10 lecture 10.pdf

# Herbal treatment of acute catarrhal rhinitis Acute catarrhal rhinitis, a common respiratory ailment characterized by inflammation of the nasal and throat lining leading to swelling and mucus production, can be effectively managed with various herbal remedies. These treatments often focus on counteracting inflammation and stimulating the immune system, with a combination of remedies proving particularly useful [2](#page=2). ### 1.1 Treatment guidelines for acute catarrhal rhinitis The treatment of acute catarrhal rhinitis generally follows a multi-pronged approach, incorporating both conventional and herbal therapies. Key guidelines include [2](#page=2): 1. **Nasal douches** with isotonic saline solution [2](#page=2). 2. **Antiphlogistics** (anti-inflammatory agents) [2](#page=2). 3. **Cold receptor stimulators** (decongestants) [2](#page=2). ### 1.2 Antiphlogistic agents: German chamomile German chamomile (*Matricaria recutita*) is a key herbal remedy employed for its anti-inflammatory properties [2](#page=2). #### 1.2.1 Constituents of German chamomile The primary constituents of German chamomile that contribute to its therapeutic effects include: * **Volatile oil** (0.4-1.5%): Major components are (-)-alpha-bisabolol (levomenol), bisabolol oxide A, bisabolol oxide B, bisabololone oxide A, beta-trans-farnesene, trans-en-yne-dicycloether (polyyne spiroether), and chamazulene. Chamazulene, which is blue in color, is formed from the non-volatile precursor matricin during steam distillation [2](#page=2). * **Flavonoids and highly methoxylized flavonoids** [3](#page=3). * **Hydroxycoumarins** [3](#page=3). * **Mucilages** (approximately 10% in mucilage ribs, including fructans like rhamanogalacturonane) [3](#page=3). #### 1.2.2 Pharmacological effects of German chamomile German chamomile exhibits several significant pharmacological actions: * **Anti-inflammatory effects:** Chamazulene plays a role by inhibiting leukotriene B4 formation. The enyne dicycloether component works by preventing mast cell degranulation and subsequent histamine release. Apigenin, a flavonoid, effectively reduces the upregulation of intercellular adhesion molecule-1 and leukocyte adhesion in response to cytokines, through a mechanism independent of free radical scavenging or leukocyte formation [3](#page=3). * **Antioxidant effects:** Chamazulene, as part of the volatile oil, contributes to antioxidant effects by inhibiting lipid peroxidation. It also inhibits the chemical peroxidation of arachidonic acid, thereby providing both antioxidant and anti-inflammatory benefits [3](#page=3). #### 1.2.3 Indications and usage of German chamomile Commission E has approved German chamomile for the following indications: * Cough and bronchitis [3](#page=3). * Fevers and colds [3](#page=3). * Inflammation of the mouth and pharynx [3](#page=3). #### 1.2.4 Contraindications and precautions for German chamomile * **Contraindications:** Individuals with a known allergy to chamomile or other plants in the Compositae family should avoid its use [3](#page=3). * **Precaution & Adverse Reaction:** Ingestion of chamomile tea infusions has, in rare instances, precipitated anaphylactic reactions [3](#page=3). * **Mode of administration:** It can be administered via inhalation, nasal drops, or as a cream [3](#page=3). ### 1.3 Cold receptor stimulators Cold receptor stimulators, often used in combination with camphor, are vital for alleviating nasal congestion and improving breathing during acute catarrhal rhinitis [4](#page=4). #### 1.3.1 Actions of cold receptor stimulators These agents possess multiple beneficial actions: 1. They stimulate cold receptors in the nose, which facilitates easier breathing due to their decongestant properties [4](#page=4). 2. They act as secretolytic agents, helping to thin and loosen mucus [4](#page=4). 3. They exhibit antimicrobial and antiseptic effects [4](#page=4). #### 1.3.2 Mode of administration for cold receptor stimulators Cold receptor stimulators are typically administered as: * Chest rubs [4](#page=4). * Steam inhalations [4](#page=4). * Nasal sprays [4](#page=4). #### 1.3.3 Mint oil Mint oil, particularly peppermint oil, is a primary example of a cold receptor stimulator. ##### 1.3.3.1 Constituents of mint oil The chief components of mint oil include: * Menthol (35-45%) [4](#page=4). * Menthone (15-20%) [4](#page=4). * Menthyl acetate (3-5%) [4](#page=4). ##### 1.3.3.2 Pharmacological effects of mint oil Mint oil demonstrates the following pharmacological effects: * Antimicrobial activity [4](#page=4). * Secretolytic action [4](#page=4). * A cooling sensation on the skin [4](#page=4). ##### 1.3.3.3 Indications and usage of mint oil Commission E has approved mint oil for: * Common colds, coughs, bronchitis, and fevers [4](#page=4). * Inflammation of the mouth and pharynx [4](#page=4). * Catarrhs of the respiratory tract and inflammation of the oral and pharyngeal mucosa [4](#page=4). ##### 1.3.3.4 Contraindications and adverse reactions of mint oil * **Contraindications:** Menthol should be avoided in infants and small children, as it can lead to severe respiratory distress [4](#page=4). * **Adverse reactions:** Allergic skin reactions and unpleasant local sensations (irritation) can occur with mentholated nasal ointments [4](#page=4). --- # Herbal treatment of acute sinusitis and cold & flu This section details herbal approaches to managing acute sinusitis by focusing on immune stimulants and extends to treatments for common cold and flu symptoms, incorporating diaphoretics and vitamin C sources. ### 2.1 Herbal treatment of acute sinusitis Acute sinusitis, also known as rhinosinusitis, is a brief inflammation of the sinuses, often involving a sinus infection and swelling of the nasal tissue. The treatment regimen for acute sinusitis involves measures similar to those for rhinitis, supplemented with immune stimulants [6](#page=6). #### 2.1.1 Echinacea (Echinaceae spp.) Echinacea is a key immune stimulant used in the treatment of acute sinusitis. It is available in various species, including *E. purpurea*, *E. angustifolia*, and *E. pallida*, with different parts of the plant (herb or root) yielding distinct constituents [6](#page=6). ##### 2.1.1.1 Constituents * **E. purpurea:** * Herb: Water-soluble immuno stimulating polysaccharides, volatile oil, flavonoids (ferulic acid derivatives, cichoriic acid), alkamides, polyenes [6](#page=6). * Root: Water-soluble immunostimulating polysaccharides, volatile oil (0.2%), caffeic and ferulic acid derivatives (0.6-2.1% including cichoriic acid), alkamides (0.01-0.04%) [6](#page=6). * **E. angustifolia:** * Herb: Volatile oil, flavonoids, caffeic acid derivatives (cichoriic acid, echinacoside), alkamides, polyynes [7](#page=7). * Root: Water-soluble, volatile oil (under 1%), flavonoids, caffeic acid derivatives (0.3-1.3% including echinacoside, cynarin), alkamides (0.01%), polyynes [7](#page=7). * **E. pallida:** * Herb: Volatile oil (0.1%), flavonoids (rutin), caffeic acid derivatives (cichoriic acid), alkamides, polyynes [7](#page=7). * Root: Water-soluble immunostimulating polysaccharides, volatile oil (0.2-2%), caffeic acid derivatives (echinacoside), alkamides, polyynes [7](#page=7). ##### 2.1.1.2 Pharmacological Effects Echinacea's primary action is on the nonspecific cellular immune system, exhibiting anti-inflammatory, immuno stimulating, bactericidal, and wound healing properties, which vary by species [7](#page=7). 1. **Immunostimulating:** Ethanolic root extracts of *E. purpurea*, *E. pallida*, and *E. angustifolia* have demonstrated a significant enhancement of phagocytosis in granulocyte smears in vitro. Ethanolic extracts from the aerial parts of *E. angustifolia* and *E. purpurea* also stimulate peritoneal macrophages and can increase spleen weight [7](#page=7). 2. **Anti-Inflammatory:** Polyunsaturated alkamides found in *Echinacea angustifolia* exert anti-inflammatory effects by inhibiting cyclooxygenase and 5-lipoxygenase. The polysaccharide fraction from *Echinacea purpurea* can induce an acute phase reaction [7](#page=7). 3. **Antiviral:** *Echinacea purpurea* herb has shown short-term resistance against influenza, herpes, and vesicular stomatitis viruses, attributed to an interferon-like effect [7](#page=7). ##### 2.1.1.3 Indication and Usage * **Herb (*E. purpurea*):** Approved by Commission E for common cold, cough/bronchitis, fevers and colds, urinary tract infections, inflammation of the mouth and pharynx, tendency to infection, wounds, and burns [8](#page=8). * **Root (*E. angustifolia*):** Unproven uses include acute and chronic respiratory tract infections (viral and bacterial), increased susceptibility to infection due to lowered resistance, and treatment of leukopenia following radio and cytostatic therapy, supporting anti-infectious chemotherapy [8](#page=8). * **Both Herb and Root (*E. pallida*):** Folk medicine applications by Native Americans include external use for burns, swollen lymph nodes, and insect bites. Internally, it has been used for headaches, stomach aches, measles, coughs, and gonorrhea. It has also been used for rattlesnake bites. Currently used for prophylaxis and treatment of flu, sepsis, and mild to moderate cold infections. Externally, it aids in treating poorly healing wounds [8](#page=8). * **Root (*E. pallida*):** Approved by Commission E as supportive therapy for influenza-like infections [8](#page=8). ##### 2.1.1.4 Precautions and Adverse Reactions * **General:** Parenteral administration may cause dose-dependent fever, nausea, and vomiting. Caution is advised when administering parentally to individuals with diabetes. Hypersensitivity reactions, including anaphylaxis, have been reported. Rashes, itching, facial swelling, breathing difficulties, dizziness, and a drop in blood pressure have been observed [8](#page=8). * **Fertility:** High concentrations of Echinacea have shown adverse effects on oocytes in animal models [8](#page=8). * **Pregnancy:** Parenteral administration should be avoided during pregnancy [8](#page=8). ##### 2.1.1.5 Contraindications * **Autoimmune Conditions:** Should not be administered in the presence of multiple sclerosis, leukosis, collagen disease, AIDS, or tuberculosis due to potential activation of autoimmune aggressions and overreactive immune responses [9](#page=9). * **Allergies:** Parenteral administration should not be used in patients prone to allergies, especially to members of the composite family (Asteraceae) [9](#page=9). * **Pregnancy:** Echinacea should not be used during pregnancy [9](#page=9). ##### 2.1.1.6 Drug Interactions The immuno-stimulating effect of echinacea may interact with: 1. Drugs with immunosuppressant effects, such as cyclosporine or other anti-rejection medications [9](#page=9). 2. Corticosteroids, potentially interfering with their chemotherapeutic effects [9](#page=9). ### 2.2 Herbal treatment of cold & flu The treatment regimen for cold and flu involves a multi-faceted approach using immune stimulants, diaphoretics, and vitamin C sources [9](#page=9). #### 2.2.1 Treatment Regimen 1. **Immuno stimulant:** Purple Echinacea (*E. purpurea*) is an example of an immune stimulant used for cold and flu [9](#page=9). 2. **Diaphoretics (Sweat inducers):** Elder flower, yarrow flower and leaf, and linden flower are diaphoretics that promote sweating. They possess antipyretic and anti-inflammatory effects due to the inhibition of prostaglandins by their flavonoid constituents. Linden flower tea also contributes to the nonspecific activation of the immune system [9](#page=9). 3. **Vitamin C supplements:** Black currant and rose hip peel are sources of Vitamin C. These supplements increase vitamin C stores and enhance the nonspecific immune system, proving beneficial for both prevention and treatment of upper respiratory tract infections [9](#page=9). --- # Herbal treatment of acute bronchitis and dry cough This section details herbal remedies used to manage acute bronchitis, focusing on their actions as demulcents, secretolytics, expectorants, and bronchospasmolytics, and also explores antitussive herbs for dry cough. ### 4.1 Herbal treatment of acute bronchitis Acute bronchitis is typically caused by a viral infection, though irritant bronchitis can result from inhaling toxic or allergic substances. The primary pathological features include abnormal mucus production and impaired clearance from the bronchi, leading to obstruction due to thick secretions and inflammation. Coughing and phlegm production are characteristic symptoms, often prolonged by smoking, and chronic adenovirus infection can also be a contributing factor [10](#page=10). The treatment regimen for acute bronchitis involves several categories of herbal remedies: * **Demulcents:** These herbs soothe irritated mucous membranes. Marshmallow is a key example [10](#page=10). * **Secretolytics & Expectorants:** These agents promote the secretion of thinner mucus and facilitate its expulsion. This category includes aromatic herbs like anise, thyme, and fennel, as well as essential oils such as eucalyptus oil. Herbs containing saponins, like Primula (Cowslip) and Liquorice, also exhibit mucolytic and expectorant effects [10](#page=10). * **Bronchospasmolytics:** These herbs help to relieve spasms in the bronchial muscles. Thyme, Ivy leaf, Primula root, and Liquorice are noted for this action [10](#page=10). * **Antiphlogistics:** These remedies possess anti-inflammatory activity. English Ivy (Hedera helix), Primula root, Liquorice, and Iceland moss are examples [10](#page=10). #### 4.1.1 Demulcents: Marshmallow * **Botanical Name:** *Althea officinalis* (flowers, leaves & root) [10](#page=10). * **Key Constituents:** Mucilages (colloidally soluble polysaccharides like galacturonic rhamnans, arabinogalactans, arabans, and glucans), pectins, and starch [10](#page=10). * **Pharmacological Effects:** Marshmallow alleviates local irritation, can inhibit mucociliary activity, stimulates phagocytosis, and possesses anti-inflammatory, immune-stimulating, and hypoglycemic properties. Its efficacy as a gargle for inflammation of the mouth and throat mucous membranes has been demonstrated [11](#page=11). * **Indications & Usage:** Approved by Commission E for cough and bronchitis [11](#page=11). * **Drug Interactions:** May delay the absorption of other simultaneously administered drugs [11](#page=11). * **Note:** Diabetics should be mindful of the sugar concentration in marshmallow syrup [11](#page=11). #### 4.1.2 Expectorants: Cowslip * **Botanical Name:** *Primula* (flowers & root) [11](#page=11). * **Constituents:** * Flowers: Flavonoids (3%), Primine, and triterpene saponins [11](#page=11). * Root: Phenol glycosides (0.2 to 2.3%) and triterpene saponins (5 to 10%), with primulic acid A being a chief component [11](#page=11). * **Pharmacological Effects:** * Flowers: Exhibit an expectorant effect attributed to their flavonoid and saponin content. Animal experiments have shown an increase in bronchial secretion volume [11](#page=11). * Root: The saponin content provides expectorant and diuretic effects, possibly through vagal stimulation [11](#page=11). * **Indications & Usage:** Approved by Commission E for cough and bronchitis [11](#page=11). #### 4.1.3 Expectorant and Bronchospasmolytic: English Ivy * **Botanical Name:** *Hedera helix* (leaves & berries) [12](#page=12). * **Constituents:** Triterpene saponins, volatile oils, polyynes, steroids, and flavonoids [12](#page=12). * **Pharmacological Effects:** English Ivy acts as an expectorant and antispasmodic. Hedera saponin C has demonstrated antiviral, antibacterial, antimycotic, anthelmintic, molluscicidal, and anti-flagellate activity. The fresh leaves can be an irritant to skin and mucosa and may cause allergic reactions [12](#page=12). * **Indications & Usage:** Approved by Commission E for cough and bronchitis. It is used for the symptomatic treatment of chronic inflammatory bronchial conditions and respiratory catarrh [12](#page=12). ### 4.2 Herbal treatment of dry cough Dry cough is often managed with antitussives, which aim to suppress the cough reflex. While effective for relief in cases of nervous cough, tumors, or severe non-productive cough, antitussives are not ideal if they hinder lung cleansing [12](#page=12). Antitussive herbs include: 1. **Herbs containing cyanogenetic glycosides:** Examples include Wild Cherry (*Prunus serotina*) [12](#page=12). 2. **Opiates and Opium-like substances:** This includes codeine and gentler alternatives like Lactuca (wild lettuce) [12](#page=12). 3. **Ma-Huang (*Ephedra sinica*)** [12](#page=12). #### 4.2.1 Antitussive and Bronchodilator: Ma-Huang * **Botanical Name:** *Ephedra sinica* (young canes collected in autumn, and dried rhizome with roots) [13](#page=13). * **Constituents:** Alkaloids of the 2-aminophenylpropane type, primarily L-(-)-ephedrine (lR,2S-(-)-ephedrine) and D-pseudoephedrine (lS,2S-(+)-ephedrine), with lesser amounts of L-norephedrine and D-norpseudoephedrine [13](#page=13). * **Pharmacological Effects:** The concentration of active principles can vary significantly. Ephedrine functions by indirectly stimulating the sympathomimetic nervous system and the central nervous system. The herb exhibits bacteriostatic, positively inotropic, and positively chronotropic effects [13](#page=13). * **Indications & Usage:** Approved by Commission E for cough and bronchitis [13](#page=13). * **Precautions & Adverse Reactions:** * Common side effects include headache, irritability, motor restlessness, nausea, sleeplessness, tachycardia, urinary disorders, and vomiting [13](#page=13). * Higher doses may lead to blood pressure and cardiac rhythm disorders [13](#page=13). * Dependence can develop with prolonged use. Due to the risk of tachyphylaxis and dependence, the drug should be administered for short durations only [13](#page=13). * Ma-Huang should not be used during pregnancy [13](#page=13). --- ## Common mistakes to avoid - Review all topics thoroughly before exams - Pay attention to formulas and key definitions - Practice with examples provided in each section - Don't memorize without understanding the underlying concepts

| Term | Definition | |------|------------| | Phytotherapy | The use of plants or plant extracts for medicinal purposes. It involves treating diseases or ailments by employing various parts of plants like flowers, leaves, roots, and bark. | | Acute Catarrhal Rhinitis | An inflammation of the mucous membrane lining the nose, characterized by swelling and the production of mucus, often triggered by infections or irritations. | | Antiphlogistic | A substance that counteracts inflammation; an anti-inflammatory agent. These agents work to reduce swelling, redness, and pain associated with inflammatory processes. | | Chamazulene | A blue-colored volatile compound found in German chamomile, derived from matricin. It possesses significant anti-inflammatory and antioxidant properties. | | Flavonoids | A class of plant compounds, also known as vitamin P, that have antioxidant effects and can help reduce inflammation. They are abundant in many fruits, vegetables, and herbs. | | Hydroxycoumarins | A group of chemical compounds found in plants that can have various pharmacological effects, including anticoagulant and antioxidant activities. | | Mucilages | Gelatinous substances derived from plants, typically soluble in water, that can swell and form a gel. They are often used for their soothing and protective properties, especially for mucous membranes. | | Cold Receptor Stimulators | Agents that activate cold receptors in the nasal passages, leading to a sensation of improved breathing and acting as decongestants. | | Secretolytic | A substance that promotes the liquefaction and reduction of viscosity of secretions, such as mucus in the respiratory tract, making them easier to expel. | | Antimicrobial | An agent that destroys or inhibits the growth of microorganisms, including bacteria, fungi, and viruses. | | Antiseptic | A substance that inhibits the growth of microorganisms on living tissue, used to prevent infection, particularly on the skin and mucous membranes. | | 1,8-cineol (Eucalyptol) | The primary active constituent of eucalyptus oil, known for its expectorant, secretolytic, and mild anti-inflammatory effects. | | Prostaglandin Biosynthesis | The process by which prostaglandins, which are lipid compounds with hormone-like effects, are synthesized in the body. Inhibiting this process can reduce inflammation and pain. | | Hyperemic | Relating to or causing hyperemia, which is an excess of blood in a part of the body. In topical applications, it can promote healing and reduce inflammation. | | Expectorant | A drug that helps to loosen and expel mucus from the lungs and respiratory passages. | | Acute Bronchitis | An inflammation of the bronchial tubes, typically caused by a viral infection, leading to coughing and mucus production. | | Demulcents | Substances that relieve irritation of the mucous membranes, especially the digestive tract and respiratory tract, by forming a protective film. | | Secretolytics | Agents that promote the flow of secretions, such as mucus, making them thinner and easier to expel from the body. | | Saponins | Naturally occurring compounds found in many plants, known for their foaming properties and their expectorant and sometimes diuretic effects. | | Bronchospasmolytics | Medications or substances that relieve spasms of the bronchial muscles, helping to open the airways and ease breathing. | | Antipyretic | A drug that reduces fever. | | Antitussives | Substances that suppress or relieve coughing by acting on the cough reflex. | | Cyanogenetic Glycosides | Organic compounds that release hydrogen cyanide when hydrolyzed. Certain plant-derived cyanogenetic glycosides have been used for their antitussive properties. | | Opiates | Narcotic drugs derived from or chemically related to opium, often used for pain relief and cough suppression, though with potential for dependence. | | Ephedrine | An alkaloid found in plants of the genus Ephedra, acting as a stimulant to the central nervous system and a decongestant. | | Tachyphylaxis | Rapidly diminishing response to a drug after administration of a few doses. | | Immunosuppressant | A drug or substance that reduces the activity of the immune system. | | Autoimmune Aggressions | An immune system response where the body attacks its own healthy tissues. | | Leukosis | A general term for diseases of the blood or bone marrow characterized by an increase in white blood cells. | | Collagen Disease | A group of disorders characterized by inflammation and damage to connective tissues throughout the body, such as lupus or rheumatoid arthritis. | | Asteraceae | A large and widely distributed family of flowering plants, commonly known as the daisy, aster, or sunflower family. | | Diaphoretics | Substances that promote sweating. | | Antihypertensive | A drug that lowers blood pressure. | | MAO-inhibitors (Monoamine Oxidase Inhibitors) | A class of drugs primarily used to treat depression and anxiety disorders. They can interact significantly with sympathomimetic substances. | | Cardiac Heart Glycosides | A class of drugs derived from plants that are used to treat heart conditions like heart failure and arrhythmias. | | Secale Alkaloid Derivatives | Compounds derived from the ergot fungus, often affecting blood pressure and uterine contractions. | | Oxytocin | A hormone and neurotransmitter that plays a role in social bonding, childbirth, and milk ejection. Synthetic forms are used medically. |