Varicose Veins (Chronic Venous Insufficiency) Natural Treatment

Clinical Considerations
➤ General comments
– In a recent survey on the German population, 70 % of all females and 50 % of all males over 30 years of age were found to have some type of venous disease. Up to 86 % of the US population will have venous disease at some time in their lives.
– Lack of physical exercise, prolonged sitting or standing on the job, and obesity contribute to the development of venous insufficiency (varicose veins). The disease occurs when the supporting and stabilizing connective tissue structures around the veins weaken due to congenital factors, fat deposition, or hormonal changes, resulting in damage to the venous walls and incompetence of the valves.

➤ Symptoms: Venous insufficiency develops gradually, with the first signs being tired and heavy legs and swelling of the ankles (edema) in the evening. Increased venous pressure and oxygen free radicals render the venous walls increasingly permeable, allowing fluids, leukocytes, and proteins to escape into the adjacent tissues. This results in edema formation and a reduced supply of nutrients and oxygen to the surrounding tissues. In severe cases, necrotic leg ulceration can also develop.

➤ General treatment measures
– It is important to start treatment early, that is, as soon as the first symptoms develop, to delay the progression of the disease.
– Physical treatment measures can be very helpful: for example, regular leg elevation, leg exercises, short exercise breaks to interrupt prolonged sitting activity, treading cold water, losing weight, and endurance sports.
– Elastic stockings should be used regularly, but most patients refuse to wear them.
– In certain rare cases, short-term treatment with diuretics may be necessary. Loop diuretics are not suitable for this indication.

➤ Clinical value of herbal medicine
– The efficacy of “vein ointments” has not been conclusively demonstrated. Use of these preparations should be limited to adjuvant therapy of varicose veins parallel to physical therapy and treatment with oral preparations.
– Treatment with herbal medicinal compounds should be initiated in the early stages of chronic venous insufficiency to maintain the decongestant effects of treatment. The herbal measures combine well with physical treatment measures.

Recommended Herbal Remedies (Overview)
External Remedies
➤ Witch hazel bark (Hamamelidis cortex), horse chestnut seed (Hippocastani semen), red or white grape leaf (Vitis viniferae folium).
– Action: These herbs reduce leakage from the capillaries and have astringent, antiphlogistic, and antiedematous effects.
– Dosage and administration: These preparations are gently applied to the affected area, several times a day. Gels are suitable for long-term use with elastic bandages and stockings. Ointments penetrate into the deeper tissues and are therefore more suitable for inflammatory processes.

Warning: Inflamed areas of the skin should not be massaged, to avoid the potential detachment of blood clots. Topical remedies should never be applied to mucous membranes or broken skin.
– Side effects: Although rare, allergic skin reactions may occur.

Internal Remedies

➤ Horse chestnut seed (Hippocastani semen).
– Action: The therapeutic action of horse chestnut seed can mainly be attributed to β-aescin, a complex saponin with antiexudative, membrane-stabilizing, antiphlogistic, diuretic, and venotonic effects. Preparations containing aescin stabilize the lysosomal membrane. The therapeutic effects should develop within around 3 to 5 days of oral administration.
– Contraindications: Pregnant or nursing mothers should not use preparations containing alcohol. High-dose horse-chestnut formulations should not be used in the last two trimesters of pregnancy or when nursing a baby unless absolutely necessary.
– Dosage and administration: One oral 50 mg dose, twice daily.
– Side effects: Horse chestnut seed can irritate the stomach and should therefore be administered as an enteric-coated, slow-release dosage form.

➤ Melilot (Meliloti herba): The herb is derived from Melilotus alba or M. officinalis (sweet clover).
– Action: Melilot contains antiedemic flavonoids and coumarins with antioxidant, antiphlogistic, antiedematous, antispasmodic, and lymphokinetic effects. The herb does not affect coagulation of the blood.
– Dosage and administration: Up to 30 mg coumarin per day (oral).
– Side effects: Headache is a rare side effect. Preparations with a high coumarin content can also cause hepatitis.

➤ Butcher’s broom (Rusci aculeati rhizoma).
– Action: Contains steroid saponins with antiexudative, antiphlogistic, and venotonic effects.
– Contraindications: None known.
– Dosage and administration: Oral commercial preparations should be used as directed on the product label. Daily dose: 7–11 mg total ruscogenins.
– Side effects: Although rare, gastrointestinal complaints and skin rashes may occur.

➤ Grape leaf (Vitis viniferae folium)
– Action: The herbal remedy contains caffeic acid derivatives, tannins, organic acids, and flavonoids such as quercetin-3-glucuronide and isoquercetin, and has antiedemic and antiphlogistic effects.
– Dosage and administration: Oral commercial preparations should be used as directed on the product label.

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Natural Remedies to Atherosclerosis

Clinical Considerations
➤ General comments
– Half of all mortality in Germany is attributed to atherosclerosis, a disease in which the walls of the arteries degenerate progressively over the course of several decades. Free radicals of oxidized lipoproteins have been implicated as cofactors in the etiology of atherosclerosis.
– Individuals with high serum cholesterol levels and LDL : HDL ratios of more than 4.0 have a particularly high risk of developing atherosclerosis. This constellation is most prevalent in men of all ages and in postmenopausal women.

➤ General treatment measures: Dietary measures are the first and foremost treatment measures. The patient should be placed on a reduced fat diet and use dietary fats high in polyunsaturated or monosaturated fatty acids (e. g., olive oil, flaxseed oil), as well as fatty fish with DHA and EPA (salmon, halibut). Foods with both added refined sugar and saturated fatty acids should be strictly avoided. Therapy should be combined with regular aerobic exercise for best results, according to recent research.

➤ Clinical value of herbal medicine
– About herbs preparations play an especially important role in prevention. Their therapeutic action is directed against important mechanisms involved in the development of atherosclerosis.
– Synthetic antilipemic drugs clearly reduce cardiovascular mortality, but are expensive and sometimes highly prone to side effects. Moreover, they are not covered by most health care insurers when used primarily for prophylactic purposes.
– The herbal alternatives have a very low incidence of side effects and can be recommended for medically supervised self-treatment.

Recommended Herbal Remedies (Overview)
Antilipemic Herbs
➤ Artichoke leaf (Cynarae folium).
– Action: Standardized artichoke leaf extract inhibits cholesterol biosynthesis on various levels and increases the biliary elimination of cholesterol, resulting in an overall antilipemic effect. Antioxidant effects have also been observed in pharmacological experiments.
– Contraindications: Hypersensitivity to artichoke or other composite plants; biliary tract obstruction; cholelithiasis.
– Dosage and administration: 320–640 mg extract, 3 times a day, equivalent to 960–1920 mg per day. Antiatherosclerotic Herbs
➤ Garlic bulb (Allii sativi bulbus).

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Dementia Herbal Remedies

Dementia

Clinical Considerations
➤ General comments
– Mental functional disorders present with unspecific symptoms such as headaches, vertigo, insomnia, lack of concentration, and depression. The later reduction of cognitive and perceptive abilities as well as a loss of intellectual abilities, an impaired sense of time and space, and changes in personality develop as the disease progresses. In the final stages, these patients exhibit affective disorders, lack of motivation, impaired social behavior, and mental confusion.
– Primary dementia
• In around 80 % of cases, the death of nerve cells (usually cholinergic neurons in the basal forebrain) or the destruction of synaptic junctions (Alzheimer’s dementia) is the underlying cause of primary dementia. Multi-infarct dementia (10 %) and mixed types of dementia (10 %) are less common causes.
• Increased oxidative stress due to increased generation of oxygen radicals during ATP production from glucose is a possible cause of nerve cell loss. The radicals lead to lipid peroxidation and sodium-potassium-ATPase inhibition. This, in turn, causes pathological changes in the cell’s electrolyte distribution and, ultimately, cell death. In Alzheimer’s dementia, β-amyloid is deposited in nerve cells, the role of which is still discussed. At least 30 % of persons over 80 years are affected.
• Multi-infarct dementia is characterized by the increasing recurrence of lacunar infarcts and damage to the cerebral medulla near the lateral ventricle. The high level of platelet-activating factor (PAF) activity is of pathogenetic importance. The increased activity results in increased platelet aggregation, microcirculatory impairment, increased vessel permeability and, ultimately, edema formation.
– Secondary dementia occurs as a result of cardiovascular diseases, hormone changes, infections, and poisoning (e. g., drug poisoning).

➤ Clinical value of herbal medicine
– Acetylcholinesterase inhibitors have recently been adopted in the treatment of dementia. These herbal remedies should always be administered under the watchful eye of a physician. The effectiveness of so-called nootropic drugs such as piracetam is debated.
– The efficacy of ginkgo extract for symptomatic treatment of all types of primary dementia has been demonstrated in various clinical studies.
– Treatment of primary dementia must be started in the early stages in order to slow down the progression of the disease. A psychometric test should be conducted after 3 months of therapy to assess treatment success.
– In secondary dementia, eliminating the underlying cause is the primary goal of treatment.

Recommended Herbal Remedies on Dementia(Overview)

Symptomatic Treatment
➤ Ginkgo leaf (Ginkgo bilobae folium).
– Action, dosage, commercial products: Ginkgo bilobae folium.

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Vertigo and Tinnitus Alternatives

Vertigo and Tinnitus

Clinical Considerations
➤ General comments
– Systemic vertigo: Usually occurs as a result of microcirculatory and macrocirculatory disturbances in the inner ear and is often associated with tinnitus and other hearing problems.
– Nonsystemic vertigo: This form of vertigo is much more common and usually occurs as a result of hypertension, hypotension, cardiac arrhythmias, or decreased mental performance.
– Tinnitus: The subjective perception of sounds (whistling, rustling, or ringing noises) in one or both ears, often due to microcirculatory disturbances.

➤ Clinical value of herbal medicine: Combinations of physical therapy and herbal remedies that modify the cerebral metabolism have proved to be effective. The effectiveness of Ginkgo biloba on aural vertigo has been demonstrated in clinical studies. Benefit should be assessed after three months of application.
Note: Sudden hearing loss is characterized by a unilateral loss of hearing of rapid onset with or without tinnitus. The patient should receive immediate medical attention, because complete restoration of health is possible only if treatment is initiated within the first 24 hours. Herbal remedies are not recommended for causative treatment.

Recommended Herbal Remedies (Overview)
Symptomatic Treatment
➤ Ginkgo leaf (Ginkgo bilobae folium).
– Action, dosage, and administration: search Ginkgo bilobae folium.

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Hypotension Herbal Remedies

Hypotension

Clinical Considerations

➤ General comments
– Hypotension is defined as a chronic reduction in the systolic blood pressure to < 100 mmHg.
– Primary hypotension is common, but clinically significant only if the symptomsare severe. The causes of hypotension are unknown. Fatiguability and orthostasis are typical symptoms.
– Secondary hypotension is rare. It can occur secondary to cardiac or adrenal insufficiency, or as the result of liver disease or cancer. When possible, the causes of the disease should be treated. No clinical data on herbal treatment of hypotension are currently available.

➤ Clinical value of herbal medicine
– Primary hypotension can usually be managed by nonpharmaceutical measures, such as exercise and physical therapy. It does not appear wise to prescribe medications unless the patient is recovering from illness of surgery or is under great physical and mental stress.
– Herbal remedies for primary hypotension are low-side-effect alternatives to synthetic drugs and chemical remedies, which often fail to provide satisfactory results, especially in long-term treatment. The herbal remedies are safe to use for self-treatment. Clinical studies are not available.

Recommended Herbal Remedies (Overview)

External Remedies
➤ Rosemary leaf (Rosmarini folium).
– Action: The essential oil in rosemary leaves stimulates the blood flow and has central analeptic effects attributed to the constituents camphor and cineol.
A circulatory tonic effect of the herbal remedy has been empirically demonstrated.
– Contraindications: Heart failure. (See Herbal Hydrotherapy.
– Dosage and administration: Steep 50 g of rosemary leaf in 1 liter of boiled water for 30 minutes, then strain and add to full bath or hip bath. Bathe for 10 minutes at 34–36 °C after getting up in the morning and rest for 1 hour afterward.
Note: Rosemary baths are stimulating, they should not be taken before retiring at night.

Internal Remedies
➤ Rosemary leaf (Rosmarini folium, see p. 112).
– Action: See above.
– Dosage and administration: Take 5 drops of rosemary tincture (1: 5) in a little warm water, 15 minutes before meals, 3 times a day.

Clinical Considerations
➤ General comments
– The incidence of peripheral and/or cerebral circulatory disturbances is growing since the average age of the population is increasing in many states.
– Peripheral vascular disease (PVD) is characterized by the development of arteriosclerotic vessel changes, especially in the extremities. Low-density lipoprotein (LDL), elevated cholesterol levels, the coagulatory system, and platelet function play a decisive role in these changes. Their interactions are responsible for the deposition of arteriosclerotic plaques on blood vessel walls. This ultimately leads to narrowing and occlusion of the blood vessels. Since this is related to an oxygen deficiency, larger quantities of free radicals develop and damage the vessel walls by way of oxidized LDL.

➤ General treatment measures
– It is essential to eliminate the risk factors (e. g., smoking and lack of exercise) and to ensure optimal management of diabetes, elevated serum lipid levels, and arterial hypertension.
– Regular physical therapy and physical exercise are achieved in only onethird of all patients with peripheral vascular disease because of concomitant cardiological or orthopedic diseases and/or lack of motivation.
➤ Clinical value of herbal medicine: Ginkgo biloba extracts are useful alternatives to the corresponding synthetic drugs and chemical remedies.

Recommended Herbal Remedies (Overview)
Symptomatic Treatment
➤ Ginkgo leaf (Ginkgo bilobae folium).
– Action: The acetone-based dry ginkgo biloba leaf extract received a positive monograph rating. The therapeutic effects of ginkgo biloba extract (GBE) are largely determined by its flavone glycoside and sesquiterpene lactone components.
• Positive rheological effect (reduction of erythrocyte and platelet aggregation)
• Inhibits free radical production
• Increases prostacyclin synthesis
• Antagonizes platelet-activating factor (PAF)
• Neuroprotective
• Improves cellular energy metabolism
– Dosage and administration: Daily dose of 120–160 mg, taken orally in 2 or 3 divided doses, for a period of at least 6 weeks.
– Side effects: Although very rare, mild gastrointestinal complaints, headaches, and allergic reactions can occur.

Prophylactic Treatment
➤ Garlic (Allii sativi bulbus).
– Action, formulations, and dosage.

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Hypertension Herbal Remedies

Hypertension

Clinical Considerations

➤ General considerations and classification
– Hypertension is defined by the World Health Organization (WHO) as systolic blood pressure >139 mmHg and/or diastolic pressure >90 mmHg.
– Classification according to severity
• First degree: 140–159/90–99 mmHg
• Second degree: 160–179/100–109 mmHg
• Third degree: ≥180/≥110 mmHg
• Isolated systolic hypertension: ≥140/<90 mmHg
– Arterial hypertension can be found in 25–30 % of the population. The incidence increases with age.
➤ General treatment measures: Lifestyle changes should be carried out before initiation of therapy (e. g., endurance sports, dietary measures such as reduced refined fat and sugar intake, weight and stress reduction).
➤ Clinical value of herbal medicine
– Although a number of very safe and effective synthetic drugs are available, the patient compliance rates with these drugs are rather low.
– Although few study data are available on herbal antihypertensives, and although they tend to be low-potency medications, many European patients request them.
– We feel that medically supervised attempts to manage hypertension using herbal preparations are justifiable in the initial stages of the disease. Moreover, herbal preparations make it easier for relatively young and older patients to accept the lifelong need for treatment.

Hypertension Recommended Herbal Remedies (Overview)

Sympatholytics

➤ Rauwolfia (Rauwolfia serpentina).
– Action: Rauwolfia total extract has antihypertensive and sympatholytic effects due to various constituents, especially reserpine and raubasine.
• Immediate blood pressure reduction cannot be expected.
– Contraindications: Depression, peptic ulcer, pheochromocytoma, pregnancy and lactation.
– Dosage and administration: To ensure consistency of potency and for safety, use should be restricted to commercial oral rauwolfia products.
– Side effects: Sedation, dryness of the mouth, nasal congestion, reduced sex drive, depression. These effects can be reduced or avoided by reducing the dose.
– Interactions: Digitalis or other cardiac glycosides, neuroleptics, barbiturates, levodopa.

Vasodilators
➤ Garlic cloves (Allii sativi bulbus,).
– Action
• The constituents allicin and ajoene cause hyperpolarization of vascular smooth-muscle cells, resulting in vasodilatation. This is presumably due to a non-potassium channel-related reduction in the intracellular calcium concentration.
• Thanks to their wide therapeutic range (e. g., antioxidant, slightly antilipemic, fibrinolytic, and inhibitory of platelet aggregation), garlic extracts are useful for adjunctive treatment of all forms of arteriosclerosis.
• The antihypertensive effect of garlic takes a while to become noticeable.The maximum effect develops after around 6 months of treatment. Dry garlic powder extracts have the largest therapeutic effect.
– Contraindications: Hemophilia A and other coagulation disorders.
– Dosage and administration: 600–900 mg per day, equivalent to 1.8–2.7 g of fresh garlic.
– Side effects: Gastrointestinal irritation and allergic reactions are rare side effects. Typical smelling.
Warning: Although garlic preparations are unlikely to affect blood coagulation enough to contraindicate it before or after surgery, it is safest to discontinue use before or after major surgery.

Drugs with Unclear Effects
➤ Mistletoe (Visci albi herba, see p. 93).
– Action: The antihypertensive constituents in aqueous mistletoe extracts have not yet been identified. They are said to reduce occasional symptoms such as headaches, dizziness, restlessness, nervousness, and reduced exercise tolerance.
– Dosage and administration
• Tea: Pour 1 cup of cold water onto 2.5 g (1 teaspoon) of the finely chopped herb, allow to stand at room temperature for 12 hours, then strain.
• Dosage: One to two cups per day. Tincture (1 : 1) 20 to 30 drops, several times daily.

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Functional Heart Disorders Herbal Remedies

Functional Heart Disorders

Clinical Considerations

➤General comments
– The diagnosis of functional heart disorder is a diagnosis of exclusion. The typical patient complains of heart palpitations.
– The most common symptoms are “loud” heartbeat, cardiac arrhythmias, subjective feeling of unrest, diffuse left precordial, non-load-dependent pressure sensation, sudden shortness of breath, nervousness, anxiety, rapid fatigability, insomnia, lack of concentration, tendency to sweat heavily, symptoms of heart “agitation.”
– The cardiac work-up usually does not reveal any abnormalities. If any changes are found, they are usually harmless extrasystoles or functional coronary spasms.

➤ Clinical value of herbal medicine: Herbal preparations can be helpful because no specific synthetic drugs or chemical remedies for functional heart disorders exist. Beta blockers are, in many cases, either contraindicated or not accepted by the patients.
Recommended Herbal Remedies (Overview)

External Remedies: See Coronary Artery Disease.

Functional Heart Disorders Internal Remedies (nonglycoside drugs)
➤ Hawthorn leaf and flower (Crataegi folium cum floribus), motherwort herb (Leonuri cardiacae herba).
– Action:
• Hawthorn.
• Motherwort has mild negative chronotropic, antihypertensive, and calming effects. Its use is recommended only as an additive to other cardiac remedies or sedatives.

Functional Heart Disorders Internal Remedies (glycoside drugs)
➤ Adonis (Adonidis herba) and lily-of-the-valley (Convallariae herba).
Note: Larger doses of any preparation containing cardiac glycosides are toxic.
– For further information, see Heart Failure.

Range of Applications

Functional Heart Disorders
➤ Tincture Rx: Extract. Adonidis Fluid., Tinct. Convallariae, Tinct. Valerianae, aa 10.0.
– Dosage and administration: 30 drops, 3 times a day.
– Clinical value: Mild cardiac sedative, useful in nervous palpitations.
➤ Tea Rx: Leonuri cardiacae herba, Convallariae herba, Melissae folium, aa 100.0.
– Dosage and administration: Steep 2 teaspoons in 1 cup of boiling water. Take
1 cup, twice daily, for several weeks.
– Clinical value: Somewhat less potent than the first formulation.

➤ Leonuri cardiacae herba (motherwort)
– Dosage and administration: Steep 2 teaspoons in 1 cup of boiling water, or add 1–2 mL of the 1 : 5 tincture to a cup of water. Take 1 cup, 3 times daily.
– Clinical value: This prescription is very mild and can be recommended for long-term use.
➤ Tea Rx: Crataegi flos, Crataegi folium, Visci albi, aa ad 100.0.
– Dosage and administration: Steep 1 to 2 teaspoons of the herbs in 1 cup of boiled water, or add 1–2 mL Tinct. Crataegi tincture and 1 mL Tinct. Visci to 1 cup of boiled water. Take 1 cup, 2 times a day.
– Clinical value: For mild antihypertensive action.

Functional Heart Disorders with Gastrocardiac Symptoms Complex (Roemheld’s Syndrome).

Functional Heart Disorders with Severe Anxiety
➤ Tincture Rx: Tinct. Convallariae 5.0, Tinct. Crataegi 10.0, Tinct. Valerianae ad 30.0.
– Dosage and administration: 15 drops, 3 times a day.
– Clinical value: The valerian component provides an additional sedative effect

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Coronary Artery Disease Herbal Remedies

Coronary Artery Disease

Clinical Considerations

➤General comments
– The prevalence of coronary artery disease (CAD) is increasing in industrialized countries. This is certainly attributable to a general lack of physical exercise, increased consumption of fatty foods, and cigarette smoking, but is also due to the fact that people now live longer.
– Despite intensive research, some risk factors of CAD are still unknown or untreatable.

➤Herbal treatment measures
– In Germany, topical heart ointments containing aromatic herbs that increase local blood flow of cutivisceral reflex regions are thought to be beneficial in acute functional coronary artery spasms.
– Flavonoids in hawthorn extract reduce wall tension in normal and sclerotic blood vessels. These chemicals are also presumed to stimulate beta-2 receptors and, thus, to widen coronary arteries and blood vessels in skeletal muscle. The usefulness of hawthorn in CAD is therefore arguable, but has not yet been confirmed in clinical studies.

➤Clinical value of herbal medicine
– The recommendations in this section are solely based on empirical experience. Clinical study data or controlled studies on most of these indications are not yet available.
– Once CAD has become manifest, herbal measures should be restricted to adjunctive treatment only.

➤Herbal measures to help counteract risk factors
– Antilipemic herbs: Garlic (see p. 70), artichoke (see p. 36).
– Antithrombotic herbs: Garlic (see p. 70).
– Antihypertensive herbs: Garlic (see p. 70).

➤Clinical value of herbal medicine for risk factors of CAD
– The herbal treatments outlined here are purely prophylactic and adjunctive measures that can be recommended as home remedies. Clinical studies are available.

Coronary Artery Disease Recommended Herbal Remedies (Overview)

External Remedies of Coronary Artery Disease
➤ Aromatic plant medicaments such as camphor (Cinnamomic camphorae aetheroleum), rosemary leaf (Rosmarini folium;), pine needles (Pini aetheroleum), eucalyptus leaf (Eucalypti folium), and menthol (Menthae aetheroleum).
–Action: Stimulate cutivisceral reflexes, blood flow and spasmolysis, thereby reducing CAD-related pain.
– Dosage and administration : The preparations are applied to the left precordial region of the chest and rubbed into the skin as often as needed.

Warning: Ointments containing camphor can cause skin irritation and inflammation and should not be applied to damaged skin.

Internal Remedies of Coronary Artery Disease
➤ Hawthorn.

Range of Applications

Acute Angina Pectoris
➤Hawthorn leaf and flower.
–Dosage and administration: Dose is diluted oil or other balm applied several times daily or as needed for mild pain of angina. Apply twice daily to the left precordial region, or as needed when chest pain occurs.
–Clinical value: Clinical studies have not been conducted. Large interindividual differences in the effects of these remedies can be observed.
Prevention and Treatment of Early-stage CAD
➤Hawthorn leaf and flower.
– Steep 2 teaspoons of the herb in 150 mL of boiling water for 20 minutes. Sweeten lightly. This mild infusion should be used only for health-promoting benefits.
– Hawthorn tincture: 2–4 mL several times a day.
– Extract standardized to flavonoids and/or proanthocyanins: 1 to 2 capsules or tablets.
–Dosage and administration: One dose, 2 to 3 times daily.
–Clinical value: For low-potency treatment, hawthorn extracts that are not standardized have a smaller therapeutic range than the corresponding standardized commercial products.

Early-stage CAD with Mild Hypertension

➤Tea Rx: Crataegi flos; Crataegi folium; Visci albi, aa ad 100.0.
–Dosage and administration: 1 to 2 teaspoons per cup, 2 times daily.
–Clinical value: For low-potency treatment. The extract is not standardized and has a smaller therapeutic range than commercial products. CAD with Gastrocardiac Symptom Complex (Roemheld’s Syndrome)

➤TinctureRx: Ol. Carvi 5.0; Tinct. Convallariae, Tinct. Crataegi, Tinct. Carminativa,Spirit. Aetheris Nitrosi, ad 10.0.
–Dosage and administration: 20 drops, 3 times a day.
–Clinical value: This has proved to be a very useful remedy in elderly patients,who often develop Roemheld’s syndrome.

Long-term Treatment of CAD
➤Hawthorn preparations, garlic.

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Heart Failure Herbal Remedies

Heart Failure

Clinical Considerations

➤General comments
– In heart failure, the heart is unable to maintain adequate circulation owing to a decrease in heart muscle function (cardiac output) resulting from cardiac myocyte death. The main causes are hypertension  with increased venous pressures or cardiac volumes, valvular defects, and ischemia due to sclerotic coronary artery disease.
– The body attempts to compensate for the circulatory deficiency by stimulating mechanisms such as the sympathetic nervous system and by narrowing the blood vessels, resulting in a higher workload on the heart. Additional compensatory mechanisms lead to a further decrease in cardiac performance.
– Effective treatment measures should be initiated as early as possible to prevent the progression of heart failure.

➤ Prognosis:
The overall prognosis for heart failure remains poor although the conventional treatments (diuretics, ACE inhibitors, beta blockers, AT 1
-blockers, digitalis) are effective.

➤Classification:
According to the system of the New York Heart Association (NYHA), heart failure is divided into four clinical stages:
– NYHA I: Symptoms do not occur during normal physical exercise.
– NYHA II: Symptoms occur during more strenuous exercise.
– NYHA III: Symptoms occur during light exercise.
– NYHA IV: Symptoms occur even at rest.

➤ Clinical value of herbal medicine:
Hawthorn and digitaloid herbs are used in NYHA I and II heart failure. The current knowledge does not support treatment of NYHA III and IV heart failure by herbal remedies.

Recommended Herbal Remedies
Flavonoid-containing Herbs

➤Hawthorn leaf and flower
(Crataegie folium cum flore;).
–Action: Procyanidins enhance the influx of calcium into cardiac muscle fibers while only moderately increasing the oxygen demand. These compounds widen the coronary arteries and other cardiac vessels, thereby extending the refractory time. This results in an antiarrhythmic effect.
– Advantages of hawthorn
•Effective and well-tolerated in the early stages of heart failure, especially in patients with age-related degenerative changes in the heart muscle.
•With a high rate of acceptance by patients, hawthorn leaf and flower have only few side effects.
•Since flavonoids do not reduce the afterload, hawthorn can also be used by patients with low blood pressure.
•Hawthorn can be recommended for long-term use, and it combines well with cardiac glycosides, but may have a synergistic effect. This potential interaction should be watched. It may allow a reduction in medications like digoxin while maintaining the same overall therapeutic effect.
–Dosage and administration: One oral dose, 2 to 3 times daily. Relatively large doses over time are needed for sufficient effects. A daily dose of ca. 900 mg hawthorn total extract is generally recommended. The herbal remedy takes around 4 weeks to become fully effective.

Note:
Tea infusion is not the best way to extract water-soluble compounds from hawthorn. Hawthorn tea therefore has only weak effects and can be recommended, at best, only for a health-promoting effect in the very early stages of cardiac insufficiency, or as a long-term preventative measure.

Digitaloid Herbs

➤Adonis
(Adonidis herba;), lily-of-the-valley (Convallariae herba;), and squill root (Scillae bulbus;).

–Action: The effects are comparable to those of the isolated substances digoxin and digitoxin, but the herbal preparations have secondary effects such as increased urinary excretion (squill) or frequency (lily-of-the-valley).
–Advantages: The herbal preparations have a somewhat wider therapeuticrange than the isolated substances, but their concentrations can extend into the toxic range.
–Disadvantages: The absorption of the active compounds in the herbal preparations is generally poor and variable. Hence, their bioavailabilities and potencies are usually low.
–Dosage and administration: One oral dose, 2 to 3 times daily. Individualized dose setting is required.

Warning:All digitaloid preparations can be toxic (similar to the glycosides digoxin and digitoxin), producing symptoms such as nausea, vomiting, stomach complaints, diarrhea, and cardiac arrhythmias.

Combinations of Flavonoid and Digitaloid Herbs
–Advantages:The tolerance is said to be better than that of preparations containingdigitaloid herbs alone.
–Disadvantages:Their therapeutic range is smaller than that of pure hawthorn preparations, and their toxic effects are similar to those of digitaloiddrugs. 4.1 Heart Failure

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