / Cimicifuga racemosa   Images By H. Zell - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=12628603

Also known as Black Cohosh,  Baneberry2, Black Snake root2, Rattle-top2, Rattleweed2   Sheng Ma (Traditional Chinese medicine) Family Ranunculaceae Root and Rhizome are the parts used According to Traditional Chinese medicine ‘Sheng Ma’ is slightly sweet, slightly cool

Key Constituents: •       Triterpene glycosides •       Salicylic acids •       Phenolic acids •       Tannins •       Resins •       Volatile oil

Therapeutic Actions:          Antirheumatic1,6          Anti-imflammatory2          Spasmolytic1          Oestrogen modulating1,12,13, HPO Axis Regulator2,7,8          Serotonergic2  and Dopaminergic2          Uterine tonic1          Antitussive, expectorant6          Anti inflammatory2          Emmenagogue 6     Osteoprotective particularly protective against post menopausal bone loss2

Indications for use v  Traditional uses Ø  Amenorrhea1,2,7 Ø  Ovarian pain1 Ø  Partus preparator1 Ø  Arthritis 1,2,3 Ø  Rheumatism1,6 Ø  Neuralgia1,3 Ø  Myalgia1,3 Ø  Sciatica1,3 Ø  Whooping cough1,6 Ø  Tinnitus1 Ø  Inflammatory disorders2 Contemporary prescribing: v  Symptoms of menopause1,2,3,4,5,7,9 Hot flushes, vaginal thinning and drying; night sweats, sleep disturbances10; anxiety and depression4,5. v  Osteoporosis relating to menopause2 v  Dysmenorrhea1,2,7,8 v  Premenstrual syndrome1,2,7 including menstrual migraine v  Ovarian dysfunction and ovarian insufficiency1,2,7,12,13 v  Endometriosis7 v  Female infertility (primary and secondary), PCOS2,7,8,12,13 Current Studies: v    Theoretical usefulness for the treatment of prostate cancer2 v    Treatment for PCOS related infertility2,7,8,12,13

⚠ Contraindications v  Pregnancy (except for assisting birth during the last month)1 v  Lactation1 Oestrogen-dependent tumours such as breast cancer and possible interaction with Tamoxifen1 - although as Fritz et al.( cited in Braun and Cohen, 2015 p109) found in recent evidence: black cohosh does not pose a risk to those with breast cancer and Oestrogen-dependent tumours. There is also no consistent evidence to suggest Tamoxifen interacts with Black cohosh2

⚠ Cautions v  Avoid use in patients taking cisplatin, Doxorubicin and Docetaxel as part of their cancer therapy as evidence is still inconclusive as to their safety when interacting with black cohosh2. v  Traditional sources: Overdose has caused nausea and vomiting and may produce vertigo as well as visual and nervous disturbance1 v  Possible side effects1: Ø  High doses cause frontal headache. Ø  Stomach complaints

Dosage recommendations 1.5-3.0 ml of 1:2 liquid extract per day1 10-20 ml of 1:2 liquid extract per week1 0.3-2ml of 1:1 Fluid extract 3 times per day2 Decoction or powdered root 0.3-2gms 3 times per day2 Perimenopausal symptoms: 40-160mg per day2 Infertility: 20-120mg per day2 Recommended Combinations With St. John’s Wort (Hypericum perforatum) for menopausal symptoms In combination with Vitex agnus-castus, Zinc, Zingiber officinale and Hyaluronic acid within a nutraceutical (ElleN)11

References 1.     Bone K.  A Clinical Guide to Blending Liquid Herbs. St Louis: Elsevier; 2003. P 96-99 2.     Braun L and Cohen M. Herbs and Natural supplements: An evidence-based guide. 4th edition. Vol 2. Chatswood NSW: Elsevier, 2015. P 103-112 3.     Wuttke W and Seidlová-Wuttke D. Black cohosh (Cimicifuga racemosa) is a non-estrogenic alternative to hormone replacement therapy. Clinical Phytoscience International Journal of Phytomedicine and Phytotherapy. 2015 November 20 ( cited 2016 Apr 22); 1:12. DOI: 10.1186/s40816-015-0013-0 4.     Mohammad-Alizadeh-Charandabi S, Shahnazi M, Nahaee J, Bayatipayan S. Efficacy of black cohosh (Cimicifuga racemosa L.) in treating early symptoms of menopause: a randomized clinical trial. Chin Med. 2013;8(1):20. DOI: 10.1186/1749-8546-8-20.  5.     Rostock M, Fischer J, Mumm A, Stammwitz U, Saller R, Bartsch HH. Black cohosh (Cimicifuga racemosa) in tamoxifen-treated breast cancer patients with climacteric complaints - a prospective observational study. Gynecol Endocrinol. Epub  2011 Jan 13; 27(10):844–8. doi: 10.3109/09513590.2010.538097. 6.     Grieve M. A Modern Herbal. Surrey: Merchant Book Company Ltd; 1973. P211 7.     Sarris J, Wardle J. Clinical Naturopathy: An evidence-based guide to practice. Chatswood, NSW: Elsevier; 2010. P353,355,365-366, 387-395, 406-416 8.     Trickey R. Women, Hormones and the menstrual cycle. 3rd edition. Victoria, Australia: Trickey enterprises; 2011 p166-170 9.     Ismail R, Taylor-Swanson L, Thomas A, Schnall JG, Cray L, Mitchell ES, Woods NF. Effects of herbal preparations on symptom clusters during the menopausal transition. Climacteric. 2015 Feb; 18(1):11-28. doi: 10.3109/13697137.2014.900746. 10.  Jiang K, Jin Y, Huang L, Feng S, Hou X, Du B, Zheng J, Li L. Black cohosh improves objective sleep in postmenopausal women with sleep disturbance. Climacteric. 2015; 18(4):559-67. doi:10.3109/13697137.2015.1042450. 11.  Cappelli V, Morgante G, Di Sabatino A, Massaro MG, De Leo V. Evaluation of the efficacy of a new nutraceutical product (ElleN®) in the treatment of postmenopausal symptoms. Minerva Ginecol. 2015 Dec; 67(6):515-521. 12.  Kamel H H. Role of phytooestrogens in ovulation induction in women with polycystic ovarian syndrome. European Journal of Obstetrics Gynecology and Reproductive Biology: 2013, 168 (1):p.60–63. 68. DOI: 10.1016/j.ejogrb.2012.12.025 13.  Shahin AY and Mohammed SA. Adding the phytoestrogen Cimicifugae Racemosae to clomiphene induction cycles with timed intercourse in polycystic ovary syndrome improves cycle outcomes and pregnancy rates-a randomized trial. Gynecol Endocrinol 2014, 30 (7):505–510. doi: 10.3109/09513590.2014.895983

Monograph of Paeonia lactiflora

Paeonia lactiflora Photo By Ulf Eliasson - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=1385608

Also known as Paeonia, White Peony Peony is sometimes referred to red peony or white peony. This does not refer to the colour of the flowers, which vary in colour and shape, but to the colour of root after processing.

Family Paeoniaceae

Part used: Root

Active constituents •       Paeoniflorin •       Paeonilactones

According to Traditional Chinese medicine the (White) peony root is mild cold in nature, bitter and sour in flavour.

Therapeutic Actions: Blood tonic (traditional) Astringent/styptic Antispasmodic8 Analgesic8 Spasmolytic1 Mild skeletal muscle relaxant1, 3 Anticonvulsant1 Anti-inflammatory1,8,9 Cognitive enhancer 1/Nootropic/Neuroprotective9 Immunomodulator8/Anti-allergic 6 Antioxidant8,9 Mild sedative HPO Axis Regulator2,7 Ovarian tonic7 Uterine Tonic Anti-androgenic7 Dopaminergic Contemporary Studies Rat studies show that due to the presence of constituent paeoniflorin there is an anti-oxytocic action on the uterine muscles3 Paeoniflorin is a mild vasodilator and smooth muscle relaxant. It has shown to inhibit twitch responses of skeletal muscle from direct and indirect stimulation3 Antiviral specifically human rhinoviruses (HRV-2 and HRV-4)5

Indications for use  Polycystic Ovarian Sydrome1/Disease7   Infertility1   Dysmenorrhoea 1,3,7,8  Fibroids1,7  Excessive uterine bleeding3,7  Hirsutism7 Endometriosis2 / Menstrual dysfunction1 Assists in memory and learning1 Skeletal muscle cramps and spasm1,8  Angina1 Epilepsy1 Autoimmune Disease          Rheumatoid arthritis1,8          Systemic lupus erythematosus8      Common Cold/Human Rhinovirus (HRV) and IgE mediated allergic responses 5,6 TCM: Swellings, trauma, abscess, boils, swollen painful eyes, Nosebleed, haematemesis

Dosage 1:2 Liquid Extract 4.5 - 8.5 ml per day / 30-60ml per week1  Combinations With Glycyrrhiza glabra for PCOS/PCOD and associated signs and symptoms eg.dysmenorrhoea1,3

No known Cautions or  Contra-indications

References 1.     Bone K.  A Clinical Guide to Blending Liquid Herbs. St Louis: Elsevier; 2003. p458- 61 2.   Sarris J, Wardle J. Clinical Naturopathy: An evidence-based guide to practice. Chatswood, NSW: Elsevier; 2010. pp 376-396; 466; 3.    Trickey R. Women, Hormones and the menstrual cycle. 3rd edition. Victoria, Australia: Trickey enterprises; 2011 p882-3, p241 4.   Peony (Paeonia SPP). Monograph. Alternative Medicine Review, October 2001. 6(5), 495+. Cited from Academic OneFile. Web. 06 Apr. 2016. 5.     Ngan, Luong Thi My et al. Antiviral Activity and Possible Mechanism of Action of Constituents Identified in Paeonia Lactiflora Root toward Human Rhinoviruses. Ed. Krzysztof Pyrc. PLoS ONE 10.4 (2015): e0121629. PMC. Web. 28 Apr. 2016. 6.     Yan-Hong Shi, Shu Zhu, Yue-Wei Ge, Yu-Min He, Kohei Kazuma, Zhengtao Wang, Kayo Yoshimatsu, Katsuko Komatsu. Monoterpene derivatives with anti-allergic activity from red peony root, the root of Paeonia lactiflora. Fitoterapia. v108. January 2016. Pages 55-61, ISSN 0367-326X, (http://dx.doi.org/10.1016/j.fitote.2015.11.011.(http://www.sciencedirect.com/science/article/pii/S0367326X15301209) 7.     Smith, P W. PCOS: a common endocrine disorder. Townsend Letter. Apr. 2015 (2016 Apr 6) p61. Academic OneFile. Web. URL(http://go.galegroup.com.ezproxy.think.edu.au/ps/i.do?id=GALE%7CA409236867&v=2.1&u=think&it=r&p=AONE&sw=w&asid=b32bcd69618e6be90705358bb8cc2cc6) 8.     He D-Y, Dai S-M. Anti-Inflammatory and Immunomodulatory Effects of Paeonia Lactiflora Pall.: a Traditional Chinese Herbal Medicine. Frontiers in Pharmacology. 2011. (cited 2016 Apr 6) 2 (10). doi:10.3389/fphar.2011.00010. 9.     Nam, K., Woo, B.-C., Moon, S.-K., Park, S.-U., Park, J.-Y., Hwang, J.-W., ...Lee, E. (2013). Paeonol attenuates inflammation-mediated neurotoxicity and microglial activation. Neural Regeneration Research. 8(18). p1637. Retrieved 2016-04-06 from (http://go.galegroup.com.ezproxy.think.edu.au/ps/i.do?id=GALE%7CA383570255&v=2.1&u=think&it=r&p=AONE&sw=w&asid=8f18ba20fcc7b464a4f5f6594dc08faa) 10.  Takeuchi T, Nishii O, Okamura T, Yaginuma T: Effect of traditional herbal medicine, shakuyaku-kanzo-to on total and free serum testosterone levels. Am J Chin Med 1989, 17(1-2):35–44 11.  Ushiroyama T, Ikeda A, Sakai M, Hosotani T, Suzuki Y, Tsubokura S, Ueki M. Effects of unkei-to, an herbal medicine, on endocrine function and ovulation in women with high basal levels of luteinizing hormone secretion. J Reprod Med 2001(Cited 2016 Apr 5) 46(5). pp451–456. 58. 12.   Yaginuma TI, Yasui R, Arai H, Kawabata T. Effect of traditional herbal medicine on serum testosterone levels and its induction of regular ovulation in hyperandrogenic and oligomenorrheic women. Nippon Sanka Fujinka Gakkai Zasshi 1982 (Cited 2016 Apr 5) 34(7):939 13.   Arentz, S., Abbott, J. A., Smith, C. A., & Bensoussan, A. Herbal medicine for the management of polycystic ovary syndrome (PCOS) and associated oligo/amenorrhoea and hyperandrogenism; a review of the laboratory evidence for effects with corroborative clinical findings. BMC Complementary and Alternative Medicine 14 (2014) (cited 20 Apr 2016 web) 511. Academic OneFile. URL(http://go.galegroup.com.ezproxy.think.edu.au/ps/i.do?id=GALE%7CA401166382&v=2.1&u=think&it=r&p=AONE&sw=w&asid=20da78983c4907ccf1ef8db0ac15d012)