Disclosures: No financial Herbs Commonly Used I will be discussing - - PDF document

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Herbs Commonly Used by Females

Molly Heublein, MD Assistant Professor UCSF Division of Internal Medicine Women’s Health Primary Care

Disclosures:

 No financial  I will be discussing non-FDA approved supplements

and integrative treatments (the FDA oversees safety but does not approve efficacy for these)

How should we think about herbal medicine?

Molly Heublein, MD Assistant Professor UCSF Division of Internal Medicine Women’s Health Primary Care

Goals of today’s talk:

 Get a brief introduction to Ayurveda and Traditional

Chinese Medicine (TCM)

 Think about prescribing herbs and if/how that fits in a

western medical system of thought

 Discuss my 5 favorite supplements

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Systems of Thought

Western Biomedical

• Seeks an isolatable

disease separate from the patient

• Cause and effect
• Pathology focused
• Evidence based

medicine Ayurveda and TCM

• Sees a pattern of disharmony

as a description of the patient’s whole experience

• Balance and relationships (no

single part can be understood

• utside the whole)
• Symptom focused
• Ancient wisdom

Western Medicine is Incredibly New Basics of Ayurveda

Health defined as: “a state of equilibrium of the Tridosha (fundamental physiological governing principles of the body), Agni (metabolic and digestive processes), and Dhatu (principles that uphold the formation of body tissues). Waste products are excreted well. The sense organs, mind and the soul are in a state of bliss”

• Basisht. Ayu. 2014 Oct-Dec; 35 (4): 351-355.

Tridosha

Dosha Vata Pitta Kapha

Element Ether + Air Fire + Water Earth + Water Qualities Dry Light Cold Movement Hot Light Oily Sharp Heavy Slow Liquid Cold

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Doshas

Vata Pitta Kapha In Balance Movement in the body Creativity Flexibility Imaginative Digestion Absorption of nutrients Body temperature Understanding Intelligence Shine of hair/eyes Cohesion of tissues Joint lubrication skin moisture Immunity Love Calmness Out of Balance/ove ractive Fear Anxiety Abnormal movement Delicate health Infertility Malabsorption Gas/bloating Constipation Rashes/acne Sour stomach Redness Anger Jealousy Inflammation Slowness Weight gain Congestion Water retention Greed

Diagnosis

 Digestion is highly important  Listening to patient’s voice  Pulse taking  Tongue inspection  Body habitus

Picture from: http://www.drramaprasad.com/tongue-analysis- article.html

Ayurvedic Treatment

Photos from Flikr Creative commons “yoga” by Paolo Reno; “sleepy man with clock” Vic Lawrence; “Spice Magic” by Atul T

Basics of Chinese Medicine

Photo from Flickr Creative Commons “yin yang grunge symbol” Nicolas Raymond

• Balance is the goal;

disease is a situation

• f imbalance
• Qi
• Yin-Yang

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Chart from Traditional Chinese Medicine World Foundation. https://www.tcmworld.org/what-is-tcm/the-five-major-

• rgan-systems/

Evaluation

4 Examinations:

• 1. Looking: Appearance, facial color, tongue.
• 2. Listening/smelling: Voice, respiration, cough,

body odors

• 3. Asking: Questions- heat/cold, perspiration,

pain

• 4. Touching: Pulse

Diagnosis

Photo from: https://qiblog.emperors.edu/2012/10/stick-out-your-tongue/

TCM- treatments

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Chinese herbs

• Over 5000 herbs described

in a recent pharmacopeia

• Start with a traditional

formulation of 3-15 herbs with modifications made for individual patient

• TCM providers aware of

narrow therapeutic window for some herbs

Photo from Flickr Creative commons **El-Len** “At the Market”

Three 30 year old women present c/o dysmenorrhea…

Safety? Evidence?

Talking to our patients about supplements…

 Check natural medicine database for safety, efficacy:

https://naturalmedicines.therapeuticresearch.com/

 Memorial Sloan Kettering Cancer Center About Herbs:

https://www.mskcc.org/cancer-care/diagnosis- treatment/symptom-management/integrative- medicine/herbs/search

 The FDA regulates under the Dietary Supplement Health

and Education Act of 1994  May not make unproven treatment claims  May not be adulterated with other substances

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Supplements I recommend the most….

 Boric acid  Red yeast rice  Cannabis  Biotin  St Johns Wort

Treatment of vulvovaginal candidiasis with boric acid powder. Van Slyke KK, Michel VP, Rein MF. Am J Obstet Gynecol. 1981 Sep 15;141(2):145-8.

Biotin

Photo from: https://www.medicalnewstoday.com/articles/318724.php

 B7 or Vitamin H  2.5mg daily studied in

several studies for nail strength and thickness

 No benefit in alopecia

(not studied)

 FDA warning: Can

interfere with lab tests (ie TSH)

Red Yeast Rice

Photo from: https://commons.wikimedia.org/wiki/File:Hongqu_3.jpg

• Rice fermented by the yeast

monascus purpureus natural statin

• An analysis of RCTs reported

LDL-c lowered by 27-32%, triglycerides lowered by 27-38%, and HDL-c raised by 15-22% (Liu 2006)

Boric Acid

 For vaginal candidiasis, and

possible benefit in BV and trichomaniasis

 Multiple studies, including 2 RTCs

show equivalent outcomes w nystatin or azoles

 Dose: 600mg gelatin capsule given

vaginally X1-2 weeks

Photo from: https://en.wikipedia.org/wiki/Boric_acid

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St John’s Wort

Photo from: https://commons.wikimedia.org/wiki/File:Saint_John%27s_wort_flowers.jpg

• don’t be afraid!
• More effective than placebo,

likely equally effective as SSRIs and TCAs for mild to moderate depression (data less strong for severe depression)

• Drug interactions ocps,

warfarin, etc

• 450mg BID or 300mg TID

Cannabis

Photo from: https://www.theroot.com/spelman-grad-bringing-pg-county-maryland-its-1st-medi-1820835987

• Limited but growing

research

• proven benefit in

neuropathic pain

• Nausea
• May be opioid sparing

Resources to learn more:

 Weil Integrative Medicine Library, Oxford University Press  Kaptchuk, Ted. The Web that Has No Weaver:

Understanding Chinese Medicine. New York: McGraw-Hill, 2000.

 Natural Medicines database:

https://naturalmedicines.therapeuticresearch.com/

 Memorial Sloan Kettering Cancer Center About Herbs:

https://www.mskcc.org/cancer-care/diagnosis- treatment/symptom-management/integrative- medicine/herbs/search

References

Burns, Beverly. “Traditional Chinese Medicine UCSF Osher Center.” Online Video. YouTube, 25 Mar 2013. https://www.youtube.com/watch?v=uwdxzBxXsf8 Accessed 9/2018.

• Basisht. “Exploring insights towards definition and laws of health in Ayurveda: Global health perspective.” Ayu.

2014 Oct-Dec; 35 (4): 351-355. Devries, Stephen et al. Integrative Cardiology. New York: Oxford University Press, 2011. FDA Warning: “The FDA Warns that Biotin May Interfere with Lab Tests: FDA Safety Communication” Date Issued: November 28, 2017 https://www.fda.gov/medicaldevices/safety/alertsandnotices/ucm586505.htm Accessed 9/2018. Gokani T. “Ayurveda--the science of healing.” Headache. 2014 Jun;54(6):1103-6. doi: 10.1111/head.12363. Epub 2014 Apr 25. Review. Kaptchuk, Ted. The Web that Has No Weaver: Understanding Chinese Medicine. New York: McGraw-Hill, 2000.

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Linde K, Berner MM, Kriston L. St John's wort for major depression. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD000448. DOI: 10.1002/14651858.CD000448.pubΩ Lipner SR. “Rethinking biotin therapy for hair, nail, and skin disorders.” J Am Acad Dermatol. 2018 Jun;78(6):1236-1238. doi: 10.1016/j.jaad.2018.02.018. Epub 2018 Feb 10. Lipner SR, Scher RK. “Biotin for the treatment of nail disease: what is the evidence?” J Dermatolog Treat. 2018 Jun;29(4):411-414. doi: 10.1080/09546634.2017.1395799. Epub 2017 Nov 9. Review. “Lysine, Professional Monograph” Natural Medicines Website. 4 Oct 2017. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs- supplements/professional.aspx?productid=237 Accessed 9/2018. Maizses, Victoria and Low Dog, Tieraona. Integrative Women’s Health, Second Edition. Oxford University Press, New York. 2015. Sharma H, Chandola HM, Singh G, Basisht G. “Utilization of Ayurveda in health care: an approach for prevention, health promotion, and treatment of disease. Part 1--Ayurveda, the science of life.” J Altern Complement Med. 2007 Nov;13(9):1011-9. Review. Soleymani T, Lo Sicco K, Shapiro J. “The Infatuation With Biotin Supplementation: Is There Truth Behind Its Rising Popularity? A Comparative Analysis of Clinical Efficacy versus Social Popularity.” J Drugs Dermatol. 2017 May 1;16(5):496-500. Review. “St Johns Wort, Professional Monograph” Natural Medicines Website. 31 July 2018. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs- supplements/professional.aspx?productid=329 Accessed 9/2018.