Botanical Medicines The Desk Reference for Major Herbal

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First published by
The Haworth Press, Inc.
10 Alice Street
Binghamton, N Y 13904-1580

This edition published 2011 by Routledge

Routledge Routledge
Taylor & Francis Group Taylor & Francis Group
711 Third Avenue 2 Park Square, Milton Park
New York, NY 10017 Abingdon, Oxon OX14 4RN

© 2002 by The Haworth Press, Inc. All rights reserved. No part of this work may be reproduced or
utilized in any form or by any means, electronic or mechanical, including photocopying, microfilm,
and recording, or by any information storage and retrieval system, without permission in writing
from the publisher.

The information contained in this publication is intended to supplement the knowledge of health care
professionals regarding the use of herbal medicine. The information is educational only and is not
intended to replace sound clinical judgment or individualized patient care. The authors disclaim all
warranties, whether expressed or implied, including any warranty as to the quality, accuracy, safety,
or suitability of this information for any particular purpose. The information in this book is also not a
substitute for diagnosis or treatment by a professional health care provider. While information is
given regarding herbal medicine usages and outcomes, the book is intended for educational purposes
only. The authors, editor, and publisher do not accept liability in the event of negative consequences
incurred as a result of information presented in this book.

Second edition of Natural Dietary Supplements: A Desktop Reference (Institute for Natural Products
Research, 1998).

The herbal illustrations appearing on the cover and in the book are by Tristan Berlund and are used
with her permission.

Cover design by Marylouise E. Doyle.

Library of Congress Cataloging-in-Publication Data

McKenna, Dennis, J.
Botanical medicines : the desk reference for major herbal supplements / Dennis J. McKenna,
Kenneth Jones, Kerry Hughes.— 2nd ed.
p. cm.
Includes bibliographical references and index.
ISBN 0-7890-1265-0 (alk. paper) — ISBN 0-7890-1266-9 (alk. paper)
1. Dietary supplements—Handbooks, manuals, etc. 2. Herbs—Handbooks, manuals, etc.
I. Jones, Kenneth. II. Hughes, Kerry. III. Title.

RM258.5 .M38 2002

615′.32—dc21
2001039101
 CONTENTS

Foreword
Gregory A. Plotnikoff
Preface
Dennis J. McKenna
A Note on the Interpretation of Information on Pregnancy, Lactation, and
Pediatrics in This Desk Reference
Sheila Humphrey

DIETARY SUPPLEMENTS
Astragalus
Bilberry
Black Cohosh
Capsicum
Cat's Claw
Chamomile
Cordyceps
Cranberry
Dong Quai
Echinacea
Eleuthero
Ephedra (Ma Huang)
Evening Primrose Oil
Feverfew
Garlic
Ginger
 Ginkgo Biloba
Ginseng
Goldenseal
Grape Seed
Green Tea
Hawthorn
Horse Chestnut
Kava
Licorice
Milk Thistle
Red Yeast Rice
Reishi
Saw Palmetto
Schisandra
St. John's Wort
Uva Ursi
Valerian
Vitex

Appendix I. A Note About Quality in Botanical Supplements

Appendix II. DSHEA: What Are the Key Provisions?

Index
 ABOUT THE AUTHORS

Dennis McKenna, PhD, has worked in the interdisciplinary fields of

pharmacognosy, ethnopharmacology, and ethnobotany for over twenty
years. Dr. McKenna received post-doctoral research fellowships in the
Laboratory of Clinical Pharmacology, National Institute of Mental Health
(NIMH), and in the Department of Neurology, Stanford University School
of Medicine. In 1990, he joined Shaman Pharmaceuticals as Director of
Ethnopharmacology and later worked as Senior Research Pharmacognosist
for the Aveda Corporation. He is currently a Senior Lecturer at the Center
for Spirituality and Healing in the Academic Health Center at the
University of Minnesota. Dr. McKenna serves on the Advisory Board of
the American Botanical Council and on the Editorial Board of
Phytomedicine, The International Journal of Phytotherapy and
Phytopharmacology.
Kenneth Jones is a medical writer specializing in food and medicinal
plants. His work has appeared in both lay and professional publications,
including The Journal of Alternative and Complementary Medicine,
Alternative and Complementary Therapies, and others. He is the author of
various books on specific medicinal plants: Cordyceps: Tonic Food of
Ancient China; Reishi: Ancient Herb for Modern Times; Cat's Claw:
Healing Vine of Peru; Shiitake: The Healing Mushroom; and Pau d'arco.
As President of Armana Research, Inc., he has provided product
development consulting services as well as written and research materials
to botanical supplement companies in North America and abroad since
1986. He also serves as Educational Director and Assistant Editor for the
Institute of Natural Products Research, a nonprofit organization in the
United States.
Kerry Hughes, MSc, is an ethnobotanist specializing in product
development, plant commercialization, and medical writing for the natural
products industry. She founded EthnoPharm Consulting as a platform to
bring new plants and plant uses to market, and to help widen our medicinal
knowledge of plants in health care. Kerry has worked with natural product
companies throughout the United States and in South America, Europe, and
Asia on the development of plant products for the functional food, dietary
supplement, specialty food, and cosmetic markets. She writes and speaks
frequently on the subject of botanicals, their use in medicine and science,
and the development of botanical products from indigenous cultures. Kerry
currently serves as the Director of EthnoPharm Consulting, and is a
Contributing and Field Editor for Prepared Foods and Nutrasolutions
magazines. She continues to serve as Assistant Editor to the Institute for
Natural Products Research (INPR), and is the Product Development
Advisor for Rockland Food Ingredients (RFI). She serves on the Journal
Advisory Board for Current Topics in Nutraceutical Research, and is a
Scientific Advisor for Supplement Watch.com.
Sheila Humphrey received a BSc from the University of British
Columbia, Canada, in 1996, majoring in Botany. After graduate work in
plant ecology, she switched to professional nursing, receiving her RN in
1984. She has been a certified La Leche League Leader since 1990,
counseling breastfeeding mothers seeking information and support. In
1996, she qualified as an International Board Certified Lactation
Consultant (IBCLC). She has continued her work with La Leche League as
an information resource for complex breastfeeding situations, particularly
questions involving medications including herbs. Over the last five years,
she has made an intensive evaluation of both the lactation and botanical
literature, focusing on safety and efficacy issues of herb use during
pregnancy and lactation. She has presented continuing education lectures
on herbs and breastfeeding for health care professionals including a co-
presentation with Dennis McKenna at the La Leche League International
Conference in 2001. She has lectured at the University of Minnesota on the
ethnopharmacology of herbs traditionally used for reproductive health. She
continues to act as an information resource on herbs for La Leche League
International, as well as lactation professionals in the United States and
abroad. She is currently writing a book for mothers on the use of herbs and
other dietary supplements during lactation.
 Foreword

Despite the wide use of coffee, cocaine, heroin, and tobacco for their
physiologic effects, the medicinal properties of plant-derived substances
have until recently been overlooked by American health professionals. Of
the best-selling 150 prescription drugs, 86 contain at least one major active
compound from natural sources. In addition to aspirin, digoxin, and
antibiotics, plant-derived medications include numerous anticholinergic
agents, anticoagulants, antihypertensives, and antineoplastic agents.
Surprisingly, of the top 150 pharmaceuticals, only 35 plant species are
represented.1
The most recent national survey documented that 44.6 million Americans
use herbal remedies on a regular basis and that more than 90 million
Americans had used an herbal remedy in the past 12 months. Thirty-six
percent of those who use herbal medicines do so instead of prescription
medicines and 31 percent do so with prescriptions. The leading reason for
substitution is preference for a natural or organic product. Leading sources
for information are, in order of preference, friends, magazines, product
labels, and advertising. Ironically, health professionals are the least
frequently consulted for information.2
At this time, there is a profound knowledge gap with significant public
health implications. The lay public appears to distrust the knowledge base
of health professionals regarding natural, plant-derived medicines. And, the
health professionals who do seek to counsel on herbal medicines from an
evidence-based perspective may not be aware that such evidence exists.
This gap represents a serious challenge.
Thankfully, the authors/editors of this new volume, Botanical Medicines:
The Desk Reference for Major Herbal Supplements, have now bridged the
evidence gap using the dialect of the scientific community. They have
provided us with the scientific rationale for 34 of the most popular and
widely consumed herbal medicines. The evidence is comprehensively
presented here; preclinical and clinical studies, as well as safety
precautions, descriptions of active constituents, and dosage information for
each of the botanicals profiled are all included within this volume. The
focus and rationale of this volume is to provide comprehensive coverage of
a limited set of botanical supplements, namely, those that the patients of
health care providers are most likely to be using, and regarding which they
are most likely to seek advice. The book's exhaustive references, inclusion
of current literature, comprehensive coverage, and standardized
organization make it a powerful reference tool, further enhancing its utility
for practitioners, researchers, and the interested public.
With the publication of this book, there is no longer any excuse for
ignorance of the scientific basis for the use of herbal medicines. The
evidence is there, and it is clearly and thoroughly presented in this volume.

Gregory A. Plotnikoff, MD, MTS

Associate Professor
Clinical Medicine and Pediatrics;
Medical Director
Center for Spirituality and Healing
University of Minnesota

1Grifo, F. (1997). Biodiversity and human health. Washington, DC: Island Press.
2Johnson, B.A. (2000). Prevention magazine assesses use of dietary supplements. HerbalGram
48: 65.
 Preface

The volume you hold in your hands (or perhaps, in view of its size, have
placed on your desk), Botanical Medicines: The Desk Reference for Major
Herbal Supplements, is the outcome of a project that began nearly five
years ago, in 1997. At that time, my co-editors, Kenneth Jones and Kerry
Hughes, had been working as independent consultants to the supplement
and pharmaceutical industries. We were presented with an attractive offer:
to develop a series of detailed, up-to-date scientific monographs on thirty-
four of the most popular herbal dietary supplements used in the United
States. The monographs were to cover the botany, chemistry, preclinical
studies, clinical studies, and safety profiles of these most widely used
herbal supplements, comprehensively and in exhaustive detail. The offer
came from Pharmanex, Inc., at that time a relatively new player in the field
of botanical and other dietary supplements. To carry out this project, they
proposed to give our small team, which was organizing a new educational
organization, called INPR, an unrestricted educational grant.
Pharmanex was committed to what was then a rather new concept in the
field of dietary supplements, to only sell supplements of the highest quality,
backed by sound scientific evidence of safety, efficacy, and clinical validity
as reflected in peer-reviewed scientific publications. Pharmanex's retail
sales strategy was that its supplements would only be sold in pharmacies,
and they would look to pharmacists to provide consumers with informed
advice and recommendations regarding appropriate use. What quickly
became apparent, however, was that a significant “information gap”
regarding dietary supplements existed even among this educated group of
professionals. It became apparent that there was a need to compile this
information in a form that was readable, comprehensive, and current, a
need resulting in the creation of such a comprehensive reference resource.
With this resource, pharmacists could educate themselves, and in turn
provide informed advice to their customers regarding the appropriate uses
of these supplements.
We all agreed that a reference of this kind would raise the quality and
tone of available information to a higher and more honest level, and thus
would benefit the entire supplement industry along with more informed
consumers. Science and evidence would replace marketing hype. Where
safety issues were found, we would identify them and provide an honest
assessment of the risks. Where efficacy was open to question or where
equivocal or contradictory results were apparent, we would provide
summaries of those studies to invite informed and educated professionals to
form their own judgments. That is largely the tack we adopted when we
undertook this project and the one we adhered to in creating this new,
revised, expanded, and updated edition.
Our initial effort appeared in 1998 under the title Natural Dietary
Supplements: A Desktop Reference. It was published under the imprimatur
of the Institute for Natural Products Research. INPR is an organization that
my colleagues and I established primarily to foster education, research, and
development in the field of botanical medicines. The mission of INPR is to
create educational tools and resources to provide the most complete,
accurate, and impartial information possible on botanical medicines, and to
conduct pioneering research and development for the natural products
industry. While creating the original Desktop Reference, we also created the
Natural Dietary Supplements Pocket Reference, which continues to be
popular with professionals and consumers alike. These works represent our
first steps toward fulfilling the mission of INPR.
Since the publication of the first edition of the Desktop Reference in
1998, the pace of scientific investigations has accelerated. Hundreds of new
studies on the topics we covered appeared in rapid succession in the
literature. Our commitment to producing a high-quality, accurate, and up-
to-date text was challenged when we faced the fact that the first edition
now required major updating and revision. The volume before you is the
result of at least three complete revisions, as we struggled to keep up with
and integrate the flood of new information on our chosen topics. Given the
pace of discovery in these times, it is the nature of scientific publications
that any book that purports to summarize the state of current science will
be out of date by the time it finds its way to the shelves of your local
bookstore. Ours will not escape that fate either. At a certain point, one must
commit the manuscript to the hands of a sympathetic and at times long-
suffering publisher, who must, sooner or later, freeze the information for all
time into a galley proof, and then into a completed volume between two
covers. However, given those constraints, we have spared no effort to
include the most important, current publications we could find. We hope to
continue covering the new research on herbal medicines through INPR, and
perhaps in the future offer versions of this book in electronic formats.
As the text went through successive iterations and revisions, we made
some major changes in the organizational structure of the chapters.
Specifically, we developed a set of standardized major headings and
subheadings that are utilized consistently in all chapters. Thus, the
information in each chapter is distributed under nine major headings: 1.
Botanical Data; 2. History and Traditional Uses; 3. Chemistry; 4.
Therapeutic Applications; 5. Preclinical Studies; 6. Clinical Studies; 7.
Dosage; 8: Safety Profile; 9. References. The subheadings under each
major heading are similarly consistently organized. Thus, for example,
each section on Botanical Data includes subheadings on Classification and
Nomenclature, and another subheading under which a detailed Botanical
Description is provided. The subheadings under the Chemistry section are
organized according to the chemical class of the constituents under
discussion, e.g., Carbohydrates, Lipid Compounds, Phenolics, Nitrogenous
Compounds, etc. Each of these, in turn, includes subheadings as
appropriate for the metabolites found in the particular botanical discussed.
The subheadings under the Preclinical and Clinical studies sections are
constructed in parallel and emphasize systems, functionalities, and
disorders. Under Preclinical Studies, for example, the reader will find the
following main subheadings: Cardiovascular and Circulatory Functions;
Digestive, Hepatic, and Gastrointestinal Functions; Endocrine and
Hormonal Functions; Genito-urinary and Renal Functions; Immune
Functions, Inflammation and Disease; Integumentary, Muscular, and
Skeletal Functions; Nutritional and Metabolic Functions; Neurological,
Psychological, and Behavioral Functions; Reproductive Functions;
Respiratory and Pulmonary Functions; and Miscellaneous Pharmacological
Activities. The Clinical Studies sections are similarly organized, and each
of these major headings has subheadings, as appropriate for the particular
disorder or functionality under discussion, and for the particular botanical.
There is admittedly some overlap in these heading categories and in some
cases it was a judgment call as to where to place information. For example,
does one discuss diabetes and insulin modulation under Endocrine and
Hormonal Functions or under Metabolic and Nutritional Functions?
Although discussion under either heading would be appropriate, once we
made such a judgment we applied it consistently.
There is a massive amount of information in these chapters, and our hope
is that the consistent application of headings will enhance their clarity and
make comparisons between them that much easier. Unfortunately,
pharmacology and physiology involve multifaceted, multirelational
systems, with the result that some readers may find fault with our
arrangement of the headings. Our intention was to make the consistent
headings useful. For instance, when it comes to comparing similar
pharmacological and systemic effects of different botanicals, our heading
structure allows one to quickly compare the effects of ginkgo, garlic, green
tea, and grape seed extract on cardiovascular and circulatory functions.
Another small but important change has been made in this edition. Of
thirty-four chapters in the first edition, only one was not a botanical
supplement, and that was Co-Q10. In order to make the current edition live
up to its new name, we eliminated the chapter on Co-Q10 and substituted
an entirely new chapter on Ephedra. In view of the current controversy
surrounding the safety of this herb, we felt it was important to include it in
this new edition.
Any project of this magnitude and duration is not accomplished in a
vacuum. It was accomplished with the help, support, and encouragement of
a large number of people whose names do not appear on the title page.
Barb Apps, Ray Cooper, and Joe Chang were our initial project managers
at Pharmanex when this work was initiated, and we thank them for their
steady support and good advice from the beginning and throughout the
publication of the first edition. As we became immersed in this project, we
came to understand the merits of their original vision and grew to share in
their passion for it. We thank them for giving us the opportunity to
undertake this project, and for giving us the chance to make something
more of it than at first they may have imagined it could be. I want to thank
my colleague and good friend Janice Thompson, who was Director of
Natural Products Research at Pharmanex at the time, for bringing this
project to us. During the initial writing of the monographic reviews, and the
subsequent extensive revisions and re-revisions, we occasionally employed
the services of other colleagues and consultants in the supplement industry.
While most of the content in the chapters was written by Kenneth Jones,
Kerry Hughes, or myself, some significant contributions to the content
were made by others, including Sheila Humphrey, Dennis Awang, Kathleen
Harrison, Uzondu Jibuike, Connie Grauds, and Maggie George. We also
gratefully acknowledge and thank our many friends and colleagues in the
supplement industry and academia who provided mentorship,
encouragement, and very often, just the right piece of information,
reference, or commentary when it was most needed: Mark Blumenthal,
Rob McCaleb, Jim Duke, Norman Farnsworth, Roy Upton, Mike
McGuffin, Marilyn Barrett, Trish Flaster, Andy Weil, Ethan Russo, Greg
Plotnikoff, and others. Wonderful people all. We are proud to share their
passion for botanical medicine, and honored that they consider us friends
and colleagues. We give special thanks to Tristan Berlund, a talented and
gifted botanical illustrator, for providing the beautiful and technically
accurate illustrations of the plants in each chapter. Her compensation was
woefully inadequate, and it was ultimately her love of the subject that
produced such stunning illustrations. Also, we owe much thanks to Maxim
Hurwicz, our always good-humored web designer who created our site at
<www.naturalproducts.org> and continues to keep the site running
smoothly.
We also thank Jim Simon, of the Department of Horticulture at Purdue
University, for seeing the merit of our work and representing it to The
Haworth Herbal Press. It was Jim who brought it to the attention of the late,
great Dr. Varro (Tip) Tyler, Emeritus Professor of Pharmacognosy at
Purdue University, and the Editor in Chief at The Haworth Herbal Press at
the time. Dr. Tyler advocated for its publication by Haworth, and thanks to
him, they appreciated its merits. We are grateful for his confidence in our
work. Many people at Haworth have provided so much help in guiding this
publication through its long and sometimes frustrating evolution into an
authoritative reference. None have been more steadfast in this respect than
Peg Marr, Haworth's Senior Production Editor. Her patience, good humor,
and unwavering support during a revision and correction process that must
have at times seemed both doomed to fail and destined to continue forever,
has been an inspiration and a much-deserved goad to all of us when we
needed it most, which was often.
 I want to give special thanks to my wife, Sheila Humphrey, who has been
an incredibly patient and understanding spouse at times when obsession
with this work has caused marriage and family priorities to be pushed, too
often, to the back burner. I also want to give special acknowledgment to her
as a respected colleague for the contributions she made to this work. As a
botanist, herbalist, RN, and International Board Certified Lactation
Consultant, her vast knowledge of this field puts my own to shame, though
she has not the degrees to show for it. The sections on the safety of these
supplements in pregnancy and lactation, and large parts of the monographs
on Vitex and Black Cohosh, are hers, and it has been invaluable to have the
benefit of her expertise. Her insistence on evidence, and not just because
“Commission E says so,” has forced us to cleave to a higher standard. As a
result, I'm happy to say that the information presented herein on the use of
these supplements during pregnancy or lactation is some of the most
accurate and evidence-based to be found anywhere.
Finally, I want to thank my colleagues and co-editors, Kerry Hughes and
Kenneth Jones. We've worked together closely over the last five years, and
we have proven that our various backgrounds fit together synergistically to
make a great team. Kerry has been fun to work with, and her extensive
revision of the section on DSHEA has made it much more accurate and
current. To Ken, especially, I give my heartfelt thanks for his devotion,
long hours, and unstinting dedication. It is largely thanks to his persistence
and nearly obsessional attention to detail that this work is as timely,
thoroughly referenced, and accurate as it is. Ken, it's been great working
with you, and I'm sure you are as relieved as I am that you will not have to
send any more of those midnight faxes haranguing me for this or that
citation or page reference; I know we're both going to sleep better.
Thanks go out also to anyone else, whom I may have overlooked by
name, but who helped make this book possible in one way or another. It has
been a great, long adventure, and could not have reached fruition without
the support and input of many caring people. Thanks to everyone for being
part of the team.
Dennis J. McKenna, PhD
Editor in Chief
Marine on St. Croix, Minnesota
 A Note on the Interpretation of Information
on Pregnancy, Lactation, and Pediatrics
in This Desk Reference
Sheila Humphrey, RN, BSc (botany), IBCLC

The chapter in this book include sections discussing safety issues during
pregnancy and lactation. Much of the herbal literature has dealt with these
core issues in human reproduction in one of two ways: some herbal
literature, including that written in antiquity, is bereft of any discussion of
safety issues, while more modern works suggest that pregnant or
breastfeeding mothers should not use any herbs at all, “just to be safe.”
This desk reference employs standard sources of pharmacological
information regarding chemical use during pregnancy and lactation and
applies this considerable body of knowledge to herbal and plant chemical
information. The following interpretive notes attempt to introduce the
reader to this medical literature; the reader is further referred to more
detailed works. To evaluate the safety of pediatric herb use, that is, the
direct feeding of herbal preparations to children, is beyond the scale of this
work. The slim but fascinating book by the pediatrician Dr. Heinz Schilcher
is a fair introduction to how and when herbs are currently prescribed for
children's health concerns, at least in Germany.1 I further refer readers to
reflect on the Lactation sections that follow whenever they are considering
giving an herbal remedy directly to a young exclusively breastfed infant.
Direct feeding of anything other than mother's milk is an introduction of
risk that cannot be embarked upon without full consideration of alternative
actions.
Since the chapters were completed, several very pertinent research
reports have crossed my desk with information that would have changed
some information in the pregnancy and lactation sections, but recalling