8 lecture 8.pdf

# Herbal treatment for inflammatory gastrointestinal conditions This section details herbal remedies for gastritis and ulcers, focusing on guidelines, constituents, pharmacological effects, and indications for chamomile and liquorice [2](#page=2). ### 1.1 Treatment guidelines for inflammatory GIT conditions General treatment for inflammatory gastrointestinal (GIT) conditions like gastritis and ulcers typically involves antacids (magnesium and aluminum salts) and demulcents (alginates and mucilage). Phytomedicines such as chamomile and liquorice can also be utilized [2](#page=2). #### 1.1.1 Helicobacter pylori infection * *Helicobacter pylori* infection is a known cause of ulceration, with antibiotics being the primary line of treatment [2](#page=2). #### 1.1.2 Pharmaceutical approaches for mild gastritis Pharmaceuticals for mild gastritis often combine demulcents to line and soothe the mucosa with carminatives, such as peppermint or anise oil [2](#page=2). ##### 1.1.2.1 Demulcents Alginates or alginic acid, anionic polysaccharides found in brown algae like Irish moss, function as demulcents. They are prepared from seaweed through washing with acid to remove insoluble ions, dissolution in sodium hydroxide to create a viscous alginate solution, and subsequent filtration to remove debris. The alginate solution binds with water, forming a viscous coating that protects the stomach and esophageal walls [2](#page=2). ### 1.2 German chamomile * **Botanical Name:** *Matricaria recutita* [2](#page=2). * **Part Used:** Flower heads [2](#page=2). #### 1.2.1 Constituents of German chamomile * **Volatile oil (0.4-1.5%):** Key components include (-)-alpha-bisabolol (levomenol), bisabolol oxide A, bisabolol oxide B, bisabololone oxide A, beta-trans-farnesene, trans-en-yne-dicycloether (polyyne spiroether, adjoining cis-en-yn-dicycloether), and chamazulene (blue due to matricin after steam distillation) [2](#page=2). * **Flavonoids and highly methoxylated flavonoids** [3](#page=3). * **Hydroxycoumarins** [3](#page=3). * **Mucilages (10% in mucilage ribs, fructans):** Including rhamanogalacturonane [3](#page=3). #### 1.2.2 Pharmacological effects of German chamomile * **Gastrointestinal Effects:** (-)-alpha-bisabolol reduces the proteolytic activity of pepsin in the GIT and offers protection against gastric toxicity induced by acetylsalicylic acid [3](#page=3). * **Anti-Inflammatory Effects:** Chamazulene reduces leukotriene B4 formation, while enyne dicycloether inhibits mast cell degranulation and histamine release. Apigenin, a flavonoid, blocks intercellular adhesion molecule-1 upregulation and leukocyte adhesion in response to cytokines, independent of free radical scavenging or leukocyte formation [3](#page=3). * **Antioxidant Effects:** Chamazulene exhibits antioxidant properties by inhibiting lipid peroxidation and blocking chemical peroxidation of arachidonic acid [3](#page=3). * **Anxiolytic Effects:** Flavonoids, particularly apigenin, are CNS-active and can exert anxiolytic and mild sedative effects by acting as ligands for central benzodiazepine receptors [3](#page=3). * **Miscellaneous Effects:** Apigenin has been linked to an increase in atrial rate due to reduced noradrenaline uptake and decreased monoamine oxidase activity [3](#page=3). #### 1.2.3 Indications and usage of German chamomile Commission E approves chamomile for internal use in inflammatory GIT diseases associated with spasms, and for irritation of the oral pharyngeal mucous membrane and upper respiratory tract [4](#page=4). #### 1.2.4 Contraindications for German chamomile Chamomile should be avoided by individuals with known allergies to its components or other members of the Compositae family [4](#page=4). #### 1.2.5 Precautions and adverse reactions of German chamomile Anaphylactic reactions have been reported following the ingestion of chamomile tea infusions [4](#page=4). ### 1.3 Liquorice * **Botanical Name:** *Glycyrrhiza glabra* [4](#page=4). * **Part Used:** Roots and rhizomes [4](#page=4). #### 1.3.1 Constituents of Liquorice * **Triterpene saponins (3-15%):** The primary components are glycyrrhetic acid (sweet-tasting, aglycone 18beta-glycyrrhetic acid, and its salts, glycyrrhizin) [4](#page=4). * **Flavonoids:** Including aglycones and isoflavonoids [4](#page=4). * **Cumestans and hydroxycoumarins** [4](#page=4). * **Steroids** [4](#page=4). * **Volatile oil (minimal):** Contains anethole, estragole, eugenol, and hexanoic acid [4](#page=4). #### 1.3.2 Pharmacological effects of Liquorice * **Anti-inflammatory and antiplatelet effects** [4](#page=4). * **Antiulcer effect:** Liquorice provides protective effects against aspirin-induced gastric ulcers and can release endogenous secretin, a potential mediator of these actions. Carbenoxolone, a derivative of glycyrrhetic acid, accelerates ulcer healing. Deglycyrrhizinated licorice is also effective for ulcer healing and lacks the adverse effects associated with carbenoxolone [4](#page=4). * **Antiviral and antifungal activity** [4](#page=4). * **Mineral corticoid effect** [4](#page=4). #### 1.3.3 Indications and usage of Liquorice Commission E approves liquorice for cough, bronchitis, and gastritis [5](#page=5). #### 1.3.4 Contraindications for Liquorice Contraindications include chronic hepatitis, cholestatic liver diseases, liver cirrhosis, severe renal insufficiency, diabetes, arrhythmias, hypertension, hypertonia, hypokalemia, and pregnancy. Tobacco use has been linked to liquorice toxicity [5](#page=5). #### 1.3.5 Precautions and adverse reactions of Liquorice * **General:** Prolonged use can lead to hypokalemia, hypernatremia, edema, hypertension, and cardiac complaints [5](#page=5). * **Endocrine:** Pseudoaldosteronism, characterized by hypertension and hypokalemic metabolic alkalosis, is attributed to glycyrrhetenic acid. This effect is associated with sodium and water retention and suppression of the renin-aldosterone system [5](#page=5). #### 1.3.6 Drug Interactions of Liquorice * **Furosemide/Thiazide Diuretics:** Concomitant use is not recommended due to the additive risk of hypokalemia [5](#page=5). * **Digitalis Glycosides:** Prolonged liquorice use can cause hypokalemia, potentially potentiating digitalis toxicity [5](#page=5). * **Anti-arrhythmic Agents (procainamide, quinidine):** Concomitant use may potentiate the risk of severe ventricular tachycardia of the torsades de pointes type, as hypokalemia associated with liquorice can increase this risk [5](#page=5). * **Corticosteroids:** Concurrent use with liquorice can potentiate the effects of corticosteroids due to the prolonged half-life of cortisol [5](#page=5). --- # Herbal treatment for nausea and vomiting This section details the use of ginger as a phytomedicine for nausea and vomiting, covering its composition, mechanisms of action, recommended usage, and potential interactions [6](#page=6). ### 2.1 Ginger (Zingiber officinalis; rhizome) Ginger is a well-established herbal remedy for nausea and vomiting, with its therapeutic properties attributed to a variety of chemical constituents [6](#page=6). #### 2.1.1 Constituents The primary active components of ginger include [6](#page=6): * **Volatile oil (2.5-3.0%)**: The specific composition varies by origin but includes compounds like (-)-zingiberene, arcurcumene, beta-bisabolene, curcumene, neral, geranial, D-camphor, beta-phellandrene, geranial, neral, linalool, (E)-alpha-farnesene, and zingiberol (a mixture of cis- and trans-beta-eudesmol). These are important as aroma carriers [6](#page=6). * **Aryl alkanes**: These include gingerols and gingerdiols [6](#page=6). * **Diarylheptanoids**: These are also key active compounds [6](#page=6). * **Starch (50%)**: A significant component by weight [6](#page=6). #### 2.1.2 Pharmacological effects Ginger exhibits a range of pharmacological actions relevant to its use in treating nausea and vomiting, as well as other conditions [6](#page=6) [7](#page=7): * **Antiemetic effect**: This is primarily attributed to gingerols and shogaols. Unlike many antiemetic drugs that act on the central nervous system (CNS), ginger's antiemetic effect is believed to be due to local actions within the gastrointestinal tract [7](#page=7). * **Positive inotropic effect**: Ginger can increase the force of heart muscle contractions [6](#page=6). * **Antithrombotic effect**: Ginger can help prevent blood clot formation [6](#page=6). * **Antioxidant effects**: It possesses properties that combat oxidative stress [6](#page=6). * **Anti-migraine effects**: Ginger may be beneficial in managing migraines [6](#page=6). * **Anti-lipidemic effects**: It can help lower lipid levels [6](#page=6). * **Promotes secretions**: Ginger promotes the secretion of saliva, gastric juices, and bile [6](#page=6). * **Anti-inflammatory effects**: These are thought to stem from the inhibition of cyclooxygenase and 5-lipoxygenase enzymes, which reduces leukotriene and prostaglandin synthesis [7](#page=7). * **Gastrointestinal effects**: In humans, ginger increases intestinal tone and peristalsis [7](#page=7). * **Immune system stimulation**: Ginger has shown some ability to stimulate the immune system [7](#page=7). * **Platelet aggregation inhibitory activity**: It can inhibit the clumping of platelets [7](#page=7). #### 2.1.3 Indications and usage The German Commission E has approved ginger for the following indications [7](#page=7): * Loss of appetite [7](#page=7). * Travel sickness [7](#page=7). * Dyspeptic complaints [7](#page=7). > **Tip:** Ginger is commonly used for motion sickness and general nausea due to its local gastrointestinal effects [7](#page=7). #### 2.1.4 Contraindications Certain conditions warrant caution or contraindication for ginger use [7](#page=7): * **Pregnancy**: Large doses of ginger are contraindicated in morning sickness associated with pregnancy [7](#page=7). * **Gallstone conditions**: Due to its cholagogic effect (promoting bile flow), ginger should not be used in patients with gallstones unless a physician has been consulted [7](#page=7). * **Hemorrhage risk**: As ginger inhibits thromboxane synthesis, it should be avoided by individuals at risk for bleeding disorders [7](#page=7). #### 2.1.5 Precautions and adverse reactions While generally safe at therapeutic doses, certain precautions and potential reactions exist [7](#page=7) [8](#page=8): * **Gastric epithelial exfoliation**: High doses (6 grams of dried powdered ginger) have been reported to increase the exfoliation of gastric surface epithelial cells, potentially leading to ulcer formation. Therefore, limiting doses to 6 grams on an empty stomach is recommended [7](#page=7). * **Hypersensitivity reactions**: Ginger can occasionally cause hypersensitivity reactions, manifesting as dermatitis [8](#page=8). * **Overdose effects**: Large overdoses may lead to central nervous system depression and cardiac arrhythmia [8](#page=8). #### 2.1.6 Drug interactions * **Anticoagulants and bleeding disorders**: Patients taking anticoagulant medications or those with existing bleeding disorders should avoid large doses of ginger [8](#page=8). --- # Herbal treatment for irritable bowel syndrome This section details the use of various herbal remedies for Irritable Bowel Syndrome (IBS), focusing on their constituents, pharmacological effects, indications, and precautions. Herbal treatments for IBS commonly involve bulk laxatives and antispasmodic carminative agents [8](#page=8). ### 3.1 Bulk laxatives While not detailed in terms of specific herbs within the provided content, bulk laxatives are mentioned as a foundational treatment approach for IBS [8](#page=8). ### 3.2 Antispasmodic carminative drugs Antispasmodic carminative drugs, often essential oils, are utilized for their ability to relieve spasms and expel gas from the digestive tract. This category includes mint and umbelliferous fruits [8](#page=8). #### 3.2.1 Mint leaves & oil (Mentha piperita) Mint, specifically *Mentha piperita*, is employed for its antispasmodic and carminative properties [8](#page=8). * **Constituents:** * Leaves contain volatile oil with chief components such as menthol (35-45%), menthone (15-20%), and menthyl acetate (3-5%), along with caffeic acid and flavonoids [8](#page=8). * The oil shares similar chief components: menthol (35-45%), menthone (15-20%), and menthyl acetate (3-5%) [8](#page=8). * **Pharmacological Effects:** * General effects include spasmolytic action on digestive tract smooth muscle, carminative properties, cholagogue effects, and antimicrobial activity [8](#page=8). * Leaves also exhibit antiviral, diuretic, and mild sedative effects [9](#page=9). * The oil is insecticidal, a secretolytic agent, and provides a cooling effect on the skin [9](#page=9). * **Indications & Usage:** * **Leaves:** Used for liver and gallbladder complaints, dyspeptic complaints, and convulsive complaints of the gastrointestinal tract [9](#page=9). * **Oil:** Indicated for common cold, cough, bronchitis, fevers, inflammation of the mouth and pharynx, liver and gallbladder complaints, dyspeptic complaints, tendency to infection, and cramps of the upper gastrointestinal tract and bile ducts, including irritable colon [9](#page=9). * **Contraindications:** * Leaves are contraindicated in cases of gallstones [9](#page=9). * Internal administration of the oil is contraindicated for biliary duct occlusion, gallbladder inflammation, and severe liver damage. Gallstone carriers may experience colic due to the cholagogic effect [9](#page=9). * **Precautions and Adverse Reactions:** * No health hazards are known with proper administration at designated therapeutic dosages [9](#page=9). * Gallstone carriers may experience colic due to the cholagogic effect of the leaves [9](#page=9). * The oil intake can cause gastric complaints in susceptible individuals [9](#page=9). * The volatile oil has a weak potential for sensitization due to its menthol content [9](#page=9). * Administration is advised against in cases of gastroesophageal reflux tendency [9](#page=9). * Preparations containing mint oil should not be applied to the faces of infants or small children, especially near the nasal area, due to the risk of glottal or bronchial spasm, potentially leading to asthma-like attacks or respiratory failure [10](#page=10). * **Overdosage:** * No poisoning cases are recorded. The estimated minimal lethal dose of menthol is 2 grams, though individuals have survived higher doses of 8-9 grams [10](#page=10). #### 3.2.2 Umbelliferous fruits This group includes anise, caraway, coriander, and fennel, all of which possess carminative and antispasmodic properties. ##### 3.2.2.1 Anise * **Constituents:** Volatile oil (anethole), caffeic acid, flavonoids, fatty acids, and proteins [10](#page=10). * **Pharmacological Effects:** Expectorant, mildly spasmolytic, antibacterial. The oil (trans-anethole) has antibacterial, antiviral, insect repellent, and estrogenic effects [10](#page=10). * **Indications & Usage:** Common cold, cough, bronchitis, fevers, inflammation of the mouth and pharynx, dyspeptic complaints, and loss of appetite [10](#page=10). * **Contraindications:** Patients allergic to anise and anethole [10](#page=10). * **Precautions and Adverse Reactions:** No general health hazards are known with proper administration at designated therapeutic dosages. Sensitization has been observed very rarely [11](#page=11). ##### 3.2.2.2 Caraway * **Constituents:** Volatile oil (carvone and limonene), fatty oil, polysaccharide, proteins, and furanocoumarin [11](#page=11). * **Pharmacological Effects:** Spasmolytic effect, antimicrobial, and choleretic effect [11](#page=11). * **Indications & Usage:** Dyspeptic complaints [11](#page=11). * **Precautions and Adverse Reactions:** No general health hazards are known with proper administration at designated therapeutic dosages. Overdose can lead to kidney and liver damage [11](#page=11). ##### 3.2.2.3 Coriander * **Constituents:** Volatile oil (linalool), fatty acids, and hydroxy-coumarins [11](#page=11). * **Pharmacological Effects:** The oil stimulates gastric juice secretion, and it is carminative, spasmolytic, antibacterial, and antifungal [11](#page=11). * **Indications & Usage:** Dyspeptic complaints and loss of appetite [11](#page=11). * **Precautions and Adverse Reactions:** No general health hazards are known with proper administration at designated therapeutic dosages. The drug has a weak potential for sensitization [12](#page=12). ##### 3.2.2.4 Fennel * **Constituents:** Volatile oil (trans-anethole, fenchone, estragole), pyranocoumarins, flavonoids, fatty oil, and proteins [12](#page=12). * **Pharmacological Effects:** Stimulates gastrointestinal motility. At higher concentrations, it acts as an antispasmodic. Anethole and fenchone have shown a secretolytic action on the respiratory tract. It is also antimicrobial [12](#page=12). * **Indications & Usage:** Cough and bronchitis, and dyspeptic complaints [12](#page=12). * **Precautions and Adverse Reactions:** No general health hazards are known with proper administration at designated therapeutic dosages. Allergic reactions have been observed very rarely. Cross-sensitivity among patients with celery allergy appears possible. Preparations, excluding the drug itself and tea infusions, are not to be administered during pregnancy and to small children [12](#page=12). ### 3.3 Other relevant treatments * **Tropane alkaloid:** Hyoscine in the form of N-butyl bromide is mentioned as a quaternary ionic compound that is poorly absorbed from the intestine, leading to fewer side effects [8](#page=8). --- ## 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 is a form of complementary and alternative medicine. | | Gastrointestinal Tract (GIT) | The series of organs responsible for digesting food and absorbing nutrients, starting from the mouth and ending at the anus. | | Antacids | Medications that neutralize stomach acid, providing temporary relief from heartburn and indigestion. They are often composed of salts of magnesium and aluminum. | | Demulcents | Substances that form a protective coating over mucous membranes, soothing irritation and inflammation. Examples include alginates and mucilage. | | Alginates | Polysaccharides derived from brown algae, which form a viscous solution when mixed with water, acting as a protective barrier in the stomach and esophagus. | | Mucilage | A viscous, gummy secretion produced by plants, often used as a demulcent to soothe internal tissues. | | Carminative | An agent that promotes the expulsion of gas from the digestive tract, relieving bloating and discomfort. Peppermint and anise are common examples. | | Helicobacter pylori | A bacterium that is a common cause of peptic ulcers and gastritis. It infects the stomach lining and can lead to inflammation. | | Chamomile | A herb from the Compositae family, known for its anti-inflammatory, antispasmodic, and anxiolytic properties, commonly used for gastrointestinal complaints. | | (-)-alpha-bisabolol (Levomenol) | A major component of chamomile's volatile oil, known for its gastrointestinal effects, including reducing pepsin activity and protecting against gastric toxicity. | | Chamazulene | A blue-colored compound found in chamomile, responsible for its anti-inflammatory effects through the inhibition of leukotriene B4 formation. | | Flavonoids | A diverse group of plant pigments that possess antioxidant and anti-inflammatory properties. In chamomile, they contribute to anxiolytic effects. | | Apigenin | A flavonoid found in chamomile that acts as a ligand for central benzodiazepine receptors, producing anxiolytic and sedative effects. | | Liquorice | The root and rhizome of *Glycyrrhiza glabra*, used for its anti-inflammatory, antiulcer, and expectorant properties, though it has potential side effects. | | Glycyrrhiza glabra | The botanical name for the liquorice plant, from which medicinal extracts are derived. | | Glycyrrhetic acid | An aglycone and active component of liquorice, responsible for many of its pharmacological effects, including mineralocorticoid activity. | | Glycyrrhizin | A salt form of glycyrrhetic acid found in liquorice, known for its sweet taste and potent pharmacological effects, but also associated with adverse reactions. | | Pseudoaldosteronism | A condition mimicking hyperaldosteronism caused by certain substances, like glycyrrhetenic acid from liquorice, leading to fluid retention, hypertension, and hypokalemia. | | Ginger | The rhizome of *Zingiber officinalis*, widely used for its antiemetic, anti-inflammatory, and digestive properties. | | Zingiber officinalis | The botanical name for the ginger plant. | | Gingerols | Pungent compounds found in ginger, believed to be responsible for its antiemetic and anti-inflammatory effects. | | Shogaols | Compounds formed from gingerols when ginger is dried or heated, also contributing to its antiemetic properties. | | Antiemetic | An agent that is effective against vomiting and nausea. | | Irritable Bowel Syndrome (IBS) | A common gastrointestinal disorder characterized by abdominal pain, bloating, and changes in bowel habits, often treated with dietary changes and medications. | | Bulk laxatives | Dietary fibers that absorb water and increase stool bulk, promoting bowel regularity. | | Antispasmodic | A drug that relieves or prevents muscle spasms, particularly in the digestive tract. | | Menthol | A compound found in peppermint oil, known for its cooling sensation, mild anesthetic properties, and spasmolytic effects. | | Menthone | A ketone found in peppermint oil, contributing to its aroma and some of its pharmacological effects. | | Menthyl acetate | An ester found in peppermint oil, contributing to its aroma and flavor. | | Umbelliferous Fruits | Fruits from plants in the Apiaceae family, such as anise, caraway, coriander, and fennel, often used for their carminative and digestive properties. | | Anethole | A key component of the volatile oil of anise and fennel, known for its expectorant, spasmolytic, and antimicrobial effects. | | Carvone | A component of caraway seed oil, contributing to its characteristic aroma and spasmolytic properties. | | Limonene | A cyclic terpene found in the volatile oils of caraway and other citrus fruits, with potential antimicrobial and anti-inflammatory effects. | | Linalool | An alcohol terpene found in the volatile oil of coriander, known for its carminative and spasmolytic effects. | | Fenchone | A ketone found in fennel oil, contributing to its aroma and secretolytic action on the respiratory tract. | | Secretolytic | An agent that promotes the secretion of mucus or other bodily fluids. |